The incidence of malnutrition among patients with chronic kidney disease (CKD) constantly increases despite the development of health care and dialysis techniques.New nutritional targets for CKD patients upon maintenance treatment have been developed.Before dialysis,evidences have shown that a long-term nutritional care plan,with a control of protein intake,can effectively correct metabolic disorders including proteinuria and acidosis.During the maintenance dialysis,the optimal protein and energy intakes have been recently challenged.The new classification of nutritional disorders in CKD patients may help the easily identification of protein-energy wasting.

Objective To investigate the cause,prognosis and risk factors of hospitalized patients with acute renal failure(ARF). Methods The clinical data of patients with ARF in our hospital from December 2003 to December 2006 were studied retrospectively. Results There were 108 744 admissions during the study period and 320 met with the diagnostic criteria of ARF.Of 320 ARF patients,135(42.2%)were indentified with the onset of the disease over or at the age of 60.Infection,heart failure and drug were the major causes of ARF.The overall mortality rate of ARF patients was 31.9%.The mortality rate of the elderly was significantly higher than that of the non-elderly.The Logistic regression analysis revealed that heart failure,respiratory failure and malignant tumor were the related risk factors of prognosis.The mortality in replacement therapy group was lower than that in conservative treatment group (23.2% vs 35.6%,P＜0.05).Conclusions The incidence and mortality of hospitalized patients with acute renal failure are high.The prognosis of replacement therapy group is better than conservative treatment group.

Objective To investigate the etiology,prognosis and risk factors of hospitalized elaerly patients with acute renal failure(ARF).Methods The clinical data of elderly patients with ARF in our hospital from De-cember 2003 to December 2006 were studied prospectively.The clinical features were comparea with those of the non-aged patients with ARF during the same period.Results Of 320 patients,135(42.2%)were identified with the onset of ARF.Infections and postrenal obstructive diseases were the major causes of ARF in the elderly.Fifty-one dead patients in the young,thirty-one in the 60-79 years old group,and twenty in the above 80 years old group(P<0.05).The results of logistic regression analysis suggested that oliguria,previous renal inadequacy and heart failure were the related risk factors of prognosis.Conclusion The incidence and mortality of hospitalized elderly patients with ARF are high.With the rising of age.the mortality of ARF increases.Dialysis in time might improve the progno-sis of ARF.

OBJECTIVE: To investigate the protection mechanism of volatile oil of Magnolia biondii Pamp. (VOMBP) against diabetic nephropathy in rats by observing its effects on level of soluble P-selectin (sP-selectin) in serum and expression of P-selectin in renal tissue. METHODS: Fifty SD rats were randomly divided into normal control group, untreated group, and low-, medium- and high-dose VOMBP-treated group. Diabetic nephropathy was induced in rats by intraperitoneal injection of 1% streptozotocin. Before and the 1st day, 4th, 8th and 12th week after the induction, random blood glucose (RBG) and 24-hour urinary micro-albumin were detected in different groups. At the 12th week, the rats were sacrificed to collect the blood samples and renal tissues. The contents of blood urea nitrogen (BUN) and serum creatinine (SCr) were detected and the pathological change in renal tissues was observed by light microscope; the level of sP-selectin was detected by enzyme-linked immunosorbent assay and the expression of P-selectin protein in renal tissues was measured by immunohistochemical method. RESULTS: Compared with the normal control group, RBG, 24-hour urinary micro-albumin, the contents of BUN, sP-selectin in serum and expression of P-selectin protein in renal tissue in the untreated group were significantly increased (P<0.01), the content of SCr was significantly decreased (P<0.01), and pathological change of renal tissues was also obvious. Compared with the untreated group, 24-hour urinary micro-albumin, the level of sP-selectin in serum and expression P-selectin protein in renal tissue of the three VOMBP-treated groups were all significantly decreased (P<0.01), and pathological change was lessened too. However, there were no significant differences among the three VOMBP-treated groups (P>0.05). CONCLUSION: VOMBP can protect the kidney in rats with diabetic nephropathy by inhibiting the expressions of P-selectin protein in serum and in renal tissue.

