Significant Improvement In Renal Function Research Articles

Bilateral ureteral obstruction caused by a detrusor wall thickness: Case report and review of literature

Benign prostatic enlargement is a common condition in elderly men, caused by a histopathologic disease called benign prostatic hyperplasia. we report a case of a 76-year-old male with a benign prostatic hyperplasia who presented kidney injury due to bilateral hydronephrosis and no amelioration after bladder catheterization. An abdominopelvic computed tomography scan was performed showing bilateral moderate ureterohydronephrosis up to the level of the ureteral orifices within a diffuse thickening of the bladder wall and the endoscopic examination showed trigonal prominence, displacing and deforming the ureteral orifice. Three-months period of ureteral stenting with transurethral resection of prostate leads to significant improvement in renal function. This case underscores the importance of considering detrusor wall thickness as a potential cause of obstructive renal insufficiency, especially in elderly males presenting with chronic retention.

#539 The active ingredient in the Nuphar lutea plant DTBN, ameliorates kidney damage and inflammation in a mouse model of chronic kidney disease (CKD)

Abstract Background and Aims Complications associated with Chronic Kidney Disease (CKD), such as disease progression and anemia, are closely linked to heightened inflammation mediated by the innate immune response. This inflammation can be mitigated through the use of anti-inflammatory agents. 6,6′-dihydroxythiobinupharidine (DTBN), an active compound derived from the aquatic plant Nuphar lutea, demonstrates notable anti-inflammatory properties, primarily by inhibiting NF-κB and LPS-induced cytokine activation. DTBN has shown efficacy in priming neutrophils, enhancing phagocytosis, regulating reactive oxygen species (ROS) production, and modulating NET formation. This study aimed to assess the impact of DTBN on CKD in mice. Method Male C57BL/6J mice, aged 8 weeks, were subjected to an adenine diet known to induce CKD through crystal deposition and tubulointerstitial inflammation. Both control and CKD-induced mice received intraperitoneal injections of DTBN (25 μg QOD) or saline and were euthanized after 8 weeks for evaluation. Results CKD mice treated with DTBN exhibited a significant decrease in serum urea and creatinine levels compared to untreated CKD mice (reduction by 1.4-fold and 1.3-fold, respectively). Histological analysis of kidney tissues revealed a notable reduction in F4/80 positive macrophage infiltration (3.4-fold decrease) and damaged renal areas (three-fold decrease), along with diminished kidney TGF-β levels in DTBN-treated CKD mice. Moreover, the p65 subunit of NF-κB showed a three-fold reduction in CKD mice treated with DTBN compared to untreated CKD mice. Indices of kidney inflammation (IL-1β, IL-6, and P-STAT3) were notably decreased in CKD mice treated with DTBN (reduction by 1.4-fold, 1.6-fold, and 2.9-fold, respectively) compared to untreated CKD mice. Notably, DTBN treatment in control mice did not induce apparent tissue damage; however, it led to reduced weight gain and mild hypoalbuminemia without proteinuria. Conclusion DTBN demonstrated significant improvements in renal function and inflammation indices in CKD mice. Hence, DTBN and substances similar to DTBN could be considered as supplementary treatments for CKD patients.

Immunosuppressant Agents as Add-On Therapy Failed to Improve the Outcome of Immunoglobulin A Nephropathy with Crescent Score C1.

Background The renoprotective benefits of adding immunosuppressant therapy to corticosteroid (CS) treatment for immunoglobulin A nephropathy (IgAN) patients with less than 25% crescent formation (C1) remains uncertain, warranting further research. Methods A retrospective study was conducted on IgAN patients with crescent C1 lesions confirmed by renal biopsy at Xinqiao Hospital between May 1, 2017, and May 1, 2020. Patients were stratified into either the CS treatment group or the CS combined with an additional immunosuppressant therapy group. Follow-up assessments were conducted within 24 months. Propensity score analysis was used to match patients receiving CS and CS+immunosuppressant drug treatment in a 1:1 ratio. Primary outcomes included changes in estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR). Subgroup analyses were performed to evaluate the benefits of different populations. Composite endpoint outcomes comprised a 30% eGFR decrease, end-stage kidney disease (ESKD) necessitating dialysis or transplant, or kidney disease-related mortality. Adverse events were also compared between the two groups. Results: 296 IgAN patients with C1 lesions were included in the analysis. Baseline characteristics indicated that IgAN patients in the CS+immunosuppressant group exhibited poorer renal function and higher UACR levels. Propensity score analysis effectively minimized the influence of baseline clinical characteristics, including age, serum creatinine, initial eGFR, UACR, and 24-hour proteinuria. Both treatment groups demonstrated continuous eGFR improvement and significant UACR reduction during follow-up, especially at 6 months. However, no significant differences in eGFR and UACR reduction rates were observed between the two groups throughout the entire follow-up period, both before and after matching. Subgroup analysis revealed improved eGFR in both treatment groups, notably among patients with an initial eGFR below 90 ml/min/1.73 m2. Conversely, IgAN patients with C1 lesions and a cellular crescent ratio exceeding 50% treated with CS and immunosuppressant therapy experienced a significant improvement in renal function and a decline in urinary protein creatinine ratio. Composite endpoint outcomes did not significantly differ between the two groups, while the incidence of adverse events was comparable. Conclusion Our findings suggest that the addition of immunosuppressant therapy to corticosteroid monotherapy did not confer significant therapeutic advantages in patients with C1 lesions compared to CS monotherapy, although some specific patient populations appeared to derive modest benefits from this combined approach.

