Spot Urine Research Articles

6621 Iodine Nutritional Status in Different Trimesters of Pregnancy: A Prospective Observational Study in Taiwan

Abstract Disclosure: L. Pan: None. C. Yeh: None. C. Yang: None. C. Hwu: None. H. Chen: None. F. Wang: None. C. Huang: None. Pregnant women are susceptible to iodine deficiency. Iodine nutritional studies in pregnant women were mostly cross sectional evaluations of iodine status. This prospective observational study was designed to longitudinally follow the iodine status of pregnant women in different trimesters of pregnancy and to assess the clinical parameters and dietary influences on iodine status. A total of 209 pregnant women in their first trimester were enrolled in Taipei Veterans General Hospital, Taiwan from March 2019 to March 2023. Subjects provided a spot urine sample and completed a food frequency questionnaire at each trimester. Urinary iodine concentration (UIC) was measured by inductively coupled plasma mass spectrometry. The median UIC for the first, second and third trimester was 156.3 μg/L (Interquartile range [IQR]: 100.7-241.1), 146.2 μg/L (84.6-224.4), and 169.9 μg/L (94.4-283.5), respectively. Mild iodine deficiency was observed in the second trimester despite adequate iodine status in the first and third trimesters. Compared to the first trimester, intake of seaweed (p = 0.004, p < 0.001, respectively), fish (p < 0.001, p < 0.001, respectively), and prenatal multivitamins (p < 0.001, p < 0.001, respectively) increased in the second and third trimesters. A gradual increment in dairy product intake was also noted between each trimesters through pregnancy (p < 0.001, p = 0.004, respectively). Multivariate analysis indicated a positive association between multiparity and increased UIC in the second trimesters (multiparity vs. uniparity; adjusted odds ratio [OR]: 2.273, 95% confidence interval [CI]: 1.202-4.310). Additionally, increased prenatal multivitamin intake elevated the odds of adequate UIC in the third trimester (≥ 3 days/week vs. ≤ 1 day/week; adjusted OR: 2.890, 95% CI: 1.351-6.173). This study revealed the longitudinal changes in iodine status during pregnancy and suggested that women who regularly took prenatal multivitamins and were multiparous were more likely to have adequate iodine nutrition. Presentation: 6/2/2024

7815 Pembrolizumab-Induced Autoimmune Hypophysitis with “Isolated” ACTH Deficiency: Need for Heightened Awareness and Action Among Medical Fraternity

Abstract Disclosure: S. Shankar: None. S.S. Sundar: None. M.S. Vaishnav: None. L. Lekkala: None. K. Thummala: None. S. Srikanta: None. T. Deepak: None. R.B. Vijay: None. K. Muniraj: None. V. Nath: None. C. Siddlingappa: None. P. Ravikumar: None. M.D. Chitra: None. Introduction: Autoimmune hypophysitis caused by immune checkpoint inhibitors [ICIs; anti-CTLA-4 (Ipilimumab alone 7.9%), anti-PD-1 (Pembrolizumab alone 1.7%; nivolumab alone 0%)] are being increasingly documented, with anterior hypopituitarism affecting corticotrophs more commonly than thyrotrophs and gonadotrophs (large time span of onset; different recovery patterns). Clinical Case 2021 Sep Age 65 years (type 2 diabetes, hypertension). Renal Cell Carcinoma S/P radical nephrectomy. 2023 Jul PET-CT= Metastatic pleuropulmonary nodules. Four admissions to Specialist Oncology Hospital [Four 2 weekly cycles of Inj Pembrolizumab 200 mg (with Tab Axitinib 10 mg/day)]. After first cycle: progressive fatigue, body aches, drowsiness. S Sodium= Pre-pembrolizumab= 137 mEq/L (135-145); Post-pembrolizumab= 124, 134, 132, 124; T3= 1.63 to 0.60 to 1.24 to 1.35 ng/mL (0.97-1.69); T4= 6.83 to 4.93 to 10.44 to 11.44 mcg/dL (5.53-11); TSH= 10.46 to 6.28 to 5.39 to 9.48 mIU/mL (0.46-4.68); S Cortisol 8 am= 1.54 mcg/dL (5-25); S Potassium= 4.59 mEq/dL (3.5-5.1)]. One episode of loss of consciousness; EEG= abnormal; MRI Brain= normal. During every hospital admission, oncology, medical, endocrinology and nephrology teams attributed the same to “illness” (no specific diagnosis) and provided symptomatic treatment (IV 3% saline, tolvaptan and sodium bicarbonate tablets).2023 Nov Medicine: Very severe nausea, anorexia, generalised weakness, myalgia, hiccoughs, and inability to walk. Frustrated family members sought admission in “new” General Hospital. S Sodium= 119, 120; S Potassium= 4.8; S Creatinine= 1.67 mg/dL (0.7-1.3); S Uric acid= 4.5 mg/dL (4.40-7.60); Urine spot Sodium= 84 mmol/L; ESR= 144 mm. Endocrinology: S Cortisol 8 am= 0.09 mcg/dL;S Cortisol post 250 mcg Inj Synacthen= 3.76 (>20);Plasma ACTH= 5.4 pg/ml (9-52). S T3= 1.35; S T4= 11.44; S TSH= 9.48; LH= 3.61mIU/mL (1.5-9.3); FSH= 1.4mIU/mL (1.4-18.1); PRL= 30.1 (2.6-13.3); Testosterone total= 314 ng/dL (241-827); TPO antibodies negative. MRI-Pituitary: Partial empty sella; infundibulum neurohypophysis normal; mild asymmetric enhancement (5.5 mm) left cavernous sinus. Treatment: Tab Hydrocortisone 25 mg/day, with complete clinical and biochemical response [Suggestion of gonadotroph dysfunction and partial recovery of thyrotrope dysfunction/ injury. Hence, not on thyroxine replacement]. Clinical Lessons: Mechanisms for differential cellular vulnerability for ICI induced autoimmune pathologies [thyroid (destructive versus stimulatory), islet beta cells, adrenal cortical cells, various anterior pituitary cells (corticotrophs vs thyrotrophs and gonadotrophs] need elucidation. Specific molecular and cellular immunopathogenic pathways in different autoimmune endocrinopathies appear distinct and disparate. Presentation: 6/2/2024

