Renal Blood Research Articles

Additional effects of diosmin in the treatment of arterial hypertension in patients with impaired renal venous blood flow

Objective: to estimate of the effect of diosmin in complex antihypertensive therapy on renal function in patients with hypertension and impaired renal venous blood flow.Materials and methods: we observed 147 patients with hypertension aged 40.86±8.27 with signs of bilateral impairment of venous blood flow in the kidneys, which, depending on the amount of therapy, were divided into 2 groups and 2 subgroups. The comparison group consisted of 57 AH patients with unchanged venous blood flow in both kidneys.Results: in the presence of impaired venous blood flow in the renal veins, the use of additional administration of diosmin allows maintaining or improving the filtration capacity of the kidneys. Additional monitoring of patients with impaired venous blood flow in the kidneys is required to assess the effectiveness of antihypertensive therapy with individual drugs with and without venoactive agents.Conclusion: the additional inclusion of diosmin in the complex antihypertensive therapy of patients with arterial hypertension and impaired venous blood flow to the kidneys can preserve and improve kidney function with normalization of GFR.

Presence of a Novel Anatomical Structure May Cause Bleeding When Using the Calyx Access in Mini-Percutaneous Nephrolithotomy.

BackgroundFused renal pyramid (FRP) is a kidney anatomical structure which was first identified by us. The vascular anatomy of FRP exhibits different from that of the normal renal pyramid (NRP), manifested by the distribution of the ectopic interlobar arteries in FRP. In this study, we analyzed the effect of FRPs on bleeding when using calyx access in mini-percutaneous nephrolithotomy (PCNL).Patients and MethodsOverall, 633 patients who underwent ultrasound-guided single-tract mini-PCNL were divided into two groups according to the puncture method used: in group A, puncture was performed through the axial direction of the renal calyx, the line from the apex of the fornix to the center of the neck plane under B-mode ultrasound guidance; and in group B, Doppler ultrasound-guided axillary puncture through calyces corresponding to NRPs when the plane of renal column blood vessels on both sides was selected or calyx puncture through the hypovascular area of the FRPs. Relevant demographic and clinical data were retrospectively analyzed.ResultsThe two groups exhibited similar baseline characteristics. No significant differences were found in hemoglobin reduction, puncture site, tract size, postoperative creatinine level, or stone-free rate between the two groups (P > 0.05). Blood transfusion and embolization rates in group B were significantly lower than those in group A (P = 0.03 and 0.045, respectively). No differences were found between the two groups in terms of persistent pain, hydrothorax, fever, subcapsular hematoma, and urosepsis (P > 0.05). The overall complication rate was not significantly different between the two groups (P = 0.505).ConclusionsFRP is a non-negligible anatomical structure that may cause hemorrhage when using calyx access. Doppler ultrasound can identify ectopic blood vessels in FRPs to reduce bleeding during calyx access in mini-PCNL procedures.

Hypertensive Workup Leading to the Discovery of Hepatic Sarcoidosis

Introduction: Sarcoidosis is a systemic disease of unknown etiology that affects many organs, including the liver. It is usually asymptomatic and manifests as nonspecific biological disturbances. It is characterized by the presence of granulomatous, non-caseating lesions in the affected organs. Although it is most often revealed by mediastinal-thoracic involvement, such as pulmonary infiltrates or mediastinal adenopathies, or by skin and eye involvement, liver involvement is an infrequent site. Objectif: To report the case of a young man, presenting with high blood pressure figures, who consulted for etiological assessment of arterial hypertension which was at the origin of a rare form of sarcoidosis. Case report: The patient was 49 years old and had recently discovered hypertension as a cardiovascular risk factor, with no particular pathological history. On admission, the patient reported a 16 kg weight loss with anorexia. Biologically, hepatic cytolysis was noted with the presence of cholestasis with GGT and PAL at twice the normal level. The bilirubin level was normal. The rest of the workup, hydrolytic, protein, renal blood and urine, as well as the hemogram were without abnormality. The etiological workup of this cytolysis was negative for viral serology, and the immunological workup for chronic liver disease was negative. While the dosage of angiotensin converting enzyme was high at 93.8 units per liter. On the imaging plan, the abdominal ultrasound was normal, a complement by abdominal scanner found a slightly heterogeneous aspect of the right liver with a coelio-mesenteric ganglion of 27x13 mm, the abdominal MRI made objectified. In view of this, we indicated that a liver biopsy should be performed for etiological purposes and to evaluate the fibrosis. The anatomopathological examination was in favor of a gigantocellular epithelioid granuloma without caseous necrosis evoking sarcoidosis. Discussion and conclusion: Liver involvement in sarcoidosis is ........

