Urine Biochemistry Research Articles

Outcomes in Fetal Lower Urinary Tract Obstruction: Analysis of Fetal Urinary Biochemistry and Ultrasound Features in Fetuses with and without Additional Upper Renal Tract Involvement

Outcomes in Fetal Lower Urinary Tract Obstruction: Analysis of Fetal Urinary Biochemistry and Ultrasound Features in Fetuses with and without Additional Upper Renal Tract Involvement

Microvascular Changes Are Associated with Proteinuria and EMG Changes in Patients with Type 2 Diabetes Using Video Capillaroscopy.

Objectives: Video capillaroscopy is a diagnostic method for evaluating microvascular changes in type 2 diabetes mellitus (T2DM). This study evaluated microvascular changes, including microvascular architecture, capillary distribution (morphology and density), and angiogenesis conditions in T2DM patients via video capillaroscopy. Methods: A total of 256 patients with T2DM enrolled in this study. Based on electromyography (EMG)-nerve conduction velocity results, patients were divided into patients with normal and abnormal EMG. Microalbuminuria was assessed using biochemical urine analysis. Finally, video capillaroscopy was performed to evaluate changes in microvascular architecture, capillary distribution, and angiogenesis status. Results: The differences between microalbuminuria in patients with normal and abnormal EMG were not significant. Other microvascular changes were not significant between normal and abnormal EMG groups. The patients with greater microalbuminuria were at risk of abnormal EMG 2.8 times higher than those with fewer microalbuminuria (odds ratio = 2.804; 1.034-7.601). However, EMG is not a risk factor for microvascular architecture alternation in T2DM (odds ratio = 1.069; 0.323-3.546). Conclusions: Microvascular alternations are common in T2DM and early detection of these changes could help to avoid the progress of nephropathic complications. Also, video capillaroscopy provides a promising diagnostic method for the detection of microvascular alternations in T2DM.

Analysis on Chemical Composition of Urinary Calculi and Evaluation on Metabolic Disturbance in 1080 Uyghur, Kazakh and Han Nationality Patients of Xinjiang

Urinary stones pose a significant health concern globally. The incidence rates vary and are influenced by diverse factors. Despite advancements in the treatment modalities, increasing rate of urinary stones necessitates the development of stone prevention strategies and understanding of metabolic risk factors. Objective: To determine the relationship between chemical composition of urinary calculi and evaluation on metabolic disturbance in 1080 Uyghur, Kazakh and Han patients of Xinjiang. Methods: The stone composition of 1080 patients and analysis of 24-h urine and serum biochemistry results of 775 cases was evaluated by infrared spectroscopic analysis and automatic biochemical machine respectively. Results: Among 644 cases of urinary stones, calcium oxalate stones (409 cases) and mixed type stones (436 cases) were predominant. Metabolic disturbances were found in 643 cases (82.97%) out of 775 patients, showing various urinary abnormalities like hyperuricosuria, hyperoxaluria, hyper-phosphaturia, hyper-cystinuria, hypercalciuria, hypomagnesuria, hypocitraturia, and reduced urine volume (<2000ml in 407 cases). Conclusions: Urinary calculi have intimate connection with metabolic evaluation. Metabolic evaluation and composition of urinary calculi have great significance in treatment and prevention of urinary calculi.

Bilateral pheochromocytoma in patients with von Hippel–Lindau syndrome: clinical and molecular genetic features

