Mean Serum Creatinine Level Research Articles

MO338: Long-Term Kidney Outcomes After Acute Kidney Injury in Patients With COVID-19

BACKGROUND AND AIMSThe acute effects of the novel coronavirus infection (COVID-19) on short-term kidney outcomes have been studied, the long-term kidney outcomes after COVID-19-associated acute kidney injury (AKI) in comparison with hospitalized patients without AKI are insufficiently researched. Our aim was to evaluate the impact of AKI in acute COVID-19 on long-term kidney outcomes in hospitalized patients with COVID-19.METHODWe performed a cohort study on 1000 patients hospitalized from April to July 2020 with laboratory-confirmed COVID-19 and lung injury by computer tomography (CT). We excluded patients with re-hospitalization, acute surgical pathology and a single serum creatinine measurement during hospitalization. In the prospective part, patients with serum creatinine measurement within 180 days after discharge were included. Definition of AKI and chronic kidney disease (CKD) were based on KDIGO criteria. P-value <0.05 was considered statistically significant.RESULTSThe prospective part included 446/792 (56%) surviving patients [47% males, mean age 66 (57;74) years, mean Charlson index 3 (2;5), 74% with hypertension (HTN), 51% with obesity, 28% with diabetes mellitus (DM), 17% with coronary artery disease (CAD) and 14% with chronic kidney disease (CKD)]. 13% of patients were hospitalized in the intensive care unit (ICU).A total of 103 (23%) of discharge patients had AKI in acute COVID-19. The majority of patients with AKI had the stage 1 (84%), 9% had the stage 2 and 7% had the stage 3. There were no patients who underwent renal replacement therapy during acute COVID-19 in the survivors’ group.Patients with AKI were older [71 (61;76) versus 65 (56;73) years; P = .006, compared with patients without AKI], more frequently had higher Charlson index [4 (3;5) versus 3 (2;4); P = .0002], CAD (25% versus 15%; P = .02) and CKD (20% versus 12%; P = .04) before hospitalization. There were no differences in the frequency of HTN and DM. Also, AKI patients had more severe lung injury by CT in acute COVID-19 (lung injury >50%: 36% versus 23%; P = .005), more frequently were hospitalized in ICU (25% versus 10%; P < .001) and were treated with mechanical ventilation (15% versus 4%; P < .001).At discharge 27% patients did not recover from AKI. The mean serum creatinine level at discharge was 93 (77;114) mmol/L in patients with AKI and 81 (70;94) mmol/L in patients without (P < .0001), mean glomerular rate filtration (GFR) CKD-EPI 2012 was 65 (50;81) versus 75 (62;91) mL/min, respectively (P < .0001). Mean serum creatinine level after 180 days of follow-up was 94 (74;117) mmol/L in patients with AKI and 78 (66;92) mmol/L in patients without (P < .0001), mean GRF was 65 (49;82) versus 80 (63;94) mL/min, respectively (P < 0.0001).After 180 days of follow-up, the frequency of CKD was statistically higher in both groups compare with time before COVID-19, especially in patients with AKI in acute COVID-19 (47% versus 23%; P < .001). Patients with AKI more frequently had CKD de novo (27% versus 11%; P< .001) and a reduction of GFR CKD-EPI by 30% compared with GFR at discharge (18% versus 4%; P < .001) after 180 days of follow-up.CONCLUSIONIn this study, patients who survived COVID-19 had an increased risk of poor long-term kidney outcomes. Patients after COVID-19-associated AKI had worse kidney outcomes. Post-acute COVID-19 care should include attention to kidney disease.

COVID-19 effect on perioperative findings of flexible/semi-rigid ureterorenoscopic lithotripsy: A match-pair analysis.

If not treated on time with proper management options, urolithiasis cause serious morphologic and functional alterations in the involved renal units. Like many other pathologies, the diagnosis, treatment, and follow-up principles of patients with urinary stones have been negatively affected by the unestimated changes in the healthcare systems dealing intensively with COVID-19 patients. In this present study, we aimed to evaluate and present the possible effects of COVID-19 infection on the ureterorenoscopic stone treatment. Clinical and procedural characteristics of 96 patients undergoing flexible and/or rigid ureterorenoscopy because of urolithiasis between March 2020 and January 2021 were evaluated in a retrospective manner. Obtained data were evaluated after match-pair analysis in a comparative manner between cases with a positive medical history of COVID-19 infection (Group 1, n: 48) and those without any COVID-19 infection (Group 2, n: 48). There was no statistically significant difference between the two groups of cases with respect to age, gender, associated comorbidities, and stone characteristics (p > 0.05). The mean serum creatinine level was determined to be higher in Group 1 than in Group 2 (1.15 ± 0.59 mg/dl, 0.83 ± 0.21 mg/dl, p = 0.007, respectively). Evaluation of the operative parameters revealed longer mean time from diagnosis to surgery (33.5 ± 14.27 vs 12.12 ± 6.33 days, p = 0.001), operating time, median length of stay in hospital along with higher additional intervention rates, and Clavien-Dindo complication scores again in Group 1 (p < 0.05). Our results indicate that the presence of COVID-19 infection anamnesis may affect the clinical and operative parameters of ureteroscopic stone management in cases with urolithiasis due to the possible effects of renal units damage and longer waiting time. Urologists may be aware of these unestimated problems during and after the intervention to take necessary measures for a safe and successful ureteroscopic stone removal.

