Objective To investigate the prevalence of kidney damage and risk factors in residents older than 40 years in Beijing， one of the greatest Chinese metropolis. 

Methods Two thousand three hundred and fifty-three residents from four of eight communities in one district of Beijing were interviewed and tested for albuminuria-morning spot urine albumin to creatinine ratio (abnormal:≥30 mg/g)， reduced renal function-estimated glomerular filtration rate by abbreviated MDRD equation [abnomal: < 60 ml▪min^-1▪(1.73 m²)^-1]， hematuria and pyuria-morning spot urine dipstick confirmed by urine microscopy. The associations among demographic characteristics， health characteristics (eg. smoking， diabetes， and hypertension) and indicators of kidney damage were examined. 

Results Albuminuria was detected in 6.2% of subjects， reduced renal function in 3.0%， hematuria in 0.8%， and non-infective pyuria in 0.09%. Approximately 9.4% of subjects had at least one indicator of kidney damage. Diabetes and systolic blood pressure were independently associated with albuminuria. Hyperuricemia， albuminuria， age， hypercholesteremia and gender were independently associated with reduced renal function. 

Conclusion The prevalence and risk factors of CKD in population older than 40 years in a Chinese metropolis are similar to those of developed countries.

Objective To conduct a population-based screening program in Guangzhou urban area and to identify the prevalence of chronic kidney disease（CKD） and risk factors in the general adult population of southern China. 

Methods 2213 residents （older than 20 years） from 3 communities in 2 districts of Guangzhou city were randomly selected using a stratified, multi-stage sampling. All residents were interviewed and tested for morning spot urine of albumin to creatinine ratio (ACR) ( abnormal: ≥30 mg/g ); morning spot urine dipstick of hematuria (abnormal: 1+ or greater) confirmed by urine microscopy (abnormal: >3 red blood cells /HP); and MDRD equation estimated GFR[abnormal: <60 ml·min^-1·(1.73 m²)^-1]. The associations of kidney damage indicators with age, gender, smoking, diabetes mellitus, hypertension and hyperuricemia were examined. 

Results Eligible data of 2128 subjects were enrolled in the study. After the adjustment of age and gender component, the prevalence of albuminuria was 6.16% （95% CI:5.9%~6.42%）, hematuria 6.5%（95%CI：5.3%~7.8%）, and reduced eGFR 1.64%（95%CI:1.3%~1.98%）. Approximately 10.1% subjects had at least one indicator of kidney damage. Age, diabetes mellitus and hypertension were independently associated with CKD. 

Conclusions The prevalence of chronic kidney disease is 10.1% and the recognition is 9.7% in urban adult population of southern China. Independent risk factors associated with kidney damage are age, diabetes mellitus and hypertension.

Objective To investigate and compare the efficacy and safety of intravenous iron sucrose and iron dextran for the treatment of iron deficiency in anemic hemodialysis patients. 

Methods In this prospective randomized controlled multi-center clinical study， 80 chronic hemodialysis patients were divided into two groups: treatment group (iron sucrose group， n=40) and control group (iron dextran group， n=40). There were no significant differences in the basic data (gender， age， duration of hemodialysis ， Hb，Hct， ferritin and transferring saturation，etc) between two groups at pre-treatment. The patients were treated with iron sucrose or iron dextran， 100 mg intravenous， during 10 consecutive hemodialysis sessions， twice a week for five weeks. The duration of follow-up was eight weeks. The total supplement iron amount of both groups was 1000 mg.Erythropoietin (EPO) was used at a dose of 120~150 U·kg^-1·week^-1. The efficacy and safety were assessed by evaluating the changes in Hb， Hct， ferritin， transferring saturation and side effects in both groups pre?-and post-treatment. 

Results Compared with the pre-treatment， the Hb levels in both groups significantly increased at post-treatment [iron sucrose group:(98.85±17.45)g/L vs (75.20±9.66) g/L，P < 0.01， iron dextran group: (94.93±14.03) g/L vs (75.53±10.61) g/L，P < 0.01， respectively]. The Hct levels in both groups significantly increased (P < 0.01). The levels of ferritin and transferring saturation increased significantly in both groups. The increament rates of Hb， Hct， ferritin and transferring saturation in iron sucrose group were higher than those in iron dextran group， although no significant difference occurred. There were no obvious changes in BUN， Scr， ALT and AST. There were no severe adverse events in both groups and 1 case suffered from muscular soreness in the lower limbs in iron dextran group. 

