Renal Dysfunction In Patients Research Articles

Predictors of irreversible renal dysfunction in patients with idiopathic retroperitoneal fibrosis.

Idiopathic retroperitoneal fibrosis (iRPF) can lead to irreversible kidney damage. This study aimed to investigate predictors of irreversible renal dysfunction in patients with iRPF. Eighty-three patients with newly diagnosed iRPF were enrolled between January 2010 and Sep 2022 at Zhongshan Hospital of Fudan University, including 60 in the training set and 23 in the validation set. They were regularly contacted or followed up via outpatient examinations by specialist doctors, who documented their condition and treatment progress. Predictors of irreversible renal dysfunction were identified using univariate and multivariate regression, logistic model, and receiver operating curve analyses. In the training set, over a median follow-up of 29 months, 16.7% of patients had an estimated glomerular filtration rate (eGFR) of < 60 ml/min/1.73m2 at the last follow-up, and 25% had hydronephrosis or required prolonged double-J stents. A prognostic score was developed by assigning 1, 1, and 2 points for peripheral CD19+ B cells <9.3%, serum creatinine (sCr) ≥120 μmol/l, and no response at 6 months, respectively. A score of ≥ 2 for predicting irreversible renal dysfunction had sensitivity and specificity of 100% and 92%, respectively. In the validation set, 21.7% of patients suffered from irreversible renal dysfunction. The sensitivity and specificity for predicting irreversible renal dysfunction were 100% and 94.4%, respectively. A prognostic score based on factors including CD19+ B cells <9.3% and sCr ≥120 μmol/l at baseline, and no response at 6 months, is suitable for predicting irreversible renal dysfunction in iRPF.

Glomerular Hematuria as a Predictor of Renal Prognosis in Malignant Hypertension Patients with Thrombotic Microangiopathy: A Propensity Score-Matched Analysis of a Biopsy-Based Cohort Study

Introduction: Malignant hypertension (mHTN) is a hypertensive emergency. Thrombotic microangiopathy (TMA) is a widespread complication of mHTN. Few studies have evaluated whether glomerular hematuria provides prognostic information for renal dysfunction in patients with mHTN-associated TMA. Methods: This observational cohort study included 292 patients with mHTN-associated TMA based on renal biopsy. Propensity-score matching (PSM) analysis was conducted to adjust for clinical characteristics in a comparison between with and without glomerular hematuria. Cox regression was employed to identify risk factors for renal prognosis. Results: A total of 70 patients with glomerular hematuria were compared to 222 patients with non-glomerular hematuria. After PSM, 67 pairs of patients with mHTN-associated TMA were matched. Patients with glomerular hematuria exhibited lower serum albumin levels, higher 24-h proteinuria, and a higher prevalence of glomerular sclerosis than those with non-glomerular hematuria. Glomerular hematuria was independently associated with deteriorated renal function compared with non-glomerular hematuria (HR: 0.51; 95% CI: 0.29–0.89, p = 0.019). This association remained significant after PSM (HR: 0.51; 95% CI: 0.28–0.91, p = 0.022). Additionally, glomerular hematuria was independently associated with renal replacement therapy (RRT) (HR: 3.14; 95% CI: 2.06–5.66, p < 0.001). This difference remained significant after PSM comparison (HR: 2.41; 95% CI: 1.34–4.33, p = 0.003). Furthermore, despite intensive blood pressure control, patients with glomerular hematuria experienced a higher incidence of RRT and a poorer recovery in renal function, specifically a 25% reduction of creatinine levels, compared to patients with non-glomerular hematuria. Conclusion: Glomerular hematuria is significantly associated with an increased risk of adverse renal outcomes in patients with mHTN-associated TMA.

Abstract P437: Correlation between plasma CT-proET-1 and renal dysfunction in patients with resistant hypertension. A biomarker analysis of the PRECISION study.

