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Phosphate Frustration: Treatment Options to Complement Current Therapies. 磷酸盐中毒:补充当前疗法的治疗方案。
IF 1.7 Q3 UROLOGY & NEPHROLOGY Pub Date : 2022-08-22 eCollection Date: 2022-01-01 DOI: 10.1155/2022/9457440
Pablo E Pergola

Hyperphosphatemia eventually develops in almost all patients with advanced chronic kidney disease and is associated with negative clinical outcomes. Thus, guidelines recommend targeting treatment to normal phosphate levels in patients with chronic kidney disease. Despite low phosphorus diets, clearance by dialysis, and phosphate binder use, many patients with chronic kidney disease on dialysis are unable to consistently achieve and maintain serum phosphate concentrations <5.5 mg/dL. A chart audit of patients on dialysis receiving phosphate binders showed that 74 to 86% were unable to consistently achieve serum phosphate ≤5.5 mg/dL over 6 months. Furthermore, although there is evidence that serum phosphate concentrations <4.5 mg/dL are associated with improved survival and cardiovascular outcomes, real-world phosphate control data suggest achieving and maintaining this goal for most patients would be extremely challenging, if not near impossible, using current therapies. As phosphate binders can only remove approximately 300 mg of the 2,500 mg or more daily dietary phosphate intake, therapeutic innovations are necessary to improve phosphate management. We present treatment options to complement current therapies including tenapanor, a novel sodium/hydrogen exchanger isoform 3 inhibitor that blocks the dominant paracellular phosphate absorption pathway and has been shown to reduce phosphate levels in several clinical trials.

几乎所有晚期慢性肾病患者最终都会出现高磷酸盐血症,并与不良的临床结果相关。因此,指南建议对慢性肾病患者进行有针对性的治疗,以达到正常的磷酸盐水平。尽管使用了低磷饮食、透析清除和磷酸盐粘合剂,但许多接受透析的慢性肾病患者仍无法持续达到并维持血清磷酸盐浓度。
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引用次数: 0
Management of COVID-19 in Kidney Transplant Recipients: A Single-Center Case Series. 肾移植受者 COVID-19 的处理:单中心病例系列
IF 1.7 Q3 UROLOGY & NEPHROLOGY Pub Date : 2022-08-18 eCollection Date: 2022-01-01 DOI: 10.1155/2022/9636624
Maruhum Bonar H Marbun, Riahdo J Saragih, Tantika Andina

Background: Kidney transplant recipients (KTRs) were reported to be at higher risk of developing severe coronavirus disease-2019 (COVID-19). Despite being one of the most impacted countries, little is known about KTRs with COVID-19 in Indonesia. This report aims to explore the management strategies and short-term clinical outcomes of KTRs with COVID-19 in an Indonesian transplant center.

Methods: We observed KTRs who were admitted following COVID-19 diagnosis. Anamnesis, physical, laboratory, and radiologic examinations were performed. Demographic and transplant histories were recorded, along with symptoms, vaccination status, and management related to COVID-19.

Results: Nineteen KTRs were observed and 14 (73.6%) were male. The most common presenting symptoms were fever, cough, and shortness of breath. Nine (47.3%) KTRs had severe-critical COVID-19. The mortality rate was 42.1%. Acute kidney injury (AKI) was present in six (31.6%) of KTRs, five (83.3%) of whom were nonsurvivors. The median D-dimer level was higher in nonsurvivors (5,800 versus 670 μL), while other laboratory parameters were comparable. Seven (36.8%) KTRs were vaccinated. The mortality rates of vaccinated and unvaccinated KTRs were 14.2% and 70%, respectively. Antiviral therapy, anticoagulant, intravenous immunoglobulin, and tocilizumab were prescribed to 89.5%, 89.5%, 15.8%, and 10.5%, respectively. Immunosuppressive therapy (IST) was halted in 68% of KTRs, among which 61.5% passed away.

Conclusion: The clinical presentation of COVID-19 in KTRs was similar to that in the general population, whereas the mortality rate was higher. Management strategies for KTRs with COVID-19 should include prevention of AKI and hypercoagulation. Vaccination seems to be beneficial for KTRs, while temporary withdrawal of IST does not.

