Estimated glomerular filtration rate in clinical practice: Consensus positioning of the Brazilian Society of Nephrology (SBN) and Brazilian Society of Clinical Pathology and Laboratory Medicine (SBPC/ML) / Estimativa da taxa de filtração glomerular na prática clínica: posicionamento consensual da Sociedade Brasileira de Nefrologia (SBN) e Sociedade Brasileira de Patologia Clínica e Medicina Laboratorial (SBPC/ML)

ABSTRACT Chronic kidney disease (CKD) represents one of today's main public health problems. Serum creatinine measurement and estimation of the glomerular filtration rate (GFR) are the main tools for evaluating renal function. There are several equations to estimate GFR, and CKD-EPI equation (Chronic Kidney Disease - Epidemiology) is the most recommended one. There are still some controversies regarding serum creatinine measurement and GFR estimation, since several factors can interfere in this process. An important recent change was the removal of the correction for race from the equations for estimating GFR, which overestimated kidney function, and consequently delayed the implementation of treatments such as dialysis and kidney transplantation. In this consensus document from the Brazilian Societies of Nephrology and Clinical Pathology and Laboratory Medicine, the main concepts related to the assessment of renal function are reviewed, as well as possible existing controversies and recommendations for estimating GFR in clinical practice.

RESUMO A doença renal crônica (DRC) representa um dos principais problemas de saúde pública da atualidade. A dosagem da creatinina sérica e a estimativa da taxa de filtração glomerular (TFG) são as principais ferramentas para avaliação da função renal. Para a estimativa da TFG, existem diversas equações, sendo a mais recomendada a CKD-EPI (Chronic Kidney Disease - Epidemiology). Existem ainda algumas controvérsias com relação à dosagem da creatinina sérica e da estimativa da TFG, uma vez que vários fatores podem interferir nesse processo. Uma importante mudança recente foi a retirada da correção por raça das equações para estimativa da TFG, que superestimavam a função renal, e consequentemente retardavam a implementação de tratamentos como diálise e transplante renal. Neste documento de consenso da Sociedade Brasileira de Nefrologia e Sociedade Brasileira de Patologia Clínica e Medicina Laboratorial são revisados os principais conceitos relacionados à avaliação da função renal, possíveis controvérsias existentes e recomendações para a estimativa da TFG na prática clínica.

Evaluation of antispermatogenic and antifertility properties of Terminalia chebula (Retz.) in albino mice

Background: The development of an orally active, safe, reversible, and effective male contraceptive of plant origin has always been a matter of great interest among researchers due to its ready availability, cost-effectiveness, and most importantly protection of privacy. The present study was conducted to evaluate the effect of oral feeding of Terminalia chebula Retz. (T. chebula; family: Combretaceae) on male reproductive organs and fertility.Methods: The albino mice were administered orally acetone, methanol, 50% ethanol, and aqueous bark extracts of T. chebula (300 mg/kg body weight daily) for 35 days, and the effect of the treatments on testis, epididymis, seminal vesicle, sperm parameters, biochemical, and fertility indices was investigated. Toxicological studies were also carried out.Results: Treatment with Terminalia extracts brought non-uniform but detectable histologic alterations in the testis, epididymis, and seminal vesicle; the alterations caused in the reproductive organs were, however, severe in mice treated with the aqueous extract of Terminalia compared to those in other treated groups and controls. Further, the level of fructose in the seminal vesicle and that of sialic acid in the epididymis reduced significantly in the above treated mice. Sperm parameters were adversely affected in extracts-treated mice. Libido was not affected, but fertility reduced significantly in aqueous extract-treated males as compared to controls. Further, histoarchitecture of the liver and kidney, serum levels of ALT, AST, creatinine, and haematological parameters remained unaltered in Terminalia-treated mice compared to controls.Conclusions: The results of the present study, therefore, suggested that the aqueous bark extract of T. chebula causes suppression of spermatogenesis and fertility in albino mice, and therefore, might be valuable in male fertility regulation.

Understanding of the role of serum creatinine in a subset of the Brazilian population / Conhecimento de uma amostragem da população brasileira sobre a função da creatinina sérica

Abstract Introduction: Chronic kidney disease is usually asymptomatic, and its diagnosis depends on laboratory tests, with emphasis on serum creatinine and proteinuria. Objective: To assess knowledge on the role of serum creatinine as a biomarker of kidney function in a sample of the Brazilian population. Method: Cross-sectional observational study conducted in São Paulo (SP, Brazil), in which a random adult population was interviewed. Results: A total of 1138 subjects were interviewed, with a median age of 36 years old (27-52); 55.1% were female. Regarding the "creatinine" biomarker, 40.6% stated they had never performed such a test. When asked about their knowledge on the usefulness of this exam, only 19.6% knew its function. The other responses were "I don't know" (71.6%), evaluating heart function (0.9%) and liver function (7.8%). Of those who reported they had already taken a creatinine test, only 29.4% correctly identified the role of creatinine. When dividing the groups into "knows" and "does not know" the function of creatinine, a statistically significant difference (p < 0.05) was observed regarding level of education, female sex, being a healthcare student/worker, having ever measured creatinine, knowing someone with kidney disease and older age. In the multivariate analysis, the main variable related to knowing the creatinine role was having previously taken the test (OR 5.16; 95% CI 3.16-8.43, p < 0.001). Conclusion: There is a significant lack of knowledge about creatinine and its use in checkups. The results indicate that greater efforts are needed from healthcare professionals to raise awareness on the role of serum creatinine.

