Guisen Li

Crush syndrome and acute kidney injury in the Wenchuan Earthquake.

BACKGROUND The Wenchuan Earthquake resulted in calamitous destruction and massive death. We report the characteristics of crush syndrome (CS) and acute kidney injury (AKI) brought by the earthquake, which took place in a mountainous area. METHODS We conducted a cross-section survey of total 2,316 consecutive admissions because of seismic trauma, of which 1,827 had complete data available after we excluded those victims with mild injuries. The characteristics of CS and AKI in the mountainous earthquake were analyzed. RESULTS A total of 149 patients (8.2%) were diagnosed with CS. They had various complications, including different kinds of infection or sepsis, AKI, hematological abnormality, adult respiratory distress syndrome, congestive heart failure, multiple organs dysfunction syndrome, etc. The incidence of hyperkalemia was 15.9% in patients with CS. The hyperkalemia relapsed in five patients after hemodialysis in the first 3 days. AKI occurred in 62 patients (41.6% of CS patients) with CS and 33 of them received renal replacement therapy. In our hospital, 5 of them died. The overall mortality rate was 1.0% and mortality of patients with CS was 6.7%. Twelve patients (50%) died in the first 3 days. CONCLUSIONS Although the mountains hampered rescue actions, causing more loss of life, CS and AKI were still common and life-threatening events in the Wenchuan Earthquake. Most patients with CS and/or AKI had severe complications, especially hyperkalemia.

Relationship of cystatin-C change and the prevalence of death or dialysis need after acute kidney injury: a meta-analysis.

Cystatin‐C (CysC) has been demonstrated as a sensitive and reliable biomarker to predict the onset of acute kidney injury (AKI). However, there are few studies concerned about the relationship between CysC and the outcomes of AKI. The aim of the present study was to determine whether CysC elevation prior to definite diagnosis of AKI is related to higher prevalence of death and dialysis need outcome.

Both pelvic radiography and lateral abdominal radiography correlate well with coronary artery calcification measured by computed tomography in hemodialysis patients: A cross‐sectional study

Introduction Lateral abdominal radiograph is suggested as an alternative to coronary artery computed tomography (CT) in evaluating vascular calcification. Simple scoring systems including pelvic radiograph scoring and abdominal scoring system were utilized to study their correlation with coronary artery calcification. Methods In 106 MHD patients, coronary artery CT, lateral abdominal, and pelvic radiograph were taken. The Agatston scoring system was applied to evaluate the degree of coronary artery calcification which was categorized according to Agatston coronary artery calcification score (CACS) ≥ 30, ≥100, ≥400, and ≥1000. Abdominal aortic calcification was scored by 4‐scored and 24‐scored systems. Pelvic artery calcification was scored by a 4‐scored system. Sensitivities and specificities of abdominal aortic calcification scores and pelvic artery calcification scores to predict different categories of coronary artery calcification were analyzed. We studied the diagnostic capability of abdominal aorta calcification and pelvic artery calcification to predict different CACS categories by calculating likelihood ratios. Receiver operator characteristic curves were used to determine the area under the curve for each of these testing procedures. Findings The prevalence was 48(45.3%), 15 (14.2%), 11 (10.4%), 11 (10.4%), and 11 (10.4%) for CACs > 0, ≥30, ≥100, ≥400, and ≥1000, respectively. The degree of CACs was positively correlated with patient age, prevalence of diabetes, abdominal aorta scores, and pelvic calcification scores. The areas under the curves for different CACS by all X‐ray scoring systems were above 0.70 except pelvic 4‐scored system for diagnosing CACS ≥30, without significant difference (P > 0.05). Discussion Both lateral abdominal and pelvic plain radiographs were demonstrated as acceptable alternatives to CT in evaluating vascular calcification.

Metabolic Syndrome without Diabetes or Hypertension Still Necessitates Early Screening for Chronic Kidney Disease: Information from a Chinese National Cross-Sectional Study.

Metabolic syndrome (MS) is prevalent, with an increasing contribution to the incidence of chronic kidney disease (CKD). The study of the relationship between them is important. The CKD survey, a national cross-sectional study, provided a large database to accomplish this study. The study population were 41 131 adults from this survey between 2008 and 2009. CKD was defined as estimate glomerular filtration rate (eGFR) less than 60 mL/min per 1.73 m2 or the presence of albuminuria. MS was diagnosed by National Cholesterol Education Program—Adult Treatment Panel III (ATPIII), ATPIII-modified or International Diabetes Federation (IDF) criteria. Logistic regression model was applied to study the impact of MS or its components on CKD or its components. The age and sex standardized prevalence of MS by ATPIII, ATPIII-modified and IDF criteria was 11.77% (11.13%–12.40%), 21.51% (20.69%–22.34%) and 16.67% (15.92–17.42)% respectively. Multivariate logistic regression models showed that MS and its components were associated with higher CKD prevalence. The risk for CKD and its components increased with the number of MS components. After adjusting for hypertension and diabetes, the odds ratios of MS for CKD decreased, but remained significantly more than 1 between 1.16(95%CI 1.07–1.26) and 1.37 (95% CI 1.25–1.50) across the different models. Similar results were found with albuminuria, while for decreased eGFR, after adjusting for hypertension and diabetes, the odds ratios of MS and MS components (except elevated TG) became insignificant. In conclusion, MS is prevalent and associated with a higher prevalence of CKD. Different MS components are associated with different risks for CKD, even after adjusting for hypertension and diabetes, which may mainly be contributed more by the increased risk for albuminuria than that for decreased eGFR. More attention must be paid to the population with MS, including those with elevated blood pressure and serum glucose.

