Objective To develop a nomogram for the use of predicting renal outcomes of Chinese lupus nephritis (LN) patients. Methods From January 1, 2005 to October 1, 2015, 513 patients with biopsy-proven LN in the First Affiliated Hospital of Sun Yat-Sen University were enrolled into this study. Renal outcomes were defined as end-stage renal disease or doubling of serum creatinine. Demographic characteristics, laboratory data, and pathologic data were recorded and included for analysis. Nomograms were designed using multivariate Cox proportional hazards regression to predict the non-outcome renal survival in 5 and 8 year according to the Akaike information criterion (AIC) and continuous reclassification net improvement (cNRI). Predictive accuracy and discriminative ability of the models were determined by concordance index (C-index) and calibration curve. Results During a median follow up of 48 (24,71) months, 44 patients (8.58%) reached the endpoint. 1-year, 5-year and 8-year non-outcome renal survival were 97.57%, 92.89%, 79.89% respectively. According to multivariate Cox regression, four nomograms including index for baseline renal function, pathologic severity, and response to treatment were designed. The best model, within which included eGFR was lower than 30 ml?min-1?(1.73 m2)-1(HR=4.44, 95%CI 2.16-9.13, P＜0.01), percentage of global glomerulosclerosis was higher (HR=12.28, 95%CI 3.58-42.13, P＜0.01) and partial remission occurred after 6-month induction treatment (HR=9.16, 95%CI 4.71-17.82, P＜0.01) demonstrated good discrimination to predict 5-year and 8-year non-outcome renal survival [C-index, 0.80(95%CI 0.81-0.91), 0.76(95%CI 0.68-0.85), respectively]. The nomogram based on above model also performed good calibration. Conclusion The nomogram based on patients’ baseline eGFR, percentage of global glomerulosclerosis, and treatment reaction after 6-month induction therapy can accurately predict 5-year and 8-year non-outcome renal survival in Chinese lupus nephritis patients.

Objective To detect the level of serum α-klotho in different obese people and to investigate the correlation between serum α-klotho and obesity-related glomerulopathy (ORG). Methods A total of 48 cases of ORG diagnosed by renal biopsy were enrolled in the study. Forty-eight gender-, age- and BMI- matched obese participants, and 48 obese chronic kidney disease (CKD) patients without ORG were included as controls. The clinical manifestations, laboratory examinations of all three groups were collected, and the level of serum α-klotho protein was measured by ELISA. Results The patients with ORG were characterized by decreased serum α-klotho concentration compared with obese patients group and obese CKD patients group [572.66(439.92, 690.58) pg/ml vs 635.85(559.52, 769.20) pg/ml and 690.30(516.15, 828.20) pg/ml, P＜0.01]. Multinomial multiple logistic regression analysis revealed that serum α-klotho (per 100 pg/ml increased) was independently associated with the prevalence of ORG, and the risk of ORG decreased by 35% in the obese participants (OR=0.652, 95% CI: 0.487-0.872) and 38% in CKD patients (OR=0.617, 95% CI: 0.453-0.832) respectively. Conclusions The level of serum α-klotho is significantly decreased in ORG and associated with the prevalence of ORG independently. Serum α-klotho may be a protective factor for ORG.

Objective To investigate the glomerular microvascular injury and repair in patients with IgA nephropathy (IgAN) as well as its relationship with intermedin (IMD). Methods Eighty cases of renal tissue taken from patients first diagnosed as IgAN in Shanxi Provincial People's Hospital Affiliated to Shanxi Medical University and 15 cases of normal renal tissue were detected by the expression of glomerular IMD, CD31, and VE-cadherin through immunohistochemical method. ELISA method was used to detect VEGF and IMD of plasm from 31 normal subjects and 36 cases chosen from the IgAN patients. Their changes and internal relationship were analyzed according to Lee's and chronic kidney disease (CKD) classification. Results (1) Compared with the control group the expressions of CD31, IMD, and VE-cadherin in IgAN patients were statistically significant (P＜0.01). Compared with the control group the levels of IMD and VEGF in plasma of IgAN patients in early stage of CKD group and late stage of CKD group were statistically significant (P＜0.01). (2) Correlation analysis: the expression of glomerular CD31 and Lee's classification were negatively correlated (r=-0.232, P＜0.05); glomerular IMD was negatively correlated with Lee's classification (r=-0.241, P＜0.05), while positively correlated with glomerular VE-cadherin (r=0.417, P＜0.01). VEGF in plasma of IgAN patients was positive correlated with CKD classification, BUN (r=0.458, 0.409, P＜0.05), and negatively correlated with serum ALB (r=-0.532, P＜0.01). Conclusion Microvascular injury exists in patients with IgAN. The expression of VE-cadherin and IMD are positively correlated, suggesting that IMD may be involved in the progression of vascular protection and angiogenesis in IgAN. The contents of IMD and VEGF in plasma of IgAN patients increase, indicating that they may play a role in the progression of IgAN.

