Spleen and Liver Stiffness to Detect Esophageal Varices in Children with Biliary Atresia.

OBJECTIVES: The aim of the study was to determine the accuracy of noninvasive parameters, such as liver (LS) and spleen stiffness (SS) to detect esophageal varices (EV) in children with biliary atresia (BA). METHODS: Children with BA between 2000 and 2015 were recruited. All underwent esophagogastroduodenoscopy and transient elastography. Demographic data, laboratory investigations, alanine transferase-to-platelet ratio index (APRI), and Varices Prediction Rule (VPR) score were collected. RESULTS: A total of 51 children (mean age 10.63 years, standard deviation (SD) = 6.08 years; 53% boys) were enrolled. There were differences in onset and outcome of portoenterostomy, spleen palpablility, platelet count, albumin, LS, SS, and VPR between the varice and varice-free groups (P < 0.05). In the varice group, the median LS was 18.12 (interquartile ratio, IQR 13.15-19.12) and the median SS was 46.85 (IQR 25.95-54.55) kPa. In the varice-free group, the median LS was 7.85 (IQR 5.88-16.75) and the median SS was 16.54 (IQR 11.75-21.75) kPa. Both LS and SS were higher in the varice than the varice-free group (P < 0001). The area under the receiver operating characteristic curve of LS, SS, spleen palpability, platelet count, APRI, and VPR were 0.734, 0.870, 0.817, 0.810, 0.751, and 0.794, respectively. Using a cut-off value of 12.5 kPa for LS, the sensitivity and specificity were 80 and 70%, respectively. Using a cut-off value of 28.9 kPa for SS, the sensitivity and specificity were 75 and 87%, respectively. Combination of LS and SS to diagnose varices increased the specificity to 93%. CONCLUSIONS: SS as a single marker had the best diagnostic value to predict esophageal varices in children with BA. The combination of SS and LS furthermore, increased the diagnostic yield.

Adding C-reactive protein and procalcitonin to the model of end-stage liver disease score improves mortality prediction in patients with complications of cirrhosis.

BACKGROUND AND AIM: This study aims to determine the performance of models adding C-reactive protein (CRP) and procalcitonin (PCT) to the model of end-stage liver disease (MELD) score for mortality prediction in patients hospitalized with complications of cirrhosis. METHODS: A prospective cohort study was carried out in consecutive cirrhotic patients admitted with complications of cirrhosis between September 2012 and December 2013 at Phramongkutklao Hospital, Bangkok, Thailand. All patients had venous CRP, PCT, and laboratory values for MELD score calculation measured at emergency room or admission. Cox regression analysis and the c-statistic were used to predict mortality. The MELD-CRP score was externally validated in 818 eligible patients from Mayo Clinic, Rochester, using data from 1288 cirrhotic patients diagnosed between 2010 and 2014. RESULTS: A cohort of 177 patients with cirrhosis was admitted during the study period. Seventy-one patients were eligible for analysis. The MELD score was predictive of 90-day mortality odds ratio (OR) 1.19 (95% confidence interval [CI] 1.09-1.32). Adding CRP and/or PCT to the MELD score improved the predictive of 90-day mortality: MELD-CRP OR 2.71 (95% CI 1.66-4.99); MELD-PCT OR 2.72 (95% CI 1.66-4.99); MELD-CRP-PCT OR 2.71 (95% CI 1.67-4.92). The c-statistics for MELD, MELD-CRP, MELD-PCT, and MELD-CRP-PCT were 0.81, 0.83, 0.84, and 0.85, respectively. Adding CRP and/or PCT to the MELD score also improved 30-day mortality prediction. Similar results for the MELD-CRP score were obtained from the Mayo Clinic external validation cohort. CONCLUSION: The MELD-CRP, MELD-PCT, and MELD-CRP-PCT scores may be superior to the MELD score alone in predicting mortality in patients hospitalized with complications of cirrhosis.

The effect of ONCE Renal on minerals and electrolytes in predialysis patients with chronic kidney disease.

BACKGROUND: Malnutrition is one common adverse consequence in patients with advanced chronic kidney disease (CKD), and most patients have a lower-than-normal dietary energy intake. The present study was undertaken to examine whether orally administered ONCE Renal formula (ORF) supplement would improve energy intake without minerals and electrolytes disturbances in predialysis patients with CKD. METHODS: All eligible nondiabetic patients with CKD received ORF supplement for 1 week. Nutrition markers, renal function, and minerals and electrolytes were evaluated before and after supplementing. All patients kept a 3-day food record and were interviewed by a registered dietitian. RESULTS: A total of 29 patients with mean age 64.9±13.3 years were included. Mean estimated glomerular filtration rate was 37.7±12.1 mL/min/1.73 m(2). A significant increase was observed in amount of energy, fat, fiber, calcium, and magnesium intake after 1 week of ORF supplement. Moreover, in comparison with baseline values, the patients displayed decreased dietary protein intake and blood urea nitrogen and increased serum magnesium. However, no significant change was found in renal function, nutritional markers (body weight, prealbumin, albumin, and protein equivalence of total nitrogen appearance), serum calcium, phosphorus, sodium, potassium, and bicarbonate. CONCLUSION: In patients with CKD, ingestion of ORF was well tolerated and had a positive effect with an increase in dietary energy, fat, and fiber intake, as well as a decreased dietary protein intake. No mineral or electrolyte abnormalities were observed during the study.

