Risk Factors of Central Venous Catheter-Related Bloodstream Infection for Continuous Renal Replacement Therapy in Kidney Intensive Care Unit Patients.

BACKGROUND: The incidence of central venous catheter-related bloodstream infection (CRBSI) for continuous renal replacement therapy (CRRT) in kidney intensive care unit (ICU) patients is worthy of particular attention and recently, we analyzed clinical characteristics and risk factors of CRBSI for CRRT in our kidney ICU patients. METHODS: To be part of this retrospective study, 1,523 patients who had a central venous catheter (CVC) for CRRT during the period April 2010 to May 2015 in our centre were enrolled. The clinical features and pathogens of CRBSI patients were investigated. Patients who also had CRRT of kidney ICU hospitalization without CRBSI were enrolled in a 1: 2 ratio as control. Risk factors of the CRBSI were analyzed. RESULTS: A total of 57 patients had central venous CRBSI. The incidence of the infection was 3.7%. The mean rate of CRBSI was 3.9 per 1,000 catheter days, and the catheter median indwelling time was 14 (7-30) days. The most common pathogens were Gram-positive bacteria, which were noted in 29 cases (50.9%), followed by Gram-negative bacteria (36.8%). The most common pathogens causing CRBSI were Staphylococcus aureus (10 cases) and sewer enterobacteriaceae (10 cases) followed by Staphylococcus epidermidis (9 cases). CVC insertion sites included internal jugular vein (33 cases) and femoral vein (24 cases), accounting for 2.9% of internal jugular vein catheterization (1,140 cases) and 6.3% of femoral vein catheterization (383 cases) respectively. In total, 16, 20, 7 and 14 cases of CRBSI were noted in Spring, Summer, Autumn and Winter, accounting for 28.1, 35.1, 12.3 and 24.6% respectively. The most common infectious manifestations were chills (68.4%), fever (100%), and septic shock (49.1%). Multivariate analysis showed that catheterization of the femoral vein, long catheter indwelling time, low CD4+ lymphocytes and high acute physiology and chronic health evaluation (APACHE) II scores were independent factors associated with CRBSI. CONCLUSIONS: The incidence of CRBSI in our kidney ICU was 3.7%. Central venous CRBSI for CRRT was associated with catheterization of the femoral vein, long catheter indwelling time, compromised immune function and high APACHE II scores. Understanding pathogens and risk factors for central venous CRBSI in kidney ICU can help doctors prevent and treat CRBSI earlier.

[Study on the relationship between WBC count levels and type 2 diabetes mellitus in Hui and Han nationality of Ningxia].

OBJECTIVE: To analyze the relationship between WBC count levels and type 2 diabetes mellitus in Hui and Han nationality of Ningxia. METHODS: Using the method of case-control study, people of regional organizations and institutions aged 20 - 60 who received medical health checkup and endocrine patients in General Hospital of Ningxia Medical College and WuZhong city People's Hospital from October 2011 to October 2012 were enrolled in the study. According to the inclusion and exclusion criteria of T2DM patients and control groups, with gender, ethnic and age are not more than 3 years old cases and controls of matching, the T2DM group (case group) of 351 cases and non-T2DM group (control group) of 655 cases were determined. These subjects underwent questionnaire investigation, understand first, like the situation, the way of life, disease and medication history, family history. Physical examination: including height, weight, waist circumference (WC), systolic blood pressure (SBP) and diastolic blood pressure (DBP), and according to the height and weight to calculate body mass index (BMI), and laboratory tests, triglyceride (TG), total cholesterol (TC), high-density lipoprotein (HDL-C), low density lipoprotein (LDL-C), blood uric acid (UA ), nmda aminotransferase ( AST) , alanine aminotransferase (ALT), blood biochemical indexes. Results Diabetes group of average age (50.28 + 8.32), 194 patients with male, (55.27%), 157 patients with female (44.73%) and control group in average age (50. 17 + 7. 14) , including 337 men (51.45% ) and 318 women (48.55%). Average age, gender, the proportion between the two groups had no statistical significance of difference. The white blood cell value of T2DM group (6.66 x 10(9) ± 1.61 x 10(9)/L) was higher than that of non-T2DM group (6.11 x 10(9) ± 1.49 x 10(9)/L), there was a significant difference (t = -5.430, P < 0.01); Comparing the mean value of white blood cell of Hui (6.459 x 10(9) ± 1.45 x 10(9)/L) and Han nationality (6.169 x 10(9) ± 1.63 x 10(9)/L), there was a significant difference (P < 0.05). T2DM group, the abnormal level of white blood cell was 2.6%, that of non-T2DM group was 0.8%, The T2DM group was significantly higher than that of non-T2DM group (χ2 = 4.168, P = 0.041). Comparing the abnormal level of white blood cell of Hui and Han nationality, there was no significant difference. After adjustment for age, gender, nation, TG, TC, HDL, LDL, ALT, AST and blood glucose, the odds ratios for T2MD were 4.072 in the people with the WBC abnormal people and the WBC normal people. After adjustment for age, gender sick or not, TG, TC, HDL, LDL, ALT, AST and blood glucose, the odds ratios for WBC increased were 1. 582 in the people with the Hui and Han nationality. CONCLUSION: The WBC count levels are closely associated with type 2 diabetes, and with the increase of the level, the association enhanced gradually, the WBC may be involved in the occurrence and development of type 2 diabetes. there is a certain relationship between ethnic genetic factors and the WBC count level.

