ABSTRACT
Objective To analyze the causes of 652 hospitalizations in the patients with autosomal dominant polycystic kidney disease (ADPKD).Methods The medical records of all ADPKD inpatients in our hospital from January 1,1990 to December 31,2010 were collected.The differences of hospitalization causes in different age,gender and period were analyzed.Results (1)In 652 hospitalizations,the most common cause was lumbar pain (15.2％),followed by cystic bleeding (14.6％),aggravating renal failure (10.1％),dialysis-related problems (9.4％),renal transplant related issues (8.3％),renal replacement therapy for ESRD (8.0％),urinary tract infection (6.4％),end stage renal failure (5.8％),hypertension (4.1％),renal cyst volume enlargement (3.7％),finding polycystic kidney disease (2.1％),urinary lithiasis (1.8％) and others (10.4％).(2)Younger patients were admitted into hospital because of polycystic kidney bleeding and finding PKD.With the increase of patients age,hospitalization due to dialysis-related problems increased,while many middle-aged patients were hospitalized because of back pain.(3)Male patients were admitted into hospital for aggravating renal failure,ESRD,kidney transplantation-related problems and urinary lithiasis,while female patients mainly for lumbar pain,dialysis-related problems and urinary tract infection.(4)The proportion was significantly reduced with time of finding PKD,renal failure and polycystic kidney bleeding,the proportion of renal cysts increasing and aggravating renal failure increased,there was a significant increase in the proportion of patients with hypertension,while a significant decrease in the proportion of patients with uncontrolled hypertension,and the average SBP was also significantly reduced.Conclusions The highest rate of hospitalization of ADPKD patients is in 40 to 60 age group.Cause of admission varies with age and gender,and changes with the change of time.Over the past decade,the proportion of hospitalization due to renal cysts enlargement and renal failure aggravation increased significantly.The incidence of hypertension is higher than that in the first 10 years,but hypertension control rate increases compared with the previous.Prevention should focus on finding the suppression measures of renal cysts enlargement.
ABSTRACT
Objective To summarize the clinical characteristics and outcome of renal cyst infection in patients with autosomal dominant polycystic kidney disease (ADPKD). Methods Clinical data of 40 ADPKD patients with 43 episodes of renal cyst infection admitted in Shanghai Changzheng Hospital from 1st January 1991 to 31st December 2010 were retrospectively analyzed.Differences of microbiological data and treatments between 1st January 1991 to 31st December 2000 and 1st January 2001 to 31st December 2010 were compared. Results Among 473 identified patients with ADPKD and 662 episodes of hospitalization,40 patients had 43 episodes of renal cyst infection,including 8 definite and 35 likely cases.Microbiological documentation was available for 34 episodes (79.0％),Escherichia coli accounting for 82.4％ of all retrieved bacterial strains.Resistant Escherichia coli to quinolone and certain β-lactamine increased in recent decade.Clinical efficacy of initial antibiotic treatment was noted in 69.8％ of episodes. Antibiotic treatment modification was more frequently required for patients receiving initial monotherapy compared with those receiving combination therapy.In the first ten-year group,initial combination therapy and clinical efficacy were noted in 30.0％ and 60.0％ of episodes respectively,and hospital stay was (20.2±6.7) d.In the second ten-year group,initial combination therapy and clinical efficacy were noted in 61.9％ and 78.2％ of episodes respectively,and hospital stay was (16.3±3.2) d.Large infected cysts (diameter ＞5 cm) frequently required drainage. Conclusions In renal cyst infection,the source of the organisms is often a gram negative enteric organism.Empiric therapy is often initiated with two antibiotics.The drainage of large infected cysts remains the main treatment for cyst infection.
ABSTRACT
Objective To observe the influence of nocturnal prolonged hemodialysis (INHD) on patients＇ nutrition status. Methods Thirty-two maintenance hemodialysis patients received INHD (3 times per week and 7.5 hours each session) and thirty-five maintenance hemodialysis patients received conventional hemodialysis (3 times per week and 4 hours each session) as control were observed for 6 months.The nutrition status of these patients on various aspects which concluded physical measurements,laboratory tests,and dietary record at baseline(0month) and exit (6 months) were recorded. Results (1)There were no differences in age,sex,body weight,and primary diseases between two groups.(2)The body weight,triceps skinfold thickness (TSF),and hand grip strength increased at exit point,but no statistical difference compared with the control group.Mid-upper arm circumference (MAC) increased signicantly from (27.1±4.2) to (30.5±6.1) cm (P＜0.05).Compared with the control group (26.9±3.4) cm,there was a significant difference (P＜0.05).(3)Serum phosphate decreased significantly from (0.5±0.5) to (0.1±0.6) μ mol/L (P=0.001) in INHD group.(4)The nutrition status were improved in INHD group evaluated by subjective global assessment (SGA)(P=0.03).(5) Dietary intake was recorded by a 3-day food record.Dietary intake of energy,protein,lipid,calcium,potassium,and phosphate increased in INHD group.None of the differences achieved statistical significance between two groups. Conclusion As compared with conventional hemodialysis,INHD can increase the dietary intake,decrease serum phosphate level,and improve patients nutrition status.
