Changes in renal function in patients with hypertension and chronic obstructive pulmonary disease according to retrospective analysis of medical records

Background. Hypertension determines both the social and economic component of the impact on the health of the population with a tendency to a significant increase in this pathology rate. Another common disease that can be prevented and treated is a chronic obstructive pulmonary disease (COPD). The concept of comorbidity implies the formation of relationships and interactions due to the common pathogenetic mechanisms, namely chronic inflammation, oxidative stress, and endothelial dysfunction. Hypertension is both a cause and a consequence of chronic kidney disease (CKD) and contributes to its progression. Patients with COPD have a higher risk of comorbidities. Aim. To study the dynamics of renal function and frequency of CKD development in patients with hypertension and COPD based on the retrospective analysis of case reports and outpatient medical records. Materials and methods. According to the criteria of inclusion and exclusion from the study, 188 patients were selected, which were divided into three groups by the clinical diagnosis: group 1 consisted of 64 patients with hypertension, group 2 — 58 patients with hypertension and chronic obstructive pulmonary disease, and group 3 — 66 patients with chronic obstructive pulmonary disease. The average age of patients with hypertension was 61.0 (57.0; 72.0) years, patients with hypertension and COPD — 62.3 (11.5), the average age of patients with COPD — 58.5 (55.0; 62.00). The physical examination, the laboratory tests of blood and urine were analyzed in all patients by studying the case reports and outpatient medical records. The obtained results were processed using biostatistical methods (Statistica v.6.1). Results. Important significance between the frequency of anemia in patients was not found, but there was a tendency to increase in anemia frequency in hypertensive patients — 14.1 % and in the comorbidity of hypertension and COPD — 8.6 %. The lowest incidence of anemia was recorded in patients with COPD and was 7.6 %. The level of total cholesterol in the respective groups did not differ statistically and was equal to 4.8 (4.2; 5.3), 4.7 (4.0; 5.4), and 5.3 (4.5; 5.9) mmol/l. The highest values ​​of total blood cholesterol were determined in patients with hypertension and chronic obstructive pulmonary disease. The highest level of blood creatinine was determined in patients with hypertension and COPD, and the lowest — in patients with COPD. Thus, the patients with hypertension had the lowest GFR and the patients with COPD had the highest one. Conclusions. COPD has a tightening effect on the renal function of patients with hypertension and leads to an increase in blood creatinine levels with statistical significance. Also, in the group of patients with hypertension and comorbid pathology, a higher incidence of anemia was registered than in the group of patients with COPD. But, in turn, the filtration function of the kidneys, which was determined by GFR, was the lowest in hypertension.

The influence of birth weight and gestational age on kidney function in premature infants

Introduction. The impact of prematurity on the functional state of the kidneys in infants has not yet been sufficiently studied. Aim. To determine the influence of birth weight and gestational age on the creatinine level in the blood and glomerular filtration rate (GFR) in early childhood. Materials and methods. A retrospective analysis was conducted on medical records of 316 children aged from 1 month to 1.5 years, hospitalized at the Department of Early Childhood Pathology (National Medical Research Center for Children’s Health, Moscow) from 2012 to 2020 due to consequences of perinatal CNS damage. Children without congenital kidney diseases, with normal urine values in medical history, without structural abnormalities on ultrasound were included in this study. Serum creatinine was determined by the enzymatic method, GFR - by the Schwartz’s formula using a coefficient of 0.413, as well as, previously proposed coefficients of 0.33 for premature and 0.44 for full-term infants. Results. In premature infants, notably born with extremely low birth weight and very low birth weight, at the age of 1 year, serum creatinine is reduced compared to full-term infants, GFR in deep-premature infants exceeds the level of GFR in full-term infants by the year. The results allow concluding the method of calculating GFR by formulas based on serum creatinine to be invalid. Due to possible hyperfiltration in preterm infants, they need regular monitoring urine tests, blood pressure, due to the risk of developing chronic kidney disease. Conclusions. It is necessary to search for other methods for determining GFR in extremely premature infants. The established indices of the blood creatinine content can be used as reference values for different periods of gestation and body weight at birth in institutions using the enzymatic method for determining blood creatinine. The obtained GFR indices as a reference can be recommended for full-term and premature babies born after 32 weeks of gestation and with a birth weight of more than 1500 g.

