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OBJECTIVE:s To investigate the prevalence, clinical features, risk factors and treatment of anemia in patients with stage3 a-5 D CKD at high altitude. METHODS: A total of 525 patients with stage3 a-5 D CKD admitted to Diqing Tibetan Autonomous Prefecture People's Hospital between Nov.2017 and Nov.2018 were enrolled in this cross-sectional study, and then categorized into 5 groups according to eGFR and whether depending on dialysis. Clinical and laboratory data were collected and analyzed to study the prevalence, clinical features, risk factors as well as the treatment of anemia in these CKD patients.RESULTS: Among 525 patients with stage3 a-5 D CKD(average age:59.2 ± 15.4 ys,CKD staging:stage3 a:n = 269;stage3 b:n=113;stage4:n=56;stage5:n=36;stage5 D:n=51),anemia was established in 233(44.4%)patients, 68.2% of which had mild anemia. The prevalence of anemie was 29%,33.6%64.3%,88.9% and 96.1,respectively from stage 3 a to stage 5 D, and the prevalence increased and the severity of anemia deteriorated with CKD progression, along with other clinical parameters including serum creatinine, albumin, uric acid,MDRD-eGFR, and calcium and phosphorus metabolism. Logistic regression analysis showed that advanced CKD stage(OR=2.206,P<0.001), hypoalbuminemia(OR=0.919,P=0.034), lower BMI(OR=0.868,P=0.012)and low serum calcium(OR=0.062,P=0.019)were independent risk factors for anemia in CKD patients at high altitude. Among 233 patients with anemia, only 37.7% had ever received treatment for anemia and the average hemoglobin concentration when initiating the treatment was(79.9±19.3)g/L. Erythropoietin was not widely used and the target-achieving rate was only 37.5%(33/88).CONCLUSION:s The prevalence of anemia increases with CKD progression in CKD patients at high altitude. Advanced CKD stage, hypoalbuminemia, lower BMI and low serum calcium are independent risk factors for anemia. The general situation of treatment for anemia is not good,with late starting time of treatment and low treatment rate,low rate in EPO use and low target-achieving rate,which should be paid affention to.
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Systemic lupus erythematosus (SLE)is an autoimmune disease whose pathogenesis is extremely complicated.With the further research,the role of inflammasome in the pathogenesis of Lupus nephritis has also been gradually emphasized.Among them,the nucleotide-binding oligomerization domain-like receptors family pyrin domain containing 3 (NLRP3) inflammasome is the most exhaustive inflammasome.We summarize the related studies on the role of NLRP3 inflammasome in Lupus nephritis in recent years.We found that NLRP3 inflammasome not only plays an important role in the pathogenesis of Lupus nephritis,but also participates in the process of kidney injury by circulating immune cells and renal innate cells.Finally,we introduced two specific inhibitors of NLRP3 inflammasome,β-hydroxybutyrate and MCC950,which provided a new strategy for the treatment of Lupus nephritis.
