Our prior investigations have established that Inonotus obliquus(Chaga)possesses hypoglycemic effects.Persistent hyperglycemia is known to precipitate renal function abnormalities.The functionality of the kidneys is i...Our prior investigations have established that Inonotus obliquus(Chaga)possesses hypoglycemic effects.Persistent hyperglycemia is known to precipitate renal function abnormalities.The functionality of the kidneys is intricately linked to the levels of cyclic guanosine-3',5'-monophosphate(cGMP),which are influenced by the activities of nitric oxide synthase(NOS)and phosphodiesterase(PDE).Enhanced cGMP levels can be achieved either through the upregulation of NOS activity or the downregulation of PDE activity.The objective of the current study is to elucidate the effects of Chaga on disorders of glucolipid metabolism and renal abnormalities in rats with type 2 diabetes mellitus(T2DM),while concurrently examining the NOS-cGMP-PDE5 signaling pathway.A model of T2DM was developed in rats using a high-fat diet(HFD)combined with streptozotocin(STZ)administration,followed by treatment with Chaga extracts at doses of 50 and 100 mg·kg^(−1)for eight weeks.The findings revealed that Chaga not only mitigated metabolic dysfunctions,evidenced by improvements in fasting blood glucose,total cholesterol,triglycerides,and insulin resistance,but also ameliorated renal function markers,including serum creatinine,urine creatinine(UCr),blood urea nitrogen,24-h urinary protein,and estimated creatinine clearance.Additionally,enhancements in glomerular volume,GBM thickness,podocyte foot process width(FPW),and the mRNA and protein expressions of podocyte markers,such as nephrin and wilms tumor-1,were observed.Chaga was found to elevate cGMP levels in both serum and kidney tissues by increasing mRNA and protein expressions of renal endothelial NOS and neural NOS,while simultaneously reducing the expressions of renal inducible NOS and PDE5.In summary,Chaga counteracts HFD/STZ-induced glucolipid metabolism and renal function disturbances by modulating the NOS-cGMP-PDE5 signaling pathway.This research supports the potential application of Chaga in the clinical prevention and treatment of T2DM and diabetic nephropathy(DN),with cGMP serving as a potential therapeutic target.展开更多
In the present study, we aimed to evaluate the effects of cilnidipine and L-type calcium channel blockers（L-type CCBs） on renal function in hypertensive patients. The randomized controlled trials（RCTs） of cilnidip...In the present study, we aimed to evaluate the effects of cilnidipine and L-type calcium channel blockers（L-type CCBs） on renal function in hypertensive patients. The randomized controlled trials（RCTs） of cilnidipine and L-type CCBs on hypertension treatment were selected from Pubmed, Embase, Google Scholar, CNKI, Science Direct, Ebsco, Springer, Ovid, Cochrane Library, Medline, VIP and Wanfang databases（from the date of databases＇ establishment to September 2014）. Data were independently evaluated following the Jadad standard. The percentage changes of serum creatinine（SCr） value, urinary protein excretion（UPE）, urinary protein/creatinine ratio（UPCR） and estimated glomerular filtration rate（e GFR） pre- and post-treatment were extracted for the subsequent meta-analysis. The mean difference（MD） and the 95% confidence interval（95% CI） were determined using RevM an 5.3 software. A total of 10 RCTs of high quality were included and analyzed by fixedor random-effect models. The results indicated that UPE（MD = –36.59, 95% CI： –70.85, –2.33） or UPCR（MD = –46.56, 95% CI： –88.50, –4.62） was significantly reduced by cilnidipine compared with L-type CCBs. However, such significant difference was not detected in reduction of SCr（MD = 0.01, 95% CI： –2.97, 2.98） or eG FR（MD = 1.56, 95% CI： –0.19, 3.31）. Compared with L-type CCBs, cilnidipine was more effective in reducing proteinuria or preventing the proteinuria progression. In addition, we did not find significant differences in SCr and eG FR between the two groups.展开更多
Background Patients with unstable angina pectoris and diabetes mellitus are very common. When they receive interventional therapy, contrast agentscan causerenal injuryand platelet activation. Alprostadil has been show...Background Patients with unstable angina pectoris and diabetes mellitus are very common. When they receive interventional therapy, contrast agentscan causerenal injuryand platelet activation. Alprostadil has been shown to decrease inflammation and microvascular resistance. There is no any report on the protection effects of alprostadilon renal injuryand the platelet activation during cardiac interventional therapy. Methods A total of 57 patients were divided into two groups, alprostadil group （n=35） and normal group n=22）. BUN （blood urea ni- trogen） and SCr （serum creatine） were measured as the renal function parameters. GFR （glomerular filtration rate） was calculated by the MDRD formula. Platelet parameters： PLT （platelet count, 109）, PDW （platelet distribu- tion width, fL）, MPV （mean platelet volume, fL）, PLCR （large platelet scale ratio, %） were measured as the platelet activationindex. T test and Chi-square test were used as statistical methods, and P〈0.05 was considered statistically significant. Results In the alprostadil group, SCr was 71.1±13.8 μmoFL and 65.9±12.6 ＆tool/L, before and after interventional therapy （P〈0.05）. BUN was 5.68±1.79 mmol/L and 3.86±1.19 mmol/L （P〈0.001）, before and after interventional therapy. I n the platelet tests, MPV was seemed to be the only useful platelet parameter, before and after interventional therapy （11.8±1.8 fL and ll.l±1.2fL, P〈0.05）, while the PLT （109/L）, PDW （fl）, PLCR （%） didn＇ t show any significant difference. In the normal group, all these tests＇ results didn＇ t significantly change after interventional therapy. Conclusions The patients with the unstable angina pectoris and diabetes mellitus have on the risk of renal function damage and platelet activation when undertaking cardiac interventional therapy. Alprostadil protects renal function and alleviates olatelet activation.展开更多
Objective To investigate the effect of prostaglandin E1 (PGE1) on recovery of early renal graft functions after transplantation. Methods One hundred and seven patients after renal transplantation were allocated in the...Objective To investigate the effect of prostaglandin E1 (PGE1) on recovery of early renal graft functions after transplantation. Methods One hundred and seven patients after renal transplantation were allocated in the treated group, and treated by conventional treatment with injection of 10 μg prostaglandin E1 additionally twice a day for 14 days. And eighty-eight patients who received conventional treatment alone after renal transplantation at the corresponding period were allocated in the control group. Indexes of the two groups, including incidence of delayed graft function and acute rejection reaction, volume of urine, serum certaintie (SCr), endogenous certainties clearance rate (CCr), the blood flow resistance in graft as well as blood viscosity (BV), and platelet aggregation rate (PAR), were determined. Results The urinary volume and endogenous certainties clearance rate of the treated group were significantly higher, but the level of SCr, incidence of renal function recovery retardation, BV, PAR and blood flow resistance in graft were significantly lower than those of the control group (P<0.05). The difference of incidence of acute rejection reaction between the two groups was insignificant (P>0.05). Conclusion Prostaglandin E1 can improve blood microcirculation and decrease the incidence of renal function recovery retardation. These effects are helpful for recovery of renal function after renal transplantation.展开更多
[Objectives]To investigate differences in BMI and renal function across constitution types and influencing factors of blood pressure.[Methods]92 college student volunteers aged 18-25 from January 2023 to December 2024...[Objectives]To investigate differences in BMI and renal function across constitution types and influencing factors of blood pressure.[Methods]92 college student volunteers aged 18-25 from January 2023 to December 2024 were selected.BMI,blood pressure,and renal function markers—blood urea nitrogen(BUN),creatinine(Cr),uric acid(UA),were compared across constitution types.Multiple stepwise regression analysis was applied to identify the influencing factors of blood pressure.[Results]Among 92 healthy participants aged 18-25,Shar-predominant constitution accounted for 50%,Khii-predominant for 25%,and Badgan-predominant for 20.65%.Significant differences existed in mean systolic and diastolic blood pressure across constitution types(systolic:F=4.56,P=0.001;diastolic:F=3.78,P=0.005).Shar-predominant group showed significantly higher systolic blood pressure than other types(P<0.05),while Khii-predominant group had higher diastolic pressure.Shar-predominant constitution demonstrated significantly greater height,weight,and BMI compared to other types(P<0.05).Males exhibited significantly higher height,weight,and BMI than females(P<0.05).Shar-predominant group showed significantly elevated urea,uric acid,and creatinine levels compared to other constitution types(P<0.05).Males had significantly higher mean urea,uric acid,and creatinine levels than females(P<0.05).Correlation analysis revealed stronger associations between BMI,renal function,and blood pressure in Shar-predominant group(r>0.50,P<0.05).Multiple regression analysis identified BMI as the primary influencing factor for blood pressure,followed by urea and uric acid.In Shar-predominant group,BMI exerted the strongest effect on blood pressure(β=0.60-0.65,P<0.001).[Conclusions]This study provides important evidence for health management in populations with different constitution types.展开更多
