Emerging evidence and perspectives have pointed towards the heart playing an important role in hepatorenal syndrome(HRS),outside of conventional understanding that liver cirrhosis is traditionally considered the sole ...Emerging evidence and perspectives have pointed towards the heart playing an important role in hepatorenal syndrome(HRS),outside of conventional understanding that liver cirrhosis is traditionally considered the sole origin of a cascade of pathophysiological mechanisms directly affecting the kidneys in this context.In the absence of established heart disease,cirrhotic cardiomyopathy may occur more frequently in those with liver cirrhosis and kidney disease.It is a specific form of cardiac dysfunction characterized by blunted contractile responsiveness to stress stimuli and altered diastolic relaxation with electrophysiological abnormalities.Despite the clinical description of these potential cardiac-related complications of the liver,the role of the heart has traditionally been an overlooked aspect of circulatory dysfunction in HRS.Yet from a physiological sense,temporality(prior onset)of cardiorenal interactions in HRS and positive effects stemming from portosystemic shunting demonstrated an important role of the heart in the development and progression of kidney dysfunction in cirrhotic patients.In this review,we discuss current concepts surrounding how the heart may influence the development and progression of HRS,and the role of systemic inflammation and endothelial dysfunction causing circulatory dysfunction within this setting.The temporality of heart and kidney dysfunction in HRS will be discussed.For a subgroup of patients who receive portosystemic shunting,the dynamics of cardiorenal interactions following treatment is reviewed.Continued research to determine the unknowns in this topic is anticipated,hopefully to further clarify the intricacies surrounding the liver-heart-kidney connection and improve strategies for management.展开更多
AIM To evaluate incidence, risk factors and treatment outcome of BK polyomavirus nephropathy(BKVN) in a cohort of renal transplant recipients in the Auckland region without a formal BK polyomavirus(BKV) surveillance p...AIM To evaluate incidence, risk factors and treatment outcome of BK polyomavirus nephropathy(BKVN) in a cohort of renal transplant recipients in the Auckland region without a formal BK polyomavirus(BKV) surveillance programme.METHODS A cohort of 226 patients who received their renal transplants from 2006 to 2012 was retrospectively reviewed.RESULTS Seventy-six recipients(33.6%) had a BK viral load(BKVL) test and 9 patients(3.9%) developed BKVN. Cold ischaemia time(HR = 1.18, 95%CI: 1.04-1.35) was found to be a risk factor for BKVN. Four recipients with BKVN had complete resolution of their BKV infection; 1 recipient had BKVL less than 625 copies/mL; 3 recipients had BKVL more than 1000 copies/mL and 1 had graft failure from BKVN. BKVN has a negative impact on graft function [median estimated glomerular filtration rate(eG FR) 22.5(IQR 18.5-53.0) mL /min per 1.73 m^2, P = 0.015), but no statistically significant difference(P = 0.374) in renal allograft function was found among negative BK viraemia group [median e GFR 60.0(IQR 48.5-74.2) mL /min per 1.73 m^2), positive BK viraemia without BKVN group [median eG FR 55.0(IQR 47.0-76.0) mL /min per 1.73 m^2] and unknown BKV status group [median eG FR 54.0(IQR 43.8-71.0) mL /min per 1.73 m^2]. The incidence and treatment outcomes of BKVN were similar to some centres with BKV surveillance programmes.CONCLUSION Recipients with BVKN have poorer graft function. Although active surveillance for BKV has been shown to be effective in reducing incidence of BKVN, it should be tailored specifically to that transplant centre based on its epidemiology and outcomes of BKVN, particularly in centres with limited resources.展开更多
Objective:To investigate the effects of sustained low-efficiency dialysis (SLED) combined with hemoperfusion (HP) on inflammatory stress, hemodynamic parameters and renal function in septic patients with severe acute ...Objective:To investigate the effects of sustained low-efficiency dialysis (SLED) combined with hemoperfusion (HP) on inflammatory stress, hemodynamic parameters and renal function in septic patients with severe acute kidney injury.Methods: A total of 82 cases of sepsis with severe acute renal injury were divided into control group (n=41) and observation group (n=41) according to the random data table method. Two groups of patients were given conventional support treatment, on this basis, the control group was treated with Continuous renal replacement therapy (CRRT), and the observation group was treated with SLED plus HP. The levels of inflammatory factors, hemorheological parameters and renal function indexes of the two groups were compared before and after treatment.Results: There was no significant difference in the levels of CRP, WBC, PCT, MAP, OI, BUN and Scr between the control group and the observation group before the treatment. Compared with the level before treatment, the levels of CRP, WBC, PCT, BUN and Scr in the two groups were significantly decreased after treatment, while the levels of MAP and OI were significantly increased. Compared with the level of the control group after treatment, the levels of CRP, WBC, PCT, BUN and Scr in the observation group were significantly lower than those in the control group, the levels of MAP and OI were significantly increased, the difference was statistically significant.Conclusion:SLED combined with HP regimen in treatment of sepsis combined with severe acute kidney injury can effectively inhibit the release of inflammatory factors, improve hemodynamics and renal function, and has an important clinical value.展开更多
Objective: To investigate the changes and clinical significance of renal function impairment, extracellular matrix regulation, renal fibrosis and inflammation in patients with chronic glomerulonephritis. Methods: A to...Objective: To investigate the changes and clinical significance of renal function impairment, extracellular matrix regulation, renal fibrosis and inflammation in patients with chronic glomerulonephritis. Methods: A total of 50 patients with chronic glomerulonephritis admitted to our hospital from May 2016 to February 2018 were selected as observation group and 50 healthy people as control group.The expression levels and related inflammatory markers of renal dysfunction [including Uric acid (UA), retinol binding protein (RBP) and type IV collagen (Col-IV)], extracellular matrix modulation [including tissue inhibitor of metalloproteinase -1 (TIMP-1) and matrix metalloproteinase-9 (MMP-9)], renal fibrosis [including transforming growth factor β1 (TGF-β1), laminin (LN) and hyaluronic acid (HA).] and degree of inflammation [including leukocyte stimulating hormone-1 (Lkn-1) and tumor necrosis factor-α (TNF-α)] were observed and compared between the two groups. Results:The changes of renal function impairment, extracellular matrix regulation, renal fibrosis and inflammation were significant in both groups. Compared with healthy controls in the control group, UA[(352.49±26.57) μmol/L], RBP[(98.75±26.91) mg/L], Col-IV[(224.77±72.32) ng/L], TIMP-1[(145.79±49.67) ng/mL], MMP-9[(177.71±52.35) ng/mL], TGF-β1[(15.23±7.61) ng/mL], LN[(153.82±23.01) μg/L], HA[(366.80±77.98) μg/L], Lkn-1[(82.71±20.64) pmol/L] and TNF-α[(138.01±45.26) pg/mL] levels were significantly elevated. The differences were statistically significant. Conclusions: Chronic glomerulonephritis patients with renal dysfunction and abnormal regulation of extracellular matrix, and severe renal fibrosis, the body is at a higher level of inflammation, clinical indicators should be strengthened to detect the early diagnosis of the disease and treatment basis.展开更多