Longitudinal biomonitoring of mycotoxin exposure during pregnancy in the Yale pregnancy Outcome Prediction study

Mycotoxins are fungal toxins that may trigger adverse health effects in pregnant women and their unborn children. Yet, data is scarce on the dynamic exposure patterns of mycotoxins in pregnant women, especially in the United States. This study assessed mycotoxin exposure profiles (n = 50) from the Yale Pregnancy Outcome Prediction Study (YPOPS) cohort at four distinct time points. Multi-analyte human biomonitoring (HBM) assays based on liquid chromatography tandem mass spectrometry (LC-MS/MS), were developed for human serum and plasma matrices. The serum method was applied, together with an established urine method, to quantify mycotoxin levels in longitudinally collected matched serum (n = 200) and spot urine (n = 200) samples throughout pregnancy. The serum samples were mostly contaminated by the potential carcinogen ochratoxin A (detection rate: 49 %; median: 0.09 ng/mL), the hepato- and nephrotoxic citrinin (detection rate: 32 %; median: 0.02 ng/mL) and two enniatins (EnnB; detection rate: 97 %; median: 0.01 ng/mL and EnnB1; detection rate: 12 %; median: 0.003 ng/mL) which may act as immunotoxins. The most prevalent mycotoxins quantified in urine included deoxynivalenol (detection rate: 99 %; median: 23 ng/mL), alternariol monomethyl ether (detection rate: 69 %; median: 0.04 ng/mL), and zearalenone (detection rate: 63 %; median: 0.16 ng/mL). Seven other biomarkers of exposure including the highly estrogenic α-zearalenol and genotoxic Alternaria toxins, were also determined. Carcinogenic aflatoxins were not detected in any of the samples. Exposure assessment was based on the urinary data and performed by calculating the probable daily intakes (PDIs) and comparing the human biomonitoring guidance value (HBM-GV) for deoxynivalenol. The results showed that the individuals exceeded the tolerable daily intake (TDI) for deoxynivalenol and zearalenone on average at 28 % and 2 % over the different time points. Using the HBM-GV approach, the average exceedances for deoxynivalenol increased to 48 % indicating high exposure. For all the samples in which ochratoxin A was quantified, the estimated margin of exposure for neoplastic effects was below 10,000, indicating possible health concerns. Overall, this study showed that pregnant women were exposed to several regulated and emerging mycotoxins and that exposome-scale assessment should be a future priority in susceptible populations to better characterize xenobiotic exposure.

