Objective To investigate the correlations between intima-media thickness(IMT) of carotid artery and its major risk factors in maintenance hemodialysis(MHD) patients. Methods A cross-sectional study was carried out in 75 MHD patients(MHD group) and 30 healthy volunteers(control group). IMT of carotid artery was examined by high-resolution B-mode ultrasonograph in all patients. The clinical and biochemical characteristics of MHD patients were collected. According to the IMT value of carotid artery the MHD patients were divided into three sub-groups: normal IMT group, abnormal IMT group and increased IMT group. Results IMT of MHD group was significantly greater than that of control group[(1.03±0.42) vs (0.63±0.11) mm, P < 0.01]. The differences of age, SBP, serum albumin, pre-albumin, cholesterol and serum phosphate between increased IMT group and normal IMT group were significant(P < 0.05 or P < 0.01). The SBP and serum phosphate level were also higher in abnormal IMT group than those in the normal IMT group(P < 0.01). Significant positive correlations were found between IMT and age(r=0.247, P=0.032), SBP(r=0.758, P<0.01), serum phosphate level(r=0.604, P<0.01). Significant negative correlations were found between IMT and serum albumnin(r=-0.292, P=0.011) as well as pre-albumin(r=-0.681, P < 0.01). The results of partial correlation test controlling for age were the same as the results of previous test. In multiple regression analysis, greater SBP(β=0.446, P < 0.01), lower serum pre-albumin level(β=-0.336, P < 0.01) and higher serum phosphate level(β=0.248, P=0.01) were significant independent risk factors for increased IMT, independent of other confounding risk factors. Conclusions IMT of carotid artery increased in MHD patients. Greater SBP, lower serum pre-albumin level and higher serum phosphate level are the significant independent risk factors for increased carotid artery IMT which may associate with advanced arteriosclerosis in MHD patients.

Objective To determine the prevalence of atherosclerotic renal artery stenosis(ARAS) in patients diagnosed and suspected coronary atherosclerosis by angiography and to find the correlative factors of ARAS through the analysis of their clinic data. Methods Coronary and renal corarteries of 126 patients were examined by angiography and clinical data were collected. Logistic regression was used to evaluate the association between renal artery stenosis(RAS) and clinical factors. Results Twenty-four (19.04%) of 126 patients examined by angiography had RAS, in whom 13(10.32%) with significant RAS. Twenty-four patients showed 28 renal artery stenosis(20 cases with unilateral, 4 with bilateral stenosis). RAS was found in the ostial(60.7%), in the main stem(35.7%) and in the branch(3.57%) of renal artery, respectively. Eighteen of 64 patients with and 6 of 62 without coronary atherosclerosis showed RAS. The result of logistic regression revealed that there was significant association between RAS and clinical factors such as coronary artery disease, hyperlipidemia(P<0.01), smoking and renal insufficiency(P<0.05). Conclusions The prevalence of ARAS is 19.04% in 126 patients with or without coronary atherosclerosis, but the prevalence of ARAS in the patients with coronary atherosclerosis is distinctly higher than that in the ones without. There is significant association between ARAS and coronary artery disease, hyperlipidemia, as well as smoking.

Objective To analyze the clinical and pathological characteristics of patients with MPO-ANCA positive Wegener granulomatosis(WG)and to investigate the difference between patients with MPO-ANCA and PR3-ANCA. Methods Patients with WG were selected according to both Chapel Hill Consensus Conference definition and American College of Rheumatology (ACR) classification criteria in 700 Chinese patients with ANCA-positive systemic vasculitis. The clinical manifestions were compared between patients with MPO-ANCA and with PR3-ANCA. Results Eighty-nine patients fulfilled the diagnostic criteria of WG, 54/89(60.7%) were MPO-ANCA positive, 34/89(38.2%) were PR3-ANCA positive, and the rest one was both positive. Patients with MPO-ANCA were female predominant compared with patients with PR3-ANCA, their male/female ratios were 23:31 vs 24:10, respectively(P < 0.05). Patients with MPO-ANCA also had multi-system involvement. However, the prevalences of arthagia, skin rash, ophthalmic and ear involvement were significantly lower in patients with MPO-ANCA than those in patients with PR3-ANCA (46.3% vs 70.6%, P <0.05; 20.4% vs 44.1%, P < 0.05; 27.8% vs 58.8%, P < 0.01; 40.7% vs 67.6%, P < 0.05; respectively). The prevalence of elevated initial serum creatinine was significantly higher in patients with MPO-ANCA than that in patients with PR3-ANCA (81.5% vs 61.8%, χ²=4.2, P < 0.05). The mean score of Birmingham vasculitis activity score (BVAS) was significantly lower in patients with MPO-ANCA than that in patients with PR3-ANCA(22.2±6.21 vs 24.7±6.87, P < 0.05). Conclusions Patients with MPO-ANCA positive WG were common in Chinese. The significance of patients with WG with different ANCA serotypes still needs further investigation.