ABSTRACT
Objective To initially map the gene responsible for autosomal dominant familial IgA nephropathy of a Chinese family by exclusive the five loci that had been reported with linkage analysis.Methods The genetic pattern of the familial IgA nephropathy was identified and the genomic DNA was extracted from the blood samples collected from the family members.Short tandem repeat (STR) inside the loci that had been reported was selected,such as 2q36,3p23-24,4q26-31,6q22-23,17q12-22,and the data with two-point linkage analysis were performed.Results Autosomal dominant inheritance pattern was demonstrated in phenotypes of the family and there was no linkage relationship in the above five loci of chromosomes because the maximum two-point LOD score was 0.39 at D17S1868.Conclusion Following exclusion of the loci which had been reported,there are other new pathopoiesis loci of FIgAN and it reveals that FIgAN has the genetic heterogeneity according to initial result at the same time.
ABSTRACT
Objective To analyze the clinical and pathologieal characteristics of IgA nephmlogy secondary to primary sj(o)gren's syndrome(pSS).Method The clinical and pathological data of 8 patients with pSS and IgA in Changzheng Hospital from 2004 to 2009 were analyzed.Results The average age of seven female and one male was (44±8) years old.Five patients presented with edema and proteinuria.Eight patients presented with microhematuria.The average 24-hour proteinuria was (3±4) g.Two patients had hypertension.Serum creatinine levels of two patients were higher than normal level,the others'were normal.Light microscopy examination showed three patients were mild mesangial proliferation with Lee's classification grade Ⅰ;five patients had global sclerosis with Lee's classification grade Ⅱ,Ⅲ and Ⅳ.Positive IgA was mainly found under immunofluorescence microscopy.Electronic microscopy showed no electron-dense deposits.Conclusion IgA nephrology secondary to pSS is different from primary IgA nephrology under immunofluorescence microscopy.
ABSTRACT
Objective To assess the clinical value of measuring the concentration of serum osteoprotegerin (OPG) in detecting the bone metastases in patients with prostate cancer. Methods The concentration of serum OPG in 40 patients was determined by ELISA. The data of ECT bone scan and Gleason score was collected simultaneously. The correlations between serum OPG and bone metastases, Gleason score were tested. Results The concentration of serum OPG in patients with bone metastases by ECT scan was( 16 237. 19 ±5144. 26) ng/L,which was significantly higher than the concentration in patients without bone metastases , which was (12 123.32 ±4136. 50)ng/L. There was no significant correlation between serum OPG and Gleason score. Conclusions The serum OPG has an important clinical value in prediction of prostate cancer with bone metastases. There is no significant correlation between serum OPG and the Gleason score.
ABSTRACT
Objective To investigate the protective effect and mechanism of pamidronate disodium on calcification in rat vascular smooth muscle cells (RVSMCs) induced by hyperphosphate.Methods RVSMCs were placed in various culture mediam, including normal phosphate medium (Pi 1.4 mmol/L), high phosphate medium (Pi 4.5 mmol/L), different pamidronate disodium concentrations medium (Pi 4.5 mmol/L+pamidronate disodium 10-5, 10-6, 10-7 mmol/L). Calcium content and cell protein content were quantified by the O-cresolphthalein complexone method and BCA protein assay respectively. Calcification was visualized by yon Kossa staining, and cbfα-1,osteocalcin were quantified by Western blotting. Results After culture for 3 days, calcium content in high phosphate group were much higher than that in control group, and pamidronate disodium groups had a lower calcium content compared with high phosphate group (all P＜0.05).Calcium deposit in RVSMCs was greater in high phosphate group, while pamidronate disodium groups revealed obviously decreased deposit (all P＜0.05). Protein expression of cbfα-1 and osteocalcin in pamidronate disodium groups was much lower than that in high phosphate group.Conclusion Pamidronate disodium can protect RVSMCs from phosphate-induced calcification in vitro, which may be associated with the blockage of transformation of RVSMCs into osteoblast.
