Nephropathy In Elderly Patients Research Articles

Vaspin Levels and Diabetic Nephropathy in Elderly Patients with Type 2 Diabetes Mellitus

Vaspin Levels and Diabetic Nephropathy in Elderly Patients with Type 2 Diabetes Mellitus

Assessment of Serum 25-Hydroxyvitamin D and Its Association in Type 2 Diabetes Mellitus Elderly Patients with Kidney Disease: A Retrospective Cross Sectional Study

The overall aim of this study is to determine the prevalence of vitamin D deficiency and its association with diabetic nephropathy in elderly patients with type 2 diabetes mellitus. This study is a single center retrospective cross-sectional design conducted at private medical center. The study group included all patients (18 years or older) suffering from type 2 diabetes mellitus that attended the diabetic clinic from September 2019 to January 2021. The main outcome variable is a trough level of (<20 ng/mL) for 25OHD. The patients were categorized as having diabetic nephropathy based on estimated glomerular filtration rate (eGFR). Total glycated hemoglobin (HbA1c), creatinine serum, Alb: Cr ratio, total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were compared between vitamin D deficiency groups. Univariate and multivariate logistic regression was used to investigate the association between vitamin D deficiency and other significant anthropometric and biochemical factors. A p value < 0.05 was chosen as the criterion to make decisions regarding statistical significance. Among the 453 diabetic patients included in study, 48.6% (n = 220) were male and 51.4% (n = 233) were female. The mean age ± S.D of the patients was 54.5 ± 10.6 years old. Out of 453 diabetic patients, 71.1% (95% CI: 66.9%-75.3%) had vitamin D deficiency (25OHD < 20 ng/mL). There was a statistically significant association between 25OHD level and diabetic nephropathy in elderly patients with type 2 diabetes mellitus. Diabetic patients with e-GFR < 60 mL/min more likely to have vitamin D deficiency (p < 0.001). Similarly, individuals with Alb: Cr ratio > 30 mg/g were more likely to have vitamin D deficiency (p < 0.001). Moreover, diabetic patients with serum creatinine > 1.8 mg/dL were more likely to have vitamin D deficiency (p < 0.001). The study revealed a high prevalence of vitamin D deficiency in elderly patients with type 2 diabetes mellitus. A significant association was reported between 25-hydroxyvitamin D, e-GFR and Alb: Cr ratio.

Fatty Acid Binding Protein (1 &amp; 2) as Markers of Diabetic Nephropathy in Elderly Patients with Type 2 Diabetes Mellitus

Fatty Acid Binding Protein (1 &amp; 2) as Markers of Diabetic Nephropathy in Elderly Patients with Type 2 Diabetes Mellitus

A rare report of obstructive nephropathy induced hyponatremia

ABSTRACT Hyponatremia is a common finding in patients admitted to hospitals in the USA. There is a plethora of causes ranging from excessive diuretic use to volume overload from underlying heart failure or liver cirrhosis. The consequences of missing or mistreating the aforementioned diagnosis can lead to catastrophic outcomes. Here, we focus on a rare yet overlooked cause of hyponatremia: obstructive nephropathy. The causes of obstructive nephropathy in elderly patients are broad with neurogenic bladder being one of the common ones. Our patient is an elderly male who presented with hyponatremia in setting of urine retention post an orthopedic surgery.

What factors are Associated with the Development of Contras-induced Nephropathy in Elderly Patients with Acute Coronary Syndrome in Real Clinical Practice?