Objective:To analyze the risk factors for protein-energy wasting(PEW)in elderly patients undergoing hemodialysis(HD)and peritoneal dialysis(PD), in order to provide evidence for the prevention of PEW and improve the prognosis in these patients.Methods:According to the diagnostic criteria for PEW proposed by the International Society for Renal Nutrition and Metabolism, 112 elderly patients who had undergone PD and HD without PEW from May 2016 to June 2020 in the renal medicine department of the Eighth People's Hospital of Shanghai, the geriatric medicine department of Zhongshan Hospital Affiliated to Fudan University and the renal medicine department of the Sixth People's Hospital Affiliated to Shanghai Jiaotong University were included as the non-PEW group.During the same period, 114 cases with PEW were recruited as the PEW group.Differences in general patient data, biochemical test values, anthropometric measurements, bioelectrical impedance and other index values were compared between the two groups.Independent risk factors for PEW in elderly HD and PD patients were analyzed by using binary Logistic regression analysis.Results:Compared with the non-PEW group, the PEW group had a higher mean age( t=0.951, P<0.001), a higher proportion of patients aged ≥65 years( χ2=17.161, P<0.001), a lower body mass index( t=6.740, P<0.001), a higher incidence of diabetic nephropathy( χ2=14.176, P<0.001), a higher hemodialysis rate( χ2=4.543, P=0.033), and a longer duration(months)of dialysis( t=2.306, P=0.023). Levels of serum transferrin, prealbumin, total protein, hemoglobin and total cholesterol and body cell mass index were lower( t=6.262, 13.405, 9.507, 8.341, 4.610, 5.599 and 2.499, all P<0.05), high-sensitivity C-reactive protein levels and the body water percentage were higher( t=6.380, 4.519, both P<0.001), and the upper arm muscle circumference was smaller( t=5.418, P=0.000)in the PEW group than in the non-PEW group.Binary Logistic regression analysis showed that age≥65 years, dialysis duration, serum albumin and high-sensitivity C-reactive protein levels were independent influencing factors for PEW in elderly HD patients( OR=2.762, 0.182, 2.694 and 2.980, P=0.023, 0.007, 0.009 and 0.027). Age ≥65 years, body mass index and the hemoglobin level were independent influencing factors for PEW in elderly PD patients( OR=2.452, 0.671 and 0.962, P=0.013, 0.000 and 0.000). Conclusions:The incidence of PEW is lower in elderly HD patients than in elderly PD patients.Clinical intervention should be carried out based on influencing factors, in order to prevent the occurrence of PEW.

Objective To observe the therapeutic effects of the drugs alternation multiple stages and long term therapy in elderly patients with recurrent urinary tract infection.Methods The patients were divided into elderly group (age≥65 years,n=30) and non-elderly group (n=48).The multiple effective antibiotics were selected for alternate use.The treatment included four periods as follows:(1)Treatment period:the regular dose of antibiotic was maintained until the urine routine test result became normal;(2)Consolidation period:the dosage of antibiotic was reduced;(3)Maintenance period:the dosage of antibiotic was reduced to once every night and the treatment should be kept for three months;(4)Observation period:the patients were observed for six months after withdrawal of antibiotics.During the treatment,if the urine routine test became abnormal repeatedly,the patient should return to the previous treatment period.During the treatment and consolidation period,each medication should be applied for one week alternatively.Results Among 78 patients,69 cases (88.5%) were cured,7 cases (8.9%) were effective,and two cases (2.56%) were invalid.There were 28 cured cases,1 effective case and 1 invalid case in elderly group.The corresponding data were 41,6 and 1 in non-elderly group,respectively.There was no difference in cure rate between the two groups (F= 0.469).Compared with non-elderly group,the overall treatment time [(54.8± 16.2)weeks vs.(44.5± 13.7) weeks,t= 2.8467,P＜0.01],treatment period [( 34.3± 15.2) weeks vs.(26.2±14.8) weeks,t=2.2081,P＜0.05] and consolidation period [(5.7±2.6) weeks vs.(4.1±0.2) weeks,t=3.9369,P＜0.01] were all prolonged in elderly group.But there was no difference in maintenance period [(14.8±4.6) weeks vs.(14.2±3.1) weeks,t=0.6480,P＞0.05].There were no markedly changes in blood routine,liver and kidney function during the course of treatment.Conclusions For the elderly patients with recurrent urinary tract infection,the drugs alternation,multiple stages and long-term treatment has a high cure rate and no adverse effect on blood routine,liver and renal function.

ObjectiveTo improve the correction rate of clinical, understand transpedicular vertebral intervertebral spinal shortening osteotomy for treatment of clinical efficacy of kyphosis. Methods40 patients with kyphosis,were selected as research objects. beffore and after the kyphosis correction surgery, pain improvement, efficacy and complications were retrospectively studied. ResultsBefore and after surgical correction of spinal kyphosis angle control study showed significant differences. Before and after surgical correction of grading oral pain control study showed significant differences.40 patients,the effects of surgical correction achieved grade Ⅰ ,35 cases(87.5％ ) ,grade Ⅱ in 5 cases ( 12.5％ ), grade Ⅲ and Ⅳ 0. ConclusionIntervertebral vertebral pedicle shortening osteotomy surgery could effectively correct spinal kyphosis, relieve pain and discomfort of patients, and safe, and it was worth to promote in the clinical use.

