Association between plasma factor VIII level and clinical indicators and prognosis in patients with IgA nephropathy / 中华肾脏病杂志

Objective:To investigate the relationship between plasma factor VIII (FVIII) level and the clinical indicators and prognosis in IgA nephropathy (IgAN) patients.Methods:The clinical data of IgAN patients diagnosed from the Second Xiangya Hospital of Central South University from January 2016 to December 2016 were collected. Patients were divided into high FVIII group (FVIII>140.50%) and low FVIII group (FVIII≤140.50%) according to the time-dependent receiver operating characteristic curve analysis. The baseline clinical parameters at the time of renal biopsy between two groups of patients were compared. Taking the estimated glomerular filtration rate (eGFR) reduction ≥30% or entering end-stage renal disease (ESRD) as the endpoint event, Kaplan-Meier analysis and Cox proportional hazards models were used to explore the association between plasma FVIII level and prognosis in IgAN patients.Results:A total of 93 patients were ultimately retained for this study, with a median follow-up of 35.15(33.77, 36.76) months. Twelve (12.90%) patients reached the endpoint event. The levels of serum creatinine, urea nitrogen, triglyceride, total cholesterol, plasma fibrinogen, D-dimer, 24-hour urinary protein, protein C, protein S, slope of eGFR and age in the high FVIII group were higher than those in the low FVIII group (all P<0.05). The levels of eGFR, serum albumin and follow-up time in the high FVIII group were lower than those in the low FVIII group (all P<0.05). The renal cumulative survival rate was significantly lower in the high FVIII group than that in the low FVIII group ( χ2=5.635, P=0.018) according to the Kaplan-Meier analysis. After adjusting for variables such as systolic blood pressure, eGFR, urinary protein, and renal tubular atrophy/interstitial fibrosis, multivariate Cox proportional hazards models analysis showed that high level of plasma FVIII was an independent risk factor for poor prognosis in IgAN patients ( HR=4.147, 95% CI 1.055-16.308, P=0.042). Conclusions:The level of plasma FVIII is associated with clinical indicators and prognosis in IgAN patients. The higher level of plasma FVIII can be identified as an independent risk factor for poor prognosis in IgAN patients.

Hookworm Infection Caused Acute Intestinal Bleeding Diagnosed by Capsule: A Case Report and Literature Review

Hookworm infections are rare causes of acute gastrointestinal bleeding. We report a middle aged man with primary nephrotic syndrome and pulmonary embolism. During the treatment with steroids and anticoagulants, the patient presented acute massive hemorrhage of the gastrointestinal tract. The results of gastroscopy showed red worms in the duodenum. Colonoscopy and CT angiogram of abdomen were unremarkable. Capsule endoscopy revealed fresh blood and multiple hookworms in the jejunum and ileum. Hookworms caused the acute intestinal bleeding. The patient responded well to albendazole. Hematochezia was markedly ameliorated after eliminating the parasites. Hence, hookworm infection should be considered in the differential diagnosis of a patient with obscure gastrointestinal bleeding. Capsule endoscopy may offer a better means of diagnosis for intestinal hookworm infections.

Role of mTOR signaling in the activation of renal interstitial fibroblasts / 中华肾脏病杂志

Objective To evaluate the regulatory role of mTOR signaling in activation of renal interstitial fibroblasts and the potential effect on interstitial fibrosis. Methods 8-week old female C57BL/6 mice (n=30) underwent unilateral ureteral obstruction (UUO) to induce renal interstitial fibrosis. Animals were randomly divided into rapamycin (2 mg·kg-1· d-1) group and UUO group (vehicle-treated) (n=15 each group). Daily intraperitoneal injection of rapamycin or saline was applied to animals from day 1 before operation to the end of experiment.Three mice were sacrificed at day 1,3,7,14 respectively and kidneys were harvested for further analysis.NIH3T3 cells were stimulated by TGF-β for 12 hours with the presence or bsence of rapamycin (100 nmol/L). Results Immunofluorescent co-staining revealed that active fibroblasts highly expressed pS6K and α-SMA in kidney interstitium.Administation of rapamycin significantly inhibited activation of mTOR signaling in fibroblasts and ameliorated interstitial fibrosis of obstructed kidneys.Real-time PCR confirmed that rapamycin decreased the mRNA expression of FSP1,TGF-β,CTGF and Col4A1 in fibrotic kidneys. In vitro experiment revealed that TGF-β induced highly expression of pS6K and αSMA in cultured NIH3T3 cells,which could be markedly inhibited by rapamycin. Conclusions mTOR signaling highly activates in interstitial fibroblasts during kidney fibrosis.Inhibition of mTOR signaling by rapamycin decreases the activation of fibroblasts and ameliorates interstitial fibrosis.

MicroRNA-29 and fibrosis diseases / 中南大学学报(医学版)

MicroRNAs (miRNAs,miR) are small, noncoding RNAs with 21-23 nucleotides. MicroRNA-29 (miR-29), a newly discovered miRNAs, is closely related with fibrosis diseases. MiR-29 directly suppresses the expression of a variety of extracellular matrix components and regulates signaling pathways associated with fibrosis. The serum level of miR-29 in patients with liver disease is consistent with the degree of liver cirrhosis.