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1.
J Korean Med Sci ; 35(13): e95, 2020 Apr 06.
Artículo en Inglés | MEDLINE | ID: mdl-32242346

RESUMEN

BACKGROUND: The 24-hour uric acid excretion measurement is important in assessing disease status and helping to select the appropriate uric acid-lowering agent for patients with gout, however, it is inconvenient. The authors investigated the efficacy of the random urine uric acid-to-creatinine (UA/CR) ratio to screen the patients who under-secreted 24-hour urine uric acid. METHODS: This was a retrospective cross-sectional study. Ninety patients with gout, without undergoing uric acid-lowering treatment were enrolled. Twenty-four-hour urine and random urine samples were obtained on the same day. Six hundred mg of uric acid in the 24-hour urine sample was used as a standard for distinguishing between over and under-excretion groups. RESULTS: The random urinary UA/CR ratio showed positive correlation with 24-hour urine uric acid excretion (γ = 0.398, P < 0.001). All the patients with the random UA/CR less than 0.2 excreted less than 600 mg uric acid in 24-hour urine collection. When the random urine UA/CR ratio < 0.2 was regarded as a positive result, the positive predictive value, negative predictive value, sensitivity, and specificity in the uric acid under-excretion were 100% (8 of 8), 64.6% (53 of 82), 21.6% (8 of 37), and 100% (53 of 53), respectively. CONCLUSION: There is a moderate positive correlation between the random urinary UA/CR ratio and 24-hour urine uric acid excretion, so that UA/CR ratio may not be a good predictor of 24-hour urine uric acid excretion. However, the random urine UA/CR ratio 0.2 can be a useful predictor to screen the gouty patients who need to be treated with uricosuric drugs.


Asunto(s)
Creatinina , Gota , Ácido Úrico , Uricosúricos , Adulto , Anciano , Creatinina/orina , Estudios Transversales , Femenino , Gota/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sensibilidad y Especificidad , Ácido Úrico/orina , Uricosúricos/uso terapéutico
2.
J Agric Food Chem ; 68(9): 2765-2772, 2020 Mar 04.
Artículo en Inglés | MEDLINE | ID: mdl-32045244

RESUMEN

Fatty acid esters of 3-monochloropropane 1,2-diol (3-MCPD esters) are processing-induced food toxicants, with the kidney as their major target organ. For the first time, this study treated Sprague Dawley (SD) rats with 3-MCPD 1-monooleate at 10 and 100 mg/kg BW/day and 1-monostearate at 15 and 150 mg/kg BW/day for 90 days and examined for their potential semi-long-term nephrotoxicity and the associated molecular mechanisms. No bodyweight difference was observed between groups during the study. Both 3-MCPD 1-monooleate and 1-monostearate resulted in a dose-dependent increase of serum urea creatinine, uric acid and urea nitrogen levels, and histological renal impairment. The proteomic analysis of the kidney samples showed that the 3-MCPD esters deregulated proteins involved in the pathways for ion transportation, apoptosis, the metabolism of xenobiotics, and enzymes related to endogenous biological metabolisms of carbohydrates, amino acids, nitrogen, lipids, fatty acids, and the tricarboxylic acid (TCA) cycle, providing partial explanation for the nephrotoxicity of 3-MCPD esters.


Asunto(s)
Enfermedades Renales/metabolismo , Riñón/efectos de los fármacos , Estearatos/toxicidad , alfa-Clorhidrina/toxicidad , Animales , Creatinina/orina , Ésteres/metabolismo , Ésteres/toxicidad , Humanos , Riñón/metabolismo , Enfermedades Renales/etiología , Enfermedades Renales/genética , Enfermedades Renales/orina , Masculino , Proteómica , Ratas , Ratas Sprague-Dawley , Estearatos/química , Estearatos/metabolismo , Ácido Úrico/orina , alfa-Clorhidrina/metabolismo
3.
Medicine (Baltimore) ; 99(8): e19278, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32080140

RESUMEN

To investigate whether the control of morning blood pressure (MBP) reflects the control of blood pressure (BP) in other periods (daytime, nighttime and 24-hour) and to assess whether morning BP displays a closer association with subclinical target organ damage (TOD) than the BP measured in other periods.One thousand one hundred forty patients with primary hypertension who completed subclinical TOD detection and 24-hour ambulatory BP monitoring were included in the analysis. Pearson correlation analysis, Kappa consistency test, multiple linear regression analysis, and area under the receiver operating curve were used to analyze the data.Morning BP and daytime BP displayed good agreement, but not 24-hour BP , particularly the nighttime BP (all P < .001). Approximately 39.4% of the hypertensive patients receiving drug treatment who had achieved control of the morning BP presented masked nocturnal hypertension, which was associated with worse subclinical TOD. The BP measured in all periods correlated with subclinical TOD, and the correlation was more obvious in the treatment subgroup. However, morning BP did not independently affect subclinical TOD. Morning BP appeared to exhibit less discriminatory power than nighttime BP, particularly with respect to the urinary albumin to creatinine ratio.The use of morning BP for monitoring during hypertension management may not be enough. Masked uncontrolled nocturnal hypertension should be screened when morning BP is controlled.


