Tumoral calcinosis on thigh in a hemodialysis patient and literature review / 中华肾脏病杂志

The paper reported a patient under maintained hemodialysis for 11 years, with a large mass appeared in the right thigh after local injury. The mass was clinically considered as tumoral calcinosis combined with clinical, imaging and pathological findings. Several treatments such as enhancing dialysis adequacy, low calcium dialysate, calcimimetic agent, non-calcium- phosphorus binding agents, parathyroidectomy and intravenous infusion of sodium thiosulfate could not vanish the mass. Finally, the lump was surgically removed. The treatment of tumoral calcinosis in the hemodialysis patient can provide a instruction for similar situations in clinical practice.

Risk factors of postoperative acute kidney injury and the impact on outcome in non-senile patients undergoing cardiac valvular surgery / 中华心血管病杂志

Objective@#To investigate the risk factors of postoperative acute kidney injury (AKI) in patients aged between 40 and 50 years old undergoing cardiac valvular surgery and the impact on outcome.@*Methods@#The clinical data of 286 patients aged between 40 and 50 years old undergoing cardiac valve surgery in Guangdong Provincial People′s Hospital from January 2012 to December 2016 were analyzed retrospectively. Preoperative coronary angiography was performed in all patients. All patients enrolled were divided into AKI group and non-AKI group according to the existence or not of postoperative AKI. Patients with AKI were further divided into AKI stage 1, stage 2, and stage 3 groups according to KDIGO guideline. Demographic characteristics, preoperative clinical data including serum creatinine, estimated glomerular filtration rate, hemoglobin, uric acid, urinary protein, presence or absence of chronic kidney disease, left ventricular ejection fraction, pulmonary artery pressure, New York Heart Association (NYHA) functional classification, preoperative co-morbidity (hypertension, diabetes, anemia, cerebrovascular disease, peripheral artery disease), preoperative medication(vasoactive drugs, diuretic, renin-angiotensin system inhibitor (RASI), surgical data (contrast dosage in coronary angiography, type of cardiac valve surgery) were recorded and analyzed in this retrospective study. The risk factors for postoperative AKI and its impact on clinical outcomes (mortality, hospitalization expenses and Intensive Care Unit stay duration) were evaluated. Logistic regression analysis was used to determine the risk factors for postoperative AKI and the adjusted variables with P<0.2 were selected for the multivariate logistic regression analysis to define the independent determinants for AKI.@*Results@#AKI was defined in 106 out of 286 enrolled patients, including 96 patients with AKI stage 1, 10 patients with AKI stage 2 and no patients with AKI stage 3. The proportion of coexisting cerebrovascular diseases was higher in AKI group than in non-AKI group (9(8.49%) and 5(2.78%), χ2=4.677, P=0.031), while there was no difference among other baseline data between the two groups. Multivariate logistic regression analysis showed that preoperative complications of cerebral vascular disease was an independent risk factor of postoperative AKI (OR=3.578, 95%CI 1.139-11.242, P=0.029). Five out of 106 AKI patients died during hospitalization while there was only 1 patient died among 180 patients without AKI. Patients with AKI after cardiac valve operation experienced higher mortality than patients without AKI (χ2=5.625, P=0.028). Further analysis showed that there was no difference in hospitalization mortality between patients with AKI stage 2 and stage (χ2=0.686, P=0.408) while the hospitalization mortality in patients with AKI stage 2 was higher than those without AKI (χ2=8.113, P=0.004). The hospitalization expenses in patients with AKI were 10.38(8.59,12.54) ×104 RMB, significantly higher than that in patients without AKI (9.72(8.03,11.93) ×104 RMB)(P=0.043). There was no difference in hospitalization expenses between patients with AKI stage 1 and without AKI (P=0.635). The hospitalization expenses in patients with AKI stage 2 was higher than those without AKI (P=0.023). Intensive Care Unit stay duration in patients with AKI was 3(1,4) days, significantly higher than those without AKI (P=0.044). There was no difference in Intensive Care Unit stay duration in patients with AKI stage 1 and without AKI (P=0.978), while Intensive Care Unit stay duration in patients with AKI stage 2 was significantly longer than those without AKI (P=0.006).@*Conclusions@#Preoperative complications of cerebral vascular disease is an independent risk factor of postoperative AKI. Non-senile patients with AKI after cardiac valvular surgery is associated with a higher proportion of mortality, hospitalization expenses and Intensive Care Unit stay duration as compared patients without postoperative AKI.