Hypothesis: Endothelin (ET)-1 is upregulated in hypertension and especially resistant forms of hypertension. As ET-1 is a paracrine hormone involved in renal organ damage, we investigated the correlation between eGFR and activity of the ET system in the resistant hypertensive population of the PRECISION trial (NCT03541174), in which aprocitentan, a dual endothelin ET A /ET B receptor antagonist, significantly reduced blood pressure and UACR. To assess activity of the ET system, ET-1 and CT-proET-1, a stable peptide and biomarker for ET-1 production, were measured in plasma. Methods: From plasma collected at screening from the future randomized patients in PRECISION, ET-1 (n=688) and CT-proET-1 (n=100, randomly selected) were measured by ELISA and LC-MS-based assays respectively. Baseline levels of CT-proET-1 were determined on pooled plasma from healthy adults (n=70). Pearson correlation coefficient was determined between biomarkers of the ET system and eGFR. Results: CT-proET-1 concentrations measured in patients with resistant hypertension were higher than concentrations from healthy subjects (83 vs 55 pM). In patients with an eGFR≥60 mL/min/1.73m 2 , mean CT-proET-1 concentration was 75 pM [95% CI 70-81; n=77] as compared to 116 pM [95% CI 95-140 n=23] in patients with eGFR&lt;60 mL/min/1.73m 2 . In these two subgroups, mean ET-1 concentrations were 1.90 ng/L [95% CI 1.85-1.95; n=531] and 2.10 ng/L [95% CI 1.99-2.22; n=157] for patients with an eGFR≥60 and eGFR&lt;60 mL/min/1.73m 2 respectively. There was an inverse correlation between CT-proET-1 and eGFR (r=-0.61, p&lt;0.0001) and a less pronounced correlation between ET-1 and eGFR (r=-0.11, p=0.0027) (see Figure ). Conclusions: In patients with resistant hypertension, there was a strong inverse correlation between plasma CT-proET-1 and renal function, suggesting the role of the ET system not only in hypertension but also in renal damage. These data demonstrate that CT-proET-1 is a sensitive biomarker of the ET system, reflecting the production of ET-1.

Impairment of Cognitive Function Increases Mortality Risk in Relation to Cardiac Sympathetic Denervation and Renal Dysfunction in Patients With Systolic Heart Failure.

In contrast to the well-known prognostic values of the cardiorenal linkage, it remains unclear whether impaired cognitive function affects cardiac prognosis in relation to cardiac sympathetic innervation and renal function in patients with heart failure (HF). A total of 433 consecutive HF patients with left ventricular ejection fraction (LVEF) <50% underwent the Mini-Mental State Examination (MMSE) and a neuropsychological test for screening of cognition impairment or subclinical dementia. Following metaiodobenzylguanidine (MIBG) scintigraphy, patient outcomes with a primary endpoint of lethal cardiac events (CEs) were evaluated for a mean period of 14.8 months. CEs were documented in 84 HF patients during follow-up. MMSE score, estimated glomerular filtration rate (eGFR) and standardized heart-to-mediastinum ratio of MIBG activity (sHMR) were significantly reduced in patients with CEs compared with patients without CEs. Furthermore, overall multivariate analysis revealed that these parameters were significant independent determinants of CEs. The cutoff values of MMSE score (<26), sHMR (<1.80) and eGFR (<47.0 mL/min/1.73 m2) determined by receiver operating characteristic (ROC) analysis successfully differentiated HF patients at more increased risk for CEs from other HF patients. Impairment of cognitive function is not only independently related to but also synergistically increases cardiac mortality risk in association with cardiac sympathetic function and renal function in patients with HF.

Impact of chronic kidney disease and end-stage renal disease on the mid-term adverse outcomes in diabetic patients with cardiovascular diseases

The evidence for the impact of renal dysfunction in patients with diabetes mellitus (DM) and first cardiovascular diseases on mid-term adverse outcomes remain scarce. This study included the data of patients with DM having first atherosclerotic cardiovascular disease (ASCVD) or congestive heart failure (CHF) from the Taipei Medical University Clinical Research Database. A Cox proportional hazards regression model was used to assess the impact of chronic kidney disease (CKD) or end-stage renal disease (ESRD) on the 1-year mortality and recurrent ASCVD/CHF outcomes. We enrolled 21,320 patients with DM hospitalized for ASCVD or CHF; of them, 18,185, 2639, and 496 were assigned to the non-CKD, CKD, and ESRD groups, respectively. After propensity score matching, compared with the non-CKD group, the CKD and ESRD groups had higher mid-term all-cause mortality (adjusted hazard ratio 1.72 [95% confidence interval 1.48–1.99] and 2.77 [2.05–3.73], respectively), cardiovascular death (1.84 [1.44–2.35] and 1.87 [1.08–3.24], respectively), and recurrent hospitalization for ASCVD (1.44 [1.24–1.68] and 2.33 [1.69–3.23], respectively) and CHF (2.08 [1.75–2.47] and 1.50 [1.04–2.17], respectively). The advancing age was associated with mortality in CKD/ESRD groups. In CKD group, male sex was associated with all-cause mortality and recurrent ASCVD risk; the diuretics usage was associated with mortality and recurrent CHF risks. Our findings suggest that CKD and ESRD are significant risk factors for mid-term adverse outcomes in patients with DM and established cardiovascular diseases. Additionally, old age, male sex and diuretics usage requires attention. Further good quality studies are needed in the future.

