Objective To explore the clinical characteristics and risk factors of catheter-related infection in continuous renal replacement therapy (CRRT) patients. Methods The demographic and clinical data of CRRT patients who inserted with double-lumen non-cuffed dialysis catheter at the First Affiliated Hospital of Sun Yat-sen University from January 1, 2016 to December 31, 2016 were collected. According to the presence or absence of catheter-related infections, they were divided into infected group and uninfected group. Statistics and analysis of the incidence and pathogenic characteristics of catheter-related infections; Comparison of clinical features of infected and uninfected groups; A multivariate Cox proportional hazard model was used to analyze risk factors for catheter-related infections. Results A total of 364 patients with CRRT (437 cases of central venous catheterization) were enrolled in the study. Catheter-related bloodstream infection (CRBSI) and catheter-related colonization (CRCOL) rates were 3.565 and 2.228 events per 1000 catheter-days. These catheters were associated with higher proportion of inserted in ICU (P=0.007), immunosuppression (P=0.002), receive catecholamine inotropes therapy (P=0.001) and shock (P=0.030). The infection catheters also had shorter indwelling time (P=0.032) and lower level of blood hemoglobin (P=0.017), serum creatinine (P=0.004), blood brain natriuretic peptide (P=0.005) pericatheter use. The most common pathogens were Gram-negative bacteria, especially Acinetobacter baumannii, which caused 37.5% CRBSI and 20.0% CRCOL. Multivariate Cox regression model showed female (P=0.029, HR=2.151), diabetes (P=0.016, HR=2.807), receive catecholamine inotropes therapy (P=0.012, HR=2.655), immunosuppression (P=0.037, HR=2.203) were independent risk factors associated with catheter-related infection. Conclusions The incidence of CRBSI and CRCOL is 3.565 and 2.228 events per 1000 catheter-days CRRT patients in our hospital. The most common pathogen of catherter-related infection is Gram-negative bacteria. Female, diabetes, received catecholamine inotropic drugs, and immunosuppression were independent risk factors associated with catheter-related infection.

Objective To investigate the clinicopathological characteristics of renal light chain deposition disease coexisted with cast nephropathy (LCDD&LCN). Methods Patients with LCDD&LCN (n=10), isolated LCDD (I-LCDD, n=21) and isolated LCN(I-LCN, n=17) diagnosed by renal biopsy in Peking University First Hospital from January 1, 2000 to March 31, 2018 were enrolled, and all cases were examined by light microscopy, immunofluorescence (IF) (including light chain) and electron microscopy (EM). The semi-quantitative evaluation of the main features of renal pathology was performed. The clinical manifestations and pathological features were reviewed and compared. Results LCDD&LCN was more prevalent in middle-aged males. Nine patients showed acute renal insufficiency with small molecular proteinuria (97.1%) and microscopic hematuria. The hematologic diseases included 9 patients of multiple myeloma. The type of monoclonal light chain in serum and urine by immunofixation electrophoresis showed λ dominant (5/8). By light microscopy, glomerular lesions presented with mild mesangial proliferation in most patients, and only one of them displayed mesangial nodular sclerosis. At the same time, acute tubular injury with light chain casts was the prominent feature, and the clinical manifestations and histological features of LCDD&LCN were similar to that of I-LCN. IF revealed linear staining of monoclonal light chain along the glomerular basement membrane (GBM), tubular basement membrane (TBM) and Bowman's capsule, and also positive in tubular casts. By electron microscopy, diffuse powder-like or granular electron-dense deposits located in the inner side of the GBM, the outer layer of the TBM, renal interstitium and arteriolar walls were observed. Conclusions Patients with LCDD&LCN manifest as acute renal insufficiency, and the majority have multiple myeloma. The pathology of LCDD&LCN possesses the features of both I-LCDD and I-LCN. The IF stain of light chains(κ, λ) and ultrastructural examination by electron microscopy are the inevitable methods for the diagnosis of LCDD&LCN.

