Risk Factors For Renal Impairment Research Articles

Decline in measured glomerular filtration rate is associated with simple renal cyst in Chinese patients with type 2 diabetes.

Simple renal cysts (SRC) are associated with age, hypertension and hyperuricemia, which are risk factors of renal impairment. This study aimed to investigate the prevalence of SRC and its association with measured glomerular filtration rate (mGFR) in patients with type 2 diabetes mellitus in China. A total of 3,552 patients with type 2 diabetes mellitus admitted to Shanghai Sixth People's Hospital from January 2012 to December 2016 were investigated. All participants were diagnosed as SRC by color Doppler, and all participants were measured for GFR by using dynamic renal scintigraphy with technetium-99m-diethylene triamine peta-acetic acid. The prevalence of SRC was 17.4% (619 cases). Participants with SRC had significantly lower mGFR values than those without SRC (86.16 ± 26.20 vs 94.88 ± 23.98 mL/min/1.73 m2 , P < 0.001). In 478 participants with unilateral renal cyst, the mGFR of the kidney affected by SRC was significantly lower than that of the unaffected kidney (43.32 ± 13.74 vs 44.18 ± 13.34 mL/min/1.73 m2 , P = 0.014). The participants were divided into four groups according to the quartiles of mGFR level (≥109.50, 93.80-109.49, 76.90-93.79 and <76.90 mL/min/1.73 m2 ). The prevalence of SRC gradually increased with decreasing mGFR level (12.9, 13.9, 16.6 and 27.8%, respectively; P trend <0.01). After adjusting for age, sex, duration of diabetes, hypertension and other potential confounders, the logistic regression showed that SRC was an independent risk factor for impaired GFR (<60 mL/min/1.73 m2 ; odds ratio 1.656; 95% confidence interval 1.451-1.890, P < 0.001). SRC is an independent risk factor for the decrease of mGFR in Chinese diabetes patients, and could affect the renal GFR measured by dynamic renal scintigraphy on the SRC side.

Renal safety of zoledronic acid in patients with osteoporosis: a retrospective study.

This study aimed to investigate the renal safety of Zoledronic Acid (ZOL) in patients with osteoporosis (OP). A total of 1379 patients (baseline estimated glomerular filtration rate, eGFR ≥ 60 mL/min/1.73 m2) with primary OP who received ZOL from January 2008 to October 2020 at our hospital were retrospectively analyzed. Baseline and the changes in renal function within 1 year following infusions were collected, the incidence of renal impairment (eGFR < 60 mL/min/1.73 m2 or a > 25% reduction in the eGFR from baseline) was noted and the risk factors were analyzed. Furthermore, the changes in renal function between a 3-year consecutive infusion and a single infusion of ZOL were compared. Renal impairment occurred in 8.05% of patients, who with a significantly higher age, Charlson Comorbidity Index (CCI), smoking history, combination of hypertension or diabetes mellitus and worse renal function indicators (all P < 0.05). Binary logistic regression analysis showed that higher CCI (≥5) or smoking history or the baseline eGFR <90 mL/min/1.73 m2 were the risk factors for renal impairment (all P < 0.05). Patients of 3-year continuous infusion group had a significantly greater drop in the eGFR levels than the single infusion group after 1 year of infusion(s) (P < 0.05). Attention should be given to possible potential renal impairment following ZOL infusion in clinical practice for the management of OP, particularly in patients with higher CCI (≥5) or smoking history or the baseline eGFR <90 mL/min/1.73 m2. Continuous infusion of ZOL exerts a significant impact on renal function when compared to single infusion and intensive monitoring of renal function is necessary.