Effects of perirenal fat thickness on postoperative renal dysfunction in patients who underwent robot-assisted partial nephrectomy for renal tumours.

Despite partial nephrectomy (PN) renal function preservation benefits, postoperative renal dysfunction may occur. Perirenal fat thickness (PFT) is associated with renal dysfunction such as diabetes; however, its role in renal tumour surgery is unclear. This study investigates the role of PFT in renal function after robot-assisted partial nephrectomy (RAPN). Pre-operative factors for postoperative renal dysfunction were analysed in 156 patients undergoing RAPN with ≥1-year follow-up. PFT measured using computed tomography categorised patients with PFT >21.0mm (median) as high-PFT. Tumour size, total R.E.N.A.L. nephrometry score and its N component, renal calyx opening, achievement of trifecta, and PFT were risk factors for renal dysfunction 1year postoperatively. Age ≥75years (p=0.024), total RNS ≥7 (p=0.036), and PFT >21.0mm (p=0.002) significantly correlated with postoperative renal dysfunction. CT-measured PFT is a valuable predictor of postoperative renal dysfunction.

Following a strict renal protection protocol in cloacal malformations: A descriptive analysis

In children with cloacal malformations, renal dysfunction is a constant concern, with reported incidence as high as 50%. Multiple factors exist that may impair renal function. Our institution follows a strict renal protection protocol in this population. Incidence of renal dysfunction in these patients is unknown. We aimed to evaluate incidence of renal dysfunction while implementing this protocol in a cohort of children with cloacal malformation. We reviewed a prospectively collected database of children with cloacal malformations managed at a single institution since implementation of a renal protection protocol. This involves regular laboratory evaluation, appropriate selection of total urogenital mobilization or urogenital separation, proactive imaging in patients with signs of impending renal dysfunction or urinary retention, and early catheterization teaching and implementation if necessary. Glomerular filtration rate (GFR) was calculated with the Schwartz formula and CKD grades assigned per standard definitions. Renal dysfunction was defined as CKD grade 3b or higher, need for renal replacement therapy (RRT) or transplantation. Descriptive statistics were computed. A total of 105 children were managed under this protocol with a median follow-up of 4.2 years [IQR: 2.0-5.9]. Six children (5.7%) had renal dysfunction at most recent follow-up; of these children, only three (2.9%) progressed from normal renal function at initial evaluation to renal dysfunction (Table). No child with normal presenting renal function thus far has progressed to require dialysis or transplantation. Previous literature estimated rates of renal dysfunction in cloaca patients as high as 50%; in contrast, we demonstrate a rate of progression to renal dysfunction of 2.9% in girls following a strict renal protection protocol. Most children who developed renal dysfunction had dysfunctional kidneys on presentation. This suggests that preservation of renal function may be possible in early childhood with a strict, multi-disciplinary renal protection protocol. In our cohort of patients with cloacal malformations following a strict renal protection protocol, incidence of progressive renal dysfunction is low at 2.9%. Most who go on to renal dysfunction present with impaired renal function.

A Study of Prevalence of Renal Function Abnormalities and Their Association with the Individual Components of Metabolic Syndrome.

Metabolic syndrome (MetS) is one of the most important emerging pandemics of the 21st century and is associated with renal dysfunction in a significant number of subjects, the association of which is shown to be of greater significance in the South Asian population. The prevalence of renal dysfunction in patients with MetS is the primary outcome. The secondary outcome is to assess the strength and significance of the association between the individual components of MetS and the presence of renal dysfunction. This is a hospital-based cross-sectional observational study conducted for 2 years in a tertiary care hospital in India. A total of 100 diagnosed subjects of MetS were taken as cases and underwent relevant blood tests. Data were collected and analyzed in a Statistical Package for the Social Sciences (SPSS) v29 sheet. Over a period of 18 months, 100 subjects with MetS were documented, among which 66% had albuminuria, with microalbuminuria being 24% and the rest being macroalbuminuria. Among the same subjects, 30% had an estimated glomerular filtration rate (eGFR) <60 mL/minute/1.73m2. Waist circumference (WC) [measured by the National Institutes of Health (NIH) protocol] had the strongest association with increased albuminuria (r = 0.540; p-value < 0.001) as well as reduced eGFR (r = 0.460; p-value < 0.001). All the components of MetS, for example, increased WC, hypertension, increased fasting glucose, raised triglyceride (TG), and low high-density lipoprotein (HDL), have statistically significant correlations with increased urine albumin-to-creatinine ratio (ACR) and decreased eGFR, signifying glomerular injury and renal dysfunction, respectively.

