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Objective To analyze the pathogenic bacteria and drug resistance of peritoneal dialysis-associated peritonitis(PDAP),and provide a clinical reference for the rational use of antibiotics.Methods The demographic data of PDAP patients admitted to the peritoneal dialysis(PD)Center of the First Affiliated Hospital of Soochow University from July 1,2015 to December 30,2021 were collected,and the pathogens,drug resistance and prognosis were retrospectively analyzed.Results A total of 150 episodes of PDAP occurred in 92 patients.The positive rate of PD fluid culture was 61.33％,including 65 cases(70.65％)of Gram-positive(G+)bacteria,mainly Staphylococcus and Streptococcus.Gram-negative(G-)bacteria were in 16 cases(17.39％),mainly Escherichia coli and Enterobacter cloacae.There were 11 cases(11.96％)of multiple infections,including 5 cases of combined fungal infection.From 2016 to 2021,the incidence of G+bacteria-related PDAP decreased from 14 to 8 cases.G+strains were resistant to methicillin(35.00％),and were sensitive to linezolid(100.00％),teicoplanin(100.00％)and rifampicin(100.00％).The sensitivity rate to vancomycin was 98.59％.G-strains were sensitive to ceftazidime(86.36％),ceftizoxime(88.89％)and amikacin(100.00％).The MIC of vancomycin against Staphylococcus showed an upward trend in 2019-2021.The overall cure rate of PDAP was 81.33％in patients who responded to antibiotic treatment,and the cure rate of G+bacteria was higher than that of multiple infections(89.23％vs.36.36％,P＜0.01).The outcome of patients with multiple infections,especially those with concurrent fungal infection was poor.Conclusion The incidence of PDAP in the PD center has shown a decreasing trend in recent years.G+bacteria are still the main pathogenic bacteria causing PDAP,and they are highly resistant to methicillin,so vancomycin should be used as empirical therapy.For G-bacteria,cefotaxime and amikacin can be chosen as empirical therapy.There is a drift in the MIC values of vancomycin against Staphylococcus in the study period,so it is necessary to monitor the MIC of vancomycin against Staphylococcus and its changing trend.
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Objective:To investigate the epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with maintenance hemodialysis (MHD) in Jiangsu province during SARS-CoV-2 pandemic in China from December 7, 2022 to January 27, 2023, and to analyze the influencing factors of all-cause death.Methods:It was a multi-center cross-sectional investigation. Structured questionnaire was used to collect patient information by medical staff of each hemodialysis center (room) as investigators. Part of the demography data and laboratory examination data came from the Jiangsu Province Hemodialysis Data Information System. MHD patients from hemodialysis centers (rooms) at all levels of medical institutions and independent hemodialysis institutions in Jiangsu province during the outbreak of SARS-CoV-2 infection were included, and the clinical characteristics and all-cause mortality of confirmed and suspected cases of SARS-CoV-2 infection were analyzed.Results:Questionnaire surveys and data analysis on 57 278 patients in 407 hemodialysis centers (rooms) were completed, accounting for 90.41% of the total number of MHD patients (63 357 cases) in Jiangsu province during the same period. There were 24 038 cases (41.97%) of SARS-CoV-2 infection and 14 805 cases (25.85%) of suspected infection, which were widely distributed in all dialysis centers in Jiangsu province. After clinical classification of 38 843 confirmed and suspected SARS-CoV-2 infection cases, 3 662 cases were severe and critical cases, accounting for 9.43% of the infected and suspected cases. Among the patients who had completed the questionnaires, there were 1 812 all-cause deaths, with an all-cause mortality rate of 3.16%. Multivariate logistic regression analysis showed that elderly (taking ≤50 years as a reference, 51-59 years: OR=1.583, 95% CI 1.279-1.933, P=0.001; 60-69 years: OR=3.972, 95% CI 3.271-4.858, P<0.001; 70-79 years: OR=7.236, 95% CI 5.917-8.698, P<0.001; ≥80 years: OR=11.738, 95% CI 9.459-14.663, P<0.001), male ( OR=1.371, 95% CI 1.229-1.529, P<0.001), and co-infection with hepatitis B virus (HBV) (positive serum HBV surface antigen, OR=0.629, 95% CI 0.484-0.817, P<0.001) were independent influencing factors for all cause mortality. Receiver-operating characteristic curve analysis showed that the area under the curve for male, age and current HBV infection prediction of all-cause death was 0.529 ( P<0.001), 0.724 ( P<0.001) and 0.514 ( P=0.042), respectively, and the cut-off value for age prediction of all-cause death was 65.5 years old. Compared with patients without HBV infection, MHD patients with HBV infection significantly reduced the proportion of severe and critically ill patients, all-cause hospitalizations and all cause deaths when infected with SARS-CoV-2 (4.99% vs. 6.41%, χ2=6.136, P=0.013; 8.90% vs. 11.44%, χ2=11.662, P<0.001; 2.01% vs. 3.37%, χ2=10.713, P=0.001, respectively). Conclusion:The MHD patients in Jiangsu province are susceptible to SARS-CoV-2. Elderly age and male gender are independent risk factors for death in MHD patients during the epidemic, while the HBV infection may be a protective factor for death of MHD patients infected with SARS-CoV-2.
