Prevalence and risk factors for impaired renal function among Asian patients with nonalcoholic fatty liver disease

Background:Nonalcoholic fatty liver disease(NAFLD)is associated with impaired renal function,and both diseases often occur alongside other metabolic disorders.However,the prevalence and risk factors for impaired renal function in patients with NAFLD remain unclear.The objective of this study was to identify the prevalence and risk factors for renal impairment in NAFLD patients.Methods:All adults aged 18-70 years with ultrasound-diagnosed NAFLD and transient elastography examination from eight Asian centers were enrolled in this prospective study.Liver fibrosis and cirrhosis were assessed by FibroScan-aspartate aminotransferase(FAST),Agile 3+and Agile 4 scores.Impaired renal function and chronic kidney disease(CKD)were defined by an estimated glomerular filtration rate(eGFR)with value of<90 mL/min/1.73 m^(2) and<60 mL/min/1.73 m^(2),respectively,as estimated by the CKD-Epidemiology Collaboration(CKD-EPI)equation.Results:Among 529 included NAFLD patients,the prevalence rates of impaired renal function and CKD were 37.4%and 4.9%,respectively.In multivariate analysis,a moderate-high risk of advanced liver fibrosis and cirrhosis according to Agile 3+and Agile 4 scores were independent risk factors for CKD(P<0.05).Furthermore,increased fasting plasma glucose(FPG)and blood pressure were significantly associated with impaired renal function after controlling for the other components of metabolic syndrome(P<0.05).Compared with patients with normoglycemia,those with prediabetes[FPG≥5.6 mmol/L or hemoglobin A1c(HbA1c)≥5.7%]were more likely to have impaired renal function(P<0.05).Conclusions:Agile 3+and Agile 4 are reliable for identifying NAFLD patients with high risk of CKD.Early glycemic control in the prediabetic stage might have a potential renoprotective role in these patients.

Factors Associated with Renal Impairment in Patients on Tenofovir for Chronic Hepatitis B in Yaoundé (Cameroon)

Background: Tenofovir (TFV) is widely used to treat patients with hepatitis B virus (HBV) infection. But kidney abnormalities are the main concern using this drug. Few studies have described the renal impairment due to the TFV in chronic hepatitis B (CHB) in Sub-Saharan Africa. The objective was to evaluate factors associated with renal impairment observed in patients on TFV for CHB. Method: It was a hospital based cross sectional prospective study carried out from June 2023 to July 2023 in Yaoundé (Cameroon) and included any patient treated with TFV for CHB during at least a period of 6 months. For each participant, we collected in the medical report socio-demographic data, clinical data, baseline creatinine, treatment information (type of TFV which was Disoproxil Fumarate (TDF) or Alafenamide (TAF), duration). Then, we collected blood samples to measure serum creatinine and phosphate levels and urine dipstick analysis. Factors associated with renal impairment were assessed with the Odds Ratio. A p value of Results: A total of 60 participants were included. The median age was 44 years [36-55] and median duration of TFV therapy was 17.5 months [11.7-25.7]. The prevalence of reduced eGFR (Conclusion: Kidney function was impaired in some patients receiving TFV for CHB. It should be monitored, particularly after 36 months and for those receiving TDF prodrug.

Brain Functional Networks with Dynamic Hypergraph Manifold Regularization for Classification of End-Stage Renal Disease Associated with Mild Cognitive Impairment

The structure and function of brain networks have been altered in patients with end-stage renal disease(ESRD).Manifold regularization(MR)only considers the pairing relationship between two brain regions and cannot represent functional interactions or higher-order relationships between multiple brain regions.To solve this issue,we developed a method to construct a dynamic brain functional network(DBFN)based on dynamic hypergraph MR(DHMR)and applied it to the classification of ESRD associated with mild cognitive impairment(ESRDaMCI).The construction of DBFN with Pearson’s correlation(PC)was transformed into an optimization model.Node convolution and hyperedge convolution superposition were adopted to dynamically modify the hypergraph structure,and then got the dynamic hypergraph to form the manifold regular terms of the dynamic hypergraph.The DHMR and L_(1) norm regularization were introduced into the PC-based optimization model to obtain the final DHMR-based DBFN(DDBFN).Experiment results demonstrated the validity of the DDBFN method by comparing the classification results with several related brain functional network construction methods.Our work not only improves better classification performance but also reveals the discriminative regions of ESRDaMCI,providing a reference for clinical research and auxiliary diagnosis of concomitant cognitive impairments.

