Mean Serum Creatinine Values Research Articles

Prognostic impact of heart mate risk score among elderly heart failure patients with non-responder for cardiac resynchronization therapy

Abstract Background For patients with severe heart failure (HF) who are not eligible for transplantation, there is destination therapy (DT) that uses a continuous flow left ventricular assist device (LVAD). Implantation of LVAD improves HF and can be expected to improve the prognosis of life. Elderly refractory HF patients with non-responders for cardiac resynchronization therapy (CRT) may benefit from LVAD as DT. In considering indications of LVAD as DT for the elderly in Japan, conditions such as a low risk of Heart Mate Risk Score (HMRS) have been raised. HMRS has been shown to correlate with mortality in the cohort of LVAD patients enrolled in the Heartmate II trials. Purpose Because elderly CRT non-responder refractory HF patients are not indicated for transplantation and may benefit from LVAD as DT in Japan, we aimed to investigate the HMRS and prognosis among elderly CRT non-responders. Methods Of 467 patients underwent CRT implantation between 2000 and 2015, 157 were aged 65–75 years old. Of which 59 patients who could be determined to be non-responders based on echocardiographic data were included in this study. The primary endpoint was all-cause mortality, the secondary was readmission for HF and appropriate implantable cardioverter defibrillator (ICD) therapy. Results The patients' mean age was 68 years, males were 71%. The mean serum creatinine value was 1.1 mg/dl, albumin was 3.8 mg/dl, and BNP was 383 pg/ml. The mean left ventricular ejection fraction (LVEF) was 26%. The subjects were divided into 3 groups according to HMRS. The average of HMRS was 2.2, the low-risk group included 17 (29%) patients, the medium was 22 (37%), and the high was 20 (34%). There was no significant difference in age, LVEF, BNP, and NYHA functional classification at the time of CRT implantation between three groups. In the low-risk group, creatinine and INR were significantly lower, and albumin was significantly higher compared to the high-risk group. BNP tended to be lower in the low-risk group, but there was no significant difference. The mortality rate by HMRS was 12% in the low-risk group, 36% in the medium-risk group, and 50% in the high-risk group. On the Kaplan-Meier analysis, the low-risk group had a significantly lower mortality rate than the high-risk group (Figure). Furthermore, focusing on HF readmission, the rate of readmission was 59% in the low-risk group, 86% in the medium -risk group, and 65% in the high-risk group, and there was no significant difference between three groups. There was also no significant difference in appropriate ICD therapy between three groups. Conclusion Approximately 30% of elderly non-responders of CRT are in the low-risk group by HMRS and their mortality was lower than that of the other two groups. These elderly CRT non-responder patients might be considered a candidate for DT in Japan. Funding Acknowledgement Type of funding sources: None.

Prevalence and risk of chronic kidney disease in oral lichen planus: a large cross-sectional study from eastern China.

BackgroundOral lichen planus (OLP) is a chronic inflammatory mucocutaneous disease which is frequently associated with comorbidities such as diabetes and cardiovascular diseases. However, little is known about the association of OLP with impaired kidney function. To elucidate the possible association of chronic kidney disease (CKD) with OLP and its severity, this study investigated the prevalence of CKD as well as its risk factors in patients with OLP.MethodsA large prospective cross-sectional study of 1,021 patients with OLP was carried out using questionnaires and laboratory tests available from an oral medicine clinic at a university in eastern China. According to the Kidney Disease: Improving Global Outcomes (KDIGO) diagnostic guideline, CKD was classified based on the estimated glomerular filtration rate (eGFR, <60 mL/min/1.73 m2) or urinary albumin to creatinine ratio (UACR, >30 mg/g).ResultsThe prevalence of CKD in the patients with OLP in this study was 14.3% (95% CI, 12.3–16.6%), which was higher than that in the general Chinese population (10.8%; 95% CI, 10.2–11.3%). The mean values of serum creatinine, eGFR, UACR, and urine N-acetyl-β-D-glucosidase in patients with CKD were significantly higher than those in patients without CKD (all P<0.01). Pearson’s correlation analysis revealed that CKD stage and UACR were positively correlated with the severity of OLP (both P<0.001). Importantly, multivariate regression analysis revealed that age ≥58 years old, female sex, and hypertension were independent risk factors for incident CKD and abnormal UACR (>30 mg/g) in patients with OLP (all P<0.01).ConclusionsThis study has reported for the first time that CKD is a comorbidity in patients with OLP. The occurrence and staging of incident CKD are associated with OLP and its severity.

