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Chronic Kidney Disease: Decreasing Serum Klotho Levels Predict Adverse Renal and Vascular Outcomes. 慢性肾脏病:血清 Klotho 水平下降可预测不良的肾脏和血管预后。
IF 1.7 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-11-07 eCollection Date: 2024-01-01 DOI: 10.1155/2024/2803739
Abhijit Konnur, Sishir Gang, Umapati Hegde, Hardik Patel, Akash Pandya, Nitiraj Shete

Background and Objectives: Soluble alpha Klotho (s.Klotho) is an emerging marker for chronic kidney disease (CKD) prognosis. The objective was to study the association between s.Klotho and CKD-related decrease in glomerular filtration rate (GFR), bone and vascular damage. Method: A total of 118 patients with CKD stage 2-4 were enrolled and 107 patients continued in the study. Clinical and laboratory parameters were recorded at time of enrollment and 12 months. A double sandwich ELISA for s.Klotho was recorded in controls (n = 25) and patients' serum samples at 6 months (n = 107) and 12 months (n = 102). Primary endpoints like 40% or more fall in GFR, a requirement for renal replacement therapy (RRT), and death with different grades of s.Klotho deficiency were studied. Results: Of the 107 patients (80 male and 27 female), mean s.Klotho was 3.46 ng/mL (02.3-04.2). The GFR fall was significantly different (p value < 0.0001) in the different grades of s.Klotho deficiency with Grade 4 s.Klotho deficiency (0.1-2.99 ng/mL) having the maximum fall of GFR at 9.2 mL/min/1.73 m2 (04.8-12.0) and minimum in Grade 2 (3-5.99 ng/mL) at 1.35 mL/min/1.73 m2 (03.0-02.75). The Ankle Brachial Pressure Index positively correlated with s.Klotho and the correlation coefficient was 0.536 (0.382-0.662) (p < 0.001). The carotid intimal medial thickness negatively correlated with s.Klotho and the correlation coefficient was -0.712 (95% CI: -0.797--0.601, p < 0.001). All five deaths had s.Klotho Grade 4 (severe) deficiency. The event-free survival rate was maximum (100%) in Grade 2 Klotho deficiency and lowest (55%) in Grade 4 s.Klotho deficiency. Conclusions: s.Klotho levels decreased significantly in patients with progressive kidney failure. s.Klotho levels significantly correlated with the presence of vascular disease. Death and need for RRT were significantly more in patients with severe s.Klotho deficiency.

背景和目的:可溶性α-Klotho(s.Klotho)是慢性肾脏病(CKD)预后的新标记物。目的:研究 s.Klotho 与 CKD 相关的肾小球滤过率(GFR)下降、骨骼和血管损伤之间的关联。研究方法共招募了 118 名 2-4 期 CKD 患者,其中 107 名患者继续参与研究。分别记录了入组时和入组后 12 个月的临床和实验室参数。在对照组(25 人)和患者血清样本中分别记录了 6 个月(107 人)和 12 个月(102 人)的 s.Klotho 双夹心 ELISA 检测结果。研究的主要终点包括肾小球滤过率下降 40% 或更多,需要肾脏替代疗法 (RRT),以及不同程度 s.Klotho 缺乏症患者的死亡。研究结果在 107 名患者(80 名男性和 27 名女性)中,s.Klotho 的平均值为 3.46 纳克/毫升(02.3-04.2)。不同等级的 s.Klotho 缺乏症患者的 GFR 下降幅度明显不同(p 值<0.0001),其中 4 级 s.Klotho 缺乏症(0.1-2.99 纳克/毫升)患者的 GFR 下降幅度最大,为 9.2 毫升/分钟/1.73 平方米(04.8-12.0),而 2 级患者(3-5.99 纳克/毫升)的 GFR 下降幅度最小,为 1.35 毫升/分钟/1.73 平方米(03.0-02.75)。踝臂压指数与 s.Klotho 呈正相关,相关系数为 0.536 (0.382-0.662) (p < 0.001)。颈动脉内膜内侧厚度与 s.Klotho 负相关,相关系数为 -0.712 (95% CI: -0.797--0.601, p < 0.001)。所有 5 例死亡病例均为 s.Klotho 4 级(严重)缺乏。2级s.Klotho缺乏症的无事件生存率最高(100%),4级s.Klotho缺乏症的无事件生存率最低(55%)。结论:进行性肾衰竭患者的 s.Klotho水平显著下降。严重s.Klotho缺乏症患者中死亡和需要接受RRT治疗的人数明显增多。
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引用次数: 0
Urinary Nephrin: A Potential Biomarker of Early Glomerular Injury in a Cohort of Pregnant Women Attending Routine Antenatal Care Services. 尿肾素在接受常规产前护理服务的孕妇群体中,尿肾素是早期肾小球损伤的潜在生物标志物。
IF 1.7 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-11-02 eCollection Date: 2024-01-01 DOI: 10.1155/2024/9089557
Belete Biadgo Mesfine, Danica Vojisavljevic, Ranjna Kapoor, David Watson, Yogavijayan Kandasamy, Donna Rudd

