Renal Injury Group Research Articles

The Application Study of Voriconazole and Its Metabolites Concentration Monitoring in Allogeneic Hematopoietic Stem Cell Transplantation Patients

To explore the application value of simultaneous monitoring of voriconazole (VRCZ) and voriconazole N-oxide (VNO) in efficacy and safety of VRCZ in the prevention and treatment of fungal infections in allogeneic hematopoietic stem cell transplantation (allo-HSCT) patients before engraftment (i.e., days +1 to +30 after transplantation). The influencing factors of VRCZ, VNO concentration and MR (CVNO/CVRCZ) and the difference of VRCZ in the prevention and treatment of fungal infection and liver and kidney injury were analyzed. The receiver operating characteristic curve (ROC) was used to analyze the differences (the corresponding to the maximum of the Youden index on the curve was set as the cut-off value) to confirm the critical value. The factors affecting VRCZ concentration (CVRCZ), VNO concentration (CVNO) and MR were patient weight, VRCZ daily dose, and transplantation type (all P < 0.05). CVRCZ and CVNO in the effective group were higher than those in the ineffective group (P < 0.001), the opposite of MR (P < 0.001); the liver and renal injury group had lower MR than the normal group (P < 0.05). ROC showed that CVRCZ, C VNO and MR had important value in predicting VRCZ in the prevention and treatment of invasive fungal infections in allo-HSCT patients before engraftment, and their cutoff of concentrations were 0.95 μg/ml, 1.35 μg/ml and 1.645, respectively (AUC: 0.9677, 0.7634, 0.9564). CVRCZ and MR can assist in indicating liver ［cutoff values: 0.65 μg/ml, 1.96 (AUC: 0.5971, 0.6663)］ and renal injury ［cutoff values: 0.95 μg/ml, 1.705 (AUC: 0.6039, 0.6164)］. The great value of simultaneous monitoring of VRCZ, VNO and MR can predict in the efficacy and safety of VRCZ in allo-HSCT patients before engraftment. The prediction accuracy of CVRCZ was higher than that of MR, followed by that of CVNO. Increased CVRCZ and decreased MR increase the risk of liver and kidney injury.

Maternal and Fetal Prognosis in Pregnant Women with Renal Disease Associating Urinary Tract Infection.

Pregnancy related acute renal injury is a challenging diagnosis, mainly due to, among other factors, the physiological decrease in blood nitrogen retention parameters. As a consequence, the criteria required to establish the diagnosis may be first met as a result of the complications that appear, especially hypertension. The maternal and fetal complications which may occur in pregnancies with renal failure can be worsened by the relative immunodeficiency during pregnancy, which represents an elusive mechanism that is associated with a high risk of urinary tract infection (UTI). Therefore, the risk for intensive care unit admission, or developing sepsis, or preterm birth can increase. The present study aims to investigate whether the superimposition of UTI over an altered renal function leads to a worsened maternal and fetal prognosis. We performed an observational retrospective study that included pregnant women with increased serum creatinine levels, both with and without UTI. Thus, we analyzed 47 pregnant women who delivered in our unit between 1 January 2021 and 1 September 2023. Patients were divided into three groups: an acute renal injury (AKI) group (n=16), a chronic kidney disease (CKD) group (n=8) and a control group (n=23) which included patients with serum creatinine levels between 0.80-1 mg/dL. We evaluated the maternal and fetal complications in all three groups, taking into consideration the comparison between maternal and fetal parameters in women with UTI. Our study highlighted an important difference between fetal weight at delivery by patients with AKI associating UTI and the two remaining groups (1395 ± 992.50 grams compared to 2340 grams in the CKD group and 3103.33±83.86 grams in the control group, respectively). There was no statistically significant difference regarding preterm birth, intrauterine grow restriction, stillbirth or neonatal intensive care unit (NICU) admission. Preterm birth had a higher incidence in all patients with AKI (87.5% compared to 50% and 34.78%, respectively). Neonatal complications are important in pregnant women with AKI and CKD, irrespective of the UTI diagnosis. Most fetal complications occurred in patients diagnosed with AKI. The correlations highlighted by us should be studied further.

Does Bi-Exponential Fitting Perform Better than Mono-Exponential Fitting in IVIM-DWI? An Assessment of Renal Pathological Injury of IgA Nephropathy.

Chronic kidney disease has become one of the world's major public health problems, immunoglobulin A (IgA) nephropathy is a common pathological type of CKD. Delaying the progression of IgA nephropathy has currently become the main clinical treatment strategy, precise evaluation of renal pathological injury during follow-up of patients with IgA nephropathy is important. Therefore, it is imperative to develop an accurate and non-invasive imaging technique for effective follow-up of renal pathological injury in patients with IgA nephropathy. To investigate the clinical value of intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) in assessing renal pathological injury in patients with immunoglobulin A (IgA) nephropathy compared with a mono-exponential model. Altogether, 80 patients with IgA nephropathy were divided into the mild (41 cases) andmoderate-severe (m-s) renal injury groups (39 cases) according to pathology scores, and 20 healthy volunteers were recruited as controls. All participants underwent IVIM-DWI of the kidneys, and renal parenchymal apparent diffusion coefficient (ADC), pure molecular diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f) values were measured. One-way analysis of variance, receiver operating characteristic (ROC) curve analysis, and Pearson correlation analysis were performed for all the DWI-derived parameters. The DWI-derived parameters of the m-s renal injury group were significantly lower than those of the mild renal injury and control groups (P < 0.01). The ROC analysis revealed that f had the largest area under the ROC curve for differentiation between the m-s and mild renal injury groups and between the m-s renal injury and control groups. The f had the largest correlation coefficient with renal pathology scores (r=-0.81), followed by the D* (-0.69), ADC (-0.54), and D values (-0.53), respectively (all P<0.01). IVIM-DWI demonstrated better diagnostic performance than the mono-exponential model in assessing renal pathological injury in patients with IgA nephropathy.

