Cellular senescence determines endothelial cell damage induced by uremia

Renal dysfunction is closely associated with endothelial damage leading to cardiovascular disease. However, the extent to which endothelial damage induced by uremia is modulated by aging is poorly known. Aging can render endothelial cells more susceptible to apoptosis through an oxidative stress-dependent pathway. We examined whether senescence-associated to oxidative stress determines the injury induced by the uremia in endothelial cells.     

Serum tumour markers in patients with chronic kidney disease

Objective. Tumour markers are widely used for monitoring cancer patients and for screening certain tumours. It has recently been shown that the concentrations of some tumour markers are higher in patients with chronic kidney disease (CKD) than in healthy subjects. We analysed the influence of renal function and hemodialysis treatment on the serum levels of CA19‐9, CA125, alpha fetoprotein (AFP), CA15.3, CA72.4, CYFRA 21‐1, neuron‐specific enolase (NSE) and squamous cell carcinoma antigen (SCC‐Ag). Material and methods. 232 non‐dialysis patients with CKD and 37 uraemic patients treated with maintenance hemodialysis were enrolled in this study. The non‐dialysis patients were divided into three groups depending on their creatinine clearance (Ccr) levels: group 1 = Ccr ?25?mL/min; group 2 = 25.1–49.9?mL/min; group 3 = Ccr ?50?mL/min. For comparison, we chose 37 non‐dialysis patients with similar Ccr, age and same gender as controls. Results. The serum concentrations of CA19‐9, CA125 (male), CYFRA 21‐1, NSE and SCC‐Ag correlated negatively with Ccr, while there were no significant differences in the concentrations of CA125 (female), AFP, CA15.3, CA72.4. The serum levels of CA19‐9, CA125, AFP, CA15.3, CA72.4, CYFRA 21‐1, NSE and SCC‐Ag showed no differences between hemodialysis patients and non‐dialysis controls (p>0.017). Conclusions. The increase in the serum levels of CA19‐9, CA125 (in males), CYFRA 21‐1, NSE and SCC‐Ag in patients with CKD affects the specificity of these markers in the diagnosis of cancer. Hemodialysis does not affect the serum levels of CA19‐9, CA125, AFP, CA15.3, CA72.4, CYFRA 21‐1, NSE and SCC‐Ag.     

Differential regulation of mesothelial cell fibrinolysis by transforming growth factor beta 1

Management of hypertension and diabetes mellitus in primary health care requires occasional assessment of kidney function. Monitoring the urinary albumin excretion every 24?h is often used as a diagnostic gold standard but measurement of U‐Albumin concentrations in morning urine either alone or together with U‐Creatinine is a well‐established surrogate measure. We compared the ratio U‐Albumin/U‐Creatinine and U‐Albumin concentrations measured by commonly used POC (Point of care) instruments with those obtained in a central laboratory and estimated the uncertainty of the results after establishing an uncertainty budget. It is concluded that the presentation of ratios or concentrations on an ordinal scale is less satisfactory than reporting U‐Albumin concentration on a ratio scale. Moreover the latter will have the advantage of allowing the physician to adjust the diagnostic sensitivity and specificity to local needs. The present report is a methodological study and does not consider the diagnostic performance of the studied properties per se.     

Serum cystatin C as an early predictor of acute kidney injury in preterm neonates with respiratory distress syndrome

Abstract

Preterm neonates with respiratory distress syndrome (RDS) are at increased risk of acute kidney injury (AKI). Our study aimed at determining whether serum cystatin C (sCysC) on day 3 of life (D3) can early predict AKI in preterm neonates with RDS. This prospective study was conducted on 75 preterm neonates; 50 with RDS and 25 without RDS. On D3, sCysC, serum creatinine (sCr) and blood urea nitrogen (BUN) were measured and estimated glomerular filtration rate (eGFR) was calculated. sCr and BUN levels were measured again on days 5 and 7. Neonates were evaluated for development of AKI during first week of life according to the modified pediatric RIFLE (pRIFLE) criteria. Thirteen neonates with RDS developed AKI (26%).There was no significant difference between RDS and control groups with respect to sCysC. RDS neonates with AKI had significantly higher sCysC than those without AKI (1.62?±?0.12 versus 1.16?±?0.09?mg/l; p?<?.001). RDS grade III–IV neonates had significantly higher sCysC than RDS grade I–II. There was a significant positive correlation between D3 sCysC and (D5 and D7 sCr and BUN). Receiver operating characteristic (ROC) curve showed that D3 sCysC can predict AKI in preterm neonates with RDS at a cutoff point of >1.3?mg/l with sensitivity of 92.30% and specificity of 96%. We conclude that neonates with RDS are at increased risk of AKI. sCysC on day 3 of life can predict AKI earlier than Cr and eGFR.     

苏叶地黄汤治疗慢性肾衰竭临床观察

目的：观察苏叶地黄汤治疗早中期慢性肾衰竭（ chronic renal fcilure,CRF）的临床疗效。方法：将符合标准的68例CRF患者在基础治疗同时予以自拟苏叶地黄汤口服,观察治疗前后患者尿素氮、肌酐、内生肌酐清除率、血红蛋白、24 h尿蛋白定量变化情况。结果：68例患者中显效43例,稳定14例,无效11例,有效率为83.80%。治疗后尿素氮、肌酐、内生肌酐清除率、24 h尿蛋白定量等指标均有明显改善,与治疗前比较,差异有统计学意义（ P<0.05）。结论：苏叶地黄汤能有效改善早中期CRF患者肾功能水平。     

