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.     

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.     

慢性肾衰竭中合理应用中成药的教学研究

慢性肾脏病逐渐成为全球性公共卫生问题,并成为新的流行病,严重危害人民群众健康与生命。随着中医学在肾脏病治疗中地位的逐步提高,西医医生能否合理使用中成药治疗肾脏病是值得关注和探讨的问题。研究中通过分析目前多家综合医院使用中成药的现状,探讨慢性肾衰竭中成药使用的可靠性,实用性,并归纳出中成药在肾脏病治疗中的作用,分析其不合理应用所带来的弊端。从临床研究与教学中得出结论认为,慢性肾衰竭中成药的合理应用任重而道远,需要不懈努力。     

Development of the Kidney Disease Quality of Life (KDQOLTM) Instrument

This paper describes the Kidney Disease Quality of Life (KDQOL^TM) Instrument (dialysis version), a self-report measure that includes a 36-item health survey as the generic core, supplemented with multi-item scales targeted at particular concerns of individuals with kidney disease and on dialysis (symptom/problems, effects of kidney disease on daily life, burden of kidney disease, cognitive function, work status, sexual function, quality of social interaction, sleep). Also included were multi-item measures of social support, dialysis staff encouragement and patient satisfaction, and a single-item overall rating of health. The KDQOL^TM was administered to 165 individuals with kidney disease (52% female; 48% male; 47% White; 27% African-American; 11% Hispanic; 8% Asian; 4% Native American; and 3% other ethnicities), sampled from nine different outpatient dialysis centres located in Southern California, the Northwest, and the Midwest. The average age of the sample was 53 years (range from 22 to 87), and 10% were 75 years or older. Internal consistency reliability estimates for the 19 multi-item scales exceeded 0.75 for every measure except one. The mean scores for individuals in this sample on the 36-item health scales were lower than the general population by one-quarter (emotional well-being) to a full standard deviation (physical function, role limitations due to physical health, general health), but similar to scores for dialysis patients in other studies. Correlations of the KDQOL^TM scales with number of hospital days in the last 6 months were statistically significant (p<0.05) for 14 of the 19 scales and number of medications currently being taken for nine of the scales. Results of this study provide support for the reliability and validity of the KDQOL^TM.Development of the KDQOL measure was supported in part by a subgrant from the University of Arizona to RAND and an unrestricted research grant from Amgen to RAND. The measures weee developed for use in the Enhancing the Role of Pharmacists in the Care of Chronic Dialysis Patients Through the Use of Computer-modeled Algorithms for Epogen Dosing research project sponsored by Amgen through a grant to the University of Arizona (S. J. Coons, PI). A copy of the measures can be obtained from RAND free of charge.     

Association of Nutrition Education and Its Interaction with Lifestyle Factors on Kidney Function Parameters and Cardiovascular Risk Factors among Chronic Kidney Disease Patients in Taiwan

We evaluated the interactive effects of nutrition education (NE) and lifestyle factors on kidney function parameters and cardiovascular risk factors among chronic kidney disease (CKD) patients. This cross-sectional cohort study recruited 2176 CKD stages 3–5 patients aged > 20 years from Integrated Chronic Kidney Disease Care Network, Shuang Ho Hospital, Taiwan between December 2008 and April 2019. The multivariable regression analysis was performed to investigate the interactive effects of NE with lifestyle factors on kidney function parameters and cardiovascular risk factors. Relative excess risk due to interaction (RERI) and attributable proportion (AP) were applied to assess additive interaction. Patients who were smoking or physically inactive but received NE had better estimated glomerular filtration rate (eGFR) (β: 3.83, 95% CI: 1.17–6.49 or β: 3.67, 95% CI: 2.04–5.29) compared to those without NE. Patients with smoking and NE significantly reduced risks for having high glycated hemoglobin A_1c (HbA_1c) by 47%, high low-density lipoprotein cholesterol (LDL-C) by 38%, and high corrected calcium (C-Ca) by 50% compared to those without NE. Moreover, NE and smoking or inactive physical activity exhibited an excess risk of high C-Ca (RERI: 0.47, 95% CI: 0.09–0.85 for smoking or RERI: 0.46, 95% CI: 0.01–0.90 and AP: 0.51, 95% CI: 0.03–0.99 for physical activity). Our study suggests that CKD patients who were enrolled in the NE program had better kidney function. Thus, NE could be associated with slowing kidney function decline and improving cardiovascular risk factors.     

