Renal Function Tests Research Articles

Can CT or MRI volumetry substitute scintigraphy in living kidney donor evaluation? A systematic review

BackgroundCurrent potential living kidney donor’s assessment includes functional and anatomical evaluation. Scintigraphy is recommended in some cases and some centers include this test in the donor’s protocol. Recent studies advocate for the avoidance of this test as CT or MRI volumetry showed to accurately assess donor’s renal function.ObjectiveTo summarize scientific evidence on image tests for pre-donation and/or post-nephrectomy renal function evaluation.Evidence acquisitionThis review followed the guidelines set by the European Association of Urology and adhered to PRISMA 2020 recommendations. The protocol was registered in PROSPERO on 10th December 2022 (ID: CRD42022379273).Evidence synthesisTwenty-one studies met the inclusion criteria after thorough screening and eligibility assessment. According to QUADAS-2, patient selection and flow/timing domains showed a predominant low risk of bias.The correlation between split renal function (SRF) using CT and scintigraphy varied from weak (r = 0.21) to remarkably strong (r = 0.949). Bland–Altman agreement demonstrated moderate to excellent results, with mean differences ranging from -0.06% to 1.76%. The correlation between split renal volume (CT) and estimated glomerular filtration rate (eGFR) at 6 months or 1 year after nephrectomy showed a moderate correlation, with coefficients ranging from 0.708 to 0.83.The correlation between SRF (MRI) and renal scintigraphy reported a moderate correlation, with correlation coefficients of 0.58 and 0.84. MRI and scintigraphy displayed a good agreement, with a 66% agreement observed and mean differences of ± 0.3%.ConclusionsDespite study heterogeneity, MRI or CT-based renal volumetry appears promising compared to scintigraphy, with favorable correlations and agreement.

Transforming growth factor-β1: relation between its single-nucleotide genetic variants and sickle cell nephropathy

BackgroundSickle cell nephropathy is a complication of sickle cell disease characterized by functional abnormalities of the kidney and glomeruli. Our study aimed to investigate the single-nucleotide genetic variants in TGF-β-1-related genes as an early predictor of sickle cell nephropathy (SCN) risk.MethodsTwo hundred participants, 100 patients with SCD, and 100 age and sex-matched control. The study included full history taking, clinical examination, and laboratory evaluation. Renal function tests (serum urea and creatinine, microalbuminuria, albumin/ creatinine ratio, and e-GFR). Genotyping for TGF-β1 genetic variants rs1800469 and rs1800471.ResultsTwenty-one percent of patients had glomerular hyperfiltration, while 31% had reduced e-GFR. Microalbuminuria was present in 14%, and none had macroalbuminuria or edema. TGF-β1 genotyping revealed a statistically significant difference in the rs 1800471 C allele, which was more common in the control group (p 0.028). No significant correlation between the result of TGF‐ β genotyping and the albumin-to-creatinine ratio, creatinine, and e-GFR.ConclusionTGF-β1 rs1800469 and rs1800471 genetic variants were not associated with the risk of sickle nephropathy in children with sickle cell disease.

Electroacupuncture for slow flow/no-reflow phenomenon in patients with acute myocardial infarction undergoing percutaneous coronary intervention: protocol for a pilot randomized controlled trial.

Slow flow/no-reflow (SF-NR) during percutaneous coronary intervention (PCI) is associated with poor prognosis of patients with acute myocardial infarction (AMI). Currently, effective treatment is not available for SF-NR. Electroacupuncture (EA) has shown significant efficacy as an adjuvant therapy for many cardiovascular diseases by improving microcirculation and reducing ischemia-reperfusion injury. However, its effects on SF-NR in the AMI patients during PCI are not clear. This pilot trial aims to determine the efficacy of intraoperative EA in alleviating SF-NR in AMI patients undergoing PCI. This prospective, single-center, randomized controlled, pilot trial will recruit 60 AMI patients scheduled for PCI at the Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, China. The patients will be randomized in a 1:1 ratio into the EA or the control groups. Patients in the control group will undergo standard PCI. Patients in the EA group will undergo intraoperative electroacupuncture while undergoing standard PCI. Incidence of SF-NR is the primary outcome for this study. This study will also assess secondary outcomes including cardiac biomarkers, inflammatory biomarkers, pain and anxiety scores, electrocardiography parameters, traditional Chinese medicine (TCM) symptom score, and major adverse cardiovascular and cerebrovascular events (MACCE). All the included patients will undergo laboratory tests including routine blood tests, levels of electrolytes, as well as liver and renal function tests. Patients will be followed up for 1 month after the procedure. This pilot trial will provide evidence for the potential benefits of intraoperative EA in improving microvascular perfusion and preventing or alleviating SF-NR during PCI in patients with AMI. If proven effective, intraoperative EA will provide a new and effective strategy against SF-NR and provide evidence for subsequent multicenter trials. ClinicalTrials.gov, identifier (ChiCTR2300072265). Registered on 8 June 2023.

