Factores de progresión de la enfermedad renal crónica en pacientes atendidos en una consulta de Nefrología comunitaria

Introducción: la enfermedad renal crónica representa un significativo problema de salud en el siglo XXI. Se han identificado diversos factores asociados a un incremento del daño renal y a la consecuente progresión de la enfermedad. Objetivo: analizar el comportamiento de los factores de progresión de la enfermedad renal crónica en pacientes atendidos en una consulta de Nefrología comunitaria. Materiales y métodos: estudio observacional, descriptivo y prospectivo. Se incluyeron 65 pacientes con enfermedad renal crónica, que tuvieron seguimiento estable durante un período de 12 meses en la consulta de Nefrología comunitaria, del municipio Pedro Betancourt, de la provincia Matanzas. Fueron analizadas variables sociodemográficas y las relacionadas con la enfermedad renal crónica (etiología, estadio, factores de progresión y marcadores de daño renal). Resultados: se constató una edad promedio de 68,79 años; el 64,6 % de los enfermos eran blancos; diabéticos el 46,15 %; se expusieron a nefrotóxicos el 93,8 %; el 56,9 % presentó proteinuria; el 66,1 % mostró estabilidad en la función renal, y seis factores de progresión concurrieron en pacientes con estadio 3b. Conclusiones: predominaron los pacientes blancos, longevos y con diabetes como enfermedad de base. Hubo una distribución equitativa en cuanto a sexo. El empleo de fármacos nefrotóxicos, y la proteinuria, hiperuricemia e hiperlipidemia, se destacaron como los principales factores de progresión; no obstante, sola la proteinuria, la anemia y la acidosis estuvieron asociadas estadísticamente con la posible progresión de la enfermedad, que no fue constatada en ningún paciente.

Introduction: chronic kidney disease represents a significant health problem in the 21st century. Various factors associated to kidney damage increase and to the consequent progression of the disease have been identified. Objective: to analyze the behavior of chronic kidney disease progression factors in patients treated in a community nephrology consultation. Materials and methods: observational, descriptive and prospective study. Sixty-five patients with chronic kidney disease that were stably followed up during a twelve-month period in the community nephrology consultation of the Pedro Betancourt municipality, province of Matanzas, were included. Socio-demographic variables and those related to chronic kidney disease (etiology, stage, progression factors, and kidney damage markers) were analyzed. Results: an average age of 68.79 years was found; 64.6% of the patients were white; 46.15% were diabetics; 93.8% were exposed to nephrotoxics; 56.9% presented proteinuria; 66.1% showed renal function stability, and six progression factors concurred in 3b stage patients. Conclusions: white, aged patients predominated, with diabetes as underlying disease. There was an equitable distribution in terms of gender. The use of nephrotoxic drugs, and proteinuria, hyperuricemia, and hyperlipidemia stood out as the main progression factors. However, only proteinuria, anemia and acidosis were statistically associated to the possible disease progression, which was not found in any patient.

Correlation between urine vitamin D -binding protein and early -stage renal damage in Type 2 diabetes / 中南大学学报(医学版)

OBJECTIVES@#The excretion of urinary vitamin D-binding protein (uVDBP) is related to the occurrence and development of early-stage renal damage in patients with Type 2 diabetes (T2DM). This study aims to explore the significance of detecting uVDBP in T2DM patients and its relationship with renal tubules, and to provide a new direction for the early diagnosis of T2DM renal damage.@*METHODS@#A total of 105 patients with T2DM, who met the inclusion criteria, were included as a patient group, and recruited 30 individuals as a normal control group. The general information and blood and urine biochemical indicators of all subjects were collected; the levels of uVDBP, and a marker of tubular injury [urine kidney injury molecule 1 (uKIM-1), urine neutrophil gelatinase-associated lipocalin (uNGAL) and urine retinol-binding protein (uRBP)] were detected by enzyme-linked immunosorbent assay. The results were corrected by urinary creatinine (Cr) to uVDBP/Cr, uKIM-1/Cr, uNGAL/Cr and uRBP/Cr. The Pearson's and Spearman's correlation tests were used to analyze the correlation between uVDBP/Cr and urine albumin-to-creatinine ratio (UACR), estimated glomerular filtration rate (eGFR) and markers of tubular injury, and multivariate linear regression and receiver operating characteristic curve were used to analyze the correlation between uVDBP/Cr and UACR or eGFR.@*RESULTS@#Compared with the normal control group, the uVDBP/Cr level in the patient group was increased (P<0.05), and which was positively correlated with UACR (r=0.774, P<0.01), and negatively correlated with eGFR (r=-0.397, P<0.01). There were differences in the levels of uKIM-1/Cr, uNGAL/Cr, and uRBP/Cr between the 2 groups (all P<0.01). The uVDBP/Cr was positively correlated with uKIM-1/Cr (r=0.752, P<0.01), uNGAL/Cr (r=0.644, P<0.01) and uRBP/Cr (r=0.812, P<0.01). The sensitivity was 90.0% and the specificity was 82.9% (UACR>30 mg/g) for evaluation of uVDBP/Cr on T2DM patients with early-stage renal damage, while the sensitivity was 75.0% and the specificity was 72.6% for evaluation of eGFR on T2DM patients with early-stage renal damage.@*CONCLUSIONS@#The uVDBP/Cr can be used as a biomarker in early-stage renal damage in T2DM patients.

