End-stage Kidney Research Articles

The Peculiarity of Process and Treatment of Arterial Hypertension in Patients with Type 2 Diabetes Mellitus

Arterial hypertension (AH) is powerful and modifying factor of developing macrovascular and microvascular complications of diabetes. Patients with AH and diabetes belong to group with high and very high levels risk of developing cardiovascular complications and chronic kidney disease. The combination of type 2 diabetes mellitus and AH dramatically increases the risk of developing terminal stages of microvascular and macrovascular diabetic complications: blindness, end-stage chronic kidney disease, amputation of the lower extremities, myocardial infarction, cerebral stroke, worsens the patients prognosis and quality of life. There is ample evidence that blood pressure control in diabetic patients may be critical for improving long-term prognosis. This observation does not lose its relevance even with the emergence of new antidiabetic drugs with proven cardio- and nephroprotective effects. Modern clinical researchers and meta-analysis show the priority of combined antihypertensive therapy, which increases the efficacy of blood pressure correction and prophylaxis of long-term complications in patients with type 2 diabetes. In this article we want to pay attention to features of AH in patients with diabetes, to bi-directional pathogenic mechanisms, to discuss the new algorithms of the treatment and therapeutic needs of these patients. It is important to accent the understanding of the integrity and unity of pathogenic mechanisms which are needed in correction. Innovative antihyperglycemic therapy demonstrates the ability of blood pressure decrease. The synergy of effects let us successfully realize the strategy of multi-factor control and reduce a risk of micro- and macrovascular complications.

Subphenotypes of ANCA-associated vasculitis identified by latent class analysis.

ANCA-associated vasculitides (AAV) are a heterogeneous group of rare diseases with unknown aetiology and the clinical spectrum ranging from life-threatening systemic disease, through single organ involvement to minor isolated skin changes. Thus, there is an unmet need for phenotype identification, especially among patients with granulomatosis with polyangiitis (GPA). Patients with microscopic polyangiitis (MPA) seem to be clinically much more uniform. Recently, three subcategories of AAV have been proposed and described as non-severe AAV, severe PR3-AAV, and severe MPO-AAV. In line with these attempts, we decided to use an unbiased approach offered by latent class analysis (LCA) to subcategorise GPA and MPA in a large cohort of Polish AAV patients included in a multicentre POLVAS registry. LCA of our AAV group identified a four-class model of AAV, including previously proposed three subphenotypes and revealing a fourth (previously not described) clinically relevant subphenotype. This new subphenotype includes only GPA patients, usually diagnosed at a younger age as compared to other groups, and characterised by multiorgan involvement, high relapse rate, relatively high risk of death, but no end-stage kidney disease. Based on multiple clinical and serological variables, LCA methodology identified 4-class model of AAV. This newly described fourth class of AAV may be of clinical relevance and may require prompt diagnosis and aggressive treatment due to the multiorgan involvement, high risk of relapse and marked mortality among these relatively young GPA subjects.

Massive retroperitoneal haemorrhage after retrograde pyelogram in end-stage kidneys: A case report

Severe retroperitoneal haemorrhage after retrograde pyelogram (RPG) is rare and has not been reported in the literature. One of the few indications for performing RPG in end-stage kidneys is evaluation of the upper urinary tract for malignancy. We present a rare case of massive retroperitoneal haemorrhage in a 58-year-old man, with a history of deceased donor kidney transplantation for end-stage kidney disease (ESKD), following bilateral RPG for the evaluation of urothelial cancer. The bleeding was successfully stopped with renal artery angioembolisation. This case demonstrates the importance of exercising extra caution when performing endoscopic procedures in patients with ESKD and keeping the intrarenal pressure as low as possible.

