Occult Adrenal Insufficiency in Patients with Chronic Renal Disease

Background: Addison’s disease is a rare disorder of the adrenal cortex that leads to inadequate production of cortisol initially followed by aldosterone and androgens. Its manifestations are usually slow and non-specific with potential for life-threatening adrenal crisis following hypermetabolic demands (infection, trauma, surgery). Patients: Over the past 10 years, 19 CRD-patients were diagnosed with occult PAI in our center. Results: Unprovoked hypotension was the most common manifestations of occult PAI and was the unmasking event in 11 (58%). It was without significant cardiac and/or severe systemic sepsis and was refractory to isotonic saline infusions. Equal number of the remaining patients (n = 2) presented with persistent and inexplicable electrolytes abnormalities viz. 1) hyponatremia despite restricted oral fluid intake, lack of dehydration and massive fluid overload, as well as 2) hyperkalemia despite potassium-restricted diet, hyperkalemic drugs and adequate therapy with Furosemide and low-potassium dialysis-baths. On the other hand, similar proportions presented with unprovoked 3) progressive weight loss, decrease appetite and cachexia as well as 4) frequent hypoglycemic attacks. All patients were treated and were medically stable after 29 (2 - 60) months of follow up. Autoantibodies to 21-hydroxylase enzyme were positive in 16 (90%). At diagnosis, and subsequent follow up, only 7 patients (37%) had multi-endocrine dysfunction of whom 2 with type 1 and 5 with type 2. Conclusion: High index of suspicion should be exerted in diagnosis of PAI in patients with CRD, since its clinical picture is similar to CRD manifestations and complications. In those patients, confirmatory tests and specific management can save their lives. .

Clinical Features of Renal Insufficiency due to Multiple Myeloma and Related Risk Factors

Objective: To study clinical features of the patients with multiple myeloma(MM) accompanied by renal insufficiency and investigate the related risk factors of renalimpairment. Methods: A control study of clinical characteristics was performed between 91 patientswith renal insufficiency due to MM and 165 patients with normal renal function in MM during the sameperiod. The data were statistically analyzed by chi-square test and logistic regression analysis.Results: Renal insufficiency was the initial presentation in 48 (52.7%) of the 91 patients, and 30(62.5%) of the 48 patients were misdiagnosed. The prognosis of group with renal insufficiency wassignificantly poorer than that of group with normal renal function: mortality in 3 months, 3months-1 year was 26/91 vs 14/165 (P 【 0.0001), 14/91 vs 12/165 (P 【 0.05) respectively, andpatients survived 】 1 year was 18/91 vs 95/165 (P 【 0.0001). The incidence of hypercalcemia,hyperuricemic, severe anemia, high serum M-protein concentration and lytic bone lesions weresignificantly higher in renal insufficiency group than those in control group (P 【 0.05). Logisticregression analysis identified 5 risk factors of renal impairment, including, severe anemia(Exp(β)=13.819, P 【 0.0001), use of nephrotoxic drugs (Exp(β)=6.217, P = 0.001), high serumM-protein concentration (Exp(β) = 5.026, P = 0.001), male (Exp(β)=3.745, P=0.006), andhypercalcemia (Exp(β)=3A72, P=0.006), but age, serum density of uric acid, type of serum M-protein,and Bence Jones proteinuria were not significantly associated with renal insufficiency. Conclusion:Renal insufficiency was a common early complication of MM, which often resulted in misdiagnosis.The status of these patients tended to be very bad, with many other complications, when MM wasdiagnosed, so their prognosis was poor. The occurrence of renal insufficiency in patients with MMand hypercalcemia, severe anemia, high serum M-protein concentration, especially use of nephrotoxicdrugs should be alert.