BACKGROUND The specific mechanism of diabetic nephropathy(DN)has not been fully elucidated,and more and more evidence shows that the development of DN is related to intestinal flora imbalance and micro-inflammatory st...BACKGROUND The specific mechanism of diabetic nephropathy(DN)has not been fully elucidated,and more and more evidence shows that the development of DN is related to intestinal flora imbalance and micro-inflammatory state process,and this mechanism urgently needs to be further clarified by relevant research.AIM To investigate the correlation between intestinal microbiota dysbiosis,low-grade inflammatory status,renal function impairment,and disease severity in older patients with DN,in order to provide a basis for the prevention and therapeutic intervention of DN.METHODS We enrolled 167 older patients with DN,diagnosed in the Department of Nephrology between June 2020 and June 2023.Eighty-five patients with type 2 diabetes mellitus(without DN)were enrolled to serve as the control group.A one-year follow-up observation was conducted.We compared the differences in gut microbiota composition,levels of inflammatory markers,and renal function indicators between the two groups,and the characteristics of gut microbiota and the changing patterns of inflammatory markers across different stages of disease progression.RESULTS In the DN group,the Chao,Ace,and Shannon indices were significantly lower,while the Simpson index was significantly higher than the control group.The relative abundances of Bacteroides and Bifidobacterium were significantly lower,whereas the relative abundances of Clostridium,Butyricimonas,Klebsiella,Enterococcus,Veillonella,and Megamonas were significantly higher than those in the control group(P<0.05).Estimated glomerular filtration rate was positively correlated with the Chao,Ace,and Shannon diversity indices of the gut microbiota,as well as with the relative abundances of Bacteroides,Bifidobacterium,and Akkermansia,and was negatively correlated with the relative abundances of Clostridium,Klebsiella,and Enterococcus(P<0.05).Logistic regression analysis indicated that lower Chao,Ace,and Shannon indices and higher Simpson index were associated with an increased risk of developing DN.After one year of follow-up,patients in the progression group exhibited a significantly greater decrease in Chao,Ace,and Shannon indices and a greater increase in Simpson index than the stable group.The reduction in the relative abundances of Bacteroides,Clostridium,Bifidobacterium,and Butyricimonas,as well as the increase in Klebsiella,Enterococcus,Veillonella,and Megamonas,were significantly more pronounced in the progression group than in the stable group(P<0.05).Regression analysis indicated that greater declines in Chao,Ace,and Shannon indices and Bacteroides relative abundance,along with greater increases in Simpson index and Enterococcus relative abundance,were associated with a more rapid decline in renal function.CONCLUSION The onset and progression of DN in older patients with diabetes are closely associated with gut microbiota composition.The more severe the dysbiosis,the lower the abundance of beneficial bacteria and the higher the abundance of harmful bacteria,leading to an increased risk of both DN occurrence and disease progression.展开更多
Chronic kidney disease(CKD)is a recognized global public health burden affecting over 15%of the general population[1].By 2040,CKD is expected to become the fifth-leading cause of death in the world[2].The neutrophil-t...Chronic kidney disease(CKD)is a recognized global public health burden affecting over 15%of the general population[1].By 2040,CKD is expected to become the fifth-leading cause of death in the world[2].The neutrophil-to-lymphocyte ratio(NLR)indicates local or systemic inflammation status.The NLR has been demonstrated to exhibit predictive value in various pathological conditions,including—but not limited to—pancreatic cancer,as well as macrovascular and microvascular diseases,and sepsis[3,4].展开更多
Objective Traditional Chinese medicine exhibits positive therapeutic effects as a primary or adjunctive treatment for diabetic nephropathy(DN).This study aimed to evaluate the impact and mechanism of action of Xiaoke ...Objective Traditional Chinese medicine exhibits positive therapeutic effects as a primary or adjunctive treatment for diabetic nephropathy(DN).This study aimed to evaluate the impact and mechanism of action of Xiaoke decoction(XKD),a traditional Chinese medicine,on renal function in DN rats.Methods A rat model of DN was established,and the rats were divided into five groups(n=7 per group):normal control group(NC),DN model group(DN),low-dose XKD treatment group(DN+XKD-L,1.5 g/kg/d),high-dose XKD treatment group(DN+XKD-H,6 g/kg/d),and cyclooxygenase-2(COX-2)inhibitor(NS398)treatment group(DN+NS398,8 mg/kg/d).Medications were administered via gavage for 12 consecutive weeks,while equal volumes of normal saline were given to the NC and DN groups.A glucometer was used to detect changes in blood glucose(BG).Enzyme-linked immunosorbent assay(ELISA)and an automatic biochemical analyzer were employed to measure levels of insulin,serum creatinine(Scr),blood urea nitrogen(BUN),triglyceride(TG),total cholesterol(TC),high-density lipoprotein(HDL),low-density lipoprotein(LDL),and 24-h urine protein quantity(UP/24 h)in rats.Renal tissue sections from different treatment groups were prepared,with tissue lesions examined via periodic acid-Schiff(PAS)and hematoxylin–eosin(HE)staining.Tissue inflammation and lipid deposition were evaluated using ELISA and Oil Red O staining.Immunohistochemistry and Western blotting were used to detect changes in the expression levels of COX-2 and low-density lipoprotein receptor(LDLr)in tissues,and to clarify the regulatory mechanism of XKD on renal function in DN rats.Results XKD,particularly at the high dose(XKD-H,6 g/kg/d),significantly reduced BG,insulin levels,renal weight ratio,Scr,BUN,and UP/24 h in DN rats.DN rats showed significant renal lesions,and XKD gavage(especially XKD-H)markedly improved these pathological changes.In DN rats,XKD significantly decreased the protein expression levels of COX-2 and LDLr,downregulated the levels of inflammatory factors and lipid factors,reduced lipid deposition in renal tissues,and ameliorated structural abnormalities in glomeruli,basement membranes,and renal tubules.Conclusions XKD alleviates renal tissue damage by regulating the COX-2-mediated LDLr pathway,thereby reducing the release of inflammatory factors and lipid accumulation in DN rats and protecting renal function.Graphical Abstract XKD improves renal function in streptozotocin(STZ)-induced DN rats by regulating the COX-2-mediated LDLr pathway,reducing inflammatory factors and lipid deposition,and alleviating renal tissue damage.展开更多
