Clinical characteristics and related risk factors of impaired liver and renal function in hospitalized patients with gout / 中华内分泌代谢杂志

Objective:To analyze the clinical characteristics and risk factors of impaired liver and renal function in hospitalized patients with gout.Methods:A total of 494 hospitalized patients with confirmed gout were selected and divided into four groups according to liver and renal function, control(Con), impaired liver function (ILF), impaired renal function (IRF), and both function impaired (ILRF) group. Multivariate logistic regression was used to analyze the risk factors related with impaired liver and renal function.Results:Compared to Con group, ILF group were younger with shorter gout duration, higher body mass index, waist circumference, homeostasis model assessment for insulin resistance (HOMA-IR), serum uric acid, low density lipoprotein-cholesterol (LDL-C), total cholesterol, triglycerides, C reactive protein, higher prevalence of dyslipidemia, obesity, fatty liver, and monosodium urate crystal (MSU) deposition (all P<0.05). IRF group were older and with higher serum uric acid, serum creatinine, C reactive protein, and hypertension, MSU deposition prevalence, with lower prevalence of fatty liver (all P<0.05). Compared to ILF group, IRF group were older, with longer gout duration, lower level of body mass index, waist circumference, HOMA-IR, LDL-C, total cholesterol, triglycerides, lower prevalence of obesity, fatty liver, and higher prevalence of hypertension and type 2 diabetes (all P<0.05). The univariate logistic regression analysis showed that age( OR=0.941, 95% CI 0.906-0.977, P<0.001), serum uric acid ( OR=1.002, 95% CI 1.000-1.005, P=0.043), HOMA-IR ( OR=1.147, 95% CI 1.024-1.285, P=0.018), and MSU deposition ( OR=1.959, 95% CI 1.154-3.326, P=0.013) were the independent risk factors of impaired liver function, while the independent risk factors of impaired renal function were age ( OR=1.104, 95% CI 1.048-1.162, P<0.001), serum uric acid ( OR=1.007, 95% CI 1.004-1.010, P<0.001), and MSU deposition ( OR=2.393, 95% CI 1.191-4.805, P=0.014). Conclusions:Serum uric acid and MSU deposition are the common independent risk factors for impaired liver and renal function in patients with gout. Younger patients with insulin resistance are susceptible to impaired liver function, older patients with hypertension and diabetes are susceptible to impaired renal function.

Diclofenac-induced biochemical changes in nephrotoxicity among male Albino rats

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with adverse renal effects caused by the reduction in synthesis of renal prostaglandins in sensitive persons or animal species, and potentially during long-term use in non-sensitive persons if resistance to side effects decreases with age. The effects of diclofenac sodium on the kidneys were studied during 4 1/2 hours in eight patients with normal renal function. Urinary output decreased within 10 min after the injection, and maximally by 80%. The renal plasma flow and the glomerular filtration rate initially diminished significantly, by 35%, but began to increase after only 2 hours. The dominant and persistent effect was a reduction of free water clearance, with maximum fall from 5.9 to 0.08ml/min after 2 1/2 hours. Aim: The aim of this study was to evaluate the effects of diclofenac-induced acute nephrotoxicity using biochemical parameters in rats.Methods: 12 male Wistar rats allotted in 4 equal groups were intraperitoneally injected with 0, 10, 50 and 100mg/kg diclofenac, respectively and 12 hours after injection, blood serum samples were collected for assessment of basic renal function test parameters such as urea, creatinine, and uric acid, sodium, Potassium.Results: Rats treated up to 50mg/kg diclofenac were considered to be within normal range in rats. By increase in dose more than 50mg/kg showed significant increases in uremia were evidenced in intoxicated animals. Observed specifically in group IV Rats.Conclusions: In this study, uremia, as an indicator of kidney damage, was significantly increased depending on dose. Diclofenac may cause kidney damage depending on dose and this effect may also be observed. NSAIDs-induced nephrotoxicity may be due to the inhibitory effect of these drugs on prostaglandin synthesis, thus causing kidney ischemia.

Nephrotoxicity during tenofovir treatment: a three-year follow-up study in a Brazilian reference clinic

Abstract In this study, 275 patients in use of tenofovir were retrospectively followed-up for three years to evaluate risk factors involved in impaired renal function. Analysis of variance (ANOVA) and Tukey's test were used to verify any differences in creatinine levels and estimated clearance at 0, 6, 12, 24 and 36 months, adjusting for the co-variables sex, skin color, age >50 years, arterial hypertension, diabetes and the use of the ritonavir-boosted protease inhibitors (PI/r) lopinavir/r or atazanavir/r. The software package STATISTICA 10® was used for statistical analysis. The patients’ mean age was 43.2 ± 10.7 years. Systemic arterial hypertension (SAH) and diabetes were found in 20.4% and 8.7% of the patients, respectively. Overall, 96.7% were on tenofovir associated with lamivudine (TDF + 3TC), 39.3% on lopinavir/r, 29.8% on efavirenz, and 17.6% on atazanavir/r. There was a statistically significant difference in estimated creatinine clearance at 24 months, when the co-variables male (F = 3.95; p = 0.048), SAH (F = 6.964; p = 0.009), and age over 50 years (F = 45.81; p < 0.001) were taken into consideration. Analysis of the co-variable use of atazanavir/r showed a tendency toward an increased risk over time (F = 2.437; p = 0.063); however, no significant time interaction was seen. At 36-month, a statistically significant difference was found for age over 50 years, (F = 32.02; p < 0.05) and there was a significant time-by-sex interaction (F = 3.117; p = 0.0149). TDF was discontinued in 12 patients, one because of a femoral neck fracture (0.7%) and 11 due to nephrotoxicity (4%). Of these latter cases, 9/11 patients were also using protease inhibitors. These data strongly alert that tenofovir use should be individualized with careful attention to renal function especially in male patients, over 50 years, with SAH, and probably those on ATV/r.

Low-dose methotrexate-induced pancytopenia in three patients with impaired renal function / 대한내과학회지

Methotrexate (MTX) is indicated for patients with moderate to severe rheumatoid arthritis (RA), but it sometimes causes severe hematologic complications in patients with impaired renal function. We experienced three cases of pancytopenia due to low-dose MTX treatment in RA patients with impaired renal function. Two patients were dialysis patients, and the other had stage 4 chronic kidney disease. The mean cumulative MTX dose and treatment duration for the three patients was 25 mg and 10 days, respectively. All cases experienced severe stomatitis and pancytopenia and recovered with conservative care. In conclusion, MTX should be used cautiously in patients with impaired renal function.

Serum CA 125 Levels in Patients with Impaired Renal Function / 대한부인종양콜포스코피학회잡지

Measurement of the serum CA 125 level as a tumor marker in patients with epithelial ovarian cancer has been widely used to monitor disease status and predict survival of patient. While a number of benign gynecologic as well as benign or malignant non-gynecologic conditions are associated with elevations of serum CA 125 levels, the established normal range describes a healthy population of women. Because the metabolism and clearance of CA 125 is not well understood and mild or moderate degrees of renal impairment frequently occurs in ovarian cancer patients during treatment or course of disease, it is valuable to investigate the effect of impaired renal function on serum level of CA 125. Eighty-nine women on hemodialysis who had no other definite cause to elevate serum CA 125 level were selected at random. The age of the patients ranged from 19 to 83 and renal disease was secondary in most cases to diabetes mellitus, hypertension or glomeru-lonephritis. The creatinine clearance was less than 10cc/min for all patients. (continue)