Anti-thymocyte globulin(ATG)is a pivotal immunosuppressive therapy utilized in the management of T-cell-mediated rejection and steroid-resistant rejection among renal transplant recipients.Commercially available as Th...Anti-thymocyte globulin(ATG)is a pivotal immunosuppressive therapy utilized in the management of T-cell-mediated rejection and steroid-resistant rejection among renal transplant recipients.Commercially available as Thymoglobulin(rabbit-derived,Sanofi,United States),ATG-Fresenius S(rabbit-derived),and ATGAM(equine-derived,Pfizer,United States),these formulations share a common mechanism of action centered on their interaction with cell surface markers of immune cells,imparting immunosuppressive effects.Although the prevailing mechanism predominantly involves T-cell depletion via the complement-mediated pathway,alternate mechanisms have been elucidated.Optimal dosing and treatment duration of ATG have exhibited variance across randomised trials and clinical reports,rendering the establishment of standardized guidelines a challenge.The spectrum of risks associated with ATG administration spans from transient adverse effects such as fever,chills,and skin rash in the acute phase to long-term concerns related to immunosuppression,including susceptibility to infections and malignancies.This comprehensive review aims to provide a thorough exploration of the current understanding of ATG,encompassing its mechanism of action,clinical utility in the treatment of acute renal graft rejections,specifically steroid-resistant cases,efficacy in rejection episode reversal,and a synthesis of findings from different eras of maintenance immunosuppression.Additionally,it delves into the adverse effects associated with ATG therapy and its impact on long-term graft function.Furthermore,the review underscores the existing gaps in evidence,particularly in the context of the Banff classification of rejections,and highlights the challenges faced by clinicians when navigating the available literature to strike the optimal balance between the risks and benefits of ATG utilization in renal transplantation.展开更多
A major concern inhibiting some clinicians from embracing peritoneal dialysis(PD) as the preferred first modality of dialysis is the effects of PD solutions on the peritoneal membrane. These anatomical and functional ...A major concern inhibiting some clinicians from embracing peritoneal dialysis(PD) as the preferred first modality of dialysis is the effects of PD solutions on the peritoneal membrane. These anatomical and functional changes predispose to complications like peritonitis,encapsulating peritoneal sclerosis and ultrafiltration failure. In recent years, "biocompatible" and glucosesparing PD regimens have been developed to minimize damage to the peritoneal membrane. Can the use of these more expensive solutions be justified on current evidence? In this review of the literature, we explore how we may individualize the prescription of biocompatible PD fluid.展开更多
Health literacy (HL) is essential to access, comprehend, assess and use health data allowing patients to make better health and quality of life decisions. To assess the health literacy level of hemodialysis Egyptian p...Health literacy (HL) is essential to access, comprehend, assess and use health data allowing patients to make better health and quality of life decisions. To assess the health literacy level of hemodialysis Egyptian patients, a cross-sectional study from March to September 2020 was conducted at 4 hemodialysis (HD) units on 439 patients. A translated questionnaire including demographic characteristics and health literacy components was conducted. This study adapted Nutbeam’s model incorporating critical health literacy, interactive health literacy, and functional health literacy. Health literacy of hemodialysis patients was satisfactory among 35.5% of the studied patients. The average total score of health literacy questionnaire was (15.53 ± 4.32) distributed as (2.90 ± 1.26) for functional literacy, (3.10 ± 1.26) for basic health knowledge, (1.65 ± 1.21) for communicative literacy, (2.53 ± 0.70) for interactive literacy, (1.75 ± 1.30) for advanced health knowledge, (1.74 ± 0.48) for critical literacy, and (1.83 ± 0.93) for patient safety. It was found that poor health literacy was associated with low income (OR = 2.54, CI 95%: 1.66_3.89, <i>p</i> < 0.001), of increasing age (OR = 0.12 CI 95%: 0.07_0.19, <i>p</i> < 0.001), low education (OR = 1.08, CI 95%: 1.04_1.11, <i>p</i> < 0.001) and the patient did not undergo kidney transplant (OR = 4.19 CI 95%: 1.12_15.62, <i>p</i> = 0.033). There was a prevalent low health literacy among the studied regular hemodialysis patients which was affected by education, age and income and in turn it affected the adherence to treatment. Understanding the linkage between HL and self-care attitudes should enhance efforts to improve hemodialysis outcomes.展开更多
AIM:To determine the temporal expression and pattern of Rel/nuclear factor(NF)-κB proteins in renal tissue in polycystic kidney disease(PKD). METHODS: The renal expression of Rel/NF-κB proteins was determined by imm...AIM:To determine the temporal expression and pattern of Rel/nuclear factor(NF)-κB proteins in renal tissue in polycystic kidney disease(PKD). METHODS: The renal expression of Rel/NF-κB proteins was determined by immunohistochemistry, immunofluorescence and immunoblot analysis in Lewis polycystic kidney rats(LPK, a genetic ortholog of human nephronopthsis-9) from postnatal weeks 3 to 20. At each timepoint, renal disease progression and the mR NA expression of NF-κB-dependent genes(TNFa and CCL2) were determined. NF-κB was also histologicaly assessed in human PKD tissue.RESULTS: Progressive kidney enlargement in LPK rats was accompanied by increased renal cell proliferation and interstitial monocyte accumulation(peaking at weeks 3 and 10 respectively), and progressive interstitial fibrosis(with a smooth muscle actin and Sirius Red deposition significantly increased compared to Lewis kidneys from weeks 3 to 6 onwards). Rel/NF-κB proteins(phosphorylated-p105, p65, p50, c-Rel and RelB) were expressed in cystic epithelial cells(CECs) of LPK kidneys as early as postnatal week 3 and sustained until latestage disease at week 20. From weeks 10 to 20, nuclear p65, p50, Rel B and cytoplasmic IκBa protein levels, and TNFa and CCL2 expression, were upregulated in LPK compared to Lewis kidneys. NF-κB proteins were consistently expressed in CECs of human PKD. The DNA damage marker γ-H2AX was also identified in the CECs of LPK and human polycystic kidneys. CONCLUSION: Several NF-κB proteins are consistently expressed in CECs in human and experimental PKD. These data suggest that the upregulation of both the canonical and non-canonical pathways of NF-κB signaling may be a constitutive and early pathological feature of cystic renal diseases.展开更多
Coronavirus disease 2019(COVID-19)is a highly infectious disease which emerged into a global pandemic.Although it primarily causes respiratory symptoms for affected patients,COVID-19 was shown to have multi-organ mani...Coronavirus disease 2019(COVID-19)is a highly infectious disease which emerged into a global pandemic.Although it primarily causes respiratory symptoms for affected patients,COVID-19 was shown to have multi-organ manifestations.Elevated liver enzymes appear to be commonly observed during the course of COVID-19,and there have been numerous reports of liver injury secondary to COVID-19 infection.It has been established that patients with pre-existing chronic liver disease(CLD)are more likely to have poorer outcomes following COVID-19 infection compared to those without CLD.Co-morbidities such as diabetes,hypertension,obesity,cardiovascular and chronic kidney disease frequently co-exist in individuals living with CLD,and a substantial population may also live with some degree of frailty.The mechanisms of how COVID-19 induces liver injury have been postulated.Hepatorenal syndrome(HRS)is the occurrence of kidney dysfunction in patients with severe CLD/fulminant liver failure in the absence of another identifiable cause,and is usually a marker of severe decompensated liver disease.Select reports of HRS following acute COVID-19 infection have been presented,although the risk factors and pathophysiological mechanisms leading to HRS in COVID-19 infection or following COVID-19 treatment remain largely unestablished due to the relative lack and novelty of published data.Evidence discussing the management of HRS in highdependency care and intensive care contexts is only emerging.In this article,we provide an overview on the speculative pathophysiological me-chanisms of COVID-19 induced HRS and propose strategies for clinical diagnosis and management to optimize outcomes in this scenario.展开更多
