Immunological features and functional analysis of anti-CFH autoantibodies in patients with atypical hemolytic uremic syndrome.

OBJECTIVE: Atypical hemolytic uremic syndrome (aHUS) is associated with defective complement regulation. Anti-complement factor H (CFH) antibodies were thought to participate in the pathogenesis of aHUS. The aim of this study was to address the functions and properties of CFH autoantibodies in a Chinese Han cohort of aHUS patients. METHODS: Thirty-six anti-CFH antibody-positive aHUS patients at the acute phase of the disease were involved in this study. Clinical data of the patients were collected. Anti-CFH immunoglobulin G (IgG) subclasses and antibody isotypes were detected by ELISA. Epitope mapping was performed using recombinant CFH fragments (SCRs 1-4, SCR 7, SCRs 11-14, and SCRs 19-20). Purified IgG from plasma from seven patients were used for functional analyses. RESULTS: All patients presented with the classic triad of HUS. The anti-CFH autoantibodies mostly bound to the SCRs 19-20 domains of CFH but not the SCRs 1-4 domains. CFI cofactor activity was not disturbed by the anti-CFH antibody in any of the seven patients. Purified IgG interfered with the binding of CFH to C3b and CFH-mediated sheep erythrocyte protection in all seven patients. IgG from 4/5 (80%) patients tested inhibited the binding of CFH to glomerular endothelial cells. CONCLUSIONS: Our study suggests that the properties of CFH antibodies from patients with aHUS, including the recognition of SCRs and IgG subclasses, can influence and impair the biological role of CFH and therefore contribute to aHUS susceptibility.

The clinical and laboratory features of Chinese Han anti-factor H autoantibody-associated hemolytic uremic syndrome.

BACKGROUND: Anti-complement factor H (CFH) autoantibody-associated hemolytic uremic syndrome (HUS) is a severe sub-type of HUS. METHODS: We assessed the clinical and renal pathological features, circulating complement levels, and genetic background of Chinese pediatric patients with this sub-type of HUS. Thirty-three consecutive patients with acute kidney injury who tested positive for serum anti-CFH autoantibodies were enrolled in this study. RESULTS: All of the eight patients who underwent renal biopsies presented with changes typical of thrombotic microangiopathy, especially changes in chronic characteristics. Compared to patients in remission and normal control subjects, patients with acute disease had significantly lower plasma CFH levels and significantly higher plasma complement 3a (C3a), C5a, and terminal complement complex (SC5b-9) levels. The CFH-anti-CFH immunoglobin G (IgG) circulating immunocomplex (CFH-CIC) titers were more closely correlated with CFH plasma levels than anti-CFH IgG levels. Of the 22 patients, four (18%) were homozygous for CFHR3-1Δ and ten were heterozygous for CFHR1 or CFHR3 deletions. Most patients responded well to a combination of plasma and immunosuppressive therapies, with a remission rate of 87%. At the end of the follow-up, nine patients reached the combined end-points, including two with end-stage renal disease and seven with relapses. CONCLUSION: Plasma C3a, C5a, and SC5b-9 levels predicted disease activity in anti-CFH autoantibody-associated HUS patients enrolled in this study. These patients responded well to plasma therapy combined with immunosuppression.

[Clinical analysis and follow-up study of cardiavascular system involvement in 10 children with methylmalonic aciduria combined with hyperhomocysteinemia].

OBJECTIVE: To study the clinical features and treatment outcomes of cardiovascular system involvement in children with methylmalonic aciduria combined with hyperhomocysteinemia (MMACHC). METHODS: The clinical data of 10 children with methylmalonic aciduria combined with hyperhomocysteinemia and who had cardiovascular system involvement were retrospectively analyzed and the treatment outcomes were followed up. RESULTS: In the 10 patients, there were 4 cases with initial presentations of cardiovascular system symptoms such as shortness of breath and dyspnea, 3 cases with urinary tract symptoms such as edema, hematuria and proteinuria, and 3 cases with nervous system symptoms such as developmental retardation and convulsions. The 10 patients had different types and severity of cardiovascular injuries. After 3 months to 8 years of follow-up, the congenital heart defects resolved naturally in 2 cases, and the patient with arrhythmia had no obvious changes. In 5 cases of hypertension, blood pressures recovered to normal in 3 cases, and 1 case was lost to follow-up. In 5 patients with pulmonary hypertension, 2 died, 2 recovered, and 1 case had mildly elevated pulmonary artery pressure. Seven patients underwent MMACHC gene testing, and 5 showed c.80A>G mutations. CONCLUSIONS: Metabolic disease should be taken into account for the children with unexplained pulmonary hypertension and hypertension with the onset of the shortness of breath and dyspnea. The severity of cardiovascular system involvement might be one of the most important factors affecting the prognosis of children with MMACHC. Cardiavascular system involvement of the patients may be related to MMACHC c.80A>G mutations.

