Risk factors of childhood systemic lupus erythematosus with thyroid dysfunction / 中华儿科杂志

Objective: To investigate the risk factors of childhood systemic lupus erythematosus (SLE) with thyroid dysfunction and to explore the relationship between thyroid hormone and kidney injury of lupus nephritis (LN). Methods: In this retrospective study, 253 patients who were diagnosed with childhood SLE and hospitalized in the First Affiliated Hospital of Zhengzhou University from January 2019 to January 2021 were enrolled in the case group, and 70 healthy children were the control cases. The patients in the case group were divided into the normal thyroid group and the thyroid dysfunction group. Independent t-test, χ2 test, and Mann-Whitney U test were used for comparison between the groups, Logistic regression analysis was used for multivariate analysis, and Spearman correlation. Results: A total of 253 patients, there were 44 males and 209 females in the case group, and the age of onset was 14 (12, 16) years; a total of 70 patients, 24 males and 46 females were in the control group, and the age of onset was 13 (10, 13) years. The incidence of thyroid dysfunction in the case group was higher than that in the control group (48.2% (122/253) vs. 8.6% (6/70), χ²=36.03, P<0.05). Of the 131 patients, there were 17 males and 114 females in the normal thyroid group, and the age of onset was 14 (12, 16) years. Of the 122 patients in the thyroid dysfunction group, 28 males and 94 females were in the thyroid dysfunction group, and the age of onset was 14 (12, 16) years. Of the 122 had thyroid dysfunction, including 51 cases (41.8%) with euthyroid sick syndrome, 25 cases (20.5%) with subclinical hypothyroidism, 18 cases (14.8%) patients with sub-hyperthyroidism, 12 cases (9.8%) with hypothyroidism, 10 cases (8.2%) with Hashimoto's thyroiditis, 4 cases (3.3%) with hyperthyroidism, and 2 cases (1.6%) with Graves disease. Compared to patients with normal thyroid function, the serum level of triglyceride, total cholesterol, urine white blood cell, urine red blood cell, 24 h urine protein, D-dimer, and fibrinogen, ferritin and systemic lupus erythematosus disease activity Index-2000 (SLEDAI-2K) score were higher in patients with thyroid dysfunction (Z=3.07, 3.07, 2.48, 3.16, 2.40, 3.99, 2.68, 2.55, 2.80, all P<0.05), while the serum level of free thyroxine and C3 were lower in thyroid disfunction patients (10.6 (9.1, 12.7) vs. 11.3 (10.0, 12.9) pmol/L, and 0.46 (0.27, 0.74) vs. 0.57 (0.37, 0.82) g/L, Z=2.18, 2.42, both P<0.05). The higher level of triglyceride and D-dimer were the independent risk factors for childhood SLE with thyroid dysfunction (OR=1.40 and 1.35, 95%CI 1.03-1.89 and 1.00-1.81, respectively, both P<0.05). There were 161 patients with LN in the case group, all of which were conducted with renal biopsies, including 11 cases (6.8%) with types Ⅰ LN, 11 cases (6.8%) with typesⅡLN, 31 cases (19.3%) with types Ⅲ LN, 92 cases (57.1%) with types Ⅳ LN, and 16 cases (9.9%) with types Ⅴ LN. There were significant differences in the level of free triiodothyronine and thyroid stimulating hormone among different types of kidney pathology (both P<0.05); compared with types I LN, the serum level of free triiodothyronine was lower in types Ⅳ LN (3.4 (2.8, 3.9) vs. 4.3 (3.7, 5.5) pmol/L, Z=3.75, P<0.05). The serum level of free triiodothyronine was negatively correlated with the acute activity index score of lupus nephritis (r=-0.228, P<0.05), while the serum level of thyroid stimulating hormone was positively correlated with the renal pathological acute activity index score of lupus nephritis (r=0.257, P<0.05). Conclusions: There is a high incidence of thyroid dysfunction in childhood SLE patients. The higher SLEDAI and more severe renal damage were found in SLE patients with thyroid dysfunction compared to these with normal thyroid functions. The risk factors of childhood SLE with thyroid dysfunction are the higher level of triglyceride and D-dimer. The serum level of thyroid hormone is possibly related to the kidney injury of LN.

