Risk of renal damage associated with intravitreal anti-VEGF therapy for diabetic macular edema in routine clinical practice

Purpose: Vascular endothelial growth factor inhibitors (anti?VEGF) have been shown to be effective in the treatment of diabetic macular edema. However, there is little information about the systemic effects of intraocular administration of anti?VEGF drugs in patients with coexistent diabetic nephropathy because it can produce adverse renal effects. Methods: This retrospective cohort study analyzed the effect of intravitreal anti?VEGF drugs (bevacizumab, ranibizumab, or aflibercept) on eFGR and microalbuminuria (MicA) in patients with diabetic macular edema and nonproliferative retinopathy without chronic kidney disease (CKD). Results: Sixty?six patients were included, 54.5% male and 45.5% female, with a mean age of 66.70 ± 11.6 years. The mean follow?up of patients with antiangiogenic treatment was 42.5 ± 28.07 months, and the mean number of injections was 10.91 ± 7.54. In 12.1% of the cases, there was a worsening of the glomerular filtration rate (eFGR) and a 19.7% worsening of the microalbuminuria (MicA). The number of injections was not related to the worsening of the eFGR (P = 0.74) or the MicA (P = 0.239). No relationship was found between the type of drug and the deterioration of the GFR (P = 0.689) or the MicA (P = 0.53). Conclusions: Based on the results, there is a small proportion of patients with increase in MicA and the decrease in eFGR after anti?VEGF therapy, and these was no associated with the number of injection or the drug type. Ophthalmologists should be aware of renal damage in order to do a close monitoring of renal function and proteinuria after intravitreal administration of anti?VEGF mainly in hypertensive patients.

PREVALENCE AND PATTERN OF DYSLIPIDEMIA AND ITS ASSOCIATED FACTORS IN CHRONIC KIDNEY DISEASE PATIENTS

A study of Lipid profile in CKD patient is subject of interest due to impact on the individual and society as dyslipidaemia is one of the traditional risk factors for CVD which is responsible for most of the morbidity & mortality in CKD patient. And its study can lead to therapeutical result affecting both short term and long-term outcomes. To identify and analyse lipid AIMS & OBJECTIVE - alteration in CKD patients and study the correlation between renal function and lipid abnormalities in CKD Our study is hospital METHODS – based descriptive observational study for duration of 18 months. Study included 100 patients RESULTS – in which mean age was 51.88 and male to female ratio of 1.5:1. Prevalence of Lipid Profile abnormalities seen as HDL decreased in 100% patient and Cholesterol, LDL, Triglyceride increased in 40%, 24%, 64% patients respectively Dyslipidaemia is common among pa CONCLUSION - tients with CKD and predominant lipid profile abnormalities were reduced HDL and elevated Triglycerides. Hence regular monitoring of lipid profile should be done in patients of CKD

Status of Serum Magnesium in Different Stages of CKD Patients: A Tertiary Care Hospital Study in Bangladesh

Background: In chronic kidney disease (CKD), renal regulatory mechanisms may be insufficient to balance intestinal magnesium absorption hence insufficient to maintain homeostasis. But related data are relatively sparse and not readily available, especially in Bangladesh context. Aim of the study: The aim of the study was to assess the pattern of serum magnesium level in different stages of CKD patients. Material & Methods: This descriptive cross-sectional study was conducted in the Department of Medicine and the Department of Nephrology, Dhaka Medical College Hospital (DMCH) for nine months’ period. Approval for the study was taken from the ethical review committee of DMC before the commencement of the study. Diagnosed patients of chronic kidney disease (CKD) were approached for the inclusion of the study. Informed written consent was taken from each patient. All patients were subjected to detailed history taking, physical examination, and relevant investigations. For the study purpose, serum magnesium was done for all patients. Results: After compiling data from all participants, statistical analysis was performed using the statistical package for social science (SPSS) version 22 for windows, and a p < 0.05 was considered statistically significant. Mean age of the patients was 53 years with male predominance (male 64% vs female 36%). Of all, 6.7% of cases had hypomagnesemia and 55.3% had hypermagnesemia. The mean serum magnesium level was 2.68±0.81 mg/dl. Assessment of serum magnesium in a different stages of CKD showed that hypermagnesemia is associated with higher staging (p<0.05), and there is a negative correlation between lower e-GFR with serum magnesium ((r=-0.753, p<0.01). Conclusion: Nearly two-third of CKD patients were found with altered magnesium level in the form of hypomagnesemia or hypermagnesemia in this study. Serum magnesium was found increased in higher stages of CKD. That means serum magnesium level increases along with higher stage of the disease. Urinary magnesium excretion also decreases when eGFR of patient decreased.

