Objective To report the spontaneous remission and induced remission of phospholipase A2 receptor (PLA2R)-associated idiopathic membranous nephropathy (IMN) in adults, as well as to explore the potential prognostic factors. Methods A total of 120 patients with IMN in Huashan Hospital during 2012 and 2017 were enrolled and their clinical data were collected. Results PLA2R-associated IMN patients accounted for 89.2% of the IMN patients. Spontaneous remission occurred in 35.5% of PLA2R-associated IMN patients. The patients with higher serum albumin and lower level of PLA2R antibody were more likely to achieve spontaneous remission (both P＜0.05). Multivariate logistic regression analysis showed that male was an independent risk factor for spontaneous remission in PLA2R-associated IMN patients (OR=0.060, 95%CI 0.007-0.493, P=0.009), while higher serum albumin at baseline (OR=1.480, 95%CI 1.144-1.932, P=0.004) and the improvement of serum albumin after 3 months' non-immunosuppressive treatment (OR=2.040, 95%CI 1.322-3.151, P=0.001) were independent protective factors for spontaneous remission. About 42.1% PLA2R-associated IMN patients had received immunosuppressive therapy, with induced remission rate being 70.7%. High serum albumin before treatment was an independent protective factor for induced remission (OR=1.268, 95%CI 1.014-1.585, P=0.038). Conclusions PLA2R-associated IMN accounts for most of the IMN patients, with a spontaneous remission rate of 35.5%, during the follow-up period, which is even higher in patients with higher baseline serum albumin and lower PLA2R antibody titer. Induced remission rate is 70.7% in patients in need of immunosuppresants. The serum albumin level may be helpful in predicting spontaneous remission and response to immunosuppressive therapy.

Objective To investigate the predictive factors affecting the efficacy of cyclophosphamide (CTX) combined with glucocorticoids in the treatment of idiopathic membranous nephropathy (IMN), and to evaluate the efficacy of calcineurin inhibitor (CNI) adjustment due to poor treatment. Methods A retrospective cohort study was conducted. Two hundreds and twenty-eight patients with IMN diagnosed by renal biopsy in the People's Hospital of Guangxi Zhuang Autonomous Region from January 1, 2007 to December 1, 2016 were enrolled. All subjects were treated with CTX in combination with glucocorticoids. The patients were divided into two groups: remission group and no remission group. Multivariable logistic regression analysis was used to determine the baseline clinical-pathological influencing factors for the remission of IMN in the enrolled patients. Results The number of total remission (including complete and partial remission) of the first CTX combined with glucocorticoid treatment in 228 patients with IMN was 188(82.5%). Among them, 141 patients (61.8%) had complete remission (CR), the median time for CR was 8(6, 12) months, and the median time for partial remission (PR) was 3(1, 4) months. The median follow-up time for this study was 25(13, 43) months. Compared with the remission group, the serum albumin level was lower in the non-remission group, the 24-hour urine protein content, the blood complement C3 and C4 levels were higher, and the pathological stage was milder (all P﹤0.05). Multivariate logistic regression analysis suggested that the levels of baseline serum albumin, complement C4, and pathological stage were independent predictors of clinical remission in IMN patients. Twenty-four non-remission patients were treated with CNI. The overall response rate was 66.7%(16/24) at 6 months and 77.3%(17/22) at 12 months. Conclusions The levels of baseline albumin, blood complement C4, and pathological stage were independent predictors of clinical remission in IMN patients treated with CTX plus glucocorticoids. The non-remission patients with CTX combined with glucocorticoid therapy can still achieve a higher response rate after adjusting for CNI.

