Renal Function Tests Research Articles

A Comparative Analysis of the Efficacy and Safety of Nimesulide/Paracetamol Fixed-Dose Combination With Other NSAIDs in Acute Pain Management: A Randomized, Prospective, Multicenter, Active-Controlled Study (the SAFE-2 Study).

Objective In this study, we aimed to compare the efficacy and safety of the fixed-dose combination (FDC) of nimesulide (100 mg) + paracetamol (325 mg) [NP], ketorolac (10 mg) [Kt] alone, diclofenac (50 mg) + paracetamol (325 mg) [DP], and aceclofenac (100 mg) + paracetamol (325 mg) [AP] in patients with acute painful conditions. Methods This was a randomized, prospective, open-label, multicentre, active-controlled study involving patients aged ≥18 years, with acute painful conditions like low back pain, acute musculoskeletal disorders, and trauma such as tendinitis, tenosynovitis, bursitis, sprains and strains, migraine, dental pain, painful dental procedures, and post-surgical pain. Reduction in pain intensity and liver, renal, gastrointestinal, and cardiovascular safety were assessed on days seven and14. Results A total of 600 patients were randomized into NP, Kt, DP, and AP groups in a 1:1:1:1 ratio. NP, DP, and AP were administered twice a day while Kt was given three times a day. The reduction of pain as measured by the numerical rating scale (NRS) scores at the end of day seven was 3.75 ± 1.58 in the NP group, 2.96 ± 1.18 in the Kt group, 3.42 ± 1.42 in the DP group, and 3.47 ± 1.30 in the AP group. The pain reduction in the NP group was significantly greater (p<0.001) as compared to the Kt group and non-inferior to the DP and AP groups on days seven and 14. Non-inferiority was concluded between the NP, DP, and AP groups as the lower limit of 95% CI of the difference in the change of pain intensity on both days seven and14 was above the predefined margin of -1.0. All the drugs were well tolerated, but a significantly greater number of adverse events were reported in the DP group (32) as compared to the NP group (14)(p<0.05). The most common adverse events reported during the study were nausea, gastritis, and abdominal pain in all four groups. There was no significant alteration in liver and renal function tests except a rise in serum creatinine in the DP group. Conclusions The FDC of nimesulide with paracetamol is superior to ketorolac and non-inferior to the FDC of diclofenac with paracetamol and aceclofenac with paracetamol in the management of pain in patients with acute painful conditions. The tolerability profile of the FDC of nimesulide with paracetamol is similar to that of ketorolac but better than diclofenac with paracetamol and aceclofenac with paracetamol combinations.

IJCM_169A: Correlation of sonographic renal dimensions with anthropometric measurements among individuals without renal disorders

Background: Normal kidney dimensions are suggestive of normal kidney function. Degree of kidney function has a positive correlation with ultrasonic renal measurements. Co-morbid conditions affect the renal size. Therefore it becomes necessary to establish normal values of kidney dimensions for the diagnosis, prognosis and also as an early indication of renal diseases in order to prevent them. Objectives: To study the renal dimensions and association with socio- demographic conditions among the outpatient attendees in the study hospital. Methodology: This was a descriptive cross-sectional study done among the attendees of KMC Hospitals, Mangalore. Data extraction sheet included the socio-demographic details, Anthropometric measurements, personal history, history of comorbidities and sonographic dimensions of Kidney and laboratory findings of Renal Function Test. Data was entered and analyzed by using statistical software Statistical Package for Social Sciences (SPSS) Version 29.0. Results: Out of 194 participants, 118(60.8%) were males. The difference between corresponding kidney lengths of males and females is found to be statistically significant. The length and anteroposterior dimension of left kidney is greater than right kidney and the difference is statistically significant. When the kidney lengths and the heights of the individual were correlated a positive correlation was obtained, (0.278) in case of right kidney and (0.245) in case of left kidney. Conclusion: Kidney length had positive correlation with height and BMI. Female kidney length was significantly smaller than the male kidney length. There was significant variation between right and left kidney lengths.

