Normalization Of Serum Creatinine Research Articles

Estimated glomerular filtration rate: applicability of creatinine-based equations in African children.

The Schwartz equation is the most widely used serum creatinine (SCr)-based formula to estimate the glomerular filtration rate (GFR) in children of European descent, but whether this applies to African children is unclear. In a cross-sectional study, 513 apparently healthy African children aged 6 to 16years were randomly recruited in school area of Kinshasa, the Democratic Republic of Congo (DRC). SCr was measured using calibrated enzymatic method. SCr was normalized using Q-values designed for European descent children, due to the absence of Q-values for African children. Commonly used eGFR equations were applied in this population. Normalization of SCr using Q-values for European descent children was effective in this cohort. The majority of African children (93.4%) have normalized SCr (SCr/Q) values within the reference interval (0.67-1.33) of children of European descent. The bedside-Schwartz equation was associated with significant age and sex dependency. However, the FAS-Age formula showed no sex and age dependency. The new CKiDU25 equation did not show a significant sex dependency. The recently introduced EKFC and LMR18 equations also showed no age and sex dependency, although the distribution of eGFR-values was not symmetrical. On the other hand, the FAS-Height and the Schwartz-Lyon equations showed significant sex dependency but no age dependency. The reference interval for SCr designed for European descent children can be applied to African children. Of all the equations studied, FAS-Age performed best and is most suitable because no height measurements are required. Establishment of specific Q-values for the widespread Jaffe-measured creatinine in Africa can further broaden applicability.

Meta-analysis of perioperative outcomes and safety of percutaneous nephrostomy versus retrograde ureteral stenting in the treatment of acute obstructive upper urinary tract infection.

The debate regarding the optimal drainage method for acute obstructive upper urinary tract infection persists, focusing on the choice between percutaneous nephrostomy (PCN) and retrograde ureteral stenting (RUS). This study aims to systematically examine the perioperative outcomes and safety associated with PCN and RUS in treating acute obstructive upper urinary tract infections. A comprehensive investigation was conducted using the Medline, Embase, Web of Science, and Cochrane databases up to December 2022, following the guidelines of the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. The utilized keywords included 'PCN', 'RUS', 'acute upper obstructive uropathy', and 'RCT'. Inclusion criteria encompassed studies providing accurate and analyzable data, which incorporated the total subject count, perioperative outcomes, and complication rates. The assessed perioperative outcomes included fluoroscopy time, normalization of temperature, normalization of serum creatinine, normalization of white blood cell (WBC) count, and operative time. Safety outcomes encompassed failure rate, intraoperative and postoperative hematuria, postoperative fever, postoperative pain, and postoperative nephrostomy tube or stent slippage rate. The study protocol was prospectively registered at PROSPERO (CRD42022352474). The meta-analysis encompassed 7 trials involving 727 patients, with 412 assigned to the PCN group and 315 to the RUS group. The outcome of the meta-analysis unveiled a reduced occurrence of postoperative hematuria in the PCN group [odds ratio (OR) = 0.54, 95% confidence interval (CI) 0.30-0.99, p = 0.04], along with a decreased frequency of insertion failure (OR = 0.42, 95% CI 0.21-0.81, p = 0.01). In addition, the RUS group exhibited a shorter fluoroscopy time than the PCN group (mean difference = 0.31, 95% CI 0.14-0.48, p = 0.0004). Given the significant impact of hematuria and catheterization failure on postoperative quality of life, the preference for PCN appears more advantageous than RUS.

Acute kidney injury leading to the diagnosis of sporadic testicular Burkitt's lymphoma: A case report.