Dendritic cell and M2 macrophages are associated with the severity of disease in IgA nephropathy patients / 中华肾脏病杂志

Objective@#To investigate the number and distribution of dendritic cells (DCs), macrophages and M2 macrophages in renal tissues of patients with IgA nephropathy (IgAN) and their correlation with clinicopathological parameters, and explore its role in the progression of IgAN.@*Methods@#Renal tissue samples from 42 patients aged ≥18 years with IgAN were collected by kidney biopsy in Guangdong Provincial People's Hospital from January 2018 to June 2018. The patients were divided into different groups according to Oxford classification and Lee grade classification criteria. The distribution and number of DCs (CD209), macrophages (CD68) and M2 macrophages (CD68 and CD206) were detected by immunohistochemistry. Spearman correlation test was used to analyze the correlation between the number of DCs and macrophages in renal tissues and clinical pathological parameters.@*Results@#The number of DCs in the glomeruli of the M1, T0 and C1 groups increased significantly compared with the M0, T1 and C0 groups, and the number of DCs in the renal interstitium of the T1 group increased significantly compared with the T0 group (all P<0.05). The number of glomerular macrophages in group C1 was significantly higher than that in group C0. The number of macrophages in S1, T1 and Lee IV-V tubulointerstitial groups was significantly higher than that in S0, T0 and Lee II-III groups (P<0.05). The number of M2 macrophages in the S1, T1 and Lee IV-V groups was significantly higher in the tubulointerstitial group than in the S0, T0 and Lee II-III groups (all P<0.05). The blood urea nitrogen, serum creatinine and 24 h urine protein levels in the T1 and Lee IV-V groups were significantly higher than those in the T0 and Lee II-III groups, and the serum albumin levels in the Lee IV-V group were significantly lower (all P<0.05). Spearman correlation analysis showed that the number of DCs in renal interstitium was positively correlated with the proportion of tubulointerstitial fibrosis. There were a positive correlation between the proportion of glomerular segmental sclerosis and tubulointerstitial fibrosis and renal interstitial macrophages and M2 macrophages. The number of M2 macrophages was positively correlated with serum creatinine and 24 h urine protein (both P<0.05).@*Conclusions@#The number of DCs and M2 macrophages in kidneys are positively correlated with the clinicopathological features of IgAN patients, which indicates that they may be associated with disease progression.

Analysis of potential predictors of internal jugular vein stenosis and the anatomic position in hemodialysis patients / 中华肾脏病杂志

Objective@#To identify the anatomical positional relation of the internal jugular vein and the common carotid artery, and investigate the predictive factors associated with the stenosis rate of the internal jugular vein after catheterization in hemodialysis patients.@*Methods@#A single-center cross-sectional survey study of 235 patients from the Department of Nephrology, Guangdong Provincial People's Hospital between August 2017 and June 2018 was performed. According to whether received hemodialysis treatment, The patients were divided into dialysis group (n=187) and control group (chronic kidney disease non-dialysis patients, n=48). Clinical data such as age, primary disease, history of deep vein catheterization, catheter indwelling time and dialysis age were collected. The positional relationship between the internal jugular vein and the common carotid artery was examined by Doppler ultrasound. Measure the cross-sectional area of the internal jugular vein in different neck anatomical planes and analyse of the incidence of internal jugular vein stenosis in the dialysis group. Chi-square test was used to compare the differences in the incidence of internal jugular vein stenosis between subgroups of different ages, with or without catheter retention, catheter indwelling time, dialysis age and presence or absence of diabetic nephropathy.@*Results@#Doppler ultrasonography showed that in the 235 patients, there were four types of anatomical relationship between the internal jugular vein and the common carotid artery in the plane of the flat thyroid cartilage and the apex plane of the upper clavicle. The internal jugular vein was located on the lateral, anterolateral, anterior and medial sides of the common carotid artery, accounting for 16.23%, 36.52%, 41.11% and 3.14% respectively. There were significant differences in the anatomical relationship between the internal jugular vein and the common carotid artery between the left and right sides, different anatomical planes and patients of different ages (P<0.05). The rate of internal jugular vein stenosis in 187 hemodialysis patients was 47.1%. The right internal jugular vein stenosis rate was 66.4% and 44.1% in the age<65 years old group (n=128) and age≥65 years old group (n=59), respectively (P=0.004). The rate of internal jugular vein stenosis was 49.0% and 32.8% (P=0.018) in the catheter placement group (n=151) and the catheterless retention group (n=36), respectively. Two variables including age and history of catheterization were included in the logistic regression equation. The results showed that the history of catheterization was a risk factor for internal jugular vein stenosis (OR=1.668, 95% CI 1.083-2.568, P=0.020).@*Conclusions@#There is variability in the anatomical relationship between the internal jugular vein and the common carotid artery. Internal jugular vein stenosis is a common complication after indwelling catheters in hemodialysis patients. The history of internal jugular vein catheterization is a risk factor affecting internal jugular vein stenosis.

