RESUMO
Objective To establish a management mode for patients with chronic kidney disease (CKD) of stage 3 to 4 by continuous quality improvement (CQI), and to observe the effect of CQI on renal function in CKD patients. Methods A total of 86 patients with CKD (50 in stage 3 and 36 in stage 4) were enrolled in this study, and they were regularly followed-up in the CKD outpatient of the Department of Nephrology of Jing’an District Zhabei Centre Hospital of Shanghai. The patients were randomly divided into observation group and control group, with 43 cases in each group. In the observation group, we used the management mode combining medical intervention and health education by plan-do-check-act (PDCA) four-step method; in the control group, we used the traditional management mode of medical intervention. All the patients were followed up once a month for one year. The end points included doubling serum creatinine (Scr) or entering end-stage renal disease, and occurence of cardiovascular and cerebrovascular events. The follow-up on time rate (%), Scr level, and estimated glomerular filtration rate (eGFR) were compared between the two groups. Results In the observation group, the average follow-up times were 10.7±2.8 and the follow-up on time rate was (89.9±12.8)%; while those were 4.1±2.2 and (34.2±4.9)% in the control group, and there were significant differences between the two groups (all P0.01). During the 1-year follow-up period, two cases had end-stage renal disease and one case had acute angina in the control group, while no end point was found in the observation group. Before the implementation of CQI, there were no significant differences in eGFR or Scr level between the two groups (all P0.05). The eGFR of the observation group after implementation of CQI was (39.35±12.23) mL/(min • 1.73 m2), which was significantly higher than those of the observation group before implementation ([37.22±11.02] mL/[min • 1.73 m2], P0.05) and the control group after implementation ([35.04±12.31] mL/[min • 1.73 m2], P0.05). The Scr level of the observation group after implementation of CQI was (139.25±14.15) µmol/L, which was significantly lower than those of the observation group before implementation ([145.16±15.41] µmol/L, P0.05) and the control group after the implementation ([148.06±15.63] µmol/L, P0.05). Conclusion CQI management method with the combination of medical intervention and health education can improve the renal function of patients with CKD stages 3-4, and reduce the incidence of end-stage renal disease and cardiovascular and cerevascular events.
RESUMO
Objective: To investigate the concentrations of secreted protein acidic and rich in cysteine(SPARC) in the serum and urine of patients with IgA nephropathy and its expression in the kidney tissues. Methods: The concentrations of SPARC, tumor necrosis factor-a (TNF-a),interleukin 1β (IL-1β), and interleukin 6 (IL-6) in the serum and urine were measured with enzyme-linked immunosorbent assay(ELISA). The contents of SPARC protein in the culture medium of human mesangial cell (HMC) and human renal tubular epithelial cell (HKC), which had been treated with IL-6, were determined by ELISA. The expression and distribution of SPARC in IgA nephropathy and normal kidney tissues were observed by immunohistochemistry assay. Results: The concentrations of SPARC in serum and urine of IgA nephropathy patients were higher than those of the normal control subjects ([2.43±±1.22] μg/ml vs [0.69±0.21] 2μg/ml, [7.73±2.81] μg/ml vs [1.17±1.03]ρg/ml, P<0.01). The serum levels of TNF-α, IL-1β and IL-6 in IgA nephropathy group were significantly higher than those in the control group (P< 0.05); the urinary levels of TNF-α and IL-6 in IgA nephropathy group were also higher than those in the controls (P<0.01). SPARC protein secreted by HKC was higher than that by HMC (P<0.01). SPARC was weakly positive in normal distal cortical tubules. SPARC protein expression in tubular epithelial cells of IgA nephropathy patients was obviously higher than that of the normal controls. Conclusion: The secretion of SPARC by renal tubular epithelial cells is increased in patients with IgA nephropathy, which results in elevation of serum SPARC and may have a protective feedback inhibitory effect on HMC proliferation.