Expression of LRG-1 in mice with hypertensive renal damage and its significance / 中南大学学报(医学版)

OBJECTIVES@#Long-term elevated blood pressure may lead to kidney damage, yet the pathogenesis of hypertensive kidney damage is still unclear. This study aims to explore the role and significance of leucine-rich alpha-2-glycoprotein-1 (LRG-1) in hypertensive renal damage through detecting the levels of LRG-1 in the serum and kidney of mice with hypertensive renal damage and its relationship with related indexes.@*METHODS@#C57BL/6 mice were used in this study and randomly divided into a control group, an angiotensin II (Ang II) group, and an Ang II+irbesartan group. The control group was gavaged with physiological saline. The Ang II group was pumped subcutaneously at a rate of 1.5 mg/(kg·d) for 28 days to establish the hypertensive renal damage model in mice, and then gavaged with equivalent physiological saline. The Ang II+irbesartan group used the same method to establish the hypertensive renal damage model, and then was gavaged with irbesartan. Immunohistochemistry and Western blotting were used to detect the expression of LRG-1 and fibrosis-related indicators (collagen I and fibronectin) in renal tissues. ELISA was used to evaluate the level of serum LRG-1 and inflammatory cytokines in mice. The urinary protein-creatinine ratio and renal function were determined, and correlation analysis was conducted.@*RESULTS@#Compared with the control group, the levels of serum LRG-1, the expression of LRG-1 protein, collagen I, and fibronectin in kidney in the Ang II group were increased (all P<0.01). After treating with irbesartan, renal damage of hypertensive mice was alleviated, while the levels of LRG-1 in serum and kidney were decreased, and the expression of collagen I and fibronectin was down-regulated (all P<0.01). Correlation analysis showed that the level of serum LRG-1 was positively correlated with urinary protein-creatinine ratio, blood urea nitrogen, and blood creatinine level in hypertensive kidney damage mice. Serum level of LRG-1 was also positively correlated with serum inflammatory factors including TNF-α, IL-1β, and IL-6.@*CONCLUSIONS@#Hypertensive renal damage mice display elevated expression of LRG-1 in serum and kidney, and irbesartan can reduce the expression of LRG-1 while alleviating renal damage. The level of serum LRG-1 is positively correlated with the degree of hypertensive renal damage, suggesting that it may participate in the occurrence and development of hypertensive renal damage.

Mitigation of cisplatin induced nephrotoxicity by casticin in male albino rats / Mitigação da nefrotoxicidade induzida pela cisplatina pela casticina em ratos albinos machos

Cisplatin (CP) is a commonly used, powerful antineoplastic drug, having numerous side effects. Casticin (CAS) is considered as a free radical scavenger and a potent antioxidant. The present research was planned to assess the curative potential of CAS on CP persuaded renal injury in male albino rats. Twenty four male albino rats were distributed into four equal groups. Group-1 was considered as a control group. Animals of Group-2 were injected with 5mg/kg of CP intraperitoneally. Group-3 was co-treated with CAS (50mg/kg) orally and injection of CP (5mg/kg). Group-4 was treated with CAS (50mg/kg) orally throughout the experiment. CP administration substantially reduced the activities of catalase (CAT), superoxide dismutase (SOD), peroxidase (POD), glutathione S-transferase (GST), glutathione reductase (GSR), glutathione (GSH) content while increased thiobarbituric acid reactive substances (TBARS), and hydrogen peroxide (H2O2) levels. Urea, urinary creatinine, urobilinogen, urinary proteins, kidney injury molecule-1 (KIM-1), and neutrophil gelatinase-associated lipocalin (NGAL) levels were substantially increased. In contrast, albumin and creatinine clearance was significantly reduced in CP treated group. The results demonstrated that CP significantly increased the inflammation indicators including nuclear factor kappa-B (NF-κB), tumor necrosis factor-α (TNF-α), Interleukin-1β (IL-1β), Interleukin-6 (IL-6) levels and cyclooxygenase-2 (COX-2) activity and histopathological damages. However, the administration of CAS displayed a palliative effect against CP-generated renal toxicity and recovered all parameters by bringing them to a normal level. These results revealed that the CAS is an effective compound having the curative potential to counter the CP-induced renal damage.

A cisplatina (CP) é uma droga antineoplásica poderosa, comumente usada, com vários efeitos colaterais. Casticin (CAS) é considerado um eliminador de radicais livres e um potente antioxidante. A presente pesquisa foi planejada para avaliar o potencial curativo da CAS em lesão renal induzida por PC em ratos albinos machos. Vinte e quatro ratos albinos machos foram distribuídos em quatro grupos iguais. O Grupo 1 foi considerado grupo controle. Os animais do Grupo 2 foram injetados com 5 mg / kg de PB por via intraperitoneal. O Grupo 3 foi cotratado com CAS (50 mg / kg) por via oral e injeção de CP (5 mg / kg). O Grupo 4 foi tratado com CAS (50 mg / kg) por via oral durante todo o experimento. A administração de CP reduziu substancialmente as atividades de catalase (CAT), superóxido dismutase (SOD), peroxidase (POD), glutationa S-transferase (GST), glutationa redutase (GSR), glutationa (GSH), enquanto aumentou as substâncias reativas ao ácido tiobarbitúrico (TBARS) e níveis de peróxido de hidrogênio (H2O2). Os níveis de ureia, creatinina urinária, urobilinogênio, proteínas urinárias, molécula 1 de lesão renal (KIM-1) e lipocalina associada à gelatinase de neutrófilos (NGAL) aumentaram substancialmente. Em contraste, a albumina e a depuração da creatinina foram significativamente reduzidas no grupo tratado com PC. Os resultados demonstraram que a CP aumentou significativamente os indicadores de inflamação, incluindo fator nuclear kappa-B (NF-κB), fator de necrose tumoral-α (TNF-α), interleucina-1β (IL-1β), interleucina-6 (IL-6) níveis e atividade da ciclooxigenase-2 (COX-2) e danos histopatológicos. No entanto, a administração de CAS apresentou um efeito paliativo contra a toxicidade renal gerada por CP e recuperou todos os parâmetros, trazendo-os a um nível normal. Estes resultados revelaram que o CAS é um composto eficaz com potencial curativo para combater o dano renal induzido por CP.

