Caracterización de enfermedades glomerulares: análisis de 22 años de biopsias renales / Frequency of glomerular diseases in an analysis of 550 kidney biopsies

BACKGROUND: The frequency of glomerular diseases is dynamic and varies according to geographic area. AIM: To evaluate the frequency of primary and secondary glomerulopathies, their demographic profile and main clinical characteristics. MATERIAL AND METHODS: Renal biopsies from native kidneys performed between 1999 and 2020 were retrospectively reviewed. Demographic characteristics, clinical presentation, most relevant laboratory tests, frequency of primary and secondary glomerulopathies were analyzed. RESULTS: We analyzed 550 kidney biopsies from patients with a median age of 48 years (64% females). Nephrotic syndrome was the main indication for renal biopsy. Primary and secondary glomerulopathies occurred with similar frequency. Within the primary glomerulopathies, membranous nephropathy (34.1%) was the most common, followed by IgA nephropathy (31.1%) and focal segmental glomerulosclerosis (14.1%). Among the secondary glomerulopathies, lupus nephropathy was the most common (41.7%), followed by pauciimmune glomerulonephritis (27.1%) and diabetic nephropathy (6.4%). When comparing the results with other regions, significant differences were observed with reported frequencies in United States, Europe, Asia and the rest of Latin America. CONCLUSIONS: The most common primary glomerulopathies were membranous nephropathy and IgA nephropathy. Among the secondary glomerulopathies lupus nephropathy and pauci-immune glomerulonephritis were the most common. Compared to international registries, we observed a high proportion of membranous nephropathy and pauci-immune glomerulonephritis.

Diagnostic value and safety of percutaneous renal biopsy at different puncture sites guided by real-time abdominal mode ultrasound with an L9 superficial probe / 中国基层医药

Objective:To investigate the best operation mode for percutaneous renal biopsy guided by real-time abdominal mode ultrasound, to increase the puncture success rate, and avoid serious complications using safe and effective renal puncture biopsy.Methods:A total of 44 patients with renal disease who received treatment in Ji'an Central People's Hospital from November 2019 to March 2022 were included in this study. According to the puncture location on the right kidney, these patients were divided into a control group (lower pole of the right kidney, n = 22) and an observation group (middle and lower pole of the right kidney, n = 22). A percutaneous renal biopsy was performed from the back to the right side of the spine under the guidance of abdominal mode ultrasound with an L9 superficial probe. General data, the number of punctures, the length of the safe puncture path, the maximum length of the tissue strip subjected to biopsy, the proportion of endothelial medulla in the tissue strip, the number of glomeruli, and the incidence of complications of perirenal hematoma were compared between the two groups. Results:All 44 patients succeeded in sampling, with a 100% success rate. A total of 7-32 glomeruli were obtained. A pathological diagnosis was made in all 44 patients. There were no significant differences in age, body mass, or medical history between the two groups (all P > 0.05). There were significant differences in the maximum length of renal tissue strip subjected to biopsy [(15.55 ± 1.75) mm vs. (11.45 ± 2.46) mm] and the number of glomeruli in renal tissue strip subjected to biopsy [(18.00 ± 6.12) vs. (11.32 ± 2.38)] between the two groups ( t = 6.20, 4.66, both P < 0.05). The difference in the incidence of complications of perirenal hematoma after percutaneous renal biopsy differed greatly between the two groups [100.0% (22/22) vs. 27.2% (6/22), χ2 = 3.86, P = 0.001]. No serious complications occurred in each group. There were no significant differences in the length of the safe puncture path, the number of punctures, or the proportion of endothelial medulla in tissue strips subjected to biopsy between the two groups (all P > 0.05). Conclusion:L9 superficial probe abdominal mode real-time ultrasound-guided percutaneous renal biopsy from the inside out has a good application value, a high puncture success rate, is safe and reliable, and yields a satisfactory pathological diagnosis. Percutaneous renal puncture biopsy of the middle and lower poles of the right kidney under the abdominal lobe has a higher pathological diagnostic value and is safer than percutaneous renal puncture biopsy of the lower pole of the right kidney.

