Three-dimensional imaging reconstruction of the kidney’s anatomy for a tailored minimally invasive partial nephrectomy:A pilot study

Objective:The aim of the study was to evaluate three-dimensional virtual models(3DVMs)usefulness in the intraoperative assistance of minimally-invasive partial nephrectomy in highly complex renal tumors.Methods:At our institution cT1-2N0M0 all renal masses with Preoperative Aspects and Dimensions Used for an Anatomical classification score≥10 treated with minimally-invasive partial nephrectomy were considered for the present study.For inclusion a baseline contrast-enhanced computed tomography in order to obtain 3DVMs,the baseline and postoperative serum creatinine as well as estimated glomerular filtration rate values were needed.These patients,in which 3DVMs were used to assist the surgeon in the planning and intraoperative guidance,were then compared with a control group of patients who underwent minimally-invasive partial nephrectomy with the same renal function assessments,but without 3DVMs.Multivariable logistic regression models were used to predict the margin,ischemia,and complication score achievement.Results:Overall,79 patients met the inclusion criteria and were compared with 143 complex renal masses without 3DVM assistance.The 3DVM group showed better postoperative outcomes in terms of baseline-weighted differential estimated glomerular filtration rate(-17.7%vs.-22.2%,p=0.03),postoperative complications(16.5%vs.23.1%,p=0.03),and major complications(Clavien Dindo>III,2.5%vs.5.6%,p=0.03).At multivariable logistic regression 3DVM assistance independently predicted higher rates of successful partial nephrectomy(odds ratio:1.42,p=0.03).Conclusion:3DVMs represent a useful tool to plan a tailored surgical approach in case of surgically complex masses.They can be used in different ways,matching the surgeon's needs from the planning phase to the demolitive and reconstructive phase,leading towards maximum safety and efficacy outcomes.

Evaluation of Left Ventricular Function by Three-Dimensional Speckle-Tracking Echocardiography in Patients with Chronic Kidney Failure

Objective:To establish a quantitative evaluation of the left ventricle's systolic function in patients with chronic kidney failure(CKF)by three-dimensional speckle-tracking echocardiography.Methods:Two-dimensional and three-dimensional transthoracic echocardiography was performed on 30 patients with CKF.The ejection fraction,mass and global peak longitudinal strain,global circumferential strain,global area strain,and global radial strain of the left ventricle were calculated.Results:The ejection fraction,mass and global peak longitudinal strain(GLS),global circumferential strain(GCS),global area strain(GAS),and global radial strain(GRS)in the CKF group were significantly lower than those in the control group.Simultaneously,the GLS,GCS,GAS and GRS were well correlated with the ejection fraction.For patients with normal ejection fraction in the CKF group,the GLS,GCS,GAS and GRS were lower than those in the control group,while the left ventricular mass was significantly higher in CKF patients than in the control group.For patients with hypertension in the CKF group,ejection fraction,GLS,GCS,GAS and GRS calculated using three-dimensional echocardiography were significantly lower than those in patients with normal blood pressure;however,the myocardial mass was higher.Conclusions:The parameters(GLS,GCS,GAS and GRS)calculated using three-dimensional speckle-tracking software were lower in the CKF group.Simultaneously,the left ventricular mass was higher in CFK patients than in the control group,thus showing that the myocardial contraction function was impaired and that myocardial remodeling had occurred.

