Objective To evaluate the clinicopathological characteristics and long-term outcomes of crescentic IgA nephropathy (crescentic IgAN) and Henoch-Schonlein purpura nephritis (crescentic HSPN). Methods Patients who were diagnosed with crescentic IgAN and crescentic HSPN through renal biopsy in Peking University First Hospital from 1998 to 2015 were enrolled and retrospectively analyzed. They were defined as ≥50% crescentic glomeruli on kidney biopsy-one of the common causes of rapidly progressive glomerulonephritis. The primary outcome was end-stage renal disease (ESRD) and all-causes death. Multivariate COX regression was used to analyze the risk factors for prognosis. A prediction model was developed by Logistic curve. Results One hundred and forty nine patients, including 127 cases of crescentic IgAN and 22 cases of crescentic HSPN, were included. Their mean age was 36 years old and 61.7% were men. The median proteinuria was 4.4 (2.8, 6.9) g/d, serum creatinine (Scr) 294 (152, 615) μmol/L and percentage of crescents was 64.3% (55.6% to 78.0%). There were no significant differences between crescentic IgAN and HSPN (all P＞0.05) regarding above characteristics. A total of 113 patients (75.8%) entered the follow-up cohort, including 97 patients with IgAN and 16 with HSPN. After a median follow-up of 36 months (range 6 to 189), 62 (54.9%) patients progressed to ESRD or death. After adjusting initial Scr, renal survival showed no difference between these two groups (P=0.865). In a multivariate Cox regression model, initial Scr (HR=1.002, 95%CI 1.001-1.003, P＜0.001) and tubular atrophy/interstitial fibrosis ＞50% (HR=2.986, 95%CI 1.046-8.530, P=0.041) were the independent risk factors for ESRD. Cumulative probability of ESRD prediction model was P=exp(-3.166+0.655×Scr)/[1+exp(-3.166+0.655×Scr)] with sigmoid curve. Patients with Scr≥570 μmol/L were difficult to recover from dialysis, which was identified as a non-return point. This non-return point increased to 725 μmol/L when plasma exchange therapy was added. Conclusions Crescentic HSPN and IgAN have similar clinical-pathological characters and outcomes with poor prognosis. Initial Scr and tubular atrophy/interstitial fibrosis are the independent risk factors affecting prognosis. The prediction model based on Scr is established and the non-return point is identified.

Objective To investigate the characteristics and outcome of glomerulonephritis in patients with both antineutrophil cytoplasmic antibody and anti-glomerular basement membrane antibody. Methods The sera of 23 anti-GBM glomerulonephritis patients were collected and were tested for ANCA respectively. Characteristics and outcome of patients with coexisting anti-GBM antibody and ANCA were analyzed, and were compared with anti-GBM glomerulonephritis patients without coexisting ANCA. Results Among the 23 sera with anti-GBM antibody, 7 sera had coexisting ANCA (7 MPO-ANCA, 1 PR3-ANCA), which represented 30.4% of the anti-GBM glomerulonephritis patients. The incidence of hemoptysis and hematuria in ANCA+-anti-GBM glomerulonephritis group was significantly higher than that in ANCA--anti-GBM glomerulonephritis group (P＜0.05). No significant difference in age, sex, other clinical manifestations and pathological features were found between patients with and without coexisting serum ANCA. Conclusion The incidence of hemoptysis and hematuria in ANCA+-anti-GBM glomerulonephritis group is significantly higher than that in ANCA--anti-GBM glomerulonephritis group, but the prognoses of the two groups were poor.