MO950SIMULTANEOUS LIVER-KIDNEY TRANSPLANT. SIXTEEN YEARS OF MONOCENTRIC EXPERIENCE

Abstract Background and Aims Combined liver-kidney transplant is the best treatment for patients with hepatic and renal failure, even though some studies reported a poor patient survival. The aim of our study is to summarize the clinical characteristics of subjects who undergo simultaneous combined liver-kidney transplantation (SLKT) for advanced liver and kidney disease. Furthermore, we evaluated patient and kidney survival of SLKT recipients compared to solitary kidney transplant (KT) recipients. Method We performed a retrospective analysis of all SLKT recipients performed in a single transplant Center (University Hospital of Modena, Italy) from 01/01/2004 to 12/31/2016. All patients were aged more than 18 years. Results 34 SLKT were performed over 16 years of transplant activity. Mean age of recipients was 51.3 ±9.1years. Males accounted for 65% of the population. All patients were of Caucasians origin except one of African origin. Mean BMI was 69.5 ± 13.9 Kg. Hepatitis C Virus (HCV)-related cirrhosis was the main cause (38.1%) of hepatic failure. Other causes of hepatic disease were ADPKD (26.5%), hepatitis B Virus (HBV) (11.8%), alcohol (8.8%), combined HCV-HBV infection (5.9%), Von Gierke Disease (2.9%), primary biliary cirrhosis (2.9%), and autoimmune cirrhosis (2.9%). Six patients developed hepatocellular carcinoma before undergoing SLKT. Renal disease was caused by ADPKD (26.5%), diabetic nephropathy (14.7%), glomerulonephrites (29.4%), hepatorenal syndrome (8.8%) and other renal diseases (20.6%). Overall, 14.7% of patients was affected by Human Immunodeficiency Virus (HIV), 50% by hypertension and 41% by diabetes. Mean MELD at transplantation was 42 (39.2-46.5) and mean serum creatinine value in pre-emptive patients was 3.09 ±1.4 mg/dl. Mean of donors was 46.7±15.3 years and main cause of death was cranial trauma (47.1%), followed by cerebral haemorrhage (41.2%). Mean KDPI was 52% (22-63) and KDRI 1 (0.73-1.1). Mean time on waiting list was 2.8±1.2 years and half of patients was on dialysis maintenance before SLKT. Mean ischemia time were 6.5 ±1.3 and 12.3 ±2.1 hours for liver and kidney, respectively. Only one patient (2.9%) received double kidney transplantation. Primary induction agent was anti-IL2 receptor monoclonal antibodies (82.6%), thymoglobulin (13%) and with methylprednisolone (4.1%). Post SLKT, kidney early complication consisted of 3 delayed graft functions and 1 transplanctectomy in the only double kidney transplant recipient. At the end of the follow-up (8±4.1 years), mean creatinine was 1.44 ± 0.5 mg/dl and kidney survival accounted for 87.9%. Cox regression analysis showed recipient’ age as a protective factor (HR, 0.03; CI95%, 0.8-0.9) for kidney rejection and donor age as a risk factor (HR, 1.13,CI95% 1-1.1) for renal graft loss. Patient survival at 10 years was 91.2%. Two deaths were caused by infections (50%) and 2 by digestive haemorrhages (50%). SLKT recipients were confronted with 304 cadaveric donor KT recipients performed in the same transplant Center from 01/01/2006 to 12/31/2016. Statistical analysis showed that SLKT recipients had shorter waiting list, dialysis vintage and ischemia times. SLKT recipients had a major prevalence of diabetes and HCV infection but a lower prevalence of hypertension. DGF were less common in SLKT. Patient and graft survival a 1, 5 and 10 years did not show statistically significant differences between SLKT and KT. Conclusion Our analysis shows excellent kidney and patient survival in SLKT. SLKT and KT recipients had similar 1, 5 and 10-years patient and graft survival.

Clinical biochemistry profile of Leptospira IgG seropositive trade horses

Background: Trade horses in Nigeria are not vaccinated against leptospirosis. Clinical biochemistry profile of Leptospira IgG (LEP-IgG) seropositive trade horses, alongside the effect of physiological factors (age, sex and pregnancy) were determined in this study. Methods and materials: Blood samples were collected via jugular veins of 129 horses of varying ages and sex at the Obollo Afor horse lairage. The harvested sera were subjected to qualitative test for LEP-IgG antibodies by sandwich ELISA method, and serum biochemistry evaluation which followed standard procedures. Results: A total number of 16 (12.4%) trade horses were recorded to be Leptospira seropositive. A significant association was recorded between the presence of LEP-IgG antibodies and age (p = 0.025), sex (p = 0.005), and pregnancy (p = 0.009). The mean serum total protein, albumin and total cholesterol values of the Leptospira seropositive trade horses were significantly (p < 0.05) lower than those of seronegative horses. Also, the mean blood urea nitrogen (BUN) level was significantly (p < 0.05) higher than those of seronegative horses. The mean serum ALT, AST, ALP and total protein values of the seropositive stallions were significantly (p < 0.05) lower than those of the Leptospira seropositive mares. The mean serum albumin and creatinine values of the Leptospira seropositive stallions were significantly (p < 0.05) higher than those of the Leptospira seropositive mares. The serum ALP of the seropositive young horses was significantly (p < 0.05) lower than those of the adult and horses. The mean serum albumin of young horses was significantly (p < 0.05) higher than those of old trade horses. The mean serum ALP value of the pregnant mares was significantly (p < 0.05) higher than that of the non-pregnant mares. The mean serum albumin value of seropositive pregnant mares was significantly (p < 0.05) lower than those of the non-pregnant seropositive mares. Also, the serum globulin and creatinine values of seropositive pregnant mares were significantly (p < 0.05) higher than those of the non-pregnant seropositive mares. Conclusion: Therefore, it was concluded that the seroprevalence of leptospirosis in trade horses was 12.4%. LEP-IgG seropositive horses were hypoproteinaemic, hypoalbuminaemic, hypocholesterolemic, with elevated levels of BUN. This suggests that the level of anti-LEP IgG is less protective and leptospirosis in horses is more associated with hepatic than renal involvement.

