临床肾脏病学会杂志

库的实践模式和结果促肾上腺皮质激素注入(ActharA®凝胶)用在儿童肾病综合症:一项研究北美儿科肾脏试验和协作研究和小儿肾脏学研究财团

07/23/2021

Summary

Objective: We set up a U.S. registry to examine prescription patterns and patient outcomes of repository corticotropin injection (Acthar® Gel) for childhood nephrotic syndrome.

Methods: 18 participating U.S. pediatric centers performed retrospective review and prospective observation of patients < 21 years old with nephrotic syndrome treated with Acthar Gel. We captured baseline characteristics, drug regimen and duration, and disease response following treatment.

Results: 46 patients, enrolled from 2015 to 2020 were included. 27 (58.7%) were male. 18 patients (39.1%) had a diagnosis of minimal change followed by focal segmental glomerulosclerosis in 16 patients (34.7%). Median age at start of treatment was 12.5 years (IQR 8.5-17.4) compared to 5.3 years at diagnosis (IQR 2.7-10.5 years). 52% were resistant to corticosteroids. The most common Acthar Gel regimen was 80IU twice a week with a median duration of 199 days (IQR 88-365). Among 37 patients with active disease, 18 (49%) were able to achieve partial or complete remission, though all patients that had a positive response were on other immunosuppressants concomitantly.

Conclusion: We report the findings of the largest registry cohort of pediatric patients in the U.S. treated with Acthar Gel for clinically challenging cases of nephrotic syndrome. Acthar Gel was successful in inducing remission in approximately half of the patients with active disease at time of treatment. No predictors of response with respect to demographic data, age at start of Acthar Gel therapy, etiology of nephrotic syndrome, presence or absence of comorbidities, or steroid responsiveness was noted.

Multifrecuency bioimpedance相位角作为一种工具来预测本机为血液透析管状器官的成熟失败

07/21/2021

Summary

Background and objectives: An arteriovenous fistula is considered to be an ideal vascular access for patients receiving hemodialysis, its main limitation is its high failure rate to achieve maturation and long-term functionality loss. Multiple strategies have attempted to identify patients at risk. Bioelectrical impedance has shown to be a valuable resource in the determination of the hydration status, and the measurement of the phase angle through this method has demonstrated to be a good indicator of the nutritional state and its related as a general marker of survival. The objective of this study is to analyze the role of plasma albumin and phase angle measured through bioelectrical impedance as tools useful for predicting failure of arteriovenous fistulas.

Materials and methods: prospective observational study, including 104 patients with chronic kidney disease receiving hemodialysis who underwent a native arteriovenous fistula during a period of 24 months. Analyzing its clinical characteristics, laboratory and phase angle through electrical bioimpedance, both univariate and multivariate analysis was performed both with logistic regression, furthermore calculation of coordinates and ROC curve to establish a better cut-off point.

Results: of the variables that were analyzed only the phase angle measurement showed statistical significance OR 2.61 (1.6 – 4.4) p - value 0.001 for predicting arteriovenous fistula failure. In female patients with a phase angle value of 3.25 had a 90% sensibility and 53% specificity for male patients a value of 3.58 showed a sensibility of 84% and a specificity of 52% with ROC curve of 0.78.

Conclusion: phase angle through bioimpedance is a useful parameter, helpful in predicting failure of native arteriovenous fistula, it is also an important tool for identifying patients at risk, in early stages prior to the construction of a vascular access.

有用的短兵相接bioimpedance分析评估卷状态在慢性血液透析患者阿里斯蒂德Le Dantec大学医院(塞内加尔)

07/20/2021

Summary

Introduction: Determination of dry weight is one of the daily goals to achieve in hemodialysis. The aim of this study was to validate the use of bioelectrical impedance analysis (BIA) in estimation of dry weight in a population of Senegalese chronic hemodialysis patients.

Patients and methods: A 9-week cross-sectional study was carried out at the hemodialysis unit of Aristide Le Dantec University Hospital. Adult patients with no previous hospital history were included. The total body water (TBW) was measured with a single frequency bioelectric impedance foot-to-foot analyzer, before and after six successive hemodialysis sessions. These results were compared with those from clinical measurements with the Watson equation using a Student’s t-test and Bland-Altman analysis.

Results: 264 measurements were made in 22 patients (46.6 years, 54.5% men, 92.3 months on dialysis, 62.7 kg mean dry weight). A significant reduction in weight (ΔWeight = 2.0 ± 1.1 kg; p < 0.0001) and in TBW measured by the BIA (ΔTBWBIA = 3.3 ± 1.0 liters; p < 0.0001)) or calculated by Watson’s equation (ΔTBWWatson = 0.5 ± 0.2 liter; p = 0.0001) was observed. There was a strong linear correlation and agreement between the 2 TBW measurements in pre-dialysis. In post-dialysis the concordance diagram indicated a bias = –2.2 and wide agreement limits.

Conclusion: The BIA allows reproducible and reliable measurements and a fair estimate of the TBW in pre-dialysis.

急性肾损伤由于自发Atheroembolic疾病,叠加在糖尿病肾病,最近没有血管或心脏干预,表现为快速进行性肾小球肾炎(展)

07/14/2021

Atheroembolic disease (AED), or Cholesterol Crystals Embolism, is a systemic disease presented as a complication of severe atherosclerosis [1], where older age, male sex, diabetes hypercholesterolemia, smoking and hypertension [2], are the main risk factors for the development of Atherosclerosis, it is known that spontaneous atherosclerotic renal disease is rare in the absence of any vascular intervention [3], and in the absence of anticoagulant [4], or the absence of calcified aorta, with the most common presentation of the disease is subacute kidney injury progress into renal dysfunction occurs in like a staircase pattern and the renal dysfunction is usually observed several weeks after a possible intervention, caused by dislodging the micro cholesterol plaques from a major artery, and start showering multiple organs causing micro and macro embolic phenomena.

一个多学科pre-dialysis程序对肾的影响治疗方法的选择

05/05/2021

& lt; p>在葡萄牙,约有2500患者终末期慢性肾脏疾病(CKD阶段5)启动一个肾脏替代治疗(RRT)每年首次[1]。他们有四个主要治疗方法:肾移植(TX);血液透析(HD);腹膜透析(PD)和保守治疗(CT)。RRT选择是相当复杂的特异性patient&每个选项和深远的影响,年代的生活质量。患者必须发挥决定性的作用在治疗方式的选择和选择选择最适合他们的价值观和需求灵活;/ p>

血糖之间的非线性关系和30天死亡率在关键的急性肾损伤患者:一项回顾性队列研究

04/27/2021

& lt; h2> Abstract< / h2>

Background: Acute kidney injury (AKI) is a major health problem affecting millions of people worldwide. Effective preventative and therapeutic treatments remain to be produced. We aim to determine the association between blood glucose and mortality in critical patients with AKI.

Method: This cohort study included 18,703 patients with AKI. The exposure of interest was baseline blood glucose. The outcome was 30-day mortality. Multivariable Cox regression analyses and smooth curve fitting were adopted to assess the independent association between blood glucose and 30-day mortality.

Results: We identified 18,703 consecutive individuals with AKI. The average age of the participants was 66.8 ± 16.0 years, and about 42.7% of them were female. The overall 30-day mortality was 16.9%. Through the multivariate COX regression model and smooth curve fitting, we observed that the correlation between blood glucose and 30-day mortality is nonlinear. An inflection point was found at about 5.93 mmol/L. On the left side of inflection point, the effect size was 0.81 (HR: 0.81, 95% CI 0.74-0.89, p < 0.001). On the right side of inflection point, the effect size was 1.02 (HR: 1.02,95% CI 1.01-1.03, p < 0.001).

Conclusion: Our study suggested that, among patients with AKI, there was a nonlinearity relationship between blood glucose and mortality in patients with AKI. The optimal of blood glucose associated with the lowest risk of 30-day mortality was around 5.93 mmol/L. .

慢性肾脏疾病的预后因素和终末期肾病患者狼疮肾炎:回顾性队列研究

04/27/2021

& lt; h2> Abstract< / h2>

Background: Lupus Nephritis (LN) occurs in approximately half of all patients with Systemic Lupus Erythematosus (SLE) and it is the most common cause of morbidity and mortality in patients with SLE. Factors associated with poor renal outcome vary among studies, and researches coming from Brazil are scarce.

Objectives: To identify the prognostic factors associated to the development of Chronic Kidney Disease (CKD) and End Stage Renal Disease (ESRD) in LN patients followed in a tertiary hospital.

Design and Settings: We conducted a retrospective cohort study set in a tertiary hospital in Fortaleza, Ceará, Brazil. Methods: We compiled a total of 214 LN patients diagnosed between 1983 and 2015. Data was collected from medical records and further analyzed using logistic regression.

Results: LN prevalence was 53.9%. The cohort had a mean follow-up of 11.2 years (SD ± 7.2 years). At the end of follow-up, 93 of 197 patients (47.2%) had CKD, and 49 of 191 (25.6%) were on regular dialysis. The main factors associated for developing CKD after logistic regression analysis were the following predictors: hypertension (HR 2.80; 95% CI 1.30-6.01; p = 0.008), time between diagnosis of SLE and diagnosis of LN (HR 0.98; 95% CI 0.97-0.99; p = 0.009) and discontinuation of medications (HR 2.41; 95% CI 1.08-5.37; p = 0.03).

Conclusion: Hypertension, discontinuation of medications, and time between diagnosis of SLE and diagnosis of LN are independent variables associated with the development of CKD and ESDR in our study.

弥漫性肺泡出血:不寻常的系统性红斑狼疮

04/22/2021

Diffuse alveolar hemorrhage (DAH) is a rare complication of systemic lupus erythematosus (SLE) and carries a high mortality.

It was first described by Osler in 1904 as the most devastating pulmonary complication of SLE.

We describe a case of a 23-year-old girl recently diagnosed with SLE associated by a class III nephritis treated with oral corticoids and mycophenolate mofetil who developed a Diffuse Alveolar Hemorrhage DAH a few days later. The early diagnosis and the aggressive therapy allowed us to have a favorable outcome.

收集管PGE2反应减少水损失empagliflozin与2型糖尿病的老鼠

04/08/2021

& lt; h2> Abstract< / h2>

Introduction: Sodium-glucose cotransporter 2 inhibitors such as empagliflozin (EMPA) protect against diabetic kidney disease. Prostaglandin E2 (PGE2) the main renal product of cyclooxygenase-2, inhibits vasopressin (AVP)-water reabsorption in the collecting duct (CD). The novelty of this study is that for the first time, we examined if EMPA affects the renal PGE2/EP receptor system and determined if CD responses to EMPA prevent water loss.

Methods: Four groups of adult male mice were studied after 6 weeks of treatment: control (db/m), db/m+EMPA (10 mg/kg/day in chow), type 2 diabetic diabetic/dyslipidemia (db/db), and db/db+EMPA. Tubules were microdissected for quantitative polymerase chain reaction (qPCR) and CD water transport was measured in response to AVP, with or without PGE2.

Results: Hyperglycemia and albuminuria were attenuated by EMPA. Renal mRNA expression for COX, PGE synthase, PGE2 (EP) receptor subtypes, CD AVP V2 receptors and aquaporin-2 was elevated in db/db mice, but unchanged by EMPA. Urine PGE2 levels increased in db/db but were unchanged by EMPA. AVP-water reabsorption was comparable in db/m and db/m+EMPA, and equally attenuated to 50% by PGE2. In db/db mice, AVP-water reabsorption was reduced by 50% compared to non-diabetic mice, and this reduction was unaffected by EMPA. In db/db mice, AVP-stimulated water transport was more significantly attenuated with PGE2 (62%), compared to non-diabetic mice, but this attenuation was reduced in response to EMPA, to 28%.

Conclusion: In summary, expression of renal PGE2/EP receptors is increased in db/db mice, and this expression is unaffected by EMPA. However, in diabetic CD, PGE2 caused a greater attenuation in AVP-stimulated water reabsorption, and this attenuation is reduced by EMPA. This suggests that EMPA attenuates diabetes-induced excess CD water loss.