A clinical study of using ROC to compare the efficiency of ASL and BOLD in diagnosis of renal allograft function.

This retrospective study aims to evaluate the effectiveness of renal transplantation function by comparing arterial spin labeling (ASL) and blood oxygen level dependent (BOLD) imaging with the receiver operating characteristic (ROC) curve. According to the estimated glomerular filtration rate (eGFR) values, 42 patients with normal kidney grafts (the normal kidney graft group, eGFR <60 mL/min/1.73 m2) and 93 patients with injured grafts (the kidney graft injury group, eGFR <60 mL/min/1.73 m2) were included in the present study. Renal blood flow (RBF) and the effective transverse relaxation rate (R2*) were calculated by comparing ASL and BOLD imaging. The ROC curve and the youden index were used to evaluate the diagnostic performance of ASL, BOLD, and the combination of them. The results showed that all the clinical features of the patients, except for gender, differed significantly between the 2 groups (P<0.05). The mean RBF value of the renal transplant injury group (104.33±54.76 mL/100 g/min) was significantly lower than that of the normal group (191.84±63.96 mL/100 g/min, P<0.01). The mean medullary R2* value of the renal transplant injury group (27.91±3.35 1/s) was significantly higher than that of the normal group (25.22±2.94 1/s, P<0.01). Negative correlations were found between R2* and eGFR (r=-0.44), and RBF and R2* (r=-0.54; both P<0.01). The ROC analysis showed that both RBF and R2* reflected injured renal function [area under the curves (AUC) =0.86 and 0.72, respectively]. In addition, the AUC of RBF and R2* combined was 0.86, which was comparable to that of RBF alone (P=0.95), while combining R2* and RBF improved the diagnostic performance of R2* alone (AUC =0.86 versus 0.72, respectively; P<0.01). The youden index analysis showed that the diagnostic accuracy of ASL was 80.00%, better than 71.85% of BOLD; the sensitivity and specificity of ASL in diagnosing renal allograft dysfunction were 79.57% and 80.95%, superior to 77.42% and 59.52% of BOLD. Our results showed that the non-invasive assessment of ASL in clinical kidney transplant function is a more promising imaging technique than BOLD.

Arterial spin labeling and diffusion-weighted MR imaging: quantitative assessment of renal pathological injury in chronic kidney disease.

The aim of the study was to investigate the performance of arterial spin labeling (ASL), diffusion-weighted imaging (DWI), and clinical biomarkers in assessing renal pathological injury in CKD. Forty-five biopsy-proven CKD patients and 17 healthy volunteers underwent DWI and ASL examinations. Renal cortical blood flow (RBF) and apparent diffusion coefficient (ADC) values were acquired. Correlations between RBF, ADC, serum creatinine (SCr), estimated glomerular filtration rate (eGFR), and pathological scores were assessed. The diagnostic efficacy of SCr, eGFR, RBF, and ADC in assessing renal pathological injury was assessed by ROC curve analysis. The cortical RBF, ADC, SCr, and eGFR were significantly correlated with the renal histology score (all p < 0.01). The AUC values of SCr, eGFR, RBF, and ADC were 0.705 (95% confidence interval (CI): 0.536-0.827), 0.718 (0.552-0.839), 0.823 (0.658-0.916), and 0.624 (0.451-0.786), respectively, in discriminating the minimal-mild renal pathological injury group (N = 30) from the control group (N = 17). The diagnostic ability of ASL was significantly higher than that of DWI (p = 0.049) and slightly but not significantly higher than that of eGFR and SCr (p = 0.151 and p = 0.129, respectively). When compared with that of eGFR, the sensitivity of ASL in detecting early renal injury increased from 50 to 70% (p = 0.014). However, in differentiating between the minimal-mild and moderate-severe renal injury groups (N = 15), there was no significant difference in diagnostic ability among the four parameters (all p > 0.05). ASL is practicable for noninvasive evaluation of renal pathology, especially for predicting early renal pathological injury in CKD patients.

Value of T1 Mapping in the Non-invasive Assessment of Renal Pathologic Injury for Chronic Kidney Disease Patients.

The objective of this study was to evaluate renal function and pathologic injury in chronic kidney disease (CKD) using T1 mapping. We recruited fifteen healthy volunteers (HV) and seventy-five CKD patients to undergo T1 mapping examination, and renal parenchymal T1 values were measured. Spearman correlation analysis was used to evaluate the relevance between the pathologic injury score, estimated glomerular filtration rate (eGFR), and renal parenchymal T1 values. The diagnostic efficiency of T1 value in evaluating renal pathologic impairment was assessed. In all subjects, renal cortical T1 value was remarkably lower than renal medullary T1 value (P < 0.01). The renal medullary T1 value of HV was considerably lower than that of CKD patients in all stages (P < 0.05). The T1 values were negatively correlated with eGFR (cortex, r = -0.718; medulla, r = -0.645). The T1 values were positively correlated with glomerular injury score (cortex, r = 0.692; medulla, r = 0.632), tubulointerstitial injury score (cortex, r = 0.758; medulla, r = 0.690) (all P < 0.01). The area under the curve (AUC) of renal cortical and medullary T1 values were 0.914 and 0.880 to distinguish moderate-severe from mild renal injury groups. To differentiate mild renal injury group from control group, the AUC values of renal cortical and medullary T1 values were 0.879 and 0.856. T1 mapping has potential application value in non-invasively assessing renal pathologic injury in CKD.

