Paraquat‐induced acute kidney and liver injury: Case report of a survivor from Bangladesh

Despite high fatality following paraquat ingestion, a few percentages of patients survive even after organ damage appears. We need to focus more on careful clinical and laboratory monitoring. Early diagnosis and Supportive therapy are crucial.     

The role of CT perfusion imaging in acute stroke diagnosis: a large single-center experience

The objective of this study was to determine the utility of computed tomography perfusion (CTP) scans in diagnosing acute ischemic stroke (AIS). CTP abnormalities in two contiguous supratentorial levels were correlated with diffusion weighted image (DWI) abnormalities on magnetic resonance imaging (the standard for stroke diagnosis) performed within 1 week in 422 suspected acute ischemic strokes. Of 157 AIS confirmed by DWI, 78 showed CTP abnormalities (sensitivity 49.7%). All of these examinations were performed with a mean of 35 min from the initial emergency department neurological examination. Excluding small non-vascular territory strokes left 77 AIS with a total volume of infarcted tissue of more than 5 cc by DWI. Of these, 71 showed CTP abnormalities (sensitivity 92.2%). Of the 265 patients without AIS, none showed CTP abnormalities (specificity 100%). CTP is a rapid, readily available and effective method of diagnosing AIS in clinical practice, particularly the major intracranial vessel strokes that result in a more devastating outcome.     

比较不同剂量地塞米松对小鼠脓毒症致急性肾损伤的保护作用

目的 比较不同剂量地塞米松(DEX)对脓毒症导致的急性肾损伤(AKI)的影响.方法 健康雄性昆明小鼠130只,按随机数字表法均分为假手术组、脓毒症模型组和DEX生理剂量组(0.12 mg/kg)、应激剂量组(1.2 mg/kg)、大剂量组(12 mg/kg).采用盲肠结扎穿孔术(CLP)制备脓毒症模型,分别在术后24 h、48 h观察肾组织病理学变化,免疫组化法检测肾组织糖皮质激素受体-α(GR-α)蛋白表达水平,实时荧光定量聚合酶链反应(PCR)检测肾组织GR-α、核转录因子-κB(NF-κB)的mRNA表达水平,酶联免疫吸附试验(ELISA)测定血浆肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)的含量.结果 与假手术组比较,脓毒症模型组小鼠肾小管病理损害严重;肾组织GR-α蛋白和mRNA表达明显降低,NF-κB mRNA表达及血浆TNF-α、IL-1β水平均明显升高.与脓毒症模型组比较,各剂量DEX组肾小管病理损害不同程度减轻;肾组织GR-α蛋白和mRNA表达均明显升高,NF-κB mRNA表达和血浆TNF-α、IL-1β水平均明显降低,其中以DEX生理剂量组作用尤佳[AKI评分(分)24 h:1.480±0.334比3.040±0.517,48 h:1.840±0.167比3.400±0.400;GR-α蛋白(A值)24 h:0.102±0.009比0.088±0.005,48 h:0.103±0.008比0.085±0.006;GR-o mRNA 24 h:0.0400(0.0300,0.0400)比0.0100 (0.0093,0.0100),48 h:0.0350 (0.0300,0.0475)比0.0100 (0.0010,0.0138); NF-κBmRNA 24 h:0.009±0.001比0.012±0.000,48 h:0.011±0.000比0.013±0.001;TNF-α (ng/L)24 h:105.84±3.84比135.52±4.49,48 h:111.35±3.67比141.22±4.46;IL-1β(ng/L)24 h:45.71±2.93比64.12±3.62,48 h:57.04±3.04比74.87±3.67; P＜0.05或P＜0.01].结论 生理剂量DEX可以通过上调肾组织中GR-α表达,减轻脓毒症引起的肾组织损伤,其作用明显优于大剂量DEX.     

