Renal Insufficiency In Patients Research Articles

Correlation renal cortical echogenicity with serum creatinine in patients with chronic kidney disease

Background: Sonography is the best screening modality to detect renal insufficiency in patients. Because ultrasonographic observations such as echogenicity, longitudinal length, parenchymal and cortical thickness reflect irreversible changes, when it comes to assessing the development of the disease, ultrasonography is a better imaging tool. Aims: Our aimed to compare renal echogenicity with serum creatinine levels and to investigate the importance of renal echogenicity in the detection of CKD development and the use of sonographic imaging in CKD classification. Materials and methods: 80patients above 30 years of age who had been diagnosed with CKD according to the guidelines of the National Kidney Foundation were included in the study. serum creatinine levels. Renal cortical echogenicity was compared with serum creatinine. A P value less than 0.05 was considered statistically significant. Results: In total 80 patients, 38 patients(48%) had sonological Grade 1 CKD, 29(36%) had Grade 2 CKD, 9(11%) had Grade 3 CKD, and 4(5%) had Grade 4 CKD. The mean serum creatinine was 2.7 mg/dl for Grade 1, 3.7 mg/dl for Grade 2 it is 3.9 mg/dl for Grade 3 and 7.8 mg/dl for Grade 4. There was a statistically significant positive association between serum creatinine and the grading of cortical echogenicity. The statistically significant positive association between mean longitudinal size and renal echogenicity, parenchymal thickness and renal echogenicity, cortical thickness and renal echogenicity was also statistically significant. Conclusion: In CKD patients, renal cortical echogenicity and its grading compared to longitudinal length, parenchymal thickness, and cortical thickness is the strongest sonographic parameter that correlates with serum creatinine. It can be used as a parameter of renal activity because renal cortical echogenicity has the advantage of being irreversible compared with serum creatinine levels.

Elective proximal aortic surgery in patients with renal insufficiency.

To evaluate preoperative risk factors and postoperative outcomes in patients with preoperative renal insufficiency undergoing open surgical repair of the aortic root, ascending aorta, or aortic arch. Our institutional database was reviewed for all patients undergoing elective aortic root, ascending aorta, and aortic arch open repairs. Patients were separated into two groups based on renal function. Patients with preoperative renal insufficiency were compared to those with normal renal function. Regression analyses were used to identify independent predictors of short and long term postoperative outcomes. The cohort consisted of 2140 patients, of which 55 had preoperative renal insufficiency (PRI). Patients with PRI were older and had worse cardiovascular risk profiles. On presentation, PRI patients were more likely to have lower ejection fraction. There was no difference in operative mortality between the two groups. The most frequent major postoperative complications among renal insufficiency patients were reoperation for bleeding (9.1%, P = .02). Logistic regression analysis indicated that PRI and left ventricular ejection fraction were independent predictors of major adverse events. Long-term survival was significantly reduced in preoperative renal insufficiency patients in the unmatched cohort. Aortic patients with preoperative renal insufficiency have a higher risk profile of mortality. Renal insufficiency remains an independent predictor of adverse outcomes following aortic surgery and understanding this patient population can guide physicians to improve outcomes.

Cardiac Troponin Had Limited Diagnostic Value for Acute Myocardial Infarction in Renal Insufficiency: A Meta-Analysis

Aim: To evaluate the diagnostic efficiency of cardiac troponin (cTn) for acute myocardial infarction in renal insufficiency patients. Materials& methods: Medline, EMBASE and the CENTRAL databases were searched for eligible studies. Results: Thirteen studies were included. The sensitivity of the 99th percentiles for high-sensitivity cTn (hs-cTn) was 0.94 (95% CI: 0.87, 0.97), the specificity was 0.56 (95% CI: 0.42, 0.68). Subgroup analysis found that the sensitivity for hs-cTnT and hs-cTnI were similar, but the specificity was higher for hs-cTnI. The optimized cut-off values slightly increased the specificity, but decreased the sensitivity. Serial sampling of hs-cTn seemed to increase the diagnostic efficiency. Conclusion: The usual and optimized cut-off threshold for cTn had decreased diagnostic efficacy for acute myocardial infarction. Serial sampling seemed to increase the diagnostic efficiency.

