慢性肾脏病不同分期血尿酸的变化及其影响因素分析

目的 单中心横断面调查慢性肾脏病(CKD)患者血尿酸(UA)水平的基础状况.方法 对我院肾内科门诊就诊的CKD患者进行为期9个月的前瞻性横断面调查.结果 共有713例CKD患者入选.前3位CKD的病因分别为原发性肾小球疾病(61.2%,436/713)、高血压肾病(7.2%,51/713)和糖尿病肾病(5.8%,41/713).随着CKD分期的进展,UA水平(F=73.569,P=0.000)和高尿酸血症的发生率(χ2=138.156,P=0.000)显著上升.多元回归分析结果显示,UA水平和GFR呈显著负相关(RR=-1.045,P=0.000),UA水平和DBP、尿蛋白、吸烟、BMI呈显著正相关(RR分别为1.400、15.149、37.696和3.421,P均<0.05).结论 针对CKD患者UA水平进行单中心横断面调查,有助于确定CKD患者UA水平的变化规律,为进一步综合防治CKD及其心血管并发症奠定基础.     

慢性肾功能衰竭538例病因分析

将2010年7月~2014年6月我院门诊、血液透析、腹膜透析中心收治的慢性肾功能衰竭患者538例的临床资料进行回顾性分析。结果慢性肾功能衰竭病因主要包括慢性肾小球肾炎140例(26.02%),糖尿病肾病135例(25.09%),慢性间质性肾炎99例(18.40%),高血压肾损害25例(4.64%),其他(紫癜性、狼疮性、痛风性肾病等)43例(7.99%);CKD3~4期有292例,其中首位病因为糖尿病肾病(87,29.79%);CKD 5期有246例,其中首位病因为慢性肾小球肾炎(75,30.49%)。慢性肾小球肾炎为慢性肾功能衰竭的首要病因,但与糖尿病肾病构成比较接近。CKD 3~4期慢性肾功能衰竭首要病因为糖尿病肾病。     

门诊慢性肾脏病3～5期患者的钙磷代谢诊疗现状317例分析

慢性肾脏病(chronic kidney disease,CKD)已成为全球范围内的公共卫生问题,如不能得到及时有效治疗,病情会由1期开始呈持续进行性发展,最终进入到终末期肾衰竭(end stage renal disease,ESRD)后则需长期肾脏替代治疗.CKD 3期以后的患者会出现明显的并发症,如高血压、贫血、钙磷代谢紊乱等,因而有必要明确CKD 3～5期患者危险因素,延缓肾功能的进程,减少CKD总体病死率.本研究通过对本院门诊CKD 3～5期患者钙磷代谢诊疗现状进行横断面研究分析,为CKD的干预治疗提供依据.     

门诊慢性肾脏病3～5期患者129例病因分析

目的分析门诊慢性肾脏病(CKD)3～5期患者的病因分布特点。方法回顾性横断面研究,分析2010年4月至2010年8月就诊的CKD 3～5期129例患者的病因及相关的信息资料。结果 129例CKD3～5期患者中60岁以上老年人所占比率(61.2%)高于60岁以下患者(38.8%)。前3位病因依次为高血压、慢性肾小球肾炎、糖尿病。60岁以下的非老年组前3位病因依次为慢性肾小球肾炎、高血压、糖尿病。结论门诊CKD 3～5期患者以老年人为主,首要病因为高血压;而非老年组的首要病因为慢性肾小球肾炎。     

