The gene expression of adenosine receptors in the processes of contrast induced nephropathy in mouse kidney

Objective: Contrast induced nephropathy (CIN) is the third leading cause of hospital acquired renal failure. The mechanism of CIN is not fully understood. The objectives of this study were to investigate the expression changes of the four subtypes of adenosine receptors (A1AR, A2AAR, A2BAR, and A3AR) following administration of contrast media in mice. Methods: C57BL/6J mice were randomized into treatment and control groups. Iodixanol (IDX) was administered to two treatment groups through retroorbital injection at two different dosages, 0.75 gI/kg and 2.75 gI/kg. Phosphate buffered saline (PBS) was given to the control group. Mice kidneys were harvested at day 3 and day 7 after Iodixanol administration. Kidney injuries and function were evaluated according to Hematoxylin and eosin stain, Ki67 protein expression, and TUNEL assay of paraffin embedded kidney sections, and plasma creatinine assay. RNA and protein were extracted from the kidney specimens. A1AR, A2AAR, A2BAR, and A3AR RNA and protein level of the samples were assessed using qRT-PCR and Western blotting, with GAPDH as an endogenous control. Results: H&E staining showed no significant histopathology injuries after Iodixanol administration. No evidence of kidney injury and functional impairment was found. However, there was an increased number of A1AR, A2AAR, A2BAR, and A3AR RNA transcripts detected in the kidney 3 days after Iodixanol injection. The RNA levels in all the four subtypes of adenosine receptors were increased 2-3 fold in the day 3 specimens and back to normal at day 7. Western blot demonstrated that A1AR, A2AAR, and A3AR expression increased 1.5 to 2 fold at day 3 and day 7 following Iodixanol injection. A2BAR baseline expression was low in normal physiological conditions and no significant change was detected by Western blot. Conclusions: Iodixanol significantly increases adenosine receptors gene expression in mice. This suggests that adenosine receptors may play a role in the development of CIN.

Contrast Induced Nephropathy after Radial or Femoral Access for Invasive Management of Acute Coronary Syndrome

Background: Percutaneous coronary intervention is now the best way of management of acute coronary syndrome (ACS). Contrast induced nephropathy is a serious complication and greatly dependent on several factors. It is still unclear whether the vascular access migrates CIN risk. Objective: To study the impact of Radial Access (RA) compared with Femoral Access (FA) on developing contrast-induced nephropathy (CIN) in patients undergoing invasive management of acute coronary syndrome (ACS). Methods: Sixty patients eligible for invasive management of ACS at cardiology department (Menoufia University hospital and National Heart Institute) were randomized into two groups. Group I: included 30 patients with femoral approach and Group II: included 30 patients with radial approach. The occurrence of CIN estimated by KDIGO definition (absolute increase in serum creatinine (SCr) by ≥0.5 mg/dl within 48 hours;or increase in SCr to ≥25% of baseline) was estimated in both groups. Results: Only 9 patients (15%) developed CIN, 5 patients (55.6%) of them underwent PCI through FA without statistically significant difference between the two approaches.Conclusion: CIN is considered a potential complication of percutaneous coronary intervention (PCI). Our study did not show the preference of using an approach over the other.

Preventing radiocontrast-induced nephropathy in chronic kidney disease patients undergoing coronary angiography

Radiocontrast-induced nephropathy(RCIN) is an acute and severe complication after coronary angiography,particularly for patients with pre-existing chronic kidney disease(CKD).It has been associated with both short-and long-term adverse outcomes,including the need for renal replacement therapy,increased length of hospital stay,major cardiac adverse events,and mortality.RCIN is generally defined as an increase in serum creatinine concentration of 0.5 mg/dL or 25%above baseline within 48 h after contrast administration.There is no effective therapy once injury has occurred,therefore,prevention is the cornerstone for all patients at risk for acute kidney injury(AKI).There is a small but growing body of evidence that prevention of AKI is associated with a reduction in later adverse outcomes.The optimal strategy for preventing RCIN has not yet been established.This review discusses the principal risk factors for RCIN,evaluates and summarizes the evidence for RCIN prophylaxis,and proposes recommendations for preventing RCIN in CKD patients undergoing coronary angiography.