Comparison of efficacy of single dose versus split dose prednisolone therapy in achieving remission in patients with nephrotic syndrome in children

Background: Nephrotic syndrome is a medical problem clinically characterized by proteinuria, generalized body edema and hypercholesterolemia. We did this study to compare the effectiveness of single dose versus split dose prednisolone in achieving remission in patients with nephrotic syndrome in children.Patients and methods: This open-ended randomized control trial was done in pediatric unit of tertiary care hospital from January to December 2019.We included one hundred Patients of nephrotic syndrome in the study who met the inclusion criteria. We divided total Patients into 2 groups (group A &amp; B) 50 patients in each group. Group A was given single dose prednisolone, while group B was given split dose prednisolone therapy. Both groups were compared with respect of achievement of remission.Results: Out of 50 patients of group A who were given single dose prednisolone 37 (74%) were male, while in group B who were given split dose prednisolone 22 (44%) were male (p-value=0.137). Mean age of patients of study group A and B was 4.5 ±1.67 years and 4.9 ±1.49 years respectively (p-value=0.1876). Mean serum creatinine level in study group A and B was 0.744±0.189 and 0.736±0.167 (p-value=0.823). Similarly mean serum albumin level in study group A and B was 2.34±0.358 and 2.39±0.33 (p-value=0.473). When both groups were compared with regard to response to treatment, in group A mean remission duration was 16.48 ±3.69. In group B mean remission duration was 19.42 ±3.11 days (p-value&lt;0.05).Conclusion: From our study we concluded that single dose prednisolone is more effective in achieving remission in steroid sensitive nephrotic syndrome as compared to split dose prednisolone.

Single-center retrospective analysis of Pneumocystis jirovecii pneumonia in patients after deceased donor renal transplantation

ObjectiveTo investigate the clinical features, early diagnosis, and treatment methods of Pneumocystis jirovecii pneumonia (PJP) after renal transplantation (RT). MethodsWe retrospectively analyzed the clinical data of 80 patients with confirmed PJP who underwent RT between 2018 and 2021 in our hospital. ResultsIn the present study, the incidence of PJP was 6.2% (80/1300). A 50% of cases (40 out of 80 patients) had developed a PJP infection during the first 6 months after RT and 81.3% (65 out of 80 patients) within 12 months. The median onset time of PJP was 6.5 months after RT. The most common symptom was fever (73.8%), followed by progressive dyspnea (51.3%) and dry cough (31.3%). In the initial phase of PJP, the most frequent CT finding was the presence of diffuse ground-grass shadows. In all, 27.5%, 37.5%, and 35% patients were diagnosed by induced sputum metagenomic next-generation sequencing (mNGS), peripheral blood mNGS, and characteristic clinical diagnostic features, respectively. The median 1,3-β-D-glucan level was 500 pg/mL, while the median C-reactive protein level was 63.4 mg/L. In most patients (83.8%), the procalcitonin levels were negative. The mean serum creatinine level was 171.9 ± 87.4 μmol/L. Of the 80 patients, 37 (46.2%) had coexisting cytomegalovirus (CMV) infection. All patients were treated with trimethoprim-sulfamethoxazole and third generation cephalosporin to prevent bacterial infection. The methylprednisolone dose (40–120 mg/d) varied according to illness. ConclusionPJP usually occurs within 1 year after RT, typically within 6 months. Fever, dry cough, and progressive dyspnea are the most common clinical symptoms. PJP should be highly suspected if the patient has clinical symptoms and diffuse, patchy, ground-glass opacities on CT in both lungs after RT within 1 year. Peripheral blood or induced sputum mNGS is helpful for early diagnosis of PJP. Trimethoprim-sulfamethoxazole is still the first choice for the treatment of PJP. Combined use of caspofungin can reduce the dose and adverse reactions of trimethoprim-sulfamethoxazole in theory.

Does prostate specific antigen act as predictor in benign prostatic hyperplasia?