Expression of HO-1 in Chronic Renal Insufficiency Rat Kidney and Implication

The expression, activity and clinical implication of heme oxygenase-1 (HO-1) in the chronic renal insufficiency (CRI) rat kidney and its mechanism were investigated The 5/6 nephrectomized rats were assigned to sham operation group, CRI group and Hemin group At the 8th week after second operation, blood pressure, urinary protein, serum creatinine(Scr) and BUN were measured Renal pathologic changes were observed The activity of HO and contents of erythropoietin (EPO) in serum and renal tissue were determined Immunohistochemistry was used to detect the expression and distribution of HO-1 in the CRI rat kidney As compared with CRI group, the urinary protein, blood pressure, Scr and BUN in Hemin group were reduced significantly ( P< 0 05) The glomerular mesangial proliferation, inflammatory cellular infiltration of renal interstitium and interstitial fibrosis were ameliorated significantly Immunohistochemistry and measurement of HO-1 activity revealed that the expression and activity of HO-1 was decreased in renal tissues and increased in serum in CRI group as compared with normal rats HO-1 distributed mainly in tubular epithelial cells The EPO contents in Hemin group were significantly higher than in CRI group Through up-regulating the EPO level in serum and renal tissues, HO-1 retards the progression of CRI

Low-molecular-weight dextran for optical coherence tomography may not be protective against kidney injury in patients with renal insufficiency

BACKGROUND Low-molecular-weight dextran(LMWD)is considered a safe alternative to contrast media for blood displacement during optical coherence tomography(OCT)imaging.AIM To investigate whether the use of LMWD for OCT is protective against kidney injury in patients with advanced renal insufficiency.METHODS In this retrospective cohort study,we identified 421 patients with advanced renal insufficiency(estimated glomerular filtration rate<45 mL/min/1.73 m2)who underwent coronary angiography or percutaneous coronary intervention;79 patients who used additional LMWD for OCT imaging(LMWD group)and 342 patients who used contrast medium exclusively(control group).We evaluated the differences between these two groups and performed a propensity score-matched subgroup comparison.RESULTS The median total volume of contrast medium was 133.0 mL in the control group vs 140.0 mL in the LMWD group.Although baseline renal function was not statistically different between these two groups,the LMWD group demonstrated a strong trend toward the progression of renal insufficiency as indicated by the greater change in serum creatinine level during the 1-year follow-up compared with the control group.Patients in the LMWD group experienced worsening renal function more frequently than patients in the control group.Propensity score matching adjusted for total contrast media volume consistently indicated a trend toward worsening renal function in the LMWD group at the 1-year follow-up.Delta serum creatinine at 1-year follow-up was significantly greater in the LMWD group than that in the control group[0.06(-0.06,0.29)vs-0.04(-0.23,0.08)mg/dL,P=0.001],despite using similar contrast volume.CONCLUSION OCT using LMWD may not be protective against worsening renal function in patients with advanced renal insufficiency.

Atherosclerosis in elderly patients with renal insufficiency

IntroductionAs people age,cardiovascular structure and function change and this is superimposed on by specific pathophysiologic disease mechanism.In addition to lipid levels,diabetes,sedentary lifestyle,and genetic factors that are known risks for coronary disease,hypertension,and stroke - the quintessential cardiovascular (CV) diseases related to atherosclerosis within our society - advancing age unequivocally confers the major risk.(Fig.1) Mortality due to cardiovascular disease is more than any other disease and creates enormous costs for the health care system.The main underlying problem in cardiovascular disease is atherosclerosis,a process that obstructs major arteries with lipid deposits and cell accumulation.1 Decreased kidney function (estimated GFR＜70 mL/min/1.73 m2) is an independent risk factor for cardiovascular disease and all-cause mortality in the general population.

Protective Effects of Mongolian Medicine Borantunggal on Rats with Chronic Renal Insufficiency

