慢性肾脏病（chronic kidney disease，CKD）已成为全球性的公共卫生问题。“肾脏病预后质量倡议（Kidney Disease Outcome Quality Initiative，KDOQI）”和“改善全球肾脏病预后组织（Kidney Disease: Improving Global Outcomes，KDIGO）”工作组先后制定了CKD 临床实践指南。为提高我国CKD防治水平，在参考国外指南基础上，结合中国特点，我们组织上海市肾脏病专家制定了《CKD筛查 诊断及防治指南》，并于2017年发表。该指南对各级全科医师和肾脏病专科医师均有参考价值，有力推动了对CKD的认识和提高了对CKD的管理水平。近年来CKD 研究又取得了很多重大进展，基于临床证据的积累及各种新药的问世，上海市肾内科临床质量控制中心专家组对2017年版《CKD筛查 诊断及防治指南》进行了更新和修订，内容主要包括CKD筛查的对象和方式、进展的评估及防治等方面。

糖尿病肾脏疾病（diabetic kidney disease，DKD）是我国常见病与多发病，同时也是引起终末期肾脏病的主要原因。因此，加强DKD防治具有重要意义。目前，国内外已颁布了多种有关糖尿病诊断、治疗、管理的临床指南或专家共识，其中也涉及了DKD诊疗的部分内容，但并不能满足肾科医生的需求。对DKD患者这一特殊人群，合理用药、规范诊疗、细化管理等问题仍有待解决。另外，随着医疗新技术的发展，有关DKD的知识不断更新，特别是新型药物的临床应用，拓展了DKD诊疗策略，因此有必要编写一部适用于中国人群的DKD诊疗指南。鉴于此，中华医学会肾脏病学分会组织了专家组编写了这部《DKD临床诊疗中国指南》。该指南参考了国内外相关指南与专家共识，整合了中国肾脏病专家的临床经验，系统地介绍了DKD诊断、肾脏病理活检、治疗与管理、合并症处理及常用药物的合理应用等问题。另外，专家组在编写过程中本着严谨、简明、权威的原则，参阅了国际指南格式，提出诊疗要点、逐条列证说明。该指南反映了当今DKD诊疗的新趋势、新观点，对进一步加强DKD认识、规范DKD诊疗体系、制定合理治疗原则、指导精准用药、延缓肾脏病进展、提高患者生活质量具有重要价值，可供广大医师在临床工作中参考。

Objective To investigate the death causes and risk factors of uremia patients in order to improve the prognosis of uremia patients. Methods Clinical data of 247 uremia inpatients and outpatients from 2001 to 2011 in our hospital were retrospectively analyzed. Dead patients were served as death group (n=124) and survival patients as control group (n=123). Death causes and primary disease were studied. Frequency of hemodialysis, prealbumin, albumin, natremia and pulmonary infection were compared between two groups. Results Age and gender were not associated with the death of uremia patients. The most common cause of death was cardiovascular disease followed by respiratory failure，uremic encephalopathy, cerebral hemorrhage, gastrointestinal hemorrhage, etc. Hemodialysis frequency, prealbumin, albumin and natremia of dead patients were obviously lower than those of control group. More patients in death group suffered from pulmonary infection. Logistic multivariate analysis revealed that death risk increased by 40.7% when reducing 1 time per week of hemodialysis; death risk increased by 53.4% when reducing 50 mg/L of prealbumin; death risk increased by 14.6% when reducing 5 mmol/L of blood sodium; death risk of patients with pulmonary infection increased by 15.06 times of patients without pulmonary infection; death risk of diabetes mellitus increased by 4.26 times of patients without diabetes mellitus. Conclusions Cardiovascular disease, respiratory failure, uremic encephalopathy, cerebral hemorrhage, and gastrointestinal hemorrhage are common causes of death in uremia patients. Hemodialysis frequency, prealbumin, hyponatremia, pulmonary infection and diabetes can be regarded as risk factors for death of uremia patients.

Objective To explore the predicting value of plasma asymmetric dimethylarginine (ADMA) in cardiac structure and function of patients with chronic kidney diseases (CKD). Methods A total of 100 CKD patients were enrolled in this cross-sectional study. According to staging of the K-DOQI guideline, CKD patients were divided into five groups. Twenty healthy people were enrolled as control. Plasma level of ADMA was determined by reversed-phase high performance liquid chromatography. Cardiac structure and function were detected by color echocardiography. Results Plasma levels (μmol/L) of ADMA in CKD stage 3 to 5 patients (1.3318±0.4684, 1.5712±0.4210, 2.1093±0.7714) were significantly higher than those in CKD stage 1, 2 patients (0.4387±0.2575, 0.4809±0.2846) and healthy control (0.4611±0.1615) (all P<0.01). Meanwhile, ADMA level of CKD stage 5 was significantly higher as compared to CKD stage 3-4. The left ventricular mass index (LVMI) was significantly higher in stage 4-5 patients than that in stage 1-3 and healthy control. Plasma ADMA was positively correlated with LVMI (r=0.476, P=0.028) and negatively correlated with left ventricular ejection fraction (EF) (r=-0.327, P=0.041). Multivariate stepwise Logistic regression analysis revealed plasma ADMA level was an independent predictors for EF (OR=0.984, P＜0.01). Conclusions Plasma level of ADMA begins to increase in CKD patients of stage 3 and rises proportionally to the decline of renal function. Plasma ADMA level is useful in predicting the cardiovascular complications of CKD patients.

Objectives To modify glomerular filtration rate (GFR) estimating equation (also called abbreviated MDRD equation) based on plasma creatinine (Pcr) and other demographic data from Chinese chronic kidney disease (CKD) population， and compare the diagnostic performance of the modified abbreviated MDRD equations with that of original abbreviated MDRD equation in different CKD stages. 

Methods Six hundred and eighty-four patients with CKD including 352 males and 332 females，with average (49.9±15.8) years，were collected from 9 renal institutes of university hospital located in 9 different geographic regions of China，and were enrolled in this study from June 2004 to September 2005. Four hundred and fifty-four cases were randomly selected to be included in the training samples， and the remaining 230 cases were used as testing samples. Using 99mTc-diethylene triamine pentaacetic acid(99mTc-DTPA) plasma clearance by dual plasma sampling method as reference GFR(rGFR)，the original abbreviated MDRD equation was modified by the following two methods. Firstly， a racial factor for Chinese was added to the original abbreviated MDRD equation. Secondly， multiple linear regression was applied to the training sample， and the coefficient associated with each variable in the original abbreviated MDRD equation was modified respectively. The modified equations were validated in the testing samples and were compared with the original abbreviated MDRD equation. 

Results Both modified abbreviated MDRD equations showed significant performance improvement in bias(the areas between the regression line of difference and a common distance along the zero difference line were 543.0， 677.2， and 2175.0 arbitrary units， respectively)， precision [the widths between the 95% limits of agreement for the regression line of difference were 57.5，56.5 and 60.7 ml▪min^-1▪(1.73 m²) ^-1， respectively]. Compared with the original abbreviated MDRD equation，the 30% accuracy of modified abbreviated MDRD equations was significantly higher(from 66.1% to 77.8% and 79.6%， P < 0.05). 

Conclusions Compared with original abbreviated MDRD equation，the modified abbreviated MDRD equations based on the Chinese CKD patients offer significantly advantages in different CKD stages. It can be applied to GFR estimation in substitution of original abbreviated MDRD equation.

Objective    To evaluate the efficacy and safety of calcium polystyrene sulfonate in treating hyperkalemia patients with chronic kidney disease.  Methods    A single-arm, open, multi- center, phase Ⅳ clinical trial was carried out. Ninety-eight patients were enrolled in 11 centers from September 5, 2011 to June 21, 2012. The patients took calcium polystyrene sulfonate 15 g/d for one week. Total 5 visits were on 0, 2, 4, 8 and 14 days respectively.  Results    One day after treatment, potassium levels decreased rapidly from (5.85±0.26) mmol/L to (5.16±0.51) mmol/L (P＜0.01) and average value dropped to normal range. Three days after treatment, serum potassium levels decreased to (4.88±0.58) mmol/L(P＜0.01). After one week of treatment, serum potassium levels decreased to (4.67±0.57) mmol/L (P＜0.01). A week after the withdrawal, potassium levels were (4.96±0.66) mmol/L (P＜0.01). Serum potassium levels in all visits during the treatment and after discontinuation of calcium polystyrene sulfonate were all significantly decreased comparing to the baseline level (all P＜0.01). At the same time, serum levels of sodium, phosphorus, calcium showed no significant changes during the treatment. Constipation (9.2% ) was the commonest side effect. There was no treatment-related serious adverse effect.  Conclusions    This single-arm, open, multi-center clinical study shows that calcium polystyrene sulfonate is effective and safe in treating hyperkalemia due to chronic kidney disease.

Objective To study interdialytic body weight gain (IBWG) in maintenance hemodialysis (MHD) patients, and to analyze the associated factors. Methods A total of 269 patients undergoing maintenance hemodialysis were enrolled in this cross-sectional study. The patients were divided into two groups according to the percentage of IBWG (PIBWG: interdialytic body weight gain/dry weight×100%): PIBWG>3.50% (190 cases) and PIBWG≤3.50% (79 cases). Associated factors of IBWG were analyzed. Results The average IBWG of 269 MHD patients was (2.42±1.01) kg (0-6.33 kg), and PIBWG was (4.25±1.79)%. In male patients, IBWG was (2.45±1.09) kg, and PIBWG was (3.99±1.79)%. In female patients, IBWG was (2.39±0.85) kg, and PIBWG was (4.64±1.74)% which was significantly higher compared to males (P<0.01). Patients with PIBWG＜3.00% accounted for 20%, with PIBWG≥3.00% to ＜5.00% accounted for 50%, with PIBWG≥5.00% accounted for 30%. Compared to patients with PIBWG>3.50%, those with PIBWG≤ 3.50% were characterized by elder age (year) (60.50±14.49 vs 54.07±13.78), more males ( 70.88% vs 54.74%), shorter dialysis duration (month) (41.03±41.92 vs 58.83±43.57), larger BMI (kg/m2) (22.67±3.36 vs 20.91±3.25) and less dry weight (kg) (56.69±10.94 vs 62.82±10.97), more residual urine (ml, In) (6.19±0.94 vs 5.48±0.8), lower predialysis serum β2-MG (mmol/L) (31.61±9.82 vs 38.54±10.38) and phosphorus(mmol/L) (1.92±0.66 vs 2.15±0.58). Correlation analysis revealed that PIBWG was positively correlated with dialysis duration, Scr, BUN, β2-MG, phosphorus, decrease and decrease percentage of BP during hemodialysis, and negatively correlated with age, dry weight, BMI, residual urine, and pre-dialysis SBP, MAP. Conclusions PIBWG of about 70% of our patients was below 5%. Young, female, low BMI and dry body weight, long dialysis duration, low residual urine, chronic glomerulonephritis and diabetic nephropathy are associated with more IBWG, which may lead to greater intradialytic BP fluctuation.

