Comparison of clinical characteristics of acute kidney injury versus acute-on-chronic renal failure: Our experience in a developing country

SummaryBackgroundFrom developing countries, there is paucity of information regarding epidemiological characteristics of acute-on-chronic renal failure (ACRF) that differs from acute kidney injury (AKI).MethodsIn this prospective study, we analyzed and compared clinical characteristics and outcome of ACRF with AKI from January 2007 to August 2012.ResultsA total of 1117 patients with community-acquired AKI were included in study (AKI = 835; ACRF = 282). Patients with ACRF were older than patients with AKI (p < 0.001). Sepsis was the main cause of acute decline in renal functions in patients with ACRF in comparison to AKI (p < 0.001). Volume depletion/renal hypoperfusion was the most common cause of AKI and the difference was statistically significant as compared to ACRF (33.9% vs. 17.7%; p < 0.001). Need for dialysis was significantly less in patients with ACRF as compared to AKI (68% vs. 77.4%; p 0.002). Lower inhospital mortality was observed in ACRF in comparison to AKI (5% vs. 8.9%, p = 0.04), while no significant difference was noted in terms of duration of hospital stay between the two groups (p = 0.67). However, a significantly higher proportion of patients with ACRF did not recover and progressed to end-stage renal disease as compared to AKI (20% vs. 7.8%; p < 0.001).ConclusionACRF constituted an important cause (25%) of AKI. An episode of superimposed AKI is associated with significantly increased risk of progression to end-stage renal disease in patients with chronic kidney disease.背景慢性腎病合併急性腎衰竭 (ACRF) 不同於急性腎損傷 (AKI)，然而在發展中國家，ACRF 的流行病學數據仍然相當有限。方法在 2007 年 1 月至 2012 年 8 月期間，我們進行了一項前瞻性研究，分析並比較了 ACRF 與 AKI 的臨床特徵和治療後果。結果研究對象為 1117 位社區性 AKI 患者 (AKI = 835；ACRF = 282)，其中 ACRF 患者較 AKI 患者年老 (p < 0.001)。相比於 AKI，ACRF 的急性腎功能下降較常歸因於敗血症 (p < 0.001)；相比於 ACRF，AKI 則較常歸因於容積匱乏/腎灌流不足 (33.9% vs. 17.7%；p < 0.001)；ACRF 患者比 AKI 患者較少需要接受透析療法 (68% vs. 77.4%；p = 0.002)；ACRF 患者的院內死亡率低於 AKI 患者 (5% vs. 8.9%；p = 0.04)，兩組間的住院期則無明顯差別 (p = 0.67)；然而，相比於 AKI 患者，明顯較多的 ACRF 患者無法康復並惡化成末期腎病 (ESRD) (20% vs. 7.8%；p < 0.001)。結論慢性腎病合併急性腎衰竭是急性腎損傷的重要病因 (25%)；在慢性腎病患者間，AKI 的發生明顯增加惡化為 ESRD 的風險

Half-sandwich &#951;<SUP>6</SUP>-benzene Ru(II) complexes of phenolate-based pyridylalkylamine/alkylamine ligands: synthesis, structure, and stabilization of one-electron oxidized species

