Acute kidney injury due to ammonium acid urate stones in a patient with adenovirus gastroenteritis: a case report

Background Adenovirus gastroenteritis is a common cause of diarrhea and vomiting in infants, resulting in prerenal acute kidney injury (AKI). However, postrenal AKI due to urinary stones associated with adenovirus gastroenteritis is extremely rare. Here, we describe postrenal AKI due to obstructive ammonium acid urate stones associated with adenovirus gastroenteritis. Case presentation A previously healthy 6-month-old boy had an 11-day history of severe diarrhea and a 5-day history of vomiting. His stool was positive for adenovirus antigens. We initiated fluid replacement therapy. On the second hospital day, he suddenly developed anuria. Abdominal computed tomography revealed bilateral hydronephrosis, left ureteral stones, and right bladder ureteral junction stones. Laboratory data showed that the creatinine level increased to 1.00 mg/dL. We diagnosed postrenal AKI due to obstructive bilateral urinary stones. Urination with stable urine volume resumed spontaneously after hydration. A few stones were found in the urine, which consisted of ammonium acid urate (> 98%). The serum creatinine level improved to 0.25 mg/dL. He was discharged nine days after admission. Conclusions We suggest that adenovirus gastroenteritis be considered in pediatric patients with postrenal AKI due to urinary stones.

CREATININE AND CREATINE KINASE RATIO IN BLOOD OF DIFFERENT BODY TYPES - A NEW APPROACH.

Purpose: The inconsistencies and variations of creatine kinase level due to modifiable and non-modifiable factors were the basis of this study. The aim was to find out the relationships between creatinine and creatine kinase in the blood of somatotypes. Methods: The 122 males, aged 10 to 20 years, were classified according to their somatotypes. Somatotypes were measured by the ISAK method. By standard laboratory methods, creatinine and creatine kinase estimate. The IBM SPSS version 24 is used for calculation. One way ANOVA followed by post hoc tests was performed to compare the variables among the three groups (p<0.05). Results: Creatinine level in the blood insignificantly deferred among the three somatotypes. The significant differences (p<0.05) were found in creatine kinase level in the blood and creatinine/creatine kinase ratio among the three dominant Somatotypes. Creatine Kinase was significantly higher in Ectomorphs (212 U/L) than Endomorphs. Ectomorphs and mesomorphs have crossed normal creatine kinase levels (35 -175 U/L). The creatinine/creatine kinase ratio was found highest in endomorphs and lowest in the ectomorphs and significantly differed in three Somatotypes. Conclusion: Creatinine production remains the same, indicating production of Creatinine is independent of specific body types. A significant higher Creatine Kinase level in Ectomorphs over Endomorphs showed fat content was not associated with it. Significant differences in Creatinine / Creatine Kinase ratio among Somatotypes suggested its relevance between cellular and morphological relationships and might uses as biomarkers.

Serum Creatinine Reference Limits in Pediatric Population—A Single Center Electronic Health Record-Based Database in Taiwan

Objective: To assess age- and sex-specific serum creatinine levels in a pediatric population using a hospital-based database in Taiwan.Study Design: Data on serum creatinine levels were obtained from the National Taiwan University Hospital-integrated Medical Database (NTUH-iMD). Due to the possibility of having acute kidney injury or chronic kidney disease, individuals with multiple serum creatinine measurements were excluded, and outliers in each age- and sex-specific group were also subsequently removed. The remaining creatinine measurements in each group were analyzed, and 95% reference limits were established.Results: Serum creatinine data of individuals aged between 1 month and 18 years from May 2011 to January 2018 were retrieved. After applying the exclusion criteria, 27,911 individuals with a single corresponding serum creatinine measurement were enrolled. Creatinine level reference limits for each age- and sex-specific group were generated. The upper reference limits (URLs), which are particularly useful in clinical practice, followed the natural trend of increasing serum creatinine with age.Conclusion: We generated serum creatinine reference limits from a single hospital-integrated medical database in Taiwan for different age- and sex-specific groups of children. Our results will aid physicians in clinical practice regarding renal function evaluation, especially for patients without a recent baseline serum creatinine level.