背景:据报道,肾移植受者(KTR)罹患严重冠状病毒病-2019(COVID-19)的风险较高。尽管印尼是受影响最严重的国家之一,但人们对印尼 KTR 感染 COVID-19 的情况知之甚少。本报告旨在探讨印度尼西亚移植中心对感染 COVID-19 的 KTR 的管理策略和短期临床结果:我们对确诊 COVID-19 后入院的 KTR 进行了观察。方法:我们对确诊 COVID-19 后入院的 KTR 进行了观察,并进行了病史、体格、实验室和放射学检查。记录人口统计学和移植史,以及与 COVID-19 相关的症状、疫苗接种情况和处理方法:共观察到 19 例 KTR,其中 14 例(73.6%)为男性。最常见的症状是发烧、咳嗽和气短。9例(47.3%)KTR患有严重危重的COVID-19。死亡率为 42.1%。6例(31.6%)KTR患者出现急性肾损伤(AKI),其中5例(83.3%)为非存活患者。非存活者的中位 D-二聚体水平较高(5800 与 670 μL),其他实验室参数相当。7名(36.8%)KTR接种了疫苗。接种疫苗和未接种疫苗的 KTR 死亡率分别为 14.2% 和 70%。89.5%、89.5%、15.8%和10.5%的患者接受了抗病毒治疗、抗凝剂、静脉注射免疫球蛋白和托珠单抗。68%的KTR患者停止了免疫抑制治疗(IST),其中61.5%的患者去世:结论:KTR 中 COVID-19 的临床表现与普通人群相似,但死亡率较高。对患有 COVID-19 的 KTR 的管理策略应包括预防 AKI 和高凝状态。接种疫苗似乎对KTR有益,而暂时停用IST则无益。
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引用次数: 0
Early, Noninvasive Clinical Indicators of Kidney Prognosis in Primary Nephrotic Syndrome: A Retrospective Exploratory Study. 原发性肾病综合征肾脏预后的早期、无创临床指标:回顾性探索性研究。
IF 2.1 Q3 Medicine Pub Date : 2022-08-09 eCollection Date: 2022-01-01 DOI: 10.1155/2022/2718810
Keiji Fujimoto, Takatoshi Haraguchi, Sho Kumano, Keita Yamazaki, Nobuhiko Miyatake, Kanae Nomura, Kiyotaka Mukai, Kazuaki Okino, Norifumi Hayashi, Hiroki Adachi, Hitoshi Yokoyama, Yasuo Iida, Kengo Furuichi

This retrospective exploratory study aimed to identify early clinical indicators of kidney prognosis in primary nephrotic syndrome (NS). Univariate Cox proportional hazards regression analysis identified clinical parameters in the 2-month period after initiating immunosuppressive therapy (IST); it predicted 40% reduction in the estimated glomerular filtration rate (eGFR) in 36 patients with primary NS. Time-dependent receiver operating characteristic curve analysis was used to evaluate the performance of the predictors for the cumulative incidence of 40% reduction in the eGFR up to 8 years after initiating IST. The mean follow-up period was 71.9 months. The eGFR was reduced by 40% in four patients. Significant predictors for time to 40% reduction in the eGFR were as follows: an increase in the serum soluble urokinase plasminogen activator receptor (s-suPAR) 2 months after initiating IST (Δs-suPAR (2M); hazard ratio (HR) for every 500 pg/mL increase: 1.36, P=0.006), s-suPAR at 2 months after initiating IST (s-suPAR (2M); HR for every 500 pg/mL increase: 1.13, P=0.015), urinary protein-to-creatinine ratio (u-PCR) (u-PCR (2M); HR for every 1.0 g/gCr increase: 2.94, P=0.003), and urinary liver-type fatty acid-binding protein (u-L-FABP) (u-L-FABP (2M); HR for every 1.0 μg/gCr increase: 1.14, P=0.006). All four factors exhibited high predictive accuracy for cumulative incidence of 40% reduction in the eGFR up to 8 years after initiating IST, with areas under the receiver operating characteristic curve of 0.92 for Δs-suPAR (2M), 0.87 for s-suPAR (2M), 0.93 for u-PCR (2M), and 0.93 for u-L-FABP (2M). These findings suggest that Δs-suPAR (2M), s-suPAR (2M), u-PCR (2M), and u-L-FABP (2M) could be useful indicators of initial therapeutic response for predicting kidney prognosis in primary NS.

本回顾性探索性研究旨在确定原发性肾病综合征(NS)肾脏预后的早期临床指标。单因素Cox比例风险回归分析确定了开始免疫抑制治疗(IST)后2个月期间的临床参数;它预测在36例原发性NS患者中估计肾小球滤过率(eGFR)降低40%。使用时间相关的受试者工作特征曲线分析来评估在开始IST治疗后8年内eGFR累计降低40%发生率的预测指标的性能。平均随访时间为71.9个月。4例患者的eGFR降低了40%。eGFR降低40%的重要预测因素如下:开始IST治疗2个月后血清可溶性尿激酶纤溶酶原激活物受体(s-suPAR)升高(Δs-suPAR (2M);每增加500 pg/mL的风险比(HR): 1.36, P=0.006),开始IST治疗后2个月的s-suPAR (s-suPAR (2M);HR每增加500 pg/mL: 1.13, P=0.015),尿蛋白与肌酐比值(u-PCR) (u-PCR (2M);每增加1.0 g/gCr, HR为2.94,P=0.003),尿肝型脂肪酸结合蛋白(u-L-FABP) (u-L-FABP (2M);每增加1.0 μg/gCr, HR为1.14,P=0.006)。所有四个因素对启动IST后8年内eGFR累计降低40%的发生率均具有较高的预测准确性,Δs-suPAR (2M)的受试者工作特征曲线下面积为0.92,s-suPAR (2M)的为0.87,u-PCR (2M)的为0.93,u-L-FABP (2M)的为0.93。这些发现提示Δs-suPAR (2M)、s-suPAR (2M)、u-PCR (2M)和u-L-FABP (2M)可作为预测原发性NS患者肾脏预后的有效指标。
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引用次数: 0
Challenging, Safe, and Effective Use of External Iliac Vein for Insertion of Tunneled Cuffed Hemodialysis Catheters: A Single-Center Prospective Study. 挑战、安全、有效地使用髂外静脉插入隧道式袖带血液透析导管:一项单中心前瞻性研究。
IF 2.1 Q3 Medicine Pub Date : 2022-08-09 eCollection Date: 2022-01-01 DOI: 10.1155/2022/4576781
Ayman R Abd El-Hameed, Walid A R Abdelhamid

