TO STUDY THE CORRELATION OF URINARY URIC ACID AND CREATININE RATIO IN BIRTH ASPHYXIA

Introduction: Perinatal asphyxia is one of the leading causes of perinatal morbidity and mortality. Feasible and early biochemical markers to diagnose and predict the neurologic outcome is a great need of time as APGAR score alone is inuenced by various factors. The present study was performed to determine the urinary uric acid to creatinine ratio in perinatal asphyxia and its correlation with APGAR score and compare urinary uric acid to creatinine ratio with Sarnat and Sarnat staging. Materials and Methods: This study was carried out on 100 term neonates with an equal number of cases and control 50 each, control group being the neonates with Apgar score ≥ 7 at 1 minute of life and cases being the neonates who suffered from perinatal asphyxia with Apgar < 7 at 1 minute of life. The spot urine sample was collected within 24 hours of birth and their uric acid and creatinine levels were measured and the ratio calculated. Asphyxiated neonates were classied according to Sarnat and Sarnat staging. We Compare UA/Cr ratio with Apgar score and HIE staging using Sarnat and Sarnat staging.Results: On comparison of UUA/Cr among cases and controls we found that ratio was signicantly higher in asphyxiated neonates as compared to non asphyxiate neonates. (Control vs. Cases Group: 2.4 ± 1 vs. 3.6 ± 1.5; p –value < 0.0001). On comparison of UUA/Cr among cases with Sarnat and Sarnat staging of HIE, there is a signicant difference observed in mean UA/Cr ratio across Sarnat and Sarnat staging of HIE (F – Value = 68.760; p – value = 0.0001). Conclusion: Urinary uric acid and creatinine ratio can be used as markers for perinatal asphyxia for screening in centers where other markers for assessing perinatal asphyxia are not available. Urinary uric acid and creatinine ratio is a non-invasive, cheap and easily available marker for assessing the severity perinatal asphyxia.

FC 054FUNCTIONAL SODIUM MAGNETIC RESONANCE IMAGING OF THE HUMAN KIDNEY

Background and Aims Maintenance of a cortico-medullary concentration gradient (CMG) required for urine concentration, is one of most important tubular function. However, we are lacking of functional tubular parameters to explore this function. The only tool available to assess it currently, is urinary osmolarity that is an indirect and nonspecific maker of CMG. In this study, we explore the ability of 23NaMRI in measuring 1) the dynamics of CMG for the first time compared to urinary osmolarity after a water load 2) the CMG in kidney disease. Method We conducted an exploratory pilot study for 10 healthy controls with water load then 5 cardiorenal patients with kidney disease. 1) Healthy controls were asked to be fasting since midnight. Urines sample were collected to measure fasting osmolarity and a first MRIscan were performed to acquire baseline anatomical and sodium images. Once the baseline was completed, healthy participants were asked to ingest water (15 mL/kg) within 15 minutes. Four subsequent sodium pictures were acquired an hour after water ingestion. Urine samples were obtained after each sodium acquisition every 15 min during one hours. 2) Cardiorenal patients underwent an MRI scan, provided a spot urine sample and have blood work collected. All MR experiments were carried out on a GE MR750 3T (GE Healthcare, WI). A custom-built two-loop (18cm in diameter) butterfly radiofrequency surface coil tuned for 23Na frequency (33.786 MHz) was used to acquire renal 23Na images. Results Mean age of the 10 healthy controls was 41.8 ± 15.3 years, mean body mass index (BMI) was 24.3 ± 3.8 kg/m2. Mean water intake was 1092 ± 233 mL, total water excreted was 1250 ± 301 mL . Mean age of the 5 cardiorenal patients was 76.6 ± 12.2 years, mean BMI was 28.1 ± 6.9 kg/m2. eGFR was 54 ± 37 mL/min/1.73m2. Urinary osmolarity was 498 ± 145 mosm/L and medulla/cortex ratio was 1.35 ± 0.11. Sodium imaging was successfully acquired in all volunteers. In the morning fasting, medulla/cortex ratio was 1.55 ± 0.11 regarding to a urinary osmolarity to 814 ± 121 mosm/L. Mean ± SD fasting urinary osmolarity dropped significantly to 73 ± 14 mosm/L for maximal dilution, p=0.001. Mean medulla/cortex ratio dropped significantly to 1.31 ± 0.09 mosm/L for maximal dilution, p=0.002. Figure 1 displays changes of 23NaMRI pictures before (A) then 1h (B), 1H15 (C), 1h30 (D) and 1h45 (E) after a water load. Urinary osmolarity and medulla/cortex ratio are significantly correlated, r=0.54, p=0.0001. We measured corticomedullary gradient in cardiorenal patient with different level of eGFR to show the ability and feasibility to measure this gradient in pathological settings. We were able to measure medulla/cortex ratio in patients with CKD with a mean SNR of 20.45 ± 9.45. Conclusion We explored CMG dynamically every 15 min and we were able to discriminate significant changes after a water load. We were also able to provide efficient 23NaMRI pictures in cardiorenal patients with kidney disease. CMG exploration would provide a relevant assessment of tubular dysfunction independently of glomerular alteration and thus could be of prognostic value.

