Serum Creatinine

Renal impairment is a common complication of multiple myeloma. Cystatin-C is considered an accurate marker of glomerular filtration rate in several renal disorders. Microarray analysis has revealed that cystatin-C is one of the most highly up-regulated genes in multiple myeloma. The aim of this study was to evaluate the serum levels of cystatin-C in myeloma patients, explore possible correlations with clinical data, including survival, and assess the effect of bortezomib on cystatin-C in relapsed multiple myeloma.

Background-Acute renal failure is a serious complication of cardiac surgery causing high morbidity and mortality. The aim of this study was to evaluate the usefulness of fenoldopam, a specific agonist of the dopamine-1 receptor, in patients at high risk of perioperative renal dysfunction. Methods and Results-A prospective single-center, randomized, double-blind trial was performed after local ethical committee approval and after written consent was obtained from 80 patients undergoing cardiac surgery. Patients received either fenoldopam at 0.05 g/kg per minute or dopamine at 2.5 g/kg per minute after the induction of anesthesia for a 24-hour period. All these patients were at high risk of perioperative renal dysfunction as indicated by Continuous Improvement in Cardiac Surgery Program score Ͼ10. Primary end point was defined as 25% creatinine increase from baseline levels after cardiac surgery. The 2 groups (fenoldopam versus dopamine) were homogeneous cohorts, and no difference in outcome was observed. Acute renal failure was similar: 17 of 40 (42.5%) in the fenoldopam group and 16 of 40 (40%) in the dopamine group (Pϭ0.9). Peak postoperative serum creatinine level, intensive care unit and hospital stay, and mortality were also similar in the 2 groups. Conclusions-Despite an increasing number of reports of renal protective properties from fenoldopam, we observed no difference in the clinical outcome compared with dopamine in a high-risk population undergoing cardiac surgery. (Circulation. 2005;111:3230-3235.)

subjects. The patients were divided into four groups: 18 with normoalbuminuria (urinary albumin excretion rate [AER] <30 mg/24 h, stage I), 10 with microalbuminuria (30 -< AER -< 300 mg/24 h, stage II), seven with overt proteinuria (AER > 300 mg/24 h, stage III), and 10 with uremia (serum creatinine levels >2.0 mg/dL, stage IV). There were no significant differences in age, body mass index (BMI), fasting plasma glucose, or hemoglobin Alc (HbAlc) among the four groups. No significant difference in M/I values was seen between stage I and stage II (6.30 -+ 0.73 and 5.95 4-0.85 mg/kg/(min per irU/mL) x 100, respectively). M/I values in the stage I and stage II groups were strongly correlated with BMI (r = -.790, P = .0001 and r = -.785, P = .007, respectively). M/I values in the stage III group (4.53 ---0.51) were lower than in the stage I group, although not significantly so. M/I values in the stage IV group (3.16 -+ 0.37) were significantly lower than in the stage I group (P = .025). In multiple regression analysis with a model in which age, sex, BMI, HbAlc, and creatinine clearance (Ccr) were included as independent variables, BMI and Ccr were demonstrated to be significant and independent contributors to insulin sensitivity indices as the dependent variable (l~ = -0.716 and ~ = 0.272, respectively, R 2 = .564, P < .0001). In conclusion, the present cross-sectional study demonstrated in non-obese NIDDM patients with nephropathy that microalbuminuria did not affect peripheral insulin resistance, but uremia did, as in nondiabetic patients, and that the peripheral insulin resistance was significantly contributed to by the degree of obesity and uremia.

Introduction. Kidney transplant recipients have a higher quality of life and consume fewer health care resources compared with patients on dialysis. However, optimal timing of transplantation has been controversial. Recent studies have clearly demonstrated that preemptive renal transplantation is associated with better graft survival, lower complications, and better cost-effective outcomes. We evaluated differential effects on long-term outcomes according to dialysis type/duration versus no dialysis. Materials and Methods. We retrospectively analyzed 499 cases of first living-donor kidney transplantations performed in our center from January 1990 to January 2007. We compared 3 groups according to graft survival, acute and chronic rejection, postoperative complication, and delayed graft function rates. The mean duration of follow-up was 119.1 Ϯ 47.2 months. Results. Among 499 cases, 81 cases were preemptive renal transplantations with 418 cases hemodialysis [HD], 343 cases, peritoneal dialysis [PD] 75 cases) performed after dialysis. The 1-, 5-, and 10-year graft survival rates were 98.8%, 89.5%, 79.4% among the preemptive renal transplantation group and 92.4%, 78.2%, and 69.2% and 85.3%, 74.5%, and 68.2% (P ϭ .03) in the dialysis groups (HD, PD), respectively. The differential effect of pretransplantation HD or PD was not significant. However, the graft survival rates in the HD group were not significantly higher than the PD group (P ϭ .61). The duration of dialysis was not associated with graft survival. Conclusion. We suggest that preemptive renal transplantation should be the first choice of treatment for patients with end-stage renal disease.