Apolipoprotein E genetic polymorphisms and the development of nephropathy in type 2 diabetes.

BACKGROUND: Apolipoprotein E (ApoE) polymorphisms have been proposed as the risk factor for the development of diabetic nephropathy (DN). A number of studies have investigated the association between the ApoE isoforms and DN. However the findings remain inconclusive. OBJECTIVE: To determine the association between the ApoE polymorphisms and DN. MATERIAL AND METHOD: Two hundred thirty patients with type 2 diabetes were divided into two groups, patients with clinically diagnosed DN and normoalbuminuric patients. ApoE genotypes were determined by RT-PCR analysis. Student's t-test, ANOVA test, Chi-square test, odds ratio, and logistic regression was performed. RESULTS: The frequency of ApoE4 genotype was significantly lower in DN patients (8.7%) than in normoalbuminuric patients (21.7%). Logistical regression analysis showed that subjects with ApoE4 genotype (adjusted OR = 0.43; 95% CI: 0.19-0.99) were less likely to have DN than subjects with ApoE3 genotype. Furthermore, when analyzed only in patients with overt DN vs. patients with normoalbuminuria, the frequency of e4 allele was decreased in overt DN (2.8% vs. 21.7%, adjusted OR = 0.13; 95% CI: 0.03-0.57) and the frequency of e2 allele was increased (25.4% vs. 13.0%, adjusted OR = 2.34; 95% CI: 1.02- 5.38). CONCLUSION: ApoE4 genotype is associated with protection from type 2 DN, and subjects with e2 allele have increased risk of developing type 2 overt DN.

Effect of enhanced external counterpulsation treatment on renal function in cardiac patients.

BACKGROUND: Enhanced external counterpulsation (EECP) enhances coronary perfusion and reduces left ventricular afterload. However, the role of EECP on renal function in cardiac patients is unknown. Our aim was to assess renal function determined by serum cystatin C in cardiac patients before and after EECP treatment. METHODS: A prospective observational longitudinal study was conducted in order to evaluate renal function using serum cystatin C (Cys C) and estimated glomerular filtration rate (GFR) after 35 sessions of EECP treatment in 30 patients with chronic stable angina and/or heart failure. The median (IQR) time for follow-up period after starting EECP treatment was 16 (10-24) months. RESULTS: Cys C significantly declined from 1.00 (0.78-1.31) to 0.94 (0.77-1.27) mg/L (p < 0.001) and estimated GFR increased from 70.47 (43.88-89.41) to 76.27 (49.02-91.46) mL/min/1.73 m(2) (p = 0.006) after EECP treatment. Subgroup analysis showed that patients with baseline GFR <60 mL/min/1.73 m(2) or NT-proBNP >125 pg/mL had a significant decrease in Cys C when compared to other groups (p < 0.01). CONCLUSIONS: The study demonstrated that EECP could improve long-term renal function in cardiac patients especially in cases with declined renal function or with high NT-proBNP. TRIAL REGISTRATION: The study was registered in the clinical trial as International Standard Randomized Controlled Trial Number ISRCTN11560035.

Obesity and its relation to chronic kidney disease: a population-based, cross-sectional study of a Thai army population and relatives.

AIM: Obesity represents a significant problem in patients with cardiovascular disease and chronic kidney disease (CKD). The aim of the present study was to investigate the association between body mass index (BMI) and CKD in Thai individuals. METHODS: Participants underwent general health screening. Overweight, weight at risk, obese I and obese II were defined as having a BMI ≥23 kg/m(2), 23-24.9 kg/m(2) , 25-29.9 kg/m(2) and ≥30 kg/m(2), respectively. Waist circumference ≥ 90 cm for men and > 80 cm for women were represented by abdominal obesity. CKD was defined as a glomerular filtration rate (GFR) < 60 mL/min per 1.73 m(2). An estimate of the GFR was obtained by the four-variable Modification of Diet in Renal Disease (MDRD) equation. RESULTS: The study population had 12 348 males and 3009 females. The survey population had a 7.5% prevalence of CKD. There was also a significant graded relationship between the degrees of overweight with the prevalence of CKD. Mean BMI were 25.36 ± 3.29 kg/m(2) for CKD subjects and 24.04 ± 3.13 kg/m(2) for non-CKD subjects (P < 0.001). Prevalence of overweight and abdominal obesity in the participants with CKD were found to be higher than in those without CKD (overweight, 77.6% vs. 61.6%, P < 0.001; abdominal obesity, 35.7% vs. 25.3%, P < 0.001). In a multivariate logistic regression analysis, weight at risk (adjusted odds ratio 1.29; 95% CI 1.07-1.54), obese I (adjusted odds ratio 1.58; 95% CI 1.33-1.87) and obese II (adjusted odds ratio 1.65; 95% CI 1.24-2.19) were associated with CKD. CONCLUSION: Our data showed that overweight and obesity were associated with CKD in Thai members of the army population and their relatives undergoing a general health screening, independently of age, gender, blood pressure, serum lipid, uric acid and glucose levels.