Dynamic Analysis of Kidney Function and Its Correlation with Nutritional Indicators in a Large Sample of Hospitalized Elderly Patients.

BACKGROUND The aim of this study was to analyze changes in kidney function and its correlation with nutritional metabolism indicators in hospitalized elderly patients in a large medical center over the past 7 years. MATERIAL AND METHODS The renal function of patients over 60 years old in the Chinese PLA General Hospital in 2008, 2011, and 2014 were comparatively analyzed. The hemoglobin, serum albumin, triglycerides, cholesterol, uric acid, and urea nitrogen data were collected and used as the nutritional metabolism indicators. In addition, the correlation between these indicators and the eGFR was analyzed. RESULTS The numbers of patients who received kidney function assessments in the 3 years were 15 752, 23 539, and 49 828; their mean ages were 69.97±6.99, 69.51±7.11, and 69.45±7.74 years. The median values of serum creatinine were 75.4, 76.5, and 77.5 µmol/L in the men and 59.6, 60.7, and 62.1 µmol/L in the women. The eGFR in both sexes demonstrated a gradual decreasing trend over the 3 years. According to the CKD staging method, analysis of the different percentages of eGFR intervals in the patients showed that the percentages of the 3 groups with an eGFR lower than 60 mL/min/1.73 m² exhibited a rising trend annually. Correlational analysis of the nutritional indicators showed that the correlations between Hb, ALB, TG, TC, Ur, and BUN with an eGFR lower than 60 mL/min/1.73 m² were 0.582, 0.780, 1.219, 1.364, 2.180, and 3.677, respectively. CONCLUSIONS Serum creatinine showed a gradually increasing trend over the 3 study years. The CKD-EPI equation calculation results showed that the eGFR in elderly people of both sexes gradually decreased. Reduction of hemoglobin and albumin was a risk factor for decreased kidney function, while increases in uric acid and blood lipids affected the progression of renal insufficiency.

Analysis of pathological data of renal biopsy at one single center in China from 1987 to 2012 / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>In China, the prevalence of chronic kidney disease has increased significantly. Many studies shows that the spectrum of kidney disease had changed in recent years. We retrospectively analyzed the pathological types of renal biopsy and its spectrum change at the General Hospital of the Chinese People's Liberation Army from December 1987 to December 2012, in order to offer new supporting evidences for further specifying the distribution of renal pathological types in China.</p><p><b>METHODS</b>According to the "Revised Protocol for the Histological Typing of Glomerulopathy" (WHO, 1995), pathological diagnosis of renal biopsy was classified, detection rate of each pathological type was summarized (i.e., percentage of total renal biopsy cases), study period was divided at an interval of 5 years, and age-stratified distribution change of main pathological types was analyzed.</p><p><b>RESULTS</b>The proportion of pathological types in 11 618 cases of renal biopsy was as follows: primary glomerulonephritis (PGN, 70.7%), secondary glomerulonephritis (SGN, 20.7%), tubular-interstitial nephropathy (4.0%), hereditary/rare nephropathy (0.3%), end-stage renal disease (0.9%), and unclassified renal disease (3.3%). Among PGN, there was IgA nephropathy (IgAN, 37.0%), membranous nephropathy (MN, 11.8%), mesangial proliferative glomerulonephritis (MsPGN, 8.9%), minimal change disease (MCD, 6.6%), and focal segmental glomerulosclerosis (3.9%). Among SGN there was lupus nephritis (LN, 5.5%), Henoch-Schönlein purpura glomerulonephritis (5.3%), hepatitis B virus-associated nephritis (HBVAN, 3.03%), diabetic nephropathy (2.2%), and hypertension/malignant hypertension-associated renal damage (1.9%). Pathological data were analyzed from 1987-1992 to 2008-2012 (after age adjustment). Detection rate of IgAN tended to rise (P < 0.001). Detection rates of MN and MCD rose significantly (P < 0.001), but detection rate of MsPGN dropped significantly (P < 0.001). Among SGN, detection rate of HBVAN tended to drop (P < 0.001).</p><p><b>CONCLUSION</b>In China, PGN was the most common glomerulopathy (mostly IgAN), LN was the most common SGN, and detection rate of MN and MCD rose significantly.</p>

Influence of different anticoagulants on coagulation state in hemodialysis / 中华肾脏病杂志

Objective To investigate the characteristics and proper use of anticoagulants in hemodialysis (HD). Methods Thirty-one HD patients were enrolled in the study. Unfractionated heparins (UFH), dalteparin sodium or argatroban were used for HD anticoagulation respectively. Blood specimens were taken from the arterial line at the beginning (0 h) and at the end of HD (4 h), and from the arterial (2a) and the venous (2v) line respectively at 2 h of the HD session. Glass bead activated clotting time (gbACT), clot rate (CR) and platelet function (PF) were examined by Sonoclot analyzer. Prothrombin fragment 1+2 (PF1+2) and granule membrane protein-140 (GMP-140) were assayed by ELISA. Meanwhile, blood was taken from 8 healthy volunteers to examine the above parameters as control. Results (1) Compared with the control group, CR, PF1+2, PF, GMP-140 were increased significantly in all the patients (P<0.05). (2) UFH group:Compared with the 0 h point, gbACT of other time points increased significantly (P<0.05), CR, PF, and PF1+2 decreased significantly (P<0.05). Compared with the control group, gbACT increased (P<0.05) and CR decreased (P<0.05) significantly at the end of the sessions. (3) Daheparin sodium group: Compared with the 0 h point, gbACT of 2a point increased significantly (P<0.05), CR and PF1+2 of 2a, 2v and 4 h points decreased significantly (P<0.05), meanwhile, the extents of increased gbACT and decreased CR from the arterial line were greater than those from the venous line. Compared with the control group, gbACT increased significantly at the end of HD session (P<0.05), but CR was not significantly different. (4) Argatroban group: There were no significant differences of gbACT between 0 h and other time points. CR of 2a, 2v points decreased obviously than that of 0 h point, and CR of 2v decreased more significantly. CR of 2a point was not different from the control group, while CR of 4 h point was greater as compared to control group. During the monitoring, PF1 +2 tended to increase. Conclusions With intensive anticoagulant effect, UFH may induce the risk of hemorrhage not only during but also after the dialysis sessions. Dalteparin sodium, a good anticoagulant, is stir related with the risk of hemorrhage during HD. Argatroban is an ideal anticoagulant for patients with the risk of hemorrhage.

