Normal Serum Creatinine Levels Research Articles

SUN-284 STUDY OF CLINICAL SIGNIFICANCE OF UNRECOGNIZED RENAL DYSFUNCTION IN PATIENTS WITH ACUTE STROKE

STUDY OF CLINICAL SIGNIFICANCE OF UNRECOGNIZED RENAL DYSFUNCTION IN PATIENTS WITH ACUTE STROKE Unrecognized renal insufficiency, defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2 in the presence of normal serum creatinine levels, is a common co morbid condition among patients with various cardiovascular conditions. Epidemiological study demonstrated that renal insufficiency forecast long-term mortality and hence can be used to stratify risk for stroke patients. Our purpose of study is to evaluate the prevalence and clinical significance of unrecognized renal dysfunction in patients admitted with acute stroke. STUDY DESIGN: Cross sectional prospective study. STUDY DURATION: March 2017 to August 2017. INCLUSION CRITERIA: All patients admitted with acute stroke . EXCLUSION CRITERIA: Acute stroke in < 18 years ,Head injury. MATERIAL & METHODS: Our study group consisted of 100 patients with acute stroke admitted in Stanley Medical College. The detailed history of the patients has been recorded and patients underwent a detailed clinical examination. Appropiate investigations were done. The estimated glomerular filtration rate is calculated using the MDRD and CKD-EPI equation. The study groups are stratified into 3 groups according to the renal function assessment (normal renal Function, unrecognized renal insufficiency and recognized renal insufficiency). Out of the 100 patients with acute stroke included in the study, 62 have normal renal function, 31 have recognized renal insufficiency, and 7 have unrecognized renal insufficiency. Majority of the study subjects in normal renal function group were males (n=48), females in unrecognized renal insufficiency group (n=7) and males in recognized renal insufficiency group (n=24). Using single factor ANOVA test, age distribution,the mean difference of blood urea values and serum creatinine values, the mean difference of MDRD values and CKD-EPI values, the mean difference of systolic blood pressure and diastolic blood pressure ,the mean difference of hemoglobin, the mean difference of random blood sugar values were found to be statistically significant (p <0.05). Using fishers exact test,the difference in percentage of females, the difference in percentage of diabetics, the difference in percentage of subjects with dyslipidemia were found to be statistically significant (p < 0.05) In our study, modified Rankin score(MRS) was significantly higher in patients with recognized renal insufficiency compared to unrecognized renal insufficiency patients. Mortality rates are higher in patients with recognized and unrecognized renal insufficiency compared with patients with normal renal function (29%, 28.5% and 9.6% respectively, p< 0.05). Severe disability rates at discharge are also higher in patients with recognized and unrecognized renal insufficiency compared with patients with normal renal function (72.27%, 80 %, and 32.14%) respectively, p<0.05. 1. Unrecognized renal insufficiency is found to be a common co morbidity among patients with acute stroke in our study.2. Unrecognized renal insufficiency is significantly common among older age group and more frequently in females compared to male in our study group. 3. Mortality rate and severe disability rate are higher in patients with recognized and unrecognized renal insufficiency compared to patients with normal renal function.

Impact of Remote Ischemic Preconditioning Conducted in Living Kidney Donors on Renal Function in Donors and Recipients Following Living Donor Kidney Transplantation: A Randomized Clinical Trial.

Although remote ischemic preconditioning (RIPC) has been shown to have renoprotective effects, few studies have assessed the effects of RIPC on renal function in living kidney donors. This study investigated whether RIPC performed in living kidney donors could improve residual renal function in donors and outcomes in recipients following kidney transplantation. The donors were randomized into a control group (n = 85) and a RIPC group (n = 85). The recipients were included according to the matched donors. Serum creatinine (sCr) concentrations and estimated glomerular filtration rate (eGFR) were compared between control and RIPC groups in donors and recipients. Delayed graft function, acute rejection, and graft failure within one year after transplantation were evaluated in recipients. sCr was significantly increased in the control group (mean, 1.13; 95% confidence interval (CI), 1.07–1.18) than the RIPC group (1.01; 95% CI, 0.95–1.07) (p = 0.003) at discharge. Donors with serum creatinine >1.4 mg/dL at discharge had higher prevalence of chronic kidney disease (n = 6, 26.1%) than donors with a normal serum creatinine level (n = 8, 5.4%) (p = 0.003) after one year. sCr concentrations and eGFR were similar in the RIPC and control groups of recipients over the one-year follow-up period. Among recipients, no outcome variables differed significantly in the RIPC and control groups. RIPC was effective in improving early renal function in kidney donors but did not improve renal function in recipients.

