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1.
Mymensingh Med J ; 30(1): 35-42, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33397848

RESUMO

This cross sectional comparative study was conducted in the Nephrology and Medicine outdoor and in-patients department of Mymensingh Medical College Hospital, Bangladesh from April 2014 to March 2015. A total of 100 patients with CKD and 100 healthy subjects were included in the study. Data were collected by interview of the patients, clinical examination and laboratory investigations using a semi-structured case record form. Among all subjects, 50.0% had no CKD and 50.0% patients had CKD: Stage 3 CKD were 8.5%, CKD Stage 4 CKD were 21.0%, CKD Stage 5 CKD were 20.5%. Serum creatinine was 4.32±3.08mg/dl in patients with CKD and 1.00±0.22mg/dl was in healthy subjects. Mean±SD of CCR/ml/min was found 17.67±11.63ml/min in patients with CKD and 79.31±13.31ml/min was found in healthy subjects. On the other hand, Mean±SD CCCR/ml/m/1.73m² was found 19.79±12.85 ml/m/1.73m² in patient with CKD and healthy subjects had 83.83±13.33 ml/m/1.73m². Urinary creatinine was 45.59±15.63 & 57.66±11.45mg/dl respectively. CKD-EPI eGFR was 22.10±15.02 & 90.61±23.27ml/m/1.73m²; MDRD eGFR was 22.15±14.18 & 89.35±26.19 ml/m/1.73m² respectively. Difference between all the variables between CKD group and healthy group was found statistically significant (p<0.001). CKD-EPIeGFR and MDRDeGFR were increased both in CKD patients and healthy subjects in respect to CCR and CCCR. There was a strong positive correlation between CCCR (ml/m/1.73m2) and CKD-EPI (ml/m/1.73m²) among all patients (r=0.934 and p<0.001) and also a positive correlation of CCCR with MDRD among all patients (r=0.913 and p<0.001). A positive correlation of CCCR was found with CKD-EPIeGFR among CKD patients (r=0.848 and p<0.001). A positive correlation of CCCR was also found with MDRDeGFR among CKD patients (r=0.841, p<0.001). There are positive correlations between CCCR and CKD/EPI among healthy subjects (r=0.616 and p<0.05) and between CCCR with MDRD among healthy subjects (r=0.568 and p<0.05). Various formulae were used to calculate GFR on the basis of serum creatinine levels. The Overall correlation of population (healthy and CKD patients) between CCCR and CKD EPI and MDRD formula was (r=0.93 and 0.91) respectively, among CKD patients it was (r=0.848 and r=0.841) in healthy subjects it was (r=0.616 and r=0.568) respectively. CKD EPI eGFR and MDRD eGFR formula had fairly good correlation with conventional 24 hours creatinine clearance in both CKD patient and healthy subjects, there was even more strong correlation especially in CKD patients. The performance of CKD-EPI equation is better than MDRD equation to estimate the eGFR in both CKD patients and healthy subjects.


Assuntos
Insuficiência Renal Crônica , Bangladesh , Creatinina , Estudos Transversais , Receptores ErbB , Taxa de Filtração Glomerular , Voluntários Saudáveis , Humanos , Insuficiência Renal Crônica/diagnóstico
2.
PLoS One ; 16(1): e0244779, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33400721

RESUMO

BACKGROUND: Currently, the SARS-CoV-2 promptly spread across China and around the world. However, there are controversies about whether preexisting chronic kidney disease (CKD) and acute kidney injury complication (AKI) are involved in the COVID-19 pandemic. MEASUREMENTS: Studies reported the kidney outcomes in different severity of COVID-19 were included in this study. Standardized mean differences or odds ratios were calculated by employing Review Manager meta-analysis software. RESULTS: Thirty-six trials were included in this systematic review with a total of 6395 COVID-19 patients. The overall effects indicated that preexisting CKD (OR = 3.28), complication of AKI (OR = 11.02), serum creatinine (SMD = 0.68), abnormal serum creatinine (OR = 4.86), blood urea nitrogen (SMD = 1.95), abnormal blood urea nitrogen (OR = 6.53), received continuous renal replacement therapy (CRRT) (OR = 23.63) were significantly increased in severe group than that in nonsevere group. Additionally, the complication of AKI (OR = 13.92) and blood urea nitrogen (SMD = 1.18) were remarkably elevated in the critical group than that in the severe group. CONCLUSIONS: CKD and AKI are susceptible to occur in patients with severe COVID-19. CRRT is applied frequently in severe COVID-19 patients than that in nonsevere COVID-19 patients. The risk of AKI is higher in the critical group than that in the severe group.