Bilateral adrenal pheochromocytoma (PCС) is extremely rare in children, with major predisposing factors being multiple endocrine neoplasia type 2 and von Hippel–Lindau syndrome. In case of bilateral PCC with underlying von Hippel–Lindau syndrome, organ-preserving surgery is preferred in view of the low malignant potential of such neoplasms. We aimed to study clinical and molecular genetic features of patients with bilateral adrenal PCCs treated at the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Ministry of Healthcare of the Russian Federation. The study was approved by the Independent Ethics Committee and the Scientific Council of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Ministry of Healthcare of the Russian Federation. The study included 20 patients with paraganglioma (PGL)/PCC (PPGL) who had received treatment (n = 17) or outpatient care (n = 3) at the Center over the period from 2012 to 2023. Bilateral adrenal PCC was diagnosed in 4 (20%) patients. In all these cases, the diagnosis was confirmed by histology. Molecular genetic testing was carried out at the Laboratory of Molecular Biology at the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Ministry of Healthcare of the Russian Federation in order to search for germline pathogenic variants in PCC/PGL susceptibility genes. The median age of the four patients with bilateral adrenal PCC was 9.5 years (range 4.5–14.6 years). All the patients were male. In one patient, synchronous bilateral PCC/PGL was observed. In 100% of the cases, arterial hypertension was diagnosed at the onset of the primary disease and was treated with alpha-blockers as part of preparation for surgery. According to the results of a 24-hour urine biochemistry test, all the patients had at least a 4-fold increase above the upper limit of normal for normetanephrine levels. Molecular genetic testing using the multiplex ligation-dependent probe amplification method revealed a pathogenic germline variant in exon 3 of the VHL gene in all the children (4/4). Hereditary PPGL was proven in 2/4 (50%) patients. In all the cases, R0/R1 resection was achieved. Organ-sparing surgery on one/two adrenal glands was performed in 3/4 cases. One out of four (25%) patients developed a local relapse 18.4 months after diagnosis. The overall survival rate in this group was 100%, with a median follow-up time of 8.1 months (range 0.8–50.2 months). Bilateral adrenal PCC is a very rare childhood tumor. A medical genetic consultation is necessary to identify tumor predisposition syndromes. A multidisciplinary team discussion of a surgical strategy is recommended, with organ-sparing surgery on one or two adrenal glands being the treatment of choice that should be carried out at centers specializing in pediatric surgical oncology. Here, we report a rare clinical case of bilateral retroperitoneal PCC/PGL in a patient with von Hippel-Lindau syndrome. The patient's parents gave consent to the use of their child's data, including photographs, for research purposes and in publications.

SARS-CoV-2 induced urinary tract infection in an infant: a rare case

BackgroundThe incidence of SARS-CoV-2 infection in pediatric population is less than 7% that too when associated with a urinary tract infection, the presentation is very rare. There have been numerous case reports in adults and adolescent population but very few in pediatrics and none in our socioeconomic.Case presentationWe present here the case of a 1-year-old boy with SARS-CoV-2 induced urinary tract infection whose urine biochemistry showed severe urinary tract infection but no hematuria. His COVID-PCR was positive. His chest radiograph showed bilateral lung infiltrates with peri-hilar lymphadenopathy. His computerized tomography scan showed infiltrates with lung fibrosis. He was admitted to the isolation ward, successfully managed, and discharged home after 5 days of in-hospital treatment.ConclusionPediatricians and pediatric emergency physicians should be vigilant and well aware of the atypical presentation of SARS-CoV-2 infection in infants and children, as they can present with both gastrointestinal and renal manifestations. And once missed, the patient may end up with devastating complications.

Gualou xiebai decoction ameliorates cardiorenal syndrome type II by regulation of PI3K/AKT/NF-κB signalling pathway

BackgroundCardiorenal syndromes type II (CRS2) is a multi-organ ailment that manifests as a combination of cardiac and renal dysfunction, resulting in chronic kidney disease due to chronic cardiac insufficiency. It affects at least 26 million people worldwide, and its prevalence is increasing. Gualou Xiebai Decoction (GXD), a traditional Chinese medicine (TCM) with a rich history of application in the management of coronary artery disease, has been explored for its potential therapeutic benefits in CRS2. Nevertheless, the mechanism by which GXD alleviates CRS2 remains obscure, necessitating further investigation. PurposeThe aim of this study was to assess the effects of the ethanolic extract of GXD on CRS2 and to elucidate the underlying mechanism in a rat model of myocardial infarction, offering a potential target for clinical treatment for CRS2. Study design and MethodsA rat model of CRS2 was induced by surgical myocardial infarction and treated with GXD for 10 weeks. Cardiac function was assessed using echocardiography, while serum and urine biochemistry were analyzed to evaluate potential cardiac and renal damage. Furthermore, tissue samples were obtained for histological, protein, and genetic investigations. In addition, network pharmacology analysis and molecular docking were utilized to predict the primary active compounds, potential therapeutic targets, and interventional pathways through which GXD could potentially exert its effects on CRS2. Subsequently, these predictions were confirmed in vivo and vitro through various analyses. ResultsThe current investigation employed echocardiography to exhibit the apparent cardiac remodeling following the induction of myocardial infarction. Damage to the heart and kidneys of CRS2 rats was effectively ameliorated by administration of GXD. The outcomes derived from the analyses of HE and Masson staining indicated that the pathological damage to the heart and kidney tissues of rats in the GXD groups was considerably alleviated. Using network pharmacology analysis, AKT1, IL-6, and TNF-α were identified as plausible therapeutic targets for the treatment of CRS with GXD. Subsequent functional and pathway enrichment analysis of the underlying targets disclosed that the PI3K/AKT/NF-κB signaling pathway may be involved in the mechanism of GXD in the treatment of CRS2. Immunohistochemical, western blot, RT-PCR and immunofluorescence staining were employed to demonstrate that GXD can regulate the PI3K/AKT/NF-κB signaling pathway in the CRS2 rat model. Ultimately, administration of the PI3K/AKT agonist 740Y-P counteracted the effect of diosmetin, which was one of the potential active components of GXD analysed by compound-target-disease network, on p-PI3K and p-AKT in vitro. ConclusionsThe findings of this study suggest that GXD improves cardiac and renal function in CRS2 rats and that the underlying mechanism involves inhibition of the PI3K/AKT/NF-κB pathway.