Asunto(s)
Monitoreo Ambulatorio de la Presión Arterial , Ritmo Circadiano/fisiología , Hipertensión/fisiopatología , Hipertensión Enmascarada/diagnóstico , Albuminuria , Antihipertensivos/uso terapéutico , Grosor Intima-Media Carotídeo , Creatinina/orina , Estudios Transversales , Ecocardiografía , Femenino , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Hipertensión/tratamiento farmacológico , Masculino , Hipertensión Enmascarada/fisiopatología , Persona de Mediana Edad
4.
Ecotoxicol Environ Saf ; 191: 110237, 2020 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-31986454

RESUMEN

Extensive antibiotic exposure in the general population has been documented by bio-monitoring, but data regarding antibiotic burden across three generations in families living in the same household are lacking. We investigated the distribution of antibiotics and the potential health risk among the three generations by selecting 691 participants from 256 households in Fuyang city, China. A total of 45 antibiotics and two metabolites were screened in urine samples through liquid chromatography electrospray tandem mass spectrometry. In total, 34 antibiotics were found in the samples with an overall detection frequency of 92.0%, and the detection frequencies of individual antibiotic ranged from 0.3% to 28.7%. Specifically, the concentrations of seven antibiotics (azithromycin, amoxicillin, oxytetracycline, levofloxacin, norfloxacin, trimethoprim and sulfamethoxazole) were extremely high (i.e., above 10, 000 ng/mL). The detection rates of tetracyclines were significantly different among the three generations, with parents having the highest detection rate. Penicillin V, chlortetracycline, doxycycline, enrofloxacin, and ciprofloxacin showed a higher detection frequency in parents, whereas tetracycline, danofloxacin, and ofloxacin were more likely to be found in grandparents. The proportions of the sum of the daily exposure dose of VAs and PVAs more than 1 µg/kg/d in children, parents, and grandparents were 31.6%, 39.5%, and 26.5%, respectively. A hazard index (HI) greater than 1 was observed in 14.7% children, which was less than the 23.6% in parents and slightly higher than the 11.8% in grandparents. Ciprofloxacin was the biggest contributor to HI among the three generations. Collectively, these findings indicate that households are widely exposed to various antibiotics in Fuyang city, where parents had the highest health risk associated with the disturbance of gut microbiota.


Asunto(s)
Antibacterianos/orina , Monitoreo Biológico/métodos , Contaminantes Ambientales/orina , Drogas Veterinarias/orina , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Niño , Preescolar , China , Creatinina/orina , Femenino , Humanos , Masculino , Persona de Mediana Edad , Medición de Riesgo , Factores Sexuales , Encuestas y Cuestionarios , Adulto Joven
5.
Anesth Analg ; 130(4): 910-916, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31922998

RESUMEN

BACKGROUND: The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend a bundle of different measures for patients at increased risk of acute kidney injury (AKI). Prospective, single-center, randomized controlled trials (RCTs) have shown that management in accordance with the KDIGO recommendations was associated with a significant reduction in the incidence of postoperative AKI in high-risk patients. However, compliance with the KDIGO bundle in routine clinical practice is unknown. METHODS: This observational prevalence study was performed in conjunction with a prospective RCT investigating the role of the KDIGO bundle in high-risk patients undergoing cardiac surgery. A 2-day observational prevalence study was performed in all participating centers before the RCT to explore routine clinical practice. The participating hospitals provided the following data: demographics and surgical characteristics, AKI rates, and compliance rates with the individual components of the bundle. RESULTS: Ninety-five patients were enrolled in 12 participating hospitals. The incidence of AKI within 72 hours after cardiac surgery was 24.2%. In 5.3% of all patients, clinical management was fully compliant with all 6 components of the bundle. Nephrotoxic drugs were discontinued in 52.6% of patients, volume optimization was performed in 70.5%, 52.6% of the patients underwent functional hemodynamic monitoring, close monitoring of serum creatinine and urine output was undertaken in 24.2% of patients, hyperglycemia was avoided in 41.1% of patients, and no patient received radiocontrast agents. The patients received on average 3.4 (standard deviation [SD] ±1.1) of 6 supportive measures as recommended by the KDIGO guidelines. There was no significant difference in the number of applied measures between AKI and non-AKI patients (3.2 [SD ±1.1] vs 3.5 [SD ±1.1]; P = .347). CONCLUSIONS: In patients after cardiac surgery, compliance with the KDIGO recommendations was low in routine clinical practice.


