ABSTRACT
Objective:To summarize and analyze the clinical features and risk factors of acute focal bacterial nephritis (AFBN) in children.Methods:It was a retrospective cohort study. The clinical data of patients diagnosed with upper urinary tract infection in Children's Hospital Affiliated to Capital Institute of Pediatrics from July 1, 2016 to July 31, 2021 were collected, and the patients all received abdominal enhanced CT examination. According to the imaging examination results, the patients were divided into AFBN group and acute pyelonephritis (APN) group, and the clinical manifestations, laboratory and imaging examination between the two groups were compared. Logistic regression model and receiver operating characteristic curve were used to analyze the risk factors of AFBN.Results:A total of 135 patients with upper urinary tract infection were enrolled in this study, with age of 2.5 (0.5, 3.7) years old, and 68 males (50.4%). There were 67 patients (49.6%) in AFBN group and 68 patients (50.4%) in APN group. There were statistically significant differences in the highest fever temperature, duration of fever after treatment, proportion of lower urinary tract irritation symptoms, proportion of urinary tract malformation or abnormality, white blood cell count, neutrophil count, procalcitonin, C-reactive protein, proportion of pyuria, urinary β2 microglobulin and proportion of using carbapenem antibiotics between the two groups (all P<0.05). Multivariate logistic regression analysis result showed that urinary tract malformation/abnormality ( OR=3.34, 95% CI 1.23-9.10) and leukocytosis ( OR=1.25, 95% CI 1.03-1.51) were the independent risk factors of AFBN. Conclusions:The children with urinary tract infection who have high peak fever, long duration, obvious increase of inflammatory indexes and urinary β2 microglobulin may suggest AFBN. Urinary tract malformation/abnormality and high white blood cells are risk factors of AFBN.
ABSTRACT
Infection is the most common complication of nephrotic syndrome in children.Serious infection leads to poor prognosis, and always deteriorates rapidly, especially in the infection of pneumocystis jeroveci and varicella.For the long-term use of steroid and immunosuppressor, patients with infection always have atypical clinical symptoms and the correct diagnosis is liable to be delayed.Therefore, it′s important to be well aware of medical histories, physical signs and associated laboratory tests.Timely control of infection and protection of renal function are the main principles of treatment in the children with nephrotic syndrome and serious infection.Meanwhile, daily health management should be strengthened for the patients to prevent the occurrence of infection.
ABSTRACT
Objective@#To investigate the association between adherens junction proteins E-cadherin and β-catenin and tight junction protein claudin-2 and clinical symptoms in patients with diarrhea predominant irritable bowel syndrome (IBS-D).@*Methods@#Cecal biopsy tissues were collected from IBS-D patients (n=26) according to Rome Ⅲ criterion and healthy controls (n=26). The duration of symptoms, abdominal pain score and mean weekly bowel movements were recorded. Colorectal dilatation combined with restraint stress were applied to establish visceral hypersensitivity rat model. Abdominal contraction reflex (AWR) was applied to assess the visceral sensitivity in rats. The stool frequency within 1 hour was recorded after establishing the rat model. The expression of E-cadherin、β-catenin and claudin-2 were assessed by Western blot and immunofluorescence microscopy. Intercellular ultrastructure was observed by transmission electron microscopy.@*Results@#Compared with the healthy controls, the protein expression of E-cadherin and β-catenin in cecal epithelium in IBS-D patients were significantly lower (P=0.015 and P=0.005, respectively), while claudin-2 was significantly higher (P=0.000). Reduced E-cadherin and β-catenin expression was associated high abdominal pain score (r=-0.463, P=0.017 and r=-0.407, P=0.039). The lower expression of β-catenin was associated with longer duration of symptoms (r=-0.458, P=0.019). The protein expression of E-cadherin and ß-catenin in the cecal epithelium of the visceral hypersensitivity rats were significantly lower (P=0.004 and P=0.003, respectively), while claudin-2 was significantly higher (P=0.008). Reduced E-cadherin and ß-catenin expression was associated high visceral sensitivity in IBS-D rats (r=-0.639, P=0.047 and r=-0.888, P=0.001).@*Conclusions@#Intercellular ultrastructure alterations well as cecal β-catenin and E-cadherin protein expression decrease and are associated with high abdominal pain score in IBS-D patients and hypersensitivity rats. β-catenin is further associated with prolonged duration of symptoms in IBS-D patients. The expression of E-cadherin and β-catenin may play a vital role in visceral sensitivity and intestinal barrier dysfunction in IBS-D.
