Urinary Creatinine Levels Research Articles

EVALUATION OF RENOPROTECTIVE EFFECT OF CILNIDIPINE IN PATIENTS WITH MILD TO MODERATE HYPERTENSION AND TYPE 2 DIABETES MELLITUS – A PROSPECTIVE STUDY

Objective: The objective of the study was to evaluate the renoprotective effect of cilnidipine by estimating urinary albumin and creatinine levels in mild-to-moderate hypertension (HTN) with type 2 diabetes mellitus (DM) and also evaluate the adverse drug profile of cilnidipine in the same patients.
 Methods: This was a single-center, prospective, open-labeled, randomized study. A total of 60 patients of either gender aged between 30 and 60 with mild-to-moderate HTN with type 2 DM were included in the study. Urine albumin and urine creatinine were measured at day 1 and day 181. Blood pressure (BP) was measured in all visits. The drug cilnidipine at a dose of 10–20 mg oral was given and the corresponding improvement in the levels of urine albumin and other parameters was identified.
 Results: There was a significant reduction in the mean systolic BP from 150.07±5.44 mmHg in visit 0 to 123.03±5.23 mmHg in visit 3. And also, there was a significant reduction in the mean diastolic BP from 95.5±8.15 mmHg in visit 0 to 80.8±2.42 mmHg in visit 3. The mean heart rate at visit zero was 76.71±4.86. At the end of 6 months of treatment, there was a significant reduction to 70.63±2.74. There was a significant reduction in the microalbuminuria from 66.62±8.39 to 38.8±6.45. The mean reduction was 27.56±10.25. There was no change in the creatinine level.
 Conclusion: The study reveals that the drug cilnidipine is safe and effective in reducing the microalbuminuria and also effectively reduces BP in hypertensive patients. Hence, the drug cilnidipine can be safely administered to the patient with diabetes and HTN.

Buprenorphine Dosage and Urine Quantitative Buprenorphine, Norbuprenorphine, and Creatinine Levels in an Office-Based Opioid Treatment Program.

Background:Treatment progress is routinely monitored by urine testing in patients with opioid use disorder (OUD) undergoing buprenorphine medication-assisted treatment (MAT). However, interpretation of urine test results could be challenging. This retrospective study aims to examine the results of quantitative buprenorphine, norbuprenorphine, and creatinine levels in urine testing in relation to sublingual buprenorphine dosage to facilitate an accurate interpretation of urine testing results.Methods:We reviewed the medical charts of 41 consecutive patients, who were residing in halfway houses where their medication intake was closely monitored and who had enrolled in an office-based MAT program at an urban clinic between July 2018 and June 2019. The patients’ urine testing results were reviewed, and demographic variables were recorded. We focused on the patients treated with 8-, 12-, or 16-mg/day of buprenorphine, examining their urine buprenorphine, norbuprenorphine, and creatinine levels. Analysis of variance tested the statistical association between the dosage and urine testing results on the norbuprenorphine-to-creatinine ratio.Results:A total of 240 urine samples from 41 patients were included for this study. The 41 patients received a mean buprenorphine dose of 10.5 ± 3.7 mg/day (range, 4-20 mg/day). Then, this study examined the distribution of the 240 urine samples and then focused on 184 urine samples that came from the 33 patients who were treated with 8-, 12-, and 16-mg/day of buprenorphine, the 3 most common dosages. All of the 184 urine samples had a creatinine level of >20 mg/dL and buprenorphine-to-norbuprenorphine ratio <50:1. The average norbuprenorphine-to-creatinine ratio in the 8 mg/day dosage group was 3.85 ± 2.24 × 10−4 (n = 66; range, 0.44-11.12). The respective ratios in the 12- and 16-mg dosage groups were 5.64 ± 3.40 × 10−4 (n = 83; range, 1.55-22.72) and 6.23 ± 4.92 × 10−4 (n = 35; range, 1.37-27.12). The 3 dosage groups differed significantly in the mean ratios (P < .01), except when the 12- and 16-mg dosage groups were compared (P = .58). The results of this study thus suggest that prescribers should pay attention to the following features: (1) unexpected substance(s) in urine testing, (2) creatinine level under 20 mg/dL, (3) buprenorphine-to-creatinine ratio over 50:1, (4) buprenorphine dosage over 24 mg/day, and (5) norbuprenorphine-to-creatinine ratio consistently under 0.5 × 10−4 in patients treated with 8 mg/day or 1.5 × 10−4 in patients treated with 12 mg/day or more.Conclusion:This study suggested parameters for interpreting quantitative urine test results in relation to buprenorphine intake dose in office-based opioid treatment programs.

