Chronic kidney disease (CKD) and hypertension are very common chronic diseases. Active and standardized treatment of hypertension in patients with CKD can not only delay the progress of renal disease, but also reduce the risk of cardiovascular events. In recent years, although the guidelines for hypertension have put forward detailed suggestions for the management of hypertension in CKD patients, there are differences in the recommendation of blood pressure target value for CKD patients. Combined with the latest guidelines, this review interprets the blood pressure measurement methods, diagnostic criteria, antihypertensive targets and drug therapy in patients with CKD.
ObjectiveTo explore the correlation of serum lipocalin-2 (LCN2) with inflammation and the predictive value of LCN2 for detecting acute kidney injury (AKI) in acute pancreatitis (AP).MethodsNighty-one patients with AP, who were admitted to Bazhong Municipal Hospital of Traditional Chinese Medicine between June 2016 and June 2018, were enrolled in the present study. Clinical paramaters were analyzed between patients with AKI (n=29) and patients without AKI (n=62). The correlation of serum LCN2 with inflammation was assessed with Pearson’s correlation analysis. The area under the receiver operating characteristic curve (ROC AUC) for serum LCN2 predicting AKI in AP patients was assessed.ResultsCompared with the patients without AKI, the patients with AKI showed increased serum levels of C-reactive protein [(64.8±10.5) vs. (148.3±21.6) mg/L], procalcitonin [(3.5±2.3) vs. (4.8±3.9) μg/L], urea nitrogen [(5.5±2.1) vs. (6.6±2.8) mmol/L], creatinine [(80.3±28.1) vs. (107.3±30.8) μmol/L], interleukin-6 [(10.1±3.7) vs. (16.2±4.6) pg/mL], and LCN2 [(155.0±37.6) vs. (394.8±53.1) mg/mL], as well as decreased level of calcium [(2.6±1.3) vs. (2.0±1.0) mmol/L], the differences were all statistically significant (P<0.05). The serum level of LCN2 was correlated with C-reactive protein (r=0.694, P<0.05), interleukin-6 (r=0.762, P<0.05), and procalcitonin (r=0.555, P<0.05) in patients with AP. The ROC AUC of LCN2 for predicting AKI was 0.844 (P<0.05) , with a sensitivity of 81.3% and a specificity of 81.4% when the cut-off value was 210.2 ng/mL.ConclusionsSerum LCN2 concentration is elevated in patients with AKI. In patients with AP, serum LCN2 level is positively correlated with C-reactive protein, interleukin-6, and procalcitonin. It can be regarded as a reliable indicator for predicting AKI.
ObjectiveTo investigate the health literacy level and its influencing factors among follow-up patients with chronic kidney disease (CKD).MethodsFrom March to August 2018, 248 patients from the CKD Follow-up Management Center, West China Hospital, Sichuan University were included. Basic information questionnaire and chronic diseases health literacy scale were used. Analysis of variance and t test were used in univariate analysis, and multiple linear stepwise regression was used in multivariate analysis, to explore the influencing factors of health literacy score.ResultsThe average health literacy score of the 248 CKD patients (97.24±12.22) were in medium to low level. Listed from high to low, the score of each dimension was: ability to obtain information (4.24±0.50), willingness to improve health (4.17±0.66), competence to communicate and interact with others (3.95±0.59), and willingness to support financially (3.41±1.10). The result of multiple linear stepwise regression showed that whether followed up on time, families’ monthly income per capita, and the patients’ age were independent influencing factors of health literacy score (P<0.05).ConclusionsThe health literacy level of follow-up patients with CKD remains to be improved. Medical personnel should pay attention to whether patients with CKD are followed up on time, make targeted intervention, and improve the self-management of patients so as to delay the disease progress of CKD.
Acute kidney injury is a common complication in the critically ill patients with high morbidity and mortality. Continuous renal replacement therapy (CRRT) is one of the most important treatments for the disease. The timing of starting and stopping of CRRT is often a matter of choice for clinicians. Early stopping of CRRT may lead to inadequate treatment, recurrent disease and poor prognosis, while excessive treatment of CRRT may prolong the hospital stay, increase medical costs and increase the risk of CRRT-related complications. In order to illustrate the proper stopping time of CRRT, this paper summarizes the research progress of the clinical indicators and biomarkers by reviewing relevant domestic and foreign data.