Liver and Kidney Transplant During a 6-Month Period in the COVID-19 Pandemic: A Single-Center Experience.

With the declaration of COVID-19 as a pandemic, many studies have indicated that elective surgeries should be postponed. However, postponement of transplants may cause diseases to get worse and increase the number in wait lists. We believe that, with precautions, transplant does not pose a risk during pandemic. Here, we aimed to evaluate our transplant results, which we safely performed during a 6-month pandemic period. Until September 2020, 3140 kidney and 667 liver transplants have been performed in our centers. We evaluated 38 kidney transplants and 9 liver transplants procedures performed during the pandemic (March 1 to September 2, 2020). Recipient and donor candidates were screened for COVID-19 with polymerase chain reaction and thoracic computed tomography. All recipients had routine immunosuppressive protocol. During hospitalization at our COVID-19-free transplant facility, we restricted the interactions during multidisciplinary rounds. During the pandemic, 38 kidney transplants with an average length of hospital stay of 8.1 days were performed. Mean serum creatinine values of recipients were 0.91, 0.86, and 0.74 mg/dL on postoperative days 7, 30, and 90, respectively. During the pandemic, 9 living donor liver transplants (1 adult, 8 pediatric) were performed with an average length of hospital stay of 17.1 days. Mean serum total bilirubin levels were 0.9, 0.5, and 0.4 mg/dL on postoperative days 7, 30, and 90, respectively. Mean serum aspartate aminotransferase levels were 38.1, 28.3, and 22.3 U/L on postoperative days 7, 30, and 90, respectively. All recipients and donors were successfully discharged. Only 1 liver recipient died (on day 55 after discharge as a result of oxalosis-induced heart failure). According to our results, when precautions are taken, transplant does not pose a risk to patients during the pandemic period. We attribute the safety and success shown to our newly developed protocol in response to the COVID-19 pandemic.

Acute kidney injury following coronary artery bypass grafting and control angiography: a comprehensive analysis of 221 patients.

Postoperative coronary angiography offers the basis for prompt management of ischemic complications after coronary artery bypass grafting (CABG). Little is known about the effects of postoperative angiography on renal function. The current study aims to assess the incidence and risk factors for acute kidney injury (AKI) following postoperative coronary angiography. A total of 221 CABG patients (mean age, 67 ± 8years) underwent postoperative coronary angiography due to perioperative myocardial infarction (PMI). AKI was defined according to the KDIGO criteria. Logistic regression analyses were performed to find out risk factors responsible for AKI and to ascertain significant associations between AKI and in-hospital death. Mean delay from CABG operation to postoperative angiography was 1.4 ± 1.0days. AKI occurred in 79/221 (36%) patients. Mean serum-creatinine (sCr) values peaked on the first day after the angiography and reached the lowest level at the fourth day. In the multivariable analysis, the following variables were independent predictors for AKI: postoperative peak values of CK-MB (p = 0.049, OR 1.03, 95% CI 1.00-1.06 per 10 U/l), EuroSCORE I (p = 0.011, OR 1.18, 95% CI 1.04-1.35), and AKI before re-angiography (p = 0.004, OR 3.50, 95% CI 1.51-8.16), whereas a delayed angiography (p = 0.031, OR 0.69, 95% CI 0.49-0.97) was protective against AKI. Patients with post-angiography AKI had a significantly higher mortality after multivariable adjustment than patients without AKI (15.5% vs. 2.11%, p = 0.001, OR 5.42, 95% CI 1.35-21.75). Over one-third of patients who undergo postoperatively angiography develop AKI. The occurrence of AKI must be considered during the decision-making prior to coronary angiography, especially in patients presenting the identified risk factors for AKI.

