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INTRODUCTION: The current definition of acute kidney injury (AKI) includes increased serum creatinine (sCr) concentration and decreased urinary output (UO). Recent studies suggest that the standard UO threshold of 0.5 ml/kg/h may be suboptimal. This study aimed to develop and validate a novel UO-based AKI classification system that improves mortality prediction and patient stratification. METHODS: Data were obtained from the MIMIC-IV and eICU databases. The development process included (1) evaluating UO as a continuous variable over 3-, 6-, 12-, and 24-h periods; (2) identifying 3 optimal UO cutoff points for each time window (stages 1, 2, and 3); (3) comparing sensitivity and specificity to develop a unified staging system; (4) assessing average versus persistent reduced UO hourly; (5) comparing the new UO-AKI system to the KDIGO UO-AKI system; (6) integrating sCr criteria with both systems and comparing them; and (7) validating the new classification with an independent cohort. In all these steps, the outcome was hospital mortality. Another analyzed outcome was 90-day mortality. The analyses included ROC curve analysis, net reclassification improvement (NRI), integrated discrimination improvement (IDI), and logistic and Cox regression analyses. RESULTS: From the MIMIC-IV database, 35,845 patients were included in the development cohort. After comparing the sensitivity and specificity of 12 different lowest UO thresholds across four time frames, 3 cutoff points were selected to compose the proposed UO-AKI classification: stage 1 (0.2-0.3 mL/kg/h), stage 2 (0.1-0.2 mL/kg/h), and stage 3 (< 0.1 mL/kg/h) over 6 h. The proposed classification had better discrimination when the average was used than when the persistent method was used. The adjusted odds ratio demonstrated a significant stepwise increase in hospital mortality with advancing UO-AKI stage. The proposed classification combined or not with the sCr criterion outperformed the KDIGO criteria in terms of predictive accuracy-AUC-ROC 0.75 (0.74-0.76) vs. 0.69 (0.68-0.70); NRI: 25.4% (95% CI: 23.3-27.6); and IDI: 4.0% (95% CI: 3.6-4.5). External validation with the eICU database confirmed the superior performance of the new classification system. CONCLUSION: The proposed UO-AKI classification enhances mortality prediction and patient stratification in critically ill patients, offering a more accurate and practical approach than the current KDIGO criteria.

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INTRODUCTION: In hospitalized patients with acute renal injury (AKI), acute tubulointerstitial nephritis (AIN) constitutes one of the leading etiologies. The objective of this study was to identify clinical and biochemical variables in patients with AKI associated with kidney biopsy-confirmed AIN. METHODS: For our prospective study, we recruited hospitalized patients aged 18 years and older who were diagnosed with AKI based on biochemical criteria. Prior to enrollment, each patient was assessed with a complete metabolic panel and a kidney biopsy. RESULTS: The study consisted of 42 patients (with a mean age of 45 years) and equal numbers of male and female patients. Diabetes and hypertension were the main comorbidities. Nineteen patients had histological findings consistent with AIN. There was a correlation between histology and the BUN/creatinine ratio (BCR) (r = -0.57, p = 0.001). The optimal Youden point for classifying AIN via a receiver operating characteristic (ROC) curve analysis was a BCR ≤ 12 (AUC = 0.73, p = 0.024). Additionally, in diagnosing AIN, BCR had a sensitivity of 76%, a specificity of 81%, a positive predictive value of 81%, a negative predictive value of 76%, and OR of 14 (95% CI = 2.6 to 75.7, p = 0.021). In the multivariable analysis, BCR was the sole variable associated with AIN. CONCLUSION: A BCR ≤ 12 identifies AIN in patients with AKI. This study is the first to prospectively assess the relationship between renal biopsy results and BCR.

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The degradation of the chemotherapeutic drug cyclophosphamide in artificial urine was evaluated by Electrochemical Advanced Oxidation Processes (EAOP). The system consisted of an electrochemical flow reactor with a commercial DSA® electrode (nominal composition Ti / Ru0,3Ti0,7O2) and Ti-mesh cathode. In order to assess the best parameters, the effect of current density, time and flow rate were analyzed using an initial 23 factorial design. The chosen response variable was the energy efficiency to produce free chlorine species (HClO/ClO-). After obtaining the most significant factors, the Central Composite Design (CCD) was performed, where the optimum conditions were determined for the current density range (11.714 mA cm-2 and 66.57 mA cm-2), flow rate (31.33 mL min-1) and time range (19 and 37 min). Under an optimized condition, the efficiency of other combined methods (photo-assisted electrochemical, photochemical, sonoelectrochemical and photo-assisted sonoelectrochemical) was evaluated. The efficiency of degradation processes was determined by removal of Chemical Oxygen Demand (COD), creatinine and urea. Analysis by HPLC demonstrates that the cyclophosphamide was substantially removed during the treatment process of ∼77%. Based on these results, it can be observed that the coupling between electrochemical and photochemical processes is a promising alternative for the treatment of this effluent, as a marked reduction of organic matter is observed (63, 94% of creatinine, 29.62% of urea, 39.1% of TOC) and a low treatment cost ratio.

