Spot Urinary Ratio Research Articles

Association between sodium-to-potassium ratio in spot urine and hospitalization due to heart failure in high-risk Japanese patients

BackgroundIn Japanese cardiovascular (CV) high-risk patients, the ESPRIT (Evaluation of Sodium Intake for the Prediction of Cardiovascular Events in Japanese High-risk Patients) study showed that high sodium excretion (≥4.0 g/day) was associated with a composite CV events of heart failure (HF) hospitalization, acute coronary syndrome, cerebrovascular events, and CV deaths. In this context, the sodium-to-creatinine (Na/Cr) ratio in spot urine was found to be significantly associated with HF hospitalizations. Since a stable potassium balance plays a particularly relevant role for CV patients, this post-hoc study was designed to investigate the extent to which consideration of the sodium-to-potassium (Na/K) ratio represents a better predictor of HF hospitalizations in the ESPRIT study population. MethodsThis is a post-hoc analysis of a previously reported ESPRIT study (n = 520, 60 HF hospitalizations). ResultsReceiver operating curve analysis yielded optimal Na/K ratio cut-off value of 2.9 for detecting HF hospitalization. Kaplan–Meier curve showed that high Na/K ratio in spot urine was associated with increased HF hospitalization (p < 0.001). Cox proportional hazards model analysis revealed that high Na/K ratio was associated with HF hospitalization with a hazard ratio of 2.97 (confidence interval: 1.67–5.61). An association between high Na/K ratio and HF hospitalization remained after adjustments for Na/Cr ratio in spot urine or the use of diuretics. ConclusionThe Na/K ratio in spot urine is associated with HF hospitalization in high-risk Japanese patients.

Do not forget the kidney in graves' disease.

To investigate the prevalence of microalbuminuria and factors associated with microalbuminuria in Graves' Disease (GD). This cross-sectional and single-center study included 99 patients with GD and 47 healthy controls (HC). Exclusion criteria such as active infection, uncontrolled diabetes, and chronic kidney disease were applied to the participants. The participants' clinical findings, comorbidities, drug use, laboratory tests, and thyroid antibody levels were recorded. Spot urine samples were collected and stored at -80℃ to analyze the presence of microalbuminuria. The prevalence of microalbuminuria in patients with GD was 12.1%. The median microalbumin/creatinine ratio in spot urine (UACR) in patients with GD (9.49mg/g [5.09-18.10]) was higher than in the HC group (7.99mg/g [3.48-12.88], p = 0.033). UACR was correlated with thyroid-stimulating hormone receptor antibody (TRAb), thyroid-stimulating hormone (TSH), and free triiodothyronine (FT3) levels (p = 0.020, p = 0.006, p = 0.009 respectively). In the regression analysis, only the relationship between TRAb level and UACR remained (p = 0.040). This study demonstrates an increased prevalence of microalbuminuria in patients with GD. There was a significant correlation between microalbuminuria and TRAb level in patients with GD. This relationship suggests that one of the underlying mechanisms of microalbuminuria seen in patients with GD may be autoimmunity.

High normal blood pressure and left ventricular structural and functional disorders in young adults

Aim. To evaluate the association of a high normal blood pressure (BP) with the risk of early hypertension-mediated organ damage (HMOD) in young adults.Material and methods. Medical screening of population aged 18-45 years (n=987) revealed that in 173 persons, office BP corresponded to a high normal level or hypertension (HTN). Echocardiography (GE Healthcare Vivid 9, using EchoPAC Software) was performed when HTN was confirmed by office BP measurement and/or according to 24-hour ambulatory BP monitoring (ABPM) (n=127). In addition, creatinine and albumin-to-creatinine ratio in spot urine were measured.Results. The median age was 23 [21; 25] years. The median systolic (SBP) and diastolic BP (DBP) was 129 [121; 137] and 75±12 mm Hg, respectively. The detection rate of LV geometry abnormalities was 3,3 times higher in the high normal BP group [95% CI, 1,06-6,28, p=0,02], and 10,7 times higher in the HTN group [95% CI, 2,32-16,49, p=0,04] compared with the optimal+normal BP group. In a multivariate analysis, the independence of associations with the LV mass index (LVMI) was confirmed only for the mean nighttime DBP, left atrial volume index, and the ratio of LV peak early diastolic velocity to the average septal and lateral peak early diastolic mitral annular velocity.Conclusion. In young people, the prevalance of HMOD is comparable in the groups with high normal BP and HTN, while significant differences were found between the group with optimal+normal BP levels and patients with HTN and high normal BP. An independent association of elevated LVMI with mean nighttime DBP was found.