Objective To identify an adequate measurement of glomerular filtration rate (GFR) in clinical practice. Methods ^99mTc-DTPA clearance (^99mTc-GFR) was measured as GFR marker in 101 patients with different chronic kidney disease. At same time GFR was determiued and calculated via the iohexol clearance (iohexol-GFR); the equation developed from the Modification of Diet in Renal Disease Study (MDRD-GFR)and Cockcroft-Gault formula(CG-Ccr)according to Scr. They were analyzed by correlation and regression, receiver operating characteristic (ROC) curve. Results According to the standard of NKF/K-DOQI, from the first to fifth stage of chronic kidney disease, the correlation coefficients for iohexol-GFR were 0.87, 0.89, 0.88, 0.86, 0.87 respecfiuerg(P < 0.001). The mean area under ROC curve of iohexol-GFR was 0.97; the correlation coefficients for MDRD-GFR were 0.80&#65380; 0.75&#65380; 0.71&#65380; 0.67&#65380; 0.56 respecfiuely(P < 0.01). The mean area under ROC curve of MDRD-GFR was 0.82; the correlation coefficients for CG-Ccr were 0.76&#65380;0.67&#65380; 0.62&#65380; 0.60&#65380; 0.53(P < 0.05). The mean area under ROC curve of CG-Ccr was 0.82. Conclusions Iohexol-GFR is the most accurate measurement among the three methods. The accuracy of MDRD-GFR is more accurate than CG-Ccr.

Objective    To evaluate if KDIGO (kidney disease: improving global outcomes) criteria for short?term prognosis of cardiorenal syndrome type I was superior to RIFLE (risk, injury, failure, loss of kidney function, end?stage kidney disease) and AKIN (the acute kidney injury network) criteria.    Methods    Data was retrospectively collected from patients with acute heart failure in Guangdong General Hospital between July 2005 and July 2012. The in?hospital mortality was regarded as outcome measures. Baseline serum creatinine was defined as first serum creatinine on admission. Kaplan?Meier curve was used to evaluate in?hospital survival by three AKI criteria and AKI by KDIGO but not RIFLE or AKIN in patients with cardiorenal syndrome type I. Cox regression was used for multivariate analysis of in?hospital mortality.    Results    Among 732 patients, 154 cases (21%) were diagnosed as AKI by KDIGO instead of RIFLE or AKIN. Incidence for the cardiorenal syndrome type I by KDIGO, RIFLE and AKIN were significantly different (54.7% vs. 38.6%, 54.7% vs 50.1%, P＜0.001). Kaplan?Meier curve showed that in?hospital survival rates of patients with AKI diagnosed by KDIGO but not RIFLE or AKIN are lower than those without AKI (Log rank P=0.011). Cox regression indicated that AKI by KDIGO but not RIFLE or AKIN was an independent risk factor of in?hospital mortality (P=0.008).    Conclusion    KDIGO criteria is superior to RIFLE and AKIN criteria on predicting in?hospital mortality of cardiorenal syndrome type I.

Objective To explore the prognostic value of Acute Kidney Injury Network (AKIN) criteria combined with Acute Physiology and Chronic Health EvaluationⅡ (APACHEⅡ) and Sequential Organ Failure Assessment (SOFA) scoring system in acute kidney injury (AKI) after cardiac surgery. Methods Clinical data of patients who underwent open-heart surgery in Zhongshan Hospital, Fudan University from April 2009 to August 2009 were prospectively collected. AKI after cardiac surgery was classified by AKIN staging system. APACHEⅡ and SOFA scores were evaluated according to the worst value of physiologic variables in the 1st 24 h after surgery. Discrimination and calibration of these three models were assessed by receiver operating characteristic (ROC) curve and Hosmer-Lemeshow goodness-of-fit test. Besides, their effects on in-hospital mortality were evaluated by multivariate Logistic regression analysis. Results Of the 993 admissions, 309 patients developed AKI and the incidence was 31.1%. The median time that developed postoperative AKI and reached the Scr peak were 1 d and 2 d respectively. Either APACHEⅡ or SOFA scores, which was positively correlated with the severity of AKI (APACHEⅡr=0.37, P<0.01; SOFA r=0.42, P<0.01) was higher in AKI patients compared with that in non-AKI patients (P<0.01). The mortality rose corresponding to the severity of kidney injury. However, the predicted death rate-adjusted (PDR-A) calculated by APACHEⅡ scores was higher than the actual value in non-AKI patients and AKIN stage 1 (P<0.01), while it was lower in AKIN stage 3 (P<0.01). The areas under the ROC curve of APACHEⅡ, SOFA and AKIN criteria were all above 0.8 and the results of Hosmer-Lemeshow goodness-of-fit test indicated good calibration of three models. Multivariate analysis showed that APACHEⅡ≥19 (OR=4.26) and AKIN stage 3 (OR= 76.15) were independent predictors of in-hospital mortality. Conclusions AKI can be classified by AKIN criteria in the early stage after cardiac surgery and the AKIN staging system may serve the prediction of prognosis. The APACHEⅡ and SOFA scores just evaluated in the 1st 24 h after operation can discern the severity of patients' illness. Three models all present good discrimination and calibration in predicting patients' outcome. APACHEⅡ≥19 along with AKIN stage 3 are found to be the independent predictors of in-hospital mortality. It should be noticed that the deviation between PDR-A and the actual mortality in subgroups, dynamic evaluation may raise the accuracy of scoring system.

Objective To study the effect of medically activated charcoal on serum phosphorus level and calcium-phosphorus products in dialysis patients with poorly controlled hyperphosphatemia. Methods A single-center, prospective, self-controlled study was performed. Medically activated charcoal was administered 4.5-7.2 g per day with meals for three months to hemodialysis or peritoneal dialysis patients with hyperphosphatemia after taking calcium-based phosphate binders. The levels of blood phosphorus, calcium, calcium-phosphorus products, intact parathyroid hormone (iPTH), albumin and hemoglobin were detected before and after the treatment. The results were analyzed using paired t-test. Results After 3 months of treatment, the patients’ serum phosphorus level was significantly reduced from (2.16±0.34) mmol/L (pre-treatment) to (1.85±0.30) mmol/L (post-treatment) (P<0.01). Similarly, the serum calcium-phosphorus products were lowered from pre-treatment level of (63.93±8.83) mg2/dl2 to post-treatment of (54.12±8.37) mg2/dl2 (P<0.01). Serum albumin level was slightly reduced from (41.7±2.9) g/L to (40.1±2.2) g/L (P=0.001). In contrast, there were no significant changes in serum calcium and iPTH levels when compared pre- to post-treatment values (P=0.734 and P=0.665, repectively). Conclusion In combination with calcium-based phosphate binder therapy, oral medically activated charcoal can effectively reduce the levels of blood phosphorus and calcium-phosphorus products in dialysis patients with refractory hyperphosphatemia.

Objective      To evaluate the effects of high glucose on autophagy and apoptosis of podocyte and explore the signaling pathway in high glucose - induce podocyte autophagy.    Methods       Differentiated mouse podocytes were exposed to high glucose(30 mmol/L) or rapamycin (autophagy enhancer, 1 μg/L) or LY294002 (a selective PI3K inhibitor, 50 mmol/L) for 24 h. The formations of autophagy were observed by electron microscopy and acridine orange staining. Apoptosis was evaluated by flow cytometry. The expression of autophagy protein LC3 - II/I and Beclin - 1 as well as the phosphorylation of AKT and mTOR were examined by Western blotting analysis.   Results       High glucose induced podocytes apoptosis，increased autophagy and the expression of autophagy-associated proteins (all P＜0.05). Rapamycin further increased the expression of LC3-II and Beclin-1 protein (all P＜0.05)，but LY294002 inhibited partialiy the protein expression of LC3-II and Beclin-1 induced by high glucose (both P＜0.05). Treatment with rapamycin increased the phosphorylation of AKT, but reduced that of mTOR in podocytes. Moreover, LY294002 inhibited phosphorylation of both AKT and mTOR (both P＜0.05).   Conclusions       High glucose promotes podocyte autophagy and apoptosis. High glucose-induced autophagy is mediated partly through PI3K-AKT-mTOR signaling pathway.

