Clinical nephrology最新文献

Background: Refractory peritonitis is one of the leading causes of catheter failure in peritoneal dialysis (PD) patients. However, there are no established curative therapies available, and only catheter removal should be performed. Here we present a case series study to illustrate the efficacy of antibiotic lock for PD-associated refractory peritonitis.

Materials and methods: Patients with refractory peritonitis treated with intraperitoneal antibiotics plus antibiotic lock from September 2020 to March 2022 were retrospectively analyzed. Medical cure was identified as a success of treatment.

Results: We identified 11 patients, of which 7 (63.64%) had a history of PD-associated peritonitis, with the episode of continuous ambulatory peritoneal dialysis (CAPD) ranging from 1 to 158 months at a median of 36 (9.5, 50.5) months. The dialysis effluent culture showed Gram-positive, Gram-negative bacteria, and was culture-negative in 5, 2, and 4 cases, respectively. The cure rates were 85.71% for culture-positive cases and 25% for culture-negative cases, and the total cure rate was 63.64%. No relevant adverse events occurred, including sepsis.

Conclusions: Treatment with the additional antibiotic lock was successful in most cases, especially in those that were culture-positive. Additional antibiotic lock deserves great attention and further investigation in treating PD-associated refractory peritonitis.

Objectives: Non-infectious complications of peritoneal dialysis (NICPD) are common and could be an important cause of technical failure, especially in the early period of peritoneal dialysis (PD) initiation. NICPD are also center- and provider-dependent. This study aimed to investigate the frequency, etiology, and associated outcomes of NICPD in a single center over a period of 20 years.

Materials and methods: Data were retrospectively collected in 262 patients who were initiated on PD between April 2001 and April 2021. Inclusion criteria were age 18 years or older and a minimum follow-up period of 3 months. Patients were grouped according to the reason of NICPD: catheter-related, increased intra-abdominal pressure-related, metabolic, and other complications.

Results: There were 142 females and 120 males in the study, with a mean age of 44 ± 16.9 years. The mean time on PD was 52.6 ± 40 months. During the follow-up period, 185 (71%) patients experienced 382 NICPD episodes. 26 patients (9.9%) were switched to maintenance hemodialysis (HD) due to NICPD. Outflow failure was the most common NICPD (n = 97). It was also the most common reason for catheter revision (n = 23) and PD discontinuation (n = 12). Catheter intervention was required in 32 patients (12.2%). Prior HD treatment and male gender were independent risk factors for NICPD and catheter-related complications (OR 2.076; p = 0.037; OR: 1.797, p = 0.042, respectively). Early-start PD was associated with a lower risk for NICPD development (OR: 0.393, p = 0.013).

Conclusion: In this select cohort of PD patients, we found that NICPD are common and outflow failure is the most common cause of NICPD. NICPD are associated with major complications requiring catheter removal or transfer to in-center HD. Early recognition and appropriate management of NICPD are essential to prolonging time on PD in end-stage renal disease patients.

Purpose: To evaluate the formation of encrustation on double J stents (DJSs) using artificial urine.

Materials and methods: In this study, a static urinary system containing artificial urine was created, and a total of 45 DJSs were used to evaluate the formation of encrustation. Three groups of 15 DJSs were tested for 4, 8, or 14 weeks. The formation of encrustation on the DJSs over the weeks was analyzed using methods including X-ray powder diffraction (XRD), inductively coupled plasma spectrophotometer (ICP), and scanning electron microscope (SEM). Statistical analysis and the uncertainty test were used for data analysis using R language.

Results: The ICP analyzed the weight of the calcium and magnesium, which are the major components of urinary stones and encrustation, and showed that it was the heaviest at 14 weeks. Measurement of the area of encrustation on the outer surface of the DJSs revealed that the encrustation area at the bottom of the stent was greater than that at the top of the stent, regardless of the experimental period (proximal part: ≤ 41,099 µm², distal part: ≤ 183,259 µm²). Encrustation occurred around the side holes of DJSs and became bigger over time to fill up the side holes.

Conclusion: Encrustation spots included the bottom zone of the DJS and around the side holes. These results indicate that the performance of DJSs would be improved by modifying the shape of DJSs located near the bladder and side holes.

