Objectives To investigate the prevalence and its risk factors of restless legs syndrome (RLS) in maintenance peritoneal dialysis (PD) patients. Methods Patients who performed PD in the First Affiliated Hospital of Sun Yat-sen University were recruited by convenience sampling. International Restless Legs Syndrome Study Group diagnostic criteria and International Restless Leg Syndrome rating scale were used to diagnose and evaluate the RLS and its severity. Co-morbidities level, baseline demographic, clinical and biochemical data were collected to analyze the clinical characteristics of patients with RLS. Multivariate logistic regression analysis was used to assess the risk factors for RLS. Results A total of 421 PD patients were enrolled in this study. Their age was (46.3±12.8) years old, 44.2% were female and 17.3% with diabetes. The median vintage of PD was 46.8(28.0, 73.5) months. The prevalence of RLS was 14.0%, most of whom were affected with moderate or severe RLS. Logistic regression analysis showed that younger age, long-term dialysis duration, higher serum calcium and phosphorus were the risk factors associated with RLS in PD patients after adjustment for confounders (all P﹤0.05). Conclusions Prevalence of RLS in PD patients is 14.0%. Younger age, long-term dialysis duration, higher serum calcium and phosphorus were the risk factors associated with RLS.

Objective To investigate the relationship between ultrafiltration rate (UFR) and cardiovascular death in maintenance hemodialysis patients. Methods This retrospective study observed adult hemodialysis patients treated in Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University during January 2010 to December 2015 and the follow-up were finished at April 2017. Patients were averagely divided into 3 groups according to their UFR. Their clinic characteristics were collected, the survival rate and death related factors were analyzed by Kaplan-Meier (Log-rank test) method and Logistic regression. Results Totally 2184 patients (male 1370, 62.7%) were enrolled, the age was 53.39±16.47. The UFR was (8.88±3.05) ml?h-1?kg-1. During the 7 years' follow-up, 168 patients died, of whom 58 cases (34.5%) died due to the cardiovascular events. Chi-square test showed that there were significant differences in death causes among the high, middle and low UFR group (χ2=12.584, P＜0.01), and the mortality rate of cardiovascular events in high UFR group was significantly higher than that in low (χ2=10.861, P= 0.010) and middle UFR group ( χ2=4.671, P=0.031). Kaplan-Meier survival curve showed that the difference of the survival rates in the 3 groups was statistically significant (Log-rank test χ2=23.394, P＜0.001). Cox regression analysis showed that high UFR (UFR≥10.95 ml?h-1?kg-1), old age (＞60 years old), and low left ventricular ejection fraction (LVEF, ≤50%) were independent risk factors of cardiovascular death. Conclusions High UFR level, old age and low LVEF are independent risk factors of cardiovascular death in hemodialysis patients. Maintaining low UFR level is beneficial to reduce cardiovascular mortality in hemodialysis patients.

Objective To evaluate the muscle mass in maintenance hemodialysis (MHD) patients and analyze the influential factors. Methods Ninety-seven patients on MHD and 34 healthy people were recruited. Muscle mass was measured by bioelectrical impedance analysis and compared. Patients'age, sex, height, body weight, walking activity, modified quantitative subjective global assessment (MQSGA) score and laboratory tests were recorded. The relationship of appendicular skeletal muscle mass/height2 (ASM/H2) and other factors were analyzed using multivariate linear regression. Results Compared with normal cohort, the MHD patients showed lower body fat rate and lower ASM/H2 (both P＜0.05). In 97 MHD patients, 21.4% of male patients suffered from sarcopenia, and 24.4% of female patients suffered from sarcopenia. Patients were divided into two groups according to the level of ASM/H2 (male＜7.0 kg/m2, female＜5.8 kg/m2). The grip strength, serum creatinine, 1,25(OH)2D and mid-arm muscle circumference in low ASM/H2 group were lower than those in normal ASM/H2 group, and the differences were significant (all P＜0.05). In multivariable regression model, male (β=0.534, P=0.003), 1,25(OH)2D (β=0.582, P=0.024), creatinine (β=0.421, P=0.037), grip strength (β=0.681, P=0.001), and lg[NT-proBNP] (β=-1.760, P=0.042) were independently associated with ASM/H2 in MHD patients. Conclusion The prevalence of sarcopenia is much higher in MHD patients than in healthy people. The levels of grip strength, NT-proBNP, creatinine and 1, 25(OH)2D are the important influential factors for muscle mass in MHD patients.

