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Acute kidney injury(AKI)refers to a clinical syndrome in which the glomerular filtration rate decreases sharply in a short period of time due to various causes.Since elderly patients often have low renal functional reserve, complex underlying diseases, frequent acute events and various types of drug combinations, the incidence of AKI in elderly patients is significantly higher than that in the general population and trends upward each year.The prevention and treatment of elderly AKI should place an emphasis on the identification of risk factors and early diagnosis.There is considerable controversy over whether the existing real-world diagnostic criteria are clinically practical and appropriate.The application of novel diagnostic biomarkers for the diagnosis of AKI in the elderly population remains to be justified.This paper reviews considerations on the diagnostic criteria for AKI in the elderly and the clinical application of new biomarkers, in order to arrive at improved diagnosis and treatment recommendations.
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Objective:To analyze the association of clinical characteristics and laboratory indicators at initial maintenance hemodialysis(MHD)with long-term prognosis in advance-aged patients, and to find influencing factors for the prognosis in advance-aged MHD patients.Methods:This retrospective study was conducted at the Nephrology Department of Beijing Hospital between April 2007 and January 2018.A total of 61 patients receiving first-time hemodialysis at ≥ 80 years of age and undergone regular dialysis for 3 months or longer were enrolled.All patients were followed-up until death or the end of July 1, 2018.Patients were divided into the survivor and non-survivor groups, and differences in clinical characteristics and laboratory indicator values were compared between the two groups.Influencing factors for prognosis in advance-aged MHD patients were analyzed by using multivariate Cox regression.Results:For the 61 subjects, the median follow-up time was 25.8 months.During the follow-up, 32 patients died(52.5%). The main death causes were infectious diseases(40.6%, n=13)and cardiovascular and cerebrovascular diseases(37.5%, n=12). The 1-, 2-, 3-, 4-, and 5-year cumulative survival rates were 75.4%(46/61), 54.1%(33/61), 37.7%(23/61), 22.9%(14/61)and 16.4%(10/61), respectively.The median survival time was 25.8 months for all patients, 27.5 months for patients aged 80-84 years, and 14.9 months for patients aged 85 years and over.The non-survivor group had a higher male ratio(65.6% or 21/32 vs.37.9% or 11/29, χ2=4.678, P=0.031)and lower levels of hemoglobin(85.4±13.0 vs.95.0±17.6 g/L, t=2.867, P=0.019)and albumin(30.3±5.0 vs.34.6±4.8 g/L, t=3.039, P=0.001)than the survivor group.Kaplan-Meier curves indicated that the survival rate decreased with age, and subjects aged less than 85 years had a higher survival rate than subjects aged 85 years and older(the median survival time: 14.9 months vs.27.5 months, Log Rank P=0.006); patients who received continuous renal replacement therapy(CRRT)before dialysis had lower survival rates than patients who did not receive CRRT(the median survival time: 7.8 months vs.29.2 months, Log Rank P=0.002); patients with high serum levels of albumin(≥33 g/L)had higher survival rates than patients with low serum levels of albumin(<33 g/L)(the median survival time: 29.2 months vs.18.9 months, Log Rank P=0.003). Multivariate Cox regression analysis showed that age at initial dialysis( HR=1.136, 95% CI: 1.005-1.285, P=0.041), female( HR=0.409; 95% CI: 0.169-0.994, P=0.048), serum albumin level( HR=0.836, 95% CI: 0.772-0.906, P<0.001)and CRRT before dialysis( HR=6.161, 95% CI: 1.848-20.538, P=0.003)were independent predictors of all-cause mortality in advance-aged patients. Conclusions:Advance-aged patients undergoing hemodialysis have complicated clinical conditions and poor prognosis.Age, gender and serum albumin level at initial dialysis and CRRT before dialysis are independent predictors of prognosis in these patients.
