BACKGROUND Kidney function loss or renal insufficiency indicated by elevated creatinine levels and/or an estimated glomerular filtration rate(eGFR)<60 mL/minute/1.73 m²at presentation in patients with primary ...BACKGROUND Kidney function loss or renal insufficiency indicated by elevated creatinine levels and/or an estimated glomerular filtration rate(eGFR)<60 mL/minute/1.73 m²at presentation in patients with primary focal segmental glomerulosclerosis(FSGS)is commonly seen as a poor prognostic marker for kidney survival.However,a pre>vious study from our center suggested this may be due to hemodynamic factors.AIM To observe the clinical and biochemical parameters,treatment response,kidney survival,and overall outcomes of adult patients with primary FSGS presenting with kidney function insufficiency.METHODS This retrospective observational study was conducted at the Department of Nephrology,Sindh Institute of Urology and Transplantation,Karachi,Pakistan,from January 1995 to December 2017.During this period,401 biopsy-proven primary FSGS patients were identified,of which 98(24.4%)presented with kidney function loss or renal insufficiency defined as eGFR<60 mL/minute/1.73 m²at presentation and were studied in detail.RESULTS Among the 98 patients with renal function loss on presentation,the mean age was 30.9 years±13.6 years with a male-to-female ratio of 2.5:1.The mean serum creatinine level was 2.2 mg/dL±1.3 mg/dL and mean eGFR 37.1 mL/minute/1.73 m2±12.8 mL/minute/1.73 m2.The mean 24-hour urinary protein excretion was 5.9 g/day±4.0 g/day,and the mean serum albumin was 2.1 g/dL±1.0 g/dL(median:1.5 g/dL).The mean systolic blood pressure(BP)was 132.7 mmHg±19.8 mmHg,and the mean diastolic BP was 87.4 mmHg±12.7 mmHg.Steroid treatment was given to 81(82.6%)of 98 patients for an average duration of 19.9 weeks±14.4 weeks,with a mean total steroid dose of 4.4 g±1.5 g.Treatment response showed that 20(24.6%)patients achieved complete remission,9(11.1%)achieved partial remission,and 52(64.1%)did not respond.The baseline eGFR was significantly lower in the non-responsive group(P=0.006).The distribution of FSGS variants was also significantly different among steroid-responsive and non-responsive groups(P=0.012).CONCLUSION Renal function loss in FSGS patients at presentation does not necessarily indicate irreversible kidney function loss and a significant number of patients respond to appropriate treatment of the underlying disease.展开更多
Objective To evaluate the association between serum uric acid(SUA)and kidney function decline.Methods Data was obtained from the China Health and Retirement Longitudinal Study on the Chinese middle-aged and older popu...Objective To evaluate the association between serum uric acid(SUA)and kidney function decline.Methods Data was obtained from the China Health and Retirement Longitudinal Study on the Chinese middle-aged and older population for analysis.The kidney function decline was defined as an annual estimated glomerular filtration rate(e GFR)decrease by>3 mL/min per 1.73 m^(2).Multivariable logistic regression was applied to determine the association between SUA and kidney function decline.The shape of the association was investigated by restricted cubic splines.Results A total of 7,346 participants were included,of which 1,004 individuals(13.67%)developed kidney function decline during the follow-up of 4 years.A significant dose-response relation was recorded between SUA and the kidney function decline(OR 1.14,95%CI 1.03-1.27),as the risk of kidney function decline increased by 14%per 1 mg/d L increase in SUA.In the subgroup analyses,such a relation was only recorded among women(OR 1.22,95%CI 1.03-1.45),those aged<60 years(OR 1.22,95%CI 1.05-1.42),and those without hypertension and without diabetes(OR 1.22,95%CI 1.06-1.41).Although the dose-response relation was not observed in men,the high level of SUA was related to kidney function decline(OR 1.83,95%CI 1.05-3.17).The restricted cubic spline analysis indicated that SUA>5 mg/dL was associated with a significantly higher risk of kidney function decline.Conclusion The SUA level was associated with kidney function decline.An elevation of SUA should therefore be addressed to prevent possible kidney impairment and dysfunction.展开更多
BACKGROUND Retroperitoneal fibrosis is an exceptionally rare disease characterized by proliferation of fibrous tissue and inflammation in the retroperitoneum.It features many symptoms in the kidneys and in other organ...BACKGROUND Retroperitoneal fibrosis is an exceptionally rare disease characterized by proliferation of fibrous tissue and inflammation in the retroperitoneum.It features many symptoms in the kidneys and in other organs and usually leads to ureteral obstruction.CASE SUMMARY Here we present 9 consecutive cases of idiopathic retroperitoneal fibrosis(IRPF)in patients who presented to the Department of Nephrology or Department of Rheumatology,Xuanwu Hospital,Capital Medical University,Beijing,China,between January 2012 and June 2017 with ureteral obstruction due to external compression of the ureter that led to hydronephrosis and kidney dysfunction.Computed tomography imaging was used to identify hydronephrosis and ureteral obstruction and to evaluate kidney function.Each patient was diagnosed with IRPF based on clinical observation and computed tomography examination results.To restore kidney function,a retrograde metallic stent was placed in the ureter under X-ray guidance 2 d after each patient’s admission.No perioperative complications occurred in any patient,but postoperative complications occurred in two patients as follows:Patient 2 had stent migration and repeated metallic stent infections that resolved with treatment;and patient 4 had postoperative hematuria because he resumed normal activities too soon after stent placement(contrary to instruction).Placement of the metallic ureteral stents provided relief from ureteral obstruction and restored kidney function in all patients.CONCLUSION Our 9-case series underscores the utility and efficacy of applying the Resonance®metallic ureteral stent to treat ureteral obstruction in patients with IRPF.For all retroperitoneal fibrosis cases in our series,ureteral stents provided effective relief and were shown to reduce the incidence rate of perioperative and postoperative complications.展开更多
BACKGROUND Obesity usually causes diabetes mellitus(DM)and is a serious danger to human health.Type 2 DM(T2DM)mostly occurs along with obesity.Foodborne obesityinduced DM is caused by an excessive long-term diet and s...BACKGROUND Obesity usually causes diabetes mellitus(DM)and is a serious danger to human health.Type 2 DM(T2DM)mostly occurs along with obesity.Foodborne obesityinduced DM is caused by an excessive long-term diet and surplus energy.Bariatric surgery can improve the symptoms of T2DM in some obese patients.But different types of bariatric surgery may have different effects.AIM To investigate the effect of bariatric surgery on glucose and lipid metabolism and liver and kidney function in rats.METHODS Male Sprague-Dawley rats aged 6-8 wk underwent Roux-en-Y gastric bypass surgery(RYGB),sleeve gastrectomy(SG),or gastric banding(GB).Glucose and insulin tolerance tests,analyses of biochemical parameters,histological examination,western blot,and quantitative real-time polymerase chain reaction were conducted.RESULTS In comparison to the sham operation group,the RYGB,SG,and GB groups had decreased body weight and food intake,reduced glucose intolerance and insulin insensitivity,downregulated biochemical parameters,alleviated morphological changes in the liver and kidneys,and decreased levels of protein kinase Cβ/P66shc.The effect in the RYGB group was better than that in the SG and GB groups.CONCLUSION These results suggest that RYGB,SG and GB may be helpful for the treatment of foodborne obesity-induced DM.展开更多
The diagnosis of small renal masses(SRMs) continues to increase likely attributable to widespread use of axial cross-sectional imaging. Many of these SRMs present in elderly patients with abnormal baseline renal funct...The diagnosis of small renal masses(SRMs) continues to increase likely attributable to widespread use of axial cross-sectional imaging. Many of these SRMs present in elderly patients with abnormal baseline renal function. Such patients are at risk for further decline following therapeutic intervention. Renal thermal ablation presents one approach for management of SRMs whereby tumors are treated in situ without need for global renal ischemia. These treatment characteristics contribute to favorable renal function outcomes following kidney tumor ablation particularly in patients with an anatomic or functional solitary renal unit.展开更多