Background: Providing well-functioning vascular access is crucial for patients undergoing chronic hemodialysis. Peripheral arteriovenous fistulas and grafts are the preferred accesses in hemodialysis patients. Patients with bilateral obstruction of internal jugular veins and subclavian veins require a suitable vascular access. Thus, the insertion of iliac vein tunneled cuffed catheters (TCCs) by interventional nephrologists may be a good option for these patients. We aimed to evaluate the outcomes of iliac vein TCCs in patients lacking other vascular options.

Methods: 80 tunneled cuffed hemodialysis catheters were inserted through the iliac veins of 80 patients with an end-stage kidney disease. Catheter insertion was guided by Doppler ultrasonography followed by plain radiography to detect the catheter tip and exclude complications.

Results: The insertion success rate was 100%. 25 patients developed catheter-related infections. The mean survival time per catheter was 328 days. At the end of the study, 40 catheters were still functioning, 15 patients were shifted to continuous ambulatory peritoneal dialysis and 5 patients were referred to the interventional radiology department for insertion of transhepatic inferior vena cava tunneled catheters. Resistant catheter-related infection was the main cause of catheter removal in 11 patients (17.5%) in this study. Catheter malfunction was the second most common cause of catheter removal in 9 patients (11.25%).

Conclusion: This study concluded that iliac vein TCCs can provide suitable vascular access in hemodialysis patients with bilateral obstruction of internal jugular veins and subclavian veins.

背景:提供功能良好的血管通道对慢性血液透析患者至关重要。外周动静脉瘘和移植物是血液透析患者首选的通路。双侧颈内静脉和锁骨下静脉梗阻的患者需要合适的血管通路。因此,介入肾病专家为这些患者置入髂静脉隧道套管导管(tcc)可能是一个不错的选择。我们的目的是评估缺乏其他血管选择的患者髂静脉tcc的结果。方法:对80例终末期肾病患者经髂静脉置入80根带套管的血液透析导管。在多普勒超声引导下,行x线平片检查导管尖端,排除并发症。结果:置入成功率100%。25例发生导管相关性感染。每根导管的平均生存时间为328天。研究结束时,40根导管仍能正常工作,15例患者转入持续门诊腹膜透析,5例患者转至介入放射科行经肝下腔静脉隧道导管插入。顽固性导管相关感染是本研究中11例(17.5%)患者拔管的主要原因。9例(11.25%)患者导管故障是第二大常见拔管原因。结论:对于双侧颈内静脉和锁骨下静脉梗阻的血液透析患者,髂静脉tcc可提供合适的血管通路。
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引用次数: 0
Anti-Phospholipase A2 Receptor Antibody Expression at Different Stages of Idiopathic Membranous Nephropathy. 抗磷脂酶A2受体抗体在特发性膜性肾病不同阶段的表达。
IF 2.1 Q3 Medicine Pub Date : 2022-07-30 eCollection Date: 2022-01-01 DOI: 10.1155/2022/5962195
Keying Fu, Pei Zhang, Yeguang Han, Ru Wang, Junhong Cai

The significance of blood anti-phospholipase A2 receptor (PLA2R) antibodies in the diagnosis of different stages of idiopathic membranous nephropathy (IMN) was investigated. The expression and distribution of anti-PLA2R antibodies in renal biopsy tissue of patients with different stages of IMN were examined by immunohistochemistry. In addition, blood anti-PLA2R antibodies were determined by indirect immunofluorescence for the same patients, and the results were compared with the anti-PLA2R antibody expression in renal biopsy tissue. The positive fluorescence intensities of IMN stages I, IV, and V were mostly ± or + (40/80). There was no significant difference in fluorescence titer between these stages (p > 0.05). These results were consistent with the immunohistochemistry results, and the kappa statistic was 0.95. The positive fluorescence intensities of IMN stages II and III were mostly ++ to ++++ (33/60). There was no significant difference in fluorescence intensities between these two stages (p > 0.05), but there was a significant difference in fluorescence intensities between stages II and III and stages I, IV, and V (p < 0.001). These results were consistent with the immunohistochemistry results, and the kappa statistic was 0.97 (p < 0.001). Therefore, blood anti-PLA2R levels were positively correlated with anti-PLA2R expression in renal biopsy tissue in patients with different stages of IMN. In addition, the fluorescence intensities of IMN stages II and III were significantly different from those of stages I, IV, and V. Therefore, blood anti-PLA2R levels can be used for in vitro differential diagnosis and the monitoring of treatment, as it can distinguish stage II; and III; from stage I, IV, and V IMN.

