Clinical nephrology最新文献

{"title":"Prevalence and factors associated with renal insufficiency in patients with lung cancer: A cross-sectional study.","authors":"Guibao Ke, Yongzhang Huang, Ying Yu, Yonghua Peng, Zongshun Huang, Peilan Zhou, Ping Zhang, Xiaomin Yu, Qianglin Zeng, Xin Xu, Jie Xiao","doi":"10.5414/CN110961","DOIUrl":"10.5414/CN110961","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to determine the prevalence of renal insufficiency in patients with lung cancer and factors associated with its development.</p><p><strong>Materials and methods: </strong>All patients at the First Affiliated Hospital of Guangzhou Medical University from January 1 to December 31, 2016 who had lung cancer were included in this study. Baseline characteristics, including age, sex, clinical features, estimated glomerular filtration rate (eGFR), echocardiographic findings, electrocardiogram results, and biochemical indicators were collected retrospectively. eGFR was divided into three categories: ≥ 60, 45 - 59, and < 45 mL/min/1.73m². Renal insufficiency was defined as eGFR < 60 mL/min/1.73m². The prevalence of co-occurring lung cancer and renal insufficiency as well as factors associated with it were also studied.</p><p><strong>Results: </strong>A total of 140 patients with a lung cancer diagnosis confirmed by pathologic examination were included. The prevalence of eGFR ≥ 60, 45 - 59, and < 45 mL/min/1.73m² categories was 77.14%, 12.14%, and 10.71%, respectively. The lung cancer subtypes were adenocarcinoma (102 cases (72.86%)), squamous cell carcinoma (23 cases (16.43%)), and small cell carcinoma (15 cases (10.71%)). Logistic regression analysis showed that age (odds ratio (OR), 5.522; 95% CI, 2.712 - 11.243; p < 0.001), proteinuria (OR, 4.832; 95% CI, 1.518 - 15.383; p = 0.008), and thyroid-specific transcription factor-1 (TTF-1) positivity (OR, 5.730; 95% CI, 1.509 - 21.754; p = 0.010) were independently associated with eGFR category < 60 mL/min/1.73m². Age (OR, 2.372; 95% CI, 1.331 - 4.228; p = 0.003) and TTF-1 positivity (OR, 12.791; 95% CI, 3.394 - 49.575; p < 0.001) were independently associated with eGFR category 45 - 59 mL/min/1.73m2. Finally, age (OR, 4.083; 95% CI, 1.979 - 8.426; p < 0.001), low albumin (OR, 9.05; 95% CI, 1.335 - 61.349; p = 0.024), and hyperuricemia (OR, 4.974; 95% CI, 1.22 - 20.282; p = 0.025) were independently associated with eGFR category < 45 mL/min/1.73m².</p><p><strong>Conclusion: </strong>Renal function is an important parameter to monitor in patients undergoing lung cancer treatment. The patient's age and presence of proteinuria, low albumin, hyperuricemia, and TTF-1 positivity in lung cancer are all independently associated with renal insufficiency in these patients. To ensure safe recovery and discharge after lung cancer treatment, factors associated with renal insufficiency should be recognized during treatment. Large-scale multicenter trials are warranted for further validation of these findings.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"303-311"},"PeriodicalIF":1.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unraveling hypertension through mineralocorticoid receptor activation in Cushing's syndrome: A case report.","authors":"Holly Thomson, Sydney Westphal, Musab S Hommos","doi":"10.5414/CN111430","DOIUrl":"10.5414/CN111430","url":null,"abstract":"<p><strong>Background: </strong>Cushing's syndrome is a rare cause of secondary hypertension. There are several mechanisms reported as contributing factors for blood pressure elevation in hypercortisolism patients. This case highlights the central role of mineralocorticoid receptors' activation by the excess cortisol in the development of hypertension.</p><p><strong>Case presentation: </strong>A 45-year-old male presented with several months of cushingoid features and refractory hypertension on maximum doses of five antihypertensive drugs, not including a mineralocorticoid receptor blocker. Workup for other causes of secondary hypertension revealed sleep apnea but was otherwise negative. Further evaluation revealed a carcinoid lung tumor as the cause of Cushing's syndrome with its ectopic production of adrenocorticotropic hormone (ACTH). Prior to the resection of this tumor, the addition of eplerenone, a mineralocorticoid receptor blocker, resulted in significant improvement in blood pressure within 4 weeks, highlighting that cortisol activation of mineralocorticoid receptors is one of the main mechanisms of hypertension in this patient with hypercortisolism.