Burkitt's lymphoma of the testis (TBL) is a rare and extremely aggressive malignant usually diagnosed in front of a testicular mass. We report an exceptional case of a TBL revealed by an Acute Kidney Injury (AKI) of functional origin in a Tunisian man. A 53-year-old patient, known to smoke and drug addict, presented uncontrollable vomiting responsible for extracellular dehydration. Biology showed AKI and radiological explorations revealed compression of the stomach and the right urinary tract by a retro-peritoneal mass continuing with the right testicle. The testicular biopsy with immunohistochemical study concluded with a testicular Burkitt's lymphoma. After correction of hydro-electrolyte disorders with normalization of serum creatinine, the patient was transferred to oncology for chemotherapy. Unfortunately, he refused treatment. The high aggressiveness of TBL would explain the significant, and surprising intra-abdominal tumoral extension with compression of the stomach leading to the functional AKI observed in the reported case. A testicular mass is a usual circumstance for the discovery of a primary tumor of the testicle. In the case of TBL, the rapid tumor growth associated with a diagnostic delay can lead to an impressive extra gonadal extension. • Burkitt’s lymphoma of the testis is extremely aggressive. • The rapid tumor growth of Burkitt’s lymphoma of the testis can be responsible for an important tumoral extension. • Diagnostic delay can lead to an impressive extra gonadal extension of Burkitt’s lymphoma of the testis.

Cardiac autonomic modulation in juvenile idiopathic arthritis with use of biological medication: case report

Introduction: The introduction of biological medication in Juvenile Idiopathic Arthritis (JIA) proposes better therapeutic results with decreased pain and inflammation and consequent reduction in joint damage. The autonomic state can be a predictor for verifying the response to immunomodulation therapy. Thus, measuring heart rate variability can express autonomous behavior and possibly accompany the response to therapy through the expression of the inflammatory condition. Objective: Analysis of heart rate variability in a child with Juvenile Idiopathic Arthritis using the anti-Tumor Necrosis Factor. Methods: This is a clinical case report of an 8-year-old male with a diagnosis of JIA - oligoarticular form, using etanercept, admitted to Clínica Escola de Fisioterapia UNINORTE, Acre, Brazil in 2017. We analyzed laboratory and imaging tests, kinetic-functional evaluation, examination of cardiac autonomic modulation and physiotherapeutic treatment for analgesic, anti-inflammatory purposes, gaining flexibility, strength and postural re-education, according to CARE guidelines, case report guidelines. Results: After medication administration, there was a decrease in pain and normalization of serum creatinine (0.50 mg / dL) and CRP (less than 6 mg / dL) and an increase in erythrocyte sedimentation rate (17 mm3). In the examination of heart rate variability, the linear indices in the time domain showed a predominance of parasympathetic activity (RMSSD: 35ms), with decreased sympathetic control measured through the frequency domain (LF: 27.1 un). However, non-linear methods showed low variability with little dispersion of RR intervals. Conclusion: In the present report, the linear indices showed parasympathetic predominance and in the non-linear analysis a low heart rate variability with abnormal and insufficient adaptation of the autonomic nervous system in a child with juvenile idiopathic arthritis using biological medication.

Persistent decrease of renal functional reserve in patients after cardiac surgery-associated acute kidney injury despite clinical recovery.