The predictive value of the prognostic nutritional index for postoperative acute kidney injury in patients undergoing on-pump coronary bypass surgery

BackgroundWe aimed to investigate the predictive value of the prognostic nutritional index (PNI) regarding the development of acute kidney injury (AKI) after elective coronary artery bypass grafting (CABG).MethodsA total of 336 consecutive patients with normal serum creatinine levels undergoing CABG were enrolled in this retrospective study. AKI was defined as meeting Acute Kidney Injury Network (AKIN) criteria based on the occurrence of creatinine changes within the first 48 h after CABG surgery. The patients were grouped according to whether they developed AKI or not into an AKI (−) and an AKI (+) group.ResultsAKI developed in 88 (26.2%) of all patients. The PNI was independently predictive of AKI (OR: 0.829, 95% CI: 0.783–0.877, p < 0.001). Moreover, C-reactive protein (CRP), a history of diabetes mellitus, and positive inotropric usage were independent risk factors for AKI in the multivariate logistic regression analysis. The area under the curve (AUC) of the multivariable model, including positive inotrope support, a history of diabetes mellitus, and CRP, was 0.693 (95% CI: 0.626–0.760, p < 0.001) in predicting AKIN. When the PNI was added to the multivariable model, the AUC was 0.819 (95% CI, 0.762–0.865, z = 3.777, difference p = 0.0002). Also, the addition of the PNI to the multivariable model was associated with a significant net reclassification improvement estimated at 88.2% (p < 0.001) and an integrated discrimination improvement of 0.22 (p < 0.001).ConclusionsOur study demonstrated that decreasing the PNI could be associated with the development of AKI after coronary artery bypass surgery.

Ameliorative Effect of Ethanolic Extract of Cucumis Sativus (Cucumber) Pulp on Alloxan Induced Kidney Toxicity in Male Adult Wistar Rats

Nephropathy is a common complication of diabetes, managed with both orthodox and herbal remedies. Cucumis sativus is a creeping plant belonging to the Cucurbitaceae family. Its edible fruits possess diverse pharmacological activities. This study investigated the effect of ethanolic extract of cucumis sativus pulp (EECSP) on alloxan induced renotoxicity in adult male Wistar rats. Thirty adult male Wistar rats weighing between 170-190g were purchased and acclimatized for 2 weeks and afterwards grouped into 6 groups (A-F) of 5 rats each. Group A (Control) received distilled water and rat feed ad libitum . Diabetes was induced in Groups B, C, D, and E with consequent renotoxicity using a single intraperitoneal injection of 150mg/kg of Alloxan after an overnight fast. Group C, D and E were afterwards treated with 100, 250 and 500mg/kg of ethanolic extract of cucumis sativus pulp respectively. Group F received 500mg/kg of EECSP. Extract administration was oral and once daily for 28days. At the end of the experiment, blood samples were collected via ocular puncture and sera separated for kidney function test. The animals were sacrificed and their kidneys collected, and prepared for light microscopy. Results showed that treatment with EECSP caused a dose dependent restoration of kidney architecture and renal functions when compared with untreated alloxan group that showed severe distortions in renal architecture and higher than normal serum urea and creatinine levels. Ethanolic extract of cucumis sativus pulp thus caused a dose dependent ameliorative effect on alloxan induced diabetic nephropathy in adult male Wistar rats. Keywords : Nephropathy, diabetes, Cucumis sativus , alloxan DOI : 10.7176/JNSR/9-4-02

Robot-assisted surgery for benign distal ureteral strictures: step-by-step technique using the SP® surgical system.