Alirocumab boosts antioxidant status and halts inflammation in rat model of sepsis-induced nephrotoxicity via modulation of Nrf2/HO-1, PCSK9/HMGB1/NF-ᴋB/NLRP3 and Fractalkine/CX3CR1 hubs

Acute kidney injury (AKI) is a devastating consequence of sepsis, accompanied by high mortality rates. It was suggested that inflammatory pathways are closely linked to the pathogenesis of lipopolysaccharide (LPS)-induced AKI. Inflammatory signaling, including PCSK9, HMGB1/RAGE/TLR4/MYD88/NF-κB, NLRP3/caspase-1 and Fractalkine/CX3CR1 are considered major forerunners in this link. Alirocumab, PCSK9 inhibitor, with remarkable anti-inflammatory features. Accordingly, this study aimed to elucidate the antibacterial effect of alirocumab against E. coli in vitro. Additionally, evaluation of the potential nephroprotective effects of alirocumab against LPS-induced AKI in rats, highlighting the potential underlying mechanisms involved in these beneficial actions. Thirty-six adult male Wistar rats were assorted into three groups (n=12). Group I; was a normal control group, whereas sepsis-mediated AKI was induced in groups II and III through single-dose intraperitoneal injection of LPS on day 16. In group III, animals were given alirocumab. The results revealed that LPS-induced AKI was mitigated by alirocumab, evidenced by amelioration in renal function tests (creatinine, cystatin C, KIM-1, and NGAL); oxidative stress biomarkers (Nrf2, HO-1, TAC, and MDA); apoptotic markers and renal histopathological findings. Besides, alirocumab pronouncedly hindered LPS-mediated inflammatory response, confirmed by diminishing HMGB1, TNF-α, IL-1β, and caspase-1 contents; the gene expression of PCSK9, RAGE, NF-ᴋB and Fractalkine/CX3CR1, along with mRNA expression of TLR4, MYD88, and NLRP3. Regarding the antibacterial actions, results showed that alirocumab displayed potential anti-bacterial activity against pathogenic gram-negative E. coli. In conclusion, alirocumab elicited nephroprotective activities against LPS-induced AKI via modulation of Nrf2/HO-1, PCSK9, HMGB1/RAGE/TLR4/MYD88/NF-ᴋB/NLRP3/Caspase-1, Fractalkine/CX3R1 and apoptotic axes.

An incidental finding of a hemoglobin E variant in a diabetic patient with an abnormal glycated hemoglobin level: a case report

BackgroundGlycated hemoglobin is a well-known marker for evaluating long-term glycemic control. However, the accuracy of glycated hemoglobin measurement can be affected by the presence of hemoglobin variants, which makes the determination and interpretation of glycated hemoglobin values in terms of glycemic control not only difficult but also misleading. Here we present the first ever case of a patient with type 2 diabetes with hemoglobin E from Nepal, diagnosed incidentally because of spurious glycated hemoglobin levels.Case presentationA 45-year-old Hindu Mongolian female with a history of type 2 diabetes for around 9 years but not very compliant with follow-ups was referred to our facility for plasma fasting and postprandial blood glucose levels and glycated hemoglobin. Fasting and postprandial blood sugars were found to be high. A consistent very low glycated hemoglobin by two different high-performance liquid chromatography (HPLC) methods compelled us to call the patient for a detailed clinical history and for the records of investigations done in the past. The patient has been a known case of type 2 diabetes for around 9 years and presented irregularly for follow-up visits. Around 4 years ago, she presented to a healthcare facility with fatigue, severe headaches, pain in the abdomen, discomfort, and dizziness for a couple of months, where she was shown to have high blood glucose. She was referred to a tertiary-level hospital in Kathmandu, where she was prescribed metformin 500 mg once daily (OD). Due to her abnormal hemoglobin A1c reports, she was then sent to the National Public Health Laboratory for repeat investigations. Her blood and urine investigations were sent. Complete blood count findings revealed high red blood cell and white blood cell counts, a low mean corpuscular volume, and a high red cell distribution width-coefficient of variation. Other parameters, including serum electrolytes, renal function tests, liver function tests, and urine routine examinations, were within normal limits. A peripheral blood smear revealed microcytic hypochromic red cells with some target cells. Hemoglobin electrophoresis showed a very high percentage of hemoglobin E, a very low percentage of hemoglobin A2, and normal proportions of hemoglobin A and hemoglobin F. A diagnosis of homozygous hemoglobin E was made, and family screening was advised.ConclusionsClinicians should be aware of the limitations of glycated hemoglobin estimation by ion exchange high-performance liquid chromatography in patients with hemoglobin E and other hemoglobin variants. If the clinical impression and glycated hemoglobin test results do not match, glycated hemoglobin values should be determined with a second method based on a different principle, and glycemic status should be confirmed through alternative investigations, preferably those that are not influenced by the presence of hemoglobin variants (for example, boronate affinity chromatography, fructosamine test, glycated albumin test, the oral glucose tolerance test, continuous glucose monitoring, etc.). Consistent or even doubtful results should also raise the suspicion of a hemoglobin variant, which should be confirmed through further evaluation and investigations.