A high triglyceride glucose index is associated with early renal impairment in the hypertensive patients.

Serum β2-microglobulin (β2-MG) and serum cystatin C (CysC) are sensitive and reliable indicators of early renal impairment. Triglyceride glucose index (TyG) is an emerging vital indicator of insulin resistance and is associated with increased risk of hypertension. We aimed to analyze the relationship between TyG and early renal impairment in hypertensive patients. A retrospective analysis was performed on 881 hypertensive patients treated in Qinghai Provincial People, s Hospital from March 2018 to March 2021, their clinical data and corresponding laboratory index values were recorded, and the TyG index was calculated. According to the TyG index, the patients were divided into a low TyG (L-TyG) group (TyG ≤ 8.50, n=306), medium TyG (M-TyG) group (8.51≤TyG ≤ 8.94, n=281), and high TyG (H-TyG) group (TyG>8.95, n=294) in sequence by using tertiles. Then, according to serum β2-MG and CysC levels, they were divided into a normal renal function group (β2-MG ≤ 2.4 mg/L, n=700 and CysC ≤ 1.25mg/L, n=721) and a renal function injury group (β2-MG>2.4 mg/L, n=181, and CysC>1.25 mg/L, n=160). Multivariate linear regression analysis was used to analyze the influencing factors of serum β2-microglobulin and cystatin C. Multivariate Logistic regression was used to analyze the relationship between the TyG index and early renal impairment in hypertensive patients. The receiver operating characteristic curve (ROC) was used to determine the value of the TyG index in predicting early renal impairment in patients with hypertension. As the TyG index level increased, serum β2-MG and CysC levels also gradually increased. Multivariate linear regression analysis showed that TyG index was the influencing factor of serum β2-MG (B=0.060, P=0.007) and serum CysC (B=0.096, P<0.001). For every 1 standard deviation increase in the TyG index, the serum β2-MG and CysC increased by 0.06mg/L and 0.096mg/L, respectively. When compared to the normal group, the TyG level (8.91 ± 0.65 vs 8.64 ± 0.60, P<0.001) was higher in the renal impairment group with β2-MG>2.4 mg/L. The results of multivariate logistic regression analysis revealed that for every 1 standard deviation increase in the TyG index, the risk of early renal impairment in hypertensive patients increased 1.53 times (OR=1.53, 95%CI 1.006-2.303).The ROC curves showed that the TyG index was not superior to TG in predicting early renal impairment in hypertensive patients. the AUC values were 0.623 and 0.617, respectively. Then, when CysC>1.25 mg/L was used as the renal damage group, the level of TyG was still higher than that in the normal group (8.94 ± 0.67 and 8.64 ± 0.60, P<0.001). Multivariate Logistic regression analysis showed that for every 1 standard deviation increase in the TyG index, the risk of early renal impairment in hypertensive patients increased 2.82 times (OR=2.82, 95%CI 1.863-4.262). The ROC curves showed that the TyG index was not superior to TG in predicting early renal impairment in hypertensive patients. the AUC values were 0.629 and 0.626, respectively. TyG index is an influential factor in serum β2-MG and CysC levels. The elevated TyG index levels are closely associated with the occurrence and development of early renal impairment in hypertensive patients, but it should be used cautiously in the prediction of early renal impairment.

Long-term outcomes in patients with potential reversible causes of bradycardia

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Hyperkalemia and negative chronotropic drugs are well known causes of reversible bradycardia. Their synergic combination may result in BRASH syndrome (Bradycardia, Renal failure, Atrioventricular blockade, Shock, and Hyperkalemia), a consequence of the vicious cycle between bradycardia, renal failure and worsening hyperkalemia, leading ultimately to multiorgan dysfunction. In potentially reversible bradycardia, drug discontinuation or metabolic correction is recommended before permanent pacemaker (PPM) implantation. Objectives To determine the long-term prognosis in patients with potentially reversible symptomatic bradycardia. Methods We retrospectively reviewed 176 patients who presented to the emergency department with symptomatic bradycardia, between January 2015 and August 2016. Patients without any reversible cause of bradycardia were excluded. Participants were stratified into three groups according to the reversible causes of bradycardia: patients with hyperkalemia, with or without acute renal injury (ARI) (group 1); patients taking negative chronotropic drugs, with or without ARI (group 2); patients with BRASH syndrome (combination of hyperkalemia and negative chronotropic drugs, with or without ARI) (group 3). The primary endpoint was PPM implantation after discharge. Secondary endpoints included: bradycardia-related rehospitalization, heart failure (HF) hospitalization, all-cause mortality and a composite of all the previous endpoints. Results A total of 105 patients were included (52.4% female; mean age 79.8±8.6 years). Group 1 was comprised by 15 patients (14.3%), group 2 by 69 patients (65.7%) and group 3 by 21 patients (20%, figure 1). The incidence of each event is presented in figure 2. During a mean follow-up of 3.2±2.1 years, PPM was implanted in 60 patients (57.1%) – 51 during hospital stay (85%) and 9 after discharge (15%). Across all groups, approximately 50% of the patients needed PPM implantation at some point, without significant differences between groups (p=0.508). Group 3 had the lowest need of in-hospital PPM (38.1%) but the highest bradycardia-related readmissions (9.5%). Nevertheless, post-discharge PPM implantation was still higher in group 1 (33.3%), followed by group 3 (22.2%). There were no significant differences in the post-discharge PPM implantation rate between groups (p=0.76). In groups 1 and 3 the composite endpoint (73.3% and 76.2%, respectively) was significantly more frequent than in group 2 (44.9%, p=0.046 and p=0.012, respectively). Conclusions Nearly half of the patients with an episode of reversible bradycardia needed a PPM at some point. Given the advanced age of most patients with bradycardia secondary to metabolic derangement and/or drug toxicity, it is possible that this unveils underlying conduction system disease, which is likely to recur without PPM implantation.

