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Objective To investigate the prevalence and correlation factors of cardiovascular damage in patients with diabetic nephropathy (DN) and non-diabetic nephropathy (NDN).Methods A total of 278 chronic kidney disease (CKD) patients admitted to the First Affiliated Hospital of Jinan University from January 2014 to May 2016 were enrolled,including 78 case of DN and 200 case of NDN.Patients had cardiac and carotid ultrasonography test by colour doppler ultrasonography,and their clinical and biochemical data were collected.Multiple linear regression analysis and multivariable logistic regression analysis were applied to study the correlation factors of cardiovascular damage in CKD patients.Results Mean age was 48.22 years in the 278-patient cohort,which included 178(64.03％) men.Compared with NDN group,DN patients had higher left atrial dimension,interventricular septal thickness,left ventricular end-diastolic dimension,left ventricular posterior wall thickness,left ventricular mass index (LVMI),carotid intima-media thickness (cIMT) and carotid plaques ratio.Their estimated glomerular filtration rate (eGFR) and the ratio between the peak speed of the early filling wave and that of the atrial contraction wave (E/A ratio) were however lower (all P ＜ 0.05).Prevalence of left ventricular hypertrophy (LVH),left ventricular relaxant function reduction and cIMT thickening in DN group were 67.95％,70.27％ and 57.14％,higher than those in NDN group (40.00％,42.31％ and 17.39％,respectively) (all P＜ 0.05).Along with the progress of CKD,LVMI and LVH proportion in patients with DN and NDN increased gradually.LVMI and LVH proportion in DN patients in CKD 1-2 phase and CKD 3-4 phase were higher than those in NDN patients (all P ＜ 0.05).In all CKD phases,cIMT and cIMT thickening proportion in DN group were higher than those in NDN group (all P ＜ 0.05).Just in CKD 1-2 phase,DN group had lower E/A ratio and higher proportion of left ventricular relaxant function reduction than NDN group (all P ＜ 0.05).After multiple linear regression analysis,gender,BMI,hemoglobin,eGFR and DN were related with LVMI;age,serum calcium and DN were related with E/A ratio;age and DN were related with cIMT (all P ＜ 0.05).In multivariate logistic regression,DN,hemoglobin and eGFR decrease were independently associated with LVH;age and BMI were independently associated with reduction of left ventricular relaxant function;age and DN were independently associated with cIMT thickening in all CKD patients (all P ＜ 0.05).Conclusions DN patients have more severe cardiovascular damage than NDN patients,and DN may be associated with LVMI,E/A ratio,cIMT,LVH and cIMT thickening in all CKD patients.
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Objeetive To analyze the clinicopathologic features of proliferative sclerosing IgA nephropathy and the efficacy of prednisone therapy.Methods A retrospective analysis was conducted,enrolling 50 patients with biopsy-proven primary proliferative sclerosing IgA nephropathy who were admitted in the Hospital from January 2005 to June 2015-26 males and 24 females,mean age (36.8 ± 10.4) years.Clinicopathologic features and prednisone therapeutic effect were analyzed.Results The clinical manifestations of 50 cases were nephritis syndrome with varying degrees of renal insufficiency,including 32 cases (64.0％) with hypertension,15 cases (30.0％) with microscopic hematuria.Renal biopsy showed the incidence of glomerular global sclerosis was 17.0％-47.2％,tubular atrophy/ interstitial fibrosis outstanding (T0 50％,T1 32％,T2 18％).After prednisone treatment,compared with sustained remission group and relapse group,invalid patients had higher incidence of hypertension (P ＜ 0.05),relatively lower Hb (P ＜ 0.01) and serum albumin,more significant renal dysfunction (P ＜ 0.01),more severe glomerular global sclerosis,segmental sclerosis,tubular atrophy/ interstitial fibrosis,while the lower interstitial inflammatory cell infiltration.During the follow-up,which lasted from 6 to 132 months (median 27.3 months),the effective rate of treatment was 74.0％ after sufficient prednisone or half dose prednisone therapy.Repeated recurrence rate was 32.0％.At the end of the follow-up period,13(26.0％) patients entered the stage of uremia.Conclusions Application of glucocorticoids in the treatment of proliferative sclerosing IgA nephropathy can protect renal function and delay the progression of renal impairment.The efficacy of glucocorticoids therapy is significantly associated with the presence or absence of hypertension,the degree of renal function impairment,and the severity of the onset of renal pathology.
