Changes In Renal Function Research Articles

Effects of electroacupuncture at KI3 and ST36 on the hypothalamic paraventricular nucleus in a rat model of chronic glomerulonephritis.

The hypothalamic paraventricular nucleus (PVN) acts as a critical integrating center of endocrine/autonomic responses and regulates visceral functional activities. However, its involvement in electroacupuncture (EA) treatment of chronic glomerulonephritis (CGN) remains unclear. Over four experiments, we randomized 111 rats into: control, untreated model (CGN) or EA-treated model (CGN + EA) groups, a model group receiving EA after PVN damage (CGN + EA + Lesion) or untreated model groups injected with adeno-associated viral vectors encoding human M4 muscarinic receptor (CGN + hM4D) or enhanced green fluorescent protein (CGN + EGFP). CGN was modeled by intraperitoneal injection of bovine serum albumin for 2 weeks. Rats in the CGN + EA and CGN + EA + Lesion groups received EA at bilateral ST36 and KI3 for 14 days. Urine/serum samples were collected to evaluate inflammatory factors and changes in renal function. EA inhibited the release of interleukin (IL)-6, tumor necrosis factor (TNF)-α and IL-1β, and decreased urine protein (PRO), creatinine (Cre) and blood urea nitrogen (BUN) levels. PVN damage influenced the effect of EA on the levels of these parameters. EA appeared to inhibit the firing frequency and spectral energy of PVN neurons. In the viral vector experiment, levels of PRO, Cre, IL-6, IL-1β and TNF-α in the CGN group were increased in CGN versus control groups (p < 0.0001), decreased in CGN + hM4D versus CGN groups (p < 0.05) and did not differ between CGN + EGFP and control groups (p > 0.05). Our findings indicate that EA at ST36 and KI3 improves CGN in this rat model by weakening the activity of PVN neurons, alleviating impairment of renal function impairment and restricting the release of inflammatory factors.

Safety, Efficacy and Mid-Term Outcome for Transarterial Embolization (TAE) of Renal Angiomyolipoma (AML) Using Ethylene Vinyl Alcohol Copolymer Liquid Embolic Agent (EVOH).

Transarterial embolization (TAE) of renal angiomyolipoma (AML) is effective in treating and preventing hemorrhage. We report our experience using EVOH with a single-center retrospective study of all AML embolized with EVOH between June 2013 and March 2022 at the Montpellier University Hospital. A total of 29 embolizations were carried out in 24 consecutive patients (mean age: 53.86 years; 21 women and 3 men) with 25 AMLs for severe bleeding, symptomatic AML, tumor size > 4 cm, or presence of aneurysm(s) > 5 mm. Data collected included imaging and clinical outcomes, tuberous sclerosis complex status, change in AML volume, rebleeding, renal function, volume and concentration of EVOH used, and complications. Out of 29 embolizations performed for 25 AMLs, four were performed in an emergency. Technical success was achieved for 24/25 AMLs. Mean AML volume reduction was 53.59% after a mean follow-up time of 446 days using MRI or CT scan. Aneurysms on angiogram and the symptomatological nature of AML, as well as secondary TAE and multiple arterial pedicles, were statistically associated (p < 0.05). Two patients (8%) underwent nephrectomy after TAE. Four patients had a second embolization. Minor and major complication rates were 12% and 8%, respectively. Neither rebleeding nor renal function impairment was noticed. TAE of AML using EVOH is, thus, highly effective and safe.

Sequential afferent and sympathetic renal denervation impact on cardiovascular and renal homeostasis in the male Sprague-Dawley rat

Renal denervation (RDNx) is emerging as a promising treatment for cardiovascular disease, yet the underlying mechanisms and contributions of afferent (sensory) and efferent (sympathetic) renal nerves in healthy conditions remains limited. We hypothesize that sympathetic renal nerves contribute to long-term MAP and renal function, whereas afferent renal nerves do not contribute to the maintenance of cardiovascular and renal function. To test this hypothesis, we performed two experiments. In experiment one, we performed total renal denervation (T-RDNx), ablating afferent and sympathetic renal nerves, in normotensive adult SD rats to determine effects on MAP and renal function. Experiment 2 employed a sequential surgical ablation using: (1) afferent targeted renal denervation (A-RDNx), then (2) sympathetic (T-RDNx) denervation to determine the individual contributions to cardiovascular and renal homeostasis. In experiment 1, MAP decreased following T-RDNx and GFR increased. In experiment 2, A-RDNx led to an increase in MAP but did not change renal function. In contrast, T-RDNx decreased MAP and improved renal filtration. Together, these data partially support our hypothesis that renal sympathetic nerves contribute to the chronic regulation of arterial pressure and renal function. Contrary to the hypothesis, A-RDNx produced an increase in MAP without a detected change in renal function. We concluded that renal sympathetic nerves influence MAP and renal function regulation through a well-defined tonic contribution to renal vascular resistance and sodium reabsorption, whereas afferent renal nerves likely contribute to the maintenance of MAP through a tonic sympatho-inhibitory, negative feedback regulation in the normotensive, healthy rat.