Ocular Status with Chronic Kidney Disease- a Hospital Based Two Year Study on 150 Cases

Background: Chronic Kidney Disease (CKD) is a growing public health problem affecting millions of people worldwide. Along with its well-known systemic effects, CKD has been associated with various ocular abnormalities, including uveitis, macular edema, and retinal vascular changes. Early detection and management of these ocular complications can prevent significant visual loss and improve the quality of life of patients with CKD. This highlights the importance of regular ophthalmic examinations as part of the comprehensive management of CKD. The aim of this study was to evaluate the ocular status of chronic kidney disease. Material & Methods: This was an observational study. The present study was conducted on 150 Patients attending the Department of Ophthalmology at Dr. Sirajul Islam Medical College and Hospital Ltd, Dhaka, Bangladesh. The duration of the study was 2 years. All collected data was entered in MS Excel and Statistical analysis was done using the SPSS-24 version. Results: The study analyzed a population between the ages of 40-59 years, with a slight majority of women (52.67%) and moderate CKD (64.00%). The most common cause of CKD in the population was hypertension and diabetes (52.00%). 66.67% of 300 eyes had good vision (6/18 or better), while the remainder had impaired or legally blind vision (increasing as the severity of CKD increases). Ocular anterior segment findings showed that lid oedema and conjunctival pallor were present in 3.5% and 56.9% of the eyes, respectively. Dry eyes and cataract were present in 5.6% and 11.1% of the eyes, respectively. Hypertensive retinopathy was present in 48.00% of eyes in the moderate CKD group, and diabetic retinopathy was present in 32.00% of eyes in the severe and end-stage CKD groups. Maculopathy and vitreous hemorrhage were present in 12.67% and 6.33% of eyes in the end-stage CKD group. Of the 100 eyes with poor or blind visual acuity, 24 (24%) were affected by Maculopathy and 21 (21%) by Cystoid Macular Edema. The causes of visual impairment were also listed with their corresponding percentage. Conclusion: In CRF patients, eye exams can detect ocular problems. Early treatment prevents negative outcomes and those with a history of abnormal renal function need close monitoring due to increased risk of vision loss. Awareness of ocular complications is important, as well as thorough eye exams and control of diabetes and hypertension for maintaining eye health.

Clinical Profile and Quality of Life of Incident Hemodialysis Patients

Hemodialysis is the most commonly used treatment modality for end stage renal disease. A 6 months observational study was conducted in the Dialysis unit of Kasturba Hospital, Manipal to study the clinical profile, quality of life with the help of KDQoL SF 36 questionnaire and factors affecting quality of life of hemodialysis patients. A total of 45 participants were included who initiated dialysis in the year 2018 and 2019 and were receiving dialysis in our hospital. Out of 45 participant 77.8% were males and 22.2% were females, the mean age was 55.29 (11.29) years. 23 patient-initiated dialysis in the year 2018 22 patients-initiated dialysis in the year 2019. The prevalence of hypertension, diabetes mellitus and cardiovascular diseases in this population were found to be 95.2%, 35.6% and 8.9% respectively. The mean scores of the sub scales were analyzed with the help of scoring manual and descriptive statistics. In the result it was found the hemoglobin, intradialytic weight gain were found to be positively correlated with the Physical component summary (PCS) and Mental component summary (MCS). Effects of kidney disease was found to be very strongly and positively correlated with dialysis vintage. In the result of the study due to its smaller population we cannot determine more factors which were affecting the Quality of life scores.

