Renal resistive index in hypertensive patients

Spectral Doppler ultrasonography provides the evaluation of renal resistive index (RRI), a noninvasive and reproducible measure to investigate arterial compliance and/or resistance. RRI seems to possess an important role in the evaluation of diverse cases of secondary hypertension. In essential hypertension, RRI is associated with subclinical markers of target organ damage and reflects renal disease progression beyond albuminuria and creatinine clearance. Also, RRI can estimate cardiovascular and renal risk. The evaluation of RRI may also help the therapeutic decisions. Given its simple assessment, RRI emerges as a simple method and a “multifunctional” tool that could help on the cardiovascular risk evaluation of the hypertensive patient.     

非何杰金淋巴瘤的肾脏损害

目的:了解非何杰金淋巴瘤(NHL)肾脏损害的临床特征和肾脏病理表现.方法:收集住院患者8例临床资料及其中6例肾活检病理资料加以分析.结果:①8例NHL患者诊断为:T细胞淋巴瘤3例,小B细胞淋巴瘤2例,大B细胞淋巴瘤1例,皮肤T细胞淋巴瘤1例,B细胞淋巴瘤1例.②首发症状:以肉眼血尿、下肢水肿和皮疹起病各2例,以发热伴少尿及关节痛伴口腔溃疡各1例.③肾外损害:发热4例,皮疹5例,淋巴结肿大7例;多数患者合并贫血和白/球蛋白比下降或倒置;血清抗核抗体阳性3例,低补体血症5例,抗中性粒细胞胞浆抗体(ANCA)阳性1例.④肾脏损害:临床表现尿检异常3例,急性肾衰4例,慢性肾衰1例;⑤6例行肾活检病理改变分别为:毛细血管内增生性病变(2例),膜增生样病变(3例),轻度系膜增生性病变1例;免疫荧光可见较多免疫复合物沉积,尤其是补体C1q沉积;2例小B细胞淋巴瘤患者伴间质淋巴瘤细胞浸润.结论:NHL肾脏损害从轻度尿检异常至急性肾衰不等,肾脏病理多为急性增殖性病变;肾外损害除了发热、贫血等表现外,多数患者还有皮疹,低补体血症,甚至自身抗体和ANCA阳性,类似系统红斑狼疮和系统性血管炎,临床需注意鉴别.     

Renal Outcomes in Critically Ill Patients Receiving Propofol or Midazolam

Background and objectives

Propofol has been shown to provide protection against renal ischemia/reperfusion injury experimentally, but clinical evidence is limited to patients undergoing cardiac surgery. There are no data about its association with oliguria and AKI in critically ill patients.

Design, setting, participants, & measurements

We obtained data from the Multiparameter Intelligent Monitoring in Intensive Care II database (2001–2008). Patient selection criteria included adult patients in their first intensive care unit (ICU) admission, need for mechanical ventilation, and treatment with propofol or midazolam. Propensity score analysis (1:1) was used and renal-related outcomes (AKI, oliguria, cumulative fluid balance, and need for RRT) were evaluated during the first 7 days of ICU stay.

Results

There were 1396 propofol/midazolam-matched patients. AKI in the first 7-day ICU time period was statistically lower in propofol-treated patients compared with midazolam-treated patients (55.0% versus 67.3%, P<0.001). Propofol was associated with lower AKI incidence using both urine output (45.0% versus 55.7%, P<0.001) and serum creatinine criteria (28.8% versus 37.2%, P=0.001). Patients receiving propofol had oliguria (<400 ml/d) less frequently (12.4% versus 19.6%, P=0.001) and had diuretics prescribed less often (8.5% versus 14.3%, P=0.001). In addition, during the first 7 days of ICU stay, patients receiving propofol less frequently achieved cumulative fluid balance >5% of body weight (50.1% versus 58.3%, P=0.01). The need for RRT in the first 7 days of ICU stay was also less frequent in propofol-treated patients (3.4% versus 5.9%, P=0.03). ICU mortality was lower in propofol-treated patients (14.6% versus 29.7%, P<0.001).