探讨血抗磷脂酶A2受体(PLA2R)抗体在特发性膜性肾病(IMN)不同分期诊断中的意义。应用免疫组织化学方法检测不同分期IMN患者肾活检组织中抗pla2r抗体的表达和分布。此外,采用间接免疫荧光法检测同一组患者血液中抗pla2r抗体,并与肾活检组织中抗pla2r抗体表达进行比较。IMN I、IV、V期阳性荧光强度多为±或+(40/80)。各组间荧光效价差异无统计学意义(p > 0.05)。这些结果与免疫组化结果一致,kappa统计量为0.95。IMNⅱ、ⅲ期阳性荧光强度多为++ ~ ++++(33/60)。两期间荧光强度差异无统计学意义(p > 0.05),但II、III期及I、IV、V期间荧光强度差异有统计学意义(p < 0.001)。这些结果与免疫组化结果一致,kappa统计量为0.97 (p < 0.001)。因此,不同分期IMN患者血液中抗pla2r水平与肾活检组织中抗pla2r表达呈正相关。此外,IMN II期和III期的荧光强度与I期、IV期和v期的荧光强度有显著差异。因此,血液中抗pla2r水平可以用于体外鉴别诊断和治疗监测,因为它可以区分II期;和第三;从I、IV、V期开始。
{"title":"Anti-Phospholipase A2 Receptor Antibody Expression at Different Stages of Idiopathic Membranous Nephropathy.","authors":"Keying Fu,&nbsp;Pei Zhang,&nbsp;Yeguang Han,&nbsp;Ru Wang,&nbsp;Junhong Cai","doi":"10.1155/2022/5962195","DOIUrl":"https://doi.org/10.1155/2022/5962195","url":null,"abstract":"<p><p>The significance of blood anti-phospholipase A2 receptor (PLA<sub>2</sub>R) antibodies in the diagnosis of different stages of idiopathic membranous nephropathy (IMN) was investigated. The expression and distribution of anti-PLA<sub>2</sub>R antibodies in renal biopsy tissue of patients with different stages of IMN were examined by immunohistochemistry. In addition, blood anti-PLA<sub>2</sub>R antibodies were determined by indirect immunofluorescence for the same patients, and the results were compared with the anti-PLA<sub>2</sub>R antibody expression in renal biopsy tissue. The positive fluorescence intensities of IMN stages I, IV, and V were mostly ± or + (40/80). There was no significant difference in fluorescence titer between these stages (<i>p</i> > 0.05). These results were consistent with the immunohistochemistry results, and the kappa statistic was 0.95. The positive fluorescence intensities of IMN stages II and III were mostly ++ to ++++ (33/60). There was no significant difference in fluorescence intensities between these two stages (<i>p</i> > 0.05), but there was a significant difference in fluorescence intensities between stages II and III and stages I, IV, and V (<i>p</i> < 0.001). These results were consistent with the immunohistochemistry results, and the kappa statistic was 0.97 (<i>p</i> < 0.001). Therefore, blood anti-PLA<sub>2</sub>R levels were positively correlated with anti-PLA<sub>2</sub>R expression in renal biopsy tissue in patients with different stages of IMN. In addition, the fluorescence intensities of IMN stages II and III were significantly different from those of stages I, IV, and V. Therefore, blood anti-PLA<sub>2</sub>R levels can be used for in vitro differential diagnosis and the monitoring of treatment, as it can distinguish stage II; and III; from stage I, IV, and V IMN.</p>","PeriodicalId":14177,"journal":{"name":"International Journal of Nephrology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2022-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9356905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40596117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Laparoscopic Surgery for Pheochromocytoma in Hemodialysis Patients. 血液透析患者嗜铬细胞瘤的腹腔镜手术治疗。
IF 2.1 Q3 Medicine Pub Date : 2022-07-21 eCollection Date: 2022-01-01 DOI: 10.1155/2022/3060647
Shuichi Tatarano, Akihiko Mitsuke, Takashi Sakaguchi, Ryosuke Matsushita, Satoru Inoguchi, Hirofumi Yoshino, Hiroaki Nishimura, Yasutoshi Yamada, Hideki Enokida

Objectives: We analyzed the clinical outcomes of laparoscopic adrenalectomy for pheochromocytomas in hemodialysis compared with nonhemodialysis patients.

Methods: Fifty-seven patients (7 hemodialysis and 50 nonhemodialysis) were included in the study. We analyzed the differences in clinical parameters and outcomes between the hemodialysis patient groups and nonhemodialysis patient groups as well as identified predictors for an intraoperative hypertensive spike.

Results: The increasing intravascular volume before surgery in hemodialysis patients made perioperative hemodynamic management safer. No significant difference in clinical parameters between the two groups was observed except for the length of hospitalization that was significantly longer in the hemodialysis patients (9 vs. 6 days, P=0.005). An increase in systolic blood pressure at CO2 insufflation was an independent predictor of a hypertensive spike with a cutoff value of 22.5 mmHg (odds ratio 1.038, 95% confidence interval 1.012-1.078).

