Serum Cr Levels Research Articles

Modified creatinine index and risk for cardiovascular events and all-cause mortality in patients undergoing hemodialysis: The Q-Cohort study

Background and aimsThe modified creatinine (Cr) index, calculated by age, sex, pre-dialysis serum Cr levels, and Kt/V for urea, reflects skeletal muscle mass in patients on hemodialysis. Whether the modified Cr index is associated with cardiovascular events and all-cause mortality remains unknown. MethodsA total of 3027 patients registered in the Q-Cohort Study, a multicenter, prospective study of patients on hemodialysis in Japan, were analyzed. The main outcomes were cardiovascular events and all-cause mortality. Associations between sex-specific quartiles of the modified Cr index and outcomes were analyzed by the Cox proportional hazard models and the Fine–Gray proportional subdistribution hazards model. ResultsThe modified Cr index was correlated with known nutritional and inflammatory markers. During a 4-year follow-up, 499 patients died of any cause, 372 experienced heart disease, and 194 developed stroke. The risk for all-cause mortality was significantly higher in the lower quartiles (Q1 and Q2) than in the highest quartile (Q4) as the reference group (hazard ratios and 95% confidence intervals: Q1, 2.65 [1.69–4.25], Q2, 1.92 [1.27–2.94], and Q3, 1.31 [0.87–2.02]). The risk of heart disease was significantly higher in Q1 than in Q4 (hazard ratios and 95% confidence intervals: Q1, 1.64 [1.04–2.61], Q2, 1.34 [0.91–2.00], and Q3, 1.04 [0.71–1.52]). The risk of stroke was not associated with the modified Cr index. ConclusionsA lower modified Cr index is associated with an increased risk for heart disease and all-cause mortality, but not with the risk for stroke in patients on hemodialysis.

Inhaled nitric oxide therapy was not associated with postoperative acute kidney injury in patients undergoing lung transplantation: A retrospective pilot study.

Inhaled nitric oxide (iNO) therapy is commonly used in lung transplantation (LT) recipients during the perioperative periods. However, previous studies report that the use of iNO may increase the risk of renal dysfunction. Post-LT acute kidney injury (AKI) can lead to critical situations, including prolonged intensive care unit or hospital stays and increased morbidity and mortality. Accordingly, the aim of this study was to investigate the relationship between iNO therapy and incidence of post-LT AKI in LT recipients.The medical data of 36 patients who underwent LT surgery from January 2012 to July 2017 in a single university hospital setting were retrospectively collected and analyzed. Patients were divided into 2 groups: iNO (n = 14) and control (n = 19). The demographic data, anesthetic methods, complications, and perioperative laboratory test values of each patient were assessed. Patients were categorized according to changes in plasma creatinine (Cr) concentration levels within 48 hours after LT using Acute Kidney Injury Network criteria.There was no significant difference in the occurrence (P = .13) and severity (P = .9) of post-LT AKI between iNO and control groups. The mean serum Cr levels after surgery were 0.91 ± 0.44 and 0.81 ± 0.37 mg/dL in the iNO and control groups, respectively (P = .50).AKI plays a critical role in the prognosis of LT recipients. Our results revealed that iNO therapy was not associated with the incidence of post-LT AKI. Therefore, if iNO treatment is indicated, active use under close monitoring of renal function is recommended in LT-patients concerned about AKI after surgery.

Trace element levels are associated with neuroinflammatory markers in children with autistic spectrum disorder