Comparison of estimated sodium intake by dietary recall method and spot urine samples in patients with CKD

Comparison of estimated sodium intake by dietary recall method and spot urine samples in patients with CKD

Urinary Dickkopf-3 Reflects Disease Severity and Predicts Short-Term Kidney Function Decline in Renal Ciliopathies

BackgroundPhenotypic heterogeneity and unpredictability of individual disease progression present enormous challenges in ultrarare renal ciliopathies. The tubular-derived glycoprotein Dickkopf-related protein 3 (DKK3) is a promising biomarker for kidney fibrosis and prediction of kidney function decline. Here, we measured urinary (u)DKK3 levels in 195 pediatric renal ciliopathy patients to assess its potential as a discriminative and prediction marker. MethodsUDKK3 concentration was measured in 357 spot urine samples from 247 individuals including 52 healthy age-matched controls. Disease entities comprised nephronophthisis (NPH) (n=37), autosomal recessive polycystic kidney disease (ARPKD) (n=61), Bardet Biedl syndrome (BBS) (n=57) and hepatocyte nuclear factor 1 beta (HNF1B)-nephropathy (n=40). Results were correlated with chronic kidney disease (CKD) stage and annual estimated glomerular filtration rate (eGFR) decline. ResultsMedian uDKK3/creatinine ratios in all disease entities were significantly higher compared with healthy controls (11pg/mg uDKK3/crea, p<0.001): NPH 1.219pg/mg, HNF1B 731pg/mg, BBS 541pg/mg and ARPKD 437pg/mg. A significant correlation of CKD stage with uDKK3 levels was observed for all disease entities (p<0.0001) with no other clinical parameter having a relevant impact. In our cohort, uDKK3 values >4.700 pg/mg were associated with a significantly greater annual eGFR loss independently of diagnosis and eGFR (p=0.0029). While we observed a trend towards lower uDKK3 levels in glomerulopathies compared to renal ciliopathies, there was no discriminative difference between individual ciliopathy entities (p=0.2637). ConclusionIn renal ciliopathies uDKK3 is a marker to assess disease severity and estimate short-term kidney function decline.

Effective Newborn Screening for Type 1 and 3 Primary Hyperoxaluria

IntroductionNewborn Screening programs for a defined set of eligible diseases have been enormously successful, but genomic newborn screening allowing for detection of additional treatable disorders has not been broadly implemented. All three types of primary hyperoxaluria (PH1-3) are rare autosomal recessive diseases caused by distinct defects of glyoxylate metabolism that are diagnosed genetically with certainty. Early diagnosis and treatment are mandatory to avoid renal failure or sequalae associated with persistent hyperoxaluria. MethodsThe prospective pilot study was undertaken within the framework of the German Newborn Screening. DNA samples extracted from dried blood spot cards were screened by multiplex PCR for the two most prevalent mutations: AGXT c.508G>A (PH1) and HOGA1 c.700+5G>T (PH3). Heterozygous AGXT/HOGA1 carriers received repeated spot urine analyses and, in case of persistent hyperoxaluria, complete Sanger sequencing of AGXT and HOGA1 gene, respectively. ResultsBetween March 15th 2022 and June 30th 2023 additional screening for PH1 and PH3 was performed in 77199 out of 222638 newborns included in the regular newborn screening program. No homozygous individuals, but 274 potential carriers for the AGXT mistargeting and 287 potential carriers for the HOGA1 splice variant were identified. Further work up revealed two already symptomatic compound heterozygous infants, one with PH1 (genotype c.508G>A; c.33delC) and one with PH3 (genotype: c.700+5G>T;c.134C>G). A second symptomatic PH1 patient (father of an identified carrier; genotype: c.508G>A;c.508G>A) was uncovered via family history. ConclusionThis pilot study demonstrated the efficacy of a genomic neonatal screening program for primary hyperoxaluria even in relatively small cohorts.

A Position Statement on Diabetes with β-Cell Failure

Diabetes mellitus is a heterogeneous disease that encompasses a wide range of conditions, from mild cases to severe conditions where survival depends on insulin therapy. The Korean Diabetes Association Task Force Team for Diabetes with β-Cell Failure has established the term to classify severe refractory disease with β-cell failure. Individuals with β-cell failure are at high risk of diabetes-related complications. We propose that diabetes with β-cell failure can be diagnosed when individuals treated with multiple daily insulin injections or insulin pumps meet at least one of the following criteria: fasting C-peptide ≤ 0.6 ng/mL, non-fasting C-peptide ≤ 1.8 ng/mL, 24-hour urine C-peptide &lt; 30 μg/day, or spot urine C-peptide/creatinine ratio ≤ 0.6 nmol/mmol. Among cases of diabetes with β-cell failure, β-cell failure with absolute insulin deficiency can be diagnosed when at least one of the following criteria is met: fasting C-peptide &lt; 0.24 ng/mL, non-fasting C-peptide &lt; 0.6 ng/mL, or spot urine C-peptide/ creatinine ratio &lt; 0.2 nmol/mmol. Multiple daily insulin injections with long-acting insulin analogs and rapid-acting insulin analogs or insulin pumps are required for treatment of diabetes with β-cell failure. Continuous glucose monitoring and an automated insulin delivery system, sensor-augmented pump, or smart insulin pen, along with structured education, are necessary. We call for improvements in the relevant systems to ensure that such treatments can be provided.