Conclusions

In this large, propensity-matched ICU population, patients treated with propofol had a lower risk of AKI, fluid-related complications, and need for RRT.     

Renal denervation in a patient with prior renal artery stenting

This is a case report of a 69‐year‐old female with treatment‐resistant severe arterial hypertension despite prior successful percutaneous intervention to both renal arteries for significant renal artery stenoses (stenting of the right and balloon angioplasty of the left renal artery). The office blood pressure was 221/108 mm Hg at baseline. Secondary hypertension was ruled out and catheter‐based renal denervation performed (distal to the stent in the right renal artery and in the usual fashion in the left renal artery) without complications. The office blood pressure decreased at 1‐ and 3‐month follow‐up to 185/93 mm Hg and 182/95 mm Hg, respectively. This case illustrates the feasibility and potential efficacy of catheter‐based renal denervation in patients with a renal artery stent, an important finding as persistent hypertension is common in patients despite successful renal artery stenting and currently available trials examining renal denervation have excluded patients with prior renal artery stents. © 2012 Wiley Periodicals, Inc.     

Dopamine‐induced changes in renal blood flow in normals and in patients with renal dysfunction

Background : Despite their controversial effect, “renal” doses of dopamine (3–5 μg · kg^?1 · min^?1) are often used in intensive care units to preserve renal function and to improve final outcome. Aim : To assess the effects of different doses of dopamine on renal blood flow in patients with normal renal function and in patients with renal dysfunction. Methods and Results : In 17 patients with normal renal function and in 12 patients with moderate renal dysfunction, mean arterial pressure (MAP), heart rate (HR), and average peak renal flow velocities (FlowWire APV) were continuously recorded at baseline and during IV administration of increasing dopamine doses (3, 5, 10, 20, and 30 μg · kg^?1 · min^?1). MAP and HR did not change during infusion of 3–5 μg · kg^?1 · min^?1 but increased to the same extent in both groups during infusion of >10 μg · kg^?1 · min^?1. Baseline APV was similar in both groups. Infusion of 3–5 μg · kg^?1 · min^?1 induced a significant change in APV only in patients with normal renal function. In patients with renal dysfunction, APV increased only during infusion of >10 μg · kg^?1 · min^?1 in parallel with MAP and HR. Conclusion : “Renal” doses of dopamine increase renal blood flow in normals but not in patients with moderate renal dysfunction. © 2008 Wiley‐Liss, Inc.     

慢性肾功能衰竭患者铝与骨病的关系

观察了２３例慢性肾功能衰竭（ＣＲＦ）患者，血铝含量平均为１．２７８±０．６４３ｐｐｍ，发铝含量为２．３７３±０．７９３μｇ／ｇ，明显高于正常人血铝０．７３８±０．０８２ｐｐｍ，发铝１．４９５±０．５９μｇ／ｇ，Ｐ值分别＜０．０１及＜０．００１。血铝与血钙水平呈明显负相关，ｒ＝－０．６２５３，Ｐ＜０．０５。肾性骨病（ＲＯＤ）患者血铝明显高于非骨病组，Ｐ＜０．０５。提示ＣＲＦ患者存在明显铝蓄积，并且与ＲＯＤ密切相关。对ＣＲＦ患者一经确诊即应采取有效的防治铝中毒的各项措施。     

How Much Does the Kidney Participate in the Origin of Primary Hypertension?

The existence of a relationship between the kidney and arterial hypertension has long been known. Renal participation in the development of arterial hypertension has been clearly shown in different animal models that mimic human essential hypertension. Different theories have tried to explain the mechanism(s) underlying the renal participation in human hypertension. According to the data contained in the literature renal vasoconstriction is present in the kidney since the very early stages of the hypertensive disease and could constitute the mechanism facilitating the development of arterial hypertension.     

