Plasma Creatinine Concentration Research Articles

Early metabolic and hemodynamic indicators of kidney dysfunction in mice offspring from parental low protein diet

BackgroundParental malnutrition, particularly a low-protein diet (LPD), causes oligonephropathy at birth and predisposes offspring to hypertension and chronic kidney disease later in life. The onset of adult kidney disease varies based on genetics and environmental factors, often with subclinical alterations in kidney function being overlooked. This study aimed to examine changes in kidney morphology before significant kidney function decline in the offspring of mice fed a low-protein diet.MethodsUsing a combination of histological analysis, kidney metabolic and hemodynamic panel assessments, and advanced statistical techniques such as Linear Discriminant Analysis (LDA) and Principal Component Analysis (PCA), we investigated the initial impact of a maternal low-protein diet (LPD) on kidney development and function. Our study utilized 12-week-old F1 mice from F0 parents fed either a low-protein diet (LPD) or a normal-protein diet (NPD) before the onset of hypertension.ResultsThe offspring (F1 generation) of parents (F0 generation) fed an LPD show reduced body weight from birth to P20. The kidney weight was also reduced compared to F1 offspring from parents fed an NPD. At 12 weeks of age, body weight normalized, but kidney weight remained low. Offspring of parents fed an LPD displayed abnormal kidney morphology, including dilated tubules, oligonephropathy, and fluid-filled cysts which had worsened with age. A kidney metabolic panel analysis at 12 weeks revealed a slight but consistent increase in urine albumin, plasma creatinine, mean urea, and BUN concentrations. Although no significant changes in hemodynamic variables were observed, 2/12 mice, both males, showed alterations in systolic blood pressure, suggesting sex-specific effects when comparing F1 mice from F0 fed either diet. Overall, kidney metabolic changes were strongly correlated to parental LPD.ConclusionOur findings indicate that significant kidney damage must accumulate in the F1 generation from parents fed an LPD before any detectable changes in blood pressure occur. Our study suggests that small variations in kidney metabolic function may point to early kidney damage and should not be overlooked in the offspring of these malnourished mice and likely humans.

Effects of diluted seawater in drinking water on physiological responses, feeding, drinking patterns, and water balance in crossbred dairy goats

Background and Aim: In tropical regions, the intrusion of saline from seawater (SW) due to global warming and sea level rise in recent years is an important natural factor influencing goat well-being. This study aimed to determine the effects of diluted SW in drinking water on the physiological responses and eating and drinking patterns of crossbred dairy goats under tropical conditions. Materials and Methods: Twenty dairy goats were divided into four groups (five animals each) based on body weight and milk yield. Animals received either fresh drinking water (SW0.0, control) or diluted SW at concentrations of 0.5% (SW0.5, low salinity), 1% (SW1.0, moderate salinity), and 1.5% (SW1.5, high salinity). The experiment was performed for 49 days (1st–7th week). Throughout this period, daily food and water intake were measured every day. In addition, blood collection was performed on day 25. Total urine and feces were collected from days 25 to 29. Meal and drinking patterns were determined on days 31 and 32. Results: Salinity did not influence dry matter intake throughout the experiment (p > 0.05). However, SW had a significant effect on eating patterns. The effect of SW on water intake (WI) was pronounced from the 2nd to 7th weeks of this experiment (p < 0.05). The water balance decreased and plasma antidiuretic hormone levels increased from SW1.5 to SW2.5 compared to the other treatments. Rectal temperature and respiration rate increased from 15:00 to 17:00 in SW1.5 patients. The concentrations of plasma electrolyte, creatinine, and heat shock protein 70 did not differ between treatments (p > 0.05). The urinary excretion of Na+ from SW1.5 and K+ and Cl- from SW1.0 was higher than that from SW0.0 and SW0.5 (p < 0.01). Conclusion: Lactating crossbred goats adapted to low and moderate SW by increasing urine volume and urinary electrolyte excretion (Uex), whereas animals responded to high SW by either increasing Uex or altering drinking patterns to minimize salt stress. Keywords: antidiuretic hormone, dairy goat, kidney, saline water, water balance.

Pre- and postpartum metabolizable protein supply: II. Effects on plasma amino acids and markers of tissue mobilization in transition Holstein dairy cows.

