Prognosis Of Kidney Disease Research Articles

Protocol and establishment of a Queensland renal biopsy registry in Australia

BackgroundRenal biopsy is often required to obtain information for diagnosis, management and prognosis of kidney disease that can be broadly classified into acute kidney injury (AKI) and chronic kidney disease (CKD). The most common conditions identified on renal biopsy are glomerulonephritis and tubulo-interstitial disorders. There is a paucity of information on management strategies and therapeutic outcomes in AKI and CKD patients. A renal biopsy registry will provide information on biopsy-proven kidney disorders to improve disease understanding and tracking, healthcare planning, patient care and outcomes.MethodsA registry of patients, that includes biopsy-proven kidney disease, was established through the collaboration of nephrologists from Queensland Hospital and Health Services and pathologists from Pathology Queensland services. The registry is in keeping with directions of the Advancing Kidney Care 2026 Collaborative, established in September 2018 as a Queensland Health initiative. Phase 1 of the registry entailed retrospective acquisition of data from all adult native kidney biopsies performed in Queensland, Australia, from 2002 to 2018. Data were also linked with the existing CKD.QLD patient registry. From 2019 onwards, phase 2 of the registry involves prospective collection of all incident consenting patients referred to Queensland public hospitals and having a renal biopsy. Annual reports on patient outcomes will be generated and disseminated.DiscussionEstablishment of the Queensland Renal Biopsy Registry (QRBR) aims to provide a profile of patients with biopsy-proven kidney disease that will lead to better understanding of clinico-pathological association and facilitate future research. It is expected to improve patient care and outcomes.

The Effect of Chinese Traditional Medicine Huaiqihuang (HQH) on the Protection of Nephropathy

Kidney disease is one of the common diseases with high morbidity and high mortality, which brings a huge burden to the society and the patient's family. The pathogenesis, treatment, and prognosis of kidney diseases are related to oxidative stress, inflammation, mitochondrial damage, and immune dysfunction. However, existing treatments always cause some damage to the kidneys. Kidney disease and immunosuppressant used together often lead to drug toxicity, patients with weakened immunity, organic rupture of the normal structure of the kidney, damage to the physiological function of the kidney, etc. Huaiqihuang is a kind of traditional Chinese medicine with a history of more than one thousand years. According to research, Robinia pseudoacacia can regulate the immune function by regulating oxidative stress, calcium inflow, and mitochondrial ATP. At the same time, it is also involved in regulating the ways of cell death, such as apoptosis, autophagy, ferroptosis, pyroptosis, and clockophagy, to reduce kidney damage, which has important clinical value. This article reviews the exact mechanism and clinical application of Huaiqihuang in different types of nephropathy. The aim is to provide new ideas for the treatment of clinical nephropathy.

Proteinurie z pohledu internisty

A basal level of proteinuria is about 30-100 mg/day, the upper limit of basal proteinuria does not exceed 150 mg/day which is considered non-pathology. Albumin accounts approximately 15 % of basal protein in the urine, other plasma proteins (immunoglobulins, β-2 microglobulin, Tamm-Horsfall mucoprotein) comprise the remaining 85 % of total quantity non-pathology proteinuria. Persistent proteinuria present for more than three months already meets the definition of chronic kidney disease independently of the stage of the estimated glomerular filtration rate. Patients are classified as A1-A3 based on the level of albuminuria. Examination of the albumin in the urine is one of the single sensitive indicators of chronic kidney disease. Proteinuria is an independent risk factor for cardiovascular disease, overall mortality and end stage renal failure both in general population and in population with chronic kidney disease. Presence of the urinary protein is associated with a higher mortality rate in critically ill patients. The degree of proteinuria after kidney transplantation predicts graft and patient survival in this population. Pharmacological and non-pharmacological treatments that attenuate proteinuria have been associated with better prognosis of kidney disease.

