Renal Dysfunction In Patients Research Articles

Tubulointerstitial B-cell infiltration and tertiary lymphoid tissue in adult-onset immunoglobulin A vasculitis with nephritis.

This study aimed to examine tubulointerstitial B-cell infiltration in patients with adult-onset immunoglobulin A vasculitis (IgAV) and nephritis (IgAV-N), and to evaluate whether B-cell infiltration correlated with clinicopathological variables at kidney biopsy and with short-term renal outcomes. Twenty patients with adult-onset IgAV-N and 10 control patients with thin basement membrane nephropathy (TBMN) were retrospectively examined. The lymphatic organization was graded based on B-cell infiltration and was classified into 4 groups: 0-T cells without B cells, 1-scattered B and T cells, 2-clustered B and T cells, and 3-nodular compartmentally arranged B- and T-cell aggregates, equivalent to tertiary lymphoid tissue (TLT). The B-cell infiltration grade was significantly higher in patients with IgAV-N than in patients with TBMN, and no age differences were observed. The B-cell infiltration grade in patients with IgAV-N was significantly correlated with age, serum IgA level, renal dysfunction, and tubulointerstitial injury parameters, but was not correlated with duration after purpura or glomerular injury parameters. Most patients with IgAV-N were treated with corticosteroids. The proteinuria level was significantly decreased, but renal function was not improved in 12 patients after the 24-month follow-up compared with the values at baseline. The B-cell infiltration grade was significantly correlated with renal dysfunction after 24months of follow-up. The B-cell infiltration grade in patients with IgAV-N was associated with renal dysfunction and tubulointerstitial injuries but not with glomerular injury parameters. B-cell infiltration and TLT might have a pathologically significant role in irreversible renal dysfunction in patients with early phase adult-onset IgAV-N.

Renal Dysfunction in Patients with Left Ventricular Assist Device.

Late-stage heart failure and renal dysfunction are often seen in conjunction. Cardiorenal syndrome (CRS) describes the complex interaction between the two disease states. Early literature described the pathophysiology of CRS as related only to reduced cardiac output and decreased renal perfusion. Recent literature suggests a more multifaceted mechanism. Left ventricular assist devices (LVAD), used as bridge-to-transplant and destination therapy in patients with heart failure, impact not only cardiac function but also renal function, especially in those patients with preoperative renal dysfunction. The mechanism by which LVAD implantation affects renal function is complex and understated in early literature. In this review, we discuss the pathogenesis of CRS, the impact of preoperative renal dysfunction in patients undergoing LVAD implantation, and the effect of LVAD implantation on postoperative renal function.

Prerenal kidney damage in patients with local cold injury

Introduction. Important links in the pathogenesis of cold alterations are vascular damage and powerful systemic alterations. The presence of premorbid pathology and the duration of the wound process negatively affects to the function of most organs and systems, including the kidneys. Renal insufficiency in patients with frostbite develops in the acute period of cold damage. This is indicated by a decrease in the amount of urine and an increase in creatinine levels in victims with frostbite. In this regard, the identification and analysis of the dynamics of new markers of renal dysfunction in patients with frostbite is promising both from a scientific and practical point of view.The aim. To investigate the dynamics of changes in serum creatinine, NGAL and cystatin C levels in patients with local cold trauma.Materials and methods. The study included 60 patients with frostbite of the III–IV degree of distal limb segments. The study was carried out depending on the volume of the lesion and the timing from the moment of cryoalteration.The results of the study. In patients with grade III–IV frostbite, an increase in the level of lipocalin and serum creatinine was detected in the blood. The concentration of lipocalin and serum creatinine is directly proportional to the volume of cold-affected tissues. Indicators of lipocalin and serum creatinine decrease in the late stages of cryopreservation. The level of cystatin C significantly decreases during all periods of frostbite; the concentration of the latter does not depend on the severity of cryopreservation.

