Pregnancy-Related Acute Kidney Injury, Dialysis Versus Conservative Management in the Nephrology Ward

2021 ◽  
Vol 15 (11) ◽  
pp. 3417-3420
Author(s):  
Shahid Anwar ◽  
Zahid Anwar ◽  
Andleeb Kanwal ◽  
Sobia Mazhar ◽  
Mateen Akram
Keyword(s):  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Conservative Management ◽  
Kidney Injury ◽  
Complete Recovery ◽  
Third Trimester ◽  
The Third ◽  
Kdigo Guidelines ◽  
The Mean ◽  
Medical University

Aim: To determine the overall frequency of patients suffering from P-AKI in the third trimester requiring dialysis as compared to conservative management. Study Design: Prospective study Place and Duration: Nephrology department of Fatima Jinnah Medical University/Sir Ganga Ram Hospital, Lahore from 3rd June 2017 to 31st December 2017. Methodology: 106 pregnant women having age 15 to 45 years with AKI during the third trimester or postpartum period (42 days of delivery) who were hemodynamically stable and shifted to the Nephrology department without any surgical intervention or ICU requirements were included in the study. For the diagnosis of AKI, KDIGO guidelines were utilized. After taking informed consent from patients, current clinical data, baseline S. Cr before pregnancy, and current renal function tests were recorded. Clinical progress was monitored, and patients were treated as per SOPs of the department. Records of conservative management and dialysis were made. Patients were followed up from the day of admission to the date of discharge. Results: The mean age of the patients was 27 ± 4.169 years. Almost 70% (n=74) of the patients had age 15-29 years, while 30 % (n=32) of patients had age 30-45 years. The mean creatinine of the patients was 4.76 ± 3.55 mg/dl. The frequency of patients requiring dialysis was 23.6% (n=25) and 76.4% patients (n=81) were treated conservatively. Patients who received conservative management, 55 patients (67.9%) had full recovery of renal functions, 25(30.9%) had mildly raised serum creatinine (1.3 to 2mg/dl), and only 1.2% had S. Cr of more than 3mg/dl. 14(56%) were off hemodialysis while 11(44%) were needed regular hemodialysis. Of those who were off hemodialysis, 6(24%) had complete recovery, 5(20%) had mildly raised serum creatinine and 1(4%) had moderate derangement of S.Cr. Of those patients who were discharged on dialysis 13(52%) had severely deranged serum creatinine. Conclusion: It is concluded that conservative treatment is effective for renal recovery with short hospital stay. Sepsis is leading cause of P-AKI in third trimester. HD is required only in 23.6% of P-AKI patients in Nephrology ward. Keywords: Pregnancy, Acute Kidney Injury, Conservative Management, Dialysis

scholarly journals Platelet counts during pregnancy in Chinese women

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Li-Xia Zhang ◽  
Ning Dong ◽  
Rui-Xia Yang ◽  
Ang Li ◽  
Xuan-Mei Luo ◽  
...  
Keyword(s):  
Chinese Women ◽  
Third Trimester ◽  
Bleeding Events ◽  
Common Cause ◽  
Platelet Counts ◽  
The Third ◽  
Uncomplicated Pregnancy ◽  
Gestational Thrombocytopenia ◽  
The Mean ◽  
Medical University

AbstractObjectivesGestational thrombocytopenia (GT) is the most common cause of thrombocytopenia during pregnancy. However, the occurrence and severity of thrombocytopenia throughout pregnancy in Chinese women are not fully defined.MethodsWe analyzed platelet counts in Chinese women who received prenatal care and/or delivered at the First Affiliated Hospital with Nanjing Medical University between January 2, 2018 and July 19, 2018 in China. These platelet counts were compared with those of nonpregnant women in the same study period.ResultsThe platelet counts of all women continued to decrease significantly each trimester (p < 0.0001). The mean platelet counts of the 818 women who had pregnancy-related complications were lower than those of the 796 women who had uncomplicated pregnancies during the third trimester (p = 0.047). At the time of delivery, platelet counts less than 150 × 109/L were more common in women with pregnancy-related complications than in women with uncomplicated pregnancy (26.7% vs. 19.7%, p = 0.03).ConclusionsPlatelet counts decrease throughout pregnancy in Chinese women and platelet counts less than 150 × 109/L were more common in women with pregnancy-related complications than in women with uncomplicated pregnancy. The pregnant women should be paid more attention for thrombocytopenia to avoid the occurrence of bleeding events.