等渗与低渗造影剂对慢性肾功能不全患者肾毒性的对比研究

目的:对比等渗与低渗造影剂时不同程度慢性肾功能不全患者的肾脏损害程度.方法:回顾性分析我院收治的住院疑诊冠心痛行冠状动脉造影术或行经皮冠状动脉介入术的慢性肾功能不全病例350例,将350例患者按血清肌酐清除率分为CKD(慢性肾脏疾病)3期组、CKD 4期组及CKD 5期组,各组按所使用造影剂的不同分为两个亚组.比较手术前后各亚组间肌酐(SCr)浓度升高值、造影剂肾病的发生率以及尿N-乙酰-β-D氨基葡萄糖苷酶(NAG)酶和β2微球蛋白浓度升高值的差异.结果:(1)CKD 3期组患者等渗与低渗造影剂亚组术后SCr浓度升高值、术后患者造影剂肾病的发生率、术后尿NAG酶和β2微球蛋白浓度升高值比较差异均无显著统计学意义.(2)CKD4、5期组患者中低渗造影剂亚组术后SCr浓度升高值、术后患者造影剂肾病的发生率、术后尿NAG酶和β2微球蛋白浓度升高值均显著高于等渗造影剂亚组.结论:在慢性肾功能不全患者中,等渗性造影剂比低渗性造影剂对血清肌酐清除率＜29%(CKD4-5期)的慢性肾功能不全患者有更低的肾脏毒性.     

慢性肾脏病合并感染的治疗

慢性肾脏病(ChronicKidneyDiseases,CKD)是临床上常见的疾病,是肾小球肾炎、肾盂肾炎、肾病综合 征、肾小管间质性疾病、糖尿病肾病、高血压肾病、肾血管性疾病等绝大多数肾脏疾病的统称。CKD患者极易并发各 种感染,促使肾功能进一步恶化造成慢性肾脏衰竭(ChronicRenalFailure,CRF),直接影响患者的生存质量,并常常 是患者的直接死因。因此,了解CKD感染的危险因素及其特点,并积极控制感染,是提高CKD诊疗水准、改善患者预 后的一项重要措施。     

中性粒细胞明胶酶相关脂质运载蛋白在慢性肾病新分期中的临床意义

目的探讨中性粒细胞明胶酶相关脂质运载蛋白(NGAL)在不同分期慢性肾病(CKD)中的临床价值。方法选取2012年5月至2013年12月解放军总医院明确诊断为CKD的患者240例,按照美国肾脏病与透析患者生存质量指导指南(K/DOQI)制订的CKD分期标准分为6组,即CKD 1期组、CKD 2期组、CKD 3a期组、CKD 3b期组、CKD 4期组、CKD 5期组,应用胶乳增强免疫比浊法测定血液NGAL(sNGAL)浓度,对sNGAL在CKD中的应用价值进行横断面研究。结果在CKD各分期中,随着病变程度的增加,eGFR的减少,sNGAL浓度呈明显升高趋势(P0.01)。sNGAL与eGFR呈明显负相关(P0.05)。sNGAL浓度在CKD 3b期组明显高于CKD 3a期组(P0.05)。在ROC曲线分析中,诊断肾功能轻中度损伤时,血清标本sNGAL同CysC、sβ2-MG曲线下面积相似(0.903、0.945、0.937),在诊断肾功能轻度损伤中,血清sNGAL、CysC、sβ2-MG水平ROC曲线下面积相似(0.819、0.899、0.900)。sNGAL在CKD 3~5期的临床诊断界值为CKD 3a期189.5g/L、CKD 3b期222.0g/L、CKD 4期259.0g/L、CKD 5期317.5g/L。结论 NGAL对CKD患者的肾损伤程度有一定的诊断价值。     

慢性肾病患者血1,25-二羟基维生素D3水平变化

目的 研究慢性肾病(CKD)患者血1,25-二羟基维生素D3(维生素D3)水平异常与肾功能受累程度的关系.方法 研究对象包括150例健康对照者和101例CKD患者,检测其血维生素D3、甲状旁腺素、钙、磷、肌酐、清蛋白及尿素氮水平,计算肾小球滤过率(GFR).结果 与对照组相比,第4~5期患者的血维生素D3水平显著降低(P<0.05),第3~5期患者的血甲状旁腺素(PTH)、肌酐及尿素氮(BUN)水平显著升高(P<0.05),第4~5期患者的血磷水平显著升高(P<0.05),各期CKD患者的清蛋白水平均显著降低(P<0.05),仅第5期CKD患者的血钙浓度显著降低(P<0.05).血维生素D3水平与血PTH、尿素氮及肌酐水平呈负线性相关关系,与血钙、清蛋白及GFR水平呈正线性相关关系.结论 第4~5期CKD患者缺乏维生素D3,说明只有当肾功能受损严重时,CKD患者血维生素D3水平才会出现明显异常.此外,本研究还表明CKD患者血维生素D3水平与其他肾功能相关生化指标存在一定的相关性.     

