Biomarkers for Diagnosis and Prediction of Outcomes in Contrast-Induced NephropathyRead the full article
International Journal of Nephrology publishes original research articles, review articles, and clinical studies on the prevention, diagnosis, and management of kidney diseases and associated disorders.
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Renal Involvement in Children with Dengue Fever: A Study in Tertiary Care Hospital of Bangladesh
Background and Objective: Dengue has emerged globally as the most relevant viral infection transmitted by a mosquito bite and represents a major threat to public health. Dengue-related renal manifestations such as proteinuria, hematuria, acute kidney injury (AKI), and rhabdomyolysis are not uncommon, and acute kidney injury (AKI) is a serious complication of dengue fever. There is relatively few data on the renal manifestations of dengue fever in children. Hence, this study was conducted to evaluate the incidence, characteristics, and clinical outcome of dengue fever with renal manifestations. Method. This prospective cross sectional study was conducted in Dr. M R Khan Children Hospital and Institute of Child Health, Dhaka, over a period of 1 year from January 2018 to December 2018. The study was approved by the ethical committee of the institute. A total number of 316 patients were admitted with the diagnosis of dengue fever either NS1 positive or antibody IgM positive or both IgM and IgG positive. Data were collected in a structured questionnaire form and were analyzed by SPSS version 20.0. The disease severity was classified according to the World Health Organization criteria. Renal manifestations were divided into AKI groups using pRIFLE criteria. Proteinuria was defined as urinary protein >1+ (30 mg/dL) by dipstick test. Hematuria was defined as red blood cell (RBC) >5/μL in a fresh uncentrifuged urine specimen. Result. Among 316 dengue patients, thirty-one patients (9.8%) had renal involvement. Most of the patients (54.83%) with renal manifestations were aged between 1 and 5 years. A total of 14 patients were found to have proteinuria (4.4%). Nephrotic-range proteinuria was seen in only one patient (0.3%). AKI was defined by pRIFLE criteria and was seen in 13 patients (4.1%); among AKI 6 (46.15%) had risk, three patients (23.07%) had injury and 4 (30.7%) had failure and needed peritoneal dialysis. Death occurred in 3 patients (9.6%) in dengue with AKI who had failure. The incidence of renal manifestations (proteinuria, hematuria, and AKI) is as high as 9.8% among patients with dengue, and those with AKI had significant morbidity and mortality. Conclusion. Renal involvement in children with dengue is not uncommon. Dengue associated with AKI had significant mortality and morbidity.
Prevalence of APOL1 Risk Variants in Afro-Descendant Patients with Chronic Kidney Disease in a Latin American Country
Introduction. In Colombia, the genetic background of the populations was shaped by different levels of admixture between Natives, European, and Africans. Approximately 35.363 patients have diagnosed chronic kidney disease and according to population studies, 10.4% of these patients are Afro-descendant. We aim to assess the frequency of APOL1 variants G1 and G2 in Afro-descendant patients with ESRD treated at la Fundacion Valle del Lili University Hospital in Cali, Colombia. Methods. This is an observational cross-sectional study. Afro-descendant patients with ESRD in waitlist or recipients of kidney transplant were evaluated. Clinical data were collected from the electronic medical records. Genotyping was carried out by amplification of the exon 7 of the APOL1 gene. For the identification of risk genotypes, the bioinformatics tool BLAST was used. Results. We enrolled 102 participants. The frequency of APOL1 risk variants was 67.2%, in which 24.5% (n = 25) were G1 heterozygous and 5.8% (n = 6) were G2 heterozygous and 37% of the patients had high-risk status with two alleles in homozygous (G1/G1 = 21 and G2/G2 = 3) or compound heterozygote (G1/G2 = 14) form.
Prevalence and Management of Hypokalemia in Peritoneal Dialysis Patients in Qatar
Introduction. Hypokalemia is common in patients undergoing peritoneal dialysis (PD). It is associated with increased cardiovascular and all-cause mortality. Treatment usually includes oral potassium supplements, which are poorly tolerated. Our aim was to evaluate the prevalence of hypokalemia in PD patients in Qatar and to improve treatment measures. Methods. All PD patients in Qatar with persistent hypokalemia and on potassium supplement were included. We performed a root cause analysis, and a management pathway was created. We collected data before (Period 1) and after (Period 2) implementation of the new pathway. Results. A total of 143 patients with a mean age of 54 years (range 21–82 years) were included in the study. Initial results of Period 1 showed hypokalemia in 48 patients (34%); of these, 14 (29%) had hypomagnesemia. Hypokalemia resolved in 10 of the patients after correction of their hypomagnesemia. The remaining 4 patients continued to require potassium supplementation despite correction of their hypomagnesemia. We started spironolactone (25 mg daily) in 13 of the hypokalemia patients. After 3 months, their mean serum potassium level improved from 3.2 ± 0.3 mmol/L to 3.9 ± 0.4 mmol/L (), and the prevalence of patients with persistent hypokalemia decreased from 36% to 21% (statistically significant with 0.006). No episodes of hypotension or hyperkalemia were observed. Only 1 patient developed mild gynecomastia without discontinuation of the medications. Conclusion. Our study showed that hypokalemia is a prevalent problem in PD patients in Qatar. Hypomagnesemia is a significant contributing factor to hypokalemia in PD and correcting it leads to improvement of hypokalemia. Addition of spironolactone is safe and effective in treating hypokalemia. Implementing a holistic pathway led to a significant improvement in hypokalemia prevalence in PD patients.