Chemically synthetic nanomotors can consume fuel in the environment and utilize the self-generated concentration gradient to self-propel themselves in the system.We study the collective dynamics of an ensemble of sphe...Chemically synthetic nanomotors can consume fuel in the environment and utilize the self-generated concentration gradient to self-propel themselves in the system.We study the collective dynamics of an ensemble of sphere dimers built from linked catalytic and noncatalytic monomers.Because of the confinement from the fuel Held and the interactions among motors,the ensemble of dimer motors can self-organize into varlous nanostructures,such as a radial pattern in the spherical fuel field and a staggered radial pattern in a cylindrical fuel Held.The influence of the dimer volume fraction on the self-assembly is also investigated and the formed nanostructures are analyzed in detail.The results presented here may give insight into the application of the self-assembly of active materials.展开更多
Objective:To study the clinical significance of troponinI(TnI),high sensitivity C reactive protein(hs-CRP)and N-terminal pro-brain natriuretic peptide(NT-proBNP)in the diagnosis of myocardial damage in uremia patients...Objective:To study the clinical significance of troponinI(TnI),high sensitivity C reactive protein(hs-CRP)and N-terminal pro-brain natriuretic peptide(NT-proBNP)in the diagnosis of myocardial damage in uremia patients.Methods:114 uremia patients treated in our hospital from January 2017 to February 2019 were selected.According to whether myocardial damage occurred,patients were divided into two groups including uremia group(63 cases)anduremia myocardial damage group(51 cases).50 hospitalized patients with non-chronic kidney disease and non-cardiovascular disease in our hospital were selected as control group.The levels of TnI,hs-CRP and NT-proBNP in 1,3 and 7 days after admission were detected and compared.Meanwhile,the ecg indexes of left?ventricular?ejection?fraction(LVEF)and Thickness of the posterior wall of the left ventricle(LVPWd)were recorded and compared.Person correlation was used to analyze the correlation between the levels of TnI,hs-CRP,NT-proBNP and ecg indexes including LVEF and LVPWd.COX regression analysis was used to analyze the independent riskfactors affecting the clinical prognosis of uremia patients.Results:The levels of TnI,hs-CRP,NT-proBNP in the three groups were significantly different on 1,3,7 days after admission.The levels of the three indexes(TnI,hs-CRP,NT-proBNP)in uremia combined with myocardial damage group and uremia group were decreased with treatment.However,the levels of the three indexes(TnI,hs-CRP,NT-proBNP)in uremia combined with myocardial damage group were the highest(P<0.05).Compared with the other two groups,the LVEF of uremia combined with myocardial damage group was the lowest,while the LVPWd was the thickest,showing a significant difference(P<0.05).There was negativecorrelation between LVEF and TnI,hs-CRP,NT-proBNP levels.However,LVPWd was positively correlated with TnI,hs-CRP and NT-proBNP levels(P<0.05).COX regression analysis showed that TnI,hs-CRP,NT-proBNP levels,LVEF and LVPWd were the independent factors affecting the clinical prognosis of uremia patients Conclusion:The level of TnI,hs-CRP,NT-proBNP was dynamic change in the onset and treatment process in uremia combined with myocardial damage patients,which could be used for early diagnosis of uremia combined with myocardial damage.展开更多
End-stage kidney failure(ESKD)is a global issue where kidney replacement therapy imposes enormous economic burden to people of developing countries,in addition to the severe limitations to the availability of hemodial...End-stage kidney failure(ESKD)is a global issue where kidney replacement therapy imposes enormous economic burden to people of developing countries,in addition to the severe limitations to the availability of hemodialysis and peritoneal dialysis technique.The best option of kidney transplantation also requires lifelong combination immunosuppressive medicines,the cost of which is equally comparable to lifelong dialysis.A strategy of achieving transplant tolerance that requires minimum immunosuppressive medicines,although in experimental stage,also requires state-of-art technology with costly medicines and interventions.This is evidently beyond the reach of ESKD patients of developing countries.Hence,globally in developing countries,a need for an innovative but cost-effective tolerance protocol is a burning need for a successful transplant program.In brief,transplant tolerance is defined as a state of donorspecific unresponsiveness to the allograft antigens without the need for ongoing pharmacologic immunosuppression or with a minimal need.Current state-of-art techniques involves:(1)A state of hematological chimera,for complete tolerance;(2)Prope or partial tolerance where immune-reactive T-lymphocytes are inhibited using monoclonal antibodies;and(3)Chimeric antigen receptor for T-regulatory(T-reg)cell therapy using genetically engineered T-reg cells targeting specific Tlymphocyte receptors for inducing anergy.From our real-world experience in transplant management in post-transplant lympho-proliferative disorders(PTLD),we noticed frequently a drastic reduction in the need of immunosuppressive medicines following lympho-ablative therapy for PTLD.We recently published a case study on a real-world experience transplant case where we explained a partial or prope tolerance that developed after lymphocyte ablation therapy,following which the allograft was maintained with low dose dual standard immunosuppressive medicines.Based on this publication,we propose here an innovative tolerance protocol for living related low risk kidney transplantation for developing countries,in this opinion review.展开更多
People exposed to liver ischaemia reperfusion(IR)injury often develop acute kidney injury and the combination is associated with significant morbidity and mortality.Molecular mediators released by the liver in respons...People exposed to liver ischaemia reperfusion(IR)injury often develop acute kidney injury and the combination is associated with significant morbidity and mortality.Molecular mediators released by the liver in response to IR injury are the likely cause of acute kidney injury(AKI)in this setting,but the mediators have not yet been identified.Identifying the mechanism of injury will allow the identification of therapeutic targets which may modulate both liver IR injury and AKI following liver IR injury.展开更多
Objective:To investigate calcitriol, cinacalcet plus comprehensive intervention on maintenance hemodialysis (MHD) patients with secondary hyperparathyroidism (SHPT) calcium (Ca), phosphorus (P) metabolism and parathyr...Objective:To investigate calcitriol, cinacalcet plus comprehensive intervention on maintenance hemodialysis (MHD) patients with secondary hyperparathyroidism (SHPT) calcium (Ca), phosphorus (P) metabolism and parathyroid hormone (PTH) effect.Methods: A total of 80 cases of patients with SHPT from January 2014 to January 2016 in our hospital were randomly divided into observation group and control group, control group to eat the whole piece of cinacalcet hydrochloride oral tablets, the initial dose of 25 mg/d, every 2 to 4 weeks, according to Ca×P, parathyroid hormone (iPTH) test results adjust the dose, the maximum dose of not more than 75 mg/d, the observation group in the control group on the basis of oral administration of Calcitriol Soft Capsules 0.25 g/d, 3 times/week, 2 groups were given comprehensive intervention measures, to evaluate the curative effect after 3 months of treatment. The 2 groups before and after treatment collected fasting peripheral venous blood, the determination of Ca, P and alkaline phosphatase by colorimetric method (ALP), Ca, P product calculation (Ca×P), to detect the level of iPTH before and after treatment by ELISA method;TY-6858-HI type ultrasound instrument, measuring length, width and thickness of the parathyroid glands, and calculate the parathyroid gland volume.Results:in the observation group after treatment, Ca, Ca×P increased degree, P, ALP, iPTH lower than the control group, the size of the parathyroid gland was better than the control group.Conclusion:calcitriol, cinacalcet combined intervention therapy has good clinical effect in patients with MHD SHPT, Ca, P can effectively improve the metabolism, reduce the level of iPTH, reduce the parathyroid gland volume is worthy of promotion.展开更多
