Background: Renal replacement therapy (RRT) was often needed by some severe burn patients with acute kidney injury (AKI). The primary aim of this study was to review incidence rate and mortality of RRT in severe burn patients. Second aims were to review RRT complications and renal outcome. Methods: We searched multiple databases for studies published between 1 January 1960 and 31 December 2019. Studies about adult populations with burn injury, providing epidemiologic data on prevalence or mortality of RRT, were included. Results: A total of selected 57 studies, including 27,437 patients were enrolled in our analysis. The prevalence rates of RRT were 8.34% (95% CI 7.18–9.5%) in all burn patients and 37.05% (95% CI 29.85–44.24%) in AKI patients. The mortality of all burn patients with RRT was 65.52% (95% CI 58.41–72.64%). The prevalence rates of RRT in sample size≥100 group were 6.86% (95% CI 5.70–8.03%), which was lower than that of <100 group (17.61%, 95% CI 13.39–21.82%). With the increase of TBSA, the prevalence of RRT may have the increasing trend. The prevalence rates of RRT in Asian group was 12.75% (95% CI 9.50–16.00%), which was higher than that of European (10.45%, 95% CI 7.30–13.61%) and North America group (5.61%, 95% CI 4.27–6.95%). The prevalence rates of RRT in 2010–2019 group was 12.22% (95% CI 10.09–14.35%), which was higher than that of 2009–2000 group (5.17%, 95% CI 2.88–7.46%). The prevalence rates of RRT in 1989 and before group was the lowest, which was 1.56% (95% CI 0–3.68%). However, there was no significant correlation between the year of publication and the mortality of burn patients with RRT. Dialysis-requiring AKI in burn patients could increases the risk of chronic kidney disease progression and end-stage renal disease. About 35% of RRT patients need to maintain haemodialysis temporarily, even if they survive and leave hospital. Conclusions: The prevalence rate of RRT is about 6–8%; approximately, one-third of burn patients with AKI need RRT. The prevalence rate of RRT increased over time, but the mortality did not change. The prevalence rates of RRT in Asian group was higher than that of European and North America group.

目的 研究维持性血液透析(maintenance hemodialysis,MHD)相关肌肉减少症(sarcope-nia,简称肌少症)的患病率及危险因素.方法 入选359例MHD患者,收集患者相关资料测量肌肉质量、力量及肌肉功能,将研究对象分成肌少症组和非肌少症组,分析肌少症的患病率及危险因素.结果 本研究纳入359名MHD患者,肌少症83例,非肌少症276例,肌少症患病率为23.1％.多因素Logistic回归分析显示年龄(OR=1.962,95％CI:1.264～3.044,P=0.003)、营养不良(OR=-2.697,95％CI:1.283～5.669,P=0.009)及抑郁(OR=1.707,95％CI:1.116～2.611,P=0.014)是肌少症的独立危险因素,体质量指数(BMI)是肌少症的保护因素(OR=0.040,95％CI:0.015～0.108,P＜0.001).结论 MHD肌少症患病率高达23.1％,年龄、营养不良、抑郁是其独立危险因素,BMI是其保护性因素.