Urinothorax, another complication of bladder tumor: case report

Background Rupture of the fornix is a rare and serious urological complication of obstructive pathologies. The main cause is ureteral stone, but rarely a bladder tumor. Described complications of fornix rupture are superinfection, perirenal abscesses and even sepsis, but not urinothorax. Case presentation Patient of 56 years old, active and chronic smoker, was hospitalized for anemia and obstructive renal failure on a non-documented bladder tumor; clinically, he was presented with hematuria and an intense right loin pain associated with homolateral basithoracic pain and dyspnea. The CT scan without injection showed a right perirenal collection with bilateral renal dilatation on endo-vesical tumor and a right pleural effusion of less abundance. The ratio of pleural fluid creatinine to blood creatinine was greater than 1, confirming urinothorax. As an emergency, a percutaneous nephrostomy was performed. After clinical stabilization, the patient underwent a trans-urethral resection of the bladder and derivation by a double j stent. The ultimate evolution was favorable. Conclusions Beyond the metabolic complications secondary to obstructions, mechanical complications, which can also be fatal, must be included.

Correlation Of Hemoglobin And Blood Creatinine Levels In Chronic Kidney Disease Patients Post Repeated Transfusion

Kidneys are part of the body that has an important role. One of the functions of the kidney is the production of erythropoietin. Erythropoietin stimulates the production of red blood cells. People or patients who have kidney problems can cause anemia. This study aims to determine the relationship between hemoglobin levels and blood creatinine levels in patients with chronic kidney disease after receiving a transfusion. Blood creatinine levels in this study were used as an index to measure kidney function. The study was conducted at the Wira Tamtama Hospital Semarang by taking data on 20 patients in 2020 with chronic kidney disease and taking data on hemoglobin (cut-off 12 g/dL) and serum creatinine (cut-off 1.5 mg/dL). The relationship between the two was calculated by chi-square test and found 80% of patients with low hemoglobin in patients with high creatinine levels and 0% of patients with low hemoglobin in patients with normal creatinine levels (p=0.040). There is a risk of decreased hemoglobin levels (OR = 3,442) in patients with high creatinine levels. It was concluded that there was a significant relationship between hemoglobin levels and blood creatinine levels and patients with high creatinine levels tended to be at risk of anemia.

Indications and outcomes of the percutaneous nephrostomy at Urology-Andrology Teaching Hospital of CNHU-HKM in Cotonou

Background: The percutaneous nephrostomy constitutes a backup remedy allowing the derivation of urine and thus cancelling the emergency, while waiting for adequate etiological treatment. The objective of this study was to determine indications and outcomes of the percutaneous nephrostomy at Urology-Andrology Teaching Hospital of the National Centre Academic Hospital Hubert KOUTOUKOU MAGA (CNHU-HKM) of Cotonou. Methods: It was a retrospective study carried out from January 1st, 2016 to May 30, 2020. Results: The placement of nephrostomy tubes has been indicated in 15.26% of urine derivations for the obstruction of the upper urinary tract. The average age of patients was 54.85 years with extremes of 28 and 70 years. The two sexes are interested in the same proportion, 10 cases for each. The average consultation time is 31.4 days with the extremes of 5 and 90 days. The obstruction was bilateral in 19 cases on 20. The gynaecological cancers were majority with 9 cases follow-up of those of the colon (4 cases), of the bladder (3 cases) and of the prostate (3 cases). The drainage was unilateral in 18 cases out of 20. The mean blood creatinine rate is 145.52 mg/l with extremes of 10 and 436 mg/l. Blood creatinine rate was pathological in 19 of our patients; it has been ameliorated among patients having an elevated initial creatinine blood level but without reaching normal values in 18 out of 19 patients. The lowest rates of creatinine blood level have been reached after 10.33 days with extremes of 2 and 23 days. After the percutaneous nephrostomy, the surgical abstention has been decided in 13 cases, the dialysis had been done in 5 cases, the reimplantation + installation of the probe double J in 1 case and the chemotherapy in 1 case. The main reason of death of the patients having undergone the nephrostomy was the ionic disorders (13 cases out of 18) mainly the hyperkalemia and the hyponatremia followed of anemia (3 cases out of 18) and of the uremic coma (2 cases out of 18). The middle duration of hospitalization after the drainage was of 16.85 days, with extremes of 1 and 50 days. The death occurred at 18 out of 20 patients and the middle period of survival was 31.25 days with extremes of 1 to 60 days. Conclusion: The percutaneous nephrostomy remains the beneficial alternative for the derivation of the upper urinary tract instead of the double J installation. Popularization of percutaneous nephrostomy would reduce the morbidity and mortality linked to complications of obstructive syndrome of the upper urinary tract; hence the need for awareness for early urological consultation