The relationship between nonalcoholic fatty liver disease with visceral fat depots of other localization, metabolic parameters and markers of renal dysfunction in patients with obesity

Background and Aims : To assess the relationship between non-alcoholic fatty liver disease (NAFLD) with visceral fat, metabolic parameters, markers of renal dysfunction in patients with obesity.Methods: The study included 105 people aged 44.8±6.4 years. The group №1-patients with NAFLD, BMI 36.1±3.2kg/m2. The group №2- without NAFLD with BMI 35.5±3.9kg/m2. The TNF, β2 microglobulin, ACRU, IL 6, MCP-1, leptin, resistin and cystatin C was determined by ELISA. GFR was calculated by CKD-EPI formula and cystatin C. The examination of visceral adipose tissue: VAT- measurement at the level of the navel from the inner surface of the rectus abdominis to the posterior wall of the aorta and L4; the thickness of the posterior perirenal fatty tissue and perirenal fatty tissue on both sides.Conclusions: In patients with NAFLD, the parameters of the lipid profile and renal dysfunction deteriorate, which can contribute to the development of atherosclerosis. Background and Aims : To assess the relationship between non-alcoholic fatty liver disease (NAFLD) with visceral fat, metabolic parameters, markers of renal dysfunction in patients with obesity. Methods: The study included 105 people aged 44.8±6.4 years. The group №1-patients with NAFLD, BMI 36.1±3.2kg/m2. The group №2- without NAFLD with BMI 35.5±3.9kg/m2. The TNF, β2 microglobulin, ACRU, IL 6, MCP-1, leptin, resistin and cystatin C was determined by ELISA. GFR was calculated by CKD-EPI formula and cystatin C. The examination of visceral adipose tissue: VAT- measurement at the level of the navel from the inner surface of the rectus abdominis to the posterior wall of the aorta and L4; the thickness of the posterior perirenal fatty tissue and perirenal fatty tissue on both sides. Conclusions: In patients with NAFLD, the parameters of the lipid profile and renal dysfunction deteriorate, which can contribute to the development of atherosclerosis.

Mechanical bowel preparation and post-operative renal dysfunction in patients undergoing cytoreductive surgery for ovarian cancer (003)

<b>Objectives:</b> The use of mechanical and oral antibiotic bowel preparation in the preoperative setting for gynecologic oncology surgery is controversial. One concern is its effects on body fluid physiology and the subsequent impact on postoperative renal function, especially in the setting of complex cytoreductive surgery (CRS) in ovarian cancer patients. The objective of this study was to examine the impact of bowel preparation on postoperative estimated creatinine clearance in patients undergoing cytoreductive surgery for ovarian cancer. <b>Methods:</b> We performed a retrospective review of patient data recorded in a prospectively collected university cancer center database. Patients with stage III or IV ovarian cancer who underwent primary or interval CRS were included. Patients without longitudinal follow-up were excluded. Patients were then divided into two groups: those who had a preoperative mechanical and oral antibiotic bowel preparation and those who did not. We collected information on demographics, medical comorbid conditions, and operative and oncologic characteristics. We also recorded preoperative, postoperative, and day of discharge estimated creatinine clearance, urine output, and total intravenous fluid (IVF) administered. The Chi-square test compared categorical variables and the t-test compared continuous variables. <b>Results:</b> A total of 831 patients met the criteria for analysis, of whom 221 (24%) had a preoperative bowel prep, and 610 (76%) did not. Demographics, medical comorbid conditions, cancer characteristics, and operative data were similar between both groups, except for significantly higher intraoperative IVF in those who underwent bowel prep than those who did not (2703 vs 1650 mL, p<0.001). There was no difference in preoperative estimated creatinine clearance (67 vs 68 mL/min, p=0.45), but estimated creatinine clearance on postoperative days one and two were significantly lower for patients who underwent bowel preparation (day one: 49 vs 69 mL/min, p-value <0.001; day two: 58 vs 72mL/min p<0.001). The estimated creatinine clearance for patients who underwent bowel preparation was fully recovered by the time of discharge (67 vs 65 mL/min, p=0.084). Patients who had bowel preparation received significantly more IVF than those who did not get bowel preparation on postop days one and two (day one: 1823 vs 1250 mL, p<0.001; day two: 1215 vs 783mL, p<0.001). There were no differences in urine output or units of blood transfused preoperatively or postoperatively. <b>Conclusions:</b> Use of preoperative bowel preparation for ovarian cancer CRS was associated with a transient statistically significant decrease in estimated creatinine clearance on postop days one and two that resolved by the time of discharge.Fig. 1

Nephrogenic Systemic Fibrosis in Patients with Chronic Kidney Disease after the Use of Gadolinium-Based Contrast Agents: A Review for the Cardiovascular Imager.

