Objective    To evaluate the diagnostic accuracy of IgG subclasses in differentiating membranous lupus nephritis (MLN) from idiopathic membranous nephropathy (IMN).    Methods    A total of 214 patients with membranous nephropathy (MN) who underwent renal biopsy at Peking Union Medical College Hospital from October 2011 to December 2012 were included. All renal biopsy specimens were examined and immunofluorescence staining against IgG1, IgG2, IgG3, IgG4 as well as C3, C1q and C4 were evaluated. Clinical manifestations and pathological features were compared between MLN patients and IMN patients. Diagnostic accuracy of IgG subclasses and complements were evaluated.    Results    Among all the patients selected in this study, 81% were diagnosed IMN while 14% were diagnosed MLN. The immunofluorescence staining showed that IgG4 tended to be highly expressed in IMN and its intensity was significantly higher than that in MLN (P＜0.01). The intensity of IgG3 was higher than other subclasses in MLN. The AUC of IgG4 intensity was 0.814 and its sensitivity was 91.8% and 84.2%, the specificity was 46.7% and 70.0%, when the cut?off point was 1 and 2 respectively. The AUC of the intensity difference between IgG4 and IgG3 was 0.793 and its sensitivity was 91.8% and the specificity was 66.7% when the cut?off point was 0. The sensitivity of IgG4≥1 and IgG4≥IgG3 was 88.9% and the specificity was 70.0%. The AUC of C1q intensity was 0.979 and its sensitivity was 93.3% and the specificity was 94.2% when cut?off point was 1. The sensitivity of IgG4≥1 and C1q＜1 was 87.7% and the specificity was 93.3%.    Conclusions    IgG4 is highly expressed in IMN while IgG3 is highly expressed in MLN by means of immunofluorescence staining. Intensity of IgG4, intensity difference between IgG4 and IgG3 and intensity of C1q are of high diagnostic value in MN. The combination of IgG4 intensity and the latter two markers could be helpful in differentiating MLN from IMN.  

Objective To explore the present status on achieving Kt/Vurea target in Chinese peritoneal dialysis (PD) patients and its relation with residual renal function (RRF) and clinical characteristics.    Methods    This was a cross-sectional study carried out in 5 PD centers in different area of China. Totally 681 clinical stable PD patients with duration≥3 months who completed dialysis adequacy and biochemical test during April 1st, 2011 and August 31st, 2011 were enrolled in this study. The demographic data and clinical characteristics were compared according to varied Kt/Vurea and RRF levels.    Results    (1)The total Kt/Vurea was 1.95±0.59，and total Ccr was （63.80±30.84）L·week-1·(1.73 m²) -1 for the whole group, there were 67.4% subjects achieving the Kt/Vurea target. (2) Patients achieving Kt/Vurea target were prone to be female and had smaller size with higher RRF and urine volume (P＜0.05). The serum calcium and phosphorus were controlled well in these patients (P＜0.05). They also had better higher cholesterol and low-density lipoprotein, and lower CRP level and less complications (P＜0.05). (3)Serum albumin was higher but inflammation and complications were less in patients with Kt/Vurea value≥1.7 and RRF≥2 ml·min-1·（1.73 m2）-1 (subgroup 1), as compared to those with Kt/Vurea≥1.7 but RRF＜2 ml·min-1·（1.73 m2）-1 (subgroup 2) and those with Kt/Vurea＜1.7(subgroup 3) (P＜0.05). The subgroup 2 and 3 were statistically different in these clinical indices, serum calcium [(2.22±0.21) mmol/L vs (2.14±0.24) mmol/L, P＜0.01], serum phosphorous [(1.43±0.47) mmol/L vs (1.66±0.52) mmol/L, P＜0.01], cholesterol [(4.91±1.29) mmol/L vs (4.62±0.99) mmol/L, P＜0.05], low-density lipoprotein [(2.86±0.96) mmol/L vs (1.13±0.61) mmol/L, P＜0.01], high-density lipoprotein [(1.08±0.33) mmol/L vs (2.20±0.72) mmol/L, P＜0.01]. (4)The Kt/Vurea was positively correlated with RRF (R2＝0.317); if RRF decreased 1 ml/min, the hazard of Kt/Vurea un-targeting increased 40.3%.    Conclusions    About 67.4% of PD patients can reach the Kt/Vurea target recommended by K/DOQI. RRF makes a great contribution to Kt/Vurea target. The clinical characteristics are poorer in patients who can not achieve the Kt/Vurea target, or with worse RRF. 