北京部分地区人群心血管疾病危险因素与慢性肾脏病的相关性分析

目的 探讨一般人群中传统心血管疾病危险因素与慢性肾脏病的相关关系.方法 2007-2008年随机对北京部分地区5100名成年人进行估计肾小球滤过率(eGFR)水平及心血管疾病危险因素的横断面调查,4515名符合入选标准并对其资料进行分析.设计统一的心血管疾病危险因素调查表,进行心血管疾病传统危险因素现况调查,测量身高、体重、血压,检测TC、TG、LDL-C、HDL-C及肌酐(Scr)指标,用简化的MDRD公式估算GFR(eGFR),并以eGFR[ml·min~(-1)·(1.73 m~2)~(-1)]<60定义为慢性肾脏病(CKD).按eGFR≥90、60-89和<60将人群分为3组,采用单因素方差分析进行组间均值的比较,X~2检验进行组间率的比较,以有无CKD为因变量(eGFR≥60为0,eGFR<60为1),以所选择的研究因素为自变量,进行单因素及多因素logistic回归分析.结果随着eGFR水平下降,心血管疾病危险因素检出率增加;单因素分析显示,年龄、吸烟情况、高血压及糖尿病病史、BMI、SBP、LDL-C及TG是CKD的危险因素,女性是其保护性因素;多因素分析表明,增龄、吸烟、高血压、高TG是CKD的重要危险因素,OR值(95%CI)分别为1.80(1.28～2.52)、1.09(1.06～1.13)、2.50(1.75～3.57)、1.73(1.18～2.54),而女性是其保护性因素.结论 北京地区一般人群心血管疾病危险因素随eGFR水平下降检出率增高,年龄、血压、TG、吸烟是CKD的危险因素.     

Dietary Phosphorus as a Marker of Mineral Metabolism and Progression of Diabetic Kidney Disease

Phosphorus is an essential nutrient that is critically important in the control of cell and tissue function and body homeostasis. Phosphorus excess may result in severe adverse medical consequences. The most apparent is an impact on cardiovascular (CV) disease, mainly through the ability of phosphate to change the phenotype of vascular smooth muscle cells and its contribution to pathologic vascular, valvular and other soft tissue calcification. Chronic kidney disease (CKD) is the most prevalent chronic disease manifesting with the persistent derangement of phosphate homeostasis. Diabetes and resulting diabetic kidney disease (DKD) remain the leading causes of CKD and end-stage kidney disease (ESRD) worldwide. Mineral and bone disorders of CKD (CKD-MBD), profound derangement of mineral metabolism, develop in the course of the disease and adversely impact on bone health and the CV system. In this review we aimed to discuss the data concerning CKD-MBD in patients with diabetes and to analyze the possible link between hyperphosphatemia, certain biomarkers of CKD-MBD and high dietary phosphate intake on prognosis in patients with diabetes and DKD. We also attempted to clarify if hyperphosphatemia and high phosphorus intake may impact the onset and progression of DKD. Careful analysis of the available literature brings us to the conclusion that, as for today, no clear recommendations based on the firm clinical data can be provided in terms of phosphorus intake aiming to prevent the incidence or progression of diabetic kidney disease.     

