ABSTRACT
Objective:To investigate the value of cystatin C (Cys-C) in the early diagnosis of acute kidney injury (AKI) after radical nephrectomy and the predictive value for the prognosis of Cys-C based estimated glomerular filtration rate (eGFR Cys-C) after surgery. Methods:The clinical data of 118 patients who underwent unilateral radical nephrectomy in our hospital from January 2019 to December 2020 were retrospectively analyzed. According to the diagnostic criteria of AKI, they were divided into AKI group of 75 cases and no-AKI group of 43 cases. AKI group was (62.7±10.7) years old, with 49 males and 26 females. The no-AKI group was (62.3±12.8) years old, with 21 males and 22 females. The urea nitrogen was (4.9±1.3) mmol/L, creatinine (75.7±14.5)μmol/L, Cys-C (0.85±0.22) mg/L, eGFR Cr(76.3±11.2)ml/(min·1.73m 2), and eGFR Cys-C(101.4±17.4)ml/(min·1.73m 2)in AKI group before operation.In no-AKI group, preoperative urea nitrogen was (4.9±1.5) mmol/L, creatinine (74.5±13.1)μmol/L, Cys-C (0.81±0.29) mg/L, eGFR Cr(78.6±12.5)ml/(min·1.73m 2), and eGFR Cys-C(99.3±18.8)ml/(min·1.73m 2), and there were no significant differences in the values of urea nitrogen, creatinine, Cys-C and eGFR between the two groups before surgery ( P>0.05). ROC curve was used to analyze the diagnostic value of urea nitrogen, creatinine, Cys-C, eGFR calculated based on creatinine and Cys-C at 48h after surgery, and binary Logistic regression was used to analyze the risk factors for AKI. The creatinine status of patients diagnosed with SPS was evaluated 6 months after surgery, based on the definition of Cys-C based eGFR being less than 70% of creatinine-based eGFR(SPS=eGFR Cys-C/ eGFR Cr≤0.7). Results:In AKI group, creatinine was(115.2±22.1)μumol/L, Cys-C (1.8±0.27) mg/L, eGFR Cr (51.6±9.6)ml/(min·1.73m 2), and eGFR Cys-C(43.4±8.5)ml/(min·1.73m 2)48 h after operation. The creatinine was(92.7±13.3)μmol/L, Cys-C(1.3±0.23) mg/L, eGFR Cr(62.2±11.3)ml/(min·1.73m 2), and eGFR Cys-C(61.5±9.5)ml/(min·1.73m 2) in no-AKI group, and difference were statistically significant between the two groups ( P<0.01). ROC curve was used to analyze the diagnosis of AKI. Creatinine, Cys-C, eGFR Cr and eGFR Cys-Cwere all of diagnostic value for AKI (all P<0.01), and AUC(Area under curve) were 0.809, 0.889, 0.761 and 0.925 respectively. The sensitivity, specificity and area under the curve of eGFR Cys-C were 93.3%, 74.4% and 92.5% respectively. Binary Logistic regression analysis showed that creatinine( OR=10.851, 95% CI 2.322-50.688, P=0.004), Cys-C( OR=10.016, 95% CI 2.306-43.362, P=0.001), eGFR Cr( OR=17.923, 95%CI 3.216-53.172, P=0.001) and eGFR Cys-C( OR=19.817, 95% CI 3.367-55.263, P=0.001)were all independent risk factors for AKI. The predictive accuracy of eGFR Cys-C, creatinine, Cys-C, eGFR Cr were 91.6%, 85.7%, 90.2%, 88.5%, respectively. There were 15 cases were confirmed SPS in the AKI group, and only 2 cases were confirmed SPS in the no-AKI group, indicating patients in the AKI group developed more SPS than those in the no-AKI group, with statistically significant difference(Kappa value was 5.22, P=0.02). The 6-month follow-up showed that the creatinine of confirmed SPS was (103.8±23.4)μmol/L and the creatinine of unconfirmed SPS was (86.8±27.2)μmol/L, with statistically significant difference ( P<0.01). Conclusions:eGFR Cys-C calculated based on Cys-C has high sensitivity in diagnosing AKI and has early diagnostic value. Patients diagnosed with SPS based on eGFR Cys-C had higher creatinine 6 months after surgery.
ABSTRACT
A case of varicella pneumonia, hepatitis and pancreatitis after kidney transplantation was retrospectively analyzed. One week after kidney transplantation, the patient had a papule with pruritus, which was diagnosed as varicella by dermatologist as well as high-throughput sequencing. The patient was found to have pneumonia, hepatitis and pancreatitis. The individualized treatment regimen was used, including the dosage reduction of immunosuppressive agents, the blood drug concentration monitoring, antiviral therapy, anti-infection therapy, supportive treatment, and symptomatic alleviation for complications. The treatment was adjusted according to the indicators'variation. The timely review of the indicators and immunosuppressant blood concentration were performed to protect the transplanted kidney function, and the patient recovered in time. This rare case of postoperative complications of kidney transplantation were summarized and analyzed in order to accumulate clinical experience for the treatment of renal transplantation.