Clinical effect of tacrolimus combined with glucocorticoid in the treatment of IgA nephropathy in children / 中国当代儿科杂志

OBJECTIVE@#To study the clinical effect and safety of tacrolimus (TAC) combined with glucocorticoid (GC) versus mycophenolate mofetil (MMF) combined with GC in the treatment of primary IgA nephropathy (IgAN) in children.@*METHODS@#A retrospective analysis was performed for the clinical data of children with primary IgAN confirmed by renal pathology between January 2012 and December 2017. These children were divided into TAC group and MMF group according to the treatment regimen. Their clinical data before treatment and at 1, 3, and 6 months of treatment were collected, and the remission status of IgAN and adverse reactions were compared between the two groups.@*RESULTS@#A total of 43 children who met the inclusion criteria were enrolled, with 15 children in the TAC group and 28 children in the MMF group. At 1 month of treatment, there was no significant difference in the remission status between the two groups (P>0.05). At 3 and 6 months of treatment, the TAC group had a significantly better remission status than the MMF group (P0.05), but fungal infection was observed in one child from the TAC group.@*CONCLUSIONS@#TAC combined with GC can effectively reduce urinary protein in children with primary IgAN, and it has a better short-term clinical effect than MMF combined with GC, with good safety.

Significance of serum cholesterol and fibrinogen in evaluating the risk of glomerulosclerosis in children with nephrotic syndrome / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the significance of serum cholesterol and fibrinogen (Fib) in evaluating the risk of glomerulosclerosis in children with nephrotic syndrome.</p><p><b>METHODS</b>Sixty-three children with primary nephrotic syndrome were divided into two groups according to their pathological types: minimal change glomerulopathy (MCG) (n=39) and focal segmental glomerulosclerosis (FSGS) groups (n=24). Serum levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), non-HDL-C and Fib and 24-hour urinary protein excretion were retrospectively analyzed.</p><p><b>RESULTS</b>Serum levels of TC, non-HDL-C, and LDL-C were significantly higher in the FSGS group than in the MCG group (P<0.05), but there were no significant differences in HDL-C, Fib and 24-hour urinary protein excretion between the two groups (P>0.05). According to the results of logistic regression analysis, high levels of LDL-C, non-HDL-C and TC were risk factors for FSGS (P<0.05). In patients whose proteinuria did not disappear after taking enough glucocorticoid for 4 weeks, the level of non-HDL-C was significantly higher in the FSGS group than in the MCG group (P<0.05); there were no significant differences in TC, LDL-C, HDL-C, and Fib between the MCG and FSGS groups (P>0.05).</p><p><b>CONCLUSIONS</b>Serum cholesterol, especially non-LDL-C, is of great significance in evaluating the risk of glomerulosclerosis in children with nephrotic syndrome. There is no sufficient evidence to support serum Fib as a marker for predicting glomerulosclerosis in these children.</p>

Analysis of clinical and pathological characteristics in 167 children with Henoch Sch(o)nlein purpura nephritis / 中华实用儿科临床杂志

Objective To investigate the clinical,renal pathological characteristics of Henoch Sch(O)nlein purpura nephritis (HSPN) in children.Methods One hundred and sixty-seven children hospitalized with HSPN from Jan.2008 to Dec.2011 in the First Affiliated Hospital of Zhengzhou University were divided into 2 groups by 24-hour urinary protein quantity:group A with 24-hour urinary protein quantity ＜ 25 mg/kg,group B with 24-hour urinary protein quantity ≥ 25 mg/kg.Age of onset,gender,injury time of kidney,clinical manifestations,24-hour urinary protein quantity and renal pathological grades of the 2 groups were collected and analyzed.Results In 167 HSPN children,the ratio of male to female was 1.8:1.0.The ages from 5 to 10 years old accounted for 70.7％.Renal injurytime was from a day to 5 months,91.6％ of the HSPN children occurred renal damage within 1 month.HSPN children had clinical signs of gastrointestinal involvement in 56 cases(33.5％),at the same time,the digestive tract and joint involvement in 52 cases(31.1％).Pathological classification of 6 grades:8 cases(4.8％) of grade Ⅰ ;32 cases(19.2％) of grade Ⅱ ;124 cases (74.3 ％) of grade Ⅲ ;3 cases (1.8％) of grade Ⅳ ; no grade Ⅴ or Ⅵ.Pathologic grade of group B was higher than group A,and the difference was significant (P ＜ 0.05).Conclusions The HSPN children,expecially the boys,were more found with digestive tract injury or multiple organ damage.Most HSPN children occurred renal damage within 1 month.The renal biopsy of HSPN children should be positive,especially when the 24-hour urinary protein quantity is ≥25 mg/kg.