Volume Status among Hyponatremic admitted Patients

Introduction: The kidneys play a vital role in the management of hyponatremic patients with fluid disturbances. This task becomes more challenging in presence of comorbidities like chronic kidney disease or congestive heart failure. Accurate assessment of volume status and urinary sodium excretion is essential part for the correct management.. Both impaired renal function and compromised left ventricular function complicate the accurate evaluation of a patient's fluid status. Method: This cross-sectional prospective study was conducted over 262 adult patients with hyponatremia at The Indus Hospital, Karachi from 2017 to 2020. The patient's volume status at the time of enrollment was categorized as normovolemic, hypovolemic, or hypervolemic based on clinical examination. Spot urine sodium, chloride, potassium, urine and serum osmolality, serum urea, and Random blood sugar were all done. Results: There was a total of 262 patients in which 123 (46.9%) were male and 139 (53.1%) were female. The mean age was 54.1 ± 16.4 years. The overall comorbid burden was high 227(86.64%), in which hypertension and CKD contributed more. Out of 262 patients, half of them suffered from hypovolemia 131(50%). Spot urine sodium (&gt;20 meq) was found in 219(83.58/%) patients, in which predominant volume status was hypovolemia 104(47.5%). Moreover, among those who could not survive were 28 (10.7%), in which hypovolemia contributed more than other volume status 12(42.85%). Conclusion: Hypovolemia came out to be the predominant volume status among hyponatremic patients with high comorbid burden. Majority excreted more sodium in spot urine sample despite of hypovolemia in majority.

Effect of age, sex, and chronic kidney disease on urinary creatinine excretion in Japanese patients.

Urinary creatinine levels are used to estimate the excretion rates of certain analytes from the respective analyte-to-creatinine ratios. We clarified the influence of age and sex on estimated daily urinary creatinine excretion (eUCrE) based on the urinary creatinine level and daily urine volume. All inpatients aged ≥ 18years who attended the Kochi Medical School Hospital with serum and urinary creatinine measurement results were enrolled. Serum and urinary creatinine concentrations were extracted from the database and fluctuations with sex and age were investigated. The eUCrE was calculated for patients with early morning spot urine protein excretion (UPE), and daily urine volume was measured on the same day. Overall, 643 participants (322 men, 321 women) were enrolled. The eUCrE levels of men and women aged 18 - 64 and 18 - 44years, respectively, significantly exceeded 1g/day. Those of women aged 65-74 and ≥ 75years were significantly lower than 1g/day. Each age group was further categorised into Groups A (patients with eGFR ≥ 30mL/min/1.73 m2 and UPE < 0.5g/gCr), B (eGFR ≥ 30mL/min/1.73 m2 and UPE ≥ 0.5g/gCr), and C (eGFR < 30mL/min/1.73 m2 and UPE ≥ 0.5g/gCr). The eUCrE levels were the highest in Group A, followed by Groups B and C. This study revealed age-, sex-, and renal function-related biases in adjusted values using urinary biomarkers, including proteinuria and creatinine ratio.

Portable Electrochemical System and Platform with Point-of-Care Determination of Urine Albumin-to-Creatinine Ratio to Evaluate Chronic Kidney Disease and Cardiorenal Syndrome.

The urine albumin (Alb)-to-creatinine (Crn) ratio (UACR) is a sensitive and early indicator of chronic kidney disease (CKD) and cardiorenal syndrome. This study developed a portable and wireless electrochemical-sensing platform for the sensitive and accurate determination of UACR. The developed platform consists of a carbon nanotube (CNT)-2,2'-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid)(ABTS)-based modified UACR sensor, a miniaturised potentiostat, a cup holder embedded with a magnetic stirrer and a smartphone app. The UACR sensing electrode is composed of two screen-printed carbon working electrodes, one screen-printed carbon counter electrode and a screen-printed AgCl reference electrode. The miniaturised potentiostat, which is controlled by the developed app, performs cyclic voltammetry and amperometry to detect Alb and Crn, respectively. Clinical trials of the proposed system by using spot urine samples from 30 diabetic patients indicate that it can accurately classify all three CKD risk statuses within 30 min. The high accuracy of our proposed sensing system exhibits satisfactory agreement with the commercial biochemical analyser TBA-25FR (Y = 0.999X, R2 = 0.995). The proposed UACR sensing system offers a convenient, reliable and affordable solution for personal mobile health monitoring and point-of-care urinalysis.