Cardiac surgery is a leading cause of acute kidney injury (AKI). Such AKI patients may develop progressive chronic kidney disease (CKD). Others, who appear to have sustained no permanent loss of function (normal serum creatinine), may still lose renal functional reserve (RFR). We extended the follow-up in the observational 'Preoperative RFR Predicts Risk of AKI after Cardiac Surgery' study from hospital discharge to 3 months after surgery for 86 (78.2%) patients with normal baseline estimated glomerular filtration rate (eGFR), and re-measured RFR with a high oral protein load. The primary study endpoint was change in RFR. Study registration at clinicaltrials.gov Identifier: NCT03092947, ISRCTN Registry: ISRCTN16109759. At 3 months, three patients developed new CKD. All remaining patients continued to have a normal eGFR (93.3 ± 15.1 mL/min/1.73 m2). However, when stratified by post-operative AKI and cell cycle arrest (CCA) biomarkers, AKI patients displayed a significant decrease in RFR {from 14.4 [interquartile range (IQR) 9.5 - 24.3] to 9.1 (IQR 7.1 - 12.5) mL/min/1.73 m2; P < 0.001} and patients without AKI but with positive post-operative CCA biomarkers also experienced a similar decrease of RFR [from 26.7 (IQR 22.9 - 31.5) to 19.7 (IQR 15.8 - 22.8) mL/min/1.73 m2; P < 0.001]. In contrast, patients with neither clinical AKI nor positive biomarkers had no such decrease of RFR. Finally, of the three patients who developed new CKD, two sustained AKI and one had positive CCA biomarkers but without AKI. Among elective cardiac surgery patients, AKI or elevated post-operative CCA biomarkers were associated with decreased RFR at 3 months despite normalization of serum creatinine. Larger prospective studies to validate the use of RFR to assess renal recovery in combination with biochemical biomarkers are warranted.

Peritoneal Dialysis in Extremely Low Birth Weight Baby using Chronic PD Catheter

Acute kidney injury (AKI) and fluid overload are serious and common complication in premature babies and may increase morbidity and mortality. Renal replacement therapy should be considered for babies who fail medical interventions. Peritoneal dialysis (PD) is considered a safe and practical option for premature infants by producing efficient gentle removal of solutes and excessive water. There are few reports of PD done in extremely low birth weight (ELBW) infants. Acute PD catheters commonly used in children are reported to have more complications thus seldom used in premature babies. Several authors report using regular intravenous or central venous catheters to dialyze premature babies. We describe an ELBW (700g, twin A) infant born at 24 weeks gestation, who was dialyzed on the 34th day (910g) via pediatric size chronic PD catheter. Filling and drainage of PD fluid were performed manually. We encountered few complications and they were easily controlled. The dialysis resulted in normalization of serum creatinine and correction of fluid and electrolyte imbalance within 10 days. The infant continued to grow and eventually was discharged in good condition, with normal renal function at an adjusted age of 40 weeks (term).

Targeting HO-1 by Epigallocatechin-3-Gallate Reduces Contrast-Induced Renal Injury via Anti-Oxidative Stress and Anti-Inflammation Pathways.

Both oxidative stress and inflammation are involved in the pathogenesis of contrast-induced nephropathy (CIN). Epigallocatechin-3-gallate (EGCG), a purified catechin from green tea, has antioxidant and anti-inflammatory effects. However, it is unknown whether or not EGCG is effective in treating CIN. Our present study found that intravenous administration of EGCG, either before or just after the establishment of CIN, had a protective effect, determined by normalization of serum creatinine and blood urea nitrogen levels, improvement in renal histopathological scoring and alleviation of apoptosis, accompanied by decreased oxidative stress and inflammation. Because EGCG is a potent inducer of the antioxidant heme oxygenase-1 (HO-1), we studied HO-1 signaling in CIN. HO-1 levels were increased in CIN; treatment with EGCG further increased HO-1 levels, accompanied by an increase in Nrf2, a regulator of antioxidant proteins. Interestingly, blockade of HO-1 with protoporphyrin IX zinc(II) (ZnPP) prevented the protective effect of EGCG on CIN. ZnPP also blocked the ability of EGCG to increase the activity of an antioxidant (superoxide dismutase), and decrease markers of oxidative stress (myeloperoxidase and malondialdehyde) and inflammation (myeloperoxidase and IL-1β), indicating that HO-1 is the upstream molecule that regulates the EGCG-mediated protection. To determine further the role of HO-1 on the EGCG-mediated inhibition of inflammation, we studied the effect of EGCG on the NLRP3 inflammasome, an upstream signaling of IL-1β. EGCG down-regulated NLRP3 expression, which was blocked by ZnPP, indicating that HO-1 links EGCG with NLRP3. Therefore, EGCG, via up-regulation of HO-1, protects against CIN by amelioration of oxidative stress and inflammation.

