Background: Addison’s disease is a rare disorder of the adrenal cortex that leads to inadequate production of cortisol initially followed by aldosterone and androgens. Its manifestations are usually slow and non-spec...Background: Addison’s disease is a rare disorder of the adrenal cortex that leads to inadequate production of cortisol initially followed by aldosterone and androgens. Its manifestations are usually slow and non-specific with potential for life-threatening adrenal crisis following hypermetabolic demands (infection, trauma, surgery). Patients: Over the past 10 years, 19 CRD-patients were diagnosed with occult PAI in our center. Results: Unprovoked hypotension was the most common manifestations of occult PAI and was the unmasking event in 11 (58%). It was without significant cardiac and/or severe systemic sepsis and was refractory to isotonic saline infusions. Equal number of the remaining patients (n = 2) presented with persistent and inexplicable electrolytes abnormalities viz. 1) hyponatremia despite restricted oral fluid intake, lack of dehydration and massive fluid overload, as well as 2) hyperkalemia despite potassium-restricted diet, hyperkalemic drugs and adequate therapy with Furosemide and low-potassium dialysis-baths. On the other hand, similar proportions presented with unprovoked 3) progressive weight loss, decrease appetite and cachexia as well as 4) frequent hypoglycemic attacks. All patients were treated and were medically stable after 29 (2 - 60) months of follow up. Autoantibodies to 21-hydroxylase enzyme were positive in 16 (90%). At diagnosis, and subsequent follow up, only 7 patients (37%) had multi-endocrine dysfunction of whom 2 with type 1 and 5 with type 2. Conclusion: High index of suspicion should be exerted in diagnosis of PAI in patients with CRD, since its clinical picture is similar to CRD manifestations and complications. In those patients, confirmatory tests and specific management can save their lives. .展开更多
The expression, activity and clinical implication of heme oxygenase-1 (HO-1) in the chronic renal insufficiency (CRI) rat kidney and its mechanism were investigated The 5/6 nephrectomized rats were assigned to sham ...The expression, activity and clinical implication of heme oxygenase-1 (HO-1) in the chronic renal insufficiency (CRI) rat kidney and its mechanism were investigated The 5/6 nephrectomized rats were assigned to sham operation group, CRI group and Hemin group At the 8th week after second operation, blood pressure, urinary protein, serum creatinine(Scr) and BUN were measured Renal pathologic changes were observed The activity of HO and contents of erythropoietin (EPO) in serum and renal tissue were determined Immunohistochemistry was used to detect the expression and distribution of HO-1 in the CRI rat kidney As compared with CRI group, the urinary protein, blood pressure, Scr and BUN in Hemin group were reduced significantly ( P< 0 05) The glomerular mesangial proliferation, inflammatory cellular infiltration of renal interstitium and interstitial fibrosis were ameliorated significantly Immunohistochemistry and measurement of HO-1 activity revealed that the expression and activity of HO-1 was decreased in renal tissues and increased in serum in CRI group as compared with normal rats HO-1 distributed mainly in tubular epithelial cells The EPO contents in Hemin group were significantly higher than in CRI group Through up-regulating the EPO level in serum and renal tissues, HO-1 retards the progression of CRI展开更多
[Objectives]To observe the protective effects of Mongolian medicine Borantunggal on rats with chronic renal insufficiency.[Methods]Male Wister rats were gavaged with 50 mg/kg/d adenine for 12 consecutive weeks,and wer...[Objectives]To observe the protective effects of Mongolian medicine Borantunggal on rats with chronic renal insufficiency.[Methods]Male Wister rats were gavaged with 50 mg/kg/d adenine for 12 consecutive weeks,and were intervened with positive control drug Niaoduqing and three groups of different doses of Mongolian medicine Borantunggal.The rats general state,such as body posture,hair color,activity status,renal function,thyroid gland,adrenal gland,and gonadal hormone levels,expression levels of inflammatory mediators,α-smooth muscle actin(α-SMA)and nuclear factor-κB(P65)in renal tissue,and histopathological changes of rat kidney were observed before and after treatment.[Results]The recovery of the general state of rats with chronic renal insufficiency in the low dose group after intervention with Mongolian medicine Borantunggal was the most obvious.Compared with the model group,the level of CRE in the low dose Mongolian medicine group decreased,and the difference was statistically significant(P<0.05).Compared with the normal group,the 24-h urinary protein in the low dose Mongolian medicine group had a declining trend,but the difference was not statistically significant(P>0.05).The urea level in low,medium and high dose Mongolian medicine groups showed a declining trend,and the effect of low dose Mongolian medicine was better.Compared with the model group,the feed intake of the low dose Mongolian medicine group had an increasing trend,while P and TCHO also had a declining trend.Compared with the model group,the levels of LH and COR in the low,medium and high dose Mongolian medicine groups decreased significantly,and the difference was statistically significant(P<0.05).The levels of T,T3 and T4 were significantly increased,the difference was statistically significant(P<0.05),and the effect of low dose Mongolian medicine was better.Compared with the model group,the levels of IL-6,TNF-αand HIF-1 in the low,medium and high dose Mongolian medicine groups were significantly reduced,and the difference was statistically significant(P<0.05).The levels of TGF-β1 and Ang II in the low dose Mongolian medicine group were significantly reduced,and the difference was statistically significant(P<0.05).The level of TGF-β1 in the medium and high dose Mongolian medicine groups decreased,and the difference was statistically significant(P<0.05).The expression of NF-κB P65 andα-SMA proteins in the low dose Mongolian medicine group showed a declining trend,which was better than Niaoduqing.[Conclusions]Mongolian medicine Borantunggal has significant protective and preventive effects on rats with adenine-induced chronic renal insufficiency.In particular,the dose of 0.31 kg/d had the most significant protective effect.Its action mechanism may be related to regulating hormone levels in the body,improving renal function,reducing renal inflammatory response,reducing the"three highs"in the kidney,and inhibiting renal tubular epithelial cell-to-mesenchymal transition and deposition of extracellular matrix(ECM).展开更多
BACKGROUND Nocardiosis is a rare bacterial infection with unclear epidemiology,pathogenesis,and characteristics.Its clinical manifestations are diverse and nonspecific,making diagnosis prone to errors,including misdia...BACKGROUND Nocardiosis is a rare bacterial infection with unclear epidemiology,pathogenesis,and characteristics.Its clinical manifestations are diverse and nonspecific,making diagnosis prone to errors,including misdiagnosis and missed diagnosis.Additionally,this disease is difficult to treat,often requiring months or even years of antibacterial therapy,and can be fatal in patients with underlying conditions.CASE SUMMARY A 93-year-old male patient with chronic renal insufficiency sustained a skin injury at the tip of his right thumb.As a result of an initial misdiagnosis and inadequate treatment,the infection progressed,resulting in multiple rashes on his right upper limb.Local incision and drainage of pus,combined with oral antibiotics administered at a different hospital,yielded no significant improvement.Upon hospitalization,the patient’s immune function was assessed,and further local incision and drainage were performed.Cultures of the pus identified Nocardia brasiliensis.Treatment involved intravenous infusion of piperacillin-tazobactam sodium and oral administration of sulfamethoxazole-trimethoprim,leading to the patient’s recovery.After discharge,the patient continued to take sulfamethoxazole tablets for 6 months,with complete healing of the skin lesions and no recurrence.CONCLUSION Nocardiosis should be considered in patients with underlying conditions and compromised immunity.Prompt and accurate diagnosis is crucial.展开更多