[Comparison of phenotypic features between patients with X-linked and autosomal recessive Alport syndrome].

OBJECTIVE: To further improve the recognition of Alport syndrome. METHODS: The patients with COL4A3, COL4A4 or COL4A5 mutations, admitted to Department of Pediatric, Peking University First Hospital from 2005 to 2009, were retrospectively studied. Their clinical and ultrastructural characteristics were compared between the male patients with X-linked dominant inheritance Alport syndrome (XLAS) and the patients with autosomal recessive inheritance Alport syndrome (ARAS). RESULTS: There were 54 male patients with XLAS and 14 patients with ARAS. Compared with the male patients with XLAS, episodic gross hematuria was prominent (P<0.001) in patients with ARAS. Family history was also different between the two groups (P=0.016). However, there was no significant difference in the age of identification of symptoms, initial manifestations, levels of proteinuria, extrarenal signs and ultra-structural glomerular basement membrane changes between the two groups. CONCLUSION: There are some features that distinguish between the patients with XLAS and the patients with ARAS.

[Complement system regulation and C3 glomerulopathy].

Complement system is a key system for immune surveillance and homeostasis. Excessive activation of complement system,especially the activation of alternative pathway may play a very important role in the pathogenesis of primary and secondary glomerulonephritis. C3 glomerulopathy is a newly named disease characterized by evident C3 deposition in the glomeruli with little or no immunoglobulin under immunofluorescence (IF). Its clinical and pathological manifestations vary a lot. The decreased plasma C3 and Factor H(FH)suggest that abnormal regulation of complement system plays an importment role in its pathogenesis. C3 glomerulopathy varies a lot as to its clinical manifestation, treatment and prognosis. The inhibition of excessive complement activation might be the key to treating C3 glomerulopathy.

Assessment on the declining degree of farmland shelter forest in a desert oasis based on LiDAR and hyperspectrum imagery.

We examined the growth decline and health status of farmland protective forest belt (Populus alba var. pyramidalis and Populus simonii shelterbelts) in Ulanbuh Desert Oasis by using airborne hyperspectral and ground-based LiDAR to collect the hyperspectral images and point cloud data of the whole forest belt respectively. Through correlation analysis and stepwise regression analysis, we constructed the evaluation model of the decline degree of farmland protection forest with the spectral differential value, vegetation index, and forest structure parameters as independent variables and the tree canopy dead branch index of the field survey as dependent variables. We further tested the accuracy of the model. The results showed that the evaluation accuracy of the decline degree of P. alba var. pyramidalis and P. simonii by LiDAR method was better than that by hyperspectral method, and that the evaluation accuracy of the combined LiDAR and hyperspectral method was the highest. Using the LiDAR method, hyperspectral method, the combined method, the optimal model of P. alba var. pyramidalis was all light gradient boosting machine model, with the overall classification accuracy being 0.75, 0.68, 0.80, and Kappa coefficient being 0.58, 0.43, 0.66, respectively. The optimal model of P. simonii was random forest model, random forest model, and multilayer perceptron model, with the overall classification accuracy being 0.76, 0.62, 0.81, and Kappa coefficient being 0.60, 0.34, 0.71, respectively. This research method could accurately check and monitor the decline of plantations.

Three-dimensional model construction and wind simulation of different tree species in farmland shelter.

