Kidney Function In Patients Research Articles

Roxadustat combined with immunosuppressants for treatment of pure red cell aplasia with kidney injury.

Pure red cell aplasia is a rare condition that may be congenital or associated with an underlying disease.Immunosuppressants are a commonly employed therapeutic option for the treatment of pure red cell aplasia;however, they are associated with considerable adverse effects, including nephrotoxicity. This case report describesa 74-year-old patient with pure red cell aplasia who developed long-term kidney injury following cyclosporinetherapy. Renal anemia is a common complication after chronic kidney injury and contributes to the poor outcome ofanemia treatment. Following a series of medication adjustments, the final treatment with roxarestat combined withsirolimus proved effective in delaying the impairment of this patient's kidney function, with the hemoglobin levelremaining above 100 g/L throughout. This case report demonstrates the efficacy of roxarestat in conjunction with animmunosuppressive agent in the treatment of pure red cell aplasia combined with kidney injury, with a dual effect ofalleviating the anemia and reducing serum creatinine levels.

A side effect that should be considered in patients using metformin: lactic acidosis

The most serious and life-threatening side effect seen in patients using metformin is metabolic acidosis. If there is a history of diabetes in patients with high anion gap metabolic acidosis who present to the emergency department, metformin use should be questioned. In our case, metformin-related lactic acidosis was detected in a 67-year-old female patient who applied to the emergency department with a complaint of palpitations. The patient's kidney function tests were within normal range and he did not describe excessive drug intake. Despite the treatments administered in the emergency room, the patient's blood gas lactate level continued to increase and his acidosis deepened. After other causes of lactic acidosis were excluded, the patient was consulted with internal medicine and transferred to the intensive care unit. With this case report, we tried to draw attention to the fact that the patient group for which metformin will be used in the treatment should be carefully selected and that lactic acidosis, which is a fatal side effect, should be considered in the differential diagnosis and treatment should be started in those using this drug.

Bromadiolone may cause severe acute kidney injury through severe disorder of coagulation: a case report

BackgroundBromadiolone is a wide-use long-acting anticoagulant rodenticide known to cause severe coagulation dysfunction. At present, there have been no detailed reports of acute kidney injury (AKI) resulting from bromadiolone poisoning.Case presentationA 27-year-old woman was admitted to the hospital due to severe coagulopathy and severe AKI. Coagulation test revealed a prothrombin time exceeding 120 s and an international normalized ratio (INR) greater than 10. Further examination for coagulation factors showed significantly reduced level of factors II, VII, IX and X, indicating a vitamin K deficiency. The AKI was non-oliguric and characterized by gross dysmorphic hematuria. Following the onset of the disease, the patient’s serum creatinine rose from 0.86 to 6.96 mg/dL. Suspecting anticoagulant rodenticide poisoning, plasma bromadiolone was identified at a concentration of 117 ng/mL via gas chromatography/mass spectrometry. All other potential causes of AKI were excluded, except for the presence of a horseshoe kidney. The patient’s kidney function fully recovered after the coagulopathy was corrected with high doses of vitamin K and plasma transfusion. At a follow-up 160 days post-discharge, the coagulation function had normalized, and the serum creatinine had returned to 0.51 mg/dL.ConclusionBromadiolone can induce AKI through a severe and prolonged coagulation disorder. Kidney function can be restored within days following treatment with high-dose vitamin K1.

Hypoaldosteronism due to a novel SEC61A1 variant successfully treated with fludrocortisone.

Genetic variants in SEC61A1 are associated with autosomal dominant tubulointerstitial kidney disease. SEC61A1 is a translocon in the endoplasmic reticulum membrane and variants affect biosynthesis of renin and uromodulin. A patient is described that presented at 1 year of age with failure-to-thrive, kidney failure (glomerular filtration rate, GFR, 18 ml/min/1.73m2), hyperkalemia and acidosis. Genetic evaluation was performed by whole genome sequencing. The patient has a novel de novo heterozygous SEC61A1 variant, Phe458Val. Plasma renin was low or normal, aldosterone was low or undetectable and uromodulin was low. Kidney biopsy at 2 years exhibited subtle changes suggestive of tubular dysgenesis without tubulocystic or glomerulocystic lesions and with renin staining of the juxtaglomerular cells. The patient experienced extreme fatigue due to severe hypotension attributed to hypoaldosteronism and at 8 years of age fludrocortisone treatment was initiated with marked improvement in her well-being. Blood pressure and potassium normalized. Biopsy at 9 years showed extensive glomerulosclerosis and mild tubulointerstitial fibrosis, as well as tubular mitochondrial abnormalities, without specific diagnostic changes. Her GFR improved to 54 ml/min/1.73m2. As the renin-angiotensin system promotes aldosterone release, and the patient had repeatedly undetectable aldosterone levels, the SEC61A1 variant presumably contributed to severe hypotension. Treatment with a mineralocorticoid had a beneficial effect and corrected the electrolyte and acid-base disorder. We suggest that the increased blood pressure hemodynamically improved the patient's kidney function.

