scholarly journals Systemic Associations with Residual Subretinal Fluid after Ranibizumab in Diabetic Macular Edema

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Meng-Ju Tsai ◽  
Yi-Ting Hsieh ◽  
Elizabeth P. Shen ◽  
Yi-Jie Peng
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Serum Albumin ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Subretinal Fluid ◽  
Panretinal Photocoagulation ◽  
Intravitreal Ranibizumab ◽  
The Impact

Purpose. To investigate the impact of systemic diseases on the occurrence of subretinal fluid (SRF) in diabetic macular edema (DME) and prognostic factors for residual SRF following three consecutive monthly intravitreal ranibizumab. Methods. Ninety-seven eyes from 68 patients with DME who completed 3 consecutive monthly injections of ranibizumab were enrolled. Systemic parameters mainly included chronic kidney disease (CKD), hypertension, HbA1c, and insulin dependence. Renal parameters for CKD were serum creatinine, estimated glomerular filtration rate (eGFR), and serum albumin. Ocular factors were baseline central macular thickness (CMT), severity of diabetic retinopathy (DR), and status of panretinal photocoagulation (PRP). Results. Chronic kidney disease had significant correlation with baseline SRF (R=0.397, p<0.001 after partial correlation with adjustment for age and DR severity). As for CKD, lower serum albumin, but not eGFR or serum creatinine, was associated with baseline presence of SRF (p=0.026, p=0.08 and p=0.53, resp., after adjustment for age and DR severity). Overall, lower eGFR and lower HbA1c values, contrary to popular belief, predicted the presence of residual SRF following intravitreal injections (p=0.016 and p<0.001, resp.). Conclusions. Tight sugar control and poorer baseline kidney function may slow the resorption of SRF after anti-VEGF injections in patients with DME in the short term.

scholarly journals Study of serum homocysteine level in patients with chronic kidney disease and its association with renal function and serum albumin

2020 ◽  
Vol 8 (6) ◽  
pp. 2195
Author(s):  
Vandana Yadav ◽  
Vivek Prakash ◽  
Bushra Fiza ◽  
Maheep Sinha
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Serum Albumin ◽  
Control Group ◽  
Serum Homocysteine ◽  
The Mean ◽  
Gandhi Medical College ◽  
And Control

 Background: Chronic kidney disease (CKD) includes irreversible destruction of nephrons leading to progressive decline in glomerular filtration rate. A preferential defect in Homocysteine disposal could hypothetically occur in CKD and subsequently lead to hyperhomocysteinemia. Understanding the status of Homocysteine and other parameters in CKD is useful in the management of the disease. Objective of the study is to estimate serum Homocysteine in CKD patients and its association with renal function and serum albumin in patients with CKD.Methods: The study design involves hospital based observational comparative study. The study was conducted in Department of Biochemistry in association with Department of Nephrology of Mahatma Gandhi Medical College and Hospital, Jaipur between May 2017 to June 2018. 100 diagnosed patients of CKD, visiting the Outpatient Department of Nephrology were enrolled as cases for the study. Patients having cardiovascular disease, Chronic liver disease, Age more than 60 years and pregnant females were excluded from study. The control group consists of 100 age and sex matched healthy individuals.Results: The mean serum creatinine levels of case and control group were 7.50±3.74 mg% and 0.83±0.22 mg% respectively. The mean of serum homocysteine levels of subject group was 27.35±12.52 µmol/L while the mean serum homocysteine levels of control group was 11.06±3.52 µmol/L. The serum homocysteine levels were significantly higher in the CKD patient group. The serum level of albumin in CKD patients and control group were 2.86±0.86 g/dl and 4.10±0.58 g/dl respectively. A positive correlation was found between serum creatinine and serum homocysteine levels. A negative correlation between serum homocysteine and serum albumin was found.Conclusions: Findings of the present study exhibit that serum homocysteine levels are elevated in CKD in comparison to healthy controls and it is positively correlated with serum creatinine level.

