Predictor Of Renal Dysfunction Research Articles

Burden and Factors Associated with Renal Dysfunction among People Living with HIV in Dar es Salaam, Tanzania

Renal diseases pose a significant burden of morbidity and mortality, particularly among People Living with HIV (PLHIV). The risks are further compounded by drug-induced renal toxicity, and the growing burden of hypertension, diabetes, and Hepatitis C infections. This study assessed the magnitude and factors associated with renal dysfunction among PLHIV attending clinics in Dar es Salaam, Tanzania. A hospital-based cross-sectional study was conducted between January and March 2022 among 331 PLHIV recruited through a multistage sampling. Renal disease was determined through urine analysis and clinical, demographic, and disease-specific data were collected using a structured questionnaire. The analysis, performed in SPSS version 25, involved descriptive analysis, univariate, and multivariable logistic regression to determine the magnitude and predictors of renal dysfunction among PLHIV. Renal dysfunction was observed in 37 (11.1%) participants. Patients with advanced age were 3.89 times more likely to have renal dysfunction (95% CI: 1.56 – 9.72, p = 0.004) compared to lower age groups. No statistically significant association was found between renal dysfunction and sex, duration from diagnosis of HIV and on ART, ART-based regimen, HIV viral load, hypertension, or diabetes mellitus. More than one in ten PLHIV in Dar es Salaam, Tanzania, presented with signs of renal dysfunctions, which was more significant among patients aged 55 and older. Routine screening for renal diseases among PLHIV, especially for patients with advanced age is essential to prevent and control for progression to renal failure.

#1146 Role of renal dysfunction in the use of anticoagulants in COPD patients with atrial fibrillation

Abstract Background and Aims The renal dysfunction is known to be the most important predictor of outcome in patients with atrial fibrillation (AF). At the same time, assessment of the functional state of the kidneys is an integral part of the protocol when selecting the dose of oral anticoagulants. The prognostic role of the functional state of the kidneys during treatment with oral anticoagulants on a possible worsening of the cardiac prognosis during the treatment of AF in patients with concomitant comorbid background, in particular with COPD, has not been sufficiently studied. The aim of the study was to evaluate the prognostic role of renal dysfunction in terms of possible cardiovascular events and bleeding in patients with COPD and AF treated with oral anticoagulants. Method 56 COPD patients with CHF and AF who received oral anticoagulants were examined. Renal function (creatinine level and estimated glomerular filtration rate - eGFR) was assessed at baseline and follow-up. The functional state of the kidneys was calculated using the CKD-EPI-2011 formula. At baseline, the risk of bleeding was assessed using the HAS-BLED scale. Worsening of the functional state of the kidneys was detected when the level of creatinine increased or eGFR decreased by at least 20%. Results In addition to standard treatment for COPD in the presence of AF, patients received oral anticoagulants during six months of observation. Worsening of the functional state of the kidneys was observed in 18.3% of patients. In patients with renal dysfunction, the frequency of episodes of CHF decompensation and non-major bleeding (MB) was significantly higher. With a reduced glomerular filtration rate, there was no effect on the incidence of bleeding and stroke. The oral anticoagulants used did not have a significant effect on the observed renal dysfunction and did not affect the occurrence of new cardiovascular events in patients with COPD. It turned out that predictors of renal dysfunction in patients with COPD are age, female gender, and lower hemoglobin levels. In multivariate analysis, renal dysfunction was identified as an independent predictor of non-major bleeding (OR 2.04, 95%, p < 0.05). Conclusion In patients with COPD and atrial fibrillation, the presence of renal dysfunction was an additional exacerbating factor associated with a poor mid-term cardiovascular prognosis and the risk of bleeding. However, oral anticoagulants did not affect the degree of deterioration of renal function or the incidence of cardiovascular events.

