Efficacy of individualized rituximab as the rescue therapy for active lupus nephritis with acute kidney injury / 中华肾脏病杂志

Objective:To investigate the efficacy and safety of individualized rituximab rescue therapy for active lupus nephritis with acute kidney injury (AKI).Methods:The clinical data of lupus nephritis patients with AKI treated with rituximab at the Kidney Disease Center of the First Affiliated Hospital of Zhejiang University School of Medicine from April 2017 to June 2020 were collected, and the renal remission rate and adverse events after rituximab treatment were analyzed retrospectively. The Kaplan-Meier method was used to calculate the cumulative incidence of patients' remission.Results:There were 13 patients enrolled, including 8 females, and aged (35.23±15.92) years old. The urinary protein/creatinine ratio was (5.22±1.57) g/g before rituximab treatment. Four patients were on dialysis at admission, and 9 patients without dialysis had serum creatinine of (223.22±85.73) μmol/L. Eight patients were confirmed as proliferative lupus nephritis by renal biopsies, including 7 cases with crescent formation and 1 case with thrombotic microangiopathy (TMA), and the other 5 cases without renal biopsies were clinically diagnosed as TMA. The dose of rituximab was (815±516) mg (200-2 100 mg), and all the patients reached the state of peripheral blood B cells clearance (CD19 + B cell count was<5/μl). After the first treatment of rituximab, the median time to B-cell clearance was 21(15, 35) days, and 8 patients reached B-cell depletion (CD19 + B cell count was 0). The remission rate was 12/13 (two cases reached complete remission, and 10 cases reached partial remission). Three cases stopped dialysis, and 1 case (with glomerulosclerosis of 52.94%) entered maintaining dialysis. The relapse times in the maintenance remission period of 7 patients with refractory lupus nephritis declined significantly from (1.57±0.53) times in a median history of 60(20, 109) months to (0.43±0.79) times in a median history of 18(10, 23) months after the use of rituximab ( P=0.015). After using rituximab, the incidence of infection was 7/13. The median time from the use of rituximab to infection was 26(4, 44) days. Pulmonary infection (5/13) was the most common type and all infected patients recovered after anti-infection treatment. Conclusions:Rituximab can be used in the treatment of active lupus nephritis with AKI, especially in patients with crescent formation and TMA, but the infection should be paid close attention to and prevented.

Updates on the role of T lymphocytes in crescentic glomerulonephritis / 国际儿科学杂志

The formation of crescent is a typical pathological change characterized by a rapid deterioration of renal function.T lymphocytes are involved in the formation of crescent and the pathological progression of crescent nephritis.CD4 + and CD8 + cells in T lymphocyte subsets, and T cell costimulatory factors mediate immune responses in different ways.They participate in the occurrence, development and fibrosis of crescent, or delay their deterioration.In order to provide a new target for clinical treatment of crescent nephritis, we review the mechanism of T lymphocytes in the formation and development of crescentic body.

Treatment of hypospadias in children with urethral plate combined with one crescent flap / 中华泌尿外科杂志

