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Objective To investigate the glomerular microvascular injury and repair in patients with IgA nephropathy (IgAN) as well as its relationship with intermedin (IMD).Methods Eighty cases of renal tissue taken from patients first diagnosed as IgAN in Shanxi Provincial People's Hospital Affiliated to Shanxi Medical University and 15 cases of normal renal tissue were detected by the expression of glomerular IMD,CD31,and VE-cadherin through immunohistochemical method.ELISA method was used to detect VEGF and IMD of plasm from 31 normal subjects and 36 cases chosen from the IgAN patients.Their changes and internal relationship were analyzed according to Lee's and chronic kidney disease (CKD) classification.Results (1) Compared with the control group the expressions of CD31,IMD,and VE-cadherin in IgAN patients were statistically significant (P ＜0.01).Compared with the control group the levels of IMD and VEGF in plasma of IgAN patients in early stage of CKD group and late stage of CKD group were statistically significant (P ＜ 0.01).(2)Correlation analysis:the expression of glomerular CD31 and Lee's classification were negatively correlated (r=-0.232,P ＜ 0.05);glomerular IMD was negatively correlated with Lee's classification (r=-0.241,P＜0.05),while positively correlated with glomerular VE-cadherin (r=0.417,P＜ 0.01).VEGF in plasma of IgAN patients was positive correlated with CKD classification,BUN (r=0.458,0.409,P＜0.05),and negatively correlated with serum ALB (r=-0.532,P＜0.01).Conclusion Microvascular injury exists in patients with IgAN.The expression of VE-cadherin and IMD are positively correlated,suggesting that IMD may be involved in the progression of vascular protection and angiogenesis in IgAN.The contents of IMD and VEGF in plasma of IgAN patients increase,indicating that they may play a role in the progression of IgAN.
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Objective To observe the effect of intermedin(IMD) on microvascular injury of renal fibrosis in unilateral ureteral obstruction (UUO) rat model.Methods Seventy-two male Wistar rats were randomly divided into two groups:the sham-operation group (n=24) underwent the left ureteral dissection,the other 48 rats were made as unilateral ureteral obstruction models and subdivided into model group(UUO,n=24) and IMD group (n=24).At the 7,14,21,28 day after the operation,6 randomly-selected rats from each of the three groups respectively were blooded by abdominal arotic and their obstructive kidneys were taken out.The renal histopathological changes were observed through HE and Masson staining,the contents of BUN,Scr and cystatin C (CysC) of the obstructive kidneys were determined,the expressions of transforming growth factor-β1 (TGF-β1),α-SMA,bone morphogenetic protein-7 (BMP-7),E-cadherin,thrombospondin 1 (TSP-1) and vascular endothelial growth factor (VEGF) were detected by RT-PCR and immunohistochemistry.Results Compared with the sham-operated group,the pathological changes of kidney in the model group showed that the degree of fibrosis was obvious,tubular interstitial damage aggravated,the levels of BUN,Scr,CysC in the model group increased (P ＜ 0.05),the mRNA expression and protein content of TGF-β1,oα-SMA,TSP-1 increased (P ＜ 0.05),while the levels of BMP-7,E-cadherin and VEGF decreased (P ＜0.05).Compared with the UUO group,renal tubular damage,interstitial fibrosis in the IMD group were lighter,the levels of BUN,Scr,CysC in the IMD group were lower (P ＜ 0.05),the mRNA expression and protein content of TGF-β1,α-SMA,TSP-1 were down-regulated (P ＜ 0.05),while the levels of BMP-7,E-cadherin and VEGF were up-regulated (P ＜ 0.05).Conclusion IMD can ameliorate the renal interstitial fibrosis,and the mechanism may be related to the fact that VEGF mediated by IMD can reduce vascular injury.
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Objective Few prospective data are currently available on acute gastrointestinal hemorrhage (AGIH) as a complication in acute kidney injury (AKI).The aim of the present study was to find out clinical characteristics,incidence,etiology,risk factors,and outcome of AGIH in patients with AKI.Methods We performed a prospective study on an inceptione cohprt of 512 patients admitted for AKI in our hospital.Data on clinical risk factors for bleeding,frequency of occurrence of AGIH,in-hospital mortality were collected,and independent predictors of AGIH were identified.Results A total of 53 patients had AGIH as a complication of AKI,and 45 were upper AGIH.Fifteen patients had clinically severe bleeding.Independent baseline predictors of AGIH were severity of illness,cardiac failure,mechanical ventilation,low platelet count,chronic hepatic disease,liever cirrhosis,severe AKI.Inhospital mortality was 52.8％ in patients with AGIH,and 22.2％ in the other patients.AGIH was significantly associated with an increase in hospital mortality.Conclusions AGIH are frequent complications of AKI.In this clinical condition,AGIH is more often due to upper gastrointestinal bleeding and is associated with a significantly increased risk of death.Both renal and extrarenal risk factors are related to the occurrence of AGIH.