99Tcm-DTPA肾动态显像评估单侧根治性肾切除术后早期患者肾功能

目的 观察⁹⁹Tc^m-二亚乙基三胺五乙酸（DTPA）肾动态显像评估单侧根治性肾切除术后早期患者肾功能的价值。方法 回顾性分析158例接受根治性肾切除术的单侧肾实质肿瘤患者资料及术前经肾动态显像所获肾小球滤过率（GFR）结果,计算估算GFR （eGFR）,并以eGFR 60、90 ml/（min·1.73 m²）为临界值将患者分为3组;评价各组临床资料、肾功能指标与术后3个月eGFR的关系,并以线性回归分析影响术后早期肾功能的独立因素。结果 术前eGFR<60 ml/（min·1.73 m²）患者术后早期肾功能与术前eGFR及对侧GFR均相关（P均<0.05）;对侧GFR为术后早期肾功能的独立影响因素（调整R²=0.910,P<0.001）。术前60 ml/（min·1.73 m²）≤ eGFR<90 ml/（min·1.73 m²）时,术后早期肾功能与患者年龄、高血压病史及术前对侧GFR均相关（P均<0.05）,其中术前对侧GFR为独立影响因素（调整R²=0.463,P<0.001）;术前eGFR ≥ 90 ml/（min·1.73 m²）时,术后早期肾功能与患者年龄、肿瘤性质、术前eGFR、对侧GFR及患侧GFR均相关（P均<0.05）,其中患者年龄、术前eGFR及对侧GFR为独立影响因素（调整R²=0.486,P<0.001）。结论 术前⁹⁹Tc^m-DTPA肾动态显像可用于评估单侧根治性肾切除术后早期患者肾功能。     

基于MR T2WI影像组学诊断早期糖尿病肾病

目的 观察基于MR T2WI影像组学诊断早期糖尿病肾病（DN）的价值。方法 收集59例估算肾小球滤过率（eGFR）为60~120 ml/（min·1.73 m²）且尿白蛋白/肌酐比值（ACR）>30 mg/g的早期DN患者作为试验组,另以46名无肾脏疾病、心脏疾病、高血压及痛风且eGFR为80~120 ml/（min·1.73 m²）的健康志愿者为对照组。按照7∶3比例将全部受试者分为训练集（n=73）和测试集（n=32）,训练集包括试验组40例、对照组33名,测试集包括试验组19例、对照组13名受试者。提取训练集右侧肾脏T2WI影像组学特征,并进行筛选,构建影像组学模型,观察其诊断早期DN的价值。结果 试验组与对照组性别及年龄差异均无统计学意义（P均>0.05）,而试验组尿素及肌酐均大于对照组（P均<0.05）。影像组学模型诊断训练集及测试集早期DN的敏感度、特异度及曲线下面积分别为95.20%、77.41%及0.892和88.23%、53.33%及0.765。结论 基于MR T2WI影像组学诊断早期DN具有一定价值。     

超声造影联合声辐射力脉冲弹性成像评估微波消融治疗大鼠肝泡型棘球蚴病

目的 观察超声造影（CEUS）联合声辐射力脉冲（ARFI）弹性成像技术评价微波消融（MWA）治疗大鼠肝泡型棘球蚴病（HAE）效果的价值。方法 将40只HAE大鼠模型分为实验组（n=30）和对照组（n=10）。实验组予超声引导下MWA,对照组仅常规饲养。术前及术后1个月采用二维超声、CEUS和ARFI测量2组病灶最大径,以及实验组病灶边缘带平均灰阶比值与剪切波速度（SWV）。完成检测后处死大鼠,对组织切片行常规HE染色、CD34免疫组织化学染色及Masson染色,计数病灶边缘带微血管密度（MVD）及纤维化面积。结果 术后1个月,3种方法所测实验组病灶最大径均较术前缩小（P均<0.001）,对照组病灶最大径均较入组时增大（P均<0.001）;CEUS、ARFI所测病灶最大径均大于二维超声（P均<0.05）,CEUS与ARFI组间差异无统计学意义（P均>0.05）。术后1个月实验组病灶边缘带平均灰阶比值低于术前,平均SWV高于术前（P均<0.001）;病灶边缘带MVD低于而纤维化面积高于对照组（P均<0.001）,MVD与病灶边缘带灰阶比值呈正相关（r=0.541,P=0.011）,SWV与纤维化面积呈正相关（r=0.494,P=0.023）。结论 CEUS联合ARFI对评估MWA治疗大鼠HAE效果具有一定应用价值。     

