Objective To validate the effect of Renji acute kidney injury score (RAKIS) on predicting patients with acute kidney injury (AKI) after cardiac surgeries, and make comparison with Cleveland score, simplified renal index (SRI) and acute kidney injury following cardiac surgery (AKICS). Methods Patients undergoing open heart surgery from 2008/01/01 to 2010/10/31 in Renji hospital were enrolled, and their scores of those four scoring models were calculated. AKI patients were diagnosed by KDIGO, and those scores of AKI patients and non-AKI patients were compared. Receiver operating characteristic (ROC) curve and area under curve (AUC) were used to decide the predictive values of those models. Results A total of 1126 patients were chosen in this cohort, with the average age of (58.43±14.88) years (rang from 18 to 88). The male to female ratio was 1.47∶1. And 355(31.5%) patients were developed AKI. AKI stage Ⅰ, Ⅱ and Ⅲ were 65.4%, 23.7% and 11.0% respectively. RAKIS was significantly higher in AKI patients than in non-AKI patients (17.5 vs 9.0, P＜0.001). The AUCs of RAKIS to predict AKI, AKI Ⅱ-Ⅲ stages, renal replacement therapy (RRT) and in-hospital death were 0.818, 0.819, 0.800 and 0.784 respectively. The AUCs of Cleveland score and SRI were 0.659 to 0.710, lower than those of RAKIS and AKICS. AKICS had lower value for predicting AKI and AKI Ⅱ-Ⅲ stages (AUC 0.766 and 0.793), but good value in predicting RRT and in-hospital death after surgery (AUC 0.804 and 0.835) as compared with RAKIS. Conclusions RAKIS is valid and accurate in the discrimination of KDIGO defined AKI patients, while for predicting the composite end point, AKICS may be more useful.

Objective To evaluate the predictive factors and renal outcomes of idiopathic membranous nephropathy (IMN) in patients with type 2 diabetes (T2DM). Methods In this retrospective study, clinical data of 101 IMN patients with T2DM and 96 patients with diabetic nephropathy (DN) were consecutively collected. Logistic regression was used to assess potential clinical factors indicating IMN and COX regression was employed to analyze risks of IMN in developing to end-stage renal disease (ESRD), as compared with that of DN, in patients with T2DM. Results In a multivariate model, age≥55 years old, presence of nephrotic syndrome, estimated glomerular filtration rate (eGFR)＞60 ml?min-1?(1.73 m2)-1, duration of diabetes≤5 years and absence of diabetic retinopathy, were associated with IMN, as compared with DN, in patients with T2DM. In T2DM patients presented with nephrotic syndrome, age≥55 years old, eGFR＞60 ml?min-1?(1.73 m2)-1, duration of diabetes≤5 years and absence of diabetic retinopathy, were also associated with IMN, as compared with DN. Receiver operating characteristic curve (ROC) showed eGFR 65.5 ml?min-1?(1.73 m2)-1 was an optimal cutoff in differentiating DN and IMN. DN was associated with 16.8 times as high risk of incident ESRD as compared with IMN in T2DM patients. Conclusions In patients with T2DM, age≥55 years, presence of nephrotic syndrome, early stage of CKD, duration of diabetes≤5 years and absence of retinopathy, may indicate IMN rather than DN. T2DM patients with IMN have much better renal prognosis as compared with DN.

