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A Chinese Multi-Specialty Delphi Consensus to Optimize RAASi Usage and Hyperkalaemia Management in Patients with Chronic Kidney Disease and Heart Failure

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Chinese Medical Sciences Journal 2024年第2期39卷 79-90页

作者： Ming-Hui Zhao Wei Chen Hong Cheng Bi-Cheng Liu Zhi-Guo Mao Zhuang Tian Gang Xu Jing-Min Zhou Renal Division Peking University First HospitalBeijing 100034China department of nephrology The First Affiliated HospitalSun Yat-Sen UniversityGuangzhou 510080China department of nephrology Capital Medical UniversityBeijing 100029China department of nephrology Southeast University Zhongda HospitalNanjing 210009China department of nephrology Shanghai Changzheng HospitalShanghai 200003China department of Cardiology Peking Union Medical College HospitalBeijing 100730China Renal Division Tongji Medical College of Huazhong University of Science and TechnologyWuhan 430030China department of Cardiology Zhongshan HospitalFudan UniversityShanghai 200032China

Objective Variations are present in common clinical practices regarding best practice in managing hyperkalaemia(HK),there is therefore a need to establish a multi-specialty approach to optimal renin angiotension-aldosterone system inhibitors(RAASi)usage and HK management in patients with chronic kidney disease(CKD)&heart failure(HF).This study aimed to establish a multi-speciality approach to the optimal use of RAASi and the management of HK in patients with CKD and *** A steering expert group of cardiology and nephrology experts across China were convened to discuss challenges to HK management through a nominal group *** group then created a list of 41 statements for a consensus questionnaire,which was distributed for a further survey in extended panel group of cardiologists and nephrologists across *** was assessed using a modified Delphi technique,with agreement defined as"strong"(≥75%and<90%)and"very strong"(≥90%).The steering group,data collection,and analysis were aided by an independent *** A total of 150 responses from 21 provinces across China were recruited in the *** were comprised of an even split(n=75,50%)between cardiologists and *** 41 statements achieved the 75%consensus agreement threshold,of which 27 statements attained very strong consensus(≥90%agreement)and 14 attained strong consensus(agreement between 75%and 90%).Conclusion Based on the agreement levels from respondents,the steering group agreed a set of recommendations intended to improve patient outcomes in the use of RAASi therapy and HK management in China.

关键词： Sardiorenal syndrome chronic kidney failure heart failure hyperkalemia multidisciplinary communication RAASi

Infective Endocarditis in Chronic Hemodialysis Patients: Specificities and Therapeutic Management

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Open Journal of Internal medicine 2024年第2期14卷 247-258页

作者： Imane Saidi Amal Zniber Mina Agrou Tarik Bouattar Naima Ouzeddoun Loubna Benamar department of nephrology Dialysis and Renal Transplantation Ibn Sina University Hospital Rabat Morocco Faculty of medicine and Pharmacy Mohammed V University Rabat Rabat Morocco Acute Medical Unit Ibn Sina University Hospital Rabat Morocco

Infective endocarditis (IE) is a frequent complication in chronic hemodialysis patients (CHD). The repeated placement and manipulation of central venous catheters, underlying valvulopathies, and immunosuppression are the main predisposing factors for these patients to develop IE. We aimed to highlight the clinical and microbiological specificities of IE in CHD patients, detail the therapeutic management in these patients and identify the risk factors for in-hospital mortality. We included 28 CHD patients in whom the diagnosis of IE was established according to modified Duke criteria. The mean age was 47 ± 17 years. Among them, 57% were hypertensive and 39% were diabetic. The average duration of hemodialysis was 3.5 ± 7 years. The vascular access was a tunnelled jugular catheter, arteriovenous fistula, and temporary catheter in 54%, 28%, and 18% of patients, respectively. Half of the patients presented with heart failure at admission. Methicillin-sensitive Staphylococcus is the most commonly implicated pathogen. Transthoracic echocardiography revealed vegetation in all patients. In 60% of cases, the lesion is located on the mitral valve, and in 35% it is on the tricuspid valve. Patients initially received empirical antibiotic therapy, which was adjusted according to bacteriological results. Valve surgery was indicated in 12 patients, with aortic valve replacement being the most performed procedure followed by tricuspid annuloplasty. The in-hospital mortality rate was 32%. Factors associated with mortality were severe mitral insufficiency (p = 0.036), heart failure (p = 0.043), and the presence of Methicillin-resistant Staphylococcus in blood cultures (p = 0.047). IE is a complication with high morbidity and mortality. Its increasing incidence, specificities in chronic CHD patients, and the complexity of its management require a rigorous preventive strategy. A multidisciplinary collaboration between nephrologists, infectious disease specialists, cardiologists, and sur