Urine Cystatin C Determination in the Establishment of Reference Interval in the Diagnosis and Treatment of Renal Injury

Objective: To establish the diagnostic concentration range of urine cystatin C and the control level of urine cystatin C for patients with renal injury, and to help promote the establishment of standardization of urine cystatin C detection. Methods: 150 urine specimens and blood specimens from kidney injury patients and healthy people were collected, and stored in the refrigerator at -80°C for later use. After the specimens were collected, they were uniformly tested. Comparing the difference of blood and urine cystatin C between the kidney injury group and the healthy control group, the application value of urine cystatin C in the diagnosis and treatment of kidney injury was put forward. Results: The concentrations of cystatin C in urine and blood of renal injury group were 1.04 ± 2.14 mg/L and 1.94 ± 2.36 mg/L respectively; the concentrations of cystatin C in urine and blood of healthy control group were 0.11 ± 0.05 mg/L and 0.83 ± 0.20 mg/L respectively. The urine and blood cystatin C of the kidney injury group were significantly higher than those of the healthy control group. Compared the results of the two groups, the t values were 5.3210 and 5.7399, respectively. The P value is 0.0000; the difference is statistically significant; in comparison of urine and blood cystatin C in the kidney injury group, the value is that t = 3.4600, P = 0.0003; in comparison of urine and blood cystatin C in the healthy control group, the value is that t = 42.7744, P = 0.0000. By investigating the urine cystatin C concentration of patients with kidney injury, whether it is kidney injury or healthy controls, urine cystatin C is significantly lower than blood cystatin C. Conclusion: According to the results of this study, the concentration of urinary cystatin C in the healthy control group is 0.11 ± 0.05 mg/L. The reference interval of urinary cystatin C proposed in this study is 0.06 - 0.16 mg/L, which can be established by comprehensive multi center research. Through a multi-center study of the baseline level of urinary cystatin C in patients with renal injury, the diagnostic concentration interval of urinary cystatin C and the control level of urine cystatin C for renal injury patients were established.

Tribulus terrestris L. protects glomerular endothelial cells via the miR155-H2AC6 interaction network in hypertensive renal injury.

BackgroundHypertensive renal injury is one of the most lethal complications of hypertension. At present, renin-angiotensin-aldosterone system (RAAS) blockers are considered the best drugs for the treatment of renal injury in hypertension because of their nephroprotective effect of reducing proteinuria, but there are no specific drugs for this purpose, however, clinical trials proved that Chinese medicine has a protective effect on target organs in the treatment of hypertension. Tribulus terrestris L. (TrT), a traditional Chinese medicine (TCM), has potential applications due to its reno-protective and immunomodulatory effects.MethodsWe investigated the underlying reno-protective mechanism of TrT on Angiotensin II (AngII)-induced hypertensive renal injury in glomerular endothelial cells by integrating the differential expression profiles of micro RNA (miRNA) and messenger RNA (mRNA) to construct a miRNA-mRNA interaction network associated with hypertensive kidney injury, followed by quantitative real-time polymerase chain reaction (qRT-PCR) for validation.ResultsSeventy-six differentially expressed mRNAs (DEmRNAs) and 1 differentially expressed miRNAs (DEmiRNAs) were identified in the control group and the AngII-induced hypertensive renal injury group, respectively. 110 DEmRNAs and 27 DEmiRNAs were identified in the TrT treatment group and the AngII-induced group, respectively. The core component of the miRNA-mRNA network was miR-155-5p. Our study showed that miR-155-5p expression levels were more decreased in the AngII-induced hypertensive renal injury group than the control group. TrT treatment also significantly upregulated miR-155-5p. Additionally, we found that miR-155-5p expression levels were negatively correlated with H2A clustered histone 6 (H2AC6).ConclusionsThe results of this study indicate that TrT has a reno-protective effect on AngII-induced hypertensive renal injury by miR-155-5p, which negatively regulates the expression of H2AC6. Our findings offer a new therapeutic strategy and have identified an effective candidate target for the treatment of hypertensive renal injury in clinical settings.