Effect Of AJI-NO-MOTO On Kidney Of Adult Albino Rat: A Histopathological Evaluation

Introduction: Aji-No-Moto (MSG), the wonder flavoring agent, has been reportedly overused in all packed food products and the cuisines being served in restaurants. This salt effect almost all the organs of the body but the evidences regarding its ill effects are very limited. Thus, no guidelines are there for the safe limits of Aji-No-Moto use. In current study we planned to analyses the histopathological effects of Aji-No-Moto on kidney. Methods: The study was conducted on 18 inbred adult albino rats of either sex. The rats of control group (C) received only standard diet with dis?lled water, low dose test group (T1) rats received 0.5mg/kg of MSG dissolved in dis?lled water and high dose test group (T2) rats received 1.5mg/kg of MSG dissolved in dis?lled water per orally for 28 days. A?er the experimental period, the rats were sacrificed to dissect out the renal ?ssue which was later subjected to histological processing and ?ssue sec?oning. Observa?ons: The kidney ?ssue sec?ons of the control group (C) revealed normal renal architecture consis?ng of cor?cal labyrinth and medulla. The cor?cal labyrinth consisted of glomeruli, PCT and DCT whereas the medulla consisted of the ascending and descending limbs of loop of henle and collec?ng ducts. On the other hand, renal sec?ons of low dose group (T1) showed focal shrinkage of renal glomerulus and widening of the Bowman’s space. Furthermore, these changes were more pronounced in high dose group (T2) along with hypercellularity of glomeruli, dilata?on, hyperaemia and conges?on in the intertubular cor?cal blood vessels and mononuclear cell infiltrate. Conclusion: Aji-No-Moto is the most widely used flavoring agent whose minimal dose for use has to be evaluated. The current study was planned to access the minimal low dose limit of MSG for use. The results of aforemen?oned study revealed that even small dose of 0.5mg/kg/day is capable of producing histopathological effects on kidney.

Hyperbilirubinemia induced oxidative stress resulting in glomerular injury in rats / 中华危重病急救医学

Objective:To observe the effect of hyperbilirubinemia on glomerulus of rats, and to explore its dose-response and mechanism.Methods:Twenty-four adult male Sprague-Dawley (SD) rats were divided into four groups according to the random number table method, with 6 rats in each group. Hyperbilirubinemia rat model was reproduced by intraperitoneal injection of bilirubin once every 12 hours for 4 times, at doses of 50, 100, and 200 mg/kg in low, medium, and high dose bilirubin group (LB group, MB group, HB group), respectively. The rats in negative control group (NC group) were given the same solvent without bilirubin powder. Urine was collected 24 hours after administration, and total protein (TP) level was detected. Then the rats were sacrificed, the blood was collected by cardiac puncture, and the total bilirubin (TBil) and direct bilirubin (DBil) levels were measured by automatic biochemical analyzer. The renal tissue was collected and stained with periodic acid-Schiff (PAS) staine, the glomerular morphology was observed under light microscope, and the glomerular injury score was performed. Podocyte morphology was observed by transmission electron microscopy after uranium acetate and lead citrate double staining. The activity of superoxide dismutase (SOD) and content of malondialdehyde (MDA) were determined by colorimetric method. The expression level of podocyte specific marker Wilms tumor protein-1 (WT-1) was determined by Western blotting.Results:With the increase of bilirubin dose, the contents of 24-hour urine TP, blood TBil, blood DBil and MDA content in kidney tissue were gradually increased, and the SOD activity and WT-1 expression in kidney tissue were gradually decreased. The differences between LB group, MB group, HB group and NC group were statistically significant [24-hour urine TP (mg): 24.85±2.22, 52.57±3.66, 56.84±3.49 vs. 7.50±1.33; blood TBil (μmol/L): 37.75±2.19, 81.37±2.13, 125.13±9.96 vs. 5.53±0.41; blood DBil (μmol/L): 15.50±1.96, 37.88±1.05, 64.53±2.89 vs. 2.38±0.35; kidney MDA (μmol/g): 3.14±0.65, 5.01±0.28, 7.50±1.08 vs. 2.30±0.20; kidney SOD (kU/g): 95.91±10.43, 57.06±15.90, 37.12±11.72 vs. 113.91±12.16; kidney WT-1 protein (WT-1/GAPDH): 0.280±0.006, 0.239±0.006, 0.198±0.001 vs. 0.361±0.005; all P < 0.05]. It was shown under light microscope that uneven thickness of mesangial membrane and basement membrane of the glomerulus, and some of them were accompanied by hyperplasia and widening. The glomerular injury score increased with the increase in bilirubin dose. The differences between LB group, MB group, HB group and NC group were statistically significant (17.50±1.05, 25.00±1.41, 34.00±1.41 vs. 11.67±0.82, all P < 0.05). Transmission electron microscopy showed that with the increase of bilirubin dose, the damage of glomerular podocytes was aggravated. Conclusions:Hyperbilirubinemia induced damage to glomerulus in a dose-dependent manner. In the lethal dose range, the higher the dose, the stronger the damage, which might be related to the oxidative stress promoted by bilirubin and the damage of glomerular podocytes.