Conclusion Intravenous iron sucrose is an effective and safe agent for the treatment of iron deficiency in anemic hemodialysis patients.

Objective To explore the effect of Rhein on TGF-β1-induced renal interstitial fibroblast activation. Methods Normal rat renal interstitial fibroblast (NRK-49F) treated by TGF-β1 were cultured with or without Rhein at different concentrations. Cell number was counted， and cell cycle was analyzed by flow cytometry. The fibroblast activation was assessed by expression of α-smooth muscle actin (α-SMA)， and deposition of fibronectin (FN) by Western blotting. Results Rhein suppressed TGF-β-induced fibroblast growth in time-and dose-dependent manner， and blocked resting cells into S and G2/M phase. It was demonstrated that Rhein abolished α-SMA expression of fibroblast induced by TGF-β1 in a dose-dependent manner. Meanwhile， Rhein suppressed TGF-β1-induced FN deposition and its extracellular assembly in fibroblast. Conclusion Rhein can block renal interstitial fibroblast growth and activation， and the effect of Rhubarb on delaying progression of CRF may be associated with this action of Rhein.

Objective To investigate the prevalence, awareness and risk factors of chronic kidney disease (CKD) among community adult population in Shanghai, China, in order to provide early diagnosis and treatment of CKD, and informations for national health policy makers. Methods Two thousand five hundred and ninety six residents (≥18 years old) were randomly selected from community population in Changning district of Shanghai, China. They were interviewed and tested for albuminuria -morning spot urine albumin to creatinine ratio [ACR, abnormal: ≥17 mg/g (male), ≥25 mg/g (female)], reduced renal function-estimated GFR by abbreviated MDRD equation [abnormal: <60 ml&#8226;min-1&#8226;(1.73 m2)-1] and hematuria-morning spot urine dipstick confirmed by urine microscopy. The associations among demographic characteristics, healthy characteristics (e.g. diabetes and hypertension) and indicators of kidney damage were examined. The investigators and neighborhood committee were well trained. Those who had semi-quantitative positive were detected again by albuminuria-morning spot urine albumin to creatinine ratio after three months. Results Two thousand five hundred and fifty four residents with complete data were enrolled in the study. Albuminuria was detected in 6.3% of subjects, reduced renal function in 5.8%, hematuria in 1.2%. Approximately 11.8% of these subjects had at least one indicator of kidney damage. The awareness rate of CKD was 8.2%. The Logistic regression model showed that hyperuricemia, nephrolithiasis, anemia, diabetes, central obesity, hypertension and age contributed to the development of CKD. Conclusions The prevalence of CKD in community adult population in Shanghai is 11.8%, And the awareness rate of CKD is 8.2%. Hyperuricemia, nephrolithiasis, anemia, diabetes, central obesity, hypertension and age are risk factors of CKD.

Objective To investigate the characteristics of infecting pathogens, their changes and antimicrobial susceptibilities on CAPD related peritonitis in our peritoneal dialysis(PD) center in the past 15 years. Methods Two hundred and six CAPD related peritonitis episodes in 145 patients from 2000 to 2005 were analyzed and compared with 109 episodes from 1991 to 2000. The causative pathogens, their antimicrobial susceptibilities and outcomes on CAPD related peritonitis from the two periods were retrospectively reviewed and compared. Results Culture negative rate decreased from 60.6% in 1990 s to 47.6% in the last five years(P = 0.031). Among culture positive peritonitis episodes, the incidence of gram positive bacteria (GPB) peritonitis increased from 25.6% to 39.8% (P = 0.059). This was mainly due to a significant increase in coagulase-neagative staphylococcus peritonitis, which significantly increased from 4.7% to 26.9% (P = 0.01). Gram negative bacteria(GNB) peritonitis decreased slightly (44.2% vs 34.3%, P=0.322). The incidence of Klebsiella pneumoniae peritonitis significantly decreased (14.0% vs 3.7%, P = 0.023), while Pseudomonas aeruginosa and Escherichis coli peritonitis rates slightly increased (4.7% vs 9.3%, P = 0.338; 7% vs 18.7%, P = 0.072). The decrease of fungal peritonitis rate was not significant (30.2% vs 17.6%,P = 0.123). The comparison of clinical outcomes showed an improvement of total recovery rate from 68.8% in 1990 s to 73.9% for 2000-2005(P = 0.09). The catheter removal rate decreased from 19.2% to 14.3% (P = 0.238), and the mortality from 10.1% to 5.4% (P = 0.118). In both periods, fungal peritonitis had the poorest results, which all the patients either withdrew from PD or died. Conclusions Compared with that in 1990 s, the culture positive rate for CAPD related peritonitis in 2000-2005 has been greatly improved. Coagulase-negative staphylococcus is the most common causative pathogen. The mortality and catheter removal rate have been markedly reduced in the last five years. Fungal peritonitis is the most important reason for patients′ dropout.