Resumo Introdução: A doença renal crônica costuma ser assintomática e seu diagnóstico depende da realização de exames laboratoriais, com destaque para a creatinina sérica e pesquisa de proteinúria. Objetivo: Avaliar em uma amostra da população brasileira o conhecimento sobre o papel da creatinina sérica como marcador de função renal. Método: Estudo observacional transversal realizado na cidade de São Paulo (SP, Brasil), em que foi entrevistada uma população adulta aleatória. Resultados: Foram entrevistados 1138 indivíduos, com idade mediana de 36 anos (27-52); 55,1% do sexo feminino. Com relação ao marcador "creatinina", 40,6% afirmaram que nunca realizaram tal dosagem. Quando questionados quanto ao conhecimento sobre a utilidade desse exame, somente 19,6% sabiam a sua função. As outras respostas foram "não sei" (71,6%), avaliar o funcionamento do coração (0,9%) e fígado (7,8%). Dos que afirmaram já terem realizado o exame de creatinina, somente 29,4% acertaram a função da creatinina. Ao dividir os grupos em "sabe" e "não sabe" a função da creatinina, percebeu-se diferença estatisticamente significante (p < 0,05) em relação ao grau de escolaridade, sexo feminino, ser aluno/trabalhador da saúde, ter dosado creatinina alguma vez, conhecer alguém com doença renal e maior idade. Na análise multivariada, a principal variável relacionada com conhecer a função da creatinina foi ter realizado o exame anteriormente (OR 5,16; IC 95% 3,16-8,43, p < 0,001). Conclusão: Há grande desconhecimento sobre a creatinina e seu uso em check-ups. Os resultados indicam que é necessário maior esforço por parte dos profissionais de saúde para divulgar o papel da creatinina sérica.

Improving efficiency in preeclampsia diagnosis: spot urinary protein/creatinine ratio

Background: Preeclampsia poses significant challenges to maternal healthcare due to its potential complications. Timely and accurate diagnosis is crucial for maternal and fetal well-being. Traditional methods like the 24-hour urine collection for assessing proteinuria have limitations. The spot urinary protein/creatinine ratio offers a quicker alternative, but its clinical significance remains underexplored.Methods: This cross-sectional study, conducted from July 1, 2018, to June 30, 2019, aimed to compare the spot urinary protein/creatinine ratio with the conventional 24-hour urine protein collection method in pregnant women with preeclampsia. A total of 90 inpatients were included, meeting specific inclusion and exclusion criteria.Results: In our study, 6.66% of subjects exhibited abnormal fundus examination findings, lower than a similar study (13%). No subjects had papilloedema, and conservatively managed abnormalities were comparable between studies. The mean urine protein creatinine ratio in our study was 1.75±2.32.Conclusions: This study highlights the potential of the spot urinary protein/creatinine ratio as an efficient diagnostic tool for preeclampsia at Kamla Nehru State Hospital for Mother and Child. Swift identification of significant proteinuria can streamline patient care, benefiting maternal and fetal outcomes in resource-constrained healthcare settings.

Proteinuria assessment in preeclampsia: a comparative study

Background: Preeclampsia, a severe pregnancy-related hypertensive disorder, presents substantial maternal and fetal health risks. Accurate proteinuria assessment is crucial but traditional methods are cumbersome and error-prone. This study compares the spot urinary protein/creatinine ratio with 24-hour urine collection for proteinuria estimation in preeclampsia at Kamla Nehru State Hospital for Mother and Child.Methods: A cross-sectional study with 90 eligible pregnant women collected comprehensive medical data. Both spot urinary protein/creatinine ratios and 24-hour urine collections were analyzed. Strong correlation (r=0.942, p<0.0001) was observed.Results: Spot urinary protein/creatinine ratio demonstrated moderate diagnostic accuracy (AUC=0.3). Sensitivity was 100%, specificity 87.9%, with PPV and NPV at 90.4% and 92%, confirming its clinical utility for proteinuria diagnosis.Conclusions: This study validates the spot urinary protein/creatinine ratio as an efficient method for proteinuria assessment in preeclampsia, with a strong correlation and high diagnostic value. Widespread adoption has the potential to expedite diagnosis, enhance outpatient care, and improve outcomes for preeclampsia patients, addressing a crucial healthcare challenge in maternal and fetal health.

Experiencia de un programa de estandarización de creatinina en una región de ingresos bajos de Latinoamérica / Experience of a creatinine standardisation programme in a low-income region of Latin America / Experiência de um programa de padronização de creatinina em uma região de baixa renda da América Latina

Resumen Los programas de estandarización de creatinina mantienen su vigencia. El objetivo es describir la experiencia adquirida durante el desarrollo de un programa de estandarización de creatinina en una provincia de bajos recursos y mostrar los aspectos que se deben considerar para su escalabilidad en un contexto semejante. El programa se desarrolló en etapas: en la primera (2010) se realizó el relevamiento de 49 laboratorios clínicos (LC) distribuidos en toda la provincia del Chaco, Argentina. En la segunda (2012) se ajustó el error aleatorio (EA) aplicando protocolos internacionales (CLSI EP-5A). En la tercera etapa (2014-2015) se procesaron paneles de sueros con concentraciones asignadas por un método trazable al de referencia y al estándar internacional (CG-IDMS). Se aplicaron protocolos internacionales para evaluar el error total (ET) de la determinación en cada laboratorio (CLSI EP-10A). En 2016, aplicando herramientas de calidad, se evaluaron las barreras en el proceso. Se observó en el EA: para un nivel de 1,00 mg/dL, ningún LC alcanzó los niveles deseables; para un nivel de 2,5 mg/dL solo 9 (23%) los alcanzaron. Concluida la segunda y tercera etapa, solo 18 laboratorios (48,7%) lograron ajustar el EA y/o ET, pero resultó dificultoso sostenerlo en el tiempo. Los reactivos, calibradores y controles son producidos por la industria y depende del estado el control de los mismos. La homogeneidad del equipamiento depende de la accesibilidad económica y del volumen de trabajo. El medio ambiente, la temperatura y la calidad del agua siguen siendo una dificultad para la escalabilidad.