Assuntos
Lesão Renal Aguda/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Lesão Renal Aguda/sangue , Nitrogênio da Ureia Sanguínea , China/epidemiologia , Creatinina/sangue , Humanos , Razão de Chances , Pandemias , Insuficiência Renal Crônica/sangue , Resultado do Tratamento
3.
Kidney Int ; 99(1): 28-31, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33390237

RESUMO

Metabolic acidosis is an early and deleterious complication of chronic kidney disease. Because it is frequently eubicarbonatemic, diagnosis may be difficult. In this issue, Gianella et al. suggest that lower urinary citrate excretion, considered as an homeostatic response to metabolic acidosis, may be helpful for early diagnosis and monitoring of alkali treatment. This study should be an incentive for further assessment of the tubular handling of urinary citrate in CKD patients and determination of the performance of urinary citrate for the diagnosis of eubicarbonatemic metabolic acidosis and monitoring of alkali therapy.


Assuntos
Acidose , Insuficiência Renal Crônica , Acidose/diagnóstico , Acidose/etiologia , Citratos , Ácido Cítrico , Creatinina , Humanos , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/terapia
5.
Yonsei Med J ; 62(1): 41-49, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33381933

RESUMO

PURPOSE: Oral adsorbents delay disease progression and improve uremic symptoms in patients with chronic kidney disease (CKD). DW-7202 is a newly developed oral adsorbent with high adsorptive selectivity for uremic toxins. We evaluated patient preference for and adherence to DW-7202 versus AST-120 therapy and compared treatment efficacy and safety in patients with pre-dialysis CKD. MATERIALS AND METHODS: A seven-center, randomized, open-label, two-way crossover, active-controlled, phase IV clinical trial was conducted. Patients with stable CKD were randomly assigned to receive DW-7202 (capsule type) or AST-120 (granule type) for 12 weeks. The groups then switched to the other adsorbent and took it for the next 12 weeks. Patient preference was the primary outcome. Secondary outcomes included changes in estimated glomerular filtration rate (eGFR) and serum creatinine, cystatin C, and indoxyl sulfate (IS) levels. RESULTS: Significantly more patients preferred DW-7202 than AST-120 (p<0.001). Patient adherence improved after switching from AST-120 to DW-7202; there was no apparent change in adherence after switching from DW-7202 to AST-120. Changes in eGFR and serum creatinine, cystatin C, and IS levels were not significantly different according to adsorbent type. There was also no significant difference in the incidences of adverse events during treatment with DW-7202 and AST-120. CONCLUSION: DW-7202 can be considered as an alternative to AST-120 in patients who cannot tolerate or show poor adherence to granule type adsorbents. Further studies to evaluate factors affecting patient preferences and improved adherence are warranted (Clinical trial registration No. NCT02681952).


Assuntos
Insuficiência Renal Crônica/tratamento farmacológico , Adsorção , Carbono/administração & dosagem , Carbono/uso terapêutico , Creatinina/sangue , Estudos Cross-Over , Cistatina C/sangue , Progressão da Doença , Feminino , Taxa de Filtração Glomerular/efeitos dos fármacos , Humanos , Indicã/sangue , Masculino , Pessoa de Meia-Idade , Óxidos/administração & dosagem , Óxidos/uso terapêutico , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/fisiopatologia , Resultado do Tratamento
6.
Am J Infect Control ; 49(1): 82-89, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32540370

RESUMO

OBJECTIVE: We aimed to investigate the relationship between clinical characteristics, outcomes and the severity of severe acute respiratory syndrome coronavirus 2 pneumonia. METHODS: We performed a systematic review and meta-analysis using PubMed, Embase, and Cochrane Library databases to assess the clinical characteristics and outcomes of confirmed COVID-19 cases and compared severe (ICU) and nonsevere (non-ICU) groups. RESULTS: We included 12 cohort studies including 2,445 patients with COVID-19. Compared with nonsevere (non-ICU) patients, severe (ICU) disease was associated with a smoking history (P = .003) and comorbidities including chronic obstructive pulmonary disease (OR = 5.08, P < .001), diabetes (OR = 3.17, P < .001), hypertension (OR = 2.40, P < .001), coronary heart disease (OR = 2.66, P < .001), cerebrovascular diseases (OR = 2.68, P = .008), and malignancy (OR=2.21, P = .040). We found significant differences between the 2 groups for fever, dyspnea, decreased lymphocyte and platelet counts, and increased leukocyte count, C-creative protein, procalcitonin, lactose dehydrogenase, aspartate aminotransferase, alanine aminotransferase, creatinine kinase, and creatinine levels (P < .05). Significant differences were also observed for multiple treatments (P < .05). Patients in the severe (ICU) group were more likely to have complications and had a much higher mortality rate and lower discharge rate than those with nonsevere (non-ICU) disease (P < .05). CONCLUSIONS: Investigation of clinical characteristics and outcomes of severe cases of COVID-19 will contribute to early prediction, accurate diagnosis, and treatment to improve the prognosis of patients with severe illness.


