Stages Of Chronic Renal Disease Research Articles

To study thyroid profile in CKD patients in Eastern Uttar Pradesh

Chronic kidney disease (CKD) remains a universal pandemic that has evolved into a serious public health problem that imposes a significant socioeconomic burden. Thyroid profile is disrupted in CKD patients due to aberrant thyroid hormone metabolism. The purpose of our study was to assess thyroid function in people who had chronic renal disease (CKD).According to the inclusion-exclusion criteria, this cross-sectional observational research enrolled 150 chronic renal disease patients.All patients who met the above criteria underwent a detailed history as well as a general and systemic examination. Thyroid function tests, USG entire abdomen, chest X-ray, ECG, and 2D Echocardiogram, were performed. There were 84 men and 66 women among the 150 CKD patients. Thyroid hormone abnormalities were found in 93.3 % of the individuals. 14.7 % of the participants had hypothyroidism, 14.7 % had low T3 and T4 readings, 10% had low T4 values alone, 38 % had low T3 only, and 17% had subclinical hypothyroidism. Low T3 levels (58 %) were the most prevalent thyroid anomaly, with or without low T4 or elevated TSH levels. Low T3 levels were more common in patients with advanced CKD.Thyroid hormone abnormalities are linked to different stages of chronic renal disease.

Clinical significance of Osteoprotegerin, Vitamin D, Obestatin and some biochemical variables in Kidney failure Patients

Chronic kidney disease (CKD) is described as an abnormalities of renal function, existing for a long period of time. By reason of the early grades of Chronic kidney disease can be experiences no symptoms, its premature identification is strenuous. initial stage CRD can cause various complications, such as anemia, matabolyic disorders of bone mineral. The study was done to assess the effect the chronic renal disease stage on the Osteoprotegerin, 1,25 dihydroxyvitamin D, Obestatin levels and some biochemical parameters in patients not undertaken dialysis therapy. In this case-control study fifty-five patients with Kidney failure and fourty healthy people were examined. Circulating concentrations of Osteoprotegerin, 1,25 dihydroxyvitamin D and Obestatin were estimated by ELIZA technique, serum urea, uric acid, total protein and total calciumu were estimated enzymatically using spectrophotometer.
 Serum concentration of Osteoprotegerin, Obestatin, renal function markers in patients group were higher (328.3±41.68 pg/mL; 15.52±4.28pg/mL; 183.2±10.35 mg/dL; 8.88±0.54 mg/dL; 6.57±0.22 mg/dL) respectively in comparison to the control group (172.6±55.48 pg/mL; 11.64±3.26 pg/mL; 33.45±1.08 mg/dL; 0.95±0.03 mg/dL; 4.35±0.22 mg/dL) respectively. Vitamin D, Total Calcium and Total Proteins level in patients group were lower(24.49±2.53 ng/mL; 8.06±0.18 mg/dL; 6.49±0.12 g/dL) respectively as compared to controls (57.11±12.39 ng/mL; 10.15±0.23 mg/dL; 6.82±0.10 g/dL) respectively. The current study reveals that circulating levels of Osteoprotegerin Obestatin are remarkably linked with the existence of renal failure, the current data identify a high prevalence deficiency and insufficiency of 1,25 dihydroxyvitamin D in patients with moderate and severe Chronic nephropathy.

Cystatin C proteoforms in chronic kidney disease.

Cross-sectional study of patients with different stages of chronic renal disease (pre-dialysis n = 53; hemodialysis n = 51, renal transplant n = 53). Measurement of cystatin C proteoforms by MALDI-TOF MS, assessment of medicine prescription using the first two levels of the Anatomical Therapeutic chemical system from patients' records. Patients receiving hemodialysis had the highest cystatin C concentrations, followed by pre-dialysis patients and patients with a renal transplant. In all groups, the most common proteoforms were native cystatin C and CysC 3Pro-OH while the truncated forms made up 28%. The distribution of the different proteoforms was largely independent of renal function and total cystatin C. However, the use of corticosteroids (ATC-L02) and immunosuppressants (ATC-H04) considerably impacted the distribution of proteoforms. The different proteoforms of cystatin C increased proportionally with total cystatin C in patients with chronic kidney disease. Prescription of corticosteroids and immunosuppressants had a significant effect on the distribution of proteoforms. The biological significance of these proteoforms remains to be determined.