Kidney Diseases: The Age of Molecular Markers.

Kidney diseases are conditions that increase the morbidity and mortality of those afflicted. Diagnosis of these conditions is based on parameters such as the glomerular filtration rate (GFR), measurement of serum and urinary creatinine levels and equations derived from these measurements (Wasung, Chawla, Madero. Clin Chim Acta 438:350-357, 2015). However, serum creatinine as a marker for measuring renal dysfunction has its limitations since it is altered in several other physiological situations, such as in patients with muscle loss, after intense physical exercise or in people on a high protein diet (Riley, Powers, Welch. Res Q Exerc Sport 52(3):339-347, 1981; Juraschek, Appel, Anderson, Miller. Am J Kidney Dis 61(4):547-554, 2013). Besides the fact that serum creatinine is a marker that indicates glomerular damage, it is necessary the discovery of new biomarkers that reflect not only glomerular damage but also tubular impairment. Recent advances in Molecular Biology have led to the generation or identification of new biomarkers for kidney diseases such as: Acute Kidney Failure (AKI), chronic kidney disease (CKD), nephritis or nephrotic syndrome. There are recent markers that have been used to aid in diagnosis and have been shown to be more sensitive and specific than classical markers, such as neutrophil gelatinase associated lipocalin (NGAL) or kidney injury molecule-1 (KIM-1) (Wasung, Chawla, Madero. Clin Chim Acta 438:350-357, 2015; George, Gounden. Adv Clin Chem 88:91-119, 2019; Han, Bailly, Abichandani, Thadhani, Bonventre. Kidney Int 62(1):237-244, 2002; Fontanilla, Han. Expert Opin Med Diagn 5(2):161-173, 2011). However, early diagnostic biomarkers are still necessary to assist the intervention and monitor of the progression of these conditions.

Evaluation of Response to Treatment in Children with Nephrotic Syndrome over a 10-Year Period: A Retrospective Study

Background Nephrotic syndrome (NS), defined as massive loss of urinary protein results in a triad of hypoalbuminemia, hyperlipidemia and edema. We aimed to determine the frequency of clinical symptoms, laboratory findings and treatment response in children with Nephrotic Syndrome. Materials and Methods: We conducted a longitudinal retrospective study from 2009 to 2019 at a single regional pediatric center, Zahedan, Iran, on 206 children (up to 14 years) with NS that were selected from all clinical records files. Parameters extracted included age, sex, presenting symptoms, blood pressure. Laboratory information included complete blood count, urine analysis, 24-hour urinary protein excretion, creatinine clearance, serum electrolytes, serum urea and creatinine levels, total protein and albumin, triglyceride and cholesterol, acute phase reactant, treatment and outcome. All the data extracted were recorded in pre-prepared forms. Results: A total of 107 men (52%) and 99 women (49%) participated in the study. Edema was most commonly found in 197 (95.6%), respiratory distress in 2 (0.9%), abdominal pain in 45 (21.8%), nausea and vomiting in 28 (13.5%), and gross hematuria in 6 (2.9%). Leukopenia was seen in 0.5% followed by 42.4% of normal white blood cells (WBCs) and 57.1% leukocytosis. 74.4% of all patients had anemia in their laboratory tests in spite of thrombocytopenia only seen in 1.7%. 49% had pyuria and hematuria was seen in 41%. The mean level of serum albumin was 2.5 g/l, cholesterol was 381 mg/dl, triglyceride was 287 mg/dl and the mean level of 24-hour urinary protein excretion was 2084 mg/dl. Conclusion The most common clinical symptom in nephrotic syndrome was edema followed by nausea and vomiting and abdominal pain.

