The kidney plays a crucial role in glucose homeostasis by regulating glucose transport. We aimed ... more The kidney plays a crucial role in glucose homeostasis by regulating glucose transport. We aimed to investigate the impact of alterations in glucose transport on glucose metabolism during ageing. Adult male Sprague Dawley rats were divided into five groups: 3-month, 6-month, and 12-month control groups, and 6- and 12-month groups receiving the hydrogen sulfide donor molecule GYY4137. The study found that, as age increased, daily urinary uric acid and protein levels increased in the 12-month group. Blood sugar level and HOMA-IR index increased in the 12-month group, and were partially improved by GYY4137. The kidney tissue showed mild glomerulosclerosis in the 12-month group, which was diminished by GYY4137. Gene expression analysis showed decreased sirtuin and increased p21 expression in the aging groups. Increased SGLT1 and SGLT2 expression was observed in the 12-month group, which was reversed by GYY4137. Both GLUT1 and GLUT2 expression was increased in the 6- and 12-month groups,...
Background: Nowadays, peritoneal dialysis has become a popular renal replacement therapy for urem... more Background: Nowadays, peritoneal dialysis has become a popular renal replacement therapy for uremic patients. A home visit program was designed to assess its value and significance in peritoneal dialysis patient care. Method: From January to April in 1999, 19 uremic patients on peritoneal dialysis received a visit by a professional staff member. The whole visit program included advanced communications on clinical problems, evaluation of technique for peritoneal dialysis, patient participation in dialysis therapy, home environment and drug compliance. A total of 18 items of four major categories were evaluated and assessed by scoring. The association between peritoneal dialysis-related infection and results of home visit was analyzed. Result: The total home visit score was related to peritoneal dialysis duration (p=0.028). Their participation was significantly associated with dialysis exchange technique (p=0.001). Patients who experienced catheter-related infection have poorer home environment (p=0.031). The age, gender, education level did not affect any infection rate. Conclusion: Home visit program offers additional information on our care of peritoneal dialysis patients. For those patients with infection complication, home visit is of help to find out factors contributing to their infection.
Encapsulating peritoneal sclerosis (EPS) is a rare and serious complication in patients undergoin... more Encapsulating peritoneal sclerosis (EPS) is a rare and serious complication in patients undergoing peritoneal dialysis (PD). The incidence of EPS increases with duration of PD. The rate of EPS-associated mortality rate is usually high. We encountered a 51-year-old uremic female patient who received PD therapy initially but was shifted to hemodialysis 9 years later due to dialysis inadequacy and ultrafiltration failure. There were three episodes of PD-related peritonitis during her PD therapy. EPS was diagnosed according to image and operation findings during a peritonitis episode. Enterolysis was performed and short-term steroid therapy was also administered. However, she experienced another episode of rapid progressive abdominal pain with compromised hemodynamic status. Abdominal computed tomography demonstrated perforation of small bowel with pneumoperitoneum. Despite emergency laparotomy and antibacterial therapy, the patient died 2 days later. We conclude that EPS can still progress in uremic patients despite suspension of PD. Our patients died of small bowel perforation with overwhelming sepsis.
Thromboembolism is a well-recognized complication in patients with nephrotic syndrome owing to th... more Thromboembolism is a well-recognized complication in patients with nephrotic syndrome owing to their hypercoagulable status. Usually, the venous system is affected, whereas the very rare occurrence of arterial thrombosis is mainly restricted to pediatric patients. This complication often results in high rates of mortality and limb loss. We report the case of an adult female patient with histologically diagnosed minimal change disease and nephrotic syndrome associated with malignant thymoma, who eventually developed concurrent bilateral kidney and lower limb thrombosis. Conservative systemic anticoagulation was administered and she recovered ample kidney function. In addition, although she underwent an emergent thrombectomy of the left popliteal artery, an amputation was necessary. To the best of our knowledge, this is the first reported arterial thrombosis case involving bilateral kidney and lower limb simultaneously in nephrotic patients. Our experience indicates that arterial thrombosis is a serious complication in nephrotic patients, and early detection and aggressive management are crucial in these patients to improve their outcome.