Analysis of potential predictors of internal jugular vein stenosis and the anatomic position in hemodialysis patients / 中华肾脏病杂志

Objective To identify the anatomical positional relation of the internal jugular vein and the common carotid artery, and investigate the predictive factors associated with the stenosis rate of the internal jugular vein after catheterization in hemodialysis patients. Methods A single-center cross-sectional survey study of 235 patients from the Department of Nephrology, Guangdong Provincial People's Hospital between August 2017 and June 2018 was performed. According to whether received hemodialysis treatment, The patients were divided into dialysis group (n=187) and control group (chronic kidney disease non-dialysis patients, n=48). Clinical data such as age, primary disease, history of deep vein catheterization, catheter indwelling time and dialysis age were collected. The positional relationship between the internal jugular vein and the common carotid artery was examined by Doppler ultrasound. Measure the cross-sectional area of the internal jugular vein in different neck anatomical planes and analyse of the incidence of internal jugular vein stenosis in the dialysis group. Chi-square test was used to compare the differences in the incidence of internal jugular vein stenosis between subgroups of different ages, with or without catheter retention, catheter indwelling time, dialysis age and presence or absence of diabetic nephropathy. Results Doppler ultrasonography showed that in the 235 patients, there were four types of anatomical relationship between the internal jugular vein and the common carotid artery in the plane of the flat thyroid cartilage and the apex plane of the upper clavicle. The internal jugular vein was located on the lateral, anterolateral, anterior and medial sides of the common carotid artery, accounting for 16.23％, 36.52％, 41.11％ and 3.14％respectively. There were significant differences in the anatomical relationship between the internal jugular vein and the common carotid artery between the left and right sides, different anatomical planes and patients of different ages (P﹤0.05). The rate of internal jugular vein stenosis in 187 hemodialysis patients was 47.1％. The right internal jugular vein stenosis rate was 66.4％and 44.1％in the age﹤65 years old group (n=128) and age≥65 years old group (n=59), respectively (P=0.004). The rate of internal jugular vein stenosis was 49.0％and 32.8％(P=0.018) in the catheter placement group (n=151) and the catheterless retention group (n=36), respectively. Two variables including age and history of catheterization were included in the logistic regression equation. The results showed that the history of catheterization was a risk factor for internal jugular vein stenosis (OR=1.668, 95％ CI 1.083-2.568, P=0.020). Conclusions There is variability in the anatomical relationship between the internal jugular vein and the common carotid artery. Internal jugular vein stenosis is a common complication after indwelling catheters in hemodialysis patients. The history of internal jugular vein catheterization is a risk factor affecting internal jugular vein stenosis.

Incidence and risk factors of hyperkalaemia after acute kidney injury in cardiology department / 实用医学杂志

Objective To investigate the incidence of hyperkalaemia and analyze the risk factors in pa-tients with acute kidney injury(AKI)in cardiology department.Methods We conducted a retrospective case-con-trol study,using the electronic medical information of the patients in Guangdong General Hospital. Results A to-tal of 37 837 patients were included in this study and 1 571(4.3%)patients with AKI were detected.Hyperkalae-mia occurred in 517 patients(1.4%).The incidence of hyperkalaemia in AKI patients was higher than that in non-AKI patients(10.1% vs. 1.0%,P < 0.001)and the incidences of hyperkalaemia at AKI stage 1~3 were 2.6 %, 13.9% and 20.6 %,respectively. Multiple logistic regression analysis demonstrated that AKI stages,chronic kid-ney disease and heart failure were risk factors for hyperkalaemia.AKI and hyperkalaemia were related to increased hospitalization expenses,delayed hospital stay,renal replacement therapy and in-hospital mortality. Based on AKI,the combination of hyperkalemia could significantly increase clinical burden and adverse outcomes. Conclu-sion In cardiology department,the monitoring of serum creatinine and potassium level should be emphasized.

