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。
Abstract： Objective To evaluate the incidence and prognosis of postoperative acute kidney injury （AKI） in patients after cardiovascular surgery， and analyse the value of AKI criteria and classification using the Acute Kidney Injury Network （AKIN） definition to predict their in-hospital mortality. Methods A total of 1 056 adult patients undergoing cardiovascular surgery in Renji Hospital of School of Medicine， Shanghai Jiaotong University from Jan. 2004 to Jun. 2007 were included in this study. AKI criteria and classification under AKIN definition were used to evaluate the incidence and in-hospital mortality of AKI patients. Univariate and multivariate analyses were used to evaluate preoperative， intraoperative， and postoperative risk factors related to AKI. Results Among the 1 056 patients， 328 patients（31.06%） had AKI. In-hospital mortality of AKI patients was significantly higher than that of non-AKI patients （11.59% vs. 0.69%， P＜0.05）. Multivariate logistic regression analysis suggested that advanced age （OR=1.40 per decade）， preoperative hyperuricemia（OR=1.97）， preoperative left ventricular failure （OR=2.53）， combined CABG and valvular surgery （OR=2.79）， prolonged operation time （OR=1.43 per hour）， postoperative hypovolemia （OR=11.08） were independent risk factors of AKI after cardiovascular surgery. The area under the ROC curve of AKIN classification to predict in-hospital mortality was 0.865 （95% CI 0.801-0.929）. Conclusion Higher AKIN classification is related to higher in-hospital mortality after cardiovascular surgery. Advanced age， preoperative hyperuricemia， preoperative left ventricular failure， combined CABG and valvular surgery， prolonged operation time， postoperative hypovolemia are independent risk factors of AKI after cardiovascular surgery. AKIN classification can effectively predict in-hospital mortality in patients after cardiovascular surgery， which provides evidence to take effective preventive and interventive measures for high-risk patients as early as possible.
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.
Sepsis is a common clinical critical illness, which often leads to multiple organ damage including the kidney damage, which is difficult to treat and has a high mortality rate. In recent years, extracorporeal blood purification therapy has made some progress in the field of sepsis. There are a variety of blood purification modes to choose, but there is still no unified standard for the initiation timing of blood purification therapy. Clinicians mainly evaluate the indicators and the initiation timing of blood purification therapy according to the patient’s needs for renal function replacement and/or inflammatory mediator clearance. This article mainly summarizes and discusses the initiation timing of blood purification therapy in sepsis.
Objective To evaluate the efficacy and safety of intermittent hemodialysis (IHD) and continuous renal replacement therapy (CRRT) on patients with acute kidney injury (AKI) after bee sting. Methods A prospective observational analysis was made on patients with AKI after bee sting treated in Jianyang People’s Hospital or West China Hospital of Sichuan University between July 2015 and December 2020. According to different initial renal replacement therapy modes, the patients were divided into IHD group and CRRT group. The IHD group received hemodialysis for 4 hours each time, once a day or 3-5 times a week; the CRRT group used Prismaflex machine for continuous veno-venous hemofiltration or continuous veno-venous hemodiafiltration within 72 hours after admission, for at least 12 hours a day, followed by CRRT or IHD, depending on the patient’s condition. Both groups could be treated with hemoperfusion (HP) and symptomatic support such as glucocorticoid, blood transfusion and fluid rehydration. The IHD group was divided into IHD subgroup and IHD+HP subgroup, and the CRRT group was divided into CRRT subgroup and CRRT+HP subgroup according to whether renal replacement therapy was combined with HP. The basic information of patients and clinical laboratory examination results were collected, and the renal function recovery and mortality rates of patients in the two groups were compared, as well as the changes of laboratory indicators. Results A total of 106 patients were enrolled, 50 in the IHD group and 56 in the CRRT group. There was no statistical difference in the rate of complete renal function recovery 30, 60, or 90 days after treatment between the two groups (28.2% vs. 31.2%, P=0.758; 46.2% vs. 50.0%, P=0.721; 82.1% vs. 81.2%, P=0.924). But in the CRRT subgroup analysis, there was a statistical difference in the 30-day renal function recovery rate of CRRT+HP patients compared with CRRT alone (47.6% vs. 18.5%, P=0.031), while no statistical difference was found in the IHD subgroup analysis. After 3 days of treatment, the levels of creatine kinase of the IHD+HP subgroup and the CRRT+HP subgroup were lower than those in the IHD and CRRT subgroups, and the differences were statistically significant [(7875±6871) vs. (15157±8546) U/L, P=0.026; (10002±8256) vs. (14498±10362) U/L, P=0.032]. There was no statistical difference in 30-day mortality or incidence of serious adverse reactions between the two groups (P>0.05). Conclusions There is no obvious difference in improving renal prognosis or reducing mortality between CRRT and IHD for patients with AKI after bee sting. However, CRRT combined with HP therapy could shorten the recovery time of renal function and increase the 30-day kidney recovery rate. HP may contribute to early renal function recovery in patients with AKI after bee sting, but more high-quality randomized controlled trials are needed to further confirm this.