【Abstract】 Objective To dynamically observe the expression of slit diaphragm complex molecules, including nephrin, podocin, CD2AP, and cytoskeleton protein α-actinin-4, in adriamycin-induced nephrotic (ADN) rats, and to further explore the molecular behavior of podocyte proteins during the occurrence and development of proteinuria and their possible mechanisms. Methods Adriamycin nephropathy was induced by a single tail intravenous injection of adriamycin. Renal tissue samples were collected at day 3, 7, 14, and 28, respectively. The distribution, mRNA expression and protein expression of nephrin, podocin, CD2AP and α-actinin-4 were examined by indirect immunofluorescence, real-time PCR and Western blotting, respectively. Results (1) After the adriamycin injection, a significant increment of the 24-hour urinary protein was observed at day 14 and persisted up to day 28 (P < 0.01). (2) In ADN rats, the foot processes broadened to a different extent at day 14, and the diffuse fusion and effacement of foot processes were observed at day 28. (3) From the 7th day to the 28th day after adriamycin injection, nephrin and podocin staining gradually shifted from a linear-like pattern along the capillary loops of glomerulus to a discontinuous coarse granular pattern. Similarly, CD2AP shifted from an even GBM-like pattern to a coarse granular pattern, and α-actinin-4 changed from a dot linear-like pattern along capillary loops to a coarse granular pattern. (4) In ADN rats, nephrin mRNA expression was up-regulated at day 7 (P < 0.01) and returned to normal level at day 14 and 28. Podocin and CD2AP constantly increased from day 3 and reached a significant level at day 14 and day 28, respectively (P < 0.05). (5) The protein expression of nephrin started to increase at day 7 after adriamycin injection and was markedly elevated up to day 28 (P < 0.05). Likewise, compared with the control group, CD2AP protein expression of the ADN rats prominently increased at day 14 and persisted to day 28(P < 0.05). Interestingly, after the injection of adriamycin, podocin protein expression was dramatically upregulated at day 7 (P < 0.05), and thereafter recovered again, whereas it was significantly down-regulated at day 28 (P < 0.05). (6) Alpha-actinin-4 mRNA and protein expression showed no change at the time studied. Conclusion The increased expression of nephrin, podocin and CD2AP and their abnormal distributions are the molecular mechanism that leads to the occurrence and development of proteinuria in ADN rats. The enhanced expression may be a compensatory reaction of podocyte to injury.

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 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 prevalence of chronic kidney disease(CKD) and associated factors in a village of Zhejiang province. Methods All residents older than 18 years in the village were interviewed and screened for albuminuria with morning spot urine albumin to creatinine ratio (abnormal:≥30 mg/g), reduced renal function with estimated glomerular filtration rate by modified MDRD equation [abnomal: <60 ml·min^-1·（173 m²)^-1; hematuria with morning spot urine dipstick confirmed by urine sediments microscopy test. The correlations among demographic characteristics, health characteristics (eg. smoking, diabetes and hypertension) and indicators of kidney damage were examined. Results Complete information was obtained in 76.2% of the residents. After age and gender adjustment, the prevalence of albuminuria, reduced renal function and hematuria was 10.4%, 3.0% and 1.4%, respectively. Compared with subjects older than 40 years in Beijing and NHANES Ⅲ, participants older than 40 years in the present study tended to have lower prevalence of diabetes and hypertension, and higher prevalence of albuminuria and reduced renal function. Age and diabetes and systolic blood pressure were independently correlated with albuminuria. Female, age and hyperuricemia were independently correlated with reduced renal function. Age and smoking were independently correlated with reduced renal function. Conclusion The spectrum and correlated factors of CKD in a village undergoing rapidly economic development are close to those of Beijing and developed countries, while certain specific factors might contribute to the high prevalence of CKD in the present village.

