Establishment of dry chemistry based reference intervals of renal function test parameters for the adult population of Kaski District, Nepal

Background Reference intervals (RIs) for clinical chemistry test parameters are specific to the method of measurement and population under service. However, there has been no locally available dry chemistry based RIs for the Nepalese population. Thus, the present study aimed to establish dry chemistry based RIs for sodium, potassium, urea, and creatinine specific to adult populations of Kaski districts, Nepal Methods This was a cross-sectional study conducted at the Manipal Teaching Hospital, Pokhara, Kaski, Nepal on 360 healthy adult participants aged 18–65 years. The test parameters under study were analyzed using a fully automated OCD Vitros 350 dry chemistry analyzer following the protocols provided by the reagent kit manufacturer. The RIs were estimated using reference limits at 2.5th and 97.5th percentiles. The normal distribution of the data was tested by Kolmogorov–Smirnov, and Shapiro–Wilk tests. The differences between males and females RIs were compared by the Mann-Whitney test while age-specific RIs for each sex was compared by One-Way-ANOVA and Dunnett’s Multiple Comparisons Tests. All the data were managed and analyzed using MS Excel and SPSS version 20. Results The RIs of urea, creatinine, sodium, and potassium specific to the adult population of Kaski district, Nepal are as follows: urea: 4.20–13.70 mmol/L (males: 4.70–13.99; females: 4.20–13.23); creatinine: 44.20–106.10 μmol/L (males: 48.82–106.10; females: 35.40–83.78); sodium 135–146 mmol/L (males: 135–146; females: 135–146) and potassium 3.60–5.10 mmol/L (males: 3.54–5.0; females: 3.60–5.10). These RIs were found to be different from currently used RIs provided by the reagent manufacturer. RIs of all the test parameters were significantly influenced by the age of the study participants. However, only the RIs of urea, creatinine, and potassium were significantly influenced by sex. Conclusions The present study has for the first time established dry chemistry based RIs for selected renal function test parameters specific to the adult population of Kaski district, Nepal. This result will aid the clinician in minimizing the errors in result interpretation and making a precise clinical decision.

Is Elevated Lipase in Covid-19 Patients Due to Acute Pancreatitis? - A Study from Punjab, India

BACKGROUND Since the outbreak of coronavirus disease (Covid-19) many patients have presented with a variety of other symptoms along with primary respiratory symptoms. The increased reporting of these extra-pulmonary symptoms has made it necessary for the clinicians to establish a proper cause and relation between coronavirus disease 2019 (Covid-19) and extra-pulmonary symptoms. This study was undertaken to assess if the cause of elevated lipase levels in Covid-19 patients was due to acute pancreatitis. METHODS A retrospective observational study was performed at a local critical care ICU facility in Bathinda, India (MediWin Hospital, Bathinda, Punjab). RT - PCR, Rapid antigen test, CT scans were done to establish the Covid-19 status. Clinical signs and symptoms, CT scans were used to confirm the diagnosis of acute pancreatitis. MRI was preferred in patients with deranged renal function test. RESULTS Lipase test was done in 62 patients and the levels were found elevated in 52 patients. 40 patients were found to have symptoms of the spectrum of acute pancreatitis. 10 patients had symptoms along with signs of1 severe inflammatory response syndrome. Imaging was advised in these 10 patients with1 moderate to severe presentation of acute pancreatitis. 9 patients were advised CT scans which had no significant findings. 1 patient with deranged renal function test was advised2 MRI scan which showed mildly diffusely bulky pancreas. Mild peripancreatic fat stranding and fluid collection, suggestive of acute interstitial pancreatitis. It was associated with poor outcomes and lead to the patient’s death eventually. CONCLUSIONS Hyperlipasemia led to acute pancreatitis in 1 (1.6 %) patient. It was associated with poor outcome and caused eventual death of the patient. The prospects of a Covid-19 patient developing Hyperlipasemia due to acute pancreatitis were found to be statistically insignificant. KEY WORDS Coronavirus, Hyperlipasemia, Pancreatitis, Lipase, RT - PCR, Rapid Antigen Test.

Comparative efficacy of protein creatinine ratio and calcium creatinine ratio in determining organ dysfunction in ante-natal patients with pre-eclampsia

Aim: To evaluate the biochemical parameters in determining the severity of pre-eclampsia andcompare the efficacy between protein creatinine ratio and calcium creatinine ratio in determiningorgan dysfunction in ante-natal women with pregnancy-induced hypertension. Material andMethods: 150 cases of pregnancy-induced hypertension admitted in the labour room were studiedin the Department of Obstetrics and Gynaecology, SRMSIMS and were divided into two groups mildand severe pre-eclampsia depending on blood pressure, clinical and biochemical parameters. Variousparameters for renal function and liver function were evaluated along with fundoscopy. Results: Onthe evaluation of various parameters of renal function test and liver function test, a statisticallysignificant p-value was observed with increase in grade of pre-eclampsia. When abnormal organfunctions were compared, it was observed that PCR ≥ 0.3 is associated with 85%, 75.6% and81.25% cases of abnormal fundoscopy, deranged renal function test and deranged liver function testcompared to CCR ≤ 0.04 which was associated with 77%, 78.6% and 65% cases of abnormalfundoscopy, deranged renal function test and deranged liver function test respectively. Conclusion:The degree of derangement among biochemical parameters increases as the disease progresses.Early determination by a single test helps to predict organ involvement and correlates with diseaseseverity.