Background. Infections such as malaria, schistosomiasis, hepatitis B and HIV have been suggested as major causes of the nephrotic syndrome (NS) in African children. We retrospectively analysed the course of the NS in 32 children from Ghana and reviewed the literature on NS from 18 different African countries for the presence of 'the tropical nephrotic syndrome'. Methods. Thirty-two children (22 boys, 10 girls, median age 12 years, range 1-18 years) with NS were treated from 2000-2003 at Battor Hospital, Ghana. Thirteen out of 32 children underwent a renal biopsy which was investigated by light, immune and electron microscopy. All 32 patients were initially treated with oral prednisone (PRED) therapy (29 with standard therapy for 8 weeks and three individually tailored), and steroid-resistant children received also intravenous methylprednisolone pulses (three children) or oral cyclophosphamide (two children). Results. All patients fulfilled the clinical and laboratory criteria of a NS. The initial median serum creatinine was 65 mmol/l (range 44-133 mmol/l). Renal biopsy was performed in 13/32 children and revealed focal and segmental glomerulosclerosis (FSGS) in 10 patients, minimal change disease (MCNs) in two and no conclusive result in one patient. Glomerular immune complex deposition was absent in all biopsies. After treatment with PRED, oedema disappeared in 24/32 patients; however, proteinuria normalized in 16/32 patients only. The NS relapsed in 9/16 steroid-sensitive patients after cessation of PRED therapy, and two children were frequent relapsers. however, steroid resistance and FSGS resulted in a high mortality.

Few large-scale epidemiologic studies have quantified the possible link between obesity and chronic renal failure (CRF). This study analyzed anthropometric data from a nationwide, population-based, case-control study of incident, moderately severe CRF. Eligible as cases were all native Swedes who were aged 18 to 74 yr and had CRF and whose serum creatinine for the first time and permanently exceeded 3.4 mg/dl (men) or 2.8 mg/dl (women) during the study period. A total of 926 case patients and 998 control subjects, randomly drawn from the study base, were enrolled. Face-to-face interviews, supplemented with self-administered questionnaires, provided information about anthropometric measures and other lifestyle factors. Logistic regression models with adjustments for several co-factors estimated the relative risk for CRF in relation to body mass index (BMI). Overweight (BMI > 25 kg/m 2 ) at age 20 was associated with a significant three-fold excess risk for CRF, relative to BMI <25. Obesity (BMI >30) among men and morbid obesity (BMI > 35) among women anytime during lifetime was linked to three-to four-fold increases in risk. The strongest association was with diabetic nephropathy, but two-to three-fold risk elevations were observed for all major subtypes of CRF. Analyses that were confined to strata without hypertension or diabetes revealed a three-fold increased risk among patients who were overweight at age 20, whereas the two-fold observed risk elevation among those who had a highest lifetime BMI of >35 was statistically nonsignificant. Obesity seems to be an important-and potentially preventable-risk factor for CRF. Although hypertension and type 2 diabetes are important mediators, additional pathways also may exist.

The kidney is one of the organs most prominently affected by aging. This can be seen by a loss of renal mass which is caused by a decrease in the number of nephrons resulting in hyperfiltration, hypertrophy and elevations in glomerular pressure. The factors influencing aging of the kidney are not fully elucidated. Epidemiological, experimental and interventional studies resulted in inconsistent results and have not firmly established whether uric acid levels affect progression of Chronic Kidney Disease (CKD). Therefore, we analyzed whether uric acid levels predict the progression of CKD in the Mild to Moderate Kidney Disease Study comprising at baseline 227 Caucasian patients aged 18-65 years with primary non-diabetic CKD of various degrees of renal impairment. Of them, 177 completed a prospective follow-up of 7 years. Primary endpoint was progression of CKD defined as doubling of baseline serum creatinine and/or terminal renal failure. Patients who reached a progression endpoint (n = 65) were significantly older, had higher baseline serum creatinine and protein excretion rates as well as lower Glomerular Filtration Rate (GFR). Uric acid levels were only higher in patients with progression of disease when patients with uric acid-lowering drugs were excluded from the analysis. Cox regression analysis revealed that increasing uric acid levels predict disease progression only when the analysis was not adjusted for baseline kidney function parameters. As soon as we adjusted the analysis for GFR and proteinuria this association completely vanished. In summary, our prospective 7 year follow-up study in patients with non-diabetic primary CKD did not support uric acid as an independent predictor for CKD progression.

Background: Chronic kidney disease (CKD) is a significant public health problem that leads to end-stage renal disease (ESRD) with as many as 2 million people predicted to need therapy worldwide by 2010. Obesity is a risk factor for CKD and leptin, the obesity hormone, correlates with body fat mass and markers of renal function. A number of clinical and experimental studies have suggested a link between serum leptin and kidney disease. We hypothesised that variants in the leptin gene (LEP) may be associated with markers of CKD in indigenous black Africans.

