Renal Function Parameters Research Articles

Role of NADPH Oxidases in Renal Aging

Introduction: Aging of the kidney is associated with complex molecular, histological, and functional changes. Although the aging process itself does not induce renal damage, underlying disease such as diabetes mellitus can aggravate kidney injury during aging. Although oxidative stress is considered an important mediator in age-related renal fibrosis, it is unclear how oxidative stress increases during normal and diabetic aging. Methods: In this study, we investigated molecular changes in the kidney in normal and diabetic aging mice. C57BL/6 mice were studied at 2, 12, and 24 months of age, and leptin receptor-deficient db/db mice were studied at 8, 12, 16, 20, 24, and 38 weeks of age. We measured renal functional parameters, fibrotic and inflammatory markers, and oxidative stress markers at all the above time points. Results: Both nondiabetic and diabetic mice exhibited progressive microalbuminuria during their lifespan. Interestingly, both diabetic aging and normal aging mice showed progressive increases in oxidative stress markers such as plasma and urinary 8-isoprostane, as well as renal lipid hydroperoxide content. In renal tissues, proinflammatory and profibrotic molecules were significantly upregulated in an age-dependent manner. Expression of three NADPH oxidase (Nox) isoforms, namely, Nox1, Nox2, and Nox4, was significantly increased during aging. Compared with normal aging mice, diabetic db/db mice demonstrated more dramatic changes during aging process. Conclusions: Our findings suggest that NADPH oxidases play an important role in the aging kidney under both normal and diabetic conditions. Targeting of these oxidases might be a new promising therapy to treat issues associated with aging kidneys.

Relationship and outcomes between volume status, cardiac and renal dysfunction in patients with chronic heart failure

Abstract Funding Acknowledgements Type of funding sources: None. Background Right heart and renal dysfunction occurring due to volume fluid redistribution remain a front-line issue in the development of the syndrome of congestion in chronic heart failure (HF). Quantitative total blood volume (TBV) measurements and Speckle-tracking Echo (STE) provide complementary information on the myocardial function which allows for providing a more integrated assessment of clinical status and outcomes. Purpose We hypothesize adverse outcomes in patients with heart failure (HF) who have expansion of TBV, right ventricular (RV) and renal dysfunction. Methods This is a prospective study and a total of 66 participants NYHA class III&IV with chronic HF are enrolled from 2014-2022. TBV, right heart catheterization, TTE, TEE, and kidney function tests is performed. STE is calculated using TomTec software for all heart chambers. Patients is divided into 1-st group of the total participants, 2-nd group is patients adverse outcomes which are heart transplant (HT) or death, 3rd group is of alive patients. Simple, multivariable linear regression analyses is used to evaluate associations between TBV, cardiac and renal function. Statistical analyses is performed using JMP, BlueSky, and two-sided with P-values <0.05 considered to be statistically. Results Of 66 patients, the 1-st group has 66 patients, the 2nd group has 44 patients out of which deceased are 32 patients (48.4%), HT has 12 patients (18.1%), and the 3rd group has 22 patients (33.3%). In the 2nd group, out of the 44 patients, 35 (79.5%) patients have HFrEF, and 9 (20.4%) patients presented HFpEF. In the 3rd group out of 22 patients, 15 (68.2%) have HFrEF, and 7 (31.8%) patients have HFpEF. RV dimensions are significantly related to TBV in all groups of participants (Table 1). In the total patients, TBV is directly correlated to a moderate degree with EDSRV (r = 0.51, P < 0.001), ESSRV (r = 0.44, P < 0.001) and FAC (r = 0.40, P < 0.001). More significant moderate and strong relationships are observed in patients with adverse outcome between TVB and EDSRV (r = 0.54, P < 0.001), ESSRV (r = 0.65, P < 0.001) and FAC (r = 0.48, P < 0.001). In group 1, weak and direct association of TBV and RV GLS, FW LS, FW LSR, and RA reservoir strain. In the 2nd group, TBV directly correlated to a moderate degree with FW LS (r = 0.41, P = 0.005) and FW LSR (r = 0.43, P = 0.002). Similar relationships in the 2nd group are observed between TBV and renal function parameters (TBV and eGFR (r = 0.53, P < 0.001)). The direct and weak correlation obtained between TBV and BUN in both 1st and 2nd groups. In patients with adverse outcomes, TBV is directly proportional to LV Diastolic BP. Conclusion The association among intravascular volume and parameters of RV dilatation, myocardial and renal dysfunction in patients with chronic HF is associated with adverse outcomes. Understanding the impact of all these variables guide optimal and effective individualized HF management and therapy.

