Random Urine Research Articles

Application Value of Random Urine Potassium-to-Creatinine Ratio in Diagnosing Renal Potassium Loss

To analyze the value of applying random urine potassium-to-creatinine ratio (rUK/Ucr) in diagnosing renal potassium loss. patients diagnosed with hypokalemia, including 373 cases of renal potassium loss, 83 cases of non-renal potassium loss , and 358 cases of normal serum potassium, between 2017 and 2021 were enrolled. The clinical data of the patients were collected and the correlation between rUK/Ucr and 24-hour urine potassium (24 hUK) in the three groups was analyzed. The receiver operating characteristic (ROC) curve was used to analyze the value of applying rUK/Ucr in diagnosing renal potassium loss. Serum potassium decreased in the normal serum potassium group, the renal potassium loss group, and the non-renal renal potassium loss group ( P<0.01). The 24 hUK and the rUK/Ucr of the renal potassium loss group were higher than those of the non-renal potassium loss group and normal serum potassium group ( P<0.01). rUK/Ucr showed low to moderate correlation with 24 hUK. The AUC of 24 hUK and rUK/Ucr for determining renal potassium loss were 0.73 and 0.71, respectively. When the optimal cutoff point of rUK/Ucr for determining renal potassium loss was 3.4, the sensitivity was 67.6% and the specificity was 67.5%. rUK/Ucr shows a moderate correlation with 24 hUK and its accuracy in determining renal potassium loss is comparable to that of 24 hUK. When 24-hour urine samples cannot be obtained, it is recommended that rUK/Ucr be used instead of 24 hUK to determine whether renal potassium loss exists, with the optimal cutoff point for diagnosis being 3.4.

The Correlation of Urine Protein/osmolality and Protein/creatinine Ratio as Predictor of 24-hour Urinary Protein Excretion.

The drawback of 24-hour urine collection is that it is troublesome, takes a lot of time, and is inaccurate because of collection errors and improper timing. The research in the Indian adult population about the correlation of spot urine protein/osmolality ratio (UPOR) and spot urine protein/creatinine ratio (UPCR) as a predictor of 24-hour urinary protein excretion is lacking. To study the correlation of spot UPOR and spot UPCR as the prognosticator of 24-hour urinary protein excretion. The present cross-sectional observational study was undertaken on 50 patients &gt;18 years of age and of either sex who presented with proteinuria (dipstick test or urine routine) and were advised 24-hour urine protein examination. A 24-hour urine was collected for protein analysis starting from any time of day. Random urine samples were collected and processed for protein, creatinine, and osmolality. The spot UPOR and UPCR were calculated. The sensitivity and specificity were determined. Pearson's correlation was used to find the correlation. There was a statistically significant positive correlation of UPOR and UPCR (r = 0.418 and r = 0.512, respectively) with 24-hour urinary protein excretion. The sensitivity and specificity of UPOR to predict 24-hour urinary protein at cutoff point 1.32 was 82.3% and 81%, respectively. The sensitivity and specificity of UPCR to predict 24-hour urinary protein at cutoff point 1.09 was 87 and 86%, respectively. For the medical determination of proteins in urine, spot UPOR and UPCR are suitable, cheap, and dependable methods that can substitute the measurement of 24-hour urine protein.

Predictive Models for Kidney Recovery and Death in Patients Continuing Dialysis as Outpatients after Starting in Hospital.

For patients who initiate dialysis during a hospital admission and continue to require dialysis after discharge, outpatient dialysis management could be improved by better understanding the future likelihood of recovery to dialysis independence and the competing risk of death. We derived and validated linked models to predict the subsequent recovery to dialysis independence and death within 1 year of hospital discharge using a population-based cohort of 7657 patients in Ontario, Canada. Predictive variables included age, comorbidities, length of hospital admission, intensive care status, discharge disposition, and prehospital admission eGFR and random urine albumin-to-creatinine ratio. Models were externally validated in 1503 contemporaneous patients from Alberta, Canada. Both models were created using proportional hazards survival analysis, with the "Recovery Model" using Fine-Gray methods. Probabilities generated from both models were used to develop 16 distinct "Recovery and Death in Outpatients" (ReDO) risk groups. ReDO risk groups in the derivation group had significantly distinct 1-year probabilities for recovery to dialysis independence (first quartile: 10% [95% confidence interval (CI), 9% to 11%]; fourth quartile: 73% [70% to 77%]) and for death (first quartile: 12% [11% to 13%]; fourth quartile: 46% [43% to 50%]). In the validation group, model discrimination was modest (c-statistics [95% CI] for recovery and for death quartiles were 0.70 [0.67 to 0.73] and 0.66 [0.62 to 0.69], respectively), but calibration was excellent (integrated calibration index [95% CI] was 7% [5% to 9%] and 4% [2% to 6%] for recovery and death, respectively). The ReDO models generated accurate expected probabilities of recovery to dialysis independence and death in patients who continued outpatient dialysis after initiating dialysis in hospital. An online tool on the basis of the models is available at https://qxmd.com/calculate/calculator_874 .