Abstract 656: N-acetylcystein Reduces Lipid Peroxidation and Advanced Glycation Related to Prevention of Macrophage Endoplasmic Reticulum Stress Induced by Albumin Isolated from Rats With Chronic Kidney Disease

2014 ◽  
Vol 34 (suppl_1) ◽  
Author(s):  
Juliana T Machado ◽  
Rodrigo T Iborra ◽  
Fernanda B Fusco ◽  
Gabriela Castilho ◽  
Raphael S Pinto ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Lipid Peroxidation ◽  
Endoplasmic Reticulum ◽  
Kidney Disease ◽  
Endoplasmic Reticulum Stress ◽  
Serum Albumin ◽  
Plasma Lipid ◽  
Lipid Peroxides ◽  
Advanced Glycation ◽  
The Impact

Objective: We analyzed the influence of N-acetylcysteine (NAC) in chronic kidney disease (CKD) rats on the plasma concentration of lipid peroxides (TBARS) and advanced glycation end products (AGE) and on the impact of serum CKD-albumin in the development of macrophage endoplasmic reticulum stress (ERS). Methods: CKD was induced by 5/6 nephrectomy in 2-month old male Wistar rats. Controls (C) were sham operated. Animals were treated or not with NAC (600mg/L of water). FPLC isolated serum albumin was purified by alchoolic extraction. J774 macrophages were incubated with serum albumin (1mg/mL; 18h) from all groups, and the expression of ERS markers (protein disulfide isomerase - PDI and Grp94 chaperone) determined by immunoblot. Comparisons were done by one-way ANOVA, Student t test. Results: After 60 days of CKD, body weight was 10% lower in CKD compared to C (p<0.01). This was prevented by NAC. Urea, creatinine, total cholesterol (TC), triglycerides (TG) (mg/dL), urinary protein excretion (mg/24h) (C, n= 31; C+NAC, n=20; CKD, n=74; CKD+NAC, n=32), total AGE and pentosidine (n= 8; fluorescence arbitrary unit) and TBARS (n= 7; nmoL/mL) were higher in CKD (122±8; 0.9±0.07; 151±6; 83±4; 46±2.5; 32620±673; 16700±1370; 6.6±0.5, respectively) and in CKD+NAC (91.4±5; 0.6±0.02; 126±7.5; 73±6; 51±3.5; 24,720±1,114; 10,080±748; 4.5±0.5, respectively) in comparison to C (41±0.9; 0.4±0.03; 76±2.7; 51.5±3; 14±0.9; 21,750±960; 5,314±129; 2±0.2, respectively; p<0.001) and C+NAC (40±0.9; 0.3±0.02; 76±2.6; 68±4; 18.4±1.5; 20,040±700; 5,050±267; 1.8±0.2, respectively; p<0,001). TC, urea, creatinine, total AGE, pentosidine and TBARS were respectively, 17%, 25%, 33%, 24%, 40% and 28% (p<0.01) lower in CKD+NAC, than in CKD. Glycemia was higher in C+NAC (107±4.6) and CKD+NAC (107±2.6) than in C (96±1.8; p<0.05) and CKD (98±1.6; p<0.01), respectively. In macrophages (n=6), CKD albumin increased PDI (5 and 7 times, p<0.01) and Grp94 (66% and 80%, p<0.01) in comparison to C and CKD+NAC-albumin treated cells, respectively. Conclusion: NAC reduces plasma lipid peroxidation and AGE and abrogates ERS induced by CKD-albumin. This may contribute to attenuate the deleterious effects of CKD-albumin on lipid accumulation in macrophages helping preventing atherogenesis in CKD.

scholarly journals The impact of chronic kidney disease Stages 3–5 on pregnancy outcomes

2020 ◽  
Author(s):  
Kate Wiles ◽  
Philip Webster ◽  
Paul T Seed ◽  
Katy Bennett-Richards ◽  
Kate Bramham ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Post Partum ◽  
Renal Outcome ◽  
Chronic Hypertension ◽  
Renal Transplants ◽  
Ckd Stage ◽  
The Impact

