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Background: Leptospirosis is a widespread re-emerging zoonotic disease, especially in developing countries. According to World Health Organization, despite being severe, the disease is neglected in most endemic countries because of a lack of information and awareness about the extent of the problem. Objective: The objective was to study the seroprevalence and epidemiology of leptospirosis with its biochemical correlation in the general population in Pune, Maharashtra. Materials and Methods: It is a retrospective observational laboratory-based study over 1 year from January to December 2020 in a tertiary care hospital in western India. A total of 561 blood specimens received during 1 year for the diagnosis of fever were processed for Leptospira IgM antibodies using enzyme-linked immunosorbent assay (ELISA). Results: A total of 111 of 561 blood specimens that were received during the study period tested positive for IgM antibody against Leptospira. The seroprevalence of Leptospira spp. was found to be 19.78%. In seropositive patients, the age ranged from 4 to 77 years. The highest seropositivity was observed in the age group of 21–30 years (42%). There were 34% (n = 38) males and 66% (n = 73) females, among those who tested positive. Seroprevalence in Pune was highest in the months of June–August. Renal function tests were deranged in 44 (39.63%) patients (serum creatinine > 1.5 mL). Hyponatremia and hypokalemia were observed in 37.84% and 21.62% of patients, respectively. In liver function tests, serum glutamic oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT) both were deranged (SGOT > 40 U/L; SGPT > 56 U/L) in 36 (32.43%) patients, whereas SGOT alone was deranged in additional 18 patients (48.64%). Serum bilirubin was deranged in 65.45%. Coinfection was observed with chikungunya, dengue, and malaria in 7.2%, 6.3%, and 0.90% of patients, respectively. Conclusion: Because morbidity is high in this infection, early diagnosis of leptospirosis is essential because antibiotic therapy provides the greatest benefit when initiated early in the course of illness.
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Gentamicin induced acute nephrotoxicity (GIAN) is considered as one of the important causes of acute renal failure. In recent years' great effort has been focused on the introduction of herbal medicine as a novel therapeutic agent for prevention of GIAN. Hence, the current study was designed to investigate the effect of green coffee bean extract (GCBE) on GIAN in rats. Results of the present study showed that rat groups that received oral GCBE for 7 days after induction of GIAN(by a daily intraperitoneal injection of gentamicin for 7days), reported a significant improvement in renal functions tests when compared to the GIAN model groups. Moreover, there was significant amelioration in renal oxidative stress markers (renal malondialdehyde, renal superoxide dismutase) and renal histopathological changes in the GCBE-treated groups when compared to GIAN model group. These results indicate that GCBE has a potential role in ameliorating renal damage involved in GIAN.
La nefrotoxicidad aguda inducida por gentamicina (GIAN) se considera una de las causas importantes de insuficiencia renal aguda. En los últimos años, el gran esfuerzo se ha centrado en la introducción de la medicina herbal como un nuevo agente terapéutico para la prevención de GIAN. Por lo tanto, el estudio actual fue diseñado para investigar el efecto del extracto de grano de café verde (GCBE) sobre la GIAN en ratas. Los resultados del presente estudio mostraron que los grupos de ratas que recibieron GCBE oral durante 7 días después de la inducción de GIAN (mediante una inyección intraperitoneal diaria de gentamicina durante 7 días), informaron una mejora significativa en las pruebas de función renal en comparación con los grupos del modelo GIAN. Además, hubo una mejora significativa en los marcadores de estrés oxidativo renal (malondialdehído renal, superóxido dismutasa renal) y cambios histopatológicos renales en los grupos tratados con GCBE en comparación con el grupo del modelo GIAN. Estos resultados indican que GCBE tiene un papel potencial en la mejora del daño renal involucrado en GIAN.
