Objective    To evaluate if KDIGO (kidney disease: improving global outcomes) criteria for short?term prognosis of cardiorenal syndrome type I was superior to RIFLE (risk, injury, failure, loss of kidney function, end?stage kidney disease) and AKIN (the acute kidney injury network) criteria.    Methods    Data was retrospectively collected from patients with acute heart failure in Guangdong General Hospital between July 2005 and July 2012. The in?hospital mortality was regarded as outcome measures. Baseline serum creatinine was defined as first serum creatinine on admission. Kaplan?Meier curve was used to evaluate in?hospital survival by three AKI criteria and AKI by KDIGO but not RIFLE or AKIN in patients with cardiorenal syndrome type I. Cox regression was used for multivariate analysis of in?hospital mortality.    Results    Among 732 patients, 154 cases (21%) were diagnosed as AKI by KDIGO instead of RIFLE or AKIN. Incidence for the cardiorenal syndrome type I by KDIGO, RIFLE and AKIN were significantly different (54.7% vs. 38.6%, 54.7% vs 50.1%, P＜0.001). Kaplan?Meier curve showed that in?hospital survival rates of patients with AKI diagnosed by KDIGO but not RIFLE or AKIN are lower than those without AKI (Log rank P=0.011). Cox regression indicated that AKI by KDIGO but not RIFLE or AKIN was an independent risk factor of in?hospital mortality (P=0.008).    Conclusion    KDIGO criteria is superior to RIFLE and AKIN criteria on predicting in?hospital mortality of cardiorenal syndrome type I.

Objective    To enhance the understanding of mercury poisoning related minimal change disease (MP?MCD).    Methods    A retrospective analysis about the clinical, laboratory and pathological manifestations, diagnosis, treatment and outcome of 7 patients with MP?MCD caused by skin?lightening cosmetics were conducted.    Results    All of the 7 patients were female with mean age 37.2 years. One patient had intermittently used skin?lightening cosmetics for 15 years and the other 6 patients continuously used the cosmetics for 2～6 months. Urine mercury levels of the 7 patients were significantly increased, reaching to 2.2～59.1 times of the normal value. The mercury content of 2 cosmetics used by patients was 1200 to 1560 times the mercury limit in cosmetics set by the government in 1987. Seven patients all presented as nephrotic syndrome, and all had MCD on renal biopsy. After the diagnosis of MP?MCD was confirmed, all the patients stopped using the mercury?contain cosmetics and accepted corticosteroid and chelation therapy. The nephrotic syndrome underwent complete remission after 1～2 months of therapy. Urine mercury levels in the 5 patients who repeated test returned to normal levels after 1～3 courses of chelation therapy.    Conclusion    MP?MCD caused by skin?lightening cosmetics should be considered as one of the differential diagnosis in the patients, especially in adult females who present with nephrotic syndrome in China.   

Objective    To analyze the clinical outcome of PD related peritonitis in our center.   Methods    All patients who developed PD related peritonitis between January 2004 and December 2010 in Renji Hospital of Shanghai Jiao Tong University School of Medicine were included. Outcomes of PD related peritonitis were analyzed.    Results    A total of 220 patients developed 371 episodes of PD related peritonitis during the study period in our center, and the average peritonitis rate was one episode per every 54.4 patient-months. Among the 371 episodes of peritonitis, 285 (76.8%) episodes had been cured, 17 (4.6%) episodes had needed temporary hemodialysis (HD), 46 (12.4%) episodes had led to switch to permanent HD and 21 (5.7%) episodes had caused death. After refractory peritonitis, there was a significant reduction of 4 h ultrafiltration (330 vs 270 ml, P＝0.036) and an increase tendency of 4h D/Pcr (0.55±0.08 vs 0.58±0.10, P＝0.086).    Conclusions    Peritoneal dialysis related peritonitis is an important contributor to technique failure and death in Chinese PD patients. Refractory peritonitis might injure peritoneal membrane function. 

Objective    To evaluate fluid distribution in patients on maintenance hemodialysis(HD) by bioimpedance analysis and on the effect of adjusting the dry weight in hemodialysis patients. Methods    Forty maintenance HD patients from the dialysis center of the Second Affiliated Hospital of Dalian Medical University were enrolled as study group. One hundred and two individuals who were tested of physical examination in the same hospital were enrolled as the control group. Sex and age of the two groups were recorded. Body weight, body high, blood pressure, bioimpedance of HD patients (pre-dialysis and post-dialysis) and controls were measured. Bioimpedance was measured by multi-frequency segmental bioimpedance analysis, including right arm (RA) bioimpedance, trunk (TR)bioimpedance and right leg (RL) bioimpedance. Bioimpedance ratio (BIR) of three parts was calculated as of 100kHz and 20kHz including RA-BIR, TR-BIR and RL-BIR. Then eight HD patients who had high RA-BIA or TR-BIA according to the reference range which were obtained from 102 controls were chosen for dry weight adjustment. Post-dialysis body weight, blood pressure, and bioimpedance of the eight HD patients were measured again after adjusting the dry weight.    Results     ⑴ BIR of three parts in pre-dialysis HD patients were all significantly higher than that in the control group (P＜0.05). BIR of three parts of the post-dialysis HD patients were still higher than that of the control group, but RL-BIR was not significantly (P＞0.05). BIR of three parts of the post-dialysis HD patients were lower than BIR of three parts of the pre-dialysis HD patients, and there was significant different (P＜0.05) with RA-BIR and RL-BIR. ⑵ After adjusting the dry weight, BIR of three parts of the post-dialysis HD patients were still higher than that of the control group, but none of them was significantly (P＞0.05）. BIR of three parts of the HD patients after adjusting the dry weight were lower than BIR of three parts of the HD patients before adjusting the dry weight, but there was no significant different with TR-BIR(P＞0.05). After adjusting the dry weight, systolic blood pressure of the post-dialysis HD patients were significantly decrease[(150.00±29.28) vs (140.63±20.78) mm Hg，P＜0.05].    Conclusions     Bioimpedance analysis may be an effective method for adjusting dry weight in hemodialysis patients, and the bioimpedance of arms is the most effective method. The bioimpedance reference range of hemodialysis patients can be according to the reference range of normal individuals