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Objective To explore the relationship between serum homocysteine (Hcy) level before coronary angiography(CAG) and contrast induced nephropathy (CIN) after CAG.Methods We included 2264 cases of suspected coronary heart disease from May 2013 to May 2016 and all patients received CAG examination.According to whether CIN has developed or not after CAG, the patients were divided into the non-CIN group (n=2162) and the CIN group (n=102).We analyzed and compared the clinical baseline data, serum Hcy and creatinine (Cr) levels and the estimated glomerular filtration rate between the 2 groups eGFR.Results Patients in the non-CIN group were younger and with less comorbidities of diabetes and chronic kidney disease (all P0.05).At 72 hours after CAG, Cr level of the non-CIN group (69.34±19.54 μmol/L) was lower than that of the CIN group (87.34±21.38) μmol/L (P<0.05).eGFR was higher in the non-CIN group (79.34±19.54)ml/min than that in the CIN group (67.34±21.38)ml/min (P<0.05).Linear regression analysis showed that Hcy level before CAG were positively correlated with Cr level after CAG (r=0.547,P<0.01) and negatively correlated with eGFR after CAG (r=-0.271,P<0.01).Conclusions Hcy level before CAG can be used as one of an effective parameter to predict CIN.
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Objective:To detect the levels of TGF-β1 in hypertensive renal function impairment patients and its clinical value. Methods: Primary hypertension patients with no target organs damage were enrolled in control group, primary hypertension patients with renal function stageⅠand stageⅡwere enrolled in renal function stageⅠgroup and stageⅡgroup. Serum TGF-β1 levels and renal function indices of three groups were compared. Results:There were no significant difference of serum creatinine and blood urea nitrogen of three groups(F=23.523, P<0.05);endogenous creatinine clearance rate of renal functionⅠandⅡgroups were lower than that of control group, TGF-β1 levels of renal functionⅠandⅡ groups were higher than of control group; TGF-β1 levels were negatively correlated with creatinine clearance rate. Conclusion:TGF-β1 level is an ideal index to reflect renal function for its level significantly changes in renal damage stageⅠ,Ⅱand has good correlation with Cin.
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Objective To investigate the clinical efficacy of herbal cake moxibustion in treating chronic renal failure. Methods Sixty CRF patients were randomly allocated to treatment and control groups, 30 cases each. The control group received medication and diet control and the treatment group, herbal cake moxibustion on Shenshu, Pishu or Ganshu in addition. Pre-/post-treatment differences in serum creatinine (Scr), blood urea nitrogen (BUN), endogenous creatinine clearance rate (Ccr) and 24-h urinary protein quantity were observed in the two groups and the clinical therapeutic effects were compared between the two groups after 3 months of treatment.Results The marked efficacy rate and the total efficacy rate were 46.7% and 86.7%, respectively, in the treatment group and 20.0% and 46.6%, respectively, in the control group, and there were statistically significant differences in both between the two groups (P<0.05). There were statistically significant pre-/post-treatment differences in Scr, BUN, Ccr and 24-h urinary protein quantity in the two groups (P<0.05). There were statistically significant post-treatment differences in Scr, BUN and 24-h urinary protein quantity between the treatment and control groups (P<0.05).Conclusion Herbal cake moxibustion is an effective way to treat chronic renal failure.
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Objective To assess the effectiveness and safety of dexmedetomidine (Dex) in anesthesia for end-stage renal disease (ESRD)recipients in living related renal transplantation.Methods Forty ESRD patients undergoing living related renal transplantation in the Affiliated Provincial Hospital of Anhui Medical University from October 201 3 to December 201 4 were randomized into the Dex group and the control group,20 patients in each group.In the Dex group,the patients were pumped with the loading dose of Dex at 0.6 μg/kg before anesthesia induction and the procedure was completed within 20 min.Then,the patients were pumped at 0.2 μg/(kg·h)for 1 h and underwent general anesthesia induction.In the control group,the patients were pumped with equivalent normal saline.The anesthesia induction and the maintenance drug of the two groups were the same.The mean arterial pressure (MAP),heart rate (HR)and bispectral index (BIS) before administration (T0 ),20 min after administration (T1 ),before laryngeal mask placement (T2 )and after laryngeal mask placement (T3 )of the two groups were observed and recorded.Delayed recovery and emergence delirium were also observed.Urine output during transplantation,4,8,1 2,24 h after transplantation,as well as endogenous creatinine clearance rate (Ccr)before transplantation and 1 2,24 h after transplantation were recorded.Results Compared with T0 ,the MAP,HR and BIS of the two groups at T2 decreased significantly (all in P <0.05).As for the comparison between two groups,the HR and BIS of the Dex group decreased significantly (both in P <0.05 ),but the MAP didn't decrease significantly (P >0.05 ).The emergence delirium in the Dex group was all mild with the incidence of 1 5% (3 /20),which significantly deceased in comparison with that in the control group (30%,6 /20)(P <0.05).The urine outputs of Dex group during transplantation,and 4 h and 8 h after transplantation were significantly higher than those of the control group (all in P <0.05).The Ccr of the two groups at 1 2 h and 24 h after transplantation significantly increased, compared with that before transplantation (all in P <0.01 ).Conclusions Dex may reduce the incidence of emergence delirium of recipient in living related renal transplantation,increase urine output after transplantation and cause no delayed recovery,which may be used in ESRD patients safely.