Asunto(s)
Lesión Pulmonar Aguda/prevención & control , Procedimientos Quirúrgicos Cardíacos/métodos , Adhesión a Directriz/estadística & datos numéricos , Enfermedades Renales/terapia , Complicaciones Posoperatorias/prevención & control , Lesión Pulmonar Aguda/epidemiología , Adulto , Anciano , Estudios de Cohortes , Creatinina/sangre , Creatinina/orina , Femenino , Humanos , Incidencia , Enfermedades Renales/complicaciones , Pruebas de Función Renal , Tiempo de Internación , Masculino , Persona de Mediana Edad , Monitoreo Fisiológico , Prevalencia , Estudios Prospectivos
6.
Chemosphere ; 241: 125081, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31622890

RESUMEN

To take an insight into the long-term accumulation of chromium (Cr) and cadmium (Cd) in school-age children living near an MWI and to assess their early renal impairment, we conducted a cross-sectional study in 2015. A total of 116 children from the exposure area and 122 from the control area were recruited. We measured the urinary levels of Cr (U-Cr) and Cd (U-Cd) by inductively coupled plasma mass spectrometry (ICP-MS), and detected three classic renal tubule indicators, including N-acetyl-ß-d-glucosaminidase (NAG), ß2-microglobulin (BMG), and retinol binding protein (RBP). The U-Cd and U-Cr levels in children living near the MWI were 0.11 and 1.57 µg/g creatinine, respectively. Both the U-Cd and U-Cr levels in the exposure group were lower than those in the control group, although only U-Cd showed a statistical difference (p < 0.01). The U-NAG and U-RBP levels in the exposure group were also statistically lower than those in the control group (0.80 vs. 1.74 IU/g creatinine, 0.26 vs. 0.48 mg/g creatinine, respectively). The U-Cd level in this study was positively correlated with the U-NAG level (r = 0.26, p < 0.01), as the U-Cr level was also positively correlated with the levels of U-NAG, U-RBP, and U-BMG (r = 0.21, 0.33, 0.18, p < 0.01, respectively). This study indicates that children living close to this particular MWI may not suffer considerable long-term accumulation of Cd or Cr, nor early renal impairment.


Asunto(s)
Exposición a Riesgos Ambientales/estadística & datos numéricos , Contaminantes Ambientales/orina , Incineración , Metales/orina , Acetilglucosaminidasa/orina , Adulto , Cadmio/análisis , Niño , Cromo , Creatinina/orina , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proteínas de Unión al Retinol , Microglobulina beta-2/orina
7.
Eur J Ophthalmol ; 30(1): 19-25, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30409042

RESUMEN

PURPOSE: To investigate the effect of microalbuminuria on macular thickness in patients with type-2 diabetes mellitus with no or mild diabetic retinopathy and to investigate the relationship between macular thickness and metabolic parameters. MATERIALS AND METHODS: Fifty eight eyes of 58 patients without diabetic retinopathy (group 1) in microalbuminuria stage, 42 eyes of 42 patients with mild diabetic retinopathy (group 2) in microalbuminuria stage, and 50 eyes of 50 patients without diabetic retinopathy and microalbuminuria (group 3) were included in this study. After detailed ophthalmologic examination, all patients underwent spectral domain-optical coherence tomography measurements. Macular thickness was noted from nine different areas (fovea, four parafoveal, and four perifoveal areas) and compared between groups. The correlations between macular thickness and age, duration of diabetes mellitus, microalbuminuria, serum urea, creatinine, glycosylated hemoglobin (HbAIc), albumin, sodium (Na), and urinary Na were evaluated. RESULTS: The mean age was 53.29 ± 6.49 in group 1, 55.86 ± 6.97 in group 2, and 52.98 ± 5.66 years in group 3 (p = 0.06). The macular thickness values of superior, inferior, and nasal parafoveal areas were significantly different between groups (p = 0.001, p = 0.006, and p = 0.03, respectively). Bonferroni post test revealed that this difference originated from the difference between group 2 and 3 (p < 0.05 for all values). There were significant negative correlations between the macular thickness values of parafoveal areas and serum urea, HbA1c, albumin, microalbuminuria levels (p < 0.05 for all values). CONCLUSION: In this study, a significantly decreased parafoveal macular thickness was measured in patients with mild diabetic retinopathy and microalbuminuria compared to patients without diabetic retinopathy and microalbuminuria.


Asunto(s)
Albuminuria/diagnóstico , Diabetes Mellitus Tipo 2/diagnóstico , Retinopatía Diabética/diagnóstico , Retina/patología , Adulto , Anciano , Albuminuria/sangre , Albuminuria/orina , Creatinina/orina , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/orina , Retinopatía Diabética/sangre , Retinopatía Diabética/orina , Femenino , Fóvea Central , Hemoglobina A Glucada/metabolismo , Humanos , Masculino , Persona de Mediana Edad , Tamaño de los Órganos , Sodio/orina , Tomografía de Coherencia Óptica/métodos , Urea/sangre
8.
Environ Pollut ; 256: 113334, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31677874

RESUMEN

The goal of this study was to assess biomarkers of exposure to glyphosate and assess potential associations with renal function in children. Glyphosate is used ubiquitously in agriculture worldwide. While previous studies have indicated that glyphosate may have nephrotoxic effects, few have examined potential effects on kidney function in children. We leveraged three cohorts across different phases of child development and measured urinary levels of glyphosate. We evaluated associations of glyphosate with three biomarkers of kidney injury: albuminuria (ACR), neutrophil gelatinase-associated lipocalin (NGAL), and kidney injury marker 1 (KIM-1). Multivariable regression analyses examined associations of glyphosate with kidney injury biomarkers controlling for covariates. We identified glyphosate in 11.1% of the total participants. The herbicide was detected more frequently in the neonate population (30%). Multivariable regression models failed to identify significant associations of log-transformed glyphosate with any of the kidney injury biomarkers, controlling for covariates age, sex, and maternal education. While we confirm detectability of glyphosate in children's urine at various ages and stages of life, there is no evidence in this study for renal injury in children exposed to low levels of glyphosate. Further studies of larger sample size are indicated to better understand putative deleterious effects of the herbicide after different levels of exposure.


