The experience on management of abnormal blood vessels in 128 cases of donor kidney during the tailoring operation was reported. The various techniques used for different types of abnormal arteries and veins, and the critical points which should be paid attention to have been discussed. It was concluded that the multiple renal arteries should be treated in a single renal artery and anastomosed with internal iliac artery or/and external iliac artery. The appropriate management given to abnormal renal blood vessels during the tailoring operation may shorten the warm ishemia time, ensure the renal blood supply, reduce the renal vasular complication, and promote the recovery of renal function.
Studies of evidence-based medicine have provided much important evidence, clarified problems, and guided the clinical practice in the treatment of renal diseases. As examples, several therapeutic problems in renal hypertension, renal anemia and low protein diet for the patients with chronic kidney disease are discussed in this paper.
Chronic kidney disease (CKD) is now recognized as a worldwide public health challenge, and the incidence rate and hospitalization rate have significantly increased in recent years. Without prompt diagnoses and effective treatment in the early renal function damage of CKD, the symptoms will continue to worsen and eventually develop into end-stage renal disease. Functional imaging techniques such as single photon emission computed tomography (SPECT), contrast-enhanced ultrasound (CEUS), computerized tomography perfusion (CTP), and magnetic resonance perfusion weighted imaging (MR-PWI) could be used to quantitatively analyze renal perfusion and renal filtration function. Their diagnostic values are increasingly evident and have become the research hotspot in evaluating renal function. The aim of this review is to briefly evaluate the research and application advances in the early renal function damage assessment of CKD, so as to raise the efficiency of clinical applications.
Objective To evaluate the efficacy and safety of intermittent hemodialysis (IHD) and continuous renal replacement therapy (CRRT) on patients with acute kidney injury (AKI) after bee sting. Methods A prospective observational analysis was made on patients with AKI after bee sting treated in Jianyang People’s Hospital or West China Hospital of Sichuan University between July 2015 and December 2020. According to different initial renal replacement therapy modes, the patients were divided into IHD group and CRRT group. The IHD group received hemodialysis for 4 hours each time, once a day or 3-5 times a week; the CRRT group used Prismaflex machine for continuous veno-venous hemofiltration or continuous veno-venous hemodiafiltration within 72 hours after admission, for at least 12 hours a day, followed by CRRT or IHD, depending on the patient’s condition. Both groups could be treated with hemoperfusion (HP) and symptomatic support such as glucocorticoid, blood transfusion and fluid rehydration. The IHD group was divided into IHD subgroup and IHD+HP subgroup, and the CRRT group was divided into CRRT subgroup and CRRT+HP subgroup according to whether renal replacement therapy was combined with HP. The basic information of patients and clinical laboratory examination results were collected, and the renal function recovery and mortality rates of patients in the two groups were compared, as well as the changes of laboratory indicators. Results A total of 106 patients were enrolled, 50 in the IHD group and 56 in the CRRT group. There was no statistical difference in the rate of complete renal function recovery 30, 60, or 90 days after treatment between the two groups (28.2% vs. 31.2%, P=0.758; 46.2% vs. 50.0%, P=0.721; 82.1% vs. 81.2%, P=0.924). But in the CRRT subgroup analysis, there was a statistical difference in the 30-day renal function recovery rate of CRRT+HP patients compared with CRRT alone (47.6% vs. 18.5%, P=0.031), while no statistical difference was found in the IHD subgroup analysis. After 3 days of treatment, the levels of creatine kinase of the IHD+HP subgroup and the CRRT+HP subgroup were lower than those in the IHD and CRRT subgroups, and the differences were statistically significant [(7875±6871) vs. (15157±8546) U/L, P=0.026; (10002±8256) vs. (14498±10362) U/L, P=0.032]. There was no statistical difference in 30-day mortality or incidence of serious adverse reactions between the two groups (P>0.05). Conclusions There is no obvious difference in improving renal prognosis or reducing mortality between CRRT and IHD for patients with AKI after bee sting. However, CRRT combined with HP therapy could shorten the recovery time of renal function and increase the 30-day kidney recovery rate. HP may contribute to early renal function recovery in patients with AKI after bee sting, but more high-quality randomized controlled trials are needed to further confirm this.
Objective To assess the relationship between the change in fluid overload at 48 h after initiation of continuous renal replacement therapy (CRRT) and 28-day mortality in critically ill patients with acute kidney injury (AKI). Methods A retrospective cohort study was performed using data from the MIMIC-IV database from 2008 to 2019. Patients who received CRRT for AKI for more than 24 h within 14 d of admission to the intensive care unit were included. The exposure variable was the proportion of change of fluid overload (ΔFO%, defined as the difference between body weight normalized fluid input and output) at 48 h after CRRT initiation, and the endpoint was 28-day mortality. Generalized additive linear regression models and logistic regression models were used to determine the relationship between the exposure and endpoint. Results A total of 911 patients were included in the study, with a median (lower quartile, upper quartile) ΔFO% of −3.27% (−6.03%, 0.01%) and a 28-day mortality of 40.1%. Generalized additive linear regression model showed that the ΔFO% at 48 h after CRRT initiation was associated with a J-shaped curve with 28-day mortality. After adjusting for other variables, as compared with the second quartile of ΔFO% group, the first quartile group [odds ratio (OR)=1.23, 95% confidence interval (CI) (0.81, 1.87), P=0.338] was not associated with higher risk of 28-day mortality, while the third quartile group [OR=1.54, 95%CI (1.01, 2.35), P=0.046] and the fourth quartile group [OR=2.05, 95%CI (1.32, 3.18), P=0.001] were significantly associated with higher risk of 28-day mortality. There was no significant relationship between ΔFO% groups and 28-day mortality in the first 24-hour after CRRT initiation (P>0.05), but there was a linear relationship between ΔFO% and 28-day mortality in the second 24-hour after CRRT initiation, the larger the ΔFO%, the higher the mortality rate [OR=1.10, 95%CI (1.04 1.16), P<0.001 for per 1% increase]. ConclusionIn critically ill patients with AKI, the ΔFO% greater than −3.27% within 48 h after CRRT initiation is independently associated with an increased risk of 28-day mortality, and the goals of CRRT fluid management may be dynamical.