The risk-benefit balance of anticoagulant treatment: case report

A 76-year-old female presents at the emergency department with dyspnea and pleuritic, sharp right laterothoracic pain that started suddenly. Her medical history includes stage 2 hypertension, diabetes mellitus type 2, chronic obstructive pulmonary disease stage IV GOLD with home oxygen therapy, chronic pulmonary heart disease, diffuse interstitial lung disease with a previous episode of alveolar hemorrhage, chronic renal disease stage 2, and paroxysmal atrial fibrillation, for which she had a Watchman device implanted, taking into consideration her anticoagulation contraindication due to the previous alveolar hemorrhage episode. The biological findings reveal hypoxemia and hypocapnia, a positive D-dimer test, an inflammatory syndrome, mild hypopotassemia, acute decompensation of chronic renal disease, and a positive urine culture with Enterococcus faecium. Emergency thoracic computed tomography reveals bilateral pulmonary thromboembolism. Immediate parenteral anticoagulation and antibiotic therapy are initiated with favorable evolution. At discharge, concerning the risk-benefit balance of anticoagulation in a senior patient with multiple comorbidities, the anticoagulant therapy is changed to a novel oral anticoagulant for at least three months, with reevaluation needed after that period.

MO358: Analysis of Acute Kidney Injury Incidence in Patients After Left Ventricle Assist Device Implantation

Abstract BACKGROUND AND AIMS Chronic heart failure (CHF) in the terminal stage is a crucial issue of medicine. Heart transplantation is still the best treatment option. Lack of donors, long waiting time make heart transplantation almost impossible. Implantation of left ventricular assist device—LVAD) in patients with CHF is a bridge to transplantation. Nevertheless, the LVAD implantation procedure is time-consuming, requires significant material costs, and leads to numerous complications in the postoperative period. Acute kidney injury (AKI) is one of the most common and dangerous complications. Issues of AKI in patients with LVAD should be carefully taught. The aim of the study is to examine the incidence of postoperative renal failure after the implantation of LVAD and its relationship to outcomes. In addition, we want to share with our experience of AKI management in patients with LVAD. METHOD A retrospective analysis of 265 medical records of patients after surgical implantation of LVAD who were hospitalized to the National Research Cardiac Surgery Center, Nur-Sultan city, Kazakhstan. Period of hospitalization from 01.2015 to 10.2021 year. The Kidney Disease Improving Global Outcome (KDIGO) criteria were used to define AKI. RESULTS Total number of patients 265 after LVAD implantation. Male—85.66% and female—14.34%. Mean ICU stay of patient without severe AKI—7.17±5.47 days. Mean ICU stay of patient with severe AKI—11.82±7.47 days. Patients with severe AKI and blood purification—59 patients (24.9%), male—61–92.4%, femal—-5–7.6%. Total number of LVAD patients—265. ICU Mortality rate of patients after LVAD implantation—11 patients (4.15%). Severe AKI—59 patients (22.3%). Recovery of AKI—47 patients (79.66%). Transformation to terminal stage of chronic renal disease (CRD) with chronic dialysis—1 patient (1.69%). ICU Mortality rate of patients with severe AKI—11 (18.64%). CONCLUSION AKI is a common complication in the immediate postoperative period after LVAD implantation. AKI negatively affects the outcome of the disease. The mortality rate of LVAD patients with renal insufficiency exceeds by 14% the mortality of patients with renal insufficiency. Blood purification is the effective method of severe AKI therapy.