#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 &amp;lt; 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.

Renal implications of pneumoperitoneum in laparoscopic surgery: mechanisms, risk factors, and preventive strategies.

Pneumoperitoneum, which is established for laparoscopic surgery, has systemic implications on the renal system and may contribute to acute kidney injury or postoperative renal dysfunction. Specifically, when the pressure exceeds 10 mmHg, pneumoperitoneum decreases renal blood flow, leading to renal dysfunction and temporary oliguria. The renal effects of pneumoperitoneum stem from both the direct effects of increased intra-abdominal pressure and indirect factors such as carbon dioxide absorption, neuroendocrine influences, and tissue damage resulting from oxidative stress. While pneumoperitoneum can exacerbate renal dysfunction in patients with pre-existing kidney issues, preserving the function of the remaining kidney is crucial in certain procedures such as laparoscopic live donor nephrectomy. However, available evidence on the effects of pneumoperitoneum on renal function is limited and of moderate quality. This review focuses on exploring the pathophysiological hypotheses underlying kidney damage, mechanisms leading to oliguria and kidney damage, and fluid management strategies for surgical patients during pneumoperitoneum.

Renal tubular necrosis associated with anagrelide administration: a case report.

A 62-year-old female patient with essential thrombocythemia experienced rapid renal dysfunction and was subsequently referred to our hospital. Further investigations did not reveal any significant abnormalities except for a slight increase in urinary β2-microglobulin levels. A renal biopsy was performed to investigate the cause of her renal dysfunction, revealing acute tubular necrosis, interstitial edema, and arteriosclerosis. No significant glomerular lesions were observed. Immunofluorescence staining and electron microscopy showed no abnormalities. She had been using anagrelide for 4years, and her dosage was increased from 2.0 to 3.0mg/day 10months before her initial admission. Her renal function began to deteriorate 2months after the anagrelide dosage increase. Although 0.625mg of bisoprolol was initiated for tachycardia 3months after the anagrelide dosage adjustment, we suspected that the acute tubular necrosis was associated with anagrelide administration. After transitioning from anagrelide to hydroxyurea and discontinuing bisoprolol, her renal function improved. This case suggests the importance of considering anagrelide as a potential cause of renal dysfunction in patients using this medication. Therefore, renal biopsy, combined with a comprehensive medical history, is crucial for evaluating the etiology of renal injury in such cases.

Renal ultrasonography predicts worsening renal function in patients with heart failure under tolvaptan administration.

Renal dysfunction in patients with chronic heart failure predicts a poor prognosis. Tolvaptan has a diuretic effect in patients with chronic kidney disease and heart failure without adverse effects on renal function. We aimed to determine the effects of tolvaptan and predictors of worsening renal function in patients with heart failure. This post hoc analysis was a sub-analysis of a single-centre prospectively randomized trial on the early and short-term tolvaptan administration. We enrolled 201 participants with decompensated heart failure between January 2014 and March 2019 (early group, n=104; age: 79.0±12.8years; late group, n=97; age: 80.3±10.8years). Renal ultrasonography was performed before and after the administration of tolvaptan. Urine output and oral water intake significantly increased during tolvaptan administration. The difference between water intake and urine volume increased during tolvaptan administration. Changes in body weight, blood pressure, heart rate, and estimated glomerular filtration rate (eGFR) in both groups were comparable. The changes in peak-systolic velocity (PSV), acceleration time (AT) of the renal arteries, and resistance index were comparable. The changes in PSV and end-diastolic velocity (EDV) of the interlobar arteries increased following tolvaptan administration (Δmax PSV: 0.0±14.8cm/s before tolvaptan vs. 5.6±15.7cm/s after tolvaptan, P=0.002; Δmean PSV: 0.4±12.3 vs. 4.9±12.7cm/s, P=0.002; Δmax EDV: -0.2±3.5 vs. 1.4±4.0cm/s, P=0.001; Δmean EDV: -0.0±3.1 vs. 1.1±3.4cm/s, P=0.003). The renal artery AT was negatively correlated with the eGFR (Δmax AT: beta=-0.2354, P=0.044; Δmean AT: beta=-0.2477, P=0.035). Tolvaptan increased the PSV and EDV of the interlobar artery, which may mean tolvaptan increased renal blood flow. The renal artery AT may be a surrogate for worsening renal function.