Correlation between 24-hour Urinary Total Protein Excretion and Single Urinary Protein Creatinine ratio in the Diagnosis of Childhood Nephrotic Syndrome : Study in a Tertiary Level Hospital

Introduction:Protein excretion varies in the course of the day, for this reason 24-hours urinary total protein excretion has been considered as the classic reference method for protein determination in nephotic syndrome. As the collection of urine for 24 hours is tedious and errors may occur during the process, so the protein:creatinine ratio was developed as a diagnostic alterative for Nephrotic syndrome.The main aim of this study is to determine the correlation between 24-hour urinary total protein excretion and single urinary protein creatinine ratio in childhood Nephrotic syndrome. Methods: This cross-sectional study was conducted in the department of Paediatrics,Shaheed Suhrawardy Medical College &amp; Hospital from June 2018 to May 2019. After taking valid consent total 60 cases of Nephrotic syndrome were selected purposively according to inclusion and exclusion criteria. Here we tried to determine the correlation between 24-hour urinary total protein excretion and single urinary protein creatinine ratio in the diagnosis of childhood Nephrotic syndrome by measuring the spot urinary protein creatinine ratio and the 24 hours urinary total protein excretion of the patients. Results : Among total 60(N) children of Nephrotic syndrome 42 (70%) patients were male and 18 (30%) patients were female with M:F = 2.16:1.The mean age was 4.57 ± 2.01SD years. Most of the patients were presented with some associated diseases like urinary tract infection (30%), upper respiratory tract infection (28.3%), viral illness(8.3%), atopic dermatitis(3.3%) and nonspecific illnesses(30%). The main physical findings were only puffy face(100%), with ascites (86.6%) and swelling of genitalia (38.3%).The mean 24 hours urinary total protein excretion was 3114.45 ± 1627.89 mg/24 hours and spot urinary protein creatinine ratio was 5.57 ± 3.13 SD. There was a very significant correlation between 24 hour total urinary protein excretion and spot urinary protein creatinine ratio. The sensitivity of the study was 80.49 – 100% and specificity of 91.78 - 100% at £2000 mg /sqm body surface area/ day protein excretion. The p value was .002 with correlation coefficient was 0.39. Conclusion: The protein creatinine ratio of a random urine sample might be used as an alternative method for the diagnosis of Nephrotic syndrome in children in view of the obvious advantages in terms of cost, time and patient convenience. J Shaheed Suhrawardy Med Coll 2021; 13(2): 137-142

Bacterial profile, their antibiotic susceptibility pattern, and associated factors of urinary tract infections in children at Hiwot Fana Specialized University Hospital, Eastern Ethiopia.

Urinary tract infections (UTIs) are common pediatric infections and contribute to high morbidity and mortality. At present, the antimicrobial resistance emergency has quadrupled worldwide and poses a serious threat to the treatment of patients. However, there have been few studies on UTIs in children in Ethiopia, particularly in the east. This study aimed to assess the bacterial profile of urinary tract infections, their susceptibility to antimicrobial agents, and associated factors in under-five children at Hiwot Fana Specialized University Hospital, eastern Ethiopia. We conducted hospital-based quantitative study on 332 consecutively selected under-five children from March 20 to June 10, 2021. Parents and guardians were interviewed to collect data using a structured questionnaire. Random urine samples were collected aseptically, and standard microbiological techniques were used to identify the bacteria and test for susceptibility to various antibiotics. Data were entered into Epi Info version 7 and exported to Statistical Package for the Social Sciences (SPSS) version 25 for analysis. Data were analyzed using descriptive analysis, bivariate, and multivariable logistic regression analysis. The crude odds ratio (COR) and adjusted odds ratio (AOR) with their respective 95% confidence intervals (CI) were used to determine the significance of the predictors. A p-value at a 95% confidence interval of less than 0.05 was considered statistically significant. The overall prevalence of bacterial urinary tract infections was 80 (24.1%) 95% CI:19.40-29.00%). Most of the bacterial isolates 55 (68.75%) were gram-negative bacteria, predominantly E. coli 23 (28.75%) and K. pneumoniae 10 (12.50%). Being a rural resident (AOR: 4.10, 95%CI: 1.45 11.54), uncircumcised male (AOR: 3.52, 95%CI: 1.33, 9.39), previous history of antibiotic usage (AOR: 7.32, 95%CI: 2.11, 25.37), indwelling catheterization (AOR: 10.35, 95%CI: 3.74, 28.63), previous history of urinary tract infections (AOR: 5.64, 95% CI: 1.36, 23.38), and urinary frequency (AOR: 5.56, 95%CI: 2.03, 15.25) had higher odds of culture positive result. The majority of the isolates have shown high levels of antibiotic resistance. Meropenem, ciprofloxacin, and amoxicillin-clavulanic acid were effective against gram-negative uropathogens, whereas rifampin and ciprofloxacin were the most sensitive drugs for gram-positive isolates. From the tested bacterial isolates, 53/86 (61.6%), 11/86 (11.6%), and 2/86 (2.3%) were found to have multidrug resistance (MDR), extreme drug resistance (XDR), and pan drug resistance (PDR), respectively. About one-fourth of the children were culture-positive for many types of bacterial uropathogens; this is higher compared with most of the previous studies in Africa. Rural dwellers, uncircumcised males, indwelling catheterization, a history of antibiotic use and urinary tract infection, and frequent urination all had a higher risk of bacterial infections. Many isolates were resistant to multiple drugs, primarily beta-lactams. Urinary tract infections as well as the growth and spread of resistant bacterial pathogens should be monitor regularly.