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Objective To evaluate the role of thioredoxin?interacting protein(TXNIP)∕oligomer?ization domain?like receptor family pyrin domain?containing 3(NLRP3)signaling pathway in renal ische?mia?reperfusion(I∕R)injury in diabetic rats. Methods Pathogen?free healthy male Sprague?Dawley rats, aged 8-12 weeks, weighing 200-220 g, were used in the study. Diabetes mellitus was induced by intrap?eritoneal injection of 1% streptozotocin 65 mg∕kg and confirmed by blood glucose≥16.7 mmol∕L 3 days lat?er. Twenty?four diabetic rats were divided into 3 groups(n=8 each)using a random number table: sham operation group(group S), renal I∕R group(group I∕R)and resveratrol(TXNIP inhibitor)group (group R). Resveratrol 10 mg∕kg was intraperitoneally injected every day for 7 consecutive days starting from 3rd week after successful establishment of the model in group R. At 4th week after successful establish?ment of the model, renal I∕R was produced by occlusion of bilateral renal pedicles for 25 min followed by reperfusion in anesthetized rats in group R. The animals were sacrificed at 48 h of reperfusion, and renal specimens were obtained for microscopic examination of pathologic changes and for measurement of malondi?aldehyde(MDA)content, superoxide dismutase(SOD)activity and superoxide anion scavenging capa?bility(using colorimetric method), interleukin?1beta(IL?1β)and IL?18 contents(by enzyme?linked immunosorbent assay), cell apoptosis(using TUNEL)and expression of TXNIP, NLRP3 and caspase?1 in renal tissues(using Western blot). Blood samples were obtained from the left ventricle for determination of serum urea nitrogen(BUN)and creatinine(Cr)concentrations. Results Compared with group S, the serum Cr concentration and apoptosis index were significantly increased, superoxide anion scavenging capability in renal tissues was decreased, and the expression of TXNIP, NLRP3 and caspase?1 was up?reg?ulated in I∕R and R groups, and the serum BUN concentration and contents of MDA, IL?1β and IL?18 in renal tissues were increased, the SOD activity was decreased(P<0.05), and the pathological changes of renal tissues were aggravated in group I∕R. Compared with group I∕R, the serum BUN and Cr concentra?tions were significantly decreased, the contents of MDA, IL?1β and IL?18 and apoptosis index were de?creased, the SOD activity and superoxide anion scavenging capability were increased, the expression of TXNIP, NLRP3 and caspase?1 was down?regulated(P<0.05), and the pathological changes of renal tis?sues were significantly attenuated in group R. Conclusion The pathophysiological mechanism of renal I∕R injury is associated with the activation of TXNIP∕NLRP3 signaling pathway in diabetic rats.
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ObjectiveTo explore the significance of plasma neutrophil gelatinase-associated lipocalin (pNGAL) and urine neutrophil gelatinase-associated lipocalin (uNGAL) in the diagnosis of acute kidney injury (AKI) in patients with cirrhosis. MethodsA total of 78 patients with cirrhosis admitted to our hospital from January 2012 to December 2014 were selected and divided into group A of 38 patients with cirrhosis and AKI and group B of 40 patients with cirrhosis alone. The control group (group C) included 40 healthy people undergoing the routine physical examination. The NGAL concentrations in serum and urine were measured by enzyme-linked immunosorbent assay. The levels of pNGAL, uNGAL, and serum creatinine, as well as glomerular filtration rate (GFR), were compared between different groups. The comparison between different groups was made by one-way ANOVA and simple linear correlation analysis was used to investigate the relationship of GFR with pNGAL and uNGAL in group A. ResultsThe NGAL levels in serum and urine in group A were significantly higher than those in groups B and C (all P＜0.01). Staging of AKI was made according to the kidney injury criteria and the NGAL levels in serum and urine significantly increased with AKI stage (all P＜0.01). In group A, NGAL level was negatively correlated with GFR in both serum (r=-0.757, P＜0.05) and urine (r=-0.547, P＜0.05). ConclusionNGAL can be used as an indicator in the diagnosis of AKI in patients with cirrhosis. Early and continuous measurement of serum and urine NGAL levels in patients with cirrhosis and AKI has a great significance in monitoring the progression of renal damage in the patients and developing timely and appropriate intervention measures.
