[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 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
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 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
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
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
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
Anti-B cell maturation antigen(BCMA)chimeric antigen receptor(CAR)T-cell therapyis effective and well-tolerated for refractory or relapsed multiple myeloma(RRMM).The purposcof the present study was to analyze efficacy...Anti-B cell maturation antigen(BCMA)chimeric antigen receptor(CAR)T-cell therapyis effective and well-tolerated for refractory or relapsed multiple myeloma(RRMM).The purposcof the present study was to analyze efficacy in RRMM patients with renal impairment treated byanti-BCMA CAR-T cell therapy.A total of 59 RRMM patients were selected,and divided intoimpaired renal function(lRF)group[basclinc cstimated giomerular filtration rate(eSFR)<90 m/min/1.73 m^2(n=18)]and normal renal function(NRF)group(baseline eGFR≥90 mL/min/1.73 m,n=41).For patients with IRF,eGFR at the 6th month post-CAR-T cells infusion was significantlyhigher than the baseline(P<0.05).The multivariate analysis showed that light chain type and beta-2 micro-globulin(bcta-2M)were associated factors with the decrease of serum creatinine.Medianprogression-free survival(PFS)in the NRF group and IRF group was 266 days and 181 daysrespectively.Overall survival(OS)in the NRF group and lRF group was 877 days and 238 daysrespectively.There was no significant difference in the objective response rate(ORR)between thelRF group and the NRF group.It is suggested that CAR-T cells therapy could improve the renalfunction during the treatment of RRMM.The renal function could be more significantly improvedin RRMM patients with light chain type than with other types.展开更多
BACKGROUND Immunoglobulin A nephropathy(IgAN)is a common form of chronic glomer-ulonephritis.Currently,IgAN is one of the main causes of chronic renal failure in China;its prognosis varies greatly between patients,wit...BACKGROUND Immunoglobulin A nephropathy(IgAN)is a common form of chronic glomer-ulonephritis.Currently,IgAN is one of the main causes of chronic renal failure in China;its prognosis varies greatly between patients,with renal function at the time of diagnosis and prognosis being strongly correlated.Mycophenolate mofetil(MMF)is a drug with a good immunomodulatory effect and is commonly used clinically.However,its effects in IgAN have not yet been clearly demonstrated.Therefore,herein,we retrospectively compared the effectiveness and safety of prednisone alone or combined with MMF for the treatment of primary IgAN with moderate-to-severe renal impairment.METHODS Between January 2011 and December 2020,200 patients with moderate-to-severe IgAN were included in this study,all of whom were admitted to Wuxi People's Hospital affiliated with Nanjing Medical University.All patients underwent a renal puncture biopsy,which revealed primary IgAN with a glomerular filtration rate(GFR)of 30–60 mL/min.The patients were divided into a glucocorticoid therapy group(GTG)and an immunosuppressive therapy group(ITG)according to the different treatment regimens,with 100 patients in each group.Based on general treatments,such as angiotensin-converting enzyme inhibitors/angiotensin receptor blockers,patients in the GTG were administered prednisone 0.5–0.8 mg/(kg·d^(-1))for 4–8 wk,which was reduced by 5 mg every two weeks until the maintenance(30 mg/d)dose was reached and maintained for 12 mo.In the ITG,MMF was administered at 1.0 g/d for 6–12 mo,followed by a maintenance dosage of 0.5 g/d for 12 mo.Age,sex,blood pressure,24-h urinary egg white measurement,serum creatinine(Scr),blood uric acid,blood albumin,blood potassium(K),hemoglobin,GFR,alanine aminotransferase,total cholesterol(T-CHO),fasting blood glucose,and body mass index were recorded.The 24-h urinary protein,Scr,and GFR levels were recorded 3,6,9,and 12 mo after treatment.Follow-up data were also collected.RESULTS No discernible differences existed between the two groups in terms of age,sex,blood pressure,creatinine,24-h urinary protein level,GFR,or other biochemical indicators at the time of enrollment.Both regimens significantly reduced the 24-h urinary protein quantitation and stabilized renal function.Nine months after treatment,the 24-h urinary protein and Scr of the ITG decreased more significantly than those of the GTG.By the 12th month of treatment,the 24-h urinary protein and Scr in both groups continued to decrease compared to those by the 9th month.In addition,the overall response rate in the ITG was significantly higher than that in the GTG.The occurrence of side effects did not vary significantly between the two regimens;however,endpoint events were significantly more common in the GTG than in the ITG.The follow-up time for the GTG was noticeably lower than that for the ITG.CONCLUSION Prednisone combined with MMF was effective for the treatment of IgAN with moderate-to-severe renal dysfunction.展开更多
