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Objective To investigate the clinico-pathological characteristics, outcomes and their predictors in malignant hypertension related kidney injury with and without primary glomerular diseases. Methods Patients with clinical diagnosis of malignant hypertension, biopsy-proven kidney injury caused by malignant hypertension and complete clinical data from January 2010 to December 2018 were retrospectively analyzed. According to clinical and renal pathology, patients were divided into malignant hypertension related kidney injury without primary nephropathy group and with primary nephropathy group. Clinico-pathological characteristics and outcomes were evaluated and compared between malignant hypertension related kidney injury with and without primary glomerular diseases. Results Totally 31 biopsy-proven kidney injury patients were analyzed. Among them, there were 18 cases with primary glomerular diseases and 13 cases without primary glomerular diseases, with age of (32.5 ± 6.5) years old and (34.7 ± 8.1) years old, respectively. There were 12 males in both group. The proportion of primary IgA nephropathy was higher (16/18) in the group of malignant hypertension related kidney injury with primary glomerular diseases. Malignant hypertension with primary glomerular diseases patients had lower plasma albunin level [(32.7±6.4) g/L vs (38.5±7.3) g/L, P=0.027], higher 24-hour proteinuria level [(4.03 ± 2.71) g vs (1.45 ± 0.98) g, P=0.002] and higher incidence rates of dysmorphic hematuria (14/18 vs 0, P=0.001) than those without primary glomerular diseases patients. Glomerular sclerosis, mesangial proliferation, tubular atrophy and interstitial fibrosis were more severe in malignant hypertension with primary glomerular diseases patients (all P<0.05), but the ischemic wrinkling of glomerular capillary was more severe in malignant hypertension without primary glomerular diseases (P<0.01). There were no differences of acute or chronic malignant hypertensive injury in small artery and in afferent arterioles between the two groups. Cox regression analysis showed that loss of brush-border with flattening of tubular epithelium was the predictor for renal partial recovery (HR=5.956, 95％CI 1.198-29.614, P=0.029). Kaplan-Meier analysis showed that malignant hypertension patients with primary glomerular diseases had shorter renal survival time than those without primary glomerular diseases [(24.1±9.3) months vs (56.6±12.4) months], and accumulative renal survival rate of malignant hypertension patients with primary glomerular diseases was lower than that without primary glomerular diseases (11.6％ vs 53.3％, Log-rank χ2=5.022, P=0.025). Multivariate Cox regression analysis showed that severe tubular atrophy and interstitial fibrosis were independent risk factors for end-stage renal disease in malignant hypertension patients (HR=5.870, 95％CI 1.372-25.112, P=0.017). Conclusions Malignant hypertension with primary glomerular diseases patients have more severe clinico-pathological renal impairment and poorer prognosis of long-term renal survival than those without primary glomerular diseases. Acute renal tubular injury (loss of brush-border with flattening of tubular epithelium) is the only predictor of renal function improvement in patients with malignant hypertension and renal impairment within one year. Tubular atrophy/interstitial fibrosis is a risk factor for end-stage renal disease in patients with malignant hypertension. Renal biopsy is an indispensable tool for predicting short-term and long-term renal outcomes.