IgA vasculitis - similarities and differences to IgA nephropathy

IgA vasculitis - similarities and differences to IgA nephropathy Abstract. IgA vasculitis (IgAV), formerly called Henoch-Schönlein Purpura (HSP) is an immune complex-mediated vasculitis of small vessels typically affecting the skin, gastrointestinal tract, and the kidneys. Based on distinct histopathological and pathophysiological commonalities of IgAV and IgA nephropathy (IgAN) they are viewed as part of a spectrum of IgA-mediated inflammatory syndromes. While the disease course in children is most often benign, IgAV has a high risk of renal and gastrointestinal complications when first appearing in adulthood. Acute morbidity and mortality in IgAV are determined by gastrointestinal complications such as intussusception or perforation, while chronic morbidity depends on renal involvement. Nephritis symptoms can appear, subclinically, many weeks after the initial manifestation of IgAV, and can therefore be missed. Continuous monitoring of renal parameters and blood pressure is therefore recommended even after apparent remission of the disease. As there are no data from randomized controlled trials available, the treatment of IgAV is currently based on consensus-based expert opinions.

231-LB: GLP-1 Promotes Cortical and Medullary Perfusion in Human Kidney and Maintains Tissue Oxygenation during Na Loading

Purpose: GLP-1 receptor agonism has shown beneficial cardiovascular effects which could include the kidneys. In the human kidney, the high GLP-1 extraction and its natriuretic effect depend on the GLP-1 receptor and is accompanied by suppression of angiotensin II, independent of changes in renal plasma flow. Preclinical data showed that angiotensin II constricts the vasa recta and lowers medullary perfusion. The current randomized, controlled study was designed to test the hypothesis that GLP-1 increases renal medullary perfusion in healthy humans. Methods: Healthy male participants (n=10, 27 ± 4 years) ingested a fixed sodium intake for 4 days and were examined twice during a 1-hour infusion of either GLP-1 (1.5 pmol/kg/min) or placebo together with infusion of 0.9% NaCl (750 mL/h) . Interleaved measurements of renal artery flow, oxygenation (R2*) , and perfusion were acquired in the renal cortex and medulla during infusions, using magnetic resonance imaging. Results: GLP-1 infusion increased medullary perfusion (32 ± 7%, p<0.001) and cortical perfusion (13 ± 4%, p<0.001) compared to placebo. Here, NaCl infusion decreased medullary perfusion (-5 ± 2%, p=0.007) while cortical perfusion remained unchanged. R2* values increased by 3 ± 2% (p=0.025) in the medulla and 4 ± 1% (p=0.008) in the cortex during placebo, indicative of decreased oxygenation but remained unchanged during GLP-1. Renal arterial blood flow was not altered significantly by either intervention. Conclusions: GLP-1 increases predominantly medullary but also cortical perfusion in healthy human kidneys and maintains oxygenation during NaCl-loading. In perspective, GLP-1 may exert protective effects against renal hypoperfusion and ischemia. Disclosure B. Haddock: n/a. B. L. Jensen: None. A. Asmar: None.

Radiologic features of immune checkpoint inhibitor-related nephritis with clinical correlation in biopsy-proven cases.

