Current Issue : January - March Volume : 2017 Issue Number : 1 Articles : 7 Articles
We report a case of IgG4-related disease presenting both tubulointerstitial nephritis\nand retroperitoneal fibrosis causing acute renal failure in a 63-year-old male. He was\nadmitted to our hospital because of acute renal failure requiring emergent hemodialysis.\nComputed tomography showed a soft-tissue density mass with an irregular\nborder in the retroperitoneum. The mass involved bilateral ureters and had caused\nacute renal failure by bilateral hydronephrosis. Because of a history of uveitis and\nhigh IgG4 levels, we considered a diagnosis of retroperitoneal fibrosis, IgG4-related\ndisease. Kidney biopsy revealed IgG4-related kidney disease with interstitial nephritis.\nAfter relief of urinary obstruction by inserting ureteral catheters into the bilateral\nureters, renal function recovered....
Background: Researchers have developed several equations to predict glomerular filtration rate (GFR) in patients\nwith chronic kidney diseases (CKD). However, there are scarcely any studies performed to discern the best equation\nto estimate GFR in patients with pure obstructive nephropathy. In present study, we assessed the suitability of six\nprediction equations and compared their performance in eGFR evaluation for Chinese patients with obstructive\nnephropathy.\nMethods: A total of 245 adult patients with obstructive nephropathy were enrolled. We evaluated the performance\nof the 3 Modification of Diet in Renal Disease equations (MDRD) (the original MDRD7, 7MDRD; the abbreviated\nMDRD, aMDRD; and re-expressed abbreviated MDRD, re-aMDRD) and 3 Chronic Kidney Disease Epidemiology\nCollaboration equations (CKD-EPI) (CKD-EPI equation based on creatinine alone, CKD-EPIcr; CKD-EPI equation based\non cystatin C alone, CKD-EPIcys; CKD-EPI equation based on combined creatinine-cystatin, CKD-EPIcr-cys). The\nmeasured GFR (mGFR) by 99mTc-DTPA renal dynamic imaging method was used as the reference GFR.\nResults: The mean age of the study population was 51.61 Ã?± 14.17 and 131 were male (53.47 %). The mean\nmeasured GFR was 66.54 Ã?± 23.99 ml/min/1.73 m2. Overall, the CKD-EPIcr-cys equation gave the best performance\nwith the best correlation (R = 0.72) and agreement (âË?â??34.87, 40.83). CKD-EPIcr-cys equation also exhibited the highest\naccuracy (69.39 %, P < 0.01) and diagnostic efficacy (ROCAUC = 0.874) with the smallest bias (2.98, P < 0.01). In the\nsubgroup of the lowest GFR, CKD-EPIcys equation exhibited the highest accuracy (52.69 %) and the smallest bias\n(0.27). In the youngest age subgroup, CKD-EPIcys equation had the highest accuracy (71.64 %) and the smallest bias\n(âË?â??1.24). In other subgroups stratified by GFR, age and gender, CKD-EPIcr-cys equation remained the best\nperformance.\nConclusion: The 3 CKD-EPI equations performed better than the 3 MDRD equations in estimating GFR in Chinese\nobstructive nephropathy patients; while the CKD-EPI equation based on combined creatinine-cystatin C provided\nthe best estimation of GFR....
Diabetes mellitus (DM) significantly increases the overall morbidity andmortality, particularly by elevating the cardiovascular risk.\nThekidneys are severely affected as well, partly as a result of intrarenal athero- and arteriosclerosis but also due to noninflammatory\nglomerular damage (diabetic nephropathy). DM is the most frequent cause of end-stage renal disease in our society. Acute kidney\ninjury (AKI) remains a clinical and prognostic problem of fundamental importance since incidences have been increased in\nrecent years while mortality has not substantially been improved. As a matter of fact, not many studies particularly addressed\nthe topic ââ?¬Å?AKI in diabetes mellitus.ââ?¬Â Aim of this article is to summarize AKI epidemiology and outcomes in DM and current\nrecommendations on blood glucose control in the intensive care unit with regard to the risk for acquiring AKI, and finally several\naspects related to postischemic microvasculopathy in AKI of diabetic patients shall be discussed.We intend to deal with this relevant\ntopic, last but not least with regard to increasing incidences and prevalences of both disorders, AKI and DM....