重度膝骨关节炎与骨髓水肿相关性研究

目的：探讨骨髓水肿与重度膝骨关节炎病理改变及症状体征的关系。方法：自2020年1月至2021年3月于中国中医科学院望京医院骨关节科就诊已行膝关节MRI检查的重度膝骨关节炎患者160例。合并骨髓水肿患者80例为病例组,男12例,女68例,年龄51~80（66.58±8.10）岁,病程5~40（15.61±9.25）个月,身体质量指数（body mass index,BMI）21.81~34.70（27.79±3.00） kg·m^-2;不合并骨髓水肿的患者80例为对照组,男15例,女65例,年龄50~80（67.82±8.05）岁,病程6~37（15.75±8.18）个月,BMI 21.39~34.46（28.26±3.13） kg·m^-2。采用膝关节整体磁共振成像评分（whole oragan magnetic resonance imaging score,WORMS）评价骨髓水肿程度,采用Kellgren-Lawrence （K-L）等级、Western Outario and McMaster大学骨关节炎指数评分（Western Ontario and McMaster University osteoarthritis index,WOMAC）评价膝骨关节炎病变程度,采用视觉模拟评分（visual analogue scale,VAS）,WOMAC疼痛评分评价关节疼痛程度,采用压痛、叩击痛、关节肿胀度、关节活动度评分评价关节体征。比较两组患者K-L等级分布的差异探讨骨髓水肿与膝骨关节炎病变程度的关系;并进一步通过Spearman相关性分析病例组患者骨髓水肿WORMS评分与WOMAC指数、疼痛相关评分、体征相关评分的相关系数,以进一步探讨骨髓水肿与膝骨关节炎指数、关节疼痛症状、体征的关系。结果：病例组患者K-L等级Ⅳ级者占68.75%（55/80）,对照组患者等级Ⅳ级者占52.50%（42/80）,病例组中Ⅳ级患者所占比例高于对照组（χ²=4.425,P<0.05）。病例组患者骨髓水肿WORMS与膝骨关节炎WOMAC指数相关系数为强正相关（r=0.873>0.8,P<0.001）,骨髓水肿WORMS与VAS相关系数r=0.752>0.5,与WOMAC量表疼痛评分相关系数r=0.650>0.5,为中度相关（P<0.001）;骨髓水肿WORMS与叩击痛评分相关系数r=0.784>0.5,（P<0.001）,为中度相关（P<0.05）;骨髓水肿WORMS评分与压痛评分相关系数r=0.194<0.3、关节肿胀度评分相关系数r=0.259<0.3、关节活动度评分相关系数r=0.296<0.3,相关性极弱（P<0.05）。结论：膝骨关节炎病变越严重越容易引起骨髓水肿,同时骨髓水肿亦可加重膝骨关节炎病情;骨髓水肿可导致膝骨关节炎关节疼痛,叩击痛阳性体征,而压痛、关节肿胀、活动受限与骨髓水肿无明显相关。     