Objective To investigate the relationship between interventricular septum thickness (IVST) and renal prognosis in IgA nephropathy patients. Methods A total of 213 patients with IgA nephropathy proven by biopsy from Department of Nephrology of Shenzhen Second People's Hospital were enrolled in this study, and these participants were divided into normal IVST group (＜11 mm) and higher IVST (≥11 mm) group according to IVST. The demographic characteristics, clinical biochemical indexs, CKD stage and pathologic characteristics in these two groups were compared. Binary logistic regression analysis was used to analyze the influencing factors of eGFR＜60 ml?min-1?(1.73 m2)-1, and Kaplan-Meier survival curve was used to analyze the effect of IVST on renal prognosis. Results Compared with IVST normal group, the patients in IVST higher group were more male sex, older, and had higher level of systolic pressure, Hb, Scr, BUN, UA, 24 h urine protein excretion, urinary protein creatinine ratio, triacylglycerol, total cholesterol, LDL, Serum C3, C4, and had more serious mesangial proliferation, tubular atrophy (all P＜0.05). However, the levels of eGFR and HDL were decreased in IVST higher group (both P＜0.05). There were a significant difference in CKD staging distributions and IgA Lee grade between two groups (both P＜0.01). Spearman and Pearson correlation analysis indicated that IVST was negatively correlated with eGFR and positively correlated with proteinuria level in IgA nephropathy patients. Baseline IVST was an independent risk factor of eGFR＜60 ml?min-1?(1.73 m2)-1 in IgA nephropathy patients. Serum C3, UA and hemoglobin were independent influential factors of eGFR decline (all P＜0.05). Kaplan-Meier survival curve indicated that the renal function was worse in patients with thickened interventricular septum. Conclusion The IgA nephropathy patients with thicker interventricular septum has a poor renal prognosis.

Objective To summarize the clinical data of atypical hemolytic uremic syndrome (aHUS) and analyze the treatment and prognosis. Methods A prospective cohort study was conducted on 66 cases in Beijing Children's Hospital affiliated to Capital Medical University from January 2011 to December 2017. The children were divided into positive and negative auto-antibody groups according to the results of anti-factor H autoantibody test. The clinical characteristics, treatment plan and prognosis of the two groups were compared. Results Among the 66 children who met the inclusion criteria, there were 43 cases (65.2%) in the positive group, with an average onset age of (8.0±2.9) years. There were 23 cases (34.8%) in the negative group, with an average onset age of (3.0±2.6) years. On the basis of plasma treatment, in the positive group, the usage rate of hormone was 83.3%(35/42) and the usage rate of immunosuppressive agents was 42.9%(18/42), while in the negative group, the rates were 63.6%(14/22) and 13.6%(3/22) respectively. The average follow-up time was 19.3 months. One child in each group was lost to follow-up. In the positive group, 8 cases recurred (19.0%) and the average recurrence interval time was 16.1 months. In the negative group, 7 cases recurred (31.8%) and the average recurrence interval time was 9.3 months. And the recurrent interval time in the positive group was more longer than the negative group (P＜0.05). A total of 85.9%(55/64) children had complete hemolysis control and complete recovery of renal function, in which the positive group was 85.7%(36/42) and negative group was 86.4%(19/22). However, 7.8%(5/64) children had abnormal renal function, in which the positive group was 9.5%(4/42) and the negative group was 4.5%(1/22). And 4.7%(3/64) children died, in which the positive group was 2.4%(1/42) and the negative group was 9.1%(2/22). The one left (1.6%) showed dialysis dependence, which was positive for the auto-antibody. Multifactor Cox regression analysis showed that the age of less than 3 years old was the risk factor of poor prognosis (HR=4.651, 95%CI 0.988-21.898, P=0.047). Conclusions The positive proportion of anti-factor H autoantibody in children with aHUS is high. The age of these children is older. Individualized therapy based on anti-factor H autoantibody and immunosuppressive therapy is of great significance for disease remission, preventing recurrence and improving the prognosis. Age less than 3 years old is the risk factor for poor prognosis.