肾脏可复性评估

急性肾损伤是重症患者常见合并症,其恢复与否密切关系到患者的短期和长期预后,采取有效监测措施判断其可复性及影响因素是采取有效干预和改善预后的关键。肾脏可恢复性受损伤类型和程度、肾脏局部因素和全身状况等诸多因素影响,本文从危险因素、临床信息、病理、分子标志物、影像学等方面对其进行探讨,为临床实践提供参考。     

碘对比剂诱导急性肾损伤研究进展

造影后急性肾损伤（PC-AKI）是注射含碘对比剂后严重并发症之一，其发生原因及机制尚不明确。生化指标联合功能磁共振技术可用于监测PC-AKI，对指导临床治疗及判断预后有重要价值。研究PC-AKI的发病机制，寻找可预防PC-AKI的新靶点，同时联合代谢组学等对PC-AKI有重要意义。本文对碘PC-AKI研究进展进行综述。     

急性肾损伤后慢性肾脏病发病机制及其诊治进展

急性肾损伤后常出现肾小管间质纤维化等慢性肾脏病表现,甚至进展至终末期肾病,发病机制包括小管上皮细胞适应不良性修复、免疫炎症过度反应、毛细血管稀疏、氧化应激等。随着人们对急性肾损伤后慢性化转归机制的深入认识,近年来相关的干预新靶点和新策略相继问世,展示了人类攻克急性肾损伤预后不良的良好前景。     

Establishment of a time‐resolved immunoassay for acute kidney injury based on the detection of Kim‐1

AimTo establish a highly sensitive time‐resolved fluorescence immunoassay (TRFIA) of kidney injury molecule‐1 (Kim‐1) and evaluate its clinical value in acute kidney injury (AKI).MethodsThe Kim‐1‐TRFIA was established by the double‐antibody sandwich method, and the method was evaluated. The established Kim‐1‐TRFIA was used to detect the concentration of Kim‐1 in the serum of healthy controls and patients with AKI.ResultsThe optimal coating antibody concentration and optimal Eu³⁺‐labeled antibody dilution ratio for Kim‐1‐TRFIA are 1 μg/ml and 1:140, respectively. The linear range is 42.71–4666.69 pg/ml. The intra‐ and inter‐assay coefficients of variation are <10%. The specificity of our Kim‐1‐TRFIA is acceptable. The recovery is between 95.14% and 102.84%. The concentration of Kim‐1 in the serum of patients with AKI is 126.50 ± 67.99 pg/ml, which is significantly higher than that in the serum of healthy controls (49.72 ± 16.40 pg/ml, p < 0.001). Staging patients with AKI by glomerular filtration rate shows that the serum concentration of Kim‐1 increases significantly with increasing disease severity (p < 0.05).ConclusionA highly sensitive Kim‐1‐TRFIA was established. With this immunoassay, a good differential diagnosis can be made, and healthy people and AKI patients can be differentiated by detecting the concentration of Kim‐1 in the serum. Moreover, the severity of AKI patients can be determined.     

Clinical value of serum miR‐320‐3p expression in predicting the prognosis of sepsis‐induced acute kidney injury

BackgroundFor investigating the expression of miR‐320‐3p in children with sepsis‐induced acute kidney injury (AKI) and its prognostic value.MethodsA total of 142 patients were grouped into a survival group (n = 95) and death group (n = 47), which was based on their 28‐day survival. Serum degrees of miR‐320‐3p, neutrophil gelatinase‐associated lipid carrier protein (NGAL) and kidney injury molecule‐1 (KIM‐1) were detected. The Acute Physiology and Chronic Health scoring system Ⅱ (APACHE Ⅱ) marks were recorded. Target gene forecast and functional enrichment discussion of miR‐320‐3p were performed, and a protein–protein interaction (PPI) network diagram was plotted by applying bioinformatics methods. Multivariate logistic regression, ROC curve and Pearson correlation analysis were applied.ResultsThe death group showed greatly higher serum levels of miR‐320‐3p, KIM‐1 and APACHE Ⅱ scores than the survival group (p < 0.01). Multivariate logistic regression analysis showed that levels of miR‐320‐3p, NGAL, KIM‐1 and APACHE Ⅱ scores were independent risk elements for death in sepsis children with AKI (p < 0.01). According to ROC curve analysis, the region under the curve (0.963, 95% CI: 0.908–0.996) of miR‐320‐3p, NGAL, KIM‐1 levels and APACHE Ⅱ scores combined to forecast the death of kids suffering from sepsis and AKI were the biggest. According to correlation analysis, the expression degree of serum miR‐320‐3p in the death group was positively correlated with NGAL, KIM‐1 and APACHE Ⅱ scores (all p < 0.01).ConclusionsThe expression level of serum miR‐320‐3p in children with sepsis‐induced AKI was significantly increased, and the combination of NGAL, KIM‐1 and APACHE Ⅱ scores has good value for prognosis prediction in children.     

