Nephroprotective activity of Solanum xanthocarpum fruit extract against gentamicin-induced nephrotoxicity and renal dysfunction in experimental rodents

ObjectiveTo evaluate nephroprotective potential of Solanum xanthocarpum (S. xanthocarpum) fruit extract(SXE) against gentamicin (GM) induced nephrotoxicity and renal dysfunction.MethodsTwenty-four Wistar rats were divided into four groups (n=6). Control rats that received normal saline (i.p.) and 0.5% carboxymethyl cellulose (p.o.) per day for 8 d. Nephrotoxicity was induced in rats by intraperitoneal administration of GM (100 mg/kg/d for 8 d) and were treated with SXE (200 and 400 mg/kg/d (p.o.) for 8 d). Plasma and urine urea and creatinine, kidney weight, urine output, blood urea nitrogen, renal enzymatic and non-enzymatic antioxidants and lipid peroxidation was evaluated along with histopathological investigation in various experimental groupsof rats.ResultsIt was observed that the GM treatment induced significant elevation (P<0.001) in plasma and urine urea, creatinine, kidney weight, blood urea nitrogen, renal lipid peroxidation along with significant decrement (P<0.001) in urine output, renal enzymatic and non-enzymatic antioxidants. SXE 200 and 400 mg/kg treatment to GM treated rats recorded significant decrement (up to P<0.001) in plasma and urine urea and creatinine, renal lipid peroxidation along with significant increment (up to P<0.001) in renal enzymatic and non-enzymatic antioxidants. Histological observations of kidney tissues too correlated with the biochemical observations.ConclusionsThese finding powerfully supports that S. xanthocarpum fruit extract acts in the kidney as a potent scavenger of free radicals to prevent the toxic effects of GM both in the biochemical and histopathological parameters and thus validates its ethnomedicinal use.     

Expression and effect of TLR4 in rats with diabetic nephropathy

ObjectiveTo observe the expression of TLR4 in kidney tissue of rats with diabetic nephropathy and discuss the role of TLR4 in the occurrence and development of the diabetic nephropathy.MethodsA total of 60 clean male SD rats were selected and randomly divided into the modeling group and control group after 1 week of breeding, including 30 rats in each group. Biochemical indices as well as the protein expression of TLR4 were observed and compared between two groups at 2 w, 4 w, 6 w, 8 w and 12 w after the modeling, and the correlation between TLR4 and each biochemical indexes was analyzed.ResultsRats in the modeling group had higher levels of blood glucose, 24-hour urine protein and blood urea nitrogen after the modeling, and showed the increase in the serum creatinine, kidney/body weight ratio, CRP and serum TNF-α at 4w after the modeling, with the significant difference compared to results of the control group (P<0.05). The cross-section area and mean volume of glomerulus in the modeling group at 4 w, 6 w, 8 w and 12 w were significantly higher than those in the control group, with the statistically significant difference (P<0.05). The expression of TLR4 at each time point in the control group was relatively low. Rats in the modeling group had the high expression of TLR4 in kidney's glomerular basement membrane, proximal convoluted tubule and renal interstitial area since 2 w, with the significant difference compared to the control group (P<0.05). The expression in rats of the modeling group was higher than the one of the control group since the 2nd week. As the time flied, its expression increased, with the statistically significant difference between two groups (P<0.05). There was certain correlation between the protein expression of TLR4 and the increased serum titer of 24-hour urine protein excretion, serum creatinine, CRP and TNF-α.ConclusionsTLR4 may activate the immuno-inflammatory reactions to play a role in the occurrence and development of the diabetic nephropathy.     