The value of proteinuria in predicting acute kidney injury after cardiac surgery in elderly patients / 中华老年医学杂志

Objective To evaluate the value of proteinuria in predicting acute kidney injury (AKI) after cardiac surgery in elderly patients.Methods To retrospectively analyze the perioperative clinical data of elderly patients (age 60 or older)undergone cardiac surgery with cardiopulmonary bypass at Guangdong General Hospital from January 2005 to December 2010.Target patients were divided into two groups according to AKI defined by the KDIGO criteria.Data for those two groups were examined by single-factor analysis,and then logistic regression analysis was used to further determine independent factors of AKI after cardiac surgery.Results Among 848 elderly patients,AKI occurred in 524(61.8％) participants,including 39.2％(n=332)at AKI stage 1,16.6％ (n =141) at AK I stage 2,and 6.0 ％ (n=51) at AKI stage 3.A total of 15.9 ％ of patients(n=135) had preoperative proteinuria,including 12.4 ％ (n =106) with mild proteinuria,and 3.5 ％ (n =30) with heavy proteinuria.Logistic regression analysis showed that proteinuria was correlated with postoperative AKI.With the increase of proteinuria,the risk of AKI also increased,and the OR values of mild and severe proteinuria were 1.758 (1.020-3.029) and 4.758 (1.326-17.077),respectively.Conclusions Preoperative proteinuria may predict the occurrence of AKI after cardiac surgery in elderly patients.There is a gradual increase in the risk of AKI as proteinuria becomes more severe.Early institution of therapeutic interventions may be used in elderly patients with preoperative proteinuria undergoing cardiac surgery to attenuate the risk of AKI.

Epidemics study of acute kidney injury on patients in dermatology department / 实用医学杂志

Objective To assess the epidemiology and clinical correlates of acute kidney injury(AKI)on patients in department of dermatology. Methods A total of 4710 patients hospitalized in dermatology department with at least two creatinine tests within 7 days were selected as research objects.AKI was defined and staged accord-ing to Kidney Disease Improving Global Outcomes criteria. Results The incidence of AKI was 6.3%. AKI inci-dences of psoriasis with systemic reaction(14.8%),erythroderma(12.8%),drug eruption(12.6%)and systemic lupus erythematosus (12.5%) were significant higher than the total incidence. In multivariate logistic regression model,these 4 skin diseases were independent risk factor of AKI incidence. The OR(95% confidencel interval) was 2.970(2.047~4.310),1.932(1.005~3.717),2.446(1.752~3.415)and 2.254(1.287~3.946). The in-hospital mortality was much higher in patients with AKI than those without(3.1% vs 0.1%,P < 0.001). And the AKI was related to in-hospital death after adjusted by age and comorbidities(Odds ratio 24.630,95%confidencel interval 7.385~82.149 ). Conclusion AKI is common in patients hospitalized in department of dermatology and is associated with patiensts′medical burden ,which shoule be noticed.

Epidemics study of acute kidney injury on patients in dermatology department / 实用医学杂志

Objective To assess the epidemiology and clinical correlates of acute kidney injury(AKI)on patients in department of dermatology. Methods A total of 4710 patients hospitalized in dermatology department with at least two creatinine tests within 7 days were selected as research objects.AKI was defined and staged accord-ing to Kidney Disease Improving Global Outcomes criteria. Results The incidence of AKI was 6.3%. AKI inci-dences of psoriasis with systemic reaction(14.8%),erythroderma(12.8%),drug eruption(12.6%)and systemic lupus erythematosus (12.5%) were significant higher than the total incidence. In multivariate logistic regression model,these 4 skin diseases were independent risk factor of AKI incidence. The OR(95% confidencel interval) was 2.970(2.047~4.310),1.932(1.005~3.717),2.446(1.752~3.415)and 2.254(1.287~3.946). The in-hospital mortality was much higher in patients with AKI than those without(3.1% vs 0.1%,P < 0.001). And the AKI was related to in-hospital death after adjusted by age and comorbidities(Odds ratio 24.630,95%confidencel interval 7.385~82.149 ). Conclusion AKI is common in patients hospitalized in department of dermatology and is associated with patiensts′medical burden ,which shoule be noticed.