e14585 Background: Radiologic findings associated with biopsy proven immune checkpoint inhibitor (ICI) related nephritis have not been described. The objective of this study is to describe the radiologic features of immunotherapy related nephritis on computerized tomography (CT) and positron emission tomography (PET). A secondary objective is to investigate the association of these radiologic features with renal outcomes. Methods: A retrospective review of all biopsy proven ICI-related nephritis between February 2017 and April 2021 was performed and 34 patients were identified. CT and PET-CT scans before the initiation of immune checkpoint inhibitors (baseline), at nephritis and after resolution of nephritis were reviewed. Total kidney volume, renal parenchymal SUVmax, renal pelvis SUVmax and blood pool SUVmean were obtained. Results: The total kidney volume was significantly higher at nephritis compared to baseline (464.7±96.8 mL vs. 371.7±187.7 mL; p < 0.001). Fifteen patients (44.1%) had > 30% increase in total kidney volume at nephritis. A > 30% increase in total kidney volume was associated with significantly higher renal toxicity grade (p = 0.007), higher peak creatinine level (p = 0.004) and more aggressive medical treatment (p = 0.011). New/increasing perinephric fat stranding was noted in 10 patients (29.4%) at nephritis. Among 8 patients with contrast-enhanced CT at nephritis, 1 patient (12.5%) developed bilateral wedge-shaped hypoenhancing cortical lesions that healed with focal scarring on subsequent scans. On PET-CT, the renal parenchymal SUVmax-to-blood pool SUVmean ratio was significantly higher at nephritis compared to baseline (2.13 vs. 1.68; p = 0.035). The renal pelvis SUVmax-to-blood pool SUVmean ratio was significantly lower at nephritis compered to baseline (3.47 vs. 8.22; p = 0.011). Conclusions: Bilateral increase in kidney size, new/increasing perinephric stranding and bilateral wedge-shaped hypoenhancing cortical lesions can occur in immunotherapy-related nephritis. On PET-CT, diffuse bilateral increase in radiotracer uptake throughout the renal cortex and decrease in radiotracer activity in the renal pelvis can be seen. A > 30% increase in total kidney volume was associated with significantly higher renal toxicity grade and more aggressive medical treatment in a subset of patients. Acknowledgment: National Institute of Health K01 Award (N.A.: K01AI163412).

Estradiol and Hyperhomocysteinemia Are Linked Predominantly Through Part Renal Function Indicators.

BackgroundPrevious studies have shown that estrogen, kidney function, and homocysteine (Hcy) or hyperhomocysteinemia (HHcy) are related to each other. However, the underlying biological mechanisms still remain unclear. We aimed to explore the association between estradiol (E2) and HHcy in the female population, and to further evaluate the mediating role of renal function indicators.MethodsThis unmatched case–control study consisted of 1,044 female participants who were 60.60 ± 12.46 years old. Data on general demographic characteristics, such as age, smoking and drinking status, menopause and so on were collected in a personal interview, and laboratory examinations were performed by well-trained personnel. The mediating effect model was applied to analyze the direct and indirect effects of E2 on Hcy.ResultsThe average levels of Hcy and E2 of the participants were 12.6 μmol/L and 14.95 pg/ml. There were statistical differences in renal indexes blood urea nitrogen (BUN), serum creatinine (Scr), uric acid (UA), glomerular filtration rate (GFR) and E2 between HHcy group and non-HHcy group. The logistic regression models showed that UA was risk factor for HHcy (P <0.001), GFR and E2 were protective factors for HHcy after adjusting for confounding factors (P <0.001). The indirect effects of E2 on Hcy through UA and GFR accounted for 14.63 and 18.29% of the total impacts of E2 on Hcy.ConclusionsThese data indicated that E2 was a protective factor of HHcy, and the effects of E2 on HHcy may be mediated by renal function indicators UA and GFR.

CHRONIC RENAL DISEASE AND CEREBROVASCULAR PATHOLOGY (LITERATURE REVIEW)

Introduction. Chronic renal disease is an umbrella term including kidney impairment or impaired renal function for more than 3 months. According to various estimates, chronic renal disease affects 8-16% of the world's population, and this figure is growing steadily. The etiological factors of chronic renal disease the most commonly include diabetic nephropathy, glomerulonephritis, hypertensive nephropathy, tubulointerstitial kidney disease, and polycystic kidney disease. Glomerular filtration rate and albuminuria are the most valuable markers of chronic renal disease that determine the severity of the disease. The objectives of this article is to review and systematize the results of global studies of chronic renal disease as a risk factor for cerebrovascular pathology and a factor, which determines the severity of stroke as well as post-stroke consequences. Results. Decreased glomerular filtration rate is an independent risk factor for chronic renal disease. There is an independent link between proteinuria and the risk of stroke. Chronic renal disease is associated with the clinical severity of strokes and the severity of post-stroke sequelae. Chronic renal disease has significant associations with the severity of neuroimaging markers of cerebral microangiopathy. The mechanisms of the development of cerebrovascular pathology in patients with chronic kidney disease have not been clearly understood, but are thought to be complex, involving a variety of factors, including arterial hypertension, impaired lipid metabolism, diabetes mellitus, and some others. Haemo-cerebral barrier disruptions due to chronic renal disease may contribute to the development of chronic renal disease. Moreover, chronic renal disease is an independent risk factor for atherosclerotic lesions of cerebral arteries. Considerable attention is paid to the genetic factors in the axis "chronic renal disease cerebrovascular pathology". Certain monogenic mutations can simultaneously have a negative impact on the development of chronic renal disease and cerebrovascular pathology. Recently the role of haemodialysis as a factor that mediates the relationship between chronic kidney disease and cerebrovascular pathology has been found out. Conclusion. Chronic renal disease and cerebrovascular pathology have many common pathophysiological mechanisms. Understanding the interaction between renal damage and impaired cerebral blood supply as well as close collaboration between neurologists and nephrologists are important issues to manage cerebrovascular complications effectively in patients with chronic renal disease.