Switching from tenofovir disoproxil fumarate to tenofovir alafenamide in virologically suppressed patient with chronic hepatitis B.

Our study evaluated the outcomes of switching from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF) in patients with chronic hepatitis B (CHB). We assessed viral and biochemical responses as well as changes in the estimated glomerular filtration rate (eGFR) and bone mineral density (BMD). This retrospective multicenter study included CHB patients who achieved virologic response (VR) (HBV DNA<20IU/mL) while on TDF and were subsequently switched to TAF between April 2018 and October 2021. This study included 309 patients with a median age of 59years, and 42.1% were male. The mean duration of TDF and TAF administration were 54.0 and 37.5months, respectively. All patients maintained VR after switching to TAF. Alanine aminotransferase (ALT) normalization rate significantly increased 6months after switching (74.8%-83.5%; P=0.008). Adjusted eGFR significantly improved at 6months (+5.55±10.52mL/min/1.73m2; P<0.001) and 12months (+6.02±10.70mL/min/1.73m2; P<0.001) after switching. In the subgroup of patients with renal impairment (eGFR<60mL/min/1.73m2), significant improvement in renal function was observed at 6months (+0.6±10.5mL/min/1.73m2; P<0.001) and 12months (+1.0±10.7mL/min/1.73m2; P<0.001) after switching to TAF. In patients with osteoporosis (n=182), switching to TAF resulted in significant improvement in spine and hip BMD at 12months, with increases of 9.7% (95% CI: 7.0-12.5) and 9.4% (95% CI: 7.0-11.8), respectively. In this real-world study, switching to TAF was effective and safe in patients, with notable improvements in ALT levels, renal function, and BMD.

Annona Muricata L. extract restores renal function, oxidative stress, immunohistochemical structure, and gene expression of TNF-α, IL-β1, and CYP2E1 in the kidney of DMBA-intoxicated rats.

Introduction: 7,12-dimethylbenz (a) anthracene (DMBA) is a harmful polycyclic aromatic hydrocarbon derivative known for its cytotoxic, carcinogenic, and mutagenic effects in mammals and other species. Annona muricata, L. (Graviola; GRV) is a tropical fruit tree traditionally well-documented for its various medicinal benefits. This investigation is the first report on the potential antioxidant and antinfammatory reno-protective impact of GRV against DMBA-induced nephrotoxicity in rats. Methods: Forty male albino rats were allocated into four equal groups (n = 10). The 1st group served as the control, the 2nd group (GRV) was gastro-gavaged with GRV (200mg/kg b.wt), the 3rd group (DMBA) was treated with a single dose of DMBA (15mg/kg body weight), and the 4th group (DMBA + GRV) was gastro-gavaged with a single dose of DMBA, followed by GRV (200mg/kg b.wt). The GRV administration was continued for 8weeks. Results and Discussion: Results revealed a significant improvement in renal function, represented by a decrease in urea, creatinine, and uric acid (UA) in the DMBA + GRV group. The antioxidant potential of GRV was confirmed in the DMBA + GRV group by a significant decline in malondialdehyde (MDA) and a significant increase in catalase (CAT), superoxide dismutase (SOD), glutathione S transferase (GST), and reduced glutathione (GSH) compared to DMBA-intoxicated rats; however, it was not identical to the control. Additionally, the antiinflammatory role of GRV was suggested by a significant decline in mRNA expression of cytochrome P450, family 2, subfamily e, polypeptide 1 (CYP2E1), tumor necrosis factor-alpha (TNF-α), and interleukin 1 beta (IL-1β) in the DMBA + GRV group. Moreover, GRV improved the histopathologic and immunohistochemical expression of TNF-α, CYP450, and IL1β in DMBA-intoxicated kidney tissue. Conclusively, GRV is a natural medicinal product that can alleviate the renal injury resulting from environmental exposure to DMBA. The reno-protective effects of GRV may involve its anti-inflammatory and/or antioxidant properties, which are based on the presence of phytochemical compounds such as acetogenins, alkaloids, and flavonoids.

