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Clinicopathological features and outcomes of PLA2R-related membranous nephropathy with renal glycosuria. 伴有肾糖尿的 PLA2R 相关膜性肾病的临床病理特征和预后。
IF 1.1 4区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-11-01 DOI: 10.5414/CN111362
Piao Zhang, Feng Xu, Xumeng Liu, Ziyun Hu, Dandan Liang, Shaoshan Liang, Xiaodong Zhu, Fan Yang, Caihong Zeng

Background: Membranous nephropathy (MN) is an immune complex-mediated disease. Massive proteinuria can lead to Fanconi syndrome, clinically manifesting as renal glycosuria. The prevalence and prognosis of M-type phospholipase A2 receptor (PLA2R)-related MN with renal glycosuria remain unknown.

Materials and methods: Patients diagnosed with PLA2R-related MN with renal glycosuria were reviewed, and the control group comprised patients with MN without renal glycosuria who were randomly selected at a ratio of 1 : 3.

Results: 50 patients diagnosed with PLA2R-related MN with renal glycosuria from January 2015 to January 2020 were included, with a prevalence of 2.3%. Compared with patients without renal glycosuria, those with renal glycosuria exhibited greater proteinuria, lower estimated glomerular filtration rate (eGFR), and higher use of diuretics, anticoagulants, antibiotics, traditional Chinese medicine, and tacrolimus within 3 months prior to renal biopsy (all p < 0.05). Histologically, patients with renal glycosuria exhibited more severe pathological stages, acute/chronic tubulointerstitial lesions, and tubulointerstitial inflammation (all p < 0.05). Of the 10 patients treated with rituximab (RTX), proteinuria remission was maintained in 6 (60%) patients, and urine glucose remission was achieved in 5 of these 6 patients (83.3%). Multivariate Cox regression analysis showed that renal glycosuria and age > 50 years were independent risk factors for end-stage renal disease (ESRD) or a 30% reduction in the eGFR in patients with PLA2R-related MN.

Conclusion: PLA2R-related MN patients with renal glycosuria presented with more severe clinicopathological manifestations and worse prognoses. Nephrotoxic drugs should be administered rationally, and RTX should be considered as a promising treatment option.

背景:膜性肾病(MN)是一种由免疫复合物介导的疾病:膜性肾病(MN)是一种免疫复合物介导的疾病。大量蛋白尿可导致范可尼综合征,临床表现为肾糖尿。与 M 型磷脂酶 A2 受体(PLA2R)相关的肾性糖尿 MN 的发病率和预后仍不清楚:回顾性分析被诊断为PLA2R相关MN并伴有肾性糖尿的患者,对照组由随机抽取的不伴有肾性糖尿的MN患者组成,比例为1:3:结果:纳入了 50 名在 2015 年 1 月至 2020 年 1 月期间确诊为 PLA2R 相关 MN 并伴有肾性糖尿的患者,发病率为 2.3%。与无肾性糖尿的患者相比,有肾性糖尿的患者蛋白尿更多,估计肾小球滤过率(eGFR)更低,肾活检前3个月内使用利尿剂、抗凝剂、抗生素、中药和他克莫司的比例更高(均为50%),这些都是PLA2R相关MN患者发生终末期肾病(ESRD)或eGFR降低30%的独立危险因素:结论:伴有肾糖尿的 PLA2R 相关 MN 患者临床病理表现更严重,预后更差。应合理使用肾毒性药物,并将 RTX 作为一种有前景的治疗方案。
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引用次数: 0
Use of the Omaha System nursing model on nutritional status outcomes in peritoneal dialysis patients. 奥马哈系统护理模式对腹膜透析患者营养状况的影响。
IF 1.1 4区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-11-01 DOI: 10.5414/CN111385
Cen Zhang, Ruo Zhuang, Xiao-Lei Chen, Xiao-Dong Cao, Meng-Ting Xue

Objective: To construct and apply a risk screening and intervention system for malnutrition in peritoneal dialysis patients based on the Omaha System.

Materials and methods: A total of 75 peritoneal dialysis patients were randomly divided into control (38 cases) and intervention group (37 cases). The control group received routine operation training and health education, and the intervention group implemented a nutritional management plan based on the Omaha System. The modified quantitative subjective comprehensive nutritional scale (MQSGA) score, kidney disease dietary compliance attitude (RAAQ) and behavior (RABQ) score, body mass index (BMI), serum albumin (ALB), prealbumin (PA), and hemoglobin (Hb) were observed.

Results: Before intervention, there was no significant difference in these indicators between the two groups (p > 0.05). After 6 months, the MQSGA score in the intervention group was significantly lower than that in the control group (p < 0.05). RAAQ score and RABQ score in the intervention group were higher than those in the control group and (p < 0.05), and the nutritional indicators in the intervention group, such as BMI, ALB, PA, and Hb, were higher than those in the control group (p < 0.05).

Conclusion: A nutritional management plan based on the Omaha System can help improve the nutrition condition of peritoneal dialysis patients, and improve the dietary compliance of chronic kidney disease patients.