Resveratrol, a phytochemical, has shown antioxidant properties and potential benefits in hyperten... more Resveratrol, a phytochemical, has shown antioxidant properties and potential benefits in hypertension. Asymmetric dimethylarginine (ADMA)-related nitric oxide (NO) deficiency and gut microbiota-derived metabolite trimethylamine-N-oxide (TMAO) have been linked to hypertension. We aimed to test whether maternal resveratrol therapy would protect adult offspring against hypertension programmed by prenatal exposure to ADMA and TMAO. Pregnant Sprague-Dawley rats received ADMA 10 mg/kg/day (A), TMAO 0.65 mg/hr (T), ADMA+TMAO (AT), or vesicle (CV). One group of ADMA+TMAO-exposed rats received 50 mg/L of resveratrol in drinking water during pregnancy and lactation periods (ATR). Male offspring (n=8/group) were assigned to five groups: CV, A, T, AT, and ATR. Rats were killed at 12 weeks of age. ADMA exposure caused the elevation of blood pressure in 12-week-old male offspring, which was exacerbated by TMAO exposure. Treatment with resveratrol rescued hypertension programmed by combined ADMA and TMAO exposure. This was accompanied by alterations in the compositions of gut microbiota and increased fecal butyrate levels. Both the abundance of the butyrate-producing genera Lachnospiraceae and Ruminococcaceae were augmented by resveratrol. Meanwhile, resveratrol therapy significantly increased the abundance of the Cyanobiaceae and Erysipelotrichaceae families. Moreover, the protective effects of resveratrol were related to the mediation of the renin-angiotensin system (RAS). Our data provide new insights into the protective mechanisms of resveratrol against hypertension programmed by ADMA and TMAO, including regulation of gut microbiota and their metabolites, the RAS, and NO pathway. Resveratrol might be a potential reprogramming strategy to protect against the hypertension of developmental origins.
Nitric oxide (NO) deficiency induced by the NO synthase (NOS) inhibitor N G-nitro-L-arginine-meth... more Nitric oxide (NO) deficiency induced by the NO synthase (NOS) inhibitor N G-nitro-L-arginine-methyl ester (L-NAME) resulted in hypertension. L-citrulline (CIT) can be converted to L-arginine to generate NO. We examined whether maternal CIT supplementation can prevent L-NAME-induced programmed hypertension. Pregnant Sprague-Dawley rats were assigned to four groups: control, L-NAME, control + citrulline (CIT), and L-NAME + citrulline (L-NAME+CIT). Pregnant rats received L-NAME administration at 60 mg/kg/day subcutaneously during pregnancy alone or with additional 0.25% L-citrulline solution in drinking water during the whole period of pregnancy and lactation. Male offspring were sacrificed at 12 wk of age. L-NAME exposure during pregnancy induces hypertension in the 12-wk-old offspring. Maternal CIT therapy prevented L-NAMEinduced programmed hypertension, which was associated with a decreased asymmetric dimethylarginine (ADMA) concentration and an increased L-arginine-to-ADMA ratio in the kidney, increased urinary cGMP levels, and decreased renal protein levels of type 3 sodium hydrogen exchanger (NHE3). Together, our data suggest that the beneficial effects of CIT supplementation are attributed to its ability to increase NO level in the kidney and inhibition of NHE3 expression. Our results suggest that supplementing CIT in pregnant women with NO deficiency can improve fetal development and prevent programmed hypertension.
BACKGROUND: Gram-negative peritonitis in peritoneal dialysis (PD) patients is more severe and fre... more BACKGROUND: Gram-negative peritonitis in peritoneal dialysis (PD) patients is more severe and frequently associated with higher rate of catheter loss than gram-positive infection. The aims of our study were to investigate factors relevant to the catheter removal after first time gram-negative peritonitis. METHODS: Patients with first PD-related gram-negative peritonitis were included in this retrospective study. Patients were divided into catheter removed group and catheter preserved group. RESULTS: One hundred and forty-two patients were enrolled in the study. The leading causative organisms of the first episode of gram-negative peritonitis were Escherichia coli (38%). Compared to catheter preserved group (n = 107), catheter removal group (n = 35) had significantly longer time from PD initiation to the first gram-negative peritonitis episode (5.2 ± 3.8 years vs. 3.0 ± 2.4 years, P ＜ 0.001), polymicrobial peritonitis (25.7% vs. 11.2%, P = 0.036) and higher proportion of empiric antibiotic resistance (37.1% vs. 17.8%, P = 0.017). Multivariate analysis revealed longer duration of PD was an independent risk factor for PD catheter removal and appropriate empiric antibiotic treatment was associated with a 77% lower risk for catheter loss. CONCLUSION: About one-quarter of patients required catheter removal as the event outcome during the peritonitis. Duration of PD therapy and resistance of initial empiric antibiotic are the predictors associated with PD catheter loss.