Sodium to creatinine ratio in spot urine is associated with heart failure hospitalization in Japanese high-risk patients.

Our previous study [Evaluation of sodium intake for the prediction of cardiovascular events in Japanese high-risk patients (ESPRIT study)] reported that increased sodium excretion ≥4.0 g/day was associated with composite cardiovascular events in hospitalization for heart failure (HF), acute coronary syndrome, cerebrovascular events and documented cardiovascular-related mortality in Japanese high-risk patients with either stable and compensated HF, coronary artery disease, cerebrovascular disease, chronic kidney disease or atrial fibrillation. However, the method of estimating sodium excretion levels using spot urine is complex, requiring age, body weight, height and multiplier factors for calculation. The aim of the present study was to elucidate whether the sodium to creatinine ratio in spot urine, a key component in estimating daily sodium excretion, was associated with hospitalization for HF. The present study performed a post-hoc analysis of the ESPRIT study (n=520; 60 hospitalizations for HF). Receiver operating curve analysis yielded an optimal sodium to creatinine ratio cut-off value of 24.8 for detecting hospitalization for HF. Kaplan-Meier curve analysis revealed that a high sodium to creatinine ratio in spot urine was associated with an increased hospitalization for HF (P<0.001). Cox regression analysis revealed that a high sodium to creatinine ratio was associated with hospitalization for HF with a hazard ratio (HR) of 2.49 [95% confidence interval (95% CI), 1.47-4.16]. Following adjustment for age, sex and body weight, the HR was as high as 2.74 (95% CI, 1.51-4.71). This association remained following further adjustment for brain natriuretic peptide, estimated glomerular filtration rate, diabetes mellitus or the use of diuretics. Overall, the present study demonstrated that the sodium to creatinine ratio in spot urine is associated with hospitalization for HF in Japanese high-risk patients.

Effects of contrast medium exposure on urine albumin/creatinine ratio

Aim: Albuminuria is a direct consequence of renal glomerular injury and increases with glomerular dysfunction. Spot urine albumin/creatinine (Alb/Cr) ratio is a reasonable surrogate for 24-hour urine albumin excretion rate and certainly not without limitations. It is known that renal function can be affected following contrast agent administration. The aim of our study is to assess the changes in Alb/Cr ratio in spot urine before and after contrast agents in patients undergoing computed tomography (CT) scanning.&#x0D; Material and Method: The present study included 103 hospitalized patients aged between 18 and 75 years, who underwent contrast-enhanced CT scanning for any reason and did not develop contrast-induced nephropathy (CIN). We compared the values of Alb/Cr ratio at the 6th, 12th, 24th, 48th, and 72nd hours after the procedure (post-procedure time) with the values at pre-procedure time. &#x0D; Results: The median age of the patients were 61 years. It has been observed that there is no significant increased in microalbuminuria after the use of contrast media. When the patients were evaluated for the albuminuria level before the procedure, it has been seen that 73 patients (70.9%) had an Alb/Cr ratio of

Evaluation of Urinary Calcium, Creatinine and their Ratio in Preeclampsia: A Case-control Study

Introduction: Preeclampsia is a hypertensive disorder characterised by high blood pressure during pregnancy. It is the major cause of maternal and perinatal morbidity and mortality in females. Prediction of Pregnancy Induced Hypertension (PIH) can be done by using a valuable marker i.e. Urinary CalciumCreatinine ratio (UCa/Cr). Aim: To evaluate the urinary calcium, creatinine and UCa/Cr ratio in patients with preeclampsia and also to check the association of UCa/Cr ratio with the severity of the disease. Materials and Methods: The present case-control study was conducted in the Department of Biochemistry in collaboration with department of Obsteritics and Gynecology, Maharishi Markandeshwar University, Ambala, Haryana from January 2018 to January 2021. Total of 120 pregnant women with gestational age ≥20 weeks (60 normal and 60 preeclampsia) were evaluated for urinary calcium, urinary creatinine and UCa/ Cr ratio. For statistical analysis, Unpaired t-test and Chi-square test and was applied. Results: The mean age of control group was 27.51±5.05 years and for case group was 29.8±5.49 years. The level of urinary calcium and urinary creatinine was found to be significantly (p-value&lt;0.001) lower in case group (3.54 mg/dL and 42.90 mg/dL respectively) as compared to control group (8.22 mg/dL and 80.40 mg/dL respectively). The level of UCa/Cr ratio was also significantly (p-value &lt;0.001) lower in case group (0.08±0.04) than control group (0.11±0.04) (p&lt;0.001). Conclusion: UCa/Cr ratio was significantly decreased in preeclampsia compared to normal pregnancy. UCa/Cr ratio in spot urine can be useful in identifying pregnant women at risk for preeclampsia.

