Prevalence and risk factors for impaired renal function among Asian patients with nonalcoholic fatty liver disease

Background:Nonalcoholic fatty liver disease(NAFLD)is associated with impaired renal function,and both diseases often occur alongside other metabolic disorders.However,the prevalence and risk factors for impaired renal function in patients with NAFLD remain unclear.The objective of this study was to identify the prevalence and risk factors for renal impairment in NAFLD patients.Methods:All adults aged 18-70 years with ultrasound-diagnosed NAFLD and transient elastography examination from eight Asian centers were enrolled in this prospective study.Liver fibrosis and cirrhosis were assessed by FibroScan-aspartate aminotransferase(FAST),Agile 3+and Agile 4 scores.Impaired renal function and chronic kidney disease(CKD)were defined by an estimated glomerular filtration rate(eGFR)with value of<90 mL/min/1.73 m^(2) and<60 mL/min/1.73 m^(2),respectively,as estimated by the CKD-Epidemiology Collaboration(CKD-EPI)equation.Results:Among 529 included NAFLD patients,the prevalence rates of impaired renal function and CKD were 37.4%and 4.9%,respectively.In multivariate analysis,a moderate-high risk of advanced liver fibrosis and cirrhosis according to Agile 3+and Agile 4 scores were independent risk factors for CKD(P<0.05).Furthermore,increased fasting plasma glucose(FPG)and blood pressure were significantly associated with impaired renal function after controlling for the other components of metabolic syndrome(P<0.05).Compared with patients with normoglycemia,those with prediabetes[FPG≥5.6 mmol/L or hemoglobin A1c(HbA1c)≥5.7%]were more likely to have impaired renal function(P<0.05).Conclusions:Agile 3+and Agile 4 are reliable for identifying NAFLD patients with high risk of CKD.Early glycemic control in the prediabetic stage might have a potential renoprotective role in these patients.

Changes in renal function and morphological variations of kidney diseases in rheumatoid arthritis patients

Objective:Rheumatoid nephropathy is one of the most severe extra-articular manifestations of rheumatoid arthritis(RA)associated with a very unfavorable prognosis.This study aimed to identify changes in renal function and morphological variations of kidney diseases in RA patients.Methods:The study enrolled patients(126 patients)between 18 and 55 years of age with a confirmed active RA of more than 12 months.Each patient underwent the following range of laboratory and instrumental research methods:general clinical analysis of blood and urine,performing urinalysis according to Nechiporenko method;determining daily proteinuria;determining the blood content of glucose,urea,creatinine,uric acid,total bilirubin,liver transaminase level,ionogram,lipidogram,and coagulogram;determining the blood content of rheumatoid factor,anti-streptolysin O,and C-reactive protein;and X-ray of the joints of hands and feet.Renal function was examined by estimating glomerular filtration rate,tubular reabsorption index,and renal functional reserve.For studying the morphological changes in the kidneys under ultrasound examination,renal biopsy was performed in 31 patients with RA with urinary syndrome(proteinuria more than 0.3 g per day and hematuria).Results:Nephropathy in RA is characterized by impaired renal function and manifested by an increased blood creatinine and a decrease in glomerular filtration rate and renal functional reserve.Among morphological variations of nephropathy at RA,mesangial proliferative glomerulonephritis prevails,accounting for 48.4%of patients.Other disorders include the secondary amyloidosis(29.0%of patients),tubulointerstitial nephritis(16.1%),membranous glomerulonephritis(3.2%),and focal-segmental glomerulosclerosis(3.2%).Conclusion:Kidney damage is a common systemic manifestation of RA with a long and active course,a major nephropathy trigger.

Risk Factors of the Progression of Renal Function Deterioration Among Patients with Diabetic Nephropathy