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Introducción: el método recomendado para la medición de creatinina plasmática (Cr) es el enzimático, que permite obtener la tasa de filtrado glomerular estimado (TFGe) con la fórmula Full-Age-Spectrum (FAS) para todas las edades, al normalizar la TFGe con valores poblacionales de Cr. Objetivos: obtener valores poblacionales de Cr medida con un método enzimático y evaluar la fórmula FAS, en una población pediátrica ambulatoria de la Argentina, puesto que no existen publicaciones al respecto en nuestro país. Material y métodos: estudio descriptivo, retrospectivo, transversal, por muestreo consecutivo. Se consideró la población pediátrica ambulatoria de 2 a 17 años que concurrió una sola vez, entre 07/2018 y 11/2021 al laboratorio del Hospital Municipal (Bahía Blanca, Argentina) con petición médica de Cr. Se evaluó la distribución poblacional de Cr. Se comparó FAS original (FAS-Belga) con FAS normalizada con valores locales de Cr (FAS-Local). Resultados: se estudiaron 2793 individuos. Los varones tuvieron un valor de Cr superior al de las mujeres a los 16 y 17 años. La TFGe fue menor con FAS-Local que con FAS-Belga [mediana (RI) mL/min/1,73 m2 : 107,3 (22,9) vs. 117,0 (26,5); p=0,0001; rbis=0,87 (tamaño del efecto grande)]. Del análisis del gráfico de Bland-Altman y el índice de concordancia Kappa se obtuvo que FAS-Local no fue comparable con FAS-Belga. Conclusiones: los valores poblacionales de Cr, medida con un método enzimático, son los primeros en obtenerse en una población pediátrica ambulatoria argentina. Dichos valores son necesarios para aplicar FAS en la Argentina (AU)

Introduction: the recommended test for the measurement of plasma creatinine (Cr) is the enzymatic method, which allows calculating the estimated glomerular filtration rate (eGFR) with the Full-Age-Spectrum (FAS) equation for all ages, by normalizing the eGFR with population Cr values. Objectives: to obtain population Cr values measured with an enzymatic method and to evaluate the FAS equation in an pediatric outpatient population in Argentina, since there are no reports on this subject in our country. Material and methods: A descriptive, retrospective, cross-sectional, consecutive sampling study. The pediatric outpatient population aged 2 to 17 years who attended only once to the laboratory of the Municipal Hospital (Bahía Blanca, Argentina) between 07/2018 and 11/2021 with medical request for Cr measurement. The population distribution of Cr was evaluated. The original FAS (FAS-Belgian) was compared to FAS normalized with local Cr values (FAS-Local). Results: 2793 individuals were studied. Males had a higher Cr value than females at 16 and 17 years of age. The eGFR was lower with FAS-Local than with FAS-Belgian [median (IQR) mL/min/1.73 m2: 107.3 (22.9) vs. 117.0 (26.5); p=0.0001; rbis=0.87 (large effect size)]. Analysis of the Bland-Altman plot and the Kappa concordance index showed that FAS-Local was not comparable to FAS-Belgian. Conclusions: population Cr values, measured with an enzymatic method, are the first to be obtained in an Argentine pediatric outpatient population. These values are necessary to apply the FAS in Argentina (AU)

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We assessed the occurrence of aflatoxin M1 (AFM1) in urine in a sample of the MAUCO population-based cohort (n = 120) using an enzyme-linked immune sorbent assay (ELISA) kit specially designed for the analysis of AFM1 in urine. We found AFM1 in the urine of 59% of the participants (> limit of detection), with 12% of the samples being over the limit of quantification. The mean of the quantifiable samples was 0.66 (± 0.35) ng/mg adjusted creatinine, ranging from 0.31 to 1.39 ng/mg creatinine. The mean probable daily intake (PDI) of AFB1 was 0.23 (± 0.37) ng/kg bw according to the upper bound (UB), being significantly higher in women and 0.14 (± 0.23) ng/kg bw in the modified lower bound (mLB) approach, ranging from 0.01 to 1.98 ng/kg bw. The risk of AFB1 was assessed with the margin of exposure (MOE) approach estimated at 2800 in the mean mLB and 1733 in the mean UB. According to the MOE values obtained in this study, aflatoxin B1 exposure must be considered a public health concern and must be taken as a priority for food risk management.

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This study aimed to evaluate the effect of the first and last stocking strategies combined with a partial substitution of the protein from the supplement for urea nitrogen on nutrient intake and digestibility, milk composition, and nitrogen balance of primiparous Girolando cows. The cows were allocated to a double 4 × 4 Latin square composed of four animals and four treatments in a 2 × 2 factorial arrangement. Supplements were formulated to provide an intake of 0.6% body weight, with and without the inclusion of 21% urea nitrogen in their composition. The first stocking management method improved nutrient intake and digestibility. Supplementation with urea led to a 47% higher excretion of urine N (g/day) than the urea treatment. The combination of the supplement without urea and the first stocking provided higher intake and retention of nitrogen and higher retained-N levels (%digested N). The combination of a supplement containing 21% urea nitrogen and the first stocking can be used without compromising the nutritional and productive parameters of the cows.