Effect of Fluid Therapy on Acid-Base Balance in Patients Undergoing Clipping for Ruptured Intracranial Aneurysm: A Prospective Randomized Controlled Trial.

Objectives Neurosurgical patients often receive 0.9% normal saline (NS) during the perioperative period. Theoretically, a balanced salt solution (BSS) is better than 0.9% saline. We compared the effects of two different fluids on acid-base balance, renal function, and neurological outcome in patients who underwent clipping following subarachnoid hemorrhage from a ruptured intracranial aneurysm. Materials and Methods Patients in group NS ( n = 30) received 0.9% saline and group BSS ( N = 30) received BSS (Plasmalyte-A) in the perioperative period for 48 hours. Comparison of arterial pH, bicarbonate, and base deficit measured preoperatively, intraoperatively (first and second hour), and postoperatively (at 24 and 48 hours) was the primary outcome of the study. The secondary outcome compared serum electrolytes, renal function tests, urine neutrophil gelatinase-associated lipocalin (NGAL), serum cystatin C, and the neurological outcome using modified Rankin score (MRS) at discharge, 1, and 3 months. Results In group NS, significantly low pH at 1-hour intraoperative period was seen compared with group BSS (7.37 ± 0.06 vs. 7.40 ± 0.05, p = 0.024). The bicarbonate level in group NS was significantly lower and the base deficit was higher at second intraoperative hour (bicarbonate: 17.49 vs. 21.99 mEq/L, p = 0.001; base deficit: 6.41 mmol/L vs. 1.89 mmol/L, p = 0.003) and at 24 hours post-surgery (bicarbonate: 20.38 vs. 21.96 mEq/L, p = 0.012; base deficit: 3.56 mmol/L vs. 2.12 mmol/L, p = 0.034)). Serum creatinine was higher in group NS at 24 hours (0.66 vs. 0.52 mg/dL, p = 0.013) and 48 hours (0.62 vs. 0.53 mg/dL, p = 0.047). Serum urea, electrolytes, cystatin, urine NGAL, and MRS were comparable. Conclusion In neurosurgical patients undergoing clipping for ruptured intracranial aneurysm, using a BSS during the perioperative period is associated with a better acid-base and renal profile. However, the biomarkers of kidney injury and long-term outcomes were comparable.

Assessment of Renal Function Test and Estimated Glomerular Filtration Rate in Subclinical Hypothyroidism

Assessment of Renal Function Test and Estimated Glomerular Filtration Rate in Subclinical Hypothyroidism

Comparison of Hepatic and Renal Functions during Intraoperative Sedation with Remimazolam in Elderly Patients under Intrathecal Anesthesia

