Objective    To investigate the clinical and pathological characteristics of IgA nephropathy (IgAN) with macrohematuria (MH).    Method    1512 consecutive patients with biopsy-proven IgAN diagnosed from January 2006 to December 2011 were enrolled, and divided into MH group and control group respectively, according to whether there existed episodes of MH before renal biopsy. The clinical and pathological characteristics were compared between two groups. Patients in MH group were then divided into three groups according to the interval from the last episode of MH to renal biopsy to clarify the concomitant clinicopathological changes associated with occurrence of MH.    Results    The rate of MH in history was 22.1%. MH group patients had significantly lower serum creatinine, slighter proteinuria, lower prevalence of hypertension and heavier microhematuria than control group (all P＜0.001). The prebiopsy durations were similar in two groups (P=0.627). In MH group, chronic pathological indicators, including global/segmental sclerosis, tubule atrophy/interstitial fibrosis were all slighter (all P＜0.001), whereas activity indicators, including necrosis lesions, crescents and mesangial proliferation were all more severe compared with control group (all P＜0.05). Those who underwent renal biopsy within 30 days of the last episode of MH had more severe proteinuria and microhematuria, higher prevalence of necrosis lesions, more severe crescents formation, and endothelial proliferation (all P＜0.05).    Conclusions    IgAN patients with MH in history have relatively milder clinical and chronic pathological manifestations, however more active pathological changes especially in those who suffer episode of MH recently.

Objective    To explore the relationship of serum uric acid level with estimated glomerular filtration rate (eGFR) of elderly patients with hypertention based on a retrospective cohort study. Method    The subjects included 465 cases who had a readmission after 3 years of follow-up in an original cohort of 1648 patients with diagnosis of essential hypertension in Fujian Provincial Hospital from August 2007 to September 2009. Multiple regression analysis was performed to examine the effect of serum uric acid level on renal function.    Results    Four hundred and sixty-five subjects were followed up for an average of 3.9 years. Mean patient age was 68.3±9.7 years. There was no significant difference in uric acid between the baseline and 3 years later (P＞0.05). Multiple regression analysis showed that after adjustment for age, gender, diabetes, body mass index, blood pressure etc, each 100 μmol/L-higher uric acid at baseline was associated with 4.40 ml•min^-1•(1.73m²)^-1 decrease in eGFR[95% confidence interval (CI): -6.25--2.55, P＜0.01]. According to the alteration of the serum uric acid, all patients were divided into the group with decreased uric acid and the group with increase uric acid. The eGFR was lower in patients with increased uric acid than that in patients with decreased uric acid 3 years later [(70.63±21.54) ml•min^-1•(1.73m²)^-1 vs (79.62±21.16) ml•min^-1•(1.73 m²)^-1, P＜0.01] and there was no significant difference at baseline between the two groups (P＞0.05). Multiple logistic regression analysis showed that after adjusting for aging, gender, diabetes, alteration of blood pressure etc, baseline uric acid was associated with a higher risk for eGFR decreasing more than 10 ml•min^-1•(1.73m²)^-1 3 years later [hazard ratio (HR)=2.11, 95%CI: 1.24-3.59, P＜0.01]; increased uric acid 3 years later resulted in a higher risk for renal function deterioration (HR=2.60, 95%CI: 1.67-4.07, P＜0.01).    Conclusions    Elderly hypertensive patients with baseline hyperuricemia have a lower eGFR, resulting an increased risk of chronic kidney disease. While the patients with declined uric acid had a lesser imparied renal function. It suggests that the improvement of uric acid may help to slow down the deterioration of renal function in elderly hypertensive patients.

