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1.
Medicine (Baltimore) ; 99(6): e19125, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028438

RESUMO

Pain, the main symptom of osteoarthritis (OA), can lead to functional disability in patients with knee OA. Understanding the association factors related to knee pain is important since preventing OA-induced disabilities can be achieved by modifying these pain-associated issues. Therefore, this study was aimed to investigate the association factors for OA-induced knee pain in Taiwanese patients who received total knee replacements (TKR).In this retrospective study, 357 subjects who had undergone TKR at the Taipei Municipal Wan-Fang Hospital were recruited. The distribution of pain severity among patients with knee OA was evaluated. Demographic data and clinical parameters were analyzed to determine relationships between these variables and the severity of knee OA pain.Of the 357 patients studied, 54% and 33% had moderate and severe knee pain, respectively. Furthermore, a multivariate logistic regression analysis revealed that serum creatinine (>1.5 mg/dL) and an estimated glomerular filtration rate (eGFR) (<60 mL/min/1.73 m) were significantly associated with severe knee pain in OA patients. A significant correlation between severe knee pain and serum creatinine or eGFR was demonstrated by Pearson correlations.Taken together, the renal insufficiency defined by an elevated serum creatinine or a low eGFR in OA patients who required TKR was associated with severe knee pain. These variables must be considered while treating knee OA pain, especially in those patients with severe pain.


Assuntos
Artralgia/etiologia , Artroplastia do Joelho/efeitos adversos , Osteoartrite do Joelho/complicações , Insuficiência Renal/complicações , Idoso , Creatinina/sangue , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Medição da Dor , Estudos Retrospectivos
7.
Angiology ; 71(2): 183-188, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-30987432

RESUMO

We investigated the preventive effect of nicorandil on contrast-induced nephropathy (CIN) in patients with moderate renal insufficiency undergoing percutaneous coronary intervention (PCI). A total of 250 patients with a creatinine clearance (crCl) ≤60 mL/min undergoing PCI were randomly assigned to either a nicorandil group (nicorandil 10 mg 3 times/d and hydration; n = 125) or a control group (hydration only; n = 125). The first end point was the incidence of CIN defined as an increase in serum creatinine (Scr) levels by ≥0.5 mg/dL or ≥25% within 72 hours after exposure to the contrast medium. The secondary end points were (1) changes in Scr, blood urea nitrogen, and crCl and (2) the incidence of major adverse events during hospitalization. The incidence of CIN was 1.6% (2/125) in the nicorandil group and 9.6% (12/125) in the control group (P = .011). There was no obvious difference in the incidence of major adverse events during hospitalization between the nicorandil and the control group (4.0% vs 4.8%, P = 1.000). Multivariate logistic regression analysis showed that nicorandil was a protective factor for CIN (odds ratios = 0.126, 95% confidence interval: -19.996 to -0.932, P = .012). Prophylactic administration of nicorandil may prevent against CIN in patients with moderate renal insufficiency undergoing PCI.


Assuntos
Nefropatias/induzido quimicamente , Nefropatias/prevenção & controle , Nicorandil/uso terapêutico , Intervenção Coronária Percutânea , Insuficiência Renal/complicações , Idoso , Meios de Contraste/efeitos adversos , Feminino , Humanos , Masculino , Índice de Gravidade de Doença
9.
Chemosphere ; 238: 124607, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31524603

RESUMO

A fluoride exposure mouse model is established to evaluate the relationship between mitochondrial respiratory chain complexes and renal dysfunction. Morphological changes in kidney tissues were observed. Renal function and cell proliferation in the kidneys were evaluated. The expression of mitochondrial fusion protein including mitofusin-1 (Mfn1) and optic atrophy 1 (OPA1), and mitochondrial respiratory chain complex subunits, including NDUFV2, SDHA, CYC1 and COX Ⅳ, were detected via real-time polymerase chain reaction, immunohistochemistry staining and Western blot, respectively. Results showed that the structures of renal tubule, renal glomerulus and renal papilla were seriously damaged. Renal function was impaired, and cell proliferation was remarkably inhibited by excessive fluoride in kidney. The mRNA and protein expression levels of Mfn1, OPA1, NDUFV2, CYC1 and COX Ⅳ were significantly increased after excessive fluoride exposure. However, the mRNA and protein expression of SDHA significantly decreased. Overall, our findings revealed that excessive fluoride can damage kidney structure, inhibit renal cell proliferation, interfere with the expression of mitochondrial respiratory chain complexes and elevate mitochondrial fusion. Consequently, renal function disorder occurred.