Background and aims: Electrolyte and acid-base disturbances are common in kidney transplant recipients, but there are few reports of low-solute hyponatremia or beer potomania in this population. We report herein a case of low-solute hyponatremia in a kidney transplant recipient with impaired graft function, highlighting key issues in diagnosis and management of low-solute hyponatremia, as well as exploring the pathophysiology of hyponatremia after kidney transplantation.

Case presentation: A 51-year-old man who had received a cadaveric renal transplant 18 years before presented with symptomatic hyponatremia and seizure. Workup for an underlying intracranial pathology was negative, and subsequent biochemical workup suggested low-solute hyponatremia with potomania, arising from dietary modifications taken by the patient while self-isolating during the COVID-19 pandemic. Correction of hyponatremia was successful with conservative management with close monitoring.

Conclusion: This case illustrates key points in the diagnosis and management of low-solute hyponatremia and highlights the pathophysiology of hyponatremia after kidney transplantation.

Background: HbA1c variability may be related to risk of poor prognoses in chronic kidney disease patients with type 2 diabetes mellitus (T2DM). The aim of this study was to investigate whether HbA1c variability is associated with rapid renal function decline and the related risk factors in type 2 diabetic nephropathy (DN).

Materials and methods: An observational analysis was performed on 387 DN patients who were diagnosed by kidney biopsy from January 2006 through January 2016 at the Department of Nephrology, Jinling Hospital Affiliated to Nanjing University. The rapid decliners were defined as an estimated glomerular filtration rate (eGFR) decline slope ≥ 5 mL/min/1.73m²/year. HbA1c variability and 24 baseline clinicopathologic parameters was evaluated using the least absolute shrinkage and selection operator regression (LASSO) and multivariate logistic regression. The nomogram method was applied to score the factors, and a scoring model was constructed.

Results: HbA1c variability positively correlated with the rate of renal function decline (r = 0.277; p < 0.001). Higher baseline eGFR, lower serum calcium concentration, glomerular lesions, arteriosclerosis, and interstitial fibrosis and tubular atrophy (IFTA) were selected into the nomogram. The calibration curve for the probability of survival showed good agreement between the prediction by nomogram and actual observation. The C-index for predicting survival was 0.811 (95% confidence interval (CI) 0.680 - 0.785).

Conclusion: The proposed nomogram and score provide a useful risk estimate of fast renal function decline in patients with type 2 diabetic nephropathy.

Introduction: Bioimpedance methods are currently used abundantly in patients on chronic hemodialysis. In this population, their most important role is to determine the level of fluid volume, respectively its intra- and extracellular components. There are several bioimpedance devices on the market. In this project, we compared two frequently used devices: Body Composition Monitor and InBody S10.

Materials and methods: We invited patients on chronic hemodialysis who are being treated in our institution. Inclusion criteria were: clinically stable condition, lack of artificial joints, pacemakers, or other implanted metal objects. The examinations were performed just prior to hemodialysis by both methods 5 minutes apart. Patients were examined in the supine position after 15 minutes at rest to stabilize body fluids. Studied parameters were those that are obtainable by both methods: total body water (TBW) (L), extracellular water (ECW) (L) and intracellular water (ICW) (kg), lean tissue mass (LTM) (L), and fat tissue mass (kg).

Results: We included 14 participants (aged 64.4 ± 18.0 years). Statistically and clinically significant differences between data from compared devices were observed for all variables. Inbody S10 overestimated TBW by 2.58 ± 2.73 L and ICW by 4.56 ± 2.27 L in comparison to BCM. The highest difference (27%) was measured for LTM and ICW 22%. LTM, fat, and ECW were higher when measured by BCM (LTM by 8.54 ± 6.43 kg, p < 0.001; fat by 3.41 ± 4.22, p = 0.01; ECW by 2.01 ± 0.89 L, p < 0.001).

Conclusion: The differences between tested devices were significant not only statistically, but also clinically. These two devices cannot be used interchangeably for dry weight setting of hemodialysis patients.

