Associations between exposure to perfluoroalkyl substances and estimated glomerular filtration rate in population without kidney disease / 环境与职业医学

Background Perfluoroalkyl substances (PFASs) are classified as persistent organic pollutants and have been widely detected in human. Studies investigating the associations between PFASs exposure and estimated glomerular filtration rate (eGFR) yielded inconsistent results, and little is known about the effects of PFASs on eGFR in population without kidney disease. Objective To explore the associations of exposure to PFASs with eGFR and renal dysfunction in population without kidney disease. Methods A total of 609 participants with an eGFR > 60 mL·min−1·1.73 m−2 and without renal impairment matched for sex and age (1∶1) were recruited from endocrinology department and medical examination center of two hospitals in Tianjin, China, from April 2021 to March 2022. Each subject was interviewed using a structured questionnaire to collect information about sex, age, height, weight, disease history, smoking, alcohol intake, etc. Clinical parameters were obtained from medical record, such as fasting blood glucose (FBG), creatinine (Cre), total cholesterol (TC), and triglyceride (TG). Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured by professionals using standard methods. The serum concentrations of PFASs were determined by liquid chromatography/mass spectrometry. Multivariable linear and logistic regression models were performed to evaluate the associations of PFASs exposure with eGFR and renal dysfunction, respectively. Subgroup analyses stratified by age and sex were also performed to assess the modified effects of covariates on the associations of PFASs exposure with eGFR. Results There were 283 males, accounting for 46.5% of the total population. The mean age of the participants was (56.86±12.47) years, and the average body mass index (BMI) was (25.59±3.84) kg·m−2. Perfluoro-n-octanoic acid (PFOA), perfluorohexane sulfonic acid (PFHxS), perfluorooctane sulfonic acid (PFOS), perfluoro-n-nonanoic acid (PFNA), perfluoro-n-decanoic acid (PFDA), perfluoro-n-undecanoic acid (PFUnDA), sodium 1H, 1H, 2H, 2H-perfluoro-1-octanesulfonate (6:2 FTS), and perfluoropentane sulfonic acid (PFPeS) were positive in more than 75% of serum samples, and the corresponding median concentrations were 9.50, 1.67, 17.22, 1.86, 1.41, 0.78, 0.42, and 0.43 μg·L−1, respectively. After full adjustments of sex, age, BMI, hypertension, diabetes, TC, TG, smoking, and drinking, the linear regression models showed that log2-transformed PFHxS concentration was negatively associated with eGFR (b=−1.160, 95%CI: −2.280, −0.410). Compared with the lowest exposure tertile, the estimated change of eGFR in the highest tertile for PFHxS was significantly decreased (b=−2.471, 95%CI: −4.574, −0.368). Furthermore, compared with males, the negative association of PFHxS with eGFR was strengthened among females (female: b=−1.281, 95%CI: −2.388, −0.174; male: b=−0.781, 95%CI: −2.823, 1.261, Pinteraction=0.043). Conclusion A significant negative association between serum PFHxS and eGFR is observed in the sampled population without kidney disease, and females are more susceptible to PFASs exposure than the males.

Impact of different types of heart failure on long-term renal prognosis in patients with renal insufficiency and heart failure / 中华肾脏病杂志

