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Objective To investigate the relationship between interventricular septum thickness (IVST) and renal prognosis in IgA nephropathy patients.Methods A total of 213 patients with IgA nephropathy proven by biopsy from Department of Nephrology of Shenzhen Second People's Hospital were enrolled in this study,and these participants were divided into normal IVST group (＜ 11 mm) and higher IVST (≥ 11 mm) group according to IVST.The demographic characteristics,clinical biochemical indexs,CKD stage and pathologic characteristics in these two groups were compared.Binary logistic regression analysis was used to analyze the influencing factors of eGFR ＜ 60 ml · min-1 ·(1.73 m2)-1,and Kaplan-Meier survival curve was used to analyze the effect of IVST on renal prognosis.Results Compared with IVST normal group,the patients in IVST higher group were more male sex,older,and had higher level of systolic pressure,Hb,Scr,BUN,UA,24 h urine protein excretion,urinary protein creatinine ratio,triacylglycerol,total cholesterol,LDL,Serum C3,C4,and had more serious mesangial proliferation,tubular atrophy (all P ＜ 0.05).However,the levels of eGFR and HDL were decreased in IVST higher group (both P ＜ 0.05).There were a significant difference in CKD staging distributions and IgA Lee grade between two groups (both P ＜ 0.01).Spearman and Pearson correlation analysis indicated that IVST was negatively correlated with eGFR and positively correlated with proteinuria level in IgA nephropathy patients.Baseline IVST was an independent risk factor of eGFR ＜ 60 ml · min-1 · (1.73 m2)-1 in IgA nephropathy patients.Serum C3,UA and hemoglobin were independent influential factors of eGFR decline (all P ＜ 0.05).Kaplan-Meier survival curve indicated that the renal function was worse in patients with thickened interventricular septum.Conclusion The IgA nephropathy patients with thicker interventricular septum has a poor renal prognosis.
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Objective To explore the clinicopathological features and outcomes of IgA nephropathy patients with different proportions of crescents.Methods A total of 270 patients who were diagnosed as IgA nephropathy by renal biopsies from January 2010 to December 2015 in the First Affiliated Hospital of Shenzhen University were enrolled.All patients were divided into 3 groups according to the optimal cutoff level of crescents proportion in the Receiver Operating Characteristic Curve (ROC) as follows:0％,＜ 14％;≥ 14％.The endpoint was defined as the doubling of baseline serum creatinine (Scr) and/or end-stage renal disease (ESRD).Kaplan-Meier curve and Cox regression model were used to analyze the renal survival among three groups.Results One hundred and four patients (38.5％) without any crescents;84 patients (31.1％) with crescents proportion ＜ 14％ and 82 patients (31.4％) with crescents proportion ≥14％.Patients with crescents proportion ≥14％ group were older and had higher level of systolic blood pressure and diastolic blood pressure,24-hour urine protein and serum uric acid level;more patients treated with RAS blocker,glucocorticoid and immunotherapy,but lower eGFR,hemoglobin and serum albumin level than those with crescents proportion ＜ 14％.Compared with those without crescents and crescent proportion ＜ 14％,patients with crescent proportion ≥ 14％ also had higher proportion of global glomerulosclerosis,more endocapillary hypercellularity and severe tubulointerstitial lesions,higher degree of IgA and C3 depositions in renal.24-hour proteinuria,serum uric acid level,low hemoglobin level,endocapillary hypercellularity and renal C3 depositions were risk factors for crescents formation.Patients were followed-up for a median of (31.7±21.0) months,and Kaplan-Meier analysis revealed that renal survival rate was significantly lower in patients with crescents proportion ≥ 14％ compared with other groups (P=0.001).But there was no significant difference between no crescent group and crescents proportion ＜ 14％ group.However,multivariate Cox analysis showed no significant difference between crescents proportion and renal survival.Conclusion Crescents proportion is associated with higher risk of renal function and renal progression.
