Clinical features and initial outcomes in elderly patients with idiopathic membranous nephropathy / 中华老年医学杂志

Objective:The purpose of this study was to examine the clinical features and initial treatment outcomes of elderly individuals with idiopathic membranous nephropathy.Methods:This study retrospectively analyzed the clinical characteristics and therapeutic effect of hospitalized patients aged 60 years or older with renal-biopsy-proven idiopathic membranous nephropathy for at least one year.Results:This study enrolled a total of 91 elderly patients with IMN, consisting of 51 males(56.0%)and 40 females(44.0%). The median age of the patients was 67 years.The urinary protein creatinine ratio(uPCR)and urinary albumin creatinine ratio(uACR)of the patients were 4 454.3 mg/g and 2 258.5 mg/g, respectively.The median 24-hour urinary protein and urinary albumin levels were 5 098.2 mg/24 h and 2 800.6 mg/24 h, respectively.The average estimated glomerular filtration rate(eGFR)was(60.5±20.4)ml·min -1·1.73 m -2.Out of the total of 61 patients, 67.0% achieved remission, including complete and partial remission, within a year of renal biopsy.The levels of uPCR and uACR were significantly higher in the non-remission group compared to the remission group(5 462.5 vs.2 271.1 mg/g, P<0.001; 2 774.4 vs.1 320.0 mg/g, P=0.001). Additionally, the levels of 24h urinary protein and urinary albumin were significantly higher in the non-remission group compared to the remission group(6 526.4 vs.3 210.4 mg/g, P=0.002; 3 067.7 vs.2 102.4 mg/g, P=0.007). The remission group had a higher proportion of patients receiving immunosuppressive therapy(85.2% vs.33.3%, P<0.001). The remission rates were higher in patients treated with glucocorticoid combined with cyclophosphamide, glucocorticoid combined with calcineurin inhibitors, or glucocorticoid combined with mycophenolate mofetil compared to those receiving conservative treatment(88.2% vs.31.0%, P=0.001; 80.0% vs.31.0%, P<0.001; 100.0% vs.31.0%, P=0.007). There was no significant difference in remission rate between the three immunosuppressive therapy groups( P>0.05). However, upon further analysis, it was found that the levels of uPCR, uACR, and serum cystatin C(CysC)were higher in the immunosuppressive therapy groups compared to conservative treatment.Additionally, serum total protein and albumin were lower in the immunosuppressive therapy groups, and these differences were statistically significant( P<0.05). Conclusions:The majority of elderly patients diagnosed with IMN have multiple comorbidities.For those at high risk with elevated urinary protein levels, early initiation of immunosuppressive therapy may lead to a higher initial urinary protein remission rate.Therefore, it is advisable to develop individualized treatment plans for elderly patients with IMN based on their clinical characteristics, as well as the risks and benefits associated with immunosuppressive therapy.

Dendritic cell and M2 macrophages are associated with the severity of disease in IgA nephropathy patients / 中华肾脏病杂志