Progress of glomerular injury in type Ⅰ cardiorenal syndrome / 国际儿科学杂志

Type Ⅰ cardiorenal syndrome is a common disease syndrome in clinic.Cardiac surgery and acute heart failure caused by various causes are common causes of type Ⅰ cardiorenal syndrome.More recognized pathogenesis includes overactivation of sympathetic nervous system and renin-angiotensin-aldosterone system, renal ischemia-reperfusion, inflammatory response and oxidative stress.In the current research, most of the renal injuries caused by type Ⅰ cardiorenal syndrome are related to renal tubular epithelial injury, but there are few reports on glomerular injury.With the continuous in-depth study, more and more people realize that glomerular injury plays an important role in the occurrence and progress of acute renal injury.This paper mainly reviews the research progress and future research direction of glomerular injury in type Ⅰ cardiorenal syndrome.

Establishment of a diagnostic model for glomerular micro thrombosis in patients with lupus nephritis based on machine learning / 中华风湿病学杂志

Objective:To establish a diagnostic model for glomerular micro thrombosis (GMT) in lupus nephritis through clinical indicators.Methods:A continuous collection of patients diagnosed with lupus nephritis (LN) by renal biopsy in the Department of Nephrology, Shenzhen Second People's Hospital, from January 2010 to March 2021. All patients were admitted and discharged through the inclusion and exclusion criteria. Demographic data, clinical characteristics, biochemical indicators, and immune indicators were collected. A GMT diagnosis model was established from the most important variables among the abovementioned variables through machine learning and Logistic stepwise regression analysis. The model was presented through a nomogram. The receiver operating characteristic curve (ROC), the clinical decision curve and the calibration curve were used to evaluate the model discrimination, clinical use and accuracy, respectively. The internal verification of the model was carried out by repeated sampling 500 times by the Bootstrap method.Results:There were a total of 129 patients with lupus nephritis including the study, including 117 females (90.7%); the average age was (34±11) years. There were 39 patients with GMT (30.2%). Using machine learning to screen out the top 10 important variables from 47 candidate variables, then through logistic stepwise regression analysis, five variables were further screened to establish the diagnostic model of GMT, namely hemoglobin [ OR(95% CI)=0.966(0.943, 0.990), P=0.005], serum C3 [ OR(95% CI)=0.133(0.022, 0.819), P=0.030], systolic blood pressure [ OR(95% CI)=1.027(1.005, 1.049), P=0.017], lymphocyte count [ OR(95% CI)=0.462(0.213, 0.999), P=0.049], and TT [ OR(95% CI)=1.260(0.993, 1.597), P=0.057]. Draw up the equation of the GMT diagnosis model of lupus nephritis and establish a nomogram to present the model. The area under curve (AUC) of the diagnostic model was 0.823, 95% CI(0.753, 0.893), indicating that the model had a reasonable degree of discrimin-ation. The Hosmer-Lemeshow test showed a perfect fit between the predicted GMT risk and the observed GMT risk ( χ2= 14.62, P=0.067). The clinical decision curve and clinical impact curve reflect that the model had a good clinical application value, especially when the threshold probability is between 0.4 and 0.6, the application value is more significant. In addition, after 500 repeated samplings by the Bootstrap method, the average AUC was 0.825, 95% CI(0.753, 0.893), which is basically the same as the AUC obtained by the original model. Conclusion:We established a diagnostic model of GMT inLN based on clinical indicators through machine learning and logistic stepwise regression analysis. It is used for early diagnosis of the risk of GMT before the renal biopsy.

Morphometry: assessing direct and indirect methods of measuring the diameters of tubular structures / Morfometría: evaluación de métodos directos e indirectos para medir los diámetros de las estructuras tubulares

SUMMARY: Knowledge of the diameter of a structure or particle is required for stereological calculations. However, there is no consensus on the methodology for its measurement. This study aims to assess the differences between direct and indirect methods of measuring diameter. It is hypothesised that kidneys were removed, fixed, processed, sectioned, and stained. The stained slides were imaged using a digital microscope. The images were processed using the ImageJ software. The diameters of the renal glomeruli and collecting tubules were measured using direct and indirect methods. The measured diameters were analysed using the SPSS software v20. The differences between the measurements were assessed using a Z-test and test of association, and P < 0.05 was considered significant. No significant differences were observed between the diameters of the glomeruli (P = 0.82) and proximal (P = 0.86) and distal (P = 0.55) convoluted tubules as measured via direct and indirect methods. There was a strong positive correlation between the diameters of glomeruli (P = 0.97) and proximal (P = 0.82) and distal (P = 0.93) convoluted tubules measured using the two methods, both of which are convenient, accurate and suitable. The P-values based on these measurements were more than 0.05. Therefore, the study hypothesis was rejected. There was no significant difference between the direct and indirect methods of measuring diameter, and the null hypothesis was rejected; thus, both methods can be applied either independently or jointly.