Rifampin monotherapy for children with idiopathic infantile hypercalcemia

Idiopathic Infantile Hypercalcemia (IIH) is characterized by hypercalcemia and hypercalciuria owing to PTH-independent increases in circulating concentrations of 1,25(OH)2D. At least 3 forms of IHH can be distinguished genetically and mechanistically: infantile hypercalcemia-1 (Hypercalcemia, Infantile, 1; HCINF1) due to CYP24A1 mutations results in decreased inactivation of 1,25(OH)2D; HCINF2 due to SLC34A1 mutations results in excessive 1,25(OH)2D production; and HCINF3 in which a variety of gene variants of uncertain significance (VUS) have been identified and where the mechanism for increased 1,25 (OH)2D is unclear. Conventional management with dietary calcium and vitamin D restriction has only limited success. Induction of the P450 enzyme CYP3A4 by rifampin can provide an alternate pathway for inactivation of 1,25(OH)2D that is useful in HCINF1 and may be effective in other forms of IIH.We sought to assess the efficacy of rifampin to decrease levels of serum 1,25(OH)2D and calcium, and urinary calcium concentrations in subjects with HCINF3, and to compare the response to a control subject with HCINF1.Four subjects with HCINF3 and the control subject with HCINF1 completed the study using rifampin 5 mg/kg/day and 10 mg/kg/day each for 2 months separated by a 2-month washout period. Patients had age-appropriate intake of dietary calcium plus 200 IU vitamin D/day. Primary outcome was efficacy of rifampin to lower serum concentrations of 1,25(OH)2D. The secondary outcomes included the reduction of serum calcium, urinary calcium excretion (as random urine calcium: creatinine (ca:cr) ratio) and serum 1,25(OH)2D/PTH ratio.Rifampin was well tolerated and induced CYP3A4 at both doses in all subjects. The control subject with HCINF1 showed significant response to both rifampin doses with decreases in the serum concentration of 1,25(OH)2D and the 1,25(OH)2D/PTH ratio while the serum and urine ca:cr levels were unchanged. The four patients with HCINF3 showed reductions in 1,25(OH)2D and urinary ca:cr after 10 mg/kg/d, but hypercalcemia did not improve and there were variable responses in 1,25(OH)2D/PTH ratios. These results support further longer-term studies to clarify the usefulness of rifampin as a medical therapy for IIH.

Metabolomic Methods to Predict Cancer-Associated Skeletal Muscle Wasting from Profiles of Urinary Metabolites

It is known that cachexia is a cancer-associated muscle wasting and reduction in the function status due to treatment especially chemotherapy and in life expectancy, to assess cachexia muscle loss there are many methods as Computed Tomography (CT) scan which has many disadvantages as high cost, invasive, time consuming and cannot detect early stages of muscle wasting [1]. This novel approach uses single-time point urinary metabolite profiles for determining whether the patient is subjected to muscle wasting by analysis of 93 random urine samples from patients with cancer using 2 successive CT images by assessing of lumbar skeletal muscle area by cubic centimeter to estimate the rate of muscle change per time for every patient. The average muscle change over time was -4.71% in 100 days in the muscle-losing group and 3.91% in 100 days in the control group. Bivariate statistics identified metabolites to muscle wasting including constituents and metabolites of muscle as creatine and creatinine, amino acids as serine, threonine, glutamic acid, isoleucine and valine. These results suggest that urine analysis of a single random urine sample is cheap, fast, and non-invasive tool to screen muscle loss and it is useful to clarify prediction of related metabolic conditions possible with methodology presented. The metabolomics methods used in this article are Univariate analysis T-test, correlation analysis, principal component analysis and heatmap clustering.

