Objective To analyze how is the elastography of renal tissue correlated to clinical biochemical indexes and pathological changes in patients with chronic kidney disease (CKD), and to explore the potential of renal elastography to become a new noninvasive method available for the dynamic monitoring of renal disease progression, as well as its efficacy assessment and prognosis evaluation. Methods Patients admitted to the department of nephrology of the First Affiliated Hospital of China Medical University and received renal biopsy from August 2014 to January 2015 were selected. One hundred and thirteen cases of CKD patients, 61 males and 52 females were enrolled, including 23 cases of IgA nephropathy, 39 cases of membranous nephropathy, 15 cases of minimal change nephropathy and 7 cases of focal segmental glomerulosclerosis. The Young modulus of renal cortex and medulla (YMcortex and YMmedulla) were detected by Aix Plorer type full digital color Doppler ultrasound. The correlations between the YMs and clinical biochemical indicators in blood and urine, and the difference of YMs among different pathological changes in patients with CKD were analyzed by statistics. Results The YMcortex and YMmedulla in CKD patients were higher than those in the control group (all P＜0.05); and with the progression of CKD, the YMcortex and YMmedulla gradually increased. The YMcortex in CKD G5 patients was higher than that in CKD G1-3 patients (all P＜0.05). The YMmedulla in CKD G3-5 patients was higher than that in CKD G1-2 patients (all P＜0.05). The YMcortex was correlated with systolic pressure, serum creatinine, cystatin C, serum albumin, serum phosphorus, calcium and phosphorus product, uric acid, intact parathyroid hormone (iPTH), urinary NAG, estimate glomerular filtration rate (eGFR) and hemoglobin (all P＜0.05). The YMmedulla was correlated with systolic pressure, serum creatinine, serum albumin, uric acid, iPTH, urine microalbumin (MA), urinary NAG and hemoglobin (all P＜0.05). Serum cystatin C (β=0.485, P=0.018) and uric acid (β=0.418, P=0.039) were independently correlated with the YMcortex. Serum creatinine (β=0.380, P=0.019), uric acid (β=0.482, P=0.004) and smoking (β=0.337, P=0.009) were independently correlated with YMmedulla. The YMcortex and YMmedulla in different pathological types were statistically significant (P＜0.001, P=0.003). The YMcortex and YMmedulla in patients with membranous nephropathy and IgA nephropathy were higher than those in the patients with minimal change nephropathy (all P＜0.05). The YMmedulla in patients with focal segmental glomerulosclerosis was higher than that in the patients with minimal change nephropathy (P＜0.05). The YMcortex in the patients with phases Ⅳ and Ⅴ based on the Lee grading system of IgA nephropathy was higher than that in the patients with phases Ⅱ and Ⅲ (P＜0.05). According the Oxford classification for IgA nephropathy, the YMcortex and YMmedulla in the T1 and T2 patients were higher than those in the T0 patients (P＜0.05). The YMcortex and YMmedulla showed no statistically significant differences among different stages of membranous nephropathy. Conclusions The YMcortex and YMmedulla are associated with the progress of renal insufficiency, which may become new indicators for determining CKD progression. The renal ultrasound elastography may become a new non-invasive method for early diagnosing CKD, dynamic monitoring disease progression, and assessing efficacy and prognosis.

Objective To investigate the relationship between serum phosphorus variability and mortality in maintenance hemodialysis (MHD) patients. Methods A total of 502 MHD cases from Renji hospital hemodialysis center were registered in Shanghai Registry Network from January 2007 to April 2015. They were recruited with general information, laboratory results and outcomes. According to their median of coefficient of variation (CV) of blood phosphorus, the patients were divided into high variation group (CV≥0.226 mmol/L) and low variation group (CV＜0.226 mmol/L). The relationship of serum phosphorus CV with all-cause mortality and cardiovascular disease mortality was assessed respectively. Results The average age was (63.9±14.6) years, the median dialysis age was 82.0 (43.0, 139.0) months, 118 patients (23.5%) died for all cause and 64 patients (12.7%) died for cardiovascular disease. Compared with patients in low phosphorus variation group, patients had a higher all-cause mortality in high phosphorus variation group (27.7% vs 19.3%, P=0.028). Higher cardiovascular disease mortality was observed in high variation group as well, but this difference was no statistical significant (15.4% vs 10.0%, P=0.082). COX regression analysis showed that ＞60 years of age (HR=2.762, 95%CI 1.707-4.468, P＜0.001), low hemoglobin (HR=0.466, 95%CI 0.317-0.686, P＜0.001), low albumin (HR=0.555, 95%CI 0.366-0.840, P=0.005), high CV of phosphorus (HR=1.479, 95%CI 1.023-2.139, P=0.037) were independent risk factors for all-cause mortality. Moreover, ＞60 years of age (HR=2.666, 95%CI 1.469-4.837, P=0.001), low hemoglobin (HR=0.480, 95%CI 0.238-0.801, P=0.005), and high CV of phosphorus (HR=1.655, 95%CI 1.003-2.729, P=0.049) were independent risk factors for cardiovascular disease mortality. There was no significant statistical difference between patients phosphorus on target and patients phosphorus below target in all-cause disease mortality (P=0.065) and cardiovascular disease mortality (P=0.425). High variation group whose phosphorus on target had higher all-cause mortality and cardiovascular disease mortality than those in low variation group (29.2% vs 16.9%, P=0.047; 15.0% vs 6.0%, P=0.033). Kaplan-Meier method showed that patients with high phosphorus variation had higher all-cause (P=0.023) and cardiovascular disease mortality (P=0.047) than patients with low phosphorus variation. Conclusions The high CV of phosphorus is independently correlated with all-cause and cardiovascular disease mortality. Patients with standard-reaching phosphorus in the low variation group have a lower mortality. A serum phosphorus level sustainably reaching the standard may improve the survival in MHD patients.