Conclusion: Laparoscopic adrenalectomy for pheochromocytomas in hemodialysis was safe and feasible. An increase in systolic blood pressure at CO2 insufflation was a predictor of the intraoperative hypertensive spike. The research in this manuscript is not registered. This is a retrospective study.

目的:分析血透患者行腹腔镜肾上腺切除术治疗嗜铬细胞瘤的临床效果,并与非血透患者进行比较。方法:57例患者(血液透析7例,非血液透析50例)纳入研究。我们分析了血液透析患者组和非血液透析患者组的临床参数和结果的差异,并确定了术中高血压尖峰的预测因素。结果:血液透析患者术前血管内容量的增加使围手术期血流动力学管理更加安全。两组间除血透组住院时间明显长于血透组(9天vs. 6天,P=0.005)外,其他临床参数均无显著差异。CO2注入时收缩压升高是高血压尖峰的独立预测因子,临界值为22.5 mmHg(优势比1.038,95%可信区间1.012-1.078)。结论:腹腔镜肾上腺切除术治疗血液透析嗜铬细胞瘤是安全可行的。CO2充气时收缩压升高是术中高血压尖峰的预测因子。本文中的研究未注册。这是一项回顾性研究。
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引用次数: 0
Renal Amyloidosis: Epidemiological, Clinical, and Laboratory Profile in Adults from One Nephrology Center. 肾淀粉样变:流行病学,临床和实验室资料在成人肾脏学中心。
IF 2.1 Q3 Medicine Pub Date : 2022-07-18 eCollection Date: 2022-01-01 DOI: 10.1155/2022/8493479
Hayet Kaaroud, Amel Harzallah, Mariem Hajji, Soumaya Chargui, Samia Barbouch, Sami Turki, Raja Trabelsi, Rim Goucha, Fatma Ben Moussa, Hedi Ben Maiz, Fethi Ben Hamida, Ezzeddine Abderrahim

Background: Renal amyloidosis is one of the main differential diagnoses of nephrotic proteinuria in adults and the elderly. The aim of this study with the most important series in our country is to contribute to the epidemiological, clinical, and etiological study of the renal amyloidosis.

Methods: In a retrospective study carried out between 1975 and 2019, 310 cases of histologically proven and typed renal amyloidosis were selected for this study.

Results: There were 209 men and 101 women with a mean age of 53.8 ± 15.4 years (range, 17-84 years). Of the 310 cases, 255 (82.3%) were diagnosed with AA renal amyloidosis and 55 (17.7%) with non-AA amyloidosis. Infections were the main cause of AA amyloidosis, and tuberculosis was the most frequent etiology. The period from the onset of the underlying disease to diagnosis of the renal amyloidosis was an average of 177 months. The most frequent manifestations at the time of diagnosis were nephrotic syndrome (84%), chronic renal failure (30.3%), and end-stage renal disease (37.8%). After a medium follow-up of 16 months (range, 0-68 months), mortality occurred in 60 cases.

Conclusions: Given the high frequency of AA amyloidosis in our country, awareness of the proper management of infectious and chronic inflammatory diseases remains a priority in reducing the occurrence of this serious disease.

背景:肾脏淀粉样变是成人和老年人肾病性蛋白尿的主要鉴别诊断之一。本研究是国内最重要的系列研究,旨在为肾脏淀粉样变的流行病学、临床和病因学研究做出贡献。方法:在1975年至2019年进行的一项回顾性研究中,选择了310例经组织学证实并分型的肾脏淀粉样变性患者进行研究。结果:男性209例,女性101例,平均年龄53.8±15.4岁(范围17 ~ 84岁)。310例中,255例(82.3%)诊断为AA型肾淀粉样变,55例(17.7%)诊断为非AA型肾淀粉样变。感染是AA淀粉样变的主要病因,肺结核是最常见的病因。从发病到诊断为肾淀粉样变性平均为177个月。诊断时最常见的表现是肾病综合征(84%)、慢性肾功能衰竭(30.3%)和终末期肾病(37.8%)。中期随访16个月(0 ~ 68个月)后,60例死亡。结论:鉴于我国AA淀粉样变的高发性,提高对感染性和慢性炎症性疾病的正确管理意识仍然是减少这一严重疾病发生的重点。
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引用次数: 1
Common Glomerular Diseases in Adult Jordanians: A Single-Center Experience. 约旦成人常见肾小球疾病:单中心经验。
IF 2.1 Q3 Medicine Pub Date : 2022-07-04 eCollection Date: 2022-01-01 DOI: 10.1155/2022/5292635
Ahmed Sheyyab, Mohammad Al-Thnaibat, Aseel A Zghayer, Jafar Alsheyyab, Radi Hamed