对比直接抽吸一次性取栓与支架取栓治疗急性大脑中动脉闭塞的辐射剂量

目的 对比观察直接抽吸一次性取栓（ADAPT）与常规支架取栓治疗急性大脑中动脉闭塞的辐射剂量。方法 回顾性分析54例大脑中动脉闭塞患者,按照不同介入治疗方法分为ADAPT组（n=29）和支架组（常规支架取栓,n=25）;比较2组术中透视时间、空气比释动能（AK）、剂量面积乘积（DAP）、摄影序列数和摄影帧数以及上述指标之间的相关性。结果 ADAPT组透视时间、AK、DAP、摄影序列数和摄影帧数均低于支架组（P均<0.05）。ADAPT组25例（25/29,86.21%）、支架组13例（13/25,52.00%）AK值<1.0 Gy,ADAPT组中AK值<1.0 Gy者占比高于支架组（P<0.01）;ADAPT组22例（22/29,75.86%）、支架组11例（11/25,44.00%）DAP值<100 Gy·cm²,ADAPT组中DAP<100 Gy·cm²者占比高于支架组（P=0.01）。透视时间与DAP（r=0.60,P<0.01）、AK（r=0.69,P<0.01）均呈正相关,DAP与AK呈正相关（r=0.81,P<0.01）。结论 ADAPT治疗急性大脑中动脉闭塞的辐射剂量低于常规支架取栓。     

对比经远端桡动脉与肱动脉入路支架成形术治疗髂动脉慢性闭塞症的有效性及安全性

目的 对比经远端桡动脉入路与肱动脉入路支架成形术治疗髂动脉慢性闭塞症的有效性及安全性。方法 回顾性分析70例接受经左侧桡动脉远端入路（A组）与72例经左侧肱动脉入路（B组）支架成形术治疗髂动脉慢性闭塞症患者,其中B组18例因穿刺左侧桡动脉远端失败而改为穿刺左侧肱动脉;观察2种方法穿刺成功率、2组髂动脉开通成功率和穿刺并发症发生率。结果 穿刺桡动脉远端成功率为79.55%（70/88）,穿刺肱动脉成功率为100%（72/72）。髂动脉顺行开通成功率[78.57%（55/70）vs.80.56%（58/72）,<χ²=3.67,P=0.09]及总体开通成功率[94.29%（66/70）vs.95.83%（69/72）,χ²=2.34,P=0.10]组间差异均无统计学意义。A组穿刺并发症发生率低于B组[5.71%（4/70）vs.13.89%（10/72）,<χ²=3.24,P=0.02]。结论 相比经肱动脉入路,经远端桡动脉穿刺入路腔内支架成形术治疗髂动脉慢性闭塞症更为安全,而开通成功率相当。     

原发性中枢神经系统淋巴瘤Toll样受体4表达水平与弥散加权成像表观弥散系数值的相关性

目的 观察原发性中枢神经系统淋巴瘤(PCNSL)Toll样受体4(TLR4)表达水平与MR弥散加权成像(DWI)表观弥散系数(ADC)值的相关性。方法 回顾性分析17例经病理确诊的PCNSL患者,观察病灶ADC值、TLR4及NF-κB表达水平之间的相关性。结果 PCNSL病灶ADC值为460×10^－6~1 034×10^－6 mm²/s,平均(756±147)×10^－6 mm²/s;TLR4表达水平为0.02~0.11,平均0.06±0.03,NF-κB表达水平为0.04~0.15,平均0.08±0.03。TLR4表达水平与ADC值呈负相关(r=－0.76,P<0.01);NF-κB表达水平与TLR4及ADC值之间无明显相关性(P均>0.05)。结论 PCNSL的TLR4表达水平与其ADC值呈负相关。     

心脏MR组织追踪技术定量评估心肌淀粉样变性患者心肌应变

目的 观察利用心脏MR组织追踪（CMR-TT）技术定量评估心肌淀粉样变性（CA）患者心肌应变的可行性。方法 对20例免疫球蛋白轻链型心肌淀粉样变性（AL-CA,A组）、20例转甲状腺素蛋白型CA（ATTR-CA,B组）患者及20名健康受试者（C组）采集心脏MRI,以CMR-TT技术获得心肌应变参数;比较3组间左心室心功能参数差异,以及左心室各节段及整体心肌应变参数的差异,包括3D纵向应变（LS）、3D径向应变（RS）及3D圆周应变（CS）。结果 A、B组左心室心功能参数与C组差异均有统计学意义（P均<0.01）,而A与B组间左心室心功能参数差异均无统计学意义（P均>0.05）。除心尖段RS（P=0.81）外,A、B组应变参数均低于C组（P均<0.01）,而A与B组间应变参数差异均无统计学意义（P均>0.05）。结论 CMR-TT技术可用于定量评估CA患者左心室心肌应变。     