</p><p><strong>Conclusion: </strong>In hypercortisolism patients, some excess cortisol escapes deactivation by the 11β-hydroxysteroid dehydrogenase 2 enzyme in the kidney and directly activates mineralocorticoid receptors. Recent literature suggests that specific patient populations have subtle elevations in cortisol levels, and cortisol's effect on end-organ damage follows a spectrum from high-normal cortisol to overt hypercortisolism. Other data suggest a decline in 11β-hydroxysteroid dehydrogenase 2 enzyme activity with age. Additional research is needed to further define the role of cortisol-mineralocorticoid receptor interaction in hypertension among patients without overt hypercortisolism but with high-normal cortisol or low 11β-hydroxysteroid dehydrogenase 2 enzymatic activity.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"349-353"},"PeriodicalIF":1.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting AKI in critical patients: An interpretable model based on albumin and fluid balance.","authors":"Yifan Xu, Zengyu Zhang, Bai Xu, Lan Sun, Lei Zhong, Yuqi Chen, Siyu Tang, Yan Qu, Shanen Jin, Xianghong Yang","doi":"10.5414/CN111510","DOIUrl":"10.5414/CN111510","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is a clinically complex syndrome with a high incidence and mortality rate in the intensive care unit (ICU). Early identification of high-risk patients and timely intervention are crucial.</p><p><strong>Objective: </strong>A local database was used to construct a model that predicts the incidence of AKI in ICU patients within 48 hours.</p><p><strong>Materials and methods: </strong>We conducted a study involving 9,628 critically ill patients at Zhejiang Provincial People's Hospital and divided the cohort into derivation and validation groups. We collected and analyzed demographic data, vital signs, laboratory tests, medications, clinical interventions, and other information for all patients, resulting in a total of 232 variables. Six different machine learning algorithms were employed to construct models, and the optimal model was selected and validated.</p><p><strong>Results: </strong>A total of 2,441 patients were included, of whom 1,138 (46.62%) met the AKI criteria. A model was derived that included 16 variables such as albumin transfusion, fluid balance, diastolic blood pressure (DBP), partial pressure of oxygen (PO₂), blood glucose (GLU), platelet (PLT), baseline serum creatinine (bSCr), serum sodium, age, epinephrine, proton pump inhibitor (PPI), intra-abdominal infection, anemia, diabetes, glycerin fructose, and nutritional pathway. The area under the receiver operating characteristic curve (AUC) was 0.822. Subgroup analysis revealed the impact of blood pressure fluctuations on AKI. Additionally, the study demonstrated a bidirectional effect of albumin and fluid balance on AKI.</p><p><strong>Conclusion: </strong>This model is highly accurate and may facilitate the early diagnosis of and interventions for AKI.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"333-348"},"PeriodicalIF":1.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metabolic testing in urinary diversion stone formers.","authors":"Arrsh Bajaj, Jane Li, Amy A Yau","doi":"10.5414/CN111532","DOIUrl":"10.5414/CN111532","url":null,"abstract":"","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"354-357"},"PeriodicalIF":1.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The nonlinear correlation between total bilirubin and lumbar spine bone mineral density in patients receiving maintenance hemodialysis.","authors":"Na Zhao, Song-Tao Yang, Xiao-Fang Shen, Yue-Fei Xiao","doi":"10.5414/CN111473","DOIUrl":"10.5414/CN111473","url":null,"abstract":"<p><strong>Background: </strong>Patients receiving maintenance hemodialysis (MHD) are at increased risk of osteoporosis. The effects of bilirubin on bone metabolism vary among different disease populations. However, the relationship between total bilirubin (TBIL) and bone metabolism in MHD has not been investigated yet.