Evaluation of Renal Function Tests and Electrolytes in Iraqi Males with Repeated Smoking and Alcohol Abuse

Abstract Background: Wrong lifestyles such as smoking and drinking alcohol all lead to negative effects. Moreover, smoking is one of the most dangerous effects on people’s health, and it is considered one of the motives for slow suicide in humans, due to its consist deadly compounds and drinking alcohol has a dangerous effects too on people’s health. Objective: Is to estimate the variables at kidney function tests (uric acid, creatinine, and urea) and electrolytes like Na+, K+, and Cl−) in Iraqi male smokers. The major goal research is to check the variation on kidney function tests (uric acid, creatinine, and urea) and electrolytes like Na+, K+, and Cl−) in Iraqi alcoholic smokers males. Materials and Methods: This research carried out on 115 specimens of alcoholic smoker person’s sera bloods and nonalcoholic smoker persons from Iraqi males. Some kidney functions and electrolytes were determined included: uric acid, creatinine, and urea of kidney functions beside to sodium, potassium, and chloride of the electrolytes. Results: In this study, the results showed that affect smoking and alcohol consumption on kidney role was shown by the sera contents of urea, creatinine, uric acid, and urea values as it was observed that the sera contents of uric acid, creatinine, and urea were higher within alcoholic smokers persons compared with the blood specimens of the control group. The contents ranged of uric acid (5.99–9.25), creatinine (0.78–1.2), and urea contents were ranged between 26.3 and 30.03 of alcoholic smoker specimens. While the same markers in nonalcoholic smoker specimens (control group) were as following: uric acid (5.11), creatinine (0.69), and urea values (27.9) sequentially. Conclusion: There are a significant difference in serum Na+, K+, and Cl− in alcoholic smokers when compared to controls, also there are a significant difference in uric acid, urea, and creatinine levels.

Frequency of Dengue and Malaria Co-Infection in Patients Admitted in Jinnah Hospital, Lahore

Prevalence of malaria and dengue infection coexistence is increasing during endemic periods although causing quite similar symptoms and signs, the treatment of these two illnesses is different. Any suspicion of malaria in disease-endemic areas must be excluded with microscopy and/or rapid antigen test. Objective: To find out the incidence of co-infection of dengue and malaria based on clinical and hematological parameters in patients presenting with acute febrile illness. Methods: This cross-sectional study was done in the Medicine Unit of Jinnah hospital, Lahore from October - December 2022. 140 diagnosed as dengue fever by Non-Structural Protein 1 (NS1) and IgM were included in the study. All the cases were subject to a thorough medical examination i.e. complete battery summary of temperature together with the serology of Dengue, X-ray of the chest, abdominal ultrasound scan, renal function test (RFT), liver function test (LFT), malarial parasite slide, complete blood count with peripheral smear etc. Accordingly, the treatment was given to them with follow-up medical evaluation including detailed investigations. Data were entered and analyzed in SPSS version. 27.0 and presented as frequency and percentages. Chi square test was used to assess statistical significance with P &lt; .05. Results: Mean age of respondent was 35.5 + 15.6 years. Co-infection rate with malaria and severe disease along with prolong duration fever and persistent thrombocytopenia among subjects was15.0%. Conclusions: Majority of co infected individuals were having severe disease, with subsequent development of disseminated intravascular coagulation and sepsis, responding well to anti-malarial treatments

Anti-gouty arthritis and anti-inflammatory effects of curcumin nanoparticles in monosodium urate crystals induced Balb/C mice.

Gout is a metabolic condition characterized by the accumulation of urate crystals in the synovial joints. These crystal depositions result in joint swelling and increased concentration of serum uric acid in blood. The commercially available drugs lower serum uric acid levels and reduce inflammation, but these standard therapies have many side effects.This study aimed to investigate anti-gout and anti-inflammatory properties of curcumin nanoparticles (CNPs). For this purpose, CNPs were prepared by dissolving curcumin into dichloromethane. Then, gout was induced by injecting monosodium urate crystals (MSU) in the ankle joint and in the intra-peritoneal cavity which caused ankle swelling and increased blood uric acid levels. CNPs in different concentrations (5, 10, and 20ppm) and allopurinol were orally administered. The MSU crystals increased the xanthine oxidase levels both in serum and the liver. Moreover, MSU crystals increased the serum levels of interleukin 1β, interleukin-6, tumor necrosis factor-alpha, liver function tests markers, renal function tests markers, and lipid profiles. However, the administration of CNPs decreased the levels of all these variables. CNPs increased the serum high-density lipoprotein and interleukin-10 levels. Moreover, CNPs also reduced ankle swelling significantly. Hence, the levels ofxanthine oxidase, uric acid and ankle swelling were reduced significantly by oral administration of CNPs. Our findingsindicate that CNPs through their anti-inflammatory properties significantly alleviate gouty arthritis. Thus, the study concluded that CNPs can be developed as an efficient anti-gout agent with minimal side effects.

