calca-protein--human and Albuminuria

The aim of this study was to investigate the effect of low-dose hydrocortisone on glomerular permeability measured by the microalbuminuria to creatinine ratio (MACR) and on other markers of sepsis in severe septic patients.. Randomized prospective study.. University intensive care unit.. The study involved 40 patients with severe sepsis randomized into the hydrocortisone group (n = 20) and the standard therapy group (n = 20).. The hydrocortisone group received standard therapy plus a continuous infusion of hydrocortisone for 6 days, whereas the standard therapy group received only standard therapy.. MACR, serum C-reactive protein, and procalcitonin concentrations were recorded every day from the day before the steroid therapy (T(0)) until the 6 days after (T(1), T(2), T(3), T(4), T(5), and T(6)). Concentrations in the hydrocortisone group and the standard therapy group were compared using Mann-Whitney test at each time. We also compared with Wilcoxon signed rank test the values determined in each group at T(0) with those at each subsequent time. Median MACR decreased from T(0) to T(6) in both patient groups; however, values were significantly lower in the hydrocortisone group from T(3) through to T(6). Median serum C-reactive protein also decreased from T(0) in both patient groups, with significantly lower values in the hydrocortisone group from T(3) through to T(6). There were no significant differences in procalcitonin between groups compared with baseline values or at any individual time point.. Low-dose hydrocortisone seems to reduce MACR and serum C-reactive protein but not procalcitonin in patients with severe sepsis. Further studies are needed to confirm these results and to understand the underlying molecular mechanisms.

Topics: Aged; Albuminuria; Anti-Inflammatory Agents; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Creatinine; Humans; Hydrocortisone; Intensive Care Units; Middle Aged; Prospective Studies; Protein Precursors; Sepsis

Our objective was to investigate whether short-term infusion of the oxygen free radical scavenger N-acetylcysteine (NAC) administered before and during extensive abdominal surgery could ameliorate the progression of early systemic inflammatory response.. Prospective, randomised, double-blinded, placebo-controlled clinical trial.. Twenty-bed intensive care unit in a university hospital.. Following written informed consent, 100 patients were randomised into NAC and placebo groups. Three patients from the NAC group and four from the placebo group withdrew before the final analysis.. The treatment group (n=47) received NAC (150 mg/kg(-1) bolus followed by a continuous infusion of 12 mg/kg(-1)/h(-1)) and the placebo group ( n=46) received the same volume of 5% dextrose during surgery.. Serum procalcitonin (PCT), C-reactive protein (CRP) and microalbuminuria was monitored preoperatively, on admission to ICU, then daily during the first 3 postoperative days. For statistical analysis Mann Whitney and Chi-squared tests were used. Patients' clinical course was similar in each group as monitored by the Multiple Organ Dysfunction Scores. There was no significant difference between the two groups regarding PCT and microalbuminuria at any assessment point. Significantly lower CRP levels were found in the NAC group on days 1 and 2 (t(24): median: 84.5 interquartile range: [62-120] vs. 118 [86-137] mg/l; p=0.020; t(48): 136 [103-232] vs. 195 [154-252] mg/l; p=0.013, NAC vs. placebo respectively).. In this study, short-term NAC treatment decreased CRP levels, but failed to attenuate any other inflammatory response, as monitored by serum PCT and microalbuminuria. Overall, our results do not support the routine prophylactic use of NAC as a free radical scavenger in abdominal surgery.

Topics: Abdomen; Acetylcysteine; Aged; Albuminuria; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Double-Blind Method; Female; Free Radical Scavengers; Humans; Intensive Care Units; Male; Middle Aged; Multiple Organ Failure; Postoperative Period; Protein Precursors; Systemic Inflammatory Response Syndrome