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Objective:To compare death causes and the survival time in elderly patients undergoing hemodialysis versus peritoneal dialysis in the nephrology department of Beijing Hospital in the last 10 years.Methods:This was a retrospective study.Patients aged more than 60 years who had undergone dialysis and died in the dialysis center of Beijing Hospital between January 2010 and January 2019 were enrolled.A detailed medical history including gender, age, primary diseases, diabetes mellitus, time of dialysis initiation, time of death and direct cause of death were recorded.Results:A total of 153 elderly dialysis patients were enrolled, with a mean age of 76.6±7.7 years, a median dialysis vintage of 54.1(26.9, 86.4)months, including 83(54.2%)cases with diabetes.Patients were divided into the hemodialysis group(HD, n=114)and the peritoneal dialysis group(PD, n=39)according to the dialysis method.The mean ages of patients in the HD and PD groups were 77.1±7.9 and 75.0±7.0 years, and the median dialysis vintages were 56.5(27.4, 104.2)and 48.3(26.3, 66.6)months, respectively.The primary diseases of patients undergoing HD and PD were diabetic nephropathy(DN, 32.5% vs.48.7%), chronic glomerulonephritis(29.8% vs.17.9%)and hypertensive renal damage(21.1% vs.10.3%). The top three causes of mortality in patients undergoing HD and PD were cardiovascular diseases(32.4% vs.43.6%), infections(29.8% vs.28.2%)and cerebrovascular diseases(11.4% vs.15.4%). The compositions of primary diseases and death causes were similar between the two groups, with no significant difference.Kaplan-Meier curves indicated that the survival time of dialysis patients with diabetes mellitus was shorter than that of patients without diabetes mellitus(chi-square value was 12.829, P<0.001), and the survival time of HD patients was longer than that of PD patients(chi-square value was 8.161, P=0.004). In patients without diabetes mellitus, the survival time of HD patients was longer than that of PD patients( Z=-2.716, P=0.007). In patients with diabetes mellitus, HD and PD had similar survival outcomes( Z=-0.581, P=0.561). Conclusions:The proportion of patients with diabetic nephropathy is high in elderly dialysis patients.Cardiovascular and cerebrovascular diseases and infections are the main causes of death in elderly dialysis patients.The survival time is longer in HD patients than in PD patients.
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Objective@#To assess the value of different equations for estimating glomerular filtration rate (GFR) for evaluating renal function in people aged 70 years and older.@*Methods@#A retrospective study was conducted involving 11 966 elderly people aged 70 years and older, including 5 741 males (48.0%), who underwent routine physical examinations in Beijing Hospital from January 2012 to December 2014 and were followed up for 3 years.Baseline data, including the age, gender, and serum creatinine, were recorded.@*Results@#function was assessed using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Modification of Diet in Renal Disease (MDRD) Study, Chinese Modification of Diet in Renal Disease (MDRD) Study, full age spectrum (FAS) equation and Berlin Initiative Study (BIS) equation, respectively.Results The serum creatinine level increased with age in male and female subjects, and the standard deviation also increased with age, indicating greater variability of serum creatinine in the elderly.Of all equations, the FAS and BIS equations had the lowest GFR estimates.The five equations showed good consistency.In males, the Kendall's W coefficient was 0.796 (P = 0.000); the female Kendall's W coefficient was 0.715 (P = 0.000). Based on three ranges of serum creatinine (<88.4 μmol/L, ≥88.4 μmol/L and <132.6 μmol/L, ≥132.6 μmol/L), all patients were divided into three groups.The BIS, MDRD, MDRDc and FAS equations were all consistent in staging CKD at any creatinine level; however, the CKD-EPI equation significantly overestimated renal function at higher levels of serum creatinine.There was no clear age-related trend when each of the five equations was used to calculate the average 3-year eGFR rate.@*Conclusions@#The CKD-EPI, MDRD, MDRDc, FAS and BIS equations can be used to assess renal function, but the results vary among different populations.Which equation has the best accuracy for the elderly in China remains inconclusive and further research is urgently needed.
