Pub Date : 2024-02-29DOI: 10.47363/jone/2024(4)129
Sofia Ventura
Kidney-pancreas transplantation is the preferable therapeutic option for patients with type 1 diabetes mellitus and end-stage kidney disease. We describe the case of a 35-year-old pancreas-kidney transplant recipient with dual-graft failure that presents with massive hematochezia and hemodynamic instability, evolving into hemorrhagic shock. The diagnostic assessment revealed a fistula between a pseudoaneurysm of the right common iliac artery and the adjacent transplanted duodenum segment, a rare but life-threatening cause of gastrointestinal bleeding in these patients. An endoprosthesis was placed into the iliac artery, prophylactic antibiotics were instituted, and a pancreatic transplantectomy was performed in a second procedure. This case highlights that the diagnostic workup of gastrointestinal bleeding in pancreas-kidney transplant recipients must include the possibility of arterio-enteric fistulas, which is more frequent in the presence of pancreatic graft failure, as was the case of our patient. Endovascular exclusion is the advocated treatment. Pancreatic graft transplantectomy could also be a possible approach for patients with a failed pancreas but it is highly controversial due to potential risks.
{"title":"A Rare Cause of Gastrointestinal Bleeding in a Kidney-Pancreas Transplant Recipient – Case Report","authors":"Sofia Ventura","doi":"10.47363/jone/2024(4)129","DOIUrl":"https://doi.org/10.47363/jone/2024(4)129","url":null,"abstract":"Kidney-pancreas transplantation is the preferable therapeutic option for patients with type 1 diabetes mellitus and end-stage kidney disease. We describe the case of a 35-year-old pancreas-kidney transplant recipient with dual-graft failure that presents with massive hematochezia and hemodynamic instability, evolving into hemorrhagic shock. The diagnostic assessment revealed a fistula between a pseudoaneurysm of the right common iliac artery and the adjacent transplanted duodenum segment, a rare but life-threatening cause of gastrointestinal bleeding in these patients. An endoprosthesis was placed into the iliac artery, prophylactic antibiotics were instituted, and a pancreatic transplantectomy was performed in a second procedure. This case highlights that the diagnostic workup of gastrointestinal bleeding in pancreas-kidney transplant recipients must include the possibility of arterio-enteric fistulas, which is more frequent in the presence of pancreatic graft failure, as was the case of our patient. Endovascular exclusion is the advocated treatment. Pancreatic graft transplantectomy could also be a possible approach for patients with a failed pancreas but it is highly controversial due to potential risks.","PeriodicalId":145640,"journal":{"name":"Journal of Nephrology & Endocrinology Research","volume":"91 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140415927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-31DOI: 10.47363/jone/2023(3)125
I. Nacef, Days Khalifa
Introduction: Primary hyperaldosteronism, 1st cause of secondary hypertension, 2nd cause of hypertension potentially curable by surgery. The objective of this work is to determine the predictive factors for complete resolution of hypertension after adrenalectomy. Material: We conducted a retrospective study of 25 patients with primary hyperaldosteronism operated and followed between 1985 and 2018. Results: Our patients were divided into 16 women and 9 men, mean age 54 years. 40% of our patients were smokers, 36% dyslipidemic, 68% diabetic and 76% had a BMI ≥ 25 kg / m2. Patients underwent unilateral adrenalectomy, the surgical approach was posterior lumbar in 9 cases and laparoscopic in 16 cases. No per or postoperative complication was noted. The postoperative course was marked by the HTA in 36% of the cases, an improvement in 36% of the cases and persistence in 31% of the cases. We found a significant decrease of the PAS and the PAD at six months of the surgery. The comparative study of the patients whose HTA was cured versus unhealed did not show a statistically significant correlation with the following predictors of healing: young age, female gender, lack of family history of hypertension, adenoma’s dimension, the presence of comorbidities including diabetes and dyslipidemia and the average number of antihypertensive treatment.Only the absence of overweight or obesity was a predictor of healing in our series. Conclusion: Knowing the predictive factors of healing aims to pose the operative indication and especially to improve the prognosis of hypertension after surgery by acting on certain modifiable factors.