An Evaluation of Anti-hyperlipidemic Activity of Ethanolic Extract of Moringa oleifera on High Fat Induced Hyperlipidemic Rat Model

Background: The art or practice of herbal remedies refers to the use of herbs and herbal treatments for the purpose of maintaining health and preventing, treating, or curing sickness. In some areas, herbal treatments can also be referred to as herbal medicine.&#x0D; Aim: The present study was designed to investigate the antihyperlipidemic and antiatherogenic potentiality of ethanolic extract of Moringa oleifera extract in high fat diet-induced hyperlipidemic rats.&#x0D; Materials and Methods: Moringa oleifera ethanolic extract was prepared using Soxhlet apparatus. Male rats were made hyperlipidemic by giving high fat diet. M. oleifera was administered in a dose of 250, 500 and 750 mg/kg.b.w./day for 30 days in high fat diet-induced hyperlipidemic rats. The SGPT, SGOT, total cholesterol,triglyceride, LDL,HDL , Urea and creatinine levels were measured after the treatment.&#x0D; Results: For both the SGPT and the SGOT, it was seen that groups 5 and 6 exhibited statistically significant (p&lt; 0.05) outcomes in the case of the SGPT. When conducting the renal function test, it was observed that the levels of creatinine and urea were statistically significant (p&lt; 0.05) in the cases of groups 4, 5, and 6. In the case of high-density lipoprotein (HDL) and low-density lipoprotein (LDL), groups 4, 5, and 6 showed statistically significant findings (p&lt; 0.05) in HDL levels, while groups 5 and 6 showed statistically significant LDL levels. The triglyceride levels in the group were found to be statistically significant (p&lt; 0.05), while the findings obtained from groups 5 and 6 were also found to be statistically significant.&#x0D; Conclusion: The study revealed that M. oleifera has anti hyperlipidemic activity.

A Study Assessing the Role of Renal Grayscale Ultrasonography and Flowmetry in Correlation With Renal Function Tests Across Various Renal Diseases.

Background Renal insufficiency, a critical concern in native and transplant kidneys, necessitates effective screening modalities for evaluation and management. Grayscale sonography has been a cornerstone in renal diagnostics, providing basic anatomical insights such as renal length, cortical thickness, and collecting system dilatation. Despite technological advancements, its impact on the differential diagnosis or management of renal disease remains limited, often showing normal findings in the presence of severe renal dysfunction. On the other hand, Doppler sonography, particularly the Doppler resistive index (RI), has shown potential in enhancing the assessment of renal dysfunction by quantifying alterations in renal blood flow and correlating with various renal pathologies and prognoses. Thus, this study aims to assess and compare the sensitivity of transabdominal and Doppler sonography as a diagnostic modality to evaluate medical renal diseases with altered renal function tests (RFTs). Methodology Participants included patients visiting the ultrasonography (USG)room at our hospital for USG of the kidneys, ureters, and bladder (USG KUB) and USG of the whole abdomen(USG W/A) with altered RFTs. Each underwent renal grayscale USG and RImeasurement, alongside standard RFTs, aiming to investigate the relationship between USG and RI findings and RFT outcomes to assess their predictive accuracy for renal function. Renal grayscale USG assessed parameters including renal dimensions, echogenicity, corticomedullary differentiation, and RI. Data management and charting were conducted with Microsoft Excel 2021 and Microsoft Word 2021. IBM SPSS Statistics for Windows, Version 24 (IBM Corp.,Armonk, NY) was utilized for data analysis. The analysis of variance (ANOVA) test examined relationships between renal parameters and RI across diagnostic groups. Furthermore, the chi-square test evaluated associations of renal ultrasound findings with RFTs and their significance. Results The study analyzed 93 patients with altered RFTs. Chronic kidney disease (CKD) affected 68 patients, primarily males in their fifth and sixth decades, showing reduced renal dimensions, increased cortical echogenicity, and elevated Doppler RI mean (RIm) with 83% sensitivity. Acute kidney injury (AKI) was found in 12 patients, mainly in their fourth decade, displaying increased renal parameters and elevated RIm with 75% sensitivity. Glomerular diseases, including nephrotic syndrome (NS) and nephritic syndrome (NeS), occurred in 9 patients, predominantly males in their fourth decade, with heightened renal cortical echogenicity and elevated RIm with 55.5% sensitivity. Lupus nephritis (LN) was detected in 4 female patients, despite normal renal parameters, showing elevated serum creatinine levels. Conclusions Doppler assessment of renal vascular waveforms effectively identifies chronic renal changes, aiding in the diagnosis of altered RFTs and guiding prognosis. While it detects typical changes like decreased size and parenchymal atrophy, it may not be as indicative of diabetic nephropathy. Key ultrasound indicators such as changes in echotexture and size, along with associated findings like ascites and effusions, help recognize altered renal function and minimize unnecessary interventions.