Objective To investigate the clinicopathological characteristics and treatment of C1q nephropathy in children. Methods Data of 23 C1q nephropathy cases in Nanjing Children’s Hospital during recent eight years were retrospectively reviewed. Results The incidence of C1q nephropathy was 4.78% in primary glomerulonephritis proven by biopsy. Among 23 patients, 15 were boys and 8 were girls. The mean age at onset was (5.0±3.4) years old with a range of 0.9-12.4 years. The clinical manifestations included nephrotic syndrome (NS) in 18 cases (78.3%), nephrotic-range proteinuria in 4 cases (17.4%) and microhematuria in 1 case. Two patients with NS and one patient with nephrotic-range proteinuria also presented microhematuria. One patient with NS who received oral herbal medicine for two weeks developed acute renal insufficiency at the same time of diagnosis. Three cases had a family history of kidney disease, among them two patients (presented nephrotic range proteinuria) were siblings, their father had proteinuria as well, and routine genetic examination confirmed familial Denys-Drash syndrome in association with C1q nephropathy. One NS patient’s sister had nephrotic-range proteinuria too, but renal biopsy was not performed. No patient had hypertension. None of the patients had low C3 or C4 levels, and serological markers of systemic lupus erythematosus were absent. Light microscopy showed minimal change disease (MCD) in 13 cases (56.5%), mesangial proliferative glomerulonephritis (MsPGN) in 6 (26.1%) and focal segmental glomerulosclerosis (FSGS) in 4 (17.4%). Immunofluorescence displayed C1q co-deposits of IgG (78.3%), IgM (78.3%), IgA (34.8%) and C3 (47.8%), and a “full-house” pattern was found in 6 patients (26.1%). Electron microscopy revealed 4 out of 19 had mesangial deposits, except for 4 patients whose glomerulus could not be found. Children with either NS (18 cases) or nephrotic-range proteinuria (2 cases) received prednisone, among them, 15 were steroid-resistant, 4 were steroid-dependent, only 1 was steroid-sensitive. Those with steroid-resistant (15 cases) or steroid-dependent (3 cases) received further immunosuppression with cyclophosphamide (CTX) or cyclosporine A(CsA). One NS case of steroid-dependent received prednisone re-induction therapy. The siblings associated with Denys-Drash syndrome and one case presented microhematuria were commenced on angiotensin-converting enzyme inhibitor (ACEI). Of the 19 patients with sufficient follow-up date, 15 cases(78.9%) achieved complete remission, 2 cases(10.5%) achieved partial remission, and 2 cases (10.5%) were ineffective. Median follow-up was 15 months. Remission of the NS occurred in 94.4% (17/18) while nephrotic-range proteinuria was 50.0%(2/4). Remission of MCD was 100.0%, MsPGN was 83.4%(5/6), but FSGS was only 50.0%(2/4). Conclusions C1q nephropathy is rare, and often manifests as steroid-resistant or steroid-dependent NS and nephrotic-range proteinuria. The most common histological feature is MCD, and some as MsPGN or FSGS. A combination of prednisone and immunosuppressive agent is always effective for MCD and MsPGN, but FSGS always has a poor response.

Objective To investigate the incidence and prognosis of cognitive impairment and to find out the risk factors associated with the outcome for better understanding and preventing cognitive impairment in maintenance hemodialysis (MHD) patients. Methods The patients who met the criteria as below: MHD patients (≥3 months) in Renji Hospital, Shanghai Jiao Tong University School of Medicine from January 2000 to July 2014, ≥18 years old were enrolled and could carry on the montreal cognitive assessment (MoCA) of voluntary cooperation. According to the score of MoCA, all enrolled patients were divided into two groups: cognitive impairment (MoCA＜26) group and non-cognitive impairment (MoCA≥26) group. The follow-up period was 3 years. There were 130 males, and the incidence, demography data, medical history, hemodialysis data, laboratory examination and prognosis of cognitive impairment in hemodialysis patients were prospectively compared and analyzed. Logistic regression analysis was used to investigate the risk factors of cognitive impairment. Kaplan-Meier survival curve and Cox regression model were used for prognostic analysis. Results A total of 219 MHD patients were enrolled. The incidence of cognitive impairment in MHD patients was 51.6%. There were 130 males, and the ratio of male to female was 1.46∶1. Age was (60.07±12.44) years old and dialysis vintage was (100.79±70.23) months. Compared with non-cognitive impairment group (n=106), patients in cognitive impairment group (n=113) were older, and had higher proportion of education status＜12 years, history of diabetes and anuria (all P＜0.05); however, the post-dialysis systolic pressure, pre-dialysis diastolic pressure, post-dialysis diastolic pressure, platelet and spKt/V were lower (all P＜0.05). Multivariate logistic regression analysis showed that education status＜12 years (OR=3.428, 95%CI 1.919-6.125, P＜0.001), post-dialysis diastolic pressure＜73 mmHg (OR=2.234, 95%CI 1.253-3.984, P=0.006) and spKt/V＜1.72(OR=1.982, 95%CI 1.102-3.564, P=0.022) were the independent risk factors for cognitive impairment in MHD patients. The Kaplan-Meier survival curve analysis showed that the survival rate of patients with cognitive impairment was lower than that of non-cognitive impairment group in MHD patients during 3 years follow-up (χ2=3.977, P=0.046). Multivariate Cox regression analysis showed that cognitive impairment was an independent risk factor for death in MHD patients (RR=2.661, 95%CI 0.967-7.321, P=0.058). Conclusions Cognitive impairment is one of the common complications and an independent risk factor for death in MHD patients. The mortality is high in patients who suffer cognitive impairment. Education status ＜12 years, post-dialysis diastolic pressure＜73 mmHg and spKt/V＜1.72 are the independent risk factors for cognitive impairment in MHD patients.

Objective To investigate the correlation of serum anti-M-type phospholipase A2 receptor (PLA2R) antibody with laboratory parameters of idiopathic membranous nephropathy (IMN) in adult patients with membranous nephropathy (MN), and to explore the role of anti-PLA2R antibody in the pathogenesis of IMN. Methods Forty-six adult patients with biopsy-proved glomerular diseases were involved in this study, including 20 cases with IMN, 7 cases with IgA nephropathy (IgAN), 6 cases with hepatitis B-associated membranous nephropathy (HBV-MN), 6 cases with minimal change nephropathy (MCN), 4 cases with focal segmental glomerulosclerosis (FSGS) and 3 cases with class Ⅴ lupus nephritis. Total RNA was extracted from human glomeruli and was reversely transcribed to the first-strand cDNA. The full-length human M-type PLA2R was amplified by PCR and the 605 bp product was subcloned into eukaryotic expression vector containing CMV promoter. The recombinant human M-type PLA2R plasmid vector was transiently transfected into human embryonic kidney (HEK) 239T cell line using the FuGene6 transfection reagent. Western blotting was used to detect serum anti-PLA2R antibodies. Correlations of anti-PLA2R antibody level with laboratory parameters, including serum albumin, total cholesterol, Scr and 24-hour urine protein, of IMN patients were evaluated. Results Among 20 cases with IMN, 15 cases showed positive anti-PLA2R antibodies (positive rate 75%). Of 7 cases with IgAN and 6 cases with HBV-MN, only 1 case showed positive anti-PLA2R antibody respectively (positive rate 14.29% and 16.67% respectively). Anti-PLA2R antibody was negative in other patients. The positive rate of anti-PLA2R antibody in IMN patients was significantly higher than that in patients with secondary MN and other types of glomerlonephritis (all P<0.01). Furthermore, anti-PLA2R antibody level was positively correlated with 24-hour urine protein(r=0.803, P<0.01) and negatively correlated with serum albumin in IMN patients (r=-0.816, P<0.01). Conclusions The high positive ratio of anti-PLA2R antibody may indicate that it is the specific autoantibody in IMN. Anti-PLA2R antibody is correlated with IMN disease severity, which indicates that it may be the pathogenic autoantibody in IMN.

Objective To explore the association between coagulation indicators and all-cause mortality in sepsis-related acute kidney injury (AKI) patients. Methods Clinical data of patients with sepsis-related AKI admitted to the First Affiliated Hospital of Guangxi Medical University from June 10, 2016 to June 10, 2018 were retrospectively analyzed. The patients were divided into death group and survival group according to the outcome of 28 d. The risk factors of all-cause mortality in sepsis-related AKI patients were analyzed. Receiver operating characteristic curve (ROC) was used to evaluate the prognostic value of independent risk factor for the death of sepsis-related AKI patients and Kaplan-Meier method was used to draw the survival curve. Results A total of 214 patients with sepsis-related AKI were enrolled into this study. Their age was (57.90±16.96) years old, and the ratio of male to female was 2.57∶1. There was at least one abnormal coagulation indicator in 74.77%(160/214) of patients, and multiple organ dysfunction syndrome (MODS) in 37.38% of patients. The 28-day all-cause mortality was 28.04%(60/214). Prothrombin time, activated partial thrombin time (APTT), international standardized ratio, thrombin time, procalcitonin, abnormal coagulation indicators and the incidence of MODS in the death group were higher than those in the survival group, while body weight, hemoglobin, the percent of neutrophile granulocyte, platelet count, prothrombin activity, serum albumin and the proportion of renal replacement therapy (RRT) were lower than those in the survival group (all P＜0.05). Cox regression analysis suggested that sepsis-related AKI patients with prolonged APTT had a higher risk for all-cause death (HR=2.610, 95%CI 1.077-6.326, P=0.034). The Kaplan-Meier survival curve indicated that 28 d survival rate of APTT extension group was lower than that of the non-APTT extension group (37.1% vs 70.6%, Log-rank χ2=16.881, P＜0.001), and the average survival time was shorter than that of the non-APTT extension group (21.79 d vs 24.73 d). Conclusions Coagulation abnormalities are common in patients with sepsis-related AKI, which are also correlated to the all-cause death. APTT extension is an independent risk factor for the all-cause death in sepsis-related AKI patients.

Objective To investigate the association of genetic polymorphisms in glutathione S-transferases T1 (GSTT1), M1 (GSTM1) and P1 (GSTP1) with aristolochic acid nephropathy (AAN) of Chinese people in Wenzhou of China. Methods Fifty-nine patients with AAN (AAN group) including 29 male and 30 female as well as 157 healthy ethnically matched controls (control group) including 93 male and 64 female were enrolled in this study. The genotypes of GSTT1, GSTM1 and GSTP1 were determined by multiple PCR and confronting two-pair primers PCR (CTPP-PCR). Results The genotype frequencies of GSTP1 were in Hardy-Weinberg equilibrium. Compared with the healthy controls, the frequency of GSTT1 null genotype was significantly higher in the patients with AAN (66.1％ vs 48.4％，P<0.05). Risk of AAN for individuals with GSTT1 null genotype was 1.747 fold of those without GSTTI null genotype (95% CI=0.818-3.731). The frequency of GSTM1 null genotype, GSTP1 variant genotypes and GSTP1 G allele in the patients and in the controls were 40.7％, 28.8％, 16.1％ and 47.8％, 31.8％, 17.5％, respectively, which were not significantly different. No significant differences were found in prevalence of GSTM1 and GSTP1 gene distribution between patients and controls. Conclusion GSTT1 gene polymorphism appears to be associated with susceptibility to AAN in Southern China.