C-Phycocyanin isolated from Microcystis aeruginosa Kützing mitigates renal injury induced by potassium dichromate via toll-like receptor-4 down regulation in rats

C-Phycocyanin is among the most promising microalgal derived molecules with an array of pharmacological activities. Toll-like receptors (TLRs) have a vital role in regulating inflammatory response in renal injury. The aim of this study was to evaluate the possible renal therapeutic effect of phycocyanin isolated from Microcystis aeruginosa Kutzing harvested from high rate algal pond on potassium dichromate (PD)-induced renal injury in rats. Rats were assigned randomly into: Group I: Normal control group. Group II: Rats injected with a single injection of PD (15 mg/kg; s.c) and served as renal injury group. Group III and IV: Rats received C-phycocyanin (25 & 50 mg/Kg; orally), after PD injection, daily for 7 days. Injection of PD induced a marked renal injury, evidenced by a significant increase in kidney functions and renal contents of malondialdehyde (MDA), tumor necrosis factor–alpha (TNF-α), toll-like receptor 4 (TLR4), heat shock protein 70 (HSP70) and insulin growth factor-1 (IGF-1) In addition PD reduced renal content of reduced glutathione (GSH) and exhibited tubular degeneration and necrosis. C-phycocyanin has renal therapeutic effect against renal injury induced by PD through improving kidney function, down regulation of oxidative stress and TLR4/TNF-α/HSP70 inflammatory pathway as well as modulation of IGF-1.

Pathological assessment of chronic kidney disease with DWI: Is there an added value for diffusion kurtosis imaging?

Chronic kidney disease (CKD) is a worldwide health problem, precise functional and pathological assessment is beneficial to better treatment. Diffusion kurtosis imaging (DKI) can evaluate non-Gaussian diffusion and may help to assess renal pathology and function. To assess pathological and functional alterations in CKD using DKI compared with diffusion-weighted imaging (DWI). Prospective study. 70 CKD patients and 20 healthy volunteers. 1.5 T. All participants underwent DKI, and apparent diffusion coefficient (ADC), mean diffusivity (MD), and mean kurtosis (MK) of renal parenchyma were acquired. Correlation between renal parenchymal ADC, MD, MK, and estimated glomerular filtration rate (eGFR), pathological scores were assessed. The diagnostic efficacy of ADC, MD, and MK for assessing the degree of renal pathological injury were compared. ANOVA, Spearman correlation analysis, and ROC curve analysis. The cortical ADC, MD were significantly higher than medulla for all participants, whereas medullary MK was significantly higher than cortex (P < 0.01). Whether eGFR reduced or not, renal parenchymal MK were significantly higher in patients than controls (P < 0.05). Positive correlation was found between eGFR and ADC (cortex, r=0.562; medulla, r=0.527), and negative correlation between eGFR and MK (cortex, r=-0.786; medulla, r=-0.709) (all P < 0.001). There was positive correlation between MK and glomerular injury (cortex, r=0.681; medulla, r=0.652), tubulointerstitial lesion (cortex, r=0.650; medulla, r=0.599) (all P < 0.001). For discrimination between mild and m-s renal injury group, the AUC values of ADC, MD, MK were cortex: 0.723, 0.655, 0.864 and medulla: 0.718, 0.581, 0.829. The AUC values of ADC, MD, MK were cortex: 0.708, 0.679, 0.770 and medulla: 0.713, 0.830, 0.780 for differentiating control group from mild renal injury group. DKI is practicable for noninvasive assessment of renal pathology and function of CKD, DKI offer better diagnostic performance than DWI. Evidence Level 1 Technical Efficacy 2.

Research on Renal Injury in Hashimoto&amp;apos;s Thyroiditis Patients with Different Thyroid Function

Objective: To assess the relationship between thyroid function and renal injury in Patients with Hashimoto's Thyroiditis. Method: To select 156 diagnosed HT patients as the research object, according to whether there is renal injury, they were divided into renal injury group with 21 cases and non-renal injury group with 135 cases. According to the thyroid function, they were divided into HT hyperthyroidism group (Group A) with 19 cases, normal HT thyroid function group (Group B) with 37 cases, HT subclinical hypothyroidism group (Group C) with 61 cases, and HT hypothyroidism group (Group D) with 39 cases. Besides, 40 cases of healthy check-up people are selected as the control group. ECLIA is adopted to test the thyroid function index of each group, Serum cystatin C and 24-hour urinary microalbumin were measured by immunoturbidimetry, serum creatinine was measured by creatine oxidase method, and the endogenous creatinine clearance rate was calculated. Result: TSH, TPOAb and TGAb in renal injury group were distinctly higher than those in non-renal injury group, while FT3 and FT4 were distinctly lower than those in non-renal injury group; Comparison of serum creatinine in Hashimoto groups, Group D is significantly higher than other groups, Group C is obviously higher than Group A, Group B, and the control group, Group B is obviously higher than Group A, Group A is significantly lower than other groups; Comparison of cystatin C and creatinine clearance of each group, Group D is significantly lower than other groups, Group C is obviously lower than Group A, Group B, and the control group, Group B is obviously lower than Group A, Group A is significantly higher than other groups; Comparison of 24-hour urinary microalbumin of each group, Group D is significantly higher than other groups, Group C is obviously higher than Group A, Group B, and the control group, and the differences have statistic significance (P<0.05). The correlation analysis shows that FT3, FT4 are in negative correlation with serum creatinine and in positive correlation with cystatin C and creatinine clearance; TSH, TPOAb, TGAb is in positive correlation with 24-hour urinary microalbumin. Conclusion: There are obvious differences in renal function indexes of HT patients with different thyroid function states, which may be related to the effect of thyroid hormones and autoantibodies.

