Renal Vascular Disease Research Articles

Radiologic evaluation of the kidney transplant donor and recipient.

The kidney is the most common solid organ transplant globally and rates continue to climb, driven by the increasing prevalence of end stage renal disease (ESRD). Compounded by advancements in surgical techniques and immunosuppression leading to longer graft survival, radiologists evermore commonly evaluate kidney transplant patients and candidates, underscoring their role along the transplant process. Multiphase computed tomography (CT) with multiplanar and 3D reformatting is the primary method for evaluating renal donor candidates, detailing renal size, vascular/collecting system anatomy, and identifying significant pathologies such as renal vascular diseases and nephrolithiasis. Ultrasound is the preferred initial postoperative imaging modality for graft evaluation due to its low cost, accessibility, noninvasiveness, and lack of radiation. CT and magnetic resonance imaging (MRI) may be useful adjunctive imaging techniques in diagnosing transplant pathology when ultrasound alone is not diagnostic. Kidney transplant complications are categorized by an approximate timeline framework, aiding in differential diagnosis based on onset, duration, and severity and include perinephric fluid collections, graft compression, iatrogenic injuries, vascular compromise, graft rejection, and neoplastic processes. This review discusses imaging strategies and important findings along the transplant timeline, from donor assessment to long-term recipient complications.

The validity of pathology codes for biopsy-confirmed kidney disease in the Danish National Patobank.

This study validates the application of Systematized Nomenclature of Medicine second edition (SNOMED II) codes used to describe medical kidney biopsies in Denmark in encoded form, aiming to support robust epidemiological research on the causes, treatments and prognosis of kidney diseases. Kidney biopsy reports from 1 January 1998 to 31 December 2018 were randomly extracted from the Danish National Patobank, using SNOMED codes. A 5% sample was selected, and nephrologists assessed the corresponding medical records, assigning each case the applied clinical diagnoses. Sensitivity, specificity, positive predictive values (PPV), negative predictive values and Cohen's kappa coefficient for the retrieved SNOMED codes were calculated. A total of 613 kidney biopsies were included. The primary clinical disease groups were glomerular disease (n=368), tubulointerstitial disease (n=67), renal vascular disease (n=51), diabetic nephropathy (n=51) and various renal disorders (n=40). Several SNOMED codes were used to describe each clinical disease group and PPV for the combined SNOMED codes were high for glomerular disease (94%), diabetic nephropathy (85%) and systemic diseases affecting the kidney (96%). Conversely, tubulointerstitial disease (62%), renal vascular disease (60%) and other renal disorders (17%) showed lower PPV. SNOMED codes have a high PPV for glomerular diseases, diabetic nephropathy and systemic diseases affecting the kidney, in which they could be applied for future epidemiological research.

Three-Dimensional Laparoscopic Nephrectomy for Benign Nonfunctioning Kidneys: A Single-Center Initial Experience.

There are several types of benign renal diseases, such as urological stones, ureteropelvic junction obstruction, renal vascular disease, and inflammation, which are responsible for nonfunctioning kidneys. Laparoscopic nephrectomy (LN) is the gold standard for treating nonfunctioning kidneys with complications. This study presents the results of our initial experiences with 3D laparoscopic nephrectomy (3D-LN) for benign, nonfunctioning kidneys. From July 2021 to July 2023, 40 consecutive patients who underwent 3D transperitoneal laparoscopic nephrectomy were retrospectively evaluated at the Department of Urology and Department of General Surgery, Hue Central Hospital, Hue, Vietnam. Patient demographics, intraoperative and early postoperative results, postoperative recovery, complications, and three-month follow-up results were recorded. The mean age was 58.35 ± 14.9 years. There were 13 (32.5%) male and 27 (67.5%) female patients. Flank pain was the main reason for hospitalization in 33 cases (82.5%); the common cause of a nonfunctioning kidney was urological stones (62.5%). Twenty-three out of 40 patients underwent a left nephrectomy. The average operative time was 92.57 ± 28.69 minutes. A statistically significant difference in surgery time was found between the group with no adhesion and the group with mild adhesion, as well as between the first 19 patients and the last 18 patients (p <0.05). The mean blood loss was 51.62 ± 24.35 ml. Three cases were converted to open surgery due to severe adhesions. The postoperative complications rate was 8.1%. The average length of the postoperative hospital stay was 7.89 ± 3.59 days. Three-dimensional laparoscopic nephrectomy is a safe and effective method that increases depth perception and spatial orientation for surgeons and can compensate for the remaining shortcomings of traditional 2D systems.