A study on clinical outcomes of combination of terlipressin and albumin in Hepatorenal Syndrome

BackgroundHepatorenal Syndrome (HRS) is a reversible functional renal impairment that occurs in patients with advanced liver cirrhosis or those with fulminant hepatic failureAimTo evaluate the effect of terlipressin and albumin combination in various clinical outcomes in Hepatorenal Syndrome patientsMethods and Material: It was a prospective study involving 50 patients with HRS. The effectiveness parameters of the treatments were: confirmed HRS reversal, Recurrence of HRS within 90 days of treatment and mortality rate up to 90 days. The safety assessment includes adverse events collected up to 14 days of post-treatment. The quality of life of HRS patients was assessed using SF-12 questionnaire.ResultsIn the present study the mean age of patients was found to be 55.10 ± 9.35 years. Mean serum creatinine values were found to be reduced (1.22 ± 0.96) by 10th day in type 1 HRS which indicated improved renal function. Study patients showed a marked improvement in liver function throughout the observation period. 74% of patients did not have HRS recurrence and 79.48% of patients had completely relieved from HRS. Loose stool (14.2%) and hyponatremia (14.2%) were the prominent side effects of the therapy. The quality of life of patients also showed a statistically significant betterment in both physical and mental functioning.ConclusionsOur study concluded that terlipressin and albumin combination was safe and effective in successfully stabilising cirrhosis patients with Hepatorenal Syndrome and bridging eligible patients to liver transplantation by restoring the liver and renal function with minimal adverse effects.

P0670DIFFUSIONAL KURTOSIS IMAGING PREDICTS THE PROGNOSIS OF CHRONIC KIDNEY DISEASE

Abstract Background and Aims Renal fibrosis is the strongest prognosis predictor of ESRD in chronic kidney disease (CKD), but non-invasive and repeatable imaging markers are missing. Magnetic resonance imaging (MRI) has wide range of applications in renal parenchymal diseases, and diffusional kurtosis imaging (DKI) is a new promising noninvasive method of MRI which can provide more information about non-Gaussian diffusion using a polynomial model. We had successfully used DKI to assess renal fibrosis in IgA nephropathy in our previous work. This study aimed to evaluate the prognostic value of DKI in CKD. Method We prospectively enrolled forty-two CKD patients in our study in Jan. 2017. On recruitment, the basic clinical data were documented, and DKI was performed on a clinical 3T MR scanner. Region-of-interest (ROI) measurements were performed to determine apparent diffusion coefficient (ADC), kurtosis (K) and diffusivity (D) of the cortex of the kidneys. We had followed up these patients for 3 years, and collected all the clinical data and outcomes. The prognostic value of DKI metrics and clinical parameters were investigated. Results Forty-two patients consisted of 26 males and 16 females with mean age of 41.3±15.4 years. The most common etiology was IgA nephropathy (25/42, 59.5%). At baseline, the mean value of serum creatinine (SCr) was 224.4±156.2μmol/L. Among them, 18 patients had eGFR≥45ml/min and 24 patients had eGFR&amp;lt;45ml/min. According to the etiology and CKD classification, all the patients had received appropriate treatment. Besides supportive treatment and management of CKD complications, 21 patients (50%) had received corticosteroid and/or immunosuppressants treatment. After 36 months follow up, 12 patients had progressed to end stage renal disease (ESRD), and the mean value of SCr of the remaining 30 patients was 153.0±78.8umol/L. The Kaplan-Meyer survival regression showed that the patients with eGFR&amp;lt;45ml/min had worse clinical outcomes (p=0.0006). ROC analysis and Kaplan-Meyer survival regression showed that DKI metrics (K≥0.66 or ADC&amp;lt;1.35) not only predicted severe renal fibrosis, but also had worse clinical outcomes (p=0.01 and p&amp;lt;0.0001) (Figure 1). According to the COX regression analysis, both K (K≥0.66, HR 4.676, 95%CI 1.262-17.325) and ADC (ADC&amp;lt;1.35, HR 13.118, 95%CI 3.499-49.178) values, but not age, gender and eGFR group (cut-off value: 45ml/min), were the independent risk factors for the progression to ESRD. Conclusion Renal ADC and K values obtained from DKI showed significant predictive value for the prognosis of CKD, could be a promising non-invasive technique in patients follow-up.

P0501THE EPIDEMIOLOGICAL FEATURES OF PIRMARY GLOMERULAR DISEASES IN TURKEY: THE MULTICENTER STUDY OF TURKISH SOCIETY OF NEPHROLOGY GLOMERULAR DISEASES (TSN-GOLD) WORKING GROUP