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Objective To investigate the relationship between interventricular septum thickness(IVS) and renal function in patients with diabetes mellitus.Methods Two hundred and sixty-five patients of type 2 diabetes without dialysis were enrolled in a cross-sectional study.According to their IVS,the patients were divided into normal group (IVS≤ 11 mm) and higher IVS group (IVS ＞ 11 mm).All patients according to evaluated glomerular filtration rate (eGFR) level were divided into eGFR≥60 ml· min-1 · (1.73 m2) 1 group and eGFR ＜ 60 ml· min-1 · (1.73 m2)-1 group.The demographic characteristic,biochemical examination,eGFR,and proteinuria of different groups were compared.Pearson or spearman correlation was used to analyze the relationship between eGFR,IVS and other parameters.eGFR ＜ 60 ml · min-1 · (1.73 m2)-1 and IVS thickening were analyzed by binary logistic regression.Risk factors affect the prognosis of renal function in patients with diabetes mellitus were analyzed by Cox regression analysis.Results Compared with normal group,patients in the higher IVS group had higher systolic pressure (P=0.002),their level of Scr,BUN,24 h urinary protein were increased (all P ＜ 0.05),while the level of eGFR,albumin (ALB),hemoglobin (Hb) and fasting blood glucose were decreased (all P ＜ 0.05).The prevalence of hypertension was increased (81.16％ vs 58.67％,x2=11.273,P=0.001),and there was also a difference in the proportion of patients in each stage of CKD (x2=34.593,P ＜ 0.001).Correlation analysis showed that IVS was positively correlated with BMI,systolic BP,Scr,BUN,24 h urinary albumin,24 h urinary protein (all P ＜ 0.05),while negative correlation was observed between the thickened degree of IVS and Hb,albumin,eGFR and total calcium (all P ＜ 0.05).It's worth noting that IVS also correlated with history of hypertension and degree of renal injury (all P ＜ 0.01).Logistic regression analysis showed that longer duration of diabetes,higher systolic pressure and BUN were independent risk factors for eGFR ＜ 60 ml·min-1·(1.73 m2)-1 (all P ＜ 0.05),while higher Hb and Alb were independent protective factors for eGFR ＜ 60 ml· min-1· (1.73 m2)-1 (all P ＜ 0.05).Logistic regression analysis also showed that the baseline increased Scr was independent risk factor for interventricular thickening (P ＜ 0.05),while the increase of fasting blood-glucose was independent protective factor for interventricular thickening (P ＜ 0.05).Cox regression analysis showed that interventricular thickening was an independent risk factor in predicting the progression of type 2 diabetes (HR=1.396,95％ CI=1.098-1.774,P=0.006).Conclusion Interventricular septum thickness is closely related to the state of renal function,as well as is an independent risk factor to predict kidney function decline in patients with type 2 diabetes.
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Objective To investigate the association between left ventricular hypertrophy and peritoneal transport properties in Peritoneal Dialysis patients.Methods Sixty-nine Continuous Ambulatory Peritoneal Dialysis (CAPD)patients were enrolled in current study.All patients underwent echocardiography for left ventricular mass index (LVMI).Transport status was categorized as high transport,high average transport,low average transport and low transport based on modified peritoneal equilibration test (PET).The data collected included hemoglobin,albumin,blood urea nitrogen,creatinine,urea clearance (Kt/V) and creatinine clearance rate (Ccr),dialysis vintage,systolic blood pressure,diastolic blood pressure.Results Patients with high transport status were 41 cases,more than those with low transport status(28 cases).The dialysis age of high transport,high average transport,low average transport and low transport vintage were (39.2 ± 21.8),(26.6 ±15.6),(28.6 ± 14.4),(45.7 ± 35.0) years old respectively,and the difference was significant (F =4.128,P ＜ 0.05).The dialysis age in the higher transport group was longer than that in high average transport group and low average transport group (P ＜ 0.05).LVMI has significant positive correlations with D/Pcr at 4th hour,SBP and DBP (r =0.339,0.351,0.316,P ＜ 0.01) and the negative correlation with albmin (r =-0.292,P ＜0.05).Left ventricular hypertrophy(LVH) in all patients was 63.8％,ant it was higher in high transport group than that low average transport and low transport group (x2 =5.455,5.091,P ＜ 0.05) Conclusion High transport status is the most common in CAPD patients.There is high incident rate of LVH in this population.LVH has significant positive correlations with D/Pcr,higher SBP,DBP,and lower albumin.
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Objective To observe the effect of fleabane injection on serum level of D-dimer, fibrinogen and hypersensitive C-reactive protein in patients with IgA nephropathy and to explore the mechanism of fleabane injection for treating IgA nephropathy. Methods 29 patients with IgA nephropathy were given fleabane injection together with routine treatment. Another group of 28 patients with IgA nephropathy were only treated with routine treatment as con-trol. Determinations of 24 hours urine protein output(24HPQ), serum level of D-dimer(D-D), Fibrinogen(Fib) and hypersensitive C-reactive protein (hsCRP) were carried out pre- and post-study. Results Significant decrease in 24HPQ , serum level of D-D, Fib and hsCRP were observed in both treatment group and control group(P <0. 01 ～0. 05), but more significant in treatment group as compared with control group ( P < 0. 05). Conclusion Flea-bane Injection plus routine treatment could significantly decrease 24HPQ in patients with IgA nephropathy, and this maybe contribute to regulation of D-D, Fib and hsCRP by fleabane injection.