Effect of Heavy Metals on Creatinine Level in Human Blood Samples of Inhabitants Living in the Vicinity of Hudiara Drain, Lahore, Pakistan

Aims: Modern industrialization, anthropogenic and industrial activities have increased the risk of human exposure to heavy metals and in turn effecting human health badly. Hundreds of millions of people are globally affected by heavy metal toxicity through contaminated water in one way or. another. In order to find a correlation between the heavy metal concentrations and serum creatinine level, a study was conducted on the inhabitants living near the Hudiara drain suffering from kidney diseases. Study Design: The subjects (n=498) were selected from the vicinity of polluted Hudiara drain to conduct this matched case–control study in 2019-2020. Instrumental techniques were used for the determination of heavy metals and creatinine was determined by using Kit. The correlation between heavy metals and creatinine was checked. Place and Duration of Study: To determine heavy metals and creatinine in blood, samples were collected from the habitants of Hudiara drain and the control group 100Km far from Hudiara drain. Methodology: Blood samples of male subjects with and tested for heavy metals in the blood using atomic absorption spectrophotometer and creatinine level using Creatinine Elisa Kit. The study was conducted in 2020 and included n= 498 healthy volunteers (control) and n=498 effected (suffering from chronic kidney disease). Results: The ANOVA shows the significant difference between two groups i.e. control group and affected group in all traits of the respondents (weight, age, heavy metal values and serum creatinine level). Pearson’s correlation coefficient was calculated for heavy metals and creatinine subjects’ blood samples. It was found that heavy metal levels in subjects have a significant correlation with serum creatinine. The study shows that serum creatinine level has no significant correlation with age, so is independent of age. Conclusion: The concentration of heavy metal contaminants (Cd, Hg, Pb) in the blood of the inhabitants of Hudiara drain flowing in Lahore city, Pakistan is highly polluted by industrial effluents. The effects of higher concentration of heavy metals in the inhabitants of Hudiara drain have been determined in serum creatinine levels. It was observed that high serum creatinine values are found in subjects suffering from CKD.

RENAL FUNCTION AND CLINICAL PROFILE IN CHILDREN WITH CONGENITAL HEART DISEASE – AN OBSERVATIONAL STUDY FROM TERTIARY CARE HOSPITAL IN CENTRAL INDIA.

Purpose: To evaluate the renal function and clinical prole in children with congenital heart disease. Method: After taking informed consent from the parents of 118 children aged 1 month to 14 years were recruited in study. Anthropometry and vitals were noted. Complete physical examination and USG abdomen done to identify any other associated congenital anomaly. Laboratory evaluation of serum creatinine was done on day 1 and day 5. 24 hours urine output was strictly measured till day 5 of admission. Result: The maximum number of cases belonged to age group 1-6 month. Male children were affected more than females (1.5:1) and majority of the children belong to family of lower middle and lower socioeconomic status. Most of the children belong to rural area. Among syndromic features, microcephaly and cleft lip and cleft palate were most frequently observed. Most of the cases had weight /height <-3SD. There was no major signicant difference in mean value of urine output and serum creatinine level in different age groups and in between cyanotic and acyanotic group. Conclusion: Congenital heart disease forms a significant diagnosis in hospitalized children. Larger studies are needed to evaluate newer associations (like male gender and low socioeconomic status). Microcephaly and cleft lip/palate were most observed associated syndromic features. No signicant effect was observed on the mean urine output and serum creatinine level in children with congenital heart disease.

Atrial Fibrillation as a Predictor of In-Hospital Outcome in Patients with Acute Coronary Syndrome Treated by Primary Percutaneous Coronary Intervention

