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OBJECTIVE: To analyze the relationship between renal function impairment and intraoperative nephrotoxic drugs in elderly patients undergoing abdominal surgery. METHODS: A retrospective analysis was performed on renal function data before and after surgery for elderly patients (≥75 years old) who underwent abdominal surgery from January 2016 to December 2017 in Xuanwu Hospital of Capital Medical University. The medication group were divided into five groups according to the type of nephrotoxic drugs used in the operation: group (H)--hetastarch (HES), group (N)-- non-steroidal anti-inflammatory drugs (NSAIDs), group (N+H)--combined use NSAIDs and HES, group (F+H)--combined use furosemide and HES, group (Z)- iodinated contrast agent. The control group did not use nephrotoxic drugs.According to the principle of pairing, patients in the untreated group and the medication group were paired, and paired t-test was used to analyze the relationship between intraoperative nephrotoxic drugs and creatinine clearance(Ccr) reduction rates after surgery. RESULTS: A total of 275 elderly patients were enrolled in the study and pairing the untreated group with the patient in the medication group, the pairing success: the number of the group (Z) is 3,and the pairing is not performed, the group (H) number is 41, the group (N) number is 15, the group (N+ H) is 21, the group (F+H) is 7. The paired t-test was used to compare the reduction rate of creatinine clearance between the two groups. The RESULTS showed that there was no significant difference in the group (H), and the other three groups′ RESULTS were all significant differences. CONCLUSION: The nephrotoxic drugs such as NSAIDs, iodinated contrast agents should be controlled during the operation. In particular, the combination of multiple nephrotoxic drugs should be avoided, such as NSAIDs combined with HES and furosemide combined with HES.
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Objective To investigate whether microRNA-34a (miR-34a) participates in lipopolysaccharide (LPS) mediated sepsis related renal function impairment via Kruppel-like factor 4 (KLF4). Methods Thirty healthy male Sprague-Dawley (SD) rats, weighing 180-200 g, were randomly divided into two groups: control group and model group, with 15 rats in each group. The SD rats from model group were injected with LPS 7.5 mg/kg to induce sepsis related renal function impairment model, the SD rats from control group were injected with normal saline. The serum creatinine concentration (SCr) and blood urine nitrogen (BUN) content was detected by multifunction biochemical analyzer; the morphological changes of renal tissue were observed by hematoxylin and eosin stain (HE) staining; the expression of miR-34a and KLF4 gene in plasma and renal tissue were detected by real-time quantitative reverse transcriptase polymerase chain reaction (qRT-PCR); the protein expression of KLF4 in renal tissue was detected by Western Blot; the target gene of miR-34a was verified by double luciferase reporter gene analysis. Results Compared with control group, inflammatory cell infiltration in renal tissue was increased in model group, the SCr and BUN were significantly increased [SCr (μmol/L): 142.5±10.6 vs. 46.4±5.6, BUN (mmol/L): 31.6±6.2 vs. 8.5±1.2, both P < 0.01], the gene expression of miR-34 in plasma and renal tissue were significantly increased (2 -ΔΔCt: 2.26±0.11 vs. 1.14±0.05 in plasma, 4.23±0.12 vs. 1.12±0.04 in renal tissue, both P < 0.01), the gene and protein expressions of KLF4 were significantly decreased [KLF4 gene (2 -ΔΔCt): 0.52±0.03 vs. 1.21±0.06, KLF4 protein (A value): 0.72±0.03 vs. 1.05±0.04, both P < 0.01], which indicated that kidney injury occurred in rats. Pearson correlation analysis showed that plasma miR-34a was positively correlated with SCr and BUN (r value were 0.678, 0.721, respectively, both P < 0.05). Double luciferase reporter assay confirmed that KLF4 was the target gene of miR-34a. Conclusion The miR-34a participates in LPS mediated sepsis related renal function impairment via KLF4.
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Objective To evaluate renal function in congenital spinal deformities patients with urinary malformations.Methods We prospectively enrolled patients diagnosed with congenital spinal deformities combined with urinary malformation as well as age- and weight-matched healthy individuals and divided them into three groups:renal malformations group,urinary tract malformations group,and healthy control group.Serum creatinine,blood urea,blood uric acid,serum cystatin C,and estimate glomerular filtration rate(eGFR)level were used to evaluate general renal function.Urinary microalbumin(mALB),urinary alpha-1-microglobulin(α1-MG), beta-2-microglobulin(β2-MG),and N-acetyl-beta-D-glucosaminidase(NAG)level were determined to evaluate early renal function.Results We enrolled totally 16 patients with renal malformations,14 patients with urinary tract malformations group,and 20 healthy individuals as controls.The concentration of serum creatinine,blood urea, blood uric acid,serum cystatin C,and the value of eGFR in the three groups were within normal reference values, with no significant difference(P＞0.05).There were significant differences in the urinary levels of mALB,α1-MG and NAG in the three groups(P＜0.05),but not for the concentration of β2-MG(P＞0.05).Urinary levels of mALB and NAG were significantly higher in renal malformations group than in urinary tract malformations group (P＜0.05),but not for the concentration of α1-MG(P＞ 0.05).Conclusion Early renal function impairment occurs in congenital spinal deformities children with urinary malformation.Moreover,it appears more severe in patients with renal malformations than in those with urinary tract malformations.