Protective forests are the ecological barriers of oases in arid sand areas and can effectively prevent and control wind and sand hazards. The structural characteristics of individual trees, as the basic unit of protective forests, are the key factors affecting the protective benefits. With the typical leafless tree species of Ulan Buh Desert oasis, i.e., Populus alba var. pyramidalis, Populus nigra var. thevestina, and Populus popularis, as the research objects, and by using the ground-based LiDAR and through computational fluid dynamics (CFD), we fully explored the structural characteristics of individual trees and their surrounding aerodynamic characteristics on the basis of real 3D models. We further established the relationship between structural parameters of individual trees and wind field index. The results showed that combining AdQSM and MeshLab to build tree models had high accuracy. The wind field around the individual trees could be roughly divided into six regions, including the attenuation zone of the windward side of the plant, the acceleration zone at the top of the plant, the eddy zone, the calm zone, the transition zone, and the recovery zone of leeward side of the plant. The pressure field around individual trees showed a gradual change of high pressure on the windward side to low pressure on the leeward side. Horizontally, in the range of 20% to 50% reduction in relative wind speed, the effective protection distances were 0.21H-1.51H, 0.20H-0.91H, and 0.25H-1.64H (H was the corresponding tree height) for P. alba var. pyramidalis, P. nigra var. thevestina, and P. popularis, corresponding to effective protection areas of 18-294, 15-227, and 18-261 m2, respectively. The maximum wind speed decay rate in the vertical direction was at 0.3H height for P. alba var. pyramidalis and P. popularis, and was reflected at 0.5H height for P. nigra var. thevestina. The correlation and stepwise regression analysis of the single tree structure parameters with the wind field indicators clearly indicated that optical porosity and volume porosity dominated the protection effect. Among the wind field factors, the best regression models related to the porous coefficient were screened for three factors, including diameter at breast height, tree surface area, and optical porosity. The regression variables screened for effective protection distance and effective protection area differed among the classes.

[Features of proteinuria in Chinese male patients with Alport syndrome].

OBJECTIVE: To explore the timing and course of proteinuria in Chinese patients with Alport syndrome (AS). METHODS: This retrospectively study included 118 unrelated male AS patients at Department of Pediatrics, Peking University First Hospital between 1994 and 2009. The clinical data of the onset age of proteinuria, the degree of proteinuria and the prevalence of microalbuminuria were analyzed. Urinary total protein was detected by the pyrogallol red protein dye-binding assay, urinary microalbumin by immunoturbidimetric assay and urinary creatinine level by alkaline kinetics. Microalbuminuria was detected when the microalbumin: creatinine ratio was > 30 mg/g on a single random midstream first morning urine sample. RESULTS: A total of 106 patients had proteinuria. The occurring or detecting age of proteinuria varied from 1 month to 27 years. Five patients (4.7%) were under 1 year of age and 15 patients (14.2%) at toddler's age. Among 43 cases with nephrotic-level proteinuria, 21 cases (48.8%) presented with nephrotic-level proteinuria at age 6 - 12 year. Both urine total protein and morning urine microalbumin measurements within 7 days were made in 53 patients. Microalbuminuria occurred in 4 of 5 patients with normal daily urinary protein excretion. All 48 patients had daily proteinuria > 0.15 g. Increased urinary microalbumin was detected in 4 of 5 patients with normal daily urinary protein excretion and 46 patients with daily proteinuria > 0.15 g. The consistency of urine microalbumin concentration and urine microalbumin-to-creatinine ratio was excellent in 51 patients. However, in 2 patients with slightly increased daily urine total protein, urine microalbumin concentration was normal while the urine microalbumin-to-creatinine ratio abnormal (> 30 mg/g). CONCLUSIONS: In AS males, proteinuria occurs earlier and progresses rapidly. Since microalbuminuria precedes the onset of proteinuria, either urine microalbumin concentration or urine microalbumin-to-creatinine ratio in morning specimens should be used for detecting microalbuminuria. And microalbuminuria may serve as an early endpoint in intervention trials.

[Soil organic carbon density and its influencing factors in croplands with different cultivation years in the Northeastern Ulan Buh Desert, China]. / ä¹Œå °å¸ƒå’Œæ²™æ¼ ä¸œåŒ—éƒ¨ä¸åŒè€•ä½œå¹´é™å†œç”°åœŸå£¤æœ‰æœºç¢³å¯†åº¦åŠå ¶å½±å“å› ç´ .

