Endogenous Creatinine Clearance Rate Research Articles

Relationship between the methylenetetrahydrofolate reductase (MTHFR) rs1801133 SNP and serum homocysteine levels of Zhuang hypertensive patients in the central region of Guangxi

BackgroundThe relationship between the methylenetetrahydrofolate reductase (MTHFR) single nucleotide polymorphism (SNP) and serum homocysteine (Hcy) levels or H-type hypertension in different populations is inconsistent. This study aimed to explore the association between the MTHFR rs1801133 SNP and serum Hcy levels of Zhuang hypertensive patients in the central region of Guangxi.MethodsA total of 606 Zhuang inpatients with essential hypertension were recruited in our hospital from August 2016 to December 2018. The patients were divided into H-type hypertension (Hcy > 10 µmol/L, n = 528) and non–H-type hypertension (Hcy ≤ 10 µmol/L, n = 78) groups. At the same time, an age- and sex-matched group of 379 subjects with normal physical examination in our hospital were selected as the control group. Blood biochemical measurements and genotyping of the MTHFR rs1801133 SNP were performed.ResultsThe prevalence of H-type hypertension was 87.13%. The levels of serum Hcy in patients with hypertension were higher than those in control group (14.20 ± 5.78 μmol/L vs. 11.97 ± 5.39 μmol/L, P < 0.001), especially in patients with H-type hypertension (15.08 ± 5.65 μmol/L, P < 0.001). The frequencies of TT genotype (22.73%) and T allele (46.21%) in patients with H-type hypertension were significantly higher than those in control group (11.35% and 30.47%, respectively) and non–H-type hypertension group (10.26% and 28.85%, respectively; P < 0.001 for all). Multivariate linear regression analysis showed that serum Hcy levels were significantly correlated with creatinine, low-density lipoprotein cholesterol, endogenous creatinine clearance rate, and the MTHFR rs1801133 genotypes in control group, while serum Hcy levels were significantly correlated with creatinine, triglyceride, low-density lipoprotein cholesterol, endogenous creatinine clearance rate, glycosylated hemoglobin, and the MTHFR rs1801133 genotypes in H-type hypertension group (P < 0.05–0.001). Serum Hcy levels in the T allele carriers were higher than those in the T allele noncarriers in both H-type hypertension and control groups.ConclusionsThere was closely related between the MTHFR rs1801133 SNP and serum Hcy levels in Zhuang patients with H-type hypertension in the central region of Guangxi. The MTHFR SNP may be an important reason for the increase of serum Hcy levels in Zhuang patients with H-type hypertension in this region.

Comparative pharmacokinetics of six bioactive components of Shen-Wu-Yi-Shen tablets in normal and chronic renal failure rats based on UPLC-TSQ-MS/MS

Ethnopharmacological relevanceShen-Wu-Yi-Shen tablets (SWYST), a Chinese patent medicine consisting of 12 herbal medicines, was formulated by a famous TCM nephrologist, Zou Yunxiang. It is clinically used to improve the symptoms of nausea, vomiting, poor appetite, dry mouth and throat, and dry stool in patients with chronic renal failure (CRF) accompanied by qi and yin deficiency, dampness, and turbidity. SWYST can reduce urea nitrogen, blood creatinine, and urinary protein loss, and increase the endogenous creatinine clearance rate. However, little is known about its pharmacokinetics. Aim of studyTo compare the pharmacokinetics of six bioactive components after oral administration of SWYST in normal and adenine-induced CRF rats. Materials and methodsA method based on ultra-performance liquid chromatography coupled with a triple-stage quadrupole mass spectrometer (UPLC-TSQ-MS/MS) was developed and validated to determine the six bioactive compounds (albiflorin, paeoniflorin, plantagoguanidinic acid, rhein, aloe-emodin, and emodin) in rat plasma. Rat plasma samples were prepared using protein precipitation. Chromatography was performed on an Agilent Eclipse Plus C18 column (3.0 × 50 mm, 1.8 μm) using gradient elution with a mobile phase composed of acetonitrile and water containing 0.1% (v/v) formic acid, while detection was achieved by electrospray ionization MS under the multiple selective reaction monitoring modes. After SWYST administration, rat plasma was collected at different time points, and the pharmacokinetic parameters of six analytes were calculated and analyzed based on the measured plasma concentrations. ResultsThe UPLC-TSQ-MS/MS method was fully validated for its satisfactory linearity (r ≥ 0.9913), good precisions (RSD <11.5%), and accuracy (RE: -13.4∼13.1%), as well as acceptable limits in the extraction recoveries, matrix effects, and stability (RSD <15%). In normal rats, the six analytes were rapidly absorbed (Tmax ≤ 2 h), and approximately 80% of their total exposure was eliminated within 10 h. Moreover, in normal rats, the AUC0-t and Cmax of albiflorin, plantagoguanidinic acid, and rhein exhibited linear pharmacokinetics within the dose ranges, while that of paeoniflorin is non-linear. However, in CRF rats, the six analytes exhibited reduced elimination and significantly different AUC or Cmax values. These changes may reflect a decreased renal clearance rate or inhibition of drug-metabolizing enzymes and transporters in the liver and gastrointestinal tract caused by CRF. ConclusionsA sensitive UPLC-TSQ-MS/MS method was validated and used to investigate the pharmacokinetics of SWYST in normal and CRF rats. This is the first study to investigate the pharmacokinetics of SWYST, and our findings elucidate the causes of their different pharmacokinetic behaviors in CRF rats. Furthermore, the results provide useful information to guide further research on the pharmacokinetic-pharmacodynamic correlation and clinical application of SWYST.