Mitigation of cisplatin induced nephrotoxicity by casticin in male albino rats

Abstract Cisplatin (CP) is a commonly used, powerful antineoplastic drug, having numerous side effects. Casticin (CAS) is considered as a free radical scavenger and a potent antioxidant. The present research was planned to assess the curative potential of CAS on CP persuaded renal injury in male albino rats. Twenty four male albino rats were distributed into four equal groups. Group-1 was considered as a control group. Animals of Group-2 were injected with 5mg/kg of CP intraperitoneally. Group-3 was co-treated with CAS (50mg/kg) orally and injection of CP (5mg/kg). Group-4 was treated with CAS (50mg/kg) orally throughout the experiment. CP administration substantially reduced the activities of catalase (CAT), superoxide dismutase (SOD), peroxidase (POD), glutathione S-transferase (GST), glutathione reductase (GSR), glutathione (GSH) content while increased thiobarbituric acid reactive substances (TBARS), and hydrogen peroxide (H2O2) levels. Urea, urinary creatinine, urobilinogen, urinary proteins, kidney injury molecule-1 (KIM-1), and neutrophil gelatinase-associated lipocalin (NGAL) levels were substantially increased. In contrast, albumin and creatinine clearance was significantly reduced in CP treated group. The results demonstrated that CP significantly increased the inflammation indicators including nuclear factor kappa-B (NF-B), tumor necrosis factor- (TNF-), Interleukin-1 (IL-1), Interleukin-6 (IL-6) levels and cyclooxygenase-2 (COX-2) activity and histopathological damages. However, the administration of CAS displayed a palliative effect against CP-generated renal toxicity and recovered all parameters by bringing them to a normal level. These results revealed that the CAS is an effective compound having the curative potential to counter the CP-induced renal damage.

Resumo A cisplatina (CP) é uma droga antineoplásica poderosa, comumente usada, com vários efeitos colaterais. Casticin (CAS) é considerado um eliminador de radicais livres e um potente antioxidante. A presente pesquisa foi planejada para avaliar o potencial curativo da CAS em lesão renal induzida por PC em ratos albinos machos. Vinte e quatro ratos albinos machos foram distribuídos em quatro grupos iguais. O Grupo 1 foi considerado grupo controle. Os animais do Grupo 2 foram injetados com 5 mg / kg de PB por via intraperitoneal. O Grupo 3 foi cotratado com CAS (50 mg / kg) por via oral e injeção de CP (5 mg / kg). O Grupo 4 foi tratado com CAS (50 mg / kg) por via oral durante todo o experimento. A administração de CP reduziu substancialmente as atividades de catalase (CAT), superóxido dismutase (SOD), peroxidase (POD), glutationa S-transferase (GST), glutationa redutase (GSR), glutationa (GSH), enquanto aumentou as substâncias reativas ao ácido tiobarbitúrico (TBARS) e níveis de peróxido de hidrogênio (H2O2). Os níveis de ureia, creatinina urinária, urobilinogênio, proteínas urinárias, molécula 1 de lesão renal (KIM-1) e lipocalina associada à gelatinase de neutrófilos (NGAL) aumentaram substancialmente. Em contraste, a albumina e a depuração da creatinina foram significativamente reduzidas no grupo tratado com PC. Os resultados demonstraram que a CP aumentou significativamente os indicadores de inflamação, incluindo fator nuclear kappa-B (NF-B), fator de necrose tumoral- (TNF-), interleucina-1 (IL-1), interleucina-6 (IL-6) níveis e atividade da ciclooxigenase-2 (COX-2) e danos histopatológicos. No entanto, a administração de CAS apresentou um efeito paliativo contra a toxicidade renal gerada por CP e recuperou todos os parâmetros, trazendo-os a um nível normal. Estes resultados revelaram que o CAS é um composto eficaz com potencial curativo para combater o dano renal induzido por CP.

Association between residual cholesterol and the risk of subclinical renal damage / 西安交通大学学报(医学版)

【Objective】 Dyslipidemia has shown to be associated with cardiovascular, metabolic and renal diseases. This study aimed to investigate the association between residual cholesterol and the risk of subclinical renal damage (SRD). 【Methods】 A total of 2 342 participants were recruited from the previously established Hanzhong Adolescent Hypertension Study cohort. According to estimated glomerular filtration rate(eGFR) and urinary albumin-to-creatine ratio(uACR), the subjects were divided into SRD group and non-SRD group. The associations of residual cholesterol with eGFR, uACR, and the risk of SRD were analyzed by multiple linear and Logistic regression analyses. 【Results】 Residual cholesterol was positively correlated with uACR(r=0.081, P<0.001) but negatively correlated with eGFR (r=-0.091, P<0.001). Multiple linear regression analysis revealed that residual cholesterol was an influencing factor of uACR (β=0.075, P<0.001) and eGFR (β=-0.027, P<0.001) after adjustment for gender, age, smoke, alcohol, exercise, BMI, hypertension, diabetes and serum uric acid. In addition, Logistic regression analysis revealed that residual cholesterol was significantly associated with the risk of SRD independently of potential confounders [OR(95% CI)=1.387 (1.113-1.728), P<0.001]. Further subgroup analysis showed that residual cholesterol was significantly associated with the risk of SRD in women but not in men. 【Conclusion】 Residual cholesterol is a contributing factor in the risk of subclinical renal damage with gender-specific association.