The Effect of Endosulfan Pesticide in Some Biochemical Parameters of white Mice

The present study aimed to examine the effect of endosulfan insecticide on some molecular and biochemical parameters in white mice. Thirty mice were separated randomly into three groups for treatment with endosulfan. One group (G1) served as the control, while the other two groups received intraperitoneal injections of endosulfan G2 (3 mg/kg) and G3 (17 mg/kg) twice a week for 21 and 45 days, respectively. A biochemical study by measuring liver function parameters, including (alanine aminotransferase (ALT) and aspartate aminotransferase (AST)) and kidney function parameters, including (Blood Urea and Creatinine) and malondialdehyde (MDA), catalase activity (CAT). This study also tested DNA damage by comet assay (normal%, low%, medium%, high%). The results of renal function parameters (Blood Urea and Creatinine) were significantly increased in all treated groups after 21 and 45 days exposed to endosulfan compared with control groups. The highest value of blood urea recorded was (49.33 ±0.88 mg/dl) at 17 mg/kg for 45 days compared with the control group, and the highest value of Creatinine recorded was (1.81 ±0.13 mg/dl) at 17 mg/kg for 45 days compared with the control group. Liver function parameters (ALT and AST) significantly increased in all treated groups compared with control groups. The results of MDA, CAT enzyme, were significantly increased in all treated groups after 21 and 45 days compared with control groups. The highest value of MDA recorded was (3.93 ±0.07 μM) at 17 mg/kg for 45 days compared with the control group. Tail DNA (%) showed a significant increase at high concentrations, and the results showed a considerable increase in the severe damage of DNA in the treated group 17 mg\kg b.wt. (25.00 ±1.00)% for 45 days, compared with the control group (3.00 ±1.00) %.

Grape Seed Extract and Urolithiasis: Protection Against Oxidative Stress and Inflammation

Background Grape seed extract (GSE) has demonstrated various pharmacological actions. Urolithiasis is the occurrence of calculus in the renal system. The present study evaluated the anti-urolithic effect of GSE on ethylene glycol (EG) and ammonium chloride (AC)-induced experimental urolithiasis in rats. Materials and Methods Rats were assigned into six groups; Normal control and Normal + GSE, in which rats received standard drinking water and GSE orally daily, respectively; Urolithiatic animals received EG with AC in drinking water for 28 days; Urolithiatic animals + GSE, in which rats were administered EG with AC in drinking water and GSE 100 and 200 mg/kg orally; and Urolithiatic + cystone, where rats received EG with AC in drinking water and 750 g/kg of cystone as a standard drug orally. Results Urolithiatic animals showed a significant decrease in excreted magnesium and citrate and antioxidant enzymes, whereas they exhibited amplified oxalate crystal numbers, urinary excreted calcium, phosphate, oxalate ions, uric acid, intensified renal function parameters, lipid peroxidation, and inflammatory mediators. Management with GSE and cystone significantly augmented urolithiasis inhibitors (excreted magnesium and citrate) and amplified the antioxidant enzymes’ activities. GSE reduced oxalate crystal numbers and urolithiasis promoters, including excreted calcium, oxalate, phosphate, and uric acid excretion, lessened renal function parameters, and declined lipid peroxidation and the inflammatory mediators. Conclusion GSE could protect against EG-induced renal stones as evidenced by mitigated kidney dysfunction, histological alterations, and oxalate crystal formation. This action may be related to the antioxidant as well as anti-inflammatory activities of the extracts.

Sesamolin Attenuates Kidney Injury, Intestinal Barrier Dysfunction, and Gut Microbiota Imbalance in High-Fat and High-Fructose Diet-Fed Mice.

This study investigated the effects of sesamolin on kidney injury, intestinal barrier dysfunction, and gut microbiota imbalance in high-fat and high-fructose (HF-HF) diet-fed mice and explored the underlying correlations among them. The results indicated that sesamolin suppressed metabolic disorders and increased renal function parameters. Histological evaluation showed that sesamolin mitigated renal epithelial cell degeneration and brush border damage. Meanwhile, sesamolin inhibited the endotoxin-mediated induction of the Toll-like receptor 4-related IKKα/NF-κB p65 pathway activation. Additionally, sesamolin mitigated intestinal barrier dysfunction and improved the composition of gut microbiota. The correlation results further indicated that changes in the dominant phyla, including Firmicutes, Deferribacterota, Desulfobacterota, and Bacteroidota, were more highly correlated with a reduction in endotoxemia and metabolic disorders, as well as decreases in intestinal proinflammatory response and related renal risk biomarkers. The results of this study suggest that sesamolin attenuates kidney injuries, which might be associated with its effects on the reduction of endotoxemia and related metabolic disorders through the restoration of the intestinal barrier and the modulation of gut microbiota. Thus, sesamolin may be a potential dietary supplement for protection against obesity-associated kidney injury.

