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Objective:To investigate the potential of the antineutrophil cytoplasmic antibody (ANCA) renal risk score (ARRS) in predicting the prognosis of children with ANCA-associated glomerulonephritis (AAGN).Methods:Laboratory testing, renal pathology results, treatment and prognosis of 61 children with AAGN diagnosed by renal biopsy from June 2007 to May 2022 in General Hospital of Eastern Theater Command were retrospectively analyzed.The Kaplan-Meier method was used to evaluate the overall and renal survival of children with AAGN, and risk factors of progression to end stage renal disease (ESRD) were analyzed by Cox regression analysis. Results:Among the 61 children with AAGN, there were 14 males and 47 females with the age of (15.65±3.74) years.According to ARRS, AAGN children were assigned into low-risk group (27 cases), medium-risk group (21 cases) and high-risk group (13 cases). During a median follow-up duration of 46.36 (14.58, 95.62) months, the number of ESRD cases in the high-risk group (9 cases) was significantly higher than that of low-risk group (2 cases) and medium-risk group (3 cases) ( χ2=13.079, P<0.001). Kaplan-Meier survival analysis showed that AAGN children in the high-risk group had the worst renal prognosis ( χ2=5.796, P=0.016), while no significant difference was detected in the overall survival among the 3 groups ( χ2=2.883, P=0.237). Multivariate Cox regression showed that estimate glomerular filtration rate(eGFR)≤15 mL/(min·1.73 m 2) ( HR=9.574, 95% CI: 4.205-25.187, P=0.015) and ARRS ( HR=2.115, 95% CI: 1.206-4.174, P=0.012) were independent risk factors for children with AAGN progress to ESRD.Receiver operating characteristic (ROC) curve analysis results showed that the area under the curve of ARRS for predicting the risk of progressing to ESRD in AAGN children was 0.880 (95% CI: 0.759-1.000), and the optimal cutoff value of ARRS was 5.50, with the sensitivity and specificity of 85.71% and 82.98%, respectively. Conclusions:ARRS was an independent risk factor for children with AAGN progress to ESRD, which had a predictive value for the progression of AAGN to ESRD.
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Resumen Introducción: Varios estudios han demostrado en poblaciones indígenas alta prevalencia de obesidad, diabetes mellitus, hipertensión arterial, proteinuria y enfermedad renal crónica. Objetivo: Detectar factores de riesgo cardiovascular y renal, hipertensión arterial, sobrepeso y obesidad, obesidad central, diabetes y proteinuria, y evaluar nivel educativo, situación laboral, nivel socioeconómico y cobertura de salud en sujetos de la etnia wichi, habitantes de "El Impenetrable" chaqueño. Material y métodos: Se realizó un estudio descriptivo observacional, de corte transversal, con muestra aleatoria de sujetos mayores de 18 años. La encuesta semiestructurada, y traducida a lengua wichi, incluyó: edad, sexo, sedentarismo, tabaquismo, nivel educativo, situación laboral, cobertura de salud y nivel socioeconómico. Se midió peso, talla, circunferencia de cintura, presión arterial sistólica y diastólica, glucemia y proteinuria. Se calculó el índice de masa corporal. Resultados: Se evaluaron 156 personas (el 58,3% varones, edad 34 ± 12 años). El índice de masa corporal fue de 27,9 ± 5,3, sin diferencia entre sexos. Presentó hipertensión arterial el 10,8%, sobrepeso el 34,0%, obesidad el 30,9%, obesidad central el 40,1% (mayor en mujeres, p= 0,03), tabaquismo el 17,4%, sedentarismo el 83,3%, y proteinuria el 14,5%. Se registró un único caso de diabetes. Solo 6,4% refirió trabajar, el 49,3% no había finalizado estudios primarios, el 61,7% calificó como marginal en el nivel socioeconómico, y solo el 3,8% tenía cobertura de salud. Conclusión: Este grupo poblacional evidencia un alto grado de vulnerabilidad alimentaria, educativa, laboral, social y sanitaria, reflejado en la alta prevalencia de factores de riesgo cardiovascular y renal (en particular exceso de peso y obesidad central), en el bajo nivel educativo, laboral y socioeconómico, y en la falta de cobertura de salud.
Abstract Introduction: Several studies have shown a high prevalence of obesity, diabetes mellitus, hypertension, proteinuria and chronic kidney disease in indigenous populations. Aim: To detect cardiovascular and renal risk factors, hypertension, overweight and obesity, truncal obesity, diabetes and proteinuria, and to evaluate educational level, employment situation, socioeconomic level and health care coverage in subjects from the Wichi ethnic group who inhabit in "El Impenetrable" in Chaco. Methods: An observational, descriptive, cross-sectional study was carried out, with a random sample of subjects over 18 years of age. The semi-structured survey, translated into the Wichi language, included: age, sex, sedentary lifestyle, smoking habit, educational level, employment situation, health care coverage and socioeconomic level. Weight, height, waist circumference, systolic and diastolic blood pressure, blood glucose and proteinuria were measured. Body mass index was calculated. Results: 156 people were evaluated (58.3% men; age: 34 ± 12 years). The body mass index was 27.9 ± 5.3, with no difference between the sexes. Hypertension was present in 10.8% of individuals; overweight in 34.0%; obesity in 30.9%; truncal obesity in 40.1% (higher in women, p = 0.03); smoking habit in 17.4%; sedentary lifestyle in 83.3%, and proteinuria in 14.5%. A single case of diabetes was registered. Only 6.4% reported having a job, 49.3% had not completed primary studies, 61.7% qualified as marginal in terms of socioeconomic status, and only 3.8% had health care coverage. Conclusion: This population group shows a high degree of food, educational, occupational, social and health vulnerability, reflected in the high prevalence of cardiovascular and renal risk factors (particularly excess weight and truncal obesity), in the low educational, employment and socioeconomic levels, and in the lack of health coverage.
