AIMTo investigate the role of contrast enhanced ultrasound(CEUS)in evaluating patients with renal function impairment(RFI)showing:(1)acute renal failure(ARF)of suspicious vascular origin;or(2)suspicious renal lesions....AIMTo investigate the role of contrast enhanced ultrasound(CEUS)in evaluating patients with renal function impairment(RFI)showing:(1)acute renal failure(ARF)of suspicious vascular origin;or(2)suspicious renal lesions.METHODSWe retrospectively evaluated patients addressed to CEUS over an eight years period to rule-out vascular causes of ARF(first group of 50 subjects)or assess previously found suspicious renal lesions(second group of 41 subjects with acute or chronic RFI).After preliminary grey-scale and color Doppler investigation,each kidney was investigated individually with CEUS,using 1.2-2.4 mL of a sulfur hexafluoride-filled microbubble contrast agent.Image analysis was performed in consensus by two readers who reviewed digital clips of CEUS.We calculated the detection rate of vascular abnormalities in the first group and performed descriptive statistics of imaging findings for the second group.RESULTSIn the first group,CEUS detected renal infarction or cortical ischemia in 18/50 patients(36%;95%CI:23.3-50.9)and 1/50 patients(2%;95%CI:0.1-12),respectively.The detection rate of infarction was significantly higher(P=0.0002;McNemar test)compared to color Doppler ultrasonography(10%).No vascular causes of ARF were identified in the remaining 31/50 patients(62%).In the second group,CEUS detected 41 lesions on 39 patients,allowing differentiation between solid lesions(21/41;51.2%)vs complex cysts(20/41;48.8%),and properly addressing 15/39 patients to intervention when feasible based on clinical conditions(surgery and cryoablation in 13 and 2 cases,respectively).Cysts were categorized Bosniak II,IIF,III and IV in 8,5,4 and 3 cases,respectively.In the remaining two patients,CEUS found 1 pseudolesion and 1 subcapsular hematoma.CONCLUSIONCEUS showed high detection rate of renal perfusion abnormalities in patients with ARF,influencing the management of patients with acute or chronic RFI and renal masses throughout their proper characterization.展开更多
Background Hyperuricemia is frequently present in patients with heart failure. Many pathological conditions, such as tissue ischemia, renal function impairment, cardiac function impairment, metabolic syndrome, and inf...Background Hyperuricemia is frequently present in patients with heart failure. Many pathological conditions, such as tissue ischemia, renal function impairment, cardiac function impairment, metabolic syndrome, and inflammatory status, may impact uric acid （UA） metabolism. This study was to assess their potential relations to UA metabolism in heart failure. Methods We retrospectively assessed clinical charac- teristics, echocardiological, renal, metabolic and inflammatory variables selected on the basis of previous evidence of their involvement in cardiovascular diseases and UA metabolism in a large cohort of randomly selected adults with congestive heart failure （n = 553）. By clustering of indices, those variables were explored using factor analysis. Results In factor analysis, serum uric acid （SUA） formed part of a principal cluster of renal functional variables which included serum creatinine （SCr） and blood urea nitrogen （BUN）. Univariate correlation coefficients between variables of patients with congestive heart failure showed that the strongest correlations for SUA were with BUN （r = 0.48, P 〈 0.001） and SCr （r = 0.47, P 〈 0.001）. Conclusions There was an inverse relationship between SUA levels and measures of renal function in patients with congestive heart failure. The strong correlation between SUA and SCr and BUN levels suggests that elevated SUA concentrations reflect an impairment of renal function in heart failure.展开更多
Anti-B cell maturation antigen(BCMA)chimeric antigen receptor(CAR)T-cell therapyis effective and well-tolerated for refractory or relapsed multiple myeloma(RRMM).The purposcof the present study was to analyze efficacy...Anti-B cell maturation antigen(BCMA)chimeric antigen receptor(CAR)T-cell therapyis effective and well-tolerated for refractory or relapsed multiple myeloma(RRMM).The purposcof the present study was to analyze efficacy in RRMM patients with renal impairment treated byanti-BCMA CAR-T cell therapy.A total of 59 RRMM patients were selected,and divided intoimpaired renal function(lRF)group[basclinc cstimated giomerular filtration rate(eSFR)<90 m/min/1.73 m^2(n=18)]and normal renal function(NRF)group(baseline eGFR≥90 mL/min/1.73 m,n=41).For patients with IRF,eGFR at the 6th month post-CAR-T cells infusion was significantlyhigher than the baseline(P<0.05).The multivariate analysis showed that light chain type and beta-2 micro-globulin(bcta-2M)were associated factors with the decrease of serum creatinine.Medianprogression-free survival(PFS)in the NRF group and IRF group was 266 days and 181 daysrespectively.Overall survival(OS)in the NRF group and lRF group was 877 days and 238 daysrespectively.There was no significant difference in the objective response rate(ORR)between thelRF group and the NRF group.It is suggested that CAR-T cells therapy could improve the renalfunction during the treatment of RRMM.The renal function could be more significantly improvedin RRMM patients with light chain type than with other types.展开更多
