A Study on the Correlations of Anxiety and Depression With Self-Management Ability and Endogenous Creatinine Clearance Rate in Renal Transplant Recipients.

Objective: To explore the effects of anxiety and depression on the self-management ability and endogenous creatinine clearance rate of renal transplant patients. Method: Eighty-eight renal transplant recipients who were followed up in the outpatient clinic of the Affiliated Hospital of Zunyi Medical University were selected using convenient sampling. The self-made general data sheet, Self-Rating Anxiety Scale, Self-Rating Depression Scale, and Self-Management Scale for Kidney Transplant Recipients were used. Correlation analysis was used to find factors related to endogenous creatinine clearance, while multiple linear regression was used to identify factors influencing endogenous creatinine clearance. Patients with or without anxiety and depression were divided into groups, and the indexes of the groups were compared using the independent samples t test, rank-sum test, or chi-squared test. Results: Anxiety was present in 12.5% of patients, depression in 25%, and a moderate level of self-management in 34.1%. Only 9.1% of renal transplant recipients had endogenous creatinine clearance within the normal range, and 34.1% had a body mass index not in the normal range (25% were overweight, and 9.1% were underweight). The endogenous creatinine clearance rate was negatively correlated with age and degree of depression, and positively correlated with body mass index, treatment management score, and psychosocial management score. The main influencing factors of endogenous creatinine clearance rate were age, sex, depression, body mass index, and treatment management score. The endogenous creatinine clearance rate and psychosocial management ability were significantly higher in patients without anxiety and depression than in patients with anxiety and depression (all P < 0.05). Conclusions: Anxiety and depression showed significant negative effects on the psychosocial self-management ability and endogenous creatinine clearance rate of renal transplant recipients and thus should be given more attention.

High-Salt Diet Accelerated the Decline of Residual Renal Function in Patients With Peritoneal Dialysis.

Objective: This study aims to investigate the relationship between dietary salt intake and residual renal function in peritoneal dialysis (PD) patients. Methods: The daily salt intake of the patients was calculated based on a 3 day dietary record. Sixty-two patients were divided into three groups: 33 patients in the low salt intake group (salt intake <6.0 g/day), 17 in the medium salt intake group (salt intake 6.0 to <8.0 g/day), and 12 in the high salt intake group (salt intake ≥8.0 g/day). Regular follow-up was conducted every 3 months. Urine volume, peritoneal ultrafiltration volume, and other clinical indicators were recorded. Biochemical indexes were detected to evaluate the changes in residual renal function and peritoneal function during follow-up. Results: A positive correlation between dietary sodium intake and sodium excretion was found. During 12-month follow-up, a decrease of residual renal function showed a significant difference among the three groups (p = 0.041) (15.3 ± 27.5 vs. 12.5 ± 11.5 vs. 32.9 ± 18.4 L/W/1.73 m2 in the low-, medium-, and high salt intake groups, respectively). Consistently, a higher decline of residual renal function (adjusted ß, 20.37; 95% CI, 2.83, 37.91) was found in participants with high salt intake (salt intake ≥8 g/day) compared with those in non-high salt intake. Conclusion: Our study showed that the sodium excretion by peritoneal dialysis was positively correlated with dietary sodium intake in PD patients. The high salt intake diet (salt intake ≥8 g/day) may lead to a faster decline of residual renal function in PD patients.

Clinical efficacies, underlying mechanisms and molecular targets of Chinese medicines for diabetic nephropathy treatment and management.