Rhabdomyolysis-induced acute kidney injury (RIAKI) is a serious clinical disease in intensive care unit, characterized by high mortality and low cure rate. Continuous renal replacement therapy (CRRT) is a common form of treatment for RIAKI. There are currently no guidelines to guide the application of CRRT in RIAKI. To solve this problem, this article reviews the advantages and limitations of CRRT in the treatment of RIAKI, as well as new viewpoints and research progress in the selection of treatment timing, treatment mode, treatment dose and filtration membrane, with the aim of providing theoretical guidance for the treatment of CRRT in RIAKI patients.
Most patients with coronavirus disease 2019 (COVID-19) have a good prognosis, but a certain proportion of the elderly and people with underlying diseases are still prone to develop into severe and critical COVID-19. Kidney is one of the common target organs of COVID-19. Acute kidney injury (AKI) is a common complication of severe COVID-19 patients, especially critical COVID-19 patients admitted to intensive care units. AKI associated with COVID-19 is also an independent risk factor for poor prognosis in patients. This article mainly focuses on the epidemiological data, possible pathogenesis, diagnostic criteria, and prevention and treatment based on the 5R principle of AKI associated with COVID-19. It summarizes the existing evidence to explore standardized management strategies for AKI associated with COVID-19.
Objective To investigate the nutritional status of hospitalized patients with chronic kidney disease (CKD), analyze the influencing factors, and construct a predictive model to provide a localized theoretical basis and more convenient risk prediction indicators and models for clinical nutrition support and intervention treatment of CKD patients in China. Methods Convenience sampling was used to select hospitalized CKD patients from Department of Nephrology, West China Hospital, Sichuan University, from January to October 2019. General information questionnaires, the Nutritional Risk Screening 2002 scale, and the Huaxi Emotional-distress Index questionnaire were used for data collection. Single factor analyses and multiple logistic regression analysis were conducted to explore the risk factors for malnutrition in CKD hospitalized patients. A predictive model was established and evaluated using receiver operating characteristic (ROC) curve analysis and bootstrap resampling. Results A total of 1059 valid copies of questionnaires were collected out of 1118 distributed. Among the 1059 CKD hospitalized patients, 207 cases (19.5%) were identified as having nutritional risk. The multiple logistic regression analysis showed that CKD stage [odds ratio (OR)=1.874, 95% confidence interval (CI) (1.631, 2.152), P<0.001], age [OR=1.015, 95%CI (1.003, 1.028), P=0.018], and the Huaxi Emotional-distress Index [OR=1.024, 95%CI (1.002, 1.048), P=0.033] were independent risk factors for malnutrition in CKD hospitalized patients, while serum albumin [OR=0.880, 95%CI (0.854, 0.907), P<0.001] was an independent protective factor. The evaluation of the multiple logistic regression analysis predictive model showed a concordance index of 0.977, standard deviation of 0.021, and P<0.05. The area under the ROC curve was 0.977. Conclusions The prevalence of malnutrition is relatively high among CKD hospitalized patients. CKD stage, age, psychological status, and serum albumin are influencing factors for malnutrition in CKD hospitalized patients. The multiple logistic regression model based on the above indicators demonstrates good predictive performance and is expected to provide assistance for early nutritional intervention to improve the clinical outcomes and quality of life for CKD patients with malnutrition in China.