Introduction: Glomerular injury may occur during pregnancy as a consequence of systemic disease and pregnancy-related medical complications. While urinary nephrin has been shown to provide early identification of preeclampsia (PE) in high-risk pregnancies, the role of urinary nephrin in determining glomerular injury in pregnant women is yet to be explored. This study aimed to investigate the use of urinary nephrin as a predictor for early glomerular injury in a study conducted at the Townville University Hospital. Methods and Materials: A cross-sectional study was conducted. All pregnant women with a full dataset (n = 273) were classified into three categories according to their urinary albumin-to-creatinine ratio (ACR): normoalbuminuria, microalbuminuria and macroalbuminuria. Continuous variables were compared between groups, and the cut-off value for the urinary nephrin-to-creatinine ratio (NCR) was determined to predict albuminuria as an indirect indicator of early glomerular injury. The percentages of pregnant women who had elevated nephrinuria were calculated for each of the ACR categories. Results: Urinary NCR positively correlated with urinary ACR (r = 0.29, p < 0.0001). Urinary NCR increased comparably in women with normoalbuminuria, microalbuminuria and macroalbuminuria. Using a cut-off value of 14 ng/mg, nephrinuria was detected in 65% of women with normoalbuminuria, 95% with microalbuminuria and 100% with macroalbuminuria. Of the normoalbuminuric women who had an elevated urinary NCR (> 14 ng/mg), 78% were diagnosed with a hypertensive disorder and 63% were diagnosed with diabetes in pregnancy. In women with PE, urinary NCR and ACR were significantly higher when compared to women who did not develop PE. The AUC of the ROC for urinary NCR was 0.74 (95% CI: 0.650-0.824), with a sensitivity of 97% and a specificity of 36% to predict glomerular injury and a sensitivity of 93% and specificity of 42% to predict glomerular injury of PE. Conclusion: The study found that urinary NCR were elevated not only in women with micro- and macroalbuminuria but also in pregnant women with normoalbuminuria. Increased urinary NCR without increased urinary albumin may be associated with early glomerular injury. Urinary NCR may be a more sensitive marker than microalbuminuria to detect early glomerular injury in women with systemic disease and adverse pregnancy outcomes.

导言:由于全身性疾病和与妊娠相关的并发症,妊娠期间可能会出现肾小球损伤。虽然尿肾素已被证明可早期识别高危妊娠中的子痫前期(PE),但尿肾素在确定孕妇肾小球损伤方面的作用仍有待探索。本研究旨在调查汤维尔大学医院开展的一项研究中将尿肾素用作早期肾小球损伤的预测指标的情况。方法和材料:进行了一项横断面研究。根据尿白蛋白与肌酐比值(ACR)将所有具有完整数据集的孕妇(n = 273)分为三类:正常白蛋白尿、微量白蛋白尿和大量白蛋白尿。对各组间的连续变量进行比较,并确定尿液肾素与肌酐比值(NCR)的临界值,以预测白蛋白尿,作为早期肾小球损伤的间接指标。计算了每个 ACR 类别中肾小球蛋白尿升高的孕妇百分比。结果显示尿 NCR 与尿 ACR 呈正相关(r = 0.29,p < 0.0001)。正常白蛋白尿、微量白蛋白尿和大量白蛋白尿妇女的尿液 NCR 增高程度相当。以 14 纳克/毫克为临界值,65% 的正常白蛋白尿妇女、95% 的微量白蛋白尿妇女和 100% 的大量白蛋白尿妇女都能检测到肾小球肾炎。在尿 NCR 升高(> 14 纳克/毫克)的正常白蛋白尿妇女中,78% 被诊断患有高血压疾病,63% 被诊断患有妊娠糖尿病。与未患 PE 的妇女相比,患 PE 的妇女的尿 NCR 和 ACR 明显更高。尿NCR的ROC的AUC为0.74(95% CI:0.650-0.824),预测PE肾小球损伤的灵敏度为97%,特异度为36%;预测PE肾小球损伤的灵敏度为93%,特异度为42%。结论研究发现,不仅微量和大量白蛋白尿妇女的尿NCR升高,正常白蛋白尿孕妇的尿NCR也升高。尿 NCR 升高而尿白蛋白不升高可能与早期肾小球损伤有关。与微量白蛋白尿相比,尿NCR可能是检测患有全身性疾病和不良妊娠结局的妇女早期肾小球损伤的更灵敏的标志物。
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引用次数: 0
Peritoneal Dialysis of Three-Cuff Catheter Experience in Qassim Province, Saudi Arabia. 沙特阿拉伯卡西姆省使用三袖带导管进行腹膜透析的经验。
IF 1.7 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-10-30 eCollection Date: 2024-01-01 DOI: 10.1155/2024/5554703
Ahmed AlSalloom, Chandra Sekhar Kalevaru, Kholoud Alomeri, Sultan Alsayegh