To investigate whether short-term N-acetylcysteine (NAC) infusion administered before and during extensive abdominal surgery could modify the progression of early postoperative organ dysfunction and systemic inflammatory response.. After randomisation the treatment group (n = 47) received NAC (150 mg kg-1 bolus followed by a continuous infusion of 12 mg kg-1 h-1) and the placebo group (n = 46) received the same volume of 5% dextrose during surgery. Clinical progress was monitored by the Multiple organ dysfunction score, systemic inflammatory response by serum procalcitonin (PCT), C-reactive protein (CRP) and microalbuminuria during the first 3 postoperative days. Mann-Whitney and chi 2 tests were used for statistical analysis.. There was no significant difference between the two groups regarding the MODS, organ dysfunction, length of intensive care stay, days of mechanical ventilation and mortality. PCT and microalbuminuria did not differ significantly. Significantly lower CRP levels were found in the NAC group on day one and two [t24: median: 84.5 interquartile range: (62.48-120.25) vs. 118 (86-137) mg/l; p = 0.020; t48: 136 (103-232) vs. 195 (154.5-252) mg/l p = 0.013, NAC vs. placebo].. The results of this study do not support the routine use of NAC as a prophylactic drug during surgery, and reinforce previous evidence which challenge the indication of NAC in the critically ill patient.

Topics: Abdominal Neoplasms; Acetylcysteine; Aged; Albuminuria; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Critical Care; Double-Blind Method; Female; Humans; Inflammation; Infusions, Intravenous; Length of Stay; Male; Middle Aged; Multiple Organ Failure; Prospective Studies; Protein Precursors; Respiration, Artificial; Treatment Outcome

Nephropathia epidemica (NE) is a mild form of hemorrhagic fever with renal syndrome (HFRS) that is caused by the Puumala virus. Periodic outbreaks have been described in endemic areas, with a substantial number of previously healthy individuals developing acute kidney injury (AKI). There is a considerable diversity in the clinical course of the disease, and few patients require renal replacement therapy.. We tested whether urinary neutrophil gelatinase associated lipocalin (uNGAL), urine albumin/creatinine ratio (uACR), urine protein/creatinine ratio (uPCR), urine dipstick protein, C-reactive protein, procalcitonin, leukocyte and platelet count, determined on admission to the hospital, can predict the severity of AKI. Sixty-one patients were analyzed during admission in the emergency department.. The variables most strongly associated with peak plasma creatinine concentration were uNGAL (β = 0.70, p <0.0001), uPCR (β = 0.64, p = 0.001), uACR (β = 0.61, p = 0.002), and dipstick proteinuria (β = 0.34, p = 0.008). The highest AUC-ROC to predict stage 3 AKI according to the acute kidney injury network's (AKIN) classification was seen for uNGAL (0.81, p = 0.001).. uNGAL accurately predicts the severity of AKI in NE. This could help emergency room physicians predict disease severity and allow for initial risk stratification.

Topics: Acute Kidney Injury; Acute-Phase Proteins; Adult; Albuminuria; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Creatinine; Emergency Service, Hospital; Female; Hemorrhagic Fever with Renal Syndrome; Humans; Lipocalin-2; Lipocalins; Male; Middle Aged; Protein Precursors; Proteinuria; Proto-Oncogene Proteins; Puumala virus; Retrospective Studies

Neutrophil gelatinase associated lipocalin (NGAL) is a novel predictor of acute kidney injury (AKI), which increases with inflammation. We aimed to assess whether serum NGAL (SNGAL) and urine NGAL (UNGAL) can predict AKI in burned children.. Patients were referred within the 12 h of burn to our center. Serum samples for SNGAL, C-reactive protein (CRP), procalcitonin (PCT) and urine for UNGAL, microalbumine (Umalb), creatinine (Ucr) were obtained at both admission and the 5th day after burn. Blood urea nitrogen (BUN) and serum creatinine (Scr) were examined daily.. Twenty-two subjects were enrolled and six (27.2%) of them developed AKI within the 48 h of injury. Burn size and abbreviated burn severity index (ABSI) were significantly increased in patients with AKI. CRP, PCT, SNGAL and UNGAL levels at admission and day 5 were significantly higher in patients with AKI than in those without AKI and controls. Scr was not significant between AKI and non-AKI groups at hospital days 1 and 5. A SNGAL level of 315 ng/ml and a UNGAL level of 100 ng/ml were determined as predictive cut-off values of AKI at admission (sensitivity and specificity: 71.4%, 83.3% and 93.3%, 93.7%, respectively). SNGAL and UNGAL were positively correlated with CRP, PCT, ABSI and Umalb/Ucr.. SNGAL and UNGAL are good early predictors of AKI in children with severe burn. NGAL might reflect the severity of burn insult and also could be used as an indicator of inflammation in burn children.