</p><p><strong>Materials and methods: </strong>This cross-sectional study included 122 MHD patients aged ≥ 18 years who underwent regular hemodialysis at the Blood Purification Center of Aerospace Central Hospital from April 2021 to April 2023. Blood sampling and bone mineral density (BMD) examinations were conducted. Multivariate linear regression, restricted cubic spline and subgroup analyses were performed to evaluate the association between TBIL and BMD.</p><p><strong>Results: </strong>TBIL (correlation coefficient: 1.7 (0.17, 3.25); p = 0.04) was independently associated with BMD in the multivariate linear regression analysis. The results showed that BMD was nonlinearly related to TBIL in MHD patients, exhibiting a J shaped curve (p = 0.035). When plasma TBIL level < 0.64 mg/dL, there is an average increase of 5.3 (95% CI: 2.0 - 8.7; p = 0.002) g/cm² in BMD for every 1-unit increase in plasma TBIL level. The association between TBIL and BMD was not significant when the plasma TBIL level was ≥ 0.64 mg/dL.</p><p><strong>Conclusion: </strong>The relationship between TBIL and BMD in MHD patients is J-shaped, with an inflection point of 0.64 mg/dL.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"318-325"},"PeriodicalIF":1.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The global NCD 6×6 approach: What it means for kidney health.","authors":"Manan Raina, Boris Bikbov, Valerie A Luyckx","doi":"10.5414/CN111642","DOIUrl":"https://doi.org/10.5414/CN111642","url":null,"abstract":"","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of renal function on serum pro-gastrin-releasing peptide expression and its clinical relevance.","authors":"Jie Liu, Tengda Xu, Songbai Lin","doi":"10.5414/CN111593","DOIUrl":"https://doi.org/10.5414/CN111593","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to evaluate the effect of renal function on serum pro-gastrin-releasing peptide (ProGRP) expression and to assess its clinical significance.</p><p><strong>Materials and methods: </strong>A total of 3,906 individuals who underwent physical examinations at Peking Union Medical College Hospital between May 2017 and May 2020 were enrolled in this study. Participants were categorized into four groups based on their creatinine clearance rate (Ccr): the Ccr1 group (34 cases, < 30 mL/min), the Ccr2 group (715 cases, 30 - 60 mL/min), the Ccr3 group (2,289 cases, 60 - 90 mL/min), and the Ccr4 group (868 cases, > 90 mL/min). Levels of blood urea nitrogen (BUN), serum creatinine (Scr), cystatin C (Cys-C), and ProGRP were measured and compared across the groups. Additionally, endogenous Ccr values were calculated for all participants.</p><p><strong>Results: </strong>Serum levels of BUN, Scr, Cys-C, and ProGRP, as well as Ccr values, exhibited significant differences among the groups (p < 0.05). A negative correlation was found between Ccr and serum ProGRP (p = 0.001).</p><p><strong>Conclusion: </strong>Higher serum ProGRP levels were associated with more severe renal dysfunction. These findings underscore the importance of considering renal function when interpreting serum ProGRP levels for clinical diagnosis and prognosis.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143955318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urinary thiosulfate level in pregnant women.","authors":"Shuo-Chieh Wu, Eileen Brandes, Elizabeth Johnson, Stephen A Harrington, Lee Yang, John Asplin, Vernon M Pais","doi":"10.5414/CN111592","DOIUrl":"https://doi.org/10.5414/CN111592","url":null,"abstract":"<p><strong>Introduction: </strong>Renal colic is the most common cause of non-obstetric hospitalization in pregnant patients. Prior study has established increased excretion of inhibitors of calcium salt crystallization in pregnancy. This phenomenon is thought to be a physiological protective mechanism against urolithiasis promoters. Thiosulfate is a compound reported to have a protective effect against calcium stone formation and urinary excretion of thiosulfate and has been reported to increase during pregnancy. Our study measured urinary thiosulfate on a controlled diet during the third trimester and the post-partum period and sought to assess whether thiosulfate serves as a viable lithogenic protective agent.