BACKGROUND Diabetes and its associated microvascular complications,such as nephropathy and retinopathy,significantly impact global health.These complications often begin in the prediabetic stage,emphasizing the import...BACKGROUND Diabetes and its associated microvascular complications,such as nephropathy and retinopathy,significantly impact global health.These complications often begin in the prediabetic stage,emphasizing the importance of early detection and intervention.Inflammatory pathways are key contributors to these conditions,and recent research has identified members of the tumor necrosis factor(TNF)receptor superfamily as potential biomarkers.However,their association with renal and retinal dysfunction in individuals with intermediate hyperglycemia(IH)remains underexplored.The Early Prevention of Diabetes Complications(ePREDICE)trial provides a valuable cohort to investigate these associations and improve risk assessment strategies.AIM To identify inflammatory biomarkers associated with early renal and retinal dysfunction in individuals with IH.Specifically,we evaluate the diagnostic and prognostic potential of TNF receptor superfamily members[TNF receptor 1(TNF-R1),TNF receptor 2(TNF-R2)],T-cell immunoglobulin and mucin domain 3(TIM-3)/HAVCR2,galectin-3,and interleukin-6(IL-6)in detecting kidney dysfunction and retinopathy in this high-risk population.By understanding their roles,we seek to enhance early screening methods and inform personalized intervention strategies.METHODS A cross-sectional analysis of 967 individuals with IH from the ePREDICE trial was conducted.Participants underwent comprehensive anthropometric and biochemical assessments.Key inflammatory biomarkers,including TNF-R1,TNF-R2,TIM-3/HAVCR2,galectin-3,and IL-6,were quantified using immunoassays.Renal function was assessed using estimated glomerular filtration rate(eGFR)and albuminuria,while retinopathy was evaluated through fundoscopic examination.Statistical analyses included adjusted mean comparisons,correlation studies,and receiver operating characteristic curve analysis to assess biomarker diagnostic accuracy.RESULTS TNF-R1,TNF-R2,and TIM-3/HAVCR2 were significantly associated with reduced filtration function(eGFR<60 mL/minute/1.73 m^(2))and albuminuria,with area under the curve(AUC)values between 0.815 and 0.845.TIM-3/HAVCR2 emerged as the strongest predictor of retinopathy(AUC=0.737).Strong correlations(r>0.75)were observed among TNF-R1,TNF-R2,and TIM-3/HAVCR2,suggesting a coordinated role in inflammatory pathways.CONCLUSION Our findings highlight the potential of TNF receptor superfamily members as biomarkers for early-stage renal and retinal complications in individuals with IH.Their integration into clinical screening protocols could facilitate earlier detection,improving patient stratification and personalized management strategies.Further longitudinal studies are necessary to validate their predictive value and potential for guiding therapeutic interventions in IH and early diabetes management.展开更多
BACKGROUND Patients with chronic hepatitis B(CHB)require long-term antiviral therapy.The effects of different antiviral drugs on kidney function are unclear.There is a lack of effective markers for monitoring early re...BACKGROUND Patients with chronic hepatitis B(CHB)require long-term antiviral therapy.The effects of different antiviral drugs on kidney function are unclear.There is a lack of effective markers for monitoring early renal impairment.AIM To investigate the rate of abnormal renal function index and related potential hazards in patients with CHB.METHODS Clinical data of patients with CHB with urinaryβ2-microglobulin(β2-M)detec-tion,including demographic characteristics,hepatitis B virus(HBV)DNA,serum liver function(alanine aminotransferase,aspartate aminotransferase,total bilirubin,direct bilirubin),serum renal function(urea nitrogen,creatinine),blood lipid index(high density lipoprotein,low density lipoprotein,cholesterol,trigly-ceride),liver imaging,and other routine tests were retrospectively collected.The normal level of urinaryβ2-M and estimated glomerular filtration rate(eGFR)is defined as<0.173 mg/L and≥90 mL/min/1.73 m^(2),retrospectively.The pro-portion of patients with abnormal renal function index and related risk factors were analyzed.RESULTS A total of 500 patients with CHB were enrolled;these patients were aged 44.7±10.8 years,67.2%(336/500)were male,57.2%(286/500)were treated with anti-viral drugs,and 52.2%(261/500)had an HBV-related family history.In total,28.8%(144/500)of patients had fatty liver,35.0%(175/500)had liver fibrosis,and 13.2%(66/500)had cirrhosis.The proportion of patients with eGFR<90 mL/min/1.73 m^(2) was 43.2%(216/500),and the abnormal rate of urinaryβ2-M was 56.2%(281/500).There was no significant difference in the abnormal rate of urinaryβ2-M between the untreated group and the antiviral treated group(54.2%vs 57.7%;P=0.25).The abnormal rate ofβ2-M after long-term entecavir treatment(more than 1 year)was 54.6%(89/163).In the treatment group,56.4%(92/163)of patients with eGFR≥90 mL/min/1.73 m^(2) had abnormal urinaryβ2-M.CONCLUSION In patients with CHB,a higher proportion had greater urinaryβ2-M levels than eGFR for renal injury.Male patients should pay more attention to renal function and use antiviral regimens with a renal safety profile.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
Objective:To conduct a meta-analysis assessing the perioperative,functional and oncological outcomes of partial nephrectomy(PN)and radical nephrectomy(RN)for T1b tumours.The primary endpoints were the oncological outc...Objective:To conduct a meta-analysis assessing the perioperative,functional and oncological outcomes of partial nephrectomy(PN)and radical nephrectomy(RN)for T1b tumours.The primary endpoints were the oncological outcomes.The secondary endpoints were the perioperative and functional outcomes.Methods:A systematic literature review was performed by searching multiple databases through February 2019 to identify eligible comparative studies according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement.Identified reports were assessed according to the Newcastle-Ottawa Scale for nonrandomized controlled trials.Results:Overall,13 retrospective cohort studies were included in the analysis.Patients undergoing PN were younger(weighted mean difference[WMD]3.49 years,95%confidence interval[CI]5.16 to1.82;p<0.0001)and had smaller masses(WMD0.45 cm,95%CI0.59 to0.31;p<0.0001).There were no differences in the oncological outcome,which was demonstrated by progression-free survival(hazard ratio[HR]0.70;pZ0.22),cancerspecific mortality(HR 0.91;pZ0.57)and all-cause mortality(HR 1.01;pZ0.96).The two procedures were similar in estimated blood loss(WMD16.47 mL;pZ0.53)and postoperative complications(risk ratio[RR]1.32;pZ0.10),and PN provided better renal function preservation and was related to a lower likelihood of chronic kidney disease onset(RR 0.38;pZ0.006).Conclusion:PN is an effective treatment for T1b tumours because it offers similar surgical morbidity,equivalent cancer control,and better renal preservation compared to RN.展开更多
The relationship between the levels of renalase and changes in proteinuria, hypertension, renal function, renal tubular epithelial cell apoptosis and B-cell lymphoma-2 （Bcl-2） expression was investigated in patients...The relationship between the levels of renalase and changes in proteinuria, hypertension, renal function, renal tubular epithelial cell apoptosis and B-cell lymphoma-2 （Bcl-2） expression was investigated in patients （chronic nephritis, primary nephrotic syndrome or other kidney disease） that underwent renal biopsy. The study group comprised 72 patients undergoing renal biopsy. Patient profiles and renal function were collected. Concentrations of renalase and Bcl-2 were measured by immunohistochemistry. Tubular injury was detected by periodic acid Schiff staining （PAS） and renal tubular epithelial cell apoptosis was assessed by TUNEL assay. The expression of renalase was significantly lower in renal biopsy specimens than in normal kidney tissues. There was a positive linear relationship between renalase and some serum and cardiac indices; a negative correlation was found between age, eGFR, Ccr and 24-h urinary protein. Renal tubule injury index and tubular epithelial cell apoptosis index showed a negative linear correlation with renalase. The results showed that renalase probably increased the expression of Bel-2. By two independent samples t-test, renalase levels were significantly increased in the non-hypertension group than in the hypertension group. One-way ANOVA showed that renalase expression was higher in samples with Lee＇s grade Ⅲ than in those with Lee＇s grade V. The expression of renalase was significantly decreased in patients who underwent renal biopsy, and was also associated with blood and renal function. The research proved that renalase may reduce renal tubular injury and apoptosis of renal tubular epithelial cells through the mitochondrial apoptosis pathway, finally achieving the purpose of delaying the progress of renal failure.展开更多