Assuntos
/fisiopatologia , Dispneia/fisiopatologia , Febre/fisiopatologia , Leucocitose/fisiopatologia , Linfopenia/fisiopatologia , Trombocitopenia/fisiopatologia , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Proteína C-Reativa/metabolismo , /mortalidade , Transtornos Cerebrovasculares/epidemiologia , Comorbidade , Doença das Coronárias/epidemiologia , Creatina Quinase/sangue , Creatinina/sangue , Diabetes Mellitus/epidemiologia , Humanos , Hipertensão/epidemiologia , Unidades de Terapia Intensiva , L-Lactato Desidrogenase/sangue , Leucocitose/sangue , Linfopenia/sangue , Pró-Calcitonina/sangue , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Índice de Gravidade de Doença , Fumar/epidemiologia , Trombocitopenia/sangue
7.
Curr Diabetes Rev ; 17(1): 91-100, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32664840

RESUMO

BACKGROUND: Type 2 diabetes (T2DM) has been associated with deficiencies in serum magnesium level, decreasing insulin sensitivity and glucose metabolism. Glycosylated hemoglobin (Hb1Ac) is a biomarker of glucose values within the half-life of the erythrocyte, that is, 3 months. Low circulating and intracellular magnesium levels can modify glucose metabolism and insulin sensitivity. Renal solute management is a parameter little used to estimate circulating and excreted concentrations of elements such as magnesium. OBJECTIVE: The purpose of this study was to assess and associated fractional excretion of magnesium (FEMg) and serum magnesium with metabolic parameters, especially Hb1Ac percent, in a group of well characterized subjects with T2DM and non-diabetics subjects (ND). METHODS: According to Hb1Ac, two groups were compared and associated with existing biochemical parameters, included Hb1Ac, fasting glucose, lipid profile, serum creatinine, serum magnesium and urinary creatinine for FEMg. RESULTS: HbA1c levels were explained by serum magnesium in 25%. Serum magnesium levels in the ND group were higher than in the T2DM group and this was a statistically significant difference. Serum magnesium ≤1.8 is a risk factor (OD 16.1; P=0.021) for an HbA1c ≥ 6.5%. CONCLUSION: In this study, hypomagnesemia was a parameter strongly associated with the diagnosis and progression of T2DM, while FEMg showed no significant association.


Assuntos
Diabetes Mellitus Tipo 2 , Magnésio , Glicemia , Creatinina , Hemoglobina A Glicada , Humanos
8.
Food Chem ; 343: 128478, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33158682

RESUMO

Reaction mixtures of reactive carbonyls and creatinine were submitted to high temperature and studied to identify the reactive carbonyl(s) responsible for 2-amino-3,8-dimethylimidazo[4,5-f]quinoxaline (MeIQx) formation. MeIQx was produced by reaction of acrolein and creatinine within a wide pH range and with an activation energy of 81.1 ± 1.4 kJ/mol. No additional reactants were required, although methylglyoxal, ammonia, and formaldehyde also participated in the reaction. Nevertheless, these additional reactants were produced in situ from either acrolein or creatinine. A reaction pathway that both explains the formation of MeIQx and is valid for the formation of other heterocyclic aromatic amines (HAAs) with the structure of quinoxaline is proposed. Obtained results demonstrate the key role of reactive carbonyls present in foods (the food carbonylome) on HAA formation. Because creatinine is ubiquitous in proteinaceous foods, the control of the food carbonylome seems to be the key point to control HAA formation in foods.


Assuntos
Acroleína/química , Quinoxalinas/química , Animais , Creatinina/química , Temperatura Alta , Concentração de Íons de Hidrogênio
9.
Life Sci ; 265: 118811, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33259867

RESUMO

AIMS: To study the effect of direct renin inhibitor (aliskiren) on the renal function during acute and chronic partial ureteral obstruction (PUO) in rat solitary kidney. MAIN METHODS: Sixty male Sprague-Dawley rats were randomly allocated into three groups (20 rats each); sham, PUO and aliskiren groups. Right nephrectomy was performed in all groups. Rats in PUO and aliskiren groups were subjected to left PUO and received no treatment and aliskiren (10 mg/kg, orally, once per day till sacrification), respectively. Blood samples were then collected for biochemical measurements. Ten rats from each group were sacrificed after two weeks, while the remaining rats were sacrificed after four weeks. Left kidneys were harvested for histopathological examination, BCL-2, interleukin (IL)-6, transforming growth factor (TGF)-ß1, collagen I and fibronectin relative gene expression and assessment of glutathione (GSH), superoxide dismutase (SOD), malondialdehyde (MDA) and nitric oxide (NO) activity. KEY FINDINGS: After two and four weeks of PUO, aliskiren significantly recompensed the rise of serum creatinine (Scr) and blood urea nitrogen (BUN). Aliskiren also revealed significantly better histopathological results regarding cortical and medullary necrosis, regeneration and inflammatory cell infiltration. Aliskiren group showed statistically significant up-regulation of BCL-2 and down-regulation of IL-6, TGF-ß1, collagen I and fibronectin relative gene expression. Aliskiren significantly increased GSH and SOD activity and reduced MDA and NO activity. Moreover, aliskiren administration for four weeks after PUO significantly yielded more renoprotective effect compared to its administration for two weeks. SIGNIFICANCE: Aliskiren ameliorates the deterioration of the renal function during acute and chronic PUO in a solitary kidney.