Effect of low salicylate diet on clinical and inflammatory markers in patients with aspirin exacerbated respiratory disease \u2013 a randomized crossover trial

BackgroundAspirin-exacerbated respiratory disease (AERD) is characterized by eosinophilic rhinosinusitis, nasal polyposis, and bronchial asthma, along with the onset of respiratory reactions after the ingestion of nonsteroidal anti-inflammatory drugs (NSAIDs) or acetylsalicylic acid (ASA). In addition to the therapeutic routines and surgical options available, a low dietary intake of food salicylate has been suggested as adjunctive therapy for this condition.This study aimed to assess the influence of a short-term low salicylate diet on inflammatory markers in patients with AERD and whether that would result in symptomatic improvement.MethodsProspective study with randomization to either a high or low salicylate diet for 1 week, followed by cross-over to the other study arm. Participants were asked to record their dietary salicylate for each week of the study. Urinary creatinine, salicylate and leukotriene levels were measured at the time of recruitment, end of week one and end of week two and the SNOT-22 questionnaire was filled out at the same time points.ResultsA total of seven participants completed the study. There was no statistical difference in the urinary salicylate and leukotriene levels between the two diets; nevertheless, participants on low salicylate diet reported improved SNOT-22 symptoms scores (p = 0.04), mainly in the rhinologic, ear/facial, and sleep dysfunction symptom domains. In addition, these last two domains outcomes were more significant than the minimal clinically important difference.ConclusionsA short-term low salicylate diet may not result in biochemical outcomes changes but seems to provide significant symptomatic relief for patients with AERD.Trial registrationNCT01778465 (www.clinicaltrials.gov)Graphical abstract

Urinary kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin are early predictors for acute kidney injury among patients admitted to the surgical ICU

ABSTRACT Objectives: Evaluation of urinary neutrophil gelatinase-associated lipocalin (UNGAL) and kidney injury molecule 1 (UKIM-1) as early predictors of development of acute kidney injury (AKI) in patients admitted to surgical ICU. Patients & Methods: 188 ICU patients were clinically evaluated and gave blood samples for estimation of at admission (T0) serum creatinine (SCr) and urine samples for estimation of urinary creatinine (UCr), UNGAL and UKIM-1 and their values were adjusted to UCr level. At 48-hr after admission SCr levels were re-estimated and AKI was diagnosed and staged according to the Acute Kidney Injury Network criteria. Study outcomes included the ability of estimated markers for prediction of possible AKI development. Results: At 48-hr after ICU admission, 73 patients (38.8%) developed AKI; 42, 21 and 10 mild, moderate and severe AKI, respectively. At T0, UNGAL and UKIM1, and their UCr ratios showed progressive increase with increased AKI grade. Calculated ∆SCr was positively correlated with clinical data and estimated levels of urinary markers. Regression analysis defined elevated BMI, TISS-28 score, UNGAL and UKIM-1 as early significant predictors for AKI. ROC curve analysis defined UNGAL and UKIM-1 and their ratios to UCr as the significant predictors for AKI development. Conclusion: Development of AKI in ICU patients was related to severity of surgical trauma. High UNGAL and UKIM-1 at time of ICU admission can predict upcoming AKI and its AUC after adjustment to UCr levels had superior predictive value for AKI. A high uKIM-1/UCr ratio can be considered the most significant early predictor for AKI.

The value of urinary uric acid and creatinine ratio in neonatal asphyxia

Objective: The value of urinary uric acid and creatinine ratio in neonatal asphyxia. Method: This was a prospective observational study conducted over one year, on 45 newborns admitted in NICU with perinatal asphyxia. Cord blood from the umbilical artery was sent for pH analysis and urinary uric acid and creatinine levels were estimated in spot urine samples. Results: The urinary uric acid and creatinine ratio had a positive correlation with low APGAR scores at the 1st and 5th minute. Also, urinary uric acid to creatinine ratios was significantly higher in infants with severe HIE (3.18±0.61) when compared with infants of moderate HIE (2.19±0.32). It showed a significant negative correlation with pH of cord blood in neonates with perinatal asphyxia. Conclusion: The urinary uric acid and creatinine ratio can be used as a supportive diagnostic test for early diagnosis of perinatal asphyxia.