Establishment of dry chemistry based reference intervals of renal function test parameters for the adult population of Kaski District, Nepal

BackgroundReference intervals (RI) for clinical chemistry test parameters are specific to the method of measurement and population under service. However, there have been no locally available dry chemistry based RIs for the Nepalese population. Thus, the present study aimed to establish dry chemistry based RIs for sodium, potassium, urea, and creatinine specific to adult populations of Kaski districts, Nepal.MethodsThis was a cross-sectional study conducted at the Manipal Teaching Hospital, Pokhara, Kaski, Nepal on 360 healthy adult participants aged 18-65 years. The test parameters under study were analyzed using a fully automated OCD Vitros 350 dry chemistry analyzer following the protocols provided by the reagent kit manufacturer. The RIs were estimated using reference limits at 2.5th and 97.5th percentiles. The normal distribution of the data was tested by Kolmogorov–Smirnov, and Shapiro–Wilk tests. The differences between males and females RIs were compared by the Mann-Whitney test while age-specific RI for each gender was compared by One-Way-ANOVA and Dunnett's Multiple Comparisons Tests. All the data were managed and analyzed using MS Excel and SPSS version 20.ResultsThe RIs of urea, creatinine, sodium and potassium specific to the adult population of Kaski district, Nepal are as follows: urea: 11.89-37.81 mg/dL (males: 13.09-38.40; females: 11.80-36.20); creatinine: 0.50-1.20 mg/dL (males: 0.55-1.20; females: 0.40-0.90); sodium 135-146 mEq/L (males: 135-146; females: 135-146) and potassium 3.60-5.10 mEq/L (males: 3.54-5.0; females: 3.60-5.10). These RIs were found to be different from currently used RIs provided by the reagent manufacturer. RIs of all the test parameters were significantly influenced by the age of the study participants. However, only the RIs of urea, creatinine, and potassium were significantly influenced by gender.Conclusions The present study has for the first time established dry chemistry based RI for selected renal function test parameters specific to the adult population of Kaski district, Nepal. This result will aid the clinician in minimizing the errors in result interpretation and making a precise clinical decision.

Changes in Renal Function Test Following Kidney Donation

Objectives: The aim of this study was to find out any Changes in renal function test following kidney donation. Materials and Methods: A Hospital based prospective study was conducted in the Department of Urology of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from April 2011 to September 2012. Investigations included specific gravity and urinary microalbumin, serum creatinine. According to inclusion and exclusion criteria a total of 37 donors were enrolled in this study. Subsequent follow up were taken at the end of three months, six months and nine months. Data were evaluated by Paired t-test, Significance was defined p value<0.05. Results: The age range varied from 25 to 39 years and 45.9% of patients belonged to 25- 30 years and male to female ratio was 1:2.4. The mean baseline specific gravity was 1016.97±8.03, serum creatinine 1.03±0.24. The baseline urinary micro albumin was found nil and subsequent 1st, 2nd, and 3rd follow up were also nil. The mean difference of specific gravity, urinary micro albumin, and serum creatinine (mg/dl) were almost consistent between baseline and the subsequent follow-up, no statistical significant (P>0.05) was found between baseline and the subsequent follow-up. Conclusion: Renal function test of the remaining kidney in living donors does not significantly change after donor nephrectomy. Bangladesh Journal of Urology, Vol. 18, No. 1, Jan 2015 p.3-7

Effects of Highly Active Antiretroviral Treatment on Liver and Kidney Functions

Aim: This study assesses the effects of HAART on liver and renal functions in HIV infected individuals on HAART. Study Design: Cross sectional study. Place and Methods: This study was conducted in Tamale, Ghana from August, 2015 to November 2017. Methodology: A total of 300 HIV infected participants with ages ranging from 19 to 79 years who have been administered with HAART for at least 6 months were recruited. Pre-HAART administration (baseline) demographic and clinical information, with initial liver and renal function test results were retrieved from the medical records of the participants present at the ART center. Post HAART administration blood sample (5 mLs) was taken from each participant into a gel separated vacutainer tube, allowed to clot and spun at 3000 rpm for 3 minutes to produce serum. The product (serum) was used for liver and renal function test analysis using a fully automated chemistry analyser (Vital Scientific Selectra Flexor XL). Results: Of the study population, 72% were administered with AZT/3TC/EFV, 13% with AZT/3TC/NVP, 6.7% with TDF/3TC/LPV/r and TDF/3TC/NVP, 1% with AZT/3TC/EFV while 0.7% were administered with TDF/FTC/EFV. The following parameters were significantly increased post HAART administration; ALT (25.53 ± 16.90 to 30.87 ± 19.28 U/L), ALP (163.7 ± 141.0 to 215.2 ± 143.4 U/L), GGT (37.27 ± 25.21 to 53.19 ± 41.71 U/L), Total protein (73.97 ± 17.08 to 82.31 ± 11.62 g/L), Albumin (38.02 ± 9.331 to 41.01 ± 7.471 g/L), Globulin 38.02 ± 15.71 to 42.79 ± 25.20 (g/L). There were however significant reductions in Total bilirubin (12.13 ± 10.85 to 9.434 ± 4.560 µmol/L), Direct bilirubin (6.616 ± 5.770 to 4.184 ± 2.806 µmol/L), (Creatinine 73.19 ± 36.13 to 63.14 ± 27.14 µmol/L) and Urea (3.515 ± 2.552 to 3.011±1.274 mmol/L). Conclusion: HAART improves renal function, induces elevation in liver enzymes, stimulates the production of plasma proteins and reduces serum bilirubin concentration.