BACKGROUND MicroRNAs(miRNAs)have been suggested as biomarkers for malignant diseases including hepatocellular carcinoma(HCC).Specifically,hsa-miR-21-5p(miR-21)is among the most frequently deregulated miRNA in cancer.T...BACKGROUND MicroRNAs(miRNAs)have been suggested as biomarkers for malignant diseases including hepatocellular carcinoma(HCC).Specifically,hsa-miR-21-5p(miR-21)is among the most frequently deregulated miRNA in cancer.The diagnostic and prognostic value of miR-21 has been demonstrated in HCC tissue,mostly in the Asian population.Although the impact of various factors has been recently reported for circulating hsa-miR-122-5p(miR-122),at present only limited knowledge is available for miR-21.AIM To evaluate the value of miR-21 for the assessment of prognosis in HCC patients and to delineate the influence of clinical and preanalytical factors on miR-21 level in sera.METHODS Patients with confirmed HCC from our European cohort with predominantly alcohol-associated liver damage were included in the study.All subjects were characterized according to their clinical and laboratory work-up and overall survival data were obtained.Quantitative real-time polymerase chain reaction was performed for miR-21 and spiked-in cel-miR-39-3p.The results were compared to previously reported miR-122 data.RESULTS Survival of HCC patients was comparable between patients with low and high serum miR-21 concentration.No association was observed between miR-21 level in sera and Child-Pugh score,Barcelona Clinic Liver Cancer staging system,or etiology of HCC/liver disease.Age,gender,or pretreatment had no association with miR-21 level.A positive correlation was observed between miR-21 and aspartate aminotransferase(r=0.2854,P=0.0061),serum miR-122(r=0.2624,P=0.0120),and the International Normalized Ratio(r=0.2065,P=0.0496).Negative correlation of miR-21 with serum creatinine(r=-0.2215,P=0.0348)suggests renal function as a potential influencing factor in miR-21 biogenesis in blood.CONCLUSION The results from this work do not support clinically relevant prognostic value of circulating miR-21 in HCC patients in real-life settings.Following systematic evaluation,we identified renal function and aspartate aminotransferase as potential factors that may affect miR-21 concentration in blood.This knowledge should be considered in future miRNA-based biomarker studies not only for HCC but also for other diseases.展开更多
AIM To evaluate the effect of a 12-mo supervised aerobic and resistance training, on renal function and exercise capacity compared to usual care recommendations.METHODS Ninety-nine kidney transplant recipients(KTRs) w...AIM To evaluate the effect of a 12-mo supervised aerobic and resistance training, on renal function and exercise capacity compared to usual care recommendations.METHODS Ninety-nine kidney transplant recipients(KTRs) were assigned to interventional exercise(Group A; n = 52) and a usual care cohort(Group B; n = 47). Blood and urine chemistry, exercise capacity, muscular strength, anthropometric measures and health-related quality of life(HRQo L) were assessed at baseline, and after 6 and 12 mo. Group A underwent a supervised training three times per week for 12 mo. Group B received only general recommendations about home-based physical activities.RESULTS Eighty-five KTRs completed the study(Group A, n = 44; Group B, n = 41). After 12 mo, renal function remained stable in both groups. Group A significantly increased maximum workload(+13 W, P = 0.0003), V'O2 peak(+3.1 mL/kg per minute, P = 0.0099), muscular strength in plantar flexor(+12 kg, P = 0.0368), height in the countermovement jump(+1.9 cm, P = 0.0293) and decreased in Body Mass Index(-0.5 kg/m^2, P = 0.0013). HRQo L significantly improved in physical function(P = 0.0019), physical-role limitations(P = 0.0321) and social functioning scales(P = 0.0346). Noimprovements were found in Group B.CONCLUSION Twelve-month of supervised aerobic and resistance training improves the physiological variables related to physical fitness and cardiovascular risks without consequences on renal function. Recommendations alone are not sufficient to induce changes in exercise capacity of KTRs. Our study is an example of collaborative working between transplant centres, sports medicine and exercise facilities.展开更多
Background: Pregnancy is implicated in notable physiological changes and the extraordinary kidney physiology during pregnancy is believed to have an effect on kidney functions. However, during pregnancy the glomerular...Background: Pregnancy is implicated in notable physiological changes and the extraordinary kidney physiology during pregnancy is believed to have an effect on kidney functions. However, during pregnancy the glomerular filtration rate (GFR) increases its work rate up to 50%, on the contrary, in preeclampsia the GFR turns back to decline. Objectives: This study aims to measure and compare kidney function between preeclamptic and normal pregnant women. Materials and Methods: A cross-sectional hospital-based study was conducted in the period from March to May 2021 in Wad Medani Obstetrics and Gynecology Teaching Hospital. A total of 100 pregnant women, 50 apparently healthy pregnant women and 50 pregnant ladies proved to have preeclamptic