Objective To study the prevalence and risk factors of chronic kidney disease (CKD) among adults in Zhengzhou. Methods One thousand eight hundred and fifty five residents (≥20 years) from 4 communities in 4 districts of Zhengzhou city were randomly selected by using a stratified，multistage sampling． They were interviewed, and received physical examination and measurements of urine and blood for renal damage as well as risk factors. Results Eligible data of 1752 subjects were included in the study． After the adjustment of age and gender component, albuminuria was found in 5.78％ of the subjects, hematuria in 8.19％, and reduced renal function in 1.58％. Male had lower prevalence of albuminuria and hematuria (4.37％ vs 7.29％, χ2=6.252, P=0.012; 5.08％ vs 11.51％, χ2=24.499, P＜0.01), but higher prevalence of reduced eGFR（2.26％ vs 0.86％, χ2=5.830, P=0.016) as compared with female. The prevalence of albuminuria and reduced eGFR increased with age. The crude prevalence of CKD was 14.50%, while the standardized rate was 13.57％. The prevalence of female was higher than that of male (17.83％ vs 9.59％, χ2=23.132, P＜0.01), which also increased with age. The most common manifestations of CKD were hematuria and albuminuria. Gender, age, smoking, hypertension, diabetes mellitus, obesity and hyperuricaemia were independently associated with CKD. The awareness rate of CKD was 8.27% and only 7.09% of the subjects received treatment. Conclusions The prevalence of CKD is 13.57％ and the recognition is 8.27％ in urban adult population of Zhengzhou．Independent risk factors associated with kidney damage are gender, age, smoking, hypertension, diabetes mellitus, obesity and hyperuricaemia．

Objective    To evaluate the efficacy and safety of calcium acetate in treating hemodialysis(HD) patients with hyperphosphatemia. Methods    A randomized, controlled multicenter study was performed. Phosphate binders were discontinued during a two-week washout period． A total of 171 hemodialysis patients from 10 sites with serum phosphorus during 1.94-2.75 mmol/L after two-week washout period were randomized to calcium acetate or calcium carbonate for 8 - week treatment period. Patients with serum phosphorus between 1.94-2.26 mmol/L were given elemental calcium 1000 mg/d and between 2.27- 2.75 mmol/L were given elemental calcium 1500 mg/d. The dose was constant during the 8 - week treatment period. Results     All of 171 patients entered the safety analysis set, including 123 cases who completed the study into effect analysis set. In terms of efficacy: compared with the baseline, serum phosphorus, calcium - phosphorus products, parathyroid hormone (iPTH) levels were significantly decreased (all P＜0.05) and serum calcium levels increased slightly in both groups; compared with the calcium carbonate group, calcium acetate group had a significant advantage in the change of serum phosphorus content [(1.73 ± 1.85) vs (0.99 ± 1.60) mmol/L, P＜0.05] and drug response ratio (compared with the baseline serum phosphorus level fell more than 25%) (51.6% vs 32.8%, P＜0.05). In safety aspects, calcium acetate group and the control group had no significant differences in the incidence of adverse events (19.8% vs 18.8%) and adverse reactions (8.1% vs 4.7%), all P＞0.05. The main adverse reactions of calcium acetate were mild to moderate gastrointestinal reactions, including nausea, vomiting. Conclusions     In hemodialysis patients with hyperphosphatemia, calcium acetate can decrease serum phosphorus and reduce the levels of calcium - phosphorus product and iPTH. In the phosphate binding capacity, calcium acetate is superior to calcium carbonate. Mild to moderate gastrointestinal reactions are most common after administration.

Objective To establish a relatively concise semi-quantitative pathological scoring and approach to predict the prognosis of IgA nephropathy (IgAN). Methods One hundred and fifty-five cases diagnosed as primary IgA nephropathy with 2 years follow-up were enrolled into our study. In order to examine intra- and inter-observer reproducibility of classification according to the scores, pathological data of 91 cases were reviewed twice by one pathologist, and data of 56 cases were reviewed again by another pathologist. Eight histological indices were analyzed at the beginning: (1) endothelial proliferative index (endoI). (2) active crescents and segmental necrosis of glomerular capillary wall (dGAI). (3) mesangial hypercellularity index (MsHI). (4) increment of mesangial matrix area (MsMI). (5) glomerular chronicity index (GCI). (6) interstitial inflammatory cells infiltration (infI). (7) tubular atrophy and interstitial fibrosis (TCI). (8) vascular chronicity index (VCI). Results Twenty-five (16.13%) patients progressed into irreversible end stage renal disease (ESRD) during follow-up period [(69.07±28.66) months, ranged from 10 to 170 months]. Serum creatinine at biopsy was（112.18±83.13） μmol/L. The initial histological variables were analyzed using Cox proportional hazard model and three variables, including dGAI，GCI and TCI, were finally chosen. GCI and TCI were added up to indicate the chronicity index (CI). dGAI and CI were both found as independent factors in predicting renal outcome (RR=1.255 and 1.691, P<0.05, respectively). Patients in group with both higher dGAI (≥4) and CI (≥6) had the worst renal prognosis (P<0.01). For patients in CKD grade 1 and grade 2, multivariate analysis including clinical and histological variables showed CI was the only independent risk factor of bad prognosis. The reproducibility of the scoring system was proved acceptable (inter- and intra-observer’s kappa values >0.4). Conclusions This relatively concise pathological scoring method containing dGAI and CI has good reproducibility and can predict renal outcome of IgAN.

Objective To determine the normal value range of glomerular diameter in Chinese adults and to investigate the measurement methods. Methods One hundred patients with minor glomerular abnormalities or thin basement membrane nephropathy diagnosed by renal biopsies from 1998 to 2008 with normal body weight and serum glucose were selected for the determination of normal value range of glomerular diameter. The maximal profile diameter of glomerular capillary loops was measured by Motic Med 6.0 image analysis system in the following ways: (1) direct measurement: two perpendicular longest diameters of each glomerulus were measured. (2) indirect measurement: the area of each glomerular capillary loop was measured, then its diameter was calculated by formula. Ten patients with minimal change disease, 10 with focal segmental glomerulosclerosis, and 10 with membranous nephropathy, who all had normal body weight and serum glucose, were also selected for the measurement of glomerular diameter, whose results were then compared with normal values. Results The results obtained from the direct and indirect measurements were not significantly different. The gender and age had no significant effects on glomerular size. The normal value ranges of glomerular maximal profile diameter were as follows: (1) the glomeruli with pole(s) which maximal profiles were with vascular pole and/or urinary pole: the diameter range measured by the direct method was 101.3-182.9 μm, and by the indirect method was 100.3-181.5 μm. (2) the glomeruli with pole(s) and the glumeruli without pole which maximal profiles were without vascular pole or urinary pole, but were bigger than those in smallest glomeruli with pole(s):the diameter range measured by the direct method was 108.5-182.9 μm, and by the indirect method was 107.6-183.2 μm. In addition, the glomerular maximal profile diameters of 30 patients with glomerular diseases were all in the normal value range. Conclusions Direct and indirect measurement methods are both available. The normal value range of glomerular diameter obtained from this study may be used for Chinese adults.

Objective To investigate the effect and mechanism of prostaglandin E2 (PGE2) in renin regulation at the juxtaglomerular apparatus (JGA). Methods Macula densa cell line (MMDD1) was cultured on the special filter. In the medium on the apical lateral of the cells, low concentration of sodium chloride, chloride and different doses of angiotensin Ⅱ(AngⅡ) were used to stimulate the PGE2 secretion. The PGE2 concentration was tested by ELISA. In the animal experiment, the response of plasma renin activity (PRA) to acute intraperitoneal administration of captopril (30 mg/kg) was determined, in conscious wild-type (WT) and cyclooxygenase COX-2－/－ mice on C57BL/6 genetic backgrounds. PRA was measured in plasma obtained by tail vein puncture. Different concentrations of PGE2 were used to stimulate the renin secretion of primary cultured JGA cells from COX-2－/－ mice and wild type mice. In specific Gsα gene delete mice (low renin producing mice), 24 h urine was collected to test the concentration of PGE2. The COX-2 mRNA and protein of the kidney cortex were observed by real-time PCR and immunohistochemical staining. Results Low chloride could stimulate the PGE2 secretion both at the apical and basement of the macula densa cells. In COX-2－/－ mice, the base PRA and [(378.3±96.4) vs(1115.0±210.0) ng AngI&#8226;ml-1&#8226;h-1，P＝0.0051，n＝10] the renin secretion of primary cultured JGA cells [(153.7±14.7) vs (672.4±129.0) ng AngI&#8226;ml-1&#8226;h-1，P＝0.0162，n＝3] were obviously lower than wild type mice. Captopril could stimulate the PRA of (COX)-2－/－ mice increasing 32.8 times. But AngⅡ had no effect on PGE2 secretion in macula densa cells. In primary cultured JGA cells, the decreasing renin scretion was partly recovered by PGE2 in cells from COX-2－/－ mice. In low renin producing mice, the expression of COX-2 mRNA in the kidney cortex increased by (8.07±1.08) times(n=6, P=0.0022). The COX-2 protein of the kidney cortex and the urine PGE2 increased by several times. Conclusions Low chloride is the primary stimulation messenger of PGE2 secretion in macula densa cells. The PRA in COX-2－/－ mice can be stimulated by angiotensin converting enzyme inhibitor, but the AngⅡ has no direct effect on macula densa cells. When renin production is abolished in JGA cells (Gsα delete mice), COX-2 mRNA and protein up-regulation is observed in kidney cortex and macula densa. PGE2 plays an important role in regulation of renin secretion and renin release in JGA by precise feedback mechanism.

Objective To observe the change of 24-hour blood pressure and to explore the relation between abnormality of circadian rhythm and renal injury in patients with chronic kidney disease. Methods Circadian blood pressure rhythm was studied by ambulatory 24-hour monitoring in normotensive(n=130) and hypertensive (n=106) patients with chronic kidney disease， and in matched control groups (14 healthy subjects and 43 patients with essential hypertension) without renal disease. Ambulatory blood pressure monitoring(ABPM) was performed with a portable oscillometric recorder(Spacelab 90217). ABP Report Management System Version1.03.03 was used to analyze the 24-hour data. The term “dipper” was described as BP during sleep drops at least 10% below daytime pressure. The term “non-dipper” referred to those subjects in whom the nocturnal decline in BP is reversed， absent， or blunted (ie， less than 10%). Results In normotensive subjects， average night systolic and diastolic BP values were constantly higher in the patients with chronic kidney disease than those in the controls (111.2±10.8 vs 91.6±7.5，68.7±9.5 vs 56.2±4.6，P < 0.05). Average daytime SBP and DBP levels did not differ considerably in CKD patients and essential hypertensivers. The frequency of non-dippers was 70.0% in NCKD group， 81.6% in HCKD group， 37.2% in EH group， 7.14% in NC subjects respectively. The normotensive and hypertensive renal patients had higher heart rate(HR) than the corresponding groups，especially at nighttime， with a significant blunted nocturnal decline as compared to control subjects. The NCKD group and HCKD group revealed a much less pronounced decline in nocturnal mean BP values，with a typical non-dipper pattern.Hypertensives with chronic kidney disease displayed pronounced abnormalities in the 24-hour BP pattern， with markedly blunted nocturnal fall and flattened or reversed day-night circadian rhythm BP values. Conclusions Normotensive patients with chronic kidney disease are exposed to a relative hypertension at nighttime and that renal hypertensive subjects can be underestimated in their hypertensive status if the measurement of BP is confined to daytime. There is a compelling need for studying if treating nocturnal hypertension in CKD can prevent renal disease progression.