Asunto(s)
Exposición a Riesgos Ambientales/análisis , Contaminantes Ambientales/orina , Glicina/análogos & derivados , Enfermedades Renales/orina , Biomarcadores/orina , Niño , Preescolar , Estudios de Cohortes , Creatinina/orina , Estudios Transversales , Femenino , Glicina/orina , Receptor Celular 1 del Virus de la Hepatitis A/análisis , Humanos , Lactante , Recién Nacido , Enfermedades Renales/epidemiología , Lipocalina 2/orina , Estudios Longitudinales , Masculino , Prevalencia , Albúmina Sérica Humana/orina
9.
Ann Lab Med ; 40(3): 238-244, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-31858764

RESUMEN

BACKGROUND: Pyuria seems to be common in chronic kidney disease (CKD), irrespective of urinary tract infection (UTI). It has been hypothesized that sterile pyuria occurs in CKD because of chronic renal parenchymal inflammation. However, there are limited data on whether CKD increases the rate of pyuria or how pyuria in CKD should be interpreted. We investigated the prevalence and characteristics of asymptomatic pyuria (ASP) in CKD via urinary white blood cell (WBC) analysis. METHODS: Urine examination was performed for all stable hemodialysis (HD) and non-dialysis CKD patients of the outpatient clinic (total N=298). Patients with infection symptoms or recent history of antibiotic use were excluded. Urine culture and WBC analysis were performed when urinalysis revealed pyuria. RESULTS: The prevalence of ASP was 30.5% (24.1% in non-dialysis CKD and 51.4% in HD patients). Over 70% of the pyuria cases were sterile. The majority of urinary WBCs were neutrophils, even in sterile pyuria. However, the percentage of neutrophils was significantly lower in sterile pyuria. In multivariate logistic regression analysis, the degree of pyuria, percentage of neutrophils, and presence of urinary nitrites remained independently associated with sterile pyuria. CONCLUSIONS: The prevalence of ASP was higher in CKD patients and increased according to CKD stage. Most ASP in CKD was sterile. Ascertaining the number and distribution of urinary WBCs may be helpful for interpreting ASP in CKD.


Asunto(s)
Piuria/diagnóstico , Insuficiencia Renal Crónica/patología , Anciano , Área Bajo la Curva , Enfermedades Asintomáticas , Proteína C-Reactiva/análisis , Creatinina/orina , Estudios Transversales , Femenino , Tasa de Filtración Glomerular , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Neutrófilos/citología , Prevalencia , Piuria/complicaciones , Piuria/epidemiología , Curva ROC , Diálisis Renal , Insuficiencia Renal Crónica/complicaciones
10.
J Pharm Biomed Anal ; 177: 112854, 2020 Jan 05.
Artículo en Inglés | MEDLINE | ID: mdl-31518861

RESUMEN

Human urine recently became a popular medium for metabolomics biomarker discovery because its collection is non-invasive. Sometimes renal dilution of urine can be problematic in this type of urinary biomarker analysis. Currently, various normalization techniques such as creatinine ratio, osmolality, specific gravity, dry mass, urine volume, and area under the curve are used to account for the renal dilution. However, these normalization techniques have their own drawbacks. In this project, mass spectrometry-based urinary metabolomic data obtained from prostate cancer (n = 56), bladder cancer (n = 57) and control (n = 69) groups were analyzed using statistical normalization techniques. The normalization techniques investigated in this study are Creatinine Ratio, Log Value, Linear Baseline, Cyclic Loess, Quantile, Probabilistic Quotient, Auto Scaling, Pareto Scaling, and Variance Stabilizing Normalization. The appropriate summary statistics for comparison of normalization techniques were created using variances, coefficients of variation, and boxplots. For each normalization technique, a principal component analysis was performed to identify clusters based on cancer type. In addition, hypothesis tests were conducted to determine if the normalized biomarkers could be used to differentiate between the cancer types. The results indicate that the determination of statistical significance can be dependent upon which normalization method is utilized. Therefore, careful consideration should go into choosing an appropriate normalization technique as no method had universally superior performance.