Effects of Dietary Sodium and Protein Intake on Glomerular Filtration Rate in Subjects with Type 2 Diabetes Treated with Sodium-Glucose Cotransporter 2 Inhibitors.

Approximately one-fourth of patients treated with sodium-glucose cotransporter 2 inhibitors (SGLT2i) experience an acute estimated glomerular filtration rate (eGFR) reduction of more than 10% ("dippers"). High sodium and protein intake can increase intraglomerular pressure and predispose to a decline in renal function. We investigated whether measured creatinine clearance (CrCl) is a sensitive enough method to detect the initial dip of GFR and if dietary sodium and protein intake might influence the extent of the early change in GFR. 28 subjects with type 2 diabetes (T2D) were enrolled. For sodium and urea determination, 24-h urinary samples were collected to estimate sodium and protein intake respectively before and 1, 3 and 6 months after SGLT2i initiation. Mean CrCl was 83.23±25.52 mL/min/1.73 m2 (eGFR 67.32±16.07) and dropped by 19% at month 1 (eGFR by 6%). Dippers were 64 and 40%, according to CrCl and eGFR, respectively. Exploring the potential correlation between changes in renal function and salt intake, ΔCrCl and baseline urinary sodium were inversely related at month 1 (r=-0,61; p<0.01), at month 3 (r=-0.51; p=0.01) and month 6 (r=-0,48; p<0.05). Likewise, an inverse correlation between ΔCrCl and baseline urinary urea was demonstrated at months 1 and 3 (r=-0.46; p<0.05 for both); at month 6, a similar trend was observed (r=-0.47; p=0.054). The present study suggests that a higher dietary sodium and protein intake may amplify the extent of the early dip in GFR, as detected with measured CrCl, in diabetic patients undergoing SGLT2i treatment.

Long-Term Results in Recipients of Late Conversion to a Calcineurin Inhibitor-Free Regimen with Everolimus After Kidney Transplantation

Conversion to a calcineurin inhibitor (CNI)-free regimen in cases of CNI nephrotoxicity (CNIT) is a strategy to improve the long-term outcomes of kidney transplantation. However, the long-term results of late conversion to a CNI-free regimen using everolimus (EVR) remain uncertain. Nine kidney transplant recipients with biopsy-confirmed CNIT were enrolled. The median time of CNIT diagnosis was 9.0 years. All recipients underwent a conversion from CNI to EVR. We evaluated the clinical outcomes, development of donor-specific antibody (DSA), the incidence of rejection, alternativearteriolar hyalinosis (aah) scores, renal function changes, and T cell responses by mixed lymphocyte reaction (MLR) assay after conversion. The median follow-up after conversion was 5.4 years. Currently, 7 of 9 recipients have received a CNI-free regimen for 1.6 to 9.5 years. In the other 2 recipients, one experienced graft loss due to CNIT 3.8 years after conversion, and the other had to resume CNI due to acute T cell-mediated rejection (ATMR) a year after conversion. None of the recipients developed DSA. No rejection was observed in the kidney allograft histology except for the ATMR case. Moreover, improvement in aah scores was noted in one patient. Furthermore, serum creatinine levels were stable in recipients without proteinuria before the EVR add-on. In the MLR analysis, low responses against donors were observed in stable patients. Late conversion to an EVR-based regimen without CNI may be a promising therapeutic strategy against CNIT, particularly for recipients without proteinuria before the EVR add-on.

Diabetic kidney disease: Risk factors, challenges and opportunities in the era of precision medicine

DKD is now recognized as the primary cause of chronic and end-stage-renal disease worldwide. The disease is characterized by changes in renal function and structure, followed by a gradual decline in kidney function, leading to ESRD. Risk factors for DKD include age, sex, race/ethnicity, family history of hyperglycemia and AKI. Recent studies have shown that certain medication classes, such as SGLT-2 inhibitors, can protect the kidneys independent of diabetes control. However, there are still gaps in our understanding of DKD, and its diagnosis is subjective due to the lack of a noninvasive biomarker. This makes it challenging to design clinical trials to identify effective treatments for the disease. Our review article aims to provide information on basic mechanisms of DKD, various treatment strategies and challenges by using personalized approaches to diagnosis and prevention.

Efficacy and safety of entecavir for hepatitis B virus-associated glomerulonephritis with renal insufficiency.

