Serum Natrium Research Articles

MO392: Mildly Impaired Kidney Function May Be Associated With the Risk of Hippocampal Atrophy in Young and Midlife Adults

Abstract BACKGROUND AND AIMS To date, associations between kidney function and brain structural abnormalities have been described in several studies [1]. Reports of renal function in relation to hippocampal atrophy have been scarce and the majority of studies have been focussed on older end-stage renal disease populations [2]. Particularly, with the ageing process, the hippocampus has a greater propensity to atrophy than other cerebral structures.The purpose of this study was to evaluate the relationship between kidney function assessed by estimated glomerular filtration rate (eGFR) and the degrees of hippocampal atrophy among young and midlife adults. METHOD In this cross-sectional study, the risk factors for hippocampal atrophy were evaluated in a cohort of 219 non-diabetic chronic kidney disease (CKD) patients, age ≤ 55 years, who had undergone magnetic resonance imaging (MRI) of the brain. The eGFR was calculated using the CKD-EPI formula. Hippocampal volume (HV) was assessed in brain MRIs with the Scheltens’ Medial Temporal Atrophy score, including a 5-stage escalation—0: no atrophy, 1: only widening of choroid fissure, 2: also widening of the temporal horn of lateral ventricle, 3: moderate loss of HV (decrease in height) and 4: severe loss of HV [3]. RESULTS In our group, the median and interquartile ranges (IQR) of age was 45 (14) years, 57.53% (126 patients) being males. The median eGFR was 100.6 (34.7) mL/min/1.73m2 and 46.75% (102 patients) presented with mild reduction in eGFR (eGFR between 60 to 89 mL/min/1.73m2). In univariable regression analysis, eGFR (R2 = 0.207, P < 0.001), arterial hypertension (R2 = 0.018, P = 0.045), dyslipidaemia (R2 = 0.044, P = 0.002), haematocrit (R2 = 0.021, P = 0.032), natrium levels (R2 = 0.018, P = 0.047), and potassium levels ( R2 = 0.019, P = 0.042) were associated with smaller HV. In multivariable regression analysis, eGFR [odds ratio (OR), 0.95; 95% confidence interval (CI), 0.94–0.97; P < 0.001) and serum natrium (OR, 0.91; 95% CI, 0.83–0.98; P = 0.027) were significantly associated with hippocampal atrophy. CONCLUSION This cross-sectional study shows that mild decrease in eGFR is independently associated with hippocampal atrophy. Our results suggest that brain imaging tests should be routinely performed in patients with mild reduction of eGFR, as the hippocampal atrophy process appears to be due, in part, to the mild renal dysfunction itself.

Iatrogenic hyponatremia in pediatrics: pathophysiology, classification and prevention

Dovile Gineityte1, Greta Habdanke1 1Lithuanian University of Health Sciences, Medical Academy, Faculty of Medicine, Kaunas, Lithuania Summary Introduction. Hyponatremia – it is an electrolyte natrium disbalance and it appears when serum natrium concentration decreases to <135 mmol/l. The development of iatrogenic hyponatremia is still a serious problem in clinical practice, often associated with infusion therapy […]

Altered serum levels of neprilysin in heart failure patients with reduced ejection fraction.

In addition to the recent success of neprilysin inhibition in treatment of heart failure, elevated soluble neprilysin (sNEP) in circulation has been suggested to be a prognostic biomarker in heart failure with a reduced ejection fraction (HFrEF). However, the diagnostic performance of sNEP is nebulous and its levels in HFrEF have not been compared with controls. For the purpose of this study, we determined the role of sNEP levels as a biomarker in routine ambulatory care of HFrEF patients, when compared to the control subjects. Ambulant patients with chronic HFrEF (n = 18) were included. Apparently healthy volunteers - hospital physicians (n = 9) were included as the controls. Besides standard diagnostic tools (echocardiographic examination and laboratory biochemical diagnostic tests including NT-proBNP assessment), we analysed serum levels of neprilysin with a commercially available human soluble neprilysin ultrasensitive ELISA kit (Aviscera Bioscience, USA). Concentrations of sNEP were significantly reduced in HFrEF patients (average ± S.E.M.=1038 ± 464 pg/ml) when compared to the controls (1947 ± 613 pg/ml; p < 0.05). Two of eighteen HFrEF samples were below, while two of ten control samples were above the detection limit of the immunoassay. We documented a lack of significant correlation between sNEP and left ventricular ejection fraction (LVEF) and other echocardiographic features as well as NT-proBNP. However, sNEP significantly negatively correlated to serum natrium levels (Spearman r = ‒0.6112, p < 0.05) and to systolic blood pressure (Spearman r = ‒0.4746, p < 0.05) in HFrEF. Levels of sNEP were significantly reduced in HFrEF, when compared to the controls, with absent correlations to relevant HF-related features (e.g. LVEF). These findings might contribute to clarification of the diagnostic value of sNEP in HF (Tab. 2, Fig. 2, Ref. 30) Keywords: soluble neprilysin, heart failure, reduced ejection fraction, pharmacotherapy.

