Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.599
Filtrar
1.
Zhonghua Yi Xue Yi Chuan Xue Za Zhi ; 37(9): 958-961, 2020 Sep 10.
Artigo em Chinês | MEDLINE | ID: mdl-32820507

RESUMO

OBJECTIVE: To determine the carrier rate of deafness-related genetic variants among 53 873 newborns from Zhengzhou. METHODS: Heel blood samples of the newborns were collected with informed consent from the parents, and 15 loci of 4 genes related to congenital deafness were detected by microarray. RESULTS: In total 2770 newborns were found to carry deafness-related variants, with a carrier rate of 5.142%. 1325 newborns (2.459%) were found to carry heterozygous variants of the GJB2 gene, 1071 (1.988%) were found with SLC26A4 gene variants, 205 were found with GJB3 gene variants (0.381%), and 120 were found with 12S rRNA variants (0.223%). Five newborns have carried homozygous GJB2 variants, two have carried homozygous SLC26A4 variants, five have carried compound heterozygous GJB2 variants, and four have carried compound heterozygous SLC26A4 variants. 33 neonates have carried heterozygous variants of two genes at the same time. CONCLUSION: The carrier rate of deafness-related variants in Zhengzhou, in a declining order, is for GJB2, SLC26A4, GJB3 and 12S rRNA. The common variants included GJB2 235delC and SLC26A4 IVS7-2A>G, which are similar to other regions in China. To carry out genetic screening of neonatal deafness can help to identify congenital, delayed and drug-induced deafness, and initiate treatment and follow-up as early as possible.


Assuntos
Coloboma/genética , Conexinas , Heterozigoto , Diagnóstico Pré-Natal , Insuficiência Renal/genética , Refluxo Vesicoureteral/genética , China , Coloboma/diagnóstico , Conexinas/genética , Análise Mutacional de DNA , Surdez/genética , Feminino , Feto , Homozigoto , Humanos , Recém-Nascido , Mutação , Fenótipo , Gravidez , Insuficiência Renal/diagnóstico , Transportadores de Sulfato/genética , Refluxo Vesicoureteral/diagnóstico
2.
Zhonghua Yi Xue Yi Chuan Xue Za Zhi ; 37(8): 847-850, 2020 Aug 10.
Artigo em Chinês | MEDLINE | ID: mdl-32761592

RESUMO

OBJECTIVE: To diagnose a fetus with Papillorenal syndrome by prenatal ultrasonography and genetic testing, and to correlate its genotype with phenotype. METHODS: Ultrasound finding of the fetus was reviewed. Muscle sample of the abortus was taken, and genetic variant related to the clinical phenotype was screened by whole exome sequencing (WES). Suspected pathogenic variant was verified by Sanger sequencing. RESULTS: Prenatal ultrasound revealed severe dysplasia of the fetal kidneys and oligohydramnios. WES revealed that the fetus has carried a c.736G>T (p.Glu246Ter) nonsense variant of the PAX2 gene, which was unreported previously. The result of Sanger sequencing was consistent with that of WES. Both parents of the fetus were of the wild-type, suggesting a de novo origin of the fetal variant. CONCLUSION: The novel heterozygous c.736G>T (p.Glu246Ter) variant of the PAX2 gene probably underlay the Papillorenal syndrome in the fetus. Above finding has provided a basis for genetic counseling and clinical decision-making.


Assuntos
Coloboma/diagnóstico , Coloboma/genética , Feto , Testes Genéticos , Diagnóstico Pré-Natal , Insuficiência Renal/diagnóstico , Insuficiência Renal/genética , Refluxo Vesicoureteral/diagnóstico , Refluxo Vesicoureteral/genética , Feminino , Humanos , Fator de Transcrição PAX2/genética , Fenótipo , Gravidez , Sequenciamento Completo do Exoma
4.
Diabetes Res Clin Pract ; 165: 108272, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32561454