Neutrophils-derived Parameters as Cost-effective Inflammatory, Disease Activity Marker in Systemic Lupus Erythematosus (SLE) and Role in Prediction of Lupus Nephritis

Introduction: Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease with various clinical manifestations and approximately 50% of the SLE patients develop lupus nephritis (LN), which increases the risk of renal failure, cardiovascular diseases and overall survival. Objectives: Evaluation of neutrophil-derived parameters (Neut-X, Neut-Y and Neut-Z) as an inflammatory, disease activity marker and as a predictor of nephritis in SLE patients. Material and Methods: In this cross-sectional study, 3 ml K3EDTA blood was taken from 110 SLE patients presented in Department of Clinical Immunology to evaluate neutrophil-derived parameters in Sysmex XT2000i haematology analyser and their correlation with other inflammatory biomarkers like, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) as well as SLE disease activity index-2000 (SLEDAI-2K). 24-hours urine protein levels were also estimated as a marker of renal involvement. Records of renal biopsy were available in 73 SLE patients, who belonged to different morphologic classification of LN. Results: After performing bivariate Spearman correlation analysis (SPSS software, version 26.0), Neut-X (measures cytoplasmic granularity by side scattering) and Neut-Z (vector sum of Neut-X and Neut-Y) showed a significant positive correlation ( r > 0.200, P < .05) with ESR, CRP and SLEDAI-2K while Neut-Y (measures nucleic acid content by sideward fluorescence) showed a significant negative correlation ( r > 0.200, P < .05) with ESR and CRP. Receiver-operating characteristic curve analysis was used to evaluate diagnostic value of 24-hour urine protein and predictive values of neutrophil-derived parameters for renal involvement in SLE patients. Among neutrophil-derived parameters, Neut-X was found to be the best predictor of renal dysfunction with highest AUC of 0.710 (95% CI: 0.604-0.816; cut-off: 1344.50; sensitivity: 84.7%; specificity: 50%) followed by Neut-Z with AUC of 0.707 (95% CI: 0.600-0.813; cut-off: 1403.67; sensitivity: 87.5%; specificity: 50%). Conclusion: Our study shows that neutrophil-derived parameters may be used as novel cost-effective, non-invasive biomarker of disease activity as well as for predicting renal involvement in SLE patients.

Development and validation of a nomogram for predicting the occurrence of renal dysfunction after treatment of immune checkpoint inhibitor: a retrospective case–control study

PurposeThe administration of immune checkpoint inhibitors (ICIs) may lead to renal adverse events, notably including renal dysfunction. To early predict the probability of renal dysfunction after ICIs therapy, a retrospective...

Clinicopathologic Study of Sickle Cell-associated Kidney Disease: A Nigerian Experience.

Improvements in sickle cell disease (SCD) care have resulted in the survival of many patients into adulthood, although this is accompanied by the increased incidence of end-organ damage, including chronic kidney disease (CKD). This study assessed the prevalence, pattern and predictors of renal dysfunction in SCD patients and investigated the associated renal histopathologic changes. We evaluated 105 patients with SCD, for proteinuria, estimated glomerular filtration rate (eGFR), and tubular dysfunction. Renal biopsy was conducted on 22 patients who qualified. Data were analysed using SPSS package version 23. Thirty-seven (35.2%) of the 105 patients had CKD, as defined by an eGFR of 60 ml/min/1.73 m2 and/or proteinuria. The fractional excretion of potassium (FEK) was elevated in all patients, whereas the fractional excretion of sodium (FENa) was elevated in 98.1%. Glomerular filtration rate was negatively correlated with irreversible percentage sickle cell count (r = -0.616, P = 0.0001), FEK (r = -0.448, P = 0.0001) and FENa (r = -0.336, P = 0.004). Age, irreversible percentage sickle cell count, haemoglobin levels and FENa were the major predictors of CKD. The histological pattern in the 22 patients who had biopsies was consistent with mesangioproliferative glomerulonephritis 11 (50%), minimal change disease 6 (27.3%), focal segmental glomerulosclerosis 3 (13.6%) and interstitial nephritis 2 (9.1%). CKD was prevalent in SCD patients, and it was characterised by tubular dysfunction and mesangioproliferative glomerulonephritis. The main predictors of CKD were increased age, severity of vaso-occlusive crisis, worsening anaemia and tubular dysfunction.

