IgG4相关性疾病泌尿系统损害分析

目的 总结IgG4相关性疾病泌尿系统损害的临床特点,以其提高对该疾病的认识.方法 回顾性分析出现泌尿系统损害的IgG4相关性疾病患者6例的临床表现、实验室检查、影像学资料、病理表现、治疗及预后情况.结果 诊断为IgG4相关性疾病患者中6例存在泌尿系统损害,男女比例为4:2,中位年龄59岁(36～ 72岁),中位病程为10.5个月.除肾脏、输尿管受累外,所有患者均同时存在泌尿系统外的多器官受累.泌尿系统损害临床表现多样,包括肾功能异常、水肿和腹痛.所有患者均存在高球蛋白血症、血清IgG(中位值23.3 g/L)及IgG4亚型(中位值4227.0 mg/L)升高,肾小管源性蛋白尿;5例患者Scr明显升高(中位值237 μmol/L).影像学表现可分为4类:肾脏弥漫增大、CT多发低密度灶可伴不均匀强化灶、肾盂和(或)输尿管积水、肾脏萎缩.肾脏病理显示为弥漫纤维化伴肾间质大量淋巴细胞、浆细胞浸润的间质性肾炎表现,伴淋巴细胞、浆细胞IgG4免疫组化染色阳性.患者对中至大剂量糖皮质激素治疗反应良好,经治疗,临床症状改善,IgG、IgG4及Scr均明显降低.结论 IgG4相关性疾病泌尿系统损害临床表现多样化,多同时合并其他器官受累;肾组织病理学以IgG4阳性的淋巴细胞和浆细胞浸润的间质性肾炎为其突出特点;糖皮质激素治疗有效.     

雷公藤多苷联合小剂量糖皮质激素对IgA肾病伴肾功能减退患者的疗效观察

目的：观察雷公藤多苷联合小剂量糖皮质激素（简称激素）较单用激素治疗IgA肾病伴肾功能减退患者的临床疗效和安全性。方法：56例经肾活检证实且伴肾功能轻中度减退（肾小球率过滤50~80 ml/min）的IgA肾病患者分成两组。雷公藤组应用雷公藤多苷联合小剂量激素治疗,激素组为常规激素治疗,观察治疗0、3、6、9和12个月的蛋白尿、肾功能等临床指标变化,并评价不良反应。结果：激素组治疗9个月时24 h尿蛋白定量较治疗前开始减少（P＜0.05）,雷公藤组治疗6个月时开始减少（P＜0.05）。12个月时,激素组由治疗前（2.12±0.81）g降至（0.99±0.59）g,P＜0.01;雷公藤组由（2.21±0.75）g降至（0.43±0.18）g,P ＜0.01。治疗9、12个月时,雷公藤组24 h尿蛋白定量较激素组降低显著（P＜0.05）。与治疗前比较,激素组治疗6个月时,肾功能开始下降,表现为Scr升高（P＜0.01）,内生肌酐清除率（Ccr）下降（P＜0.01）。雷公藤组9个月时开始下降,Scr升高（P ＜0.01）,Ccr下降（P＜0.01）。两组间治疗后3、6、9个月疗效比较,Scr以及Ccr的变化差异均无统计学意义（P〉0.05）,12个月时,雷公藤组肾功能优于激素组（P＜0.05）。治疗期间激素组3例（10%）出现柯兴貌、面部痤疮,雷公藤组1例出现白细胞轻度减少。结论：雷公藤多苷联合小剂量激素能有效减少伴肾功能减退IgA肾病的蛋白尿,且一定程度上延缓肾功能进展,耐受性好。长期疗效仍需继续随访。     