Ultrasonographic estimation of kidney size in adult Bangladeshi population without known renal disease: a preliminary report

Background: The kidney size of a patient is a valuable diagnostic parameter in clinical practice. Renal size varies with age, gender, body mass index (BMI), pregnancy, race and co-morbid conditions like diabetes mellitus (DM) and hypertension (HTN). Measurements of renal dimensions can be carried out by using different modern techniques like ultrasonography (USG), computed tomography (CT) scan and magnetic resonance imaging (MRI). Out of these modalities USG is choice because of its simplicity, inexpensive, easily available, non-invasive and easy reproducibility. There is no established nomogram for renal size in the Bangladeshi population. Aim of the study was to determine the ultrasonographic renal size in adult Bangladeshi population with no known renal disease and to correlate renal size with age, gender and BMI. In addition, we assess whether hypertension and diabetes mellitus affect renal size. Methods: This cross-sectional study was done in BIRDEM General Hospital and included 55 patients with age &gt;18 years over 6 month period. Study population were not known to have renal disease documented by urine routine microscopy, spot urine for albumin creatinine ratio (ACR), serum creatinine and USG. Their body weight, height and BMI were calculated along with duration of DM and HTN. Analysis was done for differences due to age, gender and laterality. The correlation of renal dimensions with anthropometric parameters were also done. Results: A total of 55 patients were analyzed. There were 19 (34.5%) male and 36 (65.5%) female. The mean age was 46±.10 years. There mean weight, height and BMI were 61 ± 11 kg, 1.54±.069 meter, 25.7 ± 4.8 kg/m2 respectively. In total population 34.5% (19) were diabetic and 32.5% (18) were hypertensive. The means of length, width and parenchymal thickness (PT) of right kidneys (RK) were 10.1 ± 0.87, 4.2 ± 0.67 and 1.4± 0.32 cm respectively. The means of length, width and PT of left kidneys (LK) were 10.3 ± 0.89, 4.5 ± 0.49 and 1.5 ± 0.32 cm respectively. Measurements were significantly higher in LK than those of RK respectively (p=.003, p&lt;.001 and p=.041). There were significant differences in kidney length and PT between sex and age. There were also significant differences in kidney length and PT between subjects of higher BMI, long duration of DM and HTN. The correlation between renal length and weight showed a positive correlation (r = 0.16, p &lt; 0.023). Conclusion: The variation of parameters of both kidneys varies on gender, age, obesity, comorbidity like DM &amp; HTN and with their duration. Length of both kidneys depends on body weight. Further study needed with large samples. BIRDEM Med J 2024; 14(3): 151-157

A field investigation of 3 masks proposed as respiratory protection for wildland firefighters: a randomized controlled trial in British Columbia, Canada.

Wildland firefighters are exposed through the lungs and skin to particulate matter, fumes, and vapors containing polycyclic aromatic hydrocarbons (PAH). Wearing respiratory protection should reduce pulmonary exposure, but there is uncertainty about the most effective and acceptable type of mask. Firefighters from 6 unit crews working with the British Columbia Wildfire Service were approached and those consenting were randomly allocated within each crew to a "no mask" control group or to use 1 of 3 types of masks: X, half-face respirator with P100/multi gas cartridge; Y, cloth with alpaca filter; Z mesh fabric with a carbon filter. Crews were followed for 3 consecutive firefighting days. The mask allocated was constant for each firefighter throughout. All participants completed a brief questionnaire at the start and end of each day, giving information on mask use, respiratory symptoms, and assessment of mask qualities. Spot urine samples were collected pre and post shift to assess 1-hydroxypyrene (1-HP) concentration as an indicator of total PAH absorption. Skin wipe samples from the hands and throat were collected pre and post shift and analyzed for PAH concentration. On each day monitored, 4 participants carried sampling pumps to measure total particulates and PAHs on particles and in vapor phase. The primary outcome was the concentration of urinary 1-HP at the end of the fire day. Secondary outcomes were changes in respiratory and eye symptoms during the course of the shift, reported mask use, and perception of mask qualities. The analysis used a 3-level random intercept regression model that clustered observations within individuals and crews. We aimed to detect any relation of allocated mask type to the 4 outcomes, having allowed for estimated exposure. Information was collected from 89 firefighters, including 14 women: 49% (37/75) of male firefighters were bearded. Nineteen fire days were monitored for a total of 263 firefighter × days, 64 to 68 for each intervention group. The end of shift 1-HP was higher than the start of the shift. Urinary 1-HP was more strongly related to PAHs on the skin than in the breathing zone. Men with beards had higher end-of-shift urinary log 1-HP/creat (ng/g) than other firefighters. None of the groups allocated a mask had lower 1-HP than the no-mask group, either in the study group overall or when stratified by beard-wearing. Among those without either beards or a failed fit-test, Mask Z reduced at the end of shift 1-HP where airborne PAH concentration was high. End-of-shift symptoms were related to particle mass in the breathing zone but was not mitigated by any of the masks. Hours electing not to wear a mask increased from the first to third shift for all mask types. Mask Z was rated as more comfortable than other types. Mask X was rated highest on fit and perceived protection. Mask Y gained the lowest ratings on fit, comfort and feelings of protection. Allocated masks did not provide protection overall, but the results highlighted the need for a wider understanding of the circumstances in which wearing efficient protection is well-advised.