Prevalence and clinical outcomes of different forms of renal dysfunction in patients hospitalized for decompensated cirrhosis: focus on acute kidney disease. A prospective observational study

Prevalence and clinical outcomes of different forms of renal dysfunction in patients hospitalized for decompensated cirrhosis: focus on acute kidney disease. A prospective observational study

Cystatin C as an Early Marker of Renal Dysfunction in Patients with Cirrhosis of Liver: A Cross-sectional Study

Introduction: Serum cystatin C has been proposed as a sensitive marker for detecting renal impairment. Renal impairment can often co-exist with liver cirrhosis, as decreased blood flow through the cirrhotic liver can lead to kidney dysfunction. However, its role in patients with liver cirrhosis has not been extensively studied, especially in the detection of early renal impairment. Aim: To investigate whether serum cystatin C could serve as a potential marker for detecting early renal dysfunction in patients with liver cirrhosis. Materials and Methods: This hospital-based cross-sectional study was conducted on 60 patients with liver cirrhosis at Assam Medical College and Hospital, Dibrugarh, Assam, India, from June 2019 to May 2020. All patients were assessed for clinical symptoms and laboratory parameters, focusing on renal function tests, measurement of serum cystatin C levels, and Glomerular Filtration Rate (GFR). A two-tailed p-value &lt;0.05 was considered statistically significant in all calculations. Results: In total, 60 consecutive patients with liver cirrhosis were evaluated during the study period, 85% of whom were males. The mean age was 47.4±9.3 years. The mean values of GFR calculated from the mean values of serum creatinine and serum cystatin C were 59.57±31.48 and 31.25±18.32, respectively, both showing a negative correlation (r=-0.802 and r=-0.817, respectively), indicating that cystatin C has a superior correlation with GFR when compared to serum creatinine. Regression analysis showed a tighter distribution of results around the regression line for cystatin C, as indicated by an R2 value of 0.67, compared to 0.64 for creatinine. It was also observed that for every unit rise in serum creatinine and cystatin C value, GFR decreased by 29.89 and 14.67, respectively. Conclusion: Serum cystatin C is a better predictor of GFR than serum creatinine and can therefore be used as an early marker of renal dysfunction in the course of liver cirrhosis

РЕТРОСПЕКТИВНЕ КОГОРТНЕ ДОСЛІДЖЕННЯ ПО ОЦІНЦІ КЛІНІЧНОЇ ЕФЕКТИВНОСТІ РЕМДЕСИВІРУ В ЛІКУВАННІ ПАЦІЄНТІВ ІЗ ТЯЖКИМ ПЕРЕБІГОМ COVID-19

The purpose of the study is to evaluate the clinical effectiveness of remdesivir in hospitalized patients with severe COVD-19 during complex treatment according to the National Protocol of the Ministry of Health of Ukraine. Materials and methods. We used to the data of a retrospective cohort study in adult patients (≥ 18 years old) with severe COVID-19, who were admitted to the infectious diseases department No. 2 of the Volyn Regional Clinical Hospital from December 2020 to May 2021. The statistical analysis included a group of patients who received Remdesivir (n = 98) and a control group of patients who did not receive Remdesivir (n = 190), which was modified. Results. It was found that 98 patients (n = 98) with severe COVID-19 who received Remdesivir at a course dose of 600 mg in 91.8% of cases (n = 90) recovered, the average age of those who recovered was 56.8 ± 2.56 years. On average, the beginning of the infusion of Remdesivir upon admission to the infectious diseases hospital occurred on the 9th day from the first day of the disease. In 8.2 % (n = 8), Remdesivir did not help patients with severe COVID-19 who died in intensive care, the average age of the deceased was 68.5 ± 5.83 years. During the study, it was found that the use of Remdesivir on average from the 9th day of illness at a course dose of 600 mg did not additionally affect the rate of restoration of saturation in patients with severe COVID-19 at the time of discharge from the hospital, and as an additive drug did not additionally affect on the reduction of CRP in the complex therapy with Dexamethasone of severe COVID-19, and also did not affect the use and/or reduction of the use of antibacterial drugs in patients with severe COVID-19. The use of Remdesivir did not significantly affect the decrease in the number of days of hospitalization, however, it significantly influenced the time of normalization of body temperature and, on average, this decrease was 1.7 ± 0.6 days in patients with severe COVID-19 compared with the control group without antiviral drug. It was found that Remdesivir in a course dose of 600 mg does not negatively affect creatinine levels and does not lead to renal dysfunction in patients with severe COVID-19. Despite the fact that 91.8 % of patients who received Remdesivir recovered, there was no statistically significant reduction in mortality (р &gt; 0,05) in the age group of patients aged 56 to 79 years with severe COVID-19 when using Redmesivir in the second week of illness (median onset of antiviral therapy is 9 days), therefore, Remdesivir must be administered prior to the onset of severe COVID-19 with a hyperinflammatory condition. Key words: coronavirus disease, severe COVID-19, remdesivir, retrospective cohort study.