Evaluation of Inflammatory markers in different stages of Chronic Renal Disease

Background: Chronic kidney disease (CKD) refers to a long-term loss of kidney function. The progression of CKD leads to the damage of other organs including cardiovascular disease which increased the risk of mortality. Early detection of kidney failure can slow down the end-stage renal disease. Aims and Objectives: To estimate the inflammatory marker Adenosine deaminase (ADA) activity in different stages of CKD. To correlate the level of ADA activity with Serum Creatinine with different stages of CKD on the basis of estimated glomerular filtration rate (eGFR). Materials and Methods: The participants having age more than 18 and <60 years having CKD have been enrolled as a study group. CKD was confirmed by calculating eGFR using Cockcroft-Gault equation, plasma creatinine estimation done in all the patients. This study was approved by the Ethical Committee of TMMC and RC. Results: It is observed that the incidence of CKD reaches its maximum strength during middle age. 28% of the young patients, i.e., 45 years of age or younger at the time of CKD, had increased level of ADA. Serum levels of ADA, Creatinine were higher among participants with lower level of eGFR. Inflammation was higher among those with lower eGFR. All biochemical parameter (ADA, CRP, ESR) shows the negative correlation with eGFR. eGFR shows a negative highly significant correlation withESR with a correlation coefficient of r=−4.702 (P<0.001). Conclusion: With the progression of Kidney disease (CKD stages 1–5) it comes to significantly increase of inflammatory markers as decrease in the eGFR with statistical significance. Inflammatory Biomarkers were inversely associated with the measure of kidney function. It is clear that a single indicator of renal function is not sufficient in evaluating the kidney disease stage.

Fuzzy Logic-Based Systems for the Diagnosis of Chronic Kidney Disease.

Kidney failure occurs whenever the kidney stops to operate properly and would be unable to cleanse or refine the bloodstream as it should. Chronic kidney disease (CKD) is a potentially fatal consequence. If this condition is diagnosed early, its progression can be delayed. There are various factors that increase the likelihood of developing kidney failure. As a consequence, in order to detect this potentially fatal condition early on, these risk factors must be checked on a regular basis before the individual's health deteriorates. Furthermore, it lowers the cost of therapy. The chronic kidney or renal disease will be recognized in this work utilizing fuzzy and adaptive neural fuzzy inference systems. The fundamental purpose of this initiative is to enhance the precision of medical diagnostics used to diagnose illnesses. Nephron functioning, glucose levels, systolic and diastolic blood pressure, maturity level, weight and height, and smoking are all elements to consider while developing a fuzzy and adaptable neural fuzzy inference system. The output variable describes a specific patient's stage of chronic renal disease based on input factors such as stage 1, stage 2, stage 3, stage 4, and stage 5. The outcome will show the present stage of a patient's kidney. As a result, these methods can assist specialists in determining the stage of chronic renal disease. MATLAB software is used to create the fuzzy and neural fuzzy inference systems.

Metabolic Syndrome a Cornerstone in Cardiorenal Syndrome

Objective: The purpose of the study was to evaluate the relationship of metabolic syndrome (MetS) and cardiorenal syndrome(CRS) type 4 in the early stage of chronic renal disease. Introduction: Metabolic syndrome is facing a continually increasing nowadays. That is why he is turning in to a worldwide problem. On the other hand, improving of life expectancy is associated with rising morbidity, which is also reflected in expanding number cardiorenal patients. Materials and Methods: We conducted an observational study.139 patients with chronic renal disease stage 3 and 4 were en-rolled Statistical analysis was performed by χ2 test, logistic regression, Fisher's exact test. Results: Cardiorenal syndrome was found in 85.6% of patients(pts). The mean age was 56.7 ± 12.5 years. Males were 60.4% patients. Metabolic syndrome was defined by NCEP -ATP III and was observed in 66.9% of patients, hypertension in 71.9% of pts, obesity in 68.3% of pts,diabetes mellitus in 78.4% of pts, dislipidemia in 71.9% of pts, and uricemia in 61.9% of pts. Study results showed that metabolic syndrome had a powerfull significant association with cardiorenal syndrome p≤0.002. Also, hypertension, obesity, dislipidemia, hyperuricemia ans diabetes had a strong relationship p≤0.05 with CRS. Conclusions: Cardiorenal syndrome is quite common even in the early stages of renal disease. Its linking with metabolic syndrome is very important. Our efforts should be focused in early recognition and timely identification of MetS compounds: obesity, hypertension, diabetes mellitus, so as to prevent and reduce morbidity and health costs these syndromes carried.