257例儿童急、慢性肾功能衰竭的病因分析

目的 :了解儿童急、慢性肾功能衰竭的常见病因及构成比例。方法 :回顾分析近十年间 2 5 7例住院儿童急、慢性肾功能衰竭的临床资料 ,以及部分肾组织病理结果。结果 :急性肾功能衰竭(ARF)占住院病例总数的 8.0 2 %,慢性肾功能衰竭 (CRF)占 2 .0 3%;ARF病例以急性肾小球肾炎最为常见 ,占 5 9.0 2 %;CRF病例以肾髓质囊性病最为常见 ,占 32 .6 9%。结论 :儿童急、慢性肾功能衰竭病因的构成比例与现有的文献资料有差异 ,反映了本地区儿童肾功能衰竭有关病因的分布状况。     

肾动脉交感神经射频消融术器械相关研究进展

肾动脉交感神经射频消融术具有显著的降压效果和良好的安全性,为顽固性高血压治疗提供了一种新方法。近年来,肾动脉交感神经射频消融术的射频消融装置层出不穷,各具特色,现将5种常见的肾动脉交感神经射频消融术器械及其临床研究进行综述。     

Prognosis in Glomerulonephritis

ABSTRACT Between 1967 and 1977, 395 consecutive cases of glomerulonephritis (GN) were collected by a Copenhagen study group. The diagnosis was established by histological and biochemical criteria. Light microscopy investigations of thin silver-stained sections were applied. In a follow-up in 1980 all cases were categorized by one of the following end points: death without uremia, uremia, recovery, or censored cases. The course is presented in figures showing the cumulated distribution of outcomes in relation to observation time. Each histological subgroup of GN had its own characteristic course with respect to initial rates of changes in the renal state, as well as to frequency of recovery, uremia and death. The prognosis was good in minimal changes GN and proliferative GN, bad in unclassified GN and worst in extracapillary GN. When part of a connective tissue disease, GN carried a poor prognosis. We conclude that histological classification of GN based on light microscopy offers a reliable means of predicting the long-term prognosis.     

Renal angiographic findings in systemic sclerosis: ‘the Egyptian experience’

Objective: This study was designed to search for a possible pathological involvement of renal arteries among patients with systemic sclerosis (SSc) and to correlate the findings with renal functions. Patients and methods: Fourteen female patients with SSc were recruited for this study. The diagnosis and classification of SSc was based on the 1980 American College of Rheumatology criteria for classification of SSc. Nine patients had diffuse‐type SSc, and the remaining five belonged to the limited type of the disease. All patients were evaluated by history‐taking, clinical examination, laboratory investigations and renal angiography. Results: Three out of the nine patients (33.3%) with diffuse SSc had tortuous renal arteries, but there were none in the limited type. Two patients (22.2%) with diffuse SSc had ectatic renal arteries and three (33.3%) had osteal renal artery stenosis. Tortuous abdominal aorta was detected in one patient (11.1%) with diffuse SSc and congenital double renal artery in another (11.1%). Two out of the five patients with limited‐type disease (40%) had osteal renal artery stenosis that was bilateral in one case. Bilateral renal artery affection was observed in 3/14 studied patients (21.42%), and two of these had diffuse disease and one had limited disease. Three patients had hypertension (two had diffuse pattern and one had limited pattern). Conclusion: We consider that renal artery stenosis is the most important among all the findings detected and should be considered in SSc patients presenting with renal crisis because use of angiotensin converting enzyme (ACE) inhibitors in this situation may be deleterious rather than beneficial.     

Octreotide in liver cirrhosis: a salvage for variceal bleeding can be a gunshot for kidneys.

BACKGROUND: The renal effects of octreotide, used for bleeding esophageal varices in cirrhosis, are controversial. METHODS: Fourteen cirrhotic patients (Child-Pugh; A/B/C: 1/12/1) were enrolled. Plasma nitrite and endothelin (ET) levels, urinary nitrite output, free water clearance (FWC) and fractional excretion of filtered sodium (FENa) were measured and renal Doppler ultrasound was carried out. Octreotide was infused at a rate of 0.75 microg/kg/h for 3 h after a bolus of 0.75 microg/kg body weight. All the parameters were reevaluated during octreotide administration while the patients acted as their own controls. RESULTS: Octreotide induced significant reductions in urinary nitrite, FENa and FWC. Plasma ET levels increased (baseline: 6.7 pg/ml, octreotide: 8.4 pg/ml), whereas the plasma nitrite level did not change significantly after octreotide infusion. Overall, no significant change in renal resistive index (RRI) could be demonstrated on Doppler after octreotide administration. However, patients with elevated baseline RRI values had significantly more deterioration in FWC and FENa compared with patients with normal RRI in response to octreotide. CONCLUSION: A marked decrease in FENa, FWC and urinary nitrite output, together with a significant increase in plasma ET level in response to octreotide, may indicate renal dysfunction in cirrhotic patients. This deleterious renal effect of octreotide may be more enhanced in patients with elevated baseline RRI.     

