Chronic kidney disease(CKD) is associated with a high burden of coronary artery disease. In patients with acute coronary syndromes(ACS), CKD is highly prevalent and associated with poor short- and long-term outcomes. ...Chronic kidney disease(CKD) is associated with a high burden of coronary artery disease. In patients with acute coronary syndromes(ACS), CKD is highly prevalent and associated with poor short- and long-term outcomes. Management of patients with CKD presenting with ACS is more complex than in the general population because of the lack of well-designed randomized trials assessing therapeutic strategies in such patients. The almost uniform exclusion of patients with CKD from randomized studies evaluating new targeted therapies for ACS, coupled with concerns about further deterioration of renal function and therapy-related toxic effects, may explain the less frequent use of proven medical therapies in this subgroup of high-risk patients. However, these patients potentially have much to gain from conventional revascularization strategies used in the general population. The objective of this review is to summarize the current evidence regarding the epidemiology and the clinical and prognostic relevance of CKD in ACS patients, in particular with respect to unresolved issues and uncertainties regarding recommended medical therapies and coronary revascularization strategies.展开更多
Objective: To use the etiology list of abdominal pain to help identify acute abdominal pain. Methods: to design a list of causes of acute abdominal pain as per the concept of system thinking, determine the five differ...Objective: To use the etiology list of abdominal pain to help identify acute abdominal pain. Methods: to design a list of causes of acute abdominal pain as per the concept of system thinking, determine the five differential diagnosis directions of “local organ disease, adjacent organ disease, systemic disease, psychogenic disease, and female reproductive system disease”, and elaborate the application effect of the checklist in the diagnosis of acute abdominal pain by virtue of the analysis of one case of acute abdominal pain. Results: according to the list of causes of abdominal pain, the causes of acute abdominal pain were screened, and patients suffering from acute renal infarction (ARI) who presented with simple abdominal pain were diagnosed and treated timely. Conclusion: the etiology list is helpful to guide the diagnosis direction of acute abdominal pain, and make a rapid clinical diagnosis, so as to form a systematic thinking mode.展开更多
Objective： To investigate the relationship between renal function and clinical outcomes among patients with acute ST-segment elevation myocardial infamtion （ASTEMI）, who were treated with emergency percutaneous cor...Objective： To investigate the relationship between renal function and clinical outcomes among patients with acute ST-segment elevation myocardial infamtion （ASTEMI）, who were treated with emergency percutaneous coronary intervention （PCI）. Methods： 420 patients hospitalized in Peking University First Hospital, diagnosed with ASTEMI treated with emergency （PCI） from January 2001 to June 2011 were enrolled in this study. Estimated glomerular filtration rate （eGFR） was used as a measure of renal function. We compared the clinical parameters and outcomes between ASTEMI patients combined renal insufficiency and the patients with normal renal function. Results： There was a significant increase in the concentrations of fibrinogen and D-Dimer （P〈0.05） and a much higher morbidity of diabetes mellitus in the group of patients with chronic kidney disease （CKD; eGFR〈60 ml/（min-1.73 m^2）） （P〈0.01）. CKD （eGFR〈60 ml/（min.1.73 m^2）） was an independent predictor of in-hospital mortality for patients hospitalized with ASTEMI receiving PCI therapy rapidly （P=0.032, odds ratio （OR） 4.159, 95% confidence interval （CI） 1.127-15.346）. Conclusions： Renal insufficiency is an independent predictor of in-hospital mortality for patients hospitalized with ASTEMI treated with primary PCI.展开更多