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Podocyte infolding glomerulopathy (PIG) is a pathologic type of podocyte glomerulopathy reported recently. The characteristic is that the ultrastructure related to podocytes, such as microspheres and microtubules, are folded into the glomerular basement membrane (GBM) under electron microscope. At present, there are few reports about this disease at home and abroad, and most of them are concentrated in Japan. The clinical characteristics and pathogenesis of PIG are still unclear. In this paper, we report a case of clinical manifestations of nephrotic syndrome, renal biopsy indicated PIG, after the treatment of glucocorticoid, hydroxychloroquine and tacrolimus, the patient's clinical symptoms were relieved and urinary protein decreased.
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Objective To investigate the significance of combined detection of urine neutrophil gelatinase-associated lipocalin (NGAL),kidney injury molecule-1 (KIM-1),and interleukin-18 (IL-18) in early diagnosis of contrast-induced nephropathy (CIN).Methods A total of 367 hospitalized patients undergone CT angiography (CTA) was enrolled into this study from May 2015 to February 2017.According to the European Society of Urology and radiology (ESUR) guidelines 2011,CIN was diagnosed in 31 patients (CIN group),and a total of 30 non CIN patients were randomly selected as non-CIN group.Another 30 patients who were hospitalized during the same period without contrast media were randomly selected as the control group.The changes of serum creatinine (Scr),urinary NGAL,KIM-1,and IL-18 were detected before and 8 h,24 h and 72 h after CTA.The same serum and urinary samples were collected at the time of admission in the control group.The sensitivity and specificity values of combined urinary NGAL,KIM-1,and IL-18 in early diagnosis CIN were evaluated by the under area of the receiver operating characteristic curves and area under curve (AUC).Results (1) According to ESUR guidelines 2011,CIN was diagnosed in 31 patients (8.4％).(2) At 8h after CTA,the levels of urinary NGAL,KIM-1,and IL-18 were significantly increased in the CIN group,compared with non-CIN group (P ＜ 0.05).(3) The AUC,sensitivity and specificity for early diagnosis of CIN were 0.999,96.8％,and 100％,when combine urinary NGAL,KIM1,and IL-18,at 8h after CTA.AUC for 24 h,and 72 h after contrast media injection approach to 1.0,at this time sensitivity and specificity were 100％,and 100％,respectively.Conclusions (1) At 8 h after CTA,the urinary NGAL,KIM-1,and IL-18 levels were significantly increased in the CIN group.(2) The predictable time of CIN onset determined by urinary NGAL,KIM-1,and IL-18 was earlier than Scr,and the sensitivity and specificity is higher in these biomarkers than Scr in early diagnosis of CIN.Especially combination of urinary NGAL,KIM-1,and IL-18 is more valuable in predicting the sensitivity and specificity of the diagnosis,and can be used as an indicator for early diagnosis of CIN.