Diabetic nephropathy (DN) has been recognized as a severe complication of diabetes mellitus and a dominant pathogeny of end-stage kidney disease, which causes serious health problems and great financial burden to human society worldwide. Conventional strategies, such as renin-angiotensin-aldosterone system blockade, blood glucose level control, and bodyweight reduction, may not achieve satisfactory outcomes in many clinical practices for DN management. Notably, due to the multi-target function, Chinese medicine possesses promising clinical benefits as primary or alternative therapies for DN treatment. Increasing studies have emphasized identifying bioactive compounds and molecular mechanisms of reno-protective effects of Chinese medicines. Signaling pathways involved in glucose/lipid metabolism regulation, antioxidation, anti-inflammation, anti-fibrosis, and podocyte protection have been identified as crucial mechanisms of action. Herein, we summarize the clinical efficacies of Chinese medicines and their bioactive components in treating and managing DN after reviewing the results demonstrated in clinical trials, systematic reviews, and meta-analyses, with a thorough discussion on the relative underlying mechanisms and molecular targets reported in animal and cellular experiments. We aim to provide comprehensive insights into the protective effects of Chinese medicines against DN.

VEGF-B antibody and interleukin-22 fusion protein ameliorates diabetic nephropathy through inhibiting lipid accumulation and inflammatory responses.

Diabetic nephropathy (DN) is considered the primary causes of end-stage renal disease (ESRD) and is related to abnormal glycolipid metabolism, hemodynamic abnormalities, oxidative stress and chronic inflammation. Antagonism of vascular endothelial growth factor B (VEGF-B) could efficiently ameliorate DN by reducing renal lipotoxicity. However, this pharmacological strategy is far from satisfactory, as it ignores numerous pathogenic factors, including anomalous reactive oxygen species (ROS) generation and inflammatory responses. We found that the upregulation of VEGF-B and downregulation of interleukin-22 (IL-22) among DN patients were significantly associated with the progression of DN. Thus, we hypothesized that a combination of a VEGF-B antibody and IL-22 could protect against DN not only by regulating glycolipid metabolism but also by reducing the accumulation of inflammation and ROS. To meet these challenges, a novel anti-VEGFB/IL22 fusion protein was developed, and its therapeutic effects on DN were further studied. We found that the anti-VEGFB/IL22 fusion protein reduced renal lipid accumulation by inhibiting the expression of fatty acid transport proteins and ameliorated inflammatory responses via the inhibition of renal oxidative stress and mitochondrial dysfunction. Moreover, the fusion protein could also improve diabetic kidney disease by increasing insulin sensitivity. Collectively, our findings indicate that the bifunctional VEGF-B antibody and IL-22 fusion protein could improve the progression of DN, which highlighted a novel therapeutic approach to DN.

Creatinine clearance rate predicts prognosis of patients with systemic lupus erythematosus: a large retrospective cohort study.

OBJECTIVE: To explore the association between the creatinine clearance rate (Ccr) and the prognosis of patients, and compared with estimated glomerular filtration rate (eGFR). METHODS: We retrospectively collected information of patients with SLE who were first hospitalized between 1999 and 2009 in Jiangsu Province, China, and followed up in 2010 and 2015. Ccr was calculated and dichotomized into normal group (Ccr ≥ 70) and decreasing group (Ccr < 70). The clinical characteristics of the two groups were compared and Cox proportional-hazards regression models were used to calculate hazard ratio (HR) and 95% confidence interval (CI). RESULTS: Among 1990 SLE patients, we observed 437 (22.0%) with decreased Ccr, including 237 cases (11.9%) with mild renal dysfunction, 136 cases (6.8%) with moderate renal dysfunction, and 64 cases (3.2%) with severe renal dysfunction. Compared to normal Ccr, decreasing Ccr had a higher risk for mortality with adjusted HR (95% CI) of 2.21 (1.59-3.06). Dose-response relationships were significantly found between increased mortality of SLE and decreased Ccr (p for trend < 0. 001), as well as eGFR. Positive associations were consistently observed in subgroups, such as systemic lupus disease activity index (SLEDAI) ≥ 15, without comorbidities and abnormal laboratory indexes. Decreasing Ccr was positively associated with mortality from infection and renal failure with HR (95% CI) of 1.80 (1.02-3.19) and 6.84 (3.05-15.36). CONCLUSIONS: A significant association has been observed between decreased Ccr and increased risk for mortality of SLE patients. Early clinical interventions to modulate the Ccr of SLE patients may be beneficial to their survival. Key points • Decreasing creatinine clearance rate (Ccr) was positively associated with an overall mortality of SLE patients, with a dose-response relationship. • Moreover, decreasing Ccr was associated with elevated mortality primarily due to infection and renal failure.