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Objective To assess the value of different equations for estimating glomerular filtration rate (GFR) for evaluating renal function in people aged 70 years and older.Methods A retrospective study was conducted involving 11 966 elderly people aged 70 years and older,including 5 741males (48.0％),who underwent routine physical examinations in Beijing Hospital from January 2012 to December 2014 and were followed up for 3 years.Baseline data,including the age,gender,and serum creatinine,were recorded.Results function was assessed using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI),Modification of Diet in Renal Disease (MDRD) Study,Chinese Modification of Diet in Renal Disease (MDRD) Study,full age spectrum (FAS) equation and Berlin Initiative Study (BIS) equation,respectively.Results The serum creatinine level increased with age in male and female subjects,and the standard deviation also increased with age,indicating greater variability of serum creatinine in the elderly.Of all equations,the FAS and BIS equations had the lowest GFR estimates.The five equations showed good consistency.In males,the Kendall's W coefficient was 0.796 (P =0.000);the female Kendall's W coefficient was 0.715 (P =0.000)Based on three ranges of serum creatinine (＜88.4 μmol/L,≥88.4 μmol/L and ＜132.6 μmol/L,≥132.6 μmol/L),all patients were divided into three groups.The BIS,MDRD,MDRDc and FAS equations were all consistent in staging CKD at any creatinine level;however,the CKD-EPI equation significantly overestimated renal function at higher levels of serum creatinine.There was no clear age-related trend when each of the five equations was used to calculate the average 3-year eGFR rate.Conclusions The CKD-EPI,MDRD,MDRDc,FAS and BIS equations can be used to assess renal function,but the results vary among different populations.Which equation has the best accuracy for the elderly in China remains inconclusive and further research is urgently needed.
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Objective To assess the predictive value of serum fibroblast growth factor(FGF)23 level and carotid intima-media thickness (CIMT)for the long-term outcome in maintenance hemodialysis(MHD)patients.Methods A total of 88 MHD patients were enrolled,with a median follow-up of 73.2 months(a range from 11.5 to 75.7 months).CIMT and atherosclerotic plaques were measured by Bmode Doppler ultrasound at baseline by an experienced sonographer.Blood samples were collected and stored in the-80℃ refrigerator for measuring serum FGF23 levels.Results The 88 patients were aged(64.2±11.5)years,with 52 males and 36 females,and the mean CIMT was (1.34±0.38)mm.Carotid artery atherosclerotic plaque was detected in 72(81.8％)subjects.Carotid artery atherosclerotic plaques (CASP)were found in 58 (65.9％)patients aged 60 years and over.Compared with non-elderly patients,elderly patients had the characteristics of high incidence of cardiovascular disease and poor nutritional status.During the follow up period,34 patients died and 23 (67.6％) patients died of cardiovascular disease.Kaplan-Meier curves showed that cardiovascular disease-free survival rate was higher in the normal CIMT group than in thickening CIMT group(Log Rank P=0.003).And subjects with low level of FGF23 had a better survival rate than those with moderate to high level of FGF23(Log Rank P =0.043).Multivariate COX regression analysis showed that FGF23(HR=1.056,95％CI:1.007-1.108,P=0.026)and CIMT(HR=1.165,95％CI:1.032 1.315,P =0.013)were independent predictors for cardiovascular mortality.Multivariate COX regression analysis showed that serum calcium (HR =0.022,95％ CI:0.001-0.489,P =0.016),hemoglobin(HR =0.966,95％CI:0.937-0.997,P =0.033),FGF23 (HR =1.071,95％ CI:1.017-1.128,P =0.010) and CIMT (HR =1.202,95％ CI:1.049-1.377,P =0.008) were independent predictors for cardiovascular mortality in elderly MHD patients.Conclusions Serum level of FGF23 and CIMT are the important predictors for cardiovascular mortality in MHD patients.The proportion of elderly patients with cardiovascular disease is higher,in which the factors affecting prognosis are more complex.