Clinical Observation on Breviscapine in Treating Hypertension Patients Complicated with Micro-albuminuria of Renal Impairment

Objective: To evaluate the efficacy of Breviscapine on essential hypertension (EH) patients complicated with micro-albuminuria of renal impairment. Methods: Seventy-six EH patients were randomly assigned to the control group and the treated group, the former was given amlodipine, captopril/uropidil and the latter was given in addition Breviscapine intravenously dripped for 2 treatment courses. The indexes of serum creatinine (Cr), blood urea nitrogen (BUN), blood and urinary β 2-microglobulin (β 2-MG), and quantitative determination of 24 hrs urinary protein were evaluated before and after treatment. Results: In the control group, compared with before treatment, the quantitative determination of 24 hrs urinary protein got reduced significantly ( P <0.05), while in the treated group, both urinary β 2-MG and quantitative determination of 24 hrs urinary protein got lowered significantly ( P <0.05 and P <0.01). But after treatment, compared with the control group, urinary β 2-MG and quantitative determination of 24 hrs urinary protein in the treated group were obviously reduced ( P <0.05). Conclusion: Besides lowering blood pressure effectively, Breviscapine could improve the renal function significantly and reduce the urinary micro-albuminuria, hence showing promising effect on renal protection.

Townes–Brocks syndrome with adult renal impairment in a Chinese family:A case report

BACKGROUND Townes–Brocks syndrome(TBS)is a rare autosomal dominant syndrome that is characterized by a triad of imperforate anus,dysplastic ears,and thumb malformations.Heterozygous variants of SALL1 are responsible for this syndrome.Renal structural abnormalities and functional impairments are often reported in TBS patients.CASE SUMMARY We report a case of TBS in a Chinese family.The index patients showed obvious renal atrophy and renal failure.TBS was suggested after a physical examination and pedigree analysis.Whole exome sequencing revealed a heterozygous variant of SALL1.The variant(NM_001127892 c.1289_c.1290 insC)led to a read-frame shift of the encoded protein,which was confirmed by Sanger sequencing.The variant cosegregated with the phenotype among affected members.CONCLUSION A novel variant in SALL1 gene may be the molecular pathogenic basis of this disorder.

多模态MRI在终末期肾病合并认知障碍中的研究进展

认知障碍在终末期肾病(end-stage renal disease, ESRD)患者中非常普遍,这种障碍涉及一系列认知领域,包括注意力、记忆力和执行力等,严重降低了患者的生活质量。然而这种神经认知缺陷的确切机制尚不清楚,因此在早期阶段检测和管理这种认知障碍具有很大的挑战性。近年来多模态磁共振成像在这一领域取得了诸多成果,并有望选择出指导早期筛查及诊断慢性肾脏疾病(chronic kidney disease, CKD)患者认知缺陷的影像学生物标志物。本文将简要阐述多种MRI新兴技术及人工智能在ESRD合并认知障碍患者中的研究进展,尝试揭示ESRD患者脑结构、功能、灌注、代谢及神经血管耦合与认知功能障碍之间的联系,帮助临床了解ESRD患者大脑缺陷的潜在神经元机制,有利于合并认知障碍ESRD患者的早期诊断、治疗及随访。

Bortezomib, dexamethasone plus thalidomide for treatment of newly diagnosed multiple myeloma patients with or without renal impairment