Epstein-Barr virus (EBV) mucocutaneous ulceration is a rare complication of immunosuppression that results in painful ulceration of the tongue or gingiva, and less commonly, refractory ulceration of the gastrointestin...Epstein-Barr virus (EBV) mucocutaneous ulceration is a rare complication of immunosuppression that results in painful ulceration of the tongue or gingiva, and less commonly, refractory ulceration of the gastrointestinal tract. High clinical suspicion is required, as failure to diagnose EBV mucocutaneous ulceration may result in significant morbidity and mortality. We report the case of a 64-year-old female renal transplant recipient requiring admission to hospital for management of severe oral and epigastric pain. Examination revealed a large, superficial, well-circumscribed ulcer at the base of the tongue. Blood tests suggested a secondary immunodeficiency characterised by mild leucopenia, hypogammaglobulinaemia, and low memory B-cells with normal immunophenotype. Endoscopy revealed four, cratered ulcers in the pre-pyloric region of the stomach. A core biopsy of the tongue ulcer confirmed EBV mucocutaneous ulceration. The patient’s immunosuppression was optimised, which resulted in complete resolution of the tongue and gastric ulcers at eight and twelve weeks of follow-up respectively.展开更多
AIM To study the relationship between overhydration(OH) in peritoneal dialysis(PD) patients and cardiac mortality.METHODS OH, as measured by body composition monitor(BCM), is associated with increased mortality in dia...AIM To study the relationship between overhydration(OH) in peritoneal dialysis(PD) patients and cardiac mortality.METHODS OH, as measured by body composition monitor(BCM), is associated with increased mortality in dialysis patients. BCM has been used to guide treatment on the assumption that correcting OH will improve cardiac morbidity and mortality although data demonstrating causality that is reversible is limited. We wished to determine if OH in PD patients predicted cardiac mortality, and if there was a correlation between OH and cardiac troponin-T(cT n T) levels. Finally, we wished to determine if improving OH values would lead to a decrement in cT n T. All prevalent PD patients over the study period of 57 mo who had contemporaneous BCM and cT nT measurements were followed irrespective of transplantation or PD technique failure. We also studied a cohort of patients with who had severe OH(> +2L).The Fresenius Body Composition Monitor was used to obtain hydration parameters. cT nT levels were done as part of routine clinical care. Data was analysed using SPSS version 20.0.RESULTS There were 48 deaths in the 336 patients. The patients that died from cardiac or non-cardiac causes were similar with respect to their age, incidence of diabetes mellitus, gender, ethnicity and cause of renal failure. However, the patients with cardiac causes of death had significantly shorter dialysis vintage(10.3 mo vs 37.0 mo, P < 0.0001) and were significantly more overhydrated by BCM measurement(2.95 L vs 1.35 L, P < 0.05). The mean(standard error of the means) hydration status of the 336 patients was +1.15(0.12) L and the median [interquartile range(IQR)] cT nT level was 43.5(20-90) ng/L. The cT nT results were not normally distributed and were therefore transformed logarithmically. There was a statistically significant correlation between Log(cT nT) with the OH value(Spearman r value 0.425, P < 0.0001). We identified a sub-group of patients that were severely overhydrated; median(IQR) hydration at baseline was +2.7(2.3 to 3.7) L. They were followed up for a minimum of 6 mo. Reduction in OH values in these patients over 6 mo correlated with lowering of cT nT levels(Spearman r value 0.29, P < 0.02). CONCLUSION Patients that were overhydrated had higher cT nT, and had deaths that were more likely to be cardiac related. Reduction in OH correlated with lowering of cT nT.展开更多
AIM: To explore whether serum bicarbonate at admission to intensive care unit(ICU) predicted development of acute kidney injury(AKI).METHODS:We studied all patients admitted to our ICU over a 2 year period(February 20...AIM: To explore whether serum bicarbonate at admission to intensive care unit(ICU) predicted development of acute kidney injury(AKI).METHODS:We studied all patients admitted to our ICU over a 2 year period(February 2010 to 2012).The ICU has a case mix of medical and surgical patients excluding cardiac surgical,trauma and neurosurgical patients.We analysed 2035 consecutive patients admitted to ICU during the study period.Data were collected by two investigators independently and in duplicate using a standardised spread sheet to ensure accuracy.Ambiguous data were checked for accuracy where indicated.AKI was defined using the Kidney Disease Improving Global Outcomes criteria.Patients were divided into two groups;patients who developed AKI or those who did not,in order to compare the baseline characteristics,and laboratory and physiologic data of the two cohorts.Regression analysis was used to identify if serum bicarbonate on admission predicted the development of AKI.RESULTS:Of 2036 patients 152(7.5%)were excluded due to missing data.AKI developed in 43.1%of the patients.The AKI group,compared to the nonAKI group,was sicker based on their lower systolic,diastolic and mean arterial pressures and a higher acutephysiology and chronic health evaluation(APACHE)Ⅲand SAPSⅡscores.Moreover,patients who developed AKI had more co-morbidities and a higher proportion of patients who developed AKI required mechanical ventilation.The multi-regression analysis of independent variables showed that serum bicarbonate on admission(OR=0.821;95%CI:0.796-0.846;P<0.0001),APACHEⅢ(OR=1.011;95%CI:1.007-1.015;P<0.0001),age(OR=1.016;95%CI:1.008-1.024;P<0.0001)and presence of sepsis at ICU admission(OR=2.819;95%CI:2.122-23.744;P=0.004)were each significant independent predictors of AKI.The area under the ROC curve was 0.8(95%CI:0.78-0.83),thereby demonstrating that the predictive model has relatively good discriminating power for predicting AKI.CONCLUSION:Serum bicarbonate on admission may independently be used to make a diagnosis of AKI.展开更多
The availability of disease-modifying drugs for the management of autosomal dominant polycystic kidney disease(ADPKD) has accelerated the need to accurately predict renal prognosis and/or treatment response in this co...The availability of disease-modifying drugs for the management of autosomal dominant polycystic kidney disease(ADPKD) has accelerated the need to accurately predict renal prognosis and/or treatment response in this condition. Arginine vasopressin (AVP) is a critical determinant of postnatal kidney cyst growth in ADPKD. Copeptin (the C-terminal glycoprotein of the precursor AVP peptide) is an accurate surrogate marker of AVP release that is stable and easily measured by immunoassay. Cohort studies show that serum copeptin is correlated with disease severity in ADPKD, and predicts future renal events [decline in renal function and increase in total kidney volume (TKV)]. However, serum copeptin is strongly correlated with creatinine, and its additional value as a prognostic biomarker over estimated glomerular filtration rate and TKV is not certain. It has also been suggested that copeptin could be a predictive biomarker to select ADPKD patients who are most likely to benefit from AVP-modifying therapies, but prospective data to validate this assumption are required. In this regard, long-term randomised clinical trials evaluating the effect of prescribed water intake on renal cyst growth may contribute to addressing this hypothesis. In conclusion, although serum copeptin is aligned with the basic pathogenesis of ADPKD, further rigorous studies are needed to define if it will contribute to enabling the delivery of personalised care in ADPKD.展开更多