Asunto(s)
Biomarcadores de Tumor/orina , Metabolómica/métodos , Neoplasias de la Próstata/diagnóstico , Urinálisis/métodos , Neoplasias de la Vejiga Urinaria/diagnóstico , Biomarcadores de Tumor/metabolismo , Creatinina/orina , Interpretación Estadística de Datos , Conjuntos de Datos como Asunto , Humanos , Masculino , Metabolómica/estadística & datos numéricos , Análisis de Componente Principal , Neoplasias de la Próstata/metabolismo , Neoplasias de la Próstata/orina , Urinálisis/estadística & datos numéricos , Neoplasias de la Vejiga Urinaria/metabolismo , Neoplasias de la Vejiga Urinaria/orina
11.
Talanta ; 207: 120277, 2020 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-31594622

RESUMEN

A low-cost and disposable microcell was constructed with a screen-printed electrode for the non-enzymatic electrochemical determination of creatinine. The working electrode was modified with carbon black and maintained in contact with paper-adsorbed iron (III) ions. A small sample volume of 3 µL was required for the device operation. Then, iron (III) ions were complexed in the presence of creatinine in a chemical step, followed by an electrochemical reduction of non-complexed metallic ions in excess. Cyclic voltammetry and differential-pulse voltammetry experiments were employed for the electrochemical characterizations and analytical performance evaluation of the microcell. The working electrode modification with carbon black provided a significant increase of analytical signal. The sensor presented a linear response for creatinine concentrations ranging from 0.10 to 6.5 mmol L-1, with a limit of detection of 0.043 mmol L-1. Experiments for creatinine determination in real samples were successful performed through of standard recovery in urine.


Asunto(s)
Creatinina/análisis , Electroquímica/instrumentación , Análisis por Micromatrices/instrumentación , Impresión , Creatinina/química , Creatinina/orina , Electrodos , Tecnología Química Verde , Humanos , Hierro/química , Límite de Detección , Hollín/química
12.
Ceska Slov Farm ; 68(4): 173-179, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31822110

RESUMEN

The article presents the results of the study of the nephroprotective effect of N-acetylglucosamine (NAG) under the development of experimental acute kidney injury (AKI). The study was conducted on a model of acute glycerol nephrosis in rats. NAG was studied at a dose of 50 mg/kg at daily parenteral administration during 1 week compared to quercetin, which was administered intraperitoneally at a dose of 34 mg/kg. The efficiency of the drugs was assessed by the functional state of animals, the renal excretory function and the nitrogen metabolism indices. The NAG effect on rats with AKI caused a reduction of the mortality rate, an increase in diuresis, a reduction of proteinuria, an increase in creatinine and urea excretion, which indicates the normalization of the renal excretory function and nitrogen metabolism. At the same time, NAG has statistically significantly exceeded the effect of quercetin in the majority of indices and, therefore, the level of efficiency. Thus, NAG is an efficient agent for AKI treatment, which can be used at parenteral route of administration.


Asunto(s)
Acetilglucosamina/farmacología , Lesión Renal Aguda/tratamiento farmacológico , Animales , Creatinina/orina , Diuresis , Proteinuria , Quercetina/farmacología , Ratas , Urea/orina
13.
J Water Health ; 17(6): 884-895, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31850896

RESUMEN

The current study aimed to determine the association between trichloroacetic acid (TCAA) levels and adverse pregnancy outcomes among third-trimester pregnant women who were exposed to chlorinated drinking water. A total of 205 pregnant women who participated in the disinfection by-products exposure and adverse pregnancy outcome study in South Africa were randomly asked to participate in this study by providing their morning urine sample voids. Samples were analysed for urinary creatinine and TCAA. Furthermore, participants gave individual data using a structured questionnaire. The mean (median) concentration of creatinine-adjusted urinary TCAA was 2.34 (1.95) µg/g creatinine. Elevated levels of creatinine-adjusted TCAA concentrations showed an increased risk of premature birth, small for gestational age (SGA) and low birth weight. There was no significant statistical correlation observed between creatinine-adjusted TCAA concentrations and the total volume of cold water ingested among the study population. No statistically significant association was observed between creatinine-adjusted urinary TCAA and premature birth, SGA and low birth weight newborns among the study subjects. However, the urinary TCAA concentrations identified in this study suggest potential health risks towards women and foetus. Therefore, further studies are warranted to prevent further adverse pregnancy outcomes.


Asunto(s)
Creatinina/orina , Agua Potable , Exposición Materna/efectos adversos , Resultado del Embarazo/epidemiología , Nacimiento Prematuro/epidemiología , Ácido Tricloroacético/orina , Adolescente , Adulto , Estudios Transversales , Desinfección , Femenino , Humanos , Recién Nacido de Bajo Peso , Recién Nacido , Recién Nacido Pequeño para la Edad Gestacional , Embarazo , Tercer Trimestre del Embarazo , Sudáfrica/epidemiología
14.
PLoS Med ; 16(11): e1002955, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31693662

