Reversal of complete atrioventricular block in dialysis patients following parathyroidectomy: A case report.

BACKGROUND: Refractory secondary hyperparathyroidism (SHPT) is a common complication observed in patients with end-stage renal disease and can result in ectopic calcification. Metastatic calcification involving the heart valves and the conduction system can easily lead to arrhythmias, including atrioventricular block. This case report describes a maintenance hemodialysis patient with refractory SHPT resulting in a complete atrioventricular block (CAVB), which was eventually reversed to a first-degree atrioventricular block. CASE SUMMARY: We present the case of a 31-year-old Asian female who was receiving maintenance hemodialysis because of lupus nephropathy. She developed SHPT, and an electrocardiogram revealed a first-degree atrioventricular block. Then, she underwent parathyroidectomy (PTX) with autotransplantation. Unfortunately, a few years later, she developed SHPT again, and an electrocardiogram revealed a CAVB. A few years after the second PTX surgery, the calcification of the left atrium and left ventricle improved, and her CAVB was reversed. CONCLUSION: This case revealed that metastatic cardiac calcification can result in complete atrioventricular blockage. Following parathyroid surgery, calcification of the cardiac conduction system improved, leading to reversal of the atrioventricular block. It is important for dialysis patients to optimize intact parathyroid hormone therapy and pay attention to calcification metastasis.

IL-10 -1082 A/G polymorphism is related with the risk and clinical characteristics of acute kidney injury: a case-control study.

BACKGROUND: Interleukin-10 (IL-10), a kind of anti-inflammation cytokine, has a key role in the development of acute kidney injury (AKI). Recently, several studies addressed the link between the risk of AKI and the IL-10 -1082 A/G polymorphism with conflicting findings. METHODS: To identify the effects of the IL-10 -1082 A/G polymorphism on the risk of AKI, we designed this case-control study. This study recruited 320 AKI patients and 408 ICU patients without AKI. The association between the AKI risk and this polymorphism was analyzed using the logistic regression analysis adjusted for confounding factors. RESULTS: The IL-10 -1082 A/G polymorphism enhanced the risk of AKI. After stratified analysis, this polymorphism increased the risk of AKI among the males, smokers, those aged exceeding 60 years old, and overweight individuals (BMI ≥ 25). Moreover, -1082 A/G polymorphism was remarkably related with APACHE II score and eGFR. CONCLUSIONS: Collectively, the IL-10 -1082 A/G polymorphism is linked with an elevated risk of AKI. Further studies in China need be performed to verify these results.

Associations between the concentrations of CD68, TGF-ß1, renal injury index and prognosis in glomerular diseases.

The present study aimed to investigate the association between the concentrations of CD68, TGF-ß1, renal injury index and prognosis in glomerular diseases. Altogether 218 patients with glomerular diseases admitted to Weifang People's Hospital from January, 2014 to March, 2017 were used as the study group. A total of 100 healthy individuals who visited Weifang People's Hospital for a physical examination during the same time period were used as the control group. The levels of CD68 in peripheral blood obtained from the 2 groups of subjects were detected by flow cytometry, and the expression of TGF-ß1 in serum was detected by enzyme-linked immunosorbent assay (ELISA). The concentrations of CD68 and TGF-ß1 between the 2 groups were compared. The correlation between the concentrations of CD68, TGF-ß1 and renal injury indexes in the study group was analyzed, as well as prognostic significance. The diagnostic value of CD68 and TGF-ß1 in patients with glomerular disease was analyzed using a ROC curve, and the recovery of the patients was observed. The serum concentrations of CD68 and TGF-ß1 in the study group were higher than those in the control group (P<0.05). The concentrations of CD68 and TGF-ß1 in the study group positively correlated with the renal injury indexes, such as blood urea nitrogen (BUN), serum creatinine (SCR), uric acid (UA) and the 24-h urinary protein quantity (P<0.05). ROC curve analysis revealed that the area under the curve of CD68 and TGF-ß1 as regards the diagnostic value in patients with glomerular disease was 0.808 and 0.738, respectively, while the area under the combined detection curve was 0.866. Multivariate unconditional logistic regression analysis revealed that the clinical classification and the concentrations of CD68 and TGF-ß1 were independent prognostic factors in the study group. On the whole, the findings of the present study demonstrate that clinical classification, and the CD68 and TGF-ß1 concentrations are independent prognostic factors for patients with glomerular disease. CD68 and TGF-ß1 have certain value in the diagnosis of glomerular diseases, and may thus be used as predictors of the diagnosis and recovery of glomerular disease.