目的:根据奥马哈系统构建并应用腹膜透析患者营养不良风险筛查和干预系统:以奥马哈系统为基础,构建并应用腹膜透析患者营养不良风险筛查和干预系统:将 75 例腹膜透析患者随机分为对照组(38 例)和干预组(37 例)。对照组接受常规操作培训和健康教育,干预组实施基于奥马哈系统的营养管理计划。观察改良定量主观综合营养量表(MQSGA)评分、肾病饮食依从性态度(RAAQ)和行为(RABQ)评分、体重指数(BMI)、血清白蛋白(ALB)、前白蛋白(PA)和血红蛋白(Hb):结果:干预前,两组患者的上述指标无明显差异(P>0.05)。6 个月后,干预组的 MQSGA 评分明显低于对照组(P 结论:干预组的 MQSGA 评分明显高于对照组(P基于奥马哈系统的营养管理计划有助于改善腹膜透析患者的营养状况,提高慢性肾病患者的饮食依从性。
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引用次数: 0
Comparison of the efficacy of educational materials for chronic kidney disease during outpatient waiting time. 门诊候诊期间慢性肾病教育材料的效果比较。
IF 1.1 4区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-11-01 DOI: 10.5414/CN111413
Maiko Kimura, Daisuke Honda, Mizuyo Okura, Yuki Shiko, Yohei Kawasaki, Masashi Aizawa, Katsuhiko Asanuma

Aim: Patient education is crucial for preventing chronic kidney disease (CKD) progression, but adequate educational time is not always available in standard nephrology outpatient clinics. However, usefulness of educational materials provided by healthcare providers in educational settings has been reported. This study aimed to compare the efficacy of pamphlet and video materials in increasing CKD knowledge at a nephrology clinic using waiting time.

Materials and methods: 44 CKD stage 3 - 5 patients were randomly assigned to either pamphlet or video education group, receiving a single session during an outpatient visit. We evaluated the objective CKD knowledge score, perceived kidney disease knowledge score, self-care scores, and amount of estimated salt intake before and after the educational intervention.

Results: In both groups, the educational intervention significantly increased objective and perceived CKD knowledge scores (p < 0.001). No significant differences in increase in total knowledge scores between both groups were observed; however, different educational effects were observed in several individual knowledge items such as urinary protein and CKD stages. In both groups, self-care scores and amount of estimated salt intake did not change significantly before and after the intervention, but amount of estimated salt intake significantly decreased in patients with a history of dietary guidance (p = 0.044).

Conclusion: A single educational session with simple materials during outpatient waiting time at the nephrology clinic visit significantly improved patients' CKD knowledge, and suitable educational methods may differ according to knowledge items. Furthermore, patients who receive dietary guidance with specific instructions might exhibit salt reduction behavior through the use of educational materials.

目的:患者教育对预防慢性肾脏病(CKD)进展至关重要,但标准的肾脏病门诊并不总能提供充足的教育时间。不过,有报道称医疗服务提供者在教育环境中提供的教育材料非常有用。本研究旨在比较小册子和视频材料在肾科门诊利用候诊时间增加慢性肾脏病知识的效果。材料和方法:44 名慢性肾脏病 3-5 期患者被随机分配到小册子或视频教育组,在门诊就诊期间接受一次教育。我们评估了教育干预前后的客观肾脏病知识得分、感知肾脏病知识得分、自我护理得分以及估计的盐摄入量:在两组中,教育干预都显著提高了客观的肾脏病知识得分和感知的肾脏病知识得分(P < 0.001)。两组在知识总分的增加上无明显差异;但在尿蛋白和 CKD 分期等几个单项知识上,观察到了不同的教育效果。在干预前后,两组患者的自我护理得分和盐的估计摄入量没有明显变化,但有饮食指导史的患者盐的估计摄入量明显减少(p = 0.044):结论:在肾内科门诊候诊时间进行一次简单材料的教育可显著提高患者的慢性肾脏病知识水平,不同知识项目适合的教育方法可能不同。此外,接受有具体说明的饮食指导的患者可能会通过使用教育材料表现出减盐行为。
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引用次数: 0
Current use, training, and barriers in point-of-care ultrasound in nephrology: A national survey of VA medical centers. 肾内科护理点超声波的当前使用、培训和障碍:退伍军人医疗中心全国调查。
IF 1.1 4区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-11-01 DOI: 10.5414/CN111464
Kevin J Murray, Abhilash Koratala, Ariadna Perez-Sanchez, Terry Lund, Anthony Andrade, Steven M Gorbatkin, John M Duch, Sandipani Sandilya, Jorge Lamarche, Michael J Mader, Elizabeth K Haro, Nilam J Soni, Robert Nathanson

Background: Point-of-care ultrasound (POCUS) can improve diagnostic accuracy, reduce procedural complications and enhance physician-patient interactions in nephrology. Currently, there is limited knowledge about how practicing nephrologists are using POCUS.

Objective: This study aimed to characterize current POCUS use, training needs, and barriers to use among nephrology groups.