Contrast induced nephropathy after percutaneous coronary intervention： risk factors and preventive strategy

Objective To analyze the risk factors and clinical outcome of contrast induced nephropathy （CIN） in patients with coronary artery disease （CAD） after percutaneous coronary intervention （PCI） and discuss its prevention. Methods Fifty-four patients with C1N among 729 patients who received PCI were retrospectively studied and the related risk factors, cardiovascular events and preventive strategy were analyzed. Results C1N was strongly associated with pre-procedure chronic renal failure, diabetes mellitus and large-dose contrast. The incidence of cardiac mortality and major adverse cardiac events 1 year after PCI in CIN group was higher than that in group without CIN. Conclusion Chronic renal failure, diabetes mellitus and dosage of contrast agent were three independent risk factors of CIN. CIN could affect the patients＇ prognosis. A well overall perioperative management of CAD patients following PCI, especially hydration therapy, is the most important strategy for prevention of CIN.

Contrast-Induced Nephropathy in Patients with Hepatocellular Carcinoma Undergoing Transcatheter Arterial Chemoembolization

Purpose: The purpose of this retrospective study was to assess the incidence and the risk factors of contrast-induced nephropathy (CIN) following transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). Materials and Methods: We performed a retrospective review of 186 sessions of TACE in 122 patients with HCC. We examined the incidence and factors associated with risk of CIN, defined as an increase of at least 0.5 mg/dl (44.2 μmol/l) or 25% of the baseline serum creatinine level between 48 and 72 hours after TACE. Results: CIN developed in 14 (7.5%) of the 186 sessions after TACE. A univariate analysis showed that the Child-Pugh class B or C [10/14 (71%) vs. 70/172 (41%), P = 0.046], a low albumin level (3.0 ± 0.5 vs. 3.4 ± 0.6, P = 0.018), and a low hemoglobin level (10.6 ± 2.0 vs. 11.8 ± 2.0, P = 0.035) were significantly associated with the development of CIN. Multivariate analysis revealed that the hemoglobin value was associated with CIN [odds ratio (OR) 1.6;P = 0.038]. Conclusions: CIN after TACE is closely associated with the severity of liver cirrhosis, and with low levels of albumin and hemoglobin. Effective preventive methods remain to be considered in patients with HCC and advanced LC who are undergoing TACE.

Contrast Agents and Contrast-Induced Nephropathy

Recent advances in medical sciences, especially in imaging, have dramatically increased the use of contrast agents. The constantly changing nature of medicine and the availability of new information, such as new pharmaceutical formulations, have necessitated periodic revisions and drafting of new guidelines for the safe use of intravenous contrast agents in radiology. This study examined the majority of guidelines, articles, and authoritative references available on the use of intravenous contrast agents in adults to reduce the risk of contrast-induced nephropathy. The search engines of PubMed, Web of Science, Scopus, and Google Scholar were used, and relevant English articles cited at least twice between 1979 and 2014 were studied. Review of the collected papers showed no consensus among them for guidelines on the incidence of contrast-induced nephropathy in patients at risk. Different formulas were used to calculate estimated glomerular filtration rate, which could be problematic in some cases. Further studies are needed for unification of existing guidelines.