Background:Nonalcoholic fatty liver disease(NAFLD)is associated with impaired renal function,and both diseases often occur alongside other metabolic disorders.However,the prevalence and risk factors for impaired renal...Background:Nonalcoholic fatty liver disease(NAFLD)is associated with impaired renal function,and both diseases often occur alongside other metabolic disorders.However,the prevalence and risk factors for impaired renal function in patients with NAFLD remain unclear.The objective of this study was to identify the prevalence and risk factors for renal impairment in NAFLD patients.Methods:All adults aged 18-70 years with ultrasound-diagnosed NAFLD and transient elastography examination from eight Asian centers were enrolled in this prospective study.Liver fibrosis and cirrhosis were assessed by FibroScan-aspartate aminotransferase(FAST),Agile 3+and Agile 4 scores.Impaired renal function and chronic kidney disease(CKD)were defined by an estimated glomerular filtration rate(eGFR)with value of<90 mL/min/1.73 m^(2) and<60 mL/min/1.73 m^(2),respectively,as estimated by the CKD-Epidemiology Collaboration(CKD-EPI)equation.Results:Among 529 included NAFLD patients,the prevalence rates of impaired renal function and CKD were 37.4%and 4.9%,respectively.In multivariate analysis,a moderate-high risk of advanced liver fibrosis and cirrhosis according to Agile 3+and Agile 4 scores were independent risk factors for CKD(P<0.05).Furthermore,increased fasting plasma glucose(FPG)and blood pressure were significantly associated with impaired renal function after controlling for the other components of metabolic syndrome(P<0.05).Compared with patients with normoglycemia,those with prediabetes[FPG≥5.6 mmol/L or hemoglobin A1c(HbA1c)≥5.7%]were more likely to have impaired renal function(P<0.05).Conclusions:Agile 3+and Agile 4 are reliable for identifying NAFLD patients with high risk of CKD.Early glycemic control in the prediabetic stage might have a potential renoprotective role in these patients.展开更多
Dear Editor,Primary bladder neck obstruction(PBNO)affects approximately 28%–54%of men[1].Its etiology remains unclear.Symptoms of PBNO present as voiding(e.g.,decreased force of stream,hesitancy,intermittent stream,a...Dear Editor,Primary bladder neck obstruction(PBNO)affects approximately 28%–54%of men[1].Its etiology remains unclear.Symptoms of PBNO present as voiding(e.g.,decreased force of stream,hesitancy,intermittent stream,and incomplete emptying),storage(e.g.,frequency,urgency,urge incontinence,and nocturia),or a combination of both[2].Untreated PBNO can lead to bladder dysfunction,bladder diverticula,hydronephrosis,and impaired renal function[3].展开更多
Objective Limited evidence is available regarding the risk-benefit ratio of thrombolytic therapy in patients with stroke and renal impairment complications,particularly for the drug tenecteplase.Therefore,we examined ...Objective Limited evidence is available regarding the risk-benefit ratio of thrombolytic therapy in patients with stroke and renal impairment complications,particularly for the drug tenecteplase.Therefore,we examined the association of impaired renal function with the safety and efficacy of intravenous thrombolytic treatment(IVT)in patients with acute ischaemic stroke(AIS).Methods A post hoc analysis of a randomised controlled trial(ClinicalTrials gov.NCT04797013)was conducted.Participants who received IVT with tenecteplase and alteplase(0.25 and 0.9 mg/kg,respectively)within 4.5 hours of symptoms onset were categorised based on their estimated glomerular filtration rate as follows:(1)≥90 mL/min/1.73 m2,normal renal function;(2)60-89 mL/min/1.73 m2,mildly decreased renal function;and(3)<60 mL/min/1.73 m2,moderately to severely decreased renal function.Patients stratified based on the normal renal function were used as the references.The primary efficacy and safety outcome were the percentage of patients achieving a modified Rankin Scale score of 0-1 at 90 days and the symptomatic intracranial haemorrhage(sICH)occurrence within 36 hours,respectively.Results In intravenous tenecteplase-treated patients,mildly decreased renal function(OR 3.10;95%CI:1.41 to 6.78)and moderately to severely decreased renal function(OR:8.03;95%CI:2.76 to 23.38)showed an association with a higher risk of all-cause mortality but not with sICH incidence compared with normal renal function.Among patients administered intravenous alteplase,those with a moderate-to severe decrease in renal function exhibited an elevated risk of sICH(adjusted OR:10.01;95%CI:1.61 to 62.15)and all-cause mortality(adjusted OR:4.54;95%CI:1.48 to 13.91).Comparative treatment effects between tenecteplase and alteplase according to renal function grades showed no heterogeneity.Conclusions A significant correlation was noted between kidney dysfunction and unfavourable outcomes in individuals with AIS who received treatment with either tenecteplase or alteplase.展开更多