Prevalence and risk factors for impaired renal function among Asian patients with nonalcoholic fatty liver disease

BackgroundNonalcoholic fatty liver disease (NAFLD) is associated with impaired renal function, and both diseases often occur alongside other metabolic disorders. However, the prevalence and risk factors for impaired renal function in patients with NAFLD remain unclear. The objective of this study was to identify the prevalence and risk factors for renal impairment in NAFLD patients. MethodsAll adults aged 18–70 years with ultrasound-diagnosed NAFLD and transient elastography examination from eight Asian centers were enrolled in this prospective study. Liver fibrosis and cirrhosis were assessed by FibroScan-aspartate aminotransferase (FAST), Agile 3+ and Agile 4 scores. Impaired renal function and chronic kidney disease (CKD) were defined by an estimated glomerular filtration rate (eGFR) with value of < 90 mL/min/1.73 m2 and < 60 mL/min/1.73 m2, respectively, as estimated by the CKD-Epidemiology Collaboration (CKD-EPI) equation. ResultsAmong 529 included NAFLD patients, the prevalence rates of impaired renal function and CKD were 37.4% and 4.9%, respectively. In multivariate analysis, a moderate-high risk of advanced liver fibrosis and cirrhosis according to Agile 3+ and Agile 4 scores were independent risk factors for CKD (P< 0.05). Furthermore, increased fasting plasma glucose (FPG) and blood pressure were significantly associated with impaired renal function after controlling for the other components of metabolic syndrome (P< 0.05). Compared with patients with normoglycemia, those with prediabetes [FPG ≥ 5.6 mmol/L or hemoglobin A1c (HbA1c) ≥ 5.7%] were more likely to have impaired renal function (P< 0.05). ConclusionsAgile 3+ and Agile 4 are reliable for identifying NAFLD patients with high risk of CKD. Early glycemic control in the prediabetic stage might have a potential renoprotective role in these patients.

The relationship between obstructive sleep apnea and risk of renal impairment in patients with hypertension, a longitudinal study

ObjectiveAssociation of obstructive sleep apnea (OSA) with renal damage is undetermined, especially in the population with hypertension, a high-risk group for chronic kidney disease. Therefore, we aimed to explore whether OSA is an independent risk factor for renal impairment in patients with hypertension, by considering the effects of gender, age, obesity and OSA severity. MethodsThe longitudinal observational study included patients with hypertension and suspected OSA without renal damage at baseline who visited Hypertension Center between January 2011 and December 2018, and followed up till renal outcomes, death, loss to follow-up, or May 31, 2022, using annual health check-ups, hospital readmission or out-patient visits. Main renal outcome was chronic kidney disease (CKD), defined as estimated glomerular filtration rate <60 ml/min per 1.73 m2 and/or positive proteinuria. Cox proportional hazard models were used to evaluate the association, and repeated after propensity score matching. Sensitivity analysis were performed by excluding those with primary aldosteronism. Results7961 patients with hypertension were included with 5022 ones with OSA, and 82% were followed up. During median follow-up of 3.42 years, 1486 patients developed CKD. Per 1000 person-year incidence of CKD was 56.72 in OSA group. In Cox regression analysis, OSA and severe OSA group respectively showed 1.21 (95% CI: 1.08−1.35) and 1.27 (95% CI: 1.09−1.47) fold risk for CKD in total, compared with non-OSA group. Overall results remained consistent in propensity score matching and sensitivity analysis. ConclusionOSA is independently associated with higher risk of chronic kidney disease in hypertension.

Impact of Renal Function on the Prognosis of Patients Receiving Atezolizumab/Bevacizumab Combination Therapy and Lenvatinib Monotherapy for Unresectable Hepatocellular Carcinoma

Introduction: Several studies have reported kidney injury caused by immune checkpoint inhibitors, and proteinuria caused by vascular endothelial growth factor inhibitors for unresectable hepatocellular carcinoma (u-HCC). We investigated the relationship between renal function and prognosis in patients with u-HCC receiving atezolizumab and bevacizumab (AB) and lenvatinib (LEN) therapy. Methods: Fifty-one patients who received AB and 50 patients who received LEN therapy were included. We analyzed prognostic factors related to the overall survival (OS), and characteristics related to renal function. Results: In patients with AB therapy, OS was shorter in patients with baseline proteinuria of 1+ or higher, as assessed by urine dipstick test, compared to those with –/± (p = 0.024). There were many cases with two or more drugs with a high risk of renal dysfunction (p = 0.019) in patients with 1+ or higher. Furthermore, OS was shorter in the group with estimated glomerular filtration rate (eGFR) grade deterioration without urinary protein-creatinine ratio (UPCR) of 2 g/g·Cre or higher than in the other groups (p = 0.027). In the group where eGFR worsened without an increase in UPCR, there were many cases with a daily salt intake of 10 g or more (p = 0.027), three or more drugs with a high risk of renal dysfunction (p = 0.021), and a history of arteriosclerosis (p = 0.021). On the other hand, in patients with LEN therapy, OS tends to be shorter in patients with proteinuria of ± or higher, compared to those without (p = 0.074). There were many cases with a daily salt intake of 10 g or more in patients with ± or higher (p = 0.002). Conclusion: In patients receiving AB and LEN therapy, baseline proteinuria was associated with OS. Renal function deterioration without proteinuria was associated with a poor prognosis in AB therapy. Excessive salt intake, preexisting atherosclerotic disease, and drug with a high risk of renal dysfunction were risk factors for renal deterioration.

