Objective To evaluate the clinicopathological characteristics and outcomes of IgA nephropathy (IgAN) with acute tubulointerstitial nephropathy (ATIN). Methods Patients who were diagnosed as IgAN with ATIN and IgAN without ATIN by renal biopsy in Peking University First Hospital were enrolled. There were 74 cases of IgAN with ATIN, and seventy-four cases of IgAN without ATIN were enrolled based on stratified sampling (chosen by 1∶1). The two groups were well matched with age, gender, follow-up time, mesangial hypercellularity(M), endocapillaryhypercellularity(E), segmental glomerulosclerosis(S), tubular atrophy/interstitial fibrosis(T) and cellular/fibrocellular crescent(C). The clinicopathological characteristics and outcomes of two groups were retrospectively analyzed. A composite end point, defined as 30% or 50% estimated glomerular filtration rate (eGFR) decline and end stage renal disease (ESRD) was used. Renal function and proteinuria during follow-up were observed. Renal survival was calculated by Kaplan-Meier survival analysis and risk factors of progression were analyzed by using univariate and multivariate Cox regression models. Results Seventy-four cases of IgAN with ATIN and seventy-four cases of IgAN without ATIN were enrolled. Serum creatinine [(185.6±83.2) μmol/L vs (146.3±69.2) μmol/L, P=0.010] and incidence of acute kidney disease (AKD) (31.1% vs 5.4%, P＜0.001) were higher in IgAN with ATIN group than those in IgAN without ATIN group. Patients in ATIN group received more immunosuppressive treatment (86.5% vs 58.1%, P＜0.001). During 1 year after biopsy, mean eGFR increased significantly in IgAN with ATIN group [(39.7±14.6) ml?min-1?(1.73 m2)-1 vs (47.2±19.9) ml?min-1?(1.73 m2)-1, P=0.017], but mean eGFR was not statistic different in IgAN without ATIN group [(60.0±30.5) ml?min-1?(1.73 m2)-1 vs (59.0±31.7) ml?min-1?(1.73 m2)-1, P=0.567]. Median follow-up was 23.0 months in IgAN with ATIN group, and Median follow-up was 30.0 months in IgAN without ATIN group. Incidence of composite end point had no significant differences between two groups. IgAN with ATIN was not the independent risk factor for end point. IgAN patients with ATIN were divided into two groups (with AKD and without AKD), then renal survival rate was higher (Log-rank test, χ2=5.293, P=0.021) and the risk for composite end point decreased by 79.2% (HR=0.208, 95%CI 0.046-0.939, P=0.041) in the group with AKD. Conclusions In IgAN, there is a subgroup of patients with the specific pathological phenotype combined with ATIN. Compared with those without AKD, the risk for composite end point of IgAN patients with ATIN and AKD showed a 79.2% decrease.

Objectives To detect the level of soluble programmed death 1 (sPD-1) and soluble programmed death ligand 1 (sPD-L1) in serum and urine of children with primary nephrotic syndrome (PNS), and explore its clinical significance. Methods From July 2017 to November 2017, children with PNS admitted to the Children's Hospital Affiliated to Soochow University were divided into onset group (36 cases) and remission group (33 cases). Thirty healthy children who underwent medical examination for enrollment, undersize or overweight in the outpatient department of pediatric health care and inpatient department of Endocrinology were selected as healthy control group. Serum and urine samples were collected, in which the levels of sPD-1 and sPD-L1 were detected by enzyme-linked immunosorbent assay (ELISA). The correlation between serum and urine sPD-1, sPD-L1 levels and lymphocyte subsets, urinary protein were analyzed by Pearson and Spearman correlation analysis. Results The level of sPD-1 in serum was lower in remission group than those in healthy control group [1.60(0.48, 8.15) ng/ml vs 7.38(2.15, 19.02) ng/ml, P﹤0.01]. The level of urinary sPD-1 in onset group was higher than that in remission group [1.21(0.61, 2.56) pg/μg vs 0.51(0.31, 0.97) pg/μg, P﹤0.001] and healthy control group [1.21(0.61, 2.56) pg/μg vs 0.82(0.34, 1.15) pg/μg, P﹤0.01]. The levels of sPD-L1 in serum and urine were higher in onset and remission group than those in healthy control group (P﹤0.001). The level of sPD-1 in the serum was positive correlated with the numbers of CD3+, CD3+CD4+, CD3+ CD8+ T lymphocytes and CD3-CD19+, CD19+CD23+ B lymphocytes (r=0.537, 0.478, 0.454, 0.429 and 0.374; P=0.002, 0.008, 0.012, 0.018 and 0.042). The level of sPD-1 in the urine had positive relation with the ratio of 24 hours urinary albumin and weight (24 h UmAlb/Wt), N-acetylglucosaminidase and urinary creatinine (UNAG/Cr) and β2 microglobulin and urinary creatinine (Uβ2MG/Cr) (r=0.409, 0.588 and 0.276; P=0.016, 0.000 and 0.032). Conclusions The dynamic changes of sPD-1 and sPD-L1 in serum and urine suggested that PD-1/PD-L1 signaling pathway is involved in the development process of childhood primary nephrotic syndrome.