Rhabdomyolysis-induced acute kidney injury (RIAKI) is a serious clinical disease in intensive care unit, characterized by high mortality and low cure rate. Continuous renal replacement therapy (CRRT) is a common form of treatment for RIAKI. There are currently no guidelines to guide the application of CRRT in RIAKI. To solve this problem, this article reviews the advantages and limitations of CRRT in the treatment of RIAKI, as well as new viewpoints and research progress in the selection of treatment timing, treatment mode, treatment dose and filtration membrane, with the aim of providing theoretical guidance for the treatment of CRRT in RIAKI patients.
ObjectiveTo investigate the risk factors of death in patients undergoing continuous renal replacement therapy (CRRT) after cardiac surgery. MethodsWe retrospectively analyzed records of 66 adult patients without history of chronic renal failure suffering acute kidney injury (AKI) following cardiac surgery and undergoing CRRT in our hospital between July 2007 and June 2014. There were 38 males and 28 females with mean age of 59.11±12.62 years. They were divided into a survival group and a non-survival group according to prognosis at discharge. All perioperative data were collected and analyzed by univariate analysis and multivariate logistic regression analysis. ResultsIn sixty-six adult patients, eighteen patients survived with a mortality rate of 72.7%. Through univariate analysis and multivariate logistic regression, risk factors of death in the post-operative AKI patients requiring CRRT included hypotension on postoperative day 1 (B=2.897, OR=18.127, P=0.001), duration of oliguria until hemofiltration (B=0.168, OR=1.183, P=0.024), and blood platelet on postoperative day 1 (B=-0.026, OR=0.974, P=0.001). ConclusionHypotension on postoperative day 1 (POD1) is the predominant risk factor of death in patients requiring CRRT after cardiac surgery, while blood platelet on POD1 is a protective factor. If CRRT is required, the sooner the better.
ObjectiveTo conduct a comprehensive analysis of risk prediction models for acute kidney injury (AKI) following Stanford type A aortic dissection surgery through a systematic review. MethodsA systematic search was performed in English and Chinese databases such as PubMed, EMbase, ProQuest, Web of Science, China National Knowledge Infrastructure (CNKI), VIP, Wanfang, and SinoMed to collect relevant literature published up to January 2025. Two researchers completed the literature screening and data extraction. The methodological quality of the prediction models was assessed using bias risk assessment tools, and a meta-analysis was performed using R version 4.3.1, with a focus on evaluating the predictive factors of the models. Results A total of 15 studies were included (13 retrospective cohort studies, 1 prospective cohort study, and 1 case-control study), involving 22 risk prediction models and a cumulative sample size of 4 498 patients. The overall applicability of the included studies was good, but all 15 studies exhibited a high risk of bias. The meta-analysis revealed that the area under the curve (AUC) for the predictive performance of the models was 0.834 [95%CI (0.798, 0.869)]. Further subgroup analysis indicated that the number of predictive factors was a source of heterogeneity. Additionally, hypertension [OR=2.35, 95%CI (1.55, 3.54)], serum creatinine [OR=1.01, 95%CI (1.00, 1.01)], age [OR=1.05, 95%CI (1.02, 1.09)], and white blood cell count [OR=1.14, 95%CI (1.06, 1.22)] were identified as predictors of AKI following type A aortic dissection surgery. Conclusion Currently, the predictive models for AKI after type A aortic dissection surgery demonstrate good performance. However, all included models carry a high risk of bias. It is recommended to strengthen multicenter prospective studies and external validation of the models to enhance their clinical applicability.