[Objectives]To observe the protective effects of Mongolian medicine Borantunggal on rats with chronic renal insufficiency.[Methods]Male Wister rats were gavaged with 50 mg/kg/d adenine for 12 consecutive weeks,and were intervened with positive control drug Niaoduqing and three groups of different doses of Mongolian medicine Borantunggal.The rats general state,such as body posture,hair color,activity status,renal function,thyroid gland,adrenal gland,and gonadal hormone levels,expression levels of inflammatory mediators,α-smooth muscle actin(α-SMA)and nuclear factor-κB(P65)in renal tissue,and histopathological changes of rat kidney were observed before and after treatment.[Results]The recovery of the general state of rats with chronic renal insufficiency in the low dose group after intervention with Mongolian medicine Borantunggal was the most obvious.Compared with the model group,the level of CRE in the low dose Mongolian medicine group decreased,and the difference was statistically significant(P<0.05).Compared with the normal group,the 24-h urinary protein in the low dose Mongolian medicine group had a declining trend,but the difference was not statistically significant(P>0.05).The urea level in low,medium and high dose Mongolian medicine groups showed a declining trend,and the effect of low dose Mongolian medicine was better.Compared with the model group,the feed intake of the low dose Mongolian medicine group had an increasing trend,while P and TCHO also had a declining trend.Compared with the model group,the levels of LH and COR in the low,medium and high dose Mongolian medicine groups decreased significantly,and the difference was statistically significant(P<0.05).The levels of T,T3 and T4 were significantly increased,the difference was statistically significant(P<0.05),and the effect of low dose Mongolian medicine was better.Compared with the model group,the levels of IL-6,TNF-αand HIF-1 in the low,medium and high dose Mongolian medicine groups were significantly reduced,and the difference was statistically significant(P<0.05).The levels of TGF-β1 and Ang II in the low dose Mongolian medicine group were significantly reduced,and the difference was statistically significant(P<0.05).The level of TGF-β1 in the medium and high dose Mongolian medicine groups decreased,and the difference was statistically significant(P<0.05).The expression of NF-κB P65 andα-SMA proteins in the low dose Mongolian medicine group showed a declining trend,which was better than Niaoduqing.[Conclusions]Mongolian medicine Borantunggal has significant protective and preventive effects on rats with adenine-induced chronic renal insufficiency.In particular,the dose of 0.31 kg/d had the most significant protective effect.Its action mechanism may be related to regulating hormone levels in the body,improving renal function,reducing renal inflammatory response,reducing the"three highs"in the kidney,and inhibiting renal tubular epithelial cell-to-mesenchymal transition and deposition of extracellular matrix(ECM).

Heparin-induced thrombocytopenia in renal insufficiency undergoing dialysis and percutaneous coronary intervention after acute myocardial infarction:A case report

BACKGROUND Heparin-induced thrombocytopenia(HIT)is a rare complication of heparin therapy,and is characterized by arteriovenous thrombosis and bleeding events.The incidence of HIT after percutaneous coronary intervention(PCI)in patients with myocardial infarction complicated with renal failure is rarely reported.CASE SUMMARY We report a 73-year-old man with acute myocardial infarction and renal failure who underwent hemodialysis and PCI,and developed a progressive decline in platelets and subcutaneous hemorrhage of both upper limbs after heparin treatment.In addition to a gradual decrease in platelets,the patient’s 4T's score was 7,and HIT antibody was positive,confirming the diagnosis of HIT.CONCLUSION Patients receiving heparin combined with antiplatelet therapy should be monitored closely,especially for their platelet count.In the case of thrombocytopenia,HIT should be highly suspected.When the diagnosis of HIT is confirmed,timely individualized treatment should be delivered.

A 75-year-old man with renal insufficiency and eosinophilia after coronary angiography

Case presentation A 75-year-old male patient received esophageal carcinoma surgery in Oct 2005. The next day of the operation, he had dyspnea, chest discomfort and sweating when he was on some activities. ……

Platelet reactivity and clinical outcome in patients with renal insufficiency undergoing percutaneous coronary intervention

Background and Objective Renal insufficiency(RI)is reported to be associated with increased ischemic and bleeding events after percutaneous coronary intervention(PCI),which is possibly due to high residual platelet reactivity(HRPR)during DAPT therapy.Therefore,we performed a large prospective observational study to evaluate the platelet reactivity and related clinical outcomes in real-world patients with different renal insufficiency stage after PCI,and to examine whether HRPR is associated with higher incidence of adverse cardiovascular events in a 2-year follow up.

Prevalence and the Risk Factors of Renal Insufficiency in the City of Saint Louis in Senegal

