Objective To compare the diuretic efficacy of torasemide as a 2-hour continuous infusion and as a bolus injection of equal dose in patients with nephrotic syndrome, and to investigate a preferable administration mode of torasemide for these patients. Methods Twenty-three hospitalized patients were randomized to receive torasemide 20 mg or 40 mg per day by either 2-hour intravenous infusion or bolus injection, and interchanged after 48 hours of washout. Results Patients received torasemide by 2-hour intravenous infusion exhibited significantly higher daily urinary volume, chloride excretion, sodium excretion and fractional excretion of sodium (FENa) within 24 hours than those by bolus injection (P＜0.05). Significantly lower bound-state torasemide excretion, higher ratio of urinary volume to torasemide excretion and a markedly larger area under the curve in the plasma concentration-time profiles were also observed in the infusion group (P＜0.05). Conclusion 2-hour continuous infusion delivers a better diuretic effect compared with a bolus injection of equal dose of torasemide in patients with nephrotic syndrome.

Objective To evaluate the additional role of 99mTc-MIBI SPECT-CT imaging before parathyroidectomy (PTX) for secondary hyperparathyroidism (SHPT) patients. Methods A total of 359 SHPT patients from the First Affiliated Hospital of Nanjing Medical University were enrolled in the study from April 2011 to January 2016. Patients were divided into two groups according to the difference of 99mTc-MIBI imaging techniques preoperatively. Patients in group A had dual-phase 99mTc-sestamibi parathyroid scintigraphy performed only. Patients in group B had SPECT-CT parathyroid scintigraphy added in the early phase. With the parathyroid glands confirmed by pathology after operation being the reference, sensitivity, specificity, consistency and surgical success rates of the patients in two groups were compared. Results 359 patients (166 men and 193 women) were enrolled, among which 339 on hemodialysis and 20 on peritoneal dialysis. The average age of those patients was (45.90±11.20) years and median dialysis age was 84 (60.0, 120.0) months. Total detection sensitivity, specificity, consistency in group A (169 patients) were 65.54%, 56.52%, 65.24% and in group B (190 patients) were 73.84%, 84.62%, 74.21% respectively. Total sensitivity and consistency were higher in group B than those in group A (P＜0.01), while no difference in total specificity was observed between two groups (P=0.055). In group A, detection sensitivity of parathyroid glands were 47.56%, 77.44%, 57.14% and 79.88% in right upper gland (RU), right lower gland (RL), left upper gland (LU) and left lower gland (LL) respectively. Consistency in group A were 48.52%, 77.51%, 56.21% and 78.70% respectively. In group B, sensitivity were 58.33%, 83.78%, 69.78% and 82.89% in RU, RL, LU and LL respectively. Consistency in group B were 59.47%, 84.21%, 70.53% and 82.63% respectively. Sensitivity and consistency of upper glands were lower than lower glands in both groups (P＜0.01). When SPECT-CT was added, sensitivity and consistency of upper glands for both sides were higher in group B than those in group A, while no difference of surgical success rates was found between two groups (87.57% vs 92.63%, P=0.107). Conclusion 99mTc-MIBI SPECT-CT can be combined with anatomic image effectively and increase the sensitivity and consistency of total and upper parathyroid glands. It can also make the accurate location of the lesions, which improves the efficiency of the operation.

Objective To evaluate the incidence and mortality of acute kidney injury (AKI) in coronary care unit (CCU), and to identify the risk factors of the incidence of AKI and the mortality of CCU patients. Methods A total of 414 patients in CCU from January 1, 2014 to June 1, 2015 at Zhongnan Hospital of Wuhan University were enrolled. Based on the KDIGO-AKI criteria, these patients were classified into two groups: NAKI group (patients without AKI) and AKI group. Clinical characteristics and laboratory data of two groups were compared. The risk factors of the incidence of AKI and the mortality of CCU patients was analyzed by logistic regression, and then the receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of these risk factors. Results (1) Among 414 patients, 136(32.9%) patients fulfilled the criteria for AKI, and 14.0% patients in AKI stage 1, 10.9% in AKI stage 2 and 8.0% in AKI stage 3. (2) The total CCU mortality was 15.0%. Mortality of AKI patients in the CCU was 33.3%, higher than 6.1% in patients without AKI (OR=7.735, 95%CI 4.215-14.196, P＜0.001). The mortality worsened with increasing severity of AKI (22.4% for AKI stage 1 group, 37.8% for AKI stage 2 group, 45.4% for AKI stage 3 group). (3) Anemia (OR=8.274, 95%CI 4.363-15.689), history of chronic illness (OR=2.582, 95%CI 1.400-4.760), APACHEⅡ scores (OR=1.813, 95%CI 1.739-1.895), male (OR=3.666, 95%CI 1.860-7.226) were the independent risk factors for AKI, while the normal mean arterial pressure (MAP) (OR=0.292, 95%CI 0.153-0.556) and normal estimated glomerular filtration rate (eGFR) (OR=0.166, 95%CI 0.090-0.306) are the protective factors for AKI (all P＜0.05). (4) AKI was the most powerful independent factor associated with the mortality of CCU patients (OR=7.050, 95%CI 2.970-16.735, P＜0.001). Other independent risk factors for CCU mortality included history of chronic illness, ejection fraction and APACHEⅡ≥15 scores (all P＜0.05), while the normal MAP and normal eGFR were the protective factors (all P＜0.05). (5) For predicting AKI, eGFR displayed an excellent areas under the ROC curve (AUC=0.815, P＜0.001), and for CCU mortality, APACHEⅡ scores had the highest overall correctness of prediction (AUC=0.757 P＜0.001). Conclusions CCU patients have high morbidity of AKI, which is the most powerful independent factor associated with the increased CCU mortality. The eGFR is the best predictor for AKI, and then through the evaluation of eGFR for CCU patients, we can evaluate high-risk groups, make early interventions and then improve the prognosis of CCU patients.