{"title":"Predictive Factors for Complete Resolution of Hypertension After Adrenalectomy for Aldosteronoma","authors":"I. Nacef, Days Khalifa","doi":"10.47363/jone/2023(3)125","DOIUrl":"https://doi.org/10.47363/jone/2023(3)125","url":null,"abstract":"Introduction: Primary hyperaldosteronism, 1st cause of secondary hypertension, 2nd cause of hypertension potentially curable by surgery. The objective of this work is to determine the predictive factors for complete resolution of hypertension after adrenalectomy. Material: We conducted a retrospective study of 25 patients with primary hyperaldosteronism operated and followed between 1985 and 2018. Results: Our patients were divided into 16 women and 9 men, mean age 54 years. 40% of our patients were smokers, 36% dyslipidemic, 68% diabetic and 76% had a BMI ≥ 25 kg / m2. Patients underwent unilateral adrenalectomy, the surgical approach was posterior lumbar in 9 cases and laparoscopic in 16 cases. No per or postoperative complication was noted. The postoperative course was marked by the HTA in 36% of the cases, an improvement in 36% of the cases and persistence in 31% of the cases. We found a significant decrease of the PAS and the PAD at six months of the surgery. The comparative study of the patients whose HTA was cured versus unhealed did not show a statistically significant correlation with the following predictors of healing: young age, female gender, lack of family history of hypertension, adenoma’s dimension, the presence of comorbidities including diabetes and dyslipidemia and the average number of antihypertensive treatment.Only the absence of overweight or obesity was a predictor of healing in our series. Conclusion: Knowing the predictive factors of healing aims to pose the operative indication and especially to improve the prognosis of hypertension after surgery by acting on certain modifiable factors.","PeriodicalId":145640,"journal":{"name":"Journal of Nephrology & Endocrinology Research","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126943437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-31DOI: 10.47363/jone/2023(3)124
Trisha Sachan, A. Saxena
Chronic kidney disease (CKD) is becoming a public-health problem, at a global level. In CKD, patients progressively lose the ability to excrete phosphorus. Several observational studies have determined hyperphosphatemia emerging as an independent cardiovascular risk factor in CKD-Mineral and Bone Disorder (CKD-MBD). In early CKD, serum Klotho declines and fibroblast growth factor-23 (FGF‐23) starts increasing which coincides with its effects on augmenting urinary phosphate excretion with reduced serum phosphate reabsorption and decreased levels of calcitriol. The Klotho/FGF23 axis should be a novel target for renal clinicians being pathogenic contributors to CKD progression and cardiovascular disease (CVD) development. The high phosphorous load has been found to increase serum FGF-23 levels in the early stages of CKD which further leads to CVD and increased mortality. To control hyperphosphatemia, a potentially simple and effective approach of dietary phosphate control should be incorporated to reduce the early clinical consequences of CKD-MBD. Along with the amount of dietary phosphorus intake, its type (organic vs. inorganic), its source (animal vs. plant derived), phosphorus-to-protein ratio and preparation of food by boiling should also be made aware to patients which is likely a neglected aspect of dietary counselling in CKD. A kidney-friendly diet plan is needed to protect kidneys from further damage which is rather an arduous period for making patients follow a phosphate-restricted diet. Here, the role of the renal dietitian appears mandatory in counselling and educating the patients to effectively integrate dietary interventions into the therapeutic approach of CKD-MBD.