Background: The true scale of renal insufficiency (RI) in Sub-Saharan Africa remains unknown due to the lack of national registries. The aim of this study is to describe the epidemiological characteristics of renal insufficiency in urban areas in Saint Louis of Senegal. Materials and Methods: It is an observational, cross-sectional and descriptive study. The study was conducted during 27 days starting from 3 to 30 May 2010. All senegalese residents of Saint Louis (older than 15 years at the time of the study) in whom creatinine clearance was performed were included in the study. The sampling method used was a systematic random sampling, stratified cluster. The survey was designed by an expert comitee based on STEPS survey of the World Health Organization. RI was defined as a glomerular filtration rate (GFR) 2. Results: Among 1424 people initially selected a final selection of 1416 was made. The sex ratio was 0.45. The mean age was 43.4 ± 17.8 years. The overall prevalence of renal insufficiency according to MDRD (Modification of diet in renal disease) formula was 181 cases or 12.7%. The mean age of the people with renal insufficiency was 47.6 ± 17.4 years. Renal insufficiency was correlated to height blood pressure (p = 0.01) and Physical inactivity (p = 0.0001). The prevalence of renal insufficiency was higher in diabetics (71.4%) and obese people (66.6%) than in non-diabetics (64.9%) and non-obese people (56.5%), although the difference was not statistically significant. Dyslipidemia and smoking were not correlated to the risk of occurrence of IR. Conclusions: This study reports the increasing magnitude of RI and its risk factors in the city of Saint Louis in Senegal. It is imperative to establish à national prevention strategies to avoid the dizzying growth of this scourge.

Effects of bortezomib combined with dexamethasone and thalidomide on bone metabolism regulating factors, immune function and renal function in patients with multiple myeloma complicated with renal insufficiency

Objective: To investigate the effects of bortezomib combined with dexamethasone and thalidomide on the levels of bone metabolism regulating factors, immune function and renal function in patients with multiple myeloma complicated with renal insufficiency. Methods:According to the random data table, a total of 90 patients with multiple myeloma complicated with renal insufficiency were divided into the control group (n=45) and observation group (n=45), patients in the two groups were treated with diuretic, hydration and other symptomatic and supportive treatment, on this basis, the control group were treated with cyclophosphamide, dexamethasone and thalidomide regimen treatment, and the patients in the observation group were given bortezomib, dexamethasone and thalidomide regimen treatment, before treatment (before chemotherapy) and after treatment (3 cycles of chemotherapy) the levels of bone metabolic regulating factors, immune function and renal function between the two groups were compared. Results: The difference of the levels of RANKL, TRACP-5b, CD3+, CD4+, CD8+, CD4+/CD8+, SCr, BUN in the two groups before treatment were not significant. Compared with the control groups levels after treatment, the levels of RANKL, TRACP-5b, CD8+, SCr and BUN in the observation group were significantly decreased, and the levels of CD3+, CD4+and CD4+/CD8+ were significantly increased, the difference was statistically significant. Conclusion: Bortezomib in combination with dexamethasone and thalidomide in treatment of multiple myeloma with renal insufficiency, can effectively reduce the level of bone metabolism in regulating factor, improve immune function and renal function, it has an important clinical value.

A Multicentre Prospective Evaluation of the Impact of Renal Insufficiency on In-hospital and Long-term Mortality of Patients with Acute ST-elevation Myocardial Infarction

Background：Numerous previous studies have shown that renal insufficiency （RI） in patients with acute coronary syndrome is associated with poor cardiovascular outcomes.These studies do not well address the impact of RI on the long-term outcome of patients with acute ST-elevation myocardial infarction （STEMI） in China.The aim of this study was to investigate the association of admission RI and inhospital and long-term mortality of patients with acute STEMI.Methods：This was a multicenter,observational,prospective-cohort study.718 consecutive patients were admitted to 19 hospitals in Beijing within 24 hours of onset of STEMI,between January 1,2006 and December 31,2006.Estimation of glomerular filtration rate （eGFR） was calculated using the modified abbreviated modification of diet in renal disease equation-based on the Chinese chronic kidney disease patients.The patients were categorized according to eGFR,as normal renal dysfunction （eGFR ≥ 90 ml·min^-1·1.73 m^-2）,mild RI （60 ml·min^-1· 1.73 m^-2 〈 eGFR 〈 90 ml·min^-1· 1.73 m^2） and moderate or severe RI （eGFR 〈 60 ml·min^-1· 1.73 m^2）.The association between RI and inhospital and 6-year mortality of was evaluated.Results：Seven hundred and eighteen patients with STEMI were evaluated.There were 551 men and 167 women with a mean age of 61.0 ＆#177; 13.0 years.Two hundred and eighty patients （39.0%） had RI,in which 61 patients （8.5%） reached the level of moderate or severe RI.Patients with RI were more often female,elderly,hypertensive,and more patients had heart failure and stroke with higher killip class.Patients with RI were less likely to present with chest pain.The inhospital mortality （1.4% vs.5.9% vs.22.9%,P 〈 0.001）,6-year all-cause mortality （9.5% vs.19.8 vs.45.2%,P 〈 0.001） and 6-year cardiac mortality （2.9% vs.12.2% vs.23.8%,P 〈 0.001） were markedly increased in patients with RI.After adjusting for other confounding factors,classification of admission renal function was an independent predictor of inhospital mortality （Odd ratio,1.966; 95% confidence interval [CO,1.002-3.070,P =0.019）,6-year all-cause mortality （relative risk [RR] =1.501,95% CI：1.018-4.373,P =0.039） and 6-year cardiac mortality （RR =1.663,95% CI：1.122-4.617,P =0.042）.Conclusions：RI is very common in STEMI patients.RI evaluated by eGFR is an important independent predictor of short-term and long-term outcome in patients with acute STEMI.