Gadolinium-enhanced cardiac magnetic resonance has revolutionized cardiac imaging in the last two decades and has emerged as an essential and powerful tool for the characterization and treatment guidance of a wide range of cardiovascular diseases. However, due to the high prevalence of chronic renal dysfunction in patients with cardiovascular conditions, the risk of nephrogenic systemic fibrosis (NSF) after gadolinium exposure has been a permanent concern. Even though the newer macrocyclic agents have proven to be much safer in patients with chronic kidney disease and end-stage renal failure, clinicians must fully understand the clinical characteristics and risk factors of this devastating pathology and maintain a high degree of suspicion to prevent and recognize it. This review aimed to summarize the existing evidence regarding the physiopathology, clinical manifestations, diagnosis, and prevention of NSF related to the use of gadolinium-based contrast agents.

Impact of comorbid renal dysfunction in patients with hepatocellular carcinoma on long-term outcomes after curative resection.

BACKGROUNDHepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. However, the number of patients with chronic kidney disease (CKD) is on the rise because of the increase in lifestyle-related diseases.AIMTo establish a tailored management strategy for HCC patients, we evaluated the impact of comorbid renal dysfunction (RD), as stratified by using the estimated glomerular filtration rate (EGFR), and assessed the oncologic validity of hepatectomy for HCC patients with RD.METHODSWe enrolled 800 HCC patients who underwent hepatectomy between 1997 and 2015 at our university hospital. We categorized patients into two (RD, EGFR < 60 mL/min/1.73 m2; non-RD, EGFR ≥ 60 mL/min/1.73 m2) and three groups (severe CKD, EGFR < 30 mL/min/1.73 m2; mild CKD, 30 ≤ EGFR < 60 mL/min/1.73 m2; control, EGFR ≥ 60 mL/min/1.73 m2) according to renal function as defined by the EGFR. Overall survival (OS) and recurrence-free survival (RFS) were compared among these groups with the log-rank test, and we also analyzed survival by using a propensity score matching (PSM) model to exclude the influence of patient characteristics. The mean postoperative observation period was 64.7 ± 53.0 mo.RESULTSThe RD patients were significantly older and had lower serum total bilirubin, aspartate aminotransferase, and aspartate aminotransferase levels than the non-RD patients (P < 0.0001, P < 0.001, P < 0.05, and P < 0.01, respectively). No patient received maintenance hemodialysis after surgery. Although the overall postoperative complication rates were similar between the RD and non-RD patients, the proportions of postoperative bleeding and surgical site infection were significantly higher in the RD patients (5.5% vs 1.8%; P < 0.05, 3.9% vs 1.8%; P < 0.05, respectively), and postoperative bleeding was the highest in the severe CKD group (P < 0.05). Regardless of the degree of comorbid RD, OS and RFS were comparable, even after PSM between the RD and non-RD groups to exclude the influence of patient characteristics, liver function, and other causes of death.CONCLUSIONComorbid mild RD had a negligible impact on the prognosis of HCC patients who underwent curative hepatectomy with appropriate perioperative management, and close attention to severe CKD is necessary to prevent postoperative bleeding and surgical site infection.

Features in the Processes of Left Ventricular Remodeling Depending on the Degree of Renal Dysfunction in Patients with Chronic Heart Failure

Background: The aim of this research was to study the features of changes in the parameters of heart remodeling in patients with coronary heart disease (CHD) and chronic heart failure (CHF), depending on the degree of renal dysfunction (RD). Methods and Results: The study included 150 CHD patients with NYHA functional class (FC) I-IIII of CHF. All examined patients were subdivided according to the level of eGFR: Group A included 81 patients with CHF FCI-III and eGFRCKD-EPI&gt;60 mL/min per 1.73m2; Group B included 69 patients with CHF FCI-III and eGFRCKD-EPI≤60 mL/min per 1.73m2. It was found an increase in left ventricular (LV) mass in Group B by 11.4%, compared to Group A (P=0.000). Analysis of LV systolic function showed that in Group B, values of LF ejection fraction and fractional shortening were significantly lower than in Group A (47.64±0.61% vs. 52.7±0.28%, and 25.40±0.46% vs. 28.23±0.25%, respectively, P=0.000). Thus, in Group B, we found CHFrEF, compared to Group A with CHFpEF. Analysis of diastolic function revealed that in Group B, the E/A ratio was statistically higher than in Group A (1.12±0.05 vs. 0.81±0.04, respectively, P=0.000). At the same time, in Group B, values of IVRT and DT were significantly lower than in Group A (85.01±0.8 ms vs. 91.25±0.99 ms, and 177.8±2.1 ms vs. 197.5±2.07 ms, respectively, P=0.000). Thus, the signs of the impaired relaxation (Grade 1 DD) and the pseudonormal filling pattern (Grade 2 DD) were found in Group A and Group B, respectively. Conclusion: RD in patients with CHF is an important factor in the significant deterioration of LV systolic and diastolic functions.