Subject(s)
Animals , Male , Rats , Plant Extracts/administration & dosage , Gentamicins/toxicity , Coffea/chemistry , Acute Kidney Injury/chemically induced , Acute Kidney Injury/prevention & control , Antioxidants/administration & dosage , Superoxide Dismutase/analysis , Plant Extracts/pharmacology , Rats, Wistar , Coffee , Oxidative Stress/drug effects , Kidney/drug effects , Kidney/pathology , Kidney Function Tests , Malondialdehyde/analysis , Antioxidants/pharmacologyABSTRACT
Background: This study aims to evaluate the level of podocalyxin (PCX) in preeclampsia with severe features patients and correlate it with the results of laboratory tests.Methods: The current study was a cross-sectional study conducted in Assiut Women Health Hospital between April and October 2018. The study included 60 patients divided into two groups; Group (A): 30 patients diagnosed to have preeclampsia with severe features and Group (B): 30 patients as normal control group. Complete laboratory investigations with measurements of the PCX level was performed for all study participants.Results: No statistically significant difference between the study group and control group according to blood urea (p= 0.339) and serum creatinine (p= 0.801).There was statistically significant difference between the study group and control group according to PCX level (p= 0.001); the mean PCX was 3340.0 ± 2394.6 in the study group versus 1083.5±1400.2 in the control group. Univariate analysis revealed podocalyxin was not correlated with clinical data or laboratory investigations.Conclusions: Podocalyxin levels were significantly elevated in preeclampsia.
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Introdução: a Síndrome Hemolítico Urêmica é uma doença rara e grave que se define pela anemia hemolítica microangiopática não imune, trombocitopenia e insuficiência renal aguda. Objetivo: identificar informações disponíveis na literatura acerca do uso do eculizumab no tratamento da síndrome hemolítico urêmica atípica com comprometimento da função renal associado. Material e métodos: trata-se de uma revisão integrativa realizada nas seguintes bases de dados: Literatura Latino-Americana e do Caribe em Ciências da Saúde e Medical Literature Analysis and Retrieval System Online. O estudo foi norteado pela seguinte questão: O que há na literatura acerca do uso do eculizumab no tratamento da SHUa com comprometimento da função renal? Para busca de artigos foram utilizados três descritores em português, inglês e espanhol. O recorte temporal foi de 2007 à 2017. Resultados:Inicialmente foram localizados dez artigos e após a aplicação dos critérios de inclusão e exclusão foram selecionados sete deles. Todos os artigos relatam melhora da função renal logo no início da terapia e não há consenso quanto a indicação de descontinuação do uso do eculizumab nesses pacientes, mesmo nos casos onde houve completa remissão da patologia. Conclusão: Ainda são poucos os estudos sobre o uso do eculizumab. Estudos dessa natureza tem relevante contribuição para o avanço da terapia em casos raros como a SHUa, tendo em vista que o uso do anticorpo pode aumentar a sobrevida e melhorar a qualidade de vida de pessoas acometidas com a doença.
Introduction: Hemolytic Uremic Syndrome is a rare and serious disease that is defined by non-immune microangiopathic hemolytic anemia, thrombocytopenia and acute renal failure. Objective: To identify information available in the literature about the use of eculizumab in the treatment of atypical hemolytic uremic syndrome with impaired renal function. Material and methods: This is an integrative review carried out in the following databases: Latin American and Caribbean Literature in Health Sciences and Medical Literature Analysis and Retrieval System Online. The study was guided by the following question: What is there in the literature about the use of eculizumab in the treatment of atypical HUS with impaired renal function? Three descriptors were used to search for articles in Portuguese, English and Spanish. The time frame was from 2007 to 2017. Results: Ten articles were initially located, and seven of them were selected after the inclusion and exclusion criteria were applied. Ten articles were initially located, and seven of them were selected after the inclusion and exclusion criteria were applied. All articles report an improvement in renal function early in therapy and there isn't consensus regarding the indication of discontinuation of eculizumab in these patients, even in cases where there was complete remission of the condition. Conclusion: There are still few studies on the use of eculizumab. Studies of this nature have a relevant contribution to the advancement of therapy in rare cases, such as SHUa, since the use of antibody may increase survival and improve the quality of life of people affected by the disease.
Subject(s)
Drug Therapy/methods , Renal Insufficiency/drug therapy , Hemolytic-Uremic Syndrome/drug therapyABSTRACT
Background: Thyroid hormones can cause significant changes in renal function such as decrease in sodium re-absorption in the proximal tubules, impairment in the concentrating and diluting capacities of the distal tubules, a decrease in the urinary urate excretion and a decrease in the renal blood flow and glomerular filtration rate (GFR). This study was therefore planned to analyse the changes in biochemical markers of renal function in patients with subclinical and overt hypothyroidism and to correlate these values with the thyroid profile of the patients with an aim to determine whether thyroid dysfunction has deleterious effects on renal function.Methods: Study was conducted on 200 patients, in the age group of 20-70 years, in the Department of Medicine, in collaboration with Department of Biochemistry, GMC Jammu over a period of 6 months. After centrifugation, the serum was divided into 2 aliquots: one for renal function tests and the other for thyroid function tests.Results: Age wise, mean was found to be 33.2±9.3 years for euthyroid group and 42.8±8.7 years for hypothyroid group. Patients with both subclinical hypothyroidism and overt hypothyroidism showed statistically significant rise in TSH levels as compared to controls.Conclusions: It was seen that primary hypothyroidism is associated with a reversible elevation of serum creatinine in adults as well as children. It is believed that renal impairment with hypothyroidism is due to reduced cardiac output and increased systemic and renal vasoconstriction leading to reduced renal blood and plasma flow and decreased GFR.