结肠透析配合益肾汤对CKD3～4期颈动脉钙化患者血清ICAM-1、VCAM-1水平的影响

目的:探讨结肠透析配合益肾汤对CKD3~4期颈动脉钙化患者血清ICAM-1、VCAM-1水平的影响。方法:选择CKD3~4期伴颈动脉钙化患者40例,随机分为结肠透析与结肠透析+益肾汤两组,同时选择CKD3~4期伴颈动脉钙化未做结肠透析患者10例为对照组。结肠透析治疗时间8周,观察治疗前后血红蛋白(Hb)、尿素氮(BUN)、肌酐(Scr)、血尿酸(UA)、血钙(Ca~(2+))、血磷(P3-)、血浆甲状旁腺素(PTH)、血浆白蛋白(Alb)的变化,同时用ELISA法测定各组治疗前后血清ICAM-1、VCAM-1水平的变化,最后进行统计分析。结果:(1)与对照组相比,结肠透析组与结肠透析+益肾汤组BUN、Scr、UA、VCAM-1治疗后均明显下降(P0.01),结肠透析组ICAM-1治疗后无明显变化(P0.05),结肠透析+益肾汤组ICAM-1治疗后明显下降(P0.05);(2)与结肠透析组相比,结肠透析+益肾汤组BUN、Scr、UA、ICAM-1及VCAM-1治疗后均明显下降(P0.05)。结论:结肠透析配合益肾汤可降低CKD3~4期颈动脉钙化患者BUN、Scr、UA及血清ICAM-1、VCAM-1水平,推测结肠透析配合中药可以改善CKD3~4期患者血管钙化。     

肾脏病理活动积分与IgA肾病伴肾衰竭患者免疫治疗疗效相关性研究

目的:观察轻中度肾衰竭Ig A肾病(Ig AN)患者不同肾脏病理活动积分应用免疫抑制治疗的疗效,分析其相关性,为提高Ig AN伴有肾衰竭患者疗效提供依据。方法:回顾性分析70例接受糖皮质激素(GC)或GC联合环磷酰胺(CTX)治疗合并轻中度肾衰竭[30 ml/min≤肾小球滤过率(e GFR)≤90 ml/min]的Ig AN患者的临床资料及病理资料。根据患者病理活动性病变积分占总积分百分比,比值的均数为47%,将患者分为低活动积分组(34例,47%)和高活动积分组(36例,≥47%)。根据治疗方案不同将上述两组患者分别分为GC治疗组与GC联合CTX治疗组,其中低活动积分组使用GC治疗患者18例,GC联合CTX治疗组16例;高活动积分组使用GC治疗15例,GC联合CTX治疗21例。随访1年,记录所有患者治疗前后24 h尿蛋白定量、血清肌酐(Scr)和e GFR等临床数据,进行统计学分析。结果:(1)高活动积分组患者单用GC治疗组和GC联合CTX治疗组尿蛋白,在治疗6、12个月时尿蛋白水平较基线有明显下降,差异有统计学意义(P0.01),Scr下降和e GFR上升较基线差异有统计学意义(P0.05);(2)高活动积分组患者GC联合CTX治疗组在6、12个月时尿蛋白水平较单用GC组有明显下降(P0.05),Scr和e GFR之间没有意义(P0.05)。(3)低活动积分组GC治疗组与GC联合CTX治疗组在治疗6、12个月时尿蛋白水平较基线有所下降差异有统计学意义(P0.05),Scr和e GFR较基线差异无统计学意义(P0.05)。(4)高活动积分组较低活动积分组,尿蛋白、Scr和e GFR在治疗6、12个月时,组间结果分析,差异均有统计学意义(P0.05)。结论:在轻中度肾衰竭Ig AN患者中,对于肾脏活动性病变较重的患者使用GC与GC联合CTX治疗可以降低患者尿蛋白水平、改善肾功能,且GC联合CTX较单纯GC治疗在降低患者尿蛋白上可以取得更好效果。     

吗替麦考酚酯治疗难治性肾病综合征的临床观察

目的:研究吗替麦考酚酯(MMF)治疗原发性难治性肾病综合征(NS)的疗效及其安全性.方法:对糖皮质激素和环磷酰胺治疗无效或复发的30例原发性难治性肾病综合征患者,采用皮质激素和MMF联合治疗;MMF初始剂量1.0～1.5 g/d,3个月后逐渐减量为半量,疗程6个月以上;同时口服泼尼松20～40 mg/d,根据病情加快皮质激素的撤药速度.定期随访并记录疗效、副作用.结果:MMF 联合皮质激素治疗可以使患者尿蛋白定量下降和血清白蛋白上升(P<0.01),87%患者尿蛋白定量下降, 90%患者血清白蛋白上升,缓解率83%.大部分患者肾功能明显改善至正常,6例透析患者也完全脱离透析.未见明显副作用.结论:MMF对传统免疫抑制剂和糖皮质激素治疗无效或复发的难治性肾病综合征患者有效,未见明显副作用.对MMF的临床应用还有待进一步研究.     