Chronic kidney disease （CKD） has become a worldwide public health problem, and currently, it affects approximately 10% of adults in the United States[I]. Meanwhile, it also has emerged as an important social challen...Chronic kidney disease （CKD） has become a worldwide public health problem, and currently, it affects approximately 10% of adults in the United States[I]. Meanwhile, it also has emerged as an important social challenge in China[2]. CKD has been reported to be a major risk factor for cardiovascular diseases, premature death, and end-stage renal diseaseTM. Thus, it is necessary to determine the risk factors for CKD.展开更多
Acute kidney injury(AKI)incidence is growing rapidly,and AKI is one of the predictors of inpatient mortality.After nephrectomy,all the patients have decreased kidney function with AKI and recover from AKI.However,the ...Acute kidney injury(AKI)incidence is growing rapidly,and AKI is one of the predictors of inpatient mortality.After nephrectomy,all the patients have decreased kidney function with AKI and recover from AKI.However,the characteristic and behavior of AKI is different from usual AKI and compensatory kidney function has been well known in the postoperative setting,especially in living donors.In this review,we have focused on the compensation of kidney function after nephrectomy in living donors.We discuss factors that have been identified as being associated with kidney recovery in donors including age,sex,body mass index,remnant kidney volume,estimated glomerular filtration rate,and various comorbidities.展开更多
To the Editor:Light chain deposition disease(LCDD)is a rare systemic complication of plasma cell disorders that primarily affects the kidneys,and LCDD can lead to chronic kidney failure.[1]Before the development of no...To the Editor:Light chain deposition disease(LCDD)is a rare systemic complication of plasma cell disorders that primarily affects the kidneys,and LCDD can lead to chronic kidney failure.[1]Before the development of novel anti-plasmacyte agents,the overall prognosis of LCDD patients was poor.The introduction of novel plasmacyte-targeted therapies,such as the proteasome inhibitor bortezomib,has improved kidney survival in LCDD patients.[2]However,the kidney response rate of LCDD patients to bortezomib-based treatment remains approximately 50%,and 25.7%of patients progress to end-stage kidney disease(ESKD)within 60 months.Daratumumab,an anti-CD38 monoclonal antibody that has been available in China since 2021,has shown promising results in both multi ple myeloma(MM)and light-chain(AL)amyloidosis patients.[3,4]Several case series have demonstrated rapid hematological responses and preservation of kidney function in LCDD patients treated with daratumumab who were previously treated with bortezomib.[5,6]However,the efficacy of a combination of daratumumab and bortezomib compared to regimes involving bortezomib alone in newly diagnosed LCDD patients has yet to be systematically assessed.We retrospectively reviewed our database to address this issue and conducted a comparative study.展开更多
Observational studies have identified that declined kidney function was associated with a higher risk of cardiovascular disease(CVD).However,the causation of such associations requires further exploration.Here,we comp...Observational studies have identified that declined kidney function was associated with a higher risk of cardiovascular disease(CVD).However,the causation of such associations requires further exploration.Here,we compared the observational associations of various kidney function measurements with CVD and its major subtypes and further assessed the potential causality using Mendelian randomization(MR)analyses with individual-level data of 306,246 participants from the UK Biobank and genome-wide association study summary-level data from FinnGen consortium,Coronary ARtery DIsease Genome wide Replication and Meta-analysis plus The Coronary Artery Disease Genetics(CARDIoGRAMplusC4D)consortium,and MEGASTROKE Consortium,respectively.Kidney function measurements included circulating levels of cystatin C and creatinine,urine albumin-to-creatinine ratio(uACR),and estimated glomerular filtration rates(eGFR)from three chronic kidney disease epidemiology collaboration formulae(i.e.,that using cystatin C,creatinine,and both).In the observational analyses,decreased kidney function measurements were associated with a higher risk of CVD in the UK Biobank study.For example,per one standard deviation decrease in baseline estimated glomerular filtration rates using both cystatin C and creatinine(eGFRcys+cre)was associated with 11%higher risk of CVD(hazard ratio=0.89;95%confidence interval,0.87-0.90).In contrast,two-sample MR analyses did not suggest significant associations of any genetically instrumented kidney function measurement with the risk of CVD or its subtypes.Our findings suggested the inverse associations of kidney function measurements with CVD risk from observational studies were not supported by large MR analyses.展开更多
To evaluate the effects of sacubitril/valsartan and ARB on renal function in patients with and without heart failure, we conducted a comprehensive literature search using both Chinese and English databases. These incl...To evaluate the effects of sacubitril/valsartan and ARB on renal function in patients with and without heart failure, we conducted a comprehensive literature search using both Chinese and English databases. These included the Cochrane Library, Wanfang Database, PubMed, CNKI, Embase, and Clinical Trials. The search encompassed studies published from the inception of the databases to March 2024. Randomized controlled studies meeting the inclusion criteria were assessed for bias using the Cochrane risk of bias assessment tool. Data were analyzed using Review Manager 5.4, with relative risk (RR) as the effect indicator. Depending on the heterogeneity of the studies, either a fixed-effects model or a random-effects model was employed to combine effect sizes. Seven studies met the inclusion criteria. Compared with ARB drugs, sacubitril/valsartan showed a reduction in the deterioration of renal function (RR = 0.70, 95% CI: 0.44–1.12, P = 0.14) and acute renal function injury (RR = 0.77, 95% CI: 0.59–1.00, P = 0.05). The risk of end-stage renal disease was also lower (RR = 0.53, 95% CI: 0.30–0.96, P = 0.16). For serum creatinine levels greater than 2.5 mg/dL, the RR was 0.88 (95% CI: 0.68–1.15, P = 0.37). For a reduction in eGFR of more than 25%, the RR was 0.89 (95% CI: 0.57–1.41, P = 0.63). The incidence of serum potassium levels greater than 5.5 mmol/L was not significantly different between the groups (RR = 1.23, 95% CI: 0.86–1.75, P = 0.26), nor was the incidence of serum potassium levels greater than 6.0 mmol/L (RR = 1.06, 95% CI: 0.58–1.93, P = 0.86). However, the incidence of eGFR decreasing by more than 50% was significantly reduced (RR = 0.58, 95% CI: 0.34–0.99, P < 0.05). In conclusion, sacubitril/valsartan demonstrated a protective effect on the kidneys, effectively reducing the risk of renal deterioration and presenting a potential alternative to ARB drugs.展开更多
