scholarly journals Menstrual Abnormalities and Associated Hormone Profile In Chronic Kidney Disease Stage 5 Patients

2022 ◽  
Vol 40 (1) ◽  
pp. 45-51
Author(s):  
Masrura Jabin ◽  
Md Nizamuddin Chowdhury ◽  
Md Nazrul Islam ◽  
Mohammad Ehasun Uddin Khan

Background: Although menstrual abnormalities and associated hormonal dysregulations are very common in the reproductive age group of Chronic Kidney Disease (CKD) patients, this remains a neglected area. This field had been poorly explored in last ten years worldwide and a few research regarding this area in Bangladesh as well. Aim: To evaluate menstrual abnormalities occurring in CKD stage 5 (CKD5)patients undergoing twice-weekly and thriceweekly maintenance hemodialysis (HD) also in non-dialytic CKD5 patients and to provide more detail information on hormone profile (FSH, LH, Prolactin, Estradiol) of these patients. Materials and method: This obsevational study was conducted in the Department of Nephrology, DMCH, the sample population was also collected from BSMMU and NIKDU from April 2017 to March 2018. A total of 51 CKD stage 5 patients were enrolled in this study. Among them, 34 patients were dialytic (17 of them were taking twice weekly HD and 17 of them were taking thrice weekly HD) and 17 non-dialytic patients at reproductive age were evaluated. Detailed menstrual histories, thorough clinical examinations as well as investigations were done in all the patients. Serum FSH, LH, Estradiol, and Prolactin were evaluated using chemiluminescence immunoassay in the Department of Microbiology of BSMMU. Statistical analysis of the study was done by SPSS-24. The confidence interval was considered at 95% level. P-value <0.05 was considered statistically significant. Results: 100% of non-dialytic CKD5 women had menstrual disorders (72% of patients had secondary amenorrhea, 18% had oligomenorrhoea and 10% had menometrorrhagia). And 73.52% of patients in the HD group had menstrual disorders (29% patients had regular menstruation, 28.5% had secondary amenorrhea, 23.5% had oligomenorrhoea and 19% had menometrorrhagia). With continuation of HD amenorrhea disappeared in 43% of patients in the thrice-weekly HD group, also 22.22% patients in the twice-weekly HD group regained menstruation. Serum LH and prolactin levels were significantly higher in the non-HD group compared to the HD group (p<0.05). Estradiol levels were also higher in HD patients than the non-HD patients. LH and Prolactin levels were also higher in the twice-weekly HD group compared to the thrice-weekly HD group. In the secondary amenorrheic group, serum FSH, LH, Prolactin levels were significantly higher than the other groups having menstrual disorder (p<0.05). Conclusion: Menstrual abnormalities and associated hormonal dysregulations were significantly lower in thriceweekly HD patients compared to the twice-weekly HD patients and significantly lower in twice-weekly HD patients compared to the non-dialytic CKD5 patients. Besides, it is suggested that long-duration dialysis might improve menstrual disorders in such patients as prolactin, LH levels gradually decreased with longer duration of dialysis. J Bangladesh Coll Phys Surg 2022; 40: 45-51

Author(s):  
Agri Febria Sari ◽  
Rikarni Rikarni ◽  
Deswita Sari

Reticulocyte hemoglobin equivalent (RET-He) represents hemoglobin content in reticulocyte. Reticulocyte hemoglobin equivalent test can be used to asses iron status of chronic kidney disease (CKD). Iron deficiency happens in 40% CKD and could lead to anemia manifestation. Level of RET-He gives real-time assesment of iron availability for hemoglobin production and the level will getting lower when iron storage for erythropoiesis decreasing. Reticulocyte hemoglobin equivalent is more stabil than feritin and transferin saturation in assessing iron status. Aim of this study is to determine RET-He level in patients with CKD stage IV and V. This study is  a cross sectional descripstive study. Subjects were 96 CKD stage IV and V patients that met inclusion and exclusion criterias. Subjects conducted blood tests at Central Laboratory Installation Dr. M. Djamil Hospital Padang from July to September 2020. Examination of RET-He level was analyzed by Sysmex XN-1000 flowcytometry fluorescense method. Data was presented in frequency distribution table. The RET-He level below cutoff (<29,2 pg) indicates the need for iron suplementation therapy for CKD stage IV and V patients. Samples with RET-He level below cutoff were 48 (50%) and 48 (50%) were above cutoff.


