Creatinine Uric Acid Research Articles

The Relationship of Serum Uric Acid, Serum Uric Acid Creatinine Ratios With Disease Severity and Metabolic Syndrome in Schizophrenia Patients

Aim: The objective of this research was to examine the association between serum uric acid (SUA) and serum uric acid/creatinine ratio (SUA/Cre), disease severity and metabolic syndrome in schizophrenia with a multifaceted etiopathogenesis. Methods: The study comprised 240 participants in total, 120 of whom were healthy controls and 120 of whom were schizophrenia patients. Sociodemographic, clinical and laboratory data was collected and metabolic syndrome was assessed according to the established criteria. SUA and creatinine levels were measured and the SUA/Cre ratio was calculated. The severity of the disease was evaluated utilizing the Positive and Negative Syndrome Scale (PANSS). Statistical analyses were conducted to ascertain correlations and associations. Results: SUA levels and SUA/Cre ratio higher in schizophrenia patients than controls (p=0.14, p=0.010, respectively). SUA/Cre ratio was positively correlated with PANSS negative score (r=0.266, p=0.03). SUA levels were elevated in individuals diagnosed with schizophrenia who also had metabolic syndrome, in comparison to those who did not have metabolic syndrome (p=0.009). Linear regression analyses showed that the association between SUA levels and SUA/Cre ratio and schizophrenia persisted when the effects of gender, age, metabolic syndrome, BMI and smoking were fixed. Conclusions: This study highlights the association of SUA and SUA/Cre ratio with disease severity and metabolic syndrome among individuals diagnosed with schizophrenia.

Association between Serum Uric Acid Levels and Primary Open-angle Glaucoma: A Cross-sectional Study

Introduction: There is an intricate association between serum Uric Acid (UA) levels and Primary Open Angle Glaucoma (POAG). UA levels in the blood are known to be a good indicator of antioxidant function, and a decrease in UA plays a key role in the pathogenesis of POAG. However, the association of serum UA and Uric Acid Creatinine Ratio (UACR) in POAG cases in the Indian population remains unexplored. Aim: To investigate the association of serum UA levels and serum UACR with POAG. Materials and Methods: This cross-sectional study was conducted among patients who attended the Outpatient Department (OPD) of Opthalmology at Maharajah’s Institute of Medical Sciences, Vizianagaram, Andhra Pradesh, India. The duration of the study was one year and six months, from January 15, 2021 to July 15, 2022. The study included 200 recently diagnosed patients with POAG, who were divided into three groups based on Intraocular Pressure (IOP): Group 1 (mild) with an IOP of 21-30 mmHg, group 2 (moderate) with an IOP of 31-50 mmHg, and group 3 (severe) with an IOP greater than 51 mmHg. Age and gender-matched 199 healthy subjects were included as the control group. Blood samples were collected from the study subjects after obtaining informed consent and were tested for serum UA (using the modified Trinder method) and serum creatinine (using Jaffe’s method) in a semiautomatic analyser (Erba chem 7). The data were analysed using Statistical Package for Social Sciences (SPSS) version 21.0 software and MS Excel 2007. Results: The mean age of the study participants of all three groups was found to be 51.19±5.06 years with 46.7% male and 53.3% female subjects. The serum UA levels were 5.55±0.74 mg/dL in the mild POAG group, 4.1±0.5 mg/dL in the moderate POAG group, and 2.67±0.6 mg/dL in the severe POAG group (p-value <0.001). The present study also found that among the three study groups of POAG, UA levels were the lowest in the severe POAG group, followed by the moderate POAG group, and then the mild POAG group. This pattern was observed in both the males and females population. Conclusion: The present study found that serum UA levels were decreased in POAG patients compared to the normal healthy control group. Furthermore, the study revealed a significant negative association between serum UA levels and serum UACR levels with the severity of POAG.