ABSTRACT
Objective:To explore the related factors of poor prognostis in children with Henoch-Sch?nlein purpura nephritis (HSPN), and provide reference for predicting and improving the prognosis of children with HSPN.Methods:The clinical and pathological data of children with HSPN hospitalized in the Department of Nephrology, Children's Hospital Affiliated to Capital Institute of Pediatrics from May 2007 to June 2019 were retrospectively reviewed. According to the prognosis, the patients were divided into complete remission group and persistent abnormal group.Results:(1) Among 108 cases, there were 73 males and 35 females, with the onset age ranging from 5 to 16 years and average age of (9.5±2.8) years. The interval time from the first clinic in our hospital to the last follow-up was 2-131 months, with average of 24.8 months. Renal involvement occurred in the course of Henoch-Sch?nlein purpura from 1 day to 51 months, and the renal biopsy time was 5 days to 60 months after renal involvement. (2) Hematuria with proteinuria type and nephrotic syndrome type were predominant, and there was no significant difference between the two groups. The proportion of gross hematuria in the persistent abnormal group were significantly higher than that in the complete remission group (52.6% vs 31.4%, χ2=4.659, P=0.031). There were significant differences in serum creatinine and urea between the two groups (both P<0.05). The proportion of hyperuricemia in the persistent abnormal group was higher than that in the complete remission group (39.5% vs 21.4%, χ2=3.998, P=0.046). After clinical treatment, though there was no significant difference in proteinuria between the two groups at the beginning of the disease, the negative transformation rate of proteinuria in the complete remission group was higher than that in the persistent abnormal group after 3 months (55.7% vs 34.2%, χ2=4.562, P=0.033). (3) According to International study of Kidney Disease in Children (ISKDC) pathology classification, 14 cases (36.8%), 21 cases (55.3%), 3 cases (7.9%) withⅡ, Ⅲ, Ⅳ level in the persistent abnormal group and 21 cases (30.0%), 49 cases (70.0%), 0 case with Ⅱ, Ⅲ, Ⅳ level (70.0%) in the complete remission group after (20.16±24.86) months of follow-up, and the difference between the two groups was not statisticcally significant ( Z=-0.135, P=0.892). According to the Oxford Classification of IgA nephropathy, 36(33.3%) children had tubule-interstitial lesions (T1, 26%-50% tubular atrophy or interstitial fibrosis), and the proportion in the persistent abnormal group was significantly higher than that in the complete remission group (50.0% vs 24.3%, Z=-2.695, P=0.007). (4) Compared with T0 (0-25% tubular atrophy or interstitial fibrosis), the incidence of gross hematuria and hyperuricemia in the T1 tubule-interstitial lesion were both higher than that (respectively 63.9% vs 27.8%, χ2=13.061, P<0.001; 38.9% vs 22.2%, χ2=3.983, P=0.046). (5) Multivariate logistic regression analysis showed that renal tubule-interstitial lesion was a risk factor for poor prognosis of HSPN ( OR=2.580, 95% CI 1.055-6.310, P=0.038). Conclusions:Renal tubule-interstitial lesion is a risk factor for the persistent abnormal of HSPN. Gross hematuria and hyperuricemia are related to tubule-interstitial lesions.
ABSTRACT
Objective:To investigate the association between adherens junction proteins E-cadherin and β-catenin and tight junction protein claudin-2 and clinical symptoms in patients with diarrhea predominant irritable bowel syndrome (IBS-D).Methods:Cecal biopsy tissues were collected from IBS-D patients ( n=26) according to Rome Ⅲ criterion and healthy controls ( n=26). The duration of symptoms, abdominal pain score and mean weekly bowel movements were recorded. Colorectal dilatation combined with restraint stress were applied to establish visceral hypersensitivity rat model. Abdominal contraction reflex (AWR) was applied to assess the visceral sensitivity in rats. The stool frequency within 1 hour was recorded after establishing the rat model. The expression of E-cadherin、β-catenin and claudin-2 were assessed by Western blot and immunofluorescence microscopy. Intercellular ultrastructure was observed by transmission electron microscopy. Results:Compared with the healthy controls, the protein expression of E-cadherin and β-catenin in cecal epithelium in IBS-D patients were significantly lower ( P=0.015 and P=0.005, respectively), while claudin-2 was significantly higher ( P=0.000). Reduced E-cadherin and β-catenin expression was associated high abdominal pain score ( r=-0.463, P=0.017 and r=-0.407, P=0.039). The lower expression of β-catenin was associated with longer duration of symptoms ( r=-0.458, P=0.019). The protein expression of E-cadherin and ?-catenin in the cecal epithelium of the visceral hypersensitivity rats were significantly lower ( P=0.004 and P=0.003, respectively), while claudin-2 was significantly higher ( P=0.008). Reduced E-cadherin and ?-catenin expression was associated high visceral sensitivity in IBS-D rats ( r=-0.639, P=0.047 and r=-0.888, P=0.001). Conclusions:Intercellular ultrastructure alterations well as cecal β-catenin and E-cadherin protein expression decrease and are associated with high abdominal pain score in IBS-D patients and hypersensitivity rats. β-catenin is further associated with prolonged duration of symptoms in IBS-D patients. The expression of E-cadherin and β-catenin may play a vital role in visceral sensitivity and intestinal barrier dysfunction in IBS-D.
ABSTRACT
Objective:To investigate the changes of distribution and antimicrobial resistance of pathogens in children with urinary tract infection in a single center in Beijing, and to provide references for the rational use of antibio-tics agent in clinical practice.Methods:The clinical data as well as urine culture and drug sensitivity results of children with urinary tract infection treated in the Department of Nephrology, Children′s Hospital Affiliated to Capital Institute of Pediatrics from January 2013 to May 2018 were retrospectively analyzed.According to the time of onset, the patients were divided into 2 groups, namely the 2013 to 2015 group and the 2016 to 2018 group.SPSS 17.0 software was used for statistical analysis of clinical data.Results:Among the 744 pathogenic bacteria isolated, the most common type was Gram-negative bacteria (59.4%, 442/744 strains), and the proportion of Escherichia coli ( E.coli) was the highest (39.4%, 293/744 strains). Gram-positive bacteria were the second most common (36.8%, 274/744 strains), among which, Enterococcus faecium (21.8%, 162/744 strains) accounted for the largest proportion (3.8%, 28/744 strains). Fungi were the least common type of pathogenic bacteria (3.8%, 28/744 strains). In Gram-negative bacteria, E.coli was highly resistant to Ampicillin (87.6%, 255/291 strains), but less resistant to Piperacillin/Tazobactam (12.7%, 37/291 strains). By comparing the overall distribution of Gram-positive, Gram-negative and common pathogenic bacteria in 2013 to 2015 and 2016 to 2018, the infection rate of Gram-negative bacteria (63.8%, 55.5%)was always higher than that of Gram-positive bacteria(33.1%, 40.2%), but the infection rate of Gram-positive bacteria has shown an upward trend in recent years, and the differences were statistically significant ( χ2=4.080, P<0.05). Conclusions:The main pathogenic bacteria of urinary tract infection in children are Gram-negative bacteria, and E.coli is the most common causative bacteria.However, the infection rate of Gram-positive bacteria has been increasing in recent years. E.coli is highly sensitive to Piperacillin and Tazobactam, which can be used as the adequate selection for treating urinary tract infection in children. E.coli is highly resistant to the first and the second-generation cephalosporin antibiotics, but sensitive to the third-generation cephalosporin antibiotics, such as Cefotetan.