Materials and methods: A prospective observational study of all Veterans Affairs (VA) medical centers was conducted between August 2019 and March 2020 using a web-based survey sent to all chiefs of staff and nephrology specialty chiefs.

Results: Chiefs of staff (n = 130) and nephrology chiefs (n = 79) completed surveys on facility- and service-level POCUS use (response rates of 100% and 77%, respectively). Current diagnostic or procedural POCUS use was reported by 41% of nephrology groups, and the most common POCUS applications were central line insertion (28%) and assessment of urinary retention (23%), hydronephrosis (18%), volume status (15%), and bladder (14%). Lack of training was the most common barrier (72%), and most nephrology groups (65%) desired POCUS training. Limited access to ultrasound equipment and POCUS training were barriers reported by 54% and 18% of groups, respectively.

Conclusion: A minority of nephrology groups currently use common POCUS applications including evaluation of urinary retention, hydronephrosis, and volume status. The most common barriers to POCUS use in nephrology were lack of trained providers and ultrasound equipment. Investment in POCUS training and infrastructure is needed to expand and standardize POCUS use in nephrology.

背景:护理点超声检查(POCUS)可提高诊断准确性、减少手术并发症并加强肾脏病学领域的医患互动。目前,人们对肾内科医师如何使用 POCUS 的了解还很有限:本研究旨在了解肾脏内科医师目前使用 POCUS 的情况、培训需求以及使用障碍:在 2019 年 8 月至 2020 年 3 月期间,对所有退伍军人事务(VA)医疗中心进行了一项前瞻性观察研究,向所有参谋长和肾内科专科主任发送了一份网络调查:参谋长(n = 130)和肾内科主任(n = 79)完成了关于设施和服务层面 POCUS 使用情况的调查(回复率分别为 100% 和 77%)。41% 的肾内科小组报告了当前诊断性或程序性 POCUS 的使用情况,最常见的 POCUS 应用是中心管插入(28%)和尿潴留评估(23%)、肾积水(18%)、容量状态(15%)和膀胱(14%)。缺乏培训是最常见的障碍(72%),大多数肾病学组(65%)希望获得 POCUS 培训。分别有 54% 和 18% 的小组报告称,超声设备和 POCUS 培训的获取受到限制:结论:少数肾脏病学组目前使用常见的 POCUS 应用,包括评估尿潴留、肾积水和容量状态。肾内科使用 POCUS 的最常见障碍是缺乏训练有素的医疗人员和超声设备。需要对 POCUS 培训和基础设施进行投资,以扩大 POCUS 在肾内科的应用并使其标准化。
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引用次数: 0
The unsolved Gitelman's syndrome paradox and the hypomagnesemia/albuminuria relationship in type 2 diabetics. 尚未解决的吉特曼综合征悖论和 2 型糖尿病患者的低镁血症/白蛋白尿关系。
IF 1.1 4区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-10-30 DOI: 10.5414/CN111527
Martina Cacciapuoti, Lucia Federica Stefanelli, Lorenzo A Calò
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引用次数: 0
Determinants of the serum potassium concentration in chronic kidney disease. 慢性肾病患者血清钾浓度的决定因素。
IF 1.1 4区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-10-30 DOI: 10.5414/CN111490
Yinna Wang, Kenneth R Phelps, Darren E Gemoets, Elvira O Gosmanova

Background: If Ccr is creatinine clearance, a surrogate for glomerular filtration rate (GFR), the serum potassium concentration (Ks) is the sum of EK/Ccr and TRK/Ccr, which are amounts of potassium excreted and (net) reabsorbed per volume of filtrate (Ks = EK/Ccr + TRK/Ccr). We investigated changes in EK/Ccr, TRK/Ccr, and Ks through the stages of chronic kidney disease (CKD).

Materials and methods: We performed a retrospective study of 452 patients with CKD stages G1 - 5. Simultaneous measurements of serum and urine potassium and creatinine concentrations (Ks, Ku, crs, and cru) were used to calculate 1,007 individual values of EK/Ccr and TRK/Ccr as Ku×crs/cru and Ks - EK/Ccr, respectively. Mean values of EK/Ccr and TRK/Ccr were determined in CKD stages G1 - 5. Within each stage, means of the ratios were also ascertained in subsets with hyperkalemia (Ks > 5.1 mmol/L), normokalemia (Ks 3.8 - 5.1 mmol/L), and hypokalemia (Ks < 3.8 mmol/L).

Results: In comparison to values in CKD stages G1 - 2, EK/Ccr rose and TRK/Ccr fell in each higher stage. Decrements in TRK/Ccr equaled increments in EK/Ccr in G3a and G3b, and Ks remained stable. In G4 - 5, the ascent of EK/Ccr exceeded the decline in TRK/Ccr, and Ks rose accordingly. Within each CKD stage, EK/Ccr was remarkably similar in the three kalemic subsets; consequently, differences in TRK/Ccr were the sole source of differences in Ks.