Assuntos
Amidas/farmacologia , Fumaratos/farmacologia , Renina/antagonistas & inibidores , Rim Único/fisiopatologia , Obstrução Ureteral/tratamento farmacológico , Amidas/administração & dosagem , Animais , Creatinina/sangue , Modelos Animais de Doenças , Fumaratos/administração & dosagem , Regulação da Expressão Gênica/efeitos dos fármacos , Testes de Função Renal , Masculino , Ratos , Ratos Sprague-Dawley , Fatores de Tempo , Obstrução Ureteral/fisiopatologia
10.
Eur J Hosp Pharm ; 28(1): 22-27, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32912961

RESUMO

BACKGROUND: In December 2019 a novel coronavirus designated SARS-CoV-2 was identified, and the disease COVID-19 has caused many deaths. SARS-CoV-2 infection has been associated with the development of cytokine storm (including interleukin 6 (IL-6)), which can cause lung damage and lack of oxygen. Tocilizumab (TCZ) inhibits ligand binding to the IL-6 receptor and may be a potential treatment for the hyperinflammation symptoms of COVID-19. However, data regarding the efficacy of TCZ in COVID-19 are lacking. The rapid spread of the pandemic in France, especially in the Paris region, constrained us to the off-label use of TCZ in patients with severe clinical conditions. METHODS: A single-centre observational cohort study of 44 patients infected with COVID-19 was carried out between 6 April and 21 April 2020 in Groupe Hospitalier Intercommunal Le Raincy-Montfermeil (GHILRM). Twenty-two patients diagnosed with COVID-19 were treated with TCZ and were compared with 22 patients not treated with TCZ matched for age, gender and length of hospital stay for COVID-19. Respiratory rate and oxygen supplementation as well as laboratory parameters (such as C-reactive protein (CRP), aspartate aminotransferase and alanine aminotransferase) were collected at baseline and during 14 days of follow-up. Our primary objective was to assess the efficacy of TCZ on respiratory clinical conditions. FINDINGS: The average respiratory rate was lower in the TCZ group than in the control group (21.5 vs 25.5 breaths/min at day 14, 95% CI -7.5 to -0.4; p=0.03). Treated patients tended to be intubated less during the course of the disease (2/22 vs 6/22, 95% CI -0.4 to 0.1; p=0.12). In each group, 10 patients no longer required oxygen therapy. We found a significant decrease in CRP in treated patients on day 7 (p=0.04). TCZ caused cytolysis in more than half (14/22) of the patients but without clinical impact. INTERPRETATION: There was a significant difference in the respiratory rate on day 14 of follow-up, with a greater decrease observed in the treated group. Fewer patients required mechanical ventilation in the TCZ group, especially among patients with more extensive CT lung damage, than in the control group. The same number of patients were weaned off oxygen on day 14 in the two groups, while the patients in the TCZ group had more severe impairment at inclusion. We consider that TCZ showed significant control of the biological inflammatory syndrome, suggesting that it may limit the effect of the cytokine storm. Our study seems to indicate the efficacy of TCZ, particularly in patients with severe initial pulmonary impairment. Selecting the best candidates and the best timing for TCZ therapy needs to be determined in randomised clinical trials.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Antivirais/uso terapêutico , /tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Proteína C-Reativa/análise , Estudos de Coortes , Creatinina/sangue , Feminino , Humanos , Intubação Intratraqueal , Tempo de Internação , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Uso Off-Label , Oxigenoterapia , Respiração Artificial , Taxa Respiratória , Resultado do Tratamento
11.
J Med Virol ; 93(2): 786-793, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32662893

RESUMO

We aimed to examine independent predictive factors for the severity and survival of COVID-19 disease, from routine blood parameters, especially the blood urea nitrogen (BUN)/creatinine (Cr) ratio. A total of 139 patients with COVID-19 were investigated at Siirt State Hospital. According to the disease severity, the patients were categorized as three groups (moderate: 85, severe: 54, and critical: 20). Then, patients were divided into two groups: nonsevere (moderate) and severe (severe and critical). Demographic, clinical data, and routine blood parameters were analyzed. In multivariate model adjusted for potential confounders BUN/Cr ratio (odds ratio [OR] = 1.70; 95% confidence interval [CI]: 1.20-2.40; P = .002) and neutrophil to lymphocyte ratio (NLR) (OR = 2.21; 95% CI: 1.20-4.30; P < .001) were independent predictive factors for disease severity. In multivariate Cox proportional hazard model BUN/Cr ratio (hazard ratio [HR] = 1.02; 95% CI: 1.01-1.05; P = .030), and NLR (HR = 1.17; 95% CI: 1.06-1.30; P = .020) were independent predictors for survival of COVID-19 disease. The optimal thresholds of the BUN/Cr ratio at 33.5 and 51.7 had the superior possibility for severe disease and mortality, area under the curve (AUC) were 0.98 and 0.95, respectively. The optimal thresholds of NLR at 3.27 and 5.72 had a superior possibility for severe disease and mortality, AUC were 0.87 and 0.85, respectively. BUN/Cr and NLR are independent predictors for COVID-19 patient severity and survival. Routine evaluation of BUN/Cr and NLR can help identify high-risk cases with COVID-19.


