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Objective:To analyze the antibody level of phospholipase A2 receptor (PLA2R) in Chinese patients with primary membrane nephropathy (PMN) and its correlation with clinical indicators, and to explore more suitable cut-off value for Chinese patients.Methods:All hospitalized patients with renal biopsy at Peking University People's Hospital from January to August 2018 were retrospectively reviewed. According to the primary disease, patients were divided into PMN group (including patients with idiopathic membranous nephropathy and atypical membranous nephropathy of unknown cause) and control group (other pathological types, including secondary membranous nephropathy patients). Their clinical and pathological characteristics were analyzed, and the level of serum PLA2R antibodies was detected using the method of enzyme-linked immunosorbent assay (ELISA). Spearman correlation was used to analyze the correlation between PMN patients' blood anti-PLA2R antibody level and clinical indicators. The risk factors of PMN were analyzed by logistic regression model, and the optimal cut-off value of PMN was analyzed by ROC curve.Results:A total of 354 patients were included in this study, including 114 patients in PMN group and 240 patients in control group. The age of PMN group was (51.7±14.1) years old and the ratio of male to female was 2.2∶1. The median concentration of PLA2R antibody in PMN group was 16.87 RU/ml [inter-quartile range ( IQR) 1.88-57.26], which was significantly higher than that in control group (1.43 RU/ml, IQR 1.20-1.62, P<0.001). In PMN group, the concentration of anti-PLA2R antibody was correlated with the 24-hour urine protein ration ( r=0.278, P=0.003) and urine erythrocyte ( r=0.190, P=0.043), but not with serum albumin ( r=-0.149, P=0.114) and serum creatinine ( r=0.136, P=0.149). The ROC curve showed that the sensitivity of distinguishing PMN from other diseases was 69.3% (95% CI 60.3%-77.0%), the specificity was 92.9%(95% CI 89.0%-95.5%), and the area under the curve was 0.859(95% CI 0.813-0.905) when the cut-off value was set as 2.28 RU/ml, which was significantly better than the cut-off value of 20.00 RU/ml (the sensitivity/specificity was 46.5%/97.5%) and 14.00 RU/ml (the sensitivity/specificity was 53.5%/97.1%). Conclusions:PLA2R antibody is one of the main pathogenic antibodies of PMN. In China, it is recommended to lower its cut-off value to 2.28 RU/ml, which can improve the sensitivity of distinguishing PMN from other pathological types without reducing specificity.
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Objective To investigate the characteristic of autoantibodies of M-type phospholipase A2 receptor (PLA2R) in serum and the glomerular IgG subclass deposits in undetermined atypical membranous nephropathy (MN) patients.Methods From Feb 2004 to Nov 2011,53 cases diagnosed as MN by kidney puneture biopsy in our hospital were included into the study.There were 20 undetermined atypical membranous nephropathy (UAMN),20 idiopathic membranous nephropathy (IMN) and 13 secondary membranous nephropathy (SMN) which were composed of lupus membranous nephropathy (LMN) and HBV related membranous nephropathy (HBV-MN).Clinlical and pathological characteristics were analyzed.The autoantibodies of PLA2R in serum were detected and the glomerular IgG subclass deposits were observed.Results (1) The average age underwent renal biopsy was (37.9±3.8) years of UAMN,(50.1±3.0) years of IMN and (49.5±4.5) years of SMN.The difference in onset average age at disease was significant between UAMN and IMN (P =0.0178).The female/male ratio (F/M) in UAMN,IMN and SMN was 0.8∶ 1,0.7∶1 and 0.6∶ 1(P ＞ 0.05).(2) Compared with SMN,the level of 24-hours urinary protein excretion (3.47 g vs 7.89 g,P =0.023),the ratio of amount urinary protein patients (50.0％ vs 84.6％,P=0.043),the level of serum IgG [(8.40±3.58) g/L vs (10.09±4.69) g/L,P =0.025] and the positive rate of ANA in serum (10.0％ vs 53.8％,P =0.006) in UAMN were all much lower.There were no significant statistical differences in serum albumin,serum creatinine,eGFR,positive rate of HBsAg,HBeAg or HCV,as well as the ratio of hypo-albuminemia and nephrotic syndrome among the three groups.(3) IF positive rate of IgA,IgM and C1q in UAMN were all significantly higher than that in IMN (P ＜ 0.01).There were no significant differences in IF positive rate of IgA,IgM,C1q,IgG and C3 between UAMN and SMN.The IF strength of IgA,IgG,IgM,C3 and C1q in UAMN showed no significant differences between UAMN and SMN.(4) The serum autoantibodies of PLA2R were only detected in 10 cases of IMN group (50％) with all the other cases negative.This detection rate of serum autoantibodies of PLA2R showed significant statistical differences among the three groups (P ＜ 0.01),but no differences between UAMN and SMN (the detection rate in both groups were 0％).(5) IgG1 deposits was the dominant IgG on the glomeruli in UAMN group (40％),as well as in SMN group (76.9％).IgG4 deposits was the dominant IgG on the glomeruli in IMN group (60％).The positive rate of IgG1 and IgG3 in UAMN showed no significant statistical differences when compared with IMN or SMN.The positive rate of IgG2 in UAMN was significantly lower than in SMN (30.0％ vs 69.2％,P ＜ 0.05).The positive rate of IgG4 in UAMN was significantly lower than in IMN (20％ vs 60％,P ＜ 0.05).The positive rate of IgG1,IgG2 and IgG3 in SMN were all significantly higher than in IMN.Conclusions None of the UAMN group had autoantibodies of PLA2R in serum,and IgG1 deposits was the dominant IgG subclass on the glomeruli which indicated the similarity with the SMN group.At the same time,UAMN was significantly different from SMN in clinical manifestations.