{"title":"Importance of Renal Dietitians in Nutritional Counselling and Dietary Interventions in The Early Stages of Chronic Kidney Disease","authors":"Trisha Sachan, A. Saxena","doi":"10.47363/jone/2023(3)124","DOIUrl":"https://doi.org/10.47363/jone/2023(3)124","url":null,"abstract":"Chronic kidney disease (CKD) is becoming a public-health problem, at a global level. In CKD, patients progressively lose the ability to excrete phosphorus. Several observational studies have determined hyperphosphatemia emerging as an independent cardiovascular risk factor in CKD-Mineral and Bone Disorder (CKD-MBD). In early CKD, serum Klotho declines and fibroblast growth factor-23 (FGF‐23) starts increasing which coincides with its effects on augmenting urinary phosphate excretion with reduced serum phosphate reabsorption and decreased levels of calcitriol. The Klotho/FGF23 axis should be a novel target for renal clinicians being pathogenic contributors to CKD progression and cardiovascular disease (CVD) development. The high phosphorous load has been found to increase serum FGF-23 levels in the early stages of CKD which further leads to CVD and increased mortality. To control hyperphosphatemia, a potentially simple and effective approach of dietary phosphate control should be incorporated to reduce the early clinical consequences of CKD-MBD. Along with the amount of dietary phosphorus intake, its type (organic vs. inorganic), its source (animal vs. plant derived), phosphorus-to-protein ratio and preparation of food by boiling should also be made aware to patients which is likely a neglected aspect of dietary counselling in CKD. A kidney-friendly diet plan is needed to protect kidneys from further damage which is rather an arduous period for making patients follow a phosphate-restricted diet. Here, the role of the renal dietitian appears mandatory in counselling and educating the patients to effectively integrate dietary interventions into the therapeutic approach of CKD-MBD.","PeriodicalId":145640,"journal":{"name":"Journal of Nephrology & Endocrinology Research","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128182481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-31DOI: 10.47363/jone/2022(2)120
D. K., D. M
Introduction: Renal infraction is a rare medical-surgical emergency that should be evoked before any lumbar pain syndrome. We report in this work, two cases of renal infraction with their clinical evolution. Clinical observation: These patients, aged respectively 48 and 70 years, were hospitalized in our department concomitant for low back pain. Emboligenic heart disease was responsible for the renal infraction in both cases. Diagnostic certainty was established by a CT scan with injection of contrast medium. Renal function was normal in the young patient versus renal insufficiency at 20mg/l creatinine for a GFR estimated at 35ml/minute according to MDRD in the elderly patient. We had a clinical and biological improvement with a curative anticoagulant treatment relayed by a long term treatment with an anti vitamin K in both cases but the elderly man kept a sequential renal insufficiency. Conclusion: Acute renal infarction is a rare pathology which must be systematically evoked in front of a lumbar pain syndrome. Angioscan with injection of contrast medium allows to make the diagnosis. Heparinization at an effective dose is the mainstay of treatment in the case of unilateral involvement, or surgery if bilateral.
{"title":"Renal Infarction: Clinical and Evolutionary Aspects in the Nephrology Department Ibn Sina University Hospital of Rabat-Morocco","authors":"D. K., D. M","doi":"10.47363/jone/2022(2)120","DOIUrl":"https://doi.org/10.47363/jone/2022(2)120","url":null,"abstract":"Introduction: Renal infraction is a rare medical-surgical emergency that should be evoked before any lumbar pain syndrome. We report in this work, two cases of renal infraction with their clinical evolution. Clinical observation: These patients, aged respectively 48 and 70 years, were hospitalized in our department concomitant for low back pain. Emboligenic heart disease was responsible for the renal infraction in both cases. Diagnostic certainty was established by a CT scan with injection of contrast medium. Renal function was normal in the young patient versus renal insufficiency at 20mg/l creatinine for a GFR estimated at 35ml/minute according to MDRD in the elderly patient. We had a clinical and biological improvement with a curative anticoagulant treatment relayed by a long term treatment with an anti vitamin K in both cases but the elderly man kept a sequential renal insufficiency. Conclusion: Acute renal infarction is a rare pathology which must be systematically evoked in front of a lumbar pain syndrome. Angioscan with injection of contrast medium allows to make the diagnosis. Heparinization at an effective dose is the mainstay of treatment in the case of unilateral involvement, or surgery if bilateral.","PeriodicalId":145640,"journal":{"name":"Journal of Nephrology & Endocrinology Research","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133834432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chronic Kidney Disease (CKD) is being recognized as a global public health problem. It is a major non-communicable disease with the global prevalence varying between 10.5% and 13.1%. Diabetes and hypertension appear to be the leading causes of chronic kidney disease worldwide. An institution based cross-sectional study was undertaken from Oct 20, 2018 to Nov 20, 2019 G.C. Data was collected using a pre-tested questionnaire designed to meet the study objective. After describing variables, logistic regression was conducted to identify independent associated factors of CKD. Statistical significance was declared at P<0.05. Of the 450 studied patients, 260(57.8%) were males and more than half (54.2%) were between ages of 25 to 40 years. The prevalence of CKD among patients admitted to medical ward was 17.3% (95% CI 13 - 29.9) and 14.4% (95 % CI 6.2 – 12.3) by Cockcroft Gault and MDRD equations, respectively and majority (61.5%) of them were stage 5. Hypertension (AOR= 7.8 95%CI 4.1, 14.9), history of recurrent urinary tract infection (AOR= 3.5 95% CI 1.1, 7.3) and history of using nephrotoxic drugs (AOR=3.4 95% CI 2, 9.3) were significantly associated with CKD. The burden of CKD among patients in a medical inpatient unit was high and majority of the patients present late. Hypertension, use of nephrotoxic agents and recurrent urinary tract infections were found to be important predictors.
