[Clinical Research Progress on Using κ-Opioid Receptor Agonists to Treat Uremic Pruritus]. / κé˜¿ç‰‡å—ä½“æ¿€åŠ¨å‰‚æ²»ç–—å°¿æ¯’ç—‡ç˜™ç—’ä¸´åºŠç ”ç©¶è¿›å±•.

Uremic pruritus, a severe complication in patients with chronic kidney disease, is associated with a high prevalence. It can cause depression and sleep disorders, and seriously affect the quality of life and the social relations of patients. Recently, there is growing evidence showing that κ-opioid receptor agonists, including nalfurafine, difelikefalin, and nalbuphine, can effectively and safely reduce itching symptoms in patients with refractory uremic pruritus. Herein, we reviewed the epidemiology, pathogenesis, clinical symptoms, and treatment strategies of uremic pruritus, and summarized in detail the progress in clinical research on the use of κ-opioid receptor agonists, including nalfurafine, difelikefalin, and nalbuphine, in the management of patients with uremic pruritus.

Performance of the Pandemic Medical Early Warning Score (PMEWS), Simple Triage Scoring System (STSS) and Confusion, Uremia, Respiratory rate, Blood pressure and age ≥ 65 (CURB-65) score among patients with COVID-19 pneumonia in an emergency department triage setting: a retrospective study

ABSTRACT BACKGROUND: Healthcare institutions are confronted with large numbers of patient admissions during large-scale or long-term public health emergencies like pandemics. Appropriate and effective triage is needed for effective resource use. OBJECTIVES: To evaluate the effectiveness of the Pandemic Medical Early Warning Score (PMEWS), Simple Triage Scoring System (STSS) and Confusion, Uremia, Respiratory rate, Blood pressure and age ≥ 65 years (CURB-65) score in an emergency department (ED) triage setting. DESIGN AND SETTING: Retrospective study in the ED of a tertiary-care university hospital in Düzce, Turkey. METHODS: PMEWS, STSS and CURB-65 scores of patients diagnosed with COVID-19 pneumonia were calculated. Thirty-day mortality, intensive care unit (ICU) admission, mechanical ventilation (MV) need and outcomes were recorded. The predictive accuracy of the scores was assessed using receiver operating characteristic curve analysis. RESULTS: One hundred patients with COVID-19 pneumonia were included. The 30-day mortality was 6%. PMEWS, STSS and CURB-65 showed high performance for predicting 30-day mortality (area under the curve: 0.968, 0.962 and 0.942, respectively). Age > 65 years, respiratory rate > 20/minute, oxygen saturation (SpO2) < 90% and ED length of stay > 4 hours showed associations with 30-day mortality (P < 0.05). CONCLUSIONS: CURB-65, STSS and PMEWS scores are useful for predicting mortality, ICU admission and MV need among patients diagnosed with COVID-19 pneumonia. Advanced age, increased respiratory rate, low SpO2 and prolonged ED length of stay may increase mortality. Further studies are needed for developing the triage scoring systems, to ensure effective long-term use of healthcare service capacity during pandemics.

Estomatitis Urémica como Complicación Oral de Insuficiencia Renal Crónica: Reporte de Caso y Revisión de la Literatura / Uremic Stomatitis as an Oral Complication of Chronic Renal Failure: Case Report and Literature Review

RESUMEN: La Estomatitis Urémica es una lesión oral poco frecuente que se presenta generalmente en pacientes con insuficiencia renal crónica avanzada o no tratada. A continuación, se reporta un caso clínico de un paciente masculino de 22 años de edad que acude a un servicio de urgencia con la presencia de placas blanquecinas indoloras en piso de boca, cara interna de mejilla, y lengua. Las probables causas, presentaciones clínicas, y manejo odontológico son discutidos.

ABSTRACT: Uremic stomatitis is a rare oral lesion that usually occurs in patients with advanced or untreated chronic renal failure. Here we report a case of a 22-year-old male patient who comes to an emergency department with the presence of painless whitish plaques on the floor of the mouth, internal cheek face, and tongue. Probable causes, clinical presentations, and dental management are discussed.

