Clinical and Experimental Research Progress of Wulingsan in Treatment of Renal Diseases： A Review / 中国实验方剂学杂志

Wulingsan， a classic prescription first recorded in the Treatise on Cold Damage （Shang Han Lun） by ZHANG Zhong-jing for patients with water retention syndrome due to the disturbance of Qi transformation in bladder， has often been modified by ancient and modern doctors for the treatment of renal diseases. It produced satisfactory outcomes without inducing adverse reactions. The databases including China National Knowledge Infrastructure （CNKI）， Wanfang Data Knowledge Service Platform， and PubMed were searched for articles concerning the clinical application and pharmacological mechanism of Wulingsan in the treatment of renal diseases published by domestic and foreign scholars in recent years. The summary of the included articles revealed that Wulingsan has been widely employed for the treatment of renal edema， diabetic nephropathy， acute and chronic glomerulonephritis， nephrotic syndrome， renal insufficiency， abnormal urination， etc.， and the resulting outcomes were satisfactory. Wulingsan alone or in combination with western medicine yielded better clinical outcomes than the western medicine alone. In the exploration of its pharmacological mechanism， there existed some individual reports by Korean scholars， while Chinese scholars tended to work as a team. After years of research， each team has found that Wulingsan was superior to Wulingsan decoction in excreting water， which might be related to the absence of massive low-polarity and volatile components in the decoction that were responsible for regulating the expression of aquaporins （AQP） in kidney of saline-loaded rats. Wulingsan regulates the endocrine state of rats with kidney yang deficiency， inhibits the reabsorption of water， increases the activity of Na+-K+-ATPase， and reduces the expression of AQP 1， AQP 2， AQP 3， and AQP 4. Besides， it bi-directionally regulates the human water metabolism， which is achieved via the dual-directional regulation of purinergic P2X3 receptor expression on bladder detrusor. The efficacy of Wulingsan in treating chronic renal failure is attributed to its protection against the damaged renal tissue，structure and fanction. Hence， this paper summarized the research progress of Wulingsan in the treatment of renal diseases in recent years， aiming to provide a reference for the clinical and basic exploration of Wulingsan against renal diseases in the future.

Traditional Chinese Medicine Regulates Notch Signaling Pathway to Prevent and Treat Renal Diseases：A Review / 中国实验方剂学杂志

As common and frequently-occurring disorders in clinic practice，renal diseases are characterized by the impairment of kidney structure and function due to a variety of reasons and can be divided into primary，secondary， and hereditary types. Clinically，the impairment of kidney structure and function is usually a chronic progressive process，and the resulting chronic renal diseases have become a major public health problem endangering human health worldwide. Notch signaling pathway affects cell proliferation，differentiation，migration，growth， and apoptosis and determines the fate of cells. Abnormal expression or gene mutation of Notch will cause tissue damage， followed by the occurrence and development of a variety of renal diseases. Traditional Chinese medicine （TCM）， as an important means to prevent and treat renal diseases，has the characteristics of acting on multiple targets and signaling pathways with multiple components，and is often used as a routine or potential complementary therapy for the treatment of chronic renal diseases and also a source of new drug discovery. In recent years， considering the limitations of western medicine in treating renal diseases，more and more scholars have begun to take Notch signaling pathway as the breakthrough point for exploring TCM prevention and treatment of renal diseases. They have conducted clinical and experimental studies on the regulation of Notch signaling pathway by a variety of individual Chinese herbs or their extracts，Chinese patent medicines， and Chinese medicinal compounds，and found that TCM exerted the renal protective effects by inhibiting the Notch signaling pathway. By collecting relevant literatures on TCM prevention and treatment of various renal diseases，especially those concerning TCM regulation of Notch signaling pathway for preventing and treating such chronic renal diseases as diabetic nephropathy，immunoglobulin A （IgA） nephropathy，renal fibrosis，membranous nephropathy，focal segmental glomerulosclerosis， and renal cell carcinoma，this paper summarized the current research status，in order to provide reference for clinical prevention and treatment of various renal diseases and build up the factual basis for the universal application of TCM.

Role of special stains as a useful complementary tool in the diagnosis of renal diseases: a case series study

Background: Renal diseases constitute a major cause of morbidity in clinical practice and their incidence is on rise. Investigation usually requires division into even smaller samples to permit the application of specialized techniques.Methods: This is a prospective study conducted over a period of one year from January 2018 to December 2018 in the Department of Pathology, Coimbatore. A total of 58 renal biopsies were received from the Nephrology Department and the tissues were subjected to light microscopic and special stain studies.Results: Total 53 patients (91.38%) had high blood urea nitrogen value more than 20.0 mg/dl. 48 patients (82.76%) had high serum creatinine value more than 1.2 mg/dl. Out of 58 biopsy specimens, 46 (79.31%) showed primary glomerular lesions, 10 (17.24%) showed secondary glomerular lesion and 2 (3.45%) showed tubulointerstitial nephritis. Jones’s methanamine silver stain along with PAS stain helped in typing/staging of membranous glomerulopathy and membranoproliferative glomerulonephritis. Various changes in GBM like spike formation, thickening and moth-eaten appearance of GBM was noted which is seen in MGN stage II, IV and III respectively. Double contour and thickening of GBM was noted which is seen in type I and II MPGN respectively. In Myeloma cast nephropathy, tubular casts stained negative with Congo red which was used to differentiate it from amyloid deposition.Conclusions: The special stains used in this study helped in supplementing the light microscopic findings for diagnosis of kidney lesions. However, the use of other ancillary techniques like immunofluorescence and electron microscopy would help the pathologists in better and more accurate diagnosis.