Background Prognosis of patients with acute ST-elevation myocardial infarction （STEMI） and renal dysfunction （RD） who received primary percutaneous coronary intervention （PCI） has not been fully investigated in ...Background Prognosis of patients with acute ST-elevation myocardial infarction （STEMI） and renal dysfunction （RD） who received primary percutaneous coronary intervention （PCI） has not been fully investigated in the drug-eluting stent （DES） era. This study aimed to evaluate the impact of admission serum creatinine level on short-term outcomes in patients with acute STEMI undergoing DES-based primary PCI. Methods Primary PCI with DES implantation was attempted in 619 consecutive STEMI patients within 12 hours of symptom onset. Among them, 86 patients had a serum creatinine level ≥115 μmol/L on admission （RD group）, and the remaining 533 patients had normal renal function （non-RD group）. The primary endpoint was 30-day major adverse cardiac events （MACE, including death, non-fatal reinfarction, and target vessel revascularization）, and the secondary endpoint was subacute stent thrombosis. Results Patients in the RD group were older than those in the non-RD group. There are more female patients in the RD group and they had a history of hypertension, myocardial infarction and revascularization. The occurrence rates of Killip class ≥2 （29.1% vs 18.6%, P=0.02） and multi-vessel （62.8% vs 44.5%, P=0.001） and triple vessel disease （32.6% vs 18.2%, P=0.002）, in-hospital mortality （9.3% vs 3.8%, P=0.03）, and MACE rate during hospitalization （17.4% vs 7.7%, P=-0.006） were higher in the RD group than those in the non-RD group. At a 30-day clinical follow-up, the MACE-free survival rate was significantly reduced in the RD group （76.7% vs 89.9%, P=-0.0003）. Angiographic stent thrombosis occurred in 3 （3.5%） and 7 （1.3%） of patients in the RD group and non-RD group, respectively （P=0.15）. Multivariate analysis revealed that the serum creatinine level 〉115 μmol/L on admission was an independent predictor for MACE rate at a 30-day follow-up （Hazard ratio （HR） 3.31,95% CI 1.19-9.18, P 〈0.001）. Conclusion Despite similar prevalence of stent thrombosis at a 30-day clinical follow-up, the short-term prognosis of STEMI patients with elevated serum creatinine on admission undergoing DES-based primary PCI remains unfavorable.展开更多
AIMTo investigate the role of contrast enhanced ultrasound (CEUS) in evaluating patients with renal function impairment (RFI) showing: (1) acute renal failure (ARF) of suspicious vascular origin; or (2) suspicious ren...AIMTo investigate the role of contrast enhanced ultrasound (CEUS) in evaluating patients with renal function impairment (RFI) showing: (1) acute renal failure (ARF) of suspicious vascular origin; or (2) suspicious renal lesions.METHODSWe retrospectively evaluated patients addressed to CEUS over an eight years period to rule-out vascular causes of ARF (first group of 50 subjects) or assess previously found suspicious renal lesions (second group of 41 subjects with acute or chronic RFI). After preliminary grey-scale and color Doppler investigation, each kidney was investigated individually with CEUS, using 1.2-2.4 mL of a sulfur hexafluoride-filled microbubble contrast agent. Image analysis was performed in consensus by two readers who reviewed digital clips of CEUS. We calculated the detection rate of vascular abnormalities in the first group and performed descriptive statistics of imaging findings for the second group.RESULTSIn the first group, CEUS detected renal infarction or cortical ischemia in 18/50 patients (36%; 95%CI: 23.3-50.9) and 1/50 patients (2%; 95%CI: 0.1-12), respectively. The detection rate of infarction was significantly higher (P = 0.0002; McNemar test) compared to color Doppler ultrasonography (10%). No vascular causes of ARF were identified in the remaining 31/50 patients (62%). In the second group, CEUS detected 41 lesions on 39 patients, allowing differentiation between solid lesions (21/41; 51.2%) vs complex cysts (20/41; 48.8%), and properly addressing 15/39 patients to intervention when feasible based on clinical conditions (surgery and cryoablation in 13 and 2 cases, respectively). Cysts were categorized Bosniak II, IIF, III and IV in 8, 5, 4 and 3 cases, respectively. In the remaining two patients, CEUS found 1 pseudolesion and 1 subcapsular hematoma.CONCLUSIONCEUS showed high detection rate of renal perfusion abnormalities in patients with ARF, influencing the management of patients with acute or chronic RFI and renal masses throughout their proper characterization.展开更多