A diagnostically challenging case of Lymphoplasmacytic lymphoma involving the kidney clinically mimicking benign hypertension associated chronic kidney disease

Abstract Introduction/Objective Lymphomas involving the kidneys are under-recognized and often do not present clinically with signs and symptoms raising suspicion for a hematological malignancy. Worsening renal function may necessitate renal biopsy, but often the clinical picture may not warrant a biopsy. We herein present a case of lymphoplasmacytic lymphoma involving the kidney clinically mimicking benign renal vascular disease associated chronic kidney disease. Methods/Case Report Elderly male with past medical history of stage 3 chronic kidney disease presumed to be due to benign hypertension and undergoing treatment for the same presented to his nephrologist for routine follow up. His renal parameters were stable, but his high blood pressure seemed to be difficult to control despite maximum medical intervention. Upon the patient’s request to know exact etiology of his kidney problem, a renal biopsy was performed. Histomorphological evaluation revealed multifocal areas of renal parenchymal infiltration by atypical lymphocytic aggregates with background renal parenchyma showing moderate arteriosclerosis, mild interstitial fibrosis, tubular atrophy and no significant glomerulopathy. Further workup of the lymphoid aggregates led to the finding of a low grade CD5 negative, CD10 negative B-cell lymphoma with plasmacytic differentiation. Molecular testing for final characterization revealed a MYD88 mutation, which along with the immunomorphological findings confirmed the diagnosis of lymphoplasmacytic lymphoma (LPL). The patient was referred to hematology-oncology and was recommended to start chemotherapy due to renal involvement. Results (if a Case Study enter NA) n/a Conclusion In medical renal biopsies, lymphocytic infiltrates in areas of interstitial fibrosis are very common, and an atypical lymphocytic infiltrate can be easily overlooked. Pathologists evaluating these biopsies should have a high degree of suspicion for a hematological malignancy if they encounter atypical lymphocytic infiltrates in the renal parenchyma. Accurate diagnosis is essential, as renal lymphoma whether primary or metastatic, requires initiation of timely systemic chemotherapy.

Serum calprotectin and renal function decline in ANCA-associated vasculitides: a post hoc analysis of MAINRITSAN trial

ObjectiveSerum calprotectin appears to be an interesting biomarker associated with renal vascular disease activity in antineutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV). The aim of this study was to assess whether...

Addition of Neostigmine and Atropine to Conventional Management of Postdural Puncture Headache in Patients Undergoing Lower Abdominal Surgeries

