Objective:Diabetic nephropathy is one of the most important microvascular complications of diabetes,which mainly refers to glomerular capillary sclerosis.Podocytes are an important part of glomerular capillaries.Previ...Objective:Diabetic nephropathy is one of the most important microvascular complications of diabetes,which mainly refers to glomerular capillary sclerosis.Podocytes are an important part of glomerular capillaries.Previous clinical and basic studies have shown that fibrosis is the main factor of diabetic nephropathy.This study aimed to assess the protective mechanism of glycyrrhizic acid(GA)on glomerular podocytes induced by high glucose as we hypothesized that GA may have antifibrotic and anti-inflammatory effects on podocytes through regulation of the adenosine 5'-monophosphate-activated protein kinase(AMPK)/sucrose nonfermenting AMPK-related kinase(SNARK)signaling pathway.Methods:SNARK siRNA was used to transfect podocytes.Real-time quantitative polymerase chain reaction and immunofluorescence staining assays were used for molecular and pathological analysis.The expression levels of key pathway proteins(including TGF-β1,α-SMA,SITR1,AMPKα,LKB1,PGC-1α,NF-κB,IL-6,and TNF-α)were verified by Western blotting.The expression of inflammatory factors in podocytes was detected by ELISA.Results:We demonstrated that GA decreased the expression of podocyte fibrosis signaling pathway-related factors by upregulating the AMPK pathway and its related factors.However,after transfection of podocytes with SNARK siRNA,there was an increased expression of fibrosis-related factors and inflammation-related factors.Conclusion:GA can protect podocytes and alleviate fibrosis and inflammation induced by high glucose,which is related to the AMPK signaling pathway.Meanwhile,knockdown of SNARK protein can inhibit the AMPK signaling pathway,aggravate fibrosis,and increase inflammation.展开更多
Objective:The main characteristics of diabetic nephropathy(DN)at the early stage are abnormal angiogenesis of glomerular endothelial cells(GECs)and macrophage infiltration.Galectin-3 plays a pivotal role in the pathog...Objective:The main characteristics of diabetic nephropathy(DN)at the early stage are abnormal angiogenesis of glomerular endothelial cells(GECs)and macrophage infiltration.Galectin-3 plays a pivotal role in the pathogenesis of DN via binding with its ligand,advanced glycation end products(AGEs).Catalpol,an iridoid glucoside extracted from Rehmannia glutinosa,has been found to ameliorate vascular inflammation,reduce endothelial permeability,and protect against endothelial damage in diabetic milieu.However,little is known about whether catalpol could exert an anti-angiogenesis and anti-inflammation effect induced by AGEs.Methods:Mouse GECs(mGECs)and RAW 264.7 macrophages were treated with different concentrations of AGEs(0,50,100,200 and 400μg/mL)for different time(0,6,12,24 and 48 h)to determine the optimal concentration of AGEs and treatment time.Cells were treated with catalpol(10μmol/L),GB1107(1μmol/L,galectin-3 inhibitor),PX-478(50μmol/L,HIF-1αinhibitor),adenovirus-green fluorescent protein(Ad-GFP)[3×10^(7)plaque-forming unit(PFU)/mL]or Ad-galectin-3-GFP(2×10^(8)PFU/mL),which was followed by incubation with 50μg/mL AGEs.The levels of galectin-3,vascular endothelial growth factor A(VEGFA)and pro-angiogenic factors angiopoietin-1(Ang-1),angiopoietin-2(Ang-2),tunica interna endothelial cell kinase-2(Tie-2)were detected by enzyme-linked immunosorbent assay(ELISA).Cell counting kit-8(CCK-8)assay was used to evaluate the proliferation of these cells.The expression levels of galectin-3,vascular endothelial growth factor receptor 1(VEGFR1),VEGFR2,and hypoxia-inducible factor-1α(HIF-1α)in mGECs and those of galectin-3 and HIF-1αin RAW 264.7 macrophages were detected by Western blotting and immunofluorescence(IF)staining.The rat DN model was established.Catalpol(100 mg/kg)or GB1107(10 mg/kg)was administered intragastrically once a day for 12 weeks.Ad-galectin-3-GFP(6×10^(7)PFU/mL,0.5 mL)or Ad-GFP(6×10^(6)PFU/mL,0.5 mL)was injected into the tail vein of rats 48 h before the sacrifice of the animals.The expression of galectin-3,VEGFR1,.VEGFR2,and HIF-1αin renal cortices was analyzed by Western blotting.The expression of galectin-3,F4/80(a macrophage biomarker),and CD34(an endothelium biomarker)in renal cortices was detected by IF staining,and collagen accumulation by Masson staining.Results:The expression levels of galectin-3 and VEGFA were significantly higher in mGECs and RAW 264.7 macrophages treated with 50μg/mL AGEs for 48 h than those in untreated cells.Catalpol and GB1107 could block the AGEs-induced proliferation of mGECs and RAW 264.7 macrophages.Over-expression of galectin-3 was found to reduce the inhibitory effect of catalpol on the proliferation of cells.Catalpol could significantly decrease the levels of Ang-1,Ang-2 and Tie-2 released by AGEs-treated mGECs,which could be reversed by over-expression of galectin-3.Catalpol could significantly inhibit AGEs-induced expression of galectin-3,HIF-1α,VEGFR1,and VEGFR2 in mGECs.The inhibitory effect of catalpol on galectin-3 in AGEs-treated mGECs was impaired by PX-478.Moreover,catalpol attenuated the AGEs-activated HIF-1α/galectin-3 pathway in RAW 264.7 macrophages,which was weakened by PX-478.Additionally,catalpol significantly inhibited the expression of galectin-3,macrophage infiltration,collagen accumulation,and angiogenesis in the kidney of diabetic rats.Over-expression of galectin-3 could antagonize these inhibitory effects of catalpol.Conclusion:Catalpol prevented the angiogenesis of mGECs and macrophage proliferation via inhibiting galectin-3.It could prevent the progression of diabetes-induced renal damage.展开更多
Introduction: Our study focused on the evaluation of renal function in children with sickle cell disease compared to children without sickle cell disease at the pediatric emergency unit of the Donka National Hospital ...Introduction: Our study focused on the evaluation of renal function in children with sickle cell disease compared to children without sickle cell disease at the pediatric emergency unit of the Donka National Hospital and SOS Drepano-Guinea center. Patients and Methods: This was a cross-sectional descriptive and analytical study lasting 3 months (October 1 to December 31, 2020). Were included, all sickle cell and non-sickle cell children aged 0 to 15 received on an outpatient basis and had undergone an exploration of renal function (serum creatinine and urine dipstick). Results: We performed the urine dipstick and serum creatinine in 75 children, 45 of whom were sickle cell and 30 were not sickle cell. 27 of our patients or 36% had a reduction in GFR, among them 9 or 20% were sickle cell and 18 or 60% were not sickle cell. The most affected age group was 5 to 9 years in sickle cell (66.7%) and non-sickle cell (38.9%). In sickle cell patients, 9 cases (100%) had mild renal failure (IRL). Non-sickle cell patients, had 14 cases or 77.8% of IRL and 4 cases (22.2%) of moderate IR. Sickle cell disease and antibiotics which had the respective p-value (0.01);(0.02), were statistically significant with the onset of renal failure. Conclusion: Several factors including sickle cell anemia and antibiotics are believed to be involved in lowering GFR. It would be essential to detect early the children received in consultation.展开更多
Objectives To study the relationship between plasma hemoglobin concentration and estimated glomerular filtration rate （eGFR） in elderly patients with ischemic cardiomyopathy （ICM）.Methods Clinical data of patients...Objectives To study the relationship between plasma hemoglobin concentration and estimated glomerular filtration rate （eGFR） in elderly patients with ischemic cardiomyopathy （ICM）.Methods Clinical data of patients with coronary heart disease who were discharged from The First Affiliated Hospital,Chongqing Medical University between 2005 and 2007 were analyzed retrospectively. Echocardiography results,plasma hemoglobin and creatinine concentration were abstracted from the medical records.The study included 235 Chinese Hart patients with age 60 years and older with angiography confirmed coronary heart disease,silent myocardial ischemia or angina pectoris,of whom 154 had ICM defined as left ventricular end-diastolic diameter （LVDd）,male≥56 mm,female≥51 mm （63. 51±7.70 mm） measured by M-mode echocardiography.The differences in plasma hemoglobin concentration were analyzed retrospec- tively between patients with and without ICM,and between patients with an eGFR【60 ml·min<sup>-1</sup>·1.73m<sup>-2</sup> and those with an eGFR≥60 ml·min<sup>-1</sup>·1.73m<sup>-2</sup>.Results There were no significant differences in plasma hemoglobin concentration and eGFR between ICM and non-ICM group (118.49±20.52 g·L<sup>-1</sup> vs.115.80±23.32 g·L<sup>-1</sup> and 75.13±24.21 ml·min<sup>-1</sup>·1.73m<sup>-2</sup> vs.79.09±28.41 ml·min<sup>- 1</sup>·1.73m<sup>-2</sup>,respectively,both P】0.05).However,in both ICM and non-ICM groups,plasma hemoglobin concentration was lower in those with an eGFR【60 ml·min<sup>-1</sup>·1.73m<sup>-2</sup> compared with compared with those with an eGFR≥60 ml·min<sup>-1</sup>·1.73m<sup>-2</sup> group (112. 29±18.61 g·L<sup>-1</sup> vs.119.92±20.74L<sup>-1</sup>,P【0.05);plasma hemoglobin concentration was related positively to eGFR.Conclusions There were no significant changes in plasma hemoglobin concentration and eGFR;however,plasma hemoglobin concentration was related to eGFR significantly positively in elderly patients with ICM due to coronary heart展开更多
