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Objective: To analyze the risk factors of hyperuricemia (HUA) and its outcomes of renal function in patients with diabetes mellitus in Shanghai. Methods: A total of 3 454 patients with diabetes who were admitted to the Shanghai Diabetes Clinical Center from July 2011 to September 2014 were selected. The prevalence of HUA, predisposing factors and renal function of diabetic patients were analyzed. Patients were divided into HUA group (n=548) and normal serum uric acid (SUA) group (n=2 906). General characteristics and clinical parameters of diabetic patients were compared between two groups. Pearson correlation analysis and multivariate Logistic regression were used to analyze the relationship between SUA and renal dysfunction and abnormal proteinuria in diabetic patients. Results: In Shanghai patients with diabetes, the prevalence of HUA was 15.87%, 14.52% in men, 17.80% in women. Glomerular filtration rate (GFR), fasting C-peptide, gender, age, natural logarithm of the ratio of microalbuminuria to creatinine (LnACR), glycated albumin (GA), triacylglycerol (TAG), high density lipoprotein cholesterol (HDL-C) and body mass index (BMI) were independently associated with SUA (all P<0.05). In diabetic patients with HUA, 1-SD increment in the SUA level was associated with a 0.8% increased prevalence of renal dysfunction, 0.3% increased prevalence of incident abnormal albuminuria and 0.5% decreased prevalence of hyperfiltration (all P<0.05). Conclusion: Diabetes has an important impact on HUA. Actively improving insulin resistance and controlling blood glucose may improve HUA. HUA is an independent risk factor for the occurrence and development of diabetic nephropathy. Therefore, monitoring the level of SUA in diabetic patients is of great significance in the prevention of diabetic nephropathy.
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Objective To investigate the risk factors of renal inadequacy after postpartum hemorrhage. Methods According to the diagnostic criteria of postpartum hemorrhage, 200 cases of postpartum hemorrhage who were admitted to the Intensive Care Unit from January 2010 to December 2014 were collected. The general situation, history of pregnancy induced hypertension and gestational diabetes mellitus, ASA classification, anesthesia method, delivery mode, postpartum hemorrhage and other indicators. The risk factors were analyzed by logistic regression.Results Among 200 cases of postpartum hemorrhage who were admitted in the intensive care unit, 21 cases with renal insufficiency were seenafter delivery (10.5%) aged between 20 and 44 years old with the average age of (29.24 ±4.58) years old. Using the ASA evaluation criteria to evaluate the preoperative situation, we observed179 cases in ASA grade levelⅠ (89.5%), 20 casesin level Ⅱ (10%), one casein level Ⅲ (0.5%) and no case in grade Ⅳ. Among all the women, we found 147 cases of vaginal delivery (73.5%), 53 cases of cesarean section (26.5%),196 cases of spinal anesthesia (including labor analgesia) (98%) and 4 casesof general anesthesia (2%) . There were 12 patients with hypertension during pregnancy (6%), and 188 patients without hypertension (94%) . There were 9 cases of gestational diabetes mellitus (4.5%), and 191patients without gestational diabetes mellitus (95.5%).Conclusions The risk factors of renal insufficiency after postpartum hemorrhage were: age older than 35 years, cesarean delivery, pregnancy history of hypertension or gestational diabetes mellitus.
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Objective To explore the change of serum high-sensitivity cardiac troponin T(hs-cTnT),myoglobin(MYO),creatine kinase isoenzyme(CK-MB)mass(CK-MB mass)and N-terminal pro-brain natriuretic peptide(NT-proBNP)levels in the patients with renal dysfunction.Methods The inpatients with renal dysfunction(excluding cardiac and skeletal muscle diseases)in our hos-pital were collected and divided into the compensation period group(30 cases),decompensation period group(24 cases)and uremia group(22 cases)according to serum urea and creatine concentration,and 36 healthy individuals were selected as the control group. Venous blood was collected on an empty stomach and separated for obtaining serum.Serum levels of hs-cTnT,MYO,CK-MB mass and NT-proBNP were measured by the electrochemiluminescent immunoassay.Results Serum hs-cTnT levels in the compensation period group,decompensation period group,uremia group and the control group were 16.4(10.9-24.2),17.0(13.0-25.5),25.9 (16.5-33.8),13.7(9.4 -19.7 )pg/mL respectively.Serum MYO levels were 52.4 (40.0 -96.5 ),87.9 (57.7 -118.3 ),115.7 (94.2-175.8),34.8(24.3-48.1)ng/mL,respectively.Serum CK-MB mass levels were 1.03(0.82 -1.75),1.31 (1.08 -1.69), 1.66(1.01-2.46),1.88(1.63-2.43)ng/mL,respectively.Serum NT-proBNP levels were 292.5(123.3-576.2),363.3(192.3-893.3),1 357.2(536.5 -4 662.9),110.3 (70.1 -196.3)ng/mL,respectively.The serum hs-cTnT,MYO and NT-proBNP levels were increased with renal function decrease.The nonparametric Kruskal-Wallis H test showed statistically significant difference a-mong groups(H =14.46,49.81 and 35.00,P 0.05).Conclusion The patients with renal dysfunction have the higher risk rate for complicating the cardiovascular e-vents.Early detection of cardiac markers conduces to the diagnosis of myocardial injury,the evaluation of the risk rate of myocardial infarction occurrence in future and the diagnosis of heart failure and evaluation of the risk rate of heart failure occurrence in future.