Objetivou-se avaliar os efeitos dos manejos do pastejo ponta e repasse combinados a substituição parcial da proteína do suplemento por nitrogênio ureico sobre o consumo e digestibilidade dos nutrientes, composição do leite e balanço de nitrogênio de vacas primíparas da raça Girolanda. As vacas foram alocadas em dois quadrados latinos 4 x 4 compostos de quatro animais cada e quatro tratamentos em um esquema fatorial 2 x 2. Os suplementos foram formulados para um consumo de 0,6% do peso corporal: sem utilização de nitrogênio ureico; ou com 21% de nitrogênio ureico em sua composição. O manejo do pastejo de ponta melhorou o consumo e a digestibilidade dos nutrientes. O suplemento contendo ureia excretou 47% a mais de N urina (g/dia) em comparação ao suplemento sem ureia. A combinação entre o suplemento sem ureia e o manejo de pastejo ponta apresentou maior ingestão e retenção de nitrogênio e maior N retido (%N digerido). A combinação entre o suplemento contendo 21% de nitrogênio ureico e o pastejo de ponta pode ser utilizada sem prejuízos aos parâmetros nutricionais e produtivos das vacas.

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Purpose: To analyze the role of serum creatinine levels as a biomarker of intracranial aneurysm outcomes. Methods: This is a prospective analysis of outcomes of patients with intracranial aneurysm. One hundred forty-seven patients with serum creatinine at admission and 6 months follow up were included. Linear and logistic regressions were used to analyze the data. Modified Rankin scale (mRS) was used to assess outcome. Results: Creatinine level was not directly related to aneurysm outcome nor aneurysm rupture (p > 0.05). However, patients with a glomerular filtration rate (GFR) lower than 72.50 mL·min­1 had an odds ratio (OR) of 3.049 (p = 0.006) for worse outcome. Similarly, aneurysm rupture had an OR of 2.957 (p = 0.014) for worse outcomes. Stepwise selection model selected 4 variables for outcomes prediction: serum creatinine, sex, hypertension and treatment. Hypertensive patients had, on average, an increase in 0.588 in mRS (p = 0.022), while treatment with microsurgery had a decrease in 0.555 (p = 0.038). Conclusions: Patients with higher GFR had better outcomes after 6 months. Patients with higher GFR had better outcomes after 6 months. Creatinine presented an indirect role in GFR values and should be included in models for outcome prediction.

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SUMMARY: Cisplatin is a chemotherapeutic agent inducing liver and kidney damage. In this study, we intended to investigate the impact of kefir beverage, an essential probiotic and functional food, on liver and kidney damage induced by cisplatin. Wistar albino rats were divided into four groups: Control, Cisplatin (single dose of 7 mg/kg, intraperitoneal), Kefir (2 ml/d, 7 d, oral gavage), and Cisplatin+Kefir (CK). At the end of day 7, animals were euthanized. Blood, kidney, and liver tissue samples were collected. For both tissues, biochemically ALT, AST, Urea, Creatine; histomorphologically, hematoxylin-eosin, Masson's Trichrome, and immunohistochemical staining of caspase-3, a marker of apoptosis, were performed. Serum urea and creatinine levels of the Cisplatin group were significantly higher than the Control group (p<0.05). In the CK group, kefir consumption decreased urea and creatinin levels approached to Control and Kefir groups. Cisplatin resulted in higher ALT and AST activities, indicating hepatocellular damage, compared to the Control group (p<0.05). Kefir consumption decreased ALT activities approached to both the Control and Kefir group. Histomorphological observations were in agreement biochemical results. In liver and kidney tissues, structural damage was observed with an increase in collagen fibers in the Cisplatin group, and Caspase-3 activity was immunohistochemically higher than in the other groups. In the CK group, collagen fiber increase, structural damage, and Caspase-3 activities were less than in the Cisplatin group. Kefir consumption alleviated liver and kidney damage. However, more research is required to understand such effect of kefir better.

RESUMEN: El cisplatino es un agente quimioterapéutico que induce daño hepático y renal. En este estudio, intentamos investigar el efecto del kéfir, un alimento funcional y probiótico esencial, en el daño hepático y renal inducido por el cisplatino. Se dividieron ratas albinas Wistar en cuatro grupos: control, cisplatino (dosis única de 7 mg/kg, intraperitoneal), kéfir (2 ml/día, 7 días, sonda oral) y cisplatino + kéfir (CK). Al final del día 7, los animales fueron sacrificados. Se recolectaron muestras de sangre, riñón y tejido hepático. Se determinó ALT, AST, Urea y Creatina; Para el análisis histomorfológico, se realizaron tinciones con hematoxilina-eosina, tricrómico de Masson y para inmunohistoquímica, caspasa-3, un marcador de apoptosis. Los niveles séricos de urea y creatinina del grupo de cisplatino fueron significativamente más altos que los del grupo de control (p<0,05). En el grupo CK, el consumo de kéfir disminuyó los niveles de urea y creatinina acercándose a los grupos Control y Kéfir. El cisplatino resultó en actividades más altas de ALT y AST, lo que indica daño hepatocelular, en comparación con el grupo Control (p<0.05). El consumo de kéfir disminuyó las actividades de ALT tanto en el grupo Control como en el de Kéfir. Las observaciones histomorfológicas coincidieron con los resultados bioquímicos. En tejidos hepáticos y renales se observó daño estructural con aumento de fibras colágenas en el grupo de Cisplatino, y la actividad de Caspasa-3 fue inmunohistoquímicamente mayor que en los otros grupos. En el grupo de CK, el aumento de las fibras colágenas, el daño estructural y las actividades de Caspasa-3 fueron menores que en el grupo Cisplatino. El consumo de kéfir mejoró el daño hepático y renal. Sin embargo, se requiere más investigación para comprender mejor el efecto del kéfir.