Clindamycin-induced acute kidney injury: large biopsy case series.

BACKGROUND: While clindamycin-induced acute kidney injury (AKI) is uncommon, it has occurred more frequently in recent years. SUMMARY: We investigated 24 patients diagnosed with clindamycin-induced AKI retrospectively. The dosage of clindamycin was 1.0-1.5 g/day. Fifteen patients had episodes of gross hematuria, but fever, skin rash and eosinophilia were rare. Urine analysis revealed mild proteinuria and severe tubular dysfunction. Twenty-three patients were diagnosed with AKI stage 3 upon admission. The clindamycin lymphocyte transformation assay was positive for 63.2% of the patients. Acute interstitial nephritis (AIN) and acute tubular necrosis (ATN) were proven by renal biopsy, and renal insufficiency appeared to result from tubular toxicity and drug crystals. In the majority (87.5%) of the patients, AKI was severe and required renal replacement therapy, but all of their renal function recovered significantly 2 months after discharge. Clindamycin-induced AKI is largely reversible and has episodes of gross hematuria. Renal biopsies confirmed AIN or ATN in these patients.

Predominance of intraglomerular T-bet or GATA3 may determine mechanism of transplant rejection.

The transcription factors T-bet and GATA3 determine the differentiation of helper T cells into Th1 or Th2 cells, respectively. An altered ratio of their relative expression promotes the pathogenesis of certain immunological diseases, but whether this may also contribute to the pathogenesis of antibody-mediated rejection (ABMR) versus T cell-mediated rejection (TCMR) is unknown. Here, we characterized the intragraft expression of T-bet and GATA3 and determined the correlation of their levels with the presence of typical lesions of ABMR and TCMR. We found a predominant intraglomerular expression of T-bet in patients with ABMR, which was distinct from that in patients with TCMR. In ABMR, interstitial T-bet expression was typically located in peritubular capillaries, although the overall quantity of interstitial T-bet was less than that observed in TCMR. The expression of intraglomerular T-bet correlated with infiltration of CD4+ and CD8+ lymphocytes, which express T-bet, as well as intraglomerular CD68+ monocyte/macrophages, which do not express T-bet. The predominance of intraglomerular T-bet expression relative to GATA3 expression associated with poor response to treatment with bolus steroid. In summary, predominance of intraglomerular T-bet expression correlates with antibody-mediated rejection and resistance to steroid treatment.

Evaluation of Intradialytic Hypertension Using Bioelectrical Impedance Combined With Echocardiography in Maintenance Hemodialysis Patients.

Although intra-dialytic hypertension (IDH) has been noted in clinical settings for many years, its pathogenesis remains unclear. In this cross-sectional study, we analyzed IDH incidence in our center and the correlation between postdialysis volume state and IDH. One hundred thirty-one maintenance hemodialysis (MHD) patients were enrolled in our study, and bioelectrical impedance (BIA) and echocardiography (ECG) were recorded. In addition, demographic data were collected, and laboratory examinations were conducted. The patients were grouped into four groups according to the change in systolic blood pressure (SBP) between predialysis and postdialysis. The incidence of IDH was 10.7%. The proportion of extracellular water to total body weight (ECW/TW), as evaluated by BIA, was significantly higher in the IDH group than in the other three groups both in pre-and post-dialysis. In particular, postdialysis SBP was highest in the highest tertile interval of ECW/TW. In addition, among the four groups, left ventricular volume (LVV) was highest in the IDH group. Binary logistic analyses revealed that predialysis SBP, postdialysis ECW/TW and LVV were independent risk factors of intradialytic hypertension. When predicting IDH, the AUC of the ROC curve was higher for ECW/TW combined with LVV (0.752, 95% CI 0.613-0.896) than for either LVV or ECW/TW alone. Our study further showed that post-dialysis volume expansion is an important factor for the development of IDH.