Thrombosis in both the arterial and the venous circulations is a relatively frequent and serious ... more Thrombosis in both the arterial and the venous circulations is a relatively frequent and serious complication of nephrotic syndrome. Only 5 cases of portal vein thrombosis (PVT) have been reported as a complication of nephrotic syndrome. We report a 26-year-old man with histologically diagnosed minimal change disease, who developed acute thrombosis of the portal and superior mesenteric vein with presentation of abdominal pain and general edema. The patient was initially treated with anticoagulant therapy. However, the medical therapy was interrupted because of gastrointestinal bleeding and was resumed a few days later. Surgical intervention was suggested but not performed until the critical period. Thrombectomy was not allowed because of poor general condition. The patient eventually died of perforation and necrosis of the small intestine and severe sepsis. In this report, a case experience is presented and we reviewed all the patients reported in the literature with regard to their clinical features, treatment modality and final outcome.
We report a sixty-three years old woman with diabetes mellitus, end stage renal disease, and main... more We report a sixty-three years old woman with diabetes mellitus, end stage renal disease, and maintenance peritoneal dialysis (PD) who under went right radical nephrectomy for transitional cell carcinoma. Post-operative course was complicated by surgical wound infection and was successfully treated with antibiotic therapy. Postoperatively, patient was switched to hemodialysis (HD) for a short period of time. Then, PD was resumed as previous prescription after 17 days. However, over the next two months, patient developed clinical ultrafiltration failure manifested as increasing abdominal fullness and gradual weight gain of 10 kilograms. Abdominal CT revealed fluid infiltration within the subcutaneous tissue and muscle layers of the abdominal wall. She was again switched to HD and this treatment achieved adequate ultrafiltration with restoration of her prior dry weight 3 weeks later. Daily ultrafiltration remained adequate thereafter. Patient's dialysatel peritoneal creatinine ration and dialysis clearance after resolution of ultrafiltration failure was not affected compared with the values before nephrectomy. In this report, we will discuss the causes and management for ultrafiltration failure in PD patients, and the duration to hold PD after nephrectomy. In patients with perioperative complications, such as wound infection in our case, it may be necessary to hold PD longer so that the peritoneum has enough time to recover adequate ultrafiltration function.
Journal of the Renin-Angiotensin-Aldosterone System, Dec 7, 2012
Introduction: The combination therapy of aliskiren and renin-angiotensin-aldosterone system (RAAS... more Introduction: The combination therapy of aliskiren and renin-angiotensin-aldosterone system (RAAS) blocker in chronic kidney disease (CKD) is controversial. Whether such dual blockade can effectively apply to patients with CKD irrespective of stage and amount of proteinuria remains uncertain. Methods: We added aliskiren at a dosage of 150 mg/day for six months in 103 Chinese CKD patients who had been treated with angiotensin converting enzyme inhibitors (ACEis) or angiotensin receptor blockers (ARBs) and still had significant proteinuria or uncontrolled hypertension. Blood pressure, serum creatinine, estimated glomerular filtration rate (eGFR), potassium, and spot urine protein-to-creatinine ratio (UPCR) were measured at three and six months after aliskiren add-on therapy and compared with baseline. Results: The combination of aliskiren and ACEi or ARB significantly reduced UPCR by 23% (p=0.001) and mean arterial pressure by 7.9 ± 13.8 mmHg (p<0.001) at six months. Twenty-five percent of subjects had a greater than 50% reduction in UPCR. No significant changes in eGFR and serum potassium level were noted at six months. Conclusions: Adding aliskiren on ACEi or ARB in CKD patients, both in diabetes and non-diabetes, has a favorable effect on reducing residual proteinuria and inadequately controlled blood pressure.
International Journal of Environmental Research and Public Health, 2021
Low-level cadmium exposure has adverse effects on chronic kidney disease (CKD); however, the risk... more Low-level cadmium exposure has adverse effects on chronic kidney disease (CKD); however, the risk factors for elevated blood cadmium levels (BCLs) have not been studied in CKD. We conducted a cross-sectional investigation in 200 CKD patients and stratified them by the tertiles of BCL to compare their demographic, environmental, and biochemical data. The factors associated with BCL were identified, and their effects were examined in subgroups. In the analyses, female sex, smoking, and CKD stage 5D were associated with high BCL, and statin was inversely correlated with BCL (odds ratio [95% confidence interval, CI], 6.858 [2.381–19.746], p < 0.001, 11.719 [2.843–48.296], p = 0.001, 30.333 [2.252–408.520], p = 0.010, and 0.326 [0.122–0.873], p = 0.026; deviations of BCL [nmol/L, 95% CI], 2.66 [1.33–4.00], p < 0.001, 3.68 [1.81–5.56], p < 0.001, 3.38 [0.95–5.82], p = 0.007, and −2.07 [−3.35–−0.78], p = 0.002). These factors were also independently correlated with BCL in subgroup...
