Real-time glomerular filtration rate: improving sensitivity, accuracy and prognostic value in acute kidney injury
CURRENT OPINION IN CRITICAL CARE
Authors: Schneider, Antoine G.; Molitoris, Bruce A.
Purpose of review Acute kidney injury (AKI) is common and associated with high patient mortality, and accelerated progression to chronic kidney disease. Our ability to diagnose and stratify patients with AKI is paramount for translational progress. Unfortunately, currently available methods have major pitfalls. Serum creatinine is an insensitive functional biomarker of AKI, slow to register the event and influenced by multiple variables. Cystatin C, a proposed alternative, requires long laboratory processing and also lacks specificity. Other techniques are either very cumbersome (inuline, iohexol) or involve administration of radioactive products, and are therefore, not applicable on a large scale. Recent findings The development of two optical measurement techniques utilizing novel minimally invasive techniques to quantify kidney function, independent of serum or urinary measurements is advancing. Utilization of both one and two compartmental models, as well as continuous monitoring, are being developed. The clinical utility of rapid GFR measurements in AKI patients remains unknown as these disruptive technologies have not been tested in studies exploring clinical outcomes. However, these approaches have the potential to improve our understanding of AKI and clinical care. This overdue technology has the potential to individualize patient care and foster therapeutic success in AKI.
Polycyclic aromatic hydrocarbon exposure results in altered CRH, reproductive, and thyroid hormone concentrations during human pregnancy
SCIENCE OF THE TOTAL ENVIRONMENT
Authors: Cathey, Amber L.; Watkins, Deborah J.; Rosario, Zaira Y.; Vega, Carmen M. Velez; Loch-Caruso, Rita; Alshawabkeh, Akram N.; Cordero, Jose F.; Meeker, John D.
Polycyclic aromatic hydrocarbons (PAHs) are byproducts of incomplete combustion reactions and are ubiquitous in the environment, leading to widespread human exposure via inhalation and ingestion pathways. PAHs have been implicated as endocrine disrupting compounds in previous animal and in vitro studies, but human studies are currently lacking. Pregnant women and their developing fetuses are particularly susceptible populations to environmental contaminants, in part because alterations in hormone physiology during gestation can have adverse consequences on the health of the pregnancy. We utilized data on 659 pregnant women from the PROTECT longitudinal birth cohort in Puerto Rico to assess associations between repeated measures of 3 urinary hydroxylated PAH (OH-PAH) metabolites and 9 serum hormones during gestation. Urine samples were collected at 3 study visits (median gestational ages of 18, 22, and 26 weeks at each visit, respectively) and serum samples were collected at the first and third study visits. Linear mixed effects models were used to ascertain longitudinal associations between OH-PAHs and hormones, and sensitivity analyses were employed to assess potential nonlinearity and differences in associations on the basis of fetal sex and timing of biomarker measurement. Among the multiple positive associations we observed between OH-PAHs and CRH, estriol, progesterone, T3, and the ratio of T3 to T4, and inverse associations with testosterone, the most notable are a 24.3% increase (95% Cl: 13.0, 36.7) in CRH with an interquartile range (1QR) increase in 1-hydroxyphenanthrene and a 17.2% decrease (95% CI: 8.13, 25.4) in testosterone with an 1QR increase in 1-hydroxynapthalene. Many associations observed were dependent on fetal sex, and some relationships showed evidence of nonlinearity. These findings demonstrate the importance of studying PAH exposures during pregnancy and highlight the potential complexity of their impacts on the physiology of human pregnancy. (C) 2020 Elsevier B.V. All rights reserved.