Background: To improve the prognosis of burn patients with renal replacement therapy (RRT), we performed this systematic review and meta-analysis. Methods: We searched multiple databases for studies published before February 2020. Studies about adult populations with burn injury, providing epidemiologic data on prevalence or mortality of RRT, were included. Results: A total of selected 58 studies, including 38,787 patients were enrolled in our analysis. The prevalence rates of RRT were 5.14% (95%CI 4.54%-5.74%) in all burn patients and 35.8% (95%CI 29.54%-42.07%) in acute kidney injury (AKI) patients. The prevalence of RRT among burn patients in the intensive care unit (ICU) was 10.92% (95%CI 8.71%-13.14%). The mortality of all burn patients with RRT was 65.52% (95%CI 58.41%-72.64%). The mortality of patients with RRT in ICU was 62.7% (95%CI 53.7%-71.7%). The mortality rate of RRT patients was 30.33% (95%CI 22.06%-38.59%) of the total. There was no significant correlation (r=-0.224, P=0.159) between the year of publication and the mortality of burn patients with RRT. Neither cohort studies nor RCT studies of subgroup analyses show that RRT could reduce the risk of death in burn patients with AKI. Bleeding (10.92%) and secondary infection (9.61%) were the most common RRT-related adverse reactions. Compared with heparin, regional citrate anticoagulation has advantages in superior filter life spans and fewer bleeding episodes. Dialysis-requiring AKI in burn patients could increases the risk of chronic kidney disease progression and end-stage renal disease. About 35% of RRT patients need to maintain hemodialysis temporarily, even if they survive and leave hospital. Conclusions: The prevalence of RRT is not low; approximately, one-third of burn patients with AKI need RRT. The mortality of burn patients with RRT is very high and accounts for 1/3 of the total deaths. There is no evidence that RRT can improve the prognosis of burn patients with AKI. Regional citrate anticoagulation has some advantages in reducing bleeding and extending filter life spans, which may be more suitable for severe burn patients with CRRT.

Objective:To evaluate the effect of orthostatic hypotension(OH) on long-term prognosis of elderly maintenance hemodialysis (MHD) patients.Methods:68 elderly patients treated in the Blood Purification Center, The Fourth Medical Center of People’s Liberation Army (PLA) General Hospital on July 7, 2015 were recruited prospectively. Blood pressure (BP) was measured in supine position and orthostatic position during 6 consecutive hemodialysis sessions. The patients were followed up for 3 years. The Kaplan-Meier curve was used to analyze the relationship between the number of OH in different postures and the survival time of the patients. The patients were divided into two groups according to their death or survival at the end of follow-up. The differences of general condition, complications, dialysis age and occurrence times of OH between the two groups were compared.Results:A total of 408 measurements were carried out in 68 patients. The incidence of OH was 37.25%, but only 1.96% was consistent with hypotension during dialysis. With the increase of the occurrence of OH, the survival time did not decrease significantly ( t=-0.006, P=0.995), and the 3-years mortality rate did not increase significantly ( χ2=0.197, P=0.657). The death patients were only older than the survivors( t=0.262, P=0.794), and there was no significant difference in other indicators. It was not found that the occurrence of postural hypotension would affect the survival time of the patients ( P=0.287). Conclusions:Orthostatic hypotension had no effect on the survival of elderly MHD patients.

The mechanisms of traumatic injury-induced acute kidney injury (AKI) are very complicated. Among these mechanisms, sepsis-related AKI is the most harmful and the most difficult to treat. The medical community gave a high priority on this disease, dedicated to raise the level of awareness and treatment through its pathogenesis, early diagnosis ideas and biomarkers, and standardization of treatment. There has been some consensus on the classification of sepsis, AKI, and treatments of antiinfection, fluid resuscitation, renal replacement therapy. A series articles and guidelines have also been published and the survival status of patients have been improved, but many basic and clinical issues are still controversial and need to be answered by further trails. This article focuses on the progress of pathogenesis, diagnosis and treatment about sepsis-related AKI, and tries to raise the understanding level of early diagnosis and standardized treatment of it. DOI: 10.11855/j.issn.0577-7402.2019.07.05

Objective:To investigate related factors of death in elderly hemodialysis patients with uremia.Methods:21 elderly patients (deceased) with uremia accepted hemodialysis for 3 ～ 24 months as death group,and at the same period 168 cases accepting in hemodialysis with the survival time more than 24 month as control group.Retrospective analysis of clinical data of patients to explore influencing factors of death related factors and survival status in hemodialysis patients.Results:9 cases in death group (42.8％) died because of cardiovascular events,5 cases (23.8％) died because of cerebrovascular accident;cardiovascular events and cerebrovascular accident was the leading cause of death for elderly uremia hemodialysis patients;single factor analysis indicated that uremia hemodialysis patients survival status was correlated with age,complication,glomerular filtration rate (eGFR),the entire section before parathyroid hormone (iPTH),low density lipoprotein cholesterol (LDL),C-reactive protein (CRP),check coulson complications index (CCI),urea nitrogen decreased after dialysis (Kt/V),weekly dialysis time,nephrology specialist clinic visits before dialysis (P ＜ 0.05);Multiariable Logistic analysis results showed that eGFR before dialysis,LDL,CRP and Kt/V were for living conditions of the independent risk factors patients with uremia hemodialysis(P ＜0.05).Conclusions:Age,complications before dialysis,high eGFR and CRP before dialysis,low LDL and Kt/V ＞ 1.2 before dialysis,none nephrology specialist visited elderly patients would lead to poor survival status,it is suggested to strengthen the monitoring of patients in order to improve the survival rate.

