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Objective To compare the estimated glomerular filtration rates (eGFR) by five formulas based on serum creatinine (SCr), and to explore the diagnostic efficacy of full age spectrum (FAS) equation based on SCr for renal insufficiency in patients with chronic kidney disease (CKD).Methods 2219 patients with CKD admitted to department of nephrology of Guangdong Provincial Second People's Hospital from December 2015 to January 2018 were enrolled. According to the diagnostic criteria of kidney disease outcomes quality initiative (K/DOQI), patients were divided into CKD 1-5 stages. In all patients, Tc-GFR was measured by clearance rate of99mTc-diethylene triaminepen taacetic acid (99mTc-DTPA) within 1 month, and SCr was determined. The eGFR was calculated by Cockcrofi-Gault (C-G) formula bases on SCr, Chinese modified modification of diet in renal disease (cMDRD) equation, Chronic Kidney Disease Epidemiology Collaboration Group (CKD-EPI) equation, measure and calculation (MC) equation and FAS equation, respectively, and body surface area (BSA) was used for correction of eGFR. The differences of Tc-GFR and eGFR calculated by different formulas were compared, and the correlations between eGFR calculated by different formulas and Tc-GFR were analyzed by Spearman correlation analysis. Tc-GFR was used as a reference standard to evaluate the bias,precision and accuracy of eGFR formulas, and the receiver operating characteristics (ROC) curve of each eGFR formula was plotted to evaluate its diagnostic efficacy for renal insufficiency in patients with CKD.Results According to the inclusion and exclusion criteria, 382 patients with CKD were enrolled in the final analysis. There were 31, 69, 92, 75 and 115 patients with CKD 1-5 stages, respectively. In all patients, the differences between Tc-GFR and eGFR calculated by different formulas were statistically significant, and eGFR was positively correlated with Tc-GFR. The best correlation coefficient was between eGFR of cMDRD formula and Tc-GFR (r = 0.883,P = 0.000), and the lowest was of MC formula (r = 0.848,P = 0.000). The best correlation between the eGFR calculated by FAS formula and the Tc-GFR was in CKD 2 stage (r = 0.538,P = 0.000), and the lowest correlation was found in CKD 5 stage (r = 0.229,P = 0.014). Compared with Tc-GFR (the reference equation), the FAS formula showed the smallest bias [the difference between Tc-GFR and eGFR = 8.64, 95％ confidence interval (95％CI) = 7.04-10.19], and the best accuracy [the percentage of eGFR falling into the range of Tc-GFR±30％ (P30) = 42.67％, 95％CI = 37.69-47.65]; CKD-EPI equation showed the best precision (QR of the difference between Tc-GFR and eGFR = 17.43, 95％CI = 15.33-21.28). ROC curve analysis showed that the area under the curve (AUC) of cMDRD formula was the largest (0.944), and the specificity was the highest (87.23％);the sensitivity of CKD-EPI formula was the highest (94.00％); and the AUC of MC formula was the smallest (0.918). The AUC of FAS formula was 0.940 (95％CI = 0.917-0.964,P = 0.000), it was higher than that of MC formula, but there was no significant difference between FAS formula and other formulas. When the cut-off value of eGFR calculated by FAS formula was 32.62 mL·min-1·1.73 m-2, the sensitivity, specificity, positive predictive value, negative predictive value was 93.00％, 81.56％, 83.64％, 11.54％, respectively.Conclusion Compared with C-G formula, cMDRD formula, CKD-EPI formula and MC formula, FAS formula showed smaller bias and higher accuracy, and had higher specificity and sensitivity in the diagnosis of renal insufficiency in patients with CKD, which could be applied to the determination of GFR in early stage of CKD.Clinical Trial Registration Chinese Clinical Trial Registry, ChiCTR1800017727.
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Objective To explore the clinical application value of the new formula for estimating glomerular filtration rate(eGFR) for adult Chinese(AC-eGFR).Methods GFR from 117 patients in hospital suffering from the difference diseases was determined accurately using clearance rate of 99mTc-DTPA(Tc-GFR).The serum cystatin C,creatinine and blood urea nitrogen were determined by the biochemical apparatus.Simultaneously,GFR was calculated by the eleven formulas such as AC-eGFR,CKD-EPI formula etc..Then,the results were compared and analyzed.Results eGFR from the eleven formulas could all give expression to GFR accurately in some extent,AC-eGFR,CKDEPI-eGFR and Larsson A et al-eGFR were more accurate than others and could take place of Tc-GFR clinically.Robert TT-eGFR,Filler Get al-eGFR and Grubb Aet al-eGFR were worse than others.Conclusion AC-eGFR,CKDEPI-eGFR and Larsson A et al-eGFR were all accurate,simple,fast,safe,cheap and rational method for estimatingGFR,which should apply and popularize clinically.
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Objective To establish an accurate,simple,safe,cheap,and logical new adult Chinese formula for measurement and calculation of glomerular filtration rate (eGFR).Methods GFRs from 136 cases of patients in hospital suffering from the different diseases were determined accurately using clearance rate of 99mTc-DTPA (Tc-GFR),and many clinical factors including serum creatinine (SCr) were determined simultaneously with routine method.The new equation for adult Chinese based on the SCr was obtained by the relationship and regression analysis for measurement and calculation GFR (SCrAC-eGFR).Tc-GFR from another 117 cases of patients were determined by the same method.SCr,and blood urea nitrogen were determined using routine method.eGFR were measured and calculated by 12 formulae such as SCrAC-eGFR,and USA DMS method.The relationship analysis and the contrast study from all data were performed.Results The equation was tenable,and the regression coefficient was significant ( P ＜ 0.01 ).eGFR from the six formulae for example SCrAC-eGFR,USA DMS method,Japan Picric method and so on could all give expression to GFR accurately at the some extent and the SCrAC-eGFR new formulae and USA DMS method formulae was more accurately than other and could take the place of Tc-GFR clinically.Conclusions The six formulae including SCrAC-eGFR,and USA DMS method were all accurate,simple,celer,safe,cheap,and rational methods for estimating GFR.It should apply and popularize clinically.