Conclusion: EK/Ccr rises and TRK/Ccr falls through the stages of CKD. Ks remains stable in stages G3a - 3b in association with equal and opposite changes in EK/Ccr and TRK/Ccr. In stages G4 - 5, Ks increases progressively because EK/Ccr rises more than TRK/Ccr falls. Within each CKD stage, differences in TRK/Ccr account entirely for differences in Ks among hyper-, normo-, and hypokalemic subsets. Causes of variability of TRK/Ccr require additional investigation.

背景:如果 Ccr 是肌酐清除率(肾小球滤过率 (GFR) 的替代指标),那么血清钾浓度 (Ks) 就是 EK/Ccr 和 TRK/Ccr 的总和,即每滤液体积排出和(净)重吸收的钾量(Ks = EK/Ccr + TRK/Ccr)。我们研究了 EK/Ccr、TRK/Ccr 和 Ks 在慢性肾脏病(CKD)不同阶段的变化:我们对 452 名 CKD G1 - 5 期患者进行了回顾性研究。通过同时测量血清和尿液中的钾和肌酐浓度(Ks、Ku、crs 和 cru),计算出 1,007 个 EK/Ccr 和 TRK/Ccr 值,分别为 Ku×crs/cru 和 Ks - EK/Ccr。EK/Ccr 和 TRK/Ccr 的平均值按 CKD G1 - 5 期确定。在每个分期中,还确定了高钾血症(Ks > 5.1 mmol/L)、正常血钾(Ks 3.8 - 5.1 mmol/L)和低钾血症(Ks < 3.8 mmol/L)子群的比率平均值:与 CKD G1 - 2 期的数值相比,EK/Ccr 在每一个更高的阶段都会上升,而 TRK/Ccr 则会下降。在 G3a 和 G3b 阶段,TRK/Ccr 的下降与 EK/Ccr 的上升相等,而 Ks 保持稳定。在 G4 - 5 阶段,EK/Ccr 的上升超过了 TRK/Ccr 的下降,Ks 也相应上升。在每个慢性肾脏病分期中,EK/Ccr 在三个肾小球贫血亚组中都非常相似;因此,TRK/Ccr 的差异是 Ks 差异的唯一来源:结论:在 CKD 的各个阶段,EK/Ccr 会上升,TRK/Ccr 会下降。在 G3a - 3b 阶段,Ks 保持稳定,而 EK/Ccr 和 TRK/Ccr 的变化相同且相反。在 G4 - 5 期,由于 EK/Ccr 的上升幅度大于 TRK/Ccr 的下降幅度,Ks 逐渐增加。在每个 CKD 阶段中,TRK/Ccr 的差异完全解释了高钾、正常和低钾血症亚群之间 Ks 的差异。TRK/Ccr 变异的原因需要进一步研究。
{"title":"Determinants of the serum potassium concentration in chronic kidney disease.","authors":"Yinna Wang, Kenneth R Phelps, Darren E Gemoets, Elvira O Gosmanova","doi":"10.5414/CN111490","DOIUrl":"10.5414/CN111490","url":null,"abstract":"<p><strong>Background: </strong>If C<sub>cr</sub> is creatinine clearance, a surrogate for glomerular filtration rate (GFR), the serum potassium concentration (K<sub>s</sub>) is the sum of E<sub>K</sub>/C<sub>cr</sub> and TR<sub>K</sub>/C<sub>cr</sub>, which are amounts of potassium excreted and (net) reabsorbed per volume of filtrate (K<sub>s</sub> = E<sub>K</sub>/C<sub>cr</sub> + TR<sub>K</sub>/C<sub>cr</sub>). We investigated changes in E<sub>K</sub>/C<sub>cr</sub>, TR<sub>K</sub>/C<sub>cr</sub>, and K<sub>s</sub> through the stages of chronic kidney disease (CKD).</p><p><strong>Materials and methods: </strong>We performed a retrospective study of 452 patients with CKD stages G1 - 5. Simultaneous measurements of serum and urine potassium and creatinine concentrations (K<sub>s</sub>, K<sub>u</sub>, cr<sub>s</sub>, and cr<sub>u</sub>) were used to calculate 1,007 individual values of E<sub>K</sub>/C<sub>cr</sub> and TR<sub>K</sub>/C<sub>cr</sub> as K<sub>u</sub>×cr<sub>s</sub>/cr<sub>u</sub> and K<sub>s</sub> - E<sub>K</sub>/C<sub>cr</sub>, respectively. Mean values of E<sub>K</sub>/C<sub>cr</sub> and TR<sub>K</sub>/C<sub>cr</sub> were determined in CKD stages G1 - 5. Within each stage, means of the ratios were also ascertained in subsets with hyperkalemia (K<sub>s</sub> > 5.1 mmol/L), normokalemia (K<sub>s</sub> 3.8 - 5.1 mmol/L), and hypokalemia (K<sub>s</sub> < 3.8 mmol/L).</p><p><strong>Results: </strong>In comparison to values in CKD stages G1 - 2, E<sub>K</sub>/C<sub>cr</sub> rose and TR<sub>K</sub>/C<sub>cr</sub> fell in each higher stage. Decrements in TR<sub>K</sub>/C<sub>cr</sub> equaled increments in E<sub>K</sub>/C<sub>cr</sub> in G3a and G3b, and K<sub>s</sub> remained stable. In G4 - 5, the ascent of E<sub>K</sub>/C<sub>cr</sub> exceeded the decline in TR<sub>K</sub>/C<sub>cr</sub>, and K<sub>s</sub> rose accordingly. Within each CKD stage, E<sub>K</sub>/C<sub>cr</sub> was remarkably similar in the three kalemic subsets; consequently, differences in TR<sub>K</sub>/C<sub>cr</sub> were the sole source of differences in K<sub>s</sub>.</p><p><strong>Conclusion: </strong>E<sub>K</sub>/C<sub>cr</sub> rises and TR<sub>K</sub>/C<sub>cr</sub> falls through the stages of CKD. K<sub>s</sub> remains stable in stages G3a - 3b in association with equal and opposite changes in E<sub>K</sub>/C<sub>cr</sub> and TR<sub>K</sub>/C<sub>cr</sub>. In stages G4 - 5, K<sub>s</sub> increases progressively because E<sub>K</sub>/C<sub>cr</sub> rises more than TR<sub>K</sub>/C<sub>cr</sub> falls. Within each CKD stage, differences in TR<sub>K</sub>/C<sub>cr</sub> account entirely for differences in K<sub>s</sub> among hyper-, normo-, and hypokalemic subsets. Causes of variability of TR<sub>K</sub>/C<sub>cr</sub> require additional investigation.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142544122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Post-COVID-19 complement-mediated TMA: A case report. COVID-19 后补体介导的 TMA:病例报告。
IF 1.1 4区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-10-01 DOI: 10.5414/CN111217
Jan A Jochims, Babak Yazdani, Bernd Krüger, Zoran V Popovic, Bernhard K Krämer