Neutrophil-to-lymphocyte ratio (NLR) as a predictive index for liver and coagulation dysfunction in preeclampsia patients

BackgroundPre-eclampsia (PE) is a pregnancy disorder that is related to an enhanced immune response. Immune cell characteristics such as neutrophil or monocyte to lymphocyte ratios (NLR, MLR) are known to be related to kidney and liver dysfunction in hypertensive patients. Here, we aimed to analyze the correlations between NLR, MLR and platelet to lymphocyte ratio (PLR) and liver, renal and coagulation functional parameters and the impacts of these immune cell profiles to the prognostic significance in PE patients.MethodsPre-delivery hematological and biochemical parameters of 320 first-time pregnant women registered at the Obstetrics Department of Yanbian University Hospital from 2016 to 2019 were analyzed retrospectively. Patients were divided into normal pregnancy (normal, n = 161), mild PE (mPE, n = 28) and severe PE (sPE, n = 131) groups according to diagnostic criteria. Pearson correlation analysis were performed and area under the curve (AUC) were conducted for the diagnostic values of NLR, MLR and PLR. Results were validated with data from the Department of Obstetrics and Gynecology of Seoul National University Hospital (SNUH).ResultsKidney functional indexes were adversative in mPE and sPE and liver and coagulation indexes were worse in sPE compared to normal groups. Among immune cells, lymphocytes were increased in mPE and sPE patients, resulted in reduced NLR, MLR and PLR in PE groups, more significant difference were shown in sPE. NLR and PLR were associated with CREA and/or BUN negatively and positive associations were observed with total protein (TP) and albumin (ALB) in sPE. Only NLR showed positive associations with coagulation indexes (PT and APTT) in sPE. AUC analysis for NLR, MLR and PLR were 0.700, 0.656, 0.643, respectively, and NLR < 3.7 predicted hypertension (95% CI in all participants: 0.647–0.749, p < 0.001). Blood pressure, liver, kidney and coagulation indexes were worse at cut off value (NLR < 3.7), and this was validated with the data from SNUH.ConclusionNLR could be used as an independent predictor of liver and coagulation dysfunction in PE patients. Our results may provide non-invasive and efficient way of the risk assessment among PE patients.

PS-C30-7: THE ASSOCIATION BETWEEN INSULIN RESISTANCE AND DECLINE IN ORGAN FUNCTION IN NON-OBESE JAPANESE INDIVIDUALS

Background: Obesity-induced insulin resistance is a critical metabolic abnormality involved in the decline in various organ functions, which likely contributes to the development of serious diseases, such as type 2 diabetes, hypertension, and cardiovascular disease. However, little information is available on the association between insulin resistance and organ function in non-obese people. The major purpose of this study was to investigate the relationship between insulin resistance (estimated by the homeostasis model assessment for insulin resistance, HOMA-IR) and selected indicators of organ-specific functions in non-obese individuals. Materials and Methods: We analyzed data obtained from non-obese (body mass index [BMI], 18.5 to &lt; 25 kg/m2), non-diabetic 3546 Japanese individuals (2034 men and 1512 women) who received health checkups in 2018 at Keio University Hospital. Individuals were divided into quartiles according to their HOMA-IR values. Multiple regression analysis was performed to further investigate the relationship between HOMA-IR values and organ parameters after adjustment for covariates, such as age, gender, and BMI. Results: Those with HOMA-IR in the highest quartile had a higher incidence of metabolic syndrome, hypertension, stroke, and chronic kidney disease. There were significant stepwise (P &lt; 0.05) increases in metabolic syndrome indicators (BMI, visceral adipose tissue area, triglyceride, uric acid), liver enzymes (AST, ALT, γGTP, ChE), systemic inflammatory markers (white blood cell count, CRP), systolic and diastolic blood pressure, and ocular pressure, from the first quartile to fourth quartile of HOMA-IR, whereas there were stepwise decreases in HDL-C and parameters of renal function (eGFR) and pulmonary function (forced expiratory volume, vital capacity). Multiple regression analyses revealed that HOMA-IR values were significantly (P &lt; 0.05) associated with these parameters expect eGFR even after adjusting for covariates. Conclusion: Our results suggest that insulin resistance is associated with decline in the function of multiple organs in non-obese, non-diabetic Japanese individuals. Further studies are required to establish cause and effect in this relationship.