Kinetic eGFR and Novel AKI Biomarkers to Predict Renal Recovery.

Prompt recognition of severe renal impairment could improve the early management of critically ill patients. We compared the value of kinetic eGFR, plasma neutrophil gelatinase-associated lipocalin (NGAL), and urine tissue inhibitor of metalloproteinase-2 and urine insulin-like growth factor-binding protein 7 ([TIMP-2]*[IGFBP7]) in predicting short-term recovery from AKI and major adverse kidney events. During the 6-month study period, 245 patients were admitted to our intensive care unit. This study included 57 consecutive patients presenting with AKI within the first 24 hours after admission. AKI markers were evaluated at inclusion (day 0) and 24 hours later (day 1). Kinetic eGFR was calculated on day 1 according to serum creatinine evolution. Renal recovery was defined as normalization of serum creatinine with reversal of oliguria within 48 hours. Major adverse kidney events included death, need for RRT, or persistence of renal dysfunction at hospital discharge. Plasma NGAL and [TIMP-2]*[IGFBP7] predicted renal recovery, with area under the receiver-operating characteristic curve (AUC-ROC) values between 0.70 and 0.79 at inclusion. Although plasma NGAL values frequently reached the maximal measurement range, their decrease on day 1 predicted recovery. The kinetic eGFR calculation after initial resuscitation provided the best AUC-ROC value for renal recovery, at 0.87. The best predictions for major adverse kidney events were provided by [TIMP-2]*[IGFBP7] and kinetic eGFR (equal AUC-ROCs of 0.81). Combining AKI markers in addition to clinical prediction models improved the discrimination and reclassification of patients who will recover from AKI or suffer from major adverse kidney events. Biomarkers of kidney damage predicted short-term renal recovery and major adverse kidney events for an unselected cohort of critically ill patients. Calculating the kinetic eGFR imposed a delay after initial resuscitation but provided a good diagnostic and prognostic approach. The utility of functional and damage AKI marker combinations in addition to clinical information requires validation in larger prospective studies.

Immunosuppressive therapies for the induction treatment of proliferative lupus nephritis: a systematic review and network metaanalysis.

To evaluate and determine the most effective immunosuppressive therapy for the induction treatment of proliferative lupus nephritis (PLN) based on renal remission. A systematic review of randomized controlled trials was conducted. The outcomes were renal remission at 6 months: (1) normalization of serum creatinine [(sCr), or within 15% of the normal range, i.e., sCr < 132 µmol/l - creatinine remission]; and (2) proteinuric remission (prU < 0.5 g/day/1.73m(2)). A Bayesian network metaanalysis was used. The OR (95% credible interval) of inducing an sCr remission at 6 months was 1.70 (0.51, 6.87) for mycophenolate mofetil (MMF) versus cyclophosphamide (CYC); 2.16 (0.38, 13.36) for tacrolimus (Tac) versus CYC; and 1.25 (0.13, 10.51) for Tac versus MMF. For proteinuric remission the OR was 1.46 (0.81, 3.04) for MMF versus CYC; 1.96 (0.80, 5.11) for Tac versus CYC; and 1.34 (0.43, 3.90) for Tac versus MMF. The probability (95% credible interval) of inducing a creatinine remission at 6 months was Tac 56% (19%, 88%); MMF 51% (23%, 79%); and CYC 37% (28%, 47%). The probability of inducing a proteinuric remission was Tac 41% (23%, 63%); MMF 34% (23%, 50%); CYC 26% (20%, 32%); azathioprine 10% (1%, 55%); prednisone 11% (2%, 38%). None of the results were conclusive when examined in a sensitivity analysis. There is currently insufficient evidence to determine which of these immunosuppressive agents is superior. The probability of renal remission is 50% or lower at 6 months.