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Objective To evaluate the sensitivity and specificity of plain radiography in the diagnosis of vascular calcification in maintenance hemodialysis (MHD) patients. Methods Multi-slice computed tomography (MSCT) was used as the reference standard in the assessment of vascular calcification in MHD patients. A total of 54 MHD patients, 26 male and 28 female, mean age (60.4±13.3) years, underwent both MSCT and plain radiography of lateral abdomen and pelvis to evaluate abdominal aortic calcification, bilateral iliac and femoral artery calcification. Abdominal aorta was divided into upper and lower segment by L2-L3 intervertebral space. The severity of vascular calcification by MSCT was graded from score 0 to 5. Two independent radiologists analyzed the results of plain radiography and MSCT, and inter-observer agreements were calculated by using K statistics. Results According to the results of MSCT, the calcification rate of abdominal aorta was 86.1%, and the calcification rate of iliac and femoral artery was 74.5%. There was significant difference of the calcification rate between large artery and muscular arteries. Inter-observer agreement of calcification was excellent (K =0.864-0.893). Compared with MSCT, the specificity of plain radiography with regard to detection of abdominal aortic, iliac and femoral calcification were 100%. The sensitivity of plain radiography was different according to the different MSCT score, which was as follows: MSCT score ≥ grade 1: 60.2% and 24.8% for lateral abdomen radiography to detect abdominal aortic calcification and pelvic radiography to detect iliac, femoral calcification respectively; MSCT score ≥ grade 2: 76.9% and 43.5% respectively; MSCT score grade 3: 100% and 74.4% respectively. Conclusions The sensitivity of plain radiography in the assessment of vascular calcification increases with the severity of calcification. The sensitivity in the assessment of abdominal aortic calcification is higher than that of iliac and femoral artery calcification. Plain radiography can be used to detect moderate to severe vascular calcification in MHD patients.
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Objective: To investigate the effects of low molecular weight heparin(LMWH) on vascular endothelial growth factor(VEGF) expression of early diabetic nephropathy. Methods: Ninety-five male SD rats were randomly divided into three groups: normal control rats, STZ-induced diabetic rats and diabetic rats treated with LMWH. The renal tissues were subjected to immunohistochemical staining after 1,2,4,6,and 8 weeks’ treatment respectively to quantify the VEGF expression. Results: Immunohistochemical staining demonstrated an increasing in VEGF positive cells in diabetic rats. It was found that there were significant differences in VEGF staining intensity between diabetic rats and normal control rats and between LMWH treated rats and untreated diabetic rats after two weeks treatment. Conclusion: The inhibition of VEGF expression may be one of the mechanisms of LMWH’s renal protective effects on early diabetic nephropathy.
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Objective To investigate the prevalence and risk factors of renal injury in chronic hepatitis C patients(CHC).Methods The clinical data of 213 CHC patients,who were hospitalized in the People's Hospital of Peking University from Jan.2002 to Oct.2007,were collected.The eGFR was caculated by MDRD equation.The prevalence and risk factors of renal injury in the CHC patients was analyzed by SPSS software.Results The patients has an average age of (53.5?14.7)years old,with male patients accounting for 59.6% and female accounting for 40.4%.We also found that 22.1% patients had hypertension,25.8% had diabetes mellitus,and 94.8% had serum positive HCV RNA.The prevalence of CKD was 26.3%,the prevalence of proteinuria was 14.6%,and the rate of hematuria was 2.8%.Serumpostive HCV RNA was the independent risk factor of proteinuria as demonstrated by multiple variation logistic regress analysis(P=0.028,OR:2.610,95%CI:1.107~6.151).Proteinuria(P=0.02,OR:3.759,95%CI:1.227~11.521),age(P=0.004,OR:1.058,95%CI:1.018~1.100)and blood uric acid(P
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Objective To observe the clinical outcome of maintenance hemodialysis patients with hepatitis C viruses(HCV)infection.Methods A retrospective investigation about hepatitis C viruses infection was performed in our hemodialysis centre on December 31,2007.The clinical data including demography,serum transaminase,bilirubin,albumin,anti-HCV antibody,HCV RNA,infection-control procedures associated hemodialysis and ultrasound of the liver was analyzed.Results The prevalent rate of HCV infection in our hemodialysis centre was 20.2%(20/99),The mean age of maintenance hemodialysis patients with HCV infection was(63.3?10.9)years old,the duration on dialysis was(79.9?38.7)months,and the duration of positive serum anti-HCV was(32.6?22.6)months(the longest duration was 103.5 months).16 patients(80%)had blood transfusion history in the patients with HCV infection.Only four cases had viremia of HCV,the serum HCV RNA became negative in one of them spontaneously and in another one after interferon therapy for half a year,the other two of them have viremia now.Most of patients found their serum transaminase elevated transiently and mildly.The age and duration on dialysis of the patients with positive serum anti-HCV were significantly longer than those of patients with negative serum anti-HCV.After strict infection-control procedures were carried out,the new onset cases of HCV infection was significantly decreased(1.2% vs 5.3%,P
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Objective To alleviate the side effects of glucocorticoid, we established a new procedure - intra - renal adipose capsule injection therapy to treat chronic glomerulonephritis. Methylprednisolone was injected into human renal adipose capsules of patients to treat primary glomerulonephritis. Methods 21 patients were diagnosed as primary glomerulonephritis by renal biopsies. Under the guide of sonograph,40mg methylprednisolone was injected into each renal adipose capsule of the patients twice a week, and each one of them was totally given ten times of the treatment. The urinary protein,plasma albumin, serum creatinine and blood pressure before and after the treatment were measured. Results The condition of most patients had been improved after the treatments. The excretion of urinary protein in 18 of 21 patients (85.1% ) had significantly been decreased (P