toxemia, their ages ranged from 18 to 44 years old and at the third trimester of pregnancy. Blood samples were taken and serum was separated, then urea, creatinine, uric acid, sodium and potassium were determined. Data were analyzed using Statistical Package for Social Science (SPSS). Results: The results of this study revealed that 92% of preeclamptic pregnant women had the first time of the incidence and 8% were family inherited preeclampsia and injured multiple times. The preeclamptic pregnant women showed elevation in both systolic and diastolic blood pressure compared to the normal pregnant women. Although the creatinine values of all study subjects were in the normal range, the mean of its serum level was found to be higher in normal pregnant women than that in preeclamptic women. The study also showed urea level was elevated in the preeclampsia group in comparison to the normal one, while all values were in the normal range. In addition to the significant difference that observed in the uric acid mean between preeclamptic (higher) and normal pregnant groups, abnormal values were only noticed with many preeclamptic patients. The levels of electrolytes (sodium and potassium) were elevated in the preeclampsia women group, whereas all values were in the normal range. Conclusion: This study concluded that preeclamptics showed significant elevation in the urea, uric acid, sodium and potassium levels and a significant decrease in creatinine level compared to normal pregnant women, although all parameters values for both groups were in the reference values for non-pregnancy.展开更多
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
Background:Nonalcoholic fatty liver disease(NAFLD)is associated with impaired renal function,and both diseases often occur alongside other metabolic disorders.However,the prevalence and risk factors for impaired renal...Background:Nonalcoholic fatty liver disease(NAFLD)is associated with impaired renal function,and both diseases often occur alongside other metabolic disorders.However,the prevalence and risk factors for impaired renal function in patients with NAFLD remain unclear.The objective of this study was to identify the prevalence and risk factors for renal impairment in NAFLD patients.Methods:All adults aged 18-70 years with ultrasound-diagnosed NAFLD and transient elastography examination from eight Asian centers were enrolled in this prospective study.Liver fibrosis and cirrhosis were assessed by FibroScan-aspartate aminotransferase(FAST),Agile 3+and Agile 4 scores.Impaired renal function and chronic kidney disease(CKD)were defined by an estimated glomerular filtration rate(eGFR)with value of<90 mL/min/1.73 m^(2) and<60 mL/min/1.73 m^(2),respectively,as estimated by the CKD-Epidemiology Collaboration(CKD-EPI)equation.Results:Among 529 included NAFLD patients,the prevalence rates of impaired renal function and CKD were 37.4%and 4.9%,respectively.In multivariate analysis,a moderate-high risk of advanced liver fibrosis and cirrhosis according to Agile 3+and Agile 4 scores were independent risk factors for CKD(P<0.05).Furthermore,increased fasting plasma glucose(FPG)and blood pressure were significantly associated with impaired renal function after controlling for the other components of metabolic syndrome(P<0.05).Compared with patients with normoglycemia,those with prediabetes[FPG≥5.6 mmol/L or hemoglobin A1c(HbA1c)≥5.7%]were more likely to have impaired renal function(P<0.05).Conclusions:Agile 3+and Agile 4 are reliable for identifying NAFLD patients with high risk of CKD.Early glycemic control in the prediabetic stage might have a potential renoprotective role in these patients.展开更多
Immunosuppression(IS) is often withdrawn in patients with end stage renal disease secondary to a failed renal allograft, and this can lead to an accelerated loss of residual renal function(RRF). As maintenance of RRF ...Immunosuppression(IS) is often withdrawn in patients with end stage renal disease secondary to a failed renal allograft, and this can lead to an accelerated loss of residual renal function(RRF). As maintenance of RRF appears to provide a survival benefit to peritoneal dialysis(PD) patients, it is not clear whether this benefit of maintaining RRF in failed allograft patients returning to PD outweigh the risks of maintaining IS. A 49 year-old Caucasian male developed progressive allograft failure nine years after living-donor renal transplantation. Hemodialysis was initiated via tunneled dialysis catheter(TDC) and IS was gradually withdrawn. Two weeksafter IS withdrawal he developed a febrile illness, which necessitate removal of the TDC and conversion to PD. He was maintained on small dose of tacrolimus(1 mg/d) and prednisone(5 mg/d). Currently(1 year later) he is doing exceedingly well on cycler-assisted PD. Residual urine output ranges between 600-1200 m L/d. Total weekly Kt/V achieved 1.82. RRF remained well preserved in this patient with failed renal allograft with minimal immunosuppressive therapy. This strategy will need further study in well-defined cohorts of PD patients with failed allografts and residual RRF to determine efficacy and safety.展开更多