Efficacy and safety of belimumab in patients with lupus nephritis: a real-world retrospective observational study.

To evaluate the differences in efficacy and safety between Lupus Nephritis (LN) patients who received belimumab plus standard therapy and those who received only standard therapy in real world practice. Patients diagnosed with LN at the First Affiliated Hospital of Wenzhou Medical University from November 2012 to July 2023 were identified, and eligible cases were divided into two groups according to whether they received additional treatment with belimumab during the course of the disease. A total of 1,169 LN patients were identified from our follow-up database. 112 patients receiving add-on treatment with belimumab (BLM group) and 112 control patients matched for relevant baseline characteristics were enrolled in this study. The median duration of treatment with belimumab was 13.82 [7.24, 20.29] months. Compared with the control group, the BLM group had more significant improvement in disease activity indicators such as serum albumin and complement levels, significantly lower B cell count, immunoglobulin, and earlier first attainment of renal remission, but there was no significant improvement in renal function and kidney-related events or death during the 2-year follow-up period. In the BLM group, the treatment effect of belimumab was more prominent in patients with lower levels of proteinuria. The safety profile of belimumab treatment was favorable, with a lower incidence of respiratory tract infection in the BLM group than in the control group during the follow-up period (p= 0.015). This real-world study revealed that add-on treatment with belimumab provided better disease remission, and the therapeutic effect was more significant in patients with lower proteinuria levels. In addition, it had a favorable safety profile and reduced the risk of respiratory tract infection.

Clinical efficacy and safety of beraprost sodium in the treatment of nephrotic syndrome: A meta-analysis.

Beraprost sodium has been shown to have positive effects in the kidney; however, its efficacy and safety in the treatment of nephrotic syndrome (NS) are currently unknown. Therefore, the aim of this meta-analysis was to evaluate the clinical efficacy and safety of beraprost sodium in the treatment of NS. We systematically searched EMBASE, PubMed, MEDLINE, China National Knowledge Internet (CNKI), Chinese Biomedical Database (CBM), and Wanfang database for articles from their inception to August 2022. A total of 12 randomized controlled trials (RCTs) involving 1200 subjects were collected for careful evaluation. The meta-analysis indicated that compared with the controls, combination therapy with berprost sodium could remarkably improve the total effective rate (odds ratio 4.21, 95% confidence interval [CI]: 2.87 to 7.25) and reduce 24 hours proteinuria (mean difference [MD] -1.03, 95% CI: -1.26 to -0.8), serum creatinine (MD -18.39; 95% CI: -27.81 to -8.98), blood urea nitrogen (MD -1.43,95% CI: -1.94 to -0.92), serum total cholesterol (MD -1.24; 95% CI: -1.36 to -1.11), and triglyceride (MD -0.69; 95% CI: -1.03 to -0.35), and increase serum albumin (MD 4.96, 95% CI: 2.98 to 6.93). But the adverse effects of dizziness and headache were higher (RD = 0.05. 95% CI: 0.02 to 0.08). For NS patients, combination therapy with beraprost sodium can achieve higher clinical efficacy and significant improvement in renal function than conventional therapy.

#6722 A RARE CASE OF ACUTE KIDNEY INJURY IN A PATIENT GRANULOMATOSIS WITH POLYANGIITIS, MONOCLONAL GAMMOPATHY WITH RENAL SIGNIFICANCE AND AMYLOIDOSIS

