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1.
Biochim Biophys Acta Mol Basis Dis ; 1866(6): 165764, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32169506

RESUMO

Recent studies have shown that laboratory murine autoimmunity models under the same environment display different outcomes. We established diabetic nephropathy model mice under the same environment using the classic streptozotocin method. Renal dysfunction was different among the mice. Proteinuria was more significant in the severe proteinuria group (SP) than in the mild proteinuria group (MP). We hypothesized a role for the gut microbiota in the outcome and reproducibility of induced DN models. 16S rDNA gene sequencing technology was used to analyze the differences in the gut microbiota between the two groups. Here, through fecal microbiota transplantation (FMT) and gas chromatography mass spectrometry (GC-MS), we verified the role of the gut microbiota and its short-chain fatty acid (SCFA) generation in DN mouse renal dysfunction. In the SP group, there was a reduced abundance of Firmicutes (P < 0.0001), and the dominant genus Allobaculum [linear discriminant analysis (LDA) >3, P < 0.05] was positively correlated with body weight (Rho = 0.767, P < 0.01) and blood glucose content (Rho = 0.648, P < 0.05), while the dominant genus Anaerosporobacter (LDA > 3, P < 0.05) was positively correlated with 24-hour urinary protein content (Rho = 0.773, P < 0.01). In the MP group, the dominant genus Blautia (LDA > 3, P < 0.05) was negatively correlated with 24-hour urinary protein content (Rho = -0.829, P < 0.05). The results indicated that Allobaculum and Anaerosporobacter may worsen renal function, while Blautia may be a protective factor in DN. These findings suggested that the gut microbiota may contribute to the heterogeneity of the induced response since we observed potential disease-associated microbial taxonomies and correlations with DN.

2.
Int Urol Nephrol ; 52(1): 169-177, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31667689

RESUMO

BACKGROUND: The relationship between the endothelial glycocalyx constituents and the early failure of autologous arteriovenous fistulas (AVFs) in ESRD patients is still unknown. METHODS: In this prospective cohort study, 181 ESRD patients (the mean age was 53.3 ± 11.8 years, 66.3% of them were males) received forearm AVFs surgery were consecutively enrolled with a median follow-up time of 10 months. The early AVF failure was defined as a fistula that never developed adequately for dialysis use or that failed within the first 3 months of use. The serum levels of glycocalyx constituents including glypicans-1 (GPC-1), syndecans-1 (SDC-1), and hyaluronan (HA), and the indicator of endothelial activation reflected by E-selectin (ES) were determined by ELISAs. RESULTS: The primary patencies of AVFs were 98.3%, 96.7%, 91.7%, and 89.5% at 3, 6, 12, and 18 months, respectively. The ROC curve was plotted and demonstrated that HA, not GPC-1, SDC-1 or ES, can diagnose the AVF failure, with the cut-off value of 6.37 ng/ml, the sensitivity of 87.5%, the specificity of 46.9%, and the Youden index of 0.34, respectively. The Kaplan-Meier survival analysis demonstrated that patients with HA < 6.37 ng/mL had better patency of AVFs than patients with HA ≥ 6.37 ng/mL (log-rank test, p = 0.008). In the Cox proportional hazards analysis, after adjusting for confounders, HA (≥ 6.37 ng/mL vs. < 6.37 ng/mL) was associated with the early AVFs failure, with the OR of 5.88 (1.21-28.60). CONCLUSIONS: This study demonstrated that HA can predict the early failure of forearm AVFs, when its serum level is more than 6.37 ng/mL.

3.
Ren Fail ; 41(1): 1036-1044, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31814501

RESUMO

Background: Most prior studies have explored surgery for the treatment of failed autologous arteriovenous fistulas (AVFs) with limited follow-up times and a lack of end point mortality. Accordingly, we conducted a retrospective cohort study to evaluate the clinical outcomes of the surgery of new AVF proximal to the failed forearm AVF.Methods: In this study, 538 end-stage renal disease patients (group A, 418 with primary AVF; and group B, 120 with failed AVF) were consecutively enrolled between January 2013 and June 2016, with a median follow-up time of 41 months. Primary and secondary patency, all-cause mortality, and risk factors associated with AVF failure were explored by the Kaplan-Meier method or Cox proportional hazards model.Results: In group A (n = 418), the primary and secondary patencies of AVF were 85.6% vs. 96.8%, 79.7% vs. 95.0%, 75.1% vs.93.9%, 73.2% vs. 93.6% and 73.2% vs. 93.6% at 12, 24, 36, 48 and 60 months, respectively. The primary patencies of AVF in group B were 95.0%, 91.7%, 89.2%, 88.3% and 88.3% at 12, 24, 36, 48 and 60 months, respectively. After adjusting for potential confounders, age, angiotensin-converting inhibitors or angiotensin-receptor blockers (anti-RAAS) drugs and D-dimer were independent predictors of AVF failure. However, there were no differences between functional and failed AVF regarding all-cause mortality.Conclusions: The study revealed that the primary and secondary patiencies of the surgery of new AVF proximal to the failed ones were ideal operations to restore failed forearm AVF.