Abstract Background Postdural puncture headache (PDPH) is a complication of spinal anesthesia or lumbar puncture and is an unpleasant experience for the patient as well as the anesthetist. It is thought to result from meningeal traction related to low cerebrospinal fluid (CSF) pressure or cerebral vasodilation as an indirect effect of decreased CSF pressure. Neostigmine is a reversible inhibitor of the enzyme cholinesterase, which results in an increased concentration of the neurotransmitter acetylcholine. It produces cholinergic-mediated analgesia and has been used as an adjunct analgesic postoperatively. Neostigmine can pass through the choroid plexus but not the blood–brain barrier, the central effect of both neostigmine and atropine influence both CSF secretion and cerebral vascular tone which are the primary pathophysiological changes in PDPH. Objective Assess the effectiveness of postdural anesthesia with addition of Neostigmine and Atropine versus conventional postdural anesthesia. Patients and Methods A 90 patients were included in our prospective randomized controlled double-blind study that was conducted at Ain Shams University Hospitals for 4 months on patients who fulfilled the inclusion criteria: patients with ASA Grade I &amp; II, aged from (18 to 40) years old and scheduled for cesarean section. All patients aged &amp;gt;18 or &amp;lt;40, body weight &amp;gt;50, ASA III, IV, patients with uncontrolled chronic diseases such as hypertension, cardiac, renal, hepatic, cerebral diseases and peripheral vascular diseases, patients with history of PDPH, chronic headache, cluster headache, migraine, convulsions, cerebrovascular accident, signs of meningismus, preeclampsia, eclampsia coagulopathy, and previous neurological diseases and patients with history of bronchial asthma were excluded. Patients were divided into 2 groups: Group I (experimental group): neostigmine and atropine and Group II (placebo group): Saline placebo. Results The results of this study showed that incidence of postoperative headache was significantly lower among the intervention group, furthermore, VAS was significantly lower in the experimental arm versus placebo one. However, there was no significant difference regarding demographic, vital signs, and need for post-operative analgesia. The presented study showed that there is statistically non-significant difference between the studied groups regarding age, weight, and height and body mass index. There is statistically non-significant difference between the studied groups regarding duration of surgery. Conclusion After demonstrating many management options for post dural puncture headache (PDPH), in this study, we tried to prove the value of the use of neostigmine as a new management option that looks promising to alleviate the symptoms of such distressing condition. The current study results proved that the drug reduced the number of cases that experienced (PDPH) after spinal anesthesia for lower segment caesarean section, and how it prevent &amp;control headache. A combination of neostigmine and atropine are effective in managing PDPH by reducing the associated VAS score and preventing persistence of headache.

#4150 INTERNATIONAL COMPARISON AND TIME TRENDS OF FIRST KIDNEY TRANSPLANT RECIPIENT CHARACTERISTICS ACROSS EUROPE: A STUDY FROM THE ERA REGISTRY

Abstract Background and Aims Large international differences exist in the kidney transplantation (KT) rate across Europe. Countries might transplant a different group of end-stage kidney disease (ESKD) patients, but up to now an overview of recipient characteristics in first kidney transplant recipients in the different European countries is lacking. Therefore, the aim of this study was to give an overview as well as time trends in age, sex and primary renal disease (PRD) distribution of first kidney transplant recipients in Europe. Method The European Renal Association (ERA) Registry database was used to obtain data on adult patients receiving their first KT between 2010 and 2019 from 12 European countries. The numbers and percentages of recipients in each age, sex and PRD group were calculated by country, donor type and year. The first KT rate was calculated by dividing the number of first KTs by the adult general population counts and multiplied by one million. Results In total, 99,543 patients received a first KT between 2010 and 2019 for all countries combined. The percentage of recipients aged 65 years and older varied greatly between countries, with Bosnia and Herzegovina having the lowest percentage (1%), and the Netherlands, Spain and Norway having the highest percentages (&amp;gt;25%). Similar results were found for deceased donor first KT, but for living donor first KT Spain was no longer among the countries with the highest percentage of recipients aged 65 years and older. The percentage of female recipients ranged between 33% in Austria and 38% in the Netherlands for total first KT, between 33% in Austria and 38% in Denmark for deceased donor first KT and between 30% in Austria and 39% in the United Kingdom for living donor first KT. When comparing the distribution of PRDs, Bosnia and Herzegovina had a relative high percentage of recipients with glomerulonephritis (35%), while Finland had a high percentage of recipients with diabetes mellitus (29%) and the Netherlands and Norway a high percentage of recipients with hypertension / renal vascular diseases (17% and 22% respectively). This distribution was similar for deceased and living donor first KT recipients. Over time, the most prominent change regarding the recipient characteristics was observed for the age of the recipient, with an increasing proportion of recipients aged 65 years and older from 18% in 2010 to 28% in 2019 for all countries combined, and with a similar trend observed in most countries. Conclusion We observed large differences in the recipient characteristics at first KT between European countries and over time, especially for the recipient age and PRD. These new insights in the distribution of recipient characteristics in the first KT population could elucidate which ESKD patients receive a KT.