To describe the step-by-step techniques for robot-assisted ureteric reimplantation performed using the Vinci SP® surgical system (Intuitive Surgical, Sunnyvale, CA, USA), including different case scenarios with an educational purpose. Three consecutive patients diagnosed with distal benign ureteric strictures were counselled for ureteric reimplantation and consented to undergo surgery performed using the da Vinci SP surgical system. Demographics and peri-operative outcomes were collected after institutional review board approval (IRB 13-780). Patients provided informed consent having received an explanation for the adoption of the novel platform. The first patient was a woman referred to our institution for a left distal ureteric stricture after total hysterectomy for uterine fibroids with ureteric injury. The second patient was a man with BPH and recurrent UTIs, who was diagnosed with a 1.5-cm bladder stone and a large bladder diverticulum compressing the left distal ureter. The third patient was a man diagnosed with bilateral uretero-enteric anastomoses stricture status after radical cystectomy with orthotopic ileal neobladder urinary diversion for bladder cancer. The procedures were successfully completed. An extra port through a separate skin incision for the bedside assistant was placed for the first two procedures. In such cases, this additional port was used electively from the start of the procedure and did not represent a change in the treatment plan. Moreover, the port wound was used to accommodate the drainage. The bilateral ureteric reimplantation, however, was completed according to a pure single-site approach (no extra ports were placed out of the GelSeal cap). The mean operating times were 165, 150 and 180 min, respectively. Blood loss was 50 mL in all cases. No intra-operative complications occurred. Patients were discharged on postoperative days 1, 1 and 2, respectively, with normal serum creatinine levels. Neither transfusions nor major complications occurred. Robot-assisted reconstructive surgery for benign distal ureteric strictures is feasible and safe using the da Vinci SP surgical system.

Hyperemesis Graviderum: An observational study and outcome at a tertiary teaching hospital in Dhaka city

Hyperemesis graviderum is a complication of pregnancy that can lead to severe maternal nutritional deprivation. About 0.14% -1.3% of pregnant women sufferedfrom hyperemesis graviderum. Women with hyperemesis grmidanan causing loss of greater than 5% of their pre-pregnancy weight. And has been linked to fetal growth restriction, wernickes encephalopathy resulting in fetal death in 40% of cases . Ilyperemesis graviderzaninterfire there working life, it is important to know the outcome of hyperemesis graviderum on fetus and mother. A tertiary level hospital based prospective study was conducted on woman suffering from Hyperemesis graviderum and attended in OPD and 1F'D of Holy Family Red Crescent Medical College Hospital, Bangladesh to asses the adverse outcome of Hyperemesis Graviderum on .mother and baby and identifies its determinants. The mean age of the study group was 26.2513.25 years. Regarding parity, 54.0% patients were found primipara and 46.0% patients found multipara. The majority of the subjects (66%) were normal weight, 18% patients had overweight by BM1 (body mass index) 12% patients were underweight and 4% patients were obese. Distribution of the study subjects according to educational status, it was found that 32% were primary, 44% patients were high school, 12% patients were SSC, 8% patients were HSC and 4% patients were graduate and above. Out of 50 cases, 64% were housewife, 18% patients were service, 4% patients were business and 10% patients were student. Majority of patients (70%) had positive family history of hyperemsisgravidenn. Study showed 46% respondent started vomiting within 6-10 gestational weeks, 30% started vomiting more than 10 gestational weeks and 24% started vomiting within 1-5 gestational weeks. Maximum subjects (78%) needed home treatment and 22% patients were hospitalization. Most of the patients (68.0%) hemoglobin level 6- 10mg/d 1 . Maximum were rhesus positive blood group. Most of the patients 98% had normal serum creatinine level, 86% patients had normal serum electrolytes, 94% patients had normal urine R/M/E, 78% patients had normal RS'S level, 100% patients of hyperemesis gravidunn patients ultrasonography reports in pregnancy was normal. Among 50 patients, 4% patients had abortion history, 2% cases had IUD, 44% patients had IUGR and 10% patients had AGA in pre-term pregnancy. Out of 23 term pregnancy, 24% cases had 1UGR and 22% cases had AGA. Two percent neonatal death after delivery. hyperemesis Graviderum is related to maternal age, parity, education level, body mass index, occupation of the patients, education level, family history of hyperemesis graviderum and adverse outcome on mother and baby.