Resveratrol, a phytochemical, has shown antioxidant properties and potential benefits in hyperten... more Resveratrol, a phytochemical, has shown antioxidant properties and potential benefits in hypertension. Asymmetric dimethylarginine (ADMA)-related nitric oxide (NO) deficiency and gut microbiota-derived metabolite trimethylamine-N-oxide (TMAO) have been linked to hypertension. We aimed to test whether maternal resveratrol therapy would protect adult offspring against hypertension programmed by prenatal exposure to ADMA and TMAO. Pregnant Sprague-Dawley rats received ADMA 10 mg/kg/day (A), TMAO 0.65 mg/hr (T), ADMA+TMAO (AT), or vesicle (CV). One group of ADMA+TMAO-exposed rats received 50 mg/L of resveratrol in drinking water during pregnancy and lactation periods (ATR). Male offspring (n=8/group) were assigned to five groups: CV, A, T, AT, and ATR. Rats were killed at 12 weeks of age. ADMA exposure caused the elevation of blood pressure in 12-week-old male offspring, which was exacerbated by TMAO exposure. Treatment with resveratrol rescued hypertension programmed by combined ADMA and TMAO exposure. This was accompanied by alterations in the compositions of gut microbiota and increased fecal butyrate levels. Both the abundance of the butyrate-producing genera Lachnospiraceae and Ruminococcaceae were augmented by resveratrol. Meanwhile, resveratrol therapy significantly increased the abundance of the Cyanobiaceae and Erysipelotrichaceae families. Moreover, the protective effects of resveratrol were related to the mediation of the renin-angiotensin system (RAS). Our data provide new insights into the protective mechanisms of resveratrol against hypertension programmed by ADMA and TMAO, including regulation of gut microbiota and their metabolites, the RAS, and NO pathway. Resveratrol might be a potential reprogramming strategy to protect against the hypertension of developmental origins.
Background: Gout is a disorder of purine metabolism or renal excretion of uric acid, and frequent... more Background: Gout is a disorder of purine metabolism or renal excretion of uric acid, and frequently involves the kidney. Sonographic abnormalities are specific findings suggestive of renal tissue damage. We aimed to investigate clinical manifestations of gouty nephropathy, evaluate renal function and find out factors contributing to renal failure. Methods: We retrospectively enrolled 151 gouty patients with sonographic evidence of gouts nephropathy between May 1998 and October 2005. Demographic data, kidney size by sonography, biochemical data including blood urea nitrogen and creatinine, urinalysis report, and comorbidities of each patient were collected. Results: Among the 151 gouty nephropathy patients enrolled. 87.4% (N=132) were men. About 56% of the patients had hematuria and 30% had proteinuria. We found that 81.4% of the patients had marked renal function impairment (chronic kidney disease, CKD, Stages 3-5). Normal kidney size was observed in 77.5% of the subjects, among whi...
Background: Nowadays, peritoneal dialysis has become a popular renal replacement therapy for urem... more Background: Nowadays, peritoneal dialysis has become a popular renal replacement therapy for uremic patients. A home visit program was designed to assess its value and significance in peritoneal dialysis patient care. Method: From January to April in 1999, 19 uremic patients on peritoneal dialysis received a visit by a professional staff member. The whole visit program included advanced communications on clinical problems, evaluation of technique for peritoneal dialysis, patient participation in dialysis therapy, home environment and drug compliance. A total of 18 items of four major categories were evaluated and assessed by scoring. The association between peritoneal dialysis-related infection and results of home visit was analyzed. Result: The total home visit score was related to peritoneal dialysis duration (p=0.028). Their participation was significantly associated with dialysis exchange technique (p=0.001). Patients who experienced catheter-related infection have poorer home environment (p=0.031). The age, gender, education level did not affect any infection rate. Conclusion: Home visit program offers additional information on our care of peritoneal dialysis patients. For those patients with infection complication, home visit is of help to find out factors contributing to their infection.
Thromboembolism is a well-recognized complication in patients with nephrotic syndrome owing to th... more Thromboembolism is a well-recognized complication in patients with nephrotic syndrome owing to their hypercoagulable status. Usually, the venous system is affected, whereas the very rare occurrence of arterial thrombosis is mainly restricted to pediatric patients. This complication often results in high rates of mortality and limb loss. We report the case of an adult female patient with histologically diagnosed minimal change disease and nephrotic syndrome associated with malignant thymoma, who eventually developed concurrent bilateral kidney and lower limb thrombosis. Conservative systemic anticoagulation was administered and she recovered ample kidney function. In addition, although she underwent an emergent thrombectomy of the left popliteal artery, an amputation was necessary. To the best of our knowledge, this is the first reported arterial thrombosis case involving bilateral kidney and lower limb simultaneously in nephrotic patients. Our experience indicates that arterial thro...