Objective:To explore the risk factors for the progression of renal function deterioration in patients with diabetic nephropathy(DN).Methods:The clinical data and biochemical indexes of 100 diabetic patients admitted to our hospital from October 2021 to October 2022 were retrospectively analyzed.The patients were divided into a DN group,which consisted of 55 cases,and a nondiabetic nephropathy group(NDN),which consisted of 45 cases.The urinary microalbumin to creatinine ratio,the clinical data(gender,age,duration of the disease,and BMI),and the biochemical indexes(triglycerides[TG],low-density lipoprotein cholesterol[LDL-C],high-density lipoprotein cholesterol[HDL-C],total cholesterol[TC],glycated hemoglobin A1c[HbA1c],systolic blood pressure[SBP],diastolic blood pressure[DBP])of the two groups were compared.Subsequently,the risk factors related to the progression of renal function deterioration in DN were analyzed through multifactorial logistic regression analysis.Results:No statistically significant difference was observed in the comparison of gender,age,BMI,LDL-C,and DBP between the two groups(P>0.05).The DN group demonstrated a longer disease duration and higher SBP,TC,HDL-C,HbA1c,and TG compared to the NDN group(P<0.05).Through multifactorial logistic regression analysis,it was found that the duration of the disease,the TC,the HDL-C,the HbA1c,the TG,and the SBP were independent risk factors of the deterioration of renal function in DN patients.Conclusion:Other than conventional indicators,TC,HDL-C,HbA1c,TG,and SBP are also crucial indicators in determining the progression of renal function deterioration in DN patients.

Roles of biochemistry data, lifestyle, and inflammation in identifying abnormal renal function in old Chinese

BACKGROUND The incidence of chronic kidney disease(CKD)has dramatically increased in recent years,with significant impacts on patient mortality rates.Previous studies have identified multiple risk factors for CKD,but they mostly relied on the use of traditional statistical methods such as logistic regression and only focused on a few risk factors.AIM To determine factors that can be used to identify subjects with a low estimated glomerular filtration rate(L-eGFR<60 mL/min per 1.73 m^(2))in a cohort of 1236 Chinese people aged over 65.METHODS Twenty risk factors were divided into three models.Model 1 consisted of demographic and biochemistry data.Model 2 added lifestyle data to Model 1,and Model 3 added inflammatory markers to Model 2.Five machine learning methods were used:Multivariate adaptive regression splines,eXtreme Gradient Boosting,stochastic gradient boosting,Light Gradient Boosting Machine,and Categorical Features+Gradient Boosting.Evaluation criteria included accuracy,sensitivity,specificity,area under the receiver operating characteristic curve(AUC),F-1 score,and balanced accuracy.RESULTS A trend of increasing AUC of each was observed from Model 1 to Model 3 and reached statistical significance.Model 3 selected uric acid as the most important risk factor,followed by age,hemoglobin(Hb),body mass index(BMI),sport hours,and systolic blood pressure(SBP).CONCLUSION Among all the risk factors including demographic,biochemistry,and lifestyle risk factors,along with inflammation markers,UA is the most important risk factor to identify L-eGFR,followed by age,Hb,BMI,sport hours,and SBP in a cohort of elderly Chinese people.

Evolution of Proteinuria and Renal Function in Women with Pre-Eclampsia at the Gynecology Department of the Teaching Hospital of Cocody

Background: Pre-eclampsia has long been considered as a disease that disappears after the removal of the placenta. It has now been shown that its symptoms can persist for months after giving birth. Objectives: To study the evolution of proteinuria and renal function in women with pre-eclampsia. Patients and Methods: An analytical prospective study was carried out in the Hospitalization Unit of the Gynecology Department of the Teaching Hospital of Cocody (Abidjan) from May 3, 2021 to November 15, 2021. It focused on the follow-up of proteinuria and renal function in 50 women who had pre-eclampsia during their pregnancy, in the three months following their delivery. Results: The average age of the patients was 30.38 ± 6 years (range 18 and 40 years). Thirty-two percent were nulliparous and 62% had no risk factors for pre-eclampsia. The diagnosis of pre-eclampsia was made in 52% of cases before 37 weeks of amenorrhea. Sixty-two percent had Grade 3 arte-rial hypertension. The average proteinuria/creatininuria ratio was 3592.08 ± 7009.57 mg/g and 32% of women had glomerular grade proteinuria. The mean serum creatinine was 13.61 ± 12.62 mg/l. AKI (Acute Renal Failure) was present in 30% of women. All patients had received a central antihypertensive drug of which 88% were a calcium channel blocker. For the delivery mode, a Caesarean section was performed in 88% of cases. In the three months postpartum, 40% of women had persistent hypertension, 58% had persistent proteinuria and 6% had persistent impaired renal function. Prematurity (p = 0.0091), IUGR (intrauterine growth restriction) (p = 0.0012) and IUFD (intrauterine fetal death) (p = 0.0012) were associated with the persistence of proteinuria at M3 postpartum. Conclusion: Symptoms of pre-eclampsia do not automatically disappear after the delivery. Proteinuria and renal failure can persist beyond three months after the delivery and require treatment by a nephrologist.