Assuntos
Complexo de Proteínas da Cadeia de Transporte de Elétrons/metabolismo , Fluoretos/toxicidade , Doenças Mitocondriais/induzido quimicamente , Dinâmica Mitocondrial/efeitos dos fármacos , Proteínas Mitocondriais/metabolismo , Insuficiência Renal/induzido quimicamente , Animais , Western Blotting , Proliferação de Células/efeitos dos fármacos , Modelos Animais de Doenças , Transporte de Elétrons , GTP Fosfo-Hidrolases/metabolismo , Rim/patologia , Camundongos , Mitocôndrias/patologia , Proteínas Mitocondriais/genética , RNA Mensageiro/biossíntese
10.
Zhonghua Nei Ke Za Zhi ; 59(1): 82-85, 2020 Jan 01.
Artigo em Chinês | MEDLINE | ID: mdl-31887844

RESUMO

A 43-year-old male presented with elevated serum creatinine for 4 years and developed abdominal pain for 3 days. He started peritoneal dialysis 2 months ago. Dialysis-related peritonitis was ruled out and acute gastroenteritis was diagnosed. The patient was administrated with ertapenem 500 mg/d. An acute mental abnormality developed 3 days later. After excluded organic encephalopathy, ertapenem was discontinued for the suspicion of antibiotic-related encephalopathy. The frequency of peritoneal dialysis was increased to accelerate the clearance of antibiotics. However, the metal abnormality became even more severe. Then a diagnosis of Wernick-Korsakoff syndrome was considered. After the administration of high dose vitamin B(1), the mental disorder dramatically relieved. Vitamin B(1) 30 mg/d is maintained during peritoneal dialysis and the mental disorder does not relapse.


Assuntos
Dor Abdominal/etiologia , Síndrome de Korsakoff/tratamento farmacológico , Diálise Peritoneal , Insuficiência Renal/terapia , Tiamina/administração & dosagem , Encefalopatia de Wernicke/tratamento farmacológico , Adulto , Antibacterianos/uso terapêutico , Ertapenem/uso terapêutico , Gastroenterite/diagnóstico , Gastroenterite/tratamento farmacológico , Humanos , Síndrome de Korsakoff/diagnóstico , Masculino , Transtornos Mentais , Peritonite , Insuficiência Renal/complicações , Resultado do Tratamento , Encefalopatia de Wernicke/diagnóstico
15.
Medicine (Baltimore) ; 98(52): e18427, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876719

RESUMO

RATIONALE: Contrast-enhanced computed tomographic venography (CTV) or magnetic resonance venography (MRV) are usually used to detect May-Thurner syndrome (MTS). However, both are associated with contrast-induced nephrotoxicity. For patients who cannot receive contrast media, non-contrast-enhanced MRV using three-dimensional (3D) turbo spin-echo (TSE) is considered an alternative. We report a case of MTS to describe its clinical utility and advantages. PATIENT CONCERNS: A 49-year-old male experienced isolated left leg swelling and pain for half a month. He had a history of chronic renal insufficiency that made contrast-enhanced imaging studies inadequate. DIAGNOSES: A lower extremity venous Duplex scan showed a thrombus extending from the left distal femoral vein to the popliteal vein with valvular reflux, consistent with infrainguinal deep vein thrombosis (DVT). The suprainguinal DVT was evaluated by non-contrast-enhanced MRV. The results showed sandwich external compression of the left common iliac vein between the right common iliac artery and lumbar vertebrae, consistent with DVT of the left common iliac vein caused by MTS. INTERVENTIONS: The patient received angioplasty with the implantation of a balloon-expandable stent over the left common iliac vein. OUTCOMES: Excellent recanalization of the left iliac vein was noted postoperatively. LESSONS: In the evaluation of suprainguinal venous lesions, non-contrast-enhanced MRV presents the venous structure alone at high resolution without the accompanying arterial structure, which makes it an excellent diagnostic imaging tool for MTS. These findings indicate that non-contrast-enhanced MRV could be useful for detecting systemic venous pathologies in patients with renal insufficiency.


