Dysuria,heat stress,and muscle injury among Nicaraguan sugarcane workers at risk for Mesoamerican nephropathy

Objectives:Nicaraguan sugarcane workers, particularly cane cutters, have an elevated prevalence of chronic kidney disease of unknown origin, also referred to as Mesoamerican nephropathy (MeN). The pathogenesis of MeN may include recurrent heat stress, crystalluria, and muscle injury with subsequent kidney injury. Yet, studies examining the frequency of such events in long-term, longitudinal studies are limited.Methods:Using employment and medical data for male workers at a Nicaraguan sugarcane company, we classified months of active work as either work as a cane cutter or other sugarcane job and determined occurrence of dysuria, heat events and muscle events. Work months and events occurred January 1997 to June 2010. Associations between cane cutting and each outcome were analyzed using logistic regression based on generalized estimating equations for repeated events, controlling for age.Results:Among 242 workers with 7257 active work months, 19.5% of person-months were as a cane cutter. There were 160, 21, and 16 episodes of dysuria, heat events, and muscle events, respectively. Compared with work months in other jobs, cane cutting was associated with an elevated odds of dysuria [odds ratio 2.40 (95% confidence interval 1.56–3.68)]. The number of heat and muscle events by cane cutter and other job were limited.Conclusions:Working as a cane cutter compared with other jobs in the sugarcane industry was associated with increased dysuria, supporting the hypothesis that cane cutters are at increased risk of events suspected of inducing or presaging clinically evident kidney injury.     

Body Composition,Anemia, and Kidney Function among Guatemalan Sugarcane Workers

Rates of anemia among agricultural workers, who are also at risk for kidney injury and chronic kidney disease of unknown cause (CKDu), are unknown. We evaluated body composition through the sum of three skinfolds among 203 male sugarcane cutters and assessed the relationship of variables related to nutrition, anemia (hemoglobin < 13 g/dL), and elevated hemoglobin A1c (HbA1c ≥ 5.7%) with estimated glomerular filtration rate (eGFR) using linear regression. Eleven percent of workers were at the level of essential body fat (2–5%). Anemia was present among 13% of workers, 70% of which were normochromic normocytic, a type of anemia suggesting potential underlying chronic disease. Anemia was more common among those with lower BMI and fat free mass. The prevalence of elevated HbA1c was 21%. A moderate negative correlation was found between hemoglobin and HbA1c (Pearson’s r = −0.32, p < 0.01) which suggests that HbA1c values should be interpreted with caution in populations that have high rates of anemia. Twelve percent of workers had reduced kidney function with an eGFR < 90 mL/min/1.73 m². On average, the eGFR was 18 mL/min per 1.73 m² lower [(95% CI:−24, −12), p < 0.01)] for those with anemia than those without, and 8 mL/min per 1.73 m² lower among those with elevated HbA1c [(95% CI: −13, −2), p < 0.01]. Results will inform future studies examining the role of anemia in the evaluation of CKDu and interventions to improve nutrition for workers in low-resource settings.     

亚急性对二氯苯染毒对小鼠组织中Zn、Cu、Fe、Se含量的影响

[目的]采用亚急性试验，探讨对二氯苯（p-DCB）对小鼠组织中Zn、Cu、Fe、Se的影响。[方法]选用36只小鼠，雌雄各半，随机分成3组，每组12只，分别给予P-DCB0（对照）、450、900mg／kg，每天灌胃染毒1次，连续7天，染毒结束后24h处死动物并称量体重、肝、肾质量，计算脏器系数。用火焰原子吸收法测定肝脏、血液和肾脏中Zn、Cu、Fe含量，原子荧光法测定Se含量。[结果]与对照组相比，各染毒组体重无明显变化。各组肝体系数无差异，但染毒组肾体系数明显高于对照组（P〈0．05）。900mg／kg组肝脏中Zn含量及Zn／Cu值较450mg／kg组有明显升高。与对照组相比，各染毒组血液中Zn含量呈现下降趋势，900mg／kg组较对照组明显下降（P〈0．05）。900mg／kg组肾脏中Se、Cu含量明显低于450mg／kg组，Fe含量则较对照组及450mg／kg组均有降低。[结论]p-DCB可影响小鼠组织中元素Zn、Cu、Fe、Se的含量及不同器官的再分布，提示微量元素失衡可能是p-DCB毒作用的重要机制。     

