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01 December 2014, Volume 34 Issue 12 Previous Issue    Next Issue

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Prevention，diagnosis，and treatment of kidney diseases in the elderly：current status and perspectives CAI Guang-yan，CHEN Xiang-mei. 2014, 34(12): 1133-1134.  DOI: 10.7504/nk2014110101 Abstract ( )   PDF (874KB) ( )   Abstract：The elderly are at high risk of chronic kidney disease，who has become a major population in the newly admission to dialysis treatment.So the elderly will be the focus of CKD prevention task in future.At present，challenges still remain in the diagnosis and treatment of CKD in the elderly：there is no unified criteria for CKD diagnosis in the elderly，un-settled treatment target of CKD complications in the elderly；complicated theraputic strategies in the elderly ESRD patients.We particularly stress the importance of patient-centered，instead of disease-oriented，individualized treatment in the prevention and treatment of CKD in the elderly.

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Clinical evaluation and management of chronic kidney disease in the elderly YUE Rong-zheng，FU Ping. 2014, 34(12): 1135-1138.  DOI: 10.7504/nk2014110201 Abstract ( )   PDF (945KB) ( )   Abstract：A suitable evaluation and management structure is important for slowing and delaying the progression of chronic kidney disease (CKD) and improving the quality of life in the elderly patients.Due to the special features of the elderly CKD patients，there also exist some problems to be solved or researched on currently.According to the latest guideline for clinical practice，we discuss some aspects in diagnosis and prognosis of the elderly CKD patients as well as management of common complications，so as to reduce over-diagnosis，and better predict the risks of progression to end stage renal failure and take necessary measures for clinical intervention as soon as possible.

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Diagnosis and treatment of nephrotic syndrome in the elderly LI Min-xia，CAI Guang-yan. 2014, 34(12): 1140-1143.  DOI: 10.7504/nk2014110202 Abstract ( )   PDF (931KB) ( )   Abstract：Nephrotic syndrome is a common clinical type of glomerular diseases in the elderly and has its own characteristics in the pathological types，clinical manifestations and diagnoses.Renal biopsy is an important diagnostic method for patients with senile nephrotic syndrome.Membranous nephropathy is the most common primary pathology，while amyloidosis and diabetic nephropathy are common secondary causes.Individualized treatments should be performed according to ages and physical characteristics of the elderly patients.

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Comprehensive treatment in preventing progression of chronic kidney disease in elderly patients TANG Zheng，CHEN Sha-sha. 2014, 34(12): 1144-1146.  DOI: 10.7504/nk2014110203 Abstract ( )   PDF (923KB) ( )   Abstract：The global population is progressively aging，to the extent that over 1.5 billion people worldwide will be aged 65 years or more by 2050.Chronic kidney disease (CKD) in the elderly has become a major public health problem in China with approximately one third to one half of the individuals older than 70 years have CKD.Rates of treated end-stage renal disease (ESRD) among the elderly have been rising dramatically over the last decade.Most of older individuals with CKD die from cardiovascular diseases，infections and cerebrovascular diseases before reaching ESRD.Proteinuria，hypertension，diabetes，hyperlipidemia，and diet are strong risk factors for progression from CKD to ESRD.In this review，we will discuss comprehensive treatment strategy in preventing and slowing progression of CKD in elderly patients concerning the above risk factors.

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Characteristics in prevention and treatment of the elderly patients with acute kidney injury JIANG Wu-hua，DING Xiao-qiang. 2014, 34(12): 1147-1150.  DOI: 10.7504/nk2014110204 Abstract ( )   PDF (938KB) ( )   Abstract：As the growth of age，the aging of renal structure and function，self-adjusting capacity of the kidney is decreased，and the morbidity of acute kidney injury (AKI) is increased significantly in the elderly.AKI is one of the main risk factors increasing the mortality of hospitalized elderly patients prolonging the length of hospital stay and undergoing renal replacement therapy，and it is closely related to prognosis of the elderly.Although medical treatment level is progressing rapidly，prognosis of AKI is still not optimistic，especially in the intensive care unit，severe AKI patients are very commonly seen.Due to the lack of effective drugs in prevention and treatment of AKI，blood purification technology is still the main method for treatment of severe AKI.In combination with the latest research progress and experiences of experts，this paper introduces the characteristics of AKI in the elderly and its prevention strategies，so as to provide clinicians with practical guidance and help in management of the elderly patients with AKI.