MP32-08 AORTIC CALCIFICATION BURDEN IS ASSOCIATED WITH AN INCREASED RISK OF ACUTE KIDNEY INJURY IN PATIENTS WHO UNDERGOING RADICAL CYSTECTOMY: A MULTI-INSTITUTIONAL RETROSPECTIVE COHORT STUDY

You have accessJournal of UrologyCME1 Apr 2023MP32-08 AORTIC CALCIFICATION BURDEN IS ASSOCIATED WITH AN INCREASED RISK OF ACUTE KIDNEY INJURY IN PATIENTS WHO UNDERGOING RADICAL CYSTECTOMY: A MULTI-INSTITUTIONAL RETROSPECTIVE COHORT STUDY Naoki Fujita, Masaki Momota, Hirotaka Horiguchi, Shingo Hatakeyama, Hiroyuki Ito, Takahiro Yoneyam, Yasuhiro Hashimoto, Shoji Nishimura, Kazuaki Yoshikawa, and Chikara Ohyama Naoki FujitaNaoki Fujita More articles by this author , Masaki MomotaMasaki Momota More articles by this author , Hirotaka HoriguchiHirotaka Horiguchi More articles by this author , Shingo HatakeyamaShingo Hatakeyama More articles by this author , Hiroyuki ItoHiroyuki Ito More articles by this author , Takahiro YoneyamTakahiro Yoneyam More articles by this author , Yasuhiro HashimotoYasuhiro Hashimoto More articles by this author , Shoji NishimuraShoji Nishimura More articles by this author , Kazuaki YoshikawaKazuaki Yoshikawa More articles by this author , and Chikara OhyamaChikara Ohyama More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003265.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although acute kidney injury (AKI) is one of the frequent complications in patients undergoing radical cystectomy (RC), its risk factors remain unclear. As arterial degradation is suggested to be a risk factor for renal impairment, we hypothesized that preexisting aortic calcification may play a crucial role in AKI development. METHODS: This multi-institutional retrospective cohort study included 616 patients with muscle invasive bladder cancer who underwent RC between September 1998 and April 2022. Aortic calcification burden was quantified with aortic calcification index using preoperative computed tomography scan (ACI, %) (Fig. A). Patients were divided into two groups: lower ACI (ACI <25%) and higher ACI groups (ACI ≥25%). AKI was defined according to the KDIGO criteria. Multivariable logistic regression analysis was performed to evaluate the association between aortic calcification burden and the risk of AKI. RESULTS: Of 616 patients, 248 (40%) were classified as the higher ACI group and 335 (54%) developed to AKI (any stage). Rate of AKI development in the higher ACI group was significantly higher than that of the lower ACI group (Fig. B; p<0.001). ACI in patients who developed AKI was significantly higher than that in patients who did not (Fig. C; p<0.001). In univariable analyses, age, performance status, body mass index, hypertension, cardiovascular disease, renal function, neobladder reconstruction, and ACI were associated with AKI development (Table 1). After adjustment for these confounding variables, ACI was selected as a significant independent risk factor for AKI development (Table 2; odds ratio 1.534, p=0.023). CONCLUSIONS: High aortic calcification burden is a risk factor for AKI in patients who undergoing RC. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e443 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Naoki Fujita More articles by this author Masaki Momota More articles by this author Hirotaka Horiguchi More articles by this author Shingo Hatakeyama More articles by this author Hiroyuki Ito More articles by this author Takahiro Yoneyam More articles by this author Yasuhiro Hashimoto More articles by this author Shoji Nishimura More articles by this author Kazuaki Yoshikawa More articles by this author Chikara Ohyama More articles by this author Expand All Advertisement PDF downloadLoading ...