MP36-03 EXAMINING THE ROLE OF CONTRAST-ENHANCED RENAL ULTRASOUND IN CHARACTERIZING INDETERMINATE RENAL LESIONS IN THE SETTING OF CHRONIC KIDNEY DISEASE

You have accessJournal of UrologyImaging/Radiology: Uroradiology I (MP36)1 Apr 2020MP36-03 EXAMINING THE ROLE OF CONTRAST-ENHANCED RENAL ULTRASOUND IN CHARACTERIZING INDETERMINATE RENAL LESIONS IN THE SETTING OF CHRONIC KIDNEY DISEASE Ava Saidian*, Taylor Tucker, Stephen Leahy, Kristin Porter, and Soroush Rais-Bahrami Ava Saidian*Ava Saidian* More articles by this author , Taylor TuckerTaylor Tucker More articles by this author , Stephen LeahyStephen Leahy More articles by this author , Kristin PorterKristin Porter More articles by this author , and Soroush Rais-BahramiSoroush Rais-Bahrami More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000880.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The prevalence of chronic kidney disease (CKD) in the United States is estimated to be over 14%. A particular difficulty that arises when caring for CKD patients is accurate diagnosis of renal lesions without the use of intravenous contrast. Contrast Enhanced Renal Ultrasound (CEUS) is a diagnostic tool with the potential for more precise imaging without the nephrotoxic effects of standard contrast in patients with indeterminate renal lesions and CKD. The primary objective of this study was to compare the results of CEUS with other imaging modalities in both renal sufficient and insufficient patients when evaluating indeterminate renal lesions. METHODS: Retrospective chart review of patients who underwent CEUS from 2014 to 2015 was performed at a single institution with data collection focused on renal function, prior imaging of renal lesions, and final clinical and pathological diagnoses. Patients were separated into two cohorts based on renal function with an eGFR<60 defining the CKD cohort. Using SPSS Statistics, comparative analysis between results of prior imaging and follow-up CEUS was performed for each cohort. RESULTS: A total of 169 patients had a CEUS completed from 2014 to 2015 at our institution. There were 104 patients who were classified as having CKD. Imaging modalities patients underwent prior to CEUS included Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and non-contrast enhanced ultrasound. A comparative analysis of categorical variables was done using chi-squared and Fisher’s exact test. CEUS provided specific diagnosis, new diagnosis and/or confirmed diagnosis of previously labeled “indeterminate renal lesions” by other imaging modalities in 41 (39.4%) CKD patients compared to 13 patients (20.0%) with normal renal function (p=0.0084). CEUS resulted in a change in Bosniak cyst classification in 2 (4.3%) CKD patients compared to 8 (22.8%) patients with normal renal function (p=0.017). CEUS also resulted in a change in the number of lesions in 2 (1.9%) CKD patients compared to 5 (7.7%) patients with normal renal function (p=0.11). CONCLUSIONS: CEUS can be used to diagnose and follow renal lesions in patients with CKD who otherwise are not able to undergo imaging with nephrotoxic contrast. CEUS can help differentiate and further classify indeterminate renal lesions that may be concerning for malignancy. Further studies are necessary to validate these findings and further elucidate the diagnostic role of CEUS in patients with and without CKD. Source of Funding: UAB UCSD O’Brien Center for Kidney Injury © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e522-e523 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ava Saidian* More articles by this author Taylor Tucker More articles by this author Stephen Leahy More articles by this author Kristin Porter More articles by this author Soroush Rais-Bahrami More articles by this author Expand All Advertisement PDF downloadLoading ...

Abstract No. 488 Trimetazidine in the prevention of contrast-induced nephropathy in patients with renal insufficiency undergoing percutaneous coronary intervention: a systematic review and meta-analysis

Contrast-induced acute kidney injury (CI-AKI) is one of the leading causes of acute kidney injury. Trimetazidine (TMZ) is a type of anti-ischemic drug developed in recent year. Available data on the renal effects showed TMZ can significantly reduce the incidence of (CI-AKI). We conducted this systematic review and meta-analysis of clinical trials that investigated the clinical effect of TMZ on the prevention of CIN in patients with renal insufficiency patients undergoing percutaneous coronary intervention. This meta-analysis was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). A search of the Medline, Cochrane and Google Scholar databases were conducted independently by two researchers for randomized controlled trials comparing TMZ versus conventional hydration alone for the prevention of CIN. The relative risk (RR) was estimated with a 95% confidence interval (CI). Heterogeneity was reported with the I2 statistic, using a fixed-effects model, and >50% of I2 was considered to be statistically significant. All statistical analyses were performed using STATA software, version 12.0. 11 studies met our inclusion/exclusion criteria including 1611 patients: 797 undergoing TMZ plus hydration and 814 controls (hydration only). Heterogeneity of each study was low, I2 = 0%, P = 0.747. The incidence of CIN in the TMZ plus hydration group was 6.0% (48/797) and the incidence of CIN in the control (hydration) group was 20.6% (168/814). A pooled analysis for all studies showed that TMZ can significantly reduce the incidence of CIN AKI compared to saline alone (relative risk 0.35, 95% confidence interval [CI] 0.25, 0.48, P = 0.000). Present systematic review and meta-analysis by combining data from 11 studies showed Trimetazidine can effectively protect renal function and reducing the incidence of CIN in patients undergoing coronary angiography.

