Validation of equations to estimate kidney function with and without adjustment by race/color in Brazilian adults (ELSA-Brazil) / Validação das equações para estimativa da função renal com e sem ajuste por raça/cor em adultos brasileiros (ELSA-Brasil)

ABSTRACT Objective: To evaluate accuracy and agreement between creatinine clearance (CrCl) measured in 12-h urine and glomerular filtration rate (GFR) calculated by the Modification of Diet in Renal Disease (MDRD-4) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulas, with and without adjustment for race/color. Methods: Baseline data from the Longitudinal Study of Adult Health (ELSA-Brazil) in adults (35-74 years of age) of both genders were used. Serum creatinine was measured in fasting blood and urinary creatinine was measured in an overnight 12-h urine collect. The agreement between CrCl and the calculated GFR was analyzed by the Bland-Altman method. One-way analysis of variance (ANOVA) with race/color factor was used to verify differences between means of CrCl and GFR with and without correction for race/color. Statistical significance was accepted for p<0.05. Results: From 15,105 participants in the ELSA-Brazil, 12,813 had a validated urine collect. The Bland-Altman diagrams showed that formulas and CrCl agree with each other with a better accuracy for GFR <90 mL/.min x 1.73m2. The adjustment by race/color increased data dispersion. In this range, one-way ANOVA of CrCl with race/color factor showed similarity between groups (p=0.27). Conclusion: MDRD-4 and CKD-EPI are useful formulas for screening cases of chronic kidney disease, and correction by race/color, only in blacks or in black and brown subjects, proved to be unnecessary and reduced the reliability of the equations.

RESUMO Objetivo: Avaliar a acurácia e a concordância entre o clearance de creatinina (ClCr) medido na urina de 12 h e a taxa de filtração glomerular (TFG) calculada pelas fórmulas Modification of Diet in Renal Disease (MDRD-4) e Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), com e sem ajuste por raça/cor. Métodos: Foram usados dados da linha de base do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil), em adultos (35-74 anos) de ambos os sexos. A creatinina sérica foi medida no sangue em jejum e a creatinina urinária foi medida na urina de 12 h coletada no período noturno. A concordância entre o ClCr e a TFG calculada pelas fórmulas foi analisada pelo método de Bland-Altman. Análise de variância (ANOVA) de uma via com fator raça/cor foi usada para comparar médias do ClCr e da TFG calculadas com e sem ajuste por raça/cor. A significância estatística foi aceita para p<0,05. Resultados: Dos 15.105 participantes do ELSA-Brasil, 12.813 tiveram a coleta urinária de 12 h validada. Os diagramas de Bland-Altman mostraram que as fórmulas e o ClCr concordam entre si e têm melhor acurácia para TFG <90 mL/min/1,73m2, e que o ajuste por raça/cor aumenta a dispersão dos dados. Nessa faixa, a ANOVA de uma via do ClCr com fator raça/cor mostrou semelhança entre grupos (p=0,27). Conclusão: MDRD-4 e CKD-EPI são fórmulas adequadas para rastreamento da doença renal crônica na população brasileira, sendo desnecessário o ajuste por raça/cor para o uso desses instrumentos, uma vez que a introdução do ajuste tanto em pretos quanto em pretos e pardos diminuiu a acurácia dos métodos.

Prevalence of latent tuberculosis and associated factors in patients with chronic kidney disease on hemodialysis / Prevalência de tuberculose latente e fatores associados em pacientes com doença renal crônica em hemodiálise / Prevalencia de tuberculosis latente y factores asociados en pacientes con enfermedad renal crónica en hemodiálisis

Objective: to identify the prevalence of latent tuberculosis in patients with chronic kidney disease on hemodialysis and associated factors. Method: a cross-sectional study conducted with 176 patients with chronic kidney disease on hemodialysis. The tuberculin test was performed with the standardized antigen, distributed by the Brazilian Ministry of Health, and the reading occurred after 72 to 96 hours of the application. An association test (Chi-square, Fisher's exact), prevalence ratio, and multivariate regression tests were performed. Results: the prevalence of latent tuberculosis diagnosed through Tuberculosis Skin Test was 8.5% (15/176). The "has/has had diabetes" (aOR: 0.117; 95%CI: 0.015-0.92) and "having regular garbage collection (aOR: 0.076; 95%CI: 0.008-0.702) factors were associated with a lower probability of having a Positive skin test. Conclusion: the low prevalence of latent tuberculosis identified and the factors associated with it reinforce the need for screening for latent tuberculosis infection for diabetics combined with an analysis of previous risk factors and comorbidities.