2020 ◽  
pp. 105477382095854
Author(s):  
Emanuele Poliana Lawall Gravina ◽  
Bruno Valle Pinheiro ◽  
Luciana Angélica da Silva Jesus ◽  
Fabrício Sciammarella Barros ◽  
Leda Marília Fonseca Lucinda ◽  
...  

To evaluate the factors associated with functional capacity in patients with chronic kidney disease (CKD). All patients were submitted to six-minute walk test (6MWT), 10-repetition sit-to-stand test (STS-10) and SF-36 health-related quality of life questionnaire (HRQoL). Patients with functional capacity ≥80% exhibited higher education level, family income, body mass index, estimated glomerular filtration rate, and lower age and STS-10 time. Multiple linear regression showed that gender, age, family income, chronic kidney disease stage, STS-10 time, and physical component summary of HRQoL were significantly associated with the 6MWT distance. Functional capacity was significantly associated with gender, age, family income, CKD stage, STS-10 time, and physical component of HRQoL. The progression of CKD has an impact on the decrease in functional capacity in these patients.


2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Roberto Gordillo ◽  
Marcela Del Rio ◽  
David B. Thomas ◽  
Joseph T. Flynn ◽  
Robert P. Woroniecki

We report a child with Hermansky-Pudlak Syndrome (HPS) and chronic kidney disease (stage II) with histological diagnosis of focal segmental glomerulosclerosis (FSGS). A 15-year-old male of Puerto Rico ancestry with history of HPS, hypertension (HTN), asthma, obesity, and chronic kidney disease (CKD) stage II presented with new-onset proteinuria without edema. His blood pressure had been controlled, serum creatinine had been 0.9–1.4 mg/dL, and first morning urine protein/creatinine ratio (UPC) ranged from 0.2 to 0.38. Due to persistent nonorthostatic proteinuria with CKD, renal biopsy was performed and FSGS (not otherwise specified) with chronic diffuse tubulopathy (tubular cytoplasmic droplets) and acute tubular injury was reported. Ceroid-like material is known to infiltrate tissues (i.e., lungs, colon, and kidney) in HPS, but the reason for the renal insufficiency is unknown. Nonspecific kidney disease and in one adult case IgA nephropathy with ANCA-positive glomerulonephritis have previously been reported in patients with Hermansky-Pudlak syndrome. To our knowledge, we report the first pediatric renal pathology case of HPS associated with CKD. This paper discusses presentation and management of renal disease in HPS.


2016 ◽  
Vol 4 (1) ◽  
Author(s):  
Medhyka S.A. Kawilarang ◽  
Arthur E. Mongan ◽  
Maya Memah