AIM: To determine whether complement membrane attack complex(C5b-9) has a pathogenic role in tubulointerstitial injury in a renal disease model characterized by acute highly selective proteinuria. METHODS: Protein-ove...AIM: To determine whether complement membrane attack complex(C5b-9) has a pathogenic role in tubulointerstitial injury in a renal disease model characterized by acute highly selective proteinuria. METHODS: Protein-overload nephropathy(PON) was induced in adult female Piebald-Viral-Glaxo rats with or without complement C6 deficiency(C6- and C6+) by daily intraperitoneal injections of bovine serum albumin(BSA, 2 g/d), and examined on days 2, 4 and 8.RESULTS: Groups with PON developed equivalent levels of heavy proteinuria within 24 h of BSA injection. In C6+ rats with PON, the tubulointerstitial expression of C5b-9 was increased and localized predominantly to the basolateral surface of tubular epithelial cells(TECs), whereas it was undetectable in C6- animals. TEC proliferation(as assessed by the number of BrdU +cells) increased by more than 50-fold in PON, peaking on day 2 and declining on days 4 to 8. There was a trend for a reduction in the number of BrdU + TECs on day 4 in the C6- PON group(P = 0.10 compared to C6+) but not at any other time-point. Kidney enlargement, TEC apoptosis(TUNEL+ cells) and markers of tubular injury(tubule dilatation, loss of TEC height, protein cast formation) were not altered by C6 deficiency in PON. Interstitial monocyte(ED-1+ cell) accumulation was partially reduced in C6- animals with PON on day 4(P = 0.01) but there was no change in myofibroblast accumulation. CONCLUSION: These data suggest that C5b-9 does not mediate tubulointerstitial injury in acute glomerular diseases characterized by selective proteinuria.展开更多
文摘Emerging evidence and perspectives have pointed towards the heart playing an important role in hepatorenal syndrome(HRS),outside of conventional understanding that liver cirrhosis is traditionally considered the sole origin of a cascade of pathophysiological mechanisms directly affecting the kidneys in this context.In the absence of established heart disease,cirrhotic cardiomyopathy may occur more frequently in those with liver cirrhosis and kidney disease.It is a specific form of cardiac dysfunction characterized by blunted contractile responsiveness to stress stimuli and altered diastolic relaxation with electrophysiological abnormalities.Despite the clinical description of these potential cardiac-related complications of the liver,the role of the heart has traditionally been an overlooked aspect of circulatory dysfunction in HRS.Yet from a physiological sense,temporality(prior onset)of cardiorenal interactions in HRS and positive effects stemming from portosystemic shunting demonstrated an important role of the heart in the development and progression of kidney dysfunction in cirrhotic patients.In this review,we discuss current concepts surrounding how the heart may influence the development and progression of HRS,and the role of systemic inflammation and endothelial dysfunction causing circulatory dysfunction within this setting.The temporality of heart and kidney dysfunction in HRS will be discussed.For a subgroup of patients who receive portosystemic shunting,the dynamics of cardiorenal interactions following treatment is reviewed.Continued research to determine the unknowns in this topic is anticipated,hopefully to further clarify the intricacies surrounding the liver-heart-kidney connection and improve strategies for management.
文摘AIM To evaluate incidence, risk factors and treatment outcome of BK polyomavirus nephropathy(BKVN) in a cohort of renal transplant recipients in the Auckland region without a formal BK polyomavirus(BKV) surveillance programme.METHODS A cohort of 226 patients who received their renal transplants from 2006 to 2012 was retrospectively reviewed.RESULTS Seventy-six recipients(33.6%) had a BK viral load(BKVL) test and 9 patients(3.9%) developed BKVN. Cold ischaemia time(HR = 1.18, 95%CI: 1.04-1.35) was found to be a risk factor for BKVN. Four recipients with BKVN had complete resolution of their BKV infection; 1 recipient had BKVL less than 625 copies/mL; 3 recipients had BKVL more than 1000 copies/mL and 1 had graft failure from BKVN. BKVN has a negative impact on graft function [median estimated glomerular filtration rate(eG FR) 22.5(IQR 18.5-53.0) mL /min per 1.73 m^2, P = 0.015), but no statistically significant difference(P = 0.374) in renal allograft function was found among negative BK viraemia group [median e GFR 60.0(IQR 48.5-74.2) mL /min per 1.73 m^2), positive BK viraemia without BKVN group [median eG FR 55.0(IQR 47.0-76.0) mL /min per 1.73 m^2] and unknown BKV status group [median eG FR 54.0(IQR 43.8-71.0) mL /min per 1.73 m^2]. The incidence and treatment outcomes of BKVN were similar to some centres with BKV surveillance programmes.CONCLUSION Recipients with BVKN have poorer graft function. Although active surveillance for BKV has been shown to be effective in reducing incidence of BKVN, it should be tailored specifically to that transplant centre based on its epidemiology and outcomes of BKVN, particularly in centres with limited resources.
文摘Objective:To investigate the effects of sustained low-efficiency dialysis (SLED) combined with hemoperfusion (HP) on inflammatory stress, hemodynamic parameters and renal function in septic patients with severe acute kidney injury.Methods: A total of 82 cases of sepsis with severe acute renal injury were divided into control group (n=41) and observation group (n=41) according to the random data table method. Two groups of patients were given conventional support treatment, on this basis, the control group was treated with Continuous renal replacement therapy (CRRT), and the observation group was treated with SLED plus HP. The levels of inflammatory factors, hemorheological parameters and renal function indexes of the two groups were compared before and after treatment.Results: There was no significant difference in the levels of CRP, WBC, PCT, MAP, OI, BUN and Scr between the control group and the observation group before the treatment. Compared with the level before treatment, the levels of CRP, WBC, PCT, BUN and Scr in the two groups were significantly decreased after treatment, while the levels of MAP and OI were significantly increased. Compared with the level of the control group after treatment, the levels of CRP, WBC, PCT, BUN and Scr in the observation group were significantly lower than those in the control group, the levels of MAP and OI were significantly increased, the difference was statistically significant.Conclusion:SLED combined with HP regimen in treatment of sepsis combined with severe acute kidney injury can effectively inhibit the release of inflammatory factors, improve hemodynamics and renal function, and has an important clinical value.
文摘Objective: To investigate the changes and clinical significance of renal function impairment, extracellular matrix regulation, renal fibrosis and inflammation in patients with chronic glomerulonephritis. Methods: A total of 50 patients with chronic glomerulonephritis admitted to our hospital from May 2016 to February 2018 were selected as observation group and 50 healthy people as control group.The expression levels and related inflammatory markers of renal dysfunction [including Uric acid (UA), retinol binding protein (RBP) and type IV collagen (Col-IV)], extracellular matrix modulation [including tissue inhibitor of metalloproteinase -1 (TIMP-1) and matrix metalloproteinase-9 (MMP-9)], renal fibrosis [including transforming growth factor β1 (TGF-β1), laminin (LN) and hyaluronic acid (HA).] and degree of inflammation [including leukocyte stimulating hormone-1 (Lkn-1) and tumor necrosis factor-α (TNF-α)] were observed and compared between the two groups. Results:The changes of renal function impairment, extracellular matrix regulation, renal fibrosis and inflammation were significant in both groups. Compared with healthy controls in the control group, UA[(352.49±26.57) μmol/L], RBP[(98.75±26.91) mg/L], Col-IV[(224.77±72.32) ng/L], TIMP-1[(145.79±49.67) ng/mL], MMP-9[(177.71±52.35) ng/mL], TGF-β1[(15.23±7.61) ng/mL], LN[(153.82±23.01) μg/L], HA[(366.80±77.98) μg/L], Lkn-1[(82.71±20.64) pmol/L] and TNF-α[(138.01±45.26) pg/mL] levels were significantly elevated. The differences were statistically significant. Conclusions: Chronic glomerulonephritis patients with renal dysfunction and abnormal regulation of extracellular matrix, and severe renal fibrosis, the body is at a higher level of inflammation, clinical indicators should be strengthened to detect the early diagnosis of the disease and treatment basis.