Comparison of effect of continuous renal replacement therapy in AKI 2 stage and AKI 3 stage on the prognosis of critical patients with acute kidney injury

Objective To compare the effect of continuous renal replacement therapy(CRRT) in AKI 2 stage and AKI 3 stage on the prognosis of critical patients with acute kidney injury(AKI). Methods From February 2017 to October 2018, 56 cases of critical patients with AKI 2-3 stage who underwent CRRT in ICU of our hospital were selected as the research objects. According to the new AKI criteria formulated by the international organization for improving the prognosis of global kidney disease (KDIGO) in 2012, the patients were divided into AKI 2 stage group (n=26) and AKI3 stage group (n=30). The prognostic indexes (length of hospital stay, duration of CRRT, renal function recovery rate in 28 days, all-cause mortality in 28 days) were compared between two groups. The acute physiology and chronic healthⅡ(APACEⅡ)scores were compared between two groups before and after treatment. Survival analysis was performed by Kaplan-Meier in two groups. Results The duration of CRRT [(188.6±112.5)h vs. (96.3±44.7)h], all-cause mortality in 28 d[66.7%(20/30) vs.15.4%(4/26)] of AKI 3 stage group was significantly higher than that of AKI 2 stage group (P<0.05) and the renal function recovery rate in 28 days[36.7%(11/30) vs.92.3%(24/26)] of AKI 3 stage group was significantly lower than that of AKI 2 stage group (P<0.05). After treatment, the APACEⅡscores were significantly reduced in two groups (P<0.05) and the APACEⅡscores[(23.4±3.6) scores vs.(19.8±2.1) scores] of the AKI 3 stage group was significantly higher than that of AKI 2 stage group (P<0.05). The median survival time (34 days vs. 109 days) of AKI 3 stage group was significantly shorter than that of AKI 2 stage group (P<0.05). Conclusions CRRT initiation in AKI 2 stage could significantly reduce all-cause mortality in 28 days, prolong the median survival time and improve the health condition of patients. Key words: Acute Kidney Injury; Renal Replacement Therapy

Urinary cell-free mitochondrial and nuclear deoxyribonucleic acid correlates with the prognosis of chronic kidney diseases

IntroductionCell-free deoxyribonucleic acid DNA (cf-DNA) in urine is promising due to the advantage of urine as an easily obtained and non-invasive sample source over tissue and blood. In clinical practice, it is important to identify non-invasive biomarkers of chronic kidney disease (CKD) in monitoring and surveillance of disease progression. Information is limited, however, regarding the relationship between urine and plasma cf-DNA and the renal outcome in CKD patients.MethodsOne hundred and thirty-one CKD patients were enrolled between January 2016 and September 2018. Baseline urine and plasma cell-free mitochondrial DNA (cf-mtDNA) and cell-free nuclear DNA (cf-nDNA) were isolated using quantitative real-time PCR. Estimated glomerular filtration rate (eGFR) measurement was performed at baseline and 6-month follow-up. Favorable renal outcome was defined as eGFR at 6 months minus baseline eGFR> = 0. Receiver operator characteristics (ROC) curve analysis was performed to assess different samples of cf-DNA to predict favorable renal outcomes at 6 months. A multivariate linear regression model was used to evaluate independent associations between possible predictors and different samples of cf-DNA.ResultsPatients with an advanced stage of CKD has significantly low plasma cf-nDNA and high plasma neutrophil gelatinase-associated lipocalin (NGAL) levels. Low urine cf-mtDNA, cf-nDNA levels and low plasma NGAL were significantly correlated with favorable renal outcomes at 6 months. The urine albumin-creatinine ratio (ACR) or urine protein-creatinine ratio (PCR) level is a robust predictor of cf-mtDNA and cf-nDNA in CKD patients. Baseline urine levels of cf-mtDNA and cf-nDNA could predict renal outcomes at 6 months.ConclusionsUrinary cf-mtDNA and cf-nDNA may provide novel prognostic biomarkers for renal outcome in CKD patients. The levels of plasma cf-nDNA and plasma NGAL are significantly correlated with the severity of CKD.