Four half-sandwich ruthenium(II) complexes [(&#951;6-C6H6)Ru(L1-O)][PF6] (1), [(&#951;6-C6H6)Ru(L2-O)][PF6] (2), [(&#951;6-C6H6)Ru(L3-O)][PF6] (3), [(&#951;6-C6H6)Ru(L4-O)][PF6] (4a), and [(&#951;6-C6H6)Ru(L4-O)][BPh4] (4b) [L1-OH, 4-nitro-6-{[(2'-(pyridin-2-yl)ethyl)methylamino]methyl}-phenol; L2-OH, 2,4-di-tert-butyl-6-{[(2'-(pyridin-2-yl)ethyl)methylamino]methyl}-phenol; L3-OH, 2,4-di-tert-butyl-6-{[2'-((pyridin-2-yl)benzylamino)methyl}-phenol; L4-OH, 2,4-di-tert-butyl-6-{[(2'-imethylaminoethyl)methylamino]methyl}-phenol (L4-OH)], supported by a systematically varied series of tridentate phenolate-based pyridylalkylamine and alkylamine ligands are reported. The molecular structures of 1-3, 4a, and 4b have been elucidated in solution using 1H NMR spectroscopy and of 1, 3, and 4b in the solid state by X-ray crystallography. Notably, due to coordination by the ligands the Ru center assumes a chiral center and in turn the central amine nitrogen also becomes chiral. The 1H NMR spectra exhibit only one set of signals, suggesting that the reaction is completely diastereoselective [1: SRu,SN/RRu,RN; 2: RRu,RN/SRu,SN; 3: SRu,RN/RRu,SN; 4b: SRu,RN/RRu,SN]. The crystal packing in 1 and 3 is stabilized by C-H...O interactions, in 4b no meaningful secondary interactions are observed. From the standpoint of generating phenoxyl radical, as investigated by cyclic voltammetry (CV), complex 1 is redox-inactive in MeCN solution. However, 2, 3, and 4a generate a one-electron oxidized phenoxyl radical coordinated species [2]2+, [3]2+, and [4a]2+, respectively. The radical species are characterized by CV, UV-Vis, and EPR spectroscopy. The stability of the radical species has been determined by measuring the decay constant (UV-Vis spectroscopy)

Half-sandwich &#951;<SUP>6</SUP>-benzene Ru(II) complexes of pyridylpyrazole and pyridylimidazole ligands: synthesis, spectra, and structure

New series of half-sandwich ruthenium(II) complexes supported by a group of bidentate pyridylpyrazole and pyridylimidazole ligands [(&#951;6-C6H6)Ru(L2)Cl][PF6] (1), [(&#951;6-C6H6)Ru(HL3)Cl][PF6] (2), [(&#951;6-C6H6)Ru(L4)Cl][PF6] (3), and [(&#951;6-C6H6)Ru(HL5)Cl][PF6] (4) [L2, 2-[3-(4-chlorophenyl)pyrazol-1-ylmethyl]pyridine; HL3, 3-(2-pyridyl)pyrazole; L4, 1-benzyl-[3-(2'-pyridyl)]pyrazole; HL5, 2-(1-imidazol-2-yl)pyridine] are reported. The molecular structures of 1-4 both in the solid state by X-ray crystallography and in solution using 1H NMR spectroscopy have been elucidated. Further, the crystal packing in the complexes is stabilized by C-H&#183;&#183;&#183;X (X = Cl and &#960;), N-H&#183;&#183;&#183;Cl, and &#960;-&#960; interactions

Coordination versatility of 1,3-bis[3-(2-pyridyl)pyrazol-1-yl]propane: Co(II) and Ni(II) complexes

The ligand 1,3-bis[3-(2-pyridyl)pyrazol-1-yl]propane (L8) has afforded six-coordinate monomeric and dimeric complexes [(L8)CoII(H2O)2][ClO4]2 (1), [(L8)NiII(MeCN)2][BPh4]2 (2), [(L8)NiII(O2CMe)][BPh4] (3), and [(L8)2Co2II(&#956;-O2CMe)2][BPh<SUB >4]2 (4). The crystal structures of 1, 2 . MeCN, 3, and 4 revealed that the ligand L8 is flexible enough to expand its coordinating ability by fine-tuning the angle between the chelating fragments and hence folds around cobalt(II)/nickel(II) centers to act as a tetradentate chelate, allowing additional coordination by two trans-H2O, cis-MeCN, and a bidentate acetate affording examples of distorted octahedral CoIIN2(pyridyl)N'2(pyrazole)O2(water), NiIIN2(pyridyl)N'2(pyrazole)N"2(acetonitrile), and NiIIN2(pyridyl)N'2(pyrazole)O'2(acetate) coordination. The angles between the two CoN2/NiN2 planes span a wide range 23.539(1)&#176; (1), 76.934(8)&#176; (2), and 69.874(14)&#176; (3). In contrast, complex 4 is a bis-&#956;-1,3-acetato-bridged (syn-anti coordination mode) dicobalt(II) complex [Co&#183;&#183;&#183;Co separation: 4.797(8) &#197;] in which L8 provides terminal bidentate pyridylpyrazole coordination to each cobalt(II) center. To our knowledge, this report provides first examples of such a coordination versatility of L8. Absorption spectral studies (MeCN solution) have been done for all the complexes. Complexes 1-3 are uniformly high-spin. Temperature-dependent (2-300 K) magnetic studies on 4 reveal weak ferromagnetic exchange coupling (H^=-JS1&#183;S2) between two cobalt(II) (S = 3/2) ions. The best-fit parameters obtained are: &#916; (axial splitting parameter) = -765(5) cm-1, &#955; (spin-orbit coupling) = -120(3) cm-1, k (orbital reduction factor) = 0.93, and J (magnetic exchange coupling constant) = +1.60(2) m-1