Pain is a common complaint among patients seeking medical care.If left un-treated,pain can become chronic,significantly affecting patients’quality of life.An accurate diagnosis of the underlying cause of pain is cruc...Pain is a common complaint among patients seeking medical care.If left un-treated,pain can become chronic,significantly affecting patients’quality of life.An accurate diagnosis of the underlying cause of pain is crucial for effective treatment.Chronic venous insufficiency(CVI)is frequently overlooked by pain physicians.Moreover,many pain physicians lack sufficient knowledge about CVI.CVI is a common condition resulting from malfunctioning or damaged valves in lower limb veins.Symptoms of CVI,ranging from mild to severe,include pain,heaviness,fatigue,itching,swelling,skin color changes,and ulcers in the lower limbs.Recently,it has become more widely known that these symptoms can be attributed to CVI.Even slight or mild CVI can cause related symptoms.Pain physicians primarily consider neuromusculoskeletal disorders when assessing patients with leg pain,and often neglect the possibility of CVI.In clinical practice,when pain physicians encounter patients with unresolved leg pain,they must assess whether the patients exhibit symptoms of CVI and conduct tests to differ-entiate CVI from other potential causes.展开更多
Background: Tenofovir (TFV) is widely used to treat patients with hepatitis B virus (HBV) infection. But kidney abnormalities are the main concern using this drug. Few studies have described the renal impairment due t...Background: Tenofovir (TFV) is widely used to treat patients with hepatitis B virus (HBV) infection. But kidney abnormalities are the main concern using this drug. Few studies have described the renal impairment due to the TFV in chronic hepatitis B (CHB) in Sub-Saharan Africa. The objective was to evaluate factors associated with renal impairment observed in patients on TFV for CHB. Method: It was a hospital based cross sectional prospective study carried out from June 2023 to July 2023 in Yaoundé (Cameroon) and included any patient treated with TFV for CHB during at least a period of 6 months. For each participant, we collected in the medical report socio-demographic data, clinical data, baseline creatinine, treatment information (type of TFV which was Disoproxil Fumarate (TDF) or Alafenamide (TAF), duration). Then, we collected blood samples to measure serum creatinine and phosphate levels and urine dipstick analysis. Factors associated with renal impairment were assessed with the Odds Ratio. A p value of Results: A total of 60 participants were included. The median age was 44 years [36-55] and median duration of TFV therapy was 17.5 months [11.7-25.7]. The prevalence of reduced eGFR (Conclusion: Kidney function was impaired in some patients receiving TFV for CHB. It should be monitored, particularly after 36 months and for those receiving TDF prodrug.展开更多
Background: Chronic venous insufficiency (CVI) describes a condition that affects the venous system of the lower extremities due to venous hypertension (VH. The prevalence is between 5% - 30%. CVI is associated with o...Background: Chronic venous insufficiency (CVI) describes a condition that affects the venous system of the lower extremities due to venous hypertension (VH. The prevalence is between 5% - 30%. CVI is associated with older age, smoking, lower extremity trauma, presence of an arteriovenous shunt, and elevated estrogen levels. All patients should be initially treated with conservative management. Venoactive drugs like calcium dobesilate are useful. Objectives: The primary objective compared the clinical improvement in patients with CVI, grades 0 - 3 of the CEAP classification of chronic venous disease, produced by two formulations of calcium dobesilate: calcium dobesilate LP 1 g OD vs calcium dobesilate 500 mg BID, immediate release. The secondary objective assessed the side effects of both formulations. Method: All patients took one tablet and one capsule at 7 am, and one capsule at 7 pm, for 8 weeks. One group received dobesilate 1 g OD and the other group received dobesilate 500 md BID. They were evaluated after 15, 30 and 60 days of treatment, using the symptom evaluation scale. Results: In both groups, there was a significant decrease in the symptom score after 15 days. Four patients in the Dobesilate OD group: had adverse effects, which did not require suspension of treatment. In the BID dobesilate group, there was one therapeutic failure, and one case of gastric discomfort. Conclusions: Prolonged-release Calcium dobesilate 1 g OD is as effective as calcium dobesilate 500 mg BID for the treatment of patients with chronic venous insufficiency.展开更多
Background and Objectives: Chronic kidney disease (CKD) is now a global public health problem. In low- and middle-income countries such as the Congo, access to dialysis is low and inequitable. The prevention of CKD in...Background and Objectives: Chronic kidney disease (CKD) is now a global public health problem. In low- and middle-income countries such as the Congo, access to dialysis is low and inequitable. The prevention of CKD involves raising awareness among patients at risk, such as those suffering from arterial hypertension (AH), by improving their knowledge of CKD. The objectives of our work were to determine the level of knowledge about CKD among hypertensive patients and to identify the factors associated with a low level of knowledge. Methodology: We conducted a 3-month descriptive and analytical cross-sectional study from 1 August to 30 October 2023 in 3 large public hospitals in Brazzaville (capital of the Republic of Congo). We included: hypertensive patients aged 18 and over who had freely consented to participate in our study and were able to answer the questions on the survey form. Patients with known hypertension who had been followed for less than 3 years and those with known chronic renal failure were not included. Results: The mean age was 58.4 ± 14.4 years (29 - 88 years). There were 121 men and 150 women (sex ratio = 0.8). All the patients were educated;37.2% with a higher level of education and 13.6% with primary education. 24 patients (9%) had a good level of knowledge about CKD and 153 (56%) had poor knowledge. A good level of knowledge was associated with the duration of hypertension, intellectual level and the existence of associated heart disease. Conclusion: Our study reveals a significant lack of knowledge about chronic kidney disease among hypertensive patients in Brazzaville.展开更多
Objective: To study clinical features of the patients with multiple myeloma(MM) accompanied by renal insufficiency and investigate the related risk factors of renalimpairment. Methods: A control study of clinical char...Objective: To study clinical features of the patients with multiple myeloma(MM) accompanied by renal insufficiency and investigate the related risk factors of renalimpairment. Methods: A control study of clinical characteristics was performed between 91 patientswith renal insufficiency due to MM and 165 patients with normal renal function in MM during the sameperiod. The data were statistically analyzed by chi-square test and logistic regression analysis.Results: Renal insufficiency was the initial presentation in 48 (52.7%) of the 91 patients, and 30(62.5%) of the 48 patients were misdiagnosed. The prognosis of group with renal insufficiency wassignificantly poorer than that of group with normal renal function: mortality in 3 months, 3months-1 year was 26/91 vs 14/165 (P 【 0.0001), 14/91 vs 12/165 (P 【 0.05) respectively, andpatients survived 】 1 year was 18/91 vs 95/165 (P 【 0.0001). The incidence of hypercalcemia,hyperuricemic, severe anemia, high serum M-protein concentration and lytic bone lesions weresignificantly higher in renal insufficiency group than those in control group (P 【 0.05). Logisticregression analysis identified 5 risk factors of renal impairment, including, severe anemia(Exp(β)=13.819, P 【 0.0001), use of nephrotoxic drugs (Exp(β)=6.217, P = 0.001), high serumM-protein concentration (Exp(β) = 5.026, P = 0.001), male (Exp(β)=3.745, P=0.006), andhypercalcemia (Exp(β)=3A72, P=0.006), but age, serum density of uric acid, type of serum M-protein,and Bence Jones proteinuria were not significantly associated with renal insufficiency. Conclusion:Renal insufficiency was a common early complication of MM, which often resulted in misdiagnosis.The status of these patients tended to be very bad, with many other complications, when MM wasdiagnosed, so their prognosis was poor. The occurrence of renal insufficiency in patients with MMand hypercalcemia, severe anemia, high serum M-protein concentration, especially use of nephrotoxicdrugs should be alert.展开更多