Urinary chlorine: a potential biomarker of diuretic resistant patients

Background Natriuresis is gaining growing interest in identifying diuretic resistance (DR) patients. However, it has not been proved useful beyond the first day with intravenous (iv) furosemide. Moreover, data regarding urinary chlorine (uCl) or urinary potassium (uK) are scarce. We sought to assess the urine electrolyte pattern in acute heart failure (AHF) outpatients to identify those who will present DR. Methods Single-center prospective registry of outpatients with AHF who need iv furosemide. In visit 1 (V1), baseline spot urine sample was collected. Furosemide iv bolus plus intensification of oral diuretics were performed. In control visit (V2), baseline spot urine sample was collected and congestion data were evaluated. Urine electrolytes were assessed in relation to DR (defined as need of iv furosemide in V2 due to persistent congestion). Results From June to December 2019, 76 patients were included: median age of 75.5 years (68.2–82), glomerular filtration 40 ml/min/1.73m2 (29.2–59.2) and NT-proBNP 3340 ng/L (1296–7044). In V1, DR patients showed higher levels of uK and lower uNa/uK than NDR (p=0.014 and p=0.007, respectively). In V2, after a median of 6 (6–15) days of intensified diuretic treatment, uNa and uCl dropped with adequate decongestion but not in DR patients (p=0.020 and p=0.001, respectively). Thus, DR patients showed in V2 higher uCl and similar uNa than NDR (table). Conclusions After several days of intensified diuretic treatment, uCl and uNa dropped during proper decongestion but not in DR patients, showing higher levels of uCl than NDR. Mantained levels of uCl could help to identify patients with persistent congestion. Funding Acknowledgement Type of funding source: None

The Utility of Spot vs 24-Hour Urine Samples for Metal Determination in Veterans With Retained Fragments

Objectives The objective of this investigation is to explore the utility of using a spot urine sample in lieu of a 24-hour collection in assessing fragment-related metal exposure in war-injured veterans. Methods Twenty-four veterans collected each urine void over a 24-hour period in separate containers. Concentrations of 13 metals were measured in each void and in a pooled 24-hour sample using inductively coupled plasma mass spectrometry. To assess the reliability of spot sample measures over time, intraclass correlations (ICCs) were calculated across all spot samples. Lin’s concordance correlation coefficient was used to assess agreement between a randomly selected spot urine sample and each corresponding 24-hour sample. Results In total, 149 spot urine samples were collected. Ten of the 13 metals measured had ICCs more than 0.4, suggesting “fair to good” reliability. Concordance coefficients were more than 0.4 for all metals, suggesting “moderate” agreement between spot and 24-hour concentrations, and more than 0.6 for seven of the 13 metals, suggesting “good” agreement. Conclusions Our fair to good reliability findings, for most metals investigated, and moderate to good agreement findings for all metals, across the range of concentrations observed here, suggest the utility of spot urine samples to obtain valid estimates of exposure in the longitudinal surveillance of metal-exposed populations.

Daily Salt Intake, its Discretionary Use and Validation of Methods for Estimation using Spot Urine, Findings from Islamabad, Pakistan

Background: The study was designed to estimate daily salt intake, its discretionary use in healthy individuals and to validate three common methods for salt estimation in Pakistani population. Methods: Information on demography and discretionary salt use was collected healthy adults (>18 years) along with a blood sample, spot urine sample and 24 hours urine samples. Sodium, chloride, potassium levels and serum creatinine were measured using standard methods. For daily salt estimation, three common methods i.e. INTERSALT, Tanaka and Kawasaki were validated for their applicability in local settings. Results: Overall 24 h sodium excretion was 158 mmol/l indicating intake of 8.64 (4.43) grams salt per day which was significantly associated with male gender (p. <0.004) and adding salt during cooking (p. <0.0001). Most (73%) of the participants know about hazardous effects of high salt intake, however, only 25% consider important to lower salt intake. Although, there is insignificant difference (p. 0.09) between measured and estimated 24 hour urine however none of three methods i.e. INTERSALT(bias: -19.64; CCC -0.79), Tanaka(bias: 167.35; CCC -0.37) and Kawasaki (bias: -42.49, CCC -0.79) showed any agreement between measured and estimated 24 hour sodium. Conclusion: Daily intake of salt was high than recommended by the WHO. Findings showed that none of the three methods could be used for estimating daily intake of salt in local settings of Pakistan.