血清胱抑素C在危重患者急性肾损伤中的应用价值

目的 探讨血清胱抑素C(Cystatin C)在早期诊断危重患者急性肾损伤(AKI)的价值.方法 收集重症病房中危重患者资料108例,分为AKI组24例和非AKI组84例,分别用免疫比浊法检测两组血清胱抑素C( Cystatin C)、β2微球蛋白(β2 - MG)、用酶法检测血清肌酐(Scr)、用公式计算肾小球滤过率(eGFR),比较两组患者上述指标的差异.结果 AKI患者的Cystatin C水平、β2 - MG水平和Scr水平均较非AKI患者显著升高(P＜0.05);AKI患者的Cystatin C与Scr呈正相关(r=0.662,P＜0.01),AKI组患者的Cystatin C水平与β2 - MG呈正相关,(r=0.569,P＜0.01),(CystatinC)-1与eGFR呈正相关(r =0.808,P＜0.01).AKI患者的Cystatin C水平早于Scr和β2 - MG出现异常,Cystatin C诊断AKI的灵敏度明显优于Scr和β2-MG(P＜0.05).结论 危重患者发生AKI时,血清Cystatin C显著升高,且Cystatin C较Scr和β2 - MG更敏感、更准确地反映危重患者早期肾功能的损害,可作为危重患者并发AKI的早期诊断指标之一.     

肾康注射液对急性肾衰竭的疗效及安全性观察

目的:观察肾康注射液(SKI)治疗急性肾衰竭(ARE)的疗效及安全性.方法:选择24例ARF患者,采用SKI配合常规治疗10天,观察病人治疗前后临床症状、体征及肾小球滤过率[Cys-eGFR(Mac)]、血肌酐(Scr)、血尿素氮(BUN)、血胱抑素(ScysC)、血钾(血K+)、尿钠、尿蛋白/尿肌酐(尿ACR)、尿胱抑素/尿肌酐(尿Cysc/CR)变化.结果:治疗后病人Cys-eGFR(Mac)明显升高,Scr、BUN、ScysC、血 K+、尿钠、尿ACR及尿CysC/CR明显下降,与治疗前比较均具有非常显著性差异(P＜0.01).治愈9例,好转10例,无效5例,总有效率79.17％.疗程中未见不良反应.结论:SKI治疗ARF效果好,无不良反应,用药安全,可作为ARF的救治药物.     

重组人红细胞生成素对腹膜透析患者血脂的影响

目的:探讨重组人红细胞生成素(rh-EPO)对腹膜透析(PD)患者脂质代谢紊乱的改善作用及其相关机制.方法:50例PD患者,20例采用常规PD治疗(PD组),30例加用常规剂量的rh-EPO(EPO组),分别测定两组患者透析6个月、12个月的血脂水平、空腹血糖(Glu)、空腹血浆胰岛素(Ins)及胰岛素敏感指数(ISI)的变化.结果:PD组较治疗前总甘油三酯(TG)、载脂蛋白B(Apo B)明显升高(P＜0.05),高密度脂蛋白(HDL)、载脂蛋白A1(Apo A1)、Apo A1/ApoB明显降低(P＜0.05);rh-EPO组治疗后TG、Apo B明显下降(P＜0.05),而HDL、Apo A1、Apo A1/Apo B明显升高(P＜0.05);EPO组治疗后Ins明显降低(P＜0.01),ISI显著升高(P＜0.05),PD组则无变化.结论:rh-EPO可通过提高胰岛素敏感性,降低血清胰岛素而改善PD患者脂质代谢紊乱.     

尿毒清颗粒对老年腹膜透析患者透析充分性及营养状态效果分析

目的:探讨尿毒清颗粒对老年连续不卧床腹膜透析患者透析充分性及营养状态的改善。方法:选取我院腹膜透析门诊规律随访的CAPD患者67例,透析剂量8 L/d。所有患者随机分为两组,透析方案为:治疗组32例,2 L/次,4次/d,CAPD,在腹膜透析的同时予以尿毒清颗粒口服;对照组31例。6个月为观察终点,评估两组KT/V、Ccr、Alb、Hb、血钙、血磷、iPTH及SGA营养状况变化。结果:治疗组在治疗3个月及6个月低钙血症得到明显纠正(P0.05);血磷在治疗6个月时有明显减低(P0.05),iP TH也有明显下降(P0.01)。治疗组Hb有明显升高(P0.01),Alb在6个月时有明显升高(P0.05)。治疗组KT/V与Ccr均有升高(P0.05),而与对照组比较差异无统计学意义。治疗组经过治疗6个月后营养不良发生率明显下降(P0.05),而对照组差异无统计学意义。结论:尿毒清颗粒治疗6个月可有效改善老年CAPD患者贫血、营养不良、透析充分性、钙磷代谢和继发性甲状旁腺功能亢进。     