肾癌组织中CapG蛋白的表达变化及临床意义

目的观察肾透明细胞癌（肾癌）组织中CapG蛋白的表达变化,并探讨其意义。方法选取132例肾癌标本（观察组）及40例癌旁正常肾组织标本（对照组）,采用免疫组化SP法检测CapG蛋白的表达。结果对照组CapG蛋白阳性表达率为7.5%,明显低于观察组的56.1%,P〈0.001。观察组CapG蛋白表达与淋巴结转移和预后有关（P均〈0.05）,与患者年龄、性别、T分期、病理分级、复发转移无显著相关（P均〉0.05）。结论肾癌组织中CapG蛋白表达上调。其与肾癌的转移和预后有关。     

连续肾脏替代治疗在肝移植中的应用

目的探讨连续肾脏替代治疗(CRRT)在肝移植术后急性肾功能衰竭(ARF)合并多器官功能不全(MODS)治疗中的应用价值。方法分析连续静脉静脉血液滤过(CVVH)治疗7例肝移植术后ARF、成人呼吸窘迫综合征(ARDS)、急性心衰、全身炎症反应综合征(SIRS)等患者。3例合并ARDS患者同时进行呼吸机辅助呼吸治疗。结果4例治愈,另3例ARF合并MODS患者死亡。经CVVH治疗后,患者血清中的肌酐、尿素氮、血钾较治疗前降低(P<0.05),凝血酶原时间变化无意义。结论CVVH能有效控制氮质血症和高血钾等高分解状态,而不影响凝血功能。早期应用可以改善肝移植术后ARF、ARDS、充血性心力衰竭、SIRS等MODS患者的预后。     

Preglomerular and postglomerular basal diameter changes and reactivity to angiotensin II in obese rats

Aim and Methods: Obesity in humans is associated with proteinuria and an increased glomerular filtration, possibly related to an increase in glomerular capillary pressure. We investigated in obese and lean Zucker rats (10–12 weeks old) whether this might be related to alterations in the diameter of preglomerular and postglomerular microvessels and their reactivity to the resistance regulator angiotensin II (AngII), using the hydronephrotic kidney model. Results: The obese rats exhibited a hyperinsulinaemic, euglycaemic state and hypertension. Urinary protein concentration and fluid intake were both increased threefold. Basal diameters of distal interlobular arteries (ILAs) and afferent arterioles (AAs) were larger in the obese rat than in the lean rat (ILA: 25.7 ± 0.3 vs. 23.0 ± 0.4 μm and AA: 18.8 ± 0.3 vs. 16.7 ± 0.5 μm, respectively; p ≤ 0.01), while diameters of efferent arterioles (EAs) were smaller in obese animals (14.2 ± 1.1 vs. 18.2 ± 1.2 μm; p ≤ 0.05). AngII induced a concentration‐dependent constriction in ILA, AA and EA with an augmented response in the obese compared with the lean rats. Thus, at higher concentrations, AngII abolished the diameter difference between obese and lean animals in preglomerular microvessels while exaggerating that in postglomerular arterioles. Conclusions: Our data indicate that in obese rats, a vasodilated state in small preglomerular microvessels and a vasoconstricted state in the postglomerular arterioles exist. Although AngII cancelled the former, the latter remained. Therefore, these data reveal periglomerular vascular changes that may play a role in glomerular dysfunction and renal pathology associated with obesity.     