Neutrophil gelatinase associated lipocalin, an early biomarker for diagnosis of acute kidney injury after percutaneous coronary intervention

2017 ◽  
Vol 43 (1) ◽  
pp. 15-21 ◽  
Author(s):  
Nakhshab Choudhry ◽  
Amna Ihsan ◽  
Sadia Mahmood ◽  
Fahim Ul Haq ◽  
Aamir Jamal Gondal
Keyword(s):  
Acute Kidney Injury ◽  
Percutaneous Coronary Intervention ◽  
Serum Creatinine ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Diagnostic Biomarker ◽  
Elective Percutaneous Coronary Intervention ◽  
Percutaneous Coronary ◽  
Significant Difference ◽  
The Mean

AbstractObjectives:This study was designed to find the reliability of serum NGAL as an early and better diagnostic biomarker than that of serum creatinine for acute kidney injury after percutaneous coronary intervention in Pakistani population.Materials and methods:One hundred and fifty-one patients undergoing elective percutaneous coronary intervention were included and demographic data were recorded. Blood was drawn by venipuncture in clot activator vacutainers and serum was separated and stored at 4°C. Sample was drawn before the percutaneous procedure and subsequently sampling was done serially for 5 days.Results:The mean±SD serum NGAL pre-PCI (39.92± 10.35 μg/L) and 4 h post-PCI (100.42±26.07 μg/L) showed highly significant difference (p<0.001). The mean±SD serum creatinine pre-PCI (70.1±11.8 μmol/L) and post-PCI (71.2±11.6 μmol/L) showed significant difference (p=0.005) on day 2 onwards but mean microalbumin showed insignificant results (p=0.533). The serum NGAL predicted CI-AKI with sensitivity of 95.8% and specificity of 97.6% for a cut off value of 118 μg/L.Conclusion:Our results suggest that NGAL is an excellent early diagnostic biomarker for acute kidney injury in patients undergoing elective percutaneous coronary intervention.

scholarly journals ACUTE KIDNEY INJURY IN PREMATURE CHILDREN WITH HEMODYNAMICALLY SIGNIFICANT OPEN ARTERIAL DUCT

2020 ◽  
Vol 10 (4(38)) ◽  
pp. 26-34
Author(s):  
T. Borysova ◽  
O. Obolonska ◽  
D. Surkov
Keyword(s):  
Acute Kidney Injury ◽  
Patent Ductus Arteriosus ◽  
Serum Creatinine ◽  
Premature Infants ◽  
Ductus Arteriosus ◽  
Kidney Injury ◽  
The Third ◽  
Premature Babies ◽  
Arterial Duct ◽  
Patent Ductus