The influence of diet composition on the degree of adipose and lean muscle mobilization and concentrations of circulating AA has been demonstrated during the transition period. Altering the MP supply might offer a strategy to control tissue mobilization and increase circulating AA availability, but the optimum supply of MP fed pre- and postpartum remains unknown. We investigated the effect of increasing the MP supply in the prepartum, postpartum, or both diets on plasma AA concentrations and ultrasound and circulating indicators of tissue mobilization. Multiparous Holstein cows (n = 96) were assigned to 1 of 4 treatment groups at 28 d before expected calving following a randomized block design. Prepartum diets were formulated to contain either a control (C; 85 g of MP/kg DM; 1,175 g of MP/d) or high (H; 113 g of MP/kg DM; 1,603 g of MP/d) level of estimated MP. From calving to 21 DIM, fresh diets were formulated to contain either a control (C; 104 g of MP/kg DM; 2,044 g of MP/d) or high (H; 131 g of MP/kg DM; 2,685 g of MP/d) level of estimated MP. To control the potential confounding effect of Met and Lys supply, diets were formulated to supply an equal amount at 1.24 and 3.84 g/Mcal of ME in both prepartum diets and 1.15 and 3.16 g/Mcal of ME in both postpartum diets, respectively. The combination of a pre- and postpartum diet resulted in 4 treatment groups: 1) CC (n = 23), 2) CH (n = 24), 3) HC (n = 22), and 4) HH (n = 23). A common lactation diet (113 g of MP/kg DM; 2,956 g of MP/d) was fed from 22 DIM to the end of the observation period at 42 DIM. Transcutaneous ultrasonography was used to determine the longissimus dorsi muscle diameter and backfat thickness. Concentrations of plasma AA, 3-methylhistidine (3MH), and creatinine were determined on a subset of cows (n = 60) using ultra-high-performance liquid chromatography and mass spectrometry. Treatment did not affect the longissimus dorsi muscle diameter from -14 to 21 d relative to calving, but the diameter was greater in CH compared with HH at 40 DIM. Backfat thickness and the ratio of 3MH to creatinine did not differ by treatment. Concentrations of EAA were greater at -13 d relative to calving in HH compared with CC and CH and at -6 d relative to calving EAA concentrations were higher in HC compared with CC. Cows fed the H diet postpartum had elevated EAA concentrations at 6 and 20 DIM compared with cows fed the C postpartum diet but EAA concentration did not differ at 40 DIM. Total NEAA concentrations were higher in CH compared with HC and HH at -6 d relative to calving, but NEAA concentration did not differ by treatment at -13, 6, 20, or 40 d relative to calving. In conclusion, increasing the supply of MP fed prepartum, postpartum, or both had minimal effects on tissue mobilization but influenced concentrations of plasma AA.

A case report of elevated bromide levels from pyridostigmine bromide for treatment of myasthenia gravis.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Elevated serum bromide levels can cause dermatological, gastrointestinal, and neurological abnormalities. As bromide and chloride are both halogens, bromide may interfere with chloride assays, causing a falsely high serum chloride concentration and a low or negative anion gap. There is a paucity of data describing bromide toxicity from high doses of pyridostigmine bromide (PB). This case report describes a patient with an elevated bromide level with neurological symptoms from a therapeutic dose of PB. A 37-year-old male with myasthenia gravis secondary to type B2 thymoma status following thymectomy presented in myasthenic crisis. He required mechanical ventilation and was managed with steroids, intravenous immune globulin, plasmapheresis, and PB. On day 9, the patient experienced acute agitation. He had an anion gap of 2 mEq/L and a chloride concentration of 109 mEq/L. The plasma creatinine concentration was 0.63 to 1.15mg/dL and urine output was 0.76 to 1.79mL/kg/h throughout his admission. All other laboratory values were normal. The daily dose of PB was 660mg on day 9, but the patient received 76mg of intravenous PB over the first few days of his admission with the largest dose in 24 hours equal to 48mg. On day 10, the patient's bromide level was 37 μg/mL. His agitation was initially managed with quetiapine, followed by PB dose reduction. To our knowledge, there are 2 cases in the literature of bromide toxicity secondary to PB. These patients experienced neurological symptoms with bromide levels of 88 to 90 μg/mL. Bromide concentrations of more than 12 μg/mL are associated with a higher risk of neuronal dysfunction demonstrated as disturbances on an electroencephalogram, and levels greater than 50 μg/mL are considered toxic. While our patient's bromide level was not as high as those previously reported, no other causes for his agitation were identified. Elevated bromide levels from therapeutic PB can occur, and monitoring of these levels should be considered.

Which is the best glomerular filtration marker: Creatinine, cystatin C or both?

The glomerular filtration rate (GFR) is estimated by the serum or plasma concentration of creatinine and/or cystatin C using equations that include demographic data. The equations worldwide most widely used are those of the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) consortium and updated in 2021 to remove the Afro-American racial correction factor. In 2021 and then in 2023, the European Kidney Function Consortium also developed equations based on creatinine and cystatin C, usable across the full age spectrum, and constructed by including the Q value (i.e. the median creatinine or cystatin C in healthy men and women, which is customizable for specific populations). The aim of this narrative review is to examine the strengths and weaknesses of each biomarker. Both biomarkers have non-GFR determinants, namely muscle mass, protein intake and tubular secretion for creatinine; dysthyroidism and systemic corticosteroids for cystatin C, as well as other more debated determinants (diabetes, obesity, proteinuria, inflammatory syndrome). These non-GFR determinants are the reason why no equation based on a single endogenous biomarker has an accuracy within 30% greater than 90% over the entire age spectrum (in at least one patient in 10, estimated GFR is at least 30% higher or at least 30% lower than the measured GFR). Equations combining the two biomarkers provide a better estimate of GFR, particularly in the subgroup of patients whose estimates based on each of the biomarkers are highly discordant. These patients must also be identified as being at increased risk of morbidity, particularly cardiovascular, and mortality.