RESUMEN: Se requiere el conocimiento del diámetro de una estructura o partícula para los cálculos estereológicos. Sin embargo, no existe consenso sobre la metodología para su medición. Este estudio tuvo como objetivo evaluar las diferencias entre los métodos directos e indirectos de medición del diámetro de una estructura. Riñones de ratas Wistar fueron extirpados, fijados, procesados y seccionados, y luego se tiñeron con HE. Se tomaron imágenes de las muestras teñidas usando un microscopio digital. Las imágenes fueron procesadas utilizando el software ImageJ. Los diámetros de los glomérulos renales y túbulos colectores se midieron por métodos directos e indirectos. Los diámetros medidos se analizaron utilizando el software SPSS v20. Las diferencias entre las medidas se evaluaron mediante una prueba Z y una prueba de asociación, y se consideró significativa P < 0,05. No se observaron diferencias significativas entre los diámetros de los glomérulos (P = 0,82) y túbulos contorneados proximales (P = 0,86) y distales (P = 0,55) medidos mediante métodos directos e indirectos. Hubo una fuerte correlación positiva entre los diámetros de los glomérulos (P = 0,97) y los túbulos contorneados proximales (P = 0,82) y distales (P = 0,93) medidos con los dos métodos, ambos convenientes, precisos y adecuados. Los valores P basados en estas mediciones fueron superiores a 0,05. Por lo tanto, se rechazó la hipótesis del estudio. No hubo diferencia significativa entre los métodos directo e indirecto de medición del diámetro, y se rechazó la hipótesis nula; por lo tanto, ambos métodos se pueden aplicar de forma independiente o conjunta.

Ultrasound-guided percutaneous renal biopsy at a university hospital: retrospective analysis of success and complication rates / Biópsia renal percutânea guiada por ultrassonografia: análise retrospectiva de sucesso e complicações em um hospital universitário

Abstract Objective: To evaluate the success and complication rates of ultrasound-guided renal biopsy at a tertiary care hospital. Materials and Methods: This was a retrospective analysis of 97 ultrasound-guided renal biopsies, all performed by the same radiologist, between 1 March, 2017 and 31 October, 2019. Results: Of the 97 biopsies evaluated, 87 had a definitive pathological diagnosis. In five cases (5.4%), the biopsy results were inconclusive and a second procedure was required. In seven procedures (7.6%), there were complications, all of which were properly resolved. Conclusion: Ultrasound-guided renal biopsy has proven to be a safe, effective method for the diagnosis of nephropathies, with high success rates.

Resumo Objetivo: Avaliar taxas de sucesso e de complicações de biópsias renais guiadas por ultrassonografia em um hospital terciário. Materiais e Métodos: Análise retrospectiva de 97 biópsias renais realizadas entre 1º de março de 2017 e 31 de outubro de 2019, guiadas por ultrassonografia e executadas por um único médico radiologista. Resultados: Oitenta e sete biópsias apresentaram diagnóstico anatomopatológico definitivo. Cinco biópsias foram inconclusivas (5,4%) e precisaram de um segundo procedimento. Houve complicações em sete procedimentos (7,6%), todas devidamente solucionadas. Conclusão: A biópsia renal guiada por ultrassonografia demonstrou ser um método efetivo e seguro para o diagnóstico de nefropatias, com elevada taxa de sucesso em sua execução.

Morphometry of the capillary loop stage glomerulus in developing mice / 解剖学报

Objective To describe quantitatively the development of the capillary loop stage glomerulus (capG) with respect to the volume density of capillaries in the glomerulus based on the morphogenesis of the kidney. Methods The kidneys were obtained from mice at various developing time points and prepared for paraffin sections. The volume density of CD34 positive endothelial cells and surrounded capillary lumen in glomeruli was measured using a combination of immunohistochemical staining and the stereological grid system. Results The capG was divided into early, middle, and late phases, and middle phase capG was subdivided into early-middle and late-middle phases, according to the morphology of developing glomeruli and the arrangement of podocytes. As result, the volume density of capillary loops in early phase capG could not be measured due to the complex "glomerular" shape. The volume density of capillary loops increased from (35.95±6.45)% in the early-middle phase capG, to (58.36±6. 30) % in the late-middle phase capG, and to (79.89± 5.21) % in the late phase capG, compared to (93.61 ±1.96) % in the mature glomerulus. Furthermore, the volume density of capillary loops remained constant at same stage even though at different developmental time points. Conclusion This study demonstrated a significantly increased volume density of capillary loops with the kidney development. In addition, the results provide a descriptive and reliable parameter for the evaluation of glomerular development.