Objective To explore the risk factors of bone density disorder and vascular calcification in non-dialysis chronic kidney disease (CKD) patients. Methods Clinical data of non-dialysis CKD patients who were admitted to the First Affiliated Hospital of Fujian Medical University between January 2013 and June 2014 were retrospectively analyzed. Using dual energy X-ray absorptiometry to evaluate their bone mineral density (BMD) and T value. Patients were divided into normal BMD group (T≥-1), osteopenia group (-2.5＜T＜-1) and osteoporosis group (T≤-2.5). The vascular calcification was evaluated by pectoral computed tomography. Multi-factor stepwise logistic regression analysis was used to assess the risk factors for low bone density and vascular calcification in non-dialysis CKD patients. Results A total of 337 non-dialysis CKD patients were enrolled. There were 110 (32.6%) patients with normal BMD, and 146(43.3%) patients with osteopenia, and 81(24.0%) patients with osteoporosis. Gender, history of hypertension, 25-hydroxy vitamin D and N-terminal osteocalcin shown statistical differences among three groups (all P＜0.05). The incidence rate of 25-hydroxy vitamin D deficiency shown statistical difference among three groups (P=0.012). Further, the rates were increased with the decreased bone mass (χ2=7.100, P=0.008). The other mineral bone disorders, such as hypocalcemia, hyperphosphatemia, low intact parathyroid hormone (iPTH) and high iPTH had no statistical difference among three groups (all P＞0.05). Multi-factor stepwise logistic regression analysis revealed that increased iPTH (OR=1.938), and low bone density (OR=1.724) were independent risk factors for CKD patients with vascular calcification (all P＜0.05), while women (OR=3.312) and vascular calcification (OR=1.742) were independent risk factors for CKD patients with low bone density (all P＜0.05). Conclusion Increased iPTH and low bone density are independent risk factors for non-dialysis CKD patients with vascular calcification, while women and vascular calcification are independent risk factors for non-dialysis CKD patients with low bone density.

Objective To evaluate the relationship between serum magnesium and coronary artery calcification (CAC) and their associated factors. Methods 131 patients with chronic kidney disease on regular hemodialysis (HD) were recruited into this study from December 2014 to December 2015 in our center. Demographic and clinical data of selected patients were collected. Serum fibroblast growth factor 23 (FGF-23) level was quantified by enzyme linked immunosorbent assay(ELISA). Quantification of coronary artery calcification score (CACs) was determined by multi-slice spiral computed tomography (MSCT). The relationships between serum magnesium and FGF-23 level, CACs, demographic and clinical data were investigated. Results Patients were divided into low serum magnesium group, normal serum magnesium group and high serum magnesium group according to their serum magnesium levels. There were significant differences in the distribution of diabetes history, serum phosphorus, serum albumin, serum pre albumin, serum uric acid among these three groups(P＜0.05). A significant positive correlation was confirmed between serum magnesium level and serum albumin, serum pre albumin, serum phosphorus and serum uric acid by Pearson correlation analysis and Spearman correlation analysis (r=0.389, 0.234, 0.200, 0.234, P=0.000, 0.007, 0.022, 0.007, respectively). According to the degree of CAC, all maintenance hemodialysis (MHD) patients were divided into non-calcification group, low calcification group, moderate calcification group and high calcification group, and there were significant differences in the distribution of the age, serum phosphorus, serum magnesium, FGF-23 levels among these groups (P＜0.05) . Spearman correlation analysis showed that CACs was positively correlated with age, FGF-23, serum phosphorus (r=0.309, 0.277, 0.180, P=0.000, 0.001, 0.040, respectively), while negatively correlated with serum magnesium level (r=-0.238, P=0.006) in patients with MHD. The independent risk factors of CACs were aging, high level of FGF-23 in MHD patients by using ordinal logistic regression. However, Hypermagnesemia was a protective factor. Conclusions The history of diabetes, low serum albumin, phosphorus metabolism disorder and CAC are associated with hypomagnesemia in MHD patients. In MHD patients, aging as well as high level of FGF-23 are the risk factors of CAC, and hypermagnesemia is a protective factor of CAC.