Epidemiological status of metabolic syndrome and its correlation with renal damage in Shanghai Chongming rural areas

Objective To investigate the prevalence of metabolic syndrome in adults in Shanghai Chongming area and to analyze the relationship between metabolic syndrome and chronic kidney disease. Methods A total of 7 679 residents aged 30 years and over in Chongming District of Shanghai were randomly sampled and investigated by questionnaires, physical examinations, and laboratory examinations. The metabolic syndrome was diagnosed by the diagnostic criteria of metabolic syndrome according to the Chinese Guidelines for the Prevention and Treatment of Type 2 Diabetes in 2017. According to the criteria of the International Society of Nephrology Working Group on Improving the Overall Prognosis of Kidney Diseases, estimated glomerular filration rate (eGFR)<60 ml·min-1·(1.73 m2)-1 was diagnosed as chronic kidney disease. Results The prevalence of metabolic syndrome was 38.61% in the total population. The prevalence of metabolic syndrome was 47.06% in males and 34.71% in females. Urinary albumin-creatinine ratio (ACR), eGFR, age, smoking, waist circumference, blood glucose, blood pressure, high density lipoprotein-cholesterol and triglyceride in metabolic syndrome group were significantly higher than those in non- metabolic syndrome group. With the increase of metabolic components, eGFR decreased, and ACR increased. According to logistic regression analysis, age, male, hyperglycemia, hypertension, hypertriglyceride were risk factors for eGFR. Male, hypertension, hyperglycemia, hypertriglyceride, central obesity, smoking history, lower education level were risk factors for ACR. Conclusion The number of metabolic components is related to renal damage. Male, hypertension, hyperglycemia, hypertriglyceride are risk factors for early renal damage. Key words: Metabolic syndrome; Chronic kidney disease; Epidemiology

Biomarkers of Chronic Renal Tubulointerstitial Injury.

Progression of renal parenchyma injury is characterized by increasing interstitial fibrosis and tubular atrophy, irrespective of the cause. Histopathologic assessment of renal tissue obtained by biopsy remains the gold standard for determining the presence and extent of tubulointerstitial scarring. Discovery of robust non-invasive means for capturing a snapshot and for longitudinal monitoring of parenchymal deterioration has been the focus of intense multimodal effort by investigators within the renal community and beyond. Research in this field has included the use of in vitro and in vivo experimental models and has fostered the development and evaluation of tissue and biofluid assays for novel analytes with potential translation to the diagnosis and prognosis of kidney disease. Here, we examine recent advances in the search of "biomarkers" for detection of renal tubulointerstitial scarring and prediction of renal outcome in human renal disease.

Clinical analysis of 169 cases of ultrasound-guided renal biopsy

Objective To explore the clinical value and complication rate of ultrasound-guided renal biopsy. Methods From January 2013 to July 2017, 169 cases of ultrasound-guided percutaneous renal biopsy were selected as the research objects, and the clinical data, pathological type and postoperative complications were analyzed retrospectively. Results One hundred and fifty cases of primary glomerular diseases (89.8%) and 17 cases of secondary glomerular diseases(10.2%) were found in 167 renal biopsy patients with successful puncture, the incidence of MN in primary renal disease was the highest, accounting for 35.3%, followed by IgAN, accounting for 34.1%, the incidence of lupus nephritis in secondary nephropathy was the highest, accounting for 3.6%. The postoperative complications of backache, >2 cm perirenal hematoma, hematuria, complication rates were: 58.0%, 24.3%, 2.4%. Conclusions Ultrasound-guided renal biopsy has a high success rate, which is of great significance for the diagnosis, treatment and prognosis of kidney disease, but it also has certain risks, and the complications should be treated promptly and effectively. Key words: Kidney Diseases; Biopsy, Needle

Mini-review of kidney disease following hematopoietic stem cell transplant .