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Objective To evaluate the effect of methylene blue pertreatment on acute kidney injury induced by sepsis in rats.Methods Ninety male Sprague-Dawley rats,aged 1.5-2.5 months,weighing 200-250 g,were randomly assigned into 3 groups (n =30 each) using a random number table:sham operation group (S group),cecal ligation and puncture (CLP) group and methylene blue group (MB group).The rats were anesthetized with 10％ chloral hydrate 350 mg/kg.Normal saline 0.8 ml was injected via the caudal vein in and CLP groups,while 10％ methylene blue 15 mg/kg (in normal saline 0.8 ml) was injected via the caudal vein in group MB.Sepsis was induced by CLP after the end of administration in CLP and MB groups.Twenty animals in each group were chosen and observed for 72 h survival rate.Ten animals were sacrificed in each group at 18 h after operation and kidney specimens were removed for microscopic examination and for determination of the expression of poly (ADP-ribose) polymerase (PARP-1) using immunohistochemistry and Western blot.Blood samples were taken from the heart for determination of serum concentrations of blood urea nitrogen (BUN),creatinine (Cr),cystatin C and neutrophil gelatinase-associated lipocalin (NGAL).Results Compared with group S,the survival rate was significantly decreased at 24,48 and 72 h after operation,and the serum concentrations of BUN,Cr,cystatin C and NGAL and expression of PARP-1 in kidney tissues were increased in CLP and MB groups (P ＜ 0.05).Compared with group CLP,the survival rate was significantly increased at 24 and 48 h after operation,and the serum concentrations of BUN,Cr,cystatin C and NGAL and expression of PARP-1 in kidney tissues were decreased in group MB (P ＜ 0.05).The pathological changes were significantly attenuated in group MB as compared with group CLP.Conclusion Methylene blue pertreatment can attenuate acute kidney injury induced by sepsis in rats through down-regulating the expression of PARP-1.
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ObjectiveTo investigate the value of serum β2-microglobulin for diagnosis of early renal insufficiency. MethodsThe levels of β2-microglobulin and Scr were measured in one hundred and twelve patients diagnosed of nephropathy and 41 of control group.And the results were analyzed. ResultsCompared with the control group,there was significant difference in serum β2-microglobulin(all P＜0.05).The levels of β2-microglobulin of renal insufficiency were increased,include(3.51 ± 0.46)mg/L,(5.8 ± 1.13)mg/L,(12.4 ± 3.63)mg/L,and (21.3 ± 4.73)mg/L,also correlated with degree of Scr,and negatively correlated with degree of Ccr. ConclusionSerum β2-microglobulin could be used as the early diagnostic marker of early renal insufficiency.
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Objective To investigate the expression changes of microRNAs and VEGF-NOTCH in renal ischemic injury in mice, and to explore the potential mechanism associated with renal angiogenesis.Method Male Balb/c mice were subjected to a standard renal ischemia to induce acute kidney injury (AKI) after 45 min of bilateral renal artery clamping. Following 4 h, 24 h of reperfusion or sham operation, kindey tissues were collected and subjected to detect the expression changes of microRNAs which relatived with angiogenesis and VEGF, Flk-1, Notch1 mRNA by Quantitative Real-time RT-PCR. Flk-1 protein was detected by Western blotting analysis at 24 h and 72 h following Ischemia/Reperfusion(I/R) injury. The expression of CD31 was examined in tissue sections by immunohistochemistry staining, and the microvessels in ischemic region of each group were counted. Results miRNA-210 and miRNA-92a expression increased significantly, with prominent changes at 4 h and 24 h after reperfusion( P ＜ 0.05 ). VEGF and Flk-1 mRNA expression and Flk-1 protein were increased in renal I/R compared with control group respectively (P＜0.05 ).Immunohistochemistry staining results of CD31 showed a significant increase of microvessels in renal ischemic region. Conclusion This study first reported the changes in miRNAs expression in response to kidney I/R in mouse. our results implied that miRNAs may be involved in targeting VEGF-Notch pathway signaling to regulate angiogenesis after renal I/R injury. It provided novel insights into the angiogenesis mechanism of renal ischemic injury.