Alprostadil for hypertensive nephropathy: A systematic review and meta-analysis of randomized controlled trials.

We performed a meta-analysis to evaluate the efficacy of alprostadil in the treatment of hypertensive nephropathy. Seven online databases (PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure [CNKI] database, Wanfang Data Knowledge Service Platform, VIP Information Resource Integration Service Platform [cqVIP], and China Biology Medicine Disc [SinoMed]) were searched from inception to January 31, 2022, and a set of clinical indicators for hypertensive nephropathy was selected. The main indicators were 24-h urinary protein, serum creatinine, endogenous serum creatinine clearance rate, blood urea nitrogen, cystatin C, and mean arterial pressure. The methodological quality of the included trials was analyzed using a risk of bias assessment according to the Cochrane Manual guidelines, and a meta-analysis was performed. A random-effects model was implemented to pool the results. A total of 20 randomized controlled trials involving 1441 patients with hypertensive nephropathy were included in this review. Our findings showed that alprostadil had a positive effect on 24-h urinary protein (mean difference [MD] = −0.79, 95% confidence interval [CI] [−1.16, −0.42], P < 0.0001), serum creatinine (MD = −13.83, 95% CI [−19.34, −8.32], P < 0.00001), endogenous serum creatinine clearance rate (MD = 6.09, 95% CI [3.59, 8.59], P < 0.00001), blood urea nitrogen (MD = −6.42, 95% CI [−8.63, −4.21], P < 0.00001), cystatin C (MD = −0.26, 95% CI [−0.34, −0.18], P < 0.00001), and mean arterial pressure levels(MD = −13.65, 95% CI [−16.08, −11.21], P < 0.00001). Compared to conventional treatment alone, alprostadil combined with conventional treatment can improve renal function in patients with hypertensive nephropathy more effectively. However, additional large-scale, multicenter, rigorously designed randomized controlled trials are needed to verify these results. This is the first meta-analysis to evaluate the efficacy of alprostadil for hypertensive nephropathy, and the results may guide clinical practice.

C/MIC > 4: A Potential Instrument to Predict the Efficacy of Meropenem

This prospective study aimed to explore the determinants of meropenem trough concentration (Ctrough) in patients with bacterial pneumonia and to investigate the association between its concentration and efficacy. From January 2019 to December 2019, patients with pulmonary infections were prospectively enrolled from the intensive care unit. Factors affecting the meropenem trough concentration were analyzed, and a multiple linear regression model was constructed. Logistic regression analyses were used to investigate the relationship between Ctrough and clinical efficacy. A total of 64 patients were enrolled, in whom 210 meropenem concentrations were measured. Of the total, 60.9% (39/64) were considered clinically successful after treatment. Ctrough may increase with increased blood urea nitrogen, albumin, and concomitant antifungal use. By contrast, concentration may decrease with increased endogenous creatinine clearance rate. Six variables, including Ctrough/minimum inhibitory concentration (MIC) > 4, were associated with the efficacy of meropenem. There was an independent correlation between Ctrough/MIC > 4 and efficacy after fully adjusting for confounding factors. Based upon renal function indexes, it is possible to predict changes in meropenem concentration and adjust the dosage precisely and individually. Ctrough/MIC > 4 is a potential instrument to predict successful treatment with meropenem.