Objective:To investigate the effects of different types of heart failure on long-term renal prognosis in patients with renal insufficiency and heart failure.Methods:The patients with renal insufficiency [baseline estimated glomerular filtration rate < 60 ml·min -1·(1.73 m 2) -1] and heart failure followed-up for more than 2 years and hospitalized in Beijing Anzhen Hospital, Capital Medical University from January 1, 2018 to June 30, 2019 were enrolled in this retrospective cohort study. The patients were divided into three groups based on the baseline left ventricular ejection fraction (LVEF): heart failure with reduced ejection fraction (HFrEF, LVEF < 40%) group, heart failure with mildly reduced ejection fraction (HFmrEF, 40% ≤ LVEF < 50%) group, and heart failure with preserved ejection fraction (HFpEF, LVEF ≥ 50%) group. Clinical data were collected and endpoint events (adverse renal outcome: the composite outcome of all-cause death or worsening renal function) were recorded through the electronic medical record system. Kaplan-Meier survival curve was used to analyze the incidence of endpoint events of different heart failure subgroups. Cox regression model was performed to analyze the risk factors of endpoint events. Results:A total of 228 patients with renal insufficiency complicated with heart failure were included, with age of (68.14±14.21) years old and 138 males (60.5%). There were 85 patients (37.3%) in the HFrEF group, 40 patients (17.5%) in the HFmrEF group, and 103 patients (45.2%) in the HFpEF group. There were statistically significant differences in age, proportion of age > 65 years old, sex distribution, systolic blood pressure, pulmonary artery pressure, serum sodium, serum calcium, hemoglobin, serum cholesterol, low-density lipoprotein cholesterol, serum uric acid, troponin I, hypersensitive C-reactive protein, LVEF, ventricular septal thickness, left ventricular end-diastolic diameter, B-type natriuretic peptide, estimated glomerular filtration rate, and proportions of using beta blockers, using spirolactone, myocardial infarction, hypertension, cardiomyopathy and atrial fibrillation (all P < 0.05). During the median follow-up of 36.0 (28.0, 46.0) months, 73 patients (32.0%) had adverse renal outcomes. The total incidences of adverse renal outcomes were 32.9% (28/85) in the HFrEF group, 35.0% (14/40) in the HFmrEF group, and 30.1% (31/103) in the HFpEF group. Kaplan-Meier survival curve showed that there was no significant difference in the incidence of endpoint events among the three groups (log-rank test χ2=0.17, P=0.680). Multivariate Cox regression analysis showed that HFpEF (HFrEF as reference, HR=2.430, 95% CI 1.055-5.596, P=0.037) was an independent influencing factor of endpoint events. Conclusions:The long-term renal prognosis of patients with renal insufficiency and heart failure is poor. Compared with HFrEF, HFpEF is an independent risk factor of poor long-term renal prognosis in renal insufficiency patients with heart failure.

Sinkihwan-gamibang ameliorates puromycin aminonucleoside-induced nephrotic syndrome / 中国天然药物

Nephrotic syndrome (NS) is a kidney disease characterized by hypertriglyceridemia, massive proteinuria, hypo-albuminemia and peripheral edema. Sinkihwan-gamibang (SKHGMB) was recorded in a traditional Chinese medical book named "Bangyakhappyeon ()" and its three prescriptions Sinkihwan, Geumgwe-sinkihwan, and Jesaeng-sinkihwan belong to Gamibang. This study confirmed the effect of SKHGMB on renal dysfunction in an NS model induced by puromycin aminonucleoside (PAN). The experimental NS model was induced in male Sprague Dawley (SD) rats through injection of PAN (50 mg·kg-1)via the femoral vein. SKHGMB not only reduced the size of the kidneys increased due to PAN-induced NS, but also decreased proteinuria and ascites. In addition, SKHGMB significantly ameliorated creatinine clearance, creatinine, and blood urea nitrogen. SKHGMB relieved glomeruli dilation and tubules fibrosis in the glomeruli of the NS model. SKHGMB inhibited the protein and mRNA levels of the NLRP3 inflammasome including NLRP3, ASC, and pro-caspase-1 in NS rats. SKHGMB reduced the protein and mRNA levels of fibrosis regulators in NS rats. The results indicated that SKHGMB exerts protective effects against renal dysfunction by inhibiting of renal inflammation and fibrosis in NS rats.

A Study on the Safety of Long-Term Magnesium Oxide Administration in Elderly Patients with Impaired Renal Function / 医薬品情報学

Objective: Risk factors for hypermagnesemia due to magnesium oxide (MgO) include advanced age, decreased renal function, and long-term administration; however, no study has evaluated patients that present all of these factors. This study was aimed to evaluate the safety of long-term MgO administration in elderly patients with impaired renal function.Methods: We investigated changes in serum Mg in patients aged 65 years or older, who had been taking oral MgO and presenting a glomerular filtration rate (eGFR) ＜60 mL/min/1.73 m2 for 6 months or longer.Results: Thirty patients were surveyed. Their median age was 81 years (range, 68-92). No significant change in patient background was observed before and after initiating MgO administration, with no change in serum Mg detected. Furthermore, the oral dose of MgO was divided into groups taking ＜1,000 mg and ≥ 1,000 mg; no change in serum Mg was observed in either group. Based on renal function, the analysis was divided into a mildly decreased group (60＞ eGFR ≥ 45) and a moderately to severely decreased group (45＞ eGFR ≥ 15), and no change in serum Mg was observed in either group.Conclusions: We targeted elderly patients with renal dysfunction who were taking long-term MgO, a known risk factor for hypermagnesemia, indicating that MgO can be safely continued.