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Objective To investigate the curative effect of leflunomide in the treatment of diabetic nephropathy-Ⅳ (DN-Ⅳ).Methods Sixty cases with DN-Ⅳ were assigned to the leflunomide treatment group and the control group.Both groups were given hypoglycemic,antihypertensive,regulate lipid and angiotensin converting enzyme inhibitors or angiotensin Ⅱ inhibitor class of drugs.Meanwhile patients in the treatment group were orally administered leflunomide once daily for two month with a dose of 50 mg/d in the first three days and 20 mg/d afterwards.24 hour pre-and post-treatment values of urinary protein,C-reactive protein (CRP),endogenous creatinine clearance rate (Ccr),triglyceride (TG),total cholesterol (TC),albumin (ALB),glycosylated hemoglobin (HbA1c) and blood pressure were measured.Analyzed the correlation of Ccr with other laboratory indicators after treatment for one year.Results At 24 hour before treatment,after treatment for two months and one year,the level of 24 h urinary protein of the treatment group (n =26) were (3.75 ± 0.94)g/24 h,(2.02 ± 0.45) g/24 h,and (2.46 ± 0.55) g/24 h respectively,and the level of Ccr were (69.04 ± 13.35) ml/min,(71.35 ± 11.25) ml/min,and (67.48 ± 10.58) ml/min respectively.While in the control group(n =28),the 24 h urinary protein level of were (3.68 ± 1.03) g/24 h,(3.43 ± 0.65) g/24 h,and (5.46 ±0.47) g/24 h respectively at the three time points,and the Ccr level were (68.55 ± 10.09) ml/min,(66.76 ± 9.45) ml/min,(57.50 ± 15.75) ml/min respectively.The levels of 24 h urinary protein in the treatment group after treatment for two months and one year were significantly lower than before treatment in the treatment group as well as at the corresponding period of the control group (P ＜ 0.05),while the level of Ccr in the treatment group was higher than that of the control group at the same period,and the difference was statistically significant(P ＜ 0.05).The levels of CRP,TG,TC,HbAlc and systolic pressure in the treatment group after treatment for two months and one year were significantly lower than that of control group at the same period,while ALB was significantly higher than before treatment in the treatment group as well as at the corresponding period of the control group (P ＜ 0.05).The 24 h urine protein,TC,systolic blood pressure were significantly correlated with Ccr after treatment for one year (β =-0.771,-0.682,0.656,-0.530respectively;P ＜0.01).Conclusion Leflunomide treatment of diabetic nephropathy was safe and effective,but the duration of leflunomide treatment and second selection time of leflunomide therapy needed to further study.
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PURPOSE: Split renal function on diuretic renography has been considered to be a good tool for evaluating renal function, selecting treatment modalities and assessing efficacy of surgery in hydronephrosis, especially in ureteropelvic junction(UPJ) obstruction. However, contradictory supranormal function on renography has provided controversy with urologists. Is the phenomenon the result of fact or artifact? The authers thought that contradictory supranormal renal function measured with 99mTc-DTPA Is fundamentally related with a question. How accurately does the split renal function test represent the real renal function, namely, glomerular filtration rate(GFR)? To know relation of split renal function with real renal function(GFR) and to disclose clinical significance of contradictory supranormal renal function on diuretic renal scan, a prospective study was performed. MATERIALS AND METHODS: Diuretic renography was done in 14patients with upper urinary tract obstruction including UPJ obstruction, ureteral stone and lower urethral obstruction. Afer the first diuretic renography using 99mTc-DTPA percutaneous nephrostomy was performed on affected kidney, which was followed by the second diuretic renography. Endogenous creatinine clearance tests were done on the patients. Urine was collected through the nephrostomy tube, self voiding or indwelling Foley catheter, respectively So the endogenous creatinine clearance was determined respectively on both the renal unit. Also the endogenous creatinine clearance ratio of affected kidney was determined to compare with split renal function on renography. RESULTS: In 7patients, ratio of endogenous creatinine clearance on affected kidney was less than 40%. In the other 7patients, the ratio was more than 48%. In patients with less than 40% of endogenous creatinine clearance ratio on affected kidney, split renal function was overestimated by 10.3% to 27.5%(19.5+/-4.9%) comparing to endogenous creatinine clearance ratio. In the other 7patients split renal function had a little difference from endogenous creatinine clearance ratio (4.5+/-2.5%). The endogenous creatinine clearance ratio was not closely related with split renal function(correlation coefficients: 0.65). Split renal function of the first renography was closely related with that of the second renography(correlation coefficients: 0.88). Contradictory supranormal function occurred in 4cases. In 2cases it was real finding, in the other it was not. CONCLUSIONS: It appears that split renal function is overestimated in poor renal function and split renal function is closely related with real renal function in good renal function slate. Supranormal renal function is real finding in part, not in part. Clinical significance of split renal function should be cautiously and basically reevaluated through further study.