Objective To investigate the relationship between serum levels of oxidative stress indicators and the degree of renal interstitial fibrosis in patients with IgA nephropathy (IgAN). Methods Seventy eight patients with confirmed primary IgAN in General Hospital of Ningxia Medical University from January 2013 to December 2014 were enrolled. The patients were divided into T0 group (n=30), T1 group (n=26) and T2 group (n=22) according to the grade of tubular atrophy/interstitial fibrosis of Oxford pathological classification criteria for IgAN in 2009. Meanwhile, thirty cases of health examiner were enrolled as control subjects. The levels of serum malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GSH-Px) were detected by xanthine oxidase method, thiobarbituric acid spectrophotometry method, ultraviolet spectrophotometry method, chemical colorimetric method, respectively. The levels of serum advanced oxidation protein products (AOPPs), transforming growth factor beta 1 (TGF-β1), monocyte chemotactic protein 1 (MCP-1), transforming growth factor alpha (TGF-α), interleukin 6 (IL-6) and hypoxia inducible factor 1 alpha (HIF-1α) were detected by enzyme linked immunosorbent assay (ELISA) in all groups. Spearman correlation analysis was used to analyze the correlation between serum oxidative stress indicators and traditional risk factors of tubular atrophy/renal interstitial fibrosis. Multivariable linear regression analysis was used to analyze the correlation between oxidative stress indicators and degree of renal tubular atrophy/renal interstitial fibrosis. Results There were differences in serum levels of AOPPs, MDA, SOD, CAT and GSH-Px in IgAN patients with different degrees of renal interstitial fibrosis (all P﹤0.05). With the increase of renal interstitial fibrosis, the levels of AOPPs and MDA increased gradually, while the levels of SOD, CAT and GSH-Px decreased gradually. Serum AOPPs, MDA, SOD, CAT, GSH-Px concentration in IgAN patients were correlated with the mean arterial pressure (MAP), total blood protein (TP), albumin (Alb), Scr, uric acid (UA), 24-hour urinary protein volume and estimated glomerular filtration rate (eGFR). Multivariate regression analysis showed that the AOPPs levels of blood were positively correlated with MAP, Scr, UA and 24-hour urinary protein (all P﹤0.01), and negatively correlated with TP, Alb, eGFR (all P﹤0.05). The serum levels of AOPPs and MDA in IgAN patients were positively correlated with the levels of TGF-β1, MCP-1, TGF-α, IL-6 and HIF-1α. The levels of SOD, CAT and GSH-Px were negatively correlated with the levels of TGF-β1, MCP-1, TGF-α, IL-6 and HIF-1α. Multivariate stepwise regression analysis showed that the degree of renal interstitial fibrosis in IgAN patients was positively correlated with serum AOPPs level (β=0.285, P=0.001), negatively correlated with CAT (β=-0.346, P﹤0.001), GSH-Px (β=-0.303, P﹤0.001). Conclusions The level of serum oxidative stress in IgAN patients is elevated and positively correlated with the degree of renal interstitial fibrosis, suggesting that oxidative stress may be involved in the occurrence and development of renal interstitial fibrosis.

Objective To investigate the incidence and clinical features of women with hypertension disorders of pregnancy complicated with renal impairment at high altitude, and explore the impact of proteinuria, renal insufficiency and preexisting chronic kidney disease (CKD) on these patients. Methods A pool of 1790 pregnant women admitted to Yunnan Diqing Tibetan Autonomous Prefecture People's Hospital from September 2017 to September 2018. Data of 123 patients who met the criteria of hypertension disorders in pregnancy were collected and retrospectively studied. Their clinical characteristics and pregnancy outcomes were analyzed. Patients with hypertension and renal impairment, simple hypertension patients as well as normal pregnant women were compared. Hypertensive patients with proteinuria, renal insufficiency (Scr＞70 μmol/L) and preexisting CKD were also compared with simple hypertension patients. The impact of proteinuria, renal insufficiency and preexisting CKD on patients with hypertension disorders of pregnancy was assessed by multivariate logistic analysis. Results Of these 123 patients, 61 cases (49.6%) had renal impairment, 57 cases (46.3%) had proteinuria, 15 cases (12.2%) had renal insufficiency and 6 cases (4.9%) had preexisting CKD. Compared with normal pregnant women and simple hypertension patients, patients with hypertension and renal impairment had higher blood pressure, Scr, primipara rate and caesarean section rate (all P＜0.05), lower gestational age, neonatal Apgar scores and plasma albumin level (all P＜0.05), as well as adverse pregnancy outcomes, including premature birth, stillbirth/neonatal death, intrauterine growth restriction, infants of low-birth weight and admission to the neonatal intensive care unit (NICU) (all P＜0.05). The clinical features and pregnancy outcomes of 57 patients with proteinuria correlated with the proteinuria. Compared with non-nephrotic syndrome patients and patients without proteinuria, patients with nephrotic syndrome (NS) had lower plasma albumin level and higher rates of premature birth, infants of low-birth weight and admission to NICU (all P＜0.05). Among 15 patients with renal insufficiency, there were 13 mild abnormal cases (70 μmol/L＜Scr≤123 μmol/L, 86.7%). Compared with those with normal renal function, patients with renal insufficiency had higher Scr, uric acid and rates of preeclampsia/eclampsia, intrauterine growth restriction, infants of low-birth weight and admission to NICU, while lower plasma albumin level (all P＜0.05). Among 6 patients with preexisting CKD, 4 had NS, 2 had renal insufficiency, 5 delivered before 37 weeks, and 2 infants died. Logistic regression analysis showed that NS (OR=4.863, P=0.032), renal insufficiency (OR=7.550, P=0.017) and systolic pressure (OR=1.061, P=0.002) were independent risk factors for adverse pregnancy outcomes among patients with hypertension disorders in pregnancy. Conclusions Renal impairment is common among patients with hypertension disorders in pregnancy at high altitude and has adverse effects on pregnancy outcomes. Massive proteinuria, renal insufficiency and systolic pressure are risk factors for these patients.

