Objective:To explore the risk factors for the progression of renal function deterioration in patients with diabetic nephropathy(DN).Methods:The clinical data and biochemical indexes of 100 diabetic patients admitted t...Objective:To explore the risk factors for the progression of renal function deterioration in patients with diabetic nephropathy(DN).Methods:The clinical data and biochemical indexes of 100 diabetic patients admitted to our hospital from October 2021 to October 2022 were retrospectively analyzed.The patients were divided into a DN group,which consisted of 55 cases,and a nondiabetic nephropathy group(NDN),which consisted of 45 cases.The urinary microalbumin to creatinine ratio,the clinical data(gender,age,duration of the disease,and BMI),and the biochemical indexes(triglycerides[TG],low-density lipoprotein cholesterol[LDL-C],high-density lipoprotein cholesterol[HDL-C],total cholesterol[TC],glycated hemoglobin A1c[HbA1c],systolic blood pressure[SBP],diastolic blood pressure[DBP])of the two groups were compared.Subsequently,the risk factors related to the progression of renal function deterioration in DN were analyzed through multifactorial logistic regression analysis.Results:No statistically significant difference was observed in the comparison of gender,age,BMI,LDL-C,and DBP between the two groups(P>0.05).The DN group demonstrated a longer disease duration and higher SBP,TC,HDL-C,HbA1c,and TG compared to the NDN group(P<0.05).Through multifactorial logistic regression analysis,it was found that the duration of the disease,the TC,the HDL-C,the HbA1c,the TG,and the SBP were independent risk factors of the deterioration of renal function in DN patients.Conclusion:Other than conventional indicators,TC,HDL-C,HbA1c,TG,and SBP are also crucial indicators in determining the progression of renal function deterioration in DN patients.展开更多
Over recent years,the nomenclature of non-alcoholic fatty liver disease has undergone significant changes.Indeed,in 2020,an expert consensus panel proposed the term“Metabolic(dysfunction)associated fatty liver diseas...Over recent years,the nomenclature of non-alcoholic fatty liver disease has undergone significant changes.Indeed,in 2020,an expert consensus panel proposed the term“Metabolic(dysfunction)associated fatty liver disease”(MAFLD)to underscore the close association of fatty liver with metabolic abnormalities,thereby highlighting the cardiometabolic risks(such as metabolic syndrome,type 2 diabetes,insulin resistance,and cardiovascular disease)faced by these patients since childhood.More recently,this term has been further replaced with metabolic associated steatotic liver disease.It is worth noting that emerging evidence not only supports a close and independent association of MAFLD with chronic kidney disease in adults but also indicates its interplay with metabolic impairments.However,comparable pediatric data remain limited.Given the progressive and chronic nature of both diseases and their prognostic cardiometabolic implications,this editorial aims to provide a pediatric perspective on the intriguing relationship between MAFLD and renal function in childhood.展开更多
BACKGROUND The incidence of chronic kidney disease(CKD)has dramatically increased in recent years,with significant impacts on patient mortality rates.Previous studies have identified multiple risk factors for CKD,but ...BACKGROUND The incidence of chronic kidney disease(CKD)has dramatically increased in recent years,with significant impacts on patient mortality rates.Previous studies have identified multiple risk factors for CKD,but they mostly relied on the use of traditional statistical methods such as logistic regression and only focused on a few risk factors.AIM To determine factors that can be used to identify subjects with a low estimated glomerular filtration rate(L-eGFR<60 mL/min per 1.73 m^(2))in a cohort of 1236 Chinese people aged over 65.METHODS Twenty risk factors were divided into three models.Model 1 consisted of demographic and biochemistry data.Model 2 added lifestyle data to Model 1,and Model 3 added inflammatory markers to Model 2.Five machine learning methods were used:Multivariate adaptive regression splines,eXtreme Gradient Boosting,stochastic gradient boosting,Light Gradient Boosting Machine,and Categorical Features+Gradient Boosting.Evaluation criteria included accuracy,sensitivity,specificity,area under the receiver operating characteristic curve(AUC),F-1 score,and balanced accuracy.RESULTS A trend of increasing AUC of each was observed from Model 1 to Model 3 and reached statistical significance.Model 3 selected uric acid as the most important risk factor,followed by age,hemoglobin(Hb),body mass index(BMI),sport hours,and systolic blood pressure(SBP).CONCLUSION Among all the risk factors including demographic,biochemistry,and lifestyle risk factors,along with inflammation markers,UA is the most important risk factor to identify L-eGFR,followed by age,Hb,BMI,sport hours,and SBP in a cohort of elderly Chinese people.展开更多
Background: Pre-eclampsia has long been considered as a disease that disappears after the removal of the placenta. It has now been shown that its symptoms can persist for months after giving birth. Objectives: To stud...Background: Pre-eclampsia has long been considered as a disease that disappears after the removal of the placenta. It has now been shown that its symptoms can persist for months after giving birth. Objectives: To study the evolution of proteinuria and renal function in women with pre-eclampsia. Patients and Methods: An analytical prospective study was carried out in the Hospitalization Unit of the Gynecology Department of the Teaching Hospital of Cocody (Abidjan) from May 3, 2021 to November 15, 2021. It focused on the follow-up of proteinuria and renal function in 50 women who had pre-eclampsia during their pregnancy, in the three months following their delivery. Results: The average age of the patients was 30.38 ± 6 years (range 18 and 40 years). Thirty-two percent were nulliparous and 62% had no risk factors for pre-eclampsia. The diagnosis of pre-eclampsia was made in 52% of cases before 37 weeks of amenorrhea. Sixty-two percent had Grade 3 arte-rial hypertension. The average proteinuria/creatininuria ratio was 3592.08 ± 7009.57 mg/g and 32% of women had glomerular grade proteinuria. The mean serum creatinine was 13.61 ± 12.62 mg/l. AKI (Acute Renal Failure) was present in 30% of women. All patients had received a central antihypertensive drug of which 88% were a calcium channel blocker. For the delivery mode, a Caesarean section was performed in 88% of cases. In the three months postpartum, 40% of women had persistent hypertension, 58% had persistent proteinuria and 6% had persistent impaired renal function. Prematurity (p = 0.0091), IUGR (intrauterine growth restriction) (p = 0.0012) and IUFD (intrauterine fetal death) (p = 0.0012) were associated with the persistence of proteinuria at M3 postpartum. Conclusion: Symptoms of pre-eclampsia do not automatically disappear after the delivery. Proteinuria and renal failure can persist beyond three months after the delivery and require treatment by a nephrologist.展开更多
OBJECTIVE To evaluate the prospective association between cumulative resting heart rate(cumRHR)and rapid renal function decline(RRFD)in a cohort of individuals aged 60 and older.METHODS In the Tianjin Chronic Kidney D...OBJECTIVE To evaluate the prospective association between cumulative resting heart rate(cumRHR)and rapid renal function decline(RRFD)in a cohort of individuals aged 60 and older.METHODS In the Tianjin Chronic Kidney Disease Cohort Study,the individuals who underwent three consecutive physical examinations between 2014 and 2017,with estimated glomerular filtration rate(eGFR)greater than 60 mL/min per 1.73 m2 and aged 60 years or older were enrolled.A total of 27,564 patients were prospectively followed up from January 1,2017 to December 31,2020.The 3-year cumRHR was calculated.The primary outcome was RRFD,defined as an annualized decline in eGFR of 5 mL/min per 1.73 m2 or greater.Logistic and restricted spline regression models and subgroup analysis were used to investigate the association of cumRHR with RRFD after adjusting for all confounders.RESULTS During a median follow-up of 3.2 years,a total of 4,347(15.77%)subjects developed RRFD.In fully-adjusted models,compared with the lowest quartile of cumRHR,the odds ratio(OR)for the highest was 1.44(1.28–1.61),P<0.001.Furthermore,each 1-standard deviation(27.97 beats/min per year)increment in cumRHR was associated with a 17%(P<0.001)increased risk of RRFD,with a linear positive correlation(P for non-linear=0.803).Participants with a 3-year cumRHR≥207(beats/min)*year(equivalent to≥69 beats/min per year in 3 years)were found to be at a higher risk of RRFD.CONCLUSIONS The cumRHR is significantly associated with a higher risk of RRFD among older adults.These results might provide an effective goal for managing and delaying the decline of renal function in the older adults.展开更多
