The relationship between oxidized serum albumin and blood pressure in hypoalbuminemic peritoneal dialysis patients

Background: Oxidative stress produces molecular modifications of serum albumin that disturb its biological functions and interfere with its detection by the bromocresol green assay (BCG). Oxidative stress, inflammation, and hypoalbuminemia are common peritoneal dialysis (PD). This study aimed to evaluate the relationship between serum albumin, oxidized serum albumin (OSA), oncotic pressure, and blood pressure in hypoalbuminemic PD patients. Methods: Twenty-four PD patients with serum albumin levels <3.5 g/dl enrolled in the study. Data were compared between participants with the mean arterial pressure (MAP) <105 mmHg (n = 12) and MAP ≥ 105 mmHg (n = 12). Results: Serum albumin levels were ≤3.0 g/dl and similar in both groups (p = 0.298). The calculated OSA and oncotic pressure were significantly higher in patients with MAP ≥ 105 mmHg than in those with MAP < 105 mmHg. MAP was positively and marginally correlated with serum albumin levels (measured by BCG) (r = 0.34, p = 0.05), and positively and significantly correlated with the calculated OSA and oncotic pressure (r = 0.44, p = 0.015, r = 0.58, p = 0.002; respectively). The oncotic pressure was positively correlated with the calculated OSA (r = 0.47, p = 0.011). Conclusion: OSA, undetectable by the commonly used BCG, may contribute to higher blood pressure in hypoalbuminemic PD patients.     

早发型重度子痫前期并发低蛋白血症的临床分析

目的:探讨低蛋白血症对早发型重度子痫前期妊娠结局的影响.方法·对98例早发型重度子痫前期患者的临床资料进行分析总结,按是否发生低蛋白血症分为低蛋白血症组和非低蛋白血症组,对其一般资料、并发症、胎儿新生儿情况进行比较.结果:早发型重度子痫前期患者合并低蛋白血症,两组治疗时间、终止妊娠孕周、入院时平均动脉血压等指标比较,差异均有统计学意义(P＜0.05),低蛋白血症组发生肝肾功能损害、胸腹水、胎盘早剥、心功能不全的发生率均高于非低蛋白血症组,差异有统计学意义.在低蛋白血症组将24h尿蛋白定量与血浆白蛋白值比较,两者间无相关性(r=-0.026,P=0.114).低蛋白血症组围生儿死亡率明显增加(P =0.000),新生儿窒息率也存在差异(P=0.037);两组血浆白蛋白值与新生儿体重呈正相关性.结论:并发低蛋白血症是重度子痫前期病情的进一步加重,可能出现严重并发症,并可造成围生儿不良结局.     

Weight-based vancomycin loading strategy may not improve achievement of optimal vancomycin concentration in patients with preserved renal function

Abstract

We performed a retrospective study to evaluate clinical effectiveness of vancomycin loading strategy and factors associated with achieving optimal C _min. Patients administered vancomycin for ≥72?h from January to June 2018 were enrolled. Patients were divided into two groups: loading (LD) and non-loading (NLD). LD was defined as initial vancomycin dose ≥20?mg/kg and ≥120% of maintenance dose. During study period, 70 and 71 received initial LD (24.2?±?2.5?mg/kg) and NLD (17.3?±?3.3?mg/kg) doses of vancomycin, respectively (p?<?.001). Achievement of optimal C _min was not different before administration of the third dose (24.4% in LD versus 18.2% in NLD, p?=?.484) and within 72?h (22.9% versus 28.2%, p?=?.759). Risk factors for failure to achieve optimal C _min before administration of the third dose were higher creatinine clearance and higher level of serum albumin. Therefore, more sufficient loading or patient-specific dose strategies should be used to achieve optimal serum vancomycin C _min.     