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Objective To detect the osteopontin(OPN)expression in renal tissue of rats with fluorosis and low calcium diet,and study the role of OPN in renal injury of fluorosis.Methods Forty-eight aged 1 month Wistar rats,80-120 g,were randomly divided into 4 groups by 2×2 factorial design(the number of female and male in each group was equal):the control group,high-flluoride group,low-calcium group and low-calcium with high-fluoride group.All rats of the fluorosis groups were fed with feed containing corn exposed to coal-burning from endemic fluorosis areas with high fluoride(100 mg/kg,corn),the other two groups were fed with feed containing coru from nonendemic fluorosis areas(fluoride 5 mg/kg,corn).After 16 weeks,the rats were killed.The change of teeth was examined,and the incidence rate of dental fluorosis was calculated.The expressions of both protein and mRNA of OPN in rat renal tissue were determined by RT-PCR and immunohistochemistry after four-month experimentation.Results The growth of teeth was very well in the control group and the low-calcium group.The two high-fluoride groups showed evident dental fluorosis(100%).The results of immunohistochemistry showed that the OPN protein was localized in renal tubule cytoplasm.The OPN-positive cells from renal tissue were lightly and scatteredly stained in control and low-calcium groups.The OPN-positive cells had deeper color in high-fluoride group and low-calcium with high-fluoride group,widely distributed in the renal tubular epithelial cells.The protein expression of OPN in the two groups exposed to fluoride(168.64±13.21,169.26±8.92)was significantly higher than those of the corresponding control group(145.78±10.26,all P<0.01)and low-calcium group(149.60±16.84,all P<0.01).The mRNA expression of OPN in the two groups exposed to fluoride(1.89±0.37,1.94±0.22)was significantly higher than those of the corresponding control group(1.32±0.26,all P<0.05)and low-calcium group(1.30±0.186,P<0.05),respectively.High fluoride influenced the expression of protein and mRNA of OPN(F=13.821,4.24,all P<0.05).Low calcium did not affect the expression of protein and mRNA of OPN(F=2.164,0.58,all P>0.05).However,high fluoride and low calcium had a cross interaction on the expression of protein and mRNA of OPN(F=6.257,432,all P<0.05).Conclusions Over-dose fluoride enhances the expression of OPN.The higher expression observed in the cases exposed to high fluoride concentration is associated with serious renal injury.OPN may he a potential marker for renal injury in fluorosis.Moreover,over-dose fluoride and low calcium make the renal injury worse,indicating low calcium plays an important part in renal injury by fluoride.
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Objective To investigate the effects of ketamine on the renal ischemia-reperfusion (IR) injury in rats and the underlying mechanism. Methods Twenty-four male Wistur rats weighing 220-250 g were randomly divided into 4 groups (n=6 each): sham operation group (group S), IR group, ketumine 2 mg/kg group (group K_1), ketamine 10 mg/kg group (group K_2). The rats were anesthetized with intraperitoneal chloral hydrate 300 mg/kg. Renal ischemia was induced by clamping the left renal artery for 45 min followed by 6 h of repednsion using an atraumatic clamp. In group K_1 and K_2, ketaminc 2 and 10 mg/kg were injected via the caudal vein 5 min before the repedusion respectively. The rats were killed at 6 h of reperfusion, and blood samples were collected from the right auricle for measurement of serum creatiniue (Cr) and blood urea nitrogen (BUN) concentrations. Pathological changes in renal tissues were observed with light and electron microscopes. The expression of Fas and Caspsse-3 in the renal tubular epithelial cell was determined by immuno-histochemistry. The apeptosis in the renal tubular epithelial cell was detected by TUNEL assay. Apeptotic index (AI) was calculated. Results Compared with group S, the levels of serum Cr and BUN, expression of Fas and Caspase-3 and AI were significantly increased in group IR, K_1 and K_2 (P < 0.01). The levels of serum Cr and BUN, expression of Fas and Caspase-3 and AI were significantly lower in group K_(1,2) than in group IR and in group K2 than in group K_1 (P<0.01). The microscopic examination showed that the renal IR injury was obviously attenuated in group K_2 compared with group K_1. Conclusion Ketamine can attenuate the renal injury induced by IR in a dose-dependent manner in rats. The underlying mechanism may be related to the inhibition of apoptosis in the renal tubular epithelial cell.