A Study on the Correlations of Anxiety and Depression With Self-Management Ability and Endogenous Creatinine Clearance Rate in Renal Transplant Recipients.

Objective: To explore the effects of anxiety and depression on the self-management ability and endogenous creatinine clearance rate of renal transplant patients.Method: Eighty-eight renal transplant recipients who were followed up in the outpatient clinic of the Affiliated Hospital of Zunyi Medical University were selected using convenient sampling. The self-made general data sheet, Self-Rating Anxiety Scale, Self-Rating Depression Scale, and Self-Management Scale for Kidney Transplant Recipients were used. Correlation analysis was used to find factors related to endogenous creatinine clearance, while multiple linear regression was used to identify factors influencing endogenous creatinine clearance. Patients with or without anxiety and depression were divided into groups, and the indexes of the groups were compared using the independent samples t test, rank-sum test, or chi-squared test.Results: Anxiety was present in 12.5% of patients, depression in 25%, and a moderate level of self-management in 34.1%. Only 9.1% of renal transplant recipients had endogenous creatinine clearance within the normal range, and 34.1% had a body mass index not in the normal range (25% were overweight, and 9.1% were underweight). The endogenous creatinine clearance rate was negatively correlated with age and degree of depression, and positively correlated with body mass index, treatment management score, and psychosocial management score. The main influencing factors of endogenous creatinine clearance rate were age, sex, depression, body mass index, and treatment management score. The endogenous creatinine clearance rate and psychosocial management ability were significantly higher in patients without anxiety and depression than in patients with anxiety and depression (all P < 0.05).Conclusions: Anxiety and depression showed significant negative effects on the psychosocial self-management ability and endogenous creatinine clearance rate of renal transplant recipients and thus should be given more attention.

Ренин-ангиотензиновая система в регуляции экскреторной функции почек при экспериментальном сахарном диабете

Целью исследования было изучение роли ренин-ангиотензиновой системы в нарушении экскреторной функции почек в динамике аллоксан-индуцированного экспериментального сахарного диабета. Материалы и методы. Исследования выполнены на 78 нелинейных половозрелых самцах белых крыс с 11-, 26- и 46-дневным экспериментальным сахарным диабетом, вызванным внутрибрюшинным введением аллоксана (160 мг/кг), на фоне фармакологической блокады внутрипочечной ренин-ангиотензиновой системы, индуцированной внутрибрюшинным введением каптоприла (10 мг/кг). Изучение экскреторной функции почек осуществляли клиренс-методом в условиях водного индуцированного 2-часового диуреза с определением клиренса эндогенного креатинина, скорости клубочковой фильтрации, относительной реабсорбции воды, содержания белка в моче, его экскреции. Результаты. Анализ изменений функции почек после фармакологической блокады ренин-ангиотензиновой системы у крыс на 11-й день аллоксанового диабета показал достоверное возрастание диуреза, скорости клубочковой фильтрации, концентрационного индекса эндогенного креатинина, а также экскреции белка. При этом фармакологическая блокада ренин-ангиотензиновой системы практически не влияла на интенсивность относительной реабсорбции воды у аллоксан-диабетических крыс. На 26-й день развития аллоксанового диабета после введения каптоприла наблюдалось незначительное уменьшение объема конечной мочи, интенсивности гломерулярной фильтрации, относительной реабсорбции воды, концентрационного индекса эндогенного креатинина. Вместе с тем каптоприл не вызывал антипротеинурического эффекта, а экскреция белка даже продемонстрировала тенденцию к увеличению. На 46-й день аллоксан-индуцированного диабета после введения каптоприла достоверно снижались диурез крыс, клиренс эндогенного креатинина и скорость клубочковой фильтрации, а также концентрация белка в моче и его экскреция. Выводы. Результаты исследования позволяют сделать вывод о том, что начальный этап формирования ренальных нарушений при аллоксан-индуцированном экспериментальным сахарным диабетом связан с гемодинамически-гиперперфузионным характером функционирования почек при сохранном почечном функциональном резерве и структуре клубочково-канальцевого аппарата почки, авторегуляторных механизмов. Указанные компенсаторно-функциональные изменения функций почек постепенно осложняются истощением почечного функционального резерва и патологической активацией внутрипочечной ренин-ангиотензиновой системы с последующим прогрессированием гиперперфузионно-ишемического поражения почек, уменьшением массы функционирующих нефронов.

