Objectives:
This systematic review and meta-analysis assesses the utility of trimetazidine (TMZ) to prevent contrast induced nephropathy (CIN) in patients with renal insufficiency undergoing coronary angiography and angioplasty.
Materials and methods:
This meta-analysis was formulated and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search of databases was conducted by 2 researchers independently for clinical trials, comparing hydration plus TMZ vs conventional hydration alone for prevention of CIN through January 2020. All patients had renal insufficiency (defined as GFR < 89 ml/minute/1.73 m
2
) and the outcome of interest was the incidence of contrast induced acute kidney injury. The odds ratio (OR) was estimated with 95% confidence interval (CI). Heterogeneity was reported with the
I
2
statistic, using a fixed-effects model, and >50% of
I
2
was considered to be statistically significant.
Results:
Eleven studies, 1611 patients, met the inclusion/exclusion criteria: 797 patients comprised the TMZ plus hydration group and the remaining 814 patients comprised the control (hydration only) group. Heterogeneity was low
I
2
= 0%,
P
= .84, and the heterogeneity of each study was also low. The incidence of CIN in the TMZ plus hydration group was 6.6% (53/797), while the incidence of CIN in the control (hydration only) group was 20% (165/814). Pooled analysis of all studies showed TMZ reduced incidence of CIN compared to saline hydration alone (OR risk 0.30, 95% CI 0.21, 0.42,
P
< .0001).
Conclusion:
TMZ added to hydration reduces CIN in renal insufficiency patients undergoing coronary angiography.
Discussion: A rare presentation of syphilis is with liver manifestations. Syphilis can easily be confused with PBC, with an isolated elevation of alkaline phosphatase, and AMA. This is an important consideration when making the diagnosis of PBC. Syphilis should be considered greater in patients with history of multiple sexual partners, patients with HIV, or other sexually transmitted diseases. The patient in this case had complained of joint pain and rash which were thought to be an unrelated rheumatologic condition given improvement with steroids. Alkaline phosphatase was presumed to be artificially decreased secondary to the steroids before starting Ursodiol. Treatment of the underlying syphilis normalized lab values. This case demonstrates the need to consider syphilis in the differential diagnosis of patients presenting with suspected PBC, especially male patients with no history of other autoimmune diseases.
Figure 1. Timeline of JCV-specific testing and treatment over disease course. Abbreviations: A&O, Alert and oriented; HD, hospital day; JCV, Jamestown Canyon virus; STM, short term memory. *Discontinued on HD 30. ** JCV testing performed and resulted after 2 months.
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