Diabetic kidney disease (DKD)is a microvascular complication of type 2 diabetes.The study of DKD mechanisms is the most important target for the prevention of DKD.Renal senescence is one of the important pathogeneses ...Diabetic kidney disease (DKD)is a microvascular complication of type 2 diabetes.The study of DKD mechanisms is the most important target for the prevention of DKD.Renal senescence is one of the important pathogeneses for DKD,but the mechanism of renal and cellular senescence is unclear.Decreased expression of circulating miR-126 is associated with the development of DKD and may be a promising blood-based biomarker for DKD.This study is to probe the effect and mechanism of miR-126 on the aging of human glomerular mesangial cells (HGMCs)induced by high glucose.HGMCs were cultured with Roswell Park Memorial Institute (RPMI-1640)in vitro.The effect of high glucose on morphology of HGMCs was observed 72h after intervention.The cell cycle was examined by flow cytometry.The telomere length was measured by Southern blotting.The expression levels of p53,p21 and Rb proteins in p53-p21-Rb signaling pathway and p-statl,p-stat3 in JAK/STAT signaling pathway were detected by Western blotting respectively.The expression of miR-126 was examined by qRT-PCR.MiR-126 mimics was transfected into HGMCs.The effects of miR-126 mimics transfection on cell morphology,cell cycle,telomere length,p53,p21,Rb,p-stat1 and p-stat3 were observed. The results showed that high glucose not only arrested the cell cycle in G1phase but also shortened the telomere length.High glucose led to high expression of p53,p21,Rb,p-statl and p-stat3 and premature senescence of HGMCs by activating the telomere-p53-p21-Rb and JAK/STAT signaling pathways.Moreover,the miR-126 was decreased in HGMCs induced by high glucose.It was suggested that the transfection of miR-126 mimics could inhibit the telomere-p53-p21-Rb and JAK/STAT signaling pathway activity in vitro and delay the senescence of HGMCs.The results may serve as a new strategy for the treatment of DKD.展开更多
The development of formulas estimating glomerular filtration rate(eG FR) from serum creatinine and cystatin C and accounting for certain variables affecting the production rate of these biomarkers, including ethnicity...The development of formulas estimating glomerular filtration rate(eG FR) from serum creatinine and cystatin C and accounting for certain variables affecting the production rate of these biomarkers, including ethnicity, gender and age, has led to the current scheme of diagnosing and staging chronic kidney disease(CKD),which is based on e GFR values and albuminuria.This scheme has been applied extensively in various populations and has led to the current estimates of prevalence of CKD. In addition, this scheme is applied in clinical studies evaluating the risks of CKD and the efficacy of various interventions directed towards improving its course. Disagreements between creatinine-based and cystatin-based e GFR values and between e GFR values and measured GFR have been reported in various cohorts. These disagreements are the consequence of variations in the rate of production and in factors, other than GFR, affecting the rate of removal of creatinine and cystatin C. The disagreements create limitations for all e GFR formulas developed so far. The main limitations are low sensitivity in detecting early CKD in several subjects, e.g., those with hyperfiltration, and poor prediction of the course of CKD. Research efforts in CKD are currently directed towards identification of biomarkers that are better indices of GFR than the current biomarkers and,particularly, biomarkers of early renal tissue injury.展开更多
OBJECTIVE Diabetic nephropathy(DN)has been one of the most common complications of diabetes and the leading cause of end-stage renal disease.Glomerular hyperfiltrationis central in earlystage of DN and leads to the pr...OBJECTIVE Diabetic nephropathy(DN)has been one of the most common complications of diabetes and the leading cause of end-stage renal disease.Glomerular hyperfiltrationis central in earlystage of DN and leads to the progression of renal architectonic and functional abnormalities.Salvianolic acid A(SalA)has been proved to protect diabetic complications such as hepatic fibrosis and neuropathy.The present study was designed to investigate the effects of SalA on glomerular endothelial dysfunctionand diabetic nephropathy.METHODS Primary glomerular endothelial cells were subjected to assess permeability under injury of advanced glycation end-products(AGEs).AGEs-induced changes of Rho A/ROCK pathway and cytoskeleton rearrangement were assessed bywestern blotandimmunofluorescence.The beneficial effects of SalA on diabetic nephropathy were investigated in a rat model induced by high-fat and high-glucose diet combined with low dose of streptozocin(35 mg·kg^(-1),ip).Renal function and architectonic changes were evaluated by biochemical assay and PAS staining.RESULTS SalA 3μMameliorated AGEs-induced glomerular endothelial permeability(P<0.05)and suppressed rearrangement of cytoskeleton through inhibiting AGE-RAGE-Rho A/ROCK pathway.SalA1 mg·kg^(-1)markedly reduced endothelium loss(P<0.01)and glomerular hyperfiltration(P<0.05)in diabetic kidney.Subsequently,SalA 1 mg·kg^(-1) suppressed glomerular hypertrophy and mesangial matrix expansion,eventually reduced 24 h-urinary albumin and ameliorated renal function by decreasing blood urine nitrogen(BUN),serum creatinine(Scr)and serum n-acetyl-β-d-glucosaminidase(NAG).AGEs-RAGE-Nox4-induced oxidative stress was suppressed by the treatment of SalA 1 mg·kg^(-1).CONCLUSION SalA ameliorated AGEs-induced glomerular endothelial hyperpermeability,and effectively protected against early-stage diabetic nephropathy by reducing hyperfiltration and alleviating renal structural deterioration through inhibiting AGEs and its downstream pathway.Thus,SalA might be a promising therapeutic agent for the treatment of diabetic nephropathy.展开更多
AIM: To incorporate estimated glomerular filtrationrate (eGFR) into the model for end-stage liver disease(MELD) score to evaluate the predictive value.METHODS: From January 2004 to October 2008,the records of 4127 adm...AIM: To incorporate estimated glomerular filtrationrate (eGFR) into the model for end-stage liver disease(MELD) score to evaluate the predictive value.METHODS: From January 2004 to October 2008,the records of 4127 admitted cirrhotic patients were reviewed. Patients who survived and were followed up as outpatients were defined as survivors and theirmost recent available laboratory data were collected.Patients whose records indicated death at any time during the hospital stay were defined as non-survivors(in-hospital mortality). Patients with incomplete dataor with cirrhosis due to a congenital abnormality suchas primary biliary cirrhosis were excluded; thus, a totalof 3857 patients were enrolled in the present study.The eGFR, which was calculated by using either the modification of diet in renal disease (MDRD) equationor the chronic kidney disease epidemiology collaboration (CKD-EPI) equation, was incorporated into the MELD score after adjustment with the original MELDequation by logistic regression analysis [bilirubin and international normalized ratio (INR) were set at 1.0 forvalues less than 1.0].RESULTS: Patients defined as survivors were significantly younger, had a lower incidence of hepatoma,lower Child-Pugh and MELD scores, and better renalfunction. The underlying causes of cirrhosis werevery different from those in Western countries. In Tai-wan, most cirrhotic patients were associated with thehepatitis virus, especially hepatitis B. There were 16parameters included in univariate logistic regressionanalysis to predict in-hospital mortality and those with significant predicting values were included in furthermultivariate analysis. Both 4-variable MDRD eGFR and6-variable MDRD eGFR, rather than creatinine, weresignificant predictors of in-hospital mortality. Threenew equations were constructed (MELD-MDRD-4,MELD-MDRD-6, MELD-CKD-EPI). As expected, originalMELD score was a significant predictor of in-hospitalmortality (odds ratio = 1.25, P 【 0.001). MELD-MDRD-4 excluded serum creatinine, with the coeffi-cients refit among the remaining 3 variables, i.e., totalbilirubin, INR and 4-variable MDRD eGFR. This model represented an exacerbated outcome over MELD score,as suggested by a decrease in chi-square (2161.45 vs2198.32) and an increase in -2 log (likelihood) (2810.77vs 2773.90). MELD-MDRD-6 included 6-variable MDRDeGFR as one of the variables and showed an improvement over MELD score, as suggested by an increasein chi-square (2293.82 vs 2198.32) and a decrease in-2 log (likelihood) (2810.77 vs 2664.79). Finally, whenserum creatinine was replaced by CKD-EPI eGFR, itshowed a slight improvement compared to the originalMELD score (chisquare: 2199.16, -2 log (likelihood): 2773.07). In the receiver-operating characteristic curve, the MELD-MDRD-6 score showed a marginal improvement in area under the curve (0.909 vs 0.902), sensitivity (0.854 vs 0.819) and specificity (0.818 vs 0.839) compared to the original MELD equation. In patients with a different eGFR, the MELD-MDRD-6 equation showed a better predictive value in patients with eGFR ≥ 90, 60-89, 30-59 and 15-29.CONCLUSION: Incorporating eGFR obtained by the 6-variable MDRD equation into the MELD score showed an equal predictive performance in in-hospital mortality compared to a creatinine-based MELD score.展开更多