Background: Information on acute kidney injury (AKI) in elderly hospitalized patients is limited. This study aims to\nassess the incidence, risk factors and outcomes of AKI in elderly Chinese patients.\nMethod: The Epidemiology of AKI in Chinese Hospitalized adults (EACH) study is a multicenter, retrospective cohort\nstudy conducted in nine regional central hospitals across China. Patients aged more than 65 years were selected\nfrom the EACH study for this analysis. A novel approach with adjustment for frequency of serum creatinine was\nused to estimate the incidence of AKI in elderly patients. In-hospital outcomes, including mortality, renal recovery,\nlength of stay and daily cost of elderly patients, were analyzed and compared with outcomes in younger patients.\nResults: Of 144,232 adult patients in the EACH study, 42,737 (29.63 %) patients were 65 years or older, including 9773\nvery elderly patients (ââ?°Â¥80 years old). The incidence of AKI was 15.44 % in patients 65ââ?¬â??79 years old (community-acquired\n(CA) AKI of 3.89 % and hospital-acquired (HA) AKI of 11.55 %) and 22.22 % in the very elderly group (CA-AKI of 6.58 %\nand HA-AKI of 15.64 %). The mortality rate of AKI was 10.3 % in patients aged from 65 to 80 and 19.6 % in patients older\nthan 80 years. AKI incidence, in-hospital mortality, percentage of patients requiring dialysis and percentage without renal\nrecovery were higher in elderly patients than in younger patients.\nConclusion: The incidence of AKI in elderly Chinese hospitalized patients is high, which becomes a substantial\nburden on medical care in China....
Background: Lower Urinary Tract Symptoms (LUTS) in men are a common clinical problem in urology and have\nbeen historically strictly linked to benign prostatic hyperplasia (BPH), which may lead to bladder outlet obstruction\n(BOO). New molecules have been approved and have entered the urologistsââ?¬â?¢ armamentarium, targeting new\nsignaling pathways and tackling specific aspects of LUTS. Objective of this review is to summarize the evidence\nregarding the new medical therapies currently available for male non-neurogenic LUTS, including superselective\nÃ?±1-antagonists, PDE-5 inhibitors, anticholinergic drugs and intraprostatic onabotulinum toxin injections.\nMethods: The National Library of Medicine Database was searched for relevant articles published between\nJanuary 2006 and December 2015, including the combination of ââ?¬Å?BPHââ?¬Â, ââ?¬Å?LUTSââ?¬Â, ââ?¬Å?medicalââ?¬Â and ââ?¬Å?newââ?¬Â. Each articleââ?¬â?¢s\ntitle, abstract and text were reviewed for their appropriateness and their relevance. One hundred forty eight\narticles were reviewed.\nResults: Of the 148 articles reviewed, 92 were excluded. Silodosin may be considered a valid alternative to nonselective\nÃ?±1-antagonists, especially in the older patients where blood pressure alterations may determine major\nclinical problems and ejaculatory alterations may be not truly bothersome. Tadalafil 5 mg causes a significant\ndecrease of IPSS score with an amelioration of patientsââ?¬â?¢ QoL, although with no significant increase in Qmax.\nAntimuscarinic drugs are effective on storage symptoms but should be used with caution in patients with\nelevated post-void residual. Intraprostatic injections of botulinum toxin are well-tolerated and effective, with a\nlow rate of adverse events; however profound ameliorations were seen also in the sham arms of RCTs evaluating\nintraprostatic injections....
Testicular cancer is rare. The authors report the case of a young Senegalese 21, who\nhas consulted for an occlusive syndrome evolving for 48 hours that prompted his\nhospitalization. Note that the patient has consulted several times to persistent inguinal\nscrotal pain, a big right purse with chronic analgesic requirements and anti-\ninflammatory. Occlusive before this table, abdominal pelvic CT was performed\nand highlighted the presence of lung metastases, a large pelvic lymph node casting\nbridging the inter vesico-rectal space and responsible for extrinsic compression of\nthe small intestine, lymph node inter casting aorto-cellar and latero aortic liver and\nmultiple secondary locations. Faced with this bundle of arguments, clinical and laboratory,\nmetastatic testicular tumor was raised and measured tumor markers. A\nright orchiectomy by inguinal was made with histology: A non-seminomatous germ\ncell tumor stage III. After orchiectomy germinal markers were still high and there\nwas the problem of persistent occlusive syndrome despite resuscitation. A chemotherapy\nregimen was initiated with 4 cycles of chemotherapy according to the protocol\nBEP (bleomycin, etoposide, cisplatin). A significant regression of occlusive syndrome\nwith a decline in clinical symptoms was noted. The revaluation at 3 months, 6\nmonths and 1 year were highlighted: A normal clinical examination associated with a\npersistent correction rate of germline markers and lack of active lesion at thoraco-\nabdominopelvic CT....
Diabetic nephropathy (DN) and diabetic retinopathy (DR) are major complications of type 1 and type 2 diabetes. DN and DR\nare mainly caused by injury to the perivascular supporting cells, the mesangial cells within the glomerulus, and the pericytes\nin the retina. The genes and molecular mechanisms predisposing retinal and glomerular pericytes to diabetic injury are poorly\ncharacterized. In this study, the genetic deletion of proteasome activator genes, PA28...
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