Introduction. Hemodynamically significant patent ductus arteriosus (HSPDA) leads to the “steal” phenomenon of the systemic circulation and renal hypoperfusion, which can contribute to the development of acute kidney injury (AKI). Aim of the study. To assess the frequency and severity of AKI according to the criteria of neonatal modification of KDIGO in premature infants with HSPDA. Material and research methods. We examined 74 premature infants (gestational age 29-36 weeks) who were treated in the department of anesthesiology and intensive care of newborns. The duration of observation was ten days from the first day of life. The patients were divided into three groups depending on the presence of patent ductus arteriosus (PDA) and its hemodynamic significance: group I - 40 children with HSPDA, group II - 17 children with PDA without hemodynamic disorders, group III - 17 children with closed arterial duct. Clinical examination and treatment of premature infants was carried out according to the generally accepted methods. In HSPDA, ibuprofen was used to close the ductus arteriosus for 32 premature babies, and restrictive infusion therapy for 8 ones. Doppler echocardiography was performed at 5-11 hours of life and then daily to determine the PDA, its size and hemodynamic significance. Diagnosis and stratification of the severity of acute kidney injury were carried out according to the criteria of neonatal modification KDIGO, for which the concentration of serum creatinine was studied on the first, third, fifth, seventh, tenth days and the level of urine output every 6-12 hours. Research results. AKI on the third day of life was diagnosed in 52.5% of children with HSPDA, which is 2.2 times more often than in children with PDA without hemodynamic significance (p <0.05) and 4.4 times more often than with closed arterial duct (p<0.007). On the fifth day of life, AKI was detected in two more children and their total number increased to 57.5%. On the seventh and tenth days of life, AKI in children with HSPDA was more common than in children with a closed duct (50.0% versus 11.8%, p<0.008, and 29.4% versus 0%, p<0.02, respectively). Analysis of the severity of acute kidney injury showed the effect of HSPDA on this parameter. The presence of HSPDA was a factor that led to the development of stage II AKI on the third and fifth days of life. In addition, with HSPDA, the frequency of stage III AKI increased 2.7 times within four days, while the percentage of stages I-II AKI decreased by 1.5 times. The frequency and severity of AKI in children with HSPDA depended on the size of the ductus arteriosus. With PDA up to 2 mm in diameter, on the third and fifth days of life, AKI was diagnosed in every fifth patient of stage I only, and on the tenth day of life - only in one patient. Meanwhile, in the majority of children with a PDA diameter of more than 2 mm, AKI was diagnosed on the third, fifth and seventh days; only on the tenth day of life, the number of such patients decreased 1.3 times. But the proportion of severe acute kidney injury practically did not change - acute kidney injury of stages II-III was observed on the first day in every second child with a large PDA diameter. The serum creatinine level on the third and tenth days directly depended on the size of the PDA on the first day (ρ = 0.493, p˂0.001 and ρ = 0.432, p˂0.002, respectively). With HSPDA, this dependence was more pronounced (ρ = 0.732, p˂0.001 and ρ = 0.731, p˂0.001, respectively) than in the group with PDA without hemodynamic significance (ρ = 0.285, p<0.05 and ρ = 0.324, p>0.05, respectively). The serum creatinine concentration directly correlated with the closure time of the PDA. Analysis of the connection between the rate of closure of the PDA and the presence of AKI in the HSPDA group showed that in the case of late closure of the ductus arteriosus (at 3-5 days of life), 16 (94.1%) premature infants suffered from kidney damage versus 1 (5.9%) case among children, in which the duct closed in the first two days (OR = 36.57; CI: 4.02-332.34 p<0.001). A close correlation was also established between the rate of closure of the PDA and the maximum stage of the AKI (ρ = 0.700, p˂0.001). Conclusions. HSPDA contributes to the development of AKI in premature infants. The diameter and rate of closure of the ductus arteriosus determine the frequency and severity of AKI in premature infants with HSPDA. Additional research is needed to diagnose acute kidney injury in premature babies with HSPDA earlier.

scholarly journals Incidence of acute kidney injury in asphyxiated babies in university of Uyo teaching hospital, Uyo, Nigeria

2020 ◽  
Vol 8 (7) ◽  
pp. 2477
Author(s):  
Ikpeme Enobong Emmanuel ◽  
Dixonumo Ofonime Tony ◽  
Udoh Mary Paulinus ◽  
Udo Jacob J.
Keyword(s):  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Teaching Hospital ◽  
Birth Asphyxia ◽  
Kidney Injury ◽  
Neonatal Morbidity ◽  
Urinary Output ◽  
Cross Sectional ◽  
Female Ratio ◽  
The Mean

