Effect of serum uric acid level on renal function in elderly hypertensive patients: a retrospective cohort study

Objective To explore the relationship of serum uric acid level with estimated glomerular filtration rate (eGFR) of elderly patients with hypertention based on a retrospective cohort study. Method The subjects included 465 cases who had a readmission after 3 years of follow-up in an original cohort of 1648 patients with diagnosis of essential hypertension in Fujian Provincial Hospital from August 2007 to September 2009. Multiple regression analysis was performed to examine the effect of serum uric acid level on renal function. Results Four hundred and sixty-five subjects were followed up for an average of 3.9 years. Mean patient age was 68.3±9.7 years. There was no significant difference in uric acid between the baseline and 3 years later (P＞0.05). Multiple regression analysis showed that after adjustment for age, gender, diabetes, body mass index, blood pressure etc, each 100 μmol/L-higher uric acid at baseline was associated with 4.40 ml•min-1•(1.73m2)-1 decrease in eGFR[95% confidence interval (CI): -6.25--2.55, P＜0.01]. According to the alteration of the serum uric acid, all patients were divided into the group with decreased uric acid and the group with increase uric acid. The eGFR was lower in patients with increased uric acid than that in patients with decreased uric acid 3 years later [(70.63±21.54) ml•min-1•(1.73m2)-1 vs (79.62±21.16) ml•min-1•(1.73 m2)-1, P＜0.01] and there was no significant difference at baseline between the two groups (P＞0.05). Multiple logistic regression analysis showed that after adjusting for aging, gender, diabetes, alteration of blood pressure etc, baseline uric acid was associated with a higher risk for eGFR decreasing more than 10 ml•min-1•(1.73m2)-1 3 years later [hazard ratio (HR)=2.11, 95%CI: 1.24-3.59, P＜0.01]; increased uric acid 3 years later resulted in a higher risk for renal function deterioration (HR=2.60, 95%CI: 1.67-4.07, P＜0.01). Conclusions Elderly hypertensive patients with baseline hyperuricemia have a lower eGFR, resulting an increased risk of chronic kidney disease. While the patients with declined uric acid had a lesser imparied renal function. It suggests that the improvement of uric acid may help to slow down the deterioration of renal function in elderly hypertensive patients.     

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.     

The effect of vitamin C intake on the risk of hyperuricemia and serum uric acid level in Korean Multi-Rural Communities Cohort

ObjectiveThe aim of this study was to determine the association between vitamin C intake and risk of hyperuricemia or serum uric acid levels in male and female subjects in the Korean Multi-Rural Communities Prospective Cohort.MethodsThis cross-sectional analysis was conducted in 9400 subjects enrolled in the Korean Multi-Rural Communities Cohort Study. The risk of hyperuricemia was assessed in five quintiles (Q1 to Q5) according to dietary and total vitamin C intake using multivariate-adjusted logistic regression models. Relationships between serum uric acid levels and vitamin C intake were evaluated using linear regression analysis after adjustment for covariates. Information about dietary components was collected using validated food frequency questionnaires.ResultsDietary vitamin C intake, but not total vitamin C intake, was significantly different between hyperuricemic and non-hyperuricemic subjects in males (P = 0.01) and females (P = 0.02). The risk of hyperuricemia decreased with increased dietary vitamin C intake in male and female subjects after multivariate adjustment (P for trend = 0.002 in males and P for trend = 0.02 in females). An effect of total vitamin C intake on hyperuricemia risk was identified in females (P for trend = 0.04), but not males (P for trend = 0.06). Serum uric acid level was linearly associated with total vitamin C intake in females (β = −0.0001, P = 0.01), but not with dietary vitamin C intake in either gender.ConclusionThis study showed that vitamin C intake might be in part responsible for hyperuricemia or serum uric acid level in the Korean Multi-Rural Communities Cohort.     