RESUMO

BACKGROUND: Several studies have indicated that high albuminuria is associated with renal function decline. However, the relationship between the urinary albumin-to-creatinine ratio (ACR) and risk of developing tubular injury remains unclear. Our aim was to investigate the association of ACR with the risk of developing tubular impairment in patients with type 2 diabetes. METHODS: This longitudinal observational study compared baseline with follow-up data in 183 patients with type 2 diabetes. ACR, urinary alpha-1-microglobulin-to-creatinine ratio (A1MCR) and estimated glomerular filtration rate (eGFR) were used to evaluate albuminuira, tubular injury and glomerular filtration function, respectively. RESULTS: Levels of high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and A1MCR were significantly different at the two-year follow-up compared with baseline levels. Among patients both with baseline ACR above and below 30 mg/g, the percentage with A1MCR > 15 mg/g clearly increased after follow-up (P < 0.05). The risk of A1MCR rising from normal ranges to >15 mg/g over the follow-up increased with increasing baseline ACR values lower baseline eGFR. Among the patients with baseline ACR > 63.10 mg/g, all showed increased A1MCR values at follow-up compared with baseline. In the multivariate regression analysis, the patients with baseline ACR > 63.10 mg/g had a strong risk of A1MCR rising from normal to >15 mg/g (odds ratio (OR) = 11.12, P = 0.001) over the follow-up, while the males had a 2.89-fold risk of A1MCR increasing from normal to >15 mg/g compared with females. CONCLUSION: Baseline ACR level is related to increased risk of developing renal tubular injury; in particular, this association is much stronger in patients with type 2 diabetes and baseline ACR > 63.10 mg/g.


Assuntos
Albuminúria/urina , Creatinina/urina , Diabetes Mellitus Tipo 2/complicações , Testes de Função Renal/métodos , Insuficiência Renal/diagnóstico , Insuficiência Renal/urina , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fatores de Risco
5.
Cardiovasc Diabetol ; 19(1): 98, 2020 06 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590982

RESUMO

Sodium/glucose cotransporter-2 inhibitors (SGLT2i) are a new type of glucose-lowering drug that can reduce blood glucose by inhibiting its reabsorption in proximal tubules and by promoting urinary glucose excretion. SGLT2i are widely used in the clinical treatment of type 2 diabetes mellitus (T2DM). In recent studies, SGLT2i were found to not only reduce blood glucose but also protect the heart and kidney, which can significantly reduce cardiovascular events, delay the progression of renal failure, greatly improve the quality of life of patients, and reduce medical expenses for families and society. As adverse cardiac and renal events are the most common and serious complications of T2DM, it is very important to understand the cardio- and renoprotective mechanisms of SGLT2i. This article reviews the historical development, pharmacological mechanism, heart and kidney protection and safety of SGLT2i. The information presented provides a theoretical basis for the clinical prevention and treatment of diabetes and its complications and for the development of new glucose-lowering drugs.


Assuntos
Glicemia/efeitos dos fármacos , Doenças Cardiovasculares/prevenção & controle , Sistema Cardiovascular/efeitos dos fármacos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Nefropatias Diabéticas/prevenção & controle , Rim/efeitos dos fármacos , Insuficiência Renal/prevenção & controle , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Animais , Biomarcadores/sangue , Glicemia/metabolismo , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/fisiopatologia , Sistema Cardiovascular/fisiopatologia , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/epidemiologia , Nefropatias Diabéticas/fisiopatologia , Regulação para Baixo , Humanos , Rim/fisiopatologia , Insuficiência Renal/diagnóstico , Insuficiência Renal/epidemiologia , Insuficiência Renal/fisiopatologia , Medição de Risco , Fatores de Risco , Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversos , Resultado do Tratamento
6.
Clin Interv Aging ; 15: 733-742, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32546991

