Evaluation of glomerular filtration rate estimation equations based on serum creatinine in healthy Chinese children and adolescents: a nationwide cross-sectional study.

BACKGROUND: Several equations for glomerular filtration rate (GFR) estimation based on serum creatinine (SCr) have been proposed for children, but most were developed among patients with kidney disease. The association between SCr and GFR may be distorted by kidney dysfunction and thus not applicable to healthy children. This study aimed to evaluate the applicability of existing SCr-based GFR estimation equations in healthy Chinese children. METHODS: GFR estimation equations that developed in healthy children were mainly analysed, including the Flanders Metadata (FM), simple height-independent (Simple), full age spectrum (FAS) and FAS-height equations. The FM equation assumed that GFR is proportional to the ratio of height to SCr. The Simple, FAS and FAS-height equations assumed that the ratio of GFR to population mean is equal to the reciprocal ratio of SCr to population mean (denoted by Q). Estimated GFR were calculated using data of SCr, age, sex and height collected from 12 208 healthy Chinese children aged 3 months to <20 years. The performance of GFR estimation equations was evaluated by the sex and age distribution of the estimated GFR and the deviation from the measured GFR reported by other literatures. RESULTS: The FM and Simple equations performed well in their applicable age of 1 month to 14 years, but presented undesirable sex difference after adolescence. The FAS and FAS-height equations showed reasonable development trend of estimated GFR throughout childhood, and the FAS equation had higher consistency than the FAS-height equation compared with measured GFR in healthy children. The GFR estimated by the FAS equation increased with age before 2 years, and reached the adult level thereafter without important sex difference. CONCLUSIONS: The FAS equation is applicable to healthy Chinese children.

Definition, Staging, and Role of Biomarkers in Acute Kidney Injury in the Context of Cardiovascular Interventions.

Acute kidney injury (AKI) is a frequently occurring complication of cardiovascular interventions, and associated with adverse outcomes. Therefore, a clear definition of AKI is of paramount importance to enable timely recognition and treatment. Historically, changes in the serum creatinine and urine output have been used to define AKI, and the criteria have evolved over time with better understanding of the impact of AKI on the outcomes. However, the reliance on serum creatinine for these AKI definitions carries numerous limitations including delayed rise, inability to differentiate between hemodynamics versus structural injury and assay variability to name a few.

African American/Black race, apolipoprotein L1 , and serum creatinine among persons with HIV.

OBJECTIVE: Accurate estimation of kidney function is critical among persons with HIV (PWH) to avoid under-dosing of antiretroviral therapies and ensure timely referral for kidney transplantation. Existing estimation equations for kidney function include race, the appropriateness of which has been debated. Given advancements in understanding of race and the necessity of accuracy in kidney function estimation, this study aimed to examine whether race, or genetic factors, improved prediction of serum creatinine among PWH. DESIGN: This cross-sectional study utilized data from the Center for AIDS Research Network of Integrated Clinical Systems cohort (2008-2018). The outcome was baseline serum creatinine. METHODS: Ordinary least squares regression was used to examine whether inclusion of race or genetic factors [ apolipoprotein-L1 ( APOL1 ) variants and genetic African ancestry] improved serum creatinine prediction. A reduction in root mean squared error (RMSE) greater than 2% was a clinically relevant improvement in predictive ability. RESULTS: There were 4183 PWH included. Among PWH whose serum creatinine was less than 1.7 mg/dl, race was significantly associated with serum creatinine ( ß â€Š= 0.06, SE = 0.01, P  < 0.001) but did not improve predictive ability. African ancestry and APOL1 variants similarly failed to improve predictive ability. Whereas, when serum creatinine was at least 1.7 mg/dl, inclusion of race reduced the RMSE by 2.1%, indicating improvement in predictive ability. APOL1 variants further improved predictive ability by reducing the RMSE by 2.9%. CONCLUSION: These data suggest that, among PWH, inclusion of race or genetic factors may only be warranted at higher serum creatinine levels. Work eliminating existing healthcare disparities while preserving the utility of estimating equations is needed.

Pseudohypercreatininemia after surgery for aortic dissection: a case report.

BACKGROUND: Elevated creatinine concentrations often indicate acute renal injury and renal biopsies are considered in this situation. However,pseudohypercreatininemia is potential cause of elevated creatinine concentrations, and invasive interventions should be avoided. CASE PRESENTATION: A 54-year-old woman underwent surgery for descending aortic dissection.Nine days postoperatively, her creatinine concentration increased from 1 mg/dl to 5.78 mg/dl (normal range, 0.47-0.7 mg/dl). Azotemia and hyperkalemia were absent and physical examination findings were unremarkable. Cystatin C concentration was 1.56 mg/l (normal range, 0.56-0.8 mg/l) and pseudohypercreatininemia was suspected. Testing with different reagents showed a creatinine concentration of 0.84 mg/dl. Immunoglobulin (Ig)G was markedly elevated, and creatinine and IgG fluctuated in parallel, suggesting the cause of the pseudohypercreatininemia. IgG4 was also elevated at 844 mg/dl. Immunosuppressive steroid therapy effectively decreased the IgG concentration and resolved the pseudohypercreatininemia. CONCLUSIONS: In cases of elevated creatinine concentration with the presence of abnormal proteins, pseudohypercreatininemia should be considered. We report a rare case of pseudohypercreatininemia caused by polyclonal IgG.

Assessing the Burden of Kidney Disease among Type 2 Diabetic Subjects Attending a Semi-Urban Tertiary Health Facility in South-West Nigeria.