To study the influence of iron deficiency anaemia on hba1c in diabetic screening

Introduction: HbA1c is used for monitoring glycaemic control and to predict diabetic complications. IDA attributes to 50% of all forms of anaemia, globally. Reduced iron stores have a link with increased HbA1c, leading to false-high values of HbA1c. There is lack of clinical evidence suggestive of the influence of Iron Deficiency Anaemia on HbA1c.Objectives: To evaluate the association between Iron Deficiency Anaemia and HbA1c values.Methodology: Observational Cross-sectional study was conducted on 50 patients attending OPD/admitted to MVJ Medical College & Research Hospital, during the study period from January 2018 to December 2018. By Simple Random Sampling, patients with anaemia, normal fasting and postprandial plasma glucose levels, normal liver function tests, normal blood urea and serum creatinine levels were recruited for this study.Results: Twenty-Five participants were in the iron deficiency anaemia group and 25 in the control (normal) group. Mean Hb among cases was 8.48±1.5 (5.4 to 10.9 gm dL) and that among controls was 14.2±0.8 (12.3-15.5 gm/dL). The mean HbA1c was 6.5±0.6. The mean HbA1c for cases with Iron Deficiency Anaemia was more than that for healthy controls (7.1±0.3 and 6.0±0.3 respectively) (p-value

Sustained low-efficiency diafiltration is superior to hemodialysis in promoting renal function recovery in elderly wasp sting victims with stage III acute kidney injury: a retrospective study

Objective: To study the efficacy and safety of sustained low-efficiency diafiltration (SLEDf) versus hemodialysis (HD) for patients with wasp stings who developed stage III acute kidney injury (AKI).Methods: We retrospectively analyzed the clinical data of consecutive patients who developed AKI following wasp stings. All eligible patients received renal replacement therapy in combination with hemoperfusion. Thereafter, blood purification therapy and HD were performed with a volumetrically controlled machine and 1.7 m2 surface, Fresenius Polysulfone HD filter and SLEDf was undertaken with a volumetrically controlled machine and 1.3 m2 surface, Fresenius Polysulfone HD filter.Results: Forty patients developed stage III AKI following wasp stings, including 14 patients that received SLEDf and 26 patients underwent HD. Thirteen patients were aged less than 60 years and underwent HD (group I), 27 patients were aged at least 60 years, including 13 patients undergoing HD (group II) and 14 patients receiving SLEDf (group III). Groups I and II completed 150 and 162 sessions of HD, respectively, and group III completed 156 sessions of sustained low-efficiency blood purification therapy, including 50 sessions of SLEDf. The time to return to normal serum creatinine levels was 38.8 ± 2.7 days for group I, 47.2 ± 5.3 days for group II, and 39.2 ± 3.3 days for group III. A statistically significant difference was observed in time to normal serum creatinine levels among the three groups.Conclusion: Elderly wasp victims have more severe illness than younger wasp victims and SLEDf is safe and superior to HD in recovery of renal function of elderly wasp victims.

Cystatin C as a novel predictor of preterm labor in severe preeclampsia.

BackgroundThe most common cause of acute kidney injury (AKI) in pregnancy is preeclampsia. Serum cystatin C (CysC) is a potential biomarker of early kidney damage as its levels are not disturbed by volume status changes in pregnancy, and serum CysC levels could serve as a replacement for conventionally used creatinine. In this study, we investigated the serum levels of CysC in severe preeclampsia cases and the associations between CysC levels and poor obstetric outcomes.MethodsOur cohort included severe preeclampsia patients with a normal serum creatinine level. Creatinine was measured to calculate estimated glomerular filtration rate (eGFR) based on the Cockcroft and Gault, Modification of Diet in Renal Disease Study (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations, while CysC was measured to calculated eGFR based on a CysC-based equation. We then evaluated the correlations between serum CysC level, eGFR, and obstetric outcomes.ResultsTwenty-six patients were evaluated of which 38.5% delivered preterm and 30.8% had low-birth weight babies. Unlike creatinine-based eGFR and CysC-based eGFR, serum CysC demonstrate significant negative correlation with gestational age. Receiver operating characteristic curve analysis indicated that serum CysC is a potential biomarker of preterm delivery with a cut-off serum level of 1.48 mg/L with 80% sensitivity and 75% specificity.ConclusionGFR estimation using CysC is likely to be inaccurate in pregnancy. However, we found a significant correlation between preterm delivery and serum CysC level. Our results suggest that serum CysC level has the potential to predict preterm delivery in severe preeclampsia patients.

