Current Issue : October - December Volume : 2016 Issue Number : 4 Articles : 6 Articles
Background: Nonbacterial prostatitis, together with chronic pelvic pain syndrome, accounts for 90ââ?¬â??95 % of\nprostatitis cases. Anti-inflammatory medications are commonly used to reduce storage/inflammatory symptoms\nthat can deteriorate quality of life. The purpose of this study was to observe the efficacy and safety of\nbeclomethasone dipropionate rectal suppositories (TopsterÃ?®) in inflammations of the lower urinary tract in men.\nMethods: Patients underwent diagnostic and therapeutic protocols according to current evidence-based practice.\nEfficacy assessments: voiding parameters, perineal pain, International Prostate Symptom Score (IPSS), digital rectal\nexamination (DRE). Adverse events and patient compliance were recorded throughout the study.\nResults: One hundred eighty patients were enrolled, mean age 52 Ã?± 14.97. Most frequent diagnosis: nonbacterial\nprostatitis (85 %). All patients completed visits 1 and 2. All patients were treated with beclomethasone dipropionate\n(BDP) suppositories, 136/180 also with Serenoa repens (SR) extract. Antibiotics were rarely required.\n162/180 patients presented clinically significant improvements and terminated treatment.\nMean change vs. baseline in voiding frequency: âË?â??3.55 Ã?± 2.70 n/day in patients taking only BDP and âË?â??3.68 Ã?± 2.81 n/day\nin those taking both BDP and SR (P<.0001 in both groups). Uroflowmetry improved significantly; change from baseline\n3.26 Ã?± 5.35 ml/s in BDP only group and 5.61 Ã?± 7.32 ml/s in BDP + SR group (P = 0.0002 for BDP, P<.0001 for BDP + SR).\nUrine stream normal in 35 % of patients at visit 1 and 57.22 % of patients at visit 2. Mean change in perineal pain, on\n0ââ?¬â??10 VAS, âË?â??0.66 Ã?± 2.24 for BDP only group (P = 0.0699) and âË?â??1.37 Ã?± 2.40 for BDP + SR group (P<.0001). IPSS increased at\nvisit 2. No adverse events were reported.\nFor all parameters, none of the comparisons between groups was found to be statistically significant.\nConclusion: This study confirmed the drugââ?¬â?¢s good safety profile. We also observed an improvement in the main\nstorage symptoms and clinical findings associated with lower urinary tract inflammation in patients treated with\nbeclomethasone dipropionate suppositories....
Urine neutrophil gelatinase-associated lipocalin (NGAL) is widely used as a biomarker for acute kidney injury. Cross-sectional\nstudies have shown that NGAL may be elevated in glomerular diseases, but there is limited information on the value of NGAL in\npredicting treatment response or on the changes of NGAL levels after therapy.We prospectively evaluated the effects of therapy on\nNGAL in nondiabetic glomerular diseases. Urine NGAL was collected at biopsy and follow-up at 12 months. At baseline, NGAL\nin glomerular disease patients (n = 43) correlated with proteinuria, but not with glomerular filtration rate (GFR). After therapy\nwith renin-angiotensin blockers and/or immune modulating agents, change of NGAL correlated with change of proteinuria, but\nnot with change of GFR. NGAL at baseline was not different between patients in complete remission (CR) at follow-up compared\nto those not in remission (NR). Compared to baseline, NGAL at follow-up decreased in CR (n = 10), but not in NR. Change of\nNGAL was greater in CR than NR. In conclusion, the change of urine NGAL correlated with the change of proteinuria. Baseline\nNGAL was not a predictor of complete remission. Future studies will be necessary to determine the role of NGAL as a predictor of\nlong term outcome in proteinuric glomerular diseases....
Background: Diabetes mellitus (DM) is the leading cause of end-stage renal disease. Little is known about practice\npatterns of anti-diabetic therapy in the presence of chronic kidney disease (CKD) and correlates with glycaemic\ncontrol. We therefore aimed to analyze current antidiabetic treatment and correlates of metabolic control in a large\ncontemporary prospective cohort of patients with diabetes and CKD.\nMethods: The German Chronic Kidney Disease (GCKD) study enrolled 5217 patients aged 18ââ?¬â??74 years with an\nestimated glomerular filtration rate (eGFR) between 30ââ?¬â??60 mL/min/1.73 m2 or proteinuria >0.5 g/d. The use of diet\nprescription, oral anti-diabetic medication, and insulin was assessed at baseline. HbA1c, measured centrally, was the\nmain outcome measure.\nResults: At baseline, DM was present in 1842 patients (35 %) and the median HbA1C was 7.0 % (25thââ?¬â??75th\npercentile: 6.8ââ?¬â??7.9 %), equalling 53 mmol/mol (51, 63); 24.2 % of patients received dietary treatment only, 25.5 % oral\nantidiabetic drugs but not insulin, 8.4 % oral antidiabetic drugs with insulin, and 41.8 % insulin alone. Metformin was\nused by 18.8 %. Factors associated with an HbA1C level >7.0 % (53 mmol/mol) were higher BMI (OR = 1.04 per increase\nof 1 kg/m2, 95 % CI 1.02ââ?¬â??1.06), hemoglobin (OR = 1.11 per increase of 1 g/dL, 95 % CI 1.04ââ?¬â??1.18), treatment with insulin\nalone (OR = 5.63, 95 % CI 4.26ââ?¬â??7.45) or in combination with oral antidiabetic agents (OR = 4.23, 95 % CI 2.77ââ?¬â??6.46) but\nnot monotherapy with metformin, DPP-4 inhibitors, or glinides.\nConclusions: Within the GCKD cohort of patients with CKD stage 3 or overt proteinuria, antidiabetic treatment\npatterns were highly variable with a remarkably high proportion of more than 50 % receiving insulin-based therapies.\nMetabolic control was overall satisfactory, but insulin use was associated with higher HbA1C levels...