The pattern of glomerular diseases has been reported previously with contradictory results. Our primary objective is to assess the relative frequencies of glomerular disease in adult Jordanians and compare it with other institutes. A secondary objective is to assess the contribution of environmental factors, in an industrial city Zarqa, to kidney disease patterns. Methods. A retrospective study was conducted at a referral hospital center in the central region of Jordan. Assessment of native kidney biopsies, pathological reports, and the patients' characteristics were obtained from electronic medical records. Results. Our study assessed a total of 178 biopsies, of which 106 patients were included achieving the age criterion for adults. The mean age of our patient was 34 ± 12.7. The number of females (53.7%) was slightly more than males (46.3%). The average creatinine at presentation was 198 umol/L. Almost half of the patients had mild renal impairment (50.9%), while the remaining were divided between moderate (26.1%) and severe (27.3%). The indications of kidney biopsy were proteinuria (11.3%), proteinuria (54.7%), and unexplained renal impairment (34%). The leading common glomerular diseases were represented as a group with a relative frequency ranging between 11% and 13%. Both IgA nephropathy (13.2%) and lupus nephritis (12.2%) were the top conditions causing the nephritic syndrome, while focal segmental glomerulosclerosis (12.2%) and minimal change disease (11.3%) were the conditions leading to nephrotic syndrome. Our secondary analysis showed nonstatistically significantly higher glomerular filtration rates in the city of Zarqa, when compared to Amman (median 94 and 54, respectively, U = 469.5, r = 0.08, p = 0.491). Additionally, Zarqa had higher frequency rates of interstitial/tubular nephritis (χ 2(1) = 1.17, p = 0.279, Cramér's V = 0.13. Conclusion. Common glomerular diseases, as reported internationally, were common among Jordanian adults.

肾小球疾病的模式先前已有报道,但结果相互矛盾。我们的主要目标是评估成年约旦人肾小球疾病的相对频率,并将其与其他研究机构进行比较。第二个目标是评估工业城市扎尔卡的环境因素对肾脏疾病模式的影响。方法。在约旦中部地区的一家转诊医院中心进行了一项回顾性研究。从电子医疗记录中获得对本地肾活检、病理报告和患者特征的评估。后果我们的研究共评估了178例活检,其中106例患者符合成人年龄标准。我们病人的平均年龄是34岁 ± 12.7.女性(53.7%)略多于男性(46.3%)。出现时的平均肌酸酐为198 umol/L。几乎一半的患者有轻度肾损伤(50.9%),其余患者分为中度(26.1%)和重度(27.3%)。肾活检的指征是蛋白尿(11.3%)、蛋白尿(54.7%)和不明原因的肾损伤(34%)。主要常见肾小球疾病是一组相对频率在11%至13%之间的疾病。IgA肾病(13.2%)和狼疮性肾炎(12.2%)是引起肾病综合征的首要条件,而局灶节段性肾小球硬化(12.2%,)和微小病变(11.3%)是导致肾病综合征。我们的二次分析显示,与安曼相比,扎尔卡市的肾小球滤过率(中位数分别为94和54,U = 469.5,r = 0.08,p=0.491)。此外,Zarqa的间质性/肾小管肾炎发生率较高(χ2(1) = 1.17,p=0.279,克雷默V = 0.13.结论。国际上报道的常见肾小球疾病在约旦成年人中很常见。
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引用次数: 1
The Significance of Exposure to Pregestational Type 2 Diabetes in Utero on Fetal Renal Size and Subcutaneous Fat Thickness. 妊娠期子宫内暴露于2型糖尿病对胎儿肾脏大小和皮下脂肪厚度的影响。
IF 2.1 Q3 Medicine Pub Date : 2022-06-30 eCollection Date: 2022-01-01 DOI: 10.1155/2022/3573963
Christy L Pylypjuk, Chelsea Day, Yasmine ElSalakawy, Gregory J Reid

Objectives: To determine the relationship between exposure to pregestational type 2 diabetes (T2D) and renal size and subcutaneous fat thickness in fetuses during routine obstetrical ultrasound.

Methods: This was a case-control study (January 1, 2019 to December 31, 2019). Routine obstetrical ultrasounds performed between 18 and 22 weeks' gestation at a tertiary-care fetal assessment unit were reviewed. "Cases" comprised ultrasounds of fetuses exposed to pregestational T2D in utero. The control group was assembled from ultrasounds of healthy controls. Postprocessing measurements of fetal renal size and abdominal wall thickness from stored images were performed by two independent observers, and findings were compared between groups.

Results: There were 54 cases and 428 ultrasounds of healthy controls. The mean maternal age of cases was 32.1 years (SD 6.2) compared to 33.2 years (SD 5.3) for healthy controls, and the majority of ultrasounds were performed in multiparous patients (83%). At the 18 to 22 week ultrasound, there was a significant reduction in renal size amongst fetuses exposed to maternal T2D in utero compared to controls; among cases, the mean renal width was 8.0 mm (95% CI 7.8-8.1) compared to 11.4 mm (95% CI 10.6-12.7) in controls (p < 0.0001); the mean renal thickness among cases was 8.1 mm (95% CI 7.9-8.2) compared to 11.5 mm (95% CI 10.7-12.9) in controls (p=0.001). There was no obvious difference in estimated fetal weight between groups, yet fetuses exposed to maternal T2D had increased subcutaneous abdominal wall fat thickness at this early gestational age (p=0.008).

Conclusions: Fetal renal size in cases exposed to pregestational T2D is significantly smaller compared to controls, and subcutaneous abdominal wall fat is significantly thicker. Given emerging evidence about the developmental origins of disease, further study is needed to correlate the association between fetal renal size and fat distribution in the fetus and the long-term risk of chronic renal disease and diabetes in these offspring.

