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Objective:To report a rare case of paroxysmal nocturnal hemoglobinuria (PNH) complicated with chronic tubulointerstitial nephropathy, combined with literature review, and discuss the clinical, imaging and pathological characteristics of the disease and the diagnosis and treatment ideas.Methods:The patient's clinical data, magnetic resonance imaging (MRI) and kidney pathological examination results, treatment measures and effects were collected and reported. Through systematic review of relevant literature, the clinical manifestations and pathogenesis of chronic tubular interstitial nephropathy complicated by PNH were summarized and discussed.Results:In this case, PNH was diagnosed for more than 30 years, the peripheral blood PNH clone was positive, urine specific gravity was 1.012, urine pH 6.0-7.0, urine protein (+), urine sugar (3+), serum creatinine 259 μmol/L, serum lactic acid dehydrogenase 800 U/L. MRI showed bilateral renal cortical signal was low intensity on both T1- and T2- weighted images. Kidney biopsy revealed remarkable chronic tubulointerstitial nephropathy with massive hemosiderin deposition in proximal tubular cells demonstrated by Prussian blue staining and electron microscopy. By using low-dose prednisone to control hemolytic attack and other supportive treatments, the patient's renal function has been stabilized for a long time.Conclusions:PNH complicated with chronic tubulointerstitial nephritis is easy to be misdiagnosed due to insidious onset. MRI and kidney histopathological examination are helpful to clarify the diagnosis. Early diagnosis and treatment are helpful to improve the prognosis of such patients.
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Objective:To evaluate the prevalence of masked hypertension defined by home blood pressure monitoring in patients on peritoneal dialysis (PD) and examine its determinants.Methods:The patients who performed PD in the First Affiliated Hospital of Sun Yat-sen University from January 1, 2006 to December 31, 2013 were recruited. Baseline demographic, clinical and biochemical examination data were collected to analyze the prevalence and clinical characteristics in patients with masked hypertension defined by home blood pressure monitoring. Multivariate logistic regression model was used to analyze the related risk factors of masked hypertension in PD patients with clinic normotension.Results:There were 1 425 patients (866 males) enrolled in this study, with age of (46.9±14.9) years and body mass index of (21.6±3.1) kg/m 2. The prevalence of masked hypertension in PD patients was 31.9%, and the prevalence of masked hypertension in patients with clinic normotension was 57.5%. Multivariate logistic regression analysis showed that higher body mass index ( OR=1.057, 95% CI 1.001-1.116, P=0.047), incorporating diabetes mellitus ( OR=1.996, 95% CI 1.160-3.433, P=0.013), use of multiple antihypertensive drugs ( OR=1.336, 95% CI 1.122-1.590, P=0.001) and elevated office blood pressure ( OR=1.785, 95% CI 1.546-2.060, P<0.001) were independent risk factors of masked hypertension in PD patients with clinic normotension. Conclusions:The prevalence of masked hypertension is high in PD patients. Higher body mass index, incorporating diabetes mellitus, use of multiple antihypertensive drugs and elevated office blood pressure are independent risk factors for masked hypertension in PD patients with clinic normotension.
