Background:
Hyperuricemia is associated strongly with the development of hypertension, renal disease, and progression. Allopurinol decreases serum uric acid levels by inhibiting the enzyme xanthine ...oxidase. We hypothesized that administrating allopurinol to decrease serum uric acid levels to the normal range in hyperuricemic patients with chronic kidney disease may be of benefit in decreasing blood pressure and slowing the rate of renal disease progression in these patients.
Methods:
We conducted a prospective, randomized, controlled trial of 54 hyperuricemic patients with chronic kidney disease. Patients were randomly assigned to treatment with allopurinol, 100 to 300 mg/d, or to continue the usual therapy for 12 months. Clinical, hematologic, and biochemical parameters were measured at baseline and 3, 6, and 12 months of treatment. We define our study end points as: (1) stable kidney function with less than 40% increase in serum creatinine level, (2) impaired renal function with creatinine level increase greater than 40% of baseline value, (3) initiation of dialysis therapy, and (4) death.
Results:
One patient in the treatment group dropped out because of skin allergy to allopurinol. Serum uric acid levels were significantly decreased in subjects treated with allopurinol, from 9.75 ± 1.18 mg/dL (0.58 ± 0.07 mmol/L) to 5.88 ± 1.01 mg/dL (0.35 ± 0.06 mmol/L;
P < 0.001). There were no significant differences in systolic or diastolic blood pressure at the end of the study comparing the 2 groups. There was a trend toward a lower serum creatinine level in the treatment group compared with controls after 12 months of therapy, although it did not reach statistical significance (
P = 0.08). Overall, 4 of 25 patients (16%) in the allopurinol group reached the combined end points of significant deterioration in renal function and dialysis dependence compared with 12 of 26 patients (46.1%) in the control group (
P = 0.015).
Conclusion:
Allopurinol therapy significantly decreases serum uric acid levels in hyperuricemic patients with mild to moderate chronic kidney disease. Its use is safe and helps preserve kidney function during 12 months of therapy compared with controls. Results of this study need to be confirmed with an additional prospective trial involving a larger cohort of patients to determine the long-term efficacy of allopurinol therapy and in specific chronic kidney disease subpopulations.
Melamine Toxicity and the Kidney HAU, Anthony Kai-Ching; TZE HOI KWAN; LI, Philip Kam-Tao
Journal of the American Society of Nephrology,
02/2009, Letnik:
20, Številka:
2
Journal Article
Recenzirano
Odprti dostop
The toxicity of melamine caught the attention of physicians as a result of a recent spate of renal injury after exposure to melamine-tainted milk in China. Melamine is an organic nitrogenous compound ...used in the production of plastics, dyes, fertilizers, and fabrics. In the current incident, melamine was added to milk to elevate falsely assay results for protein content. A variety of toxic effects from melamine, including nephrolithiasis, chronic kidney inflammation, and bladder carcinoma, all have been studied in animals. We review here the epidemiology, clinical features, and investigative findings concerning the only outbreak of melamine poisoning in humans. We also examine the renal toxicities of melamine and cyanuric acid--a by-product of its synthesis--and the associated risk factors on exposure and provide guidance on levels in foods.
Hepatitis E virus (HEV) genotype 4 (HEV-4) is an emerging cause of acute hepatitis in China. Less is known about the clinical characteristics and natural history of HEV-4 than HEV genotype 3 ...infections in immunocompromised patients. We report transmission of HEV-4 from a deceased organ donor to 5 transplant recipients. The donor had been viremic but HEV IgM and IgG seronegative, and liver function test results were within reference ranges. After a mean of 52 days after transplantation, hepatitis developed in all 5 recipients; in the liver graft recipient, disease was severe and with progressive portal hypertension. Despite reduced immunosuppression, all HEV-4 infections progressed to persistent hepatitis. Four patients received ribavirin and showed evidence of response after 2 months. This study highlights the role of organ donation in HEV transmission, provides additional data on the natural history of HEV-4 infection, and points out differences between genotype 3 and 4 infections in immunocompromised patients.