Thrombophilia genetic mutations and their relation to disease severity among patients with COVID-19.

Patients with COVID-19 infection appear to develop virus-induced hypercoagulability resulting in numerous thrombotic events. The aim of the present study was to determine the relationship between the thrombophilia genes mutations (prothrombin G20210A, factor V Leiden, and methyltetrahydrofolate reductase (MTHFR)) and the severity of COVID-19 patients. Prospective cross-sectional study. One hundred and forty patients (80 adults and 60 children) were included in the current study. They were divided into the severe COVID-19 group and the mild COVID-19 group, with each group comprising 40 adults and 30 children. The patients were assessed for FV R506Q, FV R2H1299R, MTHFR A1298C, MTHFR C677T, and prothrombin gene G20210A polymorphisms. CBC, D-dimer, renal and liver function tests, hs-CRP, ferritin, and LDH were also assessed. Thrombotic events were clinically and radiologically documented. Severe COVID-19 cases were significantly more frequent to have a heterozygous mutation for all the studied genes compared to mild COVID-19 cases (p<0.05 for all). Being mutant to gene FV R506Q carried the highest risk of developing a severe disease course (p<0.0001). Patients with abnormally high D-dimer levels were significantly more frequent to be heterozygous for FV R506Q, FV R2H1299R, and prothrombin gene G20210A (p = 0.006, 0.007, and 0.02, respectively). We concluded that there is an evident relationship between severe COVID-19 and inherited thrombophilia. In the current study, FV R506Q gene mutation carried the highest risk of developing a severe COVID-19 disease course.

Pediatric Cases Diagnosed with Drug-Related Acute Tubulointerstitial Nephritis: A Single-Center Experience

Aim: Acute tubulointerstitial nephritis (TIN) is inflammation of the renal interstitium. It is also a common cause of acute kidney injury (AKI). The aim is to contribute to the literature by evaluating patients diagnosed with drug-induced TIN.&#x0D; Material methods: 29 Turkish children aged between 3 and 217 months, 5 of whom had undergone a biopsy, were retrospectively analyzed in terms of clinical and laboratory findings.&#x0D; Results: 29 patients, 19 of whom were girls, were evaluated. The mean age at diagnosis was 138.6(3-217) ± 67.4 months. Nausea-vomiting complaint of 12 cases, 6 under treatment during hospitalization, 4 with headache, 2 with isolated fatigue, and the remaining 5 patients with incidentally detected renal function test disorder, oligo-anuria, urinary incontinence, red urination, and uveitis. At the time of diagnosis, 4 patients had hypertension and 26 patients had AKI. Two of these cases were anuric. The low eGFR values at the time of diagnosis were observed to improve at the end of the follow-up. Hematuria was detected in 18 cases and of them were macroscopic hematuria. 4 patients had pyuria, 19 patients had proteinuria, and 2 of them were nephrotic. FeNa was the most common abnormality of the tubular tests with 4.5%. Biopsy was performed in 5 cases. While one of the patients presented with uveitis, uveitis developed in 1 patient during the 3rd month of follow-up.&#x0D; Conclusion: Consequently, although TIN is a reversible disease, its recognition is important in terms of treatment and follow-up.

Just give the contrast? Appraisal of guidelines on intravenous iodinated contrast media use in patients with kidney disease

ObjectiveTo appraise the quality of guidelines on intravenous iodinated contrast media (ICM) use in patients with kidney disease, and to compare the recommendations among them.MethodsWe searched four literature databases, eight guideline libraries, and ten homepages of radiological societies to identify English and Chinese guidelines on intravenous ICM use in patients with kidney disease published between January 2018 and June 2023. The quality of the guidelines was assessed with the Scientific, Transparent, and Applicable Rankings (STAR) tool.ResultsTen guidelines were included, with a median STAR score of 46.0 (range 28.5–61.5). The guidelines performed well in “Recommendations” domain (31/40, 78%), while poor in “Registry” (0/20, 0%) and “Protocol” domains (0/20, 0%). Nine guidelines recommended estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2 as the cutoff for referring patients to discuss the risk-benefit balance of ICM administration. Three guidelines further suggested that patients with an eGFR < 45 mL/min/1.73 m2 and high-risk factors also need referring. Variable recommendations were seen in the acceptable time interval between renal function test and ICM administration, and that between scan and repeated scan. Nine guidelines recommended to use iso-osmolar or low-osmolar ICM, while no consensus has been reached for the dosing of ICM. Nine guidelines supported hydration after ICM use, but their protocols varied. Drugs or blood purification therapy were not recommended as preventative means.ConclusionGuidelines on intravenous ICM use in patients with kidney disease have heterogeneous quality. The scientific societies may consider joint statements on controversial recommendations for variable timing and protocols.Critical relevance statementThe heterogeneous quality of guidelines, and their controversial recommendations, leave gaps in workflow timing, dosing, and post-administration hydration protocols of contrast-enhanced CT scans for patients with kidney diseases, calling for more evidence to establish a safer and more practicable workflow.Key points• Guidelines concerning iodinated contrast media use in kidney disease patients vary.• Controversy remains in workflow timing, contrast dosing, and post-administration hydration protocols.• Investigations are encouraged to establish a safer iodinated contrast media use workflow.Graphical