The objective of the present study was to estimate the association between brain inflammatory markers and serum trace element levels as assessed by inductively coupled plasma mass spectrometry at NexION 300D. Leukocyte elastase (LE), α1-proteinase inhibitor (α1-PI) activity, anti-nerve growth factor-antibodies (anti-NGF-Ab), and anti-myelin basic protein-antibodies (anti-MBP-Ab) levels were assessed as inflammatory markers. The obtained data demonstrate that the increase in LE and α1-PI activity is associated with higher serum Cr and Cu levels, respectively. The increase in Anti-NGF-Ab levels was associated with a nearly significant 16% increase in serum Mn levels. Autistic children with high MBP-Ab levels were characterized by 28% higher serum Mn and lower Mg concentration. The results of correlation analysis were generally in agreement with the outcome of group comparisons. Regression analysis demonstrated that serum Mg was significantly negatively associated with LE activity, whereas both serum Fe and V concentrations were characterized by a positive influence on the parameter. In turn, serum Cu was a significant predictor of α1-PI, as well as Cr levels. At the same time, the serum concentrations of Cd and Fe were found to be inversely associated with α1-PI levels. Serum Cd and Mn levels were significant positive predictors of anti-MBP-Ab levels, whereas Mg levels had a negative impact on anti-MBP-Ab values. Generally, the obtained data demonstrate the interrelationship between trace element homeostasis and neuroinflammation in autism. Hypothetically, modulation of trace element status may be used for reduction of neuroinflammatory response, although further studies are required to reveal the underlying mechanisms of the observed associations.

Renal ischemia-reperfusion injury attenuated by splenic ischemic preconditioning.

To investigate the therapeutic effect of splenic ischemic preconditioning (sIPC) on renal ischemia-reperfusion (IR) injury. A total of 18 adult male Sprague Dawley (SD) rats were treated by 45 min renal ischemia and followed by 24 h reperfusion. In the sIPC group, three cycles of splenic ischemic preconditioning including 5 min ischemia and 5 min reperfusion were carried out before renal ischemia. The blood samples and kidney tissues were collected after 24 h. The levels of Cr and BUN in serum were measured to evaluate the kidney function. The morphological changes in ischemia-reperfusion kidneys were determined by hematoxylin-eosin (HE) staining. The levels of pro-inflammatory cytokines including TNF-α and IL-6 in serum, and renal tissues, were measured by ELISA and Western Blotting. Furthermore, the levels of IKK-β, intra-nuclear NF-κB, p65, and IL-10 in renal tissues were also measured. The results demonstrated that the level of Cr and BUN in the IR group were increased while decreased in the sIPC group. HE staining showed that the damage caused by renal ischemia-reperfusion was attenuated by sIPC with a low renal injury score in the sIPC group. ELISA and Western Blotting results showed that the production and secretion of TNF-α and IL-6 induced by IR were inhibited by sIPC. The expression level of IKK-β and intranuclear p65 in renal tissues were increased in the IR group while sIPC had exhibited the function of depressing the increased expression levels of IKK-β and intranuclear p65. Compared with the IR group, the expression level of IL-10 of serum and renal tissues in the sIPC group were increased. sIPC exhibited a potent anti-inflammatory capacity to attenuated renal IR injury.

Protective effect of mild hypothermia at different starting times on organ function in patient with exertional heat stroke