Assuntos
Derivação Arteriovenosa Cirúrgica/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Feminino , Humanos , Falência Renal Crônica/mortalidade , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Falha de Tratamento , Adulto Jovem
4.
Ther Apher Dial ; 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31574579

RESUMO

High body mass index (BMI) is the most common parameter to assess excess adiposity, and has been linked to glomerular hyperfiltration (GH). However, BMI may be misleading in the estimation of body fat content due to its inability to discriminate between body fat and lean mass. In recent years, the convenient biological impedance analysis has made prediction of certain diseases somewhat feasible and accessible using body composition (BC). Accordingly, we conducted a cross-sectional study to explore the association between BC and GH among Chinese adult population. A total of 6902 adults (aged 38.6 ± 8.3 years, 70.1% males) who consecutively visited the Health Checkup Clinic were enrolled. BC including fat mass and lean body mass (LBM) was evaluated by biological impedance analysis. The upper quartile of eGFR which exceeded 117.3 mL/min/1.73 m2 was defined as GH, in comparison with the lower three quartiles (control group). As a categorical outcome, GH subjects had higher fat/LBM than the control group, which was 34.7 ± 10.9 (%) vs. 34.0 ± 10.5 (%), P = 0.01; however, the BMI in GH group was lower than in the control group, which was 24.5 ± 3.7 (%) vs. 24.9 ± 3.6 (%), P < 0.001. Fat/height and Fat/BSA were not significantly different between the two groups. Moreover, after adjusting for potential confounders, fat/LBM significantly correlated with GH (OR = 2.09, 95% CI, 1.11 to 3.93). The study revealed that fat/LBM significantly correlated with GH among Chinese adult population, which highlights that adiposity might be an important and potentially modifiable determinant of GH.

5.
J Transl Med ; 17(1): 228, 2019 07 17.
Artigo em Inglês | MEDLINE | ID: mdl-31315634

RESUMO

BACKGROUND: Chronic kidney disease (CKD) is a universal chronic disease in China. The balance of the gut microbiome is highly crucial for a healthy human body, especially for the immune system. However, the relationship between the gut microbiome and CKD has not yet been clarified. METHODS: A total of 122 patients were recruited for this study. Among them, 24 patients were diagnosed with CKD5 but did not receive hemodialysis therapy, 29 patients were diagnosed with CKD5 and received hemodialysis therapy and 69 were matched healthy controls. The gut microbiome composition was analyzed by a 16S rRNA (16S ribosomal RNA) gene-based sequencing protocol. High-performance liquid chromatography-electrospray ionization-tandem mass spectrometry (HPLC/ESI-MS/MS) technology was used to evaluate the levels of microbiome-related protein-binding uremic toxins level, indoxyl sulfate (IS) and p-cresyl sulfate (PCS), in the patients. RESULTS: We compared the gut microbiome results of 122 subjects and established a correlation between the gut microbiome and IS and PCS levels. The results indicated that alpha and beta diversity were different in patients with CKD5 than in the healthy controls (p < 0.01). In comparison to healthy controls, CKD5 patients exhibited a significantly higher relative abundance of Neisseria (p < 0.001), Lachnoclostridium (p < 0.001) and Bifidobacterium (p < 0.001). Faecalibacterium (p < 0.001) displayed a notably lower relative abundance for CKD5 patients both with and without hemodialysis than for controls. It was also found that the concentrations of IS and PCS were correlated with the gut microbiome. CONCLUSIONS: Our results indicate that CKD5 patients both with and without hemodialysis had dysbiosis of the gut microbiome and that this dysbiosis was associated with an accumulation of IS and PCS. These results may support further clinical diagnosis to a great extent and help in developing potential probiotics to facilitate the treatment of CKD5.

