Association of Polymorphisms in Antioxidant Enzyme-Encoding Genes with Diabetic Nephropathy in a Group of Saudi Arabian Patients with Type II Diabetes Mellitus.

Introduction: An imbalance between reactive oxygen species (ROS) generation and the defence mechanisms underlying the activity of antioxidant enzymes has been demonstrated as the leading pathology in diabetes mellitus (DM)-related microvascular complications. Purpose: This study aims to evaluate the association between polymorphisms in antioxidant enzyme-encoding genes: catalase (CAT); manganese superoxide dismutase (Mn-SOD); glutathione S transferase M1 (GSTM1); and GSTT1 glutathione S transferase T1 (GSTT1), and the risk of type II diabetic nephropathy (DN) in the Saudi population. Patients and Methods: The present study involved 64 type II DM patients with nephropathy and 64 type II diabetes patients without nephropathy from the King Abdulaziz University (KAU) Hospital. They underwent real-time PCR genotyping for the Mn-SOD and CAT genes. Multiplex PCR was used to detect GSTM1- and GSTT1-null polymorphisms. Results: A statistically significant difference was observed between the case and control groups with regard to polymorphisms in the CAT gene (P = 0.037), but not for polymorphisms in the Mn-SOD (P = 0.64) gene. In addition, a statistically significant association was observed between null polymorphisms of the GSTT1 and GSTM1 genes and DN in the case and control groups (P = 0.046 and P = 0.035, respectively). Conclusion: Our results showed that the genetic ability to combat oxidative stress may play a major role in DN pathogenesis in Saudi type II DM patients. These polymorphisms in antioxidant enzyme-encoding genes could be used as independent genetic markers for the construction of risk prediction models for kidney-related complications in type II DM patients.

Electrolyte imbalance in infectious disease patients at King Abdulaziz Hospital, Jeddah.

Objectives: Infectious diseases are the common cause of morbidity and mortality among humans. Electrolyte imbalance occurs frequently in patients with infectious diseases. This study aims to identify electrolyte imbalances in hospitalised patients with infectious diseases. Methods: Two hundred and eighty-three patients with age mean 36.48 ± 18.86 years, consisting of 127 (53.4%) males, 111 (46.6%) females, enrolled in a retrospective cohort study carried out at the King Abdulaziz University Hospital, Jeddah, KSA from September to December 2020. All hospitalised patients with infectious diseases were included. Demographic data, comorbidity, and diagnosis were collected from patients' sheets. Serum levels of electrolytes (chloride, potassium, sodium), urea, and creatinine were collected at admission (period 1), during hospital stay (period 2), and at discharge (period 3). Levels were compared during different periods. Results: Most infectious diseases were viral infections (63.4%), while comorbidity was diabetes mellitus (7.1%). Serum chloride elevated from period 1 to period 3 (P = 0.046). Sodium elevated between period 1 and both period 2 and period 3 (P < 0.001). Urea decreased between period 1 and both period 2 (P = 0.018) and period 3 (P < 0.001). Creatinine decreased between period 1 and both period 2 and period 3 (P < 0.001) and between period 2 and period 3 (P < 0.001). Patients with decreased chloride and sodium levels were mostly in the 1st period, while those with decreased potassium levels were mostly in the period 2. Conclusion: Prevalence of electrolyte imbalance in hospitalised patients with an infectious disease at the King Abdulaziz University Hospital, Jeddah was high, especially at admission and during the hospital stay.

Acute Kidney Injury as a Risk Factor for Cerebrovascular Disease Outcome among Patients Presenting with Stroke in King Abdulaziz University Hospital, Jeddah, Saudi Arabia: A Retrospective Cohort Study.

Patients suffering from stroke may develop different complications including acute kidney injury (AKI). AKI affects mortality among the stroke patients. The association between stroke and AKI despite extensive research has been not completely understood. The study aimed to determine an AKI as an independent poor risk factor of cerebrovascular disease outcome among the stroke patients. Our objectives were to estimate AKI incidence among stroke patients at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia, between 2013 and 2017 and assess the major risk factors related to AKI among stroke patients. The research population was sourced from the publicly available KAUH records from 2013 to 2017. The total number of stroke cases was 717 with a mean age of 63.94 ± 15.70 years. As many as 83.5% of cases had no AKI and 16.5% were suffered from AKI among total stroke patients studied. Furthermore, 74.1% of stroke patients were alive compared to 25.9% reported dead. The study concluded that AKI incidence is higher in stroke patients after admission immediately or during hospitalization. As such, the renal function file could be used as an early indicator upon stroke patients' admission to health-care facilities. Prevention and control of AKI seem to be very important among patients with stroke.

