Humans ; Blood Pressure/physiology* ; Renal Insufficiency, Chronic ; Hypertension/drug therapy* ; Antihypertensive Agents/therapeutic use*

The population of chronic kidney disease (CKD) with hypertension in China is characterized by complex etiology, high incidence rate, low awareness and control rate. How to diagnose and treat hypertension in CKD patients properly and improve their prognosis is particularly urgent. Several clinical guidelines or expert consensus on the diagnosis, treatment and management of hypertension have been issued. Some of them involve the diagnosis and treatment of hypertension in CKD patients, but they still can not meet the demand for diagnosis and treatment of hypertension in CKD patients. Based on the situation of hypertension in CKD patients in China, the Chinese Society of Nephrology organized an expert group to formulate this guideline. This guideline systematically introduces the diagnostic criteria, epidemiology, risk factors, poor prognosis of hypertension, the purpose, timing and control goals of antihypertensive therapy in CKD patients, as well as blood pressure control goals for special populations, non drug treatment and drug treatment of hypertension. This guideline aims to further strengthen the management of hypertension in CKD patients, standardize the diagnosis and treatment standards, formulate reasonable treatment plans, effectively control hypertension, reduce complications, so as to delay the progress of kidney diseases and improve the long-term prognosis of hypertension in Chinese CKD patients.
Humans ; Antihypertensive Agents/therapeutic use* ; Hypertension/therapy* ; Renal Insufficiency, Chronic/therapy* ; Blood Pressure ; Risk Factors ; China/epidemiology*

OBJECTIVE: To investigate the status quo of recognition and management of renal colic among urological surgeons in China. METHODS: From November 2021 to March 2022, 725 urological surgeons in China were surveyed in the form of a questionnaire, including their province, hospital grade, professional title, the number of patients with renal colic treated per week, the preferred drugs and the cognition of the disease. This study was approved by the Medical Ethics Committee of Peking University People's Hospital, and all respondents completed informed consent online. RESULTS: During November 2021 and March 2022, urological surgeons across China were surveyed in the form of a questionnaire, and the reliability and validity of the questionnaire were verified before the study was carried out. In the study, 720 valid questionnaires were collected (accounting for 99.31% of the total number), in which 42.4% of the doctors' preferred drugs were non-steroidal anti-inflammatory drugs (NSAIDs), and 40.0% of the doctors' preferred antispasmodic drugs. Opioids were the first choice of 11.0% of the physicians and other treatments were preferred by 6.6% of physicians. In addition, 61.1% of the doctors thought that the mechanism of renal colic was elevated prostaglandin, 32.2% thought it was ureteral spasm, 5.0% thought it was calculi irritation, and 1.7% thought the mechanism was unclear. The doctor of the cognition of the generation mechanism of renal colic pain had a significant influence on the preferred treatment option (χ²=54.399, P < 0.001) that the "elevated prostaglandins" doctor more often preferred NSAIDs than the doctor who thought cramps and ureter stones caused renal colic (51.6% vs. 28.0%, χ²=34.356, P < 0.001;51.6% vs. 19.4%, χ²=13.759, P < 0.001). In addition, hospital class, physician title, and the number of weekly consultations by physicians influenced the choice of medications for renal colic (P < 0.05), tertiary hospitals, middle and senior professional titles and weekly patients with renal colic > 8 cases generally preferred NSAIDs. CONCLUSION There are deficiencies in the cognition and drug treatment of renal colic among urological surgeons in China. The choice of the preferred drug was related to the doctor's cognition of the disease, the grade of the hospital, the doctor's professional title and the weekly treatment volume.
Humans ; Renal Colic/drug therapy* ; Urologists ; East Asian People ; Reproducibility of Results ; Anti-Inflammatory Agents, Non-Steroidal ; Surveys and Questionnaires

OBJECTIVE: To investigate the potential effect of modification of antihypertensive medications on the association of nitrogen dioxide (NO₂) long-term exposure and chronic kidney disease (CKD). METHODS: Data of the national representative sample of adult population from the China National Survey of Chronic Kidney Disease (2007-2010) were included in the analyses, and exposure data of NO₂ were collected and matched. Generalized mixed-effects models were used to analyze the associations between NO₂ and CKD, stratified by the presence of hypertension and taking antihypertensive medications. The stratified exposure-response curves of NO₂ and CKD were fitted using the natural spine smoothing function. The modifying effects of antihypertensive medications on the association and the exposure-response curve of NO₂ and CKD were analyzed. RESULTS: Data of 45 136 participants were included, with an average age of (49.5±15.3) years. The annual average exposure concentration of NO₂ was (7.2±6.4) μg/m³. Altogether 6 517 (14.4%) participants were taking antihypertensive medications, and 4 833 (10.7%) participants were identified as having CKD. After adjustment for potential confounders, in the hypertension population not using antihypertensive medications, long-term exposure to NO₂ was associated with a significant increase risk of CKD (OR: 1.38, 95%CI: 1.24-1.54, P < 0.001); while in the hypertension population using antihypertensive medications, no significant association between long-term exposure to NO₂ and CKD (OR: 0.96, 95%CI: 0.86-1.07, P=0.431) was observed. The exposure-response curve of NO₂ and CKD suggested that there was a non-linear trend in the association between NO₂ and CKD. The antihypertension medications showed significant modifying effects both on the association and the exposure-response curve of NO₂ and CKD (interaction P < 0.001). CONCLUSION The association between long-term exposure to NO₂ and CKD was modified by antihypertensive medications. Taking antihypertensive medications may mitigate the effect of long-term exposure to NO₂ on CKD.
Adult ; Air Pollutants/analysis* ; Air Pollution/analysis* ; Antihypertensive Agents/adverse effects* ; Environmental Exposure/analysis* ; Humans ; Hypertension/epidemiology* ; Middle Aged ; Nitrogen Dioxide/analysis* ; Particulate Matter ; Renal Insufficiency, Chronic/epidemiology*