Objective To investigate the clinical effect of urethral plate combined with unilateral crescent flap in the treatment of hypospadias in children.Methods The clinical data of 14 cases of hypospadias treated from March 2017 to March 2018 were retrospectively analyzed,with average age of (3.3 ± 2.1) years.The external urethral orifice was located in the middle and distal part of the ventral side of the penis,with mild and moderate bends of the penis.The prepuce was piling up on the penile dorsal side,the ventral skin was deficient,and there was no concomitant disease such as penis scrotum transposition or cryptorchidism.All children were primarily treated with urethroplasty with urethral plate and one crescent flap.One side of the free urethral plate had a crescent superficial fascia,which was used as the new urethral material together with the urethral plate.By design,the urethra sutured deviating from the midline.The external urethral orifice was formed by trimming the anterior opening of urethra in the form of shallow "V" shape,and the new urethra was covered with the dorsal fleshy vascular pedicle.The pterygoid flap of the penis was sutured to form the penile head,and the foreskin was cut to cover the body of the penis.The specimens were taken for HE staining.Results The operation was successfully completed in 14 children.The length of the penis was measured before it is stretched out.The penile length was(3.5 ±0.5)cm,the penile diameter was(1.2 ±0.3) cm at the coronal sulcus,and the diameter of the tortoise head was (1.5 ± 0.3) cm at the pterygoid.The width of urethral plate was (0.6 ± 0.1) cm.Remeasurement was performed after complete correction of penile bending deformity.The length of the penis was (3.5 ± 0.5) cm,and the urethral defect was (1.7 ± 0.7)cm.According to Barcat method,there were 2 cases of coronal sulcus type,7 cases of anterior penile type and 5 cases of middle penile type.The results of HE staining showed that the number of blood vessels in the dorsal prepuce and fascia was (8.5 ± 2.1),dorsal foreskin plate was (5.1 ± 1.6),ventral prepuce internal plates was (7.6 ± 1.8),and ventral outer prepuce plates was (4.8 ±1.6).The number of superficial fascia vessels and deep fascia vessels were (10.3 ± 1.4) and (4.2 ± 1.7).The analysis of variance showed that there was significant difference in the mean number among groups(P =0.036),which was compared with each other by SNK-q test.The number of fasciae in dorsal prepuce was the most abundant,there was significant difference between dorsal and outer prepuce(P =0.033),and there was also significant difference with ventral prepuce(P =0.047).But there was no significant difference between the two groups(P =0.326).There was no significant difference in the number of blood vessels between the dorsal and ventral prepuce (P =0.682).The number of superficial fascia vessels near the skin was significantly more than that of deep fascia(P =0.037).On the transverse plane,there are more branches of the superficial fascia to the urethral plate at the junction of the ventral external plate and the urethral plate.All 14 cases were followed up for 3 to 9 months with an average of(5.4 ± 2.1) months.The penis was straight and satisfactory,urethral orifice was not cracked,urination was laborious and not forked,and there was no fistula.One patient with middle penile type developed postoperative infection and was controlled after antiinfective treatment.One patient with anterior penile type had slight urination after operation,but had no difficulty in urination.F6 metal urethral dilator was used to dilate for 2 months,and the urination was normal.Conclusion Urethral plate combined with crescent flap urethroplasty for hypospadias has a satisfactory appearance and fewer complications.It provides an optional operative method for the children who need no transection of urethra plate to straighten the penis,especially for the poor development of the penis and the insufficiency of the new urethral materials.The superficial fascia tissue on both sides of the urethral plate is an ideal material for the new urethra because of its abundant blood supply adjacent to the urethral plate and direct vascular connection.

The predictive value of crescents in adult Henoch-Sch(o)lein purpura nephritis / 中华肾脏病杂志

Objective To study the renal prognosis with the type and proportion of crescentic in adult Henoch Schonlein purpura nephritis (HSPN).Methods A total of 275 HSPN cases diagnosed in the First Affiliated Hospital of Zhejiang University were retrospectively analyzed.According to the pathological results,they were divided into four groups:99 patients in none crescent group (NC),35 patients in segmental crescents group (SC),122 patients with circumferential crescent ＜25％ (C1),and 19 patients with circumferential crescent≥25％ (C2).Renal prognostic events were defined as estimated glomerular filtration rate (eGFR) decreased by 30％ over baseline within 2 years,doubling of serum creatinine or end-stage renal disease during follow-up.Kaplan-Meier survival analysis was used to compare the renal survival rate of each group.Univariate and multivariate Cox regression model was used to recognize the risk factor of poor renal outcome.Results There was no significant difference in age,extra renal organ performance and mean arterial pressure among groups.Among NC group,SC group,C1 group and C2 group,difference in serum creatinine (P=0.001),eGFR (P=0.003) and proteinuria levels (P ＜ 0.001) were statistically significant.There was no significant difference in the ratio of global sclerosis,mesangial hypercellularity and interstitial inflammation/fibrosis among the groups.The patients were followed up for 86(58,116) months.The renal survival rates of NC group,SC group,C1 group and C2 group were 96％,100％,83.6％ and 68.4％ respectively.Kaplan-meier survival analysis showed significant differences (Log Rank=23.24,P＜ 0.001).Cox multivariate regression analysis indicated that presence of circumferential crescent (HR=3.59,95％CI 1.34-9.62,P=0.008) and low eGFR (HR=0.979,95％ CI 0.968-0.989,P ＜ 0.001) were independent prognostic factors.Conclusion The presence of circumferential crescent and low eGFR level are independent risk factors for poor renal prognosis in HSPN patients.