Renal cell carcinoma (RCC) is the most common malignancy in the kidney in the world, and the 5-year overall survival for patients remains poor due to the lack of effective treatment strategies. Although ABT-737, as a Bcl-2/Bcl-xL inhibitor, has recently emerged as a novel cancer therapeutic reagent, apoptosis induced by ABT-737 is often blocked in several types of cancer cells. This study investigated whether the combination of the small-molecule BH3 mimetic ABT-737 and the lysosome inhibitor chloroquine was an effective strategy for treating renal cancer cells. We found that the combination of ABT-737 and chloroquine synergistically decreased cell viability when compared to treatment with either single reagent. Cell apoptosis induced by a combined treatment was markedly inhibited by the caspase inhibitors z-DEVD-FMK and z-VAD-FMK. It was also inhibited by cathepsin inhibitor E-64 and CTSI (cathepsin inhibitor), which suggested that apoptosis was dependent on the cascade of caspase activation and cathepsins released from lysosomes. Furthermore, we found that ABT-737 could increase the cell level of ROS, which triggers cathepsin-mediated cell death and augments the role of chloroquine in cell death. So the combination of ABT-737 and chloroquine was an effective strategy for the treatment of renal cancer cells, and this combined strategy may widen the therapeutic window of ABT-737 and chloroquine as well as enhance the clinical efficacy of synergistic drug combinations.

中心静脉导管(CVC)常见的导管功能不良原因包括导管内血栓形成以及导管相关性感染.封管液可通过抗凝达到保持导管通畅的目的,同时具有抗感染和减少生物膜形成的作用.临床较为关注的是常用封管液肝素的不足.本文总结肝素封管液的特点,探讨高浓度肝素增加血液透析患者出血风险的原因,综述近几年导管封管液应用的相关进展.

Objective To investigate the changes in levels of serum soluble transferrin receptor ( sTfR) after switc-hing from maintenance hemodialysis to high-flux hemodialysis ( HFD) in patients with uremia, and to analyze its related factors.Methods Forty patients undergoing low-flux maintenance hemodialysis were treated by high-flux maintenance he-modialysis for 12 months.The levels of sTfR, iron metabolism indices, anemia index and inflammatory index were meas-ured before HFD treatment ( T0 ) and after HFD treatment for 2 months ( T1 ) , 6 months ( T2 ) and 12 months ( T3 ) .Pear-son correlation and multiple regression method were used to analyze the relationship between serum sTfR and other indexes. At the same time, we observed the changing trend of erythropoietin and the amount of iron therapy.Results Serum sTfR level was significantly decreased at T1 , T2 and T3 as compared with that at T0 , and significant difference was found ( all P<0.01).Pearson correlation analysis showed that sTfR was positively correlated with Ret%, SF (r=0.154, 0.152;all P<0.05) and was negatively correlated with Hb, HCT, β2-MG and TBC ( r =-0.251, -0.299, -0.384 and-0.166;P<0.01 or P<0.05).Multiple regression showed that HCT, TSAT andβ2-MG levels were closed related with serum sTfR level in HFD patients (all P<0.01).The erythropoietin and iron dosage in this group reduced with prolonged HFD treatment.Conclusions HFD can effectively improve renal anemia in patients with maintenance hemodialysis.The detection of sTfR level reflects the effects of iron reserves and erythropoietic stimulation on patients.