Impact of Cigarette Smoking on Serum Cystatin C and Creatinine Levels and MAU: A Case-Control Study

Background: Smoking-related hemodynamic events may adversely influence renal function. The aim of this study was to evaluate renal impairment biomarkers among healthy people influenced by cigarette smoke. Methods and Results: In this case-control study, 90 subjects were enrolled: 60 were smokers, and 30 were non-smokers (apparently healthy control). Serum CysC was measured using a semi-automated, specific protein analyzer Mispa-i2 (Germany). Serum creatinine and MAU were assayed in the fully automated biochemistry analyzer (Mindray BS380). The mean concentration of CysC was significantly higher in cigarette smokers than in non-smokers (0.793±0.125 vs. 0.619±0.103, P=0.000). Also, the mean of MAU and serum creatinine levels were significantly higher in cigarette smokers than in non-smokers (18.33±3.41 vs. 12.70±0.517, 1.06±0.161 vs. 0.810±0.058, respectively, P=0.000 in both cases). The mean concentration of CysC and MAU was significantly greater in heavy smokers than in light smokers (P=0.000 and P=0.001, respectively). Serum CysC and MAU levels were positively correlated with the age of cigarette smokers (r=0.734 and r=0.730, respectively; P=0.000 in both cases) and the duration of smoking (r=0.773 and r=0.790, respectively; P=0.000 in both cases). Conclusion: cigarette smoking increases the specific renal biomarkers considered risk factors for renal impairment. Using such inflammatory biomarkers as diagnostic tools can be a necessary precaution in the development of chronic kidney disease caused by smoking and in the avoidance of acute renal consequences linked to cigarette smoking.

Decline in kidney function greater with longer exposure to lithium

Research using data from two cohort studies in Sweden has concluded that after 10 years of exposure to lithium, risk of decline in kidney function in patients with bipolar disorder or schizoaffective disorder increases considerably compared with patients exposed for shorter periods or the general population. The study found that neither disorder is an independent risk factor for renal impairment. Results were published online Sept. 12, 2022, in Lancet Psychiatry.

Competitive interaction between smoking and chronic obstructive pulmonary disease for explaining renal function reduction in hypertensive patients.

Chronic kidney disease is a risk factor for cardiovascular events. Smoking and chronic obstructive pulmonary disease (COPD) are risk factors for renal impairment. The aim of this study was to test the combined effect of smoking and COPD on renal function decline in hypertensives. We enrolled 1728 hypertensives stratified by smoking status and presence/absence of COPD. To test the mutual effect modification by both smoking and COPD and e-GFR, we performed crude and adjusted linear regression analyses, these latter taking into account potential confounders. Smokers displayed significantly lower e-GFR values than non-smokers (90 ± 24 vs. 121 ± 35ml/min/1.73m2); this difference was confirmed when comparing e-GFR values between patients with/without COPD (81 ± 17 vs. 109 ± 32ml/min/1.73m2). Smoking and COPD were directly and significantly interrelated (Cramer's V coefficient = 0.200; P = < 0.001). At interaction analyses, smoking significantly modified the effect of COPD on e-GFR and COPD significantly modified the effect of smoking on e-GFR, indicating a competitive interaction between smoking and COPD in the appearance of renal damage. e-GFR was 35ml/min/1.73m2 lower in patients with COPD than in those without; this reduction was of higher magnitude than that found between COPD and COPD-free patients among smokers (19ml/min/1.73m2). Smoking and COPD competitively interact in the appearance of renal function decline. These results suggest to screen for kidney damageboth smokers and COPD patients, especially those with both conditions.

Diverting ileostomy is a risk factor for renal impairment during CAPOX therapy.