Abstract Background Contemporaneous data are required for women with chronic kidney disease (CKD) Stages 3–5 to inform pre-pregnancy counselling and institute appropriate antenatal surveillance. Methods A retrospective cohort study in women with CKD Stages 3–5 after 20 weeks’ gestation was undertaken in six UK tertiary renal centres in the UK between 2003 and 2017. Factors predicting adverse outcomes and the impact of pregnancy in accelerating the need for renal replacement therapy (RRT) were assessed. Results There were 178 pregnancies in 159 women, including 43 women with renal transplants. The live birth rate was 98%, but 56% of babies were born preterm (before 37 weeks’ gestation). Chronic hypertension was the strongest predictor of delivery before 34 weeks’ gestation. Of 121 women with known pre-pregnancy hypertension status, the incidence of delivery before 34 weeks was 32% (31/96) in women with confirmed chronic hypertension compared with 0% (0/25) in normotensive women. The risk of delivery before 34 weeks doubled in women with chronic hypertension from 20% [95% confidence interval (CI) 9–36%] to 40% (95% CI 26–56%) if the gestational fall in serum creatinine was &lt;10% of pre-pregnancy concentrations. Women with a urinary protein:creatinine ratio &gt;100 mg/mmol prior to pregnancy or before 20 weeks’ gestation had an increased risk for birthweight below the 10th centile (odds ratio 2.57, 95% CI 1.20–5.53). There was a measurable drop in estimated glomerular filtration rate (eGFR) between pre-pregnancy and post-partum values (4.5 mL/min/1.73 m2), which was greater than the annual decline in eGFR prior to pregnancy (1.8 mL/min/1.73 m2/year). The effect of pregnancy was, therefore, equivalent to 1.7, 2.1 and 4.9 years of pre-pregnancy renal disease in CKD Stages 3a, 3b and 4–5, respectively. The pregnancy-associated decline in renal function was greater in women with chronic hypertension and in those with a gestational fall in serum creatinine of &lt;10% of pre-pregnancy concentrations. At 1 year post-partum, 46% (58/126) of women had lost ≥25% of their pre-pregnancy eGFR or required RRT. Most women with renal transplants had CKD Stage 3 and more stable renal function prior to pregnancy. Renal transplantation was not independently associated with adverse obstetric or renal outcomes. Conclusions Contemporary pregnancies in women with CKD Stages 3–5 are complicated by preterm delivery, low birthweight and loss of maternal renal function. Chronic hypertension, pre- or early pregnancy proteinuria and a gestational fall in serum creatinine of &lt;10% of pre-pregnancy values are more important predictors of adverse obstetric and renal outcome than CKD Stages 3–5. Pregnancy in women with CKD Stages 3–5 advances the need for dialysis or transplantation by 2.5 years.

Impact of Removing Race Adjustment When Estimating GFR on Chronic Kidney Disease Staging

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S34-S35
Author(s):  
C Cai ◽  
F Sahor ◽  
B Wilson ◽  
T Veeramachaneni ◽  
I Hashim
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Kidney Function ◽  
Healthcare Disparities ◽  
Safety Net ◽  
Black Patients ◽  
Ckd Stage ◽  
Safety Net Hospital ◽  
The Impact