常染色体隐性遗传多囊肾病 PKHD1基因检测

目的对1例引产的常染色体隐性遗传性多囊肾病胎儿的多囊肾/多囊肝病变1基因（ PKHD1）进行基因突变鉴定和结果分析。方法采集引产胎儿及其父母外周静脉血,分别提取基因组DNA,应用PCR扩增、DNA直接测序等技术手段对该胎儿及其父母进行PKHD1基因突变分析。结果胎儿PKHD1基因出现几种序列变异：PKHD1基因第7号内含子发生ISV7＋51G＞T变异;第17号外显子发生c．1587T＞C（p．N529N）变异;第32号外显子发生c．3785C＞T（p．A1262V）变异,导致编码PKHD1蛋白多肽链第1262号氨基酸由丙氨酸变为缬氨酸。结论 PKHD1基因序列变异可能是常染色体隐性遗传性多囊肾病的病因,PKHD1基因检测可作为产前筛查的有效诊断手段。     

综合性营养评估法在维持性血液透析患者中的应用

目的对血液透析患者的几项营养指标进行评估。方法对142例维持性血液透析（MHD）患者进行主观综合性营养评估（SGA）、膳食调查、生化参数的测定。结果依据SGA评分,在营养良好、轻中度营养不良及重度营养不良三组间进行以下指标比较：平均每日每公斤体重能量（DEI）和蛋白质摄入（DPI）、血白蛋白（ALb）,均有显著性差异（P〈0.001～0.05）。但营养良好组的DEI和DPI异常率高达46.0%、49.0%,重度营养不良组中各指标异常率均在80%以上。血前白蛋白（PA）与血ALb有显著相关（P〈0.01）,与DPI、DEI均无相关。结论SGA是评价MHD患者营养状况的简便方法,但还需其它反映营养状况不同侧面指标的补充,如DEI、DPI、血ALb、血PA。     

The Impact of Kidney Transplantation on the Serum Fatty Acid Profile in Patients with End-Stage Kidney Disease

Epidemiological data indicate that metabolic disturbances and increased cardiovascular risk in renal transplant patients are a significant and common problem. Therefore, it is important to search for new solutions and, at the same time, counteract the negative effects of currently used therapies. In this study, we examined the effect of kidney transplantation on the serum levels of fatty acids (FAs) in order to assess the role of these compounds in the health of transplant patients. The FA profile was analyzed by gas chromatography-mass spectrometry in the serum of 35 kidney transplant recipients, just before transplantation and 3 months later. The content of total n-3 polyunsaturated FAs (PUFAs) decreased after transplantation (3.06 ± 0.13% vs. 2.66 ± 0.14%; p < 0.05). The total amount of ultra-long-chain FAs containing 26 and more carbon atoms was significantly reduced (0.08 ± 0.009% vs. 0.05 ± 0.007%; p < 0.05). The desaturation index (18:1/18:0) increased after transplantation (3.92 ± 0.11% vs. 4.36 ± 0.18%; p < 0.05). The study showed a significant reduction in n-3 PUFAs in renal transplant recipients 3 months after transplantation, which may contribute to increased cardiovascular risk in this patient population.     

肾病患儿血清微量元素的测定及意义

目的观察肾病患儿血清铜、锌、铁、镁含量。方法采用原子吸收分光光度法测定肾病患儿血清铜、锌、铁、镁与正常对照组进行比较。结果单纯性肾病组、肾炎性肾病组、紫癜性肾病组及肾炎组血清锌均显著低于正常对照组P〈0．05，血清铁、镁与正常对照组比较无显著差异P〉0．05。单纯性肾病组，肾炎性肾病组血清铜显著低于正常对照组P〈0．05。结论血清铜、锌、铁、镁含量的变化与疾病发生和疾病状态有关。     

Changes in kidney function among Nicaraguan sugarcane workers

Background:

There is an epidemic of chronic kidney disease (CKD) of unknown etiology in Central American workers.

Objectives:

To investigate changes and job-specific differences in kidney function over a 6-month sugarcane harvest season, explore the potential role of hydration, and measure proteinuria.