Characterization of an experimental model of progressive renal disease in rats

ABSTRACT PURPOSE: To characterize an experimental model of progressive renal disease induced by different degrees of nephrectomy in rats. METHODS: Eighty male Wistar rats were divided into four experimental groups (n=20/group): sham surgery (control group), progressive degrees of nephrectomy leading to mild uremia (group 1), moderate uremia (group 2) and severe uremia (group 3). Ten animals of each group were followed for two or four weeks. At the end, blood and 24-hour urine samples were collected to determine renal function parameters. Urine output and water and food intake were daily monitored. RESULTS: In rats of group 1, serum levels of creatinine and urea and microalbuminuria were increased, while reduced creatinine clearance (p<0.05, compared with control group), without changing blood pressure. Animals of group 2 had more accentuated alterations: increases in urinary output, blood pressure, serum concentrations of urea, creatinine, sodium, potassium, and in microalbuminuria, and reduction of creatinine clearance (p<0.05). Group 3 exhibited even more increased serum concentrations of urea, creatinine, sodium and potassium, blood pressure and microalbuminuria, and decreased creatinine clearance (p<0.05) in comparison with control group and unilateral nephrectomy. CONCLUSION: Progressive nephrectomy in rats seems to be useful to study the physiopathology of chronic kidney disease and its mechanisms of progression.

Influência da escolaridade na hipertrofia miocárdica de pacientes em hemodiálise / Influence of educational level on myocardial hypertrophy of hemodialysis patients

Introdução: A doença renal crônica apresenta elevado risco cardiovascular. dados da população geral associam as doenças cardiovasculares a baixo nível de escolaridade, porém nehum trabalho avaliou essa associação entre pacientes em hemodiálise. objetivo: Avaliar a associação entre Botucatu (UNESP). dados clínicos, laboratoriais e ecocardiográficos foram extraídos dos prontuários. os pacientes foram divididos em dois grupos de acordo com a mediana da escolaridade: o grupo I foi constituído por pacientes com escolaridade <- três anos, e grupo II por pacientes com escolaridade superior a três anos. resultados: pressão arterial, ganho de peso interdialítico e variáveis com diferença estatística entre os dois grupos ao nível de p< 0,2 foram selecionadas para análise múltipla. Na análise múltipla, associações independentes foram consideradas ao nível de p< 0,05. A média de idade dos pacientes foi 57+- 12.8 anos, 46 pacientes eram homens (57%) e 53 eram brancos (67%). As variáveis selecionadas para análise múltipla foram: idade (p= 0,004), anos de escolaridade (p, 0,0001), índice de massa corpórea (p= 0,124), diâmetro do ventrículo esquerdo (p= 0,048) e índice de massa ventricular (p= 0,006). As drogas anti-hipertensivas empregadas foram similares em ambos os grupos. A pressão sistólica (p=0,006) e a escolaridade (p=0,047) apresentaram correlação significativa e independente com índice de massa ventricular. Conclusão: Em pacientes em hemodiálise, houve correlação da massa do ventrículo esquerdo não apenas com a pressão arterial, mas também com o nível educacional.

Introduction: Chronic kidney disease has a high cardiovascular risk. data from the general population associated cardiovascular disease to low levels of schooling, but match any study evaluated the association between hemodialysis patients. Objective: To evaluate the association between Botucatu (UNESP). clinical, laboratory and echocardiographic findings were extracted from medical records. Patients were divided into two groups according to the median education level: group I comprised patients with educational <- three years, and group II patients with higher education for three years. results: blood pressure, interdialytic weight gain and variable with a statistical difference between the two groups at p <0.2 were selected for multivariate analysis. On multivariate analysis, independent associations were considered at p <0.05. The average patient age was 57 + - 12.8 years, 46 patients were men (57%) and 53 were white (67%). Variables selected for multivariate analysis were age (p = 0.004), years of schooling (p, 0.0001), body mass index (p = 0.124), left ventricular diameter (p = 0.048) and left ventricular mass indeThe antihypertensive drugs used were similar in both groups. Systolic pressure (p = 0.006) and education (p = 0.047) correlated significantly and independently with left ventricular mass index. Conclusion: In hemodialysis patients, there was a correlation between left ventricular mass with not only blood pressure but also to the educational level.x (p = 0.006).