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Objective To evaluate the clinical effects of pulsatile perfusion on the renal inadequacy during cardiopulmonary bypass ( CPB). Methods From January 2007 to May 2010, 55 patients with renal inadequacy undergoing open heart surgery were randomized into pulsatile group ( n = 28 ) and nonpulsatile group (n =27). Following parameters were examined: urea nitrogen , creatinine,uric acid, urine volume and blood gas, electrolyte and lactic acid before arteriae aorta opening. Results The urine volume during CPB was significant higher in the pulsatile group ( P ＜0. 01). The blood lactate level before arteriae aorta opening were significant lower in the pulsatile group ( P ＜0. 01). Conclusion The pulsatile flow is better than nopulsatile flow in oxygen metabolism of renal protection.
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Objetivos: apresentar os resultados obtidos com a paratireoidectomia (PTX) subtotal em pacientes com hiperparatireoidismo (HPT) secundário àinsuficiência renal crônica (IRC), enfocando a contribuição e as dificuldades técnicas da cirurgia. Pacientes e Métodos: no período de janeiro de 1998 ajunho de 2005 foram operados consecutivamente no Hospital Universitário Antonio Pedro, 33 pacientes renais crônicos portadores de HPT secundário. Ascirurgias foram realizadas pelo mesmo cirurgião e a mesma equipe de nefrologista se encarregou do controle pré e pós-operatório. Esse grupo foiconstituído por 19 homens e 14 mulheres com idade média de 40,5 (16/68) anos e todos se encontravam em tratamento dialítico regular, com tempo médiode diálise de 113 (20/189) meses. Além dos cuidados habituais, todos os pacientes receberam calcitriol após as três últimas sessões de diálise queantecederam a cirurgia. Resultados: os resultados mais expressivos se refletiram sobre o aparelho músculo-esquelético e foram muito significativas as remissões das queixas de dor ósteo-articular, fraqueza e prurido; as calcificações não vasculares foram reabsorvidas e sinais de remineralização ósseaforam identificados após a cirurgia. As complicações pós-operatórias mais freqüentes foram a rouquidão transitória (21%), a hiperpotassemia (12%) e osangramento pós-operatório (12%). Nesse grupo há uma recidiva comprovada e já reoperada e dois pacientes encontram-se em fase de investigação, por provável insucesso na cirurgia, já que o PTH continua elevado. Os resultados menos favoráveis foram mais freqüentes nos casos onde foram encontradas apenas três glândulas paratireóides. Não houve mortalidade operatória. Conclusões: a PTX subtotal pode ser realizada com segurança e é efetiva para a remissão de diversas manifestações do HPT secundário, desde que continuem sob rigoroso controle clínico para evitar possíveis recidivas por hiperplasia do resíduo glandular.
Objective: to report the results obtained with subtotal parathyroidectomy (PTX) in patients with hyperparathyroidism (HPT) secondary to chronic renaldisease (CRD), focusing on the contribution and technical difficulties of the surgery. Methods: From January of 1998 to June of 2005, thirty-three end-stagerenal disease (ESRD) patients consecutively underwent PTX in the university hospital. Their mean age was 40.5 years; Nineteen were male, and 14 female.Mean time on dialysis was 113 months. Surgeries were accomplished by the same surgeon and the same nephrologist was in charge of the pre- andpostoperative care of the whole patients. Among the clinical manifestations those related to the osteopathy were the most prevalent ones. All patientsunderwent preoperative care and received calcitriol after the last three dialysis sessions that preceded the surgery. Results: the most expressiveimprovements pertained to the muscle-skeletal system. The alleviation of bone pain, joint pain, muscle weakness and itch were marked. Extra-vascularcalcifications were reabsorbed and radiological signs of bone remineralization were identified after the surgery. The most frequent postoperativecomplications were temporary hoarseness (21%), hyperkalemia (12%), and postoperative bleeding (12%). So far, we have faced one proven recurrencethat was managed by a surgical reintervention. In addition, PTH continues to be high in two patients who are undergoing prepare for a new surgery. Bad results seemed to be more frequent on patients in which only three parathyroid glands were found during the operation. Surgery was not associated to fatalities. Conclusions: subtotal PTX can be accomplished with safety in ESRD patients being effective for the alleviation of several manifestations of the secondary HPT. Patients should be maintained under strict clinical control to monitor for recurrences due to hyperplasia of the residual glandular tissue.