Effects of postbiotic products from Saccharomyces cerevisiae fermentation on lactation performance, antioxidant capacities, and blood immunity in transition dairy cows

This study aimed to evaluate the effects of dietary supplementation with different types of Saccharomyces cerevisiae fermentation products (SCFP) on lactational performance, metabolism, acute phase protein response, and antioxidant capacities in dairy cows from -21 to 56 d in milk (DIM). One hundred and 80 multiparous Holstein dairy cows were blocked by parity, expected calving date, pre-trial body condition score, and previous 305-d ME yield, and then randomly assigned to 1 of 3 dietary treatments: basal diet (CON; n = 60), basal diet supplemented with 40 g/d of SCFP1 (XPC; n = 60; XPC, Diamond V, Cedar Rapids, IA), and basal diet supplemented with 19 g/d of SCFP2 (NTK; n = 60, NutriTek®, Diamond V, Cedar Rapids, IA). Blood (n = 15, 13 and 12 in the CON, XPC and NTK groups, respectively) was sampled at -7 ± 3, + 3, + 7, + 21, and + 28 d, and milk samples (n = 19, 18 and 15 in the CON, XPC and NTK groups, respectively) was sampled during 1-8 wk from a subset of cows from -21 to 56 d relative to calving. Data were analyzed using the MIXED procedure in SAS (SAS Institute Inc.). All data were subjected to repeated measures ANOVA. Dietary treatment (TRT), time, and their interaction (TRT × time) were considered as fixed effects and cow as the random effect. Cows fed XPC and NTK had greater energy-corrected milk (ECM). Supplementing NTK increased milk fat content and yield, and 3.5% fat-corrected milk (FCM) yield compared with CON. Milk urea nitrogen (MUN) was lower in XPC cows than CON. SCFP supplementation decreased plasma β-hydroxybutyrate (BHB), ceruloplasmin (CER), haptoglobin (HPT), and interleukin-1β (IL-1β) concentrations, whereas increased plasma phosphorus (P) concentrations. In addition, cows fed NTK showed lower creatinine (CR) and cortisol (COR) concentrations but increased plasma calcium (Ca) and myeloperoxidase (MPO) concentrations than those in the CON cows. In addition, cows fed NTK and XPC both had reduced plasma concentrations of serum amyloid-A (SAA) at 3 DIM of lactation compared with CON fed cows. Furthermore, SCFP cows had greater concentrations of plasma glucose (GLU) and calcium (Ca) than CON cows at 7 DIM, and greater concentrations of plasma phosphorus (P) at 21 DIM. Between different SCFP type fed groups, plasma concentrations of nonesterified fatty acids (NEFA), MDA, creatinine (CR), SAA, and HPT were lower in cows fed NTK compared with cows fed XPC at 7 DIM. Overall, our results indicate the potential benefits of supplementing SCFP in transition dairy cows by modulating immunity, liver metabolic function and supporting ECM yield. The results also suggest that NutriTek at 19 g/d appears to support the performance and health of dairy cows better compared with XPC at 40 g/d, based on improved metabolic and inflammatory status during the transition period.

Serial paired arterial and jugular venous point-of-care values in dogs undergoing manual basic life support.

To evaluate differences in point-of-care (POC) variables obtained from arterial and jugular venous blood in dogs undergoing manual basic life support (BLS) and report changes over time. Experimental study. Small animal research facility. Twenty-four purpose-bred research dogs. Dogs were anesthetized, and arterial catheters were placed before euthanasia. One minute after cardiopulmonary arrest, BLS consisting of manual chest compressions and ventilation delivered via endotracheal intubation, face mask, mouth-to-nose, or no ventilation was initiated. Paired arterial and jugular venous blood samples were obtained for POC testing before euthanasia (T0), at 3minutes (T3), and at 6minutes (T6) into BLS. The association of POC variables with arterial or venous sample type while controlling for type of ventilation and sampling timepoint was determined using a generalized linear mixed model. Variables obtained from arterial and venous blood samples were compared over time using repeated measures ANOVA or Friedman test. Pao2, anion gap, potassium, chloride, glucose concentration, and PCV were significantly higher in arterial blood samples compared with venous samples (P<0.03). By T6, arterial glucose concentration, arterial and venous base excess, venous pH, and plasma lactate, potassium, creatinine, bicarbonate, and sodium concentrations were significantly increased, and arterial and venous Po2, ionized calcium concentration, PCV, and total plasma protein concentration were significantly decreased from T0 (P<0.05). Although statistically significant, arteriovenous differences and changes in POC blood variables during BLS were small and not clinically relevant over time. Given the challenges of arterial blood sampling, it may be reasonable to pursue venous blood sampling during CPR. Further studies in dogs undergoing BLS and advanced life support are needed to better understand the potential clinical role of POC testing during CPR.