Objective@#To investigate the number and distribution of dendritic cells (DCs), macrophages and M2 macrophages in renal tissues of patients with IgA nephropathy (IgAN) and their correlation with clinicopathological parameters, and explore its role in the progression of IgAN.@*Methods@#Renal tissue samples from 42 patients aged ≥18 years with IgAN were collected by kidney biopsy in Guangdong Provincial People's Hospital from January 2018 to June 2018. The patients were divided into different groups according to Oxford classification and Lee grade classification criteria. The distribution and number of DCs (CD209), macrophages (CD68) and M2 macrophages (CD68 and CD206) were detected by immunohistochemistry. Spearman correlation test was used to analyze the correlation between the number of DCs and macrophages in renal tissues and clinical pathological parameters.@*Results@#The number of DCs in the glomeruli of the M1, T0 and C1 groups increased significantly compared with the M0, T1 and C0 groups, and the number of DCs in the renal interstitium of the T1 group increased significantly compared with the T0 group (all P<0.05). The number of glomerular macrophages in group C1 was significantly higher than that in group C0. The number of macrophages in S1, T1 and Lee IV-V tubulointerstitial groups was significantly higher than that in S0, T0 and Lee II-III groups (P<0.05). The number of M2 macrophages in the S1, T1 and Lee IV-V groups was significantly higher in the tubulointerstitial group than in the S0, T0 and Lee II-III groups (all P<0.05). The blood urea nitrogen, serum creatinine and 24 h urine protein levels in the T1 and Lee IV-V groups were significantly higher than those in the T0 and Lee II-III groups, and the serum albumin levels in the Lee IV-V group were significantly lower (all P<0.05). Spearman correlation analysis showed that the number of DCs in renal interstitium was positively correlated with the proportion of tubulointerstitial fibrosis. There were a positive correlation between the proportion of glomerular segmental sclerosis and tubulointerstitial fibrosis and renal interstitial macrophages and M2 macrophages. The number of M2 macrophages was positively correlated with serum creatinine and 24 h urine protein (both P<0.05).@*Conclusions@#The number of DCs and M2 macrophages in kidneys are positively correlated with the clinicopathological features of IgAN patients, which indicates that they may be associated with disease progression.

Analysis of compliance with medical therapy in elderly patients with benign prostatic hyperplasia / 中华老年医学杂志

Objective To investigate the compliance with medical therapy in elderly patients with benign prostatic hyperplasia (BPH).Methods The BPH patients aged 66 to 93 treated with 5α-reductase inhibitor (finasteride) and/or α-blockers (tamsulosin,doxazosin or terazosin) were followed up for 6 months.The retrospective data,including international prostatic symptom score (IPSS),quality of life (QOL),maximum flow rate (Qmax),prostate volume (PV),the information of medical types,total number of days of medication supplied,discontinuation and switching of therapy,and adverse effects were collected and analyzed.Results In all 103 subjects,30 patients (29.1％) received α-blockers,25 patients (24.3％) received finasteride,and 48 patients (46.6％)received combination therapy.After a follow-up of 6 months,the medication possession ratio (MPR)was 0.89±0.23 with a good-compliance rate (MPR≥0.8),discontinuation rate and switching rate were 79.6％ (82 cases),5.8％ (6 cases) and 6.8％ (7 cases),respectively,while the efficacy rate,the adverse reaction rate,incidence of acute urinary retention (AUR) and incidence of BPH related operations were 73.8％ (76 cases),12.6％ (13 cases),15.5％ (16 cases) and 4.9％ (5 cases),separately.The MPR (0.90±0.24) and good-compliance rate (84.0％) in patients treated with finasteride were both greater than those with α-blockers (0.87 ± 0.25,76.7％) and combination therapy (0.89 ±0.22,79.2％),but with no significant difference.Compared with patients with badcompliance,the efficacy ratio of medical therapy was significant higher in patients with goodcompliance (81.7％ vs.42.9％),while the incidence of adverse effects and AUR were significant fewer (7.3％ vs.33.3％ and 9.8％ vs.38.1％).Conclusions Elderly patients received either monotherapy or combination therapy with finasteride and α-blockers have good-compliance,which might be associated with the good effect of medical therapy and fewer adverse effects.