Microbiome-metabolomics reveals gut microbiota associated with glycine-conjugated metabolites and polyamine metabolism in chronic kidney disease.

Dysbiosis of the gut microbiome and related metabolites in chronic kidney disease (CKD) have been intimately associated with the prevalence of cardiovascular diseases. Unfortunately, thus far, there is a paucity of sufficient knowledge of gut microbiome and related metabolites on CKD progression partly due to the severely limited investigations. Using a 5/6 nephrectomized (NX) rat model, we carried out 16S rRNA sequence and untargeted metabolomic analyses to explore the relationship between colon's microbiota and serum metabolites. Marked decline in microbial diversity and richness was accompanied by significant changes in 291 serum metabolites, which were mediated by altered enzymatic activities and dysregulations of lipids, amino acids, bile acids and polyamines metabolisms. Interestingly, CCr was directly associated with some microbial genera and polyamine metabolism. However, SBP was directly related to certain microbial genera and glycine-conjugated metabolites in CKD rats. Administration of poricoic acid A (PAA) and Poria cocos (PC) ameliorated microbial dysbiosis as well as attenuated hypertension and renal fibrosis. In addition, treatments with PAA and PC lowered serum levels of microbial-derived products including glycine-conjugated compounds and polyamine metabolites. Collectively, the present study confirmed the CKD-associated gut microbial dysbiosis and identified a novel dietary and therapeutic strategy to improve the gut microbial dysbiosis and the associated metabolomic disorders and retarded the progression of kidney disease in the rat model of CKD.

Mild renal dysfunction defined by creatinine clearance rate has limited impact on clinical outcomes after allogeneic hematopoietic stem cell transplantation.

Creatinine clearance rate (Ccr) is a more accurate indicator of renal function than serum creatinine. Data are sparse regarding the prognostic value of renal impairment calculated using Ccr in patients who undergo allogeneic hematopoietic stem cell transplantation (allo-HSCT). We performed a retrospective analysis of 185 patients who underwent allo-HSCT. These patients were divided into two groups by Ccr (ml/min) before transplantation; one showed normal renal function (Ccr ≥ 60, n = 156) and the other showed mild renal dysfunction (30 ≤ Ccr < 60, n = 29), and transplant outcomes were compared between the groups. We observed no significant difference between the groups in terms of clinical characteristics other than age, estimated glomerular filtration rate, serum creatinine, Ccr predicted by Cockcroft-Gault formula, primary disease, and conditioning intensity. With respect to transplant outcomes, no significant difference was observed in overall survival, relapse, or non-relapse mortality between the two groups. Multivariate analysis demonstrated that 30 ≤ Ccr < 60 before allo-HSCT was not an independent prognostic factor for transplant outcome. In conclusion, these results suggest that patients with mild renal dysfunction, defined as 30 ≤ Ccr < 60 ml/min, can safely undergo allo-HSCT. However, a larger series of patients is needed to evaluate the impact of mild renal dysfunction before allo-HSCT in more detail.

Teicoplanin trough concentrations following different loading doses in critically ill patients / 中国感染控制杂志