Treatment approach for young, fit, newly diagnosed multiple myeloma patients

Treatment approach for young, fit, newly diagnosed multiple myeloma patients

Renal dysfunction among adult HIV/AIDS patients on antiretroviral therapy at a tertiary facility in Ghana

BackgroundKidney diseases have emerged as significant cause of morbidity and mortality in HIV subject on antiretroviral therapy (ART). In Ghana, routine follow up of HIV positive clients is by estimation of serum creatinine and urea levels. Glomerular Filtration Rate (GFR) is not routinely calculated and proteinuria is not routinely checked. This study sought to investigate the kidney profiles of adult HIV/AIDS patients being managed on ART at the Cape Coast Teaching Hospital (CCTH), Ghana.MethodsA hospital-based analytical cross sectional study with a retrospective component was conducted using systematic sampling method to recruit HIV/AIDS who visited the ART clinic. A total of 440 participants of both sexes aged 18 years and above, confirmed as HIV/AIDS positive and on ART were involved in this study. Blood and urine samples were collected from all subjects and the levels of serum creatinine and urea and proteinuria were estimated and eGFR calculated using the Modification of Diet in Renal Disease (MDRD) equations. Data analyses were performed using Stata version 13 software (Stata Corp, Texas USA).ResultsThe mean age (years) of participants was 45.5 years (±11.6) with 288 (65.4%) being on Tenofovir based ART regimen. The mean eGFR was found to decrease from 112.4 ml/min/1.73 m at baseline, to 103.4 ml/min/1.73 m after 6 months on ART and to a mean of 99.4 ml/min/1.73 m at recruitment into this study. Factors which were found to be associated with having eGFR < 60 included age, gender and CD4 count though not statistically significant. Patients > 45 years had the highest odds with OR 2.0 (95% CI: 0.8–5.1), females had higher odds with OR 1.5 (95% CI: 0.5–5.2), and those with CD4 count > 350 had OR of 0.4 (95% CI 0.2–1.3). A total of 30.9% of the participants had proteinuria at recruitment. TDF based ART regimen had no statistically significant effect on serum creatinine and urea levels.ConclusionEstimated GFR decreased after 6 months among patients on ART despite normal serum creatinine and urea levels. This finding suggests that clients in care at HIV/ART clinics in Ghana may benefit from routine estimation of GFR and proteinuria.

Long-term Graft and Patient Survival after Percutaneous Angioplasty or Arterial Stent Placement for Transplant Renal Artery Stenosis: A 21-year Matched Cohort Study.

Purpose To compare long-term graft and patient survival after percutaneous angioplasty (PTA) or stent placement for transplant renal artery stenosis (TRAS) with a control cohort without TRAS. Materials and Methods This is a retrospective matched cohort study of 41 patients (median age, 49 years; range, 18-72 years), including 27 male patients (median age, 48 years; range, 18-67 years) and 14 female patients (median age, 52 years; range, 24-68 years), with TRAS from December 1995 through 2016. Primary end points were death-censored graft and patient survival, compared by using log-rank test and Cox proportional regression. Secondary outcomes were improvement in renal function, blood pressure (BP), and complications. Results Twenty-four patients underwent PTA and 17 received stent placements. Ten-year graft survival was 92.1% (range, 83.2%-100%) versus 81.4% (range, 67.8%-95.3%) (P = .56), and 10-year patient survival was 89.9% (79.1%-100%) versus 84.7% (72.1%-97.5%) (P = .49), for the study and control groups, respectively. Five patients (12%) resumed dialysis in each group and a total of 17 patients died (eight in the study group and nine in the control group). Most patients died with a functioning graft (seven of eight in the study group and seven of nine in the control group). Posttreatment median systolic and diastolic BP improved by 12% and 7.4%, respectively, and serum creatinine improved by 27%. Normal systolic BP and serum creatinine level at 1 year after treatment were associated with better survival for patients (P = .04; hazard ratio [HR], 1.04; 95% confidence interval [CI]: 1.0, 1.075) and grafts (P < .001; HR, 1.02; 95% CI: 1.0, 1.027). Other covariates, including PTA versus renal stent placement, intra-arterial pressure gradient greater than 10%, diastolic BP, age at transplantation, sex, graft type, rejection, and delayed graft function, were not significant. Five patients (12.2%) had a complication (Society of Interventional Radiology class A, two of 41 [4.9%]; class B, two of 41 [4.9%]; and class D, one of 41 [2.4%]); 30-day graft loss and patient mortality were zero. Conclusion Long-term graft and patient survival after endovascular correction of transplant renal artery stenosis (TRAS) was similar to that without TRAS and most patients avoided returning to dialysis. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Dickey and Durrani in this issue.