#2964 THE ROLE OF RENAL DYSFUNCTION DURING ANTICOAGULANT USE IN COPD PATIENTS WITH ATRIAL FIBRILLATION

Abstract Background and Aims Renal dysfunction is known to be the most important predictor of outcome in patients with atrial fibrillation (AF). Purpose of the study was to evaluate the prognostic role of kidney dysfunction in terms of possible cardiovascular events and bleeding in patients with COPD and AF treated with oral anticoagulants. Method We examined 56 COPD patients with CHF and AF who received oral anticoagulants. Renal function (creatinine level and estimated glomerular filtration rate - eGFR) was assessed at baseline and at follow-up. The functional state of the kidneys was calculated using the CKD-EPI-2011 formula. Initially, the risk of bleeding was assessed using the HAS-BLED score. The deterioration of the functional state of the kidneys was noted with an increase in the level of creatinine or a decrease in eGFR by at least 20%. Results In addition to the standard treatment for COPD in the presence of AF, patients received oral anticoagulants during a six-month follow-up. The deterioration of the functional state of the kidneys was observed in 18.3% of patients. In patients with kidney dysfunction, the frequency of episodes of CHF decompensation and non-massive bleeding (MB) was significantly higher. When reduced glomerular filtration rate did not affect the frequency of bleeding and stroke. The oral anticoagulants used did not significantly affect the observed renal dysfunction and did not affect the occurrence of new cardiovascular events in patients with COPD. It turned out that the predictors of renal dysfunction in patients with COPD are age, female gender, and lower hemoglobin levels. In multivariate analysis, renal dysfunction was identified as an independent predictor of non-massive bleeding (OR 2.04, 95%, p<0.05). Conclusion In patients with COPD and atrial fibrillation, the presence of kidney dysfunction was an additional aggravating factor associated with adverse cardiovascular prognosis in the medium term and the risk of bleeding. However, oral anticoagulants did not affect the degree of deterioration in renal function or the incidence of cardiovascular events.

Can we predict early renal impairment in pediatric cirrhosis?

Published literature on renal dysfunction (RD) in pediatric cirrhosis are limited. We aimed to detect early RD in cirrhotic children by renal resistive index (RI) and plasma aldosterone (PA). We evaluated the effects of large-volume paracentesis (LVP) and albumin infusion on the same. Non-azotemic cirrhotic children with tense ascites (undergoing LVP with albumin infusion) were prospectively enrolled. Blood biochemistry and doppler ultrasonography for RI and PA were measured at regular intervals. RI >0.7 was considered as RD. Outcomes were noted at D90 and 1 year. Chronic liver disease children without ascites were included as controls. Of the 99 cirrhotic children, tense ascites (n=51) had higher baseline RI than controls (n=48) (p<0.001). Overall, baseline RD was observed in 32% and was significantly higher in tense ascites compared to controls (59% vs. 4%, p<0.001). Tense ascites with RD at admission had higher chances of acute kidney injury (AKI) (p=0.009), ascites recurrence (p=0.043), hospital readmission (p=0.048), and mortality (p=0.009) compared to patients without RD by D90. Significant reduction in RI was noted at 48 h, D7, D30, and D90 compared to baseline after LVP with albumin. Pediatric End-stage Liver Disease (PELD) score and PA had a strong positive correlation with baseline RI (R2=0.51, R2=0.47). Using multivariate analysis, PELD score and PA were predictors of AKI (odds ratio [OR]: 1.14; 95% confidence interval [CI]: 1.04-1.24; p=0.003) and mortality (OR: 1.82; 95% CI: 1.22-2.72; p=0.004), respectively. Abnormal baseline RI can be used as an early predictor of RD and predict long-term renal ouctomes in pediatric cirrhosis. Baseline RI correlated well with the severity of liver disease and PA. Paracentesis and albumin infusion effectively reduced RI.

Prevalence and predictors of renal dysfunction among people living with HIV on antiretroviral therapy in the Southern Highland of Tanzania: a hospital-based cross-sectional study.