A case of acute kidney injury and Fanconi syndrome while taking multiple supplements, including Red Yeast Rice Cholesterol Help®.

A 62-year-old man visited his primary care physician with the complaints of loss of appetite and fatigue. He was admitted to our hospital based on a diagnosis of acute kidney injury, Fanconi syndrome as indicated by hypokalemia, hypouricemia, hypophosphatemia, elevated glucose levels in urine, and aminoaciduria. He had been taking multiple supplements, including Red Yeast Rice Cholesterol Help®, for one and a half years. After admission, all the supplements were stopped. Blood samples were collected; however, the samples were negative for diseases that could cause Fanconi syndrome. Renal biopsy revealed renal proximal tubular damage, mainly characterized by simplification of the proximal tubular epithelium. The mycotoxin, citrinin, which is reported to be produced by the mold used for producing red yeast rice, but not the mold Monascus pilosus used for Red Yeast Rice Cholesterol Help®, reportedly causes proximal tubular damage. However, although the causative agent has not been identified, it was thought that a substance similar to citrinin, produced by the mold used for Red Yeast Rice Cholesterol Help®, caused proximal tubular damage, leading to acute kidney injury and Fanconi syndrome. Hence, all supplements were stopped, and the patient was treated with oral potassium and phosphorus preparations, leading to gradual recovery of his kidney function. We herein report the first case of acute kidney injury and Fanconi syndrome in a patient taking multiple health supplements, including Red Yeast Rice Cholesterol Help®. Early discontinuation of the oral supplements was probably useful in improving the patient's kidney function.

#1135 Evaluation of the adequacy of urate lowering therapy prescriptions in patients with chronic kidney disease: results from the CKD-REIN cohort

Abstract Background and Aims Urate Lowering Therapy (ULT) is frequently prescribed to patients with chronic kidney disease (CKD). However, these prescriptions are often inadequate when considering kidney function. Studies evaluating the appropriateness of ULT in the CKD population are predominantly cross-sectional. Yet, the evolution and reassessment of prescriptions remain unexplored in this context. This study aims to assess the prevalence of inappropriate ULT prescriptions (whether contraindications or inappropriately high doses) with regard to kidney function in patients with CKD. Method We used 5-year longitudinal data from the CKD-REIN cohort, a nationwide sample of 3033 nephrology outpatients with moderate-to-advanced CKD. Prescriptions for colchicine, used in the treatment of acute gout attacks, and ULT, such as allopurinol and febuxostat, were prospectively recorded. An inappropriate prescription was defined as the reported prescription of either a contraindicated drug, an indicated drug at an inappropriately high dose level, or a non-recommended prescription relative to the patient's eGFR, as estimated with de-indexed CKD-EPI equation and according to the European (or French if not available) summary of product characteristics. For patients initiating ULT during follow-up, uric acid levels were compared six months before and after the initiation of ULT. Results At baseline, 987 (33%) out of the 3033 included patients (mean ± standard deviation age 67 ± 13 years, 65% men) were prescribed ULT, with 781 (26%) receiving allopurinol and 206 (7%) receiving febuxostat. Compared to patients without a prescription for ULT, those with a ULT prescription were more frequently male, older, had lower kidney function, higher cardiovascular comorbidities, and were more commonly prescribed diuretics and inhibitors of the renin-angiotensin system. Moreover, their uric acid levels were lower (patients with ULT prescription 377.0 ± 110.4 µmol/L versus without ULT prescription 456.5 ± 116.4 µmol/L, p < 0.001). Notably, 316 (40%) allopurinol prescriptions were prescribed at inappropriately high dosages, while 77 (37%) febuxostat prescriptions were not recommended (resulting in a total of 393 (40%) inappropriate ULT prescriptions at baseline). Of the 54 colchicine prescriptions, one-third (n = 18) were contraindicated according to kidney function and nine were prescribed “on-demand” for crisis anticipation. During a median follow-up of 5.0 [1st-3rd quartile, 4.0–5.1] years, 253 patients were newly prescribed allopurinol and 176 were newly prescribed febuxostat, 54 (21%) out of 253 new allopurinol prescriptions were at inappropriately high dosages, and 68 (39%) out of the 176 new febuxostat prescriptions were not recommended based on the patient's kidney function (Figure). The majority of initially inappropriate ULT prescriptions (n = 393) remained so during follow-up (274 (70%)). Among the 179 patients initiating ULT during follow-up and with available data on uric acid levels, there was a significant decrease in uric acid levels after ULT initiation compared to before initiation (before: 494.5 ± 146.2 µmol/L versus after 408.5 ± 130.9 µmol/L, p < 0.001). A total of 197 patients had initiated colchicine during follow-up, with 61 (31%) receiving contraindicated prescriptions, and 18 (9%) having “on-demand” prescriptions. Conclusion Our findings emphasize the lack of reassessment of ULT prescriptions during the follow-up of patients with CKD. Colchicine prescriptions in case of severe kidney impairment persist despite contraindications. Further evaluation is required to understand the association between ULT prescriptions and the progression of kidney disease.