Abstract: Magnesium is a metal, one of the eight most abundant element in universe. Magnesium also is a mineral that responsible for bone metabolism control, neural transmission, cardiac excitability, neuromuscular conduction, muscular contraction, vasomotor, and blood pressure. In chronic kidney disease stage 4-5, compensation mechanism become inadequate that caused a hypermagnesemia. Objectives: This study aimed to know the picture of magnesium serum in non dialysis CKD stage 5 in Manado. Material Methods: This is a descriptive study, conducted by selecting 35 blood samples in Nephrology-Hypertension Polyclinic and IRINA of Interna of Prof. Dr. R.D Kandou Hospital and Teling Adventist Hospital. Result: There are 16 samples (45.7%) experience hypomagnesemia consisted of 8 home-care patient (22.9%) and 8 hospital-care patient (22.9%), 10 samples (28.6%) are in normal range consisted of 3 home-care patient (8.6%) and 7 hospital-care patient (20.0%), and 9 samples (25.7%) are experience hypermagnesemia consisted of 6 home-care patient (17.1%) and 3 hospital-care patient (8.6%) from total non dialysis CKD stage 5 samples result from laboratory examination. Conclusion: Patient with hypomagnesemia most frekuent than patient with hypermagnesemia.Keywords: magnesium, chronic kidney disease, non dialysisAbstrak: Magnesium merupakan logam yang masuk dalam delapan elemen paling melimpah di alam semesta. Magnesium juga merupakan mineral yang bertanggung jawab dalam pengaturan metabolisme tulang, transmisi saraf, eksitabilitas jantung, konduksi neuromuskular, kontraksi muscular, vasomotor, dan tekanan darah. Pada penyakit ginjal kronik stadium 4-5 mekanisme kompensasi ginjal menjadi inadekuat sehingga dapat menghasilkan hipermagnesemia. Tujuan: Penelitian ini bertujuan untuk mengetahui gambaran kadar serum magnesium pada pasien PGK non dialisis stadium 5 di Manado. Metode Penelitian: Penelitian ini adalah penelitian yang bersifat deskriptif yang dilaksanakan dengan cara mengambil sampel darah di Poliklinik Nefrologi-Hipertensi dan IRINA bagian Penyakit Dalam RSUP Prof. DR. R. D. Kandou Manado dan RS Advent Teling sebanyak 35 sampel. Hasil: Tercatat 16 orang yang mengalami hipomagnesemia (45,7%) diantaranya 8 orang pasien rawat jalan (22,9%) dan 8 orang pasien rawat inap (22,9%), 10 orang dalam batas nilai normal (28,6%) diantaranya 3 orang pasien rawat jalan (8,6%) dan 7 orang pasien rawat inap (20,0%), serta 9 orang mengalami hipermagnesemia (25,7%) diantaranya 6 orang pasien rawat jalan (17,1%) dan 3 orang pasien rawat inap (8,6%) dari total jumlah pasien terdiagnosis dokter PGK stadium 5 non dialisis yang didapatkan dari hasil pemeriksaan laboratorium. Simpulan: Frekuensi pasien yang mengalami hipomagnesemia lebih banyak dibandingkan pasien hipermagnesemiaKata kunci: magnesium, penyakit ginjal kronik, non dialisis


2021 ◽  
Vol 15 (9) ◽  
pp. 3087-3090
Author(s):  
Muhammad Rizwan ◽  
Muhammad Taha Lodhi ◽  
Asim Maqsood ◽  
Tahir Mukhtar Sayed

Background and Aim: Chronic kidney disease patients are more likely to develop cardiovascular diseases caused by atherosclerosis accelerated rate and variety of other factors, of which they exhibit the abnormality of lipid profile atherogonic characteristics. The current study aim was to investigate the lipid profile abnormalities pattern in non-diabetic chronic kidney disease patients and to evaluate the association between the lipid profile alteration extent and renal impairment degree. Methods: This cross-sectional study was carried out on 118 chronic disease patients in the Department of Nephrology, Shaikh Zayed Hospital Lahore during the period, from August 2020 to May 2021. All the patients were carefully chosen based on their eligibility criteria. A history was taken, clinical investigation was performed, and biochemical tests were conducted. Blood was drawn for lipid profile analysis after 9 hours abstaining. The Institutional Ethical Committee approved the study and informed consent was taken from each individual. Chronic Kidney Disease as defined by the KDOQI Criteria Kidney damage for three months, defined as functional kidney abnormalities with or without decreased GFR, manifested by either: Pathological abnormalities; kidney damage markers such as changes in blood or urine composition, or abnormalities in imaging tests. GFR of less than 60 mL/min/1.73m2 for 3 months, with or without kidney damage. SPSS version 20 was used for data analysis. Results: The study included 118 patients, 79 (66.9%) of whom were males and 39 (33.1%) were females. The mean age of patients was 49.46 + 9.35 years with an age range of 28 to 78 years. Stage 5CKD patients were 23 who underwent dialysis. Chronic kidney disease patients had lower HDL and higher levels of triglyceride whereas, with chronic kidney disease stage progression, the HDL and TGL levels increased. In both stages 4 and 5 CKD, there is a positive correlation between triglyceride levels and serum phosphorous and TGL and calcium had inverse correlation. Dialysis patients' lipid profiles do not differ from those of non-dialysis patients. Conclusion: Our study found that patients with non-diabetic CKD have high triglyceride levels, low HDL, and had LDL and total cholesterol unchanged levels. As the CKD stage advances and GFR declines, triglyceride increases, and HDL decreases. TGL and serum phosphorous had a positive association in chronic kidney disease stage 4 and 5 whereas TGL and serum calcium had an inverse correlation in stages 4 and 5. Moreover, no significant difference between dialysed and non-dialysed chronic kidney disease patients’ lipid profiles was observed. Keywords: Chronic Kidney Disease; Lipid Profile; Lipid Profile Abnormalities


Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Satoshi Nishiyama ◽  
Tetsu Watanabe ◽  
Shintaro Sasaki ◽  
Masahiro Wanezaki ◽  
Gensai Yamaura ◽  
...  