Abstract Creatinine standardisation programmes remain valid. The objective of this work is to describe the experience acquired during the development of a creatinine standardisation programme in a low-resource province and show the aspects that should be considered for its scalability in a similar context. The programme was developed in stages. The first one was carried out in 2010. It consists of a structured survey completed by 49 clinical laboratories (CL) distributed throughout the province. In the second stage (2012) the random error (RE) was adjusted by applying international protocols (CLSI EP-5A). In the third stage (2014-2015), panels of sera were processed with concentrations assigned by a method traceable to the reference and the international standard (CG-IDMS). International protocols were applied to evaluate the total error (TE) of the determination in each laboratory (CLSI EP-10A). In 2016, applying quality tools, the barriers in the process were evaluated. In the RE, it was observed: for a level of 1.00 mg/dL, no CL reached the desirable levels; for a level of 2.5 mg/dL only 9 (23%) CL achieved them. Once the second and third stages were completed, only 18 laboratories (48.7%) managed to adjust the RE and/or TE, but it was difficult to sustain it over time. With respect to materials, reagents, calibrators, and controls, they are produced by the industry depending on the state of their control. The homogeneity of the equipment depends on economic accessibility and volume of work. The environment, temperature, and water quality are a barrier to scalability.

Resumo Os programas de padronização da creatinina permanecem válidos. O objetivo é descrever a experiência adquirida durante o desenvolvimento de um programa de padronização de creatinina em uma província com poucos recursos e mostrar os aspectos que devem ser levados em consideração para sua escalabilidade em um contexto semelhante. O programa foi desenvolvido em etapas: Na primeira (2010), foi realizado um levantamento de 49 laboratórios clínicos (LC) distribuídos em toda a provincia do Chaco, na Argentina. Na segunda etapa (2012) o erro aleatório (EA) foi ajustado através da aplicação de protocolos internacionais (CLSI EP-5A). Na terceira etapa (2014-2015), foram processados paineis de soros com concentrações atribuídas por método rastreável à referência e ao padrão internacional (CG-IDMS). Protocolos internacionais foram aplicados para avaliar o erro total (ET) da determinação em cada laboratório (CLSI EP-10A). Em 2016, aplicando ferramentas de qualidade, foram avaliadas as barreiras no processo. Observou-se na EA: para o nível de 1,00 mg/dL nenhuma LC atingiu os níveis desejáveis; para um nível de 2,5 mg/dL, apenas 9 (23%) os atingiram. Concluídas a segunda e terceira etapas, apenas 18 laboratórios (48,7%) conseguiram ajustar o EA e/ou o ET, mas foi difícil sustentá-lo ao longo do tempo. No que diz respeito aos reagentes, calibradores e controles, eles são produzidos pela indústria. dependendo do estado o seu controle. A homogeneidade do equipamento depende da acessibilidade econômica e do volume de trabalho. O meio ambiente, a temperatura e a qualidade da água continuam sendo uma dificuldade para a escalabilidade.

Renal deficit and associated factors in children born with low birth weight / Déficit renal e fatores associados em crianças nascidas com baixo peso

ABSTRACT Introduction: Kidney problems may be due to low birth weight alone or may occur in association with other conditions. The objective this study was to evaluate the association between maternal and birth characteristics, anthropometric measurements, and kidney function deficit in low birth weight infants. Methods: Cross-sectional study with children who were born weighing < 2500 grams and were under outpatient follow-up. Maternal factors investigated were prenatal care and presence of hypertension, diabetes, and infection during pregnancy. The children's variables were sex, gestational age, birth weight, Apgar score, use of nephrotoxic medications, age, body weight at the time of evaluation, height, and serum creatinine and cystatin C dosages. The glomerular filtration rate (GFR) was estimated with the combined Zapittelli equation. Multivariate logistic regression model was used for identification of associated factors, with renal function deficit (GFR < 60 mL/min/1.73 m2) as the dependent variable. Results: Of the 154 children evaluated, 34.42% had kidney function deficit. Most of them had a gestational age > 32 weeks (56.6%), a mean birth weight of 1439.7 grams, and mean estimated GFR of 46.9 ± 9.3 mL/min/1.73 m2. There was a significant association of GFR < 60 mL/min/1.73 m2 with children's current weight and use of nephrotoxic drugs. Discussion: Children born with low birth weight had a high prevalence of kidney function deficit and current normal weight was a protective factor while the use of nephrotoxic drugs during perinatal period increased the chance of kidney deficit. These findings reinforce the need to evaluate the kidney function in these children, especially those who use nephrotoxic drugs.

RESUMO Introdução: Problemas renais podem ser devido apenas ao baixo peso ao nascer ou podem ocorrer em associação com outras condições. O objetivo deste estudo foi avaliar a associação entre características maternas e de nascimento, medidas antropométricas e déficit da função renal em bebês de baixo peso ao nascer. Métodos: Estudo transversal com crianças que nasceram com peso < 2500 gramas e estavam sob acompanhamento ambulatorial. Os fatores maternos investigados foram cuidados pré-natal e presença de hipertensão, diabetes e infecção durante a gravidez. As variáveis das crianças foram sexo, idade gestacional, peso ao nascer, índice Apgar, uso de medicamentos nefrotóxicos, idade, peso corporal no momento da avaliação, altura e dosagens séricas de creatinina e cistatina C. A taxa de filtração glomerular (TFG) foi estimada com a equação combinada de Zapittelli. Utilizou-se um modelo de regressão logística multivariada para identificação de fatores associados, com déficit da função renal (TFG < 60 mL/min/1,73 m2) como variável dependente. Resultados: Das 154 crianças avaliadas, 34,42% apresentaram déficit da função renal. A maioria tinha idade gestacional > 32 semanas (56,6%), peso médio ao nascer de 1439,7 gramas, e TFG média estimada de 46,9 ± 9,3 mL/min/1,73 m2. Houve uma associação significativa da TFG < 60 mL/min/1,73 m2 com o peso atual das crianças e o uso de medicamentos nefrotóxicos. Discussão: Crianças nascidas com baixo peso apresentaram alta prevalência de déficit da função renal e o peso atual normal foi um fator de proteção, enquanto o uso de medicamentos nefrotóxicos durante o período perinatal aumentou a chance de déficit renal. Estes achados reforçam a necessidade de avaliar a função renal destas crianças, especialmente aquelas que usam medicamentos nefrotóxicos.