Objective    To explore the protection of early autophagy activation on podocyte injury induced by aldosterone.     Methods     In vitro cultured mouse podocyte clones (MPC5) were treated with aldosterone for 6, 12, 24, 48 h respectively. Apoptosis of podocytes was detected by Annexin V combined with flow cytometry. After 24 h treatment with aldosterone, the existence of apoptotic body and autophagosome was observed by electron microscopy. The protein expressions of LC3, caspase?3 and nephrin were examined by Western blotting. The mRNA expression of Beclin?1 was detected by real?time PCR.    Results     The induction of apoptosis and autophagy by aldosterone in podocytes was in time?dependent mannner. After 24 h treatment with aldosterone, the apoptosis was increased by 26.5% (P＜0.05) and the expression of nephrin was decreased by 28.0% (P＜0.05) compared to control group. Aldosterone remarkably induced the expression of Beclin?1 at 6 h and promoted the transformation of LC3?Ⅰto LC3?Ⅱ at 12 h (P＜0.05). Compared to simple aldosterone treatment, the apoptosis rate of podocyte was increased by 39.0%（P＜0.05）and the expression of nephrin was declined by 19.5%（P＜0.05) after 3?methyladenine (3?MA) pre?treatment.    Conclusions     Aldosterone can induce autophagy and apoptosis in podocytes. Autophagy occurs earlier (12 h) than apoptosis (24 h). The occurrence of autophagy can inhibit the apoptosis，so the autophagy pathway may be a new research topic of glomerular disease treatment.
  

Objective To investigate the characteristics of BK virus (BKV) infection in renal transplant recipients. Methods A total of 243 renal recipients from our clinic within 48 months after transplantation were enrolled as the trial group and 82 healthy people as the control group. Urine and peripheral blood samples of these two groups were harvested for urinary sediment BKV cytology by Decoy cell counting and BKV DNA by real-time PCR. Results The positive rates of urinary Decoy cell, BKV viruria and viremia were 35.4%, 36.6% and 16.9% in trial group, and 4.9 %, 20.7% and 2.9% in control group, respectively. In trial group, the medians of urinary Decoy cell, urinary BKV and peripheral blood BKV were 6/10 HPF, 1.50×104 copy/ml and 6.87×103 copy/ml respectively, while in control group, they were 2/10 HPF, 1.10×104 copy/ml and 2.24×103 copy/ml. Compared with the healthy people, the positive rates and the levels of BKV DNA in urine and peripheral blood of recipients were significantly higher. The amount of urinary Decoy cells was positively correlated to urinary BKV load(r=0.636, P<0.01). Conclusions BKV replication is easier to happen in renal recipients as compared to healthy people. Counting of urinary Decoy cells is convenient, useful and sensitive to evaluate BK viruria and viremia in renal transplant recipients. BKV DNA detection in urine and peripheral blood can be used to screen the evidence of BK reaction in order to prevent irreversible graft damage by BKV.

Objective To explore the effects of intra-jugular vein dual lumen catheter lock heparin in different concentrations on the coagulation function, hemorrhagic tendency and catheter thrombosis risk in hemodialysis patients, and to investigate the reasonable lock heparin concentration. Method Ninety end stage renal disease (ESRD) patients receiving regular hemodialysis were enrolled and randomly assigned into 3 groups(n=30): Group A (pure heparin lock solution, 6250 U/ml), Group B (medium heparin lock solution, 1040 U/ml) and Group C (low heparin lock solution, 625 U/ml). The coagulation indexes were determined in short term. Complications such as bleeding, thrombosis, infection and thrombocytopenia were monitored. Results Prothrombin time(PT), activated partial thromboplastin time (APTT) and thrombin time(TT) were significantly prolonged in Group A（P<0.01）; only APTT was significantly prolonged in Group B; however, no significant changes were observed in Group C. Hemorrhage risk was much higher in Group A than that in Group B and C (26.7% vs 10% and 0， P<0.05). Catheter thrombosis incidence was significantly higher in Group C than that in Group A and B (23.3% vs 0 and 10%， P<0.05). Only 1 suspected catheter related infection was found in Group C, and 2 cases of moderated thrombocytopenia in Group A. Conclusion Moderate concentration of lock heparin solution has the best balance of hemorrhagic and thrombotic risk, and should be recommended to most of regular hemodialysis patients.

Objective To report a simple formula to estimate phosphate removal by standard four-hour hemodialysis in Chinese patients. Methods A total of 165 MHD patients in Huashan Hospital were enrolled. Effluent dialysate samples were collected during treatment to estimate the total amount of phosphate removal. Pre-dialysis levels of serum phosphate, potassium(K+), hematocrit(Hct), parathyroid hormone(iPTH), carbon dioxide combining power(CO2CP), alkaline phosphatase (AKP), Kt/V, and ultrafiltration volume, age, gender, dry body weight, blood flow, phosphate clearance of dialyser, phosphate concentration of dialysate at 60 min after the start of HD were obtained. 80% observations were randomly selected for formula building by backward stepwise and the remaining 20% observations were used to validate the formula. Results The formula was described as Tpo4=88.6×C60-0.03×Age+1.07×Gender+0.06×Clearance-4.59, where C60 was phosphate concentration in dialysate measured 60 min into HD and Clearance was the phosphate clearance of dialyser. Formula validation further suggested good predictive ability. Conclusion This study derives an approach to quantify phosphate removal by a simple formula, which will be helpful for clinicians to treat patient individually.

Objective To evaluate the efficacy and safety of 7.5% icodextrin peritoneal dialysis solution for once-daily long dwell exchange in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Methods A prospective, multicenter, randomized, double blind, parallel controlled study was conducted for 5 weeks in 201 CAPD patients (96 male, 105 female) with mean age (56.1±13.7) years old. These patients were from 7 centers with 98 allocated to the icodextrin group and 103 to the dextrose group randomly. Patients in the icodextrin group were given 7.5% icodextrin and those in the dextrose group were given 2.5% Dianeal?誖PD-2 or PD-4 for the nocturnal long dwell exchange while the diurnal dialysis remained unchanged. During the 4- week treatment, patients were tested every other week for net ultrafiltration, peritoneal creatinine and urea nitrogen clearance after the long dwell. Other laboratory tests and adverse events were recorded. Results Compared to the dextrose group, the net ultrafiltration was up-regulated more significantly from the baseline in the icodextrin group [(342.53±25.79) ml vs (73.59±24.09) ml, P<0.01]. Episodes of net ultrafiltration less than 0 ml in the icodextrin group were much less than those in the dextrose group. Similarly, the mean difference between groups for change from baseline for peritoneal creatinine and urea nitrogen clearance was much higher[（428.02±53.14） ml/12 h vs （－99.79±50.19） ml/12 h， P<0.01； （306.43±53.31） ml/12 h vs (－116.02±51.05） ml/12 h， P<0.01， respectively] in the icodextrin group. In the icodextrin group, there was a decrease in serum sodium and chloride compared with baseline (P<0.01). Serum amylase activity decreased from (87.04±48.01) U/L to (21.59±13.58) U/L(P<0.01). Cholesterol in the icodextrin group was lower than baseline (P<0.05). There was no significant difference between two groups for the incidence and severity of adverse events. Conclusion 7.5% icodextrin is a safe and effective peritoneal dialysis solution for once-daily long dwell exchange in CAPD patients.

Objective To evaluate the effect of hemodialysis with fresh frozen plasma-based dialysate (HD-PBD) plus high volume hemofiltration (HVHF) on serum bilirubin removal in patients with liver failure. Methods Fifteen patients with liver failure were enrolled as viewing group who received HD-PBD therapy for 6 hours, then HVHF for 24 hours with the same filter (AV600). Six patients with hyperbilirubinemia treated only with HVHF for 24 hours were as control group. Blood samples from vein and artery end of the filter, plasma-based dialysate from entry and exit of the filter and ultrafiltrate were taken at 5 min（T0）, 2 h (T1), 4 h (T2) and 6 h (T3) during HD-PBD and 5 min（t0）, 6 h (t1), 12 h (t2) and 24 h (t3) during HVHF. Bilirubin levels of dialysate, ultrafiltrate and plasma were measured and quantity of serum bilirubin removed by extracorpomal circulation was calculated. Results (1) The total efficacy of HD-PBD plus HVHF on bilirubin removal was 93.3%, and no obvious adverse reaction occurred. (2) The clearance of serum bilirubin by HD-PBD for 6 hours was significantly higher than that by HVHF for 24 hours (P<0.05). (3) The highest removal quantity of total bilirubin (TB) for dispersion and adsorption was（15.6±5.6） mmol/min and（10.3±3.2）mmol/min at T0 of HD-PBD, which decreased significantly in the next 4~6 hours. (4) TB was mainly removed by adsorption in HVHF and the adsorption removal ratio was 77%～98%, which decreased 12 h later, while ultrafiltration removal quantity was stable. (5) Adsorption quantity and removal ratio of TB by HD-PBD for 6 hours was significantly higher than those by HVHF for 24 hours (P<0.05). (6) Adsorption coefficient of TB by HVHF was obviously degraded after 12 hours in viewing group, but was significantly degraded after 24 hours in control group, and the difference was significant. Conclusions HD-PBD plus HVHF can remove serum bilirubin effectively. Dispersion and adsorption are the major mechanism of serum bilirubin clearance during HD-PBD, which decrease gradually after 4 hours. Adsorption is the major mechanism of serum bilirubin clearance during HVHF with less clearance quantity as compared to HD-PBD.

