Medullary sponge kidney with IgA nephropathy: a case report and literature review.

BACKGROUND: Medullary sponge kidney (MSK)is rare in association with glomerulonephritis. We report a patient with medullary sponge kidney, and the kidney biopsy revealed a diagnosis of IgA nephropathy. CASE PRESENTATION: A 27-year-old female presented with hematuria and proteinuria, and imaging studies indicated the presence of medullary spongy kidney. With appropriate preparation, a kidney biopsy was performed. Considering the patient's clinical and pathological characteristics, the final diagnosis was determined to be medullary sponge kidney associated by IgA nephropathy. The combination of corticosteroids and angiotensin receptor blockers (ARBs) proved to be significantly effective in reducing proteinuria in the current case. To the best of our knowledge, this is the first reported case that demonstrates the coexistence of MSK and IgA nephropathy. CONCLUSIONS: Administering precise therapy based on renal pathology can potentially enhance outcomes for patients with renal conditions, necessitating the need for clinicians to be vigilant about differential diagnosis in order to reduce the rates of missed diagnoses and misdiagnosis.

[Warming acupuncture combined with moxibustion at Yongquan (KI 1) for knee osteoarthritis with kidney-marrow deficiency: a randomized controlled trial].

OBJECTIVE: To compare the clinical effect between warming acupuncture combined with moxibustion at Yongquan (KI 1) and simple warming acupuncture for knee osteoarthritis with kidney-marrow deficiency. METHODS: A total of 66 patients of knee osteoarthritis with kidney-marrow deficiency were randomized into an observation group and a control group, 33 cases in each one. Warming acupuncture was applied at Neixiyan (EX-LE 4), Dubi (ST 35), Zusanli (ST 36) and Xuanzhong (GB 39) on the affected side in both of the groups. In the observation group, mild moxibustion at bilateral Yongquan (KI 1) was adopted additionally. Each treatment lasted for 30 min, 3 times a week (once every other day), and the consecutive 6 weeks of treatment were required. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score (such as joint pain, stiffness and physical function), the amount of joint effusion and the serum contents of interleukin-1ß(IL-1ß), tumor necrosis factor-α (TNF-α) and high-sensitivity C-reactive protein (hs-CRP) were observed before and after treatment in the two groups. RESULTS: The total effective rate in the observation group was 93.3% (28/30), which was superior to 87.1% (27/30) in the control group (P<0.05). Compared before treatment, the pain scores, stiffness scores, physical function scores, the amount of joint effusion and the contents of IL-1ß, TNF-α and hs-CRP after treatment were significantly reduced in the two groups (P<0.05), and the improvements of these indices in the observation group were superior to the control group (P<0.05). CONCLUSION: Warming acupuncture combined with moxibustion at Yongquan (KI 1) can improve joint function, reduce the amount of joint effusion and the contents of inflammatory response indices for knee osteoarthritis with kidney-marrow deficiency. The therapeutic effect of warming acupuncture combined with moxibustion at Yongquan (KI 1) is better than simple warming acupuncture.

Soluble monosodium urate, but not its crystal, induces toll like receptor 4-dependent immune activation in renal mesangial cells.

BACKGROUND: Uric acid has emerged as a novel and potential modifiable risk factor for the incidence and progression of kidney diseases, however, the deteriorate effect of uric acid on renal mesangial cells remains unclear. The present study is to examine the immune activation of soluble and crystal forms of uric acid in human mesangial cells. METHODS: We stimulated primary human mesangial cells (HMCs) with increasing concentrations (from 50 to 200 µg/ml) of soluble monosodium urate (MSU) or MSU crystals. We examined interleukin (IL)-1ß protein expression levels in cell culture by ELISA. The stimulated HMCs were further stimulated with soluble MSU or MSU crystals at 200 µg/ml with or without the pre-incubation of toll like receptor (TLR) 4 inhibitor TAK242 (1µM). TLR4, nod-like receptor protein (NLRP3, also known as NALP3), IL-1ß, human leukocyte antigen (HLA)-DR and CD40 were examined by Realtime-PCR, Western blot and ELISA, respectively. RESULTS: We found that both soluble MSU and MSU crystals increased IL-1ß protein expression levels in dose-dependent fashion. Soluble MSU significantly enhanced the expression of TLR4, NLRP3, IL-1ß, HLA-DR and CD40 while MSU crystals only upregulated the expression of TLR4 and IL-1ß. TLR4 inhibitor TAK242 significantly blocked the up-regulation of NLRP3, IL-1ß, HLA-DR and CD40 induced by soluble MSU while no TAK242 suppression effect on MSU crystals induced IL-1ß up-regulation was found. CONCLUSIONS: Our results suggested that soluble MSU, but not MSU crystals, induce NLRP3, IL-1ß, HLA-DR and CD40 upregulation in a TLR4-dependent manner. These findings indicate that soluble MSU may play a pathological role in hyperuricemia induced renal mesangial injury.