Clinical profile and outcome of acute kidney injury in preterm neonates in a level three neonatal intensive care unit

Background: Acute kidney injury is an important cause of neonatal mortality and morbidity. Preterm neonates, in particular are a vulnerable population as they are associated with various risk factors, predisposing them to multi-organ injury. Data on AKI in preterm neonates in India are limited. There are several gaps including the risk factors, demographic profile and associations with other comorbidities which remain unanswered. The objectives of this study were to study the clinical profile, outcomes and various associated risk factors of AKI in preterm neonates.Methods: It is a prospective observational study conducted in neonatal intensive care unit of a government medical college hospital in Rajkot, Gujarat, India. 300 preterm neonates with AKI were selected and demographic details, risk factors associated with AKI and outcomes were studied.Results: It was found that among 300 newborns under study, 82% were males, 92% had sepsis, 65% had respiratory distress syndrome, 32% had birth asphyxia, 29% had shock, 30% had exposure to nephrotoxic drugs, 54% had requirement for mechanical ventilation, 94% patients were discharged and 6% patients expired.Conclusions: The most common risk factor associated with AKI was sepsis. The other important risk factors are birth asphyxia, respiratory distress syndrome, and shock. Monitoring of serum creatinine can help in early detection of acute kidney injury.

Kidney function among male workers of a lithium-ion battery-related enterprise in Shanghai / 环境与职业医学

Background Under the guidance of achieving carbon peaking and carbon neutrality goals, the demand for lithium-ion batteries has increased significantly. However, during the production, use, and maintenance of lithium-ion batteries, workers are inevitably exposed to various occupational hazards, and some chemicals are nephrotoxic. Objective To evaluate the kidney function and potential determinants among male workers in a lithium-ion battery-related enterprise in Shanghai. Methods The data of occupational health examination carried out by an occupational disease prevention and control institution for workers in a lithium-ion battery-related enterprise in Shanghai were collected. The workers participating pre-employment occupational health examination were treated as a control group, and the other group was recruited from those participating periodic health examination. Serum creatinine, urea nitrogen, uric acid, and renal ultrasound were used to assess the kidney function of workers. Kidney function was classified according to the reference range of kidney function indicators in Diagnostics (9th Edition, national planning textbook for high education in medicine). Binary logistic regression and generalized linear regression were used to identify potential determinants of abnormal values in kidney function indicators in workers. Results There were 6184 workers in the control group (pre-employment) with a mean age of (27.40±4.50) years. There were 3526 workers on the job with a mean age of (29.40±4.99) years and the median time of service was 2.00 (1.00, 3.42) years. The prevalence rates of high serum creatinine, high urea nitrogen, and high uric acid, and abnormal kidney ultrasound among the control group were 0.66%, 2.47%, 30.32%, and 10.12%, respectively; the indicators in the on-the-job workers were 0.96%, 3.35%, 38.25%, and 12.68%, respectively, significantly higher than those in the control group (P<0.05). After adjusting for worker age, length of service, smoking status, drinking status, hypertension, and hyperglycemia, the binary logistic regression models showed that regular smokers had a higher risk of high urea nitrogen than nonsmokers (OR=1.411, 95%CI: 1.011, 1.969). The risk of high uric acid was lower in older workers (OR=0.966, 95%CI: 0.953, 0.979), and higher in workers with more years of service (≤1 year, OR=1.295, 95%CI: 1.093, 1.534; >1-3 years, OR=1.747, 95%CI: 1.494, 2.042; >3 years, OR=1.866, 95%CI: 1.511, 2.304), hypertension (OR=1.400, 95%CI: 1.055, 1.859), and hyperglycemia (OR=1.565, 95%CI: 1.221, 2.006). Workers who were older (OR=1.038, 95%CI: 1.022, 1.054) and had longer working years (>1-3 years, OR=1.518, 95%CI: 1.201, 1.920), occasional smoking habits (OR=1.239, 95%CI: 1.039, 1.478), regular drinking habits (OR=1.875, 95%CI: 1.139, 3.087), and hypertension (OR=1.465, 95%CI: 1.075, 1.998) were at a higher risk of renal ultrasound abnormalities. The generalized linear models showed that length of service (>1-3 years, β=1.120, 95%CI: 0.360, 1.880; >3 years, β=1.451, 95%CI: 0.543, 2.358), smoking status (occasional, β=0.818, 95%CI: 0.156, 1.479; regular, β=0.841, 95%CI: 0.066, 1.616), and hypertension (β=2.742, 95%CI: 1.390, 4.094) were the influencing factors of serum creatinine concentration in the workers. Age (β=0.014, 95%CI: 0.009, 0.019) and length of service (>1-3 years, β=0.079, 95%CI: 0.012, 0.146) were the influencing factors of urea nitrogen. Age (β=−1.759, 95%CI: −2.288, −1.231), length of service (≤1 year, β=10.676, 95%CI: 4.035, 17.316; >1-3 years, β=26.117, 95%CI: 19.962, 32.272; >3 years, β=34.558, 95%CI: 26.116, 43.001), hypertension (β=23.162, 95%CI: 11.617, 34.707), and hyperglycemia (β=15.017, 95%CI: 4.853, 25.180) were the influencing factors of uric acid. Conclusion The prevalence of abnormal kidney function of workers in selected lithium-ion battery-related enterprise is varied by age, length of service, smoking status, drinking status, hypertension, and hyperglycemia. There may be a trend that the longer the time working in a lithium-ion battery-related enterprise, the worse the workers' kidney function. Therefore, the enterprise should pay attention to the possible reasons for their changes and take targeted interventions.