Background: Remimazolam mesylate for injection (RM) is a new benzodiazepine sedative drug. The aim of this trial was to evaluate the effects of drug metabolism on patients’ hepatic and renal functions by comparing liver and renal function laboratory tests 24 hours before and 24 hours after surgery when using Remimazolam mesylate for injection (RM) for intraoperative sedation. Methods: 40 surgical patients who underwent prostate electrocision under elective intrathecal anesthesia were included in this trial. Changes in the patients’ perioperative hepatic and renal function indexes were analyzed using paired t-tests to assess the safety of Remimazolam mesylate for injection (RM) used for sedation in elderly patients under intrathecal anesthesia. Results: The patients’ preoperative 24-hour ALT (u/L) was 18.10 ± 4.97; the postoperative 24-hour ALT (u/L) was 18.08 ± 5.72; P = 0.975. The preoperative 24-hour AST (u/L) was 18.83 ± 4.89; the postoperative 24-hour AST (u/L) was 19.73 ± 4.91; P = 0.358. The preoperative 24-hour TBil (μmol/L) was 10.34 ± 6.16; the postoperative 24-hour TBil (μmol/L) was 12.03 ± 5.25; P = 0.008. The preoperative 24-hour sCr (μmol/L) was 79.43 ± 26.31; the postoperative 24-hour sCr (μmol/L) was 71.80 ± 22.93; P = 0.001. The preoperative 24-hour BUN (mmol/L) was 5.85 ± 1.75; the postoperative 24-hour BUN (mmol/L) was 4.83 ± 1.71; P < 0.001. The preoperative 24-hour GFR (ml/min) was 82.73 ± 29.88; the postoperative 24-hour GFR (ml/min) was 125.23 ± 60.02; P < 0.001. Important vital signs of the patients during the trial were stable, and laboratory tests of liver and renal function showed no abnormal changes of clinical significance. Conclusion: The intraoperative vital signs of the patients were stable, and no significant adverse reactions were observed in liver and kidney functions when Remimazolam mesylate for injection (RM) was used for intrathecal anesthesia-assisted sedation in elderly patients.

Experimental animal research on the subchronic toxicity of “Dứa Tre Lão Nhà Quê” extract

“Dứa tre Lão nhà quê” extract (DTLNQ extract) was intended to treat several diseases such as dyslipidemia and venous insufficiency. To provide information on the its safety, this study evaluated the subchronic toxicity of DTLNQ extract. Wistar rats were divided into three groups and were given orally for 12 weeks: group 1 distilled water; group 2 and group 3: DTLNQ extract at 0.6g and 1.8g/kg b.w./day, respectively. General conditions and body weight change, hematological and biochemical parameters, and hepatic and renal histological examinations were evaluated in treated rats compared with the control group and baseline. The results showed that DTLNQ extract did not cause significant changes in general conditions, body weight gain, hematological parameters, biochemical parameters of hepatic and renal function tests and the histological examination of the liver and kidneys. Though the values of AST and ALT increased after 12 weeks of administration compared with the control group and baseline, they were within the normal limits or slightly greater than the upper limit of normal in rats.

Fibromuscular Dysplasia: Renal Artery Dissection and Infarction in a Young Male

Fibromuscular dysplasia is an abnormal cell growth of the arterial wall that usually affects the renal and carotid arteries. It may lead to stenosis, tortuosity, aneurysm, or dissection of the artery and can potentially compromise the circulation from ensuing total occlusion and infarction of the recipient area. We report a case of a young male who presented with severe acute abdominal pain in the right side of the abdomen associated with nausea, vomiting, and constipation. Computed tomography of the abdomen with intravenous contrast showed acute renal infarction of a focal area at the lower pole of the right kidney, subsequent computed angiography showed dissection of a segmental branch of the right renal artery associated with fibromuscular dysplasia and beading appearance of the right renal artery. The renal function test and urinalysis were both normal. The patient was treated with unfractionated heparin infusion, with the resolution of abdominal pain, he was subsequently discharged home uneventfully on oral aspirin.

The Acute Coronary Syndrome Risk in Medically Managed Subjects with Type 2 Diabetes Mellitus - Is the ASCVD Risk Score Failing Here?

Type 2 Diabetics have elevated risk for acute coronary syndrome (ACS). The current management algorithm focuses on atherosclerotic cardiovascular (ASCVD) risk score to stratify this risk. However, in medically managed subjects, this algorithm may not be accurate. This study compares the ASCVD risk score in an Indian population with T2DM under medical supervision and the actual incidence of ACS. It also compared the ASCVD risk scores in cases with T2DM who developed ACS to controls and tried to estimate whether the ASCVD risk score is different in the two subsets, evaluating the utility of the ASCVD risk score in predicting ACS. This is an electronic medical record (EMR) based case-control study. Only records of subjects with T2DM where details of age, sex, body mass index, blood pressure, duration of diabetes, family history of ACS, lipid profile, renal and liver function tests were included. The incidence of ACS was calculated in the selected records, and the records of subjects with ACS were compared with age and sex-matched subjects without ACS. Data are summarized as median and interquartile range (IQR). Wilcoxon rank-sum test was used for checking differences in continuous variables and Pearson's Chi-squared test for categorical data. Univariate and multivariate logistic regression analyses were used to check the effect of ASCVD scores and other variables on the occurrence of ACS.Statistical data analyses were performed using JASP, version 0.16.4 (JASP Team [2022]) for MS Windows. Of the 1226 EMRs included in the analysis, 207 had ACS. The actual incidence of ACS was 16.85% in 6 years, higher than the mean predicted 10-year incidence of 14.56 percent (p <0.05). The cases were age and sex-matched with controls and the ASCVD incidence was estimated in the two groups. The mean ASCVD score in the cases was 14.565 ± 8.709 (Min: 1.5, Max: 38.3) and controls 13.114 ± 8.247 (Min: 1.4, Max: 45). The chance of development of ACS increases with elevated systolic blood pressure (per mmHg rise OR: 1.04, 95% CI: 1.03, 1.06; p <0.001), positive family history (OR: 5.70, 95% CI: 3.41, 9.77; p <0.001), statin use (OR: 2.26, 95% CI: 1.46, 3.52; p <0.001), and longer duration of diabetes (for every year increase OR: 1.19, 95% CI: 1.13, 1.25; p <0.001). The ASCVD risk score underestimates the ACS risk in subjects with T2DM under medical supervision and may not differ in those who developed and did not develop ACS. We also conclude that factors like a negative family history (30% less risk), longer duration of diabetes, and higher SBP are relevant in those who developed ACS.