Understanding the changes and influencing factors of soil organic carbon density (SOCD) during the conversion of uncultivated natural soil to croplands is of great significance for the assessment of carbon sequestration in arid areas. In this study, we compared SOCD in the uncultivated soil and that in croplands with different cultivation years (2-5, 12-15, 25-30, 40-50 years) in the Northeastern Ulan Buh Desert. The change of SOCD and its influencing factors at 0-2 m soil depth during the conversion of uncultivated natural soil to croplands were explored by the method of replacing time with space. The results showed that SOCD at the shallow soil depth (0-0.4 m) in croplands increased continuously with cultivation years, but basically at low levels (0.990-1.983 kg·m-2). The SOCD at deep soil (1.2-2 m) increased in the croplands with longer cultivation years (25-30 and 40-50 years), whereas no obvious change trends in both the croplands with shorter cultivation years (2-5 and 12-15 years) and the uncultivated natural soil. The SOCD at deep soil (1.2-2 m) were relatively large (28.9%-38.6%) of the 0-2 m soil depth of uncultivated natural soil and croplands with different cultivation years. The vertical distribution of SOCD in croplands with different cultivation years were well fitted by quadratic functions (with R2 ranging from 0.757 to 0.972). It was noteworthy that soil clay and silt contents had dominant influences on SOCD at all the soil profile (0-2 m), and that cultivation years mainly contributed to the accumulation of SOC at the shallow soil (0-0.4 m).

[Congenital syphillis presenting congenital nephrotic syndrome in two children and related data review].

OBJECTIVE: To study the clinical features of congenital syphillis presenting congenital nephrotic syndrome (CNS) in children. METHODS: Two cases diagnosed as congenital syphillis presenting CNS in our hospital were retrospectively analyzed and related data reviewed. RESULTS: The two children had edema, gross proteinuria, haematuria, hepatosplenomegaly, abdominal distention and anaema. Rapid plasmin regain (RPR) and treponema palidum hemagglutination assay (TPHA) were all positive. One chiild was also had renal biopsy and showed membraous nephropathy. Adequate penicillin therapy got satisfatory effects without steroid treatment. CONCLUSION: For children with early occurrence of proteinuria, edema accompanied by anaema, and hepatosplenomegaly, we should conside the possibility of syphillis nephropathy, which should be treated with enough dosage of penicillin in instead of steroid. Early diagnosis and treatmen could get complete recovery of CNS.

Spectrum of thrombotic complications and their outcomes in Chinese children with primary nephrotic syndrome.

BACKGROUND: Thromboembolism is a life-threatening, limb-threatening or organ-threatening complication that occurs in patients with primary nephrotic syndrome (NS). There are few studies on the spectrum, complications and outcomes of thrombosis in children with NS. This study aimed to determine the spectrum of thrombosis and its relationship with the nephrotic state, treatment and outcomes in children and adolescents with primary NS. METHODS: The medical records of subjects aged 1-18 years with NS complicated with thromboembolism treated at our centre within the last 26 years were retrieved. Data on the status of NS, site, symptoms and signs, laboratory investigations, diagnosis, treatment, complications and outcomes of thrombosis were collected and reviewed retrospectively. A severe complication was defined as a condition associated with thrombosis requiring a special diagnostic modality to confirm or a specific treatment such as surgical intervention. The outcome of thrombosis was defined as the status of thrombosis, as determined by imaging methods and the functional status with respect to the anatomic sites of thrombosis at the last follow-up. The permanent dysfunction of an organ or limb related to thrombosis was defined as a sequela. RESULTS: We observed thrombosis in 1.4% (27/1995) of subjects with NS during the study period. There were 27 subjects with thrombosis, including 21 males and 6 females. Thrombosis was observed in 51.9% (14/27) of the study participants with steroid resistant NS. Most episodes of thrombosis occurred during the active stage of NS; however, 7.4% of thrombosis cases occurred during the remission of proteinuria. Renal vein thrombosis (33.3%) and pulmonary embolism (25.9%) were the most common types of thrombosis. Among the 17 subjects biopsied, minimal change disease and membranous nephropathy were the two most common findings. Six (22.2%) subjects experienced severe complications or sequelae; 1 had persistent intracranial hypertension, 1 had intestinal perforation, 1 had hypoxemia and pulmonary hypertension, 1 had lameness, 1 had epilepsy, and 1 had an askew mouth due to facial paralysis. In 19 (70.4%) subjects, the symptoms resolved completely or improved without severe complications or sequelae. CONCLUSIONS: Thrombosis mostly occurred in males of school age during the active stage of NS. Renal vein thrombosis and pulmonary embolism were the most common types of thrombosis. In most patients with thrombosis, the symptoms improved completely without complications with standard anticoagulation therapy. However, 22.2% had severe complications or sequelae requiring an advanced diagnostic modality and aggressive treatment.