THE CORRELATION BETWEEN BONE MINERAL DISORDERS AND SOME CLINICAL AND SUBCLINICAL FACTORS IN THE PATIENTS WITH DIALYSIS CHRONIC KIDNEY DISEASE

Objectives: To investigate the correlation between the concentration in blood of bone minerals: Phosphorus, calcium, PTH, vitamin D, β2 microglobulin, aluminium with some clinical and subclinical factors in patients with dialysis chronic kidney patients. Materials and Methods: Descriptive cross-sectional study, include 163 patients with dialysis chronic kidney disease, from January 2017 to December 2018 at the Department of Haemodyalysis, District 2 Hospital, Ho Chi Minh City. Results: Serum phosphorus is negatively correlated with age r = - 0.342; positively correlated with albumin: r = 0.156, urea: r = 0.328, creatinine: r = 0.175, calcium x phosphorus index: r = 0.809,PTH: 0.273. Corrected serum calcium is negatively correlated with albumin: r = - 0.917, Hb: r = - 0.369, urea: r = - 0.178, creatinine: r = - 0.188, calcium x phosphorus index: r = 0.492. Plasma PTH positively correlated with dialysis time: r = 0.336, β2 microglobulin: r = 0.247; negatively correlated with Aluminum: r = - 0.161. Serum vitamin D negatively correlated with age: r = - 0.166, β2microglobulin: r = - 0.231. Serum aluminium positively correlated with diastolic blood pressure: r = 0.207 and systolic: r = 0.209. Serum β2 microglobulin positively correlated with dialysis time: r = 0.233, urea: r = 0.168; negatively correlated with Aluminum: r = - 0.224. Conclusion: Some bone mineral in dialysis patients are correlated with age, dialysis time, blood pressure, albumin, urea, creatinine. There is also a intercorrelation between bone minerals. Therefore, it is necessary to screen for bone mineral disorders and correlations as recommended by KDOQI, KDIGO. Key words: End-stage chronic kidney disease, dialysis, correlation, bone mineral disorders

THE CORRELATION BETWEEN BONE DENSITY AND SOME CLINICAL AND SUBCLINICAL FACTORS IN THE PATIENTS WITH DIALYSIS CHRONIC KIDNEY DISEASE

Objectives: To investigate the correlation between bone density and osteoporosis with some clinical and subclinical factors in patients with dialysis chronic kidney patients. Materials and Methods: Descriptive cross-sectional study, include 163 patients with dialysis chronic kidney disease, from January 2017 to December 2018 at the Department of Haemodyalysis, District 2 Hospital, Ho Chi Minh City. Results: Bone density was negatively correlated with age at the lumbar spine (LS) (r = - 0.225), total hip (total H) (r = - 0.288), femoral neck (FN) (r = - 0.352); with urea at the total H (r = - 0.206), FN (r = - 0.194); with PTH at LS (r = - 0.266), total H (r = - 0.219), FN (r = - 0.168); with β2 Microglobulin at the LS (r = - 0.269). Bone density was positively correlated with glomerular filtration rate at the LS (r = 0.200), FN (r = 0.179); with vitamin D at the LS (r = 0.218) and total H (r = 0.179). Multivariate regression analysis of the risk of decreased bone density at the FN has 2 factors: age (OR = 1.117), PTH (OR = 1.001); at the LS, there are 3 factors: gender (OR = 4.572), PTH (OR=4.078), age (OR = 1.045); at the total H, there are 2 factors: PTH (OR = 3.683), age (OR = 1.117). Osteoporosis in all 3 positions was related to sex (p < 0.05) and age group (p < 0.01). Osteoporosis was associated with PTH, Phosphorus, Aluminum disorders at the FN (p < 0.05), with PTH at the LS (p < 0.05), with PTH, calcium at the total H (p < 0.05). Multivariate regression analysis of the risk of osteoporosis has 3 factors: age (OR = 4.058), PTH (OR = 2.967), female (OR = 2.841). Conclusion: Bone density, osteoporosis is correlated, associated with common factors and factors associated with bone mineral disorders in patients with dialysis chronic kidney disease (CKD - MBD). Key words: End-stage chronic kidney disease, dialysis, bone density

