Intensive renal support in critically ill patients with acute kidney injury did not decrease mortality, improve recovery of kidney function, or reduce the rate of nonrenal organ failure as compared with less-intensive therapy involving a defined dose of intermittent hemodialysis three times per week and continuous renal-replacement therapy at 20 ml per kilogram per hour. (ClinicalTrials.gov number, NCT00076219.)
Objectives: To assess the effect of fasting Ramadan during the hottest month of the year in Riyadh, Saudi Arabia. Materials and Methods: This prospective cohort study was performed at the King Fahd National Guard Hospital in Riyadh, Saudi Arabia. We used the Modification of Diet in Renal Disease formula to estimate the glomerular filtration rate in renal transplant patients who fasted and did not fast before and after Ramadan. Results: There were 43 fasters and 37 nonfasters of comparable ages, with fasters having longer posttransplant times compared with nonfasters (P = .0001). The 2 groups had similar mean estimated glomerular filtration rates before Ramadan: 75.6 ± 29.2 and 65.9 ± 25.9 mL/min (P = .1) and similar mean estimated glomerular filtration rates 6 months after Ramadan: 77.2 ± 29.7 and 64.1 ± 29 mL/min (P = .21). Mean changes in the estimated glomerular filtration rate were similar in the 2 groups: -1.5 ± 10.9 and -2.8 ± 19.3 (P = .7) as was the percentage change (-0.2.2 ± 13.4 and 1.8 ± 15.9; P = .4). In the fasting group, serum creatinine and estimated glomerular filtration rate were similar before and 6 months after Ramadan: 105.1 ± 55 and 105.14 ± 61 µmol/L (P = 1.0) and 75.6 ± 29 and 72.2 ± 29.7 mL/min (P = .36). No significant changes were observed in the nonfasting group. No significant differences were detected regarding fasting in the estimated glomerular filtration rate before and 6 months after Ramadan in the 3 groups with the low, moderate, and high glomerular filtration rates at baseline. Conclusions: Fasting for Ramadan in August does not adversely affect graft function at a mean followup of 7.6 ± 1.3 months.
The aim of the current study is to comparatively examine the nephroprotective effects of pioglitazone and glibenclamide in a rat model subjected to gentamicin-induced nephrotoxicity. Six groups of rats were given either normal saline, or gentamicin, or pioglitazone, or gentamicin plus pioglitazone, or glibenclamide, or gentamicin plus glibenclamide for 11 days. The group administered gentamicin plus glibenclamide had a significant elevation of antioxidant enzyme activity and a significant reduction in lipid peroxidation when compared with the group treated just with gentamicin. The gentamicin plus glibenclamide group also showed mild necrosis according to histopathology when compared with the gentamicin-alone group. In contrast, the gentamicin plus pioglitazone group had a significant reduction in antioxidant enzyme activity and a significant elevation in lipid peroxidation levels when compared with the gentamicin-alone group. Our study showed that only glibenclamide but not pioglitazone has protective effects against gentamicin-induced nephrotoxicity in rats.
Objectives: To investigate the predictive value of urinary neutrophil gelatinase-associated lipocalin in the occurrence of delayed graft function after kidney transplant. Materials and Methods: In this prospective cohort study of 67 consecutive patients who received a living-related (40 patients [61%]) or deceased-donor kidney transplant (27 patients [39%]), urinary neutrophil gelatinase-associated lipocalin was determined in the first 100 mL perfusate of the donor kidney and in urine at 6 hours after transplant. Patients were followed (11 ± 7 mo) for changes in estimated glomerular filtration rate and delayed graft function. Results: The mean urinary neutrophil gelatinaseassociated lipocalin level at 6 hours after transplant was significantly higher after deceased-donor (781 ± 452 ng/mL) than living-donor transplant (229 ± 223 ng/mL; P ≤ 0.001). The decrease in estimated glomerular filtration rate from 6 to 12 months after transplant was positively correlated with the urinary neutrophil gelatinase-associated lipocalin levels in the perfusate in living-donor transplant. A significant correlation was noted between the occurrence of delayed graft function and the urinary neutrophil gelatinase-associated lipocalin level at 6 hours after living-donor transplant. In the deceased-donor group, the occurrence of delayed graft function was correlated with urinary neutrophil gelatinase-associated lipocalin levels in the perfusate. In deceased-donor kidney transplant, the mean urinary neutrophil gelatinase-associated lipocalin level in the perfusion fluid was significantly greater from donors who had terminal serum creatinine > 150 μmol/L, and urinary neutrophil gelatinase-associated lipocalin level at 6 hours after transplant was significantly greater in transplants with longer cold ischemia time and donors who had hypertension. Conclusions: Urinary neutrophil gelatinase-associated lipocalin levels in the donor kidney perfusate and 6 hours after transplant may be a useful predictor of delayed graft function and decreased graft function from 6 to 12 months after transplant.
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