Effect of the interaction between estimated glomerular filtration rate and serum uric acid on all-cause and cardiovascular mortality in patients on peritoneal dialysis

Objective To explore the effect of the interaction between estimated glomerular filtration rate (eGFR) and serum uric acid (SUA) on all-cause and cardiovascular mortality in patients on peritoneal dialysis (PD). Methods Patients who performed PD catheterization at the PD center of the First Affiliated Hospital of Sun Yat-sen University and had initiated PD therapy for over 3 months from January 2006 to December 2016 were enrolled and followed up until December 2018. Demographic data, baseline clinical and laboratory examination results of the patients were collected. Kaplan-Meier survival curve and Cox regression analysis were used to explore the correlation between SUA and all-cause mortality, cardiovascular mortality in different eGFR groups of PD patients. Results A total of 2 124 PD patients were enrolled with age of (47.0±15.2) years, among whom 1 269 patients were male and 536 patients had diabetes. The SUA level was (429±96) μmol/L and the median level of eGFR was 6.69(5.17, 8.61) ml?min-1?(1.73 m2)-1. After a median follow-up time of 42 months, 554 patients died, among whom 275 patients were cardiovascular death. The Cox regression analysis revealed that there was a significant interaction between eGFR and SUA on all-cause mortality (P=0.043). The Kaplan-Meier curve showed that the tertile 1 (SUA＜384 μmol/L) and tertile 3 (SUA＞460 μmol/L) group had significantly higher all-cause mortality (P=0.009) than the reference group of tertile 2 (SUA 384-460 μmol/L) in the higher eGFR group [eGFR＞6.69 ml?min-1?(1.73 m2)-1]but not in the lower eGFR. After adjusting for relevant demographic data, complications, biochemical results and other variables, in patients with higher eGFR, the risk of all-cause mortality increased by 0.2% (HR=1.002, 95%CI 1.000-1.003, P=0.019) for every 1 μmol/L increase in SUA. In addition, compared with the tertile 2 reference group, the tertile 3 group was independently correlated with higher risk of all-cause mortality (HR=1.670, 95%CI 1.242-2.245, P=0.001). Conclusions The eGFR and SUA level significantly interacts with all-cause mortality, and the higher SUA level in higher eGFR group is an independent risk factor for all-cause mortality in PD patients.     

肾移植术后早期的高尿酸血症与结石形成（附四例报告）

本文报告了４例肾移植患者术后１－３个月出现高尿酸血症并形成了移植肾、输尿管尿酸盐结石，结合复习文献探讨了环孢素Ａ（ＣｓＡ）引起高尿酸血症的可能机制和促成结石形成的因素。通过回顾４例患者成功治疗的体验，讨论了移植肾、输尿管尿酸结石预防及治疗的选择。     