The effect of micro-particle curcumin on chronic kidney disease progression: the MPAC-CKD randomized clinical trial.

Curcumin is a commonly used herbal supplement with anti-inflammatory and anti-fibrotic properties. Animal studies and small human trials suggest that curcumin reduces albuminuria in patients with chronic kidney disease (CKD). Micro-particle curcumin is a new, more bioavailable formulation of curcumin. To determine whether micro-particle curcumin versus placebo slows the progression of albuminuric CKD we conducted a randomized, double-blind, placebo-controlled trial with 6-month follow-up. We included adults with albuminuria [a random urine albumin-to-creatinine ratio >30mg/mmol (265mg/g) or a 24-h urine collection with more than 300mg of protein] and an estimated glomerular filtration rate (eGFR) between 15 and 60mL/min/1.73 m2 within the 3months before randomization. We randomly allocated participants 1:1 to receive micro-particle curcumin capsules (90mg/day) or matching placebo for 6months. After randomization, the co-primary outcomes were the changes in albuminuria and the eGFR. We enrolled 533 participants, but 4/265 participants in the curcumin group and 15/268 in the placebo group withdrew consent or became ineligible. The 6-month change in albuminuria did not differ significantly between the curcumin and placebo groups [geometric mean ratio 0.94, 97.5% confidence interval (CI) 0.82 to 1.08, P=.32]. Similarly, the 6-month change in eGFR did not differ between groups (mean between-group difference -0.22mL/min/1.73m2, 97.5% CI-1.38 to 0.95, P=.68). Ninety milligrams of micro-particle curcumin daily did not slow the progression of albuminuric CKD over 6months. ClinicalTrials.gov Identifier: NCT02369549.

The application of new complex indicators in the detection of urine

BackgroundAccurate diagnosis and assessment of hematuria is crucial for the early detection of chronic kidney disease(CKD). As instability of urinary RBC count (URBC) often results with clinical uncertainty, therefore new urinary indexes are demanded to improve the accuracy of diagnosis of hematuria. In this study, we aimed to investigate the benefit of applying new complex indicators based on random urine red blood cell counts confirmed in hematuric kidney diseases.MethodsAll patients enrolled underwent renal biopsy, and their clinical information was collected. Urinary and blood biomedical indexes were implemented with red blood cell counts to derive complex indicators. Patients were divided into two groups (hematuria-dominant renal histologic lesions and non-hematuria-dominant renal histologic lesions) based on their renal pathological manifestations. The target index was determined by comparing the predictive capabilities of the candidate parameters for hematuric kidney diseases. Hematuria stratification was divided into four categories based on the scale of complex indicators and distributional features. The practicality of the new complex indicators was demonstrated by fitting candidate parameters to models comprising demographic information.ResultsA total of 1,066 cases (678 hematuria-dominant renal histologic lesions) were included in this study, with a mean age of 44.9 ± 15 years. In differentiating hematuria-dominant renal histologic lesion from the non-hematuria-dominant renal histologic lesion, the AUC value of “The ratio of the random URBC to 24-h albumin excretion” was 0.76, higher than the standard approach of Lg (URBC) [AUC = 0.744] (95% Confidence interval (CI) 0.712 ~ 0.776). The odds ratio of hematuria-dominant renal histologic lesion (Type I) increased from Q2 (3.81, 95% CI 2.66 ~ 5.50) to Q4 (14.17, 95% CI 9.09 ~ 22.72). The predictive model, composed of stratification of new composite indexes, basic demographic characteristics, and biochemical parameters, performed best with AUC value of 0.869 (95% CI 0.856–0.905).ConclusionThe new urinary complex indicators improved the diagnostic accuracy of hematuria and may serve as a useful parameter for screening hematuric kidney diseases.

Excessive iodine status among school‐aged children in the State of Qatar: Results of the National Iodine Deficiency Disorder Survey

AbstractBackgroundIodine deficiency poses a significant public health challenge worldwide, particularly in preschool children and pregnant women. Assessing the iodine intake at a population level is essential, as both deficient and excessive iodine status can have adverse health consequences. The main objective of this survey is to understand the iodine deficiency status in schoolchildren aged 6–12 years in the State of Qatar.MethodsA cross‐sectional survey was conducted from March to June 2014 among school‐aged children using a two‐stage cluster sampling technique. Anthropometric, biochemical, clinical, and dietary parameters for seafood were collected. Spot urine samples were collected from 967 participants, and a repeat random subsample urine was collected from 288 participants. Overall median urinary iodine concentration (UIC) was calculated. Iodine content in household salt samples was estimated by qualitative and quantitative methods. Mann–Whitney U test was used for comparison.ResultsThe median UIC was 333.2 μg/L (IQR = 228.6). UIC prevalence rates between 300–999 and &gt;1000 μg/L were 56.7% and 2.8%, respectively. The goiter prevalence was 0.4%. A significant difference was noted in overall median UIC levels between boys and girls (p = 0.003). Adequate iodized salt consumption was reported by 74.9% of households, and weekly seafood consumption was reported by one third of the respondents.ConclusionThe results indicate an excess intake of iodine among the studied population in the State of Qatar, and national efforts are needed to bring iodine intake and concentration levels within the cutoff value for the concerned survey population's age group. In addition, a surveillance system needs to be set up for continuous monitoring of iodine content and salt intake at the population level in the State of Qatar.