Renal Functional Response Following Percutaneous Nephrolithotomy in Patients of Renal Stone Disease With Impaired Renal Function

Background : Urolithiasis is one of the oldest disease known to human beings and has been documented in ancient Greek. Urolithiasis continues to pose a significant health hazard, causing progressive renal impairment, if left untreated. The etiology of renal insufficiency in patients with nephrolithiasis is multifactorial and includes renal obstruction, urinary infection, frequent surgical interventions, and coexisting medical diseases. The purpose of this study is to assess the change in renal function following removal of kidney stones by Percutaneous Nephrolithotomy (PCNL) in patients with associated impaired renal function.&#x0D; Materials and methods : 50 Patients with renal stone disease with associated impaired renal function who were admitted and underwent PCNL in Urology department were selected as per inclusion and exclusion criteria by purposive sampling. Complete clinical evaluation including history, physical examination, relevant examinations &amp; laboratory investigations were performed. All the patients were treated by PCNL monotherapy with Double J stenting. Mean age was 46.63±11.95 years (Age range: 24-72 years). There were 36 males (72%) &amp; 14 females (28%) &amp; male to female ratio was 2.57:1.&#x0D; Results : In this study, a significant fall in mean serum creatinine (0.5 mg%) was demonstrated following the stone removal. The creatinine value remained unchanged in 12% and improved in 84% patients. In contrast to the improvement of renal function as evident by a decline in the mean serum creatinine values, the mean Glomerular Filtration Rate (GFR) registered a small fall of 1.78 ml/min (Statistically not significant). we have observed that total 12 (24%) patients out of 50 cases experienced different sorts of complications.&#x0D; Conclusion: This study showed that PCNL approach to urolithiasis in patients with impaired renal function significantly improves renal functional status manifested according to the preoperative and postoperative difference of serum creatinine and 99mTc DTPA performance.&#x0D; JCMCTA 2019 ; 30 (2) : 70-74

Renal cortical thickness as an indicator of renal insufficiency in chronic kidney disease

Background Chronic kidney disease (CKD) is one of the common causes of renal failure. Renal sonography is an essential diagnostic tool in nephrology. Renal sonographic dimensional parameters could be of great utility, providing indirect but valuable information about the morphostructural changes occurring in the kidney in the course of CKD. Aim To determine whether there is a relationship between renal cortical thickness and renal length measured on ultrasound and the degree of renal insufficiency in patients with CKD. Patients and methods From December 2016 to October 2017, 50 patients with clinically stable chronic renal insufficiency participated in this study. Renal sonographic parameters including length of the kidney, cortical thickness, and renal echogenicity were measured. Serum creatinine was used for estimated glomerular filtration rate using Cockcroft and Gault equation for all patients. Results The most common cause of CKD in our patients was systemic lupus (22%) followed by hypertension (16%). The mean renal length was 97.6 ± 12.2 mm, the mean cortical thickness was 9.38 ± 1.79 mm, the mean serum creatinine level was 2.46 ± 1.74 mg/dl, and the mean value of estimated glomerular filtration rate using Cockcroft and Gault equation was 60.95 ± 53.78 ml/min. There was a high statistically significant relationship between cortical thickness and creatinine clearance (r = 0.67,P Conclusion Renal cortical thickness measured at ultrasound appears to be more closely related to the degree of renal impairment in patients with CKD than renal length.

MRI of Acute Gynecologic Conditions.

Although usually not a first-line imaging modality in the setting of acute pelvic pain, magnetic resonance imaging (MRI) is able to depict and characterize a wide range gynecologic diagnoses with high accuracy. Lack of ionizing radiation renders MRI particularly useful for assessment of pregnant women and children. Furthermore, inherent high soft-tissue resolution of MRI allows accurate diagnosis without intravenous contrast use, which is advantageous for patients with renal insufficiency and pregnant patients. Familiarity with the typical MRI appearance of various acute gynecologic conditions helps establish the correct diagnosis. This article reviews the common MRI findings of acute gynecologic processes, in both pregnant and nonpregnant patients. Level of Evidence: 3 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2020;51:1291-1309.