Clinicopathological characteristics and predictors of outcome of rapidly progressive glomerulonephritis: a retrospective study.

Globally, there are regional and time-based variations in the prevalence, etiology, and prognosis of rapidly progressive glomerulonephritis (RPGN). Prognosis of RPGN is poor, with a higher risk of death and end stage renal disease (ESRD) even with immunosuppressive medications. In the Middle East and North Africa, the studies on this disease are very limited. Therefore, we determined the predictors of outcome of RPGN. We retrospectively assessed 101 adult patients over age of 18, diagnosed with RPGN based on renal biopsy illustrating crescents in ≥ 50% of the glomeruli. Patients who had crescents in their renal biopsies that were < 50% and those who refused to consent to a renal biopsy were excluded. We categorized the patients into 3 groups based on immunohistochemistry; type I, type II and type III. Then, depending on renal loss, we divided them into ESRD and non-ESRD groups. The clinical history and physical examination were retrieved. Additionally, 24-hour urine protein, urine analysis, renal function tests, serum albumin, complete blood count, antinuclear antibodies, anti-double stranded DNA antibodies, ANCA antibodies and serum complement levels were checked. Each patient underwent a kidney biopsy for immunohistochemistry and light microscopy. The percentage of crescentic glomeruli, number of sclerosed glomeruli, tertiary lymphoid organ (TLO), neutrophil infiltration, endocapillary or mesangial hypercellularity, interstitial fibrosis with tubular atrophy (IFTA) were analyzed. Primary outcomes (remission, ESRD and mortality) and secondary outcomes were assessed. Type II was the most frequent cause of RPGN (47.5%), followed by type III (32.7%) and type I (19.8%). 32 patients (31.7%) died during follow up, whereas 60 patients (59.4%) developed ESRD. In 41 patients (40.6%), remission occurred. Oliguria, serum creatinine, and need for HD at presentation were significantly increased in ESRD group compared to non-ESRD group (P < 0.001 for each). Mesangial proliferation, IFTA, TLO formation, sclerotic glomeruli and fibrous crescents were also significantly increased in ESRD group in comparison to non-ESRD group (P < 0.001 for each). Glomerulosclerosis (P = 0.036), and IFTA (P = 0.008) were predictors of ESRD. Infections (P = 0.02), respiratory failure (P < 0.001), and heart failure (P = 0.004) were mortality risk factors. Type II RPGN was the most common. Infection was the most frequent secondary outcome. Oliguria, glomerulosclerosis, the requirement for hemodialysis at presentation, IFTA and TLO formation were predictors of ESRD. Respiratory failure, heart failure and infections were significant predictors of mortality.

The Efficacy of On-Site Integration Screening and Microelimination Programs for Chronic Hepatitis C in a Detection Center: A Comparison of the Treatment Outcomes and Characteristics of Incarcerated Patients and Outpatients.

We aimed to analyze the different patient characteristics and treatment outcomes (such as sustained viral response, SVR) between incarcerated patients with chronic hepatitis C (CHC) and those with CHC from the outpatient department through an on-site integrated screening and microelimination program in a detection center. In this retrospective study, which ran from May 2021 to April 2022, we included 32 consenting male prisoners aged at least 20 years who were willing to participate in the study. Members of the control group (who received DAAs in an outpatient setting) were selected from the treated CHC patient databank of individuals who received DAA regimens at Chi Mei Hospital between January 2021 and December 2022. The patients in the two groups did not differ significantly in terms of age, FIB-4 score, HCV RNA, HBV coinfection, hemogram findings, coagulation profiles, and renal function tests. However, the patients in the incarcerated group had a significantly different genotype distribution compared to the control group, significantly lower liver enzyme levels, and higher albumin and bilirubin levels compared to those in the control group. The rate of SVR to DAA treatment obtained among incarcerated patients did not differ significantly from that obtained among patients in the control group. Loss to follow-up (for several reasons) is a major reason for treatment discontinuation among these patients.