Assuntos
Angiografia por Ressonância Magnética/métodos , Síndrome de May-Thurner/diagnóstico por imagem , Insuficiência Renal/diagnóstico por imagem , Veia Femoral/diagnóstico por imagem , Humanos , Masculino , Síndrome de May-Thurner/complicações , Pessoa de Meia-Idade , Veia Poplítea/diagnóstico por imagem , Insuficiência Renal/etiologia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologia
17.
J Cardiothorac Surg ; 14(1): 191, 2019 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-31699143

RESUMO

BACKGROUND: Mild preoperative renal dysfunction (RD) is not rare in patients receiving isolated cardiopulmonary coronary artery bypass grafting (CCABG). However, there are not too many studies about the impact of mild preoperative RD on in-hospital and follow-up outcomes after isolated CCABG. This single-centre, retrospective propensity score matching study designed to study the impact of mild preoperative RD on in-hospital and long-term outcomes after first isolated CCABG. METHODS: After propensity score matching, 1144 patients with preoperative estimated glomerular filtration rate (eGFR) of more than 60 ml/min/1.73 m2 receiving first isolated CCABG surgery from January 2012 to December 2015 entered the study, who were divided into 2 groups: A group (eGFR ≥90 ml/min/1.73 m2, n = 572) and B group (eGFR of 60-89 ml/min/1.73 m2, n = 572). The in-hospital and long-term outcomes were recorded and analyzed. The mean follow-up time was 54.4 ± 10.7 months. Acute kidney injury (AKI) was defined and classified according to the Acute Kidney Injury Network (AKIN) criteria. RESULTS: The 2 propensity score-matched groups had similar baseline and procedure except the baseline eGFR. There were 8 patients died in A group (mortality is 1.4%) and 14 died in B group (mortality is 2.5%) during the in hospital and 30-day postoperatively(χ2 = 1.159, p = 0.282). There were totally 38 patients lost to follow-up, 18 in group A and 20 in group B. 21 patients died in group A and 37 died in group B during the follow-up, and long-term survival in group A was higher than in group B (96.2% vs 93.1%, χ2 = 4.336, p = 0.037). Comparing with group A, group B was associated with an increased rates and severity of AKI postoperatively (total AKI: 62 vs 144. AKIN stageI: 54 vs 113; AKIN stageII: 6 vs 22; AKIN stageIII: 2 vs 9, p<0.0001). During follow-up, group B also had a higher rate of new onset of dialysis (0 vs 6, χ2 = 4.432, p = 0.039). Multivariable logistic regression showed that comparing with A group, the HR for long-term mortality and new onset of dialysis in B group was 1.67 and 1.52 respectively (95%CI 1.09-2.90, p = 0.035; 95%CI 1.14-2.49, p = 0.027). CONCLUSIONS: Comparing with normal preoperative renal function, patients with mild preoperative RD had a similar in-hosptial mortality, but with an increased in-hosptial rates and severity of AKI, and with a decreased long-term survival and increased long-term new onset of dialysis.