The Study on the Relationship between Serum Vascular Endothelial Growth Factor and Proteinuria in Adriamycin induced Nephrotic Rats

To study the relationship between serum vascular endothelial growth factor (VEGF) and proteinuria in adriamycin induced nephrotic rats, a rat model of adriamycin induced nephrotitis was developed by injection of adriamycin into a tail vein in a rat. At different time points, 24 h urinary protein excretion was measured by using Coomassie brilliant blue method and the serum VEGF levels detected by using ELISA assay. The interventional effect of VEGF on this model was observed. The results showed that: (1) The adriamycin induced nephrotic syndrome rat model was developed successfully; (2) Serum VEGF levels and proteinuria were significantly increased at 7th day after intravenous injection of adriamycin. There was a positive correlation between serum VEGF levels and 24 h urinary protein excretion ( r=0.67, P <0.05). (3) The 24 h urinary protein excretion was significantly increased in the rats receiving administration of VEGF ( P <0.05). It was concluded that VEGF might play an important role in the pathogenesis of proteinuria in adriamycin induced nephrotic rats.

High Glucose Promotes the CTGF Expression in Human Mesangial Cells via Serum and Glucocorticoid-induced Kinase 1 Pathway

The role of serum and glucocorticoid-induced kinase 1 （SGK1） pathway in the connective tissue growth factor （CTGF） expression was investigated in cultured human mesangial cells （HMCs） under high glucose. By using RT-PCR and Western blot, the effect of SGK1 on the CTGF expression in HMCs under high glucose was examined. Overexpression of active SGK1 in HMCs transfected with PIRES2-EGFP- S422D hSGK1 （SD） could increase the expression of phosphorylated SGK1 and CTGF as compared with HMCs groups transfected with PIRES2-EGFP （FP） under high glucose or normal glucose. Overexpression of inactive SGK1 in HMCs transfected with PIRES2-EGFP- K127N hSGK1 （KN） could decrease phosphorylated SGK1 and CTGF expression as compared with HMCs groups transfected with FP under high glucose. In conclusion, these results suggest that high glucose-induced CTGF expression is mediated through the active SGK1 in HMCs.

Contrast-induced acute kidney injury in kidney transplant recipients: A systematic review and meta-analysis

AIM To evaluate the incidence of contrast-induced acute kidney injury(CIAKI) in kidney transplant recipients. METHODS A literature search was performed using MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews from the inception of the databases through July 2016. Studies assessing the incidence of CIAKI in kidney transplant recipients were included. We applied a randomeffects model to estimate the incidence of CIAKI.RESULTS Six studies of 431 kidney transplant recipients were included in the analyses to assess the incidence of CIAKI in kidney transplant recipients. The estimated incidence of CIAKI and CIAKI-requiring dialysis were 9.6%(95%CI: 4.5%-16.3%) and 0.4%(95%CI: 0.0%-1.2%), respectively. A sensitivity analysis limited only to the studies that used low-osmolar or iso-osmolar contrast showed the estimated incidence of CIAKI was 8.0%(95%CI: 3.5%-14.2%). The estimated incidences of CIAKI in recipients who received contrast media with cardiac catheterization, other types of angiogram, and CT scan were 16.1%(95%CI: 6.6%-28.4%), 10.1%(95%CI: 4.2%-18.0%), and 6.1%(95%CI: 1.8%-12.4%), respectively. No graft losses were reported within 30 d post-contrast media administration. However, data on the effects of CIAKI on long-term graft function were limited.CONCLUSION The estimated incidence of CIAKI in kidney transplant recipients is 9.6%. The risk stratification should be considered based on allograft function, indication, and type of procedure.

Significance and Expression of Serum and Glucocorticoid-inducible Kinase in Kidney of Mice with Diabetic Nephropathy

Summary: To investigate the expression and the role of three isoforms of Serum and Glucocorticoid-inducible Kinase (SGK) in experimental diabetic nephropathy (DN), 12 male C57BL/6 mice of 8-weeks-old were divided into two groups. Streptozotocin (STZ)-induced diabetic nephropathy and normal controls were analyzed at the end of the 4th week after the induction of diabetes. Renal hemodynamics and histological studies were performed. The expression of SGK1 mRNA, SGK2 mRNA and SGK3 mRNA of kidney cortex were measured by RT-PCR, and the cortical SGK1 protein was detected with Western blotting. Our results showed that the blood glucose, blood HbA1c, 24-h urinary protein, creatinine clearance and the renal index were all increased in DN group. More extracellular matrix (ECM) accumulation was observed. The level of cortical SGK1 mRNA and protein were up-regulated in DN group in comparison with control group. SGK2 and SGK3 mRNA were elevated in DN mice. In DN, mRNA level of three SGK isoforms and SGK1 protein were increased significantly. It is concluded that SGKs may contribute to the early renal injury of DN.

