N-terminal-pro-brain natriuretic peptide is decreased in insulin dependent gestational diabetes mellitus: a prospective cohort trial

<p>Abstract</p> <p>Background</p> <p>N-terminal-pro-brain natriuretic peptide (NT-proBNP) is elevated in gestational hypertension and preeclampsia. This trial aimed to generate data for gestational diabetes mellitus patients, who are at risk to develop these complications.</p> <p>Methods</p> <p>We have measured NT-proBNP in 223 otherwise healthy women between gestational week 24 and 32 referred to the outpatient diabetes unit in a cross-sectional study.</p> <p>Results</p> <p>88 control subjects, 45 patients with indication for medical nutrition therapy (MNT) alone and 90 patients who required insulin therapy were included. Groups of women were comparable regarding gestational week. Body mass index before pregnancy and at blood draw was significantly higher in subjects with insulin dependent gestational diabetes mellitus compared to MNT controlled gestational diabetes mellitus. NT-proBNP was significantly lower in patients with insulin dependent gestational diabetes mellitus (35 ± 25 pg/ml) compared to controls (53 ± 43 pg/ml, p = 0.012).</p> <p>Conclusions</p> <p>NT-proBNP is within the reference range of normal subjects in women with gestational diabetes mellitus. Differences in body mass index, changes in glomerular filtration rate and haemodynamics may explain lower NT-proBNP concentrations in insulin dependent gestational diabetes mellitus. A false negative interpretation needs to be considered in these women.</p

Fetuin-A Characteristics during and after Pregnancy: Result from a Case Control Pilot Study

Objective. Fetuin-A has been associated with gestational diabetes mellitus (GDM). We investigated fetuin-A levels during and after pregnancy in women with GDM. Fetuin-A measurements were performed in 10 women with GDM and 10 age and body mass index (BMI) matched healthy pregnant women. All women underwent an oral glucose tolerance test (OGTT) in and 3 months after gestation. Results. Fasting fetuin-A correlated with BMI in women with former GDM (r = 0.90, P < 0.0001) but showed no association with parameters of glucose tolerance in women with GDM or post-GDM. GDM featured significantly lower insulin sensitivity and higher insulin and C-peptide secretion profiles compared to NGT during pregnancy (P < 0.05). Fasting and postprandial fetuin-A did not differ between groups, neither during nor after pregnancy. Conclusion. Fetuin-A is not influenced by glucose tolerance during or after pregnancy or acute glucose elevations following glucose ingestion in young women, but closely relates to BMI early postpartum

Circulating progranulin levels in women with gestational diabetes mellitus and healthy controls during and after pregnancy

ObjectiveProgranulin (PGRN) was recently introduced as a novel marker of chronic inflammatory response in obesity and type 2 diabetes capable of directly affecting the insulin signaling pathway. This study aimed to investigate the role of PGRN in gestational diabetes mellitus (GDM), which is regarded as a model for early type 2 diabetes.MethodsPGRN serum levels were measured in 90 pregnant women (45 GDM and 45 normal glucose tolerance (NGT)). In addition, PGRN was measured during a 2-h, 75 g oral glucose tolerance test in 20 pregnant women (ten GDM and ten NGT) and in 16 of thempost partum(ten GDM and six NGT).ResultsPGRN concentrations were significantly higher in pregnant women compared withpost partumlevels (536.79±31.81 vs 241.53±8.86,P<0.001). Multivariate regression analyses showed a strong positive correlation of PGRN with estrogen and progesterone. The insulinogenic index, a marker of early insulin secretion, displayed a positive correlation with PGRN, both during and after pregnancy (R=0.47,P=0.034;R=0.63,P=0.012). HbA1c and the oral glucose insulin sensitivity index showed significantpost partumassociations with PGRN (R=0.43,P=0.049;R=−0.65,P=0.009).ConclusionsPGRN concentrations are markedly lower after pregnancy regardless of the gestational glucose tolerance state. PGRN levelsper sedo not discriminate between mild GDM and NGT in pregnant women. Therefore, the development of GDM appears to be due to impaired β-cell function that is not related to PGRN effect

Urine osmolarity and risk of dialysis initiation in a chronic kidney disease cohort--a possible titration target?