关键词： Infective Endocarditis Infectious Complications Chronic Hemodialysis Patients

Renal Vein Thrombosis Suggestive of Extramembranous Glomerulonephritis Associated with Sjögren’s Syndrome (Case Report)

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Open Journal of Internal medicine 2024年第2期14卷 181-187页

作者： Mariam El Galiou Mina Agrou Rihab Dkhissi Loubna Benamar Naima Ouzeddoun Lamyae Rouass Tarik Bouattar department of nephrology Dialysis and transplantation IbnSina University Hospital Mohamed V University Rabat Morocco department of Pathological Anatomy IbnSina University Hospital Mohammed V University Rabat Morocco

Introduction: Glomerular damage during Gougerot-Sjgren syndrome is much rarer than interstitial damage, and is essentially extra-membranous and membrano-proliferative glomerulonephritis. Observation: We report the case of a 44-year-old woman with primary Sjgrens syndrome, confirmed by clinical dryness syndrome, positive anti-SSA and anti-SSB antibodies, and a salivary gland biopsy revealing grade 4 lymphocytic sialadenitis according to CHISHOLMs classification. Later, the patient developed nephrotic syndrome, along with hypertension. Renal function remained normal with a creatinine level of 9.3 mg/l, and hematuria was absent. Only antinuclear antibodies tested positive, while anti-PLA2R antibodies were negative. A renal biopsy was performed, which was complicated on the same day by hemodynamic instability with hematuria. Renal CT scan with contrast injection revealed a posterior perirenal hematoma without contrast extravasation. Additionally, bilateral renal vein thrombosis was incidentally discovered, suggesting extramembranous glomerulonephritis. The patients hemodynamic status stabilized after fluid resuscitation with isotonic saline solution (0.9%), without the need for blood transfusion. Renal biopsy confirmed extramembranous glomerulonephritis with interstitial fibrosis and minimal tubular atrophy. The initial etiological assessment was negative. The patient was started on oral corticosteroids, angiotensin-converting enzyme inhibitors, and therapeutic anticoagulation for renal vein thrombosis. The patients condition improved, with the disappearance of the syndrome and spontaneous regression of the hematoma. Discussion: The association of nephrotic syndrome and renal vein thrombosis primarily suggests glomerulopathy, in particular extra-membranous glomerulonephritis. Sjgrens syndrome can be associated with extra-membranous glomerulonephritis without being its direct cause. Like, it is possible that it is a cause of glomerulonephritis, essentially extra membrano

关键词： Sjögren’s Syndrome Extramembranous Glomerulonephritis Nephrotic Syndrome Anti-PLA2R Antibodies

Clinicopathological features and medium-term outcomes of histologic variants of primary focal segmental glomerulosclerosis in adults:A retrospective study

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World Journal of nephrology 2024年第1期13卷 14-24页

作者： Nazarul Hassan Jafry Shumaila Manan Rahma Rashid Muhammed Mubarak department of nephrology Sindh Institute of Urology and TransplantationSindhKarachi 74200Pakistan department of Pathology Sindh Institute of Urology and TransplantationSindhKarachi 74200Pakistan