慢性肾脏病患者血清成纤维细胞生长因子23与肾功能及钙磷代谢的关系

目的 了解慢性肾脏病(CKD)患者不同分期血中成纤维细胞生长因子23(FGF-23)的变化,探讨FGF-23与CKD患者肾功能及钙磷代谢的关系。方法 选择CKD患者124例,健康对照组32例,测定患者的血清FGF-23、血钙、血磷、甲状旁腺激素(iPTH)、血清尿素氮(BUN)和肌酐(SCr),按照CKD-EPI公式计算肾小球滤过率(eGFR),分析FGF-23与肾功能及钙磷代谢的关系。结果 CKD患者血FGF-23水平较对照组显著升高(P<0.01)。随着肾功能减退,CKD患者血FGF-23和iPTH水平逐渐增高,在CKD3～4期与对照组比较差异有统计学意义(均P<0.01),在CKD5期明显高于对照组、CKD1～2期、CKD3～4期。随着肾功能减退血钙水平逐渐降低、血磷水平逐渐增高,CKD患者在CKD5期与对照组、CKD1～2期、CKD3～4期比较差异有显著统计学意义(均P<0.01)。相关分析显示,LogFGF-23与血磷、LogiPTH、BUN、SCr呈正相关,与eGFR呈负相关。多元线性回归表明,FGF-23与CKD患者BUN、SCr呈正相关。结论 CKD患者血清FGF-23在CKD3～4期就显著增高,变化早于血磷的增高。肾功能状态、血磷、iPTH与FGF-23相关。肾功能状态可能是CKD患者血FGF-23升高的主要影响因素。     

2型糖尿病患者慢性肾病的现状调查

目的:评价无已知慢性肾病的2型糖尿病患者的蛋白尿程度和肾功能状态,探讨慢性肾病的相关危险因素。方法:对内分泌科门诊无已知慢性肾病的923例2型糖尿病患者进行横断面研究。测量患者身高、体质量、血压,并检测尿常规、尿白蛋白肌酐比值和血液生化指标。应用肾病膳食改良试验方程计算肾小球滤过率。采用美国肾脏病基金会制定的肾脏病预后质量指南(kidney disease outcome quality initiative,K/DOQI)对慢性肾病进行分期。由专业眼科医师判断视网膜病变分期。结果:932例患者中,397例(43.0%)有蛋白尿,其中281例(30.4%)为微量蛋白尿,116例(12.6%)为临床蛋白尿。慢性肾病1期、2期、3期、4～5期分别为401例(45.0%)、339例(38.0%)、102例(11.4%)和49例(5.5%)。将932例患者按照蛋白尿程度分为蛋白尿阴性组和蛋白尿组(包括微量蛋白尿亚组、临床蛋白尿亚组)。蛋白尿组患者收缩压、总胆固醇、甘油三酯、低密度脂蛋白胆固醇及空腹血糖均高于蛋白尿阴性组。Logistic多元回归分析提示,年龄、视网膜病变程度和高血压史是肾脏功能不全的独立危险因素。结论:2型糖尿病患者中,蛋白尿和肾功能不全伴发率高,伴发蛋白尿的患者其他代谢异常的发生率也较高。     