Percutaneous Nephrolithotomy 500 Cases in High-Risk and Altered Renal Function Test: Our Experience at Tertiary Care Centre

Introduction The study aims to evaluate the results of percutaneous nephrolithotomy (PCNL) in high-risk patients and patients with altered renal function tests (RFT) and complications in the management of renal stones in our hospital. Methods We retrospectively analyzed the outcomes of 500 patients who underwent PCNL between September 2020 and September 2023. We have analyzed data regarding patient details, investigations, PCNL puncture site, operative duration, number of punctures, stone-free rates (SFRs), duration of hospital stay, and complications. Results Out of 500 patients, 384 (76.87%) were males and 116 (23.13%) were females, with a male-to-female ratio of 3.32:1. The average age was 40.8±10.4 (mean±SD) (range: 24 to 74-years). The average operative time was 127±37 min (mean±standard deviation (SD)). The radiation exposure was from 1 min 30 sec to 3 min, with a mean (±SD) of 30 sec. The mean duration of the hospital stay was 2.7±1.6 days. Complete stone clearance was 87%, whereas SFRs defined by no identifiable stone on a plain radiograph or ultrasound or residual fragments &lt;5 mm were 90.93%. The complication rate was 2.2%. Conclusion The usual course of treatment for renal stones larger than 2 cm is PCNL. Significant factors influencing the stone-free rate include stone burden, stone type, PCNL puncture, number of punctures, and operative time. With the development of several lithotripsy procedures and the miniaturization of instruments, PCNL continues to be an excellent therapeutic option for patients with large renal stones, comorbidities, and changed RFT, with tolerable rates of complications.

Renal function in pediatric urologic surgical patients: Insight from the National Surgical Quality Improvement Program—Pediatric cohort

Abstract Background Renal protection is a frequent indication for urological surgery in pediatric patients; however, preoperative assessment is not routinely performed. We assessed the rates of preoperative renal function testing and stratified outcomes after major pediatric urological surgery. Pediatric urology patients, specifically high-risk patients undergoing genitourinary surgeries, are likely to have an underdiagnosis of renal dysfunction after surgery. Materials and methods Cases were identified from the 2012 to 2019 National Surgical Quality Improvement Program—Pediatric database. Patients who underwent major urological surgery on an inpatient basis were included in this study. Abnormal renal function was defined as a creatinine (Cr) level of ≥0.5 mg/dL (younger than 2 years) and a glomerular filtration rate of &lt;90 mL/min (2 years or older). Glomerular filtration rate was calculated using the bedside Schwartz equation (2 years or older): estimated glomerular filtration rate = 0.413 × (height/Cr). Results A total of 17,315 patients were included, of whom 3792 (21.9%) had documented Cr values. Based on the defined criteria, abnormal renal function was found in 7.3% of infants (younger than 2 years), 33.6% of children (2–9 years), and 52.5% of adolescents (10–18 years). Patients with abnormal preoperative renal function values were significantly (p &lt; 0.001) more likely to experience readmission (10.2% vs. 5.8%), reoperation (3.7% vs. 1.6%), surgical organ/space infection (0.9% vs. 0.4%), transfusion (1.5% vs. 0.6%), renal insufficiency (1.6% vs. 0.4%), or urinary tract infection (5.1% vs. 3.6%). Conclusions In this pediatric population, 21.9% of the patients had documented preoperative Cr values before major urological surgery. Patients with documented abnormal preoperative renal function tests experienced higher complication rates. These patients have higher rates of progressive renal insufficiency and acute renal failure than those with normal renal function. The introduction of a standardized and unbiased risk assessment tool has the potential to offer patients benefits by pinpointing individuals with a heightened risk of complications. Further investigation is necessary to enhance the precise categorization of at-risk patients.