Objetivo: identificar a prevalência de tuberculose latente em pacientes com doença renal crônica em hemodiálise e fatores associados. Método: estudo transversal realizado com 176 pacientes com doença renal crônica em hemodiálise. O teste tuberculínico foi realizado com o antígeno padronizado, distribuído pelo Ministério da Saúde do Brasil, e a leitura ocorreu após 72 a 96 horas da aplicação. Foram realizados teste de associação (Qui-quadrado, exato de Fisher), razão de prevalência e regressão multivariada. Resultados: a prevalência de tuberculose latente (teste tuberculínico positivo) foi de 8,5% (15/176). Os fatores "tem/teve diabetes" (ORa:0,117; IC95% 0,015-0,92) e "ter coleta de lixo regular" (ORa:0,076; IC95% 0,008-0,702) foram associados a menores probabilidades de ter teste tuberculínico positivo. Conclusão: a baixa prevalência de tuberculose latente identificada e os fatores associados à mesma reforçam a necessidade de uma triagem da infecção latente por tuberculose para diabéticos combinada com a análise de fatores de risco e comorbidades prévias.

Objetivo: identificar la prevalencia de tuberculosis latente en pacientes con enfermedad renal crónica en hemodiálisis y factores asociados. Método: estudio transversal realizado con 176 pacientes con enfermedad renal crónica en hemodiálisis. La prueba cutánea de la tuberculina se realizó con el antígeno estandarizado, distribuido por el Ministerio de Salud de Brasil, y la lectura se realizó después de 72 a 96 horas de la aplicación. Se realizaron pruebas de asociación (Chi-cuadrado, exacta de Fisher), razón de prevalencia y regresión multivariante. Resultados: la prevalencia de tuberculosis latente (prueba de tuberculina positiva) fue de 8,5% (15/176). Los factores "tiene/ha tenido diabetes" (ORa: 0,117; IC del 95%: 0,015-0,92) y "tener recolección regular de residuos" (ORa: 0,076; IC del 95%: 0,008-0,702) se asociaron con menores probabilidades de tener una prueba de tuberculina positiva. Conclusión: la baja prevalencia de tuberculosis latente registrada y sus factores asociados refuerzan la necesidad del cribado de la infección tuberculosa latente en diabéticos combinado con el análisis de factores de riesgo y comorbilidades previas.

A comparação do desempenho ocupacional entre as modalidades de tratamento dialítico / Comparison of occupational performance between dialytic treatment modalities

Resumo Introdução A Doença Renal Crônica é uma patologia progressiva e irreversível, podendo afetar as habilidades de desempenho nas atividades ocupacionais. Objetivo Neste estudo, comparou-se o desempenho ocupacional de pacientes que realizam hemodiálise e diálise peritoneal de um Serviço de Terapia Renal Substitutiva. Método A pesquisa foi do tipo observacional, transversal, descritiva e analítica, tendo uma amostra média de (n=53), sendo 13 em diálise peritoneal e 40 em hemodiálise. Foram coletados os dados dos pacientes em diálise peritoneal, a partir da aplicação de um questionário sociodemográfico e econômico, e do protocolo Medida Canadense de Desempenho Ocupacional. Os dados do perfil sociodemográfico e do desempenho ocupacional de pacientes em hemodiálise foram coletados para fins de comparação com aqueles em diálise peritoneal. Os dados foram analisados com testes estatísticos, sendo considerado p-valor<0,05. Resultados A maioria dos pacientes foi do sexo masculino, viúvo/divorciado e com renda de até um salário. Com a Medida Canadense de Desempenho Ocupacional foi possível comparar os desempenhos ocupacionais dos pacientes em diálise peritoneal e hemodiálise, nos quais os indivíduos que realizam diálise peritoneal possuem melhor desempenho ocupacional que aqueles em hemodiálise. O teste de correlação de Spearman mostrou que existe forte correlação positiva (rs=0,9861) e altamente significante (p<0,0001*) entre a satisfação e o desempenho dos pacientes em diálise peritoneal. Conclusão Sendo assim, o estudo demonstra que há relação entre o desempenho ocupacional e a modalidade de tratamento dialítico.