Background: The global rise in noncommunicable diseases, including chronic kidney diseases (CKDs), has led to a significant increase in the use of dialysis units to enhance patient longevity and quality of life. Over time, two-cuff catheters have been replaced by three-cuff catheters, with their usage expanding in nephrology centers across Saudi Arabia. This study aimed to evaluate the benefits, complications, and duration of therapy associated with three-cuff catheters in peritoneal dialysis (PD) patients. Methodology: To ensure the reliability of our results, we conducted a comprehensive cross-sectional study involving 257 patients who underwent three-cuff PD catheter (PDC) insertion and omentopexy. Data were retrospectively collected from 2016 to 2023 at King Fahad Specialist Hospital, Buraidah. The questionnaire was designed based on available variables in the records section and validated by subject experts and experienced research faculty. Data were then entered and analyzed using SPSS version 21.0. Descriptive statistics were employed for inferential statistics, while the chi-square test and logistic regression analysis were used to identify predictors of PD outcomes. Results: The average duration of therapy was 27.84 months, with a standard deviation of 27.23 months. Early complications were minimal, with just 5.1% (n = 13) experiencing peritonitis, 0.8% (n = 2) facing catheter migration, and 0.4% (n = 1 each) encountering omental wrap and exit site infection (ESI) within 30 days of catheter insertion. Remarkably, only 7.8% (n = 20) required catheter reinsertion. In addition, catheter removal due to catheter-related issues was low, affecting only 3.8% of patients. Conclusions: According to the study findings, three-cuff catheters exhibited fewer complications, superior performance, and longer therapy duration. These outcomes may be attributed to the thorough design of the three-cuff catheters, the dedication of the staff, and the implementation of strict policies. To maintain these positive results, it is crucial for the Ministry of Health and the Health Cluster to adopt long-term supportive measures.

背景:包括慢性肾脏疾病(CKD)在内的非传染性疾病在全球呈上升趋势,这导致透析设备的使用大幅增加,以延长患者的寿命并提高生活质量。随着时间的推移,双袖带导管已被三袖带导管所取代,其使用范围在沙特阿拉伯的肾病中心不断扩大。本研究旨在评估腹膜透析(PD)患者使用三袖口导管的好处、并发症和治疗时间。研究方法:为确保研究结果的可靠性,我们开展了一项全面的横断面研究,涉及 257 名接受了三袖口腹膜透析导管(PDC)插入术和网膜切除术的患者。我们回顾性地收集了 2016 年至 2023 年期间布赖达法哈德国王专科医院的数据。问卷根据记录部分的可用变量进行设计,并由学科专家和经验丰富的研究教师进行验证。然后使用 SPSS 21.0 版对数据进行输入和分析。推论性统计采用描述性统计,而 PD 结果的预测因素则采用卡方检验和逻辑回归分析。结果平均疗程为 27.84 个月,标准差为 27.23 个月。早期并发症极少,仅有 5.1%(n = 13)的患者在插入导管后 30 天内出现腹膜炎,0.8%(n = 2)的患者出现导管移位,0.4%(n = 1)的患者出现网膜包裹和出口部位感染(ESI)。值得注意的是,只有 7.8%(20 人)需要重新插入导管。此外,因导管相关问题而拔除导管的患者很少,仅占 3.8%。结论:研究结果表明,三拷贝导管并发症少、性能优越、治疗时间长。这些结果可能归功于三拷贝导管的周密设计、工作人员的敬业精神以及严格的政策执行。为了保持这些积极成果,卫生部和卫生组必须采取长期的支持措施。
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引用次数: 0
The Protective Activity of Withania somnifera Against Mercuric Chloride (HgCl2)-Induced Renal Toxicity in Male Rats. 睡茄对氯化汞(HgCl2)引起的雄性大鼠肾毒性的保护作用
IF 1.7 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-10-28 eCollection Date: 2024-01-01 DOI: 10.1155/2024/8023989
Haddad A El Rabey, Samar M Rezk, Aseel Abusaber, Rwaah Khlabi, Ayah H Alhawiti, Romana M Algorayed, Nadia Bakry