Objective To analyze the relationship between the least diameter of autogenous arteriovenous fistula and other parameters like flow rate and artery diameter. To identify an appropriate way in defining fistula stenosis. Methods Physical examination and Doppler ultrasound were used to examine the autogenous arteriovenous fistula of maintenance hemodialysis patients. Well-used wrist arteriovenous fistula was included. The least diameter of the fistula vein was found and marked by ultrasound, and the diameter and the distance between the point and the anastomotic stoma were measured. Diameters of different places along the cephalic vein of the fistula, including the forearm place, the place close to elbow and the upper arm place were measured by ultrasound. Meanwhile, diameter as well as flow velocity and flow rate of brachial artery, radial artery and ulnar artery were also measured. Result Sixty-eight patients were enrolled in the study. The average age of those patients was 52.56±2.00 years old. Thirty-one patients were female. Forty-nine fistula were located on the left arm. The average diameter and flow rate of brachial artery were 5.72(5.34, 6.33) mm and 821.50(540.50, 1075.00) ml/min, respectively. The average diameters of radial artery and ulnar artery were 3.95±0.10mm and 3.17(2.73,3.75) mm, respectively. The least diameter of cephalic vein was 3.34±0.11mm in average. The distance between the least place to the anastomotic stoma was 3.76±0.14cm in average. The diameter of forearm cephalic vein was averaged 5.36(4.52, 6.45) mm. Diameter of place close to elbow and the upper arm place in the cephalic vein were (5.57±0.12) mm and (5.80±0.14) mm, respectively. The least diameter of cephalic vein was positively and statistically associated with the diameter and flow rate of brachial artery as well as radial artery. The least diameter was also positively and statistically associated with the diameter of each place in the cephalic vein. Statistical inter-group difference was found when the division was based on the value of the least diameter. Conclusion sThe least diameter of the wrist autogenous arteriovenous fistula vein will indeed affect the whole diameter and flow rate of the fistula. The value of the least diameter is more closely associated with the fistula function rather than narrow rate.

Objective To observe the short-term clinical outcomes of kidney transplantation from brain and cardiac death donors (DBCD) and assess its feasibility to expand organ donor pool. Methods A retrospective analysis was performed on 48 cases of kidney transplantation from DBCD.The transplant recipients had finished 12-month follow-up in the First People's Hospital of Foshan from September 2011 to February 2015, with their renal function, rejection reaction and complications at 1 week, 1 month, 3 months, 6 months and 12 months after renal transplantation being collected. Survival rates of transplant recipients and transplant kidneys, incidence of delayed graft function (DGF) and its influence for recipients and graft survival were analyzed by statistics. Results In the 48 cases, the survival rates of recipients at 1, 3, 6 and 12 months after transplantation were 100.0%, 100.0%, 97.9%, 95.8%, and the survival rates of transplanted kidneys were 95.8%, 95.8%, 93.8%, 91.7%, respectively. DGF occurred in 8 of 48 (17.0%), but the occurrence of DGF did not adversely influence patient's survival (P=0.524) or graft survival (P=0.362). Conclusions The short-term clinical outcomes of kidney transplantation from DBCD are ideal. As the legislation of donation after brain death (DBD) has not been ratified in China, the kidney transplantation from DBCD could be an important way to solve the shortage of organs, and increase the number of kidneys available for transplantation.

Objective To establish blood purification system for rats and provide a safe and reliable experimental platform for further research of blood purification. Methods The right carotid artery and the contralateral jugular vein of adult male Sprague-Dawley rats were cannulated to creat vascular access for blood purification, by which continuous arteriovenous hemofiltration blood purification system was established. Blood flow, substitution fluid flow and ultrafiltration rate were regulated by rotary mini-pumps. Blood purification therapy continued for 4 hours on the basis of maintained anesthesia and effective anticoagulation. The safety of continuous arteriovenous hemofiltration blood purification systems was evaluated by comparing the arterial blood gas, electrolyte indexes and blood glucose during the blood purification therapy. Closely monitoring the vital signs of rats, such as blood pressure and heart rate, and observing whether there were any side effects, such as massive haemorrhage, thrombogenesis and gas embolism in the therapeutic process. Results There were no obvious changes of arterial blood gas, electrolyte indexes and blood glucose during the blood purification therapy (P＞0.05). The vital signs did not fluctuate acutely before and after the blood purification therapy (P＞0.05). The incidence rate of side effects was very low. Conclusions Continuous arteriovenous hemofiltration blood purification system had no obvious adverse effects on healthy rats. Our blood purification system for rats appears to be safe and reliable.