Renal diseases causing hematuria

Background: Hematuria is a common laboratory finding in clinical practice, occurring mostly in the kidneys. However, it can occur in the rest of the urinary system, including the ureters, bladder, and urethra, as well as in the prostate in men. This paper will discuss cases of hematuria observed in various diseases, especially kidney disease.Current Concepts: Hematuria is diagnosed when three or more red blood cells are found in a high-power field microscopic urinalysis. Identifying urine sediment is critical in differentiating between glomerular and nonglomerular hematuria, classified according to location. If hematuria is accompanied by proteinuria, dysmorphic red blood cells, or cellular casts in urine microscopy, as well as hypertension or renal function decline, glomerular disease may be present; thus, a nephrologist should be consulted. Hematuria is also observed in renal vascular diseases, including renal infarction, renal artery dissection, and nutcracker syndrome. In polycystic kidney disease, hematuria may present in combination with renal stones or malignancy. Diabetic nephropathy can manifest hematuria, which is a negative prognosticator of end-stage kidney disease.Discussion and Conclusion: Hematuria is a laboratory finding for various diseases, and appropriate diagnosis and treatment should be provided according to its clinical features.

Rapid identification of chronic kidney disease in electronic health record database using computable phenotype combining a common data model.

Rapid identification of chronic kidney disease in electronic health record database using computable phenotype combining a common data model.

Hypertension and Plant Extract as A Solution

Hypertension is a critical health problem and worse other cardiovascular diseases. It is mainly of two types: Primary or essential hypertension and Secondary hypertension. Hypertension is the primary possibility feature for coronary heart disease, stroke and renal vascular disease. Herbal medicines have been used for millions of years for the management and treatment of hypertension with minimum side effects. Over aim to write this review is to collect information on the anti-hypertensive effects of natural herbs in animal studies and human involvement as well as to recapitulate the underlying mechanisms, from the bottom of cell culture and ex-vivo tissue data. According to WHO, natural herbs/shrubs are widely used in increasing order to treat almost all the ailments of the human body. Plants are the regular industrial units for the invention of chemical constituents, they used as immunity booster to enhance the natural capacity of the body to fight against different health problems as well as herbal medicines and food products also. Eighty percent population of the world (around 5.6 billion people) consume medicines from natural plants for major health concerns. This review provides a bird’s eye analysis primarily on the traditional utilization, phytochemical constituents and pharmacological values of medicinal herbs used to normalize hypertension; Hibiscus sabdariffa, Allium sativum, Andrographis paniculata, Apium graveolens, Bidenspilosa, Camellia sinensis, Coptis chinensis, Coriandrum sativum, Crataegus spp., Crocus sativus, Cymbopogon citrates, Nigella sativa, Panax ginseng, Salvia emiltiorrhizae, Zingiber officinale, Tribulus terrestris, Carum copticum, Cola lewrifeira, Cassia occidentailis, Cyranchum wilfordii.

Role of Indian Fruits in the Prevention and Management of Hypertension

Hypertension (HTN) is a serious health problem worldwide and worse than other cardiovascular diseases. HTN is a chief risk factor for stroke, myocardial infarction, heart failure, aortic aneurysm, peripheral arterial disease, and renal vascular disease. Herbal medicines are used by about 75% to 80% of the world population, in primary health care because of their enhanced tolerability and minor side effects. The consumption of fruits is advised for good health as a result of their high fiber, antioxidant, mineral, vitamin, and phytochemical contents. Of the many fruiting trees, indigenous to India such as mango (Mangifera indica), black plum (Eugenia jambolana), pomegranate (Punica granatum), and amla (Emblica officinalis) are useful in preventing HTN and in the treatment of HTN in validated preclinical and clinical studies. In this review, efforts are made to collate the fruits' antihypertensive effects and their important phytochemicals. Efforts are also made to address the underlying mechanism/s responsible for the beneficial effects of these fruits in HTN prevention and treatment.

Population-Based Limits of Urine Creatinine Excretion

The validity of a timed urine collection is typically judged by measurement of urine creatinine excretion, but prevailing limits may be unreliable. We sought to empirically derive population-based limits of excretion for evaluating the validity of a timed urine collection. Covariate and 24-hour urine data were obtained from 3582 participants in the Chronic Renal Insufficiency Cohort (CRIC) study, 814 participants in the Modification of Diet in Renal Disease (MDRD) study, 1010 participants in the Jackson Heart Study (JHS), and 8536 participants in the Prevention of Renal Vascular End Stage Disease (PREVEND) study. Weight, height, age, sex, and serum creatinine concentrations were evaluated as potential predictors of urine creatinine excretion using Akaike Information Criteria, R-squared values, and deviance. Bias and precision of the fitted models were assessed by analyses of residuals. Agreement between 24-hour creatinine clearance and 125I-iothalamate clearance was assessed before and after exclusion of potentially invalid urine samples. A best-fitting model to predict 24-hour urine creatinine excretion among the 9199 discovery cohort members included sex-specific terms for weight, height, and age (R-squared= 0.328). This model had a median bias of+4.3 mg creatinine/day (95% confidence interval-5.6,+13.3 mg/day) in 4599 validation cohort members, and 82% of observed values were within 30% of predicted model. Serum creatinine concentrations only marginally improved model precision but reduced bias in persons with advanced chronic kidney disease (CKD). The limits of urine creatinine excretion derived here represent the most valid and representative data for appraising the adequacy of a timed urine collection.

The Relationship Of Depression-Anxiety Inspection And Hypertension In Newly Diagnosed Young Hypertensive Patients

Aim: Hypertension (HT) is a very important risk factor for cerebrovascular, renal and various vascular diseases, especially&#x0D; cardiovascular diseases. It is seen in almost 1/3 of the adult world population and its incidence is gradually increasing.&#x0D; 95% of HT is essential and various reasons are emphasized in the etiology. Conditions that cause psychological stress,&#x0D; especially depression; Although the relationship between them is not clear, it was seen as a risk factor for HT. Because&#x0D; they will live with HT for a long time, early diagnosis and treatment is important, especially in young patients. Predisposing&#x0D; factors should also be taken into account in treatment. Anxiety and depression, which are called increased sympathetic&#x0D; activity in young people, can be a trigger for HT. In this study, we wanted to investigate the susceptibility to depressionanxiety in newly diagnosed young hypertensive patients. According to the result, we thought that we could make new&#x0D; recommendations in the treatment of HT.&#x0D; Materials and Methods: 175 patients under the age of 45 with newly diagnosed HT and 125 individuals under 45 without&#x0D; any health problems were included in the study. Those diagnosed with HT with secondary reasons and those with chronic&#x0D; diseases such as coronary artery disease (CAD), diabetes mellitus (DM), chronic renal failure (CRF), congestive heart failure&#x0D; (CHF) were excluded from the study. Testing was performed with the Hospital Depression Anxiety Scale (HDAS). In this test&#x0D; for both anxiety and depression; 0-7 points were considered normal, 8-10 points were considered borderline, and over 11&#x0D; points were considered abnormal.&#x0D; Results: When the results were evaluated, there was no difference between the groups in terms of age, gender, and&#x0D; routine biochemical tests. Both depression and anxiety scales were found to be significantly higher in the HT group. In&#x0D; young hypertensive patients, we have seen that HT and depression-anxiety frequently coexist.&#x0D; Conclusion: In this case, we should definitely examine the psychological stress states of young patients we diagnosed with&#x0D; HT. It would be appropriate to refer patients who we think may have depression and anxiety for psychological support and&#x0D; treatment. When psychological problems are treated, HT may improve without the need for antihypertensive treatment.&#x0D; Thus, we can develop new approaches in HT treatment.

Clinical Characteristics of Hospitalized Pediatric Patients With Hypertensive Crisis-A Retrospective, Single-Center Study in China.

BackgroundA hypertensive crisis is a medical emergency that causes acute damage to multiple organs. However, the etiology, clinical features, and prognosis of hypertensive crisis in Chinese children remain relatively unknown. The purpose of this study was to analyze the clinical characteristics of pediatric hypertensive crisis patients from a single center in China.MethodsWe analyzed data from 70 children with hypertensive crisis between January, 2000, and January, 2022. The patients were divided into two groups: those diagnosed with a hypertensive emergency (n = 46) and those diagnosed with hypertensive urgency (n = 24). Baseline etiologies and risk factors were compared between the two groups. The following data were collected and analyzed: age, sex, weight, height, family history of hypertension, blood pressure, clinical manifestations of hypertensive crisis, underlying causes, biochemical indicators, and antihypertensive drugs.ResultsThe major symptoms of hypertensive crisis were headache (n = 31, 44.29%), followed by visual symptoms (n = 15, 21.43%), and dizziness (n = 13, 18.57%). Further analysis showed that the incidence of convulsions was significantly higher in patients with hypertensive emergency than those with hypertensive urgency (χ2 = 5.38, p = 0.02). The leading underlying causes were renal disease (n = 34, 48.57%), followed by vascular disease (n = 11, 15.71%), essential hypertension (n = 9, 12.86%), oncological disease (n = 9, 12.86%), central nervous system disease (n = 3, 4.29%), endocrine and metabolic diseases (n = 2, 2.86%), and other (one case with lead poisoning, one case with histiocytosis). End-organ damage occurred in 46 patients with hypertensive crisis, including retinal damage (n = 20, 43.48%), brain damage (n = 19, 41.30%), heart damage (n = 15, 32.61%), and renal damage (n = 3, 6.52%). Hypertensive crisis was most common among children aged 7–12 years. Among children aged 13–18 years, hypertensive urgency was more common than hypertensive emergency. The incidence of dyslipidemia, elevated serum creatinine, and elevated uric acid did not differ significantly between the two groups. Most patients with hypertensive crisis need combined antihypertensive therapy (n = 60, 85.71%). There were no cases of mortality.ConclusionsHypertensive crisis is caused by secondary diseases, especially renal disease and vascular disease, in the majority of pediatric patients. Combination therapy with antihypertensive agents and treatment of secondary etiology results in a good prognosis.

FC 104: Apathy Associates with Cognitive Dysfunction and Mortality in Older Ckd Patients

Abstract BACKGROUND AND AIMS The growing population of older patients with chronic kidney disease (CKD) often faces unidentified cognitive impairments and high prevalence of depressive symptoms. Apathy is a clinical syndrome associated with both depression and cognitive decline in community-dwelling older people. Furthermore, apathy has been more often linked to vascular impairments, which are also highly prevalent in the CKD population. However, so far, prevalence and consequences of apathy in older CKD patients have not been studied. We aimed (1) to investigate the prevalence of apathy symptoms in an older population with CKD stage G4/G5 (eGFR &amp;lt; 20 mL/min/1.73 m2), and (2) to assess if apathy is associated with, frailty, cognitive and functional impairments and mood. In addition, we (3) investigated the relation between apathy at baseline and mortality during four years of follow-up. METHOD Data was used from the prospective multicenter COPE (Cognitive Decline in Older Patients with ESKD) cohort, which included CKD patients aged ≥65 years with an eGFR of ≤20 mL/min/1.73 m2. Symptoms of apathy were assessed with the 3-item subscale of the 15-item Geriatric Depression (GDS-3A score ≥2) and depressive symptoms with the remaining items of this scale (GDS-12D ≥2). Frailty, (Fried Frailty Index ≥3), functional dependence (GARS score), handgrip strength and walking speed were measured. Cognitive functioning was assessed by means of global cognition (Mini Mental State Examination), visuoconstruction (Clock drawing), memory (15-Word Verbal Learning Test and Visual Association Test), executive function (Trail Making Test-B) and psychomotor speed (Letter Digit Substitution Test, Trail Making Test -A). Cross-sectional correlations between groups were tested with t-tests, Mann–Whitney and Chi-squared tests. Hazard ratio for mortality was analysed with Cox regression adjusting for age, gender and primary vascular kidney disease. RESULTS In total n = 180 patients, 67% male, were included with a median age of 75.5 years (IQR 71.0–80.9) and mean eGFR of 16.5 (SD 4.6). Symptoms of apathy and isolated apathy (i.e. with no symptoms of depression) were seen in respectively 36% (n = 64) and 17% (n = 30) of the study population. Presence of apathy symptoms at baseline was associated with primary vascular kidney disease (P = 0.031), depression (P &amp;lt; 0.001), frailty (P &amp;lt; 0.001) and decreased physical functioning (i.e. functional dependence; P &amp;lt; 0.001, handgrip strength; P = 0.026 and walking speed; P &amp;lt; 0.001). Presence of apathy symptoms was also associated with reduced executive function (P = 0.045) and psychomotor speed (P = 0.022). Furthermore, patients with apathy symptoms had a 1.9 times higher mortality risk (P = 0.022, adjusted for age, gender and primary vascular renal disease). CONCLUSION Symptoms of apathy occurred in one third of this cohort of older advanced CKD patients. Although apathy was associated with presence of depressive symptoms, half of the cases were not. Apathy is associated with multiple functional and cognitive measures and two-fold increased mortality. Future investigations should focus on cause of apathy and its value in predicting cognitive decline in older CKD patients. Because of the relation of apathy with future outcomes, assessment of apathy might be of value in shared decision making on renal replacement therapy in older CKD patients.

Saphenous Vein Graft between Brachial Artery and Cephalic Vein in Antebrachial Arteriovenous Anastomosis – Simulation of the Procedure

Patients with chronic renal failure and vascular diseases require the vascular access for hemodialysis procedure to be performed with the most possible comfort for the patient. Native vein graft has a longer-lasting term in the patients’ limb, lower risk of graft infection and lower price. Native vein graft is constructed from the great saphenous vein, if the diameter of the vessel is smaller than the diameters of vessels (brachial artery, cephalic vein) it is connected to the cubital fossa region due to the risk of graft folding, that might occur, if the graft diameter is bigger than the diameter of one or both vessels, on which anastomosis is made. The most important sizes, that were taken before graft placement, are the length of the forearm compartment, the distance between the brachial artery and cephalic vein in the cubital fossa region, distance from an expected incision in the brachial artery to the middle of the forearm compartment, the distance between incision in cephalic vein to the middle of the forearm compartment, length of the great saphenous vein (the graft) and diameters of blood vessels, used in the procedure. Finally, the right position of the graft should be determined for the successful outcome of anastomosis creating procedure.

DIABETES -THE URGENCY TO DEVELOP AND IMPLEMENT MULTI-SECTORAL STRATEGIES TO COMBAT THE GROWING EPIDEMIC

Diabetes is a major cause of morbidity and mortality, though these outcomes are not due to the immediate effects of the disorder. They are instead related to the diseases that develop as a result of chronic diabetes mellitus. These include diseases of large blood vessels,microvascular disease, and&#x0D; peripheral ,coronary heart diseases, arterial disease) and small blood vessels (microvascular disease, including retinal and renal vascular disease), as well as diseases of the nerves.&#x0D; Keywords: DM type II, multy sectoral strategies

Abstract WP220: Ischemic Stroke In Young Adults With Heart Failure

Background: Heart failure (HF), traditionally considered a disease of the elderly, is the second leading cause of cardioembolic stroke. In young adults however the prevalence and outcomes following HF-related stroke remain unclear. Here we investigate the prevalence of HF among young adults with ischemic stroke and analyze in-hospital outcomes. Methods: Using the National Inpatient Sample (2012-2018) we performed a retrospective analysis of all ischemic stroke hospitalizations among young adults (18-45) using previously validated ICD-9 and 10 codes. Presence of HF and relevant covariates were also extracted. Poor functional outcome was defined as either discharge to nursing facility, placement of percutaneous endoscopic gastrostomy tube or tracheostomy. Multivariable logistic and linear regression models were used to compare outcomes. Results: 65,160 young adults were hospitalized for ischemic stroke, 12% with comorbid heart failure. A greater proportion of patients with HF were men (61% vs 50% p &lt; 0.001), of Black race (35% vs 24%, p &lt; 0.001) and of the lowest income quartile (40% vs 34% p &lt; 0.001). Along with traditional vascular risk factors (atrial fibrillation, hypertension, diabetes, and coronary artery disease, all p &lt; 0.05), renal failure and COPD were also more prevalent in young adults with HF (24% vs 7% and 5% vs 2%, both p &lt;0.001). HF was associated with longer hospitalizations (15.0 [0.23] vs 8.5 [0.06] days, p&lt;0.001) and greater total charges ($240,665 vs $125,201, p&lt;0.001). In crude analysis, HF was associated with significantly increased odds of poor functional outcome (OR 1.72, 95% CI: 1.64-1.81) and death (OR 2.86, 95% CI: 2.69-3.05). After adjustment for demographics, hospital factors, comorbidities, and disease severity, mortality remained significant (1.38, 95% CI: 1.27-1.51). Conclusion: Disparities in prevalent HF exist among young adults with ischemic stroke. HF is associated with longer and more expensive stroke hospitalizations in young adults and significantly greater odds of death. Along with traditional vascular risk factors, pulmonary and renal disease are more prevalent in young stroke patients with HF. Further research may identify prevention strategies to improve outcomes in these young, high-risk patients.

The Therapeutic Strategies for Uremic Toxins Control in Chronic Kidney Disease.

Uremic toxins (UTs) are mainly produced by protein metabolized by the intestinal microbiota and converted in the liver or by mitochondria or other enzymes. The accumulation of UTs can damage the intestinal barrier integrity and cause vascular damage and progressive kidney damage. Together, these factors lead to metabolic imbalances, which in turn increase oxidative stress and inflammation and then produce uremia that affects many organs and causes diseases including renal fibrosis, vascular disease, and renal osteodystrophy. This article is based on the theory of the intestinal–renal axis, from bench to bedside, and it discusses nonextracorporeal therapies for UTs, which are classified into three categories: medication, diet and supplement therapy, and complementary and alternative medicine (CAM) and other therapies. The effects of medications such as AST-120 and meclofenamate are described. Diet and supplement therapies include plant-based diet, very low-protein diet, probiotics, prebiotics, synbiotics, and nutraceuticals. The research status of Chinese herbal medicine is discussed for CAM and other therapies. This review can provide some treatment recommendations for the reduction of UTs in patients with chronic kidney disease.

Centennial history and development of adrenal tumor treatment from exploring and innovating the PUMCH pattern

<p indent=0mm>In the past century of diagnosing and treating adrenal tumors, Peking Union Medical College Hospital has explored the pathophysiology, tissue anatomy, endocrine, and biochemical examination. Additionally, specific radionuclide scanning, multidisciplinary discussion of complex cases, continuous improvement of surgical methods, wide application of minimally invasive surgery, continuous exploration of molecular mechanism, gene diagnosis, and other aspects of the disease has been studied to explore a set of PUMCH model for diagnosing and treating adrenal tumors. Secondary hypertension is harmful and is often associated with adrenal tumors; thus, we need to exclude the confusing causes related to adrenal tumors, such as hyperthyroidism, menopausal symptoms, idiopathic tidal fever, hyperadrenergic attack, renal vascular disease, hypoglycemia, postural tachycardia syndrome, mast cell disease, and carcinoid syndrome. At the beginning of Peking Union Medical College Hospital, there were many patients with adrenal tumors. By observing clinical symptoms and signs, biochemical tests, autopsy, and pathological anatomy, valuable data were obtained, making patients benefit from the study. Furthermore, huge clinical and tissue specimen databases were established, laying a good foundation for future clinical research. This article reviews the history of adrenal tumor diagnosis and treatment in Peking Union Medical College Hospital and the related progress at home and abroad in taking the diagnosis and treatment of adrenal surgical diseases to a new level and coping with new future challenges.