Abstract Background and Aims The largest data on the epidemiology of primary glomerular diseases (PGD) are obtained from the databases of countries or centers. Here, we presented the extended results of the Primary Glomerular Diseases Study of the Turkish Society of Nephrology Glomerular Diseases (TSN-GOLD)Working Group. Method The data of patients who underwent renal biopsy and diagnosed as primary glomerular disease were recorded in the database prepared for the study. Between May 2009 and May 2019, a total of 4399 patients from 47 centers were evaluated. Basal data of 3875 patients were analyzed after exclusion of those lacking light microscopy and immunofluorescence findings. Results The mean age was 41.5 ± 14.9 years. Of the patients, 1690 were female (43.6%) and 2180 (56.3%) were male. Nephrotic syndrome was the most common biopsy indication (51.7%). This was followed by asymptomatic urinary abnormalities (18.3%) and nephritic syndrome (17.8%). The most common PGH was IgA nephropathy (25.7%), followed by membranous nephropathy (25.6%) and FSGS (21.9%). The mean total number of glomeruli per biopsy was 17 ± 10. Mean baseline systolic blood pressure was 130 ± 20 mmHg and diastolic blood pressure was 81 ± 12 mmHg. Median proteinuria was 3300 (IQR: 1467-6307) mg / day, mean serum creatinine, estimated GFR and albumin values were 1.4 ± 1.5 mg / dl, 80.7 ± 39.1 ml / min and 3.2 ± 0.9 g / dl, respectively. Conclusion In Turkey, the incidence of IgA nephropathy patients have become more common than membranous nephropathy among PGD patients diagnosed with renal biopsy.

Evaluation of serum levels of iron, total iron binding capacity, transferrin saturation and ferritin in chronic kidney disease patients vs. control group

The magnitude of chronic renal disease is enormous, as the prevalence of kidney failure is rising. Anaemia is a common complication of chronic kidney disease (CKD) that develops early in its course and becomes increasingly severe as the disease progresses. The aim is to evaluate the serum level of iron, Total Iron Binding Capacity (TIBC), transferrin saturation and ferritin in chronic kidney disease population in Zaria and control subjects. This study was conducted at ABUTH Zaria were 125 patients in various stages of CKD who presented at the nephrology clinic and equal number of apparently healthy age and sex matched controls were recruited. The mean (SD) age of patient and controls were 48 (14) years. These were made up of 53.6% males, and 46.4% females. Mean values of serum creatinine significantly higher in the patients (&lt;0.0001). There was no significant difference in the mean values of iron (p=0.32) and TIBC (p=1.29) in both study groups. The patients had a significantly (p˂0.0001) higher mean value for ferritin and TSAT than the control group. There were higher serum creatinine and ferritin values in males than in females while higher serum TIBC, estimated creatinine clearance and iron were observed in females than males. Serum creatinine, ferritin and estimated creatinine clearance of male patients were found to be significantly higher with p-value of 0.002, 0.000 and 0.028 respectively than that of female patients. No significant differences were noted in serum levels of iron, TIBC and TSAT. Serum creatinine, ferritin and TSAT were found to be significantly elevated in CKD patients while serum Iron and TIBC were not.

Renal Functional Response Following Percutaneous Nephrolithotomy in Patients of Renal Stone Disease With Impaired Renal Function

Background : Urolithiasis is one of the oldest disease known to human beings and has been documented in ancient Greek. Urolithiasis continues to pose a significant health hazard, causing progressive renal impairment, if left untreated. The etiology of renal insufficiency in patients with nephrolithiasis is multifactorial and includes renal obstruction, urinary infection, frequent surgical interventions, and coexisting medical diseases. The purpose of this study is to assess the change in renal function following removal of kidney stones by Percutaneous Nephrolithotomy (PCNL) in patients with associated impaired renal function.&#x0D; Materials and methods : 50 Patients with renal stone disease with associated impaired renal function who were admitted and underwent PCNL in Urology department were selected as per inclusion and exclusion criteria by purposive sampling. Complete clinical evaluation including history, physical examination, relevant examinations &amp; laboratory investigations were performed. All the patients were treated by PCNL monotherapy with Double J stenting. Mean age was 46.63±11.95 years (Age range: 24-72 years). There were 36 males (72%) &amp; 14 females (28%) &amp; male to female ratio was 2.57:1.&#x0D; Results : In this study, a significant fall in mean serum creatinine (0.5 mg%) was demonstrated following the stone removal. The creatinine value remained unchanged in 12% and improved in 84% patients. In contrast to the improvement of renal function as evident by a decline in the mean serum creatinine values, the mean Glomerular Filtration Rate (GFR) registered a small fall of 1.78 ml/min (Statistically not significant). we have observed that total 12 (24%) patients out of 50 cases experienced different sorts of complications.&#x0D; Conclusion: This study showed that PCNL approach to urolithiasis in patients with impaired renal function significantly improves renal functional status manifested according to the preoperative and postoperative difference of serum creatinine and 99mTc DTPA performance.&#x0D; JCMCTA 2019 ; 30 (2) : 70-74

Frequency of Chronic Kidney Disease in Type 2 Diabetic Patients Presenting with Diabetic Foot Ulcer

