Long-term effect of radiocontrast-enhanced computed tomography on the renal function of chronic kidney disease patients

Background

The risk of acute kidney injury produced by intravenous radiocontrast in patients with chronic kidney disease (CKD) has been well known, but little is known about the long-term effects on renal function.

Methods

We retrospectively reviewed the medical records of 176 CKD patients with estimated glomerular filtration rates (eGFR) <60?ml/min/1.73?m² who underwent computed tomography (CT) with intravenous radiocontrast at Pusan National University Hospital. Patients were divided into 3 groups (CKD stage 3, n?=?104; CKD stage 4, n?=?52; peritoneal dialysis, n?=?20). Follow-up eGFR values were assessed on a monthly basis for up to 8?months.

Results

In baseline characteristics, there were no significant differences between the 3 groups (i.e., CKD stage 3, stage 4, and PD) in the variables of age, sex, presence of diabetes and follow-up period. There were no significant differences between eGFR before and after CT in all patients and each of the 3 investigated groups. In each group, data analysis according to the presence of diabetes mellitus (DM) did not show significant differences of eGFR before and after CT.

Conclusion

Overall, these results illustrate that intravenous contrast media used in the standard CT scan have no significant long-term effects on renal function in CKD patients, irrespective of DM. Therefore, from a long-term perspective, contrast-enhanced CT might be a better option than gadolinium-based magnetic resonance imaging, which is known to be associated with fatal nephrogenic systemic fibrosis in CKD patients.     

The significance of clinical features in the prognosis of acute renal infarction: single center experience

Objective

Acute renal infarct (ARI) is a common renovascular disease caused by the abrupt interruption of renal blood flow. Since the presenting symptoms are often non-specific, a major concern in ARI has been prompt diagnosis, and its long-term outcome has never been studied.

Materials and methods

From January 2000 through to December 2009, adult patients with ARI were enrolled in this study. We retrospectively reviewed their clinical data, and followed them up until July 2011. Renal outcome and all-cause mortality were measured.

Results

A total of 67 patients were finally enrolled in this study. Their mean age was 56.1?±?16.4 years, and 52.2% of them were male. Over 76% of patients were identified to have more than one comorbidity and concurrent thromboembolic events occurred in 16.4% of the patients. Although, acute kidney injury (AKI) was present in 40.7% of the patients, long-term renal outcome was relatively good. In all cases, AKI was resolved within a month, and renal loss was found in only one patient. In-hospital mortality was 8.9% and during the median follow-up period of 40.6?months, long-term mortality was 19.7%. Independent risk factors for mortality were age, atrial fibrillation, myocardial infarction and hematuria [hazard ratio (HR) 1.051, 95% confidence interval (CI) 1.008–1.096; HR 3.322, 95% CI 1.119–9.860; HR 9.315, 95% CI 1.555–55.796 and HR 7.745, 95% CI 1.606–37.353, respectively].

Conclusions

Our study suggested that in-hospital and long-term outcomes of ARI were closely related to the comorbidities or underlying disease of ARI, rather than the disease itself.     

Anatomical repair of double outlet right ventricle associated with complete atrioventricular septal defect and pulmonary stenosis: extending the indications for aortic translocation

The combination of double outlet right ventricle (DORV) and complete atrioventricular septal defect (CAVSD) remains a surgical challenge for anatomical repair. Inasmuch as the ventricular septal defect is noncommitted in this combination, the major concern regarding anatomical repair is the reconstruction of the unobstructed left ventricular outflow tract without compromising right ventricular volume and the right ventricular outflow tract. We report on a patient who underwent an anatomical repair using aortic root translocation for DORV with CAVSD and pulmonary stenosis (PS).     

Nomograms to predict the pathological stage of clinically localized prostate cancer in Korean men: Comparison with Western predictive tools using decision curve analysis

Objectives: To develop and evaluate nomograms to predict the pathological stage of clinically localized prostate cancer after radical prostatectomy in Korean men. Methods: We reviewed the medical records of 2041 patients who had clinical stages T1c–T3a prostate cancer and were treated solely with radical prostatectomy at two hospitals. Logistic regressions were carried out to predict organ‐confined disease, extraprostatic extension, seminal vesicle invasion, and lymph node metastasis using preoperative variables and resulting nomograms. Internal validations were assessed using the area under the receiver operating characteristic curve and calibration plot, and then external validations were carried out on 129 patients from another hospital. Head‐to‐head comparisons with 2007 Partin tables and Cancer of the Prostate Risk Assessment score were carried out using the area under the curve and decision curve analysis. Results: The significant predictors for organ‐confined disease and extraprostatic extension were clinical stage, prostate‐specific antigen, Gleason score and a percent positive core of biopsy. Significant predictors for seminal vesicle invasion were prostate‐specific antigen, Gleason score and percent positive core, and those for lymph node metastasis were prostate‐specific antigen and percent positive core. The area under the curve of established nomograms for organ‐confined disease, extraprostatic extension, seminal vesicle invasion and lymph node metastasis were 0.809, 0.804, 0.889 and 0.838, respectively. The nomograms were well calibrated and externally validated. These nomograms showed significantly higher accuracies and net benefits than two Western tools in Korean men. Conclusion: This is the first study to have developed and fully validated nomograms to predict the pathological stage of prostate cancer in an Asian population. These nomograms might be more accurate and useful for Korean men than other predictive models developed using Western populations.     

