Usefulness of Kidney Donor Profile Index (KDPI) to predict graft survival in a South Brazilian Cohort / Utilidade do Índice de Perfil de Doadores de Rins (KDPI) para prever a sobrevida do enxerto em uma coorte do Sul do Brasil

Abstract Introduction: Kidney Donor Profile Index (KDPI) has been incorporated in the United States to improve the kidney transplant allocation system. Objectives: To evaluate deceased kidney donors' profile using KDPI and compare to the previous United Network for Organ Sharing (UNOS) definition of expanded criteria donors (ECD) and assess the KDPI applicability to predict five-year graft survival and renal function in our sample. Methods: Retrospective cohort of 589 kidney transplants from deceased donors performed from January 2009 to May 2013 with follow-up until May 2018. Results: In 589 kidney transplants, 36.6% of donors were classified as ECD and 28.8% had KDPI ≥ 85%. Mean KDPI was 63.1 (95%CI: 60.8-65.3). There was an overlap of standard and ECD in KDPI between 60 and 95 and a significantly lower death-censored graft survival in KDPI ≥ 85% (78.6%); KDPI 0-20: 89.8%, KDPI 21-59: 91.6%, and KDPI 60-84: 83.0%; p = 0.006. The AUC-ROC was 0.577 (95%CI: 0.514-0.641; p = 0.027). Renal function at 5 years was significantly lower according to the incremental KDPI (p < 0.002). KDPI (HR 1.011; 95%CI 1.001-1.020; p = 0.008), donor-specific antibodies (HR 2.77; 95%CI 1.69-4.54; p < 0.001), acute rejection episode (HR 1.73; 95%CI 1.04-2.86; p = 0.034) were independent and significant risk factors for death-censored graft loss at 5 years. Conclusion: In our study, 36.6% were classified as ECD and 28.8% had KDPI ≥ 85%. KDPI score showed a moderate power to predict graft survival at 5 years. Renal function was significantly lower in patients with higher KDPI.

Resumo Introdução: O Índice de Perfil de Doadores de Rins (KDPI) foi adotado nos Estados Unidos para melhorar o sistema de alocação de transplantes renais. Objetivos: avaliar o perfil dos doadores de rim falecidos usando o KDPI e comparar com a definição anterior do United Network for Organ Sharing (UNOS) de doadores de critérios expandidos (DCE) e avaliar a aplicabilidade do KDPI para prever a sobrevida do enxerto em cinco anos e a função renal em nossa amostra. Métodos: Coorte retrospectiva de 589 transplantes renais de doadores falecidos, realizada de janeiro de 2009 a maio de 2013, com acompanhamento até maio de 2018. Resultados: Em 589 transplantes renais, 36,6% dos doadores foram classificados como DCE e 28,8% apresentaram KDPI ≥ 85%. O KDPI médio foi de 63,1 (IC 95%: 60,8-65,3). Houve uma sobreposição de padrão e DCE no KDPI entre 60 e 95 e uma sobrevida do enxerto censurada por óbito significativamente menor no KDPI ≥ 85% (78,6%); KDPI 0-20: 89,8%, KDPI 21-59: 91,6% e KDPI 60-84: 83,0%; p = 0,006. A ASC-ROC foi de 0,577 (IC 95%: 0,514-0,641; p = 0,027). A função renal aos 5 anos foi significativamente menor de acordo com o aumento do KDPI (p <0,002). KDPI (HR 1.011; 95% CI 1.001-1.020; p = 0.008), anticorpos específicos contra doadores (HR 2,77; 95% CI 1,69-4,54; p <0,001), episódio de rejeição aguda (HR 1,73; 95% CI 1,04-2,86; p = 0,034) foram fatores de risco independentes e significativos para perda do enxerto censurada por óbito em 5 anos. Conclusão: Em nosso estudo, 36,6% foram classificados como DCE e 28,8% apresentaram KDPI ≥ 85%. O escore KDPI mostrou potencial moderado para prever a sobrevida do enxerto em 5 anos. A função renal foi significativamente menor nos pacientes com maior KDPI.