Objective To identify the significance of serum phospholipase A2 receptor antibody (PLA2R-Ab) in idiopathic membranous nephropathy (IMN) patients. Methods A total of 108 patients diagnosed as IMN by medical history, physical examination, laboratory examination and renal biopsy in Tongji Hospital affiliated to Tongji Medical College, Huazhong University of Science and Technology between Dec 1, 2014 and Aug 31, 2017 were enrolled, and all related data were recorded. According to the results of serum PLA2R-Ab test, patients were divided to positive group and negative group, and the data were compared with the independent sample t test and the chi-square test. Kaplan-Meier survival analysis was performed to compare remission rates between groups, and the Log-rank method was used to evaluate the significance of differences. Univariate and multivariate Cox regression analysis were used to verify predicting factors for achieving remission. Results Overall, 67.6%(73/108) patients had detectable serum PLA2R-Ab. Compared with patients in negative group, patients in positive group exhibited higher proportion of male patients (P=0.002), lower level of serum albumin (P＜0.001), higher level of cholesterol (P＜0.001), lower level of immunoglobulin G (P＜0.001), higher level of proteinuria (P=0.003), a lower of chance of remission (P=0.049), longer time needed to achieve partial remission (P=0.001) and complete remission (P=0.002). The 1- and 2-year cumulative renal partial remission rates were 72.4%, 86.1%, and the cumulative renal complete remission rates were 43.8%, 54.0%, respectively. Patients in negative group had higher partial remission(χ2=9.84, P=0.002) and complete remission (χ2=15.50, P＜0.001) than those in positive group. Multivariate Cox regression model indicated that serum positive PLA2R-Ab was a significant independent risk factor. Conclusions IMN patients with serum PLA2R-Ab show more severe condition and lower remission rates than those without serum PLA2R-Ab. Serum positive PLA2R-Ab is an independent remission-related predictor for IMN patients.

Objective To analyze and summarize the cases of pregnancy on maintenance hemodialysis (MHD), and review the literature. Methods Seven cases of pregnancy and childbirth in patients on MHD in the First Affiliated Hospital of Zhejiang University from Jan 2009 to Dec 2017 were analyzed, and the literature about pregnancy in patients on MHD reported in Pubmed and Web of Science database was retrieved. Both maternal and fetal outcome were studied. Results There are seven pregnant MHD patients in this center, among whom six patients went through a smooth pregnancy and one patient had intra-uterine fetal death at 14 weeks of pregnancy. The six patients had preterm labor. Among six fetuses, four grew in good health and developed well, one had physical development retardation and one had heart malformation at born. In the literature, 169 cases reported pregnant patients and 182 fetuses were evaluated, of which 145 live infants were delivered, 79.67% overall fetal survival rate, with gestational age of (32.94±3.34) weeks. In 164 delivered fetuses, 147 were preterm labor (89.63%). The weight of live births was (1824±609) g. There were no maternal deaths. Fetal survival rate was zero in＜20 weeks of gestational age, 20-24 weeks was 14.29%, 25-27 weeks was 45.45%, ≥28 weeks was 94.44%. The fetal survival rate was higher in pregnant woman receiving hemodialysis≥28 hours weekly compared to women receiving ＜16 hours weekly (92.31% vs 52.94%, P=0.02). Conclusions There are still a very high maternal and fetal complication rate in hemodialysis patients, especially in fetus. Gestational age≥28 weeks has a high fetal survival rate. Intensive dialysis during pregnancy may benefit higher fetal survival rate.