Preliminary experience of robotic-assisted kidney transplantation in a single center / 器官移植

<b>Objective</b> To evaluate the safety, effectiveness and feasibility of robotic-assisted kidney transplantation (RAKT). <b>Methods</b> Clinical data of 16 patients who underwent kidney transplantation were collected. Among them, 8 recipients received RAKT (RAKT group) and 8 cases underwent open kidney transplantation (OKT) with the contralateral kidney from the same donor (OKT group). Perioperative status and the recovery of renal allograft function were compared between two groups. <b>Results</b> All patients successfully completed the surgery. In the RAKT group, no patient was converted to open surgery. The operation time in the RAKT group was longer than that in the OKT group (<i>P</i>=0.015). No significant differences were observed in the serum creatinine levels before surgery and upon discharge between two groups (both <i>P</i>>0.05). In the OKT group, one recipient developed delayed graft function (DGF), and the remaining recipients did not experience perioperative complications. No significant difference was noted in the short-term recovery of renal allograft function between two groups (<i>P</i>>0.05). <b>Conclusions</b> Postoperative recovery of the recipients in the RAKT group is equivalent to that of their counterparts in the OKT group. RAKT is a safe and effective procedure for the team expertise in kidney transplantation.

Analysis of prognostic factors in patients with acute diquat poisoning / 中华急诊医学杂志

Objective:To investigate the factors influencing the short-term prognosis of patients with acute diquat poisoning (ADQP).Methods:Patients with ADQP admitted to the Affiliated Hospital of Xuzhou Medical University and Xuzhou Occupational Disease Prevention Hospital from August 2015 to July 2022 were retrospectively selected. Patients were divided into survival group and death group according to 30-day survival status after poisoning. The general data and the results of the first laboratory examination after admission were compared between the two groups. Logistic regression analysis was used to analyze the independent risk factors associated with prognosis. And the receiver operating characteristic (ROC) curve was drawn to evaluate the prognostic value of risk factors in patients with ADQP.Results:A total of 79 ADQP patients were included in this study, including 40 patients in the survival group and 39 patients in the death group. There were statistically significant differences in the age, poisoning dose, white blood cell, alanine aminotransferase, aspartate aminotransferase, serum creatinine, blood urea, neutrophil to lymphocyte ratio, monocyte to lymphocyte ratio, and systemic immune inflammation index (SII) between survival and death groups (all P<0.05). Multivariate logistic regression analysis showed that the poisoning dose ( OR=1.018, 95% CI: 1.001-1.035, P=0.033), serum creatinine ( OR=1.049, 95% CI: 1.005-1.095, P=0.028), and SII ( OR=1.001, 95% CI: 1.000-1.002, P=0.029) were independent risk factors for the prognosis of patients with diquat poisoning. The areas under the curves of the combined detection of poisoning dose, serum creatinine and SII was 0.968, the sensitivity was 0.949, and the specificity was 0.900, which were higher than those of the single index. Conclusions:The poisoning dose, serum creatinine and SII are independent prognostic predictors of patients with ADQP. The combination of three independent factors has higher sensitivity and specificity in evaluating the prognosis of ADQP, which could be used as a reliable indicator to predict the prognosis of patients with ADQP.

Screening of early risk factors and prediction of prognosis in patients with diquat poisoning / 中华急诊医学杂志

Objective:To analyze the change characteristics of creatinine level in the early stage of patients with diquat (DQ) poisoning, and to explore the early risk factors and the value of prognosis.Methods:A retrospective analysis was carried out on patients with DQ admitted to the the first affiliated hospital of Zhengzhou University from January 2020 to June 2022. The DQ patients were divided into death group and the survival group according to the 28 days survival status after posioning. The basic data and serum indexes and blood gas analysis of the patients on day 1 (D1), day 3 (D3) and day 5 (D5) were collected. The difference of clinical features between the two groups was analyzed, the variables were screened by multiple logistic regression analysis, and the predictive value of the variables was evaluated by drawing receiver operating characteristic curve (ROC curve).Results:A total of 88 patients were included, including 40 patients in the survival group and 48 patients in the death group. The toxic dose in death group was significantly higher than that in survival group [100(40.00, 120.00) mL vs. 50.00(20.00, 90.00) mL, P=0.003]. The higher the toxic dose, the higher the fatality rate. All 4 patients with oral doses greater than 200 mL died. Compared with the survival group, the levels of alanine aminotransferase (ALT) (D3, D5), creatinine (CR) (D3, D5), blood amylase (AMY) (D5) and oxygen partial pressure (PaO 2) (D5) in the death group were significantly higher than those in the survival group (all P<0.05). Multiple Logistic regression analysis showed that CR (D3) and AMY(D5) were independent risk factors for death after poisoning, and PaO 2(D5) was independent protective factor. ROC curve showed that the areas under ROC curve of CR (D3), AMY (D5) and PaO 2 (D5) were 0.814, 0.741 and 0.702, respectively. Conclusion:The higher the oral dose, the higher the death rate. After admission, CR(D3), AMY (D5) and PaO 2 (D5) were independent factors influencing the prognosis of DQ poisoning. In particular, CR (D3) is more effective in predicting death after poisoning.