2394. A Longitudinal Study of the Effect of Renal Failure on Readmission Rates of Patients with Clostridioides difficile

Background Clostridioides difficile Infection (CDI) is a highly contagious bacterium that can be transferred from an infected surface. In this study, the Nationwide Readmissions Database was used to assess the risk of 30-, 60-, and 90-day readmissions in patients with comorbid CDI and renal failure (RF).MethodsUsing the Nationwide Inpatient Sample (NIS, 35 million hospitalizations/year) and the Nationwide Readmissions Database (NRD, 36 million/year), CDI in renal insufficient patients were identified. Years 2001–2014 of the NIS, as well as years 2010–2014 of the NRD were used for analysis. Chronic kidney disease (CKD) was based on the stage of the disease using IDC-9-CM coding (585.1–585.5). ICD-9-CM 585.6 was used for end-stage renal disease (ESRD). All analyses were done in R version 3.4.3.ResultsOver the 14 year period, the proportion of inpatients with CDI and RF increased from 0.004% (95% CI, 0.0038%-0.0042%) to 0.010% (95% CI, 0.0100%-0.0104%) in 2014. Inpatient RF and CDI increased a mean of 220,827 people over the 14 years. Inpatient CDI and RF prevalence is described as linearly increasing trend (Figure 1). Median age (2001–2014) for RF patients with CDI decreased 5 years to 68 (95% CI, 68–69). Using this model, expected CDI infections in RF to increase to 437,605.1 (95% CI, 427,984.2–447,380.8) hospital inpatients in 2018. In patients with CDI and CKD, ESRD is a significant predictor of 30-, 60-, and 90-day readmission.ConclusionUsing the NIS and NRD identified ESRD patients as a significant predictor of readmission for 30-, 60-, and 90-days. CDI infections in ESRD are expected to increase substantially by 2018. Disclosures All authors: No reported disclosures.

P1487The additive effect of diastolic dysfunction and renal insufficiency on mortality in patients undergoing coronary angiography

Abstract Background Coronary artery disease (CAD) is the leading cause of diastolic dysfunction. Diastolic dysfunction is associated with adverse outcomes. Renal insufficiency is also associated with adverse outcomes in CAD patients. The interaction between diastolic dysfunction and renal insufficiency is not completely elucidated. Aims We evaluated the prognostic value of diastolic function assessed by echocardiography in patients with and without renal failure undergoing coronary angiography. Patients and methods An observational prospective study of 547 consecutive patients undergoing coronary angiography. The median follow up was 30 months. Significant diastolic dysfunction was defined as elevated LV filling pressure with e/e'&gt;12. Renal insufficiency was defined as adjusted GFR&lt;60 ml/min. One hundred seventy-nine patients (32.7%) had significant diastolic dysfunction and 259 (47.3%) had renal insufficiency. Patients were categorized into 4 groups according to the presence of both significant diastolic dysfunction and renal insufficiency (Table 1). Results Significant diastolic dysfunction and renal insufficiency had additive effect on mortality (Table 1). A significant association was observed between diastolic dysfunction and mortality in patients with and without renal insufficiency (p&lt;0.0001 &amp; p=0.005, respectively). The presence of either diastolic dysfunction or renal insufficiency was associated with mortality (Figure 1), with the combination of both leading to the highest mortality (p&lt;0.0001). In Cox regression model which combined diastolic dysfunction, presence of AF, LVEF, obstructive coronary disease on angiography, presence of acute coronary syndrome and renal insufficiency, both elevated filling pressure and renal insufficiency were independently associated with higher mortality (HR 2.65, CI 1.65–4.24, p&lt;0.001 and HR 2.92, CI 1.72–4.98, p&lt;0.0001, respectively). Table 1. Patients divided into 4 groups according to the presence of the significant diastolic dysfunction and renal insufficiency Patients' group N (%) Mortality Normal LV filling pressure / Normal renal function 230 (42.0%) 4.8% Elevated LV filling pressure / Normal renal function 58 (10.6%) 15.5% Normal LV filling pressure / Renal insufficiency 138 (25.2%) 15.9% Elevated LV filling pressure / Renal insufficiency 121 (22.1%) 38.8% P&lt;0.0001 in Pearson Chi-Square. Fugure 1 Conclusions In patients undergoing coronary angiography, significant diastolic dysfunction with elevated filling pressure is associated with mortality in patients both with and without renal insufficiency. Both significant diastolic dysfunction and renal insufficiency are independent predictors of mortality.