The purpose of this study was to test the protective effect of Withania somnifera (WS) against the harmful effects of mercuric chloride (HgCl2)-induced kidney failure at the histological, biochemical, and immune levels in Wistar rats. The study assessed the biochemical and immunological changes in five groups (n = 6): Group 1 (G1) was the negative control, and the other rats received a single subcutaneous dose of HgCl2 (2.5 mg/kg in 0.5 mL of 0.9% saline solution) and randomly divided into 4 groups. Group 2 (G2) was the positive control and left without treatment. Groups 3, 4, and 5 (G3, G4, and G5) were treated with different doses of WS root powder for 30 days. The HgCl2-positive group showed significant signs of renal toxicity as reflected by increased levels of kidney function parameters (blood urea nitrogen, urea, and creatinine), inflammatory biomarkers, immunological indices (SDF-1, IL-6, NGAL, and KIM-1), and oxidative stress (SOD, TAC, CAT, GSH, and MDA). The positive group rats also showed drastic pathological changes in renal tissues. Different doses of WS treatment significantly reduced the levels of all biochemical markers and decreased pathological damage to the kidney tissues. The antioxidant, phenolic, and flavonoid constituents of WS root powder helped protect rats' kidneys against HgCl2-induced kidney toxicity in male rats.

本研究旨在从组织学、生化和免疫学层面测试薇甘菊(WS)对氯化汞(HgCl2)诱导的 Wistar 大鼠肾衰竭的保护作用。研究评估了五组(n = 6)大鼠的生化和免疫学变化:第 1 组(G1)为阴性对照组,其他大鼠接受单剂量氯化汞皮下注射(2.5 毫克/千克溶于 0.5 毫升 0.9% 生理盐水),并随机分为 4 组。第 2 组(G2)为阳性对照,不做任何处理。第 3、4 和 5 组(G3、G4 和 G5)使用不同剂量的 WS 根粉治疗 30 天。HgCl2 阳性组的肾功能参数(血尿素氮、尿素和肌酐)、炎症生物标志物、免疫学指标(SDF-1、IL-6、NGAL 和 KIM-1)和氧化应激(SOD、TAC、CAT、GSH 和 MDA)水平升高,反映了肾毒性的显著迹象。阳性组大鼠的肾组织也出现了急剧的病理变化。不同剂量的 WS 治疗明显降低了所有生化指标的水平,减少了肾组织的病理损伤。WS 根粉中的抗氧化剂、酚类和类黄酮成分有助于保护雄性大鼠的肾脏免受 HgCl2 引起的肾毒性的影响。
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引用次数: 0
Key Performance Indicators of Secondary Health Care in Chronic Kidney Disease: Experience in Public and Private Services in the State of São Paulo, Brazil. 慢性肾脏病二级医疗保健的关键绩效指标:巴西圣保罗州公共和私营服务机构的经验。
IF 1.7 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-10-26 eCollection Date: 2024-01-01 DOI: 10.1155/2024/5401633
Farid Samaan, Cristiane Akemi Vicente, Luiz Antônio Coutinho Pais, Gianna Mastroianni Kirsztajn, Ricardo Sesso

Introduction: The objective of this study was to evaluate quality indicators of secondary health care in chronic kidney disease (CKD). Methods: This retrospective longitudinal study was conducted in an outpatient medical nephrology clinic of the Brazilian Unified Health System (UHS) and a multidisciplinary outpatient clinic of a private health plan (PHP). The inclusion criteria were age ≥ 18 years, ≥ 3 medical appointments, and follow-up time ≥ 6 months. Results: Compared to PHP patients (n = 183), UHS patients (n = 276) were older (63.4 vs. 59.7 years, p=0.04), had more arterial hypertension (AH) (91.7% vs. 84.7%, p=0.02) and dyslipidemia (58.3 vs. 38.3%, p < 0.01), and had a lower estimated baseline glomerular filtration rate (eGFR) (29.9 [21.5-42.0] vs. 39.1 [28.6-54.8] mL/min/1.73 m2, p < 0.01). Compared to PHP patients, UHS patients had a lower percentage of diabetics with glycated hemoglobin < 7.5% (46.1% vs. 61.2%, p=0.03), fewer people with potassium < 5.5 mEq/L (90.4% vs. 95.6%, p=0.04), and fewer referrals for hemodialysis with functioning arteriovenous fistula (AVF) (9.1% vs. 54.3%, p < 0.01). The percentages of people with hypertension and blood pressure < 140 × 90 mmHg were similar between the UHS and PHP groups (59.7% vs. 66.7%; p=0.17), as was the percentage of people with parathyroid hormone control (85.6% vs. 84.8%; p=0.83), dyslipidemia and LDL-cholesterol < 100 mg/dL (38.3% vs. 49.3%; p=0.13), phosphorus < 4.5 mg/dL (78.5% vs. 72.0%; p=0.16), and 25-OH-vitamin-D > 30 ng/mL (28.4% vs. 36.5%; p=0.11). The crude reduction in eGFR was greater in the UHS group than in PHP (2.3 [-0.1; 5.9] vs. 1.1 [-1.9; 4.6] mL/min/1.73 m2; p < 0.01). In the multivariate linear mixed-effects model, UHS patients also showed faster CKD progression over time than PHS ones (group effect, p < 0.01; time effect, p < 0.01; interaction, p < 0.01). Conclusions: Quality of care for patients with CKD can be improved through both services, and multidisciplinary care may have a positive impact on the control of comorbidities, the progression of CKD, and the planning of the initiation of hemodialysis.

