Augmented renal clearance (ARC) is a phenomenon of increased renal function in patients with risk factors. Sub-therapeutic drug concentrations and antibacterial exposure in ARC patients are the main reasons for clinical treatment failure. Decades of increased research have focused on these phenomena, but there are still some existing disputes and unresolved issues. This article reviews information on some important aspects of what we have known and provides suggestion on what we will do regarding ARC. In this article, we review the current research progress and its limitations, including clinical identification, special patients, risk factors, metabolism, animal models and clinical treatments, and provide some promising directions for further research in this area.
Background: The risk of injury to the kidney can be significantly exacerbated by the presence of tumors and the effects of related treatments. Kidney injury associated with cancer is common in multiple myeloma, tumor lysis syndrome, hematopoietic stem cell therapy, and chemotherapy. Cancer patients are at increased risk of infection, sepsis, tumor lysis syndrome, drug-related toxicity, and other comorbidities, leading to a significantly increased risk of acute kidney injury (AKI). This study retrospectively analyzed the clinical data of AKI in cancer patients and explored the predictive value of Cystatin C (CysC) in the prognosis of cancer patients with AKI.Methods: Cancer patients attending the Fifth People's Hospital of Shenyang from April 2014 to March 2019 were enrolled according to inclusion and exclusion criteria. Cancer patients with AKI were divided into two groups according to the changes in renal function during the follow-up period: a renal function recovery group and a nonrecovery group. The differences in baseline data of the two groups were compared. Logistic univariate and multivariate regression analyses were conducted to determine the risk of renal function failure.Results: A total of 3,127 cases were included. Among them, 659 cases (21.1%) had AKI, and 2,468 cases had no AKI. Among the 659 AKI patients, 473 (71.8%) patients' renal function recovered, while 186 (28.2%) did not. Logistic univariate and multivariate regression analyses indicated that age [odds ratio (OR) =1.133,
Climate change, environmental pollution, and virus epidemics have sharply increased the number of patients suffering from respiratory diseases in recent years. Prolonged periods of illness and drug use increase the occurrence of complications in these patients. Osteoporosis is the common bone metabolism disease with respiratory disturbance, which affects prognosis and increases mortality of patients. The problem of osteoporosis in patients with respiratory diseases needs more attention. In this review, we concluded the characteristics of osteoporosis in some respiratory diseases including COPD, asthma, COVID-19, tuberculosis, and lung cancer. We revealed that hypoxia was the common pathogenesis of osteoporosis secondary to respiratory diseases, with malnutrition and corticosteroid abuse driving the progression of osteoporosis. Hypoxia-induced ROS accumulation and activated HIF-1α lead to attenuated osteogenesis and enhanced osteoclastogenesis in patients with respiratory diseases. Tuberculosis and cancer also invaded bone tissue and reduced bone strength by direct infiltration. For the treatment of osteoporosis in respiratory patients, oral-optimized bisphosphonates were the best treatment modality. Vitamin D was a necessary supplement, both for calcium absorption in osteogenesis and for improvement of respiratory lesions. Reasonable adjustment of the dose and course of corticosteroids according to the etiology and condition of patients is beneficial to prevent the occurrence and development of osteoporosis. Additionally, HIF-1α was a potential target for the treatment of osteoporosis in respiratory patients, which could be activated under hypoxia condition and involved in the process of bone remodeling.
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