Effects of antihypertensive drugs on renal function after percutaneous transluminal coronary angioplasty

Objective To evaluate the effects of antihypertensive drugs on renal function after percutaneous transluminal coronary angioplasty. Methods A retrospective analysis was performed on 193 patients who underwent percutaneous transluminal coronary angioplasty and took antihypertensive drugs regularly. Those patients were admitted to Nanjing Drum Tower Hospital during January 2020 to December 2020. The patients were divided into ACEI/ARB group, β-blockers, calcium channel blockers and hydration control group. All patients received routine hydration during the perioperative period. The changes of serum creatinine (Scr), blood urea nitrogen (BUN), estimated glomerular filtration rate(eGFR) and endogenous creatinine clearance rate (Ccr) before and after operation were compared. Results The incidence of CIN was 0% in four groups. Compared with the preoperative, there was no significant change in Scr and Ccr in every group. Except for the hydration control group, the BUN levels in three treated groups were reduced after postoperative. Specifically, the BUN reduction in β-blockers group has statistically significant difference compared to the hydration control group and CCB group. In addition, eGFR levels were significantly reduced in the β-blockers group. Preoperative Scr and Ccr levels in patients with high blood pressure (SBP≥140 or DBP≥90) were significantly different from the patients with normal blood pressure (SBP Conclusion The use of ACEI/ARB and CCB before percutaneous transluminal coronary angioplasty had no effect on renal function in the short term. β-blockers can slightly reduce renal function, especially in patients with high blood pressure, who should receive special attention.

Research on Renal Injury in Hashimoto&amp;apos;s Thyroiditis Patients with Different Thyroid Function

Objective: To assess the relationship between thyroid function and renal injury in Patients with Hashimoto's Thyroiditis. Method: To select 156 diagnosed HT patients as the research object, according to whether there is renal injury, they were divided into renal injury group with 21 cases and non-renal injury group with 135 cases. According to the thyroid function, they were divided into HT hyperthyroidism group (Group A) with 19 cases, normal HT thyroid function group (Group B) with 37 cases, HT subclinical hypothyroidism group (Group C) with 61 cases, and HT hypothyroidism group (Group D) with 39 cases. Besides, 40 cases of healthy check-up people are selected as the control group. ECLIA is adopted to test the thyroid function index of each group, Serum cystatin C and 24-hour urinary microalbumin were measured by immunoturbidimetry, serum creatinine was measured by creatine oxidase method, and the endogenous creatinine clearance rate was calculated. Result: TSH, TPOAb and TGAb in renal injury group were distinctly higher than those in non-renal injury group, while FT3 and FT4 were distinctly lower than those in non-renal injury group; Comparison of serum creatinine in Hashimoto groups, Group D is significantly higher than other groups, Group C is obviously higher than Group A, Group B, and the control group, Group B is obviously higher than Group A, Group A is significantly lower than other groups; Comparison of cystatin C and creatinine clearance of each group, Group D is significantly lower than other groups, Group C is obviously lower than Group A, Group B, and the control group, Group B is obviously lower than Group A, Group A is significantly higher than other groups; Comparison of 24-hour urinary microalbumin of each group, Group D is significantly higher than other groups, Group C is obviously higher than Group A, Group B, and the control group, and the differences have statistic significance (P<0.05). The correlation analysis shows that FT3, FT4 are in negative correlation with serum creatinine and in positive correlation with cystatin C and creatinine clearance; TSH, TPOAb, TGAb is in positive correlation with 24-hour urinary microalbumin. Conclusion: There are obvious differences in renal function indexes of HT patients with different thyroid function states, which may be related to the effect of thyroid hormones and autoantibodies.

Pressure overload promotes cystatin C secretion of cardiomyocytes to regulate the MAPK signaling pathway and mediate cardiac hypertrophy.