Objective: To analyze the correlation between urine retinol binding protein-4 (RBP-4) and serum HbA1c?with glomerular filtration rate (GFR) in type 1 diabetic children. Methods:?This?was a crosssectional observational...Objective: To analyze the correlation between urine retinol binding protein-4 (RBP-4) and serum HbA1c?with glomerular filtration rate (GFR) in type 1 diabetic children. Methods:?This?was a crosssectional observational analytic?study. The subjects?were?type 1 diabetic children aged 2 - 14 years. Sample collection was conducted from October to November 2014. Exclusion criteria were patients with obesity, renal insufficiency?that?was not caused by diabetes, history of hepatic diseases, and history of blood cell disorders. We?performed anamnesis, physical examination, and blood sampling for serum HbA1c?and serum cystatin-C, and urine sampling for RBP-4?on all subjects. Glomerular filtration rate was calculated from the concentration level of cystatin-C using Filler formula. Data analysis was performed?by?Spearman test to determine the correlation between urine RBP-4 and serum HbA1c?with GFR. The Fisher’s exact test was used to determine the correlation between duration of diabetes and RBP-4, HbA1c, and also GFR. Results:?Twelve females (60%) and 8 males (40%) participated in the study. The mean age of the subjects with 95% CI?was: 10.5 (2 - 14) years while the mean age of duration diabetes with 95% CI: 3.8 (0.5 - 10) years. Twelve (60%) subjects had?<5 years duration of diabetes, while eight (40%) subjects had?≥5 years duration of diabetes. Twelve (60%) subjects had normal RBP-4 level, while eight (40%) subjects had?elevated RBP-4 level. The mean level of HbA1c?with 95% CI: 8.9 (5.1 - 15.2)%. Thirteen (65%) subjects had poor metabolic. The mean GFR of the subjects with 95% CI: 99.3 (35.2 - 147.4) mL/1.73/m2. Nineteen (95%) subjects had normal GFR, while 1 (5%) had renal insufficiency. The results of data analysis using Spearman test on the correlation between urine RBP-4 and serum HbA1cwith GFR were not significant. The result of correlation between duration of diabetes and urine RBP-4 was significant?using?Fischer’s test. Conclusion:?The results?showed?no correlation between urine RBP-4 and serum HbA1c?with GFR. Urine RBP-4 could?be considered to assess renal function in type 1 diabetic patients with a duration of diabetes of more than 5 years.展开更多
The abnormal growth of epithelium-like cells has been noticed in spontaneously hypertensive rats(SHRs)with hypertensive nephropathy.However,the characteristics of abnormal epithelium-like cells and their pathogenesis ...The abnormal growth of epithelium-like cells has been noticed in spontaneously hypertensive rats(SHRs)with hypertensive nephropathy.However,the characteristics of abnormal epithelium-like cells and their pathogenesis in hypertensive nephropathy are not fully understood.In the present study,we investigated the correlation of epithelium-like cells with glomerular injury,and the effects of early drug intervention with telmisartan,an anti-hypertensive drug,on the growth of epithelium-like cells.The results showed that the epithelium-like cells were obviously observed lining along the luminal surface of Bowman’s capsule in glomeruli,significantly resulting in the atrophy of the glomerular tuft.Some of the epithelium-like cells strongly expressed proliferating cell nuclear antigen(PCNA)and vimentin,indicating active cellular proliferation.The incidence of epithelium-like cells varied from 13.6%to 54.4%of glomeruli in 48-week-old SHRs,and from 5.1%to 18.0%of glomeruli in age-matched Wistar-Kyoto(WKY)rats(P<0.01).The linear regression analysis further confirmed an obvious correlation between the incidence of epithelium-like cells and the glomerular injury.Moreover,early intervention with telmisartan could dramatically attenuate the progression of epithelium-like cells growth.However,no significant effect of telmisartan on the established epithelium-like cells was observed.Taken together,we demonstrated the involvement of abnormal epithelium-like cells growth in glomerular injury during hypertensive nephropathy in SHRs,and firstly showed the positive effects of the anti-hypertensive drug on the progression of epithelium-like cells growth.展开更多
Vesicoureteral reflux(VUR)is one of the most common urinary tract anomalies in children and causes renal damage and studies focusing on the effect of VUR on renal function are rare.We recruited 35 primary VUR patients...Vesicoureteral reflux(VUR)is one of the most common urinary tract anomalies in children and causes renal damage and studies focusing on the effect of VUR on renal function are rare.We recruited 35 primary VUR patients with recurrent urinary tract infection(UTI)and 10 non-VUR patients with recurrent UTI.Contrast-enhanced voiding urosonography(ceVUS)was performed for VUR grading,and renal dynamic imaging was used for evaluating glomerular filtration rate(GFR,mL/min).Standardized GFR(sGFR),namely GFR/BSA(mL·min-1·m-2),was calculated based on the body surface area(BSA).Total sGFR(tsGFR,mL·min-1·m-2)was obtained from the sum of sGFR on the left and right sides of all the children.The risk of renal regurgitation was equal in the unilateral reflux group.The sGFR of children with grade Ⅳ(45.74±18.05mL·min-1·m-2)and grade V(49.67±23.63mL·min-1·m-2)reflux was significantly lower than that in children with grade Ⅱ(77.69±22.21 mL·min-1·m-2).The renal function compensation of contralateral non-reflux kidney increased in unilateral reflux group,which was higher than that in the control group and level Ⅱ,Ⅳ and Ⅴ of reflux group respectively.In VUR group of the same grade,sGFR decreased with the age at diagnosis.In unilateral grade V refux group,the tsGFR was lower than that in the unilateral grade I reflux group(133.51±48.21 vs.186.87+53.49mL·min-1·m-2).The patients with VUR of unilateral grade Ⅱ were significantly older than those with VUR of unilateral grades Ⅱ and Ⅳ.This study indicates that severe VUR is significantly associated with decreased renal function.Therefore,VUR should be diagnosed early and managed individually.展开更多
The authors conducted a retrospective study over a period of 6 months in a hypertensive population in order to determine the correlation between serum uric acid on glomerular filtration rate (GFR) and estimated serum ...The authors conducted a retrospective study over a period of 6 months in a hypertensive population in order to determine the correlation between serum uric acid on glomerular filtration rate (GFR) and estimated serum potassium with left ventricular hypertrophy (LVH) and obesity. This study enrolled 122 patients including 63 women (51.6%). The mean age was 55.9 ± 10.6 years (range 30 to 74 years). Obesity weight was found in 38 cases (31.1%) of which 20?were men (33.9%) and 18 women (28.6%). Abdominal obesity was found in 104 cases (85.2%). The average serum uric acid in patients with obesity weight was 63.3 ± 18.9 mg/L vs 62.4 ± 14.2 mg/L for no-obese patients (p?= 0.63). The average serum potassium in obese patients was 4.06 ± 0.42 mEq/L vs 4.02 ± 0.46 mEq/L for no-obese (p?= 0.65). The average GFR was 73.4 ± 21.4 ml/L in obese patients vs 66.6 ± 22.6 ml/min in no-obese (p?= 0.03). The LVH was found in 81 cases (66.4%). The LVH was found in 65 (62.5%) obese patients vs?16 (88%) non-obese patients (OR = 4.8, 95% 1.04?-?22?p?= 0.02). Only abdominal?obesity has been correlated with left ventricular hypertrophy after multivariate analysis. Emphasis must be focused on public health actions for effective and appropriate measures against obesity and hypertension, whose prevalence is increasing in our region.展开更多