Association between High-Sensitivity C-Reactive Protein and Blood Pressure among Children with History of Low Birth Weight Appropriate for Gestational Age, Low Birth Weight Small for Gestational Age, and Normal Birth Weight in Manado, North Sulawesi
Over the past years, low birth weight (LBW) has been proven to be attributed to a wide variety of long-term morbidities, including hypertension. This study aimed to investigate the association between high-sensitivity C-reactive protein (hs-CRP) and blood pressure (BP) in children with a history of LBW appropriate for gestational age (LBW AGA), LBW small for gestational age (LBW SGA), and normal birth weight appropriate for gestational age (NBW AGA). The study cohort comprised children aged 9–12 years who were born in 2007–2010 at Prof. Dr. R. D. Kandou General Hospital Manado and resided in the city of Manado from March to August 2019. The children who met the inclusion criteria were evaluated for BP and hs-CRP level. A total of 120 children who met the inclusion criteria were enrolled in this study. Analysis for the association between LBW and NBW with systolic blood pressure (SBP) showed statistical significance (). Linear regression analysis indicated a strongly significant influence of BW on serum hs-CRP level and SBP. Every 1 g increase in BW results in a decrease of serum hs-CRP level of 0.001 mg/L. Every 1 g increase in BW is attributed to 0.004 mmHg decrease in SBP. An increase in hs-CRP by 1 mg/L increases the SBP by 4.99 mmHg and DBP by 2.88 mmHg. LBW significantly correlates with hs-CRP level and higher SBP. A comprehensive education must be undertaken for the families who have children with LBW to reduce the risk of developing hypertension later in their life.
Risk Behaviors in Teens with Chronic Kidney Disease: A Study from the Midwest Pediatric Nephrology Consortium
Introduction. There is a paucity of information about risk behaviors in adolescents with chronic kidney disease (CKD). We designed this study to assess the prevalence of risk behaviors among teens with CKD in the United States and to investigate any associations between risk behavior and patient or disease characteristics. Methods. After informed consent, adolescents with CKD completed an anonymous, confidential, electronic web-based questionnaire to measure risk behaviors within five domains: sex, teen driving, alcohol and tobacco consumption, illicit drug use, and depression-related risk behavior. The reference group was composed of age-, gender-, and race-matched US high school students. Results. When compared with controls, teens with CKD showed significantly lower prevalence of risk behaviors, except for similar use of alcohol or illicit substances during sex (22.5% vs. 20.8%, ), feeling depressed for ≥2 weeks (24.3% vs. 29.1%, ), and suicide attempt resulting in injury needing medical attention (36.4% vs. 32.5%, ). Furthermore, the CKD group had low risk perception of cigarettes (28%), alcohol (34%), marijuana (50%), and illicit prescription drug (28%). Use of two or more substances was significantly associated with depression and suicidal attempts () among teens with CKD. Conclusions. Teens with CKD showed significantly lower prevalence of risk behaviors than controls. Certain patient characteristics were associated with increased risk behaviors among the CKD group. These data are somewhat reassuring, but children with CKD still need routine assessment of and counselling about risk behaviors.
Serum Sulphate Levels in Hemodialysis Patients
Objective. Sulphur, similar to phosphorus, is easily attached to organic compounds. The inadequate elimination of sulphate may cause high sulphate concentrations in hemodialysis (HD) patients because sulphate is low in free form in plasma. Although we are well aware of the accumulation of phosphorus in chronic dialysis patients, we do not have an adequate knowledge database about the sulphur compounds. This study was designed to determine the level of sulphate in hemodialysis patients. Materials and Methods. Ninety-four prevalent HD patients and 33 patients without renal failure were included in the study. The serum inorganic sulphate levels were measured by turbidimetric technique. Moreover, the serum level of urea, creatinine, albumin, calcium, phosphorus, and parathyroid hormone concentrations was simultaneously recorded. Results. Mean levels of plasma sulphate were significantly higher (0.56 ± 0.17 mM vs 0.31 ± 0.13 mM, ) in HD patients. Serum sulphate level correlated with patient’s age, serum albumin, serum BUN and creatinine, and serum phosphorus level in HD patients. Serum sulphate levels were not associated with serum parathyroid hormone levels. Conclusion. Serum sulphate levels were approximately twofold higher in HD patients than in the normal control group. Inorganic sulphate does not seem to accumulate in long-term dialysis patients, and mild increased serum levels of sulphate has no poor clinical outcome in these patients.