Association of elevated uric acid with metabolic disorders and analysis of the risk factors of hyperuricemia in type 2 diabetes mellitus / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the association of elevated serum uric acid with metabolic disorders and the risk factors of hyperuricemia in type 2 diabetes mellitus (T2DM).</p><p><b>METHODS</b>The clinical and laboratory data of 159 T2DM patients aged 40-80 years with a Scr level of 51-159 µmol/L (0.6-1.8 mg/dl) were analyzed to explore the association of hyperuricemia (HUA) with metabolic disorders and identify the risk factors of HUA.</p><p><b>RESULTS</b>Forty out of 159 T2DM patients (25.2%) were found to have HUA. Univariate analysis showed that male gender, a body mass index ≤25 kg/m(2), hypertension, serum creatinine ≤110 µmol/L, blood urea nitrogen ≤7.0 mmol/L, microalbuminuria :11.2 mg/L, triglyceride :1.70 mmol/L, high-density lipoprotein <1.04 mmol/L, low density lipoprotein ≤3.37 mmol/L were all risk factors of HUA (P<0.05) in T2DM. Binary logistic regression analysis identified serum creatinine, body mass index and triglyceride as independent risk factors of HUA in T2DM. The main risk factors related to HUA had high incidences in T2DM. Patients with HUA had a significantly higher incidences of coronary artery disease, carotid atherosclerosis, cerebral infarction, diabetic nephropathy and diabetic retinopathy than those with normal uric acid level (P<0.05).</p><p><b>CONCLUSION</b>Several risk factors contribute to the occurrence of elevated serum uric acid in T2DM, and metabolic disorders and complications are also closely associated with HUA.</p>

A comparative study of the clinicopathological features in patients with IgA nephropathy with elevated uric acid level / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the changes in the clinicopathological features of patients with IgA nephropathy with elevated uric acid level.</p><p><b>METHODS</b>A total of 171 patients with IgA nephropathy diagnosed at biopsy were classified into 3 groups, namely normotensive group with normal level uric acid (group 1), normotensive group with elevated uric acid level (group 2), and hypertensive group with elevated uric acid level (group 3). The clinicopathological features were compared between the 3 groups.</p><p><b>RESULTS</b>From group 1 to group 3, the disease duration became elongated, body weight increased, systolic and diastolic pressures elevated, blood urea nitrogen and serum creatinine increased, glomerular filtration rate decreased, and 24-h urine protein increased; the apolipoprotein A, high-density lipoprotein and albumin levels decreased, while apolipoprotein B100, triglyceride, cholesterol and low-density lipoprotein increased. The glomerular damage, tubulointerstitial lesions and arteriole hypertrophy worsened, and Lee's grade III changes were predominant in group 1, grade III or IV in group 2 and grades III-V in group 3. Mesangial proliferative glomerulonephritis was the major pathological type in groups 1 and 2, as compared with focal segmental glomerulonephritis or sclerosing glomerulonephritis in group 3.</p><p><b>CONCLUSION</b>Patients with IgA nephropathy and elevated uric acid level have greater clinicopathological damage than those with normal uric acid level, and hypertension further aggravates such damages.</p>

Balloon occlusion and hypothermic perfusion of the renal artery in laparoscopic partial nephectomy.

OBJECTIVES: We describe our initial experience with renal arterial catheterization for temporary balloon occlusion of renal artery and hypothermic perfusion during laparoscopic partial nephectomy and compare the preoperative and postoperative nephron function. METHODS: Fifteen patients received laparoscopic partial nephrectomy from September 2005 to December 2006. During the operations, the balloons of the arterial catheters were filled with distilled water to achieve pedicle control. Chilled Ringers lactate was continuously infused into the catheters for renal hypothermia. Postoperative Tc-99m diethylenetriamine pentaacetic acid (DTPA) renal scintigraphies were carried out to estimate differential renal function. The volumes of the renal tumors, tumor-bearing and contralateral kidneys from CT scans were measured using commercial software. Estimated creatinine clearance was calculated with Cockroft Gault formula. RESULTS: All procedures were successfully completed. Mean tumor size was 18.4 mL (range 2.14 to 59.0). Estimated mean intraoperative blood loss was 287 mL (range minimal to 1200). Mean estimated creatinine clearance per unit volume of functional renal parenchyma did not change statistically after the operation. Multiple regression analysis revealed that ischemic time was a significant variable which correlated with the value of lost total estimated creatinine clearance of the tumor bearing kidney. CONCLUSIONS: The initial experience shows that renal arterial catheterization for temporary balloon occlusion and hypothermic perfusion of the renal artery in laparoscopic partial nephectomy is safe, feasible and effective. The postoperative kidney function measured by mean estimated creatinine clearance per unit of functional renal volume was similar to the preoperative measurement.

Elevated plasma factor VIII coagulant activity presenting with thrombophlebitis of the deep dorsal vein of the penis.

A 55-year-old man started to suffer from severe penile pain 2 days after engaging in sexual intercourse in the woman-on-top position. A fixed, 2-cm long, cord-like lesion was found on the dorsal midline of his penis which was in a partially tumescent state. Ultrasonography showed part of the deep dorsal vein was obstructed by a hyperechoic mass. Laboratory tests revealed elevated plasma factor VIII coagulant activity. The patient received thrombophlebectomy of the deep dorsal penile vein. Pathology reported venous thrombosis with eosinophilic and lymphocytic infiltration of the venous wall. At the outpatient follow up, painful thrombophlebitic veins at the previous i.v. accesses were noted on his left arm. He has received long-term warfarin control as suggested by hematologists. This patient represents the first reported case of deep dorsal penile thrombophlebitis associated with elevated plasma factor VIII coagulant activity, which is an independent risk factor of recurrent venous thromboembolism and superficial thrombophlebitis.