BACKGROUND The Columbia classification identified five histological variants of focal segmental glomerulosclerosis(FSGS).The prognostic significance of these variants remains *** To evaluate the relative frequency,clinicopathologic characteristics,and medium-term outcomes of FSGS variants at a single center in *** This retrospective study was conducted at the department of nephrology,Sindh Institute of Urology and transplantation,Karachi,Pakistan on all consecutive adults(≥16 years)with biopsy-proven primary FSGS from January 1995 to December *** subjects were treated with steroids as a first-line *** response rates,doubling of serum creatinine,and kidney failure(KF)with replacement therapy were compared between histological variants using ANOVA or Kruskal Wallis,and Chi-square tests as *** were analyzed by SPSS version 22.0.P-value≤0.05 was considered *** A total of 401 patients were diagnosed with primary FSGS during the study *** these,352(87.7%)had a designated histological *** not otherwise specified(NOS)variant was the commonest,being found in 185(53.9%)patients,followed by the tip variant in 100(29.1%)***(COL),cellular(CEL),and perihilar(PHI)variants were seen in 58(16.9%),6(1.5%),and 3(0.7%)patients,*** and PHI variants were excluded from further analysis due to small patient *** mean follow-up period was 36.5±29.2 *** response rates of variants,patients with TIP lesions achieved remission more frequently(59.5%)than patients with NOS(41.8%)and COL(24.52%)variants(P<0.001).The hazard ratio of complete response among patients with the COL variant was 0.163[95%confidence interval(CI):0.039-0.67]as compared to patients with *** TIP variant showed a hazard ratio of 2.5(95%CI:1.61-3.89)for complete remission compared to the NOS ***,progressive KF was observed more frequently in patients with the COL variant,43.

关键词： Adults Columbia classification Focal segmental glomerulosclerosis Histological variants Kidney failure Kidney failure with replacement therapy

Will artificial intelligence widen the therapeutic gap between children and adults?

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Pediatric Investigation 2024年第1期8卷 1-6页

作者： Matthew Nagy Bryan Sisk Albert Lai Eric Kodish Cleveland Clinic Lerner College of medicine Case Western Reserve UniversityClevelandOhioUSA department of Pediatrics Division of Hematology/OncologyWashington University School of MedicineSt.LouisMissouriUSA department of medicine Bioethics Research CenterWashington University School of MedicineSt.LouisMissouriUSA Institute for Informatics Washington University School of MedicineSt.LouisMissouriUSA department of Pediatric Hematology Oncology and Blood and Marrow transplantation Cleveland Clinic Children’sClevelandOhioUSA

The impending rise of artificial intelligence(AI)-powered healthcare offers exciting hope for improved care and outcomes in children with serious illnesses.1 The historical precedent in healthcare,however,suggests that advancements in adult care do not necessarily result in proportional progress in *** disparity was first noted in the mid-20th century when tragedies that involved drugs with well-studied and known adult safety profiles,such as sulfonamide elixir and thalidomide,resulted in harm to children due to limited pediatric clinical trial inclusion.2 As a result,legislation in 1962 required drug companies to include package labels that restricted or dissuaded the use of medications in children that were not properly studied in this population.2 Subsequently,physicians became reluctant to prescribe many medications,and pharmaceutical companies had little incentive to enroll children in trials as an unfavorable result could negatively impact sales in the adult market,and a successful outcome would only marginally increase the market pool.3 This lack of access led *** Shirkey to describe children as"therapeutic orphans"in 1968.2 After more than half a century of legislation aimed at increasing pediatric representation in research and drug development(Figure 1),enrollment of children in clinical trials remains disproportionately low,4 with children included in as few as 12%of trials for diseases with a burden equal to,or greater in,the pediatric versus adult population.

关键词： companies Figure properly

A genomic association study revealing subphenotypes of childhood steroid-sensitive nephrotic syndrome in a larger genomic sequencing cohort

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Genes & Diseases 2024年第4期11卷 400-410页

作者： Han Chan Fenfen Ni Bo Zhao Huimin Jiang Juanjuan Ding Li Wang Xiaowen Wang Jingjing Cui Shipin Feng Xiaojie Gao Xueying Yang Huan Chi Hao Lee Xuelan Chen Xiaoqin Li Jia Jiao Daoqi Wu Gaofu Zhang Mo Wang Yupeng Cun Xiongzhong Ruan Haiping Yang Qiu Li department of nephrology Children's Hospital of Chongqing Medical UniversityNational Clinical Research Center for Child Health and DisordersMinistry of Education Key Laboratory of Child Development and DisordersChongqing Key Laboratory of PediatricsChongqing 400014China department of nephrology Shenzhen Children's HospitalShenzhenGuangdong 518034China department of nephrology Kunming Children's HospitalKunming Medical UniversityKunmingYunnan 650228China department of nephrology Wuhan Children's HospitalTongji Medical College of Huazhong University of Science and TechnologyWuhanHubei 430015China department of nephrology Chengdu Women and Children Central HospitalChengduSichuan 610073China Pediatric Research Institute Ministry of Education Key Laboratory of Child Development and DisordersNational Clinical Research Center for Child Health and DisordersChina International Science and Technology Cooperation Base of Child Development and Critical DisordersChongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory DisordersChildren's Hospital of Chongqing Medical UniversityChongqing 400014China department of nephrology John Moorhead Research LaboratoryUniversity College London Medical SchoolRoyal Free CampusUniversity College LondonLondon NW32PFUnited Kingdom