#2418 Effects of correction of acidosis on body composition and biochemical parameters in CKD patients on maintenance hemodialysis

Abstract Background and Aims Metabolic acidosis is a common problem in patients of chronic kidney disease and patients on maintenance hemodialysis. In resource poor countries, due to financial constraints frequency of dialysis and compliance to medication is adversely affected. This leads to worsening of clinical condition of patient and requirement of in hospital care, many times intensive care, further increasing cost of treatment. Metabolic acidosis has implications on bone and muscle health. Aim of our study was to assess the changes in body composition (fat percentage and lean body mass), changes in third space fluid, biochemical parameters, number of admissions and requirement of blood transfusions before and after correction of metabolic acidosis. Method This was a prospective, observational study. 25 patients on maintenance hemodialysis at our center were included in the study. Bio-impedance analysis (BIA), biochemical parameters (Complete blood counts, renal function tests, serum calcium and phosphorous, liver function tests, Blood gas analysis) were done at baseline before starting bicarbonate supplementation. Number of admissions and blood transfusions in 3 months prior to initiation of bicarbonate supplementation were noted. The oral bicarbonate supplementation was increased from baseline, based on the baseline blood gas analysis. The same parameters were assessed after 3 months and analyzed. Results At the end of 3 months we observed that there was significant reduction (p &amp;lt; 0.05) in total leucocyte counts (mean 8100/cumm to 6800/cumm), urea (mean 113.7 mg/dL to 83.72 ng/dL), creatinine (mean 7.87 mg/dL to 6.68 mg/dL), phosphorous (mean 5.18 mg/dL to 4.43 mg/dL), SGOT (mean 56.52 IU to 25.2 IU) and SGPT (mean 46.48 IU to 22.88 IU) with a trend of decrease (p ≤ 0.1) in percentage of extra cellular water (27.31% to 25.03%), lean body mass (44.27 kg to 43.0 kg) and trend of increase (p ≤ 0.1) in body fat composition (15.62 kg to 18.82 kg) and body fat percentage (26.924% to 31.90). There was a reduction in third space fluid (0.88 lit to 0.43 lit). The number of hospitalizations reduced (15 three months prior to initiation of therapy to 7 after initiation of therapy) and number of blood transfusions required also reduced (21 before initiation to 10 after initiation of therapy). Conclusion We concluded that correction of acidosis probably reduces the inflammation in patients of CKD on maintenance hemodialysis. This could be seen from the reduced total leucocyte counts, liver enzymes, urea and creatinine values. Changes in body composition with increased total fat mass, fat percentage and decreased lean mass was also noted. There was also a significant reduction in hospitalizations and number of blood transfusions.

#2624 Point of care creatinine for early detection of community acquired acute kidney injury in a primary health care centre in Nigeria