The relationship between cerebral salt wasting syndrome and clinical outcome in severe and moderate traumatic brain injury patient at Sanglah Hospital, Bali, Indonesia

Introduction: Intracranial and extracranial factors causing secondary Traumatic Brain Injury (TBI) are the primary targets for medical intervention and preventing brain damage. One of the extracranial factors that worsen the prognosis of TBI is Cerebral Salt Wasting (CSW) syndrome. There are only a few articles that report CSW in TBI patients, and no studies are describing the relationship between CSW and clinical outcome of head injury. This study aimed to determine the relationship between CSW and clinical outcome of TBI patients.Methods: This was a prospective cohort study conducted from October 2018 to May 2019. Data collection was carried out in a surgical emergency and inpatient ward at Sanglah Hospital. The outcome was assessed using the Glasgow Outcome Scale (GOS) 3 months after head injury. The relationship between variables was analyzed and using Chi-square analysis. Data were analyzed using SPSS version 23 for Windows. Results: Most of respondents are male (83.3%), severe head injury (73.3%), mild hyponatremia (90.0%), and negative fluid balance (100.0%) in CSW (+) group (Table 1). However, in CSW (-) group, most of respondents are male (70.0%), moderate head injury (85.0%), normal serum natrium (80.0%), and positive fluid balance (60.0%). CSW increased the risk of unfavorable outcomes, 5.7 times in moderate and severe head injuries (95% CI=1.8 – 18.4; p=&lt; 0.001).Conclusion: CSW syndrome increased the risk of unfavorable outcomes in moderate and severe traumatic brain injury patients.

Anatomical, histological and biochemical studies of desert rodent Gerbillus tarabuli (Thomas, 1902) kidney.

The present work aimed to study the anatomy, histology, cytology and some biochemical parameters (urea, osmolality, haematocrit, serum natrium, serum kalium) of the kidney of Gerbillus tarabuli. The investigated animals (n=16) were collected from the desert, weighed and transferred alive to the laboratory in separate cages. A blood sample was taken by puncture at the retro-orbital sinus of each animal using a Pasteur-type capillary pipette capillary. They were anaesthetized with urethane injection (25%), after which they were carefully dissected; their organs were taken out and prepared for the histological and cytological studies. Pasteur pipette capillary type the kidney of the Gerbillus tarabuli is subdivided into three regions: Cortex (1193.625±60μm), Outer Medulla (1316.72±73μm), Inner Medulla (2525.08±85 μm). Pasteur pipette capillary type the kidney of the Gerbillus tarabuli is subdivided into three regions: Cortex (1193.625±60μm), Outer Medulla (1316.72±73μm), Inner Medulla (2525.08±85 μm). The concentration of the biochemical parameters of urea (0.41±0.02g/L), osmolality (300.75±3.33mOs/kg), haematocrit (34.18±1.3%), serum natrium (141.37±2.31mmol/L) and serum kalium (7.69±0.39mmol/L) is in the interval of the norm compared with several studies on desert and semi-desert rodents and also on the Wistar rat. These findings revealed the adaptive morphology and physiological function in the kidney of G.tarabuli to the desert environment.

Risk factors and prognostic analysis of acute-on-chronic liver failure of chronic hepatitis B after cessation of nucleos(t)ide analogs.