Aim. To study the factors associated with contrast-induced acute kidney injury in elderly patients with acute coronary syndrome (ACS).Material and Methods. A retrospective analysis of 514 electronic medical records of patients aged 75 years and over (38% men and 62% women) with confirmed acute coronary syndrome has been performed. The contrast-induced acute kidney injury was defined as an increase in serum creatinine ≥26.5 μmol/L in 48 h or as an increase in serum creatinine in 1.5 times within 7 days after the contrast media exposure. Patients were divided into contrast-induced acute kidney injury and non-contrast-induced acute kidney injury group. Clinical characteristics and in-hospital outcomes were extracted from patients' medical records. Procedural characteristics were obtained from laboratory database.Results. Angiographic intervention was performed in 74% of patients, 32% of them (more often in women, p=0.033) were diagnosed with contrast-induced acute kidney injury. Patients with contrast-induced acute kidney injury are characterized by a higher death rate (17% и 3%, p&lt;0.001) and were more likely to have heart failure with reduced ejection fraction (34% и 21%, p=0.008) and acute heart failure (Killip class II-IV) (24% и 16%, p=0.015). The risk of developing contrast-induced acute kidney injury was related the volume of contrast medium administered.Conclusions. Prevention particular care should be taken to female patients older than 75 years with ACS, with a history of the chronic heart failure with reduced ejection fraction or acute heart failure (Killip class II-IV), and with a high volume of contrast media, highlighting that a perioperative comprehensive management strategy is needed to improve the prognosis.

Reduced glutathione does not further reduce contrast-induced nephropathy in elderly patients with diabetes receiving percutaneous coronary intervention.

ObjectiveTo investigate the preventive effect of hydration combined with reduced glutathione on contrast-induced nephropathy (CIN) after coronary intervention therapy in elderly Chinese patients with diabetes.MethodsPatients with diabetes aged ≥65 years, who received percutaneous coronary intervention (PCI) between 1 August 2016 and 31 December 2018, were enrolled and randomized into two groups: patients treated with hydration combined with reduced glutathione (treatment group) and patients who received hydration alone (controls). Serum creatinine and creatinine clearance levels were measured in all patients before PCI and then daily for 3 days after PCI. Occurrence of CIN (the primary endpoint) was defined as serum creatinine value 25% or 44.2 mmol/l (0.5 mg/dl) above baseline at 72 h after an exposure to contrast medium.ResultsA total of 396 patients were included (treatment group, n = 204; and controls, n = 192). The CIN occurrence rate in the treatment and control group was 5.88% and 6.77%, respectively, with no statistically significant between-group difference.ConclusionIn elderly patients with diabetes receiving PCI, the risk of CIN was not effectively lowered by hydration combined with reduced glutathione.

Trimetazidine can prevent the occurrence of contrast-induced nephropathy after percutaneous coronary intervention in elderly patients with renal insufficiency.

Contrast-induced nephropathy (CIN) has become a common cause of hospital-acquired acute kidney injury in elderly patients. Trimetazidine (TMZ) is a type of anti-ischemic drug developed in recent years, which can reduce the incidence of CIN. This study aimed to evaluate the efficacy of TMZ in the prevention of contrast-induced nephropathy in elderly patients with renal insufficiency undergoing percutaneous coronary intervention (PCI) and to explore the mechanism of action. A total of 310 elderly patients with renal insufficiency undergoing elective PCI were enrolled and randomly assigned to a control group (n = 155, hydration only) and a TMZ group (n = 155, 20 mg thrice daily orally 24 hours before and 72 hours after PCI). The primary endpoint of the study was the incidence of CIN, which was defined as an increase of 25% or more, or an absolute increase of 0.5 mg/dL or more in serum creatinine from baseline value, at 48 to 72 hours following the exposure to contrast media (CM). The incidence of CIN was significantly lower in the TMZ group than that in the control group (3.2% vs. 9.7%, p = 0.021). There was no difference regarding the incidence of major adverse events during hospitalization between the TMZ group and control group (1.9% vs. 2.6%, p = 1.000). Binary logistic regression results showed that TMZ was protective factors of CIN (OR = 0.274; 95% CI: 0.089-0.847; p = 0.025). Therefore, we came to the conclusion that prophylactic administration of TMZ can prevent the occurrence of CIN in elderly patients with renal insufficiency undergoing PCI and has a certain protective effect on the renal function of patients. According to the experimental results and the mechanism of TMZ on cardiomyocytes, we speculate that TMZ increases kidney glucose metabolism, reduces fatty acid oxidation, and also has a protective effect on kidney free radical damage and ischemia-reperfusion injury.

