Hookworm Anemia in a Peritoneal Dialysis Patient in China.

Hookworm infections as well as other intestinal nematodiases are endemic in China. In this case, a 70-year-old male showed symptoms of chest tightness, shortness of breath, and both lower extremities edema. The diagnostic result was chronic renal insufficiency, chronic kidney disease (5th stage), and renal anemia at first. Then, he received treatment with traditional drugs. However, this treatment did not help to alleviate the symptoms of the patient significantly. The results of gastroendoscopy showed hookworms in the duodenum, also confirmed by pathology examination. Anemia was markedly ameliorated after eliminating the parasites. The results mentioned above suggested that ancylostomiasis was the leading causes of anemia in this patient, and the etiology of anemia in uremic patients should be systematically considered. Especially when anemia could not be cured by regular treatments, rare diseases should be investigated.

Isorhamnetin alleviates cisplatin-induced acute kidney injury via enhancing fatty acid oxidation.

Cisplatin is an effective chemotherapy drug widely used in the treatment of various solid tumors. However, the clinical usage of cisplatin is limited by its nephrotoxicity. Isorhamnetin, a natural flavanol compound, displays remarkable pharmacological effects, including anti-inflammatory and anti-oxidation. In this study, we aimed to investigate the potential of isorhamnetin in alleviating acute kidney injury induced by cisplatin. In vitro study showed that isorhamnetin significantly suppressed the cytotoxic effects of cisplatin on human tubular epithelial cells. Furthermore, isorhamnetin exerted significantly inhibitory effects on cisplatin-induced apoptosis and inflammatory response. In acute kidney injury mice induced by a single intraperitoneal injection with 20 mg/kg cisplatin, oral administration of isorhamnetin two days before or 2 h after cisplatin injection effectively ameliorated renal function and renal tubule injury. Transcriptomics RNA-seq analysis of the mice kidney tissues suggested that isorhamnetin treatment may protect against cisplatin-induced nephrotoxicity via PGC-1α mediated fatty acid oxidation. Isorhamnetin achieved significant enhancements in the lipid clearance, ATP level, as well as the expression of PGC-1α and its downstream target genes PPARα and CPT1A, which were otherwise impaired by cisplatin. In addition, the protection effects of isorhamnetin against cisplatin-induced nephrotoxicity were abolished by a PGC-1α inhibitor, SR-18292. In conclusion, our findings indicate that isorhamnetin could protect against cisplatin-induced acute kidney injury by inducing PGC-1α-dependent reprogramming of fatty acid oxidation, which highlights the clinical potential of isorhamnetin as a therapeutic approach for the management of cisplatin-induced nephrotoxicity.

Clinical Efficacy and Safety of Massage for the Treatment of Restless Leg Syndrome in Hemodialysis Patients: A Meta-Analysis of 5 Randomized Controlled Trials.

Aim: We conducted this meta-analysis to evaluate the clinical efficacy and safety of massage for the treatment of hemodialysis patients with restless leg syndrome (RLS). Methods: A comprehensive literature search was performed using the PubMed database, EMBASE database (via OVID), and the Cochrane Library in order to identify eligible randomized controlled trials (RCTs) published before August 31, 2021. After extracted essential data and assessed risk of bias of each eligible study, we calculated the pooled estimate of RLS score and safety after treatment. Statistical analysis was performed by using Review Manager 5.3. Results: Five studies involving 369 hemodialysis patients with RLS were analyzed. The RLS score after treatment [mean difference (MD), -12.01; 95% confidence interval (CI), -14.91 to -9.11] and mean difference of RLS score at the beginning and end of treatment [mean difference (MD), -11.94; 95% confidence interval (CI), -15.45 to -8.43] in a massage group was significantly better than that in route care group. Subgroup analysis suggested that massage with lavender oil also significantly reduced the RLS score after treatment (MD, -14.22; 95% CI, -17.81 to -10.63) and mean difference of RLS score at the beginning and end of treatment (MD, -14.87; 95% CI, -18.29 to -11.45) compared with route care. Meanwhile, massage regime significantly relieved RLS severity compared with route care but did not increase adverse events. Conclusion: Massage may be a preferred treatment modality for hemodialysis patients with RLS because it effectively reduces RLS symptoms, relieves RLS severity, and does not increase the risk of adverse events. However, future study with a larger sample size is warranted due to the fact that only limited number of eligible studies with small sample size are enrolled.

Drug rash with eosinophilia and systemic symptoms and severe renal injury induced by proton pump inhibitor therapy: A case report.

INTRODUCTION: Proton pump inhibitors (PPIs) are widely prescribed and generally well tolerated but can rarely cause severe allergic reactions, such as drug rash with eosinophilia and systemic symptoms (DRESS). We report a case of DRESS and renal injury induced by PPIs, and describe the therapeutic process. PATIENT CONCERNS: The patient was a 66-year-old female who complained of fever, pruritus, desquamation, erythema multiforme, and anuria caused by omeprazole taken for 2 weeks to treat abdominal distention. DIAGNOSIS: The clinical history revealed a similar episode of PPI-induced fever, eosinophilia, and acute kidney injury more than 1 year ago. The present laboratory tests revealed eosinophilia and oliguric renal failure. The renal biopsy was performed subsequently and proved the diagnosis of PPI-induced DRESS. INTERVENTIONS: After the suspected diagnosis of PPI-induced DRESS, omeprazole was discontinued and methylprednisolone infusion (40 mg qd) was initiated. Because of oliguric renal failure, the patient received intermittent hemodialysis. OUTCOMES: The patient initially responded to omeprazole discontinuation, hemodialysis, and glucocorticoids but later died from severe infection during the tapering of glucocorticoid therapy. CONCLUSION: Clinicians should remain on high alert for potential life-threatening complications when prescribing PPIs. If unexplained renal injury develops in a patient taking a PPI, renal biopsy may help in identifying the pathogenesis and might facilitate timely intervention.