To explore the risk factors and prognostic factors related to the acute-on-chronic liver failure (ACLF) occurrence and adverse outcome after withdrawal of nucleos(t)ide analogs (NAs) in chronic hepatitis B (CHB) patients. Hospitalized CHB patients with relapse after NAs withdrawal at our medical center were retrospectively included in the present study from January 2011 to May 2018. Logistic regression, Cox regression analysis, Kaplan-Meier log-rank test, and area under the receiver operating characteristic curves (AUROC) were used. A total of 389 CHB patients (including 46 ACLF patients) were included. Their median age was 48.0 years; 315 patients were male and 74 were female. The age ≥30 years and HBVDNA ≤1000 copies at admission in logistic regression were the independent risk factors for ACLF after NAs withdrawal in CHB patients. In patients who developed ACLF, only the model of end-stage liver disease combining serum natrium concentration (MELD-Na) score and relapse after Lamivudine (LAM) cessation in the Cox multivariate regression analysis were independent predictors for 12-week mortality. The artificial liver support system (ALSS) showed no improvement in the 12-week survival of ACLF patients. We further defined 22.35 as the optimal cutoff value of MELD-Na score to predict 12-week mortality for ACLF patients, with the AUROC of 0.817, a sensitivity of 76.5%, and a specificity of 75.9%. The age ≥30 years and HBVDNA ≤1000 copies at admission strongly correlate with occurrence of ACLF, and higher MELD-Na score and relapse after LAM withdrawal are closely related with 12-week mortality among patients with ACLF after NAs withdrawal.

Hyponatremia in Patients with Heart Failure: a Prognostic Marker

Due to the high prevalence of cardiovascular diseases and better treatment strategies, with increased survival, heart failure is a condition with increasing prevalence, especially in developed countries. Heart failure patients often present electrolytic disorders, the most frequent one being hyponatremia. The objective of the study was to evaluate the frequency of hyponatremia in patients with chronic heart failure hospitalized in the Internal Medicine Clinic of the Clinical Emergency Hospital of Bucharest and to assess the clinical and paraclinical correlations, as well as prognostic implications of hyponatremia in these patients. We performed an observational retrospective study on 400 chronic heart failure patients hospitalized between January 1st 2014 and August 31st 2015. From these patients, 60 patients have been diagnosed with hyponatremia (defined as a serum natrium [135 mEq/L) and represented our group of study. The values of the serum natrium at admission in the study group ranged between 110-132 mmol/L. Most patients had advanced heart failure, according to NYHA classes� classification. The proportion of patients discharged with persistent hyponatremia was 48.33%, lower than the patients discharged with corrected serum sodium (51.67%), indicating an effective treatment of hyponatremia during hospitalization. The mortality rate during hospitalization in patients with corrected hyponatremia was 8.33%, smaller than the mortality rate in patients with persistent hyponatremia despite the correct administration of hydroelectrolytic rebalancing treatment (18.33%). Persistent hyponatremia may be considered a marker of a poor prognosis in hospitalized heart failure patients.

Heart rate response to exercise in heart failure patients: The prognostic role of metabolic–chronotropic relation and heart rate recovery

BackgroundThe dynamics of the sinus node response to exercise is linked to functional capacity and outcome in heart failure (HF). The goal of the work was to analyze determinants and impacts of cardio-acceleration, described by the concept of metabolic-chronotropic relation (MCR) and of cardio-deceleration, described by heart rate recovery (HRR). MethodsA cohort of 25 healthy controls and 78 patients with advanced systolic HF and optimized medical and/or device therapy (97% receiving beta-blockers, 54% ICD) underwent maximal cardiopulmonary exercise test and were prospectively followed. ResultsHF patients had impaired exercise performance compared with controls (pVO2 15±4 vs. 29±7ml.kg−1.min−1, p<0.0001) and lower both MCR slope (0.54±0.24 vs. 0.90±0.15, p<0.0001) and HRR (14.7±7.9 vs. 18.3±4.2min−1, p=0.03). In HF patients, MCR slope was inversely associated with beta-blocker dose (r=−0.24), NYHA class (r=−0.28) and HF duration (r=−0.25), whereas HRR with estimated glomerular filtration rate (eGFR, r=0.39), age (r=−0.28) and BMI (r=−0.31, all p<0.05). During a follow-up of 1269±933days, 64% patients experienced an adverse outcome (death, urgent transplantation, left ventricular assist device implantation). Those patients had higher NT-proBNP (p=0.02), worse left ventricular systolic function (LVEF, p=0.03) and lower MCR slope (p=0.02) but not HRR (p=0.19). MCR slope (but not HRR) was a significant outcome predictor (p=0.02 for Cox unadjusted model) even after adjustment for LVEF, serum natrium, systolic blood pressure, eGFR and NT-proBNP (p=0.04). ConclusionMCR slope is associated with different clinical variables than HRR. Compared to HRR, MCR slope provides significant prognostic information in HF patients.