Background: Benign prostatic hyperplasia (BPH) is associated with increase in prostate volume (PV) and increased epithelial production of prostate specific antigen (PSA). Both, PV and serum PSA, offers a non-invasive guide for identifying patients at high-risk of disease progression and making treatment decisions. Objective: To evaluate the serum PSA concentration and PV in cases of lower urinary tract symptoms (LUTS) secondary to BHP. Methods: Two hundred eligible symptomatic BHP patients with LUTS, were recruited into the study. All relevant history, clinical findings, International Prostate Symptom Score (IPSS) category and digital rectal examination grading were recorded. Blood levels of PSA, blood urea and serum creatinine were estimated followed by abdominal and trans-rectal ultrasonography (USG) to assess the size of prostate, PV, the lobes involved and residual urine volume. The results were compiled and analyzed using statistical software R version 3.6.3. Results: The mean age of the BHP patients was 68.22 ± 9.18 years, with 36% suffering from acute urinary retention (AUR). The mean IPSS, PV and PSA levels were 23.80 ± 5.67, 58.40 ± 18.56 cc and 4.61 ± 1.66 ng/mL, respectively. The mean blood urea and serum creatinine levels were 32.02 ± 6.05 mg/dL and 1.10 ± 0.28 mg/dL, respectively.

Endovascular Treatment for Transplant Renal Artery Stenosis Improves the Short- and Long-Term Graft and Patient Outcomes.

Transplant renal artery stenosis is the commonest vascular complication after kidney transplant. This study aimed to evaluate the efficacy of endovascular treatment for patients with clinically significant transplant renal artery stenosis. Electronic patient records of kidney transplant recipients who received transplants from October 1, 2010, to July 31, 2021, at the Royal Liverpool University Hospital were retrospectively reviewedtoidentify thosewhounderwent endovascular treatment for transplant renal artery stenosis. Analysis of variance and paired sample t tests were respectively used to compare serum creatinine and the mean number of antihypertensive medications before and aftertreatment. During the period of analysis, there were 1211 kidney transplant recipients, with 33 (2.72%) who received endovascular treatment for transplant renal artery stenosis. Mostofthesepatientsweremen(25/33), and the median age was 59 years (range, 27-83 y). The mean follow-up duration was 69.82 months. As primary treatment, 19/33 patients (57.6%) were treated with percutaneous balloon angioplasty and 14/33 (42.4%) received stents. Procedure-related complications occurred in 3 patients (9.1%; 2 had false aneurysms, 1 had renal artery dissection). Significant improvements in mean serum creatinine levels were shown up to 4 years after the procedure (P = .019). A significant difference in the mean number of antihypertensive drugs before and after treatment was noted in those who had resistant hypertension as a presentation for transplantrenal artery stenosis (P = .016). At the end of follow-up, 7 patients (21.1%) had graft failure, with 1 patient (3.0%) having graft failure as a direct consequence of transplant renal artery stenosis. There was no reported incidence of patient mortality. Endovascular treatment for transplant renal artery stenosis provides a sustained improvement in graft function and a significant reduction in antihypertensive drug requirement.

Impact of the kidney transplantation on renalase and blood pressure levels in renal transplant donors and recipients

Introduction and objectivesPrevalence of hypertension increases as glomerular filtration rate (GFR) declines. Renalase metabolizes catecholamines and have an important role in blood pressure (BP) regulation. The purpose of the study was to evaluate the effect of kidney transplantation on renalase levels and BP in kidney donors and recipients. Materials and methodsTwenty kidney transplant recipients and their donors were included in the study. Serum renalase levels and ambulatory BP values were measured in both donors and recipients before and after transplantation. Factor associated with change in renalase and BP levels were also evaluated. ResultsIn donors; mean GFR and hemoglobin levels decreased while night-time systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels and serum renalase levels increased simultaneously after nephrectomy. Day-time SBP and DBP levels did not changed and the night/day ratio of mean arterial pressure (MAP) increased significantly. In recipients, mean GFR increased, while mean serum renalase levels, creatinine and BP levels decreased after transplantation. Correlation analysis revealed that changes in MAP correlated with alteration in serum renalase levels and GFR. ConclusionsAfter transplantation, serum renalase levels increased in donors and decreased in recipients. The renalase levels are associated with change in MAP and circadian rhythm of BP in donors and recipients.

Morphological Spectrum of Glomerulonephritis in Medical Renal Biopsies: A Single-Center Study.