BackgroundThis study aimed to compare serum cystatin C (CysC) levels between hypertensive and non-hypertensive patients, and to explore the correlation between serum CysC and left ventricular hypertrophy (LVH). We also investigated the effects of pressure overload on cardiac expression and secretion of CysC, and explored the direct effect of CysC on the hypertrophy of primary cardiomyocytes.MethodsSerum CysC was compared in patients with hypertension (634 patients) and those without hypertension (411 patients), and the correlation between serum CysC levels and LVH was explored. A transverse aortic constriction (TAC) mouse model and a mechanical stretch model of primary cardiomyocytes and fibroblasts were developed to compare cardiac expression and secretion of CysC under pressure overload. After intervention with exogenous CysC, we compared the cross-sectional area of primary cardiomyocytes, cardiac hypertrophy-associated gene expression, and phosphorylation of the MAPK signaling pathway.ResultsIn chronic kidney disease (CKD) stage 1 patients, serum CysC was higher in hypertensive patients independent of renal function. Serum CysC elevation was an independent predictor of LVH after correction for endogenous creatinine clearance rate (eCCr), left ventricular ejection fraction (LVEF), and NT-proBNP. Cardiac levels of CysC in TAC mice were elevated. CST3 gene expression was upregulated, and both intracellular and culture supernatant CysC levels increased after mechanical stretch of primary cardiomyocytes. After intervention with exogenous CysC, the cross-sectional area of primary cardiomyocytes increased, as well as the gene expression of Nppa, Nppb, and Myh7, and the phosphorylation of ERK, p38, and TAK1.ConclusionsSerum CysC levels were higher in hypertensive patients, and serum CysC elevation was an independent predictor of LVH after correction for eCCr. Pressure overload induced greater cardiomyocyte secretion of CysC. Exogenous CysC can enter cardiomyocytes, having a pro-hypertrophic effect on primary cardiomyocytes through regulation of the MAPK signaling pathways.

Efficacy and safety of traditional Chinese medicinal enemas for treatment of chronic renal failure: A protocol for systematic review and meta-analysis.

Background:Chronic renal failure (CRF) is a common kidney disease characterized by a slow and progressive decline in kidney function. Clinical practice suggests that traditional Chinese medicinal enemas have a therapeutic effect on CRF. To assess the therapeutic efficacy and safety of traditional Chinese medicinal enemas in treating CRF, we created a protocol for a systematic review to inform future clinical applications.Methods:We completed a literature search of all clinical randomized controlled trials evaluating traditional Chinese medicinal enemas on CRF in the following five English and four Chinese databases completed before August 2020: Medline, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Library database, Chinese National Knowledge Infrastructure (CNKI), WANFANE Database, Chinese Scientific and Technological Periodical Database (VIP) and Chinese Biomedical Database (CBM). The primary outcomes evaluated blood urea nitrogen levels, uric acid levels, endogenous creatinine clearance rate, and serum creatinine, and the secondary outcomes included clinical efficacy and adverse effects of treatment. Two independent researchers performed data extraction and quality assessment. RevMan5.3 software was used to assess data quality and bias. This protocol was conducted according to the Preferred Reporting Item for Systematic Review and Meta-analysis Protocol (PRISMA-P) statement.Results:This study will provide a rational synthesis of current evidence for traditional Chinese medicinal enemas for the treatment of CRF.Conclusion:This study presents evidence on whether traditional Chinese medicinal enemas are an effective and safe intervention for CRF patients.Registration number:INPLASY202080052

Effect of large dosage of Fuling on urinary protein of diabetic nephropathy: A protocol of systematic review and meta-analysis of randomized clinical trials.

Introduction:Diabetic nephropathy (DN) is one of the most common and serious microvascular complications in patients with diabetes, which seriously affects their life quality and survival time. large dose herb Fuling or compound prescription contain large dose Fuling for treatment of DN has already been confirmed. However, due to the lack of evidence, there is no specific method or suggestion, so it is necessary to carry out systematic evaluation on Fuling and provide effective evidence for further research.Methods and analysis:The following databases will be searched from their inception to June 2020: Electronic database includes PubMed, Embase, Cochrane Library, Web of Science, Nature, Science online, Chinese Biomedical Database WangFang, VIP medicine information, and China National Knowledge Infrastructure (CNKI). Primary outcomes:24-hurinary-albumin, Urinary albumin-to-creatinine ratio. Additional outcomes: Serum creatinine, Blood urea nitrogen, Glomerular filtration rate, Endogenous creatinine clearance rate. Data will be extracted by 2 researchers independently, risk of bias of the meta-analysis will be evaluated based on the Cochrane Handbook for Systematic Reviews of Interventions. All data analysis will be conducted by data statistics software Review Manager V.5.3. and Stata V.12.0.Results:The results of this study will systematically evaluate the effectiveness and safety of large dose Fuling intervention for people with DN.Conclusion:The systematic review of this study will summarize the current published evidence of large dose Fuling for the treatment of DN, which can further guide the promotion and application of it.Ethics and dissemination:This study is a systematic review, the outcomes are based on the published evidence, so examination and agreement by the ethics committee are not required in this study. We intend to publish the study results in a journal or conference presentations.Open Science Framework (OSF) registration number:August 24, 2020. osf.io/ym2c6. (https://osf.io/ym2c6).

