ABSTRACT
Objective To explore the efficacy of interventional therapy for central venous stenosis in maintenance hemodialysis patients. Methods The general clinical data of the maintenance hemodialysis patients with central venous stenosis, who received interventional therapy in Changzheng Hospital of Naval Medical University (Second Military Medical University) from Jan. 2014 to Mar. 2018, were retrospectively analyzed, and the patency of vascular access of interventional therapy were followed up. Results A total of 82 maintenance hemodialysis patients with central venous stenosis were enrolled. Six-eight patients (82.93%) had a history of temporary central venous catheterization. Among the 82 patients, 13 (15.85%) had double lesions of central vein and 69 (84.15%) had single lesion; and 5 (6.10%) had mild lesions, 17 (20.73%) had moderate lesions, 35 (42.68%) had severe lesions and 25 (30.49%) had complete occlusion. Of the 82 patients, 57 were treated by percutaneous transluminal angioplasty and 9 by percutaneous transluminal stenting. The follow-up period ranged from 12 to 62 months after operation. The patency rate of vascular access was 75.76% (50/66) at 6 months postoperatively and 68.18% (45/66) at 12 months postoperatively. The overall patency rate of vascular access was 59.09% (39/66). Conclusion Central venous stenosis of the maintenance hemodialysis patients can affect the life of vascular access. For the patients with symptoms that can not be alleviated, active intervention is recommended. Intervention therapy is safe and effective for the patients with central venous stenosis. Meanwhile, the central venous catheterization shall be avoided if possible to reduce central venous stenosis in the patients with chronic kidney disease.
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AIM:To investigate the effect of homeodomain-interacting protein kinase 2 (HIPK2) on the viabi-lity, apoptosis and JAK2/STAT3 signaling pathway in NRK-52E renal tubular epithelial cells induced by hypoxia and reox-ygenation (H/R). METHODS:HIPK2 small interfering RNA (siRNA) was transfected into NRK-52E cells by Lipo-fectamineTM 2000, and normal control group (control group) and negative control group (HIPK2-NC group) were set up. After H/R, the cell viability was measured by CCK-8 assay, the apoptotic rate and Ca2+ fluorescence intensity were ana-lyzed by flow cytometry, and the protein levels of Ki67, cleaved caspase-3, caspase-12, Bcl-2, Bax, p-JAK2 and p-STAT3 were determined by Western blot. RESULTS:Compared with control group, the protein expression of HIPK2 in the NRK-52E cells was significantly decreased after transfection with HIPK2 siRNA (P<0.05). Compared with control group, the cell viability and the protein expression of Ki67 and Bcl-2 in H/R group were also significantly decreased, and the apoptotic rate, the Ca2+ fluorescence intensity and the protein levels of cleaved caspase-3, caspase-12, Bax, p-JAK2 and p-STAT3 were significantly increased (P<0.05). Compared with H/R group, the cell viability and the protein expression of Ki67 and Bcl-2 in HIPK2-siRNA+H/R group were significantly increased, while the apoptotic rate, the Ca2+ fluorescence inten-sity and the protein levels of cleaved caspase-3, caspase-12, Bax, p-JAK2 and p-STAT3 were significantly decreased (P<0.05). CONCLUSION:Inhibition of HIPK2 gene expression promotes H/R-induced growth of NRK-52E renal tubular epi-thelial cells, and reduces the apoptosis. The mechanism is related to down-regulating the JAK2/STAT3 signaling pathway.
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Objective To evaluate the efficacy and safety of tacrolimus (TAC) therapy in patients with refractory IgA nephropathy. Methods Nine IgA nephropathy patients were included in this study were treated from Jun. 2008 tc Sep. 2013 in Changzheng Hospital of Second Military Medical University. All patients received TAC therapy after the renin-angiotensin system (RAS) blockade therapy and steroid therapy failed. The main outcome was complete or partial remission. Secondary outcomes included the time required to remission, the frequency of recurrence, TAC dosage and adverse events. Results The initial dosage of TAC" was (1. 89 + 0. 33) mg/d. After treatment with TAC for 6 months, 6 patients achieved complete remission, 2 partial remission and 1 treatment resistance, and most of the remission patients achieved remission during the first 2 months of TAC therapy. The urine protein level of enrolled patients was significantly decreased ([3. 05 ± 1. 35] g/24 h vs [0. 85±1. 54] g/24 h. P<0. 05) and the serum album level of all patients was significantly improved ([27. 00±8. 37] g/L vs [37. 33±8. 08] g/L. P<0. 05). One patient receiving TAC" therapy presented worsened hypertension, and no other adverse event was observed in this study. Three of 8 proteinuria remission patients had relapses find achieved remission by adjusting the dosages of steroids and tacrolimus. Conclusion TAC ear improve proteinuria in patients with refractory IgA nephropathy, with less adverse reactions.