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Objective:To analyze the clinicopathological characteristics, treatment responses and kidney outcomes of patients with atypical membranous nephropathy (MN), and to provide information for the clinical practice.Methods:The clinical data of patients with atypical MN and synchronous primary MN who were diagnosed, treated and followed up in Peking University First Hospital from January 2008 to June 2020 were retrospectively collected and analyzed. Clinicopathological features, treatment responses and kidney prognosis were compared between the two groups. The expression of phospholipase A2 receptor (PLA2R) in kidney tissues was detected by immunofluorescence. Serum anti-PLA2R antibody was detected by enzyme-linked immunosorbent assay. Clinicopathological indexes were compared between PLA2R-related MN group and non-PLA2R-related MN group. Kaplan-Meier (Log-rank test) survival curve and multivariate Cox regression analysis methods were used to analyze the influencing factors of kidney prognosis in patients with atypical MN. The primary endpoint of renal adverse outcome was renal insufficiency, defined as end-stage renal disease or estimated glomerular filtration rate (eGFR) decline>30% baseline and<60 ml·min -1·(1.73 m 2) -1. Results:A total of 65 atypical MN patients were enrolled in this study. Compared with primary MN ( n=324), patients with atypical MN had younger age ( Z=-4.229, P<0.001), higher proportion of hematuria ( χ2=5.555, P=0.018), higher level of urinary protein ( Z=2.228, P=0.026) and lower level of eGFR ( t=-5.108, P<0.001); the proportion of IgG4 deposition in kidneys was lower ( χ2=8.081, P=0.004), and the proportions of IgA ( χ2=16.969, P<0.001) and IgM ( χ2=9.281, P=0.002) deposition were higher. There was no significant difference on gender, serum albumin, positive proportion of anti-PLA2R antibody, anti-PLA2R antibody level and kidney C3/C1q deposition between the two groups (all P>0.05). The proportions of atypical MN patients receiving renin-angiotensin aldosterone system inhibitors (49.3% vs 57.1%), calcineurin inhibitors (27.7% vs 19.1%) and cyclophosphamide (21.5% vs 23.8%) were comparable to those of primary MN patients (all P>0.05). The rates of clinical remission (80.0% vs 77.2%), partial remission (44.6% vs 44.1%), complete remission (35.4% vs 33.1%), spontaneous remission (36.9% vs 42.6%), response to cyclophosphamide (85.7% vs 81.8%), response to calcineurin inhibitor (88.9% vs 79.0%), and relapse (30.8% vs 26.8%) in atypical MN patients were comparable to those in primary MN patients (all P>0.05). During the follow-up 30.0(21.5, 61.5) months, 15 atypical MN patients (23.1%) had eGFR reduction>30%, among whom 7 patients (10.8%) had eGFR reduction>50% and 3 patients (4.6%) had end-stage kidney disease. There was no significant difference on poor kidney prognosis between the two groups (all P>0.05). Kaplan-Meier survival curve showed that patients with age>39 years old ( χ2=10.092, P=0.001), eGFR≤100 ml·min -1·(1.73 m 2) -1( χ2=5.491, P=0.019), tubular interstitial lesion ( χ2=6.999, P=0.008) and no nephropathy remission ( χ2=22.952, P<0.001) had earlier poor renal prognosis. Multivariate Cox regression analysis showed that no nephropathy remission ( HR=12.604, 95% CI 2.691-59.037, P=0.001) was an independent influencing factor for poor renal prognosis in atypical MN patients. Conclusion:No significant difference is found between atypical MN and primary MN on treatment responses and kidney prognosis, which implies that clinical practice of atypical MN can be performed by referring to the guidelines and experience of primary MN.
