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      N-Acetyl Functions and Acetate Detected by Nuclear Magnetic Resonance Spectroscopy of Urine to Detect Renal Dysfunction following Aminoglycoside and/or Glycopeptide Antibiotic Therapy

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          Background/Aims: N-acetylneuraminidine (NeuNAc), N-acetylglutamine (GIcNAc) and acetate are metabolites present in normal urine. In patients treated with aminoglycosides and/or glycopeptides, elevation of these metabolites in urine suggests renal tubular injury. NeuNAc, GIcNAc and acetate are easily detected by magnetic resonance spectroscopy (MRS), in contrast to other bioanalytical methods. In the present study, these urinary metabolites were detected using MRS and compared with standard biochemical markers of renal injury in intensive care unit patients treated with aminoglycosides and/or glycopeptides. Methods: 16 patients with clinical and biochemical signs of renal dysfunction were included in the study. Proton magnetic resonance spectra were obtained from 134 urine samples. The resonance intensity of NeuNAc, GIcNAc and acetate were reported relative to the resonance intensity of creatinine (ct). These ratios were compared with classical parameters of renal dysfunction, such as plasma creatinine and urea concentration, and 24-hour urine volume, by logistic regression and general linear models. Results: Statistical analysis showed that changes in plasma creatinine and urea concentration were reliably reflected in changes in the NeuNAc/ct ratio, and that plasma urea concentration changes also correlated with the acetate/ct ratio; however, the GIcNAc/ct ratio was not related to these measures of overall renal function. Conclusions: NeuNAc/ct may be a useful marker of renal dysfunction in patients treated with aminoglycosides and glycopeptides; by MRS it can be both straightforward and informative to follow the renal function of patients treated with these antibiotics.

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          Most cited references 15

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          The Logistic Organ Dysfunction system. A new way to assess organ dysfunction in the intensive care unit. ICU Scoring Group.

           D Teres,  A Artigas,  J Klar (1996)
          To develop an objective method for assessing organ dysfunction among intensive care unit (ICU) patients on the first day of the ICU stay. Physiological variables defined dysfunction in 6 organ systems. Logistic regression techniques were used to determine severity levels and relative weights for the Logistic Organ Dysfunction (LOD) score and for conversion of the LOD score to a probability of mortality. A total of 13 152 consecutive admission to 137 adult medical/surgical ICUs in 12 countries from the European/North American Study of Severity Systems. Patient vital status at hospital discharge. The LOD System identified from 1 to 3 levels of organ dysfunction for 6 organ systems: neurologic, cardiovascular, renal, pulmonary, hematologic, and hepatic. From 1 to 5 LOD points were assigned to the levels of severity, and the resulting LOD scores ranged from 0 to 22 points. Model calibration was very good in the developmental and validation samples (P=.21 and P=.50, respectively), as was model discrimination (area under the receiver operating characteristic curves of 0.843 and 0.850, respectively). The LOD System provides an objective tool for assessing severity levels for organ dysfunction in the ICU, a critical component in the conduct of clinical trials. Neurologic, cardiovascular, and renal dysfunction were the most severe organ dysfunctions, followed by pulmonary and hematologic dysfunction, with hepatic dysfunction the least severe. The LOD System takes into account both the relative severity among organ systems and the degree of severity within an organ system.
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            Assignment of resonances for 'acute-phase' glycoproteins in high resolution proton NMR spectra of human blood plasma.

            Broad resonances at 2.04 and 2.08 ppm in 500 MHz Hahn spin-echo 1H NMR spectra of human blood plasma are assigned to the N-acetyl groups of mobile carbohydrate side-chains (largely N-acetylglucosamine and N-acetylneuraminic acid) of glycoproteins such as alpha 1-acid glycoprotein. Their intensities in spin-echo spectra correlate with clinical conditions in which an elevation of the level of 'acute-phase' glycoproteins is expected, and so may be of value in the study of certain diseases.
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              Analytical Reproducibility in1H NMR-Based Metabonomic Urinalysis


                Author and article information

                Nephron Physiol
                Nephron Physiology
                S. Karger AG
                August 2004
                20 August 2004
                : 97
                : 4
                : p53-p57
                aLPBC-CSSB, UMR CNRS 7033, Faculté de Médecine; bService de Réanimation, Hôpital Avicenne; cUnité de Biostatistiques et Information Médicale, Hôpital Avicenne, et dSamu 93-UPRES UA 3409, Faculté de Médecine, Bobigny, France
                79179 Nephron Physiol 2004;97:p53–p57
                © 2004 S. Karger AG, Basel

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                Figures: 2, Tables: 1, References: 26, Pages: 1
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