肾脏疾病的生化学诊断及进展

目的:分析肾脏疾病的生化诊断及进展.方法:全自动生化分析仪(美国Bckman-CX4),竞争ELISA法测透明质酸(HA).结果:肾脏疾病的诊断和治疗效果观察可使用组合指标检测.结论:血尿素氮(BUN),血肌酐(Cr),血透明质酸(HA)可作肾衰、肾移植后的检测组合;尿中乙酰β氨基葡萄糖苷酶(NAG)及尿微量白蛋白(malb)的检测组合可反映早期肾损伤.     

中国2014年肾癌发病与死亡分析

目的 分析全国肿瘤登记中心收集的登记资料，估计2014年全国肾癌的发病和死亡情况。方法 对全国肿瘤登记中心449个登记处上报的2014年肿瘤登记数据进行评估，其中339个肿瘤登记处的数据符合入选标准，按城乡和年龄分层，结合2014年全国人口数据，估计全国肾癌的发病和死亡情况。中国人口标化率（中标率）采用2000年全国人口普查的标准人口年龄构成，世界人口标化率（世标率）采用Segi''s标准人口年龄构成。结果 339个肿瘤登记地区覆盖人口为288 243 347人（城市144 061 915人，农村144 181 432人）。肾癌病理诊断比例为72.70%，只有死亡证明书比例为1.27%，死亡发病比为0.37。估计全国新发肾癌病例数约为6.83万例，发病率为4.99/10万（95% CI：4.95/10万~5.03/10万），中标发病率为3.43/10万（95% CI：3.40/10万~3.46/10万），世标发病率为3.40/10万（95% CI：3.37/10万~3.43/10万），累积发病率（0~74岁）为0.40%。男性发病率为6.09/10万（6.03/10万~6.15/10万），中标发病率为4.32/10万（4.28/10万~4.36/10万）；女性发病率为3.84/10万（3.79/10万~3.89/10万），中标发病率为2.54/10万（2.50/10万~2.58/10万）。城市地区发病率为6.60/10万（95% CI：6.54/10万~6.66/10万），中标发病率为4.25/10万（95% CI：4.21/10万~4.29/10万）；农村地区发病率为3.05/10万（95% CI：3.01/10万~3.09/10万），中标发病率为2.29/10万（95% CI：2.25/10万~2.33/10万）。估计全国肾癌死亡病例数约为2.56万例，死亡率为1.87/10万（95% CI：1.85/10万~1.89/10万），中标死亡率为1.16/10万（95% CI：1.14/10万~1.18/10万），世标死亡率为1.16/10万（95% CI：1.14/10万~1.18/10万），累积死亡率（0~74岁）为0.12%。男性死亡率为2.31/10万（95% CI：2.27/10万~2.35/10万），中标死亡率为1.52/10万（95% CI：1.50/10万~1.54/10万）；女性死亡率为1.41/10万（95% CI：1.38/10万~1.44/10万），中标死亡率为0.81/10万（95% CI：0.79/10万~0.83/10万）。城市地区死亡率为2.49/10万（95% CI：2.45/10万~2.53/10万），中标死亡率为1.42/10万（95% CI：1.40/10万~1.44/10万）。农村地区恶性肿瘤死亡率为1.12/10万（95% CI：1.09/10万~1.15/10万），中标死亡率为0.78/10万（95% CI：0.76/10万~0.80/10万）。结论 我国肾癌发病死亡水平较低，但较以往有巨大上升，城市男性为重点防控对象。     