ABSTRACT
Objective To study the clinical manifestations and surgical treatment in renal transplant recipients with benign prostatic hyperplasia (BPH). Methods From January 2013 to May 2015, 5 patients of kidney transplant recipients who suffered from BPH for transurethral resection of prostate (TURP) treatments were enrolled (kidney transplant recipients group) and 15 patients with the same surgical treatments during the same peoriod were enrolled too (common control group). The routine examination, urodynamic, sex hormone levels and and the clinical efficacy were observed. Results The levels of hemoglobin, total protein, urea nitrogen, creatinine, prostate volume , residual urine and maximum flow rate (Qmax) before operation between two groups had no significant differences (P>0.05). The level of testosterone in kidney transplant recipients group was significantly lower than that in common control group: (3.5 ± 1.2) mmol/L vs. (5.5 ± 2.2) mmol/L, P 0.05). After operation, the levels of hemoglobin, total protein, urea nitrogen, creatinine in two groups had no significant differences (P>0.05). In kidney transplant recipients group, the quality of life (QOL) score before operation was 5 scores in 4 cases and 6 scores in 1 case, and those after operation were zero in 3 cases and 1 score in 2 cases. Conclusions Under the sufficient preoperative preparation and assessment, the renal transplant recipients with BPH patients can improve the symptoms of urinary obstruction and obtain satisfactory clinical efficacy as common BPH patients.
ABSTRACT
Objective To observe the level of serum hepcidin and the relationship of hepcidin with renal anemia and micro-inflammation state in peritoneal dialysis(PD) patients.Methods Serum hepcidin,interleukin-6(IL-6),soluble transferrin receptor (sTfR) and erythropoietin (EPO) were measured in 50 PD patients with anemia,30 PD patients without anemia and 40 cases of normal control by ELISA.The indexes of blood routine examination,biochemistry and iron metabolism were also detected at the same time.Results The level of hepcidin in PD patients was significantly higher than that in normal control[(103.65±43.6) μg/L vs (56.39±35.7) μg/L,P ＜ 0.05].Furthermore,the level of hepcidin in PD patients with anemia was higher than that in PD patients without anemia [(122.67±36.6) μg/L vs (83.65±26.4) μg/L,P ＜ 0.05].The results of correlation analysis showed that serum IL-6,sTfR,EPO and ferritin were positively correlated with hepcidin(R =0.821,0.742,0.711,0.531,all P ＜ 0.05),while creatinine clearance of residual kidney in 24 hours and hemoglobin were negatively correlated with hepcidin(R =-0.533,-0.685,all P ＜ 0.05).Conclusions The higher level of hepcidin in PD patients is related with the residual renal function and the micro-inflammatory state.The higher level of hepcidin may induce the iron metabolism imbalance,and then influence the state of renal anemia.The adjustment of hepcidin may provide clinical research value of improving renal anemia and micro-inflammatory state in PD patients.
ABSTRACT
Objective To detect the expression and correlation of serum Hepcidin,IL-6,sTfR,BMP6 diversity and explore the role of serum Hepcidin in prostate cancer with bone metastasis.Methods From January 2012 to March 2012,serum Hepcidin,IL-6,sTfR,BMP6 diversity were tested by ELISA in 25 prostate cancer patients with bone metastasis,30 prostate cancer patients without bone metastasis and 30 patients with BPH were used as the control group.The mean patient's age was 67 years (range from 55 to 75 years).In prostate cancers with bone metastasis group,the mean PSA base line was 138.0 μg/L (ranged from 20.0-1500 μg/L),the prostate cancers without bone metastasis group,mean PSA was 10.2 μg/L(ranged from 3.5-28.2 μg/L),and in BPH group,the mean PSA was 3.7 μg/L (ranged from 0.3-14.2 μg/L).Venous blood samples were taken in fasting mornings,then stored 3 ml in EDTA anticoagulant vacuum tube and centrifuged at4 ℃ for 10 min,the isolated serum were then preserved in-80 ℃ refrigerator.The competitive in-phase enzyme-linked immunoassay (ELISA) was used to detect serum Hepcidin,IL-6 and sTfR and BMP6 levels.Results Serum Hepcidin expressions in three groups were 67.7 ± 40.6 μg/L,37.5 ± 15.3 μg/L and 34.3 ± 10.7 μg/L,respectively.For prostate cancers with bone metastasis group,serum Hepcidin expression were higher than control group (P ＜ 0.05),and associated with IL-6(22.5 ±22.1 μg/L),sTfR (5.7 ± 2.6 μg/L),BMP6 (429.3 ± 188.4 μg/L),correlation coefficients were 0.972,-0.987,0.971 (P ＜ 0.05).Conclusions Increased serum Hepcidin level might be a sensitive index for diagnosis and prognosis of prostate cancers with bone metastasis.