Renal alterations caused by ligature-induced periodontitis persist after ligature removal in rats.

Periodontitis may crosstalk with renal diseases, yet that remains unclear. We investigated whether the renal alterations caused by induced periodontitis are reversible after removal of the ligatures in experimental ligature-induced periodontitis. Twenty-four female rats were divided into three groups: control (without periodontitis), periodontitis (20days of ligature-induced periodontitis), and P20-20 (20days of ligature-induced periodontitis and 20days after ligature removal). The following periodontal parameters were assessed: gingival bleeding index, probing pocket depth, myeloperoxidase activity, and alveolar bone height. For renal tissues, histopathology, malonaldehyde (MDA) levels, glutathione (GSH) content, and renal weight were evaluated. In the blood, creatinine, uric acid, albumin, total cholesterol, total protein, and glucose levels were assessed. Total protein and creatinine levels in urine were also investigated. Rat renal tissues did not demonstrate reversal of periodontitis-related changes in the P20-20 group in terms of MDA, GSH, and histopathological evaluations when compared to the periodontitis group. Accordingly, only total cholesterol levels were reversible in the P20-20. Renal alterations caused by ligature-induced periodontitis persisted even after removal of ligatures in rats.

The Pattern of Cyclosporine Nephrotoxicity and Urinary Kidney Injury Molecule 1 in Allogenic Hematopoietic Stem Cell Transplant Patients

The typical immunosuppressive regimen of hematopoietic stem cell transplant includes cyclosporine. However, cyclosporine nephrotoxicity is a concern. We studied cyclosporine nephrotoxicity epidemiology in hematopoietic stem cell transplant patients and compared the pattern and urinary levels of the KIM-1 kidney injury molecule versus serum and urine creatinine levels. The study covered 10 months at Namazi Hospital, Shiraz, Iran. All patients met the following criteria: > 15 years old, received allogenic hematopoietic stem cell transplant without history of acute or chronic kidney disease, and scheduled for at least 1 week of cyclosporine treatment. Urinary and serum levels of creatinine, urea, sodium, potassium, magnesium, and the KIM-1 kidney injury molecule were measured on days 0, 3, 5, 7, 10, and 14 of cyclosporine treatment. Of 42 patients, one-third developed cyclosporine nephrotoxicity (30.95%), and median onset time was 15 days. Hypokalemia and hypomagnesemia were reported in 76.2% and 53.4% of the cohort, respectively. None of the demographic, clinical, and paraclinical parameters was significantly associated with cyclosporine nephrotoxicity. Median duration of hospital stay for patients with cyclosporine nephrotoxicity (41 days) was significantly higher (P < .001) than those without nephrotoxicity (29 days). Area under the curve for receiver operating characteristic showed that accuracy of serum creatinine (0.267; 95% CI, 0.11-0.43) at day 0 of cyclosporine treatment was significantly lower (P = .017) than the accuracy of urine creatinine (0.477; 95% CI, 0.28-0.67) and urine levels of the KIM-1 kidney injury molecule (0.594; 95% CI, 0.41-0.78). Cyclosporine nephrotoxicity is a common adverse effect in the setting of hematopoietic stem cell transplant and occurs mostly within the first 2 weeks of cyclosporine treatment. Urine KIM-1 kidney injury molecule measurement had no overall superiority and no improved accuracy over serum or urine creatinine measurements for prediction or detection of cyclosporine nephrotoxicity.