Abstract 105: Blood Pressure Variation and Renal Functional Changes in Chronic Renal Insufficiency Patients With or Without Diabetes in a Large Cohort Study

Hypertension and diabetes mellitus (DM) are leading causes for chronic kidney disease (CKD). Regardless, interplays of blood pressure, diabetes status, and renal function are largely unknown. We hypothesize that systolic blood pressure (SBP) variation affects renal function disproportionally in CKD patients with or without DM. Data from the Chronic Renal Insufficiency Cohort Study (CRIC) that enrolled 3,939 participants with CKD aged 21-74 years and followed between 2003-2013 were used. SBP was categorized into 3 levels over time: ≤120 as low, 121-140 as medium, and &gt;141 as high, and relationship of these SBP levels with four renal indices in DM versus non-DM patients was analyzed using Generalized Estimating Equation (GEE) and Curve Fitting methods. Regression results showed that after controlling for confounding factors, for each category of low, medium or high SBP, the predicted eGFR was 4.5, 3.4 and 3.1 units lower for DM comparing to non-DM patients (p&lt;0.01), respectively. Similarly, albuminuria was 0.19, 0.54 and 0.76 units higher (p&lt;0.01), serum creatinine was 0.43, 0.33 and 0.29 units higher (p&lt;0.01), and urinary creatinine was 5.24, 6.27 and 7.37 units lower (p&lt;0.01) with DM comparing to without DM for low to high SBP, respectively. Curve Fitting results showed that slopes of curves for eGFR at all SBP levels were similar for DM and non-DM patients. In contrast, the slopes for albuminuria curve in all SBP levels was much steeper for DM comparing to non-DM patients. Thus, while renal function is worse in CKD patients with DM comparing to non-DM at any given SBP, lowering blood pressure may improve renal function with bigger beneficial effects on albuminuria in CKD patients with DM.

Renal artery bypass including aortic graft for renovascular hypertension

Abstract Background Renal artery stenosis (RAS) is a rare renal manifestation of tuberous sclerosis (TS). In children, it leads to renovascular hypertension that can be managed medically or surgically. It becomes challenging to treat when other vascular anomalies coexist. Case presentation A 7-year old Caucasian boy with TS presented with hypertension. Renal angiogram showed left RAS and infrarenal abdominal aortic aneurysm (AAA). After percutaneous transluminal angioplasty (PTA) failed to control his renovascular hypertension, we elected to perform renal artery bypass and aortic graft repair of the AAA. In nine years of follow up, he maintained good blood pressure (BP) control with oral antihypertensive medications and required PTA only once for renal artery bypass graft stenosis. Conclusion We present a case of TS associated RAS and AAA treated by renal artery bypass and aortic graft repair with favorable outcome. Our surgical approach may delay progression of renal insufficiency in patients with renovascular hypertension and TS.

SUN-284 STUDY OF CLINICAL SIGNIFICANCE OF UNRECOGNIZED RENAL DYSFUNCTION IN PATIENTS WITH ACUTE STROKE

STUDY OF CLINICAL SIGNIFICANCE OF UNRECOGNIZED RENAL DYSFUNCTION IN PATIENTS WITH ACUTE STROKE Unrecognized renal insufficiency, defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2 in the presence of normal serum creatinine levels, is a common co morbid condition among patients with various cardiovascular conditions. Epidemiological study demonstrated that renal insufficiency forecast long-term mortality and hence can be used to stratify risk for stroke patients. Our purpose of study is to evaluate the prevalence and clinical significance of unrecognized renal dysfunction in patients admitted with acute stroke. STUDY DESIGN: Cross sectional prospective study. STUDY DURATION: March 2017 to August 2017. INCLUSION CRITERIA: All patients admitted with acute stroke . EXCLUSION CRITERIA: Acute stroke in < 18 years ,Head injury. MATERIAL & METHODS: Our study group consisted of 100 patients with acute stroke admitted in Stanley Medical College. The detailed history of the patients has been recorded and patients underwent a detailed clinical examination. Appropiate investigations were done. The estimated glomerular filtration rate is calculated using the MDRD and CKD-EPI equation. The study groups are stratified into 3 groups according to the renal function assessment (normal renal Function, unrecognized renal insufficiency and recognized renal insufficiency). Out of the 100 patients with acute stroke included in the study, 62 have normal renal function, 31 have recognized renal insufficiency, and 7 have unrecognized renal insufficiency. Majority of the study subjects in normal renal function group were males (n=48), females in unrecognized renal insufficiency group (n=7) and males in recognized renal insufficiency group (n=24). Using single factor ANOVA test, age distribution,the mean difference of blood urea values and serum creatinine values, the mean difference of MDRD values and CKD-EPI values, the mean difference of systolic blood pressure and diastolic blood pressure ,the mean difference of hemoglobin, the mean difference of random blood sugar values were found to be statistically significant (p <0.05). Using fishers exact test,the difference in percentage of females, the difference in percentage of diabetics, the difference in percentage of subjects with dyslipidemia were found to be statistically significant (p < 0.05) In our study, modified Rankin score(MRS) was significantly higher in patients with recognized renal insufficiency compared to unrecognized renal insufficiency patients. Mortality rates are higher in patients with recognized and unrecognized renal insufficiency compared with patients with normal renal function (29%, 28.5% and 9.6% respectively, p< 0.05). Severe disability rates at discharge are also higher in patients with recognized and unrecognized renal insufficiency compared with patients with normal renal function (72.27%, 80 %, and 32.14%) respectively, p<0.05. 1. Unrecognized renal insufficiency is found to be a common co morbidity among patients with acute stroke in our study.2. Unrecognized renal insufficiency is significantly common among older age group and more frequently in females compared to male in our study group. 3. Mortality rate and severe disability rate are higher in patients with recognized and unrecognized renal insufficiency compared to patients with normal renal function.