前列腺癌症相关的血栓性微血管病:病例报告和文献之回顾

03/08/2021

& lt; h2> Abstract< / h2>& lt; p>背景:血栓性微血管病(TMA)前列腺癌是一种罕见的和危及生命的并发症。血浆置换是否有作用,治疗仍是一个争论的话题。在这里,我们提出一个案件之后,系统回顾关于这个主题的文献。;/ p>& lt; p>病例报告:我们描述一个69岁的病人出现载,这是与一个潜在的转移性前列腺癌有关。我们进行了一项搜索文献。你们的类似案件;/ p>& lt; p>结果:我们的病人治疗和血浆置换反应良好。系统综述的文献显示,另外17例TMA与前列腺癌相关的11与血浆置换治疗大多好反应灵活;/ p>& lt; p>结论:基于当前数据我们不能排除血浆置换在前列腺癌的潜在作用相关TMA灵活;/ p>

vancomycin-associated急性肾损伤的发病率和危险因素在一个中心:回顾性研究

03/08/2021

& lt; h2> Abstract< / h2>

Background: There is enough evidence to suggest that vancomycin increases the risk of acute kidney injury (AKI) but the exact mechanism is not well understood. This study aims to understand the incidence of vancomycin-associated acute kidney injury (VA-AKI) among hospitalized patients and to identify the risk factors for VA-AKI.

Methods: Patients aged 18 and above who received a minimum of 24 hours of intravenous vancomycin and who had serial creatinine measurements over a 13-month period were identified through electronic records. Patients with pre-existing AKI, or eGFR of less than 30ml/min, and patients with end stage kidney disease were excluded. Results were analyzed using t-test and Fisher’s test. A logistic regression model was used to identify the predictors for VA-AKI.

Results: From the 598 patients who met the inclusion criteria, 70 developed AKI. Compared to those without AKI, patients with VA-AKI had higher mean serum vancomycin trough levels (22.6 mg/L vs. 14.6 mg/L), and a statistically significant longer duration of vancomycin use (6.7 vs. 5.2 days). Multivariate analysis revealed that serum vancomycin level of > 20 mg/L was associated with a six-fold increase in odds of VA-AKI when compared to those with vancomycin levels < 15 mg/L. The presence of hypotension, iodinated contrast use, and concomitant use of piperacillin-tazobactam were all associated with increased odds of VA-AKI.

Conclusion: The incidence of VA-AKI in hospitalized patients with eGFR > 30 ml/min was 11.7%. Serum vancomycin levels of > 20 mg/L, hypotension and administration of iodinated contrast significantly increased the risk of VA-AKI. Piperacillin-tazobactam, when used with vancomycin, was noted to be an independent predictor of AKI, regardless of serum vancomycin trough levels, prompting a reevaluation of the safety of this widespread practice as empiric therapy. Close monitoring of kidney function, avoiding high serum vancomycin levels, maintaining hemodynamic stability, and avoiding unnecessary use of iodinated contrast seem to be essential for the prevention of VA-AKI.

Hyperacute致命课程hypercalcemic危机

01/20/2021

& lt; h2>临床Image< / h2>& lt; p>一个39岁的女人,和一个不重要的过去病史,进入急诊室抱怨恶心、呕吐、便秘、厌食、深衰弱,漫射肌肉疼痛和痉挛。她提到零星的腹泻(一期)的前一天和恶化头痛在过去三天;她也抱怨多尿、烦渴不追究一年。临床检查不显著,除了皮肤和粘膜干燥的证据,心动过速,弥漫性腹痛。;/ p>

肾小球反渗透法在也门儿童患有镰状细胞病

01/12/2021

& lt; h2> Abstract< / h2>

Background: Glomerular hyperfiltration (GH) is a common feature of sickle cell nephropathy (SCN) starting at infancy and represents an early marker of incipient glomerular injury and renal dysfunction.

Methods: This study aimed to determine the prevalence and correlates of GH among children (≤ 16 years) with sickle cell disease (SCD) at their steady state, recruited over 6 months at the Pediatric Outpatient Clinic in Al-Sadaqa General Teaching Hospital, Aden, Yemen. Glomerular filtration rate (eGFR) was estimated using the Schwartz formula. Data on clinical history, anthropometry, blood pressure (BP) and laboratory investigations were collected.

Results: Of 101 children (mean age 7.2 ± 3.9 years), 65 (64.4%) were males. The prevalence of GH was observed in 36 (35.6%) children, who were significantly older (10.7 ± 3.2 vs. 5.2 ± 2.7 years, p < 0.001) and had a lower fetal Hb level (5 ± 3.3 vs. 9 ± 7.1, p = 0.02). All children were normotensive, but hyperfiltrating children showed significantly higher systolic (97.2 ± 7.3 vs. 89.7 ± 5.2 mmHg) and diastolic pressure (55.1 ± 5.0 vs. 49 ± 4.3 mmHg) (all p < 0.001). Among evaluated children, 25.7% had hyperfiltration alone, whereas 9.9% had an associated microalbuminuria (MA), and no significant difference in eGFR between those with and without MA (158.4 ± 33.7 vs. 160.7 ± 29.8 ml/min/173m2, p = 0.84).

Conclusion: This study demonstrated a relatively high prevalence of GH in Yemeni children with SCD that increased with age. Recognition of hyperfiltration and other early markers of nephropathy in this population could help to develop renal protective strategies to prevent progressive loss of kidney function.

不寻常的草酸肾病引起急性肾损伤:一个案例报告

11/04/2020

& lt; h2> Abstract< / h2>

Oxalate Nephropathy due to Hyperoxaluria and elevated serum oxalate level is a well-known cause for interstitial fibrosis, and ESRD. Conditions associated with high serum Oxalate, should be considered as a possible contributing factor for a patient’s tubular injury,
Well known cause for Hyperoxaluria including enteric Hyperoxaluria (due to gastric bypass, chronic pancreatitis, small Bowel resection, or malabsorption, as well as depletion of enteric oxalate-degrading bacteria [e.g., Oxalobacter). Other known causes of oxalate nephropathy include primary Hyperoxaluria, ethylene glycol intoxication, vitamin B6 deficiency, excessive ingestion of vitamin C or dietary substances rich in oxalic acid, aspergillosis, prolonged renal failure and various drugs (e.g., Known medications to cause Oxalate Nephropathy are: Orlistat, Praxilene, COX-2 inhibitors).
Unusual presentation with Acute Kidney Injury with incidental finding of high serum Oxalate in a patient with a known CKD stage III, recently started on Polyethelene Glycol to treat his constipation.

修改肾心绞痛指数识别需要肾脏替代治疗危重儿科患者

11/02/2020

Severe Acute Kidney Injury (AKI) is a common, serious problem affecting critically ill children that lacks effective treatment options. Currently, there are no treatment options for AKI other than supportive care. Continuous renal replacement therapy (CRRT) is employed to reduce Fluid Overload (FO) burden and treat metabolic disturbances in AKI. Identifying patients upon admission who may require CRRT has potential clinical care implications. The aim of this study was to determine if the RAI had diagnostic capabilities to identify patients who would require CRRT.

The analytic cohort consisted of patients who required CRRT and illness severity score matched controls who did not require CRRT at a single center. Patients who required CRRT had higher mortality rates, length of stay, and use of ventilatory and inotropic support. Sensitivity, specificity and area under the receiver operating characteristic curve (AUC) assessed and compared the discriminatory accuracy of three scores: 1) the renal angina index (RAI), 2) serum-creatinine (sCr) based AKI on day 0 and 3) modified RAI created with an additional RAI injury tranche that corresponded to severe stage 3 AKI sCr elevation.

Compared to Day0AKI (AUC 0.78, 0.70-0.87; sensitivity 0.63, 0.45-0.79; specificity 0.93, 0.870.97) and RAI (AUC 0.76, 0.69-0.82; sensitivity 0.94, 0.81-0.99; specificity 0.57, 0.47-0.66), the modified RAI had the highest AUC (0.79; 0.72-0.85) with a high sensitivity (0.91; 0.77-0.98) and moderate specificity (0.65; 0.56-0.75) for prediction of CRRT requirements. As a more accurate tool for discriminating patients in need of CRRT, a modified RAI has numerous potential implications. Identifying patients who ultimately require CRRT at an earlier timepoint may influence timing of CRRT initiation in an attempt to avoid further FO, or may influence nephrotoxin administration. The diagnostic capabilities of the modified RAI may be refined by the addition of urinary biomarkers. These findings should be validated in a larger cohort.

COVID-19相关横纹肌溶解

10/20/2020

A novel coronavirus known as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) with a high rate of human-to-human transmission has emerged, resulting in a worldwide public health crisis of catastrophic proportions. Common initial symptoms of Coronavirus Disease 2019 (COVID-19) include fever, cough, fatigue, myalgia, and shortness of breath. Complications include acute respiratory distress syndrome (ARDS), acute cardiac injury, acute kidney injury, and secondary infections [1,2]. There have been reports of patients infected with COVID-19 who either presented with muscle pain and rhabdomyolysis or developed muscle damage as a late complication during hospitalization [3-8].

唐氏综合症儿童肾小管酸中毒的频率

10/02/2020

& lt; h2> Abstract< / h2>& lt; p>背景:唐氏综合症(DS)与各种先天性疾病和畸形有关,其中包括肾脏和泌尿道。人们一直认为肾小管酸中毒(等)更频繁的在这个人口。本研究的目的是评估的频率等,其次,其他肾和泌尿疾病与DS。你们的人;/ p>& lt; p>方法:观察,ambispective,描述性和横断面研究的患者诊断为等,或怀疑肾脏或泌尿疾病,进行了从2016年7月到2017年9月在墨西哥的唐氏综合症临床儿科研究所。验尿了,连同静脉血气分析,钠、钾、氯、钙、磷、白蛋白、肌酐。有任何异常值诊断评估。你们是指肾脏学;/ p>& lt; p>结果:共有700名患者在诊所,47满足选择条件。其中,32没有区域贸易协定或其他肾脏或泌尿病变。剩下的15继续第二阶段的研究中,6个被诊断出患有肾病或尿路病(等,系统性动脉高血压、单症状的家族性血尿、轻度肾功能衰竭继发性返流性肾病,尿路感染或右肾盂输尿管狭窄)。 Four had mild metabolic acidosis without meeting the criteria for diagnosis of RTA.

Conclusion: RTA is not more common in children with Down syndrome. Nephropathies and uropathies should be investigated in the evaluation of DS patients.

急性肾损伤患者在哥伦比亚COVID-19接受肾脏支持疗法geniusA®90技术

09/11/2020

& lt; h2> Abstract< / h2>

Introduction: Acute kidney injury (AKI) is one of the complications associated with severe COVID-19 infection, and it can present in up to 20% to 40% of the cases; of these, approximately 20% will require renal replacement therapy (RRT).

Objective: To establish clinical and laboratory characteristics in a group of patients from Colombia with COVID-19 infection and AKI that received intermittent and prolonged RRT with the GENIUS® 90 technology in between March and July 2020.

Design: Cross-sectional study.

Results: 78.9% of participants were men and 21.1% were women. The main comorbidities were the following: Hypertension (65.3%), diabetes mellitus (38.9%), obesity (26.3%), cancer (5.3%), Chronic obstructive pulmonary disease (11.6%), cardiovascular disease (23.2%), active smoking (11.6%). 33.7% had chronic kidney disease (CKD) in the average serum creatinine on admission was 4.4 mg/dl.

The following inflammatory markers were elevated: C-reactive protein (CRP), d-dimer and ferritin (20.3 mg/dl, 931mcg/l and 1174 ng/ml, respectively). 63.5% of patients underwent sustained low-efficiency dialysis (SLED) (6 to 12 hours) and the rest of the patients (36.35%) underwent conventional hemodialysis (less than 4 hours). The mortality of the total patient sample was 36.9%, lower in patients with CKD than in patients with no previous renal disease history (18.7% and 40.1%, respectively).

Conclusion: Renal complications are frequent in patients with severe COVID-19. The development of AKI could be an isolated prognostic marker associated with an increase in mortality in patients with COVID-19, and one of the options is intermittent and prolonged RRT with the GENIUS® 90 system.