Serum uric acid/creatinine ratio and free androgen index are synergistically associated with increased risk of polycystic ovary syndrome in obese women

BackgroundFeatures of metabolic syndrome such as abdominal obesity, insulin resistance, hypertension and dyslipidemia are commonly encountered in polycystic ovary syndrome (PCOS). Recent evidence has suggested an association between high serum uric acid/creatinine (UA/Cr) ratio and metabolic syndrome however, no studies have investigated this association in PCOS. The current study was conducted to investigate the relationship between UA/Cr ratio and PCOS and to identify whether UA/Cr ratio and free androgen index (FAI) have an additive interaction for detection of PCOS risk in obese women.MethodsThis study enrolled 40 obese women with PCOS and 40 control women with regular menstrual cycles matched for age and body mass index (BMI). Anthropometric measurements, fasting glucose, fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), lipids profile, luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol, dehydroepiandrosterone sulfate (DHEAS), sex hormone binding globulin (SHBG), total testosterone, free androgen index (FAI), UA/Cr ratio were assessed.ResultsSerum UA/Cr ratio was significantly higher in obese women with PCOS than in non-PCOS women. UA/Cr ratio was correlated with BMI, waist and neck circumferences, blood pressure, fasting insulin, HOMA-IR, lipids, LH/FSH, estradiol, DHEAS, total testosterone, FAI and SHBG. UA/Cr ratio and FAI were independent risk factors for PCOS in obese women however, the addictive interaction between UA/Cr ratio and FAI had a higher fold risk (OR: 4.3, 95% CI, 3.4–7.58) and a more significance (P = 0.002) for determination of PCOS.ConclusionSerum UA/Cr ratio combined with FAI can exert an additive or synergistic impact on prediction of PCOS in obese women.

Estimated excretion and clearance of uric acid as optimal surrogate indices for daily urinary uric acid excretion.

Daily uric acid excretion (Eua) is an essential index for patients with gout/hyperuricaemia. We identified alternative indices most correlated with 24-hour uric acid clearance (Cua 24 h) and 24-hour Eua (Eua 24 h) using data from the reference interval of urinary clearance and excretion of urate study. The subjects were indoor workers aged 20-65 years who met the Clinical and Laboratory Standards Institute Guidelines C28-A3c. Alternative indices using spot urine were urine uric acid creatinine ratio, Cua-creatinine clearance ratio (Cua/Ccr), Eua-CCr ratio (Eua/Ccr), estimated Cua (eCua), and estimated Eua (eEua). eCua and eEua are the values obtained by multiplying Cua/Ccr and Eua/Ccr with the estimated glomerular filtration rate. The final number of subjects analysed was 739. Among the indices using spot urine, eCua and eEua showed the highest correlation with Cua 24 h and Eua 24 h, respectively. Compared with Cua 60 min and Eua 60 min obtained from 60-min urine collection, eCua and eEua showed lower root means squared error, lower bias, and significantly higher accuracy of within 30% and within 15%. The newly proposed eCua and eEua may be appropriate from a practical perspective.

Are Uric Acid and Uric Acid Creatinine Ratio Predictors for Mortality in Acute Exacerbations of Chronic Obstructive Pulmonary Disease?

Amaç: Kronik Obstrüktif Akciğer Hastalığı (KOAH) klinik seyrinde, kötü prognoza neden olan, ek
 tedavi gerektiren, solunum semptomlarında (dispne, öksürük, balgam) kötüleşme olarak tanımlanan
 alevlenmeler gözlenebilir. Maliyet-etkin mortalite öngörücüleri, KOAH’ın tedavi yönetimi için değerlidir.Akut KOAH alevlenmeleri olan serum ürik asit (ÜA) ve serum ürik asitin kreatinine oranının (ÜKO) mortalite ve hipoksemi için belirleyici olup
 olmadığını araştırmayı amaçladık.
 Gereç ve Yöntemler: Bu gözlemsel kesitsel çalışmada, Ocak 2014 ile Aralık 2018 arasında bir referans göğüs hastanesinde yatan 105
 KOAH alevlenmesindeki hasta retrospektif olarak değerlendirildi. ÜA ve ÜKO ile uzun vadeli mortalite, hipoksemi, komorbidite, FEV1 değeri,
 KOAH’ın tanı, tedavi ve önlenmesi için küresel strateji (GOLD) evreleri arasındaki ilişkiler analiz edildi.
 Bulgular: KOAH alevlenmesindeki toplam 105 hastayı (97’si erkek, ortalama yaş 65±9 yıl) içeren bu çalışmada hiperürisemi ile mortalite
 arasında anlamlı bir korelasyon bulunurken (sırasıyla, p=0.027; p=0.016), ÜKO ile mortalite arasında korelasyon bulunmadı (sırasıyla,
 p=0.051, p=0.053). Düşük ÜA seviyesi hipoksemi ile anlamlı olarak ilişkiliydi (p=0.022), ancak ÜKO ile hipoksemi arasında bir ilişki gözlenmedi
 (p=0.094).
 Sonuç: KOAH alevlenmesindeki hastaların uzun vadeli mortalitesini öngörmede serum ÜA’nin ÜKO’na göre daha değerli olduğu
 görülmektedir. Sık klinik takip ve yoğun tedavi yönetimi gerektiren yüksek riskli KOAH hastalarının tanımlanması için serum ÜA’in uzun
 vadeli mortalitenin biyobelirteci olarak kullanılabileceğini öneriyoruz.