慢性肾脏病基础上急性肾损伤的病因和预后分析——附38例报告

目的:探讨慢性肾脏病(chronic kidney disease,CKD)基础上急性肾损伤(acute kidney injury,AKI)的病因和预后的影响因素.方法:对38例CKD基础上的AKI患者按照RIFLE标准对AKI进行分层诊断,并对38例患者的病因、预后等临床资料进行数理分析.结果:38例中,符合R标准2例(5%)、I标准3例(8%)、F标准5例(13%),L标准11例(29%),E标准17例(45%);其中符合F、L、E标准33例,占87%.导致AKI最常见的病因是恶性高血压(32%)和严重感染(21%).CKD患者发生AKI后的血清肌酐较发生AKI前明显升高,GFR则明显降低(均为P＜0.01).需要肾脏替代治疗28例(74%),其中发生终末期肾脏病(end-stage renal disease,ESRD)21例,占55%;无需肾脏替代治疗7例(18%);死亡3例,病死率8%.多变量Logistic 回归分析显示,恶性高血压分别是CKD基础上的AKI患者需要肾脏替代治疗(r＝2.42,P＜0.05)和发生ESRD(r＝2.08,P＜0.05)的独立危险因素;而少尿、感染和CKD的基础病因与患者的肾脏预后无关 (P＞0.05).结论:恶性高血压和严重感染是CKD患者并发AKI的主要病因,恶性高血压是这类患者肾脏预后不良的独立危险因素,严格控制血压是预防CKD患者并发AKI和改善患者预后的关键措施之一.     

Risk factors and pathogenetic mechanisms of left ventricular hypertrophy in progressive chronic kidney disease and after transplantation of the kidney

AIM: To specify the trend in the incidence of left ventricular hypertrophy (LVH) at a predialysis stage of chronic kidney disease (CKD) in the course of its progression from stage III to stage V and after transplantation of the kidney (TK); to study correlations between homeostatic disorders caused by CKD progression and myocardial remodeling; to define the role of some hemodynamic and nonhemodynamic factors in formation of LVH. MATERIAL AND METHODS: The study enrolled 128 patients (58 males and 70 females, age 18-55 years, mean age 42 +/- 11 years) at a predialysis stage of CKD (group 1) and 225 recipients of renal allotransplant--RRA (group 2, 140 males and 85 females, age 18-69 years, mean age 43 +/- 12 years). General clinical examination, biochemical and immunological blood tests, echocardiography were made. RESULTS: At a predialysis stage of CKD, LVH was diagnosed in 56% patients. Incidence of LVH was directly related with age of the patients (p = 0.001), blood pressure (p < 0.001), duration of arterial hypertension (p = 0.004), severity of anemia (p = 0.017), the level of C-reactive protein (p = 0.003), blood phosphorus concentration and inversely correlated with glomerular filtration rate--GFR (p = < 0.001), albumin level (p = 0.023) and blood Ca (p < 0.001). LVH was followed up for 12 months in 35 patients with predialysis CKD. Factors of LVH progression and factors hindering its regression were systolic blood pressure, Hb and Ca in the blood. In group 2 of RRA incidence of LVH was 53%. Significant factors of LVH risk after transplantation were age (p = 0.002), hypertension (p = 0.005) and anemia (p = 0.04). Moreover, LVH closely correlated with proteinuria (p < 0.03), transplant dysfunction (p = 0.002) and posttransplantation ischemic heart disease (p < 0.037). Changes in LVH were analysed in 30 RRA. Frequency of LVH decreased for 2 years after transplantation (from 56 to 32%) but 36-60 and more months after transplantation it increased (46 and 64%, respectively). Transplant dysfunction was the leading factor hindering LVH regression after transplantation. CONCLUSION: The same mechanisms are involved in LVH pathogenesis after transplantation and at a predialysis stage of CKD. The significance of initial renal lesion signs--minimal proteinuria and hypercreatininemia--was higher after renal transplantation than in patients with CKD.     

