ABSTRACT
Background: Thyroid dysfunction is the commonest endocrinological disorder in pregnancy. A broad spectrum of adverse outcomes in pregnant women and the fetus have been reported which can be prevented by early diagnosis and treatment of thyroid dysfunction. Thyroid dysfunction in pregnancy has not yet been extensively studied in India. Hence, this study was conducted for assessment of the prevalence of thyroid dysfunction in pregnancy and effect on the mother and her fetus.Methods: This study is a prospective study conducted in the department of obstetrics and gynecology, MIMER Medical College and Hospital, Talegaon Dabhade, Maharashtra. A 3 years study. Antenatal women attending the outpatient and inpatient department of the hospital. The total sample population comprised of 698 pregnant women with uncomplicated singleton intra-uterine pregnancy. All participants were screened by estimation for serum TSH in first trimester. Immediately after delivery the cord blood sample was collected and cord blood TSH levels were estimated. Babies, whose cord blood TSH levels were elevated, were called for follow-up on day 5 of neonatal life and TSH, free T3 and free T4 levels were estimated. Among these babies, those diagnosed with congenital hypothyroidism were started on appropriate treatment.Results: The prevalence of thyroid dysfunction in pregnancy in present study was 17.90% whereas 82.1% patients were euthyroid (control group). Among the 17.9% patients with thyroid dysfunction, 14.6% had subclinical hypothyroidism, 1.9% had overt hypothyroidism and 1.4% had hyperthyroidism.Conclusions: With this study, we can come to the conclusion that there is high prevalence of thyroid dysfunction in pregnancy. Thus, an early diagnosis and prevention of the aftermaths of thyroid dysfunction in pregnancy is of utmost importance.
ABSTRACT
ABSTRACT Purpose We investigated the association between preoperative proteinuria and early postoperative renal function after robotic partial nephrectomy (RPN). Patients and Methods We retrospectively reviewed 1121 consecutive RPN cases at a single academic center from 2006 to 2016. Patients without pre-existing CKD (eGFR≥60 mL/min/1.73m2) who had a urinalysis within 1-month prior to RPN were included. The cohort was categorized by the presence or absence of preoperative proteinuria (trace or greater (≥1+) urine dipstick), and groups were compared in terms of clinical and functional outcomes. The incidence of acute kidney injury (AKI) was assessed using RIFLE criteria. Univariate and multivariable models were used to identify factors associated with postoperative AKI. Results Of 947 patients, 97 (10.5%) had preoperative proteinuria. Characteristics associated with preoperative proteinuria included non-white race (p<0.01), preoperative diabetes (p<0.01) and hypertension (HTN) (p<0.01), higher ASA (p<0.01), higher BMI (p<0.01), and higher Charlson score (p<0.01). The incidence of AKI was higher in patients with preoperative proteinuria (10.3% vs. 4.6%, p=0.01). The median eGFR preservation measured within one month after surgery was lower (83.6% vs. 91%, p=0.04) in those with proteinuria; however, there were no significant differences by 3 months after surgery or last follow-up visit. Independent predictors of AKI were high BMI (p<0.01), longer ischemia time (p<0.01), and preoperative proteinuria (p=0.04). Conclusion Preoperative proteinuria by urine dipstick is an independent predictor of postoperative AKI after RPN. This test may be used to identify patients, especially those without overt CKD, who are at increased risk for developing AKI after RPN.