Increasing evidence is linking fluid intake, vasopressin suppression and osmotic control with chronic kidney disease progression. Interestingly, the association between urine volume, urine osmolarity and risk of dialysis initiation has not been studied in chronic kidney disease patients before.To study the relationship between urine volume, urine osmolarity and the risk of initiating dialysis in chronic kidney disease.In a retrospective cohort analysis of 273 patients with chronic kidney disease stage 1-4 we assessed the association between urine volume, urine osmolarity and the risk of dialysis by a multivariate proportional sub-distribution hazards model for competing risk data according to Fine and Gray. Co-variables were selected via the purposeful selection algorithm.Dialysis was reached in 105 patients over a median follow-up period of 92 months. After adjustment for age, baseline creatinine clearance, other risk factors and diuretics, a higher risk for initiation of dialysis was found in patients with higher urine osmolarity. The adjusted sub-distribution hazard ratio for initiation of dialysis was 2.04 (95% confidence interval, 1.06 to 3.92) for each doubling of urine osmolarity. After 72 months, the estimated adjusted cumulative incidence probabilities of dialysis were 15%, 24%, and 34% in patients with a baseline urine osmolarity of 315, 510, and 775 mosm/L, respectively.We conclude that higher urine osmolarity is associated with a higher risk of initiating dialysis. As urine osmolarity is a potentially modifiable risk factor, it thus deserves further, prospective research as a potential target in chronic kidney disease progression

The independent effect of urine volume, age, protein excretion, kidney function, renal disease and different drugs, on the risk of of initiating dialysis in the competing risk regression analysis.

<p>Abbreviations: SH Ratio, subdistribution hazard ratio; PKD, polycystic kidney disease</p

Demographic and clinical characteristics of all patients at baseline, and in the subgroups of CKD patients stages 1-3a (creatinine clearance ≥45 ml/min) and stage 3b-4 (creatinine clearance ≥15 and <45 ml/min).

<p>Abbreviations: BMI, body mass index; CCl, creatinine clearance; MAP, mean arterial pressure; P_osm, plasma osmolarity; U_osm, urine osmolarity; ACEI/AT-II, angiotensin converting enzyme/angiotensin II receptor antagonist; CCB, calcium channel blocker. Values are given as median (Q1-Q3), if not stated otherwise.</p

A case report of septic shock syndrome caused by S. pneumoniae in an immunocompromised patient despite of vaccination

Abstract Background and case presentation We report a case of septic shock syndrome caused by Streptococcus pneumoniae in a patient who had undergone splenectomy due to an autoimmune lymphoproliferative syndrome (ALPS), which is characterized as a dysfunction of immunoregulation. Although the patient was vaccinated with a conjugated polysaccharide vaccine after the splenectomy, he was still susceptible to S. pneumoniae infection, because the isolated serovar (24F), a serovar long thought to be apathogenic, is not covered by any vaccine currently approved, neither a conjugated nor an unconjugated polysaccharide one. Conclusions This case demonstrates that, due to presence of different serovars, also infections with bacteria against which patients are vaccinated have to be considered as differential diagnosis. Although vaccine development has extended the coverage of S. pneumoniae from 7 to 23 serovars within recent years, there is still demand for novel vaccines which can provide broader protection also against so-thought “apathogenic” strains, especially for groups at high risk

Cumulative incidence probabilities of dialysis initiation for different baseline urine osmolarities.

<p>Cumulative incidence probabilities of dialysis initiation for a baseline urine osmolarity of 315, 510 or 775/L (10^th, 50^th, and 90^th percentile), estimated from the proportional sub-distribution hazards model. Given the estimated adjusted subdistribution hazard ratio (SHR) of 2.04 (p = 0.033) per doubling of urine osmolarity, the SHRs comparing patients with 775 mosm/L or 315 mosm/L to patients with 510 mosm/L were 1.54 (95%CI:1.03 to 2.28) or 0.61 (95%CI: 0.39 to 0.96), respectively.</p

The independent effect of urine osmolarity, age, protein excretion, kidney function, renal disease and different drugs, on the risk of initiating dialysis in the competing risk regression analysis.

<p>Abbreviations: SH Ratio, subdistribution hazard ratio; PKD, polycystic kidney disease</p