Serum ferritin level in type 2 diabetic patients with renal dysfunction

Background and objective: Nephropathy is the major cause of end-stage renal disease (ESRD) in type 2 diabetes mellitus (T2DM). Delay in identification and management of nephropathy in T2DM may cause development of ESRD. An increased level of serum ferritin plays a role in the pathogenesis of chronic kidney disease (CKD) in T2DM. Hence, the present study intended to assess the level of serum ferritin in renal dysfunction in patients with T2DM. Material and methods: This was a retrospective study with 81 T2DM patients with and without nephropathy. They were categorized into two groups. Group-1 consisted of 46 T2DM cases without nephropathy and remaining 35 with nephropathy.The clinical and biochemical parameters such as blood glucose, urea, creatinine, iron, ferritin, transferrin, total iron binding capacity (TIBC), and haemoglobin were measured by standard methods, and estimated glomerular filtration rate (eGFR) by MDRD formula. Results: Significantly (p&lt;0.05) elevated level of serum ferritin along with urea and creatinine was found in patients with T2DM with nephropathy.A significant positive correlation (r = 0.37) of serum ferritin and negative correlation (r = - 0.852) of eGFR with creatinine were found. It indicated that ferritin could be a good marker to monitor kidney function in T2DM. Conclusion: Apart from eGFR and serum creatinine, raised serum ferritin level was a good indicator of renal dysfunction in T2DM patients and might play an important role in renal dysfunction in early stage diabetic nephropathy. IMC J Med Sci 2022; 16(2): 008. DOI: https://doi.org/10.55010/imcjms.16.018 *Correspondence: Dr. Siva Prasad Palem., M.Sc., Ph.D., Department of Biochemistry, Faculty of Medicine, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar-505001, Telangana, India. Affiliated with Kaloji Narayana Rao University of Health Sciences (KNRUHS), Warangal, Telangana, India. E-mail: sp.biocom@yahoo.co.in.

NT-proBNP in assessment of kidney dysfunction development in patients with diffuse large B-cell lymphoma receiving immune polychemotherapy.

e19554 Background: The purpose of this study was to assess NT-proBNP as a marker of renal dysfunction in patients with diffuse large B-cell lymphoma receiving immune polychemotherapy. Methods: The study involved 24 patients aged 23-69 years (median 57 years) with a primary diagnosis of diffuse large B-cell lymphoma (DLBCL). The renal status was assessed by the blood serum levels of creatinine, urea, NT-proBNP (Vitros 5600, USA), sodium (Cobas b221, Switzerland) with the calculation of the glomerular filtration rate (GFR) according to the CKD-EPI formula, as well as urine levels of albumin (Cobas Integra 400 plus, Switzerland). The tests were conducted before and 48 hours after induction immune polychemotherapy (R-CHOP). Statistical evaluation of results was made using the Statistica 13.0 program. Results: The patients were divided into 2 groups depending on the GFR levels before the start of therapy: group 1 (n = 16) - GFR 108.04±13.9 mL/min/1.73 m2 (normal levels); group 2 (n = 8) - GFR 59.57±12.04 mL/min/1.73m2 (reduced levels). The studied parameters in group 1 were within the reference values before treatment: NT-proBNP 109.38±13.6 pg/mL, creatinine 72.67±7.96 μmol/L, urea 5.39±0.99 mmol/L, albumin in urine 4.34±0.51 mg/L. After 48 hours, a moderate increase in NT-proBNP up to 207.5±48.2 pg/mL (p &gt; 0.05) was observed, without significant changes in other parameters. In group 2, a pronounced increase in NT-proBNP was observed initially: 694±206.47 pg/mL, which was 5.6 times higher than the upper limit of the reference interval (p &lt; 0.001) and 6.4 times higher than the levels in group 1 (p &lt; 0.001), together with a significant increase in urine levels of albumin - 43.93±12.03 mg/L. Creatinine (80.67±4.35 μmol/L) and urea (6.4±1.41 mmol/L) remained within the reference range. After 48 hours, NT-proBNP increased by 3.8 times, reaching 2675±602.4 pg/mL (p &lt; 0.001), which was accompanied by an increase in urine albumin - 57.8±8.86 mg/L and serum creatinine – 102.2±5.37 μmol/L in comparison with the initial levels. The levels of urea remained unchanged (6.6±0.43 mmol/L). The sodium levels did not differ significantly between the groups and was 141.65±2.24 mmol/L in group 1 and 140.85±3.4 mmol/L in group 2 and did not change over time. According to the results, patients with an initially decreased GFR demonstrated an increase in the levels of NT-proBNP and albumin in the urine even before the start of polychemotherapy. Conclusions: NT-proBNP can be considered an early marker of renal dysfunction in patients with diffuse large B-cell lymphoma.