BackgroundGlomerulonephritis is among the most common and serious non-communicable diseases in the world, and some of them are major causes of chronic kidney disease, which eventually leads to kidney failure. In developing countries, it is the most common cause of end-stage renal disease (ESRD). Chronic kidney disease affects 10-16% of the adult population in Asia, including 21.2% in Pakistan. This study aims to determine the frequency and spectrum of glomerulonephritis at our center.MethodologyThis is a cross-sectional analysis of 81 renal core biopsies obtained between August 2020 and August 2021. The histopathological reports, demographic data, and relevant laboratory investigations, such as blood urea and creatinine levels, were collected. All cases were blindly reviewed by two pathologists with a special interest in medical renal pathology. Data were analyzed using SPSS version 22 (IBM Corp., Armonk, NY, USA).ResultsThe majority of the patients (46.9%) were between the ages of 21 and 40 years. There was a slight male predominance, with 44 (54.3%) of the 81 participants being male. Hematuria was reported in 20 (24.7%) patients, with mean serum urea and creatinine levels of 75 mg/dL and 2.6 mg/dL, respectively. Nephrotic syndrome was the most common indication for a renal biopsy, accounting for 54 (67.7%) of the 81 cases. Chronic glomerulonephritis is classified into two categories, namely, primary and secondary glomerulonephritis. Focal segmental glomerulosclerosis (FSGS), the leading cause of primary glomerulonephritis, was found in 25 (30.9%) 81 patients. Furthermore, lupus nephritis (9.9%) and advanced glomerulonephritis (9.9%) were found in equal proportions among secondary glomerulonephritis.ConclusionsAccording to our study, nephrotic syndrome was the most common indication for medical renal biopsy, with FSGS being the most common primary glomerulonephritis. Lupus nephritis and advanced glomerulonephritis were the most common secondary glomerulonephritis diagnoses.

Robot-Assisted Kidney Transplantation: Initial Experience with a Modified Hypothermia Technique

Introduction: The aim of the study was to report our initial experience of robot-assisted kidney transplantation (RAKT) with a modified hypothermia technique. Methods: Between March 2018 and May 2020, 12 patients with end-stage renal disease underwent RAKT at the Chinese PLA General Hospital, and a modified regional hypothermia was implemented by wrapping the kidney in a sealed plastic jacket filled with ice slush. Baseline, surgical, and functional outcomes were analyzed. Results: All surgeries were successfully performed. The mean operative time was 180.5 min, with a mean console time of 133.3 min. Mean warm ischemia, cold ischemia, and rewarming times were 1.5, 135.1, and 48.4 min, respectively. The median blood loss was 50 mL, and the median hospital stay was 9.5 days. No complications were observed. The mean serum creatinine levels were 119.4, 100.5, 108, and 108.5 μmol/L 7 days, 1 month, 6 months, and 1 year postoperatively, respectively. All patients and grafts survived at a median follow-up of 32.2 months. Conclusion: RAKT is a safe and feasible procedure for surgical teams with expertise in open kidney transplantation and robotic surgery. Our modification of the hypothermia technique can maintain the kidney at a constant low temperature without repeatedly adding ice and prevent the complication of paralytic ileus.

Correlation of Demographic and Biochemical Features with Histological Classification of Diabetic Nephropathy

Background: Diabetic Nephropathy (DN) is a renal disease that leads to progressive renal failure across the world and it is among the most challenging of all renal diseases. The categorization of DN is centered on the lesions of glomeruli and exhibits varied morphological features. These patients outcome is also affected by evaluating the lesions of tubules, interstitium and renal vessels. Objective: The objective of this study was to apply the current pathological categorization of DN by Tervaert et al to evaluate the lesions of kidney in DN and to correlate clinical and histopathological features. Methods: This was a retrospective study of 10 years' duration from 2010-2019 at the Histopathology Department, Chughtai Institute of Pathology, Lahore. Fifty two cases of DN were included in the study. Parameters which were assessed included age, gender, duration of diabetes, 24 hours' urinary proteinuria, serum creatinine, histologic classes of diabetic nephropathy, Interstitial inflammation Score, interstitial fibrosis &amp; tubular Atrophy (IFTA) score, Arteriolar Hyalinosis (AH) score and large vessel arteriolosclerosis. Results: Out of 52 cases, 28 were males and 24 were females. Mean age of patients was 51.40 years. Mean duration of diabetes was 11.54 years. Mean serum creatinine level was 5.42 mg/dl. Mean proteinuria was 4.72 g/24 hours.&#x0D; The most frequent glomerular lesions were in Class III comprising 48% of all classes. Conclusion: There was a significant correlation of glomerular classes with serum creatinine levels and also with proteinuria. There was also correlation of IFTA with rising serum levels of creatinine and proteinuria.