Introduction: The patients with chronic kidney disease (CKD) are likely to suffer from cardiovascular diseases as well as end stage renal disease. CKD plays a role in development of atherothrombotic stroke. In the present study, we investigated the impact of advancing CKD stage on aortic arch plaque and carotid atherosclerosis which are important causes of atherothrombotic stroke. Methods: We enrolled 368 subjects (255 males, 66 ± 12 years) who underwent transesophageal echocardiography and carotid ultrasonography, and measured estimated glomerular filtration rate (eGFR). We defined arch plaque as wall thickness ≥4 mm and the presence of ulceration or mobile plaque in aortic arch. The common carotid artery maximum intima-media thickness (IMT-C max) and carotid artery plaque score was used as parameters of carotid atherosclerosis. Results: There were 31 patients with the history of atherothrombotic stroke. The eGFR correlated with IMT-C max, carotid plaque score and arch wall thickness. IMT-C max, carotid plaque score and arch wall thickness were increased with advancing CKD stage. An increase in IMT-C max was observed even in stage 2 and 3 while carotid plaque was frequently observed in stage 3b or higher. An increase in arch plaque was observed in stage 3a or higher. The patients with atherothrombotic stroke had significantly lower eGFR than those without. The prevalence of atherothrombotic stroke was increased in stage 3b or higher. Conclusions: Aortic arch plaque and carotid plaque deteriorated with advancing chronic kidney disease stage. Aortic arch plaque and carotid plaque were observed even in early stages of CKD.


2009 ◽  
Vol 1 ◽  
pp. CMT.S3211 ◽  
Author(s):  
Yoshihiro Tominaga

It has been clarified in patients with CKD stage 3-4, cinacalcet can reduce PTH levels without severe adverse events, however calcium levels significantly decrease and phosphorus levels increase. Increase of serum phosphorus level by cinacalcet in patients with CKD stage 3-4 is a problematic issue. Undesirable decreases in serum calcium and increases in serum phosphorus caused by cinacalcet require further investigation. For patients with CKD stage 3-4 who suffer from severely advanced 2HPT which cannot be controlled by the usual medical treatment or PTx, cinacalcet can be a useful medication for managing 2HPT.


2015 ◽  
Vol 16 (1) ◽  
Author(s):  
Simon D. S. Fraser ◽  
Paul J. Roderick ◽  
Carl R. May ◽  
Natasha McIntyre ◽  
Christopher McIntyre ◽  
...  

Abstract Background Multimorbidity is a growing concern for healthcare systems, with many countries experiencing demographic transition to older population profiles. Chronic kidney disease (CKD) is common but often considered in isolation. The extent and prognostic significance of its comorbidities is not well understood. This study aimed to assess the extent and prognostic significance of 11 comorbidities in people with CKD stage 3. Methods A prospective cohort of 1741 people with CKD stage 3 was recruited from primary care between August 2008 and March 2010. Participants underwent medical history, clinical assessment, blood and urine sampling. Comorbidity was defined by self-reported doctor-diagnosed condition, disease-specific medication or blood results (hemoglobin), and treatment burden as number of ongoing medications. Logistic regression was used to identify associations with greater treatment burden (taking >5 medications) and greater multimorbidity (3 or more comorbidities). Kaplan Meier plots and multivariate Cox proportional hazards models were used to investigate associations between multimorbidity and all-cause mortality. Results One thousand seven hundred forty-one people were recruited, mean age 72.9 +/−9 years. Mean baseline eGFR was 52 ml/min/1.73 m2. Only 78/1741 (4 %) had no comorbidities, 453/1741 (26 %) had one, 508/1741 (29 %) had two and 702/1741 (40 %) had >2. Hypertension was common (88 %), 30 % had ‘painful condition’, 24 % anemia, 23 %, ischaemic heart disease, 17 % diabetes and 12 % thyroid disorders. Median medication use was 5 medications (interquartile range 3–8) and increased with degree of comorbidity. Greater treatment burden and multimorbidity were independently associated with age, smoking, increasing body mass index and decreasing eGFR. Treatment burden was also independently associated with lower education status. After median 3.6 years follow-up, 175/1741 (10 %) died. Greater multimorbidity was independently associated with mortality (hazard ratio 2.81 (95 % confidence intervals 1.72–4.58), p < 0.001) for 3 or more comorbidities vs 0 or 1). Conclusions Isolated CKD was rare and multimorbidity the norm in this cohort of people with moderate CKD. Increasing multimorbidity was associated with greater medication burden and poorer survival. CKD management should include consideration of comorbidities.