尿酸结石与血脂异常的相关性研究及危险因素分析

目的探讨尿酸结石与血脂异常的相关性,分析尿酸结石的致病危险因素。方法回顾性分析苏州大学附属常熟医院2014年1月至2019年10月收治的尿石症患者的病例资料。93例经结石成分分析确诊为尿酸结石患者为尿酸结石组,男77例(82.8%),女16例(17.2%),中位年龄64岁。按性别、年龄等条件匹配选取同时期的草酸钙结石患者321例为草酸钙结石组,男264例(82.2%),女57例(17.8%),平均年龄61岁。选取我院体检的正常非结石人群306例为对照组,男252例(82.4%),女54例(17.6%),平均年龄61岁。3组的年龄和性别比方面差异无统计学意义(P>0.05)。尿酸结石组、草酸钙结石组、对照组体质指数(BMI)分别为(26.21±2.97)、(24.48±1.87)、(23.75±1.36)kg/m2,差异有统计学意义(P<0.01)。记录3组的血尿酸、尿pH值,以及血脂指标:甘油三酯(TG)、胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C),分析上述指标与结石成分的相关性。将尿酸结石组按照有无高尿酸血症(HUA)分为伴HUA组41例和不伴HUA组52例,并选择对照组内伴HUA的人群共66例(单纯HUA组),比较上述3组的血脂异常情况及尿pH值。采用多因素logistic回归分析尿酸结石形成的独立危险因素。结果尿酸结石组与草酸钙结石组的TG[1.52(1.02,2.78)mmol/L与1.10(0.80,1.76)mmol/L,P=0.001]、高TG血症患病率[31.2%(29/93)与14.0%(45/321),P<0.01]、低HDL-C血症患病率[28.0%(26/93)与40.2%(129/321),P=0.048]、高LDL-C血症患病率[51.6%(48/93)与36.5%(117/321),P=0.031]、血尿酸水平[(422.28±114.15)mmol/L与(335.72±83.32)mmol/L,P<0.01]及尿pH值[5.5(5.0,6.0)与6.0(6.0,6.5),P<0.01]差异有统计学意义。尿酸结石组与对照组的TG[1.52(1.02,2.78)mmol/L与(1.37±0.55)mmol/L,P=0.010]、高TG血症患病率[31.2%(29/93)与4.9%(15/306),P<0.01]、HDL-C水平[1.13(0.96,1.44)mmol/L与(1.42±0.31)mmol/L,P<0.01]、低HDL-C血症患病率[28.0%(26/93)与3.9%(12/306),P<0.01]、血尿酸[(422.28±114.15)mmol/L与(354.33±79.68)mmol/L,P<0.01]及尿pH值[5.5(5.0,6.0)与6.0(5.5,6.0),P<0.01]差异有统计学意义。尿酸结石伴HUA组和不伴HUA组间尿pH值[5.5(5.0,6.0)与6.0(5.5,6.0),P=0.014]差异有统计学意义。尿酸结石伴HUA组与单纯HUA组的高TG血症患病率[31.7%(13/41)与9.1%(6/66),P=0.003]、低HDL-C血症患病率[29.3%(12/41)与13.6%(9/66),P=0.048]差异有统计学意义。多因素logistic回归分析结果显示,肥胖(OR=1.68,P<0.01)、高TG血症(OR=7.37,P=0.002)、低HDL-C血症(OR=10.46,P=0.001)及低尿pH值(OR=0.10,P<0.01)为尿酸结石致病的独立危险因素。结论尿酸结石患者多有血脂代谢异常,肥胖、高TG血症、低HDL-C血症及低尿pH值与尿酸结石的发生密切相关。     

动态监测血清胱抑素 C 评价肾移植术后肾功能的改变

目的 监测肾移植受者血清胱抑素C(Cys C)浓度以评估移植肾功能的改变. 方法 监测58例肾移植成功受者术前及术后不同时间的血清Cys C、肌酐(SCr)、β2-微球蛋白(β2-MG)和尿素氮(BUN)水平;并于术后第7天使用99mTc-DTPA测定受者肾小球虑过滤(GFR),比较其与上述四项指标的相关性.以GFR=1.5 ml/s为临界值,绘制ROC曲线,比较各项检测指标鉴别轻度与中重度肾功能损伤的诊断性能.计算受者不同时间段血清Cys C及SCr变异系数及其比值(R值). 结果 Cys C于术后第1天下降达48.1%,明显大于其他指标的下降幅度.血清Cys C、SCr、β2-MG和BUN与GFR相关系数依次为0.876、0.691、0.589和0.516.血清Cys C、SCr、β2-MG和BUN的诊断性能:敏感性分别为91.3%、87.2%、82.6%和87.0%;特异性分别为80.0%、69.2%、71.4%和42.9%;阳性预期值分别为82.0%、73.7%、74.3%和60.4%;阳性似然比分别为4.81、2.83、2.87和1.53;ROC曲线下面积(AUC)分别为0.914、0.828、0.803和0.765.SCr的变异系数显著小于Cys C(P＜0.01),Cys C＜2 mg/L的受者R值大多＜1,Cys C＞2 mg/L的受者,伴随Cys C水平升高,R值趋近于1. 结论 Cys C与GFR相关性最好;Cys C的诊断性能及准确性均优于其他指标,即使肾功能有微小损伤,Cys C也会有显著改变.因此,肾移植术后动态监测Cys C对于及时判断移植肾存活及肾微小损伤时肾功能的改变优于其他指标.     

Active surveillance is superior to radical nephrectomy and equivalent to partial nephrectomy for preserving renal function in patients with small renal masses: Results from the DISSRM registry

Purpose

We compared renal function outcomes among patients in the surveillance and intervention arms of the DISSRM registry.