The value of repeat kidney biopsy in quiescent Argentinian lupus nephritis patients

The duration of maintenance therapy after induction therapy for lupus nephritis has not been rigorously established. A common practice is to maintain immunosuppression for 1-2 years after complete remission, and longer for partial remission. The present work addresses whether a repeat kidney biopsy might be informative in deciding who should continue immunosuppression after complete or partial remission. The practice in a large Buenos Aires nephrology unit is to repeat a kidney biopsy before finalizing the decision to withdraw or continue immunosuppression. This work reports on a cohort of 25 Hispanic patients that had two or more kidney biopsies, the last occurring after at least 24 months of clinically quiescent disease. Despite normalization of serum creatinine and reduction of proteinuria to <500 mg/d, 30% of patients still had significant activity at the last biopsy. Conversely, 60% of patients with ongoing proteinuria (500-1000 mg/d), or stable but abnormal serum creatinine, had no activity by biopsy. Univariate association analyses demonstrated that improvement in the activity index (AI) of the last biopsy was associated with choice of induction therapy (cyclophosphamide or mycophenolate), improvement in serum creatinine over the first six months of treatment, and improvement in complement component C4. By multivariate regression analyses, two AI prediction models emerged. Cyclophosphamide plus change in serum creatinine or cyclophosphamide plus change in C4 accounted for 50% of the improvement in AI. These data suggest that a repeat biopsy may be useful in making the decision to withdraw or continue maintenance immunosuppression.

Low-Dose Aminophylline for the Treatment of Neonatal Non-Oliguric Renal Failure—Case Series and Review of the Literature

Aminophylline is a methylxanthine with multiple physiologic actions. At low doses, aminophylline can antagonize adenosine and improve renal function via increased glomerular filtration rate. Despite its clinical use, little data exists in neonates for this indication. Therefore, the objective of this report is to describe the impact of aminophylline on renal function indices in a series of neonates with acute renal failure. This was a retrospective chart review of 13 neonates with acute renal failure who received aminophylline during a 15-month study period. Aminophylline was administered at 1 mg/kg intravenously or orally every twelve hours. Forty-six percent (n = 6) of the patients received a 5 mg/kg loading dose before initiation of maintenance therapy. Most patients had already received other treatments for renal failure, including diuretics and dopamine. Resolution of acute renal failure (with normalization of serum creatinine and blood urea nitrogen) was documented in 10 patients (77%). Four of the thirteen patients died from complications due to their prematurity. Failure of low-dose aminophylline was observed in 3 of the 4 patients who died. Low-dose aminophylline in neonates with acute renal failure is associated with an improvement in renal function indices.

Acute poststaphylococcal glomerulonephritis superimposed on diabetic glomerulosclerosis

Acute poststaphylococcal glomerulonephritis superimposed on diabetic glomerulosclerosis

Clinical features and outcome of pediatric Wegener's granulomatosis

Wegener's granulomatosis (WG) is a predominantly small-vessel vasculitis associated with antineutrophil cytoplasmic antibodies (ANCAs). There are few reports describing its clinical features and outcome in children. We report on the experience at a single tertiary referral center over 21 years. We conducted a retrospective chart review of all patients diagnosed with WG at The Hospital for Sick Children between 1984 and 2005. Twenty-five patients were identified. Median age at diagnosis and median followup were 14.5 years and 32.7 months, respectively. Male-to-female ratio was 1:4. Median duration of symptoms before diagnosis was 2 months. Of 22 patients, 21 were ANCA positive during their disease course (classic ANCA 78.9%). Constitutional symptoms were the most common clinical feature at presentation (24 of 25). Glomerulonephritis was present in 22 patients at presentation. Only 1 of 11 patients who presented with or developed renal impairment had normalization of serum creatinine. Upper airway involvement occurred in 21 patients at presentation and 24 over followup; only 1 had subglottic stenosis. Twenty patients had initial pulmonary involvement, most commonly nodules (44%) and pulmonary hemorrhage (44%). Five patients required ventilation for pulmonary hemorrhage. Four patients (16%) had venous thrombotic events (VTEs). Treatment included prednisone (100%), cyclophosphamide (76%), azathioprine (40%), and methotrexate (32%). Pediatric WG typically presents in adolescence and has a female predominance. Glomerulonephritis and pulmonary disease are common at diagnosis and frequently present as a pulmonary-renal syndrome. Loss of renal function is common and rarely completely reversible. As in adults, children with WG are at risk of VTEs.