Dependence of renal filtration capacity on the phenotype of chronic heart failure, indicators of systolic and diastolic heart function

The issue of changes in the filtration capacity of the kidneys depending on the structural-geometric and functional remodeling of the heart in different phenotypes of chronic heart failure, disorders of systolic and diastolic function of the left ventricle remains insufficiently studied. The aim of this work: to investigate the relationship between changes in the filtration capacity of the kidneys in patients with chronic heart failure of ischemic genesis depending on the phenotype, indicators of systolic and diastolic cardiac function. Materials and methods. After an informed consent was signed, 87 patients (men – n = 45, women – n = 42) with CHF of ischemic genesis with sinus rhythm, stage II A–B, II–IV functional class NYHA, who were divided into 2 groups, were involved in the study. Group 1 included patients with reduced (<45 %) left ventricular ejection fraction (HFrEF) (n = 57; 59.6 % men), group 2 – patients with CHF with preserved left ventricular ejection fraction (HFpEF) (n = 30; 36.6 % men). Patient groups were comparable in terms of age, sex, height, weight, and body surface area. Doppler echocardiographic examination was performed using the Esaote MyLab Eight (Italy). Glomerular filtration rate (GFR) was assessed using the CKD-EPI, MDRD, and Cockcroft-Gault formulas. Results. Renal dysfunction was registered in patients with CHF in 72 % of cases when calculated using the CKD-EPI formula, 66.7 % using the MDRD formula and 52.6 % using the Cockcroft-Gault formula. Only indicators of blood creatinine level (P = 0.011) and the calculated indicator of glomerular filtration rate according to Cockcroft-Gault (p = 0.047) depended on the types of CHF. GFR for all applied formulas (СKD-EPI, MDRD, Cockcroft-Gault) depended on age (r = -0.42; P = 0.001), height (r = 0.28; P = 0.08), weight (r = 0.31; P = 0.004), body surface area (r = 0.33; P = 0.002). A direct correlation between the creatinine level and the LV myocardial mass index, calculated using the Penn Convention formula, was established, however, the dependence of the creatinine level and GFR on the types of LV geometry was not revealed. The presence of an inverse correlation between LVEF and blood creatinine level (r = -0.3172; P = 0.003), between creatinine content and S lat (r = -0.531; Р = 0.006), a direct correlation between S lat and CKD-EPI (r = 0.5586; P = 0.004), MDRD (r = 0.6254; P = 0.001), Cockcroft-Gault (r = 0.4043; P = 0.045). Conclusions. In chronic heart failure of ischemic genesis with reduced left ventricular ejection fraction, a more pronounced impairment of the filtration capacity of the kidneys than in chronic heart failure patients with preserved left ventricular ejection fraction is observed. An inverse correlation was established between the LV EF and the blood creatinine level (r = -0.3172; P = 0.003). A decrease in the systolic velocity of movement of the lateral annulus fibrosus of the mitral valve is associated with a decrease in the filtration capacity of the kidneys in terms of creatinine level (r = -0.531; P = 0.006), GFR according to the CKD-EPI (r = 0.5586; P = 0.004), MDRD (r = 0.6254; P = 0.001), Cockcroft-Gault (r = 0.4043; P = 0.045) in patients with CHF of ischemic genesis of both phenotypes. In patients with CHF of ischemic genesis of both phenotypes, the myocardial mass index, calculated according to the Penn Convention, correlates with the blood creatinine content (r = 0.95; P = 0.003). In patients with CHF of ischemic genesis, the restrictive type of diastolic filling of the left ventricle is associated with a significant increase in blood creatinine levels by 14 % (P = 0.03) compared with patients with diastolic LV dysfunction by the type of relaxation disorder.