Association between body mass index trajectories in children and adolescents of Hanzhong city of Shanxi province and subclinical renal damage in adulthood: a 30-year longitudinal follow-up study / 中华肾脏病杂志

Objective:To investigate the association between body mass index (BMI) trajectories in children and adolescents and subclinical renal damage (SRD) in adulthood.Methods:4 623 participants aged 6-18 years old were recruited from the ongoing cohort of Hanzhong adolescent hypertension study in 1987, and the subjects were followed up in 1989, 1992, 1995, 2005, 2013 and 2017, respectively. Group-based trajectory modeling was used to identify distinct BMI trajectories in longitudinal analysis. Generalized linear model was applied to examine the association between different BMI trajectories and SRD incidence in adulthood.Results:A total of 2 678 subjects from childhood to adulthood were enrolled in this study. All subjects were divided into three groups according to three distinct BMI trajectories: low-increasing BMI group ( n=1 017), moderate-increasing BMI group ( n=1 353), and high-increasing BMI group ( n=308). Over follow up for 30 years, a total of 248 participants (9.3%) developed SRD. Urinary albumin-to-creatinine ratio (uACR) in low to high-increasing BMI group was 0.9(0.6, 1.4), 1.0(0.7, 1.7), 1.6(0.8, 3.2), respectively ( P trend<0.001), and estimated glomerular filtration rate was 98.5(87.6, 111.6) , 96.2(86.4, 109.7), 95.3 (87.5, 125.0) ml·min -1·(1.73 m 2) -1, respectively ( P trend=0.025). The generalized linear model analysis showed that uACR was increased linearly from low to high-increasing BMI group [ β=3.16(95% CI 1.02-5.31), Ptrend=0.004]. There was no correlation or linear trend between BMI trajectory and estimated glomerular filtration rate [ β=-2.30(95% CI-5.18-0.57), Ptrend=0.117]. Compared with the low-increasing BMI group, the high-increasing BMI group had greater odds of experiencing SRD in adulthood after adjusting for multiple confounders such as age, gender, medical history and lifestyle ( OR=2.83, 95% CI 1.84-4.36, Ptrend<0.001). Conclusions:Higher BMI trajectorie is correlated with higher level of uACR and risk of SRD in middle age. Identifying long-term BMI trajectorie from early age may assist in predicting individuals′ renal function in later life.

Liposomal amphotericin B was successfully used to treat a case of kala-azar with prominent renal damage / 中华地方病学杂志

Objective:To analyze the diagnosis and treatment process of a kala-azar case with prominent renal damage treated with liposomal amphotericin B (L-AmB), and to provide theoretical basis for clinical diagnosis and treatment.Methods:A retrospective analysis method was used to analyze the clinical data, diagnosis and treatment process and laboratory test results of a case of kala-azar with prominent renal damage who presented to the Department of Infectious Diseases, The First Affiliated Hospital of Xi'an Jiaotong University on June 30, 2020.Results:A 56-year-old female patient presented with fever (the highest body temperature was 38.2 ℃) and chills. The results of clinical laboratory tests showed that hemoglobin(55 g/L), red blood cell (2.68 × 10 12/L), white blood cell (1.06 × 10 9/L) and platelet count (8.00 × 10 9/L) were decreased, renal function showed abnormal blood urea nitrogen and creatinine, spleen enlargement, etc., and the diagnosis of kala-azar combined with kidney insufficiency was confirmed by blood and bone marrow Leishmania spp. examination. With the assistance of continuous renal replacement therapy (CRRT), after a small dose of L-AmB was initially and slowly increased and maintained at a low dose, the patient's body temperature was normal, the blood routine showed that the three-lineage cells gradually increased, and the renal function showed blood urea nitrogen and creatinine decreased gradually the spleen was retracted; no recurrence was found at follow-up after 6 months, and renal function returned to normal. Conclusions:L-AmB is safe and effective in the treatment of kala-azar with renal damage as the prominent manifestation. The patient is not only cured by etiology, but is also recovered renal function.

S-allyl Cysteine and Taurine revert peripheral metabolic and lipid profile in non-insulin-dependent diabetes mellitus animals: Combination vs Monotherapy

Abstract The present study was designed to evaluate the beneficial synergistic effects of S-allyl Cysteine (SAC) and Taurine (TAU) on hyperglycemia, lipid profile and renal damage markers in type 2 diabetes mellitus (T2DM) in rats. Experimental T2DM was developed by administering an intraperitoneal single dose of nicotinamide (NA; 230 mg/kg) and streptozotocin (STZ; 65 mg/ kg) in adult rats. Control and diabetic rats were treated with SAC (150 mg/kg); TAU (200 mg/ kg) or SAC and TAU (75+100 mg/kg) combination for four weeks. Measurements of traditional markers of kidney toxicity in serum, such as blood urea nitrogen (BUN), serum creatinine (Scr), and alkaline phosphatase (ALP), together with serum cholesterol/triglyceride such as serum total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and very low-density lipoprotein cholesterol (VLDL-C) may yield a snapshot of renal damage and lipid profile in NA/STZ-treated rats. The variation in levels of fasting blood glucose, glycosylated hemoglobin, insulin and lipid profile was significantly augmented in SAC/TAU treatment group. The diabetic group showed elevated renal injury markers in serum, which were decreased significantly by SAC/TAU treatment. Thus the results of the experiment clearly indicate the potential of the SAC/TAU combination in improving diabetic complications.

Factores asociados a la nefropatía inducida por medios de contraste en pacientes con oclusión coronaria significativa / Contrast-induced nephropathy associated factors in patients with significant coronary obstruction

El intervencionismo coronario se asocia a la aparición de nefropatía inducida por contraste. El propósito del estudio fue evaluar el riesgo de desarrollar nefropatía inducida por contraste (NIC) en pacientes con obstrucción coronaria significativa y su relación con factores de riesgo conocidos para esta nefropatía. Se diseñó un estudio de cohorte prospectiva con 160 pacientes atendidos en el cardiocentro del hospital "Hermanos Ameijeiras", Cuba, a los cuales se les realizó una coronariografía invasiva, entre enero 2016 y julio 2017. La edad promedio fue de 61,6 ± 9,2 años; el 70,6% eran hombres. Predominaron los antecedentes patológicos personales de cardiopatía isquémica (85,6%), y de hipertensión arterial (75,6%). El 75% de los casos presentó una oclusión coronaria significativa. La frecuencia de nefropatía por contraste fue de 42,5%. Los factores que guardaron importante relación estadística con la presencia de oclusión arterial significativa fueron la cardiopatía isquémica conocida (p<0,001), el intervencionismo coronario percutáneo previo (p=0,007), la creatinina después (p=0,043) y la NIC (p=0,016) así como el volumen de contraste administrado (p=0,006). En el subgrupo de pacientes con oclusión significativa el hematocrito bajo (p=0,025) y el intervencionismo coronario percutáneo de urgencia (p=0,007) fueron los factores más influyentes. Se concluye que los pacientes con oclusión coronaria significativa tienen un riesgo aumentado para el desarrollo de la nefropatía por contraste. La corrección de aquellos factores de riesgo que sean modificables (como el hematocrito bajo) y la correcta aplicación del protocolo de hidratación son esenciales para prevenir esta complicación.