Myoglobinuria and acute renal insufficiency in patients with electrocution

This article presents a partial bioarchaeology of care case study of a mummified adult female with chronic obstructive pulmonary disease (COPD) from late historic period United States. It examines likely clinical and functional impacts of disease and corresponding need for provision of care, stopping short of Stage 4 Interpretation/analysis. The case study illustrates and argues for the importance of an interdisciplinary research team for achieving a comprehensive understanding of disability and care. The article highlights the necessity of knowledge of pathophysiology for identifying the potential interventions (supports) dictated by the associated functional limitations. inter alia, this case is a powerful illustration of the way analysis of preserved soft tissue can provide insights into disease and likely care that are inaccessible using skeletal analysis alone. The article represents an interesting contribution to the theory and methodology of both the bioarchaeology of care approach and mummy studies.

The value of serum cystatin C in early evaluation of renal insufficiency in patients undergoing chemotherapy: a systematic review and meta-analysis.

Several studies have shown that cystatin C levels can be used to detect decline in renal function in cancer patients receiving chemotherapy, and can serve as a supplement to creatinine level measurement for early detection of renal insufficiency. Nevertheless, use of the parameter remains controversial. This study aimed to assess the value of serum cystatin C levels in evaluation of early renal insufficiency due to chemotherapy. Studies were retrieved from PubMed, Ovid Embase, the Web of Science, the Cochrane Library, Ovid, and the CNKI databases up to May 15, 2018. Serum levels of cystatin C before and after chemotherapy were evaluated for its ability to assess renal function. A total of 12 studies, including 1775 participants, met our inclusion and exclusion criteria. Pooled analysis revealed that the levels of serum cystatin C in cancer patients after chemotherapy were significantly higher than those of patients prior to treatment [standard mean difference (SMD) = 0.54, 95% CI 0.34-0.74, P = 0.0000]. Compared to creatinine, serum cystatin C increased significantly in the early phases of glomerular filtration rate (GFR) change before and after chemotherapy (GFR ≥ 90ml/min/1.73m2, P < 0.05 vs. P > 0.05, 5.83%; 60 < GFR < 90ml/min/1.73m2, P < 0.01 vs. P > 0.01, 38.83%) and increased more substantially in the later phases (GFR < 60ml/min/1.73m2, P < 0.01 vs. P < 0.01, 70.87% vs. 23.09%). However, creatinine decreased even in the early phases and did not increase in an obvious manner until the later phases (GFR < 60ml/min/1.73m2, P < 0.01, 23.09%). The GFR values were derived from measured methods. Cystatin C may be superior to creatinine for the detection of minor changes in GFR in early stages of renal insufficiency secondary to chemotherapy. More studies are needed to further verify this result.

The Value of Serum Levels of Apela and Cystatin C in Evaluation of Renal Insufficiency in Patients with Heart Failure