2017 ◽  
Vol 45 (4) ◽  
pp. 356-364
Author(s):  
Masahito Miyamoto ◽  
Noriaki Kurita ◽  
Kotaro Suemitsu ◽  
Masaaki Murakami

Background: Most guidelines recommend the creation of arteriovenous fistula (AVF) in patients with chronic kidney disease (CKD) stage 4. However, an increasing number of studies suggest that early AVF creation leads to high rates of AVF failure and death before dialysis commencement. Only the Japanese guideline recommends AVF creation at CKD stage 5; however, no data are available regarding access-related outcomes at this stage. Method: This was a multicenter cohort study involving Japanese CKD stage 5 patients who underwent preemptive AVF creation from 2009 to 2013. The primary outcome was unnecessary AVF creation, defined as death before requiring dialysis or AVF failure before dialysis commencement. The secondary outcome was dialysis commencement. The associations with candidate predictors and the outcomes were examined. Results: A total of 303 patients were registered. Four cases of death before dialysis and 13 cases of AVF failure before dialysis commencement were observed. A total of 283 patients who advanced to dialysis were found to have functional AVFs. The cumulative incidences of unnecessary AVF creation and dialysis commencement at 1 year were 4.8 and 89.3%, respectively. Competing risk regression analyses showed that age ≥75 years (subhazard ratio [SHR] 3.12, 95% CI 1.20-8.09) and female gender (SHR 3.31, 95% CI 1.20-9.09) were associated with unnecessary AVF creation. Conclusions: A low incidence of unnecessary AVF creation was revealed among Japanese patients who received AVF at CKD stage 5. These results may help clarify the natural history of unnecessary AVF creation for other countries reformatting their guidelines regarding late vascular access creation.


Author(s):  
Esthy Poespitaningtyas ◽  
Roedi Irawan ◽  
Ninik Asmaningsih Soemyarso ◽  
Jusak Nugraha

Chronic kidney disease (CKD) is not uncommon issue in children. CKD is the abnormality of structure or function of the kidney that occurs for more than 3 months. Progresivity of CKD characterized by the presence of longitudinal decline in Glomerulus Filtration Rate (GFR), proteinuria and hypertension. One of the recommendations of the prevention of nutritional supplementation in CKD by administering oral Branched Chain Amino Acid (BCAA). Recently, there has been no research to figure the effects of the of BCAA on children with CKD stage 2-4. Randomized pre-post test controlled trial study was conducted in Nephrology pediatric outpatient clinic Dr. Soetomo hospital with CKD stage 2-4, divided into 2 groups, the BCAA and placebo, followed for 8 weeks to be evaluated for GFR, albumin, proteinuria, blood pressure and nutritional status. Sixteen children with CKD stage 2-4 were enrolled in this study, 71.4% of patients were boys. The mean age was 12.5 (SD 2.90) years. CKD stage 2 about 50% (p=0,767). Nephrotic syndrome was the most common underlying cause of CKD (p=0,149). Moderate malnutrition was about 50% (p=1,000) and short stature was 64.28% (p=1.000). In BCAA group there was decrease of GFR -5.08±7,13 (p=0.055), increase of albumin serum 0.20±0.23 (p=0,062), decrease of delta systole -11,57±15.08 (p=0,565) and diastole -4,85±16.25 (p=0,708), weight loss -0.07±1.01 (p=0.828), an increase of height 0.14±0.24 (p=0,771), and a decrease in BMI -0.03±0.74 (p=0,389). The conclusion in this study is Branched chain amino acid (Leucine, Isoleucine and Valine) supplementation did not provide significant effect in inhibiting progresivity of CKD stage 2-4 in children and improvement of nutritional status.


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