Introductioninfection with Human Immunodeficiency Virus (HIV) and use of antiretroviral therapy (ART) poses a significant risk of developing renal dysfunction in people living with HIV (PLHIV). Renal dysfunction contributes to the morbidity and mortality of PLHIV. There is limited information on renal dysfunction among PLHIV in the Southern Highland, the highest HIV prevalent area in Tanzania. We conducted a study to estimate the magnitude and predictors of renal dysfunction among PLHIV on ART.Methodsa cross-sectional study was conducted at Njombe Town Council Hospital from December 2019 to April 2020, recruiting 396 participants. Serum was obtained to measure creatinine level then calculated glomerular filtration rate (GFR) using CKD-EPI and the Bedside Schwartz equations. The participants' informations were collected using a structured questionnaire. Data analysis was performed using STATA version 15; a modified Poisson regression model was used to estimate prevalence ratios (PR). The level of significance was specified at 0.05.Resultsthe overall prevalence of renal dysfunction defined as GFR less than 90 mL/min/1.73 m2 was 20.7%, which increased by 4% as the age increases. The prevalence of renal dysfunction was higher in PLHIV on ART for more than six months to 24 months compared to their counterparts. Likewise, obese individuals had a 2.5 times higher prevalence of renal dysfunction than normal individuals.Conclusionthere is a relatively high prevalence of renal dysfunction among PLHIV on ART, predicted by age, duration on ART, and nutrition status.

Can Perinephric Fat Stranding be used as a Predictor of Renal Dysfunction in COVID-19 Patients? A Retrospective Study

Introduction: High Resolution Computed Tomography (HRCT) of the chest is often performed in patients with Coronavirus Disease 2019 (COVID-19) to assess the severity of lung involvement. Multiorgan dysfunction is a well-known complication of COVID-19 infection. Bilateral Perinephric Fat Stranding (PFS) is often observed in cases of COVID-19 infection while reporting the chest Computed Tomography (CT) scans, which might represent associated acute kidney injury. It is still not known whether a correlation exists between the severity of COVID-19 infection and presence of PFS or renal dysfunction. Aim: To determine the association between PFS, Computed Tomography Severity Index (CTSI) and serum creatinine levels in patients with COVID-19 infection. Materials and Methods: This retrospective cohort study was conducted in Department of Radiology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India, from April 2021 to June 2021. A total of 90 COVID-19 positive patients of all ages and gender, who underwent HRCT of chest were included in the study. The chest scans were retrospectively reviewed for severity of lung involvement using a CTSI. The cases were divided equally into two groups A (n=45) and B (n=45). Group A included cases showing PFS on CT and group B included cases with no evidence of PFS. Serum creatinine levels (obtained within 24 hrs of the scan) of all patients were noted and analysed to determine any possible association between the PFS, CTSI and serum creatinine levels. Analysis was done using Mann-Whitney U test, for continuous variables and Chi-square test was used for categorical data. Results: The mean age of patients (p-value=0.047) and the male to female ratio (p-value&lt;0.001) was significantly higher in group A than in group B. Statistically significant association was found between PFS and serum creatinine (W=1375.500, p-value=0.003) PFS as an indicator of renal dysfunction had a sensitivity of 73.3%, specificity of 54.7%, Positive Predictive Value (PPV) of 24.4%, Negative Predictive Value (NPV) of 91.1% and a diagnostic accuracy of 57.8%. with an odds ratio of 3.32. Conclusion: Presence of PFS at imaging can serve as a useful screening tool for detecting underlying renal dysfunction in patients with COVID-19 infection.

Postnatal assessment for renal dysfunction in women with hypertensive disorders of pregnancy