RESUMO

Purpose: Reduced kidney function has been associated with an increased risk for adverse outcomes. Accurate assessment of glomerular filtration rate (GFR) is key to diagnosis and management of kidney disfunction. Debate exists on the best GFR estimation equation for elderly people. This study aimed to compare the predictive validity and discriminative ability of four GFR equations in relation to 2-year and 6-year mortality in exceptional longevity (EL) (those over 95 years old with intact health) individuals and is an ideal model to address factors relating to life span and age-related diseases. Patients and Methods: This study used 6 years' data of 278 EL from the Rugao longevity cohort. Baseline GFR was estimated using four equations: Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, Modification of Diet in Renal Disease Study (MDRD) equation, Berlin Initiative Study-1 (BIS) equation, and modified MDRD equation. Predictive validity was tested using Cox proportional hazards analysis. Overall improvement in reclassification based on estimated GFR (eGFR) was assessed applying net reclassification improvement (NRI). Results: Mean age of participants was 97±2 years with median follow-up of 2.6 years. Median (IQR) eGFR by CKD-EPI, MDRD, BIS, and modified MDRD equations were 73.9 (62.2-77.6), 82.3 (67.4-98.6), 56.4 (47.9-63.9), and 101.5 (83.1-121.6) mL/min per 1.73 m2, respectively. Higher eGFREPI was associated with lower mortality after multivariate adjustment (for continuous eGFREPI, HRtwo-year 1.018, 95% CI 1.002-1.033, P=0.023; HRsix-year 1.013, 95% CI 1.002-1.025, P=0.022), while eGFR from other equations did not show any associations with mortality. NRI for two-year mortality was 0.14 and approximately significant, which may favor the CKD-EPI when compared to BIS equation (P=0.052). Conclusion: The CKD-EPI equation showed more accurate estimation of kidney function in the elderly with respect to GFR distribution and predictability of mortality risk.


Assuntos
Creatinina/sangue , Taxa de Filtração Glomerular/fisiologia , Longevidade/fisiologia , Insuficiência Renal/diagnóstico , Idoso de 80 Anos ou mais , Feminino , Humanos , Testes de Função Renal/métodos , Masculino , Mortalidade , Valor Preditivo dos Testes , Insuficiência Renal/epidemiologia , Reprodutibilidade dos Testes , Fatores de Risco
9.
Ann Emerg Med ; 76(2): 215-218, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32362432

RESUMO

To our knowledge, there are no published reports of heat exhaustion and pesticide exposure in a labor trafficked patient in the literature. Here we represent the case of J.C.J.L., who was labor trafficked. He presented to a local emergency department with heat exhaustion and pesticide exposure related to working conditions in a Mississippi corn field. Unfortunately, while he received medical treatment, his labor trafficking condition was missed. Emergency departments should be equipped to assess for human trafficking and connect trafficked persons with the resources they need. Emergency physicians should maintain a high index of suspicion for human trafficking among migrant workers presenting with occupation-related complaints.


Assuntos
Desidratação/diagnóstico , Fazendeiros , Exaustão por Calor/diagnóstico , Tráfico de Pessoas , Exposição Ocupacional , Insuficiência Renal/diagnóstico , Migrantes , Adulto , Serviço Hospitalar de Emergência , Humanos , Masculino , Mississippi , Praguicidas
11.
Rev Cardiovasc Med ; 21(1): 119-122, 2020 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-32259910

RESUMO

Arteriovenous fistula (AVF) is a rare complication of the abdominal aortic aneurysm (AAA) with complex clinical features. However, AVF and AAA usually cause no symptoms except when they rupture. This case study demonstrated that ultrasonography was a rapid and non-invasive method for the initial assessment of AAA and AVF. A 65-year-old man was admitted to the intensive care unit with hepatic and renal dysfunction. Physical examination revealed an abdominal vascular murmur and bilateral toe discoloration. Ultrasonic examination revealed an AAA and right common iliac artery aneurysm with an AVF located between the right common iliac artery and inferior vena cava. A computed tomography scan confirmed the sonographic findings. We propose that ultrasound should be used more commonly as part of the initial evaluation of the potential and established vascular diseases.


Assuntos
Aneurisma da Aorta Abdominal/diagnóstico por imagem , Ruptura Aórtica/etiologia , Fístula Arteriovenosa/diagnóstico por imagem , Síndrome Hepatorrenal/etiologia , Aneurisma Ilíaco/diagnóstico por imagem , Artéria Ilíaca/diagnóstico por imagem , Falência Hepática/etiologia , Insuficiência Renal/etiologia , Ultrassonografia Doppler em Cores , Veia Cava Inferior/diagnóstico por imagem , Idoso , Aneurisma da Aorta Abdominal/complicações , Ruptura Aórtica/diagnóstico por imagem , Fístula Arteriovenosa/etiologia , Angiografia por Tomografia Computadorizada , Progressão da Doença , Evolução Fatal , Síndrome Hepatorrenal/diagnóstico por imagem , Humanos , Aneurisma Ilíaco/complicações , Falência Hepática/diagnóstico , Masculino , Flebografia , Valor Preditivo dos Testes , Insuficiência Renal/diagnóstico
12.
Am J Kidney Dis ; 76(1): 90-99, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32197881