POS-260 Polycystic kidney disease in Chad: about 26 cases

Polycystic kidney disease is the most common inherited kidney disease with easy diagnosis by ultrasound. The aim of our work was to study the epidemiological, clinical, paraclinical and therapeutic aspects of renal polyskystosis in Chad and to assess the value of screening in patients at risk. We carried out a descriptive cross-sectional study over a period of 26 months (January 1, 2018 to May 1, 2020) in the two nephrology departments of the Renaissance and the National Reference centers of N’Djamena. were included all patients who had polycystosis (PEI ultrasound criteria). Then a family survey was carried out among family members of patients included between June 1, 2020 and October 1, 2020 During our study, 2229 patients had consulted in the 2 university hospitals. Fifteen (15) cases met the ultrasound criteria for PEI, as a hospital prevalence of 0.67% of cases. From these 15 cases, a family investigation was carried out on the members of 3 families. Eleven (11) patients were diagnosed as carriers of polycystic kidney disease (Figure 2). We identified a total of 26 cases in our study, as a prevalence of 1.16%. The average age was 42.4 years [15 and 70 years] with a sex ratio of 1.3. The mean age of onset of the first clinical signs was 37.7 years. Arterial hypertension (hypertension) was the main circumstance of discovery in 53.8% (n = 14) followed by abdominal pain, urinary tract infection and chronic renal failure in respectively 7.6% (n = 2); 7.6% (n = 2) and 3.8% (n = 1). Grade I, II and III hypertensions were found in 42.1%, respectively (n = 8); 36.9% (n = 7) and 21% (n = 4). There was a statistically significant relationship between circumstance of discovery and age (p = 0.034). A hemoglobin level of between 8 and 10g / dl was found in 57.7% of cases. The mean serum creatinine level was 45 mg / l with [4.5 to 274.42 mg / l]. It was noted that 12 patients or 46.1% of patients were in the chronic renal failure stage, including 26.9% in the end stage. All had received conservative treatment. In multivariate analysis, there was a statistically significant relationship between the different stages of chronic kidney disease and the occurrence of complications (p = 0.0000). Therapeutically, 14 patients (53.8%) were on antihypertensive drugs such as ACE inhibitors. No patient had received Tolvaptan. Urinary tract infections were the main complications (19.2%) of hypertension in the blood (15.3%) and macroscopic hematuria (15.3%). Polycystosis in Chad is an unrecognized and underdiagnosed pathology. Clinical screening should focus on the etiological research of arterial hypertension in the young subject and ultrasound screening of family members of the polycystic patient.

Prevalence of Renal Failure in Children and the Need for Dialysis in Paediatric Nephrology in a Developing Country

Background: Renal failure is among the major visceral failures responsible for morbidity and mortality in children. Epidemiological data on renal failure in children are limited in sub-Saharan Africa, including Senegal. We conducted this study to assess the prevalence of renal failure (RF) and the need for dialysis in the paediatric nephrology unit. Patients and methods: This was a retrospective and descriptive study in the pediatric nephrology unit from 1st January 2020 to 30 June 2021, including children with acute or chronic RF. The need for dialysis was judged to be met by its effectiveness in face of an indication. The data collected were analysed on sphinx plus 2017 software. Results: The prevalence of RF was 60% (n/N = 132/220). RF was acute in 59% (n/N = 78/132) of cases. The mean age was 6.53 ± 4.77 years with a sex ratio of 1.8. The mean serum creatinine level was 27.22 mg/L (240.9 μmol/L) and BUN at 0.85 g/L. The aetiologies were dominated by prerenal AKI (Acute Kidney Injury) complicating nephrotic syndrome (NS) in 37.2% (n/N = 29/78) and dehydration due to stomach flu in 17.6% (n/N = 9/51). Acute post-infectious glomerulonephritis including group A streptococcus and plasmodium falciparum accounted for 16.7% (n = 13/78) of intrinsic AKI. The need for dialysis was unmet in 50% (n/N = 7/14) with a mortality of 14.1% (n/N = 11/78). The mean age of the patients with chronic RF was 8.68 ± 4.74 years with a sex ratio of 2.6. The mean serum creatinine level was 36.56 mg/L (323.5 μmol/L) and the BUN level was 0.99 g/L. Half of the children were classified as having CKD stage II (early stage). The aetiologies were dominated by primary focal and segmental glomerulosclerosis (FSGS), 53.7% (n/N = 29/54), renal hypoplasia, 22.2% (n/N = 12/54) and reflux nephropathy, 29.4% (n/N = 5/17). The need for dialysis was unmet in 46.1% (n/N = 6/13). The overall mortality of chronic kidney disease (CKD) with RF was 29.6% (n/N = 8/27). Conclusion: The prevalence of RF was high in the unit. Most aetiologies of AKI were accessible to prevention. Only half of the children had access to free dialysis, hence the need for a dedicated pilot dialysis centre.

Outcomes of patients with end-stage kidney disease hospitalized with COVID-19: A single-center experience from Eastern India