Billions of doses of COVID-19 vaccine have been administered to combat the coronavirus pandemic. Though the vaccine is generally well tolerated, several cases of new onset or relapsing glomerulonephritis have been reported. In comparison, post-vaccination tubulointerstitial nephritis (TIN) has rarely been reported, mostly after the first or the second dose of the vaccine. Acute interstitial nephritis after booster dose of COVID-19 vaccination has not yet been reported. We report a case of acute granulomatous TIN shortly after the booster dose of Moderna vaccine. Our patient had no clinical evidence of renal injury after the first two doses of vaccine. Renal dysfunction was incidentally observed ~ 1 month after the booster dose of vaccine. The patient responded to steroids with rapid improvement in kidney function. While it is difficult to ascertain the causal relationship between the vaccination and development of TIN, it is important to be vigilant about such delayed side effects of the vaccine.

Aims: To investigate whether serum albumin level at peritoneal dialysis (PD) initiation is associated with mortality in end-stage kidney disease (ESKD) patients.

Materials and methods: We retrospectively reviewed the records of ESKD patients on continuous ambulatory PD during 2015 - 2021. Patients with initial albumin ≥ 3 mg/dL were placed in the high albumin group and those with albumin < 3 mg/dL in the low albumin group. A Cox proportional hazards model was used to identify variables influencing survival.

Results: Among 77 patients, 46 were in the high albumin group and 31 in the low albumin group. The high albumin group had significantly increased cardiovascular (1-, 3-, and 5-year cumulative survival rates of 93 vs. 83%, 81 vs. 64%, and 81 vs. 47%, respectively; log-rank p = 0.016) and overall survival (1-, 3-, and 5-year cumulative survival rates of 84 vs. 77%, 67 vs. 50%, and 60 vs. 29%, respectively; log-rank p = 0.017). Serum albumin < 3 g/dL was an independent predictor of cardiovascular (hazard ratio (HR) 4.401; 95% confidence interval (CI), 1.584 - 12.228; p = 0.004) and overall survival (HR 2.927; 95% CI 1.443 - 5.934, p = 0.003).

Conclusion: Low albumin levels at PD initiation are an independent risk factor for decreased cardiovascular and overall survival. Further research is required to know whether increasing albumin levels before PD would decrease mortality.

Aims: Renal osteodystrophy occurs in the early stages of chronic kidney disease (CKD) and progresses during loss of kidney function. Fibroblast growth factor (FGF)-23 and sclerostin, both produced by osteocytes, are increased in blood of patients with CKD. The aim of this study was to analyze the impact of decline in kidney function on FGF-23 and sclerostin protein expression in bone and to study their relationship with their serum levels and bone histomorphometry.

Materials and methods: 108 patients aged 25 - 81 years (mean ± SD: 56 ± 13 years) underwent anterior iliac crest biopsies after double-tetracycline labeling. Eleven patients were CKD-2, 16 were CKD-3, 9 were CKD-4 - 5, and 64 CKD-5D. Patients were on hemodialysis for 49 ± 117 months. 18 age-matched patients without CKD were included as controls. Immunostaining was performed on undecalcified bone sections to quantify FGF-23 and sclerostin expression. Bone sections were also evaluated by histomorphometry for bone turnover, mineralization, and volume.

Results: FGF-23 expression in bone correlated positively with CKD stages (p < 0.001) increasing from 5.3- to 7.1-fold starting at CKD-2. No difference in FGF-23 expression was seen between trabecular and cortical bone. Sclerostin expression in bone correlated positively with CKD stages (p < 0.001) with an increase from 3.8- to 5.1-fold starting at CKD-2. This increase was progressive and significantly greater in cortical than cancellous bone. FGF-23 and sclerostin in blood and bone were strongly associated with bone turnover parameters. Expression of FGF-23 in cortical bone correlated positively with activation frequency (Ac.f) and bone formation rate (BFR/BS) (p < 0.05), while sclerostin correlated negatively with Ac.f, BFR/BS, and osteoblast and osteoclast numbers (p < 0.05). FGF-23 trabecular and cortical expressions correlated positively with cortical thickness (p < 0.001). Sclerostin bone expression correlated negatively with parameters of trabecular thickness and osteoid surface (p < 0.05).

Conclusion: These data show a progressive increase in FGF-23 and sclerostin in blood and bone associated with decrease in kidney function. The observed relationships between bone turnover and sclerostin or FGF-23 should be considered when treatment modalities are developed for management of turnover abnormalities in CKD patients.