HBV-GN is one of the most common secondary kidney diseases in China. Entecavir is a first-line antiviral therapy in patients with HBV-GN. This retrospective study explored whether entecavir is effective and safe for the treatment of HBV-GN with renal insufficiency. We screened patients diagnosed with HBV-GN in The Affiliated Hospital of Qingdao University who had elevated serum creatinine levels. Group 1 (30 patients) was given entecavir as antiviral treatment. Group 2 (28 patients) was treated with ARBs. Changes in renal function and the possible influencing factors were observed, with a mean follow-up duration of 36months. At the end of follow-up, the elevation in the serum creatinine level and reduction in the eGFR were greater in group 1 than in group 2. The overall renal survival rate, using eGFR < 15ml/min as the primary renal end point, was 96.7% in group 1 and 67.9% in group 2. Urine protein excretion was decreased in both groups. Treatment with entecavir and the remission of proteinuria were protective factors against renal function impairment, while a lower baseline eGFR was a risk factor for progression to ESRD. Entecavir slows the progression of renal function impairment in HBV-GN and exerts a significant renal protective effect.

Three-dimensional Virtual Models of the Kidney with Colored Perfusion Regions: A New Algorithm-based Tool for Optimizing the Clamping Strategy During Robot-assisted Partial Nephrectomy

BackgroundAn empirical selective clamping strategy based on the direction of the arterial branches can lead to failures during partial nephrectomy, even when assisted by three-dimensional virtual models (3DVMs). ObjectiveTo develop and test new 3DVMs that include kidney perfusion regions and evaluate their intraoperative accuracy in guiding selective clamping and their impact on postoperative renal function. Design, setting, and participantsFor patients with a kidney suitable for nephron-sparing surgery, 3DVMs were supplemented with a Voronoi diagram, a Euclidean distance–based mathematical tool, to calculate vascular-dominant regions the kidney. Surgical procedureRobot-assisted partial nephrectomy guided by perfusion-region (PR)-3DVMs. MeasurementsAll anatomic information given by the PR-3DVMs was collected. Selective or superselective clamping was planned and performed intraoperatively when feasible under 3DVM assistance. Changes in split renal function (SRF) and estimated renal plasmatic flow (ERPF) were evaluated for 51 patients who underwent baseline and 3-mo postoperative renal scintigraphy. Results and limitationsA total of 103 patients were prospectively enrolled. The median number of kidney and tumor perfusion regions were 8 (interquartile range [IQR] 7–10) and 3 (IQR 2–3), respectively. A clampless, selective clamping, and global clamping strategy was applied in eight (7.8%), 79 (76.6%), and 16 (15.5%) cases, respectively, with no differences between planning and surgery in terms of the number or order of arteries clamped or the perfusion regions that underwent ischemia. Among the 51 patients who underwent renal scintigraphy, the mean SRF decreased by 11.3%, 7.7%, and 1.7% after global, selective, and superselective clamping, respectively (p = 0.004). Similar results were obtained for ERPF (18.9%, 9.9%, and 6.0%; p = 0.02). The main limitation is the need for a bioengineer to manually refine the 3DVMs. ConclusionsUse of mathematical algorithms for 3DVMs allows precise estimation of kidney perfusion regions to maximize the efficacy of selective clamping and minimize renal function impairment. Patient summaryThree-dimensional models that include regions of blood flow to the kidney can be used to guide clamping of blood vessels when part of the kidney is being surgically removed. More limited clamping can reduce damage to the remaining portion of the kidney and result in better recovery of kidney function after surgery.

Impact of OTC Purchase and Utilization of Pain Killers in Rheumatoid Arthritis

Pain may be alleviated externally using topical therapies. It's true that topical pain relievers are effective. A lot of the time they also cause a thermal or a thermal sensation on the skin. The lack of systemic absorption means that topical therapies are safer than oral drugs. There are a variety of over-the-counter (OTC) topical creams, sprays, and gel pain relievers available for the treatment of arthritis and other types of physical pain. Both nonsteroidal anti-inflammatory drugs (NSAIDs) and capsaicin, the chemical responsible for chilli peppers' spiciness, may be used. Yet, NSAIDs are not without hazards and adverse effects. Prostaglandins are involved in a variety of processes in addition to pain. Yet, since NSAIDs lower prostaglandins in the body, the stomach lining may become more susceptible to injury from acid. Causes of stomach distress, ulcers, and internal bleeding may result from this. Additional potential NSAID side effects include hives, wheezing, which may be harmful for those with asthma; changes in renal function; and a rash. This study takes an indepth look at the use of pain killers in rheumatoid arthritis.