目的 探讨慢性马兜铃酸肾病患者伴发泌尿系肿瘤情况.方法回顾分析102例慢性马兜铃酸肾病患者中4例伴发泌尿系肿瘤患者的临床资料.结果(1)4例患者均有长期间断小剂量服含马兜铃酸药物史,并被确诊为慢性马兜铃酸肾病,慢性肾功能不全;(2)4例均有明显血尿,相差显微镜检查呈均一红细胞尿,其中2例有肉眼血尿;(3)膀胱镜检查、逆行尿路造影及手术证实,3例为膀胱乳头状移行细胞癌,1例为肾盂移行细胞癌.结论慢性马兜铃酸肾病患者若出现明显均一红细胞血尿时,即应高度警惕泌尿系肿瘤发生。

Objective To analyse the effect of the low osmolar nonionic contrast medium on renal function in patients undergoing coronary angiography and/or percutaneous coronary intervention (PCI). To study the incidence and risk factors of contrast-induced nephropathy (CIN). Methods Three hundred and fifteen patients undergoing PCI or coronary-angiography from December 2004 to March 2005 were enrolled in this study. All patients received low-osmolality nonionic contrast agent. Scr， N-acetyl-β-D-glucosaminidase (NAG) and the osmolality of urine were measured at any time three days before the angiography and at 1， 2 and 6 days post procedure. Multivariate predictors of contrast-induced nephropathy were determined using logistic regression. Result (1)Among the 315 patients， 231 were males and 84 females. The average age was (63.5±11.6) years. Nineteen patients (6.03%)experienced CIN and the incidence of CIN was 6.03%. In those who had both DM and renal insufficiency， the incidence of CIN was 4/8， which was significantly higher than those who had normal renal function and/or DM (P < 0.05，P < 0.01)； (2) In 19 patients who had CIN， the level of urine NAG and Scr at day 1 and 2 post angiography were higher than those before the procedure (P < 0.05)， but they were decreased to normal level at day 6 following angiography. (3)The incidence of previously recorded renal dysfunction was 9/19 in CIN patients and 10.5% (31/296)in non-CIN patients， respectively (P < 0.01). The average contrast volume was (318.4±153.8)ml in CIN group whereas (227.9±121.9) ml in non-CIN group， and significant difference was found between the two groups(P < 0.01). Identified by logistic regression， the volume of contrast agent and pre-existed renal dysfunction were independent risk factors of contrast-induced nephropathy. Conclusions The incidence of CIN in patients who had renal dysfunction combining with DM previously is higher than that in other patients. The urinary NAG indicates early impact of renal tubular function. The volume of contrast and pre-existed renal dysfunction are independent risk factors of contrast-induced nephropathy.

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 investigate a possible relationship between CD2AP mutation and focal segmental glomerulosclerosis (FSGS). Methods Genomic DNA from peripheral blood cells of FSGS patients were extracted， and CD2AP mutation was analyzed by polymerase chain reaction (PCR) and direct sequencing. Immunofluorescence staining， confocal laser scanning microscopy and LSM-510 graphic system were used to detect the expression and distribution of protein， including both CD2AP and podocin， in patients with CD2AP mutation. Eighty-two Chinese patients with idiopathic FSGS， including 43 males and 39 females whose age ranged from 12 to 76 years old were enrolled in this study. Of these， 55 had nephrotic syndrome (NS). Sixty genomic DNA from 60 healthy volunteers were selected as normal control group. Results (1) Two CD2AP heterozygous mutations were detected in exons. One was 160G > A in exon 2， which caused the 54th amino acid changed from valine to isoleucine， and occurred in one non-NS patient with renal failure. Another was 358A > G in exon 4， which caused the 120th amino acid changed from isoleucine to valine， and occurred in one NS patient with normal renal function and relapse twice. The same mutations were not found in the control group of 60 healthy people. (2) A decreased expression was observed in glomeruli stained with CD2AP antibody， accompanied with decreasing of podocin， in the patients with CD2AP mutation. (3) Moreover， 2 mutations in introns， 1 in promoter region and 1 SNP were first reported. Conclusions The mutations in CD2AP may cause FSGS in both NS and non-NS patient. The decreasing expression of CD2AP resulting from CD2AP gene mutation may affect the expression of podocin.