Objective To explore the risk factors of post-hepatectomy acute kidney injury(AKI), a Nomogram predictive model of secondary AKI after hepatectomy was established which can provide guidance for the selection of clinically relevant treatment plans and improve the prognosis of surgical patients. Methods A total of 2769 patients who underwent hepatectomy in the Affiliated Hospital of Qingdao University from October 2012 to July 2018 were included in the study. The post-hepatectomy AKI was diagnosed according to the KDIGO AKI criteria in 2012. The selected patients were divided into AKI group (n=133) and non-AKI group (n=2636); they were divided into training group (n=2050) and test group (n=719) according to Enrollment time. The differences of preoperative clinical data, length of hospital stay, and in-hospital mortality between patients with AKI and non-AKI group were compared. The risk factors of post-hepatectomy AKI were evaluated by the Cox regression. A Nomogram predictive model of AKI after hepatectomy was established, and receiver operating curve (ROC) and consistency curve were used to verify the accuracy of the predictive model. Results The incidence of AKI after hepatectomy was 4.80%(133/2769). Compared with non-AKI group, preoperative serum albumin, hemoglobin, and hematocrit levels were lower in AKI group; the level of blood transaminase, total bilirubin, alkaline phosphatase, triglyceride, lactate dehydrogenase, and fibrinogen were higher (P＜0.050); the proportion of preoperative aspirin application was higher (P＜0.001); the duration of operation was longer (P=0.002); the proportion of open surgery was higher (P＜0.001); the mortality rate was higher (P＜0.050); the length of hospital stay was longer (P＜0.050). Cox regression results showed hypertriglyceridemia, hypoalbuminemia, alkaline phosphatase, aspartate aminotransferase, open surgery, lower preoperative glomerular filtration rate, aspirin and duration of surgery were independent risk factors for AKI. We incorporated these indicators into the Nomogram to establish a predictive model for AKI after hepatectomy, the area under ROC curve was 0.764. The area under ROC curve of the test group was 0.781. Conclusion The Nomogram predicting model of AKI after hepatectomy has high accuracy, which is helpful for prognosis of patients who underwent hepatectomy.

Objective To investigate the clinical efficacy of renal transplantation from donors of donation after brain and cardiac death(DBCD) complicated with acute kidney injury (AKI), and summarize the clinical experience of evaluation and application. Methods The clinical data of the 45 DBCD donors and 80 recipients in the First People's Hospital of Foshan from September 2011 to September 2015 were retrospectively analyzed. DBCD donors were classified into the AKI group (n=26)and non-AKI group (n=19) according to the serum creatinine level and urine output when the donors were admitted to the intensive care unit (ICU) in this hospital. A total of 80 recipients were divided into the AKI group (n=46) and non-AKI group (n=34) correspondingly. The condition of the donors before organ procurement between the two groups was compared, and the incidence of various complications, the 1 years survival rates of recipients and graft after renal transplantation were compared between the two groups. Results Among 45 donors, 26 cases(57.8%) suffered from AKI. The serum creatinine of donors was significantly higher in the AKI group than that in the non-AKI group (P＜0.01). The incidence of delayed graft function (DGF) in AKI group and non-AKI group was 21.7% and 8.8% respectively (P＞0.05). After 1 years, the serum creatinine of the recipients in AKI group was significantly higher than that in non-AKI group [(134.9±63.4) μmol/L vs (106.6±28.2) μmol/L, P＜0.05], but the survival rates of recipients and grafts did no differ between the two groups (both P＞0.05). Conclusions The donors combined with AKI do not have a worse effect on the incidence of DGF, the 1-year survival rates of recipients and grafts after transplantation. So, the donors with AKI for transplantation can widen the origin of kidney grafts.

Objective To investigate the association between microalbuminuria and cardiovascular risk factors in a general Chinese population. Methods A multi-stage cluster randomized sampling method was used to select 2400 residents (18-69 years old) in four counties in Shandong and Jiangsu provinces in October 2013 to March 2014. 24-hour MAU were measured for each subject. The prevalence of MAU in different groups was analyzed. The relationship between the aggregation of risk factors and MAU was analyzed. Logistic regression analysis was used to evaluate the association between MAU and cardiovascular risk factors. Results A total of 2265 subjects were included in the analysis. The prevalence of MAU was 8.96%(203/2265, 95%CI: 7.82-10.21). The prevalence of MAU in obesity, hypertension, diabetes, hypertriglyceridemia, and low HDL-C group were 14.65%(63/430), 12.53%(104/830), 20.22%(36/178), 15.57%(64/411), 11.99%(53/442) respectively, which were significantly higher than the corresponding healthy population (all P＜0.01). Multivariate logistic regression analysis showed that obesity, hypertension, diabetes, and hypertriglyceridemia were risk factors for MAU. The OR(95%CI) values were 1.491(1.016-2.265), 1.660(1.190-2.314), 2.291(1.494-3.515) and 1.734(1.205-2.495) respectively. With the increase in the number of influencing factors, urinary albumin levels and the prevalence of MAU all showed an upward trend. Conclusion MAU was associated with cardiovascular risk factors such as obesity, hypertension, diabetes, and hypertriglyceridemia.