血清缺氧诱导因子1α与IgA肾病肾间质病变及其预后关系的研究

目的探讨血清缺氧诱导因子1α(hypoxia inducible factor-1α,HIF-1α)与原发性IgA肾病(IgA nephropathy,IgAN)肾间质病变及其预后的关系。方法回顾性分析宁夏回族自治区人民医院(宁夏医科大学附属自治区人民医院)2017年8月至2021年8月明确诊断为IgAN的142例患者临床资料,依据血清HIF-1α水平,以肾间质病变的严重程度分为两组,肾小管间质病变比例≤25%为肾间质病变轻组,>25%为肾间质病变重组。比较两组患者的指标差异,并将两组差异有统计学意义的指标进行多因素分析;将血清HIF-1α与肾病进展的危险因素指标进行相关分析。结果两组患者性别、24 h尿蛋白定量、体重指数、血清白蛋白、低密度脂蛋白胆固醇、三酰甘油、高血压等资料比较,差异均无统计学意义(P>0.05);肾间质病变重组患者年龄[(44.45±9.65)岁比(38.36±11.09)岁]、血肌酐[(116.28±44.75)μmol/L比(84.82±42.06)μmol/L]、血尿酸[(389.03±104.57)μmol/L比(353.39±90.01)μmol/L]、血清HIF-1α[(213.53±68.86)pg/L比(141.13±60.61)pg/L]高于肾间质病变轻组(P<0.05),而血红蛋白[(124.11±28.24)g/L比(134.18±22.07)g/L]低于肾间质病变轻组(P<0.05)。多因素分析提示血清HIF^(-1)α与年龄是肾间质病变的危险因素。血清HIF-1α与血肌酐呈正相关(r=0.465,P<0.05),与24 h尿蛋白定量呈正相关(r=-0.420,P<0.05),与血尿酸呈正相关(r=-0.217,P<0.05),与血红蛋白呈负相关(r=-0.284,P=0.003)。血清HIF-1α的受试者工作特征曲线分析提示曲线下面积为0.760(P<0.001),血清HIF-1α诊断肾功能异常的临界点为201.50 pg/L,尤登指数为0.44。结论血清HIF-1α与IgAN肾间质病变相关,同时与IgAN进展的危险因素有相关性,临床上可以关注血清HIF-1α水平以判断IgAN的预后。