Diagnostic utility of protein excretion in 24-hour urine and the protein to creatinine ratio for adverse perinatal outcomes and time of delivery

Objective Our study aimed to evaluate the perinatal and neonatal outcomes of hypertensive pregnant women with or without proteinuria. We compared the predictivity of spot urinary protein to creatinine (P/C) ratio and 24-hour protein excretions on outcomes. Methods We retrospectively enrolled 230 pregnant women with a new diagnosis of hypertension between 20 and 37 weeks of gestation. We divided the patients into two groups according to the protein level determined by 24-hour urine collection and P/C ratio. The presence and level of proteinuria, its relationship with the P/C ratio, and the relationship between these findings and perinatal outcomes were evaluated. Results Gestational age at delivery weeks and latency period (duration between diagnosis of hypertension and delivery) were significantly earlier in pregnant women with ≥300 mg/24-h and P/C ratio ≥0.3. Adverse neonatal outcomes were significant in patients with proteinuria ≥300 mg/24-hour and P/C ratio ≥0.3. Urinary protein levels in 24-hour urine were significantly higher in pregnant women with P/C ratio ≥0.3 and a significantly positive correlation was found between 24-h proteinuria and P/C (r=0.382, p&lt;0.001). Conclusion Our study demonstrated that a protein loss of ≥300 mg in 24-h and a P/C ratio in spot urine ≥0.3 in hypertensive pregnant women is associated with adverse perinatal outcomes. Furthermore, we have identified that proteinuria ≥300 mg/day and spot urine P/C ratio ≥0.3 in hypertensive pregnant women make them prone to early delivery risk.

Use of Sodium Glucose Co-Transporter 2 Inhibitor (SGLT2i) in Geriatric Population

Aim: Diabetes treatment and follow-up is more difficult and sensitive in the elderly. Sodium glucose co-transporter type 2 (SGLT2) inhibitors are newly developed antidiabetic agents. In the geriatric age group, the use of SGLT2 inhibitors may be riskier in terms of side effects. We planned to evaluate the effect and tolerability of using SGLT2 inhibitors in geriatric patients. Material and Methods: Patients over 65 years of age with a diagnosis of type 2 DM who were started on empagliflozin or dapagliflozin in our center were included in the study. A total of 52 patients were included in the study. The study was designed as a retrospective file scan. Before and after SGLT2 inhibitor treatment, biochemical data, drug-related side effects and drug withdrawal information were recorded. Results: A statistically significant decrease was observed in the fasting blood glucose (FBG), postprandial blood glucose (PPBG), and HbA1c values of the patients after the SGLT2 inhibitor was started. While the urea and creatinine values of the patients increased after the treatment, a decrease was observed in the eGFR value. After treatment, a decrease in albumin/creatinine ratio in spot urine and an increase in hemoglobin and hematocrit values were observed. No complaints were reported in 31 patients (59.6%) and no side effects were detected. Side effects associated with SGLT2 inhibitor were observed in 21 patients (40.3%). In total, treatment was continued in 41 patients (78.8%) out of 52 patients, while treatment was discontinued in 11 patients (21.2%). Conclusion: In type 2 DM population over 65 years of age, glycemic control with SGLT 2 inhibitor treatment is successful, side effects and drug withdrawal rates are within acceptable limits.