Creatine homeostasis and the kidney: comparison between kidney transplant recipients and healthy controls

Creatine is a natural nitrogenous organic acid that is integral to energy metabolism and crucial for proper cell functioning. The kidneys are involved in the first step of creatine production. With kidney transplantation being the gold-standard treatment for end-stage kidney disease, kidney transplant recipients (KTR) may be at risk of impaired creatine synthesis. We aimed to compare creatine homeostasis between KTR and controls. Plasma and urine concentrations of arginine, glycine, guanidinoacetate, creatine and creatinine were measured in 553 KTR and 168 healthy controls. Creatine intake was assessed using food frequency questionnaires. Iothalamate-measured GFR data were available in subsets of 157 KTR and 167 controls. KTR and controls had comparable body weight, height and creatine intake (all P > 0.05). However, the total creatine pool was 14% lower in KTR as compared to controls (651 ± 178 vs. 753 ± 239 mmol, P < 0.001). The endogenous creatine synthesis rate was 22% lower in KTR as compared to controls (7.8 ± 3.0 vs. 10.0 ± 4.1 mmol per day, P < 0.001). Despite lower GFR, the plasma guanidinoacetate and creatine concentrations were 21% and 41% lower in KTR as compared to controls (both P < 0.001). Urinary excretion of guanidinoacetate and creatine were 66% and 59% lower in KTR as compared to controls (both P < 0.001). In KTR, but not in controls, a higher measured GFR was associated with a higher endogenous creatine synthesis rate (std. beta: 0.21, 95% CI: 0.08; 0.33; P = 0.002), as well as a higher total creatine pool (std. beta: 0.22, 95% CI: 0.11; 0.33; P < 0.001). These associations were fully mediated (93% and 95%; P < 0.001) by urinary guanidinoacetate excretion which is consistent with production of the creatine precursor guanidinoacetate as rate-limiting factor. Our findings highlight that KTR have a disturbed creatine homeostasis as compared to controls. Given the direct relationship of measured GFR with endogenous creatine synthesis rate and the total creatine pool, creatine supplementation might be beneficial in KTR with low kidney function.Trial registration ID: NCT02811835.Trial registration URL: https://clinicaltrials.gov/ct2/show/NCT02811835.

#1973 Factors conditioning cisplatin nephrotoxicity

Abstract Background and Aims Cisplatin is an antitumor drug whose use is significantly limited by its nephrotoxicity. Knowledge of the factors that determine or condition the pathogenesis of cisplatin-induced AKI will help to prevent or reduce nephrotoxic outcomes and improve safety during cisplatin treatment. Specifically, we aimed to study the impact of different factors (dehydration, hypertension, age and combinations of the former) on a pre-clinical model of AKI induced by a low dose of cisplatin. Method Young Wistar rats, young spontaneously hypertensive rats (SHR), and aged Wistar rats were divided into two experimental groups: Blood and 24-hour urine samples were collected, and renal function (plasma creatinine, plasma urea and urine protein levels) and dehydration parameters (weight loss, skin elasticity, haematocrit, plasma osmolality, urine flow and urine concentration) were monitored for each animal at three different timepoints: basal time (B), at the end of the dehydration period (D0), and 4 days after cisplatin administration (D4, day of maximum kidney damage). Results After 48 h water deprivation, dehydration was evinced by loss of weight, reduced skin elasticity, increases in plasma osmolality and haematocrit, urine flow reduction and highly concentrated urine (with elevated density and osmolality). A single, low dose of cisplatin induced minimal loss of renal function in young normohydrated Wistar rats that was not worsened by previous acute dehydration resulting from 48 h water deprivation. Interestingly, although renal function was fully preserved when cisplatin was administered to hypertensive rats under normohydrated conditions, a cisplatin-induced AKI (with significant increases in plasma creatinine, plasma urea and proteinuria) was developed in hypertensive rats when animals were previously forced to dehydration. Aged Wistar rats with free access to drinking water showed an important loss of renal function after cisplatin administration (as supported by increases in plasma creatinine and urea concentration). This effect was significantly amplified when aged animals were dehydrated at the time of cisplatin administration. Conclusion Our results suggest that age is an important factor conditioning cisplatin nephrotoxicity. Hypertension or dehydration in fully competent young rats are not in itself significant risk factors for AKI. However, when dehydration is combined with other comorbidity (age or hypertension) the risk of cisplatin-induced AKI is significantly increased. In perspective, our animal models reproducing conditions of increased vulnerability to cisplatin-induced AKI provide useful tools not only for the identification of predictive biomarkers pre-emptively detecting individuals at high risk, but also to assess preventive strategies potentially useful for vulnerable individuals. This study was supported by Project PI21/01226, funded by Instituto de Salud Carlos III (ISCIII) and co-funded by the European Union, and a grant from the Consejería de Educación, Junta de Castilla y León (IES160P20), Spain, co-funded by FEDER funds. Noelia Diaz-Morales is recipient of a Juan de la Cierva-Formación postdoctoral contract (FJC2020-043205-I) funded by MCIN/AEI/10.13039/501100011033 and European Union “NextGenerationEU/PRTR”.