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Background: Renal impairment is the primary cause of mortality and morbid conditions in patients. Inappropriate drug use in patients who are with risk of renal damage causes harmful and deleterious effects. Adjusting doses based on renal function is necessary for renal risk drugs, primarily to avoid adverse reactions of medications. Aim of the present study was to assess the risk of incidence on ADRs with drugs lowering the renal function.Methods: This is a cross-sectional observational study conducted in General Medicine department. 230 Patients constituted the sample in the study. The study was conducted for a period of one year and prescriptions with renal risk drugs were evaluated. Changes in the renal functional tests were compared to the normal range and adverse drug responses were monitored.Results: A total of 230 patients who fulfilled the inclusion criteria were included in the study. The meanage of the study subjects were 50.9±15.2 respectively. 56.39% patients were men and 43.6% were women. Renal risk drugs included in the study are anti-hypertensive, antibiotics, and analgesics. Paracetamol (24.77%) followed by telmisartan (20.85%) are the predominantly prescribed renal risk drugs with high incidence of adverse drug reactions. Causality assessment by Naranjo ADR probability scale showed out of 211 ADRs, 51.6% were possible, 25.59% were doubtful, 21.8% were probable and 0.94% was definite.Conclusions: The current study signifies that patients under high risk of renal damage require continuous monitoring and optimized therapy for better disease management.
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Objective To investigate the influence of obesity on renal lesion in IgA nephropathy (IgAN) patients by analyzing the association between obesity and absolute renal risk factors (ARR).Method Clinical-pathological data of IgAN patients diagnosed by renal biopsy in General Hospital of Ningxia Medical University were collected retrospectively.According to the body mass index (BMI),patients were divided into non-obese group (BMI ＜ 28,N-OB group) and obese group (BMI≥28,OB group).Their clinical characteristics,pathological index and ARR scores were compared.The relationship of BMI and ARR was analyzed by ordinal logistic regression models.Results (1) A total of 674 IgAN patients with mean age of 35.5+ 11.3 years were enrolled,including 94 in OB group and 580 in N-OB group respectively.Compared with those in the N-OB group,the proportion of male,age,mean arterial pressure,blood uric acid,blood triglyceride,diabetes mellitus and hypertension increased in OB group (all P ＜ 0.01).Patients in OB group had lower estimated glomerular filtration rate (eGFR) and higher ARR score than those in N-OB group (all P ＜ 0.05).(2) More severe thickening renal small artery wall and hyaline degeneration were observed in the OB group than in the N-OB group (all P ＜ 0.01).There was no statistical difference between the two groups in Lee classification,Oxford classification,mesangial cell proliferation,glomerular sclerosis,crescent formation,renal tubular atrophy,interstitial inflammatory cell in filtration and endothelial cell proliferation.(3) After adjusting for age,sex,blood uric acid,serum albumin,eGFR,low density lipoprotein,glomerular sclerosis,interstitial inflammatory cell infiltration,renal tubular atrophy and vascular wall thickening,BMI was still an independent risk factors for ARR in IgAN patients (OR=1.09,95％ CI 1.03-1.14).Conclusions BMI is an independent risk factors for ARR in IgAN patients.Early prevention and control of obesity and its associated risk factors may improve outcomes of IgAN patients.
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La infección urinaria es una de las patologías más frecuentes en pediatría. En algunos casos puede producir daño renal, llevando al paciente a hipertensión arterial e insuficiencia renal. En esta revisión se enfatiza el oportuno reconocimiento de los síntomas, la necesidad de diagnosticar la infección urinaria de acuerdo al resultado del examen de orina y cultivo, utilizando el apropiado método de recolección de orina. También se preconiza el correcto tratamiento de acuerdo a la localización de la infección. Finalmente comentamos acerca del tratamiento y profilaxis en los pacientes portadores de reflujo vésico ureteral.
Urinary tract infections (UTIs) are very common in children, and may lead to renal scarring, hypertension, and renal failure. In this review, we emphasize the prompt recognition of symptoms, the need to diagnose UTI according to bacterial colony count on urine culture from sample collected using proper methodology, and the available treatment options according to localization of site of infection in the urinary tract. New approaches on the use of antibiotic prophylaxis inpatients with vesicoureteral reflux are presented.