6.
Cell Signal ; 59: 13-23, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30857827

RESUMO

Diabetic kidney disease (DKD) is a complication associated with diabetes and is a major public health problem in modern society. Podocyte injury is the central target of the development of DKD, and the loss or dysregulation of nephrin, a key structural and signalling molecule located in the podocyte slit diaphragm (SD), initiates potentially catastrophic downstream events within podocytes. IQGAP1, a scaffold protein containing multiple protein-binding domains that regulates endocytosis, can interact with nephrin in podocytes. It is hypothesized that IQGAP1 contributes to nephrin endocytosis and may participate in the pathogenesis of DKD. The dramatically increased histo-nephrin granularity score in DKD glomeruli showed a significant positive correlation with increased IQGAP1-nephrin interaction without changes in the total protein content of nephrin and IQGAP1. In cultured human podocytes, hyperglycaemia induced the intracellular translocation of IQGAP1 from the cytosol to the vicinity of the cytomembrane, reinforced the IQGAP1-nephrin interaction, and augmented nephrin endocytosis. Moreover, impaired podocyte function, such as migration, extensibility and permeability, were further aggravated by wild-type IQGAP1 plasmid transfection, and these effects were partially restored by siRNA-mediated IQGAP1 downregulation. Collectively, these findings show that IQGAP1, an intracellular partner of nephrin, is involved in nephrin endocytosis and the functional regulation of podocytes in DKD.

7.
J Nephrol ; 32(2): 265-272, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30588573

RESUMO

BACKGROUND: The relationship between oral activated charcoal (OAC) and hyperphosphatemia and vascular calcification is not completely clear. We observed and recorded the effects of OAC on hyperphosphatemia and vascular calcification in stage 3-4 chronic kidney disease (CKD). METHODS: In a randomized controlled study, we included 97 patients with stage 3-4 CKD. In the first phase of the experiment, the patients were randomly divided into the OAC group and placebo group. The endpoint of this phase was the development of hyperphosphatemia. The patients with hyperphosphatemia were selected into the second phase of the study. These patients underwent coronary artery multidetector computed tomography (MDCT) and were randomly divided into three groups: the OAC group, the calcium carbonate (CC) group and the lanthanum carbonate (LC) group. RESULTS: The first and second phases of the experiment were followed for 12 months. In the first phase of the experiment, there was a statistically significant difference in the proportion of patients with hyperphosphatemia between the OAC and placebo groups (28.57% vs. 79.17%, X2 = 24.958, P = 0.000). In the second phase, the differences in coronary calcification score (CACS) between the OAC group, the CC group and the LC group were statistically significant (525.5 ± 104.2 vs 688.1 ± 183.7 vs 431.4 ± 122.5, P < 0.01). CONCLUSION: Oral activated charcoal effectively delays the onset of hyperphosphatemia in patients with chronic kidney disease. OAC appears to delay the development of vascular calcifications in stage 3-4 CKD patients.


Assuntos
Carbonato de Cálcio/administração & dosagem , Carvão Vegetal/administração & dosagem , Quelantes/administração & dosagem , Hiperfosfatemia/prevenção & controle , Lantânio/administração & dosagem , Fosfatos/sangue , Insuficiência Renal Crônica/tratamento farmacológico , Calcificação Vascular/prevenção & controle , Administração Oral , Adulto , Idoso , Biomarcadores/sangue , Carbonato de Cálcio/efeitos adversos , Carvão Vegetal/efeitos adversos , Quelantes/efeitos adversos , Feminino , Humanos , Hiperfosfatemia/sangue , Hiperfosfatemia/diagnóstico , Hiperfosfatemia/etiologia , Lantânio/efeitos adversos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/diagnóstico , Fatores de Tempo , Resultado do Tratamento , Calcificação Vascular/sangue , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/etiologia
8.
Hum Pathol ; 80: 87-93, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29935195

RESUMO

The antioxidant enzyme manganese superoxide dismutase (MnSOD) is up-regulated in renal cell carcinoma (RCC) and has been implicated in multiple stages of RCC tumorigenesis and progression. However, the prognostic significance of MnSOD in RCC has not been fully elucidated. This study aimed to investigate the expression profile of MnSOD in clear cell RCC (ccRCC) tissues and evaluate the clinical significance of this enzyme in ccRCC patients. MnSOD mRNA was assessed in 42 ccRCC and 33 normal kidney tissues using the Oncomine database, and its protein was detected in 145 ccRCCs and 3 normal tissues by immunohistochemistry staining. The Oncomine database confirmed higher MnSOD mRNA expression in ccRCC than in normal tissues, and immunohistochemistry analysis revealed that MnSOD protein expression was inversely associated with pathologic grade, clinical stage, tumor size, M status, and cancer-specific survival. In addition, univariate survival analysis demonstrated that high-grade, late-stage, large tumors, stage M1, and low MnSOD expression were associated with a poorer prognosis for cancer-specific survival, and further multivariate analysis revealed that tumor grade, stage, M1 stage, and MnSOD were identified as independent prognostic factors for cancer-specific survival in patients with ccRCC. Collectively, these findings imply that MnSOD is a promising prognostic marker in ccRCC and implies that oxidative stress might be involved in the tumorigenesis and progression of ccRCC.