儿童肱骨髁上骨折保守治疗旋前或旋后固定后肘内翻畸形的病例对照研究

目的: 通过回顾性分析比较手法复位后旋前或旋后位石膏固定的儿童肱骨髁上骨折肘内翻畸形发生情况,从而指导临床治疗.方法: 收集2009年6月至2011年12月在我院急诊骨科行手法复位石膏固定的儿童肱骨髁上骨折病例,经筛选排除后共64例.按手法复位后固定位置不同分为两组：A组采用手法复位并旋前位石膏固定,B组采用手法复位并旋后位石膏固定.A组30例,男18 例,女12例;平均年龄(7.5±3.5) 岁;B组34例,男23 例,女11 例,平均年龄(7.0±2.6)岁.比较两组组间及组内的肘内翻发生率及提携角减小角度.结果: A组出现13例肘内翻,B组出现16例,两组差异无统计学意义(χ²=0.089,P=0.765).A组提携角减小角度(8±4)°,B组提携角减小角度(9±5)°,两组差异无统计学意义(t=0.584,P=0.564).A组组内桡偏型与尺偏型的肘内翻发生率与提携角减小角度差异均有统计学意义(χ²=6.160,P=0.013;t=-2.409,P=0.035);B组组内桡偏型与尺偏型的肘内翻发生率与提携角减小角度差异均有统计学意义(χ²=5.120,P=0.024;t=-2.250,P=0.041).两组肘关节功能Flynn评价差异无统计学意义(P=0.822).结论: 儿童肱骨髁上骨折旋前位固定和旋后位固定肘内翻发生率和提携角减小角度均无明显差异.而尺偏型儿童肱骨髁上骨折,旋前位固定有利于降低肘内翻率及其程度;桡偏型儿童肱骨髁上骨折,旋后位固定有利于降低肘内翻率及其程度.     

小鼠肺纤维化CT影像自动分析方法

目的 基于CTAN软件建立小鼠肺纤维化（PF） CT影像自动分析方法并观察其自动分析效果。方法 将15只雄性c57小鼠随机分为博莱霉素组（A组）、博莱霉素+尼达尼布组（B组）及对照组（C组）,每组5只。于建模第1、5、8、11及15天对A、B组采用腹腔注射博莱霉素构建PF模型,对C组以相同方法注射等量生理盐水;于第25、28、31及34天对B组腹腔注射尼达尼布以抑制PF。于第41天对所有小鼠行胸部CT扫描,并将图像导入CTAN软件,通过编辑和优化程序建立自动分析方法,提取肺CT影像区域,构建3D模型并进行数据分析;之后处死小鼠,取肺组织行Masson染色,观察肺部胶原沉积,评价PF Ashcroft评分,并检测肺羟脯氨酸含量,分析PF CT影像自动分析结果与Ashcroft评分及肺羟脯氨酸含量的一致性。结果 A组肺组织区域体积与肺区域体积比及肺区域CT值均高于C组（t=14.06、10.32,P均<0.01）和B组（t=11.22、8.29,P均<0.01）;其肺羟脯氨酸含量和Ashcroft评分亦均高于C组（t=11.92、23.39,P均<0.01）和B组（t=7.44、12.07,P均<0.01）。以小鼠PF CT影像自动分析方法获得的肺组织区域体积与肺区域体积比与PF Ashcroft评分和肺羟脯氨酸含量（R²=0.945 5、0.845 0,P均<0.001）,以及小鼠肺区域CT值与PF Ashcroft评分和肺羟脯氨酸含量的一致性均佳（R²=0.895 0、0.848 0,P均<0.001）。结论 所构建的CT影像自动分析方法用于分析小鼠PF效果良好。     

The prognostic value of platelet-to-lymphocyte ratio on the long-term renal survival in patients with IgA nephropathy

Purpose

Platelet-to-lymphocyte ratio (PLR) was established showing the poor prognosis in several diseases, such as malignancies and cardiovascular diseases. But limited study has been conducted about the prognostic value of PLR on the long-term renal survival of patients with Immunoglobulin A nephropathy (IgAN).