Serum uric acid as an index of impaired renal function in congestive heart failure

Background Hyperuricemia is frequently present in patients with heart failure. Many pathological conditions, such as tissue ischemia, renal function impairment, cardiac function impairment, metabolic syndrome, and inflammatory status, may impact uric acid （UA） metabolism. This study was to assess their potential relations to UA metabolism in heart failure. Methods We retrospectively assessed clinical charac- teristics, echocardiological, renal, metabolic and inflammatory variables selected on the basis of previous evidence of their involvement in cardiovascular diseases and UA metabolism in a large cohort of randomly selected adults with congestive heart failure （n = 553）. By clustering of indices, those variables were explored using factor analysis. Results In factor analysis, serum uric acid （SUA） formed part of a principal cluster of renal functional variables which included serum creatinine （SCr） and blood urea nitrogen （BUN）. Univariate correlation coefficients between variables of patients with congestive heart failure showed that the strongest correlations for SUA were with BUN （r = 0.48, P 〈 0.001） and SCr （r = 0.47, P 〈 0.001）. Conclusions There was an inverse relationship between SUA levels and measures of renal function in patients with congestive heart failure. The strong correlation between SUA and SCr and BUN levels suggests that elevated SUA concentrations reflect an impairment of renal function in heart failure.

Effect of controlled low central venous pressure on renal function in major liver resection

Objective： To investigate the effects of low central venous pressure （LVCP） on blood loss and evaluate its influence on renal function in patients undergoing hepatectomy. Methods： Forty-six patients, ASA classification Ⅰ-Ⅲ, undergoing liver resection were randomized into LCVP group （n = 23） and control group （n = 23）. In LCVP group, CVP was maintained at 2-4 mmHg and MBP above 60 mmHg during hepatectomy, while in control group hepatectomy was performed routinely without lowering CVP. Volume of blood loss during hepatectomy, volume of blood transfusion, and changes of renal functions were compared between the two groups. Results： There were no significant differences in demographics, ASA score, type of hepatectomy, duration of inflow occlusion, operation time, weight of resected liver tissues, and renal functions between the two groups. LCVP group had a significantly lower volume of total intraoperative blood loss （P 〈 0.01） and RBC transfusion （P 〈 0.05）. Conclusion： Lowering the CVP to less than 5 mmHg is a simple and effective technique to reduce blood loss and blood infusion during liver resection, and has no detrimental effects on renal functions.

Impact of contrast-enhanced ultrasound in patients with renal function impairment

AIMTo investigate the role of contrast enhanced ultrasound (CEUS) in evaluating patients with renal function impairment (RFI) showing: (1) acute renal failure (ARF) of suspicious vascular origin; or (2) suspicious renal lesions.METHODSWe retrospectively evaluated patients addressed to CEUS over an eight years period to rule-out vascular causes of ARF (first group of 50 subjects) or assess previously found suspicious renal lesions (second group of 41 subjects with acute or chronic RFI). After preliminary grey-scale and color Doppler investigation, each kidney was investigated individually with CEUS, using 1.2-2.4 mL of a sulfur hexafluoride-filled microbubble contrast agent. Image analysis was performed in consensus by two readers who reviewed digital clips of CEUS. We calculated the detection rate of vascular abnormalities in the first group and performed descriptive statistics of imaging findings for the second group.RESULTSIn the first group, CEUS detected renal infarction or cortical ischemia in 18/50 patients (36%; 95%CI: 23.3-50.9) and 1/50 patients (2%; 95%CI: 0.1-12), respectively. The detection rate of infarction was significantly higher (P = 0.0002; McNemar test) compared to color Doppler ultrasonography (10%). No vascular causes of ARF were identified in the remaining 31/50 patients (62%). In the second group, CEUS detected 41 lesions on 39 patients, allowing differentiation between solid lesions (21/41; 51.2%) vs complex cysts (20/41; 48.8%), and properly addressing 15/39 patients to intervention when feasible based on clinical conditions (surgery and cryoablation in 13 and 2 cases, respectively). Cysts were categorized Bosniak II, IIF, III and IV in 8, 5, 4 and 3 cases, respectively. In the remaining two patients, CEUS found 1 pseudolesion and 1 subcapsular hematoma.CONCLUSIONCEUS showed high detection rate of renal perfusion abnormalities in patients with ARF, influencing the management of patients with acute or chronic RFI and renal masses throughout their proper characterization.

