Objective To follow up the long-term prognosis of acute kidney injury (AKI) patients with normal basic renal function, and to further identify the clinical features as well as risk factors associated with the prognosis of AKI patients. Methods Clinical date of 166 patients who occurred AKI episode during hospitalization from Jan 1 2011 to Dec 31 2014 in The First Affiliated Hospital of Fujian Medical University were retrospectively analyzed. All these patients had normal basic renal function and had follow-up of more than two years after discharge. According to their renal function after two years, patients were divided into recover and non-recover group. The clinical features and risk factors associated with the prognosis of AKI patients were identified using multivariate logistic regression, and the proportion of renal function progression was calculated during follow-up period. Results One hundred and sixty-six patients were enrolled in this observational study, including 114 male, 52 female with an average age of 58.1±16.6. Eighty-seven patients were AKI stage 1, 39 AKI stage 2, and 40 AKI stage 3. Thirty-seven patients were caused by pre-renal factors, 113 patients by renal causes and 16 patients by post-renal causes. Renal function when discharged (P=0.002, OR=2.980) and infection (P=0.003, OR=2.786) were the risk factors of failing to restore after two years. Eighty-four patients' renal function returned to normal when discharged, but the number of patients whose renal function progressed to CKD 3 stage and even worse 1 year and two years later were 12 (14.3%) and 20 (23.8%) respectively. Fifty-four patients were diagnosed as partial recovery and 28 patients as non-recovery when discharged. One year later 22 (40.7%) and 12 (42.9%) patients' renal function progressed to CKD 3 stage and more, while those numbers became 28 (51.9%) and 16 (57.1%) two years later. Conclusions The risk factors of AKI long-term outcome include unrecovered renal function when discharged and infection. After AKI episode, even with fully recovered renal function, patients are still possible to progress to CKD, highlighting the importance of follow-up observation.

Objective To investigate the relationship between interventricular septum thickness(IVS) and renal function in patients with diabetes mellitus. Methods Two hundred and sixty-five patients of type 2 diabetes without dialysis were enrolled in a cross-sectional study. According to their IVS, the patients were divided into normal group (IVS≤11 mm) and higher IVS group (IVS＞11 mm). All patients according to evaluated glomerular filtration rate (eGFR) level were divided into eGFR≥60 ml?min-1?(1.73 m2)-1 group and eGFR＜60 ml?min-1?(1.73 m2)-1 group. The demographic characteristic, biochemical examination, eGFR, and proteinuria of different groups were compared. Pearson or spearman correlation was used to analyze the relationship between eGFR, IVS and other parameters. eGFR＜60 ml?min-1?(1.73 m2)-1 and IVS thickening were analyzed by binary logistic regression. Risk factors affect the prognosis of renal function in patients with diabetes mellitus were analyzed by Cox regression analysis. Results Compared with normal group, patients in the higher IVS group had higher systolic pressure (P=0.002), their level of Scr, BUN, 24 h urinary protein were increased (all P＜0.05), while the level of eGFR, albumin (ALB), hemoglobin (Hb) and fasting blood glucose were decreased (all P＜0.05). The prevalence of hypertension was increased (81.16% vs 58.67%, χ2=11.273, P=0.001), and there was also a difference in the proportion of patients in each stage of CKD (χ2=34.593, P＜0.001). Correlation analysis showed that IVS was positively correlated with BMI, systolic BP, Scr, BUN, 24 h urinary albumin, 24 h urinary protein (all P＜0.05), while negative correlation was observed between the thickened degree of IVS and Hb, albumin, eGFR and total calcium (all P＜0.05). It's worth noting that IVS also correlated with history of hypertension and degree of renal injury (all P＜0.01). Logistic regression analysis showed that longer duration of diabetes, higher systolic pressure and BUN were independent risk factors for eGFR＜60 ml?min-1?(1.73 m2)-1 (all P＜0.05), while higher Hb and Alb were independent protective factors for eGFR＜60 ml?min-1?(1.73 m2)-1 (all P＜0.05). Logistic regression analysis also showed that the baseline increased Scr was independent risk factor for interventricular thickening (P＜0.05), while the increase of fasting blood-glucose was independent protective factor for interventricular thickening (P＜0.05). Cox regression analysis showed that interventricular thickening was an independent risk factor in predicting the progression of type 2 diabetes (HR=1.396, 95%CI=1.098-1.774, P=0.006). Conclusion Interventricular septum thickness is closely related to the state of renal function, as well as is an independent risk factor to predict kidney function decline in patients with type 2 diabetes.