Patients with Renal Failure Who Received a Small Dose of Hydromorphone and Presented with Neurotoxicity

In Japan, there are not many reports of using hydromorphone for patients with renal failure and occurring neurotoxicity such as disturbance of consciousness. This report includes two cases of consciousness disorder such as delirium when hydromorphone was started or increased in patients with renal dysfunction. In the case 1, delirium appeared when hydromorphone dosage was increased from 2.4 mg to 3.6 mg intravenously for cancer pain. After reduction of dosage, consciousness disorder was improved. In the case 2, delirium also appeared when oral hydromorphone started at 2 mg for cough and dyspnea. After discontinuation of hydromorphone, the disturbance of consciousness was improved. In both cases, hydromorphone improved cancer pain, cough, and dyspnea, but it was difficult to continue hydromorphone due to adverse events, and opioid switching was required. Although there are reports of neurotoxicity caused associated with the use of high-dose, long-term hydromorphone in patients with renal failure, neurotoxicity may be shown even with small doses and short-term administration.

Elucidating the Possible Mechanism of Renal Dysfunction in Alpha Thalassaemia: A Review

@#Recent improvement in the treatment and management of α-thalassaemia has enabled patients to live longer and have better quality of life, thus revealing other complications related to the disorder mainly due to the effects of chronic ineffective erythropoiesis and iron overload. We review the renal dysfunction seen in α-thalassaemia as it has been reported (published and personal communication) that the complications presented are more severe than those found in β-thalassaemia patients of similar severity clinically. This review aims to shed light on emerging complications that are currently faced by α-thalassaemia patients as they progress further in life

Association between lipoprotein (a) level and chronic cardio-renal syndrome in elderly patients / 中华心血管病杂志

Objective: To explore the relationship between lipoprotein(a) [Lp(a)] and chronic cardio-renal syndrome (CRS) in elderly patients. Methods: Chronic heart failure (CHF) patients age ≥ 65 years old, who hospitalized in the department of Cardiology of Hebei General Hospital from December 2017 to October 2019, were included in this study. According to the estimate glomerular filtration rate (eGFR) level, patients were divided into CRS group (eGFR<60 ml·min-1·1.73 m-2) and CHF group (eGFR ≥60 ml·min-1·1.73 m-2). The blood index and basic disease information were collected and compared. Left ventricular ejection fraction (LVEF) were measured by echocardiography. The correlation between clinical indicators and cardio-renal function (LVEF and eGFR) was assessed. The multivariate logistic regression analysis was used to evaluate the related risk factors of CRS in elderly patients; subgroup logistic regression analysis was performed according to the basic disease of patients to assess the relationship between Lp(a) and CRS. Results: A total of 172 elderly patients (85 males (49.4%), aged 79 (71, 84) years) were finally enrolled. Among them, 88 cases (51.2%) were in CRS group and 84 cases (48.8%) were in CHF group. Age (80 (74, 84) years old vs. 74 (70, 82) years old) and LP (a) levels (222.0 (112.0, 445.3) mg/L vs. 155.0 (97.0, 348.7) mg/L) were significantly higher in the CRS group than in the CHF group (P<0.05). Lp(a) levels were negatively correlated with LVEF (r=-0.155, P=0.043) and eGFR (r=-0.220, P=0.004) in total cohort. In the subgroup analysis of patients with 2 high-incidence basic diseases (coronary heart disease and hypertension), Lp(a) was negatively correlated with LVEF (r=-0.250, P=0.007) in the coronary heart disease group, and negatively correlated with eGFR (r=-0.233, P=0.013) in the hypertension group. Multivariate logistic regression analysis showed that age (OR = 1.069, 95%CI: 1.017-1.124, P= 0.009) and Lp(a) (OR = 3.719, 95%CI: 1.339-10.326, P = 0.012) were independent correlates of CRS. The results of logistic regression analysis showed that Lp(a) was an independent correlative factor of CRS in the subgroups of coronary heart disease (OR=3.207, 95%CI: 1.129-9.108, P=0.029) and hypertension (OR=3.054, 95%CI: 1.086-8.587, P=0.034). Conclusion: Serum Lp(a) level is independently related with CRS in elderly patients.

Ophiopogonin D of Ophiopogon japonicus ameliorates renal function by suppressing oxidative stress and inflammatory response in streptozotocin-induced diabetic nephropathy rats

Ophiopogonin D (OP-D) is the principal pharmacologically active ingredient from Ophiopogon japonicas, which has been demonstrated to have numerous pharmacological activities. However, its protective effect against renal damage in streptozotocin (STZ)-induced diabetic nephropathy (DN) rats remains unclear. The present study was performed to investigate the protective effect of OP-D in the STZ-induced DN rat model. DN rats showed renal dysfunction, as evidenced by decreased serum albumin and creatinine clearance, along with increases in serum creatinine, blood urea nitrogen, TGF-β1, and kidney hypertrophy, and these were reversed by OP-D. In addition, STZ induced oxidative damage and inflammatory response in diabetic kidney tissue. These abnormalities were reversed by OP-D treatment. The findings obtained in the present study indicated that OP-D might possess the potential to be a therapeutic agent against DN via inhibiting renal inflammation and oxidative stress.