Anti-BCMA CAR-T Cell Therapy in Relapsed or Refractory Multiple Myeloma Patients with Impaired Renal Function

Anti-B cell maturation antigen(BCMA)chimeric antigen receptor(CAR)T-cell therapyis effective and well-tolerated for refractory or relapsed multiple myeloma(RRMM).The purposcof the present study was to analyze efficacy in RRMM patients with renal impairment treated byanti-BCMA CAR-T cell therapy.A total of 59 RRMM patients were selected,and divided intoimpaired renal function(lRF)group[basclinc cstimated giomerular filtration rate(eSFR)<90 m/min/1.73 m^2(n=18)]and normal renal function(NRF)group(baseline eGFR≥90 mL/min/1.73 m,n=41).For patients with IRF,eGFR at the 6th month post-CAR-T cells infusion was significantlyhigher than the baseline(P<0.05).The multivariate analysis showed that light chain type and beta-2 micro-globulin(bcta-2M)were associated factors with the decrease of serum creatinine.Medianprogression-free survival(PFS)in the NRF group and IRF group was 266 days and 181 daysrespectively.Overall survival(OS)in the NRF group and lRF group was 877 days and 238 daysrespectively.There was no significant difference in the objective response rate(ORR)between thelRF group and the NRF group.It is suggested that CAR-T cells therapy could improve the renalfunction during the treatment of RRMM.The renal function could be more significantly improvedin RRMM patients with light chain type than with other types.

Circulating miR-21-5p level has limited prognostic value in patients with hepatocellular carcinoma and is influenced by renal function

BACKGROUND MicroRNAs(miRNAs)have been suggested as biomarkers for malignant diseases including hepatocellular carcinoma(HCC).Specifically,hsa-miR-21-5p(miR-21)is among the most frequently deregulated miRNA in cancer.The diagnostic and prognostic value of miR-21 has been demonstrated in HCC tissue,mostly in the Asian population.Although the impact of various factors has been recently reported for circulating hsa-miR-122-5p(miR-122),at present only limited knowledge is available for miR-21.AIM To evaluate the value of miR-21 for the assessment of prognosis in HCC patients and to delineate the influence of clinical and preanalytical factors on miR-21 level in sera.METHODS Patients with confirmed HCC from our European cohort with predominantly alcohol-associated liver damage were included in the study.All subjects were characterized according to their clinical and laboratory work-up and overall survival data were obtained.Quantitative real-time polymerase chain reaction was performed for miR-21 and spiked-in cel-miR-39-3p.The results were compared to previously reported miR-122 data.RESULTS Survival of HCC patients was comparable between patients with low and high serum miR-21 concentration.No association was observed between miR-21 level in sera and Child-Pugh score,Barcelona Clinic Liver Cancer staging system,or etiology of HCC/liver disease.Age,gender,or pretreatment had no association with miR-21 level.A positive correlation was observed between miR-21 and aspartate aminotransferase(r=0.2854,P=0.0061),serum miR-122(r=0.2624,P=0.0120),and the International Normalized Ratio(r=0.2065,P=0.0496).Negative correlation of miR-21 with serum creatinine(r=-0.2215,P=0.0348)suggests renal function as a potential influencing factor in miR-21 biogenesis in blood.CONCLUSION The results from this work do not support clinically relevant prognostic value of circulating miR-21 in HCC patients in real-life settings.Following systematic evaluation,we identified renal function and aspartate aminotransferase as potential factors that may affect miR-21 concentration in blood.This knowledge should be considered in future miRNA-based biomarker studies not only for HCC but also for other diseases.