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Objective:To investigate the expression of anti-endothelial cell antibodies(AECA) in patients serum with anti-neutrophil cytoplasmic antibody( ANCA) negative pauci-immune deposition type crescentic glomerulonephritis and its relationship with clinical signatures. Methods:We selected 94 pauci-immune deposition type crescentic glomerulonephritis patients from 2010 to 2015 treated in our hospital,45 of which with ANCA-negative( observation group) and 49 cases of ANCA-positive patients ( control group) , AECA levels of each groups serum were detected by Western blot test. Results: The average age of the observation group and Bermingham vasculitis activity score(BVAS) respectively (41. 08 +9. 43) years old and (15. 03 +3. 82),significantly lower than the control group (P<0. 05);the observation group had fever,joint pain accounted for 26. 67% and 13. 33%,significantly lower than the control group ( P<0. 05 );the observation group of nephrotic syndrome accounted for 48. 89%, higher than the control group ( P<0. 05);observation group positive rate of serum AECA was 46. 67%,significantly lower than the control group 81. 63% (P<0. 05);the observation group IgG-AECA identified 7 proteins,while the control group had identified 11 proteins,of which the observation group the positive rate of anti 90 kD antibody was 13. 33%( 6/45 ) , significantly lower than the control group 51. 02%( 25/49 ) ( P<0. 05 );observation group of anti 76 kD antibody positive patients had rash ratio of 100%, significantly higher than negative patients ( P<0. 05),anti 200 kD antibody positive the BVAS score of the patients was (18. 02 + 2. 51),which was significantly higher than that of the negative patients ( P < 0. 05 ) . Conclusion: The different level of AECA in ANCA negative pauci-immune crescentic glomerulonephritis patients may be associated with certain clinical manifestations;clinical manifestations differences between the ANCA negative and positive patients may be associated with different expression of the AECA related,the detail need a further study.
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Objective To analyze the dialysis adequacy of the maintenance hemodialysis patients under different dialyzate flow.Methods Forty-eight patients under maintenance hemodialysis were divided into four groups according to dialyzate flow:500 ml/min group,600 ml/min group,700 ml/min group and 800 ml/min group,with 12 patients in each group.Each group was treated 6 weeks.The albumin (Alb),hemoglobin(Hb),hematocrit(Hct),blood urea nitrogen (BUN),serum creatinine(SCr) and parathyroid hormone(iPTH) levels before and after treatment were examined,Kt/V and urea reduction ratio(URR) were calculated separately.Results There was no significant difference in Kt/V between 500 ml/min group and 600 ml/min group.Kt/V was no increased when the dialyzate flow rate increased from 500 ml/min to 600 ml/min,that was to say they could not improve the dialysis adequacy.There was statistically significant difference in Kt/V among 500 ml/min group,600 ml/min group,700 ml/min group and 800 ml/min group,and 800 ml/min group on the dialysis adequacy was better.Different dialyzate flow on the impact of the dialysis adequacy was compared in self-control method.Kt/V increased along with the increase of dialyzate flow,and the dialysis adequacy and dialyzate flow showed positive correlation.Conclusion The high dialyzate flow of dialysis treatment can improve Kt/V and has significant effect in enhancing the dialysis adequacy.
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Cardiovascular disease is the most important factor that affect the lifetime of uremia patients. Recently, scientists pay closer attention to study the mechanism of cardiac injury in uremia patients. In this article, we will make an overview on mechanism of cardiac injure caused by uremia toxin, secondary hyperparathyroidism, calcium-phosphorus metabolic disorder, rennin-angiotensin-aldosterone system.