Costus Root Extract Alleviates Blood Biochemical Derangements of Experimentally-Induced Hypo- and Hyperthyroidism in Mice

Objectives: Thyroid hormones regulate all metabolic activities; therefore, it is not amazing that hepatic; renal dysfunctions and lipid alterations are commonly detected in patients with thyroid disorders. This study estimated some biochemical changes in post pubertal hyperthyroid and hypothyroid mice and their impacts on liver and kidney functions and also on changes in the lipid pattern. In addition, the ameliorating role of Costus root extract supplementation was examined. Material and Methods: A total of 60 male Swiss albino mice were randomly divided into 5 groups; control, control with costus extract, hypo- and hyper-thyroids post-treated with costus root extract. Results: Present results revealed that, a significant increase in serum thyrotropin (TSH), alanine transaminase (ALT) and aspartate transaminase (AST), alkaline phosphatase (ALP), creatinine, urea, potassium, chloride, cholesterol and triglycerides levels in hypothyroid mice compared to control. On the other hand; a significant decrease in serumthyroxine (T4), tri‐iodothyronine (T3), albumin, total protein and calcium ions levels in hypothyroid mice compared to control. In contrast to hypothyroidism, a significant increase in serum T3, ALT, AST, ALP, creatinine, urea, sodium, potassium, chloride and total proteins levels in hyperthyroid mice compared to control. On the other hand; a significant decrease in serum TSH, T4, albumin, calcium ions cholesterol and triglycerides levels in hyperthyroid mice compared to control. Treatments of mice with Costus root extract in both hypo- and hyperthyroidism modulates the measured serum parameters. Conclusions: Our results could propose that the extract of Costus roots can be used as an adjuvant co-therapy in hypo- and hyperthyroidism syndromes with propylthiouracil and Eltroxin replacement therapy, respectively

Study of Renal Function in Chronic Liver Disease

Renal dysfunction is common in chronic liver diseases. The cause of renal dysfunction is either multi-organ involvement in acute conditions or secondary to advanced liver diseases. The present study was undertaken to assess the renal function test in chronic liver diseases and find out the association of alteration of renal function with gradation of liver diseases (assessed by child –pugh criteria) and find out the association of alteration of renal functions among the case of chronic liver disease of different aetiology. Methods: This prospective cross sectional study was conducted in the Department of Medicine, Shri. B. M. Patil Medical College, Hospital & Research Centre, Vijayapur during November 2016 to August 2018 with 65 case of chronic liver diseases after considering the exclusion criteria. The patient were interviewed with predesigned and pre tested schedule examined clinically followed by some laboratory investigation relevant to diagnose the aetiology of chronic liver diseases, and to assess the severity of renal dysfunction. Statistical analysis was done by appropriate statistical software including but not restricted to MS Excel, SPSS ver.20 Results: Majority of the patients were male(90.8%) and the mean age of the patients was 45.78 ±13.19 years. 72.2% patients suffered from Alcoholic liver diseases while 13.9% and 10.8% patients had chronic hepatitis B and chronic hepatitis C respectively. Two patients had Nonalcoholic steatohepatitis. It was observed that 36.9% patients had renal dysfunction and most. Conclusion: This study emphasizes the fact that we should be more vigilant when treating Chronic Liver Disease (CLD) patients, regarding their renal function, as proper screening, prevention and treatment of renal dysfunction can decrease morbidity and mortality.

Effects of Niaoduqing Particles () on Delaying Progression of Renal Dysfunction: A Post-trial, Open-Label, Follow-up Study / 中国结合医学杂志