P0115EFFECT OF CARDIOPULMONARY BYPASS ON THE DEVELOPMENT OF ACUTE KIDNEY INJURY AFTER OPEN-HEARD SURGERY

Abstract Background and Aims Assessment of factors associated with cardiopulmonary bypass (CPB) in acute renal dysfunction in patients in the early postoperative period after cardiac surgery. Method Monocentric observational study in patients (n = 97) who underwent elective open-heart cardiac surgery (coronary artery bypass grafting -50.44%, aortic valve prosthetics - 31.04%, mitral valve prosthetics - 12.61%) using cardiopulmonary bypass. Inclusion criteria: the study included patients not younger than 18 years old, undergoing cardiac surgery with CPB lasting up to 95 minutes (coronary bypass surgery, valve replacement), without signs of end-stage chronic kidney disease (CKD). Using nonparametric correlation analysis, we evaluated the effect on the development of acute kidney injury (AKI) of the following extracorporeal circulation factors: duration of CPB, aortic cross-clamp, mean arterial pressure (MAP), cardiac index (CI), perfusion flow rate (PFR), transport, consumption and oxygen extraction variables. The diagnosis of AKI was made on the basis of the KDIGO classification, the studied parameters were recorded initially (before the operation), 15 minutes after the start of general anesthesia, 30 minutes after the start of cardiopulmonary bypass and 15 minutes after the end of general anesthesia. Results The frequency of AKI in 24 hours after surgery was 56.3% (58 cases): including stage 1 in 37 (35.9%), stage 2 in 17 (16.5%), stage 3 - in 4 (3.9%) patients. In the 48th hour of the postoperative period signs of AKI regressed, and were presented in only 26 people (25.2%), including the stage 1 in 18 (17.5%), the stage 2 - in 5 (4.8%), stage 3 - in 3 (2.9%). Among the risk factors for AKI in cardiac surgery with CPB, the main effect of of the anemia was revealed, especially a decrease in hemoglobin levels of less than 90 g / l and hematocrit of less than 25%. Conclusion Hemodilution below the "threshold" values of hemoglobin and hematocrit during the CPB provoke acute kidney injury in patients undergoing open-heart surgery.

P0847HEPATIC ERYTHROPOIETIN SYNTHESIS IS ENHANCED IN HEMODIALYSIS PATIENTS WHO DO NOT REQUIRE ERYTHROPOIESIS-STIMULATING AGENTS

Abstract Background and Aims Erythropoietin is synthesized in the liver during the fetal period and mainly in the kidney after birth. However, some patients with end-stage chronic kidney disease do not require the administration of erythropoiesis-stimulating agents (ESA) despite their damaged renal function. This study aimed to clarify the origin of extrarenal erythropoietin generation in these patients. Method The origin of erythropoietin was investigated by analyzing the erythropoietin glycation patterns based on the percentages of migrated isoforms (PMI). Sera of stable hemodialysis (HD) patients with (ESA group) or without (non-ESA group) ESA treatment and umbilical cord blood of newborns (UCB group), which contained erythropoietin of liver origin, were analyzed. The non-ESA group was determined as HD patients without ESA treatment for > 6 months. Informed consent was obtained from all included HD patients and from the parents or guardians of the newborns. This study was performed with permission from the institutional ethical committee and was registered as a clinical trial (no. R000033462 UMIN000029335). Results The mean duration of no ESA treatment in the non-ESA group was 29.2 months. There were no differences in major clinical parameters, including age and HD duration. The hemoglobin concentration in the ESA group was 107 ± 5 g/L (mean ± standard error), which was significantly lower than that in the non-ESA group (123 ± 4 g/L) (P = 0.025, unpaired Student’s t-test). The PMI values of the ESA, non-ESA, and UCB groups were 12.6 ± 11.4％, 61.2 ± 13.1%, and 65.0 ± 13.5％, respectively, and the PMI value of the ESA group was significantly lower than that of non-ESA or UCB group (one-way analysis of variance with Tukey-Kramer test), suggesting that the glycation pattern of erythropoietin in the non-ESA group was similar to that in the UCB group but different from that in the ESA group. No significant differences were found in the reticulocyte ratio, serum iron concentration, total iron binding capacity, and ferritin and transferrin saturation between the ESA and non-ESA groups. Conclusion These results suggest that patients in the non-ESA group had enhanced extrarenal erythropoietin synthesis and that their erythropoietin originated from the liver. Further analysis of the underlying mechanism may contribute to the development of internal extrarenal erythropoietin-stimulating therapy.

