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1.
JAAPA ; 34(12): 59-61, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34813537

RESUMO

ABSTRACT: Estimated glomerular filtration rate (eGFR) calculators have included a race adjustment to help approximate measured GFR. Over the past several years, as more attention has been directed toward uncovering racial bias, the appropriateness of including race in these calculators has been called into question. The American Society of Nephrology and the National Kidney Foundation convened an expert task force to review the inclusion of race in eGFR. The deliberative review showed that race can be removed from eGFR calculators without causing adverse reactions in any group of patients. This new, refitted CKD-EPI equation can be used immediately by all laboratories in the United States. The task force also recommended greater use of cystatin C nationally in eGFR calculations. This would enable the new CKD-EPI equation to incorporate both creatinine and cystatin C without race and would yield better accuracy than a calculator that uses creatinine alone.


Assuntos
Insuficiência Renal Crônica , Creatinina , Taxa de Filtração Glomerular , Humanos , Rim , Insuficiência Renal Crônica/diagnóstico
2.
Anal Chem ; 93(45): 14996-15004, 2021 11 16.
Artigo em Inglês | MEDLINE | ID: mdl-34736319

RESUMO

The conventional tissue biopsy method yields isolated snapshots of a narrow region. Therefore, it cannot facilitate comprehensive disease characterization and monitoring. Recently, the detection of tumor-derived components in body fluids─a practice known as liquid biopsy─has attracted increased attention from the biochemical research and clinical application viewpoints. In this vein, surface-enhanced Raman scattering (SERS) has been identified as one of the most powerful liquid-biopsy analysis techniques, owing to its high sensitivity and specificity. Moreover, it affords high-capacity spectral multiplexing for simultaneous target detection and a unique ability to obtain intrinsic biomolecule-fingerprint spectra. This paper presents the fabrication of silver nanosnowflakes (SNSFs) using the polyol method and their subsequent dropping onto a hydrophobic filter paper. The SERS substrate, which comprises the SNSFs and hydrophobic filter paper, facilitates the simultaneous detection of creatinine and cortisol in human sweat using a hand-held Raman spectrometer. The proposed SERS system affords Raman spectrometry to be performed on small sample volumes (2 µL) to identify the normal and at-risk creatinine and cortisol groups.


Assuntos
Nanopartículas Metálicas , Prata , Creatinina , Humanos , Hidrocortisona , Análise Espectral Raman , Suor
3.
BMC Nephrol ; 22(1): 381, 2021 11 13.
Artigo em Inglês | MEDLINE | ID: mdl-34774005

RESUMO

BACKGROUND: Kidney dysfunction occurs in severe COVID-19, and is a predictor of COVID-19 mortality. Whether kidney dysfunction causes severe COVID-19, and hence is a target of intervention, or whether it is a symptom, is unclear because conventional observational studies are open to confounding. To obtain unconfounded estimates, we used Mendelian randomization to examine the role of kidney function in severe COVID-19. METHODS: We used genome-wide significant, uncorrelated genetic variants to predict kidney function, in terms of estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR), and then assessed whether people with genetically instrumented higher eGFR or lower UACR, an indication of better kidney function, had a lower risk of severe COVID-19 (8779 cases, 1,001,875 controls), using the largest available cohorts with extensive genotyping. For comprehensiveness, we also examined their role in COVID-19 hospitalization (24,274 cases, 2,061,529 controls) and all COVID-19 (1,12,612 cases, 2,474,079 controls). RESULTS: Genetically instrumented higher eGFR was associated with lower risk of severe COVID-19 (odds ratio (OR) 0.90, 95% confidence interval (CI) 0.83, 0.98) but not related to COVID-19 hospitalization or infection. Genetically instrumented UACR was not related to COVID-19. CONCLUSIONS: Kidney function appears to be one of the key targets for severe COVID-19 treatment. Use of available medications to improve kidney function, such as antihypertensives, might be beneficial for COVID-19 treatment, with relevance to drug repositioning.


Assuntos
COVID-19/complicações , COVID-19/genética , Taxa de Filtração Glomerular/genética , Rim/fisiopatologia , Gravidade do Paciente , Albuminúria/urina , Estudos de Casos e Controles , Creatinina/urina , Grupo com Ancestrais do Continente Europeu/genética , Variação Genética , Estudo de Associação Genômica Ampla , Hospitalização , Humanos , Análise da Randomização Mendeliana , Fatores de Risco , SARS-CoV-2
4.
J Coll Physicians Surg Pak ; 31(12): 1412-1416, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34794279