ABSTRACT
Objective To observe the efficacy of ealcitonin and bisphosphonates on renal osteopathy of maintenance hemodialysis (MHD)patients. Methods Forty-three MHD patients were raindomly divided into two groups: A group and B group. All the patients were routinely received oral calcium carbonate 1.0 g tid and calcitriol 0.25 μg qd. Calcitonin (20U) hypodermic injection was given three times a week additionally during hemodialysis in A group. Patients in B group received bisphosphonates 70 mg once a week based on the therapy of A group. Serum levels of intact parathyroid hormone (iPTH), calcium, phosphorus, alkaline phosphatase (AKP), bone mass density (BMD) of lumbar spine and femoral neck, and the degree of bone ache (visual analogue scale, VAS) were assessed before the therapy and 3, 6 and 12 months after treatment. The adverse reactions were recorded during treatment. Results The levels of AKP and iPTH in both two groups decreased significantly after treatment. The above values of pre-treatment and 12 months after treatment were as follows: AKP(U/L)of A group 244.05±41.99 and 148.35±27.71,of B group 245.60±40.86 and 143.40±28.03;PTH(ng/L) of A group 697.5±119.7 and 267.4±45.9,of B group 708.2±120.3 and 277.6±41.9 (all P<0.05). While the levels of calcium and phosphorus did not change obviously during treatment (P>0.05). BMD was not improved at 3, 6 mouths and became better at 12 mouths after treatment. As compared to pre-treatment, BMD of lumbar spine(g/cm2) in A group was 1.062±0.223 vs 1.202±0.251 ,in B group 1.033±0.152 vs 1.189±0.225; BMD of femoral neck (g/cm2)in A group was 0.993±0.108 vs 1.067±0.095,in B group 0.947±0.083 vs 1.018 ±0.217 (all P<0.05). The scores of VAS also decreased significantly at 3, 6, 12 months after treatment(P<0.05). No severe adverse reaction was found during the treatment. Conclusions Utilization of calcitonin and combination with bisphosphonates during bemodialysis can effectively preserve the BMD and prevent bone loss in MHD patients and is well tolerated. No significant difference of therapeutic effect is observed between using ealcitonin or combination with bisphosphonates.
ABSTRACT
Objective To investigate the safety and tolerability of darbepoetin alfa.a long-lasting erythmpoietin,single intravenous administration in maintenance hemodialysis(MHD) patients. Methods A single center,open clinical trial was carried out.Forty-three stable MHD patients were divided into 5 groups and received darbepoetin α at dosage of 0.225,0.45,0.9,1.8,3.6 μg/kg respectively.The vital signs,symptoms,ECG and laboratory examinations were monitored and detected before and after administration. Results Of the 43 patients (male 26and female 17),the largest tolerable dosage of darbepoetin alfa was 3.6 μg/kg.During the study,the main side effect associated with darbepoetin was hypertension aggravation(7%).One patient died but that was not associated with darbepoetin alfa. Conclusion Darbepoetin alfa is sale and well tolerated.
ABSTRACT
Objective To evaluate the effects of alendronate sodium on bone mineral density (BMD) in maintenance haemodialysis (MHD) patients with osteoporosis. Methods Twenty-eight MHD patients with osteoporosis diagnosed by dual energy X-ray absorptiometry were randomly divided into control group (n=15) and treatment group (n=13). Patients in treatment group were treated with oral 70 mg alendronate sodium once a week for 18 months. BMD of hip and lumbar spine was measured by dual energy X-ray absorptiometry at baseline and the end of the 6th, 12th and 18th month. Parathyroid hormone, calcium, phosphorous, alkaline phosphatase levels, blood routine, hepatic and renal function were assayed at baseline and the end of the 18th month, Kt/V was calculated, new bone fracture was recorded. Results The BMD, T-scores and Z-scores in the lumbar spine and specific regions of the hip were stable in the treatment group and obviously decreased in the control group (P<0.01). New bone fracture was found in 1 patient of the treatment group and 5 patients of the control group. The side-effect of alendronate sodium was epigastric discomfort in 1 cases. Conclusions Oral alendronate sodium appears to be well tolerated in MHD patients and keep the BMD stable in the lumbar spine and specific regions of the hip.
