Renal failure
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Renal tubulointerstitial injury plays an important role in disease progression of IgAN. Neutrophil gelatinase-associated lipocalin (NGAL) is a stress protein released by tubular cells. NGAL is a promising biomarker of acute kidney injury. There is a growing literature suggesting that NGAL is also a marker of chronic kidney disease and severity. Our aim was to evaluate the prognostic value of NGAL staining in patients with IgAN. ⋯ NGAL staining can be a new histological marker in IgAN progression.
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We investigated the protective effect and mechanism of neutrophil gelatinase-associated lipocalin (NGAL) on rats ischemia/reperfusion (I/R) renal injury. Eighteen Sprague-Dawley male rats were randomly divided into three groups. ⋯ Rats with NGAL displayed an attenuated renal damage and a decreased number of tubular epithelial cell apoptosis compared to the I/R + NS group (Scr 63.400 ± 11.908 vs. 121.857 ± 17.151 μmol/L, Bun 14.840 ± 2.868 vs. 28.557 ± 6.434 mmol/L, apoptosis cell number 7.800 ± 1.924 vs. 15.400 ± 3.049/high power field (HPF), p < 0.05), the values were lower in the control group (24.000 ± 3.829 μmol/L, 5.814 ± 1.961 mmol/L, 1.800 ± 0.837/HPF, p < 0.05) compared to two groups above; NGAL-treated rats showed down-regulated Cleaved caspase-3 protein (0.284 ± 0.066 vs. 0.409 ± 0.073, p < 0.05), Bax protein (0.346 ± 0.055 vs. 0.443 ± 0.041, p < 0.05), Bax mRNA (1.423 ± 0.187 vs. 2.550 ± 0.217, p < 0.05) compared to I/R + NS group, but the values were higher in both of the two groups than those in the control group (Cleaved caspase-3 protein 0.104 ± 0.029, Bax protein 0.155 ± 0.027, Bax mRNA 1.000 ± 0.000, p < 0.05). We supposed that exogenous NGAL can inhibit the activation of caspase-3, reduce the expression of Bax, and thus reduce renal tubular cell apoptosis and protect renal function in I/R injury rats.
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Acute kidney injury (AKI) can develop after multiple wasp or bee stings. The etiology is the acute tubular necrosis secondary to shock, pigment toxicity, interstitial nephritis, or direct nephrotoxicity of venom. ⋯ She did not improve with supportive management and dialysis, and kidney biopsy showed acute cortical necrosis (ACN). This is the first report of ACN after a single wasp sting.
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Randomized Controlled Trial
The pharmacodynamics of vecuronium in chronic renal failure patients: the impact of different priming doses.
The concept of priming was introduced to facilitate a faster onset of nondepolarizing neuromuscular blocker for endotracheal intubation. Vecuronium is still very much in use for most chronic renal failure patients posted for renal transplantation. The aim of this study was to examine the pharmacodynamics of vecuronium without and with preceding different small doses. ⋯ Priming the chronic renal failure patients with 10% of ED(95) vecuronium dose acquit the best pharmacodynamics with the fewest signs of muscle weakness. Larger vecuronium priming doses are unfavorable and convey no more clinical utility.
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Comparative Study
The role of nafamostat mesylate in continuous renal replacement therapy among patients at high risk of bleeding.
Continuous renal replacement therapy (CRRT) has emerged as the preferred dialysis modality for critically ill patients with acute kidney injury. The objectives of this retrospective study were to assess the effect of nafamostat on circuit patency of CRRT and the safety regarding bleeding complications in patients at high risk of bleeding. We conducted a retrospective study of 243 CRRT patients at high risk of bleeding. ⋯ The median number of RBC units transfused per CRRT day was also not different between the two groups [0.7 (0.5-1.0) units/day vs. 0.7 (0.4-1.1) units/day; p = NS]. The use of nafamostat in patients at high risk of bleeding who require CRRT effectively lengthened the filter survival time without an increase in RBC transfusion. However, 74.5% of patients at high risk of bleeding maintained an acceptable CRRT hemofilter lifespan without circuit anticoagulation.