{"title":"Burden and Predictors of Chronic Kidney Disease in Developing Country","authors":"Meskelu Kidu Weldetensae, Migbnesh Geberemedhin Weldegebreial, Measho Gebreselassie","doi":"10.47363/jone/2022(2)123","DOIUrl":"https://doi.org/10.47363/jone/2022(2)123","url":null,"abstract":"Chronic Kidney Disease (CKD) is being recognized as a global public health problem. It is a major non-communicable disease with the global prevalence varying between 10.5% and 13.1%. Diabetes and hypertension appear to be the leading causes of chronic kidney disease worldwide. An institution based cross-sectional study was undertaken from Oct 20, 2018 to Nov 20, 2019 G.C. Data was collected using a pre-tested questionnaire designed to meet the study objective. After describing variables, logistic regression was conducted to identify independent associated factors of CKD. Statistical significance was declared at P<0.05. Of the 450 studied patients, 260(57.8%) were males and more than half (54.2%) were between ages of 25 to 40 years. The prevalence of CKD among patients admitted to medical ward was 17.3% (95% CI 13 - 29.9) and 14.4% (95 % CI 6.2 – 12.3) by Cockcroft Gault and MDRD equations, respectively and majority (61.5%) of them were stage 5. Hypertension (AOR= 7.8 95%CI 4.1, 14.9), history of recurrent urinary tract infection (AOR= 3.5 95% CI 1.1, 7.3) and history of using nephrotoxic drugs (AOR=3.4 95% CI 2, 9.3) were significantly associated with CKD. The burden of CKD among patients in a medical inpatient unit was high and majority of the patients present late. Hypertension, use of nephrotoxic agents and recurrent urinary tract infections were found to be important predictors.","PeriodicalId":145640,"journal":{"name":"Journal of Nephrology & Endocrinology Research","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123851190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-31DOI: 10.47363/jone/2022(2)124
U. A. Sharaf El Din, M. Salem
When SGLT2Is were first introduced as hypoglycemic agents during the year 2008, no body was aware about their protective action on the heart, kidney, and retina of patients suffering type 2 diabetes mellitus (T2DM). SGLT2Is have revolutionized the treatment of T2DM patients with established or at risk for diabetic kidney disease (DKD). When Dapagliflosin was studied in T2DM patients with estimated glomerular filtration rate [eGFR] >90 mL/min/1.73m2, and normal urine albumin excretion, these cases were still susceptible to develop the renal end points. These results have raised the question about the ideal time to use SGLT2Is to completely abort the incidence of DKD. This review will try to answer this question.