Protective effect of pioglitazone on kidney injury in diabetic rats

Objective:To investigate the protective effect of pioglitazone on kidney injury in diabetic rat model and its mechanisms.Methods:Forty healthy Sprague Dawley rats were selected and randomly divided into five groups,with 8 rats in each group.Group A served as control group and were administered with sterile citrate buffer(i.p.)as placebo.Groups B.C,D and E rats were injected(i.p.)with streptozotocin to induce type I diabetes,Diabetic rats in Group B were intragastrically administered with sterile saline solution alone.Groups C,D and E rats were iutragastrically given pioglitazone hydrochloride suspension at doses of 10,20,30 mg/kg per day.respectively.After eight weeks of treatment,all rats were anesthetized and blood was withdrawn from the abdominal aortic ofr detection of hemoglobin A_(1c),serum creatinine(SCr)and blood ures nitrogen(BUN)levels.Rats were then sacrificed and the left kidney was excised for calculation of kidney hypertrophy index(KHI),observation of renal pathological changes using light microscope and electron microscope.Mean glomerular cross-sectional areas(MGA).mean glomerular volume(MGV).glomerular basement membrane thickness and foot process fusion ratio were ealculated.RT-PCR was employed for detection of podocalyxin(PCX)protein expression.Results:Results showed that levels of hemoglobin A_(1c),BUN.SCr in Groups B,C.D and E rats were significantly higher than those in Group A(P<0.05),while BUN aud SCr levels in rats of Groups C,D and E were significantly lower than those in Group B(P<0.05).KHI,MGA and MGV levels were significantly higher in Groups B.C,D and E rats than those in Group A(P<0.05);KHI and MGA levels in Group B rats were significantly higher than those in Groups C.D and E(P<0.05)and MGV in Groups D and E was significantly lower than that in Gtoups B and C(P<0.05).Histology study showed normal glomerulus structure,morphology,volume,endothelial cells and mesangial cells as well as clear glomerular eapillary in Group A rats.Renal mesangial matrx proliferation and expansion of glomerulus cavities in Groups B.C.D and E were observed.However.damage degree in Groups C.D and E were more moderate than that iu Group B.Conclusions:Pioglitazone can reduce kidney damage in diabetic rats.which may be attributed to its role in increasing glomerular PCX protein expression and inhibiting urinary excretion of PCX,and its effect is dose dependent.

Alleviation Effect of Lanthanum on Cadmium Stress in Seedling Hydroponic Culture of Kidney Bean and Corn

The seedling hydroponic culture experiment of kidney bean （ Phaseolus vulgaris ） and corn （ Zea mays ） was conducted to investigate the alleviation effect of lanthanum on Cd stress. It is found that growth is seriously inhibited and metabolism is maladjusted in the two crops under 30 and 300 μmol·L^-1 Cd^2＋ stress. Plant height, taproot length, leaf area, and fresh or dry weight of root, stem, and leaf are all obviously decreased. Further, chlorophyll content decreases, membrane permeability, malonydialdehyde （MDA） content, activities of catalase （CAT） and peroxidase （POD） increases under Cd stress, as compared with the control. The damage to these two crops becomes more conspicuous with the prolongation of Cd stress. It is suggested that lanthanum might help kidney bean and corn seedlings alleviate Cd stress by improving the photosynthetic capacity, reducing membrane permeability and MDA content, and maintaining the activities of CAT and POD of these two crops.

Acute kidney injury in China:A neglected truth and perspective

Acute kidney injury(AKI)affects approximately 13.3 million individuals and contributes to about 1.7 million deaths globally per year.As estimated 85% of those affected live in the developing world[1].Although there are various measures to prevent or treat AKI,including renal protective drugs and continuous renal replacement therapy,most of them have limited success or are still in their infancy[2,3].

Chronic Kidney Disease is a New Target of Cardiac Rehabilitation

Chronic heart failure is increasingly prevalent worldwide and is associated with signifi cant morbidity and mortality.The Cochrane review demonstrated that cardiac rehabilitation(CR)resulted in improvements in QOL and a reduction in long-term mortality.Chronic kidney disease(CKD)is another worldwide public health problem.This review focuses on the importance and effi cacy of rehabilitation for CKD patients as a new target of CR.Patients with CKD on hemodialysis(HD)have a high mortality rate,with cardiovascular diseases,such as chronic heart failure.A new systematic review and meta-analysis of randomized controlled trials reported that exercise-based renal rehabilitation improved aerobic capacity,muscular functioning,cardiovascular function,walking capacity,and QOL in CKD patients with HD.Moreover,exercise training may have renal protective effects,not only in some animal models of pre-HD CKD,but also in pre-HD CKD patients.Exercise therapy could be an effective clinical strategy in improving renal function,lowering the need for renal replacement therapy,such as HD,and reducing renal transplant risk in pre-HD CKD patients.This led the Ministry of Health,Labor and Welfare of Japan to extend renal rehabilitation partial coverage to stage4pre-HD CKD patients for the first time in the world in 2016.