To investigate the protective effect of mild hypothermia at different starting times on the physiological functions of the viscera of exertional heat stroke (EHS). A prospective randomized controlled trial was conducted. EHS patients admitted to intensive care unit of the 159th Hospital of People's Liberation Army and the First Affiliated Hospital of Zhengzhou University from June 2015 to June 2017 were enrolled. The patients were divided into 2, 4, 6 hours start hypothermia treatment groups according to the random number table method, the mild hypothermia was initiated at 2, 4 and 6 hours after the disease onset respectively, and the methods were the same in each group. After treatment of 2, 12, 24 hours, the venous blood in the three groups was collected to detect serum cardiac troponin I (cTnI) with chemiluminescence method, MB isoenzyme of creatine kinase (CK-MB) with immunosuppressive method, creatinine (Cr) with creatine oxidase method, β2-microglobulin (β2-MG) with turbidimetry, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) with enzyme method. Multiple organ dysfunction syndrome (MODS) within 24 hours after treatment was recorded. Linear regression analysis of the correlation between mild hypothermia start-up time and MODS was done. Ninety-three cases of EHS were included, with 32, 31 and 30 patients in 2, 4, 6 hours start treatment groups respectively. There were no significant differences in gender, age, core temperature, onset time to admission, Glasgow coma scale (GCS), acute physiology and chronic health evaluation system II (APACHE II) score at admission among the three groups. There were no significant differences in the levels of serum cTnI, CK-MB, Cr, β2-MG, ALT and AST at 2 hours after treatment. But with the prolongation of the treatment time, all indicators gradually increased. And the earlier start of the mild hypothermia, the less significant of the above indexes. All indexes in 2 hours start treatment group were significantly lower than those of 2 hours and 6 hours start treatment groups at 24 hours after treatment [cTnI (ng/L): 49.53±9.25 vs. 56.52±10.05, 64.57±11.21; CK-MB (U/L): 51.47±11.83 vs. 57.87±7.43, 64.40±7.93; Cr (μmol/L): 140.97±11.33 vs. 148.16±10.39,155.57±8.65; β2-MG (mg/L): 10.28±1.46 vs. 11.58±2.13, 12.93±1.98; ALT (U/L): 248.53±75.47 vs. 341.42±129.58, 425.77±101.23; AST (U/L): 197.25±42.59 vs. 292.81±58.49, 351.20±60.41, all P < 0.05]. There was significant difference in the incidence of MODS in 2, 4, 6 hours start treatment groups [43.75% (14/32), 64.52% (20/31), 80.08% (24/30), χ2 = 8.761, P = 0.013]. Linear regression analysis showed that the earlier onset time of mild hypothermia, the lower incidence of MODS (R2 = 0.915, P = 0.013). The application of mild hypothermia in 2 hours can effectively protect the physiological function of EHS organs and reduce the incidence of MODS.

The Fate of Elevated Metal Ion Levels After Revision Surgery for Head-Neck Taper Corrosion in Patients With Metal-on-Polyethylene Total Hip Arthroplasty

BackgroundElevated metal ion levels have been associated with the presence of adverse local tissue reactions in patients with metal-on-polyethylene (MoP) total hip arthroplasty (THA) secondary to corrosion at head-neck taper junction. Patients are frequently concerned with their elevated systemic metal ion levels. This study investigated the rate of decline of serum cobalt and chromium ion levels after revision surgery. MethodsA total of 39 patients with MoP THA were revised because of the presence of symptomatic adverse local tissue reactions on magnetic resonance imaging with elevated serum metal ion levels. The time between initial implantation of MoP THA (index surgery) and revision surgery was considered the duration of metal exposure. The prerevision measure of ion level was considered the intensity of exposure. Prerevision median serum Co and Cr levels, as well as revision serum Co/Cr ratio, were reported. ResultsThe median serum levels of cobalt and cobalt-to-chromium ratio significantly decreased from prerevision levels of 8.2 μg/L (0.2-56.1 μg/L) and 5.6 μg/L (0.1-53.3 μg/L) to 3.1 μg/L (0.2-14 μg/L) and 1.7 μg/L (0.4-3.8 μg/L) at postrevision (P < .01), respectively. The rate of decline of Co was 0.45% per day during the first month. For chromium, the rate of decline was slower with 0.08% per day during the first month. ConclusionAt 3 months after revision surgery, cobalt and chromium ion levels declined by 34% and 8% of prerevision level, respectively. This study provides evidence-based practical information for surgeons to provide MoP THA patients when considering revision surgery for head-neck taper corrosion.

The role of complement activation in rhabdomyolysis-induced acute kidney injury.

Rhabdomyolysis (RM) may cause kidney damage and results primarily in acute kidney injury (AKI). Complement is implicated in the pathogenesis of renal diseases and ischemia-reperfusion injury (IRI), but the role of complement, especially its activation pathway(s) and its effect in RM-induced AKI, is not clear. This study established a rat model of AKI induced by RM via intramuscular treatment with glycerol. Cobra venom factor (CVF) was administered via tail vein injection to deplete complement 12 h prior to intramuscular injection of glycerol. We found that the complement components, including complement 3 (C3), C1q, MBL-A, factor B(fB), C5a, C5b-9, and CD59, were significantly increased in rat kidneys after intramuscular glycerol administration. However, the levels of serum BUN and Cr, renal tubular injury scores, and the number of TUNEL-positive cells decreased significantly in the CVF+AKI group. These results suggest that complement plays an important role in RM-induced AKI and that complement depletion may improve renal function and decrease renal tissue damage by reducing the inflammatory response and apoptosis.