ABSTRACT
Objective:To investigate the features and advantages of ambulatory blood pressure monitoring (ABPM) applied in children with kidney diseases as well as the correlation between ambulatory blood pressure and clinical indicators.Methods:The clinical data of children with kidney diseases who were hospitalized and received ABPM in Children′s Hospital Affiliated to Capital Institute of Pediatrics from March 2012 to March 2018 were collected.Clinical blood pressure and ABPM indicators were analyzed and compared between different clinical groups.Results:(1) Among 170 cases enrolled, 69 cases (40.6%) were hypertension by measuring clinical blood pressure, 54 cases (31.8%) were ambulatory hypertension, 43 cases (25.3%) of whom had severe ambulatory hypertension, 17 cases (10.0%) had white coat hypertension, 41 cases (24.1%) were defined as masked hypertension, and 139 cases (81.8%) had impaired circadian rhythm of blood pressure.(2) Ninety-five point nine percent (163/170 cases) were detected of abnormal blood pressure by ABPM, and the rate was significantly higher than that detected by clinical blood pressure (40.6%, 69/170 cases) ( χ2=149.176, P<0.001). In the 40 cases who were administrated with antihypertensive drugs, 95.0%(38 cases) were detected to have anomalous blood pressure by ABPM, significantly more than that detected by clinical blood pressure(42.5%, 17/40 cases)( χ2=10.208, P=0.001). (3) Logistic regression analysis indicated that a prolonged clinical course of more than 3 months, obesity and nephrotic-range proteinuria were the risk factors of ambulatory hypertension, and the odd ratios were 5.345, 3.530 and 6.560, respectively.Circadian rhythm disorders of blood pressure were more common in the children with abnormal renal function than in those with normal renal function[89.7%(52/58 cases) vs.75.9%(85/112 cases)], and the difference was statistically significant ( χ2=4.626, P=0.031). Conclusions:Children with kidney diseases have a high incidence of hypertension.ABPM plays a key role in detecting hypertension and recognizing white coat hypertension.Nephrotic-range proteinuria and obesity are risk factors for ambulance hypertension, and abnormal renal function is associated with nocturnal blood pressure disorders.
ABSTRACT
Objective@#To analyze the relationship of clinical manifestations and pathological characteristics of Henoch-Schönlein purpura nephritis combined with hyperuricemia in children.@*Methods@#A retrospective study was conducted in 50 children with Henoch-Schönlein purpura nephritis who hospitalized at Department of Nephrology, Affiliated Children′s Hospital, Capital Institute of Pediatrics from January 2014 to May 2018.The differences between the hyperuricemia group(19 cases)and the normal uric acid group(31 cases), were compared in age, sex, blood pressure, serum albumin, 24-hour urinary protein, serum creatinine, triglyceride, cholesterol, high density lipoprotein, low density lipoprotein, serum uric acid, estimated glomerular filtration rate, and renal pathological characteristics, and the short-term prognosis was analyzed.@*Results@#(1)The average urinary protein in the hyperuricemia group and the normal uric acid group was (91.67±90.37) mg/(kg·d) and (64.62±43.28) mg/(kg·d), respectively and the difference was statistically significant between the both groups(t=2.04, P=0.047); and the morbidity with massive proteinuria in hyperuricemia group and normal uric acid group was 18/19 cases(94.7%)and 17/31 cases(54.8%), respectively and the difference was statistically significant between the both groups(χ2=8.930, P=0.003). (2)In all cases, there were 4 cases of glomerular pathological grade Ⅱ, 43 cases of grade Ⅲ and 3 cases of grade Ⅳ.The pathological grading of hyperuricemia group and normal uric acid group was mainly grade Ⅲ, including 16/19 cases (84.2%) in hyperuricemia group and 27/31 cases (87.1%) in normal uric acid group, 4 cases of grade Ⅱ in normal uric acid group and 3 cases of grade Ⅳ in hyperuricemia group, the pathological grade of hyperuricemia group was relatively severe (χ2=7.358, P=0.025). There was no significant difference about the degree of global sclerosis and mesangial proliferation between hyperuricemia group and normal uric acid group(χ2=2.426, P=0.119, χ2=0.043, P=0.836, respectively); 7/19 cases (36.8%) had severe foot process lesions in hyperuricemia group, which was significantly higher than that in normal uric acid group [4/31 cases(12.9%)](χ2=3.934, P=0.047). In hyperuricemia group, tubulointerstitial lesions were found in 9/19 cases (47.4%) of (+ ) grade and 10/19 cases (52.6%) of (+ + ) grade, and 12/31 cases (38.7%) had normal tubulointerstitium in normal uric acid group, (+ )and (+ + )grade lesions were also less than those in the hyperuricemia group(χ2=10.694, P=0.005). The mean scores of tubular atrophy and interstitial fibrosis were significantly higher in hyperuricemia group than that in normal uric acid group(t=2.36, P=0.001). (3) The interval from renal biopsy to final visit was 10.0 months and 10.5 monthsin hyperuricemia group and normal uric acid group respectively (P=0.85). In hyperuricemia group, complete remission was found in 5/19 cases (26.3%), slight abnormality in 10/19 cases (52.6%), severe abnormality in 4/19 cases (21.1%). Howe-ver, in normal uric acid group, complete remission was found in 19/31 cases (61.3%), 10/31 cases (32.3%) of slight abnormalities and 2/31 cases (6.5%)of severe abnormalities.The non-remission cases in the hyperuricemia group were significantly higher than those in the normal uric acid group(χ2=7.878, P=0.042).@*Conclusions@#Urinary protein was higher in children with Henoch-Schönlein purpura nephritis complicated with hyperuricemia, the pathological of renal tubulointerstitium and glomerulus and the foot process change are more serious than those of patients with normal uric acid.Therefore, hyperuricemia may be used as a risk factor for poor prognosis.