IgA Nephropathy in Elderly Patients.

Some studies suggest that the incidence of IgA nephropathy is increasing in older adults, but there is a lack of information about the epidemiology and behavior of the disease in that age group. In this retrospective multicentric study, we analyzed the incidence, forms of presentation, clinical and histologic characteristics, treatments received, and outcomes in a cohort of 151 patients ≥65 years old with biopsy-proven IgA nephropathy diagnosed between 1990 and 2015. The main outcome was a composite end point of kidney replacement therapy or death before kidney replacement therapy. We found a significant increase in the diagnosis of IgA nephropathy over time from six patients in 1990-1995 to 62 in 2011-2015 (P value for trend =0.03). After asymptomatic urinary abnormalities (84 patients; 55%), AKI was the most common form of presentation (61 patients; 40%). Within the latter, 53 (86%) patients presented with hematuria-related AKI (gross hematuria and tubular necrosis associated with erythrocyte casts as the most important lesions in kidney biopsy), and eight patients presented with crescentic IgA nephropathy. Six (4%) patients presented with nephrotic syndrome. Among hematuria-related AKI, 18 (34%) patients were receiving oral anticoagulants, and this proportion rose to 42% among the 34 patients older than 72 years old who presented with hematuria-related AKI. For the whole cohort, survival rates without the composite end point were 74%, 48%, and 26% at 1, 2, and 5 years, respectively. Age, serum creatinine at presentation, and the degree of interstitial fibrosis in kidney biopsy were risk factors significantly associated with the outcome, whereas treatment with renin-angiotensin-aldosterone blockers was associated with a lower risk. Immunosuppressive treatments were not significantly associated with the outcome. The diagnosis of IgA nephropathy among older adults in Spain has progressively increased in recent years, and anticoagulant therapy may be partially responsible for this trend. Prognosis was poor. This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2019_07_16_CJASNPodcast_19_08_.mp3.

2306-PUB: Long-Term Effect of Liraglutide on the Prevention of Progression of Diabetic Nephropathy in Elderly Patients with Type 2 Diabetes

Purpose: The aim of this study was to assess the long-term efficacy of liraglutide on diabetic nephropathy in elderly patients with type 2 diabetes. Methods: Liraglutide was administrated to elderly patients with poorly controlled type 2 diabetes in Aino Hospital. We recruited and retrospectively reviewed 31 patients who were treated with liraglutide for 5 years (Group L: 7 males/24 females, 75.4±8.1 years old of age, 16 with cerebrovascular and 8 patients with cardiovascular diseases at baseline) and 25 patients who were not treated with liraglutide (Group N, 9 males/16 females, 74.6±11.6 years old of age). Daily dose of liraglutide was 0.9mg except 2 patients (0.6 mg). Results: After 5 years of treatment, HbA1c, FPG, and 2h-PPG significantly decreased in both groups (7.5±0.4 to 6.8±0.5 vs. 7.4±0.6 to 6.9±0.4%, 138±19 to 120±11 vs. 132±16 to 113±13, 206±31 to 173±18 vs. 186±23 to 163±18mg/dl, respectively(p&amp;lt;0.01)). Triglycerides significantly decreased in Group L but not in Group N. Body mass index (BMI) significantly decreased in Group L but not in Group N (25.5±4.1 to 24.8±3.8 (p&amp;lt;0.05) vs. 24.1±3.8 to 24.8±3.8kg/m2 (NS)). Estimated glomerular filtration ratio (eGFR) significantly increased in Group L but significantly decreased in Group N (45.6±17.8 to 49.9±18.5 (p&amp;lt;0.05) vs. 48.7±18.9 to 46.3±21.7 ml/min/1.73m2 (p&amp;lt;0.05). When results were stratified according to eGFR at baseline in Group L (Group A(n=6): eGFR &amp;gt;60, Group B (n=18): eGFR = 30-60, Group C (n=7): eGFR&amp;lt;30), eGFR level increased in Group B (43.6±7.6 to 50.8±8.2 (p&amp;lt;0.01)) and in Group A (73.0±10.5 to 76.8±11.1 (NS)), but not in Group C(24.0±3.4 to 23.0±6.3 (NS)). No hypoglycemia requiring medical care was observed. During the treatment period, no newly onset cerebro- and cardiovascular disease were observed. Conclusion: Liraglutide improved glycemic control, lipid profile and BMI of elderly patients with type 2 diabetes. Liraglutide also demonstrated its beneficial effect on renal function. Disclosure M. Yoshida: None. A. Yoshida: None. E. Oh: None. N. Yamamoto: None. E. Sasaki: None. A. Saeki: None. S. Yoshida: None. T. Kuzuya: None. N. Ohsawa: None. M. Sugino: None.