BackgroundHypertensive disorders of pregnancy are associated with chronic kidney disease. Early detection of renal dysfunction enables implementation of strategies to prevent progression. International guidelines recommend review at 6–8 weeks postpartum to identify persistent hypertension and abnormal renal function, but evidence for the efficacy of this review is limited.MethodsAll women attending a specialist fetal-maternal medicine clinic for hypertensive disorders of pregnancy (pre-eclampsia, chronic hypertension, gestational hypertension) were invited for a 6–8 weeks postpartum review of their blood pressure and renal function in order to establish the prevalence and independent predictors of renal dysfunction. Renal dysfunction was defined as low estimated Glomerular Filtration Rate (eGFR < 60 ml/min/1.73 m2) or proteinuria (24-h protein excretion > 150 mg or urinary albumin-to-creatinine ratio > 3 mg/mmol). All women attending a specialist clinic for hypertensive disorders were invited for a 6–8 weeks postpartum review of their blood pressure and renal function. Demographics, pregnancy and renal outcomes were prospectively collected.ResultsBetween 2013 and 2019, 740 of 1050 (70.4%) women who had a pregnancy complicated by a hypertensive disorder attended their 6–8 weeks postpartum visit. Renal dysfunction was present in 32% of the total cohort and in 46% and 22% of women with and without pre-eclampsia, respectively. Multivariate logistic regression demonstrated that independent predictors were pre-eclampsia, chronic hypertension, highest measured antenatal serum creatinine, highest measured antenatal 24-h urinary protein, and blood pressure ≥ 140/90 mmHg at the postnatal visit.ConclusionsRenal dysfunction was present in one in three women with hypertensive disorders of pregnancy at 6–8 weeks postpartum. This includes women with gestational hypertension and chronic hypertension without superimposed pre-eclampsia, and thus these women should also be offered postnatal review.Graphic abstract

Combined evaluation of plasma B-type natriuretic peptide and urinary liver-type fatty acid-binding protein/creatinine ratio is related to worsening renal function in patients undergoing elective percutaneous coronary intervention.

There are few reports on the significance for the combined evaluation of blood humoral factors and urinary biomarkers in terms of worsening renal function (WRF) after coronary angiography (CAG)/percutaneous coronary arterial intervention (PCI). Urinary liver type-fatty acid-binding protein (L-FABP), neutrophil gelatinase associated lipocalin (NGAL), and adrenomedullin (AM) were measured less than 24h before and 3h, 6h, 1day, and 2days after CAG/PCI. WRF was defined as a > 20% decrease in the estimated GFR. WRF occurred in seven of 100 patients and the increase in L-FABP/creatinine (Cr) at 1day after CAG/PCI was significantly higher in the WRF group than in the non-WRF group. Plasma B-type natriuretic peptide (BNP) before CAG/PCI and L-FABP/Cr at 1day after CAG/PCI were independent predictors for WRF. The areas under the receiver-operating characteristic curves were as follows: 0.760 for BNP before CAG/PCI, 0.731 for L-FABP/Cr at 1day after CAG/PCI, and 0.892 for BNP and L-FABP/Cr. Urinary AM levels after PCI/CAG were negatively correlated only to serum potassium levels. Gene expressions of AM and AM-receptor were detectable in renal tubule epithelial cells. AM increased intracellular second messenger levels in a dose-dependent manner. Our results suggest that combined evaluation of plasma BNP and urinary L-FABP/Cr is useful as a predictor of renal dysfunction in CAG/PCI patients.

Cystatin C and interleukin-6 for prognosticating patients with acute decompensation of cirrhosis.

Background and AimSystemic inflammation and organ dysfunction/failure can complicate acute decompensation (AD) of cirrhosis with progression to acute‐on‐chronic liver failure (ACLF), leading to increased mortality. There are few studies on serum biomarkers predicting renal dysfunction (RD) or ACLF in AD. Serum cystatin C (CysC) and interleukin‐6 (IL‐6) were evaluated for predicting RD, ACLF, and mortality in AD patients.MethodsConsecutive AD patients seen from January 2018 to June 2019 were included. IL‐6 and CysC were measured in serum at the time of index presentation. Patients were followed for 90 days or until primary (development of RD) or secondary outcomes (development of ACLF or mortality). Multivariate analysis was performed to find whether CysC and IL‐6 can independently predict primary and secondary outcomes.ResultsA total of 124 patients were screened; 88 patients were included. On follow up, 22 (27.3%) developed RD, 11 (11/57, 19.3%) developed ACLF, and 21 (24%) died. The CysC predicted RD (odds ratio [OR] 7.97, 95% confidence interval [CI] 2.70–23.53, P = 0.001) and ACLF (OR 5.486, 95% CI 1.456–20.6, P = 0.012) development. IL‐6 was not an independent predictor of RD (P = 0.315), ACLF (P = 0.168), and mortality (P = 0.225).ConclusionSerum CysC can predict the development of RD and ACLF in patients of cirrhosis with AD.