简介本研究旨在评估慢性肾脏病(CKD)二级医疗保健的质量指标。研究方法这项回顾性纵向研究在巴西统一医疗系统(UHS)的一家肾脏病门诊部和一家私人医疗计划(PHP)的多学科门诊部进行。纳入标准为年龄≥ 18 岁,就诊次数≥ 3 次,随访时间≥ 6 个月。结果与 PHP 患者(人数 = 183)相比,UHS 患者(人数 = 276)年龄更大(63.4 岁对 59.7 岁,P=0.04),动脉高血压(AH)(91.7% 对 84.7%,P=0.02)和血脂异常(58.3% 对 38.3%,P<0.01),基线肾小球滤过率(eGFR)估计值较低(29.9 [21.5-42.0] 对 39.1 [28.6-54.8] mL/min/1.73 m2,P<0.01)。与 PHP 患者相比,UHS 患者中糖化血红蛋白小于 7.5% 的糖尿病患者比例较低(46.1% vs. 61.2%,p=0.03),血钾小于 5.5 mEq/L 的人数较少(90.4% vs. 95.6%,p=0.04),转诊进行血液透析且动静脉瘘 (AVF) 功能正常的人数较少(9.1% vs. 54.3%,p < 0.01)。高血压和血压 < 140 × 90 mmHg 患者的百分比在 UHS 组和 PHP 组之间相似(59.7% vs. 66.7%;P=0.17),甲状旁腺激素控制患者的百分比也相似(85.6% vs. 84.8%;P=0.01)。6% vs. 84.8%; p=0.83)、血脂异常和低密度脂蛋白胆固醇 < 100 mg/dL (38.3% vs. 49.3%; p=0.13)、磷 < 4.5 mg/dL (78.5% vs. 72.0%; p=0.16)、25-OH-维生素-D > 30 ng/mL (28.4% vs. 36.5%; p=0.11)。UHS 组 eGFR 的粗略下降幅度大于 PHP 组(2.3 [-0.1; 5.9] vs. 1.1 [-1.9; 4.6] mL/min/1.73 m2; p <0.01)。在多变量线性混合效应模型中,随着时间的推移,UHS 患者的 CKD 进展速度也快于 PHS 患者(组别效应,p < 0.01;时间效应,p < 0.01;交互效应,p < 0.01)。结论通过这两种服务可以提高对 CKD 患者的护理质量,多学科护理可能会对合并症的控制、CKD 的进展以及血液透析的启动规划产生积极影响。
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引用次数: 0
Matrix Gla Protein and Nitric Oxide Synthase-3 Genetic Variants in Chronic Kidney Disease and Their Relation with Cardiovascular Risk. 慢性肾脏病中的基质la蛋白和一氧化氮合成酶-3基因变异及其与心血管风险的关系
IF 1.7 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-08-30 eCollection Date: 2024-01-01 DOI: 10.1155/2024/3850055
G Priyadarshini, Sreejith Parameswaran, Jayaprakash Sahoo, Sandhiya Selvarajan, Ananthakrishnan Ramesh, Medha Rajappa

Background: Chronic kidney disease (CKD) is defined by gradual deterioration of renal parenchyma and decline of functioning nephrons. The risk of cardiovascular events is drastically increased in patients with CKD. This complicated link of CKD and cardiovascular disease (CVD) is not well understood till date.

Objective: We aim to study the influence of genetic variants of matrix Gla protein (MGP) gene rs1800801, rs1800802, and rs4236 and nitric oxide synthase-3 (NOS3) gene rs1799983 and rs2070744 on the risk of CKD and its associated cardiovascular comorbidity in South Indian Tamils.