慢性肾脏病患者左室整体纵向应变与肾功能的相关性研究

目的应用二维斑点追踪应变成像(2D-STI)评估慢性肾脏病(CKD)患者左室功能,探讨左室整体纵向峰值应变(GLS)与肾功能的相关性。方法连续入选经我院确诊为CKD的患者69例,根据肾小球滤过率(eGFR)分为轻度CKD组36例(eGFR 30~89 ml/min)和中重度CKD组33例(eGFR<30 ml/min),另选与之年龄、性别相匹配的30例健康志愿者为对照组。收集各组临床、实验室肾功能检查资料,经胸超声心动图测量常规超声心动图参数,包括舒张末期室间隔厚度(IVSTd)、左室舒张末期内径(LVIDd)、左室心肌质量指数(LVMI)、左室射血分数(LVEF)、左房容量指数(LAVI)、二尖瓣口舒张期E峰与室间隔e峰的比值(E/e);2D-STI测量GLS。应用多元线性回归分析各超声检测参数与eGFR之间的相关性。结果与对照组比较,轻度CKD组IVSTd、LAVI、血肌酐均增高,eGFR、GLS均明显降低(均P<0.05);与轻度CKD组比较,中重度CKD组收缩压、总胆固醇、血肌酐均明显增高,IVSTd、LVMI、LAVI、E/e均增大,eGFR、GLS均减小(均P<0.05)。相关性分析显示,eGFR与收缩压、血肌酐、IVSTd、LVMI、LAVI均呈负相关,eGFR与GLS呈正相关(均P<0.05);经多元线性回归分析调整影响因素后,GLS与eGFR仍呈独立正相关(r=0.789,P=0.005)。结论 2D-STI能敏感反映不同阶段CKD患者左室功能改变;随着病情发展,CKD患者左房扩大、左室收缩功能减低,GLS与肾功能独立相关。     

慢性肾病患者左室整体纵向应变与肾功能的相关性研究

目的 应用二维斑点追踪应变成像技术(2DSTI)评估慢性肾病患者左心室功能,探究左心室整体纵向峰值应变与肾功能的相关性。方法 连续入选2016年8月-2019年5月于我院确诊为慢性肾功能不全患者共69名,其中36例2~3期慢性肾功能不全患者(轻度CKD组),33例4~5期慢性肾功能不全患者(中重度CKD组)以及30例年龄性别相匹配的健康志愿者(对照组)。收集所有患者临床基本资料,经胸超声心动图测量常规超声心动图指标,包括室间隔舒张末期厚度(IVSTd)、左心室舒张末期内径(LVIDd)、左心室心肌质量指数(LVMI)、左心室射血分数(LVEF)、左心房容量指数(LAVI)、E/e。应用2D-STI测量左心室整体纵向峰值应变(GLS)。应用多元线性回归分析超声各参数与肾小球滤过率(eGFR)之间的相关性。结果 与对照组相比,轻度CKD组IVSTd、LAVI、血肌酐增高,eGFR、GLS明显降低；与轻度CKD组相比,中重度CKD组收缩压、总胆固醇、血肌酐明显增高,IVSTd、LVMI、LAVI、E/e增大,eGFR、GLS减小(P<0.05)。eGFR与收缩压、血肌酐、IVSTd、LVMI、LAVI呈负相关,eGFR与GLS呈正相关(P<0.05),多元线性回归分析调整影响因素后,GLS与eGFR仍呈独立正相关。结论 随着病情发展,慢性肾功能不全患者左房扩大、左心室收缩功能减低,GLS与肾功能独立相关,2D-STI能敏感反映不同阶段慢性肾功能不全患者左心室功能改变。     

崇明地区中老年人群慢性肾脏病的流行病学研究

目的研究崇明地区中老年人群慢性肾脏病的患病率及其相关危险因素。方法2011年9月至2012年3月崇明地区城桥镇城乡交界的社区40～70岁常住居民1358人,进行慢性肾脏病及相关危险因素的问卷调查、体格检查、实验室检查采集相关数据。对于被调查者如出现下列情况：尿蛋白阳性、镜下血尿、血肌酐≥110 mmol/L、血尿酸男≥0.42μmol/L、女≥0.36μmol/L,3个月后至医院复查。结果在1092例资料完整的居民中,白蛋白尿、血尿、肾功能下降的患病率分别10.7％、2.2％、1.0％。该人群慢性肾脏病患病率为13.2％,知晓率为17.3％。经多因素Logistic回归提示：高尿酸血症、高血压、糖尿病、性别、年龄为慢性肾脏病独立相关因素。结论在上海崇明慢性肾脏病的患病率为13.2％,知晓率为17.3％。高尿酸血症、高血压、糖尿病、性别、年龄为慢性肾脏病独立影响因素。     