#1436 Donor plasma cystatin C, but not creatinine, is associated with measured GFR at one year after kidney transplantation

Abstract Background and Aims Although widely used during deceased kidney donor selection, donor plasma creatinine has limited capacity to predict future recipient kidney graft function. Cystatin C is a muscle-mass independent kidney function marker that could serve as alternative for this purpose. However, the association between donor cystatin C and subsequent recipient graft function remains unclear. We aim to assess the association of pre-donation cystatin C concentrations with recipient iothalamate-measured GFR (mGFR) one year after kidney transplantation and compare it to the association of donor creatinine concentrations. Method All deceased kidney donors, within the affiliated donation region of the University Medical Center Groningen (UMCG), who donated at least one kidney to a kidney transplant recipient (KTR) affiliated to the same hospital during a period of 15 years (2004-2019) were included. We excluded all subjects with missing data on donor plasma cystatin C or recipient mGFR at 1 year. Donor plasma creatinine concentrations were measured using an enzymatic assay, while donor cystatin C concentrations were measured using a validated particle-enhanced turbidimetric immunoassay (Roche). Associations of donor plasma creatinine and cystatin C concentrations with recipients’ mGFR one year after transplant were assessed using linear regression. Results A total of 53 deceased kidney donors (55% male, age 47 ± 18 years, 47% donation after circulatory death) donated a kidney to 53 kidney transplant recipients (55% male, age 57 ± 12 years). Median pre-donation plasma creatinine and cystatin C concentrations were 64 [55 to 82] μmol/L and 0.64 [0.51 to 0.82] mg/L respectively. Mean recipient mGFR one year after transplantation was 52.7 ± 17.1 ml/min. In univariable linear regression, higher donor cystatin C was significantly associated with lower mGFR (β −0.42, 95% CI: −0.67 to −0.16, p = 0.002), while donor creatinine was not associated (β −0.03 95% CI: −0.32 to 0.25, p = 0.81). The association between donor cystatin C and recipients’ mGFR remained independent of adjustment for potential confounders, including donor sex and age, t (p = 0.008). Conclusion Higher donor cystatin C, but not creatinine, is associated with lower measured GFR one year after kidney transplant. Consequently, donor cystatin C could be valuable for inclusion in the pre-transplant evaluation of deceased kidney donors.

#1413 High performance of ACLARA calculator of rat creatinine clearance for the chronic follow up of renal function

Abstract Background and Aims A neural network-based calculator to estimate rat creatinine clearance (ClCr), as a measurement of the glomerular filtration rate (GFR), from paired plasma creatinine concentration and body weight data has been recently developed [1]. Like human GFR estimating formulae, ACLARA averts long experimental procedures and reduces animal stress (by obviating the use of individual isolation in metabolic cages). This tool is publicly available for free use among the scientific community (https://idal.uv.es/aclara/). When collated with experimentally measured ClCr, ACLARA performs very well at comparing experiments in the whole, showing almost identical behavior of all experimental groups and conditions. Yet, ACLARA was trained mostly with data from short experiments involving acute changes in renal function, and from young rats. Fewer data from older animals was included in the development of the calculator. Thus, its field performance on longer evolution of renal function in adult rats has not yet been sufficiently validated. Accordingly, the aim of this work was to deepen in the assessment of ACLARA in the long-term evolution of rat ClCr. Method The evolution of measured (mClCr) versus ACLARA-estimated ClCr (eClCr) was compared at different time points over a period of 3 months in 20 male Wistar rats with chronic renal damage and 8 age-matched controls. In total, 176 data pairs of mClCr and eClCr were obtained. On the one hand, mClCr was determined by the usual experimental procedure [2]. Briefly, rats were allocated in metabolic cages to obtain 24-hour urine samples and urine flow (UF). Creatinine concentration was measured in the urine (Cru) and plasma (Crp) by a colorimetric assay based on the Jaffe's reaction, and mCrCl was then calculated as Cru x UF / Crp. On the other hand, eClCr was estimated with the ACLARA calculator from the corresponding Crp and body weight data. A Pearson's correlation study between mClCr and eClCr was carried out. Results Our results reveal that the information provided by the 90-day evolution of mClCr and eClCr is virtually identical at the whole experiment level (see Fig. 1). Furthermore, ACLARA seems to provide slightly more coherent and homogeneous information, as the considerable experimental error introduced by urine collection is averted in eClCr but present in mClCr. At the individual data level, ACLARA-estimated values are slightly lower than the corresponding measurements. The correlation between mClCr and eClCr was highly significant (r Pearson= 0.83; p &amp;lt; 0.0001). Conclusion ACLARA shows high performance at estimating CrCl in rats of growing age. Our results support its use also in chronic studies in which renal function must be evaluated. Funding This research was funded by grants from Instituto de Salud Carlos III (ISCIII), Ministerio de Ciencia e Innovación (PI21/01226 and PI21/00548 co-funded by the European Union; and RICORS2040, RD21/0005/0004, co-funded by the European Union – NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia (MRR)) and from Consejería de Educación, Junta de Castilla y León (IES160P20), co-funded by FEDER funds. Joana Mercado-Hernández is recipient of a predoctoral fellowship from the Junta de Castilla y Leon (Spain) and the European Social Fund from the European Commission.