Development and Validation of a Prognostic Nomogram for Prognosis in Patients With Renal Artery Stenosis.

Background and ObjectiveRenal artery stenosis (RAS) is associated with an increased risk of renal function deterioration (RFD). Our previous study showed that renal cortical blood perfusion assessed by contrast-enhanced ultrasound (CEUS) was an important related factor for RFD in RAS patients. Based on several conventional related factors confirmed by previous studies, we aimed to establish and verify a CEUS+ scoring system to evaluate the risk of RFD at 1 year of follow-up in RAS patients.MethodsThis study was a single-center retrospective study. A total of 497 elderly RAS patients (247 in the training group and 250 in the verification group) admitted to the Beijing Hospital from January 2016 to December 2019 were included. The baseline characteristics of the patients on admission (including general conditions, previous medical history, blood pressure, blood creatinine, RAS, and cortical blood perfusion in the affected kidney) and renal function [glomerular filtration rate (GFR)] at 1-year of follow-up were collected. We used the univariate and multivariate logistic regressions to establish a CEUS+ scoring system model, the receiver operating characteristic (ROC) curve and area under the curve (AUC) to evaluate prediction accuracy, and the decision curve analysis and nomogram to evaluate the clinical application value of CEUS+ scoring system model.ResultsAmong the 497 patients enrolled, 266 (53.5%) were men, with an average age of (51.7 ± 19.3) years. The baseline clinical-radiomic data of the training group and the verification group were similar (all p > 0.05). Multivariate logistic regression analysis results showed that age [Odds ratio (OR) = 1.937, 95% confidence interval (CI): 1.104–3.397), diabetes (OR = 1.402, 95% CI: 1.015–1.938), blood pressure (OR = 1.575, 95% CI: 1.138–2.182), RAS (OR = 1.771, 95% CI: 1.114–2.816), and area under ascending curve (AUCi) (OR = 2.131, 95% CI: 1.263–3.596) were related factors for the renal function deterioration after 1 year of follow-up (all p < 0.05). The AUC of the ROC curve of the CEUS+ scoring system model of the training group was 0.801, and the Youden index was 0.725 (specificity 0.768, sensitivity 0.813); the AUC of the ROC curve of the validation group was 0.853, Youden index was 0.718 (specificity 0.693, sensitivity 0.835). There was no significant difference in ROC curves between the two groups (D = 1.338, p = 0.325). In addition, the calibration charts of the training and verification groups showed that the calibration curve of the CEUS+ scoring system was close to the standard curve (p = 0.701, p = 0.823, both p > 0.10).ConclusionThe CEUS+ scoring system model is helpful in predicting the risk of worsening renal function in elderly RAS patients.

ASO Visual Abstract: Effect of Papaverine on Renal Artery Blood Flow During Robot-Assisted Partial Nephrectomy

ASO Visual Abstract: Effect of Papaverine on Renal Artery Blood Flow During Robot-Assisted Partial Nephrectomy

Protective effects of pretreatment or concomitant treatment with Hypericum extract on renal function and renal toxicity in cisplatin-induced nephrotoxicity