The kidney plays a crucial role in glucose homeostasis by regulating glucose transport. We aimed ... more The kidney plays a crucial role in glucose homeostasis by regulating glucose transport. We aimed to investigate the impact of alterations in glucose transport on glucose metabolism during ageing. Adult male Sprague Dawley rats were divided into five groups: 3-month, 6-month, and 12-month control groups, and 6- and 12-month groups receiving the hydrogen sulfide donor molecule GYY4137. The study found that, as age increased, daily urinary uric acid and protein levels increased in the 12-month group. Blood sugar level and HOMA-IR index increased in the 12-month group, and were partially improved by GYY4137. The kidney tissue showed mild glomerulosclerosis in the 12-month group, which was diminished by GYY4137. Gene expression analysis showed decreased sirtuin and increased p21 expression in the aging groups. Increased SGLT1 and SGLT2 expression was observed in the 12-month group, which was reversed by GYY4137. Both GLUT1 and GLUT2 expression was increased in the 6- and 12-month groups,...
Background: Nowadays, peritoneal dialysis has become a popular renal replacement therapy for urem... more Background: Nowadays, peritoneal dialysis has become a popular renal replacement therapy for uremic patients. A home visit program was designed to assess its value and significance in peritoneal dialysis patient care. Method: From January to April in 1999, 19 uremic patients on peritoneal dialysis received a visit by a professional staff member. The whole visit program included advanced communications on clinical problems, evaluation of technique for peritoneal dialysis, patient participation in dialysis therapy, home environment and drug compliance. A total of 18 items of four major categories were evaluated and assessed by scoring. The association between peritoneal dialysis-related infection and results of home visit was analyzed. Result: The total home visit score was related to peritoneal dialysis duration (p=0.028). Their participation was significantly associated with dialysis exchange technique (p=0.001). Patients who experienced catheter-related infection have poorer home environment (p=0.031). The age, gender, education level did not affect any infection rate. Conclusion: Home visit program offers additional information on our care of peritoneal dialysis patients. For those patients with infection complication, home visit is of help to find out factors contributing to their infection.
Encapsulating peritoneal sclerosis (EPS) is a rare and serious complication in patients undergoin... more Encapsulating peritoneal sclerosis (EPS) is a rare and serious complication in patients undergoing peritoneal dialysis (PD). The incidence of EPS increases with duration of PD. The rate of EPS-associated mortality rate is usually high. We encountered a 51-year-old uremic female patient who received PD therapy initially but was shifted to hemodialysis 9 years later due to dialysis inadequacy and ultrafiltration failure. There were three episodes of PD-related peritonitis during her PD therapy. EPS was diagnosed according to image and operation findings during a peritonitis episode. Enterolysis was performed and short-term steroid therapy was also administered. However, she experienced another episode of rapid progressive abdominal pain with compromised hemodynamic status. Abdominal computed tomography demonstrated perforation of small bowel with pneumoperitoneum. Despite emergency laparotomy and antibacterial therapy, the patient died 2 days later. We conclude that EPS can still progress in uremic patients despite suspension of PD. Our patients died of small bowel perforation with overwhelming sepsis.
Thromboembolism is a well-recognized complication in patients with nephrotic syndrome owing to th... more Thromboembolism is a well-recognized complication in patients with nephrotic syndrome owing to their hypercoagulable status. Usually, the venous system is affected, whereas the very rare occurrence of arterial thrombosis is mainly restricted to pediatric patients. This complication often results in high rates of mortality and limb loss. We report the case of an adult female patient with histologically diagnosed minimal change disease and nephrotic syndrome associated with malignant thymoma, who eventually developed concurrent bilateral kidney and lower limb thrombosis. Conservative systemic anticoagulation was administered and she recovered ample kidney function. In addition, although she underwent an emergent thrombectomy of the left popliteal artery, an amputation was necessary. To the best of our knowledge, this is the first reported arterial thrombosis case involving bilateral kidney and lower limb simultaneously in nephrotic patients. Our experience indicates that arterial thrombosis is a serious complication in nephrotic patients, and early detection and aggressive management are crucial in these patients to improve their outcome.