尿毒清颗粒剂治疗118例慢性肾衰竭的疗效观察

目的:探讨中药尿毒清颗粒剂与西医结合治疗慢性肾衰竭(CRF)患者对改善肾功能和延缓CRF进展的疗效.方法:将236例CRF患者随机分成两组.对照组118例仅予西医治疗,治疗组118例在西医治疗的基础上服用尿毒清颗粒剂25～40g/d,疗程2个月.比较两组临床疗效、副作用及对CRF进展的影响.结果:治疗组总有效率为60.17%,明显高于对照组的22.88%(P＜0.01);各种症状均有明显改善,改善率70%以上,明显优于对照组(P＜0.05);治疗后血肌酐(Scr)和BUN均显著降低(P＜0.05),RBC明显升高(P＜0.01).而且治疗组中,Scr≤442μmol/L者疗效明显优于Scr≥451μmol/L者(P＜0.01),在18例Scr≥707μmol/L患者中,仅2例有效,与对照组比较无统计学差异(P＞0.05).1年内治疗组中有5/18的患者进入终末期(ESRD),显著低于对照组的13/20(P＜0.05).治疗过程未见明显毒副作用.结论:中药尿毒清颗粒剂与西医结合治疗CRF,能改善肾功能和延缓CRF进展.     

Clinical analysis of 36 cases of IgG4-related disease

Objective To explore the clinical characteristics of IgG4?related disease (IgG4?RD) in Chinese by detailed clinicopathological and laboratory assessments. Methods The baseline features of 36 patients with biopsy?proven disease were reviewed. The diagnosis was confirmed by pathology review according to consensus diagnostic criteria and clinicopathologic correlation. Disease activity and damage were assessed by the IgG4?RD responder index (RI). Results Thirty (83.3%) of the patients were male, while six were female, and the average age of onset was 65.1 years. All of the 36 patients had active disease, in which submandibular gland, lymph nodes, retroperitoneal tissue were the most common affected organs in this group of patients. Among 36 patients, 77.7% had elevated serum IgG4 concentrations and 44.4% had hypocomplementemia. Patients with elevated serum IgG4 had a higher RI, a greater number of organs involved (P＜0.01 for all comparisons). The correlation between serum IgG4 level and RI (r=0.737, P＜0.01) was stronger than IgG, ESR, CRP and serum complement levels. The incidence of hypocomplementemia in IgG4?RD patients with renal involvement was higher than that in IgG4?RD patients with other organs involvement (P＜0.01). Twenty?eight patients received glucocorticoids therapy, and had lower RI and serum IgG4 concentration after therapy (P＜0.05). Conclusions Both IgG4?RD RI and IgG4 concentration may be regarded as assessment markers of disease activity and therapeutic effect of IgG4?RD. The diagnosis of IgG4?RD should be supported by histopathology and clinical features.     

活体肾移植供肾切除术对供体早期肾功能的影响

目的 分析活体肾移植供肾切除术对供体肾功能早期的影响.方法 回顾性分析本中心自2010年4月至2014年11月467例活体供肾者的临床资料,提取肾切除术前,术后3d、7d、1个月、3个月时的血肌酐、肾小球滤过率(GFR)、尿酸、尿微量蛋白数据,了解肾切除术对供体早期肾功能的影响.结果 活体供肾者术前,术后3d、7d、1个月、3个月时的血肌酐(Scr)分别为(59.9± 12.8)、(85.8±21.0)、(91.2±21.3)、(92.8±21.6)、(91.0±21.3) μmol/L;肾小球滤过率(GFR)分别为(113.5±25.3)、(75.1±17.9)、(70.3±15.2)、(68.5±16.0)、(69.5±15.1) ml/min;血尿酸(Ua)分别为(292.60±79.58)、(142.18±55.28)、(228.41±66.39)、(321.31±83.72)、(346.61±87.21)μmol/L;术后与术前相比上述指标差异均有统计学意义(P＜0.05).术后各时间点尿IgG、微量白蛋白、视黄醇结合蛋白、β2微球蛋白与术前相比差异均有统计学意义(P＜0.05).结论 活体供肾切除术早期明显影响供体肾小球滤过率、尿酸及尿微量蛋白,临床需关注其对肾功能长期的影响.     