Background: Acute Kidney Injury (AKI) is a consequence of birth asphyxia. In resource poor countries like ours, birth asphyxia still contributes to the high rates of neonatal morbidity and mortality. A few studies have reported the incidence of AKI in birth asphyxia in Nigeria but none from Uyo, south-south region of Nigeria.Methods: A descriptive cross sectional study carried out in the Newborn Unit of the University of Uyo Teaching hospital, Uyo, Nigeria over a period of eight months. One hundred and four term neonates with provisional diagnosis of birth asphyxia using Apgar scoring were recruited. Blood sample was collected within six hours of life from each subject for serum creatinine estimation using modified Jaffe method. Urine output was assessed by application of plastic collection bag to the skin by adhesive patch. AKI was diagnosed when sCr >1.5mg/dl while oliguria was defined as urinary output <1.5ml/kg/hour.Results: Of the total of 104 asphyxiated neonates enrolled into the study, 56 (53.8%) were males while 48 (46.2%) were females giving a male/female ratio of 1.2:1. Twenty-eight (26.9%) of the subjects had severe birth asphyxia; 52 (50%) had moderate birth asphyxia while 24 (23.1%) were mildly asphyxiated. Incidence of AKI was 48 (46.1%), twelve (11.5%) had AKI based on serum creatinine criteria while 36 (34.6%) had AKI based on urinary output criteria. The mean urinary output (ml/kg/hr) for the subjects was 1.65±0.68 while the mean serum creatinine (mg/dl) was 0.88±0.46.Conclusions: The incidence of AKI among asphyxiated neonates in our locale is high at 46.1%.

scholarly journals Urine Neutrophil Gelatinase-Associated Lipocalin Measured at Admission to Predict Recovery from Acute Kidney Injury of Vietnamese ICU Patients

2019 ◽  
Vol 12 (1) ◽  
pp. 60-65
Author(s):  
Le V. Thang ◽  
Nguyen T. Kien ◽  
Pham N. H. Tuan ◽  
Nguyen T. T. Dung ◽  
Truong Q. Kien ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Area Under The Curve ◽  
Kidney Injury ◽  
Complete Recovery ◽  
Lipocalin 2 ◽  
Serum Urea ◽  
Urine Ngal ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Neutrophil Gelatinase

Aims: To evaluate the predictive value of urine Neutrophil Gelatinase-Associated Lipocalin (NGAL) measured at the time of admission during the recovery from Acute Kidney Injury (AKI) after 90 days. Materials and Methods: This study includes 101 adult patients admitted to the Intensive Care Unit (ICU) who were diagnosed as AKI (96 patients had been collected 24-hour urine and 5 patients with anuria). Acute kidney injury was diagnosed using the Acute Kidney Injury Network (AKIN) criteria. Urine NGAL was measured at admission using the BioVendor Human Lipocalin-2/NGAL ELISA. Results: The ratio of complete recovery patients after 90 days reached 71.9%. The mean of urine NGAL concentration in the recovery group was 242.04 ng/ml, lower significantly than that of non-recovery patients (371.1 ng/ml), p=0.007. At the cut-off value for 740.03 ng/ml, urine NGAL measured at admission predicted complete recovery with the area under the curve of ROC for urine NGAL = 0.888, p<0.001. Based on the multivariate regression analysis, serum urea, serum creatinine and urine NGAL were independent factors that effected the proportion of recovery in AKI patients (OR=0.856, p=0.023; OR=1.014, p=0.012 and OR=0.993, p<0.001, respectively). Conclusion: Serum urea, serum creatinine and urine NGAL were independent factors that effected the proportion of recovery in AKI patients. Urine NGAL in AKI patients measured at the time of the admission time to ICU can be used as a prognostic biomarker of recovery.

scholarly journals Pattern of acute kidney injury and its outcome in a tertiary care centre

2020 ◽  
Vol 8 (2) ◽  
pp. 618
Author(s):  
Jennie Santhanam ◽  
Meenakshi Sundari Subramaniyan Natarajan ◽  
Annam Lakshmanan ◽  
Rajeswari K. Balakrishnan
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Risk Category ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Disease Category ◽  
The Mean