Spot Urine Uric Acid to Creatinine Ratio used in the Estimation of Hyperuricosuria in the Young Korean Population

Background: Uric acid levels in urine are measured using urine specimens 24 hours or by uric acid glomerular filtration rate (UAGFR) with spot urine, which additionally requires a blood sample. This study aimed to investigate whether urinary uric acid creatinine ratio (UUACr) obtained by spot urine alone could be recognized as a substitute for UAGFR value, and hyperuricosuria can be screened by UUACr. UUACr is known to vary with age and regional differences. This study focused on the reference value of each value in Korean young populations.Method: We enrolled Korean subjects 1–20 years with normal kidney function, from a single hospital, classified into 5 age groups, 1–5 years, 6–8 years, 9–12 years, 13–15 years, and 16–20 years. We checked spot urine uric acid, creatinine and serum uric acid, creatinine levels on the same day from February 2014 to December 2018. We measured the average of UAGFR and UUACr in each groups. The UUACr cut-off value of the upper 2 standard deviation (SD) of UAGFR were taken.Results: The upper 2 SD of UUACr (mg/mg) and UAGFR (mg/dL) were determined in all age groups. UUACr decreased with grown up (P=0.000), but UAGFR were not statistically different among the groups. UUACr and UAGFR were not significantly different by gender. UUACr and UAGFR were positively correlated; UUACr cut-off value of upper 2 SD UAGFR (0.54 mg/dL) was 0.65 mg/mg in total age.Conclusions: UUACr could potentially be used to screen for hyperuricosuria.

Biological Effects of Prickly Pear Powder and Extract aginst Tartrazine Toxicity on Experimental Rats

Effects of prickly pear powder and extract on biological and biochemical changes of toxicated rats by tartrazine were investigated. Thirty male albino rats were used and divided to 5 groups (n=6) each group rats. The rats injected with tartrazine at a dose 300 mg /kg of body weight/day diluted in distilled water. Serum liver functions (GOT GPT and TP), lipid profile (TG, TC, HDL-c, LDL-c, and VIDL-c), kidney functions (creatinine uric acid and urea) and plasma glutathione transferase (GST), superoxide dismutase (SOD) enzymes and malondialdehyde (MDA) were determined. The lowest GOT, GPT liver enzyme, cholesterol triglycerides, LDL-c and VLDL-c uric acid, urea, creatinine and malondialdehyde (MDA) levels of treated group recorded for group fed on mixture 10% & 100 ml prickly pear powder and extract with significant difference and verse versa with HDL-c levels.Data also indicated that addition of prickly pear powder and extract had improved all biochemical tested compared with treated groups for reduction of tartrazine risk with significant difference. As conclusion, addition of mixture 10% & 100 ml prickly pear powder and extract of treated group rats with tartrazine pigment significantly improved all biochemical tested by different rats. Therefore, prickly pear powder and extract could be used in our beverages and daily dishes for reduction of tartrazine risk.