Abstract Background and Aims Community acquired Acute kidney injury (AKI) and leads to poor outcomes in low and middle-income countries due to delayed diagnosis however its epidemiology is poorly studied due to lack of biochemical diagnosis. Supported by the International Society of Nephrology, we evaluated the accuracy of point of care creatinine (POC Cr) technology using capillary samples [1] and its use implementing a clinical algorithm to select patients at risk of AKI for POC Cr testing in the Hospital Emergency Department in Port Harcourt in Nigeria. In this phase of the project POC Cr was used in a large primary care health centre for early detection and management of community acquired AKI. Method The study is conducted in Ozuoba Model Comprehensive Primary Health Care Centre. The centre has 4148 patient attendances per month (20.3% medical, 18.8% obstetrics and 60.8% paediatrics) with 11.1% considered acute requiring short admission at the centre usually for intravenous fluids. Historically, decision making is based largely on clinical judgement and renal function tests when requested from external laboratories are reported in &amp;gt; 48 hours. During this project POC Cr was offered on high-risk patients based on the clinical algorithm from the previous stage (Fig. 1) and patients with detected AKI were offered short admission for intravenous fluids and antibiotics. Results To date 54 patients have been screened with POC Cr. Median age is 25.5 years, minimum 2 months, maximum 85 years, interquartile range (48-10), 62% are females, 57% presented with malaria diagnosis and 9% with gastroenteritis. Mean (standard deviation) of POC Cr was 105 (54) µmol/L. There were 5 cases (9%) of AKI (Cr &amp;gt;150 µmol) detected in patients aged 5 months, 13 months, 7 years, 19 years and 31 years. All were treated with short admission and intravenous fluids and were discharged after clinical improvement. Knowledge of the presence of AKI altered management in all patients prompting short admission. Conclusion Community acquired AKI is common in young patients with malaria and early biochemical diagnosis can improve outcomes. The study continues to recruit and aims to investigate the characteristics of community acquired AKI in Africa and to contribute to the design of optimal and sustainable pathway for early detection and management of AKI.

CHANGES IN METABOLIC AND RENAL SYSTEM AFTER HCV CLEARANCE IN CHRONIC VIRAL HEPATITIS PATIENTS TREATED WITH DIRECT-ACTING ANTIVIRALS

Chronic hepatitis C infection is associated with metabolic and renal abnormalities, with direct antiviral agents (DAAs) offering a promising treatment approach. However, the influence of hepatitis C virus (HCV) clearance on metabolic and renal parameters in these patients remains underexplored. Objective: This study aimed to assess the impact of HCV clearance on the metabolic and renal system of chronic hepatitis C patients treated with direct antiviral agents. Methods: A prospective study was conducted at the Department of Medicine, Shifa Hospital, Islamabad, from January 2022 to January 2024. A total of 323 patients with chronic hepatitis C treated with DAAs were included. Hepatic and renal function tests were recorded before treatment, post-treatment, and 6-month follow-up. Insulin resistance (IR) and B-cell function were evaluated using the homeostatic model assessment (HOMA). All patients received DAAs treatment, with or without ribavirin. Statistical analysis was performed using appropriate methods. Results: Following HCV clearance, both groups exhibited a significant decrease in fasting glucose and insulin levels and improvements in HOMA-IR values. Additionally, decreased creatinine levels and increased glomerular filtration rate (GFR) indicated enhanced renal function. Sustained virologic response (SVR) emerged as an independent predictor of improvement in GFR and HOMA-IR. Conclusion: HCV clearance in chronic hepatitis C infection, achieved through treatment with direct antiviral agents, leads to notable improvements in renal and metabolic parameters. These findings underscore the importance of achieving SVR in managing chronic hepatitis C.

Trends and predictors of changes in renal function after radical nephrectomy for renal tumours

BackgroundChronic kidney disease (CKD) is a common postoperative complication in patients who undergo radical nephrectomy for renal tumours. However, the factors influencing long-term renal function require further investigation.ObjectiveThis study was designed to investigate the trends in renal function changes and risk factors for renal function deterioration in renal tumour patients after radical nephrectomy.MethodsWe monitored changes in renal function before and after surgery for 3 years. The progression of renal function was determined by the progression and degradation of CKD stages. Univariate and multivariate logistic regression analyses were used to analyse the causes of renal function progression.ResultsWe analysed the data of 329 patients with renal tumours who underwent radical nephrectomies between January 2013 and December 2018. In this study, 43.7% of patients had postoperative acute kidney injury (AKI), and 48.3% had CKD at advanced stages. Further research revealed that patients’ renal function stabilized 3 months after surgery. Additionally, renal function changes during these 3 months have a substantial impact on the progression of long-term renal function changes in patients.ConclusionAKI may be an indicator of short-term postoperative changes in renal function. Renal function tests should be performed in patients with AKI after radical nephrectomy to monitor the progression of functional impairment, particularly within the first 3 months after radical nephrectomy.