The rising threat of illicit amphetamine-type stimulant use among methadone maintenance treatment patients in East Coast Malaysia: a retrospective observational study

ABSTRACT Background: In recent years, amphetamine-type-stimulants (ATS) have been extensively misused in South-East Asia, inducing major problems among methadone-maintenance-treatment (MMT) patients. Objective: We examine ATS-misuse prevalence and its determinants among MMT patients in East-Coast-Malaysia. Methods: A retrospective–observational study was conducted on government-subsidized medication for opioid-use-disorder (MOUD) treatment clinics involving 292 MMT-patients (98% males) who were selected using a multilevel-proportional-stratified random sampling technique. Information obtained during the mandatory monitoring procedure from January 1 to December 31 2019, was utilized to determine ATS misuse prevalence from consecutive random urine drug screening. The determinants associated with its use, namely sociodemographics, social networks, comorbidities, and pharmacological assessments were analyzed via a logistic model. Results: Overall, 52.2% of the MMT-patients (95% CI: 0.42–0.54) had misused ATS at least once during their methadone treatment. These misusing patients were active smokers, hepatitis B and C seronegative, concurrently misused opioids, and had received suboptimum prescribed doses of methadone. Multiple logistic regression analysis demonstrated that the odds of misusing ATS during methadone treatment were 37 times higher among those who concurrently misused opioids (AOR: 37.60, 95% CI: 14.03–100.74) and 12 times higher among those who received suboptimal methadone doses (<60 mg/day) (AOR: 12.24, 95% CI: 5.58–25.43). Conclusion: This study demonstrated the significant prevalence of ATS misuse among MMT-patients in East-Coast-Malaysia, especially among patients who were prescribed suboptimal doses of methadone and/or demonstrated concomitant opioid-misuse. Stringent urine-monitoring is crucial to prevent diversion to ATS misuse. Nonetheless, to avoid negligence and improve physician engagement, the relevant authorities should immediately plan a comprehensive national-standard training module comprising support activities for professional methadone-prescribers.

Kidney injury molecule-1 and cystatin C as early biomarkers for renal dysfunction in Iraqi type 2 diabetes mellitus patients

Diabetic kidney disease (DKD) is caused by a variety of processes. As a result, one biomarker is insufficient to represent the complete process. This study Evaluate the diagnostic value of serum kidney injury molecule-1(KIM-1) and cystatin C (CysC) as early biochemical markers of DKD and predictive their sensitivities and specificities as biomarkers of nephropathy in Iraqi type 2 diabetic (T2DM) patients. This cross-sectional study include 161 T2DM patients from Diabetes and Endocrinology Center at Merjan medical city in Babylon. Patients divided according to urinary albumin creatinine ratio(ACR) (Group1:ACR≤30mg/g,Group2:ACR&gt;30mg/g). Random spot urine and fasting blood samples were taken from each patient and urinary ACR, blood glycated hemoglobin(HbA1c), and serum glucose, creatinine(SCr), lipid profile, CysC, KIM-1 were assayed, and the estimated glomerular filtration rat (eGFR) was calculated. When compared to the normoalbuminuric group, the DKD group had significantly greater prevalence of retinopathy, and significantly elevated HbA1c and total cholesterol values. Also had significantly greater serum levels of KIM-1 and CysC, and there is a significant (P-value&lt; 0.01) positive correlation between them. In contrast, GFR was significantly higher in normoalbuminuric group and was significantly negatively correlated with both CysC and KIM-1. Multiple linear regression analysis, found that there were a significant positive association between CysC, KIM-1 and ACR. ROC analysis reveal that eGFR had the highest area under the curve(AUC=0.717), while SCr had the lowest AUC(0.556). In conclusion, Serum KIM-1 and CysC levels consider as early biomarker for DKD along with eGFR that consider the best diagnostic indicator of DKD, Additionally, there is a strong correlation between serum CysC and KIM-1 as well as other renal measures that indicate deteriorating kidney function.