Clinical significance of serum cystatin C in early evaluation of renal impairment caused by chemotherapy in elderly patients.

BackgroundThis study aims to discuss the application value of serum cystatin C (Cys C) in detecting early renal function injury in elderly patients with malignant tumors after chemotherapy.MethodsThe data at different chemotherapy time points (before chemotherapy, after two cycles of chemotherapy, and after four cycles of chemotherapy) were analyzed.ResultsSerum Cys C was significantly higher after chemotherapy than before chemotherapy in elderly patients with malignant tumors, and the endogenous creatinine clearance rate (CCr) significantly decreased. These were significantly correlated. However, there was no significant change in serum creatinine (SCr) and blood urea nitrogen (BUN). Cys C continued to increase with the prolonged time of chemotherapy. In addition, Cys C was sensitive for detecting renal impairment caused by platinum-based chemotherapy drugs.ConclusionsThe diagnostic effect of Cys C on early renal function injury after chemotherapy in elderly patients with malignant tumors is better, when compared to traditional renal function test items, such as SCr, BUN and CCr.

Association between atherogenic index of plasma and renal function impairment in patients with gout

Objective To study the relationship between atherogenic index of plasma (AIP)and renal impairment in male patients with gout. Methods A retrospective analysis of 821 male subjects was conducted to measure the relevant biochemical indicators and to calculate the AIP, endogenous creatinine-clearance rate (Ccr), and estimated glomerular filtration rate (eGFR). EpiData 3.1 software was used for data entry, SPSS21.0 was used for statistical analysis, and GraphPad Prism 6.0 software was used for charts. Results Compared with control group, AIP, serum uric acid, triglyceride in gout group were significantly higher (all P 0.05), while Ccr and serum uric acid levels gradually increased (P<0.05). Logistic regression analysis after adjusting for various confounding factors showed that AIP, triglyceride, and serum uric acid were risk factors for renal function damage in patients with gout (P<0.05), the relevant risk were 7.030, 1.291, 1.004 respectively. After adjusting confounding factors, the associations between triglyceride, serum uric acid and renal function injury risk changed little, while AIP showed more evident, the OR value increased from 2.629 to 6.265 and 7.030. Conclusions (1)AIP is closely related to the renal function damage of patients with gout. After adjusting various confounding factors, AIP can better reflect the renal function damage than other indicators, which is of great significance to predict the renal function damage of patients with gout. (2)That patients with gout with high uric acid level may suffer from renal atherosclerosis and have a higher risk of renal impairment. (3)Dynamic observation of AIP in gout patients is helpful for early identification of the risk of renal failure in such patients. Key words: Gout; Renal damage; Atherogenic index of plasma; Confounding factors

Protective effects of azithromycin on adriamycin-induced nephropathy with albumin overload in mice

To study the protective effects of azithromycin on renal damage induced by doxorubicin and albumin in mice. Forty male BALB/c mice were randomly divided into blank control group (Ctrl group), renal damage model group (ADR+BSA group), azithromycin treated group (Azm group) and prednisone acetate positive control group (Pdn group) in accordance with random number table method. Mice in ADR+BSA, AZM and Pdn group were injected intravenously with 9.8 kg-1 doxorubicin five days a week, 10 kg-1 serum albumin was injected intraperitoneally, and normal saline was administered to the control group for 4 weeks to establish renal damage model. After that, AZM group was given daily. 62.5 kg-1 azithromycin was intragastrically administered. The Pdn group was given 12.5 kg-1 prednisone acetate daily, the other two groups were given the same amount of normal saline. After 6 weeks, the urine volume was collected and recorded for 24 hours to detected urine protein amount and endogenous creatinine clearance rate (Ccr). Serum biochemical indicators and serum immune factors were detected. Compared with the Ctrl group, the 24 h urine protein level of the ADR+BSA group was increased significantly (P＜0.05), and the Ccr was decreased significantly (P＜0.05). After the azithromycin treatment, the 24 h urine protein was decreased significantly (P＜0.05), while the Ccr was increased significantly (P＜0.05) compared with ADR+BSA group. Azithromycin has a protective effects on the renal damage induced by doxorubicin and albumin in mice.