Introduction: Cisplatin is a strong anticancer medicine, but its use is limited due to the potential nephrotoxicity induction. Objectives: The present study seeks to determine the impact of Hypericum hydroalcoholic extract on cisplatin-induced nephrotoxicity. Materials and Methods: Thirty-two male rats were assigned to groups 1 to 4. Group 1, control (Cont); treated by saline (IP). Group 2, Cis; cisplatin [intraperitoneal (IP), 7.5 mg/kg]. Group 3, CisH; cisplatin + Hypericum (70 mg/kg, IP, for one week). Group 4, HCis; first treated with Hypericum for a week, followed by cisplatin. Renal tissue and blood samples were obtained a week after cisplatin injection for tissue assay and biochemical analysis. Kidney tissue damage score (KTDS), plasma creatinine (Cr), blood urea nitrogen (BUN), serum glutamate oxaloacetate transaminase (SGOT), serum glutamate pyruvate transaminase (SGPT), malondialdehyde (MDA), superoxide dismutase (SOD), and catalase (CAT) were measured. Results: Kidney weight showed significant differences between the treated groups and the Cont group (P&lt;0.001). Serum BUN, Cr, SGOT, and SGPT increased significantly in Cont (P&lt;0.01). BUN decreased in CisH and HCis groups compared to Cis group, although there was no significant difference. Serum Cr, SGOT, and SGPT decreased significantly in CisH and HCis groups compared to the Cis group (P&lt;0.05). MDA and KTDS increased in the Cis group and decreased significantly in the CisH and HCis groups compared to the Cis group (P&lt;0.05). Serum SOD and CAT decreased significantly in Cis compared to Cont (P&lt;0.05) and increased in CisH and HCis groups compared to Cis. There was no significant difference between the CisH and HCis groups in any of the measured parameters. Conclusion: This study reveals that pretreatment with Hypericum extract or its concomitant administration with cisplatin can moderate the side-effects of cisplatin, improve renal function and decrease lipid peroxidation, renal toxicity and the KTDS.

The UK Chinese population with kidney failure: Clinical characteristics, management and access to kidney transplantation using 20 years of UK Renal Registry and NHS Blood and Transplant data.

Little is known about the clinical demographics of and access to transplantation for Chinese diaspora populations with kidney disease. The UK Renal Registry provided data on adults with ethnicity recorded as 'Chinese' or 'White' starting Kidney Replacement Therapy (KRT) 1/1/97-31/12/17. Baseline characteristics were compared between Chinese and White patients. Multivariable logistic regression models were used to investigate the relationships between Chinese ethnicity and i) being listed for deceased-donor transplantation at start of KRT, ii) being listed 2 years after start of KRT, iii) pre-emptive kidney transplantation, iv) kidney transplantation 3 years after start of KRT, and v) living-donor kidney transplantation (LDKT). UK Chinese patients were younger at start of KRT (61.6 vs 65.6 years, p <0.001) and had more diabetic kidney disease (29% vs 20%, p<0.001) and glomerulonephritis (21% vs 13%, p<0.001) than White patients. We found evidence of interaction between ethnicity and sex. Compared to UK White men, UK Chinese men had lower odds of pre-emptive transplant (aOR 0.28, 95% CI [0.10-0.76]) and transplant within 3 years of KRT start (aOR 0.65, [95% CI 0.49-0.87], P = 0.004). UK White women and Chinese women had the same likelihood of pre-emptive transplant (aOR 0.78, 95% CI [0.38-1.61]), or transplant within 3 years of KRT start (aOR 0.94, 95% CI [0.60-1.46]). Both UK Chinese men and women had markedly lower odds of LDKT compared to Whites aOR 0.34 [95% CI 0.21-0.53]. UK Chinese are less likely to receive a LDKT. UK Chinese men have lower odds of accessing pre-emptive wait-listing and transplantation. Understanding whether these disparities reflect modifiable barriers will help ensure equitable access to transplantation.

Cardiac myotropes as a novel inotropic treatment for patients of heart failure with reduced ejection fraction

Heart failure with reduced ejection (HFrEF) fraction is a common affliction of heart failure patients. It is defined as an ejection fraction of less or equal to 35% caused by a decrease in systolic function5 (1). Causes include coronary artery disease, myocardial infarction, congenital heart defects, high blood pressure and diabetes. Heart failure is a common condition in Pakistan estimated by some studies to have 2.8 million patients in the country (2). As heart transplants are to date not performed in Pakistan, physicians rely on treatments such as mechanical circulatory assist devices such as left ventricular assist devices, drugs such as inotropes, diuretics and beta blockers for patient’s treatment. Among the medical treatments, a new class of inotropes, cardiac myotrope, omecamtive mecarbil is pending US FDA approval. Omecamtiv mecarbil promotes increased interaction between myosin and actin, increasing the force, efficiency and duration of cardiac muscle contraction without affecting cytosolic calcium thereby having no negative outcomes such as arrhythmias or ischemia(3). Whereas traditional inotropic agents such as catecholamines, phosphodiesterase-3 inhibitors, sodium-potassium adenosine triphosphatase inhibitors have shown- through their calcium-based mechanisms- to have negative side effects such as arrhythmias, increased oxygen demand and mortality(4). Long-term use of catecholamines and phosphodiesterase-3 inhibitors such been shown through both observational cohort and randomized clinical trials to increase mortality in heart failure patients with reduced ejection fraction (3). Conventional inotropes are widely used in heart failure patients experiencing cardiogenic shock (3) thereby increasing the likelihood of long-term negative effects. The recent GALACTIC-HF double blind trial has shown omecamtiv mecarbil to improve cardiac function, ventricular wall stress and reverse ventricular remodeling without any negative effects on renal function, blood pressure or heart rate shown by current heart failure therapies (1). While continued research and drug development is needed, myotropes such as omecamtiv mecarbil seem to be a promising, less dangerous alternative to traditional inotropic treatments for HFrEF patients. Further drug development may produce even more effective drugs of the same class. More detailed analysis of the GALACTIC-HF trial as well as subsequent trials are still needed to cement the effectiveness and safety of myotropes. The large number of chronic heart failure patients in the country will need a safe, long term treatment for the foreseeable future, this need can easily be filled by current and future mytotropic drugs for improved heart function.