</p><p><strong>Materials and methods: </strong>We recruited a cohort of pregnant patients and obtained 24-hour urine collections on a standardized diet in the third trimester and again 6 weeks post-partum.</p><p><strong>Results: </strong>A total of 14 pregnant women submitted urine samples for the analysis of urinary thiosulfate in the third trimester. 24-hour urine samples were collected during the third trimester, post-partum, and post-lactation stages. A total of 4 patients had new stone formation during pregnancy. There was no statistical difference (p = 0.62) of urinary thiosulfate across the third trimester (12.1 µmol/day, interquartile range (IQR) 9.1 - 19.7), post-partum (11.1 µmol/day, IQR 8.8 - 17.4), and post-lactation (16.1 µmol/day, IQR 8.2 - 25.2) stage. Stratified analysis showed no statistically significant difference in thiosulfate level between stone formers vs. non-stone formers.</p><p><strong>Conclusion: </strong>Endogenous urinary thiosulfate does not change significantly from the third trimester of pregnancy to post-partum in our cohort of patients on a standardized diet. Our observation does not support urinary thiosulfate as a lithogenic protective factor augmented during pregnancy.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relationship between sclerostin and atherosclerosis and arterial stiffness in kidney transplant recipients.","authors":"Musa Ilker Durak, Melahat Coban, Beyza Algul Durak, Mine Sebnem Karakan","doi":"10.5414/CN111726","DOIUrl":"https://doi.org/10.5414/CN111726","url":null,"abstract":"<p><strong>Aim: </strong>Sclerostin, the protein product of the SOST gene, is a soluble antagonist of the canonical wingless-related integration site (Wnt)-β-catenin pathway. The aim of the study is the relationship between sclerostin and atherosclerosis and arterial stiffness.</p><p><strong>Materials and methods: </strong>110 kidney transplant recipients (KTRs) were included in the study. Patients were compared with a control group of 76 healthy individuals matched for age and gender. Renal functions were determined by estimated glomerular filtration rate (eGFR). Atherosclerosis determined by carotid artery intima-media thickness (CAT) and arterial stiffness (AS) determined by brachial-ankle pulse wave velocity (bPWV). Sclerostin levels were determined by an enzyme-related immunosorbent kit. Log₁₀ levels were used due to the dispersed distribution of variables.</p><p><strong>Results: </strong>CAT, bPWV, and log₁₀ sclerostin were significantly higher and eGFR was significantly lower in patients compared to healthy individuals. In the multivariate analysis, as the CAT value of the patients increased, the probability of having a log₁₀ sclerostin value of 3.8 and above decreased. As the bPWV value of the patients increased, the probability of having a log₁₀ sclerostin value of 3.8 and above decreased.</p><p><strong>Conclusion: </strong>Increased atherosclerosis, AS development, and increased serum sclerostin levels were detected in KTRs compared to healthy individuals. A significant inverse relationship was found between sclerostin and atherosclerosis and AS. Sclerostin produced in bone and vascular tissue may prevent the development of atherosclerosis and AS.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143955333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal tissue PLA2R and circulating anti-PLA2R detection in a Brazilian cohort: Precise immunostaining analysis in membranous nephropathy.","authors":"Giovana Mariani, Luís G R Fernandes, Leandro L L Freitas, Maria Almerinda V F Ribeiro Alves, Ricardo L Zollner","doi":"10.5414/CN111579","DOIUrl":"https://doi.org/10.5414/CN111579","url":null,"abstract":"","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}