RESUMO

RATIONALE & OBJECTIVE: Hematuria is the most typical presentation of immunoglobulin A nephropathy (IgAN); however, its role in disease progression is still controversial. This study aimed to evaluate the association of hematuria and progression of IgAN. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: A cohort of 1,333 patients with IgAN treated at a Chinese referral hospital with a median follow-up of 45 months. PREDICTORS: Microhematuria was evaluated in fresh urine using a fully automated urine particle analyzer (automated method) and urine sediment examination by a skilled examiner (manual method). Hematuria was characterized as a time-varying attribute; namely, average hematuria level was calculated for every 6-month period for each patient during follow-up. Remission was defined as average red blood cell count ≤5/high-power field (manual method) or ≤28 red blood cells/µL (automated method) during the first 6 months of follow-up. OUTCOMES: Composite event of 50% decline in estimated glomerular filtration rate or development of kidney failure. ANALYTICAL APPROACH: Multivariable cause-specific hazards models to analyze the relationship between hematuria and the composite kidney disease progression event. RESULTS: Time-varying hematuria during follow-up was an independent risk factor for the composite kidney disease progression event (HR, 1.46; 95% CI, 1.13-1.87; P = 0.003). Hematuria remission during the 6 months after diagnosis was associated with a significantly lower rate of the composite kidney disease progression event (HR, 0.41; 95% CI, 0.28-0.61; P < 0.001). A significant interaction was detected between remission of proteinuria and remission of hematuria during the first 6 months (P < 0.001). The association between remission of hematuria and kidney disease progression was detectable (HR, 0.46; 95% CI, 0.32-0.68) within the subpopulation with persistent proteinuria (protein excretion > 1.0 g/d during the first 6 months), but not among patients whose proteinuria had remitted (HR, 0.64; 95% CI, 0.31-1.29; P = 0.2). The 2 techniques for hematuria evaluation were strongly and significantly linearly correlated (r = 0.948; P < 0.001), and results using these 2 methods were consistent. LIMITATIONS: A single-center retrospective study. Proportional hazards regression incorporating time-varying covariates may create time-varying confounding. The predictive value of reductions in hematuria was not directly evaluated. CONCLUSIONS: Level of hematuria was independently associated with kidney disease progression, whereas hematuria remission was associated with improved kidney outcomes in IgAN among patients with persistent proteinuria. Additionally, to monitor IgAN progression, automated methods to evaluate hematuria hold promise as a replacement for manual evaluation of urinary sediment.


Assuntos
Progressão da Doença , Glomerulonefrite por IGA/diagnóstico , Glomerulonefrite por IGA/epidemiologia , Hematúria/diagnóstico , Hematúria/epidemiologia , Adulto , Estudos de Coortes , Feminino , Seguimentos , Glomerulonefrite por IGA/sangue , Hematúria/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Insuficiência Renal/sangue , Insuficiência Renal/diagnóstico , Insuficiência Renal/epidemiologia , Estudos Retrospectivos
13.
J Urol ; 204(1): 42-49, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32073996

RESUMO

PURPOSE: Loss of renal function remains a major limitation of radical nephrectomy. The extent of renal functional compensation by the preserved kidney after radical nephrectomy has not been adequately studied in this elderly population with comorbidities. MATERIALS AND METHODS: A total of 273 patients treated with radical nephrectomy without end stage renal disease with available preoperative nuclear renal scans were included in the analysis. Renal functional compensation was defined as percent change in estimated glomerular filtration rate of the preserved kidney after radical nephrectomy. Estimated glomerular filtration rate was calculated by the Chronic Kidney Disease-Epidemiology Collaboration formula up to 5 years postoperatively. Preoperative/postoperative parenchymal volumes of the preserved kidney were measured from cross-sectional imaging. Multiple regression was used to identify predictive factors for renal functional compensation. RESULTS: Median age was 67 years and 67% of the patients were male. Overall 70% had hypertension, 26% diabetes and 37% preexisting chronic kidney disease. Locally advanced (T3a or greater) tumors were found in 53% of cases. Renal functional compensation was observed at 2 weeks (median 10%) and increased during the first 3 months (median 26%) after radical nephrectomy. Functional stability was then observed to 5 years. Renal parenchymal volume increased a median of 10% at 3 to 12 months but in addition, the functional efficiency per unit of parenchymal volume also increased 8% (estimated glomerular filtration rate units/cm3 of parenchyma was 0.236 postoperatively vs 0.208 preoperatively, p=0.004). Age (-0.85, p <0.01), global preoperative estimated glomerular filtration rate (-0.28, p <0.01) and split renal function of the removed kidney (0.61, p <0.01) were independent predictors of renal functional compensation. CONCLUSIONS: Percent renal functional compensation after radical nephrectomy is greater in younger patients, when preoperative estimated glomerular filtration rate is lower and when the removed kidney has more robust function. Increases in measurable parenchymal mass and functional efficiency contribute substantially to renal functional compensation.