CARC17: The Impact of Persistent Renal Dysfunction in Patients Listed for Heart Transplant with Temporary MCS device

CARC17: The Impact of Persistent Renal Dysfunction in Patients Listed for Heart Transplant with Temporary MCS device

Determinants of Peak Oxygen Uptake at Each Stage of Renal Dysfunction in Patients with Heart Disease.

Identifying the causes of low peak oxygen uptake (peak V̇ ) in heart disease patients with renal dysfunction is necessary for prognostic improvement strategies. The purpose of this study was to verify the determinants of peak V̇ for each stage of renal function in heart disease patients, focusing on end-tidal oxygen partial pressure ( ). Two hundred fifty heart disease patients who underwent cardiopulmonary exercise testing (CPET) in our institution were consecutively enrolled. Patients were divided into three groups by their estimated glomerular filtration rate (eGFR): 45, 45-59 and 60 mL/min/1.73 . Patient characteristics and CPET parameters including 2 (rest-anaerobic threshold) were compared between the groups. The relationship between PETO and peak V̇ was also investigated for each group. In total, 201 patients were analyzed. decreased with the deterioration of renal function (eGFR 45, 0.1 mmHg vs. eGFR 45-59, 2.4 mmHg vs. eGFR 60, 5.2 mmHg, p 0.001). In the eGFR 45 group, left ventricular ejection fraction (LVEF) and hemoglobin (Hb) were significantly associated with peak V̇ = 0.518, p 0.001 and = 0.567, p 0.001, respectively), whereas was not. In the eGFR 45-59 group, age, Hb, and showed a significant association with peak V̇ ( = -0.354, p = 0.006; = 0.258, p = 0.007; = 0.501, p 0.001; respectively). In the univariate analysis, eGFR 45-59 group showed the highest coefficient of determination of to peak V̇ ( = 0.247, p 0.001). The determinants of peak V̇ in heart disease patients depended on the stage of renal function. The determinants of peak V̇ in patients with eGFR 45 were LVEF and Hb, while was the strongest predictor of peak V̇ in patients with eGFR 45-59.

Association between central haemodynamics and renal function in advanced heart failure: a nationwide study from Sweden.

AimsRenal dysfunction in patients with heart failure (HF) has traditionally been attributed to declining cardiac output and renal hypoperfusion. However, other central haemodynamic aberrations may contribute to impaired kidney function. This study assessed the relationship between invasive central haemodynamic measurements from right‐heart catheterizations and measured glomerular filtration rate (mGFR) in advanced HF.Methods and resultsAll patients referred for heart transplantation work‐up in Sweden between 1988 and 2019 were identified through the Scandiatransplant organ‐exchange organization database. Invasive haemodynamic variables and mGFR were retrieved retrospectively. A total of 1001 subjects (49 ± 13 years; 24% female) were eligible for the study. Analysis of covariance adjusted for age, sex, and centre revealed that higher right atrial pressure (RAP) displayed the strongest relationship with impaired GFR [β coefficient −0.59; 95% confidence interval (CI) –0.69 to −0.48; P < 0.001], followed by lower mean arterial pressure (MAP) (β coefficient 0.29; 95% CI 0.14–0.37; P < 0.001), and finally reduced cardiac index (β coefficient 3.51; 95% CI 2.14–4.84; P < 0.003). A combination of high RAP and low MAP was associated with markedly worse mGFR than any other RAP/MAP profile, and high renal perfusion pressure (RPP, MAP minus RAP) was associated with superior renal function irrespective of the degree of cardiac output.ConclusionsIn patients with advanced HF, high RAP contributed more to impaired GFR than low MAP. A higher RPP was more closely related to GFR than was high cardiac index.