The role of urinary kidney injury molecule-1 in monitoring the child with idiopathic microscopic hematuria

Background/Aim: Idiopathic microscopic hematuria is common during childhood, and numerous factors play a role with varying degrees in its etiopathogenesis. We aimed to investigate whether urinary kidney injury molecule-1 level could be a new indicator to detect a possible renal injury that may cause idiopathic microscopic hematuria. Methods: This prospective case-control study included 38 children between 1-15 years of age who were followed up due to idiopathic microscopic hematuria without hypertension and/or edema and 39 healthy individuals with similar gender distribution. Kidney injury molecule-1, urine culture, microalbumin, calcium, magnesium, uric acid, and creatinine levels in spot urine were measured in both groups. A throat culture and abdominal ultrasound were performed on all those included. Results: No significant differences were found between the patient and control groups in terms of age, gender, weight, and height (P>0.05). Microalbumin, microalbumin to creatinine ratio in spot urine, urinary kidney injury molecule-1 levels, and kidney injury molecule-1 to creatinine ratio were higher among the patients than the controls (P=0.016, P=0.013, P=0.001, and P=0.001, respectively). Conclusion: Urinary microalbumin and kidney injury molecule-1 levels, as well as rates of these two markers to creatinine, may be higher in the children with idiopathic microscopic hematuria. Our findings show that children with microscopic hematuria should be monitored for renal tubular injury and the development of chronic renal disease.

Vitamin D Metabolism Alteration in Acromegaly and Its Impact on Calcium-Phosphorus Metabolism

Objective: to evaluate metabolism of vitamin D and calcium-phosphorus metabolism in patients with an active phase of acromegaly in comparison with healthy individuals. Materials and Methods: The study included 44 patients with an active acromegaly (IGF-1 788 [521; 963] ng/mL), as well as 49 conditionally healthy individuals. There were more men in the Acromegaly group (41% vs. 20%, p <0.05), patients were older (median age 42.7 [35.5; 26.5] vs. 26.3 [25; 33.5] years, p <0.05) and had a higher BMI (28.4 [25.2; 30.2] vs. 22.2 [20.1; 26.1] kg/m2, p <0.05) in a minor way compared with the control group. All participants were tested for vitamin D metabolites (25(OH)D3, 25(OH)D2, 1,25(OH)2D3, 3-epi-25(OH)D3 and 24,25(OH)2D3) by UPLC-MS/MS, free 25(OH)D and vitamin D-binding protein by ELISA, PTH by electrochemiluminescence immunoassay, as well as routine biochemical parameters of blood serum (calcium, phosphorus, creatinine, albumin, magnesium) and urine (calcium and phosphorus-creatinine ratio in spot urine). Results: In the Acromegaly group, we observed significantly higher levels of serum total calcium (2.46 [2.37; 2.56] vs. 2.38 [2.33; 2.45] mmol/L, p <0.05), albumin-corrected calcium (2.33 [2.28; 2.42] vs. 2.26 [2.21; 2.31] mmol/L, p <0.05) and phosphorus (1.39 [1.25; 1.55] vs. 1.15 [1.06; 1.23] mmol/L, p <0.05) as well as lower levels of serum albumin (45 [44; 47] vs. 46 [45; 48] g/L, p <0.05). The rest of the studied biochemical parameters and PTH levels did not differ significantly between the groups. The IGF-1 level in patients with acromegaly positively correlated with the level of total calcium (r = 0.49, p <0.05), albumin-corrected calcium (r = 0.49, p <0.05) and phosphorus (r = 0.55, p <0.05). The Acromegaly group showed lower levels of 25(OH)D3 (14.8 [11.8; 20.5] vs. 20.5 [14.8; 24.6] ng/mL, p <0.05), 3-epi-25(OH)D3 (1.0 [0.7; 1.4] vs. 1.4 [0.9; 1.8] ng/mL, p <0.05), 24,25(OH)2D3 (0.8 [0.4; 1.2] vs. 1.7 [0.9; 2.6] ng/ml, p <0.05) and free 25(OH)D (4.6 [3.7; 5.6] vs. 5.9 [4.0; 7.5] pg/mL, p <0.05), higher levels of 1,25(OH)2D3 (50 [42; 63] vs. 39 [34; 45] pg/mL, p <0.05), a lower 25(OH)D3/1,25(OH)2D3 ratio (289 [226; 443] vs. 517 [340; 641], p <0.05) and a higher 25(OH)D3/24,25(OH)2D3 ratio (19.3 [15.4; 27.7] vs. 11.9 [9.6; 15.2], p <0.05). Conclusion: Our data suggest that high levels of the active vitamin D metabolite (1,25(OH)2D3) resulting from an increase in 1α-hydroxylase activity may contribute to the elevation of calcium and phosphorus serum levels in patients with acromegaly. Our results also indicate a decrease in 24-hydroxylase activity in patients with acromegaly, which may be due to lower levels of 25(OH)D3 in these patients. The results obtained should be evaluated taking into account the observed differences in age, gender and BMI between groups.