人尿酸转运蛋白在肾小管上皮细胞的定位表达研究

目的 明确人尿酸转运蛋白(hUAT)在人肾小管上皮细胞(HKC)内的定位表达情况&#65377; 方法 利用DNA重组技术构建hUAT&#65377;绿色荧光蛋白的融合基因分别导入人HKC及非洲爪蟾卵细胞&#65377;构建hUAT的谷胱甘肽转移酶(GST)融合表达载体并制备抗hUAT的多克隆抗体&#65377;利用免疫荧光&#65380;Western印迹及激光共聚焦显微镜等技术观察hUAT在人HKC的定位表达&#65377;结果 成功制备了兔抗hUAT-GST多克隆抗体&#65377;利用该抗体及构建的pEGFP-hUAT荧光表达载体进行Western印迹和免疫荧光检测,结果表明hUAT是一种膜蛋白,并且表达于人HKC胞膜上,Northern blot结果也表明人HKC在高尿酸环境中的hUAT表达水平明显上调(P < 0.05)&#65377;结论 hUAT并非典型的膜转运蛋白,可能是以二聚体的形式才能够表达在细胞膜上,它在细胞内的定位表达可能需要特殊的转录调控机制&#65377;     

Creatinine clearance estimation from serum creatinine values: an analysis of three mathematical models of glomerular function

The logarithmic relationship of serum creatinine and creatinine clearance was analyzed in 100 adult patient studies using a geometric regression technique. Each sex was independently analyzed, and the subsequently derived regression formulae were age corrected resulting in mathematical models useful in estimating creatinine clearance from serum creatinine concentrations. These formulae were tested prospectively in another group of 100 patient studies in which creatinine clearance had been determined, and the results compared to values derived by use of two other published formulae. This newer method resulted in a closer distribution of data around a line of identity compared to other formulae and allowed for a good "bedside" estimation of creatinine clearance from serum creatinine concentration.     

不同方法对肾功能评估的价值

目的探讨临床上常用的几种肾功能评估方法的相对准确性,寻求更为简便、快捷的肾功能评估方法。方法选择慢性肾脏病（CKD）患者80例,分别用^99mTc-DTPA肾动态显像法测定肾小球滤过率（GFR）,同时检测患者血肌酐（SCr）、血清胱抑素C（CysC）浓度,根据SCr分别用Cock-croft-Gault（C-G）方程和简化MDRD方程估算肾小球滤过率（分别为eGFR1、eGFR2）。按GFR值将患者分为4组,即A组：CKD1期;B组：CKD2期;C组：CKD3期;D组：CKD4期;排除CKD5期的患者。观察所有和各组患者eGFR1、eGFR2、SCr、CysC与GFR的相关性。结果总样本中,eGFR1、eGFR2与GFR呈正相关,SCr、CysC与GFR呈负相关（P〈0．01）。在各组中,A组：eGFR1、eGFR2、SCr与GFR之间均无明显相关性（P〉0．05）;而B、C、D组中eGFR1、eGFR2与GFR呈正相关（P〈0．01）,SCr与GFR呈负相关（P〈0．05）;CysC在A、B、C、D各组中均与GFR呈负相关（P〈0．01）。结论CKD2、3、4期患者eGFR1、eGFR2、SCr与GFR均有一定的相关性,但不论何期CKD患者,CysC均能准确反映其肾功能状况,且更加简便、快捷。     

肾功能不全患者行冠状动脉旁路移植术的长期随访结果

目的 分析估测肾小球滤过率(eGFR)<60 ml/(min·1.73 m~2)的患者冠状动脉旁路移植术后的长期随访结果.方法 回顾性分析1999年1月至2003年9月3371例冠状动脉旁路移植术患者的临床资料,用 Cockcroft-Gault公式计算eGFR,根据eGFR将患者分为肾功能不全组[eGFR<60 ml/(min·1.73 m~2),n=649]肾功能正常组[eGFR>=60 ml/(min·1.73 m~2),n=2722],比较两组患者的近远期随访结果.结果 肾功能不全组的住院病死率和随访4年病死率分别为2.77%和6.81%,明显高于肾功能正常组.肾功能不全组的其他围手术期并发症及远期不良事件发生率也明 显高于肾功能正常组.多因素 COX 回归分析结果显示,eGFR<60 ml/(rain·1.73 m~2)是冠状动脉旁 路移植术后远期死亡的独立危险因素(HR=1.948,95% CI:1.357-2.797,P<0.01).结论 eGFR <60 ml/(min·1.73 m~2)是冠状动脉旁路移植术的独立危险因素.     