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Objective To examine the clinical characteristics and red cell distribution width (RDW) changes and to investigate the prognostic value of RDW in elderly patients undergoing peritoneal dialysis(PD). Methods We retrospectively analyzed the data of 59 elderly patients aged 60 or over who had undergone regular PD for over three months at Beijing Hospital from July 1 ,2005 to June 30 ,2017.All patients were followed up until the occurrence of a composite event or until December 31 ,2017. General characteristics ,baseline laboratory data ,RDW at baseline ,and time-average RDW during the follow-up were compared between the non-survival group and the survival group.Cox regression analysis was performed to determine whether RDW was an independent risk factor of all-cause mortality. Results Fifty-nine elderly PD patients with a mean age of (70.5 ± 6.6) years were included.The median follow-up duration was 40(25 ,56)months and the median survival duration was 57(36.6 ,74.4)months. The 1-,3-,and 5-year survival rates of all patients were 98.3%(n＝58) ,72.9%(n＝ 43) ,and 52.5%(n＝ 31) ,respectively.Twenty-eight patients died during the follow-up ,of whom 15 died of infection ,8 of cardio-cerebrovascular disease and 5 of other causes.Non-survivors had higher Charlson Comorbidity Index (CCI)scores ,higher levels of RDW at baseline ,higher time-average RDW ,lower initial total KT/V ,and lower initial total CCr (all P＜0.01).In univariate analysis ,high CCI ,high basic RDW ,high time-average RDW ,low serum albumin ,low serum ferrum , and low serum cholesterol were associated with all-cause mortality (all P＜ 0.05).In multivariate- adjusted Cox analysis ,high CCI(HR＝1.679 ,95% CI :1.238-2.236 ,P＝0.001)and high time-average RDW(HR ＝ 1.889 ,95% CI :1.195-2.987 ,P ＝ 0.007)were independent predictors for all-cause mortality in elderly PD patients. Conclusions Time-average RDW may independently predict the mortality of elderly PD patients. The prognostic value of dynamic RDW may be similar to that of CCI.
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<p><b>BACKGROUND</b>Investigate into the medical expenditures of chronic kidney disease (CKD) patients through path analysis method of three consecutive years within a Grade-A tertiary hospital in Beijing to conduct the main influencing factors in diagnosis-related groups (DRGs) grouping of the diagnosis, and reassess the present grouping process to provide information and reference on cost control for hospitals and medical management departments.</p><p><b>METHODS</b>Eight hundred and fifty-five inpatient cases whose first diagnosis were defined as CKD in the year 2014-2016 within the hospital were selected as the sample of the study, multiple linear regression and path analysis method were adopted in DRGs grouping process to investigate the main influencing factors of total medical expenditures and DRGs grouping process.</p><p><b>RESULTS</b>The maximum proportion of the medical costs within CKD patients was the costs on treatment, with the highest of 35.3% on the year 2014, the second was the costs on drug, which accounted for <30% during consecutive years, and the third was the costs on examination, which accounted for about 20% on average. The main influencing factors of medical expenditures included the type of dialysis, length of hospitalization, the admission of Intensive Care Unit (ICU), and so on. The coefficients toward the effect for total costs were 0.416, 0.376, and 0.094, respectively.</p><p><b>CONCLUSIONS</b>It is suggested that the type of dialysis and the admission of ICU were the major influencing factors of inpatient medical expenditures on CKD patients, and should be taken into consideration into the reassessment of DRGs grouping process to realize the localization and generalization of prospective payment system based on DRGs within the regional area and promote the implementation of medical cost control measures to reduce the economic burdens among patients and the society.</p>