Assuntos
Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgia , Rim/patologia , Rim/fisiopatologia , Nefrectomia , Complicações Pós-Operatórias , Insuficiência Renal/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/fisiopatologia , Feminino , Humanos , Rim/cirurgia , Testes de Função Renal , Neoplasias Renais/patologia , Neoplasias Renais/fisiopatologia , Masculino , Pessoa de Meia-Idade , Nefrectomia/métodos , Tamanho do Órgão , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/fisiopatologia , Insuficiência Renal/diagnóstico , Insuficiência Renal/patologia , Insuficiência Renal/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento
14.
Clin Exp Hypertens ; 42(6): 545-552, 2020 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-32037898

RESUMO

BACKGROUND: Renin is the starting point of the renin angiotensin (RA) system cycle. Aliskiren (AL), which is a direct renin inhibitor, suppressed the entire RA cycle. In the present study, the efficacy of add-on of AL treatment in patients with essential hypertension (HT) was investigated. METHODS: This study was a multi-center, open-label, prospective, observational study. Study subjects were patients with essential HT and poor blood pressure (BP) control, who had received calcium channel blocker monotherapy or angiotensin II receptor blocker monotherapy or had not received any BP lowering drugs. Following add-on of AL for 12 months, BP and additional laboratory findings were analyzed. RESULTS: A total of 150 subjects were enrolled. There were 50 dropout subjects including discontinuation. Dropouts were the highest in the ARB combination therapy group at 9 subjects due to adverse events, and 3 of them were due to hyperkalemia. A significantly higher number of patients with chronic kidney disease (CKD) dropped out compared to patients without CKD (φ = 0.166, p < .05). BP before add-on of AL was 155/88 mmHg. After add-on of AL, BP was significantly improved and this lowering was sustained for 3 months (136/78 mmHg, p < .001), 6 months (136/77 mmHg, p < .001) and 12 months (134/78 mmHg, p < .001). In contrast, add-on of AL increased the potassium level and decreased the estimated glomerular filtration rate. CONCLUSION: While add-on AL treatment achieved a favorable and sustained decrease of BP in this study, caution is necessary with regard to elevation of potassium levels and renal impairment.


Assuntos
Amidas , Fumaratos , Hiperpotassemia , Insuficiência Renal , Renina/antagonistas & inibidores , Idoso , Amidas/administração & dosagem , Amidas/efeitos adversos , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/efeitos adversos , Anti-Hipertensivos/classificação , Pressão Sanguínea/efeitos dos fármacos , Quimioterapia Combinada , Feminino , Fumaratos/administração & dosagem , Fumaratos/efeitos adversos , Taxa de Filtração Glomerular , Humanos , Hiperpotassemia/induzido quimicamente , Hiperpotassemia/prevenção & controle , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Insuficiência Renal/induzido quimicamente , Insuficiência Renal/diagnóstico , Insuficiência Renal/prevenção & controle , Sistema Renina-Angiotensina/efeitos dos fármacos
15.
Diabetes Res Clin Pract ; 161: 108011, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31991151