Prognostic Value of Renal Function for Cardiac Events in Patients Without Significant Stenosis on Coronary Computed Tomography Angiography

This study was conducted to determine clinical parameters predicting future major adverse cardiovascular events (MACEs) in patients without significant stenosis on coronary computed tomographic angiography (CCTA). A total of 625 patients with suspected coronary artery disease (CAD) who underwent CCTA that revealed insignificant ( 90 days after CCTA) revascularization were assessed. During the mean follow-up period of 819 +/- 529 days (median 837 days), there were 28 cases of MACEs (4.5%). In multivariable Cox regression analysis, independent predictors for MACEs were male sex (hazard ratio [HR], 2.40; 95% confidence interval [CI], 1.01-5.69; P = 0.046) and low estimated creatinine clearance (eCCr) (< 60 mL/min/1.73 m2) (HR, 3.07; 95% CI, 1.22-7.74; P = 0.017). Low eCCr was the only independent predictor for hard events including cardiac death and MI (HR, 17.6, 95% CI, 1.44-215.7; P = 0.025). In conclusion, renal function is an independent predictor for cardiovascular events among patients without significant CAD by CCTA. Careful monitoring and preventive strategy are warranted in patients with impaired renal function even without significant CAD.

effect of omega-3 on renal functions and structure in experimental hyperthyroidism: possible role of angiotensin-converting enzyme 1

Hyperthyroidism is associate with reduced serum creatinine and urea, renal hypertrophy and eventually chronic renal disease. The aim of the present study was to investigate the potential therapeutic value of omega-3 on renal functions and structural changes induced by hyperthyroidism and the effect of omega-3 on angiotensin-converting enzyme 1 [ACE1] as a possible mechanism. Thirty rats were randomly divided into three groups. Control group received the vehicle. Hyperthyroid group was treated with L-thyroxine 0.1 mg/kg/day for 6 weeks and hyperthyroid-omega-3 treated group received L-thyroxine 0.1 mg/kg/day alone for 2 weeks followed by concurrent treatment with L-thyroxine 0.1 mg/kg/day and 3 g/kg/day omega-3 orally for 4 weeks. Serum creatinine, blood urea nitrogen [BUN], serum total antioxidant capacity [TAC], renal ACE1 and kidney weight to body weight [KW/BW] ratio were determined. Histopathological studies using H and E, Masson trichrome were done. Administration of L-thyroxine induced a significant decrease in serum creatinine, BUN and TAC and a significant increase in renal ACE1 and KW/BW ratio. Moreover, renal cortex thickness was increased, glomerular capillaries were congested with an increase in mesangial matrix. Proximal convoluted tubules [PCTs] were degenerated with no structural changes were observed in distal convoluted tubules [DCTs], afferent and efferent arterioles. Omega-3 administration is nearly normalized serum creatinine, BUN, TAC and renal ACE1 levels and ameliorates L-thyroxine-induced renal hypertrophy, glomerular congestion and PCTs degenerative changes. In conclusion, omega-3 administration has protective effects against hyperthyroidism-induced functional and structural changes. These reno-protective effects are possibly mediated by reducing ACE1 activity and its antioxidant activity

Dexamethasone as adjunctive therapy for treatment of varicella pneumonia

The most common and most serious complication of varicella [chickenpox] in adults is pneumonia, which can lead to severe respiratory failure. Whether addition of corticosteroids to antiviral treatment benefits patients with varicella pneumonia is unclear. To assess the effect of dexamethasone as adjunctive therapy for treatment of varicella pneumonia on the length of hospital stay, which might cause earlier resolution of varicella pneumonia. Forty patients were diagnosed as varicella pneumonia and divided into two groups, the first one involved 20 patients who received dexamethasone and acyclovir, and the second one involved also 20 patients but they received placebo and acyclovir. We measured liver function test, kidney profile, complete blood count, blood glucose, C-reactive protein and the levels of interleukin-6 on the day of presentation, after 4 days of admission and on the day of discharge from the hospital. The mean length of hospital stay in the dexamethasone group was 6.5 days compared with 7.1 days in the placebo group and was significantly different between two groups. The mean time of switching to oral administration of acyclovir was 3.4 days in the dexamethasone group and 4.2 days in the placebo group. The mean time of switching to oral was significantly lower in dexamethasone group than in placebo group. Adding of dexamethasone to acyclovir in patients with varicella pneumonia can reduce the length of hospital stay

Use of dexamethasone in cerebral oedema

Dexamethasone is prescribed routinely to reduce cerebral oedema in neurosurgical patients undergoing craniotomy for tumour .Dexamethasone, however, has been shown to cause hyperglycaemia. We describe a case of hyperglycaemic crisis, cerebral oedema secondary to dexamethasone in a patient with a Right temporal meningioma. We highlight the risks of pre-operative dexamethasone and discuss the diagnosis, treatment and complications of hyperglycaemic crises and diabetic ketoacidosis

