The two major theories of glucocorticoid (GC)-induced osteonecrosis of the femoral head (ONFH) are apoptosis and ischaemia. The traditional theory implicates ischaemia as the main aetiological factor because the final common pathway of ONFH is interruption of blood supply to the bone. The most common causes of interruption of blood supply include fat embolism and coagulation disorders. GCs can directly or indirectly lead to coagulation disorders, producing a hypercoagulable state, followed by poor blood flow, ischaemia, and eventually ONFH. This review summarizes the existing knowledge on coagulation disorders in the context of GC-induced ONFH, including hypofibrinolysis and thrombophilia, endothelial cell dysfunction and damage, endothelial cell apoptosis, lipid metabolism, platelet activation, and the effect of anticoagulant treatment.
Double-lumen catheters have been used widely to obtain temporary access in patients who are in need of acute hemodialysis (HD) because of acute renal failure. Several complications are associated with the insertion of these catheters, including bleeding, infection, injuries to arteries, and deep venous thrombosis. An arteriovenous fistula (AVF) is a rare but significant complication following catheterization for temporary HD. Herein, we present a case of AVF associated with leg swelling 6 months after the removal ofa double-lumen HD catheter.We describe a special case of a 42-year-old man who experienced acute renal failure secondary to diabetic ketoacidosis (DKA). A 12-Fr dialysis catheter was inserted in the right femoral vein. Six months after catheter removal, the patient was admittedfor pain and swelling in the right leg. Color Doppler ultrasound and three-dimensional computed tomography (CT) revealed an AVF between the right femoral vein and the right femoral superficial artery. The fistula was repaired successfully by vascular surgeons.This case highlights that an AVF is a rare but significant complication after catheterization for temporary HD. The nephrologist should be wary of the potential of this complication and perform clinical and medical examinations at the insertion and removal of temporary HD catheters.
Overall, 24 h proteinuria correlated strongly with the spot urine P/C ratio (r = 0.671, p < 0.001) with a good agreement (ICC = 0.656, 95% confidence interval (CI): 0.52-0.76). Subgroup analyses revealed that the correlation remained high in all groups (r = 0.825, p < 0.001; r = 0.567, p = 0.001; r = 0.686, p = 0.020), the agreement in group A (low AI) was good (ICC = 0.824, 95% CI: 0.70-0.89), but in group B (middle AI) and group C (high AI), the agreements were weak (ICC = 0.503, 95% CI: 0.19-0.72; ICC = 0.532, 95% CI: 0.06-0.84). Our work suggests that over the range of a higher AI, however, correlation was present but agreement was poor.
We concluded that plasma BNP offers a good sensitivity and specificity in diagnosing left ventricular dysfunction in patients with dialysis-dependent renal failure.
Plasma BNP levels are elevated in patients with chronic renal failure. Allograft renal transplantation significantly reduces BNP. Sudden increases in plasma BNP after the transplantation are associated with allograft dysfunction. Together with other biomarkers, plasma BNP may be used to predict the changes in renal function after transplantation.
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