BACKGROUND Despite the developments in the field of kidney transplantation,the already existing diagnostic techniques for patient monitoring are considered insufficient.Protein biomarkers that can be derived from mode...BACKGROUND Despite the developments in the field of kidney transplantation,the already existing diagnostic techniques for patient monitoring are considered insufficient.Protein biomarkers that can be derived from modern approaches of proteomic analysis of liquid biopsies(serum,urine)represent a promising innovation in the monitoring of kidney transplant recipients.AIM To investigate the diagnostic utility of protein biomarkers derived from proteomics approaches in renal allograft assessment.METHODS A systematic review was conducted in accordance with PRISMA guidelines,based on research results from the PubMed and Scopus databases.The primary focus was on evaluating the role of biomarkers in the non-invasive diagnosis of transplant-related com-plications.Eligibility criteria included protein biomarkers and urine and blood samples,while exclusion criteria were language other than English and the use of low resolution and sensitivity methods.The selected research articles,were categorized based on the biological sample,condition and methodology and the significantly and reproducibly differentiated proteins were manually selected and extracted.Functional and network analysis of the selected proteins was performed.RESULTS In 17 included studies,58 proteins were studied,with the cytokine CXCL10 being the most investigated.Biological pathways related to immune response and fibrosis have shown to be enriched.Applications of biomarkers for the assessment of renal damage as well as the prediction of short-term and long-term function of the graft were reported.Overall,all studies have shown satisfactory diagnostic accuracy of proteins alone or in combination with conventional methods,as far as renal graft assessment is concerned.CONCLUSION Our review suggests that protein biomarkers,evaluated in specific biological fluids,can make a significant contribution to the timely,valid and non-invasive assessment of kidney graft.展开更多
Patients with cancer have a high inherent risk of infectious complications.In addition,the incidence of acute and chronic kidney dysfunction rises in this population.Antiinfective drugs often require dosing modificati...Patients with cancer have a high inherent risk of infectious complications.In addition,the incidence of acute and chronic kidney dysfunction rises in this population.Antiinfective drugs often require dosing modifications based on an estimate of kidney function,usually the glomerular filtration rate(GFR).However,there is still no preferential GFR formula to be used,and in acute kidney injury there is always a considerable time delay between true kidney function and estimated GFR.In most cases,the anti-infective therapy should start with an immediate and high loading dose.Pharmacokinetic as well as pharmacodynamic principles must be applied for further dose adjustment.Anti-infective drugs with time-dependent action should be given with the target of high trough concentrations(e.g.,beta lactam antibiotics,penems,vancomycin,antiviral drugs).Anti-infective drugs with concentration-dependent action should be given with the target of high peak concentrations(e.g.,aminoglycosides,daptomycin,colistin,quinolones).Our group created a pharmacokinetic database,called NEPharm,hat serves as a reference to obtain reliable dosing regimens of anti-infective drugs in kidney dysfunction as well as renal replacement therapy.To avoid the risk of either too low or too infrequent peak concentrations,we prefer the eliminated fraction rule for dose adjustment calculations.展开更多
BACKGROUND Open ureteric reimplantation by cross trigonal technique described by Cohen is considered a common surgical option for correction of vesicoureteral reflux(VUR). There is a lack of evidence in literature tho...BACKGROUND Open ureteric reimplantation by cross trigonal technique described by Cohen is considered a common surgical option for correction of vesicoureteral reflux(VUR). There is a lack of evidence in literature though for what happens to such kidneys, in the long run, particularly those which are poorly functioning.AIM To assess the long-term outcomes of ureteric reimplantation in poorly functioning kidneys in children with unilateral primary VUR.METHODS Children with unilateral primary VUR and a relative renal function of less than 35% who underwent open or laparoscopic ureteric reimplantation between January 2005 and January 2017 were included in the study. Patients who had a follow up of less than five years were excluded. Preoperative evaluation consisted of a voiding cystourethrogram and Dimercaptosuccinic acid(DMSA) scan. In the follow-up period, patients underwent a diuretic scan at 6 weeks and 6 months.Follow up ultrasound was done for change in grade of hydronephrosis and retrovesical ureteric diameter. Subsequent follow up was done at 6 monthly intervals with evaluation for proteinuria and hypertension and any recurrent urinary tract infection(UTI). For assessment of cortical function, DMSA was repeated annually for 5 years after surgery. A paired-samples t-test was used to test the mean difference of DMSA between pre-post observations.RESULTS During this period, 36 children underwent ureteric reimplantation for unilateral primary VUR. After excluding those with insufficient follow-up, 31 were included in the analysis. Most of the patients were males(n = 26/31, 83.8%). Patient’s age(mean ± SD, range) was 5.21 ± 3.71, 1-18 years. The grades of VUR were grade Ⅱ(1patient), grade Ⅲ(8 patients), grade Ⅳ(10 patients), and grade Ⅴ(12 patients). The pre and postoperative DMSA was 24.064 ± 12.02 and 24.06 ± 10.93, which was almost the same(statistically equal, paired-samples t-test: P = 0.873). The median(range) follow-up duration was 82(60-120)mo. One patient had persistent reflux after surgery(preoperative: grade Ⅳ, postoperative: grade Ⅲ), and the very same patient developed recurrent UTI. The difference in the preoperative and postoperative DRF was less than 10% in 29 patients. In one patient, the DRF decreased by 17%(22% to 05%) while in another patient, the DRF increased by 12%(25% to 37%) after surgery. None of the patients had an increase in scarring after surgery. 15% of patients were hypertensive before surgery and all of them continued to be hypertensive after surgery while none developed hypertension after surgery. None of the patients had significant proteinuria(> 150 mg/d) during the follow-up period.CONCLUSION Children with unilateral primary VUR and poorly functioning kidney maintain the renal function over the long term in most cases. Hypertension and proteinuria do not progress over time in these patients.展开更多
To study the effects of noise pollution on the functions of the liver and kidney of rats, a total of 40 male SPF Wistar rats were randomly divided into a control group and three experimental groups. The rats in the ex...To study the effects of noise pollution on the functions of the liver and kidney of rats, a total of 40 male SPF Wistar rats were randomly divided into a control group and three experimental groups. The rats in the experimental groups were respectively stimulated with 38, 55 and 70 dB noise for 15 days, and the levels of blood components were determined by an automatic biochemical analyzer. The results showed that in compari-son with the control group, the level of the blood glucose in the experimental groups increased by 23.53%, 52.94% and 88.24%, respectively, and the differences were statistically significant （P〈0.01）. The levels of triglyceride in the blood rose by 20.83%, 38.54% and 79.68%, respectively, and the differences were also statistically significant （P〈0.01）. The level of globulin in the blood increased by 16.49%, 21.13% and 51.78%, and the level of albumin in the blood rose by 9.51 %, 12.67% and 17.89%, respectively. The level of total bilirubin in the blood increased by 27.04%, 41.63% and 73.67%, respectively, and the differences were statistically significant （P〈0.01）. The level of creatinine in the blood rose by 9.72%, 10.21% and 20.99%, respectively. The level of amylase in the blood reduced by 6.6%, 13.05% and 23.89%, respectively. The level of creatine kinase in the blood decreased by 19.81%, 27.37% and 36.81 %, respectively, and the level of urea in the blood reduced by 11.19%, 12.77% and 19.26%, respectively. The results revealed that noise pollution could significantly affect the levels of blood components and the functions of the liver and kidney of rats.展开更多
1 Introduction Chronic kidney disease(CKD)often coexists with or is a complication of cardiovascular disease.Previous studies have shown that CKD increases the risk of cardiovascular death and all-cause death and was ...1 Introduction Chronic kidney disease(CKD)often coexists with or is a complication of cardiovascular disease.Previous studies have shown that CKD increases the risk of cardiovascular death and all-cause death and was considered to be a risk equivalent of coronary heart disease.[1,2]Adjusted for confounders,decreased glomerular filtration rate(GFR)and increased albuminuria are both independent risk factors for cardiovascular events.[3,4]The risk for cardiovascular death linearly increases with the decline of GFR in a certain range(<70 mL/min per 1.73 m^2)and the increase of albuminuria without a threshold effect[3].展开更多