RESUMEN

BACKGROUND: The Kidney Failure Risk Equation (KFRE) uses the 4 variables of age, sex, urine albumin-to-creatinine ratio (ACR), and estimated glomerular filtration rate (eGFR) in individuals with chronic kidney disease (CKD) to predict the risk of end stage renal disease (ESRD), i.e., the need for dialysis or a kidney transplant, within 2 and 5 years. Currently, national guideline writers in the UK and other countries are evaluating the role of the KFRE in renal referrals from primary care to secondary care, but the KFRE has had limited external validation in primary care. The study's objectives were therefore to externally validate the KFRE's prediction of ESRD events in primary care, perform model recalibration if necessary, and assess its projected impact on referral rates to secondary care renal services. METHODS AND FINDINGS: Individuals with 2 or more Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) eGFR values < 60 ml/min/1.73 m2 more than 90 days apart and a urine ACR or protein-to-creatinine ratio measurement between 1 December 2004 and 1 November 2016 were included in the cohort. The cohort included 35,539 (5.6%) individuals (57.5% female, mean age 75.9 years, median CKD-EPI eGFR 51 ml/min/1.73 m2, median ACR 3.2 mg/mmol) from a total adult practice population of 630,504. Overall, 176 (0.50%) and 429 (1.21%) ESRD events occurred within 2 and 5 years, respectively. Median length of follow-up was 4.7 years (IQR 2.8 to 6.6). Model discrimination was excellent for both 2-year (C-statistic 0.932, 95% CI 0.909 to 0.954) and 5-year (C-statistic 0.924, 95% 0.909 to 0.938) ESRD prediction. The KFRE overpredicted risk in lower (<20%) risk groups. Reducing the model's baseline risk improved calibration for both 2- and 5-year risk for lower risk groups, but led to some underprediction of risk in higher risk groups. Compared to current criteria, using referral criteria based on a KFRE-calculated 5-year ESRD risk of ≥5% and/or an ACR of ≥70 mg/mmol reduced the number of individuals eligible for referral who did not develop ESRD, increased the likelihood of referral eligibility in those who did develop ESRD, and referred the latter at a younger age and with a higher eGFR. The main limitation of the current study is that the cohort is from one region of the UK and therefore may not be representative of primary care CKD care in other countries. CONCLUSIONS: In this cohort, the recalibrated KFRE accurately predicted the risk of ESRD at 2 and 5 years in primary care. Its introduction into primary care for referrals to secondary care renal services may lead to a reduction in unnecessary referrals, and earlier referrals in those who go on to develop ESRD. However, further validation studies in more diverse cohorts of the clinical impact projections and suggested referral criteria are required before the latter can be clinically implemented.


Asunto(s)
Fallo Renal Crónico/etiología , Medición de Riesgo/métodos , Factores de Edad , Anciano , Anciano de 80 o más Años , Albuminuria/orina , Algoritmos , Estudios de Cohortes , Creatinina/orina , Progresión de la Enfermedad , Femenino , Tasa de Filtración Glomerular , Humanos , Fallo Renal Crónico/mortalidad , Pruebas de Función Renal , Masculino , Persona de Mediana Edad , Atención Primaria de Salud , Pronóstico , Insuficiencia Renal/mortalidad , Insuficiencia Renal/fisiopatología , Insuficiencia Renal Crónica , Reproducibilidad de los Resultados , Factores de Riesgo , Reino Unido/epidemiología
15.
Rev Assoc Med Bras (1992) ; 65(9): 1155-1160, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31618330

RESUMEN

OBJECTIVE: In this study, we aimed to analyze the relationship between serum uric acid (UA) and microalbuminuria as a marker of renal injury in type 2 diabetes mellitus. METHODS: A total of 100 patients with type 2 diabetes mellitus were enrolled in the study. Participants were divided into two groups according to the urinary microalbumin/creatinine ratio: diabetic nephropathy and non-nephropathy group. UA and microalbuminuria were compared between the study groups. RESULTS: Serum UA levels of diabetic nephropathy patients were significantly higher than those in the non-nephropathy group (UA in patients with diabetic nephropathy groups: 6.3 (1.82) mg/dl, UA in patients of the non-nephropathic group: 4.85 (1.92) mg/dl) (p<0.001). There was a correlation between microalbuminuria and UA (r=0.238). This correlation was statistically significant (p=0.017). CONCLUSION: UA levels may be an important predictor of nephropathy in diabetic patients.


Asunto(s)
Diabetes Mellitus Tipo 2/complicaciones , Nefropatías Diabéticas/etiología , Hiperuricemia/complicaciones , Ácido Úrico/sangre , Anciano , Albuminuria/orina , Biomarcadores/sangre , Creatinina/orina , Diabetes Mellitus Tipo 2/sangre , Nefropatías Diabéticas/sangre , Femenino , Tasa de Filtración Glomerular , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sensibilidad y Especificidad
16.
Turk J Pediatr ; 61(1): 71-78, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31559724