Assessment of Kidney Function and Lipid Profile in Albino Rats Exposed to Azo-Dye Adulterated Palm Oil

Food is an important factor in human existence which makes exposure to adulterants in food an important environmental factor challenging the biological system. In West Africa, the manufacturing and processing of palm oil are done without proper hygienic monitoring; it is therefore almost impossible to detect fraud in the system. A major disadvantage associated with the use of adulterants in palm oil is that the adulterants have not undergone adequate research and the degree of health hazards they can pose to humans when consumed. This study was designed to evaluate the toxic effects of Azo dye adulterated palm oil on kidney function and Lipid profile in albino rats exposed to Azo-dye adulterated palm oil. Twenty-five albino rats were divided into five groups and treated as thus: Group I (control), Groups II and III were treated with only 1 ml/kg of unadulterated and adulterated palm oil respectively, while Groups IV and V were treated with only 50 mg/kg of Sudan III and IV dyes respectively for 28 days. Renal function tests, and lipid profiles were determined using analytical test kits. Data obtained were statistically analyzed with one-way analysis of variance (ANOVA) followed by tukey test using Graph Pad prism 9.0.0. The results were presented as mean ± standard error of mean (SEM). Differences between means of treated and control groups values at P ≤ 0.05 at 95% confidence interval were considered significant. The results showed a significant increase (p &lt; 0.05) in creatinine, urea concentrations, Sodium ion (Na+) and Potassium ion (K+) in groups treated with adulterated palm oil, Sudan III, Sudan IV (groups III, IV and V respectively) when compared with control groups. A significant increase (p &lt; 0.05) in low density lipoprotein (LDL), cholesterol, very low-density lipoprotein (VLDL) and Triacylglycerol (TAG) was observed in treated groups when compared with control groups while a significant decrease (p &lt; 0.05) in high density lipoprotein level (HDL) observed in treated groups when compared with the control group. This suggests that adulterated palm oil can induce renal damage and alter lipid profile.

Antilipidemic and Hepatorenal Effects of Aqueous Extracts of Terminalia catappa on Streptozotocin-induced Diabetic Rats

Aims: Diabetes mellitus, a condition characterized by glucose receptor abnormalities affecting glucose uptake, affects approximately 600 million individuals globally as of 2021. This study aimed to assess the antilipidemic and renal effects of aqueous extracts from the root bark and flowers of Terminalia catappa on streptozotocin-induced diabetic rats. Methodology: Twenty-five Albino rats weighing 160 – 300g were divided into five groups: A - normal control, B - diabetic control, C - diabetic treated with root bark extract, D - diabetic treated with flower extract, E - diabetic rats treated with glibenclimide. Diabetes was induced using streptozotocin (55mg/kg). The extracts (200mg/kg) were orally administered for 14 days, after which lipid profiles, renal and liver function tests were conducted. Results: There was a significant (p&lt;0.05) increase in total cholesterol, serum liver enzymes, and kidney markers in the diabetic control group compared to the normal control group. Treatment with the Terminalia catappa extracts for 14 days resulted in more than 20% decrease in urea (from 18.58 Mmol/L to between 11.58 and 13.92 Mmol/L), creatinine (from 343.56 Mmol/L to between 223.94 and 266.30 Mmol/L) and uric acid (from 570.54 µmol/L to between 413.55 and 440.62 µmol/L) concentrations by more than 20%, with the root bark extract showing the most significant effect. Additionally, the Terminalia catappa extract-treated groups exhibited a substantial (around 40%) reduction in serum liver enzymes compared to the diabetic control group. The hepatoprotective capacity of the root bark extract was similar to the glibenclimide-treated group. Furthermore, the extracts led to a 3% reduction in total cholesterol, triglycerides, and low-density lipoproteins, along with a significant increase in high-density lipoproteins. Conclusion: The aqueous root bark and flower extracts of Terminalia catappa demonstrate potentials for managing diabetes mellitus at the specified dosage.

Study on the mechanism of hirudin multi target delaying renal function decline in chronic kidney disease based on the “gut-kidney axis” theory