Morphofunctional study on the effects of passive smoking in kidneys of rats / Estudo morfofuncional sobre os efeitos do tabagismo passivo em rins de ratos

ABSTRACT Objective To analyze whether passive inhalation of cigarette smoke causes morphological, structural, and functional changes in kidneys of rats. Methods Wistar rats, aged eight weeks, weighing on average 260g, were divided into Control Group and Smoking Group. Each group was subdivided into four groups of ten animals for morphofunctional analysis, in a period of seven and 28 days. The Smoking Group was exposed to smoke of 40 cigarettes per day, at certain times and in automated equipment for cigarette burning, called smoking machine (SM-MC-01). After the exposure period, urine and blood samples were collected for the functional analyses, and the kidneys were dissected and submitted to histological procedures for morphoquantitative analyses. Results After exposure of animals of the Smoking Group, the following were observed: lower weight gain; lower water and feed intake; decreased renal weight, diameter, and volume; reduction in cortical thickness and glomerular volume density; decrease in glomerular and capsular diameter; increase in mesangial density; decreased urine volume; increased levels of glucose, serum creatinine and microalbuminuria; decreased urinary creatinine levels and creatinine clearance rate. Conclusion Passive smoking negatively influences renal morphology and glomerular filtration rate, with effects similar to those described in the literature regarding active smoking.

RESUMO Objetivo Analisar se a inalação passiva da fumaça do cigarro proporciona alterações morfológicas, estruturais e funcionais nos rins de ratos. Métodos Ratos Wistar, com oito semanas de idade, pesando, em média, 260g, foram divididos em Grupo Controle e Grupo Tabagista. Cada grupo foi subdividido em quatro grupos de dez animais para análise morfofuncional, em um período de sete e 28 dias. O Grupo Tabagista foi exposto à fumaça de 40 cigarros por dia, em horários determinados e equipamento automatizado de queima de cigarros, denominado smoking machine (SM-MC-01). Após o período de exposição, foram coletadas amostras de urina e sangue para as análises funcionais, e os rins foram dissecados e submetidos a procedimentos histológicos para análises morfoquantitativas. Resultados Após a exposição dos animais do Grupo Tabagista, observou-se menor ganho de peso; menor consumo de água e ração; menor peso, diâmetro e volume renal; redução em espessura cortical e densidade de volume glomerular; diminuição no diâmetro glomerular e capsular; aumento na densidade mesangial; volume urinário diminuído; níveis aumentados de glicose, creatinina sérica e microalbuminúria; níveis reduzidos de creatinina urinária e redução da taxa de depuração da creatinina. Conclusão O tabagismo passivo influencia negativamente na morfologia renal e na taxa de filtração glomerular, com efeitos semelhantes aos descritos na literatura em relação ao tabagismo ativo.

Increased foxo1 dna methylation level in homocysteine-induced podocyte apoptosis / 中国组织工程研究

BACKGROUND: The increase of homocysteine can lead to renal injury and podocyte apoptosis, but the specific mechanism is not clear. OBJECTIVE: To investigate the effect of Forkhead box O1 (FoxO1) and its DNA methylation in podocyte apoptosis induced by homocysteine. METHODS: Mouse renal podocytes (MPC-5) were cultured in vitro and divided into control group (0 μmol/L homocysteine) and homocysteine group (80 μmol/L homocysteine). After 48 hours of intervention, the expression of podocyte apoptosis-related proteins Bax, caspase12 and Bcl-2 was detected by immunofluorescence technique; the expression level of FoxO1 mRNA was detected by real-time fluorescence quantitative PCR; the protein expression levels of FoxO1 and DNMT1 were detected by western blot; DNA methylation level of FoxO1 was detected by nested methylation-specific PCR. RESULTS AND CONCLUSION: Compared with the control group, the expression levels of Bax and caspase12 protein in podocytes of the homocysteine group were significantly increased, while the expression of Bcl-2 protein was significantly decreased. The expression levels of FoxO1 mRNA and protein were significantly decreased in the homocysteine group compared with the control group (P < 0.01). At the same time, the methylation level of FoxO1 DNA in the homocysteine group was significantly higher than that in the control group (P < 0.01), and the expression of DNMT1 protein in podocytes in the homocysteine group was significantly higher than that in the control group (P < 0.01). To conclude, FoxO1 DNA hypermethylation plays a significant role in podocyte apoptosis induced by homocysteine, whereas DNMT1 participates in homocysteine-induced podocyte apoptosis.