Dissecting the genetic components that contribute to the two main subphenotypes of steroid-sensitive nephrotic syndrome(SSNS)using genome-wide association studies(GWAS)strategy is important for understanding the *** conducted a multicenter cohort study(360 patients and 1835 controls)combined with a GWAS strategy to identify susceptibility var-iants associated with the following two subphenotypes of ssNS:steroid-sensitive nephrotic syn-drome without relapse(SSNswR,181 patients)and steroid-dependent/frequent relapse nephrotic syndrome(SDNS/FRNS,179 patients).The distribution of two single-nucleotide poly-morphisms(SNPs)in ANKRD36 and ALPG was significant between SSNSWR and healthy controls,and that of two SNPs in GAD1 and HLA-DQA1 was significant between SDNS/FRNS and healthy ***,rs1047989 in HLA-DQA1 was a candidate locus for SDNS/FRNS but not for *** significant SNPs were observed between SSNSWR and SDNS/***,chromosome 2:171713702 in GAD1 was associated with a greater steroid dose(>0.75 mg/kg/d)upon relapse to first remission in patients with SDNS/FRNS(odds ratio=3.14;95%confidence interval,0.97-9.87;P=0.034).rs117014418 in APOL4 was significantly associated with a decrease in eGFR of greater than 20%compared with the baseline in SDNS/FRNS patients(P=0.0001).Protein-protein intersection network construction suggested that HLA-DQA1 and HLA-DQB1 function together through ***,SSNSWR belongs to non-HLA region-dependent nephropathy,and the HLA-DQA/DQB region is likely strongly associated with dis-ease relapse,especially in SDNS/*** study provides a novel approach for the GWAS strategy of SsNS and contributes to our understanding of the pathological mechanisms of SSNSWRandSDNS/FRNS.

关键词： Frequentrelapse Genome-wide association study Human leukocyte antigen region Steroid-sensitive nephrotic syndrome

Hematuria after nocturnal exercise of a man: A case report

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World Journal of Clinical Cases 2024年第5期12卷 1025-1028页

作者： Ming-Jian Bai Song-Tao Yang Xue-Kai Liu department of Clinical Laboratory Aerospace Center HospitalBeijing 100049China department of nephrology Aerospace Center HospitalBeijing 100049China

BACKGROUND A man experienced multiple episodes of macroscopic hematuria following nocturnal *** stones and tumors were considered the two most likely *** patient had two hobbies:Consuming health care products in large quantities and engaging in late-night *** SUMMARY Health care products contain a large amount of calcium phosphate,and we hypothesize that this could induce the formation of small phosphate *** exercise,the urinary system is abraded,resulting in *** patient was advised to stop using the health care ***,the aforementioned symptoms disappeared ***,the patient resumed the above two habits one year later;correspondingly,the macroscopic hematuria *** This finding further confirmed the above inference and allowed for a new avenue to determine the cause of the patient’s hematuria.

关键词： Hematuria Health care products Exercise Case report

Liver transplantation as an alternative for the treatment of intrahepatic cholangiocarcinoma: Past, present, and future directions

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Hepatobiliary & Pancreatic Diseases International 2024年第2期23卷 129-138页

作者： Sudha Kodali Ashton A Connor Souhail Thabet Elizabeth W Brombosz R Mark Ghobrial Sherrie and Alan Conover Center for Liver Disease and transplantation Houston Methodist HospitalHoustonTX 77030USA JC Walter Jr Transplant Center Houston Methodist HospitalHoustonTX 77030USA department of medicine Weill Cornell Medical CollegeNew YorkNYUSA department of Surgery Houston Methodist HospitalHoustonTX 77030USA department of Surgery Weill Cornell Medical CollegeNew YorkNYUSA School of medicine New Giza UniversityGizaEgypt