The disorder of the “gut-kidney axis” exacerbates renal function decline in chronic kidney disease (CKD), and current CKD therapy is insufficient to address this issue. Hirudin has a palliative effect on the decline of renal function. However, whether hirudin can delay CKD by regulating the “intestinal renal axis” disorder remains unclear. Unilateral ureteral ligation (UUO) induced CKD rat model, and the rats were treated with bifidobacterium and hirudin for 36 days. After 14 and 36 days of modeling, kidney and colon tissues were collected for pathology, western blot (WB) assay, and quantitative real-time PCR (qPCR) detection. Serum samples were collected for renal function testing. Fecal samples were used for 16S rRNA sequencing and research on fecal bacterial transplantation. Lipopolysaccharide combine with adenosine 5’-triphosphate (LPS + ATP)-induced intestinal epithelial cell injury was treated with a nod-like receptor pyrin domain-associated protein 3 (NLRP3) inhibitor and hirudin. Protein expression was detected using WB and qPCR. The kidneys and colons of the CKD rats exhibited varying degrees of lesions. Creatinine (CRE), blood urea nitrogen (BUN), N-acetyl-β-D-glucosidase (NAG) enzyme, and serum uremic toxins were elevated. The expression of claudin-1 and occludin was decreased, NLRP3 inflammatory-related proteins were increased, and the gut microbiota was disrupted. These pathological changes were more pronounced after 36 days of modeling. Meanwhile, high-dose hirudin treatment significantly improved these lesions and restored the intestinal flora to homeostasis in CKD rats. In vitro, hirudin demonstrated comparable effects to NLRP3 inhibitors by upregulating claudin-1 and occludin expression, and downregulating NLRP3 inflammatory-related proteins expression. The dysbiosis of the gut microbiota and impaired intestinal epithelial barrier function in CKD are associated with renal dysfunction in CKD. Hirudin delays the progression of CKD by regulating the disorder of the “gut-kidney axis” and inhibiting the activation of the NLRP3-ASC-caspase-1 pathway.

Prevalence of Diabetic Retinopathy among Self-reported Newly Diagnosed Diabetics

Introduction: Diabetic Retinopathy (DR) poses a significant threat to individuals with diabetes, leading to visual impairment and blindness if not promptly addressed. This study focuses on the prevalence of diabetic retinopathy among self-reported newly diagnosed diabetics. Material method: This is a prospective study on 200 self-reported newly diagnosed diabetics from April 2022 to May 2023. Patient data, including complaints, diabetes duration, family history, hypertension, and therapy details, were comprehensively analyzed. Complete Ocular examinations including best-corrected visual acuity, intraocular pressure, slit lamp examination, fundus examinations, and Fundus fluorescein angiography were done. Diabetic Retinopathy was graded using a modified ETDRS grading system. Laboratory investigations included complete blood count, fasting and postprandial blood sugar, lipid profile, renal function test, and Hb1AC levels, providing a thorough assessment of patients’ ocular and systemic health. Result: Out of the 200 diabetics, 43.5% had diabetic retinopathy, with a slightly higher prevalence in males (44.64%) compared to females. The age group 50 - 59 had the highest prevalence (74.19%), and Hindus, Muslims, and other communities showed comparable percentages. Family history and hypertension were significant factors, with 88% of those with a family history developing retinopathy. NPDR was predominant (87.35%), while 12.64% had PDR. Clinically Significant Macular Edema (CSME) was present in 59.77%, with 80.76% of these cases having concomitant hypertension. Conclusion: The study emphasizes the imperative for early detection and comprehensive management of diabetic retinopathy among newly diagnosed diabetics. Age, gender, family history, and hypertension emerge as crucial determinants, advocating for integrated care and targeted screening programs to safeguard vision.

Sildenafil and furosemide nanoparticles as a novel pharmacological treatment for acute renal failure in rats

Hospitalized patients often develop acute renal failure (ARF), which causes severe morbidity and death. This research investigates the potential renoprotective benefits of sildenafil and furosemide in glycerol-induced ARF, and measures kidney function metrics in response to nanoparticle versions of these medications. Inducing ARF is commonly done by injecting 50% glycerol intramuscularly. Rats underwent a 24-h period of dehydration and starvation before slaughter for renal function testing. We investigated urine analysis, markers of oxidative stress, histology of kidney tissue, immunohistochemistry analysis of caspase-3 and interleukin-1 beta (IL-1 β), kidney injury molecule-1 (KIM-1), and neutrophil gelatinase–associated lipocalin (NGAL), which are specific indicators of kidney tissue damage. The results of our study showed that the combination of sildenafil and furosemide, using both traditional and nanoparticle formulations, had a greater protective effect on the kidneys compared to using either drug alone. The recovery of renal tissue indicators, serum markers, and urine markers, which are indicative of organ damage, provides evidence of improvement. This was also indicated by the reduction in KIM-1 and NGAL tubular expression. The immunohistochemistry tests showed that the combination therapy, especially with the nanoforms, greatly improved the damaged cellular changes in the kidneys, as shown by higher levels of caspase-3 and IL-1β. According to the findings, a glycerol-induced rat model demonstrates that sildenafil and furosemide, either alone or in combination, in conventional or nanoparticulate forms, improve ARF dysfunction. The synergistic nanoparticulate compositions show remarkable effectiveness. This observation highlights the possible therapeutic implications for ARF treatment.