Drug-induced nephrotoxicity

Drugs are a common cause of acute and chronic kidney disease and contribute to patient morbidity and increased healthcare utilization. Drug-induced nephrotoxicity is approximately 14% to 26% in adults and tends to increase among certain patients and/or with complex clinical conditions. Unfortunately, apart from conservative management, including drug withdrawal, no effective treatment is known for this condition. Therefore, in order to reduce the frequency of drug-induced nephrotoxicity, early recognition of renal toxicity and appropriate prevention strategies, such as understanding the exact mechanisms of renal injury, patient and drug-related risk factors, and preemptive measures are needed. In this review, we will present the mechanisms of drug-induced nephrotoxicity and general preventive strategies for clinical physicians.

Assessment of long term outcomes after buccal mucosal graft urethroplasty: the impact of chronic kidney disease

ABSTRACT Objectives To compare and assess various outcomes and success of buccal mucosal graft urethroplasty (BMGU) in patients with CKD versus patients having normal renal function. Material and Methods This was a retrospective, single centre study, during period 2013 to 2017. Patients were grouped into two groups. Group 1 had patients with estimated Glomerular Filtration Rate (eGFR)>60mL/min/1.73m2 while group 2 had patients with eGFR <60mL/min/1.73m2. eGFR was calculated according to the MDRD equation. The two groups were compared with regard to various outcomes like length, location of stricture, technique of graft placement, intra-operative blood loss (haemoglobin drop), duration of hospital stay, post-operative complications and recurrence. Results A total of 223 patients were included in study with group 1 had 130 patients and group 2 had 93 patients. Mean age of patients with CKD were higher (47.49 years versus 29.13 years). The mean follow-up period was comparable between both groups (23.29 months and 22.54 months respectively). Patients with CKD had more post-operative Clavien Grade 2 or higher complications (p=0.01) and a greater recurrence rates (p<0.001) than in non-CKD patients. On multivariate analysis, age and CKD status was significant predictor of urethroplasty success (p=0.004) (OR= 14.98 (1.952-114.94, 95% CI). Conclusions CKD patients are more prone to post-operative complications in terms of wound infection, graft uptake and graft failure and higher recurrence rates following BMGU.

The Spectrum of Biopsy-Proven Glomerular Disease in China: A Systematic Review / 中华医学杂志(英文版)

<p><b>Background</b>Chronic kidney disease has become a leading public health concern in China, as it is associated with increased morbidity, mortality, and costs. However, the overall situation regarding common glomerular diseases in China remains unclear. Hence, the aim of this study was to assess the national profile of the common types of glomerulonephritis in China.</p><p><b>Methods</b>We searched Medline, Embase, Cochrane Library, CNKI, SinoMed, VIP, and Wanfang databases for English and Chinese language articles from inception to September 2017. We also collected potentially relevant studies and reviews using a manual search. The following words in combinations are as keywords: "renal biopsy", "kidney pathological diagnosis", and "spectrum of pathological types".</p><p><b>Results</b>We identified 23 studies involving 176,355 patients from 15 provinces/cities in China. The detection rates of primary glomerulonephritis (PGN) and secondary glomerulonephritis (SGN) were 0.740 and 0.221, respectively. Over the past 30 years, the top five types of PGN were immunoglobulin A nephropathy (IgAN; 24.3%), mesangial proliferative glomerulonephritis (MsPGN; 10.5%), membranous nephropathy (MN; 12.6%), minimal change disease (MCD; 9.8%), and focal segmental glomerulosclerosis (FSGS; 4.6%), and the top four types of SGN were lupus nephritis (LN; 8.6%), Henoch-Schönlein purpura glomerulonephritis (4.1%), hepatitis B virus-associated glomerulonephritis (HBV-GN; 2.6%), and diabetic nephropathy (DN; 1.6%). The proportion of MN, MCD, HBV-GN, and DN tended to increase, while those of IgAN, MsPGN, FSGS, and LN tended to drop.</p><p><b>Conclusions</b>Although the incidence of SGN is increasing gradually, PGN is still the leading form of kidney disease in patients undergoing renal biopsies in China. IgAN and LN are the most common types of PGN and SGN, respectively. Differences between regions are related to various factors such as nationality, environment, and diet. Furthermore, unified standards and norms for evaluating renal biopsies are urgently needed.</p>

Comparative analysis of primary and secondary glomerulopathies in the northeast of Brazil: data from the Pernambuco Registry of Glomerulopathies - REPEG / Análise comparativa de glomerulopatias primária e secundária no nordeste do Brasil: dados do Registro Pernambucano de Glomerulopatias - REPEG