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Renal replacement therapy in elderly patients with end-stage renal disease XU Tian-hua，LIU Fang-jie，YAO Li. 2014, 34(12): 1151-1154.  DOI: 10.7504/nk2014110205 Abstract ( )   PDF (949KB) ( )   Abstract：The incidence and prevalence of end-stage renal disease in elderly patients have been increasing rapidly in recent years.Previous studies have pointed out special physiopathological characteristics and clinical manifestations in elderly patients.These patients often suffer from malnutrition and multiple extra-renal comorbidities such as cardiovascular and cerebrovascular diseases.Most studies showed that the quality of life and survival of the elderly dialyzed patients were worse than those of younger patients because of multiple comorbidities.However，hemodialysis，peritoneal dialysis and kidney transplantation are elective model for the elderly，and the choice of treatment model depends on the individual，clinical，economic conditions and social factors.

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Characteristics of peritoneal dialysis in elderly patients with end-stage renal disease YANG Xiao,YU Xue-qing. 2014, 34(12): 1155-1158.  DOI: 10.7504/nk2014110206 Abstract ( )   PDF (944KB) ( )   Abstract：The elderly CKD patients constitute the fast-growing population reaching end-stage renal disease (ESRD) and commencing dialysis therapy.Peritoneal dialysis (PD) has many advantages on elderly patients such as home-based therapy，relatively stable hemodynamics，etc.However，elderly patients have multiple complicated disorders and are more susceptible to malnutrition，which are very important prognostic factors for survival of patients.A high burden of physical and cognitive impairment in elderly patients may increase the risk of peritonitis and technique failure.Intensive care should be taken to cope with the comorbidities and malnutrition in the elderly.Offering assisted peritoneal dialysis to unstable or frail elderly ESRD patients will help to perform the procedure at home and improve the technique survival.All these strategies for the care of elderly PD patients will result in better survival and quality of life.

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Establishment of blood access in elderly hemodialysis patients GUO Wang，LIU Wen-hu. 2014, 34(12): 1159-1162.  DOI: 10.7504/nk2014110207 Abstract ( )   PDF (942KB) ( )   Abstract：There will be more and more elderly patients surviving on hemodialysis due to improvement of renal replacement and medical insurance.But these patients might experience lots of dilemmas such as poor blood vessels，more complications，and impaired cardiac function.All of these factors impose restriction on blood access preparation.Based on our previous reports，in most elderly subjects autogenous arteriovenous fistula might be the first choice in consideration of expectation of life，blood vessels available，life styles and ideas of the patients，which would accordingly assure effective renal replacement and high quality of life.

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Kidney transplantation in the elderly with end-stage renal disease HAN Fei，CHEN Jiang-hua. 2014, 34(12): 1159-1162.  DOI: 10.7504/nk2014110208 Abstract ( )   Abstract：The incidence of end-stage renal disease (ESRD) increases in the elderly population.Patients received kidney transplantation had better long-term survival and quality of life than those received maintaining dialysis.However，only a smaller proportion of elderly patients received kidney transplantation because of the concerns about high post-transplant complications such as infections，diabetes，etc.In this review，we make a discussion on treatment strategies including prophylaxis of risk factors，donor selection and postoperative monitoring in order to raise awareness and improve long-term prognosis in elder patients with end-stage renal disease.

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Clinical characteristics of ANCA associated vasculitis in the elderly. HE Qiang，SHAO Li-na. 2014, 34(12): 1167-1170.  DOI: 10.7504/nk2014110209 Abstract ( )   PDF (957KB) ( )   Abstract：ANCA associated vasculitis is a necrotizing vascular inflammation，usually involving multiple organs.It is one of the major diseases that cause deterioration of renal function rapidly in the elderly.The latest CHCC2012 has updated the name of ANCA associated vasculitis.Some high quality randomized clinical trials provide evident basis for treatment of vasculitis.However，elderly patients often suffer complex diseases，and are associated with underlying diseases，so it is difficult to be diagnosed and treated.It is very important to make optimized individual strategies of treatment for elderly patients with vasculitis.