Objective    To investigate the number and activities changes of peripheral blood endothelial progenitor cells (EPCs) in continuous ambulatory peritoneal dialysis (CAPD) patients, and explore the connection between EPCs' number and the levels of advanced glycosylation end products (AGEs), homocysteine (Hcy) and C-reactive protein (CRP).    Methods   Twenty-five CAPD patients and thirty healthy volunteers were involved. Total mononuclear cells (MNCs) were isolated from peripheral blood of patients. EPCs were characterized as adherent cells by double staining of FITC-UEA-1 and DiL-AcLDL binding, and were further demonstrated by positive cells of CD34, CD133 and KDR using flow cytometry. The abilities of cell proliferation, adhesion and migration were further observed by fluorescent microscope. The correlations between the CEPCs' number and the levels of AGEs, Hcy and CRP were analyzed.    Results    The number and activities including migration and adhesion of EPCs in CAPD group were significantly lower than control group (P＜0.05). The levels of serum AGEs, Hcy and CRP in CAPD patients were increased (all P＜0.05) and had negative correlation with EPCs' number.    Conclusions    The number and activities of EPCs decrease in patients with CAPD, and EPCs' number is negatively correlated to the levels of AGEs, Hcy and CRP.   

Objective    To estimate dry weight (DW) and prevent dialysis-related hypotension and hypertension with the on-line monitoring of relative blood volume（RBV） and other judgments. Methods    One hundred and eight maintenance hemodialysis patients were assigned to three groups according to their blood pressure: normal blood pressure group (A group, n=43）, hypotension group (B group, n=35) and hypertension group (C group, n=35). The level of hemoglobin, serum albumin, dialysis adequacy were determined. Systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, ultrafiltration volume, relative blood volume changes and the corresponding clinical symptoms were monitored during hemodialysis in all patients. Each of the patients was continuously monitored of the indicators above for 10-12 times. At the observing period, the inferior vena cava diameter (IVCD), brain natriuretic peptide (BNP) and cardiothoracic ratio(CTR) were measured. Then according to the monitoring results, appropriate clinical interventions were given under on-line blood volume monitoring guidance.    Results    (1)The shape of RBV curve in group A showed double-exponential curve early, then down to the final linear decling ended during hemodialysis. (2)The RBV curve in group B was stable in the former two hours, then rapidly linear declined. RBV changes were significantly higher in group B than group A (P＜0.05), but when changes in RBV were plotted against ultrafiltration volume, there was no significant difference in the two groups. The level of RBV reduction at which symptomatic hypotension occurred showed considerable inter-individual variability (P＜0.05, coefficient of variation=0.28). (3)The RBV curve in group C slowly linear declined. At the end of dialysis, RBV changes were significantly lower in group C than group A (P＜0.05). (4)The IVCD values in three groups of patients before dialysis were greater than normal, significantly decreased after the dialysis (P＜0.05), but that in group B and group C were still greater than that in group A (P＜0.05). The BNP values were significantly greater in three groups before and after dialysis (P＜0.05), but after dialysis, the values decreased significantly than that before dialysis (P＜0.05). (5)After appropriate clinical intervention were given under on-line blood volume monitoring in hemodialysis, the patients of group B controlled weight gain, and even cut dry weight, the RBV change significantly decreased at the end of dialysis and significantly reduced the incidence of hypotension events (P＜0.05); When the patients of group C cut dry weight, increased ultrafiltration, the RBV change increased, the mean arterial pressure decreased significantly than before (P＜0.05).    Conclusions    (1)Hemodialysis patients with symptomatic hypotension show larger RBV decline rate in the forth hour and lager total RBV changes, which provides important information for forecasting the symptomatic hypotension in hemodialysis. (2)IVCD and CTR have certain significance to the adjustment of dry weight, but the BNP has guiding significance to volume change. (3)On-line monitoring of RBV can effectively guide the adjustment of dry weight, reduction of symptomatic hypotension occruence, and controlling of refractory hypertension in hemodialysis.

Objective    To explore the characteristics of diffusion tensor imaging (DTI)magnetic resonance(MR) imaging in healthy native kidneys.    Methods    Eighty patients without chronic kidney disease underwent DTI-MRI with spin echo-echo planar (SE-EPI) sequences and array spatial sensitivity encoding technique (ASSET). Cortical and medullary mean diffusivity (MD), axial and radial diffusivity (AD and RD) values and primary, secondary and tertiary eigenvalues (λ1, λ2, λ3) and fractional anisotropy (FA) were analyzed in both kidneys and in different genders. Physiological indexes including age, gender, height, weight, body mass index (BMI), body surface area (BSA), and estimated glomerular filtration rate (eGFR) were recorded. Correlations between DTI parameters and physiological indexes were analyzed.    Results    Cortical MD, λ2, λ3, RD values were higher than corresponding medullary values except for λ1 value. Cortical FA value was lower than medullary FA value. Cortical FA, λ1 values and medullary FA were higher in left kidney than in right kidney. Medullary λ3 and RD values were lower in left kidney than in right kidney. Medullary λ2, λ3 and RD values were higher and medullary FA values were lower in female than in male. Medullary FA (r＝0.351, P＝0.002) and λ1 (r＝0.277, P＝0.018) positively correlated with eGFR and medullary FA (r＝-0.250, P＝0.033) negatively correlated with age.    Conclusions    Renal water molecular diffusion differences exist in human bilateral kidneys and different genders. Renal medullary tubular regularity, tubular diffusion and perfusion correlate with age.  

