Substitution of renal function through skin catharsis: evidence from the classical period to the Middle Ages

Amantadine-associated delirium in patients with maintenance dialysis: Insomnia-associated recovery and uneven seasonal distribution

Amantadine hydrochloride is a risky drug for triggering delirium in dialysis patients; however, it is often administered casually. Furthermore, little is known regarding the recovery and prognosis of dialysis patients with amantadine-associated delirium. Data of this retrospective cohort study were collected from a local hospital database for hospitalizations between January 2011 and December 2020. Patients were divided into 2 cohorts: early recovery (recovery within 14 days) and delayed recovery (recovery more than 14 days). The cases were analyzed together with the intermonth temperature using descriptive statistics. A Kaplan-Meier survival curve and binary logistic regression were applied for the analyses of prognoses and factors. A total of 57 patients were included in this study. The most common symptoms were hallucinations (45.61%) and muscle tremors (43.86%). Early recovery was observed in 63.16% of the patients. Only 3.51% of the cases occurred in local summer (June, July, and August). Better prognoses for survival (hazard ratio [HR] = 0.066, 95% confidence interval [95% CI] = 0.021-0.212) and hospitalization costs (7968.42 ± 3438.43 CNY vs 12852.38 ± 9361.13 CNY, P = .031) were observed in patients with early recovery than in those with delayed recovery. In the multivariate logistic regression adjusted by 1:1 propensity score matching, delayed recovery was independently caused by insomnia (P = .022, = 10.119, 95% CI = 1.403-72.990) and avoided in patients with urine volume over 300 mL (P = .029, = 0.018, 95% CI = 0.006-0.621). The increment (per 100 mg) of cumulative dose (P = .190, = 1.588, 95% CI = 0.395-3.172) tended to be a risk of delayed recovery. The area under curve of the receiver operating characteristic curve was 0.867, with a sensitivity of 90.5% and a specificity of 82.4% at the cutoff point (cutoff = 0.432). For amantadine-associated delirium in dialysis patients with uneven seasonal distribution, early recovery with better prognosis should be the aim of treatment by giving priority to the remedy of insomnia.

Associations of serum urea, creatinine and uric acid with clinical and laboratory features in patients with systemic lupus erythematosus

The aim of this study is to investigate the associations of serum urea, creatinine and uric acid levels with clinical and laboratory characteristics, independent of lupus renal involvement in SLE patients. A total of 191 SLE patients were included in the present study. Some clinical and laboratory characteristics of the patients were obtained by medical record review. The results showed that serum urea, creatinine and uric acid levels seemed to be associated with several clinical and laboratory characteristics of SLE. However, multivariate logistical regression analysis indicated that increasing serum urea levels were positively associated with disease duration and thrombocytopenia, but negatively with arthritis and skin rash. Compared with quartile 1 of urea, the ORs of quartile 2, quartile 3 and quartile 4 were, respectively, 1.008 (0.997-1.015, P = 0.189), 1.010 (1.001-1.019, P = 0.038) and 1.014 (1.004-1.024, P = 0.008) with increasing disease duration; 1.912 (0.516-7.088, P = 0.332), 10.126 (2.771-36.997, P = 0.000) and 5.583 (1.285-24.266, P = 0.022) with thrombocytopenia; 0.864 (0.331-2.254, P = 0.765), 0.516 (0.18-1.475, P = 0.217) and 0.162 (0.047-0.557, P = 0.004) with arthritis; and 0.342 (0.135-0.868, P = 0.024), 0.215 (0.074-0.622, P = 0.005) and 0.332 (0.097-1.13, P = 0.078) with skin rash. Increasing serum creatinine levels were positively associated with sex, disease duration and SLEDAI, but negatively with skin rash. Compared with quartile 1 of creatinine, the ORs of quartile 2, quartile 3 and quartile 4 were, respectively, 2.993 (0.282-31.74, P = 0.363), 7.937 (0.861-73.18, P = 0.068) and 13.411 (1.32-36.246, P = 0.028) with male, 1.011 (1.002-1.02, P = 0.017), 1.002 (0.991-1.013, P = 0.684) and 1.018 (1.008-1.028, P = 0.001) with increasing disease duration; 1.112 (1.006-1.228, P = 0.038), 1.065 (0.959-1.183, P = 0.239) and 1.140 (1.022-1.272, P = 0.019) with increasing SLEDAI; and 0.303 (0.119-0.771, P = 0.012), 0.282 (0.104-0.76, P = 0.012) and 0.174 (0.052-0.584, P = 0.005) with skin rash. Increasing serum uric acid levels were only positively associated with erythrocytopenia. Compared with quartile 1 of uric acid, the ORs of quartile 2, quartile 3 and quartile 4 were, respectively, 0.910 (0.37-2.239, P = 0.837), 2.147 (0.901-5.116, P = 0.085) and 3.079 (1.211-7.828, P = 0.018) with erythrocytopenia. The present study demonstrated that, except for reflecting renal function, serum urea, creatinine and uric acid exert separate clinical significances in SLE.

Thirty-six Hippocratic aphorisms of nephrologic interest

In this article, we discuss the nephrologic content within Hippocrates' Aphorisms. Although similar attempts have taken place ever since antiquity, we believe that in each era new insights may be gained by examining the aphorisms through the prism of current medical knowledge. Of the 400 aphorisms in the Hippocratic text, we discuss the 36 that we consider to be most relevant to nephrology. We conclude that these aphorisms support the concept of Hippocrates as the "Father of Clinical Nephrology."

The use of the kidneys in secular and ritual practices according to ancient Greek and Byzantine texts

The use of kidneys in secular and spiritual practices was very common for centuries. In this article we present some references on their employment as sacrificial offers, as plain food or as a source for medicaments. Our material derives from Greek texts of the Classical, Hellenistic, Roman, and Byzantine eras. Relevant extracts from the Old Testament are also included, as they have become part of a common cultural heritage in that period of syncretism, when Jews were Hellenized and Greeks orientized. From the fragments cited in this article, it is obvious that the practical use of kidneys by priests, doctors, and lay persons in the periods under discussion was widespread. The sacrificial offering was based on the religious significance of the organ. The dietary consumption of the kidneys was limited by their function as urine producers. Their medicinal use was dictated first, by the abundance of the adipose tissue surrounding them, which was an ideal warming and binding substance. Second, it may be explained by the deeply rooted conviction that eating a particular organ led to the incorporation of its strength, thus protecting the corresponding eater's organs. Those practices should not surprise us in view of their corresponding modern use. Currently, kidney donors offer their organs in a sacrificial gesture, kidneys are consumed as a delicacy worldwide, and renal tissue is therapeutically used in transplantations and, until very recently, as a source for hormonal substances.