Adenovirus-mediated P311 ameliorates renal fibrosis through inhibition of epithelial-mesenchymal transition via TGF-β1-Smad-ILK pathway in unilateral ureteral obstruction rats

Epithelial-mesenchymal transition (EMT) is a critical step and key factor during renal fibrosis. Preventing renal tubular EMT is important for delaying the progression of chronic kidney disease (CKD). P311, a highly conserved 8-kDa intracellular protein, has been indicated as an important factor in myofibroblast transformation and in the progression of fibrosis. However, the related studies on P311 on renal fibrosis are limited and the mechanisms of P311 in the progression of renal tubulointerstitial fibrosis remain largely unknown. In the present study, we examined the effect of P311 on transforming growth factor-β1(TGF-β1)-mediated EMT in a rat model of unilateral ureteral occlusion(UUO) renal fibrosis. The recombinant adenovirus p311 (also called Ad-P311) was constructed and transferred it into UUO rats, the preventive effect and possible mechanism of P311 on TGF-β1-mediated EMT were explored. The UUO model was established successfully and Ad-P311 was administered into UUO rats each week for 4weeks, then the serum levels of Cr, blood urea nitrogen(BUN) and albumin(ALB) were evaluated. H&E staining and Masson staining were performed to observe the pathological changes of kidneys. Immunohistochemical staining and western blot analysis were used to examine the EMT markers [E-cadherin and α-smooth muscle actin (α-SMA)], and signal transducers (p-Smad2/3 and Smad7). Integrin linked kinase(ILK) as a keyintracellular mediator that controls TGF-β1-mediated-EMT was also assayed by western blot analysis. The results showed that P311 could alleviate renal tubular damage and interstitial fibrosis improving Cr, BUN and ALB serum levels in UUO kidneys. Furthermore, P311 attenuated TGF-β1-mediated EMT through Smad-ILK signaling pathway with an increase in α-SMA, pSmad2/3 and ILK expression, and a decrease in E-cadherin and Smad7 expression in UUO kidneys. In conclusion, P311 may be involved in the pathogenesis of renal fibrosis by blocking TGF-β1-mediated EMT via TGF-β1-Smad-ILK pathway in UUO kidneys. P311 may be a novel target for the control of renal fibrosis and the progression of CKD.

Cystatin C Is a Gender-Neutral Glomerular Filtration Rate Biomarker in Patients with Cirrhosis.

Lower serum Cr levels in women as compared to men result in underestimation of renal dysfunction and lower model for end-stage liver disease-sodium scores leading to reduced access to liver transplantation in women compared to men with comparable hepatic dysfunction. The aim of this study was to determine the gender differences in serum Cr, cystatin C, and other endogenous glomerular filtration rate (GFR) biomarkers, measured and estimated GFR, Cr clearance, and Cr production rates. We measured GFR by iothalamate plasma clearance in 103 patients with cirrhosis and assessed gender differences in GFR, Cr clearance and production rate, serum Cr, cystatin C and other endogenous GFR biomarkers including beta-trace protein, beta-2 microglobulin, and dimethylarginines. Comparison of men and women showed significantly lower values for mean serum Cr (0.97 vs. 0.82mg/dl, P=0.023), and Cr production rate (13.37 vs. 11.02mg/kg/day, P=0.022). In contrast to the serum Cr and Cr production rate, men and women exhibited no significant differences in the means of serum cystatin C and other GFR biomarkers, measured GFR, GFR estimated using Cr-cystatin C GFR equation for cirrhosis, measured and estimated Cr clearances. After controlling for age, race, weight, height, and GFR, female gender remained associated with lower serum Cr levels (P=0.003). Serum cystatin C levels were not associated with gender, age, race, weight, height, C-reactive protein, and history of hypothyroidism. Our results suggest that cystatin C and endogenous GFR biomarkers other than Cr, measured GFR, GFR estimated by Cr-cystatin C GFR equation for cirrhosis, measured and estimated Cr clearance minimized between-gender biases in accounting for renal function in patients with cirrhosis. Therefore, serum cystatin C should be measured as a complementary test to serum Cr when renal function is assessed in patients with cirrhosis, particularly in women and those with sarcopenia.