High Positivity Rate of Urinary Mycobacterium tuberculosis Antigens Cocktail (ESAT-6, CFP-10, and MPT-64) in Active Tuberculosis Patients With and Without Human Immunodeficiency Virus Infection: A Cross-Sectional Study.

Human immunodeficiency virus (HIV) infection is a risk factor for the occurrence of a large of Mycobacterium tuberculosis (Mtb) antigen load in the body. The antigens cocktail namely early secretory antigenic target protein 6-kDa (ESAT-6), Culture filtrate protein 10 kDa (CFP-10), and Mycobacterium tuberculosis protein 64 (MPT-64) are secreted by Mtb during replication, hence, their concentration increase in patients with active Tuberculosis (TB). This increased levels facilitates their entry into the systemic circulation, followed by secretion by the glomerulus into the urine. The aim of this study was to determine the positivity rate of the urinary Mtb antigens cocktail between TB patients with and without HIV infection. This is an observational descriptive comparative study conducted with a cross-sectional design. Random urine samples were collected from patients diagnosed with active TB in Dr. Hasan Sadikin Bandung Hospital in 2021. The subjects were divided into 2 groups, TB-HIV group and TB without HIV group. The samples were tested using the quantitative immunochromatography method. Sixty active TB patients consisting of TB patients with HIV infection (n = 30) and TB patients without HIV infection (n = 30). The positivity in the urinary Mtb antigens cocktail was 93.3% for TB-HIV group and 100% for TB without HIV group (P = .492). The median concentration of urinary Mtb antigens cocktail in TB patients without HIV infection was higher than that of TB patients with HIV infection (137.73 ng/mL vs 96.69 ng/mL, respectively; P = .001). There was no significant difference in the positivity rate, meanwhile, there was a significant difference in concentration of the urinary Mtb antigens cocktail between active TB patients with and without HIV infection. Interestingly, this urinary Mtb antigens cocktail can be found in both groups without being affected by the patient's immune condition, thus becoming a test to assist diagnose active TB.

Study of Micro Albuminuria and HbA1c in Type 2 Diabetes Mellitus Patients in Shendi Town, Sudan: Case Control Based Study

Background: Diabetes mellitus (DM) is a systemic metabolic disorder that can lead to diabetic nephropathy (DN), a leading cause of end-stage renal disease around the world.&#x0D; Objectives: The purpose of this study was to compare microalbuminuria and glycosylated hemoglobin (HbA1c) levels in patients with diabetes mellitus to healthy normal controls in Shendi, Sudan.&#x0D; Materials and Methods: This hospital-based case-control study was carried out in Shendi, Sudan. Between June and October of 2021 This study included 50 participants, 30 of whom had clinically confirmed diabetes as cases and 20 who appeared to be healthy as controls. In this study, blood and random urine samples were collected from each case and control, and the levels of microalbuminuria and hemoglobin A1C (HbA1C) were estimated using an A25 chemistry analyzer and an Ichroma immuno-analyzer, respectively. The data was collected with a structured questionnaire and analyzed with SPSS version 20.&#x0D; Results: In our study, patients had higher mean microalbuminuria than controls (26.438.2 vs 11.4 9.2 mg/l, P value = 0.000). This study found a significant increase in mean hemoglobin A1C levels in the case group compared to the control group (7.382.2 vs5.7 0.76% P value = 0.001). Our findings also revealed that there was no relationship between microalbuminuria and disease duration.&#x0D; Conclusions: Microalbuminuria levels were higher when compared to controls. In comparison to the control group, HbA1c levels were higher. Microalbuminuria and patient age had a weak positive correlation in our study group.

Nutrient Adequacy Among Pregnant Women With Altered Iodine Status

Background: Pregnant women, are one of the most vulnerable groups for iodine deficiency. Alteration in the nutritional status during pregnancy can have a significant impact on maternofoetal health outcomes. Evidence relating to macro and micronutrient requirements, their deficiency its risks, and consequences still remain a gap of knowledge. Objectives: The aim of this study was to assess the nutrient intake of pregnant women with altered iodine status in the Mysuru region. Methods: A hospital-based cross-sectional study was conducted and random spot urine samples (n=110) were collected to determine Urinary iodine concentration (UIC). Three-day 24hr recall and FFQ were collected to assess the nutrient intake. Adequacy percent and ratio was calculated for both macro and micronutrients and ANOVA was employed to find the significance among different groups. Results: Intake of both macro and micronutrients were insufficient in UIC<150μg/L and UIC>500μg/L groups except for carbohydrate. A significant difference (p

A Method for Quantitative Determination of Amino Acids and Organic Acids in Trace Random Urine and Preliminary Application in Research on Vitamin B12 Nutritional Status and Related Metabolism