Effect of gender matching on the outcomes of living-donor renal transplantation

Objective To evaluate the effect of gender matching on the outcomes of living-donor renal transplantation. Methods A total of 419 cases of living-donor renal transplantation in our center were divided into male-donor-male-recipient (MDMR) group, male-donor-female-recipient (MDFR) group, female-donor-male-recipient (FDMR) group, female-donor-female-recipient (FDFR) group. The outcomes including graft and patient survival, acute rejection and renal function were analyzed retrospectively. Results Compared to MDMR group, MDFR group and FDFR group had lower Scr [(80.7±17.9), (87.4±21.9) μmol/L vs (120.3±72.5) μmol/L, all P＜0.05] and uric acid (UA) [(318.1±86.4), (303.5±66.9) μmol/L vs (358.4±77.8) μmol/L, P＜0.05] 6 months after operation. Compared to MDFR group, FDMR group had higher Scr[(117.7±27.4) μmol/L vs (80.7±17.9) μmol/L, P＜0.01], UA [(371.0±92.4) μmol/L vs (318.1±86.4) μmol/L, P＜0.05] and lower glomerular filtration rate (GFR) [(70.4±17.8) ml/min vs (79.6±18.9) ml/min, P＜0.05]. Compared to FDMR group, FDFR group had lower Scr [(87.4±21.9) μmol/L vs (117.7±27.4) μmol/L, P＜0.01] and UA [(303.5±66.9) μmol/L vs (371.0±92.4) μmol/L, P＜0.01]. Compared to MDFR group, FDFR group showed lower GFR [(72.4±25.3) ml/min vs (82.7±18.7) ml/min, P＜0.05] 1 year after operation. Compared to MDMR group, FDFR group showed lower UA [(322.9±69.7) μmol/L vs (376.0±66.2) μmol/L, P＜0.05] 2 years after operation. Compared to FDMR group, FDFR group showed lower Scr [(88.7±27.0) μmol/L vs (112.7±27.8) μmol/L, P＜0.05] and UA [(318.3±61.2) μmol/L vs (396.2±100.3) μmol/L, P＜0.05] 3 years after operation. 5 years after operation, there were no significant differences in above indexes, the incidence of slow graft function, acute rejection and survival of graft and patient among groups. Conclusions Male recipients of female donors have the worst renal function while female recipients have better outcomes after operation.     

Anti -PLA2R autoantibodies in serum and IgG subclass deposits on glomeruli in undetermined atypical membranous nephropathy

ObjectiveTo investigate the characteristic of autoantibodies of M – type phospholipase A2 receptor (PLA2R) in serum and the glomerular IgG subclass deposits in undetermined atypical membranous nephropathy (MN) patients. MethodsFrom Feb 2004 to Nov 2011, 53 cases diagnosed as MN by kidney puncture biopsy in our hospital were included into the study. There were 20 undetermined atypical membranous nephropathy (UAMN), 20 idiopathic membranous nephropathy (IMN) and 13 secondary membranous nephropathy (SMN) which were composed of lupus membranous nephropathy (LMN) and HBV related membranous nephropathy (HBV-MN). Clinlical and pathological characteristics were analyzed. The autoantibodies of PLA2R in serum were detected and the glomerular IgG subclass deposits were observed. Results(1) The average age underwent renal biopsy was (37.9±3.8) years of UAMN, (50.1±3.0) years of IMN and (49.5±4.5) years of SMN. The difference in onset average age at disease was significant between UAMN and IMN (P＝0.0178). The female/male ratio (F/M) in UAMN, IMN and SMN was 0.8∶1, 0.7∶1 and 0.6∶1(P＞0.05). (2) Compared with SMN, the level of 24-hours urinary protein excretion (3.47 g vs 7.89 g, P＝0.023), the ratio of amount urinary protein patients (50.0% vs 84.6%, P＝0.043), the level of serum IgG [(8.40±3.58) g/L vs (10.09±4.69) g/L, P＝0.025] and the positive rate of ANA in serum (10.0% vs 53.8%, P＝0.006) in UAMN were all much lower. There were no significant statistical differences in serum albumin, serum creatinine, eGFR, positive rate of HBsAg, HBeAg or HCV, as well as the ratio of hypo - albuminemia and nephritic syndrome among the three groups. (3) IF positive rate of IgA, IgM and C1q in UAMN were all significantly higher than that in IMN (P＜0.01). There were no significant differences in IF positive rate of IgA, IgM, C1q, IgG and C3 between UAMN and SMN. The IF strength of IgA, IgG, IgM, C3 and C1q in UAMN showed no significant differences between UAMN and SMN. (4) The serum autoantibodies of PLA2R were only detected in 10 cases of IMN group (50%) with all the other cases negative. This detection rate of serum autoantibodies of PLA2R showed significant statistical differences among the three groups (P＜0.01), but no differences between UAMN and SMN (the detection rate in both groups were 0%). (5) IgG1 deposits was the dominant IgG on the glomeruli in UAMN group (40%), as well as in SMN group (76.9%). IgG4 deposits was the dominant IgG on the glomeruli in IMN group (60%). The positive rate of IgG1 and IgG3 in UAMN showed no significant statistical differences when compared with IMN or SMN. The positive rate of IgG2 in UAMN was significantly lower than in SMN（30.0% vs 69.2%, P＜0.05). The positive rate of IgG4 in UAMN was significantly lower than in IMN (20% vs 60%, P＜0.05). The positive rate of IgG1, IgG2 and IgG3 in SMN were all significantly higher than in IMN. ConclusionsNone of the UAMN group had autoantibodies of PLA2R in serum, and IgG1 deposits was the dominant IgG subclass on the glomeruli which indicated the similarity with the SMN group. At the same time, UAMN was significantly different from SMN in clinical manifestations.     

