Ahmet Taner Elmas

Urinary Neutrophil Gelatinase-Associated Lipocalin as an Early Biomarker for Prediction of Acute Kidney Injury in Preterm Infants

BACKGROUND Our aims are to determine whether the urinary neutrophil gelatinase-associated lipocalin (uNGAL) can predict acute kidney injury (AKI) development in nonseptic and nonasphyxiated but critically ill preterm infants. METHODS Fifty preterm infants, gestational age (GA) between 28 and 34 weeks, were included in this case control study. Blood and urine samples were taken for blood urea nitrogen, serum creatinine, and uNGAL on postnatal (PN) days 1 and 7. uNGAL levels were measured by enzyme-linked immunoassay. Clinical and laboratory characteristics of the AKI group were compared with the non-AKI group. RESULTS AKI was diagnosed in six infants during the first week. The median uNGAL levels were significantly higher in the preterm infants with AKI than those of the controls on PN days 1 and 7 (p = 0.006 and p = 0.023, respectively). Backward stepwise logistic regression analysis identified that 5-minute Apgar score and uNGAL levels were significantly associated with the development of AKI, even after controlling for GA, birth weight, gender, and 1-minute Apgar score in nonseptic and nonasphyxiated but critically ill preterm infants. CONCLUSIONS uNGAL can be useful as a predictive marker of AKI in nonseptic and nonasphyxiated but critically ill preterm infants.

Reference intervals of serum cystatin C for determining cystatin C-based glomerular filtration rates in preterm neonates

Abstract Objective: The aim of this study is to determine the reference values of serum Cystatin C (CysC) and CysC-based estimated glomerular filtration rate (GFR) on the 3rd and 30th day of life in comparison with serum creatinine (Cr) and Cr-based estimated GFR. Methods: This prospective study was performed on 52 preterm neonates whose gestational ages were between 28 and 34 weeks. Preterm neonates were divided into three groups according to the gestational age as follows: gestational week of 28–29 (group 1), gestational week of 30–32 (group 2) and gestational week of 33–34 (group 3). Blood samples were obtained on the 3rd and the 30th days of life. CysC was determined by particle-enhanced nephelometric immunoassay. Results: The group 1 preterm neonates have higher CysC values (1.34 ± 0.1 mg/L) on the 3rd day of life than the group 2 (1.28 ± 0.2 mg/L) and the group 3 (1.24 ± 0.2 mg/L) but the differences were not significant (p > 0.05, for each). CysC values were independent of gestational age, birth weight and gender (p > 0.05, for each). No correlation was found between CysC and Cr on the 3rd day of life (p > 0.05). Conclusions: CysC is regarded as an alternative for assessing the renal function in preterm neonates.

Platelet Counts in Children With Henoch-Schonlein Purpura--Relationship to Renal Involvement.

The aim of this study is to identify the clinical and laboratory risk factors for renal involvement and to determine the relationship between platelet counts and renal involvement in (Henoch–Schönlein purpura) HSP patients.

Analysis of urine biomarkers for early determination of acute kidney injury in non-septic and non-asphyxiated critically ill preterm neonates

Abstract Objective: We designed the present study to test the hypothesis that urinary biomarkers might predict acute kidney injury (AKI) development in non-septic and non-asphyxiated critically ill preterm infants. We evaluated urine (u) sistatin–C (uCys-C), kidney injury molecule–1 (uKIM–1) and neutrophil gelatinase associate lipocaline (uNGAL) as markers of AKI. Methods: Sixty-four preterm infants with gestational age between 28 and 32 weeks were included in this study. Biomarkers were measured on day of life (DOL) 1, 3, and 7. Results: uNGAL levels in the AKI group were significantly higher than in no-AKI group on DOL 1, 3 and 7 (p = 0.016, p = 0.007 and p = 0.0014, respectively). Conclusions: uNGAL is sensitive, early, and noninvasive AKI biomarkers, increasing significantly in non-septic and non-asphyxiated critically ill preterm neonates.

Determination of reference values for urinary neutrophil gelatinase-associated lipocalin in premature infants

Abstract Background: The aim of this study is to determine the reference values of urinary neutrophil gelatinase-associated lipocalin (uNGAL) in healthy very preterm infants. Method: The study was performed on 30 preterm infants whose gestational ages (GA) were between 28 and 34 weeks. They were divided into three groups according to the GA as group 1: GA 28–29 weeks, group 2: 30–32 weeks and group 3: 33–34 weeks. Blood and urine samples were obtained on postnatal (PN) days 1 and 7. uNGAL was measured by ELISA. Results: There were 10 preterm infants for each group. The median values of uNGAL on PN Days 1 were 19.80 (8.6–25.7) ng/ml, 9.25 (1.42–30.3) ng/ml, and 7.95 (1.60-27.8) ng/ml in group 1, group 2 and group 3, respectively. Multivariate linear regression analysis showed that uNGAL values are not associated with GA, birth weight, and gender in preterm infants on PN Days 1 and 7. Conclusion: Our study indicated that normal values of uNGAL concentrations in healthy very preterm infants, and older children or adults are similar preterm infants.