BACKGROUND AND OBJECTIVES: Diabetes Mellitus (DM) remains an important public health issue and its complications are important causes of morbidity and mortality. Diabetic nephropathy (DN) is one of these complications and could be prevented/delayed by early detection. This study determined the burden of DN among patients with type 2 diabetes (T2DM). METHODS: This cross-sectional, hospital-based study was conducted among 100 T2DM patients attending the medical outpatient clinics of a tertiary hospital in Nigeria and 100 age- and sex-matched healthy controls. The procedure included collection of sociodemographic parameters, urine for microalbuminuria and blood samples for estimation of fasting plasma glucose, glycated haemoglobin (HbA1c), and creatinine. Estimated creatinine clearance (eGFR) was derived from two formulae - Cockroft Gault formula, and Modification of Diet in Renal Disease study (MDRD) for staging chronic kidney disease. Data were analysed using the IBM SPSS version 23 software. RESULTS: Participants' ages ranged from 28 years to 73 years [mean 53.0 (±10.7) years] with males accounting for 56% of the population and females 44%. Mean HbA1c was 7.6 (±1.8) % among the subjects; 59% had poor glycaemic control with HbA1c >7% (p-value <0.001). Overt proteinuria was present in 13% of T2DM participants while 48% had microalbuminuria compared to the non-diabetic group where 2% had overt proteinuria and 17% had microalbuminuria. Using the eGFR, chronic kidney disease was present in 14% of T2DM group and in 6% of the non-diabetic population. Increased age [OR= 1.09; 95%CI (1.03-1.14)], male sex [OR = 3.50; 95%CI (1.13 10.88)], and duration of diabetes [OR =1.01; 95%CI (1.00-1.01)] were associated with DN. CONCLUSION: The burden of diabetic nephropathy is high in the T2DM patients attending our clinic and this is linked with advancing age.

CONTEXTE ET OBJECTIFS: Le diabète sucré (DM) reste un problème de santé publique important, et ses complications sont des causes importantes de morbidité et de mortalité. La néphropathie diabétique (DN) est l'une de ces complications et pourrait être évitée/ retardée par une détection précoce. Cette étude a déterminé le poids de la néphropathie diabétique chez les patients atteints de diabète detype 2 (DT2). MÉTHODES: Cette étude transversale en milieu hospitalier a été menée auprès de 100 patients atteints de diabète de type 2 fréquentant les consultations médicales externes d'un hôpital tertiaire au Nigeria, et de 100 témoins sains appariés selon l'âge et le sexe. La procédure comprend la collecte de paramètres sociodémographiques, d'urine pour la microalbuminurie et d'échantillons de sang pour l'estimation de la glycémie à jeun, de l'hémoglobine glyquée (HbA1c) et de la créatinine. La clairance estimée de la créatinine (eGFR) a été calculée à partir de deux formules : i) la formule de Cockroft Gault ii) l'étude de Modification de diète en maladie rénale (MDRD) pour la stadification de l'insuffisance rénale chronique. Les données ont été analysées à l'aide du logiciel IBM SPSS version 23. RÉSULTATS: Les participants étaient âgés de 28 à 73 ans [moyenne 53,0 (±10,7) ans], les hommes représentant 56 % de la population et les femmes 44 %. L'HbA1c moyenne était de 7,6 (±1,8) % chez les sujets ; 59 % avaient un mauvais contrôle glycémique avec une HbA1c >7 % (valeur p <0,001). Une protéinurie manifeste était présente chez 13 % des participants atteints de DT2, tandis que 48 % présentaient une microalbuminurie, par rapport au groupe non diabétique, où 2 % présentaient une protéinurie manifeste et 17 % une microalbuminurie. En utilisant le DFGe, la maladie rénale chronique était présente chez 14 % du groupe DT2 et chez 6 % de la population non diabétique. L'âge élevé [OR= 1,09 ; 95%CI (1,03 - 1,14)], le sexe masculin [OR = 3,50 ; 95%CI (1,13 - 10,88)] et la durée du diabète [OR =1,01 ; 95%CI (1,00 - 1,01)] étaient associés à la DN. CONCLUSION: Le fardeau de la néphropathie diabétique est élevé chez les patients atteints de DT2 qui fréquentent notre clinique et ceci est lié à l'âge avancé. Mots-clés: Maladie rénale diabétique, Complications du diabète, Diabète de type 2, Durée du diabète, Âge, Hypertension.

Avaliação da função renal em coelhos utilizando anti inflamatórios não esteroidais (aines) / Evaluation of renal function in rabbits using non-steroidal anti-inflammatory (aines)

Introdução: Rins são órgãos vitais para o funcionamento do organismo, fazendo parte do sistema excretor e osmorregulador, cujas funções consistem em realizar a filtração do sangue e excretar produtos finais de diversos metabolismos, além de produzirem hormônios, fundamentais para o corpo humano. Com isso em mente, destaca-se que uma causa comum para o surgimento de doenças renais crônicas é o uso exacerbado de medicamentos anti inflamatórios. Objetivo: Relacionar, por meio da análise de creatinina e a taxa de filtração glomerular, a real influência do uso de anti-inflamatórios não esteroidais na função renal. Materiais e Métodos: Estudo experimental, realizado com 8 coelhos com maturidade reprodutiva e peso superior a 1kg, tendo sido escolhidos devido às limitações impostas para animais de pequeno porte, como ratos e camundongos, em exames laboratoriais e de imagem. Resultados: Divididos em 4 grupos, com 2 coelhos em cada um deles, cada qual recebeu um anti-inflamatório não esteroide (AINE) correspondente, administrados por via oral (suspensão). Os coelhos 1 e 2 receberam Ibuprofeno, 3 e 4 Diclofenaco, 5 e 6 Nimesulida e 7 e 8 Cetoprofeno. A avaliação da função renal deu-se pela dosagem periódica da creatinina sérica e a taxa de filtração glomerular, medida por cintilografia renal dinâmica em clínica de medicina nuclear. Os coelhos (grupos 1 e 7) tiveram índices aumentados de creatinina, vindo a óbito por miopatia, e o do grupo 8 teve pneumonia. Após 42 dias de uso da medicação, 5 coelhos apresentaram valores de creatinina considerados normais. Conclusão: Conseguiu-se, por meio do experimento, demonstrar que, apesar de os anti-inflamatórios não esteroidais não necessariamente constituírem risco renal significativo, é importante utilizar esses fármacos com cautela, tendo em vista as alterações evidenciadas no estudo