RESUMO

OBJECTIVE: To determine the difference in serum Elabela level in hypertensive patients with and without nephropathy compared to the healthy control group. Study Desing:  Cross-sectional descriptive study. PLACE AND DURATION OF STUDY: Firat University Medical School, Elazig, Turkey between December 2018 and November 2020. METHODOLOGY: The cross-sectional descriptive study consisted of 37 patients with hypertensive nephropathy (group 3), 50 hypertensive patients without nephropathy (group 2), and 50 healthy controls (group 1). Hypertensive nephropathy was defined as serum creatinine ≥1.8 mg / dl or  GFR <40 ml / minute. Biochemical parameters (Glucose, AST, ALT, urea, creatinine, lipid levels, hemogram, calcium, phosphorus, parathormone) and the levels of serum Elabela were evaluated and compared. RESULTS: There was no significant difference in age (0.270) and gender (0.951) between groups. The median Elabela levels of the three groups were 40.3 ng/mL (22.5-54.6), 5.1 ng/mL (3.7-8.3), 9.2 ng/mL (6.1-23.1), respectively with a significant difference (p<0.001). CONCLUSION: The plasma levels of Elabela were lower in the case of hypertension, independent of nephropathy. However, this decrease is not specific for nephropathy and may be due to other accompanying chronic diseases. Key Words: Hypertension, Hypertensive nephropathy, Elabela.


Assuntos
Hipertensão Renal , Nefrite , Creatinina , Estudos Transversais , Humanos
5.
J Am Vet Med Assoc ; 259(10): 1163-1170, 2021 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-34727086

RESUMO

CASE DESCRIPTION: During the same week, 3 sequential patients (a 10-year-old 8.7-kg spayed female poodle cross [dog 1], 13-year-old 2.6-kg spayed female domestic longhair cat, and 13-year-old 9.0-kg castrated male mixed-breed dog [dog 2]) underwent CT-angiography (day 0) and transarterial embolization (day 1) for nonresectable hepatocellular carcinoma (n = 2) or prostatic carcinoma (1). CLINICAL FINDINGS: Contrast-induced nephropathy (CIN) was suspected in all animals on the basis of higher serum creatinine concentrations after contrast medium administration (exposure), compared with baseline concentrations before exposure, consistent with CIN definitions. The total dose of contrast medium was < 3 mL/kg for each exposure. For all 3 patients, creatinine concentration peaked at a median of 3 days (range, 2 to 3 days) after the first exposure (day 0), and the median absolute and relative increases in creatinine concentration after exposure (vs baseline concentrations before exposure) were 2.9 mg/dL (range, 2.2 to 3.7 mg/dL) and 410% (range, 260 to 720%), respectively. TREATMENT AND OUTCOME: The patients received individually tailored supportive care for acute kidney injury. Serum creatinine concentrations began to improve at a median of 4 days (range, 3 to 4 days) and returned to within reference limits at a median of 7 days (range, 3 to 13 days) following initial exposure. CLINICAL RELEVANCE: CIN should be considered as a potential complication following IV administration of contrast medium. Short-term outcome following CIN can be excellent with supportive care.


Assuntos
Injúria Renal Aguda , Doenças do Gato , Doenças do Cão , Nefropatias , Neoplasias , Injúria Renal Aguda/veterinária , Animais , Doenças do Gato/induzido quimicamente , Doenças do Gato/diagnóstico por imagem , Doenças do Gato/terapia , Gatos , Angiografia por Tomografia Computadorizada/veterinária , Meios de Contraste/efeitos adversos , Angiografia Coronária , Creatinina , Doenças do Cão/induzido quimicamente , Doenças do Cão/diagnóstico por imagem , Doenças do Cão/terapia , Cães , Feminino , Nefropatias/veterinária , Masculino , Neoplasias/veterinária , Fatores de Risco , Tomografia Computadorizada por Raios X
6.
Invest Ophthalmol Vis Sci ; 62(14): 7, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34757418

RESUMO

Purpose: To examine the morphological and hemodynamic changes of the ophthalmic artery (OA) in patients with acute coronary syndrome (ACS). Methods: This cross-sectional observational study included 31 patients with ACS and 10 healthy controls (HCs). The ACS subgroups were ST-segment elevation myocardial infarction (STEMI; n = 10), non-STEMI (n = 10), and unstable angina (n = 11). OA three-dimensional (3D) models were reconstructed based on computed tomographic angiography, and morphological aspects of the OA were measured quantitatively. Moreover, numerical simulation by computational fluid dynamics was used to obtain hemodynamic information of the OA. Results: The study reconstructed 41 OA models. Hemodynamic simulation revealed a significant decrease in OA blood velocity in patients with ACS compared with the HCs (median velocity, 0.046 vs. 0.147 m/s; P < 0.001). No differences in the morphological data for the OA were observed. Also, no differences in the mass flow ratio of OA to the ipsilateral internal carotid artery was found. Similar differences were observed between the ACS subgroups and HCs. OA blood velocity was negatively correlated with body mass index, abdominal circumference, left ventricular ejection fraction, and triacylglycerol and was positively correlated with early to late transmitral flow velocity, N-terminal pro-brain natriuretic peptide, serum creatinine, and potassium. Conclusions: The initial OA blood velocity was slower in patients with ACS and was associated with ACS-related clinical parameters. To our knowledge, this is the first study to analyze OA characteristics in ACS using 3D model reconstruction and hemodynamic simulation, providing new perspectives on the relationship between ischemic heart disease and ocular manifestations.