Association of serum uric acid levels with COVID-19 severity

AimsHyperuricemia has attracted increasing attention. However, limited concern has been paid to the potential dangers of lowering serum uric acid (SUA). We observed lower levels of SUA in patients with COVID-19. Therefore, we aim to explore whether patients with COVID-19 had SUA lower than normal and the relationship of SUA and the severity of COVID-19.MethodsThis was a case–control study based on 91 cases with COVID-19 and 273 age- and sex-matched healthy control subjects. We first compared SUA levels and uric acid/creatinine (UA/Cr) ratio between patients with COVID-19 and the healthy controls. Then, we examined the association of SUA levels and UA/Cr ratios with COVID-19 severity in COVID-19 cases only, defined according to the fifth edition of China’s Diagnosis and Treatment Guidelines of COVID-19.ResultsSUA levels in patients with COVID-19 were 2.59% lower, UA/Cr ratios 6.06% lower at admission compared with healthy controls. In sex stratified analysis, levels of SUA and UA/Cr were lower in male patients with COVID-19 while only level of SUA was lower in female patients with COVID-19. Moreover, SUA and UA/Cr values were 4.27 and 8.23% lower in the severe group than that in the moderate group among male COVID-19 patients. Bivariate and partial correlations analysis showed negative correlations between SUA or UA/Cr ratio and COVID-19 after adjusting for age, sex, BMI and eGFR. A multiple linear regression analysis showed that SARS-CoV-2 infection and male sex were independent risk factors associated with lower SUA levels. Male patients with COVID-19 accompanied by low SUA levels had higher risk of developing severe symptoms than those with high SUA levels (incidence rate ratio: 4.05; 95% CI:1.11, 14.72) at admission. Comparing SUA and UA/Cr ratio at three time points (admission, discharge, and follow-up), we found that male patients experienced severe symptoms had lower SUA and UA/Cr ratio levels comparing to moderate patients, but no significant difference between three time points. On the contrary, female patients had lower SUA and UA/Cr ratio at discharge than those at admission, but no significant difference of SUA and UA/Cr ratio between moderate and severe group.ConclusionPatients with COVID-19 had SUA and UA/Cr values lower than normal at admission. Male COVID-19 patients with low SUA levels had a significantly higher crude risk of developing severe symptoms than those with high SUA levels. During disease aggravation, the level of SUA gradually decreased until discharge. At the follow-up exam, the level of SUA was similar to the levels at admission.

Comparative study of renal function test and thyroid hormone in chronic kidney disease

Introduction: Biochemical parameters (urea, creatinine, uric acid, T3, T4, TSH) important inprognosis, monitoring of thyroid dysfunction, and chronic kidney disease. The present study wasattempted to analyze these parameters in CKD patients and a healthy control group. Materials andmethods: Fifty healthy control and 5o were chronic kidney disease subjects were taken serum urea,creatinine uric acid analyzed on the auto analyzer and T3, T4, TSH estimated on immunoassayanalyzer. Ethical permission was taken from the institutional ethical committee. Results: Level ofurea, creatinine, uric acid, and thyroid hormone T3, T4, TSH were found to be significant in thepresent study when compared with the control group. (Þ<0.0001). Conclusion: It was observedthat levels of urea, creatinine, uric acid, and T3, T4, TSH deranged value found in chronic kidneydisease subjects.

Urine Uric Acid Creatinine Ratio as a Diagnostic and Prognostic Marker of Neonatal Birth Asphyxia

Background: Cerebral hypoxia can result in anaerobic glycolysis which leads to decreased phosphorylase production and increased uric acid which gets excreted in the urine where it can be easily detected. The aim of the study is to assess the utility of urine uric acid creatinine ratio (UA/Cr) as an additional marker of neonatal depression and birth asphyxia and its utility as a potential prognostic indicator for the immediate outcome. Subjects and Methods: It was a case-control study that included 30 newborns born with an APGAR score of less than 7 at 1-min and requiring positive pressure ventilation. Cases were sub-grouped into neonatal depression and birth asphyxia. Newborns with moderate and severe encephalopathy were considered to have an unfavourable outcome. The urine UA/Cr was estimated in both groups. One-way Anova test, Spearman’s rho and Receiver Operating Characteristic curve were used for statistical analysis. Results: The mean differences of urine UA/Cr were statistically significant (p=0.011) in birth asphyxia (3.02 1.34), neonatal depression (2.31 0.81) and controls (2.01 0.69). A significant negative correlation was seen with APGAR at 1-min (r=-0.43; p=0.001) and 5-min (r=-0.52; p=0.001) and umbilical cord blood pH (r= -0.29; p=0.021). The mean difference of UA/Cr between those with unfavorable (3.23 1.49) and favourable (2.14 0.73) outcomes was significant (p=0.006). A ratio 2.85 suggested the unfavourable outcome. Conclusion: The urine UA/Cr is a useful diagnostic and prognostic biomarker in newborns with birth asphyxia.