Assuntos
Nitrogênio da Ureia Sanguínea , Creatinina/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , /mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Curva ROC , Estudos Retrospectivos , Análise de Sobrevida , Turquia
12.
Ter Arkh ; 92(10): 29-33, 2020 Nov 24.
Artigo em Russo | MEDLINE | ID: mdl-33346476

RESUMO

AIM: To assess the influence of diabetes mellitus and obesity on contrast-induced acute kidney injury risk in patients with chronic coronary artery disease requiring percutaneous coronary intervention. MATERIALS AND METHODS: 1023 patients with chronic coronary artery disease were enrolled in a prospective, open, cohort study (ClinicalTrials.gov ID NCT04014153). Contrast-induced acute kidney injury was defined as an increase of 25% or more, or an absolute increase of 0.5 mg/dl or more in serum creatinine from baseline value, assessed at 48 hours following the administration of the contrast. The majority of the patients were overweight male ones with BMI 29.25.5 kg/m2. The primary endpoint of the study was the development of contrast-induced acute kidney injury according to KDIGO criteria. RESULTS: The prevalence of contrast-induced acute kidney injury was 12.9% (132 patients). 21.2% suffered from diabetes mellitus, 43% were obese and 12.9% had both diabetes mellitus and obesity. Diabetes wasnt a statistically significant independent risk factor of the contrast-induced acute kidney injury, as well as the combination of diabetes and obesity. In the group of obese patients the prevalence of contrast-induced acute kidney injury was higher (13.4%vs12.5%), but didnt meet statistical significance (p=0.7, OR 0.924, 95% CI 0.641.325). According to the multiple logistic regression model, female gender, age, BMI, weight, arterial hypertension, baseline creatinine were the risk factors of the contrast-induced acute kidney injury development (AUC 0.742,p0.0001). CONCLUSION: Diabetes mellitus was not associated with higher incidence of contrast-induced acute kidney injury. The prevalence of contrast-induced kidney injury was higher in the group of patients with BMI30 kg/m2, but didnt meet statistical significance and needs further evaluation in larger studies.


Assuntos
Lesão Renal Aguda , Doença da Artéria Coronariana , Diabetes Mellitus , Intervenção Coronária Percutânea , Lesão Renal Aguda/induzido quimicamente , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/epidemiologia , Estudos de Coortes , Meios de Contraste/efeitos adversos , Angiografia Coronária , Doença da Artéria Coronariana/epidemiologia , Creatinina , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Masculino , Obesidade/complicações , Obesidade/epidemiologia , Intervenção Coronária Percutânea/efeitos adversos , Estudos Prospectivos , Fatores de Risco
13.
Med Sci Monit ; 26: e927674, 2020 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-33342993

RESUMO

BACKGROUND The aim of this study was to analyze the clinical features and laboratory indices of patients with coronavirus disease (COVID-19) and explore their association with the severity of the disease. MATERIAL AND METHODS A total of 61 patients with COVID-19 were divided into groups with common symptoms and with severe diseases, and clinical data were collected to analyze and compare the differences between them. RESULTS In patients with severe COVID-19, compared with the common group, lymphocyte count and albumin levels were lower, and aspartate aminotransferase (AST), blood urea, blood creatinine, lactate dehydrogenase (LDH), and C-reactive protein (CRP) levels, and prothrombin time (PT) were elevated (all P<0.05). The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume-to-lymphocyte ratio (MPVLR), and C-reactive protein-to-albumin ratio (CAR) were significantly elevated in the severe group compared with the group with common symptoms; however, the lymphocyte-to-monocyte ratio (LMR) was significantly reduced (P<0.05). Univariate logistic regression showed that lower lymphocyte count, prolonged PT, elevated CRP and LDH levels, and elevated NLR, PLR, MPVLR, and CAR were risk factors for COVID-19 severity (P<0.05). Multivariate logistic regression showed that elevated CRP levels (odds ratio [OR], 0.028; 95% confidence interval [CI]: 0.002-0.526; P=0.017), prolonged PT (OR, 0.014; 95% CI: 0.001-0.341; P=0.09), and an MPVLR >8.9 (OR, 0.026; 95% CI: 0.002-0.349; P=0.006) were independent risk factors for COVID-19 severity. CONCLUSIONS Elevated CRP and prolonged PT, and an MPVLR >8.9 were independent risk factors for COVID-19 severity.


