Study on the expression levels of connective tissue growth factor and hepatocyte growth factor in serum of patients with nephropathy and renal fibrosis and the clinical significance / 国际检验医学杂志

Objective To investigate the expression levels of connective tissue growth factor(CTGF)and hepatocyte growth fac-tor(HGF)in the serum of patients with nephropathy and the relationship with renal fibrosis.Methods Levels of serum CTGF, HGF,blood urea nitrogen(BUN),creatinine(Cr)and Cystatin C(SCys C)in 87 patients with chronic nephropathy and 40 healthy persons(control group)were determined by enzyme-linked immunosorbent assay(ELISA)and the automatic biochemical analyzer. The correlation of indexes like serum CTGF with glomerular sclerosis and renal tubule interstitial fibrosis score in patients with chronic nephropathy was analyzed by Pearson correlation analysis.Results The levels of serum BUN,Cr and Cys-C and in patients with grade Ⅲ and grade Ⅳ chronic nephropathy were significantly higher than those in the control group(P<0.05).The levels of serum CTGF and HGF in patients with grade Ⅱ,grade Ⅲ and grade Ⅳ chronic nephropathy were significantly higher than those in the control group(P<0.05).For patients with gradeⅢ - Ⅳ chronic nephropathy,the levels of Cys-C and serum CTGF increased with the increase of grade(P<0.05).Pearson correlation analysis showed that serum CTGF,HGF,BUN,Cr and Cys-C were signif-icantly positively correlated with glomerular sclerosis score and renal tubule interstitial fibrosis score(P<0.05).Conclusion Serum CTGF and HGF may be involved in the occurrence and renal fibrosis of chronic nephropathy.

Intervention mechanisms of Chinese materia medica on inflammatory injury of renal tissue with chronic nephropathy / 中草药

Chronic kidney disease is closely related to inflammation. Chinese materia medica (CMM) or their extracts can intervene in some signal transduction paths such as nuclear factor-kappa B (NF-κB) path, mitogen activated protein kinase (MAPK) path, Toll-like receptor 4 (TLR4) path, and regulate cytokines, adhesion molecules, transcription factors, acceptor molecules, and enzyme molecules to resist inflammatory injury of renal tissue from multiple target points. Because of the interaction, network, and magnification of inflammatory injury factors, the action of CMM shows the characteristics, such as multi-point, pleiotropy, overlap, and so on. The target points of CMM on inflammatory injury are explored and their molecular mechanism plays an important role in the prevention and control of chronic kidney disease and study on new drug.

Seguimiento del perfil proteico urinario en el trasplante renal / Follow-up of urine protein profile in renal transplant

La nefropatía crónica del trasplante (NCT) se caracteriza por fibrosis intersticial y atrofia tubular, pero su etiología es diversa. El objetivo del trabajo fue evaluar el seguimiento cualitativo de proteínas urinarias en pacientes con más de seis años de trasplante renal y compararlo con parámetros de laboratorio y con biopsia renal. Se evaluaron 17 pacientes durante un año, a través de creatinina sérica, proteinuria y fraccionamiento proteico por electroforesis en geles de poliacrilamida (SDS-PAGE) en una y dos dimensiones con coloración argéntica. Todos los pacientes con biopsias características de nefropatía crónica del trasplante presentaron un perfil tubular y aquellos con glomerulopatía del trasplante evidenciaron un perfil predominantemente glomerular. Los cambios en el perfil tubular se asociaron a infecciones urinarias, pulmonares e intestinales y a una respuesta inmunológica en el límite al rechazo (borderline), aún sin modificaciones evidentes en la creatinina sérica ni en la proteinuria. La electroforesis bidimensional permitió detectar claramente las proteínas orosomucoide y zinc alfa-2 glicoproteína, aparentemente asociadas a hialinosis arteriolar por toxicidad causada por ciclosporina. La electroforesis SDS-PAGE permitió identificar el sitio de lesión en el nefrón y cambios en la evolución, aún en presencia de vestigios de proteinuria. Las electroforesis SDS-PAGE mono y bidimensional se plantean como complemento para la evaluación de la condición clínica del paciente trasplantado renal crónico.