Pararenal Fat and Renal Dysfunction in Patients without Significant Cardiovascular Disease

Introduction: Accumulation of fat tissue around the kidneys is considered to be a risk factor for chronic kidney disease (CKD). The objective of the study was to investigate the association of pararenal fat tissue (PRFT) and renal dysfunction in patients without clinically significant cardiovascular diseases (CVDs). Methods: The study included 320 patients without CVDs (mean age 63.8 ± 13.9 years). All patients underwent anthropometric measurements, standard biochemical blood tests, including a lipid panel and uric acid concentration. Glomerular filtration rate (GFR) was calculated using the CKD-EPI formula. All patients underwent computed tomography of the abdomen with measurement of the PRFT thickness. The research results were processed using StatSoftStatistica 10.0 software. Results: The average PRFT thickness was 1.45 cm [0.9; 2.0]. It was significantly higher in obese individuals when compared with patients with normal body weight (1.9 cm [1.3; 2.6] vs. 1.0 cm [0.6; 1.7]) and overweight people (1.9 cm [1.3; 2.6] vs. 1.1 cm [0.8; 1.6]) (p < 0.001). GFR was significantly higher in subjects with normal body weight when compared with obese patients (72 mL/min/1.73 m² [59; 83] vs. 61 mL/min/1.73 m² [51; 70]) and overweight patients (72 mL/min/1.73 m² [59; 83] vs. 61 mL/min/1.73 m² [54; 72]) (p < 0.001). PRFT thickness was significantly higher in patients with stage 3 CKD when compared with those with stage 1 CKD (2.2 cm [1.6; 3.3] vs. 0.9 cm [0.9; 1.0]) and with stage 2 CKD (2.2 cm [1.6; 3.3] vs. 1.3 cm [0.9; 1.8]) (p < 0.001). A significant correlation was found between PRFT thickness and body mass index (r = 0.49, p < 0.05), waist circumference (r = 0.55, p < 0.05), GFR (r = −0.47, p < 0.05), and uric acid level (r = 0.46, p < 0.05). Multiple linear regression analysis revealed a significant relationship between GFR and age (β ± SE −0.43 ± 0.15, p = 0.01), PRFT thickness (β ± SE −0.38 ± 0.14, p = 0.01) and with the level of low-density lipoprotein cholesterol (β ± SE −0.32 ± 0.12, p = 0.01). Logistic regression analysis showed that the risk of renal dysfunction development was associated with PRFT thickness (OR = 6.198; 95% CI: 1.958–19.617; p < 0.05). ROC analysis determined the threshold values of PRFT thickness (>1.68 cm, AUC = 0.875), above which the development of renal dysfunction can be predicted (sensitivity 63.2%, specificity 93.4%). Conclusion: The results of our study indicate the relationship between PRFT and visceral obesity and renal dysfunction in patients without clinically significant CVDs.

Prediction of the Short-Term Risk of New-Onset Renal Dysfunction in Patients with Type 2 Diabetes: A Longitudinal Observational Study.

Background Studies in the past decade have reported many novel biomarkers for predicting the new-onset or progression risk of renal dysfunction in patients with type 2 diabetes (T2D) based on the genomic, metabolomic, and proteomic technologies. These novel predictive markers, however, are difficult to be widely used in clinical practice over the short term due to their high technology content, instability, and high cost. This study was aimed at evaluating the associations of clinical features and six traditional renal markers with the short-term risk of new-onset renal dysfunction in patients with T2D. Methods This study involved 213 participants with T2D and normal renal function at baseline. The baseline levels of the albumin-to-creatinine ratio (ACR), estimated glomerular filtration rate (eGFR), alpha-1-microglobulin-to-creatinine ratio (A1MCR), neutrophil gelatinase-associated lipocalin-to-creatinine ratio, transferrin-to-creatinine ratio (UTRF/Cr), and retinol-binding protein-to-creatinine ratio (URBP/Cr) were analyzed. Multivariate logistic models were established and validated. Results During the two-year follow-up period, 23.01% participants progressed to renal dysfunction. The basal levels of ACR, A1MCR, UTRF/Cr, and URBP/Cr were the independent risk factors of new-onset renal dysfunction (P < 0.05). Several logistic models incorporating clinical characteristics and these renal markers were constructed for predicting the short-term risk of new-onset renal dysfunction. Comparatively, the model including age, glycated hemoglobin (HbA1c), hypertension, ACR, A1MCR, UTRF/Cr, and URBP/Cr levels at baseline had the highest potential (C − index = 0.785, P < 0.001). This model was validated using the K-fold cross-validation method; the accuracy was 0.815 ± 0.013 in training sets and 0.784 ± 0.019 in validation sets, indicating a good consistency for predicting the new-onset renal dysfunction risk. Finally, a nomogram based on this model was constructed to provide a quantitative tool to assess the individualized risk of short-term new-onset renal dysfunction. Conclusion The model incorporating these markers and clinical features may have a high potential to predict the short-term risk of new-onset renal dysfunction.