A 64-year-old man was treated with sunitinib as a first-line therapy for metastatic renal cell carcinoma. He was given oral sunitinib in cycles of 50 mg once daily for 2 weeks followed by a week off. During the 5th week of treatment right upper quadrant pain developed, but this resolved spontaneously during the 6th week (off treatment). However, on the 8th week of treatment, he was admitted to hospital because the acute right upper quadrant pain recurred with nausea, vomiting, and fever. Acute acalculous cholecystitis was then diagnosed by ultrasonography and CT. In addition, his laboratory findings indicated disseminated intravascular coagulation. Accordingly, sunitinib therapy was discontinued and broad-spectrum antibiotics initiated. He subsequently recovered after emergent percutaneous cholecystostomy. His Naranjo Adverse Drug Reaction Probability Scale score was 7, indicaing a probable association of the event with sunitinib. Suspicion of sunitinib-related acute cholecystitis is required, because, although uncommon, it can be life-threatening.
Acalculous Cholecystitis ; Anti-Bacterial Agents ; Carcinoma, Renal Cell ; Cholecystitis, Acute ; Cholecystostomy ; Disseminated Intravascular Coagulation ; Drug-Related Side Effects and Adverse Reactions ; Fever ; Humans ; Middle Aged ; Nausea ; Ultrasonography ; Vomiting

The kidneys are closely connected with several organs, including the liver, and can therefore be negatively affected when the liver is damaged. The most common cause of chronic liver disease is chronic viral hepatitis, resulting from either a hepatitis B virus (HBV) or a hepatitis C virus (HCV). Chronic viral hepatitis often progresses to cirrhosis and hepatocellular carcinoma. However, it can also lead to viral-associated glomerulopathies that can cause chronic kidney disease (CKD), which can then progress to end stage renal disease (ESRD). Additionally, patients with ESRD on hemodialysis are at risk for viral infections because HBV and HCV are hematogenously transmitted. Recently, treatments with oral nucleoside/nucleotide analogues and direct-acting antivirals have yielded excellent results in HBV- and HCV-infected patients with CKD. As a result, a new paradigm for the treatment of chronic viral infections in CKD patients has emerged. This review discusses viral-associated glomerulopathies, antiviral treatments of HBV and HCV infections in patients with CKD, and prevention strategies for the transmission of HBV and HCV in patients with ESRD.
Antiviral Agents ; Carcinoma, Hepatocellular ; Chronic Disease ; Fibrosis ; Hepacivirus ; Hepatitis ; Hepatitis B virus ; Humans ; Kidney Diseases ; Kidney Failure, Chronic ; Kidney ; Liver Diseases ; Liver ; Renal Dialysis ; Renal Insufficiency, Chronic

BACKGROUND/AIMS: To investigate the treatment efficacy and renal safety of long-term tenofovir disoproxil fumarate (TDF) therapy in chronic hepatitis B (CHB) patients with preserved renal function. METHODS: The medical records of 919 CHB patients who were treated with TDF therapy were reviewed. All patients had preserved renal function with an estimated glomerular filtration rate (eGFR) of at least 60 mL/min/1.73 m2. RESULTS: A total of 426 patients (184 treatment-naïve and 242 treatment-experienced) were included for analysis. A virologic response (VR) was defined as achieving an undetectable serum hepatitis B virus (HBV) DNA level, and the overall VR was 74.9%, 86.7%, and 89.4% at the 1, 2, and 3-year follow-ups, respectively. Achieving a VR was not influenced by previous treatment experience, TDF combination therapy, or antiviral resistance. In a multivariate analysis, being hepatitis B e antigen positive at baseline and having a serum HBV DNA level ≥2,000 IU/mL at 12 months were associated with lower VR rates during the long-term TDF therapy. The overall renal impairment was 2.9%, 1.8%, and 1.7% at the 1, 2, and 3-year follow-ups, respectively. With regard to renal safety, underlying diabetes mellitus (DM) and an initial eGFR of 60 to 89 mL/min/1.73 m2 were significant independent predictors of renal impairment. CONCLUSIONS: TDF therapy appears to be an effective treatment option for CHB patients with a preserved GFR. However, patients with underlying DM and initial mild renal dysfunction (eGFR, 60 to 89 mL/min/1.73 m2) have an increased risk of renal impairment.
Antiviral Agents ; Diabetes Mellitus ; DNA ; Follow-Up Studies ; Glomerular Filtration Rate* ; Hepatitis B ; Hepatitis B virus ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Medical Records ; Multivariate Analysis ; Renal Insufficiency ; Tenofovir* ; Treatment Outcome*