OBJECTIVE@#To follow up the participants of the randomized clinical trial "Efficacy and Safety of Niaoduqing Particles () for Delaying Moderate-to-Severe Renal Dysfunction", and assess the long-term effects of Niaoduqing Particles on delaying the progression of renal dysfunction.@*METHODS@#Participants, who had previously been randomly assigned to receive Niaoduqing Particles or placebo for 24 weeks (146 cases in each group), were invited to follow-up and all were administered Niaoduqing Particles 5 g thrice daily and 10 g before bedtime for 24 weeks. The primary endpoints were changes in baseline serum creatinine (Scr) and estimated glomerular filtration rate (eGFR) after completion of the open-label treatment period.@*RESULTS@#After the double-blind period, the median (interquartile range) changes in Scr were 1.1 (-13.0-24.1) and 11.7 (-2.6-42.9) μmol/L for the Niaoduqing Particle and placebo groups, respectively (P=0.008), and the median changes in eGFRs were-0.2 (-4.3-2.7) and-2.21 (-5.7-0.8) mL•min•1.73 m, respectively (P=0.016). There were significant differences in the double-blind period changes in renal function between groups. After the open-label period, the median changes in Scr were 9.0 (-10.0-41.9) and 17.5 (-6.0-50.0) μmol/L for the Niaoduqing Particle and placebo groups according to baseline grouping, respectively (P=0.214), and the median changes in eGFRs were-2.3 (-6.4-1.9) and-3.7 (-7.5-1.1) mL•min•1.73 m, respectively (P=0.134). There were no statistical differences in the open-label period changes in renal function between groups. The eGFR reduction of participants who accepted Niaoduqing Particle treatment for 48 weeks was projected to 2.5 mL•min•1.73 m per year.@*CONCLUSION@#Niaoduqing Particles appear to have long-term efficacy for patients with moderate-to-severe renal dysfunction. Although there was no statistical difference, the early use of Niaoduqing Paticles seems to ameliorate the worsening of renal function. (Trial registration No. ChiCTR-TRC-12002448).

Assessment of Potential Renal Dysfunction in Patients with Congenital Heart Disease after Biventricular Repair

BACKGROUND AND OBJECTIVES: There are few reports on renal dysfunction in the remote period after biventricular repair, and biomarkers for early detection of renal dysfunction are not well understood. We examined whether early fluctuation of biomarkers of renal function occurs in the remote period after biventricular repair in patients with congenital heart disease (CHD). METHODS: Fourteen patients with CHD after biventricular repair were included. The examination values obtained by cardiac catheterization test and renal function indices based on blood and urine sampling were compared. RESULTS: The median estimated glomerular filtration rate (eGFR) of creatinine was 113 mL/min/1.73 m2, and the median eGFR of cystatin C was 117 mL/min/1.73 m2. A urine albumin-to-creatinine ratio (UACR) ≥10 mg/gCr was considered a risk factor for cardiovascular disease in 6 (43%) patients. There was a significant difference in right ventricular ejection fraction and deviation in right ventricular end-diastolic volume from the normal value between the 2 groups divided by UACR. Cyanosis before biventricular repair was noted in 2 (25%) patients with UACR < 10 mg/gCr and in 4 (67%) patients with UACR ≥10 mg/gCr. CONCLUSIONS: Increased UACR was noted in 43% of patients. In patients with UACR ≥10 mg/gCr, right heart system abnormality was observed, and several patients had cyanosis before radical treatment. Measurement for UACR may be able to detect renal dysfunction early in the postoperative remote period.

Effects of telbivudine and entecavir on improvement of renal function in chronic hepatitis B patients with renal impairment after adefovir dipivoxil treatment / 中国医师进修杂志

Objective To explore the effects of telbivudine (LdT) and entecavir (ETV) on renal function in chronic hepatitis B (CHB) patients with renal damage after adefovir dipivoxil (ADV) treatment. Methods The clinical data of 40 CHB patients with renal damage after ADV treatment from January 2015 to February 2016 were retrospectively analyzed. The patients were divided into 2 groups according to the substitution drugs. Twenty patients in ETV group received ETV replacement therapy, and 20 patients in LdT group received LdT replacement therapy. The serum alanine aminotransferase (ALT), serum creatinine, serum creatine kinase (SCK), urinary β2-microglobulin (Uβ2-MG), estimated glomerular filtration rate (eGFR), classification of renal function, improvement of renal function and positive rate of HBV-DNA were compared between 2 groups. Results There was no statistical difference in serum ALT between 2 group (P＞0.05). The serum creatinine, SCK, Uβ2-MG and eGFR levels after treatment in LdT group were significantly better than those in ETV group: (92.08 ± 9.35) μmol/L vs. (101.21 ± 10.31) μmol/L, (133.69 ± 31.29) U/L vs. (106.14 ± 26.19) U/L, (5 126.17 ± 415.79) μg/L vs. (6 381.92 ± 574.12) μg/L and (81.61 ± 20.52) ml/(min·1.73 m2) vs. (75.34 ± 19.67) ml/(min·1.73 m2), and there were statistical differences (P＜0.05). There was no statistical difference in the positive rate of HBV-DNA after treatment between 2 groups (P＞0.05). The abnormal rate of renal function classification after treatment in LdT group was significantly lower than that in ETV group: 0 vs. 20.0% (4/20), the improvement rate of renal function in ETV group was significantly higher than that in ETV group: 100.0% (20/20) vs. 80.0% (16/20), and there were statistical differences (P＜0.05). Conclusions The effect of LdT on renal function improvement in CHB patients with renal damage after ADV treatment is more obvious than that of ETV, which can significantly improve serum creatinine, SCK, Uβ2-MG and eGFR, and reduce the abnormal renal function.