Effects of bisphosphonates and treadmill exercise on bone and kidney in adenine-induced chronic kidney disease rats.

The increasing prevalence of osteoporosis and chronic kidney disease (CKD) due to the aging of society has highlighted the need for development of effective treatments for elderly patients. This study examined whether the combination of treadmill exercise therapy and alendronate (ALN) can improve bone mineral density (BMD) and bone strength without worsening renal function in adenine-induced CKD model rats. 8-week-old male Wistar rats (n = 70) were divided into experimental groups based on the treatment protocol, i.e., non-CKD (control), vehicle only (CKD), ALN only, exercise only, and combined ALN plus exercise. A 0.75% adenine diet was used to induce CKD. Groups were killed at either 20 or 30weeks of age. Comprehensive assessments included serum and urine biochemistry tests, renal histology, bone histomorphometry, BMD measurement, micro-computed tomography examinations, and biomechanical testing. Blood biochemistry tests, urine analyses and histological evaluations of the kidney demonstrated that ALN treatment did not worsen renal function or kidney fibrosis in moderate-stage CKD model rats. Both ALN and treadmill exercise significantly suppressed bone resorption (p < 0.05-p < 0.01). Moreover, ALN monotherapy and combined ALN and treadmill exercise significantly improved BMD of the lumbar spine and femur, bone microstructure, and trabecular bone strength (p < 0.05-p < 0.01). Treadmill exercise was also shown to decrease cortical porosity at the mid-diaphysis of the femur and improve kidney fibrosis. The combination of ALN and treadmill exercise is effective in improving BMD, the microstructure of trabecular and cortical bone, and bone strength, without compromising renal function in adenine-induced CKD model rats.

The effect of mineral water on the course of experimental oxalate nephrolithiasis

Introduction. The number of patients with urolithiasis (UCD) is increasing annually both among the adult population and among children, and therefore it is necessary to develop an integrated approach to the prevention and treatment of this pathology. Most often, with urolithiasis, oxalate-calcium crystalluria is determined, to reduce the level of which, low-mineralized mineral waters with a minimum sodium content are recommended.Aim. To study the effect of mineral water “Serebryanyy klyuch” on the course of experimental calcium oxalate nephrolithiasis.Materials and methods. During the study on laboratory rats, oxalate nephrolithiasis was simulated for 3 weeks by providing a 1% solution of ethylene glycol as a drink, while the rats of the experimental group used mineral water “Serebryanyy klyuch” as a solvent. The results of urine biochemistry (calcium, creatinine, activity of lactate dehydrogenase and γ-glutamyl transferase) and morphological studies (determination of the amount and size of calcium deposits in the kidneys, assessment of the structural and functional state of the nephrothelium) were evaluated.Results. Calcium-oxalate deposits in the control group of rats were detected in 25% of cases, while large-sized stones were observed in the kidney tubules. In the experimental group, the presence of stone deposits was detected in 1 (11.1%) case, with a clear shift towards smaller deposits. Morphological signs indicating the development of dystrophic changes with the phenomena of nephrosclerosis were much less pronounced in the conditions of consumption of mineral water “Serebryanyy klyuch”.Conclusion. Thus, the use of mineral water “Serebryanyy klyuch” in the conditions of a three-week experimental oxalate nephrolithiasis was accompanied by characteristic signs of facilitating the course of the pathology and contributed to a decrease in the proportion of large calculi in the kidneys.

