Acute Kidney Injury Classifications in the Prediction of In-hospital Mortality and Renal Function Non-recovery.

Background: In the last two decades diagnostic criteria for acute kidney injury (AKI) were developed: Risk, Injury, Failure, Loss of Kidney Function, End-Stage Kidney Disease (RIFLE), Acute Kidney Injury Network (AKIN), and Kidney Disease: Improving Global Outcomes (KDIGO) classifications. Objective: The study aimed to determine the incidence of AKI based on the RIFLE, AKIN, and KDIGO criteria, as well as analyze their predictive value for mortality and renal function outcome. Methods: This was a single-center prospective study of patients diagnosed with AKI. Acute kidney injury was defined and classified according to the RIFLE, AKIN, and KDIGO criteria. The outcomes were renal function outcome and in-hospital mortality. Results: The incidence rates of AKI based on the RIFLE, AKIN, and KDIGO criteria were 13.4%, 14-36%, and 14.64%, respectively. Multiple regression analysis showed that higher stages of AKI according to the KDIGO criteria were independently associated with non-recovery of renal function (p=0.011). However, the predictive ability of RIFLE, AKIN and KDIGO classifications for renal function recovery was poor (Area Under the Receiver Operating Characteristics-AUROC=0.599, AUROC=0.637, AUROC=0.659, respectively). According to the RIFLE and AKIN criteria, in-hospital mortality was statistically significantly higher in stage Failure/3 (p=0.0403 and p=0.0329, respectively) compared to stages Risk/1 and Injury/2. Receiver Operating Characteristics (ROC) analysis showed that all three classifications had poor predictive ability for in-hospital mortality (AUROC=0.675, AUROC=0.66, AUROC=0.681). Conclusions: KDIGO classification is an independent predictor of renal function non-recovery. However, by ROC analysis, all three classifications have poor predictive ability for renal function outcome and mortality.

Influence of thyroid hormones on bone density.

Aim To investigate the relations between hormonal status of the thyroid gland and mineral bone density in women in menopause with or without osteoporosis. Methods The study included 120 postmenopausal women, who were divided into two groups. Group I included postmenopausal patients with osteoporosis, of whom 30 were in the early stages of postmenopause, and 30 of them where in the late postmenopausal phase. The second group included patients with preserved bone mass, of which 30 were in the early stage of postmenopause, and 30 were in the late postmenopausal phase. Bone densitometry (DEXA) was performed for all patients, along with analysis of the level of follicle-stimulating hormone (FSH), thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3). Results A statistically significant correlation between TSH level and mineral bone density in the lumbar spine level (r=0.27) was found in early postmenopausal women (r<0.05), TSH and T-score at the level of the lumbar spine (r=0.31) (p<0.05), as well as between TSH and mineral content of the femur bone (r=0.29; <0.05). There was statistically significant independent association between thyroxine and mineral bone density at the lumbar spine level in the late postmenopausal women (ß=0.29; p=0.025). Conclusion In the early postmenopausal phase, TSH was associated with mineral bone density in the lumbar spine and in the area of the femur.

Evaluation of Thyroid Hormone Status and Bone Density Ratio in Euthyroid Postmenopausal Women in Early and Late Stage of Bone Loss.

INTRODUCTION: Osteoporosis is a consequence of reduction in bone mass and disorders of bone structure, which makes the bones prone to fractures. Physiological variations of thyroid-stimulating hormone (TSH) may be an early indicator of the predisposing basis of the emergence of osteoporosis. AIM: To evaluate the thyroid hormone status and bone density ratio in euthyroid postmenopausal women in early and late stage of bone loss. METHODS: The research is an observational, intersected, controlled study involving postmenopausal women admitted to the Clinic for Nuclear medicine and endocrinology of the Clinical Center University of Sarajevo (CCUS). The study included a total of 120 postmenopausal subjects divided into two groups. First group included 60 postmenopausal patients with osteoporosis, 30 of them were at the early stage of postmenopause, and 30 were in the late postmenopausal phase. The second group consisted of 60 postmenopausal patients with preserved bone mass, 30 of which were in the early stage of postmenopause and 30 in the late postmenopausal phase. For all patients included in the study follicle-stimulating hormone (FSH), TSH, free thyroxine (FT4), free triiodothyronine (FT3) were analyzed. RESULTS: The mean duration of the postmenopausal period was statistically significantly higher in the group of women with osteoporosis (11.4 ± 1.1 years). The mean values of FSH were statistically significantly higher in the group of women with osteoporosis (54.0 ± 2.6 IU / L). The mean level of TSH and FT3 did not statistically significantly differ in the group of women with osteoporosis compared to the control group of women. The mean FT4 level in women with osteoporosis was statistically significantly lower (14.7 ± 0.29 pmol / L) compared to the control group of women (15.95 ± 0.3 pmol / L) (p = 0.004). CONCLUSION: In our examined group, the FT4 patient (mean) was significantly lower in the serum of women with osteoporosis compared to subjects with preserved bone mass. It would be most effective to recognize risk factors in order to influence them on time, and to alleviate and slow down the consequences of osteoporosis. One of these possible factors is the hormonal status of the thyroid gland, that is, TSH whose physiological variations may be an early indicator of the predisposing basis for the emergence of osteoporosis. The frequency and prevalence of these medical problems require additional research, and it is also a great challenge to understand the effects of thyroid hormone on bone tissue.