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Long-term treatment of chronic hepatitis B Experts attending the discussion on long-treatment of chronic hepatitis B. 2014, 34(12): 1172-1179.  DOI: 10.7504/nk2014110301 Abstract ( )   PDF (3854KB) ( )   Abstract：Nucleoside and nucleotide analogs have been successfully used for treatment of chronic hepatitis B.Hepatitis B virus (HBV) replication is now recognized as the key driver of liver injury and disease progression，so the primary aim of treatment for chronic HBV infection is to maximize sustained suppression of HBV replication to undetectable levels.The long-term treatment has also been shown to achieve substantial histological improvement and regression of liver fibrosis or cirrhosis，and reduction of hepatocellular carcinoma.This paper has reviewed the necessity，clinical benefits，and the management of long-term treatment for chronic hepatitis B.

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The current status of clinical diagnosis and treatment on complication of Ebola hemorrhagic fever LONG Zhen-Zhou，NIE Qing-He. 2014, 34(12): 1180-1184.  DOI: 10.7504/nk2014110401 Abstract ( )   PDF (968KB) ( )   Abstract：The world experienced the largest Ebola virus outbreak ever in Western Africa，2014.The case fatality rate of this dreadful infectious disease，which pathogenesis is perplexing and the patients’ condition is instability，was close to 49%.Most of patients died of severe systematic complications，such as shock，disseminated intravascular coagulation，and acute renal failure.It is very important to diagnose various complications by clinical features and identify symptoms of deterioration of disease early and thus deal with these status of the victims of Ebola virus.

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New clinical progress in diagnosing liver disease using FibroScan ZENG Xiang-hua，SHI Dai-rong，WANG Yu-ming. 2014, 34(12): 1185-1188.  DOI: 10.7504/nk2014110402 Abstract ( )   Abstract：FibroScan(FS)，estimating the progress of liver diseases based on the measurement of liver stiffness，has been well applied to detecting various liver diseases including hepatitis，fibrosis，cirrhosis and carcinoma(especially for fibrosis and cirrhosis).However，considering the confounding factors such as ascites and abdominal distension，new approaches using combination of FS and serum markers have been proposed in order to increase the assessed value.And perhaps this will be the new direction of non-invasive methods in diagnosing chronic liver diseases.This review is aimed at discussing the new clinical progress of diagnosing the liver diseases by FS.

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Optimal timing of continuous renal replacement therapy in patients with septic acute kidney injury KAI Kang*，YANG Rong-li. 2014, 34(12): 1189-1191.  DOI: 10.7504/nk2014110501 Abstract ( )   Abstract：Objective To investigate the optimal timing of continuous renal replacement therapy (CRRT) for patients with septic acute kidney injury (AKI).Methods We retrospectively analyzed 118 patients admitted to surgical intensive care unit (SICU).The hospital information of these patients was complete，and conformed to the 2012 KDIGO stage 2 and above at the same time.All these patients were divided into 4 groups：the stage 2 CRRT group，the stage 2 control group，the stage 3 early CRRT group and the stage 3 late CRRT group.The monitoring indicators before and after 48-hour therapy include serum creatinine，serum urea nitrogen，potassium，mean arterial pressure (MAP)，oxygenation index (OI)，serum lactic acid level，urine output (UO)，acute physiology and chronic health evaluation (APACHE Ⅱ) score，sequential organ failure assessment (SOFA) score，duration of mechanical ventilation，length of ICU stay，and the 28-day and 90-day mortality.Results After 48-hour treatment，the levels of serum creatinine，blood urea nitrogen and serum potassium in the three groups of patients treated with CRRT were improved obviously.As compared with those in the stage 3 late CRRT group，the above indexes were decreased significantly in the stage 3 early CRRT group.The values of MAP，OI，lactate，UO，APACHE II score and SOFA score in the stage 2 control group，the stage 2 CRRT group and the stage 3 early CRRT group were improved obviously.As compared those in with the stage 3 late CRRT group，the values of MAP，OI，lactate and UO in the stage 3 early CRRT group were improved obviously.As compared with those in the stage 3 late CRRT group，the duration of mechanical ventilation and length of ICU stay in the stage 3 early CRRT group reduced significantly.The 28-day and 90-day mortality were significantly higher in the stage 3 late CRRT group than those in the stage 3 early CRRT group.Conclusion CRRT is an effective method for treatment of patients with septic AKI.For the stage 2 patients，CRRT treatment has little effect on the prognosis of patients.For the stage 3 patients，CRRT treatment should be performed as soon as possible.