Abstract Introduction Chronic Kidney Disease is a progressive and irreversible pathology, which can affect performance skills in occupational activities. Objective In this study, the occupational performance of patients undergoing hemodialysis and peritoneal dialysis at a Renal Replacement Therapy Service was compared. Method The research was observational, cross-sectional, descriptive, and analytical, with a sample of (n = 53) 13 in peritoneal dialysis and 40 in hemodialysis. Data on patients on peritoneal dialysis were collected, using a sociodemographic questionnaire and the Canadian Occupational Performance Measurement protocol. Only data on the occupational performance of patients on hemodialysis were collected for comparison purposes with those on peritoneal dialysis. The data were analyzed with statistical tests, with a p-value <0.05 being considered. Most patients are male, widowed/divorced, and with an income of up to one salary. Results With the Canadian Occupational Performance Measure, it was possible to associate the occupational performance of patients on peritoneal dialysis and hemodialysis, in which individuals who perform peritoneal dialysis have better occupational performance than those on hemodialysis. Spearman's correlation test showed that there is a strong positive (rs = 0.9861) and highly significant (p <0.0001 *) correlation between satisfaction and performance of patients on peritoneal dialysis. Conclusion Thus, the study demonstrates that there is a relationship between occupational performance and the type of dialysis treatment.

Salud renal para todos en todos lados - de la prevención a la detección y acceso equitativo a la atención / Kidney health for everyone everywhere - from prevention to detection and equitable access to care

La enfermedad renal crónica (ERC) será la 5.ta causa más común de años de vida perdidos para 2040. Su comienzo y progresión son, con frecuencia, prevenibles.La campaña del Día Mundial del Riñón 2020 resalta la importancia de las intervenciones preventivas. La prevención primaria debe focalizarse en modificar los riesgos y reducir la exposición a factores ambientales y nefrotoxinas. El control de la tensión arterial y de la glucemia deberían ser una de las principales intervenciones en personas con enfermedad renal pre-existente. El manejo de las comorbilidades (uremia, enfermedad cardiovascular) es altamente recomendado para evitar o postergar el uso de diálisis o trasplante renal. Con frecuencia faltan políticas específicas dirigidas a la educación, la pesquisa, el manejo y el tratamiento de la ERC.Es urgente aumentar la concientización sobre la importancia de medidas preventivas en la población, los profesionales y los responsables de políticas de salud a nivel mundial

Chronic kidney disease (CKD) is rapidly becoming the 5th most common cause of years of life lost globally by 2040. Crucially, the onset and progression of CKD is often preventable. The World Kidney Day 2020 campaign highlights the importance of preventive interventions on CKD. Primary prevention should focus on risks modification as well as reduced exposure to environmental risk factors and nephrotoxins. Blood pressure optimization and glycemic control should be one of the main interventions in persons with pre-existing kidney disease. Management of co-morbidities such as uremia and cardiovascular disease is highly recommended to avoid or delay dialysis or kidney transplantation. Globally, specific policies directed toward education and awareness about CKD screening, management and treatment are often lacking. Hence, there is an urgent need to increase the awareness of the importance of preventive measures throughout populations, professionals and policy makers around the world.

Peripheral neuropathy in Chronic Kidney Diseases: prevalence and its correlates

Background: Peripheral polyneuropathy is most common Chronic Kidney Diseases (CKD) related complication with prevalence of more than 60%. The prevalence of peripheral neuropathy is directly proportional to duration and severity of CKD. Objective of the study was to study and assess the prevalence of peripheral neuritis and its correlates in patients with chronic kidney diseases.Methods: The present study was a cross sectional; descriptive study was conducted in October 2016 to October 2018. Data analysed by using SPSS 23.0 version.Results: Out of 90 subjects, majority were from 45-54 years age group (26). 70% were male and 30% were females. Out of 60 pre-HD patients, 33(55%) showed peripheral neuropathy. Out of 30 HD patients, 24(80%) showed peripheral neuropathy. Maximum percentage of PN seen in 45-54 age group (76.92%) amongst the 60 males 39 (65%) and amongst 30 females 18(60%) showed peripheral neuropathy. Maximum percentage of PN seen in >5 years age group (79.31%). Pure axonal sensory motor neuropathy (28.88%) was most common pattern.Conclusions: Peripheral neuropathy is very common in CKD, more common in dialysis patients as compared to predialysis patients.