Study of Clinical Profile and Outcome in Patients of Alcohol Induced Chronic Liver Disease with Hepato Renal Syndrome

Background: Decompensated Chronic liver disease and cirrhosis are frequently complicated with renal dysfunction and this combination, called Hepato-Renal Syndrome (HRS) leads to significant morbidity and mortality. Acute renal dysfunction occurs in 15% to 25% of hospitalized patients with cirrhosis. The annual frequency of Hepato-renal syndrome(HRS) in cirrhotic patients with ascites is roughly 8% and, in some reports, as high as 40%.The observation that morbidity and mortality remain high once the syndrome is established has led to a focus on the prevention and early therapy of renal dysfunction in patients with cirrhosis. Hepato-renal syndrome (HRS) is a serious complication of liver cirrhosis with critically poor prognosis. Rapid diagnosis and management are important, since recent treatment modalities including vasoconstrictor therapy can improve short-term outcome and buy time for liver transplantation, which can result in complete recovery. Recognizing the trait about chronic alcoholism in a patient, counselling by doctor about avoidance of alcohol, &amp; early recognition of progression to CLD by investigations may be helpful in preventing this complication. Aims and Objectives: To study clinical profile, assess the course and severity and outcome of patients admitted with alcohol induced chronic liver disease with hepato-renal syndrome. Methodology: A prospective (observational), hospital based study was carried out in 57 patients who met our inclusion criteria. Results: The study population's most common age group was between 36 and 45 years (33.3%), 46 to 55 years (24.6%), and more than 55 years (22.8%) with the mean age of 43 + 7.8 years amongst study population with a male predominanace (87.7%), Icterus and ascitis (100%) followed by Flapping tremors (98.25%), Oliguria (82.5%), Edema Feet (73.68%), Altered sensorium (66.7%) and Abdominal Distension (59.65%) were the commonest clinical features. History of alcohol intake for more than 10 years (61.4%) followed by less than 10 years (38.6%) and most of them were heavy drinkers (&gt;4 drinks per day) (44.2%) while moderate and light drinkers (2-4 drinks/day and 1-2 drinks/day ) were 32.7% and 23.1% respectively. Previous history of admissions due to similar or related illness was observed in 78.9% of study population. Most of our patients had Type I HRS (75.4%) followed by Type II (24.53%). In our study, death was occurred in all patients with worsened hepatic and renal dysfunction (100%) and the difference was statistically significant. Conclusion: Hepato Renal Syndrome is a major decompensation in advanced alcohol induced liver cirrhosis with a high short-term mortality rate.

Associations between MRI signs of kidney parenchymal changes and biomarkers of renal dysfunction in resistant hypertension

Objective. Resistant hypertension (RHT) is often associated with kidney injury and chronic kidney disease, especially in diabetic patients. Early detection of renal changes contributes to avoiding severe cardiovascular complications, but imaging characteristics of renal dysfunction in RHT remain unclear. The aim of the present study was to determine the relationships between the renal parenchyma volumes and biomarkers reflecting kidney function in a cohort of patients with RHT.Material and Methods. The study comprised 34 patients with RHT meeting the inclusion criteria. Evaluation of renal function was based on the measurements of estimated glomerular filtration rate (eGFR) and serum levels of creatinine and cystatin C. Renal sizes were assessed by MRI based on absolute and normalized parenchymal kidney volumes.Results. Primary MRI-based changes in renal parenchyma in patients with RHT demonstrated altered cortical surface, attenuated cortical thickness, lower renal volumes, and round shape of the kidneys compared with the reference characteristics. Positive correlation of moderate power was found between eGFR value and all parameters characterizing renal parenchyma. The strongest direct correlation was found between eGFR and bsa-TKV (r = 0.6166, p = 0.000); ht-TKV correlated with eGFR (r = 0.4751, p = 0.007) and creatinine (r = –0.4302, p = 0.016). According to linear regression analysis, ht-T-Cortex-V &lt; 32.4 was a key element of MRI-presentation of renal dysfunction in patients with eGFR below 60 mL/min/1.73 m2 (sensitivity of 83.3%, specificity of 60.7%, p = 0.03).Conclusion. MRI study allowed to detect early renal parenchymal changes suggesting the presence of association between renal function and renal parenchymal volume in RHT patients. For the first time, the study revealed MRI-pattern of renal dysfunction in RHT.

