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Transplantation Proceedings Dec 2020Renal transplantation offers a better quality of life and survival rate for patients with end-stage renal disease. However, voiding dysfunction may have results such as...
INTRODUCTION
Renal transplantation offers a better quality of life and survival rate for patients with end-stage renal disease. However, voiding dysfunction may have results such as decreased bladder capacity that have been observed in patients with prolonged oliguria or anuria, impacting a patient's quality of life. This study aimed to investigate preoperative factors associated with the occurrence of voiding dysfunction after renal transplantation.
METHODS
Seventy-one patients' data who had undergone successful renal transplantation at Cipto Mangunkusumo General Hospital in Jakarta were collected. Preoperative characteristics including age, sex, history of hypertension, diabetes mellitus, preoperative anuria, and duration of renal substitution therapy were obtained. Multivariate analysis were performed examining the correlation of preoperative characteristics with postoperative voiding dysfunction measured by International Prostate Symptom Score storage (IPSS-s) sub-score > 5, overactive bladder symptom score (OABSS) > 5, maximum flow rate (Qmax) > 15 mL/cc, and postvoid residual volume (PVR) > 50 mL.
RESULTS
A significant correlation of IPSS-s score suggesting storage problem with duration of preoperative dialysis was observed (odds ratio [OR] 1.052; 95% confidence interval [CI] 1.006-1.1001, P = .027). Older age and preoperative anuria were positively correlated with OABSS score > 5 (OR 1.104 and 33.567, P value .004 and .002, respectively). Negative correlation was observed between male sex and Qmax > 15mL/s (OR 1.73; 95% CI 0.033-1.907, P = .038). Male sex was negatively correlated with PVR > 50 mL (OR 0.231; P = .043) but positively correlated with the presence history of diabetes mellitus (OR 8.146; 95% CI 1.548-42.864, P = .013).
CONCLUSION
This study demonstrated that assessment of patient age, sex, and past medical history could help determine patients' risk for developing voiding dysfunction after renal transplantation.
Topics: Aged; Female; Humans; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Quality of Life; Risk Factors; Urinary Bladder, Overactive; Urinary Bladder, Underactive
PubMed: 32593439
DOI: 10.1016/j.transproceed.2020.04.1817 -
Diagnostics (Basel, Switzerland) Nov 2023(1) Background: Uremic pruritus (UP) is a common and taxing symptom in patients on maintenance hemodialysis (MHD). We have previously shown that blood lead levels (BLLs)...
(1) Background: Uremic pruritus (UP) is a common and taxing symptom in patients on maintenance hemodialysis (MHD). We have previously shown that blood lead levels (BLLs) and blood aluminum levels (BALs) were separately positively associated with UP in MHD patients. We also found that blood cadmium levels (BCLs) were positively associated with all-cause mortality and cardiovascular-related mortality in MHD patients. We wondered whether there is any correlation between BCLs and UP after adjusting for BLLs and BALs. (2) Methods: Patients enrolled in this study were all from three hemodialysis (HD) centers at Chang Gung Memorial Hospital, Lin-Kou Medical Center, including both the Taipei and Taoyuan branches. Correlations between UP and BLLs, BALs, BCLs, and other clinical data were analyzed. (3) Results: Eight hundred and fifty-three patients were recruited. Univariate logistic regressions showed that diabetes mellitus, hepatitis B virus infection, hepatitis C virus infection, HD duration, hemodiafiltration, dialysis clearance of urea, normalized protein catabolic rate, non-anuria, serum albumin levels, log (intact-parathyroid hormone levels), total serum cholesterol levels, serum low-density lipoprotein levels, log (blood aluminum levels), and log (blood lead levels) were associated with UP. Although log BCLs were not significantly associated with UP ( = 0.136) in univariate analysis, we still included log BCLs in multivariate logistic regression to verify their effect on UP given that our aim in this study was to verify associations between serum heavy metals and UP. Multivariate logistic regressions showed that log BLLs (OR: 27.556, 95% CI: 10.912-69.587, < 0.001) and log BALs (OR: 5.485, 95% CI: 2.985-10.079, < 0.001) were positively associated with UP. The other logistic regression, which stratified BLLs and BALs into high and low BLLs and BALs, respectively, showed that high BLLs or high BALs (low BLLs and low BALs as reference) (OR: 3.760, 95% CI: 2.554-5.535, < 0.001) and high BLLs and high BALs combined (low BLLs and low BALs as reference) (OR: 10.838, 95% CI: 5.381-21.828, < 0.001) were positively correlated with UP. (4) Conclusions: BLLs and BALs were positively correlated with UP. BCLs were not correlated with UP. Clinicians should pay more attention to the environmental sources of lead and aluminum to prevent UP.