文摘Anti-thymocyte globulin(ATG)is a pivotal immunosuppressive therapy utilized in the management of T-cell-mediated rejection and steroid-resistant rejection among renal transplant recipients.Commercially available as Thymoglobulin(rabbit-derived,Sanofi,United States),ATG-Fresenius S(rabbit-derived),and ATGAM(equine-derived,Pfizer,United States),these formulations share a common mechanism of action centered on their interaction with cell surface markers of immune cells,imparting immunosuppressive effects.Although the prevailing mechanism predominantly involves T-cell depletion via the complement-mediated pathway,alternate mechanisms have been elucidated.Optimal dosing and treatment duration of ATG have exhibited variance across randomised trials and clinical reports,rendering the establishment of standardized guidelines a challenge.The spectrum of risks associated with ATG administration spans from transient adverse effects such as fever,chills,and skin rash in the acute phase to long-term concerns related to immunosuppression,including susceptibility to infections and malignancies.This comprehensive review aims to provide a thorough exploration of the current understanding of ATG,encompassing its mechanism of action,clinical utility in the treatment of acute renal graft rejections,specifically steroid-resistant cases,efficacy in rejection episode reversal,and a synthesis of findings from different eras of maintenance immunosuppression.Additionally,it delves into the adverse effects associated with ATG therapy and its impact on long-term graft function.Furthermore,the review underscores the existing gaps in evidence,particularly in the context of the Banff classification of rejections,and highlights the challenges faced by clinicians when navigating the available literature to strike the optimal balance between the risks and benefits of ATG utilization in renal transplantation.
文摘A major concern inhibiting some clinicians from embracing peritoneal dialysis(PD) as the preferred first modality of dialysis is the effects of PD solutions on the peritoneal membrane. These anatomical and functional changes predispose to complications like peritonitis,encapsulating peritoneal sclerosis and ultrafiltration failure. In recent years, "biocompatible" and glucosesparing PD regimens have been developed to minimize damage to the peritoneal membrane. Can the use of these more expensive solutions be justified on current evidence? In this review of the literature, we explore how we may individualize the prescription of biocompatible PD fluid.
文摘Health literacy (HL) is essential to access, comprehend, assess and use health data allowing patients to make better health and quality of life decisions. To assess the health literacy level of hemodialysis Egyptian patients, a cross-sectional study from March to September 2020 was conducted at 4 hemodialysis (HD) units on 439 patients. A translated questionnaire including demographic characteristics and health literacy components was conducted. This study adapted Nutbeam’s model incorporating critical health literacy, interactive health literacy, and functional health literacy. Health literacy of hemodialysis patients was satisfactory among 35.5% of the studied patients. The average total score of health literacy questionnaire was (15.53 ± 4.32) distributed as (2.90 ± 1.26) for functional literacy, (3.10 ± 1.26) for basic health knowledge, (1.65 ± 1.21) for communicative literacy, (2.53 ± 0.70) for interactive literacy, (1.75 ± 1.30) for advanced health knowledge, (1.74 ± 0.48) for critical literacy, and (1.83 ± 0.93) for patient safety. It was found that poor health literacy was associated with low income (OR = 2.54, CI 95%: 1.66_3.89, <i>p</i> < 0.001), of increasing age (OR = 0.12 CI 95%: 0.07_0.19, <i>p</i> < 0.001), low education (OR = 1.08, CI 95%: 1.04_1.11, <i>p</i> < 0.001) and the patient did not undergo kidney transplant (OR = 4.19 CI 95%: 1.12_15.62, <i>p</i> = 0.033). There was a prevalent low health literacy among the studied regular hemodialysis patients which was affected by education, age and income and in turn it affected the adherence to treatment. Understanding the linkage between HL and self-care attitudes should enhance efforts to improve hemodialysis outcomes.
基金Supported by Funding from the National Health and Medical Research Council of Australia,Nos.457575 and 632647 to Rangan GKthe Baltimore Polycystic Kidney Disease Research and Clinical Core Center,No.P30DK090868+2 种基金DK095036 to Watnick Tsupported by an Australian Postgraduate Award(University of Sydney)the Michael Stern Polycystic Kidney Disease Research Fellowship
文摘AIM:To determine the temporal expression and pattern of Rel/nuclear factor(NF)-κB proteins in renal tissue in polycystic kidney disease(PKD). METHODS: The renal expression of Rel/NF-κB proteins was determined by immunohistochemistry, immunofluorescence and immunoblot analysis in Lewis polycystic kidney rats(LPK, a genetic ortholog of human nephronopthsis-9) from postnatal weeks 3 to 20. At each timepoint, renal disease progression and the mR NA expression of NF-κB-dependent genes(TNFa and CCL2) were determined. NF-κB was also histologicaly assessed in human PKD tissue.RESULTS: Progressive kidney enlargement in LPK rats was accompanied by increased renal cell proliferation and interstitial monocyte accumulation(peaking at weeks 3 and 10 respectively), and progressive interstitial fibrosis(with a smooth muscle actin and Sirius Red deposition significantly increased compared to Lewis kidneys from weeks 3 to 6 onwards). Rel/NF-κB proteins(phosphorylated-p105, p65, p50, c-Rel and RelB) were expressed in cystic epithelial cells(CECs) of LPK kidneys as early as postnatal week 3 and sustained until latestage disease at week 20. From weeks 10 to 20, nuclear p65, p50, Rel B and cytoplasmic IκBa protein levels, and TNFa and CCL2 expression, were upregulated in LPK compared to Lewis kidneys. NF-κB proteins were consistently expressed in CECs of human PKD. The DNA damage marker γ-H2AX was also identified in the CECs of LPK and human polycystic kidneys. CONCLUSION: Several NF-κB proteins are consistently expressed in CECs in human and experimental PKD. These data suggest that the upregulation of both the canonical and non-canonical pathways of NF-κB signaling may be a constitutive and early pathological feature of cystic renal diseases.
文摘Coronavirus disease 2019(COVID-19)is a highly infectious disease which emerged into a global pandemic.Although it primarily causes respiratory symptoms for affected patients,COVID-19 was shown to have multi-organ manifestations.Elevated liver enzymes appear to be commonly observed during the course of COVID-19,and there have been numerous reports of liver injury secondary to COVID-19 infection.It has been established that patients with pre-existing chronic liver disease(CLD)are more likely to have poorer outcomes following COVID-19 infection compared to those without CLD.Co-morbidities such as diabetes,hypertension,obesity,cardiovascular and chronic kidney disease frequently co-exist in individuals living with CLD,and a substantial population may also live with some degree of frailty.The mechanisms of how COVID-19 induces liver injury have been postulated.Hepatorenal syndrome(HRS)is the occurrence of kidney dysfunction in patients with severe CLD/fulminant liver failure in the absence of another identifiable cause,and is usually a marker of severe decompensated liver disease.Select reports of HRS following acute COVID-19 infection have been presented,although the risk factors and pathophysiological mechanisms leading to HRS in COVID-19 infection or following COVID-19 treatment remain largely unestablished due to the relative lack and novelty of published data.Evidence discussing the management of HRS in highdependency care and intensive care contexts is only emerging.In this article,we provide an overview on the speculative pathophysiological me-chanisms of COVID-19 induced HRS and propose strategies for clinical diagnosis and management to optimize outcomes in this scenario.