Acute renal artery occlusion （ARAO） is a rare clinical entity. Typical clinical presentations of ARAO are non-specific and include acute lumbar or abdominal pain coexisting with nausea, vomiting and fever. Periphera...Acute renal artery occlusion （ARAO） is a rare clinical entity. Typical clinical presentations of ARAO are non-specific and include acute lumbar or abdominal pain coexisting with nausea, vomiting and fever. Peripheral emboli are the major cause of ARAO, predominantly arising from cardiac diseases. Other, relatively frequent causes of ARAO include atherosclerosis, trauma, dissection or renal artery aneurysms.展开更多
文摘Chronic kidney disease(CKD) is associated with a high burden of coronary artery disease. In patients with acute coronary syndromes(ACS), CKD is highly prevalent and associated with poor short- and long-term outcomes. Management of patients with CKD presenting with ACS is more complex than in the general population because of the lack of well-designed randomized trials assessing therapeutic strategies in such patients. The almost uniform exclusion of patients with CKD from randomized studies evaluating new targeted therapies for ACS, coupled with concerns about further deterioration of renal function and therapy-related toxic effects, may explain the less frequent use of proven medical therapies in this subgroup of high-risk patients. However, these patients potentially have much to gain from conventional revascularization strategies used in the general population. The objective of this review is to summarize the current evidence regarding the epidemiology and the clinical and prognostic relevance of CKD in ACS patients, in particular with respect to unresolved issues and uncertainties regarding recommended medical therapies and coronary revascularization strategies.
文摘Objective: To use the etiology list of abdominal pain to help identify acute abdominal pain. Methods: to design a list of causes of acute abdominal pain as per the concept of system thinking, determine the five differential diagnosis directions of “local organ disease, adjacent organ disease, systemic disease, psychogenic disease, and female reproductive system disease”, and elaborate the application effect of the checklist in the diagnosis of acute abdominal pain by virtue of the analysis of one case of acute abdominal pain. Results: according to the list of causes of abdominal pain, the causes of acute abdominal pain were screened, and patients suffering from acute renal infarction (ARI) who presented with simple abdominal pain were diagnosed and treated timely. Conclusion: the etiology list is helpful to guide the diagnosis direction of acute abdominal pain, and make a rapid clinical diagnosis, so as to form a systematic thinking mode.
文摘Objective： To investigate the relationship between renal function and clinical outcomes among patients with acute ST-segment elevation myocardial infamtion （ASTEMI）, who were treated with emergency percutaneous coronary intervention （PCI）. Methods： 420 patients hospitalized in Peking University First Hospital, diagnosed with ASTEMI treated with emergency （PCI） from January 2001 to June 2011 were enrolled in this study. Estimated glomerular filtration rate （eGFR） was used as a measure of renal function. We compared the clinical parameters and outcomes between ASTEMI patients combined renal insufficiency and the patients with normal renal function. Results： There was a significant increase in the concentrations of fibrinogen and D-Dimer （P〈0.05） and a much higher morbidity of diabetes mellitus in the group of patients with chronic kidney disease （CKD; eGFR〈60 ml/（min-1.73 m^2）） （P〈0.01）. CKD （eGFR〈60 ml/（min.1.73 m^2）） was an independent predictor of in-hospital mortality for patients hospitalized with ASTEMI receiving PCI therapy rapidly （P=0.032, odds ratio （OR） 4.159, 95% confidence interval （CI） 1.127-15.346）. Conclusions： Renal insufficiency is an independent predictor of in-hospital mortality for patients hospitalized with ASTEMI treated with primary PCI.