Severe Acute Valproic Acid Intoxication Successfully Treated with Liver Support Therapy.

Valproic acid (VPA) is widely used for the treatment of epilepsy. However, its overdose can cause intoxication and could be life-threatening. Due to the lack of specific antidote and poorness of endogenous clearance, extracorporeal treatment for severe intoxication cases is indicated. Here, we report a case of severe intoxication of VPA which was successfully treated with liver support therapy. A previously healthy woman was admitted due to coma and hypotension after intentional ingestion of 20 g of sodium valproate. Her serum concentration of VPA measured on admission was 420.84 mg/L. In addition to standard therapy, she received two sessions of extracorporeal blood purification using a system based on fractionated plasma separation and adsorption mode integrated with continuous veno-venous haemofiltration (FPSA-CVVH), which is usually used for liver support therapy at our hospital. Her serum concentration of VPA decreased dramatically to 40.18 mg/L and her consciousness recovered completely within 24 hr after admission. Therefore, although haemodialysis has been reported to be effective in the treatment for VPA poisoning, FPSA-CVVH may provide an option for patients who require bedside therapy but have an unstable haemodynamic status or other conditions that result in inability to endure haemodialysis.

Decreased platelet count in patients receiving continuous veno-venous hemofiltration: a single-center retrospective study.

BACKGROUND: A decreased platelet count may occur and portend a worse outcome in patients receiving continuous renal replacement therapy (CRRT). We aim to investigate the incidence of decreased platelet count and related risk factors in patients receiving CRRT. METHODS: In this retrospective study, we screened all patients receiving continuous veno-venous hemofiltration (CVVH) at Jinling Hospital between November 2008 and October 2012. The patients were included who received uninterrupted CVVH for more than 72 h and had records of blood test for 4 consecutive days after ruling out pre-existing conditions that may affect the platelet count. Platelet counts before and during CVVH, illness severity, CVVH settings, and outcomes were analyzed. RESULTS: The study included 125 patients. During the 3-day CVVH, 44.8% and 16% patients had a mild decline (20-49.9%) and severe decline (≥ 50%) in the platelet count,respectively; 37.6% and 16.0% patients had mild thrombocytopenia (platelet count 50.1-100 × 109/L) and severe thrombocytopenia (platelet count ≤ 50 × 10(9)/L), respectively. Patients with a severe decline in the platelet count had a significantly lower survival rate than patients without a severe decline in the platelet count (35.0% versus 59.0%, P=0.012), while patients with severe thrombocytopenia had a survival rate similar to those without severe thrombocytopenia (45.0% versus 57.1%, P=0.308). Female gender, older age, and longer course of the disease were independent risk factors for a severe decline in the platelet count. CONCLUSIONS: A decline in the platelet count and thrombocytopenia are quite common in patients receiving CVVH. The severity of the decline in the platelet count rather than the absolute count during CVVH may be associated with hospital mortality. Knowing the risk factors for a severe decline in the platelet count may allow physicians to prevent such an outcome.

Special malignancy pattern in Chinese renal transplantation recipients: a single center experience and literature review.

Malignancy is one of the main complications after renal transplantation but the situation in Chinese renal allograft recipients remains an enigma. We therefore reviewed 1,000 (8,531 person-years follow-up) renal allograft recipients from Jinling Hospital, Nanjing University, revealing an incidence rate of 2.4% of post-transplant malignancies, with a standardized incidence ratio (SIR) of 17.8 (95% C.I.: 16.7-18.8); the standardized rate is 1.67%, compared with 0.29% in the general population. However, our group demonstrated an extremely low incidence of skin cancer, which dominates in western countries. To confirm the findings, we reviewed the literature on post-transplant malignancies in Chinese renal allograft recipients, covering 296 malignancies in 18,548 renal transplant recipients in 21 reports. The top three most common sites of malignancies were the digestive tract, bladder and liver. The incidence of skin cancer was very low in most centers. These data show that Chinese renal allograft recipients have a unique spectrum of post-transplant malignancies, with an extremely very low incidence of skin cancer as compared to populations from western countries.