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Introducción: El estado nutricional al ingreso influye en la evolución del paciente quirúrgico grave. La creatininuria, indicador de este estado, podría mostrar su posible asociación con la evolución de estos pacientes. Objetivos: Identificar la evolución de los pacientes quirúrgicos graves, con ventilación mecánica invasiva y su posible asociación con la creatininuria al ingreso. Métodos: Se realizó un estudio observacional descriptivo y longitudinal, en 85 pacientes quirúrgicos con ventilación mecánica invasiva, ingresados en la sala de cuidados intensivos, desde enero del 2000 a agosto del 2007. Se evaluó el índice APACHE II al ingreso y la creatininuria en la orina de 24 horas durante 3 días seguidos, con un equipo microprocesador Hitachi 902. El valor medio se contrastó con la mortalidad, morbilidad, estadía en cuidados intensivos y tiempo de ventilación mecánica. Las variables cuantitativas se expresaron como media, con desviación estándar y las cualitativas, como frecuencias absolutas o porcentajes. La comparación de medias se realizó con la t de Student. La asociación entre variables cualitativas se evaluó con ji cuadrado. Resultados: La edad media fue de 52,3 ± 15,8 años; el 54,1 por ciento correspondió al sexo masculino y el índice de APACHE II fue 20,4 ± 6 puntos. El diagnóstico más frecuente fue la peritonitis secundaria (49,4 por ciento). Los valores inferiores de creatininuria se asociaron a la mortalidad, presencia de complicaciones, mayor estadía en cuidados intensivos y del tiempo de ventilación mecánica. Conclusiones: La creatininuria al ingreso está asociada a la evolución de los pacientes quirúrgicos con ventilación mecánica invasiva(AU)

Introduction: The nutritional status at admission influences the evolution of the severely ill surgical patient. Urine creatinine, an indicator of this state, could show its possible association with the evolution of these patients. Objectives: To identify the evolution of critically ill surgical patients with invasive mechanical ventilation and its possible association with urine creatinine on admission. Methods: A descriptive and longitudinal observational study was carried out in 85 surgical patients with invasive mechanical ventilation, admitted to the Intensive Care Unit, from January 2000 to August 2007. The APACHE II index on admission and urine creatinine in the 24-hour urine for 3 consecutive days, with a Hitachi 902 microprocessor equipment. The mean value was contrasted with mortality, morbidity, stay in intensive care and time on mechanical ventilation. Quantitative variables were expressed as mean, with standard deviation, and qualitative variables, as absolute frequencies or percentages. The comparison of means was carried out with Student's t test. The association between qualitative variables was evaluated with chi square. Results: The mean age was 52,3 ± 15,8 years; 54,1 percent corresponded to the male sex and the APACHE II index was 20,4 ± 6 points. The most frequent diagnosis was secondary peritonitis (49,4 percent). Lower urine creatinine values ​​were associated with mortality, the presence of complications, a longer stay in intensive care and the time on mechanical ventilation. Conclusions: Urine creatinine on admission is associated with the evolution of surgical patients with invasive mechanical ventilation(AU)

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Introducción: En la actualidad existen más de 150 medicamentos relacionados con la aparición de rabdomiólisis e insuficiencia renal aguda transitoria. La estreptoquinasa puede ser uno de ellos. Objetivo: Presentar un caso en el cual la administración de trombólisis con estreptoquinasa pudiera estar relacionado con una insuficiencia renal aguda transitoria. Caso clínico: Paciente de 38 años, con antecedentes de salud anterior y creatinina de 81 mg/L días antes del ingreso, sufrió infarto miocárdico agudo y después de la trombólisis con estreptoquinasa presentó dolores musculares intensos, náuseas, vómitos y lumbalgia intensa. La creatinina ascendió progresivamente; tuvo oligoanuria progresiva que evolucionó hasta las dos semanas y luego se recuperó. A los 21 días, la creatinina estaba en 116 mg/L. En la coronariografía, las coronarias son normales. Comentarios: Las causas de insuficiencia renal aguda transitoria pudieran ser, rabdomiólisis asociada con alteraciones del metabolismo del ATP y trastornos inmunológicos provocados por la administración de estreptoquinasa. La coronariografía resultó normal(AU)

Introduction: There are currently more than 150 medications related to the appearance of rhabdomyolysis and transient acute renal failure. Streptokinase can be one of them. Objective: Presenting a case the administration of streptokinase as a possible cause of acute, transient renal failure. Case report: A 38-year-old patient with a previous health history and 81 mg creatinine per liter days before admission, suffers acute myocardial infarction and after streptokinase thrombolysis he suffers severe muscle pain, nausea, vomiting, severe low back pain, creatinine ascends progressively and progressive oligoanuria that evolves until two weeks when it begins to return. At 21 days with 116 mg creatinine per liter, coronary angiography was performed with normal coronaries. Comments: The causes of transient acute renal failure may be rhabdomyolysis associated with abnormalities of the metabolism of ATP and immune disorders, caused by the administration of streptokinase. His coronary angiography was completely normal(AU)

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In this study, against streptozotocin (STZ) induced diapetic nephropathy (DN); it is aimed to investigate the use of thymoquinone (TQ) and ß-aminoisobutyric acid (BAIBA) and to compare the effects of these agents. With random selection of 35 male rats, five groups (seven rats in each group) were constituted as follows: Control, STZ, STZ + TQ, STZ + BAIBA, STZ + TQ + BAIBA. In the STZ group; body weight, glutathione (GSH) and insulin levels decreased, relative kidney weight, malondialdehyde (MDA), glucose, blood urea nitrogen (BUN) and creatinine (Cr) levels were increased. Also, in kidney tissue; histopathological changes (such as thickening of the capsular, glomerular and tubular basement membranes, increased mesangial matrix amount, increased cytoplasmic vacuolization in some of the tubular epithelial cells, increased tumor necrosis factor-alpha (TNF-α) expression, and inflammatory cell infiltrations in interstitial tissue) were detected. It was observed that these changes occurring after diabetes mellitus (DM) reversed significantly in TQ, BAIBA and TQ + BAIBA groups.

