Diabetic nephropathy (DN) is a leading cause of end-stage renal disease worldwide. The mainstay of DN has been management of hyperglycemia, blood pressure and proteinuria using hypoglycemic agents, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Application of traditional Chinese medicine (TCM) for DN has received increasing attention due to its wide availability, low side-effects, proven therapeutic mechanisms and benefits. In this paper, we mainly focus on the recent studies of TCM including Tongxinluo, Chaihuang-Yishen granule, Shenyan Kangfu tablets, Danggui Buxue Tang, Gordon Euryale Seed, Cherokee Rose Fruit and Bawei Dihuang wan, and the effective components of TCM, including Astragalus and Astragalus polysaccharide. The aim of this study is to review the protection and treatment effect of TCM for treating DN in type 1 and type 2 diabetes mellitus. Meanwhile, the possible mechanisms of major compounds and active crude drugs are also summarized.

Evidence-based medicine has become increasingly important to medicine, how to deal with evidence-based medicine traditional Chinese medicine (TCM) syndrome diagnostic criteria and treatment of the relationship between the experiences will be a hot topic currently. TCM syndrome diagnostic criteria derived from the accumulated experience of the ancient physicians in medical practice, but the diagnostic criteria specified in medicine needs to be improved; experience in the treatment of evidence-based medicine as an important component is unlikely to be replaced, for evidence-based medicine TCM specificity, only through the practice of TCM syndrome diagnosis based on standard combination treatment experience, from simple to complex, TCM evidence-based medicine in order to have a new development.

Background: Cardiovascular complications are a major cause of mortality in chronic kidney patients (CKD) patients. More than 50% of patients of end-stage renal disease (ESRD) die due to these complication. Patients undergoing chronic hemodialysis (HD) presented with frequently elevated baseline values of cardiac troponin T (cTnT). Aim of the Study: The aim of this study was to estimate the level of cTnT in ESRD patients and to evaluate its diagnostic and prognostic value in HD patients. Materials and Methods: This was a case-control study carried over a period of 14 months. One hundred and one cases of CKD stage-V as per the KDIGO guidelines 2012 with eGFR ≤15 mL/min and 50 healthy control age-matched with a GFR ≥60 mL/min were included in the study. cTnT levels were measured at the start of the study, at 48 h and 6 months after completion of hemodialysis. Results: The mean age of the controls and cases were 45.74 ± 9.99 years and 47.77 ± 17.53 years, respectively. Of 101 cases, 40 cases had cTnT levels <0.01 ng/L, 16 cases had cTnT levels 0.01-0.029 ng/mL, 20 cases had cTnT levels 0.03-0.099 ng/mL and 25 cases were had cTnT levels >0.10 ng/mL. Cardiac events were observed in 20 patients. Three patients died due to myocardial injury (cTnT levels >0.10 ng/mL) and 17 patients experienced cardiovascular events. These cardiovascular events were sudden cardiac deaths, stroke, atrial-ventricular block and congestive heart failure. Conclusion: All patients on chronic hemodialysis should be evaluated for annual measurement of serum cTnT, which could be used as a reference point. A small increase over time is common, but if any time levels more than double the baseline, which is uncommon, and if found indicate an acute coronary syndrome.

Background and Objective: Vitamin C consumption is necessary to compensate for its deficiency in hemodialysis patients, but excessive use raises concerns about increased levels of serum oxalate and oxalosis. This study was performed to compare the influence of intravenous and oral Vitamin C consumption on serum oxalate among hemodialysis patients in the 5 ^th Azar Hospital in Golestan (north of Iran). Materials and Methods: In the randomized controlled trial, 75 hemodialysis patients were selected via convenience methods. They were randomly allocated into controls (n = 25), oral Vitamin C (OAA) (n = 25) and intravenous Vitamin C (IAA) groups (n = 25). After the dialysis session (three times weekly), patients took 300 mg intravenous Vitamin C in the IAA group and orally 500 mg Vitamin C in the OAA group for 8 weeks. Serum oxalate was examined before and after therapy. SPSS 16.0 software was used for the statistical analysis. Chi-square and ANOVA were used for comparing groups. A P-value less than 0.05 was considered to be statistically significant. Results: There was no significant difference among the three groups based on mean of serum oxalate before and after intervention. After intervention, the mean value of serum oxalate was not significantly increased in the IAA and OAA groups compared with the control group. A mean difference of serum oxalate before and after IAA was not statistically significant. The mean of serum oxalate before and after intervention significantly increased in the two intervention groups (P < 0.05). Conclusion: In the hemodialysis patients, the procedure of Vitamin C supplementation was associated with the serum oxalate level. Serum oxalate level unchanged in the injected method but it is significantly increased in daily oral Vitamin C supplementation.