Objective To understand serum trough concentrations (Cmin) of teicoplanin and target concentration achieved in severely infected patients after three days treatment with different loading doses of teicoplanin,and find out optimal loading dose.Methods Severely infected patients who admitted to the intensive care unit(ICU) of a hospital from February 1,2016 to February 28,2017 were enrolled in the study.According to different drug loading doses (teicoplanin standard dose:6mg/kg;high dose:10mg/kg) and different creatinine clearance rates (Ccr:50mL/min as standard value),patients were divided into four subgroups:group of standard dose and normal Ccr (GsD1),group of standard dose and low Ccr (GSD2),group of high dose and normal Ccr (GHD1),group of high dose and low Ccr(GHD2).Serum Cmin,percentage of achieving target concentration,and adverse reactions of teicoplanin in different groups were compared.Results A total of 49 patients were enrolled in the study,17 patients were in GSD group,Cmin on 4th day before administration was (5.98 ± 2.67)mg/L;32 patients were in GHD group,Cmin on 4th day before administration was (9.05 ± 4.25)mg/L;Cmin in GHD group was higher than that in GsD group,and there was statistical difference between two groups(t=3.10,P=0.003).Values of Cmin in GSD1,GSD2,GHD1,and GHD2 groups were (5.78±2.72),(6.34±2.78),(8.21 ±3.77),and (12.07±4.81) mg/L respectively,differences among four groups were statistically significant(F =4.766,P =0.006).The Cmin in GHD2 group was higher than those in GHD1,GSD2,and GsD1 groups,percentage of achieving the target concentration were 9.09％ (1/11),16.67％ (1/6),28.00％(7/25),and 71.43％ (5/7) respectively,differences were statistically significant(x2=8.766,P=0.033).Complications associated with teicoplanin such as rash,damage to hepatic and renal function were not observed in all patients during the treatment course.Conclusion Whether the Ccr is normal or not,target Cmin can not be achieved early in patients given teicoplanin with standard loading dose;in patients with low Ccr,given high loading dose,target Cmin can be achieved early;while in patients with normal Ccr,higher loading dose may be needed.

Relationship between serum homocysteine levels and contrast induced nephropathy after coronary angiography / 中国介入心脏病学杂志

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.

Long-term Follow-up Study on Valsartan and Amlodipine Tablets(Ⅰ)on Blood Pressure Control and Re-nal Protection of Patients with Refractory Hypertension / 中国药房

OBJECTIVE:To study the effect of long-term follow-up of Valsartan and amlodipine tablets(Ⅰ)on blood pressure control and renal protection of patients with refractory hypertension. METHODS:120 patients with refractory hypertension were di-vided into control group and observation group according to the patients’wishes,with 60 cases in each group. All patients accepted the triple therapy of amlodipine+valsartan+hydrochlorothiazide and life-style intervention;at the time of discharge from hospital, the blood pressure was well controlled. After discharge from hospital,control group was given amlodipine;observation group was given Valsartan and amlodipine tablet (Ⅰ) orally,1 tablet each time,qd,and dose increasing according to blood pressure,with maximal dose no more than 2 tablets. With 18 months of follow-up,blood pressure and renal function indexes of 2 groups were ob-served at different time points,and blood pressure control rate and the rate of renal function injury were also observed at the last follow-up;the occurrence of ADR was observed. RESULTS:2 cases and 3 cases were follow-up loss in observation group and con-trol group,respectively. With 12 and 18 months of follow-up,24 h systolic pressure,24 h diastolic pressure and 24 h urine protein of 2 groups increased significantly while creatinine clearance rate decreased significantly compared with before discharge;but the in-dexes of observation group was better than that of control group,with statistical significance(P0.05). CONCLUSIONS:Valsartan amlodipine tablet(Ⅰ)has obvi-ous advantages in long-term follow-up of blood pressure control of patients with refractory hypertension. It can significantly reduce the incidence of renal function injury with good safety.

Prognostic value of urine paraquat concentrations combined with poisoning time and creatinine clearance rate ;on prognosis in patients with acute paraquat poisoning / 中华危重病急救医学