ABSTRACT
Objective@#To summarize the treatment and prognosis of children with primary vesicoureteric reflux (PVUR) and the correlation between PVUR and urinary tract infections(UTI).@*Methods@#The children with PVUR (72 cases) who were hospitalized at the Department of Nephrology and Urology of Children′s Hospital Affiliated to Capital Institute of Pediatrics from June 2007 to April 2018 were selected, and the clinical manifestations were summarized.@*Results@#A total of 72 patients (52 boys, 20 girls) were involved, and the median age at diagnosis was 8 months, in which 44 cases (61.1%) were less than 1 year old.There were 55 cases with UTI onset (76.4%), 94.5%(52/55 cases) with recurrent UTI(twice or more than twice) and 2 cases (2.8%) ended with renal failure.Refluxes were unilateral in 34 patients and bilateral in 38 patients.There were 110 ureters, in which 74 reflux ureters (67.3%) were identified as low-grade (Ⅰ-Ⅲ) PVUR, and 36 reflux ureters(32.7%) were high-grade (Ⅳ-Ⅴ) PVUR.Forty patients received conservative treatment, and significant differences of the remission rate were observed between group Ⅰ-Ⅱ grade PVUR(72.2%, 13/18 cases) and group Ⅲ-Ⅴ grade PVUR(32.5%, 13/40 cases)(χ2=7.92, P=0.005). Twenty-two patients (35 reflux ureters) underwent surgical treatment, in which 31 ureters were cured, and the remission rate was 88.6%.Ten patients with refluxes grade Ⅲ or above had no improvement after medical treatment, but the reflux was completely relieved after surgical treatment.@*Conclusions@#Children with recurrent UTI, especially less than 1 year-old, should be considered with PVUR.The conservative treatment could be prior for the patients with Ⅰ-Ⅱ grade PVUR.The surgical treatment could be chosen for those patients who suffered from high-grade PVUR, bilateral reflux or failed conservative treatment, especially with recurrent UTI, and reflux nephropathy could be reduced then.
ABSTRACT
Objective To analyze the relationship of clinical manifestations and pathological characteristics of Henoch-Sch(o)nlein purpura nephritis combined with hyperuricemia in children.Methods A retrospective study was conducted in 50 children with Henoch-Sch(o)nlein purpura nephritis who hospitalized at Department of Nephrology,Affiliated Children's Hospital,Capital Institute of Pediatrics from January 2014 to May 2018.The differences between the hyperuricemia group(19 cases)and the normal uric acid group (31 cases),were compared in age,sex,blood pressure,serum albumin,24-hour urinary protein,serum creatinine,triglyceride,cholesterol,high density lipoprotein,low density lipoprotein,serum uric acid,estimated glomerular filtration rate,and renal pathological characteristics,and the short-term prognosis was analyzed.Results (1) The average urinary protein in the hyperuricemia group and the normal uric acid group was (91.67 ±90.37) mg/(kg · d) and (64.62 ±43.28) mg/(kg · d),respectively and the difference was statistically significant between the both groups(t =2.04,P =0.047);and the morbidity with massive proteinuria in hyperuricemia group and normal uric acid group was 18/19 cases (94.7％)and 17/31 cases (54.8％),respectively and the difference was statistically significant between the both groups (x2 =8.930,P =0.003).(2)In all cases,there were 4 cases of glomerular pathological grade Ⅱ,43 cases of grade Ⅲ and 3 cases of grade Ⅳ.The pathological grading of hyperuricemia group and normal uric acid group was mainly grade Ⅲ,including 16/19 cases (84.2％) in hyperuricemia group and 27/31 cases (87.1％) in normal uric acid group,4 cases of grade Ⅱ in normal uric acid group and 3 cases of grade Ⅳ in hyperuricemia group,the pathological grade of hyperuricemia group was relatively severe (x2 =7.358,P =0.025).There was no significant difference about the degree of global sclerosis and mesangial proliferation between hyperuricemia group and normal uric acid group(x2 =2.426,P =0.119,x2 =0.043,P =0.836,respectively);7/19 cases (36.8％) had severe foot process lesions in hyperuricemia group,which was significantly higher than that in normal uric acid group [4/31 cases(12.9％)] (x2 =3.934,P =0.047).In hyperuricemia group,tubulointerstitial lesions were found in 9/19 cases (47.4％) of (+) grade and 10/19 cases (52.6％) of (+ +) grade,and 12/31 cases (38.7％) had normal tubulointerstitium in normal uric acid group,(+) and (+ +) grade lesions were also less than those in the hyperuricemia group (x2 =10.694,P =0.005).The mean scores of tubular atrophy and interstitial fibrosis were significantly higher in hyperuricemia group than that in normal uric acid group(t =2.36,P =0.001).(3) The interval from renal biopsy to final visit was 10.0 months and 10.5 monthsin hyperuricemia group and normal uric acid group respectively (P =0.85).In hyperuricemia group,complete remission was found in 5/19 cases (26.3％),slight abnormality in 10/19 cases (52.6％),severe abnormality in 4/19 cases (21.1％).Howe-ver,in normal uric acid group,complete remission was found in 19/31 cases (61.3 ％),10/31 cases (32.3 ％) of slight abnormalities and 2/31 cases (6.5％)of severe abnormalities.The non-remission cases in the hyperuricemia group were significantly higher than those in the normal uric acid group (x2 =7.878,P =0.042).Conclusions Urinary protein was higher in children with Henoch-Sch(o)nlein purpura nephritis complicated with hyperuricemia,the pathological of renal tubulointerstitium and glomerulus and the foot process change are more serious than those of patients with normal uric acid.Therefore,hyperuricemia may be used as a risk factor for poor prognosis.