Background: Recent evidence states that about a quarter of all diabetic patients will experience an ulcer on foot at some point in their lifetime and 15-25% of these will require foot amputation. In the present study, we aimed to evaluate the incidence of chronic kidney disease (CKD) in Type 2 diabetes mellitus (T2DM) patients presenting with Diabetic foot ulcer. Methods: The present study was carried out at Jinnah Postgraduate Medical Center (JPMC), Sindh from February-August 2017. Over 100 Type 2 - DM patients, aged between 35-60 years who presented with diabetic foot ulcer took part in this study. Data was collected and documented in pre-approved pro-forma, subsequently, entered and analyzed via SPSS version 19. Chi-square was applied to test any significant difference between the categories with a p-value of ≤0.05 considered as significant. Results: The mean serum creatinine (mg/dl) value was reported to be 1.17 ± 0.45. Frequency of CKD in Type 2 - DM patients presenting with diabetic foot ulcer was 31%. Male gender was affected more from CKD. Frequency distribution of chronic kidney disease among duration of DM groups 10-15 years = 35.5% and &gt;15 years = 64.5%. The characteristics of HbA1c (g/dl) of study population was 8.34 ± 0.59. Conclusion: Occurrence of CKD in Type 2 - DM patients presenting with diabetic foot ulcer was much higher as compared to national and international studies. Therefore, special attention should be given on regular screening of diabetic patients with a complaint of a foot ulcer.

Oncological and renal function outcome in children with unilateral wilms' tumors treated with nephron sparing surgery or ablative nephrectomy

Background: We prospectively evaluated the oncological and renal functional outcomes of children with unilateral Wilms' tumor (WT) undergoing nephron-sparing surgery (NSS) versus ablative nephrectomy. Materials and Methods: Children presenting with unilateral WT from January 2006 to December 2015 were prospectively randomized to undergo either ablative (simple/radical) nephrectomy or NSS. Treatment was administered according to the Societe Internationale d'Oncologie Pediatrique-2001 protocol. Results: During the 10-year study period, 13 children underwent ablative nephrectomy, and 15 underwent NSS (partial nephrectomy/wedge excision). The contralateral kidneys were found to be normal on ultrasonography and computed tomography imaging. The mean age at intervention was 44.8 ± 16.7 months. Eight children presented with Stage I disease and the remaining 20 had Stage II disease. The mean follow-up period was 53. 68 ± 23.82 months and all children were alive at the last follow-up without any clinical evidence of disease. The event-free survival rates were 100% and 92.3% in the children undergoing NSS and ablative nephrectomy, respectively. The children who underwent ablative nephrectomy presented with considerably higher mean systolic and diastolic blood pressures, as well as significantly elevated mean values of serum creatinine compared to their ablative nephrectomy counterparts. Conclusion: The oncological outcome of NSS was as good as ablative nephrectomy in children with unilateral WTs. NSS also minimized the loss of renal function.

Population Pharmacokinetic Modeling of Gentamicin in Pediatrics.

The primary objective of this work was to characterize the pharmacokinetics (PK) of gentamicin across the whole pediatric age spectrum from premature neonates to young adults with a single model by identifying significant clinical predictors. A nonlinear mixed-effect population PK model was developed with retrospective therapeutic drug-monitoring data. A total of 6459 drug concentration measurements from 3370 hospitalized patients were collected for model building (n=2357) and evaluation (n=1013). In agreement with previously reported models, a 2-compartment model with first-order elimination best described the drug PK. Patient-specific factors significantly impacting gentamicin clearance included fat-free mass, postmenstrual age, and serum creatinine (SCr). Based on our model, the deviation of the individual SCr from the age-dependent expected mean SCr value (SCrM) can result in a 40% lower clearance in a patient with renal impairment than that in a patient with normal kidney function, with SCrM:SCr ratios between 0.16 and 3.2 in this study. Consistent with the known age-dependent changes of the proportion of extracellular water in body weight, the inclusion of the impact of extracellular water maturation on the central volume of distribution was found to improve the model fitting significantly. In comparison with other published models, model evaluation suggested the developed model was the least biased and physiologically most representative. These results will be used to inform individualized initial dosing strategies and serve as a prior PK model for Bayesian updating and forecasting as individual clinical observations become available.

Patterns of Multimorbidity in a Population-Based Cohort of Older People: Sociodemographic, Lifestyle, Clinical, and Functional Differences.

The aim of this study is to identify clusters of older persons based on their multimorbidity patterns and to analyze differences among clusters according to sociodemographic, lifestyle, clinical, and functional characteristics. We analyzed data from the Swedish National Study on Aging and Care in Kungsholmen on 2,931 participants aged 60 years and older who had at least two chronic diseases. Participants were clustered by the fuzzy c-means cluster algorithm. A disease was considered to be associated with a given cluster when the observed/expected ratio was ≥2 or the exclusivity was ≥25%. Around half of the participants could be classified into five clinically meaningful clusters: respiratory and musculoskeletal diseases (RESP-MSK) 15.7%, eye diseases and cancer (EYE-CANCER) 10.7%, cognitive and sensory impairment (CNS-IMP) 10.6%, heart diseases (HEART) 9.3%, and psychiatric and respiratory diseases (PSY-RESP) 5.4%. Individuals in the CNS-IMP cluster were the oldest, with the worst function and more likely to live in a nursing home; those in the HEART cluster had the highest number of co-occurring diseases and drugs, and they exhibited the highest mean values of serum creatinine and C-reactive protein. The PSY-RESP cluster was associated with higher levels of alcoholism and neuroticism. The other half of the cohort was grouped in an unspecific cluster, which was characterized by gathering the youngest individuals, with the lowest number of co-occurring diseases, and the best functional and cognitive status. The identified multimorbidity patterns provide insight for setting targets for secondary and tertiary preventative interventions and for designing care pathways for multimorbid older people.