Evaluation of Blood Lead Levels and Their Effects on Hematological Parameters and Renal Function in Iranian Lead Mine Workers

Background: Lead toxicity has become a growing health concern in countries such as Iran. However, little information is available on the assessment and evaluation of the health effects of lead exposure in mine workers. Objectives: The present study assessed the occupational exposure to lead and examine the association of blood lead (PbB) levels with hematological and kidney function parameters in mine workers. Methods: In this matched case-control study, the level of PbB was measured in 100 workers (70 exposed and 30 non-exposed), and then its relationship was evaluated with complete blood count (CBC) parameters, zinc protoporphyrin (ZPP), urea, blood creatinine levels, urinary δ-aminolevulinic acid (ALA), coproporphyrin, and creatinine levels. Results: The results showed a linear and significant relationship between the PbB level and B-ZPP, U-ALA, U-coproporphyrin, and U-creatinine levels in states of PbB levels &gt; 20 μg/dL in a time and dose-dependent manner. A significant relationship was observed between the PbB level and the years of occupational exposure to lead and the B-urea level (P-value &lt; 0.03). Conclusions: Chronic occupational exposure to lead decreased hematocrit, RDW-CV, MCV, MCH, and HGB values but did not significantly change RBC counts. Therefore, a regular assessment of routine blood parameters (such as CBC and ZPP) and renal function indices can be effectively used to monitor the toxic effects of lead exposure.

Antihypertensive Effects of Gynura divaricata (L.) DC in Rats with Renovascular Hypertension.

Gynura divaricata (L.) DC (Compositae) (GD) could be found in various parts of Asia. It has been used as a traditional medicine to treat diabetes, high blood pressure, and other diseases, but its effects have not yet been scientifically confirmed. Therefore, we aimed at determining whether GD could affect renal function regulation, blood pressure, and the renin-angiotensin-aldosterone system (RAAS). Cardio-renal syndrome (CRS) is a disease caused by the interaction between the kidney and the cardiovascular system, where the acute or chronic dysfunction in one organ might induce acute or chronic dysfunction of the other. This study investigated whether GD could improve cardio-renal mutual in CRS type 4 model animals, two-kidney one-clip (2K1C) renal hypertensive rats. The experiments were performed on the following six experimental groups: control rats (CONT); 2K1C rats (negative control); OMT (Olmetec, 10 mg/kg/day)-treated 2K1C rats (positive control); and 2K1C rats treated with GD extracts in three different doses (50, 100, and 200 mg/kg/day) for three weeks by oral intake. Each group consisted of 10 rats. We measured the systolic blood pressure weekly using the tail-cuff method. Urine was also individually collected from the metabolic cage to investigate the effect of GD on the kidney function, monitoring urine volume, electrolyte, osmotic pressure, and creatinine levels from the collected urine. We observed that kidney weight and urine volume, which would both display typically increased values in non-treated 2K1C animals, significantly decreased following the GD treatment (### p < 0.001 vs. 2K1C). Osmolality and electrolytes were measured in the urine to determine how renal excretory function, which is reduced in 2K1C rats, could be affected. We found that the GD treatment improved renal excretory function. Moreover, using periodic acid-Schiff staining, we confirmed that the GD treatment significantly reduced fibrosis, which is typically increased in 2K1C rats. Thus, we confirmed that the GD treatment improved kidney function in 2K1C rats. Meanwhile, we conducted blood pressure and vascular relaxation studies to determine if the GD treatment could improve cardiovascular function in 2K1C rats. The heart weight percentages of the left atrium and ventricle were significantly lower in GD-treated 2K1C rats than in non-treated 2K1C rats. These results showed that GD treatment reduced cardiac hypertrophy in 2K1C rats. Furthermore, the acetylcholine-, sodium nitroprusside-, and atrial natriuretic peptide-mediated reduction of vasodilation in 2K1C rat aortic rings was also ameliorated by GD treatment (GD 200 mg/kg/day; p < 0.01, p < 0.05, and p < 0.05 vs. 2K1C for vasodilation percentage in case of each compound). The mRNA expression in the 2K1C rat heart tissue showed that the GD treatment reduced brain-type natriuretic peptide and troponin T levels (p < 0.001 and p < 0.001 vs. 2K1C). In conclusion, this study showed that GD improved the cardiovascular and renal dysfunction observed in an innovative hypertension model, highlighting the potential of GD as a therapeutic agent for hypertension. These findings indicate that GD shows beneficial effects against high blood pressure by modulating the RAAS in the cardio-renal syndrome. Thus, it should be considered an effective traditional medicine in hypertension treatment.