Serum Natrium Determines Outcome of Treatment of Advanced GIST with Imatinib: A Retrospective Study of 80 Patients from a Single Institution

Treatment with tyrosine kinase inhibitors (TKIs) has drastically improved overall survival (OS) of patients with advanced GIST. The aim of this study is to evaluate the results of treatment with different TKIs on advanced GIST and identify prognostic factors for OS. The medical records of all patients treated at the Department of Oncology, Aarhus University Hospital were retrospectively reviewed. Between 2001 and 2009, 80 patients with advanced GIST were treated with imatinib as first-line therapy. The median OS was 44 months (95% CI 31–56), and the 5-year OS was 40%. Since 2005, 32 patients were treated with sunitinib as 2nd-line therapy. The median time to progression was 9 months (95% CI: 3–13 months), and the 3-year OS was 30%. The data illustrate that data from large multicenter studies are reproducible in a single sarcoma centre. This retrospective study pointed to low serum sodium at the start of imatinib as a possible prognostic factor affecting OS.

Establishment of A New Rat Model of Chronic Cyclosporine A Nephrotoxicity

To establish a new rat model of chronic cyclosporine A nephrotoxicity and explore its features. Totally 24 male SD rats were equally randomized divided into 3 groups: sham-adrenalectomized (sham-ADX) group, ADX group and ADX plus cyclosporine A (CsA) group. Rats in ADX and CsA group first underwent adrenalectomy, followed by the administration of placebo or dexamethasone, respectively. Rats in sham-ADX group received sham adrenalectomy and distilled water as control. Six weeks later, all rats were sacrificed and the following indicators were evaluated: urine protein excretion, creatinine clearance, aldosterone level in serum and urine, aldosterone level and its synthase CYP11B2 gene expression in kidney, serum natrium and potassium, urine natrium and potassium excretion, and tubulointerstitial fibrosis by masson trichrome stain. In ADX and CsA group, serum and urine aldosterone were undetectable on the second post-operative day, with other observations including natriuresis, hyponatremia, decreased urine potassium excretion, and hyperpotassemia, suggesting that adrenals were removed intact and the adrenalectomy was successful. Rats in CsA group showed increased urine protein, decreased creatinine clearance and tubulointerstitial fibrosis, suggesting that a model of chronic CsA nephrotoxicity was successfully established. At the endpoint, serum potassium, serum aldosterone, urine potassium and urine aldosterone excretion partially retrieved. Natrium in serum and urine was not significant different between ADX group/CsA group and sham-ADX group. Local renal aldosterone and its gene expression were remarkably upregulated. We successfully established a new rat model of chronic CsA nephrotoxicity by adrenalectomy without low sodium diet. After adrenalectomy, local renal aldosterone in kidney may compensate for circulatory aldosterone deficit to maintain electrolyte balance.

Vaptane und Herzinsuffizienz

Vasopressin plays a physiological role in regulation of blood pressure, fluid volume, and serum osmolality. In heart failure inadequate release of vasopressin may result in excess fluid retention and hyponatremia. Vasopressin receptor antagonists are a new class of orally active drugs targeted to inhibit one or more of three distinct vasopressin receptors, namely V1a- (-->vasoconstriction), V1b- (-->release of ACTH) und V2-receptors (-->inhibition of free water reabsorption in the kidney). In cardiac decompensation with fluid overload selective V2- (Lixivaptan, satavaptan and tolvaptan) and non-selective V1a/V2-receptor blockers (Conivaptan) have been shown to be superior to standard therapy, as they allow for a faster weight loss and a more rapid symptomatic improvement (i.e. reduction in dyspnea). Inhibiting free water reabsorption without affecting renal sodium excretion vasopressin receptor antagonists allow for a controlled normalisation of serum natrium in euvolemic and hypervolemic hyponatremia. Vasopressin antagonists are well tolerated and have--in contrast to diuretics--no negative influence on renal function and serum potassium. Heart rate and blood pressure are not affected by vasopressin receptor antagonists. However, despite its excellent acute clinical effects long-term treatment with tolvaptan did not result in a reduced mortality and morbidity in heart failure patients over a mean follow-up of 9.9 months in the EVEREST trial.

Complications after transcallosal transseptal interforniceal resection of hypothalamic hamartoma: analysis of 37 cases

To summarize the post-operative complications of resection of hypothalamic hamartoma (HH) through transcallosal transseptal interforniceal approach. Thirty-seven HH patients, 26 males and 11 females, aged 8.7 underwent resection of the tumor via the transcallosal transseptal interforniceal approach. The symptoms and blood electrolytes were observed. After operation blood electrolyte test showed that 8 cases were normal, 19 cases showed hyponatremia as prime abnormality, and 10 cases had hypernatremia primarily. Among the 19 cases with hyponatremia transient apathy occurred in 2 cases, general epilepsy occurred in one patient, continuous minor epilepsy occurred in another one, 4 patients suffered minor epilepsy, 25 had fever the temperature of 3 of which were beyond 40 degrees C, and 2 had transient diabetes insipidus and 1 had diabetes. Resection of HH through the transcallosal transseptal interforniceal approach achieves significant improvement of gelastic seizures with fewer complications. The most common complication is disturbance of serum natrium, which, however, is mild and well managed.