SGLT2抑制剂和nephroprotection糖尿病肾病:从作用机制的最新证据

08/21/2020

Summary

Type 2 Diabetes Mellitus constitutes a major problem in public health worldwide. The disease poses a high risk of severe microvascular and macrovascular complications. Diabetic kidney disease is the most common cause of end-stage chronic kidney disease and contributes to the increasing morbidity and mortality associated to diabetes. Sodium-glucose contransporter-2 inhibitors (SGLT2 inhibitors) are the latest oral diabetic medications, which exhibit a great nephroprotective potential, not only by improving glycemic control, but also by glucose-independent mechanisms, such as decreasing blood pressure and other direct renal effects. We conduct a literature review based on the most recent scientific evidence with the goal to elucidate the postulated mechanisms of action of SGLT2 inhibitors in diabetic kidney disease, which are the base of the beneficial clinical effects that are seen in the condition.

急性肾损伤的生物标志物

07/20/2020

& lt; h2> Abstract< / h2>

Acute kidney injury is a common condition associated with high morbidity and short-term mortality. Its pathophysiology varies according to the numerous conditions associated with its genesis. Biomarkers allow detecting changes at the level of kidney function; therefore, they play an important role in the prevention, early diagnosis, therapeutic response and prognosis of acute kidney injury. The search for biomarkers for acute kidney injury began over 15 years ago; initially, only serum creatinine was available for diagnosis. However, throughout history, great advances have been made in research, which have allowed the finding of new biomarkers in order to improve the health and quality of life of patients. A narrative review of the literature is carried out on the basis of available scientific evidence to clarify the role and importance of biomarkers in the context of acute renal injury.

特定的脑膜脑炎患者移植肾脏

06/17/2020

& lt; h2> Abstract< / h2>

We described a case of specific (tuberculous) encephalitis in a patient after kidney transplantation. Immunosuppressive therapy, continuously required in post-tranplant period, may cause various complications, such as infections. Specific meningoencephalitis is an infection that is rarely diagnosed and more common in immunocompromised patients.

Case report: A 30-year-old man had kidney transplantation (kidney donor was his father). He previously was two years on chronic hemodialysis treatment because of end-stagerenal disease based on diabetic nephropathy. He has diabetes type 1. The early post-transplant period duly passed with satisfactory clinical and laboratory parameters of renal function. Two months after transplantation, he presented with febrile condition, signs of septicemia and dehydration with significant neurological deficit and expressed meningeal signs. In cerebrospinal fluid we found lymphocytosis, elevated proteins and positive micobacterium tuberculosis antibodies (Hexagon method) and we suspected to specific etiology of meningitis. Performed computed tomography (CT) scan of the brain with contrast confirmed the expected finding.

Due to the poor prognosis of infections of the central nervous system (CNS) in immunocompromised patients, only prompt diagnosis can improve survival in this group of patients. The therapeutic protocol after kidney transplantation include the prophylactic use of antituberculous drug (Isoniazid 300 mg) during the 9 months.

尿液pH值如何影响蛀牙吗?

06/05/2020

& lt; h2> Abstract< / h2>

The basic aim of the present study was to relate tooth decay with the pH of the urine. pH is very important aspect which affects and depends upon the urine specificity .The glomerulus is a necessary part in the structure of kidney .The glomerulus is involved in the filtration of blood ,which is involved in acidification with the help of kidneys. A cavity or hole is formed within the tooth and it can leads towards tooth decay. Cavity in its structure is so small when it is at its starting point but with the passage of time cavity becomes large in between of the teeth and it can be a main reason to the complex diseases. A total of 100 students get participated in this study from Bahauddin Zakariya University Multan, Pakistan. In this subjects went into the lab with their urine samples taking in the urine collection bag. In this a strip is used to find the values pH. Strip is placed in the urine collection bag for a minute. Then we noted the different values of different subjects. We designed a research project based upon the results that depend upon either there was any relation among tooth decay and pH. The aim of the project was either there is any relation among the tooth decay and urine pH. It was concluded that there was no any kind of relation among urine pH and tooth decay.

β2微球蛋白尿生物标志物的地形高低尿路感染之间的歧视?

04/28/2020

Urinary tract infections are common affection in the general population.
Diagnosis is often easy in the presence of evocative clinical signs.

肾盂成形术后持续肾盂积水:这是一个真正的阻碍?endourology的作用

04/13/2020

& lt; h2> Abstract< / h2>

Introduction: Anderson-Hynes pyeloplasty remains the gold standard in the treatment of ureteropelvic junction obstruction. The diagnostic criteria for defining the failure of pyeloplasty are not well-defined or even arbitrary. Likewise, the ideal treatment of persistent hydronephrosis after pyeloplasty is not well established. We tested an innovative endourological procedure, which simultaneously allows a diagnostic definition of failure and treatment when necessary.

Materials and methods: The endourological procedure was applied prospectively to 13 cases from 2006 to 2015. The mean hydronephrosis was 3 cm and all the patients showed an obstructive pattern at scintigraphie. Of these, only 2 patients had symptoms. The procedure consisted in the endoscopic calibration of the pyeloureteral junction. In case of confirmed persistent stenosis, the procedure continued with the high pressure dilation of the junction. The calibration/dilation procedure was carried out with a balloon catheter, previously used for high pressure dilation in the obstructive megaureter. In all patients, a ureteral stent was positioned for 6 - 8 weeks.

The patients were then followed up using ultrasound and renoscintigraphie.

Results: According to the endoscopic balloon procedure, anastomosic stenosis was confirmed in 3 cases, treated with high pressure dilation during the same procedure. In 10 cases no stenosis was found and we followed-up these patients with periodic ultrasound and scintigraphie.

Conclusion: The calibration/dilation of the pyeloureteral junction represents in our opinion a useful diagnostic and therapeutic tool that allows to limit the repetition of open surgery only to symptomatic cases and those non-responders to endoscopic treatment.

微蛋白尿的含义在儿童特发性肾病综合征

04/13/2020

& lt; h2> Abstract< / h2>

We investigated the existence of microalbuminuria in children with corticosteroid-sensitive idiopathic nephrotic syndrome in complete remission. In the study of a series of 18 cases, we noted a clearly different evolution depending on the existence or absence of pathological micro albuminuria.

Microalbuminuria appears to be a prognostic discrimination parameter in idiopathic nephrotic syndrome.

无尿症的一个偏远的原因一个孩子

02/26/2020

& lt; h2> Abstract< / h2>& lt; p>急性肾损伤是一种罕见的并发症与mesPGN特发性肾病综合征。这里我们提出一个两岁的男性患者4天无尿的历史,广义水肿和hypervolemia。蛋白尿和肾功能衰竭以外的任何证据不能确定实验室检测和多普勒超声。无尿症的表现被认为是与快速进行性肾小球肾炎,弥漫性系膜硬化或急性肾小管坏死。然而,肾活检显示系膜增生性肾小球肾炎(mesPGN)。强的松2毫克/公斤/天是规定。利尿开始逐渐和疾病的第十天,无尿是解决和急性肾损伤恢复没有续集。给出了这种情况下的临床表现和组织病理诊断之间的不兼容性。得出虽然少见,无尿症和急性肾损伤可能是特发性肾病综合征的症状童年。你们;/ p>

肉芽肿病与polyangiitis (GPA)在一个76岁的女人出现肺结节和加速急性肾损伤

01/20/2020

& lt; h2> Abstract< / h2>& lt; p>肉芽肿病与polyangiitis (GPA), ANCA-associated血管炎(AAV)的一种形式,是一种罕见的疾病,超然的演示。更常见的在第四和第五年的生活但中可以看到所有年龄。你们;/ p>& lt; p>这种情况下报告细节76岁女性出现腹痛,广义的弱点,和不适,发现肺结节在胸部成像。活检组织肺炎的肺结节。最初,抗生素用于治疗病人。然而,她开发的急性肾功能衰竭表示和几天后发现阳性血清C-ANCA以及高架ANCA-PR3血清学。随后的肾活检证实pauci-immune坏死性和新月形肾炎符合GPA和免疫抑制治疗病人开始立即组合,血浆置换,和血液透析灵活;/ p>& lt; p> GPA&,年代的临床和放射学表现可以模仿其他常见疾病如肺炎、恶性肿瘤、细菌性鼻窦炎、肺结核、结节病和尿路感染。因此,高水平的怀疑是早期诊断和治疗改变所需的高死亡率的疾病实体。 All forms of ANCA-associated vasculitis (AAV) should be in the differential diagnosis for all patients presenting with multiorgan system involvement particularly in individuals with pulmonary and renal manifesations.

巨细胞病毒感染原生肾活检

12/17/2019

& lt; h2> Text< / h2>& lt; p> 61岁的巴西黑人女性咨询与肾脏由于蛋白尿尿常规测试确认。她有一个个人历史的胸腺瘤切除术5年前,其次是肺感染包括mycobacteriosis的多个事件,复发性黏膜与皮肤的念珠菌病,和多种的天疱疮。体格检查显示没有水肿和高血压和实验室检测确认没有血尿蛋白尿的2.43 g /天,血清肌酐0.69 mg / dl,尿素34 mg / dl,血清白蛋白为2.4 g / dl,血红蛋白10.9 g / dl 292000 / mm3血小板,白细胞4950 / mm3 3910 / mm3 594 / mm3淋巴细胞和中性粒细胞。溶血试验呈阴性,血清铁低。分析glicemia和正常血清脂质水平以及血清补体和imunoglobulins,除了一个IgM 283 mg / dl水平(正常值40到230 mg / dl)和察觉IgE。血清学对梅毒、艾滋病毒、乙型肝炎、C和自身免疫性疾病的抗体呈阴性。你们;/ p>

一个试点研究与间充质干细胞治疗小儿胱氨酸病

12/09/2019

& lt; h2> Abstract< / h2>

Infantile cystinosis is a lysosomal storage disease leading to end stage kidney disease at early ages. There is no effective treatment and patients require long term dialysis or kidney transplant for survival. We present our experience on three affected children who received HLA matched allogeneic stem cell transplant. The protocol used was novel and designed to promote engraftment. The primary endpoint was safety for treatment related mortality or morbidity; All three children survived without serious adverse effects during extended follow up for over 4 years. Although we could not prove engraftment, all three children met secondary end point of sustained target functions over a 6 month follow-up. Further studies are warranted to further evaluate safety and efficacy of MSC treatment for infantile cystinosis.

感知到的原因和预防catheter-associated尿路感染脊髓受伤的患者

11/27/2019

Summary

Catheter-associated urinary tract infection (CAUTI) is among the most common nosocomial infections especially in acute care settings. Its economic and unanticipated health implications make it burdensome for the healthcare providers and patients. The paper examined the perceived causes and mode of preventing urinary tract infections in patients with spinal cord injury. Qualitative research approach was utilized; the study site was a Tertiary Hospital in Nigeria. Eight (8) in-depth interviews (IDI) were conducted with healthcare providers managing patients with spinal cord injured in the hospital. The major risk factors causing urinary tract infection identified include financial problems, organization of care, human error, hospital environment and patient-related factors. To prevent urinary tract infections among patients in the hospital, a number of suggestions were made by the participants such as training of caregivers and educating patients and relations. The authors concluded that the incidence of CAUTI could be reduced in the hospital if the opinions of stakeholders are fairly considered.

intradialytic身体活动对生活质量的影响,生物参数和血液透析患者的睡眠

11/22/2019

& lt; h2> Abstract< / h2>& lt; p>许多副作用,除了这些病理本身,发生血液透析治疗,但现有文献表明,身体活动有利于血液透析病人。然而,我们的参数不够研究阻力训练计划。在我们的研究中,我们观察到12周的影响intradialytic阻力训练计划(T0、病人)使用KDQOL-SF生活质量问卷,血液样本和睡眠生理参数使用积分规模与国际不宁腿综合征研究小组规模。阻力训练项目由每周3次和涉及下肢由于橡皮筋和软球。培训后,在病人的生活质量分数的增加趋势与T0相比。在生物参数,只有趋势减少观察c反应蛋白和一种趋势增加尿素在病人的观察。透析效率提出任何改变睡眠而且没有观察到显著的结果。一些趋势观察的结果我们的节目。锻炼的类型似乎对测量参数有不同的影响。 Nevertheless, exercise was beneficial to chronic hemodialysis patients and seemed to improve their health.