Observations on the effect of thunder-fire moxibustion with meridian point on deficiency of kidney and spleen, and blood stasis in chronic kidney diseases stage three / 中国实用护理杂志

Objective@#To observe clinical effect of thunder-fire moxibustion with meridian point, including lumbar spinal cordacupoints of bladder meridian and abdominal acupoints of Ren channel, which treating on deficiency of kidney and spleen and blood stasis in chronic kidney diseases (CKD) stage 3.@*Methods@#Totally 60 patients were randomly divided into treatment and control group. 30 patients in control were treated with blood pressure and lipid adjustment, Chinese medicine and nutritional therapy. 30 patients in treatment group were treated with thunder-fire moxibustion with meridian point based on control. A moxibustion-treated course has 2 weeks, patients were treated every other day. Observe blood urea nitrogen (Bun) , creatinine (Scr) , glomerular filtration rate (eGFR) , Chinese medicine syndrome and quantitative score, as well as clinical efficacy.@*Results@#After 4 weeks of intervention, the TCM syndrome score [8 (4,10)] in the treatment group was significantly lower than that in the control group [12 (10,14)], with a statistically significant difference (Z=-3.706, P = 0.000); in the quantitative score of symptom classification, the patients in the treatment group were significantly lower than those in the control group [2 (0,2)], chills [2 (2,2)], fatigue [2 (2,4)], the difference was statistically significant (Z=-2.625, -3.593, -4.609, P < 0.01). The frequency of nocturia in the treatment group was significantly higher than that in the control group (Z=-1.989, P < 0.05), while that in the treatment group was not significantly better than that in the control group (P > 0.05). In terms of clinical efficacy, the total effective rate of the treatment group was 93.3% (28/30), which was better than73.3% (22/30) of the control group (χ2= 38.19, P = 0.000).@*Conclusion@#Thunder-fire moxibustion with meridian point improve deficiency of kidney and spleen and blood stasis of patients in CKD stage3, such as weak waist, cold chills, poor appetite, weakness and nocturia, as well as ameliorate renal function.

Relationship of Forced Vital Capacity with Chronic Kidney Disease among Middle-Aged and Elder Korean Men

BACKGROUND: It is unclear whether impaired pulmonary function serves as a risk factor for decreased renal function. This study investigated the association between the forced vital capacity (FVC) and chronic kidney disease (CKD) in middle-aged and elderly men.METHODS: We investigated the association between FVC and CKD in 412 Korean men aged ≥50 years, without diabetes, who have not received treatment for chronic lung disease. CKD was defined based on evidence of renal tissue damage or reduced renal function indicated by estimated glomerular filtration rate < 60 mL/min/1.73 m² or proteinuria level ≥1+. We assessed the association between FVC and CKD using multivariate logistic regression analysis after adjusting for confounders.RESULTS: The overall prevalence of CKD was 29.2% in the study population. Multivariate logistic regression analysis showed that the odds ratio with a 95% confidence interval for CKD was 0.96 (0.92–0.99) with a 1% increment in FVC after adjusting for age, body mass index, smoking status, alcohol intake, regular exercise, systolic and diastolic blood pressures, fasting plasma glucose, triglyceride, and high-density lipoprotein-cholesterol levels, as well as antihypertensive and antidyslipidemic medications.CONCLUSION: We observed that FVC was independently and inversely associated with CKD. This finding suggests that careful monitoring of renal function is necessary to evaluate possible kidney dysfunction in patients with decreased FVC.

Renal involvement in paroxysmal nocturnal haemoglobinuria: a brief review of the literature

SUMMARY INTRODUCTION: Paroxysmal Nocturnal Haemoglobinuria (PNH) is an acquired genetic disorder characterized by complement-mediated haemolysis, thrombosis and variable cytopenias. Renal involvement may occur and causes significant morbidity to these patients. OBJECTIVE: To review the literature about pathophysiology and provide recommendations on diagnosis and management of renal involvement in PNH. METHODS: Online research in the Medline database with compilation of the most relevant 26 studies found. RESULTS: PNH may present with acute kidney injury caused by massive haemolysis, which is usually very severe. In the chronic setting, PNH may develop insidious decline in renal function caused by tubular deposits of hemosiderin, renal micro-infarcts and interstitial fibrosis. Although hematopoietic stem cell transplantation remains the only curative treatment for PNH, the drug Eculizumab, a humanized anti-C5 monoclonal antibody is capable of improving renal function, among other outcomes, by inhibiting C5 cleavage with the subsequent inhibition of the terminal complement pathway which would ultimately give rise to the assembly of the membrane attack complex. CONCLUSION: There is a lack of information in literature regarding renal involvement in PNH, albeit it is possible to state that the pathophysiological mechanisms of acute and chronic impairment differ. Despite not being a curative therapy, Eculizumab is able to ease kidney lesions in these patients.