Abstract Introduction Anti - neutrophil cytoplasmic antibody /ANCA/- associated vasculitis is a small vessel vasculitis. It is a rare, autoimmune, inflammatory disease, with undetermined etiology, including granulomatosis with polyangiitis, microscopic polyangiitis, eosinophilic granulomatosis with polyangiitis. It could lead to pauci - immune necrotizing and crescentic glomerulonephritis and rapidly progressive glomerulonephritis. Monoclonal gammopathy of renal significance /MGRS/ is a plasma cell or B-cell disorder that could lead to renal impairment due to production of monoclonal protein, which do not meet the criteria for myeloma multiplex. There is a significant higher risk in progression to end stage renal disease/ESRD/ in groups with renal vasculitis and concomitant disease due to nonrenal factors. Clinical case We present a rare clinical case of a patient with combination of ANCA -vasculitis, MGRS and amyloidosis. A 60 year-old male patient with deteriorated renal function was presented to the clinic. Chronic congestive heart failure, arterial hypertension, situs inversus, anemic syndrome, hepatosplenomegaly were reported as concomitant diseases. Due to progressive worsening of renal function emergency hemodialysis treatment was initiated through temporary vascular access. Against the background of several chronic diseases, which could lead to chronic kidney failure, the echographic image of the kidneys stands out. Both kidneys are enlarged, with increased echogenicity of the parenchyma as in a diffuse renal process. The performed immunological tests confirm the diagnosis of granulomatosis with polyangiitis /formerly called Wegener's/, PR3-105,7. The results for the screened viral infections was negative. An episode of severe pulmonary edema was registered in the context of obstruction of the hemodialysis catheter due to coagulation disorders. The renal biopsy supports the diagnosis of vasculitis, crescentic glomerulonephritis - in advanced stage of development, probably a morphological manifestation of secondary nephropathy. An interesting finding is the presence of amyloidosis /AL/. The immunofixation blood test identify monoclonal IgG kappa type component. A sternal puncture, SPECT/CT was performed and diagnosis of multiple myeloma was excluded. Pathogenic treatment with corticosteroids and cyclophosphamide was initiated. In addition a short-term change in vision is observed in the context of the underlying disease. A consultation with ophthalmologist and neurologist was held, confirming cerebral arteritis. At this stage the recovery of renal function is incomplete. High flux membrane were used during dialysis treatment to reduce large and middle sized molecules. In addition, for the treatment of light chain amyloidisis, bortezomib was considered. Conclusion This clinical case emphasizes on the need to precisely clarify the cause that led to acute kidney injury. A thorough search for the underlying disease causing the deterioration of kidney function is critical for the renal outcome. The reasons for incomplete recovery of renal function during active treatment of vasculitis should be sought in underlying diseases-arterial hypertension, chronic heart failure, amyloidosis. Discussion Younger patients with lower eGFR at the onset of ANCA-associated vasculitis and no concomitant disease show significant improvement in renal function by the end of the first year regardless the need of dialysis treatment. Patients with severe accompanying disease have slow and insufficient improvement in renal function due to the prevalence of higher percentage of globally sclerotic glomeruli. Considering the severe prognosis of ANCA-associated vasculitis it is crucial to start early treatment. The state of the renal function at the first year of pathogenic treatment along with the pathological findings of the renal biopsy could be a predictors for the renal function course.

Pentoxifylline and thiamine ameliorate rhabdomyolysis-induced acute kidney injury in rats via suppressing TLR4/NF-κB and NLRP-3/caspase-1/gasdermin mediated-pyroptosis

Acute kidney injury (AKI) is a common complication of rhabdomyolysis (RM), a syndrome characterized by skeletal muscle damage resulting in renal tubular oxidative stress, inflammation, and activated toll like receptor-4 (TLR-4) and NOD-like receptor protein-3 (NLRP-3) inflammasome. Pyroptosis is a programmed cell death mediated by NLRP-3 leading to the activation of caspase-1 and gasdermin D (GSDMD), the hallmark of pyroptosis. This study aims to investigate the renoprotective effects of two antioxidants; pentoxifylline (PTX) and thiamine (TM) via targeting the aforementioned pathways. RM-AKI was induced in male Albino Wistar rats by intramuscular injection of glycerol (50% v/v, 10 ml/kg). PTX (100 mg/kg, oral) and TM (25 mg/kg, i.p) were administered for 12 days prior glycerol injection and continued for 3 days following induction of RM-AKI. Serum creatinine, blood urea nitrogen (BUN), creatin kinase, lipid peroxides, total antioxidant activity, inflammatory markers (tumor necrosis factor-α, interleukin-1β, and nuclear factor kappa B), TLR4, NLRP-3, caspase-1, GSDMD and c-myc (an apoptotic marker) were estimated. Compared to AKI model, co-administered drugs revealed a significant improvement in renal function and pathology as indicated by the reduction in serum creatinine, BUN and protein cast accumulation. The elevations of oxidative stress, and inflammatory markers as well as the over-expression of c-myc were alleviated. Protein levels of TLR4, NLRP3, cleaved caspase-1, and GSDMD were significantly elevated in RM-AKI model, and this elevation was attenuated by the tested drugs. In conclusion, PTX and TM could be a potential renoprotective approach for patients with RM through targeting TLR4/NF-κB and NLRP-3/caspase-1/gasdermin mediated-pyroptosis pathways.

Disconnect between the effects of serelaxin on renal function and outcome in acute heart failure

