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| EDITORIAL |
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| Year : 2015 | Volume
: 2
| Issue : 3 | Page : 73-74 |
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Multidisciplinary Team in Crystal-Induced Kidney Injury
Zhiyong Guo, Wei Chen
Department of Nephrology, Changhai Hospital, Second Military Medical University, Shanghai, China
| Date of Web Publication | 24-Jul-2015 |
Correspondence Address:
Dr. Zhiyong Guo
Department of Nephrology, Changhai Hospital, Second Military Medical University, No. 168, Changhai Road, Shanghai
China
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2225-1243.161425
How to cite this article:
Guo Z, Chen W. Multidisciplinary Team in Crystal-Induced Kidney Injury. J Integr Nephrol Androl 2015;2:73-4 |
With clinical medicine developing till now, discipline development is becoming more detailed. In practical work, diagnosis and treatment of the clinical cases depend on active participation of multidiscipline, which gives birth to the most popular diagnosis and treatment framework, a multidisciplinary team (MDT). MDT makes its first successful experience in combined therapy of tumor and develops up to now. Usually, it refers to experts from more than two related disciplines, forming a relative fixed working team to work for a certain organ, system or a specific disease. The experts propose the best diagnosis and treatment plan through theoretical discussion in fixed period, time, and place then the clinical diagnosis and treatment model is implemented alone by the relative discipline or jointly by multidiscipline. Today, MDT modal has been gradually expanded from oncology to angiocardiopathy, cerebrovascular disease, severe medicine, rehabilitation medicine, and other disciplines and realizes continuous maturity and development in practical work.
One the one hand, MDT model has been constantly accepted and recognized. On the other hand, the concept of crystal-induced kidney injury also has been gradually concerned. All unsaturated substance in urine can form a crystal. In pathological state, the increased crystals or decreased dissolution will deposit in kidney tissue, thus causing the injury of the inherent renal cell, and to the later stage, kidney crystallization will become urinary calculi and renal function injury. Therefore, from an overall situation, the extension of the crystal kidney injury spreads, including the whole process of formation, dissolution, deposition, growth, the obstruction that urine salt crystallization evolves in tubule. Hence is this disease syndrome has the value and significance of carrying out MDT?
First, focus on the later stage manifestation of kidney injury: Research data from European and American bulk epidemiology indicate that case rate of urinary calculi takes up above 8% in the population. [1],[2] Suffering from stones will affect renal function, accelerate patients into chronic kidney disease and also bring the high risk of cardiovascular events, mellitus. [3],[4] As to the concurrent risk of urinary calculi and cardiovascular events, the present recognized view thinks that it is caused by the increase of the body system oxidative stress. [5] Thus, urinary calculi should be put at the same height with diabetes and hypertension, being brought into the framework of the whole society slow disease management. Extending afterward, stone patients need to be given medicine and surgery treatment. Going to the beginning, early warning and intervention should be given to prevent the stone. Hence, kidney damage caused by crystallization runs through urine ion saturation to urinary obstruction, the pathological and physiological chain. Of course, higher levels of attention and research should be given to it.
Review of the main components of urine salt crystallization, most of which are calcium oxalate and calcium phosphate, and less on the part of cysteine acid and magnesium salt. The material base of the formation of crystal is to affect oxalate, phosphate and calcium, and the influencing factors may directly or indirectly lead to the crystallization induced renal injury. In general speaking, diet can lead to elevated oxalate in the urine, and a series of genetic diseases characterized by the primary high oxalate urinary tract disease also works. Metabolic abnormality such as mellitus, hyperlipemia osteoporosis can cause urinary calcium excretion increased and the change of pH value, so the probability of the formation of crystal increases. Whereas, when the crystals gradually form stones, drug, or surgical treatments should be considered to relieve the obstruction, pain, and preserve kidney function. However, the recent observations find even minimally invasive lithotripsy surgery may lead to the acute renal injury occurred after operation ranging from 3% to 15% of the cases, [6] which will affect long-term prognosis.
In the case of such a crystallization of renal injury in the complex clinical event chain, the introduction of MDT model is the inevitable trend to improve the level of diagnosis and treatment. In addition to nutrition, endocrinology, rheumatology, nephrology, Department of Urology and other disciplines mentioned above, achievements of biomedical development in these years also can be fully referenced to expand the scope of MDT. Furthermore, integrating with basic medicine, biology, pharmacy, and other disciplines is also an important way for the development of crystal kidney injury. Among them, one side, traditional Chinese medicine treasure can be explored. [7],[8] On the other hand, with the help of new systematic biology research tools, horizons can be widened, and new medicine can be researched and developed. [9],[10],[11] Only in this way can MDT really exert its effect, serving the majority of patients.
Acknowledgments
This work was supported by grants from the National Scientific Foundation of China (81270773, 81403261), the TCM Program from the Science and Technology Commission of Shanghai Municipality (13401900105), the innovation program of scientific research from the Shanghai Education Commission (14ZZ080), and Clinical improvement program from Changhai Hospital (CH125520301).
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