Study of vitamin B12 deficiency in chronic kidney disease

Background: Chronic Kidney Disease (CKD) is a growing health burden and important cause of morality and morbidity worldwide as well as India. Anaemia a feature of CKD, is multifactorial, one of the most important factor responsible for the development of left ventricular hypertrophy, diastolic and later systolic dysfunction and cardiovascular disease, which is the single most important contributor to the mortality in CKD. Severe Chronic Kidney Disease has an adverse effect on haematopoiesisis. Lack of erythropoietin, Iron deficiency anaemia and shortened red cell life span, Nutritional deficiency or deranged metabolism of vitamins is the major factors contributing to anaemia in CRF. Patients with CKD show megaloblastosis on examination of the bone marrow. Suggestive of Vitamin B12 and folic acid deficiency might Be Additional Factors Contributing to inadequate Haematopoiesis in uremia. Patients with CKD are at higher risk for nutritional deficiencies due to medication interactions, dietary restrictions and malnutrition. The dialysis procedure itself may cause loss of vitamin B12, Folic acid and there deficiency.Methods: Sample size of 80 cases of CKD patients aged between 18-80 year admitted in SMIMER Hospital were included in study. Serum vitamin B12 Level was checked, correlation B12 deficiency with duration of CKD was observed.Results: It was observed that, 47 cases of CKD had vitamin B12 deficiency. The mean duration of CKD is more in B12deficient group as compared to Normal Group and also finds the higher proportion of vitamin B12 deficiency in CKD patients.Conclusions: Serum vitamin B12 level testing should be recommended routinely in patients with CKD and All the treating Nephrologists should anticipate the deficiency of vitamin B12 in CKD patients.

Application of carbon nanoparticles suspension injection in uremic patients with secondary hyperparathyroidism underwent total parathyroidectomy: 2 case report and literature review / 中南大学学报(医学版)

Total parathyroidectomy (PTX) can be used to treat secondary hyperparathyroidism (SHPT)in uremic patients,relieving the patient's osteolytic destruction.Complete resection of bilateral parathyroid glands is key to successful operation.Recently,2 patients successfully received surgical treatment,in which carbon nanoparticles suspension injection were used.With the help of carbon nanoparticles suspension injection,all of the 4 hyperplastic parathyroid glands were found successfully.The parathyroid hormone(PTH) was significantly decreased after operations and the clinical symptoms were relieved simultaneously.We conclude that the use of carbon nanoparticles suspension injection is helpful for total parathyroidectomy operation in uremic patients with SHPT,which can protect the normal thyroid and recurrent laryngeal nerve.

Association between chronic kidney disease and tuberculosis – A prospective study form a tertiary care teaching hospital

Background: Chronic kidney disease (CKD) is emerging as a major public health problem in India. The links between CKD and Tuberculosis have long been established but the exact nature of interaction is poorly understood. Bulk of the association was studied on subjects undergoing dialysis or renal transplantation, with limited studies on CKD subjects without dialysis. The amount of data is further scarce on Indian population. Hence the present study was conducted to assess the prevalence and profile of pulmonary tuberculosis in CKD patients presenting to a tertiary care teaching hospital in south India Materials and methods: The present study was a prospective study of all the CKD patients presenting to a tertiary care teaching hospital in south India diagnosed with chronic renal failure, as per the hospital protocol. The data was collected from the prospective case records of all the CKD patients diagnosed between April 2015 to 2017. Results: There were a total of 2927 patients with CKD, who satisfied the inclusion criteria and were included in the study. The average prevalence of tuberculosis among the study population was 1.16%. The age distribution of the tuberculosis cases have shown that highest proportion of subjects (47.05%) was aged above 60 years. There was a high male preponderance in study population, as 88.23% affected by tuberculosis were males and 11.77% were females. The most common x-ray finding was infiltration seen in 12 (35.29%) of the patients with TB. Cavities were present in 14 (41.17%) subjects- fibrosis was seen in 4 (11.76%) subjects. There was no statistically significant difference in blood urea nitrogen (BUN) or serum creatinine values between the two groups (P value > 0.05) G. Elango, C. Ramesh, D.D. Venkataraman. Association between chronic kidney disease and tuberculosis - A prospective study form a tertiary care teaching hospital. IAIM, 2017; 4(9): 164-170. Page 165 Conclusion: Chronic Kidney disease patients are at high risk of tuberculosis, as the prevalence in CKD patients is higher than that of general population. Considering the alterations in the immune system, the immunological response of the host to tuberculosis infection is altered in CKD patientsthis makes routine investigations like sputum examination and manteaux test less reliable in CKD patients. Chest-X-ray may be more useful in these patients