Methods:

We recruited 284 Nicaraguan sugarcane workers performing seven distinct tasks. We measured urine albumin and serum creatinine and estimated glomerular filtration rate (eGFR).

Results:

eGFR varied by job and decreased during the harvest in seed cutters (−8.6 ml/min/1.73 m²), irrigators (−7.4 ml/min/1.73 m²), and cane cutters (−5.0 ml/min/1.73 m²), as compared to factory workers. The number of years employed at the company was negatively associated with eGFR. Fewer than 5% of workers had albumin-to-creatinine ratio (ACR) >30 mg/g.

Conclusions:

The decline in kidney function during the harvest and the differences by job category and employment duration provide evidence that one or more risk factors of CKD are occupational.     

青海省典型行业女职工生殖健康状况调查

采用横断面调查方法,对青海省冶金、化工、铁路、制酒及其他行业3 848名女职工进行生殖健康问卷调查.妇科疾病、月经异常和不孕是女职工主要的生殖健康问题,以制酒和铁路行业发病率较高.接触职业有害因素、不良体位、工作负荷大等是影响女职工生殖健康的重要因素.应加强职业卫生防护和健康教育,改善工作模式,保护女职工身心健康.     

Changes in kidney function among Nicaraguan sugarcane workers

Abstract

Background:

There is an epidemic of chronic kidney disease (CKD) of unknown etiology in Central American workers.

Objectives:

To investigate changes and job-specific differences in kidney function over a 6-month sugarcane harvest season, explore the potential role of hydration, and measure proteinuria.

Methods:

We recruited 284 Nicaraguan sugarcane workers performing seven distinct tasks. We measured urine albumin and serum creatinine and estimated glomerular filtration rate (eGFR).

Results:

eGFR varied by job and decreased during the harvest in seed cutters (?8·6 ml/min/1·73 m²), irrigators (?7·4 ml/min/1·73 m²), and cane cutters (?5·0 ml/min/1·73 m²), as compared to factory workers. The number of years employed at the company was negatively associated with eGFR. Fewer than 5% of workers had albumin-to-creatinine ratio (ACR) >30 mg/g.

Conclusions:

The decline in kidney function during the harvest and the differences by job category and employment duration provide evidence that one or more risk factors of CKD are occupational.     

Role of Zinc in Diabetic Kidney Disease

Diabetic Kidney Disease (DKD) represents the most common cause of Chronic Kidney Disease (CKD) in developed countries. Approximately 30% to 40% of diabetes mellitus (DM) subjects develop DKD, and its presence significantly increases the risk for morbidity and mortality. In this context, Zinc seems to have a potential role in kidney and body homeostasis in diabetic individuals as well as in patients at a high risk of developing this condition. This essential element has functions that may counteract diabetes-related risk factors and complications, which include stabilization of insulin hexamers and pancreatic insulin storage and improved glycemic control. In our review, we analyzed the current knowledge on the role of zinc in the management of renal impairment in course of DM. Several studies underline the critical role of zinc in reducing oxidative stress levels, which is considered the common denominator of the mechanisms responsible for the progression of kidney disease. Reaching and maintaining a proper serum zinc level could represent a valuable target to reduce symptoms related to DM complications and contrast the progression of kidney impairment in patients with the high risk of developing end-stage renal disease. In conclusion, analyzing the beneficial role of zinc in this review would advance our knowledge on the possible strategies of DM and DKD treatment.     