Early predictors of acute kidney injury in COVID-19 patients.

AimThis study aims to determine the frequency of COVID‐19 related AKI and to identify the early predictors of AKI.MethodsThis study is a single‐center, retrospective, observational study. Hospitalized COVID‐19 patients between 24/03/2020 and 31/05/2020 were included in the study. All patients were evaluated for renal dysfunctions with urine dipstick, protein/creatinine ratio, albumin/creatinine ratio in spot urine, serum cystatin C, serum creatinine level on hospital admission, and 28th day of hospital admission. To assess the utility of these parameters to predict AKI, a receiver‐operating characteristic curve was generated and the area under the curve (AUC) was calculated.Results348 patients were included. The average incidence of AKI was 4.9% (n = 17). The incidence of AKI in mild, moderate and severe COVID‐19 cases was 1.3% (n = 4), 9.0% (n = 3) and 76.9% (n = 10), respectively. Proteinuria was detected in 7.8% (n = 27) of patients with a urine dipstick test. In spot urine analysis, proteinuria was found in 20.1% (n = 70) of patients. The frequency of persistent proteinuria was 5.2% (n = 18). The AUC alue of serum cystatin C, D‐dimer and albumin/creatinine ratio to predict COVID‐19 related AKI were 0.96 (0.90 to 1.0), 0.94 (0.89–0.98), and 0.95 (0.91–0.98).ConclusionIn COVID‐19 patients with normal serum creatinine levels on hospital admission, albuminuria, serum cystatin C and D‐dimer levels may be an early predictor of COVID‐19 related AKI and these patients should be monitored closely for AKI. Since the sample size in the AKI group was small, our study results should be confirmed with larger cohort studies.

Perceived stress, depressive symptoms, and cortisol-to-cortisone ratio in spot urine in 6878 older adults

BackgroundLate life depression and perceived stress could influence disease pathways via reduced 11β-HSD2 activity, particularly given suggestions that reduced 11β-HSD2 activity, which is reflected in the cortisol-to-cortisone ratio, is a risk factor of disease. To date, however, examination of the relationship between the cortisol-to-cortisone ratio and perceived stress or depressive symptoms is insufficient. MethodsWe examined the cross-sectional association of the cortisol-to-cortisone ratio with perceived stress and depressive symptoms, and analyzed whether cortisol levels modify this association, in 6878 participants aged 45–74 years. Cortisol and cortisone in spot urine were measured using liquid chromatography-mass spectrometry. Perceived stress during the past year was measured using a self-reported questionnaire. Depressive symptoms were evaluated using the Zung Self-Rating Depression Scale. Analyses were performed with adjustment for age, sex, lifestyle factors (smoking habit, alcohol consumption, physical activity, and sleeping hours), and physical health factors (body mass index [kg/m2] and medical history [diabetes, hypertension, and medication for hyperlipidemia or corticosteroids]). ResultsCortisol-to-cortisone ratio and cortisol were positively associated with perceived stress (% change: 2.33, Ptrend = 0.003; and 4.74, Ptrend = 0.001, respectively), but were not significantly associated with depressive symptoms. Further, the relationship between cortisol-to-cortisone ratio and perceived stress was modified by cortisol level and sex: the positive association between perceived stress and the cortisol-to-cortisone ratio was more evident in subjects with lower cortisol levels (Pinteraction = 0.009) and in men (Pinteraction = 0.026). ConclusionsThese findings suggest that the cortisol-to-cortisone ratio in spot urine may be a useful marker for non-acute perceived stress in daily life against a possible background of reduced 11β-HSD2 in older adults.

Edema - the nephrologist's perspective

Edema is a common symptom with mostly extrarenal causes. Nevertheless, it may also be a sign of glomerular disease. So renal causes should always be clarified to avoid serious complications, such as renal insufficiency, cardiovascular or thrombembolic events. The determination of the albumin-creatinine ratio in spot urine is easy to perform and the method of choice to diagnose nephrotic-range proteinuria. Renal biopsy then usually allows the definitive assignement to either glomerular or systemic disease. Salt restriction in combination with diuretics and antiproteinuric treatment are essential for an effective therapy. Depending on the underlying disease and individual risk factors, anticoagulation should also be considered.

