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Objective To analyze the relationship between renal pathological characteristics and clinical prognosis in type 2 diabetic kidney disease patients,and discuss predictive value of pathological type and indexes for renal function declining rate and related outcome events.Methods Ninety-two type 2 diabetes patients from PUMC Hospital (with macroalbuminuria and followed up no less than 6 months,excluding patients with non-diabetic renal disease) were divided into typical diabetic glomerulopathy group (DG,n=51) and atypical diabetes-related renal disease group(ADRD,n=41) according to renal pathological findings.A retrospective cohort study was performed to investigate renal pathological features and prognosis.Results Total of 29 renal outcome events and 12 death events occurred in DG group and none in ADRD group; the survival rate and kidney survival rate are different between two groups (P ＜ 0.05); DG group,thick GBM,severe vascular and tubular lesion are predicative indicators for renal outcome event; mesangial volume fraction is predicative indicator for renal outcome events independent of age and serum creatinine.Conclusions DG and ADRD patients have different prognosis and might undergo different pathophysiological mechanisms; renal pathological type and mesangial volume fraction could help predicting outcomes of type 2 diabetic nephropathy patients.
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Objective To investigate the clinicopathologic characteristics, classification and outcome in lupus nephritis(LN)patients with thrombotic microangiopathy(TMA). Methods LN patients with TMA proven by renal biopsy, from January 2000 to February 2009 in our hospital were enrolled. They were classified as poly-immunocomplex deposit group(n =35)and pauci-immunocomplex deposit group(n=25). Their clinicopathologic features and outcome were analyzed retrospectively. Results(l)The incidence of TMA in lupus nephritis was 9.2%(n=62), which presented severe hypertension, prominently elevated serum creatinine, anemia, thrombocytopenia, and was also the poorest prognosis of all the vascular lesion types. The incidence of death/end stage renal disease(ESRD)was 25.0%, with a mortality rate of 13.6%.(2)According to immunocomplex deposit in renal tissue, LN complicated with TMA could be classified as "poly immunocomplex deposit subtype" and "pauci-immunocomplex deposit subtype". The former presented better response to steroid and immunosuppressant therapy, in spite of more active clinicopathologic manifestations. The incidences of death/ESRD of poly subtype and pauci subtype were 8.8% and 32.0% respectively. Conclusions TMA presenting severe manifestations and the poorest prognosis is not rare in LN. LN with TMA may be classified as poly-immunocomplex deposit subtype and pauci-immunocomplex deposit subtype. This classification may be helpful in prognosis because the latter shows bad response to steroid-immunosuppressant therapy.
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Objective To investigate the efficacy differences of different doses of cyclophosphamide(CTX)among subcategories of diffuse proliferative lupus nephritis(LN). Methods Clinical data of 133 LN patients diagnosed by renal biopsy with class IV or class IV +V who were treated with corticosteroid plus CTX were analyzed retrospectively. The baseline Scr, 24 h urine protein, CTX dosages and prognosis were compared among different dosages for each subcategory. Results The average cumulative dose of CTX within 6 months was(11.1 4.1)g. The high dose group was >12 g, the medium dose group was >6-12 g and the low dose group was ≤6 g. Compared to low dose group, high dose CTX increased the remission rate of class Ⅳ +Ⅴ(67% vs 40%, P=0.314)and chronic renal lesion(43% vs 0%, P=0.212), but such enhancement was not obvious in class Ⅳ(Ⅳ-S: 67% vs 50%, P=0.548, Ⅳ-G: 65% vs 70%, P= 0.560). Difference of overall adverse reactions was not significant between high dose group and low dose group(51% vs 37% ,P=0.224). Conclusion Corticosteroid plus high dose CTX may improve the remission rate of patients with class IV + V and chronic renal lesions.
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80 years.The 104 patients had hypertension and 63 no hypertension.Average Scr level was(104.3?14.1)?mol/L,in normal range.The correlation coefficients between Cockcroft-Gault equation and age was the best(r=0.665,P