Abstract Introduction/Objective Determination of glomerular filtration rate (GFR) is essential in assessment of kidney function, particularly in patients with chronic kidney disease (CKD). Formulas were developed to calculate estimated GFR (eGFR), as direct measurement is cumbersome and not amenable to routine monitoring. CKD-EPI is the most widely used formula for eGFR, using parameters of serum creatinine, gender, race, and age. A race adjustment was added from an unfounded assumption that Black patients have more muscle mass, increasing their eGFR by about 16%. There is concern on the impact of “correcting” for Black race on patient management, utility of eGFR, and its possible contribution to healthcare disparities. This study examined the impact of eliminating race adjustment from the CKD- EPI formula on CKD staging in patients at a large safety-net hospital in an academic medical center. Methods/Case Report 80090 serum creatinine values from 56676 adult patients (31.4% Black, 67.5% female, median age 51 yrs) were collected from the electronic medical record (Epic, Verona, WI) over a 16-month timeframe. Values were excluded if they lacked age, gender, self-identified race, or serum creatinine. eGFR was calculated using the CKD-EPI equation with and without race modifier, and CKD staging was performed using 2012 Kidney Disease: Improving Global Outcomes guidelines. Results (if a Case Study enter NA) In our cohort, only 50.8% of Black patients are in CKD1, indicative of no CKD, compared to 67.9% of non-Black patients. Given that these two cohorts are demographically similar, this shows a discrepancy in kidney function even before removing the race adjustment. After removal of the race modifier, 28.1% of Black patients were reclassified into a more severe CKD stage. The most restaging occurred from CKD3A to 3B (39%). Conclusion Many Black patients in our study were reclassified to a more severe CKD stage, with the highest percentage of patients restaged to CKD3B, which would have attracted clinical attention for nephrology referral. We recommend removal of the race adjustment in eGFR, given its basis in the incorrect belief in biological differences between races. It perpetuates systemic racism and discrimination in healthcare, and its removal will provide more equitable care and reduce healthcare disparities. Future studies should examine the increase in resources required to provide adequate medical care to patients who will be placed into a more severe CKD stage.

Association Between First- and Third-Month Responses to Intravitreal Ranibizumab for Diabetic Macular Edema

2020 ◽  
pp. 247412642093646
Author(s):  
Diego Alejandro Valera-Cornejo ◽  
Verónica Romero-Morales ◽  
Marlon García-Roa ◽  
Paulina Ramírez-Neria ◽  
Yolanda Villalpando-Gómez ◽  
...  
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Multiple Logistic Regression Analysis ◽  
Subretinal Fluid ◽  
Visual Outcome ◽  
Macular Thickness ◽  
Visual Response ◽  
Anatomical Reduction ◽  
Intravitreal Ranibizumab ◽  
Visual Improvement

Purpose: This work examines the relationship between first- and third-month anatomical and visual response with antivascular endothelial growth factor for diabetic macular edema. Methods: We prospectively evaluated 58 eyes with center-involved diabetic macular edema. Response was categorized upon the anatomical status after 3 monthly doses based on the reduction of central macular thickness (CMT) from baseline (≥20% or not). Correlation analysis between the anatomical response status, gained letters, optical coherence tomography morphological features, and other baseline characteristics were obtained. Results: Twenty-five eyes (43.1%) achieved an anatomical reduction of ≥20% at the third month. Those with a reduction of ≥20% of CMT had subretinal fluid ( P < .01), lower hemoglobin A1c values ( P < .01), lower proportion of intraretinal cysts ( P < .01), a greater anatomical reduction, and visual improvement at the first month of treatment. Multiple logistic regression analysis, showed that the change of CMT after the first injection was an independent predictor for the anatomical reduction of ≥20% after the loading phase ( P < .05). Best corrected visual acuity gain after the first dose showed a significant association with an improvement of ≥10 letters after the loading phase ( P < .05), but not for macular thickness reduction. Conclusions: First month anatomical reduction was associated with the anatomical response at 3 months ( P = .042) after monthly ranibizumab therapy. Visual improvement at the first month was predictive only for the visual outcome after the 3 monthly doses ( P = .032).

scholarly journals Comparison of urinary protein-to-creatinine ration, serum albumin, serum creatinine and systolic arterial blood pressure of glomerular injury cases in dogs with chronic kidney disease