Investigation of the prevalence of CKD in 13,383 Chinese hospitalised adult patients

BACKGROUND: There is an increase prevalence of chronic kidney disease (CKD)worldwide. However, the exact incidence of CKD in China is still uncertain. In this cross-sectional study, we retrospectively investigated the prevalence and distribution of CKD in Chinese hospitalised adult patients. METHODS: Totally, 13,383 adults patients who were hospitalised at our hospital were included in this study. They included 6215 males and 7168 females. Patients' gender, age, blood pressure, serum creatinine, blood urea nitrogen, uric acid, triglyceride, total cholesterol, albumin, hemoglobin, hemotocrit, urine protein, and history of hypertension, diabetes, and smoking were investigated. CKD was defined as eGFR<60 ML/ MIN PER 1.73 m(2) and/or proteinuria, GFR was estimated by using of the simplified MDRD equation. RESULTS: The prevalence rate of CKD was 14.82% in our group, which was respectively distributed from 1 to stage 5 at the following percentage, 3.33% (stage 1), 2.49% ( stage 2), 7.07% (stage 3), 1.08% (stage 4), and 0.86% (stage 5). Elderly patients (age >65 y) accounted for 53.07%, which had a higher CKD prevalence (29.47%) than middle and young-aged patients (9.49%). It was noted that 39.06% patients at stage 1-3 were undiagnosed with CKD during their hospitalization. The common etiology for CKD was hypertension (29.49%), diabetes (11.64%) and primary glomerulonephritis (4.39%). Hypertension, diabetes and ages were main associated factors for CKD. CONCLUSIONS: CKD is a very common disease among the hospitalised patients in China. With the increasing of aging population, elderly people will be the highest risk group for CKD. More strategies have to be made for its early detection and prevention.     

慢性肾脏病患者血红蛋白变异度与肾功能进展关系的临床研究

目的评价在肾内科门诊规律随访的慢性肾脏疾病(CKD)患者的肾脏功能进展情况,及与血红蛋白变异度的相关情况。方法采用前瞻性队列研究设计,收集慢性肾脏病患者规律随访,定期抽取血样标本检测血红蛋白、肾功能等指标,建立数据库并应用统计软件对观察结果进行分析。结果共纳入197例患者,其中CKD 2期11例,3期125例,4期54例,5期7例。进入队列时基线年龄为62.3±10.6岁,基线肾小球滤过率(eGFR)为33.3±10.2 ml/(min·1.73 m2),随访18个月,72例(36.5%)患者的肾功能发生进展,与肾功能稳定组相比,肾功能进展组的血红蛋白变异度指标较高,差异有统计学意义(P<0.05)。结论慢性肾脏病患者的血红蛋白的变异度水平与肾功能进展有关,应对患者的血红蛋白波动增加关注。     