Aim: This study aimed to describe the clinical characteristics, survival outcome, and its correlation with biochemical parameters in coronavirus disease-2019 (COVID-19)-infected patients with end-stage kidney disease (ESKD). Materials and Methods: A prospective observational study was on hospitalized patients with confirmed COVID-19 infection from September 1, 2020 to October 31, 2020. Data related to demographics, baseline history of comorbid conditions, dialysis-specific data, details on hospital admissions, COVID-19 treatment regimen, laboratory investigations, computed tomography (CT) severity score, COVID-19 Reporting and Data System score, and clinical outcomes (improved/death), duration of hospital stay, oxygen/vasopressor support were collected. Results: A total of 216 ESKD patients with COVID-19 infection were included in this study. The median age was 48.0 years (74.5% men, 25.5% women). Severe acute respiratory infection (44.7%), hypertension (28.2%), and type 2 diabetes mellitus (22.4%) were the most common comorbidities. Elevated levels of serum creatinine (9.3 mg/dL) and blood urea nitrogen (84.8 mg/dL) were observed in the patients with COVID-19 infection. The change in mean levels of serum creatinine and estimated glomerular filtration rate from baseline to post-treatment was significant (0.9 [95% CI: 0.7, 1.1; P < 0.001] and 3.4 [95% CI: 3.2, 3.6; P < 0.001], respectively). Approximately, 79.6% (n = 172) of patients improved post-treatment. Serum creatinine (1.786, 95% CI: 1.031, 3.095; 0.039) and ferritin levels (51.959, 95% CI: 7.901, 341.685; P < 0.001) remained significantly and independently associated with survival. The median time to clinical survival was 17.0 days. Conclusion: Serum creatinine and ferritin levels were independently associated with survival.

Effects of intraoperative dexmedetomidine infusion on renal function in elective living donor kidney transplantation: a randomized controlled trial.

Ischemia-reperfusion injury is inevitable during donor organ harvest and recipient allograft reperfusion in kidney transplantation, and affects graft outcomes. Dexmedetomidine, an α2-adrenoreceptor agonist, has renoprotective effects against ischemia-reperfusion injury. We investigated the effects of intraoperative dexmedetomidine infusion on renal function and the development of delayed graft function after elective living donor kidney transplantation in a randomized controlled trial. A total of 104 patients were randomly assigned to receive either an intraoperative infusion of dexmedetomidine 0.4 μg·kg-1·hr-1 or 0.9% saline. The primary outcome was the serum creatinine level on postoperative day (POD) 7. Secondary outcomes were renal function and the degree of inflammation and included the following variables: serum creatinine level and estimated glomerular filtration rate up to six months; incidence of delayed graft function; and levels of serum cystatin C, plasma interleukin (IL)-1β, and IL-18 during the perioperative period. The mean (standard deviation) serum creatinine level on POD 7 was comparable between the groups (dexmedetomidine vs control: 1.11 [0.87] mg·dL-1 vs 1.06 [0.73] mg·dL-1; mean difference, 0.05; 95% confidence interval, -0.27 to 0.36; P = 0.77). Delayed graft function occurred in one patient in each group (odds ratio, 1.020; P > 0.99). There were no significant differences in the secondary outcomes between the groups (all P > 0.05). Intraoperative dexmedetomidine infusion did not produce any beneficial effects on renal function or delayed graft function in patients undergoing elective living donor kidney transplantation. www. gov (NCT03327389); registered 31 October 2017.

RENAL FUNCTION AND CLINICAL PROFILE IN CHILDREN WITH CONGENITAL HEART DISEASE – AN OBSERVATIONAL STUDY FROM TERTIARY CARE HOSPITAL IN CENTRAL INDIA.

Purpose: To evaluate the renal function and clinical prole in children with congenital heart disease. Method: After taking informed consent from the parents of 118 children aged 1 month to 14 years were recruited in study. Anthropometry and vitals were noted. Complete physical examination and USG abdomen done to identify any other associated congenital anomaly. Laboratory evaluation of serum creatinine was done on day 1 and day 5. 24 hours urine output was strictly measured till day 5 of admission. Result: The maximum number of cases belonged to age group 1-6 month. Male children were affected more than females (1.5:1) and majority of the children belong to family of lower middle and lower socioeconomic status. Most of the children belong to rural area. Among syndromic features, microcephaly and cleft lip and cleft palate were most frequently observed. Most of the cases had weight /height &lt;-3SD. There was no major signicant difference in mean value of urine output and serum creatinine level in different age groups and in between cyanotic and acyanotic group. Conclusion: Congenital heart disease forms a significant diagnosis in hospitalized children. Larger studies are needed to evaluate newer associations (like male gender and low socioeconomic status). Microcephaly and cleft lip/palate were most observed associated syndromic features. No signicant effect was observed on the mean urine output and serum creatinine level in children with congenital heart disease.