Objective To develop a method for the quantification of amino acids and organic acids in trace urine by high performance liquid chromatography-tandem mass spectrometry.Methods Random urine samples(10 μl each)were precipitated by acetonitrile and underwent derivatization with 3 mol/L HCl in n-butanol.The analytes were separated by ACE Excel 2 AQ column(50×2.1 mm,2 μm).Electrospray ionization in positive ion mode was carried out and the analytes were detected in multiple reaction monitoring mode.According to existing guidelines,the method was systematically evaluated in terms of sensitivity,specificity,accuracy,precision,recovery,matrix effect,and stability.Then,the established method was employed to detect 19 target compounds in urine samples from 70 healthy children,27 children with suspected vitamin B12 deficiency,and 3 children with cblC type methylmalonic acidemia.Results The lower limit of quantification of the method for the 19 compounds ranged from 0.01 μmol/L to 1.00 μmol/L,and the calibration curves were linear,R2>0.990.The method showed good accuracy with relative error less than ±15% and the intra-day and intra-day precision less than 15%.The run time was 8 min.No obvious matrix effect was detected except for arginine,and the recovery ranged from 80.20% to 114.97%.The samples were stable after 8 h at room temperature and 3 freeze-thaw cycles.The measured values of the compounds in the urine of healthy children were within the children's reference intervals published by Labcorp.The levels of methylmalonic acid(P=0.030)and homocysteine(P<0.001)in the urine samples of children with suspected vitamin B12 deficiency were higher than those in healthy children.The levels of methylmalonic acid,methylcitric acid,and homocysteine in the urine samples of children with cblC type methylmalonic acidemia were 5.14-76.52 times higher than the median levels of healthy children. Conclusions The method established in this study has small sample demand and short run time,which can accurately quantify the levels of amino acids and metabolites in the urine of children.Moreover,it can provide data support for related studies about the metabolic characteristics of urine amino acids and their metabolites in children with vitamin B12 deficiency.

Analysis of HR-HPV Infection Concordance Rates in Cervical and Urine Specimens; Proposal of Additional Cervical Screening Process for Women Who Refuse Invasive Cervical Sampling.

This study aimed to provide basic data for the clinical application of urine samples to prevent cervical cancer due to persistent HR-HPV infection in women who refuse invasive cervical sampling. Pairs of cervical swabs and urine samples were collected from 210 asymptomatic women who visited the obstetrics and gynecology department from August to December 2020, and a total of 420 samples were collected. Using the PANA RealTyper™ HPV Screening Kit as a real-time PCR method, paired cervical swabs and random urine samples were tested. A total of 19 samples (9.1%) were both HPV positive and 177 (84.3%) were both negative. The concordance between the two types of samples was 93.3%, with κ = 0.69 (moderate, 95% CI 0.54-0.84). The HPV infection rate by age was highest in both cervical swabs and urine samples in women in their 30s, followed by those in their 20s. Thus, the HPV infection rate was high in young women under 40 at 69.2% in cervical swabs and 61.8% in urine samples. Urine samples are considered a valuable screening test for women who refuse invasive Pap tests to prevent cervical cancer caused by persistent HPV infection.

RF30 | PSAT136 Gitelman Syndrome and Primary Hyperparathyroidism, a Case Report

Abstract Introduction Gitelman syndrome, also known as familial hypokalemia-hypomagnesemia, is a rare autosomal recessive disorder that impairs the sodium chloride cotransporter (NCC) and magnesium channels in the renal distal convoluted tubule, causing salt-losing tubulopathy. It is characterized by hypokalemia, hypomagnesemia, hypocalciuria, and secondary hyperaldosteronism. Although hypocalciuria is a distinctive characteristic of Gitelman syndrome, it seldom can cause any change in the total plasma calcium level. Thus, the occurrence of hypercalcemia would need further investigation. Case presentation We reported a case of a 36-year-old normotensive man with a past medical history significant for bipolar depression disorder and a history of chronic atrial fibrillation secondary to chronic hypokalemia, hypomagnesemia, and mild hypercalcemia. He was diagnosed with Gitelman syndrome. However, he was noncompliant with spironolactone, potassium, and magnesium supplementation. He suffered a motor vehicle accident, and on presentation to the emergency room, he was found with a serum potassium of 2.5 mEq/L (reference value 3.5-5.1), serum magnesium of 0.8 mEq/L (reference value 1.6-2.6), total serum calcium of 11.3 mEq/L (reference value 8.4-10.2), and serum phosphorus of 2.7 (reference value 2.5-4.5 mg/dl). Random urine potassium was 122.1 mEq/L, and intact parathyroid hormone was 144 pg/mL (reference value 14-65). His CT neck scan showed a 1.5 cm nodule inferior to the right thyroid lobe pole consistent with an inferior parathyroid adenoma. However, a parathyroid radionuclide scan using technetium-99m MIBI showed no radiopharmaceutical localization for parathyroid adenoma. Conclusion Hypercalcemia is extremely rare in Gitelman syndrome, offset by the action of concomitant hypomagnesemia. Our case shows the importance of investigating other causes of hypercalcemia, such as primary hyperparathyroidism in patients with Gitelman syndrome. To our knowledge, Gitelman syndrome and primary hyperparathyroidism are an extremely rare association that is present in our case. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m., Monday, June 13, 2022 12:48 p.m. - 12:53 p.m.