Risk factors of hyperamylasemia in diabetic ketoacidosis

Risk factors of hyperamylasemia in 152 diabetic ketoacidosis(DKA)patients who had no acute pancreatitis were examined.Serum levels of hemodiastase,natrium,kalium,chlorine,calcium,phosphonium,creatinine,carbon dioxide combining power,osmotic pressure,blood glucose,blood lipids and uric acid were measured.With hemodiastase and other 14 factors as independent variables,the multiple linear regression analysis was performed and the partial regression coefficient was estimated.Blood glucose,serum natrium,osmotic pressure and triglyceride entered the regression equation,and their partial coefficients were 10.26,10.35,2.21 and 8.00,respectively.The constant quantitv was -2162.06.Compared with amylase-normal group,hyperamylasemia group showed statistically significant difference in blood glucose,serum natrium,osmotic pressure and triglyceride levels.Higher blood glucose and triglyceride might be the primary causes of hyperamylasemia. Key words: Diabetic ketoacidosis; Amylases

A STUDY OF RENAL FUNCTIONS AFTER THE ADMINISTRATION OF CISPLATIN IN ESOPHAGEAL CANCER PATIENTS

Cisplatin including pre- and postoperative chemotheropy was carried out in 16 esophageal cancer patients and various renal functions were monitored after cisplatin administration in total 27 courses. Nephrotoxicity (≥grade 2) occurred in 37.5% of the cases inspite of massive fluid load with diuretics. Renal tubular dysfunction was the main body of nephrotoxicity by cisplatin, accompanied by mild glomerular dysfunction. Both functions were aggravated in the second course of chemotherapy. Hyponatremia (≥130 mEq/l) was observed in 44% of the cases, of which creatinine clearance was worse than that of non-hyponatremic cases. Plasma hormonal changes were monitored in five cases, where aldosteron tended to increase and atrial natriuretic peptide tended to decrease after cisplatin administration. Decrease in serum natrium and insufficient fluid load were conceived to be its reason. It is necessary to improve the infusion therapy regarding to a dose of sodium administration, infusion volume, and administration of plasma expander.

Relation between the duration of pancardiac asystole and the post-asystolic atrial cycle and the effects of orciprenaline on the atrioventricular conduction in a patient wieh 2: 1 A-V block and intermittent cardiac standstill.

Generally accepted is the fact that the electrocardiographic changes are induced by many factors: such as excercise, the taking of food, smoking, change in posture and breathing. The purpose of this study is to analyze the electrocardiographic changes and to classified the mechanism of the electrocardiographic changes after the administration of glucose, the important sourse of energy for the heart. MATERIALS AND METHODS Subjects were 41 normals (35 males and 6 females of ages 19 to 54, averaging 29.9) who have had no history of cardiac, diabetic, hepatic, nephrotic disease, disorder of thyroid grand, severe acute infectious disease, operation of stomach and gallbladder and also who have normal fasting electrocardiogram. Methods: Subjects were prohibited from eating after last supper, and in the next early morning electrocardiogram and phonocardiogram were taken and serum levels of glucose, potassium, natrium and calcium were measured and 100 grams of glucose was administrated orally with 400 to 500 ml of water. Same tests were repeated in 30, 60, 90, 120 and 180 minutes after glucose ingestion. In, 2 cases insulin and NEFA were measured. In 19 cases Katz Index was calculated. In some cases, insulin and glucoseintravenously and KCl orally were given. In dogs, glucose, combination of glucose and insulin, that of glucose, insulin and asparate-K were given intravenously. RESULTS Blood sugar: In all cases, blood sugar level was within normal ranges with WILKERSON'S criteria. Serum electrolytes: Serum potassium was significantly decreased 30 minutes after glucose ingestion and then slightly increased. Serum natrium was decreased in 30 minutes and became normal in 60 minutes. Serum calcium was not changed. Insulin and NEFA: Insulin level was maximum in 30 minutes and then lowered gradually. NEFA continued lowering for 3 hours. Katz Index: It was increased in 11 cases, decreased or unchanged in 8 cases.