Vignesh, A (2023) Urine Beta 2 Microglobulin as a Predictive Biomarker for Acute Kidney Injury to Chronic Kidney Disease Progression in Patients with Acute Renal Failure following Hemotoxic Snake Bite. Masters thesis, Madurai Medical College, Madurai.
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Abstract
INTRODUCTION: Acute kidney injury (AKI) secondary to hemotoxic snake bite is a significant public health concern, showing a steadily increasing prevalence in the last few decades . snake bite acute kidney injury outcomes depend on multiple factors. Patients who recovered from an snake bite AKI episode have a long-term risk of developing sequelae like chronic kidney disease (CKD) and end-stage renal disease (ESRD). In this study we are going to predict the kidney disease progression through urine beta 2 microglobulin monitoring. AIMS AND OBJECTIVES: 1. To estimate the percentage of individuals with hemotoxic snake envenomation with Acute Kidney Injury progressing to Chronic Kidney Disease. 2.To identify an accurate, reliable and sensitive marker to assess the extent of tubular damage would aid in the risk stratification, especially in individuals who lack the conventional risk factors. MATERIALS AND METHODS: • All patients admitted to medical wards with AKI (defined as per KDIGO 2012) due to hemotoxic snake envenomation were screened. Hemotoxic envenomation was defined as the presence of whole blood clotting time > 20 minutes in patients who sustained a snake bite. • Demographic, clinical, laboratory details and periodic assessment of eGFR, urine albumin excretion, sr.creatinine and urine beta 2 microglobulin are collected at the time of enrollment and periodically at end of 2 weeks, 12 weeks and 24 weeks respectively. • An ultrasound examination of the abdomen to assess kidney size was performed before recruitment. • Urine b2m will be estimated by CLIA method, serum creatinine by modified jaffe’s method, eGFR by CKD-EPI formula,urine albumin by nephelometry. RESULTS: In this study majority of patient’s age were between 31-40 years (36%), 22% were between 51-60 years, 20% were between 21-30 years, 14% between 41-50years and 8% were between the age of 10-20 years. Mean age in this study group was 37.72±13.07years. In Jaswanth [et al.], study mean age was 41.83 years. In our study majority of the patients were male (54%) and 46% were females. Urine Albumin 1+ in 2 week (n=15), 12 weeks (n=6) and in 24 weeks (n=6). 2+ in 2 week (n=3), 12 weeks (n=2) and in 24 weeks (n=2). 3+ in 2 week (n=2), 12 weeks (n=0) and in 24 weeks (n=0). In Jaswanth et al., study number of patients having urine albumin >1+ was 28, in our study urine albumin >1+ was 20 patients. Mean serum Urea level in 2 weeks 46.34±9.55 mg/dl, 12 weeks 38.42±8.52 mg/dl, in 24weeks 34.84±9.22mg/dl. There was decrease in serum urea level noted in followup weeks. Mean serum creatinine level in 2 weeks 1.418±0.32mg/dl, in 12 weeks 1.278±0.31mg/dl, in 24 weeks 1.168±0.43mg/dl. Creatinine level was decreasing constantly in following weeks. Mean eGFR in 2weeks was 57.38±7.004, in 12 weeks was 61.38±8.85, in 24weeks was 65.7±9.78. Mean urine beta 2 microglobulin in 2 weeks was 1391.36, in 12 weeks 710.52, in 24 weeks 485.78. The serum creatinine, urea, eGFR improved and beta 2 microglobulin level declined significantly between 12 weeks and 24 weeks. Urine beta 2 microglobulin level at 2weeks were correlated with serum creatinine level in 24 weeks, there was a strong correlation between microglobulin level and development of kidney disease. In our study urine bête 2 microglobulin have 80.00% sensitivity and 77.1% specificity in predicting kidney injury. CONCLUSION: Urine beta 2 microglobulin is one of the validated marker for acute kidney injury detection. From this study, we conclude that urine beta 2 microglobulin level may be a potential, reliable early marker for detecting acute kidney injury to chronic kidney disease progression in hemotoxic snake bite patients suffered from acute kidney injury. Long term follow up is further needed to confirm the exact correlation between urine beta 2 microglobulin and chronic kidney disease progression.
| Item Type: | Thesis (Masters) |
|---|---|
| Additional Information: | REG.NO: 200120101525 |
| Uncontrolled Keywords: | Urine Beta 2 Microglobulin, Predictive Biomarker, Acute Kidney Injury, Chronic Kidney Disease Progression, Acute Renal Failure, Hemotoxic Snake Bite. |
| Subjects: | MEDICAL > General Medicine > MEDICAL > General Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 12 Nov 2022 16:10 |
| Last Modified: | 22 Mar 2024 03:23 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/18604 |
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