[Sap flow of Amorpha fruticosa in the secondary saline-alkali land in Ningxia Yellow River irrigation area, China.] / 宁夏引黄灌区次生盐碱地紫穗槐茎干液流分析.

From May to October in 2017, the sap flow, water consumption and the effects of environmental factors on the sap flow of Amorpha fruticosas with different stem diameters under different water and salt conditions were examined with the packaged sap flow measuring system in a secondary saline-alkali land of Ningxia Yellow River irrigation area. The sap flow rate showed a broad peak curve with no obvious phenomenon of 'midday break' in sunny days and a multi-peak curve in cloudy, overcast and rainy days. Weak sap flow was found at night. In the growing season (May - October), total sap flow of A. fruticosas with basal stem diameters of 13, 16 and 22 mm were 138.14, 206.06, 370.11 kg, respectively. The water consumption was largest in June and July, accounting for about 50% of the whole growing season, followed by May and August, and lowest in September and October. At both 0.5 h and day scales, photosynthetically active radiation (PAR) was the dominant meteorological factor affecting the sap flow. In the first growth stage (May 13th - August 19th), soil water in shallow layer (0-40 cm) had significant effect on the sap flow of A. fruticosas with three different diameters, and soil salt in shallow layer had significant inhibitory effect only on A. fruticosa with the diameter of 13 mm. In the second growth stage (August 20th - October 10th), soil water and soil salt had no significant effect on A. fruticosas with three different diameters. In summary, the A. fruticosas with diameters <13 mm was not suitable for planting in saline soil (electrical conductivity (EC)>2 dS·m-1), and individuals with diameters >16 mm could grow well in saline soil (EC=5 dS·m-1). Moreover, reasonable irrigation should be carried out in the vigorous growth stage of the A. fruticosas.

Clinical characteristics and WT1 genetic analysis of patients with steroid resistant nephrotic syndrome accompanied with genitourinary malformations.

OBJECTIVE: To understand WT1 mutations in patients with steroid resistant nephrotic syndrome (SRNS) accompanied with genitourinary malformations. METHODS: Three cases of SRNS accompanied with genitourinary malformations were enrolled. The expression of podocyte molecules (nephrin, podocin, alpha-actinin-4, WT1, and CD2AP) in 2 cases was analyzed with the immunofluorescence and immunohistochemistry techniques. The genomic DNA and cDNA of WT1 were analyzed by using PCR and RT-PCR, respectively. GeneScan and GeneScan software were used to quantify the ratio of +KTS/-KTS isoforms. RESULTS: The onset ages of 3 cases were 6 months, 1 year, and 10 years old, respectively. The diagnosis age was 7 months, 9 years, and 15 years old, respectively. The phenotype of Case 1 and Case 3 was male accompanied with genitourinary malformations. Case 2 was phenotypic female. Karyotype analysis of 3 cases revealed 46, XY. Three cases were diagnosed as SRNS. Focal segmental glomerulosclerosis (FSGS) was confirmed in 2 cases. Podocyte molecular expression altered in renal tissues of 2 cases. In addition, WT1 staining was negative in Case 1. WT1 expression in Case 2 showed diffuse nuclear staining with less obvious speckles compared with controls. WT1 IVS 9 +5 G>A mutation was detected in Case 2 and WT1 Exon 9 1186 G>A mutation was detected in Case 3. No WT1 mutation was detected in Case 1. CONCLUSION: Karyotype analysis and WT1 genetic testing should be done in all female patients with early onset steroid resistant FSGS and in male patients with SRNS accompanied with genitourinary malformations. Abnormal podocyte molecular expression suggests that more podocyte molecules might be involved in the pathogenesis of proteinuria in WT1 mutational patients.

[Retrospective clinical features and renal pathological analysis of 15 children with anti-neutrophil cytoplasmic antibody-associated vasculitis].