Effects of exercise on urinary biochemical parameters and proteins in a group of well-trained military working dogs

Exercise-induced proteinuria has been widely investigated in humans, also in relation to intensity and duration of activity. Instead, there are only limited publications regarding urinary biochemical parameters and urinary proteins before and after physical activity in dogs. This paper aimed to investigate the effects of exercise on urinary biochemistry and proteins in military dogs. Twenty-four dogs were enrolled in this study. All the dogs were clinically sound, and they were examined before and after activity. Pulse rates (PR) and respiratory rate (RR) were monitored. Urine was sampled before and after a training session of search activity. Standard urinalysis was carried out, urine total proteins and creatinine were measured and the urinary protein:creatinine ratio was calculated; finally, the urinary proteins were separated using sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE). Clinical examination before and after activity did not reveal any pathological finding. After activity, the PR was slightly increased, while the RR was notably increased (p < 0.05). Total proteins, albumin, and their ratio with creatinine were significantly higher after exercise when considering all the dogs included or only the females while, when considering only the males no significant difference was detected. The clinical relevance of this study was related to the possibility of using urine as a non-invasive sample for monitoring health status after training activity and exercise in dogs. An increase in microalbuminuria after search activity, measured using SDS-PAGE could be considered an early biomarker of renal function during training sessions.

Evaluation of analytical performance &amp; quality specification of urine biochemical analytes

Urinary biochemical analytes are very important tools for clinical decision making. Total allowable error (TEa) by integrating internal (IQC) and external (EQC) quality control performances are used to evaluate the performance of urinary biochemical analytes along with quality specifications strategy. : Alternate 6 months Coefficient of Variation (CV%) and External Quality Assurance Scheme (EQAS) bias% data for urinary biochemistry analytes were collected for the year 2022. TEa calculated for each analyte was calculated based on average CV% and bias%. Total TEa calculated values are compared with optimal, minimal and desirable TEa of each analyte. : TEa values of urinary biochemistry analytes were performing good and fulfilled minimal, desirable and optimal quality requirements except urine creatinine which did not fulfill the minimal standards.: TEa is an excellent quality management tool and quantitatively evaluates analytical performance. The accurate results generated are useful for clinicians for decision-making.

#3444 HOW WELL INFORMED ARE PATIENTS ABOUT DIALYSIS INITIATION?

Abstract Background and Aims Studies indicate that 30% of patients on dialysis feel inadequately informed about various dialysis options and also lack involvement in the decision-making process surrounding dialysis initiation. The aim of this study was to 1) describe the provision of information to older patients with chronic kidney disease before KRT and 2) to study the association between the perceived amount of information received before dialysis and patient satisfaction with treatment post dialysis initiation. Method The EQUAL study is a multicenter, prospective cohort study in six European countries (Germany, Italy, Netherlands, Poland, Sweden, and United Kingdom). Inclusion criteria are older adults &amp;gt;65 years with an incident eGFR &amp;lt;20 ml/min/1.73 m2. Patients were followed up every 3-6 months and received routine medical care as provided by the nephrology clinic in each country. Standardized data were collected at each visit, including demographics, lifestyle, comorbidities, uremic signs and symptoms, quality of life, treatment satisfaction according to renal treatment satisfaction questionnaire (RTSQ-11), nutritional status, medication and routine blood and urine biochemistry. We described patient characteristics and perceived information provision at different time points (incident eGFR&amp;lt;20, eGFR&amp;lt;15, eGFR&amp;lt;10 ml/min/1.73 m2). Subsequentially, we compared patient characteristics between those who reported receiving more versus less information at the last eGFR before start of KRT (or end-of follow-up in patients with eGFR &amp;lt;10 ml/min/1.73 m2). We used multivariable logistic regression models to investigate if perceived information provision before start of dialysis was associated with a treatment satisfaction. Results We included 1372 patients at baseline with a median age of 76 (IQR 70–81), 34% (n = 462) women. Over follow-up, 997 of these patients progressed to an eGFR&amp;lt;15, and 573 to an eGFR&amp;lt;10 ml/min/1.73 m2. The proportion of patients who reported having received enough information about the decision on when to start dialysis increased with decreasing eGFR (53.2% at baseline to 61.2% (eGFR&amp;lt;15) and 70.9% (eGFR&amp;lt;10)). Among the 638 patients progressing to KRT or eGFR &amp;lt;10 ml/min/1.73 m2, the mean eGFR was 8.9 ml/min/1.73 m2 (SD 3.4) at their last pre-dialysis visit. Patients who reported that they had received sufficient information regarding dialysis timing were in general younger, where median age was 74 (IQR 69.4-79.3) years for those receiving information and 76 (IQR 70.7-81.4) years for those perceiving not having enough information, but there were otherwise no major differences in patient characteristics. Among these patients, 32% had still not decided on which dialysis modality to start with. There was not any statistically significant difference in RSTQ-11 score associated with type of dialysis modality (hemodialysis versus peritoneal dialysis) post dialysis initiation. Among 302 patients who started dialysis, those reporting to have received more information (highest quartile) before start of dialysis also reported being more satisfied with their treatment post dialysis (OR: 1.22; 95% CI 1.05-1.37). Conclusion Although most patients report having received pre-dialysis information, many patients with low kidney function still perceive not having received enough information to make an informed decision. Patients who are well informed are more satisfied with their treatment.

