The Prognostic Value of Serum Uric Acid in Hospitalized Patients with Acute Cerebral Infarction

Background. Previous studies reported that the level of serum uric acid (SUA) was an important risk factor for acute cerebral infarction (ACI). However, the prognostic value of SUA levels in hospitalized patients with ACI has not been fully elucidated. The aim of this study was to investigate whether the SUA level on admission was associated with subsequent mortality in hospitalized patients with ACI. Methods. The clinical data of ACI patients obtained from December 2017 to December 2019 were retrospectively reviewed. χ 2 and Kaplan–Meier methods were used to compare the clinical differences and overall survival between patients with or without hyperuricemia, respectively. Univariate and multivariate analyses were used to identify independent prognoses. Results. In the total population, the in-hospital mortality of the hyperuricemia group was significantly higher than that of the normal uric acid group ( P = 0.006 ). In the abnormal renal function group, the in-hospital mortality among the hyperuricemia group was significantly higher than the normal uric acid group ( P = 0.002 ). However, there was no statistical difference of in-hospital mortality between the two groups in the normal renal function group ( P = 0.321 ). Univariate and multivariate analyses showed that a previous history of diabetes ( P = 0.018 ), hyperuricemia ( P = 0.001 ), and National Institutes of Health Stroke Scale (NIHSS) score on admission ( P ≤ 0.001 ) were independent factors for all samples. The hyperuricemia ( P = 0.003 ) on admission were independent factors for patients with abnormal renal function. Conclusions. In ACI patients with abnormal renal function, hyperuricemia may be associated with higher in-hospital mortality than patients with normal uric acid, and hyperuricemia may be an independent associated factor for in-hospital death in the subgroup patients.

Effects of High-Dose Radioactive Iodine Treatment On Renal Function In Patients With Differentiated Thyroid Carcinoma: A Retrospective Study

Aim: This study aimed to investigate the effects of high-dose radioactive iodine (131I) treatment on the clinical metrics of renal function in patients with differentiated thyroid carcinoma (DTC).Patients and methods: The clinical metrics of renal function were analysed in 850 patients with DTC who received 131I therapy between January 2012 and December 2019. According to the baseline renal function metrics, the patients were divided into normal renal function group (group A) and abnormal renal function group (group B). Each group was further divided into three subgroups (subgroups 1, 2, and 3) based on the cumulative dose of 131I. The clinical metrics of renal function including serum creatinine (SCr) levels, blood urea nitrogen (BUN) levels and estimated glomerular filtration rate (eGFR) were measured within 1 month before the initiation of 131I therapy, 1 year after the last therapy, and 5 years after the initial therapy. The changes in renal function metrics before and after 131I therapy were compared in each group.Result: In group A (588 patients), no significant difference in the mean levels of SCr and BUN and eGFR was observed in the three subgroups (P >0.05), regardless of gender, before the initial 131I therapy and 1 year after the last therapy. A total of 8, 3, and 2 patients presented with abnormal renal function after 131I treatment in subgroups 1, 2, and 3, respectively. No statistically significant difference was observed in the incidence of renal dysfunction among the three subgroups (P = 0.287). The mean age of patients with renal dysfunction was significantly greater than that of patients without renal dysfunction after 131I treatment. In group B, of the 262 patients with abnormal renal function, SCr and BUN levels were elevated in 168 and 155 patients, respectively, and eGFR <60 mL/min/1.73 m2 was found in 87 patients before the initial 131I therapy. No significant difference was observed in the parameters among the three subgroups. However, SCr and BUN levels were found to be increased in all subgroups 5 years after the initial 131I therapy, and they were positively correlated with the cumulative dose of 131I. The difference was statistically significant (P <0.05). Furthermore, eGFR was found to be decreased in all subgroups after 131I therapy, and it was negatively correlated with the cumulative dose of 131I. The difference was statistically significant (P <0.05). A gender bias was not observed in the changing trends of SCr and BUN levels and eGFR.Conclusion: Our findings suggest that the nephrotoxicity of high-dose 131I therapy, regardless of gender, is very low in patients with DTC with normal renal function; however, high-dose 131I therapy may exacerbate the loss of renal function in those with renal dysfunction.