The evaluation of thiol/disulphide homeostasis in diabetic nephropathy

AimsThiol/disulphide homeostasis plays a critical role in antioxidant defense, and detoxification in body. Although alteration of thiol/disulfide homeostasis had been shown in patients with diabetes, the thiol/disulfide balance in patients with type 2 diabetes and nephropathy is not yet known. MethodsTwenty-six healthy volunteers (group 1), and 17 normal albuminuric (group 2), 24 middle albuminuric (group 3), 20 severe proteinuric (group 4) patients with type 2 diabetes were included. Proteinuria was tested by measuring microalbumin/creatinine ratio in spot urine. Thiol/disulphide homeostasis concentrations were measured using method developed by Erel et al. ResultsMean blood urea and creatinine levels were found to be significantly higher and GFR level was found to be significantly lower in group 4 than in the other groups. Native thiol levels are significantly lower in groups with diabetes than in healthy group and in groups 3 and 4, compared to group 2. Total thiol level was significantly lower in groups 3 and 4 than group 1 and 2. Disulphide/native thiol and disulfide/total thiol ratios were significantly higher in the groups with diabetes than in group 1 and in the group 4 than in the group 2. ConclusionThe level of native and total thiols were found to be decreased significantly with the grade of nephropathy in patients with type 2 diabetes and the balance had been disrupted in favor of disulphide. We suggest that deteriorated thiol/disulphide balance may be one of the important factors in the development or progression of diabetes induced nephropathy.

Use of Electron Microscopy (EM)to Detect Transplant Glomerulopathy (TG) in Patients with Late-Indication Allograft Biopsy

Introduction The main causes of late graft loss are: death of patients with functioning graft and chronic allograft nephropathy, in which it stands out, to chronic rejection mediated by antibodies (cABMR). cABMR was defined during the Banff meeting in 2005 due to: Transplant Glomerulopathy (TG), Multilamination of the basal membrane of the tubular pericapillary (MLMBPCT), Transplant vasculopathy and interstitial fibrosis with tubular atrophy (IFTA), with deposit of C4d in PCT and the presence of Anti-HLA Antibodies specific donor (DSA). The presence of C4d deposition in the peritubular capillary (PTC) is a diagnostic marker of ABMR greater than 50% in acute graft rejection but not in its chronic or late ABMR phenotype, so its usefulness is currently questioned in the late phase, identifying them as C4d negative. The typical characterizes cABMR is TG recognized as a glomerulopathy that manifests a double contour of the glomerular capillary,. The cABMR with duplication or MLMBG, increase of the subendothelial space, interposition of mesangial cells, loss of fenestration in the endothelial cells, and MLMBPTC as the findings most significant effects linked to the interaction of antibodies in the glomerular endothelium. Objectives Detect morphological changes of TG by ME in patients with chronic allograft dysfunction who have late biopsies for clinical indication, whose previous histopathological evaluation was by Banff classification in MO and IHC for C4d. Materials and Methods We performed a retrospective observational study of a descriptive cohort, kidney transplant patients performed in the Nephrology and Transplant Service of the CPVS, Córdoba, Argentina who presented chronic allograft dysfunction with late biopsies for clinical indication performed in the period from July 2011 to August 2016.The MO and ME analysis was performed by two different pathologists.The indication for renal biopsy was performed according to the following criteria: increase in serum creatinine ≥0.3 mg / dl or more during the post-transplant evolution. Proteinuria evaluated by Pr/Cr ratio in spot urine ≥0.3 mg / dl.3. Patients with at least 6 months of kidney transplant.4. All samples of biopsies performed should have at least 4 glomeruli for the MO and ME analysis, respectively. Results Inflammation of the glomerular endothelium (GECS) in 21/22 95%.Podocyte deletion processes in 100% of patients, 22.7% severe and in the rest 76% mild to moderate. MLMBPTC, 68% were present in 63.6% 14/22 patients mild (<3 layers) and in only 5% was moderate (7 layers). ). MLMBG in 17/22 77.2%..Conclusion The use of EM in late kidney transplant biopsies by indication allowed detecting ultrastructural changes of transplant glomerulopathy of cABMR in a high % of patients with C4d negative w/wo DSA. Prospective studies should be necessary as protocol biopsies with earlier changes suggestive of TG with EM, and anticipate the clinically evident damage.