Pulmonary Hypertension Complicated by Pericardial Effusion on the Prognosis Among Maintenance Hemodialysis Patients / 实用医学杂志

Objective Pulmonary hypertension (PH) was an independent predictor of mortality and new onset cardiovascular events in maintenance hemodialysis (MHD) patients. Recent studies revealed PH complicated by pericardial effusion (PE) increased mortality in non-CKD (chronic kidney disease) population. No such evidence existed in MHD patients. Methods We enrolled 108 MHD patients with diagnosed PH by echocardiography (61 with PE) between 2009 and 2011. All patients had been followed-up for 2 years. The endpoints were all-cause mor-tality, cardiovascular (CV) mortality and new onset CV events. Results The mean age was (60.2 ± 14.1) years, 55.6% were males and SPAP was (53.0 ± 15.4) mmHg. 12.0% were severe PH and 1.9% were moderate-to-severe PE. The overall mortality, cardiovascular mortality and new on-set cardiovascular events in PE and non-PE group were 34.4% vs. 21.3%、 23.0% vs. 12.8% and 54.1% vs. 42.6%, respectively (P > 0.05). Kaplan-Meier curve showed there was no difference on all-cause mortality , CV mortality nor new-onset CV events between PE and non-PE group (Log Rank P > 0.05). Conclusions Compared with patients without PE, the presence of PE in patients with PH did not increase the mortality and worsen the cardiovascular outcome in MHD patients.

Impact of pre-operative uric acid on acute kidney injury after cardiac surgery in elderly patients / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the impact of pre-operative uric acid on acute kidney injury (AKI) after cardiac surgery in elderly patients.</p><p><b>METHODS</b>Clinical data were collected from 936 elderly patients (age ≥ 60 years) undergoing cardiac surgery with cardiopulmonary bypass in Guangdong General Hospital between January 2005 and May 2011. The baseline serum creatinine was defined as the latest serum creatinine before surgery, and AKI was diagnosed according to RIFLE criteria. Patients were divided into three groups according to the sex-specific cutoff values of serum uric acid tertiles (group A: ≤ 384.65 µmol/L in men, and ≤ 354.00 µmol/L in women; group B:384.66-476.99 µmol/L in men and 354.01-437.96 µmol/L in women; group C: ≥ 477.00 µmol/L in men and ≥ 437.97 µmol/L in women). Multivariate logistic regression analysis was used to analyze the independent risk factors for AKI.</p><p><b>RESULTS</b>Among 936 elderly patients, 576 cases (61.5%) developed AKI. Mean uric acid concentration was higher in AKI patients than in Non-AKI patients ( (436.6 ± 119.1) µmol/L vs. (398.0 ± 107.2) µmol/L, P < 0.001). The incidence of AKI was 56.1% (175/312) in group A, 56.3% (175/311) in group B, 72.2% (226/313) in group C (P < 0.001). Multiple logistic regression analysis showed that, after adjusted for age, gender, co-morbidities(hypertension, diabetes mellitus, cerebrovascular disease, chronic obstructive pulmonary disease), previous cardiac surgery, eGFR<60 ml×min(-1) ×1.73 m(-2), heart function ≥ 3 (NYHA), positive urine protein, combination of coronary artery bypass grafting and valvular surgery, cardiopulmonary bypass operation time, aortic cross-clamping time, pre-operative angiotensin converting enzyme inhibitor or angiotensin II receptor blockers and lipid-lowering drugs use, early postoperative angiotensin converting enzyme inhibitor or angiotensin II receptor blockers, diuretics and digoxin use, post-operation central venous pressure, risk of post operative AKI was significantly higher in group C than in group A (OR:1.897, 95%CI: 1.270-2.833, P = 0.002).</p><p><b>CONCLUSION</b>Pre-operative elevated uric acid is an independent risk factor of AKI after cardiac surgery in elderly patients.</p>