Assuntos
Síndrome Coronariana Aguda/fisiopatologia , Artéria Oftálmica/fisiopatologia , Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/diagnóstico por imagem , Idoso , Velocidade do Fluxo Sanguíneo/fisiologia , Artéria Carótida Interna/fisiopatologia , Angiografia por Tomografia Computadorizada , Creatinina/sangue , Estudos Transversais , Feminino , Hemodinâmica/fisiologia , Humanos , Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Artéria Oftálmica/diagnóstico por imagem , Fragmentos de Peptídeos/sangue , Potássio/sangue , Fluxo Sanguíneo Regional/fisiologia , Volume Sistólico , Triglicerídeos/sangue , Função Ventricular Esquerda
7.
MMW Fortschr Med ; 163(20): 11, 2021 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-34767200
8.
Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi ; 39(10): 733-737, 2021 Oct 20.
Artigo em Chinês | MEDLINE | ID: mdl-34727652

RESUMO

Objective: To investigate the changes in kidney and its mechanism during the development of acute phosgene exposure in rats. Methods: Rats were randomized into 2 groups: control and phosgene group (including 1, 3, 6, 12 and 24 h after exposed to phosgene) , 6 rats in each group. Rats in control group were exposed to air for 5 min, while rats in phosgene group were exposed to 8.33 mg/L phosgene for 5 min. The blood samples were collected at 1, 3, 6, 12 and 24 h after phosgene exposure. The blood creatinine (Cr) , urea nitrogen (BUN) and blood gas analysis were detected. HE staining and immunohistochemical staining were performed to observe the expression levels of 8-hydroxy deoxyguanosine and myeloperoxidase. Results: The arterial partial pressure of oxygen and oxygenation index of rats in the phosgene group were significantly lower than those in the control group at 3, 6 and 12 h after exposure (P<0.01) . The lowest points were reached at 6 h, which were (58.67±7.89) mmHg and (202.30±27.20) mmHg, respectively. The Cr and BUN of rats in the phosgene group were significantly higher than those in the control group at 3, 6, 12, and 24 h, and the renal organ coefficients were significantly higher than those in the control group at 3, 6 and 12 h (P<0.01) . HE staining showed that there were more erythrocytes in the glomeruli of rats in the phosgene group, the volume of renal tubular epithelial cells increased, and the cytoplasm was loose and lightly stained. The damage was most obvious at 6 h. The results of immunohistochemical staining showed that the positive expressions of 8-hydroxy deoxyguanosine and myeloperoxidase in the kidney tissue of the phosgene group increased. Conclusion: Hypoxemia and oxidative stress caused by phosgene poisoning may be the cause of renal damage in rats.


Assuntos
Fosgênio , Animais , Nitrogênio da Ureia Sanguínea , Creatinina , Rim , Oxigênio , Fosgênio/toxicidade , Ratos
9.
J Med Invest ; 68(3.4): 302-308, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34759149

RESUMO

Introduction : Cystatin C (CysC) is biomarker for early detection of acute kidney injury (AKI). However, there is limited evidence in decompensated cirrhotic patients without AKI at admission. This study aimed to assess CysC as a predictor of 90-day mortality. Methods : Decompensated cirrhotic patients without AKI were prospectively enrolled. CysC and creatinine were measured within 24 hours of admission and compared between patients with in-hospital complications (AKI, hepatorenal syndrome (HRS), acute-on-chronic liver failure (ACLF)) vs. those without, and survivors vs. non-survivors. The AUROC and cut-off point of CysC in predicting 90-day mortality were determined. Results : Of 137 decompensated cirrhotic patients, 46 without AKI at admission were included (58.7% male, age 60.8 ±â€†11.2years, MELD 13.1 ±â€†5.1, ChildA / B / C 43.5% / 39.1% / 17.4%). The mean CysC level tended to be higher in patients with ACLF (1.52 ±â€†0.60 vs. 1.11 ±â€†0.28, p = 0.05), and significantly higher in non-survivors than survivors (1.61 ±â€†0.53 vs. 1.08 ±â€†0.28, p = 0.013). The 90-day mortality rate was 21.7%. After adjusting with age and bacterial infection on admission, CysC level  ≥ 1.25 mg / L was significantly associated with 90-day mortality. The CysC cut-off level  ≥ 1.25 mg / L provided 80% sensitivity and 75% specificity for predicting 90-day mortality. Conclusion : Plasma CysC within 24 hours could be used as a predictor for 90-day mortality and development of ACLF in decompensated cirrhotic patients. J. Med. Invest. 68 : 302-308, August, 2021.