Combination therapy of tripterygium glycosides plus valsartan in diabetic nephropathy treatment: A systematic review and meta-analysis

ObjectiveTo assess the efficacy and safety of the combination therapy of Chinese herbal medicines, tripterygium glycosides, plus valsartan for the treatment of diabetic nephropathy (DN). MethodsA comprehensive research of 12 electronic databases was performed. Data of the included studies were extracted and analyzed independently by two authors, and were synthesized using Review Manager (version 5.2) and Stata (version 12.0). ResultsA total of 12 randomized controlled trials (RCTs) involving 829 patients were included. Pooled results showed that the combination therapy significantly increased total efficacy of DN patients [RR = 1.35, 95% CI (1.22, 1.50), P < 0.001], the level of serum albumin [Mean difference (MD) = 3.87, 95% CI (3.12, 4.62), P < 0.001], and significantly decreased 24 h urinary protein level [MD = −0.97, 95% CI (−1.19, −0.76), P < 0.001], urinary albumin-excretion rate [MD = −145.53, 95% CI (−227.95, −63.11), P < 0.001], and urinary β2-microglobuli level [MD = −11.86, 95% CI (−13.02, −10.69), P < 0.001]. No significant differences were found in levels of serum creatinine [MD = −0.26, 95% CI (−7.52, 7.00), P > 0.05), blood urea nitrogen [MD = 0.25, 95% CI (−0.23, 0.74), P > 0.05], and endogenous creatinine clearance rate [MD = −0.43, 95% CI (−3.48, 2.62), P > 0.05]. However, tripterygium glycosides plus valsartan seemed to exert higher adverse reaction rate than valsartan monotherapy [MD = 3.41, 95% CI (1.34, 8.66), P < 0.05]. There were no publication bias for all of the pooled effect sizes. ConclusionCombination therapy of tripterygium glycosides plus valsartan may be effective for the treatment of DN. However, the safety of the combination therapy need to be further confirmed.

Population pharmacokinetics and individualized lobaplatin regimen for the treatment of Chinese small cell lung cancer in the elderly.

Background:Lobaplatin (LBP) is a third-generation platinum compound.Material and methods:This prospective study was performed in 7 institutions in 2014–2016. Elderly small cell lung cancer (SCLC) patients (≥65 years old) were divided into 2 groups to receive LBP regimens according to endogenous creatinine clearance rate (Ccr). LBP was administered at 30 and 20 mg/m2 in groups A (Ccr ≥ 80 ml/min) and B (60 ml/min ≤ Ccr < 80 ml/min), respectively. The primary endpoint was plasma LBP concentrations. Secondary endpoints were safety and efficacy parameters, including progression-free survival (PFS) and overall survival (OS).Results:One-hundred patients were enrolled. Median PFS and OS in groups A and B were 155 vs170 days and 306 vs 272 days, respectively. The rates of grade III/IV AEs in groups A and B were 60.8% (n = 31) and 51.0% (n = 25), respectively. In population pharmacokinetics, the area under the curve (AUC) value for group B was 39% lower than that of group A. With LBP administration based on body surface area (BSA), AUC differences between individuals were small.Conclusion:With Ccr ≥ 60 ml/min, BSA based administration is necessary. Meanwhile, LBP-based regimens are reliable in treating elderly patients with SCLC.

The protective effect of different dialysis types on residual renal function in patients with maintenance hemodialysis: A systematic review and meta-analysis.

Residual renal function (RRF) is an important determinant of mortality and morbidity in patients undergoing hemodialysis. Different dialysis types may have different effects on RRF. We therefore conducted this meta-analysis to examine the RRF protective effect of different dialysis types for hemodialysis patients. A systematic search was performed on PubMed, EMbase, Web of Science, Chinese Biomedical Literature Database, Wanfang database, and China National Knowledge Infrastructure for randomized controlled trials and cohort studies. Dialysis types included low-flux hemodialysis (LFHD), high-flux hemodialysis (HFHD), hemodiafiltration (HDF), and hemodialysis and hemoperfusion (HD+HP). The mean of endogenous creatinine clearance rate (CCR) and urea clearance rate (Curea), or urine volume was used to estimate RRF [95% confidence interval (95% CI), 6.05-16.80]. There were 12 articles involving 1224 patients, including 11 random controlled trials and 1 cohort study. Meta-analysis showed that the RRF protective effect of HFHD [mean difference (MD) = 1.48, 95% CI (2.11 to 0.86), P < .01] and HD+HP [MD = 0.41, 95% CI (0.69 to 0.12), P = .005] was better than that of LFHD, and the RRF decline rate was the lowest in HFHD group [MD = 0.13, 95% CI (0.17 to 0.09), P < .01]. Descriptive analysis showed that HDF could better protect RRF when compared with LFHD. However, there was no consistency among other interventions when removing LFHD due to limited data. For patients undergoing maintenance hemodialysis, the HFHD, HD+HP and HDF may better protect RRF, compared with LFHD.