糖尿病和慢性肾脏疾病:一种罕见的原因很常见的协会

11/20/2019

& lt; h2> Abstract< / h2>& lt; p>作者目前的45岁女性糖尿病患者和慢性肾脏疾病(CKD)。她不满意的血糖控制,并显示一些知识的局限性。她的尿液是毋庸置疑,她的右肾肾超声显示单一方面显示肾盂输尿管交界处综合症。她母亲也患有糖尿病和慢性肾病G5D呈现在第六第七十年。;/ p>& lt; p> CKD被认为是遗传原因,导致作者调查了一个常染色体显性遗传原因CKD阻力指标表型也许可以用,考虑到个人和家庭历史糖尿病和肾脏成像;大型删除& lt; em> HNF-1&β;& lt; / em>基因是通过多路复用配体探针测定(MLPA)分析、解释表型。;/ p>& lt; p>应考虑慢性肾病的遗传原因的存在对CKD阳性家族史,糖尿病的共存和乏味的尿液沉积物应该提高综合征引起的表型的可能性,即涉及& lt; em> HNF-1&β;& lt; / em>基因突变或缺失。;/ p>

减肥咨询透析病人准备移植

09/02/2019

Case Report

Obesity has become a worldwide Epidemic affecting more than 300 million people. Overweight is defined as BMI (Body Mass Index) of 25-29.9 kg/m2. Obesity is defined as BMI greater than 30 kg/m2, and Morbid Obesity is a BMI of > than 35 kg/m2 [1].

Many Dialysis patients are overweight. Dialysis patients that are labeled morbidly obese based on BMI, may not be able to be listed on the Transplant list. Some Dialysis Clinics require a BMI less than 35 kg/m2 and some require a BMI < than 40 kg/m2. Hence, many obese dialysis patients are asked to lose weight, and we all know that Renal Transplant provides a better quality of life [2].

Because each transplant center may use different criteria for eligibility, patients and members of the dialysis team should be aware of the BMI criteria for the referral transplant center. Patients who are not eligible for the transplant due to obesity should receive counseling emphasizing a healthy lifestyle and weight loss [3].

Successful weight management requires a multidisciplinary approach encompassing health care team members. They consist of the following: Renal Dietitian, Social Workers, Nurse, Exercise Physiologist and a Physician [6].

性别和左心室结构和功能差异在结束阶段肾病患者肺动脉高压维护血液透析

08/26/2019

& lt; h2> Abstract< / h2>

Introduction: Pulmonary hypertension (PH) is prevalent in hemodialysis (HD). In the general population, more women than men have PH due to left ventricular (LV) disease with preserved ejection fraction (EF). Little is known about the gender-specific prevalence of PH and associated LV abnormalities in patients with end stage renal disease (ESRD) on HD. Our aim was to evaluate gender differences and LV structural and functional changes in PH among ESRD patients on HD.

Methods: Ninety-four patients (ages 23-77 years) underwent echocardiography after HD. Patients were divided based on estimated pulmonary artery systolic pressure (PASP) (Group A PASP < 40 mm Hg, Group B PASP ≥ 40 mm Hg). LV measurements included LV mass, LV internal dimensions, and LV ejection fraction (EF). LV diastolic function (LVDF) was assessed from mitral inflow deceleration time (DT) and E/A ratio.

Results: Fifty-five patients (59%) had PH, including 32 of 49 men (65%) and 23 of 45 women (51%). LVEF was lower in Group B (46.4 ± 17.6 vs. 62.4 ± 14.4%, p < 0.001). Men with PH had higher LVIDd, cm (5.52 ± 0.89 vs 4.78 ± 0.75, p < 0.001), LVIDs, cm (3.75 ± 0.94 vs 3.14 ± 0.91, p = 0.03) LV mass, g (236 ± 74vs 189 ± 56, p = 0.02) and lower LVEF (40.0 ± 16.7 vs 52.0 ± 15.6, p = 0.008) than women.

Conclusion: Patients on HD have a high prevalence of PH. PH was not associated with clear LV structural changes. There was a depression in LV systolic function without changes in LVDF. PH patients were more often men with hypertrophied LV with depressed LV systolic function.

维生素D缺乏在慢性肾脏疾病预后的影响

08/07/2019

& lt; h2> Abstract< / h2>

Chronic kidney disease (CKD) is a highly prevalent disease, imposing high mortality rates worldwide, and it is closely related to cardiovascular events. Vitamin D deficiency is very prevalent in patients with CKD from the earliest stages of the disease, and it has been associated with higher mortality. In order to assess the prognostic implications of vitamin D deficiency in CKD, we undertook a literature review, searching different databases in October 2018 for publications related to vitamin D in patients with CKD and hypovitaminosis D, and not on dialysis. The main cause of death in these patients is cardiovascular disease. Vitamin D is one of the first parameters that CKD changes and has an important prognostic role in this entity. Deficient levels in blood are associated with increased cardiovascular risk and survival impacts, independently of cardiovascular disease. Treatment with paricalcitol appears to reduce this risk. However, the evidence analyzed is insufficient to establish an association between vitamin D levels and the progression of kidney disease.

有在接受减肥手术的患者肾功能的改善吗?

07/31/2019

& lt; h2> Abstract< / h2>

Introduction: Obesity may cause progressive chronic kidney disease. Weight loss in the postoperative follow-up of bariatric surgery may improve renal function in these patients. Thus, the purpose of this study was to give insight on the subject using a sensible biomarker.

Methods: This cross sectional study was performed in the Obesity Department from Campina Grande – Paraiba, Brazil. It was randomly enrolled 23 postoperative patients (7 bypass and 16 sleeve), with at least two years of follow-up, from the outpatient Department and 29 (18 bypass and 11 sleeve) in the preoperative period for bariatric surgery. They were homogeneously from both genders with ages ranging from 25 to 57 years. Serum levels of creatinine and cystatin C were measured, and the glomerular filtration rate (GFR) was estimated using the CKD Epi (chronic kidney disease epidemiology collaboration) cystatin-creatinine equation. The investigation was approved by the Ethics Committee.

Results: The mean body mass index (BMI) of the preoperative group was significantly greater than the postoperative group (p ≤ 0.0001). The mean serum levels of C cystatin was significantly greater in the postoperative group as compared to preoperative (p= 0.0197). However, there was no mean difference between creatinine serum concentrations comparing the two groups (p = 0.3252). The mean glomerular renal function rates of the groups were similar (p = 0.1240).

Conclusion: There is no definitive evidence for supporting the hypothesis that there is improvement in the kidney renal function after bariatric surgery in obese patients. Prospective cohorts are necessary to enlighten the answer for this important question.

高水摄入量在预防尿酸肾结石的风险:一项系统回顾和荟萃分析

07/12/2019

& lt; h2> Abstract< / h2>

Background: Hyperuricosuria, persistently low urinary pH, and low urinary volume are the main risk factors of uric acid nephrolithiasis. Epidemiologic studies suggest that high water intake is protective against the occurrence of symptomatic kidney stone events of all types. The objective of this systematic review and meta-analysis were to evaluate the effectiveness of increased water intake to prevent symptomatic uric acid kidney stone events.

Methods: Seventeen studies were identified for the meta-analysis. Analysis of Q and I2% statistics revealed that a high heterogeneity in 16 studies, thus, random effects model was used. Protective associations were identified for high water intake individuals (SMD=0.52 L; 95% CI: 0.19, 0.84; p=0.002); a significantly decreased relative super saturation of uric acid versus controls (SMD=-1.15; 95% CI: -2.00, -0.30; p=0.008). Risk factors including urinary uric acid excretion and pH were not significantly related to high water intake (SMD=7.32mg/d, 95% CI: -52.27, 66.91; p=0.81), (SMD=0.14; 95% CI: -0.02, 0.31; p=0.09), respectively. Further subgroup analyses revealed that urinary uric acid excretion was significantly decreased in healthy individuals (SMD=-36.23 mg/d, 95% CI: -65.14, -7.31; p=0.001) compared to stone formers (SMD=27.41 mg/d, 95% CI: -33.18, 88.01; p=0.38); urinary uric acid excretion was significantly decreased in routine water intake groups (SMD=-61.49 mg/d, 95% CI: -120.74, 12.24; p=0.04) compared to mineral water intake groups (SMD=44.50 mg/d, 95% CI: -18.30, 107.29; p=0.16); urinary pH was significantly higher in mineral water groups (SMD=0.13, 95% CI: 0.01, 0.46; p=0.04) compared to regular water groups (SMD=-0.00, 95% CI: -0.13, 0.13; p=0.98).

Results: A total of 129 patients had 150 internal jugular catheter insertions. The mean age was 51.4±15.2 years with male to female ratio of 1.5:1. All the patients had chronic kidney disease; about 80% had tunneled IJC and 96.9% of the catheters were inserted in the right internal jugular vein. Immediate complications were recorded in 10% and late complications in 34.9% of the procedures. The immediate complications were kinking of guide wire (2%), arterial puncture (1.3%) and difficulty in locating the internal jugular vein (1.3%) or tunneling (1.3%). The late complications were infection (12.8%), poor blood flow (9.2%), bleeding (5.5%) and spontaneous removal of the catheter (5.5%). There was no statistical significant difference in both immediate and late complication with age and sex.

Conclusion: This meta-analysis identified evidence that urinary uric acid excretion, volume, pH and relative supersaturation of uric acid can be altered with high water intake intervention, reducing the risk of uric acid kidney stones.

并发症颈内导管在血液透析病人的肾脏保健中心在尼日利亚

07/11/2019

& lt; h2> Abstract< / h2>

Internal jugular vein catheters (IJC) is recommended as the central venous access of choice in haemodialysis patients. However it is associated with complications of variable severity.

Objectives: To study the complications associated with internal jugular vein catheters in haemodialysis patients in southern part of Nigeria.

Methodology: The clinical details of patients who had IJC insertion at the kidney house, Hilton clinics Port Harcourt from 1st October 2011 to 30th September 2016 were documented. Complications from the IJC developed by the patients during the study period were also documented. The data obtained was analyzed using SPSS version 22. P value less than 0.05 was considered significant.

The ultrasound examination at discharge had a sensitivity of 31% and specificity of 87% to detect future symptomatic lymphoceles. The positive predictive value was only 10%. The second ultrasound test had the best test variables to detect symptomatic lymphoceles with a sensitivity of 93% and a specificity of 87% and a predictive value of 28%.

Conclusion: Internal jugular catheter is froth with immediate and late complications in haemodialysis patients.

常规超声在放电的价值来确定病人的风险症状肾移植后淋巴管瘤:case-cohort研究

07/09/2019

& lt; h2> Abstract< / h2>& lt; p> & lt; strong> Introduction< / strong>超声检查是常用的评价肾移植后的移植物和检测可能的淋巴管瘤。第一个超声波扫描通常是在我们医院进行放电。我们质疑perirenal流体集合被超声检查在排放预测未来症状性淋巴管瘤。;/ p>& lt; p> & lt; strong> Methods< / strong>:所有超声报告所有肾移植受者在我们医院接受治疗的2010年1月至2017年12月被收集和筛选等异常流体集合。病人,开发了一种淋巴囊肿症状与对照组相比,相同的队列。超声检查的敏感性和特异性检测症状性淋巴管瘤计算连续小学和超声波测试。;/ p>& lt; p> & lt; strong> Results< / strong>:没有明显差异在淋巴囊肿症状组和对照组患者基线特征,除了在肾移植(平均年龄47岁,plusmn;17年在对照组和56,plusmn;13年淋巴囊肿症状组,p = 0.02)。; / p>

Conclusion: Routinely use of ultrasound testing on the day of discharge does detect perirenal fluid collections, but is not predictive for development of symptomatic lymphoceles in the future.

地塞米松的有效性和透明质酸酶+戊酸酯的bethasone prepucial按摩治疗儿童包皮过长

07/09/2019

& lt; h2> Abstract< / h2>

Introduction: The phimosis condition is characterized by the inability to retract the foreskin on the glans, making it impossible to expose them. Surgical treatment, although effective, has been questioned by the risk to which the patient is exposed. Therefore, we have opted for the use of topical corticosteroids to resolve this pathology.