Comparison between thymoglobulin and ATGAM as an induction agent in adult kidney transplantation: a single-center experience

Objective

The best antithymocyte globulin (ATG) preparation for induction suppression in kidney transplant recipients is still not clear. The aim of this study was to identify short- and long-term outcomes in kidney transplant recipients who received Thymoglobulin or ATGAM as an induction agent.

Methods

We retrospectively reviewed patients who underwent kidney transplantation from 1996 to 2010. Recipients were classified according to the ATG preparation.

Results

One hundred fifty-two patients (64.4%) received thymoglobulin and 84 (35.6%) received ATGAM. The occurrence of delayed graft function in patients receiving Thymoglobulin was higher than in patients receiving ATGAM (P = .005), but serum creatinine levels and acute rejection after kidney transplantation were not different between the two groups. The death-censored graft survival curve in Thymoglobulin recipients was higher than in ATGAM recipients (P = .027). Bacterial infection was a predisposing factor for graft survival (P = .008).

Conclusion

The efficacy of Thymoglobulin induction is generally better than that of ATGAM induction, and prevention of bacterial infections was just as important as the use of ATG because bacterial infection was an important risk factor for graft failure.     

Decrease of Both Cofilin and LIM Kinase Phosphorylation in the Skeletal Muscles of Immobilization-induced Atrophy Rats

[Purpose] Immobilization-induced atrophy is a general phenomenon caused by prolonged muscle disuse associated with orthopaedic conditions. However, changes in the phosphorylation of atrophy-related cofilin and LIM kinases are still poorly understood. In this study, we examined whether or not phosphorylation of cofilin and LIM kinases is altered in the skeletal muscles of rats after 3, 7, 14, and 21 days of cast immobilization. [Methods] We used two-dimensional gel electrophoresis, mass spectrometry, and western blotting to examine protein expression and phosphorylation in atrophied rat gastrocnemius muscles. [Results] The expression of the cofilin was detected in gastrocnemius muscle strips using proteomic analysis. Cast immobilization after 3, 7, 14, and 21 days significantly diminished the phosphorylation of cofilin and LIM kinases. [Conclusion] The present results suggest that cast immobilization-induced atrophy may be in part related to changes in the phosphorylation of cofilin and LIM kinases in rat skeletal muscles.Key words: Cofilin, LIM kinases, Skeletal muscle atrophy     

Somatotype Analysis of Elite Boxing Athletes Compared with Nonathletes for Sports Physiotherapy

[Purpose] The purpose of this study was to show somatotype and physical characteristic differences between elite boxing athletes and non-athletes. [Methods] The somatotypes of 23 elite boxing athletes and 23 nonathletes were measured with the Heath-Carter method. The subjects were divided into four weight divisions as follows: lightweight, light middleweight, middleweight, and heavyweight class. [Results] The endomorphic component values of the boxing athletes were lower than those of the nonathletes. However, the mesomorphic component values of the boxing athletes were higher than those of the nonathletes. There was no significant difference in the ectomorphic component between the two groups. The higher weight divisions tended to have higher values of height, weight, and BMI than the lower weight divisions. The higher weight divisions also tended to have higher values for the endomorphic and mesomorphic components and a lower value for the ectomorphic component than the lower weight divisions. The group of nonathletes consisted of eight endomorphs, four mesomorphs, six ectomorphs, and five central types. Among the boxing athletes, there were 16 mesomorphic, four ectomorphic, and two central types and one endomorphic type. Subdividing the athletes into 13 somatotypes resulted in five balanced mesomorphs, five endomorphic mesomorphs, five mesomorph-ectomorphs, three mesomorph-endomorphs, two mesomorphic ectomorphs, two central types, and one ectomorphic mesomorph type. [Conclusion] The data from this study provides in part physical characteristics of elite boxing athletes that can be used to establish a reference for systemic study of sports physiotherapy.Key words: Somatotype analysis, Elite boxing athletes, Specialized sports physiotherapy