Anti-B cell maturation antigen(BCMA)chimeric antigen receptor(CAR)T-cell therapyis effective and well-tolerated for refractory or relapsed multiple myeloma(RRMM).The purposcof the present study was to analyze efficacy...Anti-B cell maturation antigen(BCMA)chimeric antigen receptor(CAR)T-cell therapyis effective and well-tolerated for refractory or relapsed multiple myeloma(RRMM).The purposcof the present study was to analyze efficacy in RRMM patients with renal impairment treated byanti-BCMA CAR-T cell therapy.A total of 59 RRMM patients were selected,and divided intoimpaired renal function(lRF)group[basclinc cstimated giomerular filtration rate(eSFR)<90 m/min/1.73 m^2(n=18)]and normal renal function(NRF)group(baseline eGFR≥90 mL/min/1.73 m,n=41).For patients with IRF,eGFR at the 6th month post-CAR-T cells infusion was significantlyhigher than the baseline(P<0.05).The multivariate analysis showed that light chain type and beta-2 micro-globulin(bcta-2M)were associated factors with the decrease of serum creatinine.Medianprogression-free survival(PFS)in the NRF group and IRF group was 266 days and 181 daysrespectively.Overall survival(OS)in the NRF group and lRF group was 877 days and 238 daysrespectively.There was no significant difference in the objective response rate(ORR)between thelRF group and the NRF group.It is suggested that CAR-T cells therapy could improve the renalfunction during the treatment of RRMM.The renal function could be more significantly improvedin RRMM patients with light chain type than with other types.展开更多
BACKGROUND MicroRNAs(miRNAs)have been suggested as biomarkers for malignant diseases including hepatocellular carcinoma(HCC).Specifically,hsa-miR-21-5p(miR-21)is among the most frequently deregulated miRNA in cancer.T...BACKGROUND MicroRNAs(miRNAs)have been suggested as biomarkers for malignant diseases including hepatocellular carcinoma(HCC).Specifically,hsa-miR-21-5p(miR-21)is among the most frequently deregulated miRNA in cancer.The diagnostic and prognostic value of miR-21 has been demonstrated in HCC tissue,mostly in the Asian population.Although the impact of various factors has been recently reported for circulating hsa-miR-122-5p(miR-122),at present only limited knowledge is available for miR-21.AIM To evaluate the value of miR-21 for the assessment of prognosis in HCC patients and to delineate the influence of clinical and preanalytical factors on miR-21 level in sera.METHODS Patients with confirmed HCC from our European cohort with predominantly alcohol-associated liver damage were included in the study.All subjects were characterized according to their clinical and laboratory work-up and overall survival data were obtained.Quantitative real-time polymerase chain reaction was performed for miR-21 and spiked-in cel-miR-39-3p.The results were compared to previously reported miR-122 data.RESULTS Survival of HCC patients was comparable between patients with low and high serum miR-21 concentration.No association was observed between miR-21 level in sera and Child-Pugh score,Barcelona Clinic Liver Cancer staging system,or etiology of HCC/liver disease.Age,gender,or pretreatment had no association with miR-21 level.A positive correlation was observed between miR-21 and aspartate aminotransferase(r=0.2854,P=0.0061),serum miR-122(r=0.2624,P=0.0120),and the International Normalized Ratio(r=0.2065,P=0.0496).Negative correlation of miR-21 with serum creatinine(r=-0.2215,P=0.0348)suggests renal function as a potential influencing factor in miR-21 biogenesis in blood.CONCLUSION The results from this work do not support clinically relevant prognostic value of circulating miR-21 in HCC patients in real-life settings.Following systematic evaluation,we identified renal function and aspartate aminotransferase as potential factors that may affect miR-21 concentration in blood.This knowledge should be considered in future miRNA-based biomarker studies not only for HCC but also for other diseases.展开更多
Background: Pregnancy is implicated in notable physiological changes and the extraordinary kidney physiology during pregnancy is believed to have an effect on kidney functions. However, during pregnancy the glomerular...Background: Pregnancy is implicated in notable physiological changes and the extraordinary kidney physiology during pregnancy is believed to have an effect on kidney functions. However, during pregnancy the glomerular filtration rate (GFR) increases its work rate up to 50%, on the contrary, in preeclampsia the GFR turns back to decline. Objectives: This study aims to measure and compare kidney function between preeclamptic and normal pregnant women. Materials and Methods: A cross-sectional hospital-based study was conducted in the period from March to May 2021 in Wad Medani Obstetrics and Gynecology Teaching Hospital. A total of 100 pregnant women, 50 apparently healthy pregnant women and 50 pregnant ladies proved to have preeclamptic toxemia, their ages ranged from 18 to 44 years old and at the third trimester of pregnancy. Blood samples were taken and serum was separated, then urea, creatinine, uric acid, sodium and potassium were determined. Data were analyzed using Statistical Package for Social Science (SPSS). Results: The results of this study revealed that 92% of preeclamptic pregnant women had the first time of the incidence and 8% were family inherited preeclampsia and injured multiple times. The preeclamptic pregnant women showed elevation in both systolic and diastolic blood pressure compared to the normal pregnant women. Although the creatinine values of all study subjects were in the normal range, the mean of its serum level was found to be higher in normal pregnant women than that in preeclamptic women. The study also showed urea level was elevated in the preeclampsia group in comparison to the normal one, while all values were in the normal range. In addition to the significant difference that observed in the uric acid mean between preeclamptic (higher) and normal pregnant groups, abnormal values were only noticed with many preeclamptic patients. The levels of electrolytes (sodium and potassium) were elevated in the preeclampsia women group, whereas all values were in the normal range. Conclusion: This study concluded that preeclamptics showed significant elevation in the urea, uric acid, sodium and potassium levels and a significant decrease in creatinine level compared to normal pregnant women, although all parameters values for both groups were in the reference values for non-pregnancy.展开更多