Efeito da lactulose sobre os teores séricos de ureia, creatinina, cálcio e fósforo em cães não azotêmicos / Effect of lactulose on serum urea, creatinine, calcium and phosphorus in non-azothemic dogs

The present study evaluated serum levels of urea, creatinine, calcium and phosphorus in non-azothemic dogs by continued use of lactulose orally. Serum levels of urea, creatinine, calcium and phosphorus were determined in Beagle dogs, clinically healthy and without biochemical changes (non-azothemic), undergoing oral treatment with lactulose (n = 6), for a period of 30 days. The prebiotic showed no significant lowering effect on serum urea and creatinine, but the values of calcium and phosphorus, as well as their relation, were modified with reduced serum phosphorus levels in animals treated with lactulose compared to controls, with a significant difference...

Obstrução uretral em felino – manejo emergencial / Feline urethral obstruction - emergency management

A obstrução uretral em felinos caracteriza-se, muitas vezes, como urgência ou emergência, sendo comum na clínica de pequenos animais. Para obtenção de bons índices de sobrevida é necessária uma rápida e precisa avaliação de cada paciente, cuidados na estabilização inicial, otimização da cateterização uretral e cuidados pós-desobstrução adequados (SERRANO, 2011). Desta forma, objetivou-se descrever um caso de obstrução uretral, onde o atendimento emergencial foi determinante na recuperação do paciente.

Clinical observation on the serum levels of heat shock protein 70 in uremic patients with different dialysis ages / 中国综合临床

Objective To investigate the serum levels of heat shock protein 70 (HSP70) in uremic patients with different dialysis ages.Methods Ninety-two maintenance haemodialysis patients were divided into short-term group(from three months to 2 years,n =32),median-term group(from 2 to 5 years,n =37) and longterm group(more than 5 years,n =23) according to different dialysis ages.Enzyme-linked immunosorbent assay (ELISA) was used to measure the serum levels of HSP70 before and after haemodialysis in each group.Results The semm levels of HSP70 had significant difference both in median-term group and long-term group before and after haemodialysis(median-term group:(54.94 + 39.21) μg/L vs (69.72 + 39.90) μg/L,t =-2.068,P =0.047 ;long-term group:(46.17 +34.63) μg/L vs (74.07 ±41.11) μg/L,t =-2.814,P =0.010).But there was no statistics difference on the serum levels of HSP70 before and after haemodialysis in the short-term group((70.42 ±38.30) μg/L vs (62.89 ±43.01) μg/L,t =0.870,P =0.390).Conclnsion Haemodialysis patients with more stress protection ability are likely to obtain long term survival.

Hemodynamics change in the elderly patients with uremia complicating heart failure / 中华老年医学杂志

