ObjectiveTo explore the correlation of serum lipocalin-2 (LCN2) with inflammation and the predictive value of LCN2 for detecting acute kidney injury (AKI) in acute pancreatitis (AP).MethodsNighty-one patients with AP, who were admitted to Bazhong Municipal Hospital of Traditional Chinese Medicine between June 2016 and June 2018, were enrolled in the present study. Clinical paramaters were analyzed between patients with AKI (n=29) and patients without AKI (n=62). The correlation of serum LCN2 with inflammation was assessed with Pearson’s correlation analysis. The area under the receiver operating characteristic curve (ROC AUC) for serum LCN2 predicting AKI in AP patients was assessed.ResultsCompared with the patients without AKI, the patients with AKI showed increased serum levels of C-reactive protein [(64.8±10.5) vs. (148.3±21.6) mg/L], procalcitonin [(3.5±2.3) vs. (4.8±3.9) μg/L], urea nitrogen [(5.5±2.1) vs. (6.6±2.8) mmol/L], creatinine [(80.3±28.1) vs. (107.3±30.8) μmol/L], interleukin-6 [(10.1±3.7) vs. (16.2±4.6) pg/mL], and LCN2 [(155.0±37.6) vs. (394.8±53.1) mg/mL], as well as decreased level of calcium [(2.6±1.3) vs. (2.0±1.0) mmol/L], the differences were all statistically significant (P<0.05). The serum level of LCN2 was correlated with C-reactive protein (r=0.694, P<0.05), interleukin-6 (r=0.762, P<0.05), and procalcitonin (r=0.555, P<0.05) in patients with AP. The ROC AUC of LCN2 for predicting AKI was 0.844 (P<0.05) , with a sensitivity of 81.3% and a specificity of 81.4% when the cut-off value was 210.2 ng/mL.ConclusionsSerum LCN2 concentration is elevated in patients with AKI. In patients with AP, serum LCN2 level is positively correlated with C-reactive protein, interleukin-6, and procalcitonin. It can be regarded as a reliable indicator for predicting AKI.
Objective To explore the risk factors affecting the prognosis of patients with acute kidney injury (AKI) after extracorporeal circulation surgery who receive continuous renal replacement therapy (CRRT). Methods Patients who developed AKI and underwent CRRT treatment after extracorporeal circulation surgery at the First Affiliated Hospital of Chongqing Medical University between May 2019 and May 2024 were retrospectively selected. According to the prognosis, patients were divided into the good prognosis group and the poor prognosis group. Basic information, duration of extracorporeal circulation during surgery, aortic occlusion time, timing and duration of CRRT initiation therapy, relevant laboratory indicators before surgery, during CRRT intervention, and upon discharge or death were collected. The risk factors affecting the prognosis of such patients were analyzed. Results A total of 45 patients were included. Among them, there were 20 cases in the good prognosis group and 25 cases in the poor prognosis group. There was no statistically significant difference in the basic information between the two groups (P>0.05). Compared with the poor prognosis group, the good prognosis group had decreased preoperative urea nitrogen and increased hemoglobin levels, reduced levels of alanine aminotransferase and aspartate aminotransferase during the initiation of CRRT treatment, and reduced levels of white blood cell count, neutrophil percentage, alanine aminotransferase and aspartate aminotransferase and elevated platelet count before discharge or death (P<0.05). The results of multivariate logistic regression analysis showed that the total duration of CRRT treatment [odds ratio (OR)=1.007, 95% confidence interval (CI) (1.000, 1.015), P=0.046], white blood cell count before discharge or death [OR=1.541, 95%CI (1.011, 2.349), P=0.044], and platelet count before discharge or death [OR=0.964, 95%CI (0.937, 0.991), P=0.010] could affect patient prognosis. Conclusions In patients with AKI after extracorporeal circulation surgery, if combined with renal dysfuction and anemia before surgery, liver function damage and secondary infection during CRRT initiation therapy may be related to poor patient prognosis. The longer the duration of CRRT treatment, the higher the white blood cells before discharge or death, and the lower the platelet count are independent risk factors for poor prognosis in patients.