Objective: To explore the value of serum levels of Apela and Cystatin C (Cys-C) in evaluation of renal insufficiency in patients with heart failure (HF). Methods: Total 89 patients were divided into HF with normal renal function group (HF group, 20 cases); HF with renal insufficiency (RI) in compensatory stage group (HF with compensatory RI group, 40 cases); HF with RI in decompensatory stage group (HF with decompensatory RI group, 29 cases). The serum concentration of Apela, Cys-C and nitrogen-terminal pro-brain natriuretic peptide (NT-pro BNP) was detected by ELISA, and left ventricular ejection fraction (LVEF) was determined by echocardiography. Results: The LVEF level was significantly lower (43.1% ± 1.7% vs. 48.9% ± 2.0%, P < 0.05), but the average level of NT-pro BNP (6174 ± 1002 pg/ml vs. 3400 ± 661.3 pg/ml, P < 0.05) was remarkably higher in HF with decompensatory RI group than that in HF group. With the deterioration of renal function in patients with heart failure, the levels of BUN, Cr and Cys-C increased gradually, while the levels of eGFR decreased gradually. Compared to HF group (0.84 ± 0.55 ng/ml), the serum level of Apela was higher in patients with compensatory (1.16 ± 0.34 ng/ml) or decompensatory RI (1.23 ± 0.53 ng/ml). The serum Cys-C level was negatively correlated with eGFR (r = −0.7763, p < 0.0001). Conclusion: With the occurrence of RI in HF patients, serum Apela and Cys-C increased gradually, and the level of serum Cys-C was well correlated with eGFR. It suggested that endogenous Apela and Cys-C levels could be used as biomarkers for evaluating early RI in patients with heart failure.

Roles of contrast-enhanced ultrasound and diffusion-weighted magnetic resonance imaging and their comparison in solid space-occupying lesions of the liver – Microbubbles and micromovements in imaging

Aims: This study aims to establish the role of contrast-enhanced ultrasound (CEUS) and diffusion-weighted (DW) magnetic resonance imaging (MRI) in the characterization of solid liver lesions. Settings and Design: An analysis of 22 patients undergoing CEUS and DW MRI following identification of 1 or more solid liver lesions on conventional ultrasonography. Subjects and Methods: The study is carried in a standard Doppler ultrasound machine with contrast ultrasound capabilities and 1.5T MRI machine over a period of 2 years from July 2015 to June 2017. After baseline US examination, a bolus of 1.0–2.4 ml of ultrasound contrast agent was administered intravenously followed by 10 ml of saline flush. CEUS images were obtained during arterial, portal venous, and delayed phases. After CEUS, patient is transferred to MRI scanning room where the DW imaging (DWI) sequence is taken. The CEUS and DW MRI diagnosis were compared to other imaging modalities, histopathology, and/or clinical follow-up after 12 months. Statistical Analysis Used: Sensitivity, specificity, positive predictive value, negative predictive value, accuracy rate and receiver operating characteristic analysis curve was performed using Statistical Package – SPSS ver. 17.0. Statistical evaluation of qualitative analysis between benign and malignant lesions was performed using the Fisher's exact test. Results: CEUS correctly identified malignant liver lesions in 13 out of 14 cases, with the final diagnosis confirmed by histopathology in 6 cases, by other imaging modalities in 7 cases and follow-up in 1 case. Eight patients were correctly identified as benign liver lesions on CEUS imaging, with all these cases confirmed on other imaging modalities and/or follow-up and two cases by histopathology. In the detection of malignancy, the sensitivity is 86.7% and specificity is 100%. On the DW images the Mean apparent diffusion coefficient (ADC) value for benign lesions is 1.5 and mean ADC value for malignant lesions is 0.7. The ADC was significantly higher in benign lesions than in malignant lesions (P < 0.01). Conclusions: In our experience, CEUS and DWI with ADC values are highly accurate in confirming benign lesions, early detection of malignant lesions, and metastases in known primary malignancy patients. Other advantage of CEUS and DW MRI is that it is also cost-effective as compared to simultaneously performing individual investigations and can be performed in renal insufficiency patients. Hence, we conclude that CEUS and DW MRI sequence should be used in routine practice.

Pathological spectrum of glomerular disease in patients with renal insufficiency: a single-center study in Northeastern China

Background: To investigate the pathological spectrum of glomerular disease in patients with renal insufficiency (RI) from 2008 to 2017.Methods and results: We calculated the estimated glomerular filtration rate (eGFR) with the Chronic Kidney Disease Epidemiology Collaboration creatinine (CKD-EPI) equation and defined RI as an eGFR <60 ml/min/1.73 m2. A total of 969 RI patients were included in our study. IgA nephropathy (IgAN) was the most common subtype of primary glomerulonephritis (37.2%). The frequencies of IgAN and non-IgA mesangioproliferative glomerulonephritis decreased from 27.3% and 9.5% during 2008–2012 to 20.7% and 2.6% during 2013–2017, respectively. However, the frequency of membranous nephropathy increased from 6.8% to 16.2%. Lupus nephritis was the most common subtype of secondary glomerulonephritis (32.1%). The frequencies of both ANCA-associated systemic vasculitis and diabetic nephropathy increased from 3.8% to 7.6% and from 4.3% to 7.6%, respectively. The number of elderly patients (≥60 years) in our study increased sharply, from 15.6% in 2008 to 35.0% in 2017. Membranous nephropathy, minimal change disease, membranoproliferative glomerulonephritis, lupus nephritis and renal amyloidosis are more frequently observed in the elderly patients than in nonelderly patients (<60 years) (p < .05). Excluding those with acute kidney injury, IgAN was the leading cause of RI (24.9%), followed by membranous nephropathy (13.3%) and lupus nephritis (12.0%).Conclusions: IgAN and lupus nephritis were the most prevalent primary glomerulonephritis and secondary glomerulonephritis in patients with RI, respectively. The frequencies of membranous nephropathy, ANCA-associated systemic vasculitis and diabetic nephropathy increased significantly. The number of elderly patients with RI increased sharply.

