A meta-analysis of the effects of dietary protein restriction on the rate of decline in renal function

Dietary protein restriction has been reported to delay the need for renal replacement therapy in clinical trials and meta-analyses. However, less clear is what effect dietary protein has on the rate of decline in renal function. We pooled the results of 13 randomized controlled trials (n = 1,919 patients) and found that dietary protein restriction reduced the rate of decline in estimated glomerular filtration rate by only 0.53 mL/min/yr (95% confidence interval [CI], 0.08 to 0.98 mL/min/yr). We also used weighted regression analysis to determine the reasons for the differences in the results of these 13 randomized trials along with 11 other nonrandomized controlled trials (n = 2,248 patients). The effect of dietary protein restriction (glomerular filtration rate decline in treatment minus control) was substantially less in randomized versus nonrandomized trials (regression coefficient, -5.2 mL/min/yr; 95% CI, -7.8 to -2.5 mL/min/yr; P < 0.05) and relatively greater among diabetic versus nondiabetic patients (5.4 mL/min/yr; 95% CI, 0.3 to 10.5 mL/min/yr; P < 0.05), while there was a trend toward a greater effect with each additional year of follow-up (2.1 mL/min/yr; 95% CI, -0.05 to 4.2 mL/min/yr; P = NS). However, the number of diabetic patients studied was small and the duration of follow-up was short in most trials. No other patient or study characteristics altered the effect of dietary protein restriction on the rate of decline in renal function. Thus, although dietary protein restriction retards the rate of renal function decline, the relatively weak magnitude of this effect suggests that better therapies are needed to slow the rate of renal disease progression.     

Percutaneous transluminal angioplasty. Radiological-pathological correlation

Radiological and pathological assessment of the degree and extent of arterial injury caused by balloon angioplasty was performed in 20 renal arteries obtained at autopsy. Intact arteries were studied angiographically before and after dilatation and then examined histologically. Both normal and diseased arteries were subjected to varying degrees of dilatation. Damage ranged from minimal intimal disruption to major tears of the muscular media. Equivalent dilatory force created greater damage in the distal (muscular) than in the proximal (elastic) portion of the renal artery. There was no evidence of plaque remodeling or compression.     

不同胆道灌洗液对肝移植供体胆道冷保存损伤的影响

目的：冷保存/再灌注损伤是导致非外科性移植物胆管树损害最重要的始动因素。观察不同胆道灌洗液对大鼠肝移植供肝胆道保存的影响，以筛选出一种较为理想的胆道灌洗液，使胆道在冷保存期间获得器官水平上的最佳保护。方法：实验于2006-08／12在中国医科大学附属盛京医院动物实验中心完成。①实验设计及分组：实验因素包括胆道灌洗液与冷保存时间，不同的灌洗液分别为胆道灌洗液a（生理盐水、HCA液），胆道灌洗液b（HTK液、UW液）；冷保存时间为4h，8h，12h。采用正交设计方法，选用[L9（3^4）]正交表对实验因素随机分组，共分为9组。②实验方法：选择雄性Wistar大鼠45只，分为9组，每组5只。制作大鼠取供肝模型，按照实验设计分别选择不同的胆道灌洗液进行胆道灌洗，在相应的冷保存时间取胆管组织进行检测。③实验评估：采用原位末端标记法进行胆管上皮细胞凋亡检测，计算凋亡指数；在电镜下观察胆管细胞的病理形态变化，并利用图像分析系统求出每张照片中所有胆管上皮细胞的线粒体平均体积和数密度。结果：45只大鼠全部进入结果分析。通过正交设计的方差分析与直观分析得出下列结果。①胆管上皮细胞凋亡指数的正交设计结果：胆道灌洗液a、胆道灌洗液b及冷保存时间是决定大鼠供肝胆道冷保存损伤的主要因素（P均〈0．01）；其中HCA液、HTK液及4h冷保存时间较为理想，且三者结合效果更好。②胆道上皮细胞线粒体平均体积及数密度的正交设计结果：胆道灌洗液a、胆道灌洗液b及冷保存时间是决定大鼠供肝胆道冷保存损伤的主要因素（P均〈0．01）；其中HCA液、HTK液及4h冷保存时间较为理想，且三者结合效果更好。结论：①正确选择胆道灌洗液可以大幅度减轻肝移植供肝胆道的冷保存损伤，保护胆管上皮细胞。②胆道灌洗液以选择HCA液与HTK液结合灌洗的方式较为理想，冷保存时间越短越理想。