Objective To evaluate the efficacy of HD02 hemodialysis monitor by means of ultrasound dilution method in surveillance of arteriovenous fistula. Methods Re-circulation, blood flow of fistula and cardiac output of 90 maintenance hemodialysis (MHD) patients were measured by HD02 hemodialysis monitor during hemodialysis session. Concerning factors of fistula blood flow were analyzed. Results Fistula re-circulation(>5%) occurred in 4 patients (3.33%). Blood flow (Qa) less than 500 ml/min was found in 21 patients(23.33%), and more than 2000 ml/min in 3 patients (3.33%). The logistic regression analysis revealed that age, sex, time of hemodialysis, time of fistula creation and mean arterial pressure were not significantly correlated, but low cardiac output and diabetes were significantly correlated to the decrease of fistula blood flow. Cardiac output less than 4 L/min was found in 33 patients(36.67%), suggesting that low cardiac output status existed in some MHD patients during hemodialysis session. Cardiac color Doppler was performed in 8 low cardiac output status patients and the result showed changes of cardiac function and structure such as interventricular septum pachynsis, cardiac valve calcification, back-streaming and left ventricle diastolic insufficiency. Conclusions Ultrasound dilution is a simple non-invasive surveillance method for hemodialysis fistula. The re-circulation rate is low when A-V fistula obtaining enough blood flow.Low cardiac output and diabetes are significantly correlated with the decrease of fistula blood flow.

Objective To observe the curative effect of total parathyroidectomy(PTX) with forearm autograft on the uremic patients suffering from severe secondary hyperparathyroidism. Methods To analyze the changes of intact parathyroid hormone(iPTH)， blood calcium and phosphate，blood haematocrit(Hct)，dyslipidemia， adequacy of hemodialysis(Kt/V、UUR)on 12 patients accepting PTX. Results The orientation of the parathyroid node detected by B-ultrasonic was consistent with location observed in surgery among 11 patients. The iPTH and blood calcium and phosphate decreased after PTX. And the operation also ameliorated the Hct， dyslipidemia and adequacy of hemodialysis. Recurrent hyperparathyroidism occurred in three patients among whom two patients received vitamin D therapy with the result of remaining iPTH in normal range and another one patient received resection of autograft resulting in normal iPTH. Conclusions PTX with forearm autograft is effective to treat severe secondary hyperparathyroidism in uremic patients. PTX can ameliorate anemia and dyslipidemia. The orientation of parathyroid node by B-ultrasonic before surgery is feasible. The “really” totally PTX and the proper tissue for autograft is crucial to avoid recurrence.

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 assess the safety and efficacy of gabapentin in treatment of refractory uremic pruritus in maintenance hemodialysis (MHD) patients. Methods A randomized controlled trial was performed. Forty-nine MHD patients with severe pruritus were randomly divided into treatment group (gabapentin 100-300 mg at dialysis day before sleep) and the control group (loratadine 10 mg daily). The efficacy was assessed by visual analogue score, pruritus score and improved Duo’s VAG score after 12-week treatment, and the side effect was also observed to assess the safety. Results After treatment, the frequency, degree and area of pruritus in 25 patients of treatment group were significantly reduced, and VAS score (1.46±1.38 vs 8.71±1.17, P<0.01), VAG score (2.92±1.63 vs 8.29±0.68, P<0.01) and the improved Duo’s pruritus score (11.33±3.99 vs 30.75±4.87, P<0.01) decreased significantly compared with that of prior treatment. The symptoms of 24 patients in control group were improved partly, which were not as good as those in treatment group (P<0.01). The side effects of gabapentin were drowsiness and dizziness, but most symptoms were relieved or disappeared within 1 week and no patient interrupted therapy. No serious adverse events were observed. Conclusion Gabapentin is safe and effective for refractory uremic pruritus, but long-term efficacy and safety requires larger sample and long-term observation.