Metabolic features and renal outcomes of urolithiasis in children

Aim: The incidence of pediatric urolithiasis has increased over the last century because of dietary changes, metabolic abnormalities, climate change, and genitourinary abnormalities. Data on pediatric urolithiasis in non-endemic countries are limited. The aim of this study was to evaluate the clinical findings and metabolic etiology of urolithiasis in Korean children. Material and methods: The medical records of 73 Korean children who were newly diagnosed with urolithiasis from January 2010 to December 2013 were retrospectively analyzed. Evaluation of metabolic risk factors, including hypercalciuria, hyperuricosuria, hypomagnesuria, hyperoxaluria, and hypocitraturia, required analysis of 24-h urine specimens or, alternatively, for infants and toddlers, the solute-creatinine ratio in spot urine. Results: The male-to-female ratio of the included patients was 1.3:1. The median age at diagnosis was 10.1 years, and the patients were divided into two age groups with pre-school-age children (n = 27, 37.0%) and school-age children (n = 46, 63.0%). While flank pain was more common in school-age children, incidentally detected or urinary tract infection (UTI)-associated urolithiasis was more common in pre-school-age children. Eight patients (11.0%) had renal function deterioration associated with urolithiasis, and three patients (4.1%) progressed to chronic kidney disease. Metabolic abnormalities according to urine chemistry were found in 30 patients (41.1%), including hypercalciuria in 21.9%, hyperuricosuria in 11.0%, hypomagnesuria in 4.1%, hyperoxaluria in 1.4%, hypocitraturia in 1.4%, and cystinuria in 1.4%. Conclusion: We suggest that school-age children with renal colic and pre-school-age children with UTI should be evaluated for urolithiasis. Additionally, the evaluation for metabolic risk factors is important in order to prevent recurrence and renal insufficiency.

Prevalence and Characteristics of Treatment-Resistant Hypertension among Hypertensive Japanese Outpatients

Aims: To retrospectively investigate the prevalence and characteristics of treatment-resistant hypertension (R-HT) among consecutive hypertensive outpatients, since patients with R-HT are candidates for catheter-based renal sympathetic denervation (RD). Methods: Consecutive hypertensive outpatients (n = 999) were recruited in our hospital. R-HT patients who were candidates for RD had clinic systolic blood pressure > 160 mmHg despite taking three or more antihypertensive drugs including at least one diuretics at higher than standard doses. Results: Our survey indicated that only 26 patients (2.6%) were potential candidates for renal denervation. Candidates for RD showed a significantly higher age (P < 0.005), brain natriuretic peptide level (P = 0.0001), urinary albumin/creatinine excretion ratio in spot urine (P < 0.005), pulse wave velocity (P < 0.01), left ventricular end-diastolic diameter (P < 0.005), and interventricular septal thickness (P < 0.005) than the other 973 patients. Candidates for denervation had a significantly lower hemoglobin (P = 0.0001), serum albumin (P < 0.001), eGFR (P < 0.0005), plasma renin activity (P = 0.0001), and plasma aldosterone level (P < 0.005) than other patients, while their urinary sodium/creatinine ratio was higher, indicating that patients with R-HT appeared to have a high salt intake. Conclusion: Our retrospective clinical survey indicated that only 0.5% of Japanese hypertensive outpatients (5/999 patients) were candidates for RD. Therefore, establishment of hypertension cohort network will be essential to recruit R-HT patients for RD.

Interrelations Between Thyrotropin Levels and Iodine Status in Thyroid-Healthy Children