BackgroundWe aimed to study whether improvement in renal function by serelaxin in patients who were hospitalized for acute heart failure (HF) might explain any potential effect on clinical outcomes.MethodsWe included 6318 patients from the RELAXin in AHF-2 (RELAX-AHF2) study. Improvement in renal function was defined as a decrease in serum creatinine of ≥ 0.3 mg/dL and ≥ 25%, or increase in estimated glomerular filtration rate of ≥ 25% between baseline and day 2. Worsening renal function (WRF) was defined as the reverse. We performed causal mediation analyses regarding 180-day all-cause mortality (ACM), cardiovascular death (CVD), and hospitalization for HF/renal failure.ResultsImprovement in renal function was more frequently observed with serelaxin when compared with placebo [OR 1.88 (95% CI 1.64–2.15, p < 0.0001)], but was not associated with subsequent clinical outcomes. WRF occurred less frequent with serelaxin [OR 0.70 (95% CI 0.60–0.83, p < 0.0001)] and was associated with increased risk of ACM, worsening HF and the composite of CVD and HF or renal failure hospitalization. Improvement in renal function did not mediate the treatment effect of serelaxin [CVD HR 1.01 (0.99–1.04), ACM HR 1.01 (0.99–1.03), HF/renal failure hospitalization HR 0.99 (0.97–1.00)].ConclusionsDespite the significant improvement in renal function by serelaxin in patients with acute HF, the potential beneficial treatment effect was not mediated by improvement in renal function. These data suggest that improvement in renal function might not be a suitable surrogate marker for potential treatment efficacy in future studies with novel relaxin agents in acute HF.Graphical abstractCentral illustration. Conceptual model explaining mediation analysis; treatment efficacy of heart failure therapies mediated by renal function.

Renal Function, Adherence and Quality of Life Improvement After Conversion From Immediate to Prolonged-Release Tacrolimus in Liver Transplantation: Prospective Ten-Year Follow-Up Study.

Immunosuppression non-adherence is a major cause of graft failure after liver transplantation. The aim of this study was to evaluate practice surrounding conversion from immediate-release to prolonged-release Tacrolimus formulation and to assess patient adherence and quality of life (QoL). One hundred and seven adult liver transplant recipients, receiving immediate-release Tacrolimus for a minimum of 6months, were converted to prolonged-release formulation, based on a dose ratio of one (1:1). The median follow-up was 120 [IQR, 120-123] months. Tacrolimus dosage and blood level, liver and renal function, lipid and glucose profiles were recorded. In addition, questionnaires were submitted to evaluate adherence and QoL following conversion. No rejection was recorded. The median serum Tacrolimus blood level decreased over 1month (5.80, [IQR, 2.0-10.8] vs. 3.8 [IQR, 1.4-8.7]; p < 0.0005). Significant improvement in renal function was noted (median GFR was 81.7 [IQR, 43.4-128.6] vs. 73.9 [IQR, 27.1-130.2]; p = 0.0002). At the end of the follow-up, conversion resulted in an overall decrease in non-adherence of 53.3% (p = 0.0001) and an improvement in QoL was reported by 76.2% of patients. Thus, 1:1 conversion from immediate to prolonged-release Tacrolimus is safe, feasible and efficient, avoiding under-therapeutic and toxic peak concentrations, improving renal function, adherence to immunosuppression and overall patient QoL.

Effect of pegylated interferon-α2b add-on therapy on renal function in chronic hepatitis B patients: A real-world experience.

Controversy remains as to pegylated interferon-α (PEG-IFNα) antiviral therapy to renal function in chronic hepatitis B (CHB) patients. The aim of this study was to evaluate the influence of PEG-IFNα2b (Y shape, 40 kD) add-on treatment for renal function in CHB patients who received entecavir therapy. This was a retrospective observational study to investigate factors related to renal function in 114 CHB patients who received PEG-IFNα2b add-on therapy to entecavir for 48 weeks. Changes of blood urea nitrogen (BUN), serum creatinine (sCr), and estimated glomerular filtration rate (eGFR), which was calculated with both Chronic Kidney Disease Epidemiology Collaboration and Modification of Diet in Renal Disease (MDRD) formulas, were analyzed by one-way analysis of variance. A linear mixed effects model for repeated measures was used to assess the correlation between baseline information and eGFR changes at 24 and 48 weeks of therapy. The model considered the baseline age, gender, body weight, viral load, hepatitis B surface antigen, BUN, sCr, and treatment strategy as fixed effects and incorporated random effects for individual subjects. BUN and sCr was decreased, while eGFR was increased at 12 weeks of therapy. Only eGFR maintained at 24 and 48 weeks of therapy. Patients with female gender, age ≥ 40 years, and baseline HBsAg level < 250 IU/mL showed significant improvement of renal function with PEG-IFNα2b add-on therapy. The linear mixed effects model revealed that female gender, baseline sCr, and PEG-IFNα2b add-on were significant positive predictors for eGFR elevation at 24 and 48 weeks of therapy. In real-world experience, PEG-IFNα2b add-on therapy might be associated with increased eGFR in CHB patients.

Umbilical Cord Mesenchymal Stem Cells Ameliorate Kidney Injury in MRL/Ipr Mice Through the TGF-β1 Pathway.