Relationship of Serum Neutrophil Gelatinase-associated Lipocalin Levels with Stroke Attack and Renal Dysfunction in Patients / 现代检验医学杂志

Objective To explore the correlations of neutrophil gelatinase associated lipocalin (NGAL) with cerebral stroke attack and renal dysfunction of patients.Methods 63 patients with first-diagnosed hemorrhagic stroke (HS),233 patients with first diagnosed ischemic stroke (IS) and 293 healthy controls were randomly selected.Their age,gender and clinical his tory of hypertension,diabetes,coronary heart disease and hyperuricemia were recorded at admission,and their serum levels of kidney function/injury biomarkers (NGAL,Cr,Urea,CysC and eGFR) were measured at the next day.According to KDIGO guidelines standards,all subjects were divided into four groups on behalf of their renal damage degree:AKI,CKD,transient or no kidney injury,and control group.And then,the relations of these indicators with stroke attack and renal function of HS and IS patients were analyzed.Results The medians of serum NGAL levels in the patients with HS and IS were 160.0 and 142.9 μg/L,their difference had no statistical significance (Z=2.332,P＞0.05),but were higher than healthy controls (Z =12.621,9.189,all P＜0.05).The levels of serum NGAL in AKI,CKD,transient or no renal dysfunction,and control groups were 375.3,228.6,141.6 and 103.8 μg/L respectively,which had statistically significant differences between each other (Z=3.661～11.237,all P＜0.05).NGAL level was positively related to HS attack (rp=0.423,P＜0.001),IS attack (rp =0.231,P＜0.001) and renal dysfunction in both HS and IS patients (rp=0.429,0.289,all P＜0.001).Its partial cor relation coefficient was only lower than hypertension within HS stroke attack,and lower than coronary heart disease and diabetes within IS stroke attack,but the highest within renal function of either HS or IS patients.For assessing HS and IS attack,NGAL levels play a limited role (OR=1.044,0.974,allP＜0.001),in contrary to NGAL abnormity (OR =27.841,15.411,all P＜0.001).Conclusion Elevated NGAL levels may be a risk factor for stroke,suggesting that kidney injury or renal dysfunction may be associated with stroke,and the prevention and treatment of stroke should pay attention to the change of NGAL.

Diálisis peritoneal paliativa en pacientes con falla cardiaca sin enfermedad renal terminal / Palliative peritoneal dialysis in patients with heart failure without end-stage renal Failure

Resumen Dentro de los grandes problemas que se tienen en falla cardiaca, el manejo del volumen en algunos de los pacientes resulta muy difícil y ocasionalmente puede producir grandes alteraciones renales, por lo cual ha sido una de las principales preocupaciones dentro de las estrategias terapéuticas. La diálisis peritoneal ha surgido como una estrategia en algunos pacientes con presencia de disfunción ventricular y de disfunción renal; sin embargo, hay un grupo de pacientes en los cuales el deterioro de la función renal no es severo, pero hay imposibilidad para el manejo óptimo con diuréticos a dosis más altas y hay necesidad de mayor manejo de volumen. La diálisis peritoneal ha evidenciado beneficios clínicos, entre los cuales se encuentra la posibilidad de manejo ambulatorio, el cambio de su clase funcional de III/IV a I/II, la mejoría de la calidad de vida, la reducción en los días de hospitalización o el aumento de la función renal. Se ha realizado una revisión de este escenario específico con presentación de los primeros casos que se han dispuesto con esta finalidad en la clínica de falla cardíaca de la Fundación Cardiovascular de Colombia.

Abstract Within the great problems of heart failure, the management of volume in some of the patients is a difficult task and could occasionally produce severe renal alterations, thus becoming one of the main worries when it comes to therapeutic strategies. Peritoneal dialysis has emerged as a strategy in some patients with ventricular dysfunction and renal dysfunction; however, there is a group of patients where the deterioration of renal function is not severe, but there is an impossibility of optimal management with diuretics at higher doses and there is a need for a greater volume management. Peritoneal dialysis has evidenced clinical benefits, among which there is the possibility of outpatient management, the change from functional class III/IV to I/II, the improvement in quality of life, the decrease of hospitalization days or the increase in renal function. A review of this specific scenario with the presentation of the first cases that have been managed with this motivation in the heart failure clinic of the Cardiovascular Foundation of Colombia is conducted.