Background: The clinic-pathological features and outcomes of Chinese patients with antineutrophil cytoplasmic\nautoantibody (ANCA)-positive eosinophilic granulomatosis with polyangiitis (EGPA) and renal involvement have\nnot been studied.\nMethods: Fourteen EGPA patients with renal involvement were included. All patients underwent renal biopsy.\nClinic-pathological features and outcomes were retrospectively analyzed.\nResults: The most common initial symptom of EGPA was asthma (57.1 %), followed by hemoptysis (21.4 %),\ngross hematuria (14.3 %), and arthritis (7.1 %). All patients had positive serum ANCA (anti-MPO in 12, anti-PR3 in 2).\nElevated eosinophils (median 15 %, range 10ââ?¬â??45 %) were found in all patients. The median serum IgE level was\n463 g/L (range 200ââ?¬â??1000 g/L). All patients presented with renal dysfunction, with a median SCr of 5.4 mg/dL\n(range 1.47ââ?¬â??11 mg/dL), seven patients (50 %) required initial renal replacement therapy. Thirteen patients showed\nhematuria and proteinuria (median 1.1 g/24 h, range 0.5ââ?¬â??7.8 g/24 h). Renal biopsy showed pauci-immune segmental\nnecrotizing glomerulonephritis with crescents in 13 patients and acute interstitial nephritis in one patient. Twelve\npatients (85.7 %) showed renal interstitial eosinophil infiltration, among whom three had eosinophilic granuloma.\nAmong seven patients (71.4 %) who required initial dialysis, 5 discontinued dialysis, one died, one received\nmaintenance dialysis after glucocorticoids plus immunosuppressive for induction treatment. Twelve patients were\nfollowed up for a median of 43.5 months (range 6ââ?¬â??83 months), during follow-up, two patients progressed to\nend-stage renal disease, nine had chronic kidney disease with eGFR < 60 mL/min, and two patients had normal eGFR.\nConclusions: Renal involvement in ANCA-positive EGPA could be severe and showed varied renal histology.\nAlthough intensive immunosuppressive therapy effectively improved the renal function, the long-term renal\nsurvival was poor. Early diagnosis and treatment are essential to improve long-term renal survival....
Late recurrence of renal cell carcinoma (RCC), arbitrarily defined, as >10 years post-nephrectomy,\nis rare. Here we review 43 reports comprising 467 cases. Metastasis occurred between few months\nand 45 years. We report a new case with a 10-year interval to metastasis....
Background: Mirabegron is a �²3-adrenoreceptor agonist developed for treatment of overactive bladder (OAB).\n�±1-Adrenergic receptor blockers are effective for lower urinary tract symptoms (LUTS) in male patients. However,\nthe efficacy of mirabegron additional treatment in elderly male patients with persistent male LUTS, especially in\nOAB after monotherapy with �±1-adrenergic blockers, is not fully understood.\nMethods: This study was conducted in male LUTS patients who were â�¥ 65 years of age and had persistent OAB\nsymptoms, regardless of whether they took an �±1-adrenergic receptor blocker orally. Before and 12 weeks after\nmirabegron additional therapy (50 mg once daily), we evaluated the efficacy of this treatment using the Overactive\nBladder Symptom Score (OABSS) and International Prostate Symptom Score (IPSS), and changes in the maximum\nflow rate (Qmax) and post-void residual urine volume (PVR). We evaluated patients overall and divided into two\ngroups by age: young-old (from 65 to 74 years old) and old-old (from 75 to 84 years old).\nResults: Fifty men were enrolled in this study. Mirabegron additional therapy improved the total OABSS, total IPSS,\nand IPSS-quality of life (QOL) score. The voided volume (VV) and Qmax improved after treatment in patients overall.\nHowever, there was no significant change in PVR. The total OABSS, total IPSS, and IPSS-QOL score significantly\nimproved in both of the young-old and old-old groups. However, a significant increasing of VV was detected in the\nyoung-old group. There were no significant differences in the Qmax or PVR in either group.\nConclusions: Mirabegron additional therapy was effective for male patients whose persistent LUTS and particularly\nOAB was not controlled with �±1-adrenergic receptor blocker monotherapy, and mirabegron did not have negative\neffects on voiding function. Additionally, mirabegron additional therapy was considered effective regardless of\npatient age....
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