RESUMO INTRODUÇÃO: A hemoglobinúria paroxística noturna (HPN) é uma doença genética adquirida, caracterizada por hemólise mediada pelo sistema complemento, eventos trombóticos e citopenias variáveis. Envolvimento renal pode ocorrer, contribuindo com morbidade significativa nesses pacientes. OBJETIVO: Realização de revisão de literatura sobre o envolvimento renal na HPN. MÉTODOS: Pesquisa on-line na base de dados Medline, com compilação e análise dos 26 estudos encontrados de maior relevância. RESULTADOS: A HPN pode se apresentar com insuficiência renal aguda induzida por hemólise maciça, que geralmente tem apresentação grave. Em quadros crônicos, declínio insidioso da função renal pode ocorrer por depósitos tubulares de hemossiderina, microinfartos renais e fibrose intersticial. Apesar de o transplante de células-tronco hematopoiéticas permanecer como a única terapia curativa para a HPN, a droga Eculizumab é capaz de melhorar a função renal, entre outros desfechos, por meio da inibição de C5 e a subsequente ativação da cascata do complemento, que culminaria com a formação do complexo de ataque à membrana. CONCLUSÃO: Há poucas informações na literatura no que concerne ao envolvimento renal na HPN, apesar de ser possível estabelecer que os mecanismos fisiopatológicos das lesões agudas e crônicas são distintos. Apesar de não ser uma terapia curativa, Eculizumab é capaz de amenizar o comprometimento renal nesses pacientes.

Preferences of ICT among Patients with Chronic Kidney Disease Undergoing Hemodialysis: An Ecuadorian Cross-Sectional Study / 대한의료정보학회지

OBJECTIVES: The aim of the present study was to assess the frequency of use, and preferences regarding information and communication technologies (ICTs) among Ecuadorian patients with chronic kidney disease (CKD) undergoing hemodialysis. METHODS: We conducted an anonymous cross-sectional survey-based study from January 2016 to April 2017, involving 393 patients with end-stage renal disease from 9 hemodialysis centers, in which they rated their use and preferences of various ICTs through a modified version of the Michigan Questionnaire. The questionnaire collected information regarding demographics, patients' interest in obtaining health-related information through ICTs, and interest in using ICTs as a potential way to communicate with their healthcare providers. A chi-square test for association and adjusted regression analyses were performed. RESULTS: Among all patients who participated, 64.3% reported owning a cellphone, with less than a third reporting active Internet connection. The most used ICT for obtaining information about CKD and/or hemodialysis was web-based Internet, followed by YouTube. SMS was rated the highest to receive and seek health-related information, followed by Facebook. Younger age and higher levels of education were associated with a higher overall usage of ICTs. Finally, more than half of the patients reported interest in using WhatsApp for communicating with their healthcare providers. CONCLUSIONS: Understanding the preferences of ICTs among patients with CKD undergoing hemodialysis could help to improve their outcomes through the potential uses and benefits of ICTs. Further research is needed to assess their role in improving the care of patients with chronic diseases.

Contrast-free (Zero-contrast) TAVR for Severe Aortic Stenosis in Patient with Chronic Kidney Disease

Transcatheter aortic valve replacement (TAVR) or transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) is a minimally invasive interventional procedure that repairs a valve without removing the old, damaged valve. Instead, a replacement valve is wedged into the location of the native aortic valve. During TAVR, contrast is used for conventional aortic root angiography, positioning of the TAVR valve device, and assessing the peripheral vasculature. Therefore, contrast-induced acute kidney injury (AKI) is a major concern when performing TAVR and is associated with increased mortality in patients with impaired renal function. Although the exact mechanism of post-TAVR AKI is unknown and appears multifactorial, contrast medium has been reported as a major contributing factor. We report a case of zero-contrast TAVR for severe AS in a patient with chronic kidney disease (CKD). The procedure was successfully performed with only fluoroscopic and transesophageal echocardiography (TEE) guidance.