<strong>Objective:</strong> To evaluate the correlation between residual renal function and hypertension in regular haemodialysis patients. <strong>Background:</strong> Initiating chronic dialy...<strong>Objective:</strong> To evaluate the correlation between residual renal function and hypertension in regular haemodialysis patients. <strong>Background:</strong> Initiating chronic dialysis treatment gives end-stage renal disease patients a new lease on life. However, the annual mortality rate in dialysis patients is ~20% and quality of life is substantially reduced. <strong>Patients and Methods:</strong> This study was carried out on a reasonable number of subjects on regular haemodialysis divided into two groups. All were given informed consent and, the study was approved by the ethics committee of Menoufia University. <strong>Results:</strong> There was significant relation between presence of residual renal function and hypertension in patients with ESRD on regular haemodialysis, but the relation between residual renal function and control of hypertension is not statistically significant. 40% of group 1 were hypertensive, 66.7% of group 2 patients were hypertensive, the interdialytic weight gain mean was 1.42 in group 1 and 2.37 in group 2. Control of hypertension was achieved in 63.6% of group 1 patients by one drug, 27.3% patients by 2 drugs;however 9.1% of patients need 3 drugs to control their blood pressure, while in group 2 40% of patients were controlled by one drug, 45% with 2 drugs and 15% need 3 drugs to control blood pressure. <strong>Conclusion:</strong> There is significant relation between presence of residual renal function and hypertension in patients with ESRD on regular haemodialysis, but the relation between residual renal function and control of hypertension is not statistically significant.展开更多
Background and Objectives: In anesthesia for bariatric surgery, alterations occur in several organs, including the kidney. The objective of this study was to compare the effect of dexmedetomidine and remifentanil on t...Background and Objectives: In anesthesia for bariatric surgery, alterations occur in several organs, including the kidney. The objective of this study was to compare the effect of dexmedetomidine and remifentanil on the renal function of morbidly obese patients submitted to bariatric surgery. Methods: Sixty-one patients were studied prospectively and divided randomly into two groups: remifentanil (R) and dexmedetomidine (D). Renal function was evaluated in three phases: before anesthesia (M0), after anesthetic induction (M1) and after surgical incision (M2). Plasma concentrations were determined for glucose, antidiuretic hormone, creatinine, urea, sodium, potassium and osmolarity and urinary concentrations for creatinine, urea, sodium, potassium and osmolarity. Results: Significant differences were found between groups for potassium at M1 (p Conclusions: In both groups, the clearance values fell from moments M0 to M2. This result indicates that renal function of obese patients submitted to bariatric surgery presented a physiological response compatible with the effect of anesthetic-surgical stress. In the group D, creatinine and sodium clearances were elevated at M1. Urinary volume was greater at M2. These results are suggestive of better preservation of renal function.展开更多
Objective:To look for change in relative renal function and document renal scarring following endoscopic renal pelvic instillation sclerotherapy(RPIS)in patients with chyluria by dimercaptosuccinic acid(DMSA)renal sca...Objective:To look for change in relative renal function and document renal scarring following endoscopic renal pelvic instillation sclerotherapy(RPIS)in patients with chyluria by dimercaptosuccinic acid(DMSA)renal scan.Methods:A prospective study was performed between November 2015 and September 2016.All patients with biochemically documented chyluria who underwent RPIS using either 1%-silver nitrate or 0.1%-povidine iodine were included.Patients received either 3-,6-or 9-doses.DMSA renal scan was performed before and 2e3 months after sclerotherapy.Results:Of the 34 patients,22 were males.Mean age was 41.08±16.64 years(range,15-70 years).Thirty-two patients(94.1%)responded to therapy while two did not respond even after 9-doses.Average follow-up was 8.94±3.70 months.The mean relative renal function(preinstillation)of normal kidney was 50.76%±3.55%while that of affected renal unit(side of instillation)was 49.20%±3.44%(range,43.0%-61.0%).After instillation therapy,the mean relative renal function of normal side was 52.26%±3.57%while that of affected renal unit was 47.50%±3.56%(range,41.0%-54.0%).The relative renal function did not change>5%from the baseline value in any patient except one(in which the differential function increased paradoxically by 12%).Two patients developed renal scar in post-instillation renal scan.Conclusion:Endoscopic sclerotherapy in chyluria is safe and effective.The relative renal function does not deteriorate by more than 5%.There is a small risk of development of renal scar.More studies involving larger number of patients are needed to answer this dilemma.展开更多
BACKGROUND High-sensitivity cardiac troponin(hs-cTn)levels are frequently elevated in elderly patients presenting to the emergency department for non-cardiac events.However,most studies on the role of elevated hs-cTn ...BACKGROUND High-sensitivity cardiac troponin(hs-cTn)levels are frequently elevated in elderly patients presenting to the emergency department for non-cardiac events.However,most studies on the role of elevated hs-cTn in elderly populations have investigated the prognostic value of hs-cTn in patients with a specific diagnosis or have assessed the relationship between hs-cTn and comorbidities.AIM To investigate the in-hospital prognosis of consecutive elderly patients admitted to the Internal Medicine Department with acute non-cardiac events and increased hs-cTnI levels.METHODS In this retrospective study,we selected patients who were aged≥65 years and admitted to the Internal Medicine Department of our hospital between January 2019 and December 2019 for non-cardiac reasons.Eligible patients were those who had hs-cTnI concentrations≥100 ng/L.We investigated the independent predictors of in-hospital mortality by multivariable logistic regression analysis.RESULTS One hundred and forty-six patients(59%female)were selected with an age range from 65 to 100(mean±SD:85.4±7.61)years.The median hs-cTnI value was 284.2 ng/L.For 72(49%)patients the diagnosis of hospitalization was an infectious disease.The overall in-hospital mortality was 32%(47 patients).Individuals who died did not have higher hs-cTnI levels compared with those who were discharged alive(median:314.8 vs 282.5 ng/L;P=0.565).There was no difference in mortality in patients with infectious vs non-infectious disease(29%vs 35%).Multivariable analysis showed that age(OR 1.062 per 1 year increase,95%CI:1.000-1.127;P=0.048)and creatinine levels(OR 2.065 per 1 mg/dL increase,95%CI:1.383-3.085;P<0.001)were the only independent predictors of death.Mortality was 49%in patients with eGFR<30 mL/min/1.73 m2.CONCLUSION Myocardial injury is a malignant condition in elderly patients admitted to the hospital for non-cardiac reasons.The presence of severe renal impairment is a marker of extremely high in-hospital mortality.展开更多
Objective:Recently,serum cystatin C(CysC)has been used as a novel marker of renal function.However,there is a lack of data on CysC levels in patients with intestinal urinary diversion(UD).Here we report CysC levels in...Objective:Recently,serum cystatin C(CysC)has been used as a novel marker of renal function.However,there is a lack of data on CysC levels in patients with intestinal urinary diversion(UD).Here we report CysC levels in such patients.Methods:We prospectively observed 38 patients who were diagnosed with bladder cancer and subsequently treated with radical cystectomy and UD at our institution in 2012 and 2013.Serum creatinine(sCr)and CysC were obtained optionally at the same time at least 1 month after radical cystectomy and UD.Results:The median CysC and sCr concentrations were 1.12 mg/L(range 0.75-2.47 mg/L)and 0.99 mg/dL(range 0.61-2.22 mg/dL),respectively.The median estimated concentrations of glomerular filtration rate(GFR)based on CysC(eGFRcys)and GFR based on creatinine(eGFRcreat)were 61.08 mL/min/1.73 m^2(range 22.64e99.89 mL/min/1.73 m^2)and 58.01 mL/min/1.73 m^2(range 23.48e91.82 mL/min/1.73 m2),respectively.CysC had a significant correlation with sCr(r=0.8607,p<0.0001)and eGFRcreat(r=-0.8993,p<0.0001).eGFRcys also had a significant correlation with eGFRcreat(r=0.8104,p<0.0001).Conclusion:The correlation between CysC and sCr was strong and the correlation coefficient was equivalent to that in patients without UD.The results suggest that CysC is not affected by UD and can be used as a marker of renal function similarly to sCr in patients with UD.展开更多