Methods: One hundred and eighty-five CKD patients and 185 controls were recruited in this research. Flow-mediated dilatation (FMD) of brachial artery was measured ultrasonically. Circulating levels of MGP and nitric oxide (NO) were measured by ELISA. Genotyping was done by real-time PCR.

Results: We observed a significant difference in the distribution of TT and CT genotypes of NOS3 (rs2070744), indicating an increase in the risk of CKD. NO level was significantly decreased in CKD cases than controls. We also found a significant difference in the distribution of TTA and CCG haplotypes of MGP polymorphisms (1-rs4236; 2-rs1800801; 3-rs1800802) between the groups, indicating an increase in the risk of CKD. CT genotype of MGP (rs4236) and CT genotype of NOS3 (rs2070744) variants were found to be associated with decreased FMD, indicating endothelial dysfunction, the harbinger of CVD.

Conclusion: We conclude that genetic variants of MGP and NOS3 enhance the risk of CKD and its associated cardiovascular comorbidity in South Indian Tamils.

背景:慢性肾脏病(CKD)是指肾实质逐渐恶化,肾小球功能衰退。慢性肾脏病患者发生心血管事件的风险大大增加。迄今为止,人们对 CKD 与心血管疾病(CVD)之间的复杂联系还不甚了解:我们旨在研究南印度泰米尔人基质格拉蛋白(MGP)基因 rs1800801、rs1800802 和 rs4236 以及一氧化氮合酶-3(NOS3)基因 rs1799983 和 rs2070744 的遗传变异对 CKD 风险及其相关心血管合并症的影响:本研究招募了 185 名 CKD 患者和 185 名对照组。用超声波测量了肱动脉的血流介导扩张(FMD)。用酶联免疫吸附法测定循环中 MGP 和一氧化氮(NO)的水平。通过实时 PCR 进行基因分型:结果:我们观察到 NOS3(rs2070744)的 TT 和 CT 基因型分布存在明显差异,表明患慢性肾脏病的风险增加。与对照组相比,CKD 病例的 NO 水平明显下降。我们还发现,MGP 多态性(1-rs4236;2-rs1800801;3-rs1800802)的 TTA 和 CCG 单倍型的分布在各组间存在明显差异,表明 CKD 风险增加。MGP的CT基因型(rs4236)和NOS3的CT基因型(rs2070744)变异与FMD下降有关,表明内皮功能障碍是心血管疾病的先兆:我们得出的结论是,MGP 和 NOS3 基因变异会增加南印度泰米尔人患慢性肾脏病及其相关心血管并发症的风险。
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引用次数: 0
Renal Manifestations of IgG4-Related Disease: A Concise Review. IgG4 相关疾病的肾脏表现:简明综述。
IF 1.7 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-06-24 eCollection Date: 2024-01-01 DOI: 10.1155/2024/4421589
Shahrukh T Towheed, Wayel Zanjir, Kevin Yi Mi Ren, Jocelyn Garland, Marie Clements-Baker

IgG4-related disease (IgG4-RD) is an immune-mediated disorder marked by fibro-inflammatory masses that can infiltrate multiple organ systems. Due to its relatively recent discovery and limited understanding of its pathophysiology, IgG4-related disease may be difficult to recognize and is consequently potentially underdiagnosed. Renal involvement is becoming regarded as one of the key features of this disease. To date, the most well-recognized renal complication of IgG4-related disease is tubulointerstitial nephritis, but membranous glomerulonephritis, renal masses, and retroperitoneal fibrosis have also been reported. This concise review has two objectives. First, it will briefly encapsulate the history, epidemiology, and presentation of IgG4-related disease. Second, it will examine the reported renal manifestations of IgG4-related disease, exploring the relevant histology, imaging, clinical features, and treatment considerations. This synthesis will be highly relevant for nephrologists, rheumatologists, general internists, and renal pathologists to raise awareness and help improve early recognition of IgG4-related kidney disease (IgG4-RKD).

IgG4 相关疾病(IgG4-RD)是一种免疫介导的疾病,其特征是可浸润多个器官系统的纤维炎性肿块。由于 IgG4 相关疾病是最近才被发现的,而且人们对其病理生理学的了解有限,因此可能难以识别,进而导致诊断不足。肾脏受累逐渐被认为是这种疾病的主要特征之一。迄今为止,IgG4 相关疾病最公认的肾脏并发症是肾小管间质性肾炎,但膜性肾小球肾炎、肾肿块和腹膜后纤维化也有报道。这篇简明扼要的综述有两个目的。首先,它将简要概述 IgG4 相关疾病的病史、流行病学和表现。其次,它将研究已报道的 IgG4 相关疾病的肾脏表现,探讨相关的组织学、影像学、临床特征和治疗注意事项。本综述对肾脏病学家、风湿病学家、普通内科医生和肾脏病理学家具有重要意义,有助于提高对 IgG4 相关肾脏疾病(IgG4-RKD)的认识和早期识别能力。
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引用次数: 0
Bacteremia and Mortality among Patients with Nontunneled and Tunneled Catheters for Hemodialysis. 血液透析非隧道式和隧道式导管患者的菌血症和死亡率。
IF 2.1 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-02-06 eCollection Date: 2024-01-01 DOI: 10.1155/2024/3292667
Carla Santos De Lima, Flora Braga Vaz, Rodrigo Peixoto Campos