En este estudio, contra la nefropatía diapética (ND) inducida por estreptozotocina (STZ); tiene como objetivo investigar el uso de timoquinona (TQ) y ácido ß-aminoisobutírico (BAIBA) y comparar los efectos de estos agentes. Con la selección aleatoria de 35 ratas macho, se constituyeron cinco grupos (siete ratas en cada grupo) como sigue: Control, STZ, STZ + TQ, STZ + BAIBA, STZ + TQ + BAIBA. En el grupo STZ; el peso corporal, los niveles de glutatión (GSH) y de insulina disminuyeron, el peso relativo de los riñones, el malondialdehído (MDA), la glucosa, el nitrógeno ureico en sangre (BUN) y los niveles de creatinina (Cr) aumentaron. Además, en tejido renal; se detectaron cambios histopatológicos (como engrosamiento de las membranas basales capsular, glomerular y tubular, aumento de la cantidad de matriz mesangial, aumento de la vacuolización citoplasmática en algunas de las células epiteliales tubulares, aumento de la expresión del factor de necrosis tumoral alfa (TNF-α) e infiltraciones de células inflamatorias en tejido intersticial). Se observó que estos cambios que ocurren después de la diabetes mellitus (DM) se revirtieron significativamente en los grupos TQ, BAIBA y TQ + BAIBA.

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Glomerular proteinuria is characterized by the loss of high-molecular-weight proteins (HMWPs), while tubulointerstitial proteinuria is characterized by the loss of low-molecular-weight proteins (LMWPs). The objective was to assess the molecular weight of urinary proteins (MWUP) in dogs with naturally acquired CKD and determine the proportion of HMWPs and LMWPs according to CKD stage. Twenty-eight dogs with CKD were recruited and divided into 4 groups based on serum creatinine (Cr) levels (group1: Cr<1,4, n=8; group2: 1,45,0, n=5). The control group consisted of 5 healthy dogs. The MWUP was determined by SDS-PAGE. The urinary protein-to-creatinine ratio (UP/C) was used to quantitatively assess proteinuria. The electrophoresis pattern revealed a proportionally greater loss of HMWPthan of LMWP in all groups with CKD and an increased loss of LMWP in group 4 (P<0.05). These results suggest a predominance of glomerular injuries throughout all stages of CKD in these dogs and an increase in tubulointerstitial injury towards the end-stage of the disease. The results of the present study support the recommendation of SDS-PAGE as an effective technique for the qualitative assessment of proteinuria, as well as a method for assessing the severity and location of renal injury.(AU)

A proteinúria glomerular é caracterizada pela perda de proteínas de alto peso molecular (PAPM), enquanto a proteinúria tubulointersticial se caracteriza pela perda de proteínas de baixo peso molecular (PBPM). O objetivo do trabalho foi determinar o peso molecular das proteínas urinárias (PMPU) de cães com DRC naturalmente adquirida e a proporção de PAPM e PBPM de acordo com o estágio da DRC. Foram utilizados 28 cães com DRC, divididos em quatro grupos, de acordo com o nível sérico de creatinina (cr) (grupo 1: cr<1,4, n=8; grupo 2: 1,45,0, n=5). O grupo controle era composto por cinco cães saudáveis. O PMPU foi determinado por SDS-PAGE. A relação proteína:creatinina urinária (RPCU) foi utilizada como um método quantitativo de proteinúria. A eletroforese revelou uma perda proporcionalmente maior de PAPM, quando comparada às PBPM, em todos os grupos de DRC, bem como uma perda crescente de PBPM no grupo 4 (P<0,05). Esses resultados sugerem uma predominância de lesão glomerular em todos os estágios de DRC nesses cães e uma progressão crescente na lesão túbulo-intersticial no estágio terminal da doença. Os resultados deste estudo reafirmam a recomendação de que a eletroforese de proteínas urinárias é uma técnica qualitativa efetiva de avaliação da proteinúria, bem como um método que permite avaliar a extensão e a localização da lesão renal.(AU)

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Glomerular proteinuria is characterized by the loss of high-molecular-weight proteins (HMWPs), while tubulointerstitial proteinuria is characterized by the loss of low-molecular-weight proteins (LMWPs). The objective was to assess the molecular weight of urinary proteins (MWUP) in dogs with naturally acquired CKD and determine the proportion of HMWPs and LMWPs according to CKD stage. Twenty-eight dogs with CKD were recruited and divided into 4 groups based on serum creatinine (Cr) levels (group1: Cr<1,4, n=8; group2: 1,45,0, n=5). The control group consisted of 5 healthy dogs. The MWUP was determined by SDS-PAGE. The urinary protein-to-creatinine ratio (UP/C) was used to quantitatively assess proteinuria. The electrophoresis pattern revealed a proportionally greater loss of HMWPthan of LMWP in all groups with CKD and an increased loss of LMWP in group 4 (P<0.05). These results suggest a predominance of glomerular injuries throughout all stages of CKD in these dogs and an increase in tubulointerstitial injury towards the end-stage of the disease. The results of the present study support the recommendation of SDS-PAGE as an effective technique for the qualitative assessment of proteinuria, as well as a method for assessing the severity and location of renal injury.(AU)