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ObjectiveTo study the effect of angiotensin Ⅱ type 1 receptor antagonist (ARB) losartan on reducing the incidence of stroke in patients which suffer from hypertension and atrial fibrillation(AF).MethodsProspective randomized analysis was used to divide one hundred and eighty hypertemion patients with atrial fibrillation into two groups.ARB treatment group was treated with losartan (n =90) and beta-blockers treatment group was treated with metoprolol ( n =90),all patients were treated for three years and followed up.Blood pressure,pulse pressure,incidence of stroke and myocardial infarction and mortality of cardiovascular events were evaluated.ResultsAfter antihypertensive treatment,blood pressure was reduced in two groups,the pulse pressure in losartan group was reduced obviously( all P ＜0.01 ).The incidence of stroke and myocardial infarction and mortality of cardiovascular events in losartan group were 22.2％,10.0％ and 13.3％,respectively,lower than that in metoprolol group 70.0％,40.0％ and 44.4％ ( all P ＜0.01 ).ConclusionLosartan reduced the incidence of stroke in the hypertension patients with AF.
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Objective To investigate risk factors bringing on death and the conversion factors of renal function in the elder acute re-nal failure (ABF) and establish the prevention and treatment measure in clinic to reduce mortality. Methods The clinical information of 143 elder ARF cases which were treated by two hospitals for many years was studied. The risk factors possible bringing on death in the elder ARF were studied by using binary logistic regression pattern. The clinical factors possible affecting the conversion of renal function in the eld-er ARF were analyzed. Results Binary logistic regression pattern study showed that heart failure, respiratory failure, gastrointestinal bleed-ing, hepatic failure, coma, organ failure number and lower blood pressure among 25 study factors were found to be the risk factors bringing on death, and heart failure, respiratory failure, organ failure number and whether chronic renal insufficiency were the most important factors of affecting recover of renal function in the elder ARF. Conclusion The effective prevention and treatment measure should be adopted in the elder ARF with these risk factors so as to reduce mortality and increase the recover rate of renal function.
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Objective To investigate the insertion/deletion(I/D) polymorphism of ACE gene in uncompen-sated hepatocirrhosis with hepatorenal syndrome(HRS). Methods ACE I/D polymorphism was detected by poly-merase chain reaction amplification of DNA fragment in 96 cases of uncompensated bepatocirrhnsis with HRS, every group as controls were involved in this study. At the same time,GPT,GOT,sarum creatinine(SCr), blood urea nitro-gen(BUN) and glomerular filtration rate(GFR) of every case were measured and the difference of these targets among different genotypes were compared. Results There was no significant difference for every genotype and allele fre-quency between the HRS group and every group as controls(P >0.05). The I allele frequencies were higher than the one of D allele for every groups except other liver disease group(P < 0.01). But in the every group as controls, there was no significant difference for the genotype frequency among three groups and in the HRS group, the Ⅱ genotype frequency was higher than the one of ID and DD(P < 0.05). SCr etc. of the Ⅱ genotype were higher than the one of ID and DD(P<0.05) and GFR of the Ⅱ genotype was lower than the one of ID and DD in the HRS group(P<0.05). Conclusion There was relationship between ACE gene polymorphism and the incidence of uncompensated bepatocirrhosis with HRS.
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Objective To investigate and evaluate the etilolgy,diagnosis and differential diagnosis,treatment method of urethral syndrome(UTS).Methods Comprehensive analysis was performed for diagnosis and treatment process of UTS and literatre review on etiology,diagnosis and treatment of UTS.Results UTS was common among women with variey of pathogenosis.Most of UTS were complicated by anxiety neurosis and some of UTS was not clear about pathogenosis.UTS was very apt to be misdiagnosed as urethral infection,as a result,the patients were long administered to antibiotics.Laboratory detection to eliminate other disease was the main way to diagnose UTS.Surgical treatment or integrated traditional and western medicine would obtain good effects.Conclusion Laboratory detection to eliminate other disease is the main way to diagnose UTS and misdiagnosis can be avoided.Inquiry of disease history and careful body examination is helpful to find out thd pathogenosis of UTS which is the basis of the therapy for UTS.
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Objective:Shenkang was prescribed and prepared by our own hospital and its clinical effect and side effect for treating latent glomerulonephritis(LGN) were observed. Methods: Shenkang was composed of dog's penis Carapar Trionycis、nephritis herb and so on and prepared by the modern pharmaceutical technology. 60 cases with LGN were divided into the control group(30 cases) and the Shenkang group(30 cases) at random. Patients with protein uria in the control group were treated with the tablet of multiglycoside of Radix Tripterygii Wilfordi and patients with accompanied symptom were treated by the supportive expectant treatment. Patients in the Shenkang Capsule group were treated with it, 5 tables each time, 3 times a day and patients with accompanied symptom were also treated by the supportive expectant treatment. The treatment courses of two groups were all 3 months. 24 hour protein uria quantity、 serum total protein(TP)、 albumin(Al)、 1 hour urine red blood cell excreting rate(1huRBCer)、 serum creatinine and sodium before and after the treatment were observed. Results: Shenkang Capsule can significantly lower protein uria of LGN so as to raise the levels of TP and Al and reduce 1huRBCer. There was no side effect in the course of using Shenkang Capsule. Conclusion: Shenkang Capsule is effective for LGN.