Objective To study the possibility of honor guard training-induced hemoglobinuria, occurring mechanism and in-fluencing factors.Methods To observe the soldiers’ blood erythrocyte malondialdehyde ( MDA) , superoxide dismutase ( SOD) , and plasma total antioxidant capacity ( T-AOC) , blood lactate ( BLA) changes before and after a routine training in the honor guard, and divide them into two groups with whether they developed naked eye“hematuria” repeatly in order to observe the change in the index of and correlation with“the naked eye hematuria”.Results The MDA before training(6.57 ±0.64)nmol/mg, after training (6.86 ± 0.67) nmol/mg; SOD before training (9.61 ±1.08) U/mg, after training (10.46 ±2.12 ) U/mg; T-AOC before training 5.18 (3.70-6.11) U/ml, after training (7.09-9.81) U/ml; BLA before training (21.4 ±5.4) mmol/L, after training (31.8 ±12.8) mmol/L.MDA, SOD, T-AOC, BLA after training increased compared with those before training increased, with statistical significance (P<0.05).Difference in MDA, SOD, T-AOC (P<0.05) existed with correlation hematuria before and after training.Conclusions The honor guards’ antioxidant capacity of red blood cell, is changed by usual training; it may be one of the causes of training-in-duced hemoglobinuria.

BACKGROUND:Locking catheter with heparin may increase bleeding risk of some hemodialysis (HD) patients. Hence, the security and effectivity of 10% concentrated sodium chloride (CSC) used as an alternative method for patients with high bleeding risk need to be investigated. METHODS:Seventy-two patients inserted temporary central venous catheters were divided into two groups randomly. A total of 3125 U/mL heparin saline (HS) was used in HS group and 10% CSC in CSC group to lock catheters. Heparin-free HD was used for the first time and plasma specimens were collected to test coagulation indicators before catheter-locking (at the end of HD) and at 30 min after it. Then, blood flow velocities (BFVs), incidences of catheter thrombosis, etc. were followed up at each time of HD. RESULTS:Activated partial thromboplastin time (APTT) of two groups had no difference at the end of heparin-free HD (27.100 [25.675-28.950] vs. 27.250 [25.150-29.575] second, p = 0.933), but at 30 minutes after using different catheter lock solutions, APTT of HS group was obviously longer than CSC group (50.100 [41.275-65.400] vs. 27.500 [25.525-29.875] second, p < 0.001). Catheters' retaining time of two groups were the same (p = 0.306), so did the average BFVs (p > 0.05). But catheters' thrombosis incidence and urokinase usage of HS group were less than CSC group (p < 0.05). CONCLUSION:Comparing with HS group, thrombosis incidences of CSC group increased, but catheters' retaining time and average BFVs remained the same and coagulation indicators of it were unaffected. Therefore, it can be an effective alternative lock method for HD patients with high bleeding risk.

目的 有研究提示维持性血液透析(maintenance hemodialysis,MHD)患者使用中心静脉置管相对于内瘘存在更重的炎症状态,而炎症又是加重肾性贫血的重要原因.本研究试图通过比较不同血管通路患者的贫血相关指标,了解通路对肾性贫血治疗产生的影响. 方法 采用回顾性的配对设计.选取2012年4月～2013年3月间在解放军总医院第一附属医院血液净化中心持续接受治疗的患者,根据血管通路不同分为半永久置管组和内瘘组,按照性别、年龄、原发病、透析龄及通路使用时间共配成14例对子.记录其在观察期内血红蛋白(Hb)、红细胞生成素(EPO)用量及超敏C反应蛋白(SCRP)等指标,比较组间差异. 结果 2组患者基线资料匹配较好(P＞0.05).观察期内2组Hb水平无差异(P =0.210),但半永久置管组EPO的月平均用量高于内瘘组(691.022±141.763比533.198±174.558IU/(Kg·月),P =0.014).对2组白细胞计数(WBC)、SCRP等指标的比较没有发现差异(P＞0.05),而半永久置管组通路感染住院次数和天数高于内瘘组(P=0.034,0.035). 结论 为维持大致相同的Hb水平,比较使用内瘘的MHD患者,半永久置管患者需要注射更大剂量的EPO,故血管通路与肾性贫血的EPO治疗可能存在联系.本研究对其原因尚不能提出明确答案,需要今后扩大样本并进行更严格的前瞻性研究.