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Objective To explore mRNA and protein expression of PAl-1 in kidney tissue of mice with IgA nephropathy (IgAN) and the effects of YiShen Decoction. Methods The IgAN model was built by the method of oral intake of bovine serum albumin(BSA)together with the injection of staphylococcus enterotoxin B(SEB)through caudal vein. The mRNA expression of PAI-1 was measured by fluorescent quantitative polymerase chain reaction (FQ-PER)and the expression of PAI-1 protein was measured by immunohistochemistry. Results No significant difference of mRNA and protein expression of PAI-1 was found between the low concentration and high concentration Yishen Decoction group. But the secretion and mRNA expression of PAI-1 in the low and hiigh concentration Yishen Decoction group was decreased more than that in the IgAN model group. Conclusion The abnormal expression of PAI-1 mRNA and protein played an important role in the onset and development of IgAN. The TCM Yishen Decoction could reduce the abnormal expression of the mRNA and protein of PAI-1 in kidney tissue of mice with IgA nephropathy.
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OBJECTIVE To investigate the infection episode and related risk factors in continuous hemodialysis patients. METHODS The relationship among infection and etiologies of infection,nutritional status,pathogens and causes of chronic renal failure(CRF) were retrospectively analyzed in 180 continuous hemodialysis patients. RESULTS Totally 113 times infections were observed among the 86 inpatients under continuous hemodialysis.The main infectious site in hemodialysis patients was lungs.Thirty eight times were positive in 50 times of etiologic detection,Gram-negative germ was the most common(60.3%).Hemoglobin and serum albumin decreased obviously in infectious patients.Diabetes and systemic lupus erythematosus patients were more susceptible to infection.The hepatitis virus infections rate in hemodialysis patients was relatively high. CONCLUSIONS There is higher infections rate in continuous hemodialysis patients.Diabetes and systemic lupus erythematosus patients are more susceptible to infection.Anemia,lower serum albumin,old age and bad compliance are the susceptible factors.
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Purpose To Investigate the effect of diet-induced hyperchole sterolemia on the kidney ofWistar rats. Methods Male Wistar rats were fed with normal chow supplemented with 5 % cholesteroland observed biochemical changes in plasma lipid concentration, urinary microalbumin excretion, renalfunction, lipid component in renal cortices and morphological changes at 30,60 and 90 days. ResultsTotal plasma cholesterol (TCh) and low density lipoprotein (LDL) concentration were significantly elevatedin the group E (P＜0.05)at 30 days, and progressively increased thereafter, but during the entire study,there ere no differences in plasma urea nitrogen(BUN),creatinine(Cr), and endogenous creatinine clearance(Ccr) between the two groups. Quantitative urinary microalbumin excration was markely elevated in group E( P ＜ 0.05 ). Cholesterol (Ch), phosphatidylcholine(PC) and phosphatidylethanolamine(PE) levels of t he renalcortices were sigificantly increased in the group E at 12 weeks. Progressive development in mesangialhypercellulary, increased mesangial matrix, glomerular capillaries collapes were observed in the group E. Noelectron dense deposits were observed in any of the glomeruli examined. There was a siginificant positivecorrelation for the urinary microalbumin, Ch in the renal corticres, and glomerular size with plasma TCh andLDL concentration. Conclusions The diet-induced hypercholesterolemia may cause lipid nephrotoxicity inWistar rats.
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Objective To investigate the cardioprotective effect of losartan o n subtotal nephrectomy renal failure rats. Methods Renal failure rats were estab lished by subtotal nephrectomy, and then divided into RF group with subtotal nep hrectomy,RF+Los group with additional losartan(10 mg?kg-1?d-1) gavage. Rats underwent sham operation(sham group) with normal saline gavage as control. Hear t changes of experimental rats were observed 12 weeks after operation. Results T he RF group developed hypertension of arterial systolic blood pressure(SBP) and myocardiac myocytes hypertrophy. The levels of collagen type Ⅰ,type Ⅲ,and fi bronectin in endocardium and surrounding intracardial coronary arteries adventit ia of the RF group were significantly increased as compared to those of the sham group. The SBP and the levels of collagen type Ⅰ,Ⅲand fibronectin were marked ly decreased in the RF+Los group as compared to those of the RF group.Expressio n of angiotensin Ⅱsubtype 1 receptor (AT1R) mRNA in the myocardium of the RF+L os group was significantly down regulated as compared to that of RF group. Concl usions Losartan can prevent the cardiac ventricular remodeling with left ventric ular hypertrophy (LVH) and myocardial interstitial fibrosis by the depression of renin-angiotensin system through the down-regulation of myocardiac AT1R mRNA.