Comparison of the RIFLE, AKIN, and KDIGO Diagnostic Classifications for Acute Renal Injury in Patients Undergoing Liver Transplantation.

BACKGROUND: The aim of this study was to determine the incidence and peri-operative risk factors for acute renal injury (ARI) and their relationship with mortality rate through the use of 3 different ARI diagnostic classifications in patients after liver transplantation (LT). METHODS: We retrospectively investigated the medical records of adult LT recipients. Post-operative ARI was determined with the Risk, Injury, Failure, Loss, and End-Stage Renal Failure (RIFLE), Acute Kidney Injury Network (AKIN), and Kidney Disease: Improving Global Outcomes (KDIGO) classifications. RESULTS: We analyzed 440 adult patients. The post-operative incidence of ARI was 8.0% by the RIFLE classification, 14.31% by the AKIN classification, and 14.54% by the KDIGO classification. Significant risk factors for ARI were pre-operative albumin (odds ratio [OR], 0.776; 95% confidence interval [CI], 0.473-1.273 for AKIN; and OR, 0.724; 95% CI, 0.444-1.182 for KDIGO) and hemoglobin levels (OR, 2.830; 95% CI, 1.157-6.9261 by RIFLE), intra-operative red blood cell transfusion (OR, 1.072; 95% CI, 1.004-1.143 by AKIN; and OR, 1.077; 95% CI, 1.011-1.147 by KDIGO), and blood loss (OR, 1.00; 95% CI, 0.999-1.000 by RIFLE). The early mortality rate was 7.9% in our series. CONCLUSIONS: The RIFLE, AKIN, and KDIGO ARI classifications classify the severity of renal dysfunction in patients who have undergone LT. Direct associations were found between higher mortality rates and severity of renal disease.

Acute Renal Injury Evaluation After Liver Transplantation: With RIFLE Criteria.

BACKGROUND: The aim of this study was to identify acute renal injury (ARI) through the use of RIFLE (risk, injury, failure, loss, end-stage kidney disease) criteria and to investigate perioperative risk factors for ARI in liver transplantation (LT). METHODS: We reviewed medical records of adult LT patients retrospectively. Postoperative ARI was staged with RIFLE criteria by the 1st and 7th days of the surgery. RESULTS: We analyzed 440 adult LT patients, categorized as risk (R), injury (I), or failure (F) according to the RIFLE criteria. In this study, in the first postoperative day, incidence of ARI was 7.95%; all of them were R-class, and, on the 7th day, the incidence of ARI was 7.27%, as R-class 6.59% and I-class 0.68%. Significant risk factors were detected within the first postoperative day including pre-operative hemoglobin levels <9 g/dL (P = .019), intra-operative transfusion of red blood cells (RBCs) (P = .049) and fresh-frozen plasma (FFP) (P = .049), blood loss (P = .011), and post-reperfusion syndrome (P = .023). Multivariate analysis revealed risk factors for ARI as RBCs (odds ratio [OR], 1.049; P = .247) and FFP (OR, 1.017; P = .627) transfusion and blood loss (OR, 1.000; P = .021) (blood loss OR: 0.9996952300184; 95% confidence interval: 0.9994356774026 to 0.999548500399). The only significant risk factor for the 7th postoperative day was the Model for End-Stage Liver Disease (MELD) score (>20) (P = .002). CONCLUSIONS: This study showed that RBC and FFP transfusion, perioperative blood loss, and MELD score >20 are risk factors for LT-related ARI. Also normalization of hemoglobin levels with non-blood products in patients with preoperative low hemoglobin levels can diminish the need for RBC and that can prevent ARI.

Effects of capsaicin on testis ghrelin expression in mice.

Capsaicin (CAP), the active substance of red hot peppers, has been reported to stimulate development of the gonad. Ghrelin is an acylated polypeptide hormone that is secreted predominantly by endocrine cells of the stomach. There is evidence that ghrelin is involved in reproductive function. Ghrelin significantly inhibits testosterone secretion in a dose-dependent manner. We investigated the effect of CAP on ghrelin expression in testes of mice and on testosterone levels during pubertal and adult periods. We used a variety of morphometric, immunohistochemical and biochemical methods, and western blot analysis. The animals were divided into two age groups: puberty and adult. Control groups for both age groups were fed with standard diet and experimental groups were fed with a diet containing 0.02% CAP. Testes were collected quickly after sacrifice. After dehydration, the specimens were embedded in paraffin and 5 µm sections were cut, and Crossman's triple staining and immunohistochemical staining for ghrelin were applied. Immunohistochemical staining with ghrelin antibody for both age groups demonstrated immunoreaction especially in Leydig and Sertoli cells, but no reaction was observed in spermatogenic cells. Ghrelin immunoreaction was less intense in the experimental groups. Serum testosterone levels were increased in both experimental groups, especially in adults. More spermatocytes were observed in the experimental group compared to the control group. In both pubertal and adult experimental groups, the seminiferous epithelium was thick. CAP appears to enhance testicular cell proliferation and can affect the release of ghrelin and testosterone directly or indirectly.

Immunohistochemical study on the chicken adenohypophysis using monoclonal mouse anti-human FSH as a primary antibody.

This experiment was conducted to investigate the use of monoclonal mouse anti-human FSH as a primary antibody for the immunohistochemical staining on chicken adenohypophysis paraffin sections. The use of monoclonal mouse anti-human primary antibody on chicken tissues has been developed. The protocol has been modified by comparing the results of the different groups. Briefly, this present protocol suggests modification in two areas; first, the antigen retrieval step, by placing the slides into the buffered citrate in microwave oven at 700 watt for 5 min, 3 times, and antigen-antibody reactions. Secondly, the incubation with the primary antibody (dilution 1/100 for anti-FSH) at 37 degrees C for 90 min.