Comportamiento epidemiológico en pacientes con enfermedad renal crónica terminal en Ecuador / Epidemiological behavior on patients with terminal chronic kidney disease from Ecuador

Introducción: alta prevalencia de la enfermedad renal crónica, en la población adulta de Ecuador. Objetivo: describir el comportamiento epidemiológico de la enfermedad renal crónica terminal, en pacientes atendidos en una clínica médica ecuatoriana. Método: se realizó un estudio transversal en 84 pacientes con enfermedad renal crónica terminal, en tratamiento de hemodiálisis, en la clínica DIALVIDA Ambato, Ecuador, de octubre 2016 a abril 2017. Las variables estudiadas en los pacientes con síntomas de la enfermedad fueron: causas, edad, datos generales, nivel de instrucción, ingresos económicos, estado nutricional según el índice de masa corporal, y hábito de fumar. Resultados: la edad media fue de 52 años, con predominio del sexo masculino del 63,1%. Los mayores de 60 años alcanzaron el 52,4%. La mayoría de los pacientes mostraron bajo nivel de instrucción (sin instrucción: 16,6%; secundaria: 33,3% y primaria; 36,9%). Se observó un predominio de pacientes con ingreso económico menor al salario unificado, el 60,7%, los pacientes normopeso con el 51,2%, seguido de pacientes con sobrepeso con el 25%. El 47,6% eran fumadores. Las causas principales de enfermedad renal fueron: diabetes mellitus (30,9%) e hipertensión arterial (23,8%). La enfermedad apareció con más frecuencia en adultos mayores (45,2%). Conclusiones: la enfermedad renal crónica terminal, predominó en el sexo masculino, en adultos mayores normopeso, no fumadores, y con bajo nivel de instrucción. Las dos primeras causas de enfermedad renal crónica terminal fueron: diabetesmellitus e hipertensión arterial.

Introduction: how chronic kidney disease has become a public health problem in Ecuador. Objective: to describe the epidemiological behavior of terminal chronic kidney disease in patients treated in an Ecuadorian medical clinic. Method: a descriptive cross-sectional study was carried out in 84 patients with terminal chronic kidney disease undergoing hemodialysis treatment, at the DIALVIDA Ambato clinic, from October 2016 to April 2017. The variables included age of appearance, educational level, economic income, smoking habit and nutritional status according to the index of corporal mass, which are the main causes of this disease. Results: average age was 52 years old. On males prevailed 53 patients a 63.1%; 31 female patients presented 36.9%. The most affected age groups were, with 44 patients over 60 years old, 52.4% and with 27 patients from 40 to 59 years old, 32.1%. The primary level was 31 patients with 36.9%, followed by the secondary level with 28 patients, with 33.3%. Patients without instruction presented 16.6%. A predominance of patients with economic income lower than the unified salary, was observed with 51 patients for 60.7%. Normal-weight patients with 43 for 51.2%, followed by overweight patients with 21 for 25%. Smoking habit was found in 40 patients, showing 47.6%. There was a predominance of 26 patients with diabetes mellitus for 30.9%, followed by 20 patients with hypertension to 23.8%. With 38 patients, predominance in the age of onset of the disease was observed, in those over 60 years of age to 45.2%, followed by ages 40-59 with 30 patients (35.7%). Conclusions: terminal chronic kidney disease is a health problem in the studied population. It usually appears in old normopes males, non-smokers, and with low level of education. Two leading causes of terminal chronic kidney disease were diabetes mellitus and arterial hypertension.

Supervivencia a largo plazo en pacientes con enfermedad renal crónica estadio 5 tratada por hemodiálisis en Lima, Perú / Long-term survival in patients with stage 5 chronic kidney disease undergoing hemodialysis in Lima, Peru