Objectives To analyze the spectrum of renal diseases associated with monoclonal gammopathy and unrelated renal diseases. Methods Hospitalized patients in Peking Union Medical College Hospital who underwent renal biopsy between January, 2013 and December, 2015. They had monoclonal gammopathy on serum protein electrophoresis (SPE), serum immunofixation electrophoresis (IFE), urine IFE and/or serum free light chain (FLC). 64 patients met the inclusion criteria and were classified as monoclonal gammopathy of renal significance (MGRS) (n=36), monoclonal gammopathy of undetermined significance (MGUS) (n=17) and hematologic malignancy (n=11). Results Renal lesions in MGRS subgroup included light chain amyloidosis (n=28, 77.8%), light chain deposition disease (n=7, 19.4%), and fibrillary glomerulopathy (n=1, 2.8%). eGFR in light chain amyloidosis subgroup differed significantly, compared with light chain deposition disease [eGFR 93 ml?min-1?(1.73 m2)-1 vs 28 ml?min-1?(1.73 m2)-1, P＜0.01], as well as HTN incidence (35.7% vs 100.0%, P＜0.01). Renal diseases in MGUS subgroup included membranous nephropathy (n=10, 58.8%), focal segmental glomerulosclerosis (n=3, 17.6%), diabetic glomerulopathy (n=1, 5.9%), Henoch-Schonlein purpura nephritis (n=1, 5.9%), anti-glomerular basement membrane disease concurrent with membranous nephropathy (n=1, 5.9%) and glomerulomegaly (n=1, 5.9%). Various renal lesions related/unrelated to hematologic malignancy were seen in third subgroup, including light chain cast nephropathy (n=3, 27.3%), tubulo-interstitial lesions (n=2, 18.2%), light chain amyloidosis (n=1, 9.1%), light chain deposition disease(n=1, 9.1%), IgA nephropathy (n=1, 9.1%), mesangial proliferative glomerulonephritis (n=1, 9.1%), endocapillary proliferative glomerulonephritis (n=1, 9.1%) and acute tubular necrosis (n=1, 9.1%). Positive rates of SPE, serum IFE and urine IFE in MGRS subgroup were 40.6%, 52.8% and 69.4%, respectively. Positive rates of SPE, serum IFE and urine IFE in MGUS subgroup were 68.8%, 100.0% and 37.5%, respectively. Positive rates of SPE, serum IFE and urine IFE in hematologic malignancy subgroup were 54.5%, 72.7% and 81.8% respectively. MGRS and MGUS subgroups differed significantly in positive rate of serum IFE (P＜0.001). Abnormal rates of serum FLC ratio in above three subgroups were 83.3%, 17.6% and 90.9%, respectively, with that in MGUS group being significantly lower than the rates in other two groups (P＜0.001, respectively). Conclusions The significance of monoclonal gammopathy in patients with renal disease should be evaluated by other clinical data, as well as renal pathology.

Objective To analyze the validity of Caprini venous thrombosis risk assessment model (Caprini RAM) in the tunneled cuffed dialysis catheters (TCCs) dysfunction patients with central venous thrombosis (CVT). Methods A total of 187 maintenance hemodialysis patients with TCCs dysfunction admitted to West China Hospital of Sichuan University from January 2013 to September 2016 were analyzed retrospectively. According to the chest computed tomography venography results, patients were divided into CVT group and non CVT group. Their general clinical data (age, gender, primary diseases, history of dialysis access, etc.), blood biochemical data (hemoglobin, serum albumin, blood lipid, etc.) and 40 risk factors of Caprini RAM were collected. Caprini RAM scores were computed for risk stratification of thrombosis. Two groups were compared to analyze the value of Caprini RAM in these patients by statistics. Results One hundred and twenty CVT patients and sixty-seven non CVT patients were enrolled. In CVT group the duration of dialysis, hemoglobin and hematocrit were higher than those in non CVT group (all P＜0.05). There was no significant difference between the two groups in gender, age, primary diseases, duration of catheter dependence, catheter tip position, usage of urokinase (all P＞0.05). The average score of Caprini RAM in CVT group and non CVT group did not show statistical difference (6.23±1.81 vs 6.19±1.95, P=0.913). All patients were stratified into higher risk level and highest risk level according to Caprini RAM. Higher risk level patients accounted for 18.18% and highest risk level patients accounted for 81.82%. As patients with inequable Caprini RAM scores, their incidence of CVT did not differ statistically (χ2=0.105, P=0.746). CVT incidence rate of higher risk level patients was 61.76%, and of highest risk level patients was 64.70%. Conclusions Caprini RAM verifies that maintenance hemodialysis patients with TCCs dysfunction have high risk of venous thrombosis, but this model fails to distinguish patients between CVT group and non CVT group. Its clinical diagnosis is relatively limited and needs to be further explored.