Influence of serum albumin on renal function in nephrotic syndrome

 Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF), determined by the clearances of inulin and para-aminohippuric acid, were evaluated in 119 children with different types of nephrotic syndrome and in different stages: the nephrotic stage (serum albumin <25 g/l), recovery stage (25–35 g/l), and remission (>35 g/l). GFR in the nephrotic stage was significantly lower than in remission and in controls, and was lowest at onset of the disease (84±6, 111±4, and 119±2 ml/min per 1.73 m²). ERPF was higher in the nephrotic stage than in recovery, especially in children with histological lesions. Thus the filtration fraction (FF) was greatly decreased in the nephrotic stage. In patients investigated both in the nephrotic and the remission phase, GFR and FF increased significantly. There was a direct correlation between the serum albumin concentration and FF and an inverse correlation between mean arterial pressure (MAP) and GFR and FF in all patients, a direct correlation between the serum albumin concentration and GFR in minimal change nephrotic syndrome patients, and an inverse correlation between ERPF and serum albumin in children with histological lesions. In conclusion, GFR and FF were decreased and ERPF increased in the nephrotic stage, normalizing in remission. The low GFR in the nephrotic stage was thus not dependent on hypoperfusion. We suggest that the low GFR is dependent on a very low ultrafiltration coefficient. The direct correlation between GFR and serum albumin and the indirect correlation between GFR and MAP suggest compensatory mechanisms that increase the ultrafiltration pressure to counteract the severely reduced ultrafiltration coefficient. Received: 19 November 1997 / Revised: 11 April 1998 / Accepted: 14 April 1998     

尿酸联合脂蛋白a预测动脉粥样硬化高危人群肾动脉狭窄

目的 研究动脉粥样硬化高危人群中尿酸和脂蛋白a[Lp(a)]预测动脉粥样硬化性肾动脉狭窄( ARAS)的价值.方法 回顾性分析2008年10月至2011年4月在北京协和医院怀疑为ARAS,并接受肾动脉造影的190例患者的临床资料,其中89例诊为ARAS;部分患者同时接受了冠脉造影.对照组为年龄、性别匹配的180例同期本院常规体检人群.收集一般临床资料、血尿酸(UA)、Lp(a)、胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL)、低密度脂蛋白( LDL)、Scr和C反应蛋白(CRP)等.分析ARAS患者的临床特点和相关危险因素,并利用二元Logistic回归分析尝试建立在高危人群中预测ARAS的临床决策工具.结果 ARAS患者的Scr、UA、Lp(a)和CRP水平显著地高于健康体检人群.高度怀疑ARAS或同时伴有冠状动脉病变而行肾动脉造影患者中,确诊ARAS组与非ARAS组生化指标、血脂、UA和肾功能差异均无统计学意义.二元Logistic回归分析显示,UA＞344μmol/L是ARAS发病的独立相关因素;且当UA＞344 μmol/L和Lp(a )＞242 mg/L时,预测ARAS的特异性达96％,阳性似然比为5.45,P=0.001,OR值为6.78,95％CI( 1.90～24.2),P=0.001.结论 ARAS的高危人群中,UA升高是ARAS的独立危险因素;UA联合Lp(a)对于预测ARAS有一定的临床意义.     