青岛市2019-2020年成年人慢性肾脏病患病状况分析

目的 了解青岛市成年人慢性肾脏病（CKD）的患病情况。方法 于2019年5月至2020年9月采用多阶段分层随机抽样方法,在青岛市抽取≥18岁常住居民6 240例研究对象,采用面对面调查方式收集调查对象的人口统计学资料。使用SPSS 25.0软件对青岛市成年人CKD患病情况进行分析。结果 本研究最终纳入5 996例研究对象。青岛市成年人CKD患病率为8.22%;男性和女性CKD患病率分别为7.70%、8.74%。城市居民CKD患病率（10.28%）高于农村居民（7.25%）,不同年龄组、文化程度、婚姻状况成年人CKD患病率差异有统计学意义（均P＜0.001）。CKD患病率呈现随年龄增长而升高、随文化程度升高而降低的趋势。结论 青岛市成年人CKD患病率较高,需积极开展CKD的早期防治工作,加强CKD的筛查和预防,减少CKD的发生与发展。     

人工肾的最新进展及临床应用

本介绍了人工肾的发展史、临床应用、选购和发展趋势。指出:随着高新技术和透析原理的发展，目前已从血液透析演变为血液净化，拓宽了其临床应用范围。采用组织工程、基因、细胞技术研制的生物人工肾，可望生产出易携带或可移植的生物人工肾，可完全替代肾功能，减少肾衰竭病人的死亡率，成为代肾发展史上的又一个里程碑。     

Causal Effects of Homocysteine,Folate, and Cobalamin on Kidney Function: A Mendelian Randomization Study

Blood homocysteine level and related vitamin levels are associated with various health outcomes. We aimed to assess causal effects of blood homocysteine, folate, and cobalamin on kidney function in the general population by performing Mendelian randomization (MR) analysis. Genetic instruments for blood homocysteine, folate, and cobalamin levels were introduced from a previous genome-wide association (GWAS) meta-analysis of European individuals. Summary-level MR analysis was performed for the estimated glomerular filtration rate (eGFR) from the CKDGen consortium GWAS that included 567,460 European ancestry individuals. For replication, allele-score-based MR was performed with an independent U.K. Biobank cohort of 337,138 individuals of white British ancestry. In summary-level MR for the CKDGen data, high genetically predicted homocysteine levels were significantly associated with low eGFR (per 1 standard deviation, beta for eGFR change −0.95 (−1.21, −0.69) %), supported by pleiotropy-robust MR sensitivity analysis. Genetically predicted high folate levels were significantly associated with high eGFR change (0.86 (0.30, 1.42) %); however, causal estimates from cobalamin were nonsignificant (−0.11 (−0.33, 0.11) %). In the U.K. Biobank data, the results were consistently identified. Therefore, a high blood homocysteine level causally decreases eGFR. Future trials with appropriate homocysteine-lowering interventions may be helpful for the primary prevention of kidney function impairment.     

Plasmodium vivax malaria-associated acute kidney injury, India, 2010-2011

Plasmodium vivax is causing increasingly more cases of severe malaria worldwide. Among 25 cases in India during 2010-2011, associated conditions were renal failure, thrombocytopenia, jaundice, severe anemia, acute respiratory distress syndrome, shock, cerebral malaria, hypoglycemia, and death. Further studies are needed to determine why P. vivax malaria is becoming more severe.     

Sugar or Fat? Renal Tubular Metabolism Reviewed in Health and Disease

The kidney is a highly metabolically active organ that relies on specialized epithelial cells comprising the renal tubules to reabsorb most of the filtered water and solutes. Most of this reabsorption is mediated by the proximal tubules, and high amounts of energy are needed to facilitate solute movement. Thus, proximal tubules use fatty acid oxidation, which generates more adenosine triphosphate (ATP) than glucose metabolism, as its preferred metabolic pathway. After kidney injury, metabolism is altered, leading to decreased fatty acid oxidation and increased lactic acid generation. This review discusses how metabolism differs between the proximal and more distal tubular segments of the healthy nephron. In addition, metabolic changes in acute kidney injury and chronic kidney disease are discussed, as well as how these changes in metabolism may impact tubule repair and chronic kidney disease progression.     