Significant protective effects of the feed additives: water extract of artichoke, sesame seed, Roxazyme-G and L-(3 phenylalanine against the growth inhibitory effect of ochratoxin A (OTA) and associated pathomorphological changes were seen. Similarly, there was less OTA-induced decrease in serum total protein and increase of serum creatinine and urea in the chicks. Whereas OTA induced strong degenerative changes and an increase in weight of kidneys and liver as well as a decrease of the weight of lymphoid organs the additives variously gave protection against these changes. The protection of Roxazyme-G and sesame seed was better expressed in kidneys and liver, whereas the phenylalanine better protected the weight changes in gizzard, heart and the changes in differential WBC count. Notably, sesame seed gave strong protection against 5 ppm OTA-induced suppression of humoral immune response, for which artichoke also had some beneficial effect, whereas phenylalanine had hardly any effect.

Objective: To evaluate changes in serum and urinary zinc, cobalt, copper, iron, and calcium concentrations in critically ill patients receiving propofol containing disodium edetate (disodium ethylenediaminetetraacetic acid [EDTA]) versus sedative agents without EDTA. Design: This was a randomised, open-label, parallel-group study with randomisation stratified by baseline Acute Physiology and Chronic Health Evaluation (APACHE II) scores. Setting: Intensive care units (ICU) in 23 medical centres. Patients: Medical, surgical, or trauma ICU patients 17 years of age or older who required mechanical ventilator support and sedation.

Acute kidney injury (AKI) is associated with significantly increased morbidity and mortality. To provide a uniformly accepted definition, the RIFLE classification was introduced by the Acute Dialysis Quality Initiative, recently modified by the Acute Kidney Injury Network (AKIN), suggesting staging of AKI based on dynamic changes within 48 h. This study compares these two classification systems with regard to outcome. Cohort analysis of SAPS 3 database. Sixteen thousand seven hundred and eighty-four ICU patients from 303 ICUs were analysed. Classification was performed according to RIFLE (Risk, Injury, Failure) or according to AKIN (stage 1, 2, 3) without including a requirement of renal replacement therapy in the analysis. Changes of serum creatinine as well as urinary output were assessed for both AKIN and RIFLE during the first 48 h of ICU admission. Primary endpoint was hospital mortality. Incidence of AKI in our population of critically ill patients was found to range between 28.5 and 35.5% when applying AKIN and RIFLE criteria, respectively, associated with increased hospital mortality averaging 36.4%. Observed-to-expected mortality ratios revealed excess mortality conferred by any degree of AKI increasing from 0.81 for patients classified as non-AKI up to 1.31 and 1.23 with AKIN stage 3 or RIFLE Failure, respectively. AKIN misclassified 1,504 patients as non-AKI compared to RIFLE which misclassified 504 patients. Acute kidney injury classified by either RIFLE or AKIN is associated with increased hospital mortality. Despite presumed increased sensitivity by the AKIN classification, RIFLE shows better robustness and a higher detection rate of AKI during the first 48 h of ICU admission.

Background Angiotensin receptor blockers (ARB) and angiotensin converting enzyme (ACE) inhibitors are known to reduce proteinuria. Their combination might be more eff ective than either treatment alone, but long-term data for comparative changes in renal function are not available. We investigated the renal eff ects of ramipril (an ACE inhibitor), telmisartan (an ARB), and their combination in patients aged 55 years or older with established atherosclerotic vascular disease or with diabetes with end-organ damage.

A computerized Urine Protein Expert System (UPES) measuring creatinine, total protein, albumin, IgG, α 1 -microglobulin, α 2 -macroglobulin, and N-acetyl-β-Dglucosaminidase, together with urine dipstick testing for granulocyte esterase and hemoglobin pseudoperoxidase, and measurement of serum creatinine had been found to be useful in adults for differentiating between renal disorders. The objective of this study was to investigate UPES for identifying the different types of proteinuria and their underlying prerenal, glomerular, tubular, and postrenal causes in 146 children characterized by routine and invasive nephrological investigations. UPES proved to be a useful tool in pediatric renal patients after refinements were implemented in the program. Comparing UPES with the pediatric nephrologist's interpretation of all available clinical and laboratory data, UPES diagnosed glomerulopathies in 46 (75%) of 61 patients. In a further 23% it suggested glomerular involvement by indicating either a disturbed glomerular permeability or increased excretion of albumin. Tubular proteinuria was correctly described by UPES in 23 (100%) patients with different tubulopathies. UPES revealed normal kidney function in all healthy children and all children with remission of renal disorders. Therefore, UPES can be regarded as a useful tool in the automated differentiation of renal diseases in children.

Nimesulide, a sulfonanilide derivative, was compared with diclofenac sodium for toxicity in poultry. In this study, Vanaraja and PB1 birds of 6 weeks old (either sex) were mixed and equally divided into 5 groups of 10 birds each. The birds were inoculated with nimesulide, @ 5 and 2 mg; vehicle @ 0.5 ml; and diclofenac sodium @ 5 mg on kg bwt basis. One group served as untreated control. All the groups were observed for a period of 28 days. Forty percent mortality was observed within 12 days in diclofenac-treated group. While birds inoculated with nimesulide remained normal. No significant differences in the weight gain, haematology, total protein contents in the nimesulide and diclofenac groups (survived birds) were observed when compared with the control group of birds. Serum creatinine, cholesterol, alkaline phosphatase, and aspartate aminotransferase levels were significantly (P < 0.05) high in diclofenac-treated group compared to nimesulide (P > 0.05) and control groups. Nimesulide-treated groups did not show any histopathological lesions, where as diclofenac-treated birds showed histopathological lesions in liver and kidney.

