deamino-arginine-vasopressin and Proteinuria

Factors determining renal function at organ recovery in deceased kidney donors are not well established.. The authors studied the prevalence and risk factors associated with elevated prerecovery creatinine and calculated glomerular filtration rate in 458 deceased organ donors identified through the California Donor Transplant Network between January 2005 and December 2006. Data collected retrospectively included demographics, medical history, laboratory values, mechanism of death, and medical treatment in the intensive care unit. Factors were analyzed by both univariate and multivariate analysis.. There were 260 men and 198 women in the study. The age was 43.2 +/- 14.9 yr, and body mass index was 26.9 +/- 6.0 (mean +/- SD). In multivariate analysis, several factors were important determinants of both prerecovery creatinine and glomerular filtration rate. Admission creatinine or glomerular filtration rate were major determinants of respective prerecovery values (P < 0.0001). Higher body mass index was associated with worse renal function (P < 0.01). Higher average glucose values and greater variability in glucose (when included) were associated with worse prerecovery renal function (P < 0.01). Administration of desmopressin acetate was highly associated with preserved renal function (P < 0.001). Lower platelet count (P < 0.0001) and proteinuria (P = 0.005) were also associated with worse renal function.. The data identify several important factors that predict renal function at kidney recovery in deceased donors. In particular, tighter control of blood glucose may improve renal function in potential organ donors, but prospective studies are needed to confirm these findings.

Topics: Adult; Analysis of Variance; Blood Glucose; Body Mass Index; Creatinine; Critical Care; Databases, Factual; Deamino Arginine Vasopressin; Female; Glomerular Filtration Rate; Humans; Intensive Care Units; Kidney Function Tests; Male; Middle Aged; Platelet Count; Predictive Value of Tests; Proteinuria; Renal Agents; Retrospective Studies; Risk Factors; Tissue Donors; Water-Electrolyte Balance

Topics: Biopsy, Needle; Computer Systems; Deamino Arginine Vasopressin; Female; Humans; Hypertension; Kidney; Male; Nephrotic Syndrome; Prone Position; Prospective Studies; Proteinuria; Renal Insufficiency; Supine Position; Ultrasonography

Beta-Thalassemia hemoglobin E (beta-thal/Hb E) is the commonest form of hemoglobinopathy in Thailand. Shortened red cell life span, rapid iron turnover and tissue deposition of excess iron are major factors responsible for functional and physiological abnormalities found in various forms of thalassemia. Increased deposition of iron had been found in renal parenchyma of thalassemic patients, but no systematic study of the effect of the deposits on renal functions has been available. The purpose of this study is to describe the functional abnormalities of the kidney in patients with beta-thal/Hb E and provide evidence that increased oxidative stress might be one of the factors responsible for the damage. Urine and serum samples from 95 patients with beta-thal/Hb E were studied comparing with 27 age-matched healthy controls. No difference in the creatinine clearance was observed. beta-thal/Hb E patients excreted significantly more urinary protein (0.8+/-0.5 vs. 0.3+/-0.1 g/day, p < 0.001). Aminoaciduria was found in 16 % of the patients. Analysis of urinary protein by SDS-PAGE electrophoresis and silver staining revealed abnormal pattern of protein with increased small molecular weight (<45 kD) bands. Morning urine analysis showed significant lower urine osmolality (578.3+/-164.6 vs. 762.4+/-169.9 mosm/kg, p < 0.001) in patients. Patients excreted more NAG (N-acetyl beta-D-glucosaminidase, 26.3+/-41.3 vs. 8.4+/-3.9 U/g Cr, p < 0.0001) and beta2-microglobulin, 124.3+/-167 vs. 71+/-65.5 microg/g Cr, p = 0.001. Plasma and urine MDA (malonyldialdehyde) levels were both raised (p < 0.0001). Nine patients were selected for renal acidification study. All were found to be normal, but showed poor response to DDAVP challenge (urine osmolality 533+/-71). This is the first report of renal tubular defects found associated with beta-thal/Hb E disease. The mechanism leading to the damage is not known but it might be related to increased oxidative stress secondary to tissue deposition of iron, as indicated by the raised levels of serum and urine MDA. It is not known whether these functional defects would have any long-term effects on the patients. Further studies are warranted and means of prevention of these defects should urgently be sought.

Topics: Acetylglucosaminidase; Adult; Ammonia; beta 2-Microglobulin; beta-Thalassemia; Bicarbonates; Creatinine; Deamino Arginine Vasopressin; Diuretics; Erythrocyte Count; Female; Ferritins; Furosemide; Hemoglobin E; Hemoglobinopathies; Humans; Hydrogen-Ion Concentration; Kidney; Male; Malondialdehyde; Osmolar Concentration; Proteinuria; Renal Agents; Renal Aminoacidurias; Splenectomy; Thailand; Urea; Water Deprivation