Objective To investigate the role of autophagy in high glucose-induced podocyte lipid droplet metabolism. Methods (1) Cultured, conditionally immortalized human podocytes (HPC) were divided into normal control group, high glucose group and mannitol group. Oil red O staining and oil red O staining extraction assay was used to observe the degree of lipid accumulation; Protein level of SREBP-1 was analyzed by Western blotting. (2) HPC were cultured and divided into normal control group, high glucose group, high glucose+3-methyladenine (3-MA) group, and mannitol group. Acridine orange staining was used to observe the formation of autophagosomes. Western blotting was used to detect the protein levels of beclin-1 and LC3-II/LC3-I. Oil red O staining and oil red O staining extraction assay was used to observe the degree of lipid accumulation; Western blotting was used to analyze the expression of SREBP-1. Results (1) Compared with the normal control group, the lipid accumulation in the high glucose group was increased and the lipid metabolism related molecule SREBP-1 was up-regulated (P＜0.05); There was no significant difference between the normal control group and the mannitol group in lipid accumulation (P＞0.05). (2) Compared with the normal group, the number of autophagosomes was increased and autophagy-related proteins beclin-1 and LC3-II/LC3-I were up-regulated in high glucose group (all P＜0.05). After intervened with 3-methyladenine, a significant decrease in autophagosomes was observed; Protein levels of autophagy-related proteins beclin-1 and LC3-II/LC3-I were decreased (all P＜0.05); The lipid droplets in the high glucose+3-MA group was decreased and lipid metabolism related molecule SREBP-1 was down-regulated (all P＜0.05). Conclusion Autophagy may be involved in the process of high-glucose-induced podocyte lipid accumulation by affecting SREBP-1 expression, and inhibition of autophagy can alleviate the high-glucose-induced podocyte lipid accumulation.

Objective To explore the effects of high phosphate and low calcium on the secretion function and cell proliferation in normal rat parathyroid tissues. Methods The rat parathyroid tissues resected by surgical operation under dissection microscope were incubated in vitro for 5 days and were treated with high phosphate or low calcium medium on the second day and the third day after incubation. The cell apoptosis at different time points was measured by flow cytometry.The levels of intact parathyroid hormone (iPTH) in the supernatant at different time points were detected by ELISA. The mRNA levels of prepro-PTH and proliferating cell nuclear antigen (PCNA) were measured by real-time PCR, while the protein levels of PCNA after the 24-hour treatment with high phosphate or low calcium medium were measured by Western blotting. Results Flow cytometric analysis showed that the percentage of normal living cells on the first day and the second day after incubation was significantly higher than that on the third day to the fifth day after incubation in the rat parathyroid tissues (all P﹤0.05), and there was no statistical difference among that on the third day to the fifth day after incubation. There was no significant difference in cell survival rates on the first day to the fifth day after incubation (all﹥85%) under normal or high phosphate medium. There was no significant difference in the daily iPTH level on the first day to the fifth day after incubation under normal medium. Compared with normal medium, the iPTH level in the supernatant under high phosphate medium increased (P﹤0.05), and the expressions of preproPTH mRNA and PCNA in parathyroid tissues were significantly up-regulated (both P﹤0.05) after the 24-hour treatment with high phosphate medium. Compared with normal medium, the iPTH level in the supernatant under low calcium medium increased (P﹤0.05), and the expression of preproPTH mRNA in parathyroid tissues was significantly up-regulated after the 24-hour treatment with low calcium medium (P﹤0.05). Conclusions It is feasible to incubate the parathyroid issues from rats in vitro, and the best incubation time should be within 2 days. Low calcium and high phosphate stimulation could increase the synthesis and secretion of PTH, while high phosphate can also promote the cell proliferation, which is an important factor for the regulation of parathyroid function in physiological state.