慢性肾脏病知晓率在社区医生中的调查与推广

目的：探索社区医生提高和防治早期CKD的效果和如何减轻疾病对健康的危害,降低医疗费用。方法：对长宁区的周家侨、华阳、新华三家社区卫生服务中心的医生随机抽取90名医生,然后到长宁区各社区进行慢性肾脏病相关知识推广和培训,1年后进行第2次问卷调查。结果：（1）推广知晓情况：推广后的平均分数（80.44±8.74）分明显高于推广前的（64.04±12.89）分,且推广后各分数段人数均明显多于推广前,差异均有统计学意义（P〈0.01）。（2）对疑似肾损害患者的处置措施：推广前尿检者20名（22.22%）,肾功能检查者21名（23.33%）,建议专科就诊者25名（27.78%）,其他24名（26.67%）。推广后尿检者45名（50.00%）,肾功能检查者36名（40.00%）,建议专科就诊者4名（4.44%）,其他5名（5.56%）,推广后社区医生给予尿检、肾功能检查、建议专科就诊、其他等处置措施的人数均明显多于推广前,差异均有统计学意义（P〈0.01）。（3）评估肾功能指标的选择：推广前选择血肌酐者77名（85.56%）,尿素者8名（8.89%）,内生肌酐清除率者3名（3.33%）,估计肾小球滤过率者2名（2.22%）。推广后选择血肌酐者60名（66.67%）,尿素者1名（1.11%）,内生肌酐清除率者10名（11.11%）,估计肾小球滤过率者19名（21.11%）,推广后社区医生选择血肌酐、尿素、内生肌酐清除情况、估计肾小球滤过问题等评估指标的人数均明显多于推广前,差异均有统计学意义（P〈0.01）。结论：通过此次推广对社区医生的慢性肾脏病知识有所提高,提供了与社区医生互相交流学习的机会。     

Obesity and Other Nutrition Related Abnormalities in Pre-Dialysis Chronic Kidney Disease (CKD) Participants

Chronic kidney disease (CKD) is increasing in sub-Saharan Africa. Undernutrition has been prevalent amongst end stage CKD patients, with limited data on the prevalence of obesity. The aim of this study was to assess the nutritional status of CKD patients using various methods sensitive to over and under-nutrition. Stage 3 to 5 CKD patients (glomerular filtration rate (GFR) < 60 mL/min/1.73 m²) attending a pre-dialysis clinic in Cape Town, were enrolled. Exclusion criteria included infectious and autoimmune conditions. Sociodemographic, clinical and biochemical data were collected, and anthropometric measurements were performed. Dietary intake was measured with a quantified food frequency questionnaire (FFQ). Statistical Package for the Social Sciences (SPSS) version 26 was used for statistical analysis. Seventy participants, with mean age of 41.8 ± 11.8 years, 52.9% females and 47.1% males were enrolled. Participants enrolled mainly had stage 5 kidney failure. Thirty percent were overweight (21) and 25 (36%) were obese, 22 (60%) of females were overweight and obese, while 13 (39.4%) of males were predominantly normal weight. Abdominal obesity was found in 42 (60%) of participants, mainly in females. Undernutrition prevalence was low at 3%. Dietary assessment showed a high sugar and protein intake. There was a high prevalence of overweight, obesity and abdominal obesity in CKD stage 35 patients, with unhealthy dietary intake and other nutritional abnormalities.     

Risk factors associated with disease progression and mortality in chronic kidney disease of uncertain etiology: a cohort study in Medawachchiya, Sri Lanka

Background

The alarming rise in the prevalence of chronic kidney disease of uncertain etiology (CKDu) among the low socioeconomic farming community in the North Central Province of Sri Lanka has been recognized as an emerging public health issue in the country.

Methods

This study sought to determine the possible factors associated with the progression and mortality of CKDu. The study utilized a single-center cohort registered in 2003 and followed up until 2009 in a regional clinic in the endemic region, and used a Cox proportional hazards model.

Results

We repeatedly found an association between disease progression and hypertension. Men were at higher risk of CKDu than women. A significant proportion of the patients in this cohort were underweight, which emphasized the need for future studies on the nutritional status of these patients.

Conclusions

Compared with findings in western countries and other regions of Asia, we identified hypertension as a major risk factor for progression of CKDu in this cohort.