Advancements in hematopoietic cell transplantation (HCT) have broadened indications for its use and resulted in more long-term survivors. Stem cell transplantation is associated with several well-known toxicities, although renal complications are not well defined. Acute and chronic kidney disease remains a common complication following transplantation itself. Incidence and risk factors for the development of chronic kidney disease (CKD) is less well understood. Recent estimates suggest that nearly 15% of subjects undergoing HCT will develop CKD, a complication that can progress to end-stage renal disease (ESRD), disrupts overall quality of life, and reduces overall survival. Several commonly-reported risk factors include acute kidney injury, graft-versus-host disease, and long-term calcineurin inhibitor use. This review highlights the incidence, timeline, etiology, risk factors, and prognosis of kidney disease in the setting of hematopoietic stem cell transplantation. Investigation of the causes of CKD is needed, as are ways to prevent, mitigate, and treat kidney injury. Renal disease importantly reflects prognosis, with dialysis-requiring patients carrying greater than 80% mortality after 3 years. Although CKD following HCT is common, prospective studies are needed to confirm risk factors and better define the underlying mechanisms in order to promote therapies that prevent this complication.

The importance of homocysteine levels in the prognosis of patients with chronic renal disease and in hemodialysis patients

ABSTRACT Introduction: Homocysteine (Hcy) is one of the metabolites of methionine (Met), an essential diet-derived amino acid. There is a close relationship between high plasma Hcy levels and declining renal function. Plasma and urinary Hcy level has been the target of studies as a biomarker that forecasts poor outcome in renal patients and in hemodialysis patients. This review evaluates the main studies that sought to correlate Hcy and poor prognosis in renal disease as well as the treatments proposed for the reduction of plasma Hcy levels in these patients. Conclusion: Hcy could be an important biomarker of renal disease progression mainly in hemodialysis patients. We emphasize the importance of normalizing plasma levels of this amino acid to ensure a better prognosis in kidney disease.

The UMOD Locus: Insights into the Pathogenesis and Prognosis of Kidney Disease.

The identification of genetic factors associated with kidney disease has the potential to provide critical insights into disease mechanisms. Genome-wide association studies have uncovered genomic regions associated with renal function metrics and risk of CKD. UMOD is among the most outstanding loci associated with CKD in the general population, because it has a large effect on eGFR and CKD risk that is consistent across different ethnic groups. The relevance of UMOD for CKD is clear, because the encoded protein, uromodulin (Tamm-Horsfall protein), is exclusively produced by the kidney tubule and has specific biochemical properties that mediate important functions in the kidney and urine. Rare mutations in UMOD are the major cause of autosomal dominant tubulointerstitial kidney disease, a condition that leads to CKD and ESRD. In this brief review, we use the UMOD paradigm to describe how population genetic studies can yield insight into the pathogenesis and prognosis of kidney diseases.

Blood Oxygen Level Dependent (BOLD) Cardiovascular Magnetic Resonance (CMR) as Predictor of Cardiac Prognosis in Asymptomatic Chronic Kidney Disease (CKD) Patients

Blood Oxygen Level Dependent (BOLD) Cardiovascular Magnetic Resonance (CMR) as Predictor of Cardiac Prognosis in Asymptomatic Chronic Kidney Disease (CKD) Patients