Coronary intervention is associated with the appearance of contrast-induced nephropathy. The purpose of the study was to assess the risk of developing contrast-induced nephropathy in patients with significant coronary obstruction and its relationship with known risk factors for this nephropathy. A prospective cohort study was designed with 160 patients treated at the cardiocenter of the "Hermanos Ameijeiras" hospital, Cuba, who underwent invasive coronary angiography, between January 2016 and July 2017. The average age was 61.6 ± 9 ,2 years; 70.6% were men. The personal pathological history of ischemic heart disease (85.6%) and arterial hypertension (75.6%) predominated. 75% of the cases presented a significant coronary occlusion. The frequency of contrast nephropathy was 42.5%. The factors that had an important statistical relationship with the presence of significant arterial occlusion were known ischemic heart disease (p <0.001), previous percutaneous coronary intervention (p = 0.007), creatinine after the procedure (p = 0.043) and CIN (p = 0.016) as well as the volume of contrast administered (p = 0.006). In the subgroup of patients with significant occlusion, low hematocrit (p = 0.025) and emergency percutaneous coronary intervention (p = 0.007) were the most influential factors. It is concluded that patients with significant coronary occlusion have an increased risk for the development of contrast nephropathy. The correction of those risk factors that are modifiable (such as low hematocrit) and the correct application of the hydration protocol are essential to prevent this complication

Tripterygium wilfordii in Treatment of Kidney Diseases and Its Toxic and Side Effect： A Review / 中国实验方剂学杂志

In recent years， with the rapid development of traditional Chinese medicine industry in China， the efficacy of Chinese medicinals in treating disease and maintaining health has been increasingly recognized. Tripterygium wilfordii， a Chinese medicinal for expelling wind， dredging collaterals， removing dampness， and relieving pain， is commonly used for treating acute and chronic glomerulonephritis， rheumatoid arthritis， and other diseases. However， the frequent occurrence of adverse reactions has limited its wide application in clinical practice. The existing studies have gradually confirmed that T. wilfordii and its active ingredients exert the bidirectional effects on kidney function. This paper reviewed the related clinical applications and articles published in the past decades and summarized the material basis for its bidirectional effects and the specific action mechanisms in renal protection and renal damage. It was found that the main active ingredients in T. wilfordii were tripterygium glycosides and triptolide， which exerted the protective or toxic and side effects on kidney by regulating immunity， influencing mitogen-activated protein kinases （MAPK） pathway， and changing the expression and function of renal transporters. Besides， the roles of administration time， dosage， and body status in the exertion of protective or toxic and side effects by T. wilfordii were also discussed. The review aimed to provide new ideas for the research on the treatment of kidney diseases with T. wilfordii and its safety application.

Investigation of Pharmacodynamic Material Basis and Mechanism of Qianyang Yuyin Granules Against Hypertensive Renal Damage Based on LC/Q-TOF-MS and Network Pharmacology / 中国实验方剂学杂志

Objective:To systematically study the chemical components of Qianyang Yuyin granules and explore its main pharmacodynamic substances and mechanism in the prevention and treatment of hypertensive renal damage. Method:Liquid chromatography coupled with quadrupole time-of-flight mass spectrometry （LC/Q-TOF-MS） was employed to comprehensively analyze the chemical components of Qianyang Yuyin granules. Agilent Poroshell 120 SB-C₁₈ column （3.0 mm×100 mm， 2.7 μm） was used， flow rate was 0.4 mL·min^-1， electrospray ionization （ESI） was applied and operated in positive and negative ion modes， the acquisition range was <italic>m</italic>/<italic>z</italic> 25-1 000. Mobile phase in positive ion mode consisted of water+10 mmol·L^-1 ammonium formate+0.125% formic acid+0.1% methanol （A）-［acetonitrile-water （9∶1）+10 mmol·L^-1 ammonium formate+0.125% formic acid］ （B）， and in negative ion mode consisted of water+10 mmol·L^-1 ammonium formate+0.1% methanol （A）-［acetonitrile-water （9∶1）+10 mmol·L^-1 ammonium formate］ （B） with the gradient elution （0-3.5 min， 5%B； 3.5-4 min， 5%-10%B； 4-9 min， 10%-25%B； 9-18 min， 25%-30%B； 18-25 min， 30%-50%B； 25-27 min， 50%-90%B； 27-32 min， 90%B； 32-33 min， 90%-5%B； 33-39 min， 5%B）. According to the information of the accurate mass， the multistage fragment ions， the mass spectrometric data of the standard substances and the relative reference literature， the structures of the chemical components in Qianyang Yuyin granules were identified. Based on the identified components， network pharmacology study， including target prediction and functional enrichment was applied to screen out the main active substances against hypertensive renal damage， and explore the potential mechanism. Result:A total of 99 chemical components were identified， from which 43 active substances and 48 key targets were screened out. The key components contained kaempferol， quercetin， ferulic acid， luteolin， caffeic acid methyl ester， cinnamic acid， aloe-emodin， emodin， gallic acid， <italic>N</italic>-<italic>trans</italic>-feruloyltyramine， isoorientin， 8-<italic>O</italic>-feruloylharpagide， ethyl caffeate， isookanin， cyasterone， 2，3，5，4'-tetrahydroxystilbene-2-<italic>O</italic>-<italic>β</italic>-<italic>D</italic>-glucopyranoside， loganin， alisol B-23-acetate and harpagide. The key targets included vascular endothelial growth factor A （VEGFA）， serine/threonine protein kinase 1 （AKT1）， Jun proto-oncogene （JUN）， etc. Conclusion:Qianyang Yuyin granules mainly exert the effects of removing heat from the liver， tonifying the kidney and removing blood stasis via modulation of vascular endothelium， angiogenesis， inflammatory reaction， oxidative stress， immune response and so on.