Introduction: Kidneys are vital organs for the functioning of the body, being part of the excretory and osmoregulating system, whose functions consist of performing blood filtration and excreting end products of various metabolisms, in addition to producing hormones, fundamental to the human body. With this in mind, it is noteworthy that a common cause for the emergence of chronic kidney diseases is the exacerbated use of anti-inflammatory drugs. Objective: To relate, through creatinine analysis and glomerular filtration rate, the real influence of the use of non-steroidal anti inflammatory drugs on renal function. Materials and Methods: Experimental study, performed with 8 rabbits with reproductive maturity and weight greater than 1kg, and were chosen due to the limitations imposed on small animals, such as rats and mice, in laboratory and imaging tests. Results: Divided into 4 groups, with 2 rabbits in each of them, each of which received a corresponding non-steroidal anti-inflammatory (NSAID) administered orally (suspension). Rabbits 1 and 2 received Ibuprofen, 3 and 4 Diclofenac, 5 and 6 Nimesulida and 7 and 8 Cetoprofen. The evaluation of renal function was performed by periodic measurement of serum creatinine and glomerular filtration rate, measured by dynamic renal scintigraphy in a nuclear medicine clinic. Rabbits (groups 1 and 7) had increased rates of creatinine, coming to obito for myopathy, and group 8 had pneumonia. After 42 days of medication use, 5 rabbits had creatinine values considered normal. Conclusion: It was possible, through the experiment, to demonstrate that, although non steroidal anti-inflammatory drugs do not necessarily constitute significant renal risk, it is important to use these drugs with caution, considering the changes evidenced in the study

Introducción: Los riñones son órganos vitales para el funcionamiento del organismo, formando parte del sistema excretor y osmorregulador, cuyas funciones consisten en filtrar la sangre y excretar productos finales de diversos metabolismos, además de producir hormonas, fundamentales para el cuerpo humano. Con eso en mente, cabe señalar que una causa común para la aparición de la enfermedad renal crónica es el uso exacerbado de medicamentos antiinflamatorios. Objetivo: Relacionar, mediante el análisis de la creatinina y el filtrado glomerular, la influencia real del uso de antiinflamatorios no esteroideos sobre la función renal. Materiales y Métodos: Estudio experimental realizado con 8 conejos en madurez reproductiva y con peso superior a 1 kg, habiendo sido elegidos por las limitaciones impuestas para animales pequeños, como ratas y ratones, en pruebas de laboratorio y de imagen. Resultados: Divididos en 4 grupos, con 2 conejos en cada grupo, cada uno de los cuales recibió un fármaco antiinflamatorio no esteroideo (AINE) correspondiente, administrado por vía oral (suspensión). Los conejos 1 y 2 recibieron Ibuprofeno, 3 y 4 Diclofenaco, 5 y 6 Nimesulida y 7 y 8 Ketoprofeno. La evaluación de la función renal se realizó mediante la medición periódica de la creatinina sérica y la tasa de filtración glomerular, medidos por gammagrafía renal dinámica en una clínica de medicina nuclear. Los conejos (grupo 1 y 7) tenían niveles elevados de creatinina, falleciendo por miopatía, y el del grupo 8 tenía neumonía. Después de 42 días de uso de medicamentos, 5 conejos tenían valores de creatinina considerados normales. Conclusión: Fue posible, a través del experimento, demostrar que, aunque los antiinflamatorios no esteroideos no necesariamente constituyen un riesgo renal significativo, es importante utilizar estos fármacos con precaución, frente a los cambios evidenciados en el estudio

Extracellular status of thrombospondin-2 in type 2 diabetes mellitus and utility as a biomarker in the determination of early diabetic kidney disease.

OBJECTIVE: Thrombospondin-2 (TSP-2) is a multifunctional matricellular glycoprotein correlated with glucose homeostasis, insulin sensitivity, and estimated glomerular filtration rate. Investigation of the association of TSP-2 with type 2 diabetes mellitus (T2DM) and the potential diagnostic value of serum TSP-2 for detecting early diabetic kidney disease (DKD) is needed. RESEARCH DESIGN AND METHODS: An enzyme-linked immunosorbent assay was used for detection serum TSP-2 levels in 494 Chinese T2DM subjects. The protein expression of TSP-2 in the kidney and other tissues were tested by western blotting. RESULTS: Serum TSP-2 levels in T2DM subjects were significantly higher than in healthy individuals. Serum TSP-2 correlated positively with triglycerides, serum uric acid, creatinine, platelets, and urinary albumin-to-creatinine ratio (UACR), but negatively with estimated glomerular filtration rate, after adjusting for age, sex, and T2DM duration. Logistic regression analysis demonstrated an independent association between serum TSP-2 and early DKD. Furthermore, the high UACR identified at risk of early DKD increased significantly from 0.78 (95%CI 0.73-0.83) to 0.82 (95%CI 0.77-0.86, p < 0.001) when added to a clinical model consisting of TSP-2 and age. In db/db mice, serum TSP-2 levels were elevated. TSP-2 expression was markedly increased in the kidney tissue compared with that in db/m and m/m mice. Furthermore, serum TSP-2 expression correlated well with UACR in mice. CONCLUSIONS: TSP-2 is a novel glycoprotein associated with early DKD in patients with T2DM. The paradoxical increase of serum TSP-2 in T2DM individuals may be due to a compensatory response to chronic inflammatory and renal vascular endothelial growth, warranting further investigation.