OBJECTIVE: Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis is a disorder with poor prognosis. This study aimed to improve the diagnosis and treatment of ANCA associated vasculitis of children, to analyze the clinical features, pathological characteristics and the prognosis of children with ANCA-associated vasculitis. METHOD: Fifteen children with ANCA associated vasculitis who were hospitalized from 2003 to 2012 in our hospital were included. Their data of pre-diagnosis status, clinical manifestations, renal pathology, treatment and prognosis were reviewed retrospectively. RESULT: Of the 15 children, 11 were girls and 4 boys with a mean age of 10.7 years. Fourteen children were categorized as microscopic polyangitis. The time to diagnosis varied from 0.5 month to 40 months. Hematuria and proteinuria were revealed by urine analysis in all of them, only 6 children complained with gross hematuria or edema of oliguria. Decreased glomerular filtration rate was revealed in 13 children, 8 of whom had a creatinine clearance rate of less than 15 ml/(min·1.73 m(2)). Twelve children underwent renal biopsy, crescent formation was found in 11 children. Most of the crescents were cellular fibrous crescents or fibrous crescents. Six children were diagnosed as crescentic nephritis; the process of rapidly progressive nephritis was only observed in 2 children. Segmental glomerulosclerosis or global glomerulosclerosis were found in 10 children, 3 of them were diagnosed as sclerotic glomerulonephritis. Anemia and pulmonary injury were the most common extra renal manifestations. Other extra renal manifestations included rash, pain joint, gastrointestinal symptoms, abnormal findings of cardiac ultrasonography and headache. Eight children were treated with steroid combined with cyclophosphamide, 4 were treated with steroid and mycophenolate mofetil, 2 were treated with steroid, cyclophosphamide and mycophenolate mofetil, 3 children were treated with plasma exchange. Fourteen children were followed up for 0.5 month to 4 years. The renal function did not recover in children with creatinine clearance rate of less than 30 ml/(min·1.73 m(2)), who showed crescentic glomerulonephritis or sclerotic glomerulonephritis. The children who had creatinine clearance rate of more than 30 ml/(min·1.73 m(2))had better prognosis. CONCLUSION: More attention should be paid to ANCA-associated vasculitis among school age girls with anemia or pulmonary diseases. The renal damage was serious in children; however, the clinical manifestations were not obvious. Children with a creatinine clearance rate of less than 30 ml/(min·1.73 m(2)) had poor prognosis. Early accurate diagnosis is very important.

[Evaluation on the eco-economic benefits of small watershed in Beijing mountainous area: a case of Yanqi River watershed].

Based on the theory of harmonious development of ecological economy, a total of 13 evaluation indices were selected from the ecological, economic, and social sub-systems of Yanqi River watershed in Huairou District of Beijing. The selected evaluation indices were normalized by using trapezoid functions, and the weights of the evaluation indices were determined by analytic hierarchy process. Then, the eco-economic benefits of the watershed were evaluated with weighted composite index method. From 2004 to 2011, the ecological, economic, and social benefits of Yanqi River watershed all had somewhat increase, among which, ecological benefit increased most, with the value changed from 0.210 in 2004 to 0.255 in 2011 and an increment of 21.5%. The eco-economic benefits of the watershed increased from 0.734 in 2004 to 0.840 in 2011, with an increment of 14.2%. At present, the watershed reached the stage of advanced ecosystem, being in beneficial circulation and harmonious development of ecology, economy, and society.

[Characteristics of pediatric C3 glomerulopathy with decreased factor H in 3 cases].