Roxadustat(FG-4592)pretreatment attenuates folic acid induced kidney injury via mitophagy

.Hypoxia precondition plays a protective role in tissues injured by oxidative stress.Whether or not mitophagy is involved needs to be explored.In the present study,the acute kidney injury model was established by folic acid(FA)administration.Roxadustat(FG-4592),a stabilizer of hypoxia-inducible factor(HIF)was used 2 days before FA insult to mimic hypoxia precondition.First of all,the results showed a protective effect,in both renal function and morphology with FG-4592 pretreatment.In addition,BNIP3 and FUNDC1,two key players in.receptor-mediated mitophagy,were induced to express with upregulation of HIF-1alpha.Meanwhile the mitochondrial marker translocase of outer mitochondrial membrane 20(TOMM20)and mtDNA decreased,indicating a decline of mitochondrial quality.On the other hand,PGC-lalpha,the master regulator of mitochondrial biogenesis,was detected no statistical significance,which implied that the decline may attribute to more mitophagy rather than less biogenesis.That upregulation of LC3B and downregulation of p62/SQSTM1 further proved the presence of mitophagy.

Identifying survival protective factors for chronic dialysis patients with surgically confirmed acute mesenteric ischemia

BACKGROUND Mesenteric ischemia is significantly more common in end-stage kidney disease patients undergoing chronic dialysis than in the general population and is associated with high morbidity and mortality. However, reports on prognostic factors in this population are limited.AIM To elucidate the in-hospital outcomes of acute mesenteric ischemia in chronic dialysis patients and to analyze protective factors for survival.METHODS The case data of 426 chronic dialysis patients who were hospitalized in a tertiary medical center for acute mesenteric ischemia over a 14-year period were retrospectively reviewed. Of these cases, 103 were surgically confirmed, and the patients were enrolled in this study. A Cox regression analysis was used to evaluate the protective factors for survival.RESULTS The in-hospital mortality rate among the 103 enrolled patients was 46.6%.Univariate analysis was performed to compare factors in survivors and nonsurvivors, with better in-hospital outcomes associated with a surgery delay(defined as the time from onset of signs and symptoms to operation) < 4.5 d, no shock, a higher potassium level on day 1 of hospitalization, no resection of the colon, and a total bowel resection length < 110 cm. After 1 wk of hospitalization, patients with lower white blood cell count and neutrophil counts, higher lymphocyte counts, and lower C-reactive protein levels had better in-hospital outcomes. Following multivariate adjustment, a higher potassium level on day 1 of hospitalization(HR 1.71, 95%CI 1.19 to 2.46;P = 0.004), a lower neutrophil count(HR 0.91, 95%CI 0.84 to 0.99;P = 0.037) at 1 wk after admission, resection not involving the colon(HR 2.70, 95%CI 1.05 to 7.14;P = 0.039), and a total bowel resection length < 110 cm(HR 4.55,95%CI 1.43 to 14.29;P = 0.010) were significantly associated with survival.CONCLUSION A surgery delay < 4.5 d, no shock, no resection of the colon, and a total bowel resection length <110 cm predicted better outcomes in chronic dialysis patients with acute mesenteric ischemia.

Effectiveness of an Secondary Prevention Program in Chronic Kidney Disease

Background: There are many programs which focus on late-stage chronic kidney disease (CKD), and it is considered that further evidence needs to be generated regarding the effectiveness of the programs used before renal replacement therapy. Study Design: A cohort study. Settings & Participants: Patients over 15 years of age who had been diagnosed with CKD according to the KDOQI (Kidney Disease Outcomes Quality Initiative) guidelines and who had undergone conventional treatment (CT) or a renal protection program (RPP). These were patients of two Colombian health insurance companies. Predictors: Age, sex, marital status, comorbidities, CKD stage, and clinical indicators. Outcomes: First CKD progression, and need for renal replacement therapy (RRT). Measures: Clinical marker. Results: The RPP is structurally and functionally different from the CT. It offers the interdisciplinary management of patients, a greater number of medical appointments, and patients start to receive treatment at younger ages and at earlier stages of their condition. The clinical markers of the patients following the RPP are within adequate ranges, and their renal function is less impaired, despite the differences in basal conditions. Upon finishing the study, we found that patients who received CT had a higher risk of receiving nephrotoxic drugs and not receiving nephroprotective drugs. The explanatory variables for the first progression were age, stage, history of dyslipidemia, and hemoglobin, potassium, and albumin levels. These variables, together with glycemia levels were also valid for RRT, except for history of dyslipidemia, as it was not significant. Upon adjusting for the explanatory variables, it was found that belonging to the RPP and attending more appointments had a protective effect in the process of controlling renal damage. Limitations: A possible selection bias. Conclusions: Belonging to a structured renal protection program is an effective way to keeping the clinical markers associated with renal impairment within normal ranges.