Objective To investigate the prevalence of restless legs syndrome (RLS) in peritoneal dialysis patients and analyze the related risk factors. Methods This study was a cross-sectional study. The patients receiving maintenance peritoneal dialysis from January 2017 to December 2017 in the Peritoneal Dialysis Center of the Second Hospital Affiliated to Soochow University were selected as the study subjects. RLS was screened for peritoneal dialysis patients by epidemiological field investigation based on the RLS diagnostic criteria of the International Restless Leg Syndrome Research Group in 2014. Clinical data and laboratory examinations of selected patients were collected and the differences of clinical indicators between RLS and non-RLS patients were compared. The risk factors related to RLS were analyzed by logistic regression. Results Seventy-six cases of RLS were screened out from 396 PD patients. The prevalence of RLS was 19.2%. Compared with non-RLS group, RLS group patients had longer dialysis age, less 24 hours urine volume, and elevated blood intact Parathormone (iPTH) and alkaline phosphatase (AKP) (all P﹤0.05). There was no significant difference in primary disease ratio, sex, age, body mass index, blood pressure, hemoglobin, creatinine, urea nitrogen, uric acid, ferritin, serum iron, transferrin saturation, blood calcium, blood phosphorus, total cholesterol, triglyceride, low density lipoprotein, high density lipoprotein, eGFR, Kt/V, Ccr between RLS and non-RLS group patients (all P﹥0.05). Multivariate logistic regression analysis showed that long dialysis age (OR=1.010, 95%CI 1.001-1.018, P=0.022) and high blood AKP (OR=1.005, 95%CI 1.001-1.010, P=0.021) were independent risk factors for RLS in peritoneal dialysis patients (both P﹤0.05). Conclusions The prevalence of RLS is high in peritoneal dialysis patients. Long dialysis age and high blood AKP are independent risk factors for RLS.

Objective To investigate the expression and mechanism of microRNA-148b (miRNA-148b) in high glucose-induced renal tubular injury. Method HK-2 cells cultured in vitro were divided into normal glucose group, mannitol hypertonic control group and high glucose group. After 48 hours of culture, the expression of miRNA-148b was detected by real-time quantitative PCR. 2',7'-Dichlorodihydrofluorescein diacetate (DCFH-DA) was used for detecting production of ROS and observed under fluorescence microscope for analysis; The expression of AMPKα1, Bcl-2, NOX2, NOX4, activated caspase3 (cleaved-caspase3) were detected by Western blotting. Results Compared with the normal glucose group, the expression of miRNA-148b was up-regulated in HK-2 cells in high glucose group and hypertonic group (P＜0.01), and the production of ROS increased (P＜0.01). The expression of NOX2 and NOX4 was increased, AMPKα1 and Bcl-2 decreased, and cleaved caspase-3 was increased (all P＜0.01). Conclusions HG up-regulated miRNA-148b expression and down-regulated its target gene AMPKα1 which promotes the expression of NOX2 and NOX4 in HK-2 cells. MiRNA-148b promotes apoptosis of HK-2 cells via increasing production of ROS and enhancing cleaved-caspase3 for Bcl-2 insufficiency. The tubular toxicity of high glucose is partly due to osmotic pressure. MiRNA-148b may be involved in the pathological injury of diabetic nephropathy and is expected to become a new therapeutic target for diabetic nephropathy.