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 design a method to characterize AOPPs. Methods Carbonyl groups were used as an oxidative index to link AOPPs and oxidized protein. Plasma-AOPPs were obtained by a series of preparation as follows. The native plasma was first determined for its protein contents followed by AOPPs level evaluation. Specimen was then washed with PBS and ultrafiltrated with an ultrafilter (10 000 cut-off membrane) to obtain clean plasma-AOPPs. A size-exclusion HPLC technique was used to verify which protein was oxidatively damaged. Fractions resulted from delipidation were also examined. Results The levels of AOPPs and total carbonyl groups in patient plasma were significantly higher than those in controls； both in native/delipidated plasma and CHCl3-resulted precipitate. HPLC revealed that serum albumin presented highest carbonyl levels. It was an exclusive protein with statistically significant difference between controls and patients (patients vs. controls in nmol carbonyl/mg protein: HSA:1.510±0.067 vs. 0.791±0.048， P < 0.01； Fg: 0.617±0.100 vs. 0.672±0.159， P = 0.773； IgG: 0.047±0.029 vs. 0.053±0.030， P = 0.791； Tf: 0.102±0.025 vs. 0.098±0.043， P = 0.385， respectively). Delipidation mainly removed fibrinogen and an unknown oxidized macromolecule. Conclusion Albumin is a more important contributor to AOPPs than other proteins， IgG in particular.

Objective To investigate the effect of losartan on urinary podocyte excretion in diabetic nephropathy (DN) patients. Methods After 6-week washout， thirty type 2 diabetic nephropathy patients received 50 mg/d losartan for 8 weeks followed by 100 mg/d losartan for an additional 8 weeks. Ten healthy volunteers served as control. Podocytes were identified and quantitated by immunofluorescence staining of urinary sediments labeled by monoclonal antibody podocalyxin. Results Urinary detached podocytes was absent in healthy controls. The amount of podocytes in the urine of DN patients were significantly greater than normal control. Therapy with losartan significantly decreased urinary podocyte excretion in DN patients. But no statistical difference of urinary podocyte amount was seen between different dose therapy phases. There was no significant correlation of the amount of urinary podocytes with urinary protein excretion and systemic blood pressure. In addition， there was significant difference of podocyte excretion between CKD stage 2 and 3 patients before therapy. Losartan treatment significantly decreased the urinary podocyte excretion of DN CKD stage 2 patients， whereas no changes were observed in CKD stage 3 DN patients. Conclusions In diabetic nephropathy， urinary podocyte is suggested to be early effective marker of disease progression. Losartan may be effective to prevent podocyte injury in DN.

Objective To investigate the correlation between urinary protein components and renal pathology in primary glomerulonephritis (PGN) patients of different pathological types. Methods One hundred and seventeen PGN patients without any special treatment were enrolled in this study. All these patients underwent renal biopsy. Scr and 24-hour urinary protein quantity were measured before the biopsy. Urinary samples were collected to analyze the protein components. Results The highest urinary concentrations of albumin (Alb) and β2-microglobumin (β2-MG) were found in patients with minimal change disease (MCD) and sclerosing glomerulonephritis (SGN)respectively. Urinary IgG/Tpro，transferrin (TRF) and β2-MG were significantly correlated with the renal tubulointerstitial scores (RTIS) and IgG/Tpro was also significantly correlated with the glomerular sclerosis. Urinary TRF and β2-MG were important influencing factors of RTIS in IgA nephropathy (IgAN) and MCD respectively， meanwhile， urinary TRF， IgG， λ light chain and β2-MG were important influencing factors of RTIS in membranous nephropathy (MN) as well. Conclusions There are differences of urinary components among PGN patients with different pathological types. Urinary IgG， TRF and β2-MG are significantly correlated with renal tubulointerstitial damage.