Cystatin C as an Early Marker of Renal Dysfunction in Patients with Cirrhosis of Liver: A Cross-sectional Study

Cystatin C as an Early Marker of Renal Dysfunction in Patients with Cirrhosis of Liver: A Cross-sectional Study

Association between kidney measurements and cognitive performance in patients with ischemic stroke

Background Individuals with chronic kidney disease (CKD) are at a substantially higher risk for stroke, which may predispose individuals to cognitive impairment. However, the association of low estimated glomerular filtration rate (eGFR) and albuminuria with poorer cognitive performance in patients with stroke is not fully understood, and the current evidence for this association is contradictory. Our aim was to retrospectively investigate whether low eGFR and albuminuria, as indicated by the urine albumin-creatinine ratio (UACR), are independently or jointly associated with worse cognitive performance in patients with ischemic stroke. Methods This retrospective study included 608 patients with acute ischemic stroke. Their UACR and eGFR values were obtained from inpatient medical records. Global cognitive function was assessed with the mini-mental state exam (MMSE) and Montreal Cognitive Assessment (MoCA) one month after hospital discharge. The relationship between renal measures and cognitive performance was assessed using univariate and multiple linear regression analyses. Potential confounders included age, gender, BMI, education, diabetes and hypertension history, NIHSS score, smoking and alcohol consumption status, serum total cholesterol, triglyceride, fasting glucose, uric acid, homocysteine, systolic blood pressure, and either eGFR or UACR. Results Patients had an average age of 66.6±4.1 years, and 48% were females. Average eGFR and UACR were 88.4±12.9 ml/min/1.73m2 and 83.6±314.2 mg/g, respectively. The number of patients with eGFR ≥90, 60–89, and &lt;60 ml/min/1.73 m2 was 371 (61%), 207 (34%), and 30 (5%), respectively, and the percentage of patients with UACR &lt;30 mg/g, 30–300 mg/g, and &gt;300 mg/g was 56%, 39%, and 5%, respectively. Multivariate adjusted models showed that eGFR was independently associated with MMSE (β = -0.4; 95% CI = -0.5,-0.4; p &lt;0.001) and MoCA (β = -0.6; 95% CI = -0.7,-0.5; p &lt;0.001). However, UACR was not significantly correlated with MMSE or MoCA. Conclusion In patients with ischemic stroke, reduced eGFR but not albuminuria was associated with lower cognitive performance. These results show that the eGFR decline could be an effective indicator of cognitive impairment after a stroke. Therefore, regular monitoring and early detection of mild renal dysfunction in patients with acute ischemic stroke might be needed.

Biochemical Markers of Early Renal Dysfunction in Patients with β-thalassemia Major: A Systematic Review and Meta-analysis.