{"title":"Is it Feasible to Completely Prevent Diabetic Kidney Disease?","authors":"U. A. Sharaf El Din, M. Salem","doi":"10.47363/jone/2022(2)124","DOIUrl":"https://doi.org/10.47363/jone/2022(2)124","url":null,"abstract":"When SGLT2Is were first introduced as hypoglycemic agents during the year 2008, no body was aware about their protective action on the heart, kidney, and retina of patients suffering type 2 diabetes mellitus (T2DM). SGLT2Is have revolutionized the treatment of T2DM patients with established or at risk for diabetic kidney disease (DKD). When Dapagliflosin was studied in T2DM patients with estimated glomerular filtration rate [eGFR] >90 mL/min/1.73m2, and normal urine albumin excretion, these cases were still susceptible to develop the renal end points. These results have raised the question about the ideal time to use SGLT2Is to completely abort the incidence of DKD. This review will try to answer this question.","PeriodicalId":145640,"journal":{"name":"Journal of Nephrology & Endocrinology Research","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123209158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-31DOI: 10.47363/jone/2022(2)126
Vandit Sevak, Balakrishnan Karuppiah
Aim: The present study elucidated the expression level of Nrf2 and NF-κB, in chronic kidney disease (CKD) patients from South India. Further, the expression levels of these genes are analyzed for cytokines TNF-α and IFN-γ and various subgroups of cases including dialysis, non-dialysis, diabetic and non-diabetic CKD patients, and correlation analysis performed. Methods: 133 CKD patients and 133 healthy individuals were enrolled for the evaluation of NF-κB and Nrf2 expression by qPCR. Results: Upregulated Nrf2 mRNA expression (as fold change) was observed in diabetic (Fc: 1.13), and non-diabetic (Fc: 1.30) patients. Inversely, Nrf2 mRNA expression was down regulated in non-dialysis groups (Fc: 0.80). NF-κB expression was significantly upregulated in non-diabetic (Fc:1.92), non-dialysis (Fc:1.59), dialysis (Fc: 1.36) and CKD patients (pooled) (Fc: 1.27). A dysregulated NF-κB expression was observed in diabetic groups (Fc: 0.69). Nrf2 mRNA expression were positively correlated with IFN-γ expression in diabetes (r = 0.28, p = 0.05) and non-diabetic CKD patients (r = 0.37, p < 0.002). Likewise, TNF-α expression was positively correlated with Nrf2 expression in CKD (pooled) patients (r = 0.33, p < 0.000). A negative correlation was observed in Nrf2 and NF-κB expression in CKD (pooled) (r = -0.028, p = 0.833). Conclusion: The study concluded the down regulated Nrf2 and upregulated NF-κB expressions in non-dialysis patients. On the contrary, in diabetic CKD patients, the expression level of NF-κB was downregulated and Nrf2 was upregulated. Thus, a negative correlation was observed between Nrf2 and NF-κB genes with respect to their expression patterns.
目的:研究南印度慢性肾脏疾病(CKD)患者Nrf2和NF-κB的表达水平。进一步，分析这些基因在细胞因子TNF-α和IFN-γ以及包括透析、非透析、糖尿病和非糖尿病CKD患者在内的各种亚组中的表达水平，并进行相关性分析。方法:选择133例CKD患者和133例健康人，采用qPCR检测NF-κB和Nrf2的表达。结果:在糖尿病患者(Fc: 1.13)和非糖尿病患者(Fc: 1.30)中观察到Nrf2 mRNA表达上调(fold change)。相反，非透析组Nrf2 mRNA表达下调(Fc: 0.80)。NF-κB在非糖尿病(Fc:1.92)、非透析(Fc:1.59)、透析(Fc: 1.36)和CKD(合并)患者(Fc: 1.27)中表达显著上调。糖尿病组NF-κB表达异常(Fc: 0.69)。糖尿病患者(r = 0.28, p = 0.05)和非糖尿病性CKD患者(r = 0.37, p < 0.002) Nrf2 mRNA表达与IFN-γ表达呈正相关。同样，CKD(合并)患者TNF-α表达与Nrf2表达呈正相关(r = 0.33, p < 0.000)。Nrf2与NF-κB在CKD中的表达呈负相关(p = 0.833, r = -0.028)。结论:非透析患者Nrf2表达下调，NF-κB表达上调。相反，在糖尿病性CKD患者中，NF-κB表达水平下调，Nrf2表达水平上调。因此，Nrf2和NF-κB基因的表达模式呈负相关。