Objective    To evaluate the diagnostic value of serum albumin (Alb), total protein (TP), body mass index (BMI), Mini Nutritional Assessment (MNA) and hand strength in the nutritional status in maintenance hemodialysis (MHD) patients.    Methods    A total of 126 MHD patients were included in this study who had been on MHD for at least 3 months. Depending on the levels of Alb, patients were divided into two groups：normal nutrition group (group A) and malnutrition group (group B). TP, BMI, MNA and hand strength were also detected at the same time. Independent samples t test, Spearman correlation analysis, ROC curve were used to analyze their difference between the two groups and evaluate their diagnostic value in nutritional status in MHD patients.    Results    Age, sex, height, weight and dialysis ages had no statistical significant difference (P＞0.05) between group A and group B, while Alb, TP, BMI, MNA and hand strength had statistical significant difference (P＜0.05) between two groups. After adjusting for age, sex and hemodialysis age, Alb, TP, BMI, MNA and hand strength were positively correlated with each other (P＜0.05). Since the area under the ROC curve of BMI was the smallest, BMI had the lowest diagnostic value in evaluation of the nutritional status in those patients.     Conclusions    Alb, TP, MNA and hand strength are good indexes in evaluation of the nutritional status in MHD patients but BMI is not.    

Objective    To investigate the mortality, hemodialysis duration and causes of death of maintenance hemodialysis patients in Shanxi province from Jan 2010 to Dec 2012.    Methods    The information data of Shanxi hemodialysis patients during 2010-2012 were exported from Chinese national renal data system. Mortality, hemodialysis duration and causes of death of maintenance hemodialysis patients were analyzed.    Results     Mortality of maintenance hemodialysis patients in Shanxi province in 2010 was 7.4%, and it was decreased to 6.4% in 2011 and 6.8% in 2012. Death patients with hemodialysis for less than 2 years accounted for 68.1%, and hemodialysis patients who could be maintained for more than 5 years only accounted for 8.1%. The main causes of mortality were sudden death (23.5%), cerebrovascular events (21.2%), heart failure(12.4%), myocardial infarction/arrhythmia(6.5%), hemorrhagic disease(5.1%) and infection(4.9%).    Conclusions    Mortality of maintenance hemodialysis patients in Shanxi province is 6.4% to 7.4%. Cardiovascular and cerebral vascular events are the main causes of death.

Objective    To investigate the effects of peroxisome proliferator-activated receptor γ (PPARγ) agonist on serum adiponectin (ADP), urine microalbumin (mALB) and kidney pathology of obese mice, and discuss the significance of PPARγ agonists preventing obesity-related glomerulopathy (ORG).    Methods    Sixteen male ob/ob mice and 8 male C57BL/6 mice which were 8 weeks old were selected in this study. Ob/ob mice were dividing into 2 groups according to body mass: obesity group (M group) and pioglitazone intervention group (T group) which were fed with high lipid chow. C57BL/6 mice were control group (C group) which were fed with ordinary chow for 12 weeks. Body mass, blood glucose, serum ADP, urine mALB were assayed in each group and compared. The morphological changes of kidney were observe by HE staining, glomerular diameters were measured and compared. Zonula occludens-1 (ZO-1) and Wilms tumor 1 (WT1) were positioned by immunohistochemistry, the level of ZO-1 expression in podocyte and podocyte number which was signed with WT1 in each group were evaluated and compared. And then the correlations between serum ADP, urine mALB, body mass, blood glucose, kidney mass, glomerular diameter, the level of ZO-1 expression, podocyte number were analyzed.    Results    The serum ADP of obese mice decreased (P＜0.05), and the urine mALB increased (P＜0.05), when compared with that of control group, and there was a negative correlation between ADP and mALB (r＝-0.538, P＜0.01). Renal pathology showed glomerular hypertrophy, in part associated with focal segmental glomerulosclerosis (FSGS), the expression of ZO-1 in podocyte and podocyte number were lower than that of control group (P＜0.05). After the intervention with pioglitazone, the urine mALB of obese mice reduced (P＜0.01), and the serum ADP level of them was higher than that of obese mice without intervention (P＜0.01). There was no glomerular hypertrophy and glomerulosclerosis in kidney of obese mice, the expression of ZO-1 in podocyte and podocyte number were higher than that of obese mice without intervention (P＜0.05).    Conclusions    The kidneys of obese mice have clinical and pathological changes indicating that obesity can lead to kidney damage. Pioglitazone can make the low serum ADP level of obese mice ameliorated, and make the urine mALB of them reduced. Renal pathological change significantly is alleviated, the expression of ZO-1 in podocyte and podocyte number are increased, indicating pioglitazone can improve renal injury related to obesity. 