Caspofungin as second-line therapy for fever of unknown origin or invasive fungal infection following allogeneic stem cell transplantation

Caspofungin (CAS) is the first of a new class of antifungal agents, the echinocandins, that interfere with fungal cell wall synthesis by inhibition of glucan synthesis. Here, we report the results of 31 patients treated with CAS following allogeneic SCT. CAS was administered as a second-line agent to patients with invasive fungal infection (IFI) (n=15) or fever of unknown origin (n=16) who were recalcitrant to or intolerant of prior antifungal therapy. Unsuccessful first-line regimes included amphotericin B (n=17), liposomal amphotericin B (n=5), fluconazole (n=3), itraconazole (n=1), and voriconazole (n=2). All patients received concomitant immunosuppressive therapy for graft-versus-host disease. In 23 patients, cyclosporin A (CSA) and CAS were administered concurrently without any major side effects detected. Observed increases in GPT were not clinically significant. Normalization of serum creatinine and significant reductions in C-reactive protein were observed in response to CAS. Favorable outcome to CAS were documented in eight of 15 patients with IFI and in 15 of 16 patients with fever of unknown origin. CAS is a promising alternative in patients with IFI and fever of unknown origin in the setting of allogeneic SCT.

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Our observation that SBP-induced type-1 hepatorenal syndrome (HRS) occurs in the setting of a significant decrease in cardiac output and in the absence of significant changes in peripheral vascular resistance modifies the current concept of the pathogenesis of circulatory dysfunction in cirrhotic patients with SBP. Up to now, type-1 HRS in patients with SBP was considered to be caused by an accentuation of the arterial vasodilation and secondary activation of the endogenous vasoconstrictors systems already present in these patients (Hepatology 1996;23:164–176). Our study is compatible with an accentuation of arterial vasodilation because peripheral vascular resistance did not change in our patients despite an intense activation of the renin-angiotensin and sympathetic nervous systems. However, in addition to this, circulatory dysfunction and HRS was clearly associated to a decrease in cardiac function. Therefore, HRS associated to SBP occurs when there is simultaneous impairment of the 2 main factors influencing the effective arterial blood volume and arterial pressure, the cardiac output and the systemic vascular resistance. The mechanism of the decrease in cardiac function was not investigated in our patients, although it was likely related to a central hypovolemia because there were no changes in cardiopulmonary pressures despite the decrease in cardiac output. Our study offers a rational explanation for the findings of recent therapeutic investigations in patients with type-1 HRS. Reversal of type-1 HRS (normalization of serum creatinine) is frequently achieved when patients are treated by plasma volume expansion with albumin and vasoconstrictors (terlipressin or noradrenaline) (J Hepatol 2000;33:43–48, Acta Gastroenterol Belg 2001;64:15–19, Gastroenterology 2002;122:923–930, Hepatology 2002;36:941–948, Hepatology 2002;36:374–380) but not when infusion of albumin or vasoconstrictors are given alone (J Hepatol 2000;33:43–48). Plasma volume expansion with albumin increases cardiac preload and cardiac output and vasoconstrictors increase peripheral vascular resistance, thus correcting the 2 factors involved in the pathogenesis of HRS. The observation that infusion of albumin at the time of diagnosis of infection is highly effective in preventing renal failure in patients with SBP (N Engl J Med 1999;341:403–409) is consistent with the important role of the impairment in cardiac output in the pathogenesis of HRS in these patients. Circulatory dysfunction associated with SBP in our patients was associated with a marked increase in portal pressure. This observation also offers a rational explanation for the frequent association of acute bacterial infections with variceal bleeding refractory to therapy in cirrhosis (Hepatology 1998;27:1207–1212). Drs. Blendis and Wong considered albumin as an expensive treatment for patients with SBP. Of course, albumin is not cheap. However, it decreases hospital mortality by 66% in these patients (from 30% to 10%) (N Engl J Med 1999;341:403–409), and we are not aware of any treatment with such efficacy in decompensated cirrhosis.