Efficacy and Safety of Tripterygium Glycoside in the Treatment of Diabetic Nephropathy: A Systematic Review and Meta-Analysis Based on the Duration of Medication

AimThe aim of this study was to assess the clinical efficacy and safety of Tripterygium-derived glycosides (TG) after 3-month and 6-month of treatments of diabetic nephropathy (DN) and to resolve the conflict between medicine guidance and clinical practice for TG application.MethodsWe conducted a systematic review and meta-analysis of randomized controlled trials involving TG application in treating DN. We extensively searched PubMed, Cochrane Library, CNKI, VIP, Wan-Fang, CBM, Chinese Clinical Trial Registry, and WHO International Clinical Trial Registration Platform till November 2020, along with grey literature for diabetes and all other relevant publications to gather eligible studies. Based on the preset inclusion and exclusion criteria, document screening, quality assessment of methodology, and data extraction was conducted by two researchers independently. The methodological quality was assessed by the Cochrane risk test from the Cochrane Handbook 5.2, and then analyses were performed by Review Manager 5.3 (Rev Man 5.3). The quality of output evidence was classified by GRADE.ResultsThirty-one eligible studies (2764 patients) were included for this meta-analysis. Our study results showed a comparable significant decrease in the 24 h-UTP and blood creatinine levels in DN patients from both 3-month and 6-month TG treatment groups, compared with the routine symptomatic treatment alone. To the contrary of the findings from the included studies, our results showed that the occurrence of serious adverse reaction events was significantly higher in the TG treated group with 6 months of treatment duration compared to that of 3 months of the treatment course. However, the total AR ratio was slightly varied while increasing the percent of severe adverse events. GRADE assessment indicated that the quality of evidence investigating TG-induced adverse reactions was moderate and that for 24 h-UTP and blood creatinine indicators were considerably low.ConclusionCombinatorial treatment regimen including TG can significantly decrease the pathological indicators for DN progression, while it can also simultaneously predispose the patient to a higher risk for developing severe adverse events, as the medicine guidance indicates. Notably, even in 3-month of course duration smaller percent of severe adverse events can get to a fatal high percent and is likely to increase proportionally as the TG treatment continues. This suggests that TG-mediated DN treatment duration should be optimized to even less than 3 continuous months to avoid adverse event onset-associated further medical complications in DN patients. In clinical practice, serious attention should be paid to these severe side-effects even in a course normally considered safe, and importantly more high-quality studies are urgently warranted to obtain detailed insights into the balance between the efficacy and safety profiles of TG application in treating DN.

Seroprevalence of Infection with Feline Morbilliviruses Is Associated with FLUTD and Increased Blood Creatinine Concentrations in Domestic Cats

Feline morbilliviruses (FeMV) are fairly newly discovered paramyxoviruses found in cats. The first description indicated an association with widely distributed chronic kidney disease (CKD) in the host species. In various studies, a global prevalence and a further genotype, designated FeMV-2, and the involvement of other organ systems in infected individuals were shown. Using an immunofluorescence assay, we detected an overall seroprevalence of FeMV in almost half of the cats investigated (n = 380), with a significantly increased proportion in younger animals. In comparison to European Shorthair cats, the rate of seropositivity is higher in pedigree cats. Regardless of the breed, FeMV infection was associated with increased blood creatinine concentrations, suggesting an association with CKD. Further analysis indicated that this association was the strongest in animals having high IFA titers against FeMV-2. In addition, a significant association between FeMV-positive status and the prevalence of feline lower urinary tract disease (FLUTD, or idiopathic cystitis) was detected. This association was dominated by cats having antibodies against FeMV-1 only. To further evaluate the positive correlation between FeMV seroprevalence and CKD as well as FLUTD, consideration of additional clinical characteristics and laboratory parameters is warranted, and controlled infection studies with both FeMV genotypes are necessary. Clinicians should, however, be aware of a possible link between renal and lower urinary tract disease and FeMV infections.