Objective： To investigate the efficacy and safety of the treatment of the newly diagnosed multiple myeloma （MM） with or without renal impairment receiving the therapy of bortezomib, dexamethasone plus thalidomide （BTD） regimen in order to analyze the effects of BTD regimen on the prognosis of the MM patients with renal impairment compared with the patients without renal impairment. Methods： Seventy-two newly diagnosed MM patients entered into our study and all the patients belonged to International Stage System （ISS） 3 in which transplantation patients were excluded or the patients refused receiving transplantation therapy. According to the level of serum creatinine （Scr）, the patients were divided into two groups including group 1 （n=42） （Scr 〈2 mg/dL） and group 2 （n=30） （Scr ≥2 mg/dL）. All the patients received the therapy of BTD regimen as induction therapy, and the median treatment time was 5 （range, 2-8） cycles. The outcome was analyzed retrospectively. Results： The overall remission （OR） rates were 81.0% （group 1） and 80.0% （group 2）. There was no statistical difference between the two groups （P〉0.05）. In group 2, 10 patients （33.3%） got renal function reversal, 14 patients （46.7%） got improved renal function and the median time to renal function reversal was 1.4 （range, 0.7-3.0） months. Among 12 patients with hemodialysis at diagnosis, 8 patients got rid of hemodialysis after median 4 cycles of therapy （range, 3-6 cycles）. After a median follow-up period of 16 （range, 2-31） months, 5 patients （11.9%） in group 1 died and 9 patients （30.0%） in group 2 died （P=0.056）. The 2-year estimate of overall survival was 77.3% in group 1 and 63.8% in group 2, respectively （P=0.188）. During a median follow-up time of 13.0 months （range, 2-25 months）, 15 patients （35.7%） in group 1 progressed and 13 patients （43.3%） in group 2 progressed （P=0.513）. The 2-year estimate of response duration was 50.6% in group 1 and 42.1% in group 2, respectively （P=1）. The main toxicities in the two groups included thrombocytopenia, peripheral neuropathy （PN）, infection, herpes zoster and so on. The incidence of grade 3 and 4 adverse events was low. Conclusions： BTD regimen may become the front-line therapy for the newly diagnosed MM patients with renal impairment because BTD regimen can improve the prognosis of the patients with renal impairment as good as the patients without renal impairment.

Serum uric acid as an index of impaired renal function in congestive heart failure

Background Hyperuricemia is frequently present in patients with heart failure. Many pathological conditions, such as tissue ischemia, renal function impairment, cardiac function impairment, metabolic syndrome, and inflammatory status, may impact uric acid （UA） metabolism. This study was to assess their potential relations to UA metabolism in heart failure. Methods We retrospectively assessed clinical charac- teristics, echocardiological, renal, metabolic and inflammatory variables selected on the basis of previous evidence of their involvement in cardiovascular diseases and UA metabolism in a large cohort of randomly selected adults with congestive heart failure （n = 553）. By clustering of indices, those variables were explored using factor analysis. Results In factor analysis, serum uric acid （SUA） formed part of a principal cluster of renal functional variables which included serum creatinine （SCr） and blood urea nitrogen （BUN）. Univariate correlation coefficients between variables of patients with congestive heart failure showed that the strongest correlations for SUA were with BUN （r = 0.48, P 〈 0.001） and SCr （r = 0.47, P 〈 0.001）. Conclusions There was an inverse relationship between SUA levels and measures of renal function in patients with congestive heart failure. The strong correlation between SUA and SCr and BUN levels suggests that elevated SUA concentrations reflect an impairment of renal function in heart failure.

Impact of contrast-enhanced ultrasound in patients with renal function impairment

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.