Methods

We performed an observational cohort study enrolling patients with biopsy-proven IgAN recorded from November 2011 to March 2016. The definition of composite endpoint was eGFR decrease by 50%, eGFR?<?15 mL/min/1.73 m², initiation of dialysis, or renal transplantation. Patients were categorized by the magnitude of PLR tertiles into three groups. The Kaplan–Meier curves and multivariate Cox models were performed to determine the association of PLR with the renal survival of IgAN patients.

Results

330 patients with a median age of 34.0 years were followed for a median of 47.4 months, and 27 patients (8.2%) had reached the composite endpoints. There were no differences among the three groups (PLR?<?106, 106?≤?PLR?≤?137, and PLR?>?137) in demographic characteristics, mean arterial pressure (MAP), proteinuria, and estimated glomerular filtration rate (eGFR) at baseline. The Kaplan–Meier curves showed that the PLR?>?137 group was significantly more likely to poor renal outcomes than the other two groups. Using univariate and multivariate cox regression analyses, we found that PLR?>?137 was an independent prognostic factor for poor renal survival in patients with IgAN. Subgroup analysis revealed that the PLR remained the prognostic value for female patients or patients with eGFR less than 60 mL/min/1.73 m².

Conclusions

Our results underscored that baseline PLR was an independent prognostic factor for poor renal survival in patients with IgAN, especially for female patients or those patients with baseline eGFR less than 60 mL/min/1.73 m².

     

Impact of serum uric acid on renal function after bariatric surgery: a retrospective study

BackgroundDespite a known negative association between serum uric acid level (SUA) and renal function, this correlation in patients after bariatric surgery remains unknown.ObjectiveTo assess correlation between postoperative SUA and estimated glomerular filtration rate (eGFR) at 12 months after bariatric surgery.SettingA single tertiary referral center.MethodsA total of 252 patients (age = 40.5 ± 11.2; body mass index = 39.0 ± 5.5 kg/m²) undergoing bariatric surgery divided into 2 groups (i.e., normal renal function [90 ≤ eGFR < 125 mL/min/1.73 m², n = 176] versus renal function impairment [eGFR < 90 mL/min/1.73 m², n = 76]) were assessed for relationships between SUA and eGFR in both groups (primary endpoint) and associations of percentage weight loss with changes in SUA (△SUA) and eGFR (△eGFR) for all patients (secondary endpoint) at 12 months.ResultsOverall, prevalence of hyperuricemia was 40.4% and 22.2% (baseline and postoperative 12 mo, respectively). Reverse relationship was observed between SUA and eGFR (r = −.152, P = .007) for all patients with no association noted between baseline SUA and eGFR in each group as well as between SUA and eGFR at 12 months in the normal group (r = −.076, P = .437). The reverse relationship was found (r = −.417, P = .005) in renal function impairment group for whom SUA was identified as a predictor of eGFR at 12 months. There was no association of percentage weight loss with △SUA (r = .089, P = .601) and △eGFR (r = −.046, P = .785).ConclusionThe results demonstrated a negative relationship between postoperative SUA and renal function in patients with preexisting renal dysfunction undergoing bariatric surgery. Clinical significance of our findings warrants further investigation.     