Pattern and Severity of Anaemia in Predialysis Chronic Kidney Disease Patients in Bangladesh: A Tertiary Care Hospital Study

Background: Anemia is a common complication in chronic kidney disease (CKD), and is associated with a reduced quality of life, and increased morbidity and mortality. The mechanisms involved in ananaemiassociated with CKD are diverse and complex. They include a decrease in endogenous erythropoietin (EPO) production, absolute and/or functional iron deficiency, and inflammation with increased hepcidin levels, among others. Objective: The objective of our study was to investigate the prevalence and severity of anaemia in pre-dialysis patients, and chronic kidney disease patients in Bangladesh.Material & Methods:This was a case-control prospective study conducted with over 300 Bangladeshi non-patients as the control group A and 87 with different stages of chronic kidney disease (CKD) patients as the case group B in the department of Nephrology BSMMU from April’2004 to June 2006. The normal people who had no history of diabetes mellitus, hypertension, or CKD and were not on any medication were controlled and different stages of the CKD patients who had no history of blood transfusion, erythropoietin and parental iron infusion were cases.Results:Out of 300 normal populations male was 158(52.7%) and the female was 142(47.3%) and the mean haemoglobin level of the male was 13.94 g/dl and the female was 12.29 g/dl. Among males 24(15.2%) and females 55(38.7%) were anaemic and the overall prevalence of anaemia was noted at 26.3%. Of the total anaemic people, 25% was microcytic anemia. Out of 87 CKD patients, 56 (64%) were male and 31 (36%) were female. The overall prevalence of anaemia in CKD patients was 95.4%. The haemoglobin level was <11g/dl in 57.14% patients with CCr 30-59 ml/min/1.73m2 which increases to 87.5 % in patients with CCr 15-29 ml/min/1.73m2, which also increases to 94.2 % in patients with CCr<15 ml/min/1.73m2. Mean haemoglobin was observed at 8.6 g/dl, 9.54 g/dl and 11.25 g/dl in stage V, stage IV and stage III CKD patients respectively. Anaemia appeared at 43.53 ml/min/1.73 m2 of CCR.Conclusions:The results demonstrate that patient with reduced renal function is more likely to have anaemia and the prevalence and severity of anaemia increase with declining kidney function. CCr and TSAT is the important predictor of anaemia. In a significant number of the CKD, patient anaemia was associated with iron deficiency.

Assessment of chronic kidney disease in patients with non-alcoholic fatty liver disease (NAFLD); A single center experience

Background: Non-alcoholic fatty liver disease (NAFLD) represents a considerable percentage of chronic liver diseases worldwide. The liver is not the only organ affected by NAFLD but also affects other organs such as the cardiovascular system and the kidney. In recent decades, there has been a growing body of evidence linking NAFLD to kidney function. So, the current study aims to assess the percentage of chronic kidney disease (CKD) in NAFLD patients and its link to different stages of hepatic fibrosis. Patients and Methods: A case-control study evaluated 62 non-alcoholic fatty liver disease patients and a control group of 38 volunteers with apparently healthy livers (normal echo pattern by ultrasound). All participants underwent serum creatinine measurement, albumin creatinine ratio in urine, calculation of estimated glomerular filtration rate (eGFR), abdominal ultrasound, and fibroScan examination. Results: The authors showed that the percentage of patients with chronic kidney diseases (patients with GFR less than 60 ml or micro-albuminuria) were significantly higher among NAFLD groups than in healthy controls. There was a significant positive correlation between the albumin creatinine ratio and subcutaneous fat thickness, BMI, and steatosis degrees. The estimated glomerular filtration rate (eGFR) and the age of the patients had a significant negative correlation. In comparison, the eGFR and AST levels had a significant positive correlation. Conclusions: Our results showed that NAFLD substantially raises the risk of getting CKD

The current status and trends of chronic kidney disease (CKD) burden in China based on GBD Data / 公共卫生与预防医学