Prevalence and Risk Factors for Augmented Renal Clearance in a Population of Critically Ill Patients.

Critically ill patients show a high, albeit variable, prevalence of augmented renal clearance (ARC). This condition has relevant consequences on the elimination of hydrophilic drugs. Knowledge of risk factors for ARC helps in the early identification of ARC. The aims of this study were evaluation of (1) risk factors for ARC and (2) the prevalence of ARC in critically ill patients over a period of 1 year. A retrospective cohort study was performed for all consecutive patients admitted to our intensive care unit (ICU). Augmented renal clearance was defined by a creatinine clearance ≥130 mL/min/1.73 m2. "Patient with ARC" was defined as a patient with a median of creatinine clearance ≥130 mL/min/1.73 m2 over the period of admission. Four variables were tested, Simplified Acute Physiology Score II (SAPS II), male gender, age, and trauma as cause for ICU admission. An analysis (patient based and clearance based) was performed with logistic regression. Of 475 patients, 446 were included in this study, contributing to 454 ICU admissions and 5586 8-hour creatinine clearance (8h-CLCR). Overall, the prevalence of patients with ARC was 24.9% (n = 113). In a subset of patients with normal serum creatinine levels, the prevalence was 43.0% (n = 104). Of the set of all 8h-CLCR measurements, 25.4% (1418) showed ARC. In the patient-based analysis, the adjusted odds ratio was: 2.0 (confidence interval [CI]:1.1-3.7; P < .05), 0.93 (CI: 0.91-0.94; P < .01), 2.7 (CI: 1.4-5.3; P < .01), and 0.98 (CI: 0.96 -1.01; P = .15), respectively, for trauma, age, male sex, and SAPS II. In the clearance-based analysis, the adjusted odds ratio were 1.7 (CI: 1.4-1.9; P < .01), 0.94 (CI: 0.932-0.942; P < .01), and 2.9 (CI: 2.4-3.4; P < .01), respectively, for trauma, age, and male sex. Trauma, young age, and male sex were independent risk factors for ARC. This condition occurs in a considerable proportion of critical care patients, which was particularly prevalent in patients without evidence of renal dysfunction.

Star fruit nephrotoxicity: a case series and literature review

BackgroundStar fruit is a popular medicinal fruit in the tropics. Its hypoglycaemic properties are considered useful in achieving glycaemic control in diabetes. Star fruit induced nephrotoxicity is a rare cause of acute kidney injury in individuals with both normal and reduced baseline renal function. We present three cases of acute kidney injury due to star fruit nephrotoxicity from Sri Lanka, and discuss the published literature on this topic.Case presentationThree Sri Lankan patients, all with a background of diabetes, presented to us with acute nausea and anorexia following recent consumption of star fruit. Two patients complained of diarrhoea and one patient complained of intractable hiccoughs. They all had elevated serum creatinine on admission. Two were known to have normal baseline serum creatinine levels. On renal biopsy two had evidence of oxalate crystal deposition. One did not show crystal deposition but had acute interstitial nephritis for which no alternate cause could be identified. Two were treated with short courses of prednisolone and two required acute haemodialysis. All recovered renal function, with both patients with known baselines approaching their premorbid serum creatinine levels.ConclusionConsumption of star fruit, especially on an empty stomach or in a state of dehydration may precipitate acute kidney injury. A history of star fruit ingestion must be actively looked for in patients presenting with unexplained acute kidney injury. The use of star fruit as a therapy for diabetes should be discouraged.

Clinical Significance of Anti-Ribosomal P Protein Antibodies in Patients with Lupus Nephritis.