Sarcopenia index based on serum creatinine and cystatin C is associated with mortality in middle-aged and older adults in Chinese: A retrospective cohort study from the China Health and Retirement Longitudinal Study.

Background: The sarcopenia index (SI, serum creatinine/serum cystatin C × 100) is recommended for predicting sarcopenia. There were several studies showing that lower SI is associated with poorer outcomes in the older adults. However, the cohorts studied in these researches were mainly patients hospitalized. The aim of this study was to evaluate the correlation between SI and all-cause mortality among middle-aged and older adults from the China Health and Retirement Longitudinal Study (CHARLS). Materials and methods: A total of 8,328 participants meeting the criteria were enrolled in this study from CHARLS between 2011 and 2012. SI was calculated as [serum creatinine (mg/dL)/cystatin C (mg/L)] × 100. Mann-Whitney U-test and Fisher's exact test were used to assess balance in baseline characteristics. Kaplan-Meier, log-rang analysis, univariate and multivariate Cox hazard ratio regression models were used to compare the mortality between different SI levels. The dose relationship between sarcopenia index and all-cause mortality was further assessed by the cubic spline functions and smooth curve fitting. Results: After adjustment for potential covariates, we found SI was significantly correlated with all-cause mortality [Hazard Ratio (HR) = 0.983, 95% confidence interval (CI) 0.977-0.988, P < 0.001]. Similarly, as SI was used as a categorical variable according to quartiles, higher SI was associated with lower mortality [Hazard Ratio (HR) = 0.44, 95% CI 0.34-0.57, P < 0.001] after adjustment for confounders. Conclusions: Lower sarcopenia index was associated with higher mortality among middle-aged and older adults in China.

¿Es apropiada la aplicación de la nueva ecuación Chronic Kidney Disease Epidemiology Consortium (CKD-EPI 2021) en la población española? / Is the use of the new Chronic Kidney Disease Epidemiology Consortium (CKD-EPI 2021) formula appropriate for the Spanish population?

Introducción Las sociedades estadounidenses de nefrología recomiendan cambiar la ecuación CKD-EPI 2009 por la nueva CKD-EPI 2021, que no incluye el coeficiente de raza, para estimar la tasa de filtrado glomerular (TFGe). Se desconoce cómo podría afectar este cambio a la distribución de la enfermedad renal de la población española predominantemente caucásica. Métodos Se estudiaron dos cohortes de adultos de la provincia de Cádiz, BD-SIDICA (n=264.217 personas) y BD-PANDEMIA (n=64.217), que disponían de mediciones de creatinina plasmática entre 2017 y 2021. Se calcularon los cambios de la TFGe y la consecuente reclasificación en las diferentes categorías de la clasificación KDIGO-2012 al modificar la ecuación CKD-EPI 2009 por la de 2021. Resultados En comparación con la ecuación de 2009, CKD-EPI-21 arrojó una TFGe más alta, con una mediana de 3,8mL/min/1,73m2 (IQR: 2,98-4,48) en BD-SIDICA y de 3,89mL/min/1,73m2 (IQR: 3,05-4,55) en BD-PANDEMIA. Como primera consecuencia, del total de la población, el 15,3% en BD-SIDICA y el 15,1% en BD-PANDEMIA y el 28,1% y el 27,3%, respectivamente, de la población con enfermedad renal (G3-G5), se reclasificó a una categoría de TFGe más alta y ningún sujeto a una más grave. Como segunda consecuencia, la prevalencia de la enfermedad renal disminuyó del 9% al 7,5% en ambas cohortes. Conclusiones Implementar la ecuación CKD-EPI-21 en la población española, predominantemente caucásica, aumentaría la TFGe en una cantidad modesta (mayor en hombres y con mayor edad o TFG) y una proporción importante de la población se clasificaría en una categoría de TFGe superior, con la consiguiente disminución de la prevalencia de la enfermedad renal (AU)

Introduction United States nephrology societies recommend changing from the CKD-EPI 2009 equation to the new CKD-EPI 2021 equation, which does not include the race coefficient, for calculating estimated glomerular filtration rate (eGFR). It is unknown how this change might affect the distribution of kidney disease in the predominantly Caucasian Spanish population. Methods Two databases of adults from the province of Cádiz, DB-SIDICA (n=264,217) and BD-PANDEMIC (n=64,217), that had plasma creatinine measurements recorded between 2017 and 2021 were studied. Changes in eGFR and the consequent reclassification into different categories of the KDIGO2012 classification resulting from substituting the CKD-EPI 2009 equation for the 2021 equation were calculated. Results Compared to the 2009 equation, CKD-EPI 2021 yielded a higher eGFR, with a median of 3.8mL/min/1.73m2 (IQR: 2.98-4.48) in DB-SIDICA and 3.89mL/min/1.73m2 (IQR: 3.05-4.55) in DB-PANDEMIA. The first consequence was that 15.3% of the total population in DB-SIDICA and 15.1% of the total population in DB-PANDEMIA were reclassified into a higher category of eGFR, as were 28.1% and 27.3%, respectively, of the population with CKD (G3-G5); no subjects were classified into the more severe category. The second consequence was that the prevalence of kidney disease decreased from 9% to 7.5% in both cohorts. Conclusions Implementing the CKD-EPI 2021 equation in the Spanish population, which is predominantly Caucasian, would increase eGFR by a modest amount (greater in men and those who are older or have a higher GFR). A significant proportion of the population would be classified into a higher eGFR category, with a consequent decrease in the prevalence of kidney disease (AU)

Cystatin C-Based Equation to Estimate GFR without the Inclusion of Race and Sex.