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 explore the molecular effect and interaction among nephrin, podocin, CD2AP and α-actinin-4. Methods Firstly, the recombinant RNA interference (RNAi) plasmid—psiRNA-hH1GFPzeo, specifically targeting to the mrna of nephrin, podocin, CD2AP or α-actinin-4, was respectively tansfected into the mouse podocyte clone (MPC5) to each knockdown (KD) the expression of nephrin, podocin, CD2AP or α-actinin-4. Molecular distributions were revealed by confocal microscopy, and the mRNA and protein expressions were detected with semi-quantitative RT-PCR and Western blotting. Results (1)In podocin KD group (siPod966 and siPod54), the mRNAs of podocin and nephrin were not detected, their protein decreased 92% and 79%, 82% and 67%, respectively. The mRNA and protein level of CD2AP increased 62% and 42%, 71% and 46%, respectively, whereas α-actinin-4 did not change. In nephrin KD group (siNep492), the mRNA expression and protein level of nephrin were not detected, CD2AP increased 35% and 48%, respectively; and whereas podocin and α-actinin-4 did not change. In CD2AP KD group (siCda744 and siCda21), the mRNA of expression CD2AP was not detected, and its protein level decreased 92% and 83%, the mRNA and protein of nephrin decreased 60% and 48%, 76% and 72%, respectively; podocin increased 38% and 22%, 56% and 44%, respectively; whereas α-actinin-4 did not change. In α-actinin-4 KD group (siAct1790 and siAct319), the mRNAs expression of α-actinin-4 and nephrin decreased 69% and 58%, 64% and 49%, respectively; their protein level decreased 81% and 55%, 71% and 64%, respectively. However, the mRNAs of podocin and CD2AP increased 50% and 34%, 45% and 28%, respectively; and their protein level increased 64% and 46%, 65% and 42%, respectively. (2) With their expression change, the distributions of nephrin, podocin and CD2AP shifted evidently from the cell membrane surface to the nucleus circumference, whereas α-actinin-4 showed no change, which was still localized in the cytoplasm and further extended to foot processes. Conclusion (1) Nephrin might more independently play a crucial role in the slit diaphragm complex. (2) Alpha-actinin-4 might interact directly or indirectly with nephrin, podocin and CD2AP. (3) The relationship among these podocyte molecules might not be spontaneous, either a single-directional or bi-directional reaction. (4) The normal localization of these podocyte molecules might depend on their normal expression quantity.

Objective To investigate the apoptosis of tubular cells after renal ischemia/reperfusion (I/R) injury in aging rats, and the effects of using butylated hydroxyanisole(BHA) to inhibit the products of ROS on the model. Methods Wistar rats aged 27 months were randomly divided into 4 groups, which were sham, I/R model, BHA gavage and nicardipine injection group. The model was established through clamping bilateral renal arteries 30 min for ischemia, and reperfusing them for 18 hours. The time points we chose were based on previous experiments. Renal function, pathological changes, apoptosis were observed, the expression of caspase-3 and Cyc C, the activity of caspase-3,MDA volume, activity of superoxide dismutase(SOD)in kidney tissue were examined. Results (1)renal function of all rats slipped following I/R injury, and the pathological changes were severe, and a lot of renal tubular epithelium turned into apoptosis. Expression of caspase-3 and Cyc C as well as MDA volume were increased, the activity of caspase-3 was increased and the activity of SOD was decreased.(2)Either BHA or nicardipine could ameliorate declines in renal function, pathological changes. Either of them could decrease MDA volume and increase the activity of SOD.Conclusions In aging rats, I/R injury leads to elevated ROS accumulation, which leads to progressive apoptosis. Both inhibition of L-type Ca²⁺ channel and activation of ROS can attenuate apoptosis in tubular cells.