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Objective: To study the protective effect of Chinese materia medica of tonifying kindey and eliminating sputum on chronic bronchitis mice induced by tobacco smoking from aspect of pathomorphology changes. Methods: 60 Healthy male mice were divided into normal group, chronic bronchitism model group, Guilong Kechuanning group, high and low dosage of tonifying kindey and eliminating sputum groups at random, each 12. Model mice of chronic bronchitis were induced tobacco smoking, giving Guilong Kechuanning and Chinese materia medica of tonifying kindey and eliminating sputum at the same time. The pathomorphology changes of trache and lung tissue were observed under light microscope. Results: Compared model group, the pathomorphology changes of trache and lung tissue in Guilong Kechuanning group, high and low dosage of tonifying kindey and eliminating sputum groups relieved(P
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Objective To investigate the new method of ureter bladder anastomosis in renal transplantation.Methods The ureter was pulled into bladder for 1.2 cm through tunnel at the lateral- top of bladder wall,and the ureter fixed on the bladder wall by 2-3 acus with catgut suture.Results Forty of 42 patients had no complications,and recovered very well,except for 1 cases of necrosis caused by acute rejection and 1 case on urine leakage caused by catheter obstruction from blood clot.Conclu- sion This method is simple,easy to operate,safe and reliable with less complications.
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As transplantation for end-stage renal disease has become more common, avascular necrosis has become a major cause of disability after a successful transplantation. We studied the relationship between development of avascular necrosis of bone and the administration and dosage of steroid, cholesterol level and triglyceride level after transplantation in 909 patients who received kidney transplantation from March 1969 until August 1994 at Catholic University, Medical College. These patients were compared against 60 patients who received kidney transplantation and steroid therapy without developing osteonecrosis. Osteonecrosis was observed in 62 of the patients (6.8 per cent) from 3 to 37 months (mean 10) after the transplant operation. The average age was thirty-eight years (range, twenty to sixty-three years). A single bone was involved in 28 patients, while in the rest of the patients there were between two and four different sites. Altogether 109 bones were affected, 102 of them being weight-bearing. The most common sites were the femoral heads, with 32 patients having bilateral involvement. There was no association between the cumulative dosage of prednisone and the development of avascular necrosis. Although the post renal transplant cholesterol and triglyceride level were significantly elevated compared to the pre-renal transplant state, there were no significantly difference between the avascular group and control group.
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Humanos , Colesterol , Cabeça , Falência Renal Crônica , Transplante de Rim , Rim , Necrose , Osteonecrose , Prednisona , Triglicerídeos , Suporte de CargaRESUMO
The criteria for removal of failed renal allografts are not clearly defined. Between December, 1985 and June. 1991, 269 renal transplantations were performed at Kosin Medical Center, Pusan, Korea. Of these 29 lost renal allograft and transplant nephrectomy was carried out within 6 weeks of transplantation in 4 instances: 1 case because of ABO incompatibility and 3 due to oliguria, progressively increasing serum creatinine and enlarged tender graft despite of pulsing therapy. Of these a patients, one patient had rupture of transplanted kidney, 4 kidney allografts were removed at least 6 months after transplsntation: three had graft pain and tenderness, graft enlargement and persistent gross hematuria. The surgical approach was carried out through the transplantation incision. In the postoperative period, there were some complications: 2 of these were wound hematoma and bleeding which resulted in no further complication but in one case immediately after transplant nephrectomy sepsis resulted in death. In conclusion, absolute indication for tansplant nephrectomy was hyperacute rejection and if chronic rejection was present, it should be considered with clinical findings. During removal of the transplanted kidneys, we think it is benefit that the vessels were ligated "en mass".