Objective
: Dissolution velocity of monosodium urate (MSU) crystal during urate-lowering therapy (ULT) had been inadequately studied. By using dual-energy computed tomography (DECT), which allows ...accurate assessment of MSU load, we analyze relationship between serum urate (SU) and volumetric reduction rate of MSU and develop a model that predicts dissolution time.
Baseline and follow-up DECTs were performed under a standard ULT protocol. Monthly dissolution rates were calculated by simple and compound methods. Correlations with average SU were compared and analyzed. Best-fit regression model was identified. MSU dissolution times were plotted against SU at different endpoints.
In 29 tophaceous gout patients, MSU volume reduced from baseline 10.94 ± 10.59 cm
3
to 2.87 ± 5.27 cm
3
on follow-up (p = .00). Dissolution rate had a stronger correlation with SU if calculated by compound method (Pearson's correlation coefficient r= −0.77, p = .00) and was independent of baseline MSU load. The ensuing dissolution model was logarithmic and explained real-life scenarios. When SU > 0.43 mmol/l, dissolution time approached infinity. It improved to 10-19 months at SU = 0.24 mmol/l. When SU approximated zero (as with pegloticase), dissolution flattened and still took 4-8 months.
MSU dissolution is better described as a logarithmic function of SU, which explains, predicts, and facilitates understanding of the dissolution process.
Hong Kong Renal Registry Report 2012 Ho, Yiu-Wing; Chau, Ka-Foon; Choy, Bo-Ying ...
Hong Kong journal of nephrology,
April 2013, 2013-04-00, Letnik:
15, Številka:
1
Journal Article
Recenzirano
Odprti dostop
This report examined the characteristics and trends of dialysis and renal transplant patients among the resident population of Hong Kong who were managed by hospitals or dialysis centers of the ...Hospital Authority, and accounted for approximately 95% of all patients receiving renal replacement therapies (RRTs) in the territory. Patients receiving RRTs solely in the private sector were not included in this report. Data trends from 1996 to 2011 are presented. In 2011, 1115 new patients were accepted into RRT programs, and the incident rate was 157 patients per million populations (pmp). An increasing trend was noted. The incident rate was 95.1 pmp at the commencement of the annual report in 1996. The point prevalence on December 31, 2012 was 8197 with a prevalence rate of 1152.5 pmp. Overall, there were 3573 patients (43.6%) on peritoneal dialysis (PD) and 1246 patients (15.2%) on hemodialysis (HD), and 3378 patients (41.2%) were living with a functioning renal transplant. The PD/HD ratio was 74.2:25.8. The “PD First” policy was continued. The overall mortality rate among RRT patients was 9.95 patients per 100 patient-years exposed. There was a decreasing trend in mortality among PD patients. Infection and cardiovascular complications were the most common causes of death. Renal transplant was the modality with the best survival rates. The 5 years cumulative patient survival rate for patients on transplant treatment was 89.6%, whereas the corresponding patient survival rates for PD and HD patients were 50.7% and 55.7%, respectively. More than 70% of RRT patients with reports on rehabilitation were active and had normal daily activities.
本報告旨在審查在香港地區之透析及腎臟移植患者的狀況，這些患者均是香港居民，接受香港醫院管理局轄下的醫院或透析中心所提供的治療，約佔當地腎臟替代療法 (RRT) 總病人數目的九成半，僅在私營醫院接受 RRT 的患者並不包括在本報告之內。以下是 1996 年至 2011 年的數據趨勢。在 2011 年，共有 1115 名新患者被納入 RRT 服務計劃，發生率為每百萬人口 157 人 (pmp)，比較在 1996 年的年度報告中發生率為 95.1 PMP，有增加的趨勢。截至2012年 12 月 31 日，點盛行個案為 8197，而患病率為 1152.5 pmp。當中有 3573 患者接受腹膜透析 (PD，43.6%)，1246 患者接受血液透析 (HD，15.2%)，以及 3378 名患者接受腎臟移植後繼續存活 (41.2%)。PD 與 HD比例為 74.2：25.8，持續了優先採用腹膜透析治療之政策。RRT 患者的整體死亡率為每 100 患者-年 9.95 人。PD 患者的死亡率呈下降趨勢。感染和心血管併發症是最常見的死亡原因。接受腎移植患者的存活率為最高，5年累計之存活率達 89.6%，相對 PD 和 HD 患者之存活率分別為 50.7% 和 55.7%。超過七成的 RRT 患者能維持正常的日常生活。
Prevalence of silent kidney disease in Hong Kong: The Screening for Hong Kong Asymptomatic Renal Population and Evaluation (SHARE) program.