Protective Effects of Astaxanthin on Nephrotoxicity in Rats with Induced Renovascular Occlusion.

Various effects of Astaxanthin were shown in the studies, including its antioxidant, anti-inflammatory, anti-tumor and immunoregulatory effects. The aim of this study was to evaluate the beneficial effects of Astaxanthin on renovascular occlusion induced renal injury and to investigate the possible mechanisms. The rats were randomly assigned into three groups as follows: Group 1: control group (n=12), Group 2: renal ischemia-reperfusion injury group (n=12), Group 3: renal ischemia-reperfusion + asthaxantine treated group (n=12). The control group and the renal ischemia-reperfusion group were given 2cc/kg/g olive oil for 7 days before establishing ischemia to renal tissue. Astaxanthin dissolved in olive oil was given orally to the renal ischemia+astaxanthin group for 7 days before inducing renal ischemia. Caspase-(3, 8, 9), GSH, SOD, Total Thiol, TNF-α, IL-6, 8-OHdG were evaluated in each group. Renal IRI was verified by analysing the pathological changes of renal tissues and the renal functions after renal reperfusion. Much less renal tubular damage was determined in the IRI+ASX group in comparison to the IRI group. Caspase-8, -9 and -3 immunoreactivity was observed to be minimal in the control group. Apoptosis was observed to be significantly reduced in the IRI + ASX group with respect to the IRI group and close to the level of the control group (p <0.05). Caspase-3 levels of tissue samples were significantly increased in the IRI group compared to the other groups, but significantly lower in the IRI+ASX group with respect to the IRI group (p<0.05). The TOS and OSI levels, indicating increased oxidative stress, were significantly lower in the IRI+ASX group with respect to the IRI group (p <0.001), but still higher than the control group (p <0.001). In addition to GSH, SOD and Total Thiol levels, TAS levels were also significantly higher in the IRI + ASX group in comparison to the IRI group (p <0.05). TNF-α, IL-6, lipid hydroperoxide, AOPP and 8-OHdG levels were lower in the IRI+ASX group than the IRI group (p <0.001). MPO, IL-6, TNF-α levels, representing the parameters indicating neutrophil infiltration and inflammation of the renal tissues, significantly increased in the IRI group with respect to the other groups (p <0.005). When all the data obtained in our study were evaluated, ASX was determined to prevent renal damage due to renovascular occlusion to a great extent, through complex mechanisms involving antioxidant, anti-inflammatory and antiapoptotic effects. Biochemical, histological and oxidative stress parameters were improved due to ASX.

Value of magnetic resonance imaging texture analysis in evaluating renal allograft injury

Objective: To explore the value of magnetic resonance imaging (MRI) texture analysis in evaluating renal allograft injury. Methods: A retrospective review was performed on sixty-six patients who underwent allograft renal transplantation (42 males, 24 females; age range, 22-63 years; mean age, (40±10) years) between November 2013 and December 2016. All the patients were divided into three groups according to their eGFR on the day of MRI examination: normal renal allograft function (nRAF) group (n=15), mild to moderate renal allograft injury (mRAI) group (n=18), and severe renal allograft injury (sRAI) group (n=33). All the patients underwent conventional T(2) weighted image (T(2)WI), susceptibility weighted imaging (SWI), and blood-oxygen level dependent (BOLD) MRI examination. MRI texture features of renal allograft were extracted. The texture features based on T(2)WI, SWI, and BOLD with absolute correlation coefficient of eGFR greater than or equal to 0.3 (P<0.05)and also with the highest Z value for Boruta algorithmwere selected. The diagnostic performance of the selected texture features in differentiating the three groups was assessed by receiver operating characteristic (ROC) curve analysis. Results: T(2)WI_Perc.50%, SWI_Perc.01%, BOLD_S(4,4)Contrast, and BOLD_S(5,5)Correlat with absolute correlation coefficient of eGFR greater than or equal to 0.3 (P<0.05) and also with the highest Z value for Boruta algorithm were selected. The AUC for T(2)WI_Perc.50%, SWI_Perc.01%, and BOLD_S(5,5)Correlat in differentiating the nRAF group with the mRAI group was 0.785, 0.720, and 0.700. The AUC for T(2)WI_Perc.50%, SWI_Perc.01%, BOLD_S(4,4)Contrast, and BOLD_S(5,5)Correlat in differentiating the nRAF group with the sRAI group was 0.687, 0.733, 0.784, and 0.737.The AUC for BOLD_S(4,4) Contrast in differentiating the mRAI group with the sRAI group was 0.667. Conclusion: MRI texture analysis can provide valuable information for evaluating renal allograft injury.