目的 观察维持性血液透析患者高通量透析治疗后血清铁调素(Hepcidin)水平的变化,并探讨相关影响因素.方法 维持性血液透析患者40例,高通量透析治疗12月.分别于0月、2月、6月、12月采血,检测血清Hepcidin、铁代谢相关指标、贫血指标及炎症指标超敏C反应蛋白(hs-CRP).采用Pearson相关和多元回归方法分析血清铁调素与其它指标的相关性. 结果 高通量透析后各时间点血清Hepcidin水平均显著高于0月(P＜0.01).铁蛋白、hs-CRP与Hepcidin水平变化趋势大致相符.Pearson相关分析显示,Hepcidin与血清铁、转铁蛋白铁饱和度、铁蛋白、hs-CRP和β2微球蛋白呈正相关(r=0.164、P＜0.05,r=0.168、P＜0.05,r=0.173、P＜0.05,r=0.204、P＜0.01,r=0.692、P＜0.01).多元回归显示,高通量透析治疗患者的转铁蛋白饱和度、hs-CRP、血红蛋白及β2微球蛋白水平与血清Hepcidin水平密切相关.结论 Hepcidin水平可以反映机体铁储备的状况,微炎症状态是影响Hepcidin表达的关键因素.高通量透析治疗可以改善维持性血液透析患者的铁代谢状态,患者的炎症状态变化是其改变的重要影响因素.

The present study was designed to elucidate the expression levels and the proliferative effect of flotillin-1, an integral membrane protein encoded by the FLOT1 gene, in human clear-cell renal cell carcinoma (RCC). Flotillin has been implicated in other types of cancer, but the role of flotillin in RCC has not been established. Immunohistochemistry and western blotting were used to determine FLOT1 protein expression levels in RCC samples from 182 patients who underwent nephrectomy. FLOT1 mRNA expression levels were analyzed using reverse-transcription (RT) and RT-quantitative polymerase chain reaction (PCR). The association between FLOT1 expression levels in the tumor samples and patient survival time was examined using Kaplan‑Meier analysis. To demonstrate the proliferative effect of FLOT1 on RCC cells, a FLOT1 vector was transfected into four RCC cell lines and FLOT1 expression was inhibited using small interfering RNA. The proliferative ability of the RCC cells was investigated using a WST-1 assay and xenograft experiments with BALB/C nude mice. The results demonstrated that FLOT1 expression levels were significantly higher in RCC cell samples from patients than in healthy renal tissue, and the expression levels were associated with tumor stage, size and histological grade. In addition, FLOT1 significantly enhanced the proliferation of RCC cell lines in vitro and in vivo. These findings suggest that FLOT1, which is upregulated in RCC, is involved in RCC cell proliferation, tumorigenesis and progression. Therefore, FLOT1 is an independent prognostic marker and therapeutic target for patients with clear-cell RCC.