Urinary Neutrophil Gelatinase-Associated Lipocalin as a Predictor of Acute Kidney Injury, Severe Kidney Injury, and the Need for Renal Replacement Therapy in the Intensive Care Unit.

BACKGROUND: Recent attempts were made to identify early indicators of acute kidney injury (AKI) in order to accelerate treatment and hopefully improve outcomes. This study aims to assess the value of urinary neutrophil gelatinase-associated lipocalin (uNGAL) as a predictor of AKI, severe AKI, and the need for renal replacement therapy (RRT). METHODS: We conducted a prospective study and included adults admitted to our intensive care unit (ICU) at King Abdulaziz University Hospital (KAUH), between May 2012 and June 2013, who had at least 1 major risk factor for AKI. They were followed up throughout their hospital stay to identify which potential characteristics predicted any of the above 3 outcomes. We collected information on patients' age and gender, the Acute Physiology And Chronic Health Evaluation, version II (APACHE II) score, the Sepsis-Related Organ Failure Assessment (SOFA) score, serum creatinine and cystatin C levels, and uNGAL. We compared ICU patients who presented with any of the 3 outcomes with others who did not. RESULTS: We included 75 patients, and among those 21 developed AKI, 18 severe AKI, and 17 required RRT. Bivariate analysis revealed intergroup differences for almost all clinical variables (e.g., patients with AKI vs. patients without AKI); while multivariate analysis identified mean arterial pressure as the only predictor for AKI (p < 0.001) and the SOFA score (p = 0.04) as the only predictor for severe AKI. For RRT, day 1 maximum uNGAL was the stronger predictor (p < 0.001) when compared to admission diagnosis (p = 0.014). Day 1 and day 2 maximum uNGAL levels were good and excellent predictors for future RRT, but only fair to good predictors for AKI and severe AKI. CONCLUSIONS: Maximum urine levels of uNGAL measured over the first and second 24 h of an ICU admission were highly accurate predictors of the future need for RRT, however less accurate at detecting early and severe AKI.

Urinary neutrophil gelatinase-associated lipocalin is an excellent predictor of mortality in intensive care unit patients.

OBJECTIVES: To assess urine neutrophil gelatinase-associated lipocalin (uNGAL) level as a potential predictor of acute kidney injury (AKI), and both intensive care unit (ICU) and in-hospital mortality. METHODS: Patients presenting to our ICU with a systolic blood pressure (SBP) less than 90 mmHg or mean arterial pressure (MAP) less than 65 mmHg, and no prior kidney disease were followed prospectively. Baseline data were collected on patient demographics, admission diagnosis, APACHE II and SOFA scores, SBP, MAP, serum creatinine and cystatin C, and uNGAL. Patients were monitored throughout hospitalization, including daily uNGAL, serum creatinine and cystatin C, and continuous MAP. Bivariate analysis compared those dying in the ICU and in-hospital versus survivors; with hierarchical binary logistic regression used to identify predictors of mortality. Areas under receiver-operating-characteristic curves (AUC) were used to measure sensitivity and specificity at different uNGAL thresholds. RESULTS: Among 75 patients followed, 16 died in the ICU, and another 24 prior to hospital discharge. Mortality rates were greatest in trauma and sepsis patients. The ICU survivors differed from non-survivors in almost all clinical variables; but only 2 predicted ICU mortality on multivariate analysis: day one uNGAL (p=0.01) and 24-hour APACHE II score (p=0.07). Only the APACHE II score significantly predicted in-hospital mortality (p=0.003). The AUC for day one uNGAL was greater for ICU (AUC=0.85) than in-hospital mortality (AUC=0.74). CONCLUSIONS: Day one uNGAL is a highly accurate predictor of ICU, but less so for in-hospital mortality.