Tratamientos sustitutivos en enfermedad renal: diálisis peritoneal, hemodiálisis y trasplante renal / Substitute treatment and replacement in chronic kidney disease: peritoneal dialysis, hemodialysis and transplant

Los tratamientos sustitutivos de diálisis crónica o trasplante renal se inician cuando la filtración glomerular del paciente medida por la depuración de creatinina endógena en la orina de 24 horas es inferior a 15 o 10 ml/mm y cuando se presentan complicaciones. A los enfermos con indicaciones de trasplante se les debe buscar un donador vivo seleccionado o inscribirlos en la lista de espera nacional de donación cadavérica si no existen contraindicaciones. Aun cuando no hay un registro nacional mexicano de pacientes en diálisis crónica, solo datos indirectos de la Fundación Mexicana del Riñón y de la industria de diálisis, se estima que de 40 mil a 50 mil son sujetos a este tratamiento y que anualmente la cifra se incrementa 11 %. En términos generales se considera que por cada enfermo en diálisis crónica hay otro que fallece sin acceso al tratamiento. Las unidades de hemodiálisis deben cumplir con la norma oficialmexicana de hemodiálisis y la cédula de evaluación de la calidad de las unidades de hemodiálisis del Consejo de Salubridad General. Es aconsejable que los pacientes sean incorporados a diálisis crónica después de ser presentados al comité de diálisis, y que el tratamiento se aplique con la aceptación del enfermo o sus familiares y se registre en el censo nominal.

Chronic dialysis replacement treatments or renal transplants are instituted when the patient's glomerular filtration rate, measured by 24-h urine endogenous creatinine clearance, is <10-15 ml/mm and, as the The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI), European and Canadian guidelines point out, when one or two of the following complications occur: "uremic toxicity" symptoms, significant fluid retention that does not respond to loop diuretics, hyperkalemia, chronic anemia (hemoglobin <8 g), metabolic acidosis or acute pulmonary edema. In all patients for whom transplant is indicated, a selected live donor must be sought or, in the absence of contraindications, the patient should be registered with the national cadaver donation waiting list. While waiting for the transplant, patients will be on a chronic dialysis program. There is no national registry of patients undergoing chronic dialysis; only indirect data from the Mexican Kidney Foundation and the dialysis industry are available. However, it is estimated that 40,000-50,000 people are under this treatment and the numbers grow by 11% every year. Overall, it is thought that for every patient receiving chronic dialysis, there is one more patient who dies without access to therapy. Hemodialysis units must comply with the Official Hemodialysis Standard and the General Health Council Hemodialysis Unit Quality Assessment Form.

Características de la insuficiencia renal crónica en niños Venezolanos / Chracteristics of chronic renal failure in venezuela children

32 niños de 2 a 14 años (X: 6,5) portadores de Insuficiencia Renal Crónica (IRC) fueron estudiados durante el período 1979-84, en el Hospital de niños de Valencia. 85% procedían de la región centro-occidental del país; 75% fueron varones (Rel 0 :1) con mayor incidencia en menores de 4 años y en el grupo de 8 a 12 años. Las manifestaciones clínicas predominantes fueron: retardo en el crecimiento y desarrollo, anasarca, anemia, hipertensión arterial, transtornos de la micción, hematuria y fiebre. Etiológicamente las causas más frecuentemente productoras de IRC fueron: glomerulopatías primarias (60.6%) predominantemente glomeruloesclerosis segmentaria y focal, uropatías obstructivas (21.2%), nefropatías hereditarias (21.2%), nefropatías hereditarias (12.2%) y glomerulopatías secundarias (6%). Los pacientes con enfermedad glomerular primaria iniciaron su enfermedad a una edad promedio de 4.1 años e IRC a los 2.5, en las uropatías el inicio de la enfermedad fue a los 2.2 años pero el comienzo de IRC fue más tardío (4.4 años), y finalmente las nefropatías hereditarias mostraron su primera manifestación a los 3 años e IRC a los 2.3. Para los tres grupos el intervalo entre IRC e insuficiencia renal terminal fue similar (1.2 a 1.9 años). Las complicaciones más frecuentes fueron: anemia severa, detención del crecimiento e hipertensión arterial. La sobrevida renal a los 36 meses fue de 54% y la total 33% para todo el grupo. La sobrevida renal fue mayor para los trastornos, urológicos pero la sobrevida total es superior en las glomerulopatías

Reduced humoral immunity in uremic mice genetically selected for high antibody response

Biozzi's Selection IV-A mice, genetically selected for 25 generations for high and low antibody response to sheep red blood cells (SRBC), 2-3 months old, were made uremic by subtotal nephrectomy and characterized for antibody production against the selection antigen. T cell activity was evaluated in vitro by lymphocyte proliferation and interleukin 2 (IL 2) production in response to the superantigen staphylococcal enterotoxin B (SEB). Total and IgM antibody titers (log2) were similar in uremic and non-uremic low responder mice (total antobody: 4.0 +/- 0.6 vs 3.6 +/- 0.6; IgG: 3.0 +/- 0.7 vs 2.4 +/- 0,4), while uremic high responders presented a blunted humoral immune response to SRBC when compared with non-uremic animals (total antibody: 10.8 +/- 1.6 vs 13.0 +/- 0.2; IgG: 10.3 +/- 1.5 vs 11.7 +/- 0.3). T cell proliferation and IL 2 production were similar in uremic and ...