Goals: To compare the effectiveness of Dexamethasone and Hyaluronidase + Betamethasone Valerate associated with preputial massage in the treatment of infantile phimosis, the degree of regression of phimosis, the time needed to achieve complete efficacy, possible adverse reactions, long-term outcome and parental adherence to treatment in children attending a specialized service in Blumenau, Santa Catarina.

Materials and methods: Controlled clinical trial, quantitative, non-blind, prospective and randomized sample analysis through the analysis of 523 patients.

Results: After 1 month of treatment, 435 patients presented some degree of regression and 63 children were referred to surgery. The success rate in this period was 45.8% in boys who were taking Hyaluronidase + Betamethasone Valerate and 49.8% in those who used Dexamethasone. In the late evaluation, 398 children reached grade 0, and 213 used Hyaluronidase + Betamethasone Valerate and 185, Dexamethasone; 39 patients were referred to the postectomy. Adherence to treatment was similar in both groups. The average time for degree 0 to be reached similar in both.

Conclusion: Both topical corticosteroids were effective in the resolution of phimosis. However, in the evaluation after the first month and in the regression, Dexamethasone proved to be more effective. The time to resolution of the condition was similar for both. The surgical procedure was taken when there was no clinical improvement. No adverse effects were reported in both groups.

另一天门诊血液透析安排适当的可行替代安排改善patientsa€™结果

06/27/2019

Introduction

The rise in all-cause and cardiovascular mortality and hospitalization rates among the hemodialysis (HD) patients after the long weekly inter-dialysis interval is very impressive. In fact, there is an additional long-term morbidity risk besides this acute rise in mortality and hospitalizations that can be expected from the weakly exaggerated pre-dialysis peaks of the less risky hemodynamic and biochemical parameters. An approach for eliminating these long weekend inter-dialysis intervals is through the provision of the hemodialysis sessions on every other day (EOD) basis, regardless of the week days. This is likely to be both practical and cost-effective. Such EOD schedule can be introduced easily beside the ongoing thrice weekly HD schedule without disturbance of the HD unit work. The availability of EOD schedule would provide a healthier and cost-effective alternative schedule for those patients who can’t tolerate the weekend intervals and for those looking for maintaining their long-term health on the option of hemodialysis. In fact, with available data, medical staff is expected to encourage all patients to shift their HD to the EOD schedule.

慢性肾脏疾病患者住院的原因在一个三级肾脏保健医院

06/21/2019

& lt; h2> Abstract< / h2>

Background: Patients with chronic kidney disease (CKD) are at the risk of increase hospital admission as compared to the general population, due to various reasons. They have increased vulnerability to cardiovascular diseases (CVD) as well as infections, therefore they usually got admit in health care units due to various reasons. The causes of hospitalization in CKD patients in this part of the world are not studied well.

Methods: This cross sectional study was conducted in The Kidney Centre Post Graduate Training Institute (TKC-PGTI) of Karachi. Variables included in the study were age, gender, are of residence, ethnicity, smoking status and level of education. Comorbid conditions like causes of CKD and causes of hospitalization. Data analysis performed by using software IBM SPSS 21.

Results: Total of 269 patients were enrolled in our study. The male 148(55%), mean age was 55 years. The most common cause of hospitalization in our population was infection148 (55%) and urinary tract infection (UTI) was the most common site of infection 55 (20%) followed by sepsis of unknown origin 29(10.8%). Cardiovascular events like volume overload 32 (11.4%) and acute coronary syndrome 20(7.4%) were the second most important cause of hospitalization.

Conclusion: Hospitalization of CKD patients is high, and in our population infection is found to be the leading cause of hospital admission. Infection originating from urinary tract is more common in all stages of CKD patients, while blood born infection originating from double lumen (DL) dialysis catheter or arteriovenous fistula (AVF) cannulation is more common in dialysis population. Cardiovascular events, both acute coronary syndrome and pulmonary edema due to volume overload followed the infections.

尿NGAL并入肾心绞痛指数急性肾损伤的早期检测生命垂危的孩子

05/31/2019

& lt; h2> Abstract< / h2>

Background and objectives: New AKI biomarkers (on the top of it NGAL biomarker) have demonstrated better performance for prediction of AKI in critically ill patients with heterogeneous illness. Renal angina index was recently reported to enhance prediction of severe AKI at the time of intensive care unit admission. This study tested the hypothesis that incorporation of uNGAL in patients with renal angina improves the prediction of severe AKI.

Design, setting, participants & measurements: In our study 53critically ill children admitted to the pediatric intensive care unit in Zagazig university hospital, Measurement of urine neutrophil gelatinase– associated lipocalin (uNGAL) was determined individually by ELISA kit and in combination with the RAI which is calculated in each critically ill child for severe AKI. Statistical analysis was done for these data.

Results: Individual uNGAL demonstrated marginal discrimination for severe AKI (area under curve [AUC]: NGAL, 0.877), little higher than prediction by RAI (AUC=0.847). Incorporation of uNGAL significantly added to the renal angina index AKI prediction (AUC=0.847, increased to 0.893).

Conclusion: This study shows that incorporation of uNGAL into the RAI improves detection ability of severe AKI in critically ill children.

儿童血压和肾脏功能的模式与镰状细胞贫血呈现三级卫生机构在尼日利亚

04/16/2019

& lt; h2> Abstract< / h2>

Background: In sickle cell anemia (SCA), compromise of the renal vasculature due to sickled red cells has been recognized.

Objectives: To assess the renal function and blood pressure pattern in children with sickle cell anaemia (SCA) presenting in a tertiary institution.

Method: A cross-sectional study of patients with sickle cell anaemia (SCA) over six months involving the use of questionnaires, general physical examination, blood pressure, investigations for haemoglobin genotype, urinalysis, serum creatinine, screening for hepatitis B and HIV.

Results: 51 children with SCA were seen. The prevalence of impaired renal function as defined by reduced eGFR <90mL/min/1.73m2 in this study was 27.5%, previous hospital admission and blood transfusion were associated with reduction in eGFR but blood pressure did not have significant correlation with the eGFR. The overall mean age at diagnosis of SCA was 4.09 ± 3.33 (years).

Conclusion: Impaired renal function is a major comorbid condition in children with SCA. In countries/locations where there is no newborn screening for sickle cell disease, diagnosis is delayed, thus detecting impaired renal function may be delayed, therefore the need for early detection and management is imperative.

血液感染可以预测的血液透析患者的鼻文化吗?

04/15/2019

& lt; h2> Abstract< / h2>

The blood and drainage cultures are suggested for early diagnosis of bloodstream infection (BSI), which are time consuming and laborious. Nasal colonization of bacteria is one of the modalities, occasionally can predict BSI. We hypothesized that nasal culture, as an accessible fluid may be helpful to predict future BSI in hemodialysis patients. The present prospective study evaluated 63 patients undergoing maintenance hemodialysis at the Pars hospital dialysis center, Tehran, Iran, from November 2015 until February 2016. Nasal fluid of patients were collected from the 1–cm internal anterior part of both nostrils of patients by a sterile swab and cultured in Trypticase soy agar. All patients were followed for three months for BSI. The results of first nasal fluid sample revealed that 33.3% in first sampling and 27.0% in sampling had positive nasal fluid culture. The type of bacteria in all positive cases was Staphylococcus aureus. The rate of BSI infection in the patients with positive and negative first nasal fluid culture was 9.5% and 2.4% respectively with no significant difference. We found also no significant association between BSI positivity and nasal culture results so that positive BSI was revealed in 5.9% of patients with positive nasal fluid culture and 4.3% in those with negative nasal fluid culture with no meaningful difference. None of the baseline variables including age and gender, underlying risk factor, access, or duration of dialysis was associated with BSI positivity. In hemodialysis patients, BSI may not be predicted by nasal fluid culture positivity.

严重的肺部感染继发于传播类圆线虫病肾病综合症患者

04/03/2019

& lt; h2> Abstract< / h2>

We report a case involving infection with Strongyloides stercoralis found in the sputum of a 66-year-old male patient who had a medical history of nephrotic syndrome and was treated with methylprednisolone and monthly intravenous cyclophosphamide therapy 3 months previously. This patient presented with stubborn pulmonary symptoms and signs, which was the mechanical destruction caused by larval migration. We found strongyloides in his sputum that provided diagnostic proof.

腹膜炎:腹膜透析下降的罪魁祸首

04/03/2019

& lt; h2> Abstract< / h2>

Peritonitis is the main complication of peritoneal dialysis caused the withdrawal of treatment like peritoneal dialysis which was used as primary treatment modality few years back in Pakistan. With this motto to know the exact cause of peritonitis this retrospective study was done and 35 out of 42 pervious peritoneal dialysis patients who had peritonitis were analyzed using old data. A total of 57 bags of all these peritonitis patients were analyzed in department of microbiology during the year 2007-2011. Out of these bags positive culture was obtained from 42 bags (74%). Most of patients with positive culture were undergoing acute peritoneal dialysis 66.67% and rest were on chronic ambulatory peritoneal dialysis. Main concern was the yield of organisms causing culture positive peritonitis. It was found that bacterial peritonitis was positive in 80%, fungal peritonitis was 11% and mycobacterium tuberculosis peritonitis was 09%. Various culture techniques along with Gram Stain, Zeihl Nielsen Stain and Auramine stain were used for knowing the yield.

Limitations: Old and only small available data of peritonitis patients and stop of further peritoneal dialysis.

Anti-glomerular基底膜疾病:罕见的病例报告演示

04/03/2019

& lt; h2> Abstract< / h2>

Anti-glomerular basement membrane (anti-GBM) disease is an uncommon autoimmune disease that classically presents as an aggressive necrotizing and crescentic glomerulonephritis (CG), with or without pulmonary hemorrhage, and typically does not relapse. The pathologic hallmark is linear staining of GBM for Immunoglobulin G (IgG) which binds to the alpha-3 chain of type IV collagen. Recent reports have noted the occurrence of anti-GBM disease with atypical clinical presentations. We describe a case of a 22-year-old female presenting an anti-GBM disease with typical histological features with a singular clinical presentation with lower limb edema, elevated serum creatinine and nephrotic range proteinuria. Renal biopsy showed signs of chronicity and direct immunofluorescence microscopy demonstrated diffuse, intense linear positivity for IgG. All serologic tests were negative, including anti-GBM antibodies. Hence, a diagnosis of atypical anti-GBM disease was made. The patient was treated initially with mycophenolate mofetil and corticosteroids. After 3 months she began to aggravate renal function so mycophenolate of mofetil was discontinued and a low dose cyclophosphamide was initiated.

血液透析的挑战:单中心经验在尼日利亚西南部

03/28/2019

& lt; h2> Abstract< / h2>

Background: Haemodialysis is the commonest method of Renal Replacement Therapy in Nigeria. Despite an advancement in the technicality and better understanding of haemodialysis, a number of complications are known to be associated with this procedure.

Objective: We aimed to highlight our experiences and share some of the uncommon complications encountered during haemodialysis and present the outcome of our patients.

Subjects and methods: A retrospective review of 101 patients during the last two years was done. Data extracted include: sociodemographic characteristic, aetiology of kidney disease, type of vascular access, intradialytic complication and outcome of treatment.

Results: The total number of dialysis session during the period was 823. Males constituted a higher proportion (64.4%) and were found to be older than female patients 49.8 vs 42.8 years (P=0.001).

Majority (89.1%) had chronic kidney disease while chronic glomerulonephritis was the main cause of CKD as seen in about 45% of the patient.

Due to the cost implication, only 2(1.98%) were able to undergo 3 sessions of dialysis per week for up to 1 month.

Vascular access was femoral (66.3%), internal jugular vein (25.7%), while only 2% used Artero-venous-fistula and one patient had femoral vessel pseudoaneurysm from frequent cannulation.

The commonest complication was hypotension which was present in 15.8%. Twenty-eight deaths were recorded, 44(43%) were either lost to follow up or absconded while 5% were transplanted at a referral centre.

Conclusion: Challenges of renal replacement therapy is overwhelming in our country due to poor human and financial resources. Early diagnosis and adequate government support are advocated.

慢性肾脏疾病:一天筛选世界肾脏日连续五年

03/12/2019

& lt; h2> Abstract< / h2>

Introduction: Chronic kidney disease is a costly and burdensome public health concern. Delayed recognition and treatment of CKD may predispose patients to unfavorable future outcomes and burden the healthcare services. The early detection of disease via screening programs is widely recommended. The present study is a hospital camp-based screening for detecting patients with chronic kidney disease in Varanasi from 2014-18.