Tyrosol and Olive Oil Ameliorate Sodium Arsenate-Induced Nephrotoxicity by Modulating of Oxidative Stress and Histological Changes in Mice.

Sodium arsenate (Na 3As0 4, Sodium As) is an important toxic substance that leads to nephrotoxicity. Due to having bioactive molecules, such as polyphenols and tyrosol, olive oil plays a significant role in scavenging free radicals. This study aimed to investigate the effects of olive oil and tyrosol on As-induced nephrotoxicity. In our study, 42 adult male BALB/c mice were randomly divided into six groups: control (normal saline), olive oil (0.4 ml/d, gavage), tyrosol (5 mg/kg/d), Sodium As (15 mg/kg), olive oil + Sodium As, and tyrosol + Sodium As (olive oil and tyrosol received one hour before Sodium As). Drugs were administreted once daily for 30 consecutive days. On the 31st day of the study, oxidative stress parameters in kidney tissue, FRAP in plasma, renal function parameters in serum, and histopathological assays were performed. Sodium As-induced renal damage as characterized by a significant increase of creatinine and BUN (P < 0.001) and histopathological changes. Also, Sodium As markedly altered oxidative stress biomarkers such as a significant increase in MDA (P < 0.001) and significantly decreased in FRAP and GSH (P < 0.01). Olive oil and tyrosol administration significantly improved the renal antioxidant defense system and decreased MDA concentration, markedly preserving the tissue structure and functional markers of kidney. However, these effects were more effective for tyrosol than olive oil. Our results suggest that olive oil and tyrosol can be used as a protective agent in preventing Sodium As-induced nephrotoxicity due to antioxidant property.

Nephrotoxicity induced by different diameters of sphere gold nanoparticles with special emphasis on the nephroprotective role of quercetin.

Although, gold nanoparticles (GNPs) are attracting more and more attention due to their ease of synthesis, modification, and great potential value in biomedical applications, exhibited harmful effects on human health and other living species. Quercetin (Qur) clarifies diverse pharmacological effects, especially anti-inflammatory, antiapoptotic, and antioxidant ones. This study aimed to evaluate the probable nephrotoxicity induced by different diameters of sphere GNPs, as well as the nephroprotective role of Qur. A total of 54 healthy mature male albino rats were grouped and treated with or without sphere GNPs; 10, 20, and 50 nm and Qur (200 mg/kg b.wt.). The effects of GNPs and Qur were estimated through the collection of blood and kidney samples from euthanized rats and performed biochemical, histopathological, and immunohistochemical investigations. In comparison between different diameters of GNPs, the 10 nm GNPs revealed more significant elevations in all renal function parameters: creatinine, urea, blood urea nitrogen, and uric acid followed by 20 nm then 50 nm. Pre-cotreatment with Qur decreased all renal functional values. Histopathologically, 10 nm revealed the most potent renal pathological changes represented in the renal cortex with cloudy swelling of renal tubules, hypercellularity of some glomeruli, severe congestion of renal blood vessels, focal inter tubular edema, and vascular endotheliosis (degeneration of endothelium). In addition, the renal medulla revealed perivascular inflammatory cellular infiltration, perivascular fibrosis, intra tubular glycogen deposition, and casts deposition of mainly cellular casts. On the other hand, the Qur treatment ameliorated most of these pathological changes. The size of GNPs is pivotal in their pathological effect on renal tissues where the small-sized GNPs; 10 nm have more potent cytotoxic, inflammatory, and apoptotic effects rather than the larger ones. Otherwise, Qur clarified a significant mitigating role against the nephrotoxicity of the GNPs.

Puerarin protects renal ischemia-reperfusion injury in rats through NLRP3/Caspase-1/GSDMD pathway.

To observe the effect of puerarin on renal ischemia-reperfusion (I/R) injury in rats, and to explore its mechanism based on NLRP3/Caspase-1/GSDMD pathway. Twenty-one Sprague-Dawley rats were divided into three groups: sham-operated group (sham), model group (RIRI), and puerarin treatment group (RIRI + Pue). The model of acute renal I/R injury was established by cutting the right kidney and clamping the left renal pedicle for 45 min. Renal function parameters were statistically significant in group comparisons. The renal tissue structure of rats in sham group was basically normal. Pathological changes were observed in the RIRI group. The renal pathological damage score and apoptosis rate in the RIRI group were higher than those in the sham group, and significantly lower in the RIRI + Pue group than in the RIRI group. Indicators of oxidative stress-superoxide dismutase, malondialdehyde, and glutathione peroxidase-were statistically significant in group comparisons. Compared with the sham group, the relative expressions of NLRP3, Caspase-1 and GSDMD proteins in the RIRI group were increased. Compared with the RIRI group, the RIRI + Pue group had significant reductions. Puerarin can inhibit the activation of NLRP3/Caspase-1/GSDMD pathway, inhibit inflammatory response and pyroptosis, and enhance the antioxidant capacity of kidney, thereby protecting renal I/R injury in rats.

PS-BPC02-2: CLINICAL IMPACTS OF ENDOTHELIUM-DEPENDENT FLOW-MEDIATED VASODILATION ASSESSMENT ON PRIMARY ALDOSTERONISM

Objective: Primary aldosteronism (PA) is defined as autonomous aldosterone production from the adrenal glands and represents the most common and treatable cause of hypertension. Also, it is well known that the incidence of cardiovascular morbidity is higher among patients with PA than among those with essential hypertension (EH). Histologically, PA is divided into two major subtypes, aldosterone-producing adenoma (APA) and bilateral idiopathic hyperplasia (IHA). However, the nature of vascular function in PA patients remains to be determined. The aim of this study was to determine the vascular function and investigate the implications of vascular function assessments in the patients with PA. Design and Method: All patients were diagnosed with PA according to the guidelines of the Japan Endocrine Society. Flow-mediated dilation (FMD), as an index of endothelial function, and cardio-ankle vascular index (CAVI), as an index of arterial stiffness, were retrospectively compared between 42 patients with APA, 37 patients with IHA, and 42 patients with EH. These values were also compared with background factors, KCNJ5 mutation and clinical outcome in terms of blood pressure reduction after adrenalectomy in the APA group. Results: No differences were found among the three groups (APA, IHA and EH) with regard to age, sex, duration of hypertension, body mass index, blood pressure, renal function and hemoglobin A1c. FMD was significantly lower in the APA group (4.8 ± 2.1%) and IHA group (4.1 ± 1.9%) than in the EH group (5.7 ± 2.1%). CAVI did not differ significantly among APA, IHA and EH groups (7.9 ± 1.3, 7.8 ± 1.0, 7.8 ± 1.1, respectively). Although no significant correlations were seen between FMD and background factors (i.e. age, body mass index, renal function, glucose and lipid metabolic parameters, and hormonal data) in the IHA group, FMD correlated negatively with BMI and plasma aldosterone concentration in the APA group (rs = -0.313, rs = -0.342, respectively). No significant difference in FMD (4.8 ± 1.4%, 4.5 ± 2.1%, respectively) or CAVI (8.1 ± 1.8, 8.0 ± 1.1, respectively) was seen between the KCNJ5-mutant group and the wild-type group. A cut-off FMD of 4.3% was selected for complete clinical success after adrenalectomy, offering 78% sensitivity and 80% specificity. Conclusions: Patients with PA displayed impaired endothelial function. Complete clinical success after adrenalectomy was associated with preserved endothelial function. This study provides a better understanding of FMD assessment in patients with PA.

Diagnostic utility of two-dimensional shear wave elastography in nephropathic dogs and its correlation with renal contrast-enhanced ultrasound in course of acute kidney injury.

Aims of our study were to evaluate the feasibility and diagnostic value of two-dimensional shear wave elastography in dogs with acute kidney injury, chronic kidney disease, and acute on chronic kidney disease, its correlation with renal functional (creatinine, urea), and prognostic parameters (serum calcium-phosphorus product, urinary output), and with contrast-enhanced ultrasound (qualitative and quantitative evaluation). The study was prospective. A group of healthy (Group A) and a group of nephropathic dogs (Group B) were included. Shear wave elastography was performed on the left kidney of the subjects of both groups; contrast-enhanced ultrasound was performed only in dogs with acute kidney injury and acute on chronic kidney disease. Sixty-four dogs were included (Group A, n=24; Group B, n=40). The renal stiffness values were significantly higher in Group B than Group A; optimal cut-off stiffness values for detection of renal pathology were: ≥1.51 m/sec (area under the curve, 0.84; 95% confidence interval 0.74-0.94) and ≥6.75 kPa (area under the curve, 0.84; 95% confidence interval 0.73-0.94). For contrast-enhanced ultrasound, a significant positive correlation was found between renal stiffness, area under the curve, and wash-out area under the curve values of cortex quantitative analysis. No correlations were found between renal stiffness and renal functional and prognostic parameters. Shear wave elastography showed diagnostic utility to detect renal abnormalities in dogs with acute kidney injury, chronic kidney disease and acute on chronic kidney disease, however, it could not differentiate between these different nephropathies.

Влияние инфузионной терапии на функцию почек и лабораторные показатели в однодневном эксперименте

Changing views on the composition of infusion therapy in medical practice over the last decade is associated with certain side effects of infusion solutions. It is of relevance to study their influence on the kidneys, metabolism, electrolyte composition and, ultimately, on the patient's treatment results. The aim of the present work is to determine the effect of colloid and crystalloid solutions on renal function and laboratory parameters in experiment. The experimental study was performed on 28 rats (males) of Wistar line. Four experimental groups were formed: I control (n=7) — intact animals (without infusions and laparotomy), II (n=7) — laparotomy without infusions, III (n=7) — laparotomy + infusion of 6 ml of 6% hydroxyethyl starch, IV (n=7) — laparotomy + infusion of 6 ml of 0.9% sodium chloride solution. All animals underwent hematologic and biochemical blood tests, morphologic studies of kidneys. The most pronounced changes in blood tests and morphology were revealed during infusion of 6 ml of 0.9% sodium chloride solution. We observed leukopenia, decreased levels of albumin, cystatin C, cholesterol, alpha-amylase activity, increased concentration of bile acids compared to groups I and II. Morphologic study revealed significant dilatation of capsules of a part of tubules with dilated lumen of their capillaries, irregularly expressed full blood vessels. In addition, displacement of nuclei of nephrothelium to the apical pole of the cell was noted in the absence of homogeneity of cytoplasm with the presence of "enlightenments" in it. Infusion of hydroxyethyl starch did not change the main hematologic and biochemical blood parameters, except for the increase in alpha-amylase activity. Morphologic study did not reveal changes that would lead to acute kidney damage. All changes were reversible. Infusion of physiological solution caused shifts in both hematologic and biochemical blood parameters, in particular, hypoalbuminemia. The results of histologic study indicated redistribution of fluid in the interstitium.

99mTc-DTPA Renal Dynamic Imaging for Evaluating the Function of Duplex Kidneys in Adult Patients.

This study aimed to explore technetium-99m-diethylenetriaminepentaacetic acid (99mTc-DTPA) renal dynamic imaging to evaluate duplex kidney function in adult patients. We retrospectively analyzed the clinical data of 25 patients with duplex kidneys who underwent 99mTc-DTPA renal dynamic imaging between June 2011 and March 2023 at our hospital. Patients in the duplex kidney group (n = 25) were divided into renogram normal (n = 9) and abnormal (n = 16) groups according to the imaging data. Additionally, normal patients were selected as the control group (n = 25). After imaging, the region of interest of the kidneys was delineated, and renography was performed. Renography can provide renal function parameters, including glomerular filtration rate (GFR), Tmax, T1/2, renal clearance, and the GFR ratio of the duplex renal segment (upper renal moiety). Compared with the control group, the serum creatinine level in the duplex kidney group was higher (p = 0.025), GFR was lower (p = 0.001), and patients with impaired renal function were mainly in the abnormal renography group (p = 0.001). In the duplex kidney group, the GFR (p = 0.026) and renal clearance (p = 0.006) of the affected kidneys were lower than those of the contralateral kidneys, and Tmax (p = 0.025) was higher than that of the contralateral kidneys. There were no differences in renal function indicators of duplex renal segments with different GFR ratios. However, when the GFR ratio exceeded 50%, the renal function tended to decline. 99mTc-DTPA renal dynamic imaging was found useful to evaluate the total renal function, split renal function, and upper urinary tract patency in patients with duplex kidneys. Patients with abnormal renography results had worse renal function, and those with poor renal clearance in the affected renal moiety required surgical treatment.

Trudnoća i porođaj kod pacijentkinje sa ektopičnim transplantiranim bubregom i bilateralnom nagluvošću

Introduction: Pregnancy management and the choice of delivery method in kidney transplant patients are still a matter of debate. The goal is to achieve the balance between mother's underlying disease treatment and optimal conditions for fetal development and maturity. Case study: The patient is a 36-year-old woman whose first pregnancy was complicated by kidney transplantation 11 years ago. During hospitalization, the values of all renal function parameters and cyclosporine concentration in the blood were regularly monitored, and nephrologists and urologists were regularly consulted. Having in mind the pelvic presentation of the fetus, ectopic localization of the transplanted kidney and comorbidities such as deafness, gestational diabetes and gestational hypertension, the delivery was completed by caesarean section with the presence of a urologist and a healthy male child was born. Conclusion: By following the trends in current literature and applying team work, intensive supervision and adequate therapy for the mother and the fetus, it is possible to manage pregnancy in complicated transplanted patients and achieve outcomes equal to those of a physiological pregnancy.

Assessment of toxicity and anti-plasmodial activities of chloroform fractions of Carapa procera and Alchornea cordifolia in murine models.

Background: Plant as a source of medicine has gained international popularity in recent times because of its natural origin, availability in local communities, cheaper to purchase, ease of administration, and its usefulness as an alternative treatment in case of numerous side effects and drug resistance. However, the use of herbal formulations can also result in short-term and long-term organ damage or dysfunction to the host. In this study, chloroform fractions of the leaves of two medicinal plants, Alchornea cordifolia (ACL) and Carapa procera (CPL), were investigated for their toxicological and anti-malarial effects in murine models. Method: Acute (14-day) and sub-acute (28-day) studies were conducted based on the Organization for Economic Cooperation and Development (OECD) Guidelines in Institute for Cancer Research (ICR) mice and Sprague Dawley (SD) rats respectively. A dosage of 2000mg/kg body weight was administered orally to each ICR mouse during the acute study and 100, 300, and 1000mg/kg body weight to each SD rat during the sub-acute study. A 5-day curative anti-plasmodial activity was assessed in ICR mouse model. Results: The assessment of toxicity revealed that all three fractions did not influence mortality, clinical appearance, body weight gain, or necropsy at the various doses. Hematological and serum biochemical analysis indicated no significant elevations in liver and renal function parameters. Histopathological examinations of the liver indicated reversible liver degeneration with the chloroform fraction of the 100% ethanol extract of Carapa procera leaves (CPL100%) at 1000mg/kg. Anti-plasmodial assessments showed CPL100% exhibiting dose-dependent anti-plasmodial activity from 16% to 26.67%. On the other hand, chloroform fraction of the 100% ethanol extract of Alchornea cordifolia leaves (ACL100%) showed declining anti-plasmodial activity from 21.1% to 15.1%. Conclusion: These preliminary findings demonstrate that chloroform fractions of the leaves of Carapa procera and Alchornea cordifolia may be safe agents for treating malaria hence further development for drug discovery must be pursued.

Delirium in hospitalized COVID-19 patients: Predictors and implications for patient outcome.

Delirium is recognized as a severe complication of coronavirus-disease-2019 (COVID-19). COVID-19-associated delirium has been linked to worse patient outcomes and is considered to be of multifactorial origin. Here we sought to evaluate the incidence and risk factors of delirium in hospitalized COVID-19 patients, along with its impact on clinical outcome. Consecutive adult COVID-19 patients admitted to a tertiary academic referral hospital between March 1st and December 31st, 2020 were included. Potential risk factors for delirium were evaluated, including: age, gender, disease severity (as per the highest WHO grading reached during admission), laboratory parameters for infection and renal function (as per their most extreme values), and presence of comorbidities. To assess the relative strength of risk factors for predicting the occurrence of delirium, we performed a random-forest survival analysis. 347 patients with positive COVID-19 PCR test and median age 68.2 [IQR 55.5, 80.5] years were included. Of those, 79 patients (22.8%) developed delirium, 81 (23.3%) were transferred to ICU, 58 (16.7%) died. 163 (73.8%) patients were discharged home, 13 (5.9%) to another hospital, 32 (14.5%) to nursing homes, 13 (5.9%) to rehabilitation with an overall median admission-to-discharge time of 53 [IQR 14, 195] days. The strongest predictors for the occurrence of delirium were blood urea nitrogen (minimal depth value (MD): 3.33), age (MD: 3.75), disease severity (as captured by WHO grading; MD: 3.93), leukocyte count (MD: 4.22), the presence of a neurodegenerative history (MD: 4.43), ferritin (MD: 4.46) and creatinine (MD: 4.59) levels. The risk of delirium in COVID-19 can be stratified based on COVID-19 disease severity and-similar to delirium associated with other respiratory infections-the factors advanced age, neurodegenerative disease history, and presence of elevated infection and renal-retention parameters. Screening for these risk factors may facilitate early identification of patients at high-risk for COVID-19-associated delirium.

Investigations of Renal Function and Age-Related Macular Degeneration Phenotypes.