P0012SHOULD WE DEFINE A NEW STANDARD PRESCRIPTION OF BICARBONATE (HCO3-) IN HEMODIALYSIS (HD)?

Abstract Background and Aims One of the aims of the regular, intermittent HD therapy prescribed for patients with end-stage chronic kidney disease, is correction of metabolic acidosis by addition of HCO3- to dialysate fluid. The KDOQI guidelines therapeutic goal is to maintain pre-dialysis HCO3-≥22mmol/L. The aim of the study was to evaluate an individualized HCO3-hemodialysis prescription as a preventing factor of metabolic changes in a HD facility and define a new standard HCO3-prescription. Method 36-month prospective study of patients on online high-flux hemodiafiltration. Every 3 months (13 time points) HCO3-, Calcium (Ca2+), Phosphorus (P+), intact Parathyroid hormone (iPTH) and protein C reactive (PCR) blood levels were analyzed. HCO3-prescription was changed using the following rules: The data collected comprised demographic information, renal disease etiology, comorbidities, HD treatment information and lab results. Categorical variables are presented as frequencies and percentages, continuous variables as means and standard deviations, or medians and interquartile ranges (IQR) for variables with skewed distributions. A p-value<0.05 was considered statistically significant. Statistical analysis was performed using SPSS version 23 for Mac OS X. Results From the 50 patients that were evaluated at Time point 0, only 24 patients completed the follow-up period. Sixteen (66.7%) were males, 54.2% (n=13) diabetic and 58.3% (n=14) hypertensives and the median age was 76 years (IQR 13). At baseline (time point 0), median pH was 7.4 (IQR 0.09) and serum HCO3-26.5 mmol/L (IQR 2.32). At time point 12, pH was 7.35 (IQR 0.12) and serum HCO3-23.25mmol/L (IQR 1.93). A repeated measures ANOVA determined that prescribed HCO3- differed with statistical significance during time (F(2.787,83.308)=39.055, p=0.001), and the post Hoc tests confirmed those assumptions between time point 1 and all the others time points, as an example the mean difference between initial prescribed HCO3-and time point 12 was 5.39mmol/L (p=0.001). Wilcoxon Sign-Rank Tests determined that throughout the analyzed period the serum HCO3- approached the reference serum HCO3- (23mmol/L) that we have defined as ideal (at time point 0, median=26.5mmol/L, Z=4.144, p=0-001; at time point 12, median 23.25mmol/L, Z=1.243, p=0.214). On the other hand, a one sample T-Test determined that the HCO3- prescription differed more in each time point from the 32mmol/L defined as standard (at time point 12, t=-2.798, p=0.01) and approached a new suggested value of 26mmol/L. However, at time point 8, 62.5% (n=15) patients had a HCO3-prescription of 28mmol/L, (t(23)=0.001,p=1) and at that time we had hypothesized that that a prescription of 28 mmol/L should be the new standard. Gender, Diabetes Mellitus, Hypertension, and renal disease etiology did not influence the HCO3- prescription neither serum HCO3-. Conclusion HCO3-prescription and serum HCO3- were not influenced by comorbidities like DM and Hypertension. Our findings suggest that the standard HCO3- prescription of 32mmol/L should be rethought, as an individualized HCO3- prescription could be beneficial for the patient. At this time, we suggest that a prescription of 26 mmol/L should be the new standard. However, the limitations of our findings include the small sample size, so further studies with larger samples should be attempted.

P0039IS A NEPHRECTOMY POLYCYSTIC KIDNEY DISEASE NECESSARY FOR PATIENTS WITH END-STAGE CHRONIC KIDNEY DISEASE?