RESUMEN

Gültekin ND, Benzer M, Tekin-Neijmann S. Is there any relation between connective tissue growth factor and scar tissue in vesicoureteral reflux. Turk J Pediatr 2019; 61: 71-78. Vesicoureteral reflux (VUR) is the most common uropathy in childhood which leads to increased frequency of urinary tract infection (UTI) and renal scarring. Connective tissue growth factor (CTGF) plays an important role in the development of glomerular and tubulointerstitial fibrosis in progressive kidney diseases. The aim of this study was to investigate the relation between urinary CTGF and renal damage resulted from VUR. This cross sectional study included 70 patients with VUR and 62 healthy sex and age matched children. Urinary creatinine and CTGF (uCTGF) concentrations were analysed in all cases and CTGF to creatinine ratio were calculated. The records of radiologic evaluations of the patients including ultrasound, voiding cystouretrography and 99m-technetium dimercaptosuccinic acid (DMSA) scintigraphy were obtained retrospectively. The patient group was further divided into two groups according to the existence of renal cortical scarring in the DMSA scan. The study consisted of three groups; Group 1 (control group) 62 children, Group 2 (VUR positive, scar negative) 24 patient, Group 3 (VUR positive, scar positive) 46 patient (VUR+scar). The medians of uCTGF and uCTGF to creatinine ratio of the three groups were significantly different (p < 0.001). Pairwise group comparisons revealed that Group 1 had significantly lower uCTGF level and uCTGF/creatinine ratio, as compared to Groups 2 and 3 (p < 0.001 and p=0.002, respectively). There was no statistically significant difference between Groups 2 and 3 (p=0.052). uCTGF is significantly increased in children with VUR, independent on the presence of renal scarring. Increased uCTGF, even in the absence of the renal scarring, could be interpreted as development and a progression of glomerular and tubulointerstitial fibrosis in vesicoureteral reflux. Further experimental and clinical investigations are required to fully elucidate the mechanism of CTGF in vesicoureteral reflux.


Asunto(s)
Cicatriz/diagnóstico por imagen , Factor de Crecimiento del Tejido Conjuntivo/orina , Corteza Renal/diagnóstico por imagen , Reflujo Vesicoureteral/complicaciones , Estudios de Casos y Controles , Niño , Preescolar , Creatinina/orina , Estudios Transversales , Femenino , Humanos , Masculino , Cintigrafía , Estudios Retrospectivos , Urografía
17.
Int J Mol Sci ; 20(18)2019 Sep 10.
Artículo en Inglés | MEDLINE | ID: mdl-31510053

RESUMEN

Standard methods for detecting and monitoring of IgA nephropathy (IgAN) have conventionally required kidney biopsies or suffer from poor sensitivity and specificity. The Kidney Injury Test (KIT) Assay of urinary biomarkers has previously been shown to distinguish between various kidney pathologies, including chronic kidney disease, nephrolithiasis, and transplant rejection. This validation study uses the KIT Assay to investigate the clinical utility of the non-invasive detection of IgAN and predicting the progression of renal damage over time. The study design benefits from longitudinally collected urine samples from an investigator-initiated, multicenter, prospective study, evaluating the efficacy of corticosteroids versus Rituximab for preventing progressive IgAN. A total of 131 urine samples were processed for this study; 64 urine samples were collected from 34 IgAN patients, and urine samples from 64 demographically matched healthy controls were also collected; multiple urinary biomarkers consisting of cell-free DNA, methylated cell-free DNA, DMAIMO, MAMIMO, total protein, clusterin, creatinine, and CXCL10 were measured by the microwell-based KIT Assay. An IgA risk score (KIT-IgA) was significantly higher in IgAN patients as compared to healthy control (87.76 vs. 14.03, p < 0.0001) and performed better than proteinuria in discriminating between the two groups. The KIT Assay biomarkers, measured on a spot random urine sample at study entry could distinguish patients likely to have progressive renal dysfunction a year later. These data support the pursuit of larger prospective studies to evaluate the predictive performance of the KIT-IgA score in both screening for non-invasive diagnosis of IgAN, and for predicting risk of progressive renal disease from IgA and utilizing the KIT score for potentially evaluating the efficacy of IgAN-targeted therapies.


Asunto(s)
Biomarcadores/orina , Glomerulonefritis por IGA/orina , Monitoreo Fisiológico/métodos , Corticoesteroides/uso terapéutico , Adulto , Creatinina/orina , Progresión de la Enfermedad , Femenino , Glomerulonefritis por IGA/diagnóstico , Glomerulonefritis por IGA/tratamiento farmacológico , Humanos , Inmunoglobulina A/orina , Factores Inmunológicos/uso terapéutico , Riñón/patología , Riñón/fisiopatología , Pruebas de Función Renal/métodos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Proteinuria/orina , Rituximab/uso terapéutico , Sensibilidad y Especificidad , Adulto Joven
18.
Nat Commun ; 10(1): 4130, 2019 09 11.
Artículo en Inglés | MEDLINE | ID: mdl-31511532

RESUMEN

Increased levels of the urinary albumin-to-creatinine ratio (UACR) are associated with higher risk of kidney disease progression and cardiovascular events, but underlying mechanisms are incompletely understood. Here, we conduct trans-ethnic (n = 564,257) and European-ancestry specific meta-analyses of genome-wide association studies of UACR, including ancestry- and diabetes-specific analyses, and identify 68 UACR-associated loci. Genetic correlation analyses and risk score associations in an independent electronic medical records database (n = 192,868) reveal connections with proteinuria, hyperlipidemia, gout, and hypertension. Fine-mapping and trans-Omics analyses with gene expression in 47 tissues and plasma protein levels implicate genes potentially operating through differential expression in kidney (including TGFB1, MUC1, PRKCI, and OAF), and allow coupling of UACR associations to altered plasma OAF concentrations. Knockdown of OAF and PRKCI orthologs in Drosophila nephrocytes reduces albumin endocytosis. Silencing fly PRKCI further impairs slit diaphragm formation. These results generate a priority list of genes and pathways for translational research to reduce albuminuria.