Objetivo: Evaluar la supervivencia a largo plazo de pacientes con enfermedad renal crónica estadio 5 (ERC-5) que ingresaron a un programa de hemodiálisis en Lima, Perú y se determinó las variables de pronóstico que afectaron la supervivencia. Materiales y métodos: Se evaluó una cohorte prospectiva de 604 pacientes que ingresaron a un programa de hemodiálisis (1982-2009) y fueron seguidos hasta diciembre del 2015. La supervivencia fue estudiada mediante las curvas de Kaplan Meier; se estableció comparaciones, utilizando la prueba Log-rank según: edad, etiología, trasplante renal y período de ingreso a hemodiálisis. Mediante el análisis de regresión de Cox, se determinó variables pronósticas de supervivencia. Resultados: La edad promedio fue de 51,95 ± 16,17 años. El 43,1% era = 60 años; el 43,4% fueron mujeres. Las etiologías más frecuentes fueron las glomerulopatías primarias (21%), diabetes mellitus (20%), hipertensión arterial (12%) y las nefropatías intersticiales y/o uropatías obstructivas (11%). El porcentaje de supervivencia (IC95%) en los años 1, 5, 10, 15 y 20 fue 80% (intervalo de confianza al 95% (IC 95%): 77% - 83%), 47% (IC 95%: 43% - 51%), 25% (IC 95%: 21% a 29%); 17% (IC 95%: 13% - 21%) y 11% (IC 955: 8% - 14%), respectivamente. La regresión de Cox identificó al adulto mayor y al diabético como variables desfavorables en la supervivencia y al trasplantado renal como variable favorable. Conclusión: La supervivencia a largo plazo es comparable a otros estudios internacionales. La menor supervivencia de nuestros pacientes se relacionó con la condición de ser adulto mayor, diabético y no tener posibilidad de trasplante renal. Los cambios tecnológicos durante el período de seguimiento no modificaron significativamente las curvas de supervivencia

Objective: To assess the long-term survival of patients with stage V chronic kidney disease that entered a hemodialysis program in Lima, Peru and prognostic variables that affected survival were determined. Materials and methods: We assessed a prospective cohort of 604 patients enrolled in a hemodialysis program (1982-2009) and who were followed-up until December 2015. Survival was studied using the Kaplan Meier curves and comparisons were established using the Log-rank test; according to age, etiology, renal transplantation and period of admission to hemodialysis. Through the Cox regression analysis, prognostic variables of survival were delimited. Results: The mean age ± SD age of the population was 51.95 ± 16.17 years; 43.1% were > 60 years old, and 43.4% were women. The most frequent etiologies were primary glomerulopathy (21%), diabetes mellitus (20%), high blood pressure (12%), and interstitial nephropathy and/or urinary tract obstruction (11%). Survival percentages (95% confidence interval) in years 1, 5, 10, 15, and 20 were 80% (77%-83%); 47% (43%-51%); 25% (21%-29%); 17% (13%-21%), and 11% (8%-14%), respectively. Cox regression analysis identified being elderly and diabetic as unfavorable variables for survival, and having undergone renal transplantation as a favorable variable. Conclusions: Long-term survival is comparable to that found in other studies performed abroad. The lower survival of our patients is related to the following conditions: advanced age, diabetes, and not having the possibility of undergoing renal transplantation. Technological changes during the follow-up period did not significantly modify the survival curves

Phenomenology on the Hemodialysis Experience of Patients with End-Stage Renal Disease / 재활간호학회지

PURPOSE: This study aimed to explain what are the experiences of patients with renal disease who are just begun hemodialysis in the end-stage. METHODS: The data were collected from February to December in 2017 through individual in-depth interviews using open-ended questions. For data analysis, a phenomenological method suggested by Colaizzi was applied. A total of 8 hemodialysis patients with end-stage renal disease (ESRD) participated in this study. RESULTS: According to the analysis, five theme clusters emerged: ‘I go into darkness’, ‘Being disappearing from others’, ‘Baby bird living with love’, ‘Dawn in darkness’ and ‘A life longing for the absolute’. CONCLUSION: Patients undergoing hemodialysis experienced fear and anxiety at the beginning of hemodialysis. Therefore, counseling and social supports were needed for patients with ESRD in their early stage of hemodialysis. In addition, a multidisciplinary education program should be implemented in the future research. It may help to overcome for the patients who are experiencing complicated health problems in their early stage of hemodialysis treatment.

Clinical significance of neutrophil gelatinase-associated lipocalin in pediatric renal diseases / 国际儿科学杂志

Neutrophil gelatinase-associated lipocalin,a small molecular lipocalin secreted by neutro phils,has a close relationship with inflammation,immune response,tumor,kidney diseases,etc.Recent studies have found that NGAL has a protective effect on kidney,and could be used as an effective indicator for early monitoring of kidney diseases.The review mainly summarizes the mechanisms,physiological functions and clinical applications of pediatric renal diseases.

Analysis of related risk factors for retinal artery occlusion / 眼科新进展

Retinal artery occlusion (RAO) is one of ophthalmic emergencies,often resulting in painless vision decline and different levels of visual impairment,thereby leading to poor prognosis.It influences the life quality of patients.It has complicated pathogenesis and many clinical risk factors,such as cardiovascular diseases,cerebrovascular diseases,end-stage renal disease,periocular injections.This paper will summarize the related risk factors for this disease.

NLRP3 inflammasome: A therapeutic option for kidney disease? / El inflamasoma NLRP3: ¿Es realmente una opción terapéutica para la enfermedad renal?