Long‐term evolution,secular trends,and risk factors of renal dysfunction following cardiac transplantation

Recent reports suggest that individuals who underwent heart transplantation in the last decade have improved post‐transplant kidney function. The objectives of this retrospective study were to describe the incidence and to identify fixed and time‐dependent predictors of renal dysfunction in cardiac recipients transplanted over a 25‐year period (1983–2008). To illustrate temporal trends, patients (n = 306) were divided into five groups based on year of transplantation. The primary endpoint was the estimated glomerular filtration rate (eGFR) at year 1. Secondary endpoints were time to moderate (eGFR <60 ml/min/1.73 m²) and severe renal dysfunction (eGFR <30 ml/min/1.73 m²). Risk factor analyses relied on multivariable regression models. Kidney function was mildly impaired before transplant (median eGFR=61.0 ml/min/1.73 m²), improved at discharge (eGFR=72.3 ml/min/1.73 m²; P < 0.001), decreased considerably in the first year (eGFR = 54.7 ml/min/1.73 m²; P < 0.001), and deteriorated less rapidly thereafter. At year 1, 2004–2008 recipients exhibited a higher eGFR compared with all other patients (P < 0.001). Factors independently associated with eGFR at year 1 and with moderate and severe renal dysfunction included age, gender, pretransplant eGFR, blood pressure, glycemia, and use of prednisone (P < 0.05). In summary, kidney function worsens constantly up to two decades after cardiac transplantation, with the greatest decline occurring in the first year. Corticosteroid minimization and treatment of modifiable risk factors (hypertension, diabetes) may minimize renal deterioration.     

Serum neutrophil gelatinase-associated lipocalin as a marker of renal function in children with chronic kidney disease

Very few biomarkers exist for monitoring chronic kidney disease (CKD). We have recently shown that serum neutrophil gelatinase-associated lipocalin (NGAL) represents a novel biomarker for early identification of acute kidney injury. In this study, we hypothesized that serum NGAL may also represent a biomarker for the quantitation of CKD. Forty-five children with CKD stages 2–4 were prospectively recruited for measurement of serum NGAL, serum cystatin C, glomerular filtration rate (GFR) by Ioversol clearance, and estimated GFR (eGFR) by Schwartz formula. Serum NGAL significantly correlated with cystatin C (r=0.74, P<0.000). Both NGAL and cystatin C significantly correlated with measured GFR (r=0.62, P<0.000; and r=0.71, P<0.000, respectively) as well as with eGFR (r=0.66, P<0.000 and r=0.59, P<0.000, respectively). At GFR levels of ≥30 ml/min per 1.73 m², serum NGAL, cystatin C, and eGFR were all significantly correlated with measured GFR. However, in subjects with lower GFRs (<30 ml/min per 1.73 m²), serum NGAL levels correlated best with measured GFR (r=0.62), followed by cystatin C (r=0.41). We conclude that (a) both serum NGAL and cystatin C may prove useful in the quantitation of CKD, and (b) by correlation analysis, NGAL outperforms cystatin C and eGFR at lower levels of measured GFR.     

Comparison of renal function after open radical cystectomy,extracorporeal robot assisted radical cystectomy,and intracorporeal robot assisted radical cystectomy

PurposeRenal function outcomes following robot-assisted radical cystectomy (RARC) have not been well established. We sought to compare long-term renal function outcomes between open radical cystectomy, RARC with extracorporeal urinary diversion and intracorporeal urinary diversion at a high volume institution.Materials and MethodsWe retrospectively reviewed our institutional bladder cancer database for patients who underwent RC from 2010 to 2019 with pre-operative estimated glomerular filtration rate (eGFR) > 45 ml/min/1.73m². Changes in renal function were assessed through locally weighted scatter plot smoothing and comparison of median eGFR between surgical groups. Chronic Kidney Disease Stage 3B was defined as eGFR < 45 ml/min/1.73m². Renal function decline was defined as a ≥10 ml/min/1.73m² drop in eGFR. Kaplan Meier method with log-rank was used to compare CKD 3B-free survival and renal function decline. Cox Proportional Hazards model was used to identify predictors of CKD 3B.ResultsSix hundred and forty four patients were included with median follow-up of 32 months (IQR 12–56). Preoperative characteristics were similar among the groups with no differences in median pre-operative eGFR (ORC: 74.6, extracorporeal urinary diversion: 74.3, intracorporeal urinary diversion: 71.6 ml/min/1.73m², P = 0.15). Median postoperative eGFR on follow up was not different between groups (P = 0.56). 33% of patients developed CKD 3B. There were no differences in CKD 3B-free survival by surgical approach (P = 0.23) or urinary diversion (P = 0.09). 64% of patients experienced renal function decline with a median time of 2.4 years (P 0.23). Predictors of CKD were pathologic T3 disease or greater (HR: 1.77, P = 0.01), ureteroenteric anastomotic stricture (HR: 2.80, P < 0.001), preoperative CKD Stage 2 (HR: 1.81, P =0.02), and preoperative CKD Stage 3A (HR: 5.56, P < 0.001).ConclusionRenal function decline is common after RC. Tumor stage, pre-operative eGFR, and ureteral stricture development, not surgical approach, influence renal function decline.     