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Objective:To assess the bacterial profiles and antimicrobial susceptibility patterns in uropathogens, and help to inform the empiric treatment decisions for urinary tract infection in outpatient settings.Methods:A single institutional retrospective analysis was performed on positive urine cultures from outpatient settings between January 1998 and December 2018. To analyze changes over time, trends analysis were undertaken on bacterial profiles, antimicrobial susceptibility and resistance.Results:A total of 1.172 pathogenic bacteria were isolated after exclusion of duplicate strains originated from the same patient, including 991(84.6%) Gram-negative bacterial strains and 181(15.4%) Gram-positive strains. The most common Gram-negative uropathogens were Escherichia coli (60.8%) and Klebsiella pneumonia (8.1%). Enterococcus faecalis (4.6%) was the predominant Gram-positive strain. The detection rate of Escherichia coli increased significantly, from 50.8% to 63.2% ( χ2=7.978, P=0.046), and no significant difference was observed in the distribution of major uropathogenic bacteria over the 20 years (all P>0.05). The proportion of extended-spectrum β-lactamase (ESBLs) producing strains increased significantly across the 20 years ( P<0.05). The resistance rates of Escherichia coli to amoxicillin and clavulanate potassium, aztreonam, ceftazidime, ciprofloxacin and sulbactam + cefoperazone increased significantly (all P<0.05). All the isolates sustained high susceptibility to tazobactam + piperacillin, amikacin, imipenem and nitrofurantoin (95.0%, 95.7%, 97.9% and 91.1%). Similar to those of Escherichia coli, Klebsiella pneumoniae remained a high and stable sensitivity to tazobactam+piperacillin, amikacin and imipenem during the 20 years (79.1%, 88.0% and 80.3%). However, the proportion of ESBLs producing strains increased significantly ( P<0.05). Among Gram-positive bacteria isolates, the sensitivity rates of Enterococcus faecalis to ampicillin, nitrofurantoin and penicillin G were 100.0%. No vancomycin resistant strain was detected in Gram-positive bacteria. Conclusions:From 1998 to 2018, Escherichia coli and Klebsiella pneumoniae are the most common Gram-negative bacteria uropathogens obtained in outpatient settings. Significant increases of resistance to some antimicrobial agents such as second- and third-generation cephalosporins and fluoroquinolones are observed during the 20 years and high susceptibilities to tazobactam+piperacillin, amikacin, imipenem and nitrofurantoin sustain over time. Local treatment strategies of urinary tract infections on outpatient basis should be made according to epidemiology of drug resistance and individual characteristics to control the spread and curb the prevalence of drug resistant.
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Objective@#To explore the clinicopathological features and the renal biopsy process of a case of IgG4-related chronic interstitial nephritis with perirenal capsule involved and review associated literature to improve the clinician's understanding for this disease and to perform a better renal biopsy.@*Methods@#The onset, diagnosis and treatment course of the disease were described and associated literature were reviewed to summary the clinicopathologic features and key points in renal biopsy.@*Results@#The data of the patient showed that the urine specific gravity was 1.011, with urine protein ± and urine sugar 3+. The concentration of hemoglobin was 53 g/L, serum creatinine was 1665 μmol/L, and IgG4 was 9.39 g/L. Computed tomography showed that both kidneys enlarged slightly with decreased density and low density shadow around the kidneys. On contrast-enhanced scan, irregular low-density enhancement areas were found in both kidneys, and the edge of the boundary was not clear. For the first renal biopsy, no renal parenchyma was found except mainly hyaline collagen fibrils. At the second time, 3 pieces of tissues were obtained, which showed chronic interstitial glomerulonephritis. The IgG4 positive plasma cells were about 60/HPF and the IgG4+/IgG+cells ratio was more than 40%. The diagnosis of IgG4-related chronic interstitial glomerulonephritis was confirmed. After corticosteroid treatment, the serum creatinine decreased to 502 μmol/L after the patient got rid of dialysis.@*Conclusions@#There are various manifestations of renal damage caused by IgG4-related disease. It is necessary to pay attention to the involvement of the perirenal capsule, and to balance the risk of bleeding and poor sampling in renal biopsy.