Introduction: Central venous catheters for hemodialysis (HD) can be nontunneled catheters (NTC) or tunneled catheters (TC). Bacteremia and dysfunction are complications that can impact morbidity and mortality. We decided to compare the rates of bacteremia and dysfunction between NTC and TC and patient survival 90 days after catheter insertion.

Methods: Retrospective cohort to evaluate catheters inserted between January 2011 and December 2020 in a tertiary hospital. Catheters in patients with end-stage chronic kidney disease were included. Patients with acute kidney injury, catheters that lasted less than three HD sessions, and patients who died within one week after insertion were excluded. Bacteremia and dysfunction rates, bacteremia-free survival, and dysfunction-free survival were investigated. Multivariable analysis was performed using a Cox proportional hazards regression model for patient survival at 90 days.

Results: 670 catheters were analyzed in 287 patients, 422 NTC (63%), and 248 TC (37%). The rates of confirmed bacteremia per 1,000 catheter-days were 1.19 for NTC and 0.20 for TC (p < 0.0001). The confirmed or possible bacteremia rates were 2.27 and 0.37 per 1,000 catheter-days for NTC and TC, respectively (p < 0.0001). The dysfunction rates were 3.96 and 0.86 for NTC and TC, respectively (p < 0.0001). Patient survival at 90 days was higher in the TC group than the NTC group (96.8% vs. 89.1%; p < 0.0001).

Conclusion: We found lower rates of bacteremia and dysfunction for TC and demonstrated that using NTC affects patient mortality.