Objective To investigate the clinical characteristics and risk factors of secondary infection in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV). Methods One hundred and eighteen patients newly diagnosed with AAV at the institute of nephrology, Tongji hospital affiliated to Huazhong university of science and technology, from 2012 to 2017, were analyzed retrospectively. Induction therapy included single corticosteroids, combination of corticosteroids with cyclophosphamide and combination of corticosteroids with other immunosuppressive agents. End point was defined as moderate to severe infection which was diagnosed by the clinical and radiological manifestation as well as microbiological evidences. The infection-related survival curve was drawn to reflect the time when the infection occurred. The clinical baseline variables in patients with and without infection were compared. Multivariate Logistic regression model was used to determine the independent predictors of infection. Receiver-operating characteristic curve (ROC) was plotted for evaluating the predictive value of lymphocyte on moderate to severe infection. Results During follow-up of median 3 months (1-30 months), 88 infection episodes were found in 63 (53.4%) patients, of which 54 times (61.4%) occurred within 6 months after treatment, 46 times (52.3%) happened within 3 months after treatment. The most common organ of infection was lung (62.5%), and the most common pathogen was bacteria (51.1%). Multivariate Logistic regression model showed that lung involvement (OR=4.44, 95%CI 1.59-12.41), moderate reduction of lymphocyte in follow-up (OR=5.69, 95%CI 2.05-15.85) and severe lymphocyte reduction (OR=36.28, 95%CI 3.45-381.17) were independent risk factors of secondary infection in AAV patients (all P＜0.05). ROC curve showed that the area under the curve of lymphocyte as a predictor of severe infection was 0.767 (95%CI 0.64-0.89, P＜0.05). Based on lymphocyte less than 0.49×109/L which was the cut-off value for predicting severe infection, the sensitivity and the specificity were 83.9% and 71.9%, respectively. Conclusions Lung involvement and moderate-severe lymphopenia during follow-up are independent risk factors of secondary infection in AAV patients. Hence, physician should pay more attention to those patients, and adjust treatment in time to avoid the occurrence of infection.

Objective To investigate changes in intestinal bacteria in chronic renal failure (CRF), their diagnostic value for CRF, and correlations between specific bacterial genera and renal function. Methods Fecal specimens were collected from 56 patients with CRF and 38 healthy controls in the Nephrology Department and Medical Examination Center of Shanxi People's Hospital between August 2017 and January 2018. High-throughput sequencing analysis of 16S rDNA V3-V4 hypervariable regions was performed for intestinal bacteria. Intestinal bacteria in CRF patients and healthy subjects were analyzed for alpha, beta diversity, species composition analysis, and differential species analysis. The diagnostic value of the presence of specific intestinal bacteria for CRF was analyzed using a receiver operating characteristic curve (ROC). Pearson's correlation analysis was used to analyze the correlation between the presence of specific genera and the estimated glomerular filtration rate (eGFR). Results The alpha and beta diversity in the CRF group was different from that in the control group (P﹤0.05). At the phylum level, Verrucomicrobia were significantly less abundant in the CRF group than that in the control group (0.70% vs 3.09%, P﹤0.001). The abundance of Actinobacteria was significantly greater in the CRF group than that in the control group (1.48% vs 1.14%, P=0.036). At the genus level, the abundance of Akkermansia (0.96% vs 3.90%), Parasutterella (0.47% vs 0.93%), and Lactobacillus (0.07% vs 0.48%) in the CRF group was significantly less than those in the control group (all P﹤0.01). The abundance of Alloprevotella (0.41% vs 0.04%) and Clostridium IV (0.6% vs 0.1%) was significantly greater than those in the control group (all P﹤0.05). The diagnostic value of CRF for the area under the ROC curve (AUC) for Akkermansia was 0.753, and that for Lactobacillus diagnostic value of CRF was 0.792. The combined AUC diagnostic value of CRF for detection of Akkermansia and Lactobacillus was 0.830, with high disease prediction value. Lactobacillus abundance was positively correlated with eGFR (R=0.29, P=0.029). Conclusions The diversity and structure of intestinal bacteria are altered in patients with CRF. The abundance of Akkermansia and Lactobacillus has diagnostic value for CRF. The abundance of Lactobacillus is positively correlated with eGFR.