Correlation between serum asymmetric dimethylarginine and blood pressure variability in chronic kidney disease patients

Objective To determine the correlation between serum asymmetric dimethylarginine (ADMA) and non-spoon-shaped blood pressure of non-dialysis chronic kidney disease (CKD) patients, also to observe the impact of the serum ADMA level on the structure and function of left ventricle. Methods One hundred and twenty cases of non-dialysis CKD patients underwent 24-hour ambulatory blood pressure monitoring were divided into three groups: CKD1-2, CKD3, CKD 4-5. Serum ADMA concentration was measured using liquid chromatograph and other clnical data such as uric acid (UA), left ventricular mass index (LVMI), 24 h urine protein, and high-sensitivity C-reactive protein (hs-CRP) were collected for further statistical analysis. Results (1) With the decline of renal function, ADMA concentration was increased, from CKD 1-2 (1.70±0.48) μmol/L rose to CKD 4-5 (4.46±1.56) μmol/L (P＜0.05). (2)There were 42 cases of CKD patients with hypertension and 78 cases of CKD patients with normal blood pressure. The serum ADMA levels in hypertension group was significantly higher than those in non-hypertensive group [(3.53±1.70) μmol/L vs (2.01±0.65) μmol/L, P＜0.05]. (3)There were 50 cases of non-spoon-shaped normotensive CKD patients and 28 cases of spoon-shaped normotensive CKD patients. Serum ADMA level and LVMI in non-spoon-shaped group were significantly higher than that in spoon-shaped group when kidney functions appeared to be equal (P＜0.05). (4)Serum ADMA level was positively correlated with UA(r=0.352, P＜0.01), LVMI (r=0.345, P＜0.05), 24 h urine protein(r=0.200, P＜0.05), and high-sensitivity C-reactive protein (r=0.309, P＜0.01), but negatively correlated with the left ventricular ejection fraction (LVEF)(r=-0.329, P＜0.01) and estimated glomerular filtration rate (eGFR)(r=-0.011, P＜0.01). Multiple regression results showed that eGFR, UA, LVMI, hs-CRP, 24 h urine protein were associated with ADMA level. The regression equation was Y=1.991-0.011×[eGFR]+0.002×[UA]+0.008×[LVMI]+0.036× [hs-CRP]-0.084×[24 h urinary protein]. Conclusions Serum ADMA level begins to increase in early stage CKD and it progressively increases with the decline of renal function, also the non-spoon-shaped blood pressure ratio and the left ventricular damage increase. Kidney function, urine protein and microinflammatory state may impact on the serum ADMA level.     