Objective To evaluate the prognostic value of urine paraquat (PQ) concentrations combined with poisoning time and creatinine clearance rate (CCr) on prognosis of patients with acute paraquat poisoning (APP). Methods A retrospective case control study was conducted. Clinical data of 96 patients with APP admitted to Department of Emergency of Shengjing Hospital of China Medical University from March 2014 to May 2016 were analyzed. The gender, age, body weight, urine PQ concentrations (determined by semi-quantitative colorimetric method), poisoning time (time from oral poison to urine detection) and CCr of patients were collected, and poisoning index (poisoning index = urine PQ concentrations × poisoning time/CCr) and simplified poisoning index (simplified poisoning index = urine PQ concentrations × poisoning time) were calculated. The patients were divided into death group and survival group according to 2-month outcome after poisoned with clinical data and telephone follow-up. The urine PQ concentrations, poisoning index, and simplified poisoning index between the two groups were compared. Binary classification logistic regression was used to analyze the risk factors affecting prognosis. Receiver-operating characteristic curve (ROC) and diagnostic test were used to analyze the prognostic value of the parameters. Results Compared with survival group, the urine PQ concentrations [mg/L: 30.00 (10.00, 100.00) vs. 10.00 (3.00, 10.00)], poisoning index [mg·h-1·μmol-1: 12.72 (1.86, 33.75) vs. 0.56 (0.18, 1.12)], and simplified poisoning index [mg·h-1·L-1: 600.00 (150.00, 1 000.00) vs. 60.00 (18.00, 120.00)] in death group were significantly increased (all P < 0.01). It was shown by logistic regression analysis that both urine PQ concentrations [odds ratio (OR) = 1.046, 95% confidence interval (95%CI) = 1.006-1.087, P = 0.022] and poisoning index (OR = 1.353, 95%CI = 0.029-1.815, P = 0.031) were independent risk factors affecting the prognosis of patients with APP. It was shown by ROC curve and diagnostic test that the poisoning index had greater area under ROC curve (AUC was 0.902) for evaluating the prognosis of patients with APP. When the best cut-off value was greater than 1.23 mg·h-1·μmol-1, the sensitivity was 90.91%, and the specificity was 73.08%. The AUC of urine PQ concentrations for evaluating the prognosis was 0.759. When the best cut-off value was greater than 20.00 mg/L, the sensitivity was 63.64%, and the specificity was 76.92%. The AUC of simplified poisoning index for evaluating the prognosis was 0.846. When the best cut-off value was greater than 135.00 mg·h-1·L-1, the sensitivity was 81.82%, and the specificity was 76.92%. Conclusion The poisoning index calculated with urine PQ concentrations combined with poisoning time and CCr has prognostic value for prognosis of APP patients, and the prognostic value of poisoning index is greater than that of the urine PQ concentrations alone.

Evaluation of diagnostic indicators in chronic renal failure / 国际检验医学杂志

Objective To evaluate the clinical values of endogenous creatinine clearance rate(Ccr) ,serum creatinine (SCr) ,urea nitrogen(Urea) ,serum cystatin C(s‐Cys‐C) ,serum retinol binding protein(s‐RBP) ,Urine total protein (u‐Pro) ,urine albumin and creatinine ratio(u‐Alb/Cr) ,urine RBP(u‐RBP) ,urine Cys‐C(u‐Cys‐C) ,u‐NAG and et al in the diagnosis of chronic renal failure (CRF) ,find suitable and effective detection combinations to increase the diagnostic accuracy of CRF .Methods SCr ,Urea ,s‐Cys‐C , s‐RBP ,u‐Pro ,u‐Alb/Cr ,u‐RBP ,u‐Cys‐C ,u‐NAG were detected respectively in 206 hospitalized patients and Ccr values were calcu‐lated at the same time .By using Excel and SPSS19 .0 softwares ,the data were analysed .Combined detections included two and four items combined detections .Results Youden index(YI) of serum Cys‐C was 0 .59 .Area under the curve in the receiver operating characteristic(ROC) of Cys‐C was 0 .872 which was the highest of all the single detection items .Combined detection of SCr and s‐Cys‐C got the highest YI (0 .60) .Combination of four items(Urea ,SCr ,s‐RBP ,s‐Cys‐C) had the highest positive predictive value (100 .00% ) .Combination of u‐RBP and u‐Cys‐C had the highest negative predictive value(100 .00% ) .Conclusion Combined detec‐tion was more favorable for CRF diagnosis .Combination detection of SCr and s‐Cys‐C was the most valuable detection for the diag‐nosis of CRF .Among single item detections ,s‐Cys‐C detection had better sensitivity and specificity ,and diagnostic efficiency than other detection items .U‐RBP and u‐Cys‐C could be used to exclude renal impairment due to its noninvasive sampling .