Chronic kidney disease (CKD) is increasing worldwide without an effective therapeutic strategy. Sympathetic nerve activation is implicated in CKD progression, as well as cardiovascular dysfunction. Renal denervation is beneficial for controlling blood pressure (BP) and improving renal function through reduction of sympathetic nerve activity in patients with resistant hypertension and CKD. Sympathetic neurotransmitter norepinephrine (NE) via adrenergic receptor (AR) signaling has been implicated in tissue homeostasis and various disease progressions, including CKD. Increased plasma NE level is a predictor of survival and the incidence of cardiovascular events in patients with end-stage renal disease, as well as future renal injury in subjects with normal BP and renal function. Our recent data demonstrate that NE derived from renal nerves causes renal inflammation and fibrosis progression through alpha-2 adrenergic receptors (α₂-AR) in renal fibrosis models independent of BP. Sympathetic nerve activation-associated molecular mechanisms and signals seem to be critical for the development and progression of CKD, but the exact role of sympathetic nerve activation in CKD progression remains undefined. This review explores the current knowledge of NE-α₂-AR signaling in renal diseases and offers prospective views on developing therapeutic strategies targeting NE-AR signaling in CKD progression.
Blood Pressure ; Denervation ; Disease Progression ; Fibrosis ; Homeostasis ; Humans ; Hypertension ; Incidence ; Inflammation ; Kidney Failure, Chronic ; Neurotransmitter Agents ; Norepinephrine ; Plasma ; Prospective Studies ; Receptors, Adrenergic ; Receptors, Adrenergic, alpha-2 ; Renal Insufficiency, Chronic ; Reperfusion Injury

BACKGROUND: The objective of this study was to establish the efficacy and safety of procalcitonin (PCT)-guided antibiotic discontinuation in critically ill patients with sepsis in a country with a high prevalence of antimicrobial resistance and a national health insurance system. METHODS: In a multi-center randomized controlled trial, patients were randomly assigned to a PCT group (stopping antibiotics based on a predefined cut-off range of PCT) or a control group. The primary end-point was antibiotic duration. We also performed a cost-minimization analysis of PCT-guided antibiotic discontinuation. RESULTS: The two groups (23 in the PCT group and 29 in the control group) had similar demographic and clinical characteristics except for need for renal replacement therapy on ICU admission (46% vs. 14%; P = 0.010). In the per-protocol analysis, the median duration of antibiotic treatment for sepsis was 4 days shorter in the PCT group than the control group (8 days; interquartile range [IQR], 6–10 days vs. 14 days; IQR, 12–21 days; P = 0.001). However, main secondary outcomes, such as clinical cure, 28-day mortality, hospital mortality, and ICU and hospital stays were not different between the two groups. In cost evaluation, PCT-guided therapy decreased antibiotic costs by USD 30 (USD 241 in the PCT group vs. USD 270 in the control group). The results of the intention-to-treat analysis were similar to those obtained for the per-protocol analysis. CONCLUSION: PCT-guided antibiotic discontinuation in critically ill patients with sepsis could reduce the duration of antibiotic use and its costs with no apparent adverse outcomes. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02202941
Anti-Bacterial Agents ; Biomarkers ; Calcitonin ; Costs and Cost Analysis ; Critical Illness ; Hospital Mortality ; Humans ; Intensive Care Units ; Length of Stay ; Mortality ; National Health Programs ; Prevalence ; Renal Replacement Therapy ; Sepsis

Kidney transplantation (KT) is the gold standard for renal replacement therapy in pediatric patients with end-stage renal disease. Recently, it has been observed that the outcome of pediatric KT is nearly identical to that in adults owing to the development and application of a variety of immunosuppressants and newer surgical techniques. However, owing to several differences in characteristics between children and adults, pediatric KT requires that additional information be learned and is associated with added concerns. These differences include post-KT complications, donor-recipient size mismatch, problems related to growth, and nonadherence to therapy, among others. This review was aimed at elucidating the clinical characteristics of pediatric KT that differ from those observed in adults.
Adult* ; Child ; Humans ; Immunosuppressive Agents ; Kidney Failure, Chronic ; Kidney Transplantation* ; Kidney* ; Renal Replacement Therapy