慢性肾脏病患者血压形态特点及临床疗效分析

目的 研究慢性肾脏病（chronic kidney disease，CKD）患者血压形态特点，以及睡前服用降压药对患者临床疗效影响。方法 2018年1月至2019年9月住院的182例CKD合并高血压患者的动态血压数据和临床指标，描述患者的血压昼夜节律特点和特殊血压类型分布。分析睡前服用降压药对患者临床疗效影响。结果 不同CKD分期患者的年龄、24 h收缩压、白天收缩压、夜间收缩压差异有统计学意义。CKD合并高血压患者血压形态以非杓型为主。与杓型血压组患者比较，非杓型或反杓型患者的年龄、超敏C反应蛋白（hypersensitive C reactiveprotein，hs CRP）偏高，血红蛋白偏低（P＜0.05）；多因素回归分析显示年龄、hs CRP是发生异常血压节律的独立危险因素。患者的诊室血压控制率25.3%，动态血压控制率14.3%，均控制率5.5%，夜间血压未控制率83.5%。19.8%的患者有隐匿性高血压，8.8%的患者有白大衣性高血压。将降压药改为睡前服用的患者3个月后的24 h尿蛋白和血尿酸显著改善（P＜0.05）。结论 CKD合并高血压患者的血压形态以非杓型为主。年龄、hs CRP是发生血压节律异常的独立危险因素，血红蛋白越低的患者更容易发生非杓型血压。睡前服用降压药可能通过恢复血压昼夜节律来减少尿蛋白及降低血尿酸。     

Assessment of the quality of care and financial impact of a virtual renal clinic compared with the traditional outpatient service model

Background: Patients with chronic kidney disease (CKD) have better outcomes when they have access to specialist nephrology services early in the course of their disease. However, up to 30% of patients with advanced kidney disease face late referral. Virtual clinics represent a potentially innovative mechanism for early assessment of high patient volumes efficiently and cost effectively while maintaining high standards of care. Methods: A retrospective observational cohort study was completed over a 4‐year period from April 2004 to March 2008 at a regional nephrology centre within Northern Ireland. All new patient attendances at the nephrology clinic were identified and those managed via the virtual renal clinic approach were included in this study. A cost comparison of this innovative modality was made with the traditional outpatient service model. Results: There were 427 patients (51.3% female, 48.7% male) managed through the virtual renal clinic. Comorbidities included 180 patients (42.1%) with known CKD and 31 patients (7.3%) with newly identified kidney disease. A total of 118 patients (27.6%) had hypertension while 6 (1.4%) and 57 (13.3%) had type I and II diabetes mellitus (DM) respectively. Referral indications included 211 patients (49.4%) with abnormal renal biochemistry, 35 (8.2%) with proteinuria, 12 (2.8%) with haematuria and 87 patients (20.4%) with a combination of issues. A conservative treatment plan consisting of biochemical surveillance was appropriate for 246 patients (57.6%) while medication review was completed for 113 patients (26.5%) and surgical referral was indicated in 20 patients (4.7%). The virtual renal clinic provided a minimum cost saving of £111.56 per patient attendance compared with traditional outpatient care resulting in 23.3% of patient referrals being managed by the virtual clinic approach in 2009. Conclusion: Delayed referral to a renal specialist adversely affects patient outcomes. This study suggests that the implementation of a virtual renal clinic for non‐complex renal pathologies can offer a cost‐effective, rapid referral mechanism for patient assessment combined with readily available specialist advice.     

Improving Prognostic and Chronicity Evaluation of Chronic Kidney Disease with Contrast‐Enhanced Ultrasound Index-Derived Peak Intensity

The capability of contrast‐enhanced ultrasound (CEUS) to assess the prognosis and chronicity of chronic kidney disease (CKD) was evaluated in patients diagnosed with CKD in 2014 at Ren Ji Hospital, Shanghai, China. Time–intensity curves and quantitative indexes were created using QLab quantification software. Kidney biopsies were analyzed with α-smooth muscle actin immunohistochemistry. According to the renal chronicity score, patients were divided into four groups: minimal (n = 14), mild (n = 73), moderate (n = 49) and severe (n = 31). Multivariate logistic regression analysis revealed that the derived peak intensity (DPI) was independently associated with the renal chronicity score. Of 167 CKD patients (median follow-up: 30.4 ± 18.7 mo), 31 (18.6%) exhibited CKD progression, with a decline in the glomerular filtration rate of more than 25% or end-stage renal disease. Multivariate Cox regression analysis revealed that a lower DPI was independently associated with CKD progression. This study indicates that DPI is a reliable CEUS parameter for evaluating chronic renal changes and an independent prognostic factor of CKD.