Assuntos
Biomarcadores Tumorais/análise , Carcinoma de Células Renais/patologia , Regulação Neoplásica da Expressão Gênica/genética , Neoplasias Renais/patologia , Superóxido Dismutase/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Renais/diagnóstico , Progressão da Doença , Feminino , Humanos , Imuno-Histoquímica/métodos , Neoplasias Renais/diagnóstico , Masculino , Pessoa de Meia-Idade , Gradação de Tumores/métodos , Recidiva Local de Neoplasia/patologia , Prognóstico
9.
Exp Ther Med ; 13(5): 2050-2055, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28565807

RESUMO

The aim of the present study was to investigate the demethylation effect of arsenic trioxide (As2O3) on the secreted frizzled-related protein 1 (SFRP1) gene and its ability to inhibit the Wingless-type MMTV integration site family (WNT) pathway in Jurkat cells. Methylation-specific polymerase chain reaction was used to examine the CpG island methylation status of the SFRP1 gene in leukemia cell lines. In addition, the effects on Jurkat cells of treatment with different concentrations of As2O3 for 48 h were investigated. Reverse transcription-quantitative polymerase chain reaction was employed to measure the expression of mRNAs, while western blot analysis was used to examine protein expression in cells. The SFRP1 gene was methylated in Jurkat cells. However, both methylated and unmethylated SFRP1 genes were detected in HL60 and K562 cells. In normal bone marrow mononuclear cells, the SFRP1 gene was unmethylated. Following treatment with As2O3 for 48 h, the SFRP1 gene was demethylated, and the mRNA and protein expression levels of the SFRP1 gene were increased. By contrast, the mRNA and protein expression levels of ß-catenin and cyclin Dl were downregulated. The protein expression of c-myc was also downregulated, but As2O3 exhibited no significant effect on the mRNA expression of c-myc. Abnormal methylation of the SFRP1 gene was detected in Jurkat cells. These results suggest that As2O3 activates SFRP1 gene expression at the mRNA and protein levels in Jurkat cells by demethylation of the SFRP1 gene. Furthermore, they indicate that As2O3 regulates WNT target genes and controls the growth of Jurkat cells through the WNT/ß-catenin signaling pathway.

10.
Clin Chim Acta ; 470: 103-108, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28501388

RESUMO

BACKGROUND: Few studies have examined the relationships between the prevalence of chronic kidney disease (CKD) and the metabolic risk factors in a developing country such as China, where genetic and environmental backgrounds differ from those in Western countries. METHODS: The subjects of this cross-sectional study were the individuals from 18 to 92y. The metabolic syndrome (MetS) was defined based on the criteria of Adult Treatment Panel Third Report (ATP III), but using body mass index (BMI) instead of waist circumference. CKD was defined as decreased estimated glomerular filtration rate (eGFR<60mL/min/1.73m2) or presence of proteinuria (urine protein≥1+) assessed using dipstick method. RESULTS: A total of 26,601 subjects (average age of 48.7y) were analyzed. Among them, the prevalence of the MetS and CKD was 36.4% and 3.0%, respectively. After adjustment for age, gender, cigarette smoking and alcohol drinking, the prevalence of CKD was significantly greater in subjects with than without MetS (OR 1.99, 95% CI 1.57-2.53, p<0.001). Multivariate-adjusted odd ratios for CKD in subjects with 3, 4 or 5 MetS components were 1.82 (95% CI 1.31-2.52, p<0.001), 2.92 (95% CI 2.09-4.09, p<0.001), and 3.07 (95% CI 1.67-5.67, p<0.001), respectively. After further adjustments were made for the other components of MetS, only high fasting glucose (OR 1.52, 95% CI 1.12-2.05) were significant risk factors for reduced renal function(eGFR<60mL/min/1.73m2). High blood pressure (OR 1.81, 95% CI 1,42-2.29), high triglycerides (OR 1.34, 95% CI 1.11-1.67) and high fasting glucose (OR 2.07, 95% CI 1.62-2.66) were significant risk factors for proteinuria. CONCLUSIONS: MetS was highly prevalent in the middle-aged and elderly Chinese population in the city of Jinan. There was a graded relationship between the number of MetS components and risk of CKD. High fasting blood glucose levels were the main risk factor of reduced renal function. High blood pressure, high fasting blood glucose levels and high triglycerides were main risk factors for proteinuria.


