Clinical nephrology最新文献

Objective: The aim of this study was to determine the prevalence of renal insufficiency in patients with lung cancer and factors associated with its development.

Materials and methods: All patients at the First Affiliated Hospital of Guangzhou Medical University from January 1 to December 31, 2016 who had lung cancer were included in this study. Baseline characteristics, including age, sex, clinical features, estimated glomerular filtration rate (eGFR), echocardiographic findings, electrocardiogram results, and biochemical indicators were collected retrospectively. eGFR was divided into three categories: ≥ 60, 45 - 59, and < 45 mL/min/1.73m². Renal insufficiency was defined as eGFR < 60 mL/min/1.73m². The prevalence of co-occurring lung cancer and renal insufficiency as well as factors associated with it were also studied.

Results: A total of 140 patients with a lung cancer diagnosis confirmed by pathologic examination were included. The prevalence of eGFR ≥ 60, 45 - 59, and < 45 mL/min/1.73m² categories was 77.14%, 12.14%, and 10.71%, respectively. The lung cancer subtypes were adenocarcinoma (102 cases (72.86%)), squamous cell carcinoma (23 cases (16.43%)), and small cell carcinoma (15 cases (10.71%)). Logistic regression analysis showed that age (odds ratio (OR), 5.522; 95% CI, 2.712 - 11.243; p < 0.001), proteinuria (OR, 4.832; 95% CI, 1.518 - 15.383; p = 0.008), and thyroid-specific transcription factor-1 (TTF-1) positivity (OR, 5.730; 95% CI, 1.509 - 21.754; p = 0.010) were independently associated with eGFR category < 60 mL/min/1.73m². Age (OR, 2.372; 95% CI, 1.331 - 4.228; p = 0.003) and TTF-1 positivity (OR, 12.791; 95% CI, 3.394 - 49.575; p < 0.001) were independently associated with eGFR category 45 - 59 mL/min/1.73m2. Finally, age (OR, 4.083; 95% CI, 1.979 - 8.426; p < 0.001), low albumin (OR, 9.05; 95% CI, 1.335 - 61.349; p = 0.024), and hyperuricemia (OR, 4.974; 95% CI, 1.22 - 20.282; p = 0.025) were independently associated with eGFR category < 45 mL/min/1.73m².

Conclusion: Renal function is an important parameter to monitor in patients undergoing lung cancer treatment. The patient's age and presence of proteinuria, low albumin, hyperuricemia, and TTF-1 positivity in lung cancer are all independently associated with renal insufficiency in these patients. To ensure safe recovery and discharge after lung cancer treatment, factors associated with renal insufficiency should be recognized during treatment. Large-scale multicenter trials are warranted for further validation of these findings.

Background: Cushing's syndrome is a rare cause of secondary hypertension. There are several mechanisms reported as contributing factors for blood pressure elevation in hypercortisolism patients. This case highlights the central role of mineralocorticoid receptors' activation by the excess cortisol in the development of hypertension.

Case presentation: A 45-year-old male presented with several months of cushingoid features and refractory hypertension on maximum doses of five antihypertensive drugs, not including a mineralocorticoid receptor blocker. Workup for other causes of secondary hypertension revealed sleep apnea but was otherwise negative. Further evaluation revealed a carcinoid lung tumor as the cause of Cushing's syndrome with its ectopic production of adrenocorticotropic hormone (ACTH). Prior to the resection of this tumor, the addition of eplerenone, a mineralocorticoid receptor blocker, resulted in significant improvement in blood pressure within 4 weeks, highlighting that cortisol activation of mineralocorticoid receptors is one of the main mechanisms of hypertension in this patient with hypercortisolism.

Conclusion: In hypercortisolism patients, some excess cortisol escapes deactivation by the 11β-hydroxysteroid dehydrogenase 2 enzyme in the kidney and directly activates mineralocorticoid receptors. Recent literature suggests that specific patient populations have subtle elevations in cortisol levels, and cortisol's effect on end-organ damage follows a spectrum from high-normal cortisol to overt hypercortisolism. Other data suggest a decline in 11β-hydroxysteroid dehydrogenase 2 enzyme activity with age. Additional research is needed to further define the role of cortisol-mineralocorticoid receptor interaction in hypertension among patients without overt hypercortisolism but with high-normal cortisol or low 11β-hydroxysteroid dehydrogenase 2 enzymatic activity.

Background: Acute kidney injury (AKI) is a clinically complex syndrome with a high incidence and mortality rate in the intensive care unit (ICU). Early identification of high-risk patients and timely intervention are crucial.