Effect of rapamycin on the proliferation and apoptosis of glomerular mesangial cells / 中华肾脏病杂志

Objective To investigate the effect of different concentrations of rapamycin on the proliferation and apoptosis of glomerular mesangial cells(GMCs)and to investigate the mechanism. Methods GMCs were treated with different concentrations of rapamycin(1 μg/L,2 μg/L,4 μg/L,8 μg/L,16 μg/L).After treatment for 24 h,48 h and 72 h,cell proliferation was assessed bv MTT colorimetric assay and the growth curve was traced.After treatment for 72 h,the cell cycle distribution and the apoptotic rate of GMCs in different concentrations of rapamycin were analyzed bv flow cytometry.The effects of different concentrations of rapamycin on the mRNA and protein expression of p27 and p53 were detected by RT-PCR and Western blot respectivelyResult The low dose of rapamycin(1 μ/L)could signiticanfly inhibit the proliferation of GMCs and showed no effect on apoptosis.The high dose of rapamycin (8-16 μg/L)could significantly increase the apoptotic rate of GMCs.Rapamycin could increase the mRNA and protein expression of p27 and p53. Conclusion Rapamycin can inhibit GMCs proliferation and promote GMCs apoptosis by increasing the expression of p27 and p53.

Effects of oxidative stress and its secondary protein impairment induced by high glucose content in human renal tubular epithelial cell / 解放军医学杂志

Objective To explore the effects of oxidative stress and its secondary protein impairment induced by high glucose content in human kidney proximal tubular epithelial cell line (HKC). Methods Cultured HKC were used to detect the reactive oxygen species (ROS) and protein carbonyl content. HKC were divided into three different groups: control group (normal glucose), short-term treatment with high glucose group and long-term treatment with high glucose group. The glucose concentrations in control group and the high glucose treatment groups were 5.5mmol/L and 30mmol/L, respectively. Six time-points were set in short-term treatment with high glucose group namely 30min, 1h, 6h, 12h, 24h and 48h; glucose treatment was instituted for 2 months in long-term treatment of high glucose group. 5-(and-6)-chloromethyl-2',7'-dichlorodihydrofluorescein diacetate, acetyl ester (CM-H2DCFDA) was used as ROS trapping agent, and flow cytometry and laser confocal microscopy were used to detect the concentration of ROS in HKC after treatment with high glucose for different periods of time. Flourescent probe JC-1 was used to test the change in mitochondrion membrane potential (MMP). The protein carbonyl content was determined by 2,4-dinitrobenzene hydralazine (DNPH) chromatometry. Results The ROS level in HKC reached the peak at 1 hour after treatment with high glucose, and it then decreased gradually (P0.05), but after 2 months, there was significant change in the content of DNPH (P

CAROTID ARTERIAL INTIMA-MEDIA THICKNESS AND RISK FACTORS IN ELDERLY CHRONIC RENAL FAILURE PATIENTS / 解放军医学杂志

To measure carotid intima media thickness(IMT) and to investigate the relationship between carotid atherosclerosis and some major risk factors in elder uremic patients, a cross sectional study was carried out in 30unselected elder uremic patients (16on hemodialysis). Fasting blood sampling for serum lipids, BUN, creatinine, hemoglobin, and echo colour Doppler evaluation of common carotid arteries and heart were performed , BP was measured in all patients (before dialysis day in hemodialysis patients). Relationship between the results and miltifactoral regression analysis were also carried out. 17 patients(56 6%)had carotid IMTwhile 12 dialysis patients(75%) had it. 6patients (20%) had at least one plaque. A significant correlation was found in internal diameter of carotid arteries, IMT and blood vessel resistance between left and right carotid arteries. Carotid IMT had a close relationship with serum BUN, creatinine, cholesterol, systolic BP and heart ejection fraction. In multiple regression models, serum creatinine and cholesterol was significant and an independent predictor of the degree of carotid IMT. In elder uremic patients, carotid IMT is quite common. Elder age, hypertension, degree of renal insufficiency and dyslipidemia are associated with carotid atherosclerosis. Serum creatinine and cholesterol appears to serve as an independent predictor of carotid atherosclerosis, which contributes to the cardiovascular complications and high mortality in elder uremic patients.

EFFECTS OF HIGH GLUCOSE CONCENTRATION ON FIBRONECTIN SYNTHESIS OF CULTURED HUMAN GLOMERULAR MESANGIAL CELLS / 解放军医学杂志

To observe the high glucose concentration on proliferation and fibronectin (FN) synthesis of glomerular mesangial cells (GMC),a culture of human GMC was established and the cell proliferation was assessed using MTT method and cell counting, and the changes in FN was analyzed with RT PCR and ELISA. It was found that high glucose concentration inhibited GMC proliferation and increased FN synthesis in dose and time dependent manner.The results suggest that hyperglycemia may have important role in the development of diabetic nephropathy.