即刻早期反应基因c－fos在老年大鼠缺血再灌注肾组织中表达的变化

目的了解老年期缺血肾分子调控水平的变化。方法应用Ｎｏｒｔｈｅｒｎｂｌｏｔ和Ｓｌｏｔｂｌｏｔ分子生物学杂交技术，在老年大鼠急性缺血再灌注１、４、８小时肾组织中，研究了即刻早期反应基因之一ｃ－ｆｏｓ的表达，并与青年鼠作了比较。结果老年及青年鼠肾组织中ｃ－ｆｏｓ信使核糖核酸（ｍＲＮＡ）表达高峰均在缺血再灌注１小时，但两者的增高幅度有明显差别，老年鼠增高仅１０．２倍，青年鼠增高近２０倍，再灌注４和８小时青年、老年鼠ｃ－ｆｏｓｍＲＮＡ表达均接近正常。结论　在分子调控水平反应了老年期缺血肾修复潜能的低下，这可能是老年人缺血性急性肾功能不全恢复不良的部分原因。     

Investigation of dose-dependent effects of berberine against renal ischemia/reperfusion injury in experimental diabetic rats

BackgroundIschemia–reperfusion injury causes various severe morphological and functional changes in diabetic patients. To date, numerous antidiabetic and antioxidant agents have been used for treatment of the disease-related changes.ObjectivesWe aimed to examine effective therapeutic doses or doses of berberine against renal ischemia/reperfusion injury (IRI) in a streptozotocin (STZ)-induced diabetic rat model by histopathological and biochemical analysis.MethodsThirty male Sprague Dawley rats were treated with STZ injection for the development of diabetes, and divided into the following groups: STZ-induced diabetic group (STZ); IRI-induced diabetic group (STZ + IRI); 50 mg/kg berberine (BRB) treated diabetic group after inducing IRI (STZ + IRI + BRB₁); 100 mg/kg BRB treated diabetic group after IRI (STZ + IRI + BRB₂); 150 mg/kg BRB treated diabetic group after IRI (STZ + IRI + BRB₃). Bilateral renal ischemia model was applied for 45 min, then reperfusion was allowed for 14 days in STZ-induced diabetic rats. Renal injury was detected histopathologically. Blood urea nitrogen (BUN), creatinine and lactate dehydrogenase (LDH) levels were measured in serum using the ELISA method. Total antioxidant status (TAS) and total oxidant status (TOS) of renal tissue was studied by spectrophotometric assay. Oxidative stress index (OSI) was calculated as TOS-to-TAS ratio. Tumor necrosis factor alpha (TNF-α), C-reactive protein (CRP), Na⁺/K⁺-ATPase (sodium pump), and Ca²⁺-ATPase (calcium ATPase) enzyme levels were measured in tissues using the ELISA method. Anti-apoptotic Bax and pro-apoptotic Bcl-2 protein levels were detected by Western blot analysis. All data were evaluated statistically.ResultsThe highest histopathological score was detected in the STZ + IRI group compared to the other group. BRB administration at the doses of 100 mg/kg and 150 mg/kg markedly improved renal injury. BUN and creatinine levels significantly increased in the STZ + IRI group compared to the STZ group (p < 0.001). 100 mg/kg and 150 mg/kg BRB administration significantly decreased those levels (p < 0.01). The highest TOS and the lowest TAS levels were detected in the STZ + IRI group (p < 0.001). IRI markedly aggravated inflammation via increasing levels of TNF-α and CRP (<0.001), and caused apoptosis via inducing Bcl-2 protein, and suppressing Bax protein (p < 0.001). BRB administration at the doses of 100 mg/kg and 150 mg/kg showed anti-oxidant, anti-inflammatory and anti-apoptotic effects (p < 0.01). The LDH enzyme, was used as a necrosis marker, was higher in the STZ + IRI group than other groups. BRB administration at all of the doses, resulted in the decline of LDH enzyme level (p < 0.001). Ca²⁺-ATPase and Na⁺/K⁺-ATPase enzyme activities decreased in the STZ + IRI group compared to the STZ group (p < 0.001), while BRB administration at the doses of 100 mg/kg and 150 mg/kg significantly increased those of enzyme activities, respectively (p < 0.05).ConclusionIschemia with diabetes caused severe histopathological and biochemical damage in renal tissue. The high doses of berberine markedly improved histopathological findings, regulated kidney function via decreasing BUN and creatinine levels, and rearranged intercellular ion concentration via increasing Na⁺/K⁺-ATPase and Ca^2+? ATPase levels. Berberine showed anti-oxidant, anti-apoptotic, and anti-inflammatory effects. According to these data, we suggest that berberine at the doses of 100 and 150 mg may be used as a potential therapeutic agent to prevent renal ischemic injury.     