PubMed: 38066806
DOI: 10.3390/diagnostics13233565 -
International Journal of Environmental... Jun 2021Renalase is an enzyme with monoamine oxidase activity that metabolizes catecholamines; therefore, it has a significant influence on arterial blood pressure regulation...
BACKGROUND/AIMS
Renalase is an enzyme with monoamine oxidase activity that metabolizes catecholamines; therefore, it has a significant influence on arterial blood pressure regulation and the development of cardiovascular diseases. Renalase is mainly produced in the kidneys. Nephrectomy and hemodialysis (HD) may alter the production and metabolism of renalase. The aim of this study was to examine the effect of bilateral nephrectomy on renalase levels in the serum and erythrocytes of hemodialysis patients.
METHODS
This study included 27 hemodialysis patients post-bilateral nephrectomy, 46 hemodialysis patients without nephrectomy but with chronic kidney disease and anuria and 30 healthy subjects with normal kidney function. Renalase levels in the serum and erythrocytes were measured using an ELISA kit.
RESULTS
Serum concentrations of renalase were significantly higher in post-bilateral nephrectomy patients when compared with those of control subjects (101.1 ± 65.5 vs. 19.6 ± 5.0; < 0.01). Additionally, renalase concentrations, calculated per gram of hemoglobin, were significantly higher in patients after bilateral nephrectomy in comparison with those of healthy subjects (994.9 ± 345.5 vs. 697.6 ± 273.4, = 0.015). There were no statistically significant differences in plasma concentrations of noradrenaline or adrenaline. In contrast, the concentration of dopamine was significantly lower in post-nephrectomy patients when compared with those of healthy subjects (116.8 ± 147.7 vs. 440.9 ± 343.2, < 0.01).
CONCLUSIONS
Increased serum levels of renalase in post-bilateral nephrectomy hemodialysis patients are likely related to production in extra-renal organs as a result of changes in the cardiovascular system and hypertension.
Topics: Blood Pressure; Catecholamines; Humans; Hypertension; Monoamine Oxidase; Nephrectomy; Renal Dialysis
PubMed: 34200667
DOI: 10.3390/ijerph18126282 -
Clinical Kidney Journal Sep 2023The combination of anti-glomerular basement membrane (GBM) disease and immunoglobulin A nephropathy (IgAN) has been well documented in sporadic cases, but lacks overall...
BACKGROUND
The combination of anti-glomerular basement membrane (GBM) disease and immunoglobulin A nephropathy (IgAN) has been well documented in sporadic cases, but lacks overall assessment in large collections. Herein, we investigated the clinical and immunological characteristics and outcome of this entity.
METHODS
Seventy-five consecutive patients with biopsy-proven anti-GBM disease from March 2012 to March 2020 were screened. Among them, patients with concurrent IgAN were identified and enrolled. The control group included biopsied classical anti-GBM patients during the same period, excluding patients with IgAN, other glomerular diseases or tumors, or patients with unavailable blood samples and missing data. Serum IgG and IgA autoantibodies against GBM were detected by enzyme-linked immunosorbent assay, as were circulating IgG subclasses against GBM.
RESULTS
Fifteen patients with combined anti-GBM disease and IgAN were identified, accounting for 20% (15/75) of all patients. Among them, nine were male and six were female, with an average (± standard deviation) age of 46.7 ± 17.3 years. Thirty patients with classical anti-GBM disease were enrolled as controls, with 10 males and 20 females at an average age of 45.4 ± 15.3 years. Patients with combined anti-GBM disease and IgAN had restricted kidney involvement without pulmonary hemorrhage. Compared with classical patients, anti-GBM patients with IgAN presented with significantly lower levels of serum creatinine on diagnosis (6.2 ± 2.9 vs 9.5 ± 5.4 mg/dL, = .03) and less occurrence of oliguria/anuria (20%, 3/15 vs 57%, 17/30, = .02), but more urine protein excretion [2.37 (1.48, 5.63) vs 1.11 (0.63, 3.90) g/24 h, = .01]. They showed better kidney outcome during follow-up (ESKD: 47%, 7/15 vs 80%, 24/30, = .03). The autoantigen and epitope spectrum were comparable between the two groups, but the prevalence of circulating anti-α3(IV)NC1 IgG1 (67% vs 97%, = .01) and IgG3 (67% vs 97%, = .01) were lower in patients with IgAN.