Intrahepatic cholangiocarcinoma(iCCA)is a rare biliary tract cancer with high mortality *** resection of the iCCA lesion is the first choice of treatment,with good prognosis after margin-negative ***,only 12%-40% of patients are eligible for resection at presentation due to cirrhosis,portal hypertension,or large tumor *** transplantation(LT)offers margin-negative iCCA extirpation for patients with unresectable ***,iCCA was a contraindication for LT until size-based selection criteria were introduced to identify patients with satisfied post-LT *** studies have shown that tumor biology-based selection can yield high post-LT survival in patients with locally advanced *** selection criterion is the tumor response to neoadjuvant *** with response to neoadjuvant therapy have better outcomes after LT compared with those without tumor response to neoadjuvant *** index that helps predict the treatment outcome is the *** survival outcomes have also opened the door for living donor LT for *** undergoing LT for iCCA now have statistically similar survival rates as patients undergoing *** combination of surgery and locoregional and systemic therapies improves the prognosis of iCCA patients.

关键词： Liver transplantation Cholangiocarcinoma Hepatectomy Transplant oncology Liver neoplasm

Haploidentical hematopoietic cell transplantation with or without an unrelated cord blood unit for adult acute myeloid leukemia:a multicenter,randomized,open-label,phase 3 trial

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Signal Transduction and Targeted Therapy 2024年第6期9卷 2669-2678页

作者： Biqi Zhou Jia Chen Tianhui Liu Yishan Ye Yanming Zhang Yiyang Ding Hong Liu MingQing Zhu Xiao Ma Xiaoli Li Longfei Zhao Zhihong Lin He Huang Yang Xu Depei Wu National Clinical Research Center for Hematologic Diseases Jiangsu Institute of HematologyThe First Affiliated Hospital of Soochow UniversitySuzhouChina Institute of Blood and Marrow transplantation Collaborative Innovation Center of HematologySoochow UniversitySuzhouChina Bone Marrow transplantation Center The First Affiliated HospitalZhejiang University School of MedicineHangzhouZhejiangChina department of Hematology The Affiliated Huai’an Hospital of Xuzhou Medical University and The Second People’s Hospital of Huai’anHuai’anChina Soochow Hopes Hematology Hospital SuzhouChina department of Hematology Hygeia Suzhou Yongding HospitalSuzhouChina

Coinfusion of unrelated cord blood(UCB)units in haploidentical hematopoietic cell transplantation(haplo-HCT)(haplo-cord HCT)for hematopoietic malignancies showed promising results in previous reports,but the efficiency of haplo-cord HCT in acute myeloid leukemia(AML)still lacks sufficient *** multicenter,randomized,phase 3 trial(*** NCT03719534)aimed to assess the efficacy and safety of haplo-cord HCT in AML patients.A total of 268 eligible patients aged 18-60 years,diagnosed with measurable residual disease in AML(excluding acute promyelocytic leukemia),with available haploidentical donors and suitable for allotransplantation,were randomly allocated(1:1)to receive haplo-cord HCT(n=134)or haplo-HCT(n=134).The 3-year overall survival(OS)was the primary endpoint in this *** median follow-up was 36.50 months(IQR 24.75-46.50).The 3-year OS of Haplo-cord HCT group was better than haplo-HCT group(80.5%,95%confidence interval[CI]:73.7-87.9 vs.67.8%95%CI 60.0-76.5,p=0.013).Favorable progression-free survival(70.3%,95%CI 62.6-78.8 vs.57.6%,95%CI 49.6-67.0,p=0.012)and cumulative incidence of relapse(12.1%,95%CI 12.0-12.2 vs.30.3%,95%CI 30.1-30.4,p=0.024)were observed in haplo-cord HCT *** 3-4 adverse events(AEs)within two years posttransplantation in the two groups were ***-cord HCT patients exhibited a faster cumulative incidence of neutrophil recovery(p=0.026)and increased T-cell reconstitution in the early period ***-cord HCT can improve OS in AML patients without excessive AEs,which may exert additional benefits for recipients of haplo-HCT.

关键词： hematopoietic acute phase