黄芩苷对马兜铃酸诱导小鼠急性肾损伤的保护作用

目的:探讨黄芩苷在马兜铃酸诱导小鼠急性肾损伤中的作用及可能的作用机制。方法:雄性C57小鼠随机分为4组:对照组、模型组、低剂量黄芩苷组和高剂量黄芩苷组。模型组建立马兜铃酸诱导小鼠急性肾损伤模型,低剂量黄芩苷和高剂量黄芩苷组分别通过腹腔注射10 mg/kg和100 mg/kg黄芩苷。3 d后收集小鼠血清检测肾功能,肾脏组织行H-E染色、TUNEL染色和Western印迹检查。结果:肾功能检测发现,与对照组相比,模型组小鼠血肌酐、尿素氮明显上升,而高剂量黄芩苷治疗后两者显著下降(P0.05)。H-E染色结果表明,模型组小鼠肾小管和肾小管间质显著扩张、淋巴细胞明显浸润,高剂量黄芩苷组小鼠肾小管和肾小管间质扩张减轻、淋巴细胞浸润减少。TUNEL染色和Western印迹结果显示,与对照组相比,模型组小鼠肾脏细胞凋亡明显增加,而高剂量黄芩苷治疗后细胞凋亡显著减少(P0.05)。结论:黄芩苷可通过减少小鼠肾脏细胞凋亡来减轻马兜铃酸诱导的急性肾损伤。     

类CT灌注成像监测奥沙利铂所致肝窦损伤北大核心CSCD

目的评价类CT灌注成像(CTPI)监测奥沙利铂(OXA)化疗致肿瘤患者肝窦损伤的价值。方法纳入128例接受OXA化疗的胃癌或结直肠癌患者,测量其肝脏门静脉灌注量(PVP)、动脉增强分数(AEF)及脾脏体积,比较化疗前、化疗中期(第2~4周期)及化疗末期(第6~8周期)各参数差异;记录化疗前后各时期血小板(PLT)、谷丙转氨酶(GPT)及谷草转氨酶(GOT),并计算GOT/PLT比值及基于4因子的纤维化指数(FIB-4),比较各时期临床指标差异。采用Spearman相关性分析评价类CTPI参数与临床指标的相关性。结果化疗各期PVP均较化疗前明显降低(P均<0.05),脾脏体积均较化疗前明显增大(P均<0.05),而AEF差异无统计学意义(P均>0.05)。相比化疗前,化疗后PLT明显降低(P<0.05),GOT、GPT、GOT/PLT比值及FIB-4明显升高(P均<0.05)。PVP变化与GOT/PLT比值、FIB-4及脾脏体积均呈负相关(r=-0.18、-0.28、-0.34,P均<0.05)。结论OXA化疗后类CTPI参数PVP明显降低,且与反映肝窦损伤的实验室指标及脾脏体积变化相关,可作为评估肝窦损伤的敏感指标。     

A risk score based on procalcitonin for predicting acute kidney injury in COVID‐19 patients