Objective To investigate the epidemiology of chronic kidney disease (CKD) in patients with hypertension and diabetes mellitus in Kunming urban area. Methods A multistage cluster randomized sampling method was used to collect 400 randomly selected patients (community managed hypertension and diabetes mellitus) in community service centers in the 4 main urban districts of Kunming, Yunnan province. The subjects were screened for CKD by questionnaires, physical examinations, and microalbuminuria tests. Results A total of 343 people were surveyed. The prevalence of albuminuria, proteinuria by routine urinalysis, decreased glomerular filtration rate, and CKD prevalence were respectively 37.3%, 12.2%, 5.0% and 39.1%.A total of 134 patients with CKD (134/343) were screened. Logistic regression analysis showed male (OR=2.312, 95%CI 1.325-4.037, P=0.003), hyperuricemia (OR=1.751, 95%CI 1.109-2.765, P=0.016) and obesity (OR=2.150, 95%CI 1.115-4.146, P=0.022) were related to CKD. Conclusions The prevalences of CKD and albuminuria are 39.1% and 37.3% in patients with chronic diseases (hypertension and diabetes) in the main urban community of Kunming, Yunnan. Hyperuricemia, male and obesity are independent risk factors for CKD.

Objective To explore the relationship between posterior reversible encephalopathy syndrome (PRES) and the treatment of immunosuppressants such as cyclosporine A (CsA) and tacrolimus (FK506) in children with nephrotic syndrome. Methods The clinical data of nephrotic syndrome children with PRES caused by immunosuppressants who were hospitalized in Guangzhou First People's Hospital from June 2014 to May 2017 were collected. Their clinical characteristics, imaging features, treatments and prognosis were analyzed. Results A total of 23 children were enrolled, including 13 children with CsA and 10 children with FK506. In the concurrent of PRES 20 cases were in the activity stage of nephrotic syndrome, with large amounts of urinary protein, obvious edema, hypoalbuminemia and hyperlipidemia; while 3 cases were in the remission of nephrotic syndrome. The main clinical symptoms of PRES were hypertension, headache, epileptic attack, consciousness disorder, visual disorder and so on. Sixty-nine point six percent of children were using high dose immunosuppressive agents, and 78.3% had high drug concentration. The cranial magnetic resonance imaging (MRI) results of 17 patients showed that they had T1 weighted (T1WI) hypointense, T2 weighted (T2WI) and fluid-attenuated inversion recovery (FLAIR) images hyperintense, as well as iso-and slight hypointense of diffusion-weighted image (DWI) in parietal-occipital regions or complicated with frontal lobes or basal nuclei region. Computer tomography (CT) examinations of 6 cases showed low-density focus of the occipital lobes. Children were relieved muscular spasm, debased intracranial hypertension, improved circulation, discontinued or reduced immunosuppressants at the onset of PRES. After these treatments, 21 patients' symptoms and signs disappeared within one week; two patients suffered convulsions 2 times in one week, but recovered after one month. After three months 5 children had MRI and CT re-examination and it showed that their brain lesions disappeared. Conclusions PRES may be related to the dose and blood concentration of immunosuppressive agents. The immunosuppressants for nephrotic syndrome children should be increased gradually with low initiating doses. Physicians need to be precautious to prevent the occurrence of PRES once neurological symptoms occur.

Objective To summarize the clinical features of 9 cases with mutations in PKHD1 gene for a better understanding of its phenotype. Methods Clinical data of nine cases with mutations in PKHD1 gene were summarized from January 2011 to December 2016 in our center, including clinical manifestations, laboratory findings, imaging data and family investigation. Next generation sequencing was used to screen 4000 genes in case 1 to 4 and whole exons in case 5 to 9. Significant variants detected by next generation sequencing were confirmed by conventional Sanger sequencing. Segregation analysis was performed using parental DNA samples. Relevant literature was reviewed. Results Among these 9 cases, 5 are male, 4 are female. The average age of onset was 2.6 years old (ranging from 0.5-5.2 years). Renal ultrasound revealed that all 9 cases had cysts in bilateral kidney, 7 cases with enlarged kidney, 1 case with normal size kidney, 1 case with normal size kidney, and 1 case with bilateral renal atrophy. Two cases with renal artery stenosis, 1 case with focal narrowing in left main branch and 1 case with vesico-ureteral reflux were found. Among the 9 cases, 3 cases had homozygous mutations, and 6 cases had compound heterozygous mutations, including 1 nonsense mutation, 1 frameshift mutation and 15 missense mutations. There were 2 cases with 3 heterozygous mutations, 2 c.5935C＞T mutations and 2 cases with C. 5869G＞A mutations. A total of 10 new mutations were identified. Conclusion Patients with mutations in the PKHD1 gene had normal size kidney, or even atrophic kidney. Renal artery stenosis, vesicoureteral reflux and bronchial stenosis were all first reported in patients with mutations in PKHD1 gene. The novel mutations, c.274C＞T, c.9059T＞C, c.8996delG, c.281C＞T, c.10424T＞A, c.7092T＞G, c.4949T＞C, c.5869G＞A, c.6197A＞G and c.1877A＞G further expanded the mutation spectrum of PKHD1 gene.