CONCLUSIONS
Concurrent IgAN was not rare in anti-GBM disease. Patients showed milder kidney lesions and better recovery after immunosuppressive therapies. This might be partly explained by lower prevalence of anti-GBM IgG1 and IgG3 in these patients.
PubMed: 37664576
DOI: 10.1093/ckj/sfad068 -
Therapeutic Advances in Urology 2020COVID-19 is now the major health concern of the century in many countries. Prolonged homestay has various undesirable consequences for people, such as physical... (Review)
Review
COVID-19 is now the major health concern of the century in many countries. Prolonged homestay has various undesirable consequences for people, such as physical inactivity and weight gain, which potentially could put people at risk of urinary stone formation. With regard to the prevention and treatment strategy for urinary stones during this COVID-19 pandemic period, patients can be divided into two groups. The first group comprises those for whom urological intervention is not indicated and where general dietary and lifestyle recommendations are helpful. The second group comprises those patients where urological intervention is indicated. This group can be divided into emergent and nonemergent subgroups. Patients with urinary stones and concomitant uremia, sepsis, anuria, or refractory pain and vomiting make up the emergent group, where intervention is necessary. The preferred option during the novel coronavirus crisis for these patients is percutaneous nephrostomy tube insertion under local anesthesia. The second subgroup is made up of those patients with asymptomatic and noncomplicated renal and ureteral stones where urologic intervention is indicated in the usual time scale. However, we suggest conservative treatment for 3 months during the COVID-19 outbreak after which re-evaluation of the patient should be carried out. Thus the operation could be chosen carefully based on the patient's and urologist's preference and the rate of infection in that center.
PubMed: 32849913
DOI: 10.1177/1756287220939513 -
Kidney Research and Clinical Practice Aug 2023This study was performed to investigate the feasibility of incremental peritoneal dialysis (iPD) in older patients.
BACKGROUND
This study was performed to investigate the feasibility of incremental peritoneal dialysis (iPD) in older patients.
METHODS
In this retrospective cohort study, we enrolled peritoneal dialysis (PD) patients with age ≥ 60 years old at our center from 2008 to 2017. The patients were divided into two groups based on the daily PD exchanges: iPD group (≤3 × 2 L exchanges), and full dose group (≥4 × 2 L exchanges). Kaplan-Meier curves and multivariate Cox regression models were applied to evaluate the risks of anuria and mortalities between groups.
RESULTS
A total of 238 patients (186 in full dose group and 52 in iPD group) were enrolled. The mean age was 67.8 ± 5.7 years, and 45.8% were females. The baseline glomerular filtration rate was 4.15 ± 2.39 mL/min/1.73 m2 . Multivariate Cox regression models showed that patients in the iPD group patients had significantly decreased risk of anuria (hazard ratio [HR], 0.44; 95% confidence interval [CI], 0.24-0.81; p = 0.008), and all-cause mortality (HR, 0.59; 95% CI, 0.36-0.98; p = 0.04). Additionally, the incidence of peritonitis was significantly lower in the iPD group than that in the full dose group (0.115 vs. 0.197 episodes per person-year, p = 0.03) during the 36 months of PD commencement.
CONCLUSION
Older patients with iPD were independently associated with better preservation of residual kidney function and survival outcomes. Moreover, iPD regimens are also associated with reduced incidence of peritonitis. The iPD strategy might offer a feasible option for older patients.
PubMed: 37559224
DOI: 10.23876/j.krcp.22.202 -
Renal Failure 2023Peritoneal dialysis-related peritonitis (PDRP) presents a significant challenge for nephrologists. Continuous intraperitoneal cefazolin and ceftazidime are recommended...
OBJECTIVE
Peritoneal dialysis-related peritonitis (PDRP) presents a significant challenge for nephrologists. Continuous intraperitoneal cefazolin and ceftazidime are recommended for the treatment of peritonitis. However, some pharmacokinetic studies have shown that doses of 15-20 mg/kg/d may not achieve sufficient therapeutic levels. In this study, we investigated the pharmacokinetics of ceftazidime and cefazolin in patients with continuous ambulatory peritoneal dialysis-related peritonitis and compared the pharmacokinetic characteristics between traditional and modified treatment groups.