Systemic COVID-19 disease is associated with a variety of organ involvement in infected patients. A rarely reported complication is the induction of complement-mediated thrombotic microangiopathy (TMA). TMA is an extremely rare pathological condition that results in thrombosis in capillaries and small arterioles, due to an endothelial injury. It is often combined with thrombocytopenia, Coombs-negative hemolytic anemia, and end-organ damage. This case involves a patient who was admitted to our hospital for the purpose of diagnosis and treatment of acute kidney injury (AKIN 3) with severe proteinuria after a preceding SARS-CoV-2 infection. A 77-year-old male patient had COVID-19 pneumonia in January 2021 with the need of high-flow oxygen therapy in the intensive care unit. In March 2021, he was hospitalized again due to elevated serum creatinine levels and proteinuria. The patient exhibited normal vital parameters. A renal biopsy showed severe TMA. A diagnosis of COVID-19-associated TMA was made, and treatment with high-dose glucocorticoid therapy and plasma exchange was initiated. Additionally, therapy with eculizumab was established. Unfortunately, the kidney failure was initially progressive, so that hemodialysis (HD) was temporarily necessary. In May 2021, kidney function recovered to an estimated glomerular filtration rate of ~ 30 mL/min/1.73m2 corresponding to chronic kidney disease stage 3bA3 - 4A3. COVID-19-associated TMA is an extremely rare disease. TMA may be a possible long-term complication with the risk of end-stage renal disease if not properly diagnosed and treated.

