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Objective To explore the clinical efficacy and safety of modified Ponticelli regimen in treating patients with idiopathic membranous nephropathy (IMN).Methods A retrospective analysis was performed in 90 patients with IMN (type Ⅰ / Ⅱ,79/11 respectively) diagnosed by clinical data and renal biopsy.The patients were divided into modified Ponticelli group (n =23),steroid plus cyclophosphamide (CTX) (CTX group,n =39) and steroid plus cyclosporine A(CsA) (CsA group,n =28) according to the treatment.Liver function,renal function,serum lipid,proteinuria were recorded before and after treatment.Efficacy and adverse reactions were evaluated in three groups.Results (1) In all three groups,the quantity of proteinuria after treatment for 3 months [(3.33 ± 1.53) g/d,(4.70 ± 2.97) g/d,(3.92 ± 2.57) g/d],6 months [(1.60 ± 1.10) g/d,(2.34 ± 1.61) g/d,(2.25 ± 1.78) g/d] was significantly decreased compared with baseline level[(7.26 ± 2.06) g/d,(7.50 ± 2.55) g/d,(7.54 ± 2.70) g/d;P ＜ 0.05].Serum albumin levels at 3 months [(31.42 ± 3.86) g/d,(30.59 ± 5.79) g/d,(30.90 ± 7.87) g/d],6 months [(36.25 ± 4.20) g/d,(34.70 ± 6.70) g/d,(35.36 ± 8.29) g/d] were significantly increased compared with baseline levels [(24.13 ± 2.61) g/d,(23.98 ± 3.79) g/d,(22.94 ± 4.57) g/d;P ＜ 0.05],whereas serum creatinine at 3 and 6 months had no significant changes (P ＞ 0.05).(2) After treatment for 3 months,partial remission rates in modified Ponticelli group,CTX group and CsA group were 39.1％,35.9％,35.7％ respectively and complete remission rates were 8.7％,5.1％,10.7％,which were not statistically significant in all three groups (P ＞ 0.05).At 6 months,partial remission rates in three groups were 56.5％,41.0％,42.9％ respectively and complete remission rates were 21.7％,20.5％,28.6％,which did not suggested significant difference in all three groups either (P ＞ 0.05).(3) In modified Ponticelli group,steroid diabetes,impaired liver dysfunction,infections and gastrointestinal adverse events occurred in 1,1,2 and 2 patients,respectively.In CTX group,steroid diabetes,infections and gastrointestinal adverse events occurred in 5,8 and 2 patients,respectively.In CsA group,steroid diabetes and infections occurred in 1 and 3 patients,respectively.Conclusion Modified Ponticelli regimen to treat patients with IMN has a trend of better outcome than classic CTX regimen.The efficacy is not inferior to CsA regimen with fewer side effects.
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Objective To explore the effect of clinical and pathological features on the incidence of Hyperuricemia (HUA) in renal glomerular disease.Methods A retrospective analysis was applied to review the clinical and pathological date collected from 3547 patients with renal glomerular disease.These patients were diagnosed as renal glomerular disease by renal biopsy from January 2007 to December 2011.Results (1) HUA incidence was 21.8％ (773/3547) in all of the patients,in which the incidence in secondary glomerular disease 27.2％ (240/882) was much higher than that in primary glomerular disease 20.7％ (552/2665),and the difference was significant (x2 =153.642,P ＜ 0.05).In primary glomerular disease,HUA incidence was the lowest in membranous nephropathy 14.4％ (96/665),while HUA incidence in lupus nephritis (LN) 45.3％(110/243) was the highest and small blood vessel infammation kidney damage 34.7％ (17/49) was the second in secondary glomerular disease.(2) With the increasing of glomerulosclerosis index,tubulointerstitial score,renal vascular lesions score and the stage of chronic kidney disease,HUA incidence increased (x2 =17.798-298.216,P =0.000).(3)Logistic regression analysis showed that high tubulointerstitial score,glomerulosclerosis index and renal dysfunction,male,overweight or obese,hypertension and hypertriglyceridemia were risk factors for hyperuricemia (OR:1.011-7.513,P ＜ 0.05).Conclusion The uric acid level is increased in nearly a quarter of patients with renal glomerular disease.Severe tubulointerstitial lesion,high glomerulosclerosis index,low glomerular filtration rate,male,overweight or obese,hypertension and hypertiglyceridemia were independent risk factors for HUA.