Post-transplant chronic nephropathy is characterized by interstitial fibrosis and tubular atrophy. These alterations are non-specific, but the glomerular and vascular lesions help to differentiate the etiological causes. The aim of this study was to determine the qualitative follow-up study of urine proteins in patients, six years after receiving a renal transplant, and compare their relationship to laboratory parameters and renal biopsy. The evolution of 17 patients with renal transplant was studied for one year, through serum creatinine, proteinuria, and polyacrylamide gel electrophoresis in the presence of sodium dodecylsulfate (SDS-PAGE) in one and two dimensions with silver staining. The patients with chronic nephropathy by renal biopsy presented a tubular profile of urinary proteins, and those who presented glomerulopathy showed a predominant glomerular profile. Changes in the tubular profiles during the follow-up study were associated to urinary tract, pulmonary, and intestinal infections, as well as borderline rejection, even without evident changes in either proteinuria or serum creatinine. The bidimensional electrophoresis clearly marked the orosomucoid proteins and zinc alpha-2 glycoprotein, generally associated to arterial hyalinosis due to ciclosporin toxicity. Even with traces of proteinuria, SDS-PAGE with silver staining made it possible to identify the renal lesion location. It also enabled the detection of the stable profiles of urinary proteins and changes in the evolution, without modification of serum creatinine. SDS-PAGE in one and two dimensions is used as a complement in the evaluation of renal transplant patients' clinical condition.

Prevención y tratamiento de la enfermedad renal crónica (ERC) / Recognition and prevention of chronic kidney disease (CKD)

La enfermedad renal crónica (ERC) es un grave problema de salud pública. Se espera que el número de personas con insuficiencia renal que reciben tratamiento con diálisis y trasplante aumente dramáticamente en los próximos años. Los malos resultados de la ERC no se limitan a la insuficiencia renal terminal, sino que también incluyen a las complicaciones derivadas de una menor función renal, como hipertensión arterial, anemia, desnutrición, trastornos óseos y minerales, neuropatía, así como un mayor riesgo de enfermedad cardiovascular. El diagnóstico precoz basado en la presencia de proteinuria o una velocidad de filtración glomerular estimada reducida, puede permitir la intervención temprana para reducir: el riesgo de insuficiencia renal progresiva, los eventos cardiovasculares y la mortalidad que se asocian con la ERC. Las estrategias eficaces para frenar la progresión de la ERC y reducir el riesgo cardiovascular están disponibles en la actualidad. Los modelos clínicos de atención que faciliten la entrega de los aspectos diversos y complejos del tratamiento en forma simultánea, podrían mejorar la gestión y probablemente los resultados clínicos

Chronic kidney disease (CKD) is a serious public health problem. The number of persons with kidney failure who are treated with dialysis and transplantation is expected to rise dramatically in the coming years. The poor outcomes of CKD are not restricted to kidney failure but also include the complications of decreased kidney function, such as hypertension, anemia, malnutrition, bone and mineral disorders and neuropathy, as well as increased risk of cardiovascular disease. Early diagnosis on the basis of presence of proteinuria or reduced estimated glomerular filtration rate could permit early intervention to reduce the risk of: kidney failure, cardiovascular events and death that are associated with CKD. Effective strategies are available to slow the progression of CKD and reduce cardiovascular risk. Clinical models of care that facilitate delivery of the many complex aspects of treatment simultaneously could enhance management and probably the clinical outcomes

Escore de condição corporal como indicador do prognóstico de gatos com doença renal crônica / Body condition score as an indicator of prognosis for cats with chronic renal disease