Neutrophil-to-lymphocyte ratio is a predictor of renal dysfunction in Japanese patients with type 2 diabetes

BackgroundNeutrophil-to-lymphocyte ratio (NLR) has been widely evaluated as a biomarker in various medical and surgical prognoses, but its usefulness in diabetic kidney disease is not yet known. MethodsThis prospective observational study included outpatients, comprised of 184 men aged 73 ± 11 (mean ± standard deviation) years and 174 women aged 76 ± 10 years at baseline, from a rural hospital. We examined the relationship between baseline NLR calculated by analyzing the differential leukocyte counts in the complete blood count and the 2-year estimated glomerular filtration rate (eGFR) decline rate (i.e. 2-year eGFR−baseline eGFR) ∗100/baseline eGFR. Rapid eGFR decline rate was defined as a value < -25%. ResultsMultiple linear regression analysis using rapid eGFR decline rates as objective variables, adjusted for confounding factors as explanatory variables, showed that NLR (β = 0.138, p = 0.007) as well as presence of antidyslipidemic medication, hemoglobinA1c, and urinary albumin excretion stage were significantly and independently associated with a rapid eGFR decline rate. The multivariate-adjusted odds ratios (95% confidence interval) of the 2nd and 3rd tertiles of baseline NLR for rapid eGFR decline rate were 3.62 (0.70–18.7) and 8.03 (1.54–41.9), respectively. Multivariate-adjusted mean eGFR (95% confidence interval) values after 2 years categorized by tertile of baseline NLR were: 1st, 63.9 (61.8–66.1); 2nd, 60.8 (58.7–62.9); and 3rd, 58.9 (56.8–61.0). ConclusionsThese results suggest that baseline NLR might be a useful biomarker for renal function decline in outpatients with diabetes.

ALTERATION IN RENAL FUNCTION FOLLOWING LOOP DIURETICS IN PATIENTS WITH ACUTE DECOMPENSATED HEART FAILURE

Objective: The objective of the study was to monitor the impact of loop diuretic therapy in patients with acute decompensated heart failure (ADHF) and to assess other predictors of renal dysfunction in patients with ADHF.&#x0D; Methods: An observational study over a period of 6 months from January 2018 to June 2018 in the Department of Cardiology, in a Tertiary Care Teaching Hospital, Coimbatore, Tamil Nadu. Patients on diuretic therapy (loop diuretic) were enrolled. Patients with prior chronic kidney disease were excluded from the study. The patients were evaluated based on change in serum creatinine (SCr) and other contributing factors were assessed by acute kidney injury network and worsening of renal function criteria.&#x0D; Results: A total of 135 patients were enrolled, of which 73% were males and 27% were females. The mean age of the subjects was 61.55±13 years. The baseline means SCr was 1.62±0.92 mg/dl. On evaluation, 41% were really affected and 59% remain unaffected. Factors such as hypertension (p=0.047) and angiotensin-converting enzyme inhibitors (ACE-I) (p=0.023) were found to be significant predictors of renal injury.&#x0D; Conclusion: Variation in renal function in ADHF patients was multifactorial. The direct influence of loop diuretics on renal function was present but was not well established. Hypertension and ACE-I have found to show influence in the development of renal injury as contributing factors. There exists both positive and negative consequence of loop diuretics on renal function.