P0866EVALUATION OF ERYPTOSIS IN PATIENTS WITH CHRONIC KIDNEY DISEASE

Abstract Background and Aims One of the many factors in the pathogenesis of renal anaemia, is eryptosis. The aim of this study is to evaluate eryptosis in patients with chronic renal disease stage 3-5 and 5 dialysis (5D). Method Patients with CKD who were monitored in our nephrology department were included in the study. The age range of the patient groups was 18-80 years and haemoglobin levels were <13 g / dl in men and <12 g / dl in women. As parameters of eryptosis, flow cytometric annexin V binding and intracellular calcium, and superoxide dismutase (SOD) activity with ELISA method were measured in 59 predialysis patient (eGFR<60 mL / min 1.73 m2), 26 haemodialysis patient, 21 peritoneal dialysis patient and 29 healthy volunteers with similar age (control). Haematological and biochemical tests including complete blood count(CBC), erythrocyte sedimentation rate (ESR), Parathormone (PTH), 25-OH vit D3, Blood urea nitrogen (BUN), Creatinine (Cr), C-reactive protein (CRP), Na, K, phosphor (P), ionized and total Calcium, Ferritin, B12 and Folate, were performed. IBM SPSS Statistics Version 20.0 was used for statistical analysis of the data Results The amount of intracellular calcium were 3.05 ± 1.66 in predialysis group, 2.24 ± 0.99 in haemodialysis group, 2.38 ± 0.87 in peritoneal dialysis group and 1.71 ± 0.46 in control group. For intracellular calcium there was statistically significant difference only between predialysis group and control group (p <0. 000). Annexin V binding were calculated as 1.05 ± 0.99 in predialysis group, 1.15 ± 0.56 in haemodialysis group, 1.06 ± 0.87 in peritoneal dialysis group and 0.88 ± 0.86 in control group. Comparing to control group annexin V binding in predialysis, haemodialysis and peritoneal dialysis groups, were statistically significantly increased (for all p <0.000). SOD activity was 0.07 ± 0.07 in predialysis group, 0.13 ± 0.08 in haemodialysis group, 0.14 ± 0.07 in peritoneal dialysis group and 0.03 ± 0.01 in control group. The difference between the control group and dialysis group was statistically significant (p <0. 00). Comparing to nonusers; patients using calcium channel blockers (CCB) had low annexin V binding level (p = 0.013). Patients using erythropoietin (EPO) had elevated annexin V binding level (p <0.000) and lower intracellular calcium (p = 0.014) according to non- users. Conclusion We determined increased eryptosis in patients with CKD stage 3-5 and 5D in our study. Inflammation and elevated parathormone were also associated with increased eryptosis. Therefore, eryptosis may be an important factor in the pathogenesis of renal anaemia. Inflammation associated CKD may increase eryptosis. In addition, this effect can be taken into consideration in the planning of treatment because of the lower incidence of eryptosis in patients using calcium channel blocker and EPO.