Objective:Rheumatoid nephropathy is one of the most severe extra-articular manifestations of rheumatoid arthritis(RA)associated with a very unfavorable prognosis.This study aimed to identify changes in renal function ...Objective:Rheumatoid nephropathy is one of the most severe extra-articular manifestations of rheumatoid arthritis(RA)associated with a very unfavorable prognosis.This study aimed to identify changes in renal function and morphological variations of kidney diseases in RA patients.Methods:The study enrolled patients(126 patients)between 18 and 55 years of age with a confirmed active RA of more than 12 months.Each patient underwent the following range of laboratory and instrumental research methods:general clinical analysis of blood and urine,performing urinalysis according to Nechiporenko method;determining daily proteinuria;determining the blood content of glucose,urea,creatinine,uric acid,total bilirubin,liver transaminase level,ionogram,lipidogram,and coagulogram;determining the blood content of rheumatoid factor,anti-streptolysin O,and C-reactive protein;and X-ray of the joints of hands and feet.Renal function was examined by estimating glomerular filtration rate,tubular reabsorption index,and renal functional reserve.For studying the morphological changes in the kidneys under ultrasound examination,renal biopsy was performed in 31 patients with RA with urinary syndrome(proteinuria more than 0.3 g per day and hematuria).Results:Nephropathy in RA is characterized by impaired renal function and manifested by an increased blood creatinine and a decrease in glomerular filtration rate and renal functional reserve.Among morphological variations of nephropathy at RA,mesangial proliferative glomerulonephritis prevails,accounting for 48.4%of patients.Other disorders include the secondary amyloidosis(29.0%of patients),tubulointerstitial nephritis(16.1%),membranous glomerulonephritis(3.2%),and focal-segmental glomerulosclerosis(3.2%).Conclusion:Kidney damage is a common systemic manifestation of RA with a long and active course,a major nephropathy trigger.展开更多
<strong>Objective:</strong> To evaluate the correlation between residual renal function and hypertension in regular haemodialysis patients. <strong>Background:</strong> Initiating chronic dialy...<strong>Objective:</strong> To evaluate the correlation between residual renal function and hypertension in regular haemodialysis patients. <strong>Background:</strong> Initiating chronic dialysis treatment gives end-stage renal disease patients a new lease on life. However, the annual mortality rate in dialysis patients is ~20% and quality of life is substantially reduced. <strong>Patients and Methods:</strong> This study was carried out on a reasonable number of subjects on regular haemodialysis divided into two groups. All were given informed consent and, the study was approved by the ethics committee of Menoufia University. <strong>Results:</strong> There was significant relation between presence of residual renal function and hypertension in patients with ESRD on regular haemodialysis, but the relation between residual renal function and control of hypertension is not statistically significant. 40% of group 1 were hypertensive, 66.7% of group 2 patients were hypertensive, the interdialytic weight gain mean was 1.42 in group 1 and 2.37 in group 2. Control of hypertension was achieved in 63.6% of group 1 patients by one drug, 27.3% patients by 2 drugs;however 9.1% of patients need 3 drugs to control their blood pressure, while in group 2 40% of patients were controlled by one drug, 45% with 2 drugs and 15% need 3 drugs to control blood pressure. <strong>Conclusion:</strong> There is significant relation between presence of residual renal function and hypertension in patients with ESRD on regular haemodialysis, but the relation between residual renal function and control of hypertension is not statistically significant.展开更多
Urolithiasis is a common disease that affects urinary tract in all age groups. Both in adults and in children, stone size, location, renal anatomy, and other factors, can infuence the success of treatment modalities. ...Urolithiasis is a common disease that affects urinary tract in all age groups. Both in adults and in children, stone size, location, renal anatomy, and other factors, can infuence the success of treatment modalities. Recently, there has been a great advancement in technology for minimally invasive management of urinary stones.The epoch of open treatment modalities has passed and currently there are much less invasive treatment approaches, such as percutaneous nephrolithotomy, ureteroscopy, shockwave lithotripsy, and retrograde internal Surgery. Furthermore, advancement in imaging technics ensures substantial knowledge that permit physician to decide the most convenient treatment method for the patient. Thus, effective and rapid treatment of urinary tract stones is substantial for the preservation of the renal function. In this review, the effects of the treatment options for urinary stones on renal function have been reviewed.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
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 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.