A proteinúria glomerular é caracterizada pela perda de proteínas de alto peso molecular (PAPM), enquanto a proteinúria tubulointersticial se caracteriza pela perda de proteínas de baixo peso molecular (PBPM). O objetivo do trabalho foi determinar o peso molecular das proteínas urinárias (PMPU) de cães com DRC naturalmente adquirida e a proporção de PAPM e PBPM de acordo com o estágio da DRC. Foram utilizados 28 cães com DRC, divididos em quatro grupos, de acordo com o nível sérico de creatinina (cr) (grupo 1: cr<1,4, n=8; grupo 2: 1,45,0, n=5). O grupo controle era composto por cinco cães saudáveis. O PMPU foi determinado por SDS-PAGE. A relação proteína:creatinina urinária (RPCU) foi utilizada como um método quantitativo de proteinúria. A eletroforese revelou uma perda proporcionalmente maior de PAPM, quando comparada às PBPM, em todos os grupos de DRC, bem como uma perda crescente de PBPM no grupo 4 (P<0,05). Esses resultados sugerem uma predominância de lesão glomerular em todos os estágios de DRC nesses cães e uma progressão crescente na lesão túbulo-intersticial no estágio terminal da doença. Os resultados deste estudo reafirmam a recomendação de que a eletroforese de proteínas urinárias é uma técnica qualitativa efetiva de avaliação da proteinúria, bem como um método que permite avaliar a extensão e a localização da lesão renal.(AU)

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INTRODUCTION: By quantifying the measurement uncertainty (MU), both the laboratory and the physician can have an objective estimate of the results' quality. There is significant flexibility on how to determine the MU in laboratory medicine and different approaches have been proposed by Nordtest, Eurolab and Cofrac to obtain the data and apply them in formulas. The purpose of this study is to compare three different top-down approaches for the estimation of the MU and to suggest which of these approaches could be the most suitable choice for routine use in clinical laboratories. MATERIALS AND METHODS: Imprecision and bias of the methods were considered as components of the MU. The bias was obtained from certified reference calibrators (CRC), proficiency tests (PT), and inter-laboratory internal quality control scheme (IQCS) programs. The bias uncertainty, the combined and the expanded uncertainty were estimated using the Nordtest, Eurolab and Cofrac approaches. RESULTS: Using different approaches, the expanded uncertainty estimates ranged from 18.9-40.4%, 18.2-22.8%, 9.3-20.9%, and 7.1-18.6% for cancer antigen (CA) 19-9, testosterone, alkaline phosphatase (ALP), and creatinine, respectively. Permissible values for MU and total error ranged from 16.0-46.1%, 13.1-21.6%, 10.7-26.2%, and 7.5-17.3%, respectively. CONCLUSION: The bias was highest using PT, followed by CRC and IQCS data, which were similar. The Cofrac approach showed the highest uncertainties, followed by Eurolab and Nordtest. However, the Eurolab approach requires additional measurements to obtain uncertainty data. In summary, the Nordtest approach using IQCS data was therefore found to be the most practical formula.

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Background: Visceral leishmaniasis is a complex vector-borne disease caused by the protozoan Leishmania infantum. In urban centers of South America, where this zoonotic cycle occurs, dogs seem to be the main reservoirs and infection sources. Animals with canine visceral leishmaniasis (CVL) may have a wide clinical spectrum, and dogs are usually classified as asymptomatic, oligosymptomatic, and symptomatic. Several organs are affected in canine CVL, and renal involvement is often a determining factor in dog prognosis. Nevertheless, serum markers are slow to indicate loss of renal function. The aim of this study was to evaluate kidney impairment in dogs diagnosed with CVL. Materials, Methods & Results: Blood and urine samples were collected from 45 dogs from Barra Mansa-RJ, and used for urinalysis, urine protein/creatinine (UPC) ratio, and serum concentrations of urea and creatinine. The animals were classified as symptomatic (42.2%), oligosymptomatic (37.8%), and asymptomatic (20.0%). Some alterations were found in the urine samples; pale-yellow color in 17.8%, low specific gravity in 6.7%, turbidity in 51.1%, proteinuria in 80%, occult blood in 46.7%, bilirubin in 8.89%, and glucose in 6.7% of the samples. According to the UPC ratio, 60% of dogs were proteinuric, and UPC > 2.0 was high in symptomatic dogs. Azotemia was observed only in three dogs with CVL. Discussion: The majority of dogs presented one or more symptoms of CVL, as expected in an endemic area from Brazil. Pale-yellow urine was observed in some samples, and this change, when accompanied by the decreased urine specific gravity in dogs with CVL, suggests some degree of kidney disease. The presence of epithelial and red blood cells, leukocytes, bacteria, suspended mucus, and phosphate crystals that precipitate in alkaline urines could be associated, to some degree, with the urine turbidity found in the present study. The alkaline urine identified in some dogs could be related to...