Objectives: to study the relation between atrial fibrillation (AF) and in-hospital outcome in patients with acute coronary syndrome (ACS) who were treated by primary percutaneous coronary intervention (PCI). Methods: This study was conducted on 80 patients admitted with ACS and treated with primary PCI at cardiovascular medicine department Tanta university hospitals starting from January 2020 till January 2021. The primary end points are all cause mortality and major adverse cardiovascular events (MACE) including a composite of death, nonfatal re-infarction, target vessel revascularization (TVR), new onset congestive heart failure, contrast induced nephropathy (CIN), or stroke during hospitalization. Patients was divided into 2 groups: Group 1: consisted of 40 consecutive AF-patients treated by primary PCI. Group 2: consisted of 40 consecutive sinus rhythm-patients treated by primary PCI. Results: Patients in AF group showed significantly older age, lower systolic and diastolic blood pressure, higher heart rate, higher Killip class II-IV, more inferior STEMI presentation, higher CK-MB, more RCA as infarction related artery, more moderate to sever mitral regurgitation, more patient developed congestive heart failure during hospitalization, and higher overall MACE during hospitalization. Univariate and multivariate regression analysis were performed to investigate the possible predictors of AF in the study population. In univariate regression analysis, older age, higher CKMB level, higher degree of mitral regurgitation, enlarged left atrium, and RCA as infarction related artery were correlated with AF. In the multivariate regression analysis, using model adjusted for aforementioned parameters, older age, higher CK-MB level, enlarged left atrium diameter, and RCA as infarction related artery independently predicted AF. Univariate and multivariate regression analyses were performed to investigate the possible predictors of overall in-hospital MACE in the study population. In univariate regression analysis, smoking, Killip II-IV, high creatinine level, lower ejection fraction, higher end systolic diameter, and AF were correlated with MACE. In the multivariate regression analysis, using model adjusted for aforementioned parameters, Killip II-IV, higher creatinine level, and AF independently predicted MACE. Conclusion: Patients older in age, with higher CK-MB level, enlarged left atrial diameter, and RCA as infarction related artery had higher incidence of AF during ACS. Patient with AF who presented with ACS had a higher incidence of heart failure during hospitalization. The independent predictors of MACE in our study were AF, Killip II-IV, and higher creatinine level.

Defining Baseline Creatinine for Identification of Acute Kidney Injury in Population-based Laboratory Databases - A Danish Nationwide Cohort Study

Background: The baseline creatinine level is central in the KDIGO criteria of acute kidney injury (AKI), but baseline creatinine is often inconsistently defined or unavailable in AKI research. We examined the rate, characteristics, and 30-day mortality of AKI in five AKI cohorts created using different definitions of baseline creatinine. Methods: This nationwide cohort study included all individuals aged ≥18 in Denmark with a creatinine measurement in year 2017. Applying the KDIGO criteria, we created four AKI cohorts using four different baseline definitions (most recent, mean, or median value of outpatient creatinine 365-8 days before, or median value 90-8 days before if available otherwise median value 365-91 days before) and one AKI cohort not using a baseline value. AKI rate and the distribution of age, sex, baseline creatinine, and comorbidity was described for each AKI cohort, and the 30-day all-cause mortality was estimated using the Kaplan-Meier method. Results: The study included 2,095,850 adults with at least one creatinine measurement in 2017. The four different baseline definitions identified between 61,189 and 62,597 AKI episodes. The AKI rate in these four cohorts was 13-14 per 1,000 person-years, and 30-day all-cause mortality was 17-18%. The cohort created without using a baseline creatinine included 37,659 AKI episodes, corresponding to an AKI rate of 8.2 per 1,000 person-years, and a 30-day mortality of 23%. All five cohorts were similar regarding age, sex, and comorbidity. Conclusions: In a population-based setting with available outpatient baseline creatinine, different baseline creatinine definitions revealed comparable AKI cohorts, while the lack of a baseline creatinine when defining AKI led to a smaller AKI cohort with a higher mortality. These findings underscore the importance of availability and consistent use of an outpatient baseline creatinine, in particular in studies of community-acquired AKI.

Chronic kidney disease and pregnancy outcomes

Pregnancy complicated by CKD is currently not fully understood topic. Outcome of pregnancy in patients with CKD is related to impaired glomerular filtration rate and the degree of proteinuria. In our study we evaluated the association of serum creatinine level and proteinuria with both maternal and fetal outcomes in the cohort of 84 pregnant patients with CKD. In CKD group we confirmed negative correlation of highest serum creatinine level in pregnancy to fetal weight (p value < 0.001) and gestation period (p value < 0.001). Likewise, negative correlation of preconception serum creatinine to fetal weight (p value < 0.001) and gestation period (p value 0.002). Negative correlation of proteinuria to gestation period (p value < 0.001) and fetal weight (p value < 0.001) was also demonstrated. CKD is serious risk factor for pregnancy outcome. Proteinuria and serum creatinine level should be examined before pregnancy and regularly monitored during pregnancy. Higher serum creatinine levels and higher proteinuria predispose to shorter gestation period and lower birth weight of the neonate.