Chronic kidney disease(CKD)in patients with liver cirrhosis has become a new frontier in hepatology.In recent years,a sharp increase in the diagnosis of CKD has been observed among patients with cirrhosis.The rising p...Chronic kidney disease(CKD)in patients with liver cirrhosis has become a new frontier in hepatology.In recent years,a sharp increase in the diagnosis of CKD has been observed among patients with cirrhosis.The rising prevalence of risk factors,such as diabetes,hypertension and nonalcoholic fatty liver disease,appears to have contributed significantly to the high prevalence of CKD.Moreover,the diagnosis of CKD in cirrhosis is now based on a reduction in the estimated glomerular filtration rate of<60 mL/min over more than 3 mo.This definition has resulted in a better differentiation of CKD from acute kidney injury(AKI),leading to its greater recognition.It has also been noted that a significant proportion of AKI transforms into CKD in patients with decompensated cirrhosis.CKD in cirrhosis can be structural CKD due to kidney injury or functional CKD secondary to circulatory and neurohormonal imbalances.The available literature on combined cirrhosis-CKD is extremely limited,as most attempts to assess renal dysfunction in cirrhosis have so far concentrated on AKI.Due to problems related to glomerular filtration rate estimation in cirrhosis,the absence of reliable biomarkers of CKD and technical difficulties in performing renal biopsy in advanced cirrhosis,CKD in cirrhosis can present many challenges for clinicians.With combined hepatorenal dysfunctions,fluid mobilization becomes problematic,and there may be difficulties with drug tolerance,hemodialysis and decision-making regarding the need for liver vs simultaneous liver and kidney transplantation.This paper offers a thorough overview of the increasingly known CKD in patients with cirrhosis,with clinical consequences and difficulties occurring in the diagnosis and treatment of such patients.展开更多
ENAL cell carcinoma （RCC） in a solitary kidney presents a unique clinical challenge to urological surgeons. Partial nephrectomy （PN） or nephron-sparing surgery in this condition provides good oncological and renal...ENAL cell carcinoma （RCC） in a solitary kidney presents a unique clinical challenge to urological surgeons. Partial nephrectomy （PN） or nephron-sparing surgery in this condition provides good oncological and renal fuctional outcomes with an acceptable complication rate.1＇ 2 Long-term renal function remains stable in most patients with solitary kidneys after a reduction of more than 50% in renal mass.展开更多
Objective： To investigate the relationship between renal function and clinical outcomes among patients with acute ST-segment elevation myocardial infamtion （ASTEMI）, who were treated with emergency percutaneous cor...Objective： To investigate the relationship between renal function and clinical outcomes among patients with acute ST-segment elevation myocardial infamtion （ASTEMI）, who were treated with emergency percutaneous coronary intervention （PCI）. Methods： 420 patients hospitalized in Peking University First Hospital, diagnosed with ASTEMI treated with emergency （PCI） from January 2001 to June 2011 were enrolled in this study. Estimated glomerular filtration rate （eGFR） was used as a measure of renal function. We compared the clinical parameters and outcomes between ASTEMI patients combined renal insufficiency and the patients with normal renal function. Results： There was a significant increase in the concentrations of fibrinogen and D-Dimer （P〈0.05） and a much higher morbidity of diabetes mellitus in the group of patients with chronic kidney disease （CKD; eGFR〈60 ml/（min-1.73 m^2）） （P〈0.01）. CKD （eGFR〈60 ml/（min.1.73 m^2）） was an independent predictor of in-hospital mortality for patients hospitalized with ASTEMI receiving PCI therapy rapidly （P=0.032, odds ratio （OR） 4.159, 95% confidence interval （CI） 1.127-15.346）. Conclusions： Renal insufficiency is an independent predictor of in-hospital mortality for patients hospitalized with ASTEMI treated with primary PCI.展开更多
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
Objective： To investigate the effects of low central venous pressure （LVCP） on blood loss and evaluate its influence on renal function in patients undergoing hepatectomy. Methods： Forty-six patients, ASA classific...Objective： To investigate the effects of low central venous pressure （LVCP） on blood loss and evaluate its influence on renal function in patients undergoing hepatectomy. Methods： Forty-six patients, ASA classification Ⅰ-Ⅲ, undergoing liver resection were randomized into LCVP group （n = 23） and control group （n = 23）. In LCVP group, CVP was maintained at 2-4 mmHg and MBP above 60 mmHg during hepatectomy, while in control group hepatectomy was performed routinely without lowering CVP. Volume of blood loss during hepatectomy, volume of blood transfusion, and changes of renal functions were compared between the two groups. Results： There were no significant differences in demographics, ASA score, type of hepatectomy, duration of inflow occlusion, operation time, weight of resected liver tissues, and renal functions between the two groups. LCVP group had a significantly lower volume of total intraoperative blood loss （P 〈 0.01） and RBC transfusion （P 〈 0.05）. Conclusion： Lowering the CVP to less than 5 mmHg is a simple and effective technique to reduce blood loss and blood infusion during liver resection, and has no detrimental effects on renal functions.展开更多
AIM: To investigate the effects of different methylenetetrahydrofolate reductase(MTHFR) 677C>T gene polymorphism and hyperhomocysteinemia for the development of renal failure and cardiovascular events, which are co...AIM: To investigate the effects of different methylenetetrahydrofolate reductase(MTHFR) 677C>T gene polymorphism and hyperhomocysteinemia for the development of renal failure and cardiovascular events, which are controversial.METHODS: We challenged the relationship, if any, of MTHFR 677C>T and MTHFR 1298A>C polymorphisms with renal and heart function. The present article is a reappraisal of these concepts, investigating within a larger population, and including a subgroup of dialysis patients, if the two most common MTHFR polymorphisms, C677 T and A1298 C, as homozygous, heterozygous or with a compound heterozygous state, show different association with chronic renal failure requiring hemodialysis. MTHFR polymorphism could be a favorable evolutionary factor, i.e., a protective factor for many ominous conditions, like cancer and renal failure. A similar finding was reported in fatty liver disease in which it is suggested that MTHFR polymorphisms could have maintained and maintain their persistence by an heterozygosis advantage mechanism. We studied a total of 630 Italian Caucasian subject aged 54.60 ± 16.35 years, addressing to the increased hazard of hemodialysis, if any, according to the studied MTHFR genetic polymorphisms. RESULTS: A favorable association with normal renal function of MTHFR polymorphisms, and notably of MTHFR C677 T is present independently of the negative effects of left ventricular hypertrophy, increased IntraRenal arterial Resistance and hyperparathyroidism. CONCLUSION: MTHFR gene polymorphisms could have a protective role on renal function as suggested by their lower frequency among our dialysis patients in end-stage renal failure; differently, the association with left ventricular hypertrophy and reduced left ventricular relaxation suggest some type of indirect, or concurrent mechanism.展开更多
AIM: To evaluate in bile duct ligated rats whether there were progressive alterations of renal function without changes in histopathology. METHODS: Male Wistar rats were submitted to sham-surgery or bile duct ligation...AIM: To evaluate in bile duct ligated rats whether there were progressive alterations of renal function without changes in histopathology. METHODS: Male Wistar rats were submitted to sham-surgery or bile duct ligation (BDL) and divided according to the post-procedure time (2, 4 and 6-wk). To determine renal function parameters, rats wereplaced in metabolic cages and, at the end of the experiment, blood and urine samples were obtained. Histology and hydroxyproline content were analyzed in liver and renal tissue. RESULTS: Rats with 2 wk of BDL increased free water clearance (P = 0.02), reduced urinary osmolality (P = 0.03) and serum creatinine (P = 0.01) in comparison to the sham group. In contrast, rats at 6 wk of BDL showed features of HRS, including signif icant increase in serum creatinine and reductions in creatinine clearance, water excretion and urinary sodium concentration. Rats with 4 wk of BDL exhibited an intermediate stage of renal dysfunction. Progressive hepatic f ibrosis according to post-procedure time was confirmed by histology. The increased levels of liver hydroxyproline contrasted with the absence of structural changes in the kidney, as assessed by histology and unchanged hydroxyproline content in renal tissue. CONCLUSION: Our data show that BDL produced progressive renal dysfunction without structural changes in the kidney, characterizing HRS. The present model will be useful to understand the pathophysiology of HRS.展开更多
基金supported by the Medical Key Research Projects of Shanxi Province(No.2020XM02)the Local Science and Technology Development Funds Projects Guided by Central Government(No.YDZJSX2021C027)+2 种基金the Basic Research Program of Shanxi Province(No.202103021224370)the Key R&D Project of Shanxi Province[International Scientific and Technological Cooperation,Independent Topics,(No.201903D421061)]Wu Jieping Medical Foundation(No.320.6750.2021-08-10).
