Changes in pathological pattern and treatment regimens based on repeat renal biopsy in lupus nephritis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Relapses occur frequently in patients with lupus nephritis. Renal biopsy is the gold standard for assessing renal activity and hence guiding the treatment. Whether repeat renal biopsy is helpful during flares of lupus nephritis remains inconclusive. In the present study, we retrospectively reviewed the patients with lupus nephritis who had more than one renal biopsy with the hope to find the clinical value of repeat biopsy.</p><p><b>METHODS</b>Patients who had a diagnosis of lupus nephritis and two or more renal biopsies were selected from the database of the patient pathology registration at this renal division. Renal biopsy was evaluated according to the International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification of lupus nephritis. The pathological patterns and treatment regimens were analyzed after a repeat biopsy.</p><p><b>RESULTS</b>We identified 44 systemic lupus erythematosus patients with serial renal biopsies. In total, there were 94 renal biopsies. Overall, the pathological transition occurred in 64% instances according to the ISN/RPS class. When the transition was analyzed according to proliferative, membranous or mix lesions, it showed different profile: 35% in patients with proliferative lesion, 23.5% patients with mix lesions, 100% in patients with pure membranous lesion. The pathological transition could not be predicted by any clinical characteristics. After the repeat renal biopsy, 34% of patients had a change in their treatment regimens.</p><p><b>CONCLUSIONS</b>The pathological conversion was very prevalent in patients with lupus nephritis. However, the transitions became less prevalent when they were analyzed according to pure membranous, proliferative, and mix lesion. Repeat biopsy might be helpful to avoid unnecessary increased immunosuppression therapy.</p>

Clinical and pathological analysis of 25 cases of microscopic polyangiitis / 南方医科大学学报

<p><b>OBJECTIVE</b>To analyze the clinical and pathological features of microscopic polyangiitis (MPA) to improve the diagnosis and treatment of the disease.</p><p><b>METHODS</b>Twenty-five cases of MPA were retrospectively analyzed.</p><p><b>RESULTS</b>The onset symptoms of MPA, often nonspecific, included fever, muscle and joint pain, fatigue, loss of weight, etc, with varying degrees of proteinuria, hematuria and renal insufficiency. The pathological types revealed by renal biopsy were mainly focal segmental necrotizing glomerulonephritis or pauci-immune crescentic glomerulonephritis. Timely immunosuppressive therapy could improve the outcome.</p><p><b>CONCLUSION</b>The early symptoms of MPA are often nonspecific to easily result in misdiagnosis. Examination of ANCA titers and timely renal biopsy are helpful to establish an early diagnosis. Immune suppression therapy and plasma exchange when necessary should be initiated after the establishment of the diagnosis. The disease activity and drug toxicity should be carefully monitored to improve the prognosis.</p>

Effects of peritoneal dialysis solution on apoptosis and intracellular free calcium, cell surface ICAM-1 expression of rat peritoneal mesothelial cells / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effects of peritoneal dialysis solution (PDS) on apoptosis and intracellular free calcium([Ca(2+)]i), cell surface ICAM-1 expression of rat peritoneal mesothelial cells (RPMCs).</p><p><b>METHODS</b>The RPMCs apoptosis rate were determined by flow cytometry. [Ca(2+)]i in the cells were monitered the fluorescence at 528 nm by confocus laser microscopy. Cell surface ICAM-1 expression were detected by flow cytometry.</p><p><b>RESULT</b>After PDS treatment for 1 h, the RPMCs apoptosis rate were increased. Such increase was more manifest with higher glucose concentration in PDS and longer treatment time of the cells. At the same times, after 3 hours, ICAM-1 expressions of the PDS containing glucose and mannitol are all increased. With the increase of glucose concentrations, the descend of [Ca(2+)]i levels were aggravated.</p><p><b>CONCLUSION</b>PDS containing high- concentration glucose can induce significant apoptosis of RPMCs in vitro. This may be related with the enhanced level of ICAM-1 expressions and the decreased level of [Ca(2+)]i. Which may due to the occurrence of peritoneal fibrosis and ultrafiltrate failure in patients suffering long term peritoneal dialysis.</p>

Effects of peritoneal dialysis solution on proliferation and apoptosis of rat peritoneal mesothelial cells / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effects of peritoneal dialysis solution (PDS) on proliferation and apoptosis of rat peritoneal mesothelial cells (RPMCs).</p><p><b>METHODS</b>The proliferation of RPMCs treated with PDS containing glucose of different concentrations for different times in vitro were examined by MTT colorimeric assay. The cell cycles and cell apoptosis rate were determined by flow cytometry.</p><p><b>RESULTS</b>After PDS treatment for 1 h, the cell proliferation inhibition rate, percentage of cells at G(0)/G(1) stage and early cell apoptosis rate increased, and such increment was more manifest with higher glucose concentration in PDS and longer treatment time of the cells. After treatment with PDS containing 4.25% glucose for 3 h, the proliferation inhibition rate of the RPMCs reached 44.12%, the percentage of cells at the G(0)/G(1) stage amounted to 71.95% and the early apoptosis rate reached 23.59%, which was several times higher than that of the negative control and 1.5% glucose/PDS groups, and also higher than that of 4.25% mannitol/PDS groups.</p><p><b>CONCLUSION</b>PDS containing high-concentration glucose can induce significant apoptosis and inhibit the proliferation of RPMCs in vitro.</p>