Serum uric acid levels and uric acid/creatinine ratios: affordable biomarkers for predicting chronic obstructive pulmonary disease severity and exacerbations

Background Chronic obstructive pulmonary disease (COPD) is an essential initiate the conditions of mortality and morbidity. Objective This study evaluated the clinical importance of measuring the level of serum uric acid (sUA) level and uric acid/creatinine (UA/Cr) ratio in stable COPD patients as objective biomarkers of disease severity and exacerbations Participants and methods The research involved 283 stable COPD patients and 123 healthy controls. The sUA levels and sUA/Cr ratios in both groups were assessed and compared; their correlations with the clinical, class of severity, number of exacerbations per year, spirometry parameters, oxygen saturation, and C-reactive protein were investigated. Linear regression analysis was done to examine the most predictors for severity and exacerbations, receiver operating characteristic curve for risk of exacerbation, and severity of COPD were reported to study the cut-off values, sensitivity, and specificity of both sUA and UA/Cr ratio. Results There were significant correlations between both sUA, and UA/Cr ratio with the number of exacerbations and hospitalizations per year, all spirometry data, and C-reactive protein. A linear regression shows significance (F=374, P Conclusion The measurement of sUA levels and the calculated sUA/Cr ratio estimation have a supplementary role in anticipating the severity of COPD and in predicting future exacerbations.

Blood pH and urinary uric acid-creatinine ratio in newborns with asphyxia

Background Asphyxia is one of the leading causes of death inthe world. Prematurity (28%), sepsis (26%), and asphyxia (23%)are the most common causes of death in newborns. In Indonesia,the newborn mortality incidence is 82 per 1,000 live births. BloodpH is a routine laboratory examination to diagnose newbornasphyxia, but it is preferrable to avoid such invasive procedures innewborns. An examination of urinary uric acid-creatinine (UA/Cr) ratio may be useful as an alternative method for diagnosisof asphyxia. Hypoxia causes anaerobic metabolism which willincrease the blood acidity, while creatinine will decline as a resultof incomplete renal function in newborns.Objective To assess for a possible correlation between blood pHand urinary UA/Cr ratio in newborn asphyxia.MethodsWe conducted an observational, cross-sectional study inProf. Dr. R. D. Kandou Hospital, Manado, North Sulawesi, fromNovember 2013 to April 2014. Subjects were full term newbornswith asphyxia. Blood pH and urinary UA/Cr ratio were comparedwith Pearson’s correlation test. Data was analyzed with SPSSversion 22 software and P values <0.05 were considered to bestatistically significant.Results Forty subjects met the inclusion criteria. Theirpredominant risk factor for asphyxia was fetal distress. Subjects’mean blood pH was 7.1 (SD 0.1) and mean urinary UA/Cr ratio was3.7 (SD 1.9). There was a moderate negative correlation betweenblood pH and urinary UA/Cr ratio (r= -0.55; P<0.001).Conclusion In newborns with asphyxia, lower blood pH iscorrelated with higher urinary UA/Cr ratio.

Effect of Monosodium Glutamate and Sodium Nitrite on Some Biochemical Parameters in Japanese Quails

ABSTRACT This study was conducted to investigate the effect of monosodium glutamate and sodium nitrite on some biochemical parameters in Japanese quails. Forty birds were randomly divided into equal four groups for 60 days. In comparison with the normal group we have found a significant increase in serum levels of AST, ALT, GGT, urea, BUN, creatinine uric acid, glucose and calcium in all treated groups while, there is a decrease in serum total protein, albumin, globulin, protein electrophoresis fractions, iron, phosphorus and zinc in all treated groups. In our view of lipid profile there is an increased level of total cholesterol and TAG concentration in MSG and mixed group while, there is an increase in total cholesterol level and a decreased level in TAG in NaNO2 treated group. In our view of thyroid hormones there is a significant increase in serum T3 level in all treated ones and a significant increase in serum T4 in all treated groups except the MSG-treated group.

Effects of Cilnidipine on Serum Uric Acid Level and Urinary Nitrogen Monoxide Excretion in Patients with Hypertension

The effects of cilnidipine on the serum uric acid level and urinary NO excretion in hypertensive patients were investigated. Blood and urine samples of 16 hypertensive outpatients were collected before and 2 months after cilnidipine therapy (10 mg). The serum uric acid level decreased significantly after cilnidipine treatment, while the uric acid–creatinine clearance ratio was unaffected. The cilnidipine medication produced a significant increase in urinary NO excretion, although amlodipine did not change it significantly. Therefore, cilnidipine has a profound antihypertensive effect and may reduce the serum uric acid level and increase NO production in the kidney.