Haematuria is the presence of red blood cells in urine. It is most often caused by urinary tract infections of which Escherichia coli is frequently implicated. Impairment of kidney functions could occur as a result of...Haematuria is the presence of red blood cells in urine. It is most often caused by urinary tract infections of which Escherichia coli is frequently implicated. Impairment of kidney functions could occur as a result of infection or other complications of the kidney. The aim of the study was to determine the prevalence of uropathogenic Escherichia coli among adult male patients with haematuria and impaired kidneys attending a general hospital in Benue state. Three hundred and sixty-eight (368) samples of urine were collected from 368 male patients (≥ 40 years) attending the 23 general hospitals in Benue state. Each of the urine samples was divided into two parts for haematuria and isolation and identification of Escherichia coli. Blood samples (368) were also collected from the patients and used for quantitative determination of creatinine and estimation of glomerular filtration rate. The presence of haematuria was 45.1% and ranges from 12.5% to 100%. Prevalence of haematuria with respect to age shows that patients within the age group of 90 - 99 years had the highest rate (100%) and the least were those within the ages of 40 - 49 years (20.0%). Isolation rate of uropathogenic Escherichia coli was 16.3% and ranged from 6.3 to 37.5%. Patients within the age group of 90 - 99 years had the highest elevated impaired renal function of 4 (80%), followed by patients within the ages of 80 - 89 years [17 (77.3%)] and the lowest were those within the ages of 40 - 49 [6 (10.0%)]. The overall presence of haematuria in the patients was high (45.1%) with similar high Escherichia coli isolation rate and impaired renal function which could mean that acute or chronic kidney disease may set in.展开更多
Objective: to assess the evolution of serum creatinine in patients undergoing radical nephrectomy (malignant) or total (benign), to identify risk factors connected with an unfavorable renal function outcome. Material ...Objective: to assess the evolution of serum creatinine in patients undergoing radical nephrectomy (malignant) or total (benign), to identify risk factors connected with an unfavorable renal function outcome. Material and Methods: observational, transversal and retrospective study, through analysis of records and lab exams of 146 patients undergoing nephrectomy from January 2015 to December 2018. Results: Statistically significant difference was found between etiology and patients’ age (p-value Conclusion: This study shows that a large number of young patients undergo nephrectomy, many times avoidable;within a benign disease context with an increased risk of developing renal failure. Greater attention from the public service is required to tackle such chronic condition and its complications.展开更多
Background: Laparoscopic cholecystectomy (LC) reduces surgical trauma and hospital stay, but requires effective and safe postoperative analgesia. This prospective and double-blind study investigated the effects of ana...Background: Laparoscopic cholecystectomy (LC) reduces surgical trauma and hospital stay, but requires effective and safe postoperative analgesia. This prospective and double-blind study investigated the effects of analgesia with tramadol combined with either dipyrone or ketorolac on the postoperative renal function of patients submitted to LC. Methods: Pre-and post-operatively (PO), estimated glomerular filtration rates (GFR), obtained by two formulas dependent on blood Cr and one on blood cystatin C values, and tubular enzymuria—alkaline phosphatase (AP), γ-glutamiltransferase (γ-GT)— were determined in well hydrated patients who underwent LC and analgesia with tramadol combined with either dipyrone (Dipyrone, n = 63) or ketorolac (Ketorolac, n = 63). Upon discharge from the post-anesthetic care unit (PACU), pain (through Verbal Numerical Scale—VNS) and need for rescue analgesia with morphine were evaluated. Results: There was hemodilution PO, which made GFR profile analysis more difficult—those dependent on Cr increased and statistically correlated, but those dependent on cystatin C did not change. There was a significant PO increase in AP in the Dipyrone and Ketorolac groups, and in the product of the both enzymes in the Ketorolac group. Upon PACU discharge, the Dipyrone group showed signifi cantly higher VNS scores than the Ketorolac group. All patients received morphine PO, and the total dose needed for pain control differed between groups, but without statistical significance. Conclusions: The association of tramadol with dipyrone or ketorolac in well hydrated patients submitted to LC had similar analgesic effectiveness in the PACU. Postoperatively, the effect on GFR may have been masked by hemodilution, and enzymuria was discreetly enhanced when ketorolac was used.展开更多
BACKGROUND Aging population is a significant issue in Viet Nam and across the globe.Elderly individuals are at higher risk of chronic kidney disease(CKD),especially those with diabetes.Several studies found that the e...BACKGROUND Aging population is a significant issue in Viet Nam and across the globe.Elderly individuals are at higher risk of chronic kidney disease(CKD),especially those with diabetes.Several studies found that the estimated glomerular filtration rate(eGFR)determined using creatinine-based equations was not as accurate as that determined using cystatin C-based equations.Cystatin C-based equations may be beneficial in elderly patients with an age-associated decline in kidney function.Early determination of eGFR decline and associated factors would aid in appropriate interventions to improve kidney function in elderly patients with diabetes.AIM To determine the utility of cystatin C-based equations in early detection of eGFR decline and to explore factors associated with eGFR decline in elderly patients with diabetes.METHODS This cross-sectional study included 93 participants aged≥60 years evaluated in Can Tho University of Medicine and Pharmacy Hospital between October 2022 and July 2023,including 47 and 46 participants with and without diabetes respectively,according to the American Diabetes Association criteria for diabetes.The kappa coefficient,Student’s t,Mann-Whitney,χ2,Pearson’s correlation,multivariate logistic regression,and multiple linear regression analyses were employed.RESULTS The eGFRs were lower with the cystatin C-based equations than with the creatinine-based equations.Good agreement was found between the Modification of Diet in Renal Disease(MDRD)and CKD Epidemiology Collaboration(CKD-EPI)2021 creatinine-cystatin C equations(kappa=0.66).In the diabetes group,30%of the participants had low eGFR.Both plasma glucose and glycated hemoglobin were associated with an increased risk of eGFR decline(P<0.05)and negatively correlated with eGFR(P=0.001).By multivariate logistic regression,total cholesterol,and exercise were independently associated with low eGFR.By multiple linear regression,higher plasma glucose levels were correlated with lower eGFR(P=0.026,r=-0.366).CONCLUSION Cystatin C-based equations were superior in the early detection of a decline in eGFR,and the MDRD equation may be considered as an alternative to the CKD-EPI 2021 creatinine-cystatin C equation.Exercise,plasma glucose,and total cholesterol were independently associated with eGFR in patients with diabetes.展开更多