文摘Our prior investigations have established that Inonotus obliquus(Chaga)possesses hypoglycemic effects.Persistent hyperglycemia is known to precipitate renal function abnormalities.The functionality of the kidneys is intricately linked to the levels of cyclic guanosine-3',5'-monophosphate(cGMP),which are influenced by the activities of nitric oxide synthase(NOS)and phosphodiesterase(PDE).Enhanced cGMP levels can be achieved either through the upregulation of NOS activity or the downregulation of PDE activity.The objective of the current study is to elucidate the effects of Chaga on disorders of glucolipid metabolism and renal abnormalities in rats with type 2 diabetes mellitus(T2DM),while concurrently examining the NOS-cGMP-PDE5 signaling pathway.A model of T2DM was developed in rats using a high-fat diet(HFD)combined with streptozotocin(STZ)administration,followed by treatment with Chaga extracts at doses of 50 and 100 mg·kg^(−1)for eight weeks.The findings revealed that Chaga not only mitigated metabolic dysfunctions,evidenced by improvements in fasting blood glucose,total cholesterol,triglycerides,and insulin resistance,but also ameliorated renal function markers,including serum creatinine,urine creatinine(UCr),blood urea nitrogen,24-h urinary protein,and estimated creatinine clearance.Additionally,enhancements in glomerular volume,GBM thickness,podocyte foot process width(FPW),and the mRNA and protein expressions of podocyte markers,such as nephrin and wilms tumor-1,were observed.Chaga was found to elevate cGMP levels in both serum and kidney tissues by increasing mRNA and protein expressions of renal endothelial NOS and neural NOS,while simultaneously reducing the expressions of renal inducible NOS and PDE5.In summary,Chaga counteracts HFD/STZ-induced glucolipid metabolism and renal function disturbances by modulating the NOS-cGMP-PDE5 signaling pathway.This research supports the potential application of Chaga in the clinical prevention and treatment of T2DM and diabetic nephropathy(DN),with cGMP serving as a potential therapeutic target.
基金Chongqing Municipal Commission of Health and Family Planning(Grant No.2015ZBXM005)
文摘In the present study, we aimed to evaluate the effects of cilnidipine and L-type calcium channel blockers（L-type CCBs） on renal function in hypertensive patients. The randomized controlled trials（RCTs） of cilnidipine and L-type CCBs on hypertension treatment were selected from Pubmed, Embase, Google Scholar, CNKI, Science Direct, Ebsco, Springer, Ovid, Cochrane Library, Medline, VIP and Wanfang databases（from the date of databases＇ establishment to September 2014）. Data were independently evaluated following the Jadad standard. The percentage changes of serum creatinine（SCr） value, urinary protein excretion（UPE）, urinary protein/creatinine ratio（UPCR） and estimated glomerular filtration rate（e GFR） pre- and post-treatment were extracted for the subsequent meta-analysis. The mean difference（MD） and the 95% confidence interval（95% CI） were determined using RevM an 5.3 software. A total of 10 RCTs of high quality were included and analyzed by fixedor random-effect models. The results indicated that UPE（MD = –36.59, 95% CI： –70.85, –2.33） or UPCR（MD = –46.56, 95% CI： –88.50, –4.62） was significantly reduced by cilnidipine compared with L-type CCBs. However, such significant difference was not detected in reduction of SCr（MD = 0.01, 95% CI： –2.97, 2.98） or eG FR（MD = 1.56, 95% CI： –0.19, 3.31）. Compared with L-type CCBs, cilnidipine was more effective in reducing proteinuria or preventing the proteinuria progression. In addition, we did not find significant differences in SCr and eG FR between the two groups.
基金supported by the National Natural Science Foundation of China(No.81170276)
文摘Background Patients with unstable angina pectoris and diabetes mellitus are very common. When they receive interventional therapy, contrast agentscan causerenal injuryand platelet activation. Alprostadil has been shown to decrease inflammation and microvascular resistance. There is no any report on the protection effects of alprostadilon renal injuryand the platelet activation during cardiac interventional therapy. Methods A total of 57 patients were divided into two groups, alprostadil group （n=35） and normal group n=22）. BUN （blood urea ni- trogen） and SCr （serum creatine） were measured as the renal function parameters. GFR （glomerular filtration rate） was calculated by the MDRD formula. Platelet parameters： PLT （platelet count, 109）, PDW （platelet distribu- tion width, fL）, MPV （mean platelet volume, fL）, PLCR （large platelet scale ratio, %） were measured as the platelet activationindex. T test and Chi-square test were used as statistical methods, and P〈0.05 was considered statistically significant. Results In the alprostadil group, SCr was 71.1±13.8 μmoFL and 65.9±12.6 ＆tool/L, before and after interventional therapy （P〈0.05）. BUN was 5.68±1.79 mmol/L and 3.86±1.19 mmol/L （P〈0.001）, before and after interventional therapy. I n the platelet tests, MPV was seemed to be the only useful platelet parameter, before and after interventional therapy （11.8±1.8 fL and ll.l±1.2fL, P〈0.05）, while the PLT （109/L）, PDW （fl）, PLCR （%） didn＇ t show any significant difference. In the normal group, all these tests＇ results didn＇ t significantly change after interventional therapy. Conclusions The patients with the unstable angina pectoris and diabetes mellitus have on the risk of renal function damage and platelet activation when undertaking cardiac interventional therapy. Alprostadil protects renal function and alleviates olatelet activation.
基金supported by the National Natural Science Foundation of China (No.30471640)
文摘Objective To investigate the effect of prostaglandin E1 (PGE1) on recovery of early renal graft functions after transplantation. Methods One hundred and seven patients after renal transplantation were allocated in the treated group, and treated by conventional treatment with injection of 10 μg prostaglandin E1 additionally twice a day for 14 days. And eighty-eight patients who received conventional treatment alone after renal transplantation at the corresponding period were allocated in the control group. Indexes of the two groups, including incidence of delayed graft function and acute rejection reaction, volume of urine, serum certaintie (SCr), endogenous certainties clearance rate (CCr), the blood flow resistance in graft as well as blood viscosity (BV), and platelet aggregation rate (PAR), were determined. Results The urinary volume and endogenous certainties clearance rate of the treated group were significantly higher, but the level of SCr, incidence of renal function recovery retardation, BV, PAR and blood flow resistance in graft were significantly lower than those of the control group (P<0.05). The difference of incidence of acute rejection reaction between the two groups was insignificant (P>0.05). Conclusion Prostaglandin E1 can improve blood microcirculation and decrease the incidence of renal function recovery retardation. These effects are helpful for recovery of renal function after renal transplantation.