Objective To detect the effect and mechanism of Cyr61 on the apoptosis of renal tissue caused by early stage of ischemic acute kidney injury (AKI). Methods 30 SD rats were randomized into 5 groups, including control group, AKI group, AKI+bicarbonate group, AKI+blank virus group, and AKI+over-expression Cyr61 virus group. After animal models were created for 2h, serum and renal tissue were collected from sacrificed animals. Expression level of TNF-α was determined by ELISA. HE staining was used to observe the histologic changes of renal tissues. The levels of NF-κB p65 and TNFR1 were measured by immunohistochemical method. RT-PCR and Western blotting assay were adopted to detect the mRNA and protein expression levels of NF-κB p65,TNFR1 and Caspase3. Results Compared with control group, AKI group, AKI+bicarbonate group, AKI+blank virus group, AKI+over-expression Cyr61 virus group had obvious kidney injury. The levels of TNF-α, the mRNA and protein expression levels of NF-κB p65, TNFR1 and caspase3 were markedly up-regulated. Over-expression of Cyr61 significantly attenuated the degree of pathological injury, numbers of apoptotic renal tubular epithelial cells and increased the degree of Scr. Although compared with other groups, the level of TNF-α in kidney tissue had no difference, there was obvious decreased protein level of NF-κB p65, while the increase of TNFR1 and Caspase3 protein was moderate. Conclusions During the early stage of AKI, over expression of Cyr61 could inhibit apoptosis, which may be related to the suppression of TNFR1 transcriptional expression and interference of TNF-α pathway. Its underlying mechanism therefore deserves further research.

Objective To observe the role of intermediate conductance calcium-activated potassium channels (KCa3.1) in alkalinization and β-glycerophosphate induced vascular calcification. Methods Vascular smooth muscle cells (VSMCs) and aortic rings were obtained from rat thoracic aorta, and then randomly divided into control group (pH was provided into 7.4, 8.0), high phosphorus groups (pH was provided into 7.4, 7.7 and 8.0, VSMCs in three groups were treated with 10 mmol/L β-glycerophosphate; HCl and NaHCO3 were used to adjust the pH) and TRAM-34 group (20 nmol/L was added into pH8.0 high phosphorus dulbecco's modified eagle's medium). Calcium deposition and alkaline phosphatase (ALP) activity were measured by Alizarin red staining, calcium content and enzyme linked immunosorbent assay after cells were simulated for 12 days. Intracellular free Ca2+ was measured by ELISA. The expression of KCa3.1, runt-related transcription factor 2 (Runx2) were detected by RT-PCR and Western blotting 4 days after cells were stimulated. Calcium deposition was measured by von Kossa staining and calcium content after aortic rings were cultured for 12 days. The expressions of KCa3.1 and Runx2 were detected by immunohistochemistry after aortic rings were cultured for 4 days. Results Compared with control group, calcification in VSMCs and aortic rings were significantly increased in high phosphorus group (P＜0.05) while decreased in TRAM-34 group (P＜0.05). Compared with control group, the expressions of KCa3.1, Runx2 and the activity of ALP in high phosphorus groups were increased (P＜0.05) while decreased in TRAM-34 group (P＜0.05). Besides, expressions of Runx2 and KCa3.1 were augmented as the pH was higher (P＜0.05). The expression of Runx2 in aortic rings was the same situation. Besides, the Ca2+ influx was blocked by TRAM-34 (P＜0.05). Conclusions Alkalinization contributes to β-glycerophosphate induced VSMCs calcification through increase of Ca2+ influx, up-regulation of KCa3.1 and promotion of osteogenic/chondrogenic differentiation.

Objective To observe the effects of bone marrow-derived mesenchymal stem cells (BMSC) on glomerular podocyte injured by lipopolysaccharide (LPS) and the expression of related protein. Methods Podocytes are divided into control group, BMSC group, LPS group and LPS plus BMSC group. After 24 hours of intervention, observing each experimental group podocyte form under inverted phase contrast microscope；detecting the expressions of mRNA and protein of nephrin, CD2AP, synaptopodin, and TRPC6 by RT-PCR and Western-blot. Results Compared with control group, expressions of nephrin, CD2AP, and synaptopodin in LPS group decreased (P＜0.05) while that of TRPC6 increased (P＜0.05); compared with LPS group, expressions of nephrin, CD2AP, and synaptopodin in LPS+MSC group increased (P＜0.05) while that of TRPC6 decreased (P＜0.05). Conclusion BMSC may relieve LPS-induced podocyte injury.