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A low-cost and disposable microcell was constructed with a screen-printed electrode for the non-enzymatic electrochemical determination of creatinine. The working electrode was modified with carbon black and maintained in contact with paper-adsorbed iron (III) ions. A small sample volume of 3 µL was required for the device operation. Then, iron (III) ions were complexed in the presence of creatinine in a chemical step, followed by an electrochemical reduction of non-complexed metallic ions in excess. Cyclic voltammetry and differential-pulse voltammetry experiments were employed for the electrochemical characterizations and analytical performance evaluation of the microcell. The working electrode modification with carbon black provided a significant increase of analytical signal. The sensor presented a linear response for creatinine concentrations ranging from 0.10 to 6.5 mmol L-1, with a limit of detection of 0.043 mmol L-1. Experiments for creatinine determination in real samples were successful performed through of standard recovery in urine.

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COVID-19 Community acquired pneumonía is a recent and frequent cause of admission in European intensive care units. Currently, there are many open questions regarding the management and prognostic factors of these patients. Among them, its association with acute renal failure in patients on mechanical ventilation. Analysis of acute renal failure in COVID-19 patients on mechanical ventilation. Prognosis and factors related to its development. Retrospective observational study carried out in the intensive care unit of a University Hospital during the COVID-19 pandemic. We analysed patients admitted to the ICU with the diagnosis of Respiratory Failure due to Pneumonia COVID-19 between 6/3/2020 and 21/4/2020. Demographic data (age, sex), APACHE II, comorbidities, analytical data (ferritin, total bilirubin), length of stay, treatments administered (mechanical ventilation, muscle relaxant, vasoactive drugs, prone) and its association to acute renal failure were analysed. 67 patients received complete treatment in our hospital. Length of stay (days) 14.1 ± 10, average age 60 years, APACHE II 14.3 ± 5.2, 67.2% males. Maximum creatinine mean value (mg/dl) 1.48 ± 1.26, Maximum ferritin mean value (ng/ml) 2,310 ± 3,322, Maximum total bilirubin mean value (mg/dl) 2 ± 2.2. 100% of the patients required mechanical ventilation. 65.7% prone positioning, 74.6% neuromuscular blockers and 98.5% required vasoactive drugs. Establishing renal failure as creatinine values greater than 1.2 mg/dl. Patients with maximum creatinine above 1.2 mg/dl presented average values of bilirubin and ferritin higher than those with values under 1.2 mg/dl (P < 0.05). The presence of renal failure was also statistically significantly associated with sex (male), presence of dyslipidaemia, and mortality. In our sample, we have associated acute renal failure with higher ferritin valúes. Likewise, we have observed higher creatinine valúes in the group of non-survivors, those with dyslipidaemia and men, with statistical signification.

La neumonía adquirida en la comunidad COVID-19 es una causa reciente y frecuente de ingreso en las unidades de cuidados intensivos europeos. Actualmente, hay muchas preguntas abiertas con respecto al manejo y los factores pronósticos de estos pacientes. Entre ellos, su asociación con insuficiencia renal aguda en pacientes en ventilación mecánica. Análisis de insuficiencia renal aguda en pacientes con COVID-19 en ventilación mecánica. Pronóstico y factores relacionados con su desarrollo. Estudio observacional retrospectivo realizado en la unidad de cuidados intensivos de un Hospital Universitario durante la pandemia de COVID-19. Analizamos los pacientes ingresados en UCI con el diagnóstico de insuficiencia respiratoria por neumonía COVID-19 entre el 3/6/2020 y el 21/4/2020. Se analizaron datos demográficos (edad, sexo), APACHE II, comorbilidades, datos analíticos (ferritina, bilirrubina total), tiempo de estancia, tratamientos administrados (ventilación mecánica, relajante muscular, fármacos vasoactivos, prono) y su asociación con insuficiencia renal aguda. 67 pacientes recibieron tratamiento completo en nuestro hospital. Duración de la estancia (días) 14,1 ± 10, edad media 60 años, APACHE II 14,3 ± 5,2, 67,2% varones. Valor medio máximo de creatinina (mg/dl) 1,48 ± 1,26, valor medio máximo de ferritina (ng/ml) 2.310 ± 3.322, valor medio máximo de bilirrubina total (mg/dl) 2 ± 2,2. El 100% de los pacientes requirió ventilación mecánica. El 65,7% en decúbito prono, el 74,6% bloqueantes neuromusculares y el 98,5% requirieron fármacos vasoactivos. Estableciendo la insuficiencia renal como valores de creatinina superiores a 1,2 mg/dl, los pacientes con creatinina máxima superior a 1,2 mg/dl presentaron valores medios de bilirrubina y ferritina superiores a aquellos con valores menores a 1,2 mg/dl, de forma estadísticamente significativa. La presencia de fallo renal, también se asoció de forma estadísticamente significativa al sexo hombre, la presencia de dislipidemia como antecedente personal de interés y a la mortalidad. En nuestra muestra hemos asociado la insuficiencia renal aguda con valores más elevados de ferritina. Asimismo, hemos observado mayores valores de creatinina en el grupo de no supervivientes, los que presentan dislipidemia y los hombres, con significación estadística.