FEATURES OF THE FUNCTIONAL STATE OF KIDNEYS AT CHRONIC RENAL DISEASE IN PATIENTS WITH NON-ALCOHOLIC STEATOHEPATITIS

The purpose. To establish the changes in the functional state of kidneys, depending on the stage of chronic renal disease in comorbidity with non-alcoholic steatohepatitis against a background of obesity.Material and methods. 240 patients with chronic kidney disease (chronic bilateral pyelonephritis) of the I-III stage were studied: 145 patients had comorbid non-alcoholic steatohepatitis (NASH) and obesity (1 group), 95 patients were diagnosed with CKD I-III stages without comorbid pathology . Depending on the stage of the CKD, the groups of patients were divided as follows: group 1 was divided into 3 subgroups: CKD stage I - 51 patients, CKD stage II - 53 patients, CKD stage III - 41 patients. The 2nd group was divided into 3 subgroups: CKD of the Ist stage - 32 patients, CKD of the IInd stage - 35 patients, CKD of the IIIrd stage - 28 patients. The control group consisted of 30 practically healthy persons (PHPs).Results. The analysis of indices of the kidneys’ functional state showed that creatinine content in the blood of group I patients exceeded the data in the PHPs in 1,5 times (p <0,05), in group II - 1,3 times (p <0,05) . In patients with CKD, stage III, blood creatinine in group I exceeded the data in PHPs by 2.3 times (p <0.05), in group 2 - by 1.9 times (p <0.05) respectively. So, comorbidity with NASH significantly affects the kidneys functional state indicators, in particular, their nitrogen-excretory function. Thus, the content of blood urea in patients with CKD I stage exceeded the indicators in PHPs, respectively, in groups I, II - in 2,4 and 2,2 times (p <0,05). In patients with CKD II stage in group 1 the urea content exceeded the index in PHPs by 2.5 times compared with 2.4 times in group 2 (p <0.05). As a result of the established changes, a significant decrease in GFR (Glomerular filtration rate) was obtained for creatinine clearance using the Cockroft-Gaulta formula. Thus, the indicator of creatinine clearance by the Cockroft-Gaulta formula in patients with CKD I stage was lower than that in PHPs only in group 1 patients (11.8%) (p <0.05); in patients of group 2, changes were unlikely and no significant difference was found between the groups (p> 0.05). In patients with CKD II stage in group 1, the creatinine clearance score was lower than the PHPs index by 39.2% versus a decrease of 25.5% in group 2 (p <0.05) with a confirmation of statistically significant difference between the groups (p <0.05). At the same time, patients with CKH III stage, the rate of creatinine clearance in patients in group 1 was lower than the normative at 55.9% (p <0.05), in group 2 - by 44.1% (p <0.05), with the presence of a probable difference between patients with a combined course NASH and CKD in comparison with patients with CKD without comorbid diseases (p <0,05). Conclusions. Non-alcoholic steatohepatitis significantly aggravates the course of chronic kidney disease of І-ІІІ stages with a possible decrease in nitrogen excretory function, glomerular filtration rate, hypopaluminemia than in the isolated course of chronic kidney disease.

Does Omega-3 Supplementation have Beneficial Effects on Blood Pressure, Left Ventricular Geometry and Arterial Function and Arterial Properties in Patients with Chronic Renal Disease Stage 1-3?

Does Omega-3 Supplementation have Beneficial Effects on Blood Pressure, Left Ventricular Geometry and Arterial Function and Arterial Properties in Patients with Chronic Renal Disease Stage 1-3?

Rationale and design of DiPPI: A randomized controlled trial to evaluate the safety and effectiveness of progressive hemodialysis in incident patients

IntroductionProgressive haemodialysis (HD) is a starting regime for renal replacement therapy (RRT) adapted to each patient's necessities. It is mainly conditioned by the residual renal function (RRF). The frequency of sessions with which patients start HD (one or two sessions per week), is lower than that for conventional HD (three times per week). Such frequency is increased (from one to two sessions, and from two to three sessions) as the RRF declines. Methodology/DesignIHDIP is a multicentre randomized experimental open trial. It is randomized in a 1:1 ratio and controlled through usual clinical practice, with a low intervention level and non-commercial. It includes 152 patients older than 18 years with chronic renal disease stage 5 and start HD as RRT, with an RRF of ≥4ml/min/1.73m2, measured by renal clearance of urea (KrU). The intervention group includes 76 patients who will start with one session of HD per week (progressive HD). The control group includes 76 patients who will start with three sessions per week (conventional HD). The primary purpose is assessing the survival rate, while the secondary purposes are the morbidity rate (hospital admissions), the clinical parameters, the quality of life and the efficiency. DiscussionThis study will enable us to know, with the highest level of scientific evidence, the number of sessions a patient should receive when starting the HD treatment, depending on his/her RRF. Trial registrationRegistered at the U.S. National Institutes of Health, ClinicalTrials.gov under the number NCT03239808.