ABSTRACT Objective To determine if considering inflammasome NLRP3 as a treatment option for kidney disease is possible. Methods Literature review related to NLRP3 inflammasome structure, biological function and relationship with renal disease and others (hypertension, diabetes, gout, atherosclerosis, amyloidosis, Alzheimer's disease); the systematic review was made searching in the databases PubMed and SciELO for the following terms: "The NLRP3 inflammasome therapeutic for kidney disease", "NLRP3 nflammasome in kidney disease" in PubMed, and "Inflammasome" for Scielo. Results 146 documents were found, althoughonly 34 matched the working hypothesis concerning the NLRP3 inflammasome as a central component of various diseases in humans, with potential therapeutic use. The NLRP3 inflammasome is responsible for the maturation of inflammatory pro-interleukin IL-1 β and IL-18, which can be triggered by aggregated or crystalline materials (particles), and by various microorganisms and toxins derived from these; however, the way how activation mechanisms work is not completely clear. Conclusions Research on new therapies that focus on removing or inhibiting inflammasome components, both individually and together, is proposed.(AU)

RESUMEN Objetivo Determinar si el inflamasoma NLRP3 puede considerarse como opción de tratamiento para la enfermedad renal. Métodos Con el fin de encontrar bibliografía relacionada con la estructura del inflamasoma NLRP3, su función biológica y su relación con la enfermedad renal y otras (hipertensión, diabetes, gota, aterosclerosis, amiloidosis, enfermedad de Alzheimer), se realizó una revisión sistemática en dos bases de datos (PubMed y SciELO) con los términos: "NLRP3 inflammasome therapeutic for kidney disease" y "NLRP3 inflammasome in kidney disease" en PubMed, e "Iinflammasome" en SciELO. Resultados Se encontró un total de 146 documentos, de los cuales solo 34 concuerdan con la hipótesis de trabajo desarrollada con relación al inflamasoma NLRP3 como componente central de diversas enfermedades en seres humanos y con potencial uso terapéutico. El inflamasoma NLRP3 es responsable de la maduración de la interleucina inflamatoria pro-IL-1 β y IL-18, l cual puede darse por causa de materiales agregados o cristalinos (partículas), y por diversos microorganismos y toxinas derivadas de los mismos; sin embargo, los mecanismos de activación de este proceso siguen sin ser claros en la actualidad. Conclusiones Se propone estudiar nuevas terapias que se centren en la eliminación o inhibición de los componentes inflamasoma, de manera individual y conjunta.(AU)

Changes in skeletal metabolism of glucocorticoids-treated children with kidney diseases / 中华实用儿科临床杂志

Objective To understand the skeletal metabolism in glucocorticoids-treated children with kidney diseases and to evaluate the role of Alfacalcidol plus calcium supplements.Methods A retrospective self-controlled study was performed in children with kidney diseases,admitted to Department of Pediatrics,Peking University First Hospital from July 2012 to November 2014,and they conformed to the inclusion and exclusion criteria.Inclusion criteria:children with renal diseases were included when they were administered with glucocorticoids,Alfacalcidol and calcium at the enrollment and follow-up,whose proteinuria was in remission or improved on follow-up,and renal function defined by glomerular filtration rate was more than 80 mL/(min · 1.73 m2),and they were followed up for at least 3 months.Exclusion criteria:whereas on follow-up,children with renal diseases were excluded if glucocorticoids was discontinued,or the follow-up period was less than 3 months,and related parameters were not available at the initial and finial visit.Serum levels of calcium,phosphate,alkaline phosphatase,25-hydroxy-vitamin D (25-OH-VitD) were detected,and bone mineral density at the left radius and mid tibia was measured by using quantitative ultrasound at the initial and finial visit.The levels of calcium,phosphate,alkaline phosphatase,25-OH-VitD and bone mineral density were compared between the initial and finial visit.Results A total of 29 cases (23 male,6 female) were recruited.Their ages at study entry were 2.4 to 14.9 years.Underlying disorders were primary nephrotic syndrome(17 cases),IgA nephropathy (4 cases),lupus nephritis (3 cases),purpura nephritis (2 cases),acute glomerulonephritis (1 case),Sjogren's disease(1 case),and autoimmune disease(1 case).At the time of enrollment,the course of disease was 1 to 69 months (median course of disease was 8 months),the duration of using corticosteroid was 0-60 months (median duration was 5 months),and the follow-up time was 92-409 days.The serum calcium,alkaline phosphatase and 25-OH-VitD levels at finial visit[(2.29 ±0.11) mmol/L,(153.21 ±71.00) U/L,and (40.96 ± 11.40) nmol/L,respectively] were significantly higher as compared with those at initial visit [(2.17 ± 0.16) mmol/L,(114.10 ±64.48) U/L,and (31.64 ± 10.99) nmol/L,respectively],and the differences were significant (all P ＜ 0.01),whereas there was no significant difference in serum level of phosphorate between initial and finial visit[(1.45 ±0.25) mmol/L vs.(1.48 ± 0.25) mmol/L] (t =-0.452,P ＞ 0.05).Meanwhile,there was significant difference in serum level of albumin level between initial and finial visit [(31.41 ± 9.31) g/L vs.(42.09 ± 4.00) g/L,t =-3.670,P ＜ 0.001].Compared with baseline assessment,bone mineral density at the left radius and tibia improved or maintained in 24/29 patients,whereas that of 5/29 patients declined.However,compared with initial and finial visit of bone mineral density in all patients(0.09 ± 1.58 vs.0.22 ± 1.07 at the left radius;0.93 ± 1.13 vs.1.00 ± 1.35 at the mid tibia),there was no significant difference (all P ＞ 0.05).Conclusions Bone loss can be prevented by Alfacalcidol plus calcium supplement in glucocorticoids-treated children with kidney diseases.