2021 ◽  
Vol 42 (4) ◽  
pp. 2339-2358
Author(s):  
Paula Bilbau Sant’Anna ◽  
◽  
Fabricio da Silva Trindade ◽  
Silvano Salgueiro Geraldes ◽  
Maria Gabriela Picelli de Azevedo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Serum Albumin ◽  
Arterial Blood Pressure ◽  
Urinary Protein ◽  
Renal Amyloidosis ◽  
Arterial Blood ◽  
Systolic Arterial Blood Pressure

This study aims at assessing the prevalence of glomerular alterations in dogs with chronic kidney disease (CKD) and comparing the clinical and laboratory parameters. The tests conducted include a double-blind histopathological assay conducted by two pathologists, urine tests including inactive sediment, urinary protein-to-creatinine (UPC), serum albumin and serum creatinine, as well as measurement of the systolic arterial blood pressure. The prevalence of glomerular injuries was determined and the predominant injury was compared with a group comprised of the remaining injuries. The study included 24 dogs with CKD. The results revealed a predominance of membranous glomerular alterations 17/24 (70,83%), followed by glomerulosclerosis 3/24 (12,50%), membranoproliferative injuries 2/24, glomerulocystic atrophy 1/24 and glomerular amyloidosis 1/24. Amyloidosis presented the highest UPC while the membranoproliferative injury presented the lowest mean concentration of serum albumin. Higher values in the UPC did not correspond with lower mean serum albumin values. Glomerulosclerosis presented the highest mean systolic blood pressure and glomerular atrophy presented the highest creatinine values. When comparing membranous injuries with a group comprised of the remaining injuries, the UPC did not present significant differences between the groups. Renal amyloidosis was included in the group with the lowest systolic arterial blood pressure values while membranoproliferative injury was included in the group with highest UPC. The group called “others” presented the highest creatinine value. Dogs with CKD may present several types of glomerular injuries with similar clinical and laboratory profiles. This study observed a predominance of membranous glomerular injuries, followed by membranoproliferative injuries, glomerulocystic atrophy and amyloidosis.

The prognostic role of optical coherence tomography in diabetic macular edema patients undergoing early dexamethasone implant shift

2021 ◽  
pp. 112067212110195
Author(s):  
Mehmet Murat Uzel ◽  
Eyyup Karahan ◽  
Melek Koroglu Canli ◽  
Cenap Guler
Keyword(s):  
Optical Coherence Tomography ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Outer Nuclear Layer ◽  
Subretinal Fluid ◽  
Fluid Volume ◽  
Optical Coherence ◽  
Characteristic Analysis ◽  
Intravitreal Ranibizumab ◽  
Visual Gain

Purpose: To determine the prognostic characteristics of optical coherence tomography (OCT) parameters by evaluating diabetic macular edema (DME) patients with early dexamethasone (DEX) shift after three doses of intravitreal ranibizumab (RNB) injection. Methods: Fifty-four eyes of 34 patients who had DEX implant after three doses of RNB were included in this retrospective study. Early DEX shift includes patients who received direct DEX implant replacement after three doses of RNB load. Baseline OCT values and factors affecting best corrected visual acuity (BCVA) and central macular thickness (CMT) response were analyzed with logistic regression analyses. Results: The presence of subretinal fluid and hyperreflective spot (HRS) >20 were found to be a negative predictive factor for anatomical response. ( p = 0.009, p = 0.001, respectively) Low initial BCVA creates a positive effect on visual gain.( p = 0.041) Giant outer nuclear layer cysts, completely disrupted inner segment-outer segment and HRS > 20 have a negative effect on visual gain. ( p = 0.025, p = 0.043, p = 0.023, respectively) According to the receiver operating characteristic analysis, the subretinal fluid volume threshold at which >20% reduction in CMT occurs was determined to be 0.85 mm3. (sensitivity 70%, specificity 84% area under the curve 0.817, p = 0.021). Conclusion: The presence of high number of HRS and high subretinal fluid volume at the baseline negatively affect prognosis even in patient groups with early DEX shift.

Sign in / Sign up

Export Citation Format

Share Document