Renal expression of RANK-RANKL in a rat model of puromycin aminonucleoside nephropathy / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate RANK-RANKL expression in the kidneys of a rat model of puromycin aminonucleoside nephropathy (PAN).</p><p><b>METHODS</b>Thirty-six SD rats were randomly divided into PAN model group and normal control group. PAN was induced by a single intravenous injection of 100 mg/kg puromycin aminonucleoside. Serum creatinine and 24-hour urinary protein were measured on days 3, 7, and 14 after the injection, and renal pathologies were assessed with optical and immune transmission electron microscopy. The expression of RANK and RANKL in the kidneys was examined using reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting.</p><p><b>RESULTS</b>The PAN model rats showed massive proteinuria and elevated serum creatinine on day 3, which peaked on day 7. RANK-RANKL protein and mRNA expressions in PAN model group was higher than those in the control group. In the PAN rats, RANK was expressed mainly on the top cell membrane and in the cytoplasm of renal podocytes with a significantly increased expression level compared with that in the control group.</p><p><b>CONCLUSION</b>The PAN rat model shows aberrant RANK and RANKL expressions in the podocytes, indicating their contribution to podocyte injury in PAN.</p>

Analysis of risk factors of contrast-induced acute kidney injury after cerebrovascular intervention / 中国脑血管病杂志

Objective To investigate the related risk factors of contrast-induced acute kidney injury (CI-AKI)after cerebrovascular intervention. Methods The clinical data of 5423 patients performed cerebrovascular angiography and intervention at the Departments of Neurology and Neurosurgery,Guangdong People′s Hospital from January 2005 to December 2013 were analyzed retrospectively. The patients who underwent cerebrovascular angiography and intervention were evaluated and screened. A clinical history database was established. All the selected patients used iodixanol,an isotonic contrast agent. The occurrence of CI-AKI was used as an endpoint. The patients were divided into either a CI-AKI group or a non CI-AKI group. A multivariate Logistic regression model was used to analyze the risk factors associated with the occurrence of CI-AKI. Results A total of 4164 patients were finally enrolled,including 137 had CI-AKI. The incidence of CI-AKI was 3. 3%. The results of multivariate Logistic regression showed that age >60 years (OR,1. 965,95%CI 1. 244-3. 136),baseline estimated glomerular filtration rate (eGFR)60 years)are the independent risk factors for occurring CI-AKI after cerebrovascular angiography and intervention.

11R-VIVIT inhibits the expression of urokinase-type plasminogen activator receptor in podocytes / 南方医科大学学报

<p><b>OBJECTIVE</b>To observe the effect of 11R-VIVIT on lipopolysaccharide (LPS)-induced expression of urokinase-type plasminogen activator receptor (uPAR) in podocytes.</p><p><b>METHODS</b>A LPS-induced proteinuria mouse model and in vitro cultured podocytes treated with LPS were both divided into control group, LPS group and LPS+11 R-VIVIT group. The mRNA and protein expressions of uPAR in mouse kidney tissues and the podocytes were measured by real-time qPCR, laser scanning confocal microscopy and Western blotting.</p><p><b>RESULTS</b>Compared with LPS group, LPS+11 R-VIVIT group showed a significantly lowered urine albumin/creatinine ratio (P<0.001) and markedly reduced mRNA and protein expressions of uPAR (PuPAR mRNA<0.001; PuPAR=0.001).</p><p><b>CONCLUSION</b>11R-VIVIT can ameliorate proteinuria probably by decreasing the expression of uPAR in podocytes.</p>

A cross-sectional study of restless legs syndrome in maintenance hemodialysis patients / 中华内科杂志

Objective To explore the incidence and possible risk factors of restless legs syndrome (RLS) in the maintenance hemodialysis patients.Methods A total of 375 maintenance hemodialysis patients were enrolled in this study from September 1 to 30 in 2012.The diagnosis and assessment of severity were based on the International Restless Leg Syndrome Study Group (IRLSSG) standard.The relevant laboratory parameters and dialysis indicators were collected,such as hemoglobin,serum ferritin,parathyroid hormone,blood flow and dialysis mode.The clinical data were analyzed by multivariate logistic regression method.Results The incidence of RLS was 13.3％ with the severity score of 18.69 ± 0.95.The logistic regression analysis showed that anuria (OR 0.292,95％ CI 0.114-0.750) and β2 microglobulin(OR 1.023,95％C1 1.003-1.044) were the risk factors for RLS in the maintenance hemodialysis patients,while hemoglobin,serum iron and parathyroid hormone were not correlated with RLS.Conclusions The incidence of RLS is high in the maintenance hemodialysis patients.The risk factors of RLS are anuria and β2 microglobulin.Therefore,the preservation of residual renal function and the improvement of dialysis adequacy,especially the removal of the middle molecular weight toxins,may reduce the occurrence of RLS and improve the quality of life in the hemodialysis patients.