Objective To analyze the current status and trends of chronic kidney disease (CKD) burden in China from the global perspective, and to provide reference for the prevention and control of CKD in China. Methods The incidence, prevalence, mortality and disability adjusted life year (DALY) rate of China and other regions were retrieved from GBD 2019. Comparative analyses were carried out to reflect the burden of CKD. Results In 2019, the incidence and the prevalence in females were higher than those in males, while the mortality and the DALY rates in females were lower than those in males. There were obvious distinctions in different age groups and people over 65 years old had a higher CKD burden. The burden of CKD mainly came from hypertensive nephropathy and type 2 diabetic nephropathy. From 1990 to 2019, the DALY rate of CKD in China showed an overall upward trend. After eliminating the differences in age composition, the standardized DALY rate of CKD in China was higher than that in Japan, Korea and Ukraine although lower than the global. The main influencing factors of the burden of CKD were metabolic factors. Conclusion The burden of CKD in China is continuously rising. It is still necessary to pay attention to the three-level prevention and control, and focus on the key people groups and high-risk factors to further reduce the burden of CKD in China.

Serum Hepcidin as an Inflammatory Marker in Chronic Kidney Disease

Background: Hepcidin is known to be the central regulator of iron homeostasis in the body. It is up-regulated by inflammation and downregulated by anemia. CKD is a state of chronic inflammation seen in kidney.Previous work has shown that serum hepcidin levels were increased in patients with CKD. This was surprising as these patients had a chronic inflammatory state and co-existent anemia. Aim and Objectives: The aim of the study is to estimate the levels of hepcidin in CKD patients and to check the correlation of hepcidin to inflammation in chronic kidney disease. Methods: This cross-sectional study was conducted at the Department of Biochemistry, Central Laboratory, Sree Balaji Medical College and Hospital,Chromepet, Chennai during January 2017 -June 2018 among 50 patients of chronic kidney disease in the age group of 18-60 years. The blood samples were collected using vacutainer system. Samples for serum hepcidin, ferritin and hsCRP were collected in red topped plain vacuum tube. The samples were centrifuged at 3000 rpm for 15 minutes. The samples were then processed, and values were obtained. The data were analysed using SPSS package.Results: The mean values of s. Hepcidin, s. ferritin and hsCRP levels were found to be increased in the study population. The mean value of s. hepcidin was found to have strong positive correlation with the mean values of s. ferritin and hsCRP with r-value > 0.7.Conclusion: Hepcidin levels are elevated in CKD and hepcidin isa predictor of inflammation since it correlated well with the inflammatory markers hsCRP and ferritin levels

Effect of Liuwei Dihuangtang on Mitochondrial Apoptotic Pathway in Rats with Chronic Renal Failure / 中国实验方剂学杂志

Objective:To observe the effect of Liuwei Dihuangtang on the mitochondrial apoptotic pathway in rats with chronic renal failure. Method:The 45 male SD rats were randomly divided into normal group （n=10）， sham group （n=10） and operation group （n=25）. The operation group received 5/6 nephrectomy， and the rats in operation group were randomly divided into the model group and the treatment group after successful modeling. The treatment group received Liuwei Dihuangtang by gavage administration， while the rest of the three groups received equal volume of distilled water by gavage administration， with a treatment course of 8 weeks. The quantitative levels of serum creatinine （SCr）， blood urea nitrogen （BUN） and urine protein in each group were determined. Hematoxylin eosin （HE） staining and Masson staining were used to observe the histopathological changes of rat kidney. The structural changes of mitochondria in renal tubular epithelial cells were observed under electron microscope. The apoptotic rate was detected by terminal-deoxynucleoitidyl transferase mediated nick end labeling（TUNEL）. The expression of B cell lymphoma -2 （Bcl-2）， Bcl-2 associated X protein （Bax）， cytochrome C （Cyt C） and cysteine aspartic acid protease -3 （Caspase-3） were analyzed by Western blot and Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR）. Result:As compared with the normal group， the quantitative levels of SCr， BUN and urinary protein in the model group were significantly increased （P<0.01）， and the above indicators were improved in the treatment group as compared with the model group （P<0.05）. No significant pathological changes and damage of mitochondrial structure were observed in the kidney tissues of the control group and the sham group. In the model group， there were different degrees of renal tubular atrophy and dilatation， interstitial inflammatory cell infiltration and collagen deposition， and mitochondria swelling and breaking， but such lesions were significantly alleviated in the treatment group. As compared with the normal group， apoptotic rate was increased significantly in model group （P<0.01）， the expression of Bax and Caspase-3 was significantly increased （P<0.01）， and the expression of Bcl-2 was significantly decreased （P<0.01）. As compared with the model group， apoptotic rate was significantly reduced in the treatment group （P<0.01）， the expression of Bax and Caspase-3 was significantly decreased （P<0.01）， and the expression of Bcl-2 was significantly increased （P<0.01）. In the normal group and sham group， Cyt C was mainly located in mitochondria. The expression of Cyt C in the cytoplasm of the model group was increased significantly （P<0.01）， while that of the treatment group was decreased （P<0.01）. Conclusion:Liuwei Dihuangtang can alleviate renal fibrosis and delay the progression of renal function. The mechanism of reducing apoptosis may be associated with protecting mitochondrial structure and regulating the expression of proteins related to mitochondrial apoptotic pathway.