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OBJECTIVE: Urinary stones with oxalate composition can cause kidney failure. Recent findings evidenced that probiotics are effective in reducing oxalate absorption in these subjects based on their high colonic absorption levels at baseline. The purpose of this study was to evaluate the effect of the simultaneous use of oxalate-degrading bacteria, Urtica dioica and T. terrestris extract in reducing urinary oxalate. MATERIALS AND METHODS: Anti-urolithiatic activity of Urtica dioica and T. terrestris extract and pro-biotic by using ethylene glycol induced rat model. In this study, 4 strains of Lactobacillus and 2 strains of Bifidobacterium and also 2 strains of L. paracasei (that showed high power in oxalate degrading in culture media) were used. Male Wistar rats were divided into four groups (n=6). The rats of group-I received normal diet (positive control group) and groups-II (negative control group), III, IV rats received diet containing ethylene glycol (3%) for 30 days. Groups III rats re-ceived Urtica dioica and T. terrestris extract. Groups IV rats received extracts + probiotic for 30 days. FINDINGS: The results show that the use of herbal extracts (Urtica dioica and T. terrestris) redu-ced the level of urinary oxalate and other parameters of urine and serum. Also, the accumulation of calcium oxalate crystals in the kidney tissue was significantly reduced. CONCLUSION: Considering that the formation of calcium oxalate crystals can cause inflammation and tissue damage in the kidney, the use of herbal extracts with oxalatedegrading bacteria can be a new therapeutic approach to preventing the formation of kidney stones.

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ABSTRACT Objective: Urinary stones with oxalate composition can cause kidney failure. Recent findings evidenced that probiotics are effective in reducing oxalate absorption in these subjects based on their high colonic absorption levels at baseline. The purpose of this study was to evaluate the effect of the simultaneous use of oxalate-degrading bacteria, Urtica dioica and T. terrestris extract in reducing urinary oxalate. Materials and Methods: Anti-urolithiatic activity of Urtica dioica and T. terrestris extract and probiotic by using ethylene glycol induced rat model. In this study, 4 strains of Lactobacillus and 2 strains of Bifidobacterium and also 2 strains of L. paracasei (that showed high power in oxalate degrading in culture media) were used. Male Wistar rats were divided into four groups (n=6). The rats of group-I received normal diet (positive control group) and groups-II (negative control group), III, IV rats received diet containing ethylene glycol (3%) for 30 days. Groups III rats received Urtica dioica and T. terrestris extract. Groups IV rats received extracts + probiotic for 30 days. Findings: The results show that the use of herbal extracts (Urtica dioica and T. terrestris) reduced the level of urinary oxalate and other parameters of urine and serum. Also, the accumulation of calcium oxalate crystals in the kidney tissue was significantly reduced. Conclusion: Considering that the formation of calcium oxalate crystals can cause inflammation and tissue damage in the kidney, the use of herbal extracts with oxalate degrading bacteria can be a new therapeutic approach to preventing the formation of kidney stones.

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INTRODUCTION: This article aims to estimate reference values for laboratory tests of cholesterol, glycosylated hemoglobin and creatinine for the Brazilian adult population. METHODS: A descriptive study carried out with laboratory data from the National Health Survey (Pesquisa Nacional de Saúde - PNS). Samples of blood and urine were collected in a PNS subsample of 8,952 individuals aged 18 years old or older. To determine the reference values, exclusion criteria were applied: presence of previous diseases and outliers, defined by values outside the range estimated by the mean ± 1.96 × standard deviation. Subsequently, reference values were calculated according to gender, age group and race/skin color. RESULTS: Differences in reference values according to gender were observed. Women had higher values of total cholesterol, LDL-c and HDL-c. Glycosylated hemoglobin showed similar values in relation to gender, and creatinine was higher among men. The mean reference values were higher in the elderly population, aged 60 years old or older. The mean, lower and upper limits of total cholesterol and fractions of non-white people were slightly lower. There was no difference according to race/skin color for glycosylated hemoglobin and creatinine. CONCLUSION: The establishment of national reference parameters for laboratory tests, adapted to the sociodemographic and geographic characteristics, provides relevant information for evaluation of diagnosis and treatment of chronic diseases in Brazil.

INTRODUÇÃO: Este artigo teve o objetivo de estimar valores de referência de exames laboratoriais de colesterol, hemoglobina glicosilada e creatinina para a população adulta brasileira. MÉTODOS: Estudo descritivo realizado com os dados laboratoriais da Pesquisa Nacional de Saúde (PNS). Foram coletadas amostras de sangue e urina em subamostra da PNS constituída de 8.952 indivíduos de 18 anos ou mais. Para determinar os valores de referência, aplicaram-se critérios de exclusão, como a presença de doenças prévias e dos outliers, definidos pelos valores fora do intervalo estimado pela média ± 1,96 × desvio padrão. Posteriormente, foram calculados os valores de referência segundo sexo, faixa etária e raça/cor. RESULTADOS: Observaram-se diferenças nos valores de referência de acordo com o sexo. O colesterol total, a lipoproteína de baixa densidade colesterol (LDL-c) e a lipoproteína de alta densidade colesterol (HDL-c) apresentaram valores mais elevados entre as mulheres. A hemoglobina glicosilada alcançou valores semelhantes segundo sexo, e a creatinina foi mais elevada entre os homens. Os valores médios de referência foram mais altos na população idosa, de 60 anos ou mais. A média e os limites inferiores e superiores do colesterol total e frações dos indivíduos não brancos foram ligeiramente mais baixos. Não houve diferença segundo raça/cor para hemoglobina glicosilada nem para creatinina. CONCLUSÃO: O estabelecimento de parâmetros nacionais de referência de exames laboratoriais, adaptados às características sociodemográficas e geográficas, fornece subsídios relevantes para a avaliação do diagnóstico e tratamento de doenças crônicas no Brasil.

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