Utility of urinary liver-type fatty acid-binding protein as a predictor of renal dysfunction in Japanese patients with HIV receiving tenofovir disoproxil fumarate with low urinary \u03b22 microglobulin levels: a retrospective observational study

BackgroundTenofovir disoproxil fumarate (TDF) is known to reduce estimated glomerular filtration rate (eGFR). It is clinically important to identify patients at high risk for renal dysfunction as early as possible. Among the tubular markers, urinary β2 microglobulin (Uβ2MG) is a well-known biomarker of TDF-related tubulopathy. However, renal dysfunction has often been occurred in patients receiving TDF with low Uβ2MG levels. Recently, urinary liver-type fatty acid–binding protein (UL-FABP) was suggested to be predictor of the progression of renal dysfunction. Thus, we focused on UL-FABP in patients receiving TDF with low Uβ2MG levels.MethodsA retrospective, observational, single-center study, between January 2013 and December 2016, was conducted. Two renal end points (> 25% decrement in eGFR and > 20 mL/min/1.73 m2 decrement relative to the baseline) were assessed. To estimate the effect of UL-FABP on time to the first event, log-rank test was performed.ResultsA total of 24 Japanese outpatients with human immunodeficiency virus receiving TDF were enrolled. The outcome each occurred in two patients during the follow-up period. UL-FABP levels ≥4.0 μg/g creatinine was significantly associated with > 25% decrement and > 20 mL/min/1.73 m2 decrement (p = 0.006 and 0.001, respectively).ConclusionBased on our preliminary analysis, UL-FABP levels ≥4.0 μg/g creatinine predict renal dysfunction in patients receiving TDF with low Uβ2MG levels.

Serum uric acid to creatinine ratio is a useful predictor of renal dysfunction among diabetic persons

BackgroundSerum uric acid (SUA) has been shown to be a predictor of renal disease progression in most but not all studies. This study aims to test whether renal function-normalized SUA {i.e, SUA/creatinine (Cr) ratio} is a predictor of decreased renal function among diabetic patients. MethodsThe subjects comprised 185 men aged 72 ± 11 (mean ± standard deviation) years and 175 women aged 77 ± 10 years from a rural hospital. We examined the relationship between SUA/creatinine (Cr) ratio and renal function evaluated by estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease Study Group equation. ResultsAnnual eGFR decline rate was significantly increased with increased tertile of baseline SUA/Cr ratio (p = 0.011), and prevalence of the rapid progression types (≥3.0 ml/min/1.73 m2/year) was significantly higher in the second and third tertile (≥7,21) of baseline SUA/Cr ratio than the first tertile (<5.86) (p = 0.032). Pearson‘s correlation coefficient showed that baseline SUA/Cr ratio (r = 0.136, p = 0.012) as well as systolic blood pressure (SBP) and SUA were significantly correlated with annual eGFR decline rate. Multiple regression analysis using annual eGFR decline rate as an objective variable, adjusted for confounding factors as explanatory variables, showed that baseline SUA/Cr ratio (β = 0.334, p < 0.001) as well as gender and SBP were significantly and independently associated with annual eGFR decline rate. The multivariate-adjusted odds ratios (ORs) (95% confidence interval) of the baseline tertile of the SUA/Cr ratio for rapid progression of annual eGFR decline rate were 1.0, 3.15 (1.66–5.95) and 3.19 (1.57–6.51), respectively. ConclusionOur data demonstrated that baseline SUA/Cr ratio was independently and significantly associated with future renal function decline among diabetic patients.

Predictors of Renal Dysfunction in Adults with Childhood Vesicoureteral Reflux after Long-Term Follow-Up

BACKGROUND:Triad of childhood vesicoureteral reflux (VUR), urinary infection (UTI) and renal scarring might initiate potentially serious consequences that lead to renal dysfunction manifested at the second or third decade of life.AIM:To identify the risk factors predictive for renal dysfunction in adults with primary VUR after long-term follow-up.METHODS:We evaluated the records of 101 children (94.1% female, 5.9% male) at a median age of 5.2 ± 2.3 years (1-12 years), suffering from UTI and VUR. The patients were interviewed after mean 21 years from the first episodes of VUR (8 to 32 years). Renal function was determined from the estimated glomerular filtration rate (eGFR).RESULTS:Renal scarring was detected in 68.3% out of 82 patients and bilateral one in 7.3% patients. Linear regression analysis revealed that presence of proteinuria (B = -33.7, p=0.0001), the greater number of years from VUR diagnosis (B = -1.6, p = 0.002) and renal scarring (B = -14.8, p = 0.005) appeared as independent predictors of reduced global eGFRcreat. The same variables plus microalbuminuria (B = -1.0, p = 0.012) appeared as independent predictors of reduced global eGFRcreat-cys. Bilateral scarring (OR=25.5, p = 0.003) appeared as independent predictor of greater risk for CKD assessed using eGFRcreat while greater number of years from VUR diagnosis (OR = 1.7, p = 0.092), microalbuminuria (OR = 1.3, p = 0.047) and again bilateral scarring (OR = 31.3, p = 0.040) appeared as predictors of risk for CKD assessed using eGFRcreat-cys.CONCLUSION:Identification of those with an increased risk of progression to CKD should be the goal in all patients with childhood VUR. Their systematic follow-up should be till adulthood and older age.