Outcome of relapse in lupus nephritis: Roles of reversal of renal fibrosis and response of inflammation to therapy

Renal relapse in lupus nephritis has been shown to have ominous prognostic significance with the majority of patients progressing to doubling of serum creatinine (CRX2). However, not all patients do so. This report explores the roles of response of inflammation to therapy and of glomerular scarring and interstitial fibrosis and their potential reversal to outcome of renal relapse. Renal biopsies from 71 patients with lupus nephritis with an initial biopsy (Bx1) and systematic control biopsy (Bx2) after six months of therapy, as well as subsequent biopsies for clinical indications, were studied. The relationships of morphologic factors to renal relapse and its outcome as well as to CRX2 and end-stage renal disease (ESRD) were analyzed. Cox proportional hazards modeling was used to assess association of morphologic variables with outcomes. Renal interstitial fibrosis and glomerular segmental scarring were partially reversible in 17 and 11 patients, respectively. This decline was associated with an excellent prognosis, with only one patient in each group (5.9% and 9.1% respectively) progressing to CRX2. All 18 patients who progressed to CRX2 either failed to respond to therapy (7 patients) as defined by normalization of serum creatinine (SCr) and reduction of proteinuria to < or =1 g/day, or relapsed after initial response (11 patients), as defined by recent rise of SCr > 50% and/or proteinuria > 3.5 g/day. However, relapse also occurred in 11 of 47 other patients without progression to CRX2. These patients showed a greater initial response of inflammation and deposits to therapy and fibrous lesions partially reversed in the period prior to relapse, so that active lesions were superimposed on a lower level of chronic lesions. By contrast, chronic lesions mounted steadily in those who progressed to CRX2. Cox proportional hazards modeling indicated a strong association of inflammatory variables with renal relapse, CRX2 and ESRD. However, the extent of immunoglobulin deposits was not significantly associated with any outcome. Finally, we found that failure of disease to remit also is associated with a high rate of CRX2 (64.8% vs. 13.0%, P = 0.00034). Interstitial fibrosis and glomerular scarring in systemic lupus erythematosus are partially reversible, and this reversal is attended by an excellent outcome. The outcome of renal relapse is determined by the initial response of inflammatory and chronicity elements to therapy, those with prior partial reversal of interstitial and glomerular scarring having a good outcome, and those in whom fibrotic lesions have continued to increase and have a poor outcome. Inflammatory variables appear to be more important in determining outcome than immunoglobulin deposits.

Systemic Cyclosporine A in Severe Atopic Keratoconjunctivitis

Atopic keratoconjunctivitis (AKC) is a potentially blinding disease. It is usually associated with atopic dermatitis that has been managed successfully with systemic cyclosporine A (CSA) in some severe forms of the disease. In this study, the authors evaluated systemic CSA therapy in patients with severe AKC. Cohort Retrospective study. Four patients aged 31 to 64 with severe AKC and atopic dermatitis refractory to or dependent on steroid therapy. The patients received oral CSA. Ocular inflammation, skin condition, CSA treatment methods (dosage, duration), CSA-related side effects. Daily dosage of oral CSA was 3 to 5 mg/kg and mean duration of treatment was 37 months (range, 22-48 months). Ocular inflammation was controlled totally in three patients. One patient responded only partially to treatment. Side effects included renal toxicity in one patient. Reduction of CSA dosage resulted in normalization of serum creatinine level. This report suggests that systemic CSA represents an interesting alternative therapy in severe AKC.