Early stage elevated platelet count is an independent risk factor for the poor prognosis of peritoneal dialysis-associated peritonitis

Objective To determine whether the early stage platelet count can predict the outcome of peritoneal dialysis-associated peritonitis (PDAP). Methods A retrospective cohort study was conducted by selecting PDAP patients who were hospitalized in the First People's Hospital of Foshan from January 2012 to January 2019. According to the final treatment outcome, the patients were divided into cured group and withdrawn group. The withdrawn group included patients who transferred to hemodialysis or died. Basic data on demography, blood routine examination, peritoneal fluid, biochemical indicators were compared between the two groups. Logistic regression analysis was used to analyze the withdrawn risk factors of PDAP. Results There were 180 patients included in the study, including 112 cases in the cured group and 68 cases in the withdrawn group. Compared with the cured group, there were older age [(53.38±14.17) years old vs (48.41±13.04) years old, t=2.407, P=0.017] , longer age of dialysis [(49.20±26.05) months vs (30.36±32.97) months, t=4.034, P＜0.001], longer hospital stay [(23.88±11.50) d vs (17.80±3.95) d, t=5.133, P＜0.001] and higher platelet count [(285.55±107.23)×109/L vs (234.90±74.03)×109/L, t=3.450, P=0.001], lower serum albumin [(31.72±7.47) g/L vs (35.40±4.93) g/L, t=-3.972, P＜0.001] in the withdrawn group. Multivariate logistic regression analysis showed that longer dialysis age (OR=1.012, 95%CI 1.007-1.024, P=0.015) and higher platelet count (OR=1.013, 95%CI 1.004-1.026, P=0.008) were independent risk factors, and higher serum albumin (OR=0.941, 95%CI 0.896-0.988, P=0.005) was an independent protective factor of withdrawal from peritoneal dialysis in PDAP patients. Conclusions The long dialysis age, early high platelet count are independent risk factors and high serum albumin level is an independent protective factor for withdrawal from peritoneal dialysis in PDAP patients.     

尿酸性肾病的中西医结合治疗进展

随着经济和社会的发展及人民生活水平的提高,我国高尿酸血症(HUA)的患病率逐年升高。HUA可造成多脏器损害。尿酸性肾病是尿酸结晶沉积于肾脏而引起的病变。目前,中西医结合治疗已应用于尿酸性肾病。西医通过抑制尿酸合成,促进尿酸排泄,抑制炎症等途径缓解高尿酸血症。尿酸酶类药物是近年来降低尿酸的一类新药,包括重组黄曲霉菌尿酸氧化酶,聚乙二醇化重组尿酸氧化酶。中药单剂鸡矢藤提取物、金刚藤提取物、槲皮素和芦丁提取物在减轻高尿酸血症、保护肾脏方面有积极作用;中药复方中的二妙丸、四妙汤以及四物汤联合二妙散可抑制高尿酸血症,改善肾功能。因此,尿酸性肾病应重视中西医结合治疗。     

活体肾移植供肾肾小球滤过率对受体早期肾功能的影响

目的 探讨活体肾移植供肾肾小球滤过率( GFR)对受体早期肾功能的影响.方法 2006年至2011年在本中心接受活体肾移植172例为研究对象,其中亲属供肾166例(96.5％),夫妻供肾5例(2.9％),帮扶供肾1例(0.6％).术前应用放射性核素99mTC-DTPA肾动态显像测定供体左右肾GFR.供体的双肾GFR为62～148 ml/min,将对象分为供肾GFR≤45ml/min受体76例和供肾GFR＞45 ml/min 96例.两组受体的透析情况、冷、热缺血时间、抗体诱导及免疫抑制方案、HLA错配率等基本资料相似.评价患者术后早期肾功能变化情况.结果 两组患者术后急性排斥反应以及肾功能延迟恢复( DGF)发生率差异无统计学意义.与供肾GFR≤45 ml/min组比较,供肾GFR＞45 ml/min组的Scr在术后1周、1个月、3个月、1年均较低,其中术后1周的差异有统计学意义(P＜0.05);术后1个月、3个月、1年的差异均无统计学意义.重复测量的方差分析显示术后1年内两组受体Scr变化差异无统计学意义.结论 活体肾移植供肾GFR高低对受体术后1周Scr下降水平有影响,供肾GFR高者受体术后1周Scr水平低,但是对受体术后早期(1年内)的Scr整体水平及变化趋势无显著影响.     