文摘Background Prognosis of patients with acute ST-elevation myocardial infarction （STEMI） and renal dysfunction （RD） who received primary percutaneous coronary intervention （PCI） has not been fully investigated in the drug-eluting stent （DES） era. This study aimed to evaluate the impact of admission serum creatinine level on short-term outcomes in patients with acute STEMI undergoing DES-based primary PCI. Methods Primary PCI with DES implantation was attempted in 619 consecutive STEMI patients within 12 hours of symptom onset. Among them, 86 patients had a serum creatinine level ≥115 μmol/L on admission （RD group）, and the remaining 533 patients had normal renal function （non-RD group）. The primary endpoint was 30-day major adverse cardiac events （MACE, including death, non-fatal reinfarction, and target vessel revascularization）, and the secondary endpoint was subacute stent thrombosis. Results Patients in the RD group were older than those in the non-RD group. There are more female patients in the RD group and they had a history of hypertension, myocardial infarction and revascularization. The occurrence rates of Killip class ≥2 （29.1% vs 18.6%, P=0.02） and multi-vessel （62.8% vs 44.5%, P=0.001） and triple vessel disease （32.6% vs 18.2%, P=0.002）, in-hospital mortality （9.3% vs 3.8%, P=0.03）, and MACE rate during hospitalization （17.4% vs 7.7%, P=-0.006） were higher in the RD group than those in the non-RD group. At a 30-day clinical follow-up, the MACE-free survival rate was significantly reduced in the RD group （76.7% vs 89.9%, P=-0.0003）. Angiographic stent thrombosis occurred in 3 （3.5%） and 7 （1.3%） of patients in the RD group and non-RD group, respectively （P=0.15）. Multivariate analysis revealed that the serum creatinine level 〉115 μmol/L on admission was an independent predictor for MACE rate at a 30-day follow-up （Hazard ratio （HR） 3.31,95% CI 1.19-9.18, P 〈0.001）. Conclusion Despite similar prevalence of stent thrombosis at a 30-day clinical follow-up, the short-term prognosis of STEMI patients with elevated serum creatinine on admission undergoing DES-based primary PCI remains unfavorable.
文摘AIMTo investigate the role of contrast enhanced ultrasound (CEUS) in evaluating patients with renal function impairment (RFI) showing: (1) acute renal failure (ARF) of suspicious vascular origin; or (2) suspicious renal lesions.METHODSWe retrospectively evaluated patients addressed to CEUS over an eight years period to rule-out vascular causes of ARF (first group of 50 subjects) or assess previously found suspicious renal lesions (second group of 41 subjects with acute or chronic RFI). After preliminary grey-scale and color Doppler investigation, each kidney was investigated individually with CEUS, using 1.2-2.4 mL of a sulfur hexafluoride-filled microbubble contrast agent. Image analysis was performed in consensus by two readers who reviewed digital clips of CEUS. We calculated the detection rate of vascular abnormalities in the first group and performed descriptive statistics of imaging findings for the second group.RESULTSIn the first group, CEUS detected renal infarction or cortical ischemia in 18/50 patients (36%; 95%CI: 23.3-50.9) and 1/50 patients (2%; 95%CI: 0.1-12), respectively. The detection rate of infarction was significantly higher (P = 0.0002; McNemar test) compared to color Doppler ultrasonography (10%). No vascular causes of ARF were identified in the remaining 31/50 patients (62%). In the second group, CEUS detected 41 lesions on 39 patients, allowing differentiation between solid lesions (21/41; 51.2%) vs complex cysts (20/41; 48.8%), and properly addressing 15/39 patients to intervention when feasible based on clinical conditions (surgery and cryoablation in 13 and 2 cases, respectively). Cysts were categorized Bosniak II, IIF, III and IV in 8, 5, 4 and 3 cases, respectively. In the remaining two patients, CEUS found 1 pseudolesion and 1 subcapsular hematoma.CONCLUSIONCEUS showed high detection rate of renal perfusion abnormalities in patients with ARF, influencing the management of patients with acute or chronic RFI and renal masses throughout their proper characterization.
文摘Acute renal artery occlusion （ARAO） is a rare clinical entity. Typical clinical presentations of ARAO are non-specific and include acute lumbar or abdominal pain coexisting with nausea, vomiting and fever. Peripheral emboli are the major cause of ARAO, predominantly arising from cardiac diseases. Other, relatively frequent causes of ARAO include atherosclerosis, trauma, dissection or renal artery aneurysms.