洛沙坦对大鼠糖尿病模型肾脏转化生长因子βⅠ型、Ⅱ型受体表达的影响

目的　观察洛沙坦对大鼠糖尿病模型肾脏转化生长因子 βⅠ型受体 (TGFβRⅠ )、Ⅱ型受体 (TGFβRⅡ )表达的影响。 方法　 30只大鼠按体重随机分为 3组 ,每组 10只。A组 :健康对照组 ;B组 :糖尿病模型组 ,尾静脉注射链脲佐菌素 5 0mg/kg体重制成糖尿病模型 ;(3)C组 :洛沙坦治疗组 ,按B组方法建立大鼠糖尿病模型后第 2天给予洛沙坦 10mg·kg体重 -1·d-1灌胃。 8周后半定量逆转录 聚合酶链反应检测 3组肾皮质TGFβRⅠ、TGFβRⅡ和纤维连接蛋白 (FN)mRNA的表达。免疫组化测 3组肾皮质TGFβRⅠ、TGFβRⅡ和FN蛋白的表达。生化法测血糖、尿素氮和肌酐水平。放射免疫法测血胰岛素和血管紧张素Ⅱ。磺基水杨酸法测 2 4h尿蛋白。结果　B组大鼠平均肾小球体积、肾重 /体重增加 ,2 4h尿蛋白、血尿素氮和肌酐水平上升 (P <0 0 5 ) ;肾皮质TGFβRⅠ、TGFβRⅡ、FNmRNA和蛋白表达显著增加 (P <0 0 5 )。C组大鼠平均肾小球体积、肾重 /体重减少 ,2 4h尿蛋白、血尿素氮和肌酐水平下降 (P <0 0 5 ) ;肾皮质TGFβRⅠ、TGFβRⅡ、FNmRNA和蛋白表达显著降低 (P <0 0 5 )。 结论　洛沙坦下调大鼠糖尿病模型肾脏TGFβRⅠ、TGFβRⅡ的表达 ,抑制肾脏细胞肥大 ,减少细胞外基质成分的合成。     

Proximal tubule overexpression of a locally acting IGF isoform, Igf-1Ea, increases inflammation after ischemic injury

ObjectiveIGF-1 is an important regulator of postnatal growth in mammals. In mice, a non-circulating, locally acting isoform of IGF-1, IGF-1Ea, has been documented as a central regulator of muscle regeneration and has been shown to improve repair in the heart and skin. In this study, we examine whether local production of IGF1-Ea protein improves tubular repair after renal ischemia reperfusion injury.DesignTransgenic mice in which the proximal-tubule specific promoter Sglt2 was driving the expression of an Igf-1Ea transgene. These animals were treated with an ischemic-reperfusion injury and the response at 24 h and 5 days compared with wildtype littermates.ResultsTransgenic mice demonstrated rapid and enhanced renal injury in comparison to wild type mice. Five days after injury the wild type and low expressing Igf-1Ea transgenic mice showed significant tubular recovery, while high expressing Igf-1Ea transgenic mice displayed significant tubular damage. This marked injury was accompanied by a two-fold increase in the number of F4/80 positive macrophages and a three-fold increase in the number of Gr1-positive neutrophils in the kidney. At the molecular level, Igf-1Ea expression resulted in significant up-regulation of proinflammatory cytokines such as TNF-α and Ccl2. Expression of Nfatc1 was also delayed, suggesting reduced tubular proliferation after kidney injury.ConclusionsThese data indicate that, unlike the muscle, heart and skin, elevated levels of IGF-1Ea in the proximal tubules exacerbates ischemia reperfusion injury resulting in increased recruitment of macrophages and neutrophils and delays repair in a renal setting.     

Evaluation of serum and urine fetuin-A levels in children with acute lymphoblastic leukemia during and after high-dose methotrexate therapy: Relation to toxicity

Background/objectives: Fetuin-A is a multifunctional protein with its urine level was considered as a marker of acute kidney injury. We investigated the serum and urine fetuin-A in acute lymphoblastic leukemia (ALL) children during and after high-dose methotrexate (HDMTX).