基于“寒主收引”理论探讨温肾通络法对肾阳虚型糖尿病肾病患者肾纤维化的影响

【目的】基于“寒主收引”理论探讨温肾通络法对肾阳虚型糖尿病肾病(DN)患者肾纤维化的影响。【方法】通过便利抽样法,选取西安交通大学医院2020年12月至2022年12月接诊的116例肾阳虚型DN患者进行回顾性研究,根据治疗方法的不同将其分为观察组和对照组,每组各58例。对照组给予常规西药治疗,观察组在对照组的基础上给予温肾通络方治疗,疗程为8周。观察2组患者治疗前后中医证候积分、血糖指标[空腹血糖(FPG)、糖化血红蛋白(HbA1c)、餐后2 h血糖(2hPG)]、肾纤维化指标[Ⅳ型胶原(IV-C)、Ⅲ型前胶原(PCIII)、透明质酸(HA)、层粘连蛋白(LN)]、血清炎性因子指标[肿瘤坏死因子α(TNF-α)、超敏C反应蛋白(hs-CRP)、白细胞介素1β(IL-1β)]、肾功能指标[血肌酐(Scr)、尿素氮(BUN)]以及24 h尿蛋白定量(24h Upro)值的变化情况,比较2组患者的临床疗效和不良反应总发生率。【结果】(1)疗效方面,治疗8周后,观察组的总有效率为94.83%(55/58),对照组为75.86%(44/58),组间比较(χ^(2)检验),观察组的疗效明显优于对照组(P<0.01)。(2)中医证候积分方面,治疗后,2组患者的腰膝酸冷、肢体浮肿、神疲畏寒、夜尿增多等中医证候积分均较治疗前下降(P<0.05),且观察组的下降幅度均明显优于对照组(P<0.01)。(3)血糖指标方面,治疗后,2组患者的FPG、HbA1c、2hPG水平均较治疗前下降(P<0.05),且观察组的下降幅度均明显优于对照组(P<0.01)。(4)肾纤维化指标方面,治疗后,2组患者的血清Ⅳ-C、PCⅢ、HA、LN水平均较治疗前下降(P<0.05),且观察组的下降幅度均明显优于对照组(P<0.01)。(5)血清炎性因子方面,治疗后,2组患者的血清TNF-α、hs-CRP、IL-1β水平均较治疗前下降(P<0.05),且观察组的下降幅度均明显优于对照组(P<0.01)。(6)肾功能指标方面,治疗后,2组患者的血清Scr、BUN水平和24h Upro值均较治疗前明显下降(P<0.05),且观察组的下降幅度均明显优于对照组(P<0.01)。(7)安全性方面,观察组的不良反应总发生率为3.45%(2/58),对照组为8.62%(5/58),组间比较,差异无统计学意义(P>0.05)。【结论】基于“寒主收引”理论的自拟方温肾通络方可有效缓解肾阳虚型DN患者腰膝酸冷等症状,改善肾纤维化及肾功能,降低血糖值,减轻炎症反应,且治疗期间患者未出现严重不良反应,安全有效。

血清高敏C反应蛋白/白蛋白与急性冠状动脉综合征PCI术后对比剂肾病的相关性

目的 分析血清高敏C反应蛋白(hs-CRP)/白蛋白(Alb)与急性冠状动脉综合征患者经皮冠状动脉介入(PCI)术后对比剂肾病的相关性。方法 选取我院接受PCI的496例急性冠状动脉综合征患者作为研究对象,根据PCI术后是否发生对比剂肾病分为对比剂肾病组(n=56)和非对比剂肾病组(n=440)。采用ELISA法检测患者术前血清hs-CRP水平,使用血液分析仪测定术前血清Alb水平,并计算hs-CRP/Alb。Logistic回归分析急性冠状动脉综合征患者PCI术后发生对比剂肾病的影响因素;受试者工作特征(ROC)曲线分析血清hs-CRP/Alb对急性冠状动脉综合征PCI术后对比剂肾病的预测价值。结果 与非对比剂肾病组相比,对比剂肾病组患者术前血清hs-CRP水平、hs-CRP/Alb均明显升高(P<0.001),Alb水平显著下降(P<0.001)。与非对比剂肾病组相比,对比剂肾病组患者术前肌酐水平、对比剂剂量明显升高(P<0.05);对比剂肾病组患者术后肌酐水平显著高于术前(P<0.05),术后血尿酸显著低于术前(P<0.05)。Logistic回归分析显示,hs-CRP、hs-CRP/Alb、肌酐水平、对比剂剂量是急性冠状动脉综合征患者PCI术后发生对比剂肾病的危险因素(P<0.05),Alb是保护因素(P<0.05)。ROC曲线显示,血清hs-CRP/Alb预测急性冠状动脉综合征患者PCI术后对比剂肾病的曲线下面积为0.965,截断值为0.19。结果 急性冠状动脉综合征患者术前血清hs-CRP/Alb较高与PCI术后发生对比剂肾病相关,其对急性冠状动脉综合征PCI术后发生对比剂肾病具有一定的预测价值。