Temporary ileostomy is sometimes created after colorectal surgery and may cause renal impairment. However, the impact of ileostomy on renal function during adjuvant chemotherapy for colorectal cancer (CRC) remains unknown. The aim of the present study was to examine the effects of ileostomy on renal function during adjuvant chemotherapy. We examined 184 patients who received adjuvant CAPOX therapy (capecitabine and oxaliplatin) for CRC with or without ileostomy between January 2011 and December 2020 at the University of Tokyo Hospital. Clinicopathological factors, including renal function, were retrospectively reviewed in association with temporary ileostomy. Factors associated with reductions in the estimated glomerular filtration rate (eGFR) during CAPOX therapy were analyzed. Eighteen patients (10%) underwent temporary ileostomy. The maximum decrease in eGFR during CAPOX therapy was significantly higher in patients with than in those without ileostomy (-16.1 vs. -5.6mL/min/1.73m2, p = 0.003). A multivariate analysis identified ileostomy as one of factors independently associated with reductions in eGFR during CAPOX therapy (p = 0.003). The cumulative number of readmission due to dehydration was also higher in patients with ileostomy (33% vs. 1%, p < 0.001). Ileostomy significantly reduced eGFR during adjuvant CAPOX therapy. Therefore, renal function needs to be monitored during CAPOX therapy, particularly in patients with ileostomy.

Risk factors for renal impairment in patients with hematological cancer receiving antineoplastic treatment.

Antineoplastic treatments, mainly chemotherapy, affect the kidneys, causing toxicity, and can trigger acute and chronic kidney injuries. This study aimed to analyze the prevalence of renal disorders in patients with oncohematological neoplasms receiving antineoplastic treatment. This retrospective cohort study included 75 patients with hematological cancer who underwent chemotherapy between 2012 and 2018 in the Hematology Sector of the Walter Cantídeo University Hospital of the Federal University of Ceará. Sociodemographic and clinical data, blood biochemical assessment findings, and glomerular filtration rate (GFR) were analyzed using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. The data were tabulated; transferred to the Statistical Package for the Social Sciences software, version 20.0; and analyzed using Pearson's chi-square test or Fisher's exact test for categorical variables followed by a multinomial logistic regression model (p < 0.05). The prevalence of renal disorders was 52.4% according to the CKD-EPI equation for GFR events. There was a significant association between the decrease in GFRs and the following variables: female sex (p = 0.002), diagnosis of multiple myeloma (p = 0.008), start of treatment within 40days (p = 0.005), and the following antineoplastic treatments: cyclophosphamide, vincristine, and prednisone (p = 0.026); irarubicin (p = 0.032); azacytidine, dexamethasone, and cyclophosphamide (p < 0.001); zoledronic acid (p < 0.001); and pamidronate (p = 0.012). CALGB 8811 (p < 0.001) was inversely associated with a reduction in the GFR. The prevalence of renal disorders was high in patients with oncohematological neoplasms receiving antineoplastic treatment. This requires periodic monitoring of the evaluation of renal function since reductions in GFRs were significantly associated with different treatment protocols used.

Uric Acid and Impairment of Renal Function in Non-diabetic Hypertensive Patients.

Hyperuricemia is a risk factor for renal impairment. However, investigations focusing on patients with hypertension are limited and inconsistent. A single-center prospective cohort study of 411 Han Chinese non-diabetic hypertensive patients was conducted in Taiwan. The mean age of the participants was 62.0 ±14.4 years. The baseline estimated glomerular filtration rate and uric acid level were 86 mL/min/1.73 m2 and 6.2 mg/dL, respectively. All patients underwent serum biochemistry tests for creatinine levels every 3 months. Renal events were defined as >25% and >50% decline in estimated glomerular filtration rate. During an average follow-up period of 4.7 ± 2.9 years (median 4.0 years), a >25 and >50% decline in estimated glomerular filtration rate was noted in 52 and 11 patients, respectively. The multivariate Cox regression analysis revealed that a baseline uric acid level ≥8.0 mg/dL increased the risk of >25% decline (hazard ratio: 3.541; 95% confidence interval: 1.655–7.574, P = 0.001) and >50% decline (hazard ratio: 6.995; 95% confidence interval: 1.309–37.385, P = 0.023) in estimated glomerular filtration rate. Similarly, a baseline uric acid level ≥7.5 mg/dL was independently associated with >25% decline (hazard ratio: 2.789; 95% confidence interval: 1.399–5.560, P = 0.004) and >50% decline (hazard ratio: 6.653; 95% confidence interval: 1.395–31.737, P = 0.017). However, this was not demonstrated at baseline uric acid level ≥7.0 mg/dL. Our study suggests that hyperuricemia is an independent risk factor for the decline in renal function in patients with hypertension. Uric acid level ≥7.5 mg/dL may be considered as the optimal cutoff value for clinical practice in predicting the development of renal impairment.