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.
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.
基金the National Natural Science Foundation of China(No.81873452)the Clinical Research Program of Huazhong University of Science and Technology Affiliated Tongji Hospital(No.2020003).
文摘Anti-B cell maturation antigen(BCMA)chimeric antigen receptor(CAR)T-cell therapyis effective and well-tolerated for refractory or relapsed multiple myeloma(RRMM).The purposcof the present study was to analyze efficacy in RRMM patients with renal impairment treated byanti-BCMA CAR-T cell therapy.A total of 59 RRMM patients were selected,and divided intoimpaired renal function(lRF)group[basclinc cstimated giomerular filtration rate(eSFR)<90 m/min/1.73 m^2(n=18)]and normal renal function(NRF)group(baseline eGFR≥90 mL/min/1.73 m,n=41).For patients with IRF,eGFR at the 6th month post-CAR-T cells infusion was significantlyhigher than the baseline(P<0.05).The multivariate analysis showed that light chain type and beta-2 micro-globulin(bcta-2M)were associated factors with the decrease of serum creatinine.Medianprogression-free survival(PFS)in the NRF group and IRF group was 266 days and 181 daysrespectively.Overall survival(OS)in the NRF group and lRF group was 877 days and 238 daysrespectively.There was no significant difference in the objective response rate(ORR)between thelRF group and the NRF group.It is suggested that CAR-T cells therapy could improve the renalfunction during the treatment of RRMM.The renal function could be more significantly improvedin RRMM patients with light chain type than with other types.
基金This study was approved by the Ethics Committee of Wuxi People's Hospital affiliated with Nanjing Medical University(approval no.KY23117).
文摘BACKGROUND Immunoglobulin A nephropathy(IgAN)is a common form of chronic glomer-ulonephritis.Currently,IgAN is one of the main causes of chronic renal failure in China;its prognosis varies greatly between patients,with renal function at the time of diagnosis and prognosis being strongly correlated.Mycophenolate mofetil(MMF)is a drug with a good immunomodulatory effect and is commonly used clinically.However,its effects in IgAN have not yet been clearly demonstrated.Therefore,herein,we retrospectively compared the effectiveness and safety of prednisone alone or combined with MMF for the treatment of primary IgAN with moderate-to-severe renal impairment.METHODS Between January 2011 and December 2020,200 patients with moderate-to-severe IgAN were included in this study,all of whom were admitted to Wuxi People's Hospital affiliated with Nanjing Medical University.All patients underwent a renal puncture biopsy,which revealed primary IgAN with a glomerular filtration rate(GFR)of 30–60 mL/min.The patients were divided into a glucocorticoid therapy group(GTG)and an immunosuppressive therapy group(ITG)according to the different treatment regimens,with 100 patients in each group.Based on general treatments,such as angiotensin-converting enzyme inhibitors/angiotensin receptor blockers,patients in the GTG were administered prednisone 0.5–0.8 mg/(kg·d^(-1))for 4–8 wk,which was reduced by 5 mg every two weeks until the maintenance(30 mg/d)dose was reached and maintained for 12 mo.In the ITG,MMF was administered at 1.0 g/d for 6–12 mo,followed by a maintenance dosage of 0.5 g/d for 12 mo.Age,sex,blood pressure,24-h urinary egg white measurement,serum creatinine(Scr),blood uric acid,blood albumin,blood potassium(K),hemoglobin,GFR,alanine aminotransferase,total cholesterol(T-CHO),fasting blood glucose,and body mass index were recorded.The 24-h urinary protein,Scr,and GFR levels were recorded 3,6,9,and 12 mo after treatment.Follow-up data were also collected.RESULTS No discernible differences existed between the two groups in terms of age,sex,blood pressure,creatinine,24-h urinary protein level,GFR,or other biochemical indicators at the time of enrollment.Both regimens significantly reduced the 24-h urinary protein quantitation and stabilized renal function.Nine months after treatment,the 24-h urinary protein and Scr of the ITG decreased more significantly than those of the GTG.By the 12th month of treatment,the 24-h urinary protein and Scr in both groups continued to decrease compared to those by the 9th month.In addition,the overall response rate in the ITG was significantly higher than that in the GTG.The occurrence of side effects did not vary significantly between the two regimens;however,endpoint events were significantly more common in the GTG than in the ITG.The follow-up time for the GTG was noticeably lower than that for the ITG.CONCLUSION Prednisone combined with MMF was effective for the treatment of IgAN with moderate-to-severe renal dysfunction.