Objective:To analyze changes in liver and kidney function and lipid metabolism in patients with refractory nephrotic syndrome(RNS)after receiving different treatments.Methods:A total of 64 patients treated in the Wuwe...Objective:To analyze changes in liver and kidney function and lipid metabolism in patients with refractory nephrotic syndrome(RNS)after receiving different treatments.Methods:A total of 64 patients treated in the Wuwei Hospital of Traditional Chinese Medicine from January 2018 to January 2021 were included in this study.All subjects were diagnosed with RNS and randomly assigned to groups:a control group(32 cases)and an observation group(32 cases).The control group received cyclophosphamide+glucocorticoids,while the observation group received tacrolimus+glucocorticoids,both for six months.The various indicators of the two groups were compared.Results:After six months of treatment,the overall clinical efficacy rate of the observation group was significantly higher than that of the control group.Six months post-treatment,levels of serum ALT,AST,BUN,SCr,24 h UTP,TG,and TC were reduced in both groups compared to baseline levels,with reductions more pronounced in the observation group.Serum ALB levels increased in both groups,with a more significant increase in the observation group.Statistical analysis showed these differences were significant(P<0.05).There were no significant changes in FBG levels in either group(P>0.05).Conclusion:For RNS patients,treatment with tacrolimus combined with glucocorticoids significantly reduces liver function damage,improves kidney function and lipid metabolism,and enhances clinical efficacy.展开更多
文摘BACKGROUND Kidney function loss or renal insufficiency indicated by elevated creatinine levels and/or an estimated glomerular filtration rate(eGFR)<60 mL/minute/1.73 m²at presentation in patients with primary focal segmental glomerulosclerosis(FSGS)is commonly seen as a poor prognostic marker for kidney survival.However,a pre>vious study from our center suggested this may be due to hemodynamic factors.AIM To observe the clinical and biochemical parameters,treatment response,kidney survival,and overall outcomes of adult patients with primary FSGS presenting with kidney function insufficiency.METHODS This retrospective observational study was conducted at the Department of Nephrology,Sindh Institute of Urology and Transplantation,Karachi,Pakistan,from January 1995 to December 2017.During this period,401 biopsy-proven primary FSGS patients were identified,of which 98(24.4%)presented with kidney function loss or renal insufficiency defined as eGFR<60 mL/minute/1.73 m²at presentation and were studied in detail.RESULTS Among the 98 patients with renal function loss on presentation,the mean age was 30.9 years±13.6 years with a male-to-female ratio of 2.5:1.The mean serum creatinine level was 2.2 mg/dL±1.3 mg/dL and mean eGFR 37.1 mL/minute/1.73 m2±12.8 mL/minute/1.73 m2.The mean 24-hour urinary protein excretion was 5.9 g/day±4.0 g/day,and the mean serum albumin was 2.1 g/dL±1.0 g/dL(median:1.5 g/dL).The mean systolic blood pressure(BP)was 132.7 mmHg±19.8 mmHg,and the mean diastolic BP was 87.4 mmHg±12.7 mmHg.Steroid treatment was given to 81(82.6%)of 98 patients for an average duration of 19.9 weeks±14.4 weeks,with a mean total steroid dose of 4.4 g±1.5 g.Treatment response showed that 20(24.6%)patients achieved complete remission,9(11.1%)achieved partial remission,and 52(64.1%)did not respond.The baseline eGFR was significantly lower in the non-responsive group(P=0.006).The distribution of FSGS variants was also significantly different among steroid-responsive and non-responsive groups(P=0.012).CONCLUSION Renal function loss in FSGS patients at presentation does not necessarily indicate irreversible kidney function loss and a significant number of patients respond to appropriate treatment of the underlying disease.
文摘Objective To evaluate the association between serum uric acid(SUA)and kidney function decline.Methods Data was obtained from the China Health and Retirement Longitudinal Study on the Chinese middle-aged and older population for analysis.The kidney function decline was defined as an annual estimated glomerular filtration rate(e GFR)decrease by>3 mL/min per 1.73 m^(2).Multivariable logistic regression was applied to determine the association between SUA and kidney function decline.The shape of the association was investigated by restricted cubic splines.Results A total of 7,346 participants were included,of which 1,004 individuals(13.67%)developed kidney function decline during the follow-up of 4 years.A significant dose-response relation was recorded between SUA and the kidney function decline(OR 1.14,95%CI 1.03-1.27),as the risk of kidney function decline increased by 14%per 1 mg/d L increase in SUA.In the subgroup analyses,such a relation was only recorded among women(OR 1.22,95%CI 1.03-1.45),those aged<60 years(OR 1.22,95%CI 1.05-1.42),and those without hypertension and without diabetes(OR 1.22,95%CI 1.06-1.41).Although the dose-response relation was not observed in men,the high level of SUA was related to kidney function decline(OR 1.83,95%CI 1.05-3.17).The restricted cubic spline analysis indicated that SUA>5 mg/dL was associated with a significantly higher risk of kidney function decline.Conclusion The SUA level was associated with kidney function decline.An elevation of SUA should therefore be addressed to prevent possible kidney impairment and dysfunction.
文摘BACKGROUND Retroperitoneal fibrosis is an exceptionally rare disease characterized by proliferation of fibrous tissue and inflammation in the retroperitoneum.It features many symptoms in the kidneys and in other organs and usually leads to ureteral obstruction.CASE SUMMARY Here we present 9 consecutive cases of idiopathic retroperitoneal fibrosis(IRPF)in patients who presented to the Department of Nephrology or Department of Rheumatology,Xuanwu Hospital,Capital Medical University,Beijing,China,between January 2012 and June 2017 with ureteral obstruction due to external compression of the ureter that led to hydronephrosis and kidney dysfunction.Computed tomography imaging was used to identify hydronephrosis and ureteral obstruction and to evaluate kidney function.Each patient was diagnosed with IRPF based on clinical observation and computed tomography examination results.To restore kidney function,a retrograde metallic stent was placed in the ureter under X-ray guidance 2 d after each patient’s admission.No perioperative complications occurred in any patient,but postoperative complications occurred in two patients as follows:Patient 2 had stent migration and repeated metallic stent infections that resolved with treatment;and patient 4 had postoperative hematuria because he resumed normal activities too soon after stent placement(contrary to instruction).Placement of the metallic ureteral stents provided relief from ureteral obstruction and restored kidney function in all patients.CONCLUSION Our 9-case series underscores the utility and efficacy of applying the Resonance®metallic ureteral stent to treat ureteral obstruction in patients with IRPF.For all retroperitoneal fibrosis cases in our series,ureteral stents provided effective relief and were shown to reduce the incidence rate of perioperative and postoperative complications.
基金the Natural Science Foundation of Hunan Province,No.2021JJ70119.
文摘BACKGROUND Obesity usually causes diabetes mellitus(DM)and is a serious danger to human health.Type 2 DM(T2DM)mostly occurs along with obesity.Foodborne obesityinduced DM is caused by an excessive long-term diet and surplus energy.Bariatric surgery can improve the symptoms of T2DM in some obese patients.But different types of bariatric surgery may have different effects.AIM To investigate the effect of bariatric surgery on glucose and lipid metabolism and liver and kidney function in rats.METHODS Male Sprague-Dawley rats aged 6-8 wk underwent Roux-en-Y gastric bypass surgery(RYGB),sleeve gastrectomy(SG),or gastric banding(GB).Glucose and insulin tolerance tests,analyses of biochemical parameters,histological examination,western blot,and quantitative real-time polymerase chain reaction were conducted.RESULTS In comparison to the sham operation group,the RYGB,SG,and GB groups had decreased body weight and food intake,reduced glucose intolerance and insulin insensitivity,downregulated biochemical parameters,alleviated morphological changes in the liver and kidneys,and decreased levels of protein kinase Cβ/P66shc.The effect in the RYGB group was better than that in the SG and GB groups.CONCLUSION These results suggest that RYGB,SG and GB may be helpful for the treatment of foodborne obesity-induced DM.