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Objective:To explore the effectiveness and complications of non-incision removal of tunneled cuffed catheter (TCC).Methods:The clinical characteristics, surgical plans and complications of patients with TCC removal in the Renal Division of Peking University First Hospital from January 1, 2015 to December 31, 2020 were collected and analyzed retrospectively. The patients were divided into non-incision removal group and traditional incision removal group. The clinical characteristics, procedure success rate, procedural duration and complications were compared between the two groups.Results:A total of 349 patients were included in this study, for whom 368 catheter removal procedures were performed, including 286 procedures in the non-incision removal group, 75 procedures in the traditional incision removal group, and 7 procedures without records of surgical plans. There was no significant difference in age, sex, basic kidney diseases and catheter remaining time and location between the two groups (all P>0.05). Two procedures in the non-incision removal group and 1 procedure in the traditional incision removal group failed respectively, and there was no significant difference in the procedure success rate between the two groups (99.3% vs 98.7%, χ2=0.290, P=0.590). The procedural duration in the non-incision removal group was lower than that in the traditional incision removal group [(5.36±1.70) min vs (17.55±3.28) min, t=44.198, P<0.001]. Among the patients who needed TCC exchange, there was no significant difference in the selection of new catheter position between the two groups ( P=0.330). In terms of complications, there were 2 procedures of local hematoma in the non-incision removal group and 1 procedure of infection in the traditional incision removal group, and there was no severe complication in both groups. Conclusions:There was no significant difference in the procedural success rate and complications between non-incision removal group and traditional incision removal group, and non-incision procedure may be superior in reducing the procedure duration and harm less to the patients. Non-incision procedure is a safe and effective method to remove TCC.
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Objective To study the effect of medically activated charcoal on serum phosphorus level and calcium-phosphorus products in dialysis patients with poorly controlled hyperphosphatemia. Methods A single-center,prospective,self-controlled study was performed.Medically activated charcoal was administered 4.5-7.2 g per day with meals for three months to hemodialysis or peritoneal dialysis patients with hyperphosphatemia after taking calcium-based phosphate binders.The levels of blood phosphorus,calcium,calcium-phosphorus products,intact parathyroid hormone (iPTH),albumin and hemoglobin were detected before and after the treatment.The results were analyzed using paired t-test. Results After 3 months of treatment,the patients' serum phosphorus level was significantly reduced from (2.16 ±0.34) mmol/L (pretreatment) to (1.85±0.30) mmol/L (post-treatment) (P＜0.01).Similarly,the serum calciumphosphorus products were lowered from pre-treatment level of (63.93 ±8.83) mg2/dl2 to posttreatment of (54.12±8.37) mg2/dl2 (P＜0.01).Serum albumin level was slightly reduced from (41.7±2.9) g/L to (40.1±2.2) g/L (P=0.001).In contrast,there were no significant changes in serum calcium and iPTH levels when compared pre- to post-treatment values (P=0.734 and P=0.665,repectively). Conclusion In combination with calcium-based phosphate binder therapy,oral medically activated charcoal can effectively reduce the levels of blood phosphorus and calciumphosphorus products in dialysis patients with refractory hyperphosphatemia.
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Objective To find out the clinical characteristics and prognostic risk factors of malignant hypertension (MHT) with pre existed chronic glomerulonephritis.Method The clinical and renal pathological data of 38 chronic glomerulonephritis patients with MHT hospitalized in our department from 1990 to 2002,and the associated factors for renal prognosis were analyzed. Results All the patients suffered from chronic glomerulonephritis.The ratio of male to female was 3 75∶1.The average age was (29 5?7 74)years old. The rates of recognition, therapy and control of hypertension before MHT onset were 75 7%, 13 5%and 5 4%respectively. IgA nephropathy was the most common pathological type.Of 38 cases,3 maintained normal renal function, 6 presented acute renal failure,13 presented chronic renal failure, and 16 had acute attack based on chronic renal failure. Twenty four patients were followed up for 1～6 months after antihypertensive therapy and renal function of 10(41 7%) was improved. 1 year renal survival rate of 20 patients was 55%. The analysis of risk factors showed that those patients who were possessed of positive hypertension family history(P=0 03), high SBP/DBP levels(P=0 023,0 047), and high scores of chronic index of renal pathology(P=0 032) had worse prognosis. The level of highest serum creatinine and the scores of chronic index of renal pathology were associated with 1 year renal survival(P=0 031,0 037).Conclusions MHT occuring in young patients with chronic glomerulonephritis is not rare, which becomes an important reason inducing rapidly decrease of renal function, especially in patients with IgA nephropathy. Actively antihypertensive therapy is helpful for renal function recovery. The low rates of recognition, therapy and control of pre existed renal hypertension may play key roles in the development of MHT. It is important to recognize and treat the hypertension at early stage of renal disease to improve the renal survival.