Abstract Background and Aims In the structure of end-stage CKD polycystic kidney disease is about 8-10 %. These patients often required preparation for transplantation. In addition, enlarged kidneys are reducing the volume of the abdominal cavity, negative impact on the peritoneal dialysis (PD). Method In 2005-2019 41 nephrectomies were performed in patients with end-stage CKD with polycystic kidney disease: 11 patients have undergone open nephrectomy, 13 patients laparoscopic nephrectomy and 17 retroperitoneoscopic nephrectomy. We analyzed postoperative period and complications, method of treatment end-stage CKD selected in future. In particular, we evaluated the effectiveness of peritoneal dialysis depending on the operating access. Results Complications: intraoperative bleeding was in 3 cases, damage of the spleen was in one. The significantly lower blood loss was in the group of operations performed endoscopic access. Subsequently, 16 patients were treated with hemodialysis (HD), 25 patients PD. The effectiveness of PD was estimated by 3 months and 1 year after start treatment by kt/v. In the group of patients with open nephrectomy, the effectiveness on average was 1.61 and 1.44 respectively. Patients underwent laparoscopic nephrectomy the efficiency is in average of 1.72, and 1.60, retroperitoneoscopic nephrectomy 1.88, 1.72 respectively. The conversion method of PD-treatment to the HD within 6 months after surgery was required in 5 patients (open nephrectomy technique), 2 patients (laparoscopic technique), no one patient (retroperitoneoscopic technique) was not required for the conversion PD to HD. Conclusion Our experience of nephrectomies in patient with end-stage CKD indicate the safety and effectivity of the endoscopic technique and its applicability to patients on PD. Retroperitoneoscopic access has less impact on the effective area of the peritoneum, which is reflected in the subsequent course of PD.

Kidney oxalate crystal deposition in adult patients: A relatively common finding .

We aim to describe the clinical and histological findings in patients with the finding of any tubular oxalate deposits in kidney biopsy specimens. The prevalence, manifestation, and outcome of secondary oxalate nephropathy have not been extensively studied. In this retrospective cohort study, we analyzed the clinical and histological findings in all patients with the finding of any tubular oxalate deposits in kidney biopsy specimens between July 1, 2017, and December 31, 2018, at Northwell Health Pathology Department (Manhasset, NY, USA). The prevalence of oxalate deposition on a kidney biopsy was 4.07% (25/615), and in 88% of cases was a major finding. Prior to biopsy, oxalate was anticipated in only 1 case. The etiology of oxalosis was clarified retrospectively in 14 cases, most commonly due to GI surgery (n=10) and increased oxalate intake (n=4). In 11 cases, etiology remained unknown, although at least 3cases were exposed to antibiotics associated with secondary oxalosis. There was no significant clinical/pathological or survival difference between known vs. unknown cause groups. The overall 3-month renal survival rate was 76.0 ± 8.5%. Multivariate Cox regression showed that creatinine at the time of biopsy (HR: 1.79, 95% CI: 0.71-4.51), background histological chronicity change (HR: 1.82, 95% CI: 0.70-4.72) and oxalate density (HR: 2.27, 95% CI: 0.49-10.55) are associated with end-stage kidney disease. Oxalate deposition is common but rarely anticipated biopsy finding. Nephrologists need to consider surgical history and other secondary causes of oxalosis as causes of acute kidney injury and chronic kidney disease.

Metabolic Markers of Insulin Resistance in Feline Hypertrophied Myocardium. Insulin Resistance in Heart Failure