Epicardial adipose tissue deposition in patients with diabetes and renal impairment: Analysis of the literature

Diabetes mellitus(DM)is defined as a chronic disease of disordered metabolism with an ongoing increase in prevalence and incidence rates.Renal disease in patients with diabetes is associated with increased morbidity and premature mortality,particularly attributed to their very high cardiovascular risk.Since this group of patients frequently lacks specific symptomatology prior to the adverse events,a screening tool for the identification of high-risk patients is necessary.The epicardial adipose tissue(EAT)is a biologically active organ having properties similar to visceral adipose tissue and has been associated with metabolic diseases and coronary artery disease.Superior to conventional cardiovascular risk factors and anthropometric measures,including body mass index and waist circumference,the EAT can early predict the development of coronary artery disease.Assessment of EAT can be performed by twodimensional echocardiography,magnetic resonance imaging or computer tomography.However,its role and significance in patients with DM and nephropathy has not been thoroughly evaluated.The aim of the current editorial is to evaluate all available evidence regarding EAT in patients with DM and renal impairment.Systematic search of the literature revealed that patients with DM and nephropathy have increased EAT measurements,uncontrolled underlying disease,high body mass index and raised cardiovascular risk markers.Acknowledging the practical implications of this test,EAT assessment could serve as a novel and non-invasive biomarker to identify high-risk patients for cardiovascular adverse events.

Optimization of Dalbavancin in Patients with Hepatic or Renal Impairment

Dalbavancin is a novel semi-synthetic glycopeptide antibiotic. In this study, we aimed to optimize the dosage regimen of dalbavancin in patients with hepatic or renal impairment by Mote Carlo simulation. Pharmacokinetic parameters and microbiological data were collected about dalbavancin. 10,000 patients with renal or hepatic impairment analyzed by Crystal Ball to calculate probability of target attainment (PTA) and cumulative fraction of response (CFR). We found that all bacterial PTA and CFR were more than 90% for dalbavancin in patients with hepatic or renal impairment, except for Enterococcus faecium. There is no need to adjust the dosage regimen of dalbavancin in patients with hepatic or renal impairment.

Alarming Presentation of a Seemingly Common Condition in a Patient with Renal Impairment

We received a 23-year-old male, working in the Army for 18 months, with advanced renal impairment, haemoptysis and hyperkalemia. An impression of the pulmonary renal syndrome was made and he was managed aggressively with haemodialysis, plasma exchange and pulsing with methyl prednisolone. His condition improved, but the renal functions did not. The vasculitic workup including Extractable Nuclear Antigen (ENA) and Anti-Neutrophil Cytoplasmic Antibody (ANCA) which were sent on admission came out to be negative. As he apparently responded to the initial management protocol, he was subjected to renal biopsy which did not reveal any vasculitis but was consistent for end-stage renal disease. Subsequently he was subjected to lung biopsy which also was not supportive for vasculitis. However, we concluded that the initial pointers for Wegener’s granulomatosis were misleading. The haemoptysis entirely subsided as the congestion improved. He was maintained on Haemodialysis three times per week schedule and discharged to the peripheral health care facility.

Renal impairment in multiple myelomas

Objective: The aim of the study was to investigate the clinic manifestation, diagnosis and treatment on multiple myeloma (MM) with the onset of renal impairment. Methods: The 27 cases of multiple myeloma with the onset of renal impair-ment were collected in Department of Nephrology, Wuhan General Hospital of Guangzhou Command, China, from January 2007 to January 2011. All cases were divided into the groups with renal dysfunction (n = 16) and normal renal function (n = 11). The clinic manifestations, treatments and prognosis of all patients were analyzed. Results: Of all the patients in normal renal function group, 5 suffered nephrotic syndrome, 4 had abnormal results of routine urinalysis (hematuria or proteinuria) which were not caused by nephrotic syndrome, and 1 suffered urinary tract infection. Five pathological specimens of renal biopsy revealed that light chain protein, immunoglobulin and complement C3 were deposited mainly in the glomerular base-ment membrane and mesangia, tubular basement membrane and arteriolar walls. Two pathological specimens were proved to be renal amyloidosis. Patients with renal dysfunction had poorer prognosis, severer anemia, higher values of serum lactate dehydrogenase (LDH) and β2-microglobulin (β2-MG), worse responses to chemotherapy. Of 16 patients with renal dysfunc-tion, 14 (87.5%) were stage III, which were significantly higher than that in the group of normal renal function [63.6% (7/11)]. Of 16 cases with renal dysfunction, 9 were treated with blood purification, and 5 of 9 cases were treated with plasma exchange. Conclusion: Multiple myeloma with the onset of renal impairment was easily misdiagnosed. Hemodialysis concomitant with chemotherapy could contribute to recovery of renal function.