Morbilidad y mortalidad por disfunción renal aguda en la unidad de terapia intensiva del Hospital General Docente Dr. Agostinho Neto / Morbidity and mortality for acute kidney failure in the intensive care unit of the General Teaching Hospital ¨Dr. Agostinho Neto¨

RESUMEN Introducción: En el Hospital General Docente "Dr. Agostinho Neto", de Guantánamo, no se ha caracterizado la problemática del daño renal agudo en la unidad de terapia intensiva. Objetivo: caracterizar esta afección en pacientes ingresados en la citada unidad en el periodo 2018-2019. Método: Se realizó un estudio descriptivo, retrospectivo y longitudinal, aprobado por el comité de ética. El universo de estudio se constituyó por el total de pacientes con este diagnóstico según la clasificación Acute Kidney Injury Network (AKIN). Se estudiaron las características de los pacientes (edad, sexo, comorbilidad, etiología, estadía en la unidad de terapia intensiva, necesidad de hemodiálisis, estado al egreso) y del daño renal agudo (estadio según los criterios de la escala AKIN). Resultados: En el 35,6 % de los pacientes se diagnosticó esta enfermedad, sobre todo en hombres (56,7 %) y con edad de 66,3 ± 24,3 años. El 41,4 % padeció hipertensión arterial sistémica. En el 48,9 % la enfermedad se presentó un en estadio 1, y en el 69,4 % la sepsis fue la principal causa. La mortalidad al egreso hospitalario fue de 16,4 %, y a los 30 días fue de 25,4 %. Se realizó hemodiálisis al 13,8 % de los pacientes, en los que el riesgo de muerte fue superior. Conclusiones: En la unidad de terapia intensiva es elevada la proporción de pacientes con daño renal agudo y resulta útil la escala que se utilizó para el diagnóstico y la evaluación de la gravedad y el pronóstico de los pacientes afectados.

ABSTRACT Introduction: Acute kidney injury in the intensive care unit in the General Teaching Hospital ¨Dr. Agostinho Neto¨ in Guantanamo has not been characterized. Objective: To characterize this disease in patients in the intensive care unit in the mentioned institution in the period 2018-2019. Method: A descriptive, retrospective and longitudinal study was undertaken, all approved by the ethics committee. The study population was made out of the total amount of the patients diagnosed according to the classification of the Acute Kidney Injury Network (AKIN). The variables taken into account were: age, gender, comorbidity, etiology, time in the intensive care unit, requirement for hemodialysis and status of the patient at the time of discharge, plus the stages of the acute kidney injury according to the AKIN scale. Results: Acute kidney injury was diagnosed in the 35.6% of the patients, especially in male patients (56.7%) with ages between 66.3 ± 24.3 years. 41.4% of the patients suffered of systemic arterial hypertension. Stage 1 was found in the 48.9% of the cases, and sepsis was the main cause in 69.4%. Mortality at the time of discharge represented the 16.4%; and after the following 30 days went up to 25.4%. Hemodialysis was required in the 13.8% of the patients; in wich the risk of death was significatively higher. Conclusions: There is a high number of patients with acute kidney injury in the intensive care unit, and it was really useful the scale implemented for diagnosis and evaluation of the severity of the condition and the prognosis of the patients.

Adverse drug reaction risk assessment with prescribed renal risk drugs among hospitalized patients attending a teaching hospital in South India

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.

Pathological classification and prognosis of renal damage caused by antineutrophil cytoplasmic antibody associated vasculitis / 中华肾脏病杂志

Objective To analyze the pathological characteristics and prognostic factors of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV).Methods A retrospective analysis of AAV patients with renal biopsy results admitted to Kidney Disease Center of the First Affiliated Hospital from January 2004 to February 2017 was performed.The patients were divided into 4 types according to Berden classification,and their clinical,pathological characteristics and prognosis were compared.The survival curves of each type of patients were plotted by Kaplan-Meier method,and the difference of survival curves was compared using Log-rank test.With entering the maintenance dialysis as the endpoint,Cox regression was used to analyze the prognostic factors.Results A total of 175 patients with AAV,including 59 cases (33.7％) of focal type,39 cases (22.3％) of crescent type,32 cases (18.3％) of sclerosis type,45 cases (25.7％) of mixed type.The basal serum creatinine levels in crescent type group and sclerosis type group were significantly higher than those in the focal type group or mixed type group (all P ＜ 0.05),and loop necrosis rate in sclerosis type group was significantly lower than chat in the focal type group or crescent type group (both P ＜ 0.05).The median follow-up period was 11.8 (0.5-86.7) months.The event-free survival rates were 83.1％,77.8％,64.1％ and 50.0％ in the focal type,mixed type,crescent type and sclerotic type groups (Log-rank x2=11.537,P=0.009).Cox regression analysis showed higher parathyroid hormone (HR=1.013,95％ CI 1.007-1.019,P ＜ 0.001),glomerular sclerosis ≥50％ (HR=10.532,95％CI 2.903-38.203,P ＜ 0.001) were independent risk factors for AAV patients entering maintenance dialysis,and higher estimated glomerular filtration rate (HR=0.943,95％ CI 0.896-0.993,P=0.025) was protective factor.Conclusion The prognosis of AAV renal damage is worsened according to focal,mixed,crescent and sclerosis types.Lower estimated glomerular filtration rate,higher parathyroid hormone and glomerular sclerosis ≥ 50％ are independent risk factors for AAV patients entering maintenance dialysis.