Investigation of myocardial tissue concentration of ATP, glucose transporters 1 and 4, pyruvate dehydrogenase, hexokinase 2, insulin receptor and adropin proteins, determining metabolic changes and possible insulin resistance in feline myocardium with hypertrophic phenotype. This is the pilot study for metabolic markers determination. Eighteen cats were studied, divided into 3 groups: Without cardiac disease (n = 5), cats with hypertrophic cardiomyopathy (n = 8), cats with chronic kidney disease and secondary myocardial hypertrophy (n = 5). Animals in the study were diagnosed for the primary disease by standard methods and algorithms. Cats were euthanized due to the end-stage chronic kidney disease, refractory heart failure or by owners’ will. The myocardium samples were obtained immediately after death. Samples for the metabolic study were taken from the apical part of the left ventricular free wall and fixed in liquid nitrogen at once and were stored in -80°C refrigerator. Studied proteins concentrations were analyzed in a specialized research laboratory, using ELISA kits, provided by Cloud-Clone Corp. (USA), included: Total ATP, pyruvate dehydrogenase, hexokinase II, Adropin, insulin receptor, GLUT1 and GLUT4. In the group with HCM, we discovered that levels of ATP, pyruvate dehydrogenase and adropin were severely suppressed in comparison to healthy cats, while GLUT1 and GLUT4 did not change. The concentration of hexokinase 2 and insulin receptor proteins significantly increased. In the group of secondary myocardial hypertrophy, suppression of most studied proteins was admitted, except insulin receptor. In conclusion, we discovered metabolic remodeling and development of insulin resistance in observed diseases with hypertrophy phenotype. We observed depression of pivotal enzymes proteins, limiting energy restoration potency for cardio myocytes.

Peculiarities of Spondylitis in the Patients Undergoing Program Hemodialysis (Case Report)

Relevance. The surgical treatment of spinal diseases and injuries in the patients on hemodialysis is one of the most complicated problems of the spine surgery, since such a surgery is associated with an increased risk of infectious complications and perioperative mortality. The case description. A 59-year-old female came to the clinic complaining back pain. Th8-9 vertebrae spondylitis complicated by an epidural and paravertebral abscess with pertinent neurological disorders and bilateral pneumonia were diagnosed. The patient had been on hemodialysis for 18 years due to the end-stage chronic kidney disease complicated by uremic osteodystrophy. The surgical debridement and stabilization of the spine were performed in one stage posterior approach using a titanium mesh implant in combination with autologous bone and posterior instrumentation. A regression of neurological disorders and the pain syndrome relief were achieved. In the late postoperative period, the instability of the posterior fixation developed twice, requiring restabilization. Within the following 3.5 years after the operation, the pain syndrome had not returned. Conclusion. The presence of equipment for hemodialysis and a multidisciplinary approach allow to achieve the positive results in the surgical treatment of inflammatory diseases of the spine in the patients with endstage chronic kidney disease.

Evaluation of Thiosulfate in End Stage Renal Disease and Kidney Transplantation

Evaluation of Thiosulfate in End Stage Renal Disease and Kidney Transplantation

SUN-200 Pulmonary Function Tests in Hemodialysis Patients and their First-Degree Rlatives as Kidney Donors