The rationale and study design of two phase II trials examining the effects of BI 685509, a soluble guanylyl cyclase activator, on clinically significant portal hypertension in patients with compensated cirrhosis

BackgroundClinically significant portal hypertension (CSPH) drives cirrhosis-related complications (i.e. hepatic decompensation). Impaired nitric oxide (NO) bioavailability promotes sinusoidal vasoconstriction, which is the initial pathomechanism of CSPH development. Activation of soluble guanylyl cyclase (sGC), a key downstream effector of NO, facilitates sinusoidal vasodilation, which in turn may improve CSPH. Two phase II studies are being conducted to assess the efficacy of the NO-independent sGC activator BI 685509 in patients with CSPH due to various cirrhosis aetiologies.MethodsThe 1366.0021 trial (NCT05161481) is a randomised, placebo-controlled, exploratory study that will assess BI 685509 (moderate or high dose) for 24 weeks in patients with CSPH due to alcohol-related liver disease. The 1366.0029 trial (NCT05282121) is a randomised, open-label, parallel-group, exploratory study that will assess BI 685509 (high dose) alone in patients with hepatitis B or C virus infection or non-alcoholic steatohepatitis (NASH) and in combination with 10 mg empagliflozin in patients with NASH and type 2 diabetes mellitus for 8 weeks. The 1366.0021 trial will enrol 105 patients, and the 1366.0029 trial will enrol 80 patients. In both studies, the primary endpoint is the change from baseline in hepatic venous pressure gradient (HVPG) until the end of treatment (24 or 8 weeks, respectively). Secondary endpoints include the proportion of patients with an HVPG reduction of >10% from baseline, the development of decompensation events and the change from baseline in HVPG after 8 weeks in the 1366.0021 trial. In addition, the trials will assess changes in liver and spleen stiffness by transient elastography, changes in hepatic and renal function and the tolerability of BI 685509.DiscussionThese trials will enable assessment of the short-term (8 weeks) and longer-term (24 weeks) safety of BI 685509, and the effect of sGC activation by BI 685509 on CSPH due to various cirrhosis aetiologies. The trials will use central readings of the diagnostic gold standard HVPG for the primary endpoint, and changes in established non-invasive biomarkers, such as liver and spleen stiffness. Ultimately, these trials will provide key information for developing future phase III trials.Trial registration1366.0021: EudraCT no. 2021–001285-38; ClinicalTrials.gov NCT05161481. Registered on 17 December 2021, https://www.clinicaltrials.gov/ct2/show/NCT05161481.1366.0029: EudraCT no. 2021–005171-40; ClinicalTrials.gov NCT05282121. Registered on 16 March 2022, https://www.clinicaltrials.gov/ct2/show/NCT05282121.

Safety assessment of a three-dimensional-printed autologous omentum patch: An application on the kidneys as a new treatment approach.

Recently, the field of regenerative medicine has made great strides in the development of new treatments for various organ dysfunctions. One of the most promising new approaches is the use of three-dimensional (3D) printing and autologous tissues. In this study, we evaluated the safety of a 3D-printed autologous omentum patch to kidneys using large animals. A total of seven micropigs underwent transplantation of the 3D-printed autologous omentum patch. Twelve weeks after transplantation, the safety was evaluated by measuring body weight, blood, and the renal resistive index. In addition, biopsy samples were histologically analyzed. The results showed no surgical complications, renal functional hematological changes, or inflammatory responses. Therefore, this study provides important insights into direct therapy to kidneys with a 3D-printed patch made of autologous tissue. Furthermore, it has the potential for the development of new therapies for various organ dysfunction.

Evaluation of the safety of retroperitoneal laparoscopic partial nephrectomy by investigating the perioperative indicators.

In recent years, open nephron sparing partial nephrectomy (OPN) has been gradually applied and generally accepted. Recent statistical data show that PN not only can safely and effectively preserve the functional nephron, but also has fewer complications, low local recurrence rate and no significant difference in long-term survival rate compared with nephrectomy/radical nephrectomy, which has gradually become a routine treatment for small renal cell carcinoma. Therefore, how to maximize the protection of postoperative residual renal function (RRF) and reduce the risk of CKD while achieving the ideal local and overall tumor control effect is the key to the treatment of renal cancer, and is also the focus of attention of urologists and nephrologists. To evaluate the safety of retroperitoneal laparoscopic partial nephrectomy (RLPN) by investigating the perioperative indicators and postoperative follow-up. A total of 40 hospitalized patients in our hospital from December 2019 to December 2021 were selected and followed up for a long time. Patients with renal tumors less than 4cm in diameter and exogeneous or partial exogeneity were randomly divided into 2 groups. Patients in retroperitoneal laparoscopic group (n = 20) were treated with nephron sparing partial nephrectomy (0.5-1cm). Twenty patients underwent retroperitoneal laparoscopic radical nephrectomy (LRN).The time of removal of drainage tube, drainage volume, time of feeding activity and postoperative hospital stay were recorded, and the safety of the operation was evaluated. nephron sparing partial nephrectomy is suitable for patients with localized renal carcinoma or benign tumor <4cm. RLPN can be applied to all indications of open nephron sparing partial nephrectomy (OPN), with good safety, and can preserve residual renal function to the greatest extent. The operative vascular occlusion time was controlled within 40 minutes, and the use of renal function protection measures during the operation was safe and controllable in reducing the prevention of warm ischemic kidney damage, with good safety. The renal tumor capsule with 0.5cm~1cm margin was complete by postoperative pathology. In the process of tumor resection and suture collection system in the RLPN group, we improved the previous operation of "resection before hemostasis" to "resection while hemostasis" and "knot-free suture" technology, which saved the operation time of intracavity suture knotting. Reduced cortical tear caused by vertical pull during knot tying. The combined effect of biological clip and hemostatic gauze can stimulate the granulation proliferation of renal cortical wound and accelerate the repair. With the combination of knot-free suture and renal segment vascular occlusion, hot ischemic kidney damage is reduced. In the RLPN group, there were no complications of urinary fistula and bleeding, and no abnormal changes in renal function during follow-up. The safety of RLPN group is worthy of affirmation. The perioperative safety and short-term postoperative renal function recovery of RLPN are good, and the overall safety of this operation is worthy of affirmation.