Assuntos
Cistatina C , Cirrose Hepática , Idoso , Biomarcadores , Creatinina , Feminino , Humanos , Cirrose Hepática/complicações , Masculino , Pessoa de Meia-Idade , Morbidade , Prognóstico
10.
Anatol J Cardiol ; 25(10): 691-698, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34622783

RESUMO

OBJECTIVE: Presently, an effective model to predict long-term cardiac mortality in patients with hypertrophic obstructive cardiomyopathy (HOCM) is lacking. Therefore, the objective of this study was to evaluate the predictive value of the modified Age, Creatinine clearance, and Ejection Fraction (mACEF) score for long-term cardiac mortality in patients with HOCM. METHODS: Two hundred and ninety two patients with HOCM treated non-invasively were enrolled in this study, all of whom had intact medical information. RESULTS: Over a median follow-up period of 41.9 months, 28 cardiac deaths occurred. In univariate Cox regression analysis, the mACEF score was associated with long-term cardiac death [hazard ratio (HR)=1.795, 95% confidence interval (CI) 1.518-2.124, p<0.001]. Multiple Cox regression analysis identified the mACEF score as an independent risk factor for long-term cardiac death (adjusted HR=1.372, 95% CI 1.076-1.749, p=0.011). Analysis of the receiver operating characteristic (ROC) for long-term cardiac death showed that the mACEF score had a considerable predictive value (area under ROC 0.844, sensitivity 89.29%, specificity 75.00%) with an optimum cut-off value of 0.96. The study population was divided into high-risk (mACEF score ≥0.96, n=91) and low-risk (mACEF score <0.96, n=201) groups according to the optimum cut-off value. Kaplan-Meier survival analysis was performed and showed a dramatic higher rate of long-term cardiac mortality in the high-risk group than in the low-risk group (27.4% vs. 1.7%, p<0.001 by log-rank test). CONCLUSION: The mACEF score has a considerable predictive value for long-term cardiac mortality in patients with HOCM treated non-invasively. A mACEF score ≥0.96 could be considered as a sign of poor prognosis in patients with HOCM.


Assuntos
Cardiomiopatia Hipertrófica , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Creatinina , Humanos , Prognóstico , Estudos Retrospectivos , Volume Sistólico
11.
Mymensingh Med J ; 30(4): 991-996, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34605468

RESUMO

The prevalence of obesity continues to increase worldwide day by day causing a serious health problem and impose a significant impact on the National Health Service (NHS) budget. Obesity usually arises from the interactions of multiple genes and lifestyle factors. This study was done to evaluate changes of serum creatinine and creatinine clearance rate in obese female age ranged 30-60 years in comparison to normal healthy female of same age. This study, a cross-sectional analytical type, was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh between the period from January 2020 to December 2020. A total number of 100 female subjects were included in this study. Among them fifty (50) normal healthy female were taken as control group (Group I) and fifty (50) obese female were taken as study group (Group II). To see the level of serum creatinine determined by Kinetic Colorimetric method and creatinine clearance rate was calculated from serum creatinine by Cockcroft-Gault equation. Data was calculated by unpaired Student's't' test and were expressed as mean (±SD). Pearson's correlation coefficient test was done to find the correlation of serum creatinine and creatinine clearance rate with BMI. In this study we found that mean serum Creatinine and Creatinine clearance rate were higher in obese female in comparison to normal healthy female. Again, serum Creatinine and Creatinine clearance rate were positively correlated with BMI. Therefore, to prevent obesity related complications and leading a healthy life we suggest estimations of these parameters routinely.


Assuntos
Obesidade , Medicina Estatal , Adulto , Creatinina , Estudos Transversais , Feminino , Taxa de Filtração Glomerular , Humanos , Pessoa de Meia-Idade , Obesidade/epidemiologia
12.
Mymensingh Med J ; 30(4): 1051-1059, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34605476