The effectiveness of traditional Chinese Medicine treatment of diabetic nephropathy in elderly patients

Objective To assess the effectiveness of traditional Chinese Medicine(TCM) syndrome differentiation treatment for diabetic nephropathy in elderly patients. Methods A total of 96 elderly patients with diabetic nephropathy admitted to our hospital from January 2015 to December 2017 were recruited and divided into a regular care group(n=48)and a TCM group(n=48). Both groups received conventional treatment, with TCM syndrome differentiation treatment added to the TCM group.The effectiveness of the treatment modalities was compared. Results In the regular care group, significant effectiveness was observed in 12 patients, effectiveness in 24 patients, and ineffectiveness in 12 patients, with a total effectiveness rate of 75%.In the TCM group, significant effectiveness was seen in 18 patients, effectiveness in 27, and ineffectiveness 3, with a total effectiveness rate of 93%.The total effectiveness rate of the TCM group was higher than that of the regular care group(χ2=6.400, P=0.011). After treatment, fasting blood glucose, 2 h postprandial blood glucose, urea nitrogen, creatinine, and 24 h urine protein in the TCM group were significantly lower than in the regular care group and than pre-treatment levels(P<0.05). Conclusions TCM differentiation can not only significantly improve the treatment effectiveness in elderly patients with diabetic nephropathy, but also relieve the clinical symptoms. Key words: Diabetic nephropathy; TCM syndrome differentiation; Clinical efficacy

The features of idiopathic membranous nephropathy in elderly patients and its correlation with the expression of the expression of phospholipase A2 receptor

Objective To investigate the clinico-pathological features of idiopathic membranous nephropathy(IMN)and the expression of phospholipase A2 receptor(PLA2R)in elderly patients. Methods A total of 109 elderly patients with IMN confirmed by renal biopsy at Wuxi People′s Hospital from July 2008 to February 2015 were included.Data were retrospectively collected. Results (1)Participating patients with IMN had a mean age of(67.3±5.4)years, and 67.9% of them had hypertension and 65.1% had nephrotic syndrome.Compared with non-elderly patients, elderly patients had a higher proportion with hypertension(67.9% vs.25.2%)(P=0.000), higher systolic pressure[(143.1±15.2)mmHg vs.(127.3±13.3)mmHg](P=0.000), higher diastolic pressure[(88.4±10.0)mmHg vs.(80.2±8.4)mmHg](P=0.000), more severe tubulointerstitial lesions[(3.1±1.9) points vs.(2.0±1.9)points](P=0.000), and lower eGFR[(70.9±22.9)ml·min-1·1.73 m-2vs.(90.6±27.1)ml·min-1·1.73 m-2](P=0.000). (2)There were more severe tubulointerstitial lesions[(4.7±1.8)points vs.(2.4±1.7)points, 2.9±1.6 points](P=0.000, 0.000)and lower eGFR[(50.4±17.4)ml·min-1·1.73 m-2vs.(80.3±19.7)ml·min-1·1.73 m-2, (72.3±21.4)ml·min-1·1.73 m-2](P=0.000, 0.000)in elderly patients of pathological stage Ⅱ, compared with patients of pathological stages Ⅰ and Ⅰ-Ⅱ.(3)The rate of positive PLA2R was 82.4%.Patients with positive PLA2R had higher proteinuria[(4.5±2.3)g vs.(2.9±1.1)g](P=0.042), lower eGFR[(66.8±21.8)ml·min-1·1.73 m-2vs.(97.7±16.0)ml·min-1·1.73 m-2](P=0.000), and more severe tubulointerstitial lesions[(3.1±2.0)points vs.(1.7±1.1)points](P=0.037)than patients with negative PLA2R.(4)Multiple regression analysis showed that PLA2R positive rate(P=0.008), tubulointerstitial lesion(P=0.000), and level of cholesterol(P=0.025)were negatively correlated with eGFR(R2=0.572). Conclusions Compared with non-elderly patients, elderly patients with IMN have poorer prognosis as a result of higher blood pressure and more severe tubulointerstitial lesions.Elderly patients with IMN of advanced pathological stages and positive PLA2R have more severe kidney injury and tubulointerstitial lesions, resulting in poor prognosis. Key words: Nephropathy, membranous; Pathology, clinical; Receptors, phospholipase A2