Evaluation urinary trehalase in patients with renal proximal tubular damage

Objective To investigate the value of urinary trehalase（T） in patients with renal proximal tubular damage. Methods 134 patients with kidney disease (male:66 female:68 age:18-59; 31 cases with acute renal failure, 30 cases with chronic renal failure, 20 cases with drug-induced renal impairment, 21 cases with renal transplantation and 32 cases with nephritic syndrome) and 101 healthy controls (58 males and 43 females) were selected.Urinary T, N-acetyl-D-glucosaminidase (NAG), β2-MG, gamma-glutamyl transferase(GGT) were detected.Data were analyzed by SPSS 11.5, including non-parametric rank test, ROC analysis. Results The level of urinary trehalase in control group was normally distributed （7.1±4.1） μmol/h·g Cr (0-25 μmol/h·g Cr). There was no significant difference between men and women (t=0.63, P=0.53).Urinary T levels were significant higher in all kidney disease groups than in control group (Z=6.80,5.90, 5.23, 6.00, 8.04，P＜0.01).According to ROC curve, the area of urinary T under the ROC curve (AUC) in 134 patients was 0.9, significantly different with NAG, β2-MG, GGT area （P＜0.01），the AUCs of T were 0.94,0.85, 0.90,0.90,0.91 in acute and chronic renal failure group, drug-induced renal impairment group, renal transplantation group and nephritic syndrome group, respectively; Youden index were 0.85,0.65,0.77,0.66,0.72 respectively.Corresponding to the Youden index，sensitivity and specificity were 90.3% and 95.1%, 73.3% and 92.1%, 85.0% and 92.1%, 81.0% and 85.2%, 87.5% and 84.2% respectively. Conclusions The Urinary trehalase is better than other markers in the diagnosis of the proximal renal tubular damage.It was better to evaluate the proximal tubular function early in time.The diagnostic value of urinary trehalase played a key role in diagnosis, treatment and prognosis of kidney diseases.（Chin J Lab Med，2012,35：1135-1138） Key words: Kidney diseases; Kidney tubules; proximal; Trehalase; Urinalysis

The effect of smoking on the kidneys

Graham Cope outlines the ways in which smoking impairs both kidney function and prognosis in kidney disease. Knowledge of the negative impact of cigarette smoking in renal disease can assist the nurse in educating and supporting patients in smoking cessation.

Kidney injury molecule-1 as an early detection tool for acute kidney injury and other kidney diseases

Although change in serum creatinine is the standard metric tool for the detection of renal injury, its lack of sensitivity has made the early diagnosis of acute kidney injury (AKI) very difficult. In fact, the absence of sensitive AKI biomarkers has impaired progress in the nephrology field and had a detrimental effect on the design and outcome of AKI clinical trials. Recently, several proteins have shown potential in the early detection of acute and chronic kidney injuries. This review discusses the current status of kidney injury molecule-1 (KIM-1) as a potential diagnostic tool in patients with various acute and chronic kidney diseases. The focus is limited to human studies from January 2002 to July 2010. The review clarifies the clinical conditions for which KIM-1 has the greatest potential utility for early detection of kidney injury. It also demonstrates to the reader the barriers to the successful use of KIM-1 and other biomarkers in clinical practice, and the future trials that will be needed to validate their use. Despite the early promise of biomarkers such as KIM-1 for the early detection and prognosis of kidney disease, more studies are required to establish their utility in clinical practice. Indeed, the published clinical studies of urine KIM-1 so far are small and insufficient to support urinary KIM-1 as an effective AKI diagnostic test in humans. It is suggested, through the heterogeneity of AKI and existing published data, that more than one biomarker may be necessary to obtain sufficient sensitivity and specificity for AKI screening.

Application of the theory of damp-heat in spleen and stomach in treatment of kidney diseases

There exists close relationship between the damp-heat and the occurrence, development, treatment and prognosis of kidney diseases. The occurrence of damp-heat is based on water and wetness, which may come from outside or may be caused by internal damage. The water and wetness can change into heat if they are stored in the body for a long period, and the combination of water and wetness and heat may cause damp-heat syndrome. The function of spleen and stomach plays the most important role in the water metabolism of sanjiao. Kidney diseases are mainly caused by damp-heat of spleen and stomach resulted from internal damage of spleen and stomach, and symptoms of damp-heat of middle-jiao are commonly seen in most patients of chronic kidney diseases. During the development from renal function damage to renal failure, the remaining of damp-heat in san-jiao can affect the function of spleen and stomach for transportation, transformation and digestion, resulting in the symptoms of dysfunction of spleen and stomach. Regulating the function of spleen and stomach is one of the most important therapeutic methods for kidney diseases.