Justificación y diseño de DiPPI: un ensayo controlado aleatorizado para evaluar la seguridad y la efectividad de la hemodiálisis progresiva en pacientes incidentes

IntroductionProgressive haemodialysis (HD) is a starting regime for renal replacement therapy (RRT) adapted to each patient's necessities. It is mainly conditioned by the residual renal function (RRF). The frequency of sessions with which patients start HD (one or two sessions per week), is lower than that for conventional HD (three times per week). Such frequency is increased (from one to two sessions, and from two to three sessions) as the RRF declines. Methodology/DesignIHDIP is a multicentre randomised experimental open trial. It is randomised in a 1:1 ratio and controlled through usual clinical practice, with a low intervention level and non-commercial. It includes 152 patients older than 18 years with chronic renal disease stage 5 and start HD as RRT, with an RRF of ≥4ml/min/1.73m2, measured by renal clearance of urea (KrU). The intervention group includes 76 patients who will start with one session of HD per week (progressive HD). The control group includes 76 patients who will start with three sessions per week (conventional HD). The primary purpose is assessing the survival rate, while the secondary purposes are the morbidity rate (hospital admissions), the clinical parameters, the quality of life and the efficiency. DiscussionThis study will enable us to know, with the highest level of scientific evidence, the number of sessions a patient should receive when starting the HD treatment, depending on his/her RRF. Trial registrationRegistered at the U.S. National Institutes of Health, ClinicalTrials.gov under the number NCT03239808.

LONG-TERM RECOVERY OF KIDNEY FUNCTION IN PATIENTS REQUIRING RENAL REPLACEMENT THERAPY AFTER CARDIAC SURGERY

Acute renal injury (AKI) occurs in up to 30% of cardiac surgery patients. Around 1% of them require renal replacement therapy (RRT) perioperatively. Long-term recovery of kidney function in patients with newly developed AKI requiring dialysis is not well studied. This retrospective review of 10 years of experience with 144 patients reports on outcomes in these patients. In our institution, clinical information of all the patients undergoing cardiac surgery was prospectively collected in the Manitoba Cardiac Surgical Database. Since 2006 laboratory results across the province were gathered in MCHP database. Linkage of these databases enabled us to evaluate perioperative and long-term outcomes. In this study, we included patients who were not on hemodialysis (HD) before the surgery but required RRT in the postoperative period. Patients without known preoperative creatinine level and who died during or shortly after discharge (within three months) were excluded from the study. To define the stage of AKI, we used Acute Kidney Injury Network (AKIN) classification. For determination of kidney function recovery and stage of chronic renal disease (CKD) Acute Dialysis Quality Initiative (ADQI) classification was utilized. Between 2006 to 2014 a total number of 144 patients in Province of Manitoba required renal replacement therapy after cardiac surgery (“Stage 3” in AKIN classification). 11 patients were on HD before hospitalization. In 6 patients, a preoperative level of creatinine was not documented. In remaining 127 patients, 60 (47.2%) died during hospitalization or within three months after discharge. 67 patients (52.8%) were successfully discharged from the hospital. In 43 (64.2%) discharged patients creatinine level returned to within 50% of a preoperative level (“Complete recovery” in ADQI classification). Six patients (8.9%) did not require dialysis, but their creatinine level failed to return to within 50% of baseline (“Partial recovery” in ADQI classification). 18 patients (26.9%) remained on HD long-term (“Non-recovery” in ADQI classification). Cumulative incidence of long-term dialysis is illustrated in Figure 1. Long-term mortality in discharged patients was also studied and showed 87.4% of one year and 51.8% of 5 years survival (Figure 2). Majority of patients requiring RRT after cardiac surgery recover their renal function completely, and only 26.9% of them require long-term dialysis. The highest incidence rate of initiation of permanent HD was within first two years after discharge. Long-term survival in these patients at the same time remains low with mortality rate of 51.8% at five years.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Life-orientation, Subjective Well-being and Social Support as Predictors of Quality of Life in Patients with End Stage Renal Disease