Objective To investigate the mechanism of Rhubarb in treating chronic kidney disease. Methods The animal model of renal disease was induced by unilateral ureteral obstruction (UUO) in CD-1 mice. The mice were divided into three groups: the sham， UUO， and UUO receiving Rhubarb extract treatment (12.5， 25， and 50 mg/kg body weight) daily. The morphological changes and content of total collagen from each group were examined at day 7 following UUO. Meanwhile， the de novo expression of α-smooth muscle actin (α-SMA)， and collagen I in tissues from mice were assessed by Western blotting. Results Administration of Rhubarb extract markedly attenuated renal tissue injury， and decreased total collagen accumulation. The expression of α-SMA was suppressed dramatically in the mice receiving Rhubarb extract treatment (50 mg/kg body weight). In addition， Rhubarb extract inhibited deposition of collagen I significantly. Conclusion Rhubarb extract is a drug for amelioration of renal fibrosis of mice in vivo.

Objective To explore the relation between specific pathological features and clinical data in diabetic patients with renal damage. Methods Pathological features and clinical data were retrospectively analyzed in 64 diabetic patients with renal damage who underwent renal biopsy from 1992 to 2002. The pathological profiles were simultaneously compared with biopsies from non-diabetic patients during the same period. Results Patients were primarily divided into 3 groups according to their pathological features: the diabetic nephropathy (DN) group (42 cases， 65.6%)， the arterio-arteriolosclerosis and ischemic glomerular damage (BNS) group (6 cases， 9.4%)， and the primary glomerulonephritis (CGN) group (16 cases， 25.0%)， including 2 patients with glomerulonephritis superimposed on diabetic glomerulosclerosis. The specific pathological profiles of the CGN group were as following: IgA nephropathy 6 cases(37.5%)， focal segmental glomerulosclerosis (FSGS) 6 cases(37.5%)， minor change renal disease (MCND) 2 cases(12.5%)， and membranous nephropathy (MN) 2 cases (12.5%)， which were similar to those of non-diabetic patients， except that the ratio of FSGS was significantly increased (27.3% vs. 4.7%， P < 0.01). Linking with clinical data， DN and BNS groups had a longer diabetic duration than the CGN group (P < 0.05). The age of CGN groups was younger than that of other two groups (P < 0.05). No differences were showed in glucose and blood pressure levels among three groups. The amount of proteinuria in BNS group was significantly less than that of DN and CGN group[(0.45±0.33) g/d vs. (3.18±2.40) g/d and (2.68±1.27) g/d， P < 0.01]， and the latter two groups were not different. Similarly， the retinopathy incidence of the BNS group was markedly lower than that of DN and CGN group (0% vs. 38.1% and 37.5%， P < 0.01)， and no difference was found between DN and CGN group. Conclusions The CGN incidence in diabetic patients with renal damage is 25%， and its pathological profiles are similar to those of non-diabetic patients. Diabetic patients with renal damage should undergo early renal biopsy to differentiate DN and CGN， which would be beneficial for patients’ individual treatment.

Objective To analyze the relationship between pathological diagnosis and clinical manifestation, and to investigate the importance of renal biopsy on the diagnosis of type 2 diabetic patients complicated with renal diseases. Methods The clinical and pathological data of 52 type 2 diabetic patients with abnormal urinalysis or increased serum creatinine who had renal biopsy performed in our department were studied. Results Among 52 patients, 32 cases were distinctly diagnosed as diabetic nephropathy (DN), including 3 presenting with diabetic nephropathy complicated with non-diabetic renal disease (NDRD), and 20 with the NDRD only. The preoperative diagnosis of 24 cases (46.15%) was accordant with the diagnosis after renal biopsy, while 10 cases (19.23%) were misdiagnosed. Between the two groups, except the differences in blood urea nitrogen, serum creatinine, diabetic duration and whether the patients were complicated with diabetic retinopathy, other clinical manifestations and laboratory findings were not significantly different. Conclusions Type 2 diabetes complicated with proteinuria may result from NDRD. It is difficult to differentiate the renal pathological changes merely by analyzing the clinical data. Therefore, renal biopsy is an important tool to confirm renal pathological changes.

