Comparative assessment of neutrophil gelatinase-associated lipocalin [NGAL] and cystatin C as early biomarkers for early detection of renal failure in patients with hypertension

Hypertension is one the most common causes of chronic kidney disease [CKD]. One of the major concerns in hypertensive patients is early detection of renal disorders. In the past, serum creatinine [Scr] concentration was used as a marker of kidney function, but it proffers a late reflection of reduced glomerular filtration rate. Cystatin C and neutrophil gelatinase-associated lipocalin [NGAL] have been recently proven to be useful for quantification of CKD. Therefore, we compared the diagnostic value of NGAL with cystatin C and creatinine to evaluate kidney function in hypertensive patients. In this study, 42 hypertensive patients and 30 healthy volunteers were recruited. Serum cystatin C [Scys C] and plasma NGAL were measured using ELISA method. Creatinine, urea, hemoglobin, fibrinogen, and C-reactive protein were measured according to the routine methods. Estimated glomerular filtration rate [eGFR] was considered as the gold standard method [cut-off value of < 78 ml/min/1.73 m[2]. In the patient group, plasma NGAL, cystatin C, and creatinine were all significantly correlated with eGFR, and plasma NGAL correlated best with eGFR. Receiver-operating characteristics analysis indicated that plasma NGAL was a better indicator than creatinine and cystatin C for predicting a GFR < 78 ml/min/1.73 m[2]. The sensitivity and specificity for NGAL were 96% and 100%, for cystatin C were 92% and 60% and for creatinine were 76% and 47%, respectively. Plasma NGAL demonstrated a higher diagnostic value to detect kidney impairment in the early stages of CKD as compared to Scys C and Scr in hypertensive patients

Assessment of Neutrophil gelatinase-associated lipocalin [NGAL] as an early biomarker for detection of renal impairment in hypertensive patients

Chronic kidney disease [CKD] is probably the most important problem of public health in advanced countries. Kidneys are often damaged as a result of high blood pressure. One of our main concerns in patients with hypertension is early detection of kidney disorders. The routine biomarkers such as creatinine have some limitation for this purpose, however recent studies suggest plasma NGAL to be a better marker. Therefor in this study we assessed the diagnostic value of plasma NGAL and compared it with serum creatinine in hypertensive patients. This study was performed on 42 hypertensive patients and 30 healthy Volunteer, both with normal serum creatinine and urea concentration who referred to Shohada Tajrish Hospital, plasma NGAL were measured subsequently using ELISA method and eGFR was considered as the gold standard method[cut off value of<78ml.min.1.73m[2]]. mean NGAL level was significantly higher in patients in comparison to control group. The sensitivity and specificity were 96% and 100% respectively for plasma NGAL[>/=32.2 ng/ml] compared with 76% and 47% for serum creatinine [>0.97 mg/dl]. Our findings indicate that NGAL is a better indicator of kidney impairment in the early stages of CKD as compared with serum creatinine in hypertensive patients

Brucellosis with kidney failure

Brucellosis is a multisystem disease that may present with a broad spectrum of clinical manifestations. The most frequent symptoms are constitutional symptoms. While involvement of the bones, joints, and liver is not rare, brucellosis may rarely involve the kidney. We present a case of brucellosis with hepatitis, pancytopenia, peripheral arthritis, and kidney failure

Successful treatment of mucormycosis after kidney transplantation

Fungal infections are rare but represent serious complications following organ transplantation. We present a case of mucormycosis primarily affecting the paranasal sinuses in a 51-year-old man with a kidney allograft. The patient presented with headache, left facial and orbital pain, nasal discharge, and elevation of serum creatinine 18 months after kidney transplantation. Laboratory tests revealed cyclosporine nephrotoxicity, cytomegalovirus infection, and prediabetes. Imaging findings were compatible with left maxillary, ethmoidal, and sphenoidal sinusitis. Diagnosis was made based on pathologic findings and detection of typical fungal hyphea in the infected tissues. The patient was successfully treated by discontinuation of cyclosporine and mycophenolate mofetil, initiation of systemic amphotericin B, and aggressive surgical debridement

Montelukast for treatment of refractory pruritus in patients on hemodialysis

One of the most common complaints in patients with end-stage renal disease [ESRD] is uremic pruritus. In the recent years, many drugs have been proposed for its treatment which have had paradoxical outcomes. We studied the antipruritus effect of montelukast sodium, a leukotriene receptor antagonist, in patients on hemodialysis. The study was conducted as randomized, single-blind, placebo-controlled crossover study in 5 hemodialysis centers. Sixteen patients with refractory pruritus were selected and were divided into 2 groups to receive firstly montelukast and then placebo, or vice versa. Patients were treated by montelukast tablets, 10 mg daily, for 20 days and the washout period was 14 days. Of 16 patients whom were included in the study, 1 died during the placebo period of myocardial infarction and another patient who received montelukast for 20 days faced hemoglobin decrease during the placebo period diagnosed as myelodysplastic syndrome. At the end of the treatment with montelukast, pruritus was reduced by 35% [95% CI, 9.5% to 62.5%], while it was reduced 7% [95% CI, 0.5% to 15.9%] with placebo [P = .002]. The patients' compliance was assessed satisfactory, except for 1 patient who exited the study due to anemia. Montelukast is more effective than placebo in the treatment of uremic pruritus not responding to the currently available antipruritus drugs, and it can be considered as a new and rather safe and effective treatment option in uremic patients