#5565 USEFULNESS OF URINARY BIOCHEMISTRY IN THE FOLLOW-UP OF PATIENTS WITH CHRONIC KIDNEY DISEASE STAGES 3B-5NOD

Abstract Background and Aims Ion and protein determinations in a simple urine sample are simple and inexpensive laboratory tests that reflect well ion balance and proteinuria. However, they are underused. Evidence of their usefulness in estimating 24-hour urine biochemistry in patients with chronic kidney disease (CKD) would allow widespread use of these tests and would help to optimize therapies. It would also avoid 24-hour urine collections. To evaluate In CKD stages G3b-5noD the accuracy of equations that estimate, through simple urine sampling, creatinine, protein, and ions in 24-hour urines. Method Retrospective observational study in incident adult patients with CKD G3b-5noD from the nephrology outpatient clinic in a Madrid university hospital, with a follow-up of at least two years and with at least one simultaneous determination of biochemistry in a simple urine sample and in 24-hour urine. The 24-hour urine analyses were restricted to those that were estimated to be well collected because urinary creatinine was between 15–25 mg/kg in men and 10–20 mg/kg in women. Correlation, bias (mean differences between estimated and measured analyte), accuracy (percentage of samples estimated at 15–30 or 50% of the measured value - P15, P30, P50) and agreement by the Bland-Altman method were analyzed. CKD progression was defined by the mean annual and percentage decrease in eGFR and the renal event at follow-up as loss of more than 40% of eGFR or entry into renal replacement therapy or conservative-palliative renal treatment. Kawasaki, Tanaka and CKD-epi (Table 1) equations were used. Results The analyzed cohort was made up of 300 patients with a median follow-up of 72 (25) months. Mean eGFR was 32.8 (9.2) ml/min/1.73m2 and mean protein/creatinine ratio was 1,180 (1,740) mg/g. During follow-up 30.7% started renal replacement therapy or conservative and palliative treatment. Twenty-one patients (7%) died. The estimation of 24-hour urine creatinine by CKD-EPI equation showed excellent correlation and accuracy with measured urinary creatinine (r = 0.887; P30: 96.1% in 464 urines). Accuracy was maintained regardless of age and CKD stage. Formulas that, using single urine samples, estimate 24-hour urine elimination of Na and K correlated well with 24-hour urine measurements, but with high dispersion, especially with Na. For Na, the Tanaka and CKD-EPI formulas had the highest performance (r = 0.540; 0.532; P30: 52.6; 54.5%; bias: -14.4; -16.1 mmol, Tanaka and CKD-EPI respectively for 464 urines). These values make them useful for population studies but not for individualized analysis. For K, the Kawasaki and CKD-EPI formulas were the most suitable (r = 0.712; 0.612; P30 = 74.6; 72.4%; bias: 4.2; 5.5 mmol; Kawasaki and CKD-EPI respectively for 464 urines). These results make them useful for both population-based studies and individualized analyses. Patients with Nao &amp;lt; 87 mmol/day (salt-poor diet) estimated by CKD-EPI, Kawasaki or Tanaka and/or Na/K ratio &amp;lt; 2 directly measured had less eGFR loss at follow-up and fewer renal events. Urinary K elimination measured or estimated did not influence renal prognosis. Proteinuria measured in 24-hour urine correlated much better with proteinuria estimated by CKD-EPI in a single urine sample than with the protein/creatinine ratio (r: 0.900 vs. 0.801; mean bias: 92.2 vs. 486 mg; P30: 72.0 vs. 42.7%; CKD-EPI vs. Proto/Cro in 464 24-hour urine samples). Conclusion Urinary biochemistry in a single urine sample in patients with advanced CKD (stages G3b-5noD) is a useful tool for estimating 24-hour urine biochemistry and to identify scenarios of increased progression of renal disease.