Urinary diagnostic indices in the management of leptospirosis: selection of patients for dialysis therapy

Cases of leptospirosis admitted to the Queen Elizabeth Hospital (QEH), Barbado, were assessed for the presence of "pre-renal azotaemia" (NON-ARF) as opposed to "acute renal failure" (ARF). Distinction between the two diagnoses was made on the basis of clinical course. Peritoneal dialysis was inappropriately utilised in 26% of patients receiving such therapy. This study evaluates diagnóstic tests for pre-renal azotaemia, and acute renal failure in leptospsirosis, and indicates guidelines for the management of azotaemia in such patientes. U/P urea and osmolar ratios show high sensitivity in diagnosing pre-renal azotaemia. While "early" dialysis is essential for patients with acute leptospiral renal failure, in those with plasma creatinines less than 600 micronmol/litre on entry and indices indicating NON-ARF, decisions regarding dialysis con safely be delayed for 48-72 hours while the effect of rehydration is assessed

Diagnóstico de insuficiencia renal aguda / Diagnosis of acute renal failure

La insuficiencia renal aguda es una disminución o el cese brusco de la excreción de los productos finales del metabolismo que normalmente son eliminados por el riñón y las consecuencias que esto acarrea en la homeostasis de los líquidos orgánicos. Generalmente se acompaña de oliguria o anuria. Clásicamente se divide en causas prerrenales, cuando es consecutiva a un estado de hipoperfusión renal y que es rápidamente reversible al mejorar el estado hemodinámico del paciente; causas post-renales cuando es consecutiva a obstrucción del flujo urinario y que también es reversible al eliminar dicha obstrución, y causas renales cuando se establece una lesión en el parénquima renal propiamente dicho, (éstas pueden ser glomerulares). El diagnóstico sindromático temprano y e esclarecimiento de la etiopatología son muy imporantes, tanto para el tratamiento oportuno como para el pronóstico.

Prurido urêmico / Uremic pruritus

A insuficiência renal crônica produz várias manifestaçöes dermatológicas, como a hiperceratose folicular, xerose, unhas ®half-and-half¼, hiperpigmentaçäo e prurido. Dessas, a que mais pode comprometer a qualidade de vida do paciente urêmico é, sem dúvida, o prurido. De etiologia näo completamente compreendida, o prurido urêmico acomete grande parte dos pacientes renais e seu tratamento envolve vários aspectos do gerenciamento da síndrome urêmica como diálise, controle do hiperparatireoidismo e correçäo da anemia. Esta revisäo discorre sobre os principais aspectos da fisiopatologia e tratamento desta freqüente manifestaçäo da uremia.

Pericarditis Uremica: estudio retrospectivo en 233 casos de insuficiencia renal crónica severa en el Hospital Cayetano Heredia entre 1980-1990 / Uremic Pericarditis: retrospective study about severe renal chronic insufficiency in 233 coles at the Hospital Nacional Cayetano Heredia betwen 1980 to 1990

El presente es un estudio retrospectivo que incluyó 233 casos de IRC severa atendidos en el HNCH durante los años 1980-1990. Se identificaron 52 pacientes con sospecha clínica de pericarditis urémica (22.26 por ciento). Dos terceras partes de los pacientes afectos tenían diagnóstico de IRC por menos de 10 meses (p igual 0.001). No hallamos diferencias en las etiologías de IRC con reportes previos. Los pacientes menores de 50 años fueron los más afectados (p igual 0.03). Dispnea, edemas y dolor torácico fueron los sintomas más usuales. Se confirmaron ecocardiográficamente 15 efusiones leves y 8 moderadas. La ecocardiografía fue el método diagnóstico de mayor utilidad. Sólo el 48 por ciento de pacientes con hemodiálisis mostraron mejoría clínica. El 78 por ciento de ellos recibió tratamiento hemodiálitico insuficiente. La diálisis peritoneal exclusiva constituyó el mejor tratamiento alternativo. Se registró taponamiento cardiáco en 10 por ciento de casos y la letalidad fue de 11 por ciento por causas directamente atribuíbles a la pericarditis y la IRC