Abstract Introduction: In Brazil, glomerulopathies are the third leading cause of chronic renal disease, accounting for 11% of dialysis patients. Studies on the prevalence of this disease in Northeastern Brazil are scarce. Objective: The aim was to describe the findings of biopsies and to conduct a comparative analysis on the clinical laboratory presentation of primary glomerulopathies (PG) and secondary glomerulopathies (SG). Methods: This was a retrospective study conducted at two public teaching hospitals in the state of Pernambuco, Northeastern Brazil. Results: A total of 1151 biopsies performed between 1998 and 2016 were analyzed. The sample consisted of 670 biopsies of native kidneys, after excluding extra glomerular diseases and unsuitable material. PG were more frequent than SG (58% vs. 42%). There was a prevalence among PG of focal segmental glomerulosclerosis (43%). Membranoproliferative glomerulonephritis and collapsing glomerulopathy, accounted for 9% and 3% of the PG, respectively. For SG, the main etiologies were lupus nephritis (67%) and infections (10%). Female sex, hematuria and an elevated level of creatinine were related to a greater chance of SG, at multivariate analysis. An increase of proteinuria reduced this chance. Nephrotic syndrome was more common among the PG, while urinary abnormalities and nephritic syndrome prevailed in patients with SG. Conclusion: This is the first registry of glomerulopathies in Northeastern Brazil. It also presents a comparative analysis of the main clinical laboratory abnormalities of PG and SG, and includes the current classifications of glomerular diseases.

Resumo Introdução: No Brasil, glomerulopatias são a terceira causa de doença renal crônica terminal, responsáveis por 11% dos pacientes em diálise. Entretanto, estudos sobre a prevalência desta patologia no nordeste do Brasil são escassos. Objetivo: O objetivo foi descrever os achados das biópsias e analisar comparativamente a apresentação clínico laboratorial entre as glomerulopatias primárias (GP) e as glomerulopatias secundárias (GS). Métodos: Estudo retrospectivo, realizado em dois hospitais públicos de ensino do estado de Pernambuco, nordeste do Brasil. Resultados: Foram avaliadas 1.151 biópsias, de 1998 a 2016. A amostra foi composta por 670 biópsias de rins nativos, após exclusão de patologias extra glomerulares e materiais inadequados. GP foram mais frequentes do que GS (58% × 42%). Dentre as GP, houve predomínio de glomeruloesclerose segmentar e focal (GESF). Glomerulonefrite membranoproliferativa e glomerulopatia colapsante foram responsáveis por 9% e 3% das GP, respectivamente. Das GS, as etiologias principais foram nefrite lúpica (67%) e infecciosas (10%). Sexo feminino, hematúria e nível elevado de creatinina estiveram relacionadas a uma maior chance de GS na análise multivariada. Síndrome nefrótica foi mais comum dentre as GP, já anormalidades urinárias e síndrome nefrítica prevaleceram nos pacientes com GS. Conclusões: Este é o primeiro registro de glomerulopatias do nordeste do Brasil. Demonstrou-se também uma análise comparativa das principais alterações clínico laboratoriais das GP e GS, com classificações atualizadas das doenças glomerulares.

The role of abatacept in the treatment of type 2 diabetic nephropathy in rats / 中华内分泌代谢杂志

Objective To observe the role of abatacept in the treatment of diabetic nephropathy in rats. Methods Type 2 diabetic nephropathy rat model was established, and was randomly divided into abatacept group and non-intervention group, 15 each. 15 normal rats were served as control group ( NC) . The abatacept group was given abatacept for 8 weeks. The control group was set at the same time period. Then the blood biochemical indexes, blood flow parameters of renal main artery, elasticity of renal parenchymal, HE staining of renal parenchymal and ultrastructure of podocytes were all evaluated. The expression of CD31, CD34, podocin, nephrin, and B7-1 in renal parenchyma were detected. Results Compared to the NC group, the fasting blood glucose, creatinine clearance rate, urine albumin excretion rate, and kidney hypertrophy index in the non-intervention and abatacept groups were significantly increased (P<0. 05);creatinine clearance rate, urine albumin excretion rate, and kidney hypertrophy index in the abatacept group were significantly lower compared to the non-intervention group (P<0. 05). There were significant differences in peak systolic velocity, end diastolic velocity, and mean velocity among these 3 groups, and these differences were ranked as non-intervention group<abatacept group<control group ( P<0. 05 ); there were significant differences in systolic acceleration, pulsatility index, and resistance index among these three groups, with the differences ranked as non-intervention>abatacept>control groups (P<0. 05). There were significant differences in the stiffness of kidneys among these three groups, with the differences ranked as non-intervention>abatacept>control groups (P<0. 05). HE staining and transmission electron microscope observation showed that there were obvious changes in the renal parenchyma of rats in the non-intervention group and the abatacept group, and the changes of kidney in the non-intervention group were worse than those in the abatacept group. CD31 and CD34 expression in kidney parenchyma of rats in the abatacept group and non-intervention group were higher than those in the control group, the abatacept group and non-intervention group>the control group (P<0. 05), while no significant differences between the abatacept group and non-intervention group in CD31 and CD34 expression (P>0. 05). There were significant differences in podocin and nephrin expression in kidney parenchyma of rats among these three groups, and these differences were ranked as the control>abatacept>non-intervention groups (P<0. 05). There were significant differences in B7-1 expression in kidney parenchyma of rats among these three groups, and these differences were ranked as the control<abatacept<non-intervention groups (P<0. 05). Conclusion Abatacept may significantly alleviate the renal injury in type 2 diabetic nephropathy rats.