Biological variation of biochemical urine and serum analytes in healthy dogs.

Biological variation (BV) of urinary (U) biochemical analytes has not been described in absolute terms, let alone as a ratio of the U-creatinine or fractional excretion in healthy dogs. These analytes are potential diagnostic tools for different types of kidney damage and electrolyte disorders in dogs. We aimed to investigate the BV of specific gravity, osmolality, creatinine, urea, protein, glucose, chloride, sodium, potassium, calcium, and phosphate in urine from healthy pet dogs. Blood and urine samples from 13 dogs were collected once weekly for 8 weeks. Samples were analyzed in duplicate and in randomized order. For each sample, U-analyte and serum concentrations were measured, and U-analyte/U-creatinine and fractional excretion (FE) were calculated. Components of variance, estimated by restricted maximum likelihood, were used to determine within-subject variation (CVI ), between-subject variation (CVG ), and analytical variation (CVA ). Index of individuality (II) and reference change values were calculated. CVI for all urine analytes varied between 12.6% and 35.9%, except for U-sodium, U-sodium/U-Cr, and FE-sodium, which had higher CVI s (59.5%-60.7%). For U-protein, U-sodium, U-potassium, U-sodium/U-creatinine, FE-urea, FE-glucose, FE-sodium, FE-potassium, and FE-phosphate II were low, indicating that population-based RIs were appropriate. The remaining analytes had an intermediate II, suggesting that population-based RIs should be used with caution. This study presents information on the biological variation of urinary and serum biochemical analytes from healthy dogs. These data are important for an appropriate interpretation of laboratory results.

Effects and mechanisms of total flavones of Abelmoschus manihot in attenuating diabetic tubulopathy by targeting endoplasmic reticulum stress-induced cell apoptosis

Renal tubular injury in patients with diabetic kidney disease(DKD) may be accompanied by glomerular and microvascular diseases. It plays a critical role in the progression of renal damage in DKD, and is now known as diabetic tubulopathy(DT). To explore the multi-targeted therapeutic effects and pharmacological mechanisms in vivo of total flavones of Abelmoschus manihot(TFA), an extract from traditional Chinese medicine for treating kidney disease, in attenuating DT, the authors randomly divided all rats into four groups: a normal control group(normal group), a DT model group(model group), a DT model+TFA-treated group(TFA group) and a DT model+rosiglitazone(ROS)-treated group(ROS group). The DT rat model was established based on the DKD rat model by means of integrated measures. After successful modeling, the rats in the four groups were continuously given double-distilled water, TFA suspension, and ROS suspension, respectively by gavage every day. After 6 weeks of treatment, all rats were sacrificed, and the samples of their urine, blood, and kidneys were collected. The effects of TFA and ROS on various indicators related to urine and blood biochemistry, renal tubular injury, renal tubular epithelial cell apoptosis and endoplasmic reticulum stress(ERS), as well as the activation of the protein kinase R-like endoplasmic reticulum kinase(PERK)-eukaryotic translation initiation factor 2α(eIF2α)-activating transcription factor 4(ATF4)-C/EBP homologous protein(CHOP) signaling pathway in the kidney of the DT model rats were investigated. The results indicated that hypertrophy of renal tubular epithelial cells, renal tubular hyperplasia and occlusion, as well as interstitial extracellular matrix and collagen deposition occurred in the DT model rats. Moreover, significant changes were found in the expression degree and the protein expression level of renal tubular injury markers. In addition, there was an abnormal increase in tubular urine proteins. After TFA or ROS treatment, urine protein, the characteristics of renal tubular injury, renal tubular epithelial cell apoptosis and ERS, as well as the activation of the PERK-eIF2α-ATF4-CHOP signaling pathway in the kidney of the DT model rats were improved to varying degrees. Therein, TFA was superior to ROS in affecting the pathological changes in renal tubule/interstitium. In short, with the DT model rats, this study demonstrated that TFA could attenuate DT by multiple targets through inhibiting renal tubular ERS-induced cell apoptosis in vivo, and its effect and mechanism were related to suppressing the activation of the PERK-eIF2α-ATF4-CHOP signaling pathway in the kidney. These findings provided preliminary pharmacological evidence for the application of TFA in the clinical treatment of DT.