Renal Function in Preeclamptics versus Normal Pregnant Women

Background: Pregnancy is implicated in notable physiological changes and the extraordinary kidney physiology during pregnancy is believed to have an effect on kidney functions. However, during pregnancy the glomerular filtration rate (GFR) increases its work rate up to 50%, on the contrary, in preeclampsia the GFR turns back to decline. Objectives: This study aims to measure and compare kidney function between preeclamptic and normal pregnant women. Materials and Methods: A cross-sectional hospital-based study was conducted in the period from March to May 2021 in Wad Medani Obstetrics and Gynecology Teaching Hospital. A total of 100 pregnant women, 50 apparently healthy pregnant women and 50 pregnant ladies proved to have preeclamptic toxemia, their ages ranged from 18 to 44 years old and at the third trimester of pregnancy. Blood samples were taken and serum was separated, then urea, creatinine, uric acid, sodium and potassium were determined. Data were analyzed using Statistical Package for Social Science (SPSS). Results: The results of this study revealed that 92% of preeclamptic pregnant women had the first time of the incidence and 8% were family inherited preeclampsia and injured multiple times. The preeclamptic pregnant women showed elevation in both systolic and diastolic blood pressure compared to the normal pregnant women. Although the creatinine values of all study subjects were in the normal range, the mean of its serum level was found to be higher in normal pregnant women than that in preeclamptic women. The study also showed urea level was elevated in the preeclampsia group in comparison to the normal one, while all values were in the normal range. In addition to the significant difference that observed in the uric acid mean between preeclamptic (higher) and normal pregnant groups, abnormal values were only noticed with many preeclamptic patients. The levels of electrolytes (sodium and potassium) were elevated in the preeclampsia women group, whereas all values were in the normal range. Conclusion: This study concluded that preeclamptics showed significant elevation in the urea, uric acid, sodium and potassium levels and a significant decrease in creatinine level compared to normal pregnant women, although all parameters values for both groups were in the reference values for non-pregnancy.

Effect of urinary stone disease and its treatment on renal function

Urolithiasis is a common disease that affects urinary tract in all age groups. Both in adults and in children, stone size, location, renal anatomy, and other factors, can infuence the success of treatment modalities. Recently, there has been a great advancement in technology for minimally invasive management of urinary stones.The epoch of open treatment modalities has passed and currently there are much less invasive treatment approaches, such as percutaneous nephrolithotomy, ureteroscopy, shockwave lithotripsy, and retrograde internal Surgery. Furthermore, advancement in imaging technics ensures substantial knowledge that permit physician to decide the most convenient treatment method for the patient. Thus, effective and rapid treatment of urinary tract stones is substantial for the preservation of the renal function. In this review, the effects of the treatment options for urinary stones on renal function have been reviewed.

Correlation between Residual Renal Function and Hypertension in Regular Haemodialysis Patients

Objective: To evaluate the correlation between residual renal function and hypertension in regular haemodialysis patients. Background: Initiating chronic dialysis treatment gives end-stage renal disease patients a new lease on life. However, the annual mortality rate in dialysis patients is ~20% and quality of life is substantially reduced. Patients and Methods: This study was carried out on a reasonable number of subjects on regular haemodialysis divided into two groups. All were given informed consent and, the study was approved by the ethics committee of Menoufia University. Results: There was significant relation between presence of residual renal function and hypertension in patients with ESRD on regular haemodialysis, but the relation between residual renal function and control of hypertension is not statistically significant. 40% of group 1 were hypertensive, 66.7% of group 2 patients were hypertensive, the interdialytic weight gain mean was 1.42 in group 1 and 2.37 in group 2. Control of hypertension was achieved in 63.6% of group 1 patients by one drug, 27.3% patients by 2 drugs;however 9.1% of patients need 3 drugs to control their blood pressure, while in group 2 40% of patients were controlled by one drug, 45% with 2 drugs and 15% need 3 drugs to control blood pressure. Conclusion: There is significant relation between presence of residual renal function and hypertension in patients with ESRD on regular haemodialysis, but the relation between residual renal function and control of hypertension is not statistically significant.

Effect of Dexmedetomidine and Remifentanil on Renal Function in Patients Undergoing Bariatric Surgery

Background and Objectives: In anesthesia for bariatric surgery, alterations occur in several organs, including the kidney. The objective of this study was to compare the effect of dexmedetomidine and remifentanil on the renal function of morbidly obese patients submitted to bariatric surgery. Methods: Sixty-one patients were studied prospectively and divided randomly into two groups: remifentanil (R) and dexmedetomidine (D). Renal function was evaluated in three phases: before anesthesia (M0), after anesthetic induction (M1) and after surgical incision (M2). Plasma concentrations were determined for glucose, antidiuretic hormone, creatinine, urea, sodium, potassium and osmolarity and urinary concentrations for creatinine, urea, sodium, potassium and osmolarity. Results: Significant differences were found between groups for potassium at M1 (p Conclusions: In both groups, the clearance values fell from moments M0 to M2. This result indicates that renal function of obese patients submitted to bariatric surgery presented a physiological response compatible with the effect of anesthetic-surgical stress. In the group D, creatinine and sodium clearances were elevated at M1. Urinary volume was greater at M2. These results are suggestive of better preservation of renal function.