Objective    To seek the risk factors of steroid resistance in children with primary nephritic syndrome, and construct the predicting model of steroid resistance.    Methods    The clinical indicators of 185 patients with primary nephrotic syndrome (PNS) were collected, including clinical data, laboratory and imaging examination. The risk factors of steroid resistance were found using single factor analysis, receiver operator characteristic (ROC) and logistic regression test. The predicting model of steroid resistance was constructed based on integral method model.    Results    The results of single factor analysis, receiver operating characteristic curve (ROC) and logistic regression analysis showed that the age more than 6.5 years old, having microscopic hematuria and the 24 h urine protein content (24 hUP) more than 177.49 mg•kg^-1•d^-1 were the significant risk factors of steroid resistant nephrotic syndrome (SRNS). Logistic regression prediction model was Y=6.761-2.947X₁-3.336X₂-2.669X₃. The result of receiver operator characteristic showed that when the score was 0.95, the sensitivity and specificity was 56.56%, 96.62% respectively and the area under ROC was 0.86, P＜0.05).    Conclusions    The age more than 6.5 years old, having microscopic hematuria and 24 h urine protein content more than 177.49 mg•kg^-1•d^-1 are the significant risk factors of SRNS.

Objectives  To evaluate the incidence and risk factors of abdominal aortic calcification (AAC) in chronic kidney disease (CKD) stage 5 patients undergoing peritoneal dialysis (PD).    Methods    Eligible CKD stage 5 patients undergoing PD in Renji Hospital, Shanghai Jiao Tong University School of Medicine were enrolled in present study. Demographic features, blood pressure, laboratory parameters, residual renal function (RRF), dialysis adequacy and medication were determined. Lateral abdominal X-ray plain film was used to assess AAC, and abdominal aortic calcification score (AACS) was calculated. Risk factors for AAC were analyzed by Logistic regression.    Results    A total of 206 PD patients aged (55.6±15.0) years with median PD duration 20 (8, 44) months were enrolled in present study. Among them, 108 (52.4%) patients were males and 35(17.0%) complicated with diabetes mellitus. AAC was presented in 118 (57.3%) patients, and 49 (23.8%) patients had severe calcification (calcification involving more than 3 lumber segments). Compared to those without AAC, patients with AAC were elder [ (62.3±11.9) years old vs (46.7±13.9) years old, P＜0.01], had longer PD duration [28(11, 57) months vs 16(7, 29)months, P＜0.01], higher diabetic nephropathy （18.6% vs 6.8%, P＜0.05）and diabetic incidence（23.7% vs 8.0%, P＜0.01）proportion, higher pulse pressure [52.0(44.0, 66.3) mmHg vs 48.0(40.0, 58.0) mmHg, P＜0.05], lower diastolic blood pressure[(81.4±11.7) mmHg vs (88.6±14.6) mmHg, P＜0.01] and mean arterial pressure [ (99.6±13.3) mmHg vs (104.8±15.1) mmHg, P＜0.05], higher high-sensitivity C-reactive protein [2.8(0.7, 5.6) mg/L vs 1.1(0.3, 4.4) mg/L, P＜0.05], lower serum albumin [ (36.9±4.5) g/L vs (38.7±4.5) g/L, P＜0.01], pre-albumin [ (373.2±89.1) g/L vs (404.9±74.7) g/L, P＜0.01], high density lipoprotein [1.1(0.9, 1.4) mmol/L vs 1.3(0.9, 1.5) mmol/L, P＜0.05], and total creatinine clearance rate [(59.1±18.9) L•week^-1•(1.73 m²)^-1 vs (67.8±29.8) L•week^-1•(1.73 m²)^-1, P＜0.05]. Logistic regression showed that old age (OR=1.104, 95%CI 1.071-1.138, P＜0.01) and high calcium phosphorus product (OR=1.467, 95%CI 1.037-2.074, P＜0.05) were independent risk factors for AAC, while RRF (OR=0.858, 95%CI 0.740-0.995, P＜0.05) as a protective factor.    Conclusions    AAC is prevalent in CKD stage 5 patients undergoing PD. Advancing age and high calcium phosphorus product are independent risk factors for AAC, while high RRF is a protective factor. The lateral abdominal X-ray plain film is an inexpensive, simple and promising tool for assessment of AAC, even though its prognostic value of PD patients requires more follow-up studies.