Long term clinical outcomes in patients with moderate renal insufficiency undergoing stent based percutaneous coronary intervention

Background Patients with end-stage renal disease have a high mortality from coronary artery disease, but the impact of moderate renal insufficiency on clinical outcomes after percutaneous coronary intervention （PCI） and the effect of drug-eluting stent implantation in these patients remain unclear. This study determined the long-term effect of moderate renal insufficiency on death and major adverse cardiac events （MACE） after stent based PCI and examined whether drug-eluting stent implantation could favourably influence clinical outcome. Methods Major adverse cardiac events and causes of mortality were determined for 1012 patients undergoing percutaneous intervention from January 1, 2002 to December 31, 2004 at Shanghai Ruijin Hospital. Based on estimated creatinine clearance levels, long term outcomes were compared between patients with estimated creatinine clearance 〈60 ml/min （renal insufficiency group; n=410） and those with estimated creatinine clearance ≥60 ml/min （control group; n=602）. Subgroup analysis was also made for patients with renal insufficiency between drug eluting stent （n=264） and bare metal stent implantation （n=146） during PCI. Results During follow-up （average 17 months） after successful PCI, all causes of death （7.1% vs 2.3%, P〈0.01） and cardiac death （3.4% vs 1.0%, all P〈0.01） were significantly higher in renal insufficiency group than in control group. For patients with moderate renal insufficiency, drug-eluting stent implantation reduced significantly all causes of death （5.3% vs 10.9%, P〈0.05） and occurrence of major cardiac adverse events （15.1% vs 24.6%, P〈0.05） compared with bare metal stents. Conclusions Moderate renal insufficiency is an important clinical factor influencing the mortality after PCI in patients with coronary artery disease and the use of drug-eluting stents should be the preferred therapy for the improvement of long-term outcomes in such patients.

Coronary stenting does not improve the long-term cardiovascular outcome of patients with mild to moderate renal insufficiency

Background Several studies have shown that coronary stenting reduces the frequency of clinical and angiographic restenosis in patients with mild to moderate renal insufficiency. However, less is known about the long-term benefits of stent use in this population. This study was aimed to determine the impact of coronary stenting on extended （5 years） long-term outcomes of patients with chronic renal insufficiency. Methods The study included 602 consecutive patients who underwent successful percutaneous coronary intervention with stenting. Renal insufficiency was defined as an estimated glomerular filtration rate 〈60 rrd.min-1-｜.73 m-2. The major adverse cardiac events were compared for patients with （n=160） and without （n=442） renal insufficiency. Results After the third year of follow-up, nonfatal myocardial infarction and revascularization rates were significantly increased in patients with renal insufficiency compared with those without renal dysfunction （16.9% vs 7.7%, P=0.001; 29.4% vs 15.8%, P 〈0.001）. In patients who had recurrent cardiovascular events, a significantly higher rate of de novo stenosis revascularization was found in patients with renal insufficiency than without renal insufficiency （57.7% vs 22.7%, P 〈0.001）, while there was no significant difference in target lesion revascularization between the groups （51.9% vs 43.6%, P=0.323）. Multivariate analysis demonstrated an independent impact of the presence of renal insufficiency on the major adverse cardiac events （hazard ratio： 1.488, 95% confidence interval： 1.051-2.106, P=0.025） and de novo stenosis （hazard ratio： 5.505, 95% confidence interval： 2.151-14.090, P 〈0.001）. Conclusions The late major adverse cardiac events, after successful coronary stenting, is increased in patients with an estimated glomerular filtration rate 〈60 ml.min-1.1.73m-2. This might be associated with increased risk of de novo stenosis in this population. Chin Med J 2009; 122（2）： 158-164