Estimated Creatinine Clearance Rate Is Associated With the Treatment Effectiveness and Toxicity of Pemetrexed As Continuation Maintenance Therapy for Advanced Nonsquamous Non-Small-Cell Lung Cancer.

UNLABELLED: The purpose of this study was to explore the predictive factors of the effectiveness and treatment toxicity for pemetrexed as continuation maintenance therapy in patients with advanced nonsquamous non-small-cell lung cancer. Patients with an estimated creatinine clearance rate (Ccr) < 60 mL/min had a significantly longer survival. However, a decrease in estimated Ccr was associated with a increased risk of Grade 3/4 neutropenia and anemia. BACKGROUND: The purpose of this study was to explore the predictive factors of the effectiveness and treatment toxicity for pemetrexed as continuation maintenance therapy in patients with advanced nonsquamous non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: Patients with advanced nonsquamous NSCLC treated with pemetrexed as continuation maintenance therapy were enrolled. The medical records were reviewed and analyzed, including data on basic characteristics, estimated creatinine clearance rate (Ccr), treatment responses, progression-free survival (PFS), overall survival (OS), and treatment-related toxicities. RESULTS: A total of 124 patients were included and all had adenocarcinoma. Patients with an estimated Ccr < 60 mL/min had a significantly longer PFS and OS (P = .045, and P = .006, respectively). Each 10 mL/min increase in estimated Ccr was associated with an increase of 9.8% in the risk of disease progression, and an increase of 9.2% in the risk of death. In contrast, an increase of 10 mL/min in estimated Ccr was associated with a decreased risk of Grade 3/4 neutropenia by 50.9% and anemia by 42.2%. CONCLUSION: Estimated Ccr is helpful in predicting the effectiveness and treatment toxicities of pemetrexed maintenance therapy.

Roles of mycobacterium tuberculosis ESAT-6 in the development of renal injury.

OBJECTIVE: The present study was designed to evaluate the role of mycobacterium tuberculosis early secretory antigen target-6 (MtbESAT-6) in the development of renal injury. METHODS: PET42a (+) ESAT6 prokaryotic expression plasmid was constructed and the purified ESAT6 protein without endotoxin was obtained. Sixty healthy, clean, male Kunming mice were randomly divided into two groups: the experimental group (n = 30) and the control group (n = 30). Each mouse in the experimental group were injected with 0.5 ml ESAT-6 protein, and each mouse in the control group were injected with 0.5 ml sterile saline on the tail vein. Blood, urine and kidney tissues were collected. Serum creatinine (Scr), blood urea nitrogen (BUN), and urinary creatinine (Cr) were determined by HITACHI 7150 automatic biochemical analyzer and creatinine clearance rate (Ccr) was calculated. Renal tissues were conducted for hematoxylin-eosin (HE) staining and pathological scores of renal injury were recorded under the light microscope. RESULTS: Using MTB H37Ra strains genome DNA as template, the ESAT6 gene amplified by Hieff Pfu DNA Polymerase using polymerase chain reaction (PCR) technique was consistent with the expected size. PET42a (+) ESAT6 vector plasmid was successfully obtained and ESAT6 recombinant protein was successfully expressed with the protein concentration of 1.69 mg/ml. BUN and Scr in the experimental group were gradually increased, Ccr was gradually decreased, and the pathological score of renal injury increased gradually, and all of which were significantly higher than that in the control group after the experiment of 12 h, 24 h and 48 h (all P < 0.05). CONCLUSION: MtbESAT-6 might contribute to the development of renal injury.

The levels of TGF-β1 in hypertensive renal function impairment patients and its clinical value analysis / 中国医学装备

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.