OBJECTIVE: To study the characteristics of clinicopathology and prognosis of 3 pediatric cases diagnosed as C3 glomerulopathy, and to improve the understanding of C3 glomerulopathy in children. METHOD: The medical record, plasma complement C3, Factor H (FH) and its autoantibody, and therapeutic response of the 3 cases were analyzed, and their prognosis were followed up. RESULT: Of the 3 cases, 2 were male and 1 was female, the age of onset was 9 years, 12 years, 5 years 4 months, the duration from onset to renal biopsy was 3 months, 7 months and 20 days, and the follow-up period were 2.6 years, 8 months and 1.5 years respectively. CLINICAL MANIFESTATIONS: All the 3 cases showed microscopic hematuria, with or without gross hematuria and proteinuria. Two showed persistently decreased plasma complement C3, in the other one C3 was in normal lower limit, all presented with decreased FH concertration, in 1 case anti-FH antibody was positive. Their clinical diagnosis was post-streptococcal glomerulonephritis, nephrotic syndrome (NS) nephritis type, and mesangial proliferative glomerulonephritis respectively. PATHOLOGICAL FINDINGS: All showed evident deposition of C3 on glomerular basement membrance (GBM) and mesangial region by immunofluorescence (IF) and electron dense deposit in GBM, mesangial region or para-mesangial region by Electron microscopic (EM) examination Treatment and prognosis: The case with NS showed no response to steroid, so steroid was gradually stopped after renal biopsy and replaced by angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor antagonist (ARB). The other two cases were treated with ACEI and renal protective treatment. Of the 3 cases, one gradually showed elevated serum creatinine (Scr) and decreased creatinine clearance rate (Ccr), the other two were normal, but slightly increased indications for early kidney injury. CONCLUSION: C3 glomerulopathy is characterized by evident C3 deposition under IF. Its clinical and pathological manifestations vary a lot. The decreased plasma C3 and FH suggest that the abnormal regulation of complement system play an importment role in its pathogenesis.

[Characteristics of repeated renal biopsy-proven primary focal segmental glomerulosclerosis in children].

OBJECTIVE: To analyze the characteristics of repeated renal biopsy-proven primary focal segmental glomerulosclerosis (PFSGS) in 8 children, and to reveal the relationship between clinical features and pathology, between the two times of renal biopsy pathology, and the indications for repeated renal biopsy. METHOD: The records of cases who ever experienced renal biopsy in this hospital were reviewed, of whom 8 cases of repeated renal biopsy-proven PFSGS were enrolled. The clinical manifestations, the reason why they had renal biopsy again, the difference in renal pathological findings, between the two biopsies and their therapeutic response. The classification of focal segmental glomerulosclerosis (FSGS) was based on the new criteria suggested by D'Agati in 2004. RESULT: Of the 8 cases, age of onset ranged from 1 to 12 years, all were diagnosed as nephrotic syndrome (NS), the age of first biopsy ranged from 1.1 to 15.0 years, and the follow-up period was 10 months to 14 years. The reason for repeated biopsy was poor therapeutic response, continuous heavy proteinuria, or the progressive renal dysfunction. Four cases had the both biopsies in this hospital, and the first renal pathology showed minimal change disease (MCD), mesangial proliferation, FSGS CELL type and FSGS GTL type. After the second biopsy, they were additionally treated with immunosuppressive agents or switched to another one, 2 cases with FSGS COLL type presented renal dysfunction or end stage renal disease (ESRD), 1 case who developed the disease at 1.4 years of age, presented renal dysfunction at 10 months follow-up. The remaining 5 cases acquired complete remission. CONCLUSION: FSGS is a clinicopathological syndrome, NS predominates clinically. It often indicates pathologic transformation when the patients show poor therapeutic response or continuous heavy proteinuria without remission. Mesangial proliferation can convert into FSGS, and the subtype of FSGS can shift. FSGS COLL type and onset at young age may suggest poor prognosis.

[Clinicopathological feature and treatment of idiopathic membranous nephropathy in children].