End-stage renal disease (ESRD) is epidemic worldwide. In ...Hong Kong, the annual incidence of ESRD has risen from 100 pmp (per million population) in 1996 to 140 pmp in 2003. SHARE (Screening for Hong Kong Asymptomatic Renal Population and Evaluation program) is a population-based screening program aimed at identifying the prevalence of unrecognized renal disease in asymptomatic individuals, allowing further evaluation and disease-modifying interventions.
From November to December 2003, SHARE was conducted in several large residential communities in Hong Kong. The screening tool included a questionnaire documenting demographics and history or family history of diabetes mellitus (DM), hypertension (HT), and chronic kidney disease (CKD), together with on-site measurements of blood pressure (BP) and urine dipstick for protein, blood, and glucose.
There were a total of 1811 participants. One thousand two hundred and one subjects were entered into the final analysis. Among the 1201 who were apparently “healthy” (asymptomatic and without history of DM, HT, or CKD), the prevalence of positive (≥1+) urine dipstick for protein, glucose, blood, protein or blood, any urine abnormality, and HT (BP≥140/90) was 3.2%, 1.7%, 13.8%, 16%, 17.4%, and 8.7%, respectively. Thirty three percent of the age over 60 years old group had either hypertension or urine abnormalities, compared with 24.0% in the 41- to 60-year-old group and 9.7% in the 20- to 40-year-old group. Having a family history of diabetes or hypertension increases the risk of having urine abnormalities, while a family history of hypertension also increases the risk of high blood pressure.
It is concluded that subclinical abnormalities in urinalysis or BP readings are prevalent across all age groups in the adult population. An effective screening program at the primary care level that identifies these subjects for further evaluation is warranted, and the public in Hong Kong should be educated toward the significance of such findings in order to have regular health check for asymptomatic renal diseases.
Objectives. The purpose of this study was to evaluate the outcome of systemic lupus erythematosus (SLE) patients on continuous ambulatory peritoneal dialysis (CAPD). Methods. Eighteen SLE patients ...who had been undergoing CAPD for at least 3 months in our unit were compared with 36 other age- and gender-matched non-diabetic CAPD patients with an underlying primary chronic glomerulonephritis (CGn). The clinical outcome, infective complications, lupus activities, biochemical parameters, haemoglobin level and the use of erythropoietin were reviewed. Results. The duration of dialysis of the two studied groups was not different, with a mean of 35.4 months for the SLE group and 36.7 months for the CGn group. Before dialysis, SLE patients had a significantly lower albumin level (30.4±6.6 vs 35.4±5.59 g/dl, P<0.01), while the mean haemoglobin levels of the two groups were similar (8.5±1.8 g/dl for SLE vs 9.0±1.9 g/dl for the control group). However, the weekly dose of erythropoietin (EPO) used was significantly higher in the SLE group (6000 vs 3818 U/week, P<0.01) to maintain a similar haemoglobin level during dialysis. Regarding the infective complications, the SLE group had a higher peritonitis rate (5.7 episodes/100 patient-months vs 2.4 episodes/100 patient-months, P<0.05), and an increase in the non catheter related infection rate (6.67 episodes/100 patient-months vs 1.1 episodes/100 patient-months, P<0.001). However, no significant difference could be demonstrated in the Tenckhoff catheter exit site infection rate (2 episodes/100 vs 1.7 episode/100 patient-months). The number of patients who received a kidney transplant or required a change of mode to haemodialysis was similar among the two groups. Seven patients died during the follow-up period, and the overall mortality rate was much higher in the SLE group than in the control group (0.83/100 vs 0.15/100 patient-months, P<0.05). Conclusions. SLE patients on CAPD have a significantly lower pre-dialysis serum albumin level and use a higher dose of Epo to achieve a comparable haemoglobin level than other non-diabetic CGn CAPD patients. They also have a poorer prognosis in terms of infective complications and mortality rate.