Introduction: Tc-99m Di-ethylene Tri-amine Penta Acetic Acid (DTPA) renogram is an accepted method to measure Glomerular Filtration Rate (GFR) of the kidneys. The depth and position of ectopic kidneys may vary. This m...Introduction: Tc-99m Di-ethylene Tri-amine Penta Acetic Acid (DTPA) renogram is an accepted method to measure Glomerular Filtration Rate (GFR) of the kidneys. The depth and position of ectopic kidneys may vary. This may lead to variation in tissue attenuation and error in the computed GFR and Differential Renal Function (DRF) of each kidney. Objective: The present study was undertaken in patients with ectopic kidneys to improve the accuracy of GFR and DRF calculation in a renogram with single injection of Tc-99m DTPA on a dual head gamma camera. Materials and Method: The study was conducted on 55 patients with ectopic kidneys. Images were acquired on a dual head gamma camera simultaneously in anterior and posterior views. Both anterior and posterior image datasets were used to compute the GFR of the ectopic kidney by Gates method. Depth correction of the ectopic kidney was done using the lateral view image. Total GFR was calculated as the sum of the anterior dataset ectopic kidney GFR and the posterior dataset normal kidney GFR. DRF was calculated again, by using the anterior dataset GFR of the ectopic kidney and posterior dataset for normal kidneys. The total GFR calculated by our method was compared to the patient’s eGFR (based on serum creatinine, age and sex). Result: The GFR calculated by anterior data set in the ectopic kidney was significantly higher than that calculated by posterior dataset (p 0.001). Similarly, the differential GFR of the ectopic kidney was higher when the anterior dataset was used (p 0.001). The ectopic kidney GFR of 34 (61.8%) of the 55 patients was greater than 35 ml/min, whereas in 21 patients (38.2%), it was less than 35 ml/min. The total GFR calculated by using both anterior and posterior data set was compared with the eGFR;the correlation coefficient was 0.74 in patients with ectopic kidney GFR of >35 ml/min and 0.83 in those with Conclusion: The GFR of ectopic kidney as calculated from the anterior data set was significantly higher in comparison to the GFR calculated from the posterior data set (p 0.001). Using the anterior dataset GFR, the DRF values for the ectopic kidneys was also significantly higher (p 0.001). This method improves the accuracy of the GFR and DRF values and helps to differentiate a normally functioning ectopic kidney from a poorly functioning one. Compared to the total GFR as calculated by the present method, the eGFR showed a better correlation in patients with ectopic kidney展开更多
Renal dysfunction is a common side-effect of chemotherapeutic agents in patients with hematopathy. Although broadly used, glomerular filtration rate(GFR) estimation equations were not fully validated in this specific ...Renal dysfunction is a common side-effect of chemotherapeutic agents in patients with hematopathy. Although broadly used, glomerular filtration rate(GFR) estimation equations were not fully validated in this specific population. Thus, this study was designed to further assess the accuracy of various GFR equations, including the newly 2012 CKD-EPI equations. Referring to ^(99m)Tc-DTPA clearance method, three Scr-based(MDRD, Peking, and CKD-EPI_(Scr)), three Scys C-based(Steven 1, Steven 2, and CKD-EPI_(Scys C)), and three Scr-Scys C combination based(Ma, Steven 3, and CKD-EPI_(Scr-Scys C)) equations were included. Bias, P_(30), and misclassification rate were applied to compare the applicability of the selected equations. A total of 180 Chinese hematological patients were enrolled.Mean bias, absolute mean bias, P_(30), misclassification rate and Bland-Altman plots of the CKD-EPI_(Scr-Scys C) equation were 7.90 mL/minute/1.73 m^2, 17.77 mL/minute/1.73 m^2, 73.3%, 38% and 79.7 mL/minute/1.73 m^2, respectively.CKD-EPI_(Scr-Scys C) predicted the most precise eGFR both in lymphoma and leukemia subgroups. Additionally, CKDEPI_(Scys C) equation in the rGFR■90 mL/minute/1.73 m^2 subgroup and Steven 2 equation in the rGFR<90 mL/minute/1.73 m^2 subgroup provided more accurate estimates in each subgroup. The CKD-EPI_(Scr-Scys C) equation could be recommended to monitor kidney function in hematopathy patients. The accuracy of GFR equations may be closely related with GFR level and kidney function markers, but not the primary cause of hematopathy.展开更多
AIM To evaluate the influence of creatinine methodology on the performance of chronic kidney disease(CKD)-Epidemiology Collaboration Group-calculated estimated glomerular filtration rate(CKD-EPI-eGFR) for CKD diagnosi...AIM To evaluate the influence of creatinine methodology on the performance of chronic kidney disease(CKD)-Epidemiology Collaboration Group-calculated estimated glomerular filtration rate(CKD-EPI-eGFR) for CKD diagnosis/staging in a large cohort of diabetic patients. METHODS Fasting blood samples were taken from diabetic patients attending our clinic for their regular annual examination, including laboratory measurement of serum creatinine and eGFR.RESULTS Our results indicated an overall excellent agreement in CKD staging(kappa = 0.918) between the Jaffé serum creatinine-and enzymatic serum creatinine-based CKDEPI-eGFR, with 9% of discordant cases. As compared to the enzymatic creatinine, the majority of discordances(8%) were positive, i.e., associated with the more advanced CKD stage re-classification, whereas only 1% of cases were negatively discordant if Jaffé creatinine was used for eGFR calculation. A minor proportion of the discordant cases(3.5%) were re-classified into clinically relevant CKD stage indicating mildly to moderately decreased kidney function(< 60 m L/min per 1.73 m^2). Significant acute and chronic hyperglycaemia, assessedas plasma glucose and Hb A1 c levels far above the recommended glycaemic goals, was associated with positively discordant cases. Due to a very low frequency, positive discordance is not likely to present a great burden for the health-care providers, while intensified medical care may actually be beneficial for the small number of discordant patients. On the other hand, a very low proportion of negatively discordant cases(1%) at the 60 m L/min per 1.73 m^2 eGFR level indicate a negligible possibility to miss the CKD diagnosis, which could be the most prominent clinical problem affecting patient care, considering high risk of CKD for adverse patient outcomes. CONCLUSION This study indicate that compensated Jaffé creatinine procedure, in spite of the glucose-dependent bias, is not inferior to enzymatic creatinine in CKD diagnosis/staging and therefore may provide a reliable and cost-effective tool for the renal function assessment in diabetic patients.展开更多
We investigated the link between estimated glomerular filtration rate (eGFR) and coffee consumption in Japanese. We used data of 376 men and 794 women who were not taking any medications, aged 20 - 78 years, in this c...We investigated the link between estimated glomerular filtration rate (eGFR) and coffee consumption in Japanese. We used data of 376 men and 794 women who were not taking any medications, aged 20 - 78 years, in this cross- sectional investigation study. eGFR was calcu-lated using serum creatinine (Cr), age and sex. Habitual coffee consumption was defined as drinking one or more cups of coffee per day. Two hundred thirty three men (62.0%) and 400 women (50.4%) were subjects with habitual coffee consumption (coffee consumption 1 cup/ day ≥). eGFR was negatively correlated with age (men: r = –0.533, women: r = –624). eGFR in subjects with coffee consumers was not significantly different from that in subjects without coffee consumers after adjusting for age in both sexes (men: p = 0.1375, women: p = 0.2069). Among Japanese not taking medications, coffee consumption was not associated with eGFR in the Japanese population.展开更多
Background: Kidney disease, even when mild, was once considered so major an impediment to successful pregnancy and so dangerous to the mother’s wellbeing. High-risk pregnancy mainly associated to renal impairment may...Background: Kidney disease, even when mild, was once considered so major an impediment to successful pregnancy and so dangerous to the mother’s wellbeing. High-risk pregnancy mainly associated to renal impairment may occur in 10-20% of gestations and it is very important that renal function is closely monitored to prevent or minimize maternal and fetal complications. This study was designed to investigate the performance of Cockcroft-Gault CGeq and the simplified MDRDeq equations in healthy pregnant women to assess renal function. Methods: We studied 167 normal ambulatory pregnant women and kidney function was contemporaneously estimated through the CGeq and the simplified MDRDeq and calculated through the creatinine clearance (Ccr). Serum and urinary creatinine were assayed using Jaffé reaction method in the same AutoAnalyser. Results: When we compared calculated and estimated clearences for measurement of kidney function we observed that CGeq overestimated renal function (CGeq = 168.41 ± 38.80 ml/ min/1.73 m2, Ccr = 146.27 ± 30.49 ml/min / 1.73 m2, p < 0.001), MDRDeq underestimated renal function (Ccr = 146.27 ± 30.49 ml/min / 1.73 m2, MDRDeq = 129.15 ± 29.28 ml/min / 1.73m2, p < 0.001). Conclusions: Our results demonstrated that CGeq overestimated, MDRDeq underestimated significantly kidney function during gestation in healthy women and cannot be recommended to assess renal function in obstetric practice. Ccr remains a useful clinical tool in pregnant women until the development of a specific equation that considers the several important maternal renal physiological alterations and provides the measure of GFR the most unbiased and precise as possible.展开更多
基金supported by the Natural Science Foundation of Ningxia Province(No.2021AAC03296).