To discuss renovascular reconstruction during l iving related donor kidney transplantation (LDKT). Methods Seventy-seven cases of LDKT from April 2006 to March 2008 were retrospectively analyzed, including 63 cases in single renal artery group and 14 cases in multi ple artery group. In multi ple artery group, there were 3 cases of three arteries and 11 cases of double arteries; 9 cases of donated left kidneys and 5 cases of donated right kidneys. Potential donors underwent fully medical evaluation before operation, including donor-reci pient human leucocyte antigen matchingand a cross match test. The donor’s operation of the incision either underneath the 12th rib approaching the dorsal lumbar was performed and the transplantation operation adopted the extraperitoneal approach in the contralateral fossa il iac. The arteries in the multiple artery group were implanted onto the external (or common) il iac artery different from the orthodox method. Results In multiple artery group, no blood transfusion during operation was performed, no compl ication occurred after operation and all donors were discharged after 7-9 days of postoperation. After a follow-up of 3 months to 1 year, all the recipients kept normal kidney function without renal tubule necrosis, renal artery embol ism, vascular stenosis, urinary fistula and ureter necrosis. The ultrasound examination showed that the transplanted kidney had good blood supply. There was no significant difference in the time of urine secretion, serum creatinine level after 1 week of operation, length of hospital ization between the multiple artery group and the single artery group (P gt; 0.05). Conclusion The accurate treatment of multiple artery anastomosis are critical for the safety of the LDKT.
ObjectiveTo explore the current status of treatment adherence in patients with chronic kidney disease without dialysis and to analyze its influencing factors.MethodsThe patients who visited the Outpatient Department of Nephrology of West China Hospital of Sichuan University from September to December 2020 were taken as the research objects. Self-designed general information questionnaire, treatment adherence questionnaire, physician-patient communication satisfaction, health information seeking behavior questionnaire, and physician-patient concordance questionnaire were used to investigate, and path analysis was used to explore the influencing factors of treatment adherence.ResultsA total of 203 valid questionnaires were obtained. Treatment adherence score was (21.69±2.42) points, self-reported health status was (2.48±0.91) points, physician-patient concordance was (20.39±2.70) points, physician-patient communication satisfaction was (67.73±5.52) points, and health information seeking behavior was (13.17±2.65) points. Health information seeking behavior (r=0.214, P=0.002), physicians-patient concordance (r=0.494, P<0.001), physician-patient communication satisfaction (r=0.229, P=0.001) were positively correlated with treatment adherence. Self-reported health status was negatively correlated with treatment adherence (r=?0.225, P=0.001). Path analysis showed that physicians-patient concordance was the most influencing factor of treatment adherence (total effect=0.474).ConclusionHealth information-seeking behavior and physicians-patient concordance are important factors affecting treatment adherence in chronic kidney disease patients without dialysis. In order to improve treatment adherence of chronic kidney disease patients, healthcare providers can provide various ways to provide information, which can help make more disease-related health knowledge available to patients. Moreover, healthcare workers should also further explore ways to improve the concordance related to reaching agreement between doctors and patients on medical and treatment options.
ObjectiveTo investigate the protective effects and mechanism of selective histone deacetylases 6 (HDAC6) inhibitor 23BB in myoglobin-induced proximal tubular cell lines (HK-2).MethodsHK-2 cells were divided into 5 groups, including control group, myoglobin (200 μmol/L) group, myoglobin (200 μmol/L)+23BB (1.25 nmol/L) group, myoglobin (200 μmol/L)+4-phenylbutyric acid (2 mmol/L) group, and myoglobin (200 μmol/L)+23BB (1.25 nmol/L)+tunicamycin (25 ng/mL) group. Cells were collected at 24 hours after treatment. The endoplasmic reticulum (ER) stress-related gene mRNA level and marker protein expression were evaluated by RT-PCR and Western blotting, including glucose regulated protein 78 (GRP78), C/EBP homology protein (CHOP), inositol-requiring enzyme 1 (IRE1), PKR-like ER kinase (PERK), and activating transcription factor 6.ResultsIn in vitro study, ER stress-related mRNA of GRP78, IRE1α, PERK, and CHOP and marker protein expression of GRP78 and CHOP were found to increase in response to myoglobin treatment. Either administration of 23BB or 4-PBA could alleviate myoglobin-induced these changes.ConclusionThe protective effect of HDAC6 inhibitor 23BB is through the inhibition of myoglobin-induced ER stress in HK-2 cells.