Role of point of care ultrasound and parathormone hormone in management of acute kidney injury in emergency department

ABSTRACT Background Role of point of care ultrasound in management of acute kidney injury (AKI) is still unclear. The discrimination between AKI and chronic kidney disease (CKD) in ED, especially in the absence of clear CKD history, represents a dilemma. Aim To test the accuracy of POCUS and intact parathormone hormone (iPTH) as differentiators between AKI and CKD, and to investigate the role of POCUS in management of AKI in the ED. Methods This prospective study involved 95 adult patients presented to ED of Alexandria Main University Hospital, with signs and/or symptoms suggesting renal impairment in the absence of prior renal functions tests from April 2022 to December 2022. POCUS was done and iPTH was measured for all enrolled patients. Validity of renal length and iPTH to discriminate AKI and CKD were tested. POCUS were used to identify different underlying causes of AKI. Results Renal length ≤ 9.62 cm could diagnose CKD (Area under curve-AUC 0.926) with 82.46% sensitivity, 92.11% specificity, 94.0% PPV and 77.8% NPV. Intact PTH level > 161 pg/ml could diagnose CKD (AUC 0.844) with 73.17% sensitivity, 92.11% specificity, 90.9% PPV and 76.1% NPV. Conclusion Both renal length and iPTH are accurate tests to differentiate AKI from CKD in ED. POCUS help identifying the different causes of AKI and reaching appropriate management decisions.

Analysis of the Relationship of Serum Ferritin, Urate, and Some Hematological Parameters with Disease Activity in Gout Patients

Background and objectives: Gout is a type of arthritis. Acute gout is a common rheumatological disease that mostly affects first metatarsopharyngeal joint. Chronic gout is the condition that characterized by repeated episodes of acute gout. The objective of this study was to further explore the relationship between iron, ferritin, and other hematological markers with serum urate and gout. Methods: This cross sectional study was conducted in the Department of Rheumatology of Rizgary Teaching Hospital, Erbil, and Northern Iraqi Kurdistan. A total of 85 cases were enrolled in this study, 76 males and 9 females. There mean age (SD) was 46.6 (±11.2) years. All participants were known to have gout and fulfilled the criteria for diagnosis of gout. Serum ferritin, C-reactive protein, Serum iron, total iron binding capacity, and serum urate level were measured in addition to renal function tests and liver function tests were measured. Results: The mean (SD) for urate was 9.04 (±1.16) mg/dL, 76 (89.4%) patients with high serum uric acid had high level of ferritin in the blood meanwhile; 9 patients have normal ferritin level. There was a significant positive correlation (76 out of 85 patients) between serum ferritin level and serum urate (p&lt;0.005 and rho=0.237). A positive correlation was found between C reactive protein and urate level, in contrast there was no correlation of iron level and urate level. Conclusion: The ferritin and C reactive protein levels were significantly high among gouty patients.

Potential Nephrotoxicity of Combination of Vancomycin and Piperacillin-Tazobactam: Recommendations from the AG ABS of the DGPI supported by experts of the GPN

The combination of vancomycin and piperacillin/tazobactam (V+P/T) is used for empirical antibiotic treatment of severe infections, especially in immunocompromised patients and those colonized with multidrug-resistant bacteria. Nephrotoxicity is a frequently observed adverse effect of vancomycin. Its risk can be reduced by therapeutic drug monitoring and adjusted dosing. Piperacillin/tazobactam (P/T) rarely causes interstitial nephritis. The results of retrospective cohort studies in children predominantly show a low, clinically irrelevant, additive nephrotoxicity (defined as an increase in creatinine in the serum) of both substances. Due to the limitations of the existing publications, the ABS working group of the DGPI and experts of the GPN do not recommend against the use of P/T plus vancomycin. Preclinical studies and a prospective study with adult patients, which evaluated different renal function tests as well as clinical outcomes, do not support previous findings of additive nephrotoxicity. Time-restricted use of V+P/T can minimize exposure and the potential risk of nephrotoxicity. Local guidelines, developed in collaboration with the antibiotic stewardship team, should define the indications for empirical and targeted use of P/T and V+P/T. When using combination therapy with V+P/T, kidney function should be monitored through clinical parameters (volume status, balancing, blood pressure) as well as additional laboratory tests such as serum creatinine and cystatin C.