RESUMO

AIMS: The association of blood glucose in advanced diabetic kidney disease (DKD) is unclear. This study investigated the association between blood glucose and renal endpoints in DKD patients. METHODS: This retrospective cohort study enrolled type 2 diabetic patients with advanced DKD with an estimated glomerular filtration rate (eGFR) between 30 and 90 ml/min/1.73 m2 and urine albumin-to-creatinine ratio (UACR) of 300-5000 mg/g. We classified patients into 2 groups according to their 1-year average HbA1c: <7% and >7%. We followed up the patients until the occurrence of primary renal endpoints. RESULTS: A total of 345 patients were included in the analysis for the period 2012-2018. Mean baseline eGFR was 58 ml/min/1.73 m2 and mean albuminuria levels were 1146 and 1313 mg/g, respectively. Median study duration was 3 years. The risk of primary renal endpoints was not decreased in patients with HbA1c less than 7% with an adjusted hazard ratio (aHR) of 0.62, 95% CI 0.26-1.45. The risks of persistent eGFR lower than 15 ml/min/1.73 m2 and doubling of serum creatinine level were similar between 2 group with aHR of 0.58 (95% CI 0.19-1.83) and 0.61 (95% CI 0.26-1.44), respectively. CONCLUSIONS: Intensive blood sugar control did not prevent renal failure in advanced DKD.


Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Nefropatias Diabéticas/sangue , Nefropatias Diabéticas/diagnóstico , Rim/fisiopatologia , Idoso , Albuminúria/sangue , Albuminúria/complicações , Albuminúria/fisiopatologia , Biomarcadores/análise , Biomarcadores/sangue , Estudos de Coortes , Diabetes Mellitus Tipo 2/diagnóstico , Nefropatias Diabéticas/fisiopatologia , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Insuficiência Renal/sangue , Insuficiência Renal/complicações , Insuficiência Renal/diagnóstico , Estudos Retrospectivos
16.
Neurol Res ; 42(1): 55-61, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31903867

RESUMO

Objectives: This study aimed to assess the preoperative risk factor for perioperative ischemic stroke (PIS) in patients undergoing non-cardiovascular and non-neurological surgeries.Methods: Patients were retrospectively enrolled and grouped into two groups at a ratio of 1:2 according to their PIS status, i.e. patients with PIS in disease group, and patients without PIS in control group. Univariate analysis and multivariate logistic regression analysis were performed on admission laboratory test indices and preoperative risk factors for stroke. The pooled cohort equation (PCE), Essen Stroke Risk Score (ESRS), and Stroke Prognostic Instrument II (SPI-II) were used to separately assess the risk of stroke in patients with or without a history of stroke.Results: There were significant differences between the two groups in the levels of high-density lipoprotein cholesterol (HDL-C), prealbumin, renal insufficiency, dyslipidemia, coronary heart disease, anemia, and hemoglobin; the incidence of electrolyte disturbance; and previous histories of smoking, drinking, and stroke. Multivariate logistic regression analysis showed that renal insufficiency, histories of smoking and stroke, and decreased HDL-C can increase the risk of PIS. There were no significant differences between the disease group and the control group in ESRS or SPI-II score in patients with stroke history. There was a significant difference between the two groups in the risk of PIS evaluated by PCE in patients without stroke history.Conclusions: History of stroke and smoking, renal insufficiency, and low HDL-C are independent risk factors for PIS. It is feasible to assess the risk of stroke in preoperative patients using PCE in clinical practice.


Assuntos
Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/epidemiologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal/diagnóstico , Insuficiência Renal/epidemiologia , Insuficiência Renal/cirurgia , Estudos Retrospectivos , Fatores de Risco , Fumar/efeitos adversos , Fumar/epidemiologia
17.
Bull Cancer ; 107(1S): S28-S35, 2020 Jan.
Artigo em Francês | MEDLINE | ID: mdl-31303250

RESUMO

Acute and chronic renal failures are very common after allogeneic HSCT. These complications have a real impact on mortality and morbidity of transplant recipients. Within the framework of the ninth workshops of practice harmonization of the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) held in Lille in September 2018, various causes and mechanisms of renal failure, diagnostic work-up, treatment and recommendations to limit renal failure after transplantation are reviewed. Recommendations to adjust medications to avoid renal failure are also proposed in this article.