Dapagliflozin Stimulates Renal Ammonia Excretion in Rats

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are drugs that induce glycosuria and are used to treat type 2 diabetes mellitus, moreover it has also been used in other conditions such as heart failure and atherosclerosis. However, little is known about the effects of these drugs on renal function. Considering that the maintenance of acid-base balance is closely related to renal physiology, in this study we evaluated the influence of chronic use of dapagliflozin on global renal function and urinary excretion of ammonia and titratable acids. Objective: To evaluate global renal function and urinary acid excretion (ammonia and titratable acid) in male Wistar rats chronically treated with dapagliflozin. Methods: 3-month-old male Wistar rats were randomized to control (C) and dapagliflozin (D) groups. Animals in group D received dapagliflozin (3 mg/kg, gavage) for 4 weeks. All animals were given food and water ad libitum throughout the experimental protocol. At 4 months of age, animals were placed in metabolic cages for 24-hour urine collection followed by blood sampling. Plasma concentrations of creatinine, sodium, potassium, urea, pH, pCO2, and bicarbonate were evaluated. The following were also evaluated: body weight, water intake, urine flow, and excretion of ammonia, titratable acids, glucose, and protein. Protocol approved by CEUA-UNIFESP number: 5985180423. Values expressed as mean ± standard error; number of animals per group: 6. Results: No significant changes were observed in blood gas parameters: pH (C: 7.33±0.043; D: 7.36±0.027), pCO2 (C: 53.30±2.40; D: 52.67±3.63 mmHg) and HCO3− (C: 27.07±1.31; D: 29.75±1.72 mEq/L) and no significant changes in plasma creatinine concentration (C: 0.41±0.04; D: 0.40±0.04mg/dl), Na+ (C: 144±0.47; D: 137±2.04 mmol/l) and K+ (C: 4.30±0.21; D: 4.16±0.20 mmol/l). We observed a significant increase in urine flow (C: 0.027±0.006; D: 0.068±0.005 mL/min/kg), possibly associated with intense glycosuria (C: 0.017±0.005; D: 8.97±0.51 g/24h). The significant increase in plasma urea concentration (C: 39.17±2.57; D: 48.83±1.27 mg/dL) and proteinuria (C: 11.04±0.30; D: 15.79±0.56 mg/24h) may indicate some renal impairment. Considering the marked increase in urinary excretion of ammonia (C: 0.65±0.05; D: 3.49±2.31 mEq/24h) and titratable acids (C: 0.180±0.036; D: 0.628±0.078 mEq/24h), we can conclude that the drug-induced glycosuria may lead to biochemical adaptations to maintain blood glucose levels within the normal range, at the expense of increased metabolic acid production. However, further experiments are needed to confirm this hypothesis. CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

The association between opioid dose and kidney function and clinical outcome in critically ill patients, a retrospective cohort study

BackgroundCritically ill patients are prone to develop acute kidney injury. Apart from the nervous system, opioid receptor expression is highest in the kidneys, although their function in the kidney is unclear. In view of the frequent use of opioids, high expression of its receptors in the kidney and high incidence of AKI in critically ill patients, these may be interconnected. AimTo determine the association between opioid dose and kidney function and outcome in critically ill patients. MethodsIn this retrospective cohort study adult patients admitted to ICU (2013–2020), were eligible. The association between opioid administration and kidney function and mortality were determined using total cumulative dose and quartiles. Demographics, disease severity, and sedatives dose were covariates. Results2824 patients (median [IQR] age 64 [53–71] years, ICU-LOS of 8 [4–15] days, 64 % male) were included. Cumulative opioid dose (day 1–3 of ICU-admission), corrected for covariates, was not associated with change in plasma creatinine concentrations: (unstandardized-B for every mg/hour opioids given these days (Confidence Interval): -0.15 (−0.36–0.06) μmol/L, p = 0.15), or urine output: -0.42 (−1.41–0.56) mL for (p = 0.40). Mortality increased from 3.5 % in Quartile 1 of cumulative opioid dose to 10.3 % in Q4. Covariate-corrected mortality hazard ratios compared with Q1 were: Q2: 1.12 (0.85–1.48), p = 0.41, Q3: 1.58 (1.19–2.09), p = 0.001 and Q4: 1.50 (1.06–2.12), p = 0.021. ConclusionsIn critically ill patients, opioid dose was not associated with a change in kidney function. However, opioid dose was associated with an increased ICU-LOS and mortality risk.