Nephrotoxicity and ototoxic symptoms of injectable second-line anti-tubercular drugs among patients treated for MDR-TB in Ethiopia: a retrospective cohort study

BackgroundNephrotoxicity and ototoxicity are clinically significant dose-related adverse effects associated with second-line anti-tubercular injectables drugs (aminoglycosides and capreomycin) used during intensive phase of treatment of multi-drug resistant tuberculosis (MDR-TB) patients. Data are scarce on injectable-induced nephrotoxicity and ototoxicity in Ethiopian MDR-TB patients. The aim of this study was to assess the prevalence, management of nephrotoxicity and ototoxic symptoms and treatment outcomes of patients treated for MDR-TB with injectable-based regimens.MethodThis was retrospective cohort study based on review of medical records of about 900 patients on MDR-TB treatment from January 2010 to December 2015 at two large TB referral hospitals in Addis Ababa, Ethiopia. Nephrotoxicity in study participants was screened using baseline and monthly measurement of serum creatinine and clinical diagnosis and patient reports.ResultsOverall, 473 (54.2%) of participants were male. Children accounted for 47 (5.5%) of cases and the mean age of participants was 32 ± 12.6 years with range of 2–75 years. The majority (n = 788, 84.6%) of participants had past history of TB. The most commonly used injectable anti-TB drug was capreomycin (n = 789, 84.7%), while kanamycin and amikacin were also used. There was a statistically significant increment (p<0.05) in the mean serum creatinine values from baseline throughout intensive phase of treatment with a 10–18% prevalence of nephrotoxicity. Based on clinical criteria, nephrotoxicity was detected in 62 (6.7%) and ototoxic symptoms were detected in 42 (4.8%) participants. Nephrotoxicity and ototoxic symptoms were clinically managed by modification of treatment regimens including dose and frequency of drug administration.ConclusionNephrotoxicity and ototoxic symptoms were significant problems among patients on follow-up for MDR-TB treatment. Based on laboratory criteria (serum creatinine), nephrotoxicity remained significant adverse events throughout intensive phase of treatment, indicating close monitoring of patients for successful outcome is mandatory until countries adopt the recent injectable-free WHO guideline and under specific conditions.

A comparative study to determine the better predictor of renal impairment in essential hypertensive patients

Introduction and Objectives: Hypertension (HTN) is one of the major public health problems of adult population. HTN and renal functions are closely related and it is a predisposing factor for renal abnormalities. The objectives of the study were to estimate and compare the levels of Microalbuminuria (MAU), serum creatinine and estimated Glomerular Filtration Rate (eGFR) in essential hypertensives and to correlate their levels with duration of HTN. Materials and Methods: The data of the cross sectional study includes physical measurements, blood pressure and biochemical investigations like serum creatinine, MAU [measured using Albumin Creatinine Ratio (ACR)] & eGFR. Result: Out of 220 subjects, 112 (48.21% male and 51.78% female) were essential hypertensives and 112 (47.32% male and 52.68% female) were non-hypertensives. Mean value of serum creatinine was within the normal range in both the study groups. 62.5% hypertensives had MAU as compared to 4.46% non-hypertensives. The difference in eGFR was not statistically significant among the study groups. Receiver Operative Characteristic curve (ROC) for duration of HTN showed that area under the curve for MAU was more as compared to serum creatinine and eGFR. Conclusion: HTN is a non-communicable disease (NCD) that still remains inadequately treated. The kidney is considered as a prime target for hypertensive damage. Our study suggests that MAU is prevalent in essential hypertensive subjects and has a positive correlation with the duration of HTN. MAU can be used as a better predictor of renal impairment in essential hypertensive patients as compared to serum creatinine and eGFR. More extensive screening for MAU should be performed to facilitate better stratification of renal disease in hypertensive patients. Keywords: HTN, Serum creatinine, MAU, ACR & eGFR.