Resveratrol, a phytochemical, has shown antioxidant properties and potential benefits in hyperten... more Resveratrol, a phytochemical, has shown antioxidant properties and potential benefits in hypertension. Asymmetric dimethylarginine (ADMA)-related nitric oxide (NO) deficiency and gut microbiota-derived metabolite trimethylamine-N-oxide (TMAO) have been linked to hypertension. We aimed to test whether maternal resveratrol therapy would protect adult offspring against hypertension programmed by prenatal exposure to ADMA and TMAO. Pregnant Sprague-Dawley rats received ADMA 10 mg/kg/day (A), TMAO 0.65 mg/hr (T), ADMA+TMAO (AT), or vesicle (CV). One group of ADMA+TMAO-exposed rats received 50 mg/L of resveratrol in drinking water during pregnancy and lactation periods (ATR). Male offspring (n=8/group) were assigned to five groups: CV, A, T, AT, and ATR. Rats were killed at 12 weeks of age. ADMA exposure caused the elevation of blood pressure in 12-week-old male offspring, which was exacerbated by TMAO exposure. Treatment with resveratrol rescued hypertension programmed by combined ADMA and TMAO exposure. This was accompanied by alterations in the compositions of gut microbiota and increased fecal butyrate levels. Both the abundance of the butyrate-producing genera Lachnospiraceae and Ruminococcaceae were augmented by resveratrol. Meanwhile, resveratrol therapy significantly increased the abundance of the Cyanobiaceae and Erysipelotrichaceae families. Moreover, the protective effects of resveratrol were related to the mediation of the renin-angiotensin system (RAS). Our data provide new insights into the protective mechanisms of resveratrol against hypertension programmed by ADMA and TMAO, including regulation of gut microbiota and their metabolites, the RAS, and NO pathway. Resveratrol might be a potential reprogramming strategy to protect against the hypertension of developmental origins.
Nitric oxide (NO) deficiency induced by the NO synthase (NOS) inhibitor N G-nitro-L-arginine-meth... more Nitric oxide (NO) deficiency induced by the NO synthase (NOS) inhibitor N G-nitro-L-arginine-methyl ester (L-NAME) resulted in hypertension. L-citrulline (CIT) can be converted to L-arginine to generate NO. We examined whether maternal CIT supplementation can prevent L-NAME-induced programmed hypertension. Pregnant Sprague-Dawley rats were assigned to four groups: control, L-NAME, control + citrulline (CIT), and L-NAME + citrulline (L-NAME+CIT). Pregnant rats received L-NAME administration at 60 mg/kg/day subcutaneously during pregnancy alone or with additional 0.25% L-citrulline solution in drinking water during the whole period of pregnancy and lactation. Male offspring were sacrificed at 12 wk of age. L-NAME exposure during pregnancy induces hypertension in the 12-wk-old offspring. Maternal CIT therapy prevented L-NAMEinduced programmed hypertension, which was associated with a decreased asymmetric dimethylarginine (ADMA) concentration and an increased L-arginine-to-ADMA ratio in the kidney, increased urinary cGMP levels, and decreased renal protein levels of type 3 sodium hydrogen exchanger (NHE3). Together, our data suggest that the beneficial effects of CIT supplementation are attributed to its ability to increase NO level in the kidney and inhibition of NHE3 expression. Our results suggest that supplementing CIT in pregnant women with NO deficiency can improve fetal development and prevent programmed hypertension.
BACKGROUND: Gram-negative peritonitis in peritoneal dialysis (PD) patients is more severe and fre... more BACKGROUND: Gram-negative peritonitis in peritoneal dialysis (PD) patients is more severe and frequently associated with higher rate of catheter loss than gram-positive infection. The aims of our study were to investigate factors relevant to the catheter removal after first time gram-negative peritonitis. METHODS: Patients with first PD-related gram-negative peritonitis were included in this retrospective study. Patients were divided into catheter removed group and catheter preserved group. RESULTS: One hundred and forty-two patients were enrolled in the study. The leading causative organisms of the first episode of gram-negative peritonitis were Escherichia coli (38%). Compared to catheter preserved group (n = 107), catheter removal group (n = 35) had significantly longer time from PD initiation to the first gram-negative peritonitis episode (5.2 ± 3.8 years vs. 3.0 ± 2.4 years, P ＜ 0.001), polymicrobial peritonitis (25.7% vs. 11.2%, P = 0.036) and higher proportion of empiric antibiotic resistance (37.1% vs. 17.8%, P = 0.017). Multivariate analysis revealed longer duration of PD was an independent risk factor for PD catheter removal and appropriate empiric antibiotic treatment was associated with a 77% lower risk for catheter loss. CONCLUSION: About one-quarter of patients required catheter removal as the event outcome during the peritonitis. Duration of PD therapy and resistance of initial empiric antibiotic are the predictors associated with PD catheter loss.