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Objective@#To investigate the clinico-pathological characteristics, outcomes and their predictors in malignant hypertension related kidney injury with and without primary glomerular diseases.@*Methods@#Patients with clinical diagnosis of malignant hypertension, biopsy-proven kidney injury caused by malignant hypertension and complete clinical data from January 2010 to December 2018 were retrospectively analyzed. According to clinical and renal pathology, patients were divided into malignant hypertension related kidney injury without primary nephropathy group and with primary nephropathy group. Clinico-pathological characteristics and outcomes were evaluated and compared between malignant hypertension related kidney injury with and without primary glomerular diseases.@*Results@#Totally 31 biopsy-proven kidney injury patients were analyzed. Among them, there were 18 cases with primary glomerular diseases and 13 cases without primary glomerular diseases, with age of (32.5±6.5) years old and (34.7±8.1) years old, respectively. There were 12 males in both group. The proportion of primary IgA nephropathy was higher (16/18) in the group of malignant hypertension related kidney injury with primary glomerular diseases. Malignant hypertension with primary glomerular diseases patients had lower plasma albunin level [(32.7±6.4) g/L vs (38.5±7.3) g/L, P=0.027], higher 24-hour proteinuria level [(4.03±2.71) g vs (1.45±0.98) g, P=0.002] and higher incidence rates of dysmorphic hematuria (14/18 vs 0, P=0.001) than those without primary glomerular diseases patients. Glomerular sclerosis, mesangial proliferation, tubular atrophy and interstitial fibrosis were more severe in malignant hypertension with primary glomerular diseases patients (all P<0.05), but the ischemic wrinkling of glomerular capillary was more severe in malignant hypertension without primary glomerular diseases (P<0.01). There were no differences of acute or chronic malignant hypertensive injury in small artery and in afferent arterioles between the two groups. Cox regression analysis showed that loss of brush-border with flattening of tubular epithelium was the predictor for renal partial recovery (HR=5.956, 95% CI 1.198-29.614, P=0.029). Kaplan-Meier analysis showed that malignant hypertension patients with primary glomerular diseases had shorter renal survival time than those without primary glomerular diseases [(24.1±9.3) months vs (56.6±12.4) months], and accumulative renal survival rate of malignant hypertension patients with primary glomerular diseases was lower than that without primary glomerular diseases (11.6% vs 53.3%, Log-rank χ2=5.022, P=0.025). Multivariate Cox regression analysis showed that severe tubular atrophy and interstitial fibrosis were independent risk factors for end-stage renal disease in malignant hypertension patients (HR=5.870, 95% CI 1.372-25.112, P=0.017).@*Conclusions@#Malignant hypertension with primary glomerular diseases patients have more severe clinico-pathological renal impairment and poorer prognosis of long-term renal survival than those without primary glomerular diseases. Acute renal tubular injury (loss of brush-border with flattening of tubular epithelium) is the only predictor of renal function improvement in patients with malignant hypertension and renal impairment within one year. Tubular atrophy/interstitial fibrosis is a risk factor for end-stage renal disease in patients with malignant hypertension. Renal biopsy is an indispensable tool for predicting short-term and long-term renal outcomes.
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Objective To investigate the effect of cinacalcet combined with low －dose calcitriol in the treatment of patients with secondary hyperparathyroidism of end －stage renal disease.Methods A prospective analysis was conducted in 129 patients with end－stage renal disease and secondary hyperparathyroidism from April 2015 to August 2017 in the Department of Nephrology of Integrative Medicine Hospital of Wenzhou City,Zhejiang Province.The patients were randomly divided into 3 groups:group A received cinacalcet,group B received calcitriol, group C received cinacalcet and low－dose calcitriol for 3 months,respectively.Before and after treatment,the levels of serum phosphorus and serum calcium in the three groups were measured.The levels of parathyroid hormone and the parathyroid hormone clearance rate were measured to find out the therapeutic effect.Results The levels of serum calcium,phosphorus and total parathyroid hormone in group A were significantly lower than those before treatment(t＝3.269,2.263,4.233,all P＜0.05).PTH was significantly decreased,blood calcium and phosphorus significantly in-creased compared with those before treatment,the differences were statistically significant(t＝2.827,2.386,3.342, all P＜0.05).The phosphorus,total parathyroid hormone levels of group C were significantly decreased(t＝3.085, 5.142,all P＜0.05),and no significant change in serum calcium level(t＝0.258,P＞0.05).The total parathyroid hormone level:group B＞group A ＞group C,the whole parathyroid hormone clearance rate:group C ＞group A ＞group B,the differences were statistically significant(t ＝3.642,3.263,all P＜0.05).After treatment,the serum calcium level among the three groups had statistically significant difference,group B＞group C＞group A,the serum phosphorus level among the three groups after treatment had statistically significant difference,group B＞group A ＞group C (t＝3.265,3.332,all P＜0.05).Conclusion The combined use of cinacalcet and low－dose calcitriol in the treatment of secondary hyperparathyroidism in patients with end－stage renal disease can significantly reduce the level of parathyroid hormone and serum phosphorus,and without affecting serum calcium concentration.