Topics: Acute Kidney Injury; Acute-Phase Proteins; Albuminuria; Biomarkers; Blood Urea Nitrogen; Burns; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Case-Control Studies; Child; Child, Preschool; Cohort Studies; Creatinine; Female; Humans; Infant; Inflammation; Injury Severity Score; Lipocalin-2; Lipocalins; Male; Predictive Value of Tests; Prospective Studies; Protein Precursors; Proto-Oncogene Proteins

To investigate the correlation between microalbuminuria and extravascular lung water in patients in septic shock who require mechanical ventilation for severe respiratory failure.. Prospective, observational, clinical study in the 20-bed intensive care unit of a university hospital.. 25 consecutive patients in septic shock and also in severe respiratory failure requiring mechanical ventilation.. Hemodynamic parameters and extravascular lung water were determined by single arterial thermodilution. Together with each hemodynamic measurement the PaO(2)/FIO(2) ratio and urinary microalbumin to creatinine ratio (M:Cr) was measured. Serum C-reactive protein (CRP) and procalcitonin (PCT) levels were also determined daily.. The EVLW index was significantly higher than normal throughout the study. Microalbuminuria was in the normal range on entry and remained so for the rest of the study period. Serum PCT and CRP levels were significantly higher than normal at every assessment points. No significant correlation was found between M:Cr and either EVLW or PaO(2)/FIO(2).. In this study patients in septic shock with significantly elevated EVLW had normal urinary M:Cr, and there was no correlation between M:Cr and EWLV, and PaO(2)/FIO(2). Therefore based on the current results routine measurements of microalbuminuria to determine endothelial permeability cannot be recommended in critically ill patients.

Topics: Aged; Albuminuria; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Capillary Permeability; Creatinine; Extravascular Lung Water; Female; Hemodynamics; Humans; Linear Models; Male; Middle Aged; Multiple Organ Failure; Prospective Studies; Protein Precursors; Respiration, Artificial; Respiratory Insufficiency; Shock, Septic; Statistics, Nonparametric; Thermodilution

Oesophagectomies carry the risk of postoperative sepsis and mortality. The aim of this study was to evaluate the course of microalbuminuria, serum procalcitonin and C-reactive protein levels following oesophagectomies. Twenty one patients undergoing elective oesophagectomy were studied. Serum procalcitonin and C-reactive protein levels were determined on arrival on the intensive care unit (t0) and then daily (t24, t48, t72). Microalbuminuria (expressed as urine albumin:creatinine ratio, mg/mmol) was measured before (tpre), and after surgery (t0, t6, t24, t48, t72). For statistical analysis Wilcoxon test was used. The clinical course of the patients studied was uneventful during the first 72 hours as monitored by daily Multiple Organ Dysfunction Scores. Preoperative microalbuminuria levels were normal (< 10 mg/mmol). Levels at t0 increased significantly but then (t6-24) they returned to normal. Serum procalcitonin (normal: < 0.5 ng/ml) at t0 was slightly elevated and by t24 it increased significantly (median: 2.7 ng/ml, p < 0.05) and remained high for the rest of the study: t48-72. C-reactive protein was normal at t0 (< 10 mg/l) and by t24 it increased dramatically (up to 10-20 times to the normal value) until t48. At t72 it decreased, but still remained in the abnormal range. This study found, that the surgical insult resulted a significant increase in microalbuminuria, serum procalcitonin and C-reactive protein levels. However, the changes were not accompanied by the clinical signs of sepsis or multiple organ dysfunction in the early postoperative period following oesophagectomies.

Topics: Aged; Albuminuria; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Esophageal Neoplasms; Esophagectomy; Female; Humans; Inflammation; Male; Middle Aged; Protein Precursors

Topics: Albuminuria; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Creatinine; Critical Care; Critical Illness; Esophagectomy; Follow-Up Studies; Glycoproteins; Humans; Protein Precursors; Sensitivity and Specificity; Sepsis; Time Factors