Spinocerebellar ataxia with ocular motor apraxia and DNA repair

At least four disorders, ataxia telangiectasia (AT), an ataxia‐telangiectasia‐like disorder, early‐onset ataxia with ocular motor apraxia and hypoalbuminemia (EAOH)/ataxia with oculomotor apraxia type 1 (AOA1), and ataxia with oculomotor apraxia type 2, are accompanied by ocular motor apraxia (OMA), which is an impairment of saccadic eye movement initiation. The characteristic pathological findings of EAOH/AOA1 and AT are a severe loss of Purkinje cells, severe myelin pallor of the posterior columns, and moderate neuronal loss in the dorsal root ganglia and anterior horn. Purkinje cells stimulate the fastigial nucleus and suppress omnipause neurons to initiate saccadic eye movement. The selective loss of Purkinje cells might cause OMA and disturb the cancellation of the vestibulo‐ocular reflex. These disorders have the following common clinical features: ataxia, involuntary movements, and peripheral neuronopathy. In addition, the causative genes for these disorders are associated with the DNA/RNA quality control system. The impairment of DNA/RNA integrity results in selective neuronal loss in these recessive‐inherited ataxias.     

肝脏在肾病低白蛋白高脂血症发生中的作用

目的 探讨肝脏在肾病综合征低白蛋白血症和高脂血症发生机制中的作用。方法 观察肝脏、肾脏被阿霉素同时或分别作用后,大鼠血浆白蛋白和血脂水平变化。结果 双肾用阿霉素大量蛋白尿（Ｂ）组、肝脏用阿霉素（Ｃ）组血浆白蛋白较正常（Ｄ）组降低,但其降低的程度远低于经典肾病（Ａ）组（Ｐ〈０．０１）。Ｂ组血总胆固醇和甘油三酯较Ｄ组升高（Ｐ〈０．０１）。Ｃ组甘油三酯和载脂蛋白－Ａ较Ｄ组升高（Ｐ〈０．０１）。结论 致病     

24h尿蛋白定量和血清白蛋白在早发型重度子痫前期预后评估的价值

目的 研究24h尿蛋白定量及血清白蛋白水平在评估早发型重度子痫前期(EOSP)母儿妊娠结局的价值.方法 回顾性分析于2012年1月至2015年12月收治温州市中西医结合医院的68例EOSP患者的临床资料,分别根据24h尿蛋白定量及是否合并低蛋白血症进行分组,比较两组患者期待治疗时间、并发症情况和围产儿结局.结果 ①在期待治疗时间上,根据是否合并低蛋白血症分组,低蛋白血症组与非低蛋白血症组比较,差异有统计学意义(t=5.229,P<0.05);根据24h尿蛋白定量分组,<5g/24h组与≥5g/24h组比较,差异无统计学意义(t=0.760,P>0.05);②在患者并发症及围产儿结局的比较上,根据24h尿蛋白定量分组,<5g/24h组与≥5g/24h组比较差异均无统计学意义(均P>0.05);而根据是否合并低蛋白血症分组,非低蛋白血症组与低蛋白血症组肝功能损害、胎盘早剥、HELLP综合征、DIC、总并发症发生率,以及胎儿宫内窘迫、胎儿宫内生长受限(FGR)及新生儿窒息发生率比较差异均有统计学意义(χ2值分别为11.588、4.566、5.479、6.774、11.619、3.951、4.573、4.830,均P<0.05);③分析EOSP患者不良结局的危险因素发现,发病孕周及血清白蛋白水平与母胎预后相关(OR值分别为1.043、0.170),差异均有统计学意义(均P<0.05),而与24h尿蛋白定量无统计学意义.结论 24h尿蛋白定量只能作为EOSP综合性评估预后的重要因素之一,对于合并低蛋白血症者,因病情急剧进展,并发症严重,应密切监测病情,积极处理,适时终止妊娠,以降低母胎不良预后.     

Cutis laxa for diagnosis of γ1‐heavy‐chain deposition disease: Report of four cases

Heavy‐chain deposition disease (HCDD) is characterized by tissue deposits of a truncated monoclonal immunoglobulin heavy‐chain (HC) on basement membranes. Diagnosis is usually made on kidney biopsy, showing nodular glomerulosclerosis with HC deposits which can be missed, resulting in delay in diagnosis. We report four γ1‐HCDD patients presenting with cutis laxa, hypocomplementemia and hypoalbuminemia. In two patients, unsuspected HCDD was revealed by cutis laxa and diagnosis was made on skin biopsy. In all patients, serum albumin and complement represented surrogate markers for disease monitoring. In γ‐HCDD, extrarenal manifestations such as cutis laxa may precede renal injury and are precious tools for an early diagnosis, which is crucial to avoid progression of irreversible renal and elastic tissue damage.