Objective To evaluate factors such as renal injury grade （Sargent Method）, blunt or penetrative renal injury, injury severity score（ISS）, and shock influencing the need for operation or nephrectomy, and predictive of mortality in renal injury. Methods A well~tesigned questionnaire was used to collect medical records retrospectively. Two hundred and twenty-one cases of renal injury in West China Hospital from 1998 to 2002 were included, logistic regression analysis was used for multi-factors analysis. Results The average age of the 221 cases was 31.6, with 191 males （86.4%） and 30 females （13.6% ）, 175 blunt injuries （79.2%） and 46 penetrative injuries （20.8%）, and 101 concomitant injuries （45.7%）. Six cases died of renal injury （2.7%）. The results of logistic regression showed that the need of operation was related to injury grade, Type of renal injury, and shock significantly. ORs （odd ratios） were 5. 965 with 95% CI 2. 767 to 12. 859, 4. 667 with 95% CI 1. 725 to 12. 628, and 2. 547 with 95% CI 1. 684 to 3. 936 respectively. The need of nephrectomy was significantly related to injury grade with OR 11. 550 and 95% CI 4. 253 to 31. 366. The death was significantly related to ISS with OR 1. 263 and 95% CI 1. 082 to 1. 411. Conclusions The results of our data suggest the need of operation depends on injury grade, blunt or penetrative renal injury, and shock. The need of nephrectomy depends on injury grade. The death is related to ISS.
目的 探讨鱼胆汁对兔肾脏的影响及其机制。 方法 将实验新西兰大耳白兔随机分为灌胃组（GP组，n=19）与静脉注射组（VI组，n=15），根据体重分别按3 mL/kg、0.3 mL/kg的剂量通过灌胃或耳缘静脉注射方式给予鱼胆汁。采集鱼胆汁处理前与处理后1～5 h的血标本，测定肾功能、酸碱平衡及电解质指标，记录GP组每个采样点前20 min尿量及鱼胆汁处理前、处理后5 h的尿常规。鱼胆汁处理后5 h处死动物取肾做病理学检查。 结果 给予一定量鱼胆汁后5 h内，两组兔血肌酐（Scr）、尿素氮、K+呈升高趋势（P均＜0.05），而血HCO3?浓度呈下降趋势（P＜0.05），其中VI组兔Scr、血K+改变早于GP组。GP组记录尿量明显下降，尿pH值升高，蛋白定量试验、隐血试验结果均呈阳性。两组兔肾组织病理检查均显示肾小球血管充盈，少量中性粒细胞浸润；肾小管水肿及间质充血，部分有局灶性出血，肾间质损伤较肾小球更为严重。 结论 无论经由消化道还是血管给予实验兔鱼胆汁均可导致急性肾功能损伤，与鱼胆汁造成急性肾实质损伤、特别是肾小管间质损伤有关。
ObjectiveTo investigate the effect of Curcumin combined with Rhodiola on rats with severe acute pancreatitis (SAP) associated renal injury and explore the possible mechanisms. MethodsA total of 24 rats were randomly divided into SAP with renal injury group (SAP group, n=8), Curcumin group (n=8), Curcumin combined with Rhodiola group (n=8).The SAP group was given 1.5 mL saline through intragastric administration before operation while the Curcumin group was fed with same amount of Curcumin diluent.The Curcumin combined with Rhodiola group was given 1.5 mL Curcumin diluent through intragastric administration and 6 g/kg Rhodiola diluent through intraperitoneal injection before operation.The pancreas and pancreatic tail-segment was dissociated and the head of pancreas were occluded in rats to make the model, blood vessel forceps was loosed after three hours.All the rats were sacrificed at 18 h after modeling.The levels of serum amylase, creatinine, blood urea nitrogen were detected and pathological changes of pancreas and the left kidney were observed under the light microscope.The cell apoptosis was analyzed using TUNEL staining.The serum levels of interleukin (IL)-1β, IL-6, and IL-10 among the three groups were detected by enzyme-linked immunosorbent assay.The expression of inducible nitric oxide synthase (iNOS) mRNA in the right kidney was detected by real-time polymerase chain reaction.The superoxide dismutase (SOD) activity of the renal tissue was determined by hydroxylamine method. ResultsCompared with the SAP group, the levels of serum amylase, creatinine, blood urea nitrogen, IL-1β, IL-6, the cell apoptosis index, and the expression of iNOS mRNA were significantly decreased, the serum level of IL-10 and the activity of SOD were significantly increased (P < 0.05), the pancreas and the kidney damaged more slightly in the Curcumin group and Curcumin combined with Rhodiola group.Compared with the Curcumin group, the above situations were more better in the Curcumin combined with Rhodiola group. ConclusionsCurcumin combined with Rhodiola has a better protective effect on SAP associated renal injury.It might be through inhibiting the expressions of IL-1β, IL-6, stimulating the expression of IL-10, down-regulating the expression of iNOS mRNA, and improving the activity of SOD.It could reduce the cell apoptosis and necrosis of the kidney and improve the ability of the kidney to tolerate hypoxia.