Clinical significance of fibroblast growth factor-23 and soluble alpha klotho in different stages of chronic kidney disease

Most chronic kidney disease (CKD) biomarkers in the current clinical use are not sensitive enough and cannot be used to identify the early stage of the disease. Klotho is a transmembrane protein predominantly expressed in the renal tubules and implicated in managing phosphate homeostasis, together with fibroblast growth factor-23 (FGF-23); a bone-derived protein that increases urinary phosphate excretion. The present study was carried out on 50 patients CKD with different etiologies referred to the Internal Medicine Department and Out Patient Clinic of Tanta University Hospitals and 30 apparently healthy individuals of matched age and sex as a control group. They were subjected to the following assessment: detailed history taking, careful clinical examination, and laboratory investigations, including urea, creatinine, estimated glomerular filtration rate (eGFR), serum electrolytes, urinary albumin, urinary phosphorus (U-Ph), and specific laboratory tests for: Alpha Klotho (α-klotho) and FGF-23 by using ELISA technique. The present study shows that the mean value of serum creatinine, urea, phosphorus, urinary albumin, and FGF-23 were significantly increased, whereas there was a significant decrease in the mean value of eGFR, calcium, and U-Ph in the patients with CKD when compared with control group. Plasma level of serum α-klotho is significantly decreased in all patients with CKD when compared to the control group and there was a significant positive correlation between serum α-klotho level and eGFR, serum calcium level and U-Ph level. Plasma level of serum α-klotho is significantly decreased in all patients with CKD and serum α-klotho can be used as a good marker for early diagnosis and staging of CKD.

Metabolic response to maxillofacial trauma revisited: A retrospective study.

Purpose:Management of a trauma patient aims at stabilization or resuscitation and revival from critical condition resulting from various sequences of systemic pathophysiological responses in the body. Hematological changes are the first signs reflecting the homeostasis mechanisms starting in the body after injury. The aim of the current study is to evaluate the physiological changes following maxillofacial trauma and extrapolate the findings to understand the posttrauma responses.Patients and Method:This is a retrospective study involving 192 subjects divided into two groups, trauma group and control group. In both the groups, baseline vitals and complete blood picture were recorded for comparison. In trauma group, the recordings were made within 24 h after maxillofacial injury.Results:All the parameters were analyzed using SPSS version 18. Independent sample t-test was used to assess the nature of data distribution and statistical significance was considered only at P value < 0.05. On comparison of complete blood picture mean values of hemoglobin (13.63 vs 12.18), RBC count (4.51 vs 4.10), WBC count (8835.48 vs 8336.56) were seen to be higher in trauma patients compared to control subjects. The mean bleeding times are almost equal (2.35 vs 2.47) but the clotting times (5.42 vs 5.26), random blood glucose (94.78 vs 90.13), and blood urea (27.14 vs 26.30) were marginally higher in trauma group but were statistically insignificant. The mean value of serum creatinine (0.84 vs 0.80) was comparatively higher in trauma patients and was statistically significant. Study of vitals revealed that mean systolic blood pressures were almost equal (120.65 vs 121.08) in both the groups. The mean diastolic blood pressures (79.46 vs 88.49) and oxygen saturation (93.73 vs 98.86) in trauma patients are comparatively reduced. The mean values of temperature (99.30 vs 98.50) and pulse rate (102.38 vs 97.14) were on relatively higher side in trauma group compared with control group.Summary and Conclusion:Using basic blood parameters and vitals in the present study, the compensatory mechanisms happening in the body after maxillofacial trauma can be seen. These changes although significant on side by side comparison can still fall within the normal physiological range provided by various diagnostic setups. Hence, the need for maxillofacial surgeon to be sensitive to minor variations in these aspects to ensure safety of the patient cannot be overemphasized.

Success of kidney transplantations from deceased donors with acute kidney injury.

BackgroundThe acceptance of organs from deceased donors with acute kidney injury (AKI) varies considerably, with uncertain outcomes. The current organ shortage has led to increased use of marginal donor organs.Material/MethodsThis retrospective, single-center study included 642 patients who underwent kidney allograft transplantation between 2005 and 2016. The recipients were categorized into 3 groups: AKI-1 (n=214), comprising donors with a peak serum creatinine (SCr) level of 1.1–2.0 mg/dl; AKI-2 (n=89), comprising donors with a peak SCr level >2 mg/dl; and non-AKI (n=339), comprising donors with normal kidney function (SCr <1.1 mg/dl).ResultsThe cumulative survival rates for patients and grafts did not significantly differ among the AKI-1, AKI-2, and non-AKI groups at the 1-year (91.6%/79.4%, 92.1%/83.1%, 95.3%/88.5%, respectively) and 5-year assessments (79.4%/67.8%, 86.8%/71.7%, 80.5%/71.1%, respectively). These findings were corroborated by mean SCr values and estimated glomerular filtration rates at the 1-year (2.08±1.7/51.16±23.45, 2.01±1.52/56.46±23.63, 1.81±1.13/ 55.44±23.26 mg/dl, respectively) and 5-year assessments (1.91±1.28/51.06±24.65, 1.74±0.66/57.44±31.21, 1.7±0.88/ 58.56±26.04 mg/dl, respectively). The incidence of delayed graft function in each group was 29.9%, 44.9%, and 28.6%, respectively.ConclusionsKidney transplantation from donors with AKI, although associated with a higher rate of delayed graft function, results in good long-term transplant survival and reliable kidney functionality after 5 years. The inclusion of donors with AKI may widely extend the pool of available organs; however, careful donor selection is necessary.