Clinical retrospective analysis of 138 cases of multiple myeloma / 中华急诊医学杂志

Objective To analysis of multiple myeloma (MM) and non-MM patients with the same clinical manifestations but significant differences in laboratory findings at the first visit to the Emergency Medicine Department suggesting that patient should be rule out the possibilities of suffering from MM by the attending physicians engaging in a specialty other than hematology as soon as possible to avoid misdiagnosis of MM.Methods Retrospective analysis of clinical features of MM cases from February 2013 to December 2016.Patients with renal dysfunction (serum creatinine ≥ 177 mmol/L),infection,bone pain and anemia were divided into four groups.The non-MM patients with the same clinical symptoms were enrolled as control group.SPSS22.0 and Medcalce 15.10 software were used for analyzing the distinct difference and diagnostic validity of routine laboratory tests in patients with MM and non-MM.Results ①The patients with serum creatinine≥ 177 mmol/L,and unexplained renal insufficiency with blood Ca2+ ＞ 2.39mmol/L,ALB ≤ 30.31 g/L and Hb≤84 g/L should be investigated the possibility of MM.②The patient with poor response to the conventional treatment and unexplained infection with IgM ＜0.42 g/L and ALB≤32.7 g/L or ESR ＞ 82 mm/h and Hb ＜ 100 g/L should be investigated the possibility of MM.③The male patients with the first symptom in bone and joint pain associated with bone damage with urinary protein and blood,and the emergence of Ca2+ ＞ 2.39 mmol/L,ALB ＜ 37.5 g/L,Hb ＜ 104 g/L and TT ＞ 19.8 s were suggested to detect MM.④The poor respose to conventional treatment,unexplained anemia (Hb≤90 g/L),IgM ＜ 0.51 g/L,ALB ＜ 34.1 g/L and GLB ＞ 46.4 g/L suggested to detect MM.Conclusions On the basis of symptoms such as renal insufficiency,infection,bone pain,anemia,routine blood laboratory findings of high calcium,low IgM,low albumin,and high globulin,it was recommended that bone marrow biopsy be made to detect MM.

Hyperhomocysteinemia Promotes Renal Function Impairment in Patients with Chronic Stable Coronary Artery Disease / 中国医科大学学报

Objective To investigate the possible mechanism of hyperhomocysteinemia (HHcy) in renal dysfunction in patients with chronic stable coronary artery disease (SCAD).Methods We consequentially enrolled patients diagnosed as having SCAD and,according to homocysteine (Hcy) levels,divided them into the HHcy group (Hcy≥15 μmol/L,n =53) and control group (Hcy＜15 μmol/L,n =47).We further tested the relationship among plasma Hcy level,renal function,and serum levels of interleukin (IL)-6 and adiponectin (APN).Results IL-6 was significantly higher in the HHcy group than in the control group (P ＜ 0.05).However,APN level was obviously lower in the HHcy group than in the control group (P ＜ 0.05).Correlation analysis revealed that Hcy level positively correlated with creatinine (r =0.379,P ＜ 0.001),uric acid (r =0.238,P =0.019),cystatin C (r =0513,P ＜ 0.001),and IL-6 levels (r =0.561,P ＜ 0.001) but negatively correlated with estimated glomerular filtration rate (eGFR;r =-0.288,P =0.023) and APN level (r =-0.428,P ＜ 0.001).IL-6 level showed positive correlations with creatinine (r =0.406,P =0.002),uric acid (r =0.359,P =0.007),and cystatin C levels (r =0.387,P =0.007) but a negative correlation with eGFR (r =-0.370,P =0.005).Meanwhile,APN level showed negative correlations with creatinine (r =-0.694,P ＜ 0.001),uric acid (r =-0.420,P ＜0.001),and cystatin C levels (r =-0.553,P ＜ 0.001),but a positive correlation with eGFR (r =0.251,P =0.034).Conclusion Plasma Hcy level may have a predictive value for renal dysfunction in patients with SCAD.Moreover,HHcy probably promoted renal dysfunction by inducing the imbalance of anti-inflammation and pro-inflammation in patients with SCAD.