Objective To evaluate the effects of baseline and changes of peritoneal transport characteristics on the prognosis of maintaining peritoneal dialysis (PD) patients. Methods Five hundred and eight-six PD patients who started PD from September 11, 2006 to October 30, 2014 in a single center were included and followed up until March 30, 2016. According to their baseline D/Pcr value in peritoneal equilibrium test (PET), the patients were divided into high transport (H) group (D/Pcr 0.82-1.03), high average transport (HA) group (D/Pcr 0.65-0.81), low average transport (LA) group (D/Pcr 0.50-0.64) and low transport (L) group (D/Pcr 0.34-0.49). According to the changes of follow-up D/Pcr comparing with baseline D/Pcr, the patients were also divided into ascending group, descending group and no-change group. The patient and technical survival rates were estimated by Kaplan-Meier analysis. Cox proportional hazards analyses were used to analyze the risk factors for PD patient death and technical failure. Results There were 67 patients in L group, 229 patients in LA group, 252 patients in HA group, and 38 patients in H group. The patient survival rate in H group was significantly lower than those of L group (P=0.036), LA group (P=0.008) and HA group (P=0.041). There was no significant difference on technical survival rate among these 4 groups. According to the tendency of follow-up D/Pcr changes, there were 127 patients in ascending group, 101 patients in descending group and 179 patients in no-change group. There was no significant difference on patient survival among these 3 groups (P=0.064). However in patients with a high transport rate (D/Pcr≥0.65), the patient survival was lower in descending group than those in ascending group (P=0.033) and no-change group (P=0.049). Age over 65 years old (HR=2.499), malnutrition during follow-up (HR=3.144), ultrafiltration less than 400 ml/d during follow-up (HR=1.863) and high sensitive C reactive protein≥10 mg/L (HR=4.526) were the independent risk factors for patient death (all P＜0.05). Gender (HR= 1.609), age over 65 years old (HR=1.929), ultrafiltration less than 400 ml/d during follow-up (HR=1.708), high sensitive C reactive protein≥10 mg/L (HR=1.829), malnutrition (HR=1.876) and change of peritoneal transport function (HR=0.579) affect technical failure (all P＜0.05). Conclusions The survival rate of PD patients with basal high peritoneal transit is relatively low, especially for patients with descending transport rate during follow-up. The concern on the peritoneal transport status is constructive for the prognosis of PD patients.

Objective To observe the effect of adenosine A1 receptor (A1AR) on the megalin defect in type 1 diabetic mice with early kidney disease. Methods 7-8 week-old, baseline body weight and fasting blood glucose matched wild type (WT) C57BL/6J mice were selected, and randomly divided into two groups: control group (n=6) and WT DM group (n=6). In the same way, male A1AR knock-out C57BL/6J mice were selected as A1AR-/- DM group (n=6). DM model was established by intraperitoneal injection of streptozocin. The blood glucose (BG), body weight (BW), kidney weight (KW), 24 h proteinuria (24hUP) and albumin creatine ratio (ACR) were measured at 4 weeks. The renal pathological lesion was observed and the expression of megalin in proximal tubules was examined by immunohistochemistry. The expression of caspase-1, IL-18 and A1AR were detected by Western blotting. Results At 4th week, compared with WT control mice, the BG, BW, KW and 24hUP of WT DM mice were increased significantly (n=6, P＜0.01), with the pathological glomerular enlargement, mesangial cell proliferation, extracellular matrix accumulation and renal tubule hypertrophy being observed. Immunohistochemistry revealed decreased expression of megalin, an important multiligand protein receptor on the brush border of proximal tubular epithelial cells in WT DM mice, which was correlated with 24hUP (r=-0.645, P＜0.01). Compared with the control mice, the expressions of caspase-1, IL-18 and A1AR were significantly increased in WT DM mice (P＜0.05). For A1AR-/- DM mice, more serious pathological lesion and megalin defect, together with increasing of casapase-1 and heavier proteinuria were observed than those in WT DM mice. Conclusion A1AR may play a protective role in megalin expression of diabetic mice with early kidney disease, in which the mechanism may be associated with caspase-1 related pyroptosis pathway. The details need further exploration.