ZnO/NiFe2O4 heterostructure on nickel foam for the electrochemical detection of uric acid

In this study, heterostructures containing hydrothermally derived ZnO and combustion derived NiFe2O4 were co-deposited on nickel foam (NF) substrate. The modification of NF based substrate with the synthesised electrocatalysts is capable of increasing the electrochemically active surface area (ECSA) due to its porous network. The fabricated ZnO@NF, NiFe2O4@NF and ZnO/NiFe2O4@NF electrodes were tested in phosphate buffer saline (PBS) (pH = 7.4 ± 0.2) to understand their chemical kinetics which reveals a diffusion-controlled process. A comparative study reveals that the presence of surface charges on ZnO/NiFe2O4@NF electrode, influences the selectivity by enhancing the sensitivity towards UA which is attributed to the low charge transfer resistance and its higher ECSA of 1.487 cm2. The linear response current was observed between 0.52 mM and 1.48 mM with a detection limit (LOD) of 8.22 μM and limit of quantification (LOQ) of 27.4 μM. The sensitivity was found to be 2.31 mA.mM−1cm−2. The main advantages of ZnO/NiFe2O4@NF electrode is its simple fabrication technique which is inexpensive, stability over a period of 13 days with current loss of ∼19.2 %. The proposed ZnO/NiFe2O4 based non-enzymatic UA sensor is capable of selectively detecting UA in the presence of various interferents. UA acts as a biomarker for the diagnosis of different stages of chronic kidney disease (CKD). Hence, the validity of the developed heterostructure was investigated for real time UA sensing using spot urine samples. The recovery percentage was found to be between 95.7 % and 103.5 % further paving way for the use of this electrode for diagnosis of CKD.

Intake and excretion of cadmium of Japanese adult

ObjectiveIt is the aim of this study if the recent Cd intake and excretion is consistent with the regression equation proposed by Ikeda et al. (Environ. Health Prev. Med. 20 (2015) 455–459) which utilized intake/excretion data of 3 decades ago MethodMatched duplicate diet and spot urine samples were collected in 2017–2019 from 150 Japanese adults (85 females and 65 males, mean age being 44.9) for the estimation of daily Cd intake and urinary excretion. Cd concentration in diet and urine was measured by ICP mass spectrometry. ResultGeometric mean (geometric standard deviation) of Cd intake was 12.1 (1.67) μg/person/day or 0.206 (1.66) μg/kg body wt./day. Urinary Cd concentration was 0.54 (2.6) μg/g creatinine or 0.67 μg/L (2.3) (gravimetric correction). These were lower than those reported previously for Japanese populations. Urinary concentration was significantly higher in females than in males for both creatinine and gravimetric corrections. Dietary intake was higher in males than in females but this difference diminished after body weight correction. There was no significant correlation between Cd intake and urinary concentration on individual basis, which was expected because urinary Cd concentration reflects Cd body burden but not recent intake level. Meanwhile, the geometric mean intake and urine concentration was consistent with the regression equation proposed by Ikeda et al., which was based on intake and excretion surveys for 30 non-exposed Japanese female populations. ConclusionThis result supported that the regression equation of Ikeda et al. could be used for conversion of urinary Cd excretion level of a population to intake level.