Background It has been suggested that glycated hemoglobin (HbA1c) underestimate the actual glycemic control levels in maintenance hemodialysis (MHD) patients, because of anemia and the using of erythropoietin (EPO); it was recommended that glycated albumin (GA) should be an alternative marker. Therefore, the assessment performances of glycemic control were compared between GA and HbA1c in this research by referring to mean plasma glucose (MPG) in diabetes mellitus (DM) patients undergoing MHD or not.Methods MPG was calculated according to the data registered at enrollment and follow-up 2 months later and corresponding HbA1c, albumin (ALB), GA, etc. were measured in 280 cases. A case-control study for comparing GA and HbA1c was done among the groups of MHD patients with DM (n=88) and without DM (NDM; n=90), and non-MHD ones with DM (n=102) using MPG for an actual glycemic control standard.Results In these 3 groups, only for DM patients' (whether undergoing MHD or not), GA and HbA1c correlated with MPG significantly (P <0.01). Through linear regression analysis, it could be found that the regression curves of GA almost coincided in MHD and non-MHD patients with DM, because the intercepts (2.418 vs. 2.329) and slopes (0.053 vs. 0.057) were very close to each other. On the contrary, regression curves of HbA1c did not coincide in the two groups, because variance of the slopes (0.036 vs. 0.052) were relatively large. Through comparing receiver operating characteristic (ROC) areas under the curve (AUC), it could be understood that the assessment performances of GA and HbA1c in MHD patients were lower than those in non-MHD ones, and assessment performance of HbA1c in MHD patients was better than GA (P <0.05). In addition, the effects of Hb and EPO dose on HbA1c, or that of ALB on GA were unobvious in our study.Conclusions Actual glycemic control level in MHD patients with DM may be underestimated by HbA1c, and it could be avoided by GA; however, glycemic evaluating performance of HbA1c may be still better than that of GA. Therefore, HbA1c should not be replaced completely although GA can be used as a choice to monitor glycemic level.

Objective To describe the clinical and pathological characteristics and diagnosis of membranous nephropathy combined with IgA nephropathy. Methods Two patients were confirmed to have idiopathic membranous nephropathy and IgA nephropathy in our hospital. We analyzed the clinical and pathological data and reviewed literature. Results Two patients were all male, 17 and 73 years old. One patient had nephrotic syndrome and microscopic hematuria, The other had proteinuria and microscopic hematuria initially, after 9 years performed nephrotic syndrome. Blood pressure and renal function of two patients were normal. The pathological characteristics included vacuolation and thickening of the glomerular basement membrane, mesangial cells and matrix hyperplasia. And IgA deposit in mesangium, IgG and C3 deposit in subepithelial site mainly. Lumpy electron dense deposited in subepithelial and mesangial area and foot processes fusion under electron microscopy. Two cases were remission after hormone therapy. During 29-41 months of follow up, the renal function remained normal. Conclusion Idiopathic membranous nephropathy combined with IgA nephropathy hadn't special clinical manifestation. Immunofluorescence, electron microscopy and immuno-electron microscopy in the diagnosis is important.

Objective To investigate the potential contributing effects of serum PF4-heparin antibody levels on cardiocerebrovascular events in maintenance hemodialysis(MHD) patients.Methods A total of 112 MHD patients were enrolled in this study.ELISA kit was used to quantify the serum PF4-heparin antibody concentration.All the patients were divided into high-level groups and low-level groups according to the average level of PF4-heparin antibody in all patients.They were followed up for 36 months for cardiocerebrovascular events and death occurrence.Results The prevalence of high-level PF4-heparin antibody was 34.8%.Multiple linear regression analysis showed that PF4-heparin antibody levels were correlated with serum ferritin(r = 0.262,P = 0.035).Cardiocerebrovascular events and mortality rate in high-level group was 50%,while it was 37.5% in low-level group.No significant difference was found in the incidence of all-cause mortality(χ2= 0.480,P = 0.488),cardiocerebrovascular events(χ2= 1.255,P = 0.358),mortality rates(χ2= 1.540,P = 0.265),survival rates(χ2=0.446,P = 0.504) between two groups.Logistic regression analysis showed that age(OR = 1.091,P = 0.000),serum FIB(OR = 10.311,P = 0.002) and serum TG(OR = 1.805,P = 0.040) were the independent risk factors of death.Conclusion Raised serum PF4-heparin antibody may not contribute to cardiocerebrovascular events in MHD patients.

<正>1临床资料患者男性,24岁,主诉乏力、纳差2月,胸闷、憋气2周于2011年6月12日收入我科,患者2011年6月于当地医院测血压249/149mmHg(1mmHg=0.133KPa),查血尿素氮(BUN)21.8mmol/L,血肌酐(Cr)758umol/L,予以置中心静脉导管,开始血液透析治疗。诊断急性肾损伤3期、恶性高血压、恶性高血压肾损害。入院后查血:血浆凝血酶原