{"title":"Nuclear Factor Erythroid 2-Related Factor 2 (Nrf2) and Nuclear Factor-Kappa B (NF- κB) Expression in Chronic Kidney Disease Patients (CKD) from South India","authors":"Vandit Sevak, Balakrishnan Karuppiah","doi":"10.47363/jone/2022(2)126","DOIUrl":"https://doi.org/10.47363/jone/2022(2)126","url":null,"abstract":"Aim: The present study elucidated the expression level of Nrf2 and NF-κB, in chronic kidney disease (CKD) patients from South India. Further, the expression levels of these genes are analyzed for cytokines TNF-α and IFN-γ and various subgroups of cases including dialysis, non-dialysis, diabetic and non-diabetic CKD patients, and correlation analysis performed. Methods: 133 CKD patients and 133 healthy individuals were enrolled for the evaluation of NF-κB and Nrf2 expression by qPCR. Results: Upregulated Nrf2 mRNA expression (as fold change) was observed in diabetic (Fc: 1.13), and non-diabetic (Fc: 1.30) patients. Inversely, Nrf2 mRNA expression was down regulated in non-dialysis groups (Fc: 0.80). NF-κB expression was significantly upregulated in non-diabetic (Fc:1.92), non-dialysis (Fc:1.59), dialysis (Fc: 1.36) and CKD patients (pooled) (Fc: 1.27). A dysregulated NF-κB expression was observed in diabetic groups (Fc: 0.69). Nrf2 mRNA expression were positively correlated with IFN-γ expression in diabetes (r = 0.28, p = 0.05) and non-diabetic CKD patients (r = 0.37, p < 0.002). Likewise, TNF-α expression was positively correlated with Nrf2 expression in CKD (pooled) patients (r = 0.33, p < 0.000). A negative correlation was observed in Nrf2 and NF-κB expression in CKD (pooled) (r = -0.028, p = 0.833). Conclusion: The study concluded the down regulated Nrf2 and upregulated NF-κB expressions in non-dialysis patients. On the contrary, in diabetic CKD patients, the expression level of NF-κB was downregulated and Nrf2 was upregulated. Thus, a negative correlation was observed between Nrf2 and NF-κB genes with respect to their expression patterns.","PeriodicalId":145640,"journal":{"name":"Journal of Nephrology & Endocrinology Research","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121580699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-30DOI: 10.47363/jone/2022(2)117
Halle Marie Patrice, Takam Lancyn Debelmond
Objective: Post-operative acute kidney injury (AKI) is a frequent surgical complication. Data on this disorder are scare in our setting. We aimed to study the prevalence, characteristics and outcome of postoperative AKI in Cameroon. Methods: A prospective and analytical study from December 2020 to Mai 2021 including all consenting adults’ patients admitted in the departments of surgery, obstetrics/gynecology and intensive care unit (ICU) of 3 referral hospitals in Douala. For each patient, 3 serum creatinine assays were done on admission before the surgery, on days 2 and 7 after surgery. Postoperative AKI was defined and classified according to the modified KDIGO 2012 criteria. Outcome measure were kidney recovery at day 7 and mortality. Kidney recovery was total if serum creatinine on day 7 was less or equal to the preoperative value, partial if less than diagnostic value of day 2 but not the preoperative value and absent if creatinine on day 7 did not decrease or if the patient required dialysis. p <0.05 was considered significant. Result: Out of 203 patients included, 52 developed postoperative AKI, giving a prevalence of 26.6%. Mean age of AKI patients was 35.34 (13.74) years with 61.6% being (32/52) male; AKI stage 1 accounts for 55.7% (29/52), 19.3% (10/52) stage 2 and 25% (13/52) stage 3. AKI was functional in 61.5% (32/52) of cases mainly due to hypovolemia 42.5% (22/52) and sepsis 34.6% (18/52). For the 40 patients diagnosed on D2, kidney recovery was known in 75% (30/40); with 66.6% (20/30) total recovery, 23.4% (7/30) partial recovery and 10 % (3/30) without recovery. Mortality rate was 19% (10/52) mainly due to hemorrhagic shock. Intra operative hypotension (aOR: 6.09; CI: 1.4 - 26.33; p = 0.016) and dirty surgery (aOR: 6.22; CI: 1.35 - 28.75; p = 0.019) were factors associated with AKI. Conclusion: Postoperative AKI occurred in 1/4 of patients in our setting. It is mainly due to hypovolemia and sepsis, renal recovery and mortality were high.