Objective To evaluate the role of acute kidney injury (AKI) in predicting the early (30-day) and late (30-day to 5-year) mortality of acute myocardial infarction (AMI) patients during hospitalization. Methods A total of 1371 adult patients diagnosed with AMI in the First People's Hospital of Changzhou from January 2008 to December 2012 were analyzed retrospectively with collecting their relevant clinical data from the hospital's database. AKI was categorized according to the 2012 KDIGO AKI criteria. To compare between death group and non-death group in AMI patients during 30-day and 30-day to 5-year. Different AKI stages of patients were compared, and their all-cause mortality were analyzed by Kaplan-Meier. Using multivariate COX regression analysis with two models to assess the factors for AMI patients in 30-day to 5-year. Results The prevalence of AKI after AMI in death group was higher than that in non-death group (the 30-day prevalence was 72.7% vs 27.4%, P＜0.001; the 5-year prevalence was 36.3% vs 26.2%, P=0.013). In both early (30-day) and late (30-day to 5-year) follow up, the KDIGO grading distribution of AKI was different between death group and non-death group (P＜0.001 in 30-day follow up and P=0.002 in 30-day to 5-year follow up). Among the 1371 AMI patients，410 (29.9%) developed AKI during the hospital stay. The 30-day and 30-day to 5-year mortality rates were 5.6% (77/1371) and 11.3% (146/1294) respectively. All-cause mortality and cardiovascular mortality were significantly higher in patients with AKI-Ⅰstage, AKI-Ⅱ stage and AKI-Ⅲ stage than those with non-AKI (all P＜0.001), especially in patients with AKI-Ⅲ stage. Further stroke history (HR=3.122, P=0.012), AKI severity (AKI-Ⅰstage HR=3.034, P=0.028; AKI-Ⅱ stage HR=7.832, P＜0.001; AKI -Ⅲ stage HR=9.919, P＜0.001), and β-blocker therapy (HR=0.591, P=0.040) were independent predictors of 30-day mortality, while aging (HR=1.061, P＜0.001), albumin (HR=0.943, P=0.023), AKI -Ⅲ stage (HR=3.944, P=0.007), β-blocker therapy (HR=0.660, P=0.041) and percutaneous coronary intervention (HR=0.256, P＜0.001) were independent predictors of 30-day to 5-year mortality. Both at early (30-day) and late (30-day to 5-year) follow-up, AKI with or without baseline renal dysfunction were independent predictors of death in patients with AMI (all P＜0.05). Conclusions AKI strongly correlated with short- and long-term all-cause mortality of AMI patients, regardless of the baseline renal impairment. Specifically, the more severe AKI, the higher short-term mortality AMI patients have.

Objectives To investigate the risk factors of acute renal injury (acute kidney injury) in patients with acute left heart failure. Methods Clinical data of 188 patients with acute left heart failure who were admitted to our hospital were retrospectively analyzed. Logistic regression analysis was used to assess the risk factors for AKI. Results Among 188 patients with acute left heart failure, incidence of acute kidney injury was 33.51%. Univariate and Multivariable logistic regression analyses showed that the independent predictors of acute kidney injury were lower baseline eGFR (OR=4.294, P＜0.001) and anemia (OR=3.573, P=0.006). Conclusions The incidence of acute left heart failure complicated with AKI was high. Basic state of renal function and anemia were the independent risk factors for AKI.

Objective To evaluate the sleep quality as well as the quality of life in end-stage renal disease (ESRD) patients, analyze the relationships between them and explore the influence factors. Methods A total of 141 ESRD patients from three hospitals were enrolled. The patients' general information including age, gender, degree of education, income, primary disease and years on dialysis were collected. Pittsburgh Sleep Quality Index (PSQI) was used to assess the sleep quality of the patients, and the life quality was assessed by using Kidney Disease Quality of Life-short form (KDQOL-SF). Results The incidence of sleep disorder was 56% in these 141 ESRD patients. The patients who suffered from sleep disorder had a higher sleep index score in all aspects of PSQI except in usage of sleep medications (P＜0.05). On the aspect of life-quality-associated factors, dialysis-related symptoms (OR=0.944, P=0.026), and change of health status (OR=1.024, P=1.024) were independent risk factors for sleep disorders. As for family-social factors, sleep quality was closely associated with dialysis (r=-0.252, P=0.003), family support (r=-0.174, P=0.040), and BMI (r=-0.189, P=0.025). Further regression analysis found that hemodialysis or peritoneal dialysis (OR= 0.544, P=0.011), poor family support (OR=0.686, P=0.030) were independently risk factors of sleep disorders. Conclusions Poor sleep quality is common in ESRD patients and it is associated with lower quality of life. More attention should be paid on assessment and management of sleep disorder in ESRD patients in order to improve their quality of life.