BackgroundAcute kidney injury (AKI) has been reported developing commonly in coronavirus disease 2019 (COVID‐19) patients and could increase the risk of poor outcomes in these patients. We design this study to explore the value of serum procalcitonin (PCT) on predicting AKI and construct risk score for predicting AKI in COVID‐19 patients.MethodsPatients diagnosed with COVID‐19 and hospitalized in Renmin Hospital of Wuhan University between January 30 and February 24, 2020, were included. The least absolute shrinkage and selection operator (LASSO) regression was performed to identify the strongest predictors of AKI. Multivariate logistic regression analysis was conducted to find independent risk factors for AKI and construct risk score using odds ratio (OR) value of those risk factors. Receiver operating characteristics (ROC) curves were plotted, and area under the ROC curve (AUC) value was calculated to evaluate the predictive value of single PCT level and the constructed risk score.ResultsAmong 389 included COVID‐19 patients, 28 (7.2%) patients developed AKI. LASSO regression showed hypertension, saturation of arterial oxygen (SaO₂), PCT, and blood urea nitrogen (BUN) were the strongest predictors for AKI. After multivariate logistic regression analysis, only SaO₂ (<0.001), PCT (p = 0.004), and BUN (p = 0.005) were independently associated with development of AKI in COVID‐19 patients. The AUC of single PCT and constructed risk score was 0. 881 and 0.928, respectively.ConclusionPCT level is correlated with AKI in COVID‐19 patients. The efficient risk score consisted of SaO₂, PCT, and BUN is readily accessible for physicians to evaluate the possibility of AKI in COVID‐19 patients.     

心脏术后急性肾损伤早期生物学标志物的研究进展

急性肾损伤(AKI)是心脏手术以及其他外科手术后常见且严重的并发症,具有较高的发病率和病死率,目前公认的最佳的治疗措施是早期发现、早期诊断。为此研究者们对AKI早期生物学标志物进行了广泛的研究。该文就几种新型标志物的生物学功能、研究现状、应用前景进行综述。     

ICU急性肾损伤的高危因素分析

目的：探讨ICU住院患者急性肾损伤的危险因素。方法：回顾性分析重症监护病房2008-03-2013-03住院治疗的840例患者临床资料,应用多因素回归分析方法探讨发生急性肾损伤的高危因素。结果：840例患者中284例发生AKI,发病率为33.8%。284例AKI患者死亡68例,死亡率23.9%。年龄、APACHEⅡ分值、脓毒症、糖尿病、使用肾毒性药物、基线血肌酐值、休克是AKI发生的危险因素。结论：AKI是ICU中常见并发症,死亡率高。年龄、APACHEⅡ分值、脓毒症、糖尿病、使用肾毒性药物、基线血肌酐值、休克是AKI发生的独立危险因素,应采取多种综合措施减少AKI发生。     

容量负荷对脓毒性急性肾损伤预后的影响

目的 探讨容量负荷对脓毒性急性肾损伤(AKI)患者预后的影响.方法 采用回顾性研究方法,选择2009年10月至2011年9月收住滨州医学院附属医院重症监护病房(ICU)的脓毒性AKI患者作为研究对象,对比观察第一个72 h内液体正平衡与负平衡患者的28 d病死率、28 d肾功能恢复率、住ICU时间及机械通气率.观察连续性肾脏替代治疗(CRRT)对患者容量负荷及预后的影响.结果 160例脓毒性AKI患者人选本研究,液体负平衡组(81例)28 d病死率[37.0％(30/81)比68.4％(54/79),P＜0.01]、住ICU时间(d:10.1 ±4.9比12.4±8.0,P＜0.05)及机械通气率[50.6％(41/81)比68.4％(54/79),P＜0.01]较液体正平衡组(79例)明显降低.根据急性肾损伤协作网(AKIN)分期,在AKI 1、2、3期(分别为49、52、59例),经CRRT治疗者第一个72 h内日平均容量(ml)均明显低于未行CRRT治疗者(-10比716,324比778,521比1177,均P＜0.05),同时AKI2期CRRT治疗者28 d病死率显著低于未行CRRT治疗者[38.7％(12/31)比66.7％(14/21),P＜ 0.05].结论 容量负荷与脓毒性AKI患者预后有关,液体负平衡可以降低患者28 d病死率,CRRT可以调节容量负荷,改善患者的预后.     