ObjectiveTo retrospectively evaluate the risk factors of mortality in postoperative acute kidney injury (AKI) patients undergoing continuous renal replacement therapy (CRRT) after cardiopulmonary bypass (CPB). MethodsWe retrospectively analyzed the clinical data of 66 patients (38 males and 28 females with mean age of 59.11±12.62 years) underwent CRRT after cardiovascular surgery in our hospital between May 2009 and June 2014. The patients were divided into a survival group (18 patients) and a death group (48 patients) according to treatment outcome at discharge. Univariate analysis for risk factors of death was carried out for preoperative characteristics and lab results among study population. Significant univariate factors were then further analyzed by multivariable logistic regression models. ResultsSignificant predictors of death included blood transfusion volume during operation, peak level of blood sugar and lactate during operation, the total bilirubin level and platelet count on the first day after operation, hypotension on the first day after operation, pulmonary infection, multiple organ dysfunction syndrome (MODS) and the interval time of oliguria and CRRT (P<0.05). Logistic regression showed that there were statistical differencs in hypotension on the first day after operation, postoperative platelet count, and interval time of oliguria and CRRT respectively (P<0.05). ConclusionImproving intraoperative management, reducing bleeding and blood transfusion, controlling blood sugar level, dealing with complications such as hypotension, pulmonary infection and MODS more aggressively, starting CRRT when needed may be helpful to reduce mortality. Monitoring of the blood pressure and platelet count on the first day after operation is useful for prognosis estimation.
Most patients with coronavirus disease 2019 (COVID-19) have a good prognosis, but a certain proportion of the elderly and people with underlying diseases are still prone to develop into severe and critical COVID-19. Kidney is one of the common target organs of COVID-19. Acute kidney injury (AKI) is a common complication of severe COVID-19 patients, especially critical COVID-19 patients admitted to intensive care units. AKI associated with COVID-19 is also an independent risk factor for poor prognosis in patients. This article mainly focuses on the epidemiological data, possible pathogenesis, diagnostic criteria, and prevention and treatment based on the 5R principle of AKI associated with COVID-19. It summarizes the existing evidence to explore standardized management strategies for AKI associated with COVID-19.
Objective To investigate the effect of renal cell apoptosis induced by obstructive jaundice on the expression of bcl-2 in rats, and to explore the mechanism of renal impairment induced by obstructive jaundice. Methods Thirty-two male SD rats were randomly divided into 2 groups: SO group and BDL group. The rats in SO group received sham operation. Bile ducts of rats in BDL group were ligated. Pathology of kidneys was observed under the microscope. The levels of D-Bil, TBA, GOT, GPT, Cr and BUN in serum and β2-MG in urine were measured. The apoptotic rate of renal cells was calculated by flow cytometry and the forms of DNA fragmentation in renal cells were detected by agarose gel electrophoresis. The expression of inhibitory gene bcl-2 in the renal tissues was detected by immunohistochemistry. Results The color of urine in BDL group became dark yellow in day 2 after operation; The ears, tails and the muscle of abdominal wall and splanchnic organs, such as liver and kidney, also became yellow and swollen in day 7. The D-Bil, TBA, GOT, GPT, BUN of serum and β2 -MG of urine in BDL group were higher than those in SO group (P＜0.05, P＜0.01), and each value (except β2 -MG) in BDL group of 14 d was higher than that in BDL group of 7 d (P＜0.05, P＜0.01), respectively. The result of flow cytometry showed that the apoptotic rate of SO group and BDL (7 d and 14 d) group were (2.10±0.75)%， (18.17±0.86)% and (36.39±2.23)% respectively, there were significantly difference among them (P＜0.05). The expression rate of bcl-2 of renal cell in BDL group of 7 d was higher than that in BDL group of 14 d. Conclusion Obstructive jaundice could induce apoptosis of the renal cells, and activate the expression of bcl-2 of the renal tubular epithelial cells in feedback, which may regulate the process of apoptosis.
Peritoneal dialysis (PD) is widely used to treat acute kidney injury (AKI) in low-resource and higher income countries. This paper summarizes the key points and improvements of the 2020 International Society for Peritoneal Dialysis guidelines in five aspects of outcomes for AKI treatment, peritoneal access, dialysis solutions, prescription of dialysis with targets of solute clearance and complications, so as to provide references for AKI in clinical practice.