METHODS
From February 2017 to December 2019, 42 PDRP patients (17 males, 25 females; mean age: 50.7 ± 12.1 years; mean body weight: 60.9 ± 11.8 kg) were recruited for the study, all participants were anuric. Twenty patients were enrolled in the traditional group and treated with cefazolin (1.0 g) and ceftazidime (1.0 g) intraperitoneal administration once daily for 14 days. Twenty-two patients were enrolled in the modified group and received the same dose of antibiotics twice daily for the initial five days, followed by once daily for the subsequent nine days. Serum and dialysate samples were collected after days 1, 2, 3, 5, 7, 10, and 14 and analyzed liquid chromatography-mass spectrometry.
RESULTS
In the traditional group, the highest and lowest serum concentrations of ceftazidime were 35.9 and 21.7 µg/mL, respectively. The highest concentration of cefazolin was 54.6 µg/mL on day 5 and the lowest concentration was 30.4 µg/mL on day 1. In the modified group, the highest and lowest serum concentrations of ceftazidime were 102.2 and 54.8 µg/mL, respectively. The highest concentration of cefazolin was 141.7 µg/mL and the lowest concentration was 79.8 µg/mL. All antibiotic concentrations were above the minimum inhibitory concentration (MIC) level (8 µg/mL of ceftazidime and 2 µg/mL of cefazolin) throughout the treatment period. However, on day 1, the concentration of ceftazidime in the third bag of dialysate effluent from the traditional group fell below the MIC level. Despite remaining above the MIC, cefazolin concentration was consistently lower in the third bag of dialysate effluent from the traditional group throughout the treatment period.
CONCLUSIONS
Intraperitoneal administration of cefazolin and ceftazidime at a dose of 1 g twice daily for 5 days and then once daily for the rest of the treatment period ensured adequate therapeutic levels of antibiotics for treating anuric PDRP patients.
Topics: Male; Female; Humans; Adult; Middle Aged; Cefazolin; Ceftazidime; Peritoneal Dialysis, Continuous Ambulatory; Prospective Studies; Anti-Bacterial Agents; Peritonitis; Dialysis Solutions; Anuria
PubMed: 38044852
DOI: 10.1080/0886022X.2023.2285873 -
Journal of Clinical Medicine Jan 2020The aim of our study was to assess the association between the macrohemodynamic profile and sepsis induced acute kidney injury (AKI). We also investigated which...
The aim of our study was to assess the association between the macrohemodynamic profile and sepsis induced acute kidney injury (AKI). We also investigated which minimally invasive hemodynamic parameters may help identify patients at risk for sepsis-AKI. We included 71 patients with sepsis and septic shock. We performed the initial fluid resuscitation using local protocols and continued to give fluids guided by the minimally invasive hemodynamic parameters. We assessed the hemodynamic status by transpulmonary thermodilution technique. Sequential organ failure assessment (SOFA score) (AUC 0.74, 95% CI 0.61-0.83, < 0.01) and cardiovascular SOFA (AUC 0.73, 95% CI 0.61-0.83, < 0.01) were found to be predictors for sepsis-induced AKI, with cut-off values of 9 and 3 points respectively. Persistent low stroke volume index (SVI) ≤ 32 mL/m/beat (AUC 0.67, 95% CI 0.54-0.78, < 0.05) and global end-diastolic index (GEDI) < 583 mL/m (AUC 0.67, 95% CI 0.54-0.78, < 0.05) after the initial fluid resuscitation are predictive for oliguria/anuria at 24 h after study inclusion. The combination of higher vasopressor dependency index (VDI, calculated as the (dobutamine dose × 1 + dopamine dose × 1 + norepinephrine dose × 100 + vasopressin × 100 + epinephrine × 100)/MAP) and norepinephrine, lower systemic vascular resistance index (SVRI), and mean arterial blood pressure (MAP) levels, in the setting of normal preload parameters, showed a more severe vasoplegia. Severe vasoplegia in the first 24 h of sepsis is associated with a higher risk of sepsis induced AKI. The SOFA and cardiovascular SOFA scores may identify patients at risk for sepsis AKI. Persistent low SVI and GEDI values after the initial fluid resuscitation may predict renal outcome.