Comparison of acute ischaemic stroke adult patients with atrial fibrillation to without atrial fibrillation in the effect on renal dysfunction / 实用医学杂志

Objective To find out whether inpatients with acute ischaemic stroke and atrial fibrillation (AF) have higher rate of renal dysfunction than without AF,and analyze risk factors associated with renal dysfunction.Method 374 patients with acute ischaemic stroke and AF were enrolled,which cases have complete data.500 patients were randomly selected as the non-AF group.To compare the prevalence of renal dysfunction [eGFR ＜ 60 mL/(min· 1.73 m2)] of two groups.Non-conditional Logistic regression analysis was used to detemmine the factors associated with renal dysfunction.Results 374 patients in AF group,114 (30.5％) were renal dysfunction;500 patients in non-AF group,75 (15％) were renal dysfunction (P =0.000,OR =2.485).The eGFR of AF and non-AF group was (77.75 ± 39.89) mL/(min· 1.73 m2) and (96.93±39.14) mL/(min · 1.73 m2).In Logis tic regression analysis,heart dysfunction (OR =2.057),hypertension (OR =1.826),diabetes (OR =1.897),hypevuricemia (OR =3.161) were found to be associated with renal dysfunction.Conclusions Adult patients with acute ischaemic stroke and AF have a higher rate of renal dysfunction than acute ischaemic stroke without AF.Heart dysfunction,hypertension,diabetes,hyperuricemia were factors associated with renal dysfunction.

Preventive effect of trimetazidine on contrast - induced nephropathy in patients with chronic renal insufficiency after coronary intervention / 实用医学杂志

Objective This study was to investigate the role of trimetazidine in the prevention of contrast-induced nephropathy (CIN) in renal dysfunction patients undergoing coronary angiography. Methods A total of 151 patients with renal dysfunction who underwent coronary angiography were enrolled in our study and randomly divided into control group (n=77) and trimetazidine group (n=74). Standard hydration was administered in all the patients. In trimetazidine group, patients were administered trimetazidine orally for 48 hours before and 7 days after coronary angiography. Adverse events were observed in 12 months. Results (1) For 24 h and 48 h after the procedure:levels of SCr and CysC in the control group were significantly increased compared with baseline levels; levels of SCr and CysC in trimetazidine group were not increased, compared with baseline levels;levels of SCr and CysC were lower in trimetazidine group than the control group. (2)The incidence of CIN was reduced in trimetazidine group compared with control group (22.1%vs 9.5%,P=0.034). (3) Kaplan-Meier analysis showed that the incidence of adverse events in trimetazidine group was lower compared with the control group (P = 0.003). Conclusions Trimetazidine in combination with standard hydration is more effective than isotonic saline alone in protecting renal function in patients with renal dysfunction who undergo coronary angiography.

Predictive value of serum Klotho level for progression of renal function in patients with chronic kidney disease / 临床检验杂志

Objective To observe the relationship between serum Klotho levels and the progression of renal function in patients with chronic kidney disease (CKD)and investigate further the feasibility of serum Klotho levels for predicting the progression of renal function in CKD patients.Methods Eighty-one non-dialysis patients with CKD 3 to 5 stages and 30 healthy volunteers in the First People's Hospital of Kunshan were enrolled for a 12 months of follow-up.The levels of Klotho and fibroblast growth factor 23 (FGF23) in serum were detected by ELISA at the beginning and the end of the follow-up.The other related indicators were also tested simultaneously.GFR values were calculated by MDRD and GC formulas.According to the decreasing range of GFR,the CKD patients were subdivided into two groups:deterioration group and stability group for renal function,and the relationships between Klotho levels and progression of kidney function were evaluated.Results The patients were followed up for an average of (9.5 + 2.9) months.GFR in CKD patients decreased from (24.8 ± 12.4) mL/min to (18.7 ± 12.1) mL/min (P ＜ 0.0 1),and serum Klotho level decreased from 2.53 (1.41,3.67)ng/mL to 1.63 (1.07,3.19)ng/mL (P ＜0.01)with more pronounced trend in the patients with renal function deterioration than the patients in stability group (P ＜0.01).Fifteen patients with high Klotho level suffered from adverse kidney outcomes while 26 ones with lower Klotho level suffered from deterioration of renal function (63.4％ vs 36.5％,P =0.02).KaplanMeier analysis revealed the high risk of adverse kidney outcomes arose in the CKD patients with lower Klotho level (P =0.013).Conclusion Klotho level in CKD patients may significantly decrease and should be more apparent with renal function progresses.Lower Klotho level in serum may be associated with high risk of adverse kidney outcomes and become a promising marker to predict CKD progression.