Assuntos
Síndrome Metabólica/complicações , Insuficiência Renal Crônica/complicações , População Urbana/estatística & dados numéricos , China/epidemiologia , Estudos Transversais , Meio Ambiente , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/genética , Pessoa de Meia-Idade , Proteinúria/complicações , Insuficiência Renal Crônica/fisiopatologia
11.
Nephrology (Carlton) ; 22(2): 168-173, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26854278

RESUMO

AIM: Primary glomerular disease (PGD) remains the most common renal disease in China. A limited number of single centre studies show that the frequency of membranous nephropathy (MN) has increased; however, IgA nephropathy (IgAN) is still the most common PGD. To the best of our knowledge, there has been no multi-centre study in China that has explored the changes in PGD spectrum. To further investigate the changes in renal histopathological spectrum, we performed the cross-sectional study. METHOD: From June 2010 to May 2015, 5935 patients from 37 hospitals in Shandong Province were involved in this retrospective study. The study was divided into five periods according to 1-year intervals. The patients were divided into four age groups (≤18 years, 19-44 years, 45-59 years and ≥60 years). RESULT: Among the 5935 qualified specimens, 4855 (81.8%) were diagnosed with PGD. MN (43.3%) became the most common PGD instead of IgA (34.1%) (P < 0.001). The frequency of MN was increased from 30.7% in period 1 to 53.5% in period 5 (P < 0.001). The prevalence of MN tended to increase in every age section. IgA was the main cause of PGD in periods 1 and 2; however, its proportion decreased significantly from 41.8% in period 2 to 25.2% in period 5 (P < 0.001). CONCLUSION: Primary glomerular disease remains the most common renal disease in our study. For the first time, this cross-sectional study suggests that MN, in place of IgAN, has grown to be the first leading pathological type of PGD.


Assuntos
Glomerulonefrite por IGA/epidemiologia , Glomerulonefrite Membranosa/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Biópsia , Criança , Pré-Escolar , China/epidemiologia , Estudos Transversais , Feminino , Glomerulonefrite por IGA/diagnóstico , Glomerulonefrite Membranosa/diagnóstico , Inquéritos Epidemiológicos , Humanos , Lactente , Rim/patologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
12.
Nephrology (Carlton) ; 22(3): 205-212, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26890606

RESUMO

AIM: Chronic kidney disease (CKD) is an independent risk factor for cardiovascular disease. Although pulse wave velocity (PWV), which reflects arterial stiffness, was increased in subjects with CKD, little is known regarding whether arterial stiffness can increase the risk of CKD. To help clarify this we conducted a prospective cohort study to measure the association of arterial stiffness with CKD. METHODS: A total of 7154 adults aged 54.8 ± 10.6 years undergoing physical examinations without CKD at baseline were enrolled. Arterial stiffness was evaluated by carotid-femoral pulse wave velocity (cfPWV). CKD was defined as decreased estimated glomerular filtration rate (eGFR < 60 mL/min per 1.73 m2 ) or presence of proteinuria (urine protein ≥ 1+) assessed using a repeated dipstick method. RESULTS: During 3 years of follow-up, 167 (2.3%) patients developed CKD, 101 (1.4%) patients with proteinuria and 68 (1.0%) patients with decreased eGFR. After adjusted for potential confounders, either cfPWV (per 1 m/s increase) or the highest quartile of cfPWV (increased cfPWV) was independently associated with increased risk of proteinuria, with a fully adjusted OR of 1.15 (95% CI, 1.07 to 1.23) and 1.93 (95% CI, 1.15 to 3.25), respectively. By contrast, neither cfPWV (per 1 m/s increase) nor increased cfPWV was associated with decreased eGFR in the multivariable logistic regression analysis. CONCLUSIONS: The study revealed that arterial stiffness increases the risk of proteinuria. This suggests that vascular stiffness could be considered as a target for delaying the development of CKD.


Assuntos
Insuficiência Renal Crônica/etiologia , Insuficiência Renal Crônica/fisiopatologia , Rigidez Vascular/fisiologia , Adulto , Idoso , Artérias Carótidas , China , Estudos de Coortes , Feminino , Artéria Femoral , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Onda de Pulso , Fatores de Risco
13.
Nephrology (Carlton) ; 22(5): 388-396, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-27085089