Methods: Twenty-two ALL children and 20 matched healthy controls were included. Liver transaminases, serum creatinine, estimated glomular filtration rate (eGFR), creatinine clearance (CrCl), serum β2 microglobulin (B2M), and serum and urine fetuin-A levels were assayed pre and 4 months after the consolidation. Among a subgroup of 15 patients, the investigations were performed 42 hours after the start of the second and the fourth HDMTX infusions.

Results: HDMTX was well tolerated. During HDMTX, there was significant decline in serum fetuin-A together with significant rise of urine fetuin-A and B2M levels compared to the control and to the pre-consolidation levels, changes that persisted 4 months after the consolidation despite recovery of the significantly altered renal functions. The second HDMTX-related serum fetuin-A level directly correlated with eGFR and CrCl (r?=?0.86, P?<?0.0001 and r?=?0.67, P?=?0.016, respectively). Four months after consolidation, urine fetuin-A directly correlated with serum creatinine (r?=?0.54, P?=?0.004) and inversely correlated with the eGFR (r?=??0.66, P?<?0.0001).

Conclusion: Significant disturbance in serum and urinary fetuin-A levels, which was related to renal functions, had occurred during HDMTX and persisted for at least 4 months after the consolidation. Serum and urine fetuin-A could be sensitive markers for subtle renal dysfunction in ALL children.     

A Randomized Trial of Recombinant Human C1-Esterase-Inhibitor in the Prevention of Contrast-Induced Kidney Injury

ObjectivesThis study sought to determine the efficacy profile and safety of recombinant human C1 esterase inhibitor (rhC1INH) in the prevention of contrast-associated acute kidney injury after elective coronary angiography.BackgroundContrast-associated acute kidney injury is caused by tubular cytotoxicity and ischemia/reperfusion injury. rhC1INH is effective in reducing renal ischemia/reperfusion injury in experimental models.MethodsIn this placebo-controlled, double-blind, single-center trial 77 patients with chronic kidney disease were randomized to receive 50 IU/kg rhC1INH before and 4 h after elective coronary angiography or placebo. The primary outcome was the peak change of urinary neutrophil gelatinase-associated lipocalin within 48 h, a surrogate marker of kidney injury.ResultsMedian peak change of urinary neutrophil gelatinase-associated lipocalin was lower in the rhC1INH group (4.7 ng/ml vs. 22.5 ng/ml; p = 0.038) in the per-protocol population but not in the modified intention-to-treat analysis, and in patients with percutaneous coronary interventions (median, 1.8 ng/ml vs. 26.2 ng/ml; p = 0.039 corresponding to a median proportion peak change of 11% vs. 205%; p = 0.002). The incidence of a cystatin C increase ≥10% within 24 h was lower in the rhC1INH group (16% vs. 33%; p = 0.045), whereas the frequency of contrast-associated acute kidney injury was comparable. Adverse events during a 3-month follow-up were similarly distributed.ConclusionsAdministration of rhC1INH before coronary angiography may attenuate renal injury as reflected by urinary neutrophil gelatinase-associated lipocalin and cystatin C. The safety profile of rhC1INH was favorable in a patient population with multiple comorbidities. (Recombinant Human C1 Esterase Inhibitor in the Prevention of Contrast-induced Nephropathy in High-risk Subjects [PROTECT]; NCT02869347)     

厄贝沙坦对糖尿病大鼠肾脏GluT-1及TGF-β1表达的影响及其临床意义

目的观察厄贝沙坦（IBST）对糖尿病大鼠肾脏皮质葡萄糖转运蛋白-1（GluT-1）及转化生长因子-β1（TGF-β1）表达的影响,并探讨其作用机制。方法48只大鼠随机分为对照（Con）组、糖尿病（DM）组与IBST治疗组,建立糖尿病肾病（DN）模型,分别检测肾皮质GluT-1 mRNA及TGF-β1 mRNA表达水平。结果与Con组相比,DM组大鼠肾组织GluT-1 mRNA表达及TGF-β1 mRNA表达均显著上调（P〈O．01）。厄贝沙坦干预后,IBST组肾组织GluT-1及TGF-β1 mRNA表达显著低于DM组（P〈0.01）。结论厄贝沙坦对DN有保护作用,这可能与厄贝沙坦显著降低肾组织GluT-1及TGF-β1 mRNA表达有关。     