Objective To analyze the spectrum of children's kidney pathology by renal biopsy. Methods The clinical and pathological data of the cases in Jinling Hospital involving the patients younger than 18 years old who received renal biopsy from April 1st, 2004 to December 31th, 2017 were retrospectively collected, and compared with the renal pathological data of 1611 children aged 0-18 years from June 1982 to March 2004. Results This study included 9925 cases of kidney diseases proven by renal biopsy. The ratio of male to female was 1.79∶1. Primary glomerulonephritis (PGN) accounted for 66.14%, and secondary glomerulonephritis (SGN) accounted for 28.00%. Top five of the PGN were IgA nephropathy (IgAN, 19.11%), mesangial proliferative glomerulonephritis (MsPGN, 16.07%), minimal change disease (MCD, 14.20%), focal segmental glomerulosclerosis (FSGS, 6.19%) and membranous nephropathy (MN, 4.70%) in whole children, IgAN (13.12%), MsPGN (11.20%), MCD(10.63%), FSGS (4.55%) and MN (2.54%) in males, and IgAN (5.99%), MsPGN (4.87%), MCD (3.57%), MN (2.16%) and FSGS (1.63%) in females. Top three of the SGN were Henoch-Schonlein purpura nephritis (HSPN, 17.74%), lupus nephritis (LN, 8.23%) and vasculitis nephropathy (1.82%). The male was in a dominant position in all kinds of pathologic types than female except LN. HSPN was the most frequent type in adolescents between 6-13 years old. LN was the commonest one in 14-18-year-old girls, while IgAN was the the most common in 14-18-year-old boys. Post infective nephritis was the most popular in 12-14-year-old teenagers. It was also found that MN ascended in female. When compared with the data before 2004, HSPN and LN accounted for a greater proportion in SGN, post infective nephritis displayed a smaller proportion. Conclusions PGN is the mainly kind of glomerular disease as before, and immune disorder related to glomerular diseases increase and post infective nephritis decreases in proportion. This study provides the reference and epidemic data for diagnosis, treatment and prevention of children's renal diseases.