BACKGROUND: Research has been reported that serum soluble CD146 (sCD146) expression was improved on the surface of endothelial cells and activated T cells by the stimulation of inflammatory factor. Therefore, it predicts that CD146 may participate in inflammatory reaction of tissue.OBJECTIVE: To investigate the expression and clinical significance of serum sCD146 in peripheral blood from patients with ankylosing spondylitis.METHODS: A total of 62 patients with ankylosing spondylitis were selected from the Sixth People's Hospital AffiUated to Shanghai Jiao Tong University. All patients were divided into two groups: active group (n=46) and inactive group (n=16); while, 20 healthy subjects were selected as the control group. Indicators including Bath Ankylosing SpondyUtis Disease ActivityIndex (BASDAI),Bath Ankylosing Spondylitis Functional Index (BASFI), patient's global assessment (PGA), night pain, visual analogue scale (VAS),morning stiffness time, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were measured in all patients. The serum concentration of sCD146 from 62 patients with ankylosing spondlitis and 20 healthy controls was measured by enzyme-linked immunosorbent assay. Westergren method was used to measure ESR and immunoturbidimetry for CRP. Clinical data of the patients were collected as well.RESULTS AND CONCLUSION: sCD146 levels of patients with ankylosing spondlitis were significantly higher than normal control group (P ＜ 0.05). The sCD146 expression in the active group was significantly higher than inactive and normal control groups (P ＜0.05). Positive correlations were observed between sCD146 and BASDAI index of patients with ankylosing spondlitis (P ＜ 0.05).The sCD146 levels of ankylosing spondUtis patients with peripheral joint involvement were significantly higher than the patients with axial involvement alone or the normal controls (P ＜ 0.05).The expression level of sCD146 in peripheral blood was positively correlated with disease activities of patients with ankylosing spondlitis. It may play important roles in the pathogenesis in ankylosing spondlitis.

Objective To retrospectively study the risk factors of aortic arch calcificationand its influence on the survival prognosis of maintenance peritoneal dialysis patients. Methods One hundred seventy-seven cases of maintenance peritoneal dialysis patients were enrolled, including 66 cases of aortic arch calcification cases. Their general dialysis data were collected for the evaluation of dialysis adequacy and residual renal function, and their chest X-rays were recorded to assess the degree of aortic arch calcification. The two variables Logistics regression was used to analyze independent risk factors of aortic arch calcification; Kaplan-Meier analysis was used to analyze the influence on prognosis of dialysis patients; and multivariate COX regression was employed to analyze independent risk factors of death in dialysis patients. Results Among the 177 selected cases of peritoneal dialysis patients, 66 cases (37.29%) presented with aortic arch calcification. Elevated serum phosphorus was an independent risk factor of aortic arch calcification (OR=54.69 ,95%CI:10.01-298.65, P<0.01). The probability of survival in patients with mild and moderate (severe) calcification of aortic arch was less than those without calcification. Moderate (severe) calcification of aortic arch was the independent risk factor of all-cause mortality and cardiovascular disease mortality, whose hazard ratios in patients with calcification were 3.779 times and 5.636 times of those in patients without calcification respectively. Conclusions Hyperphosphatemia is an independent risk factor promoting the development of calcification of aortic arch. The probability of survival in patients with mild and moderate (severe) calcification of aortic arch is less than those without calcification; moderate (severe) calcification of aortic arch is the independent risk factor of all-cause mortality and cardiovascular disease mortality.

Objective To observe the occurrence and risk factors of arrhythmia in chronic kidney disease (CKD) patients in different stages of renal function. Methods A total of 405 CKD patients were enrolled in this study and none of them received renal replacement therapy.The 24 h dynamic electrocardiogram (DCG) was performed,and baseline characteristics were compared.Multivariable Logistic regression analysis was used to examine the relationship between the severe arrhythmia and the potential risk factors,such as age,gender,CKD stage,diabetes,hypertension,hyperpotassaemia,left ventricular hypertrophy (LVH),etc. Results There were 69 patients (17.04％),79 patients (19.51％),82 patients (20.25％),88 patients (21.73 ％) and 87 patients (21.48％) in CKD stage 1,2,3,4 and 5,respectively.As high as 45.68％ of all the patients had severe arrhythmia,represented by 27.54％,29.11％,42.68％,57.95％ and 65.52％ in CKD stages 1-5 respectively.The occurrence of severe arrhythmia increased as the eGFR decreased in CKD stages 2,3,4 (p＜0.05).On multivariable Logistic regression analysis,the occurrence of severe arrhythmia was related to LVH,CKD stage,diaberes hyertension and hyperpotassaemia are signidicantly assoxiated with severe arrhythmia.