Evaluation of hypertension by ambulatory blood pressure monitoring in children with solitary kidney

Abstract In this study, we aimed to investigate the blood pressure (BP) profile in children with a unilateral functioning solitary kidney (UFSK). A group of 49 patients between the ages of 5 and 18 years, and 30 healthy controls between the ages of 6 and 16 years were investigated. Gender, weight, height and body mass index (BMI) of patients and controls were recorded. BP profile was determined by ambulatory BP monitoring (ABPM). We have observed a higher risk of hypertension compared with healthy children. Also, masked hypertension is more frequently in the patients group and white-coat hypertension was observed in the control group. The mean night-time systolic BP (SBP) load (p = 0.01) and 24-h diastolic BP (DBP) load (p = 0.008) of children with multicystic dysplastic kidney (MCDK) was significantly higher than the healthy group. The mean night-time SBP load (p = 0.001) of children with unilateral renal agenesis (URA) and 24-h DBP load (p = 0.003) of children with unilateral atrophic or hypoplastic kidney were significantly higher than healthy group. We showed that the children with a solitary kidney had increased risk of hypertension. ABPM reflects the BP profile more precisely than casual BP measurement and it can be used to evaluate white-coat and masked hypertension in children with a solitary kidney.

Evaluation of renal functions in preterm infants with respiratory distress syndrome.

The aim of this prospective study was to evaluate urinary glutathione S transferases π (GST‐π), beta‐2‐microglobulin (B2‐MG), and N‐acetyl‐β‐d‐glucosaminidase (NAG) levels as markers revealing the effect of respiratory distress syndrome (RDS) on renal function in preterm infants.

Abdominal pain, nausea, vomiting, and ascites in a 14-year-old girl with systemic lupus erythematosus: Questions

In November 2011, an 8-year-old girl had been diagnosed with systemic lupus erythematosus with kidney involvement which manifested with massive edema and proteinuria, hypoa l b um i n em i a , h y p e r l i p i d em i a , h y p e r t e n s i o n , hypocomplementemia (both C3 and C4), positive antinuclear antibody, and anti-dsDNA antibodies. Kidney biopsy had revealed diffuse proliferative lupus nephritis (type IV). Its treatment, including pulse methyl prednisolone (1000 mg/m/ d for 3 days and then monthly for 24 months) and oral prednisolone (1 mg/kg/day), and cyclophosphamide (750 mg/m first 6 months and then every 3 months) had been started and continued at least for 2 years. Treatment with ramipril and losartan for hypertension and proteinuria had also been started and continued. The titres of anti-nuclear antibody and antidsDNA had decreased and serum C3 and C4 levels increased during the follow-up. In December 2017, she was admitted to our hospital with complaints of malaise, abdominal pain, nausea, and vomiting which had lasted for 3 days. She also had complaints of persistent high fever lasting for 4 days, and edema in the eyelids and lower extremities. There was no history of malar rash, photosensitivity, oral ulcers, Raynaud’s phenomenon, xerostomia, xerophthalmia, alopecia, or polyarthralgia/arthritis. Her weight and height were within normal ranges. Her body temperature, respiratory rate, heart rate, and blood pressure were 36.7 °C, 22 breaths/min, 65 beats/min, and 115/ 65 mmHg, respectively. Physical examination revealed abdominal distensionwith dilated veins over the anterior abdominal wall; massive ascites and marked edema. Abdominal palpation showed hepatomegaly and splenomegaly each 5 cm below the costal margin. There were no cutaneous vasculitis or abnormal neurologic signs. On initial laboratory evaluation, white blood cell count was 14.000/mm (80% neutrophils and 20% lymphocytes); hemoglobin was 17.4 g/dL, and platelet count was 103.000/mm. Peripheral blood smear demonstrated no abnormal cells. Serum studies included a blood urea nitrogen of 21.41 mg/ dL, serum creatinine 1.14 mg/dL, uric acid 10.22 mg/dL, sodium 135 mmol/L, potassium 5.07 mmol/L, calcium 8.2 mmol/L, phosphorus 2.9 mg/dL, chloride 108 mmol/L, magnesium 2.06 mmol/L, total protein 6.0 g/dL, albumin 2.8 g/dL, aspartate amino-transferase 6267 U/L, alanine amino-transferase 2454 U/L, alkaline phosphatase 168 U/L, gamma-glutamyl transferase 259 U/L, total bilirubin 2.1 mg/ dL, direct bilirubin 1.4 mg/dL, lactic dehydrogenase 5384 U/ L, creatine phosphokinase 113 U/L, and creatine phosphokinase-MB fraction 145.4 U/L. Erythrocyte sedimentation rate was 18 mm/h (normal range 1–15 mm/h); and Creactive protein was 0.64 mg/dL (normal range up to 0.35 mg/ dL). Urinalysis showed a specific gravity of 1030, pH of 6.0, proteinuria of 3+, two erythrocytes and one leukocyte/HPF. Protein excretion was determined as 68 mg/m/h in 24-h urine sample. Urine and blood cultures were negative for any evidence of infection. Serum viral markers including Epstein Barr virus, hepatitis A, B, and C virus, cytomegalovirus, human immunodeficiency virus, and Herpes Simplex virus were negative. Additional parameters were as follows: lactate 39.7 mmol/L (4.5–19.8), NH3 243 micromol/L (normal range The answers to these questions can be found at https://doi.org/10.1007/ s00467-018-4059-3.