PubMed: 31935904
DOI: 10.3390/jcm9010151 -
European Heart Journal. Acute... Jan 2022The role of diuretics in patients with intermediate-risk pulmonary embolism (PE) is controversial. In this multicentre, double-blind trial, we randomly assigned... (Randomized Controlled Trial)
Randomized Controlled Trial
AIMS
The role of diuretics in patients with intermediate-risk pulmonary embolism (PE) is controversial. In this multicentre, double-blind trial, we randomly assigned normotensive patients with intermediate-risk PE to receive either a single 80 mg bolus of furosemide or a placebo.
METHODS AND RESULTS
Eligible patients had at least a simplified PE Severity Index (sPESI) ≥1 with right ventricular dysfunction. The primary efficacy endpoint assessed 24 h after randomization included (i) absence of oligo-anuria and (ii) normalization of all sPESI items. Safety outcomes were worsening renal function and major adverse outcomes at 48 hours defined by death, cardiac arrest, mechanical ventilation, or need of catecholamine. A total of 276 patients underwent randomization; 135 were assigned to receive the diuretic, and 141 to receive the placebo. The primary outcome occurred in 68/132 patients (51.5%) in the diuretic and in 49/132 (37.1%) in the placebo group (relative risk = 1.30, 95% confidence interval 1.04-1.61; P = 0.021). Major adverse outcome at 48 h occurred in 1 (0.8%) patients in the diuretic group and 4 patients (2.9%) in the placebo group (P = 0.19). Increase in serum creatinine level was greater in diuretic than placebo group [+4 µM/L (-2; 14) vs. -1 µM/L (-11; 6), P < 0.001].
CONCLUSION
In normotensive patients with intermediate-risk PE, a single bolus of furosemide improved the primary efficacy outcome at 24 h and maintained stable renal function. In the furosemide group, urine output increased, without a demonstrable improvement in heart rate, systolic blood pressure, or arterial oxygenation.ClinicalTrials.gov identifier NCT02268903.
Topics: Acute Disease; Diuretics; Double-Blind Method; Furosemide; Humans; Pulmonary Embolism; Treatment Outcome; Ventricular Dysfunction, Right
PubMed: 34632490
DOI: 10.1093/ehjacc/zuab082 -
Pediatric Emergency Care Dec 2021The most common cause of diarrheal mortality in children is dehydration. In this study, we aimed to assess the validity (sensitivity and specificity) of history and the...
OBJECTIVE
The most common cause of diarrheal mortality in children is dehydration. In this study, we aimed to assess the validity (sensitivity and specificity) of history and the clinical and laboratory findings in in the diagnosis of dehydration in children younger than 2 years with acute diarrhea.
METHODS
One hundred twenty-six 2 to 24-month-old children with acute diarrhea, who were admitted to Hacettepe University Ihsan Dogramaci Children's Hospital's Diarrheal Diseases Treatment and Training Unit, were included. The patients were examined on admission for clinical findings of dehydration. Percent weight loss on admission was calculated by using the weight on admission and the weight after the diarrhea resolution and was used as the golden standard for analyzing the validity of clinical and laboratory findings.
RESULTS
Compared with the golden standard, dehydration was overestimated in 13% of the cases and underestimated in 7% when using only the World Health Organization criteria. Dehydrated children had higher diarrheal frequency and longer anuria time. Thirst, weakness, sunken fontanelle, sunken eyes, decreased tears, dry mucous membranes, and dry lip were detected in children with 2% or greater of weight loss. The most valid laboratory findings were low serum pH (<7.30), low bicarbonate (<15 mmol/L), and hyperurisemia (>5.8 mg/dL). In multivariate analysis, physical findings, such as thirst, dry mucous membranes, weakness, sunken eyes, hoarse crying, and low pH, were found to be significant for the diagnosis of dehydration.
CONCLUSIONS
In children with acute diarrhea, diarrheal frequency and last urination time should be asked, thirst, dry mucous membranes, weakness, sunken eyes, and hoarse crying should be examined.
Topics: Bicarbonates; Child; Child, Preschool; Dehydration; Diarrhea; Humans; Infant; Sensitivity and Specificity
PubMed: 31913251
DOI: 10.1097/PEC.0000000000001980