文摘The diagnosis of small renal masses(SRMs) continues to increase likely attributable to widespread use of axial cross-sectional imaging. Many of these SRMs present in elderly patients with abnormal baseline renal function. Such patients are at risk for further decline following therapeutic intervention. Renal thermal ablation presents one approach for management of SRMs whereby tumors are treated in situ without need for global renal ischemia. These treatment characteristics contribute to favorable renal function outcomes following kidney tumor ablation particularly in patients with an anatomic or functional solitary renal unit.
基金supported by National Natural Science Foundation of China (No.81273507)Humanity and Social Science Foundation for the Youth Scholars of China's Ministry of Education (No.08JC840021)
文摘Chronic kidney disease （CKD） has become a worldwide public health problem, and currently, it affects approximately 10% of adults in the United States[I]. Meanwhile, it also has emerged as an important social challenge in China[2]. CKD has been reported to be a major risk factor for cardiovascular diseases, premature death, and end-stage renal diseaseTM. Thus, it is necessary to determine the risk factors for CKD.
文摘Acute kidney injury(AKI)incidence is growing rapidly,and AKI is one of the predictors of inpatient mortality.After nephrectomy,all the patients have decreased kidney function with AKI and recover from AKI.However,the characteristic and behavior of AKI is different from usual AKI and compensatory kidney function has been well known in the postoperative setting,especially in living donors.In this review,we have focused on the compensation of kidney function after nephrectomy in living donors.We discuss factors that have been identified as being associated with kidney recovery in donors including age,sex,body mass index,remnant kidney volume,estimated glomerular filtration rate,and various comorbidities.
基金supported by grants from the National High Level Hospital Clinical Research Funding(Scientific Research Seed Fund of Peking University First Hospital)(No.2022SF37)National High Level Hospital Clinical Research Funding(No.2022CR07)+1 种基金National Natural Science Foundation of China(No.82070747)CAMS Innovation Fund for Medical Sciences(No.2019-I2M-5-046).
文摘To the Editor:Light chain deposition disease(LCDD)is a rare systemic complication of plasma cell disorders that primarily affects the kidneys,and LCDD can lead to chronic kidney failure.[1]Before the development of novel anti-plasmacyte agents,the overall prognosis of LCDD patients was poor.The introduction of novel plasmacyte-targeted therapies,such as the proteasome inhibitor bortezomib,has improved kidney survival in LCDD patients.[2]However,the kidney response rate of LCDD patients to bortezomib-based treatment remains approximately 50%,and 25.7%of patients progress to end-stage kidney disease(ESKD)within 60 months.Daratumumab,an anti-CD38 monoclonal antibody that has been available in China since 2021,has shown promising results in both multi ple myeloma(MM)and light-chain(AL)amyloidosis patients.[3,4]Several case series have demonstrated rapid hematological responses and preservation of kidney function in LCDD patients treated with daratumumab who were previously treated with bortezomib.[5,6]However,the efficacy of a combination of daratumumab and bortezomib compared to regimes involving bortezomib alone in newly diagnosed LCDD patients has yet to be systematically assessed.We retrospectively reviewed our database to address this issue and conducted a comparative study.
基金supported by the National Key R&D Program of China(2020YFC2005000)the Program for Professor of Special Appointment(Eastern Scholar)at Shanghai Institutions of Higher LearningThe funding organization had no role in the design and conduct of the study,collection,management,analysis,interpretation of the data,and preparation of the manuscript.
文摘Observational studies have identified that declined kidney function was associated with a higher risk of cardiovascular disease(CVD).However,the causation of such associations requires further exploration.Here,we compared the observational associations of various kidney function measurements with CVD and its major subtypes and further assessed the potential causality using Mendelian randomization(MR)analyses with individual-level data of 306,246 participants from the UK Biobank and genome-wide association study summary-level data from FinnGen consortium,Coronary ARtery DIsease Genome wide Replication and Meta-analysis plus The Coronary Artery Disease Genetics(CARDIoGRAMplusC4D)consortium,and MEGASTROKE Consortium,respectively.Kidney function measurements included circulating levels of cystatin C and creatinine,urine albumin-to-creatinine ratio(uACR),and estimated glomerular filtration rates(eGFR)from three chronic kidney disease epidemiology collaboration formulae(i.e.,that using cystatin C,creatinine,and both).In the observational analyses,decreased kidney function measurements were associated with a higher risk of CVD in the UK Biobank study.For example,per one standard deviation decrease in baseline estimated glomerular filtration rates using both cystatin C and creatinine(eGFRcys+cre)was associated with 11%higher risk of CVD(hazard ratio=0.89;95%confidence interval,0.87-0.90).In contrast,two-sample MR analyses did not suggest significant associations of any genetically instrumented kidney function measurement with the risk of CVD or its subtypes.Our findings suggested the inverse associations of kidney function measurements with CVD risk from observational studies were not supported by large MR analyses.
基金Hebei Medical Science Research Project(Grant No.20221849)。
文摘To evaluate the effects of sacubitril/valsartan and ARB on renal function in patients with and without heart failure, we conducted a comprehensive literature search using both Chinese and English databases. These included the Cochrane Library, Wanfang Database, PubMed, CNKI, Embase, and Clinical Trials. The search encompassed studies published from the inception of the databases to March 2024. Randomized controlled studies meeting the inclusion criteria were assessed for bias using the Cochrane risk of bias assessment tool. Data were analyzed using Review Manager 5.4, with relative risk (RR) as the effect indicator. Depending on the heterogeneity of the studies, either a fixed-effects model or a random-effects model was employed to combine effect sizes. Seven studies met the inclusion criteria. Compared with ARB drugs, sacubitril/valsartan showed a reduction in the deterioration of renal function (RR = 0.70, 95% CI: 0.44–1.12, P = 0.14) and acute renal function injury (RR = 0.77, 95% CI: 0.59–1.00, P = 0.05). The risk of end-stage renal disease was also lower (RR = 0.53, 95% CI: 0.30–0.96, P = 0.16). For serum creatinine levels greater than 2.5 mg/dL, the RR was 0.88 (95% CI: 0.68–1.15, P = 0.37). For a reduction in eGFR of more than 25%, the RR was 0.89 (95% CI: 0.57–1.41, P = 0.63). The incidence of serum potassium levels greater than 5.5 mmol/L was not significantly different between the groups (RR = 1.23, 95% CI: 0.86–1.75, P = 0.26), nor was the incidence of serum potassium levels greater than 6.0 mmol/L (RR = 1.06, 95% CI: 0.58–1.93, P = 0.86). However, the incidence of eGFR decreasing by more than 50% was significantly reduced (RR = 0.58, 95% CI: 0.34–0.99, P < 0.05). In conclusion, sacubitril/valsartan demonstrated a protective effect on the kidneys, effectively reducing the risk of renal deterioration and presenting a potential alternative to ARB drugs.