慢性肾脏病患者成纤维细胞生长因子23与肾功能及钙磷代谢的关系

目的 探讨慢性肾脏病（CKD）患者随着肾功能的变化,其成纤维细胞生长因子23（FGF23）与钙磷代谢的关系。 方法 研究对象为2008年8月至2009年4月在上海交通大学附属第一人民医院肾内科住院的初诊CKD患者72例,按照肾小球滤过率（GFR）水平分为5组,另设健康对照组20例。抽取受试者静脉血并分离血清,以酶联免疫法检测FGF23、25（OH）VitD3、1,25（OH）2VitD3;全自动生化分析仪测量钙（Ca）、磷（P）、血肌酐（Scr）、尿素氮（BUN）、白蛋白（Alb）水平;免疫放射法测定全段甲状旁腺激素（iPTH）。 结果 CKD患者血清FGF23水平随GFR降低逐渐升高,在CKD4期和5期时,血FGF23、P、iPTH上升明显,1,25（OH）2VitD3显著下降,与CKD1期差异有统计学意义（均P < 0.05）。CKD2~3期与CKD1期的FGF23、P、Ca、iPTH、活性维生素D水平差异均无统计学意义。血Ca、25（OH）VitD3随着肾功能下降有降低趋势,但各期间差异均无统计学意义。Pearson相关分析显示,CKD1~5期logFGF23与P、logiPTH呈正相关（r = 0.653,P < 0.01;r = 0.800,P < 0.01）,与GFR、1,25（OH）2VitD3呈负相关（r = -0.753,P < 0.01;r = -0.265,P < 0.05),与Ca、25（OH）VitD3无相关。CKD1~3期logFGF23与logiPTH呈正相关(r = 0.374,P < 0.05),而与Ca、P、25（OH）VitD3、1,25（OH）2VitD3、GFR均无相关。CKD4~5期log FGF23与P、logiPTH呈正相关（r = 0.381,P < 0.05;r = 0.515,P < 0.01）,与GFR呈负相关（r = -0.654,P < 0.01）,与Ca、25（OH）VitD3、1,25（OH）2VitD3无相关。 结论 随着肾功能减退,血清FGF23、P、iPTH水平逐渐升高,活性维生素D水平逐渐下降,尤以CKD4~5期明显。在肾脏病早期阶段（CKD1~3期）血iPTH水平与FGF23有关。当GFR<30 ml/min时,肾功能状态、血磷、血iPTH均可影响血FGF23水平。     

氧化应激介导糖尿病大鼠肾小管上皮细胞转分化及普罗布考的干预作用

目的 研究氧化应激在糖尿病肾病（DN）大鼠肾小管上皮细胞转分化中的作用,探讨抗氧化剂普罗布考对大鼠DN的肾脏保护作用。 方法 30只雄性SD大鼠随机分为正常对照组、DN组和普罗布考干预组（1％普罗布考饮食）,每组10只。分别于第3周、第8周及第12周检测24 h尿蛋白（UTP）;12周末检测各组大鼠血糖、血脂（胆固醇、三酰甘油）、Scr、肌酐清除率（Ccr）、肾脏组织匀浆液丙二醛（MDA）含量及谷胱甘肽过氧化物酶（GSH-Px）活性。肾组织病理切片行 HE和Masson染色;采用免疫组化和Western印迹检测肾组织核转录因子Sp1、α平滑肌肌动蛋白（α-SMA）及E钙黏蛋白（E-cadherin）表达。 结果 与正常对照组比较,DN组血糖、Scr、肾组织匀浆MDA和24 h UTP水平显著增高（均P < 0.01）,Ccr显著降低（P < 0.01）;肾组织肾小管损伤分数、α-SMA和 Sp1蛋白表达水平明显增高（均P < 0.01）;肾组织E-cadherin蛋白表达明显下调。肾组织MDA含量分别与α-SMA及Sp1蛋白表达呈正相关（r ＝ 0.896,P < 0.01;r ＝ 0.862,P < 0.01）,与E-cadherin蛋白表达呈负相关（r = -0.673, P < 0.01）。普罗布考干预组Scr、24 h UTP、肾组织MDA、肾小管损伤分数及肾组织α-SMA、 Sp1蛋白表达水平较DN组均明显降低（均P < 0.01）;Ccr和肾组织E-cadherin蛋白表达水平较DN组均明显增加（均P < 0.01）。 结论 氧化应激在DN大鼠肾小管上皮细胞转分化中起重要作用。普罗布考可能通过抗氧化、下调肾组织Sp1蛋白表达及抑制肾小管上皮细胞转分化延缓DN大鼠肾脏病变进展。     

Clinical significance of phospholipase A2 receptor 1 in patients with idiopathic membranous nephropathy