RESUMO

AIM: Total parathyroidectomy with autotransplantation (TPTX + AT) and subtotal parathyroidectomy (SPTX) have been recommended to patients with renal hyperparathyroidism (RHPT).But which one is the best surgical method remains controversial. The aim of the present study was to compare the two surgical procedures with respect to long-term outcomes. METHODS: A literature search was undertaken using Medline, EMBASE, CNKI and CBM from inception to May 2015. Study quality was assessed using the Newcastle-Ottawa Scale. Data were analyzed using Review Manager version 5.1.0. RESULTS: A total of 13 studies comprising 1589 patients with renal failure were identified. There was no statistically significant difference in the rate of symptomatic improvement (OR 0.77; 95%CI 0.22 to 2.69; P = 0.68), radiological success (OR 0.17; 95%CI 0.02 to 1.56; P = 0.90), hyperparathyroidism recurrence or persistence (OR 1.31; 95%CI 0.65 to 2.65; P = 0.45) and reoperation (OR 1.55; 95%CI 0.62 to 3.86; P = 0.35) between TPTX + AT and SPTX. The effects on serum calcium and parathyroid hormone (PTH) were similar between two surgical protocols. CONCLUSION: Both the TPTX + AT and SPTX were effective in treating RHPT and preventing recurrence. The difference between the two surgeries in recurrence or persistence and reoperation rate was insignificant. Further prospective, randomized controlled trials with high statistic power are necessary to comparative the two surgeries on the long term safety.


Assuntos
Hiperparatireoidismo Secundário/cirurgia , Paratireoidectomia/métodos , Insuficiência Renal/complicações , Adulto , Biomarcadores/sangue , Cálcio/sangue , Distribuição de Qui-Quadrado , Feminino , Humanos , Hiperparatireoidismo Secundário/sangue , Hiperparatireoidismo Secundário/diagnóstico , Hiperparatireoidismo Secundário/etiologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Hormônio Paratireóideo/sangue , Paratireoidectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Recidiva , Insuficiência Renal/diagnóstico , Fatores de Risco , Fatores de Tempo , Transplante Autólogo , Resultado do Tratamento
14.
Int Urol Nephrol ; 47(9): 1547-53, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26265108

RESUMO

BACKGROUND: Several studies have shown ethnic differences in bone and mineral metabolism in healthy people and patients with chronic kidney disease (CKD). However, there have been few studies regarding CKD and bone mineral density (BMD) in Chinese population. We aimed to explore the relationship between mild-to-moderate CKD and decreased BMD in Chinese adult population. METHODS: A total of 24,002 adults were enrolled in this cross-sectional study. Mild-to-moderate CKD was defined as 30 < estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m(2) or eGFR ≥ 60 mL/min/1.73 m(2) with proteinuria greater than 1+. BMD was measured by dual-energy X-ray absorptiometry at the lumbar spine. Either osteopenia or osteoporosis was defined as decreased BMD. Multivariate logistic regression analysis was used to estimate the associations with decreased BMD. RESULTS: The subjects comprised 71.5 % men and 28.5 % women, the age was 49.9 ± 13.9 years. The overall prevalence of CKD was 2.9 %. Decreased BMD was 22.1, 19.9 % had osteopenia, and 2.2 % had osteoporosis. The percentage of patients with decreased BMD, osteopenia and osteoporosis were statistically higher (P < 0.05) in CKD patients compared with those of non-CKD participants, which was 29.5 versus 21.9 %, 25.9 versus 19.8 % and 3.6 versus 2.1 %, respectively. The risk for decreased BMD increased with CKD in a simple logistic analysis. However, the correlation disappeared after adjusted for age, sex, smoking, drinking, hypertension, diabetes and obesity. CONCLUSIONS: Subjects with worse renal function have significantly lower BMD, but after adjusted for confounders, mild-to-moderate CKD is not independently associated with decreased BMD.


Assuntos
Densidade Óssea , Insuficiência Renal Crônica/diagnóstico , Absorciometria de Fóton , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Estudos Transversais , Feminino , Taxa de Filtração Glomerular , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Osteoporose/diagnóstico , Osteoporose/epidemiologia , Osteoporose/etiologia , Prevalência , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/metabolismo , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
15.
Int J Clin Exp Med ; 7(10): 3725-9, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25419425

RESUMO

Essential thrombocytosis (ET) is a type of myeloproliferative neoplasm with clinical manifestations of thrombosis and hemorrhage, the mechanisms of which remains unclear. Some researches indicated that ET is mainly related to the defect of platelet function and the abnormality of coagulation mechanism. A few reports showed that ET accompanied by acquired hemophilia. However, no evidence of ET with coagulation factor XII deficiency has been published. we here report a case of ET accompanied with coagulation factor XII deficiency, which had clinically significant bleeding tendency.