文摘Objective:Diabetic nephropathy is one of the most important microvascular complications of diabetes,which mainly refers to glomerular capillary sclerosis.Podocytes are an important part of glomerular capillaries.Previous clinical and basic studies have shown that fibrosis is the main factor of diabetic nephropathy.This study aimed to assess the protective mechanism of glycyrrhizic acid(GA)on glomerular podocytes induced by high glucose as we hypothesized that GA may have antifibrotic and anti-inflammatory effects on podocytes through regulation of the adenosine 5'-monophosphate-activated protein kinase(AMPK)/sucrose nonfermenting AMPK-related kinase(SNARK)signaling pathway.Methods:SNARK siRNA was used to transfect podocytes.Real-time quantitative polymerase chain reaction and immunofluorescence staining assays were used for molecular and pathological analysis.The expression levels of key pathway proteins(including TGF-β1,α-SMA,SITR1,AMPKα,LKB1,PGC-1α,NF-κB,IL-6,and TNF-α)were verified by Western blotting.The expression of inflammatory factors in podocytes was detected by ELISA.Results:We demonstrated that GA decreased the expression of podocyte fibrosis signaling pathway-related factors by upregulating the AMPK pathway and its related factors.However,after transfection of podocytes with SNARK siRNA,there was an increased expression of fibrosis-related factors and inflammation-related factors.Conclusion:GA can protect podocytes and alleviate fibrosis and inflammation induced by high glucose,which is related to the AMPK signaling pathway.Meanwhile,knockdown of SNARK protein can inhibit the AMPK signaling pathway,aggravate fibrosis,and increase inflammation.
基金supported by grants from the National Natural Science Foundation of China(No.81374029,No.81073111,No.81874359)Natural Science Foundation of the Higher Education Institutions of Jiangsu Province(No.18KJD360002)+1 种基金a Project Funded by Jiangsu Agri-animal Husbandry Vocational College(No.NSF2021CB04)a Project Funded by the Priority Academic Program Development of Jiangsu Higher Education Institutions(PAPD)(No.JKLPSE201604).
文摘Objective:The main characteristics of diabetic nephropathy(DN)at the early stage are abnormal angiogenesis of glomerular endothelial cells(GECs)and macrophage infiltration.Galectin-3 plays a pivotal role in the pathogenesis of DN via binding with its ligand,advanced glycation end products(AGEs).Catalpol,an iridoid glucoside extracted from Rehmannia glutinosa,has been found to ameliorate vascular inflammation,reduce endothelial permeability,and protect against endothelial damage in diabetic milieu.However,little is known about whether catalpol could exert an anti-angiogenesis and anti-inflammation effect induced by AGEs.Methods:Mouse GECs(mGECs)and RAW 264.7 macrophages were treated with different concentrations of AGEs(0,50,100,200 and 400μg/mL)for different time(0,6,12,24 and 48 h)to determine the optimal concentration of AGEs and treatment time.Cells were treated with catalpol(10μmol/L),GB1107(1μmol/L,galectin-3 inhibitor),PX-478(50μmol/L,HIF-1αinhibitor),adenovirus-green fluorescent protein(Ad-GFP)[3×10^(7)plaque-forming unit(PFU)/mL]or Ad-galectin-3-GFP(2×10^(8)PFU/mL),which was followed by incubation with 50μg/mL AGEs.The levels of galectin-3,vascular endothelial growth factor A(VEGFA)and pro-angiogenic factors angiopoietin-1(Ang-1),angiopoietin-2(Ang-2),tunica interna endothelial cell kinase-2(Tie-2)were detected by enzyme-linked immunosorbent assay(ELISA).Cell counting kit-8(CCK-8)assay was used to evaluate the proliferation of these cells.The expression levels of galectin-3,vascular endothelial growth factor receptor 1(VEGFR1),VEGFR2,and hypoxia-inducible factor-1α(HIF-1α)in mGECs and those of galectin-3 and HIF-1αin RAW 264.7 macrophages were detected by Western blotting and immunofluorescence(IF)staining.The rat DN model was established.Catalpol(100 mg/kg)or GB1107(10 mg/kg)was administered intragastrically once a day for 12 weeks.Ad-galectin-3-GFP(6×10^(7)PFU/mL,0.5 mL)or Ad-GFP(6×10^(6)PFU/mL,0.5 mL)was injected into the tail vein of rats 48 h before the sacrifice of the animals.The expression of galectin-3,VEGFR1,.VEGFR2,and HIF-1αin renal cortices was analyzed by Western blotting.The expression of galectin-3,F4/80(a macrophage biomarker),and CD34(an endothelium biomarker)in renal cortices was detected by IF staining,and collagen accumulation by Masson staining.Results:The expression levels of galectin-3 and VEGFA were significantly higher in mGECs and RAW 264.7 macrophages treated with 50μg/mL AGEs for 48 h than those in untreated cells.Catalpol and GB1107 could block the AGEs-induced proliferation of mGECs and RAW 264.7 macrophages.Over-expression of galectin-3 was found to reduce the inhibitory effect of catalpol on the proliferation of cells.Catalpol could significantly decrease the levels of Ang-1,Ang-2 and Tie-2 released by AGEs-treated mGECs,which could be reversed by over-expression of galectin-3.Catalpol could significantly inhibit AGEs-induced expression of galectin-3,HIF-1α,VEGFR1,and VEGFR2 in mGECs.The inhibitory effect of catalpol on galectin-3 in AGEs-treated mGECs was impaired by PX-478.Moreover,catalpol attenuated the AGEs-activated HIF-1α/galectin-3 pathway in RAW 264.7 macrophages,which was weakened by PX-478.Additionally,catalpol significantly inhibited the expression of galectin-3,macrophage infiltration,collagen accumulation,and angiogenesis in the kidney of diabetic rats.Over-expression of galectin-3 could antagonize these inhibitory effects of catalpol.Conclusion:Catalpol prevented the angiogenesis of mGECs and macrophage proliferation via inhibiting galectin-3.It could prevent the progression of diabetes-induced renal damage.
文摘Introduction: Our study focused on the evaluation of renal function in children with sickle cell disease compared to children without sickle cell disease at the pediatric emergency unit of the Donka National Hospital and SOS Drepano-Guinea center. Patients and Methods: This was a cross-sectional descriptive and analytical study lasting 3 months (October 1 to December 31, 2020). Were included, all sickle cell and non-sickle cell children aged 0 to 15 received on an outpatient basis and had undergone an exploration of renal function (serum creatinine and urine dipstick). Results: We performed the urine dipstick and serum creatinine in 75 children, 45 of whom were sickle cell and 30 were not sickle cell. 27 of our patients or 36% had a reduction in GFR, among them 9 or 20% were sickle cell and 18 or 60% were not sickle cell. The most affected age group was 5 to 9 years in sickle cell (66.7%) and non-sickle cell (38.9%). In sickle cell patients, 9 cases (100%) had mild renal failure (IRL). Non-sickle cell patients, had 14 cases or 77.8% of IRL and 4 cases (22.2%) of moderate IR. Sickle cell disease and antibiotics which had the respective p-value (0.01);(0.02), were statistically significant with the onset of renal failure. Conclusion: Several factors including sickle cell anemia and antibiotics are believed to be involved in lowering GFR. It would be essential to detect early the children received in consultation.
基金the Medical Science & Technology Research fund of Health Bureau of Chongqing City,China [No.2004(53)04-2-154]the Nature Science Research fund of Chongqing Science & Technology Com-mission of Chongqing City,China (No.CSTC,2007BB5276).