Aim: To assess the efficacy of using ultrasonography (USG) in monitoring the progress of exit site infection (ESI) in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).
Methods: ...Twenty‐two cases of newly diagnosed ESI and 20 cases with normal exit sites as controls were assessed by using USG. The exit sites were reassessed by using USG after finishing a course of antibiotic therapy, and the sonographic findings were correlated with the clinical outcome.
Results: Out of the 22 cases of ESI, 21 cases had definite sonolucent zones around the external cuffs, while one case had normal sonographic findings. Of the 20 control cases of normal exit sites, 16 had normal sonographic findings, and four had sonolucent zones around the external cuffs. Exit site infections correlated with positive sonographic findings as compared to normal exits (P < 0.0001). The 21 cases of ultrasonic‐positive ESI were re‐examined after antibiotic therapy, and 10 of these had a post‐treatment sonolucent rim around the distal cuff ≤1 mm thick, while 11 cases were persistently >1 mm thick. The former group was shown to have a more favourable outcome (P = 0.013). And despite variable USG findings, all eight patients with Pseudomonas aeruginosa‐related ESI had an unfavourable clinical outcome.
Conclusion: Ultrasonography of the exit sites in CAPD patients is a useful adjunctive tool in the management of ESI. A sonolucent zone around the external cuff >1 mm thick following a course of antibiotic treatment and the involvement of the proximal cuff are associated with poor clinical outcome. In ESI caused by Pseudomonas aeruginosa, the clinical outcome was uniformly poor irrespective of the sonographic findings.
Background
Cordyceps sinensis (Cordyceps, Dong Chong Xia Cao), a herbal medicine also known as Chinese caterpillar fungus, is one of the most commonly used ingredients in traditional Chinese medicine ...for the treatment of people with chronic kidney disease (CKD).
Objectives
This review aimed to evaluate the therapeutic effects and potential adverse effects of
Cordyceps sinensis for the treatment of people with CKD.
Search methods
We searched the Cochrane Renal Group's Specialised Register to 14 April 2014 through contact with the Trials' Search Co‐ordinator using search terms relevant to this review. We also searched CINAHL, AMED, Current Controlled Trials, OpenSIGLE, and Chinese databases including CBM, CMCC, TCMLARS, Chinese Dissertation Database, CMAC and Index to Chinese Periodical Literature.
Selection criteria
Randomised and quasi‐randomised trials comparing Cordyceps or its products with placebo, no treatment, or conventional treatment were considered for inclusion in the review.
Data collection and analysis
Two authors independently assessed data quality and extracted data. Statistical analyses were performed using the random‐effects model and the results expressed as risk ratio (RR) for dichotomous outcomes or mean difference (MD) for continuous data with 95% confidence intervals (CI).
Main results
We included 22 studies that involved 1746 participants. Among people with CKD who were not receiving dialysis, Cordyceps preparations were found to significantly decrease serum creatinine (14 studies, 987 participants): MD ‐60.76 μmol/L, 95% CI ‐85.82 to ‐35.71); increase creatinine clearance (6 studies, 362 participants): MD 9.22 mL/min, 95% CI 3.10 to 15.34) and reduce 24 hour proteinuria (4 studies, 211 participants: MD ‐0.15 g/24 h, 95% CI ‐0.24 to ‐0.05). However, suboptimal reporting and flawed methodological approaches meant that risk of bias was assessed as high in four studies and unclear in 18 studies, and hence, these results need to be interpreted with caution.
Authors' conclusions
We found that Cordyceps preparation, as an adjuvant therapy to conventional medicine, showed potential promise to decrease serum creatinine, increase creatine clearance, reduce proteinuria and alleviate CKD‐associated complications, such as increased haemoglobin and serum albumin. However, definitive conclusions could not be made because of the low quality of evidence.
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