Evaluation of toxicity of boric acid in pregnant rats

Boron occurs most frequently in nature as borates and boric acid. Humans consume about a milligram of boron per day in foods such as fruit and vegetables. Boron is essential for the growth of many plants. At high doses, boron is developmentally toxic. The aim of this study was to evaluate signs of toxicity of boric acid administration in pregnant rats. Pregnant Sprague-Dawley rats were administrated oral doses 514, 257, 128, 51mg/kg of boric acid, from 7[th] to 16[th] day and from 1[st] to 20[th] day of gestation. Pregnant rats were evaluated for rate of abortion, weight gain during pregnancy and relative weights of liver, kidneys, placenta and uteri. At 20[th] day. The animals were sacrificed and histological study of liver and kidneys were done . Results showed that the rate of abortion was increased with the high doses meanwhile the weight gain of pregnant rats was decreased, moreover ,the relative weights of liver and kidneys of pregnant rats were increased and the weight of placenta and uteri were decreased in treated groups as compared to control . Histopathological studies of liver and kidneys revealed signs of toxicity in the form of congestion of blood vessels and fatty degeneration with atrophic changes in the parenchyma's cells of liver and kidneys. In conclusion, boric acid administration in pregnant rats induced toxicities in the form of enhanced rate of abortion ,decreased weight gain during pregnancy .Hepatic and renal toxicities of boric acid were confirmed by histopathological abnormalities. Boric acid toxicity in pregnant rats was dose and time dependent

C - reactive protein levels in cerebral infaarctioninpatients on hemodialysis

Serum C-reactive protein [CRP] concentration issensitive marker of underlying systemic inflammation. Patientsunder continuous hemodialysis have an activated inflammatoryresponse, evidenced by increased serum CRP levels especiallyin patients with cerebral stroke. The study was performed toevaluate serum levels of CRP as inflammatory markers inpatients with stroke under continuous hemodialysis. The study was included 33 patients with chronicrenal failure under continuous hemodialysis divided into twogroups. Group I included 23 patients with acute stroke. Group II [control group] included 10 patients without stroke. All patientswere subjected to complete history and clinical examinationwith special emphasis to history of co-morbid conditions,hypertension, diabetes mellitus and cardiovascular disease.Serum creatinine, urea, CBC, albumin, lipid profile, calcium,fasting and post prandial blood sugar, sodium, potassium, serumuric acid, phosphorus, C-reactive protein and other investigationwere evaluated. In addition axial CT or MRI was performed atadmission and after 72 hours. The following parameterswere significantly higher in groupe I when compared to group II;ages [t=3.5. p< 0.01], CRP [t=7.1, p<0.001], serum creatinine [tett, p<0.0] and blood urea [t=4.3, p<0.01], while serumlevels of Hb% and serum calcium were significantly lower ingroup I when compared to group II [t=3.1, p<0.01 and t=2.2,p<0.05 respectively]. On the hand no significant differences inthe other studied parameters between two groups. Serum levelsof CRP were positively correlated with INR [r=520, p<0.05] and negatively correlated with serum calcium [r=0.580, p<0.05] and serum albumin [r=-540, p<0.05]. On the other hand nosignificant correlations were found between CRP and otherstudied parameters. According to ROC curve between group Iand II in CRP the cutoff were greater than 12 with sensitivity,specificity, Positive Perdictive Value and Negative PredictiveValue were 100% by accuracy 100%. Elevatedserum CRP could be a predictor of cerebrovascular stroke indialysis patients. Therefore, regular determination of serumCRP may be helpful to detect early signs of tissue damage andasymptomatic inflammation in these patients

Effect of [urografin] on left ventriular diastolic and renal functions after cardiac catheterization