Clinicopathology characteristics of idiopathic membranous nephropathy in elderly patients

Objective To investigate the clinicopathological characteristics of idiopathic membranous nephropathy (IMN) in elderly patients. Methods Clinicopatholigical data of 400 patients with IMN identified by renal biopsy from January 2006 to December 2016 were analyzed retrospectively. The patients were divided into three groups: the young (≤44 years old), the middle-aged (45-59 years old) and the elderly (≥60 years old) , and the clinicopathological characteristics were compared among three groups. Results The average age of the elderly group was( 64.9±4.3)years, the elderly group had worse renal function than the young group (F=784.60, P=0.000) and the middle-aged group [estimated glomerular filtration rate(eGFR)were (91.1±25.9) 、(119.8±37.0) and (102.5±33.2) ml·min-1·1.73 m-2,F=21.74, P=0.000]. The incidence of hypertension was higher in the elderly group than the other two groups [40.0%(32/80) vs. 19.6%(30/153) and 22.2%(37/167), χ2=12.76, P=0.003]. The incidence of MN with ischemic nephropathy and tubulointerstitial lesion in the elderly group was higher than in the young group[15.0%(12/80) vs. 5.8%(9/153), χ2=5.31, P=0.021]. Conclusion The elderly patients with IMN are likely to be complicated with hypertension, ischemic nephropathy and tubulointerstitial lesions indicating poorer prognosis, so more attention should be paid to the early diagnosis and treatment of these comorbidities. Key words: Nephrosis; Glomerulone-phritis, membranous; Pathological conditions, signs and symptoms; Age groups

Effects of injection Shenkang and alprostadil combination on contrast-induced nephropathy in patient with diabetes complicated with mild to moderate renal insufficiency

The diabetic patients (n=109) with mild or moderate renal insufficiency underwent coronary intervention were randomly divided into control group and observation group. The patients in observation group were treated with injection Shenkang and alprostadil before operation. The results showed that the level of serum creatinine, creatinine clearance and blood urea nitrogen had no significant difference (p&gt;0.05) before and postoperative day 1 and day 2 in both groups. However, the value of serum creatinine, creatinine clearance and blood urea nitrogen were significantly different on post-operative day 3 (p&lt;0.05). The incidence of contrast-induced nephropathy was 14.8% in control group, and markedly higher than observation group (3.6%) (p&lt;0.05). Shenkang injection combined with alprostadil injection decreased the incidence of contrast-induced nephropathy in elderly patients with diabetes mellitus complicated with mild to moderate renal insufficiency.

P4279A useful method to predict contrast-induced nephropathy in elderly patients undergoing percutaneous coronary angioplasty

P4279A useful method to predict contrast-induced nephropathy in elderly patients undergoing percutaneous coronary angioplasty

Pre-Procedural Risk Score of Contrast-Induced Nephropathy in Elderly Patients Undergoing Elective Coronary Angiography.