基金National Natural Science Foundation of China(Grant Nos.11674080,11974094,and 21873087)。
文摘Chemically synthetic nanomotors can consume fuel in the environment and utilize the self-generated concentration gradient to self-propel themselves in the system.We study the collective dynamics of an ensemble of sphere dimers built from linked catalytic and noncatalytic monomers.Because of the confinement from the fuel Held and the interactions among motors,the ensemble of dimer motors can self-organize into varlous nanostructures,such as a radial pattern in the spherical fuel field and a staggered radial pattern in a cylindrical fuel Held.The influence of the dimer volume fraction on the self-assembly is also investigated and the formed nanostructures are analyzed in detail.The results presented here may give insight into the application of the self-assembly of active materials.
基金Scientific research project of Nantong municipal health and family planning commission(No.MB2019009)Nantong science and technology planning project(No.MSZ18258)
文摘Objective:To study the clinical significance of troponinI(TnI),high sensitivity C reactive protein(hs-CRP)and N-terminal pro-brain natriuretic peptide(NT-proBNP)in the diagnosis of myocardial damage in uremia patients.Methods:114 uremia patients treated in our hospital from January 2017 to February 2019 were selected.According to whether myocardial damage occurred,patients were divided into two groups including uremia group(63 cases)anduremia myocardial damage group(51 cases).50 hospitalized patients with non-chronic kidney disease and non-cardiovascular disease in our hospital were selected as control group.The levels of TnI,hs-CRP and NT-proBNP in 1,3 and 7 days after admission were detected and compared.Meanwhile,the ecg indexes of left?ventricular?ejection?fraction(LVEF)and Thickness of the posterior wall of the left ventricle(LVPWd)were recorded and compared.Person correlation was used to analyze the correlation between the levels of TnI,hs-CRP,NT-proBNP and ecg indexes including LVEF and LVPWd.COX regression analysis was used to analyze the independent riskfactors affecting the clinical prognosis of uremia patients.Results:The levels of TnI,hs-CRP,NT-proBNP in the three groups were significantly different on 1,3,7 days after admission.The levels of the three indexes(TnI,hs-CRP,NT-proBNP)in uremia combined with myocardial damage group and uremia group were decreased with treatment.However,the levels of the three indexes(TnI,hs-CRP,NT-proBNP)in uremia combined with myocardial damage group were the highest(P<0.05).Compared with the other two groups,the LVEF of uremia combined with myocardial damage group was the lowest,while the LVPWd was the thickest,showing a significant difference(P<0.05).There was negativecorrelation between LVEF and TnI,hs-CRP,NT-proBNP levels.However,LVPWd was positively correlated with TnI,hs-CRP and NT-proBNP levels(P<0.05).COX regression analysis showed that TnI,hs-CRP,NT-proBNP levels,LVEF and LVPWd were the independent factors affecting the clinical prognosis of uremia patients Conclusion:The level of TnI,hs-CRP,NT-proBNP was dynamic change in the onset and treatment process in uremia combined with myocardial damage patients,which could be used for early diagnosis of uremia combined with myocardial damage.
文摘End-stage kidney failure(ESKD)is a global issue where kidney replacement therapy imposes enormous economic burden to people of developing countries,in addition to the severe limitations to the availability of hemodialysis and peritoneal dialysis technique.The best option of kidney transplantation also requires lifelong combination immunosuppressive medicines,the cost of which is equally comparable to lifelong dialysis.A strategy of achieving transplant tolerance that requires minimum immunosuppressive medicines,although in experimental stage,also requires state-of-art technology with costly medicines and interventions.This is evidently beyond the reach of ESKD patients of developing countries.Hence,globally in developing countries,a need for an innovative but cost-effective tolerance protocol is a burning need for a successful transplant program.In brief,transplant tolerance is defined as a state of donorspecific unresponsiveness to the allograft antigens without the need for ongoing pharmacologic immunosuppression or with a minimal need.Current state-of-art techniques involves:(1)A state of hematological chimera,for complete tolerance;(2)Prope or partial tolerance where immune-reactive T-lymphocytes are inhibited using monoclonal antibodies;and(3)Chimeric antigen receptor for T-regulatory(T-reg)cell therapy using genetically engineered T-reg cells targeting specific Tlymphocyte receptors for inducing anergy.From our real-world experience in transplant management in post-transplant lympho-proliferative disorders(PTLD),we noticed frequently a drastic reduction in the need of immunosuppressive medicines following lympho-ablative therapy for PTLD.We recently published a case study on a real-world experience transplant case where we explained a partial or prope tolerance that developed after lymphocyte ablation therapy,following which the allograft was maintained with low dose dual standard immunosuppressive medicines.Based on this publication,we propose here an innovative tolerance protocol for living related low risk kidney transplantation for developing countries,in this opinion review.
文摘People exposed to liver ischaemia reperfusion(IR)injury often develop acute kidney injury and the combination is associated with significant morbidity and mortality.Molecular mediators released by the liver in response to IR injury are the likely cause of acute kidney injury(AKI)in this setting,but the mediators have not yet been identified.Identifying the mechanism of injury will allow the identification of therapeutic targets which may modulate both liver IR injury and AKI following liver IR injury.
文摘Objective:To investigate calcitriol, cinacalcet plus comprehensive intervention on maintenance hemodialysis (MHD) patients with secondary hyperparathyroidism (SHPT) calcium (Ca), phosphorus (P) metabolism and parathyroid hormone (PTH) effect.Methods: A total of 80 cases of patients with SHPT from January 2014 to January 2016 in our hospital were randomly divided into observation group and control group, control group to eat the whole piece of cinacalcet hydrochloride oral tablets, the initial dose of 25 mg/d, every 2 to 4 weeks, according to Ca×P, parathyroid hormone (iPTH) test results adjust the dose, the maximum dose of not more than 75 mg/d, the observation group in the control group on the basis of oral administration of Calcitriol Soft Capsules 0.25 g/d, 3 times/week, 2 groups were given comprehensive intervention measures, to evaluate the curative effect after 3 months of treatment. The 2 groups before and after treatment collected fasting peripheral venous blood, the determination of Ca, P and alkaline phosphatase by colorimetric method (ALP), Ca, P product calculation (Ca×P), to detect the level of iPTH before and after treatment by ELISA method;TY-6858-HI type ultrasound instrument, measuring length, width and thickness of the parathyroid glands, and calculate the parathyroid gland volume.Results:in the observation group after treatment, Ca, Ca×P increased degree, P, ALP, iPTH lower than the control group, the size of the parathyroid gland was better than the control group.Conclusion:calcitriol, cinacalcet combined intervention therapy has good clinical effect in patients with MHD SHPT, Ca, P can effectively improve the metabolism, reduce the level of iPTH, reduce the parathyroid gland volume is worthy of promotion.
文摘Epstein-Barr virus (EBV) mucocutaneous ulceration is a rare complication of immunosuppression that results in painful ulceration of the tongue or gingiva, and less commonly, refractory ulceration of the gastrointestinal tract. High clinical suspicion is required, as failure to diagnose EBV mucocutaneous ulceration may result in significant morbidity and mortality. We report the case of a 64-year-old female renal transplant recipient requiring admission to hospital for management of severe oral and epigastric pain. Examination revealed a large, superficial, well-circumscribed ulcer at the base of the tongue. Blood tests suggested a secondary immunodeficiency characterised by mild leucopenia, hypogammaglobulinaemia, and low memory B-cells with normal immunophenotype. Endoscopy revealed four, cratered ulcers in the pre-pyloric region of the stomach. A core biopsy of the tongue ulcer confirmed EBV mucocutaneous ulceration. The patient’s immunosuppression was optimised, which resulted in complete resolution of the tongue and gastric ulcers at eight and twelve weeks of follow-up respectively.