Background: Psychosocial experiences such as life-orientation, subjective well-being and social support are punitive in determining the health related quality of life of patients in end stage of Chronic Renal Disease; also termed as End Stage Renal Disease (ESRD).Objectives: to investigate the phenomenon of life-orientation, subjective well-being, social support and perceived health related quality of life in patients with end stage renal disease. ESRD patients’ life orientation, social support and subjective well-being are significant predictors of their perceived quality of life that further determines their disease management and health status.Materials and Methods: This research has been laid out through cross sectional survey research design. The data was collected between the time span of Jan, 2016 to June, 2016. The sample comprised of 200 respondents from both gender, equally distributed within the age range of 50 to 60 years, going through last stage of ESRD and relying on dialysis from at least past one year or more. Indigenously translated WHO QoL, Subjective Wellbeing Scale, multidimensional Social Support Scale, Life Orientation Scale and a demographic information sheet was used to collect the data.Results: The results revealed that life orientation, social support and subjective well-being significantly and positively predicted the health related quality of life; greater social support and higher levels of subjective wellbeing after controlling for the effects of age, gender, income and education were found when the patients ‘carried optimistic and positive life-orientation.Conclusion: The current research findings therefore incriminate preemptive direction in understanding the phenomenon of life-orientation, social support, subjective wellbeing and health related quality of life in patients with last stage ESRD. This further embarks onto highlighting the insightful guidelines for health and clinical psychologists in devising management interventions, targeting the increased subjective well-being, and promotion of optimistic life-orientation in order to facilitate health related quality of life in the patients with end stage renal disease.Bangladesh Journal of Medical Science Vol.16(3) 2017 p.346-353

Residual renal function: a paradigm shift

Residual renal function (RRF) in patients undergoing dialysis treatments is currently viewed as glomerular filtrate that has escaped tubular reabsorption. RRF has been quantified as a clearance of urea or creatinine, or urea+ creatinine. A major paradigm shift has followed the recognition that a substantial number of organic anion retention solutes (possible "uremic toxins") are protein-bound and therefore are not readily filtered. These protein-bound aryl compounds are secreted by renal tubular organic anion transporters (OATs). This has led to the recognition that RRF in dialysis patients probably represents not only unreabsorbed glomerular filtrate but also a contribution of renal tubular transporters that secrete organic anions. Tubular secretion of hippurate, indoxyl sulfate, and p-cresol sulfate, protein-bound organic anions retained in the plasma of end-stage renal disease patients, can be quantified and used to evaluate the integrity of a function dependent on active solute transport. Here we propose a shift away from the exclusive "glomerulocentric" view of RRF as unreabsorbed glomerular filtrate and of the progression of renal disease as progressive glomerular loss. We expand the definition of RRF to include the combined renal and tubule functions remaining after a disease begins to destroy nephrons and proceeds to anuria. We propose renewed application of the first principles of renal physiology, articulated in the last century by Homer Smith, to the understanding and monitoring of RRF and progression of renal injury in patients during the sometimes long course of and at the end stage of chronic renal disease.

Association of Myeloperoxidase and the Atherogenic Index of Plasma in Children with End-Stage Renal Disease.

SummaryBackgroundThe aim of this study was to explore oxidative stress status, especially the enzyme myeloperoxidase in children with end-stage renal disease. Also, we investigated possible associations between the atherogenic index of plasma and these parameters.MethodsLipid status parameters, oxidative stress status parameters, and myeloperoxidase concentration were measured in the sera of 20 children in the last stage of chronic renal disease (ESRD) and 35 healthy children of matching age and sex. The Atherogenic Index of Plasma (AIP) was calculated according to the appropriate equation.ResultsWe did not find any significant differences in myeloperoxidase concentrations between the investigated groups (p=0.394). Oxidative stress parameters were, however, significantly higher in the patient group (p<0.001), as well as the atherogenic index of plasma (p<0.001). Myeloperoxidase concentration and advanced oxidation protein product (AOPP) concentration were independently associated with increased AIP in the patient group (p<0.05).ConclusionsChanges in AIP in children with ERSD are associated with the oxidative stress status and myeloper-oxidase concentration.