The Impact Of Antihypertensive Drug Therapy In Patients With Chronic Kidney Disease: A Prospective Observational Cohort Study

Objective: Hypertension (HTN) is both a cause and an effect of chronic kidney disease (CKD). To adequately control blood pressure (BP) in CKD, choosing antihypertensive strategies with the highest nephro-protective effect is crucial for preventing or reversing end-stage renal disease (ESRD) progression and reducing cardiovascular disease (CVD) risk. The present study was therefore designed to evaluate the impact of clinical use of antihypertensive drug therapy in patients with CKD and ESRD. Methods: It is a prospective observational cohort study. The patients were divided into two cohorts i.e.; non-dialysis dependent (NDD) and dialysis-dependent (DD) CKD. This study was conducted for six months in the Nephrology department, Osmania General Hospital, Hyderabad, India. The data collected and entered into Microsoft Excel (2007) and mean, SD and range were calculated using SPSS version 25. Results: Antihypertensive drugs were prescribed alone or in combination based on the co-morbidities associated with CKD and HTN. Loop diuretics (Furosemide and Torsemide) and calcium channel blocker (Amlodipine, Nifedipine and Cilnidipine) were most commonly prescribed antihypertensive drugs. Triple therapy (44.11%) was prescribed mostly in both the cohorts (NDD = 16.66%+DD = 27.45%) of which calcium channel blockers+loop diuretic+sympatholytic accounts for 19.16% (NDD = 5.88%+DD = 13.73%).  Conclusion: The practice of prescribing antihypertensive drugs for the management of HTN and to achieve BP targets in CKD and ESRD remains uncertain. The development of new and revised guidelines is needed to reduce inappropriate variations in practice and promote better delivery of evidence-based treatment.

Treatment of Renal Proteinuria by Traditional Chinese Medicine and Its Mechanism / 中国实验方剂学杂志

Chronic kidney disease (CKD) refers to abnormal renal structure and function for more than 3 months, and is characterized by abnormal urine, blood and kidney structure. As an important clinical manifestation of CKD, proteinuria is closely related to glomerular damage. It is not only a pathological manifestation of CKD, but also an important pathological factor to accelerate the development of CKD. After thousands of years of development, traditional Chinese medicine (TCM) has a systematic theoretical foundation and rich clinical experience in the treatment of CKD. By referring to the treatment principles and methods of "leakage of vital essence", "low back pain", "asthenia", "blood urine" and "edema" in TCM, the general treatment principle of proteinuria is to coordinate the body Yin and Yang and restore the balance of Yin and Yang. Specific methods include removing blood stasis, sweating, urinating, invigorating the spleen and strengthening the kidney, smoothing liver and activating collaterals, and removing dampness and detoxification. Both ancient and modern physicians have established effective prescriptions according to the treatment principles and methods. Modern studies have showed that the mechanism of TCM to reduce proteinuria is mainly to improve the pathological manifestations of large area fusion of podocyte processes and complete disappearance of poddout, up-regulate the expression of nephrin and podocin, regulate immune, alleviate systemic inflammation, and improve the serum superoxide dismutase (SOD)level and the ability of the body to remove free radicals. The method and mechanism of treating renal proteinuria are discussed from three aspects:classical prescriptions, empirical prescriptions and the Chinese patent medicine. It provides a theoretical reference for the clinical treatment of chronic kidney disease, reducing the excretion of proteinuria and improving the clinical symptoms of the patients.