辣椒素减轻肾缺血再灌注损伤的线粒体相关机制

目的探讨辣椒素对大鼠肾缺血再灌注损伤的保护作用及线粒体相关作用机制。方法将50只雄性SD大鼠分成假手术组、肾缺血再灌注损伤组和辣椒素低、中、高剂量组。采用夹闭双侧肾蒂构建肾缺血再灌注损伤模型。肾缺血45 min,再灌注24 h,过量麻醉法处死大鼠,收集肾脏和血清。检测血清肌酐(SCr)、血尿素氮(BUN)、肾脏组织病理形态和细胞凋亡,测定线粒体三磷酸腺苷(ATP)和丙二醛(MDA)含量以及Ca~(2+)-ATP酶、Na~+-K~+-ATP酶、过氧化氢酶(CAT)、谷胱甘肽过氧化物酶(GPx)和超氧化物歧化酶(SOD)活性。结果辣椒素干预可减少SCr和BUN含量,降低肾组织病理改变和细胞凋亡,增加线粒体Ca~(2+)-ATP酶、Na~+-K~+-ATP酶、CAT、GPx和SOD酶活性以及ATP的含量,但减少MDA的水平。结论辣椒素对肾缺血再灌注损伤有保护作用,其作用呈浓度效应,机制与抑制线粒体脂质过氧化相关。     

One-week losartan administration increases sodium excretion in cirrhotic patients with and without ascites

Background. Losartan, a highly selective angiotensin II type 1 receptor antagonist, has been reported to have a significant portal hypotensive effect in cirrhotic patients. A recent study also showed that losartan exerted a dramatic natriuretic effect in preascitic cirrhosis. The influence of losartan on renal hemodynamics and sodium homeostasis in cirrhotic patients with ascites is unclear. This study was undertaken to evaluate the renal effects of 1-week losartan treatment in cirrhotic patients with and without ascites. Methods. All 12 patients in the study received a daily oral dose of 25 mg losartan for 7 consecutive days. Effective renal plasma flow, urine volume, creatinine clearance, 24h urine sodium excretion and fractional excretion of sodium, blood urea nitrogen, and serum creatinine were measured before and after treatment. Results. In cirrhotic patients without ascites, creatinine clearance, 24-h urinary sodium excretion, and fractional excretion of sodium were significantly increased after losartan administration. Effective renal plasma flow and serum creatinine showed almost no change after treatment. In cirrhotic patients with ascites, creatinine clearance, 24-h urinary sodium excretion, fractional excretion of sodium, and effective renal plasma flow were significantly increased after losartan administration. In addition, the magnitudes of the increases in the fractional excretion of sodium and in the 24-h urinary sodium excretion were greater in cirrhotic patients with ascites than in those without ascites. Conclusions. One-week treatment with losartan increases sodium excretion in association with an improvement of renal function in cirrhotic patients with and without ascites. The natriuretic effect was more profound in cirrhotic patients with ascites than in those without ascites. Received: May 1, 2001 / Accepted: August 24, 2001     

Intravascular Ultrasound Guidance to Minimize the Use of Iodine Contrast in Percutaneous Coronary Intervention: The MOZART (Minimizing cOntrast utiliZation With IVUS Guidance in coRonary angioplasTy) Randomized Controlled Trial