Objective To investigate the incidence situation of metabolic syndrome (MS) in patients with continuous ambulatory peritoneal dialysis (CAPD), and analyze the correlation between MS and prognosis of patients. Methods The patients who received peritoneal dialysis from June 1, 2002 to April 30, 2018 and followed up regularly were divided into MS group and non-MS group according to the diagnostic criteria of MS. Follow-up was until July 31, 2018. The differences of clinical data, metabolic indexes and clinical outcomes between the two groups were compared. The survival rates of the two groups were compared by Kaplan-Meier survival curve, and the risk factors of all-cause death and cardiovascular disease (CVD) death were analyzed by Cox regression analysis. Results A total of 516 patients with CAPD were enrolled in this study, including 340 males (65.9%) and 176 females (34.1%). Their age was (47.29±12.20) years. The median follow-up time was 20 (9, 39) months. According to the diagnostic criteria of MS, the patients were divided into MS group (210 cases, 40.7%) and non-MS group (306 cases, 59.3%). At baseline, there was no significant difference in age, educational background, duration of peritoneal dialysis, smoking history and drinking history between the two groups (P＞0.05), but the patients in MS group were more exposed to high glucose peritoneal dialysate (P＜0.05). The body mass index (BMI), blood phosphorus, blood glucose, blood potassium, triglyceride, cholesterol and systolic blood pressure in MS group were significantly higher than those in non-MS group (all P＜0.05), and HDL-C level was significantly lower in MS group than in non-MS group (P＜0.05). There were no significant differences in other indicators between the two groups (P＞0.05). Kaplan-Meier survival curve showed that the cumulative survival rate in MS group was significantly lower than that in non-MS group, and the difference was statistically significant (Log-rank χ2=14.87, P＜0.001). If CVD death was taken as the end event, the cumulative survival rate in the non-MS group was significantly higher than that in the MS group (Log-rank χ2=14.49, P＜0.001). Multivariate Cox regression analysis showed that MS and high 4 h dialysate creatinine/serum creatinine ratio (4hD/Pcr) were independent risk factor for all-cause death (HR=1.982, 95%CI 1.240-3.168, P=0.004; HR=3.855, 95%CI 1.306-11.381, P=0.015) and CVD death (HR=2.499, 95%CI 1.444-4.324, P=0.001; HR=5.799, 95%CI 1.658-20.278, P=0.006) in patients with CAPD. Conclusion The prevalence of MS in patients with CAPD is high, and MS and high 4hD/Pcr are independent risk factor for all-cause and CVD death in CAPD patients. They can be used as valuable indicators to predict the treatment outcomes and long-term prognosis of patients with CAPD.

Objective To investigate the correlation between neutrophil-lymphocyte ratio (NLR) and disease activity of systemic lupus erythematosus (SLE), and the changes of NLR in different organ involvement of SLE patients. Methods A total of 155 SLE patients and 135 healthy controls from the Rheumatology Department of Xiangya Hospital were enrolled in this study from 2010 to 2018. Patients with SLE were divided into lupus nephritis group (LN group) and non-lupus nephritis group (non-LN group), serositis group and non-serositis group, according to whether they had kidney involvement or serositis. According to the SLE disease activity index 2000(SLEDAI-2000), the patients were divided into mild to moderate disease activity group (SLEDAI score＜15) and severe disease activity group (SLEDAI score≥15). The NLR values of the above groups were compared. Spearman's correlation analysis was used to analyze the correlation between NLR and SLE patients' laboratory indexes. Multiple linear regression model was used to analyze the relationship between NLR and SLE disease activity. Receiver operating characteristic curve (ROC) was used to evaluate the value of NLR in SLE diagnosis and activity assessment. Results (1)The NLR value of SLE patients was significantly higher than that of healthy control group, and the difference was statistically significant (P＜0.01). (2)The NLR value of SLE patients in the LN group was higher than that in the non-LN group, and the NLR value of SLE patients with serositis was higher than that in the group without serositis, with statistically significant differences (both P＜0.05). (3)The NLR value of SLE patients in the severe disease activity group was higher than that in the mild and moderate disease activity group, and the difference was statistically significant (P＜0.01). (4)NLR of SLE patients was positively correlated with CRP (rs=0.188, P=0.019), SLEDAI score (rs=0.264, P=0.001), and negatively correlated with total serum protein (rs=-0.250, P=0.002) and serum albumin (rs=-0.329, P＜0.001), respectively. (5) Multiple linear regression showed that NLR was independently associated with SLE disease activity(B=0.351, 95%CI 0.012-0.690, t=2.047, P=0.042). (6) According to ROC curve, the optimal cut-off value of NLR for SLE diagnosis was 2.17 (sensitivity 60.0%, specificity 83.1%, AUC=0.744), and the best cut-off value for predicting the activity of severe disease activity in SLE patients was 3.28 (sensitivity 58.5%, specificity 78.1%, AUC=0.700). Conclusion NLR is closely related to renal involvement, serositis and disease activity in SLE patients, which indicates that NLR, as a new inflammatory indicator, is of great significance for the assessment of SLE disease activity and organ involvement.