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Objective To investigate the clinical characteristics and laboratory examinations in incident dialysis effect on the prognosis of elderly patients undergoing hemodialysis.Methods Ninety-three patients aged 65 years or older initiating hemodialysis were enrolled from Hemadialysis Center of Beijing Hospital from January lst,2007 to June 30th,2016.The duration time of HD of all patients was more than three months.Patients were divided into death group and non-death group.The clinical characteristics and laboratory examinations were compared between the two groups.Cox proportional hazards regression was used for the multivariate analysis to determine independent prognosis factors.Results The average year of patients was 74.2±6.5 years old with 43 months of median time of follow-up.The first two causes of death were infection (n =25,49.0％) and cardiovascular and cerebrovascular diseases (n =16,31.4％).Cox single factor regression analysis showed that the older ages,diabetic nephropathy being the cause of end-stage renal disease (ESRD),complicating with diabetes mellitus or congestive heart failure,the higher Charlson cardiovascular diseases score,ALB being under 35 g/L were correlated with poor outcome respectively(P＜0.05).Cox multivariate regression analysis indicated that older ages (HR =1.056,P =0.021),diabetic nephropathy being the cause of ESRD (HR =2.661,P =0.001),the higher Charlson cardiovascular diseases score (HR =1.675,P =0.010),central venous catheters being vascular access(HR=1.167,P=0.048) on incident dialysis were the main risk factors for mortality in elderly patients.Conclusion The older ages,diabetic nephropathy being the cause of ESRD,the higher Charlson cardiovascular diseases score,central venous catheters being vascular access on incident dialysis are independent risk factors influencing survival of elderly patients.
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Objective To investigate the preventive effect of continuous quality improvement(CQI) on malnutrition,inflammation,peritoneal dialysis adequacy and cardiovascular events in elderly patients undergoing peritoneal dialysis.Methods A single-center prospective self-controlled study was performed.32 stable elderly patients to undergo continuous ambulatory peritoneal dialysis (CAPD) were included.The continuous quality improvement program was conducted by using the 4-step problem-solving framework called the PDCA cycle (plan,do,check and act).The dialysis adequacy,nutritional status,inflammation and cardiovascular events were analyzed before and after PDCA.Results Compared with before PDCA,the proportion of patients with Kt/V≥1.7 and urea kinetics (Kt/V) level were increased after PDCA [71.8％ vs.93.75％,(1.97±0.36) vs.(2.08±0.33),both P＜ 0.05].Serum levels of albumin (ALB),prealbumin (PAB) and serum carbon dioxide combining power (CO2 CP) were increased after PDCA (all P＜0.05).The proportion of patients with ALB≥40 g/L was increased after PDCA as compared with before PDCA (9.4％ vs.31.3％,P＜0.05).The nutritional variables including mid-arm circumference (MAC),triceps skinfold thickness (TSF),mid arm muscle circumference (MAMC),and lean body mass (LBM),lean body mass percentage (LBM％),normalized protein equivalent of total nitrogen appearance (nPNA),handgrip strength were improved after PDCA (P＜ 0.05).High sensitivity C-reactive protein (hs-CRP) level and the proportion of patients with hs-CRP＞3 mg/L were decreased after PDCA as compared with before PDCA [(8.65±6.22) mg/L vs.(5.37±4.33) mg/L,53.1％ vs.25％,both P＜0.05].The incidence of peritoneal dialysis related peritonitis was reduced obviously from 1 case every 25.4 months to 1 case every 78.1 months after PDCA (P ＜ 0.05).The hospitalization rate due to cardiovascular events was decreased after PDCA as compared with before PDCA (25％ vs.3.13％,P＜0.05).Conclusions CQI may significantly improve the malnutrition,inflammation and dialysis adequacy,and reduce the hospitalization rate due to cardiovascular events in elderly patients undergoing peritoneal dialysis.