Diagnosis Value of Pericardium Crescent Sign under CT in Patients with Non-Calcified Constrictive Pericarditis / 中山大学学报(医学科学版)

[Objective]To investigate the value of"pericardium crescent sign"in the diagnosis of non-calcified con-strictive pericarditis in CT.[Methods]Twenty-seven patients with non-calcified constrictive pericarditis and forty-six cardiac tumors confirmed by surgical pathology were analyzed retrospectively. All patients underwent non-enhanced and enhanced CT scan preoperatively.Pericardial morphology,density,enhancement features,appearance of atrium,ventri-cle and inferior vena cava of non-calcified constrictive pericarditis were analyzed. Pericardial morphology of cardiac tumors was also analyzed.[Results]Of the 27 patients with non-calcified constrictive pericarditis,18 patients developed"pericardium crescent sign",accounting for 66.7%,ventricular varying degrees of deformation in 13 cases,accounting for 48%;venous dilatation in 26 cases,accounting for 93%;atrial enlargement in 7 cases,accounting for 26%. In 46 patients with cardiac tumors,only 1 patient had a similar"pericardial crescent"sign.For the diagnosis of constrictive pericarditis using pericardial crescent sign,the sensitivity was 66.7%,the specificity was 97.8%,Youden index was 0.64. The area under the ROC curve was 0.82([0.71-0.94],P<0.001).[Conclusion]"Pericardium crescent sign"is important CT features of non-calcified constrictive pericarditis. It has high specificity for differentiating non-calcified constrictive pericarditis from pericardial tumor imaging.

Clinicopathological features and prognosis of IgA nephropathy with crescentic formation in children / 中华肾脏病杂志

Objective To observe the clinical,pathological features and prognosis of IgA nephropathy in children with crescent formation.Methods A total of 38 cases of children with IgA nephropathy diagnosed by renal biopsy at Qilu Hospital of Shandong University were retrospectively analyzed.According to whether there were crescent formation,they were divided into crescents formation group (crescent formation≥10％,n=18) and control group consisting of children with complete clinical data and matching age,gender and course of disease (no crescent formation,n=20).The clinical,pathological features and prognosis of the two groups were compared.Results Fourteen cases (77.78％) of crescents formation group were associated with nausea hematuria,and 12 cases (66.67％) had hypertension,8 patients in control group (40％) had gross hematuria,and 6 cases (30％)had high blood pressure.The differences were statistically significant (P ＜ 0.05).In crescents formation group,Alb and eGFR were significantly lower than those of control group.24 h urine protein and Scr were significantly higher than those of control group and there were significant statistically differences between two groups (P ＜ 0.05).Nephropathological changes in crescent formation group were mainly in grade Ⅱ and grade Ⅲ and were usually combined with tubular interstitial damages.In addition to IgA immunoglobulin deposition,they often accompanied by IgG and IgM immunoglobulin deposition.In control group,nephropathological changes were mainly in grade Ⅰ and grade Ⅱ and tubular interstitial damages were rare.IgA was the main form of deposition in control group.After 12 weeks steroid treatment and (or) immunosuppressive therapy,urinary protein turned negative in 7 cases in crescent formation group,24 h urinary protein level declined by half than before in 7 cases and no obvious change in 4 cases.In control group,urinary protein turned negative in 12 cases,6 cases showed a more than 50％ decline in urinary protein level and 2 cases had no obvious change.During the 1-3 years of follow-up,renal function of 14 cases and 19 cases was normal in the crescent formation group and control group respectively,serum creatinine of 3 cases and 1 case increased mildly in the crescent formation group and control group respectively,1 case needed dialysis treatment in the crescent formation group and the one in the control group who had slightly increasement of Scr did not reach the standard of dialysis treatment.Conclusions The clinical and pathological manifestations of children with IgA nephropathy with crescent formation are more severe and more likely to manifest renal insufficiency,suggesting that crescent formation is one of the indicators of poor prognosis.

Treatment of Day type Ⅱ pelvic crescent fracture by using percutaneous cannulated screw fixation technique / 中国修复重建外科杂志