{"title":"Prevalence, Characteristics and Outcome of Post-Operative Acute Kidney Injury in Cameroon: A Prospective Study in Three Hospitals in Douala","authors":"Halle Marie Patrice, Takam Lancyn Debelmond","doi":"10.47363/jone/2022(2)117","DOIUrl":"https://doi.org/10.47363/jone/2022(2)117","url":null,"abstract":"Objective: Post-operative acute kidney injury (AKI) is a frequent surgical complication. Data on this disorder are scare in our setting. We aimed to study the prevalence, characteristics and outcome of postoperative AKI in Cameroon. Methods: A prospective and analytical study from December 2020 to Mai 2021 including all consenting adults’ patients admitted in the departments of surgery, obstetrics/gynecology and intensive care unit (ICU) of 3 referral hospitals in Douala. For each patient, 3 serum creatinine assays were done on admission before the surgery, on days 2 and 7 after surgery. Postoperative AKI was defined and classified according to the modified KDIGO 2012 criteria. Outcome measure were kidney recovery at day 7 and mortality. Kidney recovery was total if serum creatinine on day 7 was less or equal to the preoperative value, partial if less than diagnostic value of day 2 but not the preoperative value and absent if creatinine on day 7 did not decrease or if the patient required dialysis. p <0.05 was considered significant. Result: Out of 203 patients included, 52 developed postoperative AKI, giving a prevalence of 26.6%. Mean age of AKI patients was 35.34 (13.74) years with 61.6% being (32/52) male; AKI stage 1 accounts for 55.7% (29/52), 19.3% (10/52) stage 2 and 25% (13/52) stage 3. AKI was functional in 61.5% (32/52) of cases mainly due to hypovolemia 42.5% (22/52) and sepsis 34.6% (18/52). For the 40 patients diagnosed on D2, kidney recovery was known in 75% (30/40); with 66.6% (20/30) total recovery, 23.4% (7/30) partial recovery and 10 % (3/30) without recovery. Mortality rate was 19% (10/52) mainly due to hemorrhagic shock. Intra operative hypotension (aOR: 6.09; CI: 1.4 - 26.33; p = 0.016) and dirty surgery (aOR: 6.22; CI: 1.35 - 28.75; p = 0.019) were factors associated with AKI. Conclusion: Postoperative AKI occurred in 1/4 of patients in our setting. It is mainly due to hypovolemia and sepsis, renal recovery and mortality were high.","PeriodicalId":145640,"journal":{"name":"Journal of Nephrology & Endocrinology Research","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129943183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-30DOI: 10.47363/jone/2022(2)118
Jennifer Garay Guerrero
A 52-year-old woman with Raynaud syndrome diagnosed less than 1 year ago, consulted the emergency room due to 4 months of progressive symmetrical edema in the lower limbs, muscle weakness, dyspnea, hypertension crisis, and dark urine. Investigations revealed left ventricular dysfunction (ejection fraction 14%) without coronary artery disease and acute renal injury. Mixed Connective Tissue Disease was diagnosed and because of the renal and systemic findings in the patient a renal biopsy was performed confirming scleroderma renal crisis. To the best of our knowledge, this is the tenth patient who reported scleroderma renal crisis as a complication in patients with Mixed Connective Tissue Disease, from these 4 patients who became hemodialysis dependent, 1 died, and 4 responded to therapy. The treatment chosen was Angiotensin-converting-enzyme inhibitors and steroids based on what is known in renal scleroderma crisis with a substantial recovery of the left ventricular function and stabilization of the glomerular filtration rate followed by discharge from hospitalization.
{"title":"Scleroderma Renal Crisis in Mixed Connective Tissue Disease in a Patient: A Challenging Disease","authors":"Jennifer Garay Guerrero","doi":"10.47363/jone/2022(2)118","DOIUrl":"https://doi.org/10.47363/jone/2022(2)118","url":null,"abstract":"A 52-year-old woman with Raynaud syndrome diagnosed less than 1 year ago, consulted the emergency room due to 4 months of progressive symmetrical edema in the lower limbs, muscle weakness, dyspnea, hypertension crisis, and dark urine. Investigations revealed left ventricular dysfunction (ejection fraction 14%) without coronary artery disease and acute renal injury. Mixed Connective Tissue Disease was diagnosed and because of the renal and systemic findings in the patient a renal biopsy was performed confirming scleroderma renal crisis. To the best of our knowledge, this is the tenth patient who reported scleroderma renal crisis as a complication in patients with Mixed Connective Tissue Disease, from these 4 patients who became hemodialysis dependent, 1 died, and 4 responded to therapy. The treatment chosen was Angiotensin-converting-enzyme inhibitors and steroids based on what is known in renal scleroderma crisis with a substantial recovery of the left ventricular function and stabilization of the glomerular filtration rate followed by discharge from hospitalization.","PeriodicalId":145640,"journal":{"name":"Journal of Nephrology & Endocrinology Research","volume":"1989 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131110953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-30DOI: 10.47363/jone/2022(2)119