Effects of Oenethera Oil on Plasma Lipid,Thromboxane A2 and AngiotensinⅡof Chronic Renal Insufficiency

Oenethera biennis oil was administered (6 g per day) in 23 chronic renal insufficiency pa-tients over a 4 week period. Changes of serum creatinine, creatinine clearance, plasma lipid, renin activity,and angiatensin , urinary thromboxane B2 and 6-keto-prostaglandin F1 were observed before and after thetreatment. Results showed that after treatment. the creatinine clearance increased, serum total cholesterol,triglyceride and low density lipoprotein decreased, high density lipoprotein increased, plasma renin activity,angiotensin and urinary thromboxane B2 decreased significantly. The conclusion was that Oenethera bien-nis oil could improve the pathological process of renal diseases, and has benoficial effects on plasma lipiddisorder and glomerular hemodynamics .

Effect of bivalirudin on coagulation function and prognosis in patients with coronary artery disease and renal insufficiency undergoing PCI

Background Renal insufficiency is associated with an excess risk of vascular complications and bleeding events in patients who undergo PCI. Heparin is still used commonly for PCI, but the bleeding complications is high. However, Bivalirudin is similar to heparin in ischemic complications and superior to the bleeding complica- tions. Methods A total of 181 patients with coronary artery disease and renal insufficiency were randomly as- signed two treatment groups： Bivalirudin （n = 90）, unfractionated heparin （n = 91）. Activated clotting time （ACT） was determined in patients at 5 min after undergoing PCI at the end of operation immediately （stopping drug im- mediately） , and 30 min,1 h, 2 h after stopping drug. Activated partial thromboplastin time （APTT）, thrombin time （TT）, proth rombin time （PT）, fibrinogen （FIB） index were measured before treatment, 6 h, 24 h and 72 h af- ter the treatment through an automated coagulation analyzer. Platelet count was monitored before treatment and 24 h after treatment. The end points were the proportion of net adverse clinical events （NACE） and stent throm- bosis at 30 days. Results The use of bivalirudin was associated with a statistically significant higher at 5 min af- ter treatment, end of operation immediately （P 〈 0.05）, with statistically significant lower at lh after stopping drug , 2h after stopping drug （P 〈 0.05）. There were no differences between patients at blood coagulation and platelet after operation （P 〉 0.05）, no differences in the 30-day rates of stent thrombosis （0% vs. 0%, P = 1）. Elev- en patients（12.22%） treated with bivalirudin vs. 24 （26.38%） treated with heparin experienced an adverse clinical events at 30 days （relative risk[RR], 0.46; 95%CI, 0.36-0.56; P 〈 0.025）. There were no differences in the major adverse cardiac or cerebral event at the 30-day end point（1.11% vs. 2.20%, P 〉 0.05）. The bleeding at 30 days was abated by using bivalirudin compared with unfracfionated heparin （11.11% vs. 24.18%, P 〈 0.05）. Conclu- sions Compared with the unfractionated heparin, bivalirudin is more quickly in taking effect and recovering and more efficient for PCI in patients with coronary artery disease and renal insufficiency.

Association between Helicobacter pylori and end-stage renal disease: A meta-analysis

To investigate the prevalence and association of Helicobacter pylori (H. pylori) with end-stage renal disease (ESRD).METHODSSA comprehensive literature search was completed from inception until October 2016. Studies that reported prevalence, relative risks, odd ratios, hazard ratios or standardized incidence ratio of H. pylori among ESRD patients were included. Participants without H. pylori were used as comparators to assess the association between H. pylori infection and ESRD. Pooled risk ratios and 95%CI was calculated using a random-effect model. Adjusted point estimates from each study were combined by the generic inverse variance method of DerSimonian and Laird.RESULTSOf 4546 relevant studies, thirty-seven observational studies met all inclusion criteria. Thirty-five cross-sectional studies were included in the analyses to assess the prevalence and association of H. pylori with ESRD. The estimated prevalence of H. pylori among ESRD patients was 44% (95%CI: 40%-49%). The pooled RR of H. pylori in patients with ESRD was 0.77 (95%CI: 0.59-1.00) when compared with the patients without ESRD. Subgroup analysis showed significantly reduced risk of H. pylori in adult ESRD patients with pooled RR of 0.71 (95%CI: 0.55-0.94). The data on the risk of ESRD in patients with H. pylori were limited. Two cohort studies were included to assess the risk of ESRD in patients with H. pylori. The pooled risk RR of ESRD in patients with H. pylori was 0.61 (95%CI: 0.03-12.20).CONCLUSIONThe estimated prevalence of H. pylori in ESRD patients is 44%. Our meta-analysis demonstrates a decreased risk of H. pylori in adult ESRD patients.