Results: The operation time was 35-95 minutes (mean, 55 minutes), cumulative C-arm fluoroscopy time was 3-8 minutes (mean, 5 minutes), no iatrogenic vascular injury and pelvic organ damage occurred. Postoperative X-ray films at 2 days indicated that 2 cases of vertical shift and 2 cases of mild rotation were not completely corrected. Postoperative CT examination at 3 days indicated that 2 pubic joint screws broke through the obturator bone cortex. None of the pubic ramus screws entered into the acetabulum, but a screw of superior pubic branch broke through the posterior cortical of superior pubic branch, a screw of posterior ilium column broke through the medial bone cortex of the ilium, and no clinical symptom was observed. One patient suffered from wound infection in the pubic symphysis, then healed after 2 weeks of wound drainage, the other wounds healed by first intention. According to Matta criterion for fracture reduction, the results were excellent in 9 cases, good in 4 cases, and fair in 1 case with an excellent and good rate of 92.9%. All patients were followed up 8-24 months (mean, 14 months). All fractures healed at 4 months and restored to the normal walking at 6 months after operation, 3 patients suffered from slight pain in the sacroiliac joints and slight claudication when they were tired or walked for a long time and unnecessary for special treatment. One patient felt pain in the back of the iliac spine when he was lying down. During the follow-up, no screw loosening or other internal fixation failure occurred. At last follow-up, according to Majeed functional evaluation criteria, the results were excellent in 7 cases, good in 5 cases, and fair in 2 cases with an excellent and good rate of 85.7%.

Acute postinfectious glomerulonephritis with a large number of crescents caused by Mycoplasma pneumoniae.

Mycoplasma pneumoniae-induced acute postinfectious glomerulonephritis has various pathological changes and relatively poor prognosis. It often occurs in children, barely in adults. Currently, no clear treatment guidelines have been established for its treatment using glucocor ticoid and immunosuppressive. In this study, we report an adult who admitted to our hospital due to fever and gross hematuria. The patient presented with nephritic syndrome and renal failure and confi rmed to have M. pneumoniae infection by serum detection and acute postinfectious glomerulonephritis with a large number of crescents by renal biopsy. He was given glucocorticoid, immunosuppressive agent combined with hemodialysis as well as other supportive treatment. Three months later, his renal function became normal, urine protein level decreased to 0.4 g/24 h, and the C3 complement increased to normal level. In conclusion, glucocorticoid and immunosuppressive treatment should be given to patients with M. pneumoniaeinfection induced glomerulonephritis after confi rmed to have a large number of crescents by renal biopsy and the treatment could improve the prognosis.

Clinical and pathological features of IgA nephropathy with macrohematuria in history / 中华肾脏病杂志

Objective To investigate the clinical and pathological characteristics of IgA nephropathy (IgAN) with macrohematuria (MH).Method 1512 consecutive patients with biopsyproven IgAN diagnosed from January 2006 to December 2011 were enrolled,and divided into MH group and control group respectively,according to whether there existed episodes of MH before renal biopsy.The clinical and pathological characteristics were compared between two groups.Patients in MH group were then divided into three groups according to the interval from the last episode of MH to renal biopsy to clarify the concomitant clinicopathological changes associated with occurrence of MH.Results The rate of MH in history was 22.1％.MH group patients had significantly lower serum creatinine,slighter proteinuria,lower prevalence of hypertension and heavier microhematuria than control group (all P ＜ 0.001).The prebiopsy durations were similar in two groups (P=0.627).In MH group,chronic pathological indicators,including global/segmental sclerosis,tubule atrophy/interstitial fibrosis were all slighter (all P＜ 0.001),whereas activity indicators,including necrosis lesions,crescents and mesangial proliferation were all more severe compared with control group (all P ＜ 0.05).Those who underwent renal biopsy within 30 days of the last episode of MH had more severe proteinuria and microhematuria,higher prevalence of necrosis lesions,more severe crescents formation,and endothelial proliferation (all P ＜ 0.05).Conclusions IgAN patients with MH in history have relatively milder clinical and chronic pathological manifestations,however more active pathological changes especially in those who suffer episode of MH recently.

Clinicopathologic characteristics of membranous nephropathy with crescents / 医学研究生学报