OBJECTIVE: To investigate the clinicopathological feature and treatment of idiopathic membranous nephropathy (IMN) in children. METHOD: A retrospective analysis of 25 cases of biopsy-proven IMN seen between January 2004 and December 2009. RESULT: The incidence of IMN was 3.81% in all the children patients who underwent renal biopsy. Of 25 patients with IMN, nine were boys and sixteen were girls. The mean age at onset was (9.4 ± 3.4) years with a range of 2 - 14 years. Renal biopsies were performed at a median 2.5 months (range 0.4 - 11 months) after onset. The clinical manifestations included nephrotic syndrome (NS) nephritic type in 21 cases (84%) and glomerulonephritis in 4 cases. All patients presented with hematuria, and 7 had macroscopic hematuria. Hypertension was noted in 4 patients. Two patients were complicated with thrombosis. One patient was in a chronic renal insufficiency(CRI)state. According to the MN staging criteria, 21 cases were in stage II IMN (84%). Six patients showed moderate or severe tubulointerstitial lesion. Focal segmental glomerulosclerosis (FSGS) was found in two patients. Of the 22 patients with NS and nephrotic proteinuria, 21 cases were treated with prednisone initially and in 20 of them the efficacy of corticosteroid therapy was evaluated:one of them was steroid sensitive (became steroid-resistant after relapse) and all the others were steroid-resistant (95%). The subsequent treatment: eight of them were treated with prednisone followed by a taper to alternate-day therapy. Five of them had complete remission and three partial remission. Twelve cases were treated with combined therapy of prednisone and immunosuppressive agents. Of these 12 cases together with one case who received initially combined treatment with prednisone and immunosuppressive agent and one case treated with prednisone initially for five weeks then with combined therapy contained another immunosuppressive agent, totally 14 cases, 5 had complete remission, 2 partial remission, 3 did not achieve remission, and 3 had unknown response. CONCLUSION: Of the patient cohort, the predominant presenting feature was nephrotic syndrome, and with different degree hematuria. Almost all of them were steroid resistant, but followed by a taper to alternate-day therapy, some could achieve remission. The effect of a combination of prednisone and immunosuppressive agent is needed to be further proven in children.

[Clinical analysis of acute kidney injury in children with renal diseases].

OBJECTIVE: Acute kidney injury (AKI) was recently proposed for early recognition of renal function impairment and prompt interventions. Previous study revealed that AKI was highly associated with the prognosis. However, there was rare report of AKI in renal diseases, especially in children cohorts. Therefore, we performed the prospective clinical research in children with renal diseases in our hospital, aiming to study the prevalence, the clinical characteristics and the short-term prognosis of AKI. METHOD: The study was designed as a prospective, single-center observational study. INCLUSION CRITERIA: (1) the primary diagnosis was primary nephrotic syndrome (NS), Henoch-Schoenlein purpura nephritis (HSPN) or lupus nephritis (LN), (2) the duration from the onset of the renal diseases to the admission was less than 3 months. The serum creatinine and urine output of the subjects would be prospectively monitored. AKI was defined by the adult criteria and stratified by Acute Kidney Injury Network (AKIN) criteria. The patients were followed up at 6 months and 12 months after enrollment. RESULT: Between October 2007 and April 2009, a total of 95 children were included, including 65 cases with NS, 15 HSPN and 15 LN. Mean age was (8.9 ± 3.9) years (range 2 - 16 years). Thirty-three of the 95 patients (34.7%) fulfilled the AKI criteria, 13 patients (13.7%) were diagnosed as acute renal failure (ARF). All the AKI in children with LN and HSPN presented with serum creatinine elevation. However, 65.4% of AKI in NS presented with decreasing urine output, only 19.2% accompanied with increasing creatinine, with higher stages of urine output. Regarding the etiology, only 26.9% of AKI in NS had definite cause, most of which resulted from side-effect of cyclosporine, hypovolemia or tubule-interstitial damage, independent of glomerular diseases. In contrast, the AKI in LN and HSPN were exclusively caused by glomerular diseases. The length and costs of hospitalization of AKI group were significantly higher than non-AKI [length of hospitalization (d), 28(6 to 94) vs. 21(7 to 100), Z = -1.971, P = 0.049; cost of hospitalization (yuan), 12 035.7 (1561.7 to 94 783.1) vs. 8594.3 (1390.1 to 98 876.5), Z = -1.993, P = 0.046]. There was no significant difference in the serum creatinine at 6-month and 12-month follow-up between AKI group and non-AKI [6-month, (60.4 ± 91.8) µmol/L vs. (42.8 ± 12.2) µmol/L, t = 0.937, P = 0.358; 12-month, (48.7 ± 18.1) µmol/L vs. (47.7 ± 14.2) µmol/L, t = 0.197, P = 0.845]. CONCLUSION: The prevalence of AKI (34.7%) was higher than that of ARF (13.7%) in children with renal diseases. Most of the AKI in NS resulted from non-glomerular diseases. In contrast, most AKI in LN and HSPN were caused by underlying glomerular diseases. The length and costs of hospitalization were significantly higher in AKI group. However, there was no significant difference in serum creatinine between AKI and non-AKI group in the follow-up at 6 months and 12 months. Further investigations on criteria for the diagnosis of AKI in children with renal diseases are still needed.