Objective    To investigate the mechanism of focal necrotizing glomerulonephritis induced by FimH fusion protein.    Methods    Wistar-Kyoto (WKY) rats were immunized with purified FimH fusion protein (150 μg) emulsified in Titermax Gold. Controls received PBS in Titermax Gold alone. Glomerular injuries were assessed by 24-hour urinary protein, urea nitrogen (BUN), serum creatinine (Scr), serum uric acid (UA) and histomorphology. The levels of interleukin-17A (IL-17A) were detected by ELISA assay.    Results    The levels of 24-hour urinary protein began to rise at 3rd day after immunization with FimH fusion protein, and were significantly higher than control group on 7th , 35th and 50th day [(8.59±1.25) mg vs (3.08±1.08) mg, (10.33±1.10) mg vs (6.40±0.61) mg, (12.45±1.73) mg vs (5.93±0.83) mg, all P＜0.05]. The serum levels of BUN, Scr, UA in model rats were increased significantly at 50th day [(6.76±0.20) mmol/L vs (5.82±0.13) mmol/L, (58.00±1.53) μmol/L vs (25.67±1.45) μmol/L,(61.67±7.27) μmol/L vs (31.33±2.73) μmol/L, all P＜0.05] compared to control group. WKY rats immunized with FimH fusion protein showed segmental necrosis of glomerular capillaries, alveolar wall thickening, and significant inflammatory cells infiltration on 35 th day, and glomerular crescent formation after 50 days. The serum levels of IL-17A were increased significantly compared to control group on 35th and 50th day [(46.97±5.00) ng/L vs (11.27±2.67) ng/L, (41.95±5.51) ng/L vs (16.31±1.64) ng/L, P＜0.05]. The IL-17A level was positively correlated with 24-hour urinary protein in model group (r＝0.557, P＝0.021).    Conclusion    Bacteria FimH protein can induce glomerular focal necrotic lesion and lung injury in WKY rats, and IL - 17A may involve in the damage process.

Objective    To investigate the effect of pretreatment with pravastatin on subsequent ischemia reperfusion (IR) injury in rat kidney.    Methods    Health Sprague-Dawley rats were randomized into three subgroups: ⑴ group sham (n＝5); ⑵ group IR (n＝8); ⑶group pravastatin＋IR(n＝8). IR injury were induced by clamping both renal arteries for 45 min. Rats were pretreated with pravastatin (20 mg·kg-1·d-1) for 7 d before IR injury and killed 24 h later. Renal tissues were stained with periodic acid Schiff (PAS) to measure the tubular necrosis and the heat shock protein 70 (HSP-70) expression was measured by immunohistochemistry. TUNEL assay and Western blotting were used to measure apoptotic cell death and apoptosis-related protein (Bcl-2, Bax and active caspase-3) expression.    Results    Normal rats treated with pravastatin displayed a significant increase in HSP-70 expression [(173.9±19.2)% vs (100.9±13.7)%, P﹤0.01], which mainly located at inner cortex and outer medulla of rat kideys. Compared to group sham, the levels of BUN and Scr, tubular necrosis index [(36.0±1.2)% vs 0] and the number of TUNEL-positive cells (295.4±28.3 vs 1.4±1.1) in group IR were increased (P﹤0.01). In the molecular level, IR injury significantly inhibited the ratio of Bcl-2/Bax protein [(57.3±7.3)% vs (100.0±5.4)%, P﹤0.01], but increased active caspase-3 [(385.2±38.7)% vs (96.9±3.1)%, P﹤0.01] expression. Pre-treatment with pravastatin improved all of above parameters (all P﹤0.05). Interestingly, there was no significant difference in serum lipid levels between experimental groups.    Conclusion    Pravastatin prevents against subsequent IR injury in rat kidney, and the effect is closely associated with induction of HSP-70 which is hypolipidemia-independent.