Objective To investigate the expression of oxidative stress related factors, such as, superoxide dismutase (SOD), heme oxygenase-1 (HO-1), malondialdehyde (MDA) and 8-hydroxy-2'-deoxyguanosine (8-OHdG) in patients with idiopathic membranous nephropathy (IMN) and explore the possible role of oxidative stress in the pathogenesis of IMN. Methods Serum, urine and renal tissue of 40 patients with IMN, 20 patients with secondary membranous nephropathy (SMN), and 20 patients with minimal change nephropathy (MCD) were collected from the nephrology department of the First Affiliated Hospital of Zhengzhou University. All of them were diagnosed by renal biopsy from January 2016 to June 2016. Serum, urine and renal tissue of 20 healthy persons were collected as the normal control (NC). The expressions of SOD, HO-1, and 8-OHdG in renal tissues were detected by immunohistochemistry. The levels of SOD, HO-1, MDA and 8-OHdG in serum and urine specimens were detected by ELISA. The relationship between oxidative stress related factors and proteinuria in IMN was investigated as well. Results The expressions of SOD, HO-1 and 8-OHdG were significantly higher than those in MCD group and NC group in renal tissue; the expression of SOD in IMN group was significantly higher than that in MCD group and NC group in serum (all P＜0.01). The expressions of HO-1, MDA and 8-OHdG in the serum and urine of the IMN group were significantly higher than those of the MCD group and the NC group (all P＜0.05). There was a significant positive correlation between the urine expression of 8-OHdG and MDA and proteinuria in the IMN group. Conclusions Oxidative stress-related factors in IMN patients are elevated, which is closely related to clinical manifestations. In that sense, it is confirmed that oxidative stress is involved in the pathogenesis of IMN.

Objective To evaluate the ability of contrast-enhanced ultrasound (CEUS) as a prognostic indicator of renal function in chronic kidney disease (CKD) patients. Methods A total of 122 patients with CKD were collected, and patients with allergies to sulfur hexafluoride, pregnancy, cardiopulmonary insufficiency, urinary calculus and tumour were excluded. These patients were divided into estimated glomerular filtration rate [eGFR, ml?min-1?(1.73 m2)-1]≥60 group, eGFR 30-59 group and eGFR＜30 group. CEUS was performed after an intravenous bolus injection of 1.5 ml SonoVue (BR1; Bracco Milan, Italy). Time-intensity curves (TICs) and quantitative indexes were created using QLAB quantification software. Followed up for 2 years, and patients with eGFR dropped 50%, double serum creatinine and end-stage renal disease (ESRD) were regarded as having kidney failure events. Risk factors related to kidney survival were investigated using a multivariate Cox regression model. Results One hundred patients were enrolled in the study, with 78% patients in CKD 1-2 stages, 16% in CKD 3 stage and 6% in CKD 4-5 stages. Patients were followed for a mean period of 14.1 months, ten (10%) patients exhibited composite kidney failure events. Among 3 groups,significant differences in the left kidney length derived peak intensity (DPI) were noted (P=0.014, P=0.010). Multivariate Cox regression analysis revealed that the DPI was an independent factor of progression of kidney disease. Multiple linear regression showed that age, basic eGFR , peak intensity were associated with eGFR decline rate. Patients with DPI＜12.27 db were less to recover from kidney disease progression as compared with patients with DPI≥12.27 db (P=0.008). The area under the curve (AUC) for DPI was 0.778(95%CI 0.612-0.944, P＜0.05), with a sensitivity of 64% and a specificity of 88%. Conclusions The DPI might be the most valuable CEUS parameter for the evaluation of renal function. The DPI could serve as an independent predictor of the long-term prognosis of CKD patients.

Objective To define a parameter of autologous arteriovenous fistula stenosis that limits the fistula function for hemodialysis in our country. Methods Retrospectively study the doppler ultrasound of patients who accepted the percutaneous transluminal angioplasty (PTA) therapy due to autogenous arteriovenous fistula dysfunction; identify the least diameter of the fistula vein and compare it with the corresponding data of well-functioned fistula. Determine which absolute diameter constitutes a hemodynamically significant stenosis in a radiocephalic autologous arteriovenous fistula by receiver operating characteristic curve (ROC curve). Result Forty-two patients were enrolled in the study. The average age of those patients was 54.63±2.44 years old. Twenty-one patients were female. Twenty-six fistula located on the left arm. The minimal diameter of the dysfunction fistula averaged 1.57±0.07 mm, while the average forearm fistula vein diameter was 4.04±0.23 mm, significantly smaller than those in the compare group - an average minimal fistula vein diameter of 3.34±0.11 mm and a forearm vein diameter of 5.36(4.52, 6.45) mm (P﹤0.05). The control group contained sixty-eight patients. The average age of those patients was 52.56±2.00 years old. Thirty-one patients were female. Forty-nine fistula located on the left arm. It was quiet appropriate in using minimal diameter of the fistula vein to indicate the dysfunction istula with an under-curve area of 0.979, 95%CI 0.959-0.998. The under-curve area would be at the largest level when meeting the cutoff point at 2.40mm, in which it could achieve the area of 0.853. Conclusions The minimal diameter of the dysfunction wrist autogenous arteriovenous fistula was much smaller than the functioned ones. Minimal diameter of the fistula vein may serve as an effective parameter in detecting dysfunction fistula.