经皮肾动脉介入治疗肾动脉狭窄的远期临床疗效

目的观察肾动脉狭窄患者经皮肾动脉介入治疗对血压及肾功能的远期疗效。方法选取1998年1月至2006年6月在沈阳军区总医院心内科住院诊治的肾动脉狭窄患者120例为研究对象,观察术后72h及随访5年的血压及肾功能的变化,评价肾动脉介入治疗对肾性高血压、肾功能不全的影响。结果120例行经皮肾动脉介入治疗的患者肾动脉病变狭窄程度76．1％±19．4％,支架直径（5．8±1．2）mm,支架长（17．1±4．2）mm,支架残余狭窄2．1％±0．5％,介人手术成功率达100％。术前血压（178．7±28．4／100．2±17．6mm）Hg,术后72h血压（128．1±14．5／75．1±10．1）mmHg,随访5年时血压（140．2±18．7／84．4±13．2）mmHg;术后72h及5年随访血压值较术前显著下降,差异均有统计学意义（P〈0．05）。术后人均服用降压药物比术前明显减少,差异有统计学意义[（2．7±1．0）种m（3．5±1．0）种,P〈O．05]。术前估算肾小球率过滤（estimated glomerular filtration rate,eGFR）（65．50±24．41）mL／（min·1．73m^2）,术后72heGFR（61．16±23．36）mL／（min·1．73m^2）,术后5年eGFR（64．12±23．30）mL／（min·1．73m^2）;术后72h及术后5年与术前eGFR比较,均差异无统计学意义（P〉O．05）。27例肾动脉狭窄合并肾功能异常的患者术前eGFR（35．43±11．66）mL／（min·1．73m^2）,术后72heGFR（33．86±12．51）mL／（min．1．73m^2）,术后5年eGFR（39．10±12．69）mL／（min·1．73mz）;术后5年eGFR较术前呈上升趋势,但与术前比较,差异无统计学意义（P〉0．05）。结论肾动脉介入治疗可显著降低肾性高血压患者术后血压,减少应用降压药物种类．对术前肾功能正常者无影响;5年随访观察经皮肾动脉介入治疗对术前肾功能异常者无明显改善。     

肾移植术后雷帕霉素临床短期对照试验

目的：评价肾移植术后应用雷帕霉索（sirolimus，SRL）的疗效和药物的不良反应。方法：实验组：20例同种异体尸体供肾移植患者，免疫抑制方案为环孢素A（CsA）＋SRL＋强的松（Pred）；对照组：15例同种异体尸体供肾移植患者，免疫抑制方案为CsA＋霉酚酸酯（MMF）＋Pred。对比二组在术后6个月内的疗效和药物的不良反应。结果：两组患者肾脏6个月内均带功能存活。实验室检查无统计学差异，但急性排斥发生率、并发症及药物的副作用明显不同。实验组（n=20）：急性排斥1例（5％），移植肾功能延迟1例（5％），肺部感染3例（15％），血脂异常11例（55．0％，胆固醇升高3例，三酰甘油升高4例，二者皆升高4例），肝功能异常3例（15％）；对照组（n=15）：急性排斥2例（13．3％），肺部感染2例（13．3％），血脂异常5例（33．3％，胆固醇升高1例，三酰甘油升高2例，二者皆升高2例）；腹泻6例（40％），白细胞减少1例。结论：肾移植术后应用CsA＋SRL＋Pred三联免疫抑制治疗方案，其急性排斥发生率低于CsA＋MMF＋Pred的方案，但血脂异常发生率较高。     

Renal Denervation in Hypertension

The column in this issue is supplied by Drs. Benjamin Lee, MD, and Usman Ansari, DO. Dr. Lee is an assistant professor of clinical medicine at the Houston Methodist Institute for Academic Medicine and Weill Cornell Medical College. After earning his medical degree at Harvard Medical School, Dr. Lee completed a residency in internal medicine and a nephrology fellowship at the University of California San Francisco (UCSF) while simultaneously obtaining a master of advanced study in clinical research from the UCSF departments of Epidemiology and Biostatistics. He maintains his clinical practice with the Houston Kidney Consultants. Dr. Ansari earned a Doctor of Osteopathy from Touro University College of Osteopathic Medicine in California and is completing his internal medicine residency at Houston Methodist.