Atherosclerotic renal artery stenosis (ARAS), a common clinical finding, is increasing in prevalence as the population ages. ARAS is seen in ～ 7% of persons over 65 years of age1 and in ～ 20% of patients at the time...Atherosclerotic renal artery stenosis (ARAS), a common clinical finding, is increasing in prevalence as the population ages. ARAS is seen in ～ 7% of persons over 65 years of age1 and in ～ 20% of patients at the time of coronary angiography.2 It is an important cause of chronic kidney disease and may result in 11-14% of cases of end stage renal disease.展开更多
Objective: To understand the effects of several commonly used antipsychotics on the renal function of patients with mental illness. Method: Collected patients with mental illness who were hospitalized in our hospital ...Objective: To understand the effects of several commonly used antipsychotics on the renal function of patients with mental illness. Method: Collected patients with mental illness who were hospitalized in our hospital from January 2020 to June 2021, and selected as the research subjects patients with psychiatric disorders who were treated with 2 kinds of commonly used antipsychotic drugs;and collected 3 ml of venous blood before treatment and one month after treatment for renal function tests;observed the changes of renal function indexes before and after treatment. Results: In the collected 694 patients with mental illness, before using antipsychotic drugs, the renal function indexes were BUN: 4.42 ± 1.92 mmol/l;Cr: 70.97 ± 16.92 μmol/l;CCr: 88.37 ± 21.07 ml/min;β2-MG: 1.67 ± 0.61 mg/L;UA: 359.90 ± 112.82 μmol/l;CYS-C: 0.92 ± 0.24 mg/L. One month after using antipsychotics, BUN: 3.77 ± 1.37 mmol/l;Cr: 70.46 ± 16.71 μmol/l;CCr: 87.78 ± 20.63 ml/min;β2-MG: 1.75 ± 0.64 mg/L;UA: 332.53 ± 91.48 umol/l;CYS-C: 0.92 ± 0.24 mg/L;the renal function indexes of urea nitrogen, β2 microglobulin, uric acid and other items all changed significantly. The differences before and after treatment were statistically significant, P < 0.01. Conclusion: Several commonly used antipsychotic drugs have a greater impact on the renal function of patients with mental illness. During the treatment, the changes in renal function should be monitored regularly, if severe renal damage is found, the treatment plan or dosage should be adjusted in time to avoid endangering life.展开更多
<strong>Introduction:</strong> Percutaneous nephrolithotomy (PCNL) is a standard minimally invasive urological procedure for the treatment of large renal calculi. It is also associated with complications a...<strong>Introduction:</strong> Percutaneous nephrolithotomy (PCNL) is a standard minimally invasive urological procedure for the treatment of large renal calculi. It is also associated with complications arising from absorption of irrigation fluid and intravenous fluid injection. We evaluated the changes occurring in vital and blood parameters during PCNL using 0.9% normal saline (NS) as an irrigation fluid. <strong>Materials and Methods:</strong> We prospectively studied 71 patients who underwent PCNL in our hospital between 2016 and 2018. NS (0.9%) was used as irrigation fluid in all patients. Changes in hemodynamics, hemogram, renal function tests and serum electrolytes were noted and assessed for significance using paired t-test. These changes were correlated with ASA grade, BMI, total operating time, total irrigation fluid used and total intravenous fluid used using Pearson’s correlation test. <strong>Results:</strong> A significant fall in serum creatinine was present (1.30 ± 0.96 vs. 1.24 ± 0.93) along with a rise in eGFR (85.39 ± 24.10 vs. 90.18 ± 22.58). A significant rise in serum potassium (4.34 ± 0.45 vs. 4.5 ± 0.56) and chloride levels (104.79 ± 3.51 vs. 106.69 ± 3.14) post-operatively was noted. A significant rise in pulse rate (80.84 ± 10.13 vs. 87.76 ± 13.12) and systolic blood pressure (127.67 ± 15.90 vs. 136.88 ± 19.56) post-operatively was noted. There was no significant change noted in hemoglobin, PCV, platelets and serum sodium levels. Total operating time and irrigation fluid volume showed a positive correlation with changes in eGFR, serum chloride, post-operative pulse rate and blood pressure values. Intravenous fluids volume correlated positively with changes in serum potassium, chloride, post-operative pulse rate and blood pressure values. <strong>Conclusion:</strong> High amount of irrigation fluid absorption can cause early post-operative changes in patients’ hemodynamics and blood indices. Overzealous hydration during PCNL with potassium containing fluids can also lead to hyperkalemia and hyperchloremic acidosis. Thus, early post-operative monitoring of serum electrolytes should be done in all patients after PCNL to prevent complications arising from dyselectrolytemia.展开更多
Background: Renal and ocular vessels are some of the major vessels affected in patients with diabetes, and the involvement of these vessels is independent risk factors for other complications. Hemodynamic flow in arte...Background: Renal and ocular vessels are some of the major vessels affected in patients with diabetes, and the involvement of these vessels is independent risk factors for other complications. Hemodynamic flow in arteries may be assessed by using measures such as resistive index, which is a non-invasive measure of the resistance in vessels. The association between retinopathy and nephropathy has been conflicting. This study assessed the relationship between resistive index of the central retinal artery and indices of nephropathy in type 2 diabetes. Method: This cross-sectional study examined 74 Nigerian diabetics who were selected consecutively from the out-patient diabetic clinic of a tertiary hospital in South-West Nigeria. Doppler ultrasound was used to determine the resistive index of the central retinal artery along with the right renal artery. The urinary and serum biochemical parameters were also done to determine the urinary albumin excretion and the glomerular filtration rate. Results: The mean age of participants was 59.62 ± 9.55 years. The mean central retinal artery resistive index (CRARI) was 0.77 ± 0.06, with 65 (87.8%) of the participants having elevated CRARI. There was no statistical difference between patients with normal CRARI and elevated CRARI in respect of their urinary albumin excretion (p = 0.796). There was no significant correlation between CRARI and estimated glomerular filtration rate (r = 0.120;p = 0.309) and right renal artery resistive index (r = 0.068;p = 0.564). Conclusion: This study demonstrates that central retinal artery resistive index (CRARI) may not be a predictor of renal function in diabetics.展开更多
Background: The aim of this study was to evaluate the feasibility of a dualbolus protocol, where a first bolus of an intravascular tracer is used to measure perfusion, followed by a second bolus of a freely filtered g...Background: The aim of this study was to evaluate the feasibility of a dualbolus protocol, where a first bolus of an intravascular tracer is used to measure perfusion, followed by a second bolus of a freely filtered gadolinium-containing agent to measure filtration capacity. Methods: The study was conducted in mice subjected to complete unilateral ureteral obstruction (UUO), and sham operated mice were used as controls. Dynamic contrast- en-hanced MRI was performed 2 days after surgery. Results and discussions: Mean signal-time curves of the renal cortex, renal medulla and abdominal aorta were used to calculate the relative renal blood flow (rRBF), relative renal blood volume (rRBV), mean transit time (MTT) and the glomerular transfer rate Ktrans. We demonstrated that kidneys suffering from two days of UUO showed a decrease in cortical as well as medullary rRBF compared to kidneys from sham-operated mice. Further, we found no changes in rRBV and MTT among groups, neither in the cortex nor in the medulla. The renal functional parameter Ktrans showed a tendency (but statistically insignificant) to be reduced in the ob-structed kidney compared to the sham-operated mice. Conclusions: We showed our first experiences with the consecutive use of intra- and extra-vascularly distributed agents in a renal-diseased mouse model, allowing analysis of both functional haemo- dyamics and filtration capacity in kidneys.展开更多