Renal cancer is a common malignant tumor and the deadliest cancer of the urinary and reproductive system. Given the increasing incidence rate of kidney cancer, timely intervention of its controllable risk factors is crucial. Antimicrobial agent is widely used worldwide, and in recent years, some studies have found that long-term use of antimicrobial agent is associated with an increased risk of kidney cancer. The mechanism may involve multiple factors such as nephrotoxicity of antimicrobial agent and intestinal flora imbalance. This article reviews the relationship between long-term use of antimicrobial agent and risk of kidney cancer, and explores possible mechanisms, to understand the impact of long-term use of antimicrobial agent on the risk of kidney cancer, and to provide more references for early prevention of kidney cancer and rational use of antimicrobial agent.
ObjectiveTo evaluate the efficacy of the continuous renal replacement therapy (CRRT) for acute kidney injury (AKI) after the surgery of type A aortic dissection. MethodsWe retrospectively analyzed 58 hemodialysis patients with AKI after type A aortic dissection surgery in our hospital between January 2003 and January 2014.The 58 patients were divided into two groups including a bedside intermittent hemodialysis (IHD) group and a CRRT group based on the methods of hemodialysis. There were 38 patients with 29 males and 9 females at average age of 49.8± 13.7 years in the CRRT group. There were 20 patients in the IHD group with 14 males and 6 females at average age of 52.6± 11.0 years. ResultsCompared with IHD, CRRT had significantly greater effect on reducing the simplified acute physiology scoring system (SAPS)Ⅱscore (Ftime=60.964, P=0.000; Ftime * group=3.178, P=0.041). However, there was no significant difference in reducing the acute tubular necrosis individual illness severity index (ATN-ISI) score between the two groups (Ftime=13.803, P=0.000; Ftime * group=0.222, P=0.951). Lower incidences of dialysis-related complications including hypotension (P=0.027) and acute congestive heart failure (P=0.011) were found in the CRRT group. There was no statistical difference in operation time (P=0.367) between the two groups. While statistical differences in duration of hospitalization in intensive care unit (P=0.006), in hospital time (P=0.047), frequency of dialysis (P=0.001), and dialysis time (P=0.039) were found between the two groups. However there were no significant differences in mortality during hospital (P=0.544)and incidences of recovery (P=0.056) between the two groups. ConclusionCompared with IHD, CRRT had significantly positive effect on patients who suffered from AKI after type A aortic dissection surgery, which can help reduce incidences of dialysis-related complications, duration and cost of hospitalization in ICU.
ObjectiveTo investigate the protective effects and mechanism of selective histone deacetylases 6 (HDAC6) inhibitor 23BB in myoglobin-induced proximal tubular cell lines (HK-2).MethodsHK-2 cells were divided into 5 groups, including control group, myoglobin (200 μmol/L) group, myoglobin (200 μmol/L)+23BB (1.25 nmol/L) group, myoglobin (200 μmol/L)+4-phenylbutyric acid (2 mmol/L) group, and myoglobin (200 μmol/L)+23BB (1.25 nmol/L)+tunicamycin (25 ng/mL) group. Cells were collected at 24 hours after treatment. The endoplasmic reticulum (ER) stress-related gene mRNA level and marker protein expression were evaluated by RT-PCR and Western blotting, including glucose regulated protein 78 (GRP78), C/EBP homology protein (CHOP), inositol-requiring enzyme 1 (IRE1), PKR-like ER kinase (PERK), and activating transcription factor 6.ResultsIn in vitro study, ER stress-related mRNA of GRP78, IRE1α, PERK, and CHOP and marker protein expression of GRP78 and CHOP were found to increase in response to myoglobin treatment. Either administration of 23BB or 4-PBA could alleviate myoglobin-induced these changes.ConclusionThe protective effect of HDAC6 inhibitor 23BB is through the inhibition of myoglobin-induced ER stress in HK-2 cells.
Diabetic kidney disease (DKD) is a major complication of diabetes mellitus. One third of patients with advanced diabetes mellitus can develop to uremia, which seriously endangers people’s health. In recent years, with the improvement of people’s living standards and the increasing incidence of diabetes, it has become the main cause of end stage renal disease in China. Over the past two decades, the understanding of diagnosis and treatment of DKD has been improved, such as putting forward the new concept of normoalbuminuric DKD and developing a variety of new anti-diabetic drugs. However, at present, the basic strategies of DKD treatment are still lifestyle modification, glucose control, blood pressure control and lipid control.
Kidney transplantation is an ideal treatment for patients with end-stage renal disease. Circulating alloantibodies against donor human leukocyte antigens and blood group antigens can impair allografts, shorten allograft survival, and limit access to kidney transplantation. Furthermore, the presence of donor specific antibodies is associated with increased incidence of antibody-mediated rejection and decreased graft survival following transplantation. Plasmapheresis, an extracorporeal therapy directed at removing plasma proteins that has been found to minimize the effects of perioperative sensitization in kidney transplantation. Plasmapheresis enables transplantation across the barrier of ABO blood group incompatibility. In addition, it is also an important approach for the treatment of antibody-mediated rejection. Therefore, studying the application of plasmapheresis in perioperative period of kidney transplantation is expected to increase the chance of transplantation and improve the outcomes following transplantation. This article introduces the application of plasmapheresis in the perioperative period of kidney transplantation.