ObjectivesThe aim of this study was to evaluate the impact of intravascular ultrasound (IVUS) guidance on the final volume of contrast agent used in patients undergoing percutaneous coronary intervention (PCI).BackgroundTo date, few approaches have been described to reduce the final dose of contrast agent in PCIs. We hypothesized that IVUS might serve as an alternative imaging tool to angiography in many steps during PCI, thereby reducing the use of iodine contrast.MethodsA total of 83 patients were randomized to angiography-guided PCI or IVUS-guided PCI; both groups were treated according to a pre-defined meticulous procedural strategy. The primary endpoint was the total volume contrast agent used during PCI. Patients were followed clinically for an average of 4 months.ResultsThe median total volume of contrast was 64.5 ml (interquartile range [IQR]: 42.8 to 97.0 ml; minimum, 19 ml; maximum, 170 ml) in the angiography-guided group versus 20.0 ml (IQR: 12.5 to 30.0 ml; minimum, 3 ml; maximum, 54 ml) in the IVUS-guided group (p < 0.001). Similarly, the median volume of contrast/creatinine clearance ratio was significantly lower among patients treated with IVUS-guided PCI (1.0 [IQR: 0.6 to 1.9] vs. 0.4 [IQR: 0.2 to 0.6, respectively; p < 0.001). In-hospital and 4-month outcomes were not different between patients randomized to angiography-guided and IVUS-guided PCI.ConclusionsThoughtful and extensive use of IVUS as the primary imaging tool to guide PCI is safe and markedly reduces the volume of iodine contrast compared with angiography-alone guidance. The use of IVUS should be considered for patients at high risk of contrast-induced acute kidney injury or volume overload undergoing coronary angioplasty. (Minimizing cOntrast utiliZation With IVUS Guidance in coRonary angioplasTy [MOZART]; NCT01947335)     

Acute kidney injury after liver surgery: does postoperative urine output correlate with postoperative serum creatinine?

BackgroundAcute kidney injury (AKI) after hepatectomy occurs in around 10% of cases. AKI is often defined based only on postoperative serum creatinine increase. This study aimed to assess if postoperative urine output (UO) correlated with serum creatinine after hepatectomy.MethodsAll consecutive hepatectomy patients (2010–2016) were assessed. AKI was defined according to KDIGO criteria: serum creatinine increase ≥26.5 μmol/l, creatinine increase ≥1.5x baseline creatinine, or postoperative oliguria. Oliguria was defined as daily mean UO <0.5 mL/kg/h. AKI was subdivided into creatinine-based or oliguria-based AKI according to the defining criterion.ResultsOut of 285 patients, AKI was observed in 79 cases (28%). Creatinine-based AKI occurred in 25 patients (9%) and oliguria-based only AKI in 54 patients (19%). Ten patients fulfilled both criteria (4%). Postoperative UO correlated poorly with postoperative serum creatinine level in both whole cohort (rho = −0.34, p <0.001) and AKI subgroup (rho = −0.189, p = 0.124). No association was found between postoperative oliguria and postoperative serum creatinine increase (HR = 0.5, 95%CI: 0.2–1.9, p = 0.341). On multivariable analysis, operation duration >360 minutes was the only predictor of creatinine increase (HR = 3.6, 95%CI: 1.1–11.4, p = 0.032).ConclusionPostoperative UO showed poor correlation with postoperative serum creatinine both in all patients and AKI patients. Surgery duration >360 minutes appeared as the only independent predictor of postoperative serum creatinine increase.     

Utility of Urine Neutrophil Gelatinase-Associated Lipocalin for Worsening Renal Function during Hospitalization for Acute Heart Failure: Primary Findings of the Urine N-gal Acute Kidney Injury N-gal Evaluation of Symptomatic Heart Failure Study (AKINESIS)

Background:Worsening renal function (WRF) during acute heart failure (AHF) occurs frequently and has been associated with adverse outcomes, though this association has been questioned. WRF is now evaluated by function and injury. We evaluated whether urine neutrophil gelatinase-associated lipocalin (uNGAL) is superior to creatinine for prediction and prognosis of WRF in patients with AHF.Methods and Results:We performed a multicenter, international, prospective cohort of patients with AHF requiring IV diuretics. The primary outcome was whether uNGAL predicted development of WRF, defined as a sustained increase in creatinine of 0.5 mg/dL or ≥50% above first value or initiation of renal replacement therapy, within the first 5 days. The main secondary outcome was a composite of in-hospital adverse events. We enrolled 927 patients (mean 68.5 years of age, 62% men). The primary outcome occurred in 72 patients (7.8%). The first, peak and the ratio of uNGAL to urine creatinine (area under curves (AUC) ≤ 0.613) did not have diagnostic utility over the first creatinine (AUC 0.662). There were 235 adverse events in 144 patients. uNGAL did not predict (AUCs ≤ 0.647) adverse clinical events better than creatinine (AUC 0.695).Conclusions:uNGAL was not superior to creatinine for predicting WRF or adverse in-hospital outcomes and cannot be recommended for WRF in AHF.     