Diagnostic and prognostic value of cystatin C as an early marker of renal dysfunction in patients with cardiovascular pathology

Disorders of the kidneys often occur in cardiovascular diseases. They are connected with the heart by complex hemodynamic and neuroendocrine bonds. The structure, functions, and possibilities of using an endogenous indicator of the functional state of the kidney - cystatin C are discussed in the article. Available data allow the use of cystatin C as a predictor of renal dysfunction in patients with cardiovascular pathology and arterial hypertension, in particular. However, the widespread use of cystatin C in routine clinical practice requires further study and improvement.

Diagnostic and prognostic value of cystatin C as an early marker of renal dysfunction in patients with cardiovascular pathology

Disorders of the kidneys often occur in cardiovascular diseases. They are connected with the heart by complex hemodynamic and neuroendocrine bonds. The structure, functions, and possibilities of using an endogenous indicator of the functional state of the kidney - cystatin C are discussed in the article. Available data allow the use of cystatin C as a predictor of renal dysfunction in patients with cardiovascular pathology and arterial hypertension, in particular. However, the widespread use of cystatin C in routine clinical practice requires further study and improvement.

Predictors of renal dysfunction in patients with chronic heart failure and reduced left ventricular ejection fraction

The aim — to elucidate the predictors of renal dysfunсtion (RD) in patients with chronic heart failure (CHF) and reduced left ventricular ejection fraction (LVEF).Materials and methods. 134 patients were examined with stable CHF, II — IV NYHA functional class (FC), and LVEF < 40 %. Median age was 59.5 [54; 68] years. All patients underwent general clinical examination. Glomerular filtration rate was calculated. The levels of interleukin­6, insulin, NTproBNP, uric acid, blood urea nitrogen, levels of microalbuminuria were determined. Ultrasound diagnosis of the vasodilating function of the endothelium of the brachial artery was performed using a test with reactive hyperemia. The patients were treated according to the current guidelines of the Association of Cardiologists of Ukraine on the diagnosis and treatment of chronic heart failure.Results and discussion. RD was detected in 39.5 % of the patients examined. Older patients, women, patients with coronary heart disease (CHD), arterial hypertension (AH), diabetes mellitus, anemia, and also III — IV NYHA class have a greater chance of having RD. The presence of myocardial infarction (MI), atrial fibrillation (AF), smoking in the anamnesis did not reveal significance in calculating the odds ratio. None of the major hemodynamic and echocardiographic parameters was a predictor of PD. Among the laboratory indices, independent predictors of RD were detected levels of blood urea nitrogen, uric acid, and citrulline levels.The results obtained indicate the priority role of neuro­humoral activation, inflammation and oxidative stress in the formation of RD.Conclusions. The independent laboratory predictors of RD in 39.5 % of the patients with CHF and a reduced LVEF are the levels of blood urea nitrogen, uric acid and citrulline in the plasma. Its risk increases with age, NYHA class, the duration of CHF, and in the presence of such co­morbidities as AH, CHD, diabetes mellitus, anemia. The presence of RD is not associated with MI in anamnesis or the presence of AF, parameters of central hemodynamics, parameters of LV structural­functional states, level of microalbuminuria, ratio of albumin/creatinine, level of glucose, insulin, interleukin­6 and NTproBNP in plasma.