RESUMO

Neutrophil Gelatinase-Associated Lipocalin (NGAL) is rapidly released by renal tubules after injury, potentially allowing early identification of acute kidney injury (AKI) after cardiac surgery. However, the diagnostic performance of NGAL has varied widely in clinical studies and it remains unknown what factors modify the relationship between NGAL and AKI. The main objective of the study was to determine the efficacy of NGAL in early detection of AKI among the CABG patients undergoing cardiopulmonary bypass (CPB). This prospective observational study was conducted in the Department of Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh in collaboration with the Department of Biochemistry, BSMMU among 42 patients admitted into the Department of Cardiac Surgery, Ibrahim Cardiac Hospital and Research Institute, Dhaka Bangladesh from July 2014 to June 2015. For the measurement of NGAL, urine samples were obtained before surgery and 6 hours after commencement of CPB. Serum creatinine was measured preoperatively and 6, 24 and 48 hours postoperatively. Increase in the serum creatinine level at 6, 24 and 48 hours after surgery was used to analyze the diagnostic value of urinary NGAL. In this study 42 CABG patients with no known renal insufficiency planned to have CPB were included. Receiver-operator characteristic (ROC) was constructed by using NGAL, which gave a cut off value of ≥185.90ng/ml. Eight patients were AKI positive among them 6(75.0%) patients were NGAL positive and 2(25.0%) were NGAL negative. Diagnosis of AKI was delayed by 24-48 hours by serum creatinine measurement. This study has demonstrated that level of urinary NGAL concentration at 6 hours post CPB increased before the increase of serum creatinine level and NGAL is an early predictor of AKI in adult cardiac surgical patients. The early detection of renal injury by NGAL may allow earlier intervention in patients with high risk for AKI.


Assuntos
Injúria Renal Aguda , Ponte Cardiopulmonar , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/etiologia , Proteínas de Fase Aguda , Adulto , Bangladesh , Biomarcadores , Ponte Cardiopulmonar/efeitos adversos , Ponte de Artéria Coronária , Creatinina , Humanos , Lipocalina-2 , Lipocalinas , Valor Preditivo dos Testes , Proteínas Proto-Oncogênicas
13.
Enzyme Microb Technol ; 151: 109913, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34649686

RESUMO

Dunaliella bardawil, a unicellular green alga, can accumulate a large amount of lutein and ß-carotene under stresses. Using chemical inducers combined with abiotic stress to promote the accumulation of high value-added products such as lipids and carotenoids in microalgae has attracted more and more attention. In this study, creatinine was added into autotrophic medium to investigate its effects on the growth, chlorophyll content, and the ingredients and content of carotenoids in D. bardawil. The results showed that creatinine alone could significantly increase the biomass, chlorophyll and carotenoid contents of D. bardawil, among which the contents of lutein and ß-carotene were further increased, while the content of zeaxanthin was decreased. In order to further improve the content of the two carotenoids, different light intensities combined with creatinine have been adopted. Under 6.589 W/m2 light intensity, creatinine could effectively increase the production of lutein, zeaxanthin, α-carotene and ß-carotene. Compared with the control, the content of lutein increased by 46 % and the content of ß-carotene increased by 77 % when the concentration of creatinine was 500 µg/mL. In conclusion, creatinine can effectively improve the production lutein and ß-carotene in D. bardawil, which is more conducive under lower light intensity.


Assuntos
Clorofíceas , beta Caroteno , Carotenoides , Creatinina , Luteína
14.
Anal Chim Acta ; 1183: 338748, 2021 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-34627521

RESUMO

Creatinine biosensing is a rapidly developing field owing to the clinical relevance of creatinine as a vital biomarker for several diseases associated with renal, thyroidal, and muscular dysfunctions. Over the years, we have observed numerous creatinine biosensing strategies, including the most widely studied enzymatic creatinine biosensors. Though the enzymatic approach provides excellent selectivity and reliability, it has certain drawbacks, which include high fabrication cost and poor storage stability (that is inherent to every enzyme-based biosensors). This has led to the development of non-enzymatic creatinine biosensors, of which electrochemical sensors are the most promising for point-of-care applications. However, only a limited number of studies have been conducted and there is a lack of reviews addressing the recent advances in this research area. Herein, we present for the first time, a review with a prime focus on the various strategies implemented in non-enzymatic electrochemical creatinine biosensing. We aim to offer a comprehensive context on the achievements and limitations of currently available non-enzymatic electrochemical creatinine biosensors and address the underlying factors pertaining to the interplay of modification/fabrication techniques with the sensitivity, selectivity, interferences, and long-term storage stability of the biosensor. We hope that this work shall prove to be seminal in the conception and advancement of future non-enzymatic electrochemical creatinine biosensors.