Effects of Endurance and Endurance-strength Exercise on Renal Function in Abdominally Obese Women with Renal Hyperfiltration：A Prospective Randomized Trial

Objective Obesity is associated with kidney defects.Physical activity is a key element in the treatment of obesity.The aim of this study was to compare the effect of endurance and endurance-strength training on kidney function in abdominally obese women.Methods Forty-four abdominally obese women were randomized to endurance training or endurance-strength training,three times a week for 3 months.Before and after the intervention,kidney function was assessed by measuring blood creatinine,urine creatinine,and urine albumin levels,and the albumin-to-creatinine ratio and glomerular filtration rate（GFR） were calculated.Results Renal hyperperfusion was present in both groups before the study.Following both types of physical activity,similar modifications of the investigated parameters were observed,but with no significant between-group differences.Both courses of training led to a significant increase in blood creatinine and a subsequent decrease in the GFR.A significant increase in urine creatinine and album levels,though not exceeding the range for microalbuminuria,was not accompanied by any difference in the albumin-to-creatinine ratio after endurance-strength training alone.Conclusion Three months of either endurance or endurance-strength training has a favorable and comparable effect on renal function in abdominally obese women with renal hyperfiltration.

Effect of epinephrine on blood pressure,heart rate and renal function in the patients with severe acute pancreatitis complicated with septic shock

Objective： To retrospectively study the effects of epinephrine on blood pressure, heart rate as well as renal function in the patients with severe acute pancreatitis complicated with septic shock. Methods： Twenty-five patients with severe acute pancreatitis complicated with septic shock were divided into 3 groups according to the biggest infusing rate of epinephrine used, with the infusing rate of 0.01-0.05, 0.06-0.10, 〉0.10 μg/kg·min in group A （n=9）, B （n=8） and C （n=8）, respectively. Mean arterial blood pressure （MAP）, heart rate （HR）, urine output, blood urea nitrogen （BUN）, creatinine （CRE）, urine albumin （U-ALB） and urine β2-microglubulin （Uβ2-MG） as well as APACHE Ⅲ scoring were recorded in all the patients. Results： Before anti-shock therapy was given, hypotension, tachycardia, oliguria as well as the abnormal levels of CRE, BUN, U-ALB, Uβ2-MG and APACHE Ⅲ scoring occurred in all the 25 patients. With anti-shock therapy, MAP, HR, urine output and BUN, CRE in the patients from the 3 groups gradually returned to normal （P〈0.01 vs before anti-shock therapy）, and U-ALB, Uβ2-MG output and APACHE Ⅲ scoring also restored but still remained abnormal （P〈0.01 vs before anti-shock therapy）. Conclusion： The first goal to treat the patients with severe acute pancreatitis complicated with septic shock should be restoring the organ blood supply. Based on volume resuscitation, epinephrine and other vasoactive drugs could be combined to maintain circulatory stability and also could benefit the restoration of the renal function.

Does endoscopic sclerotherapy in filarial chyluria affect renal function and morphology? A prospective study using dimercaptosuccinic acid renal scan

Objective:To look for change in relative renal function and document renal scarring following endoscopic renal pelvic instillation sclerotherapy(RPIS)in patients with chyluria by dimercaptosuccinic acid(DMSA)renal scan.Methods:A prospective study was performed between November 2015 and September 2016.All patients with biochemically documented chyluria who underwent RPIS using either 1%-silver nitrate or 0.1%-povidine iodine were included.Patients received either 3-,6-or 9-doses.DMSA renal scan was performed before and 2e3 months after sclerotherapy.Results:Of the 34 patients,22 were males.Mean age was 41.08±16.64 years(range,15-70 years).Thirty-two patients(94.1%)responded to therapy while two did not respond even after 9-doses.Average follow-up was 8.94±3.70 months.The mean relative renal function(preinstillation)of normal kidney was 50.76%±3.55%while that of affected renal unit(side of instillation)was 49.20%±3.44%(range,43.0%-61.0%).After instillation therapy,the mean relative renal function of normal side was 52.26%±3.57%while that of affected renal unit was 47.50%±3.56%(range,41.0%-54.0%).The relative renal function did not change>5%from the baseline value in any patient except one(in which the differential function increased paradoxically by 12%).Two patients developed renal scar in post-instillation renal scan.Conclusion:Endoscopic sclerotherapy in chyluria is safe and effective.The relative renal function does not deteriorate by more than 5%.There is a small risk of development of renal scar.More studies involving larger number of patients are needed to answer this dilemma.