Real world analysis on renal impairment of elemene emulsion injection based on propensity score matching

Objective:To explore the main factors of renal function injury caused by the combination of elemene emulsion injection in the real world.Methods:Based on the hospital information system medical database constructed by the Institute of Clinical Basic Medicine of Chinese Academy of Traditional Chinese Medicine,taking the patient information of elemene emulsion injection used in 21 top three hospitals in China as the research object,the nested case control study method was used to compare the combined medication of patients with renal function injury group and control group,The main factors that may lead to renal function injury were screened by MCP variable selection method,and the above main factors were further analyzed by classical logistic regression and propensity score logistic regression method.Results:The analysis found that the combined use of potassium chloride within 7 d before the use of elemene emulsion injection or the combined use of furosemide during the use of elemene emulsion injection may be the main factor leading to renal function injury.Conclusion:The combination of elemene emulsion injection and the above main factors that may lead to renal injury should be avoided.If it must be used,clinical monitoring should be strengthened,and abnormal reactions should be treated immediately.The results of this study have certain clinical significance,and the clinical mechanism can be further studied and explored in the future.

THE PRACTICAL USE OF CYSTATIN C MEASUREMENT IN PATIENTS WITH VARIOUS RENAL DISEASES

Objective:To investigate the clinical usefulness in terms of estimation for glomerular filtration rate(GFR), we determined the serum cystatin C levels in 72 healthy adults , 63 children, and 109 patients with various renal diseases, and compared the serum cystatin C concentrations with serum creatinine levels. In addition, the renal function was evaluated in 5 adults receiving renal transplantations using cystatin C.Methods:Serum cystatin C levels were measured by a particle-enhanced nephelometric immunoassay on Dade Behring nephelometer system. Serum and urine creatinine concentrations were determined by use of Jaff’s kinetic assay.Results: The cystatin C concentration at birth was typically double that found in adults, then fell to a constant level after 1 year, a value that was maintained to about 60 years. The studies of cystatin C in the elderly showed that the circulation cystatin C levels rose gradually above 60 years. There was a significant positive correlation between serum cystatin C and creatinine level (r=0.921, P <0.01) in the patients with various renal diseases. Serum cystatin C was inversely and logarithmically correlated with creatinine clearance as shown in the equation lg cystatin C =-0.6061gCCr+1.209(r=-0.887, P <0.01). Serum cystatin C levels rose prior to creatinine concentrations and started to increase over normal range when creatinine clearance remained within normal range. After renal transplantation,cystatin C concentration significantly decreased during the first week(-43% vs -21% for creatinine) in patients without delayed graft function. In some cases of acute renal impairment, the increase in serum cystatin C values was more prominent than that of creatinine.Conclusion:Serum cystatin C is probably more attractive for estimation of renal function than serum creatinine and creatinine clearance especially for detection of the mild reduction of glomerular filtrate rate in patients with various kidney diseases. Serum cystatin C can also be used as an alternative marker of allograft function in adult transplant patients.

Temporal Variations in Mortality after Liver Transplantation: Retrospective Investigation of Potential Risk Factors Using Propensity Score

Objective: We aim to detect over-time variations in mortality of liver transplant recipients stratified by the period of transplant. Since this is a retrospective investigation, bias reduction caused by possible confounding effects can be achieved by using propensity score weighting in a multivariate logistic regression model. Methods: Medical charts of all adult liver transplant recipients (n = 250) who were transplanted in three periods 2005-2009, 2010-2014 and 2015-2019 were retrospectively reviewed. The following recipient factors were analyzed: recipients and donors’ ages, sex, renal impairment, body mass index (BMI), presence of bacterial or viral infections, MELD (Model for end-stage diseases). Multivariate logistic model adjusted by Propensity Scores (PS) was used to identify the effect of the risk factors on mortality, and death within five years, in the targeted time frame. Patient outcomes are recorded as;(patient status = 1 if dead, or patient status = 0 if alive). Results: Meld score, recipient age, and renal impairments were shown to be predictors of mortality in transplanted patients. Multivariate regression model was used to identify the significance of the specified risk factors, followed by pairwise comparisons between periods. Pairwise comparisons between periods using logistic regression weighted by the inverse propensity score, correcting for the possible confounding effect of measured covariates showed that the death rate is significantly reduced in subsequent periods as compared to the initial period. Conclusions: The clinical implications of these findings are the ability to stratify patients at high risk of posttransplant death by planning more intensive and accurate management for them.