Assuntos
/epidemiologia , Infecções por Coronavirus/diagnóstico , Adulto , Aspartato Aminotransferases/sangue , Plaquetas , Proteína C-Reativa/análise , China/epidemiologia , Coronavirus/patogenicidade , Infecções por Coronavirus/sangue , Creatinina/análise , Feminino , Humanos , Pacientes Internados , L-Lactato Desidrogenase/sangue , Contagem de Linfócitos , Linfócitos/química , Masculino , Volume Plaquetário Médio , Pessoa de Meia-Idade , Monócitos , Neutrófilos/química , Estudos Retrospectivos , Albumina Sérica/análise , Índice de Gravidade de Doença
14.
Zhonghua Yi Xue Za Zhi ; 100(48): 3853-3858, 2020 Dec 29.
Artigo em Chinês | MEDLINE | ID: mdl-33371630

RESUMO

Objective: To investigate the clinical effect of ipsilateral simultaneous pancreas and kidney transplantation (SPK). Methods: A total of 146 cases of SPK surgeries completed in the Second Affiliated Hospital of Guangzhou Medical University from September 2016 to June 2020 were selected to summarize the outcome, curative effect and complications of the operation. Results: The patients were followed up for 1 to 45 months. Good clinical results were obtained in 146 patients. Renal function indicators suggest that on the 7th day after operation, the serum creatinine returned to normal level [142.4 (108.6, 213.4)µmol/L]. The index of pancreatic function decreased to the normal level as expected. The level of blood amylase was 160.5(109.3, 249.8) U/L within 7 days after operation, and then decreased. The trend of urinary amylase was similar to that of blood amylase, which was 240(121.0, 370.0) U/L 7 days after operation, and glycosylated hemoglobin decreased to the normal level (5.8%±1.4%) 1 month after operation. The main medical complications were infection including pulmonary infection (26.03%, 38/146), urinary tract infection (26.03%,38/146), and abdominal infection (4.79%,7/146), acute rejection including renal graft rejection (5.8%,8/146), pancreas/duodenum rejection (18.49%,27/146), and renal graft combined pancreatic graft rejeciton (6.85%,10/146), as well as gastrointestinal bleeding (30.82%,45/146), of which 5 cases were severe bleeding (3.42%, 5/146). The main surgical complications were poor incision healing (10.27%, 15/146), serious surgical complications including arteriovenous thrombosis of the transplanted pancreas (2.05%, 3/146) and intestinal leakage (0.68%,1/146). The 1-year and 3-year patient, renal and pancreatic survival rates were both 92.5%, 91.5% and 89.5%, respectively, and despite the death, the 1-year, 3-year transplanted kidney survival rate was both 99.3%, and 95% for the the 1-year, 3-year pancreas survival rate. Conclusion: Strict preoperative evaluation of the function of large organs, reasonable surgical methods, perioperative anticoagulation, and prompt diagnosis of complications can achieve good clinical results for patients with SPK.


Assuntos
Diabetes Mellitus Tipo 1 , Nefropatias , Transplante de Rim , Transplante de Pâncreas , Creatinina , Rejeição de Enxerto , Sobrevivência de Enxerto , Humanos , Pâncreas
15.
Blood Adv ; 4(23): 6051-6063, 2020 12 08.
Artigo em Inglês | MEDLINE | ID: mdl-33290544

RESUMO

Most children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have mild or minimal disease, with a small proportion developing severe disease or multisystem inflammatory syndrome in children (MIS-C). Complement-mediated thrombotic microangiopathy (TMA) has been associated with SARS-CoV-2 infection in adults but has not been studied in the pediatric population. We hypothesized that complement activation plays an important role in SARS-CoV-2 infection in children and sought to understand if TMA was present in these patients. We enrolled 50 hospitalized pediatric patients with acute SARS-CoV-2 infection (n = 21, minimal coronavirus disease 2019 [COVID-19]; n = 11, severe COVID-19) or MIS-C (n = 18). As a biomarker of complement activation and TMA, soluble C5b9 (sC5b9, normal 247 ng/mL) was measured in plasma, and elevations were found in patients with minimal disease (median, 392 ng/mL; interquartile range [IQR], 244-622 ng/mL), severe disease (median, 646 ng/mL; IQR, 203-728 ng/mL), and MIS-C (median, 630 ng/mL; IQR, 359-932 ng/mL) compared with 26 healthy control subjects (median, 57 ng/mL; IQR, 9-163 ng/mL; P < .001). Higher sC5b9 levels were associated with higher serum creatinine (P = .01) but not age. Of the 19 patients for whom complete clinical criteria were available, 17 (89%) met criteria for TMA. A high proportion of tested children with SARS-CoV-2 infection had evidence of complement activation and met clinical and diagnostic criteria for TMA. Future studies are needed to determine if hospitalized children with SARS-CoV-2 should be screened for TMA, if TMA-directed management is helpful, and if there are any short- or long-term clinical consequences of complement activation and endothelial damage in children with COVID-19 or MIS-C.