Immunosuppression(IS) is often withdrawn in patients with end stage renal disease secondary to a failed renal allograft, and this can lead to an accelerated loss of residual renal function(RRF). As maintenance of RRF ...Immunosuppression(IS) is often withdrawn in patients with end stage renal disease secondary to a failed renal allograft, and this can lead to an accelerated loss of residual renal function(RRF). As maintenance of RRF appears to provide a survival benefit to peritoneal dialysis(PD) patients, it is not clear whether this benefit of maintaining RRF in failed allograft patients returning to PD outweigh the risks of maintaining IS. A 49 year-old Caucasian male developed progressive allograft failure nine years after living-donor renal transplantation. Hemodialysis was initiated via tunneled dialysis catheter(TDC) and IS was gradually withdrawn. Two weeksafter IS withdrawal he developed a febrile illness, which necessitate removal of the TDC and conversion to PD. He was maintained on small dose of tacrolimus(1 mg/d) and prednisone(5 mg/d). Currently(1 year later) he is doing exceedingly well on cycler-assisted PD. Residual urine output ranges between 600-1200 m L/d. Total weekly Kt/V achieved 1.82. RRF remained well preserved in this patient with failed renal allograft with minimal immunosuppressive therapy. This strategy will need further study in well-defined cohorts of PD patients with failed allografts and residual RRF to determine efficacy and safety.展开更多
文摘Objective:To explore the risk factors for the progression of renal function deterioration in patients with diabetic nephropathy(DN).Methods:The clinical data and biochemical indexes of 100 diabetic patients admitted to our hospital from October 2021 to October 2022 were retrospectively analyzed.The patients were divided into a DN group,which consisted of 55 cases,and a nondiabetic nephropathy group(NDN),which consisted of 45 cases.The urinary microalbumin to creatinine ratio,the clinical data(gender,age,duration of the disease,and BMI),and the biochemical indexes(triglycerides[TG],low-density lipoprotein cholesterol[LDL-C],high-density lipoprotein cholesterol[HDL-C],total cholesterol[TC],glycated hemoglobin A1c[HbA1c],systolic blood pressure[SBP],diastolic blood pressure[DBP])of the two groups were compared.Subsequently,the risk factors related to the progression of renal function deterioration in DN were analyzed through multifactorial logistic regression analysis.Results:No statistically significant difference was observed in the comparison of gender,age,BMI,LDL-C,and DBP between the two groups(P>0.05).The DN group demonstrated a longer disease duration and higher SBP,TC,HDL-C,HbA1c,and TG compared to the NDN group(P<0.05).Through multifactorial logistic regression analysis,it was found that the duration of the disease,the TC,the HDL-C,the HbA1c,the TG,and the SBP were independent risk factors of the deterioration of renal function in DN patients.Conclusion:Other than conventional indicators,TC,HDL-C,HbA1c,TG,and SBP are also crucial indicators in determining the progression of renal function deterioration in DN patients.
文摘Over recent years,the nomenclature of non-alcoholic fatty liver disease has undergone significant changes.Indeed,in 2020,an expert consensus panel proposed the term“Metabolic(dysfunction)associated fatty liver disease”(MAFLD)to underscore the close association of fatty liver with metabolic abnormalities,thereby highlighting the cardiometabolic risks(such as metabolic syndrome,type 2 diabetes,insulin resistance,and cardiovascular disease)faced by these patients since childhood.More recently,this term has been further replaced with metabolic associated steatotic liver disease.It is worth noting that emerging evidence not only supports a close and independent association of MAFLD with chronic kidney disease in adults but also indicates its interplay with metabolic impairments.However,comparable pediatric data remain limited.Given the progressive and chronic nature of both diseases and their prognostic cardiometabolic implications,this editorial aims to provide a pediatric perspective on the intriguing relationship between MAFLD and renal function in childhood.
基金Supported by the Kaohsiung Armed Forces General HospitalThe study protocol was approved by the Institutional Review Board of the Tri-Service General Hospital,National Defense Medical Center(IRB No.:KAFGHIRB 109-46).
文摘BACKGROUND The incidence of chronic kidney disease(CKD)has dramatically increased in recent years,with significant impacts on patient mortality rates.Previous studies have identified multiple risk factors for CKD,but they mostly relied on the use of traditional statistical methods such as logistic regression and only focused on a few risk factors.AIM To determine factors that can be used to identify subjects with a low estimated glomerular filtration rate(L-eGFR<60 mL/min per 1.73 m^(2))in a cohort of 1236 Chinese people aged over 65.METHODS Twenty risk factors were divided into three models.Model 1 consisted of demographic and biochemistry data.Model 2 added lifestyle data to Model 1,and Model 3 added inflammatory markers to Model 2.Five machine learning methods were used:Multivariate adaptive regression splines,eXtreme Gradient Boosting,stochastic gradient boosting,Light Gradient Boosting Machine,and Categorical Features+Gradient Boosting.Evaluation criteria included accuracy,sensitivity,specificity,area under the receiver operating characteristic curve(AUC),F-1 score,and balanced accuracy.RESULTS A trend of increasing AUC of each was observed from Model 1 to Model 3 and reached statistical significance.Model 3 selected uric acid as the most important risk factor,followed by age,hemoglobin(Hb),body mass index(BMI),sport hours,and systolic blood pressure(SBP).CONCLUSION Among all the risk factors including demographic,biochemistry,and lifestyle risk factors,along with inflammation markers,UA is the most important risk factor to identify L-eGFR,followed by age,Hb,BMI,sport hours,and SBP in a cohort of elderly Chinese people.
文摘Background: Pre-eclampsia has long been considered as a disease that disappears after the removal of the placenta. It has now been shown that its symptoms can persist for months after giving birth. Objectives: To study the evolution of proteinuria and renal function in women with pre-eclampsia. Patients and Methods: An analytical prospective study was carried out in the Hospitalization Unit of the Gynecology Department of the Teaching Hospital of Cocody (Abidjan) from May 3, 2021 to November 15, 2021. It focused on the follow-up of proteinuria and renal function in 50 women who had pre-eclampsia during their pregnancy, in the three months following their delivery. Results: The average age of the patients was 30.38 ± 6 years (range 18 and 40 years). Thirty-two percent were nulliparous and 62% had no risk factors for pre-eclampsia. The diagnosis of pre-eclampsia was made in 52% of cases before 37 weeks of amenorrhea. Sixty-two percent had Grade 3 arte-rial hypertension. The average proteinuria/creatininuria ratio was 3592.08 ± 7009.57 mg/g and 32% of women had glomerular grade proteinuria. The mean serum creatinine was 13.61 ± 12.62 mg/l. AKI (Acute Renal Failure) was present in 30% of women. All patients had received a central antihypertensive drug of which 88% were a calcium channel blocker. For the delivery mode, a Caesarean section was performed in 88% of cases. In the three months postpartum, 40% of women had persistent hypertension, 58% had persistent proteinuria and 6% had persistent impaired renal function. Prematurity (p = 0.0091), IUGR (intrauterine growth restriction) (p = 0.0012) and IUFD (intrauterine fetal death) (p = 0.0012) were associated with the persistence of proteinuria at M3 postpartum. Conclusion: Symptoms of pre-eclampsia do not automatically disappear after the delivery. Proteinuria and renal failure can persist beyond three months after the delivery and require treatment by a nephrologist.