NOVEL TECHNIQUE OF SHORT-ACTING SPINAL ANAESTHESIA FOR FRACTURE NECK OF FEMUR SURGERY ALLOWING EARLY MOBILIZATION, REDUCING MORBIDITY AND MORTALITY, AND IMPROVING OVERALL FUNCTIONAL OUTCOME

Prompt mobilisation after the Fracture neck of femur surgery is one of the important key performance index (‘KPI caterpillar charts’ 2021) affecting the overall functional outcome and mortality. Better control of peri-operative blood pressure and minimal alteration of renal profile as a result of surgery and anaesthesia may have an implication on early post-operative mobilisation.Aim was to evaluate perioperative blood pressure measurements (duration of fall of systolic BP below the critical level of 90mmHg) and effect on the post-operative renal profile with the newer short acting spinal anaesthetic agent (prilocaine and chlorprocaine) used alongside the commonly used regional nerve block. 20 patients were randomly selected who were given the newer short acting spinal anaesthetic agent along with a regional nerve block between May 2019 and February 2020. Anaesthetic charts were reviewed from all patients for data collection. The assessment criteria for perioperative hypotension: Duration of systolic blood pressure less than 90 mm of Hg and change of pre and post operative renal functions.Only one patient had a significant drop in systolic BP less than 90mmHg (25 minutes). 3 other patients had a momentary fall of systolic BP of less than 5 minutes. None of the above patients had mortality and had negligible change in pre and post op renal function. Only one patient in this cohort had elevation of post-operative creatinine levels but did not have any mortality. Only 1 patient died on day 3 post operatively who had multiple comorbidities and was under evaluation for GI cancer. Even in this patient the peri-operative blood pressure was well maintained (never below 90mmHg systolic) and post-operative renal function was also shown to have improved (309 pre-operatively to 150 post-operatively) in this patient.The use of short-acting spinal anaesthesia has shown to be associated with a better control of blood pressure and end organ perfusion, less adverse effects on renal function leading to early mobilisation and a more favourable patient outcome with reduced mortality, earlier mobilisation, shorter hospital stay and earlier discharge in this elderly patient cohort.

Comparative outcomes of anticoagulation alone versus anticoagulation plus endovascular intervention in adults with isolated renal vein thrombosis

BackgroundLimited therapeutic strategies are available for adults with isolated renal vein thrombosis (RVT). In the present study, we explore and compare the efficacy of anticoagulation therapy alone vs anticoagulation plus endovascular intervention in the treatment of this rare disease. MethodsIn the present study, we analyzed the clinical data of RVT patients treated in a tertiary referral center in urban China from April 2012 to April 2022. These patients were classified into anticoagulation therapy (best medical treatment [BMT]) and endovascular intervention (endovascular-based treatment [EBT]) groups. The primary end points, including thrombus clearance and renal function changes, were evaluated by measuring the serum creatinine levels and glomerular filtration rates (GFRs). ResultsA total of 40 consecutive patients with RVT (25 men and 15 women) were included in the present study, with a median age of 37 years (range, 18-72 years). Some patients developed symptoms, including 12 with low back pain (30%), 11 with lower extremity edema (28%), and 10 with abdominal pain (30%). Nephrotic syndrome was the underlying etiology for most patients (30 of 40; 75%). Additionally, 28 patients (70%) developed unilateral RVT, including 18 cases of left RVT (45%). Of the 40 patients, 17 had received BMT (42%) and 23 had received EBT (58%). In the acute phase of RVT, defined as <14 days from symptom onset, the EBT group had higher thrombus clearance and better improvement of creatinine and GFR after treatment compared with the BMT group (P < .05). In the subacute phase, defined as 14 to 30 days after symptom onset, thrombus clearance was higher in the EBT group than in the BMT group (P < .05). However, the improvement in creatinine and GFR were insignificantly different between the two groups (P > .05). ConclusionsThe etiologies of RVT can and should be investigated. In the present study, RVT was primarily caused by nephrotic syndrome in young patients and also was attributed to malignancy and lupus nephritis. In addition to anticoagulation therapy, endovascular intervention, including catheter-directed thrombolysis and mechanical thrombectomy, contributed to the improvement of renal function in patients with acute RVT. Endovascular intervention markedly promoted thrombus clearance in patients in the subacute phase but did not improve renal function. Therefore, endovascular intervention should be considered if RVT is diagnosed in the acute phase.

