Plasma cystatin C is an emerging parameter to assess kidney function. Its utility in assessing the adequacy of hemodialysis in patients with end-stage-renal disease has however not been established with certainty. This study was therefore carried out to assess the usefulness of serum cystatin C estimation in patients undergoing low flux membrane hemodialysis. Serum creatinine and cystatin C were estimated in 20 patients before and after undergoing hemodialysis. The mean serum creatinine decreased from a pre-dialysis value of 7.72 mg/dL to a post-dialysis value of 2.90 mg/dL. On the contrary, the mean serum cystatin C levels were found to increase from a pre-dialysis value of 5.97 mg/L to a post-dialysis value of 8.25 mg/L. Therefore, serum cystatin C cannot be used to monitor dialysis adequacy. It however, serves as a surrogate marker of the inadequacy of low flux membrane bicarbonate hemodialysis in clearing low molecular weight proteins from the circulation.
Cystatin C is an emerging parameter for the assessment of renal allograft function. The objective of the study was to compare the efficacy of serum cystatin C (SCys) with the established parameter serum creatinine (SCr) in the assessment of renal function in renal transplant recipients (RTR). The glomerular filtration rate (GFR) of 30 renal transplant patients and 29 control subjects was determined using (99m)Tc Diethylene-triamine-penta-acetate (DTPA) method. SCr was measured using an automated Jaffe's assay and SCys was measured using latex particle enhanced turbidimetric immuno assay (PETIA). The modification of diet in renal disease (MDRD) formula was used to calculate GFR from SCr, while the Le Bricon formula was used to derive GFR based on SCys. Statistical analysis was performed using MedCalc software. SCr and SCys levels were significantly higher, while DTPA clearance was significantly lower in RTR (P < 0.0001) when compared with controls. The correlation coefficient (r value) between calculated GFR based on MDRD method and DTPA clearance was 0.343 (P = 0.06) while the calculated GFR based on Le Bricon formula was 0.694 (P < 0.001). The results have shown that SCys is a better parameter than SCr in assessing renal function in RTR. The inclusion of SCys as an additional parameter would certainly help in detection of even a marginal decline in renal function and also in adjusting the dosage of immunosuppressive drugs.
Rhabdomyolysis is a clinical syndrome resulting from the disintegration of muscle cell and spillage of toxic intracellular contents into circulation. Strenuous, unaccustomed exercise leads to exertional rhabdomyolysis and cause AKI. We report a 26-year-old female who developed white collar rhabdomyolysis with AKI after performing sit-ups (Super Yoga Brain) for 108 times in temple. She was managed with hemodialysis and supporting therapy. She made a full recovery after 4 weeks. Awareness of this condition and early diagnosis is highlighted.
Background: High mortality rate in acute kidney injury (AKI) has interested many authors to conduct studies about factors predicting its outcome. The need for both dialysis and ICU care defines a group of critically ill patients who may have poor prognosis and consume vast amounts of resources. In this study we determine the variables predicting the outcome of patients with severe acute kidney failure requiring haemodialysis and to ascertain the aetiology of acute kidney injury in this group.Methods: We prospectively analysed 114 patients admitted with severe renal failure requiring renal replacement therapy over a period of one year. The influence of various factors such as demographic variables, pre morbidities, details of admission, clinical presentation and extent of organ dysfunction on the clinical outcome such as mortality and progression to end stage kidney disease were statistically analyzed using SPSS version 12 (SPSS Inc., Chicago, Ill).Results: Univariate and multivariate analysis showed that parameters such as chronic liver disease, preexisting heart disease, mechanical ventilation and vasopressor requirement, oliguria, sepsis, hepatorenal syndrome, cardiogenic shock and admission in ICU were associated with high mortality (p<0.05). Of the 114 patients, 49 died (42.98%), 61 (53.5%) were dialysis independent and 4 patients (3.5%) progressed to end stage renal disease (ESRD).Conclusions: AKI patients requiring hemodialysis were associated with high hospital mortality. Patients who were diagnosed to have acute glomerulonephritis especially rapidly progressing glomerulonephritis as the cause of AKI were more prone to ESRD. Most survivors were dialysis independent at the time of discharge.
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