AIDS-associated membranous nephropathy with advanced renal failure: Response to prednisone

We report the case of a patient with acquired immunodeficiency syndrome (AIDS) who developed nephrotic syndrome and progressive renal failure mimicking human immunodeficiency virus (HIV)-associated focal segmental glomerulosclerosis (FSGS) who required initiation of hemodialysis and was found on renal biopsy to have membranous nephropathy. Hepatitis B and C serologies were negative. Although she required hemodialysis, she was treated with prednisone and experienced a progressive decline in her serum creatinine from 10.1 mg/dL to 1.9 mg/dL, which permitted the discontinuation of hemodialysis. After she abruptly discontinued prednisone, her creatinine level increased to 4.8 mg/dL, and she experienced marked worsening of her nephrotic syndrome. Resumption of prednisone resulted in normalization of serum creatinine and reduction in urine protein excretion. No adverse effects of prednisone occurred during this time. She remains off of hemodialysis for 1 year with a serum creatinine level of 1.0 mg/dL and urine protein excretion of 0.4 g/d. Although most patients with HIV infection, nephrotic-range proteinuria, and renal failure have FSGS, a minority may have membranous nephropathy. Although typically not a steroid-responsive lesion in the setting of advanced renal failure, membranous nephropathy may be a highly steroid-responsive lesion in the HIV-infected patient, and treatment may help avert the need for dialysis in a patient population that generally has a poor outcome on dialysis.

Contrast media injection in the rat after multiple renal insults. No evidence of additional nephrotoxicity.

Experiments were performed to determine whether water-soluble contrast media (CM) show nephrotoxic properties when injected into rats after multiple renal insults. The latter consisted of combinations of prostaglandin synthesis inhibition (with indomethacin) and/or salt depletion and/or uninephrectomy. Renal function was evaluated by standard clinical methods to measure parameters such as urinary output, urinary osmolality, urinary creatinine excretion and serum creatinine. CM injected after prostaglandin synthesis inhibition alone did not influence urinary creatinine excretion or serum creatinine. After a combination of renal insults a significant increase in median serum creatinine values from 61.88 mumol/l [interquartile range (IR) 17.68] [0.70 mg% (IR 0.20)] to 97.24 mumol/l (IR 79.56) [1.10 mg% (IR 0.90)] was observed but CM or sham injections did not prevent a normalization of serum creatinine. The pattern of recovery of serum creatinine was not influenced by previous kidney mass reduction. It is concluded that the nephrotoxic properties of CM cannot be detected with standard clinical methods in rats after multiple renal insults.

Acute renal failure in the elderly: experience from a single centre in India

A total of 139 patients with acute renal failure (ARF) were studied, of which 41 (29.4%) were elderly with mean age of 67.1 years and 98 (70.6%) were younger with mean age of 32.3 years. Surgical causes accounted for 65% of geriatric ARF while medical causes were predominant in the younger patients (55.1%). Amongst the surgical causes, prostate-related problems due to obstruction or following transurethral resection of prostate were seen in 20 patients (74%). Drugs and sepsis were the predominant causes of medical ARF in the geriatric patients (85.7%). Of all the causes of geriatric ARF, which included both medical and surgical, nephrotoxic drugs either alone or in combination with other predisposing factors were the cause in 22 (51%) patients. Haemodialysis was needed in 15 of geriatric (36.6%) and 64 of younger (65.3%) ARF patients. Recovery from ARF, as evidenced by normalization of serum creatinine, was delayed in the elderly as compared to the younger patients (32.0 versus 11.4 days, P < 0.001). Mortality, though higher in the elderly as compared to the younger patients, was not significantly different (9.75% versus 6.1%).