Prediction of kidney damage in the syndrome of intra-abdominal hypertension

The syndrome of intra-abdominal hypertension and abdominal compartment syndrome can complicate the course of many surgical abdominal diseases and lead to the development and progression of multiple organ failure. In particular, impaired renal blood flow is an early and significant pathogenetic link of thanatogenesis in such patients. Mortality at an abdominal compartment syndrome reaches very significant figures — 42–68% and without treatment approaches 100%. The purpose of the work is to predict renal failure in patients with intra-abdominal hypertension syndrome and abdominal compartment syndrome. A survey of 40 patients with acute surgical abdominal pathology and signs of intra-abdominal hypertension was performed. Blood pressure measurement was performed according to the recommendations of the conciliation commission on the problem of intra-abdominal hypertension syndrome (SIGA) from 2004. Also, the calculation of perfusion pressure of the abdominal cavity was performed, which is the difference between mean arterial pressure and intraabdominal pressure. The level of perfusion pressure is less than 60 mm Hg. Art. correlates with survival of patients. Determination of cystatin C was performed in the first 48 hours after hospitalization of patients in VAIT. The calculation of the results was carried out according to the standard t-criterion calculation formulas in the Exel tables. It was found that of 40 patients died — 13, and survived — 27. The reliable difference between the indicators of intra-abdominal pressure in surviving and deceased patients was acquired only at the end of the third day of observation, whereas the abdominal perfusion pressure indices significantly differed already in the first day. In the analysis of cytatine C in surviving patients, the biomarker values were 1,299±0.827, whereas in those who died 1,882±0.828, the statistical deviation was significant at p≤0.05. Thus: the cytosine C score, in combination with the dynamics of abdominal perfusion tick, can be considered as a marker that may predict the development of renal insufficiency in patients with SIGA-AKS.

The Role of Saline and Sodium Bicarbonate Preprocedural Hydration to Prevent Mid-term Renal Insufficiency in Patients with Chronic Kidney Disease Undergoing Percutaneous Coronary Intervention.

Objective Persistent renal damage (RD) three months after exposure to contrast media is associated with contrast-induced acute kidney injury (CI-AKI) and poor clinical outcomes. Little is known about the role of preprocedural hydration on persistent RD in patients with chronic kidney disease [CKD; estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2] undergoing percutaneous coronary intervention (PCI). We therefore examined the use of preprocedural hydration to decrease the incidence of persistent RD. Methods Between 2012 and 2015, 1,230 consecutive patients undergoing PCI, except for patients with an eGFR ≥60 mL/min/1.73 m2, on dialysis, having acute myocardial infarction, or recently having started renin-angiotensin inhibitors, were screened (n=333). Before their index PCI, the 12-h saline group (n=103) received 1 mL/kg/h 0.9% sodium chloride for 12 hours, and the 1-h bicarbonate group (n=63) received 3 mL/kg 154 mEq/L sodium bicarbonate for 1 hour. The control group (n=167) received no pre-procedural hydration. The study outcome of kidney function decline was investigated using the percent-change (%-change) of the calculated creatinine clearance between the baseline value and the lowest value recorded three to six months after index PCI. Results There was less renal function deterioration in the saline group than in the control group, and the bicarbonate group showed deterioration similar to the other groups (%-change; 12-h saline 2.0±11.3% vs. control −5.6±12.6%, p<0.001; vs. 1-h bicarbonate −1.8±14.1%, p=0.18; 1-h bicarbonate vs. control, p=0.14 ANOVA). A multiple regression analysis adjusted for risk factors for persistent RD showed that saline hydration correlated independently with a higher %-change (r=0.262, p<0.001). Conclusion Preprocedural 12-h saline may be better than no preprocedural hydration in preventing mid-term renal insufficiency in CKD patients undergoing PCI.