全身性 COVID-19 疾病与感染患者的多种器官受累有关。很少报道的一种并发症是诱发补体介导的血栓性微血管病(TMA)。血栓性微血管病是一种极其罕见的病理状态,由于内皮损伤而导致毛细血管和小动脉血栓形成。它通常与血小板减少症、库姆布斯阴性溶血性贫血和内脏损害并存。本病例中,一名患者在感染 SARS-CoV-2 之后,因急性肾损伤(AKIN 3)伴严重蛋白尿而入院接受诊断和治疗。一名 77 岁的男性患者于 2021 年 1 月患上 COVID-19 肺炎,需要在重症监护室接受高流量吸氧治疗。2021 年 3 月,他因血清肌酐水平升高和蛋白尿再次住院。患者的生命参数正常。肾活检显示其患有严重的 TMA。诊断结果为 COVID-19 相关 TMA,并开始接受大剂量糖皮质激素治疗和血浆置换治疗。此外,还开始使用依库珠单抗治疗。不幸的是,肾衰竭最初是进行性的,因此暂时需要进行血液透析(HD)。2021 年 5 月,肾功能恢复到约 30 mL/min/1.73m2 的肾小球滤过率,相当于慢性肾病 3bA3 - 4A3 期。COVID-19 相关 TMA 是一种极为罕见的疾病。如果没有得到正确的诊断和治疗,TMA 可能是一种长期并发症,具有终末期肾病的风险。
{"title":"Post-COVID-19 complement-mediated TMA: A case report.","authors":"Jan A Jochims, Babak Yazdani, Bernd Krüger, Zoran V Popovic, Bernhard K Krämer","doi":"10.5414/CN111217","DOIUrl":"10.5414/CN111217","url":null,"abstract":"<p><p>Systemic COVID-19 disease is associated with a variety of organ involvement in infected patients. A rarely reported complication is the induction of complement-mediated thrombotic microangiopathy (TMA). TMA is an extremely rare pathological condition that results in thrombosis in capillaries and small arterioles, due to an endothelial injury. It is often combined with thrombocytopenia, Coombs-negative hemolytic anemia, and end-organ damage. This case involves a patient who was admitted to our hospital for the purpose of diagnosis and treatment of acute kidney injury (AKIN 3) with severe proteinuria after a preceding SARS-CoV-2 infection. A 77-year-old male patient had COVID-19 pneumonia in January 2021 with the need of high-flow oxygen therapy in the intensive care unit. In March 2021, he was hospitalized again due to elevated serum creatinine levels and proteinuria. The patient exhibited normal vital parameters. A renal biopsy showed severe TMA. A diagnosis of COVID-19-associated TMA was made, and treatment with high-dose glucocorticoid therapy and plasma exchange was initiated. Additionally, therapy with eculizumab was established. Unfortunately, the kidney failure was initially progressive, so that hemodialysis (HD) was temporarily necessary. In May 2021, kidney function recovered to an estimated glomerular filtration rate of ~ 30 mL/min/1.73m<sup>2</sup> corresponding to chronic kidney disease stage 3bA3 - 4A3. COVID-19-associated TMA is an extremely rare disease. TMA may be a possible long-term complication with the risk of end-stage renal disease if not properly diagnosed and treated.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"232-237"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141751294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Biopsy-proven BK virus nephropathy in renal transplant recipients: A multi-central study from Turkey (BK-TURK STUDY). 肾移植受者中经活检证实的 BK 病毒肾病:土耳其多中心研究(BK-TURK STUDY)。
IF 1.1 4区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-10-01 DOI: 10.5414/CN111300
Ozkan Gungor, Hamad Dheir, Mahmud Islam, Huseyin Toz, Abdulmecit Yildiz, Ayse Sinangil, Erhan Tatar, Gulay Asci, Ozkan Ulutas, Eda Altun, Orcun Altunoren, Suheyla Apaydin, Alparslan Ersoy, Berfu Korucu, Seda Safak, Ulver Derici, Saliha Yildirim, Nurhan Seyahi, Seyda Gul Ozcan, Kadir Gokhan Atilgan, Mehmet Deniz Ayli, Caner Cavdar, Ozcan Uzun, Rahmi Yilmaz, Arda Erdut, Mustafa Sevinc, Umut Kasapoğlu, Ismail Kocyigit, Cihan Uysal, Kultigin Turkmen, Hakan Ozer, Arzu Velioglu, Ebru Ok, Bulent Kaya, Zulfikar Yilmaz, Oktay Ozkan, Egemen Cebeci, Kenan Turgutalp, Meltem Gursu, Enver Yuksel, Necmi Eren, Erkan Dervisoglu, Fatma Betul Guzel, Gursel Yildiz, Serkan Bakirdogen, Ayca Inci, Can Sevinc, Aydin Turkmen

Aim: BK polyomavirus infection is a challenging complication of renal transplantation. The management is not standardized and is based on reports from transplantation centers' experiences, usually with small sample sizes. Therefore, we aimed to present our countrywide experience with BK virus nephropathy (BKVN) in renal transplant recipients.

Materials and methods: Our study was carried out with the participation of 30 transplantation centers from all regions of Turkey. Only cases with allograft biopsy-proven BKVN were included in the study.

Results: 13,857 patients from 30 transplantation centers were screened, and 207 BK nephropathy cases were included. The mean age was 46.4 ±  13.1 years, and 146 (70.5%) patients were male. The mean time to diagnosis of BK nephropathy was 15.8 ± 22.2 months after transplantation. At diagnosis, the mean creatinine level was 1.8 ±  0.7 mg/dL, and the mean estimated glomerular filtration rate was 45.8 ± 19.6 mL/min/1.73m2. In addition to dose reduction or discontinuation of immunosuppressive drugs, 18 patients were treated with cidofovir, 11 patients with leflunomide, 17 patients with quinolones, 15 patients with intravenous immunoglobulin (IVIG), 5 patients with cidofovir plus IVIG, and 12 patients with leflunomide plus IVIG. None of the patients receiving leflunomide or leflunomide plus IVIG had allograft loss. During follow-up, allograft loss occurred in 32 (15%) out of 207 patients with BK nephropathy.

Conclusion: BKVN is still a frequent cause of allograft loss in kidney transplantation and is not fully elucidated. The results of our study suggest that leflunomide treatment is associated with more favorable allograft outcomes.