Profile of Chronic Kidney Disease (CKD) patients presenting in a tertiary care center in north India

Background: Chronic Kidney Disease (CKD) is one of the most common causes of morbidity and mortality due to renal causes. There are multiple causes of CKD with diabetes, hypertension and chronic glomerulonephritis among the most common causes. All of these causes gradually lead to the final common pathway of End stage renal disease (ESRD). Chronic Kidney Disease (CKD) is defined as Kidney damage for ≥3 months, as defined by structural or functional abnormalities of the kidney, with or without decreased GFR or GFR <60 mL/min/1.73m2 for ≥3 months, with or without kidney damage. Aim: To study the profile of Chronic Kidney disease (CKD) patients presenting in a tertiary care center. Rahul Sudan, Mehroz Ahmed, Imtiyaz Ahmed Wani, Muzaffar Maqsood Wani, Khurshid Ahmed Banday, Gunjan Gupta. Profile of Chronic Kidney Disease (CKD) patients presenting in a tertiary care center in north India. IAIM, 2018; 5(8): 72- 80. Page 73 Materials and methods: This study was conducted at Sher I Kashmir Institute of Medical Sciences (SKIMS), a tertiary care center in Srinagar, Jammu and Kashmir, India, from July 2013 to January 2016. All the patients of CKD visiting our institute were enrolled in this study. This included patients on follow up at the Out Patient Department (OPD), patients presenting to emergency with complications of CKD, patients referred from other departments who were detected in initial stages of CKD during the routine investigations. A total of 300 patients were enrolled in this study. Results: In our study, a total of 300 patients were enrolled. CKD was more common in males. The most common aetiology of CKD was diabetic nephropathy which was seen in 102 patients (34%) followed by chronic glomerulonephritis seen in 80 patients (27%). Volume overload was the most common cause of morbidity in these patients. Patients in the initial stages of CKD were managed with symptomatic treatment and 230 patients (76.66%) received peritoneal dialysis at some stage of their management. It was in the stage of ESRD that patients were offered some definitive form of renal replacement therapy in the form of renal transplantation or hemodialysis. Out of 160 patients of ESRD, only 12 patients (7.5%) received renal transplantation and the remaining 148 patients (92.5%) were managed with hemodialysis. Conclusion: CKD is one of the leading causes of morbidity and mortality due to renal causes. The early stages of CKD which are managed by conservative methods gradually lead to the development of ESRD. It is therefore necessary to diagnose the patients of CKD in the early asymptomatic stages. At these stages it is feasible to slow down the loss of nephrons by controlling the underlying factors like diabetes and hypertension but once the stage of ESRD sets in, renal transplantation is the preferred modality of renal replacement therapy

A Long Way from Transfer to Transition: Challenges for Pediatric and Adult Nephrologists

Significant advances in the diagnosis and medical care of children with chronic kidney disease (CKD) are major reasons for the better survival rates of children and adolescents with CKD than the survival rates reported in previous decades. These patients are reaching adulthood, and therefore require a transition to adult medical care. This transition phase is well-recognized to be associated with considerably increased morbidities and medical problems, such as non-adherence, graft loss after transplantation, and loss to follow-up. Low adherence increases morbidity and medical complications and contributes to poorer qualities of life and an overuse of the health care system. However, these tragic outcomes may be avoidable through a structured and well-defined transition program. In the last decade, there has been increasing interest to resolve these medical and psychological problems that occur during the transfer of young adult patients from pediatric to adult renal units. The aims of a successful transition from pediatric to adult medical care include enhancing the individual development of better health-competence and stabilizing, or even improving, the state of health. This review will focus on various aspects of the transition phase of adolescents who have CKD or who underwent kidney transplantation from pediatric to adult nephrology care.