Assuntos
Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Insuficiência Renal/etiologia , Insuficiência Renal/prevenção & controle , Anti-Infecciosos/efeitos adversos , Doença Enxerto-Hospedeiro/diagnóstico , Doença Enxerto-Hospedeiro/etiologia , Doença Enxerto-Hospedeiro/terapia , Humanos , Imunossupressores/efeitos adversos , Incidência , Síndrome Nefrótica/etiologia , Insuficiência Renal/diagnóstico , Insuficiência Renal/terapia , Índice de Gravidade de Doença , Microangiopatias Trombóticas , Condicionamento Pré-Transplante/efeitos adversos , Transplante Homólogo
18.
Angiology ; 71(3): 249-255, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31808357

RESUMO

Contrast-induced nephropathy (CIN) is one of the most important complications after invasive cardiovascular procedures. The neutrophil-to-lymphocyte ratio (NLR), mean platelet volume-to-lymphocyte ratio (MPVLR), and platelet-to-lymphocyte ratio (PLR) may be markers of the risk of CIN. We aimed to investigate the association of these indices with the development of CIN in patients with ST-elevation myocardial infarction and non-ST-elevation-acute coronary syndrome who underwent percutaneous coronary intervention. We retrospectively collected the data of patients with ACS after coronary angiography (CA); 564 patients were included (mean age, 62.3 ± 13.0 years; 41.1% female). We compared 62 (10.9%) patients who developed CIN and 502 patients who did not, after CA in terms of NLR, PLR, and MPVLR. Patients who developed CIN had significantly higher MPVLR, NLR, and PLR; the MPVLR (P ≤ .001) was an independent predictor of CIN. NLR, MPVLR, and PLR are simple, cheap, and easily accessible tests that can predict CIN; the MPVLR was the strongest of these predictors.


Assuntos
Síndrome Coronariana Aguda/fisiopatologia , Angiografia Coronária , Neutrófilos/citologia , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Adulto , Idoso , Plaquetas/citologia , Angiografia Coronária/métodos , Feminino , Humanos , Masculino , Volume Plaquetário Médio/métodos , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/metabolismo , Intervenção Coronária Percutânea/métodos , Insuficiência Renal/diagnóstico , Insuficiência Renal/metabolismo , Estudos Retrospectivos , Fatores de Risco
19.
Mayo Clin Proc ; 95(1): 77-89, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31630870

RESUMO

OBJECTIVE: To investigate the pharmacodynamic properties of inclisiran, a small interfering RNA targeting proprotein convertase subtilisin-kexin type 9 (PCSK9), in individuals with normal renal function and renal impairment (RI). PATIENTS AND METHODS: The analysis included participants with normal renal function and mild, moderate, and severe RI from the phase 1 ORION-7 renal study (n=31) and the phase 2 ORION-1 study (n=247) who received 300 mg of inclisiran sodium or placebo. RESULTS: In ORION-7, PCSK9 values were reduced at day 60 in the normal renal function group (68.1%±12.4%), mild RI group (74.2%±12.3%), moderate RI group (79.8%±4.9%), and severe RI group (67.9%±16.4%) (P<.001 vs placebo in all groups). Low-density lipoprotein cholesterol levels were significantly reduced versus placebo: normal renal function, 57.6%±10.7%; mild RI, 35.1%±13.5%; moderate RI, 53.1%±21.3%; severe RI, 49.2%±26.6% (P<.001 for all). In ORION-1, PCSK9 level reductions at day 180 were 48.3% to 58.6% in the 300-mg single-dose groups and 67.3% to 73.0% in the 300-mg 2-dose groups (P<.001 vs placebo in all groups). The corresponding low-density lipoprotein cholesterol level reductions were 35.7% to 40.2% in the 300-mg single-dose groups and 50.9% to 58.0% in the 300 mg 2-dose groups (P<.001 vs placebo in all groups). In ORION-7, exposure to inclisiran was proportionally greater in individuals with increasing RI; inclisiran was undetectable in plasma 48 hours after administration in any group. CONCLUSION: The pharmacodynamic effects and safety profile of inclisiran were similar in study participants with normal and impaired renal function. Dose adjustments of inclisiran are not required in these patients. TRIAL REGISTRATION: clinicaltrials.gov Identifiers: NCT02597127 and NCT03159416.