Objective To investigate the effect of dehydroascorbate on reactive oxygen species in tubular epithelial cell induced by high glucose. Methods Tubular epithelial cell was cultured in RPMI-1640 medium containing 10% newborn calf serum. Uptake assays for AA and DHA in tubular epithelial cell was done by using the method provided by Robert Root-Bernsteinz. The intracellular formation of ROS was detected with the fluorescent probe CM-H2DCFDA by using confocal microscopy. Results At a DHA concentration of 1 mmol/L, increasing concentrations of glucose competitively inhibited DHA from entering into the cells such that the accumulation of DHA was smaller than half maximal at about 22 mmol/L glucose. Cytochalasin B, a kind of hexose transporter inhibitor, inhibited DHA from entering into the cells. At a glucose concentration of 25 mmol/L, DHA entry into cells was strengthened with increased DHA level, and DHA inhibited intracellular ROS formation in a dose-dependent manner when DHA level was less than 4 mmol/L. However, the inhibitory effect was not observed at 8 mmol/L of DHA. Conclusions Tubular epithelial cells are DHA dependent.VitC exclusion from tubular epithelial cells through competition of glucose and DHA for common transport mechanism will deprive the cells of the central antioxidant and this could lead to ROS accumulation.

Objective To observe the outcome of normal and senescent renal tubular epithelial cells after kidney ischemia/reperfusion injury (IRI), and investigate the role of cell senescence in the aging-related pathological changes in kidney. Methods Wild-type male mice at age of 2 (young group) and 12 months (aged group) were used to make ischemic models by clamping left renal hila for 45 minutes. At 0 d, 1 d, 3 d, 7 d, 1 month, 3 months and 6 month after reflow, renal tissues were examined for histomorphology, cell proliferation(PCNA), apoptosis and senescence (SA-β-gal). Results In both young and aged mice, renal tubule necrosis was the primary changes at day 0 after kidney IRI, but in aged mice, that was much more severe. Apoptotic tubular cells were detected at day 1 after IRI in young and aged mice, and they were much more widely distributed in aged mice. The most severe apoptosis occurred in tubular epithelial cells of both young and aged mice at day 7 after reflow (P < 0.05). In young mice, faint staining for SA-β-gal activity occasionally appeared in IRI kidney at month 1, and increased at month 3 and 6 after IRI(P < 0.05). No positive staining for SA-β-gal was noticed in contra-lateral kidney at any time mentioned above. Another pattern of SA-β-gal expression was detected in aged mice, both kidneys had widely positive staining for SA-β-gal at day 0 after IRI, but decreased notably at day 1 in the IRI kidney(P < 0.05), then increased again at month 3, but still less than that in the contra-lateral kidney, and more than that in the young mice at the same time point(P < 0.05). Six months after IRI, in both IRI kidney and contra-lateral kidney, positive staining for SA-β-gal almost reached the same level. Positive staining for nuclear PCNA in young and aged mice had no statistical significance (P > 0.05), although the number of positively stained nuclear PCNA were larger in young mice than that in aged mice. Correlation analysis between senescent and apoptotic cells in aged mice was made at day 1 after IRI, strikingly negative correlation was found between them (r=-0.82, P < 0.01). Conclusions IRI can promote the senescence process of normal tubular cells, and can accelerate the death(necrosis and/or apoptosis)process of senescent tubular cells. These variations may play an important role in the development and progression of aging-related pathological changes in kidney.

Objective To Compare the cost-effectiveness among hemodialysis(HD), CAPD and kidney transplantation(KT) in the first year and the second year.Methods Patients’data of above three groups in two years were retrospectively studied,including the cost,general conditions,hemoglobin level,influence on job and functional health status(by SF-36). Results The first year’s cost of KT group was higher than the other two groups, however, the second year’s cost was lower. There was no significant difference between HD group and CAPD group. The general conditions, the ratio of employment, the level of hemoglobin in KT group were better than those in HD group and CAPD group. Functional health status (SF-36): in MH dimension, VT and PF dimensions, the score of KT group and CAPD group was higher than that of HD group; in RP, GH, SF, RE dimensions, the score of KT group was higher than that of HD group and CAPD group(P<0.05), and the latter two groups were not significantly different.Conclusion KT is a less cost replacement therapy than HD and CAPD from the second year. The cost of HD and CAPD group is not significantly different within two years. The effectiveness of KT is better than HD and CAPD. The effectiveness of CAPD is a little better than HD. KT is the most cost-effective therapy as the increase of short-and long-term survival.