ABSTRACT
Objective To observe about curative effect of MMF on type Ⅳ lupus nephritis and to review the literature about MMF used to treat LN.Method Ten patients with type Ⅳ LN were treated with MMF 1～2 g/d plus prednisone at middle or little dose.Curative duration of these patients was between 6 and 12 months.After 3,6 and 12 months curative effect was observed.Results After treatment proteinurie and systemic lupus activity measurement were decreased gradually.Before and after treatment ANA positive rates were 80% and 30%,anti dsDNA antibody positive rates were 50% and 10%,respectively,and low C3 and C4 was rectified.After treatment renal failure in 3 patients was recovered.During treatment major adverse reactions included gastrointestinal symptoms and herpes zoster.Conclusion MMF has exacttly effect on type Ⅳ LN and low side effect.
ABSTRACT
Objective：To study the clinical and pathologic features of patients with lupus nephritis (LN) whose myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA) were positive. Methods：The clinical and pathological features were analyzed in 18 patients with LN whose MPO-ANCA were positive. And the data of patients with different clinical outcomes were compared. Results：（1）The hematological abnormalities, hypertension and serositis in these patients were more common than general ones with LN. （2）Proteinuria and hematuria were common, the morbidities of gross hematuria and renal failure in these patients were higher than general ones with LN.（3）Various autoantibodies were positive in these patients.（4）Segmental necrosis crescentic nephritis accompanied by density of immunocomplex in glomeruli and vasculitis in intestitium were common.（5）The morbidity of ESRF and mortality of these patients were similar to general ones with LN. The morbidity of tubular atrophy in those with poor prognosis was significantly higher than those survived. Conclusion：The patients with LN whose MPO-ANCA are positive have some difference from those with negative MPO-ANCA, but positive MPO-ANCA is not directly related to the prognosis.
ABSTRACT
Objective:To prepare type Ⅲ sodium-phosphate cotransporter(NaPi-Ⅲ) siRNA-loaded chitosan microspheres and to evaluate their physico-chemical properties and siRNA release in vitro.Methods: NaPi-Ⅲ siRNA was loaded into chitosan microspheres by using the complex coacervation method.The structure of the nanoparticles was observed under scanning electron microscope and their diameter distribution was measured by a laser grain analyzer.RNase assay was used to detect the efficacy of anoparticles in prevention of siRNA from degradation.Ultraviolet spectrophotometry and HPLC technique were used to determine the entrapment efficiency,loading capacity,and siRNA releasing rate in vitro.Results: The chitosan nanoparticles loaded with NaPi-Ⅲ siRNA were successfully prepared.The nanoparticles were spherical in shape and were well distributed,with an average diameter of 173 nm.After RNase treatment,D_(260) rose more slowly in chitosan nanoparticles-based siRNA suspension than in simple NaPi-Ⅲ siRNA solution(P
ABSTRACT
Objective:To establish a rat hyperparathyroidism model secondary to chronic renal failure,so as to lay a foundation for studying the mechanism and treatment of secondary hyperparathyroidism.Methods: Thiry-six male Sprague-Dawley rats,weighing 200-250 g,were randomly divided into 6 groups: 5/6 nephrectomy plus high phosphorus food group(STNx + HP),5/6 nephrectomy plus low phosphorus food group(STNx + LP),5/6 nephrectomy plus normal phosphorus food group(STNx + NP),sham operation plus high phosphorus food group(Sham + HP),sham operation plus low phosphorus food group(Sham + LP),and sham operation plus normal phosphorus food group(Sham + NP).Nephrectomy was performed in 2 steps.Serum phosphorus levels(P) and iPTH levels were detected at day 7 pre-operation and day 7,14,and 21 after the second operation.The kidneys,thyroid glands and parathyroid glands complex underwent pathological analysis 4 weeks after operation.Results: Five patients survived in STNx+NP group,4 in STNx+LP group and 4 in STNx+HP group postoperatively.No death occurred in sham operated groups.Serum phosphorus levels of nephrectomy groups at different time points after operation were higher than those before operation and those of sham operation groups(P
ABSTRACT
In order to further explore the protective effect of Cordyceps Sinensis (CS) on Cyclosponne A nephrotoxicity (CsA-Nx) and its possible mechanisms, SD rats were divided into two groups: CsA group and CsA + CS group. The results showed that: in different experiment period, serum BUN. Cr, Na. K and urine EOF excretion in CS group were lower than that in control group. In the third month, serum AT- |J in CS group was also lower than that in control group. Pathological examination showed that CS could protect the kidney from CsA-Nx and ameliorate the glomerular and interstitial injuries. It suggests that CS could protect the kidney from CsA-Nx, especially protect the proximal tubular function and ameliorate renal hemodynamics.