Cream Pemutih Wajah – Whitening night Pratista hadir untuk menjadikan kulit wajah Anda semakin putih, bersinar, dan yang paling penting adalah sehat kaya akan vitamin. Agar hasil bisa lebih maksimal, maka gunakanlah paket atau rangkaian whitening lainnya suaya saling mendukung. Seperti sabun pemutih, bedak, dan sebagainya. Intinya tidak hanya mengandalkan krim malam ya dears. Apa sih gunanya pakai cream malam ? males banget deh rasanya kalau udah ngantuk tapi harus pakai krim malam dulu… " duh dears, pemikiran seperti ini sebenarnya salah banget. Karena pada saat malam hari adalah waktu yang tepat bagi kulit untuk menyerap nutrisi. setelah seharian beraktivitas, terkena debu dan yang lainnya, kulit butuh waktu istirahat untuk menyerap vitamin.. Whitening night Cream dari Pratista ini memiliki banyak sekali kandungan Arbutin , termasuk juga vitamin A dan vitamin C. Perlu Anda ketahui, Arbutin memiliki manfaat lebih ampuh untuk mencerahkan kulit, karena kelebihan dari Arbutin ini adalah dapat menghambat aktivitas enzim tyrosinase (enzim penyebab proses pembentukan melanin kulit) dengan lebih efektif tanpa efek samping sama sekali. Arbutin ini juga berfungsi sebagai anti aging, yakni dapat menstimulasi produksi kolagen sehingga menghambat proses penuaan dini serta meningkatkan kehalusan kulit, selain juga mengandung anti inflammatory yang bersifat peradangan dan efektif mencegah iritasi pada kulit.

Introduction: End stage renal failure eventually develops in 40% of
patients with diabetes, the IDDM constitute the single most usual
disease leading to inadequacy in adults. Patients with type 2 diabetes
had higher HBA1c and FBS together that is distinctly reduced the
reactiveness of insulin in contrast to healthy control subjects. On
average,  death takes  place  7years  after  the  start  of  persistent
proteinuria  but  the  scale  is  wide  (2-32)  years.  Even  though
morphological bruises advance and nature in glomeruli of those that
with  diabetes  after  a  few  years  of  metabolic  deformities.Chronic
hyperglycemia as measured by mean blood glucose or HBA1c has
been  associated  with  the  development  and  advancement  of  micro
vascular diabetic complications.
Methodology: This  is  a  case  control  study  done  in  the in-patient
department of general medicine. From January to July 2014. The
patients selected has a history of diabetes for more than 3 years and
were  on  hypoglycemic  agents/insulin.  Diabetic  nephropathy  was
confirmed  by  elevated  levels  of  blood  urea  and  serum creatinine,
which  has  the  level  above  6.5  mg/dl.  All  patients  had  persistent
increase in serum creatinine examinations and controlled cases are
selected  contingent on their normal  creatinine  and urea  excretion
profile.
Results: the  mean  age  of  the  patients  with  diabetic  nephropathy  is
54.43 ± 7.99 while the mean age of patients with control profile of
diabetes were 48.37 ± 6.99. There were 22.9%, almost 23% of the
patients with diabetic nephropathy are anemic. And the mean FBS
levels in diabetic nephropathy in the current study were about180. 85
± 42.05 and the mean exhibit by control groups 81.4 ± 7.0. While the
mean HBA1C range in diabetic nephropathy patients was about 9.96
± 5.07 and 4.45 ± 0.57 is the mean of the control group. The levels of
blood  urea,  serum  creatinine  and  triglycerides  are evidently high, though  which  when  compared  to  control  group.
Conclusion:  HBA1c  and  FBS  are  the  important  predictors  of
intercapillary glomerulonephritis or diabetic nephropathy. HBA1c
is highly co-related to preceding mean blood glucose. The chief
outcome  measures  which  predicts  the  intercapillary
glomerulonephritis  or  diabetic  glomerulosclerosis  or  diabetic
nephropathy are HBA1c, triglycerides, serum creatinine and blood
urea  nitrogen.  Patients  with  progressed  nephropathy  showed
increased  levels  of  serum  triglycerides,  which  is  the  important
independent clinical attribute.

Hypoalbuminemia in patients with end-stage liver disease persists for weeks even after liver transplantation. Human albumin is widely used for volume replacement, to increase oncotic pressure, to improve organ function, and to promote wound healing. However, these practices are not evidence-based. We prospectively studied the clinical outcome of 40 patients following living related liver transplantation. Patients were randomized to an albumin group (n ϭ 20), where 20% human albumin was administered to maintain serum albumin level Ն3 g/dL, and a control group (n ϭ 20), where there was no correction for serum albumin. Hemodynamics and laboratory investigations, fluid administration, blood transfusion, and fluid balance were recorded during the first 5 days in the intensive care unit. Serum albumin level was significantly higher in the albumin group. Heart rate, blood pressure, central venous pressure, and cardiac output did not vary significantly between the groups. There was no significant difference in serum creatinine, creatinine clearance, bilirubin, ALT, AST, prothrombin time, and international normalized ratio between both groups. No significant difference between Tacrolimus level and dose required to maintain therapeutic concentration was noted between both groups. Postoperative course and complications did not vary significantly between both groups. In conclusion, postoperative albumin administration to a target serum albumin Ն3 g/dL does not have additional benefits for the postoperative course in patients scheduled for living related liver transplantation.