Asunto(s)
Albuminuria/genética , Mapeo Cromosómico , Estudio de Asociación del Genoma Completo , Metaanálisis como Asunto , Animales , Creatinina/orina , Diabetes Mellitus/genética , Diabetes Mellitus/orina , Drosophila melanogaster/genética , Regulación de la Expresión Génica , Sitios Genéticos , Predisposición Genética a la Enfermedad , Humanos , Factores de Riesgo
19.
Res Vet Sci ; 126: 131-138, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31491669

RESUMEN

This study examines correlations among serum proteins, clinical score, body weight and kidney function biomarkers after a standard treatment course (meglumine antimoniate plus allopurinol) in twelve Canine leishmaniosis (CanL) patients at the three times points pre treatment, after treatment and after the end of treatment. The laboratory variables measured were those used for the follow-up of sick dogs along with biomarkers of kidney function: glomerular filtration rate (GFR), creatinine (Cr), urea, calcium, inorganic phosphorus, urine specific gravity (USG) and urine protein to creatinine ratio (UPC). Arterial blood pressure (systolic blood pressure, SBP), clinical score (CS) and weight were also monitored over the study period. At Tp0, GFR was within the normal range in most dogs. Hyperfiltration was detected in three patients and hypofiltration in one. In dogs showing hyperfiltration, this factor remained in the non-azotemic range over the whole study period. After treatment normal filtration values were recovered. Meglumine antimoniate did not modify GFR or USG. A significant reduction in UPC was recorded. In all dogs, clinical scores improved. Negative correlation was found between GFR and Cr, UPC and albumin (Alb) and CS and Alb, while positive correlation was detected between UPC and total globulins (GlobT), CS and GlobT, UPC and total solids (TS), SBP and CS and SBP and UPC. Our findings indicate no impacts on kidney function of the treatment of CanL with meglumine antimoniate, as no effects were produced on GFR or USG. Treatment was effective and found to reduce UPC which could suggest improved glomerular injury.


Asunto(s)
Antiprotozoarios/uso terapéutico , Enfermedades de los Perros/tratamiento farmacológico , Enfermedades Renales/veterinaria , Leishmaniasis Visceral/veterinaria , Antimoniato de Meglumina/uso terapéutico , Alopurinol/administración & dosificación , Animales , Antiprotozoarios/efectos adversos , Biomarcadores , Creatinina/orina , Perros , Femenino , Tasa de Filtración Glomerular , Enfermedades Renales/inducido químicamente , Leishmania infantum , Leishmaniasis Visceral/tratamiento farmacológico , Masculino , Antimoniato de Meglumina/administración & dosificación
20.
J Diabetes Res ; 2019: 9718370, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31534974

RESUMEN

Objective: In general population, resting heart rate (RHR) is associated with cardiovascular disease. However, its relation to chronic kidney disease (CKD) is debated. We therefore investigated the relationship between RHR and urinary albumin/creatinine ratio (UACR, an indicator of early kidney injury) in general population at different levels of blood pressure and blood glucose. Methods: We screened out 32,885 subjects from the REACTION study after excluding the subjects with primary kidney disease, heart disease, tumor history, related drug application, and important data loss. The whole group was divided into four groups (Q1: RHR ≤ 71, Q2: 72 ≤ RHR ≤ 78, Q3: 79 ≤ RHR ≤ 86, and Q4: 87 ≤ RHR) according to the quartile of average resting heart rate. The renal function was evaluated by UACR (divided by quartiles of all data in the center to which the subject belonged). Ordinary logistic regression was carried out to explore the association between RHR and UACR at diverse blood pressure and blood glucose levels. Results: The subjects with higher RHR quartile tend to have a higher UACR, even multifactors were adjusted. After stratifying the subjects according to blood pressure and blood glucose, the positive relationship between RHR and UACR remained in the subjects with normal blood pressure and normal glucose tolerance, while in the hypertension (SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg) group and the diabetic mellitus (FPG ≥ 7.0 mmol/L and/or PPG ≥ 11.1 mmol/L) group, the relationship disappeared. In the subjects without hypertension, compared with the Q1 group, the UACR is significant higher in the Q3 group (OR: 1.11) and the Q4 group (OR: 1.22). In the subjects with normal glucose tolerance (NGT), compared with the Q1 group, the UACR is significantly higher in the Q3 group (OR: 1.13) and the Q4 group (OR: 1.19). Conclusions: The population with higher RHR tend to have a higher UACR in the normal blood pressure group and the normal glucose tolerance group.


Asunto(s)
Albuminuria/orina , Creatinina/orina , Frecuencia Cardíaca/fisiología , Anciano , Presión Sanguínea/fisiología , China , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Urinálisis
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