Observation of the application effect of low-volume polyethylene glycol electrolyte lavage solution (PEG-ELS) combined with ascorbic acid tablets in bowel preparation for colonoscopy in hospitalized patients

This study explored the effectiveness and safety of low-volume polyethylene glycol electrolyte lavage solution (PEG-ELS) combined with ascorbic acid tablets (PEG-ELS/Asc) in bowel preparation for a colonoscopy. A total of 240 hospitalized patients who underwent a colonoscopy in Wenzhou People's Hospital, Wenzhou Third Clinical College of Wenzhou Medical University from July 2020 to June 2022 were randomly divided into two groups, with 120 patients each. All of the participants were given a low-residue or residue-free diet one day before the examination and fasted after dinner (completed before 18:00) the day before the examination. The 2-L PEG-ELS/Asc group took 2-L PEG-ELS plus 10g ascorbic acid tablets once orally, while the 3-L PEG-ELS group took 3-L PEG orally on several occasions. The primary endpoint was the achievement of preparation adequacy and an overall colon cleansing score of ≥6, both assessed by blinded investigators using the Boston Bowel Preparation Scale (BBPS). The bowel cleansing effect, polyp detection rate, adverse reaction rate, oral drug tolerance rate, renal function, and electrolyte level changes were also compared between the two patient groups. There were no significant differences in the success rate of bowel preparation, the detection rate of polyps, or the adverse reaction rate between the two groups (P > 0.05). The tolerance rate of bowel preparation in the 2-L PEG-ELS/Asc group was significantly higher than that in the 3-L PEG-ELS group (93.3% vs. 80.23%) (P < 0.05). The levels of creatinine, serum potassium, serum sodium, and serum chlorine of the two groups before and after bowel preparation were within the normal range. In addition, the intestinal cleaning effect of the two preparation schemes for the hospitalized patients with diabetes and constipation is worse than that of those without these conditions (P < 0.05). The effectiveness and safety of using 2-L PEG-ELS/Asc in bowel preparation for a colonoscopy in hospitalized patients were not inferior to using 3-L PEG-ELS. For patients with diabetes and constipation, the cleansing effect of the two bowel preparation options was not very satisfactory, and further clinical research is needed in this regard.

Associations of Renal Function Trajectories and Long-Term Cardiovascular Risks Among a Population Without Chronic Kidney Disease.

Background The longitudinal trajectories of renal function have been associated with cardiovascular events in patients with chronic kidney disease (CKD). However, the change pattern of renal function in those without CKD has not yet been reported. We aim to explore patterns of renal function change in a non-CKD population and its associated risks with cardiovascular outcomes. Methods and Results The present study analyzed data from 4 prospective cohorts and was restricted to participants without baseline CKD. The primary outcome was major adverse cardiovascular events, defined as a composite of myocardial infarction, chronic heart failure, stroke, and cardiovascular deaths. We used a group-based trajectory model to identify latent groups and analyzed the associated risk with Cox regression models. The complete dates of this study were June 1, 2020, through January 1, 2021. The final sample comprised 23 760 participants (mean age, 58.63 [9.12] years, 10 618 men, and 17 799 White participants). During 20.56 years follow-up, 8328 (35.05%) first major adverse cardiovascular events happened. Four trajectories in estimated glomerular renal function and 3 patterns of CKD progression were identified. Compared with subjects assigned to class I trajectory (high to mildly decreased group), the adjusted hazard ratios of major adverse cardiovascular events for class II (normal to mildly decreased group), class III (normal to moderately decreased group), and class IV (mildly to severely decreased group) were 1.11 (95% CI, 1.01-1.23), 1.27 (95% CI, 1.14-1.40), and 1.56 (95% CI, 1.38-1.77), respectively. Likewise, participants assigned to the slow and rapid progression groups had elevated HRs for major adverse cardiovascular events (1.75 [95% CI, 1.39-2.21] and 2.19 [95% CI, 1.68-2.86], respectively) when compared with the stable group. Findings were generally consistent in stratification analysis, but significant interaction effects by age and smoking status were detected. Conclusions In this study, we identified unique trajectory groups for renal function. These findings may signal an underlying high-risk population and inspire future studies on individualized risk management.