De-indexed estimated glomerular filtration rates for the dosing of oral antidiabetic drugs in patients with chronic kidney disease.

Introduction: Adjusting drug dose levels based on equations that standardize the estimated glomerular filtration rate (eGFR) to a body surface area (BSA) of 1.73m2 can pose challenges, especially for patients with extremely high or low body mass index (BMI). The objective of the present study of patients with CKD and diabetes was to assess the impact of deindexing creatinine-based equations on estimates of kidney function and on the frequency of inappropriate prescriptions of oral antidiabetic drugs (OADs). Methods: The prospective CKD-REIN cohort is comprised of patients with eGFR <60mL/min/1.73m2. The inclusion criteria for this study were the use of OADs and the availability of data on weight, height and serum creatinine. We compared data for three BMI subgroups (group 1 <30kg/m2; group 2 30-34.9kg/m2; group 3 ≥35kg/m2). Inappropriate prescriptions (contraindicated or over-dosed drugs) were assessed with regard to the summary of product characteristics and the patient's kidney function estimated with the 2009 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, the 2021 CKD-EPI equation, the Modification of Diet in Renal Disease (MDRD) equation, the European Kidney Function Consortium (EKFC) equation, their deindexed estimates, and the Cockcroft-Gault (CG) formula. The impact of deindexing the equations was evaluated by assessing 1) the difference between the indexed and deindexed eGFRs, and 2) the difference in the proportion of patients with at least one inappropriate OAD prescription between the indexed and deindexed estimates. Results: At baseline, 694 patients were receiving OADs. The median BMI was 30.7kg/m2, the mean BSA was 1.98m2, and 90% of patients had a BSA >1.73m2. Deindexing the kidney function estimates led to higher eGFRs, especially in BMI group 3. The proportion of patients with at least one inappropriate prescription differed greatly when comparing indexed and deindexed estimates. The magnitude of the difference increased with the BMI: when comparing BMI group 1 with BMI group 3, the difference was respectively -4% and -10% between deindexed 2021 CKD-EPI and indexed CKD-EPI. Metformin and sitagliptin were the most frequent inappropriately prescribed OADs. Conclusion: We highlight significant differences between the BSA-indexed and deindexed versions of equations used to estimate kidney function, emphasizing the importance of using deindexed estimates to adjust drug dose levels - especially in patients with an extreme BMI.

Recurrent flash pulmonary edema in unilateral renal artery stenosis with contralateral kidney shrinkage: A case report.