BACKGROUND Heparin-induced thrombocytopenia(HIT)is a rare complication of heparin therapy,and is characterized by arteriovenous thrombosis and bleeding events.The incidence of HIT after percutaneous coronary intervent...BACKGROUND Heparin-induced thrombocytopenia(HIT)is a rare complication of heparin therapy,and is characterized by arteriovenous thrombosis and bleeding events.The incidence of HIT after percutaneous coronary intervention(PCI)in patients with myocardial infarction complicated with renal failure is rarely reported.CASE SUMMARY We report a 73-year-old man with acute myocardial infarction and renal failure who underwent hemodialysis and PCI,and developed a progressive decline in platelets and subcutaneous hemorrhage of both upper limbs after heparin treatment.In addition to a gradual decrease in platelets,the patient’s 4T's score was 7,and HIT antibody was positive,confirming the diagnosis of HIT.CONCLUSION Patients receiving heparin combined with antiplatelet therapy should be monitored closely,especially for their platelet count.In the case of thrombocytopenia,HIT should be highly suspected.When the diagnosis of HIT is confirmed,timely individualized treatment should be delivered.展开更多
Aims: In this study, Doppler parameters were studied in patients with advanced stage renal disease, and the relationship between Doppler parameters and renal disease stage was investigated. Doppler values were evaluat...Aims: In this study, Doppler parameters were studied in patients with advanced stage renal disease, and the relationship between Doppler parameters and renal disease stage was investigated. Doppler values were evaluated for a cut-off value between normal and end-stage kidney disease group. Materials and methods: 50 patients with chronic kidney disease and 15 patients belonging to the same age group and with normal serum creatinine levels were comprised of the study and control groups. Resistivity and pulsatality indices were measured at the main renal arteries and interlobular arteries at both sides. Results: Statistically significant differences were found between the PI and RI values obtained from the main renal and interlobular arteries. PI sums were compared with those from the control group, and a cut-off value of 2.15 was found, with a sensitivity of 90% and a specificity of 86.7%. Conclusion: Any increase in the RI and PI values obtained from the main renal and interlobular arteries must bring to mind the possibility of advancing renal damage and interstitial fibrosis. Patients with and without renal parenchymal damage can be differentiated by means of comparing the total PI values obtained from the right and left main renal and interlobular arteries.展开更多
Objective To observe the value of real-time shear wave elastography(SWE)combined with biochemical indicators for evaluating liver injury in patients with chronic kidney disease(CKD).Methods Totally 210 patients with C...Objective To observe the value of real-time shear wave elastography(SWE)combined with biochemical indicators for evaluating liver injury in patients with chronic kidney disease(CKD).Methods Totally 210 patients with CKD(CKD group)and 64 healthy subjects(control group)were retrospectively enrolled.Patients in CKD group were further divided into CKD1—5 subgroups according to CKD stages.SWE parameters of liver and kidney,including mean value,the maximum value and the median value of Young's modulus(EQI mean,EQI max and EQI med)were compared between CKD subgroups and control group.Spearman correlation analysis were performed to explore the correlations of liver and kidney SWE parameters with CKD stage,as well as of liver SWE parameters with biochemical indicators.Multivariate logistic regression analysis was used to screen independent predictors of liver injury in CKD patients.Receiver operating characteristic curves were drawn,the area under the curves(AUC)were calculated to evaluate the efficacy of the independent predictors alone and their combination for assessing liver injury in CKD patients.Results Significant differences of liver and kidney SWE parameters were found among CKD subgroups and control group(all P≤0.001).Pairwise comparison showed that liver SWE parameters in CKD5 subgroup and liver EQI max in CKD4 subgroup were all higher than those in control group(all P<0.003).Kidney SWE parameters in CKD3 subgroup were all higher than those in control group,while in CKD4 subgroup were all higher than those in control group and CKD1—3 subgroup(all P<0.003).Kidney EQI mean and EQI med in CKD5 subgroup were all higher than those in control group and CKD1—4 subgroup,while kidney EQI max in CKD5 subgroup were higher than those in control group and CKD1—3 subgroup(all P<0.003).Liver and kidney SWE parameters were lowly-moderately and positively correlated with CKD stages(r=0.364—0.665,all P<0.001).Liver SWE parameters of CKD were weakly and positively correlated with alkaline phosphatase(ALP)(r=0.229—0.248,all P<0.01).Theγ-glutamyl transferase,ALP and liver EQI max were all independent predictors of liver injury in CKD patients(all P<0.01),with AUC for evaluating liver injury in CKD patients alone of 0.645,0.756 and 0.741,respectively,lower than that of their combination(0.851,all P<0.01).Conclusion Real-time SWE combined with liver function indicators could reflect degree of liver injury in patients with different CKD stages.展开更多
Chronic kidney disease and its worsening are recurring conditions in chronic heart failure(CHF) which are independently associated with poor patient outcome.The heart and kidney share many pathophysiological mechanism...Chronic kidney disease and its worsening are recurring conditions in chronic heart failure(CHF) which are independently associated with poor patient outcome.The heart and kidney share many pathophysiological mechanisms which can determine dysfunction in each organ. Cardiorenal syndrome is the condition in which these two organs negatively affect each other, therefore an accurate evaluation of renal function in the clinical setting of CHF is essential. This review aims to revise the parameters currently used to evaluate renal dysfunction in CHF with particular reference to the usefulness and the limitations of biomarkers in evaluating glomerular dysfunction and tubular damage. Moreover, it is reported the possible utility of renal arterial resistance index(a parameter associated with abnormalities in renal vascular bed) for a better assesment of kidney disfunction.展开更多
Objective: To observe the therapeutic effect of Yangxue Qingnao granule (养血清脑颗粒, YXQNG) in treating chronic cerebrovascular insufficiency (CCI) and its possible mechanism. Methods: Eighty -three patients with...Objective: To observe the therapeutic effect of Yangxue Qingnao granule (养血清脑颗粒, YXQNG) in treating chronic cerebrovascular insufficiency (CCI) and its possible mechanism. Methods: Eighty -three patients with CCI were randomly divided into YXQNG and nimodipine (ND) groups, the score of vertigo and the change in cerebral blood velocity before and after treatment were observed. And in the animal experiment, the authors adopted bilateral ligation of cervical carotid communis artery to establish CCI rat models in order to observe the effect of YXQNG and ND on incubation period of vertigo in rats and on memory performance. Results: After clinical treatment, the vertigo score of YXQNG group was 2.34, and that of the ND group was 4.18, the comparison between the two groups showed that the difference was significant ( P < 0.05 ). After treatment, the middle cerebral artery mean velocity (MCA Vm) of YXQNG group was 64.78 cm/s, vertebral artery mean velocity (VA Vm) was 29.78 cm/s, while that of ND group was 60.34 cm/s and 23.23 cm/s respectively, the comparison between these two groups showing statistical significance and the difference being obvious ( P <0.05). Experimental study showed that the rats in the model group after 12 weeks learning and memory were markedly lowered, the vertigo incubation period significantly lengthened, and compared with that of the model group, learning and memory of the YXQNG group was markedly improved and vertigo incubation period shortened, with the difference from that of the ND group insignificant, P >0.05. Conclusion: YXQNG could effectively improve CCI patients' vertigo and other clinical symptoms and increase the cerebral blood flow, lessen the vertigo incubation of model group rats, elevate model group rats' memory performance.展开更多