Assuntos
LDL-Colesterol/sangue , Doença da Artéria Coronariana , RNA Interferente Pequeno , Insuficiência Renal , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/tratamento farmacológico , Monitoramento de Medicamentos/métodos , Feminino , Humanos , Hipolipemiantes/administração & dosagem , Hipolipemiantes/efeitos adversos , Hipolipemiantes/farmacocinética , Testes de Função Renal/métodos , Masculino , Taxa de Depuração Metabólica , Pessoa de Meia-Idade , Pró-Proteína Convertase 9/antagonistas & inibidores , RNA Interferente Pequeno/administração & dosagem , RNA Interferente Pequeno/efeitos adversos , RNA Interferente Pequeno/farmacocinética , Insuficiência Renal/diagnóstico , Insuficiência Renal/fisiopatologia , Resultado do Tratamento
20.
J Ethnopharmacol ; 248: 112354, 2020 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-31689480

RESUMO

ETHNOPHARMACOLOGICAL RELEVANCE: Fufang Chuanxiong capsule consists of Angelica sinensis radix and Chuanxiong rhizome, which are used in the traditional Chinese medicine for the treatment of coronary artery disease, and Xinyue capsule is composed of panax quinquefolius saponin extracted from leaves and stems of Panax quinquefolium L, which has the functions of anti-myocardial ischemia, improving myocardial energy metabolism and inhibiting apoptosis of cardiomyocytes. OBJECTIVE: To observe the role of Chinese herbal medicines in the cardiovascular outcome among patients with acute coronary syndrome (ACS) and renal insufficiency after percutaneous coronary intervention (PCI). METHODS: The subjects came from the 5C trial (chictr.org number: chictr-trc-07000021), post-PCI patients suffered from ACS with mild-to-moderate renal insufficiency (30 mL•min-1•1.73 m-2 < estimated glomerular filtration rate≤89 mL•min-1•1.73 m-2) included. The study population consisted of 215 subjects in the control group who were treated with western medicine standard therapy, and 211 subjects in the treatment group who were treated with Chinese herbal medicines (Fufang Chuanxiong Capsule and Xinyue Capsule) for 6 months on the basis of western medicine standard therapy. All were followed for 1 year. The primary endpoint included the composite of cardiac death, nonfatal recurrent myocardial infarction, and ischemia-driven revascularization. Secondary endpoint included the composite of stroke, congestive heart failure, and readmission for ACS. The serum creatinine and estimated glomerular filtration rate (eGFR) were evaluated. RESULTS: After 1 year follow-up of two groups, there were 16 cases of primary endpoint in the control group and 6 cases of primary endpoint in the treatment group [absolute risk reduction (ARR): 0.046, 95%CI: 0.004-0.088; relative risk (RR): 0.38, 95%CI: 0.15-0.96, P = 0.040]. There were 15 cases of secondary endpoint in the control group and 5 cases of secondary endpoint in the treatment (ARR: 0.041, 95%CI: 0.006-0.086; RR: 0.34, 95%CI: 0.13-0.92, P = 0.033). The eGFR in the treatment group was significantly higher than that in the control group (75.19 ±â€¯16.74 mL min-1·1.73 m-2 VS 72.03 ±â€¯14.96 mL min-1·1.73 m-2, P < 0.05). The eGFR in the treatment group was significantly higher after the intervention with Chinese herbal medicines than that before intervention (72.27 ±â€¯11.83 mL min-1·1.73 m-2 VS 75.19 ±â€¯16.74 mL min-1·1.73 m-2, P < 0.05). CONCLUSION: Chinese herbal medicines plus western medicine standard therapy improved clinical outcomes in patients with ACS and mild-to-moderate renal insufficiency. Additionally, this study also demonstrated Chinese herbal medicines were useful in deferring decline of renal function.


Assuntos
Síndrome Coronariana Aguda/terapia , Medicamentos de Ervas Chinesas/uso terapêutico , Taxa de Filtração Glomerular/efeitos dos fármacos , Rim/efeitos dos fármacos , Intervenção Coronária Percutânea , Insuficiência Renal/tratamento farmacológico , Síndrome Coronariana Aguda/diagnóstico por imagem , Síndrome Coronariana Aguda/mortalidade , Idoso , Causas de Morte , China , Progressão da Doença , Medicamentos de Ervas Chinesas/efeitos adversos , Feminino , Humanos , Rim/fisiopatologia , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/mortalidade , Recidiva , Insuficiência Renal/diagnóstico , Insuficiência Renal/mortalidade , Insuficiência Renal/fisiopatologia , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA