ObjectiveTo investigate the change of renal endothelin (ET) excretion and its relation to renal dysfunctions in obstructive jaundice.MethodsSixty male Wistar rats were randomized into two groups, the common bile ducts were ligated to establish the model of obstructive jaundice in experimental group, and only sham operation was done in control group. Ten rats were taken from each group at 5, 10 and 15 days respectively after operation, renal functions were evaluated by paminohippuric acid clearance (CPAH), inulin clearance (CIN) and fractional sodium excretion (FENa+); furthermore, plasma endotoxin (EX) level was determined, and ET1 contents in renal arterial plasma, renal venous plasma and renal tissue were detected. ResultsOnly FENa+ was significantly increased at the 5th day in experimental group; since the 10th day, all the three renal functional parameters gradually decreased, and FENa+ was significantly lower than that in control group at 15th day (P＜0.01 vs control). ②The plasma EX sustained at significantly higher levels after operation in experimental group (P＜0.01 vs control). ③The renal arterial plasma ET1 was significantly decreased, while the contents in renal venous plasma and renal tissue were significantly increased after operation in experimental group (P＜0.01 vs control). ④There were positive correlation between plasma EX and renal ET1 content, negative correlation between renal ET1 content and CPAH/CIN, and positive correlation between renal ET1 content and FENa+ (P＜0.01).ConclusionThe increased excretion of renal ET stimulated by endotoxemia may play an important role in the renal dysfunctions in obstructive jaundice.
Abstract: Objective To evaluate the protective effects of Ulinastatin on the peri-operative liver and renal function in patients undergoing cardiac surgery for tetralogy of Fallot (TO F). Methods Thirty-eight patients with TOF were divided into Ulinastatin group and control group according to admission sequence, 19 cases in each group.For Ulinastatin group, intravenous Ulinastatin was given with a dosage of 10 000U /kg at 1h before operation, 1h and 24 h after operation. For control group, no Ulinastatin was given. 10 ml fresh urine and 2 ml blood samples were collected before operation, and postoperative 1h, 10h, 24h, 48h and 72h, respect ively. The liver and renal functions were measured. Fluid intake, urine output, chest drainage, dosage of furosemide, durations of mechanical ventilation and intensive care unit ( ICU ) stay were recorded. Results Neither arrhythmia nor low cardiac output syndrome occurred for both groups. No peri-operative death. Compared with control group, dose of furosemide, period of mechanical ventilation were lower, while urine output was higher in Ulinastat in group; the aberrant climax value of urine pro tein and N-acetylglucosam inidase (NAG) were lower in Ulinastatin group (10h post-operat ively, urinem icroalbum in: 65. 2 ± 58. 3mg/L vs. 71. 8 ±58. 9mg/L ; urine transferrin: 5. 8 ± 3. 6mg/L vs. 7. 4 ± 5. 4mg/L ; urine immunoglobulin G: 26. 9±20. 3mg/L vs. 31. 3±23. 3mg/L ; 1h post-operat ively; urine NAG: 61. 4±81. 6U /L vs. 76.1±48. 5 U /L ; P lt; 0. 05) and maintained in shorter period (P lt; 0. 05) , it returned to baseline value at 48h and 72 h post-operatively. The value of alanine aminotransferase (ALT) significantly increased post-operatively at every time points in control group (P lt; 0. 01) , w hile no obvious change in Ulinastat in group (P gt; 0. 05). The increased value of aspartate aminotransferase (AST ) in Ulinastatin group was significantly lower than that in control group (10h post-operat ively: 144. 4±20. 8U /L vs. 202. 7±74. 1U /L ; P lt; 0. 01). The value of AST returned to baseline value at 48h and 72h post-operat ively. Conclusion U linastatin is an effect ive strategy for protecting peri-operat ive liver and renal function of the patients with tetralogy of Fallot and the clinical application of Ulinastatin is safe and effective.
The prevalence, incidence, and medical expenses of end-stage renal disease (ESRD) is extremely high in Taiwan, China; so decreasing the incidence of ESRD is a major work for kidney disease prevention in Taiwan, China. Current chronic kidney disease (CKD) guideline suggests multidisciplinary team (MDT) care for CKD patient with estimated glomerular filtration rate (eGFR) less than 30 mL/(min·1.73 m2). MDT includes not only nephrologist but also nursing specialty, dietitian, social worker, psychologist, and other professional personnel. The aim of the MDT care is to preserve renal function, decrease complications, provide nutrient support and nephrotoxic drug consultation, establish the concept of renal replacement therapy and preparation for dialysis access, provide the renal transplantation information, and give the psychosocial support. These cares should provide to CKD patients one year before starting renal replacement therapy. The MDT care for CKD could delay the progression from CKD to ESRD, lower the mortality and hospitalization of CKD, slow the renal function decline, provide better medical care and quality of life for patients, and decrease the medical expenditures. Besides, advanced CKD patients receiving MDT care have higher arteriovenous access preparation rate that prevent the additional intervention and hospitalization while starting dialysis. MDT care also decreases the hospitalization costs and medical expenditures, and decrease 3-year mortality rate after dialysis initiation. The further developing MDT care includes: (1) providing personalized renal care and treatment model, and intergraded care by cardiology-nephrology-diabetes-neurology model; (2) new iCKD care with health management platform and care mode combined with communication technology; (3) shared decision making for choice of renal replacement therapy; (4) advance care planning clinic for palliative treatment of ESRD. All MDT care hopes to establish a person-oriented care policy, provides a better quality care model, not only for the patient’s personalized medical care, but also hopes to improve the overall kidney disease care and prevention work. In addition, we can extend the CKD prevention and treatment experience to other countries worldwide.
Objective To investigate the ultrasonographic characteristics of acute Stanford type A aortic dissection (ATAAD) involving renal artery and its relationship with renal function. Methods The patients with ATAAD admitted to our hospital from February 2013 to May 2023 were selected. According to whether dissection involved renal artery, the patients were divided into a renal artery involved group and a renal artery uninvolved group. The general data and ultrasonic characteristics of the two groups were compared, and the relationship between ultrasonic characteristics and renal artery involvement in ATAAD patients was analyzed by logistic regression analysis and correction model. Receiver operating characteristics (ROC) curve was used to evaluate the predictive value of ultrasonic characteristics for renal artery involvement in ATAAD patients. In addition, according to blood urea nitrogen (BUN) and Serumcreatinine (Scr), patients with renal artery involvement were divided into a normal renal function group and an abnormal renal function group. The general data of the two groups were compared, and the risk effect of ultrasonic characteristics involving renal artery in renal function was analyzed by Log-binomial model. Pearson correlation analysis was used to analyze the correlation between ultrasonic features involving renal artery and renal function indexes. Results Finally 163 patients were collected, including 154 males and 89 females, aged 20 to 85 (50.06±10.46) years. There were significant differences in gender, Scr and BUN between the renal artery involved group and the non-involved group (P<0.05). Compared with the non-involved group, the ascending aorta diameter, the proportion of patients with left ventricular wall thickening and renal perfusion difference in the involved group were greater (P<0.05). Logistic regression analysis showed that after adjusting for confounder, the ultrasonic characteristics and OR values of renal artery involvement in ATAAD patients were 1.916, 2.578 and 1.969, respectively. Ascending aortal diameter, left ventricular wall thickening and poor renal perfusion were independent influencing factors of renal artery involvement (P<0.05). The ultrasonic features were effective in predicting renal artery involvement in ATAAD patients. The combined prediction of the three factors involved renal artery, and the prediction efficiency was higher. Compared with normal renal function group, BUN, Scr, ascending aorta diameter, proportion of ascending aorta widening patients and renal perfusion difference in abnormal renal function group were greater (P<0.05). Log-binomial model analysis showed that the risk ratio of increasing ascending aorta diameter, widening ascending aorta and increasing renal perfusion difference had statistical significance before and after significant adjustment (P<0.05). The results of Pearson correlation analysis showed that ascending aorta diameter, ascending aorta widening and renal perfusion difference were closely related to renal function indexes (P<0.05). ConclusionThe ultrasonic features of ATAAD involving renal artery can affect renal function and have a certain correlation, and the increase of ascending aorta diameter, widening of ascending aorta and renal perfusion difference are independent risk factors for renal function abnormalities.