Estimated Glomerular Filtration Rate as a Risk Stratification Tool for Early Complications in Revision Total Hip and Knee Arthroplasty

BackgroundEstablishing an association between postoperative outcomes and the spectrum of renal function would allow for more informed decisions to manage surgical risks and improved patient-specific care. Estimated glomerular filtration rate (eGFR) can be calculated from standard prescreening measurements to gauge renal function. This work investigates the effect of eGFR, as a continuous and categorical variable, on mortality and major and minor complications in patients undergoing revision total knee and hip arthroplasty.Methods25,056 patients having undergone revision total hip and knee arthroplasty from 2013 to 2016 were identified using the National Quality Improvement Program database. The investigated outcomes included 30-day mortality, major complications, and minor complications. Multivariate regression models were created to evaluate the effect of eGFR on the outcomes of interest. Multivariate spline regressions were generated to assess for nonlinear relationships between eGFR as a continuous variable and the outcomes.ResultsOur study revealed that as eGFR decreased <60 mL/min/1.73 m², mortality (P = .0001), any major complication (P < .001), and any minor complication (P < .001) increased. Patients with eGFR 15-30 mL/min/1.73 m² had increased risk for mortality (P = .033). There was an increased risk for any major complication at an eGFR 30-60 and <15 mL/min/1.73 m², (P < .05). There was an increased risk of minor complications for those with hyperfiltration and <60 mL/min/1.73 m².ConclusionPatients with lower preoperative eGFR generally display an increased risk for complications after revision total hip and knee arthroplasty. Proper consideration should be given to this patient population before surgical intervention to allow for preventative measures to be taken to improve patient outcomes.     

The prognostic effect of immunosuppressive therapy in IgA nephropathy with stage 3 or 4 chronic kidney disease

BackgroundIt is debated whether patients with IgAN with heavy proteinuria and decreased eGFR benefit from aggressive treatment consisting of corticosteroids alone or combined with immunosuppressive agents.MethodsA retrospective study was performed between January 2008 and December 2016 on patients with IgAN who had urinary protein excretion > 1.0 g/d and an eGFR between 15 and 59 mL/min/1.73 m². These patients were assigned to receive supportive care alone or supportive care plus immunosuppressive therapy. The primary outcome was defined as the first occurrence of a 50% decrease in eGFR or the development of ESKD.ResultsAll 208 included patients were followed for a median of 43 months, and 92 (44%) patients experienced the primary outcome. Cumulative kidney survival was better in the immunosuppression group than in the supportive care group (p < .001). The median annual rate of eGFR decline in the immunosuppression group was −2.0 (−7.3 to 4.2), compared with −8.4 (–18.9 to −4.1) mL/min/1.73 m² in the supportive care group (p < .001). In multivariate Cox regression analyses, immunosuppressive therapy was associated with a lower risk of progression to ESKD, independent of age, sex, eGFR, proteinuria, MAP, kidney histologic findings and the use of RASi agents (HR = 0.335; 95% CI 0.209–0.601). Among the adverse events, infection requiring hospitalization occurred at similar rates in both groups (p = .471).ConclusionImmunosuppressive therapy attenuated the rate of eGFR decline and was associated with a favorable kidney outcome in IgAN patients with heavy proteinuria and decreased eGFR, and the side effects were tolerable.