Dietary crude protein and protein solubility manipulation enhances intestinal nitrogen absorption and mitigates reactive nitrogen emissions through gut microbiota and metabolome reprogramming in sheep

Dietary nutrient manipulation (e.g. protein fractions) could lower the environmental footprints of ruminants, especially reactive nitrogen (N). This study investigated the impacts of dietary soluble protein (SP) levels with decreased crude protein (CP) on intestinal N absorption, hindgut N metabolism, fecal microbiota and metabolites, and their linkage with N metabolism phenotype. Thirty-two male Hu sheep, with an age of six months and an initial BW of 40.37 ± 1.18 kg, were randomly assigned to four dietary groups. The control diet (CON), aligning with NRC standards, maintained a CP content of 16.7% on a dry matter basis. Conversely, the experimental diets (LPA, LPB, and LPC) featured a 10% reduction in CP compared with CON, accompanied by SP adjustments to 21.2%, 25.9%, and 29.4% of CP, respectively. Our results showed that low-protein diets led to significant reductions in the concentrations of plasma creatinine, ammonia, urea N, and fecal total short-chain fatty acids (SCFA) (P < 0.05). Notably, LPB and LPC exhibited increased total SCFA and propionate concentrations compared with LPA (P < 0.05). The enrichment of the Prevotella genus in fecal microbiota associated with energy metabolism and amino acid (AA) biosynthesis pathways was evident with SP levels in low-protein diets of approximately 25% to 30%. Moreover, LPB and LPC diets demonstrated a decrease in fecal NH4+–N and NO2−–N contents as well as urease activity, compared with CON (P < 0.05). Concomitantly, reductions in fecal glutamic acid dehydrogenase gene (gdh), nitrite reductase gene (nirS), and nitric oxide reductase gene (norB) abundances were observed (P < 0.05), pointing towards a potential reduction in reactive N production at the source. Of significance, the up-regulation of mRNA abundance of AA and peptide transporters in the small intestine (duodenum, jejunum, and ileum) and the elevated concentration of plasma AA (e.g. arginine, methionine, aspartate, glutamate, etc.) underscored the enhancement of N absorption and N efficiency. In summary, a 10% reduction in CP, coupled with an SP level of approximately 25% to 30%, demonstrated the potential to curtail reactive N emissions through fecal Prevotella enrichment and improve intestinal energy and N utilization efficiency.

A study of size-selective renal elimination using a novel human model

The recently discovered selective glomerular hypofiltration syndromes have increased interest in the actual elimination of molecules in the human kidney. In the present study, a novel human model was introduced to directly measure the single-pass renal elimination of molecules of increasing size. Plasma concentrations of urea, creatinine, C-peptide, insulin, pro-BNP, β2-microglobulin, cystatin C, troponin-T, orosomucoid, albumin, and IgG were analysed in arterial and renal venous blood from 45 patients undergoing Transcatheter Aortic Valve Implantation (TAVI). The renal elimination ratio (RER) was calculated as the arteriovenous concentration difference divided by the arterial concentration. Estimated glomerular filtration rate (eGFR) was calculated by the CKD-EPI equations for both creatinine and cystatin C. Creatinine (0.11 kDa) showed the highest RER (21.0 ± 6.3%). With increasing molecular size, the RER gradually decreased, where the RER of cystatin C (13 kDa) was 14.4 ± 5.3% and troponin-T (36 kDa) was 11.3 ± 4.6%. The renal elimination threshold was found between 36 and 44 kDa as the RER of orosomucoid (44 kDa) was −0.2 ± 4.7%. The RER of creatinine and cystatin C showed a significant and moderate positive linear relationship with eGFR (r = 0.48 and 0.40). In conclusion, a novel human model was employed to demonstrate a decline in renal elimination with increasing molecular size. Moreover, RERs of creatinine and cystatin C were found to correlate with eGFR, suggesting the potential of this model to study selective glomerular hypofiltration syndromes.

Drinking magnetized water alters blood constituents, and structure of spleen and kidney in rabbits

This study aimed to investigate the effect of magnetic field on physicochemical properties of water and evaluating the effects of the magnetized water (MW ) on the productive performance, liver enzymes, spleen and kidney structure of rabbits. Water samples were collected to determine pH and electrical conductivity (EC), and water structure was investigated by Transmission Electron Microscopy (TEM). Twenty-four weaned Rex rabbits, 21 d old, were allotted into two experimental groups: the first group was assigned as control, received regular tap water (TW), and the treated group, received MW, for 5 weeks. Productive traits were recorded weekly and at the end of the experiment, blood samples, spleen and kidney were collected for examinations. Results showed that pH and EC of MW were higher than those of TW. In addition, the arrangement MW cluster showed a unique alteration on the nano-scale. Growth performance indicators were similar in both experimental treatments, except FCR of the MW rabbits was better than that of the TW rabbits. The MW had no significant effect on plasma concentration of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and creatinine in growing Rex rabbits received MW in comparison with those received regular TW. Spleen histological structure of rabbits of both groups was normal. However, the epithelial cells lining renal tubules of kidneys of rabbits in MW group appeared large with basophilic nuclei in comparison with TW group. Conclusively, magnetic field alters the physicochemical properties of water. The MW may consequently increase blood glucose level and spleen weight % and enhance kidney structure in growing rabbits. Moreover, more studies are still needed to know the benefits of providing the magnetized water to ‎animals. ‎

SLC6A8 creatine transporter deficiency can be detected by plasma creatine and creatinine concentrations

Creatine transporter deficiency has been described with normal or uninformative levels of creatine and creatinine in plasma, while urine has been the preferred specimen type for biochemical diagnosis. We report a cohort of untreated patients with creatine transporter deficiency and abnormal plasma creatine panel results, characterized mainly by markedly decreased plasma creatinine. We conclude that plasma should be considered a viable specimen type for the biochemical diagnosis of this disorder, and abnormal results should be followed up with further confirmatory testing.