Objective To investigate hemodynamie change in uremia complicating heart failure of elderly patients. Methods Totally 241 cases with uremia complicating heart failure received measurement of circulation dynamic detection(CD).The volume load,myocardial contractility and blood pressure were analyzed in the elderly group aged(71±6)years (n=116) and young and middleaged group aged(38± 10)years(n =125). Results The central venous pressure(CVP)[(26.7±11.3)cmH2O vs.(23.6 ± 10.7) cm H2O,t=2.410,P =0.010],effective circulation volume (ECV)[(4362± 1340)ml vs.(3085 ± 1001 ) ml,t =7.674,P =0.000],stroke volume(SV) [(185 ± 52) ml vs.(114±41)ml,t=7.803,P=0.000],cardiac output (CO)[( 13.9±4.3)L/min vs.(11.2±3.6)L/min,t=4.802,P=0.000],left ventricular end diastolic volume (LVD)[(388± 145)ml vs.(258±98)ml,t =7.673,P =0.000],left ventricular end systolic volume ( LSV ) [( 223 ± 95 ) ml vs.( 135 ± 59) ml,t =7.186,P=0.000] were significantly higher group than in young and middle-aged group.The ejection pressure (EP)[(178±29)mm Hg vs.(183±24)mm Hg,t=2.323,P=0.012],myocardium negative inotropic(MNC) [(0.609±0.149)vs.(0.683±0.188),t=3.113,P=0.002],ejection fraction (EF) [(0.433± 0.034) vs.(0.445 ± 0.031 ),t =2.451,P =0.010],diastolic blood pressure (DBP) [( 87 ±14)mm Hg vs.(1.08±22)mm Hg,t=8.141,P=0.000],systematic vascular resistance(SSR)[(952±207)gcm-4 s-2 vs.(1217± 308) gcm-4 s-2,t =7.143,P=0.000],ejection resistence(ER) [( 178± 29)vs.( 183 ± 24),t =2.323,P =0.012] were lower in elderly group than in young and middle-aged group.DBP(x2 =16.474,P=0.000,OR=0.752,95％CI:0.714-0.790),SBP(x2 =11.913,P=0.000,OR=1.148,95％CI:1.091-1.205),ER(x2 =17.892,P=0.000,OR=0.906,95％CI:0.861-0.951),CVP(x2 =14.672,P=0.000,OR=0.698,95％CI:0.663-0.733) and LDV(x2 =21.080,P=0.000,OR=0.942.95％ CI:0.895-0.989) were dangerous factors of uremia complicating heart failure.Conclnsions The increased volume load,decreased myocardial contractility and cardiac afterload may appear in the elderly patients with uremia complicating heart failure.

Clinical application and nursing of the high-flux dialyzator in hemodialysis patients / 中国实用护理杂志

Objective To investigate the clinical application of APS-15U dialyser in patients with maintenance hemodialysis in order to elevate the nursing skill of high-flux hematodialysis.Meth-ods 15 patients with maintenance hemodialysis underwent 45 times of high-flux hematodialysis re-spectively.Results 3 among 4 ostalgia phtients alleviated,symptoms disappeared in 2 patients with refractory ostalgia,4 mitigated and 1 with no change.3 patients with pericardial effusion showed re-duced effect,1 patients with carpal tunnel syndrome showed no alleviation in pain and action dysfunction.Conclusions In order to raise the therapeutic efficacy of high-flux hemadialysis,nurses should grasp new knowledge and new theories,summarize experience incessantly,standardize correlated operations and care programs,which is an important link of decreasing adverse effects and nursing questions of the high-flux hemadialysis.

Prevalência da síndrome das pernas inquietas em pacientes em terapias de hemodiálise em um centro na região sul de Santa Catarina – Brasil / Restless legs syndrome prevalence in patients in haemodialysis therapy in a reference service in south Santa Catarina – Brazil

Introdução: A síndrome das pernas inquietas (SPI) tem sido relacionada a diversas doenças, entre elas doença renal e anemia. Objetivo: Descrever a prevalência da síndrome das pernas inquietas (SPI) nos pacientes em terapia de hemodiálise na região da Associação dos Municípios da Região de Laguna, Santa Catarina, Sul do Brasil (AMUREL). Métodos: 117 indivíduos submetidos à terapia de hemodiálise na região da AMUREL foram entrevistados para se avaliar a presença, o tipo (primária ou secundária) e a gravidade da SPI, creatinina, ureia, ferro e ferritina séricos. Resultados: A prevalência de SPI foi de 30,8% (n=36). Dos portadores, 33,3% tiveram o diagnóstico de SPI primária e 66,7% (n=24) o de SPI secundária .Quanto à gravidade, 58,3% foram classificados como intermitente, 16,7% em persistente leve, 8,3% em persistente moderada e 16,7% em ersistente grave. A maior parte dos casos de SPI não tinha sido diagnosticada anteriormente. Não foi encontrada correlação com os parâmetros bioquímicos nem diferenças significativas entre os sexos. Conclusão: A síndrome das pernas inquietas é comum e pouco diagnosticada. Sua prevalência é considerável e aumenta substancialmente em indivíduos urêmicos. Não encontramos nenhuma evidência de que anemia por deficiência de ferro e ferritina, nem índices altos de ureia e creatinina séricos possam desempenhar um importante papel patogênico.