Influence of Medication Compliance of Type 2 Diabetes Chronic Disease Management Patients in Two Communities of Kunming on Disease Control / 昆明医科大学学报

Objective To analyze the influence of medication compliance of chronic type 2 diabetes management patients on disease control in two communities in Kunming.Methods A total of 138 patients with type 2 diabetes who were included in chronic disease management in Guandu and Xiaobanqiao communities of Kunming were selected from December 2021 to September 2022.Basic information collection and HbAlc and other related tests were improved.A questionnaire survey of 8-item Morisliy medication adherence scale(MMAS-8)was conducted to analyze the levels of HbAlc and other indexes of three groups with high(group A),medium(group B),and low(group C)adherence,and to conduct statistical analysis.Results Group A accounted for 22.5%,group B for 44.9%,and group C for 32.6%.There were significance differences in urinary albumin creatinine ratio(UACR),HbA1c and blood creatinine among the three groups(P<0.05).The levels of UACR,HbAlc and serum creatinine in group A were lower than those in group B and group C,and there was a negative correlation between UACR,HbAlc and serum creatinine and medication compliance rate(P<0.05).Conclusion In the Guandu Community and Xiaobanqiao community of Kunming,only 22.5%of patients with chronic type 2 diabetes had high medication compliance.The higher the compliance,the lower the level of UACR,HbAlc and serum creatinine,there is a correlation between the two,suggesting that medication compliance should be regarded as one of the key points in the management of chronic diabetes mellitus in the community,and the intervention of patients'medication compliance should be strengthened.

Risk factors of abnormal urinary albumin/creatinine ratio in people with obesity / 中华内分泌代谢杂志

Objective:To explore the clinical characteristics and risk factors of abnormal urinary albumin/creatinine ratio(UACR) in obese population.Methods:Baseline data from 2011 to 2012 in Henan Sub-center of"Risk Evaluation of cAncers in Chinese diabeTic Individuals: A lONgitudinal(REACTION) study"were utilized and those of body mass index≥28 kg/m 2 were screened. The patients were divided into UACR normal group and UACR abnormal group(101 pairs) upon being matched on a 1∶1 basis by age and gender. Multivariate logistic regression analysis, receiver operating characteristic(ROC) curve, and restricted cubic spline(RCS)analysis were performed to explore the risk factors for abnormal UACR. Results:Compared with the normal UACR group, the UACR abnormal group had a higher number of alcohol consumers, a higher prevalence of hypertension, elevated systolic blood pressure, and triglyceride(all P<0.05). Multivariate logistic regression analysis showed that alcohol consumption( P=0.008), systolic blood pressure( P<0.001), triglyceride( P=0.049), and homeostasis model assessment for insulin resistance(HOMA-IR, P=0.033) were independent risk factors for abnormal UACR in obese people. The ROC curve analysis indicated that systolic blood pressure had the strongest diagnostic performance as a single factor(ROC curve area=0.801), and there was no significant difference in diagnostic performance compared to multiple factors combination. RCS analysis results showed that the probability of abnormal UACR increased monotonically with the increase of systolic blood pressure when the systolic blood pressure was between 130 and 158 mmHg(1 mmHg=0.133 kPa). When systolic blood pressure was not in the interval, the probability of abnormal UACR did not change significantly. The results of regression analysis of triglyceride subgroup showed that when triglyceride level was greater than or equal to 5.6 mmol/L, the risk of abnormal UACR level was significantly increased( P=0.029). Conclusion:Systolic blood pressure, triglyceride, HOMA-IR, and alcohol drinking history are independent risk factors for abnormal UACR in obese people. When systolic blood pressure is≥130 mmHg or triglyceride is≥5.6 mmol/L, the risk of abnormal UACR is significantly increased.

Effects of sacubitril/valsartan on renal function in patients with primary hypertension / 中国药房

OBJECTIVE To investigate the effects of sacubitril/valsartan on renal function in patients with primary hypertension. METHODS A retrospective study was conducted among patients with primary hypertension who were admitted to PLA Strategic Support Force Characteristic Medical Center from January 2018 to June 2023. Based on their medication， they were divided into two groups： sacubitril/valsartan group and valsartan group. Propensity score matching was used to match baseline data between the two groups. Patients were treated with antihypertensive drugs based on improving their lifestyle. Sacubitril/valsartan group additionally received oral administration of 200 mg Sacubitril/valsartan tablets once daily， while valsartan group additionally received oral administration of 80 mg Valsartan capsules once daily. The increase amplitude of serum creatinine from baseline， the proportion of patients with elevated serum creatinine ＞30%-50% or ＞50%， and the proportion of patients with hyperkalemia （serum potassium ≥5.5 mmol/L） were compared between two groups at 2 months and 6 months after treatment. The trends of changes in serum creatinine， serum potassium and estimated glomerular filtration rate （eGFR） were compared between the two groups before treatment （at baseline）， 2 months and 6 months after treatment. RESULTS After propensity score matching， there were 62 patients in sacubitril/valsartan group and 61 patients in valsartan group； there were no significant differences in baseline characteristics between the two groups before treatment （P＞0.05）， indicating comparability. After 6 months of treatment， the increase of serum creatinine in the sacubitril/valsartan group was significantly lower than that in the valsartan group （P＝0.003）； the proportion of patients with elevated serum creatinine ＞30%-50% in the sacubitril/valsartan group was significantly lower than that in the valsartan group （P＝0.045）. None of the patients experienced hyperkalemia events after 2 months and 6 months of treatment. Repeated measures analysis of variance showed significantly statistical differences in serum creatinine and eGFR between the two groups within 6 months of treatment （P＜0.001）. Patients taking valsartan experienced a continuous increase in serum creatinine levels and a decrease in eGFR， while patients taking sacubitril/valsartan showed a first increase and then a decrease in serum creatinine levels， and a first decrease and then an increase in eGFR with a prolonged duration of medication. CONCLUSIONS Sacubitril/valsartan can delay or even reverse the decline in renal function levels， and limit the deterioration of renal function in patients with primary hypertension， without increasing the risk of hyperkalemia.