Objective To explore the role of phospholipase A2 receptor 1 (PLA2R1) in the diagnosis, differential diagnosis and evaluation of idiopathic membranous nephropathy (IMN) in adult patients. Methods A total of 242 renal disease patients diagnosed by renal biopsy from March 2015 to January 2016 were enrolled, consisting of 90 IMN, 20 secondary membranous nephropathy (SMN), 82 IgA nephropathy (IgAN), 30 minimal changed disease (MCD), 16 focal segmental glomerulosclerosis (FSGS) and 4 membranoproliferative glomerulonephritis (MPGN). Their clinical data including age, sex, serum creatinine (Scr), serum albumin and 24 h urinary protein were collected. Serum PLA2R1 was measured by enzyme linked immunosorbent assay. PLA2R and IgG subclasses in glomeruli were detected by indirect immunofluorescence assay. The positive rate of serum PLA2R1 among those groups and its correlation with clinical-pathological parameters were analyzed. Results Compared with IMN patients, SMN, MCD and FSGS patients were younger (all P＜0.01); IgAN patients were younger and had higher serum albumin and lower 24 h proteinuria (all P＜0.001); MPGN patients had higher Scr (all P＜0.01). The positive rate of serum PLA2R1 was 75.6% in IMN patients, while it was 0.0% in non-IMN patients. The distribution between serum PLA2R1 and pathological diagnosis had difference (P＜0.001), their positive coincidence rate was 100%, negative coincidence rate was 87.4%, total coincidence rate was 90.9% and their consistency was well (Kappa=0.795, P＜0.001). Among IgG subtype comparisons between IMN patients and SMN patients in the glomeruli, only moderate or more positive IgG4 had statistical differences (82.2% vs 5.0%, P＜0.001); the positive rate of glomerular PLA2R1 was 41.1% in IMN patients, higher than 10.0% in SMN patients (P=0.009); positive PLA2R1 with moderate or more positive IgG4 in glomeruli in IMN patients was more than that in SMN patients (40.0% vs 0.0%, P＜0.001), which could improve the diagnostic specificity of IMN. In IMN patients serum PLA2R1 and glomerular PLA2R1 had statistical differences (P＜0.001). Spearman rank correlation analysis showed that serum PLA2R1 of IMN patients positively correlated with 24 h proteinuria (r=0.315, P=0.002), negatively correlated with serum albumin (r=-0.228, P=0.030) and didn't correlate with Scr (r=0.199, P=0.059). Conclusions Serum PLA2R can be used as the specific indicator for diagnosis, differential diagnosis of IMN and to reflect the severity of IMN in patients.     

Effect of serum uric acid level on renal function in elderly hypertensive patients: a retrospective cohort study

Objective To explore the relationship of serum uric acid level with estimated glomerular filtration rate (eGFR) of elderly patients with hypertention based on a retrospective cohort study. Method The subjects included 465 cases who had a readmission after 3 years of follow-up in an original cohort of 1648 patients with diagnosis of essential hypertension in Fujian Provincial Hospital from August 2007 to September 2009. Multiple regression analysis was performed to examine the effect of serum uric acid level on renal function. Results Four hundred and sixty-five subjects were followed up for an average of 3.9 years. Mean patient age was 68.3±9.7 years. There was no significant difference in uric acid between the baseline and 3 years later (P＞0.05). Multiple regression analysis showed that after adjustment for age, gender, diabetes, body mass index, blood pressure etc, each 100 μmol/L-higher uric acid at baseline was associated with 4.40 ml•min-1•(1.73m2)-1 decrease in eGFR[95% confidence interval (CI): -6.25--2.55, P＜0.01]. According to the alteration of the serum uric acid, all patients were divided into the group with decreased uric acid and the group with increase uric acid. The eGFR was lower in patients with increased uric acid than that in patients with decreased uric acid 3 years later [(70.63±21.54) ml•min-1•(1.73m2)-1 vs (79.62±21.16) ml•min-1•(1.73 m2)-1, P＜0.01] and there was no significant difference at baseline between the two groups (P＞0.05). Multiple logistic regression analysis showed that after adjusting for aging, gender, diabetes, alteration of blood pressure etc, baseline uric acid was associated with a higher risk for eGFR decreasing more than 10 ml•min-1•(1.73m2)-1 3 years later [hazard ratio (HR)=2.11, 95%CI: 1.24-3.59, P＜0.01]; increased uric acid 3 years later resulted in a higher risk for renal function deterioration (HR=2.60, 95%CI: 1.67-4.07, P＜0.01). Conclusions Elderly hypertensive patients with baseline hyperuricemia have a lower eGFR, resulting an increased risk of chronic kidney disease. While the patients with declined uric acid had a lesser imparied renal function. It suggests that the improvement of uric acid may help to slow down the deterioration of renal function in elderly hypertensive patients.