Background: Acute kidney injury is a multiplex disease with severe morbidity and mortality. The trends of acute kidney injury vary according to the regions and the population under study. The aim of this study is to evaluate the trends of acute kidney injury and its outcome in a tertiary care hospital.Methods: The study was a prospective observational study conducted at a tertiary care hospital in a metropolitan city. A total of 102 patients of acute kidney injury were selected based on the Kidney Disease Improving Global Outcomes guidelines of acute kidney injury. The main trends of acute kidney injury presentation and its outcome were assessed.Results: Of 102 patients admitted, 42 had a sepsis related diagnosis (42.41%), 17 patients (17.16%) had cardiovascular disease related acute kidney injury and 12 patients (12.12%) had developed acute kidney injury due to drugs and poisons. According to RIFLE (risk of renal failure, injury to kidney, failure and loss of function and end-stage kidney disease) category, 43.96% of patients belonged to the risk category and 30.77% to the injury category. Of 34 patients in failure category, 23 recovered and 11 did not recover. Authors compared the trends of acute kidney injury in patients who recovered and who deteriorated. The mean serum creatinine values were 3.42 mg/dl in patients who didn’t recover from acute kidney injury and 2.05 mg/dl in patients who recovered. In patients of the recovered group, the mean urine output value is 783 ml/day; in deterioration group, 445 ml/day.Conclusions: Most common etiologies of acute kidney injury in this study include sepsis, drugs and poisons, cardiovascular diseases and diarrheal diseases in order of occurrence. High serum creatinine at admission and oliguria were the most common factors that contributed to deterioration in acute kidney injury.

scholarly journals MO962EPIDEMIOLOGY AND CLINICAL RELEVANCE OF ACUTE KIDNEY INJURY IN KIDNEY TRANSPLANT RECIPIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Greta Rosso ◽  
Gabriele Guglielmetti ◽  
Umberto Morosini ◽  
Marco Quaglia ◽  
Guido Merlotti ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Kidney Transplant ◽  
Graft Function ◽  
Kidney Injury ◽  
University Hospital ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Increased Risk ◽  
Kdigo Guidelines

Abstract Background and Aims Very few information about COVID-19 in kidney transplant recipients (KTRs) are known and the available evidence are based on limited case series. In KTRs, Acute Kidney Injury (AKI) of different causes is known to be associated with a decreased graft survival: direct viral infection and local inflammation may potentially lead to a premature loss of graft function and to an increased risk of death in COVID-19 patients. To evaluate prevalence, stage, causes of AKI and mortality in KTRs with a positive pharyngeal swab for SARS-CoV-2 in our transplant center located in a 500-bed University Hospital. Method In March-June 2020, we evaluated in 25 COVID-19 KTRs demographic and transplant characteristics, comorbidities, immunosuppressive therapies (IT). Patients were screened for type of symptoms, management of IT, complications and outcome. AKI was graded according to 2012 KDIGO guidelines and causes were investigated basing on both clinical and laboratory variables. AKI prevalence in KTRs was compared to that observed in the whole hospitalized COVID-19 patients. Results During the first wave of pandemic, a total of 945 patients were admitted to our hospital with a reported AKI prevalence of 37%. AKI classified using 2012 KDIGO guidelines associated with an increased mortality risk in the whole population. In this setting, we observed that 25 KTRs followed-up in our University Hospital had a positive molecular diagnosis for COVID-19: median age was 58 years and 80% were males. Considering the most frequent comorbidities, 100% of KTRs had hypertension and 7/25 (29%) had diabetes. Clinical symptoms at enrollment were fever (95%), cough (47%), dyspnea (30%). Regarding IT, 100% of patients were taking CNI, 64% antimetabolite agents and 76% steroids. Of note, 19/25 patients (76%) were hospitalized and 6/19 (31.5%) were admitted to Intensive Care Unit (ICU). Mean length of hospital stay was 23 days. At admission, all KTRs stopped MMF and increased steroid doses, concomitantly decreasing CNI levels. AKI occurred in 60% of KTRs (12/25), AKI KDIGO grading as follow: stage 1 4/12 (33.3%), stage 2 3/12 (25%), stage 3 5/12 (41.7%); development favored by low eGFR/increased serum creatinine (mean serum creatinine 2.06 mg/dl): 4/25 (16%) required hemodialysis and the most frequent cause of AKI was sepsis or septic shock. Overall mortality in KTRs was 37,5% (9/25): of note, 88% (8/9) of patients with a worse outcome had developed AKI. Conclusion AKI prevalence was significantly higher in KTRs than in non-transplanted COVID-19 patients. AKI development was associated with an increased risk of mortality: of note, mortality rate in KTRs was significantly higher than that observed in the non-transplanted patients. COVID-19 lead to a difficult management of IT, in particular for elevated tacrolimus levels due to associated antiviral and antibiotic therapies. COVID-19-associated AKI in KTRs may lead to an increased risk of rejection and premature loss of graft function with the need of skilled nephrological follow-up.