BACKGROUND: The accuracy of estimation of kidney function with the use of routine metabolic tests, such as measurement of the serum creatinine level, has been controversial. The European Kidney Function Consortium (EKFC) developed a creatinine-based equation (EKFC eGFRcr) to estimate the glomerular filtration rate (GFR) with a rescaled serum creatinine level (i.e., the serum creatinine level is divided by the median serum creatinine level among healthy persons to control for variation related to differences in age, sex, or race). Whether a cystatin C-based EKFC equation would increase the accuracy of estimated GFR is unknown. METHODS: We used data from patients in Sweden to estimate the rescaling factor for the cystatin C level in adults. We then replaced rescaled serum creatinine in the EKFC eGFRcr equation with rescaled cystatin C, and we validated the resulting EKFC eGFRcys equation in cohorts of White patients and Black patients in Europe, the United States, and Africa, according to measured GFR, levels of serum creatinine and cystatin C, age, and sex. RESULTS: On the basis of data from 227,643 patients in Sweden, the rescaling factor for cystatin C was estimated at 0.83 for men and women younger than 50 years of age and 0.83 + 0.005 × (age - 50) for those 50 years of age or older. The EKFC eGFRcys equation was unbiased, had accuracy that was similar to that of the EKFC eGFRcr equation in both White patients and Black patients (11,231 patients from Europe, 1093 from the United States, and 508 from Africa), and was more accurate than the Chronic Kidney Disease Epidemiology Collaboration eGFRcys equation recommended by Kidney Disease: Improving Global Outcomes. The arithmetic mean of EKFC eGFRcr and EKFC eGFRcys further improved the accuracy of estimated GFR over estimates from either biomarker equation alone. CONCLUSIONS: The EKFC eGFRcys equation had the same mathematical form as the EKFC eGFRcr equation, but it had a scaling factor for cystatin C that did not differ according to race or sex. In cohorts from Europe, the United States, and Africa, this equation improved the accuracy of GFR assessment over that of commonly used equations. (Funded by the Swedish Research Council.).

Is It Safe to Increase the Number of Percutaneous Nephrolithotomy Channels: A Systematic Review and Meta-Analysis

Purpose: Percutaneous nephrolithotomy (PCNL) requires perforating the kidney, which may damage part of the patient’s nephron. Further, compared with single-channel PCNL (S-PCNL), the safety of multi-channel PCNL (M-PCNL) and whether it affects the renal function of patients has been debated. The meta-analysis aimed to comprehensively evaluate the safety ofM-PCNL. Methods: We carefully searched the Pubmed, Embass, and Web of Science databases for relevant research reported before October 30, 2021, and analyzed the included literature using the Stata software. Changes in the serum creatinine levels, split renal function and the incidence of postoperative complications were used to evaluate the safety of M-PCNL. Results: Overall, 11 articles were included in this meta-analysis. The results showed that there was no statistically significant difference between S-PCNL and M-PCNL in terms of changes in serum creatinine levels (pooled Mean Difference (MD) = –0.015,95% CI: –0.047–0.018, I2 = 0.0%, p = 0.92). Further, a sensitivity analysis showed that our conclusions were stable. With thep-values in both Egger’s and Begg’s tests being greater than 0.05, there was no significant publication bias in the included literature. A subgroup analysis based on patient ethnicity yielded consistent results. Our meta-analysis yielded similar results interms of changes in split renal function (pooled MD = 0.008, 95% CI: –0.013–0.030, I2 = 96%, p < 0.01). There was no significant difference in the incidence of postoperative renal perforation between M-PCNL and S-PCNL (pooled Odds Ratio (OR) = 1.686,95% CI: 0.677–4.193, I2 = 0.0%, p = 0.66). However, M-PCNL was found to cause more postoperative blood transfusion, postoperative infection, and pleural damage than S-PCNL (pooled OR = 3.104, 95% CI: 2.277–4.232, I2 = 46%, p = 0.03, pooled OR= 1.862, 95% CI: 1.165–2.974, I2 = 0%, p = 0.46, and pooled OR = 3.446, 95% CI: 1.168–10.171, I2 = 0%, p = 1.00 respectively). (AU)

Changes in bone turnover markers in adolescents with gastroesophageal reflux disease treated with lansoprazole.

Background: Proton pump inhibitors (PPIs) have been suggested to lead to bone resorption, while the effects of PPIs on the bone mineral metabolism in children has received only limited attention in literature to date. The present study investigates whether lansoprazole alters bone turnover markers in adolescents with gastroesophageal reflux disease (GERD). Patients and methods: Included in the study were adolescents aged 16-18 with GERD and a healthy volunteers group. The GERD patient group was treated with lansoprazole 30 mg once daily for eight weeks. The serum calcium, phosphorus, magnesium, alkaline phosphatase (ALP), parathormone (PTH), 25 (OH) vitamin D, osteocalcin and urinary calcium, creatinine, deoxypyridinoline (DPD), collagen type-1 crosslinked C-telopeptide (CTX) and collagen type-1 crosslinked N-telopeptide (NTX) of both groups were studied before and after the end of the treatment. Results: A comparison of the 30 patients with GERD and the 30 volunteers revealed no significant difference in the serum calcium, phosphorus, magnesium, ALP, urinary calcium/creatinine ratio, 25 (OH) vitamin D and PTH levels measured before and after the lansoprazole treatment, while the osteocalcin, DPD, CTX and NTX values were found to be higher after treatment when compared to those at pre- treatment. Conclusions: The results of this study reveal that eight weeks of treatment with 30 mg lansoprazole daily increased the bone turnover markers of CTX, NTX, DPD and osteocalcin in adolescents aged 16-18.