目的:BK 多瘤病毒感染是肾移植手术中一种具有挑战性的并发症。目前的处理方法还不规范,主要基于移植中心的经验报告,通常样本量较小。因此,我们旨在介绍全国范围内肾移植受者BK病毒肾病(BKVN)的治疗经验:我们的研究由来自土耳其所有地区的 30 家移植中心共同参与。只有经活检证实患有异体移植 BKVN 的病例才被纳入研究范围:筛选了来自 30 个移植中心的 13857 名患者,其中包括 207 例 BK 肾病病例。平均年龄为(46.4 ± 13.1)岁,146 例(70.5%)患者为男性。BK 肾病的平均诊断时间为移植后 15.8 ± 22.2 个月。确诊时,平均肌酐水平为 1.8 ± 0.7 mg/dL,平均肾小球滤过率为 45.8 ± 19.6 mL/min/1.73m2 。除了减量或停用免疫抑制剂外,18 名患者接受了西多福韦酯治疗,11 名患者接受了来氟米特治疗,17 名患者接受了喹诺酮类药物治疗,15 名患者接受了静脉注射免疫球蛋白(IVIG)治疗,5 名患者接受了西多福韦酯加 IVIG 治疗,12 名患者接受了来氟米特加 IVIG 治疗。在接受来氟米特或来氟米特加 IVIG 治疗的患者中,没有人发生同种异体移植物丢失。在随访期间,207 名 BK 肾病患者中有 32 人(15%)发生了同种异体移植损失:结论:BKVN仍是肾移植中导致同种异体移植物丢失的一个常见原因,目前尚未完全阐明。我们的研究结果表明,来氟米特治疗与更有利的异体移植结果相关。
{"title":"Biopsy-proven BK virus nephropathy in renal transplant recipients: A multi-central study from Turkey (BK-TURK STUDY).","authors":"Ozkan Gungor, Hamad Dheir, Mahmud Islam, Huseyin Toz, Abdulmecit Yildiz, Ayse Sinangil, Erhan Tatar, Gulay Asci, Ozkan Ulutas, Eda Altun, Orcun Altunoren, Suheyla Apaydin, Alparslan Ersoy, Berfu Korucu, Seda Safak, Ulver Derici, Saliha Yildirim, Nurhan Seyahi, Seyda Gul Ozcan, Kadir Gokhan Atilgan, Mehmet Deniz Ayli, Caner Cavdar, Ozcan Uzun, Rahmi Yilmaz, Arda Erdut, Mustafa Sevinc, Umut Kasapoğlu, Ismail Kocyigit, Cihan Uysal, Kultigin Turkmen, Hakan Ozer, Arzu Velioglu, Ebru Ok, Bulent Kaya, Zulfikar Yilmaz, Oktay Ozkan, Egemen Cebeci, Kenan Turgutalp, Meltem Gursu, Enver Yuksel, Necmi Eren, Erkan Dervisoglu, Fatma Betul Guzel, Gursel Yildiz, Serkan Bakirdogen, Ayca Inci, Can Sevinc, Aydin Turkmen","doi":"10.5414/CN111300","DOIUrl":"10.5414/CN111300","url":null,"abstract":"<p><strong>Aim: </strong>BK polyomavirus infection is a challenging complication of renal transplantation. The management is not standardized and is based on reports from transplantation centers' experiences, usually with small sample sizes. Therefore, we aimed to present our countrywide experience with BK virus nephropathy (BKVN) in renal transplant recipients.</p><p><strong>Materials and methods: </strong>Our study was carried out with the participation of 30 transplantation centers from all regions of Turkey. Only cases with allograft biopsy-proven BKVN were included in the study.</p><p><strong>Results: </strong>13,857 patients from 30 transplantation centers were screened, and 207 BK nephropathy cases were included. The mean age was 46.4 ±  13.1 years, and 146 (70.5%) patients were male. The mean time to diagnosis of BK nephropathy was 15.8 ± 22.2 months after transplantation. At diagnosis, the mean creatinine level was 1.8 ±  0.7 mg/dL, and the mean estimated glomerular filtration rate was 45.8 ± 19.6 mL/min/1.73m<sup>2</sup>. In addition to dose reduction or discontinuation of immunosuppressive drugs, 18 patients were treated with cidofovir, 11 patients with leflunomide, 17 patients with quinolones, 15 patients with intravenous immunoglobulin (IVIG), 5 patients with cidofovir plus IVIG, and 12 patients with leflunomide plus IVIG. None of the patients receiving leflunomide or leflunomide plus IVIG had allograft loss. During follow-up, allograft loss occurred in 32 (15%) out of 207 patients with BK nephropathy.</p><p><strong>Conclusion: </strong>BKVN is still a frequent cause of allograft loss in kidney transplantation and is not fully elucidated. The results of our study suggest that leflunomide treatment is associated with more favorable allograft outcomes.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"202-211"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141733701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Association of vitamin intake with health-related quality of life in hemodialysis patients. 血液透析患者维生素摄入量与健康相关生活质量的关系。
IF 1.1 4区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-10-01 DOI: 10.5414/CN111306
Ursula Alchabab, Razane El Hajj Chehade, Chloe Kharsa, Rebecca Kassab, Serena Maria Dib, Dania Chelala, Jenny Hawi, Celine Boueri, Hiba Azar, Serge Finianos, Ibrahim Abdo, Chadia Beaini, Mabel Aoun

Background: It is still uncertain whether vitamin intake is associated with better quality of life in hemodialysis patients. This study aims to assess the association between the quantity of supplemented vitamins and health-related quality of life (HRQoL) in this population.