Analysis of Clinical Characteristics of Patients with Different Types of Primary Hyperuricemia

Objective:This paper aims to study the clinical characteristics of patients with different types of primary hyperuricemia(HUA).Methods:Using a retrospective research method,200 patients with primary HUA in the hospital from June 2020 to January 2023 were selected as the research objects.Patients were grouped according to the detection results of 24-hour urinary uric acid excretion(UUE)and fractional excretion of uric acid(FEUA)(renal insufficiency type,renal overload type,mixed type,and other types).The general information of patients in the four groups(gender,age,body mass index,living habits,etc.),underlying diseases(hypertension,diabetes),blood test results[uric acid(UA),creatinine(Cre)],urine test results(24-hour urine UA,24-hour urine Cre)were summarized and the differences between the groups were analyzed.Results:The 200 cases of HUA patients were divided into 54.00%with renal insufficiency type,38.50%with mixed type,6.00%with renal overload type,and 1.50%with other types.The age of patients with mixed HUA was younger than that of patients with other types,renal overload type,and renal insufficiency type,and the difference was statistically significant(P<0.05).The UA level of patients with other types of HUA was lower than that of patients with mixed type HUA,and there was statistical significance(P<0.05).The Cre level of patients with mixed type HUA was lower than that of patients with renal insufficiency type and renal overload type,and the difference was statistically significant(P<0.05).The 24-hour urinary UA level in patients with renal insufficiency type HUA was lower than that in patients with renal overload type and mixed type HUA,and the difference was statistically significant(P<0.05).The 24-hour urinary Cre level of patients with other types of HUA was lower than that of patients with renal overload type and mixed HUA,the difference was statistically significant(P<0.05).The estimated glomerular filtration rate(eGFR)level of patients with other types of HUA was lower than that of patients with mixed type HUA,and the difference was statistically significant(P<0.05).There was no significant difference in the proportions of hypertension,diabetes,coronary heart disease,and urinary calculi among patients with renal insufficiency type,renal overload type,mixed type,and other types of HUA(P>0.05).Conclusion:The primary HUA patients are mainly of renal insufficiency type,followed by mixed type.There are significant differences in the clinical characteristics of patients with different types of HUA.Among them,patients with other types of HUA are the oldest and have the lowest uric acid levels.Patients with mixed HUA had the best renal function but the highest 24-hour urine creatinine level.This study can be used as a basis for rational selection of urate-lowering drugs for different HUA patients.

维持性血液透析患者认知障碍与日常生活活动能力下降的研究进展

维持性血液透析(maintenance hemodialysis,MHD)是治疗和延长终末期肾病患者生命的重要手段之一,认知障碍(cognitive impairment,CI)是MHD患者一种常见的并发症,研究发现CI会引起MHD患者日常生活活动(activities of daily living,ADL)能力下降。目前,大部分人对MHD患者CI认识不足,对患者ADL能力丧失的关注度不够。因此,本文将基于国内外文献报道,对MHD患者CI和ADL能力现况进行分析,综述CI的发病机制及对ADL能力的影响,并通过必要的干预措施来提高患者的ADL能力。