基金funded by Tianjin Science and Technology Major Special ProjectEngineering Public Health Science and Technology Major Special Project (No.21ZXGWSY00100)+5 种基金Tianjin Natural Science Foundation Key Projects (22JCZDJC00590,21JCQNJC00460)Tianjin Key Medical Discipline(Specialty) Construct Project (No.TJYXZDXK-032A)The Science and technology talent project of Tianjin Health Commission (No. RC20175)The Scientific Research Funding of Tianjin Medical University Chu Hsien-I Memorial Hospital (No.ZXY-ZDSYSZD-1)China International Medical Exchange Foundation Key Fund Project (No.Z-2017-26-1902)Tianjin Municipal Health Care Commission Scientific Research Fund Project (ZC20128)
文摘OBJECTIVE To evaluate the prospective association between cumulative resting heart rate(cumRHR)and rapid renal function decline(RRFD)in a cohort of individuals aged 60 and older.METHODS In the Tianjin Chronic Kidney Disease Cohort Study,the individuals who underwent three consecutive physical examinations between 2014 and 2017,with estimated glomerular filtration rate(eGFR)greater than 60 mL/min per 1.73 m2 and aged 60 years or older were enrolled.A total of 27,564 patients were prospectively followed up from January 1,2017 to December 31,2020.The 3-year cumRHR was calculated.The primary outcome was RRFD,defined as an annualized decline in eGFR of 5 mL/min per 1.73 m2 or greater.Logistic and restricted spline regression models and subgroup analysis were used to investigate the association of cumRHR with RRFD after adjusting for all confounders.RESULTS During a median follow-up of 3.2 years,a total of 4,347(15.77%)subjects developed RRFD.In fully-adjusted models,compared with the lowest quartile of cumRHR,the odds ratio(OR)for the highest was 1.44(1.28–1.61),P<0.001.Furthermore,each 1-standard deviation(27.97 beats/min per year)increment in cumRHR was associated with a 17%(P<0.001)increased risk of RRFD,with a linear positive correlation(P for non-linear=0.803).Participants with a 3-year cumRHR≥207(beats/min)*year(equivalent to≥69 beats/min per year in 3 years)were found to be at a higher risk of RRFD.CONCLUSIONS The cumRHR is significantly associated with a higher risk of RRFD among older adults.These results might provide an effective goal for managing and delaying the decline of renal function in the older adults.
基金the National Natural Science Foundation of China(No.81873452)the Clinical Research Program of Huazhong University of Science and Technology Affiliated Tongji Hospital(No.2020003).
文摘Anti-B cell maturation antigen(BCMA)chimeric antigen receptor(CAR)T-cell therapyis effective and well-tolerated for refractory or relapsed multiple myeloma(RRMM).The purposcof the present study was to analyze efficacy in RRMM patients with renal impairment treated byanti-BCMA CAR-T cell therapy.A total of 59 RRMM patients were selected,and divided intoimpaired renal function(lRF)group[basclinc cstimated giomerular filtration rate(eSFR)<90 m/min/1.73 m^2(n=18)]and normal renal function(NRF)group(baseline eGFR≥90 mL/min/1.73 m,n=41).For patients with IRF,eGFR at the 6th month post-CAR-T cells infusion was significantlyhigher than the baseline(P<0.05).The multivariate analysis showed that light chain type and beta-2 micro-globulin(bcta-2M)were associated factors with the decrease of serum creatinine.Medianprogression-free survival(PFS)in the NRF group and IRF group was 266 days and 181 daysrespectively.Overall survival(OS)in the NRF group and lRF group was 877 days and 238 daysrespectively.There was no significant difference in the objective response rate(ORR)between thelRF group and the NRF group.It is suggested that CAR-T cells therapy could improve the renalfunction during the treatment of RRMM.The renal function could be more significantly improvedin RRMM patients with light chain type than with other types.
文摘BACKGROUND MicroRNAs(miRNAs)have been suggested as biomarkers for malignant diseases including hepatocellular carcinoma(HCC).Specifically,hsa-miR-21-5p(miR-21)is among the most frequently deregulated miRNA in cancer.The diagnostic and prognostic value of miR-21 has been demonstrated in HCC tissue,mostly in the Asian population.Although the impact of various factors has been recently reported for circulating hsa-miR-122-5p(miR-122),at present only limited knowledge is available for miR-21.AIM To evaluate the value of miR-21 for the assessment of prognosis in HCC patients and to delineate the influence of clinical and preanalytical factors on miR-21 level in sera.METHODS Patients with confirmed HCC from our European cohort with predominantly alcohol-associated liver damage were included in the study.All subjects were characterized according to their clinical and laboratory work-up and overall survival data were obtained.Quantitative real-time polymerase chain reaction was performed for miR-21 and spiked-in cel-miR-39-3p.The results were compared to previously reported miR-122 data.RESULTS Survival of HCC patients was comparable between patients with low and high serum miR-21 concentration.No association was observed between miR-21 level in sera and Child-Pugh score,Barcelona Clinic Liver Cancer staging system,or etiology of HCC/liver disease.Age,gender,or pretreatment had no association with miR-21 level.A positive correlation was observed between miR-21 and aspartate aminotransferase(r=0.2854,P=0.0061),serum miR-122(r=0.2624,P=0.0120),and the International Normalized Ratio(r=0.2065,P=0.0496).Negative correlation of miR-21 with serum creatinine(r=-0.2215,P=0.0348)suggests renal function as a potential influencing factor in miR-21 biogenesis in blood.CONCLUSION The results from this work do not support clinically relevant prognostic value of circulating miR-21 in HCC patients in real-life settings.Following systematic evaluation,we identified renal function and aspartate aminotransferase as potential factors that may affect miR-21 concentration in blood.This knowledge should be considered in future miRNA-based biomarker studies not only for HCC but also for other diseases.
文摘Background: Pregnancy is implicated in notable physiological changes and the extraordinary kidney physiology during pregnancy is believed to have an effect on kidney functions. However, during pregnancy the glomerular filtration rate (GFR) increases its work rate up to 50%, on the contrary, in preeclampsia the GFR turns back to decline. Objectives: This study aims to measure and compare kidney function between preeclamptic and normal pregnant women. Materials and Methods: A cross-sectional hospital-based study was conducted in the period from March to May 2021 in Wad Medani Obstetrics and Gynecology Teaching Hospital. A total of 100 pregnant women, 50 apparently healthy pregnant women and 50 pregnant ladies proved to have preeclamptic toxemia, their ages ranged from 18 to 44 years old and at the third trimester of pregnancy. Blood samples were taken and serum was separated, then urea, creatinine, uric acid, sodium and potassium were determined. Data were analyzed using Statistical Package for Social Science (SPSS). Results: The results of this study revealed that 92% of preeclamptic pregnant women had the first time of the incidence and 8% were family inherited preeclampsia and injured multiple times. The preeclamptic pregnant women showed elevation in both systolic and diastolic blood pressure compared to the normal pregnant women. Although the creatinine values of all study subjects were in the normal range, the mean of its serum level was found to be higher in normal pregnant women than that in preeclamptic women. The study also showed urea level was elevated in the preeclampsia group in comparison to the normal one, while all values were in the normal range. In addition to the significant difference that observed in the uric acid mean between preeclamptic (higher) and normal pregnant groups, abnormal values were only noticed with many preeclamptic patients. The levels of electrolytes (sodium and potassium) were elevated in the preeclampsia women group, whereas all values were in the normal range. Conclusion: This study concluded that preeclamptics showed significant elevation in the urea, uric acid, sodium and potassium levels and a significant decrease in creatinine level compared to normal pregnant women, although all parameters values for both groups were in the reference values for non-pregnancy.