Advances in Traditional Chinese Medicine Research on Protein-energy Wasting of Chronic Kidney Disease / 浙江中医药大学学报

[Objective]To summarize the advances in traditional Chinese medicine research on protein-energy wasting(PEW) of chronic kidney disease(CKD).[Methods]Read the domestic and foreign literature about PEW in recent years.Collate,study and summarize etiology and pathogenesis,therapeutic principle and symptomatology of PEW,as well as the application of classical prescriptions,compound prescriptions,single herbs and traditional Chinese external treatments about PEW.[Results]The external cause of PEW is feelings of six vessel disease,and the internal cause is weak and damage of Zang and Fu viscera.The pathogenesis consists of deficiency of Ben and repletion of Biao.Deficiency of Ben means dysfunction of Zang and Fu viscera,lack of Qi and blood,Yin and Yang.The disease mainly locates in the spleen and kidney;the retention of damp and hot,phlegm turbidity,blood stasis and water poison,damages the renal collaterals,which constitute Biao of PEW.The chief principle of treatment is to support the right and expel the evil.Emphasis on dialectical therapy,and center on "nourishing kidney and strengthening spleen,benefiting qi and nourishing blood,activating blood and removing stasis,cleaning bowel and dispelling turbidity,detoxificating and reconciling collaterals".Deficiency and excess exist simultaneously in the symptomatology of PEW.Qi deficiency of spleen and kidney is the most common deficiency syndrome,damp and turbidity,damp and hot and blood stasis are seen most of the time in accompanied symptom.Classical prescriptions,single traditional Chinese herb,and external therapy of TCM will be uesd to create good application prospect in the TCM treatments of PEW,which effectively improve clinical symptoms,increase nutrition related indicators,reduce micro-inflammatory response,and finally raise living quality of patients.[Conclusion]Traditional Chinese medicine treatments of the PEW provide advantages and have made certain achievements,which are worth further studying.

Correlation of Serum Insulin and Chronic Kidney Disease and Its Application Value / 现代检验医学杂志

Objective To study serum insulin level change and its clinical significance in the patients with chronic kidney dis-ease (CKD).Methods 800 cases of patients with chronic kidney disease were observed with 400 cases of healthy people as control group at the same time.According to whether there was a complication of diabetic,chronic nephropathy was divided into two groups:diabetic nephropathy chronic renal failure group (425 cases)and non-diabetic nephropathy chronic renal failure (375 cases).According to the classification standard,chronic renal failure and the diabetic nephropathy group was di-vided into four groups:type 1 diabetes (105 cases),type 2 diabetes (135 cases),gestational diabetes (95 cases),diabetes with other reasons(90 cases).Relevant clinical information was collected,including age,gender,height,weight,and the cor-responding body mass index (BMI)was calculated based on height and weight.After some laboratory examinations,related parameters of the research were collected,including object of urea(Urea),serum creatinine (SCr),fasting plasma glucose (FPG),fasting insulin (FIns).According to the corresponding formula,insulin sensitive index (ISI)and glomerular filtration rate (GFR)were calculated based on the above parameters.Statistical comparison was made after collection.Results Urea, Scr,FPG and FIns of the patients with chronic kidney disease were significantly higher than those of normal control group (t=36.788,35.612,137.216,9.294;all P=0.000 respectively).Age,gender and BMI calculatedfrom height and weight in three groups had differences,but they were not statistically significant (F=1,363,P=0.256;F=1.577,P=0.454;F=1.641,P=0.194),and had no effect on the occurrence of chronic kidney disease development.Comparison of patients with different types of diabetes and chronic kidney disease,when a group had higher FIns and lower ISI,it also had a smaller GFR,and the differences between groups were statistically significant (F=12.01,P=0.000;F=3.891,P=0.009;F=3.774,P=0.011).Conclusion The serum insulin were closely related to CKD.Observing the serum insulin can have a dee-per understanding of the disease development,make a more effective treatment and predict the probability to be recover.

Skeletal fluorosis with progressive quadriparesis U.M.N. type, non compressive myelopathy, chronic kidney disease and secondary hyperparathyroidism and hypothyroidism – A case report.