Research Progress of Astragali Radix and Salviae Miltiorrhizae Radix on Improving Renal Damage in Hypertension / 中国实验方剂学杂志

Hypertensive renal damage is one of the most serious complications of hypertension, and it is also the main cause of end-stage renal disease. Renal damage can further promote the rise of blood pressure and difficult to control, forming a vicious circle. Traditional Chinese medicine (TCM) considers that deficiency of the original and excess of the standard is its basic pathogenesis, and insufficient kidney-Qi and blood stasis are one of the most common syndromes of hypertensive kidney damage. Astragali Radix membranaceus is praised as the most important medicine for invigorating Qi, and Salviae Miltiorrhizae Radix is likened to "four things with the same function". Based on the theory of invigorating Qi and activating blood circulation, the effective ingredients of Astragali Radix membranaceus-Salviae Miltiorrhizae Radix are mainly astragaloside, Astragali Radix polysaccharide, mulberry isoflavone, salvianolic acid and tanshinone. Many studies have shown that in the process of hypertensive kidney damage, Astragali Radix membranaceu Its active ingredients, whether effective monomers, monomer compatibility or direct compatibility of drug pairs, can regulate blood pressure, reduce urinary protein, protect renal tubules, protect glomerular filtration barrier, improve renal hemodynamics and protect renal function by regulating multiple signal transduction pathways related to hypertensive renal damage. Lowering blood pressure and protecting renal function are two pronged functions. Based on the theory of Invigorating Qi and activating blood circulation, this paper reviews the research progress of Astragali Radix-Salviae Miltiorrhizae Radix in the treatment of hypertensive renal damage, with a view to providing scientific basis for the further study and clinical application of Radix astragali-Salviae Miltiorrhizae Radix in hypertensive renal damage.

Clinical Efficacy of Modified Fangji Huangqitang on Early Renal Damage with Qi Deficiency and Dampness Obstruction Syndrome in Hypertension / 中国实验方剂学杂志

Objective:To observe the efficacy of modified Fangji Huangqitang on early renal damage in hypertension (Qi deficiency and dampness obstruction syndrome) and its effect in resisting inflammation and protecting vascular endothelium. Method:One hundred and forty-four patients were randomly divided into control group and observation group by random number table. Patients in control group got losartan potassium tablets, 50 mg/time, 1 time/day, and nifedipine controlled-release tablets, 30 mg/time, 1 time/day. In addition to the therapy of control group, patients in observation group were alsog given modified Fangji Huangqitang, 1 dose/day. The qualification rate of blood pressure was recorded for every week, and ambulatory blood pressure was detected before and after treatment. Standard deviation of systolic blood pressure for 24 h (24 hSSD), standard deviation of diastolic pressure for 24 h (24 hDSD), mean systolic blood pressure for 24 h (24 hSBP), average diastolic pressure for 24 h (24 hDBP) were recorded, and dynamic pulse pressure index (PPI), dynamic arteriosclerosis index (AASI), and ratio of UmALB and creatinine (CR) were calculated, levels of beta 2 microglobulin (β2-MG), urinary N-acetyl-beta-glucosaminidase (NAG), serum cystatin C (CysC), urinary microalbumin (UmALB), interleukin-6 (IL-6), interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), nitric oxide (NO), endothelin-1 (ET-1) were detected, and symptoms and signs were scored. Result:During the 12-week observation period, the qualification rate of blood pressure in observation group was 89.09%, which was higher than 81.52%in control group (χ2=18.776, Pβ2-MG, CysC, NAG, UmALB, UACR, IL-6, IL-1β, TNF-α and ET-1 were lower than those in control group (PPZ=2.146, PConclusion:In addition of the western medicine therapy, modified Fangji Huangqitang can be added to control blood pressure level, improve blood pressure compliance rate, reduce blood pressure variability, protect renal function, prevent and relieve clinical symptoms, improve the clinical efficacy, inhibit inflammatory reaction and improve endothelial function.

Clinical value of early renal damage index in children hydronephrosis / 中华泌尿外科杂志

Objective@#To explore urinary NAG, Cr, MA, α1-MG andβ2-MG as the early renal damage index in children hydronephrosis.@*Methods@#The clinical data of 206 patients in the Bayi Children′s Hospital Affiliated to the Seventh Medical Center of Chinese PLA General Hospital from May 2018 to January 2019 were analyzed retrospectively. Among them, 152 children with hydronephrosis were set as observation group, 54 children without hydronephrosis were set as control group. In the observation group, the age ranged from 1 month to 18 years old, and the median age was 2 years old. There were 123 cases of hydronephrosis caused by ureteropelvic junction obstruction (UPJO) and 29 cases of posterior urethral valve complicated with hydronephrosis. In the control group, the age ranged from 1 month to 15 years old, with a median age of 5 years. There were 18 hypospadias cases, 15 occult penis cases and 21 phimosis. All children with hydronephrosis underwent nuclear medicine renal dynamic imaging. Urine specimens were tested for urinary NAG, Cr, MA, α1-MG, and β2-MG. According to renal dynamic results, the observed components were the renal function injury group and the normal renal function group. The above indicators analyzed to judge the clinical value to find the early renal damage.@*Results@#The expression levels of urinary NAG, MA, α1-MG and β2-MG in the observation group were higher than those in the control group, and the difference was statistically significant. The expression of urinary Cr and the abnormal rate were no significant difference between any two groups(P=0.647, P=0.572). The expression levels of urinary NAG, MA, α1-MG and β2-MG were not significantly different between the normal renal hydronephrosis group and the renal function impairment group (P=0.365, P=0.448, P=0.379, P=0.338). The abnormal expression rate of Urine MA and β2-MG was not statistically significant in the patients with normal renal hydronephrosis and the renal function impairment group (P=0.436, P=0.478). MA got the highest sensitivity of (58.8%), and NAG had the highest specificity of 89.3% to detect early renal demage. Four indexes combined analysis, sensitivity, negative predictive rate, diagnostic coincidence rate improved obviously. Joint analysis of posterior urethral valves combined with hydronephrosis, the abnormal rate was 89.7%(26/29). The renal dysfunction of the posterior urethral valve showed that the renal dynamics dysfunction rate was only 37.9%(11/29).@*Conclusions@#The combined analysis of urinary NAG, MA, α1-MG and β2-MG can accurately predict early renal injury. The index of early renal loss may be the early evidence to judge whether the posterior urethral valve is complicated with upper urinary tract function injury.