ABSTRACT
Objective@#To compare the efficacy and safety of mycophenolate mofetil versus cyclosporine A in treating children with primary refractory nephrotic syndrome.@*Methods@#Conducted a prospective randomized controlled clinical trial in 62 pediatric patients (including 44 boys and 18 girls), age ranged from 2.1 to 17.0 years; 32 cases presented with frequently relapsing nephrotic syndrome (FRNS) and 30 cases presented with steroid-resistant nephrotic syndrome (SRNS), who were admitted to department of Nephrology, Children's Hospital Affiliated to Capital Institute of Pediatrics from October 2013 to October 2015. The patients received either mycophenolate mofetil (20-30)mg/(kg·d) or cyclosporine A (3-5)mg/(kg·d) randomly, on the basis of prednisone treatment. Follow-up interview was conducted regularly for at least one year. Efficacy rate, relapse rate, time required for induction of remission, relapse-free period and prednisone dosage were compared between the two groups.@*Results@#(1) Renal histologic examination, which was available for 17 patients, revealed minimal change disease in 8 patients, mesangial proliferative glomerulonephritis (MsPGN) in five, membranous nephropathy in two, and focal segmental glomerulosclerosis (FSGS) in two. (2) Comparison of mycophenolate mofetil versus cyclosporine A in children with FRNS: There were 14 patients with FRNS in mycophenolate mofetil group and 18 patients with FRNS in cyclosporine A group respectively. The relapse rate (episodes/year) in cyclosporine A group was lower than that of mycophenolate mofetil group (1.0 (0.0, 1.0) vs. 1.0 (1.0, 3.0), Z=-2.405, P=0.016). The relapse-free period (months) in cyclosporine A group was longer than that of mycophenolate mofetil group (10.0 (5.7, 12.1) vs. 5.0 (1.0, 11.0), Z=-1.984, P=0.047). No significant difference in dosage of prednisone was found between cyclosporine A and mycophenolate mofetil groups when followed up for 1 year. (3) Comparison of mycophenolate mofetil versus cyclosporine A in children with SRNS: The efficacy rate was 6/14 in mycophenolate mofetil group and 13/16 in cyclosporine A group. The complete remission rate was 4/14 in mycophenolate mofetil group and 12/16 in cyclosporine A group (P<0.05). The time (months) required for induction of remission in cyclosporine A group was significantly shorter than that of mycophenolate mofetil group (1.0 (1.0, 2.0) vs. 3.0 (2.5, 4.0), Z=-2.529, P=0.011). No significant differences were found between the two groups with respect to relapse-free period and relapse rate. (4) Except that one patient developed hypertensive encephalopathy in cyclosporine A group, no other serious adverse events were recorded. There were no significant differences between two groups with respect to adverse events.@*Conclusion@#Our results indicated that both mycophenolate mofetil and cyclosporine A were effective in the treatment of children with refractory nephrotic syndrome. Cyclosporine A was superior to mycophenolate mofetil in preventing relapses in patients with FRNS and inducing complete remission in patients with SRNS. Although most patients were able to tolerate mycophenolate mofetil and cyclosporine A, but the toxicity and safety of cyclosporine A should be monitored closely.
ABSTRACT
Irritable bowel syndrome(IBS)is a common functional intestinal disease,and its etiology and pathogenesis are not completely clear. The pathogenesis of IBS involves disturbed gastrointestinal motility,gut hypersensitivity,intestinal inflammation,immune dysfunction and brain-gut axis abnormality. Cathepsin S(CTSS)is a proteolytic enzyme widely distributed in various cell lysosomes,and participates in a variety of pathophysiological processes. Recent studies have shown that CTSS may be involved in the pathogenesis of IBS. This article reviewed the advances in study on role of CTSS in IBS.
