Association of plasma neutrophil gelatinase-associated lipocalin with parameters of CKD-MBD in maintenance hemodialysis patients.

INTRODUCTION: Neutrophil gelatinase-associated lipocalin (NGAL) is not only a biomarker of kidney injury but also a bone-derived factor involved in metabolism. We aimed to explore relationships between plasma NGAL and chronic kidney disease-mineral bone disorder (CKD-MBD) parameters in maintenance hemodialysis (MHD) patients. MATERIALS AND METHODS: First, a cross sectional observational study, including 105 MHD patients, was conducted to explore relationships between plasma NGAL levels and CKD-MBD parameters. Second, impact of parathyroidectomy and auto-transplantation (PTX + AT) on plasma NGAL was investigated in 12 MHD patients with severe secondary hyperparathyroidism (SHPT). RESULTS: According to Spearman correlation analysis, plasma NGAL levels were positively correlated with female (r = 0.243, P = 0.012), vintage (r = 0.290, P = 0.003), Klotho (r = 0.234, P = 0.016), calcium(Ca) (r = 0.332, P = 0.001), alkaline phosphatase (ALP) (r = 0.401, P < 0.001) and intact parathyroid hormone (iPTH) (r = 0.256, P = 0.008); while inversely correlated with albumin(Alb) (r = - 0.201, P = 0.039). After adjusting for age, sex, vintage, Alb and all parameters of CKD-MBD(Ca, P, lg(ALP), lg(iPTH), Klotho and fibroblast growth factor 23(FGF23)), lg(NGAL) were positively correlated with Ca (r = 0.481, P < 0.001), P (r = 0.336, P = 0.037), lg(ALP) (r = 0.646, P < 0.001) in Partial correlation analysis; further multiple linear regression analysis showed same positive associations between lg(NGAL) and Ca (ß = 0.330, P = 0.002), P (ß = 0.218, P = 0.037), lg(ALP) (ß = 0.671, P < 0.001). During the 4-7 days after PTX + AT, plasma NGAL decreased from 715.84 (578.73, 988.14) to 688.42 (660.00, 760.26) ng/mL (P = 0.071), Klotho increased from 496.45 (341.73, 848.30) to 1138.25 (593.87, 2009.27) pg/mL (P = 0.099). CONCLUSION: Plasma NGAL levels were positively associated with ALP in MHD patients; and downtrends were shown after PTX + AT in patients with severe SHPT. These findings suggest that NGAL is a participant in CKD-MBD under MHD condition.

Effect of calcium carbonate combined with calcitonin on hypercalcemia in hemodialysis patients.

This short-term study assessed the efficacy and safety of calcium carbonate combined with calcitonin in the treatment of hypercalcemia in hemodialysis patients. Patients (n=64) on hemodialysis for chronic kidney disease for more than 6 months were included based on total serum calcium more than 10.5 mg/dL. All patients were randomized (1:1) to receive calcium carbonate combined with calcitonin (Group I) or lanthanum carbonate (Group II) for 12 weeks. Blood levels of calcium, phosphorus and intact parathyroid hormone (iPTH) were measured every month, bone mass density (BMD) and coronary artery calcium scores (CACS) were measured at 3 months. During the study period, serum calcium decreased from 10.72 ± 0.39 to 10.09 ± 0.28 mg/dL (P < 0.05), serum phosphorus decreased from 6.79 ± 1.05 to 5.46 ± 1.18 mg/dL (P < 0.05), and serum iPTH levels in the Group I and Group II were not significantly different from the baseline. There were no significant differences in CACS in either group. There were no significant differences in the BMD values between Group I and baseline. In Group II, the BMD values at the lumbar spine and femoral neck were significantly lower than those before the trial and significantly lower than the corresponding values of Group I (P<0.05). Calcium carbonate combined with calcitonin and lanthanum carbonate were equally effective in the suppression of hypercalcemia in hemodialysis patients. There were no serious treatment-related adverse events in treatment with calcium carbonate combined with calcitonin.

[Clinical significance of toll-like receptor 4 expression on the surface of peripheral blood mononuclear cells in uremic patients].

OBJECTIVE: To explore the clinical significance of toll-like receptor 4 expression on the surface of peripheral blood mononuclear cells (PBMC) in uremic patients and observe the effect of ultrapure dialysate on the PBMC expression of TLR4 in these patients. METHODS: Eighty patients on maintenance dialysis were randomly divided into two groups: conventional dialysate group (CD, n=40), ultrapure dialysate group (UPD, n=40) and 40 uremic patients without dialysis in NHD group. The blood cells from all patients and 40 healthy controls were stained with FITC labeling anti-TLR4 monoclonal antibodies. Samples were collected and analyzed by flow cytometry. RESULTS: The expression of TLR4 was significantly lower in CD group (18.1±3.7) than in NHD group (24.5±4.6, P<0.05) and healthy control group (31.6±5.8, P<0.01). And marked difference existed between CD group (18.1±3.7) and UPD group (23.1±3.2, P<0.05) at Month 6 post-dialysis. In CD group the expression of TLR4 became significantly smaller as the duration of dialysis increased (P<0.05) while in UPD group although the expression of TLR4 became smaller as the duration of dialysis became longer. But the difference was not statistically significant (P>0.05). CONCLUSION: The PBMC expression of TLR4 becomes down-regulated in uremic patients with or without dialysis and its expression is smaller in conventional dialysate group than in ultrapure dialysate group. The conventional dialysate may suppress the expression of TLR4 while the phenomenon is absent in ultrapure dialysate group.

[The value of magnifying endoscopy combined with human telomerase reverse transcriptase in diagnosing precancerous gastric lesions].

OBJECTIVE: To explore the diagnostic value of magnifying endoscopy and human telomerase reverse transcriptase (hTERT) in identifying precancerous lesions of gastric mucosa. METHODS: 154 patients with upper digestive symptoms were included in the study. They were examined by the same senior doctor using magnifying endoscopy, and real-time diagnosis was made during the examination. Forceps biopsies were taken for pathological examination and were examined the expression of human telomerase reverse transcriptase mRNA (hTERT mRNA) by real-time quantitative PCR. The morphology of gastric pits under magnifying endoscopy was classified as follows: type A: round spot pits, type B: linear, type C: sparsely and thickly linear, typed D: patchy, and type E: villous. RESULTS: The divergence of intestinal metaplasia had significant differences implications among the gastric pit patterns from B to E under magnifying endoscopy (chi(2) = 17.58, P < 0.05). The more sever the intestinal metaplasia, the higher the pattern scale of the gastric pit (Pearson = 0.531, P < 0.05). The degree of dysplasia had a parallel relationship with the gastric pit patterns changed from C to E (chi(2) = 10.256, P < 0.05, Pearson = 0.549, P < 0.05). The expressions of hTERT mRNA of mucosa had significant differences among the gastric pit patterns B, C, D and E (F = 3.274, P < 0.05); If the expression of hTERT mRNA were taken as diagnostic criteria of gastric cancer, 65% of pit type E would be considered as gastric cancer which were otherwise negative by pathology. CONCLUSIONS: The micro-structural changes of gastric mucosa under magnifying endoscopy can reflect the severity of gastric disease, hTERT is a very important marker for diagnosis of gastric carcinoma. It is useful to predict the malignant change of gastric precancerous lesions in patients by following up high expression of hTERT mRNA combined with pit type E diagnosed by magnifying endoscopy.