Methods: The study subjects constituted 436 apparently healthy adults (age ≥18 years) of Varanasi. Information on socio-demographic profile, personal characteristics and clinical investigations were recorded. Stepwise binary logistic regression analysis was applied to find the significant predictors of chronic kidney disease.

Results: Median age of the study subjects was 40.5 years. There were 39.7% males and 60.3% females. Chronic kidney disease was found in 23.9% subjects. Underweight, diabetes mellitus, hypertension, smoking status and higher creatinine levels came out as significant predictors of chronic kidney disease.

Conclusion: We screened apparently healthy individuals and found very high percentages of chronic kidney disease and its predictors. Henceforth, understanding the preventable and modifiable risk factors of chronic kidney disease becomes a prerequisite to intervene before risk populations reaches to irreversible stages of adverse future outcomes.

与长期随访Hypocomplementemic间质性肾炎

02/22/2019

& lt; h2> Abstract< / h2>

Prednisone-sensitive hypocomplementemia, renal insufficiency, and kidney biopsy demonstrating severe tubulointerstitial nephritis (TIN), storiform fibrosis, and tubulointerstitial immune deposits are typical of IgG4-related tubulointerstitial nephritis and hypocomplementemic interstitial nephritis. A diagnosis of hypocomplementemic interstitial nephritis requires clinical and pathologic exclusion of IgG4-related tubulointerstitial nephritis. We describe a patient with hypocomplementemic interstitial nephritis who did not develop diagnostic features of IgG4 related disease (RD) over 2-year follow-up. We conclude that hypocomplementemic interstitial nephritis could be on a biologic spectrum with IgG4-related disease, but not all cases will develop the abundance of IgG4-positive plasma cells, systemic manifestations, or elevated immunoglobulin levels characteristic of IgG4-RD.

抗炎益生菌发酵食品中生物标志物

01/24/2019

& lt; h2> Abstract< / h2>

We present below a mechanistic molecular approach for development of Anti-Inflammatory biomarkers of Probiotic Bacteria in Fermented Foods. Probiotics are live microorganisms that promote human health by counteracting the noxious toxic gut microflora in human intestine, by modulating of the tight junctions, and by increasing mucin production, enforcing intestinal epithelial cell barrier function, modifying microbial community within the gut intestinal disorders, and improving immune responses associated with chronic inflammation in experimental animal models, collectively enhancing human health. Cytokine secretion by intestinal epithelial cells and macrophages are regulated by probiotics through key signaling pathways such as nuclear factor-κB and mitogen-activated kinases, resulting in alleviation of several disorders such as allergies, diabetes, obesity, heart diseases and cancer. MicroRNAs are small non-coding RNA molecules involved in transcriptional and post-translational regulation of gene expression by inhibiting gene translation. Using in vitro and in vivo approaches in cell lines and mice models to study effects of probiotic conditional media and heat-killed bacterial strains with anti-inflammatory effect to elucidate the mechanisms by which probiotics affect signaling pathways, and by using global cytokine and microRNA gene expression analyses arrroaches to develop biomarkers for studying different pro- and anti-inflammatory activities, and using statistical approaches to analyse the data, we show that cytokines and miRNAs have an essential role in regulation of cancerous and inflammatory bathways. This mechanistic approach will result in developing specific disease biomarkers for the early diagnosis of certain pathogenic states, as well as evaluating the effect of different dietary componenents on developed biomarkers in health states that will promote and enhance human health. Comparing the concordance of the in vitro to the in vivo research findings will confirm the correspondence of both approaches to each other. Moreover, this study will have a major public health relevance in elucidating the role of miRNAs and their targets in inflammation, paving the way to diagnosing and treating of pathogenic human disease stages.

慢性肾脏疾病的女性:横断面扫描在瓦拉纳西的三级保健医院

01/18/2019

& lt; h2> Abstract< / h2>& lt; p> & lt; strong> Background< / strong>:慢性肾脏疾病不再被认为是今天只是一个卫生负担,但一个主要的健康优先由于其治疗成本高和糟糕的结果。世界肾脏日,国际女人;,年代在2018正好,从而提供一个机会来思考女人的重要性,,健康,特别是他们的肾脏健康。目前的研究旨在识别慢性肾脏疾病在女性通过横断面筛查在医院在瓦拉纳西基于世界肾脏日。;/ p>& lt; p> & lt; strong> Methods< / strong>: 138名女性参加卫生营筛查临床参数,如血清肌酐,随机血糖,妊娠并发症。人口统计学和人体测量参数。顺序逻辑回归分析用于查找慢性肾病阶段。你们的预测;/ p>& lt; p> & lt; strong> Results< / strong>:参与者的平均年龄是36岁。慢性肾脏疾病的患病率是6.4%与1.4%的第一阶段,第二阶段的2.1%,1.4%的第三阶段和第四阶段的1.4%。女性糖尿病患者近4倍的几率会更大更高阶段的慢性肾脏疾病相比,女性没有它。 With a unit increase in serum creatinine levels, women were nearly 13 times more likely to develop higher stages of chronic kidney disease.

Conclusion: Serum creatinine levels and diabetes were the significant predictors for the development of higher stages of chronic kidney disease. Early screening for kidney diseases in women could reduce the load of health care delivery system that is involved in renal replacement therapies.

Fetuin-A和血管之间的关系或在血液透析病人瓣膜钙化

01/07/2019

& lt; h2> Abstract< / h2>

Purpose: Deficiency of Fetuin A, as a calcification inhibitor, is assumed to be involved in vascular calcification in patients on maintenance hemodialysis (MHD). This study examined the relationship between serum Fetuin-A and vascular and valvular calcification in a cohort of MHD patients.

Methods: The study was conducted on 122 MHD patients. Serum levels of calcium, phosphorus, parathormone, and Fetuin-A were tested. Intima-media thickness (IMT) ≥0.8 mm and the presence of stenosis>50% or plaques in carotid doppler sonography were considered as vascular calcification. Calcification of cardiac valves or mitral annular calcification in two-dimensional echocardiography, were considered as cardiac valvular calcification. The presence of any or both of the two conditions was defined as cardiovascular calcification (CVC).

Results: Fetuin-A was lower than normal in 37% of 122. Totally 106 patients (87%) had CVC, who were older (61±14 vs. 38±14 years, P<0.001), more affected by diabetes (54% vs. 13%, P=0.007), had a longer dialysis vintage (median 5 vs. 2 years, P=0.006), lower levels of creatinine (8.9±2.8 vs. 11.9±3.1 mg/dL, P<0.001) and higher levels of calcium (8.7±0.7 vs. 8.4±0.5 mg/dL, P=0.026). There was no significant difference in mean Fetuin-A level between the two groups (P=0.101). In logistic regression increased age (OR=1.1, CI 95%=1.1 - 1.2) and serum calcium (OR=2.8, CI 95%=1.1- 7.6), and diabetes mellitus (OR=7.4, CI 95%=1.1 - 47.4) were risk factors.

Conclusion: This study showed that 87% of our patients had vascular and/or valvular calcification. Increased age and calcium level and diabetes were the predictors of CVC, whereas Fetuin-A was not.

的成功和失败教训腹膜Dialysis-Related布鲁氏菌腹膜炎在过去16年:病例报告和文献综述

12/31/2018

& lt; h2> Abstract< / h2>

Brucellosis is a zoonotic infection that is endemic in some Mediterranean countries, North Africa and the Middle East. Brucella is a rare cause of peritonitis in Peritoneal Dialysis (PD) population and in non-dialysis patients alike. We report here a challenging case of PD-related Brucella peritonitis in a 45-year-old Saudi male with late peritonitis that delivered some key learning throughout its course from presentation, diagnosis and treatment to catheter salvage attempts so as to circumvent PD failure. We provide an in-depth review of limited published literature on PD-related Brucella peritonitis (seven cases, and present case) and summarized the data on key clinical characteristics, management and PD technique outcome to benefit nephrologists when encountered with this rare presentation.

肝囊肿感染肾移植患者常染色体显性遗传多囊肾疾病:PET / CT在诊断和治疗的兴趣

12/14/2018

肝囊肿感染患者的常染色体显性遗传性多囊肾病(ADPKD)是一种罕见但致命的并发症。诊断和治疗仍然具有挑战性。我们报告一个64岁的肾移植患者出现发烧和腹痛。肝囊肿感染的诊断是由正电子发射断层扫描(PET / CT)。此外,我们的病人的过程中展示了随后的PET / CT在后续的利益我们的病人在antibiotherapy失败,并要求肝囊肿引流。

尿漏后肾移植:一个以证据为基础的管理计划

10/02/2018

& lt; h2> Abstract< / h2>

Care of kidney transplant recipient remains complex and long-term graft survival is not seen in every transplant recipient. Due to reduced supply and increased demand of human organs, more transplants are carried out using marginal grafts on emergency lists. Transplant recipients have altered physiology due to known end-stage renal disease, recent surgery and the use of potent analgesic and immunosuppressive medications. Amongst the known surgical complications, urine leak remains the most common. It can result from poor graft preparation due to excessive peri ureteric or lower pole dissection or damage to lower polar artery resulting in ischemic necrosis. In addition, poor surgical technique, bladder outflow obstruction, iatrogenic injury to bladder or renal pelvis may contribute to urine leak. Ongoing urine leak may manifest itself as swelling, pain, high drain output, sepsis, ileus and eventual graft loss. Early identification, localisation and quantification of leak remain essential in management of these patients. In addition, sepsis should be identified and treated promptly as these patients are highly susceptible to infections. Early recognition of this complication can significantly reduce hospital stay, improve quality of life and reduce graft loss and mortality. In this article, we aim to develop an evidence-based management approach to a patient with urine leak using a clinical scenario.

一个案例报告Hypocomplementemic荨麻疹的vasculitic综合症出现肾功能衰竭

09/12/2018

& lt; h2> Abstract< / h2>

We present a case of hypocomplementemic urticarial vasculitic syndrome (HUVS) who developed severe renal failure requiring ICU-level care. Our patient is a 66-year-old man who presented with abdominal pain, rash, confusion, oliguria, and shortness of breath. He was found to be in acute renal failure with leukocytosis and elevated lactate. Work-up for infectious, autoimmune, and hematologic malignant diseases was negative. The presence of chronic urticaria, abdominal pain, hypocomplementemia, and leukocytoclastic vasculitis on skin biopsy confirmed the diagnosis of HUVS. He required hemodialysis for renal failure as well as gastrostomy tube placement for nutritional support secondary to the development of mucosal ulcers, a rare finding in HUVS. He recovered with several months of high-dose steroids and hemodialysis. This case highlights the effectiveness of steroids for initial treatment of HUVS, and the relapsing and remitting nature of the disease. Providers should also be aware of the broad range of presenting symptoms such as mucosal lesions that may require nutritional support. Interestingly, unlike many previously reported cases of HUVS, our patient had not yet developed signs and symptoms of systemic lupus erythematosus, which often overlaps with HUVS.

三年之后的结果积极的交叉匹配肾移植尽管未能转化为负流交叉匹配后脱敏

08/30/2018

& lt; h2> Abstract< / h2>

Desensitization allows successful transplantation of patients with a positive crossmatch (PXM) against their live donor. We evaluated outcomes following PXM renal transplant despite failure to convert to negative flow cytometric crossmatch (FCXM) after desensitization. Patients that underwent desensitization before PXM transplant between 1/1/00 and 11/1/11 were identified for analysis. Patients who received a transplant despite failure to convert to negative FCXM were identified as the not converted group. Patients who converted to negative FCXM after desensitization comprised the converted group control arm. 108 patients were desensitized before PXM transplant, (not converted group=42; converted group=66). Mean eGFR was comparable between groups at all time points, and 3-year eGFR was 57.8 mL/min vs. 57.1 mL/min, p=0.91. Patients with eGFR < 30mL/min at 3 years did not differ significantly (28% vs. 14%, p=0.15). Biopsy-proven rejection rates were numerically higher within the not converted group for each type of rejection and time point, but the values did not differ significantly. Opportunistic infections rates were comparable. Patient survival (95% vs. 91%) and death-censored allograft survival (84% vs. 95%, p=0.07) were similar between arms at 3 years post-transplant.