Serum chromium and selenium levels in type 2 diabetes mellitus

Background: Emerging evidence suggests that several trace elements such as serum chromium (Cr) and selenium (Se) levels are altered in type 2 DM and its deficiencies are associated with the development of diabetes related complications.Objective: To assess the serum Cr and Se levels in patients of type 2 diabetes mellitus.Methods: This cross sectional study was conducted in the Department of Physiology, Dhaka Medical College, Dhaka from July 2014 to June 2015. Fifty type 2 diabetic patients with age ranging from 40 to 55 years were study group and fifty ages, BMI matched healthy subjects were control group. Patients were selected from Bangladesh Institute of Research for Diabetic Endocrine and Metabolic Disorders (BIRDEM) General Hospital, Dhaka. Serum Cr and Se levels were estimated by flame atomic absorption spectrophotometry. For statistical analysis unpaired Student’s‘t’ test and Chi square test were performed.Results: In this study, serum Cr and Se levels were significantly (P&lt;0.001) lower in patients than that of control group. In addition 20% patients had low Cr and 16% had Se deficiencies. Moreover, 6% of control had low Cr and 4% had low Se.Conclusion: From this study, it is concluded that serum Cr and Se deficiencies are associated with type 2 diabetes mellitus.Bangladesh Soc Physiol. 2017, December; 12(2): 72-75

Differential JNK, p38 and ERK response to renal injury in a rat model of acute pancreatitis in pregnancy.

The objective of this study was to determine the mechanism of acute renal injury (ARI) in acute necrotizing pancreatitis in late pregnancy (ANPIP). Pregnant Sprague-Dawley rats in the third trimester were used for this study, and an ANPIP model was induced by injecting 5% sodium taurocholate into the biliary pancreatic duct. The rats were randomly divided into three groups: the normal, sham-operated (SO) and acute necrotizing pancreatitis (ANP) groups. Rats were killed at 3, 6, 12h after the operation, and blood, pancreatic and renal tissue samples were harvested. Differences were detected in the physiology, pathology and cellular and molecular responses among the different groups. Serum amylase, lipase, urea and Cr levels were increased in rats with ANPIP. Additionally, expression of phosphorylation p38 and JNK as well as TNF-α and NF-κB were increased in the renal tissues of rats with ANPIP. The expression of phosphorylation ERK was decreased in the renal tissues of rats with ANPIP. Mitogen-activated protein kinases may play an important role in renal injury in rat models of ANPIP.

Serum Procalcitonin Correlates with Renal Function in Hepatitis B Virus-Related Acute-on-Chronic Liver Failure

Background/Aims: To investigate the relationship between elevated serum procalcitonin (PCT) and renal function in hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). Methods: HBV-ACLF patients (n = 201) presenting to the State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University, from January 2013 to November 2016 were categorized into three groups according to serum PCT levels: (i) normal group (n = 74) had PCT of ≤ 0.5 ng/mL; (ii) elevated group (n = 85) had PCT in the range 0.5–1.0 ng/mL; and (iii) highly elevated group (n = 42) had PCT of > 1.0 ng/mL. Thirty-five cases received standard care after admission. Serum PCT levels and renal function were determined during a two-week follow-up. Results: Significant increases in serum creatinine (Cr) were recorded in male and female patients in the elevated group and highly elevated group compared with the normal group (P < 0.05). In addition, serum Cr levels in male and female patients were significantly higher in the highly elevated group than in the elevated group (P < 0.05). The glomerular filtration rate (GFR) was significantly lower in the highly elevated group (P < 0.05) and this group had the highest risk of altered Cr (45.9% in males; 80% in females) and abnormal GFR (37.5%). Serum PCT levels correlated significantly with all renal function parameters including homocysteine (Hcy), GFR, Cr, blood urea nitrogen, uric acid, and cystatin C at baseline and during treatment. Univariate and multivariate analyses indicated that serum PCT was a strong predictor of renal dysfunction. Conclusion: Serum PCT is closely related to renal dysfunction in HBV-ACLF.