Urinary Phosphate Excretion and Microvascular Function in a Population-Based Cohort

Urinary Phosphate Excretion and Microvascular Function in a Population-Based Cohort

The Beneficial Effect of Boswellic Acid on Bone Metabolism and Possible Mechanisms of Action in Experimental Osteoporosis.

Estrogen is instrumental in the pathological process of osteoporosis because a deficiency of this hormone increases the release of bone-resorbing cytokines. Acetyl-11-keto-β-boswellic acid (AKBA), a constituent from Boswellia serrata, has an anti-inflammatory effect by inhibiting tumor necrosis factor-α (TNF-α) expression, which leads to a decline in receptor activator of nuclear factor-kappa B (NF-κB) ligand, and consequently, a reduction in osteoclast activity. Hence, AKBA may be beneficial against bone loss during osteoporosis. Therefore, the current study intended to evaluate the beneficial effects of AKBA in ovariectomy-induced osteoporosis and to investigate its mechanism of action. Sham-operation or ovariectomy female Sprague Dawley rats were used for evaluating the antiosteoporotic effect of AKBA in this study. AKBA (35 mg/kg, p.o.) and estradiol (0.05 mg/kg, i.m.) were administered for 42 days. At the end of the experiment, body and uterus weights, serum and urine calcium and phosphorus, serum alkaline phosphatase, and urinary creatinine levels, besides serum levels of NF-κB and TNF-α were determined. Weight, length, thickness, hardness, calcium content, as well as the bone mineral density of femur bone and lumbar vertebra were measured. A histopathological examination was also carried out. AKBA ameliorated all tested parameters and restored a normal histological structure. Thus, AKBA showed good antiosteoporotic activity, which may be mediated through its suppression of the NF-κB-induced TNF-α signaling pathway.

Urinary Human Kidney Injury Molecule1- (hKIM1-) is not Increased in Patients with Renal Cell Carcinoma.

Human Kidney Injury Molecule-1 (hKIM-1) was proposed as urinary biomarker of renal cell carcinoma (RCC). The aim of the study was to validate urinary hKIM-1 as a biomarker of RCC. Forty-six participants were enrolled into the study, including 30 patients with clear-cell or papillary RCC and 16 matched patients in the comparison group. Preoperative urinary hKIM-1 levels were measured using commercially available ELISA kit and normalized to urinary creatinine levels. The concentrations of urinary hKIM-1 normalized to urinary creatinine in patients with RCC and comparison group did not differ significantly (1.35 vs. 1.32 ng/mg creatinine, p=.25). There was also no difference in urinary hKIM-1 concentration regarding stage or grade of renal cancer. Additional analysis of patients without chronic kidney disease (defined as eGFR ≥60mL/min/1.73m²) also did not reveal significant difference in urinary hKIM-1 concentrations between the groups (1.54 vs. 1.37; p=.47). Results of our study do not confirm recent suggestions that urinary hKIM-1 may be a biomarker of RCC.

Salt and potassium intake among adult Ghanaians: WHO-SAGE Ghana Wave 3

Though Ghana has high hypertension prevalence, the country lacks current national salt consumption data required to build and enhance advocacy for salt reduction. We explored the characteristics of a randomly selected sub sample that had valid urine collection, along with matched survey, anthropometric and BP data (n = 839, mean age = 60y), from the World Health Organization’s Study on global AGEing and adult health (WHO-SAGE), Ghana Wave 3, n = 3053). We also investigated the relationship between salt intake and blood pressure (BP) among the cohort. BP was measured in triplicate and 24 h urine was collected for the determination of urinary sodium (Na), potassium (K), creatinine (Cr) and iodine levels. Hypertension prevalence was 44.3%. Median salt intake was 8.3 g/day, higher in women compared to men (8.6, interquartile range (IQR) 7.5 g/day vs 7.5, IQR 7.4 g/day, p < 0.01), younger participants (18–49 y) compared to older ones (50+ y) (9.7, IQR 7.9 g/day vs 8.1, IQR 7.1 g/day, p < 0.01) and those with higher Body Mass Index (BMI) (> 30 kg/m2) compared to a healthy BMI (18.5–24.9 kg/m2) (10.04, IQR 5.1 g/day vs 6.2, IQR 5.6 g/day, p < 0.01). More than three quarters (77%, n = 647) of participants had salt intakes above the WHO maximum recommendation of 5 g/d, and nearly two thirds (65%, n = 548) had daily K intakes below the recommended level of 90 mmol. Dietary sodium to potassium (Na: K) ratios above 2 mmol/mmol were positively associated with increasing BP with age. Population-based interventions to reduce salt intake and increase K consumption are needed.