Hearing impairment in patients of renal failure

<p class="abstract"><strong>Background:</strong> Kidney diseases are emerging public health problems in developing countries. A common complication of renal failure is sensorineural hearing loss which is leading to poor quality of life. The aim of the study was to determine the prevalence of hearing loss in renal failure patients and to see the correlation of dialysis, ototoxic drugs, and creatinine levels.</p><p class="abstract"><strong>Methods:</strong> This observational study was conducted at the department of otorhinolaryngology, tertiary care center, Jabalpur (Madhya Pradesh) for a period of 18 months i.e.; from March 2019 to August 2020. 70 patients with renal failure were registered for study. In all patients hematological tests include hemoglobin, urea, creatinine, random blood sugar, serum electrolytes and pure tone audiometry was done. </p><p class="abstract"><strong>Results:</strong> Out of 70 patients, 51 patients (72.9%) of renal failure had sensorineural hearing loss. Hypertension and diabetes mellitus as comorbidity play important role in hearing loss in renal failure patients. Acoustic reflex was absent in 14.3% of cases which signifying a profound hearing loss and these patients had creatinine level above 6 mg/dl.</p><p class="abstract"><strong>Conclusions:</strong> Senorineural hearing loss is more prevalent in renal failure patients. Significant association was present between raised creatinine level and sensorineural hearings loss. Diabetes mellitus and hypertension were the common comorbidities that have a significant role in hearing loss in renal failure patients. All patients having renal failure have a risk of developing sensorineural hearing loss. So, these patients should be kept under follow up by doing regular pure tone audiometry and taking preventive measures, so that the hearing loss doesn't occur.</p>

Sepsis-associated acute kidney injury

Acute kidney injury (AKI) is a condition that develops as a result of a rapid decrease in the glomerular filtration rate, which leads to the accumulation of nitrogenous, including urea and creatinine, and non-nitrogenous metabolic products with electrolytic disorders, impairment of the acid-base balance, and the volume of fluid excreted by the kidneys. Objective: to provide a review of the literature concerning sepsis-associated acute kidney injury. We presented the problems of diagnosis, risk factors, the pathogenesis of sepsis-associated acute kidney injury, as well as to outline terminologically the clinical form of sepsis-associated acute kidney injury: the paradigm shifts from ischemia and vasoconstriction to hyperemia and vasodilation, from acute tubular necrosis to acute tubular apoptosis. Sepsis contributes significantly to the development of AKI: in sepsis, it occurs in 19 % of patients; nevertheless, it is much more frequent in septic shock (45 % of cases), the mortality of individuals with AKI is especially high in non-septic and septic conditions (45 and 73 %, respectively). To effectively diagnose the functional state of the kidneys and conduct nephroprotective therapy, stratification scales for assessing the severity of acute kidney damage are applied, which are based on the determination of plasma creatinine level and urine output: RIFLE (risk, injury, failure, loss of kidney function, and end-stage renal failure), AKIN (Acute Kidney Injury Network), KDIGO (Kidney Disease Improving Global Outcomes); the experts considered KDIGO scale more modern and perfect. It has been found that plasma creatinine is not an early biomarker of AKI that indicates the advisability of using other integral indicators. AKI biomarkers are substances that either participate in the pathological process or witness it allowing diagnose AKI even before an increase in plasma creatinine level. The characteristics of the structure, role of functions of such biomarkers as neutrophil gelatinase-associated lipocalin, cystatin C, interleukin-18, kidney injury molecule-1 and others are given. Intensive care for sepsis-associated acute kidney injury includes the standard therapy corresponding to 2016 Surviving Sepsis Campaign and KDIGO guidelines. Also, the paper focuses on renal replacement therapy (RRT): renal and extrarenal indications for the initiation, factors affecting the initiation of RRT, the timing of initiation, ways of optimization, the timing of RRT discontinuation, recommendations for the dose of RRT, the dose of renal replacement therapy in sepsis-associated AKI, choice of method, advantages and disadvantages of continuous RRT and intermittent hemodialysis, medication support for continuous therapy, the role of hemodialysis machine in the intensive care unit.