AIM： To evaluate the effects of Helicobacter pylori infection on gastric epithelial cell kinetics in patients with chronic renal failure （CRF）. METHODS： Forty-four patients were enrolled in this study and divided ...AIM： To evaluate the effects of Helicobacter pylori infection on gastric epithelial cell kinetics in patients with chronic renal failure （CRF）. METHODS： Forty-four patients were enrolled in this study and divided into four groups with respect to their Helicobacter pylori （H pylori） and CRF status. Groups were labeled as follows： la： normal renal function, H pylori negative （n = 12）, lb： normal renal function, H pylori positive （n = 11）, 2a： CRF, H pylori negative （n = 10）, 2b： CRF, H pylori positive （n = 11）. Upper gastrointestinal endoscopy was done in all the patients involved in the study. During endoscopical investigation, antral biopsy specimens were taken from each patient. In order to evaluate the cell apoptosis and proliferation in gastric epithelial cells, Bax and proliferating cell nuclear antigen （PCNA） labeling indexes （LI） were assessed with immunohistochemical staining method. RESULTS： For groups la, lb, 2a, and 2b, mean Bax LI was identified as 34.4±13.7, 44.1±16.5, 46.3±20.5, 60.7±13.8, respectively and mean PCNA LI was identified as 36.2±17.2, 53.6±25.6, 59.5±25.6, 67.2±22, respectively. When the one-way ANOVA test was applied, statistically significant differences were detected between the groups for both Bax LI （P = 0.004 〈0.01） and PCNA LI （P = 0.009 〈0.01）. When groups were compared further in terms of Bax LI and PCNA LI with Tukey＇s HSD test for multiple pairwise comparisons, statistically significant difference was observed only between groups la and 2b （P = 0.006 〈0.01）.CONCLUSION： In gastric epithelial cells, expression of both the pre-apoptotic protein Bax and the proliferation marker PCNA increase with H pylori infection. This increase is more evident in patients with uremia. These findings suggest that uremia accelerates apoptosis and proliferation in gastric epithelial cells.展开更多
BACKGROUND Secondary hyperparathyroidism,renal osteodystrophy,and cardiovascular adverse events can occur if long-term hyperphosphatemia is not corrected,leading to the adverse prognosis of patients with chronic renal...BACKGROUND Secondary hyperparathyroidism,renal osteodystrophy,and cardiovascular adverse events can occur if long-term hyperphosphatemia is not corrected,leading to the adverse prognosis of patients with chronic renal failure.Besides the use of phosphorus binders,clinical control measures for hyperphosphatemia in these patients should also incorporate diet control.AIM To observe doctor-led intensive diet education effects on health-related quality of life in patients with chronic renal failure and hyperphosphatemia.METHODS We assessed 120 patients with hyperphosphatemia and chronic renal failure on hemodialysis admitted to our hospital(July 2018 to March 2020).The control group(n=60)was given routine nursing guidance,and the observation group(n=60)was given doctor-led intensive diet education.The changes in EQ-5D-3L scores,disease-related knowledge,and compliance scores before intervention and 3 and 6 mo after intervention in the two groups were recorded.The levels of serum parathyroid hormone(iPTH),calcium(Ca),phosphorus(P),calciumphosphorus product(Ca×P),serum creatinine(Scr),and blood urea nitrogen(BUN)before intervention and 3 and 6 mo after intervention in the two groups were assessed along with patient satisfaction.RESULTS There was no significant difference in blood iPTH,Ca,P,Ca×P,Scr,or BUN levels between the groups before intervention.After 3 and 6 mo of intervention,the blood iPTH,Ca,P,and Ca×P levels in the two groups decreased gradually(P<0.05),but there were no significant differences in Scr or BUN.The blood iPTH,Ca,P,and Ca×P levels in the observation group were lower than those in the control group(P<0.05).The satisfaction rate in the observation group after 3 mo was 93.33%and after 6,90.00%,which was high compared with the 80.00%and 71.67%,respectively,in the control group(P<0.05).There was no significant difference in EQ-5D-3L score between the two groups before intervention.After 3 and 6 mo of intervention,the visual analogue scale score of the two groups increased gradually(P<0.05);and the scores of action ability,self-care,daily activities,pain and discomfort,and anxiety and depression decreased gradually(P<0.05).The overall EQ-5D-3L score in the observation group was better than that in the control group(P<0.05).There was no significant difference in diseaserelated knowledge or compliance scores between the groups before intervention.After 3 and 6 mo of intervention,the scores of disease,diet,and medication knowledge and compliance in the two groups increased gradually(P<0.05).The scores of disease-related knowledge and compliance were higher in the observation group than in the control group(P<0.05).CONCLUSION Doctor-led intensive diet education can improve patient satisfaction and the quality of life in patients with chronic renal failure and hyperphosphatemia and promote low-phosphorus diet behavior.展开更多
The level of urinary FPA was assayed by high per formance liquid chromatography (HPLC ) in 42 normal controls, 57 cases of chronic glomeru-lonephritis, including 24 with normal renal function, 12 with renal insufficie...The level of urinary FPA was assayed by high per formance liquid chromatography (HPLC ) in 42 normal controls, 57 cases of chronic glomeru-lonephritis, including 24 with normal renal function, 12 with renal insufficiency and 21 with uremia. Their levels were 24. 40± 10. 30 μg/L, 26. 99±5.77 μg/L,38. 81±6. 28 μg/L, 79. 74± 18. 76 μg/L, respectively. The level of urinary FPA in renal insufficiency function group was significantly higher than those of the con-trol group and normal renal function group (P<0.01). The patients with uremia presented dramatically higher level of urinary FPA than those in the renal insufficiency group (P<0.01). A positive correlation was found between the level of urinary FPA and the blood creatine (r= 0. 9120, P<0. 01 ). It was suggested that a hypercoagulable state existed in the patients with chronic nephritis with renal failure, in which the severity was closely related with the occurrence and development of the disease. The urinary FPA could serve as a good indicator for renal function.展开更多
AIM： To investigate the role of wireless capsule endoscopy （WCE） in detection of small bowel （SB） pathology in patients with chronic renal failure （CRF） and obscure bleeding. METHODS： Consecutive CRF patients ...AIM： To investigate the role of wireless capsule endoscopy （WCE） in detection of small bowel （SB） pathology in patients with chronic renal failure （CRF） and obscure bleeding. METHODS： Consecutive CRF patients with obscure bleeding were prospectively studied. Patients with normal renal function and obscure bleeding, investigated during the same period with WCE, were used for the interpretation of results. RESULTS： Seventeen CRF patients （11 overt, 6 occult bleeding） and 51 patients （33 overt, 18 occult bleeding） with normal renal function were enrolled in this study. Positive SB findings were detected in 70.6% of CRF patients and in 41.2% of non-CRF patients （P〈0.05）. SB angiodysplasia was identified in 47% of CRF patients and in 17.6% of non-CRF patients. Univariate logistic regression revealed CRF as a significant predictive factor for angiodysplasia （P〈0.05）. Therapeutic measures were undertaken in 66% of the patients with the positive findings. CONCLUSION： According to our preliminary results, SB angiodysplasia was found in an increased prevalence among CRF patients with obscure bleeding. WCE is useful in diagnosis of gastrointestinal pathologies and in planning appropriate therapeutic intervention and, therefore, should be included in the work-up of this group of patients.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