Assessment of Acute Kidney Injury in Patients Undergoing Elective Coronary Angiography and Percutaneous Coronary Intervention

2012 ◽  
Vol 5 (1) ◽  
pp. 37-43
Author(s):  
ABMM Alam ◽  
M Moniruzzaman ◽  
MB Alam ◽  
N Islam ◽  
F Khatoon ◽  
...  
Keyword(s):  
Serum Creatinine ◽  
Contrast Media ◽  
Creatinine Level ◽  
Ace Inhibitor ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Group I ◽  
Percutaneous Coronary ◽  
The Mean ◽  
Group Ii

Background: CIN has gained increased attention in the clinical setting, particularly during cardiac intervention but also in many other radiological procedures in which iodinated contrast media are used. There is at present good clinical evidence from well-controlled randomized studies that CIN is a common cause of acute renal dysfunction.Methodology: This was a prospective study conducted among the patients who underwent coronary angiography and percutaneous coronary intervention in the Department of Cardiology, Dhaka Medical College Hospital during January 2010 to December 2010. A total of 111 patients age range from 25 to 75 years were included in the study. Serum creatinine level at baseline and at the end of 48 hours was done in all these patients. Study population was divided into two groups according to development of acute kidney injury (AKI). Group-I = AKI, Group II = Not developed AKI. Results: AKI developed 11.7% of the study patient. DM and Preexisting renal insufficiency were significantly higher in group I patients. HTN was (61.5% Vs 44.9%) higher in group I but not significantly. History of ACE inhibitor/ARB, NSAID intake and LVEF <40% were significantly higher in group I patients. The mean±SD volume of CM (Contrast Media) were 156.9±44.8 ml and 115.4±30.0 ml in group I and group II respectively, which was significant. The mean±SD of serum creatinine after 48-72 hours of CAG/PCI was 1.4±0.37 mg/dl and 1.1±0.2 mg/dl in group I and group II respectively. The serum creatinine level increased significantly (p<0.05) after 48-72 hours of CAG/PCI in group I. In group II, S. creatinine level increased but not significant (p>0.05). Impaired renal function was found 76.9% and 2.0% in group I and group II respectively. DM, HTN, preexisting renal insufficiency, ACE inhibitor/ARB, NSAIDs, contrast volume (>150 ml), eGFR (<60 ml/min/ 1.73m2) and LVEF (<40%) are significantly (p0.05) associated for CIN development.Conclusion: CIN is an iatrogenic but preventable disorder results from the administration of contract media. Although rare in the general population, CIN occurs frequently in patients with underlying renal dysfunction and diabetes. In patients with pre angiographic normal renal function, the prevalence is low but in pre-existing renal impairment it may pose a serious threat. Thus risk factors are synergistic in their ability to predispose to the development of CIN. A careful risk-benefit analysis must always be performed prior to the administration of contrast media to patients at risk for CIN. DOI: http://dx.doi.org/10.3329/cardio.v5i1.12227 Cardiovasc. j. 2012; 5(1): 37-43

Correlations Between the Values of Maternal Glycemia from the Last Trimester of Pregnancy and Fetal Birth Weight