Changes in renal function over time in outpatients with eGFR ≥ 30 mL/min/1.73 m2: implication for timing of renal function testing before contrast-enhanced CT imaging

PurposeTo evaluate the associations between comorbidities and kidney function decline at 6-month and 1-year follow-up in outpatients with initial estimated glomerular filtration rate (eGFR) ≥ 30 mL/min/1.73 m2.Materials and methodsOutpatients aged 18 and older with confirmed diagnosis, who had eGFR ≥ 30 mL/min/1.73 m2 measured between April 2017 and March 2019, were included in this retrospective observational study. Of them, 30,595 included outpatients had 6-month eGFR test and 27,698 included outpatients had 1-year eGFR test. The outpatients were further divided into two groups based on initial eGFR: between 30 and 59 and ≥ 60 mL/min/1.73 m2. Impaired renal function was defined as eGFR declined to below 30 mL/min/1.73 m2. The comorbidities with P values less than 0.1 identified in univariable logistic regression models were entered into the multivariable analysis with backward selection, thereby identifying comorbidities that increased the risk of eGFR decline at 6-month and 1-year follow-up.ResultsOutpatients with initial eGFR between 30 and 59 mL/min/1.73 m2 were 175.94 times more likely to have eGFR decline at 6 months, and were 94.10 times more likely to have eGFR decline at 1 year, compared with their corresponding initial eGFR ≥ 60 counterparts. Multivariable logistic regression analyses disclosed that chronic kidney disease, hypertension, and heart failure were independent risk factors for eGFR decline in outpatients with initial eGFR between 30 and 59 mL/min/1.73 m2.ConclusionsOutpatients with initial eGFR ≥ 60 mL/min/1.73 m2 might not need routine eGFR test prior to contrast-enhanced CT scan for 1 year. In addition, chronic kidney disease, hypertension, and heart failure increased the risk of declined renal function, particularly, in outpatients with initial eGFR between 30 and 59 mL/min/1.73 m2.

Voiding and renal function 10 years after radical cystectomy and orthotopic neobladder in women.

To assess long-term voiding and renal function (RF) changes after radical cystectomy (RC) and orthotopic neobladder (ONB) surgery in women without disease recurrence. Women who underwent RC and ONB reconstruction between 1995 and 2011 were included in this study. Patients who developed disease failure or were lost to follow-up were excluded. The study outcomes were long-term voiding function and the incidence and predictors of RF deterioration (defined as >20% decline of baseline). Analysis was performed using the log-rank test and Cox regression analysis. The study included 195 patients with a median (interquartile range) follow-up of 98 (53-151) months, of whom 95 had >10 years of follow-up. Daytime continence, night-time continence and chronic urine retention (CUR) were identified in 170 (87%), 134 (69%) and 52 patients (27%), respectively. Among patients with >10 years of follow-up, 82 (86%), 66 (70%) and 31 (33%) had daytime continence, night-time continence and CUR at the last follow-up visit, respectively. RF deterioration events occurred in 74 patients throughout the follow-up and chronic kidney disease (CKD) stage III-V developed in 80 patients. Patients' age (hazard ratio [HR] 1.41, 95% confidence interval [CI]1.06-1.89; P = 0.02) and serous-lined extramural tunnel diversion (HR 0.43, 95% CI 0.19-0.86; P = 0.02) were the independent predictors of RF deterioration. Among patients with >10 years of follow-up, RF deteriorated in 46 patients (49%) and CKD stage III-V developed in 40 (42%). Women surviving more than 10 years after RC and ONB maintained acceptable continence status, apart from having a higher CUR rate, compared to those followed for <10 years. However, RF deterioration developed in nearly half of them.

MP47-12 SINGLE LAYER CORTICAL RENORRHAPHY AS A SAFE ALTERNATIVE TO DUAL LAYER RENORRHAPHY DURING ROBOTIC PARTIAL NEPHRECTOMY

You have accessJournal of UrologyCME1 Apr 2023MP47-12 SINGLE LAYER CORTICAL RENORRHAPHY AS A SAFE ALTERNATIVE TO DUAL LAYER RENORRHAPHY DURING ROBOTIC PARTIAL NEPHRECTOMY Tarek El-Ghazaly, Jonathan Rosenfeld, Shilajit Kundu, Robert Nadler, and Kent Perry Tarek El-GhazalyTarek El-Ghazaly More articles by this author , Jonathan RosenfeldJonathan Rosenfeld More articles by this author , Shilajit KunduShilajit Kundu More articles by this author , Robert NadlerRobert Nadler More articles by this author , and Kent PerryKent Perry More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003293.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic partial nephrectomy (RPN) is being increasingly adopted in the management of renal masses amenable to nephron-sparing surgery. Robotic renorraphy techniques, including dual layer repairs, have carried over from laparoscopic partial nephrectomy (LPN) which was initially associated with higher bleeding and urine leak rates compared to open partial nephrectomy (OPN). Dual layer repair has been shown in previous studies to prolong warm ischemia time, while potentially leading to a higher rate of pseudoaneurysm formation and worse long term renal function parameters. Our aim is to compare single cortical robotic renorrhaphy (SCRR) to dual-layer robotic renorrhaphy (DLRR) in terms of bleeding rates secondary to pseudoaneurysm formation, urine leak rates, and long-term renal functional outcomes. METHODS: A prospectively maintained list of all RPN procedures at Northwestern Memorial Hospital from January 2018 to July 2022 was retrospectively reviewed. 247 RPNs were identified, including 71 cases with SCRR carried out, and 176 cases with DLRR. Preoperative imaging was used to calculate nephrometry scores using R.E.N.A.L. (radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior, location relative to polar lines, hilar) measurements. Charts of patients with a length of stay longer than 72 hours, or with any readmissions under the urology service were closely examined for bleeding or leakage complications. Other examined parameters included drain fluid-to-serum creatinine ratios, as well as short term and long term changes in glomerular filtration rates (GFR). RESULTS: Comparing SCRR to DLRR, similar nephrometry scores were seen across both groups undergoing RPN (6.6 vs 7, p=0.29), including equivalent tumor sizes (34 mm vs 30 mm, p=0.11) and nearness to the collecting system (p=0.25). No significant differences in rates of bleeding secondary to pseudoaneurysms (0.03% vs 0.02%, p=0.8), urine leak rates (0% vs 0%), or changes in GFR (p=0.25) were seen between both groups of this study. CONCLUSIONS: No significant changes in urine leakage or bleeding rates secondary to pseudoaneurysm formation or changes in renal functions were found when comparing SLRR to DLRR during RPN for masses of equivalent sizes, depth and nephrometry scores. Single layer cortical repair seems to offer a safe method of shortening renorrhaphy and warm ischemia times compared to dual layer repairs. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e648 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tarek El-Ghazaly More articles by this author Jonathan Rosenfeld More articles by this author Shilajit Kundu More articles by this author Robert Nadler More articles by this author Kent Perry More articles by this author Expand All Advertisement PDF downloadLoading ...