Flash pulmonary edema is a critical medical condition characterized by sudden and severe fluid accumulation in the lungs, which poses an immediate and life-threatening emergency. This can arise from a variety of underlying causes. This manuscript presents a case of recurrent pulmonary edema that was successfully managed through the insertion of a renal artery stent. A 78-year-old woman visited the emergency room with recurrent acute dyspnea. Computed tomography renal angiography revealed renal artery stenosis of a single-functioning kidney. Flash pulmonary edema caused by renal artery stenosis of a functioning single kidney. Percutaneous transluminal angioplasty and stenting were performed for the renal artery stenosis. The patient's kidney function rapidly improved, and she has been free of flash pulmonary edema for 2 years. Flash pulmonary edema can have various causes and can immediately be a life-threatening emergency. However, it can be treated with percutaneous revascularization if it is caused by renal artery stenosis. This case report reinforces the importance of accurate and immediate diagnosis when dealing with flash pulmonary edema. This case emphasizes the potential therapeutic benefit of renal artery stenting in the management of flash pulmonary edema caused by renal artery stenosis in patients with a single-functioning kidney.

#3928 NEPHROTIC SYNDROME IN LIVER DISEASES: PRESENTATION OF TWO UNUSUAL AND INSTRUCTIVE CASES

Abstract Background and Aims However, there are known associations between chronic liver diseases and glomerulopathies, here we report two rare cases, where diagnostic and therapeutic challenges influenced the patients’ care. Method The patients’ medical parameters were obtained from the electronical charts of the hospital. Kidney biopsy samples were examined with immunofluorescence (frozen samples), light microscopy (paraffin embedded tissue, 2-3 um sections) and electron microscopy (1 um, toluidine blue). The follow-up time was 24 months for case 1 and 23 months for case 2. Both patients gave written consent to the presentation of the reports. Results Case 1: A 42-year-old man with recent pulmonary embolism was presented in our hospital with nephrotic syndrome and reduced kidney function (estimated glomerular filtration rate (eGFR): 43 ml/min/1.73 m2, urinary protein/creatinine ratio (UPCR): 2124 mg/mmol, serum albumin: 24 g/L). Kidney biopsy confirmed primary membranous nephropathy (MN). The anti-phospholipase-A-2 receptor (aPLA2R) was positive in high titer, and PLA2R positivity was also seen in the renal sample. Additionally, an active hepatitis C (HCV) infection with viremia was confirmed. The nephrotic syndrome was worsened with severe edema requiring ultrafiltration; therefore, after one-week direct anti-HCV therapy, methylprednisolone was started. Immunosuppressive therapy had to be determined soon due to severe infections. With combined direct antiviral treatment, HCV PCR test became negative, which was followed by the disappearance of the aPLA2R antibodies. The patient's kidney function stabilized and there are no symptoms of nephrotic syndrome (eGFR: 52 ml/min/1.73 m2, serum albumin: 37 g/L, UPCR: 321 mg/mmol). Case 2: A 66-year-old woman was admitted to the hospital with coronavirus disease (COVID)- associated pneumonia. At admission, nephrotic syndrome was diagnosed (eGFR: 29 ml/min/1.73 m2, serum albumin: 22 g/L, proteinuria: 8 g/day). Additionally, elevated gamma glutamyl transferase was registered. Immune serology was negative for aPLA2R, but antinuclear antibodies (anti-cytoplasm, chromatin, Ro), and anti-mitochondrial antibodies (AMA-M2) were positive. Biopsies were performed after the COVID infection. Liver biopsy confirmed primary biliary cholangitis (stage 1-2), while the kidney biopsy showed secondary membranous nephropathy with signs of potential monoclonal gammopathy (monoclonal immunoglobulin-G1-kappa deposits). After the exclusion of malignancies, monoclonal gammopathy, and potential other causes of the secondary MN, PBC-associated MN was diagnosed. Based on case reports in the literature, cyclosporine A treatment was started. The patient reached complete remission in 5 months (no significant proteinuria, stable eGFR around 34 ml/min/1.73 m2). Conclusion The association of an active HCV infection and an aPLA2R positive MN has not been reported in the literature. Nephrotic syndrome and the aPLA2R positivity disappeared related to the direct antiviral treatment, which may indicate a diagnosis of secondary MN. PBC-associated secondary MN is a known but rare entity, where calcineurin inhibitor treatment may reduce the symptoms of nephrotic syndrome.

#3585 FAT1 ANTIGEN IN PATIENTS WITH MEMBRANOUS NEPHROPATHY AFTER HEMATOPOIETIC STEM CELL ALLOTRANSPLANTATION: A CASE SERIES

Abstract Background and Aims Nephrotic syndrome (NS) is a rare complication of haematopoietic stem cell transplantation (HSCT). When it occurs, it usually develops after cessation of immunosuppressive therapy, which is why it is commonly denominated as a renal form of chronic graft-versus-host disease. Membranous nephropathy (MN) is the most common pathological finding. The protocadherin FAT1 antigen is a novel antigen identified only in patients with MN who have undergone allogeneic HSCT. PLA2R and NELL1 antigens can also be found, even though they are rare and not specific to HSCT-associated MN. The aim of this study was to present a case series of allogeneic HSCT-associated MN, the treatment, outcomes and presence of a novel antigen specifically detected in this population. Method All patients with full blown NS due to MN after HSCT in UHC Zagreb were enrolled. Kidney biopsy was performed and examined by light, immunofluorescence and electron microscopy. Biopsy samples were sent to Renal Pathology Laboratory, Department of Laboratory Medicine and Pathology, Mayo Clinic for detection of FAT1 antigen in biopsy tissue samples Results In last 30 years there had been 1302 HSCT in UHC Zagreb and three of them developed MN. The first two patients were treated with allogeneic HSCT for acute myeloid leukaemia (AML). Both developed NS after cessation of GVHD prophylaxis, after 1 and 8 months respectively. The first patient's kidney function was preserved, while the second patient's was reduced. Kidney biopsy showed MN. Thorough examination found no secondary cause of the disease. In the first patient, complete remission (CR) was achieved after 5 months of steroids, 2 boluses of cyclophosphamide (CP) and cyclosporine treatment. The second patient reached partial remission (PR) after 6 months of steroid treatment and oral CP. Immunosuppression was terminated due to infectious complications. CR was achieved after an additional 8 months while the patient was not taking immunosuppressants. Both patients remained in CR during the follow-up period. The third patient with acute lymphoblastic leukaemia (ALL) underwent a related peripheral blood HSCT. Sixteen years later, he developed NS with preserved renal function and was diagnosed with MN. Apart from thyroid disease, no secondary cause was detected and he was treated with rituximab. Partial remission (PR) was achieved after 24 months of therapy. Anti-PLA2R antibodies were negative in all three cases. Tissue samples from patients 1 and 2 were positive for FAT1 antigen using laser microdissection and tandem mass spectrometry (MS/MS) of glomeruli. The third patient was negative for FAT1. Clinical and biopsy findings in our cohort of HSCT-associated MN are summarised in Tables 1 and 2. Conclusion MN can occur at different points in time, sometimes even years, after HSCT. It can be successfully treated with steroids and immunosuppressants, achieving long-term remission. Most patients with HSCT-associated MN are FAT1-positive, although it is not the only antigen associated with MN in HSCT patients. In the future, serum testing for anti-FAT1 antibodies in patients with HSCT could be of similar significance in diagnosing FAT1-associated MN as PLA2R antibodies are for PLA2R-associated MN.

Evaluation of The Effects ofAmlodipine Therapy on Blood Pressure and KidneyFunction among Hypertensive Patients in Mosul City

The present snrdy was mnducted to evaluate fte effect of amlodipine on blmd p€ssurc and kidney function inpatients in Mosul clb,. Thirty patients participated in ftis S.rdy ( 14 female ard 16 nrale )Arnlodipine was administercd for a period of 8 weeks in doses of 5 to l0 mg once daily. Antlripentensive efficacy wasassesd by measurement of blood pressure by standand mercury sphygmomanometer before and afur rcdnent . Bloodsampleswercobtained fiomeachpatientbeforeardafurteatnentand tlreobtainedserawereanalpodforruralpaarnetasvririch they all measr"ned in serum by using mlorimetic and en4anaic mehod. Credinine cleararce was calculded bywingthe Cockoft and Gault ecluation.The resulb of the study showd that anlodipine drerqpy lead tl a sigrificant reduction in blood pressue tllrugfrout thestudy and about 5fflo ofthe patien8 exhibit BP reduction tc notmal values afur drerapy. CreAinine clearance was significarflyincreased afur the end of the sudy . All other renal parameten including urea , credinine, sodilnn and potassiumconcentdions showed a sigrificant reductions. It was concluded that therapy with arnlodipine car be useful ard effediveflrcmpyinhpefiensivepaientswith deterioratdkidneysfi.lictionin oncedailydosage.