Augmentation uretero-enterocystoplasty for refractory urinary tract dysfunction: a long-term retrospective study

ObjectivesTo report the long-term efficacy and complications of the augmentation uretero-enterocystoplasty (AUEC), including augmentation cystoplasty with simultaneous ureteroplasty and ureteral anti-reflux implantation in a single center.MethodsWe retrospectively reviewed clinical records, video-urodynamic data, and magnetic resonance urography of 210 patients who underwent the procedure for refractory lower urinary tract dysfunction (LUTD) from 2003 to 2019. International vesicoureteral reflux (VUR) and upper urinary tract dilatation (UUTD) grading systems were applied to assess upper urinary tract function, and post-operative complications were assessed.ResultsMean age was 28.1 years, with a mean follow-up time of 57.4 months. A total of 338 ureters were simultaneously re-implanted, and ureteroplasty was performed on all ureters. There was a significant postoperative improvement in the bladder capacity, intravesical pressure, and compliance (P < 0.05). VUR improvement rate was 97.7% and postoperative improvement of UUTD presented in 72.5% ureters. Mean serum creatinine (Scr) level was significantly improved compared to preoperative Scr values (226.0 ± 89.4 μmol/L vs. 217.5 ± 133.9 umol/L, P < 0.05). The 1.0% patients had unacceptably postoperative urinary incontinence and 85.4% preoperative megaureters were improved. Primary complications included metabolic acidosis (9.5%), vesicoureteral anastomosis stenosis (6.2%), persistent VUR (2.7%), urinary calculi (6.6%), and intestinal dysfunction requiring laparotomy (3.3%).ConclusionIn the study, a large series of patients treated with a complex surgical procedure was reported. It is novel, as this case series represents patients with aggressive surgical correction of VUR, ureteral tortuosity and upper tract dilation at the time of AC. AUEC was shown to have a positive role in treating patients with refractory LUTD associated with hydronephrosis and ureteral dilatation, stenosis or obstruction, with or without high- or low-pressure VUR. It was effective in improving renal function and protecting the UUT function from further deterioration in most patients with renal insufficiency.

306.7: Do Pretransplant C-peptide Levels Influence Outcomes in Simultaneous Pancreas-Kidney Transplantation? A Matched Case-Control Study

Introduction: Experiences with simultaneous pancreas-kidney transplantation (SPKT) in uremic patients with detectable pretransplant C-peptide (Cp) levels with a “type 2” diabetes mellitus (DM) phenotype have demonstrated survival outcomes equivalent to those with type 1 (Cp negative) DM. However, few studies have analyzed these outcomes in a case-control fashion. The study purpose was to evaluate outcomes in SPKT recipients according to presence or absence of pretransplant Cp. Methods: Selection criteria for Cp positive (Cp+, ≥2.0 ng/ml) were similar to Cp negative (Cp-) patients. We retrospectively analyzed 215 SPKTs performed at our center between 8/02 - 5/19 and identified 41 patients who were Cp+ pretransplant (mean level 5.4 ng/ml) and compared to 41 Cp- (level undetectable) case controls matched for recipient age, gender, race, and date of transplant. All SPKTs were performed as intent to treat with portal-enteric drainage; all patients received depleting antibody induction with FK/MMF ± steroids. Pancreas graft failure (GF) was defined as return to daily insulin therapy. Results: The two groups were well-matched for numerous donor, preservation, recipient, and immunological characteristics. Mean donor (26 Cp+ vs 23 years Cp-) and recipient (both 44 years) ages were similar. Both groups had 21 males/20 females and 19 Caucasian (C)/20 African American (AA) patients. There was one early death secondary to infection in each group. There were no other early (<6 month) kidney GFs in either group. There were 5 other early pancreas GFs, 3 in Cp+ and 2 in Cp- patients. With a mean follow-up of 7.3 years in both groups, 5-year patient survival (PS, 93% vs 95%), kidney graft survival (GS, 73% vs 85%), and pancreas GS (68% vs 85%, p=0.11) rates were slightly lower in Cp+ vs Cp- patients, respectively. Death-censored kidney (69% vs 73%) and pancreas GS (59% vs 81%, p=0.07) rates were also slightly lower in Cp+ vs Cp- patients, respectively. The Cp+ group had fewer deaths with functioning grafts (9.8% vs 19.5% Cp) but more pancreas GFs (9.8% vs 0 Cp-, p=0.12) due to either insulin resistance (in patients with normal C-p levels and excessive weight gain) or rejection (19.5% vs 12% Cp-, p=NS). There were no differences in outcomes according to gender or race. Post-transplant weight gain >3 kg occurred in 76% of Cp+ vs 32% of Cp- patients (p=.0001). Mean post-transplant weight gain was 15 kg in Cp+ vs 6.5 kg in Cp- patients (p<.001). In patients with functioning grafts, mean post-transplant Cp (4.9 vs 2.6 ng/ml), HbA1c (5.5 vs 5.2%) and serum creatinine (1.4 vs 1.2 mg/dl) levels were slightly higher in Cp+ patients whereas mean eGFR levels (61 vs 66 ml/min/1.73 m2) were slightly lower compared to Cp- patients. Conclusions: In this matched case-control study, survival and functional outcomes in Cp+ patients are slightly inferior following SPKT, with post-transplant weight gain and GF due to insulin resistance or rejection accounting for differences in outcomes.