Implications for the use of acid preservatives in 24-hour urine for measurements of high demand biochemical analytes in clinical laboratories

BackgroundEvaluate the level of interference of biochemists dosages in the 24-hour urine using or not the 6mol/l HCl acid in different concentrations and conditions and its implications in the most demanded analytes in clinical laboratory. MethodsTwenty-two volunteers collected three 24-hour urine in 3 conditions: with 5ml/l and 20ml/l of 6mol/l HCl in the container, and without acid preservative. The samples collected without preservative were separated in aliquots and added 5ml/l of 6mol/l HCl after 24h. Analytes, uric acid creatinine, urea, chlorides, glucose, magnesium, sodium, potassium, microalbumin, proteins, amylase, aldosterone, calcium, cortisol, phosphorus, citric acid, oxalate, and metanephrines, were determined. ResultsUric acid, glucose, microalbumin, protein, amylase and aldosterone showed that %CV ranging from 16 to 57% in the presence of acid preservative. Analytes that need acid preservative cortisol, citric acid and oxalate showed %CV ranging from 6 to 27% with r=0.66, r=0.77, r=0.70 respectively provided 5ml/l after delivery and r=0.31, r=0.70 and r=0.48 without preservative acid when compared with the gold standard (with 20ml/l of 6mol/l HCl). ConclusionsGlucose, microalbumin, protein, amylase and aldosterone urinary did not show good performance in the presence of acid preservative. Analytes that need acid preservative showed variation acceptable in condition 5ml/l of 6mol/l HCl added after 24h.

Urinary calcium and uric acid excretion in children with vesicoureteral reflux

Urolithiasis is relatively common in children, and identifiable predisposing factors for stone formation, including metabolic and structural derangements, can be established in most cases. Vesicoureteral reflux (VUR) is a common cause of kidney stone formation. The pathophysiological mechanism of urolithiasis in reflux is related to urinary tract infection and urinary stasis, both of which promote urinary crystal formation, but metabolic causes, such as crystallurias (mostly hypercalciuria), may also be involved in this process. However, few studies on urinary calcium and uric acid excretion in children with VUR have been conducted. We have studied the frequency of hypercalciuria and hyperuricosuria in children with VUR and compared the results with those from a control group. The VUR group comprised 108 children with VUR (19 boys, 89 girls; age range 3 months to 12 years), and the control group comprised 110 healthy children without any history of reflux or urinary tract infection (30 boys, 80 girls; age range 2 months to 12 years). Fasting urine was analyzed for the calcium/creatinine (Ca/Cr) and uric acid/creatinine (UA/Cr) ratios. Hypercalciuria was more frequently diagnosed in the VUR patients than in the control group (21.3 vs. 3.6%; P = 0.0001). Significant differences between the two groups were also found for the mean Ca/Cr and UA/Cr ratios (P = 0.0001 and P = 0.0001, respectively). No differences were found in the urinary Ca/Cr or UA/Cr ratios related to VUR grading or unilateral/bilateral VUR in the patient group, with the exception of those for hypercalciuria and mild VUR (P = 0.03). The association of urinary stones and microlithiasis in the VUR group was 29.6%. Our results demonstrate that the frequency of hypercalciuria and hyperuricosuria was higher in pediatric patients with VUR than in healthy children. Knowing this relationship, preventive and therapeutic interventions for stone formation in VUR could be greatly expanded.

145 A New High Flux Polysulfone Dialyzer with Waved Fibers Possessing Larger Pores Packed in Lower Fiber Density (Aps-Ea) Is Superior in Eliminating Low Molecular-Weight Proteins as Well as Small Toxins in Comparison to a Conventional Polysulfone Dialyzer with Straight Fibers Possessing Conventional Pores in Popular Fiber Density (Aps-El)