End-stage kidney disease-ESKD-patients not infrequently develop pulmonary complications such as oedema, infection or pleurisy and eventually need renal replacement therapy(RRT) via dialysis (either hemodialysis or peritoneal dialysis) or kidney transplantation to survive. This prospective study evaluated the pulmonary function tests of patients with chronic kidney disease (CKD) and healthy donors who attended the kidney donor clinic at the Royal Hospital. The study was carried on during the period from Jan ’2010 till Jan “2015. All patients have undergone Pulmonary Functions Test (PFT) at the next day post their hemodialysis session. For statistical analysis, the STATA 12.0 software was used. FVC was 3.67(0.78) and 3.12 (0.82) for control and CKD participants, respectively, p=0.019. FEV1 was 2.97(0.63) 2.57 (0.74) for control and CKD participants, respectively, p=0.043. On the other hand, the FEV1/FVC ratio was 80.5(6.9) and 81.8(0.74) for control and CKD participants, respectively p=0.56. Similarly, there was no significant statistical difference regarding PEF and TLC between CKD and control participants. The VC was 3.78(0 .73) vs 3.38 (0.55), p=0.04 for control and CKD participants, respectively. The ERV values were 1.41 (0.34) and 1.78 (0.48), p=0.01 for control and CKD participants, respectively. But RV and RV/TLC showed no statistically significant difference between control and CKD participants, as shown in table 1. The DLCO was 23.29 (4.77) and 18.16 (4.57), p<0.001, for control and CKD participants, respectively. The VA for control and CKD participants was 4.62 (0.99) and 4.12 (0.84), p=0.06, respectively. DLCO/VA was 5.13 (0.88) and 4.47 (1.0), p=0.01, for control and CKD participants, respectively. The DL/VA adjusted was 5.13(0.17) and 4.46 (1.0), p=0.02, for control and CKD participants, respectively. But, IVC values showed no statistically significant difference between control and CKD participants.Tabled 1ItemPotential Kidney donorCKD -Recipient for KTXP. ValueFVC3.67 SD 0.783.12 SD 0.820.0185FEV12.97 SD 0.632.57 SD 0 .740.0434FEV1/FVC80.48 SD 6.9281.79 SD 9.000.5605PEF416.89 SD 102.89386.92 SD 105.480.3099TLC5.39 SD 2.135.23 SD 2.990.8347VC3.78 SD 0 .733.38 SD 0.550.0424ERV1.41 SD 0.341.78 SD 0.480.0122RV1.61 SD 2.081.95 SD 3.000.6464RV/TLC24.85 SD14.8529.55 SD 16.600.3172DLCO23.29 SD 4.7718.16 SD 4.570.0005DLCO/VA5.13 SD 0.884.47 SD 1.000.0192DL/VA adjusted5.13 SD 0.174.46 SD 1.000.0192VA4.62 SD 0 .994.12 SD 0.840.0695IVC2.14 SD 0.461.98 SD 0.610.3704 Open table in a new tab To the best of our knowledge, this is the first paper to compare pulmonary function tests in hemodialysis patients that being worked up for kidney transplant with their first-degree relatives who were worked up as their kidney donors. The findings of the present study demonstrated that volume overload is closely associated with restrictive and obstructive respiratory abnormalities where respiratory function tests in patients with CKD undergoing dialysis show lower values than those of the general population, and that patients undergoing dialysis have greater impairment of DLCO and FVC than do their first relatives’ kidney transplant donor patients. Uremic pulmonary toxicity is likely to be multifactorial and may differ with different patterns of CKD disease.

Intravascular imaging of atherosclerotic plaques in patients with cardiorenal syndrome: potential use of optical coherence tomography

Currently, kidney transplantation and hemodialysis are the primary therapies for end-stage renal disease. High mortality, mostly caused by cardiovascular disease, remains the main challenge in the treatment of this category of patients. It has been shown that in patients with end-stage chronic kidney disease undergoing hemodialysis, the risk of mortality due to cardiovascular disease is up to 20 times higher than in the sex- and age-matched general population. The indicated data determined the appropriateness of isolating cardiorenal relationships into a single cardiorenal syndrome (CRS). Due to the facts mentioned above, intravascular imaging methods, notably optical coherence tomography (OCT), are particularly important in diagnosing coronary artery lesions. This review analyses the data published to date on the features and capabilities of OCT in CRS patients.

Диагностика туберкулеза у больных с терминальной стадией хронической болезни почек

Диагностика туберкулеза у больных с терминальной стадией хронической болезни почек

Inhibition of lysyl oxidase ameliorates renal injury by inhibiting CD44-mediated pericyte detachment and loss of peritubular capillaries

Renal fibrosis is a common pathological manifestation of almost all forms of kidney disease irrespective of the etiological cause. Microvascular rarefaction represents itself as an important phenomenon associated with renal fibrosis and shows strong correlation with decline in renal functions. Lysyl oxidase (LOX) catalyzes crosslinking of extracellular matrix (ECM) proteins including collagens, plays an important role in stabilization of degradation resistant matrix. Since, there seems to be a causal link between deposition of excessive ECM and microvascular rarefaction, we investigated the effects of reduction in renal fibrosis on microvascular rarefaction in acute as well as end stage kidney. We used a well-established unilateral ureteral obstruction (UUO)-induced renal fibrosis model to produce renal fibrosis in animals. We treated animals with a LOX inhibitor, β-aminopropionitrile (BAPN, 100 mg/kg, i.p.) and investigated effects on renal fibrosis and microvascular rarefaction. We observed that LOX inhibition was associated with reduction in collagen deposition in UUO-induced renal fibrosis animal model. Further, ECM normalization by LOX inhibition decreased the loss of peritubular capillaries (PTCs) in fibrotic kidney in acute study while the LOX inhibition failed to inhibit PTCs loss in end stage kidney. The results of present study suggested that inhibition of LOX reduces collagen deposition and renal fibrosis. Further, the reduction in fibrosis fails to protect from PTCs loss in chronic study suggesting the absence of strong link between reduction in fibrosis and improvement in PTCs in an end stage kidney.