A clinico-pathological comparison between Henoch-Schonlein purpura nephritis and IgA nephropathy in children / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the difference in clinico-pathological features between IgA nephropathy (IgAN) and Henoch-Schonlein purpura nephritis (HSPN) in children.</p><p><b>METHODS</b>The medical data of 103 children with HSPN and 61 children with IgAN were retrospectively studied.</p><p><b>RESULTS</b>There were no significant differences in age, sex and disease course between the HSPN and IgAN groups (P>0.05). Clinical classification demonstrated that more severe conditions were found in the IgAN group than in the HSPN group and gross hematuria was more common in the IgAN group (P<0.05). Serum creatinine and cholesterol levels were higher in the IgAN group than in the HSPN group (P<0.05). Fibrinogen-related antigen deposition was more common in the HSPN group, while complement 3(C3) deposition was more common in the IgAN group. Interstitial fibrosis, tubular casts and tubular inflammatory infiltration were also more common in the IgAN group (P<0.05).</p><p><b>CONCLUSIONS</b>Significant clinico-pathological differences can be found between HSPN and IgAN in children, and these differences do not support a one disease entity hypothesis.</p>

Clinical-pathological characteristics of IgM nephropathy in 34 children / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the clinical pathologic characteristics of IgM nephropathy in children.</p><p><b>METHODS</b>The data of 34 children with IgM nephropathy from the First Affiliated Hospital of Zhengzhou University were retrospectively reviewed.</p><p><b>RESULTS</b>Of the 34 cases of IgM nephropathy, nephrotic syndrome (NS) was clinically presented in 22 cases (64.7%). The renal pathological classification was as follows: minimal change disease (12 cases, 35.3%), minimal change disease with acute renal tubular injury (3 cases, 8.8%), minimal change glomerulonephritis (6 cases, 17.6%), minimal change glomerulernephritis with ischemic renal injury (1 case, 2.9%), mesangial proliferative glomerulonephritis (7 cases, 20.6%), focal segmental glomerulosclerosis (4 cases, 11.8%), focal proliferative glomerulernephritis (1 case, 2.9 %). Glomerular injury score, renal vascular injury score and total renal injury score increased with the increasing IgM deposition.</p><p><b>CONCLUSIONS</b>The majority of children with IgM nephropathy manifest clinically as nephrotic syndrome. The patterns of renal pathology may be varied in children with IgM nephropathy. IgM deposition in the mesenteric area is an important pathologic feature and is related to the degree of renal injury.</p>

Role of mast cells in the development of renal interstitial fibrosis in children with Henoch-Schonlein purpura nephritis / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the role of mast cells in the development of renal interstitial fibrosis in children with Henoch-Schonlein purpura nephritis (HSPN) and possible mechanisms.</p><p><b>METHODS</b>Paraffin-embedded renal biopsy tissue sections from 20 children with HSPN were examined for the levels of tryptase-beta and transforming growth factor-beta1 (TGF-beta1) by immunohistochemical staining. Mast cells were counted by toluidine blue staining. Masson staining was used to assess the level of renal interstitial fibrosis and renal histopathological scores. Normal renal tissue sections from 5 nephrectomized children for nephroma were used as control group.</p><p><b>RESULTS</b>The percentages of positive tryptase-beta cellsand mast cells and the TGF-beta1 expression in the HSPN group were significantly higher than those in the control group (P < 0.05). The percentages of positive tryptase-beta cells and mast cells and the TGF-beta1 expression in renal tissue were positively correlated with the glomeruli histopathological score (r =0.940, 0.920, 0.937, respectively; P < 0.05) and were also positively correlated with the histopathological score of renal interstitium (r=0.903, 0.859, 0.948, respectively; P < 0.05). The level of renal interstitial fibrosis was positively correlated with the percentages of positive tryptase-beta cells and mast cells and the expression of TGF-beta1 (r =0.790, 0.766, 0.858, respectively; P < 0.05). There was a positive correlation between the percentages of positive tryptase-beta cells and mast cells (r =0.941, P < 0.05), between the percentage of positive tryptase-beta cells and the TGF-beta1 expression (r =0.897, P < 0.05) and between the percentage of positive mast cells and the TGF-beta1 expression (r=0.942, P < 0.05).</p><p><b>CONCLUSIONS</b>Tubulointerstitial mast cell infiltration is associated with the development of renal interstitial fibrosis in children with HSPN. Mast cells together with TGF-beta1 and mast cell-derived tryptase-beta may be involved in the development of the renal interstitial fibrosis in HSPN.</p>