Kidney Failure Risk Prediction Equations in IgA Nephropathy: A Multicenter Risk Assessment Study in Chinese Patients

BACKGROUND The clinical course of immunoglobulin A (IgA) nephropathy (IgAN) is highly variable, making it difficult to predict which patients are at risk for rapid progression. The aim of this study was to develop and validate a kidney failure risk prediction equation for adults with IgAN. STUDY DESIGN Multicenter retrospective cohort study of 2,155 Chinese patients with IgAN. CANDIDATE PREDICTORS Clinical and histology variables. OUTCOMES Time to end-stage renal disease (ESRD). ANALYTICAL APPROACH The association of baseline predictors with the outcome was tested using cause-specific hazards models by treating death as a censoring event. RESULTS The discovery cohort was composed of 934 IgAN cases with a mean follow-up of 56.3 months. The independent validation cohort was composed of 1,221 additional patients with a mean follow-up of 47.8 months. There were 212 ESRD events in the combined cohort. The best clinical predictive model of ESRD included 5 variables: age, sex, estimated glomerular filtration rate, hemoglobin concentration, and urine protein excretion. The best model combining clinical and histologic data included 2 clinical variables (age and estimated glomerular filtration rate) and 2 pathology scores (M and T scores from the Oxford classification). Both models predicted ESRD well at 10 years in the validation cohort (C statistics of 0.86 [95% CI, 0.83-0.90] and 0.83 [95% CI, 0.77-0.89], respectively). Continuous net reclassification index and integrated discrimination improvement indicated superior performance of the new models compared with previously published models. The performance of the new clinical model was similar to that of the new model that incorporated histologic variables. LIMITATIONS Retrospective study design, differences in severity of disease between the discovery and validation cohorts, the competing risk of death, lack of validation in ethnically diverse patients. CONCLUSIONS Kidney failure risk in the setting of IgAN is able to be predicted in a Chinese population using clinical and histologic variables. Additional evaluation of these equations needs to be implemented in more ethnically diverse patients before they can be applied to clinical practice broadly.

Clinical Predictors of Outcome in Patients with Anti-neutrophil Cytoplasmic Autoantibody-related Renal Vasculitis: Experiences from a Single-center

Background: Primary anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) is a chronic autoimmune disease associated with multisystem dysfunction. Renal involvement is common and closely associated with outcome. The purpose of this study was to investigate the clinical determinants of mortality of patients with AAV-related renal injury in the first 2 years after diagnosis in a single West Chinese center. Methods: Demographic and laboratory parameters of 123 consecutive patients with AAV-related renal injury diagnosed in Renal Division and Institute of Nephrology, Sichuan Provincial Peoples Hospital between 2004 and 2012 were collected retrospectively. All patients were followed up for 2 years after diagnosis. Survivors were compared with nonsurvivors to identify the clinical baseline variables associated with mortality. Multivariate Cox regression model was used to determine the independent predictors of mortality. Results: Of the 123 patients, 46 (37.4%) died by the end of 2 years after diagnosis, with 41 (33.3%) patients dying within the first 12 months. In comparison with the survivors, Birmingham Vasculitis Activity Score (BVAS), the incidence of pulmonary hemorrhage and digestive system (DS) involvement, serum creatinine, and erythrocyte sedimentation rate were significantly higher in nonsurvivors, whereas lymphocyte counts, hemoglobin, and complement 3 (C3) were significantly lower. Renal replacement therapy was more common in nonsurvivors. High BVAS (hazard ratio [HR] = 1.058, 95% confidence interval [CI]: 1.002–1.117; P = 0.042), pulmonary hemorrhage (HR = 1.970, 95% CI: 1.033–3.757; P = 0.04), DS involvement (HR = 2.911, 95% CI: 1.212–6.911; P = 0.017), and serum creatinine >400 &mgr;mol/L (HR = 2.910, 95% CI: 1.271–6.664; P = 0.012) were independent predictors of death in patients with AAV-related renal injury. Conclusions: Patients with AAV-related renal injury have high early mortality. Those with high BVAS (particularly with pulmonary or DS involvement) and serious renal dysfunction should receive aggressive therapy and careful monitoring to reduce the occurrence of adverse events and improve prognosis.

Nephrology after the Wenchuan earthquake.

The Wenchuan earthquake on May 12, 2008 was a catastrophic natural disaster and resulted in a massive number of deaths and casualties. After the earthquake, nephrologists played critical roles not only in the restoration of dialysis facilities for regular renal replacement therapy but also in the prevention and treatment of crush syndrome and crush-related acute kidney injury. Brief guidelines, functional action plans and good training were significant factors in nephrologists being able to fulfill their critical roles, but the national network of renal disaster relief was also extremely important.