Plasma metabolic profiling analysis of Strychnos nux-vomica Linn. and Tripterygium wilfordii Hook F-induced renal toxicity using metabolomics coupled with UPLC/Q-TOF-MS.

Both Strychnos nux-vomica Linn. (SNV) and Tripterygium wilfordii Hook F (TwHF) have received extensive attention due to their excellent clinical efficacies. However, clinical applications of SNV and TwHF have been limited by their narrow therapeutic windows and severe kidney toxicities. In this paper, based on ultra-performance liquid chromatography quadrupole time-of-flight mass spectrometry (UPLC/Q-TOF-MS), endogenous metabolites after administration of SNV and TwHF extracts were detected, and biomarkers were screened successfully. Additionally, the levels of Cr and BUN in serum and pathological findings of kidneys were detected and observed. Finally, both biochemical and pathological tests of the SNV group and TwHF group indicated that kidney damage had occurred. After comparison with the normal saline group, 15 nephrotoxic biomarkers were selected from the SNV group, and 17 nephrotoxic biomarkers were selected from the TwHF group. The experimental results showed that there are some differences in the mechanisms of nephrotoxicity induced by SNV and TwHF, which are significant for revealing the mechanisms of renal injury of different medicines.

Periodontitis aggravates kidney damage in obese mice by MMP2 regulation.

To investigate the effect of periodontitis on the development of kidney damage in obese mice and its possible mechanism. C57 BL/6J mice were fed high‑fat (HF) or low‑fat (LF) diet and then divided into four groups: obesity with periodontitis (HFP), obesity without periodontitis (HFC), normal mice with periodontitis (LFP) and normal mice without periodontitis (LFC). Serum indicators of renal function, namely serum total protein (TP), albumin (ALB), creatinine (Cr) and blood urea nitrogen (UREA) were measured. The histopathological examination of kidney tissues was performed. The expressions of transforming growth factor-β1 (TGF-β1), matrix metalloproteinase-2 (MMP2) and tissue inhibitors of metalloproteinases-1 (TIMP1) were detected by immunohistochemistry and real time RT-PCR. Obesity decreased TP and ALB, and increased serum Cr and UREA levels in normal and periodontitis mice groups, as well as induced glomerular and tubulointerstitial pathologic changes. Tubulointerstitial fibrosis was more severe in HFP group. In obese mice, periodontitis caused the downregulation of MMP2, and upregulation of TIMP1 and TGF-β1 at transcriptional and translational levels. In obese mice, periodontitis may aggravate pathological changes in the kidney. The possible mechanism might lie in downregulation of MMP2 and upregulation of MMP inhibitor, TIMP1, and TGF-β1 (Tab. 1, Fig. 4, Ref. 16).

Beneficial Role of Hydrogen Sulfide in Renal Ischemia Reperfusion Injury in Rats.

PurposeHydrogen sulfide (H2S) is an endogenous gaseous molecule with important physiological roles. It is synthesized from cysteine by cystathionine γ-lyase (CGL) and cystathionine β-synthase (CBS). The present study examined the benefits of exogenous H2S on renal ischemia reperfusion (IR) injury, as well as the effects of CGL or CBS inhibition. Furthermore, we elucidated the mechanism underlying the action of H2S in the kidneys.Materials and MethodsThirty male Sprague-Dawley rats were randomly assigned to five groups: a sham, renal IR control, sodium hydrosulfide (NaHS) treatment, H2S donor, and CGL or CBS inhibitor administration group. Levels of blood urea nitrogen (BUN), serum creatinine (Cr), renal tissue malondialdehyde (MDA), and superoxide dismutase (SOD) were estimated. Histological changes, apoptosis, and expression of mitogen-activated protein kinase (MAPK) family members (extracellular signal-regulated kinase, c-Jun N-terminal kinase, and p38) were also evaluated.ResultsNaHS attenuated serum BUN and Cr levels, as well as histological damage caused by renal IR injury. Administration of NaHS also reduced oxidative stress as evident from decreased MDA, preserved SOD, and reduced apoptotic cells. Additionally, NaHS prevented renal IR-induced MAPK phosphorylation. The CGL or CBS group showed increased MAPK family activity; however, there was no significant difference in the IR control group.ConclusionExogenous H2S can mitigate IR injury-led renal damage. The proposed beneficial effect of H2S is, in part, because of the anti-oxidative stress associated with modulation of the MAPK signaling pathways.