Mobilization effects of SCF along with G-CSF on bone marrow stem cells and endothelial progenitor cells in rats with unilateral ureteral obstruction / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the mobilization effects of stem cell factor (SCF) along with granulocyte colony-stimulating factor (G-CSF) on bone marrow stem cells and endothelial progenitor cells in rats with unilateral ureteral obstruction (UUO).</p><p><b>METHODS</b>Fifty-six healthy male Wistar rats were randomly divided into seven groups: control, SCF, G-CSF, SCF+G-SCF, Sham-operated, UUO and UUO+SCF+G-CSF groups (n=8 each). The rats from the control, SCF, G-CSF and SCF+G-CSF groups were hypodermically injected with normal saline (2 mL/kg), SCF (200 microg/kg), G-CSF (200 microg/kg) and SCF along with G-CSF respectively for 5 days. The rats from the UUO and UUO+SCF+G-CSF groups were subjected to the ligation of right ureter and then were hypodermically injected with normal saline (2 mL/kg) and SCF (200 microg/kg)+G-CSF (200 microg/kg) respectively for 5 days. The sham-operated group had the same operative approach as the UUO and the UUO+SCF+G-CSF groups but the right ureter was not ligated. After operation they received a hypodermical injection of 2 mL/kg normal saline for 5 days. Five days later blood samples were collected. The percentages of CD34+ and CD34+/CD133+ cells in intravenous blood mononuclear cells were detected by flow cytometry. Serum contents of glutamate-pyruvate transaminase (GPT), glutamic oxalacetic transaminase (GOT), urea nitrogen and creatinin were measured.</p><p><b>RESULTS</b>Except for the sham-operated group, the other five groups (SCF, G-CSF, SCF+G-SCF, UUO and UUO+ SCF+G-CSF groups) had significantly higher percentage of CD34+ cells and CD34+/CD133+ cells in intravenous blood mononuclear cells than the control group (P < 0.05). There were significant differences in the percentage of CD34+ cells and CD34+/CD133+ cells among the five groups (P < 0.05). The UUO+SCF+G-CSF group showed the highest percentage of CD34+ cells and CD34+/CD133+ cells, followed by the SCF+G-CSF group. There were no significant differences in serum contents of GPT, urea nitrogen and creatinin among the seven groups. Except the UUO group showed higher GOT contents, there were no significant differences in the GOT contents among the other six groups.</p><p><b>CONCLUSIONS</b>The mobilization effects of SCF and G-CSF on bone marrow stem cells and endothelial progenitor cells were not always in paraller. A combination of SCF and G-CSF can effectively mobilize stem cells and endothelial progenitor cells, and side effects were not found in the liver and the kidney.</p>

Significance of Determination of Circulating Endothelial Cells in Children with Henoch-Schonlein Purpura / 实用儿科临床杂志

Objective To explore the importance effect of circulating endothelial cells(CEC)in the pathogenesis of Henoch-Schonlein purpura(HSP)by determining the level of CEC in children with HSP,and to explore the relationship between CEC and therapeutic effect of HSP and the relationship between CEC and Henoch-Schonlein purpura nephritis(HSPN).Methods Sixty-six inpatients with HSP and 30 children as healthy control group were selected in the First Affiliated Hospital of Zhengzhou University from May to Dec.2008.The blood of all children,including the children in healthy control group,were sampled 1 mL in the early morning.And the CEC of all children were measured by flow cytometry method.The variation of CEC was analyzed in patients with HSP at acute stage and in healthy control group,in patients with HSP and in patients with HSPN,and in patients with HSP without renal damage at recovery stage and in patients with HSPN at recovery stage.SPSS 13.0 statistical software was used to analyze the data.Results CEC in patients with HSP at acute stage[(47.934 5?16.902 6)%]was significantly higher than that in healthy control group[(37.436 7?10.200 7)%](t=2.900 P0.05).CEC in patients with HSPN at recovery stage[(50.258 8?12.824 2)%]was significantly higher than that in patients with HSP without renal damage at recovery stage [(40.864 0?8.165 2)%](t=2.906 P

Effects of Mothers on Psychological Health of Children with Hematuria / 实用儿科临床杂志

Objective To study the possible relationship between the psychological health of children with hematuria and their mothers.Methods Sixty children with hematuria were tested with podiatric symptom checklist(PSC),and the findings were compared with 60 healthy children.The mothers of the patients were assessed by self-rating anxiety scale(SAS),compared with the mothers of healthy children.Results The scores of PSC in patients were higher than those in healthy children(P