Objectives    To investigate the effect of acute intermittent peritoneal dialysis(AIPD) in multiple organ dysfunction syndrome (MODS) infants with acute kidney injury (AKI) and to assess the effectiveness of the treatment.    Methods    Twenty-six cases of MODS infants with AKI (Age for 2 months to 3 years) treated with AIPD (AIPD group, n=12) or not (Control group, n=14) in intensive care unit of People’s Hospital of Guizhou Province from September 2006 to May 2014 were retrospectively reviewed. C1inical characteristics including Scr, BUN, CO₂CP, serum K⁺ and C reactive protein (CRP) before and after dialysis, mortality and renal recovery rate within 30 days were analyzed and compared between the two groups.    Result    After AIPD, the levels of Scr and BUN decreased significantly (P＜0.05), and comparison with control group was the same; serum K⁺ declined and CO₂CP increased obviously (P＜0.05); CRP also decreased but without significant difference as well as comparison with control group. Compared with control group, these infants in AIPD group showed more significant improvement, including congestive heart failure and pneumonedema; both of renal recovery rate(41.67% vs 14.29%, P=0.003) and ventilator weaning rate (58.33% vs 28.57%, P=0.086) remarkablely raised respectively; mortality rate within 30 days significantly reduced (15.4% vs 36.9%, χ²=9.58, P=0.020).    Conclusion    AIPD is a kind of effective way of renal replacement therapy, which can effectively clean out superfluous water and toxin, as well correct electrolyte imbalance, enhance renal recovery rate and reduce mortality rate, and is effective to MODS infants with AKI.

Objective    To study the effectiveness of niacinamide in treating maintenance hemodialysis patients with hyperphosphatemia.    Methods    It was a prospective and randomized controlled trial. Patients with hyperphosphatemia (serum phosphate＞1.45 mmol/L) were randomly assigned into two groups: control group (continue their original phosphate binder and rocaltrol treatment)  and niacinamide therapy group (additionally received niacinamide, titrated from 600 mg/d to 1200 mg/d). The treatment lasted for 8 weeks. Serum phosphate and calcium were tested every 2 weeks and normalized protein catabolic rate and other relevant indexes were tested monthly.    Results    100 patients were recruited and 93 of them completed the trial, including 44 from the therapy group and 49 from the control group. By the repeated measures analysis of variance, changes of serum phosphate in two groups displayed a statistical significant difference, but the levels of serum calcium in both remained steady. At the end of trial, compared to control group, therapy group  appeared decreased    serum phosphate levels [(1.59±0.36) mmol/L vs (1.94±0.25) mmol/L, P＜0.001] and increased serum HDL levels [(1.32±0.54) mmol/L vs (1.09±0.41) mmol/L, P=0.02]. Meanwhile, two groups showed no significant difference in intact parathyoid hormone and alkaline phosphatase. Adverse reactions including thrombocytopenia and gastrointestinal dysfunction were observed in niacinamide therapy group.    Conclusions    Niacinamide is effective on controlling hyperphosphatemia along with phosphate binder in maintenance hemodialysis patients. It also increases the serum HDL levels. Nonetheless, it is important to monitor the number of platelet.