The objective of this study was to determine the effect of creatine supplementation on performance and body composition of swimmers. Eighteen swimmers were evaluated in terms of post-performance lactate accumulation, body composition, creatine and creatinine excretion, and serum creatinine concentrations before and after creatine or placebo supplementation. No significant differences were observed in the marks obtained in swimming tests after supplementation, although lactate concentrations were higher in placebo group during this period. In the creatine-supplemented group, urinary creatine, creatinine, and body mass, lean mass and body water were significantly increased, but no significant difference in muscle or bone mass was observed. These results suggest that creatine supplementation cannot be considered to be an ergogenic supplement ensuring improved performance and muscle mass gain in swimmers.

To evaluate safety and feasibility of autologous bone marrow-enriched CD34+ hematopoietic stem cell Tx through the hepatic artery in patients with decompensated cirrhosis. Four patients with decompensated cirrhosis were included. Approximately 200 mL of the bone marrow of the patients was aspirated, and CD34+ stem cells were selected. Between 3 to 10 million CD34+ cells were isolated. The cells were slowly infused through the hepatic artery of the patients. Patient 1 showed marginal improvement in serum albumin and no significant changes in other test results. In patient 2 prothrombin time was decreased; however, her total bilirubin, serum creatinine, and Model of End-Stage Liver Disease (MELD) score worsened at the end of follow up. In patient 3 there was improvement in serum albumin, porthrombin time (PT), and MELD score. Patient 4 developed radiocontrast nephropathy after the procedure, and progressed to type 1 hepatorenal syndrome and died of liver failure a few days later. Beca...

Serum Pemutih Wajah – Masih bersama Lia Kosmetik disini, pada kesempatan kali ini kami akan memberikan produk terbaik kami yaitu serum whitening. Apa itu serum? Tempo lalu sebenarnya sudah kami jelaskan, tetapi tidak ada salahnya untuk mengulang kembali agar teman-teman bisa mengerti lebih gamblang. Jadi serum adalah zat cair yang formulanya terbagi dalam asam amino, air, emulasi serta beragam jenis formula pendukung hingga serum bisa meresap dalam SUSUNAN TERDALAM kulit. Molekul dari formula zat itu adalah partikel kecil serta langkah kerjanya juga lebih tinggi 10x lipat dari cream muka umum yang beredar biasanya. Oleh karena itu lah harga serum lebih tinggi dari pada cream muka pada umumnya karena dari segi manfaat atau khasiat lebih baik, akan tetapi lebih baiknya lagi mengkolaborasikan dengan whitening series lainnya agar hasil yang didapatkan MAKSIMAL. Pratista juga menyediakan beragam jenis serum yang pastinya mempunyai manfaat berlainan, dua diantaranya sudah kami posting yaitu anti acne serum dan revearse anti aging serum, dan kali ini adalah whitening serum, penjelasannya adalah sebagai berikut : 1. Anti Acne Serum yang mempunyai manfaat menangani beragam type jerawat, menyamarkan noda hitam sisa jerawat, berbentuk oil control, membuat cerah muka, serta memperkecil pori –pori muka. 2. Whitening Serum atau serum pemutih yang mempunyai manfaat : Membuat cerah muka, menyamarkan flek hitam, mengenyalkan kulit muka, menghindar terjadinya penuaan awal, melembutkan kulit muka serta leherm memperkecil pori – pori muka. 3. Revearse Aging Serum yang mempunyai manfaat : Kurangi kerutan halus diwajah, menghalangi terjadinya penuaan awal serta membuat cerah muka.. . Oh ya dears, kalian harus juga tau yaa pemakaian serum yang baik serta benar lantaran hal itu berguna untuk memaximalkan sistem serta manfaat yang dihasilkan serum, sebaiknya serum dipakai sesudah muka dibikin bersih memakai toner serta facial wash. Hal semacam ini ditujukan supaya penyerapan serum lebih efisien serta menyerap sampai kulit terdalam. Penuangan serum tidaklah mesti terlalu berlebih, cukup hanya menteskan serum 3-4 tetes pada tangan lantas tetesan serum itu dioleskan pada tiap-tiap muka, seperti dahi, pipi kanan serta kiri dan permukaan dagu sampai leher, lantas ratakan pada tiap-tiap permukaan kulit. penggunaan serum yang pas dipakai ketika siang serta malam hari, di mana manfaat dari serum pada malam hari akan memberi khasiat yg optimal serta pagi hari serum bakal bekerja sebagai penangkal radikal bebas akibat cahaya matahari serta kotoran polusi udara. Gunakanlah serum dengan teratur (sabar dan konsisten) supaya bisa mendapatkan hasil yang memuaskan.