文摘BACKGROUND MicroRNAs(miRNAs)have been suggested as biomarkers for malignant diseases including hepatocellular carcinoma(HCC).Specifically,hsa-miR-21-5p(miR-21)is among the most frequently deregulated miRNA in cancer.The diagnostic and prognostic value of miR-21 has been demonstrated in HCC tissue,mostly in the Asian population.Although the impact of various factors has been recently reported for circulating hsa-miR-122-5p(miR-122),at present only limited knowledge is available for miR-21.AIM To evaluate the value of miR-21 for the assessment of prognosis in HCC patients and to delineate the influence of clinical and preanalytical factors on miR-21 level in sera.METHODS Patients with confirmed HCC from our European cohort with predominantly alcohol-associated liver damage were included in the study.All subjects were characterized according to their clinical and laboratory work-up and overall survival data were obtained.Quantitative real-time polymerase chain reaction was performed for miR-21 and spiked-in cel-miR-39-3p.The results were compared to previously reported miR-122 data.RESULTS Survival of HCC patients was comparable between patients with low and high serum miR-21 concentration.No association was observed between miR-21 level in sera and Child-Pugh score,Barcelona Clinic Liver Cancer staging system,or etiology of HCC/liver disease.Age,gender,or pretreatment had no association with miR-21 level.A positive correlation was observed between miR-21 and aspartate aminotransferase(r=0.2854,P=0.0061),serum miR-122(r=0.2624,P=0.0120),and the International Normalized Ratio(r=0.2065,P=0.0496).Negative correlation of miR-21 with serum creatinine(r=-0.2215,P=0.0348)suggests renal function as a potential influencing factor in miR-21 biogenesis in blood.CONCLUSION The results from this work do not support clinically relevant prognostic value of circulating miR-21 in HCC patients in real-life settings.Following systematic evaluation,we identified renal function and aspartate aminotransferase as potential factors that may affect miR-21 concentration in blood.This knowledge should be considered in future miRNA-based biomarker studies not only for HCC but also for other diseases.
文摘AIM To evaluate the effect of a 12-mo supervised aerobic and resistance training, on renal function and exercise capacity compared to usual care recommendations.METHODS Ninety-nine kidney transplant recipients(KTRs) were assigned to interventional exercise(Group A; n = 52) and a usual care cohort(Group B; n = 47). Blood and urine chemistry, exercise capacity, muscular strength, anthropometric measures and health-related quality of life(HRQo L) were assessed at baseline, and after 6 and 12 mo. Group A underwent a supervised training three times per week for 12 mo. Group B received only general recommendations about home-based physical activities.RESULTS Eighty-five KTRs completed the study(Group A, n = 44; Group B, n = 41). After 12 mo, renal function remained stable in both groups. Group A significantly increased maximum workload(+13 W, P = 0.0003), V'O2 peak(+3.1 mL/kg per minute, P = 0.0099), muscular strength in plantar flexor(+12 kg, P = 0.0368), height in the countermovement jump(+1.9 cm, P = 0.0293) and decreased in Body Mass Index(-0.5 kg/m^2, P = 0.0013). HRQo L significantly improved in physical function(P = 0.0019), physical-role limitations(P = 0.0321) and social functioning scales(P = 0.0346). Noimprovements were found in Group B.CONCLUSION Twelve-month of supervised aerobic and resistance training improves the physiological variables related to physical fitness and cardiovascular risks without consequences on renal function. Recommendations alone are not sufficient to induce changes in exercise capacity of KTRs. Our study is an example of collaborative working between transplant centres, sports medicine and exercise facilities.