Cellulose acetate electrophoretic separation of serum and urine proteins in Nigerian children with autism spectrum disorders

BackgroundAutism spectrum disorder (ASD) is a neurodevelopmental disorder (NDD) characterized by social communication challenges and restricted, repetitive behaviors. While genetic and environmental factors are known to contribute to ASD, the role of the immune system remains unclear. This study investigated the separation patterns of serum and urine proteins in Nigerian children with ASD compared to typically developing children and children with other NDDs.MethodsForty-seven participants aged 3–8 years were recruited, including 16 children diagnosed with ASD and 16 children with other NDDs, both according to DSM-5 criteria, along with 15 neurotypical children. Blood and urine samples were collected for protein analysis. Total protein and albumin levels were measured in both serum and urine using established methods. Protein separation in serum and urine was performed using cellulose acetate electrophoresis, followed by densitometry analysis of the electrophoretic patterns.ResultsThe results revealed no significant differences in total serum protein levels and most protein fractions between the groups. However, children with other NDDs exhibited significantly lower levels of alpha-2 globulin compared to neurotypical children. Conversely, both ASD and NDD groups showed significantly higher gamma globulin levels compared to the control group. Interestingly, spot urine protein levels were significantly higher in children with ASD compared to neurotypical children.ConclusionThe observed changes in alpha-2 and gamma globulin levels suggest potential immune system involvement in ASD and other NDDs. The higher urine protein excretion in the ASD group warrants further investigation to explore the potential of urinary protein biomarkers for ASD diagnosis.

Iodine nutrition among pregnant women in the Faroe Islands.

Ensuring adequate iodine nutrition during pregnancy is crucial for fetal brain development. Thus, the WHO recommend monitoring iodine nutrition in pregnant women. With changing dietary habits and declining iodine intake in coastal populations, iodine nutrition in pregnant Faroese women was a focus in newly established pregnancy cohorts. This study aimed to monitor the iodine status of pregnant women in the Faroe Islands by assessing urinary iodine concentration (UIC) and maternal iodine intake. For 2 years, all pregnant women were invited to participate in a nationwide study. Participants completed questionnaires addressing personal and lifestyle factors, supplement intake and dietary habits, Additionally, they provided spot urine samples for UIC measurements. Iodine was measured spectrophotometrically using the ceri/arsen method after alkaline-ashing. Among the 1030 invited, 654 participated and 647 provided a spot-urine sample. The average age was 30·4 years (18–47 years). The overall median UIC was 110 µg/l, declined from 117 to 101 µg/l over 2 years (P = 0·004). UIC was significantly impacted by diet. Women consuming fish and eggs had a higher median UIC compared with those whose primary iodine source was dairy: fish-dinner, 151 µg/l; dairy products, 112 µg/l (P < 0·001). Furthermore, there was a positive association between maternal age, reported intake of iodine-containing supplements and the UIC. This nationwide study of pregnant Faroese women found UIC below the WHO-recommended cut-off for pregnant women and decreasing with time. This decline highlights the importance of continuous monitoring to prompty identify shifts in iodine status, enabling timely intervention to address emerging deficiencies.

Nebivolol prevents redox imbalance and attenuates bladder dysfunction induced by cyclophosphamide in mice.

Cyclophosphamide (CYP) is combined with cytoprotective agents to minimize its toxicity in the bladder, which is mediated by reactive oxygen species (ROS). Using multiple antioxidant mechanisms, nebivolol protects from oxidative stress in distinctive conditions. We hypothesized that nebivolol would attenuate both molecular and functional alterations induced by CYP in the bladder. Male C57BL/6 were pretreated or not with nebivolol (10mg/kg/day, gavage), which was given 5 days before a single injection of CYP (300mg/kg; i.p.). Molecular and functional parameters were assessed at 24h in the bladder. Nebivolol prevented increases in ROS generation and lipoperoxidation as well as reduction of superoxide dismutase activity induced by CYP. Increased voiding frequency, decreased voiding interval, and reduced bladder capacity were found in CYP-treated mice. These responses were prevented by nebivolol. An augmented number of urinary spots and smaller urinary volumes were detected in CYP-injected mice, and nebivolol partially prevented these responses. The reduction of ROS levels is the primary mechanism by which nebivolol attenuates the deleterious effects of CYP in the bladder. The association of nebivolol with other cytoprotective agents could be an option to prevent CYP-associated oxidative damage to the bladder during chemotherapy.

Kidney damage and associated risk factors in the rural Eastern Cape, South Africa: A cross-sectional study.