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Objective:To detect the levels of TGF-β1 in hypertensive renal function impairment patients and its clinical value. Methods: Primary hypertension patients with no target organs damage were enrolled in control group, primary hypertension patients with renal function stageⅠand stageⅡwere enrolled in renal function stageⅠgroup and stageⅡgroup. Serum TGF-β1 levels and renal function indices of three groups were compared. Results:There were no significant difference of serum creatinine and blood urea nitrogen of three groups(F=23.523, P<0.05);endogenous creatinine clearance rate of renal functionⅠandⅡgroups were lower than that of control group, TGF-β1 levels of renal functionⅠandⅡ groups were higher than of control group; TGF-β1 levels were negatively correlated with creatinine clearance rate. Conclusion:TGF-β1 level is an ideal index to reflect renal function for its level significantly changes in renal damage stageⅠ,Ⅱand has good correlation with Cin.
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Objective To evaluate the medium-term outcomes of minimally invasive percutaneous nephrolithotomy in patients with renal function impairment.Methods Data of 811 patients who underwent minimally invasive percutaneous nephrolithotomy between Jan.2009 and Dec.2011 were retrospectively collected.Seventy-eight patients had a preoperative estimated GFR of 30-59 ml/(min · 1.73m2).The minimum follow-up was 1 year.Patients were divided into group 1 (improved or stable disease) and group 2 (worsened disease).Patient age was (42.8 ± 16.3) and (45.3 ± 14.2) separately,with male patients 41 and 7,female patients 25 and 5 respectively.Body mass index were (24.3 ± 4.1) kg/m2 and (25.4 ±5.2) kg/m2,history of open surgery or ESWL were 19 and 4.Mild hydronephrosis were 22 and 4.Staghorn stone were 22 and 5.Multiple access were 13 and 2.Operative time was (78.2 ± 30.4) min and (80.3 ±32.3) min.Stone-free rate 1 month postoperatively were recorded.Multiple regression analysis was used.Results The stone free rate at 1 month postoperatively was 85％ by CT scan.Preoperative eGFR was (38.4±12.8) ml/(min · 1.73m2),and 1 ycar postoperative eGFR was (45.1 ±15.8) ml/(min · 1.73m2)in 78 patients.Renal function had improved in 31％ of patients,but it remained the same or deteriorated in 54％ and 15％,respectively at 1 year follow-up.On multivariate regression analysis,diabetes was associated with the deterioration of renal function.Conclusions At medium-term follow-up,renal function was maintained or improved in 85％ of patients with chronic kidney disease who underwent minimally invasive percutaneous nephrolithotomy.Minimally invasive percutaneous nephrolithotomy could be an effective and safe option for the patients with chronic renal function impairment.Diabetes mellitus was independent predictive factor of renal function impairment.Therefore,patients with diabetes should be followed up carefully.Medical management is needed if necessassry.
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Background Hyperuricemia is frequently present in patients with heart failure. Many pathological conditions, such as tissue ischemia, renal function impairment, cardiac function impairment, metabolic syndrome, and inflammatory status, may impact uric acid (UA) metabolism. This study was to assess their potential relations to UA metabolism in heart failure. Methods We retrospectively assessed clinical characteristics, echocardiological, renal, metabolic and inflammatory variables selected on the basis of previous evidence of their involvement in cardiovascular diseases and UA metabolism in a large cohort of randomly selected adults with congestive heart failure (n = 553). By clustering of indices, those variables were explored using factor analysis. Results In factor analysis, serum uric acid (SUA) formed part of a principal cluster of renal functional variables which included serum creatinine (SCr) and blood urea nitrogen (BUN). Univariate correlation coefficients between variables of patients with congestive heart failure showed that the strongest correlations for SUA were with BUN (r = 0.48, P < 0.001) and SCr (r = 0.47, P < 0.001). Conclusions There was an inverse relationship between SUA levels and measures of renal function in patients with congestive heart failure. The strong correlation between SUA and SCr and BUN levels suggests that elevated SUA concentrations reflect an impairment of renal function in heart failure.