Comparative estimation of proteinuria using spot urine albumin creatinine ratio and 24 hour urine protein among diabetics for detecting nephropathy

Purpose: Although proteinuria has been established as an independent risk factor of diabetic nephropathy, the timely and accurate estimation of proteinuria has scope for improvement. Hence, this study intends to compare the accuracy of spot sampled urine albumin creatinine ratio (UACR) to 24 hour urine protein among diabetics in the quantification of proteinuria. Design/Methodology/Approach: This prospective study was conducted amongst 120 patients diagnosed with type 2 diabetes mellitus. Two types of urine samples namely spot samples and 24-hour samples were analysed across an array of clinical variables including urine biochemistry, kidney failure and glomerular filtration rate. UACR in spot samples was correlated with the 24-hour urine protein levels. The sensitivity, accuracy, specificity and predictive values of UACR for proteinuria were determined. A p

Clinical features and risk factors of renal dysfunctions in thalassemic patients.

Chronic anemia, iron overload, and iron chelation therapy are the main contributing factors for renal complications in thalassemia, e.g., nephrolithiasis, glomerular disease, and renal tubular dysfunction. The prevalence and associated factors for developing renal dysfunctions in Thai patients with thalassemia, however, remained limited. This study aimed to determine the prevalence and risk factors of renal dysfunctions in patients with thalassemia. A cross-sectional study was conducted on adult patients with thalassemia disease at Srinagarind Hospital, Khon Kaen University, Thailand. All patients were evaluated for complete blood count, blood chemistry, urinalysis, and urine biochemistry. Renal tubular dysfunction was defined as existing in at least one of the following parameters including; proteinuria, hypercalciuria, hypouricemia with uricosuria, or hypophosphatemia with phosphaturia. Logistic regression analysis was used to identify associated factors for renal dysfunctions. Of 105 patients, renal tubular dysfunction was found in 60 patients (57.1%). In multivariate analysis of the clinical risk factors for renal tubular dysfunction in thalassemia patients, age per 10year increase (adjusted odds ratio [AOR] = 1.4, 95% CI: 1.0-2.0, pvalue 0.01) and Hb E/beta-thalassemia (AOR = 3.6, 95% CI: 1.3-10.3, pvalue 0.01) were statistically proven to be associated with renal tubular dysfunction. Hyperuricosuria was a significantly associated factor for microhematuria. (AOR = 2.9, 95% CI: 1.1-8.0, pvalue 0.03). Renal dysfunctions are prevalent in thalassemia patients, with older age and Hb E/beta-thalassemia genotype as significant risk factors for renal tubular dysfunction. Hyperuricosuria is a risk factor for microhematuria. Renal dysfunctions should be recognized and monitored in aging patients with Hb E/beta-thalassemia.

Normal values for pediatric urinary biochemistry in early infancy.

Urinary levels of N-acetyl-β-D-glucosaminidase (NAG), α1-microglobulin (α1-MG), and β2-microglobulin (β2-MG) are measured as markers of renal tubular damage. We previously determined normal values for these urine biochemical examinations in healthy children over 3years old. However, the values are not applicable to children younger than 2years old, and children less than 1year old, in particular, seem to show very high levels for all these markers. Hence, as normal values for children below 2years old remain unclear, we determined the normal values for urinary biochemical markers in this age group. Fresh urine samples were obtained from 293 healthy children (from newborns to 2-year-old children). All the samples were subjected to normal urinalysis. NAG, α1-MG, β2-MG, and creatinine (Cr) levels in extracted samples were measured immediately in the central laboratory at Kanazawa Medical Center. The normal values for each biomarker in children below 2years of age were determined. Additionally, urinary α1-MG levels were observed to decrease most rapidly with age, almost reaching the level at ≥ 3years by 6months after birth. Renal tubular function can be evaluated in children < 3years old using the normal values. Further, the most stable and useful urinary marker from early infancy seems to be urinary α1-MG.

