Renal physiology in the healthy oldest old has the fol-lowing characteristics, in comparison with the renal physiology in the young： a reduced creatinine clear-ance, tubular pattern of creatinine back-fltration, pre-...Renal physiology in the healthy oldest old has the fol-lowing characteristics, in comparison with the renal physiology in the young： a reduced creatinine clear-ance, tubular pattern of creatinine back-fltration, pre-served proximal tubule sodium reabsorption and uric acid secretion, reduced sodium reabsorption in the thick ascending loop of Henle, reduced free water clear-ance, increased urea excretion, presence of medulla hypotonicity, reduced urinary dilution and concentra-tion capabilities, and fnally a reduced collecting tubules response to furosemide which expresses a reduced potassium excretion in this segment due to a sort of aldosterone resistance. All physiological changes of the aged kidney are the same in both genders.展开更多
Metabolic bone disease after kidney transplantation has a complex pathophysiology and heterogeneous histology. Pre-existing renal osteodystrophy may not resolve completely, but continue or evolve into a dif-ferent ost...Metabolic bone disease after kidney transplantation has a complex pathophysiology and heterogeneous histology. Pre-existing renal osteodystrophy may not resolve completely, but continue or evolve into a dif-ferent osteodystrophy. Rapid bone loss immediately after transplant can persist, at a lower rate, for years to come. These greatly increase the risk of bone fracture and vertebral collapse. Each patient may have multiple risk factors of bone loss, such as steroids usage, hypo-gonadism, persistent hyperparathyroidism （HPT）, poor allograft function, metabolic acidosis, hypophosphate-mia, vitamin D defciency, aging, immobility and chronic disease. Clinical management requires a comprehen-sive approach to address the underlying and ongoing disease processes. Successful prevention of bone loss has been shown with vitamin D, bisphosphonates, cal-citonin as well as treatment of hypogonadism and HPT. Novel approach to restore the normal bone remodeling and improve the bone quality may be needed in order to effectively decrease bone fracture rate in kidney transplant recipients.展开更多
Currently,the growing number of end-stage renal disease patients in developing countries consumes a greater proportion of healthcare budget,and increasing attention is being focused on the cost-effectiveness of the pr...Currently,the growing number of end-stage renal disease patients in developing countries consumes a greater proportion of healthcare budget,and increasing attention is being focused on the cost-effectiveness of the procedure.We aimed to assess the cost-effectiveness of living-related renal transplantation (RTx) as compared with that for hemodialysis (HD) and identify medical factors associated with charges for RTx in northwestern China.This study was a retrospective analysis of 372 patients on regular HD and 122 living-related kidney transplant recipients on regular follow-up for at least 3 years in northwestern China.All data on charges included HD procedure,RTx procedure,the cost for donor operation,immunosuppression,and follow-up medicare.The average annual cost to all patients on HD and kidney recipients during the first 3 years after RTx was $14482/$31027,$13502/$11038,and $13382/$10243,respectively.The three variables were found to be significant in predicting increased costs for RTx:diltiazem administration,acute rejection and infection complications.We concluded that from the second year on,RTx in China was more effective and less costly than dialysis treatment,although recipients without diltiazem administration and with acute rejection or infection proved costlier during the first year after transplantation.展开更多
文摘Renal physiology in the healthy oldest old has the fol-lowing characteristics, in comparison with the renal physiology in the young： a reduced creatinine clear-ance, tubular pattern of creatinine back-fltration, pre-served proximal tubule sodium reabsorption and uric acid secretion, reduced sodium reabsorption in the thick ascending loop of Henle, reduced free water clear-ance, increased urea excretion, presence of medulla hypotonicity, reduced urinary dilution and concentra-tion capabilities, and fnally a reduced collecting tubules response to furosemide which expresses a reduced potassium excretion in this segment due to a sort of aldosterone resistance. All physiological changes of the aged kidney are the same in both genders.
文摘Metabolic bone disease after kidney transplantation has a complex pathophysiology and heterogeneous histology. Pre-existing renal osteodystrophy may not resolve completely, but continue or evolve into a dif-ferent osteodystrophy. Rapid bone loss immediately after transplant can persist, at a lower rate, for years to come. These greatly increase the risk of bone fracture and vertebral collapse. Each patient may have multiple risk factors of bone loss, such as steroids usage, hypo-gonadism, persistent hyperparathyroidism （HPT）, poor allograft function, metabolic acidosis, hypophosphate-mia, vitamin D defciency, aging, immobility and chronic disease. Clinical management requires a comprehen-sive approach to address the underlying and ongoing disease processes. Successful prevention of bone loss has been shown with vitamin D, bisphosphonates, cal-citonin as well as treatment of hypogonadism and HPT. Novel approach to restore the normal bone remodeling and improve the bone quality may be needed in order to effectively decrease bone fracture rate in kidney transplant recipients.
基金Supported by the Science Foundation of Shaanxi Province (No. SJ08C201)
文摘Currently,the growing number of end-stage renal disease patients in developing countries consumes a greater proportion of healthcare budget,and increasing attention is being focused on the cost-effectiveness of the procedure.We aimed to assess the cost-effectiveness of living-related renal transplantation (RTx) as compared with that for hemodialysis (HD) and identify medical factors associated with charges for RTx in northwestern China.This study was a retrospective analysis of 372 patients on regular HD and 122 living-related kidney transplant recipients on regular follow-up for at least 3 years in northwestern China.All data on charges included HD procedure,RTx procedure,the cost for donor operation,immunosuppression,and follow-up medicare.The average annual cost to all patients on HD and kidney recipients during the first 3 years after RTx was $14482/$31027,$13502/$11038,and $13382/$10243,respectively.The three variables were found to be significant in predicting increased costs for RTx:diltiazem administration,acute rejection and infection complications.We concluded that from the second year on,RTx in China was more effective and less costly than dialysis treatment,although recipients without diltiazem administration and with acute rejection or infection proved costlier during the first year after transplantation.