IABP对心肌梗死心力衰竭的效果及对BNP、Cr的影响

目的:探讨主动脉内球囊反搏对心肌梗死心力衰竭的效果及对脑尿钠肽和血清肌酐的影响.方法:选取本院心血管中心科收治的急性心肌梗死合并心力衰竭患者92例,随机分为两组,其中对照组46例,实验组46例,两组均予以卧床休息、吸氧、抗凝、抗心律失常等常规治疗,对照组予以多巴胺治疗,若升压不理想,病情无好转甚至恶化者改用主动脉内球囊反搏(IABP)治疗,实验组在常规治疗的基础上使用IABP治疗.治疗结束后,对比治疗前后患者血流动力学参数、血脑纳肽(BNP)、血肌酐(Cr)、血浆白蛋白、超敏C-反应蛋白(hs-CRP)及两组住院病死率和左心室射血分数.结果:(1)治疗后两组血流动力学参数均有所改善,且实验组血流动力学参数较对照组明显上升,差异有统计学意义(P＜0.05);(2)治疗后两组BNP、Cr、血浆白蛋白、Hs-CRP均有所改善,且实验组BNP、Cr、Hs-CRP明显低于对照组,血浆白蛋白明显高于对照组,差异均有统计学意义(P＜0.05);(3)实验组住院病死率明显低于对照组,差异有统计学意义(P＜0.05);(4)两组治疗后左心室射血分数有所提升,但实验组治疗后24h及出院时左心室射血分数明显高于对照组,差异有统计学意义(P＜0.05).结论:IABP能够明显改善急性心肌梗死心力衰竭患者血流动力学参数,降低血脑BNP、Cr、水平,有效纠正心力衰竭,提高由于心肌梗死导致心力衰竭的存活率,对临床具有指导意义,值得临床推广.     

Influence of Renal Function on the Pharmacokinetics,Pharmacodynamics, Efficacy,and Safety of Non–Vitamin K Antagonist Oral Anticoagulants

With the growing integration of non–vitamin K antagonist oral anticoagulants (NOACs) into clinical practice, questions have arisen regarding their use in special populations, including groups that may have been underrepresented in clinical trials. Patients with renal impairment, particularly in the lower echelons of renal function, are one such group. In an effort to elucidate the current evidence regarding the use of NOACs in patients with renal impairment, a systematic assessment of the literature was performed. The MEDLINE database was interrogated for studies and analyses evaluating the influence of renal function on the pharmacokinetics, pharmacodynamics, efficacy, and safety of NOACs published from January 1, 2000, through August 2, 2017. The 82 relevant publications retrieved highlight the diversity in the NOAC class regarding the impact of renal function on drug clearance, drug exposures, and clinical trial outcomes. In several large clinical trials, subgroup analyses revealed no significant differences when patients were stratified by creatinine clearance as a measure of renal function. Efficacy findings, in particular, were largely aligned with the overall population in the included studies. However, relative risks of bleeding were shown to vary, sometimes driven by changes in bleeding event rates in the comparator arm (eg, warfarin, enoxaparin). With few exceptions, minimal influence of mild renal impairment was observed on the relative efficacy and safety of NOACs. Taken together, the evidence suggests that the presence of renal impairment merits careful consideration of anticoagulant choice but should not deter physicians from appropriate use of NOACs.     

Falsely elevated human epididymis protein 4 results and Risk of Ovarian Malignancy Algorithm in polymorbid women after solid organ transplantation: A pilot and case‐control study

Background

Cancer prevention is essential after transplantation (Tx). The use of HE4 and Risk of Ovarian Malignancy Algorithm (ROMA) is recommended as a tool for selective ovarian cancer screening; however, creatinine is a known confounder. This study assessed the reliability of HE4, CA125, and ROMA after Tx.

Methods

We matched a total of 202 women without gynecological malignancies and 236 men by age and serum creatinine. Each pair consisted of a patient after Tx (kidney, liver, heart, and pancreas) and a diseased but non‐Tx consecutive patient. Serum HE4, CA125 (Roche Cobas 6000), and creatinine (enzymatic, Abbott Architect) were measured in all patients.

Results

Creatinine correlated with HE4 (women: r = .864, P < .0001; men: r = .848, P < .0001). Age correlated slightly with HE4 in women (r = .250, P < .005) and men (r = .240, P < .0005). HE4 in women after Tx (median of 84.8 pmol/L) was significantly higher than non‐Tx women (53.7 pmol/L, P < .0001) in the reference range of serum creatinine. Neither HE4 nor CA125 correlated with tacrolimus concentration, but anemia, hyperparathyroidism, kidney, liver, and lung diseases were possible confounders for HE4 after transplantation (P < .05).

Conclusion

Human epididymis protein 4 (HE4) was significantly increased in women after solid organ transplantation compared to levels without transplants matched by age and serum creatinine. HE4 results may be misleading in these patients.

     

原发性高血压患者血压变异性与尿微量白蛋白/尿肌酐比值研究

目的：探讨原发性高血压患者血压变异性（BPV）与尿微量白蛋白/尿肌酐的关系。方法：103例符合入选标准的原发性高血压患者作为高血压组,并选96例健康体检者作为对照组,予24h监测动态血压、血压变异性及尿微量白蛋白,比较两组血压变异性与尿微量白蛋白/尿肌酐的关系。结果：各组患者在年龄、性别、吸烟史、总胆固醇、甘油三酯、空腹血糖以及体重指数等指标方面比较无差异性(P>0.05),高血压组患者昼间SBPV、夜间SBPV和24h SBPV均显著高于对照组(P<0.01);高血压组尿微量白蛋白、尿微量白蛋白/尿肌酐比值显著高于对照组(P<0.05)。结论：血压变异程度与尿微量白蛋白/尿肌酐具有相关性,可预测高血压早期的肾功能损害。