A NEW HIGH FLUX POLYSULFONE DIALYZER WITH WAVED FIBERS POSESSING LARGER PORES PACKED IN LOWER FIBER DENSITY (APS-EA) IS SUPERIOR IN ELIMINATING LOW MOLECULAR-WEIGHT PROTEINS AS WELL AS SMALL TOXINS IN COMPARISON TO A CONVENTIONAL POLYSULFONE DIALYZER WITH STRAIGHT FIBERS POSSESING CONVENTIONAL PORES IN POPULAR FIBER DENSITY (APS-EL) Emi Kihara, Miho Kando, Daisuke Okita, Nozomi Okada, Ken-ichi Taira, Yasuo Nomura, Kimiko Takahashi, Kazuko Arita, Katsutoshi Maeda, Hiroaki Oda, Oda Medical Clinic, Hiroshima, Japan. Advanced progress of a high flux polysulfone dialyzer has improved the prognosis of long-term hemodialysis (HD) patients in Japan. The purpose of this study is to elucidate beneficial effects of APS-EA compared to APS-EL in eliminating uremic toxins taking account of the differences in the shape of fibers (waved vs. straight), shape of baffles (extended vs. partial), average pore diameters (8.5 nm vs. 8.3 nm) and hallow fiber packed densities (58% vs. 71%). Elimination rates of low molecular-weight proteins (β2 microglobulin; β2-m and α1 microglobulin; α1-m) as well as small toxins (BUN, creatinine, uric acid) were estimated in 49 maintenance HD patients using APS-EL followed by APS-EA. Paired Student’s t-test was applied to the statistical analysis and p<0.05 was considered significant. Elimination rates are shown in the following table (mean±SD). β2-m α1-m BUN creatinine uric acid APS-EL 66.3±6.6 14.4±4.2 65.2±7.5 59.3±6.8 67.7±7.1 APS-EA 69.1±6.3 25.5±5.0 67.1±7.8 60.4±7.1 69.1±7.7 p value <0.01 <0.01 <0.01 <0.01 <0.01 APS-EA showed significantly higher elimination rates of low molecular-weight proteins and small toxins than APS-EL. An average value of Kt/V in APS-EA (1.35±0.30) was significantly higher than that in APS-EL (1.28±0.27), while serum albumin concentration in APS-EA (3.75 g/dl) showed slight decrease compared with that in APS-EL (3.87 g/dl). In conclusion, APS-EA, waved fibers with larger pores in less fiber packed density in an extended baffle, further developed the better performance of high flux polysulfone membrane.

Juvenile Gouty Arthritis-Reply

In Reply .—I have carefully read Dr Howell's letter and think that the issue raised by him was, at least partially, addressed in our article. As mentioned in the introduction, secondary gout in children has been encountered with glycogen storage disease type I, severe uremia, and myeloproliferative disorders. Other disorders, such as methylmelonic acidemia, cirrhosis, psoriasis, and sickle cell anemia have also been associated with hyperuricemia, but there are no reports of definite gout in children having these disorders. Our clinical and laboratory data did not suggest that our patients had any of the aforementioned diseases. It is true that we did not analyze enzymes affecting purine metabolism, specifically phosphoribosylpyrophosphate synthetase or hypoxanthine guanine phosphoribosyl transferase. However, we have looked at 24-hour uric acid excretion and uric acid–creatinine ratios and both were low. As we mentioned in the discussion, this finding strongly suggests that the patients were not overproducers of

Treatment of the nephrotic syndrome with corticotropin (ACTH) and cortisone; a four-and-one-half-year survey of results with short-term courses.

The effect of corticotropin (adrenocorticotropic hormone [ACTH]) and cortisone on the acute state of the nephrotic syndrome has been described by a number of workers.* That endogenous corticotropin may be responsible for spontaneous remissions is suggested by diuresis following measles and other infections complicating the disease. Also, in one patient whom we observed during the occurrence of a spontaneous remission, we found an increase in urinary cortins and 17-ketosteroids, a fall in eosinophile count and an increase in uric acidcreatinine ratio immediately preceding the diuresis.4It is the purpose of this communication to try to evaluate the ultimate value of these hormones when given in short-term courses by reviewing our observations in 64 infants and children who had the nephrotic syndrome and who were treated with either corticotropin or cortisone during the past four and one-half years. In accordance with a recently proposed classification,5no effort will be

Physiological responses to heat stress and ACTH of normal and schizophrenic subjects.

No statistically significant differences were found in the physiological responses of chronically ill schizophrenics as compared with normal controls and nonschizophrenic patients. Moderate to severe heat was used for stress. The circulating eosinophils and lymphocytes were measured before, during, and after exposure to heat. The base values for circulating eosinophils and lymphocytes during and after heat stress were also similar in the 3 groups. In preliminary studies the uric acidcreatinine ratios were also not remarkable. It was found that even the small dose of 5 mg. of ACTH produced an eosinopenia comparable to that found in normal subjects. It should be noted that Hoagland and Pincus after studying more patients have concluded that lymphocyte response to ACTH and to heat stress does not reliably differentiate schizophrenics from nonschizophrenics. They have not reported data on eosinophils. However, they found that urinary 17-keto- steroids, sodium, potassium, uric acid, and cortins do differentiat...