文摘Background: Pregnancy is implicated in notable physiological changes and the extraordinary kidney physiology during pregnancy is believed to have an effect on kidney functions. However, during pregnancy the glomerular filtration rate (GFR) increases its work rate up to 50%, on the contrary, in preeclampsia the GFR turns back to decline. Objectives: This study aims to measure and compare kidney function between preeclamptic and normal pregnant women. Materials and Methods: A cross-sectional hospital-based study was conducted in the period from March to May 2021 in Wad Medani Obstetrics and Gynecology Teaching Hospital. A total of 100 pregnant women, 50 apparently healthy pregnant women and 50 pregnant ladies proved to have preeclamptic toxemia, their ages ranged from 18 to 44 years old and at the third trimester of pregnancy. Blood samples were taken and serum was separated, then urea, creatinine, uric acid, sodium and potassium were determined. Data were analyzed using Statistical Package for Social Science (SPSS). Results: The results of this study revealed that 92% of preeclamptic pregnant women had the first time of the incidence and 8% were family inherited preeclampsia and injured multiple times. The preeclamptic pregnant women showed elevation in both systolic and diastolic blood pressure compared to the normal pregnant women. Although the creatinine values of all study subjects were in the normal range, the mean of its serum level was found to be higher in normal pregnant women than that in preeclamptic women. The study also showed urea level was elevated in the preeclampsia group in comparison to the normal one, while all values were in the normal range. In addition to the significant difference that observed in the uric acid mean between preeclamptic (higher) and normal pregnant groups, abnormal values were only noticed with many preeclamptic patients. The levels of electrolytes (sodium and potassium) were elevated in the preeclampsia women group, whereas all values were in the normal range. Conclusion: This study concluded that preeclamptics showed significant elevation in the urea, uric acid, sodium and potassium levels and a significant decrease in creatinine level compared to normal pregnant women, although all parameters values for both groups were in the reference values for non-pregnancy.
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This study was partially supported by an unrestricted grant from Gilead Sciences(CAP-Asia Study-IN-US-989-5334).
文摘Background:Nonalcoholic fatty liver disease(NAFLD)is associated with impaired renal function,and both diseases often occur alongside other metabolic disorders.However,the prevalence and risk factors for impaired renal function in patients with NAFLD remain unclear.The objective of this study was to identify the prevalence and risk factors for renal impairment in NAFLD patients.Methods:All adults aged 18-70 years with ultrasound-diagnosed NAFLD and transient elastography examination from eight Asian centers were enrolled in this prospective study.Liver fibrosis and cirrhosis were assessed by FibroScan-aspartate aminotransferase(FAST),Agile 3+and Agile 4 scores.Impaired renal function and chronic kidney disease(CKD)were defined by an estimated glomerular filtration rate(eGFR)with value of<90 mL/min/1.73 m^(2) and<60 mL/min/1.73 m^(2),respectively,as estimated by the CKD-Epidemiology Collaboration(CKD-EPI)equation.Results:Among 529 included NAFLD patients,the prevalence rates of impaired renal function and CKD were 37.4%and 4.9%,respectively.In multivariate analysis,a moderate-high risk of advanced liver fibrosis and cirrhosis according to Agile 3+and Agile 4 scores were independent risk factors for CKD(P<0.05).Furthermore,increased fasting plasma glucose(FPG)and blood pressure were significantly associated with impaired renal function after controlling for the other components of metabolic syndrome(P<0.05).Compared with patients with normoglycemia,those with prediabetes[FPG≥5.6 mmol/L or hemoglobin A1c(HbA1c)≥5.7%]were more likely to have impaired renal function(P<0.05).Conclusions:Agile 3+and Agile 4 are reliable for identifying NAFLD patients with high risk of CKD.Early glycemic control in the prediabetic stage might have a potential renoprotective role in these patients.