Effect and mechanism of all-trans retinoic acid on cyclosporin-induced proliferation and apoptosis of glomerular mesangial cells / 器官移植

Objective To investigate the effect and mechanism of all-trans retinoic acid (ATRA) on the cyclosporin (CsA)-induced proliferation and apoptosis of glomerular mesangial cells in rat models. Methods The glomerular mesangial cells induced by different doses of CsA were treated with different doses of ATRA. MTT assay was carried out to detect cell proliferation. Hoechst 33258 fluorescent staining was adopted to observe the morphology of the apoptotic cells. Flow cytometry was conducted to detect the cellular apoptosis rate. Immunofluorescent staining was employed to quantitatively measure the expression level of mitochondria-derived pro-apoptotic Smac protein. Results Compared with the control group, administration of CsA at a dose of 0.5 μg/mL and above could suppress cellular proliferation, and use of CsA at a dose of 1.0 μg/mL and above could induce cellular apoptosis. The expression level of Smac protein was significantly up-regulated by CsA administration with a dose and time dependence (all P<0.05).Compared with the CsA group, combined administration of CsA and ATRA exerted a more significant inhibitory effect on cellular proliferation. Supplement of ATRA could significantly inhibit glomerular mesangial cellular apoptosis induced by CsA and down-regulate the expression of Smac protein with a dose dependence (both P<0.05). Conclusions CsA can inhibit cellular proliferation, induce cellular apoptosis and up-regulate the expression of Smac protein of glomerular mesangial cells. ATRA is capable of suppressing glomerular mesangial cellular apoptosis induced by CsA, which is probably mediated by the Smac signaling pathway.

The expression and value of Ax l receptor tyrosine kinase receptor tyrosine kinase in the kidney of patients with lupus nephritis / 中华风湿病学杂志

Objective To evaluate the value and the expression of Axl receptor tyrosine kinase (AxlTK) in renal pathology of lupus nephritis (LN) patients. Methods The expression of AxlTK were detected in 29 LN and 10 primary nephritic syndrome (NS) patients using immunohistochemistry in renal tissue. The correlations between the levels of AxlTK on glomeruli and clinical manifestations, laboratory parameters, disease activity, and renal pathology in LN patients were investigated. T test and single factor analysis of variance were used tp compare between groups, and Pearson or Spearman test was used for correlation analysis. Results AxlTK was extensively expressed on surface of mesangial cells, endothelial cells in glomeruli. There was more expression of AxlTK on mesangial cells in LN patients [(7.0 ±2.2)×10-2] than that in primary NS patients [(3.1 ±1.2) ×10-2] (t=5.382, P0.05). Conclusion The expression of Axl TK in glomerular is significantly increased in glomeruli in LN patients. The expression level of AxlTK on glomeruli is correlated with the occurrence of oral ulcers and AnuA. The level of AxlTK expression is related to pathological categories of kidney in LN patients. The results of this study suggest that AxlTK might participate in the pathogenesis of LN.

Glomerular loss after arteriovenous and arterial clamping for renal warm ischemia in a swine model

ABSTRACT PURPOSE: To evaluate the glomerular loss after arteriovenous or arterial warm ischemia in a swine model. METHODS: Twenty four pigs were divided into Group Sham (submitted to all surgical steps except the renal ischemia), Group AV (submitted to 30 minutes of warm ischemia by arteriovenous clamping of left kidney vessels), and Group A (submitted to 30 minutes of ischemia by arterial clamping). Right kidneys were used as controls. Weigh, volume, cortical volume, glomerular volumetric density (Vv[Glom]), volume-weighted glomerular volume (VWGV), and the total number of glomeruli were measured for each organ. RESULTS: Group AV showed a 24.5% reduction in its left kidney Vv[Glom] and a 25.4% reduction in the VWGV, when compared to the right kidney. Reductions were also observed when compared to kidneys of sham group. There was a reduction of 19.2% in the total number of glomeruli in AV kidneys. No difference was observed in any parameters analyzed on the left kidneys from group A. CONCLUSIONS: Renal warm ischemia of 30 minutes by arterial clamping did not caused significant glomerular damage, but arteriovenous clamping caused significant glomerular loss in a swine model. Clamping only the renal artery should be considered to minimize renal injury after partial nephrectomies.