Objective  To investigate the role and possible mechanism of α-Klotho in calcification and osteogenic transition of cultured rat aortic vascular smooth muscle cells(VSMCs).  Method    VSMC were cultured in vitro and divided into 5 groups: (1)control group; (2)β-glycerophosphate group; (3)β-glycerophosphate+LiCl group; (4)β-glycerophosphate+Klotho group; (5)β-glycerophosphate+Klotho+LiCl group. Calcium deposits were checked by Alizarin red staining. Extracellular calcium content were determined by arsenazo-III method. The expressions of bone morphogenetic protein-2 (BMP2), runt-related transcription factor 2 (Runx2) and β-catenin were measured by Western blotting at day 12. α-smooth muscle actin (α-SMA) was checked by fluorometry method.    Results    β-glycerophosphate induced a time-dose-dependent increasing of BMP2, Runx2, β-catenin expressions and calcium concentration. Alizarin red staining were positive under the condition of high phosphorus. The expression of BMP2, Runx2, β-catenin and calcium concentration were decreased after treating with rmKlotho. The expression of BMP2, Runx2 and β-catenin were upregulated when treated with LiCl.    Conclusions    Klotho can ameliorate the calcification and osteogenic transition of VSMCs induced by β-glycerophosphate. The mechanism of Klotho in preventing VSMCs from calcification may be partially through the inhibition of Wnt/β-catenin cellular signal pathway.

Objective    To investigate the effect of 1,25(OH)₂D₃ on high glucose induced macrophage activation and its underlying signal transduction mechanism.    Methods    RAW 264.7 cells were used to perform cell culture, the activity of intracellular iNOS was measured. VDR siRNA and PPARγ antagonist pre-treatment with macrophages were done before using 10^-8 mol/L1,25(OH)₂D₃  to intervene high glucose pre-incubated macrophages. M1 markers including iNOS, TNF-α, IL-12, M2 markers including MR, Arg-1, IL-10 and nuclear receptors VDR and PPARγ were separately examined.    Results    The iNOS activity was increased in a glucose-dose and time dependent manner. Particularly, 25 mmol/L glucose at 24 h gave the maximum response. After being treated with 25 mmol/L glucose for 24 h, not only inflammatory cytokines of TNF-α, IL-12 in the supernatant were increased, but quantitative real-time PCR and Western blotting analysis showed iNOS was also up-regulated (P＜0.05). However, M2 markers, i.e. MR and Arg-1 were significantly decreased (P＜0.05). When in the presence of 1,25(OH)₂D₃ , the trends were reversed: the markers of M1, including TNF-α, IL-12 and iNOS were obviously reduced (P＜0.05), while M2 markers, IL-10, Arg-1 and MR were increased (P＜0.05). In addition, VDR and PPARγ were also increased (P＜0.05). However, the above effects of 1,25(OH)₂D₃ were abolished when further inhibited the expression of VDR and PPARγ by VDR siRNA and PPARγ antagonist. Besides, accompanied by VDR, PPARγ was also decreased upon the treatment with VDR siRNA (P＜0.05).    Conclusion    1,25(OH)₂D₃ can promote high glucose induced classically activated macrophages (M1) converting to alternatively activated macrophages (M2) and this is achieved through VDR-PPARγ pathway.

Objective    To observe the expression of cysteine rich-protein 61 (Cyr61) on renal tubular cells, to explore its effects against hypoxic induced kidney injury and the underlying mechanisms.    Methods    A stably Cyr61 expressed tubular cell line Cyr61-HK2 was established based on HK2 cells and recombinant Cyr61-lentivirus. BrdU incorporation assay was used for cell proliferation. The apoptosis of cells was analyzed by flow cytometry with Annexin V and propidiumiodide staining. Western bloting was used to detect the protein expression of BAD, Akt and ERK.    Results    (1) Cyr61-HK2 cells displayed more proliferation ability than HK2 cells. (2) Under hypoxia condition, the apoptosis of both HK2 and Cyr61-HK2 cells increased, but the apoptosis of Cyr61-HK2 cells was lesser than HK2 cells. (3) The expression of Cyr61 led to the phosphorylation of BAD, Akt and ERK on 0 h, 0.5 h, 1 h (all P＜0.05).    Conclusion    The expression of Cyr61 can promote cell proliferation and dampen cell apoptosis induced by hypoxia, which may be involved in the Akt/ERK signal pathway.