Objective To evaluate the sensitivity and specificity of plain radiography in the diagnosis of vascular calcification in maintenance hemodialysis (MHD) patients. Methods Multi-slice computed tomography (MSCT) was used as the reference standard in the assessment of vascular calcification in MHD patients. A total of 54 MHD patients, 26 male and 28 female, mean age (60.4±13.3) years, underwent both MSCT and plain radiography of lateral abdomen and pelvis to evaluate abdominal aortic calcification, bilateral iliac and femoral artery calcification. Abdominal aorta was divided into upper and lower segment by L2-L3 intervertebral space. The severity of vascular calcification by MSCT was graded from score 0 to 5. Two independent radiologists analyzed the results of plain radiography and MSCT, and inter-observer agreements were calculated by using κ statistics. Results According to the results of MSCT, the calcification rate of abdominal aorta was 86.1%, and the calcification rate of iliac and femoral artery was 74.5%. There was significant difference of the calcification rate between large artery and muscular arteries. Inter-observer agreement of calcification was excellent (κ=0.864-0.893). Compared with MSCT, the specificity of plain radiography with regard to detection of abdominal aortic, iliac and femoral calcification were 100%. The sensitivity of plain radiography was different according to the different MSCT score, which was as follows: MSCT score≥grade 1: 60.2% and 24.8% for lateral abdomen radiography to detect abdominal aortic calcification and pelvic radiography to detect iliac, femoral calcification respectively; MSCT score≥ grade 2: 76.9% and 43.5% respectively; MSCT score≥grade 3: 100% and 74.4% respectively. Conclusions The sensitivity of plain radiography in the assessment of vascular calcification increases with the severity of calcification. The sensitivity in the assessment of abdominal aortic calcification is higher than that of iliac and femoral artery calcification. Plain radiography can be used to detect moderate to severe vascular calcification in MHD patients.

Objective To evaluate the effect and safety of anticoagulant citrate dextrose solution A (ACD-A ) in continuous blood purification (CBP) for patients at high risk of bleeding with ARF. Methods Twelve patients at high risk of bleeding， treated with continuous venovenous hemofiltration(CVVH)， were divided into regional citrate anticoagulant(RCA) group and control group. In the former， ACD-A solution was delivered， pre-filter ，with the rate adjusted to maintain a postfilter ionized calcium (iCa2+) level between 0.30~0.40 mmol/L. Before the extracorporeal blood returned to the patient，10% calcium gluconate was infused to maintain a systemic iCa2+ level between 0.90~1.20 mmol/L. In control group， CVVH were performed either with low dose of heparin LMW sodium(1700~2500 IU/12 h~24 h)or without anticoagulant. The life span of each hemofilter was recorded. In RCA group， prothrombin time (PT)， activated partial thromboplastin time (APTT)， acid-base changes， serum sodium and iCa2+ were monitored pre- and during CVVH. Result In the whole duration 1192.5 hours of CVVH in RCA group and 596 hours in control group， 62 and 42 hemofilters were used， respectively. Filter survival was 65.3% at 24 h and 24.5% at 48 h in RCA group，while 14.5% and 0 in control group. The mean life span of filter in RCA group was significantly longer than that in control group[(29.4±21.0)(1.5~71.5)h vs(14.2±8.2)(4.5~40)h， P < 0.01]. During 38 sessions of CVVH with ACD-A solution anticoagulation， PT， APTT， acid-base status，serum iCa2+ and sodium showed subtle changes， compared with pre-CVVH.There were no significant bleeding events and no muscular spasms induced by ACD-A solution. Conclusion ACD-A solusion as anticoagulant during CBP is safe， convenient and effective for patients at high risk of bleeding with ARF.

Objective To explore the prevalence, awareness and risk factors of chronic kidney disease (CKD) in general adult population of Anhui province, China. Methods A total of 3800 residents (older than 18 years) from Anhui province were randomly selected using a stratified, multi-stage sampling. All the residents were interviewed and tested for urinary albumin to creatinine ratio (abnormal: ≥30 mg/g) and reduced estimated GFR [abnormal: ＜60 ml?min-1?(1.73 m2)-1]. The associations of CKD with demographic characteristics, healthy characteristics (hypertension, diabetes and hyperuricemia) were examined. Results Eligible data of 3374 subjects were enrolled in the study. After the adjustment of age and gender component, the prevalence of albuminuria was 9.8% (95%CI 8.8%-10.9%), and reduced eGFR was 2.1% (95% CI 1.7%-2.7%). Approximately 10.4%(95%CI 9.4%-11.5%）subjects had at least one indicator of kidney damage. The awareness rate of CKD was 6.5%. Female, age, hypertension, diabetes mellitus, and hyperuricemia were independently associated with CKD. While obesity, hyperlipdemia. smoking and alcohol drinking were not associated with the prevalence of CKD. Conclusions The prevalace of chronic kidney disease is 10.4% and the awareness rate is 6.5% in general adult population of Anhui province. Independent risk factors associated with CKD are female, age, hypertension, diabetes mellitus and hyperuricemia.

Objective    To investigate the effects and mechanisms of prostaglandin E₂ receptor subtype 3 (EP3) on transforming growth factor β1 (TGF-β1)-induced mouse mesangial cells damage.    Methods    Primary mouse mesangial cells were separated and cultured. Three siRNAs were synthesized and transfected into mesangial cells for silencing EP3 by Lipofectamine^TM 2000 and the best one was chosen. MCs were grouped into: (1)control group; (2)TGF-β1 (10 μg/L) group; (3)NC-siRNA plus TGF-β1 (10  μg/L) group; (4) EP3-siRNA group; (5)EP3-siRNA plus TGF-β1 (10 μg/L). Then the proliferation of MCs was evaluated by CCK-8 assay. The expression of PGE₂ and cAMP in cell supernatant were detected by ELISA. The mRNA and protein expression of fibronectin (FN), connective tissue growth factor (CTGF), cyclooxygenase-2 (COX2), membrane-bound prostaglandin E2 synthase 1 (mPGES1) were detected by real-time quantitative PCR and Western blotting. The phosphorylation of p38 MAPK and ERK1/2 was decected by Western blotting.    Results    Compared with control group, the cell proliferation  induced by TGF-β1 was increased (P＜0.05), the expression of PGE₂ and cAMP were improved, mRNA and protein expression of FN, CTGF, COX2 and mPGES1 were up-regulated (all P＜0.05). Compared with TGF-β1 group, the cell proliferation in EP3-siRNA plus TGF-β1 group was reduced, the expression of FN, CTGF, COX2 and mPGES1 mRNA and protein were downregulated (all P＜0.05), the phosphorylation of ERK1/2, p38 MAPK were also declined (P＜0.05).    Conclusion    EP3-siRNA may reduce TGF-β1-induced cell damage through upregulating the expression of cAMP, repressing the activity of ERK1/2 and p38 MAPK, inhibiting the expression of COX2 mPGES1 and PGE2 by feedback, then decreased the expression of FN and CTGF.

Objective To evaluate the impact of OL-HDF on in vivo removal of a wide spectrum of solutes (urea， creatinine， iPTH and β2-microglobulin) in comparison to LF-HD and HF-HD. Methods Twenty-five patients(17 men，8 women)were studied. Every patient underwent three dialysis sessions with routine HD parameters. Effects were compared among 1.8 m2 polysulfone LF-HD，1.8 m2 polysulfone HF-HD and OL-HDF. Predialysis and postdialysis solute concentrations were measured.The percentage of reduction ratios for each solute were calculated. Results Urea (molecular mass of 60 daltons)and creatinine(molecular mass of 113 daltons)reduction ratios were similar in LF-HD， HF-HD and OL-HDF. B2-microglobulim and iPTH reduction ratios for LF-HD were negligible. Mean β2-microglobalin reduction rates were 32.5%±7.0% for HF-HD versus 44.2%±10% for OL-HDF.(reinfusion volume mean 36 L/session； P < 0.05).Mean iPTH reduction rates were 42.7%±9.2% and 54.4%±8.8% for HF-HD and OL-HDF， respectively(P < 0.05).Conclusion Removal of solutes with small molecular weight is similar in three type therapies of hemopurification techniques. LF-HD does not seem to remove solutes with a molecular weight greater than 9500 daltons.OL-HDF provides marked enhancement of convection volume and enables a significant increase in β2-microglobulin and iPTH removal. β2-microaglobulin extraction is almost nil with LF-HD， better with HF-HD， and more effective with OL-HDF.

Objective To observe the efficacy and safety of 46.7% sodium citrate versus heparin catheter lock for permanent hemodialysis catheters.Methods Forty-one maintenance hemodialysis patients with permanent catheters were divided into 2 groups randomly. The patients in citrate group received 46.7% sodium citrate lock for catheters after each dialysis session for 6 months. The patiency, catheter-related infection, bacterial culture of catheter lock solution and predialysis serum electrolytes were compared between two groups. Results The impatiency rate and catheter-related infection rate of citrate group were significantly lower than those of heparin group and pretreatment(P < 0.05). The serum electrolytes did not change markedly. In citrate group, the positive rate of catheter lock solution bacterial culture decreased after 2 months, and became negative after 4 months. The main side effect in citrate group was light oral lips numbness (1.93%). Conclusions Catheter filling with a solution containing 46.7% sodium citrate may significantly reduce the incidence of impatency and catheter-related infection. It appears to be effective and safe and does not carry the risk of severe side effects of high concentrations of citrate.

Objective    To investigate the role of transforming growth factor-β activated kinase-1 (TAK1) signaling pathway in the activation of bone marrow derived macrophages (BMDM) induced by high glucose.    Methods    Purity of mouse BMDM was detected by flow cytometry. The mice macrophages cultured in vitro were stimulated by high glucose and treated with TAK1 specific inhibitor 5Z-7-oxozeaenol. Cells were divided into normal control group (RPMI 1640), osmolality control group (25 mmol/L mannitol), high glucose group (33 mmol/L D-glucose) and inhibitor group (33 mmol/L         D-glucose+300 nmol/L 5Z-7-oxozeaenol). Immunocytochemistry and flow cytometry were used to detect macrophage subtype. The expression of monocyte chemotactic protein-1 (MCP-1) and tumor necrosis Factor-α (TNF-α) mRNA were determined by real time PCR. Expressions of p-TAK1, TAK1 binding protein (TAB1), p-JNK, p-p38 MAPK and NF-κB p65 proteins were analyzed by Western blotting.    Results    The purity of BMDM was about 99.36%. Compared with normal control group, high glucose group had increased percentage of M1 macrophages, increased expression of MCP-1 and TNF-α mRNA (all P＜0.05). Moreover, p-TAK1, TAB1, p-JNK, p-p38 MAPK and NF-κB p65 proteins expression also increased significantly in high glucose group (all P＜0.05). After treatment with inhibitor 5Z-7-oxozeaenol, the effects induced by high glucose were inhibited (P＜0.05).    Conclusions    High glucose can induce M1 macrophage activation and expression of inflammatory cytokine of BMDM, which can be inhibited 5Z-7-oxozeaenol through inhibiting TAK1/MAPK and TAK1/NF-κB pathway.