ABSTRACT
Objective:To construct a mutispecific internal control for competitive RT-PCR analysis of Fas、FasL、GB、P、TIA-1 and ?-actin.Methods:Invitro synthesized fragments were amplified by PCR,there are two products,of which 145 and 147 bp.The 145 bp one contained 5′ primer sequences of Fas、FasL、GB、P、TIA-1 and ?-actin,another contained 3′ primer sequences of the same genes.The products with restriction sites were inserted into the vector PKF_3.Results:Restriction enzyme analysis and DNA sequencing were used to identify the recombinant plasmid,corresponding internal control was obtained by the amplification of the recombinant plasmid with each primer pair.The mutispecific internal control was then used for quantitative detection of TIA-1 in peripheral blood leukocytes from a patient with acutely rejecting allograft.Our study on Fas、FasL、GB、P、TIA-1 and ?-actin showed that the coamplified templates accumulated in a parallel manner throughout not only the exponential phase.Conclusion:The mutispecific internal control can be used for quantitative detection of the six genes. [
ABSTRACT
Objective:To investigate the sensitivities and specificities of high-frequency color doppler ultrasonography, thin layer CT enhancing scan and 99m Tc-MIBI biphasic scintigraphy in diagnosis of secondary hyperparathyroidism(SHPT)in uremia patients.Methods: High-frequency color doppler ultrasonography, thin layer CT enhancing scan and 99m Tc-MIBI biphasic scintigraphy were performed in 35 uric patients to detect the hyperplastic parathyroid glands. Then biopsies with thin needles were conducted with B ultrasound instruction in hyperplastic glands to determine the sensitivities and specificities of the above techniques and free combination of each 2 of them in diagnosis of SHPT. Results: The sensitivities /specificities of high-frequency color doppler ultrasonography, thin layer CT enhancing scan and 99m Tc-MIBI biphasic scintigraphy were 73%/95%, 75%/93% and 89%/98%, respectively; the sensitivity/specificity of 4 combinations: high-frequency color doppler ultrasonography plus CT, high-frequency color doppler ultrasonography plus 99m Tc-MIBI biphasic scintigraphy, CT plus 99m Tc-MIBI biphasic scintigraphy,and high-frequency color doppler ultrasonography plus CT plus 99m Tc-MIBI biphasic scintigraphy were 84%/90%, 93%/93%, 95%/93%, and 100%/90%, respectively. Conclusion: The sensitivity of 99m Tc-MIBI biphasic scintigraphy SHPT is higher than that of high-frequency color doppler ultrasonography and CT, but the specificity is not significantly different 3 photographic techniques. However, combination of high-frequency color doppler ultrasonography and 99m Tc-MIBI biphasic scintigraphy is simple and sensitive and can be regarded as the first choice for diagnosis of SHPT in uremia patients.
ABSTRACT
Objective: To evaluate the value of high resolution ultrasonography for diagnosis of secondary hyperparathyroism(HPT) in uremia and its relationship with serum parathyroid hormone(PTH). Methods: Ultrasonography was used to examine parathyroid gland and serum PTH, calcium,phosphorus in 55 cases of uremic patients. Results: Totally 64 parathyroid glands in 52 patients(94%) and over 2 glands in 11 cases(20%) were found. The volumes of parathyroid gland was larger and the value of PTH was abviously increased in over 2 glands than in single gland( P
ABSTRACT
Objective:To study the clinical and pathologic features of patients with lupus nephritis (LN) whose myeloperoxidase anti neutrophil cytoplasmic antibody (MPO ANCA) were positive. Methods:The clinical and pathological features were analyzed in 18 patients with LN whose MPO ANCA were positive. And the data of patients with different clinical outcomes were compared. Results:(1)The hematological abnormalities, hypertension and serositis in these patients were more common than general ones with LN. (2)Proteinuria and hematuria were common, the morbidities of gross hematuria and renal failure in these patients were higher than general ones with LN.(3)Various autoantibodies were positive in these patients.(4)Segmental necrosis crescentic nephritis accompanied by density of immunocomplex in glomeruli and vasculitis in intestitium were common.(5)The morbidity of ESRF and mortality of these patients were similar to general ones with LN. The morbidity of tubular atrophy in those with poor prognosis was significantly higher than those survived. Conclusion:The patients with LN whose MPO ANCA are positive have some difference from those with negative MPO ANCA, but positive MPO ANCA is not directly related to the prognosis. [