2013 ◽  
Vol 20 (3) ◽  
pp. 259-265
Author(s):  
Monica Vereş ◽  
Aurel Babeş ◽  
Szidonia Lacziko
Keyword(s):  
First Trimester ◽  
Mean Value ◽  
Fetal Macrosomia ◽  
Entire Group ◽  
Third Trimester ◽  
The Third ◽  
Group I ◽  
Fetal Birth Weight ◽  
First Trimester Of Pregnancy ◽  
The Mean

Abstract Background and aims: Gestational diabetes represents a form of diabetes diagnosed during pregnancy that is not clearly overt diabetes. In the last trimester of gestation the growth of fetoplacental unit takes place, thus maternal hyperglycemia will determine an increased transplacental passage, hyperinsulinemia and fetal macrosomia. The aim of our study was that o analyzing the effect of maternal glycemia from the last trimester of pregnancy over fetal weight. Material and method: We run an observational study on a group of 46 pregnant women taken into evidence from the first trimester of pregnancy, separated in two groups according to blood glucose determined in the third trimester (before birth): group I normoglycemic and group II with hyperglycemia (>92mg/dl). Results: The mean value of third trimester glycemia for the entire group was of 87.13±22.03. The mean value of the glycemia determined in the third trimester of pregnancy was higher in the second group (109.17 mg/dl) in comparison to the first group (74.,21 mg/dl). The ROC curve for third trimester glycemia as fetal macrosomia appreciation test has an AUC of 0.517. Conclusions: Glycemia determined in the last trimester of pregnancy cannot be used alone as the predictive factor for fetal macrosomia.

scholarly journals Perioperative use of serum creatinine and postoperative acute kidney injury: a single-centre, observational retrospective study to explore physicians’ perception and practice

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Gianluca Villa ◽  
Silvia De Rosa ◽  
Caterina Scirè Calabrisotto ◽  
Alessandro Nerini ◽  
Thomas Saitta ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Retrospective Study ◽  
High Risk ◽  
Abdominal Surgery ◽  
Serum Creatinine ◽  
Malignant Disease ◽  
Kidney Injury ◽  
Major Surgery ◽  
Single Centre

Abstract Background Postoperative acute kidney injury (PO-AKI) is a leading cause of short- and long-term morbidity and mortality, as well as progression to chronic kidney disease (CKD). The aim of this study was to explore the physicians’ attitude toward the use of perioperative serum creatinine (sCr) for the identification of patients at risk for PO-AKI and long-term CKD. We also evaluated the incidence and risk factors associated with PO-AKI and renal function deterioration in patients undergoing major surgery for malignant disease. Methods Adult oncological patients who underwent major abdominal surgery from November 2016 to February 2017 were considered for this single-centre, observational retrospective study. Routinely available sCr values were used to define AKI in the first three postoperative days. Long-term kidney dysfunction (LT-KDys) was defined as a reduction in the estimated glomerular filtration rate by more than 10 ml/min/m2 at 12 months postoperatively. A questionnaire was administered to 125 physicians caring for the enrolled patients to collect information on local attitudes regarding the use of sCr perioperatively and its relationship with PO-AKI. Results A total of 423 patients were observed. sCr was not available in 59 patients (13.9%); the remaining 364 (86.1%) had at least one sCr value measured to allow for detection of postoperative kidney impairment. Among these, PO-AKI was diagnosed in 8.2% of cases. Of the 334 patients who had a sCr result available at 12-month follow-up, 56 (16.8%) developed LT-KDys. Data on long-term kidney function were not available for 21% of patients. Interestingly, 33 of 423 patients (7.8%) did not have a sCr result available in the immediate postoperative period or long term. All the physicians who participated in the survey (83 out of 125) recognised that postoperative assessment of sCr is required after major oncological abdominal surgery, particularly in those patients at high risk for PO-AKI and LT-KDys. Conclusion PO-AKI after major surgery for malignant disease is common, but clinical practice of measuring sCr is variable. As a result, the exact incidence of PO-AKI and long-term renal prognosis are unclear, including in high-risk patients. Trial registration ClinicalTrials.gov, NCT04341974.

Sign in / Sign up

Export Citation Format

Share Document