Analysis on the medical expenditure and influencing factors of the tumor and end-stage renal diseases of the poor patients in Hubei province / 中华医院管理杂志

Objective To analyze the basics and influencing factors for the medical expenditure of poor patients of tumor and end-stage renal diseases in Hubei province,and put forward policy recommendations for the critical illness insurance and health poverty alleviation.Methods 535 patients with tumor and end-stage renal diseases in Wuhan,Xiangyan and Shiyan in Hubei province were selected for a questionnaire survey,with 415 of the questionnaires subject to data analysis.Single factor variance analysis and multiple linear regression were used to analyze the influencing factors for their medical expenditure.Results 83.9% of the patients held their medical costs as too high;84.6% of them complaining significant drop of their annual family income due to their diseases; disposable household income of urban patients higher than their rural counterparts both before and after their disease; types of medical insurance and diseases are significant influencing factors for medical expenditure.Conclusions Poverty rate is high among patients of such patients.To reduce their financial burden,the government is recommended to cover more major diseases,enhance support for those of critical illness and improve the medical assistance system.

The clinicopathological characteristics of diabetic nephropathy and non-diabetic renal diseases in diabetic patients / 中华内科杂志

Objective To analyze the clinicopathological characteristics of renal lesions in type 2 diabetic patients and to differentiate diabetic nephropathy (DN) from non-diabetic renal diseases (NDRD).Methods Type 2 diabetic patients who received renal biopsy in Ruijin Hospital from January 2011 to December 2015 were recruited in this study. Clinical history, laboratory results and pathological data were retrospectively collected. According to the pathological findings, the patients were divided into 3 groups: DN, NDRD, DN+NDRD. Logistic model was applied to explore the independent clinical predictive factors in differentiating DN from NDRD. Results A total of 207 type 2 diabetic patients received renal biopsy, accounting for 6.82% of all biopsy population. Fifty-one patients were diagnosed with DN, 142 with NDRD and 14 with both DN and NDRD. In NDRD, membranous nephropathy(MN) (34.5%) was the most common finding, followed by IgA nephropathy(19.7%).By contrast, NDRD patients manifested a shorter diabetic course, a higher baseline hemoglobin level, a lower baseline serum creatinine, a higher prevalence of hematuria, a lower prevalence of hypertension and diabetic retinopathy, a better control of blood glucose, better compliance of monitoring blood glucose and less family history of diabetes. In multivariate logistic model, diabetic family history(OR=4.68, P=0.04) and long history of diabetes(OR=1.01, P=0.02) were risk factors of DN. Conclusion There is a high prevalence of NDRD in diabetic patients with renal lesions. Family history of diabetes and duration of diabetes are independent predictors of DN.

Relationship between disease stage and renal function in bisphosphonate-related osteonecrosis of the jaw

OBJECTIVES: Bisphosphonate is the primary cause of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Bisphosphonates are eliminated from the human body by the kidneys. It is anticipated that bisphosphonate levels in the body will increase if the kidney is in a weak state or if there is systemic disease that affects kidney function. The aim of this study was to analyze the relevance of renal function in the severity of BRONJ. MATERIALS AND METHODS: Ninety-three patients diagnosed with BRONJ in Pusan National University Dental Hospital from January 2012 to December 2014 were included in this study. All patients underwent a clinical exam, radiographs, and serologic lab test, including urine analysis. The patient's medical history was also taken, including the type of bisphosphonate drug, the duration of administration and drug holiday, route of administration, and other systemic diseases. In accordance with the guidelines of the 2009 position paper of American Association of Oral and Maxillofacial Surgeons, the BRONJ stage was divided into 4 groups, from stage 0 to 3, according to the severity of disease. IBM SPSS Statistics version 21.0 (IBM Co., USA) was used to perform regression analysis with a 0.05% significance level. RESULTS: BRONJ stage and renal factor (estimated glomerular filtration rate) showed a moderate statistically significant correlation. In the group with higher BRONJ stage, the creatinine level was higher, but the increase was not statistically significant. Other factors showed no significant correlation with BRONJ stage. There was a high statistically significant correlation between BRONJ stage and ‘responder group’ and ‘non-responder group,’ but there was no significant difference with the ‘worsened group.’ In addition, the age of the patients was a relative factor with BRONJ stage. CONCLUSION: With older age and lower renal function, BRONJ is more severe, and there may be a decrease in patient response to treatment.