To establish a scoring model to predict the risk of contrast-induced nephropathy (CIN) in elderly patients undergoing elective coronary angiography (CAG).A total of 1286 patients aged > 65 years who had undergone elective CAG between August 2009 and February 2013 were enrolled in this study. They were randomly (3:2) assigned to a development (n = 756) or validation dataset (n = 530). Independent predictors of CIN were identified by using logistic regression and were assigned a weighted integer, which was used to establish a score model.CIN incidence in the development set was 6.3%. The risk score model contained 3 variables (with the weighted integer): age > 75 years (1.5), creatinine clearance (CrCl) < 60 mL/minute (1), and congestive heart failure (CHF) (1.5). CIN incidence was 3.1%, 9.1%, and 29.0% in the low-risk group (≤ 1), moderate risk group (1 - 3), and high-risk group (≥ 3), respectively. The risk model demonstrated good prediction value in the development (c-statistic = 0.727) and validation (c-statistic = 0.695) datasets. Compared to the non-CIN group, the CIN group had a significantly higher rate of inhospital major adverse cardiac events (P < 0.01).The risk score model with 3 variables, namely age > 75 years, CrCl < 60 mL/minute, and CHF, is a clinical prediction tool for CIN in elderly patients before elective CAG. CIN is one of the independent risk factors of major adverse cardiac events (MACE).

Renal assessment using CKD-EPI equation is useful as an early predictor of contrast- induced nephropathy in elderly patients with cancer.

To assess respective roles of serum creatinine (SCr) alone and estimated glomerular filtration rate (eGFR) as an early predictor for contrast-induced nephropathy (CIN) in elderly patients with cancer. eGFR of 348 patients at 65years or older with malignancy who underwent contrast-enhanced computed tomography (CECT) were calculated. eGFR was calculated based on the following three equations: Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI); Modification of Diet in Renal Disease Study (MDRD); Cockcroft-Gault (CG). CIN was subdivided into two groups: CIN25% (SCr increase >25% but ≤0.5mg/dl), and CIN0.5 (SCr increase >0.5mg/dl). The occurrence and clinical outcomes of CIN were determined according to SCr and eGFR. After CECT, CIN occurred in 50 (14.4%) patients, including 33 CIN25% patients and 17 CIN0.5 patients. CIN0.5 was significantly correlated with prolonged hospitalizations and increased in-hospital mortality, but not CIN25%. Despite SCr<1.5mg/dl, preexisting renal insufficiency (RI) was observed in 47 (13.5%) patients based on CKD-EPI equation, 50 (14.4%) patients based on MDRD equation, and 144 (41.4%) patients based on CG formula. In preexisting RI, the prevalence of CIN0.5 had an odds ratio of 15.02 (5.24 to 43.07) based on CKD-EPI equation, 13.73 (4.81 to 39.20) based on MDRD equation, and 5.03 (1.60 to 15.75) based on CG formula. In elderly patients with cancer who visit the emergency department, renal assessment before CECT using CKD-EPI equation was superior to SCr alone, MDRD equation, or CG formula in predicting the occurrence of CIN related CECT.

Preventive effect of reduced glutathione on contrast-induced nephropathy in elderly patients undergoing coronary angiography or intervention: a randomized, controlled trial.

Coronary angiography can be a high-risk condition for the incidence of contrast-induced nephropathy (CIN) in elderly patients. Reduced glutathione, under a variety of mechanisms, may prevent CIN in this procedure. We prospectively examined whether hydration with reduced glutathione is superior to hydration alone for prevention of CIN in an elderly Han Chinese population. A total of 505 patients (271 males and 234 females) aged 75 years or older who underwent non-emergency coronary angiography or an intervention were randomly divided into two groups. The treatment group received hydration with reduced glutathione (n=262) and the control group received hydration alone (n=243). Serum creatinine and blood urea nitrogen levels were measured prior to coronary angiography and 48 h after this procedure. The primary endpoint was occurrence of CIN, which was defined as 25% or 44.2 µmol/L above baseline serum creatinine levels 48 h after the procedure. The overall incidence of CIN was 6.49% in the treatment group and 7.41% in the control group, with no significant difference between the groups (P=0.68). In subgroup analysis by percutaneous coronary intervention, no significant differences were found between the two groups. In summary, reduced glutathione added to optimal hydration does not further decrease the risk of CIN in elderly patients undergoing coronary angiography or an intervention.