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Objective To summarize the age-related changes and the risk factors of renal tubular function in the elderly male cases.Methods Totally 229 cases without chronic kidney disease were divided into two groups:group aged ＜80 years and group aged ≥80 years.We measured the urine routine,serum creatine,serum urea,urine β2-microglobin (β2-MG),urine α1-microglobin (α1-MG)and calculated the eGFR based on Cockcroft-Gault equation.Logistic regression was used to analyze the risk factors which may accelerate the progression of the renal tubular impairment.Results The average age of 229 cases was (76±10)years.There were 142 cases in the group of ＜80 years old and 87 cases in the group of ≥80 years old.The level of eGFR in the group of ≥80 years old was (55.0±12.7) ml/min,which was lower than that of the group of ＜ 80 years old (80.3 ± 18.0 ml/min) (t =9.882,P＜0.01).The level of urine SG was decreased in the group of ≥80 years old versus in the group of ＜80 years old(1.016±0.006 vs.1.013±0.006).The value changes of urine pH,urine β2-MG and urine α1-MG were of statistical differences between the two groups [(6.2±0.8) vs.(6.6±0.8),(0.96±1.02)mg/L vs.(2.08 ±3.56)mg/L,(6.67±3.57) mg/L vs.(8.71±6.59)mg/L].The correlation analysis showed that age correlated negatively with eGFR and urine SG(r =-0.692and r=-0.280,both P＜0.01)and positively with urine pH(r=0.255),urine β2 MG(r=0.262),urine α1-MG(r=0.228)(all P＜0.01).The Logistic regression analysis showed that coronary heart disease was an independent risk factor for the progression of renal tubular impairment (OR=4.251,P=0.002).Conclusions Renal tubular functions is decreased with ageing age in the elderly male,especially in the advanced elderly.The coronary heart disease is an independent risk factor of the progression of renal tubular impairment.
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Objective To investigate the change of renal tubular function in elderly patients after use of β lactam antibiotic. Methods The elderly patients with pulmonary infection were treated with β lactam antibiotic,the dosage was 50%-70% of normal use. The renal tubular function indicated by urine α1-MG, β2-MG, pro/Cre, NAG/Cre and glomerulus function marked by eGFR, serum creatinine (Cre)), cystatin C were detected during drugs treatment and 7 days after stopping medications. Results The infection was controlled well in 3-7 days after treatment. Urine α1-MG, β2-MG, pro/Cre and NAG/Cre were abnormal before treatment, were elevated in 3, 14 days after using antibiotic, and came down to the level before treatment on 7 days after stopping treatment. The level of Cre and eGFR was (89.0±25.97) μmol/L and (26.39±8.17) ml/min before treatment, then elevated and decreased in 14 days after treatment, respectively, and down to the level before treatment on 7 days after stopping of antibiotic. Cystatin c was abnormal before treatment and did not change significantly after treatment and after stopping antibiotic. Conclusions It is important to protect renal tubular function and to adjust antibiotic dosage according to eGFR during using antibiotic in elderly patients to control infection.
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Objective To explore the protective effect and mechanism of antioxidant N-acetyl-L-cysteine (NAC)on the cytotoxicity induced by iohexol in HK-2 cells. Methods The incubated HK-2 cells were divided into four groups:control group,iohexol group,NAC group,and NAC+iohexol group(pre-incubated with NAC and then co-incubated with iohexol).The cell viability was tested by CCK-8 assay;cell apoptosis was determined by Hoechst 33342 fluorescence staining and flow cytometry with Annexin V-FITC/PI double staining.Intracelluar ROS waft detected by flow cytometry with DCFH-DA fluorescence staining.The signaling transduction pathways were investigated by Western blotting and immunofluorescence staining. Results Iohexol decreased cell viability,and increased apoptosis in a dose-and time-dependent manner.In iohexol(100 gl/L,6 h)group,ROS was increased by 1.30-fold of control(P＜0.05).In NAC(5,10,15 mmol/L)+iohexol groups,the cell viability was increased by 104%,118%,130%respectively,and iohexol group was 63% (P＜0.05, respectively); apoptosis rate was decreased by 13.51%, 13.46%, 12.23% respectively, and iohexol group was 24.41% (P＜0.05, respectively); ROS was decreased by 1.05-fold, 0.93-fold, 0.86-fold respectively, and iohexol group was 1.3-fold (P＜0.05, respectively).Iohexol induced the increase of p53 phosphorylatian and activity, then up-regulation of Bax and down-regulation of Bcl-2 protein expression. Iohexol induced the release of cytochrome C from mitochondria to cytoplasm, all of which caused final activation of caspase-3. The expression levels of p53, Bax and caspase-3 were decreased, while Bcl-2 protein expression level was increased by NAC. Conclusions Iohexol induces the increase of apeptosis rate and ROS generation in HK-2 cells. NAC attenuates this iohexol-induced cytotoxicity by decreasing intracelluar ROS, which is mairdy through the intrinsic pathway.