文摘AIM To study the relationship between overhydration(OH) in peritoneal dialysis(PD) patients and cardiac mortality.METHODS OH, as measured by body composition monitor(BCM), is associated with increased mortality in dialysis patients. BCM has been used to guide treatment on the assumption that correcting OH will improve cardiac morbidity and mortality although data demonstrating causality that is reversible is limited. We wished to determine if OH in PD patients predicted cardiac mortality, and if there was a correlation between OH and cardiac troponin-T(cT n T) levels. Finally, we wished to determine if improving OH values would lead to a decrement in cT n T. All prevalent PD patients over the study period of 57 mo who had contemporaneous BCM and cT nT measurements were followed irrespective of transplantation or PD technique failure. We also studied a cohort of patients with who had severe OH(> +2L).The Fresenius Body Composition Monitor was used to obtain hydration parameters. cT nT levels were done as part of routine clinical care. Data was analysed using SPSS version 20.0.RESULTS There were 48 deaths in the 336 patients. The patients that died from cardiac or non-cardiac causes were similar with respect to their age, incidence of diabetes mellitus, gender, ethnicity and cause of renal failure. However, the patients with cardiac causes of death had significantly shorter dialysis vintage(10.3 mo vs 37.0 mo, P < 0.0001) and were significantly more overhydrated by BCM measurement(2.95 L vs 1.35 L, P < 0.05). The mean(standard error of the means) hydration status of the 336 patients was +1.15(0.12) L and the median [interquartile range(IQR)] cT nT level was 43.5(20-90) ng/L. The cT nT results were not normally distributed and were therefore transformed logarithmically. There was a statistically significant correlation between Log(cT nT) with the OH value(Spearman r value 0.425, P < 0.0001). We identified a sub-group of patients that were severely overhydrated; median(IQR) hydration at baseline was +2.7(2.3 to 3.7) L. They were followed up for a minimum of 6 mo. Reduction in OH values in these patients over 6 mo correlated with lowering of cT nT levels(Spearman r value 0.29, P < 0.02). CONCLUSION Patients that were overhydrated had higher cT nT, and had deaths that were more likely to be cardiac related. Reduction in OH correlated with lowering of cT nT.
文摘AIM: To explore whether serum bicarbonate at admission to intensive care unit(ICU) predicted development of acute kidney injury(AKI).METHODS:We studied all patients admitted to our ICU over a 2 year period(February 2010 to 2012).The ICU has a case mix of medical and surgical patients excluding cardiac surgical,trauma and neurosurgical patients.We analysed 2035 consecutive patients admitted to ICU during the study period.Data were collected by two investigators independently and in duplicate using a standardised spread sheet to ensure accuracy.Ambiguous data were checked for accuracy where indicated.AKI was defined using the Kidney Disease Improving Global Outcomes criteria.Patients were divided into two groups;patients who developed AKI or those who did not,in order to compare the baseline characteristics,and laboratory and physiologic data of the two cohorts.Regression analysis was used to identify if serum bicarbonate on admission predicted the development of AKI.RESULTS:Of 2036 patients 152(7.5%)were excluded due to missing data.AKI developed in 43.1%of the patients.The AKI group,compared to the nonAKI group,was sicker based on their lower systolic,diastolic and mean arterial pressures and a higher acutephysiology and chronic health evaluation(APACHE)Ⅲand SAPSⅡscores.Moreover,patients who developed AKI had more co-morbidities and a higher proportion of patients who developed AKI required mechanical ventilation.The multi-regression analysis of independent variables showed that serum bicarbonate on admission(OR=0.821;95%CI:0.796-0.846;P<0.0001),APACHEⅢ(OR=1.011;95%CI:1.007-1.015;P<0.0001),age(OR=1.016;95%CI:1.008-1.024;P<0.0001)and presence of sepsis at ICU admission(OR=2.819;95%CI:2.122-23.744;P=0.004)were each significant independent predictors of AKI.The area under the ROC curve was 0.8(95%CI:0.78-0.83),thereby demonstrating that the predictive model has relatively good discriminating power for predicting AKI.CONCLUSION:Serum bicarbonate on admission may independently be used to make a diagnosis of AKI.
文摘The availability of disease-modifying drugs for the management of autosomal dominant polycystic kidney disease(ADPKD) has accelerated the need to accurately predict renal prognosis and/or treatment response in this condition. Arginine vasopressin (AVP) is a critical determinant of postnatal kidney cyst growth in ADPKD. Copeptin (the C-terminal glycoprotein of the precursor AVP peptide) is an accurate surrogate marker of AVP release that is stable and easily measured by immunoassay. Cohort studies show that serum copeptin is correlated with disease severity in ADPKD, and predicts future renal events [decline in renal function and increase in total kidney volume (TKV)]. However, serum copeptin is strongly correlated with creatinine, and its additional value as a prognostic biomarker over estimated glomerular filtration rate and TKV is not certain. It has also been suggested that copeptin could be a predictive biomarker to select ADPKD patients who are most likely to benefit from AVP-modifying therapies, but prospective data to validate this assumption are required. In this regard, long-term randomised clinical trials evaluating the effect of prescribed water intake on renal cyst growth may contribute to addressing this hypothesis. In conclusion, although serum copeptin is aligned with the basic pathogenesis of ADPKD, further rigorous studies are needed to define if it will contribute to enabling the delivery of personalised care in ADPKD.
基金Supported by The United States National Institutes of Health(Nos.DK34198 and DK07467)to Dr.CouserThe Don Jacquot Fellowship(Australian and New Zealand Society of Nephrology Travelling Fellowship)+3 种基金The BJ Amos Travelling Fellowships(Westmead Hospital)The Medical Research Fund of Western AustraliaThe Fremantle Hospital Medical Research FoundationThe National Health and Medical Research Council(No.230500)to Dr.Rangan
文摘AIM: To determine whether complement membrane attack complex(C5b-9) has a pathogenic role in tubulointerstitial injury in a renal disease model characterized by acute highly selective proteinuria. METHODS: Protein-overload nephropathy(PON) was induced in adult female Piebald-Viral-Glaxo rats with or without complement C6 deficiency(C6- and C6+) by daily intraperitoneal injections of bovine serum albumin(BSA, 2 g/d), and examined on days 2, 4 and 8.RESULTS: Groups with PON developed equivalent levels of heavy proteinuria within 24 h of BSA injection. In C6+ rats with PON, the tubulointerstitial expression of C5b-9 was increased and localized predominantly to the basolateral surface of tubular epithelial cells(TECs), whereas it was undetectable in C6- animals. TEC proliferation(as assessed by the number of BrdU +cells) increased by more than 50-fold in PON, peaking on day 2 and declining on days 4 to 8. There was a trend for a reduction in the number of BrdU + TECs on day 4 in the C6- PON group(P = 0.10 compared to C6+) but not at any other time-point. Kidney enlargement, TEC apoptosis(TUNEL+ cells) and markers of tubular injury(tubule dilatation, loss of TEC height, protein cast formation) were not altered by C6 deficiency in PON. Interstitial monocyte(ED-1+ cell) accumulation was partially reduced in C6- animals with PON on day 4(P = 0.01) but there was no change in myofibroblast accumulation. CONCLUSION: These data suggest that C5b-9 does not mediate tubulointerstitial injury in acute glomerular diseases characterized by selective proteinuria.