Identification of biomarkers of chronic kidney disease among kidney-derived proteins

BackgroundChronic kidney disease (CKD) has few objective symptoms, and it is difficult to make an early diagnosis by using existing methods. Therefore, new biomarkers enabling diagnosis of renal dysfunction at an early stage need to be developed. Here, we searched for new biomarkers of CKD by focusing on kidney-derived proteins that could sensitively reflect that organ’s disease state.MethodsTo identify candidate marker proteins, we performed a proteomics analysis on renal influx and efflux blood collected from the same individual.ResultsProteomics analysis revealed 662 proteins in influx blood and 809 in efflux. From these identified proteins, we selected complement C1q as a candidate; the plasma C1q level was significantly elevated in the renal efflux of donors. Moreover, the plasma concentration of C1q in a mouse model of diabetic nephropathy was significantly increased, in association with increases in blood glucose concentration and urinary protein content. Importantly, we demonstrated that the tendency of C1q to increase in the plasma of CKD patients was correlated with a decrease in their estimated glomerular filtration rate.ConclusionOverall, our results indicate that our approach of focusing on kidney-derived proteins is useful for identifying new CKD biomarkers and that C1q has potential as a biomarker of renal function.

Clinical and Renal Cortical Blood Perfusion Characteristics in Patients with Severe Atherosclerotic Renal Artery Stenosis Who Underwent Stent Implantation: A Single-center Retrospective Cohort Study

Abstract Objective This study aimed to observe the clinical imaging features of patients with severe atherosclerotic renal artery stenosis (ARAS) receiving stent implantation, and to evaluate the associations between baseline clinical and imaging factors and renal-function deterioration at a 1-year follow-up. Methods This study was a single-center retrospective cohort study. A total of 159 patients with unilateral severe ARAS who underwent stent implantation at Beijing Hospital between July 2017 and December 2020 were consecutively enrolled. According to the renal glomerular filtration rate (GFR), detected by radionuclide renal imaging at 1-year follow-up, all patients were divided into a poor-prognosis group (with a ≥30% decrease in renal GFR; n=32 cases) and a control group (127 cases). Clinical imaging data, including the renal cortical blood perfusion pre- and post-sent implantation, were analyzed. Univariate and multivariate logistic regression analysis was used to evaluate the associations between clinical and imaging factors and renal-function deterioration. Results Of the 159 patients enrolled, 83 (52.2%) were men, with an average age of (57.2±14.7) years. The patient age, rate of diabetes, and systolic blood and diastolic blood pressure in the poor-prognosis group were significantly higher than those in the control group (all P&lt;0.05). Before stent treatment, patients in the poor-prognosis group, compared with the control group, had a significantly smaller area under the ascending curve (AUC1), area under the descending curve (AUC2), and peak intensity (PI), and a longer time to peak intensity (TTP) and mean transit time (MTT) (all P&lt;0.05). After stent treatment, patients in the poor-prognosis group, compared with the control group, showed significantly smaller AUC1, AUC2, and PI, and longer MTT (all P&lt;0.05). Multivariate logistic regression analysis indicated that age (OR=1.251, 95%CI: 1.113–1.406, P=0.0002), diabetes (OR=1.472, 95%CI: 1.110–1.952, P=0.007), systolic blood pressure (OR=1.339, 95%CI: 1.082–1.657, P=0.007), renal GFR (OR=2.025, 95%CI: 1.217–3.369, P=0.006), and AUC1 post-stent (OR=2.173, 95%CI: 1.148–4.113, P=0.017) were the factors associated with renal deterioration at the 1-year follow-up. Conclusions Patients with severe RAS with renal-function deterioration after stent implantation were older, and often had diabetes, hypertension, and impaired renal cortical perfusion. Age, diabetes, systolic blood pressure, renal GFR, and AUC1 after stent implantation were independent factors associated with short-term renal deterioration.