Objective Membranous nephropathy ( MN) is rarely complicated by crescents.This study was to observe the clinicopathologic characteristics of MN with crescents. Methods This retrospective study included 53 cases of biopsy-proven idiopathic MN with crescents in the absence of immunologic and clinical etiologic factors and another 100 MN patients without histological crescents as controls.The clinicopathologic features, treatment response, and out-comes were analyzed and compared between the two groups of pa-tients. Results Significantly higher percentages of hypertension and decreased eGFR were observed in the MN +crescents group than in the control (47.2%vs 19.0%, P<0.05;28.3%vs 40.%, P<0.05).Circulating autoantibodies against the M-type phospholipase A2 receptor (PLA2R) were found in 66.7%(30/45) of the patients.The glomeruli exhibited a median of 4.6%(1.8%-35.3%) involvement of crescents.Compared with the controls, the MN +crescents group showed remarkably higher rates of segmental glomer-ulosclerosis lesions (16.0%vs 49.1%, P<0.05), capillary loops necrosis (0.0%vs 11.3%, P<0.05), interstitial fibrosis/tubu-lar atrophy (IFTA) (54.0%vs 86.8%, P<0.05) and afferent arterial lesions (65.0%vs 92.5%, P<0.05).No significant differ-ences were found in the outcomes of the two groups of patients. Conclusion MN with crescents is rare, and secondary MN and cres-centic glomerulonephritis should be considered.Crescentic MN usually presents with hypertension and renal dysfunction clinically and high rates of severe segmental and global glomerulosclerosis, capillary loops necrosis, and IFTA histologically.The condition has a fa-vorable short-term prognosis.

Atypical Pelvic Crescent Fracture Caused by Vertical Shear Force / 대한고관절학회지

The crescent fracture consists of a posterior iliac wing fracture with extension into the sacroiliac joint and a dislocation of the sacroiliac joint. This fracture represents a subset of lateral compression injury. The strong posterior ligaments of sacroiliac joint remain intact and a fracture fragment (crescent shape) involving the posterior superior iliac spines remains firmly attached to the sacrum. We report a patient with atypical pelvic crescent fracture that is mainly influenced by vertical shear injury and is characterized by posterior fracture-dislocations of the sacroiliac joint. In this case report, we review the literature on classification and treatment of atypical type of crescent fracture.

Characteristics of the Gray Optic Disc Crescent and Associated Factors

PURPOSE: To investigate the characteristics of the gray optic disc crescent and associated factors. METHODS: We retrospectively reviewed stereo fundus photographs of 590 glaucoma patients and 273 non-glaucoma patients. An experienced investigator evaluated the presence or absence of the gray crescent (a crescent-shaped, slate-gray pigmentation on the periphery of the neuroretinal rim) which is entirely inside the scleral crescent. Correlations with age, gender, refractive error, disc diameters, and the presence of glaucoma or peripapillary atrophy were also analyzed. RESULTS: Out of 863 patients, the gray crescent was observed in 166 patients and was found in 19.0% of glaucoma patients and 19.8% of non-glaucoma patients. The gray crescent was most often located temporally (30.1%) and most frequently occurred within only 1 quadrant (63.9%). The prevalence of the gray crescent was not correlated with refractive error (p = 0.61) or the occurrence of glaucomatous optic neuropathy (p = 0.25), but was significantly related to peripapillary atrophy (p < 0.001) and the horizontal diameter of the optic disc (p = 0.001). CONCLUSIONS: The gray optic disc crescent is a common finding within a glaucomatous or non-glaucomatous eye and factors significantly related to occurrence of the gray crescent include peripapillary atrophy and the horizontal diameter of the optic disc. Patients with gray crescent require special attention when the optic disc is examined.

Advantage of Crescent Knife in Making Excision of Pterygium.

A pterygium is a triangular sheet of fibrovascular tissue which invades the cornea. In the management of pterygium surgical excision is needed. Common practices in pterygium surgery are simple excision, excision with post operative b- radiation or tropical thio-TEPA solution(1:2000) or mitomycin-C solution(0.4%), excision with peroperative use of mitomycin-C or conjunctival autograft or amneotic membrane graft or lamellar keratoplasty of the affected part of the cornea. Recurrence is high in pterygium surgery probably due to facing difficulty for easy and complete separation of fibrovascular growth. So this is a search for new technique where easy smooth and complete separation pterygial tissue can be done with minimum surgical trauma and a good cosmetic look. This study was carried out at Faridpur Medical College Hospital (FMCH) from January 2010 to December 2011. A total 50 cases were selected for study. Technique of operation in all the cases were excision of pterygium with conjunctival autograft. In 50% cases, the head of the pterygium removed from the cornea with crescent knife and in 50% cases the head of the pterygium removed with tooks knife. The follow up period was 12 to 24 months. In the group- A, recurrence occurred in two eyes i.e 8% and succeed in 23 eyes i.e 92%. In the group-B, recurrence occurred in 6 eyes i.e 24% and succeed in 19 eyes i.e. 76%. So, higher success rate and low recurrence rate with good cosmetic look and minimum surgical trauma for those where crescent knife were used.