Assuntos
/diagnóstico , Microangiopatias Trombóticas/diagnóstico , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/patologia , Adolescente , Anticorpos Antivirais/sangue , Biomarcadores/metabolismo , /virologia , Criança , Pré-Escolar , Análise por Conglomerados , Complexo de Ataque à Membrana do Sistema Complemento/metabolismo , Creatinina/sangue , Feminino , Humanos , Masculino , RNA Viral/metabolismo , Reação em Cadeia da Polimerase Via Transcriptase Reversa , /isolamento & purificação , Índice de Gravidade de Doença , Microangiopatias Trombóticas/complicações
16.
Acta Gastroenterol Belg ; 83(4): 633-638, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33321021

RESUMO

Renal dysfunction is frequent in liver cirrhosis, and it is associated with poor prognosis. Currently, there are major limitations when assessing renal function in cirrhotic patients. Available methods are biased and have a tendency to overestimate glomerular filtration rates (GFR) consistently. A subset of new creatinine-based formulas derived specifically from these populations may provide a more accurate estimation of renal function. In this article, we will explore the estimation methods of GFR in cirrhosis available to date and discuss possible implications in clinical practice.


Assuntos
Cirrose Hepática , Creatinina , Taxa de Filtração Glomerular , Humanos , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico
17.
BMC Infect Dis ; 20(1): 931, 2020 Dec 07.
Artigo em Inglês | MEDLINE | ID: mdl-33287722

RESUMO

BACKGROUND: Evaluate the safety and efficacy of 104-week regimen of Telbivudine(LdT)-based optimization strategy for Chinese patients who have chronic hepatits B(CHB) with HBeAg-negative. METHODS: This multi-center, open-label, prospective study enrolled 108 HBeAg-negative CHB patients who received LdT (600 mg/day) for 24 weeks, Adefovir (ADV) was added if HBV DNA remained detectable at week 24, otherwise LdT was maintained to use until 104 weeks. HBV DNA, alanine amino transferase (ALT), hepatitis B surface antigen(HBsAg), creatinine kinase(CK), and estimated glomerular filtration rate (eGFR) were measured, safety was assessed. RESULTS: Eighty-eight patients (81%) had HBV-DNA undetectable at 24 weeks and maintained to receive LdT monotherapy until 104 weeks, whereas the other 20 patients had HBV-DNA detectable and ADV was used in combination. For all patients, 72% of patients reached ALT normalization at 24 weeks, which increased to 80% at 52 weeks and 104 weeks, respectively.. 81% of total patients had undetectable HBV-DNA at 24 weeks, 92% at 52 weeks, and 94% at 104 weeks. The HBsAg titre declined steadily from baseline to 104 weeks (3.62 vs. 2.98 log10 IU/mL, p < 0.05), and the eGFR increased steadily from baseline to 104 weeks (92.9 vs. 104.4 mL/min/1.73 m2, p < 0.05). Although 79 patients (73%) had at least one time of elevated CK, most of these patients had CK elevated in Grade 1/2. CONCLUSIONS: LdT was well tolerated and effective, and 94% of patients achieved virological suppression after 104 weeks. TRIAL REGISTRATION: This study was registered in clinicaltrials.gov on January 31, 2012 and the ID No. was NCT01521975 .


Assuntos
Adenina/análogos & derivados , Antivirais/efeitos adversos , Antígenos E da Hepatite B/sangue , Vírus da Hepatite B/genética , Hepatite B Crônica/tratamento farmacológico , Organofosfonatos/administração & dosagem , Telbivudina/efeitos adversos , Adenina/administração & dosagem , Adulto , Alanina Transaminase/sangue , Antivirais/administração & dosagem , China/epidemiologia , Creatinina/sangue , DNA Viral/análise , Quimioterapia Combinada , Feminino , Taxa de Filtração Glomerular , Antígenos de Superfície da Hepatite B/sangue , Antígenos de Superfície da Hepatite B/imunologia , Antígenos E da Hepatite B/imunologia , Hepatite B Crônica/sangue , Hepatite B Crônica/epidemiologia , Hepatite B Crônica/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resposta Viral Sustentada , Telbivudina/administração & dosagem
18.
Eur Rev Med Pharmacol Sci ; 24(23): 12490-12499, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33336768

RESUMO

OBJECTIVE: The aim of this study was to retrospectively analyze clinical characteristics and laboratory results of the novel coronavirus pneumonia (COVID-19) patients so as to identify factors related to disease progression. PATIENTS AND METHODS: Sixty-one patients with COVID-19 were divided into two groups: an improvement/stabilization group (n = 53) and a progression group (n = 8). Clinical data were collected to analyze and compare the differences between the two groups. RESULTS: Of the sixty-one patients, thirty-one were male (50.8%), and thirty were female (49.2%), with a median age of 53 years. On admission, significant differences were observed between the two groups with respect to the levels of Creatine Kinase (CK), lymphocytes, D-dimer and creatinine, and prothrombin time (PT). Univariate logistic regression analysis showed that Platelet-to-lymphocyte ratio (PLR), lymphocytes, Mean platelet volume to lymphocyte ratio (MPVLR), CK, White Blood count to mean platelet volume ratio (WMR), Lymphocyte-to-monocyte ratio (LMR), and serum creatinine were important factors for disease progression. Multivariate logistic regression analysis showed that PLR was an independent factor for disease progression in COVID-19 patients. The receiver operating characteristic (ROC) curve revealed that the best predictor of disease progression was CK. Dynamic changes in the laboratory indicators of patients were tracked, and significant differences were found in the variation trends of white blood cell count, neutrophil count, and WMR, which gradually increased in the progression group, but gradually decreased in the improvement/stabilization group. CONCLUSIONS: Risk factors for disease progression included PLR, lymphocytes, MPVLR, CK, WMR, LMR, and creatinine, among which, PLR is an independent risk factor for disease progression in COVID-19 patients.