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Background: Chronic kidney disease is distinguished by progressive loss of kidney function over a period of years in the end leading to irreversible kidney failure. CKD is a significant prognosticator of cardiovascular disease. Atherosclerosis is common in patients with risk factors associated with chronic kidney disease.Methods: It was a cross sectional study on CKD patients in a tertiary care hospital. About 90 CKD stage 3-5 patients aged above 18 years were enrolled in the study. Serum lipid profile, RFT, serum calcium, phosphorous, and BP were estimated among all the patient. Patient risk factors were noted and CIMT levels were compared accordingly.Results: Out of 90 patients, males were predominant. There was a significant positive correlation between stage 5 and CIMT (P value <0.001). Mean CIMT was higher in patients with type 2 Diabetes. Patients with higher phosphorous the mean CIMT was significantly higher.Conclusions: The CIMT is early marker for atherosclerosis. Author observed it was significantly higher in patients with stage 3 and 5 CKD. CIMT is a non- invasive marker which should be done in all patients with CKD which is cost effective.
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Las infecciones del tracto urinario son causa frecuente de morbilidad en la edad pediátrica y un porcentaje importante de ellas se asocian con malformaciones de las vías urinarias, por lo que su temprana detección y manejo adecuado podría incidir positivamente sobre la prevención de cicatrices renales, hipertensión arterial y enfermedad renal crónica. La importancia de los métodos de imágenes radica en la posibilidad de identificar precozmente aquellos niños con factores de riesgo de desarrollar cicatrices renales, permitiendo prevenir la progresión del daño preexistente. El protocolo inicial de estudios debería incluir ultrasonido renovesical, uretrocistografía miccional y gammagrama renal con DMSA. En esta revisión se comentan adicionalmente, las pruebas funcionales necesarias para determinar el grado de afectación glomerular y tubular como consecuencia de las infecciones urinarias
Urinary tract infections are frequent causes of morbidity in children and a significant percentage of them are associated with malformations of the urinary tract. Their early detection and proper management could have a positive impact on the prevention of scarring, hypertension and chronic renal disease. The importance of imaging methods is the possibility to identify those children with risk factors for the development of renal scarring, which would allow prevention of the progression of renal damage. The initial study protocol should include renovesical ultrasound, cystography and DMSA renal scintigraphy. This review also discusses the necessary functional test to assess the degree of glomerular and tubular involvement as consequence of urinary tract infections
Subject(s)
Humans , Male , Female , Radionuclide Imaging , Diagnostic Imaging , Urinary Tract , Magnetic Resonance ImagingABSTRACT
Objetivo: Verificar a validade clínica das equações de Cockroft-Gault e MDRD para a estimativa do clearance de creatinina em transplantados renais e avaliar a influência de diferentes níveis de clearance no desempenho dessas equações. Métodos: O grupo estudado compôs-se de 140 pacientes transplantados renais em acompanhamento ambulatorial, sendo 81 homens (58%) e 59 mulheres (42%), com idade média de 37,5 anos. Foi calculada a estimativa da TFG pelas equações e comparada ao clearence de creatinina medido pela urina de 24h. Para análise estatística, foram utilizadas as medidas de acurácia, bias e precisão. A acurácia recomendada pelas diretrizes do K/DOQI (2002) foi considerada como referência para a validação clínica das equações. Resultados: Nenhuma equação atingiu acurácia mínima para sua validação quando analisadas no conjunto dos pacientes, sendo a melhor acurácia (73,5%) e o melhor bias (-0,4) alcançados pela equação de Cockcroft-Gault corrigida. Nos pacientes com Clearance de creatinina menor que 60 mL/min/1,73m², novamente nenhuma equação alcançou o desempenho mínimo, sendo a melhor acurácia (68,6%) e o melhor bias (0,8) observados na equação MDRD com cinco variáveis. Nos pacientes com clearance de creatinina maior ou igual a 60mL/min/1,73m², a equação de Cockroft-Gault corrigida foi a única a ultrapassar a referência mínima necessária para sua validação, alcançando a melhor acurácia (87,6%) e o melhor bias (-9,4). Conclusões: Em geral, nenhuma das equações se mostrou clinicamente satisfatória nos transplantados renais. Apenas a equação de Cockcroft-Gault corrgida pela superfície corporal se mostrou aceitável para o grupo com melhor função renal.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Creatinine/analysis , Glomerular Filtration Rate/physiology , Kidney Function Tests , Kidney Transplantation/methodsABSTRACT