文摘Objectives To study the relationship between plasma hemoglobin concentration and estimated glomerular filtration rate （eGFR） in elderly patients with ischemic cardiomyopathy （ICM）.Methods Clinical data of patients with coronary heart disease who were discharged from The First Affiliated Hospital,Chongqing Medical University between 2005 and 2007 were analyzed retrospectively. Echocardiography results,plasma hemoglobin and creatinine concentration were abstracted from the medical records.The study included 235 Chinese Hart patients with age 60 years and older with angiography confirmed coronary heart disease,silent myocardial ischemia or angina pectoris,of whom 154 had ICM defined as left ventricular end-diastolic diameter （LVDd）,male≥56 mm,female≥51 mm （63. 51±7.70 mm） measured by M-mode echocardiography.The differences in plasma hemoglobin concentration were analyzed retrospec- tively between patients with and without ICM,and between patients with an eGFR【60 ml·min<sup>-1</sup>·1.73m<sup>-2</sup> and those with an eGFR≥60 ml·min<sup>-1</sup>·1.73m<sup>-2</sup>.Results There were no significant differences in plasma hemoglobin concentration and eGFR between ICM and non-ICM group (118.49±20.52 g·L<sup>-1</sup> vs.115.80±23.32 g·L<sup>-1</sup> and 75.13±24.21 ml·min<sup>-1</sup>·1.73m<sup>-2</sup> vs.79.09±28.41 ml·min<sup>- 1</sup>·1.73m<sup>-2</sup>,respectively,both P】0.05).However,in both ICM and non-ICM groups,plasma hemoglobin concentration was lower in those with an eGFR【60 ml·min<sup>-1</sup>·1.73m<sup>-2</sup> compared with compared with those with an eGFR≥60 ml·min<sup>-1</sup>·1.73m<sup>-2</sup> group (112. 29±18.61 g·L<sup>-1</sup> vs.119.92±20.74L<sup>-1</sup>,P【0.05);plasma hemoglobin concentration was related positively to eGFR.Conclusions There were no significant changes in plasma hemoglobin concentration and eGFR;however,plasma hemoglobin concentration was related to eGFR significantly positively in elderly patients with ICM due to coronary heart
基金This project was supported by grants from the Key Science and Technology Development Program of Nanjing City of the People's Republic of China (No. YKK15057 and No.YKK16097)and the National Natural Science Foundation of China (No.81473684).
文摘Diabetic kidney disease (DKD)is a microvascular complication of type 2 diabetes.The study of DKD mechanisms is the most important target for the prevention of DKD.Renal senescence is one of the important pathogeneses for DKD,but the mechanism of renal and cellular senescence is unclear.Decreased expression of circulating miR-126 is associated with the development of DKD and may be a promising blood-based biomarker for DKD.This study is to probe the effect and mechanism of miR-126 on the aging of human glomerular mesangial cells (HGMCs)induced by high glucose.HGMCs were cultured with Roswell Park Memorial Institute (RPMI-1640)in vitro.The effect of high glucose on morphology of HGMCs was observed 72h after intervention.The cell cycle was examined by flow cytometry.The telomere length was measured by Southern blotting.The expression levels of p53,p21 and Rb proteins in p53-p21-Rb signaling pathway and p-statl,p-stat3 in JAK/STAT signaling pathway were detected by Western blotting respectively.The expression of miR-126 was examined by qRT-PCR.MiR-126 mimics was transfected into HGMCs.The effects of miR-126 mimics transfection on cell morphology,cell cycle,telomere length,p53,p21,Rb,p-stat1 and p-stat3 were observed. The results showed that high glucose not only arrested the cell cycle in G1phase but also shortened the telomere length.High glucose led to high expression of p53,p21,Rb,p-statl and p-stat3 and premature senescence of HGMCs by activating the telomere-p53-p21-Rb and JAK/STAT signaling pathways.Moreover,the miR-126 was decreased in HGMCs induced by high glucose.It was suggested that the transfection of miR-126 mimics could inhibit the telomere-p53-p21-Rb and JAK/STAT signaling pathway activity in vitro and delay the senescence of HGMCs.The results may serve as a new strategy for the treatment of DKD.
基金the Research Service of the Raymond G. Murphy VA Medical Center for its support of this work
文摘The development of formulas estimating glomerular filtration rate(eG FR) from serum creatinine and cystatin C and accounting for certain variables affecting the production rate of these biomarkers, including ethnicity, gender and age, has led to the current scheme of diagnosing and staging chronic kidney disease(CKD),which is based on e GFR values and albuminuria.This scheme has been applied extensively in various populations and has led to the current estimates of prevalence of CKD. In addition, this scheme is applied in clinical studies evaluating the risks of CKD and the efficacy of various interventions directed towards improving its course. Disagreements between creatinine-based and cystatin-based e GFR values and between e GFR values and measured GFR have been reported in various cohorts. These disagreements are the consequence of variations in the rate of production and in factors, other than GFR, affecting the rate of removal of creatinine and cystatin C. The disagreements create limitations for all e GFR formulas developed so far. The main limitations are low sensitivity in detecting early CKD in several subjects, e.g., those with hyperfiltration, and poor prediction of the course of CKD. Research efforts in CKD are currently directed towards identification of biomarkers that are better indices of GFR than the current biomarkers and,particularly, biomarkers of early renal tissue injury.
基金supported by National Nature Science Foundation of China(81770847)CAMS Innovation Fund for Medical Sciences(CIFMS)(2016-I2M-3-007,2016-I2M-1-010)National Key Research and Development Plan(2016YFC1000905)
文摘OBJECTIVE Diabetic nephropathy(DN)has been one of the most common complications of diabetes and the leading cause of end-stage renal disease.Glomerular hyperfiltrationis central in earlystage of DN and leads to the progression of renal architectonic and functional abnormalities.Salvianolic acid A(SalA)has been proved to protect diabetic complications such as hepatic fibrosis and neuropathy.The present study was designed to investigate the effects of SalA on glomerular endothelial dysfunctionand diabetic nephropathy.METHODS Primary glomerular endothelial cells were subjected to assess permeability under injury of advanced glycation end-products(AGEs).AGEs-induced changes of Rho A/ROCK pathway and cytoskeleton rearrangement were assessed bywestern blotandimmunofluorescence.The beneficial effects of SalA on diabetic nephropathy were investigated in a rat model induced by high-fat and high-glucose diet combined with low dose of streptozocin(35 mg·kg^(-1),ip).Renal function and architectonic changes were evaluated by biochemical assay and PAS staining.RESULTS SalA 3μMameliorated AGEs-induced glomerular endothelial permeability(P<0.05)and suppressed rearrangement of cytoskeleton through inhibiting AGE-RAGE-Rho A/ROCK pathway.SalA1 mg·kg^(-1)markedly reduced endothelium loss(P<0.01)and glomerular hyperfiltration(P<0.05)in diabetic kidney.Subsequently,SalA 1 mg·kg^(-1) suppressed glomerular hypertrophy and mesangial matrix expansion,eventually reduced 24 h-urinary albumin and ameliorated renal function by decreasing blood urine nitrogen(BUN),serum creatinine(Scr)and serum n-acetyl-β-d-glucosaminidase(NAG).AGEs-RAGE-Nox4-induced oxidative stress was suppressed by the treatment of SalA 1 mg·kg^(-1).CONCLUSION SalA ameliorated AGEs-induced glomerular endothelial hyperpermeability,and effectively protected against early-stage diabetic nephropathy by reducing hyperfiltration and alleviating renal structural deterioration through inhibiting AGEs and its downstream pathway.Thus,SalA might be a promising therapeutic agent for the treatment of diabetic nephropathy.