MP56-14 LONG-TERM RENAL FUNCTION IN PATIENTS UNDERGOING TRIMODAL THERAPY FOR BLADDER CANCER

You have accessJournal of UrologyCME1 Apr 2023MP56-14 LONG-TERM RENAL FUNCTION IN PATIENTS UNDERGOING TRIMODAL THERAPY FOR BLADDER CANCER Affan Zafar, Linda Nguyen, Alexandra Hunter, William Shipley, Niall Heney, Anthony Zietman, Matthew Wszolek, Jason Efstathiou, Michael Drumm, Hannah Roberts, and Adam Feldman Affan ZafarAffan Zafar More articles by this author , Linda NguyenLinda Nguyen More articles by this author , Alexandra HunterAlexandra Hunter More articles by this author , William ShipleyWilliam Shipley More articles by this author , Niall HeneyNiall Heney More articles by this author , Anthony ZietmanAnthony Zietman More articles by this author , Matthew WszolekMatthew Wszolek More articles by this author , Jason EfstathiouJason Efstathiou More articles by this author , Michael DrummMichael Drumm More articles by this author , Hannah RobertsHannah Roberts More articles by this author , and Adam FeldmanAdam Feldman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003309.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Trimodal therapy (TMT) is a standard treatment option for select patients with muscle-invasive bladder cancer. The efficacy of TMT has been shown in several randomized trials; however, the long-term effect on renal function has not been investigated. Furthermore, various types of chemotherapy agents (ie. mitomycin, 5-FU, cisplatin) used during TMT are nephrotoxic. As many bladder cancer patients are elderly with significant medical comorbidities, data on long term renal function would aid in management. We sought to evaluate the change in renal function over 10 years in bladder cancer patients who have completed TMT. METHODS: The Massachusetts General Hospital’s institutional TMT database was retrospectively reviewed to obtain baseline renal function (estimated GFR) at time of muscle-invasive bladder cancer (MIBC) diagnosis. The eGFR values were calculated using the CKD-EPI creatinine equation. Interval eGFR was obtained for years 1, 3, 5, and 10 after the date of bladder cancer diagnosis. RESULTS: 287 patients undergoing TMT treatment for muscle invasive bladder cancer were reviewed. Patients were excluded due to incomplete TMT treatment or missing data, resulting in 251 eligible patients for evaluation of baseline mean eGFR. Median follow up was 4.56 years. Baseline mean eGFR was 65.67 mL/min/1.73. Mean eGFR for years 1, 3, 5, and 10 were 58.43 mL/min/1.73, 55.4 mL/min/1.73, 54.54 mL/min/1.73, and 57.3 mL/min/1.73, respectively. CONCLUSIONS: Renal function for bladder cancer patients undergoing TMT declined slightly after 1 year of follow up but remained stable for the remainder of the 10 years of follow up. Further studies are needed to identify predictors of renal decline and compare these results with the overall bladder cancer and general population. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e780 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Affan Zafar More articles by this author Linda Nguyen More articles by this author Alexandra Hunter More articles by this author William Shipley More articles by this author Niall Heney More articles by this author Anthony Zietman More articles by this author Matthew Wszolek More articles by this author Jason Efstathiou More articles by this author Michael Drumm More articles by this author Hannah Roberts More articles by this author Adam Feldman More articles by this author Expand All Advertisement PDF downloadLoading ...