Neutrophil gelatinase-associated lipocalin does not originate from the kidney during reperfusion in clinical renal transplantation

BackgroundAcute Kidney Injury (AKI) is a common clinical complication. Plasma/serum neutrophil gelatinase-associated lipocalin (NGAL) has been proposed as a rapid marker of AKI. However, NGAL is not kidney-specific. It exists in three isoforms (monomeric, homo-dimeric and hetero-dimeric). Only the monomeric isoform is produced by renal tubular cells and plasma NGAL levels are confounded by the release of all NGAL isoforms from neutrophils. Our aim was to investigate whether NGAL is released into blood from injured renal tubules.MethodsKidney transplantation (n = 28) served as a clinical model of renal ischaemic injury. We used ELISA to measure NGAL concentrations at 2 minutes after kidney graft reperfusion in simultaneously taken samples of renal arterial and renal venous blood. Trans-renal gradients (venous–arterial) of NGAL were calculated. We performed Western blotting to distinguish between renal and non-renal NGAL isoforms. Liver-type fatty acid binding protein (LFABP) and heart-type fatty acid binding protein (HFABP) served as positive controls of proximal and distal tubular damage.ResultsSignificant renal release of LFABP [trans-renal gradient 8.4 (1.7–30.0) ng/ml, p = 0.005] and HFABP [trans-renal gradient 3.7 (1.1–5.0) ng/ml, p = 0.003] at 2 minutes after renal graft reperfusion indicated proximal and distal tubular damage. NGAL concentrations were comparable in renal venous and renal arterial blood. Thus, there was no trans-renal gradient of NGAL. Western blotting revealed that the renal NGAL isoform represented only 6% of the total NGAL in renal venous blood.ConclusionsIschaemic proximal and distal tubular damage occurs in kidney transplantation without concomitant NGAL washout from the kidney graft into blood. Plasma/serum NGAL levels are confounded by the release of NGAL from neutrophils. Present results do not support the interpretation that increase in plasma NGAL is caused by release from the renal tubules.

Abstract 12867: Neuromodulation Of The Renal Nerves In Spontaneously Hypertensive Rats

Introduction: Hypertension is a global burden. Renal denervation has been touted as a possible therapeutic strategy for the treatment of hypertension. However, neuromodulation of the renal nerves’ traffic in hypertension has yet to receive a similar attention. Aim: This study investigated cardio-respiratory responses to renal nerve stimulation in a genetic model of hypertension, the spontaneously hypertensive rat (SHR). Methods: In pentobarbital-anesthetized male SHRs (n = 9), the left renal nerve was stimulated 5 times (5-6 minutes apart) at 5 Hz, 0.5 ms, 0.5 mA for 30s. Mean arterial pressure (MAP), heart rate (HR), left renal cortical blood flow (CBF) and cortical vascular resistance (CVR), hindquarter aortic blood flow (ABF) and vascular resistance (AVR), upper (UAP) and lower (LAP) airway pressure, airway flow (AF), airway resistance (AR), respiration rate (RR) and diaphragmatic EMG (dEMG) were measured and averaged. Results: Cardiovascular responses to renal nerve stimulation were characterized by reductions in MAP, HR, CBF and AVR, which were associated with increases in ABF and CVR. Respiratory responses to renal nerve stimulation, on the other hand, demonstrated increases in AF, RR and dEMG, decreases in AR and no change in UAP and LAP. Conclusions: Under hypertensive conditions, the renal nerves not only modulate cardiovascular function but also improve respiratory function. These studies suggest that neuromodulation of the renal nerves may offer a therapeutic alternative for hypertensive patients.

Quality of life: modified triple-branched stent graft implantation versus frozen elephant trunk technique