基金Supported by Project of Science and Technology Department of Inner Mongolia Autonomous Region(2021GG0117).
文摘[Objectives]To investigate differences in BMI and renal function across constitution types and influencing factors of blood pressure.[Methods]92 college student volunteers aged 18-25 from January 2023 to December 2024 were selected.BMI,blood pressure,and renal function markers—blood urea nitrogen(BUN),creatinine(Cr),uric acid(UA),were compared across constitution types.Multiple stepwise regression analysis was applied to identify the influencing factors of blood pressure.[Results]Among 92 healthy participants aged 18-25,Shar-predominant constitution accounted for 50%,Khii-predominant for 25%,and Badgan-predominant for 20.65%.Significant differences existed in mean systolic and diastolic blood pressure across constitution types(systolic:F=4.56,P=0.001;diastolic:F=3.78,P=0.005).Shar-predominant group showed significantly higher systolic blood pressure than other types(P<0.05),while Khii-predominant group had higher diastolic pressure.Shar-predominant constitution demonstrated significantly greater height,weight,and BMI compared to other types(P<0.05).Males exhibited significantly higher height,weight,and BMI than females(P<0.05).Shar-predominant group showed significantly elevated urea,uric acid,and creatinine levels compared to other constitution types(P<0.05).Males had significantly higher mean urea,uric acid,and creatinine levels than females(P<0.05).Correlation analysis revealed stronger associations between BMI,renal function,and blood pressure in Shar-predominant group(r>0.50,P<0.05).Multiple regression analysis identified BMI as the primary influencing factor for blood pressure,followed by urea and uric acid.In Shar-predominant group,BMI exerted the strongest effect on blood pressure(β=0.60-0.65,P<0.001).[Conclusions]This study provides important evidence for health management in populations with different constitution types.
文摘BACKGROUND The specific mechanism of diabetic nephropathy(DN)has not been fully elucidated,and more and more evidence shows that the development of DN is related to intestinal flora imbalance and micro-inflammatory state process,and this mechanism urgently needs to be further clarified by relevant research.AIM To investigate the correlation between intestinal microbiota dysbiosis,low-grade inflammatory status,renal function impairment,and disease severity in older patients with DN,in order to provide a basis for the prevention and therapeutic intervention of DN.METHODS We enrolled 167 older patients with DN,diagnosed in the Department of Nephrology between June 2020 and June 2023.Eighty-five patients with type 2 diabetes mellitus(without DN)were enrolled to serve as the control group.A one-year follow-up observation was conducted.We compared the differences in gut microbiota composition,levels of inflammatory markers,and renal function indicators between the two groups,and the characteristics of gut microbiota and the changing patterns of inflammatory markers across different stages of disease progression.RESULTS In the DN group,the Chao,Ace,and Shannon indices were significantly lower,while the Simpson index was significantly higher than the control group.The relative abundances of Bacteroides and Bifidobacterium were significantly lower,whereas the relative abundances of Clostridium,Butyricimonas,Klebsiella,Enterococcus,Veillonella,and Megamonas were significantly higher than those in the control group(P<0.05).Estimated glomerular filtration rate was positively correlated with the Chao,Ace,and Shannon diversity indices of the gut microbiota,as well as with the relative abundances of Bacteroides,Bifidobacterium,and Akkermansia,and was negatively correlated with the relative abundances of Clostridium,Klebsiella,and Enterococcus(P<0.05).Logistic regression analysis indicated that lower Chao,Ace,and Shannon indices and higher Simpson index were associated with an increased risk of developing DN.After one year of follow-up,patients in the progression group exhibited a significantly greater decrease in Chao,Ace,and Shannon indices and a greater increase in Simpson index than the stable group.The reduction in the relative abundances of Bacteroides,Clostridium,Bifidobacterium,and Butyricimonas,as well as the increase in Klebsiella,Enterococcus,Veillonella,and Megamonas,were significantly more pronounced in the progression group than in the stable group(P<0.05).Regression analysis indicated that greater declines in Chao,Ace,and Shannon indices and Bacteroides relative abundance,along with greater increases in Simpson index and Enterococcus relative abundance,were associated with a more rapid decline in renal function.CONCLUSION The onset and progression of DN in older patients with diabetes are closely associated with gut microbiota composition.The more severe the dysbiosis,the lower the abundance of beneficial bacteria and the higher the abundance of harmful bacteria,leading to an increased risk of both DN occurrence and disease progression.
基金supported by the Hunan Province Key Field R&D Program(Grant no.2020SK2097)Key Research and Development Project of Hunan Province(Grant no.2020SK2089)+1 种基金the Wisdom Accumulation and Talent Cultivation Project of the Third Xiangya Hospital of Central South University(Grant no.YX202212)Fundamental Research Funds for the Central Universities of Central South University(Grant No.2023ZZTS0839).
文摘Chronic kidney disease(CKD)is a recognized global public health burden affecting over 15%of the general population[1].By 2040,CKD is expected to become the fifth-leading cause of death in the world[2].The neutrophil-to-lymphocyte ratio(NLR)indicates local or systemic inflammation status.The NLR has been demonstrated to exhibit predictive value in various pathological conditions,including—but not limited to—pancreatic cancer,as well as macrovascular and microvascular diseases,and sepsis[3,4].
基金supported by the Budget Project of Shanghai University of Traditional Chinese Medicine(18LK058).
文摘Objective Traditional Chinese medicine exhibits positive therapeutic effects as a primary or adjunctive treatment for diabetic nephropathy(DN).This study aimed to evaluate the impact and mechanism of action of Xiaoke decoction(XKD),a traditional Chinese medicine,on renal function in DN rats.Methods A rat model of DN was established,and the rats were divided into five groups(n=7 per group):normal control group(NC),DN model group(DN),low-dose XKD treatment group(DN+XKD-L,1.5 g/kg/d),high-dose XKD treatment group(DN+XKD-H,6 g/kg/d),and cyclooxygenase-2(COX-2)inhibitor(NS398)treatment group(DN+NS398,8 mg/kg/d).Medications were administered via gavage for 12 consecutive weeks,while equal volumes of normal saline were given to the NC and DN groups.A glucometer was used to detect changes in blood glucose(BG).Enzyme-linked immunosorbent assay(ELISA)and an automatic biochemical analyzer were employed to measure levels of insulin,serum creatinine(Scr),blood urea nitrogen(BUN),triglyceride(TG),total cholesterol(TC),high-density lipoprotein(HDL),low-density lipoprotein(LDL),and 24-h urine protein quantity(UP/24 h)in rats.Renal tissue sections from different treatment groups were prepared,with tissue lesions examined via periodic acid-Schiff(PAS)and hematoxylin–eosin(HE)staining.Tissue inflammation and lipid deposition were evaluated using ELISA and Oil Red O staining.Immunohistochemistry and Western blotting were used to detect changes in the expression levels of COX-2 and low-density lipoprotein receptor(LDLr)in tissues,and to clarify the regulatory mechanism of XKD on renal function in DN rats.Results XKD,particularly at the high dose(XKD-H,6 g/kg/d),significantly reduced BG,insulin levels,renal weight ratio,Scr,BUN,and UP/24 h in DN rats.DN rats showed significant renal lesions,and XKD gavage(especially XKD-H)markedly improved these pathological changes.In DN rats,XKD significantly decreased the protein expression levels of COX-2 and LDLr,downregulated the levels of inflammatory factors and lipid factors,reduced lipid deposition in renal tissues,and ameliorated structural abnormalities in glomeruli,basement membranes,and renal tubules.Conclusions XKD alleviates renal tissue damage by regulating the COX-2-mediated LDLr pathway,thereby reducing the release of inflammatory factors and lipid accumulation in DN rats and protecting renal function.Graphical Abstract XKD improves renal function in streptozotocin(STZ)-induced DN rats by regulating the COX-2-mediated LDLr pathway,reducing inflammatory factors and lipid deposition,and alleviating renal tissue damage.