Assuntos
/sangue , Creatina Quinase/sangue , Creatinina/sangue , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , China , Comorbidade , Tosse/fisiopatologia , Progressão da Doença , Feminino , Humanos , Contagem de Leucócitos , Modelos Logísticos , Contagem de Linfócitos , Masculino , Volume Plaquetário Médio , Pessoa de Meia-Idade , Monócitos , Contagem de Plaquetas , Tempo de Protrombina , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais
19.
Ter Arkh ; 92(9): 44-48, 2020 Oct 14.
Artigo em Russo | MEDLINE | ID: mdl-33346430

RESUMO

AIM: The aim of our study was to assess the prevalence of contrast-induced acute kidney injury (CI-AKI) in patients with stable coronary artery disease (CAD) receiving optimal medical treatment with indications to coronary angiography and intraarterial administration of contrast agents. MATERIALS AND METHODS: 1023 patients with stable CAD were included in the open prospective observational cohort study. The CI-AKI was defined as a rise in serum creatinine 25% from baseline. The mean age of the study group was 61.710.1 years; 72.4% were males and 84.4% had arterial hypertension. A multiple logistic regression model of prediction of CI-AKI was created. RESULTS: CI-AKI developed in 132 (12.9%) of the patients. The multiple logistic regression model included gender, BMI, weight, age, heart failure, diabetes mellitus, arterial hypertension, anemia, hyperuricemia, proteinuria and baseline serum creatinine. Area under the curve for the model was 0.749 (95% confidence interval 0.7030,795;p0.0001). When trying to build a prognostic model, including baseline GFR and contrast volume, the model lost significance and the AUC diminished. CONCLUSION: The CI-AKI remains quite a common kidney injury developing in patients with stable CAD undergoing percutaneous interventions. Several risk factors need to be assessed very carefully before any intervention requiring intraarterial contrast media administration especially in patients with comorbidities.


Assuntos
Lesão Renal Aguda , Doença da Artéria Coronariana , Intervenção Coronária Percutânea , Lesão Renal Aguda/induzido quimicamente , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/epidemiologia , Meios de Contraste/efeitos adversos , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Creatinina , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Fatores de Risco
20.
Medicine (Baltimore) ; 99(49): e22445, 2020 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-33285670

RESUMO

To assess whether MR diffusion imaging may be applied for non-invasive detection of renal changes correlating with clinical diagnosis of acute kidney injury (AKI) in patients after lung transplantation (lutx).Fifty-four patients (mean age 49.6, range 26-64 years) after lutx were enrolled in a prospective clinical study and underwent functional MR imaging of the kidneys in the early postoperative period. Baseline s-creatinine ranged from 39 to 112 µmol/L. For comparison, 14 healthy volunteers (mean age 42.1, range 24-59 years) underwent magnetic resonance imaging (MRI) using the same protocol. Renal tissue injury was evaluated using quantification of diffusion and diffusion anisotropy with diffusion-weighted (DWI) and diffusion-tensor imaging (DTI). Renal function was monitored and AKI was defined according to Acute-Kidney-Injury-Network criteria. Statistical analysis comprised one-way ANOVA and Pearson correlation.67% of lutx patients (36/54) developed AKI, 47% (17/36) had AKI stage 1, 42% (15/36) AKI stage 2, and 8% (3/36) severe AKI stage 3. Renal apparent diffusion coefficients (ADCs) were reduced in patients with AKI, but preserved in transplant patients without AKI and healthy volunteers (2.07 ±â€Š0.02 vs 2.18 ±â€Š0.05 vs 2.21 ±â€Š0.03 × 10 mm/s, P < .05). Diffusion anisotropy was reduced in all lutx recipients compared with healthy volunteers (AKI: 0.27 ±â€Š0.01 vs no AKI: 0.28 ±â€Š0.01 vs healthy: 0.33 ±â€Š0.02; P < .01). Reduction of renal ADC correlated significantly with acute loss of renal function after lutx (decrease of renal function in the postoperative period and glomerular filtration rate on the day of MRI).MR diffusion imaging enables non-invasive assessment of renal changes correlating with AKI early after lutx. Reduction of diffusion anisotropy was present in all patients after lutx, whereas marked reduction of renal ADC was observed only in the group of lutx recipients with AKI and correlated with renal function impairment.


Assuntos
Lesão Renal Aguda/diagnóstico por imagem , Lesão Renal Aguda/etiologia , Imagem de Difusão por Ressonância Magnética/métodos , Transplante de Pulmão/efeitos adversos , Lesão Renal Aguda/patologia , Adulto , Anisotropia , Creatinina/sangue , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Índice de Gravidade de Doença
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