Epidemiology Profile and Associated Factors of Depression in Chronic Kidney Disease Stage 3-5 and Chronic Haemodialysis Patients in Cameroon

Background: Depression is reported to be frequent in patients with chronic kidney disease and end stage kidney in high income countries. Little is known about depression in low income area such as Sub-Saharan Africa. Objective: Describe the epidemiology and factors associated with depression in patients with chronic kidney disease and in chronic haemodialysis in Cameroon. Methodology: We conducted a cross sectional study for 3 months in 2 nephrology services. Patients older than 18 years with CKD stage 3-5 and those on chronic haemodialysis who accepted to participate in the study were included. Depression was diagnosed using Beck Depression Inventory – Short Form (BDI -SF). A cut-off score ≥ 8 was used to diagnose depression. Results: Of the 196 patients included, 69 patients had CKD patients and 127 were on maintenance haemodialysis. Overall, depression was found in 40% (n=78) participants. Depression was less frequent in patients with CKD stage 3-4 (26%, n=12) and those who initiated dialysis ≤ 6 months (27%, n=6). Single/widow, unemployment, chronic pain and negative feeling about socio-familial life were common among depressed participants. Absence of chronic pain (OR 0.41[0.19-0.88], p=0.022), been socially active (OR 0.35[0.16-0.8], p=0.012) and good relationship with the spouse (OR 0.25[0.06-0.95], p=0.042) were independent factors associated with depression. Conclusion: Depression in frequent is chronic kidney disease and haemodialysis patients in Cameroon, affecting 2 patients out 5. Socio-demographic factors seems to be the main contributors. Psychological support should be proposed to these patients, especially among those who should initiated dialysis and with long haemodialysis stay.

Мультидисциплинарный подход к диагностике и лечению сочетанной микобактериальной и грибковой инфекции легких у больного с ANCA-ассоциированным системным васкулитом на заместительной почечной терапии. Случай из практики

Мультидисциплинарный подход к диагностике и лечению сочетанной микобактериальной и грибковой инфекции легких у больного с ANCA-ассоциированным системным васкулитом на заместительной почечной терапии. Случай из практики

Urinary chloride concentration and progression of chronic kidney disease: results from the KoreaN cohort study for Outcomes in patients With Chronic Kidney Disease.

Urinary chloride is regulated by kidney transport channels, and high urinary chloride concentration in the distal tubules can trigger tubuloglomerular feedback. However, little attention has been paid to urinary chloride as a biomarker of clinical outcomes. Here, we studied the relationship between urinary chloride concentration and chronic kidney disease (CKD) progression. We included 2086 participants with CKD from the KoreaN cohort study for Outcomes in patients With Chronic Kidney Disease. Patients were categorized into three groups, according to baseline urinary chloride concentration tertiles. The study endpoint was a composite of ≥50% decrease in estimated glomerular filtration rate from baseline values, or end-stage kidney disease. During a median follow-up period of 3.4 years (7452 person-years), 565 participants reached the primary endpoint. There was a higher rate of CKD progression events in the lowest and middle tertiles than in the highest tertile. Compared with the lowest tertile, the highest tertile was associated with 33% [95% confidence interval (CI) 0.49-0.90] lower risk for the primary outcome in a cause-specific hazard model after adjustment for confounding variables. In addition, for every 25 mEq/L increase in urinary chloride concentration, there was 11% (95% CI 0.83-0.96) lower risk for CKD progression. This association was consistent in a time-varying model. Urinary chloride concentration correlated well with tubule function and kidney injury markers, and its predictive performance for CKD progression was comparable to that of these markers. In this hypothesis-generating study, low urinary chloride concentration was associated with a higher risk for CKD progression.