Risk factors and implications associated with ultrasound-diagnosed nephrocalcinosis in cats with chronic kidney disease.

Microscopic nephrocalcinosis is a common pathological feature of chronic kidney disease (CKD) in cats. Detection of macroscopic nephrocalcinosis using ultrasonography and its implications remain unexplored. Identify risk factors associated with ultrasound-diagnosed nephrocalcinosis and evaluate the influence of nephrocalcinosis on CKD progression. Thirty-six euthyroid client-owned cats with CKD. Prospective cohort study. Cats with CKD with and without ionized hypercalcemia were enrolled for renal ultrasonography. Cats were categorized according to the presence or absence of ultrasound-diagnosed nephrocalcinosis. Binary logistic regression was performed to identify nephrocalcinosis risk factors. The influence of nephrocalcinosis on CKD progression was assessed using linear mixed models. Ultrasound-diagnosed nephrocalcinosis was evident in 61% of CKD cats overall, with increased prevalence (81%) in those with hypercalcemia. At enrollment, higher blood ionized calcium concentration (odds ratio [OR], 1.27 per 0.1 mg/dL; P = .01), plasma phosphate concentration (OR, 1.16 per 0.1 mg/dL; P = .05), plasma creatinine concentration (OR, 1.29 per 0.1 mg/dL; P = .02) and alanine aminotransferase activity (OR, 2.08 per 10 U/L; P = .04) were independent nephrocalcinosis risk factors. The rate of change in log-transformed fibroblast growth factor-23 differed significantly between groups (P = .04). Cats with CKD and nephrocalcinosis had increasing plasma creatinine concentrations (.03 ± .01 mg/dL/month; P = .04) and phosphate concentrations (.06 ± .02 mg/dL/month; P < .001) and decreasing body weight (.02 ± .01 kg/month; P < .001) over time. Nephrocalcinosis is prevalent in cats with CKD, especially in those with hypercalcemia. This pathological feature appears to be associated with CKD progression in cats.

The correlation of urea and creatinine concentrations in sweat and saliva with plasma during hemodialysis: an observational cohort study.

Urea and creatinine concentrations in plasma are used to guide hemodialysis (HD) in patients with end-stage renal disease (ESRD). To support individualized HD treatment in a home situation, there is a clinical need for a non-invasive and continuous alternative to plasma for biomarker monitoring during and between cycles of HD. In this observational study, we therefore established the correlation of urea and creatinine concentrations between sweat, saliva and plasma in a cohort of ESRD patients on HD. Forty HD patients were recruited at the Dialysis Department of the Catharina Hospital Eindhoven. Sweat and salivary urea and creatinine concentrations were analyzed at the start and at the end of one HD cycle and compared to the corresponding plasma concentrations. A decrease of urea concentrations during HD was observed in sweat, from 27.86 mmol/L to 12.60 mmol/L, and saliva, from 24.70 mmol/L to 5.64 mmol/L. Urea concentrations in sweat and saliva strongly correlated with the concentrations in plasma (ρ 0.92 [p<0.001] and 0.94 [p<0.001], respectively). Creatinine concentrations also decreased in sweat from 43.39 μmol/L to 19.69 μmol/L, and saliva, from 59.00 μmol/L to 13.70 μmol/L. However, for creatinine, correlation coefficients were lower than for urea for both sweat and saliva compared to plasma (ρ: 0.58 [p<0.001] and 0.77 [p<0.001], respectively). The results illustrate a proof of principle of urea measurements in sweat and saliva to monitor HD adequacy in a non-invasive and continuous manner. Biosensors enabling urea monitoring in sweat or saliva could fill in a clinical need to enable at-home HD for more patients and thereby decrease patient burden.

Effect of postpartum drenching on plasma parameters of cows at a large-scale dairy farm.

The aim of the present study was to explore the influence of postpartum drenching with a feed additive on the plasma concentration of biochemical parameters while factoring in prepartum rumination times (RT). One hundred and sixty-one cows were fitted with a Ruminact© HR-Tag approximately 5 days before calving. Drenching and control groups were established based on calving dates. Animals in the drenched group were treated three times (Day 1/day of calving/, Day 2, and Day 3 postpartum) using a feed additive containing calcium propionate, magnesium sulphate, yeast, potassium chloride and sodium chloride mixed in approximately 25 L of lukewarm tap water. Blood samples were collected on Days 1, 2, 3, 7 and 12. Cows with below the average RT were categorised as "low rumination" and those above it as "high rumination" animals. Drenching decreased the plasma concentrations of total protein, urea and creatinine and increased the levels of alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT) and chloride. Low rumination time prepartum resulted in higher concentrations of beta-hydroxybutyrate, total protein and activities of alkaline phosphatase and GGT, while it decreased the activity of ALT and the concentrations of calcium, magnesium, sodium and potassium. The day of lactation had an effect on all parameters except for potassium.