Objective To analyze the clinicopathological features of IgA nephropathy (IgAN) patients with anemia and the influencing factors of prognosis. Methods The clinical and pathological data of patients diagnosed with primary IgAN at the First Affiliated Hospital of Fujian Medical University from January 1, 2006 to December 31, 2016 were retrospectively analyzed. The patients were divided into anemia group and non-anemia group according to whether the patient was anemia or not. The clinical and pathological data of the two groups were collected. All of them were followed up from the date of renal biopsy to January 1, 2018. Survival curves of the two groups were drawn by Kaplan-Meier method, and compared by Log-rank test. Multivariate Cox proportional hazards regression model was adopted to explore the influencing factors of prognosis in IgAN patients. Results A total of 231 subjects were enrolled, including 122 males (52.8%), and the male-female ratio was 1.12∶1. Their age was (34.8±10.1) years (15-68 years). There were 70 patients (30.3%) in anemia group, 161 cases (69.7%) in non-anemic group. Compared with non-anemia group, anemia group had higher proportion of females, lower serum albumin, higher proportion of tubular atrophy/interstitial fibrosis (T1/2), endothelial cell proliferation (E1) and crescent formation (C1/2), which were statistically significant (all P＜0.05). The patients had a median follow-up time as 6.3 years (0.3-12.9 years). Survival analysis showed that patients in anemia group had lower cumulative renal survival rate than that in non-anemia group ( χ2=15.234, P＜0.001). Multivariate Cox hazards regression analysis revealed that anemia (HR=3.820, 95%CI 1.674-8.719, P=0.001), tubular atrophy/interstitial fibrosis (T1/2) (HR=3.770, 95%CI 1.026-13.852, P=0.046), glomerular segmental sclerosis/adhesion (S1) (HR=4.211, 95%CI 1.139-15.576, P=0.031), hypertension (HR=2.988, 95%CI 1.276-6.999, P=0.012), increased 24 h urinary protein (HR=1.103, 95%CI 1.046-1.163, P＜0.001) and estimated glomerular filtration (eGFR)＜60 ml?min-1?(1.73 m2)-1 (HR=3.725, 95%CI 1.639-8.462, P=0.002) were the independent risk factors for poor renal prognosis in patients with IgAN. Conclusions The clinicopathological features of IgAN patients with anemia are relatively serious, and the renal cumulative survival rate is lower. Anemia, tubular atrophy/interstitial fibrosis (T1/2), glomerular segmental sclerosis/adhesion (S1), hypertension, increased urinary protein and eGFR＜60 ml?min-1?(1.73 m2)-1 are the independent risk factors for poor renal prognosis in patients with IgAN.

Objective  To investigate the association between peripheral white blood cell count including its subtypes and cardiovascular disease (CVD) incidence and one-year all-cause mortality in maintenance hemodialysis (MHD) patients.  Methods  A total of 371 MHD patients at Zhongshan Hospital, Fudan University between March 2009 and February, 2011 were enrolled. Demographic, hematological, nutritional and inflammatory markers were obtained. All patients were followed for one year to investigate the risks for CVD event and mortality. Spearman correlation and linear regression were used to assess the relationship between white blood cell count and other laboratory parameters. Difference in categorical factors between two groups were determined with Chi-square test, Difference in continuous values between two groups were assessed with t test. Kaplan - Meier analysis and Cox proportional hazards model were applied to assess one-year mortality predictors.  Results  Patients with CVD event had lower lymphocyte count level (1.17±0.38 vs 1.34±0.51, P＜0.05) and higher monocyte count level (0.44 ± 0.15 vs 0.37 ± 0.15, P＜0.01) than those without CVD event. Cox proportional hazard regression showed that an increased lymphocyte count was associated with reduced mortality risk, 95%CI: 0.136-0.719, P＜0.01) and that an increased monocyte count was associated with increased mortality risk, 95% CI: 2.657 - 74.396, P＜0.01) after adjustment for hsCRP.  Conclusion  Decreased lymphocyte level and increased monocyte level are significantly related to CVD event and are independent predictors of increased one - year all - cause mortality risk in MHD patients.

Objective To investigate the discriminator value of Han Chinese first morning urine albumin creatinine ratio (ACR) for determining the microalbuminuria. Methods A total of 1056 participants (494 males and 562 females) were selected from epidemiologic study of the metabolic syndrome and chronic kidney disease in Pinggu district, Beijing. Eight-hour overnight urinary albumin excretion (UAE) was regarded as the gold standard for defining the albuminuria, and the ROC curve analysis was used to determine the ACR discriminator value for microalbuminuria. Results (1)Microalbuminuria was found in 12.5% of participants, macroalbuminuria in 1.7%. (2)The ACR discriminator value for microalbuminuria by ROC curve analysis was 1.95 g/mol(sensitivity 97.6% and specitivity 88.6%) for men, 3.62 g/mol(sensitivity 83.8% and specitivity 89.1%) for women, 2.78 g/mol (sensitivity 88.7% and specitivity 85.9%) for overall. The upper boundary of microalbuminuria by ROC curve analysis was 22.59 g/mol (sensitivity 100.0% and specitivity 98.8%) . (3)The inter-rater agreement of the result in this study showed that sensitivity was 91.3% and specitivity was 88.2%, positive likelihood ratio was 7.56 and negative likelihood ratio was 0.10, positive predictive value was 56.9% and negative predictive value was 98.4%. Conclusions The ACR discriminator value for determining microalbuminuria is obviously higher in women than that in men, and is higher than recommendation of international guidelines. The result by ROC curve analysis has better sensitivity and specitivity.

Objective To establish a pure and convenient method for the enrichment of the renal proximal tubular cells(PTCs). Methods The both kidneys of Wistar rats were underlying hemospasia via cardiac apex substituted in situ kidney perfusion before taken out. The renal cortex was separated and sliced into small pieces which were digested in typeⅠ collogen and resuspended in 45% Percoll gradient, then centrifuged by continuous density gradient. Cells were cultured and passaged in DMEM-F12 supplemented with 10% fetal bovine serum. Bred cells were identified by morphology, immunocytochemistry staining of cytokeratin-18 (CK18) and aquaporin 1(AQP1), and alkaline phosphatase staining. Results The tubular fragments obtained from the modified method had very little miscellany of renal glomerulus. After 4-5 days, the cultured cells reached confluence, displaying the typical cobblestone appearance. All the bred cells almost were positive expression in immunocytochemistry staining of CK18 and AQP1, and alkaline phosphatase staining. So they were validated as rat PTCs. Conclusion This modified method can yield large quantity of pure PTCs simply.

Objective To identify susceptible miRNAs for the pathogenesis of diabetic nephropathy(DN) and the molecular targets of losartan treatment. Methods The 8-week age KKAy mice were divided into losartan treatment group(10 mg&#8226;kg-1&#8226;d-1) and non-treatment group, C57BL/6 mice were used as the control group. At age of 20 weeks, body weight, random blood glucose, urinary albumin and urinary creatinine were tested, and kidney morphology was observed. Glomeruli were separated by magnetic beads perfusion, and total RNA were extracted. MiRNAs expression profiles were analyzed by the Affymetrix GeneChip miRNAs arrays. Results At age of 20 weeks, KKAy mice developed higher body weight, higher blood glucose and higher urinary microalbumin creatinine ratio than C57BL/6 mice, and the glomerular basement membrane thickened, mesangial matrix widened. Losartan treatment markedly improved the level of urinary albumin creatinine ratio [(539.71±100.23) mg/g vs (728±177.19) mg/g, P<0.05)] and pathological lesion of KKAy mice. The miRNA array analysis showed that there were 22 miRNAs differentially expressed between KKAy non-treatment mice and C57BL/6 mice glomeruli at age of 20 weeks. Among them, 10 miRNAs were up-regulated, and 12 miRNAs were down-regulated. The expression of 4 miRNAs was down-regulated in glumeruli of KKAy mice treated by losartan compared with that of non-treatment mice. The expressions of miRNA-503 and miRNA-181d were significantly up-regulated in the glumeruli of KKAy mice and inhibited by losartan treatment. Conclusion The expressions of miRNA-503 and miRNA-181d are significantly up-regulated in the glumeruli of KKAy mice and inhibited by losartan treatment, which may be new therapeutic targets of DN.

Objective To investigate the mutations in Chinese families with Fabry disease. Methods Genomic DNA was extracted from peripheral blood cells of three probands diagnosed as Fabry disease and some family members. Seventy genomic DNA samples extracted from 70 unrelated normal persons were used as control. By PCR and direct sequencing, all 7 exons and their neighboring intronic sequences of the GLA gene of the probands were analyzed. Results Three mutations were identified in 3 probands: (1) deletion of 1 bp at nucleotide 1142 in exon 7 (1142DelG), leading to premature termination of protein translation at codon 390. (2) 902 G to A transition in exon 6 (codon 301), resulting in replacement of an arginine residue by glutamine (902G >A, R301Q). (3) 484 T to C transition in exon 3 (codon 142), resulting in replacement of a cysteine residue by arginine (484T >C, C142R). Mutation of GLA gene in 13 relatives of 3 probands was also screened and 6 cases with the same mutation as the relevant proband were found, including 5 heterozygotes and 1 hemizygote. Conclusion Three mutations including one novel mutation (1142DelG) are found in 3 Chinese families with Fabry disease by PCR-DNA sequencing.