目的:探讨妊娠期2型糖尿病(T2D)暴露与常规产科超声检查胎儿肾脏大小和皮下脂肪厚度的关系。方法:病例对照研究(2019年1月1日至2019年12月31日)。常规产科超声在妊娠18和22周之间在一个三级保健胎儿评估单位进行审查。“病例”包括胎儿在子宫内暴露于妊娠期T2D的超声波。对照组由健康对照者的超声波组成。后处理测量胎儿肾脏大小和腹壁厚度从存储的图像进行了两个独立的观察员,并发现组之间的比较。结果:54例,正常对照428例。这些病例的平均母亲年龄为32.1岁(SD 6.2),而健康对照组为33.2岁(SD 5.3),大多数超声检查是在多胎患者中进行的(83%)。在18至22周的超声检查中,与对照组相比,子宫内暴露于母体T2D的胎儿肾脏大小显著减小;在这些病例中,平均肾脏宽度为8.0 mm (95% CI 7.8-8.1),而对照组为11.4 mm (95% CI 10.6-12.7) (p < 0.0001);病例的平均肾脏厚度为8.1 mm (95% CI 7.9-8.2),而对照组为11.5 mm (95% CI 10.7-12.9) (p=0.001)。两组之间胎儿体重的估计没有明显差异,但母体T2D暴露的胎儿在孕早期腹壁脂肪厚度增加(p=0.008)。结论:妊娠期暴露于T2D的胎儿肾脏大小明显小于对照组,皮下腹壁脂肪明显增厚。鉴于有关疾病发育起源的新证据,需要进一步研究胎儿肾脏大小和胎儿脂肪分布与这些后代患慢性肾脏疾病和糖尿病的长期风险之间的关系。
{"title":"The Significance of Exposure to Pregestational Type 2 Diabetes in Utero on Fetal Renal Size and Subcutaneous Fat Thickness.","authors":"Christy L Pylypjuk,&nbsp;Chelsea Day,&nbsp;Yasmine ElSalakawy,&nbsp;Gregory J Reid","doi":"10.1155/2022/3573963","DOIUrl":"https://doi.org/10.1155/2022/3573963","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the relationship between exposure to pregestational type 2 diabetes (T2D) and renal size and subcutaneous fat thickness in fetuses during routine obstetrical ultrasound.</p><p><strong>Methods: </strong>This was a case-control study (January 1, 2019 to December 31, 2019). Routine obstetrical ultrasounds performed between 18 and 22 weeks' gestation at a tertiary-care fetal assessment unit were reviewed. \"Cases\" comprised ultrasounds of fetuses exposed to pregestational T2D in utero. The control group was assembled from ultrasounds of healthy controls. Postprocessing measurements of fetal renal size and abdominal wall thickness from stored images were performed by two independent observers, and findings were compared between groups.</p><p><strong>Results: </strong>There were 54 cases and 428 ultrasounds of healthy controls. The mean maternal age of cases was 32.1 years (SD 6.2) compared to 33.2 years (SD 5.3) for healthy controls, and the majority of ultrasounds were performed in multiparous patients (83%). At the 18 to 22 week ultrasound, there was a significant reduction in renal size amongst fetuses exposed to maternal T2D in utero compared to controls; among cases, the mean renal width was 8.0 mm (95% CI 7.8-8.1) compared to 11.4 mm (95% CI 10.6-12.7) in controls (<i>p</i> < 0.0001); the mean renal thickness among cases was 8.1 mm (95% CI 7.9-8.2) compared to 11.5 mm (95% CI 10.7-12.9) in controls (<i>p</i>=0.001). There was no obvious difference in estimated fetal weight between groups, yet fetuses exposed to maternal T2D had increased subcutaneous abdominal wall fat thickness at this early gestational age (<i>p</i>=0.008).</p><p><strong>Conclusions: </strong>Fetal renal size in cases exposed to pregestational T2D is significantly smaller compared to controls, and subcutaneous abdominal wall fat is significantly thicker. Given emerging evidence about the developmental origins of disease, further study is needed to correlate the association between fetal renal size and fat distribution in the fetus and the long-term risk of chronic renal disease and diabetes in these offspring.</p>","PeriodicalId":14177,"journal":{"name":"International Journal of Nephrology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9262542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40604229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Urinary Podocyte Excretion Predicts Urinary Protein Selectivity and Renal Prognosis. 尿足细胞排泄预测尿蛋白选择性和肾脏预后。
IF 2.1 Q3 Medicine Pub Date : 2022-06-29 eCollection Date: 2022-01-01 DOI: 10.1155/2022/2702651
Makoto Abe, Akiko Kaiga, Takehiro Ohira, Toshihiko Ishimitsu, Akihiro Tojo

Background: Urinary podocyte excretion is related to a reduction in glomerular podocyte numbers, glomerulosclerosis, and urinary protein selectivity. To elucidate the role of urinary podocytes in proteinuria and renal prognosis and to identify the factors that cause podocyte detachment, we examined urinary podocytes in 120 renal biopsy patients.