A systematic review and meta-analysis of integrated traditional Chinese medicine and Western medicine in treating glomerulosclerosis

Background:The combination of Traditional Chinese medicine and Western medicine (TCM+WM) has been widely used in the treatment of glomerulosclerosis, but the results are still controversial. This study will assess the clinical efficacy of TCM+WM for glomerulosclerosis and provide evidence-based medical data via meta-analysis.Method:The MEDLINE, EMBASE, PubMed, Cochrane Central Registry of Controlled Trials, and multiple Chinese databases (Wan Fang, CNKI, and VIP) were searched for randomized controlled trials (RCT) that compared the effects of WM and TCM+WM. Review Manager 5.3 software was used for the meta-analysis of selected studies, and appropriate tests were performed to determine the quality, heterogeneity and sensitivity of these studies.Results:Sixteen RCTs met the inclusion criteria and were selected for the analysis. Compared with the placebo or WM-treated glomerulosclerosis patients, TCM+WM intervention significantly improved renal function indices including 24-hour urine protein quantity (24 h U-Pro), serum creatinine (Scr), blood urea nitrogen (BUN), creatinine clearance (Ccr). In addition, the serum albumin (ALB), triglyceride (TG), and cholesterol (CHOL) levels were also significantly improved (P < .05) in patients receiving the combination therapy. Finally, the combination of TCM+WM reduced the indices of glomerulosclerosis more effectively compared with WM alone.Conclusion:The combination of TCM+WM can significantly improve the renal function and prognosis of patients with glomerulosclerosis.     

姜黄素预处理对大鼠肾脏缺血再灌注损伤的预防效果及机制探讨

目的观察姜黄素预处理预防大鼠,肾脏缺血再灌注损伤(IRI)的效果,并探讨其机制。方法 36只SD雄性大鼠随机分为3组,分别为假手术组(Sham组)、肾脏缺血再灌注模型组(IR组)、姜黄素预处理组(CUR组),每组12只。IR组和CUR组先切除右肾,游离左肾蒂,钳夹左肾蒂45 min后放开。CUR组在钳夹左肾蒂前2 h给予姜黄素100 mg/kg溶于0.1%二甲基亚砜1 mL中,注入腹腔。再灌注24 h后沿原切口进入,分别取下腔静脉血和切除左肾。下腔静脉血用于测定血清肌酐(Cr)和尿素氮(BUN)。取左肾组织匀浆采用硫代巴比妥酸法测定丙二醛(MDA)含量,采用黄嘌呤氧化酶法测定超氧化物歧化酶(SOD)活性,并行HE染色观察各组肾组织结构变化。结果与Sham组比较,IR组和CUR组血清Cr、BUN均升高(P均<0.05)。与IR组比较,CUR组的血清Cr、BUN值在再灌注24 h后均下降(P均<0.05)。与Sham组比较,IR组肾脏组织匀浆SOD活性明显降低,MDA含量明显升高(P均<0.05)。与IR组比较,CUR组肾脏组织匀浆SOD活性升高,MDA含量降低(P均<0.05)。肾组织HE染色后光镜下观察可见与Sham组比较,IR组肾小管损伤明显;与IR组比较,CUR组肾小管损伤减轻明显。结论姜黄素预处理对大鼠IRI有预防作用。其机制可能与姜黄素减轻IRI大鼠肾脏氧化应激水平有关。     

Potential Utility of Cardiorenal Biomarkers for Prediction and Prognostication of Worsening Renal Function in Acute Heart Failure