The Incidence, Risk Factors, and Outcomes of Acute Kidney Injury in Patients with Decompensated Cirrhosis: A Retrospective Study

Background: To evaluate the incidence, risk factors, and outcomes of acute kidney injury (AKI) in patients with decompensated cirrhosis based on the Kidney Disease: Improving Global Outcomes Clinical Practice Guideline. Methods: For this retrospective analysis, 923 inpatients were recruited between January 2013 and December 2017. The patients’ baseline demographics and clinical information were collected and analyzed. Univariate and multiple logistic regression analyses were conducted to determine the independent risk factors for AKI and in-hospital mortality. Kaplan–Meier survival analyses were used to analyze the between-group differences in mortality. Results: Of the 923 patients, 262 (28.39%) developed AKI. According to the multivariate analysis, an age ≥65 years (odds ratio [OR]: 1.776, 95% confidence interval [CI]: 1.288–2.449, p < 0.001), infection (OR: 1.386, 95% CI: 1.024–1.875, p = 0.034), hypotension (OR: 1.709, 95% CI: 1.091–2.679, p = 0.019), white blood cell count >10 × 109 /L (OR: 4.054, 95% CI: 2.006–8.193, p < 0.001), albumin concentration <35 g/L (OR: 1.931, 95% CI: 1.392–2.680, p < 0.001), baseline serum creatinine concentration >88.4 µmol/L (OR: 2.136, 95% CI: 1.511–3.021, p < 0.001), estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 (OR: 2.384, 95% CI: 1.372–4.145, p = 0.002), and serum sodium concentration <135 mmol/L (OR: 1.686, 95% CI: 1.155–2.459, p = 0.007) were independent risk factors for AKI. Moreover, AKI was significantly associated with in-hospital mortality (OR: 6.934, 95% CI: 1.333–11.052, p = 0.021). Kaplan–Meier survival analysis confirmed that patients with AKI had higher in-hospital mortality than those without AKI. Conclusions: The incidence of AKI was high among patients with decompensated cirrhosis (AU)

Resultados a largo plazo de la cistoplastia de ampliación: una evaluación retrospectiva de 54 niños / Long-term outcomes of augmentation cystoplasty: A retrospective view of 54 children

Introducción y objetivos: A lo largo de los años los médicos que se ocupan de los trastornos urológicos pediátricos han recurrido a la ampliación vesical (AV), un procedimiento quirúrgico altamente desafiante desarrollado para preservar las funciones renales en diversos casos de anomalías urinarias congénitas. Este estudio tiene como objetivo revelar los resultados de la AV a muy largo plazo en una amplia muestra de pacientes pediátricos, así como el papel de la enfermedad subyacente en el pronóstico renal tras la AV.Materiales y métodosSe realizó un estudio transversal retrospectivo en 54 niños con anomalías urinarias congénitas que fueron sometidos a una AV. Se evaluó la técnica de ampliación utilizada, la localización de la implantación del uréter, las complicaciones y los hallazgos ecográficos. Se recogieron datos sobre los niveles de creatinina sérica en los registros preoperatorios y posteriores a la AV anuales.ResultadosDe los 54 niños 33 (61,1%) eran varones. Los diagnósticos fueron disrafismo espinal (DE) (n=13), válvula uretral posterior (VUP) (n=8), extrofia vesical (n=32) y traumatismo (n=1). La duración media del seguimiento fue de 18 (3-31) años. Las comparaciones de los niveles de creatinina sérica entre los grupos revelaron que, a pesar de que no existían diferencias significativas entre el grupo de extrofia vesical y el de VUP en el periodo preoperatorio ni en el primer año postoperatorio, los casos con VUP presentaban niveles de creatinina sérica significativamente más altos en los siguientes años posteriores a la cirugía. Además, en comparación con el grupo de DE, los sujetos con VUP tenían niveles significativamente más altos en el segundo (p=0,035) y décimo año (p=0,006) del postoperator. (AU)

Introduction and objectives: Throughout the years, clinicians dealing with pediatric urology disorders have resorted to bladder augmentation (BA), a demanding surgical procedure, to preserve renal functions in sundry congenital urinary tract defects. This study aimed to reveal the very long-term outcomes of BA in a large sample of pediatric patients and the role of underlying disease on renal prognosis after BA.Materials and methodsA retrospective cross-sectional study was conducted on 54 children with congenital urinary defects who underwent BA. The utilized augmentation technique, the location of ureter implantation, complications, and ultrasonography findings were analyzed. Data on serum creatinine levels were collected from preoperative records and anniversaries following BA.ResultsAmong 54 children, 33 (61.1%) were boys. Diagnoses were spinal dysraphism (SD) (n=13), posterior urethral valve (PUV) (n=8), bladder exstrophy (n=32) and trauma (n=1). The median follow-up duration was 18 (3-31) years. The comparisons of serum creatinine levels between groups revealed that, despite no meaningful difference was present between bladder exstrophy and PUV group in the preoperative period and postoperative 1st year, cases with PUV had significantly higher levels of serum creatinine levels in the following postoperative years. Therewithal compared with the SD group, subjects with PUV had significantly higher levels at the postoperative 2nd year (P=.035) and 10th year (P=.006).ConclusionsIn our study, significantly long-term follow-up outcomes could facilitate the pre- and postoperative approach for enterocystoplasty in children. According to our results, it is noteworthy that kidney functions are at high risk of worsening in subjects with PUV and underwent BA. (AU)

Effect of Ischemia Times and Donor and Recipient Features on Maastricht Category III Kidney Transplant Outcomes