is to evaluate the effects of iodinated contrast media "urografin" on kidney functions and left ventricular diastolic function indices in patients underwent coronary angiography. It included 100 patients with normal kidney function 57 male [57%] and 43 female [43%]. The patients are classified into four groups:- group A: diabetic hypertensive patients, group B: only diabetic patients, group C: only hypertensive patients and group D: non diabetic, non-hypertensive patients. For all patients history taking and clinical examination, standard 12 lead ECG, abdominal ultrasonography to exclude renal medical diseases, Echo-Doppler study before, immediately and 7 days after cardiac catheterization for assessment of left ventricular diastolic functions, and kidney function tests before cardiac catheterization, immediately, 3 days and 7 days after cardiac catheterization. We found an increase in blood urea, serum creatinine and decrease in creatinine clearance [not reaching the significant level] at the first day after contrast administration [P> 0.05]; However, the maximal significant effect of these contrast agent on kidney functions was reached at the third day [P< 0.05] and return to normal at the seventh day [P< 0.05]. Also we found that the level of serum creatinine is maximally changed after three days of contrast administration, where the mean values were 1.11 +/- 0.19 before coronary angiography changed to 1.24 +/- 0.17 immediately after coronary angiography and 1.79+0.13 three days after coronary angiography and 1.27+0.12 after seven days of coronary angiography. It was noted that the level of serum creatinine is increased by 25% or > 0.5 mg/dl from the base line value and decline to nearly normal level after seven days of coronary angiography. The effects of contrast agents on kidney functions were significantly higher in groups [A] and [B] than that of groups [C] and [D] and there was a significant positive correlation between the dose of contrast media and the effect on kidney functions [P< 0.05]. Also, there was a non-significant effect of the radio contrast media on the left ventricular diastolic function indices in the four studied groups [P> 0.05] immediately after and seven days after radio contrast administration. However, there was a non-significant correlation between the dose of contrast media and diastolic function parameters immediately after and seven days after coronary angiography [P> 0.05]. So the effect of radiocontrast agents after coronary angiograpghy on kidney functions is benign and transient starting within 1-2 days reaching the peak at 3-5 days and then returning to base line within 7-10 days. This effect is significantly higher in diabetic hypertensive patients than that in non-diabetic, non-hypertensive patients with positive correlation between the dose of contrast media and kidney functions. However, the ionic contrast media exerts negligible alterations on left ventricular diastolic functions indices

Study the effect of perinatal asphyxia on kidney function of term newborn

The kidney is very sensitive to oxygen deprivation, within few hours of an ischemic episode renal insufficiency will occur. The condition is reversible but prolonged renal insufficiency will cause renal damage with irreversible cortical or modularly necrosis [Groshong et al, 1991] ischemia is one of the major causes of renal failure [Rudolph, 1989]. In the study by Alejandro et al. [1999] 57% of infants with perinatal asphyxia developed acute renal failure. To study the effect of perinatal asphyxia on kidney function of full term newborn . 30 asphyxiated FT newborn and 15 control were subjected to comprehensive history and renal function evaluation study. Routine urinalysis-of cases, with perinatal hypoxia revealed proteinuria in 41.7% in patients. Many epithelial cells were found in 53.5% of the . cases with perinatal asphyxia. Mean urine analysis for R.B.Cs of patients [6.33 RBCs/HPF +/- 4.02 RBCs/HPF]' which was significantly higher than that of controls [4.16 RBCs/HPF +/- 2.69 RBCs/HPF]. Mean urine analysis for pus cells of patients [2.84 pus cells/HPF +/- 1.59 pus cells/HPF] which was not significantly different than that of controls [3.08 pus cells/HPF 4-3.87 pus cells/HPF]. Mean urinary 82 micro globulin concentration in patients [218.30 ng/ml +/- 100.93 ng/ml] was significantly higher than that of controls [144.316 ng/ml +/- 126.3 nglml] which is specific for tubular renal insult in renal impairment. Mean urinary urea in patients was [7.727 +3.16 meq/1] which was not significant in relation to controls 96.80 +2.907 meq/ 1]. Mean urinary creatinine in patients was [1.30 +1.4 meq/1] whjch was not significantly different than controls [1.22 +1.09 meq/1]. Elevated serum creatinine and urinary 82 microglobulin concentration, were detected in cases of perinatal asphyxia so in any hypoxic newborn infant. An early assessment of serum creatinine and 82 microglobulin in urine should be performed in every newborn with asphyxia

Role of N-Acetyl Cysteine to prevent nephrotoxicityin Patients with Impaired Renal Functionundergoing angioplasty

