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Aim: This study was to evaluate the correlation of urinary kallikrein to renal function, proteinuria and urinary cytokines in chronic kidney disease patients in a longitudinal follow up. Method: We measured urinary kallikrein and cytokines in 50 patients who were followed up for 12 months. Results: Using regression model we found that the kallikrein excretion (estimated by log kallikrein/creatinine) was positively correlated to log estimated glomerular filtration rate in the beginning and the end of follow up ( P = 0.049 and 0.006, respectively). No correlation existed between kallikrein excretion and proteinuria. The kallikrein excretion decreased after 12 months of follow up, which was also associated with the decrease of log estimated glomerular filtration rate. There was a significant positive correlation between the log urinary kallikrein and monocyte chemoattractant protein-1 (MCP-1) concentration (correlation coefficient = 0.277; P = 0.049). Urinary kallikrein excretion was also positively correlated with serum MCP-1 level (correlation coefficient = 0.431; P = 0.002). No correlation existed between urinary kallikrein and transforming growth factor β-1 or tumour necrosis factor-α concentration. Conclusion: Urinary kallikrein excretion is positively correlated to renal function, serum and urinary inflammatory mediator MCP-1 in chronic kidney disease patients. These findings indicate that urinary kallikrein excretion may reflect the change of renal function and kidney inflammatory status. [ABSTRACT FROM AUTHOR]

Aims: Metabolic acidosis is a common problem after infusion with chloride-based parenteral nutrition. However, it is unknown whether the occurrence of metabolic acidosis is related to this regimen of therapy or to patient-specific risk factors. Methods: Patients receiving parenteral nutrition from July to December 2003 at this hospital were included for a retrospective study. Patients were excluded who had illnesses that were potentially related to acid-base disorders. The remaining patients were divided on the basis of parental nutrition they had received: a chloride-base regimen group, and an acetate-based therapy group. Biochemical character and blood gas data were analysed. Continuous variables were analysed by t-test. Categorical variables were assessed by chi-squared test. Independent determinants for bicarbonate decline were analysed using forward stepwise multiple linear regression analysis. Results: There were 29 patients (17 women, 12 men) who received chloride-based regimen and 26 patients (16 women, 10 men) took acetate-based therapy. The acetate group had significantly higher baseline serum creatinine and blood urea nitrogen than chloride group. The blood pH, CO2, bicarbonate and base excess were significantly lower after receiving chloride-based therapy; while these changes were not observed in acetate-based therapy group. However, the serum creatinine and blood urea nitrogen levels were not statistically different. With multiple-stepwise linear regression, parenteral nutrition formula and estimated creatinine clearance are independent predictors of bicarbonate decline. Conclusion: The acetate-base regimen can decrease the occurrence of metabolic acidosis after parenteral nutrition. In addition, the risk of acidosis is higher in patients with impaired renal function. [ABSTRACT FROM AUTHOR]

Background: Renal infarction is usually an underestimated disease due to its rare and non-specific presentations; the renal survival of these patients is not well studied. The aim of the present analysis is to study the clinical features and outcome in patients who had documented renal infarction. Methods: Twenty-two patients (12 men and 10 women, mean age of 57.7 ± 3.44 years (28.4–83.3 years)) with image-confirmed segmental renal infarction in the past 15 years were enrolled. All patients were followed up at outpatient department with a median of 4 years (1–14 years). Initial and follow-up clinical characteristics and laboratory results were recorded. Results: The most common underlying disease was cardiovascular disease. Renal infarction often presented with non-specific symptoms, including flank pain (55%), vague abdominal pain (50%), nausea/vomiting (46%) and fever (27%). The levels of leucocytes, lactate dehydrogenase, blood urea nitrogen and serum creatinine were all elevated at admission. The early diagnosis group (12/22) had more obvious flank pain, nausea/vomiting ( P < 0.001) and higher alanine transaminase ( P = 0.02). It also predisposed to undergo antiplatelet or anticoagulant therapy (all P < 0.04). During follow up, there was no recurrence in the whole study group, and a trend of better recovery of renal function was noted in the early diagnosis group. Conclusion: The serum creatinine level correlates with longer hospitalization length ( P < 0.05). As regards long-term prognosis, no definite factor or treatment was found to have significant effect in segmental renal infarction patients. However, early diagnosis and early initiation of treatment seems to have a positive effect on future renal outcome. [ABSTRACT FROM AUTHOR]

The leading cause of mortality in dialysis patients is cardiovascular complications, including ventricular arrhythmias and sudden cardiac death. A reliable non-invasive predictive test of sudden death is therefore important. The interlead variation in duration of the QT interval on the surface electrocardiogram corrected with heart rate (QTc dispersion) might serve as a surrogate for ventricular arrhythmia. Prolonged QTc dispersion is commonly encountered in dialysis patients and possesses an increased risk of all mortality, including cardiovascular mortality. QT dispersion might be affected by shifts of the intracellular electrolytes during dialysis and increasing deposition of iron in cardiac muscles in these patients who have underlying heart diseases. Although no well-designed study has been done, the factors contributing to prolongation of QTc dispersion should be avoided. We summarize the results of the currently available clinical studies that examined QTc dispersion in dialysis patients. [ABSTRACT FROM AUTHOR]