Value of serum creatinine-to-cystatin C ratio in assessing the prognosis of hepatitis B virus-related acute-on-chronic liver failure / 临床肝胆病杂志

ObjectiveTo investigate the clinical value of serum creatinine-to-cystatin C ratio （CCR） in evaluating the prognosis of hepatitis B virus-related acute-on-chronic liver failure （HBV-ACLF）. MethodsA retrospective analysis was performed for the clinical data of 130 patients with HBV-ACLF （treatment group） who were hospitalized in Department of Infectious Diseases， The First Affiliated Hospital of Soochow University， from January 2021 to November 2022. According to the treatment outcome， they were divided into survival group with 87 patients and death group with 43 patients； according to the presence or absence of infection， they were divided into infection group with 37 patients and non-infection group with 93 patients. A total of 30 individuals who underwent physical examination during the same period of time were enrolled as control group. Routine blood test results were collected on the day of admission， including white blood cell count， platelet count， neutrophil count， and lymphocyte count； serum creatinine， cystatin C， serum albumin （Alb）， and prothrombin time （PT） were observed on the day of admission and on days 5， 10， and 15 of hospitalization， and related indicators were calculated， including CCR， neutrophil-to-lymphocyte ratio （NLR）， platelet-to-lymphocyte ratio （PLR）， prognostic nutritional index （PNI）， CCR5 （CCR on day 5 after admission）， ΔCCR5 （CCR on day 5 after admission minus CCR on the day of admission）， CCR10 （CCR on day 10 after admission）， ΔCCR10 （CCR on day 10 after admission minus CCR on day 5 after admission）， CCR15 （CCR on day 15 after admission）， and ΔCCR15 （CCR on day 15 after admission minus CCR on day 10 after admission）. The above indicators were compared between the survival group and the death group and between the infection group and the non-infection group. The Mann-Whitney U test was used for comparison of continuous data between two groups， and the Kruskal-Wallis H test was used for comparison between multiple groups. The univariate and multivariate logistic regression analyses were used to investigate the influencing factors for disease prognosis； the receiver operating characteristic （ROC） curve was used to assess the value of CCR in predicting HBV-ACLF death events， and the DeLong test was used for comparison of the area under the ROC curve （AUC）. ResultsThere were significant differences in CCR， NLR， PNI， PT， and Alb at baseline between the treatment group and the healthy control group （all P<0.001）， and there were significant differences in CCR， NLR， and PT between the survival group and the death group on the day of admission （all P<0.05）. Among the 130 patients with HBV-ACLF， there were 25 in the precancerous stage， 48 in the early stage， 32 in the intermediate stage， and 25 in the advanced stage， and there were significant differences in baseline CCR， PLR， and PT between the patients in different stages of HBV-ACLF （all P<0.05）. There were significant differences in ΔCCR5 and NLR between the infection group and the non-infection group （P<0.05）， and there were significant differences in ΔCCR5， CCR10， and CCR15 between the survival group and the death group （all P<0.05）. The multivariate logistic regression analysis showed that ΔCCR5 （odds ratio ［OR］=1.175， 95% confidence interval ［CI］： 1.098‍ — ‍1.256， P<0.001）， NLR （OR=0.921， 95%CI： 0.880‍ — ‍0.964， P<0.001）， and PT （OR=0.921， 95%CI： 0.873‍ — ‍0.973， P=0.003） were independent influencing factors for the prognosis of HBV-ACLF patients. ΔCCR5 had an AUC of 0.774， a sensitivity of 0.687， and a specificity of 0.757， and the AUC of ΔCCR5+PT+NLR was 0.824， which was significantly higher than the AUC of ΔCCR5， NLR， or PT alone （all P<0.05）. ConclusionΔCCR5， NLR， and PT can reflect the condition and prognosis of patients with HBV-ACLF and are independent predictive indicators for death events in patients with HBV-ACLF. The combination ofΔCCR5， PT， and NLR has the best predictive efficiency.

Effect of preoperative metabolic syndrome on early function of renal allografts in kidney transplant recipients / 器官移植

Objective To evaluate the effect of preoperative metabolic syndrome on early function of renal allografts in allogeneic kidney transplant recipients. Methods Clinical data of 117 kidney transplant recipients were retrospectively analyzed. According to the renal allograft function, they were divided into the delayed graft function (DGF) group (n=29) and non-DGF group (n=88). Relevant risk factors of DGF in recipients undergoing allogeneic kidney transplantation were assessed by univariate and multivariate regression analyses. The effect of preoperative metabolic syndrome on early function of renal allografts was analyzed. Results Among 117 kidney transplant recipients, 47 cases were complicated with preoperative metabolic syndrome, and 29 cases developed postoperative DGF. In the DGF group, 83% of the recipients were complicated with preoperative metabolic syndrome, higher than 74% in the non-DGF group (P<0.05). Univariate analysis showed that the body mass index (BMI) and terminal serum creatinine (Scr) level of the donors, and BMI, blood glucose level, triglyceride level and the proportion of preoperative metabolic syndrome of the recipients in the DGF group were higher than those in the non-DGF group (all P<0.05). Multivariate logistic regression analysis revealed that high Scr levels of the donors, high hemoglobin levels of the recipients and preoperative metabolic syndrome of the recipients were the independent risk factors for DGF after kidney transplantation (all P<0.05). Conclusions Preoperative metabolic syndrome is an independent risk factor for DGF in allogeneic kidney transplant recipients. Corresponding measures should be taken to lower the incidence of DGF and other metabolic complications.