Disturbed gastric emptying (GE) occurs commonly in critically ill patients. Admission diagnoses are believed to influence the incidence of delayed GE and subsequent feed intolerance. Although patients with burns and head injury are considered to be at greater risk, the true incidence has not been determined by examination of patient groups of sufficient number. This study aimed to evaluate the impact of admission diagnosis on GE in critically ill patients. A retrospective review of patient demographics, diagnosis, intensive care unit (ICU) admission details, GE, and enteral feeding was performed on an unselected cohort of 132 mechanically ventilated patients (94 males, 38 females; age 54 +/- 1.2 years; admission Acute Physiology and Chronic Health Evaluation II [APACHE II] score of 22 +/- 1) who had undergone GE assessment by 13C-octanoic acid breath test. Delayed GE was defined as GE coefficient (GEC) of less than 3.20 and/or gastric half-emptying time (t50) of more than 140 minute...

Background: Acute renal failure on the intensive care unit is associated with significant mortality and morbidity. Objectives: To determine recommendations for the prevention of acute kidney injury (AKI), focusing on the role of potential preventative maneuvers including volume expansion, diuretics, use of inotropes, vasopressors/vasodilators, hormonal interventions, nutrition, and extracorporeal techniques. Method: A systematic search of the literature was performed for studies using these potential protective agents in adult patients at risk for acute renal failure/kidney injury between 1966 and 2009. The following clinical conditions were considered: major surgery, critical illness, sepsis, shock, and use of potentially nephrotoxic drugs and radiocontrast media. Where possible the following endpoints were extracted: creatinine clearance, glomerular filtration rate, increase in serum creatinine, urine output, and markers of tubular injury. Clinical endpoints included the need for renal replacement therapy, length of stay, and mortality. Studies are graded according to the international Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) group system Conclusions and recommendations: Several measures are recommended, though none carries grade 1A. We recommend prompt resuscitation of the circulation with special attention to providing adequate hydration whilst avoiding high-molecular-weight hydroxy-ethyl starch (HES) preparations, maintaining adequate blood Intensive Care Med EXPERT PANEL pressure using vasopressors in vasodilatory shock. We suggest using vasopressors in vasodilatory hypotension, specific vasodilators under strict hemodynamic control, sodium bicarbonate for emergency procedures administering contrast media, and periprocedural hemofiltration in severe chronic renal insufficiency undergoing coronary intervention.

Background. Kidney Disease Outcomes Quality Initiative (KDOQI) chronic kidney disease (CKD) guidelines have focused on the utility of using the modified four-variable MDRD equation (now traceable by isotope dilution mass spectrometry IDMS) in calculating estimated glomerular filtration rates (eGFRs). This study assesses the practical implications of eGFR correction equations on the range of creatinine assays currently used in the UK and further investigates the effect of these equations on the calculated prevalence of CKD in one UK region Methods. Using simulation, a range of creatinine data (30-300 mmol/l) was generated for male and female patients aged 20-100 years. The maximum differences between the IDMS and MDRD equations for all 14 UK laboratory techniques for serum creatinine measurement were explored with an average of individual eGFRs calculated according to MDRD and IDMS <60 ml/min/1.73 m 2 and 30 ml/min/1.73 m 2 . Similar procedures were applied to 712 540 samples from patients !18 years (reflecting the five methods for serum creatinine measurement utilized in Northern Ireland) to explore, graphically, maximum differences in assays. CKD prevalence using both estimation equations was compared using an existing cohort of observed data. Results. Simulated data indicates that the majority of laboratories in the UK have small differences between the IDMS and MDRD methods of eGFR measurement for stages 4 and 5 CKD (where the averaged maximum difference for all laboratory methods was 1.27 ml/min/1.73 m 2 for females and 1.59 ml/min/ 1.73 m 2 for males). MDRD deviated furthest from the IDMS results for the Endpoint Jaffe method: the maximum difference of 9.93 ml/min/ 1.73 m 2 for females and 5.42 ml/min/1.73 m 2 for males occurred at extreme ages and in those with eGFR >30 ml/min/1.73 m 2 . Observed data for 93,870 patients yielded a first MDRD eGFR <60 ml/min/1.73 m 2 in 2001. 66 429 (71%) had a second test >3 months later of which 47 093 (71%) continued to have an eGFR <60 ml/min/1.73 m 2 . Estimated crude prevalence was 3.97% for laboratory detected CKD in adults using the MDRD equation which fell to 3.69% when applying the IDMS equation. Over 95% of this difference in prevalence was explained by older females with stage 3 CKD (eGFR 30-59 ml/min/1.73 m 2 ) close to the stage 2 CKD (eGFR 60-90 ml/min/1.73 m 2 ) interface. Conclusions. Improved accuracy of eGFR is obtainable by using IDMS correction especially in the earlier stages of CKD 1-3. Our data indicates that this improved accuracy could lead to reduced prevalence estimates and potentially a decreased likelihood of onward referral to nephrology services particularly in older females. a By way of example: 55 male subjects (20-29) were originally categorized as stage 3 CKD using MDRD equation. (5) Additional male subjects were recategorized to stage 3 using IDMS correction; the contribution to overall 2 was [0.42].