Objective To compare the influence of hemodialysis (HD) and peritoneal dialysis (PD) on early outcome of patients underwent kidney transplantation from donation after cardiac death (DCD). Methods Patients admitted in the First People's Hospital of Foshan with DCD kidney transplant from January 1st, 2011 to June 30th, 2016 were analyzed retrospectively. Recipients were grouped into HD group (n=61) and PD group (n=28) according to their pre-transplant dialysis modality. Their short-term outcomes after DCD kidney transplant were compared, including recovery of renal function, short-term complications and laboratory data. Results Patients had longer dialysis duration and lower hemoglobin, serum albumin and phosphorus in PD group than those in HD group (all P＜0.05), but no significant difference shown in age, gender, body mass index, primary disease, blood pressure, and hepatitis B infection (all P＞0.05). HD patients with 6.00(4.00, 11.00) d recovery time of renal function, 18.00(17.00, 21.50) d hospital time, had 24.59% the delayed graft function (DGF), 3.28% acute rejection and 16.39% infection during hospitalization. While for PD patients the recovery time of renal function was 4.00(3.75, 7.00) d; hospital time was 19.00(15.00, 21.75) d; the incidence rate of DGF was 14.29%; acute rejection was 3.57%; and infection during hospitalization reached 17.86%. Above indexes were not significantly different between HD and PD groups (all P＞0.05). Repeated measure ments showed that, compared with those before transplant surgery, after 1 month, 3 months and 6 months HD and PD groups had decreased creatinine and phosphorus, and increased hemoglobinserum albumin and calcium; Serum albumin and calcium were different between the two groups (P＜0.001, P=0.040), whereas creatinine, hemoglobin and phosphorus did not show difference (all P＜0.05). After transplantation the trends of creatinine, hemoglobin, calcium and phosphorus were not different between the two groups (P values were 0.295, 0.310, 0.501 and 0.063, respectively). Conclusions No significant difference of the recovery regarding renal function, anemia, nutrition status and mineral metabolites was found between pre-transplant HD and PD modality in patients who underwent DCD kidney transplantations.

Objective To observe the influence of renal sympathetic denervation (RSD) on renal interstitial fibrosis and transforming growth factor beta 1(TGF-β1) and microRNA-21 (miR-21) in rats with unilateral ureteral obstruction(UUO). Methods 40 male Wistar rats were randomly divided into UUO group (A group, n=10), sham UUO group (B group, n=10), RSD+UUO group (C group, n=10) and RSD+sham UUO group (D group, n=10). Rats in A group and C group underwent unilateral ureteral ligation, while those in B group and D group underwent sham operation. Rats in C group and D group were followed by RSD. Rats were sacrificed at 21 days after the operation to evaluate the fibrosis by Masson staining. Immunohistochemical staining and Western blotting were used to detect the expressions of collagen I (COL-I), collagen Ⅲ(COL-Ⅲ) and TGF-β1 in four groups. The expression of miR-21 was detected by fluorescence in situ hybridization (FISH) and quantitative real-time PCR (RT-qPCR). Results A large amount of collagen deposition was observed in the renal interstitial area in A and C group compared to either B or D group (P＜0.05), but the change in C group was decreased significantly than that in A group (P＜0.05). Similarly, the expressions of COL-I, COL-Ⅲ, TGF-β1 and miR-21 were obviously higher in A and C group compared to either B or D group (P＜0.05), but those change in C group were decreased significantly than those in A group (P＜0.05). The above indexes were not significantly different between B group and D group (P＞0.05). Conclusion RSD may relieve the renal interstitial fibrosis in UUO rats, and down-regulate the expression of TGF-β1 and miR-21.

Objective To investigate the expression vibration of microRNA-503(miR-503) and its effect on target gene Bcl-2, caspase enzyme activity and apoptosis of human renal tubular epithelial cells (HK-2) induced by high glucose, and to clarify the pathogenesis of renal tubular injury induced by high glucose. Methods HK-2 cells were cultured in normal glucose group (NG), mannitol hypertonic control group (MA), and high glucose group (HG). The morphology of apoptotic cells was observed using inverted microscope. The expression of miR-503 was determined using real-time quantitative PCR. The apoptosis rate of HK-2 cells was detected by Annexin Ⅴ-FITC double dye using flow cytometry instrument. The expression of Bcl-2 and cleaved caspase-9 were detected by Western blotting. Results In the high glucose and mannitol groups HK-2 cell, an obviously increased apoptotic rate was observed under inverted microscope compared with normal glucose group (P＜0.05). MA and HG up-regulated miR-503 expression (P＜0.01), down-regulated anti-apoptotic protein Bcl-2 expression (P＜0.05) and up-regulated cleaved caspase-9 (P＜0.05). Conclusions The expression of miR-503 increases in HK-2 cells cultured by high glucose and mannitol. MiR-503 promotes apoptosis of HK-2 cells via activating mitochondrial apoptotic pathways and enhancing cleaved caspase-9 for Bcl-2 insufficiency. The tubular toxicity of high glucose is partly due to osmotic pressure. The miR-503 may be involved in diabetic tubular injury and may be a new therapeutic target of DN.