基金Supported by the Instituto de Salud Carlos Ⅲ(ISCⅢ)Through the Project Co-Funded by the European Union,No.PI20-00487,No.PI23-00119 and No.PI24-01630.
文摘BACKGROUND Diabetes and its associated microvascular complications,such as nephropathy and retinopathy,significantly impact global health.These complications often begin in the prediabetic stage,emphasizing the importance of early detection and intervention.Inflammatory pathways are key contributors to these conditions,and recent research has identified members of the tumor necrosis factor(TNF)receptor superfamily as potential biomarkers.However,their association with renal and retinal dysfunction in individuals with intermediate hyperglycemia(IH)remains underexplored.The Early Prevention of Diabetes Complications(ePREDICE)trial provides a valuable cohort to investigate these associations and improve risk assessment strategies.AIM To identify inflammatory biomarkers associated with early renal and retinal dysfunction in individuals with IH.Specifically,we evaluate the diagnostic and prognostic potential of TNF receptor superfamily members[TNF receptor 1(TNF-R1),TNF receptor 2(TNF-R2)],T-cell immunoglobulin and mucin domain 3(TIM-3)/HAVCR2,galectin-3,and interleukin-6(IL-6)in detecting kidney dysfunction and retinopathy in this high-risk population.By understanding their roles,we seek to enhance early screening methods and inform personalized intervention strategies.METHODS A cross-sectional analysis of 967 individuals with IH from the ePREDICE trial was conducted.Participants underwent comprehensive anthropometric and biochemical assessments.Key inflammatory biomarkers,including TNF-R1,TNF-R2,TIM-3/HAVCR2,galectin-3,and IL-6,were quantified using immunoassays.Renal function was assessed using estimated glomerular filtration rate(eGFR)and albuminuria,while retinopathy was evaluated through fundoscopic examination.Statistical analyses included adjusted mean comparisons,correlation studies,and receiver operating characteristic curve analysis to assess biomarker diagnostic accuracy.RESULTS TNF-R1,TNF-R2,and TIM-3/HAVCR2 were significantly associated with reduced filtration function(eGFR<60 mL/minute/1.73 m^(2))and albuminuria,with area under the curve(AUC)values between 0.815 and 0.845.TIM-3/HAVCR2 emerged as the strongest predictor of retinopathy(AUC=0.737).Strong correlations(r>0.75)were observed among TNF-R1,TNF-R2,and TIM-3/HAVCR2,suggesting a coordinated role in inflammatory pathways.CONCLUSION Our findings highlight the potential of TNF receptor superfamily members as biomarkers for early-stage renal and retinal complications in individuals with IH.Their integration into clinical screening protocols could facilitate earlier detection,improving patient stratification and personalized management strategies.Further longitudinal studies are necessary to validate their predictive value and potential for guiding therapeutic interventions in IH and early diabetes management.
文摘BACKGROUND Patients with chronic hepatitis B(CHB)require long-term antiviral therapy.The effects of different antiviral drugs on kidney function are unclear.There is a lack of effective markers for monitoring early renal impairment.AIM To investigate the rate of abnormal renal function index and related potential hazards in patients with CHB.METHODS Clinical data of patients with CHB with urinaryβ2-microglobulin(β2-M)detec-tion,including demographic characteristics,hepatitis B virus(HBV)DNA,serum liver function(alanine aminotransferase,aspartate aminotransferase,total bilirubin,direct bilirubin),serum renal function(urea nitrogen,creatinine),blood lipid index(high density lipoprotein,low density lipoprotein,cholesterol,trigly-ceride),liver imaging,and other routine tests were retrospectively collected.The normal level of urinaryβ2-M and estimated glomerular filtration rate(eGFR)is defined as<0.173 mg/L and≥90 mL/min/1.73 m^(2),retrospectively.The pro-portion of patients with abnormal renal function index and related risk factors were analyzed.RESULTS A total of 500 patients with CHB were enrolled;these patients were aged 44.7±10.8 years,67.2%(336/500)were male,57.2%(286/500)were treated with anti-viral drugs,and 52.2%(261/500)had an HBV-related family history.In total,28.8%(144/500)of patients had fatty liver,35.0%(175/500)had liver fibrosis,and 13.2%(66/500)had cirrhosis.The proportion of patients with eGFR<90 mL/min/1.73 m^(2) was 43.2%(216/500),and the abnormal rate of urinaryβ2-M was 56.2%(281/500).There was no significant difference in the abnormal rate of urinaryβ2-M between the untreated group and the antiviral treated group(54.2%vs 57.7%;P=0.25).The abnormal rate ofβ2-M after long-term entecavir treatment(more than 1 year)was 54.6%(89/163).In the treatment group,56.4%(92/163)of patients with eGFR≥90 mL/min/1.73 m^(2) had abnormal urinaryβ2-M.CONCLUSION In patients with CHB,a higher proportion had greater urinaryβ2-M levels than eGFR for renal injury.Male patients should pay more attention to renal function and use antiviral regimens with a renal safety profile.
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.
文摘Objective:To conduct a meta-analysis assessing the perioperative,functional and oncological outcomes of partial nephrectomy(PN)and radical nephrectomy(RN)for T1b tumours.The primary endpoints were the oncological outcomes.The secondary endpoints were the perioperative and functional outcomes.Methods:A systematic literature review was performed by searching multiple databases through February 2019 to identify eligible comparative studies according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement.Identified reports were assessed according to the Newcastle-Ottawa Scale for nonrandomized controlled trials.Results:Overall,13 retrospective cohort studies were included in the analysis.Patients undergoing PN were younger(weighted mean difference[WMD]3.49 years,95%confidence interval[CI]5.16 to1.82;p<0.0001)and had smaller masses(WMD0.45 cm,95%CI0.59 to0.31;p<0.0001).There were no differences in the oncological outcome,which was demonstrated by progression-free survival(hazard ratio[HR]0.70;pZ0.22),cancerspecific mortality(HR 0.91;pZ0.57)and all-cause mortality(HR 1.01;pZ0.96).The two procedures were similar in estimated blood loss(WMD16.47 mL;pZ0.53)and postoperative complications(risk ratio[RR]1.32;pZ0.10),and PN provided better renal function preservation and was related to a lower likelihood of chronic kidney disease onset(RR 0.38;pZ0.006).Conclusion:PN is an effective treatment for T1b tumours because it offers similar surgical morbidity,equivalent cancer control,and better renal preservation compared to RN.
文摘The relationship between the levels of renalase and changes in proteinuria, hypertension, renal function, renal tubular epithelial cell apoptosis and B-cell lymphoma-2 （Bcl-2） expression was investigated in patients （chronic nephritis, primary nephrotic syndrome or other kidney disease） that underwent renal biopsy. The study group comprised 72 patients undergoing renal biopsy. Patient profiles and renal function were collected. Concentrations of renalase and Bcl-2 were measured by immunohistochemistry. Tubular injury was detected by periodic acid Schiff staining （PAS） and renal tubular epithelial cell apoptosis was assessed by TUNEL assay. The expression of renalase was significantly lower in renal biopsy specimens than in normal kidney tissues. There was a positive linear relationship between renalase and some serum and cardiac indices; a negative correlation was found between age, eGFR, Ccr and 24-h urinary protein. Renal tubule injury index and tubular epithelial cell apoptosis index showed a negative linear correlation with renalase. The results showed that renalase probably increased the expression of Bel-2. By two independent samples t-test, renalase levels were significantly increased in the non-hypertension group than in the hypertension group. One-way ANOVA showed that renalase expression was higher in samples with Lee＇s grade Ⅲ than in those with Lee＇s grade V. The expression of renalase was significantly decreased in patients who underwent renal biopsy, and was also associated with blood and renal function. The research proved that renalase may reduce renal tubular injury and apoptosis of renal tubular epithelial cells through the mitochondrial apoptosis pathway, finally achieving the purpose of delaying the progress of renal failure.