Factores de progresión de disfunción renal en diabéticos ingresados en Medicina Interna / Renal disease´s progression factors in diabetic people admitted in Internal Medicine

Introducción: la nefropatía diabética es un factor de riesgo para desarrollar eventos cardiovasculares. Debido a que si su presencia se establece se reduce el filtrado glomerular y se acelera la aterosclerosis. Existen muchos factores de progresión que comprometen aun más sus aspectos fisiopatológicos y el pronóstico. Objetivo: caracterizar factores de progresión de disfunción renal en diabéticos ingresados en el Servicio de Medicina Interna, período 2012 a 2013. Materiales y Métodos: se realizó un estudio descriptivo, transversal y observacional en diabéticos ingresados en Servicio de Medicina Interna, Hospital Militar de Matanzas, con menos de diez años de evolución, en el período de 2012 a 2013; con consentimiento informado de pacientes y Jefe del Servicio. Se caracterizó la función renal para detectar precozmente factores de progresión de nefropatía diabética, en cada uno, en cuanto a filtrado glomerular y microalbuminuria. Para ello se revisaron historias clínicas. Las variables de afectación renal con factores de riesgo de progresión, tanto clínicos como paraclínicos fueron: edad, microalbuminuria, alteraciones del filtrado glomerular, hiperuricemia, dislipidemia, hiperglucemia, nivel de tensión arterial, sedentarismo, dieta y hábitos tóxicos. Usando la planilla de recolección de datos y la representación mediante tablas, números y por ciento. Resultados: la hipertrigliceridemia, hiperuricemia e hiperglucemia constituyeron los más asociados a descenso del filtrado glomerular y microalbuminuria positiva con 94,44 %, 80,33 % y 48,24 % respectivamente; en tan solo diez años de evolución de la diabetes. Conclusiones: evidente presencia de factores de progresión de enfermedad renal crónica en pacientes diabéticos.

Introduction: Diabetic Nephropathy is a very important risk factor for the development of cardiovascular disorders. It´s related with glomerular filtrate reduction and atherosclerosis. Then also many renal disease´s progression factors affect their physiophatological aspects and the prognosis. Objective: To caracterize renal disease´s progression factors in diabetic people admitted in Internal Medicine period of 2012 to2013. Materials and Methods: A retrospective descriptive longitudinal study was carried out. The sample was formed by 496 patients entered in the Internal Medicine Service, Military Hospital of Matanzas, and they haved less than ten years of evolution of their illness, in the understood period of 2012 at 2013. The used variables of chronic renal disease´s progression factors were: age, microalbuminuria, glomerular filtrate, toxic habits, diet, sedentarism, blood pressure level, serum uric acid and lipid levels. For organizing the obtained indicators authors applied the descriptive statistic method, analyzing the information through distribution tables. The results were represented in numbers and percent. Results: The most associated renal disease´s progression factors were hypertrygliceridemia, hyperuricemia and hyperglucemia. They respectively showed about 94,44 %, 80,33 % and 48,24 %. They were also associated with the worst affectation on glomerular filtrate and microalbuminuria in less than ten years old of diabetes evolution. Conclusions: there is a high presence of chronic renal disease´s progression factors in diabetic people.

Fatal disseminaeed cryptococcosis with renal involvement in an HIV-infected patient / Criptococose disseminada fatal com envolvimento renal em paciente infectado pelo HIV

SUMMARYIntroduction: We present a fatal case of disseminated cryptococcosis in a young man whose diagnosis of HIV infection was made at the time of admission to the emergency room.Case report: The patient was a twenty-three-year-old man, with a history of daily fever during one month associated with diarrhea, weight loss, headache, vomiting and generalized seizures. He also had a history of diabetes mellitus, alcoholism and drug addiction. Upon physical examination the patient was pale, disoriented and had periods of agitation. White blood cells count was 3,440/mm3 (5% lymphocytes), hemoglobin was 10g/dL, platelets were 83,000/ mm3. Creatinine was 0.7 mg/dL; urea 19 mg/dL; Na, K, and liver enzymes were within normal limits. Lactic dehydrogenase was 494 IU/L. Cerebrospinal fluid (CSF) analysis revealed 10 white blood cells/mm3 (58% neutrophils, 31% lymphocytes, 11% monocytes) and 2 red blood cells/mm3. India ink test revealed six Cryptococcusyeasts/mm3. CSF glucose was 122 mg/dL and protein was 36 mg/ dL. VDRL test was negative and anti-HIV test was positive. Intravenous hydration, insulin, phenytoin, fluconazole, pyrimethamine, sulfadiazine, folinic acid, and amphotericin B were started. The patient did not improve and became obtunded and hypotensive. He was intubated and put on mechanical respiration. He received vasoactive drugs and died less than 24 hours after admission. A postmortem examination was performed and revealed disseminated cryptococcosis, with severe involvement of the kidneys.Conclusion:Cryptococcosis, as a rule, is a systemic disease that affects mostly immunocompromised individuals, especially patients with AIDS. When diagnosed late in its course it has a very high mortality.