文摘BACKGROUND Despite the developments in the field of kidney transplantation,the already existing diagnostic techniques for patient monitoring are considered insufficient.Protein biomarkers that can be derived from modern approaches of proteomic analysis of liquid biopsies(serum,urine)represent a promising innovation in the monitoring of kidney transplant recipients.AIM To investigate the diagnostic utility of protein biomarkers derived from proteomics approaches in renal allograft assessment.METHODS A systematic review was conducted in accordance with PRISMA guidelines,based on research results from the PubMed and Scopus databases.The primary focus was on evaluating the role of biomarkers in the non-invasive diagnosis of transplant-related com-plications.Eligibility criteria included protein biomarkers and urine and blood samples,while exclusion criteria were language other than English and the use of low resolution and sensitivity methods.The selected research articles,were categorized based on the biological sample,condition and methodology and the significantly and reproducibly differentiated proteins were manually selected and extracted.Functional and network analysis of the selected proteins was performed.RESULTS In 17 included studies,58 proteins were studied,with the cytokine CXCL10 being the most investigated.Biological pathways related to immune response and fibrosis have shown to be enriched.Applications of biomarkers for the assessment of renal damage as well as the prediction of short-term and long-term function of the graft were reported.Overall,all studies have shown satisfactory diagnostic accuracy of proteins alone or in combination with conventional methods,as far as renal graft assessment is concerned.CONCLUSION Our review suggests that protein biomarkers,evaluated in specific biological fluids,can make a significant contribution to the timely,valid and non-invasive assessment of kidney graft.
文摘Patients with cancer have a high inherent risk of infectious complications.In addition,the incidence of acute and chronic kidney dysfunction rises in this population.Antiinfective drugs often require dosing modifications based on an estimate of kidney function,usually the glomerular filtration rate(GFR).However,there is still no preferential GFR formula to be used,and in acute kidney injury there is always a considerable time delay between true kidney function and estimated GFR.In most cases,the anti-infective therapy should start with an immediate and high loading dose.Pharmacokinetic as well as pharmacodynamic principles must be applied for further dose adjustment.Anti-infective drugs with time-dependent action should be given with the target of high trough concentrations(e.g.,beta lactam antibiotics,penems,vancomycin,antiviral drugs).Anti-infective drugs with concentration-dependent action should be given with the target of high peak concentrations(e.g.,aminoglycosides,daptomycin,colistin,quinolones).Our group created a pharmacokinetic database,called NEPharm,hat serves as a reference to obtain reliable dosing regimens of anti-infective drugs in kidney dysfunction as well as renal replacement therapy.To avoid the risk of either too low or too infrequent peak concentrations,we prefer the eliminated fraction rule for dose adjustment calculations.
文摘BACKGROUND Open ureteric reimplantation by cross trigonal technique described by Cohen is considered a common surgical option for correction of vesicoureteral reflux(VUR). There is a lack of evidence in literature though for what happens to such kidneys, in the long run, particularly those which are poorly functioning.AIM To assess the long-term outcomes of ureteric reimplantation in poorly functioning kidneys in children with unilateral primary VUR.METHODS Children with unilateral primary VUR and a relative renal function of less than 35% who underwent open or laparoscopic ureteric reimplantation between January 2005 and January 2017 were included in the study. Patients who had a follow up of less than five years were excluded. Preoperative evaluation consisted of a voiding cystourethrogram and Dimercaptosuccinic acid(DMSA) scan. In the follow-up period, patients underwent a diuretic scan at 6 weeks and 6 months.Follow up ultrasound was done for change in grade of hydronephrosis and retrovesical ureteric diameter. Subsequent follow up was done at 6 monthly intervals with evaluation for proteinuria and hypertension and any recurrent urinary tract infection(UTI). For assessment of cortical function, DMSA was repeated annually for 5 years after surgery. A paired-samples t-test was used to test the mean difference of DMSA between pre-post observations.RESULTS During this period, 36 children underwent ureteric reimplantation for unilateral primary VUR. After excluding those with insufficient follow-up, 31 were included in the analysis. Most of the patients were males(n = 26/31, 83.8%). Patient’s age(mean ± SD, range) was 5.21 ± 3.71, 1-18 years. The grades of VUR were grade Ⅱ(1patient), grade Ⅲ(8 patients), grade Ⅳ(10 patients), and grade Ⅴ(12 patients). The pre and postoperative DMSA was 24.064 ± 12.02 and 24.06 ± 10.93, which was almost the same(statistically equal, paired-samples t-test: P = 0.873). The median(range) follow-up duration was 82(60-120)mo. One patient had persistent reflux after surgery(preoperative: grade Ⅳ, postoperative: grade Ⅲ), and the very same patient developed recurrent UTI. The difference in the preoperative and postoperative DRF was less than 10% in 29 patients. In one patient, the DRF decreased by 17%(22% to 05%) while in another patient, the DRF increased by 12%(25% to 37%) after surgery. None of the patients had an increase in scarring after surgery. 15% of patients were hypertensive before surgery and all of them continued to be hypertensive after surgery while none developed hypertension after surgery. None of the patients had significant proteinuria(> 150 mg/d) during the follow-up period.CONCLUSION Children with unilateral primary VUR and poorly functioning kidney maintain the renal function over the long term in most cases. Hypertension and proteinuria do not progress over time in these patients.
基金Supported by the Science and Technology Innovation Team Project of Colleges and Universities in Gansu Province(2016C-09)National Natural Science Foundation of Gansu Province(17JR5RA158)+3 种基金Talent Innovation and Venture Project of Lanzhou City(2016-RC-85)Project of Research Center of Investigation Theory and Practice in Northwest Ethnic RegionsCharacteristic Subject Project of Evidence Science of Gansu ProvinceScience and Technology Project of Lanzhou City(2015-3-80)
文摘To study the effects of noise pollution on the functions of the liver and kidney of rats, a total of 40 male SPF Wistar rats were randomly divided into a control group and three experimental groups. The rats in the experimental groups were respectively stimulated with 38, 55 and 70 dB noise for 15 days, and the levels of blood components were determined by an automatic biochemical analyzer. The results showed that in compari-son with the control group, the level of the blood glucose in the experimental groups increased by 23.53%, 52.94% and 88.24%, respectively, and the differences were statistically significant （P〈0.01）. The levels of triglyceride in the blood rose by 20.83%, 38.54% and 79.68%, respectively, and the differences were also statistically significant （P〈0.01）. The level of globulin in the blood increased by 16.49%, 21.13% and 51.78%, and the level of albumin in the blood rose by 9.51 %, 12.67% and 17.89%, respectively. The level of total bilirubin in the blood increased by 27.04%, 41.63% and 73.67%, respectively, and the differences were statistically significant （P〈0.01）. The level of creatinine in the blood rose by 9.72%, 10.21% and 20.99%, respectively. The level of amylase in the blood reduced by 6.6%, 13.05% and 23.89%, respectively. The level of creatine kinase in the blood decreased by 19.81%, 27.37% and 36.81 %, respectively, and the level of urea in the blood reduced by 11.19%, 12.77% and 19.26%, respectively. The results revealed that noise pollution could significantly affect the levels of blood components and the functions of the liver and kidney of rats.
基金the National Key Research and Development Programme of China(2018YFC1314003)the Education of Zhejiang Province(Y201328620).
文摘1 Introduction Chronic kidney disease(CKD)often coexists with or is a complication of cardiovascular disease.Previous studies have shown that CKD increases the risk of cardiovascular death and all-cause death and was considered to be a risk equivalent of coronary heart disease.[1,2]Adjusted for confounders,decreased glomerular filtration rate(GFR)and increased albuminuria are both independent risk factors for cardiovascular events.[3,4]The risk for cardiovascular death linearly increases with the decline of GFR in a certain range(<70 mL/min per 1.73 m^2)and the increase of albuminuria without a threshold effect[3].