Thrombosis in both the arterial and the venous circulations is a relatively frequent and serious ... more Thrombosis in both the arterial and the venous circulations is a relatively frequent and serious complication of nephrotic syndrome. Only 5 cases of portal vein thrombosis (PVT) have been reported as a complication of nephrotic syndrome. We report a 26-year-old man with histologically diagnosed minimal change disease, who developed acute thrombosis of the portal and superior mesenteric vein with presentation of abdominal pain and general edema. The patient was initially treated with anticoagulant therapy. However, the medical therapy was interrupted because of gastrointestinal bleeding and was resumed a few days later. Surgical intervention was suggested but not performed until the critical period. Thrombectomy was not allowed because of poor general condition. The patient eventually died of perforation and necrosis of the small intestine and severe sepsis. In this report, a case experience is presented and we reviewed all the patients reported in the literature with regard to their clinical features, treatment modality and final outcome.
We report a sixty-three years old woman with diabetes mellitus, end stage renal disease, and main... more We report a sixty-three years old woman with diabetes mellitus, end stage renal disease, and maintenance peritoneal dialysis (PD) who under went right radical nephrectomy for transitional cell carcinoma. Post-operative course was complicated by surgical wound infection and was successfully treated with antibiotic therapy. Postoperatively, patient was switched to hemodialysis (HD) for a short period of time. Then, PD was resumed as previous prescription after 17 days. However, over the next two months, patient developed clinical ultrafiltration failure manifested as increasing abdominal fullness and gradual weight gain of 10 kilograms. Abdominal CT revealed fluid infiltration within the subcutaneous tissue and muscle layers of the abdominal wall. She was again switched to HD and this treatment achieved adequate ultrafiltration with restoration of her prior dry weight 3 weeks later. Daily ultrafiltration remained adequate thereafter. Patient's dialysatel peritoneal creatinine ration and dialysis clearance after resolution of ultrafiltration failure was not affected compared with the values before nephrectomy. In this report, we will discuss the causes and management for ultrafiltration failure in PD patients, and the duration to hold PD after nephrectomy. In patients with perioperative complications, such as wound infection in our case, it may be necessary to hold PD longer so that the peritoneum has enough time to recover adequate ultrafiltration function.
Journal of the Renin-Angiotensin-Aldosterone System, Dec 7, 2012
Introduction: The combination therapy of aliskiren and renin-angiotensin-aldosterone system (RAAS... more Introduction: The combination therapy of aliskiren and renin-angiotensin-aldosterone system (RAAS) blocker in chronic kidney disease (CKD) is controversial. Whether such dual blockade can effectively apply to patients with CKD irrespective of stage and amount of proteinuria remains uncertain. Methods: We added aliskiren at a dosage of 150 mg/day for six months in 103 Chinese CKD patients who had been treated with angiotensin converting enzyme inhibitors (ACEis) or angiotensin receptor blockers (ARBs) and still had significant proteinuria or uncontrolled hypertension. Blood pressure, serum creatinine, estimated glomerular filtration rate (eGFR), potassium, and spot urine protein-to-creatinine ratio (UPCR) were measured at three and six months after aliskiren add-on therapy and compared with baseline. Results: The combination of aliskiren and ACEi or ARB significantly reduced UPCR by 23% (p=0.001) and mean arterial pressure by 7.9 ± 13.8 mmHg (p<0.001) at six months. Twenty-five percent of subjects had a greater than 50% reduction in UPCR. No significant changes in eGFR and serum potassium level were noted at six months. Conclusions: Adding aliskiren on ACEi or ARB in CKD patients, both in diabetes and non-diabetes, has a favorable effect on reducing residual proteinuria and inadequately controlled blood pressure.
International Journal of Environmental Research and Public Health, 2021
Low-level cadmium exposure has adverse effects on chronic kidney disease (CKD); however, the risk... more Low-level cadmium exposure has adverse effects on chronic kidney disease (CKD); however, the risk factors for elevated blood cadmium levels (BCLs) have not been studied in CKD. We conducted a cross-sectional investigation in 200 CKD patients and stratified them by the tertiles of BCL to compare their demographic, environmental, and biochemical data. The factors associated with BCL were identified, and their effects were examined in subgroups. In the analyses, female sex, smoking, and CKD stage 5D were associated with high BCL, and statin was inversely correlated with BCL (odds ratio [95% confidence interval, CI], 6.858 [2.381–19.746], p < 0.001, 11.719 [2.843–48.296], p = 0.001, 30.333 [2.252–408.520], p = 0.010, and 0.326 [0.122–0.873], p = 0.026; deviations of BCL [nmol/L, 95% CI], 2.66 [1.33–4.00], p < 0.001, 3.68 [1.81–5.56], p < 0.001, 3.38 [0.95–5.82], p = 0.007, and −2.07 [−3.35–−0.78], p = 0.002). These factors were also independently correlated with BCL in subgroup...