A rare presentation of acute kidney failure due to retroperitoneal fibrosis as a result of gastric linitis plastica: a case-based review

This case study details the experience of a 52-year-old Dutch man, with a 4-month history of epigastric pain and weight loss, who was presented to a urology team and found to have rapidly deteriorating renal function with bilateral hydronephrosis. This prompted his admission to hospital for insertion of bilateral JJ ureteral stents. However, the patient's kidney function continued to worsen despite relief of the obstruction. He became increasingly oliguric and was referred to the renal service. Retroperitoneal fibrosis with acute kidney injury resulting from both obstruction and compression of the urinary system was suspected. Treatment with high-dose steroid was initiated. Shortly after, the patient's urine volume began to increase and his kidney function improved drastically. This avoided the need for dialysis. A month after discharge, the patient was diagnosed with poorly differentiated adenocarcinoma cells of the stomach, a diagnosis consistent with linitis plastica.

Conservative treatment of emphysematous pyelonephritis and diabetes

Emphysematous pyelonephritis (EPN) is a rare but serious infectious disease caused by anaerobic bacteria that is characterized by necrotizing renal parenchymal infection and has a high mortality rate. The initial management of EPN includes resuscitation, antibiotics, management of any diabetes, and minimally invasive procedures, such as percutaneous drainage. Surgery is required in the most severe cases. Here, we describe a male patient with type 2 diabetes who presented with fever and abdominal pain and was diagnosed with EPN based on laboratory results and a computed tomography (CT) scan showing distension of the left kidney, several small air bubbles in the perirenal space, and thickening of the perinephric fascia. A subcutaneous insulin infusion and meropenem were administered. Repeat CT imaging 13 days later showed gas and necrotic tissue in the renal parenchyma. Therefore, CT-guided renal puncture was performed, and Escherichia coli was cultured from the drained pus. Antibiotic treatment was continued for 20 days after admission when the patient's kidney function and clinical symptoms had significantly improved. Sixty days after diagnosis, left nephrectomy was performed. The perinephric abscess was under high tension, and the left kidney was very soft. Histopathological examination revealed severe inflammation and necrosis of the renal pelvis, with fibrosis. The patient recovered well after surgery and remained alive 5 months later. EPN is a very rare disease with a high mortality rate and is more likely to occur in patients with diabetes. Early diagnosis and treatment of the infection are extremely important. For patients in whom gas and/or necrosis continue to accumulate after conservative treatment, we recommend nephrectomy.

Acute interstitial nephritis and nephrogenic diabetes insipidus following treatment with sulfamethoxazole‐trimethoprim and temozolomide

We report a case of acute interstitial nephritis with associated nephrogenic diabetes insipidus in a patient treated with temozolomide and sulfamethoxazole-trimethoprim for glioblastoma multiforme. Kidney biopsy demonstrated focal tubulointerstitial change with tubular dilatation, epithelial change and interstitial inflammation. The patient's kidney function improved with cessation of sulfamethoxazole-trimethoprim and treatment with hydrochlorothiazide for nephrogenic diabetes insipidus. Recommencement of temozolomide did not result in further deterioration in kidney function. In this case report, we discuss the novel association between sulfamethoxazole-trimethoprim-induced acute interstitial nephritis and nephrogenic diabetes insipidus, and suggest possible mechanisms involved.

Comparison of Patient's Kidney Function Based on Kidney Disease Improving Global Outcomes (KDIGO) Criteria and Clinical Parameters in Isolated Coronary Artery Bypass Graft (CABG) Surgery in On-Pump and Off-pump Methods in Patients with Low Cardiac Output Syndrome (LCOS) After Surgery.