ABSTRACT
Objective To explore the activation of renin-angiotensin system (RAS),efficiency and safety of Captopril,and the predictor of therapeutic activity for Henoch-Sch(o)nlein purpura nephritis (HSPN) characterized by mild proteinuria.Methods A total of 71 children who were hospitalized in Children's Hospital Affiliated to Capital Institute of Pediatrics from July 2014 to January 2017 were involved,with the diagnosis of HSPN and the characteristic of mild proteinuria.The cases were divided into 2 groups,one as Captopril group,the other as case control group.The patients were followed up for 6 months.Forty healthy children were assigned as healthy control group.Blood pressure,urinary protein excretion,levels of urinary angiotensinogen (AGT) and transforming growth factor β1 (TGF-β1),and the side effects of Captopril were surveyed.The therapeutic effects of these groups were analyzed by Kaplan-Meier survival curve.Results (1) Clinical characteristics:in the 71 cases,43 cases were male,28 cases were female,aged from 3 years to 14 years and 7 months.A total of 32 cases (45.1％) had manifested with isolated proteinuria,39 cases (54.9％) were with hematuria and proteinuria.The volume of 24 hours' urinary protein was 4.2-23.5 mg/(m2 · h) [median 9.6(7,12) mg/(m2 · h)] at the beginning.(2) The level of urinary AGT:the levels of urinary AGT in the children with HSPN were significantly higher than those of the healthy control group(Z =-3.010,P =0.003).(3) Curative effect:there was no significant difference in age,disease staging,mean arterial pressure(MAP),levels of urinary of proteinuria and estimated glomerular filtration rate (eGFR) between the patients with or without Captopril.The proteinuria was relieved in 88.57％ cases of Captopril group(35 cases),and the proportion was 80.55％ in the case control group(36 cases),and there was no significant difference between the 2 groups.The levels of proteinuria were decreased significantly in the children of Captopfil group 2 months after the enrollment,and there was a statistical significance (Z =2.010,P =0.044).But in the patients of each group,the levels of urinary protein excretion (Z =-2.127,P=0.030;Z=-2.639,P=0.010),TGF-β1(Z=-2.126,P=0.030;Z=-2.058,P=0.040) at theonset were significantly higher in the children with persistent proteinuria compared to those with remission of proteinuria completely,and there was a statistical significance.(4)Side effect:among 35 cases with therapy of Captopril,4 cases (11.42％) were verified to have adverse reaction (hypotension,dry cough and abnormal renal function),with mild symptom.Conclusion The overall prognosis of children of HSPN presenting as mild proteinuria are not improved completely by Captopril.The occurrence of adverse effects for Captopril is seldom and less severe.The level of urinary protein excretion,TGF-31 and AGT at the onset have some relevance with the prognosis of the patients of HSPN.
ABSTRACT
Objective To analyze the pathogenesis,initially diagnosed symptoms and clinical manifestations of children with chronic kidney disease (CKD) at stage 2 to 5.Methods The data of 108 children who were hospitalized in Children's Hospital Affiliated to Capital Institute of Pediatrics from September 2007 to April 2016 with CKD stage 2 to 5 were retrospectively analyzed.The etiologies,clinical manifestations and examinations were summarized,and the clinical manifestations were compared between the congenital hereditary urinary diseases group and the acquired urinary diseases group.Results (1) In the 108 cases collected,66 cases were male,42 cases were female,aged from 3 months to 15 years and 1 month old.Twenty-four cases were diagnosed at stage 2,26 cases at stage 3,35 cases at stage 4,and 23 cases at stage 5.(2) Twenty-eight kinds of illness were involved in the cause of CKD.Among them,57 cases (52.8％) had congenital anomalies of the kidney and urinary tract,5 cases(4.6％) had hereditary kidney diseases,41 cases (38.0％) had other primary or secondary kidney diseases,and in 5 cases (4.6％) the causes of disease were unknown.(3) For the initially diagnosed symptoms,29 cases(26.9％) were due to complaints associated with kidney disease,36 cases (33.3％) were of other outside kidney symptoms,and 43 cases (39.8 ％) were of negative symptoms.The results of urinary ultrasound were abnormal in 79 cases(73.1％) and 87 cases(80.6％) showed abnormality in urinary analysis.There were 105 cases (97.2％) with abnormal manifestations either in urinary tract ultrasound or in urinary analysis.(4)The ages on diagnosis as CKD in children with congenital hereditary urinary diseases(5.89 years old) were younger than that of children with acquired urinary diseases (9.20 years old),and the difference was significant(Z =-3.434,P =0.001).The frequency of cases with short stature or lower-weight in group of congenital hereditary urinary diseases[66.1％ (41/622 cases),64.5％ (40/62 cases)] were significantly higher than those of the acquired urinary diseases group[43.9％ (18/41cases),43.9％ (18/41 cases)],and the differences were statistically significant(x2 =4.983,4.263,P =0.026,0.039).Conclusions The causes of CKD are complicated,and the congenital anomalies of kidney and urinary tract are the major causes of CKD at stage 2 to 5 in the cases.The initially diagnosed symptoms of CKD are insidious and atypical.The children with congenital hereditary urinary diseases tend to have more serious growth retardation.Urinary analysis and ultrasound may have an important significance for early diagnosis of CKD in children.
ABSTRACT
Objective To evaluate the efficacy of levofloxacin-based triple therapy and bismuthbased quadruple therapy in the treatment of Helicobacter pylori (Hp) infection as rescue regimens.Methods Related randomized controlled trials assessing the efficacy and safety of levofloxacin-based triple therapy eradicating Hp as salvage treatment were retrieved from Pubmed,Cochrane Library,SPRINGER,VIP database,WanFang database and CKNI database.The literature quality was evaluated by the improved Jadad criterion.RevMan5.3 sofeware was applied to data analysis.The mergment model was chosen on the basis of the outcome of the heterogeneity tests and original data was pooled for meta-analysis.Publication bias assessed with funnel plots.Results Ultimately seventeen literatures were included for meta-analysis,the analysis showed that the eradication rate of levofloxacin-based triple therapy was higher comparing to the bismuth-based quadruple therapy but the difference was not statistically significant (77.0％ vs 68.7％,OR =1.52,95％ CI 0.96-2.42,P =0.34).In European countries,levofloxacin-based triple therapy was more effective than quadruple therapy(80.6％ vs 68.5％,OR =2.18,95％ CI 1.25-3.81,P ＜ 0.05),while eradication rates of two groups in Asian countries were similar.The 7-day levofloxacin-based triple therapy and quadruple therapy showed comparable efficacy,whereas the 10-day levofloxacin-based triple therapy was significantly more effective than quadruple therapy (87.7％ vs 61.3％,OR =4.92,95％ CI 3.09-7.82,P ＜ 0.05).The efficacy was not influenced by the dose of levofloxacin.The adverse effects were significantly lesser(19.1％ vs 29.5％,OR =0.47,95％ CI 0.26-0.82,P ＜ 0.05),whereas the compliance rate was significantly higher in levofloxacin group (96.0％ vs 89.9％,OR =2.27,95％ CI 1.33-3.87,P ＜ 0.05).Conclusions Comparing with bismuth-based quadruple therapy,levofloxacinbased triple therapy has higher eradication rate,compliance rate and lesser side effects,so we recommend it as a second-line rescue therapy after front-line Hp eradication failure.The optimal second-line alternative scheme might differ among countries depending on quinolone resistance.