To compare the effects of open surgery (OS) and endovascular graft exclusion (EVGE) for abdominal aortic aneurysms on the liver and renal functions, the serum total protein, albumin, globulin and the ratio of A/G of 57 patients with alodominal aortis aneurysm were analyzed before and after the two operations.The results showed that the serum total protein,albumin,globalin and the ratio of A/G were signifcantly decreased in the open surgery group, while remarkabe decrease was found in globulin but no significant change in the ratio of A/G in the EVGE group.Creatinine and urea introgen were significantly decreased in the open surgery graup and remained normal in the EVGE group.It is suggested that the effect of EVGE on the liver and renal function is much less than traditional(open) surgery.
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In the study 74% of urine specimens with pyuria grew signfificant colony counts. In specimens with "normal" numbers of white blood cells in the positive urine cultures were obtained in 20%. The latter observation has been occasionally reported in the medical literature as instances of bacteriuria without pyuria. Further analysis of cases with "normal" leucocyturia with the use of the Sternheimer-Malbin stain revealed that positive urine cultures were obtained in those with pale blue type of white blood cells. The importance of this observation in the diagnosis of asymptomatic urinary tract infection was stressedTwo important parameters of renal function in correlation with pyuria were also assessed in this study: glomerular filtration rate by B.U.N., serum creatinine and endogenous creatinine clearance and concentrating ability by Fishberg concentration test. The limitation of B.U.N. and serum creatinine in estimating G.F.R. was pointed out since the values of these end products of protein metabolism do not go up unless G.F.R. is reduced by over 50%. The presence of normal creatinine clearance and Fishberg concentration test in patients with pyuria and bacteriuria are strong evidences favoring the confinement of the urinary infection to the lower tract. Impaired creatinine clearance and concentration tests are observed in patients with pyelonepthritis and other underlying renal diseases with or without superimposed infection.(Summary and Conclusions)
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Objective To evaluate the effects of dopamine (DA) alone or DA plus norepinephrine (NE) on hemodynamics, tissue oxygenation, acid-base balance and renal function during orthotopic liver transplantation (OLT).Methods Thirty ASA IE or IV patients undergoing OLT were randomly divided into 2 groups of 15 patients each. In group A DA was continuously infused during operation. The initial infusion rate was 1-3 ?g?kg-1 ?min-1 . The rate was then adjusted to MAP between 60-80 mmHg. While in group B DA and NE were continuously infused. The initial infusion rate of DA was 1-3 (?g?kg-1?min-1 and that of NE 0.03 ?g?kg-1?min-1 . Both rates were adjusted to MAP between 60-80 mm Hg but the maximal DA infusion rate was 5 ?g?kg-1?min-1 . Anesthesia was induced with midazolam, propofol, fentanyl and vecuronium and maintained with isoflurane inhalation, continuous propofol infusion and intermittent i.v. boluses of fentanyl, midazolam and pipecuronium. Radial artery was cannulated and S-G catheter was placed via right internal jugular vein. Hemodynamic variables such as MAP, CVP, PAP, PCWP, SVRI, PVRI, blood gases, mixed venous blood O2 saturation (SvO2), blood lactate, Cr and BUN were measured and O2 delivery (DO2 ) and O2 consumption (VO2 ) were calculated and recorded after induction and before surgery (T1 baseline), 60 min after operation was started (T2), at 60 min anhepatic phase (T3) and 60 min neohepatic phase (T4 ) and at the end of operation ( T5). Results There were no significant differences between the two groups with respect to age, sex, body weight, duration of operation and types of surgery. MAP and HR were quite stable in both groups. CVP, MPAP, PCWP, cardiac output (CO) and CI were significantly decreased while SVR and SVRI were increased during anhepatic phase (T3 ) in both groups ( P