The negative interference of bilirubin on serum creatinine determined by the kinetic alkaline picrate (Jaffe) reaction is the unresolved problem. Though high performance liquid chromatography and gas chromatography with mass spectroscopy have been proposed to be gold standards for creatinine estimation but they are not readily available in most of the clinical chemistry laboratories due to economic and technical constraints. Most of the present day analyzers use Jaffe’s kinetic method without deproteinization. Though enzymatic methods are now routinely used as most accurate method but they are not acceptable due to cost constraints. Hence this study was planned to find out a possible solution to the problem of bilirubin interference by a minor modification in the commonly used Jaffe method so that it is amenable for use on the currently used analyzers.

Diltiazem and cyclosporin A (CsA) share a similar metabolism and degradation via the hepatic cytochrome p 450 subfamily 3A4. Co-administration of diltiazem with CsA may lead to CsA dosage reduction, blood pressure control and renal protection. To study the four year outcome of kidney transplant recipients who received diltiazem administration with CsA. This was compared to the outcomes of patients who received CsA without diltiazem and were matched for blood pressure control and other baseline characteristics. Forty eight patients were included in the diltiazem group and seventy patients in the non-diltiazem group. CsA monitoring was done by using trough level (monoclonal fluorescent polarization immunoassay). The results showed that both groups has similar 4-year graft survival (92 and 95 %) with a similar mean final serum creatinine (1.3 mg/dl). Mean dose of CsA during the first month was 30 % lower in the diltiazem than non-diltiazem group. At one year CsA dose was 11% lower in t...

Non-alcoholic fatty liver disease (NAFLD) is a common disorder which causes serum liver enzyme elevation. Elevated homocysteine levels were demonstrated in fatty liver disease and chronic liver failure. However, enough data related with homocysteine levels in patients with NAFLD is not available. We aimed to find out whether there is an association between homocysteine levels and NAFLD.

Creatine (CR) supplementation is commonly used by athletes. However, its eVects on renal function remain controversial. The aim of this study was to evaluate the eVects of creatine supplementation on renal function in healthy sedentary males (18-35 years old) submitted to exercise training. A randomized, double-blind, placebo-controlled trial was performed. Subjects (n = 18) were randomly allocated to receive treatment with either creatine (CR) (»10 g day ¡1 over 3 months) or placebo (PL) (dextrose). All subjects undertook moderate intensity aerobic training, in three 40-min sessions per week, during 3 months. Serum creatinine, serum and urinary sodium and potassium were determined at baseline and at the end of the study. Cystatin C was assessed prior to training (PRE), after 4 (POST 4) and 12 weeks (POST 12). Cystatin C levels (mg L ¡1 ) (PRE CR: 0.82 § 0.09; PL: 0.88 § 0.07 vs. POST 12 CR: 0.71 § 0.06; PL: 0.75 § 0.09, P = 0.0001) were decreased over time, suggesting an increase in glomerular Wltration rate. Serum creatinine decreased with training in PL but was unchanged with training in CR. No signiWcant diVerences were observed within or between groups in other parameters investigated. The decrease in cystatin C indicates that highdose creatine supplementation over 3 months does not provoke any renal dysfunction in healthy males undergoing aerobic training. In addition, the results suggest that moderate aerobic training per se may improve renal function.

Background: Diabetic foot disease poses a substantial problem in Malaysian diabetic population. We evaluate the clinical factors affecting minor amputation in diabetic foot disease. Methods: A cross-sectional study enrolling patients admitted to orthopaedic wards of a single tertiary hospital for diabetic foot disease was conducted. Patients who had undergone major amputation or with medical condition above the ankle joint were not included. Clinical data were collected by measurement of ankle brachial systolic index and Semmes-Weinstein 5.07 gauge monofilament test with foot clinical evaluation using King's classification respectively. Results: The total number of patients included was 138, with mean age of 59.7 years (range 29 to 94 years old). Fifty patients (36.2%) had minor amputations. Poor compliance to diabetic treatment, King's classification stage 5, low measures of ankle brachial systolic index, sensory neuropathy, high serum C-Reactive protein and high serum creatinine are significant predictive factors for minor amputation (P < 0.05). Conclusion: Identifying these risk factors may help in prevention of minor amputation and subsequently reduce limb loss in diabetic foot.

The aim of this study was to prospectively evaluate the efficacy and outcome of percutaneous nephrolithotomy in patients with nephrolithiasis and chronic renal insufficiency. Between January 2006 and June 2009, 30 patients (20 males and 10 females; mean age 45 years, range 18-65; mean serum creatinine 6.3 ± 1.57 mg%) with calculus nephropathy were treated in our department. In 25 patients with obstructed and infected systems preliminary percutaneous nephrostomy or double J stenting was done. After stabilization and treatment of sepsis, percutaneous nephrolithotomy was done. Eight patients underwent bilateral procedure and 22 underwent unilateral procedure. Twenty-two patients needed a single sitting while eight patients needed two sittings for stone clearance. The renal function was monitored by serial creatinine estimations. Of the 30 patients, 27 patients achieved complete clearance. Renal function was improved in 27 patients. Six patients developed postoperative sepsis. Two patients required angioembolization for uncontrollable bleeding. There was no mortality. Patients with calculus nephropathy can be salvaged using PNL with good improvement in renal function and acceptable morbidity when appropriate preoperative preparation and perioperative care are given.

