Echinocandins Compared to Fluconazole for Candidemia of a Urinary Tract Source: A Propensity Score Analysis.

BACKGROUND: Whether echinocandins could be used to treat candidemia of a urinary tract source (CUTS) is unknown. We aimed to provide current epidemiological information of CUTS and to compare echinocandin to fluconazole treatment on CUTS outcomes. METHODS: A multicenter study of adult patients with candidemia was conducted in 9 hospitals. CUTS was defined as a candidemia with concomitant candiduria by the same organism associated with significant urological comorbidity. The primary outcome assessed was clinical failure (defined by 7-day mortality or persistent candidemia) in patients treated with either an echinocandin or fluconazole. A propensity score was calculated and then entered into a regression model. RESULTS: Of 2176 episodes of candidemia, 128 were CUTS (5.88%). Most CUTS cases were caused by Candida albicans (52.7%), followed by Candida glabrata (25.6%) and Candida tropicalis (16.3%). Clinical failure occurred in 7 patients (20%) treated with an echinocandin and in 15 (17.1%) treated with fluconazole (P = .730). Acute renal failure (adjusted odds ratio [AOR], 3.01; 95% confidence interval [CI], 1.01-8.91; P = .047) was the only independent factor associated with clinical failure, whereas early urinary tract drainage procedures (surgical, percutaneous, or endoscopic) were identified as protective (AOR, 0.08; 95% CI, .02-.31; P < .001). Neither univariate nor multivariate analysis showed that echinocandin therapy altered the risk of clinical failure. CONCLUSIONS: Initial echinocandin therapy was not associated with clinical failure in patients with CUTS. Notably, acute renal failure predicted worse outcomes and performing an early urologic procedure was a protective measure.

Cordyceps cicadae extracts ameliorate renal malfunction in a remnant kidney model.

BACKGROUND AND OBJECTIVES: Chronic kidney disease (CKD) is a growing public health problem with an urgent need for new pharmacological agents. Cordyceps cicadae is widely used in traditional Chinese medicine (TCM) and has potential renoprotective benefits. The current study aimed to determine any scientific evidence to support its clinical use. METHODS: We analyzed the potential of two kinds of C. cicadae extract, total extract (TE) and acetic ether extract (AE), in treating kidney disease simulated by a subtotal nephrectomy (SNx) model. Sprague-Dawley rats were divided randomly into seven groups: sham-operated group, vehicle-treated SNx, Cozaar, 2 g/(kg∙d) TE SNx, 1 g/(kg∙d) TE SNx, 92 mg/(kg∙d) AE SNx, and 46 mg/(kg∙d) AE SNx. Renal injury was monitored using urine and serum analyses, and hematoxylin and eosin (HE) and periodic acid-Schiff (PAS) stainings were used to analyze the level of fibrosis. The expression of type IV collagen (Col IV), fibronectin (FN), transforming growth factor-ß1 (TGF-ß1), and connective tissue growth factor (CTGF) was detected by immunohistochemistry. RESULTS: Renal injury, reflected in urine and serum analyses, and pathological changes induced by SNx were attenuated by TE and AE intervention. The depositions of Col IV and FN were also decreased by the treatments and were accompanied by reduced expression of TGF-ß1 and CTGF. In some respects, 2 g/(kg∙d) of TE produced better effects than Cozaar. CONCLUSIONS: For the first time, we have shown that C. cicadae may inhibit renal fibrosis in vivo through the TGF-ß1/CTGF pathway. Therefore, we conclude that the use of C. cicadae could provide a rational strategy for combating renal fibrosis.

Evaluación clínica y bioquímica de la diálisis peritoneal intermitente con sesiones cortas de 30 baños en 24 horas / Clinical and biochemical evaluation of intermittent peritoneal dialysis with 30 short sessions per 24 hours

El objetivo del presente trabajo fue demostrar que con sesiones cortas (24 horas) de diálisis peritoneal intermitente (DPI) se obtiene la misma mejoría clínica y bioquímica que con la DPI habitual (48 horas). Se realizó un ensayoo clínico, ciego simple y cruzado. Los pacientes fueron asignados a dos grupos: grupo estudio-DPI sesiones cortas, grupo testigo-DPI habitual. Se les realizaron cuatro semanales a cada grupo y posteriormente se cruzaron . La valoración se realizó a través de exploración clínica, bioquímica sérica y examen de líquido de diálisis.Se analizaron cuatro pacientes con edad promedio de 49 años. Los resultados de este estudio muestran que no existen diferncias significativas en cuanto el aspecto clínico de los pacientes. El grupo de personas que recibían sesiones cortas de DPI presentaban disminución de la urea y de la creatinina sérica después de cada sesión semanal, con una p=0.001