Acute kidney injury after cardiac surgery in elderly patients: focus on modifiable risk factors / 中华胸心血管外科杂志

Objective Acute kidney injury (AKI) is a common complication after cardiac surgery,especially in elderly patients,and related with poor prognosis.Although much advances in therapies of AKI have been obtained,the prognosis of patients did not improved.In the absence of proven interventions,a reasonable strategy would be to identify modifiable risk factors for AKI.The objective of the present study was to explore modifiable risk factors of acute kidney injury after cardiac surgery with cardiopulmonary bypass in elderly patients.Methods Data from 457 consecutive elderly patients (age ≥60 years old)who underwent cardiac surgery with cardiopulmonary bypass in the Guangdong General Hospital between January 2007 and December 31,2009 were analyzed in this retrospective research.The primary outcome was AKI according to the serum creatinine criteria of the RIFLE (renal Risk,Injury,Failure,Loss of renal function and End-stage renal disease) classification as an increase in serum creatinine ＞ 50％ from baseline to peak value within the first seven postoperative days.The baseline serum creatinine was defined as the latest serum creatinine before cardiac surgery.Univariate anadysis was carried out for patients'demographics data and multivariate analysis by logistic regression was used to obtain the independent risk factors for AKI.Results Among 457 elderly patients,patients mean age was (65.22 ± 4.17) years and they comprised 253 (55.4％) men and 204 (44.6％) women.AKI occurred in 313 (68.5 ％) participants.Compared with patients without postoperative AKI,the media length of intensive care unit was longer in patients with postoperative AKI,4.0 (2.0-7.5) days versus 2.0 (1.0-3.0) days,respectively.In logistic regression model,malc (odds ratio[OR] 1.894,95％ confidence interval[CI] 1.136-3.157),age above 65 years (OR 2.391,95％ CI 1.381-4.142),hypertension (OR 2.286,95％ CI 1.249-4.184),estimated glomerular filtration rate less than 60 ml/min (OR 1.933,95％ CI 1.111-3.362),preoperative uric acid ＞ 450 μ mol/L (OR 2.938,95％ CI 1.633-5.285),use of angiotensin converting enzyme inhibitors/angiotensin receptor inhibitors (ACE1/ARB) before cardiac surgery (OR 2.196,95％ CI 1.283-3.759),use of ACEL/ARB after surgery (OR 0.329,95％ CI 0.156-0.691),use of diuretics (OR 0.149,95％ CI 0.068-0.326),time of cardiopulmonary bypass above 120 min (OR 5.228,95％ CI 3.023-9.041) and prolonged mechanical ventilation (OR 2.921,95％ CI 1.527-5.586) were independent factors of AKI after cardiac surgery with cardiopulmonary bypass.Conclusion Preoperative uric acid above 450μmol/L was a modifiable risk factor of AKI after cardiac surgery with cardiopulmonary bypass in elderly patients.Therapies aimed at mitigating high preoperative uric acid may offer protection against this complication.

Risk factors of hypertension in IgA nephropathy / 中华内科杂志

Objective To explore the risk factors of hypertension in patients with IgA nephropathy in South China. Methods The clinical and renal pathological data of 280 primary IgA nephropathy patients diagnosed by biopsy were analyzed to extinguish the risk factors of hypertension. Results A total of 96 patients were suffered with hypertension (34.3%). A single-variable analysis showed that the age (≥40 years), body weight (≥60 kg), absence of macrohematuria, duration of disease (≥60 months), blood urea nitrogen≥8 mmol/L, serum creatinine (≥133 μmol/L), hyperuricaemia, degree of 24 h-proteinuria (≥1.5 g), segmental glomerular lesions (≥25% ), globe glomerular sclerosis (≥10%), tubular atrophy (≥25%), interstitial fibrosis (≥25%), interstitial inflammation (≥25% ) and arteriole hypertrophy (≥10% ) were all risk factors related to hypertension; multivariate logistic regression analysis showed that serum creatinine, age, arteriole hypertrophy, body weight and 24 h-proteinuria were the independent risk factors. Conclusion Many factors were related the hypertension in patients with IgA nephropathy, while serum creatinine, age, arteriole hypertrophy, body weight and 24 h-proteinuria were the independent risk factors of hypertension.