集束化护理在ANCA相关性血管炎肾损害患者中的应用

目的探讨集束化护理在抗中性粒细胞胞质抗体(ANCA)相关性血管炎肾损害患者中的应用效果。方法前瞻性选取2022年1月至2023年6月郑州大学第一附属医院收治的110例ANCA相关性血管炎肾损害患者作为研究对象,按随机数表法分为观察组和对照组各55例。对照组患者采用常规护理,观察组患者在常规护理的基础上给予集束化护理。两组患者均护理至出院,比较两组患者护理前和出院时的血压、平均动脉压、血红蛋白(Hb)和C反应蛋白(CRP)水平和肾功能恢复情况[包括尿素氮(BUN)、血清肌酐(CR)、尿β_(2)-微球蛋白(β_(2)-MG)、胱抑素C(Cys-C)、肾小球滤过率(GFR)情况];比较两组患者护理前和出院时的汉密尔顿抑郁量表(HAMD)评分变化;出院时,统计两组患者的不良反应发生率,并采用自制调查问卷调查两组患者出院时的护理满意度。结果出院时,两组患者的收缩压、舒张压、平均动脉压、Hb、CRP均下降,且观察组明显低于对照组,差异均有统计学意义(P<0.05);出院时,两组患者的Cys-C、GFR均升高,且观察组患者的Cys-C、GFR分别为(792.12±43.83)μg/L、(33.32±4.36)g/L,明显高于对照组的(666.94±57.94)μg/L、(32.34±4.35)g/L,BUN、CR、β_(2)-MG均降低,且观察组患者的BUN、CR、β_(2)-MG分别为(4.02±1.33)mmol/L、(328.25±120.55)mmol/L、(0.14±0.04)mmol/L,明显低于对照组的(4.95±2.73)mmol/L、(420.42±130.38)mmol/L、(0.44±0.04)mmol/L,差异均有统计学意义(P<0.05);出院时,两组患者的HAMD评分均降低,且观察组患者的HAMD为(13.24±1.05)分,明显低于对照组的(26.24±3.19)分,差异均有统计学意义(P<0.05);观察组患者的不良反应发生率为10.91%,明显低于对照组的43.64%,护理满意度为98.18%,明显高于对照组的70.91%,差异均有统计学意义(P<0.05)。结论集束化护理应用于ANCA相关性血管炎肾损害患者中,能够控制患者的血压,改善肾功能,改善患者抑郁情绪,同时有助于减少不良反应发生率,提高患者满意度。

补肾活血汤辅助VAD治疗多发性骨髓瘤肾损害临床疗效及对骨代谢、肾功能的影响

目的 探讨补肾活血汤辅助VAD治疗(长春新碱+阿霉素+地塞米松)多发性骨髓瘤肾损害的临床疗效,同时动态观察该治疗方案对骨代谢、肾功能的影响。方法 选择2019年1月—2021年1月88例确诊为多发性骨髓瘤且伴有肾损害的患者作为研究对象,采用随机数字法平均分为观察组与对照组两组:对照组给予VAD治疗方案,观察组在对照组基础上辅以补肾活血汤治疗。比较两组治疗4个疗程后临床疗效差异,与治疗前、治疗2个疗程、4个疗程后比较骨代谢指标、肾功能指标等差异。结果 观察组总有效率90.9%明显高于对照组75.0%,差异比较有统计学意义(P<0.05)。随着治疗时间延长,两组患者主症、次症及总积分均逐渐降低(P<0.05);治疗2疗程及4疗程后观察组主症、次症及总积分均低于对照组(P<0.05)。随着治疗时间延长,两组患者RANKL逐渐降低(P<0.05),ALP、OCN逐渐升高(P<0.05);治疗2疗程及4疗程后观察组RANKL均低于对照组(P<0.05),而ALP、OCN均高于对照组(P<0.05)。随着治疗时间延长,两组患者Scr、β2-MG、NGAL、KIM-1、Cys-C、尿mAlb逐渐降低(P<0.05);治疗2疗程及4疗程后观察组Scr、β2-MG、NGAL、KIM-1、Cys-C、尿mAlb均低于对照组(P<0.05)。结论 补肾活血汤辅助VAD治疗多发性骨髓瘤肾损害的临床疗效更显著,可以更好地改善症状,更好调节骨代谢,更有效地逆转肾功能损害。