BackgroundMultiple different pathophysiologic processes can contribute to worsening renal function (WRF) in acute heart failure.Methods and ResultsWe retrospectively analyzed 787 patients with acute heart failure for the relationship between changes in serum creatinine and biomarkers including brain natriuretic peptide, high sensitivity cardiac troponin I, galectin 3, serum neutrophil gelatinase-associated lipocalin, and urine neutrophil gelatinase-associated lipocalin. WRF was defined as an increase of greater than or equal to 0.3 mg/dL or 50% in creatinine within first 5 days of hospitalization. WRF was observed in 25% of patients. Changes in biomarkers and creatinine were poorly correlated (r ≤ 0.21) and no biomarker predicted WRF better than creatinine. In the multivariable Cox analysis, brain natriuretic peptide and high sensitivity cardiac troponin I, but not WRF, were significantly associated with the 1-year composite of death or heart failure hospitalization. WRF with an increasing urine neutrophil gelatinase-associated lipocalin predicted an increased risk of heart failure hospitalization.ConclusionsBiomarkers were not able to predict WRF better than creatinine. The 1-year outcomes were associated with biomarkers of cardiac stress and injury but not with WRF, whereas a kidney injury biomarker may prognosticate WRF for heart failure hospitalization.     

Left Ventricular End-Diastolic Pressure Versus Urine Flow Rate–Guided Hydration in Preventing Contrast-Associated Acute Kidney Injury

ObjectivesThis study compared left ventricular end-diastolic pressure (LVEDP)–guided and urine flow rate (UFR)-guided hydration.BackgroundTailored hydration regimens improve the prevention of contrast-associated acute kidney injury (CA-AKI).MethodsBetween July 15, 2015, and June 6, 2019, patients at high risk for CA-AKI scheduled for coronary and peripheral procedures were randomized to 2 groups: 1) normal saline infusion rate adjusted according to the LVEDP (LVEDP-guided group); and 2) hydration controlled by the RenalGuard System in order to reach UFR ≥300 ml/h (UFR-guided group). The primary endpoint was the composite of CA-AKI (i.e., serum creatinine increase ≥25% or ≥0.5 mg/dl at 48 h) and acute pulmonary edema (PE). Major adverse events (all-cause death, renal failure requiring dialysis, PE, and sustained kidney injury) at 1 month were assessed.ResultsThe primary endpoint occurred in 20 of 351 (5.7%) patients in the UFR-guided group and in 36 of 351 (10.3%) patients in the LVEDP-guided group (relative risk [RR]: 0.560; 95% confidence interval [CI]: 0.390 to 0.790; p = 0.036). CA-AKI and PE rates in the UFR-guided group and LVEDP-guided group were 5.7% and 10.0% (RR: 0.570; 95% CI: 0.300 to 0.960; p = 0.048), and, respectively, 0.3% and 2.0% (RR: 0.070; 95% CI: 0.020 to 1.160; p = 0.069). Three patients in the UFR-guided group experienced complications related to the Foley catheter. Hypokalemia rate was 6.2% in the UFR-guided group and 2.3% in the LVEDP-guided group (p = 0.013). The 1-month major adverse events rate was 7.1% in the UFR-guided group and 12.0% in the LVEDP-guided group (p = 0.030).ConclusionsThe study demonstrates that UFR-guided hydration is superior to LVEDP-guided hydration to prevent the composite of CA-AKI and PE.     

特利加压素联合白蛋白治疗肝肾综合征患者的临床疗效观察

目的:探讨特利加压素联合白蛋白治疗肝肾综合征患者的临床疗效。方法:选取肝肾综合征患者46例,将符合纳入标准的患者随机分为对照组和治疗组,对照组患者在常规治疗的基础上联合人血白蛋白治疗,治疗组患者则在对照组治疗的基础上联合特利加压素治疗。治疗2周后比较2组患者的腹围、尿量、血肌酐、尿素氮及临床症状改善情况。结果:治疗组患者总有效率为78.3%,对照组患者为41.6%,2组疗效差异有统计学意义(P<0.05)。治疗组患者的腹围、尿量、血肌酐、尿素氮及临床症状改善明显,与治疗前相比差异有统计学意义;对照组患者的尿量较治疗前明显改善,差异有统计学意义,但血肌酐、尿素氮、腹围改善不明显,差异无统计学意义。结论:特利加压素联合白蛋白治疗肝肾综合征效果较好,能明显改善患者的腹围、尿量、血肌酐及尿素氮水平。