A caquexia tem sido relacionada à maior mortalidade de pacientes com doença renal crônica, tanto em humanos, como em animais. O escore de condição corporal (ECC) pode ser utilizado em conjunto com o peso para melhor avaliação da composição corporal desses animais. O objetivo deste trabalho foi de correlacionar o escore de condição corporal com o prognóstico de felinos com doença renal crônica. Avaliaram-se 110 felinos idosos, dos quais 70 apresentavam-se hígidos (Grupo I) e 40 apresentavam doença renal crônica (Grupo II). No grupo I, apenas 5,7 por cento dos gatos apresentaram ECC abaixo do ideal e destes nenhum foi classificado como caquético. No grupo II, 70 por cento dos gatos apresentaram ECC abaixo do ideal, dos quais 32,5 por cento eram caquéticos. A taxa de mortalidade no grupo II foi significantemente maior naqueles caquéticos. O ECC abaixo do considerado ideal indica um prognóstico desfavorável nos pacientes com doença renal crônica.

Cachexia has been associated with higher mortality in patients with chronic renal disease both in human and veterinary medicine. Body condition score (BCS) can be used along with body weight for a better evaluation of a patient's body composition. The objective of this study was to associate body condition score with prognosis of cats with chronic renal disease. One hundred and ten elderly cats were evaluated; of which 70 were healthy (Group I) and 40 had been diagnosed with chronic renal disease (Group II). In Group I, only 5.7 percent of the cats presented a BCS below ideal, though none were found to be cachectic. In Group II, 70 percent of the cats presented a BCS below ideal, where 32.5 percent were cachectic. Mortality was significantly higher within the cachectic patients of Group II. BCS below ideal indicates a poor prognosis for patients with chronic renal disease.

Efectos crónicos y tratamiento con litio sobre la anatomía y función renal / Chronic effects of lithium treatment in renal anatomy and function

Lithium is a drug widely used in clinical psychiatry, often as first-line treatment. However, it has generated much controversy because of the likely adverse effects of both acute and chronic use, mainly in the kidney. With respect to prolonged exposure to lithium, it would be detrimental to the kidneys at variable extent, depending on factors such as duration of treatment, dosage of drug, patient age, renal damage, prior comorbidities, among others not yet sufficiently elucidated. The principal mechanism of renal function changes was determined by morphological changes, such as interstitial nephritis, interstitial-medullar fibrosis and tubular atrophy, all irreversible phenomena that ultimately lead to a tubuloglomerular imbalance and commitment of the GFR. Other aspects of chronic nephropathy induced by lithium and their production mechanisms are being studied, also the search and advanced diagnostic techniques to predict and / or detect early changes. Among them have described the pathology (renal biopsy), although this form of diagnosis is very late. Thus it seeks the introduction of imaging and serological markers of kidney failure as tools that provide information about kidney condition earlier.

El Litio es un fármaco ampliamente utilizado en psiquiatría, muchas veces como tratamiento de primera línea. Existe en la actualidad una activa controversia acerca de sus probables efectos adversos a nivel renal, tanto agudos como crónicos, ya que la exposición prolongada al Litio sería deletérea para el riñón en una magnitud variable, dependiendo de factores como duración del tratamiento, dosis del fármaco, edad del paciente, daño renal previo y comorbilidad, entre otros aún no suficientemente dilucidados. El origen del mecanismo principal de alteración de la función renal estaría en alteraciones morfológicas como la Nefritis Intersticial, la Fibrosis Intersticio-Medular y la Atrofia Tubular, todos fenómenos irreversibles que finalmente conducirían a un desbalance tubuloglomerular y a un compromiso de la VFG. Otros aspectos de la Neuropatía Crónica inducida por Litio y de sus mecanismos de producción se encuentran en estudio, así como también la búsqueda y perfeccionamiento de técnicas diagnósticas que permitan predeciry/o detectar tempranamente los cambios mencionados. Entre estas últimas se ha descrito la anatomía patológica (biopsia renal), aunque esta es una forma de diagnóstico muy tardía. Es por ello que se busca la introducción de la imagenología y de marcadores serológicos de falla renal como herramientas que entreguen información sobre la condición del riñón más precozmente.