ABSTRACT
The efficacy of standard triple therapy for Helicobacter pylori (Hp) eradication has been significantly decreased, or even less than 80%.Abroad studies have shown that Hp eradication rate of sequential therapy is significantly higher than that of triple therapy.At home, we lack a large sample of data analysis to clarify the efficacy of sequential therapy.Aims: To systematically review the efficacy of sequential therapy and triple therapy in Hp eradication at home and abroad.Methods: PubMed, Medline, Embase, Cochrane Library, CNKI, Wanfang, VIP and CBMdisc were retrieved to collect the randomized controlled trials (RCT) comparing sequential therapy and triple therapy in the treatment of Hp infection in last 7 years.Article selection, data extraction and quality evaluation were conducted independently by two reviewers.Meta-analysis was conducted by RevMan 5.3 software.Results: A total of 31 RCT involving 8 371 subjects were included.Meta-analysis showed that Hp eradication rate of sequential therapy was significantly higher than that of triple therapy (83.3% vs.74.7%;RR=1.13, 95% CI: 1.09-1.16).Sixteen domestic studies showed that Hp eradication rate of sequential therapy was significantly higher than that of triple therapy (88.1% vs.78.0%;RR=1.13, 95% CI: 1.10-1.16), fifteen abroad studies showed that Hp eradication rate of sequential therapy was significantly higher than that of triple therapy (79.0% vs.71.8%;RR=1.13, 95% CI: 1.06-1.20).No significant difference in incidence of adverse reactions was found between sequential therapy and triple therapy (20.7% vs.22.0%;RR=0.94, 95% CI: 0.86-1.03).Conclusions: Sequential therapy achieves higher Hp eradication rate than standard triple therapy, and no significant difference in incidence of adverse reactions is found between sequential therapy and triple therapy.Hp eradication rate of sequential therapy is significantly higher than that of triple therapy and is higher than 80% in China, which can be recommended as a Hp eradication supplement of bismuth quadruple therapy.
ABSTRACT
Objective To analyze the clinical feature and prognosis of Henoch-Sch(o)nlein purpura nephritis (HSPN) with mild proteinuria in children.Methods The data of 78 HSPN children with mild proteinuria who were hospitalized in Children's Hospital Affiliated to Capital Institute of Pediatrics from September 2013 to September 2016 were retrospectively analyzed.All the cases were followed up.The clinical manifestation,histologic characteristics,treatment and outcome were analyzed,and the prognosis was compared between groups of different levels of proteinuria.Results (1) In the 78 cases,45 cases were male and 33 cases were female.The attack age range was from 3 years and 8 months to 14 years and 3 months,and the renal involvement occurred from 1 day to 60 months in courses of Hen(o)chSch(o)nlein purpura.(2)Twenty-seven cases were manifested with isolated proteinuria,and 51 cases were with hematuria and proteinuria.All the cases had normal kidney function while 2 cases had hypertension.Renal biopsy was performed in 9 cases,in which 6 cases were Ⅲ b,the other 3 cases were Ⅱ b.(3) Twelve cases were treated with regimen of immunosuppression and/or glucocorticoid.By the end of follow-up,the urinary analysis showed 46 cases (50.9％) had completely recovered,29 cases (37.2％)just had microscopic hematuria but no proteinuria,and 3 cases (3.8％) had obvious proteinuria.The renal involvement of 7 cases (9％) had been recurrent during the follow-up.(4) The time of recovery of proteinuria in the group with urinary protein ≤ 15 mg/kg(median:1 month) was less than that of the group with urinary protein ＞ 15 mg/kg(median:3 months),and the difference was significant (Z =-4.12,P =0.001),and 6 cases were found recurrent in the former group (10.9％) but 1 case(4.3％) in the latter group,and the difference was not significant (x2 =0.24,P =0.624).Conclusions The clinical characteristics of children with HSPN with mild proteinuria are not serious,and most of the cases had a favorable prognosis.However,some cases have protracted and recurrent courses which have serious pathological grade.So,urine analysis,long term follow-up,timely kidney biopsy and appropriate treatment are significant for HSPN with mild proteinuria.