Altered Serum Markers of Omentin and Chemerinin Chronic Renal Failure Patients on Hemodialysis

Background: Renal disease is a common cause of death and disability in many countries throughout the world. Chronic kidney disease (CKD) is defined as the presence of kidney damage, or a progressive loss of kidney function. Hemodialysis (HD) is implicated to correct the metabolic disturbances as complications have been observed. However; little is known about apelin and chemerin in chronic kidney disease (CKD). Thus, the purpose of this study was to analyseomentin, chemerin, urea (BU), creatinine, globulin, albumin, total protein (TP) serum levels in patients with chronic renal failure (CRF). Methods: Forty eight patients with CRF on maintenance HD, and another forty eight healthy controls subjects without any clinically detectable diseases have been used as control group were enrolled in the study. The patients were diagnosed by specialist doctors in Kirkuk teaching hospital, Kirkuk, Iraq. The blood samples were collected before and 24-48 hours after hemodialysis sessions. Parameters like omentin, chemerin serum level was assessed by ELISA. Serum BU, creatinine, globulin, albumin, TP levels were measured by spectrophotometric methods before and after hemodialysis session. Results: Chronic renal failure patients were found to have lower serum chemerin, total protein, globulin, and albumin levels before hemodialysis when compared to healthy control patients and higher levels after hemodialysis when compared to pre-dialysis, while serum BU, Cr , and Omentin-1 levels were found to be higher before hemodialysis compared to control and to increase further after hemodialysis compared to pre dialysis. Conclusion: Elevated serum omentin and chemerin levels could be considered as an independent predicting marker for progression of CDK.

HIFU, a noninvasive and effective treatment for chyluria: 15years of experience.

The current treatment therapies for chyluria are often invasive and recurrent. Here, we investigated a novel noninvasive treatment of chyluria with high-intensity focused ultrasound (HIFU) and evaluated its clinical efficacy. 155 patients with chyluria were treated with HIFU ablation and followed up over a period of 15years from May 2000 to December 2015. Routine examinations including urine color observation, color Doppler ultrasound examination, blood serum test of Cr, BUN, and albumin, and detection of urinary chyle were performed before and after the treatment, 1week, 1 and 6months post-treatment, and followed up via telephone and other forms. We lost contact with 54 patients during the course of the study. In the 101 complete cases, the serum levels of Cr and BUN and the color Doppler ultrasound examination did not reveal significant differences before and after the treatment. However, there was a significant increase in the hemoglobin and albumin levels, as well as the body weight after the HIFU treatment. The other 54 patients also showed an improvement of the symptoms after the HIFU treatment before losing contact. Our results suggest that the HIFU ablation therapy is a feasible, effective, and noninvasive method for the treatment of chyluria.

Protective Effects of the Third Generation Vasodilatory Βeta - Blocker Nebivolol against D-Galactosamine - Induced Hepatorenal Syndrome in Rats.