Background: Chronic Kidney Disease (CKD), associated with a slow and progressive loss of kidney function over a period of several years, is an important clinical disaster with an increasing rate of morbidity and morta...Background: Chronic Kidney Disease (CKD), associated with a slow and progressive loss of kidney function over a period of several years, is an important clinical disaster with an increasing rate of morbidity and mortality especially in the least developed countries. Many hematological parameters are thought to alter dramatically during the course of the disease. These include white blood cells, red blood cells, and platelets. Methods: We tried, retrospectively, to evaluate the peripheral blood hematological alterations in a group of patients undergoing hemodialysis in an eastern Sudan dialysis center to add local medical information. Results: Anemia (Low hemoglobin and hematocrit) was detected in 94% of the patients’ group. Mean Erythrocyte count (3.32vs.4.76 (×109/L)), Hemoglobin concentration (9.4vs.13 (g/dl)), Hematocrit (28.7vs.38.7 (L/L)) and platelet count (296 vs. 238 (×109/L)) were significantly lower in the patients’ group than in the control group (P-values Conclusion: Five out of eight studied parameters (Red cell count, hemoglobin, hematocrit, mean cell hemoglobin concentration, and platelets count) have shown a significant alteration in CKD patients. As the complete blood count (CBC) test is the most utilized test in clinical laboratory practice, these alterations may be considered as early indicators for CKD. Furthermore, all patients with CKD must be routinely checked for these alterations.展开更多
文摘Background: Addison’s disease is a rare disorder of the adrenal cortex that leads to inadequate production of cortisol initially followed by aldosterone and androgens. Its manifestations are usually slow and non-specific with potential for life-threatening adrenal crisis following hypermetabolic demands (infection, trauma, surgery). Patients: Over the past 10 years, 19 CRD-patients were diagnosed with occult PAI in our center. Results: Unprovoked hypotension was the most common manifestations of occult PAI and was the unmasking event in 11 (58%). It was without significant cardiac and/or severe systemic sepsis and was refractory to isotonic saline infusions. Equal number of the remaining patients (n = 2) presented with persistent and inexplicable electrolytes abnormalities viz. 1) hyponatremia despite restricted oral fluid intake, lack of dehydration and massive fluid overload, as well as 2) hyperkalemia despite potassium-restricted diet, hyperkalemic drugs and adequate therapy with Furosemide and low-potassium dialysis-baths. On the other hand, similar proportions presented with unprovoked 3) progressive weight loss, decrease appetite and cachexia as well as 4) frequent hypoglycemic attacks. All patients were treated and were medically stable after 29 (2 - 60) months of follow up. Autoantibodies to 21-hydroxylase enzyme were positive in 16 (90%). At diagnosis, and subsequent follow up, only 7 patients (37%) had multi-endocrine dysfunction of whom 2 with type 1 and 5 with type 2. Conclusion: High index of suspicion should be exerted in diagnosis of PAI in patients with CRD, since its clinical picture is similar to CRD manifestations and complications. In those patients, confirmatory tests and specific management can save their lives. .
文摘The expression, activity and clinical implication of heme oxygenase-1 (HO-1) in the chronic renal insufficiency (CRI) rat kidney and its mechanism were investigated The 5/6 nephrectomized rats were assigned to sham operation group, CRI group and Hemin group At the 8th week after second operation, blood pressure, urinary protein, serum creatinine(Scr) and BUN were measured Renal pathologic changes were observed The activity of HO and contents of erythropoietin (EPO) in serum and renal tissue were determined Immunohistochemistry was used to detect the expression and distribution of HO-1 in the CRI rat kidney As compared with CRI group, the urinary protein, blood pressure, Scr and BUN in Hemin group were reduced significantly ( P< 0 05) The glomerular mesangial proliferation, inflammatory cellular infiltration of renal interstitium and interstitial fibrosis were ameliorated significantly Immunohistochemistry and measurement of HO-1 activity revealed that the expression and activity of HO-1 was decreased in renal tissues and increased in serum in CRI group as compared with normal rats HO-1 distributed mainly in tubular epithelial cells The EPO contents in Hemin group were significantly higher than in CRI group Through up-regulating the EPO level in serum and renal tissues, HO-1 retards the progression of CRI
基金Supported by Natural Science Foundation of Inner Mongolia Autonomous Region(2019MS08015).
文摘[Objectives]To observe the protective effects of Mongolian medicine Borantunggal on rats with chronic renal insufficiency.[Methods]Male Wister rats were gavaged with 50 mg/kg/d adenine for 12 consecutive weeks,and were intervened with positive control drug Niaoduqing and three groups of different doses of Mongolian medicine Borantunggal.The rats general state,such as body posture,hair color,activity status,renal function,thyroid gland,adrenal gland,and gonadal hormone levels,expression levels of inflammatory mediators,α-smooth muscle actin(α-SMA)and nuclear factor-κB(P65)in renal tissue,and histopathological changes of rat kidney were observed before and after treatment.[Results]The recovery of the general state of rats with chronic renal insufficiency in the low dose group after intervention with Mongolian medicine Borantunggal was the most obvious.Compared with the model group,the level of CRE in the low dose Mongolian medicine group decreased,and the difference was statistically significant(P<0.05).Compared with the normal group,the 24-h urinary protein in the low dose Mongolian medicine group had a declining trend,but the difference was not statistically significant(P>0.05).The urea level in low,medium and high dose Mongolian medicine groups showed a declining trend,and the effect of low dose Mongolian medicine was better.Compared with the model group,the feed intake of the low dose Mongolian medicine group had an increasing trend,while P and TCHO also had a declining trend.Compared with the model group,the levels of LH and COR in the low,medium and high dose Mongolian medicine groups decreased significantly,and the difference was statistically significant(P<0.05).The levels of T,T3 and T4 were significantly increased,the difference was statistically significant(P<0.05),and the effect of low dose Mongolian medicine was better.Compared with the model group,the levels of IL-6,TNF-αand HIF-1 in the low,medium and high dose Mongolian medicine groups were significantly reduced,and the difference was statistically significant(P<0.05).The levels of TGF-β1 and Ang II in the low dose Mongolian medicine group were significantly reduced,and the difference was statistically significant(P<0.05).The level of TGF-β1 in the medium and high dose Mongolian medicine groups decreased,and the difference was statistically significant(P<0.05).The expression of NF-κB P65 andα-SMA proteins in the low dose Mongolian medicine group showed a declining trend,which was better than Niaoduqing.[Conclusions]Mongolian medicine Borantunggal has significant protective and preventive effects on rats with adenine-induced chronic renal insufficiency.In particular,the dose of 0.31 kg/d had the most significant protective effect.Its action mechanism may be related to regulating hormone levels in the body,improving renal function,reducing renal inflammatory response,reducing the"three highs"in the kidney,and inhibiting renal tubular epithelial cell-to-mesenchymal transition and deposition of extracellular matrix(ECM).
基金Supported by Zhejiang Provincial Traditional Chinese Medicine Science and Technology Program,No.2023ZF075.