Objective To evaluate the safety and efficacy of early high intensity blood purification for severe wasp venom poisoning with acute kidney injury (AKI). Method We retrospectively analyzed 120 patients [(47±14) year, F/M=68/52] with severe wasp venom poisoning (creatine kinase >20,000 IU/L; lactic dehydrogenase >5000 IU/L) and AKI who were admitted during 2012-2014 to West China Hospital of Sichuan University, Jianyang People's Hospital of Sichuan Provinces, Ziyang First People's Hospital of Sichuan Provinces and Anyue People's Hospital of Sichuan Provinces. According to the intensity of blood purification, patients were divided into early high intensity group and conventional group. Patients in early high intensity group received plasmapheresis 1 to 3 times, and continuous renal replacement therapy (CRRT) for at least 48h, and then intermittent hemodialysis (IHD) was performed when patients became stable. Patients in conventional group received IHD 3 to 6 times per week. Meanwhile, all patients received glucocorticoid, blood transfusion and fluid support if necessary. We collected all possible clinical and laboratory data. The primary outcomes were survival rate and kidney function. Results Early high intensity therapy was associated with higher survival rate compared with conventional therapy (92.6% vs 74.2%, P=0.02). Among survival patients, 3 patients (5.6%) in early high intensity group were progressed to chronic kidney disease (CKD); instead, 11 patients (16.7%) in conventional group were progressed to CKD, indicating significant difference between two groups (P=0.04). Moreover, the duration of blood purification was significantly shorter in early high intensity group in comparison with conventional group (19.5±6.2 vs 28.1±13.4 d, P＜0.05). Conclusions Early high intensity blood purification may increase the survival rate of patients with severe wasp venom poisoning and AKI, and may reduce the incidence of CKD.

Objective To understand the quality of life (QOL) and its influencing factors in maintenance hemodialysis patients (hemodialysis maintenance, MHD), and to provide theoretical basis for improving QOL of patients. Methods A cross-sectional study was conducted in the blood purification centre in 8 hospitals of Hefei, and patients clinical data were collected. KDQOL-SF self-administered questionnaire was applied to assess the health related quality of life (HRQL) of patients and to analyze the factors influencing the QOL. Results The QOL of MHD patients in Hefei City was better compared with previous similar research results. Generally speaking, gender (male), education degree and household income were positive correlated with QOL scores (P＜0.05), and the scores of primary disease of patients with diabetic nephropathy or drugs were lower (P＜0.05) in physiological component summary (PCS), mental component summary (MCS), SF-36 and KDTA. Charlson comorbidity index (CCI) was negatively correlated with the MCS scores, PCS scores and SF scores (P＜0.05), and patients' occupational and medical insurance had impacts on MCS and KDTA score (P＜0.05). Conclusions The QOL of MHD patients are affected by many factors, and the CCI and cultural level are possible independent influencing factors. In addition, gender, household income per capita, primary disease, occupation, medical insurance also have certain influence.

Objective To observe the effects of 7,8-dihydroxyflavone (7,8-DHF) on hypoxia induced endoplasmic reticulum stress (ERS) in human proximal tubular epithelial cells (HK-2). Methods The mRNA level of ERS associated biomarkers was evaluated by RT-PCR assay in cell hypoxia damaged model. And HK-2 cells were pretreated with different concentrations of 7,8-DHF through CCK-8 assay; meanwhile CCAAT/enhancer-binding protein homologous protein (CHOP), Cyr61, Akt and p-Akt were determined by western blotting assay. Moreover, HK-2 cells were pretreated by LY294002, a kind of PI3K/Akt inhibitor, to inhibit the PI3K/Akt signaling, and its effects on protein level induced by 7,8-DHF was detected. HK-2 cells was then over-expressed Cyr61 and exposed to hypoxia Apoptosis rate and CHOP expression were determined. Results Compared to hypoxia group (P＜0.01), Hypoxia for 12h was effective in inducing ERS (P＜0.01), while pretreatment with 7,8-DHF (100 μmol/L) increased cell proliferation significantly . The protein expressions of Cyr61 and p-Akt in H+7,8-DHF group were higher, but the level of CHOP was decreased (P＜0.05). With LY294002 pretreated, the expression of Cyr61, p-Akt was down-regulated (all P＜0.05) while the expression of CHOP was up-regulated (P＜0.05). In comparison to empty plasmid group, when cells were transfected with over-expression of Cyr61 plasmid and exposed to hypoxia, the number of apoptotic tubular cells was decreased (P＜0.01). And over-expression of Cyr61 significantly reduced CHOP expression compared with the empty plasmid group (P＜0.01). Conclusion Pretreatment of 7,8-DHF could protect cells from hypoxia injury and inhibit ERS, which may involve the Akt-Cyr61 signaling pathway.