Objective: The objective was to evaluate the assessment of nutritional status by dual-energy X-ray absorptiometry (DEXA) in chronic kidney disease (CKD) patients not receiving dialysis. Patients and Methods: A total of 143 patients in stage 4-5 without receiving dialysis were enrolled and classified into well-nourished and malnourished groups by subjective global assessment. Biochemical and anthropometric measurements were performed. Simultaneously, body composition including lean body mass (LBM) and fat mass (FM) was evaluated by DEXA. Results: Compared with well-nourished patients, malnourished patients showed lower pre-albumin (ALB) levels, but higher C-reactive protein (CRP) levels. There was no significant difference in serum ALB between both groups. For either men or women, body weight, body mass index, and glomerular filtration rate (GFR) were lower in the malnourished group. For the men, triceps skin-fold thickness (TSFT), mid-arm circumference (AC), mid-arm muscle circumference (AMC), LBM-DEXA and FM-DEXA were significantly lower in the malnourished patients. For the women, TSFT, mid-AC and FM-DEXA, but mid-AMC and LBM-DEX, were not significantly lower in the malnourished patients. There was a significant correlation between LBM-DEXA and mid-AMC. A significant correlation also existed between FM-DEXA and TSFT. Multiple logistic regressions showed that low percentage of FM, high serum CRP level and low GFR were independent risk factors for malnutrition. Conclusions: Low percentage of FM, high serum CRP and low GFR are independent risk factors for malnutrition. Estimation of LBM and FM by dual X-ray absorptiometry is in consistent with traditional anthropometric measurements. It's noteworthy that DEXA, a reliable and easy-to-perform assessment method, can sensitively detect early malnutrition and may be useful in monitoring nutrition changes in CKD patients.

We report a 72-year-old man with end-stage renal disease due to chronic glomerulonephritis and chronic disseminated intravascular coagulation (DIC) caused by aortic aneurysm. He had had graft replacement for abdominal aortic aneurysm in 2012 at another hospital. He indicated development of thoracic aortic aneurysm, which developed chronic DIC with much subcutaneous hemorrhage. His renal function gradually decreased and we planned hemodialysis initiation. We administered camostat mesilate and platelet concentrate transfusion to treat hemorrhagic tendency before the arteriovenus fistula in May 2014. After the operation, we added tranexamic acid because of difficulty in hemostasis. About 1 month later, the patient reported with hemorrhage from the nose and his renal function was exacerbated. He was initiated into hemodialysis with transfusion of red blood cells and fresh frozen plasma. We raised the dose of camostat mesilate and adjusted the dose of anticoagulant with reference to activated clotting time. He was successfully initiated into dialysis without major trouble.

Delayed erosion of components of an inflatable penile prosthesis (IPP) is a rare complication after placement. Both erosion of the cylinders into the urethra, and the reservoir into the bladder, as a complication of radiation has not been previously reported. We report the case of a 71 year-old male with post-prostatectomy erectile dysfunction treated with an IPP, with subsequent biochemical recurrence requiring radiation therapy, complicated by erosion of his IPP cylinder into his distal urethra, and reservoir into the bladder.

A 40-year-old lady, a known case of hypothyroidism, presented with 1-day history of progressive weakness in all four limbs and reported a history of similar episodes since 3 years. Clinical examination revealed grade 2 hyporeflexic quadriparesis without any bulbar involvement. Workup revealed hypokalemia, non-anion gap hyperchloremic metabolic acidosis and alkaline urine suggestive of distal renal tubular acidosis (RTA). Antiperoxidase and antithyroglobulin antibodies were positive, suggestive of an autoimmune basis for hypothyroidism. She was managed with intravenous potassium chloride, thyroid replacement and bicarbonate therapy, following which remarkable recovery was noted. One week later, she was discharged on oral thyroxine and oral sodium bicarbonate and she remained weakness-free for a follow-up period of over 1 year. RTA presenting in a setting of autoimmune hypothyroidism is a rare occurrence and the possible role of immunological mechanisms and thyroxine deficiency in the pathogenesis of acidification defect seems most likely.