To investigate potential associations between renal function and age-related macular degeneration (AMD) features as assessed with multimodal retinal imaging. A subset of participants included in a dark adaptation study with varying AMD severities had estimated glomerular filtration rate (eGFR) values (mL/min/1.73 m2) obtained from renal function laboratory testing of serum creatinine and cystatin C. Multimodal imaging from visit dates associated with serum samples was graded by the Wisconsin Reading Center for AMD features. Associations of eGFR with AMD features and severity grades, age, smoker status and rod-intercept time were investigated. Simple univariate analyses, age-corrected multivariate analyses, and a feature-selecting least absolute shrinkage and selection operator regression were performed for eGFR as a continuous dependent variable. A total of 110 patients (mean age, 75.1 ± 9.4 years; mean eGFR, 70.7 ± 18.2 mL/min/1.73 m2) were included. In univariate analyses age (estimate, -1.16 units/year; 95% confidence interval [CI], -1.46 to -0.87; P < 0.0001), rod-intercept time (estimate, -0.54 units/minute; 95% CI, -0.81 to -0.27; P < 0.001) and subretinal drusenoid deposits (-11.12 units for subretinal drusenoid deposit presence in either eye; 95% CI, -20.23 to -2.01; P = 0.017) were associated with decreased renal function. However, in age-corrected multivariate models, age was the only significant variable associated with renal function, confirmed by least absolute shrinkage and selection operator regression. Accounting for age, renal function parameters did not show an association with AMD features. Bruch's membrane of the eye and the glomerular basement membrane of the kidney share physiologic similarities such that decreased renal function may demonstrate associations with AMD phenotypes.

Evaluation of Renal Function Status in Type II Diabetic Patients at Khartoum State, Sudan

Background: ‏ Type II Diabetes mellitus is the most common type of DM which constitute about 85-95% of all Diabetes mellitus cases. Diabetic nephropathy is the kidney disease that occurs as a result of diabetes complication. The aim of this study was to evaluate the renal function status in Sudanese type 2 diabetic patients at Khartoum state, Sudan.&#x0D; Materials and Method: This study was analytical case control hospital-based study conducted at International University of Africa Hospital, Khartoum state, Sudan, during the period from February to May 2022. Type II diabetic patients who attended at International University of Africa Hospital during aforementioned period were included. In addition to that, healthy participants were selected as control group. A total of 2.5 ml of whole blood was collected from each participant and dispensed into heparin anticoagulated containers for Blood urea and serum creatinine measurement. Measurement of blood urea and serum creatinine was done by using Biochemistry analyzer (Myndray-BS200).&#x0D; Results: When compared some renal function parameters between cases and control group, the results revealed that the mean blood urea, serum creatinine levels and blood glucose (random) concentration of the case group were significantly high when compared with the control group (0.000). In Gender-wise correlation of renal function tests (RFT) in the cases, the results showed that male patients had higher blood urea and serum creatinine levels when compared with female patients.&#x0D; Conclusion: Our results of the renal function tests examined; showed significant increase in blood urea, serum creatinine and blood sugar when compared with non-diabetic patients, which indicates abnormality in renal function status.&#x0D; Keywords: Blood urea, creatinine, diabetes, type II diabetes, DM, renal failure, kidney, hyperglycemia, renal function tests, glucose, random blood glucose

Relationship between the dose titration and adherence of mirogabalin in patients with peripheral neuropathic pain depending on renal function: a nationwide electronic medical record database study

ABSTRACT Background Mirogabalin has been attracting attention for treating peripheral neuropathic pain. The package insert recommends that mirogabalin should be titrated depending on renal function. Here, we investigated the relationship between dose titration patterns and adherence, and persistence of mirogabalin treatment. Research design and methods Peripheral neuropathic pain patients who initiated mirogabalin between March 2020 and May 2021 were identified using an electronic medical record database. The dose titration pattern was described according to degrees of renal function. Regression analyses were performed to compare adherence and persistence between the patients with and without titration. Results Of the 4,138 identified patients, 1,696 (41.0%) titrated the dose within 45 days and were more adherent than those without titration (Adjusted odds ratio: 1.75, 95% CI 1.21, 2.54). Of the total 952 patients with renal function parameters, 229 (24.1%) titrated to the effective dose within 45 days and were less likely to discontinue than those without titration (Adjusted hazard ratio: 0.57, 95% CI 0.40, 0.81). Conclusion Mirogabalin dose titration was associated with better adherence and persistence. It is important for mirogabalin treatment to determine the initial prescription dose based on renal function and subsequent dose titration according to the package insert. Trial registration UMIN000047313