Contrast-induced nephrotoxicity [CIN],is an important cause of acute renal failure. The incidence of CIN has risen as the number of diagnostic and interventional procedures using contrast media increased in recent years. Only intravenous and intra-arterial administration of contrast media is associated with CIN. Oral contrast agents, such as Gastro grafin, do not cause CIN. CIN is now the third leading cause of new onset acute renal failure in hospitalized patients. Sequelae of CIN may include prolonged hospital stay, need for temporary or permanent dialysis [about 5% of cases], or death. This study was to evaluate the role of N-Acetyl Cysteine [NAS] oral administration in patients with impaired renal function undergoing angioplasty. Forty- eight consecutive patients undergoing to Percutaneous coronary angioplasty [PCI]. 33 patients with impaired renal function Serum createnine level [>1.5mg/dl] .And 15 patients without impaired renal function referred to International Hospital center at Ahmad Helmy Street Cairo one day before PCI. The PCI was done at Cardiovascular-Cath .lab Centre [CCC] Eldoki . Cairo at the period between May 2008 and March 2009. All patients were subjected to the following ,Full history taking ,clinical examinations ,12 lead resting ECG, blood samples for serum Urea, Creatinine and k one day before and 24 hours after PCI ,hepatitis B and C virus ,600 mg orally twice daily for four doses starting on the day prior to the procedure. Bothgroups of patients were hydrated with 0.9% normal saline at 1 ml/ kg/hour for 12 hours prior to and 12 hours following PCI . All patients underwent the same procedure for PCI. RESULTS ;There was highly statistically significant value improvement in renal function [serum creatinine and urea] in both groups before and after PCI .Also highly statistically significant improvement in serum K level in Group I with [P value 0.000] but no significant in Group II with [P value 0.082]. One out of 33patients Group I developed Acute renal failure and need renal dialysis [contrast induced nephropathy].- CONCLUSION; We conclude that prophylactic administration. Of N-Acetyl Cysteine along with hydration diminishes the incidence of deterioration of renal function induced by contrast agents in patients with renal insufficiency during coronary angioplasty procedures

Early Vascular Access Blood Flow as a Predictor of Long-term Vascular Access Patency in Incident Hemodialysis Patients

The long-term clinical benefits of vascular access blood flow (VABF) measurements in hemodialysis (HD) patients have been controversial. We evaluated whether early VABF may predict long-term vascular access (VA) patency in incident HD patients. We enrolled 57 patients, of whom 27 were starting HD with arteriovenous fistulas (AVFs) and 30 with arteriovenous grafts (AVGs). The patients' VABF was measured monthly with the ultrasound dilution technique over the course of the first six months after the VA operation. During the 20.4-month observational period, a total of 40 VA events in 23 patients were documented. The new VA events included 13 cases of stenosis and 10 thrombotic events. The lowest quartile of average early VABF was related to the new VA events. After adjusting for covariates such as gender, age, hypertension, diabetes, VA type, hemoglobin levels, body mass index, parathyroid hormone, and calcium-phosphorus product levels, the hazard ratio of VABF (defined as <853 mL/min in AVF or <830 mL/min in AVG) to incident VA was 3.077 (95% confidence interval, 1.127-8.395; P=0.028). There were no significant relationships between early VABF parameters and VA thrombosis. It is concluded that early VABF may predict long-term VA patency, particularly VA stenosis.

Effect of respiratory distress syndrome and changes in arterial blood gases on kidney function in preterm and fullterm neonates

The study included 45 infants comprised the material of the work, 15 cases of preterm infants with RDS, 15 full term neonates without RDS as a control group. The cases and control group were subjected to a complete history taking, a full clinical examination and laboratory investigations, including venous blood analysis for plasma sodium, potassium, chlorides, urea and creatinine as well as arterial blood for pH, PaO2, PaCO2, bicarbonate, O2 saturation and base deficit or excess. In comparison with control group the results of this study were 20% of preterm cases had suffered from marked acidosis, and 66.6% had moderate acidosis, while 13.3% had mild acidosis. There is a statistical significance as regard pH and base deficit white highly significances as regard PaCO2, PaO2 and O2 saturation but border line significance as regard bicarbonate group of full term with RDS. Only 13.3% had severe acidosis and 60% had moderate acidosis while 26.7% had mild acidosis, there is highly significance as regard pH, PaCO2 PaO2 and O2 saturation, while the bicarbonate and base deficit showed only significant difference. Hyponatremia was evident in all cases with RDS. On other hand, hyperkalemia was seen in both preterm and full term cases with mean values reached up to 7.20 m mol/L and 7.13 m mol/L respectively. Blood urea was markedly elevated in both preterm and full term infants, the mean values were 67.66 mg/dl and 67 mg/dl respectively. Serum creatinine was also elevated, mean values were 2.33 mg/dl and 2.22 mg/dl for preterm and full term respectively