Systemic Lupus Erythematosus (SLE) is a chronic inflammatory disorder affecting multiple systems of the body. Clinical features show wide variations in patients with the different ethnic background. Renal involvement is a predictor of poor prognosis. Immunological workup is an integral part of SLE diagnostic criteria. Anti-ribosomal P Protein (anti-P) antibodies are highly specific for SLE. They may be present in Antinuclear Antibodies (ANA) negative SLE patients. Their role in Lupus Nephritis (LN) is under debate, some researchers found them associated with poor prognosis whereas others found favorable effect of these antibodies on renal disease. In this study, we investigated frequency of anti-P antibodies and the effect of these antibodies on renal functions in the LN patients. A total of 133 SLE patients were enrolled in this study. All patients had ANA in their sera. Anti-P antibodies along with other autoantibodies against extractable nuclear antigens (anti-Sm, anti- SS-A, anti-SS-B, anti-histones and anti-RNP) were detected by Immunoblot assay. Anti-dsDNA antibodies were detected by indirect Immunofluorescence Assay (IFA). We found anti-P antibodies in 10.5% LN patients. Interestingly their presence in association with anti-dsDNA was associated with improved renal functions in comparison to those who had antidsDNA antibodies in isolation (serum creatinine: 1.3 ± 0.8 mg/dl vs. 3.0 ± 3.0; P= 0.091). Anti-dsDNA antibodies are directly involved in renal pathology in SLE patients. As these antibodies are nephrotoxic, concomitant occurrence of anti-P antibodies seems to offer a shielding effect on renal functions, which was evident by normal serum creatinine levels. Therefore, anti-P antibodies may be considered as a good prognostic marker in these patients.

A2430 Glomerulomegaly and blood pressure may predict renal progression after 10 yrs in IgA nephropathy

Objectives: We previously reported that blood pressure (BP) and glomerular size are related to pathologic findings and renal function in IgAN. We reanalyzed these effects on long-term renal progression. Methods: We analyzed renal biopsy specimens and clinical information in patients with IgAN (n = 34). Glomerular surface area (GSA) was determined using a computer imaging analyzer. Results: There were significant correlations between mean or maximal GSA and age, body mass index, systolic and diastolic BP, eGFR, and pathological findings including glomerulosclerosis, interstitial fibrosis, and tubular atrophy. The group with higher GSA had higher BP, pathological grade and lower eGFR. Twenty-two patients with initial normal serum creatinine levels were followed up for >10 yrs. As well as GSA was reversely correlated with final eGFR, GSA and initial BP were higher in the progressor group (n = 6; two on hemodialysis) than in the normal group (n = 16). Conclusion: These results suggest that glomerulomegaly and BP may predict the long-term renal progression in IgA nephropathy.

Serum cathelicidin as a marker for diabetic nephropathy in patients with type 1 diabetes.

The aim of the study was to evaluate the relationship between serum cathelicidin level and diabetic nephropathy (DN) in patients with type 1 diabetes mellitus (T1DM). The study group consisted of 76 patients with T1DM (47 men), aged 36±7years, and with duration of T1DM 14 (7-18) years. Serum cathelicidin was measured by ELISA test in healthy controls (n=20) and in 76 T1DM patients grouped as follows: G1=patients with normal urinary albumin excretion (n=20), G2=patients with microalbumin excretion (n=19), G3=patients with macroalbumin excretion but normal serum creatinine level (n=19), and G4=patients with macroalbumin excretion with increased serum creatinine (n=18). There was no significant difference in serum cathelicidin levels between healthy controls and G1 diabetic patients, but serum levels were progressively increased from the stage of microalbuminuria to frank nephropathy (P<.001). Positive correlation between serum cathelicidin level and the presence of DN, thyroid-stimulating hormone, total cholesterol, and negative with male sex and fasting plasma glucose, was found. In multiple regression analysis, serum cathelicidin level was associated with the presence of DN after adjustment of sex, waist-to-hip ratio, total cholesterol, and thyroid-stimulating hormone. Patients with T1DM and DN are characterized by increased serum cathelicidin level. There was an independent relationship between serum cathelicidin level and DN. Serum cathelicidin level can be used as an early marker for the presence and progression of DN in T1DM patients.