Objective To investigate the effect of ACEI combining with ARB on chronic kidney disease. Methods A randomized control trial was carried out in sixty chronic kidney disease patients， who were divided into ACEI group， ARB group and combined group. The ACEI group received lotensin， and the ARB group received volsartan， while the combined group received therapy of lotensin and volsartan. Clinical data were collected in the beginning， 3rd month， 6th month， 9th month and 12th month. Results Proteinuria of 24 h [(1.08±0.68)g vs.(0.27±0.29)g]and systolic blood pressure [(129±24) mm Hg vs. (116±18) mm Hg] were significantly decreased after 12 month therapy in all groups patients(P < 0.05)， while the GFR[(67.5±30.2)ml/min vs. (69.3±34.6)ml/min]and the level of serum potassium in these patients remained the same after statistical analysis(P > 0.05). Combined therapy had the most noticeable antiproteinuric and blood pressure lowering effect， while renal function improvement，the level of serum potassium and the manifestations of side effects in combined group were similar to those in other two groups(P > 0.05).Conclusion Dual blockage of RAS with ACEI and ARB for long duration has better antiproteinuric and blood pressure lowering effect， and their side effect is mild.

Objective To observe the expressive changes of angiopoietins(Ang)/Tie-2 axis and vascular endothelial growth factor(VEGF) in kidney tissue and examine the correlation of Ang/Tie-2 axis and VEGF with renal microvascular disease in diabetic rats. Methods SD male rats were randomly divided into streptozotocin-induced diabetes group and control group. The mRNA and protein expression of Ang-1， Ang-2， Tie-2， VEGF and thrombomodulin-1(TM-1)in kidney tissue of two groups was examined by RT-PCR and immunohistochemistry at week 2， 4， 8， 12， 16， 20， and 24 respectively. Results (1) Ang-1 mRNA in diabetic group was up-regulated significantly at week 4 and 8(A，83.58±10.23，88.59±6.97)， but down-regulated significantly at week 24(47.13±8.02 vs 64.53±8.77)， as compared with other time points of diabetic group and the same time points of control group. Ang-1 was expressed outstandingly in glomeruli. From week 4 to week 24， the protein expression of Ang-1 in diabetic glomeruli increased significantly(lgA，1.64±0.12 vs 1.08±0.16，at week 4，1.24±0.11 vs 1.11±0.17 at week 24). (2) From week 4 to week 16， Tie-2 mRNA in diabetic group was up-regulated obviously with the peak between week 8 and week 12(A，87.31±11.69 vs 63.62±5.61 at week 4，81.75±8.58 vs 60.15±2.66 at week 16). The protein expression of Tie-2 was found mainly in glomeruli. Throughout experimental period， the expression of Tie-2 staining in diabetic glomeruli increased apparently with the peak between week 4 and week 8. (3) Ang-2 mRNA in diabetic group was found only at week 16 and week 20. The expression of Ang-2 in peritubular microvessel of diabetic renal cortex was found from week 12 to week 24 with the peak at week 16.(4)compared with control group，TM-1 staining in diabetic glomeruli is much more from week 2 to week 20(lgA，0.99±0.15 vs 0.68±0.17 at week 2，1.03±0.17 vs 0.74±0.13 at week 20)，but a little lower at week 24. (5) The expression of VEGF increased significantly in diabetic group. (6) In diabetic group， correlations were significantly positive among Ang-1， Tie-2， VEGF and TM-1. Meanwhile，they were positively correlated with kidney/body weight， glomerular volume， glomerular area， and urine protein excretion respectively. Conclusions (1) Change of Ang/Tie-2 axis exists in diabetic kidney， which Ang-1 and Tie-2 expression is up-regulated in early stage and down-regulated along with Ang-2 up-regulation in later stage.(2) In diabetic kidney， the change of Ang/Tie-2 axis is partly associated with the renal angiogenesis which is mainly responsible for Ang-1 down-regulation and VEGF， Ang-2 up-regulation. (3) There is a formation of new peritubular microvessels at diabetic renal cortex in middle and later stages.