Correlation between blood lipids level with creatinine clearance rate in patients with heart failure / 天津医药

Objective To explore the relationship between blood lipids level with creatinine clearance rate(Ccr)in patients with heart failure(HF). Methods A total of 955 patients who were diagnosed with heart failure(cardiac function NYHAⅡ~Ⅳclassification)upon discharge from the Department of Cardiology of the Second Hospital of Tianjin Medical University, between January 2010 to June 2013 were enrolled as HF group. Healthy adults (n=200) with normal cardiac function which approximately matched basic condition with HF group were selected as control group. The HF group was fur?ther divided intoⅡ,Ⅲ,Ⅳclassification according to their cardiac function(NYHA classification). HF group was also divid?ed into normal renal function group, mild renal injury group and moderate-severe renal injury group based on their Ccr. Ef?fect of gender and lipid parameters were also compared. Binary logistic regression was used to analyze factors influencing renal function in patients with HF. Results Compared with people in the control group, the levels of triacylglycerol(TG), total cholesterol(TC), low density lipoprotein cholesterol(LDL-c)and non high density lipoprotein cholesterol(non-HDL-c)in patients of HF group were increased while Ccr and high density lipoprotein cholesterol(HDL-c)were decreased. Ccr and lipids were obviously decreased in patients with HF of Ⅳclassification. TG and HDL-c were decreased in moderate-severe renal injury group. Females had a higher lipid levels than males in HF group(P<0.05 or P<0.01). Advanced age, coronary heart disease and hypertension were all risk factors for renal impairment in patients with HF by binary logistic re?gression. On the other hand, weight gain and HDL-c were the protection factors for renal function in HF patients. Conclu?sion Dyslipidemias may lead to renal insufficiency in patients with HF. It was important to control lipids and improve re?nal function in patients with HF.

Observations on the Therapeutic Effect of Herbal Cake Moxibustion on Chronic Renal Failure / 上海针灸杂志

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.

Application of dexmedetomidine in anesthesia for recipients in living related renal transplantation / 器官移植

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.

The value of combined use of laboratory indicators for diagnosis of early renal functional damage / 中国中西医结合急救杂志

Objective To explore the value of combined use of laboratory indicators for diagnosis of early renal functional damage. Methods Eighty-six patients with various kidney diseases were enrolled in the Second Affiliated Hospital of Guangzhou Medical University. On admission,the serum Cystatin C(Cys C),creatinine(Cr), Urea,etc were determined. The value of using combined laboratory indicators in the diagnosis of renal functional damage was obtained through the analysis of the receiver operating characteristic curve(ROC curve);multiple variable indicators were grouped to establish multiple logistic regression models to be compared and evaluated. Results In the early and late renal injury groups(group B of 32 cases and group C of 12 cases),the serum levels of Cys C,Cr, and Urea were significantly higher than those in the normal renal function control group(group A of 42 cases),the elevation in level in group C being the most significant〔Cys C(mg/L):3.47±0.75 vs. 1.59±1.29,Cr(μmol/L):669±466 vs. 214±173,Urea(mmol/L):21.22±13.10 vs. 11.04±8.24,PCys C+Urea>Cys C>Cr+Urea(0.920=0.920>0.911>0.908>0.809). In this sequence,the AUC made by Cys C+Cr+Urea and Cys C+Cr were equal,both 0.920, whose sensitivity was 75.0%,specificity 100.0%,positive predictive value 100.0%,negative predictive value 80.0%and diagnostic accuracy rate 87.5%. So,Cys C + Cr combination could be used to substitute Cys C + Cr + Urea, and the former clinical diagnostic effect was the best,much higher than that by using AUC whose curve was made by Cys C alone. Conclusion The value of using only one laboratory indicator for diagnosis of patients with early renal functional damage is not high,while applying Cys C+Cr combination can improve the diagnostic effect greatly,and its sensitivity and specificity are higher.

Clinical observation of leflunomide in the treatment of diabetic nephropathy-Ⅳ / 中国综合临床

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.