Graves' Disease and the Risk of End-Stage Renal Disease: A Korean Population-Based Study.

Background Hyperthyroidism is associated with an increased glomerular filtration rate (GFR) in the hyperdynamic state, which is reversible after restoring euthyroidism. However, long-term follow-up of renal dysfunction in patients with hyperthyroidism has not been performed.Methods This was a retrospective cohort study using the Korean National Health Insurance database and biannual health checkup data. We included 41,778 Graves’ disease (GD) patients and 41,778 healthy controls, matched by age and sex. The incidences of end-stage renal disease (ESRD) were calculated in GD patients and controls. The cumulative dose and duration of antithyroid drugs (ATDs) were calculated for each patient and categorized into the highest, middle, and lowest tertiles.Results Among 41,778 GD patients, 55 ESRD cases occurred during 268,552 person-years of follow-up. Relative to the controls, regardless of smoking, drinking, or comorbidities, including chronic kidney disease, GD patients had a 47% lower risk of developing ESRD (hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.37 to 0.76). In particular, GD patients with a higher baseline GFR (≥90 mL/min/1.73 m2; HR, 0.33; 95% CI, 0.11 to 0.99), longer treatment duration (>33 months; HR, 0.31; 95% CI, 0.17 to 0.58) or higher cumulative dose (>16,463 mg; HR, 0.29; 95% CI, 0.15 to 0.57) of ATDs had a significantly reduced risk of ESRD.Conclusion This was the first epidemiological study on the effect of GD on ESRD, and we demonstrated that GD population had a reduced risk for developing ESRD.

Usefulness of urinary tubule injury markers for predicting progression of renal dysfunction in patients with type 2 diabetes and albuminuria: The Fukuoka Diabetes Registry

AimsWe prospectively investigated the association of urinary tubule injury markers with estimated glomerular filtration rate (eGFR) decline in Japanese patients with type 2 diabetes. MethodsUrinary kidney injury molecule 1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), liver-type fatty-acid-binding protein (L-FABP), and urinary albumin-to creatinine ratio (UACR) were measured in 2,685 participants with type 2 diabetes. Renal outcomes were ≥ 30% decline in eGFR from the baseline and annual eGFR decline for 5 years. ResultsIn normoalbuminuric participants, no tubular markers were associated with ≥ 30% decline in eGFR or annual eGFR changes. In those with UACR ≥ 30 mg/gCr, hazard ratios for ≥ 30% eGFR decline were 1.37 (95% confident interval (CI) 1.07–1.75) for urinary KIM-1 (>1.5 µg/gCr), 1.46 (95% CI 1.13–1.66) for urinary NGAL (>16.4 µg/gCr), and 1.26 (95% CI 0.94–1.66) for urinary L-FABP (>12.5 µg/gCr), 2.61 (95% CI 1.64–4.17) for the combination of 3 tubular markers above the cutoff after multivariable adjustments including UACR and eGFR. ConclusionsThe current study demonstrated that urinary tubule injury markers and their combination were significant predictors for the future eGFR decline in those with type 2 diabetes and albuminuria independently of UACR and eGFR. Urinary tubular markers may be useful to identify high-risk patients with albuminuria.

Development and external validation of a nomogram for predicting renal function based on preoperative data from in-hospital patients with simple renal cysts.

ObjectiveTo develop and validate a nomogram for predicting renal dysfunction in patients with simple renal cysts (SRCs).MethodsWe performed a multivariable logistic regression analysis of an in-hospital retrospective cohort of patients with SRCs in the Urology Department of the First Affiliated Hospital of Anhui Medical University. For prognostic model development, 386 patients with SRCs were enrolled from January 2016 to December 2018. External validation was performed in 46 patients with SRCs from January 2019 to April 2019. The primary outcome was renal dysfunction.ResultsPatients were divided into normal or abnormal estimated glomerular filtration rate groups (293 vs. 93) based on the cut-off value of 90 mL/minute/1.73 m2. Logistical regression analysis determined that age, haemoglobin, globulin, and creatinine might be associated with renal dysfunction, and a novel nomogram was established. Calibration curves showed that the true prediction rate was 77.42%, and decision curve analysis revealed that the nomogram was more effective with threshold probabilities ranging from 0.1 to 0.8. The area under the curves were 0.829, 0.752, and 0.888 in the overall training, internal, and external validation cohorts, respectively.ConclusionsWe established a nomogram to predict the probability of developing renal dysfunction in patients with SRCs.