Elderly patients with non-cardiac admissions and elevated highsensitivity troponin:the prognostic value of renal function

BACKGROUND High-sensitivity cardiac troponin(hs-cTn)levels are frequently elevated in elderly patients presenting to the emergency department for non-cardiac events.However,most studies on the role of elevated hs-cTn in elderly populations have investigated the prognostic value of hs-cTn in patients with a specific diagnosis or have assessed the relationship between hs-cTn and comorbidities.AIM To investigate the in-hospital prognosis of consecutive elderly patients admitted to the Internal Medicine Department with acute non-cardiac events and increased hs-cTnI levels.METHODS In this retrospective study,we selected patients who were aged≥65 years and admitted to the Internal Medicine Department of our hospital between January 2019 and December 2019 for non-cardiac reasons.Eligible patients were those who had hs-cTnI concentrations≥100 ng/L.We investigated the independent predictors of in-hospital mortality by multivariable logistic regression analysis.RESULTS One hundred and forty-six patients(59%female)were selected with an age range from 65 to 100(mean±SD:85.4±7.61)years.The median hs-cTnI value was 284.2 ng/L.For 72(49%)patients the diagnosis of hospitalization was an infectious disease.The overall in-hospital mortality was 32%(47 patients).Individuals who died did not have higher hs-cTnI levels compared with those who were discharged alive(median:314.8 vs 282.5 ng/L;P=0.565).There was no difference in mortality in patients with infectious vs non-infectious disease(29%vs 35%).Multivariable analysis showed that age(OR 1.062 per 1 year increase,95%CI:1.000-1.127;P=0.048)and creatinine levels(OR 2.065 per 1 mg/dL increase,95%CI:1.383-3.085;P<0.001)were the only independent predictors of death.Mortality was 49%in patients with eGFR<30 mL/min/1.73 m2.CONCLUSION Myocardial injury is a malignant condition in elderly patients admitted to the hospital for non-cardiac reasons.The presence of severe renal impairment is a marker of extremely high in-hospital mortality.

Serum cystatin C can be used as a marker of renal function even in patients with intestinal urinary diversion

Objective:Recently,serum cystatin C(CysC)has been used as a novel marker of renal function.However,there is a lack of data on CysC levels in patients with intestinal urinary diversion(UD).Here we report CysC levels in such patients.Methods:We prospectively observed 38 patients who were diagnosed with bladder cancer and subsequently treated with radical cystectomy and UD at our institution in 2012 and 2013.Serum creatinine(sCr)and CysC were obtained optionally at the same time at least 1 month after radical cystectomy and UD.Results:The median CysC and sCr concentrations were 1.12 mg/L(range 0.75-2.47 mg/L)and 0.99 mg/dL(range 0.61-2.22 mg/dL),respectively.The median estimated concentrations of glomerular filtration rate(GFR)based on CysC(eGFRcys)and GFR based on creatinine(eGFRcreat)were 61.08 mL/min/1.73 m^2(range 22.64e99.89 mL/min/1.73 m^2)and 58.01 mL/min/1.73 m^2(range 23.48e91.82 mL/min/1.73 m2),respectively.CysC had a significant correlation with sCr(r=0.8607,p<0.0001)and eGFRcreat(r=-0.8993,p<0.0001).eGFRcys also had a significant correlation with eGFRcreat(r=0.8104,p<0.0001).Conclusion:The correlation between CysC and sCr was strong and the correlation coefficient was equivalent to that in patients without UD.The results suggest that CysC is not affected by UD and can be used as a marker of renal function similarly to sCr in patients with UD.

Renal function after renal artery stenting

Atherosclerotic renal artery stenosis (ARAS), a common clinical finding, is increasing in prevalence as the population ages. ARAS is seen in ～ 7% of persons over 65 years of age1 and in ～ 20% of patients at the time of coronary angiography.2 It is an important cause of chronic kidney disease and may result in 11-14% of cases of end stage renal disease.