Severe mental disorders following anti-retroviral treatment in a patient on peritoneal dialysis: A case report and literature review.

BACKGROUND: Antiviral drugs are widely used in populations with viral infection caused by immunologic inadequacy. Because these drugs are mainly metabolized by the kidneys, patients with renal failure undergoing renal replacement therapy are prone to drug adverse effects and poisoning. Severe neurotoxicity caused by antiviral drugs is a rare but life-threatening complication. CASE SUMMARY: This study reported one male patient on peritoneal dialysis who suffered from severe mental disorders after receiving an overdose of acyclovir and valacyclovir for the treatment of herpes zoster. The literature review suggested that hemodialysis is better than peritoneal dialysis to clear acyclovir from the circulation. The patient died after his consciousness deteriorated despite peritoneal dialysis and continuous blood purification. CONCLUSION: This case emphasizes cautiousness when using anti-retroviral drugs in patients with uremia. Hemodialysis is optimal method to remove the drugs.

Identification of eight key miRNAs associated with renal cell carcinoma: A meta-analysis.

Renal cell carcinoma (RCC) is the most common renal carcinoma in the human kidney. To date, to the best of our knowledge, there are no biomarkers for the early monitoring and diagnosis of RCC patients. The present study aimed to develop deeper insight into the molecular mechanisms of microRNAs (miRNAs/miRs) in the regulation of RCC development and to reveal candidate miRNA biomarkers in human RCC. A meta-analysis was used to integrate the published and independent RCC miRNA expression profiling investigations that compared the miRNA expression profiles in RCC samples with control samples. The meta-signature miRNA target genes were then predicted in TargetScan. The predicted targets were further analyzed using Gene Ontology and pathway enrichment analysis with the Database for Annotation, Visualization and Integrated Discovery online tool, and then the transcription factors of meta-signature miRNA target genes were identified in Tfacts. A total of 7 publicly available and independent RCC miRNA expression profiling datasets were collected, and 2 upregulated (hsa-miR-155-5p and hsa-miR-210-5p) and 6 downregulated (hsa-miR-138-5p, hsa-miR-141-5p, hsa-miR-200c-5p, hsa-miR-362-5p, hsa-miR-363-5p and hsa-miR-429) meta-signature miRNAs in renal carcinoma were identified. The targeted gene enrichment analysis indicated that the meta-signature miRNAs may influence several pathways that participate in cancerogenesis, including the 'rap1 signaling pathway', 'renal cell carcinoma' and 'microRNAs in cancer'. Overall, the present meta-analysis identified 2 upregulated and 6 downregulated meta-signature miRNAs from 7 renal carcinoma datasets, the dysregulated miRNAs that may contribute to kidney carcinoma development. This research may reveal candidate miRNA biomarkers in human RCC.

Effects of spironolactone on dialysis patients with refractory hypertension: a randomized controlled study.

The purpose of this study was to evaluate the effects of spironolactone on dialysis patients with refractory hypertension and possible adverse effects. This was a 12-week prospective, randomized, double-blind trial of 82 patients randomly assigned to 12-week treatment with 25 mg/d spironolactone or placebo as add-on therapy. Visits were scheduled at the start of treatment and after 12 weeks. Measurements of 24-hour ambulatory blood pressure (BP) monitoring and morning BP were performed. After 12 weeks, spironolactone significantly improved refractory hypertension. Average placebo-corrected morning BP was reduced by 16.7/7.6 mm Hg. Mean 24-hour ambulatory BP was reduced by 10.9/5.8 mm Hg. In contrast, serum aldosterone levels in the spironolactone group slightly increased and serum potassium levels insignificantly increased. This study has demonstrated that spironolactone (50 mg) safely and effectively reduces BP in patients with refractory hypertension undergoing dialysis.

Effect of individualized exercise during maintenance haemodialysis on exercise capacity and health-related quality of life in patients with uraemia.

OBJECTIVE: To investigate the effect of individualized exercise on exercise capacity and health-related quality of life (HRQoL) in uraemic patients during maintenance haemodialysis (MHD). METHODS: Patients receiving MHD were divided randomly into a test group, who underwent recumbent cycling exercise during dialysis, and a control group, who performed simple stretching exercises. The same dialysis protocol was used for all study participants. At study start and after 12 weeks, exercise capacity was measured using tests of physical ability; HRQoL was measured using the kidney disease quality of life score (KDQOL-SF™). RESULTS: A total of 65 patients were included in the study: 33 in the control group and 32 in the test group. There were no significant differences in patient characteristics between the two groups at baseline. After 12 weeks, there were significant improvements in exercise capacity and in many of the items of the KDQOL-SF™ in the test group compared with the control group. CONCLUSION: Individualized exercise during MHD significantly improved the exercise capacity and HRQoL for uraemic patients within a short time period, and could therefore be used as a simple, cost-effective therapeutic approach.