Analysis of Risk Factors for High-dose Cisplatin-induced Renal Impairment in Head and Neck Cancer Patients.

Concurrent chemoradiotherapy with high-dose cisplatin (CDDP-RT) is the standard therapy for advanced head and neck cancer; however, due to CDDP-induced renal impairment, dose reduction or discontinuation is frequently required. Therefore, the identification of risk factors for renal impairment is of importance to improve the efficacy and safety of CDDP-RT. We retrospectively investigated risk factors for renal impairment in advanced head and neck cancer patients receiving CDDP-RT. Renal impairment was defined as a >25% decrease from baseline in estimated glomerular filtration rate within 14 days after CDDP administration in the first cycle. Of the 82 patients analyzed in this study, 21 (26%) patients developed renal impairment. Multivariate logistic regression analysis showed that concomitant use of a calcium channel blocker or lower hemoglobin levels significantly contributed to the increased risk of CDDP-induced renal impairment (odds ratio=3.60, 95% confidence interval=1.04-12.40; odds ratio=0.71, 95% confidence interval=0.50-0.99, respectively), while concomitant use of proton pump inhibitors was a factor associated with a decreased risk of CDDP-induced renal impairment (odds ratio=0.20, 95% confidence interval=0.04-0.86). Renal function of patients receiving calcium channel blocker or patients with lower hemoglobin levels should be monitored cautiously when receiving CDDP-RT.

Prevalence, incidence and predictors of renal impairment in persons with HIV receiving protease-inhibitors in rural Tanzania

ObjectiveRitonavir-boosted protease inhibitors (bPI) in people living with HIV (PLWH) have been associated with renal impairment. Limited data are available from rural sub-Saharan Africa.MethodsUsing data from the Kilombero and Ulanga Antiretroviral Cohort Study (KIULARCO) in rural Tanzania from 2005-01/2020, we assessed the prevalence of renal impairment (estimated glomerular filtration rate <60 mL/min/1.73m2) at the time of switch from first-line antiretroviral treatment (ART) to bPI-regimen and the incidence of renal impairment on bPI. We assessed risk factors for renal impairment using logistic and Cox regression models.ResultsRenal impairment was present in 52/687 PLWH (7.6%) at the switch to bPI. Among 556 participants with normal kidney function at switch, 41 (7.4%) developed renal impairment after a median time of 3.5 (IQR 1.6–5.1) years (incidence 22/1,000 person-years (95%CI 16.1–29.8)). Factors associated with renal impairment at switch were older age (adjusted odds ratio (aOR) 1.55 per 10 years; 95%CI 1.15–2.11), body mass index (BMI) <18.5 kg/m2 (aOR 2.80 versus ≥18kg/m2; 95%CI 1.28–6.14) and arterial hypertension (aOR 2.33; 95%CI 1.03–5.28). The risk of renal impairment was lower with increased duration of ART use (aOR 0.78 per one-year increase; 95%CI 0.67–0.91). The renal impairment incidence under bPI was associated with older age (adjusted hazard ratio 2.01 per 10 years; 95%CI 1.46–2.78).ConclusionsIn PLWH in rural sub-Saharan Africa, prevalence and incidence of renal impairment among those who were switched from first-line to bPI-regimens were high. We found associations between renal impairment and older age, arterial hypertension, low BMI and time on ART.

Is There a Place for Induction Therapy With Polyclonal Antibodies to Improve Renal Function After Liver Transplantation?

Is There a Place for Induction Therapy With Polyclonal Antibodies to Improve Renal Function After Liver Transplantation?