达格列净对老年2型糖尿病患者介入治疗术后造影剂肾病的发生及心血管预后的影响

目的探讨达格列净对老年(年龄>60岁)2型糖尿病(T2DM)患者行经皮冠状动脉介入治疗(PCI)术后造影剂肾病(CIN)的发生及预后的影响。方法回顾性选取2021年1月至2022年6月于天津大学胸科医院心内科行PCI老年T2DM患者296例,应用倾向性评分匹配以1:1比例进行分组,根据是否应用达格列净分为达格列净组148例和对照组148例。匹配后记录2组PCI术前、PCI术后72 h肾功能,包括血尿素、血清肌酐、估算肾小球滤过率、β_(2)微球蛋白(β_(2)-MG)、胱抑素C(Cys C)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)的变化;记录2组CIN发生率,应用二元logistic回归分析达格列净对CIN发生率的影响;记录2组随访期间主要不良心脏事件(MACE)发生情况,应用Kaplan-Meier曲线分析和log rank检验比较2组MACE发生的差异。结果2组一般临床资料比较无显著差异(P>0.05);PCI术后72 h,2组血清Cys C、β_(2)-MG、NGAL水平均高于PCI治疗前,且达格列净组Cys C、β_(2)-MG、NGAL水平均低于对照组,差异有统计学意义(P<0.05,P<0.01)。达格列净组CIN发生率低于对照组(4.7%vs 12.2%,P=0.035)。二元logistic回归分析显示,达格列净是CIN的独立保护因素(OR=0.256,95%CI:0.083~0.796,P=0.019)。平均随访(14.25±2.15)个月,达格列净组MACE发生率低于对照组(χ_(Log rank)~2=5.257,P=0.022;HR=0.460,95%CI:0.237~0.893)。结论达格列净可能减少老年T2DM患者PCI术后CIN及MACE的发生。

缺氧诱导因子与糖尿病肾脏疾病的研究进展

糖尿病肾脏疾病(diabetic kidney disease,DKD)是糖尿病患者最常见的微血管并发症之一,也是终末期肾病的主要病因之一。DKD发病机制复杂,目前尚未阐明。近期的研究显示肾内缺氧是DKD发生、发展的核心致病机制。缺氧诱导因子(hypoxia inducible factor,HIF)是对缺氧的适应性反应的主要调节因子。HIF作为重要的核转录因子,通过调控下游功能基因的表达,参与细胞能量代谢、红细胞生成和新生血管生成,对缺氧做出应答。HIF脯氨酰羟化酶抑制剂作为HIF稳定剂可抑制HIF降解,可能具有潜在的肾脏保护作用。在此,我们对目前HIF与DKD的研究进展进行综述,并探讨HIF稳定剂在DKD中的应用前景。

血清NLRP3水平和造影剂用量在急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗术后造影剂肾病的诊断价值研究