文摘AIM: To incorporate estimated glomerular filtrationrate (eGFR) into the model for end-stage liver disease(MELD) score to evaluate the predictive value.METHODS: From January 2004 to October 2008,the records of 4127 admitted cirrhotic patients were reviewed. Patients who survived and were followed up as outpatients were defined as survivors and theirmost recent available laboratory data were collected.Patients whose records indicated death at any time during the hospital stay were defined as non-survivors(in-hospital mortality). Patients with incomplete dataor with cirrhosis due to a congenital abnormality suchas primary biliary cirrhosis were excluded; thus, a totalof 3857 patients were enrolled in the present study.The eGFR, which was calculated by using either the modification of diet in renal disease (MDRD) equationor the chronic kidney disease epidemiology collaboration (CKD-EPI) equation, was incorporated into the MELD score after adjustment with the original MELDequation by logistic regression analysis [bilirubin and international normalized ratio (INR) were set at 1.0 forvalues less than 1.0].RESULTS: Patients defined as survivors were significantly younger, had a lower incidence of hepatoma,lower Child-Pugh and MELD scores, and better renalfunction. The underlying causes of cirrhosis werevery different from those in Western countries. In Tai-wan, most cirrhotic patients were associated with thehepatitis virus, especially hepatitis B. There were 16parameters included in univariate logistic regressionanalysis to predict in-hospital mortality and those with significant predicting values were included in furthermultivariate analysis. Both 4-variable MDRD eGFR and6-variable MDRD eGFR, rather than creatinine, weresignificant predictors of in-hospital mortality. Threenew equations were constructed (MELD-MDRD-4,MELD-MDRD-6, MELD-CKD-EPI). As expected, originalMELD score was a significant predictor of in-hospitalmortality (odds ratio = 1.25, P 【 0.001). MELD-MDRD-4 excluded serum creatinine, with the coeffi-cients refit among the remaining 3 variables, i.e., totalbilirubin, INR and 4-variable MDRD eGFR. This model represented an exacerbated outcome over MELD score,as suggested by a decrease in chi-square (2161.45 vs2198.32) and an increase in -2 log (likelihood) (2810.77vs 2773.90). MELD-MDRD-6 included 6-variable MDRDeGFR as one of the variables and showed an improvement over MELD score, as suggested by an increasein chi-square (2293.82 vs 2198.32) and a decrease in-2 log (likelihood) (2810.77 vs 2664.79). Finally, whenserum creatinine was replaced by CKD-EPI eGFR, itshowed a slight improvement compared to the originalMELD score (chisquare: 2199.16, -2 log (likelihood): 2773.07). In the receiver-operating characteristic curve, the MELD-MDRD-6 score showed a marginal improvement in area under the curve (0.909 vs 0.902), sensitivity (0.854 vs 0.819) and specificity (0.818 vs 0.839) compared to the original MELD equation. In patients with a different eGFR, the MELD-MDRD-6 equation showed a better predictive value in patients with eGFR ≥ 90, 60-89, 30-59 and 15-29.CONCLUSION: Incorporating eGFR obtained by the 6-variable MDRD equation into the MELD score showed an equal predictive performance in in-hospital mortality compared to a creatinine-based MELD score.
文摘Objective: To analyze the correlation between urine retinol binding protein-4 (RBP-4) and serum HbA1c?with glomerular filtration rate (GFR) in type 1 diabetic children. Methods:?This?was a crosssectional observational analytic?study. The subjects?were?type 1 diabetic children aged 2 - 14 years. Sample collection was conducted from October to November 2014. Exclusion criteria were patients with obesity, renal insufficiency?that?was not caused by diabetes, history of hepatic diseases, and history of blood cell disorders. We?performed anamnesis, physical examination, and blood sampling for serum HbA1c?and serum cystatin-C, and urine sampling for RBP-4?on all subjects. Glomerular filtration rate was calculated from the concentration level of cystatin-C using Filler formula. Data analysis was performed?by?Spearman test to determine the correlation between urine RBP-4 and serum HbA1c?with GFR. The Fisher’s exact test was used to determine the correlation between duration of diabetes and RBP-4, HbA1c, and also GFR. Results:?Twelve females (60%) and 8 males (40%) participated in the study. The mean age of the subjects with 95% CI?was: 10.5 (2 - 14) years while the mean age of duration diabetes with 95% CI: 3.8 (0.5 - 10) years. Twelve (60%) subjects had?<5 years duration of diabetes, while eight (40%) subjects had?≥5 years duration of diabetes. Twelve (60%) subjects had normal RBP-4 level, while eight (40%) subjects had?elevated RBP-4 level. The mean level of HbA1c?with 95% CI: 8.9 (5.1 - 15.2)%. Thirteen (65%) subjects had poor metabolic. The mean GFR of the subjects with 95% CI: 99.3 (35.2 - 147.4) mL/1.73/m2. Nineteen (95%) subjects had normal GFR, while 1 (5%) had renal insufficiency. The results of data analysis using Spearman test on the correlation between urine RBP-4 and serum HbA1cwith GFR were not significant. The result of correlation between duration of diabetes and urine RBP-4 was significant?using?Fischer’s test. Conclusion:?The results?showed?no correlation between urine RBP-4 and serum HbA1c?with GFR. Urine RBP-4 could?be considered to assess renal function in type 1 diabetic patients with a duration of diabetes of more than 5 years.
基金the General Financial Grant from the China Postdoctoral Science Foundation(No.2014M560722)the Natural Science Foundation of Sichuan University of Science and Engineering(No.2015RC30)the Science and Technology Support Program of Sichuan Province of China(No.2017RZ0083).
文摘The abnormal growth of epithelium-like cells has been noticed in spontaneously hypertensive rats(SHRs)with hypertensive nephropathy.However,the characteristics of abnormal epithelium-like cells and their pathogenesis in hypertensive nephropathy are not fully understood.In the present study,we investigated the correlation of epithelium-like cells with glomerular injury,and the effects of early drug intervention with telmisartan,an anti-hypertensive drug,on the growth of epithelium-like cells.The results showed that the epithelium-like cells were obviously observed lining along the luminal surface of Bowman’s capsule in glomeruli,significantly resulting in the atrophy of the glomerular tuft.Some of the epithelium-like cells strongly expressed proliferating cell nuclear antigen(PCNA)and vimentin,indicating active cellular proliferation.The incidence of epithelium-like cells varied from 13.6%to 54.4%of glomeruli in 48-week-old SHRs,and from 5.1%to 18.0%of glomeruli in age-matched Wistar-Kyoto(WKY)rats(P<0.01).The linear regression analysis further confirmed an obvious correlation between the incidence of epithelium-like cells and the glomerular injury.Moreover,early intervention with telmisartan could dramatically attenuate the progression of epithelium-like cells growth.However,no significant effect of telmisartan on the established epithelium-like cells was observed.Taken together,we demonstrated the involvement of abnormal epithelium-like cells growth in glomerular injury during hypertensive nephropathy in SHRs,and firstly showed the positive effects of the anti-hypertensive drug on the progression of epithelium-like cells growth.
基金This project was supported by the National Natural Science Foundation of China(No.81873596).
文摘Vesicoureteral reflux(VUR)is one of the most common urinary tract anomalies in children and causes renal damage and studies focusing on the effect of VUR on renal function are rare.We recruited 35 primary VUR patients with recurrent urinary tract infection(UTI)and 10 non-VUR patients with recurrent UTI.Contrast-enhanced voiding urosonography(ceVUS)was performed for VUR grading,and renal dynamic imaging was used for evaluating glomerular filtration rate(GFR,mL/min).Standardized GFR(sGFR),namely GFR/BSA(mL·min-1·m-2),was calculated based on the body surface area(BSA).Total sGFR(tsGFR,mL·min-1·m-2)was obtained from the sum of sGFR on the left and right sides of all the children.The risk of renal regurgitation was equal in the unilateral reflux group.The sGFR of children with grade Ⅳ(45.74±18.05mL·min-1·m-2)and grade V(49.67±23.63mL·min-1·m-2)reflux was significantly lower than that in children with grade Ⅱ(77.69±22.21 mL·min-1·m-2).The renal function compensation of contralateral non-reflux kidney increased in unilateral reflux group,which was higher than that in the control group and level Ⅱ,Ⅳ and Ⅴ of reflux group respectively.In VUR group of the same grade,sGFR decreased with the age at diagnosis.In unilateral grade V refux group,the tsGFR was lower than that in the unilateral grade I reflux group(133.51±48.21 vs.186.87+53.49mL·min-1·m-2).The patients with VUR of unilateral grade Ⅱ were significantly older than those with VUR of unilateral grades Ⅱ and Ⅳ.This study indicates that severe VUR is significantly associated with decreased renal function.Therefore,VUR should be diagnosed early and managed individually.
文摘The authors conducted a retrospective study over a period of 6 months in a hypertensive population in order to determine the correlation between serum uric acid on glomerular filtration rate (GFR) and estimated serum potassium with left ventricular hypertrophy (LVH) and obesity. This study enrolled 122 patients including 63 women (51.6%). The mean age was 55.9 ± 10.6 years (range 30 to 74 years). Obesity weight was found in 38 cases (31.1%) of which 20?were men (33.9%) and 18 women (28.6%). Abdominal obesity was found in 104 cases (85.2%). The average serum uric acid in patients with obesity weight was 63.3 ± 18.9 mg/L vs 62.4 ± 14.2 mg/L for no-obese patients (p?= 0.63). The average serum potassium in obese patients was 4.06 ± 0.42 mEq/L vs 4.02 ± 0.46 mEq/L for no-obese (p?= 0.65). The average GFR was 73.4 ± 21.4 ml/L in obese patients vs 66.6 ± 22.6 ml/min in no-obese (p?= 0.03). The LVH was found in 81 cases (66.4%). The LVH was found in 65 (62.5%) obese patients vs?16 (88%) non-obese patients (OR = 4.8, 95% 1.04?-?22?p?= 0.02). Only abdominal?obesity has been correlated with left ventricular hypertrophy after multivariate analysis. Emphasis must be focused on public health actions for effective and appropriate measures against obesity and hypertension, whose prevalence is increasing in our region.