Endemic fluorosis leads to dental fluorosis, skeletal fluorosis and visceral fluorosis. This case described about the crippling skeletal fluorosis with neurological manifestations in the form of myelopathy, due to exposure to high fluoride level in water for many years. The complications of fluoride deposition in bones resulted in generalised sclerosis, osteophytosis, with narrowing of inter vertebral disc spaces in vertebral column. In this case the skeletal fluorosis leads to severe spastic quadriparesis. This case had features of visceral fluorosis; the affected organs include thyroid gland with hypothyroidism, parathyroid gland with secondary hyperparathyroidism, pancreas with intra pancreatic calcification and the kidneys with chronic kidney disease.

Relationship between neutrophil-to-lymphocyte ratio and early-stage diabetic nephropathy in patients with ;newly diagnosed type 2 diabetes / 中国糖尿病杂志

Objective To explore the relationship between neutrophil‐to‐lymphocyte ratio (NLR) and early‐stage diabetic nephropathy in patients with newly diagnosed type 2 diabetes(T2DM ). Methods A total of 160 patients with newly diagnosed T2DM were enrolled in this study and divided into two groups:early‐stage diabetic nephropathy (EDN ) group and non‐DN group (T2DM group). The clinical and biochemical data were collected. Results NLR ,neutrophia cell count ,2 hPG ,HbA1 c ,age were significantly higher in EDN group than in T2DM group[NLR (2.27 ± 0.92)vs(1.81 ± 0.56) ,neutrophia cellcount(4.35±1.47)vs(3.78±1.08)109/L,2hPG(21.98±4.30)vs(20.37±4.40)mmol/L,HbA1c (11.06±2.02)% vs (10.22 ± 1.89)% ,age(49.22 ± 12.71) vs (44.41 ± 10.81)years] (P< 0.05).Logistic regression analysis showed that NLR (OR= 6.529 ,95% CI:1.946 ~ 21.873 ,P= 0.002)and 2 hPG(OR = 1.213 ,95% CI:1.002 ~ 1.467 ,P= 0.047 ) were independent risk factors for EDN.Conclusion Increased NLR is significantly associated with EDN. High NLR level may be a reliable predictive marker for EDN.

Anaemia in Type 2 Diabetes Mellitus (T2DM) Patients in Hospital Putrajaya

Patients with diabetes have an earlier onset and increased severity of anaemia compared to those with similar degree of renal impairment from other causes. Anaemia is associated with an increased risk of vascular complications. In this study, we determined the prevalence of anaemia in T2DM patients and its association with sociodemographic, clinical and laboratory parameters in an endocrine tertiary hospital in Malaysia. This was a cross-sectional study using retrospective electronic data from January 2011 to December 2013 of 165 T2DM patients in Hospital Putrajaya. Data was analysed using IBM SPSS Statistics version 21.0 for Windows. The prevalence of anaemia was 39.4% and majority had normocytic normochromic (80%), mild (58.5%) anaemia. Majority were Malays (73.9%), aged below 60 with comparable gender percentage and long-standing, poorly-controlled DM [median fasting blood sugar (FBS) 8mmol/L; glycated haemoglobin (HbA1c) 7.9%]. Using the KDIGO chronic kidney disease (CKD) staging system, 86% of these patients were in stages 3-5. Anaemic patients had a significantly higher serum urea, creatinine and a lower FBS, estimated glomerular filtration rate (eGFR) compared to non-anaemic patients. Anaemic patients with diabetic nephropathy had a significantly lower haemoglobin (Hb) compared to those without this complication (p=0.022). The sensitivity and specificity at a cut-off eGFR value of 38.3 ml/min/1.73 m2 (maximum Youden index = 0.462) was 66.7% and 79.5%, respectively to discriminate mild from moderate anaemia. This study shows that anaemia is already present in T2DM patients in Hospital Putrajaya at initial presentation to the specialist outpatient clinic and is significantly associated with CKD. Hence, it emphasises the obligatory need for routine and follow-up full blood count monitoring in T2DM patients in primary care as well as tertiary settings in Malaysia to enable early detection and aggressive correction of anaemia in preventing further complications.