Radiological anatomical consideration of conjoined nerve root with a case review / 대한해부학회지

Nerve root anomalies are frequently underrecognized regardless of the advances in imaging studies; they are also underappreciated and underreported when encountered surgically. The classification of conjoined nerve roots is based on whether the nerve root emerges at an abnormal level or from an anastomotic branch. In the present report, we describe case with a conjoined nerve root that emerged at a more caudal level than that normally observed that was an undiagnosed on preoperative imaging studies. We also discuss the atypical imaging features obtained through preoperative imaging studies. As observed in the present case, preoperative recognition and diagnosis of such anomalies offer the best opportunity of performing a successful procedure and preventing inadvertent damage to nerve roots intraoperatively.

Intrapelvic Anterior Plate Fixation for Crescent Fracture-Dislocation of Sacroiliac Joint

PURPOSE: To evaluate the radiological and clinical outcomes of intrapelvic anterior plate fixations for Day Classification Type II crescent fracture-dislocations of sacroiliac joints. MATERIALS AND METHODS: Ten patients who had undertaken the surgical treatment for the sacroiliac joint from 2006 to 2012 were enrolled in this study. All cases fell into Type II by Day Classification for sacroiliac joint injuries. For surgical treatments, the plate fixation through the intra-pelvic anterior approach was first performed for all cases and anterior ring fixation was performed in 4 cases with more severely displaced anterior pelvic ring injuries. Then, radiological and clinical evaluation was implemented. RESULTS: The bone union was observed from all patients whom performed the surgical fixation. In the radiological results, 9 cases with the anatomic and nearly-anatomic reductions were observed. Out of the 10 cases which performed the rotational displacement analysis, there were 3 excellent cases, 6 good cases and 1 fair case. The 10 cases that performed the deformity index and vertical displacement analysis, less variations were observed in the anterior ring fixations after intra-pelvic anterior plate fixation group. According to the clinical results, 4 excellent cases, 3 good cases, and 3 moderate cases were observed. CONCLUSION: In the Type II crescent fracture-dislocation of sacroiliac joint, the intrapelvic anterior plate fixation achieved satisfactory anatomical reductions, radiological stabilities and clinical results.

Vasculitis cutánea leucocitoclástica y glomeruesclerosis focal y segmentaria con formación de semi lunas en una joven consumidora de cocaína/crack cortada con levamisol V / Cutaneous leukocytoclastic vasculitis and focal segmental glomeruesclerosis with crescent formation in a young consumer of cocaine / crack cut with levamisole V

Se describen los hallazgos anatomopatológicos encontrados en la autopsia de una joven de 19 años de edad, indigente, trabajadora del sexo, adicta al crack desde los 12 años de edad, quien los últimos 4 meses de su vida tuvo tres ingresos hospitalarios al Hospital México de San José‚ de Costa Rica con diagnóstico de vasculitis cutánea por crack e insuficiencia renal aguda. Los hallazgos más relevantes en la autopsia fueron: vasculitis aguda leucocitoclástica con trombosis y paniculitis glomeruloesclerosis focal y segmentaria con formación de semilunas...

A Case of Crescentic IgA Nephropathy Associated with Alcoholic Liver Cirrhosis / 대한신장학회지

It has been reported that IgA nephropathy is associated with alcoholic liver cirrhosis. However, crescentic glomerulonephritis or nephrotic syndrome are relatively rare. We experienced a patient with IgA nephropathy complicated with alcoholic liver cirrhosis who showed favorable clinical outcomes through steroid treatment. A 54-year-old man with alcoholic liver cirrhosis was hospitalized for generalized edema, nephrotic-range proteinuria and azotemia. We performed a renal biopsy and crescentic formations were found in half of the glomeruli. After use of steroid, azotemia and proteinuria improved gradually.