Cálcio, fósforo, fração de excreção urinária de fósforo e paratormônio em cães com leishmaniose visceral

The kidneys perform an essential role in the regulation of serum phosphorus concentration. In visceral leishmaniasis (VL), the decline of the glomerular filtration rate leads to hyperphosphatemia, whose primary consequence is the development of secondary renal hyperparathyroidism. This study aimed to determine the concentration of serum phosphorus, ionized calcium (Cai), urinary fractional excretion of phosphorus (uFEP), and parathormone (PTH) in azotemic and non-azotemic dogs with VL and evaluate the uFEP as a marker of secondary renal hyperparathyroidism. The study comprised 31 dogs, divided into 24 sick animals and 07 healthy animals used as a control group (GC). The sick animals were classified into groups as azotemic (GA) and non-azotemic (GNA). The serum levels of phosphorus, creatinine, Cai, and the plasma levels of PTH were measured and compared between groups. The uFEP was calculated using values of serum and urinary levels of phosphorus and creatinine. The Kruskal-Wallis test with a 0.05 significance level was used, followed by the Mann-Whitney test as a post hoc test, with a 0.016 significance level. The levels of serum phosphorus were higher in the GA group, whereas for the PTH, the GNA and GA groups demonstrated high values compared to the GC. The uFEP was significantly higher in the GA when compared to the GNA, although there was no statistical difference between the GC and the GNA. The uFEP showed to be a late marker of chronic kidney disease and secondary hyperparathyroidism in dogs with visceral leishmaniasis.

Exploration of a Framework for the Identification of Chronic Kidney Disease Based on 2D Ultrasound Images: A Survey.

Chronic kidney disease (CKD) is a fatal disease that ultimately results in kidney failure. The primary threat is the aetiology of CKD. Over the years, researchers have proposed various techniques and methods to detect and diagnose the disease. The conventional method of detecting CKD is the determination of the estimated glomerular filtration rate by measuring creatinine levels in blood or urine. Conventional methods for the detection and classification of CKD are tedious; therefore, several researchers have suggested various alternative methods. Recently, the research community has shown keen interest in developing methods for the early detection of this disease using imaging modalities such as ultrasound, magnetic resonance imaging, and computed tomography. The study aimed to conduct a systematic review of various existing techniques for the detection and classification of different stages of CKD using 2D ultrasound imaging of the kidney. The review was confined to 2D ultrasound images alone, considering the feasibility of implementation even in underdeveloped countries because 2D ultrasound scans are more cost effective than other modalities. The techniques and experimentation in each work were thoroughly studied and discussed in this review. This review displayed the cutting-age research, challenges, and possibilities of further research and development in the detection and classification of CKD.

METTL3 contributes to renal ischemia-reperfusion injury by regulating Foxd1 methylation.

To investigate the mechanism of renal ischemia-reperfusion injury (IRI) via regulation of N6-methyl-adenosine (m6A) and relevant genes, IRI was induced in Sprague-Dawley rats, and urine and serum creatinine levels and tissue structure changes were observed. m6A and methyltransferase-like 3 (METTL3) protein levels were assessed via dot-blot and Western blot analyses, respectively. The hypoxia/reoxygenation (H/R) cell model was constructed using NRK-52E cells, and METTL3 protein levels were assessed. METTL3 was inhibited to observe its impact on NRK-52E cell apoptosis and m6A expression in H/R processes. Methylated RNA immunoprecipitation (MeRIP) sequencing was conducted followed by MeRIP-quantitative RT-PCR and quantitative RT-PCR validation. Our results indicated that urine and serum creatinine levels increased and that renal injury and cell apoptosis were both observed in the IRI model. In additon, m6A expression increased in the IRI model, and METTL3 protein levels significantly increased in the IRI and H/R models. When METTL3 was inhibited, m6A levels were accordingly decreased and cell apoptosis was suppressed in the H/R in vitro model. Based on MeRIP sequencing, transcription factor activating enhancer binding protein 2α (tfap2a), cytochrome P-450 1B1 (cyp1b1), and forkhead box D1 (foxd1) were significantly differentially expressed, as was m6A, which is involved in the negative regulation of cell proliferation and kidney development. We confirmed that foxd1 mRNA and its methylation levels contributed to IRI and H/R.