RESUMOIntrodução: Apresentamos um caso fatal de criptococose disseminada em homem jovem cujo diagnóstico de HIV foi feito no momento da admissão na emergência.Relato de caso: O paciente, de 23 anos, sexo masculino, tinha história de febre diária de um mês de duração, associada à diarreia, perda de peso, cefaleia, vômitos e convulsões generalizadas. Tinha ainda história de diabetes mellitus, alcoolismo e drogadição. Ao exame físico havia palidez, desorientação e períodos de agitação. Os exames laboratoriais mostraram 3.440 leucócitos/mm3(5% linfócitos), hemoglobina de 10 g/dL, 83,000 plaquetas/mm3, creatinina de 0,7mg/dL, ureia de 19 mg/dL, Na, K e enzimas hepáticas dentro dos limites da normalidade. A lactato desidrogenase era 494 UI/L. Análise do líquor revelou 10 leucócitos/mm3 (58% neutrófilos, 31% linfócitos, 11% monócitos) e 2 hemácias/mm3, glicose de 122 mg/dL e proteína de 36 mg/dL. A análise com tinta da Índia revelou seis blastoconídeos de Cryptococcus/mm³. O VDRL foi negativo e o anti-HIV positivo. Foi iniciado tratamento com hidratação venosa, insulina, fenitoína, fluconazol, pirimetamina, sulfadiazina, ácido folínico e anfotericina B. O paciente não apresentou melhora e evoluiu com obnubilação e hipotensão, sendo intubado e iniciada ventilação mecânica. Foram administradas drogas vasoativas, e o paciente evoluiu a óbito menos de 24h após a admissão. A autópsia revelou criptococose disseminada, com grave envolvimento renal.Conclusão:A criptococose é via-de-regra, doença sistêmica que afeta principalmente indivíduos imunocomprometidos, especialmente com AIDS, e quando diagnosticada tardiamente apresenta alta mortalidade.

P2 X7 receptor and renal diseases / 中国药科大学学报

P2 X7 receptor is a member of ATP-gated non-selective cation channels;and is one subtype family of the P2X purinergic receptor.Signaling pathways of P2X7 receptor couple with several key inflammatory molecules including IL-1β;IL-6 and COX-2;which suggests that P2 X7 receptor plays a key role in the development of dis-eases via increased inflammation;indicating its potential as a novel therapeutic target.Recent studies show that P2 X7 receptor has a relationship with renal diseases.This article reviews the effect of P2 X7 receptor on renal diseases and its mechanism.P2 X7 receptor may be a new drug target;and its selectivity antagonist may be a new therapeutic agent for the treatment of renal diseases.

El riñón y el aparato excretor urinario en la embarazada. Consideraciones básicas / The kidney and the urinary excretory system in the pregnant woman. Basic considerations

Los cambios en la estructura y función del aparato urinario que suceden durante el proceso reproductivo, son relevantes y garantizan la normalidad evolutiva de la preñez. Sin embargo, las complicaciones en el embarazo, parto y puerperio, además de las afecciones congénitas o adquiridas, pueden dañar la calidad de vida, e incluso la vida, del binomio madre-perinato. En esta revisión bibliográfica los autores describieron importantes aspectos del tema relacionados con la embriología, la anatomía, la fisiología, las modificaciones anatomofisiológicas, la exploración clínica y paraclínica y las enfermedades del tracto urinario. Asimismo, se consideraron la evolución del embarazo en la nefrópata, la estrecha correlación del riñón con la preeclampsia y la eclampsia, y las enfermedades crónicas no transmisibles de apreciable repercusión en la gestante (diabetes mellitus, hipertensión arterial crónica, hemoglobinopatías de tipo S rasgo S y enfermedades del colágeno). Finalmente, se reseñaron brevemente algunos elementos sobre los tumores renales en las embarazadas y los fundamentales medios terapéuticos como hemodiálisis, trasplante de riñón y trasplante de riñón y páncreas.

The changes in the structure and function of the urinary system taking place during the reproductive process are outstanding and they guarantee the progressive normality of pregnancy. However, complications in the pregnancy, childbirth and puerperium, besides the congenital or acquired disorders, can damage the life quality, and even life, of the mother-perinate binomial. In this literature review the authors described important aspects of the topic related to the embryology, anatomy, physiology, and the anatomical and physiologic modifications, the clinical and paraclinical examinations and diseases of the urinary tract. Likewise, the progress of pregnancy in the pregnant woman with nephropathy, the closed correlation of kidney with preeclampsia and eclampsia, and chronic non-communicable diseases of considerable repercussion on the pregnant woman (diabetes mellitus, chronic hypertension, S trait-S hemoglobinopathies and diseases of the collagen) were considered. Finally, some elements on the renal tumors in the pregnant women and the fundamental therapeutic means as hemodyalisis, kidney and pancreas transplant, and kidney transplant were briefly pointed out.