文摘<strong>Objective:</strong> To evaluate the correlation between residual renal function and hypertension in regular haemodialysis patients. <strong>Background:</strong> Initiating chronic dialysis treatment gives end-stage renal disease patients a new lease on life. However, the annual mortality rate in dialysis patients is ~20% and quality of life is substantially reduced. <strong>Patients and Methods:</strong> This study was carried out on a reasonable number of subjects on regular haemodialysis divided into two groups. All were given informed consent and, the study was approved by the ethics committee of Menoufia University. <strong>Results:</strong> There was significant relation between presence of residual renal function and hypertension in patients with ESRD on regular haemodialysis, but the relation between residual renal function and control of hypertension is not statistically significant. 40% of group 1 were hypertensive, 66.7% of group 2 patients were hypertensive, the interdialytic weight gain mean was 1.42 in group 1 and 2.37 in group 2. Control of hypertension was achieved in 63.6% of group 1 patients by one drug, 27.3% patients by 2 drugs;however 9.1% of patients need 3 drugs to control their blood pressure, while in group 2 40% of patients were controlled by one drug, 45% with 2 drugs and 15% need 3 drugs to control blood pressure. <strong>Conclusion:</strong> There is significant relation between presence of residual renal function and hypertension in patients with ESRD on regular haemodialysis, but the relation between residual renal function and control of hypertension is not statistically significant.
文摘Background and Objectives: In anesthesia for bariatric surgery, alterations occur in several organs, including the kidney. The objective of this study was to compare the effect of dexmedetomidine and remifentanil on the renal function of morbidly obese patients submitted to bariatric surgery. Methods: Sixty-one patients were studied prospectively and divided randomly into two groups: remifentanil (R) and dexmedetomidine (D). Renal function was evaluated in three phases: before anesthesia (M0), after anesthetic induction (M1) and after surgical incision (M2). Plasma concentrations were determined for glucose, antidiuretic hormone, creatinine, urea, sodium, potassium and osmolarity and urinary concentrations for creatinine, urea, sodium, potassium and osmolarity. Results: Significant differences were found between groups for potassium at M1 (p Conclusions: In both groups, the clearance values fell from moments M0 to M2. This result indicates that renal function of obese patients submitted to bariatric surgery presented a physiological response compatible with the effect of anesthetic-surgical stress. In the group D, creatinine and sodium clearances were elevated at M1. Urinary volume was greater at M2. These results are suggestive of better preservation of renal function.
文摘Objective:To look for change in relative renal function and document renal scarring following endoscopic renal pelvic instillation sclerotherapy(RPIS)in patients with chyluria by dimercaptosuccinic acid(DMSA)renal scan.Methods:A prospective study was performed between November 2015 and September 2016.All patients with biochemically documented chyluria who underwent RPIS using either 1%-silver nitrate or 0.1%-povidine iodine were included.Patients received either 3-,6-or 9-doses.DMSA renal scan was performed before and 2e3 months after sclerotherapy.Results:Of the 34 patients,22 were males.Mean age was 41.08±16.64 years(range,15-70 years).Thirty-two patients(94.1%)responded to therapy while two did not respond even after 9-doses.Average follow-up was 8.94±3.70 months.The mean relative renal function(preinstillation)of normal kidney was 50.76%±3.55%while that of affected renal unit(side of instillation)was 49.20%±3.44%(range,43.0%-61.0%).After instillation therapy,the mean relative renal function of normal side was 52.26%±3.57%while that of affected renal unit was 47.50%±3.56%(range,41.0%-54.0%).The relative renal function did not change>5%from the baseline value in any patient except one(in which the differential function increased paradoxically by 12%).Two patients developed renal scar in post-instillation renal scan.Conclusion:Endoscopic sclerotherapy in chyluria is safe and effective.The relative renal function does not deteriorate by more than 5%.There is a small risk of development of renal scar.More studies involving larger number of patients are needed to answer this dilemma.
文摘BACKGROUND High-sensitivity cardiac troponin(hs-cTn)levels are frequently elevated in elderly patients presenting to the emergency department for non-cardiac events.However,most studies on the role of elevated hs-cTn in elderly populations have investigated the prognostic value of hs-cTn in patients with a specific diagnosis or have assessed the relationship between hs-cTn and comorbidities.AIM To investigate the in-hospital prognosis of consecutive elderly patients admitted to the Internal Medicine Department with acute non-cardiac events and increased hs-cTnI levels.METHODS In this retrospective study,we selected patients who were aged≥65 years and admitted to the Internal Medicine Department of our hospital between January 2019 and December 2019 for non-cardiac reasons.Eligible patients were those who had hs-cTnI concentrations≥100 ng/L.We investigated the independent predictors of in-hospital mortality by multivariable logistic regression analysis.RESULTS One hundred and forty-six patients(59%female)were selected with an age range from 65 to 100(mean±SD:85.4±7.61)years.The median hs-cTnI value was 284.2 ng/L.For 72(49%)patients the diagnosis of hospitalization was an infectious disease.The overall in-hospital mortality was 32%(47 patients).Individuals who died did not have higher hs-cTnI levels compared with those who were discharged alive(median:314.8 vs 282.5 ng/L;P=0.565).There was no difference in mortality in patients with infectious vs non-infectious disease(29%vs 35%).Multivariable analysis showed that age(OR 1.062 per 1 year increase,95%CI:1.000-1.127;P=0.048)and creatinine levels(OR 2.065 per 1 mg/dL increase,95%CI:1.383-3.085;P<0.001)were the only independent predictors of death.Mortality was 49%in patients with eGFR<30 mL/min/1.73 m2.CONCLUSION Myocardial injury is a malignant condition in elderly patients admitted to the hospital for non-cardiac reasons.The presence of severe renal impairment is a marker of extremely high in-hospital mortality.
文摘Objective:Recently,serum cystatin C(CysC)has been used as a novel marker of renal function.However,there is a lack of data on CysC levels in patients with intestinal urinary diversion(UD).Here we report CysC levels in such patients.Methods:We prospectively observed 38 patients who were diagnosed with bladder cancer and subsequently treated with radical cystectomy and UD at our institution in 2012 and 2013.Serum creatinine(sCr)and CysC were obtained optionally at the same time at least 1 month after radical cystectomy and UD.Results:The median CysC and sCr concentrations were 1.12 mg/L(range 0.75-2.47 mg/L)and 0.99 mg/dL(range 0.61-2.22 mg/dL),respectively.The median estimated concentrations of glomerular filtration rate(GFR)based on CysC(eGFRcys)and GFR based on creatinine(eGFRcreat)were 61.08 mL/min/1.73 m^2(range 22.64e99.89 mL/min/1.73 m^2)and 58.01 mL/min/1.73 m^2(range 23.48e91.82 mL/min/1.73 m2),respectively.CysC had a significant correlation with sCr(r=0.8607,p<0.0001)and eGFRcreat(r=-0.8993,p<0.0001).eGFRcys also had a significant correlation with eGFRcreat(r=0.8104,p<0.0001).Conclusion:The correlation between CysC and sCr was strong and the correlation coefficient was equivalent to that in patients without UD.The results suggest that CysC is not affected by UD and can be used as a marker of renal function similarly to sCr in patients with UD.
文摘Atherosclerotic renal artery stenosis (ARAS), a common clinical finding, is increasing in prevalence as the population ages. ARAS is seen in ～ 7% of persons over 65 years of age1 and in ～ 20% of patients at the time of coronary angiography.2 It is an important cause of chronic kidney disease and may result in 11-14% of cases of end stage renal disease.