ObjectiveTo compare the effects of modified triple-branched stent implantation and frozen elephant trunk technique on the quality of life (QoL) of acute Stanford Type A aortic dissection (AAAD) patients at different follow-up times.MethodsData from 175 AAAD survivors was collected which were divided into two groups according to different surgical techniques: (group A): modified triple-branched stent graft implantation; (group B): frozen elephant trunk. The SF-36 were used to assess the QoL at discharge (AD), the third postoperative month (POM3), and the twelfth postoperative month (POM12).Results(1) The total scores at each time of both groups showed lower than the normal level; Group A scored higher than group B at some time points in terms of some items (role physical, role emotion and mental health; all P = 0.000), and some items at POM3 or POM12 scored higher than at discharge (role physical, social function; both P = 0.000). (2) There were less patients with heavy self-perceived burden in group A than group B at discharge (P = 0.032) and patients with heavy self-perceived burden decreased over time. (3) Young postoperative AAD patients (P = 0.002) in group B (P = 0.005) with heavy self-perceived burden (P = 0.000), acute renal failure (P = 0.008), long LOS (P = 0.026) and blood loss (> 1000 mL/24 h) (P = 0.039) seemed to get a worse QoL.ConclusionThe impact on QoL of the modified triple-branched stent graft implantation technique seemed to be better than those of frozen elephant trunk surgery in role physical, role emotion and mental health.

STUDY OF 24 CASES OF NECROTISING FASCIITIS FOR PREDISPOSING FACTOR AND THEIR MANAGEMENT

Background &amp; Method: Whole study was done in our Institute with patient attending outdoor and emergency department of INDEX MEDICAL COLLEGE HOSPITAL AND RESEARCH CENTER. Collection of data –From each patient thorough history was taken, clinically examination was done, vitals where recorded, systemic examination was done and local examination of the lesion was done. Every patient base line investigation of complete blood count, renal function test liver function test serum electrolyte blood grouping serology of of HIV and Hbs antigen were done.&#x0D; Result: Most of the Patient was in the age group of 40years to 60 years.&#x0D; Conclusion: A total of 24 cases of necrotizing fascitis were studied over 1st June 2019 to 25 march 2020. Greater number of cases was reported among middle aged group of 40years to 60 years. Rarity of disease among pediatric age groups affected person were mostly male -21, female-3 most common precipitating factors was trauma. Most common predisposing factors were advanced age, anemia, diabetes and alcoholism. Microbiological profile of patients reveals most polymicrobial organisms involved,most common organisms were streptococcus&gt;E. coli,&gt; staphylococci&gt;pseudomonas/.&#x0D; Keywords: necrotizing, fasciitis, predisposing &amp; management.

Сравнительная характеристика политравмы мирного времени и боевой травмы в стационаре III уровня

Актуальность. Боевые сочетанные травмы протекают тяжелее, чем политравма мирного времени, из-за разницы в поражающих факторах, условиях получения травмы, сроках оказания помощи пострадавшим, массовости поражений. Цель исследования: провести сравнительный анализ тяжести состояния пострадавших с мирной и боевой политравмой при поступлении в стационар III уровня. Материалы и методы. Обследовано 79 пострадавших с политравмой мирного времени и 65 раненых из зоны АТО. Изучались изменения сознания по шкале комы Глазго, показатели гемодинамики, потребность в вазопрессорной поддержке и искусственной вентиляции легких, перистальтика кишечника, показатели общего анализа крови, печеночный и почечный комплекс, коагулограмма, показатели кислотно-основного и газового состава крови, уровень цитокинов (IL-6, IL-10) в сыворотке крови. Результаты. При мирной политравме достоверно чаще встречались черепно-мозговые травмы и торакоабдоминальные травмы, при боевой — травмы мягких тканей. Среди причин мирной политравмы преобладали дорожно-транспортные происшествия и высотные травмы, боевой — минно-взрывная травма. Раненые на 12,2 % чаще требовали ургентных оперативных вмешательств. Нарушения сознания в группе боевой травмы чаще были связаны с седацией, а мирной — непосредственно с черепно-мозговой травмой. Гипотензия и тахикардия при боевой травме были менее выражены за счет проведенных ранее противошоковых мероприятий и вазопрессорной поддержки. При боевой травме были более выражены гипоальбуминемия, гипокоагуляция и почечная дисфункция. В проявлениях цитолитического синдрома при боевой травме преобладало повышение уровня аспартатаминотрансферазы (АсТ), что, вероятнее всего, также объяснялось разрушением больших массивов тканей. Воспалительная реакция от характера травмы не зависела и ассоциировалась только с тяжестью и локализацией повреждений. Частота ­осложнений составила 41,8 % при мирной травме и 47,7 % — при боевой, летальность — 8,9 и 13,8 % соответственно. Выводы. Таким образом, при аналогичной тяжести травмы и объеме кровопотери боевая травма отличается от мирной по своей структуре и сопровождается более выраженными системными расстройствами, в основном печеночной, почечной и гемокоагуляционной дисфункцией. Это приводит к более высокой частоте осложнений и летальности.