We conclude that poor glycaemic control before starting dialysis is a strong predictor of cardiovascular morbidity and survival for type II diabetics on haemodialysis. These results imply that better glycaemic control before dialysis might be important in improving the long-term prognosis in type II diabetics on haemodialysis.
Our observations suggest that the combined use of follow-up AFP levels and King's criteria is helpful in predicting the poor prognosis of severe acute hepatitis superimposed on chronic hepatitis B.
The population of elderly patients entering chronic dialysis programmes is increasing. Elderly patients are susceptible to malnutrition and have multiple complicating disorders in addition to uraemia. Selecting appropriate dialysis modality is particularly critical in elderly patients. Continuous ambulatory peritoneal dialysis (CAPD) has many advantages to elderly patients; however, the clinical outcome varies for elderly CAPD patients. In comparison with Westerners, Southeast Asians have a small body mass index and may be more suited to CAPD therapy. To identify the prognostic predictors in elderly Southeast Asian patients, this historical cohort study analysed 144 patients aged > or = 65 years at initiation of CAPD. A group of haemodialysis (HD) patients aged > or = 65 years was utilised as the control group. Survival curves for patient and technique were derived from Kaplan-Meier analysis and were further analysed by Cox-Mantel log-rank test. To elucidate the impact of individual factors on patient survival, various significant univariables were further subjected to multivariate analysis. No significant increase existed for relative risk of technique failure in elderly patients compared with younger patients. This analytical data indicates that CAPD was as good as HD for elderly uraemic patients regarding to the patient survival. Diabetes, dependent patients, low albumin levels and previous HD history were significant poor prognostic factors for survival of elderly CAPD patients. In conclusion, CAPD is an effective modality of renal replacement therapy for Southeast Asian elderly patients. The technique survival was not affected by patient age.
As transforming growth factor- β1 (TGF- β1) is implicated in the pathogenesis of glomerulosclerosis, the aim of the study was to demonstrate if levels of glomerular TGF- β1 mRNA in renal biopsies correlated with glomerulosclerosis. Glomeruli were collected by microdissection from renal biopsies in patients with membranous nephropathy, lupus nephritis, diabetic nephropathy, minimal change disease and IgA nephropathy presented by proteinuria when serum creatinine was < 3 mg%. Glomerular mRNAs were reverse transcribed and TGF- β1, α2(IV) collagen, β-actin cDNA quantitated by competitive polymerase chain reaction (PCR). By semiquantitative electron microscopy, a 3.5-fold increase of glomerular TGF- β1/β-actin mRNA ratio in the moderate sclerotic group (n = 23, p < 0.01) and a 1.5-fold increase in the mild sclerotic group (n = 22, p < 0.05) were observed when compared to the minimal sclerotic group (n = 12). A concordant increase of glomerular α2(IV) collagen mRNA was found with 2.2- and 1.3-fold in moderate and mild sclerotic groups, respectively. The TGF- β1/β-actin mRNA ratios were highest in membranous nephropathy (466.4 ± 133.4, n = 11), followed by lupus nephritis (394.9 ± 94.8, n = 12) and diabetic nephropathy (333.2 ± 97.6, n = 10). Patients with minimal change disease (233.1 ± 54.1, n= 15) and IgA nephropathy (185.3 ± 39.6, n = 9) had low levels. The degree of glomerulosclerosis in each group followed the TGF- β1/β-actin mRNA ratios indicating that the level is the major determinant of glomerulosclerosis but not the disease entities. Glomerular TGF- β1/β-actin mRNA ratio did not correlate with clinical parameters such as the urinary protein excretion and creatinine clearance. These results suggest that glomerular TGF- β1/β-actin mRNA ratio may be used as a marker of glomerulosclerosis in renal biopsy to reflect the local sclerotic process.
Only 68% of patients with LC-associated MBDI who underwent reconstructive surgery at our institution had long-term success. A serum alkaline phosphatase level above 400 IU in the sixth postoperative month was predictive of nonsuccess. For better long-term results, repair should be performed by the referral surgeon at a stage without coexisting active inflammation.
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