ABSTRACT
Objective To analyze the clinical feature and prognosis of Henoch-Sch(o)nlein purpura nephritis (HSPN) with mild proteinuria in children.Methods The data of 78 HSPN children with mild proteinuria who were hospitalized in Children's Hospital Affiliated to Capital Institute of Pediatrics from September 2013 to September 2016 were retrospectively analyzed.All the cases were followed up.The clinical manifestation,histologic characteristics,treatment and outcome were analyzed,and the prognosis was compared between groups of different levels of proteinuria.Results (1) In the 78 cases,45 cases were male and 33 cases were female.The attack age range was from 3 years and 8 months to 14 years and 3 months,and the renal involvement occurred from 1 day to 60 months in courses of Hen(o)chSch(o)nlein purpura.(2)Twenty-seven cases were manifested with isolated proteinuria,and 51 cases were with hematuria and proteinuria.All the cases had normal kidney function while 2 cases had hypertension.Renal biopsy was performed in 9 cases,in which 6 cases were Ⅲ b,the other 3 cases were Ⅱ b.(3) Twelve cases were treated with regimen of immunosuppression and/or glucocorticoid.By the end of follow-up,the urinary analysis showed 46 cases (50.9％) had completely recovered,29 cases (37.2％)just had microscopic hematuria but no proteinuria,and 3 cases (3.8％) had obvious proteinuria.The renal involvement of 7 cases (9％) had been recurrent during the follow-up.(4) The time of recovery of proteinuria in the group with urinary protein ≤ 15 mg/kg(median:1 month) was less than that of the group with urinary protein ＞ 15 mg/kg(median:3 months),and the difference was significant (Z =-4.12,P =0.001),and 6 cases were found recurrent in the former group (10.9％) but 1 case(4.3％) in the latter group,and the difference was not significant (x2 =0.24,P =0.624).Conclusions The clinical characteristics of children with HSPN with mild proteinuria are not serious,and most of the cases had a favorable prognosis.However,some cases have protracted and recurrent courses which have serious pathological grade.So,urine analysis,long term follow-up,timely kidney biopsy and appropriate treatment are significant for HSPN with mild proteinuria.
ABSTRACT
Objective To investigate the prevalence,missed diagnosis rate and causes of acute kidney injury (AKI) in hospitalized children,and its impact on hospitalization cost,length of stay and outcome.Methods The data of children admitted in Children's Hospital Affiliated to Capital Institute of Pediatrics from December 1st to 31st 2014 were collected,and those whose serum creatinine (Scr) were measured at least two times were selected.Patients were diagnosed as AKI according to the diagnostic criteria of 2012 Kidney Disease:Improving Global Outcomes,then divided into AKI group and non-AKI group,the former of which was further divided into AKI1 group (Scr peak value in normal range) and AKI2 group (Scr peak value above normal range).The causes and impact of AKI on hospitalization cost,length of stay and outcome in different groups were compared and analyzed.Results (1) Among 921 patients with at least two Scr results,170 patients met with the diagnostic criteria of AKI,including 100 males and 70 females.There were 112(65.9％) in AKI stage 1,43(25.3％) in stage 2,and 15(8.8％) in stage 3.The overall prevalence of AKI was 18.5％.With only 7cases getting diagnosed,the diagnostic rate was 4.1％,while 95.9％ of patients missed diagnosis.(2)Among AKI patients,67 cases had pre-renal causes,103 cases had intra-renal causes and mixed factors.100(58.8％) cases got complete recovery,34(20.0％) cases recovered partially and 36(21.2％)cases did not improve,including 4 cases of death.(3) The prevalence of AKI among those below 1-year old was higher than children elder than 1-year (23.0％ vs 15.5％,P=0.004).The prevalence of AKI in surgical ward was higher than medical ward (30.7％ vs 15.8％,P ＜ 0.001).(4) Compared with those in non-AKI group,there was lower age [1.1(0.2,3.5) year vs 2.0(0.3,4.9) year] and higher hospitalization time[12.5(8.0,20.0) d vs 8.0(6.0,11.0) d],hospitalization costs [25 279.2(13 822.8,48 856.7) yuan vs 12 616.9(8680.1,19 345.1) yuan] and mortality (2.4％ vs 0.3％) in AKI group (all P ＜ 0.05).(5) There were 126 cases in AKL group and 44 cases in AKI2 group.The costs of hospitalization,outcome and mortality showed no difference between two groups (all P ＞ 0.05).The hospitalization time in AKI2 group was shorter than that in AKL group (P=0.038).Conclusions Among hospitalized children the missed diagnosis rate of AKI is high.Pre-renal factor is the main cause of AKI.Children younger than 1-year old are more susceptible to AKI.AKI children have lower age and higher hospitalization time,hospitalization costs and mortality than non-AKI children.The effect of Scr fluctuation within normal levels needs to be further studied.
ABSTRACT
Objective To systematically evaluate whether eradication of Helicobacter pylori (H.pylori) is associated with the development of endoscopic gastroesophageal reflux disease (GERD) and reflux symptoms.Methods PubMed,CENTRAL,Embase,CNKI and Wanfang Database from April 1978 to April 2015 were retrieved to collect the randomized controlled trials (RCTs) comparing the incidence of reflux symptoms or reflux esophagitis in patients receiving H.pylori eradication treatment and those without treatment.The quality of trials was evaluated by the Cochrane Collaboration's tool for assessing risk of bias and Jadad scoring.A Meta-analysis was conducted by using RevMan 5.20 software.Results Twenty RCTs involving 6 575 cases were included.Meta-analysis showed that:(1) There was a positive link between H.pylori eradication and endoscopic reflux esophagitis.The diagnostic rate of endoscopic reflux esophagitis after H.pylori eradication therapy was higher than that of control group(7.25％ vs 4.20％;OR =1.62,95 ％ CI 1.20-2.19,P =0.002).Subgroup analysis found that Asian patients,40 to 50 years old,followup time more than 1 year,and peptic ulcer had higher incidence of endoscopic reflux esophagitis;(2) The incidence of reflux symptoms was not significantly different between H.pylori eradication group and control group (25.2％ vs 24.6％;OR =1.03,95％ CI 0.87-1.21,P =0.76).Further analysis indicated that reflux symptoms were not related to some relevant factors,such as races,age at diagnosis,follow-up time and underlying diseases.Conclusions The eradication of H.pylori is considered as one of risk factors for GERD,especially in Asian populations,long time follow-up,40 to 50 years old and patients with peptic ulcer.Meanwhile,the eradication of H.pylori does not suggest the correlation with reflux symptoms.H.pylori eradication therapy should be administrated according to patients' individual conditions.