背景急性ST段抬高型心肌梗死(STEMI)是常见的心血管急危重症之一,首选治疗方式为经皮冠状动脉介入治疗(PCI),PCI术后患者多发造影剂肾病(CIN),CIN会显著增加患者不良事件发生风险,早诊断、早治疗尤为重要。目的探讨血清NOD样受体热蛋白结构域相关蛋白3(NLRP3)水平、造影剂用量对STEMI患者PCI术后CIN的诊断价值。方法纳入2022年6—12月在喀什地区第一人民医院确诊为STEMI且急诊行PCI术的257例患者为研究对象,根据PCI术后24、48 h是否发生CIN分为CIN组61例,非CIN组196例。收集患者基本临床资料,并记录患者术中造影剂用量。患者入院第2天抽空腹静脉血,检测肾功能指标、血脂、血糖等生化指标和血清NLRP3水平,同时心脏彩超检测左心室射血分数(LVEF)。采用多因素Logistic回归分析探究发生CIN的影响因素。绘制受试者工作特征(ROC)曲线评估血清NLRP3水平及造影剂用量对CIN的诊断价值。结果CIN组患者男性比例、术前血尿酸、白蛋白低于非CIN组,造影剂剂量、NLRP3高于非CIN组(P<0.05)。多因素Logistic回归分析结果表明,造影剂用量增加(OR=1.008,95%CI=1.001~1.015,P=0.017)、血清NLRP3水平升高(OR=1.139,95%CI=1.054~1.230,P=0.001)是发生CIN的危险因素。ROC曲线结果显示造影剂用量、血清NLRP3水平以及二者联合应用诊断急性心肌梗死PCI术后CIN的ROC曲线下面积(AUC)分别为0.797(95%CI=0.716~0.879)、0.885(95%CI=0.828~0.942)、0.939(95%CI=0.896~0.981)。结论在STEMI患者中,造影剂用量和血清NLRP3水平是PCI术后CIN的危险因素,可作为PCI术后CIN的预测指标,二者联合应用对CIN的诊断价值较为明确。

高龄患者应用碘克沙醇所致对比剂肾病的风险研究

目的探讨不同高龄患者应用碘克沙醇时发生对比剂肾病(Contrast-induced nephropathy,CIN)的风险差异。方法回顾性分析2021年1月至2022年12月在南京鼓楼医院血管外科收治的使用碘克沙醇进行影像学检查的高龄患者资料,统计患者基本资料及实验室检查指标,根据应用碘克沙醇前后的血清肌酐变化判断是否发生对比剂肾病,对各相关因素应用Logistic回归模型进行多因素分析,采用限制性立方样条图绘制肾小球滤过率、白蛋白及C反应蛋白与CIN风险的关系。结果与非CIN组相比,CIN组患者心功能不全、糖尿病例数、碘克沙醇使用剂量、eGFR分级、血红蛋白、尿酸、C反应蛋白以及白蛋白水平差异均有统计学意义(P<0.05),不同eGFR分期患者碘克沙醇应用前后的肌酐水平比较差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,心功能不全、糖尿病、使用剂量、eGFR分级3期、白蛋白以及C反应蛋白是高龄患者应用碘克沙醇后发生CIN的影响因素(P<0.05)。限制性立方样条图显示,肾小球滤过率、血清白蛋白及C反应蛋白与CIN风险存在非线性关系。结论心功能不全、糖尿病、使用剂量增加、eGFR3期、白蛋白<38.2 g/L及C反应蛋白>11.4 mg/L是高龄患者CIN发生的危险因素,此类患者使用碘克沙醇时,临床医生需进行危险因素评估。

益肾化湿颗粒对糖尿病肾病患者临床参数及血清缺氧诱导因子-1α的影响

目的探讨益肾化湿颗粒对2型糖尿病肾病患者临床参数及血清缺氧诱导因子-1α(HIF-1α)的影响。方法选取2020年11月至2021年12月秦皇岛市第一医院肾内科门诊及住院收治的2型糖尿病肾病患者60例。将2型糖尿病肾病患者按随机数字表法分配至益肾化湿颗粒组(试验组30例,1袋/次,每日3次,口服)或未使用益肾化湿颗粒组(对照组30例),随访12周,试验组及对照组血糖(空腹血糖、糖化血红蛋白)、血脂(总胆固醇、三酰甘油、低密度脂蛋白胆固醇)、肾功能(肌酐、尿素氮、尿酸、β_(2)-微球蛋白)、尿白蛋白排泄率、血清缺氧诱导因子-1α水平变化。结果治疗后,试验组和对照组的肌酐[(102±34)μmol/L与(162±148)μmol/L]、β_(2)微球蛋白[(4.9±2.1)mg/L与(7.5±5.4)mg/L]、肾小球滤过率[(74±26)ml·min^(-1)·1.73 m^(-2)与(59±34)ml·min^(-1)·1.73 m^(-2)]比较,试验组下降,差异有统计学意义(t=-2.81,-2.43,3.12,P均<0.05)。试验组的中医证候疗效有效率为77%,而对照组40%,差异有统计学意义(χ^(2)=8.297,P=0.004)。试验组与对照组临床综合疗效分析有效率分别为77%和37%,差异具有统计学意义(χ^(2)=9.77,P=0.002)。结论益肾化湿颗粒可有效延缓糖尿病肾病患者肾功能的进展。目前尚未得出益肾化湿颗粒能通过抑制HIF-1α对糖尿病肾病患者的发挥肾脏保护作用的结论。