16.
BMC Nephrol ; 13: 37, 2012 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-22686733

RESUMO

BACKGROUND: Moderate to severe renal insufficiency and albuminuria have been shown to be independent risk factors for atherosclerosis. However, little is known about the direct association between subclinical atherosclerosis evaluated by carotid artery intima-media thickness (IMT) and microalbuminuria in elderly patients with normal renal function. METHODS: Subjects were 272 elderly patients (age ≥ 60 years) with normoalbuminuria (n = 238) and microalbuminuria (n = 34). Carotid IMT was measured by means of high-resolution B-mode ultrasonography. Estimated glomerular filtration rate (eGFR) ≥ 60 ml/min/1.73 m2 was defined as normal renal function. Those who had macroalbuminuria and atherosclerotic vascular disease were not included. RESULTS: Compared to subjects with normoalbuminuria, subjects with microalbuminuria had higher mean carotid IMT (1.02 ± 0.38 vs. 0.85 ± 0.28 mm; P < 0.01) and maximal IMT (1.86 ± 0.86 vs. 1.60 ± 0.73 mm; P = 0.06). By a multiple linear regression, microalbuminuria positively correlated with mean carotid IMT after adjusting for traditional cardiovascular disease risk factors including age, sex, hypertension, diabetes, smoking, total cholesterol, pulse pressure, waist circumference, serum uric acid. As a categorical outcome, the prevalence of the highest mean cariotid IMT quartile (increased IMT ≥ 1.05 mm) was compared with the lower three quartiles. After adjusted for potential confounders, microalbuminuria was associated with increased carotid IMT, with an odds ratio of 2.95 [95 % confidence interval, 1.22 - 7.10]. eGFR was not significantly associated with mean carotid IMT in our analysis. CONCLUSIONS: A slight elevation of albuminuria is a significant determinant of carotid IMT independent of traditional cardiovascular risk factors in our patients. Our study further confirms the importance of intensive examinations for the early detection of atherosclerosis when microalbuminuria is found in elderly patients, although with normal renal function.


Assuntos
Albuminúria/diagnóstico , Albuminúria/epidemiologia , Aterosclerose/diagnóstico , Aterosclerose/epidemiologia , Espessura Intima-Media Carotídea , Rim/fisiologia , Idoso , Estudos Transversais , Feminino , Humanos , Testes de Função Renal , Masculino
17.
Nephrology (Carlton) ; 17(7): 616-20, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22697887

RESUMO

AIM: Hyperphosphataemia is almost inevitable in end stage renal disease (ESRD) patients and is associated with increased morbidity and mortality. In this study we examined whether oral activated charcoal (oAC) reduces serum phosphate level in haemodialysis patients. METHODS: This was an open-label, prospective, uncontrolled study. One hundred and thirty-five haemodialysis patients were included in this study, with cessation of treatment with any phosphate binders during a 2 week washout period. Patients with serum phosphate levels greater than 5.5 mg/dL during the washout period were included for treatment with oAC. oAC was started at a dose of 600 mg three times per day with meals and was administered for 24 weeks. oAC dose was titrated up during the 24 week period to achieve phosphate control (3.5-5.5 mg/dL). A second 2 week washout period followed the end of oAC treatment. RESULTS: In the 114 patients who successfully completed the trial, the mean dose of activated charcoal was 3190 ± 806 mg/day. oAC reduced mean phosphate levels to below 5.5 mg/dL, with mean decreases of 2.60 ± 0.11 mg/dL (P < 0.01) and 103 (90.4%) of the patients reached the phosphate target. After the second washout period the phosphate levels increased to 7.50 ± 1.03 mg/dL (P < 0.01). Serum intact parathyroid hormone (iPTH) levels declined from 338.75 ± 147.77 pg/mL to 276.51 ± 127.82 pg/mL (P < 0.05) during the study. oAC had no influence on serum prealbumin, total cholesterol, triglycerides, serum ferritin, haemoglobin or platelet levels and the levels of 1,25-dihydroxyvitamin D were stable during the study. CONCLUSION: In this open-label uncontrolled study, oAC effectively controls hyperphosphataemia and hyperparathyroidism in haemodialysis patients. The safety and efficacy of oAC needs to be assessed in a randomized controlled trial.