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Objective To detect DNA damage of peripheral blood lymphocytes in patients and family members of autosomal dominant polycystic kidney disease (ADPKD),and to study the effect of irradiation on genomic stability of lymphocytes. Methods Before and after 0.5 Gy radiation dose,single-cell gel electrophoresis (SCGE) was employed to analyze DNA damage of lymphocytes in 10 ADPKD patients (group A),3 members without clinical symptoms of a ADPKD family (group B) and 20 healthy control people (group C).The damage was estimated based on the content of DNA in tail (TDNA％) with comet analysis software (CASP). Results Both before and after irradiation,the TDNA％ (8.85％±0.14％,14.84％±0.77％) and the value-added (6.00％±0.77％) of TDNA％ of group A were significantly higher than those of group C (7.50％±0.37％,12.46％±0.26％,4.96％±0.44％) respectively.There were no significant differences between group B and group C or group A and group B.While 1 person in group B had higher TDNA％ as compared to group C both before and after irradiation. Conclusions The lymphocytes of ADPKD patients are more sensitive to ionizing radiation as compared to healthy people.The genomic instability in ADPKD patients or member of ADPKD family may trigger cystic formation in multi-organs when exposing to environmental agents. SCGE may provide a new approach to elucidate the pathogenesis and prognosis of ADPKD.
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Objective To compare the level of Annexin Ⅱ in patients with systemic lupus erythematosus(SLE),diabetic nephropathy(DN),chronic glomerulonephritis and normal controls,and explorle the significance of the annexin Ⅱ in SLE.Methods Thirty-five cases of patients with SLE,ten cases of patients with DN,ten cases of patients with chronic glomerulonephritis were enrolled in this study,twenty cases of healthy controls were also enrolled.Circulating annexin Ⅱ in white blood cells was detected bv flow cytometry.Student's t test,variance analysis and Lineat correlation analysis were used for statistial analysis.Resuits Compared with healthy controls,the level of annexin Ⅱ in white blood cells in SLE patients (7.1±2.9)%and DN patients(8.0±3.7)%were significantly lower than that of the healthy controls(P<0.01,p<0.05).In the SLE group,the level of annexin Ⅱ of patients who had more active disease(SLEDAI≥9)decreased more thall those with less active disease(SLEDAI<9),(P<0.05).A positive correlation was found between annexin Ⅱ and serum albumin level(r:0.439,P<0.01),but negative correlation was found between annexin and urine protein/urine creatinine(r=-0.382,P<0.05),SLEDAI(r=-0.417,P<0.05),D-dimer(r=-0.336.p＜0.05) levels.Conclusion The level of annexin Ⅱ is decreased in patients with SLE,so it can renectthe abnormality of coagulation and fibrinolytic systems,and it may be used as a good indicator for prothrombotic status in SLE patients.It can be helpful to evaluatethe activity of the disease and the therapeutic efficacy.
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Objective To investigate the pathogenesis of renal lesion in Fechtner syndrome . Methods Pathological characteristics of kidney tissues from Fechtner syndrome patients were explored by HE staining, immunochemistry, immunofluorescence and electron microscopy . Results Immunochemistry analysis showed that non-muscle myosin heavy chain IIA (NMMHC-IIA)was expressed in podocytes of giomeruli and distal convoluted tube, and was faintly expressed in the brush border of proximal tube . Histological examination demonstrated glomerulosclerosis and decreased expression of NMMHC-IIA in abnormal podocytes . Through standard immunofluorecence, the expression of NMMHC-IIA in patient's podocyte was higher than that in normal pedocytes . The fusion of foot process and microvillus were detected by electron microscopy . Conclusion Abnormal NMMHC-IIA aggregates in the glomeruli podocyts and foot process fusion accompanied with appearance of microvillus leads to renal lesion in Fechtuer syndrome .
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Hemodialysis is a major method to treat acute and chronic renal functional failure; while, dialysis-membrane is a major component of dialyzer, determining dialysis effect by the physical and chemical characteristics. In this study, we investigated the development orientation of hemodialysis, application of common membrane materials, and biocompatibility of dialysis-membrane materials; in addition, we also summarized the improvement of dialysis-membrane materials and the effect on hemodialysis during recent years.
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The supercritical carbon dioxide was used to extract polyunsaturated fatty acid methylesters from fish oil to concentrate eicosapentaenoic and docosahexaenoic acid. The effects of experimental;temperatures,pressures and solvent ratio were reported,and the optimal fractional conditions were studied.