The therapeutic effects and mechanism of umbilical cord mesenchymal stem cells (UC-MSC) on kidney injury in MRL/Ipr mice were studied. UC-MSC, methylprednisolone (MP), and their combination were used to treat MRL/Ipr mice. The therapeutic effects were evaluated by renal function assessment, and HE, PAS, and Masson staining were carried out on renal tissues and visualized by electron microscopy. Subsequently, podocyte injury was detected by the presence of podocin in renal tissues by immunofluorescence. To further explore the mechanism, serum TGF-β1 was measured, and TGF-β1, p-Smad3, and TRAF6 in the renal tissue were detected by Western blotting. In vitro, TGF-β1 was used to stimulate podocytes, and the podocyte activity and changes in synaptopodin were observed after UC-MSC treatment. Significant improvements in renal function and pathological injury were observed in the UC-MSC group compared to the lupus nephritis (LN) model group. UC-MSC and MP treatment improved podocyte injury in MRL/Ipr mice. Western blot examination showed a significant increase in TGF-β1, p-Smad3, and TRAF6 expression in renal tissues of the LN model group, while significant downregulation of those proteins was observed in the UC-MSC group. After TGF-β1 stimulation in vitro, podocyte activity decreased, and UC-MSC treatment improved podocyte activity and restored synaptopodin expression. UC-MSC therapy could improve the deterioration of renal function and the pathological changes of the renal tissues in MRL/Ipr mice. Our study suggested that UC-MSC may improve kidney injury and podocyte injury in LN mice by inhibiting the TGF-β1 pathway.

Renal function changes associated with transcatheter aortic valve-in-valve for prosthetic regurgitation compared to stenosis.

Renal dysfunction is frequently encountered in patients with aortic prosthesis degeneration requiring valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR). The effect of VIV TAVR on renal function in patients with bioprosthetic aortic regurgitation (AR) and stenosis (AS) is unknown. The aims of this study were to describe the change in renal function after VIV TAVR and to compare differences in renal function changes in those with predominant prosthetic regurgitation compared to stenosis. All VIV TAVR between June of 2014, and October 2019 (n=141) at a single institution were reviewed. Baseline renal function parameters including estimated glomerular filtration rate (eGFR) were compared with post-discharge follow-up values in both prosthetic AR and AS patient groups. Linear regression analysis was performed to determine correlates of renal function change. Mean baseline eGFR was lower in the AR group (55 SD21 vs. 64 SD24 ml/min/1.73m2 p=0.0495). At post-discharge follow-up there was an increase in mean eGFR in the AR group which was not present in the AS group (8 SD12 vs. 0 SD11 ml/min/1.73m2 respectively p=0.0006). There were strong correlations between change in creatinine (β=-0.57, R2=0.64, p<0.0001) and BUN (β=-0.61, R2=0.51, p<0.0001), and pre-procedure values in the AR group. Patients who underwent VIV TAVR for AR experienced significant improvement of renal function at post-discharge follow-up. More advanced renal dysfunction at baseline was associated with greater improvement in renal function at post discharge in AR patients.

Remedial Action of Yoghurt Enriched with Watermelon Seed Milk on Renal Injured Hyperuricemic Rats

The consumption of plant-based dairy alternatives has increased rapidly around the world as a result of numerous positive health effects. Little information is available about the potential use of watermelon seed milk in the manufacture of yoghurt. The present study was undertaken to investigate the remedial action of yoghurt enriched with watermelon seed milk in renal injured hyperuricemic rats. A new yoghurt, substituting cow’s milk with different proportions of watermelon seed milk was prepared, followed by evaluation of its acceptability and functionality. Four different types of yoghurt were prepared from cow’s milk containing 3% fat, with different proportions of blended watermelon seed milk (0.0, 25, 50 and 75%). Sensorial traits, i.e., appearance, flavor, body and texture, and overall acceptability demonstrated that the blended treatment (50% cow’s milk and 50% watermelon seed milk.) was the most acceptable. This blend was then tested as an anti-hyperuricemia agent in rats. In this respect, twenty-four male albino rats were assigned into four groups (n = 6). The first group was solely administered a standard diet, and served as the negative control. The other rats (n = 18) received a basal diet including 20 g/kg dietary potassium oxonate in order to induce hyperuricemia. The hyperuricemic rats were then divided into three groups; the first group did not receive any treatment and served as the positive control, while the second and third groups were administered 10% cow’s milk yoghurt and 10% watermelon seed milk yoghurt, respectively. Interestingly, the results showed that the hyperuricemic group receiving a diet supplemented with 10% watermelon seed milk yoghurt was not significantly different from the negative control in the measured biological parameters, and saw a significant improvement in renal function compared to the positive control. The biologically favorable action of watermelon seed milk yoghurt could be attributed to its potential promotion of antioxidant status via enhancement of the activities of superoxide dismutase, catalase, and glutathione transferase. Collectively, this study concluded that watermelon seed milk can be used in yoghurt manufacturing in proportions of up to 50%, and may improve kidney function as an anti-hyperuricemic agent.