文摘Introduction: Tc-99m Di-ethylene Tri-amine Penta Acetic Acid (DTPA) renogram is an accepted method to measure Glomerular Filtration Rate (GFR) of the kidneys. The depth and position of ectopic kidneys may vary. This may lead to variation in tissue attenuation and error in the computed GFR and Differential Renal Function (DRF) of each kidney. Objective: The present study was undertaken in patients with ectopic kidneys to improve the accuracy of GFR and DRF calculation in a renogram with single injection of Tc-99m DTPA on a dual head gamma camera. Materials and Method: The study was conducted on 55 patients with ectopic kidneys. Images were acquired on a dual head gamma camera simultaneously in anterior and posterior views. Both anterior and posterior image datasets were used to compute the GFR of the ectopic kidney by Gates method. Depth correction of the ectopic kidney was done using the lateral view image. Total GFR was calculated as the sum of the anterior dataset ectopic kidney GFR and the posterior dataset normal kidney GFR. DRF was calculated again, by using the anterior dataset GFR of the ectopic kidney and posterior dataset for normal kidneys. The total GFR calculated by our method was compared to the patient’s eGFR (based on serum creatinine, age and sex). Result: The GFR calculated by anterior data set in the ectopic kidney was significantly higher than that calculated by posterior dataset (p 0.001). Similarly, the differential GFR of the ectopic kidney was higher when the anterior dataset was used (p 0.001). The ectopic kidney GFR of 34 (61.8%) of the 55 patients was greater than 35 ml/min, whereas in 21 patients (38.2%), it was less than 35 ml/min. The total GFR calculated by using both anterior and posterior data set was compared with the eGFR;the correlation coefficient was 0.74 in patients with ectopic kidney GFR of >35 ml/min and 0.83 in those with Conclusion: The GFR of ectopic kidney as calculated from the anterior data set was significantly higher in comparison to the GFR calculated from the posterior data set (p 0.001). Using the anterior dataset GFR, the DRF values for the ectopic kidneys was also significantly higher (p 0.001). This method improves the accuracy of the GFR and DRF values and helps to differentiate a normally functioning ectopic kidney from a poorly functioning one. Compared to the total GFR as calculated by the present method, the eGFR showed a better correlation in patients with ectopic kidney
基金supported by the grants from the Major State Basic Research Development Program of China 2013CB530803the National Natural Science Foundation of China H0511-81370843 and H051181670677+3 种基金Chinese Society of Nephrology(15020020590)the Innovation of Science and Technology Achievement Transformation Fund of Jiangsu Province BL2012066the Chinese Medical Association of Clinical Medicine Research Special Funds 15020020590a Project Funded by the Priority Academic Program Development of Jiangsu Higher Education Institutions JX10231801
文摘Renal dysfunction is a common side-effect of chemotherapeutic agents in patients with hematopathy. Although broadly used, glomerular filtration rate(GFR) estimation equations were not fully validated in this specific population. Thus, this study was designed to further assess the accuracy of various GFR equations, including the newly 2012 CKD-EPI equations. Referring to ^(99m)Tc-DTPA clearance method, three Scr-based(MDRD, Peking, and CKD-EPI_(Scr)), three Scys C-based(Steven 1, Steven 2, and CKD-EPI_(Scys C)), and three Scr-Scys C combination based(Ma, Steven 3, and CKD-EPI_(Scr-Scys C)) equations were included. Bias, P_(30), and misclassification rate were applied to compare the applicability of the selected equations. A total of 180 Chinese hematological patients were enrolled.Mean bias, absolute mean bias, P_(30), misclassification rate and Bland-Altman plots of the CKD-EPI_(Scr-Scys C) equation were 7.90 mL/minute/1.73 m^2, 17.77 mL/minute/1.73 m^2, 73.3%, 38% and 79.7 mL/minute/1.73 m^2, respectively.CKD-EPI_(Scr-Scys C) predicted the most precise eGFR both in lymphoma and leukemia subgroups. Additionally, CKDEPI_(Scys C) equation in the rGFR■90 mL/minute/1.73 m^2 subgroup and Steven 2 equation in the rGFR<90 mL/minute/1.73 m^2 subgroup provided more accurate estimates in each subgroup. The CKD-EPI_(Scr-Scys C) equation could be recommended to monitor kidney function in hematopathy patients. The accuracy of GFR equations may be closely related with GFR level and kidney function markers, but not the primary cause of hematopathy.
文摘AIM To evaluate the influence of creatinine methodology on the performance of chronic kidney disease(CKD)-Epidemiology Collaboration Group-calculated estimated glomerular filtration rate(CKD-EPI-eGFR) for CKD diagnosis/staging in a large cohort of diabetic patients. METHODS Fasting blood samples were taken from diabetic patients attending our clinic for their regular annual examination, including laboratory measurement of serum creatinine and eGFR.RESULTS Our results indicated an overall excellent agreement in CKD staging(kappa = 0.918) between the Jaffé serum creatinine-and enzymatic serum creatinine-based CKDEPI-eGFR, with 9% of discordant cases. As compared to the enzymatic creatinine, the majority of discordances(8%) were positive, i.e., associated with the more advanced CKD stage re-classification, whereas only 1% of cases were negatively discordant if Jaffé creatinine was used for eGFR calculation. A minor proportion of the discordant cases(3.5%) were re-classified into clinically relevant CKD stage indicating mildly to moderately decreased kidney function(< 60 m L/min per 1.73 m^2). Significant acute and chronic hyperglycaemia, assessedas plasma glucose and Hb A1 c levels far above the recommended glycaemic goals, was associated with positively discordant cases. Due to a very low frequency, positive discordance is not likely to present a great burden for the health-care providers, while intensified medical care may actually be beneficial for the small number of discordant patients. On the other hand, a very low proportion of negatively discordant cases(1%) at the 60 m L/min per 1.73 m^2 eGFR level indicate a negligible possibility to miss the CKD diagnosis, which could be the most prominent clinical problem affecting patient care, considering high risk of CKD for adverse patient outcomes. CONCLUSION This study indicate that compensated Jaffé creatinine procedure, in spite of the glucose-dependent bias, is not inferior to enzymatic creatinine in CKD diagnosis/staging and therefore may provide a reliable and cost-effective tool for the renal function assessment in diabetic patients.
文摘We investigated the link between estimated glomerular filtration rate (eGFR) and coffee consumption in Japanese. We used data of 376 men and 794 women who were not taking any medications, aged 20 - 78 years, in this cross- sectional investigation study. eGFR was calcu-lated using serum creatinine (Cr), age and sex. Habitual coffee consumption was defined as drinking one or more cups of coffee per day. Two hundred thirty three men (62.0%) and 400 women (50.4%) were subjects with habitual coffee consumption (coffee consumption 1 cup/ day ≥). eGFR was negatively correlated with age (men: r = –0.533, women: r = –624). eGFR in subjects with coffee consumers was not significantly different from that in subjects without coffee consumers after adjusting for age in both sexes (men: p = 0.1375, women: p = 0.2069). Among Japanese not taking medications, coffee consumption was not associated with eGFR in the Japanese population.
文摘Background: Kidney disease, even when mild, was once considered so major an impediment to successful pregnancy and so dangerous to the mother’s wellbeing. High-risk pregnancy mainly associated to renal impairment may occur in 10-20% of gestations and it is very important that renal function is closely monitored to prevent or minimize maternal and fetal complications. This study was designed to investigate the performance of Cockcroft-Gault CGeq and the simplified MDRDeq equations in healthy pregnant women to assess renal function. Methods: We studied 167 normal ambulatory pregnant women and kidney function was contemporaneously estimated through the CGeq and the simplified MDRDeq and calculated through the creatinine clearance (Ccr). Serum and urinary creatinine were assayed using Jaffé reaction method in the same AutoAnalyser. Results: When we compared calculated and estimated clearences for measurement of kidney function we observed that CGeq overestimated renal function (CGeq = 168.41 ± 38.80 ml/ min/1.73 m2, Ccr = 146.27 ± 30.49 ml/min / 1.73 m2, p < 0.001), MDRDeq underestimated renal function (Ccr = 146.27 ± 30.49 ml/min / 1.73 m2, MDRDeq = 129.15 ± 29.28 ml/min / 1.73m2, p < 0.001). Conclusions: Our results demonstrated that CGeq overestimated, MDRDeq underestimated significantly kidney function during gestation in healthy women and cannot be recommended to assess renal function in obstetric practice. Ccr remains a useful clinical tool in pregnant women until the development of a specific equation that considers the several important maternal renal physiological alterations and provides the measure of GFR the most unbiased and precise as possible.