PSAT193 Skeletal Fluorosis due to Inhalant Abuse

Abstract Introduction Skeletal fluorosis (SF) is a rare toxic osteopathy characterized by massive bone fixation of fluoride. It is prevalent in India, China, and Africa due to fluoride water contamination, high consumption of brick tea, or even fluoride air pollution in industrialized areas. In the United States, it does not constitute a public health issue; however, it has been found recently in individuals who inhale high amounts of recreational fluoride. The mechanism of fluoride toxicity on the bone is attributed to its anabolic effect, and patients usually present with diffuse and chronic bone pain, non-vertebral fractures, and hyperparathyroidism. Case We present the case of a 39-year-old woman, who presented with bone pain and joint stiffness leading to impaired gait. She was previously seen by neurology, rheumatology, and oncology due to concern for neuropathy, rheumatoid arthritis, or possible occult malignancy but was referred after an inconclusive workup. Her past medical history was significant for a motor vehicle accident resulting in chronic back pain. She began using painkillers, but eventually, she turned to inhalants to help with pain management and depressive symptoms. Her inhalant of choice was keyboard cleaner. Slowly, she began noticing diffuse bone pain, muscle weakness, and difficulty walking that required her to use crutches. She continued to abuse inhalants 2-4 cans per day for about 5 years until March 2021. Physical exam was relevant for multiple bony prominences bilaterally on the elbows and thoracic spine. She also had a diminished range of motion of her 4 limbs, being unable to fully extend arms or legs. Lab evaluation showed elevated alkaline phosphatase 971, normal AST/ALT, vitamin-D 52, normal serum calcium and PTH, elevated random urine fluoride 23 mg/L (&amp;lt;3.2), elevated osteocalcin 292ng/ml (&amp;lt;32), and elevated N-telopeptide 2283 BCE/mmol cr (&amp;lt;64). Upper extremity x-rays showed evidence of diffuse mature periosteal reaction involving the proximal humerus, radius, ulna, and metacarpals and prominent medial and lateral epicondylar enthesopathy consistent with fluorosis. Discussion Skeletal fluorosis should be suspected in patients at risk for fluoride inhalation. Occupational exposure including huffing was key in this case. Diagnosis was confirmed by the detection of excess fluoride in the blood and urine. Currently, the only accepted treatment is to stop further ingestion or inhalation of fluoride. The half-life of retained fluoride in the bone is about 7 years. Unfortunately, there is no antidote for SF. One theoretical therapy is teriparatide, which might accelerate bone turnover and release skeletal fluoride. Further research is needed to identify more treatment options for patients diagnosed with this condition as the substance abuse crisis worsens in many developed countries. This case also emphasizes the importance of a thorough history prior to undertaking costly, time-consuming medical workups. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Study to determine efficacy of urinary HPV 16 & HPV 18 detection in predicting premalignant and malignant lesions of uterine cervix.

To evaluate clinical performance and diagnostic accuracy of urinary HPV for non-invasive screening of high-grade precancerous and cancerous cervical lesions in a visual inspection under acetic acid (VIA) -positive cohort. The study included 180 women aged 35-65 years, who were VIA positive in a colposcopy clinic. All participants had the initial stream of a random urine sample tested for the presence of high-risk HPV (hrHPV) types 16 and 18 and acetowhite lesions were biopsied per protocol. Concordance analysis was conducted to assess agreement between detection of hrHPV in urine and the presence of premalignant and malignant lesions in cervix on histopathology. Measures of diagnostic accuracy were estimated to evaluate the performance of urinary HPV against histopathology (reference standard). Substantial agreement between urinary HPV detection and histopathology was found (Cohen's κ is 0.696, P≤ 0.001), with an agreement in 88.9% of the cases and disagreement in 11.1%. The diagnostic performance of urinary HPV in predicting the presence of a high-grade precancerous or cancerous lesion was as follows: sensitivity 67%, specificity 97%, positive predictive value 89%, and negative predictive value 88.8%. HPV DNA detection from urine has good concordance with the histopathology for detection of precancerous and cancerous lesions of the cervix. Further studies on optimization of urine sampling and processing techniques are warranted.