Association Of Liver Fatty Acid Binding Protein With Acute Kidney Injury In Paediatric Patients After Cardiac Surgery.

Background: Acute kidney injury (AKI) is a common complication after cardiac surgery. Like Creatinine level, the role of L-FABP in renal injury and its recovery had been shown by studies, so by using/measuring urinary Liver fatty acid-binding protein (uL-FABP) levels it can be a valuable biomarker for monitoring and diagnosis of various renal diseases. The study aimed to determine L-FABP as a biomarker for early diagnosis of AKI acute kidney injury in paediatric patients after cardiac surgery so that early treatment interventions can prevent AKI morbidity. Methods: This descriptive study was conducted in the Pathology laboratory of Sheikh Zayed Hospital, Lahore from 2015 to 2016. Selected through convenience sampling, patients' blood and urine were analysed for desired markers. Results: Out of 88, 10 (11.4%) patients developed AKI after cardiac surgery. In patients with AKI, serum creatinine levels started to rise at 24-48 h after surgery whereas uL-FABP was to be high at 4h. The optimal cut-off value of uLFABP was found 269 ng/l, with this cut-off value sensitivity of marker at four hours to recognize AKI was found to be 80% and specificity was 83.3%, the positive and negative predictive values were 38.1% and 97.0% respectively with an accuracy level 83.0%. Conclusion: It may be concluded from this study that uL-FABP may be considered as an early predictor of the development of AKI in paediatric patients undergoing cardiac surgery.

Prediction Of Renal Flare In Adult Patients With Lupus Induced Nephritis.

BACKGROUND: The most common complication of SLE is lupus nephritis (LN) causing high morbidity and mortality. The routine biomarkers used for the diagnosis of LN do not have the ability to predict the worsening in renal disease activity. Thus, there is need of a new biomarker leading to detection of flare in LN. The objective of this study was to assess the role of urinary neutrophil gelatinase associated lipocalin (uNGAL) as a predictor of renal flare in patients with lupus nephritis. METHODS: Including a total of 84 subjects, 42 cases were lupus patients without renal involvement and 42 cases were lupus patients with nephritis (24 active nephritis and 18 inactive nephritis). The diagnosis of lupus nephritis was established on the basis of renal biopsy. uNGAL was estimated in both groups. RESULTS: This study revealed that the nephritis group had increased levels of uNGAL as compared to systemic erythematosus patients without having lupus nephritis (p-value <0.05). Patients with active nephritis had increased uNGAL levels as compared to patients with inactive nephritis. CONCLUSIONS: From the findings in our study, it can be stated that uNGAL can prove to be a noninvasive, reliable and sensitive biomarker to predict flare in cases of lupus nephritis.

Insulin deficiency among newly diagnosed type 2 diabetics.

BACKGROUND: Any patient above the age of 40 years, coming with the symptoms of diabetes is labelled as type 2 diabetic. If insulin levels are included in the protocol for initial investigations of diabetic patients, they can be differentiated as having insulin deficiency or insulin resistance. They can thus be treated accordingly. This study was conducted to see the prevalence of insulin resistance and insulin deficiency in newly diagnosed type 2 diabetics. METHODS: This study was conducted on 75 newly diagnosed diabetic subjects, and 75 control subjects for comparison. Fasting serum insulin was assayed by ELISA and HOMA-IR index was calculated. The diabetic subjects with fasting hyperglycaemia and serum insulin level below 20 microIU/ml and HOMA-IR index below 3.5 were grouped as insulin deficient (Group-A), and the diabetic subjects with fasting insulin level above 20 microIU/ml and HOMA-IR index above 3.5 were grouped as insulin resistant (Group-B). RESULTS: Twenty-eight percent subjects were found to have insulin level below 20 microIU/ml while 72% subjects had insulin resistance. When gender was taken into consideration, it was seen that 18.7% males had fasting insulin level of 6.98 +/- 0.737 microIU/ml and 9.3% females had fasting insulin level of 5.21 +/- 0.885 microIU/ml while 32% males and 40% females had insulin resistance. The mean age of male subjects with insulin resistance was significantly higher compared to the male subjects with insulin deficiency. Mean weight and body mass index of the male and female subjects having insulin resistance was significantly higher than their respective control groups and also higher than the subjects with insulin deficiency. Pearson coefficient of correlation was calculated for fasting serum insulin level with age and BMI. A significant positive correlation was observed between fasting serum insulin and age of females with insulin resistance. CONCLUSION: A considerable number of persons who develop diabetes after 40 years of age but are not insulin resistant. Twenty-eight percent subjects have relative insulin deficiency, and 72% subjects have insulin resistance.

Serum bilirubin and antioxidant levels in first degree relatives of patients with ischemic heart disease and normal subjects.

BACKGROUND: Coronary diseases appear to result from an overbalance between radical-generating, compared with radical-scavenging systems, a condition called as oxidative stress. Total antioxidant status (TAS) in human plasma reflects the balance between oxidants and antioxidants in each system. Bilirubin has been considered an antioxidant, with capacity to remove reactive species of oxygen. Present study tried to measure the total antioxidant status of first degree relatives of patients with IHD. Study also tried to evaluate the prognostic role of serum bilirubin in disease prevention or progression. METHODS: Seventy five apparently healthy subjects in age group 20-50 years, comprising equal number of males and females, who were first degree relatives of ischemic heart disease patients, were included in the study. Family members were divided on the bases of their numbers, i.e., one family member (Group-A), 2 family members (Group-B) and more than 3 family members (Group-C). Study was cross sectional and carried out in a period of 6 months (Jun 2008-Jan 2009). Subjects with letter of consent were taken from general population. Seventy five healthy age matched people with no history of ischemic heart disease in family were taken as control. An overnight fasting blood sample was taken. Total antioxidant status was determined using a commercially available kit. Serum bilirubin was estimated by auto analyzer. RESULTS: Family history of ischemic heart disease with serum bilirubin showed a significant negative correlation (p<0.05). But the values of TAS failed to show any significant correlation with the family history. It was observed that the value of serum bilirubin was decreased significantly (p<0.05) with an increased number of family members. Total antioxidant status failed to show any significant difference among all the three groups. CONCLUSION: Our data demonstrated that reduced serum levels of bilirubin were seen in people with a higher prevalence of coronary artery disease in the family. The levels of serum bilirubin showed a downward trend with an increase in number of family members affected with ischemic heart disease. Present study failed to show a definite association of total antioxidant status with family history of ischemic heart disease. Additional studies are still necessary on large number of first degree relatives to confirm and demonstrate the association of these findings with clinical outcomes.