BackgroundAcute kidney injury (AKI) is one of the serious complications of cardiac surgery. It is worsened when accompanied by low cardiac output syndrome.ObjectivesIn this study, we compared kidney function based on the KDIGO criteria in isolated on-pump and off-pump coronary artery bypass graft (CABG) surgery.MethodsIn this cohort study, 52 patients with LCOS were enrolled after on-pump (28 patients) and off-pump (24 patients) CABG. In the first six hours after ICU entrance, blood samples were taken for serum creatinine based on routine. For determining AKI after surgery, we used the KDIGO criteria as a primary endpoint. Also, some clinical parameters were recorded before, during, and after surgery. The data were analyzed by SPSS software, version 24, using paired and independent t-test, ANOVA, and Pearson correlation test and non-parametric tests such as Mann-Whitney and Kruskal-Wallis tests at a significance level of P < 0.05.ResultsThere was no significant difference in age (P = 0.3) and gender (P = 0.57) between the two groups. Among cardiac disease risk factors, only hypertension (P = 0.02) had a significant difference between the two groups, but AKI in patients with hypertension did not show a significant difference (P = 0.09). In paraclinical parameters, serum creatinine showed a significant difference before and after surgery in on-pump (P < 0.001) and off-pump (P = 0.007) groups. Also, this parameter had a significant difference at 6 h, 12 h, 24 h, and 48 h after surgery between the on-pump and on-pump groups. The AKI incidence showed a significant difference between the two groups (P < 0.001).ConclusionsThe incidence of AKI was more in on-pump patients than in off-pump patients. Also, a significant difference was observed between their clinical parameters. Thus, to improve the patients’ clinical outcomes and lower the health costs, we suggest that patients with a high risk of LCOS be followed up after CABG, especially on-pump CABG.

Treatment of coronary artery disease in renal insufficiency

The treatment of chronic but stable coronary artery disease is based on the stages of chronic kidney disease (CKD) stages G1-2 and stages G3-G5, distinguishing between advanced kidney disease (stages G3-G5) and end-stage kidney disease (G5D) treated by dialysis. In Germany, national guidelines are followed for patients with normal kidney function in addition to the recommendations of Kidney Disease - Improving Global Outcomes (KDIGO) for CKD patients. These guidelines focus on standard of care and include treatment with aspirin, statins, beta-blockers, inhibitors of the renin-angiotensin system, and sodium glucose cotransporters for patients with cardiovascular disease. Revascularization strategies follow amore pragmatic approach for the fragile, comorbid, and aging patient population. Younger patients appear to benefit from surgical interventions. Treatment of acute events is currently administered independent of the patient's kidney function, but there is no consensus yet on the best strategy. The focus of our efforts should be, via more controlled studies, to avoid "navigating through the darkness" to reach the end of the tunnel.

Ketidaksesuaian Dosis dan Interval Pemberian Antibiotik pada Lansia di Bangsal Penyakit Dalam RSUD dr Moewardi Solo serta Gambaran Timbulnya Efek Samping yang Merugikan

Aging causes a decrease in renal blood flow velocity and clearance values ​​related to renal filtration function. A decrease in kidney filtration function results in a decrease in the ability of drug elimination so that the drug and its metabolites tend to accumulate in the blood. The dose of certain antibiotics must be adjusted to the patient's kidney function. Clinical estimates of kidney filtration function are expressed in terms of creatinine clearance (CrCl). This study aims to determine the percentage of suitability of the dose and interval of antibiotic administration with the CrCl value of elderly patients and to see description of the side effects arising from the administration of antibiotics.&#x0D; This research was observational with data retrospective retrieval of medical records. The subjects of the study were elderly patients who were hospitalized in the ward ward in dr. Moewardi Solo Hospital in the period January - May 2019 , ≥ 60 years aged with a diagnosis of Pneumonia, Urinary Tract Infection (UTI), Cellulitis and sepsis with complete medical record data. The antibiotics evaluated are all antibiotics given to the patient while being treated.&#x0D; The results showed the suitability of the dose and interval of antibiotic administration with the CrCl value of elderly patients hospitalized in the disease ward in RSUD Dr. Moewardi Solo for the period January-May 2019 was 63.35%, the incidence of side effects arising from the administration of antibiotics was nausea and vomiting (10 patients ) and diarrhea (4 patients).

LO01: Development and validation of an adjustment score for ruling out MI using a single high-sensitivity cardiac troponin T assay in patients with chest pain and kidney dysfunction