Objective To analyze the therapeutic effect and prognosis of peritoneal dialysis in patients with end-stage polycystic kidney disease. Methods A retrospective analysis was performed on patients with polycystic kidney disease who were treated with peritoneal dialysis for more than 3 months between July 2007 and September 2016 in the Second Hospital Affiliated to Soochow University. A total of 45 patients were enrolled in this study. Another 45 patients of non-diabetic nephropathy were selected as the control group matched by gender, age, and time of PD initiation. The information of the two groups such as general data, dialysis related complications, incidence of peritonitis, prognosis was recorded. Survival analysis was performed using the Kaplan-Meier method and Log-rank test．The risk factors affecting patients' survival were analyzed with Cox regression model. Results There were no significant difference in pre-dialysis age, sex ratio, blood pressure, urine volume, body weight, eGFR, biochemical data, and the proportion of hypertension and diabetes mellitus in the polycystic kidney group and control group. 24 h ultra-filtration volume, 4 h D/Pcr, Kt/V and Ccr between the two groups showed no significant difference (all P＞0.05). The incidence of peritonitis and the time of the first peritonitis in the two groups respectively as one episode per 82.4 months vs one episode per 81.5 months, (35.8±22.8) months vs (34.5±20.9) months had no statistical difference. The ratio of hernia (6.6% vs 2.2%), thoracic and abdominal leakage (4.4% vs 2.2%), dialysate leakage (0 vs 0), catheter dysfunction (4.4% vs 6.6%), exit-site infections (11.1% vs 6.6%), tunnel infections (4.4% vs 2.2%) and non PD related infections (11.1% vs 13.3%) had no significant difference. The 1-year, 3-year, 5-year patient survival of two groups respectively were 95.2% vs 93.3%, 78.9% vs 75.0%, 67.6% vs 64.9% (P=0.475), and 5-year technique survival was 78.7% vs 76.7% (P=0.623), demonstrating no obvious difference. Cox regression analysis showed that age and serum albumin were risk factors for the survival of patients. Conclusions The effect and prognosis of peritoneal dialysis in patients with polycystic kidney and non polycystic kidney were similar. Peritoneal dialysis is not the contraindication of polycystic kidney. Peritoneal dialysis can be used as a routine renal replacement therapy in patients with polycystic kidney disease.

Objective To explore the prevalence and the correlative factors of restless legs syndrome (RLS) in maintenance hemodialysis (MHD) patients. Methods The basic information and clinical laboratory results of 307 MHD patients were collected. The international RLS study group (IRLSSG) diagnostic criteria were applied to assess the presence and the severity of RLS. Binary logistic analysis was used for exploring correlative factors of RLS. Results The prevalence of RLS was 12.1% in the MHD patients, with 73.0% patients having mild-to-moderate symptoms and 83.8% having chronic RLS. There was no significant difference between MHD patients with and without RLS in age, gender, dialysis age, daily urine, Kt/V, history of smoking, drinking, hemoglobin, serum creatinine, urea nitrogen, uric acid, calcium, phosphorus, magnesium, potassium, intact parathyroid hormone (iPTH), prealbumin, albumin and alkaline phosphatase. But the frequency of daily exercise in RLS group is significantly lower than that in non-RLS group (Z=-4.114, P＜0.001). Logistic regression analysis showed that daily exercise was a correlative factor of RLS (B=-2.203, OR=0.111, 95%CI 0.033-0.371, P＜0.001). Conclusions RLS is a common complication in MHD patients, with chronic state and mild-to-moderate symptoms. RLS is correlated with daily exercise, which may be a scientific approach to treat or prevent this disease.