Objective To observe the effect of costimulatory molecule B7-1 on cytoskeleton rearrangement in mouse podocytes induced by angiotensinⅡ(AngⅡ), and to study the underlying molecular mechanism of B7-1 in the pathological changes of podocytes. Methods All cultivation of conditionally immortalized mouse podocytes (MPC) in vitro were divided into the following groups: normal control group, CTLA-4 group, AngⅡgroup (10-6 mmol/L 12 h, 24 h; 10-8 mmol/L 12 h, 24 h) and CTLA-4 with AngⅡgroup. Transfect B7-1 RNA interference fragment (siRNA) to the mature podocytes, and then restimulated by AngⅡ(10-6 mmol/L 12 h), the change of podocyte cytoskeleton after AngⅡ stimulation were observed. The expression of B7-1 in each group was assayed by flow cytometry and Western blotting. The nephrin and p-nephrin protein levels in the four groups were also analyzed by Western blotting. At the same time, the podocyte cytoskeleton distribution as indicated by F-actin was observed by fluorescence microscopy. Results Flow cytometry and Western blotting showed that B7-1 was not expressed in the normal control group. AngⅡshowed a concentration and time dependent induction of B7-1 expression in mouse podocytes (P＜0.05). Western blotting indicated that AngⅡinduced B7-1 protein expression (P＜0.05). Expression of nephrin and p-nephrin was significantly down-regulated by AngⅡ(P＜0.05). Compared with the normal control group, the expression of podocyte protein nephrin and p-nephrin in Ang II stimulation group was significantly reduced (P＜0.05). Using FITC phalloidin fluorescence staining showed that CTLA-4+AngⅡ stimulation group cytoskeleton rearrangement was improved significantly and F-actin recombinant score (mCFS) decreased compared with AngⅡ group (P＜0.05), suggesting that AngⅡ led to the disorder of the podocytes cytoskeleton and the destruction of the cytoskeleton of podocytes by AngⅡ could be improved after B7-1 blocking. Compared with the AngⅡ stimulation, transfection of B7-1 siRNA+AngⅡ stimulation group improved F-actin cytoskeletal rearrangement, and mCFS also decreased significantly (P＜0.05), suggesting that transfection of B7-1 siRNA might improve the damage of AngⅡ on podocytes cytoskeleton. Conclusions B7-1 participates in the process of cytoskeleton reconstruction and plays an important role in the pathological changes of podocytes.

Objective To investigate the effects of 12-lipoxygenase (12-LO) and angiotensin Ⅱ(AngⅡ) on the CIP/KIP family of cyclin-dependent kinase inhibitors (CKIs) p21, p27 and p57 related to cell hypertrophy. Methods Mesangial cells were treated with high glucose for 24 hours and 48 hours respectively. 12(S)-hydroxyeicosatetraenoic acid [12(S)-HETE] and AngⅡ were infused to rats by osmotic mini-pump for 1 week and 2 weeks respectively. Rats fed high fat diet were received low dose streptozotocin (STZ) to make type 2 diabetes (DN). The rats were divided into normal control group, DN group, DN+AngⅡ type 1 receptor blocker (ARB) group or 12-LO inhibitor (CDC) group. DN+ARB rats were treated by losartan for 6 weeks, and DN+CDC rats were treated for 8 weeks. Urine albumin and protein expressions of p21, p27 and p57 were detected by ELISA and Western blotting respectively. Glomeruli injury and expressions of p21 and p27 were detected by PAS staining and immunohistochemistry respectively. Results High glucose increased p21 and p27 protein expression in mesangial cells significantly compared with the relative control (all P＜0.05), but had no effect on p57. AngⅡ increased p27 protein expression in glomeruli significantly (P＜0.05), but had no effect on p21 and p57 protein expression. 12(S)-HETE increased both p21 and p27 protein expression in glomeruli significantly (all P＜0.05), but had no effect on p57 protein expression. Blood glucose, kidney/body weight, urinary protein, and glomerular p21 and p27 protein expressions were increased in DN group (all P＜0.05) compared with those in control group, with little change of p57 protein expression (P＜0.05). Moreover, glomerular hypertrophy and extra cellular matrix accumulation were observed in DN group. However, urine protein，kidney/body weight, renal injury, but not blood glucose, were decreased in DN+ARB group and DN+CDC group compared with DN group respectively (P＜0.05). Further DN+CDC rats had decreased both p21 and p27 protein expressions in glomeruli, but DN+ARB rats only had decreased p27 protein expression (all P＜0.05). Conclusions 12-LO may induce both p21 and p27 protein expression in DN glomeruli，but AngⅡ may induce only p27 expression.