Genetic linkage analysis, clinical features and prognosis of autosomal dominant polycystic kidney disease in Northern Ireland

Fifteen families with autosomal dominant polycystic kidney disease were analysed for coinheritance of the disease and DNA markers flanking the PKD1 locus. Eleven families demonstrated linkage to PKD1 markers. Two families were unlinked to the PKD1 locus (non-PKD1) and in two families the markers were uninformative. The clinical features and prognosis of 49 subjects with a PKD1 genotype were compared with 17 non-PKD1 subjects. The age at diagnosis in non-PKD1 subjects (37 +/- 11 years) was significantly later than PKD1 subjects (25 +/- 13 years, p < 0.001). Only two (12%) non-PKD1 subjects presented initially with clinical features of autosomal polycystic kidney disease compared to 27 (55%) of PKD1 subjects (p < 0.002). Hypertension was more common in PKD1 compared to non-PKD1 subjects (29% vs. 12%), as was stage renal failure (25% vs. 6%). Seventy-five percent of non-PKD1 subjects had not developed end-stage renal failure by the age of 54 years compared to only 35% of PKD1 subjects. Most families with autosomal polycystic kidney disease in this population have disease due to mutations at the PKD1 locus. However, the proportion of non-PKD1 families appears to be higher than estimates for other populations. This study also confirms initial reports that subjects with a non-PKD1 genotype have a milder disease with a better prognosis than those with a PKD1 genotype.

Autosomal Dominant Polycystic Kidney Disease

The lack of reliable data on frequency, age of onset, survival, spontaneous mutation rate and prognosis in autosomal dominant polycystic kidney disease is a continual source of frustration to physicians involved in counselling patients and their relatives. The only major study to address all of these issues in a defined population was presented by Dalgaard as a 251-page doctoral thesis in 1957 [1]. Although Dalgaard's work is a perfect example of careful characterization of a genetic disease, the development of more sensitive, non-invasive cyst imaging methods and the advent of chronic dialysis and transplantation have weakened many of his conclusions. Fortunately, Davies et al. [2] have begun to obtain the data required to satisfy the urgent need for answers to the above questions by studying the families of all affected individuals in a Welsh population of 2.1 million. The first report of this study deals with prevalence, de novo mutation rate and trends in dialysis acceptance and survival [2]. Davies et al. estimate the prevalence of autosomal dominant polycystic kidney disease in Wales to be 1:2459, a figure which is substantially lower than the previous estimates of between 1:400 and 1:1000 in other Caucasian populations [1,3]. There are several possible explanations for this discrepancy. First, all the probands in the Welsh study had symptomatic renal disease or hypertension. If a substantial number of all patients are asymptomatic, and if asymptomatic disease runs true in families, the selection of symptomatic probands would be expected to lead to low estimates of frequency. The fact that higher frequencies of polycystic kidney disease have been observed at autopsy than have been estimated clinically lend credence to this possibility. Hatfield and Pfister [4], for example, found that less than half of patients with polycystic kidney disease diagnosed at autopsy had symptoms, and only one of 32 asymptomatic cases had a family history. The increasing use of ultrasonography in the screening of undiagnosed abdominal illness is also bringing many additional cases of asymptomatic polycystic kidney disease to light. Therefore, whereas symptomatic disease was previously considered to be the predominant form, it now appears that it may be just the tip of the iceberg. The difference between symptomatic and asymptomatic disease has not been explained at the molecular level but Parfrey et al. [5] have recently shown that a form of autosomal dominant polycystic kidney diseases that is not linked to chromosome 16 markers has a significantly better prognosis than the linked form. Once the genes coding for autosomal dominant polycystic kidney disease have been cloned, direct analysis of their mutations may allow a better understanding of the genetic influences on prognosis.

Prognosis of Adult Onset Polycystic Kidney Disease Re-Evaluated

Prognosis of Adult Onset Polycystic Kidney Disease Re-Evaluated