Introduction: Restless legs syndrome (RLS) has been related to several diseases, including renal disease and anaemia. Aim: To determine the prevalence of restless legs syndrome in patients under haemodialysis therapy in the region of the Association of Municipalities of the Region of Laguna (AMUREL), in the state of Santa Catarina, South Brazil. Methods: 117 patients undergoing haemodialysis in the AMUREL region were interviewed in order to evaluate the presence, type (primary or secondary), and severity of RLS, as well as their serum creatinine, urea, iron, and ferritin levels. Results: The prevalence of RLS was 30.8% (n=36). Among the affected individuals, 33.3% were diagnosed with primary RLS and 66.7% (n=24) with secondary RLS. Concerning severity, 58.3% were rated as intermittent, 16.7% as mildly persistent, 8.3% as moderately persistent, and 16.7% as severely persistent. Most of the cases of RLS had not been diagnosed before. No correlation of RLS was detected with the biochemical measures, nor differences between the sexes. Conclusion: Restless legs syndrome is common and underdiagnosed. Its prevalence is considerable and increases significantly in uraemic individuals. We failed to find any evidence that iron and ferritin deficiency anaemia, or high serum urea and creatinine, can play an important pathogenic role.

Influência da dose de diálise sobre a frequência de pericardite assintomática em pacientes em terapia dialítica / Effect of dialysis dose on the frequency of pericarditis in patients with asymptomatic dialysis

Introdução: Até o momento, estudos da frequência da pericardite associada á diálise realizaram-se antes de 1997, ou seja, quando foi padronizado o clearance fracional de uréia (Kt/V) mínimo de 1,2. Atualmente, caso a uremia seja fator etiológico para pericardite da diálise, espera-se redução de sua prevalência. Objetivo: Avaliar a prevalência atual da pericardite da diálise e associar sua presença com o Kt/V. Métodos: Avaliação ecocardiográfica da frequência de efusão pericárdica em 50 pacientes assintomáticos hemodilisados entre 2000 e 2004. A casuística foi dividida em dois grupos segundo Kt/V inferior (G1:n=11) ou superior (G2:n=39) a 1,2. Resultados: Três pacientes (6%) apresentaram efusão pericárdica; frequência inferior à da literatura (31,4%). A frequência de pericardite em G1 foi superior à de G2 (p=0,0084). Conclusão: Tais achados corroboram a hipóeses da participação da toxicidade urêmica na g~enese da pericardite associada à diálise.

Introduction: Until now, studies of the frequency of dialysis associated pericarditis were held before 1997, ie, when it was standardized fractional urea clearance (Kt / V) at least 1.2. Currently, if uremia is an etiological factor for dialysis pericarditis is expected to reduce its prevalence. Objective: To evaluate the current prevalence of dialysis pericarditis and associate its presence with the Kt / V. Methods: Echocardiographic evaluation of the frequency of pericardial effusion in 50 asymptomatic patients hemodilisados ​​between 2000 and 2004. The sample was divided into two groups according to Kt / V less (G1: n = 11) or later (G2: n = 39) to 1.2. Results: Three patients (6%) had pericardial effusion, often lower than in the literature (31.4%). The frequency of pericarditis in G1 was higher than G2 (p = 0.0084). Conclusion: These findings corroborate the participation of hipóeses uremic toxicity in ~ g enes of pericarditis associated with dialysis.