Fabrication of three-dimensional WO_(3)/ZnWO_(4)/ZnO multiphase heterojunction system with electron storage capability for significantly enhanced photoinduced cathodic protection performance

A novel three-dimensional hierarchical WO_(3)photoelectrode was prepared by solvothermal method,and ZnO was deposited on its surface by electrochemical method.The WO_(3)/ZnWO_(4)/ZnO multiphaseheterojunction photoelectrode was prepared by further annealing treatment to explore the photoinduced cathodic protection(CP)performance.Compared with WO_(3)and ZnO,the photoinduced CP and electron storage capacity performance of WO_(3)/ZnWO_(4)/ZnO is significantly improved in 3.5%NaCl solution without adding any hole scavenger.The electron storage capacity of the WO_(3)/ZnWO_(4)/ZnO heterojunction makes it possible to continuously protect metallic materials in the dark after switching off the light,which can realize long-term and effective photoinduced CP.

Phytochemical Analysis of Medicinal Plants with Kidney Protective Activities

In view of the increasing number of patients undergoing kidney dialysis or transplant every year, a survey of the literature on renal protective medicinal plants was undertaken. Most of them are from traditional Chinese medicine （TCM）. Although many of the medicinal herbs reported have not been investigated in terms of active chemical ingredients, some do have compounds well characterized. They fall into a wide range of structures. Several groups of compounds with well established activities are discussed. These include： antioxidant phenolic compounds like tannins, flavonoids, isoflavonoids, unsaturated organic acids and lignans; circulation enhancing compounds like saponins, and basic alkaloids with multiple targets （G-protein coupled receptors）. Also presented are proinflammatory and antiinflammatory fatty acids like linoleic （n-6） and α-Iinolenic （n-3） acids, respectively. Attention is also drawn to the plants containing nephrotoxic aristolochic acid. Different directions of future research are also presented. We hope that this review may provide some leads for new drug discovery and development, and more rational application of TCM.

Association between COL4A3 variant rs55703767 and susceptibility to diabetic kidney disease in patients with type 2 diabetes mellitus:results from the INDEED cohort study

To the Editor:Diabetic kidney disease(DKD)is the leading cause of the end-stage renal disease nowadays.[1]The etiology of DKD is complex and remains largely unknown.[2]A genome-wide association study showed that a common missense variant in COL4A3,rs55703767,played a protective role in DKD in type 1 diabetes mellitus in Europeans,and this effect depended on blood glucose levels.[3]However,data from type 2 diabetes mellitus(T2DM)are insufficient.

miR-210 agonist alleviates renal inflammatory response and fibrosis in diabetic kidney diseaserats

Objective To investigate the protective effect and mechanism of microRNA-210 agonist (agomiR-210) on kidney in diabetic kidney disease (DKD) rats.Methods Thirty-six 5-week-old male SD rats were divided into normal control (NC) group,agomiR-NC control group,agomiR-210 control group,DKD model group,DKD+agomiR-NC group and DKD+agomiR-210 group,with 6 rats in each group.

Interstitial nephritis and interstitial nephropathy

2008467 Protective mechanism of NHE-1-siRNA on human renal tubular epithelial cell from ischemic reperfusion injury induced by antimycin A.HONG Quan(洪权), et al.Dept Nephrol, Kidney Center & Key Lab, PLA, General Hosp,PLA, Beijing 100853. Chin J Nephrol 2008;24(8):560 -565. Objective To explore the mechanism of protecting cells from ischemic reperfusion injury by constructing specific small interference RNA(siRNA) to