Objective To evaluate clinical value of interventional radiology in difficult extraction of stuck tunnel hemodialysis catheter (TCC). Methods Maintenance hemodialysis patients who required removal of stuck TCC in our hospital from June 2015 to June 2017 were enrolled. Medical history and preoperative examinations were carefully evaluated. Patients were pulled rotationally the catheter under the fluoroscopy guidance and exchanged the TCC. The information and procedure-related complication were recorded. Balloon dilation or snare technique would be used when failed to remove the stuck catheter. Results A total of 22 patients were enrolled, with an average age of (67.2±18.5) years, a median dialysis time of 54(18, 106) months, and catheter indwelling time of 37(14, 82) months. All patients were successfully removed the stuck catheter, among which 18 cases (81.8%) had fibrin sheath and 13 cases with sheath calcification. TCC mainly stuck in the junction of internal jugular vein and innominate vein, middle and lower innominate vein and middle part of superior vena cava. No procedure-related major complication occurred. Sixteen cases (72.7%) complained of transient substernal extraction pain and 1 case occurred groin hematoma during operation. Conclusions Catheter incarceration problem should be alert to the hemodialysis patients with catheter indwelling time of more than 2-3 years. The minimally invasive interventional techniques including rotationally pull-out under fluoroscopy guidance and balloon angioplasty are safe and effective in removal of the stuck TCC.

Objective To explore the changes of autophagy in the transforming growth factor (TGF)-β1-induced activation of renal fibroblasts in vitro. Methods (1) NRK-49F cells were cultured with 10 μg/L TGF-β1 for different times (0, 12, 24 h) in vitro. Morphological changes of the cells were observed under inverted microscope. The protein expressions of α-smooth muscle actin (α-SMA) and typeⅠcollagen (ColⅠ) in NRK-49F cells were measured by Western blotting. (2) NRK-49F cells were cultured with 0, 2, 5, 10, 15, 20 μg/L TGF-β1 for 1 hour and with 10 μg/L TGF-β1 for different times (0 min, 7 min, 15 min, 30 min, 1 h, 2 h, 4 h, 8 h, 12 h) in vitro. The protein expressions of microtubule-associated protein 1 light chain 3(LC3), p62, total- mammalian target of rapamycin (t-mTor), phospho-mammalian target of rapamycin (p-mTor) and Beclin 1 were detected by Western blotting. (3) NRK-49F cells were cultured with 10 μg/L TGF-β1 for different times (0, 1, 4 h) in vitro after cultured with serum-free medium for 2.5 hours. The protein expressions of LC3 and p62 in NRK-49F cells were measured by Western blotting. Results (1) The morphology of NRK-49F cells changed from stellate to spindle shape after cultured with TGF-β1. The expressions of cell activation markers α-SMA and ColⅠgradually increased as the extend of stimulation time (all P＜0.05). (2) TGF-β1 transiently increased the expressions of autophagy proteins p62 (peak value appeared after 4 h) and p-mTor (peak value appeared after 30 min), while decreased Beclin1 expression level (all P＜0.05). (3) TGF-β1 decreased the protein expression of LC3-Ⅱ in NRK-49F cells cultured with serum-free medium, whereas increased the protein expression of p62 at the same time (all P＜0.05). Conclusions The autophagy activity of renal fibroblasts is inhibited by the TGF-β1-induced cellular activation in vitro, which may contribute to the progression of renal interstitial fibrosis.

Objective To explore the effects of human umbilical cord mesenchymal stem cells(HUC-MSCs) on the innate immunity of podocytes mediated by Toll-like receptor (TLR) signaling pathway under high glucose (HG) condition. Methods Podocytes were divided into four groups according to the treatment: normal glucose group (NG), mannitol control group (NG+MA), high glucose group (HG) and HUC-MSCs co-culture group (HG+MSC). After 72 hours treatment, the protein levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), heat shock protein 70 (HSP70), high-mobility group box-1 (HMGB1) in culture medium were measured by ELISA. Real-time PCR was used to detect the mRNA expressions of TLR2 and TLR4. Western blotting was used to detect the protein expressions of TLR2, TLR4, myeloid differentiation factor 88 (MyD-88) and phospho-P65 (p-P65). Immunofluorescence staining was used to study the localization of p-P65 in podocytes. Results High glucose induced the inflammation of podocytes by activating the TLR signaling, which increased the secretion of IL-6, TNF-α, HSP70, HMGB1, the mRNA level of TLR2, TLR4 and the protein level of TLR2, TLR4, MyD-88 and p-P65 (all P＜0.05). High glucose also activated NF-κB and induced its nuclear translocation. HUC-MSCs co-culture decreased the inflammation and restrained the TLR signaling. Conclusions HUC-MSCs co-culture decreases the inflammation and innate immunity of podocytes induced by HG.