Clinical characteristics and risk factors of 209 cases of urinary tract infection after kidney transplantation / 器官移植

Objective To investigate clinical characteristics and risk factors of different stages of urinary tract infection after kidney transplantation. Methods Clinical data of 209 kidney transplant recipients were retrospectively analyzed. According to time points of postoperative follow-up, all recipients were divided into 3 stages: within 1 month post-kidney transplantation, 1-6 months post-kidney transplantation, and 7-12 months post-kidney transplantation. The incidence of urinary tract infection, urine culture results of recipients with urinary tract infection and drug resistance characteristics of common pathogens during different stages after kidney transplantation were analyzed. The strains of patients with recurrent urinary tract infection were identified. The risk factors of urinary tract infection and the effect of urinary tract infection on renal allograft function were analyzed. Results The urinary tract infection rate was 90.0% in the first stage, 49.3% in the second stage and 22.5% in the third stage. The urinary tract infection rates of male recipients undergoing living-related organ donation in the second and third stages were lower than those of female recipients (both P<0.05). Urine culture test yielded positive results in 60 cases, and 84 strains of pathogenic bacteria were detected, mainly Gram-negative bacteria, among which Klebsiella pneumoniae accounted for the highest proportion. Sixty-six recipients had recurrent urinary tract infection, and the detected pathogens included Klebsiella pneumoniae, Escherichia coli and Candida glabrata, etc. Univariate analysis showed that postoperative use of antithymocyte globulin was the risk factor for urinary tract infection in the first stage. Preoperative urinary tract infection and donor type were the risk factors for urinary tract infection in the second stage. Gender and age of the recipients were the risk factors for urinary tract infection in the third stage. Multivariate analysis revealed that postoperative use of antithymocyte globulin was the risk factor for urinary tract infection in the first stage. Gender and age of the recipients were the risk factors for urinary tract infection in the third stage (all P<0.05). In the third stage, 65 cases were cured and 38 cases were not cured. In the treated recipients, the serum creatinine level and white blood cell count were decreased after corresponding treatment than those before treatment (both P<0.05). Conclusions Gram-negative bacteria are the main pathogens of urinary tract infection in kidney transplant recipients, and drug resistance is relatively high. Postoperative use of antithymocyte globulin, female and old age are the risk factors for urinary tract infection in kidney transplant recipients.

Investigating artificial intelligence models for predicting joint pain from serum biochemistry

SUMMARY OBJECTIVE: The study used machine learning models to predict the clinical outcome with various attributes or when the models chose features based on their algorithms. METHODS: Patients who presented to an orthopedic outpatient department with joint swelling or myalgia were included in the study. A proforma collected clinical information on age, gender, uric acid, C-reactive protein, and complete blood count/liver function test/renal function test parameters. Machine learning decision models (Random Forest and Gradient Boosted) were evaluated with the selected features/attributes. To categorize input data into outputs of indications of joint discomfort, multilayer perceptron and radial basis function-neural networks were used. RESULTS: The random forest decision model outperformed with 97% accuracy and minimum errors to anticipate joint pain from input attributes. For predicted classifications, the multilayer perceptron fared better with an accuracy of 98% as compared to the radial basis function. Multilayer perceptron achieved the following normalized relevance: 100% (uric acid), 10.3% (creatinine), 9.8% (AST), 5.4% (lymphocytes), and 5% (C-reactive protein) for having joint pain. Uric acid has the highest normalized relevance for predicting joint pain. CONCLUSION: The earliest artificial intelligence-based detection of joint pain will aid in the prevention of more serious orthopedic complications.

A spurious elevation of serum creatinine level in a patient with Crohn's disease without histologic kidney damage: a case report and review of the literature / Elevação espúria do nível de creatinina sérica em ­paciente com doença de Crohn sem lesão renal histológica: relato de caso e revisão da literatura

ABSTRACT Patients with inflammatory bowel disease (IBD) are prone to develop kidney injury. Renal involvement in IBD patients is usually diagnosed by the measurement of serum creatinine and the estimation of the glomerular filtration rate. We describe a patient with IBD who presented with large fluctuations in his serum creatinine level (~3.0-fold) without significant histologic abnormalities and with a normal cystatin C level. This appears to be related to a high-protein diet and intermittent fasting. Even though the impact of a high-protein diet on mild elevations of the serum creatinine level has been described, large fluctuations in serum creatinine from diet alone, as seen in this case, have never been reported, raising the question about the potential contribution of inflamed bowel on gut absorption or metabolism of creatinine. This case highlights the importance of a detailed history, including the dietary habits, when encountering a patient with increased serum creatinine level, and careful interpretation of serum creatinine in a patient with a creatinine high-protein diet or underlying IBD.

RESUMO Pacientes com doença inflamatória intestinal (DII) são propensos a desenvolver lesão renal. O envolvimento renal em pacientes com DII é geralmente diagnosticado pela medição da creatinina sérica e pela estimativa da taxa de filtração glomerular. Descrevemos um paciente com DII que apresentou grandes flutuações em seu nível de creatinina sérica (~3,0 vezes) sem anormalidades histológicas significativas e com nível normal de cistatina C. Isso parece estar relacionado a uma dieta rica em proteínas e jejum intermitente. Ainda que o impacto de uma dieta rica em proteínas em elevações leves do nível de creatinina sérica tenha sido descrito, nunca foram relatadas grandes flutuações na creatinina sérica apenas devido à dieta, como observado neste caso, o que levanta a questão sobre a possível contribuição do intestino inflamado na absorção intestinal ou no metabolismo da creatinina. Esse caso destaca a importância de um histórico detalhado, incluindo os hábitos alimentares, ao se deparar com um paciente com nível de creatinina sérica aumentado, e a interpretação cuidadosa da creatinina sérica em um paciente com dieta rica em proteínas ou DII subjacente.