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Related risk factors and prognostic evaluation of malignant change followed by congenital choledochal cysts GUAN Hua-qin，CHEN Ren-pin，JIN Si-si，CHEN Chao,ZHANG Chun-wu,WU Jian-sheng 2014, 34(12): 1194-1196.  DOI: 10.7504/nk2014110502 Abstract ( )   Abstract：Objective To identify the potential risk factors involved in congenital choledochal cysts(CCC) malignancy transformation，as well as to elucidate survival statue in subsequent maligancy.Methods A total number of 115 patients that diagnosed as CCC in the first affiliated Hospital of Wenzhou Medical University from February 2002 to April 2014 were retrospectively reviewed，which were divided into two groups，with malignancy(A group) and without malignancy(B group).Univariate and multivariate Logistic analysis were conducted to evaluate risk factors associated with incidence of malignant change，while to survival analysis of A group.Results Among 115 cases of patientsthat diagnosed as CCC，12 cases were arising with malignancy，the total malignancy rate was 10.4%.In univariate analysis，significant differences were found between these two groups by increased of age and disease duration；Combined with jaundice and biliary calculi；and liver disfuntion (increased of CB，ALP，γ-GT)(P<0.05).In logistic regression analysis，only increated of age.disease duration and CB were recognized as the significative factors(P<0.05).In A group，the surviving time was 1 to 72months，and the middle survival time was (28.1±8.8)months(95%CI 10.817-45.461).Conclusion CCC is a premalignant lesion，incerated of age.disease duration and CB is related risk factors.the prognosis of CCC with malignancy is poor，total cysts excision and hepaticojejunostomy is an effective treatment for patients diagnosed as CCC in order to reduce the chance of subsequent development of maligancy.

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Molecular diagnosis of a pedigree with 17 alpha-hydroxylase/17，20-lyase deficiency YAN Ai-zhen，ZHENG De-zhu,ZENG Jian,WANG Zhi-hong,LAN Feng-hua. 2014, 34(12): 1194-1196.  DOI: 10.7504/nk2014110503 Abstract ( )   Abstract：Objective To make molecular diagnosis for a family with 17 alpha-hydroxylase/17，20-lyase deficiency (17OHD).Methods Genomic DNA was isolated from the blood of the patient and the family members (younger sister，mother and aunt).In order to analyze the genetic mutation，eight pairs of primers were designed to amplify the CYP17A1 gene followed by direct sequencing of the polymerase chain reaction (PCR) products.Results Clinical manifestations of the proband agreed with 17OHD.The sequencing results showed that 9 bases (TCGACTCTT) were missing in the exon 8 of the CYP17A1 gene from the proband，leading to a homozygous mutation of D487-F489 deletion.Her mother and aunt were both heterozygous carriers of CYP17A1 gene mutation，while no mutation was found in her younger sister.Conclusion The molecular diagnosis method is established to analyze the mutation by direct amplification and sequencing of CYP17A1 gene.This method can diagnose 17OHD accurately，therefore laying the foundation for genetic counseling and prenatal diagnosis.

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Non-Hodgkin’s lymphoma firstly manifested as pleural effusion：eight cases of report and literature review PENG Ya-ting，OUYANG Ruo-yun，CHEN Ping，XIAO Kui. 2014, 34(12): 1202-1205.  DOI: 10.7504/nk2014110504 Abstract ( )   Abstract：Objective To explore the clinical characteristics and diagnosis of patients with non-Hodgkin lymphoma (NHL) firstly manifested as pleural effusion.Methods The clinical data of 8 NHL patients were analyzed retrospectively and discussed with literature review.Results Clinical features of the 8 patients were non-specific.Medical thoracoscopy was performed in 7 patients，showing diffused pleural congestion，swelling or pale，multiple nodules，tortuous and engorged vessels，and pleural thickening and adhesions.Flexible fiberoptic bronchoscopy was performed in 2 patients，showing almost normal morphology in 1 case and swelling and hypertrophy of bronchial mucosa in the other case.Six patients were diagnosed by thoracoscopic biopsies，1 patient by mediastinoscopic lymph node biopsies and the rest one by surgical lobectomy.As for treatments，1 patient received only surgery and 1 case received only palliative care，while the other 6 cases underwent only chemotherapy.Only 1 patient remained alive during follow-up.Conclusion Medical thoracoscopic pleural biopsies are helpful in diagnosis of NHL firstly manifested as pleural effusion.