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Objective To observe the change of Wnt-β-catenin signaling's location and expression in kidney repair after acute kidney injury induced by ischemla reperfusion (I/R).Methods Ischemia reperfusion injury in BAT-gal reportor mice was made and blood sample was taken from tails on the 1th day after injury. Mice were sacrified on the 2th or 7th day and kidneys and blood were collected. Renal pathological change was observed by PAS stain. The changes of location and expression of Wnt-β-catenin signaling were detected by immunofluorescence costainning X-gal-LTL, X-gal-NKCC2, X-gal-DBA respectively. The protein expressions of the Wnt4 and co-receptor Lrp6 were assessed by Western blotting. Results PAS-stained kidney sections showed desquamative or flattened epithelia, necrotic debris on day 2 and regenerating tubules on day 7. An injury-induced enhancement of the Wnt pathway response (X-gal staining) in kidney cortex and out-medulla. Immunolabelling of kidney sections from injured BAT-gal mice revealed that X-gal staining was detected in kidney epithelial cells (double-labelled with LTL or NKCC2). Western blotting showed the Wnt4 protein was up-regulated and phospho-Lrp6, indicative of active canonical Wnt signaling, was noted in kidney cortex from day 2 after I/R, but in control kidney cortex pLrp6 was not detected. Conclusion Wnt-β-catenin signaling is activited after acute kidney I/R injury and is required for tubular epithelial repair and regeneration following kidney I/R injury.
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Objective To investigate the effects of TNF-?,IL-12,IL-15 and underglycosylation IgA_1 in mesangial deposition in the clinicopathological study of IgA nephropathy(IgAN).Methods Seventy-four patients with IgAN were enrolled in the study,with 10 patients randomly selected after remission,10 MCD and 10 healthy volunteers as control groups.The levels of TNF-? in serum and urine were examined by radioimmunoassay,and the levels of IL-12 and IL-15 were examined by ELISA.Immunohistochemistry was used to detect the expression of TNF-? in renal tissue,and the directed immunofluorescence was used to detect the underglycosylation of IgA_1(UGIgA_1)in mesangial deposition.Results The levels of TNF-?,IL-12 and IL-15 in serum of patients with IgAN were higher than those of MCD group,healthy control group and remission group.Compared with the negative group,33 patients with UGIgA_1 positive in renal tissues had lower levels of TNF-? in serum,longer course and less class of renal tissue injury.The positive areas of TNF-? in renal tissue and levels of TNF-? in serum were positively correlated with urinary protein(r=0.249,0.702,P=0.000).There was negative correlation between the levels of TNF-? in serum and Ccr(r=-0.231,P=0.048).The levels of IL-15 was positively correlated with the course of disease(r=0.266,P=0.022) and negatively with Scr(r=-0.320,P=0.005).Conclusions The TNF-?,IL-12 and IL-15 are all involved in the onset of proteinuria in IgAN patients,and IL-15 acts as a factor against renal injury.The patients with UGIgA_1 positive in mesangial have longer course and less pathological changes damaged than those of the UGIgA_1 negative patients.The TNF-? may serve as an important factor in the aggravation of IgAN.
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Objective To investigate the effects of long-term glucocorticoid therapy on bone mineral density(BMD) in the patients with glumerulose disease. Methods 41 patients with glumerulose disease were prospectively studied. The BMD of lumbar spine (L 2-4 ) and femur was measured using dual-energy X-ray absorptiometry at base line, and at every 3 to 6 months interval after receiving glucocorticoid therapy. Vitamin D receptor (VDR) gene polymorphism was detected using PCR-RFLP. Results ⑴ Every measured site BMD decreased(29 9～83 8)mg/cm 2 after 15-month administration of glucocorticorids, and BMD decrease in L 2-4 and femoral trochanter was significantly greater (P
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Objective To explore the relationship between diethylhexylphthalate (DEHP) and peritoneal sclerosis and its possible mechanism. Methods Isolated human peritoneal mesothelial cells (HPMC) was cultured for five days in culture solution with varied doses of DEHP ７．７?of 10-6mol/L (A group), 5.4?１０－５mol/L (B group) and 2. 2?10-4 mol/L (C group) respectively. Culture solution without DEHP was as control. Total collagen synthesis and secretion was assayed by 3H-proline incorporation. ELISA method was used to detect the level of secreted fibronectin (FN) . The expression of FN mRNA , collagen ImRNA, collagen Ⅲ mRNA and TGF－?l mRNA was determined by RT-PCR. Results (1)HPMC expressed FN, laminin, collagen Ⅲ and TGF-?１. (2)DEHP stimulated FN and collagen expression with a higher level in C group compared with control(P