Paired measurement of urinary creatinine in neonates based on a Jaffe and an enzymatic IDMS-traceable assay

Electrochemical detection of creatinine: exploiting copper(ii) complexes at Pt microelectrode arrays

This work develops a rapid and highly sensitive electrochemical sensor for creatinine detection at platinum microelectrode arrays (Pt-MEA). Copper(ii) ions are introduced to form the electroactive creatinine complex, which is then detected at Pt-MEA through a direct reduction reaction. Electrochemical behaviors of the creatinine complex are also explored at Pt macrodisc and microdisc electrodes in comparison with Pt-MEA. At the Pt-MEA, the linear range, sensitivity, and limit of detection of creatinine are determined to be 0.00-5.00 mM, 5401 ± 99 A m-2 M-1, and 0.059 mM (3SB/m), respectively. Notably, the Pt-MEA requires only 10 μL of sample and allows direct measurement of creatinine in synthetic urine with 97.39 ± 4.78% recovery.

Characterizing dynamics of serum creatinine and creatinine clearance in extremely low birth weight neonates during the first 6 weeks of life

BACKGROUND

Characterizing the dynamics of serum creatinine concentrations (Scr) and associated creatinine clearance (CLcr) as a measure of kidney function in extremely low birth weight (≤ 1000 g; ELBW) neonates remains challenging.

METHODS

We performed a retrospective study that included longitudinal Scr (enzymatic assay) data from 148 ELBW neonates up to 6 weeks after birth. Change of Scr and inter-individual variability was characterized with nonlinear mixed-effect modeling. Key covariates such as gestational age (GA), mode of delivery (MOD), and treatment with ibuprofen or inotropic agents were investigated.

RESULTS

A total of 2814 Scr concentrations were analyzed. GA was associated with Scr at birth (higher with advancing GA), and GA and MOD showed an association with postnatal maturation of CLcr (faster clearance increase with advancing GA and after C-section). Small CLcr decrease (≤ 5%) was quantified during ibuprofen treatment. For a GA of 27 weeks, mean Scr (estimated CLcr) at birth was 0.61 mg/dl (0.23 ml/min), increasing to 0.87 mg/dl (0.27 ml/min) at day three, and decreasing to 0.36 mg/dl (0.67 ml/min) at day 42 after birth.

CONCLUSIONS

We report the first mathematical model able to characterize Scr and CLcr in ELBW neonates during the first 6 weeks of life in a quantitative manner as a function of GA, MOD, and ibuprofen treatment. This model allows the derivation of GA-adjusted reference ranges for ELBW neonates and provides a rationale for normative Scr concentrations, and as such will help clinicians to further optimize monitoring and treatment decisions in this vulnerable patient population.

Elevated expression of AhR and NLRP3 link polycyclic aromatic hydrocarbon exposure to cytokine storm in preschool children

BACKGROUND

Polycyclic aromatic hydrocarbons (PAHs), as a group of persistent organic pollutants, are linked to impaired immune function and low-grade inflammation in adults and children. However, the potential of PAHs to lead to a cytokine storm associated with AhR (aryl hydrocarbon receptor) and NLRP3 (NLR family pyrin domain containing 3) in humans has been poorly studied.

OBJECTIVES

We aimed to investigate the associations between PAH exposure, AhR and NLRP3 expression, and cytokines associated with a cytokine storm in healthy preschoolers.

METHODS

Basic demographic surveys and physical examinations were conducted on 248 preschoolers from an electronic waste (e-waste) recycling area (Guiyu, n = 121) and a reference area (Haojiang, n = 127). Ten urinary PAH metabolite (OH-PAH) concentrations were measured. We also measured the expression levels of AhR and NLRP3 and seventeen serum cytokine levels.

RESULTS

The concentrations of multiple OH-PAHs were significantly higher in the exposed group than those in the reference group, especially 1-hydroxynaphthalene (1-OH-Nap) and 2-hydroxynaphthalene (2-OH-Nap). PAH exposure was closely related to a child's living environment and hygiene habits. Expression levels of AhR and NLRP3 were significantly higher in the exposed group than in the reference group. Similarly, serum IL-1β, IL-4, IL-5, IL-10, IL-12p70, IL-13, IL-17A, IL-18, IL-22, IL-23, and IFN-γ levels were notably higher in the e-waste-exposed children than in the reference children. After adjusting for age, gender, BMI, family income, parental education level, and second-hand smoke exposure, we found that increased PAH exposure was associated with higher AhR and NLRP3 expression and elevated IL-4, IL-10, IL-12p70, IL-18, IL-22, IL-23, TNF-α, and IFN-γ levels. The associations between PAH exposure and IL-1β, IL-18, IFN-γ, and TNF-β were mediated by NLRP3 expression, and the relationships between PAH exposure and IL-4, IL-10, IL-12p70, IL-22, IL-23, and TNF-α were mediated by AhR expression.

CONCLUSIONS

Our findings suggest that the association between PAH exposure and a cytokine storm may be mediated by AhR and NLRP3 expression among preschoolers.