Clinical value of early renal damage index in children hydronephrosis

Objective To explore urinary NAG, Cr, MA, α1-MG andβ2-MG as the early renal damage index in children hydronephrosis. Methods The clinical data of 206 patients in the Bayi Children′s Hospital Affiliated to the Seventh Medical Center of Chinese PLA General Hospital from May 2018 to January 2019 were analyzed retrospectively. Among them, 152 children with hydronephrosis were set as observation group, 54 children without hydronephrosis were set as control group. In the observation group, the age ranged from 1 month to 18 years old, and the median age was 2 years old. There were 123 cases of hydronephrosis caused by ureteropelvic junction obstruction (UPJO) and 29 cases of posterior urethral valve complicated with hydronephrosis. In the control group, the age ranged from 1 month to 15 years old, with a median age of 5 years. There were 18 hypospadias cases, 15 occult penis cases and 21 phimosis. All children with hydronephrosis underwent nuclear medicine renal dynamic imaging. Urine specimens were tested for urinary NAG, Cr, MA, α1-MG, and β2-MG. According to renal dynamic results, the observed components were the renal function injury group and the normal renal function group. The above indicators analyzed to judge the clinical value to find the early renal damage. Results The expression levels of urinary NAG, MA, α1-MG and β2-MG in the observation group were higher than those in the control group, and the difference was statistically significant. The expression of urinary Cr and the abnormal rate were no significant difference between any two groups(P=0.647, P=0.572). The expression levels of urinary NAG, MA, α1-MG and β2-MG were not significantly different between the normal renal hydronephrosis group and the renal function impairment group (P=0.365, P=0.448, P=0.379, P=0.338). The abnormal expression rate of Urine MA and β2-MG was not statistically significant in the patients with normal renal hydronephrosis and the renal function impairment group (P=0.436, P=0.478). MA got the highest sensitivity of (58.8%), and NAG had the highest specificity of 89.3% to detect early renal demage. Four indexes combined analysis, sensitivity, negative predictive rate, diagnostic coincidence rate improved obviously. Joint analysis of posterior urethral valves combined with hydronephrosis, the abnormal rate was 89.7%(26/29). The renal dysfunction of the posterior urethral valve showed that the renal dynamics dysfunction rate was only 37.9%(11/29). Conclusions The combined analysis of urinary NAG, MA, α1-MG and β2-MG can accurately predict early renal injury. The index of early renal loss may be the early evidence to judge whether the posterior urethral valve is complicated with upper urinary tract function injury. Key words: Hydronephrosis; Children; Early renal damage index; Clinical application

Evaluation of renal oxygen saturation using photoacoustic imaging for the early prediction of chronic renal function in a model of ischemia-induced acute kidney injury.

PurposeTo evaluate the utility of photoacoustic imaging in measuring changes in renal oxygen saturation after ischemia-induced acute kidney injury, and to compare these measurements with histological findings and serum levels of kidney function.Material and MethodsAcute kidney injury was induced by clamping the left renal pedicle in C57Bl/6 mice, with a 35-min ischemic period used to induce mild renal injury (14 mice) and a 50-min period for severe injury (13 mice). The oxygen saturation was measured before induction, and at 5 time-points over the first 48 h after induction, starting at 4 h after induction. Oxygen saturation, histological score, kidney volume, and the 24 h creatinine clearance rate and serum blood urea nitrogen were also measured on day 28. Between-group differences were evaluated using a Mann-Whitney U-test and Dunn’s multiple comparisons. The association between oxygen saturation and measured variables was evaluated using Spearman’s correlation. A receiver operator characteristic curve was constructed from oxygen saturation values at 24 h after heminephrectomy to predict chronic renal function.ResultsThe oxygen saturation was higher in the mild than severe renal injury group at 24 h after induction (73.7% and 66.9%, respectively, P<0.05). Between-group comparison on day 28 revealed a higher kidney volume (P = 0.007), lower tubular injury (P<0.001), lower serum level of blood urea nitrogen level (P = 0.016), and lower 24 h creatinine clearance rate (P = 0.042) in the mild compared with the severe injury group. The oxygen saturation at 24 h correlated with the 24 h creatinine clearance rate (P = 0.036) and serum blood urea nitrogen (P<0.001) on day 28, with an area under the receiver operating curve of 0.825.ConclusionOxygen saturation, measured by photoacoustic imaging at 24 h after acute kidney injury can predict the extent of subsequent histological alterations in the kidney early after injury.

Trajectory of Estimated Glomerular Filtration Rate Predicts Renal Injury in Children with Multicystic Dysplastic Kidney

Background/Aims: Children with a solitary functioning kidney have a risk of renal injury caused by hyperfiltration. Timely intervention with renin-angiotensin inhibitors may be beneficial. We examined whether trajectory of estimated glomerular filtration rate (eGFR) would predict renal injury, defined as microalbuminuria/proteinuria, hypertension, and/or a decline in eGFR. Methods: Seventeen patients (male 7, female 10) with multicystic dysplastic kidney (MCDK; median age 13 years, range 6–19 years) followed in our clinic were examined retrospectively. An eGFR decline was defined as a fall to < 90 mL/min/1.73 m² or a decline of > 5 mL/min/1.73 m²/year for those with baseline eGFR of ≥90 or < 90 mL/min/1.73 m² respectively. Results: Nine patients had renal injury at the time of investigation. Compared with 8 patients without renal injury, those with renal injury tended to be older (14.7 ± 4.2 vs. 11.4 ± 4.6 years) and the birth weight was smaller (2,538 ± 281 vs. 2,966 ± 361 g, p < 0.05). The frequency of contralateral congenital anomaly of kidney and urinary tract (cyst, hydronephrosis, or vesicoureteral reflux) were not different. The trajectory of eGFR in those without renal injury was either an increase (n = 3) or unidentifiable (n = 5), whereas that in the renal injury group was exclusively an increase followed by decline (p < 0.05). The average age of the onset of eGFR decline was 9.4 ± 4.2 years and that of the start of renal injury (albuminuria/proteinuria 5, eGFR decline 4, hypertension 1) was 12.5 ± 4.2 years. Conclusion: All the children with MCDK who developed renal injury had eGFR trajectory of increase followed by decline. Renal injury followed the peak eGFR by 3 years on average. This observation is in agreement with the hyperfiltration theory and underscores the importance of following eGFR trajectory closely.