DOPLEROGRAPHIC DESCRIPTION OF RENAL BLOOD SUPPLY DISTURBANCE IN PATIENTS WITH CHRONIC KIDNEY DISEASE STAGE I-II AND ARTERIAL HYPERTENSION

The purpose of this work was to investigate renal blood supply disturbance in patients with chronic renal disease stage I-II (pyelonephritis, glomerulonephritis, diabetic nephropathy).&#x0D; Material and methods. The authors carried out 131 complex ultrasonic investigations using ultrasonic duplex color kidney scanning. 47patients with chronic pyelonephritis (ChPN), 48patients with diabetic nephropathy stage IV (DN) and 36patients with chronic glomerulonephritis (ChGN) were involved into investigation. Each group consisted of 2 subgroups – with arterial hypertension (AH) and without AH. 20 healthy persons were examined as well.&#x0D; Results. Scantyintrarenal blood flow which is characterized with a decrease of maximal systolic (Vs), minimal diastolic blood velocity(Vd), as well as a decrease of indices of the averaged, according to time, maximal blood velocity (TAMX) and volumetric blood velocity (Vvol) and an increase of index resistance (IR) have been revealed in patients with chronic renal disease (ChRD) stage I-II with the presence of AH stage II. Indices of the vascular renal blood flow under study correlated with the main factors of ChRD progression – glomerular filtration rate (GFR) and daily proteinuria.&#x0D; Conclusion. Reliable Vs, Vd, TAMX and Vvol decrease and a reliable IR increase may be considered as early noninvasive criteria of ChRD progression with the presence of AH stage II.

Relationship between ultrasonographically determined kidney volume and progression of chronic kidney disease.

Aim To investigate a correlation between calculated creatinine clearance as a measure of kidney's functional abilities and ultrasonographically determined kidney volume, which represents actual size of the kidney, in fact residual renal mass in chronic kidney disease, in order to determine possibilities of ultrasound as a diagnostic method in diagnosing and follow up of chronic renal disease. Methods Prospective study included 150 patients with registered demographic and anthropometric data, and also with relevant laboratory tests of renal function. Longitudinal diameter, thickness and width of the kidney and renal volume calculated according to the Dinkel's formula were measured by ultrasound. A correlation between the measured volume of the kidneys and calculated creatinine clearance was done by the Spearman method, with statistical significance of p<0.05. Results Statistically significant correlation between the estimated creatinine clearance values and the average of the calculated values of kidney volume was found (p<0.01). Average value of the kidneys' volume showed a linear decrease with the progression of chronic kidney disease: the kidney volume in the control healthy group was 171.7 ± 32.6 mL (95.22- 229.59 mL), and in the subjects classified in stage IV it was 74.7 ± 24.6 mL (43.22-165.65 mL). Conclusion Calculated volume of kidney well correlated with creatinine clearance as a measure of functional ability of the kidneys and with the stage of chronic renal disease. It can be used in clinical practice for monitoring of chronic kidney disease in conjunction with other clinical and laboratory parameters.

Homocysteine as a predictive biomarker in early diagnosis of renal failure susceptibility and prognostic diagnosis for end stages renal disease

Glomerular filtration rate and/or creatinine are not accurate methods for renal failure prediction. This study tested homocysteine (Hcy) as a predictive and prognostic marker for end stage renal disease (ESRD). In total, 176 subjects were recruited and divided into: healthy normal group (108 subjects); mild-to-moderate impaired renal function group (21 patients); severe impaired renal function group (7 patients); and chronic renal failure group (40 patients) who were on regular hemodialysis. Blood samples were collected, and serum was separated for analysis of total Hcy, creatinine, high sensitive C-reactive protein (CRP), serum albumin, and calcium. Data showed that Hcy level was significantly increased from normal-to-mild impairment then significantly decreases from mild impairment until the patient reaches severe impairment while showing significant elevation in the last stage of chronic renal disease. Creatinine level was increased in all stages of kidney impairment in comparison with control. CRP level was showing significant elevation in the last stage. A significant decrease in both albumin and calcium was occurred in all stages of renal impairment. We conclude Hcy in combination with CRP, creatinine, albumin, and calcium can be used as a prognostic marker for ESRD and an early diagnostic marker for the risk of renal failure.