Thérèse Mbezele-Essomba, Bertille Elodie E Edinga
Background: Type 2 diabetes (T2D) is a chronic and progressive condition whose early management is crucial in preventing the occurrence of its chronic degenerative complications. Cystatin C (CysC) is a biomarker that may have a beneficial interest in the early detection of microvascular and macrovascular complications of T2D. Methods: We carried out a cross-sectional analytic study at the National Obesity Center of the Yaounde Central Hospital. We recruited 135 patients with T2D and performed a neurologic physical exam using the Toronto clinical score, a fundoscopy, ECG, ABI, and the following paraclinicals: dosage of serum levels of Cystatin C, lipid profile (with determination of Atherogenic indexes), Creatinine (with calculation of glomerular filtration rate using CKD-EPI formula) and hs-CRP. Results: Prevalences of diabetic retinopathy, nephropathy, neuropathy and PAD were 3.0%, 8.9%, 38.5%, 28.1% respectively. Electrocardiographic signs of myocardial ischemia were present in 5.9 % of the participants. We found 0.3[0.5-0.3] mg/l as median levels of the HDL-cholesterol and 0.9[1.2-0.7] mg/l for LDL-cholesterol. The median value of GFR was 105.7[119,0-85.7] ml/min/1.73m². The median serum CysC level was 0.8[0.9-0.6]mg/l and varied with age (p=0.01), A1C (p=0.016) and high blood pressure (HBP) (p=0.006). There was a relationship between serum CysC and diabetic nephropathy (p=0.01) and neuropathy (p=0.025). There was no significant relationship with diabetic retinopathy (p=0.225), PAD (p=0.169) and ECG signs of myocardial ischemia (p=0.669). Conclusion: Chronic microvascular and macrovascular complications of type 2 diabetes are common and in our study are predominantly represented by diabetic neuropathy and PAD. Serum CysC can be useful in the diagnosis of chronic complications of T2D.
{"title":"Cystatin C and Chronic Complications of Diabetes Mellitus in a Subsaharian Population","authors":"Thérèse Mbezele-Essomba, Bertille Elodie E Edinga","doi":"10.47363/jone/2022(2)119","DOIUrl":"https://doi.org/10.47363/jone/2022(2)119","url":null,"abstract":"Background: Type 2 diabetes (T2D) is a chronic and progressive condition whose early management is crucial in preventing the occurrence of its chronic degenerative complications. Cystatin C (CysC) is a biomarker that may have a beneficial interest in the early detection of microvascular and macrovascular complications of T2D. Methods: We carried out a cross-sectional analytic study at the National Obesity Center of the Yaounde Central Hospital. We recruited 135 patients with T2D and performed a neurologic physical exam using the Toronto clinical score, a fundoscopy, ECG, ABI, and the following paraclinicals: dosage of serum levels of Cystatin C, lipid profile (with determination of Atherogenic indexes), Creatinine (with calculation of glomerular filtration rate using CKD-EPI formula) and hs-CRP. Results: Prevalences of diabetic retinopathy, nephropathy, neuropathy and PAD were 3.0%, 8.9%, 38.5%, 28.1% respectively. Electrocardiographic signs of myocardial ischemia were present in 5.9 % of the participants. We found 0.3[0.5-0.3] mg/l as median levels of the HDL-cholesterol and 0.9[1.2-0.7] mg/l for LDL-cholesterol. The median value of GFR was 105.7[119,0-85.7] ml/min/1.73m². The median serum CysC level was 0.8[0.9-0.6]mg/l and varied with age (p=0.01), A1C (p=0.016) and high blood pressure (HBP) (p=0.006). There was a relationship between serum CysC and diabetic nephropathy (p=0.01) and neuropathy (p=0.025). There was no significant relationship with diabetic retinopathy (p=0.225), PAD (p=0.169) and ECG signs of myocardial ischemia (p=0.669). Conclusion: Chronic microvascular and macrovascular complications of type 2 diabetes are common and in our study are predominantly represented by diabetic neuropathy and PAD. Serum CysC can be useful in the diagnosis of chronic complications of T2D.","PeriodicalId":145640,"journal":{"name":"Journal of Nephrology & Endocrinology Research","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116015860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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