Effects of Polygonum cuspidatum on AMPK-FOXO3α Signaling Pathway in Rat Model of Uric Acid-Induced Renal Damage / 中国结合医学杂志

BACKGROUND@#To observe the effects of Chinese medicine (CM) Polygonum cuspidatum (PC) on adenosine 5'-monophosphate-activated protein kinase (AMPK), forkhead box O3α (FOXO3α), Toll-like receptor-4 (TLR4), NACHT, LRR and PYD domains-containing protein 3 (NLRP3), and monocyte chemoattractant protein-1 (MCP-1) expression in a rat model of uric acid-induced renal damage and to determine the molecular mechanism.@*METHODS@#A rat model of uric acid-induced renal damage was established, and rats were randomly divided into a model group, a positive drug group, and high-, medium-, and low-dose PC groups (n=12 per group). A normal group (n=6) was used as the control. Rats in the normal and model groups were administered distilled water (10 mL•kg) by intragastric infusion. Rats in the positive drug group and the high-, medium-, and low-dose PC groups were administered allopurinol (23.33 mg•kg), and 7.46, 3.73, or 1.87 g•kg•d PC by intragastric infusion, respectively for 6 to 8 weeks. After the intervention, reverse transcription polymerase chain reaction, Western blot, enzyme linked immunosorbent assay, and immunohistochemistry were used to detect AMPK, FOXO3α, TLR4, NLRP3, and MCP-1 mRNA and protein levels in renal tissue or serum.@*RESULTS@#Compared with the normal group, the mRNA transcription levels of AMPK and FOXO3α in the model group were significantly down-regulated, and protein levels of AMPKα1, pAMPKα1 and FOXO3α were significantly down-regulated at the 6th and 8th weeks (P<0.01 or P<0.05). The mRNA transcription and protein levels of TLR4, NLRP3 and MCP-1 were significantly up-regulated (P<0.01 or P<0.05). Compared with the model group, at the 6th week, the mRNA transcription levels of AMPK in the high- and medium-dose groups, and protein expression levels of AMPKα1, pAMPKα1 and FOXO3α in the high-dose PC group, AMPKα1 and pAMPKα1 in the mediumdose PC group, and pAMPKα1 in the low-dose PC group were significantly up-regulated (P<0.01 or P<0.05); the mRNA transcription and protein levels of TLR4 and NLRP3 in the 3 CM groups, and protein expression levels of MCP-1 in the medium- and low-dose PC groups were down-regulated (P<0.01 or P<0.05). At the 8th week, the mRNA transcription levels of AMPK in the high-dose PC group and FOXO3α in the medium-dose PC group, and protein levels of AMPKα1, pAMPKα1 and FOXO3α in the 3 CM groups were significantly up-regulated (P<0.01 or P<0.05); the mRNA transcription levels of TLR4 in the medium- and low-dose PC groups, NLRP3 in the high- and low-dose PC groups and MCP-1 in the medium- and low-dose PC groups, and protein expression levels of TLR4, NLRP3 and MCP-1 in the 3 CM groups were down-regulated (P<0.01 or P<0.05).@*CONCLUSION@#PC up-regulated the expression of AMPK and its downstream molecule FOXO3α and inhibited the biological activity of TLR4, NLRP3, and MCP-1, key signal molecules in the immunoinflammatory network pathway, which may be the molecular mechanism of PC to improve hyperuricemia-mediated immunoinflflammatory metabolic renal damage.

Association between atherogenic index of plasma and renal function impairment in patients with gout / 中华内分泌代谢杂志

Objective@#To study the relationship between atherogenic index of plasma (AIP)and renal impairment in male patients with gout.@*Methods@#A retrospective analysis of 821 male subjects was conducted to measure the relevant biochemical indicators and to calculate the AIP, endogenous creatinine-clearance rate (Ccr), and estimated glomerular filtration rate (eGFR). EpiData 3.1 software was used for data entry, SPSS21.0 was used for statistical analysis, and GraphPad Prism 6.0 software was used for charts.@*Results@#Compared with control group, AIP, serum uric acid, triglyceride in gout group were significantly higher (all P<0.01), while eGFR and high density lipoprotein-cholesterol were significantly lower (both P<0.05). The composition ratio of renal function impairment in gout group was significantly higher (P<0.01). With the increase of AIP level, eGFR level decreased and serum creatinine level increased, but the overall difference was not statistically significant (P>0.05), while Ccr and serum uric acid levels gradually increased (P<0.05). Logistic regression analysis after adjusting for various confounding factors showed that AIP, triglyceride, and serum uric acid were risk factors for renal function damage in patients with gout (P<0.05), the relevant risk were 7.030, 1.291, 1.004 respectively. After adjusting confounding factors, the associations between triglyceride, serum uric acid and renal function injury risk changed little, while AIP showed more evident, the OR value increased from 2.629 to 6.265 and 7.030.@*Conclusions@#(1)AIP is closely related to the renal function damage of patients with gout. After adjusting various confounding factors, AIP can better reflect the renal function damage than other indicators, which is of great significance to predict the renal function damage of patients with gout. (2)That patients with gout with high uric acid level may suffer from renal atherosclerosis and have a higher risk of renal impairment. (3)Dynamic observation of AIP in gout patients is helpful for early identification of the risk of renal failure in such patients.