人工肾的发展与应用

本文对人工肾的定义、原理、应用范畴、发展历程、发展现状和未来展望等进行阐述和分析,并指出人工肾的未来将朝仿生肾的方向发展。     

Marine n-3 Polyunsaturated Fatty Acids and Bone Mineral Density in Kidney Transplant Recipients: A Randomized,Placebo-Controlled Trial

Kidney transplant recipients are at high risk of progressive bone loss and low-energy fractures in the years following transplantation. Marine n-3 polyunsaturated fatty acids (n-3 PUFA) supplementation may have beneficial effects on bone strength. The Omega-3 fatty acids in Renal Transplantation (ORENTRA) trial was an investigator initiated, randomized, placebo-controlled trial investigating the effects of marine n-3 PUFA supplementation after kidney transplantation. Effects of supplementation on bone mineral density (BMD) and calcium metabolism were pre-defined secondary endpoints. Adult kidney transplant recipients (n = 132) were randomized to 2.6 g marine n-3 PUFA supplement or olive oil (control) from 8 to 52 weeks post-transplant. Dual energy X-ray absorptiometry was performed to assess changes in bone mineral density of hip, spine, and forearm, as well as trabecular bone score (TBS) of the lumbar spine. Student’s t test was used to assess between-group differences. There were no differences in ΔBMD between the two groups (intervention vs. control) at lumbar spine (−0.020 ± 0.08 vs. −0.007 ± 0.07 g/cm², p = 0.34), total hip (0.001 ± 0.03 vs. −0.005 ± 0.04, p = 0.38), or other skeletal sites in the intention-to-treat analyses. There was no difference in the change in TBS score (0.001 ± 0.096 vs. 0.009 ± 0.102, p = 0.62). Finally, no effect on biochemical parameters of mineral metabolism was seen. Results were similar when analyzed per protocol. In conclusion, we found no significant effect of 44 weeks of supplementation with 2.6 g of marine n-3 PUFA on BMD in kidney transplant recipients.     

Protective Effects of Nootkatone on Renal Inflammation,Apoptosis, and Fibrosis in a Unilateral Ureteral Obstructive Mouse Model

Nootkatone is one of the major active ingredients of Alpiniae oxyphyllae, which has been used as both food and medicinal plants for the treatment of diarrhea, ulceration, and enuresis. In this study, we aimed to investigate whether nootkatone treatment ameliorated the progression of chronic kidney diseases (CKD) and clarified its underlying mechanisms in an obstructive nephropathy (unilateral ureteral obstructive; UUO) mouse model. Our results revealed that nootkatone treatment preventively decreased the pathological changes and significantly mitigated the collagen deposition as well as the protein expression of fibrotic markers. Nootkatone could also alleviate oxidative stress-induced injury, inflammatory cell infiltration, and renal cell apoptotic death in the kidneys of UUO mice. These results demonstrated for the first time that nootkatone protected against the progression of CKD in a UUO mouse model. It may serve as a potential therapeutic candidate for CKD intervention.     