Assuntos
Técnicas Biossensoriais , Creatinina , Sistemas Automatizados de Assistência Junto ao Leito , Reprodutibilidade dos Testes
15.
FP Essent ; 509: 11-19, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34643360

RESUMO

Acute kidney injury (AKI) is characterized by an abrupt decrease in renal function or the onset of frank renal failure. Kidney Disease: Improving Global Outcomes (KDIGO) defines AKI as an increase in the serum creatinine (SCr) level of 0.3 mg/dL or more within 48 hours, an SCr level increase of 1.5 times or more of the baseline level within 7 days, or a decrease in urine output to less than 0.5 mL/kg/hour for 6 hours. AKI severity is determined by the degree of SCr increase or decrease in urine output. AKI typically is caused by systemic illness or toxic exposure. Thus, determining the cause is critical when possible. The history should focus on risk factors, including nephrotoxic drugs. The physical examination should include determination of fluid volume status. Urinalysis with microscopy can narrow the differential diagnosis. AKI management includes control of the underlying cause, achievement and maintenance of euvolemia, nutritional optimization, blood glucose control, and pharmacotherapy. Treatment with fluid resuscitation or diuresis is guided by the volume status. Emergent referral to a nephrology subspecialist is recommended for patients with stage 2 or 3 AKI; patients with stage 1 AKI and a concomitant, decompensated condition; or if the etiology of the AKI is unclear. Urgent referral should be considered if the injury does not improve with treatment or if glomerulonephritis is suspected.


Assuntos
Injúria Renal Aguda , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/terapia , Creatinina , Humanos , Fatores de Risco
16.
FP Essent ; 509: 20-25, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34643361

RESUMO

Chronic kidney disease (CKD) affects 37 million US adults. It is characterized by damage to the renal glomeruli, vascular supply, and/or tubulointerstitium through complex processes involving inflammation, fibrosis, and hyperfiltration. CKD typically is asymptomatic but may be detected incidentally via urinalysis showing proteinuria or blood test results showing an elevated creatinine level. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation is the most accurate creatinine-based method for estimating glomerular filtration rate (GFR) in routine practice. Cystatin C level measurement can be considered if patients have factors that might make creatinine-based equations inaccurate (eg, high or low muscle mass). CKD is defined as a GFR less than 60 mL/min/1.73 m2 or persistent evidence of kidney damage on imaging, biopsy, or urinalysis that persists for longer than 3 months. CKD is classified into stages based on estimated GFR, degree of proteinuria, and the cause. Screening guidelines vary. Screening should be considered if patients are at high risk of CKD (eg, patients with diabetes, hypertension, cardiovascular disease, family history of kidney failure). After CKD is identified, is it important to identify and reduce or eliminate exposure to nephrotoxic drugs. Management goals include mitigation of CKD risk factors to slow disease progression, including optimizing management of underlying conditions (eg, hypertension, diabetes).


Assuntos
Insuficiência Renal Crônica , Creatinina , Taxa de Filtração Glomerular , Humanos , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Fatores de Risco
17.
Medicine (Baltimore) ; 100(40): e27422, 2021 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-34622851

RESUMO

ABSTRACT: As severe acute respiratory syndrome coronavirus 2 continues to spread, easy-to-use risk models that predict hospital mortality can assist in clinical decision making and triage. We aimed to develop a risk score model for in-hospital mortality in patients hospitalized with 2019 novel coronavirus (COVID-19) that was robust across hospitals and used clinical factors that are readily available and measured standardly across hospitals.In this retrospective observational study, we developed a risk score model using data collected by trained abstractors for patients in 20 diverse hospitals across the state of Michigan (Mi-COVID19) who were discharged between March 5, 2020 and August 14, 2020. Patients who tested positive for severe acute respiratory syndrome coronavirus 2 during hospitalization or were discharged with an ICD-10 code for COVID-19 (U07.1) were included. We employed an iterative forward selection approach to consider the inclusion of 145 potential risk factors available at hospital presentation. Model performance was externally validated with patients from 19 hospitals in the Mi-COVID19 registry not used in model development. We shared the model in an easy-to-use online application that allows the user to predict in-hospital mortality risk for a patient if they have any subset of the variables in the final model.Two thousand one hundred and ninety-three patients in the Mi-COVID19 registry met our inclusion criteria. The derivation and validation sets ultimately included 1690 and 398 patients, respectively, with mortality rates of 19.6% and 18.6%, respectively. The average age of participants in the study after exclusions was 64 years old, and the participants were 48% female, 49% Black, and 87% non-Hispanic. Our final model includes the patient's age, first recorded respiratory rate, first recorded pulse oximetry, highest creatinine level on day of presentation, and hospital's COVID-19 mortality rate. No other factors showed sufficient incremental model improvement to warrant inclusion. The area under the receiver operating characteristics curve for the derivation and validation sets were .796 (95% confidence interval, .767-.826) and .829 (95% confidence interval, .782-.876) respectively.We conclude that the risk of in-hospital mortality in COVID-19 patients can be reliably estimated using a few factors, which are standardly measured and available to physicians very early in a hospital encounter.