Prediction of renal function improvement in azotemic patients using glomerular filtration rate from 99mTc-DTPA renal scan: An observational study.

This study aimed to evaluate the ratio of glomerular filtration rate (GFR) from 99mTc-diethylenetriamine-pentaacetic acid dynamic renal scan (GFRSCAN) to estimated GFR (eGFR) as a predictor of renal function improvement in patients with azotemia.A retrospective review of medical records was conducted to identify consecutive patients with newly discovered or aggravated azotemia who underwent 99mTc-diethylenetriamine-pentaacetic acid renal scan. Significant renal function improvement was defined as ≥100% and ≥10 mL/min improvement of eGFR at 12 weeks compared to eGFR on the day of renal scan (eGFR0). The GFRSCAN/eGFR0 ratio was evaluated as a predictor of significant renal function improvement using logistic regression and receiver operating characteristic (ROC) curve analyses. Added value of the GFRSCAN/eGFR0 ratio in the prediction of significant renal function improvement were demonstrated by adjusting for best clinical predictor variables.The eligibility criteria were met by 224 patients, among whom 22 patients (9.8%) showed significant renal function improvement. The odds ratios of the GFRSCAN/eGFR0 ratio for predicting significant renal function improvement were 1.76 (95% confidence interval [CI]: 1.26–2.45, P < .001) in the univariable analysis and 1.70 (95% CI: 1.19–2.42, P = .003) after adjusting for clinical variables. The area under the ROC curve of the GFRSCAN/eGFR0 ratio for predicting significant renal function improvement was 0.762 (95% CI: 0.648–0.871). The addition of the GFRSCAN/eGFR0 ratio to the best clinical prediction model raised the area under the ROC curve from 0.726 to 0.794, and this increment was statistically significant (P = .02).The GFRSCAN/eGFR ratio can predict renal function improvement in patients with azotemia. Future prospective studies are necessary to validate its potential clinical utilities.

Dose-dependent dynamics of glomerular filtration rate in patients with reduced renal function in the postinfarction period

Abstract Objective To evaluate the effect of 48-week therapy with atorvastatin at various doses on the glomerular filtration rate (GFR) in patients after acute ST-segment elevation myocardial infarction (STEMI). Methods 103 STEMI patients aged 52 (45.5; 59) years (92 men and 11 women) were examined. The patients were randomized into three groups: group 1 – 39 patients taking atorvastatin 80 mg; group 2 – 26 patients who received atorvastatin 40 mg; group 3 – 38 people who took atorvastatin 20 mg. The compared subjects were matched by age, sex, height, BMI, and office BP. All patients were receiving STEMI treatment prior to study entry. Initially and after 24, 48 weeks of follow-up, the creatinine level was determined on an Olympus AU400 analyzer (Olympus Corporation, Japan), followed by the calculation of GFR using the CKD-EPI formula. Results In group 1, GFR was 86.3 at baseline [95% CI 80.3; 92.3], after 24 weeks – 85.1 [95% CI 80.4; 89.7], after 48 weeks – 85.9 [95% CI 80.4; 91.4] ml/min. In group 2, the following GFR values were found: on days 7–9 – 78.4 [95% CI 73; 83.8], after 24 weeks – 82.2 [95% CI 75.5; 89], and 48 weeks – 78.9 [95% CI 74.1; 83.6] ml/min. In group 3, GFR was 88.2 at baseline [95% CI 80.9; 95.5], at the 24th week – 84.9 [95% CI 80.4; 89.4], after 48 weeks of therapy – 81.1 [95% CI 75.5; 86.7] ml/min. Individuals with a baseline decreased GFR &amp;lt;90 ml/min were identified in each group in accordance with the clinical practice guidelines of KDIGO (2012). At the same time, against the background of therapy with atorvastatin 80 mg, a significant increase in GFR from 71.8 [95% CI 67.9; 75.7] to 79.9 [95% CI 74.2; 85.6] after 24 weeks (p=0.02) and the subsequent increase in GFR to 81.0 [95% CI 74.9; 87.2] ml/min after 48 weeks (p=0.02). Against the background lower doses of atorvastatin, GFR dynamics were not observed: in group 2 – 74.0 [95% CI 69.1; 78.9], 79.3 [95% CI 71.5; 87.1], 77.2 [95% CI 71.7; 82.7] ml/min; in group 3 – 70.9 [95% CI 67.6; 74.1], 79.2 [95% CI 73.1; 85.4], 74.9 [95% CI 65.9; 83.9] ml/min. Conclusions In STEMI patients with an initially reduced GFR level, only atorvastatin therapy at a dose of 80 mg for 48 weeks of treatment was accompanied by a significant improvement in renal function. Funding Acknowledgement Type of funding sources: None.