Assuntos
Carvão Vegetal/administração & dosagem , Hiperfosfatemia/tratamento farmacológico , Fosfatos/sangue , Diálise Renal/efeitos adversos , Administração Oral , Idoso , Análise de Variância , Biomarcadores/sangue , Carvão Vegetal/efeitos adversos , China , Esquema de Medicação , Feminino , Ferritinas/sangue , Hemoglobinas/metabolismo , Humanos , Hiperparatireoidismo/sangue , Hiperparatireoidismo/tratamento farmacológico , Hiperparatireoidismo/etiologia , Hiperfosfatemia/sangue , Hiperfosfatemia/etiologia , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Contagem de Plaquetas , Pré-Albumina/metabolismo , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento , Vitamina D/análogos & derivados , Vitamina D/sangue
18.
Zhonghua Yi Xue Za Zhi ; 90(34): 2389-91, 2010 Sep 14.
Artigo em Chinês | MEDLINE | ID: mdl-21092506

RESUMO

OBJECTIVE: To explore the clinical significance of toll-like receptor 4 expression on the surface of peripheral blood mononuclear cells (PBMC) in uremic patients and observe the effect of ultrapure dialysate on the PBMC expression of TLR4 in these patients. METHODS: Eighty patients on maintenance dialysis were randomly divided into two groups: conventional dialysate group (CD, n=40), ultrapure dialysate group (UPD, n=40) and 40 uremic patients without dialysis in NHD group. The blood cells from all patients and 40 healthy controls were stained with FITC labeling anti-TLR4 monoclonal antibodies. Samples were collected and analyzed by flow cytometry. RESULTS: The expression of TLR4 was significantly lower in CD group (18.1±3.7) than in NHD group (24.5±4.6, P<0.05) and healthy control group (31.6±5.8, P<0.01). And marked difference existed between CD group (18.1±3.7) and UPD group (23.1±3.2, P<0.05) at Month 6 post-dialysis. In CD group the expression of TLR4 became significantly smaller as the duration of dialysis increased (P<0.05) while in UPD group although the expression of TLR4 became smaller as the duration of dialysis became longer. But the difference was not statistically significant (P>0.05). CONCLUSION: The PBMC expression of TLR4 becomes down-regulated in uremic patients with or without dialysis and its expression is smaller in conventional dialysate group than in ultrapure dialysate group. The conventional dialysate may suppress the expression of TLR4 while the phenomenon is absent in ultrapure dialysate group.


Assuntos
Falência Renal Crônica/metabolismo , Leucócitos Mononucleares/metabolismo , Receptor 4 Toll-Like/metabolismo , Uremia/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Diálise Renal , Adulto Jovem
19.
Zhonghua Nei Ke Za Zhi ; 45(1): 17-20, 2006 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-16624081

RESUMO

OBJECTIVE: To explore the diagnostic value of magnifying endoscopy and human telomerase reverse transcriptase (hTERT) in identifying precancerous lesions of gastric mucosa. METHODS: 154 patients with upper digestive symptoms were included in the study. They were examined by the same senior doctor using magnifying endoscopy, and real-time diagnosis was made during the examination. Forceps biopsies were taken for pathological examination and were examined the expression of human telomerase reverse transcriptase mRNA (hTERT mRNA) by real-time quantitative PCR. The morphology of gastric pits under magnifying endoscopy was classified as follows: type A: round spot pits, type B: linear, type C: sparsely and thickly linear, typed D: patchy, and type E: villous. RESULTS: The divergence of intestinal metaplasia had significant differences implications among the gastric pit patterns from B to E under magnifying endoscopy (chi(2) = 17.58, P < 0.05). The more sever the intestinal metaplasia, the higher the pattern scale of the gastric pit (Pearson = 0.531, P < 0.05). The degree of dysplasia had a parallel relationship with the gastric pit patterns changed from C to E (chi(2) = 10.256, P < 0.05, Pearson = 0.549, P < 0.05). The expressions of hTERT mRNA of mucosa had significant differences among the gastric pit patterns B, C, D and E (F = 3.274, P < 0.05); If the expression of hTERT mRNA were taken as diagnostic criteria of gastric cancer, 65% of pit type E would be considered as gastric cancer which were otherwise negative by pathology. CONCLUSIONS: The micro-structural changes of gastric mucosa under magnifying endoscopy can reflect the severity of gastric disease, hTERT is a very important marker for diagnosis of gastric carcinoma. It is useful to predict the malignant change of gastric precancerous lesions in patients by following up high expression of hTERT mRNA combined with pit type E diagnosed by magnifying endoscopy.


Assuntos
Proteínas de Ligação a DNA/metabolismo , Mucosa Gástrica/patologia , Gastroscopia , Lesões Pré-Cancerosas/diagnóstico , Neoplasias Gástricas/diagnóstico , Telomerase/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Proteínas de Ligação a DNA/genética , Feminino , Mucosa Gástrica/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Lesões Pré-Cancerosas/metabolismo , Lesões Pré-Cancerosas/patologia , RNA Mensageiro/genética , Neoplasias Gástricas/metabolismo , Neoplasias Gástricas/patologia , Telomerase/genética
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