BACKGROUND:Renal dysfunction is very common in patients with advanced liver cirrhosis and portal hypertension. The development of renal failure in the absence of clinical, anatomical or pathological causes renal of failure is termed hepatorenal syndrome (HRS).AIM:The present study was constructed to investigate the possible protective effects of nebivolol (Nebi) against D-galactosamine (Gal)-induced HRS in rats.MATERIAL AND METHODS:Rats were treated with Nebi for ten successive days. On the 8th day of the experiment, they received a single dose of Gal. Serum levels of Cr, BUN, Na+ and K+ as well as AST, ALT, total bilirubin (TB), NH3 and endothelin-1 (ET-1) were determined following Gal administration. Moreover, renal and liver contents of MDA, GSH, F2-isoprostanes (F2-IPs), tumor necrosis factor-alpha (TNF-α), nuclear factor kappa-B (NF-κB), total nitric oxide (NO), in addition to activities of caspase-3 (Cas-3), heme oxygenase-1 (HO-1), inducible and endothelial NO synthase (iNOS and eNOS) enzymes were also assessed. Finally, histopathological examination was performed.RESULTS:Nebi attenuated Gal-induced renal and hepatic dysfunction. It also decreased the Gal-induced oxidative stress and inflammatory recruitment.CONCLUSION:Results demonstrated both nephroprotective and hepatoprotective effects of Nebi against HRS and suggested a role of its antioxidant, anti-inflammatory, anti-apoptotic and NO-releasing properties.

Nitric oxide metabolite changes in gentamicin-induced nephrotoxicity; the effects of antioxidant vitamins

Introduction: Nitric oxide (NO) has some important roles in endothelial functioning and renal hemodynamics. Based on previous studies, NO function is different in both genders. Probably, antioxidant vitamins, as free radical scavengers, have some protective effects on renal injury. Objectives: This study aims to search the possible antioxidant effects on nitrite level in both sexes. Materials and Methods: The rats were divided into 8 groups each including both male and female ones; The categories include 1) gentamicin treated, 2) gentamicin and vitamin E-treated, 3) gentamicin and vitamin C-treated, 4) gentamicin plus vitamin E and C treated. Nine days after administering drugs, blood samples were collected from the heart. The level of urea, creatinine (Cr), and nitrite were measured in the animals serum. Also, nitrite level was measured in the homogenized kidney tissue. Results: Gentamicin, in male and female rats enhanced serum urea and Cr levels significantly at the level of P<0.05. In the presence of the vitamins E and C individually urea and Cr levels decreased significantly too. After GM administration serum nitrite level was higher in female than male rats at the statistically significant level. Vitamin E increased serum nitrite level in male and female rats in comparison with GM group. Similarly, the vitamins enhanced kidney nitrite level which was significantly higher in male than female animals. Conclusion: This study shows that administrating vitamin E and C could individually have stronger effect on nitrite more prominently among male rats.

Effects of apigenin on the expression levels of B-cell lymphoma-2, Fas and Fas ligand in renal ischemia-reperfusion injury in rats.

The aim of the present study was to investigate the effect and possible mechanism of apigenin on renal ischemia-reperfusion (I/R) injury in rats, as well as in in vitro experiments. In total, 36 rats were subjected to 45 min of renal ischemia, with or without treatment prior to ischemia with different concentrations of apigenin (2, 10 and 50 mg/kg) administered intravenously. All rats were sacrificed at 24 h after I/R injury. The serum creatinine (Cr) and blood urea nitrogen (BUN) levels were analyzed, and histological examination was conducted. In addition, the expression levels of B-cell lymphoma 2 (Bcl-2) and Fas/Fas ligand (FasL) were detected by immunohistochemistry, reverse transcription-quantitative polymerase chain reaction and western blot analysis. For in vitro experiments, the NRK-52E cell line was employed. The viability, apoptosis and expression levels of Fas, FasL and Bcl-2 were examined in the culture of NRK-52E cells following the I/R. The results indicated that apigenin significantly decreased the levels of serum Cr and BUN induced by renal I/R, demonstrating an improvement in renal function. The histological evidence of renal damage associated with I/R was also mitigated by apigenin in vivo. Furthermore, apigenin increased the cell viability and decreased cell apoptosis in the culture of NRK52E after I/R in vitro. Compared with the I/R group, the expression of Bcl-2 was upregulated and the expression levels of Fas and FasL were downregulated by apigenin at the mRNA and protein levels in vivo and in vitro. In conclusion, apigenin appeared to increase the expression of Bcl-2 and reduce Fas/FasL expression in renal I/R injury, providing evident protection against renal I/R injury in rats.