文摘AIMTo investigate the role of contrast enhanced ultrasound(CEUS)in evaluating patients with renal function impairment(RFI)showing:(1)acute renal failure(ARF)of suspicious vascular origin;or(2)suspicious renal lesions.METHODSWe retrospectively evaluated patients addressed to CEUS over an eight years period to rule-out vascular causes of ARF(first group of 50 subjects)or assess previously found suspicious renal lesions(second group of 41 subjects with acute or chronic RFI).After preliminary grey-scale and color Doppler investigation,each kidney was investigated individually with CEUS,using 1.2-2.4 mL of a sulfur hexafluoride-filled microbubble contrast agent.Image analysis was performed in consensus by two readers who reviewed digital clips of CEUS.We calculated the detection rate of vascular abnormalities in the first group and performed descriptive statistics of imaging findings for the second group.RESULTSIn the first group,CEUS detected renal infarction or cortical ischemia in 18/50 patients(36%;95%CI:23.3-50.9)and 1/50 patients(2%;95%CI:0.1-12),respectively.The detection rate of infarction was significantly higher(P=0.0002;McNemar test)compared to color Doppler ultrasonography(10%).No vascular causes of ARF were identified in the remaining 31/50 patients(62%).In the second group,CEUS detected 41 lesions on 39 patients,allowing differentiation between solid lesions(21/41;51.2%)vs complex cysts(20/41;48.8%),and properly addressing 15/39 patients to intervention when feasible based on clinical conditions(surgery and cryoablation in 13 and 2 cases,respectively).Cysts were categorized Bosniak II,IIF,III and IV in 8,5,4 and 3 cases,respectively.In the remaining two patients,CEUS found 1 pseudolesion and 1 subcapsular hematoma.CONCLUSIONCEUS showed high detection rate of renal perfusion abnormalities in patients with ARF,influencing the management of patients with acute or chronic RFI and renal masses throughout their proper characterization.
文摘Background Hyperuricemia is frequently present in patients with heart failure. Many pathological conditions, such as tissue ischemia, renal function impairment, cardiac function impairment, metabolic syndrome, and inflammatory status, may impact uric acid （UA） metabolism. This study was to assess their potential relations to UA metabolism in heart failure. Methods We retrospectively assessed clinical charac- teristics, echocardiological, renal, metabolic and inflammatory variables selected on the basis of previous evidence of their involvement in cardiovascular diseases and UA metabolism in a large cohort of randomly selected adults with congestive heart failure （n = 553）. By clustering of indices, those variables were explored using factor analysis. Results In factor analysis, serum uric acid （SUA） formed part of a principal cluster of renal functional variables which included serum creatinine （SCr） and blood urea nitrogen （BUN）. Univariate correlation coefficients between variables of patients with congestive heart failure showed that the strongest correlations for SUA were with BUN （r = 0.48, P 〈 0.001） and SCr （r = 0.47, P 〈 0.001）. Conclusions There was an inverse relationship between SUA levels and measures of renal function in patients with congestive heart failure. The strong correlation between SUA and SCr and BUN levels suggests that elevated SUA concentrations reflect an impairment of renal function in heart failure.
基金the National Natural Science Foundation of China(No.81873452)the Clinical Research Program of Huazhong University of Science and Technology Affiliated Tongji Hospital(No.2020003).
文摘Anti-B cell maturation antigen(BCMA)chimeric antigen receptor(CAR)T-cell therapyis effective and well-tolerated for refractory or relapsed multiple myeloma(RRMM).The purposcof the present study was to analyze efficacy in RRMM patients with renal impairment treated byanti-BCMA CAR-T cell therapy.A total of 59 RRMM patients were selected,and divided intoimpaired renal function(lRF)group[basclinc cstimated giomerular filtration rate(eSFR)<90 m/min/1.73 m^2(n=18)]and normal renal function(NRF)group(baseline eGFR≥90 mL/min/1.73 m,n=41).For patients with IRF,eGFR at the 6th month post-CAR-T cells infusion was significantlyhigher than the baseline(P<0.05).The multivariate analysis showed that light chain type and beta-2 micro-globulin(bcta-2M)were associated factors with the decrease of serum creatinine.Medianprogression-free survival(PFS)in the NRF group and IRF group was 266 days and 181 daysrespectively.Overall survival(OS)in the NRF group and lRF group was 877 days and 238 daysrespectively.There was no significant difference in the objective response rate(ORR)between thelRF group and the NRF group.It is suggested that CAR-T cells therapy could improve the renalfunction during the treatment of RRMM.The renal function could be more significantly improvedin RRMM patients with light chain type than with other types.