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Objective@#To investigate the risk factors of left ventricular hypertrophy (LVH) in non-dialysis dependent end-stage renal disease (ESRD) patients.@*Methods@#ESRD patients in the First Affiliated Hospital of Sun Yat-sen University from Jan to July 2019 were enrolled. Demographic data of patients were collected and biochemical parameters were measured. Hydration status index (extracellular water/total body water, ECW/TBW) was measured by bioelectrical impedance analysis (BIA), and LVH was diagnosed by echocardiography. Patients were divided into LVH group and non-LVH group according to LVH diagnostic criteria, and the incidence of LVH in ESRD non-dialysis patients was calculated. Logistic regression was used to analyze the risk factors of LVH.@*Results@#A total of 105 non-dialysis dependent ESRD patients aged (47.03±12.56) years (21-78 years) were enrolled in present study, among whom 74 patients (70.5%) had LVH. Compared to non-LVH group, patients in LVH group had higher proportion of diabetes and calcium antagonist used, higher value of ECW/TBW and ECW/Height, higher level of night systolic pressure, and were older (all P<0.05). Spearman correlation analysis showed LVH was positively correlated to diabetes (r=0.345, P<0.001), night systolic pressure (r=0.286, P<0.001), night diastolic pressure (r=0.251, P=0.012), calcium antagonist used (r=0.381, P=0.013), ECW/TBW (r=0.383, P=0.005), ECW/Height (r=0.298, P=0.003), 24 h sodium urinary excretion (r=0.257, P=0.025), brain natriuretic peptide (r=0.315, P=0.005) and hemoglobin (r=0.307, P=0.018), and negatively correlated to 24 h potassium urinary excretion (r=-0.248, P=0.023). Logistic regression showed that increased night diastolic pressure (OR=2.036, 95%CI 1.144-3.623, P=0.016) and ECW/TBW (OR=1.232, 95%CI 1.025-1.523, P=0.014) were the independent risk factors of LVH after adjusting for gender, age, diabetes, nocturnal blood pressure, antihypertensive drugs used, ECW/TBW, urinary sodium excretion and hemoglobin.@*Conclusions@#LVH is common in non-dialysis dependent ESRD patients. Over hydration and high night diastolic blood pressure are the independent risk factors of LVH in non-dialysis dependent ESRD patients.
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Objective To investigate the risk factors of left ventricular hypertrophy (LVH) in non-dialysis dependent end-stage renal disease (ESRD) patients. Methods ESRD patients in the First Affiliated Hospital of Sun Yat-sen University from Jan to July 2019 were enrolled. Demographic data of patients were collected and biochemical parameters were measured. Hydration status index (extracellular water/total body water, ECW/TBW) was measured by bioelectrical impedance analysis (BIA), and LVH was diagnosed by echocardiography. Patients were divided into LVH group and non-LVH group according to LVH diagnostic criteria, and the incidence of LVH in ESRD non-dialysis patients was calculated. Logistic regression was used to analyze the risk factors of LVH. Results A total of 105 non-dialysis dependent ESRD patients aged (47.03 ± 12.56) years (21-78 years) wereenrolled in present study, among whom 74 patients (70.5％) had LVH. Compared to non-LVH group, patients in LVH group had higher proportion of diabetes and calcium antagonist used, higher value of ECW/TBW and ECW/Height, higher level of night systolic pressure, and were older (all P<0.05). Spearman correlation analysis showed LVH was positively correlated to diabetes (r=0.345, P<0.001), night systolic pressure (r=0.286, P<0.001), night diastolic pressure (r=0.251, P=0.012), calcium antagonist used (r=0.381, P=0.013), ECW/TBW (r=0.383, P=0.005), ECW/Height (r=0.298, P=0.003), 24 h sodium urinary excretion (r=0.257, P=0.025), brain natriuretic peptide (r=0.315, P=0.005) and hemoglobin (r=0.307, P=0.018), and negatively correlated to 24 h potassium urinary excretion (r=-0.248, P=0.023). Logistic regression showed that increased night diastolic pressure (OR=2.036, 95％CI 1.144-3.623, P=0.016) and ECW/TBW (OR=1.232, 95％CI 1.025-1.523, P=0.014)were the independent risk factors of LVH after adjusting for gender, age, diabetes, nocturnal blood pressure, antihypertensive drugs used, ECW/TBW, urinary sodium excretion and hemoglobin. Conclusions LVH is common in non-dialysis dependent ESRD patients. Over hydration and high night diastolic blood pressure are the independent risk factors of LVH in non-dialysis dependent ESRD patients.