文摘BACKGROUND Nocardiosis is a rare bacterial infection with unclear epidemiology,pathogenesis,and characteristics.Its clinical manifestations are diverse and nonspecific,making diagnosis prone to errors,including misdiagnosis and missed diagnosis.Additionally,this disease is difficult to treat,often requiring months or even years of antibacterial therapy,and can be fatal in patients with underlying conditions.CASE SUMMARY A 93-year-old male patient with chronic renal insufficiency sustained a skin injury at the tip of his right thumb.As a result of an initial misdiagnosis and inadequate treatment,the infection progressed,resulting in multiple rashes on his right upper limb.Local incision and drainage of pus,combined with oral antibiotics administered at a different hospital,yielded no significant improvement.Upon hospitalization,the patient’s immune function was assessed,and further local incision and drainage were performed.Cultures of the pus identified Nocardia brasiliensis.Treatment involved intravenous infusion of piperacillin-tazobactam sodium and oral administration of sulfamethoxazole-trimethoprim,leading to the patient’s recovery.After discharge,the patient continued to take sulfamethoxazole tablets for 6 months,with complete healing of the skin lesions and no recurrence.CONCLUSION Nocardiosis should be considered in patients with underlying conditions and compromised immunity.Prompt and accurate diagnosis is crucial.
基金Supported by The National Research Foundation of Korea Grant Funded by The Korea Government(MSIT),No.00219725.
文摘Pain is a common complaint among patients seeking medical care.If left un-treated,pain can become chronic,significantly affecting patients’quality of life.An accurate diagnosis of the underlying cause of pain is crucial for effective treatment.Chronic venous insufficiency(CVI)is frequently overlooked by pain physicians.Moreover,many pain physicians lack sufficient knowledge about CVI.CVI is a common condition resulting from malfunctioning or damaged valves in lower limb veins.Symptoms of CVI,ranging from mild to severe,include pain,heaviness,fatigue,itching,swelling,skin color changes,and ulcers in the lower limbs.Recently,it has become more widely known that these symptoms can be attributed to CVI.Even slight or mild CVI can cause related symptoms.Pain physicians primarily consider neuromusculoskeletal disorders when assessing patients with leg pain,and often neglect the possibility of CVI.In clinical practice,when pain physicians encounter patients with unresolved leg pain,they must assess whether the patients exhibit symptoms of CVI and conduct tests to differ-entiate CVI from other potential causes.
文摘Background: Tenofovir (TFV) is widely used to treat patients with hepatitis B virus (HBV) infection. But kidney abnormalities are the main concern using this drug. Few studies have described the renal impairment due to the TFV in chronic hepatitis B (CHB) in Sub-Saharan Africa. The objective was to evaluate factors associated with renal impairment observed in patients on TFV for CHB. Method: It was a hospital based cross sectional prospective study carried out from June 2023 to July 2023 in Yaoundé (Cameroon) and included any patient treated with TFV for CHB during at least a period of 6 months. For each participant, we collected in the medical report socio-demographic data, clinical data, baseline creatinine, treatment information (type of TFV which was Disoproxil Fumarate (TDF) or Alafenamide (TAF), duration). Then, we collected blood samples to measure serum creatinine and phosphate levels and urine dipstick analysis. Factors associated with renal impairment were assessed with the Odds Ratio. A p value of Results: A total of 60 participants were included. The median age was 44 years [36-55] and median duration of TFV therapy was 17.5 months [11.7-25.7]. The prevalence of reduced eGFR (Conclusion: Kidney function was impaired in some patients receiving TFV for CHB. It should be monitored, particularly after 36 months and for those receiving TDF prodrug.
文摘Background: Chronic venous insufficiency (CVI) describes a condition that affects the venous system of the lower extremities due to venous hypertension (VH. The prevalence is between 5% - 30%. CVI is associated with older age, smoking, lower extremity trauma, presence of an arteriovenous shunt, and elevated estrogen levels. All patients should be initially treated with conservative management. Venoactive drugs like calcium dobesilate are useful. Objectives: The primary objective compared the clinical improvement in patients with CVI, grades 0 - 3 of the CEAP classification of chronic venous disease, produced by two formulations of calcium dobesilate: calcium dobesilate LP 1 g OD vs calcium dobesilate 500 mg BID, immediate release. The secondary objective assessed the side effects of both formulations. Method: All patients took one tablet and one capsule at 7 am, and one capsule at 7 pm, for 8 weeks. One group received dobesilate 1 g OD and the other group received dobesilate 500 md BID. They were evaluated after 15, 30 and 60 days of treatment, using the symptom evaluation scale. Results: In both groups, there was a significant decrease in the symptom score after 15 days. Four patients in the Dobesilate OD group: had adverse effects, which did not require suspension of treatment. In the BID dobesilate group, there was one therapeutic failure, and one case of gastric discomfort. Conclusions: Prolonged-release Calcium dobesilate 1 g OD is as effective as calcium dobesilate 500 mg BID for the treatment of patients with chronic venous insufficiency.
文摘Background and Objectives: Chronic kidney disease (CKD) is now a global public health problem. In low- and middle-income countries such as the Congo, access to dialysis is low and inequitable. The prevention of CKD involves raising awareness among patients at risk, such as those suffering from arterial hypertension (AH), by improving their knowledge of CKD. The objectives of our work were to determine the level of knowledge about CKD among hypertensive patients and to identify the factors associated with a low level of knowledge. Methodology: We conducted a 3-month descriptive and analytical cross-sectional study from 1 August to 30 October 2023 in 3 large public hospitals in Brazzaville (capital of the Republic of Congo). We included: hypertensive patients aged 18 and over who had freely consented to participate in our study and were able to answer the questions on the survey form. Patients with known hypertension who had been followed for less than 3 years and those with known chronic renal failure were not included. Results: The mean age was 58.4 ± 14.4 years (29 - 88 years). There were 121 men and 150 women (sex ratio = 0.8). All the patients were educated;37.2% with a higher level of education and 13.6% with primary education. 24 patients (9%) had a good level of knowledge about CKD and 153 (56%) had poor knowledge. A good level of knowledge was associated with the duration of hypertension, intellectual level and the existence of associated heart disease. Conclusion: Our study reveals a significant lack of knowledge about chronic kidney disease among hypertensive patients in Brazzaville.
文摘Objective: To study clinical features of the patients with multiple myeloma(MM) accompanied by renal insufficiency and investigate the related risk factors of renalimpairment. Methods: A control study of clinical characteristics was performed between 91 patientswith renal insufficiency due to MM and 165 patients with normal renal function in MM during the sameperiod. The data were statistically analyzed by chi-square test and logistic regression analysis.Results: Renal insufficiency was the initial presentation in 48 (52.7%) of the 91 patients, and 30(62.5%) of the 48 patients were misdiagnosed. The prognosis of group with renal insufficiency wassignificantly poorer than that of group with normal renal function: mortality in 3 months, 3months-1 year was 26/91 vs 14/165 (P 【 0.0001), 14/91 vs 12/165 (P 【 0.05) respectively, andpatients survived 】 1 year was 18/91 vs 95/165 (P 【 0.0001). The incidence of hypercalcemia,hyperuricemic, severe anemia, high serum M-protein concentration and lytic bone lesions weresignificantly higher in renal insufficiency group than those in control group (P 【 0.05). Logisticregression analysis identified 5 risk factors of renal impairment, including, severe anemia(Exp(β)=13.819, P 【 0.0001), use of nephrotoxic drugs (Exp(β)=6.217, P = 0.001), high serumM-protein concentration (Exp(β) = 5.026, P = 0.001), male (Exp(β)=3.745, P=0.006), andhypercalcemia (Exp(β)=3A72, P=0.006), but age, serum density of uric acid, type of serum M-protein,and Bence Jones proteinuria were not significantly associated with renal insufficiency. Conclusion:Renal insufficiency was a common early complication of MM, which often resulted in misdiagnosis.The status of these patients tended to be very bad, with many other complications, when MM wasdiagnosed, so their prognosis was poor. The occurrence of renal insufficiency in patients with MMand hypercalcemia, severe anemia, high serum M-protein concentration, especially use of nephrotoxicdrugs should be alert.