老年急性肾损伤相关因素临床分析及探讨

目的 探讨老年急性肾损伤(AKI)患者的临床特点及血清胱抑素C(cysC)在AKI中的变化,以期提高老年人AKI的诊治水平.方法 回顾性分析76例老年(≥60岁)AKI发生原因及转归,并与同期52例中青年患者(18～59岁)进行比较,同时探讨cysC在AKI中的意义.结果 老年AKI病因:感染占23.7％,低血容量占17.1％,慢性肾脏病(CKD)急性加重占14.5％;肿瘤相关占11.8％,肾后性10.5％.转归:老年组死亡占28.9％,以合并重症感染、多器官功能衰竭、肿瘤、呼吸衰竭者病死率高.cysC在梗阻性肾病及非梗阻性肾病组,肌酐分别为(539.3±344.3) μmol/L vs (373.3±235.8)μmol/L(P＞0.05),而相对应的cysC为(1.6±0.7)mg/L vs(2.7±0.8)mg/L(P＜0.01);16例患者血肌酐开始恢复时间(7.0±2.6)天,cysC恢复时间(5.8±2.9)天.结论 老年AKI发生的病因多样,主要与感染、低血容量、合并CKD、肿瘤、肾后性等因素有关.老年患者病死率高,与重症感染、多器官功能衰竭、肿瘤及呼吸衰竭有关.当cysC与血肌酐值背离时,须排除梗阻性肾病,同时cysC在AKI的恢复期的变化早于血肌酐值.     

不同剂量猪肺表面活性物质对大鼠油酸型急性肺损伤疗效的影响

目的 探讨不同剂量猪肺表面活性物质（PPS）混悬液对油酸致大鼠急性肺损伤（ALI）的治疗作用及量-效关系。方法56只SD大鼠按随机数字表法分为假手术组、油酸模型组和5个不同剂量PPS治疗组。静脉注入油酸诱发大鼠ALI，30min后治疗组和模型组经气管分别滴入50、80、100、150和200mg／kg PPS和等量生理盐水。实验过程中计数大鼠呼吸频率，测定动脉血气。4h后处死，计算大鼠存活率，观察肺组织形态学改变，并检测肺系数、支气管肺泡灌洗液（BALF）中总蛋白含量和血浆肿瘤坏死因子-α（TNF-α）的浓度。结果与模型组比较，PPS50mg／kg组有减慢呼吸频率、短时间内提高动脉血氧分压（PaO2）的作用，但是并不能明显改善肺损伤；PPS80～200mg／kg组除改善呼吸功能外，大鼠肺毛细血管通透性、肺出血、肺水肿、血浆TNF-α浓度以及大鼠死亡率也均明显降低（P均〈0．05）。显示高剂量PPS（150～200mg／kg）在减轻炎症反应和肺损伤方面具有更好的效果。结论单独应用PPS能明显改善早期油酸型ALI大鼠的呼吸功能，≥80mg／kg的PPS有明显减轻肺损伤的作用，而各剂量之间无量-效关系。     

阿托伐他汀治疗对急性心力衰竭患者炎症标志物和急性肾损伤的影响

目的探讨阿托伐他汀治疗对急性心力衰竭(AHF)患者炎症标志物和急性肾损伤(AKI)的影响。方法选择2012年10月至2014年7月在惠州市仲恺高新区人民医院收治并诊断为AHF的患者92例,将其随机分为阿托伐他汀治疗组(46例)和对照组(46例)。治疗组入院后给予阿托伐他汀80 mg/d持续3 d,随后10 mg/d直至出院。对照组未给予他汀类药物治疗。主要终点事件为AKI发生和炎症标志物的改变。次要终点事件为院内和3个月随访期内全因病死率。结果治疗组患者AKI的发生率(13%)低于对照组AKI的发生率(15%),差异未见统计学意义(P=0.213)。两组患者的N端脑钠肽、超敏C-反应蛋白、胱抑素C水平比较差异未见统计学意义。同时,治疗组和对照组两组间的院内病死率(4.3%和3.8%,P0.999)和90 d随访全因病死率比较差异未见统计学意义。结论 AHF患者住院期间服用大剂量阿托伐他汀治疗可能是安全的,但对于降低炎症标志物和AKI是无效的。