Clinical research of fractional excretion of IgG on predicting drug responsiveness in patients with idiopathic membranous nephropathy / 中国医师杂志

Objective:To explore the predictive value of fractional excretion of IgG (FE IgG) on drug responsiveness and remission in patients with idiopathic membranous nephropathy (IMN).Methods:Retrospective analysis of 82 patients with IMN diagnosed by clinical and pathological data and regularly followed up from April 2014 to August 2017. Receiver operating characteristic (ROC) curve was used to determine the FE IgG threshold. Comparing the difference of remission time under different baseline levels of FE IgG, and analyzing the effect of different levels of FE IgG on the drug responsiveness of immunosuppressive therapy (tacrolimus or cyclophosphamide) and supportive therapy.Results:Areas under the curve (AUC) of estimated glomerular filtration rate (eGFR), 24-hour urinary protein quantity and FE IgG were 0.509, 0.701 and 0.948, respectively. Before treatment, there was no significant difference in gender, age, mean arterial pressure and eGFR between the high FE IgG group (FE IgG>0.029) and low FE IgG group (FE IgG<0.029) ( P>0.05). The remission time of high FE IgG group was (18.75±6.81)months, while it was (8.46±3.74)months in low FE IgG group, with significant difference ( P<0.01). There was no difference in remission time of immunosuppressive therapy and supportive therapy in low FE IgG group ( P=0.265), bo-th of which were lower than the high-level immunosuppressive therapy group ( P<0.001). The remission time of tacrolimus was shorter than that of cyclophosphamide in high FE IgG group, but with no significant difference ( P=0.131). There was significant difference in the remission time of tacrolimus between the high and low level groups of FE IgG ( P<0.01). Under electron microscope, the ratio of foot process fusion and podocyte diffuse vacuolar degeneration in the high level group of FE IgG was higher than that in the low level group ( P<0.01). Conclusions:FE IgG can be used as a clinical indicator for predicting drug responsiveness and remission in patients with IMN, and is essential for early identification of high-risk patients and for making clinical decisions. Patients with high FE-IgG may benefit from early initiation of immunosuppressive therapy.

Clinical characteristics and prognosis of peritoneal dialysis treatment in children with acute kidney injury / 中华肾脏病杂志

Objective:To investigate the efficiency and safety of peritoneal dialysis (PD) in pediatric patients with acute kidney injury (AKI).Method:A retrospective study of children who underwent PD for AKI in the First Affiliated Hospital of Xi’an Jiaotong University from 2003 to 2013 was performed, and the laboratory examinations, the causes, the complication, the prognosis and the risk factors were evaluated.Results:The study included 48 children, with the age of (67.6±51.7) months (ranging from 3 months to 15 years old), including 31 males (64.6%) and 34 co-infections (70.8%). Primary glomerulonephritis (27.1%) was the most common cause of AKI, followed by the hemolytic uremic syndrome (18.7%) and drug induced AKI (18.7%). Peritoneal dialysis was performed manually using percutaneous or adapted catheters. The duration of PD during hospitalization was 11(7,14) days. PD treatment was highly effective in attenuation of toxics retention and correction of electrolyte disturbances (all P<0.05). There were 3 cases of PD-related complications, including 1 case of peritonitis, 1 case of catheter outflow obstruction, 1 case of catheter exit site hematoma, and no child patient died of PD complications. Among the AKI children, 37 cases (77.1%) recovered with the PD treatment and had the catheter successfully removed till discharge, 7 cases (14.6%) needed further peritoneal dialysis and 4 cases (8.3%) died. The serum albumin level was significantly higher in patients who got recovered with PD treatment than other unrecovered cases [(32.6±6.7) g/L vs (23.2±4.3) g/L, t=-3.994, P<0.001]. Conclusions:PD can be safely and efficiently performed for the treatment of pediatric AKI. Low albumin level may be related to poor prognosis of AKI.

Amyloid nephropathy:a clinicopathologic analysis of 31 cases / 临床与实验病理学杂志

Purpose To investigate the clinical and pathological features of amyloid nephropathy. Methods A retrospective analysis was conducted in 31 cases of amyloidosis nephropathy. The clinical data and pathologic features of kidney biopsy were analyzed. Re-sults 31 cases of amyloid degeneration accounted for 1. 19% (31/2 603) in all patients of kidney biopsy in the same period. 15 pa-tients were female, and 16 males. Patients’ age ranged from 36 to 77 years old, with mean age of (61. 28 ± 10. 95) years. Clinical staging showed that simple proteinuria were 4 cases (12. 90%), nephrotic syndrome, 21 cases (67. 74%), and renal failure, 6 cases (19. 35%). Under microscope, amyloid deposits were observed in the glomerular mesangial area, capillary basement membrane and small arteries, and those also deposited between renal interstitial and tubular basement membrane in severe cases. Potassium permanga-nate oxidation Congo red staining showed that AL type were 27 cases and AA 4 cases. Immunofluorescence study in some cases showed some degree of weak immunoglobulin and complement deposition, but some cases were negative. Immunohistochemical staining showed different expression of immunoglobulin light chain κ and λ light chains. Under electron microscope, amyloid fibrils were noted in the mesangial area and capillary walls. Conclusion Amyloidosis nephropathy occurs in middle-aged patients with kidney disease, some-times lack of specific clinical manifestations. Renal biopsy is the only approach to confirm the diagnosis. For suspicious patients, renal biopsy should be done as early as possible.

Expression of urea transporters in sweat gland tissue of normal subjects and uremic patients / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the expression of urea transporters (UTs) in the skin and sweat glands of normal subjects and patients with uremia.</p><p><b>METHODS</b>Abdominal skin biopsy samples of patients with uremia and normal patients and apocrine sweat gland tissue from patients with bromidrosis were examined for the expression of UTs using immunohistochemistry and fluorescence immunoassay for quantitative analysis.</p><p><b>RESULTS</b>Both UT-A1 and UT-B1 proteins were expressed in the skin basal cell layer, eccrine sweat gland and apocrine sweat gland tissues. In uremic patients, N-UT-A1 and UT-B1 expressions were significantly higher than those in the control (P<0.05) but C-UT-A1 expression was similar (P>0.05).</p><p><b>CONCLUSION</b>UTs are expressed in human skin basal cell layer, eccrine sweat gland and apocrine sweat gland tissues, and their expressions are upregulated in uremic patients.</p>

Construction and identification of recombination expression vector Ksp-Cadherin-Gpx1-Kik1 / 药物分析学报

Objective To construct and identify the Gpx1-Klk1 vector which contains kidney-specific promoter (Ksp-cadherin). Methods Through PCR amplification, the human Gpx1, Klk1, and Ksp-cadherin eDNA were obtained by taking Gpx1 cDNA, Klk1 eDNA, and Ksp-cadherin BAC as templates. After being testified, the PCR products were inserted into the expressive vector pIRES-EGFP step-by-step to produce a recombinant vector Ksp-cadherin-Gpx1-Klk1. This vector was examined by restriction enzyme digestion and sequence analysis. Results The recombinant expressive vector Ksp-cadherin-Gpx1-Klk1 was successfully constructed. Conclusion The construction of the recombinant vector Ksp-cadherin-Gpx1-Kik1 laid foundations for investigations in establishing transgenic animal models, the over-expression of Gpx1 and Kikl in mammal kidney, and gene therapy for ischemia-reperfnsion injury during kidney transplantation.