文摘BACKGROUND Heparin-induced thrombocytopenia(HIT)is a rare complication of heparin therapy,and is characterized by arteriovenous thrombosis and bleeding events.The incidence of HIT after percutaneous coronary intervention(PCI)in patients with myocardial infarction complicated with renal failure is rarely reported.CASE SUMMARY We report a 73-year-old man with acute myocardial infarction and renal failure who underwent hemodialysis and PCI,and developed a progressive decline in platelets and subcutaneous hemorrhage of both upper limbs after heparin treatment.In addition to a gradual decrease in platelets,the patient’s 4T's score was 7,and HIT antibody was positive,confirming the diagnosis of HIT.CONCLUSION Patients receiving heparin combined with antiplatelet therapy should be monitored closely,especially for their platelet count.In the case of thrombocytopenia,HIT should be highly suspected.When the diagnosis of HIT is confirmed,timely individualized treatment should be delivered.
文摘Aims: In this study, Doppler parameters were studied in patients with advanced stage renal disease, and the relationship between Doppler parameters and renal disease stage was investigated. Doppler values were evaluated for a cut-off value between normal and end-stage kidney disease group. Materials and methods: 50 patients with chronic kidney disease and 15 patients belonging to the same age group and with normal serum creatinine levels were comprised of the study and control groups. Resistivity and pulsatality indices were measured at the main renal arteries and interlobular arteries at both sides. Results: Statistically significant differences were found between the PI and RI values obtained from the main renal and interlobular arteries. PI sums were compared with those from the control group, and a cut-off value of 2.15 was found, with a sensitivity of 90% and a specificity of 86.7%. Conclusion: Any increase in the RI and PI values obtained from the main renal and interlobular arteries must bring to mind the possibility of advancing renal damage and interstitial fibrosis. Patients with and without renal parenchymal damage can be differentiated by means of comparing the total PI values obtained from the right and left main renal and interlobular arteries.
文摘Objective To observe the value of real-time shear wave elastography(SWE)combined with biochemical indicators for evaluating liver injury in patients with chronic kidney disease(CKD).Methods Totally 210 patients with CKD(CKD group)and 64 healthy subjects(control group)were retrospectively enrolled.Patients in CKD group were further divided into CKD1—5 subgroups according to CKD stages.SWE parameters of liver and kidney,including mean value,the maximum value and the median value of Young's modulus(EQI mean,EQI max and EQI med)were compared between CKD subgroups and control group.Spearman correlation analysis were performed to explore the correlations of liver and kidney SWE parameters with CKD stage,as well as of liver SWE parameters with biochemical indicators.Multivariate logistic regression analysis was used to screen independent predictors of liver injury in CKD patients.Receiver operating characteristic curves were drawn,the area under the curves(AUC)were calculated to evaluate the efficacy of the independent predictors alone and their combination for assessing liver injury in CKD patients.Results Significant differences of liver and kidney SWE parameters were found among CKD subgroups and control group(all P≤0.001).Pairwise comparison showed that liver SWE parameters in CKD5 subgroup and liver EQI max in CKD4 subgroup were all higher than those in control group(all P<0.003).Kidney SWE parameters in CKD3 subgroup were all higher than those in control group,while in CKD4 subgroup were all higher than those in control group and CKD1—3 subgroup(all P<0.003).Kidney EQI mean and EQI med in CKD5 subgroup were all higher than those in control group and CKD1—4 subgroup,while kidney EQI max in CKD5 subgroup were higher than those in control group and CKD1—3 subgroup(all P<0.003).Liver and kidney SWE parameters were lowly-moderately and positively correlated with CKD stages(r=0.364—0.665,all P<0.001).Liver SWE parameters of CKD were weakly and positively correlated with alkaline phosphatase(ALP)(r=0.229—0.248,all P<0.01).Theγ-glutamyl transferase,ALP and liver EQI max were all independent predictors of liver injury in CKD patients(all P<0.01),with AUC for evaluating liver injury in CKD patients alone of 0.645,0.756 and 0.741,respectively,lower than that of their combination(0.851,all P<0.01).Conclusion Real-time SWE combined with liver function indicators could reflect degree of liver injury in patients with different CKD stages.
文摘Chronic kidney disease and its worsening are recurring conditions in chronic heart failure(CHF) which are independently associated with poor patient outcome.The heart and kidney share many pathophysiological mechanisms which can determine dysfunction in each organ. Cardiorenal syndrome is the condition in which these two organs negatively affect each other, therefore an accurate evaluation of renal function in the clinical setting of CHF is essential. This review aims to revise the parameters currently used to evaluate renal dysfunction in CHF with particular reference to the usefulness and the limitations of biomarkers in evaluating glomerular dysfunction and tubular damage. Moreover, it is reported the possible utility of renal arterial resistance index(a parameter associated with abnormalities in renal vascular bed) for a better assesment of kidney disfunction.
基金Supported by Hundred Project of Shanghai Health Ad ministration (BR 97016)
文摘Objective: To observe the therapeutic effect of Yangxue Qingnao granule (养血清脑颗粒, YXQNG) in treating chronic cerebrovascular insufficiency (CCI) and its possible mechanism. Methods: Eighty -three patients with CCI were randomly divided into YXQNG and nimodipine (ND) groups, the score of vertigo and the change in cerebral blood velocity before and after treatment were observed. And in the animal experiment, the authors adopted bilateral ligation of cervical carotid communis artery to establish CCI rat models in order to observe the effect of YXQNG and ND on incubation period of vertigo in rats and on memory performance. Results: After clinical treatment, the vertigo score of YXQNG group was 2.34, and that of the ND group was 4.18, the comparison between the two groups showed that the difference was significant ( P < 0.05 ). After treatment, the middle cerebral artery mean velocity (MCA Vm) of YXQNG group was 64.78 cm/s, vertebral artery mean velocity (VA Vm) was 29.78 cm/s, while that of ND group was 60.34 cm/s and 23.23 cm/s respectively, the comparison between these two groups showing statistical significance and the difference being obvious ( P <0.05). Experimental study showed that the rats in the model group after 12 weeks learning and memory were markedly lowered, the vertigo incubation period significantly lengthened, and compared with that of the model group, learning and memory of the YXQNG group was markedly improved and vertigo incubation period shortened, with the difference from that of the ND group insignificant, P >0.05. Conclusion: YXQNG could effectively improve CCI patients' vertigo and other clinical symptoms and increase the cerebral blood flow, lessen the vertigo incubation of model group rats, elevate model group rats' memory performance.