Assuntos
Ponte de Artéria Coronária , Complicações Pós-Operatórias/etiologia , Insuficiência Renal/complicações , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/mortalidade , Lesão Renal Aguda/terapia , Idoso , Feminino , Seguimentos , Taxa de Filtração Glomerular , Mortalidade Hospitalar , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Período Pré-Operatório , Pontuação de Propensão , Diálise Renal , Insuficiência Renal/diagnóstico , Insuficiência Renal/mortalidade , Insuficiência Renal/terapia , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Resultado do Tratamento
18.
Rev Med Suisse ; 15(673): 2210-2212, 2019 Nov 27.
Artigo em Francês | MEDLINE | ID: mdl-31778052

RESUMO

Since 2017 the world suffers from a piperacillin/tazobactam shortage. Cefepime is then proposed as a broad spectrum antibiotic alternative. Up to 15 % of the patients under treatment develop neurotoxicity, mostly in kidney failure settings. Cefepime serum concentration and electroencephalogram guide diagnosis. Treatment consists in withholding or reducing the dose. Most of the patients recover without neurologic sequelae.


Assuntos
Encefalopatias/induzido quimicamente , Cefepima/efeitos adversos , Antibacterianos/efeitos adversos , Antibacterianos/provisão & distribução , Antibacterianos/uso terapêutico , Encefalopatias/sangue , Encefalopatias/diagnóstico , Cefepima/administração & dosagem , Cefepima/sangue , Cefepima/uso terapêutico , Humanos , Insuficiência Renal/sangue , Insuficiência Renal/complicações , Insuficiência Renal/tratamento farmacológico
19.
Medicine (Baltimore) ; 98(48): e18205, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770278

RESUMO

BACKGROUND AND OBJECTIVES: This meta-analysis was to investigate the efficacy and safety of new oral anticoagulant (NOAC) in atrial fibrillation (AF) patients with renal function insufficiency, and to explore whether renal decline occurs in AF patients with NOAC and its impact on outcomes. METHODS AND RESULTS: In AF patients with mild renal insufficiency, the NOAC was associated with significantly lower rates of stroke (odds ratio [OR], 0.78; 95% confidence interval [CI], 0.67-0.91; P < .05). Lower rates of bleeding were significantly observed in NOAC group (OR, 0.85; 95% CI, 0.75-0.97; P < .05). In AF patients with moderate renal impairment, similar results were revealed (OR for stroke or systemic embolism, 0.80; 95% CI, 0.67-0.95, P < .05; OR for major bleeding, 0.78; 95% CI, 0.59-1.03; P = .07). During the follow-up, pooled data revealed that NOAC showed a less renal toxicity, but the difference did not reach statistical significance (creatinine clearance decline: -0.12 mL/min [-0.84, 0.61 mL/min]). We have revealed that the NOACs were associated with significantly lower rates of stroke or systemic embolism (hazard ratio [HR], 0.66; 95% CI, 0.42-0.89; P < .05) and lower rates of bleeding (HR, 0.93; 95% CI, 0.70-1.16; P = .153) in AF patients with worsening renal function. CONCLUSIONS: NOAC may have the potentiality to be at least as effective as warfarin and may equal safety outcomes in AF patients with renal impairment. Renal decline during therapeutics may be less likely happened in NOAC than warfarin dose. NOAC may reveal good efficacy and safety outcomes in these scenarios. Further detailed research is needed to gain more clear profile on this new anticoagulant.


Assuntos
Anticoagulantes , Fibrilação Atrial , Insuficiência Renal/complicações , Anticoagulantes/classificação , Anticoagulantes/farmacologia , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Humanos , Farmacovigilância , Resultado do Tratamento
20.
Rev Med Suisse ; 15(667): 1866-1869, 2019 Oct 16.
Artigo em Francês | MEDLINE | ID: mdl-31617974

RESUMO

Crystalloid-type solutions are currently recommended for volume resuscitation. Although historically considered as «â€…physiological saline ¼, NaCl 0.9 % has a high concentration of sodium and chloride that can lead to metabolic acidosis and impaired renal function when large volumes are used. Recent evidence confirms that use of low-chloride crystalloids (so-called balanced solutions) could reduce the occurrence of renal failure and should be preferred during high volume resuscitation.


Assuntos
Cuidados Críticos/métodos , Hidratação , Ressuscitação , Humanos , Insuficiência Renal/prevenção & controle , Solução Salina
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