Hearing loss risk and DNA methylation signatures in preschool children following lead and cadmium exposure from an electronic waste recycling area

Experimental studies have uncovered chemical exposure-induced ototoxicity, but population-based hearing risk assessment especially for early-life exposure to heavy metals and relevant biological mechanism remains unclear. We aimed to measure lead (Pb) and cadmium (Cd) levels, blood DNA methylations of Rb1, CASP8 and MeCP2 and hearing in 116 preschool children 3- to 7-years of age from an e-waste and a reference area, and to evaluate the association of exposures with hearing loss potentially affected by epigenetic modifications. A higher median Pb level but not Cd was found in the exposed group than the reference group. Average hearing thresholds in either ear of the exposed children were higher. Higher promoter methylation levels at cg02978827 and position +14, and lower at position +4 of Rb1 were found in the exposed group. Pb was positively correlated with chewing pencil habit while negatively correlated with washing hands before dinner. Slightly negative trends of promoter methylations in Rb1 and CASP8, while a strong positive trend of MeCP2 promoter methylation, were found along with increasing Pb and Cd levels. Logistic analyses showed the adjusted OR of Pb for hearing loss in the left ear and both ears was 1.46 (95% CI: 1.12, 1.91) and 1.40 (95% CI: 1.06, 1.84), respectively. Our results show an elevated Pb level, altered promoter DNA methylations and hearing ability in children of e-waste areas, suggesting that epigenetic changes of specific genes involves in the development of the auditory system during early exposure to environmental chemicals.

Pharmacometric Approaches to Personalize Use of Primarily Renally Eliminated Antibiotics in Preterm and Term Neonates

Sepsis remains a major cause of mortality and morbidity in neonates, and, as a consequence, antibiotics are the most frequently prescribed drugs in this vulnerable patient population. Growth and dynamic maturation processes during the first weeks of life result in large inter- and intrasubject variability in the pharmacokinetics (PK) and pharmacodynamics (PD) of antibiotics. In this review we (1) summarize the available population PK data and models for primarily renally eliminated antibiotics, (2) discuss quantitative approaches to account for effects of growth and maturation processes on drug exposure and response, (3) evaluate current dose recommendations, and (4) identify opportunities to further optimize and personalize dosing strategies of these antibiotics in preterm and term neonates. Although population PK models have been developed for several of these drugs, exposure-response relationships of primarily renally eliminated antibiotics in these fragile infants are not well understood, monitoring strategies remain inconsistent, and consensus on optimal, personalized dosing of these drugs in these patients is absent. Tailored PK/PD studies and models are useful to better understand relationships between drug exposures and microbiological or clinical outcomes. Pharmacometric modeling and simulation approaches facilitate quantitative evaluation and optimization of treatment strategies. National and international collaborations and platforms are essential to standardize and harmonize not only studies and models but also monitoring and dosing strategies. Simple bedside decision tools assist clinical pharmacologists and neonatologists in their efforts to fine-tune and personalize the use of primarily renally eliminated antibiotics in term and preterm neonates.

Evaluation of five immunoturbidimetric assays for urinary albumin quantification and their impact on albuminuria categorization

OBJECTIVES

The study was designed to evaluate the performance of five automated immunoturbidimetric assays to quantify urinary albumin, each corresponding to a combination of a reagent and an analyzer (Olympus on AU640, Roche on Cobas Integra, Abbott on Architect, Ortho-Clinical Diagnostics Vitros on Fusion and Siemens on Dimension).

DESIGN AND METHODS

To assess imprecision, albumin was measured in three urinary pools with a mean value of 25, 66 and 131 mg/L. One hundred and eight patient urine samples were then used to compare each turbidimetric method using the Passing-Bablok regression and Bland-Altman analyses. Concordance of the albumin/creatinine ratio (ACR), according to the albuminuria classifications proposed by the KDIGO, was calculated to test the agreement between the different assays.

RESULTS

All immunoturbidimetric methods evaluated in this study exhibited acceptable imprecision (CV<6%). Mean values for 108 urine samples varied from 0.5 to 762.2 mg/L. Significant differences were found (p<0.05) between all methods except between Olympus and Ortho (p=1.0) and between Abbott and Roche (p=0.12). Regarding the albuminuria categories based on the ACR proposed by the KDIGO, only the classification obtained with the Roche method was significantly different from the four other methods (p<0.001).

CONCLUSIONS

We demonstrated that all assays were not strictly equivalent which could affect ACR categories in clinical practice, suggesting the need for harmonization of commercial methods.

Urinary N-acetyl-beta-D-glucosaminidase as an early marker for acute kidney injury in full-term newborns with neonatal hyperbilirubinemia

Purpose. To investigate renal function estimated by markers in full-term newborns with hyperbilirubinemia. Methods. A total of 332 full-term newborns with hyperbilirubinemia and 60 healthy full-term newborns were enrolled. Total serum bilirubin, serum creatinine (Cr), serum blood urea nitrogen (BUN), serum cystatin C (Cys-C), urinary beta-2-microglobulin (β₂MG) index, and urinary N-acetyl-beta-D-glucosaminidase (NAG) index were measured before and after treatment. All newborns were divided into three groups according to total serum bilirubin levels: group 1 (221-256), group 2 (256-342), and group 3 (>342). Results. The control group and group 1 did not differ significantly in regard to serum Cr, serum BUN, serum Cys-C, urinary β₂MG index, and urinary NAG index. Urinary NAG index in group 2 was significantly higher than that in control group (P < 0.001). Between control group and group 3, serum Cys-C, urinary β₂MG index, and urinary NAG index differed significantly. The significant positive correlation between total serum bilirubin and urinary NAG index was found in newborns when total serum bilirubin level was more than 272 μmol/L. Conclusions. High unconjugated bilirubin could result in acute kidney injury in full-term newborns. Urinary NAG might be the suitable marker for predicting acute kidney injury in full-term newborns with hyperbilirubinemia.