Expression changes of soluble urokinase-type plasminogen activator receptor and soluble triggering receptors expressed by myeloid cell-1 in serum of children with primary nephrotic syndrome and their clinical significance

Objective To investigate the expression changes of soluble urokinase-type plasminogen activator receptor (suPAR) and soluble triggering receptors expressed by myeloid cell-1(sTREM-1) in serum of children with primary nephrotic syndrome(PNS) and their clinical significance. Methods A total of 92 cases of newly diagnosed PNS children were selected in Central Hospital of Yidu Affiliated to Weifang Medical College from June 2014 to September 2016.According to presence or absence of acute tubular necrosis, they were divided into acute renal injury group (27 cases) and non-acute renal injury group (65 cases). According to pathology type, they were divided into mesangial proliferative glomerulonephritis (30 cases), focal segmental glomerulosclerosis (23 cases), membranous nephropathy (18 cases), minimal change disease (14 cases) and membrane proliferative glomerulonephritis (7 cases). In the same period, 45 healthy children were selected as the healthy control group.The clinical data were collected.The serum levels of suPAR and sTREM-1 were measured by adopting enzyme-linked immunosorbent assay (ELISA). Results The levels of total cholesterol(TC), triglycerides(TG), uric acid(UA), urinary protein/creatinine, 24 h urinary protein, urinary N-acetyl-β-glucosaminidase(NAG) and β2-microglobulin(MG) in children with PNS were higher than those in the healthy control group, while serum albumin(ALB) was lower than that in the healthy control group, and the differences were statistically significant (all P<0.05). The serum levels of suPAR and sTREM-1 in PNS patients were (133.09±62.48) ng/L and (79.29±34.68), respectively, which were significantly higher than those in the healthy control group[(31.11±11.61) ng/L and (25.08±8.10) ng/L](t=51.714, 49.435; all P=0.000). The serum levels of suPAR and sTREM-1 in acute renal injury group were (188.82±32.21) ng/L and (109.11±24.78) ng/L, respectively, which were significantly higher than those in non-acute renal injury group [(75.96±28.69) ng/L and (52.23±14.07) ng/L] and healthy control group [(31.11±11.61) ng/L and (25.08±8.10) ng/L] (F=16 739.607, 10 487.256, all P=0.000). The serum levels of suPAR and sTREM-1 in children with focal segmental glomerulosclerosis and membrane proliferative glomerulonephritis were higher than those with minimal change disease, membranous nephropathy and mesangial proliferative glomerulonephritis, and the differences were statistically significant (all P<0.05). Pearson correlation analysis results showed that the serum levels of suPAR and sTREM-1 were positively correlated with TC, TG, urinary protein/creatinine, 24 h urinary protein, urinary NAG and β2-MG (all P<0.05), while negatively correlated with ALB (P<0.05). Conclusions The serum levels of suPAR and sTREM-1 are elevated in children with PNS, and which are related with acute renal injury and pathological type, which can reflect the degree of renal tubular disease and kidney function to a certain extent. Key words: Primary nephrotic syndrome; Soluble urokinase-type plasminogen activator receptor; Soluble triggering receptors expressed by myeloid cell-1; Child

The effect of a concomitant renal injury on the outcome of colonic trauma

BackgroundThe management of colon injuries has steadily evolved over the course of the last half century. So too has the management of renal trauma. It is not clear from the literature as to whether concomitant colon and renal injuries carry increased risk of morbidity and mortality, and whether this combination of injuries necessitates a specifically tailored management approach. MethodsA retrospective review was carried out for the period January 2012 to December 2016. All patients over the age of 18 years who were subjected to laparotomy for penetrating trauma (gunshot wounds or stab wounds) and who sustained an intra-operatively proven colonic injury were included in this study. Operative management and outcomes were investigated. A direct comparison was made between patients with a combined colonic and renal injury and those with only a colonic injury. ResultsOver the five-year period a total of 268 patients sustained a colonic injury. The 239 patients with a colonic injury (Group A) were compared to the 29 patients with a combined colonic and renal injury (Group B). Regarding the management of the colonic injuries, there were no differences in the rates of primary repair, anastomosis, exteriorization, or damage control surgery between groups A and B. As for the management of the renal injury, 14 were not explored at laparotomy; in 12 a nephrectomy was performed and in 3 the renal injury was repaired. The nephrectomy cohort were more likely to have undergone damage control surgery, to be admitted to ICU, to receive a colostomy, and had higher mortality. While there was no difference in the need for damage control surgery or mortality between groups, Group B had a significantly greater need for ICU admission. Morbidity was similar between the two groups – in particular, there was no difference in the rates of either gastro-intestinal complications or acute kidney injury between the two groups. ConclusionIn patients with combined colon and renal injuries, it seems reasonable to treat each organ on its own merit, without the expectation of increased morbidity or mortality. In the non-damage control setting, most colonic injuries may be safely repaired, and a peri-renal haematoma that is not expanding or actively bleeding may be safely left alone.