导言:用于血液透析(HD)的中心静脉导管可以是非隧道式导管(NTC)或隧道式导管(TC)。菌血症和功能障碍是会影响发病率和死亡率的并发症。我们决定比较 NTC 和 TC 的菌血症和功能障碍发生率以及导管插入后 90 天的患者存活率:方法:对一家三级医院 2011 年 1 月至 2020 年 12 月期间插入的导管进行回顾性队列评估。纳入了终末期慢性肾病患者的导管。急性肾损伤患者、导管持续时间少于三次血液透析疗程的患者以及插入导管后一周内死亡的患者除外。对菌血症和功能障碍发生率、无菌血症存活率和无功能障碍存活率进行了调查。使用 Cox 比例危险回归模型对患者 90 天的存活率进行了多变量分析:对 287 名患者的 670 根导管进行了分析,其中 422 根为 NTC 导管(占 63%),248 根为 TC 导管(占 37%)。每 1,000 个导管日中,NTC 和 TC 的确诊菌血症率分别为 1.19 和 0.20(P < 0.0001)。NTC 和 TC 的确诊或可能菌血症率分别为每 1,000 导管日 2.27 例和 0.37 例(P < 0.0001)。NTC 和 TC 的功能障碍率分别为 3.96 和 0.86(P < 0.0001)。TC组患者的90天存活率高于NTC组(96.8% vs. 89.1%;p < 0.0001):我们发现 TC 的菌血症和功能障碍发生率较低,并证明使用 NTC 会影响患者死亡率。
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引用次数: 0
Endovascular versus Surgical Lower Extremity Revascularization among Patients with Chronic Kidney Disease 慢性肾病患者下肢血管重建的血管内治疗与外科治疗对比
IF 2.1 Q3 UROLOGY & NEPHROLOGY Pub Date : 2023-12-16 DOI: 10.1155/2023/5586060
Qingzheng Chen, Jialin Han, Gomathy Parvathinathan, E. Ross, Margaret R. Stedman, Tara I. Chang
Introduction. Patients with chronic kidney disease (CKD) have a high prevalence of peripheral artery disease. How best to manage lower extremity peripheral artery disease remains unclear in this patient population. We therefore sought to compare the outcomes after endovascular versus surgical lower extremity revascularization among patients with CKD. Methods. We used data from Optum’s de-identifed Clinformatics® Data Mart Database, a nationwide database of commercially insured persons in the United States to study patients with CKD who underwent lower extremity endovascular or surgical revascularization. We used inverse probability of treatment weighting to balance covariates. We employed proportional hazard regression to study the primary outcome of major adverse limb events (MALE), defined as a repeat revascularization or amputation. We also studied each of these events separately and death from any cause. Results. In our cohort, 60,057 patients underwent endovascular revascularization and 9,338 patients underwent surgical revascularization. Endovascular revascularization compared with surgical revascularization was associated with a higher adjusted hazard of MALE (hazard ratio (HR) 1.52; 95% confidence interval (CI) 1.46–1.59). Endovascular revascularization was also associated with a higher adjusted hazard of repeat revascularization (HR 1.65; 95% CI 1.57–1.72) but a lower adjusted risk of amputation (HR 0.71; CI 0.73–0.89). Patients undergoing endovascular revascularization also had a lower adjusted hazard for death from any cause (0.85; CI 0.82–0.88). Conclusions. In this analysis of patients with CKD undergoing lower extremity revascularization, an endovascular approach was associated with a higher rate of repeated revascularization but a lower risk of subsequent amputation and death compared with surgical revascularization. Multiple factors must be considered when counseling patients with CKD, who have a high burden of comorbid conditions. Clinical trials should include more patients with kidney disease, who are often otherwise excluded from participation, to better understand the most effective treatment strategies for this vulnerable patient population.
简介慢性肾脏病(CKD)患者的外周动脉疾病发病率很高。对于这类患者,如何更好地治疗下肢外周动脉疾病仍不清楚。因此,我们试图比较 CKD 患者接受血管内和外科下肢血运重建术后的疗效。方法。我们使用 Optum 的去标识化 Clinformatics® Data Mart 数据库中的数据对接受下肢血管内或外科血管再通手术的 CKD 患者进行了研究。我们使用治疗反概率加权法来平衡协变量。我们采用比例危险回归法研究了肢体主要不良事件(MALE)这一主要结局,其定义为重复血管再通或截肢。我们还分别研究了这些事件以及任何原因导致的死亡。研究结果在我们的队列中,60,057 名患者接受了血管内血运重建,9,338 名患者接受了外科血运重建。血管内血运重建与手术血运重建相比,调整后的MALE风险更高(风险比(HR)1.52;95% 置信区间(CI)1.46-1.59)。血管内血运重建还与较高的重复血管内血运重建调整后风险(HR 1.65;95% CI 1.57-1.72)相关,但截肢调整后风险较低(HR 0.71;CI 0.73-0.89)。接受血管内再通术的患者因任何原因死亡的调整后风险也较低(0.85;CI 0.82-0.88)。结论在这项对接受下肢血管再通手术的慢性肾脏病患者进行的分析中,与外科血管再通手术相比,血管内治疗与较高的重复血管再通率相关,但随后截肢和死亡的风险较低。慢性肾脏病患者合并症较多,在为他们提供咨询时必须考虑多种因素。临床试验应纳入更多肾病患者,以便更好地了解针对这一弱势患者群体的最有效治疗策略。
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引用次数: 0
The Impact of Hot Ambient Temperature and Prolonged Fasting Duration during Ramadan on Patients with Chronic Kidney Disease: A Literature Review 斋月期间环境温度过高和禁食时间过长对慢性肾病患者的影响:文献综述
IF 2.1 Q3 UROLOGY & NEPHROLOGY Pub Date : 2023-12-09 DOI: 10.1155/2023/2636507
A. Alsahow
The Islamic (lunar) calendar has 11 fewer days each year than the Gregorian (solar) calendar. Consequently, ambient temperatures during the month of Ramadan and the duration of the presunrise-to-sunset fast will change each year. At some point, individuals observing Ramadan will experience prolonged periods of fasting during the hot summer months. In this manuscript, findings published in the English-language medical literature that address the impact of prolonged fasting during the warmer summer months on patients with chronic kidney disease, including dialysis and transplantation patients, are reviewed. This is of particular concern given the accelerated pace of global warming. The limitations of the evidence that is currently available are also discussed, and an approach that might be used to standardize future evaluations of the impact of fasting on kidney health is suggested.
伊斯兰历(阴历)每年比公历(阳历)少11天。因此,斋月期间的环境温度和日出至日落斋戒的持续时间每年都会发生变化。在某些时候,遵守斋月的人将在炎热的夏季经历长时间的禁食。在这篇论文中,对发表在英语医学文献上的研究结果进行了综述,这些研究涉及在温暖的夏季延长禁食对慢性肾脏疾病患者(包括透析和移植患者)的影响。考虑到全球变暖的加速,这一点尤其令人担忧。本文还讨论了现有证据的局限性,并提出了一种可能用于标准化未来禁食对肾脏健康影响评估的方法。
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引用次数: 0
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International Journal of Nephrology
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