文摘Objective: To understand the effects of several commonly used antipsychotics on the renal function of patients with mental illness. Method: Collected patients with mental illness who were hospitalized in our hospital from January 2020 to June 2021, and selected as the research subjects patients with psychiatric disorders who were treated with 2 kinds of commonly used antipsychotic drugs;and collected 3 ml of venous blood before treatment and one month after treatment for renal function tests;observed the changes of renal function indexes before and after treatment. Results: In the collected 694 patients with mental illness, before using antipsychotic drugs, the renal function indexes were BUN: 4.42 ± 1.92 mmol/l;Cr: 70.97 ± 16.92 μmol/l;CCr: 88.37 ± 21.07 ml/min;β2-MG: 1.67 ± 0.61 mg/L;UA: 359.90 ± 112.82 μmol/l;CYS-C: 0.92 ± 0.24 mg/L. One month after using antipsychotics, BUN: 3.77 ± 1.37 mmol/l;Cr: 70.46 ± 16.71 μmol/l;CCr: 87.78 ± 20.63 ml/min;β2-MG: 1.75 ± 0.64 mg/L;UA: 332.53 ± 91.48 umol/l;CYS-C: 0.92 ± 0.24 mg/L;the renal function indexes of urea nitrogen, β2 microglobulin, uric acid and other items all changed significantly. The differences before and after treatment were statistically significant, P < 0.01. Conclusion: Several commonly used antipsychotic drugs have a greater impact on the renal function of patients with mental illness. During the treatment, the changes in renal function should be monitored regularly, if severe renal damage is found, the treatment plan or dosage should be adjusted in time to avoid endangering life.
文摘<strong>Introduction:</strong> Percutaneous nephrolithotomy (PCNL) is a standard minimally invasive urological procedure for the treatment of large renal calculi. It is also associated with complications arising from absorption of irrigation fluid and intravenous fluid injection. We evaluated the changes occurring in vital and blood parameters during PCNL using 0.9% normal saline (NS) as an irrigation fluid. <strong>Materials and Methods:</strong> We prospectively studied 71 patients who underwent PCNL in our hospital between 2016 and 2018. NS (0.9%) was used as irrigation fluid in all patients. Changes in hemodynamics, hemogram, renal function tests and serum electrolytes were noted and assessed for significance using paired t-test. These changes were correlated with ASA grade, BMI, total operating time, total irrigation fluid used and total intravenous fluid used using Pearson’s correlation test. <strong>Results:</strong> A significant fall in serum creatinine was present (1.30 ± 0.96 vs. 1.24 ± 0.93) along with a rise in eGFR (85.39 ± 24.10 vs. 90.18 ± 22.58). A significant rise in serum potassium (4.34 ± 0.45 vs. 4.5 ± 0.56) and chloride levels (104.79 ± 3.51 vs. 106.69 ± 3.14) post-operatively was noted. A significant rise in pulse rate (80.84 ± 10.13 vs. 87.76 ± 13.12) and systolic blood pressure (127.67 ± 15.90 vs. 136.88 ± 19.56) post-operatively was noted. There was no significant change noted in hemoglobin, PCV, platelets and serum sodium levels. Total operating time and irrigation fluid volume showed a positive correlation with changes in eGFR, serum chloride, post-operative pulse rate and blood pressure values. Intravenous fluids volume correlated positively with changes in serum potassium, chloride, post-operative pulse rate and blood pressure values. <strong>Conclusion:</strong> High amount of irrigation fluid absorption can cause early post-operative changes in patients’ hemodynamics and blood indices. Overzealous hydration during PCNL with potassium containing fluids can also lead to hyperkalemia and hyperchloremic acidosis. Thus, early post-operative monitoring of serum electrolytes should be done in all patients after PCNL to prevent complications arising from dyselectrolytemia.
文摘Background: Renal and ocular vessels are some of the major vessels affected in patients with diabetes, and the involvement of these vessels is independent risk factors for other complications. Hemodynamic flow in arteries may be assessed by using measures such as resistive index, which is a non-invasive measure of the resistance in vessels. The association between retinopathy and nephropathy has been conflicting. This study assessed the relationship between resistive index of the central retinal artery and indices of nephropathy in type 2 diabetes. Method: This cross-sectional study examined 74 Nigerian diabetics who were selected consecutively from the out-patient diabetic clinic of a tertiary hospital in South-West Nigeria. Doppler ultrasound was used to determine the resistive index of the central retinal artery along with the right renal artery. The urinary and serum biochemical parameters were also done to determine the urinary albumin excretion and the glomerular filtration rate. Results: The mean age of participants was 59.62 ± 9.55 years. The mean central retinal artery resistive index (CRARI) was 0.77 ± 0.06, with 65 (87.8%) of the participants having elevated CRARI. There was no statistical difference between patients with normal CRARI and elevated CRARI in respect of their urinary albumin excretion (p = 0.796). There was no significant correlation between CRARI and estimated glomerular filtration rate (r = 0.120;p = 0.309) and right renal artery resistive index (r = 0.068;p = 0.564). Conclusion: This study demonstrates that central retinal artery resistive index (CRARI) may not be a predictor of renal function in diabetics.
文摘Background: The aim of this study was to evaluate the feasibility of a dualbolus protocol, where a first bolus of an intravascular tracer is used to measure perfusion, followed by a second bolus of a freely filtered gadolinium-containing agent to measure filtration capacity. Methods: The study was conducted in mice subjected to complete unilateral ureteral obstruction (UUO), and sham operated mice were used as controls. Dynamic contrast- en-hanced MRI was performed 2 days after surgery. Results and discussions: Mean signal-time curves of the renal cortex, renal medulla and abdominal aorta were used to calculate the relative renal blood flow (rRBF), relative renal blood volume (rRBV), mean transit time (MTT) and the glomerular transfer rate Ktrans. We demonstrated that kidneys suffering from two days of UUO showed a decrease in cortical as well as medullary rRBF compared to kidneys from sham-operated mice. Further, we found no changes in rRBV and MTT among groups, neither in the cortex nor in the medulla. The renal functional parameter Ktrans showed a tendency (but statistically insignificant) to be reduced in the ob-structed kidney compared to the sham-operated mice. Conclusions: We showed our first experiences with the consecutive use of intra- and extra-vascularly distributed agents in a renal-diseased mouse model, allowing analysis of both functional haemo- dyamics and filtration capacity in kidneys.
文摘Immunosuppression(IS) is often withdrawn in patients with end stage renal disease secondary to a failed renal allograft, and this can lead to an accelerated loss of residual renal function(RRF). As maintenance of RRF appears to provide a survival benefit to peritoneal dialysis(PD) patients, it is not clear whether this benefit of maintaining RRF in failed allograft patients returning to PD outweigh the risks of maintaining IS. A 49 year-old Caucasian male developed progressive allograft failure nine years after living-donor renal transplantation. Hemodialysis was initiated via tunneled dialysis catheter(TDC) and IS was gradually withdrawn. Two weeksafter IS withdrawal he developed a febrile illness, which necessitate removal of the TDC and conversion to PD. He was maintained on small dose of tacrolimus(1 mg/d) and prednisone(5 mg/d). Currently(1 year later) he is doing exceedingly well on cycler-assisted PD. Residual urine output ranges between 600-1200 m L/d. Total weekly Kt/V achieved 1.82. RRF remained well preserved in this patient with failed renal allograft with minimal immunosuppressive therapy. This strategy will need further study in well-defined cohorts of PD patients with failed allografts and residual RRF to determine efficacy and safety.