Resveratrol, a phytochemical, has shown antioxidant properties and potential benefits in hyperten... more Resveratrol, a phytochemical, has shown antioxidant properties and potential benefits in hypertension. Asymmetric dimethylarginine (ADMA)-related nitric oxide (NO) deficiency and gut microbiota-derived metabolite trimethylamine-N-oxide (TMAO) have been linked to hypertension. We aimed to test whether maternal resveratrol therapy would protect adult offspring against hypertension programmed by prenatal exposure to ADMA and TMAO. Pregnant Sprague-Dawley rats received ADMA 10 mg/kg/day (A), TMAO 0.65 mg/hr (T), ADMA+TMAO (AT), or vesicle (CV). One group of ADMA+TMAO-exposed rats received 50 mg/L of resveratrol in drinking water during pregnancy and lactation periods (ATR). Male offspring (n=8/group) were assigned to five groups: CV, A, T, AT, and ATR. Rats were killed at 12 weeks of age. ADMA exposure caused the elevation of blood pressure in 12-week-old male offspring, which was exacerbated by TMAO exposure. Treatment with resveratrol rescued hypertension programmed by combined ADMA and TMAO exposure. This was accompanied by alterations in the compositions of gut microbiota and increased fecal butyrate levels. Both the abundance of the butyrate-producing genera Lachnospiraceae and Ruminococcaceae were augmented by resveratrol. Meanwhile, resveratrol therapy significantly increased the abundance of the Cyanobiaceae and Erysipelotrichaceae families. Moreover, the protective effects of resveratrol were related to the mediation of the renin-angiotensin system (RAS). Our data provide new insights into the protective mechanisms of resveratrol against hypertension programmed by ADMA and TMAO, including regulation of gut microbiota and their metabolites, the RAS, and NO pathway. Resveratrol might be a potential reprogramming strategy to protect against the hypertension of developmental origins.
Background: Gout is a disorder of purine metabolism or renal excretion of uric acid, and frequent... more Background: Gout is a disorder of purine metabolism or renal excretion of uric acid, and frequently involves the kidney. Sonographic abnormalities are specific findings suggestive of renal tissue damage. We aimed to investigate clinical manifestations of gouty nephropathy, evaluate renal function and find out factors contributing to renal failure. Methods: We retrospectively enrolled 151 gouty patients with sonographic evidence of gouts nephropathy between May 1998 and October 2005. Demographic data, kidney size by sonography, biochemical data including blood urea nitrogen and creatinine, urinalysis report, and comorbidities of each patient were collected. Results: Among the 151 gouty nephropathy patients enrolled. 87.4% (N=132) were men. About 56% of the patients had hematuria and 30% had proteinuria. We found that 81.4% of the patients had marked renal function impairment (chronic kidney disease, CKD, Stages 3-5). Normal kidney size was observed in 77.5% of the subjects, among whi...
Background: Nowadays, peritoneal dialysis has become a popular renal replacement therapy for urem... more Background: Nowadays, peritoneal dialysis has become a popular renal replacement therapy for uremic patients. A home visit program was designed to assess its value and significance in peritoneal dialysis patient care. Method: From January to April in 1999, 19 uremic patients on peritoneal dialysis received a visit by a professional staff member. The whole visit program included advanced communications on clinical problems, evaluation of technique for peritoneal dialysis, patient participation in dialysis therapy, home environment and drug compliance. A total of 18 items of four major categories were evaluated and assessed by scoring. The association between peritoneal dialysis-related infection and results of home visit was analyzed. Result: The total home visit score was related to peritoneal dialysis duration (p=0.028). Their participation was significantly associated with dialysis exchange technique (p=0.001). Patients who experienced catheter-related infection have poorer home environment (p=0.031). The age, gender, education level did not affect any infection rate. Conclusion: Home visit program offers additional information on our care of peritoneal dialysis patients. For those patients with infection complication, home visit is of help to find out factors contributing to their infection.
Thromboembolism is a well-recognized complication in patients with nephrotic syndrome owing to th... more Thromboembolism is a well-recognized complication in patients with nephrotic syndrome owing to their hypercoagulable status. Usually, the venous system is affected, whereas the very rare occurrence of arterial thrombosis is mainly restricted to pediatric patients. This complication often results in high rates of mortality and limb loss. We report the case of an adult female patient with histologically diagnosed minimal change disease and nephrotic syndrome associated with malignant thymoma, who eventually developed concurrent bilateral kidney and lower limb thrombosis. Conservative systemic anticoagulation was administered and she recovered ample kidney function. In addition, although she underwent an emergent thrombectomy of the left popliteal artery, an amputation was necessary. To the best of our knowledge, this is the first reported arterial thrombosis case involving bilateral kidney and lower limb simultaneously in nephrotic patients. Our experience indicates that arterial thro...
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