Objective To evaluate the efficacy of bare mental stent (BMS) and covered stent (CS) in the treatment of complete central venous occlusive disease (CVOD) in hemodialysis patients. Methods A total of 66 cases of CVOD who have been treated by endovascular methods successfully in the First Affiliated Hospital of Sun Yat-sen University from Jan 2015 to Jan 2017 were enrolled in this study. According to the type of stent，the patients were divided into two groups, BMS group (n=46) and CS group (n=20). The demographic data, clinical signs and symptoms, and pre-procedure and post-procedure imaging data were followed up and recorded. The primary patency rates were calculated at 1, 3, 6, 9, and 12 months. Results The related symptoms were improved within 2 day post-procedure. The primary patency rates of BMS group in 1, 3, 6, 9 and 12 months were 97.83%, 95.65%, 69.56%, 41.3%, and 34.78% respectively. The rates of CS group were 100%, 100%, 95%, 65%, and 60% respectively. They did not reached statistical significance for primary patency rates between two groups in 1, 3, and 6 months (P＞0.05 respectively). However, from 9 months after procedure, it began to show the significant difference between two groups (P＜0.05). The median patency time of the CS group was (10.30±5.32) months, while BMS group was (8.52±0.49) months. The difference between the two groups was statistically significant (P=0.046). Conclusions Stent implantation for complete occlusion of central venous in hemodialysis patients can get credible effect. The use of CS for CVOD provides superior patency as well as patency time in long period after procedure as compared with BMS.

Objective To investigate effects of melatonin (MT) on high glucose-induced cell proliferation, Toll-like receptor 4 (TLR4) signaling pathway and expressions of inflammatory factor in mouse mesangial cells (SV40). Methods SV40 cells were divided into mannitol control group (30 mmol/L mannitol), normal control group (5 mmol/L glucose), control (5 mmol/L glucose)+1000 μmol/L MT group, high glucose group (25 mmol/L glucose), high glucose +10, 100, 1000 μmol/L MT group and high glucose+TLR4 inhibitor (TAK242) group. (1) The cell viability was measured by CCK-8 cytotoxicity kits, and cell proliferation was measured by EdU kits. The expression of TLR4 and the nuclear translocation of nuclear factor-κB (NF-κB p65) were observed by immunofluorescence. (2) Real-time quantitative PCR was used to detect TLR4 mRNA expression. Real-time quantitative PCR and ELISA were used to determine the mRNA and protein secretion levels of the downstream inflammatory factors, such as monocyte chemoattractant-1 (MCP-1), interleukin-1β (IL-1β) and tumor necrosis factor of α (TNF-α); Western blotting was used to detect TLR4 pathway proteins, such as TLR4, myeloid differentiation factor 88 (MyD88), β interferon TIR domain adaptor (Trif), phosphorylated interferon regulatory factor 3 (p-IRF3) and phosphorylated NF-κB inhibitory protein (p-IκB). Results High glucose stimulated mesangial cell proliferation, promoted TLR4 expression and NF-κB p65 transcription activity. Both MT and TAK242 inhibited the above reactions, and the effects of MT was concentration-dependent. Compared with the normal control group, high glucose group had up-regulated expressions of TLR4, MCP-1, IL-1β and TNF-α mRNA (all P＜0.05), but also significantly increased the protein expressions of MyD88, Trif, p-IRF3 and p-IκB (all P＜0.05). Compared with those in the high glucose group, the expression of TLR4 was down-regulated in the high glucose+10, 100, 1000 μmol/L MT group and the high glucose+TAK242 group (all P＜0.05), while the expressions of MyD88, Trif, p-IRF3, p-IκB, MCP-1, IL-1β and TNF-α decreased (all P＜0.05). The effects of MT was concentration-dependent. Conclusions High glucose stimulates the proliferation of SV40, and MT can inhibit the proliferation of mesangial cells and the expressions of inflammatory factors through TLR4 signaling pathway.