文摘Haematuria is the presence of red blood cells in urine. It is most often caused by urinary tract infections of which Escherichia coli is frequently implicated. Impairment of kidney functions could occur as a result of infection or other complications of the kidney. The aim of the study was to determine the prevalence of uropathogenic Escherichia coli among adult male patients with haematuria and impaired kidneys attending a general hospital in Benue state. Three hundred and sixty-eight (368) samples of urine were collected from 368 male patients (≥ 40 years) attending the 23 general hospitals in Benue state. Each of the urine samples was divided into two parts for haematuria and isolation and identification of Escherichia coli. Blood samples (368) were also collected from the patients and used for quantitative determination of creatinine and estimation of glomerular filtration rate. The presence of haematuria was 45.1% and ranges from 12.5% to 100%. Prevalence of haematuria with respect to age shows that patients within the age group of 90 - 99 years had the highest rate (100%) and the least were those within the ages of 40 - 49 years (20.0%). Isolation rate of uropathogenic Escherichia coli was 16.3% and ranged from 6.3 to 37.5%. Patients within the age group of 90 - 99 years had the highest elevated impaired renal function of 4 (80%), followed by patients within the ages of 80 - 89 years [17 (77.3%)] and the lowest were those within the ages of 40 - 49 [6 (10.0%)]. The overall presence of haematuria in the patients was high (45.1%) with similar high Escherichia coli isolation rate and impaired renal function which could mean that acute or chronic kidney disease may set in.
文摘Objective: to assess the evolution of serum creatinine in patients undergoing radical nephrectomy (malignant) or total (benign), to identify risk factors connected with an unfavorable renal function outcome. Material and Methods: observational, transversal and retrospective study, through analysis of records and lab exams of 146 patients undergoing nephrectomy from January 2015 to December 2018. Results: Statistically significant difference was found between etiology and patients’ age (p-value Conclusion: This study shows that a large number of young patients undergo nephrectomy, many times avoidable;within a benign disease context with an increased risk of developing renal failure. Greater attention from the public service is required to tackle such chronic condition and its complications.
基金Sao Paulo Research Foundation (FAPESP) TP Medeiros was granted a scholarship from CAPES
文摘Background: Laparoscopic cholecystectomy (LC) reduces surgical trauma and hospital stay, but requires effective and safe postoperative analgesia. This prospective and double-blind study investigated the effects of analgesia with tramadol combined with either dipyrone or ketorolac on the postoperative renal function of patients submitted to LC. Methods: Pre-and post-operatively (PO), estimated glomerular filtration rates (GFR), obtained by two formulas dependent on blood Cr and one on blood cystatin C values, and tubular enzymuria—alkaline phosphatase (AP), γ-glutamiltransferase (γ-GT)— were determined in well hydrated patients who underwent LC and analgesia with tramadol combined with either dipyrone (Dipyrone, n = 63) or ketorolac (Ketorolac, n = 63). Upon discharge from the post-anesthetic care unit (PACU), pain (through Verbal Numerical Scale—VNS) and need for rescue analgesia with morphine were evaluated. Results: There was hemodilution PO, which made GFR profile analysis more difficult—those dependent on Cr increased and statistically correlated, but those dependent on cystatin C did not change. There was a significant PO increase in AP in the Dipyrone and Ketorolac groups, and in the product of the both enzymes in the Ketorolac group. Upon PACU discharge, the Dipyrone group showed signifi cantly higher VNS scores than the Ketorolac group. All patients received morphine PO, and the total dose needed for pain control differed between groups, but without statistical significance. Conclusions: The association of tramadol with dipyrone or ketorolac in well hydrated patients submitted to LC had similar analgesic effectiveness in the PACU. Postoperatively, the effect on GFR may have been masked by hemodilution, and enzymuria was discreetly enhanced when ketorolac was used.
文摘BACKGROUND Aging population is a significant issue in Viet Nam and across the globe.Elderly individuals are at higher risk of chronic kidney disease(CKD),especially those with diabetes.Several studies found that the estimated glomerular filtration rate(eGFR)determined using creatinine-based equations was not as accurate as that determined using cystatin C-based equations.Cystatin C-based equations may be beneficial in elderly patients with an age-associated decline in kidney function.Early determination of eGFR decline and associated factors would aid in appropriate interventions to improve kidney function in elderly patients with diabetes.AIM To determine the utility of cystatin C-based equations in early detection of eGFR decline and to explore factors associated with eGFR decline in elderly patients with diabetes.METHODS This cross-sectional study included 93 participants aged≥60 years evaluated in Can Tho University of Medicine and Pharmacy Hospital between October 2022 and July 2023,including 47 and 46 participants with and without diabetes respectively,according to the American Diabetes Association criteria for diabetes.The kappa coefficient,Student’s t,Mann-Whitney,χ2,Pearson’s correlation,multivariate logistic regression,and multiple linear regression analyses were employed.RESULTS The eGFRs were lower with the cystatin C-based equations than with the creatinine-based equations.Good agreement was found between the Modification of Diet in Renal Disease(MDRD)and CKD Epidemiology Collaboration(CKD-EPI)2021 creatinine-cystatin C equations(kappa=0.66).In the diabetes group,30%of the participants had low eGFR.Both plasma glucose and glycated hemoglobin were associated with an increased risk of eGFR decline(P<0.05)and negatively correlated with eGFR(P=0.001).By multivariate logistic regression,total cholesterol,and exercise were independently associated with low eGFR.By multiple linear regression,higher plasma glucose levels were correlated with lower eGFR(P=0.026,r=-0.366).CONCLUSION Cystatin C-based equations were superior in the early detection of a decline in eGFR,and the MDRD equation may be considered as an alternative to the CKD-EPI 2021 creatinine-cystatin C equation.Exercise,plasma glucose,and total cholesterol were independently associated with eGFR in patients with diabetes.
基金Wuwei City Science and Technology Plan Project“Efficacy Analysis of Tacrolimus Combined with Glucocorticoids in the Treatment of Refractory Nephrotic Syndrome”(Project No.WW2101161)。
文摘Objective:To analyze changes in liver and kidney function and lipid metabolism in patients with refractory nephrotic syndrome(RNS)after receiving different treatments.Methods:A total of 64 patients treated in the Wuwei Hospital of Traditional Chinese Medicine from January 2018 to January 2021 were included in this study.All subjects were diagnosed with RNS and randomly assigned to groups:a control group(32 cases)and an observation group(32 cases).The control group received cyclophosphamide+glucocorticoids,while the observation group received tacrolimus+glucocorticoids,both for six months.The various indicators of the two groups were compared.Results:After six months of treatment,the overall clinical efficacy rate of the observation group was significantly higher than that of the control group.Six months post-treatment,levels of serum ALT,AST,BUN,SCr,24 h UTP,TG,and TC were reduced in both groups compared to baseline levels,with reductions more pronounced in the observation group.Serum ALB levels increased in both groups,with a more significant increase in the observation group.Statistical analysis showed these differences were significant(P<0.05).There were no significant changes in FBG levels in either group(P>0.05).Conclusion:For RNS patients,treatment with tacrolimus combined with glucocorticoids significantly reduces liver function damage,improves kidney function and lipid metabolism,and enhances clinical efficacy.
