Diagnostic Value Of Serum Urea, Creatinine, Sodium And Potassium For Complicated Appendicitis - A One Year Retrospective Study.

BACKGROUND: Acute appendicitis is a common surgical emergency and if complicated, manifesting as abscess, perforation, suppurative or gangrenous appendicitis, carries significant morbidity and mortality. Its early preoperative diagnosis can improve outcome in patients and reduce incidence of negative appendectomies. It, however, mandates identification of new diagnostic parameters for it. This retrospective study evaluates diagnostic accuracy of serum urea, creatinine, sodium and potassium for complicated appendicitis. METHODS: Sixty patients with suspected appendicitis were grouped into complicated and uncomplicated appendicitis based on histological reports. Preoperative laboratory results for serum urea, creatinine, sodium and potassium levels were obtained from hospital records. Diagnostic strength of these markers was calculated as specificity, sensitivity and area under curve. ROC curve analysis was used for their diagnostic accuracy. RESULTS: The levels of serum urea, creatinine and K were not significantly different in uncomplicated and complicated appendicitis. However, sodium was significantly higher in complicated appendicitis. ROC curve analysis showed AUC values for all the studied variables to be greater than 0.5. However, none of the markers had good capability to differentiate complicated appendicitis from uncomplicated appendicitis. CONCLUSIONS: Serum urea, creatinine, sodium and potassium levels have shown a tendency to be predictive of complicated appendicitis but a strong association could not have been established. Hence, further investigation is warranted.

Desenlaces obstétricos en mujeres embarazadas con enfermedad renal crónica y factores asociados / Obstetric outcomes in pregnant women with chronic kidney disease and associated factors

Resumen OBJETIVO: Identificar los factores asociados con los desenlaces fetales, maternos y renales en embarazadas con enfermedad renal crónica. MATERIALES Y MÉTODOS: Estudio observacional y prospectivo llevado a cabo en el Hospital de Ginecoobstetricia 4 del IMSS de 2016 a 2018 en pacientes embarazadas con enfermedad renal crónica, con parámetros bioquímicos (creatinina, urea) y desenlaces obstétricos; se excluyeron los casos incompletos. Por el tipo de población se usó estadística no paramétrica con mediana (tendencia central) y rango intercuartilar (dispersión). Para la comparación de medias se utilizó t de Student y Kruskal Wallis; los valores de p < 0.05 se consideraron estadísticamente significativos. Para establecer el riesgo se efectuó análisis bivariado. Se utilizó el programa estadístico SPSS 25. RESULTADOS: Se estudiaron 48 pacientes; de éstas 16 cursaron con preeclampsia. La cesárea fue la vía de finalización del embarazo más común en 32 de los 48 casos. En relación con los recién nacidos: 41 supervivieron, 22 de 41 fueron prematuros, 19 de 41 nacieron a término, 29 de 41 recién nacidos no experimentaron complicaciones. Se registró elevación de la creatinina de 0.28 mg/dL y descenso de la tasa de filtración glomerular de 9.67 mL/min. CONCLUSIONES: Se identificaron 4 factores. La maduración pulmonar y las enfermedades crónico-degenerativas representaron riesgo de prematurez. Los factores contibuyentes para el embarazo de término fueron: no cursar con preeclampsia y no tener eventos de hospitalización o infección. La enfermedad renal crónica influye de forma directa en desenlaces adversos para la madre y el feto; el embarazo influye en mayor deterioro renal.

Abstract OBJECTIVE: To know the factors associated with fetal, maternal and renal outcomes in known pregnant women with chronic kidney disease. MATERIALS AND METHODS: An observational, prospective study at the IMSS Hospital of Gynecobstetrics No. 4 from 2016 to 2018 of pregnant women with chronic kidney disease with biochemical parameters (creatinine, urea) and obstetric outcomes; Incomplete cases were excluded. For the type of population, non-parametric statistics were used with median (central tendency), interquartile range (dispersion), for the comparison of means, a student's "t" was used, with a significance of p < 0.05 and Kruskal Wallis. To establish risk, a bivariate analysis is performed. SPSS 25 statistical program. RESULTS: The obstetric results obtained were: 16/48 of the women with preeclampsia, caesarean section was the most common resolution in 32/48 cases. In relation to newborns, 41 survived, 22/41 with prematurity, 19/41 were full term, 29/41 newborns without complications. There was an elevation of 0.28 mg/dL creatinine and a decrease in the glomerular filtration rate of 9.67 mL/min. CONCLUSIONS: 4 factors were identified. Pulmonary maturation and chronic-degenerative diseases represented a risk for prematurity; Two influential factors for the termination of pregnancy were: not taking preeclampsia and having no hospitalization and/or infection events. chronic kidney disease directly influences both maternal and fetal adverse outcomes, and pregnancy also has an influence on greater renal impairment.