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Objective To investigate the protective effect and mechanism of taurine on the cytotoxicity of iohexol on HK-2 cells. Methods HK-2 cells were exposed to iohexol at different dosage (25, 50, 100, 125 gI/L) for 6 h and at the dose of 100 gl/L for different time(2 h, 4 h, 6 h). Then taurine (3,12,24 mmol/L) was coincubated with iohexol (100 gI/L) for 6 h.Cell viability was assessed by CCK-8 assay. Cell apoptosis was determined by Hoechest 33342 flurescence stains,flow cytometry with Annexin V-FITC/PI double stains and caspase-3 activity by colorimetric assay. Bcl-2 and Bax expression were examined by Western blot. Intracellular ROS was detected by flow cytometry with fluorescent probe DCFH-DA. Results Iohexol decreased HK-2 cell viability and induced apoptosis in concentration-dependant and time-dependant manner (all P＜0.05). ROS was increased following iohexol (100 gI/L for 6 h) treatment (P＜0.05). Taurine increased cell viability and attenuated apoptosis in dose-dependant manner. The cell viability levels in taurine intervention (3,12,24 mmol/L) group were significantly increased compared with that in iohexol treated group respectively [(88.00±1.00)%, (91.33±0.58)%, (95.67±1.52) % vs (76.67±1.53)%, all P＜0.05]. Apoptosis rate by flow cytometry were decreased respectively [(8.84±1.75)%,(7.86±1.82)%, (6.30±1.50)% vs (11.98±0.39)%, all P＜0.05]. Caspase-3 activities were decreased respectively [(1.33±0.10), (1.27±0.06), (1.10±0.04) vs (1.42±0.13), all P＜0.05].Taurine up-regulated the expression of Bcl-2, and decreased the intracellular ROS (all P＜0.05).Conclusions Iohexol induces cell apoptosis and oxidative stress. Taurine attenuates direct cytotoxic effect induced by iohexol. The anti-oxidative stress effect and up-regulated Bcl-2 expression may partly account for the protection of taurine.
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Objective Rapamycin (RAPA) is an anti-proliferative immunosuppressant and has been used to suppress rejection of transplanted organs. In present study, we observed the effect of rapamycin on epithelial-myofibroblast transition (EMT)of cultured HKC cells in vitro. Methods Cultured human proximal tubular epithelial cells (HKCs) were divided into three groups: blank control, treated with TGF-?1 (1 ?g/L) and treated with TGF-?1 (1 ?g/L) plus rapamycin (0.1, 1, 10, 100 ?g/L). The protein and mRNA for ?-SMA and E-cadherin in HKC cells were determined by Western Blot and RT-PCR.The mRNA level of Snail in HKC was detected by RT-PCR. Results Rapamycin dramatically abrogated TGF-?1 induced ?-SMA expression and restored E-cadherin expressionin HKC cells in a dose-dependent manner. At a concentration of 100 ?g/L, rapamycin almost completely blocked ?-SMA mRNA and protein expression induced by TGF-?1(1 ?g/L). Rapamycin also suppressed expression of ?-SMA in HKC cells at both mRNA and protein level in a time dependent manner.We also found rapamycin dramatically abrogated TGF-?1 induced Snail mRNA expression in HKC cells in a dose-dependent manner. Conclusion Rapamycin may inhibit EMT of tubular cells in vitro. The downregulation of Snail expression might be one of the mechanisms of rapamycin blocking EMT.