Assessment of Haematological Markers in Relation with Blood Urea Nitrogen and Serum Creatinine in Pre-dialysis Patients with Chronic Kidney Disease

Background: To investigate the hematological and biochemical parameters in pre – dialysis chronic kidney disease (CKD) patients and compared with the normal individuals.  Methods: The samples of CKD patients (n= 30) belong to both genders were collected from different tertiary care hospitals of Karachi, Pakistan and compared with normal individuals (n = 30) not suffering from any disease used as control. Results: 18 of CKD patients and 19 from normal groups were male and 12 from CKD and 11 from normal group were female. The average age (yr) was 38 ± 12.06 for normal group and 44 ± 09.10 for CKD. The mean height (cm) of normal subjects was 163 ± 6.87 and body weights (kg) were 71.04 ± 10.12. Mean height of CKD group was 165.3 ± 7.79 and weights were 64.35 ± 12.23. Higher magnitudes of blood urea nitrogen (BUN) and serum creatinine were found as 85.63 ± 56.11 and 6.86 ± 3.42 mg/dL respectively in CKD group. Hemoglobin, red blood cells (RBCs), pack cell volume, lymphocytes and eosinophils were found significantly (p<0.01) very low while white blood cells, monocytes and neutrophils were found high (p<0.01) in CKD patients. Conclusions: Findings concluded that hematological parameters were severely affected in CKD patients as compared to normal controls. Kidney dysfunction in turn not only affects the erythropoietin synthesis that normally stimulates the bone marrow to produce RBC’s but also the synthesis of rennin and Vitamin D that normally regulates blood volume and blood pressures and involves in making bones respectively.

Food intake and Physical activity of Hemodialysis Patient Undergoing Treatment at National Kidney Center, Kathmandu, Nepal

Background and Objectives: Nutrition has been an integral part of medical management in CKD patient in which total food and protein intake plays vital role in survival rate of patient. This study was done to investigate the nutritional status, food intake and physical activity level of hemodialysis patient for the period of three month in National Kidney center in Kathmandu. Materials and Methods: Quantitative descriptive method was applied for the collection of data from 80 patients undergoing hemodialysis in National kidney center, Kathmandu. The data so obtained was further analyzed by using SPSS 16 version software and Microsoft excel sheet.Discussion: The BMI result of sample population underdoing hemodialysis showed that 12% of them were underweight, 9% were overweight, 57% were in normal range and 1% were obese. Similarly 42.5% of sample population were involved in some kind of physical activity where as 57.5% of the patient were not involved in any sort of physical activity. On the other hand, 52.5% of MHD patient did not follow the instruction provided in food chart and only 47.5% patient consume food according to diet chart. Conclusion: The patient should be provided nutritional counseling before starting dialysis so that nutritional challenges could be reduced. As poor nutritional intake, Socio economic barrier, low physical activity level etc. are major problem of dialysis patient.

Research Progress in Blood Stasis Syndrome of Chronic Kidney Diseases / 中国中医药信息杂志

Blood stasis, as an important mechanism in chronic kidney diseases, its occurrence and development are throughout the development of the diseases. This article reviewed modern research progress from the form the blood stasis syndrome of chronic kidney disease (biochemical basis, pathology basis), correlation between infection and immune inflammation, and TCM therapy, and pointed out the significance of diagnosis and treatment from blood stasis for protecting kidney functions and postponing disease development.

Research Progress in Blood Stasis Syndrome of Chronic Kidney Diseases / 中国中医药信息杂志

Blood stasis, as an important mechanism in chronic kidney diseases, its occurrence and development are throughout the development of the diseases. This article reviewed modern research progress from the form the blood stasis syndrome of chronic kidney disease (biochemical basis, pathology basis), correlation between infection and immune inflammation, and TCM therapy, and pointed out the significance of diagnosis and treatment from blood stasis for protecting kidney functions and postponing disease development.

"The ""3B"" in the clinical management of non-neurogenic male lower urinary tract symptoms" / 中华泌尿外科杂志

Lower urinary tract symptoms (LUTS),consisting storage,voiding and postmicturition symptoms,is a comprehensive definition involving multiple organs.There has been an increasing emphasis on the integrated management of non-neurogenic male lower urinary tract symptoms.Instead of focusing on the enlarged prostate,the current treatment has paid more attention on the entire urinary tract as well as multiple organ factors.Therefore,we provided a literature review and summarized the key points during the management of male LUTS as 3B,namely beyond prostate,beyond surgery and beyond urology.