文摘AIM： To evaluate the effects of Helicobacter pylori infection on gastric epithelial cell kinetics in patients with chronic renal failure （CRF）. METHODS： Forty-four patients were enrolled in this study and divided into four groups with respect to their Helicobacter pylori （H pylori） and CRF status. Groups were labeled as follows： la： normal renal function, H pylori negative （n = 12）, lb： normal renal function, H pylori positive （n = 11）, 2a： CRF, H pylori negative （n = 10）, 2b： CRF, H pylori positive （n = 11）. Upper gastrointestinal endoscopy was done in all the patients involved in the study. During endoscopical investigation, antral biopsy specimens were taken from each patient. In order to evaluate the cell apoptosis and proliferation in gastric epithelial cells, Bax and proliferating cell nuclear antigen （PCNA） labeling indexes （LI） were assessed with immunohistochemical staining method. RESULTS： For groups la, lb, 2a, and 2b, mean Bax LI was identified as 34.4±13.7, 44.1±16.5, 46.3±20.5, 60.7±13.8, respectively and mean PCNA LI was identified as 36.2±17.2, 53.6±25.6, 59.5±25.6, 67.2±22, respectively. When the one-way ANOVA test was applied, statistically significant differences were detected between the groups for both Bax LI （P = 0.004 〈0.01） and PCNA LI （P = 0.009 〈0.01）. When groups were compared further in terms of Bax LI and PCNA LI with Tukey＇s HSD test for multiple pairwise comparisons, statistically significant difference was observed only between groups la and 2b （P = 0.006 〈0.01）.CONCLUSION： In gastric epithelial cells, expression of both the pre-apoptotic protein Bax and the proliferation marker PCNA increase with H pylori infection. This increase is more evident in patients with uremia. These findings suggest that uremia accelerates apoptosis and proliferation in gastric epithelial cells.
文摘BACKGROUND Secondary hyperparathyroidism,renal osteodystrophy,and cardiovascular adverse events can occur if long-term hyperphosphatemia is not corrected,leading to the adverse prognosis of patients with chronic renal failure.Besides the use of phosphorus binders,clinical control measures for hyperphosphatemia in these patients should also incorporate diet control.AIM To observe doctor-led intensive diet education effects on health-related quality of life in patients with chronic renal failure and hyperphosphatemia.METHODS We assessed 120 patients with hyperphosphatemia and chronic renal failure on hemodialysis admitted to our hospital(July 2018 to March 2020).The control group(n=60)was given routine nursing guidance,and the observation group(n=60)was given doctor-led intensive diet education.The changes in EQ-5D-3L scores,disease-related knowledge,and compliance scores before intervention and 3 and 6 mo after intervention in the two groups were recorded.The levels of serum parathyroid hormone(iPTH),calcium(Ca),phosphorus(P),calciumphosphorus product(Ca×P),serum creatinine(Scr),and blood urea nitrogen(BUN)before intervention and 3 and 6 mo after intervention in the two groups were assessed along with patient satisfaction.RESULTS There was no significant difference in blood iPTH,Ca,P,Ca×P,Scr,or BUN levels between the groups before intervention.After 3 and 6 mo of intervention,the blood iPTH,Ca,P,and Ca×P levels in the two groups decreased gradually(P<0.05),but there were no significant differences in Scr or BUN.The blood iPTH,Ca,P,and Ca×P levels in the observation group were lower than those in the control group(P<0.05).The satisfaction rate in the observation group after 3 mo was 93.33%and after 6,90.00%,which was high compared with the 80.00%and 71.67%,respectively,in the control group(P<0.05).There was no significant difference in EQ-5D-3L score between the two groups before intervention.After 3 and 6 mo of intervention,the visual analogue scale score of the two groups increased gradually(P<0.05);and the scores of action ability,self-care,daily activities,pain and discomfort,and anxiety and depression decreased gradually(P<0.05).The overall EQ-5D-3L score in the observation group was better than that in the control group(P<0.05).There was no significant difference in diseaserelated knowledge or compliance scores between the groups before intervention.After 3 and 6 mo of intervention,the scores of disease,diet,and medication knowledge and compliance in the two groups increased gradually(P<0.05).The scores of disease-related knowledge and compliance were higher in the observation group than in the control group(P<0.05).CONCLUSION Doctor-led intensive diet education can improve patient satisfaction and the quality of life in patients with chronic renal failure and hyperphosphatemia and promote low-phosphorus diet behavior.
文摘The level of urinary FPA was assayed by high per formance liquid chromatography (HPLC ) in 42 normal controls, 57 cases of chronic glomeru-lonephritis, including 24 with normal renal function, 12 with renal insufficiency and 21 with uremia. Their levels were 24. 40± 10. 30 μg/L, 26. 99±5.77 μg/L,38. 81±6. 28 μg/L, 79. 74± 18. 76 μg/L, respectively. The level of urinary FPA in renal insufficiency function group was significantly higher than those of the con-trol group and normal renal function group (P<0.01). The patients with uremia presented dramatically higher level of urinary FPA than those in the renal insufficiency group (P<0.01). A positive correlation was found between the level of urinary FPA and the blood creatine (r= 0. 9120, P<0. 01 ). It was suggested that a hypercoagulable state existed in the patients with chronic nephritis with renal failure, in which the severity was closely related with the occurrence and development of the disease. The urinary FPA could serve as a good indicator for renal function.
文摘AIM： To investigate the role of wireless capsule endoscopy （WCE） in detection of small bowel （SB） pathology in patients with chronic renal failure （CRF） and obscure bleeding. METHODS： Consecutive CRF patients with obscure bleeding were prospectively studied. Patients with normal renal function and obscure bleeding, investigated during the same period with WCE, were used for the interpretation of results. RESULTS： Seventeen CRF patients （11 overt, 6 occult bleeding） and 51 patients （33 overt, 18 occult bleeding） with normal renal function were enrolled in this study. Positive SB findings were detected in 70.6% of CRF patients and in 41.2% of non-CRF patients （P〈0.05）. SB angiodysplasia was identified in 47% of CRF patients and in 17.6% of non-CRF patients. Univariate logistic regression revealed CRF as a significant predictive factor for angiodysplasia （P〈0.05）. Therapeutic measures were undertaken in 66% of the patients with the positive findings. CONCLUSION： According to our preliminary results, SB angiodysplasia was found in an increased prevalence among CRF patients with obscure bleeding. WCE is useful in diagnosis of gastrointestinal pathologies and in planning appropriate therapeutic intervention and, therefore, should be included in the work-up of this group of patients.
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Background: Chronic Kidney Disease (CKD), associated with a slow and progressive loss of kidney function over a period of several years, is an important clinical disaster with an increasing rate of morbidity and mortality especially in the least developed countries. Many hematological parameters are thought to alter dramatically during the course of the disease. These include white blood cells, red blood cells, and platelets. Methods: We tried, retrospectively, to evaluate the peripheral blood hematological alterations in a group of patients undergoing hemodialysis in an eastern Sudan dialysis center to add local medical information. Results: Anemia (Low hemoglobin and hematocrit) was detected in 94% of the patients’ group. Mean Erythrocyte count (3.32vs.4.76 (×109/L)), Hemoglobin concentration (9.4vs.13 (g/dl)), Hematocrit (28.7vs.38.7 (L/L)) and platelet count (296 vs. 238 (×109/L)) were significantly lower in the patients’ group than in the control group (P-values Conclusion: Five out of eight studied parameters (Red cell count, hemoglobin, hematocrit, mean cell hemoglobin concentration, and platelets count) have shown a significant alteration in CKD patients. As the complete blood count (CBC) test is the most utilized test in clinical laboratory practice, these alterations may be considered as early indicators for CKD. Furthermore, all patients with CKD must be routinely checked for these alterations.