Mehran评分用于老年人群造影剂肾病风险评估效果分析

目的验证Mehran评分用于老年冠状动脉粥样硬化性心脏病(简称冠心病)人群造影剂肾病(CIN)风险评估的效果。方法收集上海某院心血管内科2015年1月至2017年12月行经皮冠状动脉介入(PCI)术老年(>65岁)患者的临床资料(包括基本信息、合并症、实验室指标及合并用药情况),采用单因素和二元Logistic回归分析评估发生CIN的危险因素及与Mehran评分的相关性。结果共纳入378例患者,其中45例(11.90%)围术期发生CIN,Mehran分级为低危(≤5分)、中危(6~10分)、高危(11~15分)、极高危(≥16分)的患者分别有182例、147例、41例、8例,且各组患者CIN发生率差异有统计学意义(P<0.05)。二元Logistic回归分析结果表明,术前预估肾小球滤过率(eGFR)[OR=0.939,95%CI(0.883,0.998),P=0.044]及Mehran危险分级为高危[OR=3.414,95%CI(1.116,10.441),P=0.031]和极高危[OR=9.604,95%CI(1.311,70.355),P=0.026],是预测老年冠心病患者PCI术后发生CIN的重要因素。结论术前eGFR及Mehran危险分级为高危、极高危,为预测老年冠心病患者PCI术后CIN发生风险的影响因素。

老年急性冠脉综合征患者PCI术前血清miR-34a、miR-182水平与术后对比剂肾病发生的相关性

目的 探究老年急性冠脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)术前血清微小RNA(miR)-34a、miR-182水平与术后对比剂肾病(CIN)发生的关系。方法 纳入行PCI治疗的146例老年ACS患者。收集ACS患者临床资料;全自动生化分析仪检测术前血脂、肾功能指标;实时荧光定量PCR法测定血清miR-34a、miR-182水平。根据患者PCI术后是否发生CIN分为CIN组(20例)和非CIN组(126例)。比较CIN组和非CIN组临床资料、术前血脂、肾功能指标、血清miR-34a、miR-182、术后血清肌酐(Scr)、肾小球滤过率(eGFR)水平;分析老年ACS患者术前血清miR-34a、miR-182、术后Scr、eGFR的相关性及影响老年ACS患者PCI术后发生CIN的因素,受试者工作特征(ROC)曲线评估术前血清miR-34a、miR-182水平对老年ACS患者PCI术后发生CIN的预测价值。结果 CIN组术前血清miR-34a和miR-182水平、术后Scr水平均高于非CIN组,术后eGFR水平低于非CIN组(P<0.05);ACS患者术前血清miR-34a、miR-182与术后Scr呈正相关,与术后eGFR呈负相关(P<0.05);术前血清miR-34a与miR-182呈正相关(P<0.05);术前血清miR-34a、miR-182水平升高是影响老年ACS患者PCI术后发生CIN的独立危险因素(P<0.05);术前血清miR-34a、miR-182及两者联合预测老年ACS患者PCI术后发生CIN的曲线下面积(AUC)分别为0.881、0.888、0.964,两者联合预测的AUC高于各自单独预测(P<0.05)。结论 术前血清miR-34a、miR-182水平升高是老年ACS患者PCI术后发生CIN的危险因素,两者联合可有效预测CIN的发生。