Hyperfibrinogenemia is an independent risk factor for atherosclerotic renal artery stenosis

It is important to identify patients at risk for atherosclerotic renal artery stenosis because renal artery stenosis is a progressive disease and a potentially correctable problem. To determine the risk factors for atherosclerotic renal artery stenosis, we performed renal arteriography at the time of cardiac catheterization in 270 patients (M:F, 193:77, mean age: 59 years) with clinical ischemic heart disease. Before the procedure, demographic data, medical history, physical findings and laboratory data were obtained. The degree of coronary artery stenosis and renal artery stenosis was quantified with automatic edge detection technique. Significant renal artery stenosis, defined as a narrowing of the diameter by more than 50%, was identified in 28 (10%) patients. Three patients (1%) had bilateral disease. Significant coronary artery disease, defined as a narrowing of the diameter by more than 50%, was present in 231 patients (85%). By univariate logistic regression analysis, older age (68 +/- 8 vs. 58 +/- 10 years), the presence of hypertension (61% vs. 38%), the extent of coronary artery disease, a high fibrinogen level (391 +/- 93 mg/dl vs. 335 +/- 109 mg/dl), a low albumin level (3.9 +/- 0.4 g/dl vs. 4.1 +/- 0.4 g/dl), and a low hemoglobin level (12.5 +/- 1.6 g/dl vs. 13.5 +/- 1.6 g/dl) were associated with the presence of renal artery stenosis (p < 0.05). Serum lipids, lipoprotein(a), creatinine, sex, smoking, or diabetes were not associated. By multivariate logistic regression analysis, older age (OR: 2.43 analyzed by 10 years increment, p = 0.0001), the presence of hypertension (OR: 2.68, p = 0.039) and a higher fibrinogen level (OR: 1.63 analyzed by 100 mg/dl increment, p = 0. 038) were significant risk factors of renal artery stenosis. Fibrinogen level was negatively correlated with albumin level (r = -0.18, p = 0.004). These results suggest that hyperfibrinogenemia as well as old age and hypertension are independent risk factors for atherosclerotic renal artery stenosis. Copyright Copyright 1999 S. Karger AG, Basel     

Elevated plasma aldosterone is an independent risk factor for erectile dysfunction in men

Introduction

Erectile dysfunction (ED) and cardiovascular disease (CVD) share a great number of common risk factors. There is growing evidence that aldosterone, an independent CVD risk factor, is associated with ED.

Aims

The purpose of this study was to determine the relationship between plasma aldosterone and erectile dysfunction.

Methods

This study recruited 287 participants, ranging from 18 to 84 years old; 217 were suffering from ED, diagnosed by the International Index of Erectile Function 5 (IIEF-5) scores. Based on IIEF-5 scores, patients were divided into one control group and three ED groups (mild ED; moderate ED; severe ED).

Main outcome measures

The differences in principal characteristics, blood routine, sexual hormone, adrenal hormone, thyroid hormone, renal function, liver function and blood lipid were compared between ED and control groups.

Results

Our study demonstrated that the difference of mean plasma aldosterone levels between ED group and the control group was statistically significant (P < 0.05). Stepwise logistic regression analysis of all the possible factors support the role of aldosterone as an independent risk factor for ED (OR 1.011; 95 % CI 1.003–1.018; P = 0.004). Similar statistical methods were applied to the comparison between moderate to severe ED group and control to mild ED group (OR 1.017; 95 % CI 1.009–1.024; P < 0.001). ROC curve and the area under the curve (0.718; 95 % CI 0.643–0.794; P < 0.001) were performed to assess the diagnostic effect and to compare the severity of risk with the known independent risk factors, such as age and cholesterol (0.704; 95 % CI 0.631–0.778; P < 0.001). When using a 374 pg/mL cut-off value from Youden index, the OR of ED group versus controls is 3.106 (95 % CI 1.458–6.617), while the OR of moderate to severe ED versus control and mild ED is 5.480 (95 % CI 3.108–9.662).

Conclusions

We determined that elevated plasma aldosterone concentration is an independent risk factor for ED. Our findings also indicate that the aldosterone, a well-recognized contributor to vascular injury, might be a potential bond between ED and CVD.