Objective: To update the follow-up of the Euro-Lupus Nephritis Trial (ELNT), a randomised prospective trial comparing low-dose (LD) and high-dose (HD) intravenous (IV) cyclophosphamide (CY) followed by azathioprine (AZA) as treatment for proliferative lupus nephritis. Patients and methods: Data for survival and kidney function were prospectively collected during a 10-year period for the 90 patients randomised in the ELNT, except in 6 lost to follow-up. Results: Death, sustained doubling of serum creatinine and end-stage renal disease rates did not differ between the LD and HD group (5/44 (11%) vs 2/46 (4%), 6/44 (14%) vs 5/46 (11%) and 2/44 (5%) vs 4/46 (9%), respectively) nor did mean serum creatinine, 24 h proteinuria and damage score at last follow-up. Most patients in both groups were still treated with glucocorticoids, other immunosuppressant agents and blood pressure lowering drugs. After 10 years of follow-up, the positive predictive value for a good outcome of an early drop in proteinuria in response to initial immunosuppressive therapy was confirmed. Conclusion: The data confirm that a LD IVCY regimen followed by AZA-the ''Euro-Lupus regimen''-achieves good clinical results in the very long term.

The goal of this study is to investigate if metallothionein (MT) gene polymorphism affects the susceptibility to lead as well as renal function parameters and blood pressures (BP) in workers exposed to lead for extended period of time. By means of real-time polymerase chain reaction, the MT4-216 A/G genotypes classified as rs396230 in the single nucleotide polymorphism database of the National Center for Biotechnology Information (database) were analyzed on 113 workers of a lead battery-recycling factory. Workers with G (mutant) allele were more susceptible to the toxic effects of lead on their systolic BP and serum renal function parameters. Their BP was 10 mmHg higher than those with wild-type (AA type) allele. Among subjects with the 3-genome, the GG mutant type subjects appear to be more susceptible to lead. Regression models of serum creatinine and BUN showed significant differences between the GG and GA types compared to AA type subjects. This cross-sectional study shows that ...

Acute renal failure (ARF) is an uncommon complication in children with nephrotic syndrome. We report here the case of a 10-year-old male child with primary steroid-resistant nephrotic syndrome who was nonresponsive to steroids and cyclophosphamide. A kidney biopsy revealed that he had focal segmental glomerulosclerosis. His treatment was initiated with tacrolimus (dose of 0.15 mg/kg/day) in two divided doses along with prednisolone 60 mg/m 2 /daily. After 1 month of treatment, he was diagnosed as having acute renal failure secondary to HUS. This was postulated to be due to the tacrolimus therapy, which was withdrawn. Two weeks after stopping the adminsitration of tacrolimus, his urine output improved, and the hemoglobin and serum creatinine normalized. Thus, tacrolimus-induced HUS is a rare cause of ARF in nephrotic syndrome. With the increasing use of tacrolimus in steroid-resistant nephrotic syndrome, the treating physicians need to be aware of this rare, but potentially lifethreatening side effect.

Methods. We reviewed our prospectively maintained database of 2005 liver transplantations. Therapy was either started de novo or converted from calcineurin inhibitors (CNIs) to sirolimus as the main immunosuppressive agent for nephrotoxicity or rejection. Glomerular filtration rate (GFR) was determined with iodine 125-labeled sodium isthalamate (Glofil-125), and serum creatinine concentration was obtained before and 3 months after transplantation, and yearly in both groups. Sirolimus levels were 10 to 15 ng/mL in patients at less than 3 months after transplantations and 5 to 10 ng/mL in the remaining patients. All patients received mycophenolate mofetil as maintenance therapy. Results. Data for 29 patients in the de novo group and 35 in the conversion group were reviewed. Patients in the de novo group demonstrated an acute cellular rejection rate of 17.2%, 40% of which were steroid resistant. In this group, 48.2% discontinuation of sirolimus was necessary because of adverse effects. Patients in the conversion group demonstrated an acute cellular rejection rate of 2.8% and a 34.3% rate of sirolimus discontinuation. Seventeen (56.7%) patients at 1 year and 8 (44.4%) patients at 2 years demonstrated continued improvement in GFR. In the conversion group, case-control analysis did not demonstrate a significant difference in GFR and serum creatinine concentration (P Ͼ .05) at 1 and 2 years after conversion. At the time of review, no patients in the conversion group required hemodialysis. Conclusions. Conversion to sirolimus therapy is an effective strategy in improving renal function in patients with CNI-induced nephrotoxicity and can be done without increased rejection. Most of our patients (65.7%) tolerated sirolimus conversion. Of these, 56.7% and 44.4% demonstrated continued increase in GFR with the CNI-free regimen at 1 and 2 years, respectively. Long-term, large-population, prospective, randomized, controlled studies should further validate these results.