Risk factors and short-term prognosis of preoperative renal insufficiency in infective endocarditis.

The incidence of postoperative complications and the in-hospital mortality rate of infective endocarditis (IE) complicated with renal insufficiency are relatively high. This study aimed to analyze the clinical features, etiological characteristics, diagnosis and treatment, and prognosis of IE with renal insufficiency and to explore the risk factors for renal damage. IE patients undergoing valvular surgery between 2008 and 2017 in two cardiac centers were retrospectively analyzed. They were divided into renal insufficiency (RI) [endogenous creatinine clearance rate (Ccr) <60 mL/min/1.73 m2] and normal renal function (NRF) (Ccr ≥60 mL/min/1.73 m2) groups. The disease conditions at admission, etiology, treatment, and prognosis were compared between the two groups. Multivariate regression analysis was performed for the related factors. A total of 8,055 cases of valvular surgery was performed during the study period. We analyzed 401 IE patients [average age 43.9±15 years; RI, n=56 (14%); NRF, n=345 (86%)], after the exclusion of 2 patients with primary glomerulonephritis. RI patients showed higher perioperative mortality (14.3% vs. 4.5%, P=0.042) and streptococcal infection (71.4% vs. 43.8%, P=0.001) rates. The RI group was also older and had worse heart function, greater decreases in hemoglobin and platelet levels, a higher rate of prosthetic valve involvement, more cases of postoperative dialysis, and worse prognosis (all P<0.05). Binary logistic multivariate regression analysis showed that the incidence of streptococcal infection [odds ratio (OR) =4.271, 95% confidence interval (CI), 1.846-9.884; P=0.001], age ≥51 years (OR =5.138, 95% CI, 2.258-11.694; P<0.001), and New York Heart Association (NYHA) functional class III-IV (OR =10.768, 95% CI, 2.417-47.972; P=0.002) were independent risk factors for preoperative renal insufficiency. IE patients with preoperative renal insufficiency had a high mortality rate and poor prognosis, with streptococcal infection predisposing to a higher risk of renal insufficiency. Moreover, older the age and worse heart function in IE resulted in a greater risk for renal insufficiency.

Protective effect of rosuvastatin on acute kidney injury in the patients after coronary artery bypass grafting

Objective To investigate the prevention of acute kidney injury(AKI) by earlier application of rosuvastatin in patients after coronary artery bypass grafting (CABG). Methods A total of 200 patients with CABG were enrolled from May 2013 to April 2017. According to whether rosuvastatin were used routinely before operation or not, all patients were divided into the trial group (n=136) and the control group (n=64). Demographics, and clinical data were collected before and after CABG. The renal function markers including blood urea nitrogen (BUN), serum creatinine (sCr), endogenous creatinine clearance rate (GFR) , emergence of AKI of two groups were documented and compared. Enumeration data were analyzed with χ2 test, measurement data were analyzed with t test, and P<0.05 was considered to be significant. Results There were no differences in sCr(t=-1.156, P>0.05) but differences in BUN and eGFR ( t=-2.915, 3.690, respectively, P 0.05). The BUN and sCr were increased(t=-3.792, -5.027, respectively, P<0.05)after operation compared with that of pre-operation in the control group, while the eGFR was decreased(t=5.540, P<0.05) . Compared with the control group, BUN, sCr and the incidence of AKI were significantly decreased in the trial group ( t/χ2=5.759, 4.196, 15.506, respectively, P<0.05), while the eGFR was increased(t=-6.215, P<0. 05). Conclusions Earlier application of rosuvastatin before CABG can effectively protect renal function and reduce the incidence of AKI. Key words: Rosuvastatin; Coronary artery bypass grafting; Perioperative; Acute kidney injury; Renal function

1146 - Comparison of DCE-MRI renography, SPECT renography and endogenous creatinine clearance rate in kidney transplant recipients

1146 - Comparison of DCE-MRI renography, SPECT renography and endogenous creatinine clearance rate in kidney transplant recipients