Early diagnosis of renal dysfunction in β-thalassemia major (β- TM) may help take specific measures to delay irreversible damage and renal failure. Therefore, the present meta-analysis aimed to compare biochemical markers of premature renal dysfunction between β-TM and healthy subjects and identify renal issues' prevalence in patients with β-TM. We searched PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline, Scopus, Web of Science, ScienceDirect, ProQuest, Google Scholar, and State Inpatient Databases (SIDs) without any language constraints for all relevant articles published up to April 2019. Out of 1458 articles published up to April 2019, 24 case-control and 22 crosssectional studies were investigated. The investigated levels of serum phosphorus, uric acid (UA), cystatin C, and ferritin were significantly different between β-TM patients and controls. The albumin/creatinine ratio (ACR), N-acetyl-β-D-glucosaminidase/creatinine (NAG/Cr) ratio, urinary and serum β2 microglobulin (β2MG), and serum ferritin levels were significantly higher in β-TM patients than in healthy individuals. However, glomerular filtration rate, creatinine clearance, and pretransfusion hemoglobin indicated a significantly lower rate. The general prevalence of renal glomerular and/or tubular defects in patients with β-TM was 50.22%. Urinary NAG, β2MG, ACR, and Scys-C may be early markers of renal dysfunction in patients with β-thalassemia major. An observation of elevated levels of these markers despite normal levels of other markers of renal dysfunction may indicate primary, subclinical injury to the renal tubules and glomeruli.

Ureteral obstruction following transurethral resection of bladder cancer within the Hutch's diverticulum.

Here, we report a rare case of bladder cancer within the left congenital periureteral diverticulum, termed the Hutch's diverticulum. Following transurethral resection of the bladder tumor, repeated pyelonephritis was caused by stricture of the diverticulum orifice and ureter. We attempted transurethral dilation and ureteral stenting, but the obstruction did not improve. The patient's renal dysfunction showed gradual progression due to recurrent left pyelonephritis as well as the ureteral obstruction. Therefore, we finally performed a partial cystectomy, involving stricture and ureteral reimplantation. No tumor recurrence was observed over 39months, and renal dysfunction did not progress following partial cystectomy.

DIAGNOSTIC AND PROGNOSTIC VALUE OF Β2-MICROGLOBULIN IN THE DEVELOPMENT OF CARDIORENAL SYNDROME IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AND ARTERIAL HYPERTENSION

Arterial hypertension is the largest pandemic in the history of mankind, which defines the structure of cardiovascular morbidity and mortality. Currently, the correlation between hypertension and various pathological conditions and diseases has been proven, which largely determines its progression and contributes to the development of cardiovascular and renal complications. These diseases include type 2 diabetes mellitus, which is spreading globally as a pandemic. The history of arterial hypertension in combination with type 2 diabetes mellitus is often accompanied by the development of cardiorenal syndrome, so it is crucial to diagnose renal dysfunction and prevent cardiovascular complications in such patients. One of these biomarkers is β2-microglobulin (β2-M), which depends on the glomerular filtration rate and tubular reabsorption.&#x0D; Materials and methods. 90 patients with AH (men/women – 48/42) and 20 control subjects were examined. During a thorough examination and follow-up of patients, they were classified into 3 groups: patients with AH – group 1 – 31 people; group 2 – AH in combination with T2DM – 31 people; group 3 – patients with AH, T2DM, and obesity – 28 people. Body weight and height were measured in all patients, and BMI = body weight/height2 (m2) was calculated. The β2-microglobulin levels in the patients' serum, cardiotrophin-1, catestatin, leptin, cystatin C, neutrophil gelatinase-associated lipocalin, and N-terminal pro-brain natriuretic peptide, 25-OH total vitamin D, serum insulin levels, glycosylated hemoglobin, lipid metabolism, and systolic and diastolic blood pressure were measured. Statistical data analysis was performed using Statistica, 12 (Stat Soft Inc, USA) and Microsoft Office Excel 2013. The data are presented as mean (M) and standard deviation (δ). Differences between groups of mean values were evaluated using the Student's t-test.&#x0D; Results and conclusions. The level of β2-M in the observed groups of patients differed significantly from that of healthy individuals. An increase in β2-M concentration allowed us to confirm the presence of tubular renal dysfunction, which was not diagnosed by conventional methods. All examined patients were divided into 2 groups depending on the β2-M level. Our data prove the role of β2-microglobulin as an independent biomarker of renal dysfunction, as well as the development of early cardiovascular complications. The data obtained from the mathematical models between creatinine and β2-microglobulin, urea and β2-microglobulin levels show a highly significant correlation between β2-microglobulin and renal function and demonstrate that β2-microglobulin is an independent factor in the prediction of renal dysfunction in patients with hypertension and concomitant type 2 diabetes mellitus. β2-microglobulin is a biomarker that should be used in the diagnosis and prognosis of early manifestations of cardiorenal syndrome.