OPERATIVE MORTALITY OF CORONARY ARTERY BYPASS GRAFTING IN PATIENTS WITH LOW SERUM ALBUMIN AFTER NUTRITIONAL SUPPORT

Objectives: The aim of this study was to determine the frequency of operative mortality in patients who had low serum albumin on admission and were undergoing coronary artery bypass grafting (CABG) after nutritional support at a tertiary care cardiac center in Karachi, Pakistan. Methodology: A retrospective study was conducted at an adult cardiac surgery department of the largest tertiary care cardiac center in Karachi, Pakistan. Patients who had undergone isolated CABG during January to December 2019 admitted with low serum albumin (less than 3.5mg/dl) and received nutritional treatment before surgery were included in the study. Patients were monitored for a month to measure the 30 day mortality. Results: There were 82.4% male patients and the mean age was 55.49±8.52 years. Preoperative mean serum haemoglobin, serum creatinine, and serum albumin levels were 12.225±1.19 mg/dl, 1.05±0.21 mg/dl, and 2.825±0.39 mg/dl respectively. Postoperative mortality was recorded in 1.7% of the total patients. Conclusion: In patients with low serum albumin levels and had undergone isolated CABG after nutritional pre-treatment, mortality was mainly associated with peri-operative myocardial infarction. While, the incidence of delayed wound healing and atrial fibrillation were found to be high in these patients.

Evaluation of Graft Outcome and Patient Survival in Children after Renal Transplantation: A Single Center Experience:

Background and Aim: Quality of life has been improved by kidney transplantation (KT), especially in pediatric patients. Children have a higher risk of rejection and graft loss compared to adults. It is important to determine the pediatric graft outcome and prevent early graft loss, if possible. This study was done to evaluate graft and patient survival in pediatric patients after kidney transplantation. Methods: This cross-sectional study was done on all children below 18 years old that underwent kidney transplantation in Shahid Beheshti Kidney Transplant Center. Sex, time of transplantation, serum creatinine, acute rejection, viral infection (cytomegalovirus), and graft survival and patient survival were recorded. Results: Fifty-eight patients underwent kidney transplantation. The mean serum creatinine level was 0.89±0.88 mg/dl, 0.7±1.29 mg/dl, 058±0.92 mg/dl, 0.9±0.83 mg/dl and 1.32±0.91 mg/dl on day 1, 2, and 3 post KT, discharge day, and the last follow-up visit, respectively. Graft survival was 93.1%, 89.5% and 86.5% at 1, 5 and 10 years, respectively. During the study, five patients expired and therefore patient survival was 99.6%, 92.3% and 92.3% at 1, 5 and10 years, respectively. Conclusion: This study, compared to other studies, showed that the graft and patient survival were acceptable. More attention should be paid to improve the outcome.

State of blood pressure control in adult type 2 diabetic patients with chronic kidney disease and hypertension: experience from a tertiary care centre of Bangladesh

Background: Well controlled blood pressure (BP) is associated with decreased risk of kidney disease progression, cardiovascular events and death. Patients with chronic kidney disease (CKD) are frequently seen to have low rates of BP control. This study aimed to find out the proportion of adult type 2 diabetic CKD patients with hypertension achieving the goal of target blood pressure.&#x0D; Methods: This cross-sectional study included 105 hypertensive subjects having type 2 diabetes and CKD at the outpatient department of Nephrology, BIRDEM General Hospital in Dhaka, Bangladesh from May to August, 2012.&#x0D; Results: The mean age was 55.6 years and maximum numbers of patients were in the age group of 39-66 years. Among 105 subjects, 52.3% were male and rest 47.7% were female. The mean duration of diabetes, CKD and hypertension were 6.73 (±3.22), 3.12 (±2.47) and 3.1 (±1.77) years respectively. The study revealed that ischemic heart disease (30.5%), dyslipidemia (56.1%) and stroke (13.3%) were associated comorbidity along with diabetes and CKD. Mean estimated glomerular filtration rate was 52.19 ml/min. Mean serum creatinine level was 3.4 mg/ dl. It was observed that majority (49.5%) of the study subjects were prescribed at least two drugs to control hypertension. Three anti-hypertensive medications were given in 35.2% subjects. Among 105 study subjects, 25.7% were found to have high systolic blood pressure and 8.8% high diastolic blood pressure. It was observed that only 40% subjects achieved target systolic blood pressure and 68.6% reached the target diastolic pressure for CKD with diabetes. In correlation analysis, it was observed that both systolic and diastolic blood pressure was significantly correlated with age of the subject, duration diabetes and duration of HTN.&#x0D; Conclusion: From the present study it was seen that both the target systolic and diastolic blood pressure were correlated with numbers of medications used for controlling hypertension but only diastolic blood pressure control was significantly correlated with number of medication used in this present study.&#x0D; BIRDEM Med J 2021; 11(3): 212-217