Risk factors and mortality rate in premature babies with acute kidney injury

Acute kidney injury (AKI) is a common morbidity in neonatal intensive care units and associated with poor outcome. This study aimed to determine the prevalence of AKI and provide a demographic data and risk factors associated with the mortality and morbidity.

Evaluation of Renal Function in Children with Wilson’s Disease

Öz Giriş: Bu çalışmada Wilson hastalığında (WH) böbrek fonksiyonlarının üriner N-Asetil-β-D-glukozaminidaz (NAG) ve NAG/kreatinin aktivite indeksi kullanılarak değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: WH tanısı alan 20 hasta çalışma grubu, benzer yaş ve cinsiyette olan 37 sağlıklı çocuk kontrol grubu olarak alındı. NAG düzeyleri mlU/L olarak hesaplanırken, NAG aktivite indeksi mlU/mg kreatinin olarak belirlendi. Bulgular: Toplam dört hasta (%20) tanı anında asemptomatik iken; sırasıyla kronik hepatit, nörolojik WH, fulminan hepatit ve akut hepatit ise altı (%30), beş (%25), üç (%15) ve iki (%10) hastada saptandı. Çalışma anında toplam 13 hasta (%65) trientin ve çinko tedavisi alırken, yedi (%35) hasta ise D-penisilamin ve çinko tedavileri almaktaydı. Olguların 10’unda (%50) proteinüri, birinde (%5) glikozüri ve bir hastada (%5) mikroskopik hematüri saptandı. Hasta grubunun idrar sodyumu ve kreatinini kontrol grubundan anlamlı olarak düşük iken (p=0,048 ve p=0,001), NAG ve NAG indeks anlamlı olarak daha yüksek saptandı (p=0,049 ve p=0,03). Klinik başvuru şeklinin bu parametreler üzerinde etkili olmadığı gözlendi (p>0,05). İdrar kreatinini trientin alanlarda anlamlı olarak yüksek bulundu (p=0,004). Child-Pugh skoru ile bu parametreler arasında herhangi bir ilişki saptanmadı (p>0,05). Sonuç: Bu çalışmada; WH’li çocuklarda WH’nin kendisinin ve/veya kullanılan ilaçların böbrek fonksiyonları üzerine olumsuz etkisinin olduğu, karaciğer hasarının ciddiyeti ve klinik özelliklerin etkisinin olmadığı görülmüştür. Introduction: In this study it was aimed to evaluate the renal functions in Wilson’s disease (WD) using urinary N-acetyl-β-D-glucosaminidase (NAG) and NAG/ creatinine activity index. Materials and Methods: Twenty children of similar age and gender with WD were determined to be the patient group and 37 healthy children were determined to be the control group for the study. NAG levels were calculated as mlU/L and NAG activity index was determined as mlU/mg. Results: While four (20%) patients were asymptomatic at diagnosis, chronic hepatitis, neurologic WD, fulminant hepatitis, and acute hepatitis were observed in six (30%), five (25%), three (15%), and two (10%) patients, respectively. Of children, 13 (65%) were on trientine and zinc treatment and seven (35%) were on d-penicillamine and zinc. Ten (50%) children had proteinuria, one (5%) had glycosuria, and one (5%) had microscopic hematuria. While mean urine sodium and creatinine levels were significantly lower compared to controls (p=0.048 and p=0.001, respectively), NAG and NAG index were significantly higher (p=0.049 Ya zış ma Ad re si/Ad dress for Cor res pon den ce: Dr. Yılmaz Tabel, İnönü Üniversitesi Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Çocuk Nefroloji Bilim Dalı, Malatya, Türkiye Tel.: +90 533 545 63 46 E-posta: yilmaztabel@yahoo.com Anah tar ke li me ler Çocuk, böbrek fonksiyonları, N-asetil-β-Dglikozaminidaz, Wilson hastalığı