Podocyte apoptosis is suppressed by 1,25(OH)2D3 in puromycin aminonudeoside nephropathy rats / 中华肾脏病杂志

ObjectiveTo evaluate the effects of 1,25(OH)zD3 on podocyte apoptosis in kidney of puremyein aminonueleoside nephropathy (PAN) rats. Methods Seventy-two male Sprague-Dawley rats were randomly divided into three groups: PAN model group(PAN), 1,25 (OH)2D3 treated group (T, 0.2 μg·kg-1d-1 by garages) and normal control group (NC). PAN rat model was constructed by a single intravenous injection of 100 mg/kg body weight. Renal function and 24hour urinary protein were measured at day 3, 7, 14, 21 after PAN injection. The renal tissue morphology was observed by light and electron microscope. Podocyte apeptosis was evaluated by TUNEL. Protein expressions of nephrin, TGF-β1 and p-Smad2/3 were examined by immunofluoreacence, immunohistochemistry and Western blot, respectively. Results(1)The levels of serum creafinine, BUN and 24-h urinary protein [(20.26±4.87) mg vs (1.01±0.41) mg at day 7, P ＜0.01] were significantly higher and the number of glomerular pedocyte was significantly lower [(10.9±4.2)/glomerular volume vs (31.9±6.2)/glomerular volume at day 14, P＜0.01] in PAN group compared with NC group. T group rats had less urinary protein excretion [(9.95±3.82) mg/24 h, P＜0.01] and more glomerular podocytes compared with PAN group. (2) Distribution of nephrin expression was changed from linear to granular pattern in PAN rats on day 7, nephrin mRNA and protein expressions were markedly decreased(P＜0.01), while the number of apoptotic podocyte was increased in PAN group(P＜0.01). However, higher nephrin expression and less apoptotic podocytes were found in T group (P＜0.01). (3) Compared with NC group, the mRNA and protein expression of TGF-β1 and p-Smad2/3 were higher in PAN group (P＜0.01), while 1,25 (OH)2D3 treatment abrogated PAN-induced changes in the expression of TGF-β1 and p-Smad2/3 (P＜0.01). Conclusions 1,25 (OH)2D3 can significantly suppress PAN-induced podocyte apoptosis and ameliorate proteinnuria. The beneficial effect of 1,25(OH)2D3 on podocyte may contribute to direct suppression of TGF-β signaling.

Clinical characteristics and outcome evaluation of acute renal failure in critically ill patients in ICU / 中国实用内科杂志

Objective To analyze the clinical characteristics and to evaluate prognosis of critically ill patients who developed acute renal failure(ARF).Methods A retrospective study was carried out in critically ill patients who developed ARF.APACHE Ⅱ,SAPSⅡ,SOFA and ATN-ISI were used to evaluate outcome of ARF.Results The incidence of ARF in critically ill patients was 19.1% with a high mortality(51.2%).The clinical characteristics of 41 patients with ARF were:mechanical ventilation 65.9%,vasopressor support 46.3%,oliguria 41.5%,number of insufficient organs 2.16,APACHEⅡscore 17.3,SAPSⅡ score 52.0,SOFA score 9.26 and ATN-ISI 0.54.By COX regression,number of insufficient organs(RR 2.54;95%CI 1.316 ~ 4.913)(P=0.006)and requirement of mechanical ventilation(RR 6.0;95%CI 1.102~32.6)(P=0.038)were independent risk factors for ICU mortality of ARF.APACHEⅡscore,SAPSⅡscore,SOFA score and ATN-ISI were demonstrated to predict mortality of ARF patients accurately as indicated by areas under the receiver operating characteristics(ROC)curves of 0.848(95% CI: 0.722~0.974;P

Application of emergency hysterectomy on severe postpartum hemorrhage / 中华妇产科杂志

Objective To investigate the value of emergency hysterectomy on arresting severe postpartum hemorrhage Methods A retrospective analysis was performed on 10 cases of hysterectomy by reason of postpartum hemorrhage between Jan 1990 and Dec 2000 Results All the patients were severe postpartum hemorrhage that couldn't be controlled by conservative treatment. Among them,there were 5 cases of DIC,2 cases of placental adherence,1 case each of uterine atony,uterine rupture and infection of uterine incision. Blood loss averaged 2 427 ml. All the 10 patients were recovered. Emergency hysterectomy was related to times of gestation and delivery and also to delivery pattern Conclusion Emergency hysterectomy is one of the effective methods on arresting severe postpartum hemorrhage.