The colliding epidemic of infectious and non-communicable diseases in South Africa could potentially increase the prevalence of kidney disease in the country. This study determines the prevalence of kidney damage and known risk factors in a rural community of the Eastern Cape province, South Africa. This observational cross-sectional study was conducted in the outpatient department of the Mbekweni Community Health Centre in the Eastern Cape between May and July 2022. Relevant data on demography, medical history, anthropometry and blood pressure were obtained. The glomerular filtration rate was estimated using the Chronic Kidney Disease Epidemiology Collaboration Creatinine (CKD-EPICreatinine) equation and the re-expressed four-variable Modification of Diet in Renal Disease (MDRD) equation, without any adjustment for black ethnicity. Prevalence of kidney damage was defined as the proportion of individuals with low eGFR (<60mL/min per 1.73m2). The presence of proteins in the spot urine samples was determined with the use of test strips. We used the logistic regression model analysis to identify the independent risk factors for significant kidney damage. The mean (±standard deviation) age of the 389 participants was 52.3 (± 17.5) years, with 69.9% female. The prevalence of significant kidney damage was 17.2% (n = 67), as estimated by the CKD-EPICreatinine, with a slight difference by the MDRD equation (n = 69; 17.7%), while the prevalence of proteinuria was 7.2%. Older age was identified as a significant risk factor for CKD, with an odds ratio (OR) = 1.08 (95% confidence interval [CI]: 1.06-1.1, p < 0.001). Hypertension was strongly associated with proteinuria (OR = 4.17, 95% CI 1.67-10.4, p<0.001). This study found a high prevalence of kidney damage (17.2%) and proteinuria (7.97%) in this rural community, largely attributed to advanced age and hypertension, respectively. Early detection of proteinuria and decreased renal function at community health centres should trigger a referral to a higher level of care for further management of patients.

Abstract MP09: Characteristics of Antihypertension Medication Adherence Among Patients with Resistant Hypertension in the RADIANCE HTN-TRIO Ultrasound Renal Denervation Trial

Background: About 50% of patients are nonadherent to antihypertensive medications (AHM), impairing blood pressure (BP) management. The RADIANCE-HTN TRIO trial screened patients with resistant hypertension by first placing them on a fixed-dose combination triple pill (ARB+amlodipine+HCTZ). Ambulatory BP measurement 4 weeks later found 43% had controlled BP and were thus ineligible for enrollment. A total of 136 patients with uncontrolled BP were randomized to ultrasound renal denervation (uRDN) or sham-control. This analysis assessed adherence characteristics among patients in the trial. Method: TRIO patients consented to have chemical adherence testing that detected AHM or their metabolites in spot urine samples at baseline, 2 and 6 months. Full adherence (FA) was defined by all prescribed drugs detected in the sample. Results: Adherence data were available at any timepoint for 129 and all timepoints for 91 patients. Among patients with data at all timepoints, 66% (60/91) were FA and 34% (31/91) were partially- or fully nonadherent (PA/NA) to any of their prescribed medications. Adherence rates did not differ between treatment groups or geographies. Women were less likely to be FA (p&lt;0.001) (Table). PA/NA patients had higher rates of peripheral and cerebrovascular disease, and higher BP before and after triple pill. Adherence to triple pill was 81% at baseline, 85% at 2-months, and 83% at 6-months. Medications were titrated after 2-months. At 6-months, adherence to additional medication classes prescribed was: aldosterone antagonist 71%, beta blockers 62%, and centrally-acting alpha-2 agonists 60%. Conclusions: The stringent TRIO study design uncovered significant medication nonadherence that translated into a high rate of apparent resistant HTN. It also showed high adherence to a fixed-dose triple pill. One third of enrolled patients were not fully adherent to medications, and these patients had higher BP and higher rates of vascular disease. Understanding clinical features associated with medication adherence may improve hypertension management.

Reliability of the spot urine protein/creatinine ratio for assessing proteinuria in patients with renal disease.

This study aimed to assess the reliability of the spot urine protein/creatinine (sP/Cr) ratio for evaluating proteinuria across different ranges and renal functions. In this retrospective study, we analyzed 24-hour urine protein excretion (24 h UP) and sP/Cr measurements in 216 patients with renal disease. Pearson correlation and Bland-Altman analyses were performed to evaluate the correlation and agreement between 24 h UP and the sP/Cr. The patients were categorized into the following three 24 h UP groups: 150 to 299 mg/24 hours, 300 to 3499 mg/24 hours, and >3500 mg/24 hours. Significant positive correlations were found between the sP/Cr and the first two 24 h UP groups (r = 0.9104 and r = 0.9721, respectively) but not between the third group (r = 0.3110). Bland-Altman analysis confirmed good agreement in the group with <3500 mg/day proteinuria. Estimated glomerular filtration rates ≥60 mL/minute and <60 mL/minute were significantly correlated with the sP/Cr (r = 0.8714 and r = 0.4516, respectively). The sP/Cr ratio is a reliable indicator for non-nephrotic proteinuria, irrespective of renal function, but is unreliable for nephrotic-range proteinuria.