Assuntos
COVID-19/mortalidade , Mortalidade Hospitalar/tendências , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Comorbidade , Grupos de Populações Continentais , Creatinina/sangue , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Modelos Logísticos , Masculino , Michigan/epidemiologia , Pessoa de Meia-Idade , Oximetria , Prognóstico , Curva ROC , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , SARS-CoV-2 , Índice de Gravidade de Doença , Fatores Sexuais , Fatores Socioeconômicos
18.
Clinics (Sao Paulo) ; 76: e2942, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34669873

RESUMO

OBJECTIVES: This study assessed the protective effect of calcium dobesilate against contrast-induced nephropathy (CIN) after coronary angiography (CAG) or percutaneous coronary intervention (PCI) in patients with diabetes and chronic kidney disease (CKD). METHODS: A total of 130 patients with diabetes and CKD estimated glomerular filtration rate: 30-90 mL/min/1.73m2 were enrolled and included in the analysis. They were divided into experimental (n=65) and control groups (n=65). Patients in the experimental group were administered oral calcium dobesilate (500 mg) three times daily for 2 days before and 3 days after the procedure. The serum creatinine (SCr), cystatin C (Cys C), and neutrophil gelatinase-associated lipocalin (NGAL) levels were measured before and after the procedure. RESULTS: The mean SCr level at 24h after the procedure was found to be significantly lower in the experimental group than in the control group (79.1±19.6 µmol/L vs. 87.0±19.3 µmol/L, p=0.023). However, the Cys C and NGAL levels were not significantly different between the two groups at all measurement time points (all p>0.05). The incidence of CIN defined by the SCr level was significantly lower in the experimental group than in the control group (3 [4.6%] vs. 13 [20.0%], p=0.017). However, the incidence of CIN defined by the Cys C level was not statistically different between the two groups (7 [10.8%] vs. 7 [10.8%], p=1.000). CONCLUSIONS: This study revealed that calcium dobesilate has no preventive effect against CIN in patients with diabetes and CKD.


Assuntos
Dobesilato de Cálcio , Diabetes Mellitus , Nefropatias , Intervenção Coronária Percutânea , Insuficiência Renal Crônica , Biomarcadores , Meios de Contraste/efeitos adversos , Angiografia Coronária , Creatinina , Taxa de Filtração Glomerular , Humanos , Insuficiência Renal Crônica/complicações
19.
Zhonghua Er Ke Za Zhi ; 59(11): 942-948, 2021 Nov 02.
Artigo em Chinês | MEDLINE | ID: mdl-34711029

RESUMO

Objective: To compare the consistency in diagnosing and staging acute kidney injury (AKI) in children with chronic kidney disease (CKD) according to three criterias. Methods: Children with CKD hospitalized in the First Affiliated Hospital of Sun Yat sen University from January 2013 to December 2019 were analyzed retrospectively. These patients underwent serum creatinine examination more than twice during hospitalization. The AKI diagnosis and staging were performed for each patient according to the 2007 pRIFLE, 2012 KDIGO and 2018 pROCK criteria respectively. All the children were followed up for 1 year after discharge through outpatient visit, re-hospitalization or online consultation. The clinical characteristics and prognosis of CKD children with or without AKI that were diagnosed by 3 criteria were compared. Analysis of variance and chi-squared tests were used for the comparison among groups. Concordance between the different diagnostic criteria was evaluated using Cohen's kappa coefficient. Result: A total of 2 551 children with CKD were included in this study, with an age of (8±4) years. There were 1 628 boys and 923 girls. Nephrotic syndrome was the most prevalent primary disease (55.4%), followed by lupus nephritis (11.2%) and purpura nephritis (8.2%). Among all stages of CKD, CKD category G1 was the most common type (2 146 cases, 84.1%), followed by CKD category G2 (221 cases, 8.7%). AKI occurence rates according to pRIFLE, KDIGO and pROCK criteria were 33.9% (866/2 551), 26.2%(669/2 551) and 19.5% (498/2 551) respectively (χ²=136.3,P<0.01). The diagnostic consistency within three criteria for AKI was high in children with CKD (κ=0.702), but AKI staging consistency was low (κ=0.329). Both the diagnosis and staging consistency of three AKI criteria were poor in children with CKD category G5 (all κ<0.400). The length of hospital stay (LOS), hospitalization costs, the occurence of intensive care unit (ICU) admission and in-hospital mortality were significantly higher in children with AKI diagnosed by different criteria (P<0.05). After 1-year follow-up, the repeated admission rate and CKD staging progress significantly increased in children with AKI (P<0.05). In children with baseline serum creatinine≥200 µmol/L, compared with children who did not experience AKI during hospitalization, the LOS and the hospitalization costs in children who were diagnosed AKI according to pRIFLE or pROCK criteria was significantly higher (P<0.05). However, there was no significant difference in the LOS and hospitalization costs between children with or without AKI who were diagnosed according to KDIGO criteria (all P>0.05). Conclusions: AKI diagnosed by all of the three criteria (pRIFLE, KDIGO and pROCK criteria) was associated with the poor prognosis in children with CKD. However, in those whose baseline serum creatinine≥ 200 µmol/L, AKI diagnosed by pRIFLE and pROCK criteria could better reflect the poor outcomes than by KDIGO criteria.