Disturbances of circadian rhythm of blood pressure and local cardiac clock genes in nephrotic rats / 中华肾脏病杂志

Objective To observe the circadian blood pressure (BP) rhythms and the phase of heart circadian gene expression in adriamycin (ADR)-induced nephropathy rats,thus exploring the effect of circadian systems on circadian BP variation in nephrotic rats.Methods Sprague-Dawley (SD) male rats (8 weeks) were housed in a 12∶12 hour light/dark cycle in two weeks,and randomly divided into ADR group and control group.ADR rats were injected 6.5 mg/kg adriamycin via vein to establish nephrotic rats model two weeks later,while control rats were injected the equal volume of saline.Five rats in each group were implanted with the radio-telemetry into abdominal aortic.After seven days,systolic blood pressure (SBP),diastolic blood pressure (DBP),mean arterial pressure (MAP) and heart rate (HR) were recorded every one minute during 72 hours via radio-telemetry.Three rats in each group were sacrificed in six time points (zeitgeber time=02:00,06:00,10:00,14:00,18:00,22:00) to get the blood sample and heart tissue,respectively.The mRNA expressions of core clock gene CLOCK,BMAL1,Per1,Per2,Cry1 and Cry2 in heart issue were evaluated by the real-time quantitative PCR.The plasma levels of renin activity angiotensin Ⅱ and aldosterone were measured by radioimmunoassay.All the data were analyzed by a partial Fourier analysis and stepwise regression.Results (1) There was no significant difference in 24 h average of SBP,DBP and MAP between two groups.In control group,there was higher SBP (3.22 mmHg),DBP (1.16 mmHg) and MAP (3.19 mmHg) in dark period than those in light period,only SBP and MAP showing statistical difference (all P ＜ 0.05).However,SBP,DBP and MAP had no significant difference between dark and light in ADR group (all P ＞ 0.05).(2) Control rats had (8.0+24.0) h rhythm of SBP,and their DBP,MAP and HR appeared 24.0-hour normal circadian pattern (all P ＜ 0.05).In ADR group,the rhythm of SBP completely disappeared.And their DBP and MAP remained 24.0 h circadian rhythm,but the peak time advanced 1.5 h to 3.0 h compared with SD rats.(3) In SD controls,daily rhythms period of the core clock genes (CLOCK,BMAL1,Cry1,Cry2,Per1 and Per2) mRNA expression in the heart were (4.8+ 12.0) h,24.0 h,12.0 h,(12.0+24.0) h,(4.8+12.0) h and 12.0 h (all P ＜ 0.05),respectively.In ADR rats,the rhythm of CLOCK,BMAL1,Cry2,Per1 and Per2 mRNA completely disappeared (all P ＞ 0.05).The circadian rhythm of Cry1 mRNA remained,but the period was changed from 12.0 h to (4.8+6.0) h.(4) The plasma renin and aldosterone concentration presented 12.0 h and 24.0 h daily rhythms in SD rats (all P ＜ 0.05).These diurnal changes however completely disappeared in ADR rats (all P ＞ 0.05).Conclusions ADR nephrotic rats lose the circadian rhythm of BP with the disturbances of cardiac circadian clock system.The disrupted diurnal rhythm of the core clock genes (CLOCK,BMAL1,Cry2,Per1 and Per2) mRNA expression in the heart may regulate the pathological circadian rhythms of heart tissue,which is involved with disturbances of circadian rhythm of BP.

Relationship between Chronic Kidney Disease and Depression in Elderly Koreans Using the 2013 Korea National Health and Nutrition Examination Survey Data / 가정의학회지

BACKGROUND: Depression is prevalent in patients with chronic kidney disease (CKD) and continues to increase in elderly adults. Therefore, the aim of our study was to examine the relationship between CKD and depression in older patients. METHODS: We conducted a cross-sectional study based on 2013 Korea National Health and Nutrition Examination Survey data. In total, data of 973 subjects aged ≥65 years were analyzed, and the estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. RESULTS: The prevalence of depression in older adults was 4.1% in men and 8.8% in women (P=0.004). The prevalence of depression did not differ according to CKD stage in women (normal eGFR and CKD stages 1 and 2 women, 41/474 [8.6%]) vs. CKD stages 3–5 women, 6/63 [9.5%]); however, the prevalence of depression in men with CKD stages 3–5 (8/83 [9.6%]) was significantly higher than in men with normal eGFR and CKD stage 1 and 2 (10/353 [2.8%], P=0.010). Multivariate logistic regression analysis showed that the odds ratio for depression in men with CKD stages 3–5 was 3.822 (95% confidence interval, 1.229 to 11.879) after adjusting for social status and chronic diseases (P=0.021). CONCLUSION: The prevalence of depression was higher in elderly women than in men, while the prevalence of depression increased in elderly men with CKD stages 3–5 and was almost equal to that of women. Therefore, elderly men with progressive renal function impairment should be counseled and monitored for psychological problems.