AngioJetTM rheolytic血栓切除术诱导血管内溶血导致急性肾损伤需要透析

08/03/2017

& lt; h2> Abstract< / h2>

Background: AngioJetTM rheolytic thrombectomy has been used in the treatment of deep vein thrombosis (DVT) to prevent post-thrombotic syndrome. Though not widely appreciated, it has the potential to cause intravascular haemolysis.

Report: A 37 year old man with no previous medical history presented to his GP with a three week history of progressive right upper limb swelling. Doppler imaging confirmed right upper limb DVT and CT scan demonstrated thoracic outlet syndrome. The patient underwent AngioJetTM thrombectomy followed by IV heparin infusion. Successful revascularisation of the occluded vein was achieved. Overnight he developed haematuria, which was initially attributed to IV heparin. Urinalysis however revealed no red cells or casts. Apart from an Hb drop from 134 to 117 his blood profile and blood film showed no abnormality. He subsequently developed progressive oliguria with marked oedema and acute kidney injury (AKI). His creatinine peaked at 1070umol/l at 96 hours post procedure and he was started on intermittent dialysis. He remained dialysis dependent for 6 days. Ultrasound imaging excluded urinary obstruction. Autoimmune and vasculitic serology were negative. Intravascular haemolysis and haemoglobinuria was confirmed by raised LDH (1714u/L) and low haptoglobin (<0.1units). Direct Coomb’s test, Cold agglutinin test and paroxysmal nocturnal haemoglobinuria screen were negative. The patient’s renal function normalised over 3 months.

Conclusions: The likely cause of this man’s AKI is heme pigment nephropathy from intra-vascular haemolysis. Increased awareness of this condition may allow early identification and intervention to reduce the risk of renal injury from AngioJetTM associated haemolysis.

气性肾盂肾炎€”系列案件从一个中心在印度南部

05/03/2018

& lt; h2> Abstract< / h2>

TEmphysematous pyelonephritis (EPN) is a rare but potentially life-threatening necrotizing renal parenchymal infection characterised by the production of intra-parenchymal gas. The approach and the management of emphysematous has changed dramatically over the last two decades with the advent of computed tomography (CT)-based diagnosis and advances in antibiotic therapy as well as multidisciplinary intensive care of sepsis leading to an overall decline in mortality rates to 20-25%. The previously standard treatment for EPN which included nephrectomy of the affected kidney has been replaced by minimally invasive and nephron sparing surgery with better patient outcomes. We present our case series of 12 patients with EPN over a short period of two years treated at our tertiary care centre in South Western India.

马Anti-Thymocyte球蛋白(ATGAM)政府在病人与先前的兔子Anti-Thymocyte球蛋白抗胸腺细胞球蛋白组有()诱导血清病:一个案例报告

03/23/2018

& lt; h2> Abstract< / h2>

Thymoglobulin is a rabbit-derived anti-thymocyte antibody directed at T-cells and commonly used for induction immunosuppression therapy in solid organ transplantation, especially in immunologically high risk kidney transplant recipients. Despite its frequent use and efficacy, the heterologous makeup of thymoglobulin can induce the immune system resulting in serum sickness which typically presents with rash, fever, fatigue, and poly-arthralgia in the weeks following drug exposure. ATGAM is another anti-thymocyte antibody, targeting the same epitopes, but differs from thymoglobulin by the animal in which the preparations are generated (equine vs. rabbit). Herein, we present a case of a patient with a known history of thymoglobulin-induced serum sickness, who presented with evidence of acute cellular and vascular rejection at their 12-month post-operative visit. Given their immunologically high risk status, they were successfully treated with ATGAM with improvement in their rejection and kidney function. To the author’s knowledge, this is the first case report of successful administration of ATGAM in a patient with a documented history of thymoglobulin induced serum sickness, demonstrating a possible treatment option for acute rejection in patients with reactions to thymoglobulin.

完全恢复血浆置换的慢性渗透性脱髓鞘综合征

03/08/2018

& lt; h2> Abstract< / h2>

A 50-years old female presented with dysarthria, inability to swallow and quadriparesis for three weeks. She had rapid correction of her serum sodium (Na) from 99meq/l to 138meq/l within 24 hours 1 week prior to development of these symptoms. She was diagnosed as a case of Osmotic demyelination syndrome (ODS) formerly known as central pontine myelinolysis (CPM) which was confirmed by MRI. She underwent Plasma Exchange (PE) on the 20th day since her symptoms started and underwent 7 cycles of PE with complete neurological recovery. Pt was discharged with ability to ambulate independently and complete recovery of speech and swallowing. Hence, we report that PE is beneficial in chronic ODS.

后部可逆性脑白质病综合症第二剂量的利妥昔单抗治疗后患者的抗血栓性血小板减少性紫癜

02/16/2018

Introduction

Posterior reversible encephalopathy syndrome (PRES) is a neurological syndrome with clinical features of altered sensorium, headaches, visual problems and seizures. It has been associated with uncontrolled hypertension (HTN), thrombotic thrombocytopenic purpura (TTP) and immunosuppressive drugs. Rituximab has also been implicated as a cause of PRES that usually occurs after the first dose. We report a case of PRES that occurred after the second dose of Rituximab. A twenty three years old female known case of resistant TTP treated with multiple courses of steroids and plasmapharesis was admitted with renal failure, severe volume overload ad lower respiratory tract infection. She was treated with hemodialysis, intravenous antibiotics, steroids and plasma exchange (PEX). She did not responded and due to worsening thrombocytopenia and persistent hemolysis was administered Rituximab as an adjunct therapy. She tolerated the first dose well, however 48 hours after the second dose she developed uncontrolled HTN of 190/110 associated with generalized tonic clonic seizures and altered sensorium requiring intubation and mechanical ventilation. MRI findings were suggestive of PRES. Seizures did not get controlled with conventional therapy and patient underwent two consecutive cycles of PEX to remove the drug which resolved the seizures.

However, the patient developed Ventilator associated pneumonia (VAP) and sepsis and expired after family withdrew ventilator support.

联系bh4 / bh2比率在高血压和蛋白尿的2型糖尿病患者

12/29/2017

& lt; h2> Abstract< / h2>

Endothelial dysfunction and inflammation play a key role in the pathophysiology of diabetic nephropathy; Tetrahydrobiopterin (BH4) is an essential cofactor for nitric oxide synthase, when BH4 is reduced to dihydrobiopterin (BH2), endothelial dysfunction is induced.

Purpose: The aim of this study is to evaluate the relationship between the levels of biopterins with albuminuria in type-2 diabetic hypertensive patients.

Methods: We studied 30 hypertensive type-2 diabetic patients in whom biopterins levels were measured by reverse phase high performance liquid chromatography with fluorescence detection. Additionally, 24 h urinary albumin excretion was also measured (nephelometry). The levels of biopterins and albuminuria were correlated with the Pearson correlation coefficient.

Results: We did not find a significantly correlation between biopterins levels and albuminuria, However, we found a significantly inverse correlation (R= -0.498, p<0.005) between the BH4/BH2 ratio and albuminuria.

Conclusion: Our results suggest that the BH4/BH2 ratio instead of biopterins levels may be a marker of nephropathy in hypertensive type-2 diabetic patients.

短期影响静脉注入间歇性补充铁和铁丸注入铁参数在血液透析病人

12/21/2017

& lt; h2> Abstract< / h2>

Intravenous iron is used in combination with erythropoi esis-stimulating agents to treat the anemia of hemodialysis patients, however, there is variety in the dose and the frequency. So we compare bolus intravenous iron administration protocol vs an intermittent intravenous iron infusion protocol for 3 months in a single blinded design that was conducted on 30 patients randomized into 2 matching groups. Iron parameter, hemoglobin level, and CRP were monitored before and at the end of study. Patients with end stage renal disease on regular hemodialysis with iron deficiency anemia can be treated with intravenous iron administration either by the protocol of divided doses of IV iron through the sessions of hemodialysis or by giving the total dose of iron needed as a single large dose on only one session of hemodialysis, obtaining the same outcome in correction of iron parameters in treatment of iron deficiency anemia.

结果急性肾损伤的重症疟疾患者

11/08/2017

& lt; h2> Abstract< / h2>

Background: Acute kidney injury (AKI) is a frequent and serious clinical complication in patients with severe malaria. The purpose of this study was to assess the incidence of AKI in a large population of hospitalized patients with a primary admission diagnosis of malaria, and to investigate the robustness of the KDIGO criteria for predicting the need for dialysis, length of hospital stay and hospital mortality.

Results: We studied 695 consecutive patients admitted with primary diagnoses of malaria, in a 6 months period. AKI occurred in 86 (12.4%) patients (Stage 1 in 30.2%, Stage 2 in 23.3% and Stage 3 in 46.5%), and 19 (22.1%) patients required hemodialysis. No patient in the no-AKI or AKI Stage 1 groups (admission or maximum AKI Stage) required hemodialysis, and the requirement of hemodialysis was higher in patients with AKI Stage 2 (23.1%) and Stage 3 (42.4%). The length of hospital stay was longer (7.3±7.4 days vs 5.1±3.0 days; t=4.996, p<0.0001), and mortality was higher in patients who developed AKI than in those who did not (22,5% vs 2,5%; χ2=79.52; p<0.0001). Patients with AKI Stage 1, 2 and 3 had significantly higher hospital mortality (11%, 23% and 30%, respectively), compared with 2.5% for patients without AKI [odds ratio 5.2 (1.40-19.11, p=0.0331), 13.2 (4.24-41.06, p=0.0002), and 16.9 (7.26-36.65, p<0.0001)], respectively.

Conclusion: In a relatively large cohort of patients with falciparum malaria infection, the KDIGO criteria identified 12.4% with a diagnosis of AKI. The KDIGO classification was robust in this population for predicting the need for dialysis, length of hospital stay and hospital mortality. The results support the utilization of the KDIGO criteria in diagnosis and to predicting outcomes for patients with malarial AKI.

贫血对甲氧基聚乙烯Glycol-Epoetinβ(Mircera)与重组人红细胞生成素(Eprex)在慢性肾脏疾病患者血液透析

09/05/2017

& lt; h2> Abstract< / h2>

Objective: Anemia, a common complication of chronic kidney disease, usually develops because of erythropoietin deficiency. Maintaining target hemoglobin (Hb) with minimal variability is a challenge in hemodialysis (HD) patients. The aim of this study is to compare the long- and short-acting erythropoietin erythropoietin stimulating agents such as Mircera and Eprex in achieving these targets.

Results: The response rate in the evaluation period was higher in patients treated with methoxypolyethylene glycol-epoetin beta (Mircera) than with epoetin (Eprex) alfa: 36 of 50 (72%) mean Hb concentration (10.51g/dl) versus 29 of 50 (58%) mean Hb concentration (9.81), with statistically significant p-value <0.0001.

Conclusion: Treatment with (Mircera) administered intravenously once monthly was superior to treatment with (Eprex) administered subcutaneously three times weekly for maintaining haemoglobin concentrations in patients with chronic kidney disease on hemodialysis.