Surgical Correction of Pelvic Organ Prolapse Has No Effect on Renal Function

The aims of the study were to determine whether symptomatic pelvic organ prolapse (POP) is a cause of subclinical renal impairment by characterizing baseline renal function in women undergoing surgical correction for POP and to assess the effect of surgical POP repair on estimated glomerular filtration rate (eGFR) postoperatively. A prospective cohort study was designed to evaluate women undergoing surgical repair for at least stage II anterior or apical POP at a single institution. Data collected included preoperative serum creatinine values, patient demographics, and clinical risk factors for renal impairment. Postoperative serum creatinine values were obtained at routine 4- to 6-week follow-up. At that time, patients were evaluated for objective and subjective surgical success and surveyed on postoperative nonsteroidal anti-inflammatory drug use. Preoperative eGFRs were calculated and compared with postoperative values. Appropriate statistical tests were performed. A total of 25 participants were recruited between August 2019 and March 2020. The median age was 70 years (interquartile range, 62-73 years). One participant (4%) reported a history of stage III chronic kidney disease preoperatively. At a median follow-up of 40 days (interquartile range, 34-49 days), no prolapse was recorded past the level of the hymen. There was no difference between preoperative and postoperative eGFR (median preoperative, 81 vs 76 mL/min per 1.73 m2, P = 0.3). Higher POP stage was not associated with significant changes in postoperative eGFR (P = 0.09). Surgical POP repair is not associated with any change in eGFR. It is unlikely that untreated POP causes subclinical renal impairment in the vast majority of women.

WHAT IS THE MAJOR FACTOR ON THE KIDNEY INJURY INDUCED BY HYPERTENSION OR HYPERHOMOCYSTEINEMIA

Objective: As we all know kidney injury could be induced by hypertension or hyperhomocysteinemia (HHcy). What is the major factor? HHcy plays a synergistic role with hypertension in vascular injury; however, the relationship between HHcy and hypertension in renal injury remains unclear. Here, we sought to evaluate the relationship between HHcy and hypertension in the context of renal injury and to elucidate the mechanism of action underlying this relationship. Design and method: Wistar Kyoto (WKY) and spontaneously hypertensive (SHR) rats were randomized into WKY, WKY+HHcy, SHR, and SHR+HHcy groups. Blood pressure, plasma homocysteine, creatinine, serum malondialdehyde (MDA), serum superoxide dismutase (SOD), and urinary albumin creatinine ratio (UACR) were measured. mRNA and protein expression levels of NOX2, NOX4, and nephrin in the kidneys were also examined. Results: The WKY+HHcy group exhibited lower serum SOD levels, relative to the WKY group, along with higher levels of both serum MDA and UACR. Similar effects were observed in the SHR+HHcy group, relative to the SHR group. Moreover, compared with the levels in the WKY+HHcy group, mean SOD levels in the SHR+HHcy group were lower, while mean MDA and UACR levels were higher. Higher mRNA and protein expression levels of NOX2 and NOX4, along with lower mRNA and protein expression levels of nephrin, were observed in the kidneys of WKY+HHcy and SHR+HHcy rats, relative to SHR and WKY controls, respectively. Furthermore, the mRNA and protein levels of NOX2 and NOX4 were higher and the mRNA and protein levels of nephrin were lower in the SHR+HHcy group than in the WKY+HHcy group. In addition, compared with WKY+HHcy group, the UACR level of SHR group was higher. Conclusions: HHcy appears to synergistically increase hypertensive renal damage by enhancing oxidative stress. However, hypertension remains a major risk factor for renal impairment compared to HHcy.

Risk Factors for Renal Impairment in Adult Patients With Short Bowel Syndrome.

