BackgroundFibroblast growth factor-23 (FGF-23), a novel regulator of mineral metabolism, is markedly elevated in chronic kidney disease and has been associated with poor long-term outcomes. However, whether FGF-23 has an analogous role in acute kidney injury is unknown. The goal of this study was to measure FGF-23 levels in critically ill patients with acute kidney injury to determine whether FGF-23 levels were elevated, as in chronic kidney disease.MethodsPlasma FGF-23 and intact parathyroid hormone (PTH) levels were measured in 12 patients with acute kidney injury and 8 control subjects.ResultsFGF-23 levels were significantly higher in acute kidney injury cases than in critically ill subjects without acute kidney injury, with a median FGF-23 level of 1948 RU/mL (interquartile range (IQR), 437-4369) in cases compared with 252 RU/mL (IQR, 65-533) in controls (p = 0.01). No correlations were observed between FGF-23 and severity of acute kidney injury (defined by the Acute Kidney Injury Network criteria); among patients with acute kidney injury, FGF-23 levels were higher in nonsurvivors than survivors (median levels of 4446 RU/mL (IQR, 3455-5443) versus 544 RU/mL (IQR, 390-1948; p = 0.02). Severe hyperparathyroidism (defined as intact PTH >250 mg/dL) was present in 3 of 12 (25%) of the acute kidney injury subjects versus none of the subjects without acute kidney injury, although this result did not meet statistical significance.ConclusionsWe provide novel data that demonstrate that FGF-23 levels are elevated in acute kidney injury, suggesting that FGF-23 dysregulation occurs in acute kidney injury as well as chronic kidney disease. Further studies are needed to define the short- and long-term clinical effects of dysregulated mineral metabolism in acute kidney injury patients.

Our findings suggest that the preoperative administration of phenazopyridine may improve postoperative voiding function after a retropubic midurethral sling. Additional prospective trials are needed to confirm this finding.

INTRODUCTION: Up to 75% of babies born growth restricted were undiagnosed prior to delivery. Certain placental changes have associated with growth restriction. Our objective is to determine if these changes are increased in cases with ultrasound estimated fetal weight (EFW) 10-20%. METHODS: Retrospective analysis on singleton placentas from 2011 to 2016. Exclusion criteria were less than 24 weeks’ gestation or EFW <10%, multiple anomalies, known aneuploidy. Primary outcome was decreased placental weight. Secondary outcomes were infarcts, villitis, fibrin deposition, calcium deposition and a composite of outcomes. Pathology reports, ultrasound reports, and the electronic medical records were reviewed. Chi square was used for categorical variables and logistic regression for adjusted analyses. RESULTS: 1748 ultrasounds had with EFW >10th%. Pregnancies with EFW 10-20% were more likely in women who were younger, nulliparous, had lower BMI, less gestational weight gain, and delivered less than a week earlier (p<0.05). Rates of SGA at birth were also increased (69.2% vs 8.7%, p<0.001). Placental pathology was sent in 35 (37%) of EFW 10-20% pregnancies and 281 (17%) those with EFW>20%. There were more placentas with decreased placental weight in the EFW 10-20% group (p<0.005). There was a trend toward increase in the incidence of infarcts, villitis, no differences in any of the other secondary outcomes, except decreased placental weight and one other placental finding (p=0.005). CONCLUSION: Placentas from pregnancies with EFW 10-20% had higher rates of decreased placental weight. No difference found in secondary outcomes, but with small numbers, further research is needed to assess these outcomes.

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