维生素D受体的多态性Bsm我和FokI结束阶段埃及在维持血液透析患者肾脏疾病

08/30/2017

<强>目标< /强>:在结束阶段肾疾病,维生素D的合成是打扰。甲状旁腺功能亢进的关键因素之一是许多透析并发症的发病机理主要是骨骼和心血管并发症。目的:本研究旨在评估维生素D受体基因多态性BsmIand FokI在埃及结束阶段在维护血液透析和肾脏疾病患者的assosciation这些多态性与心血管并发症和甲状旁腺功能亢进患者之一。< br / > < br / > <强> < /强>方法:一百例,招募从医学研究所,从3月到2014年7月,分为两个主要的组;对照组包括三十显然健康受试者和病人组包括七十年结束阶段肾病维持血液透析患者平均4年。对所有研究对象,详细的历史了,彻底的身体检查,媒体颈动脉内膜厚度、斑块和心电图缺血性改变。实验室调查包括血清水平:glucouse、尿素、肌酐、尿酸、白蛋白、总胆固醇、高密度脂蛋白、低钙,磷,和c反应蛋白,以及血浆甲状旁腺素的水平。检验局的检测和分子研究FokI多态性用聚合酶链反应和限制性片段长度多态性(PCR - RFLP)技术。< br / > < br / > < /强> <强>结果:1。没有统计上的显著差异可以被发现在检验局和FokI血液透析患者和对照组之间的基因多态性,表明ESRD的发展没有与船舶检验局或polymorphisms.2 FokI基因。没有统计上的显著差异被发现在这些多态性之间的血液透析患者或患者甲状旁腺素水平之间没有心血管并发症或少或超过300 pg / ml。这些结果表明,心血管并发症和继发甲状旁腺功能亢进的发展在埃及在维持血液透析患者不能归咎于这两个基因多态性。< br / > < br / > <强> < /强>结论:没有联系能找到检验局和FokI变异等位基因之间的基因多态性和ESRD的发展,心血管并发症和继发甲状旁腺功能亢进的研究样本中埃及维护血液透析病人。

阻力指标肾炎也许可以急性苯妥英:病例报告

06/13/2017

& lt; h2> SUMMARY< / h2>

Introduction: Acute tubulointerstitial nephritis (ATIN) is an acute kidney injury (AKI) resulting from damage to the tubulointerstitial tissue due to infection, trauma, or use of medication. It is clinically non-specific.

Case: A teenager with multiple trauma, hospitalised after lowering of level of conscience, and convulsion fits. While in the emergency ward, he received: midazolam, fentanyl and phenytoin. The cranial and abdominal CT scans were normal. He was stable with no signs of shock, trauma or infection; he developed oliguria and serum creatinine (Scr) 1.7mg/dL), 12 hours after the admission. After 36 hours, Scr levels were at 3.4mg/dL and urea at 55mg/dL. He had AKI according to pRIFLE (66.2% reduction in clearance). After other causes of AKI had been ruled out, the possibility of ATIN was raised; the phenytoin was suspended and pulse therapy, with methylprednisolone, was promptly initiated. After the first pulse, there was already a decline in the creatinine and urea readings; 48 hours later: Scr at 2.2mg/dL and urea at 86mg/dL. Thirty days after being discharged from hospital, the patient was in good health and had full restoration of kidney function.

Discussion: The singularity of this report relies on the rarity of ATIN secondary to the use of phenytoin and also in the importance of recognizing this aetiology as being one of the origins of AKI.

Conclusion: Early diagnosis allows the reversal of AKI through suppression of treatment with phenytoin and introduction of corticosteroid therapy, when necessary.

腹腔内和随后的静脉注射万古霉素:一种有效的治疗选择腹膜透析的革兰氏阳性腹膜炎

04/20/2017

& lt; h2> SUMMARY< / h2>& lt; p>腹腔万古霉素吸收较高时腹膜炎症,但吸收减少腹膜炎的复苏。因此,腹腔内维护剂量是无效的,减少治疗。你们的速度;/ p>& lt; p> & lt; strong> Aim< / strong>:评估的结果革兰氏阳性腹膜炎治疗腹腔内和随后的静脉注射万古霉素。;/ p>& lt; p> & lt; strong> Methods< / strong>: 1996年4月,我们发起一个协议用于治疗由革兰氏阳性微生物引起的腹膜炎使用2 g腹腔内负荷剂量1 g的万古霉素静脉注射万古霉素紧随其后两次5天为1 g coagulase-negative葡萄球菌和金黄色葡萄球菌的三次5天。我们分析的革兰氏阳性腹膜炎(coagulase-negative和金黄色葡萄球菌)和治疗效率的协议在113年4月1日之间接受腹膜透析的患者,1996年8月3日,2016年。有6090 patient-months和平均治疗持续了54,plusmn; 44个月。结果被评估为(1)完成治疗,(2)复发性腹膜炎,(3)导管移除难治性腹膜炎,和(4)死亡。你们;/ p>& lt; p> & lt; strong> Results< / strong>:共51例coagulase-negative葡萄球菌腹膜炎和37的金黄色葡萄球菌是46岁的113名患者(40.7%)。其中,coagulase-negative葡萄球菌(92.15%)和34个金黄色葡萄球菌腹膜炎(91.89%)解决。你们;/ p>

Conclusion:The response to treatment was very satisfactory.

心脏在抗磷脂综合征表现

03/23/2017

SHORT COMMUNICATION

Antiphospholipid syndrome may present in various ways from cutaneous manifestation, obstetric complications, neurological manifestation, and cardiac manifestation to renal involvement. There are many cardiac complication of anti-phospholipid syndrome, among them are valvular dysfunction, pulmonary hypertension, myocardial infarction, intracardiac thrombi, and ventricular dysfunction [1]. The most common cardiac manifestation is valvular abnormalities ranging from 11.6-32% [2-5].

对实际结果的风险调整影响术中Hemofi ltration接受心脏手术的患者

02/27/2017

ABSTRACT

Objectives: The role of perioperative hemofiltration (HF) in adult patients with impaired renal function undergoing cardiac surgery is controversial. There are suggestions that it may be beneficial for high risk patients undergoing prolonged cardiopulmonary bypass (CPB) surgery. However, long term outcomes in coronary artery bypass graft (CABG) surgery patients have not been investigated.

Methods: To address this we retrospectively followed 7620 patients who underwent CABG between April 2001 and March 2006. Logistic regression was used to risk adjust in-hospital outcomes. Cox proportional hazards analysis was used to risk adjust Kaplan-Meier freedom from death curves. Outcomes were adjusted for American Heart Association and American College of College of Cardiology recommended variables.

Results: 113 patients had intraoperative HF, 38 had postoperative HF and control group of 7006 that had no HF. After adjusting for differences in case-mix, patients with preoperative kidney disease who received postoperative HF proportionately had significantly higher rates of hospital deaths as compared with intraoperative HF patients. In addition, 5-year follow-up risk-adjusted freedom from death indicated significant differences between intraoperative HF group and postoperative HF patients.

Conclusions: These findings support the hypothesis that after adjusting for differences in case mixes, the use of intraoperative hemofiltration may offer superior short term clinical outcomes and longer-term survival benefits for patients with preoperative kidney disease.

临床肾脏病学会杂志

库的实践模式和结果促肾上腺皮质激素注入(ActharA®凝胶)用在儿童肾病综合症:一项研究北美儿科肾脏试验和协作研究和小儿肾脏学研究财团

Summary

Multifrecuency bioimpedance相位角作为一种工具来预测本机为血液透析管状器官的成熟失败

Summary

有用的短兵相接bioimpedance分析评估卷状态在慢性血液透析患者阿里斯蒂德Le Dantec大学医院(塞内加尔)

Summary

急性肾损伤由于自发Atheroembolic疾病,叠加在糖尿病肾病,最近没有血管或心脏干预,表现为快速进行性肾小球肾炎(展)

一个多学科pre-dialysis程序对肾的影响治疗方法的选择

血糖之间的非线性关系和30天死亡率在关键的急性肾损伤患者:一项回顾性队列研究

慢性肾脏疾病的预后因素和终末期肾病患者狼疮肾炎:回顾性队列研究

弥漫性肺泡出血:不寻常的系统性红斑狼疮

收集管PGE2反应减少水损失empagliflozin与2型糖尿病的老鼠

前列腺癌症相关的血栓性微血管病:病例报告和文献之回顾

vancomycin-associated急性肾损伤的发病率和危险因素在一个中心:回顾性研究

Hyperacute致命课程hypercalcemic危机

肾小球反渗透法在也门儿童患有镰状细胞病

不寻常的草酸肾病引起急性肾损伤:一个案例报告

修改肾心绞痛指数识别需要肾脏替代治疗危重儿科患者

COVID-19相关横纹肌溶解

唐氏综合症儿童肾小管酸中毒的频率

急性肾损伤患者在哥伦比亚COVID-19接受肾脏支持疗法geniusA®90技术

SGLT2抑制剂和nephroprotection糖尿病肾病:从作用机制的最新证据

Summary

相关性interdialytic体重增加,左心室肥大和FGF - 23在普遍的血液透析病人

急性肾损伤的生物标志物

特定的脑膜脑炎患者移植肾脏

尿液pH值如何影响蛀牙吗?

β2微球蛋白尿生物标志物的地形高低尿路感染之间的歧视?

肾盂成形术后持续肾盂积水:这是一个真正的阻碍?endourology的作用

微蛋白尿的含义在儿童特发性肾病综合征

无尿症的一个偏远的原因一个孩子

肉芽肿病与polyangiitis (GPA)在一个76岁的女人出现肺结节和加速急性肾损伤

巨细胞病毒感染原生肾活检

一个试点研究与间充质干细胞治疗小儿胱氨酸病

感知到的原因和预防catheter-associated尿路感染脊髓受伤的患者

Summary

intradialytic身体活动对生活质量的影响,生物参数和血液透析患者的睡眠

糖尿病和慢性肾脏疾病:一种罕见的原因很常见的协会

减肥咨询透析病人准备移植

Case Report

性别和左心室结构和功能差异在结束阶段肾病患者肺动脉高压维护血液透析

维生素D缺乏在慢性肾脏疾病预后的影响

有在接受减肥手术的患者肾功能的改善吗?

高水摄入量在预防尿酸肾结石的风险:一项系统回顾和荟萃分析

并发症颈内导管在血液透析病人的肾脏保健中心在尼日利亚

常规超声在放电的价值来确定病人的风险症状肾移植后淋巴管瘤:case-cohort研究

地塞米松的有效性和透明质酸酶+戊酸酯的bethasone prepucial按摩治疗儿童包皮过长

另一天门诊血液透析安排适当的可行替代安排改善patientsa€™结果

Introduction

慢性肾脏疾病患者住院的原因在一个三级肾脏保健医院

尿NGAL并入肾心绞痛指数急性肾损伤的早期检测生命垂危的孩子

儿童血压和肾脏功能的模式与镰状细胞贫血呈现三级卫生机构在尼日利亚

血液感染可以预测的血液透析患者的鼻文化吗?

严重的肺部感染继发于传播类圆线虫病肾病综合症患者

腹膜炎:腹膜透析下降的罪魁祸首

Anti-glomerular基底膜疾病:罕见的病例报告演示

血液透析的挑战:单中心经验在尼日利亚西南部

慢性肾脏疾病:一天筛选世界肾脏日连续五年

与长期随访Hypocomplementemic间质性肾炎

抗炎益生菌发酵食品中生物标志物

慢性肾脏疾病的女性:横断面扫描在瓦拉纳西的三级保健医院

Fetuin-A和血管之间的关系或在血液透析病人瓣膜钙化

的成功和失败教训腹膜Dialysis-Related布鲁氏菌腹膜炎在过去16年:病例报告和文献综述

肝囊肿感染肾移植患者常染色体显性遗传多囊肾疾病:PET / CT在诊断和治疗的兴趣

尿漏后肾移植:一个以证据为基础的管理计划

一个案例报告Hypocomplementemic荨麻疹的vasculitic综合症出现肾功能衰竭

三年之后的结果积极的交叉匹配肾移植尽管未能转化为负流交叉匹配后脱敏

AngioJetTM rheolytic血栓切除术诱导血管内溶血导致急性肾损伤需要透析

气性肾盂肾炎€”系列案件从一个中心在印度南部

马Anti-Thymocyte球蛋白(ATGAM)政府在病人与先前的兔子Anti-Thymocyte球蛋白抗胸腺细胞球蛋白组有()诱导血清病:一个案例报告

完全恢复血浆置换的慢性渗透性脱髓鞘综合征

后部可逆性脑白质病综合症第二剂量的利妥昔单抗治疗后患者的抗血栓性血小板减少性紫癜

Introduction

联系bh4 / bh2比率在高血压和蛋白尿的2型糖尿病患者

短期影响静脉注入间歇性补充铁和铁丸注入铁参数在血液透析病人

结果急性肾损伤的重症疟疾患者

贫血对甲氧基聚乙烯Glycol-Epoetinβ(Mircera)与重组人红细胞生成素(Eprex)在慢性肾脏疾病患者血液透析

维生素D受体的多态性Bsm我和FokI结束阶段埃及在维持血液透析患者肾脏疾病

阻力指标肾炎也许可以急性苯妥英:病例报告