MO305NEPHROTIC SYNDROME AND NEPHROTIC-RANGE PROTEINURIA - CLINICOPATHOLOGICAL DIAGNOSES AND PATIENT CHARACTERISTICS IN A MULTIETHNIC SINGLE CENTRE POPULATION

Background and Aims Nephrotic syndrome (NS) is a common indication for renal biopsy, and a frequent presenting clinical syndrome for certain glomerulonephritis (GN), particularly minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS) or membranous nephropathy (MN). However, less is known on the spectrum of clinicopathological diagnosis and characteristics in patients with nephrotic-range proteinuria without nephrotic syndrome (NRP). We aim to evaluate the differences in clinicopathological diagnosis and characteristics of patients with NS versus NRP. Method All patients who underwent a renal biopsy from the 1st January 2014 to 31st December 2016 were included in the study. Patients with no urine protein quantification, serum albumin or lipid panel done at the time of renal biopsy or no glomeruli seen on renal histology were excluded. Data for renal histopathology, clinical diagnosis and patient characteristics were obtained from review of medical records. Results A total of 362 patients underwent a renal biopsy from the 1st January 2014 to 31st December 2016. Of these, 76 patients had NS and 106 patients had NRP. Mean age was 51.1±17.0, 51.5% were male and 70.9% were Chinese. In the NS group, there were 25 (32.9%) MCD, 10 (13.2%) FSGS of which 8 were primary, 14 (18.4%) lupus nephritis (LN), 11 (14.5%) MN, 8 (10.5%) diabetic glomerulosclerosis, 2 (2.6%) Immunoglobulin A nephropathy (IgAN), 2 (2.6%) amyloidosis and 4 (5.3%) with other diagnoses (2 membranoproliferative GN, 1 acute interstitial nephritis, 1 chronic glomerulosclerosis). In the NRP group, there were 26 (24.5%) diabetic nephropathy, 21 (19.8%) IgAN, 15 (14.2%) LN, 13 (12.3%) FSGS of which 12 were secondary FSGS, 12 (11.3%) chronic glomerulosclerosis, 8 (7.5%) MN, 4 (3.8%) pauci-immune GN and 7 (6.6%) with other diagnosis (2 infection-related glomerulonephritis, 3 had mild chronic changes with proteinuria attributable to overflow proteinuria from myeloma, 1 Alport syndrome, 1 thrombotic microangiopathy). There were significantly more cases of primary GN in the NS group (63.2% versus 28.3%, p&lt;0.001), while the NRP group had more secondary GN and non-GN cases. The most common cause of primary GN is MCD in the NS group and IgAN in the NRP group. LN is the most common secondary GN in both NS and NRP groups. There was no significant difference in age, gender and race between the NS and NRP group. The NS group had a significantly higher proteinuria (10.8±5.5 versus 6.3±3.5, p&lt;0.001) and lower serum albumin (17.0±5.7 versus 28.0±7.6, p&lt;0.001). The NRP group had significantly more patients with abnormal renal function at the time of biopsy (83 (78.30%) versus 39 (51.32%) patients, p&lt;0.001), a higher mean systolic BP (144.1±26.3mmHg versus 134.2±26.2mmHg, p=0.014) and a higher percentage of diabetes mellitus (38 (35.85%) versus 15 (19.74%) patients, p=0.018) compared to the NS group. Conclusion The clinicopathological diagnosis between patients with NS and NRP differ significantly. Patients with NRP are more likely to have secondary glomerular disease or non-glomerular disease, with abnormal renal function and higher prevalence of hypertension and diabetes mellitus.

Levosimendan use in patients with acute heart failure and reduced ejection fraction with or without severe renal dysfunction in critical cardiac care units: a multi-institution database study

Background Acute heart failure is a life-threatening clinical condition. Levosimendan is an effective inotropic agent used to maintain cardiac output, but its usage is limited by the lack of evidence in patients with severely abnormal renal function. Therefore, we analyzed data of patients with acute heart failure with and without abnormal renal function to examine the effects of levosimendan. Methods We performed this retrospective cohort study using data from the Chang Gung Research Database (CGRD) of Chang Gung Memorial Hospital (CGMH). Patients admitted for heart failure with LVEF ≤ 40% between January 2013 and December 2018 who received levosimendan or dobutamine in the critical cardiac care units (CCU) were identified. Patients with extracorporeal membrane oxygenation (ECMO) were excluded. Outcomes of interest were mortality at 30, 90, and 180 days after the cohort entry date. Results There were no significant differences in mortality rate at 30, 90, and 180 days after the cohort entry date between the levosimendan and dobutamine groups, or between subgroups of patients with an estimated glomerular filtration rate (eGFR) ≥ 30 mL/min/1.73 m2 and eGFR < 30 mL/min/1.73 m2 or on dialysis. The results were consistent before and after propensity score matching. Conclusions Levosimendan did not increase short- or long-term mortality rates in critical patients with acute heart failure and reduced ejection fraction compared to dobutamine, regardless of their renal function. An eGFR less than 30 mL/min/1.73 m2 was not necessarily considered a contraindication for levosimendan in these patients.