Objective To establish adriamycin-induced focal segmental glomerular sclerosis (FSGS) mice model, and observe the expressions of and relation between oxidative stress and p38 MAPK signal pathway in renal injury. Methods Eight-week-old male Balb/c mice were randomly divided into FSGS group (n=20) and control group (n=20). In FSGS group mice were intravenously injected with a single dose of adriamycin (0.01 mg/g), and mice in control group were received saline with the same dose. At day 3, 7, 14, 22 and 32, urine protein-to-urine creatinine ratio (P/C) was detected. At day 22 and 32, serum creatinine, blood urea nitrogen, nitric oxide (NO) and reactive oxygen species (ROS) in blood and urine, and ROS in kidney tissues were detected; changes of pathological morphology in renal tissue were analyzed by HE stain; the expressions of NF-κB, CD36, IL-13, BAX and Bcl-2 mRNA were detected by real time quantitative PCR; the expressions of NF-κB, p-p38 and p-ERK1/2 protein were detected by Western blotting. Results Compared with that in control group, P/C was gradually increasing in FSGS group, and peaked at day 22 (P＜0.05). At day 22 and 32, mice had higher creatinine, serum creatinine, urea nitrogen, ROS and NO in FSGS group than those in control group (all P＜0.05). There were mild hyperplasia of mesangial cells and mesangial matrix, segment with moderate exacerbations, podocytes with significant proliferation, and the capillary loops of the stenosed in the glomerular in FSGS group at day 32. Compared with those in control group, the mRNA expression of NF-κB, BAX, IL-13 and CD36, and the protein expressions of NF-κB and p-p38 MAPK were gradually increased in FSGS group, all showed statistical differences at day 32 (all P＜0.05); the expression of p-ERK1/2 was increased at day 22 (P＜0.05) but was reduced at day 32 (P＜0.05). Conclusions Adriamycin has induced FSGS in mice successfully, which may through oxidative stress activating p38, up-regulating NF-κB, increasing the inflammatory cytokines and inducing apoptosis pathways.

Objective To investigate the prevalence and risk factors of adult chronic kidney disease (CKD) in the Xishuangbanna district of Yunnan province with a big population of minorities. Methods Residents aged 20 years and older in the area of Xishuangbannan were randomly selected by using a stratified, multi-stage sampling method. All the residents were tested for morning spot urine of albumin to creatinine ratio (ACR) (abnormal≥30 mg/g); morning spot urine dipstick of hematuria (abnormal l+ or greater) was confirmed by urine microscopy (abnormal >3 red blood cells/HP); and modified simplified MDRD equation for Chinese adult was applied to estimate GFR [abnormal <60 ml·min-1·(1.73 m2)-1]. The association among demographic characteristics, health characteristics (e.g. hyperglycemia, hyperlipidemia and hypertension) and indicators of kidney damage were also examined. Results Eligible data of 5566 subjects were included in the study. The prevalence of albuminuria was 8.06%, hematuria was 4.01% and reduced eGFR was 2.89%. Apart from the repetition among microalbuminuria, hematuria and reduced eGFR, approximately 12.53% subjects had at least one indicator of kidney damage. The prevalence of CKD in stratified subgroups with age, gender, nations and CKD risk factors was coincidence with the Logistic regression results. Age increase, hypertension, hyperlipidemia and fasting plasma glucose increase were independently associated with albuminuria; age increase, hypertension were independently associated with reduced renal function; age increase was independently associated with hematouria. Conclusions The prevalence of adult chronic kidney disease is 12.53% in the Xishuangbanna district of Yunnan province. Independent risk factors associated with kidney damage are age, hyperglycemia, hyperlipidemia and hypertension.

Objective To investigate the protective role of bone marrow-derived stem cells (BMDSCs) in progressive glomerulosclerosis rats, and to observe whether BMDSCs promote glomerular repair and regeneration. Methods Progressive glomerulosclerosis was induced in enhanced green fluorescent protein (EGFP) bone marrow chimeric rats by injecting with anti-Thy-1.1 antibody, followed by unilateral nephrectomy. Subsequently, these rats were treated with either BMDSCs infusion (treatment group, 10 rats) or phosphate-buffered saline (untreated group, 10 rats). Renal function and histological alterations were examined at week 12 after Thy1.1 antibody injection. Repair and regeneration of glomerular endothelial cells was detected by immunofluorescence. Results Only 3 rats survived in untreated group, other 7 rats died at week 2, 7, 9, 11 after antibody injection. In treatment group, 9 rats survived at week 12, only 1 rat died at week 10. The BUN and Scr were significantly lower in treatment group as compared to untreated group [BUN(43.55±29.06) vs (76.58±66.19) mmol/L, Scr (138.79±75.14) vs (233.38±164.43) μmol/L]. Proteinuria was not significantly different between two groups at day 3, 7, 14 and 28, while it was significantly decreased at day 42, 56 and 84 in treatment group compared with untreated group. Light microscopy showed that there was severe diffuse mesangial cell proliferation, mesangial matrix expansion and glomerulosclerosis in untreated group, and such changes were ameliorated in treatment group. The mesangial expansion index and glomerular sclerosis index in untreated group was significantly higher than those in treatment group. More BMDCs were recruited into the glomeruli and differentiated into glomerular endothelial cells in treatment group as compared with untreated group. Double immunofluorescence stain also demonstrated that BMDSCs infusion promoted glomerular capillary repair and regeneration. Conclusion BMDSCs infusion can improve renal function and histological changes, and promote the repair and regeneration of glomerular capillary.

Objective To search the ideal management for gross hematuria in autosomal dominant polycystic kidney disease (ADPKD). Methods ADPKD patients who were ever hospitalized and followed up in our department since 1993 were enrolled in the study. Demographic and clinical data were colloected, such as gender, age of gross hematuria, level of renal function, causative factors, management strategies, duration of gross hematuria, blood platelet count, activated partial thromboplastin time, prothrombin time, international normalized ratio, size of kidney cyst and so on. ADPKD patients were divided into different groups according to causative factors or management. The clinical data were compared among groups. Results A total of 905 ADPKD patients were screened, among whom 279 patients ever had gross hematuria (male/female:150/129). One hundred and forty-six patients had integrated therapeutic process records, while only 101 patients could provide relevant laboratory examination results. In these 101 patients, gross hematuria was found in any stage of chronic kidney disease (CKD); the average eGFR was (56.4±44.1) mml&#8226;min-1&#8226;(1.73 m2)-1; the duration of gross hematuria was (8.8±8.0) d; no significant difference between male and female in duration of gross hematuria existed [(8.2±7.3) d vs (9.5±8.8) d, P=0.426]; coagulation parameters were all normal. The platelet count was also normal in 91 patients. Duration of gross hematuria among groups divided according to different causative factors was significantly different (P<0.05). The patients in bed rest group had significantly shorter duration of gross hematuria compared with other groups (P<0.05). The platelet count, prothrombin time and international normalized ratio were all at similar level in different groups. Conclusions The causative factors in ADPKD patients with gross hematuria should be confirmed as the first step of management strategies. Bed rest is the key point in management. Antifibrinolytic agent is a proper choice in the cases receiving hemostatic drugs. It is unnecessary to use antibiotic agent for prevention.

Objective To observe the steps of vascular smooth muscle cells(VSMCs) calcification induced by high phosphate enviroment in vitro. Methods VSMCs were incubated with high phosphate(2.5 mmol/L or 3.5 mmol/L) medium for different times. Expression of core binding factor α1(Cbfα1), osteopontin(OP), collagen type I(Col I), osteocalcin(OC) and α-smooth muscle actin(α-SMA) was investigated by Western blot, immunofluorescence staining and real time PCR. Mineral deposition was assessed by von Kossa and Alizarin red staining. Ultrastructure of VSMCs calcification was observed by electron microscopy (EM). Results Up-regulated expression of osteoblast-specific transcription factor Cbfα1 in the nuclei occured at as early as 12 hours. The protein of Col I and OP was up-regulated when VSMCs were incubated in high phosphate medium for 3 days, and content of OC increased at the time of 6 days. When cultured in 2.5 mmol/L phosphate medium for 15 days, VSMCs lost their lineage marker α-SMA, developed granular calcium deposits. Moreover, the results of real time PCR indicated mRNA level of OP and Col I increased at day 1, OC increased at day 5 and α-SMA level decreased at day 10, respectively. Ultrastructural analysis also confirmed the presence of collagen and matrix vesicles in the cells. Conclusion VSMCs phenotype transformation induced by high phosphate enviroment is an orchestrated, highly regulated process.

Objective    To compared two classical rat models of nephrotic syndrome and to provide some reference data to researchers.    Methods    Thirty male SD rats were randomly divided into control group, puromycin aminonucleoside-induced nephrotic syndrome (PAN) group and adriamycin-induced nephrotic syndrome (ADR) group. The body weight, twenty four hour proteinuria level, serum albumin concentration, cholesterol concentration, creatinine and urea concentration were measured. The renal pathology change was evaluated. The drug toxic effects, administration methods and the costs were also compared.    Results    There was no significant difference in body weight and hair color between control group and PAN group. Compared to control group, the body weight of the rats significantly decreased at day 15 and day 21 in ADR group (P＜0.01), accompanied by epilation and diarrhea. Compared to control group, the 24-hour urinary protein levels increased significantly at day 10 (P＜0.01), day 15 (P＜0.01), and  reached the peak level at day 15 (P＜0.01), day 21 (P＜0.01) in PAN group and ADR group respectively. Compared to control group, the serum albumin concentration decreased significantly at day 10 (P＜0.01), and return to normal level at day 15. The serum cholesterol concentration was increased significantly at day 10 (P＜0.01) and return to normal at day 15 in PAN group. Compared to control group, the serum albumin concentration was decreased significantly at day 15 (P＜0.05) and return to normal at day 21 in ADR group. No significant difference of serum creatinine and serum urea nitrogen levels were found among three groups. Compared to control group, the width of foot process increased significantly at day10 (P＜0.01) and day 15 (P＜0.05) in PAN group and ADR group respectively. To successfully induce a nephrotic rat model (per 100 g), the cost of PAN group was 3.1 times of ADR group (578.10 yuan vs 186.94 yuan).    Conclusions    Nephrotic syndrome can be induced by both PAN and ADR. The administration of PAN via intraperitoneal injection is more convenient as compared to ADR via tail intravenous injection. Compared to ADR, PAN can induce nephrotic syndrome model more rapidly, with more consistent detection index, and less toxic effects, but its cost is more expensive.