Renal impairment is a common complication in patients with intestinal failure that is mostly caused by short bowel syndrome (SBS) and is associated with adverse outcomes that severely affect the quality of life or even survival. The prevalence and risk factors for renal impairment in patients with SBS remain unclarified. Therefore, we aimed to determine the prevalence of renal impairment and identify potential risk factors for renal impairment in adult patients with SBS. We retrospectively identified 199 patients diagnosed with SBS admitted to the Department of General Surgery between January 1, 2012 and January 1, 2019, from a prospectively maintained database. Overall, 56 patients (28.1%) with decreased renal function (eGFR < 90 mL/min/1.73 m2). The median duration of SBS was 7 months (IQR, 3–31 months) and the mean eGFR was 103.1 ± 39.4 mL/min/1.73 m2. Logistic regression modeling indicated that older age [odds ratio (OR), 1.074; 95% CI, 1.037–1.112, P < 0.001], kidney stones (OR, 4.887; 95% CI, 1.753–13.626; P = 0.002), decreased length of the small intestine (OR, 0.988; 95% CI, 0.979–0.998; P = 0.019), and prolonged duration of SBS (OR, 1.007; 95% CI, 1.001–1.013; P = 0.046) were significant risk factors for renal impairment. This is the largest study that has specifically explored the risk factors for renal impairment in a large cohort of adults with SBS. The present study showed that renal function should be closely monitored during treatment, and patients should be given prophylactic interventions if necessary. This retrospective study is a part of clinical study NCT03277014, registered in ClinicalTrials.gov PRS. And the PRS URL is http://register.clinicaltrials.gov.

Chronic Nephropathies in the Internal Medicine Department of the Sylvanus Olympio University Hospital

Introduction: The chronic nephropathies constitute a real global public health concern due to the constant increase in the prevalence estimated between 10% and 15%. In Sub-Saharan Africa, this prevalence has been estimated at 13.9%. This study will allow knowing the epidemiological, clinical, paraclinical and etiological aspects of chronic kidney disease in the internal medicine department of CHU-SO Lomé. Method: This was a cross-sectional, retrospective and descriptive study. It concerned all the patients suffering from a chronic kidney disease, hospitalized between the 1st of January 2014 and the 31st of December 2018, for a duration of 5 years. Results: During our study, 330 cases of chronic nephropathy were identified. The prevalence of chronic kidney disease was 8.3% of admissions. The mean age of the patients was 46.3 years with extremes of 19 and 86 years and a sex ratio of 1.32. A low socio-economic level of patients was observed in 63.9% with an urban origin in 69.7%. The main risk factors for renal impairment were hypertension (55.2%), diabetes mellitus (29.1%), obesity (20.6%), use of nephrotoxic products (19.4%), HIV infection (17%) and smoking (16.1%). The causes were dominated by nephroangiosclerosis (33.3%), followed by diabetic nephropathy (25.5%) and HIV-associated nephropathy (17%). Chronic renal failure was present in 95.8% of cases and was end stage in 69.7% of cases. Anemia was the main complication during the evolution of chronic kidney disease (98.2%). Mortality was 57.3% during hospitalization. Conclusion: Chronic kidney disease is a fairly common reason for hospitalization in the internal medicine department. Emphasis should therefore be placed on preventive measures for hypertension, diabetes and HIV.

Renal Impairment in Patients with Metabolic Syndrome after Living Kidney Donation: A Systematic Review.

Metabolic syndromes are considered a significant risk factor for renal impairment in renal transplant patients. However, the impact of metabolic syndrome on long-term kidney function is still unclear. This study aims to review the medical literature to investigate the long-term impact of metabolic syndrome on renal impairment in kidney donors. The literature was evaluated through PubMed, Embase, Cochrane, and CINAHL databases in the duration between 1990 and May 2019. Searching terms included synonyms and components for "metabolic syndrome," "renal impairment," "kidney donors," combined with the operators "OR" and "AND." Following this, results were refined to include only original research articles evaluating the long-term effects of kidney donation on kidney function in donors with metabolic syndrome. Eligible trials mentioned the exact duration of follow-up. A total of 820 articles were recovered. After the exclusion of articles on animals and including only analyses on humans, 38 studies appeared. A total of eight studies were considered eligible, covering a total of 1574 living donors with metabolic syndrome. Two studies were observational cohort, while three studies were retrospective and three randomized controlled studies. Living donors with metabolic syndrome are at risk of reduced renal functions of the remaining kidney after donation, with obesity appearing to be the significant contributor. Further randomized controlled studies with a longer follow-up duration are required.