Renal function in a cohort of HIV-infected patients initiating antiretroviral therapy in an outpatient setting in Ethiopia

Aim To evaluate the prevalence and associated factors of abnormal renal function among Ethiopian HIV-infected patients at baseline prior to initiation of antiretroviral therapy (ART) and during follow-up. Methods We conducted a retrospective observational cohort study of HIV infected patients who initiated ART at the outpatient ART clinic of Mehal Meda Hospital of North Shewa, Ethiopia from January 2012 to August 2018. Demographic and clinical data were abstracted from the medical records of patients. Renal function was assessed by estimated glomerular filtration rate (eGFR) calculated using the Modification of Diet in Renal Disease (MDRD) equation. Univariate and multivariate analysis were conducted to determine the factors associated with abnormal renal function at baseline and during follow-up. Results Among 353 patients, 70 (19.8%) had baseline eGFR <60 ml/min/1.73m2 and 102 (28.9%) had eGFR = 60–89.9 ml/min/1.73m2. Factors associated with baseline renal impairment (eGFR <60 ml/min/1.73m2) included female sex (AOR = 3.52, CI 1.75–7.09), CD4 count < 200 cells/mm3 (AOR = 2.75, CI 1.40–5.42), BMI < 25 Kg/m2 (AOR = 3.04, CI 1.15–8.92), low hemoglobin (AOR = 2.19, CI 1.16–4.09) and high total cholesterol (AOR = 3.15, CI 1.68–5.92). After a median of 3.0 years of ART, the mean eGFR declined from 112.9 ± 81.2 ml/min/1.73m2 at baseline to 93.9 ± 60.6 ml/min/1.73m2 (P < 0.001). The prevalence of renal impairment increased from 19.8% at baseline to 22.1% during follow-up. Of 181 patients with baseline normal renal function, 49.7% experienced some degree of renal impairment. Older age (AOR = 3.85, 95% CI 2.03–7.31), female sex (AOR = 4.18, 95% CI 2.08–8.40), low baseline CD4 (AOR = 2.41, 95% CI 1.24–4.69), low current CD4 count (AOR = 2.32, 95% CI 1.15–4.68), high BMI (AOR = 2.91, 95% CI 1.49–5.71), and low hemoglobin (AOR = 3.38, 95% CI 2.00–7.46) were the factors associated with renal impairment during follow-up. Conclusion Impaired renal function was common in HIV-infected patients initiating ART in an outpatient setting in Ethiopia, and there appears to be a high prevalence of renal impairment after a median ART follow-up of 3 years. There is a need for assessment of renal function at baseline before ART initiation and regular monitoring of renal function for patients with HIV during follow-up.

Reckoning the Dearth of Bioinformatics in the Arena of Diabetic Nephropathy (DN)—Need to Improvise

Diabetic nephropathy (DN) is a recent rising concern amongst diabetics and diabetologist. Characterized by abnormal renal function and ending in total loss of kidney function, this is becoming a lurking danger for the ever increasing population of diabetics. This review touches upon the intensity of this complication and briefly reviews the role of bioinformatics in the area of diabetes. The advances made in the area of DN using proteomic approaches are presented. Compared to the enumerable inputs observed through the use of bioinformatics resources in the area of proteomics and even diabetes, the existing scenario of skeletal application of bioinformatics advances to DN is highlighted and the reasons behind this discussed. As this review highlights, almost none of the well-established tools that have brought breakthroughs in proteomic research have been applied into DN. Laborious, voluminous, cost expensive and time-consuming methodologies and advances in diagnostics and biomarker discovery promised through beckoning bioinformatics mechanistic approaches to improvise DN research and achieve breakthroughs. This review is expected to sensitize the researchers to fill in this gap, exploiting the available inputs from bioinformatics resources.

Analysis of Prognostic Factors in Patients with Paraquat Poisoning for Better Therapy Regimen

Background Paraquat poisoning is associated with very high mortality rate and extremely difficult to manage due to lack of antidotes. The purpose of this study was to identify prognostic factors after paraquat poisoning and discuss the efficacy of current therapy regimen. Methods In this retrospective study, 211 paraquat poisoning cases admitted to the First Affiliated Hospital, School of Medicine, Zhejiang University between 1 June 2010 and 30 April 2016 were enrolled. The demographic characteristic, medical records of clinical features, laboratory parameters, therapy regimen and the prognosis were analyzed. Results The overall survival rate was 55.45%. the mean age was 35.85 years old. Twelve patients who ingested paraquat combined with alcohol had a higher survival rate. The patients in survival group ingested less amount of paraquat, presented with lower serum creatinine level at admission, developed lower incidence of acute kidney injury and pulmonary CT deterioration. The survivors were treated with higher dosage of methylprednisolone, daily dose of aspirin, daily dose of rapamycin and lower dose of vitamin C. The frequency of hemoperfusion was much more in the survival group. The Cox regression survival analysis demonstrated larger amount of paraquat ingestion, abnormal renal function at admission or developing acute kidney injury (AKI) after admission were independent risk factors for mortality. Higher dose of methylprednisolone and aspirin were independent protective prognostic factors. Conclusions Non-survivor characteristics are larger amount of paraquat ingestion, manifestation of abnormal renal function at admission or developing AKI after admission, whereas the survivor characteristics are higher dose of methylprednisolone and aspirin.