Relative stability of half-sandwich &#951;<SUP>6</SUP>-benzene Ru(II) complexes of tridentate (2-pyridyl)alkylamine ligands of varying chelate ring-size: nucleophilic addition of hydride ion onto the benzene ring

A full account of half-sandwich complexes of ruthenium(II) having three-legged "piano-stool" geometry supported by tridentate (2-pyridyl)alkylamine ligands is presented. Reaction of the dimer [{(&#951;6-C6H6)RuCl(&#956;-Cl)}2] with N-methyl-N,N-bis(2-pyridylmethyl)amine (MeL) in CH3OH in the presence of NH4PF6 affords the complex [(&#951;6-C6H6)Ru(MeL)][PF6]2 (1). A similar reaction with N-methyl-N,N-bis(2-pyridylethyl)amine (MeL), however, affords a non-organometallic Ru(III)-dimeric complex [(MeL)2Ru2III(&#956;-O)(&#956;-Cl)Cl2][PF6](5) (the composition of this complex has been established by physicochemical method). Nucleophilic addition reaction on 1 with NaBH4 leads to the isolation of a cyclohexadienyl complex [(&#951;5-C6H7)Ru(MeL)][PF6] (3). The molecular structure of 1&#183;2CH3CN, 3, and previously reported cyclohexadienyl complex [(&#951;5-C6H7)Ru(MeL)][PF6] (4) [MeL = N-methyl-[(2-pyridyl)ethyl(2-pyridyl)-methyl]amine], obtained from the reaction between NaBH4 and previously reported "piano-stool" complex [(&#951;6-C6H6)Ru(MeL)][PF6]2 (2), has been confirmed by X-ray crystallography. Solution-state structure of new complexes 1 and 3 has been elucidated by their 1H NMR spectra in CD3CN. The behavior of complex 3 has been investigated with the aid of two-dimensional 1H NMR spectroscopy, as well. An attempt has been made to provide a rationale for the effect of supporting tridentate N-donor ligand [MeL, MeL, and MeL], varying in the chelate ring-size on (i) the relative stability of half-sandwich &#951;6-benzene Ru(II) complexes and (ii) the electrophilicity of Ru(II)-coordinated benzene ring on the nucleophilic addition reactions

Age-Specific Nomograms for Antral Follicle Count in Fertile and Infertile Indian Women: A Comparative Study

Objectives The aim of this study was to develop age-specific nomograms for antral follicle count (AFC) in fertile and infertile Indian women and (2) to compare the influence of age on AFC in both groups. Setting and Design It is a prospective cross-sectional study in a tertiary-care hospital in north-central India. Methods and Material One-thousand four-hundred seventy-eight fertile and 1,447 infertile women (primary infertility) of reproductive age (18–49 years) were recruited. One-thousand one-hundred eighty-one fertile and 1,083 infertile women fulfilled the selection criteria for the study. Transvaginal ultrasonography was done on the second or third day of the menstrual cycle. Statistical Analysis Age-specific nomograms for AFC were built for the 3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentiles in both groups. Correlation and regression analysis was done to estimate the relationship between the study variables. Statistical analysis was done by using IBM SPSS Statistics for Windows, version 20. Results At every age, each percentile value of AFC was lower in infertile than in fertile women. The decline of AFC with increasing age was linear in both fertile (r = − 0.431, p < 0.001) and infertile (r = − 0.520, p < 0.001) women; however, the rate was higher in the latter (0.50 follicle/year) than in former (0.44 follicle/year) group. The variation in AFC explained by age was 16.3% in fertile and 22.7% in infertile women. Conclusion AFC decreased linearly with advancing age in both fertile and infertile women, but more rapidly in the latter. The age only modestly explained the decline of AFC. The age-specific percentile thresholds for AFC should be used instead of age-independent constant thresholds in infertility counselling