Efficacy and safety of sofosbuvir-based regimens for treatment in chronic hepatitis C genotype 1 patients with moderately impaired renal function

BACKGROUND/AIMS: Treatment of chronic hepatitis C virus (HCV) infection in patients with chronic kidney disease (CKD) is essential. The availability of sofosbuvir (SOF) has dramatically improved overall HCV cure rates, however there is insufficient data regarding its use in patients with CKD. We evaluated SOF in patients with hepatitis C genotype 1 (G1) and moderately impaired renal function. METHODS: We retrospectively reviewed all patients treated with a SOF-based regimen from December 2013 through September 2015 at Virginia Mason Medical Center. Data was then collected for HCV G1 patients with stage 3 CKD. RESULTS: A total of 28 patients with HCV G1 and stage 3 CKD were treated with a SOF-based regimen. Twenty-one patients had stage 3A CKD (estimated glomerular filtration rate [eGFR] 45–60 mL/min/1.73m2) and 7 patients had stage 3B CKD (eGFR 30–45 mL/min/1.73m2). The overall rate of sustained virologic response (SVR) 12 weeks after completion of therapy (SVR12) was 85.7% (24/28). SVR12 in stage 3A CKD patients was 81.0% (17/21) and in stage 3B CKD patients, SVR12 was 100% (7/7). Based on the treatment regimen used, the SVR12 was 81.8% (9/11), 92.3% (12/13), and 75.0% (3/4) for SOF/ledipasvir (LDV), SOF/simeprevir (SIM), and SOF/pegylated interferon (PEG)/ribavirin (RBV), respectively. Greater than 30% reduction eGFR was observed in 4 out of 28 patients. CONCLUSIONS: SOF-based regimens resulted in high SVR12 rates in patients with moderately impaired renal function. During therapy, HCV patients with CKD should be carefully monitored for worsening renal function.

Relationship between Periodontal Disease and Chronic Kidney Disease: A Systematic Review of Cohort Studies / 치위생과학회지

The purpose of this systematic review was to investigate the association between periodontal disease and chronic kidney disease. A search of Embase, PubMed and The Cochrane Library databases was performed up to April 17, 2016. Article selection was based on cohort study design and the study subjects were patients with periodontal disease or severe periodontal disease. The final result was development of chronic kidney disease and kidney function decrease based on the estimated glomerular filtration rate values. The quantitative synthesis of the final selected articles was assessed using Review Manager statistical analysis software. A fixed-effects model meta-analysis was performed to estimate the degree of association between periodontal disease and chronic kidney disease. The search strategy identified 3,018 potentially eligible articles, of these, four studies were finally selected for meta-analysis, revealing that periodontal disease was significantly associated with the risk of developing chronic kidney disease (odds ratio, 1.65; 95% confidence interval, 1.44~1.90; p<0.001). In order to prevent the development of chronic kidney disease and kidney function decrease it is important to prevent periodontal disease, as well as minimizing the traditional risk factors known to reduce the quality of life of patients and increase disease burden.

A Sporadic Case of Epstein Syndrome: A Rare Cause of Refractory Thrombocytopenia / 대한내과학회지

A 37-year-old female presented to our hospital with a history of bleeding episodes (excessive bleeding after tooth extraction, gum bleeding, easy bruising, and excessive menstruation) and severe thrombocytopenia (2,000/µL). She had no family history of bleeding tendency or thrombocytopenia. No peripheral lymphadenopathy or splenomegaly was noted. The patient's white blood cell count was normal; hemoglobin was 9.7 g/dL. A peripheral blood smear showed markedly decreased platelets, with occasional giant or large platelets. Bone marrow examination found increased megakaryocytes. The patient also complained of hearing difficulty; a hearing test indicated sensory-neural hearing impairment. Her thrombocytopenia was refractory to treatment with glucocorticosteroids, intravenous gamma-globulin, and danazol. In the 13 years following her initial presentation, the patient required anti-hypertensive treatment, a hearing-aid for progressive hearing loss, and started maintenance kidney dialysis. Her clinical history of refractory thrombocytopenia, progressive hearing impairment, and renal failure suggested myosin heavy chain 9 gene-related congenital syndrome (Epstein syndrome), which was confirmed by the presence of a heterozygous deletion mutation, c.221_223del, (p.Lys74del) in peripheral leukocyte deoxyribonucleic acid.