Safe contrast volumes for preventing contrast-induced nephropathy in elderly patients with relatively normal renal function during percutaneous coronary intervention.

The aim of this study was to evaluate contrast media volume to creatinine clearance (V/CrCl) ratio for predicting contrast-induced nephropathy (CIN) and to determine a safe V/CrCl cut off value to avoid CIN in elderly patients with relatively normal renal function during percutaneous coronary intervention (PCI).We prospectively enrolled 1020 consecutive elderly patients (age ≥65 years) with relative normal renal function (baseline serum creatinine <1.5 mg/dL) undergoing PCI. Receiver operating characteristic (ROC) curves were used to identify the optimal cut off value of V/CrCl for detecting CIN. The predictive value of V/CrCl for CIN was assessed with a multivariate logistic regression.Thirty-nine patients (3.8%) developed CIN. There was a significant association between a higher V/CrCl ratio and CIN risk (P < 0.001). ROC curve analysis indicated that a V/CrCl ratio of 2.74 was a fair discriminator for CIN (C statistic = 0.68). After adjusting for other known CIN risk factors, V/CrCl ratios >2.74 remained significantly associated with CIN (odds ratio = 3.21, 95% confidence interval [CI] 1.45–7.09, P = 0.004) and worse long-term mortality (hazard ratio = 1.96, 95% CI 1.14–3.38, P = 0.016).A V/CrCl ratio >2.74 was a significant independent predictor of CIN and was independently associated with long-term mortality in elderly patients with relatively normal renal function.

Analysis of clinical and pathological relationship of idiopathic membranous nephropathy in elderly patients

Objective To understand the clinical and pathological characteristics of idiopathic membranous nephropathy, and to investigate their relationships in the elderly patients. Methods The clinical and pathological data of idiopathic membranous nephropathy diagnosed by renal biopsy in the recently 10 years in our hospital were retrospectively analyzed and compared. Results Sex composition variable was not significant between elderly and non-elderly groups, with male accounting for 57.4% and 59.2% respectively (P>0.05). The ratio of idiopathic membranous nephropathy in primary glomerular disease was higher in the elderly than in non-elderly group (42.8% vs. 17.4%, χ2 =119.058, P 0.05). Conclusions The risk for idiopathic membranous nephropathy is higher in elderly group than in non-elderly group. Edema, hypertension and renal dysfunction occur more commonly in elderly patients with idiopathic membranous nephropathy. Key words: Nephritic syndrome; Glomerulonephritis, Membranoproliferative

Risk Score for the Prediction of Contrast-Induced Nephropathy in Elderly Patients Undergoing Percutaneous Coronary Intervention

We developed a risk score for contrast-induced nephropathy (CIN) in elderly patients (n = 668) before percutaneous coronary intervention (PCI). Another 277 elderly patients were studied for validation. Based on the odds ratio, risk factors were assigned a weighted integer; the sum of the integers was the risk score. Among the 668 elderly patients, 105 (15.7%) experienced CIN. There were 9 risk factors for CIN (with weighted integer): estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m(2) (4), diabetes (3), left ventricular ejection fraction <45% (3), hypotension (2), age >70 years (2), myocardial infarction (2), emergency PCI (2), anemia (2), and contrast agent volume >200 mL (2). The incidence of CIN was 3.4%, 11.9%, 36.9%, and 69.8% in the low-risk (≤4), moderate risk (5-8), high-risk (9-12), and very-high-risk groups (≥13). The model demonstrated good discriminative power in the validation population (c statistic = 0.79). This score can be used to plan preventative measures.