Methods: Podocytes were identified in urinary sediments stained with fluorescent-labeled anti-podocalyxin antibodies in ten high power fields. The amounts of protein bands, separated by SDS-polyacrylamide gel electrophoresis, were calculated using an image software program and the correlation with urinary podocytes was analyzed. Podocyte surface pores were observed using a low-vacuum scanning electron microscope. The renal prognosis, including induction of hemodialysis or 30% reduction in eGFR, was investigated.

Results: Urinary podocyte excretion showed a higher positive correlation with albumin excretion compared to IgG, prealbumin, and transferrin. There were no significant correlations between urinary podocyte count and low molecular weight proteins, including β2-microglobulin and α1-microglobulin. The number of podocyte surface pores was positively correlated with proteinuria, suggesting enhanced albumin transcytosis. The hemodynamic pressure on the glomerular capillary wall, including products of pulse pressure and pulse rate (water hammer pressure), was positively correlated with urinary podocyte excretion. Urinary podocyte excretion and Tamm-Horsfall protein (THP) were independent risk factors for renal prognosis but were not related to response to treatment.

Conclusion: Urinary podocyte excretion was correlated with urinary albumin excretion, indicating specific albumin transport by podocytes. Podocytes were detached from the glomerular capillaries by water hammer pressure and THP was involved in the renal prognosis.

背景:尿足细胞排泄与肾小球足细胞数量减少、肾小球硬化和尿蛋白选择性有关。为了阐明尿足细胞在蛋白尿和肾脏预后中的作用,并确定导致足细胞脱离的因素,我们对120例肾活检患者的尿足细胞进行了检查。方法:用荧光标记抗足霉素抗体在10个高倍视场下对尿沉积物中的足细胞进行鉴定。使用图像软件程序计算sds -聚丙烯酰胺凝胶电泳分离的蛋白条带数量,并分析其与尿足细胞的相关性。用低真空扫描电镜观察足细胞表面气孔。研究了肾脏预后,包括诱导血液透析或eGFR降低30%。结果:尿足细胞排泄与白蛋白排泄的正相关性高于IgG、白蛋白前和转铁蛋白排泄。尿足细胞计数与低分子量蛋白(β2-微球蛋白和α1-微球蛋白)无显著相关性。足细胞表面气孔数量与蛋白尿呈正相关,提示白蛋白胞吞作用增强。肾小球毛细血管壁上的血流动力学压力,包括脉压和脉率(水锤压)的产物,与尿足细胞排泄呈正相关。尿足细胞排泄和THP是肾脏预后的独立危险因素,但与治疗反应无关。结论:尿足细胞排泄与尿白蛋白排泄相关,提示足细胞特异性转运白蛋白。足细胞在水锤压力作用下脱离肾小球毛细血管,THP参与肾脏预后。
{"title":"Urinary Podocyte Excretion Predicts Urinary Protein Selectivity and Renal Prognosis.","authors":"Makoto Abe,&nbsp;Akiko Kaiga,&nbsp;Takehiro Ohira,&nbsp;Toshihiko Ishimitsu,&nbsp;Akihiro Tojo","doi":"10.1155/2022/2702651","DOIUrl":"https://doi.org/10.1155/2022/2702651","url":null,"abstract":"<p><strong>Background: </strong>Urinary podocyte excretion is related to a reduction in glomerular podocyte numbers, glomerulosclerosis, and urinary protein selectivity. To elucidate the role of urinary podocytes in proteinuria and renal prognosis and to identify the factors that cause podocyte detachment, we examined urinary podocytes in 120 renal biopsy patients.</p><p><strong>Methods: </strong>Podocytes were identified in urinary sediments stained with fluorescent-labeled anti-podocalyxin antibodies in ten high power fields. The amounts of protein bands, separated by SDS-polyacrylamide gel electrophoresis, were calculated using an image software program and the correlation with urinary podocytes was analyzed. Podocyte surface pores were observed using a low-vacuum scanning electron microscope. The renal prognosis, including induction of hemodialysis or 30% reduction in eGFR, was investigated.</p><p><strong>Results: </strong>Urinary podocyte excretion showed a higher positive correlation with albumin excretion compared to IgG, prealbumin, and transferrin. There were no significant correlations between urinary podocyte count and low molecular weight proteins, including <i>β</i>2-microglobulin and <i>α</i>1-microglobulin. The number of podocyte surface pores was positively correlated with proteinuria, suggesting enhanced albumin transcytosis. The hemodynamic pressure on the glomerular capillary wall, including products of pulse pressure and pulse rate (water hammer pressure), was positively correlated with urinary podocyte excretion. Urinary podocyte excretion and Tamm-Horsfall protein (THP) were independent risk factors for renal prognosis but were not related to response to treatment.</p><p><strong>Conclusion: </strong>Urinary podocyte excretion was correlated with urinary albumin excretion, indicating specific albumin transport by podocytes. Podocytes were detached from the glomerular capillaries by water hammer pressure and THP was involved in the renal prognosis.</p>","PeriodicalId":14177,"journal":{"name":"International Journal of Nephrology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2022-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9296344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40529858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
期刊
International Journal of Nephrology
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