Objective: Expansion of the donor pool has been enabled by the use of donation after circulatory death (DCD). The aim of this study is to identify what donation features are able to predict kidney transplant (KT) outcomes from DCD. Materials and Methods: A prospective analysis of all DCD KT from June 2016 to November 2019 was conducted. Association between donor and recipient features, and ischemia times with delayed graft function (DGF) and serum creatinine (Cr) at discharge, and at three and twelve months were analysed. Results: A total of 86 KT were performed. The results revealed a relationship between donor age (p = 0.014) and receptors on haemodialysis (p = 0.001) with DGF. There was no association between different ischemia times and DGF. Residual urine output greater than 500mL/day and being on peritoneal dialysis were found to be protective factors for DGF. Correlation analysis illustrated a significant correlation between donor age and Cr at discharge and at 3 months. Conclusion: Higher donor age and being on haemodialysis were risk factors for DGF. Likewise, donor age did not show a significant association with 12-month serum Cr. These results demonstrate that donor age is a risk factor for DGF but does not affect long term graft function (AU)

The role of renal damage markers in the diagnosis of early stages of kidney injury in patients with latent autoimmune diabetes in adults.

Serum creatinine level begins to increase after a decrease in glomerular filtration rate (GFR) by 50% and more, so the question emerged about a more accurate method of determining GFR. The study aimed to determine the role of renal damage markers in the diagnosis of early-stage renal disease in patients with latent autoimmune diabetes in adults (LADA). We included 84 patients with diabetes mellitus (DM) and chronic kidney disease (CKD) caused by diabetic kidney disease (DKD), as well as 25 representatives of the control group. Patients were divided into three groups - 43 people with LADA, 21 with type 1 diabetes mellitus (T1DM), and 20 patients with type 2 diabetes mellitus (T2DM). GFR was assessed using six formulas after establishing the category of GFR and albuminuria. The GFR rate estimated by the CKD-EPI formula in patients with LADA and DKD did not significantly differ from that of CKD-EPI cysC, slightly different from MDRD GFR (10.6% higher, respectively) but 21.9% lower compared to CG formula. In patients with LADA and T1DM, GFR was higher in cases with existing albuminuria, regardless of the formulas used. Thus, the non albuminuria phenotype is accompanied by a greater degree of renal impairment, which indicates the need to determine serum cystatin C in the early stages of LADA. Cystatin C levels are the most accurate, early, and independent predictor of the development and progression of CKD in patients with DM, including LADA.

Study of the Role of Plasma NT-proBNP in the Diagnosis of Heart Failure.

BACKGROUND: The diagnosis of heart failure (HF) remains essentially clinical-Based. However, the history, physical examination, and chest radiograph findings are often inadequate in the diagnosis because multiple other conditions that affect the cardiopulmonary system mimic the symptoms of HF. N-terminal pro-BNP (NT-proBNP) has long been used for diagnosing HF. N-terminal pro-BNP values vary with different patient parameters. There is a scarcity of Indian studies on this topic. Especially with the use of newer drugs like angiotensin receptor neprilysin inhibitor (ARNI), it is important to have data from our own population on the same. AIMS AND OBJECTIVES: (i) To assess the role of NT-proBNP in the diagnosis of HF. (ii) Achieve diagnostic clarity in cases having cardiorespiratory symptoms and signs like acute onset dyspnea, pedal edema, and basal crepitations. (iii) To study the effect of various factors like age, body mass index (BMI), and creatinine on NT-proBNP. (iv) Establish a relation between NT-proBNP levels and left ventricular ejection fraction (LVEF), disease severity, and etiology of HF. MATERIALS AND METHODS: An observational prospective study of 50 patients presenting with acute onset breathlessness was carried out, fulfilling inclusion and exclusion criteria over a period of 10 months. Detailed history and examination of the patients were obtained. Venous sample for the measurement of NT-proBNP was collected within 24 hours of onset of symptoms. Other relevant blood and radiographic investigations were obtained. The NT-proBNP "cut-offs" set forth by the American Heart Association (AHA)/American College of Cardiology (ACC) were used to "rule in" or "rule out" HF. Two-dimensional echocardiography (2D Echo) was used to confirm the diagnosis. The correlation between NT-proBNP and various parameters like age, BMI, creatinine, and LVEF was obtained. Sensitivity and specificity tests were applied as well. RESULTS: Out of the 50 patients presenting with acute onset dyspnea, the most common cause was ischemic heart disease (IHD) (44%) followed by dilated cardiomyopathy (DCM) (32%), chronic obstructive pulmonary disease (COPD) (10%), anemia (4%), followed by other causes. The median NT-proBNP value was the highest for IHD patients (9485 pg/mL), followed by DCM (8969 pg/mL), followed by COPD (2846 pg/mL), and followed by anemia (850 pg/mL). There is a significant positive correlation between NT-proBNP and age (coefficient of correlation r = 0.4007, significance level p = 0.0389, and class interval = 0.137-0.61). There is a significant negative correlation between creatinine clearance and NT-proBNP (coefficient of correlation r = -0.372, significance level p = 0.007, and class interval = -0.58 to -0.105). There was significant negative correlation between LVEF and NT-proBNP (coefficient of correlation r = -0.36, significance level p = 0.009, and class interval = -0.58 to -0.09). Higher LVEF is associated with lower NT-proBNP values. There is marked heterogeneity in the values though. CONCLUSION: It is seen that the values of NT-proBNP vary with factors like age, BMI, and creatinine clearance in addition to LVEF. This may lead to falsely positive or falsely negative diagnosis of HF. With the above observations in mind, it can be concluded that NT-proBNP can help diagnose HF but only in addition to clinical findings.