文摘Chronic kidney disease(CKD)in patients with liver cirrhosis has become a new frontier in hepatology.In recent years,a sharp increase in the diagnosis of CKD has been observed among patients with cirrhosis.The rising prevalence of risk factors,such as diabetes,hypertension and nonalcoholic fatty liver disease,appears to have contributed significantly to the high prevalence of CKD.Moreover,the diagnosis of CKD in cirrhosis is now based on a reduction in the estimated glomerular filtration rate of<60 mL/min over more than 3 mo.This definition has resulted in a better differentiation of CKD from acute kidney injury(AKI),leading to its greater recognition.It has also been noted that a significant proportion of AKI transforms into CKD in patients with decompensated cirrhosis.CKD in cirrhosis can be structural CKD due to kidney injury or functional CKD secondary to circulatory and neurohormonal imbalances.The available literature on combined cirrhosis-CKD is extremely limited,as most attempts to assess renal dysfunction in cirrhosis have so far concentrated on AKI.Due to problems related to glomerular filtration rate estimation in cirrhosis,the absence of reliable biomarkers of CKD and technical difficulties in performing renal biopsy in advanced cirrhosis,CKD in cirrhosis can present many challenges for clinicians.With combined hepatorenal dysfunctions,fluid mobilization becomes problematic,and there may be difficulties with drug tolerance,hemodialysis and decision-making regarding the need for liver vs simultaneous liver and kidney transplantation.This paper offers a thorough overview of the increasingly known CKD in patients with cirrhosis,with clinical consequences and difficulties occurring in the diagnosis and treatment of such patients.
文摘ENAL cell carcinoma （RCC） in a solitary kidney presents a unique clinical challenge to urological surgeons. Partial nephrectomy （PN） or nephron-sparing surgery in this condition provides good oncological and renal fuctional outcomes with an acceptable complication rate.1＇ 2 Long-term renal function remains stable in most patients with solitary kidneys after a reduction of more than 50% in renal mass.
文摘Objective： To investigate the relationship between renal function and clinical outcomes among patients with acute ST-segment elevation myocardial infamtion （ASTEMI）, who were treated with emergency percutaneous coronary intervention （PCI）. Methods： 420 patients hospitalized in Peking University First Hospital, diagnosed with ASTEMI treated with emergency （PCI） from January 2001 to June 2011 were enrolled in this study. Estimated glomerular filtration rate （eGFR） was used as a measure of renal function. We compared the clinical parameters and outcomes between ASTEMI patients combined renal insufficiency and the patients with normal renal function. Results： There was a significant increase in the concentrations of fibrinogen and D-Dimer （P〈0.05） and a much higher morbidity of diabetes mellitus in the group of patients with chronic kidney disease （CKD; eGFR〈60 ml/（min-1.73 m^2）） （P〈0.01）. CKD （eGFR〈60 ml/（min.1.73 m^2）） was an independent predictor of in-hospital mortality for patients hospitalized with ASTEMI receiving PCI therapy rapidly （P=0.032, odds ratio （OR） 4.159, 95% confidence interval （CI） 1.127-15.346）. Conclusions： Renal insufficiency is an independent predictor of in-hospital mortality for patients hospitalized with ASTEMI treated with primary PCI.
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Objective： To investigate the effects of low central venous pressure （LVCP） on blood loss and evaluate its influence on renal function in patients undergoing hepatectomy. Methods： Forty-six patients, ASA classification Ⅰ-Ⅲ, undergoing liver resection were randomized into LCVP group （n = 23） and control group （n = 23）. In LCVP group, CVP was maintained at 2-4 mmHg and MBP above 60 mmHg during hepatectomy, while in control group hepatectomy was performed routinely without lowering CVP. Volume of blood loss during hepatectomy, volume of blood transfusion, and changes of renal functions were compared between the two groups. Results： There were no significant differences in demographics, ASA score, type of hepatectomy, duration of inflow occlusion, operation time, weight of resected liver tissues, and renal functions between the two groups. LCVP group had a significantly lower volume of total intraoperative blood loss （P 〈 0.01） and RBC transfusion （P 〈 0.05）. Conclusion： Lowering the CVP to less than 5 mmHg is a simple and effective technique to reduce blood loss and blood infusion during liver resection, and has no detrimental effects on renal functions.
文摘AIM: To investigate the effects of different methylenetetrahydrofolate reductase(MTHFR) 677C>T gene polymorphism and hyperhomocysteinemia for the development of renal failure and cardiovascular events, which are controversial.METHODS: We challenged the relationship, if any, of MTHFR 677C>T and MTHFR 1298A>C polymorphisms with renal and heart function. The present article is a reappraisal of these concepts, investigating within a larger population, and including a subgroup of dialysis patients, if the two most common MTHFR polymorphisms, C677 T and A1298 C, as homozygous, heterozygous or with a compound heterozygous state, show different association with chronic renal failure requiring hemodialysis. MTHFR polymorphism could be a favorable evolutionary factor, i.e., a protective factor for many ominous conditions, like cancer and renal failure. A similar finding was reported in fatty liver disease in which it is suggested that MTHFR polymorphisms could have maintained and maintain their persistence by an heterozygosis advantage mechanism. We studied a total of 630 Italian Caucasian subject aged 54.60 ± 16.35 years, addressing to the increased hazard of hemodialysis, if any, according to the studied MTHFR genetic polymorphisms. RESULTS: A favorable association with normal renal function of MTHFR polymorphisms, and notably of MTHFR C677 T is present independently of the negative effects of left ventricular hypertrophy, increased IntraRenal arterial Resistance and hyperparathyroidism. CONCLUSION: MTHFR gene polymorphisms could have a protective role on renal function as suggested by their lower frequency among our dialysis patients in end-stage renal failure; differently, the association with left ventricular hypertrophy and reduced left ventricular relaxation suggest some type of indirect, or concurrent mechanism.
基金FAPEMIG (Funda■o de Amparo à Pesquisa do Estado de Minas Gerais)CNPq (Conselho Nacional de Desenvolvimento Científico e Tecnológico)PRONEX (Grupos de Excelência)
文摘AIM: To evaluate in bile duct ligated rats whether there were progressive alterations of renal function without changes in histopathology. METHODS: Male Wistar rats were submitted to sham-surgery or bile duct ligation (BDL) and divided according to the post-procedure time (2, 4 and 6-wk). To determine renal function parameters, rats wereplaced in metabolic cages and, at the end of the experiment, blood and urine samples were obtained. Histology and hydroxyproline content were analyzed in liver and renal tissue. RESULTS: Rats with 2 wk of BDL increased free water clearance (P = 0.02), reduced urinary osmolality (P = 0.03) and serum creatinine (P = 0.01) in comparison to the sham group. In contrast, rats at 6 wk of BDL showed features of HRS, including signif icant increase in serum creatinine and reductions in creatinine clearance, water excretion and urinary sodium concentration. Rats with 4 wk of BDL exhibited an intermediate stage of renal dysfunction. Progressive hepatic f ibrosis according to post-procedure time was confirmed by histology. The increased levels of liver hydroxyproline contrasted with the absence of structural changes in the kidney, as assessed by histology and unchanged hydroxyproline content in renal tissue. CONCLUSION: Our data show that BDL produced progressive renal dysfunction without structural changes in the kidney, characterizing HRS. The present model will be useful to understand the pathophysiology of HRS.