Materials and methods: This cross-sectional study included all patients on chronic hemodialysis from three units. Vitamins and micronutrients assessed were B1, B6, B12, C, D, folic acid, menaquinone, carnitine, zinc, and coenzyme Q10. Quality of life scores included the 8 domains of SF-36 and the 11 domains of the Kidney Disease Quality of Life (KDQOL). Bivariate analysis compared two groups of patients divided based on the median of vitamin intake. Spearman Rho test assessed the correlation between number of vitamins and different dimensions of HRQoL.

Results: A total of 183 patients were included. Median number of vitamins supplemented was 2 (1,3); 112 patients had an intake of ≤ 2 vitamins, and 71 patients were taking > 2 vitamins. There was a significant association between higher vitamin intake and the burden of kidney disease that remained significant in the multivariable analysis (p = 0.03), but no correlation between the number of vitamins (0 - 13) and different HRQoL scores. Sub-analyses of each category of vitamins showed no significant difference in HRQoL scores except for Vitamin B and staff encouragement (p = 0.01) and for multivitamins and quality of social interaction (p = 0.03).

Conclusion: A higher number of vitamins in hemodialysis patients is associated with an increased perception of the burden of kidney disease. Interventional studies are needed to assess whether selective vitamin supplementation in case of deficiencies is associated with better quality of life.

背景:维生素摄入量是否与血液透析患者生活质量的提高有关,目前仍不确定。本研究旨在评估血液透析患者补充维生素的数量与健康相关生活质量(HRQoL)之间的关系:这项横断面研究包括三个单位的所有慢性血液透析患者。评估的维生素和微量营养素包括 B1、B6、B12、C、D、叶酸、甲萘醌、肉毒碱、锌和辅酶 Q10。生活质量评分包括 SF-36 的 8 个领域和肾病生活质量 (KDQOL) 的 11 个领域。双变量分析比较了根据维生素摄入量中位数划分的两组患者。Spearman Rho 检验评估了维生素摄入量与 HRQoL 不同维度之间的相关性:结果:共纳入 183 名患者。补充维生素的中位数为 2(1,3)种;112 名患者的维生素摄入量少于 2 种,71 名患者的维生素摄入量大于 2 种。维生素摄入量较高与肾脏疾病负担之间存在明显的关联,这种关联在多变量分析中仍有意义(p = 0.03),但维生素数量(0 - 13)与不同的 HRQoL 评分之间没有关联。对各类维生素进行的子分析表明,除维生素 B 和员工鼓励(p = 0.01)以及多种维生素和社会交往质量(p = 0.03)外,其他维生素在 HRQoL 评分中均无显著差异:结论:血液透析患者维生素摄入量增加与肾病负担感知增加有关。需要进行干预性研究,以评估在缺乏维生素的情况下选择性补充维生素是否会提高生活质量。
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引用次数: 0
Influenza vaccination-associated cryoglobulinemic vasculitis. 流感疫苗接种相关的冷球蛋白血症血管炎。
IF 1.1 4区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-10-01 DOI: 10.5414/CN111383
Estelle Taki, Stephanie Wirtshafter, Abdallah S Geara

Mixed cryoglobulinemia is a small vessel vasculitis associated with viral infections, mainly hepatitis C virus, however, other important causes include lymphoproliferative and autoimmune disorders. Influenza vaccine-induced cryoglobulinemia has been rarely reported. A 68-year-old male presented on three occasions following influenza vaccination with purpuric rash and lower extremities swelling. His lab work showed mixed cryoglobulins. On his most recent presentation, in addition to the purpura, he presented with thrombocytopenia and nephritic syndrome. A kidney biopsy showed endocapillary proliferative glomerulonephritis with organized deposits, consistent with mixed type cryoglobulinemic glomerulonephritis. The patient was treated with rituximab infusion with progressive improvement of the acute kidney injury (AKI) and complete recovery. It is unclear why cryoglobulins are produced as a response to a vaccination, but this association is important to be aware of for prompt monitoring and treatment.

混合型低温球蛋白血症是一种与病毒感染(主要是丙型肝炎病毒)相关的小血管炎,但其他重要原因还包括淋巴增生性疾病和自身免疫性疾病。流感疫苗诱发的冷球蛋白血症鲜有报道。一名 68 岁的男性在接种流感疫苗后三次出现紫癜性皮疹和下肢肿胀。他的实验室检查结果显示存在混合型低温球蛋白。最近一次就诊时,除了紫癜外,他还出现了血小板减少和肾炎综合征。肾脏活检显示,肾小球内毛细血管增生性肾小球肾炎伴有有组织沉积,与混合型冷球蛋白血症肾小球肾炎一致。患者在接受利妥昔单抗输注治疗后,急性肾损伤(AKI)逐渐好转并完全康复。目前还不清楚为什么接种疫苗后会产生冷凝球蛋白,但这种关联对于及时监测和治疗非常重要。
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引用次数: 0
期刊
Clinical nephrology
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