Objective: A local database was used to construct a model that predicts the incidence of AKI in ICU patients within 48 hours.

Materials and methods: We conducted a study involving 9,628 critically ill patients at Zhejiang Provincial People's Hospital and divided the cohort into derivation and validation groups. We collected and analyzed demographic data, vital signs, laboratory tests, medications, clinical interventions, and other information for all patients, resulting in a total of 232 variables. Six different machine learning algorithms were employed to construct models, and the optimal model was selected and validated.

Results: A total of 2,441 patients were included, of whom 1,138 (46.62%) met the AKI criteria. A model was derived that included 16 variables such as albumin transfusion, fluid balance, diastolic blood pressure (DBP), partial pressure of oxygen (PO₂), blood glucose (GLU), platelet (PLT), baseline serum creatinine (bSCr), serum sodium, age, epinephrine, proton pump inhibitor (PPI), intra-abdominal infection, anemia, diabetes, glycerin fructose, and nutritional pathway. The area under the receiver operating characteristic curve (AUC) was 0.822. Subgroup analysis revealed the impact of blood pressure fluctuations on AKI. Additionally, the study demonstrated a bidirectional effect of albumin and fluid balance on AKI.

Conclusion: This model is highly accurate and may facilitate the early diagnosis of and interventions for AKI.

Background: Patients receiving maintenance hemodialysis (MHD) are at increased risk of osteoporosis. The effects of bilirubin on bone metabolism vary among different disease populations. However, the relationship between total bilirubin (TBIL) and bone metabolism in MHD has not been investigated yet.

Materials and methods: This cross-sectional study included 122 MHD patients aged ≥ 18 years who underwent regular hemodialysis at the Blood Purification Center of Aerospace Central Hospital from April 2021 to April 2023. Blood sampling and bone mineral density (BMD) examinations were conducted. Multivariate linear regression, restricted cubic spline and subgroup analyses were performed to evaluate the association between TBIL and BMD.

Results: TBIL (correlation coefficient: 1.7 (0.17, 3.25); p = 0.04) was independently associated with BMD in the multivariate linear regression analysis. The results showed that BMD was nonlinearly related to TBIL in MHD patients, exhibiting a J shaped curve (p = 0.035). When plasma TBIL level < 0.64 mg/dL, there is an average increase of 5.3 (95% CI: 2.0 - 8.7; p = 0.002) g/cm² in BMD for every 1-unit increase in plasma TBIL level. The association between TBIL and BMD was not significant when the plasma TBIL level was ≥ 0.64 mg/dL.

Conclusion: The relationship between TBIL and BMD in MHD patients is J-shaped, with an inflection point of 0.64 mg/dL.

Introduction: Lung cancer ranks among the foremost causes of mortality associated with cancer. Ensartinib is a highly effective oral anaplastic lymphoma kinase (ALK) inhibitor utilized in the treatment of ALK-positive lung adenocarcinoma. This report presents a case of acute renal failure attributed to the administration of ensartinib. This is the first case report documenting the nephrotoxic effects of ensartinib, specifically manifesting as acute tubulointerstitial nephritis (ATIN) and IgA nephropathy.

Case presentation: This report details the case of a 52-year-old man diagnosed with ALK-positive lung adenocarcinoma. The patient was initially treated with crizotinib for a duration exceeding 6 months; however, he was subsequently transitioned to ensartinib due to disease progression characterized by the development of brain metastases. Within 3 months of initiating treatment with ensartinib, the patient experienced acute kidney failure. The renal failure was attributed to ATIN and IgA nephropathy, which were considered manifestations of renal toxicity associated with ensartinib.

Conclusion: This case underscores the uncommon adverse effect of ALK-targeting therapy, specifically regarding acute renal failure induced by ensartinib. We recommend conducting a renal biopsy to ascertain the presence of drug-induced nephrotoxicity. An accurate diagnosis and timely intervention can prevent the deterioration of renal function.

Background: Kidney transplant (KT) recipients are at risk of severe disease and high mortality from COVID-19, and vaccination offers some degree of protection. In this study, KT recipients' and controls' attitudes towards COVID-19 vaccination were examined.

Materials and methods: In this cross-sectional survey-based study, the willingness and hesitancy towards COVID-19 vaccines in KT recipients and a control group from the general population were assessed via questionnaire. Vaccine hesitancy was described as either not being fully vaccinated or vaccine refusal.