Worldwide, iodine prophylaxis measures have improved iodine status in populations. Several studies have reported an increase in thyrotropin (TSH) levels coinciding with this prophylaxis. Whether this implies an increased risk for hypothyroidism or simply reflects a physiologic TSH adaptation mechanism is not clear. Data on iodine and thyroid status of 6-17 year old children and adolescents (n=9175), collected between 2003 and 2006 in the German-wide Health Interview and Examination Survey for Children and Adolescents (KiGGS) Study, provided the basis for the analyses of mutual relationships of urinary iodine status (assessed by iodine/creatinine ratio in spot urines), serum TSH levels, and thyroid volume (determined by ultrasound). For data analyses (multivariable linear regression analysis), only those children were included for whom none of the available parameters (including free triiodothyronine [fT3], free thyroxine [fT4], and thyroperoxidase antibody [TPO-Ab] measurements) indicated a potential pathophysiologic thyroid status (n=6101). In this population-based sample of thyroid-healthy children, higher urinary iodine excretion was associated with higher TSH levels (p<0.05), adjusted for sex, age, body surface area, body mass index, fT3/fT4 ratio, and time of blood sampling. Higher TSH levels were not associated with a higher prevalence of TPO-Ab but with lower thyroid volume (p<0.001, fully adjusted). For the present study sample, one-time spot measurements of urinary iodine excretion were not related to thyroid volume, the long-term marker of iodine status. Our findings show for the first time in thyroid-healthy children that smaller thyroid volume is associated with higher normal TSH levels. A decreased thyroid cell mass and cell amount, as induced by an improved iodine status, does presumably require a higher TSH signal to maintain a constant thyroid hormone production, suggesting an underlying physiologic adaptation. Correspondingly, an increased TSH level should not be used as the single criterion to evaluate the prevalence of hypothyroidism, and the repeatedly observed parallel increases of iodine supply and TSH levels should not readily be interpreted as evidence for an increased hypothyroidism risk. These insights, contradicting conventional interpretations, may contribute to dispel uncertainties about the safety of iodine prophylaxis measures.

Scientific Statement

Salt-reduction guidance to hypertensive patients should be performed by evaluating salt intake of the individuals. However, each method to assess salt intake has both merits and limitations. Therefore, evaluation methods must be selected in accordance with the subject and facility's environment. In special facilities for hypertension treatment, measurement of sodium (Na) excretion with 24-h pooled urine or a survey on dietary contents by dietitians is recommended. In medical facilities in general, measurement of the levels of Na and creatinine (Cr) using second urine samples after waking-up or spot urine samples is recommended. The reliability of this method improves by using formulae including a formula to estimate 24-h Cr excretion. A method to estimate salt intake based on the Na excretion per gram Cr using the Na/Cr ratio in spot urine is simple, but not reliable. The method to estimate the daily excretion of salt from nighttime urine using an electronic salt sensor installed with a formula is recommended to hypertensive patients. Although its reliability is not high, patients themselves can measure this parameter simply at home and thus useful for monitoring salt intake and may intensify consciousness regarding salt reduction. Using these methods, salt intake (excretion) should be evaluated, and salt-reduction guidance targeting <6 g (Na: 100 mmol) per day should be conducted in the management of hypertension.

Lack of nephrotoxicity of gadopentetate dimeglumine-enhanced non-vascular MRI and MRI without contrast agent in patients at high-risk for acute kidney injury

BackgroundGadolinium chelates (GCs) have been traditionally considered as non-nephrotoxic magnetic resonance imaging (MRI) contrast materials. However, it has been suggested in some recent articles that GCs may have a nephrotoxic potential, but most of these reports are retrospective. However, the evaluated contrast agents, their doses, and the tests used to determine the kidney function were not consistent across studies. We aimed to investigate the effect of magnetic field and an MRI contrast agent, gadopentetate dimeglumine (GD), on renal functions in patients at high risk for acute kidney injury (AKI).Material/MethodsWe designed a prospective case-control study with 2 age- and sex-matched groups of patients at high-risk for AKI (n=72 for each group). Patients in Group 1 received a fixed dose of (0.2 mmol/kg) GD-enhanced non-vascular MRI and patients in Group 2 received MRI without GD. Before the MRI and at 6, 24, 72, and 168 hours after the MRI, biochemical tests, estimated glomerular filtration rate (eGFR), albumin/creatinine ratio in spot urine, and early AKI biomarkers (cystatin C, N-Acetyl-Glucosaminidase [NAG], Neutrophil gelatinase-associated lipocalin [NGAL]) were measured.ResultsSerum creatinine, albumin/creatinine ratio, and eGFR were not different between Group 1 and 2 (p>0.05). There were no significant changes in renal function tests and AKI biomarkers (Δserum creatinine, Δalbumin/creatinine ratio, ΔGFR, Δcystatin C, ΔNAG, and ΔNGAL) for either groups 6, 24, 72, and 168 hours after the procedures (p>0.05).ConclusionsMRI without contrast agent and non-vascular contrast-enhanced (GD, 0.2 mmol/kg) MRI are not nephrotoxic procedures for patients at high risk for AKI.