Terapia renal de reemplazo dialítica en cuba: tendencia durante los últimos 10 años / Dialitic renal replacement therapy in cuba: trend over the past 10 years

Introducción: la especialidad de Nefrología existe en Cuba, desde 1966. Ante los avances y el perfeccionamiento desarrollado en la Salud Pública es importante evaluar los cambios en los métodos dialíticos. Objetivo: reportar la tendencia de la terapia renal de reemplazo dialítica (TRR-D) en el país en el período 2001-2011. Método: el reporte incluye los datos de los indicadores de estructura, proceso y resultado de los pacientes, quienes reciben métodos dialíticos crónicos, recolectados por el Centro Coordinador del Programa Atención Nacional Enfermedad Renal, Diálisis y Trasplante (PANER). Resultados: el acceso a las TRR-D es universal y gratuito. El total de Servicios se incrementó de 24 en 2001 a 49 en 2011. La prevalencia en TRR-D crece; en 2001, fue de 150 por Millón de Población, a 243 pMP en el 2011. La hipertensión (34%) y la diabetes (27%) son las principales causas de Enfermedad Renal Crónica terminal. Las posibles explicaciones del incremento de pacientes en métodos dialíticos y la disminución de la mortalidad bruta están dadas por el incremento en las capacidades dialíticas, la mejoría tecnológica, el empleo de eritropoyetina a todos los que la requieran con la mejoría de la anemia, entre otras. Conclusión: la TRR-D, en Cuba, se ha incrementado en el período 2001-2011; ha aumentado el número de especialistas en Nefrología, su competencia, expresado en la mejoría de los resultados clínicos, consecuencia del acercamiento multidisciplinario a los pacientes, la mejor atención a sus comorbilidades y, en primer término, por la prioridad brindada por el Estado a este Programa a todos los niveles del Sistema.

Introduction: the nephrology in Cuba has been since 1966. Chronic Kidney Disease is now recognized as a global public health problem. As health improvement development in Cuba, it is important to evaluate the changes in dialysis status. We report the dialysys Program trend over de past 10 years. Methods: this report includes data of indicators of structure, process and results defined from patients who were receiving chronic dialysis treament over he past 2001-2011. Data was collected by the Center of PANER. Results: access to dialysis care is a right of every Cuban citizen and all treatment modalities are availables and it is universal. The total number of Services increase of 24 in 2001 to 49 in 2011 The prevalence of D-RRT continue to grow: in 2001 was 150 pMP, ant the 2011 of 243 pMP. Hypertension (34%) and diabetes (27%) are the leading cause of renal disease. In our case the possible explanations for the increase of patients and decrease of the crude mortality are of the increase in the capabilities of hemodialysis, improvements in technology, the use of erythropoietin and iron to all who need, between others. Conclusion: the dialysis RRT in Cuba has increased over the past 10 years, at the expense of the haemodialysis, as the clinical results have improved by the increase in the number of nephrologists their expertise and competence, comprehensive, multidisciplinary approach to patient care, the best treatment of comorbidities and the priority given to the Program at all levels of the health system.

A Case of Tubulointerstitial Nephritis and Uveitis Syndrome in an Elderly Patient

Tubulointerstitial nephritis and uveitis (TINU) syndrome is a rare disease entity usually occurring in children. In the present study a case of TINU syndrome in an elderly patient is described and relevant literature is reviewed. A 61-year-old man presented with bilateral flank pain, urinary frequency, and foamy urine. A kidney ultrasonography revealed an increase in kidney parenchyma echogenicity. Following a kidney biopsy, the patient was diagnosed with acute tubulointerstitial nephritis. An ophthalmology examination initially performed for floater symptoms, revealed anterior uveitis in both eyes. Acute tubulointerstitial nephritis and anterior uveitis in both eyes responded to treatment with oral prednisolone, furosemide, carvedilol, and a topical steroid. TINU syndrome can occur in the elderly and should be part of the differential diagnosis when seeing a patient who has uveitis in association with renal disease; any therapy should be managed by both an internist and an ophthalmologist.

Effects of intrauterine malnutrition on the renal morphology of Wistar rats: a systematic review

Introduction: Many epidemiological studies suggest that the intrauterine environment is extremely importantto the determination of the individual’s future health. Alterations in the maternal nutritional state, reflectedon the weight on birth, may program the litter for the development of diseases on the adult age. Studies withanimals exposed to intrauterine malnutrition have suggested a reduction in the number of glomeruli, as wellas arterial pressure increase. To review in the literature the alterations of the renal physiology of adult Wistarrats exposed to malnourishment during intrauterine life. Material and methods: A search was performedin the following databases: SciELO, MEDLINE, PUBMED, SCIENCE DIRECT and LILACS. The mainsearch terms were “malnutrition” and “renal function” both in Portuguese and in English. Were includedoriginal articles involving albino rats. Were excluded the review articles as well as those involving humanbeings. Results: According to Franco et al. (2009) the renal function and the number of glomeruli werereduced by the intrauterine malnutrition, predisposing the adult animals to renal diseases. For Chen and Chou(2009) the glomerular ultrastructure is not affected by maternal undernutrition, suggesting that this factordoes not contribute to the hypertension pathogenesis after maternal malnutrition. Conclusion: Intrauterinemalnourishment seems to interfere in the renal functions programming with alterations to the glomerulimorphology, but its mechanisms are yet uncertain. More randomized studies and clinical essays are suggestedin order to comprehend the factors that cause such process.