Results: A total of 154 KT recipients and 172 controls completed the questionnaire. The rate of those who had received at least 1 dose of COVID-19 vaccine was similar in the two study groups (92.4 vs. 92.9%, p = 0.88). The proportion of those fully vaccinated against COVID-19 was significantly lower in the KT recipients (58.7 vs. 70.4% p = 0.033). Only 11 (7.1%) of the KT recipients refused the COVID-19 vaccination. There was no significant difference between the groups in terms of vaccine refusal and vaccine hesitancy rates. Concerns about vaccine-related adverse events were common in both groups (63.6 vs. 53.8%; p = 0.488).

Conclusion: Although participants showed a high willingness towards COVID-19 vaccination, the number of KT recipients who were fully vaccinated appears to be lower than controls. Concerns about vaccine-related adverse events were the main reason for avoiding vaccination. Healthcare personnel, particularly nephrologists and public health experts, must take a proactive role in addressing vaccine hesitancy and ensuring that patients receive the required protection against COVID-19.

Introduction: After kidney transplantation, persistent hyperparathyroidism commonly occurs, often alongside increased serum calcium levels. It is reasonable to infer that kidney transplant recipients (KTRs) with hypercalcemia related to persistent hyperparathyroidism are more susceptible to developing anemia. However, reports suggest that hypercalcemia could be a contributing factor to erythrocytosis. Our aim was to assess the effect of persistent hypercalcemia on the trajectory of hemoglobin levels after transplantation.

Materials and methods: We conducted a retrospective cohort study investigating the trajectory of hemoglobin in 385 KTRs with and without persistent hypercalcemia (free Ca > 5.2 mg/dL). We performed mixed-model analyses adjusting for potential confounders.

Results: Persistent hypercalcemia was present in 62% KTRs (56% male, median age 36 (IQR 28 - 48) years, median follow-up 4.1 (IQR 1 - 8.2) years). Compared to KTRs without hypercalcemia, KTRs with persistent hypercalcemia had a mean positive difference in hemoglobin levels of +0.76 g/dL/year (95% CI +0.45 - +1.08, p < 0.001) throughout the follow-up period. Specifically, the change slope was +0.80 (95% CI +0.32 - +1.27, p < 0.001) g/dL/year for males and +0.36 (95% CI +0.16 - +1.08, p < 0.001) g/dL/year for females. Persistent hypercalcemia was significantly associated with post-transplant erythrocytosis according to the WHO (47 vs. 24%, OR 2.8, 95% CI 1.8 - 4.4) and altitude-adjusted criteria (22 vs. 10%, OR 2.5, 95% CI 1.2 - 4.5). The effect of hypercalcemia on hemoglobin levels was consistent after adjusting for confounders, except in KTRs who developed an estimated glomerular filtration rate < 45 mL/min/1.73m² after transplantation.

Conclusion: Persistent hypercalcemia after kidney transplantation was significantly associated with higher hemoglobin levels and an increased risk of developing post-transplant erythrocytosis.

Background: No drug has been shown to be effective in preventing cardiac surgery-associated acute kidney injury (CSA-AKI). In different clinical settings, sodium-glucose transporter 2 (SGLT2) inhibitors confer renal protection and may be promising drug candidates. We examined the association between preoperative dapagliflozin use and the incidence and prognosis of CSA-AKI.

Materials and methods: Data were obtained for consecutive patients undergoing cardiac surgery with cardiopulmonary bypass between December 2020 and November 2022 at a large teaching hospital in Eastern China. The exposure was preoperative dapagliflozin use, and the primary outcome was the incidence of AKI within seven days following cardiac surgery. The secondary outcomes included dialysis, death, AKI recovery, and length of hospitalization. The association between the exposures and outcomes was determined by various logistic regression models with propensity scores.

Results: A total of 1,424 patients were included, of which 201 (14.1%) received dapagliflozin preoperatively, and 321 (22.5%) developed CSA-AKI. Patients with dapagliflozin use developed CSA-AKI more frequently than those without (32.3 vs. 20.9%, unadjusted odds ratio 1.81; 95% CI, 1.30 - 2.50). However, the association became non-significant in the multivariate model (adjusted odds ratio, 1.11; 95% CI, 0.73 - 1.68), in the adjusted model with inverse probability weighting (odds ratio, 1.21; 95% CI, 0.76 - 1.93), or in the propensity-score-matched model (odds ratio, 1.09, 95% CI, 0.68 - 1.73). Furthermore, there was no significant association between preoperative dapagliflozin use and secondary outcomes.

Conclusion: Results from this study suggest that preoperative dapagliflozin use was not associated with a lower risk of CSA-AKI.