Introduction: Very low concentrations of high-sensitivity cardiac troponin can rule-out myocardial infarction (MI) at ED arrival in patients with chest pain. However, this single troponin rule-out strategy works poorly in patients with renal impairment and elevated baseline troponin levels. The objective of this study was to develop and validate a troponin adjustment strategy to accurately rule-out MI with a single hs-cTnTmeasurement in patients with kidney dysfunction. Methods: We used data from three cohorts of ED chest pain patients to develop an adjustment score for a high-sensitivity troponin T (hs-cTnT) assay in patients with kidney dysfunction. The derivation cohort (n = 8846) used administrative and registry data. Two validation cohorts (n = 1187 and 1092) were prospectively-collected. The score assigned points for increasing hs-cTnT levels and subtracted points for lower estimated glomerular filtration rate (eGFR). In the derivation cohort, hs-cTnT concentrations achieving 98.5% sensitivity in of patients with eGFR ≥60, 45-59, 30-44, 15-29 and &amp;lt;15 were assigned ascending positive integer values. Negative integer values were assigned to eGFR values 45-59, 30-44, 15-29 and &amp;lt;15. The scpres for troponin and eGFR were summed for each patient, with scores ranging from −4 to +5. The proportion of patients with 7-day MI ruled out by a score ≤0, sensitivity, NPV, negative likelihood ratio (LR-) and area under the curve (AUC) were quantified in each study cohort. Results: The derivation and validation cohorts had 7-day MI rates of 5.7, 8.6 and 9.1%. In the derivation cohort, a score ≤0 ruled out MI in 35% of patients, with a sensitivity for 7-day MI of 99.5% (95% CI 98-100), NPV of 99.9% (95% CI 98.4-99.9), LR- of 0.02 (95% CI 0.01-0.05) and AUC of 0.88. In the first validation cohort, a score ≤0 ruled out MI in 45% of patients, with a sensitivity for 7-day MI of 97% (95% CI 90-100%), NPV of 99% (95% CI 98-100%), LR- 0.06 (0.02-0.18) and AUC of 0.89. In the second validation cohort, a score ≤0 ruled out MI in 20% of patients, with a sensitivity for 7-day MI of 96% (95% CI 93-99%), NPV of 98% (95% CI 96-100%), LR- of 0.16 (95% CI 0.07-0.39) and AUC of 0.78. Conclusion: We developed and validated a simple scoring system to adjust hs-cTnT concentrations for a patient's kidney function that enables MI to be ruled out in a large proportion of chest pain patients using a single measurement on ED presentation.

Population pharmacokinetics and pharmacodynamics of fondaparinux inJapanese patients after artificial total kneereplacement .

This study was designed to clarify the factors affecting the efficacy, adverse events, and pharmacokinetics of fondaparinux in Japanese patients undergoing artificial knee replacement surgery. Fondaparinux (1.5mg/d) was administered subcutaneously to patients (n=30) at 24hours after surgery, and blood samples were taken at various time points thereafter. Venous thromboembolism (VTE), presence of bleeding, and pharmacokinetics were evaluated. Multivariate analysis and population pharmacokinetic analysis were performed to detect factors that necessitated withdrawal of fondaparinux and individual differences in its pharmacokinetics. VTE was observed in 9 patients (3 for whom administration was continued and 6 for whom withdrawal was necessary). The maximum plasma concentration of fondaparinux was found to be a significant factor determining withdrawal of the drug. Population pharmacokinetic analysis demonstrated that individual renal function and body weight were significant factors associated with apparent clearance and volume of distribution, respectively. A high maximum plasma concentration of fondaparinux may result in subcutaneous hemorrhage, necessitating withdrawal of fondaparinux administration. The patient's kidney function and body weight also contribute to individual differences in pharmacokinetics. We recommend considering an adjustment to the dose of fondaparinux based on body weight in patients undergoing artificial knee replacement surgery. .

Kinetic glomerular filtration rate equation can accommodate a changing body volume: Derivation and usage of the formula

Ascertaining a patient's kidney function is more difficult to do when the serum creatinine is changing than when it is stable. To accomplish the task, various kinetic clearance equations have been developed. To date, however, none of them have allowed for ongoing changes to the creatinine's volume of distribution. These diluting or concentrating effects on the [creatinine] can greatly impact the accuracy of kidney function assessment. Described herein is a model of creatinine kinetics that also accommodates volume changes. The differential equation is solved for the kinetic glomerular filtration rate (GFR), which is helpful information to the physician. Some of the equation's discontinuities, such as from dividing by a volume rate of zero, can be resolved by using limits. Being “volume-capable,” the new kinetic equation reveals how a changing volume influences the maximum rate of rise in [creatinine], a parameter that heretofore was chosen empirically. To show the advantages of incorporating volume, the new and old kinetic equations are applied to a clinical case of overzealous fluid resuscitation. Appropriately, when the volume gain's dilution of [creatinine] is taken into account, the creatinine clearance is calculated to be substantially lower. In conclusion, the kinetic GFR equation has been upgraded to handle volume changes simultaneously with [creatinine] changes.