Clinicopathologic Characteristics of IgA Nephropathy with Crescents / 대한신장학회지

PURPOSE: In IgA nephropathy (IgAN), crescent formation appears to represent a nonspecific response to severe injury to the glomerular capillary wall. This study was performed to evaluate the clinicopathological manifestations of the crescents and their effects on the clinical courses of IgAN. METHODS: The patients diagnosed IgAN were included and the information about their renal biopsies, chemistries and immunohistochemistry findings were collected retrospectively. Some patients that have similar renal function and protenuria were followed up for 12 months to examine the effects of crescents on the renal prognosis. RESULTS: 38 patients with crescents and 177 patients without crescents were enrolled. The patients with IgAN with crescents showed significantly lower renal function (MDRD eGFR 58.5 vs 88.4 ml/min/1.73m2), higher blood pressure, larger amount of proteinuria and more severe hematuria than those patients without crescents. In pathologic findings, HS Lee grades were higher (2.9 vs 1.9). When we selected patients with mildly decreased renal function (serum creatinine <2.5 mg/dL, PCR 0.5-8 g/gCr), the patients with crescents presented lower renal function and higher proteinuria but no statistical significance. After 12 months of treatment, the patients with crescents showed significantly lower renal function (MDRD eGFR 78.6 vs 96.5 ml/min/1.73m2) and higher proteinuria (0.9 vs 0.6 g/gCr). CONCLUSION: The patients with IgAN with crescents showed more deteriorated clinicopathological findings than those without crescents. Despite aggressive treatments, they presented a significantly decreased renal function and larger amount of proteinuria after 1 year. So crescents are supposed to have poor effects on the clinical course.

A Case of Idiopathic Membranous Nephropathy with Crescents Formation Associated with Anti-GBM Antibody / 대한신장학회지

Crescents formation associated with anti-glomerular basement membrane (anti-GBM) antibody is a rare complication in patients with idiopathic membranous nephropathy (MN). Here, we report a 25-year-old male with crescentic MN associated with anti-GBM antibody, who presented with general edema and decreased renal function. Renal biopsy specimen revealed thickening of the glomerular capillary wall consistent with MN. Of 12 glomeruli, three sclerosed, and two crescents formations with interstitial fibrosis were seen. Serology was positive for anti-GBM antibody with titer of 125 enzyme unit (EU)/mL. The patient was treated with pulse intravenous methylprednisolone for 3 days followed by oral prednisolone, and intravenous cyclophosphamide. His renal function was improved significantly 2 weeks after initiation of treatment. In conclusion, crescents formation should be considered in patients with nephrotic syndrome accompanied with acute renal dysfunction, and the early biopsy of the kidney and appropriate treatment will be required to improve the clinical outcome.

The effect of umbilical cord mesenchymal stem cells transplantation for the MRL/Ipr mice / 中华风湿病学杂志

Objective To investigate the efficacy of umbilical cord mesenchymal stem cells (UC-MSCs) transplantation in the treatment of the MRL/lpr mice. Methods Twenty four 18-week-old MRL/lpr female mice were divided into 3 groups:group 1 (G1) were transplanted with 1×106 UC- MSCs through caudal vein, group 2 (G2) were transplanted with 1×106 UC- MSCs three times and group 3 (G3) were treated with 0.5 ml normal saline as controls. Enzyme linked immunosorbent assay (ELISA) was used to measure the levels of serum anti-dsDNA antibodies. Twenty-four hours proteinuria and body weight were assessed every two weeks. The histopathology changes of the kidneys and lungs were observed. Results ① At the 25th weeks, the 24 hours proteinuria in group G1 (2.3±1.9) mg and G2 (1.8±1.4) mg was decreased than that in the control group (3.8±2.1) mg (P<0.05), and at the 27th weeks, that of groups G1 (2.5±1.5) mg and G2 (1.9±1.2) mg was also significantly decreased than in the control group (5.4±2.4) mg (P<0.01); ② From the 24th week, the body weight of groups G1 and G2 increased significantly than that of the control group (P< 0.05). At week 29, serum creatinine decreased significantly in both groups G1 (7.2±3.2) μmol/L and G2 (6.2±2.8) μmol/L than in the control group (12.5±2.3 ) μmol/L (P<0.05); ③One week after transplantation, the levels of anti-dsDNA antibodies in group G1 (46±11)×102 U/ml and G2(49×43)×102 U/ml were bothsignificantly decreased than those of the control groups (99±42)×102 U/ml (P<0.05) and the difference between group G2 (36±15)×102 U/ml and the controls (68±32)×102 U/ml was statistically significant; ④The nephron crescent formation in group G1 (0.12±0.07) and G2 (0.08±0.02) was significantly lower that of the control group (0.20±0.06) (P<0.05) and that of group G2 was significantly less that of froup G1 (P<0.05); ⑤ The interstitial pneumonitis was singnificantly milder in group G1 than group G2. Conclusions UC- MSCs is very effective in treating MRL/lpr mice. It is safe and free of rejection reactions.