Pretransplantation Cystatin C, but not Creatinine, Predicts 30-day Cardiovascular Events and Mortality in Liver Transplant Recipients With Normal Serum Creatinine Levels

BackgroundThe connection between renal dysfunction and cardiovascular dysfunction has been consistently shown. In patients with liver cirrhosis, renal dysfunction shows a tight correlation with prognosis after liver transplantation (LT); therefore, precise renal assessment is mandatory. Cystatin C, a sensitive biomarker for assessing renal function, has shown superiority in detecting mild renal dysfunction compared to classical biomarker creatinine. In this study, we aimed to compare cystatin C and creatinine in predicting 30-day major cardiovascular events (MACE) and all-cause mortality in LT recipients with normal serum creatinine levels. Patients and MethodsBetween May 2010 and October 2015, 1181 LT recipients (mean Model for End-stage Liver Disease score 12.1) with pretransplantation creatinine level ≤1.4 mg/dL were divided into tertiles according to each renal biomarker. The 30-day MACE was a composite of troponin I >0.2 ng/mL, arrhythmia, congestive heart failure, death, and cerebrovascular events. ResultsThe highest tertile of cystatin C (≥0.95 mg/L) was associated with a higher risk for a 30-day MACE event (odds ratio: 1.62; 95% confidence interval: 1.07 to 2.48) and higher risk of death (hazard ratio: 1.96; 95% confidence interval: 1.04 to 3.67) than the lowest tertile (<0.74 mg/L) after multivariate adjustments. However, the highest tertile of creatinine level showed neither increasing MACE event rate nor worse survival rate compared with the lowest tertile (both insignificant after multivariate adjustment). ConclusionsPretransplantation cystatin C is superior in risk prediction of MACE and all-cause mortality in LT recipients with normal creatinine, compared to creatinine. It would assist further risk stratification which may not be detected with creatinine.

Is serum creatinine mandatory prior to contrast ehanced computer tomography

Introduction: Contrast-enhanced Computed Tomography (CECT) is an imaging technique to diagnose many clinical manifestations. Contrast media used in CECT can lead to contrast induced nephropathy (CIN). Hence, screening of serum creatinine (SCr) level prior to CECT is commonly practiced as it is considered to be an indicator for the risk of Contrast Induced Nephropathy (CIN). But, it adds up extra cost and also increases duration for investigation. The purpose of this study is to find out, if SCr screening can be skipped among certain group by medical history related to risk factors of CIN.&#x0D; Methodology: A total 250 patient SCr were obtained prior to CECT over period of 4 months between June 2016 to September 2016. Duplication in the samples was avoided. A survey of medical history regarding risk factors for CIN was taken in each case. Chi square test and odds ratio was applied for data analysis.&#x0D; Results: In this study 68% of total (250) patients were found to have normal SCr level without any risk factors for CIN and among 3% abnormal categorized patients (SCr ≥1.5mg/dl)) 71% (5 of 7) were identified with risk factors.&#x0D; Conclusions: The data suggests that screening SCr prior to CECT is significant only to those patients who acquire any of the identifiable risk factors for CIN. Those patients who are not identified with any of the associated risk factors, especially for renal disease, are not mandatory to obtain SCr value. This can reduce many challenges while checking patient’s creatinine status, such as patient’s booking delays, extra cost and time, additional pricking while taking blood sample. This practice can also increase the departmental throughput and efficiency of service.

A novel technique for en bloc kidney transplantation from infant donors with extremely low body weight by using the distal abdominal aorta as an outflow tract.

Pediatric kidney donors remain underutilized due to the high risk of postoperative thrombosis. To address this problem, we developed a novel en bloc kidney transplantation technique using donor thoracic aorta and the distal abdominal aorta as inflow and outflow tracts, respectively. Briefly, eight kidneys from deceased infant donors under fivemonths old and with low body weight (1.9-4.9kg) were transplanted en bloc into four pediatric and four adult patients. The donor's common iliac artery or external iliac artery was anastomosed to the recipient's distal external iliac artery or inferior epigastric artery, respectively, as an outflow tract. Recipients received basiliximab or antithymocyte globulin as induction therapy followed by tacrolimus, mycophenolate mofetil, and prednisone but without prophylactic anticoagulation. Delayed graft function was observed in one patient but was reversed at 90days posttransplant. Two patients had urine leakage, which was cured by conservative treatment. Two recipients developed lung infections that eventually cleared. No patients experienced posttransplant vascular thrombosis. After 1-1.5years of follow-up, all patients are well and have normal serum creatinine levels. In conclusion, this novel en bloc kidney transplantation technique using a modified arterial inflow and outflow tract can prevent vascular thrombosis and provide adequate graft function.