Association of vancomycin plus piperacillin-tazobactam with early changes in creatinine versus cystatin C in critically ill adults: a prospective cohort study.

PURPOSE: Although dozens of studies have associated vancomycin + piperacillin-tazobactam with increased acute kidney injury (AKI) risk, it is unclear whether the association represents true injury or a pseudotoxicity characterized by isolated effects on creatinine secretion. We tested this hypothesis by contrasting changes in creatinine concentration after antibiotic initiation with changes in cystatin C concentration, a kidney biomarker unaffected by tubular secretion. METHODS: We included patients enrolled in the Molecular Epidemiology of SepsiS in the ICU (MESSI) prospective cohort who were treated for ≥ 48 h with vancomycin + piperacillin-tazobactam or vancomycin + cefepime. Kidney function biomarkers [creatinine, cystatin C, and blood urea nitrogen (BUN)] were measured before antibiotic treatment and at day two after initiation. Creatinine-defined AKI and dialysis were examined through day-14, and mortality through day-30. Inverse probability of treatment weighting was used to adjust for confounding. Multiple imputation was used to impute missing baseline covariates. RESULTS: The study included 739 patients (vancomycin + piperacillin-tazobactam n = 297, vancomycin + cefepime n = 442), of whom 192 had cystatin C measurements. Vancomycin + piperacillin-tazobactam was associated with a higher percentage increase of creatinine at day-two 8.04% (95% CI 1.21, 15.34) and higher incidence of creatinine-defined AKI: rate ratio (RR) 1.34 (95% CI 1.01, 1.78). In contrast, vancomycin + piperacillin-tazobactam was not associated with change in alternative biomarkers: cystatin C: - 5.63% (95% CI - 18.19, 8.86); BUN: - 4.51% (95% CI - 12.83, 4.59); or clinical outcomes: dialysis: RR 0.63 (95% CI 0.31, 1.29); mortality: RR 1.05 (95%CI 0.79, 1.41). CONCLUSIONS: Vancomycin + piperacillin-tazobactam was associated with creatinine-defined AKI, but not changes in alternative kidney biomarkers, dialysis, or mortality, supporting the hypothesis that vancomycin + piperacillin-tazobactam effects on creatinine represent pseudotoxicity.

Relationship between serum creatinine to cystatin C ratio and subclinical atherosclerosis in patients with type 2 diabetes.

INTRODUCTION: Sarcopenia index (SI), calculated by (serum creatinine/cystatin C)×100, is reported to be associated with sarcopenia. Few studies reported the association between SI and subclinical atherosclerosis. We evaluated the association between SI and subclinical atherosclerosis, assessed by brachial-ankle pulse wave velocity (baPWV). RESEARCH DESIGN AND METHODS: One hundred seventy-four patients with type 2 diabetes were included in this cross-sectional study. The relationship between SI and baPWV was assessed by Pearson's correlation coefficient. To calculate area under the receiver operator characteristic (ROC) curve (AUC) of SI for the presence of subclinical atherosclerosis, which was defined as baPWV >1800 cm/s, ROC analysis was performed. Logistic regression analyses were performed to assess the effect of SI on the prevalence of subclinical atherosclerosis adjusting for covariates. RESULTS: Mean age, duration of diabetes, baPWV, and SI were 66.9 (10.1) years, 17.7 (11.6) years, 1802 (372) cm/s, and 77.6 (15.8), respectively. There was an association between SI and baPWV (men; r=-0.25, p=0.001, and women; r=-0.37, p=0.015). The optimal cut-off point of SI for the presence of subclinical atherosclerosis was 77.4 (sensitivity=0.72, specificity=0.58, p<0.001, AUC 0.66 (95% CI: 0.57 to 0.74)). In addition, SI was associated with the prevalence of subclinical atherosclerosis (adjusted OR 0.95, 95% CI: 0.91 to 0.99, p=0.015). CONCLUSIONS: SI is associated with the prevalence of subclinical atherosclerosis in patients with type 2 diabetes.

Clinical characteristics and factors associated with acute kidney injury among patients hospitalized with coronavirus disease: an observational retrospective study.

BACKGROUND: Coronavirus disease 19 (COVID-19) is a multisystemic disease with high incidence of acute kidney injury (AKI). OBJECTIVE: To describe the clinical characteristics and factors associated with AKI among patients hospitalized with COVID-19. DESIGN AND SETTING: Retrospective cohort conducted at Hospital Civil de Culiacan, Mexico. METHODS: We included 307 patients hospitalized due to COVID-19. AKI was defined and staged based on serum creatinine levels in accordance with the criteria of the Acute Kidney Injury Network (AKIN). Multivariate logistic regression analysis was used to determine factors associated with AKI. RESULTS: The patients' age was 56 ± 15 years (64.5% male). The incidence of AKI was 33.6% (n = 103). Overall, 53.4% of patients had community-acquired AKI, and 46.6% had hospital-acquired AKI. Additionally, 15.5% of them presented AKIN stage 1; 34% had AKIN stage 2; and 50.5% had AKIN stage 3. Hemodialysis was required for 10.7% of the patients. The factors associated with AKI were chronic kidney disease (odds ratio, OR: 10.8; P = 0.04), use of norepinephrine (OR: 7.3; P = 0.002), diabetes mellitus (OR: 2.9; P = 0.03), C-reactive protein level (OR: 1.005; P = 0.01) and COVID-19 severity index based on chest tomography (OR: 1.09; statistical trend, P = 0.07). Hospital stay (11 ± 7 days; P < 0.001) and mortality (83.5 versus 31.4%; P < 0.05) were greater among patients with AKI. CONCLUSION: AKI was a frequent and serious complication in our cohort of patients hospitalized with COVID-19, which was associated with high mortality and long hospital stay.