Objective To investigate the effects of active vitamin D (VD) on the expression of triggering receptor expressed on myeloid cells-1 (TREM-1) in renal tissue of diabetic nephropathies (DN) rats and to explore the impact of TREM-1 on adhesion and migration capacity of macrophage. Methods DN rat models were established by streptozotocin. Rats were randomly distributed into four groups: control (NC) group, VD group, DN group and DN+VD group (DN rats with 0.1 μg?kg-1?d-1 calcitriol by gavages). Rats were sacrificed respectively at 8 weeks and 12 weeks after treatment. Pathological changes in kidney tissue were detected and the expressions of CD68 and TREM-1 were acquired by immunohistochemistry stain and Western blotting. In vitro, RAW264.7 cells were divided into NC group, VD group, high glucose (HG) group and HG+VD group. In HG+VD group rats were treated by high glucose with 10-8 mol/L 1,25(OH)2D3. TREM-1 expression was measured by immunohistochemistry stain and Western blotting, and the ability of macrophage in migration and adhesion was evaluated by Transwell migration assay and adhesion assay. TREM-1 siRNA was transferred to silence TREM-1 expression, while plasmid of TREM-1 was transferred for high expression. Their ability of adhesion and migration in macrophage and the effect of 1,25(OH)2D3 were examined. Results (1) Compared with the NC group, the expressions of CD68 and TREM-1 were increased in DN group (P＜0.05), whereas markedly decreased in DN+VD group (P＜0.05). (2) The number of adhesion and migration cells, and the expression of TREM-1 protein in macrophage were obviously increased in HG group as compared with those in NC group (all P＜0.05); whereas above changes were markedly decreased in HG+VD group than those in HG group (P＜0.05). (3) The number of adhesion and migrated macrophage was reduced after TREM-1 siRNA intervention (all P＜0.05). VD could significantly decrease the effect of high glucose on adhesion and migrated macrophages after TREM-1 siRNA (all P＜0.05). (4) Adhesion and migration of macrophage were increased via TREM-1 overexpression (all P＜0.05), but the effects of VD on high glucose-induced adhesion and migration of macrophage were disappeared. Conclusions VD can suppress the adhesion and migration of macrophage via reducing the expression of TREM-1, and inhibit infiltration of macrophage in renal tissue of DN rats.

Objective To investigate whether the effect of transient high glucose on inflammatory factors expression could be continuous in rat glomerular mesangial cell, and its relation with histone methylation modification. Methods Rat glomerular mesangial cells (HBZY-1) were divided into three groups: the high glucose group (25.0 mmol/L glucose), the hypertonic group (MA, 5.5 mmol/L glucose+19.5 mmol/L mannitol) and the normal-glucose control group (5.5 mmol/L glucose), which were cultured for 24 h respectively. All 3 groups were then changed with normal-glucose medium to culture for 24 h, 48 h and 72 h. Their protein, mRNA and supernatant were harvested. The protein expressions of mono-methylation of H3 lysine 4 (H3K4me1) was measured by Western blotting, and the mRNA expressions of NF-κB subunit p65 and set7/9 were determined by real time-quantitative PCR. The expression of monocyte chemoattractant protein 1 (MCP-1) and vascular cell adhesion molecule 1 (VCAM-1) were detected by enzyme-linked immunosorbent assay. Results (1) Compared with those in normal control group, the expressions of H3K4me1 protein and set7/9 mRNA were first up-regulated in high glucose group, then gradually down-regulated in the following 48 h normal-glucose medium (as compared with those at 0 h, all P＜0.05). At 72 h there was no statistic difference between high glucose group and normal control group (all P＞0.05). (2) Compared with those in normal control group, the up-regulated p65 mRNA, VCAM-1 and MCP-1 sustained at least for 72 h in high glucose group. Conclusions Transient high glucose can induce persistent inflammatory factors expression in rat glomerular mesangial cells, which may via histone modification.