基金This study was partially supported by an unrestricted grant from Gilead Sciences(CAP-Asia Study-IN-US-989-5334).
文摘Background:Nonalcoholic fatty liver disease(NAFLD)is associated with impaired renal function,and both diseases often occur alongside other metabolic disorders.However,the prevalence and risk factors for impaired renal function in patients with NAFLD remain unclear.The objective of this study was to identify the prevalence and risk factors for renal impairment in NAFLD patients.Methods:All adults aged 18-70 years with ultrasound-diagnosed NAFLD and transient elastography examination from eight Asian centers were enrolled in this prospective study.Liver fibrosis and cirrhosis were assessed by FibroScan-aspartate aminotransferase(FAST),Agile 3+and Agile 4 scores.Impaired renal function and chronic kidney disease(CKD)were defined by an estimated glomerular filtration rate(eGFR)with value of<90 mL/min/1.73 m^(2) and<60 mL/min/1.73 m^(2),respectively,as estimated by the CKD-Epidemiology Collaboration(CKD-EPI)equation.Results:Among 529 included NAFLD patients,the prevalence rates of impaired renal function and CKD were 37.4%and 4.9%,respectively.In multivariate analysis,a moderate-high risk of advanced liver fibrosis and cirrhosis according to Agile 3+and Agile 4 scores were independent risk factors for CKD(P<0.05).Furthermore,increased fasting plasma glucose(FPG)and blood pressure were significantly associated with impaired renal function after controlling for the other components of metabolic syndrome(P<0.05).Compared with patients with normoglycemia,those with prediabetes[FPG≥5.6 mmol/L or hemoglobin A1c(HbA1c)≥5.7%]were more likely to have impaired renal function(P<0.05).Conclusions:Agile 3+and Agile 4 are reliable for identifying NAFLD patients with high risk of CKD.Early glycemic control in the prediabetic stage might have a potential renoprotective role in these patients.
文摘Dear Editor,Primary bladder neck obstruction(PBNO)affects approximately 28%–54%of men[1].Its etiology remains unclear.Symptoms of PBNO present as voiding(e.g.,decreased force of stream,hesitancy,intermittent stream,and incomplete emptying),storage(e.g.,frequency,urgency,urge incontinence,and nocturia),or a combination of both[2].Untreated PBNO can lead to bladder dysfunction,bladder diverticula,hydronephrosis,and impaired renal function[3].
基金funded by Key R&D Program of China(2017YFC1308204)This study was funded by Key R&D Program of China(2017YFC1308204),。
文摘Objective Limited evidence is available regarding the risk-benefit ratio of thrombolytic therapy in patients with stroke and renal impairment complications,particularly for the drug tenecteplase.Therefore,we examined the association of impaired renal function with the safety and efficacy of intravenous thrombolytic treatment(IVT)in patients with acute ischaemic stroke(AIS).Methods A post hoc analysis of a randomised controlled trial(ClinicalTrials gov.NCT04797013)was conducted.Participants who received IVT with tenecteplase and alteplase(0.25 and 0.9 mg/kg,respectively)within 4.5 hours of symptoms onset were categorised based on their estimated glomerular filtration rate as follows:(1)≥90 mL/min/1.73 m2,normal renal function;(2)60-89 mL/min/1.73 m2,mildly decreased renal function;and(3)<60 mL/min/1.73 m2,moderately to severely decreased renal function.Patients stratified based on the normal renal function were used as the references.The primary efficacy and safety outcome were the percentage of patients achieving a modified Rankin Scale score of 0-1 at 90 days and the symptomatic intracranial haemorrhage(sICH)occurrence within 36 hours,respectively.Results In intravenous tenecteplase-treated patients,mildly decreased renal function(OR 3.10;95%CI:1.41 to 6.78)and moderately to severely decreased renal function(OR:8.03;95%CI:2.76 to 23.38)showed an association with a higher risk of all-cause mortality but not with sICH incidence compared with normal renal function.Among patients administered intravenous alteplase,those with a moderate-to severe decrease in renal function exhibited an elevated risk of sICH(adjusted OR:10.01;95%CI:1.61 to 62.15)and all-cause mortality(adjusted OR:4.54;95%CI:1.48 to 13.91).Comparative treatment effects between tenecteplase and alteplase according to renal function grades showed no heterogeneity.Conclusions A significant correlation was noted between kidney dysfunction and unfavourable outcomes in individuals with AIS who received treatment with either tenecteplase or alteplase.