Major influence of renal function on hyperlipidemia after living donor liver transplantation

AIM:To investigate the impact of renal and graft function on post-transplant hyperlipidemia(PTHL) in living donor liver transplantation(LDLT).METHODS:A total of 115 adult patients undergoing LDLT from January 2007 to May 2009 at a single center were enrolled.Data were collected and analyzed by the China Liver Transplant Registry retrospectively.PTHL was defined as serum triglycerides ≥ 150 mg/dL or serum cholesterol ≥ 200 mg/dL or the need for pharmacologic treatment at the sixth month after LDLT.Early renal dysfunction(ERD) was defined as serum creatinine ≥ 2 mg/dL and/or the need for renal replacement therapy in the first post-transplant week.RESULTS:In 115 eligible patients,the incidence of PTHL was 24.3%.Recipients with PTHL showed a higher incidence of post-transplant cardiovascular events compared to those without PTHL(17.9% vs 4.6%,P = 0.037).Serum creatinine showed significant positive correlations with total serum triglycerides,both at posttransplant month 1 and 3(P < 0.01).Patients with ERD had much higher pre-transplant serum creatinine levels(P < 0.001) and longer duration of pre-transplant renal insufficiency(P < 0.001) than those without ERD.Pretransplant serum creatinine,graft-to-recipient weight ratio,graft volume/standard liver volume ratio,body mass index(BMI) and ERD were identified as risk factors for PTHL by univariate analysis.Furthermore,ERD [odds ratio(OR) = 9.593,P < 0.001] and BMI(OR = 6.358,P = 0.002) were identified as independent risk factors for PTHL by multivariate analysis.CONCLUSION:Renal function is closely associated with the development of PTHL in LDLT.Post-transplant renal dysfunction,which mainly results from pre-transplant renal insufficiency,contributes to PTHL.

Retroperitoneal laparoscopic partial resection of the renal pelvis for urothelial carcinoma:A case report

BACKGROUND The standard treatment of transitional cell carcinoma of the upper urinary tract consists of radical nephroureterectomy with bladder cuff removal,which can be performed either in open or laparoscopy or robot-assisted laparoscopy.Treatment of chronic renal insufficiency patients with upper urothelial tumor is in a dilemma.Urologists weigh and consider the balance between tumor control and effective renal function preservation.European Association of Urology guidelines recommend that select patients may benefit from endoscopic treatment,but laparoscopic treatment is rarely reported.CASE SUMMARY In this case report,we describe a case of 79-year-old female diagnosed with urothelial carcinoma of the renal pelvis and adrenal adenoma with chronic renal insufficiency.The patient was treated with retroperitoneal laparoscopic partial resection of the renal pelvis and adrenal adenoma resection simultaneously.CONCLUSION Retroperitoneal laparoscopic partial resection of the renal pelvis is an effective surgical procedure for the treatment of urothelial carcinoma of the renal pelvis.

Evidence based review of management of cardiorenal syndrome type 1

Cardiorenal syndrome(CRS)type 1 is the development of acute kidney injury in patients with acute decompensated heart failure.CRS often results in prolonged hospitalization,a higher rate of rehospitalization,high morbidity,and high mortality.The pathophysiology of CRS is complex and involves hemodynamic changes,neurohormonal activation,hypothalamic-pituitary stress reaction,inflammation,and infection.However,there is limited evidence or guideline in managing CRS type 1,and the established therapeutic strategies mainly target the symptomatic relief of heart failure.This review will discuss the strategies in the management of CRS type 1.Six clinical studies have been included in this review that include different treatment strategies such as nesiritide,dopamine,levosimendan,tolvaptan,dobutamine,and ultrafiltration.Treatment strategies for CRS type 1 are derived based on the current literature.Early recognition and treatment of CRS can improve the outcomes of the patients significantly.