Assuntos
Injúria Renal Aguda , Insuficiência Renal Crônica , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/etiologia , Criança , Pré-Escolar , Creatinina , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/diagnóstico , Estudos Retrospectivos
20.
Lancet Diabetes Endocrinol ; 9(11): 755-766, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34619106

RESUMO

BACKGROUND: Reductions in albuminuria are associated with a subsequent lower risk of kidney failure in patients with chronic kidney disease. The SGLT2 inhibitor dapagliflozin significantly reduced albuminuria in patients with type 2 diabetes and normal or near-normal kidney function. Whether this effect persists in patients with chronic kidney disease with and without type 2 diabetes is unknown. We assessed the effects of dapagliflozin on albuminuria in patients with chronic kidney disease with and without type 2 diabetes in the dapagliflozin and prevention of adverse outcomes in chronic kidney disease (DAPA-CKD) trial. METHODS: DAPA-CKD was a multicentre, double-blind, placebo-controlled, randomised trial done at 386 sites in 21 countries. Patients were eligible for the trial if they had chronic kidney disease, defined as an estimated glomerular filtration rate (eGFR) between 25 mL/min per 1·73 m2 and 75 mL/min per 1·73 m2 and a urinary albumin-to-creatinine ratio (UACR) between 200 mg/g and 5000 mg/g (22·6 to 565·6 mg/mmol). Participants were randomly assigned to dapagliflozin 10 mg (AstraZeneca; Gothenburg, Sweden) once daily or matching placebo, in accordance with the sequestered, fixed randomisation schedule, using balanced blocks to ensure an approximate 1:1 ratio. Change in albuminuria was a pre-specified exploratory outcome of DAPA-CKD. Regression in UACR stage, defined as a transition from macroalbuminuria (≥300 mg/g) to microalbuminuria or normoalbuminuria (<300 mg/g), and progression in UACR stage, defined as a transition from less than 3000 mg/g to 3000 mg/g or greater, were additional discrete endpoints. The trial is registered with ClinicalTrials.gov, NCT03036150. FINDINGS: Between Feb 2, 2017, and April 3, 2020, 4304 patients were recruited and randomly assigned to either dapagliflozin (n=2152) or placebo (n=2152). Median UACR was 949 mg/g (IQR 477 to 1885). Overall, compared with placebo, dapagliflozin reduced geometric mean UACR by 29·3% (95% CI -33·1 to -25·2; p<0·0001); relative to placebo, treatment with dapagliflozin resulted in a geometric mean percentage change of -35·1% (95% CI -39·4 to -30·6; p<0·0001) in patients with type 2 diabetes and -14·8% (-22·9 to -5·9; p=0·0016) in patients without type 2 diabetes over the follow-up visits (pinteraction<0·0001) Among 3860 patients with UACR of 300 mg/g or greater at baseline, dapagliflozin increased the likelihood of regression in UACR stage (hazard ratio 1·81, 95% CI 1·60 to 2·05). Among 3820 patients with UACR less than 3000 mg/g at baseline, dapagliflozin decreased the risk of progression in UACR stage (0·41, 0·32 to 0·52). Larger reductions in UACR at day 14 during dapagliflozin treatment were significantly associated with attenuated eGFR decline during subsequent follow-up (ß per log unit UACR change -3·06, 95% CI -5·20 to -0·90; p=0·0056). INTERPRETATION: In patients with chronic kidney disease with and without type 2 diabetes, dapagliflozin significantly reduced albuminuria, with a larger relative reduction in patients with type 2 diabetes. The similar effects of dapagliflozin on clinical outcomes in patients with or without type 2 diabetes, but different effects on UACR, suggest that part of the protective effect of dapagliflozin in patients with chronic kidney disease might be mediated through pathways unrelated to reduction in albuminuria. FUNDING: AstraZeneca.


Assuntos
Albuminúria/tratamento farmacológico , Compostos Benzidrílicos/uso terapêutico , Diabetes Mellitus Tipo 2/urina , Glucosídeos/uso terapêutico , Insuficiência Renal Crônica/urina , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Idoso , Creatinina/urina , Diabetes Mellitus Tipo 2/tratamento farmacológico , Nefropatias Diabéticas/tratamento farmacológico , Nefropatias Diabéticas/urina , Método Duplo-Cego , Feminino , Taxa de Filtração Glomerular/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Placebos , Insuficiência Renal/prevenção & controle , Insuficiência Renal Crônica/tratamento farmacológico
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