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Objective To explore the clinical efficacy and safety of leflunomide combined with prednisone in the treatment of immunoglobulin A nephropathy.Methods 80 patients with IgA nephropathy were chosen and randomly divided into two groups,40 cases in each group.The control group was orally given prednisone(initial dose 1 mg · kg-1 · d-1),after 2 months of treatment 5mg/2 weeks reduction,and 10mg/d as maintenance therapy,while the observation group was treated with 20mg/d leflunomide treatment based on the treatment of control group.All the two groups had 3 months as a course of treatment.Before treatment and after treatment,the 24h urinary protein,serum albumin,serum creatinine,glomerular filtration rate,cholesterol,triglycerides,cystatin C levels and urinary vascular cell adhesion molecule-1 after treatment (urinary VCAM-1) and interleukin-18 (IL-8) in the two groups were recorded and compared,as well as the clinical efficacy and adverse reactions.Results The total effective rate in the observation group was 92.5％,which was significantly higher than 75.0％ in the control group (x2 =4.501,P ＜ 0.05).After treatment,the serum creatinine,serum albumin,cholesterol,triglycerides,cystatin C,24h urine protein,glomerular filtration rate and urinary VCAM-1,IL-8 in the two groups were all significantly improved (t ≥ 1.945,all P ＜ 0.05).After treatment,the cholesterol and triglycerides in the two groups had no significant differences (t =0.322,1.307,all P ＞ 0.05).After treatment,in the observation group,the serum creatinine,cystatin C,24h urinary protein excretion,VCAM-1 and IL-8 in urine were significantly lower than those in the control group,while serum albumin and glomerular filtration rate were significantly higher (t ≥2.632,all P ＜ 0.05).In the observation group,the total effective rate of Ⅳ,Ⅴ grade by Lee classification were significantly higher (x2 =4.269,4.600,all P ＜ 0.05).And in the two groups,the total effective rate of Ⅰ,Ⅱ grade by Lee classification had no statistically significant differences(x2 =0.000,0.000,all P ＞0.05).In the observation group,the incidence rate of adverse reaction was 10.0％,that in the control group was 8.6％,there was no statistically significant difference between the two groups (x2 =0.157,P ＞ 0.05).Conclusion Leflunomide combined with prednisone in the treatment of IgA nephropathy has better clinical efficacy and higher safety,its mechanism may be associated with decreased urinary VCAM-1 and serum IL-18 levels.
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Objective To discuss the curative effects of alfacalcidol combined with losartan potassium tablets in the treatment of early diabetic nephropathy (EDN).Methods 90 EDN patients in our hospital were chosen and randomly divided into the observation group and control group (45 cases in each group).The control group was given losartan potassium tablets treatment,while the observation group was given alfacalcidol combiend with telmisartan treatment.All the two groups were treated for 3 months.Before and after treatment,the fasting blood glucose (FBG), 24h urine trace albumin quantitative (UAER),24h urine protein (24h pro),serum creatinine (SCr),25 -hydroxyl vitamin D [2 5 (OH )D ],blood calcium (Ca2+),potassium (K+),glycosylated hemoglobin (HbA 1 C )and serum inflammatory factors[C-reactive protein (CRP),tumor necrosis factor alpha (TNF-α),interleukin-6 (IL-6 )] were observed,and the correlation between 25 (OH)D and UAER,24h pro was analyzed.At the same time,the clinical curative effects and adverse reactions during treatment were evaluated.Results In the observation group,the total effective rate was 93.3%,which was significantly higher than 71.1% in the control group (χ2 =7.601,P0.05).After treatment,Scr,24h pro and UAER in the two groups were all significantly reduced compared with before treatment (P0.331).After treatment,25(OH)D in the observation group decreased significantly compared with before treatment (t=12.000,P0.436).Pearson correlation analysis showed that 25 (OH)D level was negatively correlated with 24h pro and UAER (r=0.483,0.778,all P0.151 ).Conclusion Alfacalcidol combined with losartan potassium tablets can significantly reduce the proteinuria levels of EDN patients and inflammation,which has better clinical curative effects and higher safety.
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<p><b>OBJECTIVE</b>To study the effect of the volatile oil from nutmeg on liver microsomal cytochrome P450 in mice.</p><p><b>METHOD</b>Mice were administered the volatile oil from nutmeg at 0.4, 0.8 and 1.2 mg x g(-1), respectively, twice a day for 10 days. And then, the contents of liver microsomal cytochrome P450 (CYP), cytochrome b5 (Cytb5), MDA and GST in serum were examined by UV chromatography method.</p><p><b>RESULT</b>The contents of liver CYP, Cytb5 and GST in serum were increased significantly (P < 0.01) and the contents of MDA was reduced significantly (P < 0.01).</p><p><b>CONCLUSION</b>The volatile oil from nutmeg showed induction effect on the hepatic microsomal CYP in mice.</p>