Impact of anti-inflammatory agent like Bryophyllum pinnatum aqueous extract and diclofenac on blood pressure and creatinine clearance.

Objectives: To study the impact of anti-inflammatory agent like Bryophyllum pinnatum aqueous extract and diclofenac on blood pressure and creatinine clearance. Study Design: Experimental study. Setting: Sargodha Medical College, Sargodha, Department of Pharmacy, University of Sargodha. Period: 1st January 2019 to 30th June 2019. Material &amp; Methods: 24 Sprague Dawley rats were obtained and were then divided into four groups. Negative control group (A) contained animals received normal diet while Group B, C and D received diet containing sucrose (20% w/w) to induce hypertension. After that group B (positive control group) received distilled water 0.5 ml was by oral route, group C (Bryophyllum pinnatum group) received Bryophyllum pinnatum aqueous extract 300 mg/ml intraperitoneally and group D received diclofenac 12 mg/kg intraperitoneally as a single morning dose for two weeks. Blood pressure of animals was recorded at baseline and then weekly throughout the study using tail cuff using non-invasive blood pressure controller (ML125R). Animals were anesthetised with chloroform and two ml blood was drawn through cardiac puncture at 0, 4and 6 weeks. Blood was tested for haematocrit. Serum sodium and potassium levels were estimated by flame photometer. Urinary creatinine levels were estimated by kinetic Jaffé method. The data collected was processed by using Statistical Package for Social Sciences (SPSS 20). Results: Mean and standard deviation of systolic blood pressure (BP) of group A rats did not change with time, while that of group B, C and D increased till 4th week. Creatinine clearance of group A, B and C did not change much with time but that of group D decreased towards end of study period. Conclusion: Bryophyllum pinnatum leaf aqueous extract is an effective anti-hypertensive agent with minimal renal effects.

Evaluation of Urinary Neutrophil Gelatinase-associated Lipocalin as a Biomarker in Pediatric Vesicoureteral Reflux Assessment

Introduction. Defining a non-invasive marker to predict the risk of kidney damage is very helpful to manage vesicoureteral reflux (VUR) in children. This study aimed to investigate the predictive value of urinary neutrophil gelatinase-associated lipocalin (uNGAL) as a non-invasive biomarker of reflux nephropathy in pediatric with primary VUR. Methods. This case-control study was performed on 63 children with primary VUR and 72 age- and sex-matched healthy children as controls. Urinary NGAL and creatinine levels were measured and compared between patients and control groups as well as among the subgroups of patients in terms of disease severity. Results. Among patients, 9 cases were diagnosed as mild, 35 as moderate, and 19 with a severe form of VUR. We observed higher but insignificant levels of uNGAL in patients versus healthy controls (P > .05), in cases with severe form compared to mild and moderate forms of VUR (P > .05) as well as in those patients with bilateral versus unilateral involvement (P > .05). The mean ratios of uNGAL/uCr were significantly higher in patients group than controls (P < .05) as well as in patients with severe form compared to moderate and mild forms of VUR (P < .05 and P < .05, respectively). Also, ROC analysis revealed the sensitivity of 61% and specificity of 53% for uNGAL/uCr ratio for prediction of VUR. Conclusion. Our findings indicate a potential predictive value of uNGAL/uCr ratio as a non-invasive biomarker for the management of VUR although, its clinical application has been challenging and needs to be confirmed by further investigations.