Implementing Modern Technology for Vital Sign Monitoring to Enhance Athletic Training and Sports Performance

(1) Background: Applying medical procedures to keep track of athletes’ metabolic health is a well-known behavior for increasing sports performance. This study’s primary goal was to examine whether implementing a health-screening routine using invasive and non-invasive methods in a mountain running training program can increase sports performance by obtaining a better rank in specific races. (2) Methods: Seven male mountain runners with good results at the international level participated in the research, which featured an initial and a final test. The initial test took place in March at the beginning of the competitive season, and the final test took place in September at the end of the annual training plan in 2021. The entire experiment used invasive tests, such as taking blood samples to perform blood biochemistry analysis, and non-invasive tests, such as mountain running races, determinations of VO2max, EKGs, urine biochemistry and NeuroTracker tests. (3) Results: Comparing the initial test with the final one from a statistical point of view, a significant improvement was found in the final test regarding the obtained results in most tests and, most importantly, the occupied position in the final general rank (p = 0.005). The main variations after effort were decreased Ca++ and increased Cl−, a low TGL level if the diet was inadequate, increased LDH and CPK strongly correlated with the skeletal muscle response, and only physiological changes were found in the EKG and urine summary. (4) Conclusions: The invasive and non-invasive tests applied in this study provided crucial information on the athletes’ health statuses, enabling the coach to adjust the training program in light of the findings in order to improve sports performance and avoid overexertion.

Reducing Dietary Acid With Fruit and Vegetables Versus Oral Alkali in People With Chronic Kidney Disease (ReDACKD): A Clinical Research Protocol.

Individuals with chronic kidney disease (CKD) can develop metabolic acidosis which, in turn, is associated with faster progression of CKD and an increased need for dialysis. Oral sodium bicarbonate (the current standard of care therapy for metabolic acidosis) is poorly tolerated leading to low adherence. Base-producing or alkalizing Fruit and vegetables have potential as an alternative treatment for metabolic acidosis as they have been shown to reduce acid load arising from the diet. This trial will evaluate the feasibility of providing base-producing fruit and vegetables as a dietary treatment for metabolic acidosis, compared with oral sodium bicarbonate. A 2-arm, open-label, dual-center, randomized controlled feasibility trial. Two Canadian sites: a nephrology clinic in Winnipeg, Manitoba, and a nephrology clinic in Halifax, Nova Scotia. Adult participants with G3-G5 CKD and metabolic acidosis. Participants will undergo baseline measurements and attend 5 study visits over 12 months at which they will have a measurement of feasibility criteria as well as blood pressure, blood and urine biochemistry, 5-repetition chair stand test (STS5), and questionnaires to assess quality of life and symptoms. Furthermore, participants fill out Automated Self-Administered 24-hour recalls (ASA-24) in the beginning, middle, and end of trial. A total of 40 eligible participants will be randomized 1:1 to either base-producing fruit and vegetables (experimental) group or sodium bicarbonate (control) group, beginning from a daily dose of 1500 mg. Using self-administered dietary assessments, lack of supervision over the consumption of study treatments and the possible disappointment of the control group for not receiving fruit and vegetables would be considered as limitations for this study. However, we are planning to undertake proper practices to overcome the possible limitations. These practices are discussed throughout the article in detail. This study will generate data on base-producing fruit and vegetables consumption as a dietary treatment for metabolic acidosis in CKD. The data will be used to design a future multi-center trial looking at slowing CKD progression in people with metabolic acidosis. This study is registered on clinicaltrials.gov with the identifier NCT05113641.

Post-pituitary surgery copeptin analysis as a ‘rule-out’ test for post-operative diabetes insipidus

BackgroundDiabetes insipidus (DI) is a recognised complication of pituitary surgery, with diagnosis requiring clinical observation aided by plasma and urine electrolytes and osmolalities. Copeptin is a stable surrogate marker of AVP release and has potential to facilitate prompt diagnosis of post-operative DI. This assay has been shown to accurately predict which patients are likely to develop DI following pituitary surgery.ObjectiveTo determine whether copeptin analysis can be used to predict which patients are at risk of developing DI following trans-sphenoidal surgery (TSS).MethodsSeventy-eight patients undergoing TSS had samples taken for copeptin pre-operatively and at day 1 post-TSS. The majority of patients also had samples from day 2, day 8, and week 6 post-TSS. Results from patients who developed post-operative DI (based on clinical assessment, urine and plasma biochemistry and the need for treatment with DDAVP) were compared to those who did not. Patients with any evidence of pre-operative DI were excluded.ResultsOf 78 patients assessed, 11 were clinically determined to have developed DI. Differences were observed between patients with DI and those without in post-operative samples. Of note, there was a significant difference in plasma copeptin at day 1 post-operation (p = 0.010 on Kruskal–Wallis test), with copeptin levels greater than 3.4 pmol/l helping to rule out DI (91% sensitivity, 55% specificity at this cut off).ConclusionIn the post-TSS setting, copeptin is a useful rule-out test in patients with values above a defined threshold, which may facilitate earlier decision making and shorter hospital stays.