Clinical Factors Associated with Renal Outcome After Heart Transplantation.

Cardiorenal syndrome (CRS) frequently occurs in end-stage heart failure patients waiting for heart transplantation (HT). Decision-making regarding simultaneous heart and kidney transplantation is an unresolved issue in these patients. We investigated clinical factors associated with renal outcome after HT. A total of 180 patients who received HT from 1996 to 2015 were included. Factors associated with early post-HT chronic kidney disease (CKD, estimated glomerular filtration rate [eGFR] < 60 mL/minute/1.73 m2 within 1 year post-HT), post-HT end-stage kidney disease (ESKD), and significant renal function improvement (%ΔeGFR > 15%) at 1 year post-HT were analyzed. Early post-HT CKD and post-HT ESKD developed in 61 (33.9%) and 8 (4.4%) of 180 patients, respectively. Old age was only independently associated with early post-HT CKD and preexisting CKD tended to be associated with early post-HT CKD. Old age and preexisting CKD were independently associated with post-HT ESKD. Low pre-HT eGFR and preoperative renal replacement therapy were not associated with early post-HT CKD or post-HT ESKD. Young age, low pre-HT eGFR, and high %ΔeGFR 1 month post-HT were independently associated with significant renal function improvement. Preoperative renal function, including preoperative RRT, was not associated with post-HT mortality. In conclusion, preexisting CKD may impact renal outcomes after HT, but preoperative severe renal dysfunction, even that severe enough to require RRT, may not be a contraindication for HT alone. Our data suggest the necessity of early HT in end-stage heart failure patients with CRS and the importance of careful management during the early postoperative period.

Real-Life Experience of mTOR Inhibitors in Liver Transplant Recipients in a Region Where Living Donation Is Predominant.

Background: Mammalian target of rapamycin (mTOR) inhibitors, such as everolimus and sirolimus, may be efficacious in preserving renal function in liver transplantation (LT) recipients while preventing hepatocellular carcinoma (HCC) recurrence. Materials and Methods: In this study, we retrospectively evaluated the safety, efficacy, and renoprotective effects of mTOR inhibitors in LT recipients. Among the 84 patients enrolled, mTOR inhibitor was commenced during the first year after LT. Renal function was measured by estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease equation. Results: Regarding the type of mTOR inhibitor, everolimus was used in 71 patients and sirolimus in 13 patients. Concomitant tacrolimus was used in 63 patients (75.0%). For total enrolled patients, kidney function did not significantly change during 12 months after initiation of mTOR inhibitors, although tacrolimus-withdrawn patients (n = 21) showed better kidney function compared to tacrolimus-minimized patients (n = 63) after conversion. However, a significant improvement in kidney function was observed in the eGFR <60 ml/min/1.73 m2 group (n = 19) 12 months after initiation of mTOR inhibitors, for both patient groups with early + mid starters (n = 7, stating within 1 year after LT) and late starters (n = 12, starting over 1 year after LT). mTOR inhibitors were safely administered without serious adverse events that led to drug discontinuation. Conclusion: We demonstrated that patients with renal impairment showed significant improvement in renal function regardless of the timing of mTOR inhibitor start, suggesting that switch to mTOR inhibitors may be beneficial when renal function declines.

Renal function evaluation after percutaneous nephrolithotomy in patients with solitary kidney

Objective: To evaluate renal function change after percutaneous nephrolithotomy in patients with solitary kidney. Methods: A prospective study conducted in the urology department at Rizgary Teaching Hospital for a period of 15 months from first of June 2018 until the end of August 2019. It included nine adult patients, all of them with solitary kidney and undergone percutaneous nephrolithotomy for management of renal calculi. Patients were considered to have a solitary kidney in case of congenital abnormality, contralateral nephrectomy, or solitary functioning kidney with contralateral atrophy (relative function &lt; 10%). All patients were received prophylactic antibiotics (Ceftriaxone) at induction of anesthesia. All percutaneous nephrolithotomy procedures performed under general anesthesia in the prone position. Serum creatinine and creatinine clearance before the operation, at day one and day 21 postoperatively, operation time, duration of hospitalization, and postoperative complications recorded. Results: In this study, Means of serum creatinine at 1 day and 21 days postoperatively were significantly decreased compared to preoperative s. creatinine level Mean of creatinine clearance significantly increased after 21 days postoperatively compared to preoperative test, while no significant change in creatinine clearance after one day postoperatively. Conclusion: Generally, percutaneous nephrolithotomy considered as a safe and effective option for treatment of renal stones in solitary kidney patients considering the overall rate of complications and minimal morbidity. Moreover, significant renal function improvement anticipated in the early postoperative period.