Pro-Inflammatory Profile of Adipokines in Obesity Contributes to Pathogenesis,Nutritional Disorders,and Cardiovascular Risk in Chronic Kidney Disease

Obesity is a disease which leads to the development of many other disorders. Excessive accumulation of lipids in adipose tissue (AT) leads to metabolic changes, including hypertrophy of adipocytes, macrophage migration, changes in the composition of immune cells, and impaired secretion of adipokines. Adipokines are cytokines produced by AT and greatly influence human health. Obesity and the pro-inflammatory profile of adipokines lead to the development of chronic kidney disease (CKD) through different mechanisms. In obesity and adipokine profile, there are gender differences that characterize the male gender as more susceptible to metabolic disorders accompanying obesity, including impaired renal function. The relationship between impaired adipokine secretion and renal disease is two-sided. In the developed CKD, the concentration of adipokines in the serum is additionally disturbed due to their insufficient excretion by the excretory system caused by renal pathology. Increased levels of adipokines affect the nutritional status and cardiovascular risk (CVR) of patients with CKD. This article aims to systematize the current knowledge on the influence of obesity, AT, and adipokine secretion disorders on the pathogenesis of CKD and their influence on nutritional status and CVR in patients with CKD.     

Effect of Unripe Banana Flour on Gut-Derived Uremic Toxins in Individuals Undergoing Peritoneal Dialysis: A Randomized,Double-Blind,Placebo-Controlled,Crossover Trial

In chronic kidney disease (CKD), the accumulation of gut-derived metabolites, such as indoxyl sulfate (IS), p-cresyl sulfate (pCS), and indole 3-acetic acid (IAA), has been associated with the burden of the disease. In this context, prebiotics emerge as a strategy to mitigate the accumulation of such compounds, by modulating the gut microbiota and production of their metabolites. The aim of this study was to evaluate the effect of unripe banana flour (UBF—48% resistant starch, a prebiotic) on serum concentrations of IS, pCS, and IAA in individuals undergoing peritoneal dialysis (PD). A randomized, double-blind, placebo-controlled, crossover trial was conducted. Forty-three individuals on PD were randomized to sequential treatment with UBF (21 g/day) and placebo (waxy corn starch—12 g/day) for 4 weeks, or vice versa (4-week washout). The primary outcomes were total and free serum levels of IS, pCS, and IAA. Secondary outcomes were 24 h urine excretion and dialysis removal of IS, pCS, and IAA, serum inflammatory markers [high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), interleukin-10 (IL-10), and tumor necrosis factor-α (TNF-α)], serum lipopolysaccharide LPS, and dietary intake. Of the 43 individuals randomized, 26 completed the follow-up (age = 55 ± 12 years; 53.8% men). UBF did not promote changes in serum levels of IS (p = 0.70), pCS (p = 0.70), and IAA (p = 0.74). Total serum IS reduction was observed in a subgroup of participants (n = 11; placebo: median 79.5 μmol/L (31–142) versus UBF: 62.5 μmol/L (31–133), p = 0.009) who had a daily UBF intake closer to that proposed in the study. No changes were observed in other secondary outcomes. UBF did not promote changes in serum levels of IS or pCS and IAA; a decrease in IS was only found in the subgroup of participants who were able to take 21g/day of the UBF.     

Vitamin D and Secondary Hyperparathyroidism in Chronic Kidney Disease: A Critical Appraisal of the Past,Present, and the Future

The association between vitamin D deficiency and especially critical shortage of active vitamin D (1,25-dihydroxyvitamin D, calcitriol) with the development of secondary hyperparathyroidism (sHPT) is a well-known fact in patients with chronic kidney disease (CKD). The association between sHPT and important clinical outcomes, such as kidney disease progression, fractures, cardiovascular events, and mortality, has turned the prevention and the control of HPT into a core issue of patients with CKD and on dialysis. However, vitamin D therapy entails the risk of unwanted side effects, such as hypercalcemia and hyperphosphatemia. This review summarizes the developments of vitamin D therapies in CKD patients of the last decades, from calcitriol substitution to extended-release calcifediol. In view of the study situation for vitamin D insufficiency and sHPT in CKD patients, we conclude that the nephrology community has to solve three core issues: (1) What is the optimal parathyroid hormone (PTH) target level for CKD and dialysis patients? (2) What is the optimal vitamin D level to support optimal PTH titration? (3) How can sHPT treatment support reduction in the occurrence of hard renal and cardiovascular events in CKD and dialysis patients?