Synthesis and properties of [M<SUP>II</SUP>(L<SUP>6</SUP>)<SUB>2</SUB>][ClO<SUB>4</SUB>]<SUB>2</SUB>(M = Fe, Co and Ni): structures of Co and Ni complexes and spin-state transition by Fe complex (L<SUP>6</SUP>= 2-[3-(2'-pyridyl)pyrazol-1-ylmethyl]pyridine)

A new non-planar tridentate ligand 2-[3-(2'-pyridyl)pyrazol-1-ylmethyl]pyridine (L6) and its mononuclear bis-ligand complexes [M(L6)2][ClO4]2 [M = Fe (1), Co (2) and Ni (3)] have been synthesized. In the dications of six-co-ordinate complexes of 2 and 3, each L6 is arranged in a meridional mode. Structural analyses reveal that the M-Npyrazole bond length is appreciably shorter than the M-Npyridine bond lengths. Due to the weak field nature of L6 (absorption spectral analyses) towards Fe(II), Co(II) and Ni(II) the complexes are uniformly high-spin at room-temperature. Temperature-dependent magnetic susceptibility measurements reveal that while Co(II) and Ni(II) complexes remain high-spin over the entire range investigated (6-300 K for 2 and 63-300 K for 3), the Fe(II) complex exhibits a temperature-induced (5.2-300 K) spin transition in going from the S = 2 state at 300 K to predominantly an S = 0 state below 80 K. From the linear ln Keq [1A1 (ls) &#8596; 5T2 (hs)] vs. 1/T relationship (190-250 K) the derived thermodyanamic parameters are: &#916;H = 9.7 &#177; 0.04 kJ mol-1 and &#916;S = 56 &#177; 0.18 J K-1 mol-1. While complex 1 displays in MeCN an irreversible MIII/MII redox process [anodic peak potential, Epa = 1.06 V vs. SCE], for complex 2 such a redox process is reversible [E&#189; = 0.74 V vs. SCE and &#916;Ep = 80 mV]

Six-coordinate Co<SUP>III</SUP> and four-coordinate M<SUP>II</SUP> (M = Co, Zn) mixed-valence dimers supported by a deprotonated pyridine amide ligand: magnetism of a Co<SUP>III</SUP>Co<SUP>II</SUP> complex and C-H&#183;&#183;&#183;O/Cl/Br interactions

Using a pyridine amide ligand 4-methyl-2-{N-(2-pyridyl)carbamoyl}pyridine (HL), in its deprotonated form, binuclear mixed-valence homonuclear bimetallic complexes [CoIII,II2(L)3(X)]X&#183;S [X = Cl (1); X = Br, S = CH3OH (2)] and heteronuclear bimetallic complex [CoIIIZnII(L)3(Cl)]Cl&#183;CH3OH&#183;5H2O (3) have been synthesized. Structural analysis revealed that trivalent cobalt is in distorted octahedral and bivalent cobalt/zinc is in distorted tetrahedral environment. Three L(-) ligands provide six-coordination by utilizing three pyridine amide units (pyridine N and amide N donor set) in a facial mode, which in turn places three 4-methylpyridine nitrogens to coordinate to another metal center, which completes four-coordination by a chloride/bromide ion. Temperature-dependent magnetic susceptibility measurements in the solid state of a representative complex 1 revealed the spin-states as CoIII (S = 0) and CoII (S = 3/2), with a zero-field splitting parameter for CoII (g = 2.20 and D = 3.9 cm-1; 2D is the energy gap between the two Kramers doublets Ms = |&#177;3/2&gt; and |&#177;&#189;&gt;). To the best of our knowledge, this is for the first time that a pyridine amide ligand has been utilized to accommodate two cobalt ions or a cobalt and a zinc ion in different geometry, oxidation state, and spin-state (class I mixed-valence dimer). The crystal packing diagram reveals interesting non-covalent interactions involving C-H&#183;&#183;&#183;O/Cl/Br, leading to the generation of 1D, 2D and 3D supramolecular architectures. Absorption spectral and redox properties of the complexes have also been investigated