文摘Immunosuppression(IS) is often withdrawn in patients with end stage renal disease secondary to a failed renal allograft, and this can lead to an accelerated loss of residual renal function(RRF). As maintenance of RRF appears to provide a survival benefit to peritoneal dialysis(PD) patients, it is not clear whether this benefit of maintaining RRF in failed allograft patients returning to PD outweigh the risks of maintaining IS. A 49 year-old Caucasian male developed progressive allograft failure nine years after living-donor renal transplantation. Hemodialysis was initiated via tunneled dialysis catheter(TDC) and IS was gradually withdrawn. Two weeksafter IS withdrawal he developed a febrile illness, which necessitate removal of the TDC and conversion to PD. He was maintained on small dose of tacrolimus(1 mg/d) and prednisone(5 mg/d). Currently(1 year later) he is doing exceedingly well on cycler-assisted PD. Residual urine output ranges between 600-1200 m L/d. Total weekly Kt/V achieved 1.82. RRF remained well preserved in this patient with failed renal allograft with minimal immunosuppressive therapy. This strategy will need further study in well-defined cohorts of PD patients with failed allografts and residual RRF to determine efficacy and safety.
文摘Objective:Rheumatoid nephropathy is one of the most severe extra-articular manifestations of rheumatoid arthritis(RA)associated with a very unfavorable prognosis.This study aimed to identify changes in renal function and morphological variations of kidney diseases in RA patients.Methods:The study enrolled patients(126 patients)between 18 and 55 years of age with a confirmed active RA of more than 12 months.Each patient underwent the following range of laboratory and instrumental research methods:general clinical analysis of blood and urine,performing urinalysis according to Nechiporenko method;determining daily proteinuria;determining the blood content of glucose,urea,creatinine,uric acid,total bilirubin,liver transaminase level,ionogram,lipidogram,and coagulogram;determining the blood content of rheumatoid factor,anti-streptolysin O,and C-reactive protein;and X-ray of the joints of hands and feet.Renal function was examined by estimating glomerular filtration rate,tubular reabsorption index,and renal functional reserve.For studying the morphological changes in the kidneys under ultrasound examination,renal biopsy was performed in 31 patients with RA with urinary syndrome(proteinuria more than 0.3 g per day and hematuria).Results:Nephropathy in RA is characterized by impaired renal function and manifested by an increased blood creatinine and a decrease in glomerular filtration rate and renal functional reserve.Among morphological variations of nephropathy at RA,mesangial proliferative glomerulonephritis prevails,accounting for 48.4%of patients.Other disorders include the secondary amyloidosis(29.0%of patients),tubulointerstitial nephritis(16.1%),membranous glomerulonephritis(3.2%),and focal-segmental glomerulosclerosis(3.2%).Conclusion:Kidney damage is a common systemic manifestation of RA with a long and active course,a major nephropathy trigger.
文摘<strong>Objective:</strong> To evaluate the correlation between residual renal function and hypertension in regular haemodialysis patients. <strong>Background:</strong> Initiating chronic dialysis treatment gives end-stage renal disease patients a new lease on life. However, the annual mortality rate in dialysis patients is ~20% and quality of life is substantially reduced. <strong>Patients and Methods:</strong> This study was carried out on a reasonable number of subjects on regular haemodialysis divided into two groups. All were given informed consent and, the study was approved by the ethics committee of Menoufia University. <strong>Results:</strong> There was significant relation between presence of residual renal function and hypertension in patients with ESRD on regular haemodialysis, but the relation between residual renal function and control of hypertension is not statistically significant. 40% of group 1 were hypertensive, 66.7% of group 2 patients were hypertensive, the interdialytic weight gain mean was 1.42 in group 1 and 2.37 in group 2. Control of hypertension was achieved in 63.6% of group 1 patients by one drug, 27.3% patients by 2 drugs;however 9.1% of patients need 3 drugs to control their blood pressure, while in group 2 40% of patients were controlled by one drug, 45% with 2 drugs and 15% need 3 drugs to control blood pressure. <strong>Conclusion:</strong> There is significant relation between presence of residual renal function and hypertension in patients with ESRD on regular haemodialysis, but the relation between residual renal function and control of hypertension is not statistically significant.
文摘Urolithiasis is a common disease that affects urinary tract in all age groups. Both in adults and in children, stone size, location, renal anatomy, and other factors, can infuence the success of treatment modalities. Recently, there has been a great advancement in technology for minimally invasive management of urinary stones.The epoch of open treatment modalities has passed and currently there are much less invasive treatment approaches, such as percutaneous nephrolithotomy, ureteroscopy, shockwave lithotripsy, and retrograde internal Surgery. Furthermore, advancement in imaging technics ensures substantial knowledge that permit physician to decide the most convenient treatment method for the patient. Thus, effective and rapid treatment of urinary tract stones is substantial for the preservation of the renal function. In this review, the effects of the treatment options for urinary stones on renal function have been reviewed.
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.