THE ADVERSE DRUG REACTIONS OF INTERMITTENT AND DAILY REGIMENS IN THE TREATMENT OF THE INTENSIVE PHASE OF TUBERCULOSIS

Objective: To study the adverse drug reactions (ADRs) of intermittent and daily anti-tubercular therapy in intensive phase (IP), in patients attending the RNTCP unit, Government Medical College (GMC), Thrissur. Methods: A prospective observational study was done at the RNTCP unit, GMC, Thrissur, during October 2016-2017. Two hundred and thirty-five patients satisfying inclusion criteria, receiving anti-tubercular therapy as intermittent and daily regimens were selected. Demographic data, risk factors, comorbidities, and investigations were recorded and patients were followed up for IP. Results of investigations, treatment outcome, and ADRs recorded after IP. ADRs were monitored and its causality and severity were assessed. Data were entered in MS Excel and analyzed using SPSS. Qualitative variables are represented as proportions and quantitative as mean and standard deviation. Associations were analyzed using appropriate statistical tests. Analysis was performed using paired t-test p&lt;0.05 taken as significant. Results: Orange-red urine and secretions were the most common ADR, followed by nausea, fatigue, heartburn, etc. Significant increase in random blood sugar, renal function tests (RFTs), and liver function tests (LFT) after treatment, then before noticed. 84.4% of patients from the daily group and 78% of patients from the intermittent group experienced ADRs. Causality was assessed using Naranjo’s algorithm and severity using a modified Hartwig and Siegel scale. Conclusion: The majority of patients developed ADRs, which were mild and managed symptomatically. Some reactions required alteration of therapy, reduction of drug dose, or change of suspected drug. To conclude, meticulous monitoring of ADRs in patients on anti-tubercular drugs is mandatory.

COMPARATIVE STUDY OF INTRAVENOUS PARACETAMOL AND INTRAVENOUS DICLOFENAC ANALGESIA WITH RESPECT TO EFFECT ON RENAL FUNCTION, BLEEDING TIME, AND CLOTTING TIME IN POST-OPERATIVE CASES UNDERGOING LSCS UNDER SPINAL ANESTHESIA

Objectives: The aims and objectives of the study are to compare paracetamol and diclofenac for post-operative analgesia, efficacy, and safety profiles in patients undergoing LSCS under spinal anesthesia. Methods: Fifty-eight patients undergoing LSCS under spinal anesthesia were included in this study. Out of these 58 patients, 30 patients received paracetamol (Group P) and the remaining 28 patients received diclofenac (Group D). Post-operative pain was assessed using the Visual Analog Scale. Rescue analgesic used was buprenorphine intravenous at a dose of 1 mg/kg. Injection buprenorphine was given to the patient with a VAS score of more than three in addition to the routine dose of the study drug. Pre-operative and post-operative values of blood urea, serum creatinine, bleeding time, and clotting time were compared in both groups. p&lt;0.05 were taken as statistically significant. Results: The mean age of patients in both groups was found to be comparable with no statistically significant difference (p=0.3849). In post-operative period at 150, 180 min, and 210 min, Group P reported significantly higher pain scores as compared to Group D with p-values indicating statistical significance (p&lt;0.05). The analysis of pre- and post-operative renal function tests, bleeding time, and clotting time showed that there was no significant difference in the pre- and post-operative renal function tests, bleeding time, and clotting time of the patients in Group P and Group D. Conclusion: Intravenous diclofenac is found to have a superior analgesic effect as compared to intravenous paracetamol. Both paracetamol and diclofenac were found to have no significant side effects on renal functions, bleeding time, or clotting time.

Diagnostic accuracy of computed tomography brain perfusion in the prediction of acute ischemic stroke taking the findings of MRI as gold standard.

Objectives: To determine the diagnostic accuracy of computed tomography brain perfusion to predict acute ischemic stroke taking the findings of MRI as gold standard. Study Design: Cross-sectional Validation study. Setting: Department of Radiology Allied Hospital Faisalabad. Period: 20th May 2022 to 19th November 2022. Material &amp; Methods: A total of 215 individuals, aged between 30 and 70, of both sexes, and exhibiting ischemic stroke symptoms lasting no more than 12 hours, were included. Patients with abnormal renal function tests having renal disease were excluded. The conventional non-contrast CT used in the CT stroke protocol had basal sections that were either 3 mm or 4 mm in thickness and supra tentorial sections that were either 3 mm or 4 mm in thickness. The acquisition parameters were 80kVp and 120mAs. Dynamic CT perfusion was carried out with 4 cm plane coverage. At the seventh day, all patients underwent a follow-up MRI using a 1.5 Tesla Philips MRI scanner. A radiologist examined CTP to look for signs of early ischemic changes. For CT perfusion (CTP), measurements were taken for time to peak (TTP), cerebral blood flow (CBF), and cerebral blood volume (CBV). Results: Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of computed tomography brain perfusion in the prediction of acute ischemic stroke taking the findings of MRI as gold standard was 85.37%, 76.09%, 82.68%, 79.55% and 81.40% respectively. Conclusion: This study led to the conclusion that diagnostic accuracy of computed tomography brain perfusion to predict acute ischemic stroke is quite high.