Objective To study the renal prognosis with the type and proportion of crescentic in adult Henoch Schonlein purpura nephritis (HSPN). Methods A total of 275 HSPN cases diagnosed in the First Affiliated Hospital of Zhejiang University were retrospectively analyzed. According to the pathological results, they were divided into four groups: 99 patients in none crescent group (NC), 35 patients in segmental crescents group (SC), 122 patients with circumferential crescent ＜25% (C1), and 19 patients with circumferential crescent≥25% (C2). Renal prognostic events were defined as estimated glomerular filtration rate (eGFR) decreased by 30% over baseline within 2 years, doubling of serum creatinine or end-stage renal disease during follow-up. Kaplan-Meier survival analysis was used to compare the renal survival rate of each group. Univariate and multivariate Cox regression model was used to recognize the risk factor of poor renal outcome. Results There was no significant difference in age, extra renal organ performance and mean arterial pressure among groups. Among NC group, SC group, C1 group and C2 group, difference in serum creatinine (P=0.001), eGFR (P=0.003) and proteinuria levels (P＜0.001) were statistically significant. There was no significant difference in the ratio of global sclerosis, mesangial hypercellularity and interstitial inflammation/fibrosis among the groups. The patients were followed up for 86(58, 116) months. The renal survival rates of NC group, SC group, C1 group and C2 group were 96%, 100%, 83.6% and 68.4% respectively. Kaplan-meier survival analysis showed significant differences (Log Rank=23.24, P＜0.001). Cox multivariate regression analysis indicated that presence of circumferential crescent (HR=3.59, 95%CI 1.34-9.62, P=0.008) and low eGFR (HR=0.979, 95%CI 0.968-0.989, P＜0.001) were independent prognostic factors. Conclusion The presence of circumferential crescent and low eGFR level are independent risk factors for poor renal prognosis in HSPN patients.

Objective To explore the changes of renal cortical energy metabolism and its related molecular mechanisms in rats with progressive kidney disease. Methods A rat model of 5/6 nephrectomy was established as the model of progressive nephropathy. Rats were divided into surgical group (5/6Nx group) and sham-operated group (Sham group). Respectively, the rats were sacrificed at 1 week and 12 weeks after completing the model, and their blood, urine sample and kidney specimens were collected. Blood urea nitrogen, serum creatinine and 24 h urine protein were used to evaluate the renal function. Pathological changes in renal tissue were detected by PAS staining and Sirius red staining. The renal cortical energy metabolites were made quantitative analysis by liquid chromatography-mass spectrometry-based targeted metabolomics. The mRNA expressions of inflammatory cytokines (IL-6, IL-1β), fibrosis factors (fibronectin, collagen-1), glycolytic and tricarboxylic acid (TCA) cycle related enzymes were confirmed by real-time PCR. The protein expressions of fibrotic proteins (fibronectin, collagen-1), silent information regulator 1 (SIRT-1) and liver kinase B1 (LKB1) were tested by Western blotting. Results Compared with those in Sham group, the renal function indexes increased, the renal tissue pathological damage was obvious, the mRNA expressions of renal cortical inflammatory and fibrosis factors increased, and fibrotic proteins also increased in 5/6Nx group rats at 1 week and 12 weeks (all P＜0.05), meanwhile, kidney damage worsened over time. Compared with those in Sham group, in the renal cortex of 5/6Nx group glycolytic metabolite lactate, the TCA cycle metabolites (citrate, isocitrate, oxaloacetate) and the oxidized phosphorylation metabolite reduced coenzymeⅠ were up-regulated (all P＜0.05), but adenosine triphosphate (ATP) was no change at 1 week, then the abnormal metabolites increased further at 12 weeks, such as the down-regulation of pyruvate, oxidized coenzyme Ⅰ and ATP (all P＜0.05). The pentose phosphate pathway metabolites (reduction and oxidized coenzyme Ⅱ) shows no statistical significant difference in the two group (all P＞0.05). Compared with those in Sham group, in the 5/6Nx group the mRNA expressions of glycolytic enzyme hexokinase 2 and lactate dehydrogenase a were up-regulated in the renal cortex at 1 week, whereas the mRNA expressions of pyruvate dehydrogenase α, pyruvate dehydrogenase β and succinate dehydrogenase of the TCA cycle related enzymes were down-regulated (all P＜0.05). Meanwhile, renal abnormal metabolic enzyme mRNA expressions were further increased in the 5/6Nx group at 12 weeks. The protein levels of SIRT-1 and LKB1 were not significantly different in the renal cortex of two group rats at 1 week, while SIRT-1 and LKB1 levels decreased in 5/6Nx group than those in Sham group at 12 weeks (all P＜0.05). Conclusions During the progression of nephropathy, rats accompanied with renal fibrosis and inflammatory have energy metabolism changes in the renal cortex which accompanies. The features of metabolic changes are manifested as enhanced glycolysis and decreased oxidative phosphorylation, which is aggravated gradually. Its mechanism is related to the inhibition of energy-regulating proteins LKB1 and SIRT-1.