Impact of intermittent androgen deprivation therapy on prostate volume and lower urinary tract symptoms in patients with prostate cancer combined with prostatic hyperplasia / 中华老年医学杂志

Objective To explore the impact of intermittent androgen deprivation therapy on prostate volume and lower urinary tract symptoms (LUTS) in patients with prostate cancer combined with prostatic hyperplasia (BPH),and to evaluate the clinical effect of intermittent androgen deprivation therapy as compared with conventional drug in patients with BPH.Methods Patients with prostate cancer (n=57) and BPH (n=83) were respectively treated with intermittent androgen deprivation therapy and finasteride combined with alpha-receptor antagonist.Prostate volume,international prostate symptom score (IPSS),quality of life index (QOL) and maximum urinary flow rate (Qmax) in patients were observed before and 1,3,6 and 12 months after treatment.Results The improvements in prostate volume,IPSS,QOL and Qmax were higher in prostate cancer patients treated with intermittent androgen deprivation therapy than in BPH patients treated with finasteride combined with alpha-receptor antagonist (P ＜ 0.05).Conclusions Intermittent androgen deprivation therapy can significantly reduce prostate volume and improve LUTS in patients with prostate cancer,and has a better clinical effect than finasteride combined with alpha-receptor antagonist treatment.

Diagnostic and therapeutic status of the elderly outpatients with benign prostatic hyperplasia in Guangzhou / 中华老年医学杂志

Objective To evaluate the diagnostic and therapeutic status of lower urinary tract symptoms (LUTS) in the elderly outpatients with benign prostatic hyperplasia (BPH) in Guangzhou.Methods The investigation was conducted in outpatient departments for elderly patients in 3 hospitals of Guangzhou. The eligible male patients with LUTS/BPH were chosen from patients who came to the clinic in the process of investigation. Results The 29.7% (1824/6140) of them had history of LUTS/BPH previously or presently. In 134 patients received medical questionnaire, the proportion of LUTS/BPH patients with mild, middle and severe degree based on international prostate symptom score (IPSS) was 24.5%, 72.5% and 3.0% respectively. The abnormal percentage of PSA was 37. 3 %. The most common examinations that patients received were directeral rectun examination (96.8%), PSA (88. 7%) and transabdominal ultrasonography (84.8%). The 44.7% of cases were given the treatment of 5α-reductase inhibitor, and 24.7% of cases received a combination therapy of 5α-reductase inhibitor plus α receptor blocker. The 16.7% of cases were given a combination treatment of 5α-reductase inhibitor plus herbs. The proportion of therapy with α receptor blocker and herbs was similar (6.8% and 7.1% respectively). Conclusions LUTS/BPH is one of the most common diseases in elderly male patients. The examinations conducted by doctors are unreasonable.The doctors are easy to ignore inquirement of patient's history and IPSS. The drugs conducted by doctors are reasonable basically.

Effects of antibiotic treatment on the inflammatory mediator expression in peritoneum and the peritoneal transport function in the rat with acute bacterial peritonitis / 中国病理生理杂志

AIM: To observe the effect of antibiotic treatment on the inflammatory mediator expression in peritoneum and the peritoneal transport function in rats with acute peritonitis, and explore its mechanisms. METHODS: Eighty-six SD rats were randomly divided into three groups. Control group (n=28) were treated with PBS (ip), peritonitis group (n=28) and treatment group (n=28) were challenged with the E.coli (ip), but at 3 h and 9 h gentamicin was given (ip) in treatment group. Seven rats of every group were randomly sacrificed at 24 h, 48 h, 72 h and 7 d. Peritoneal equilibration test (PET) was did before they were killed. Leukocyte count, pathological changes and the expression of CD45, NF-?B, IL-1?, TNF-? in peritoneum were examined. RESULTS: (1)The blood leukocytes in peritonitis group decreased strikingly, but did not change obviously in other two groups. The peritoneal fluid leukocytes in peritonitis group increased significantly from 24 h to 72 h, while in treatment group, it enhanced more strikingly than peritonitis group at 24 h, and recovered earlier. (2) Both in peritonitis group and treatment group, the expression of activated NF-?B, IL-1?, TNF-? and CD45 increased significantly, but the treatment group was lower than model group at 48 h and 72 h. The mRNA level of IL-1? and TNF-? had the same trend as their protein expression. (3) Compared with the control group, UF and D/D_0 Glu decreased significantly in model group and treatment group, and D/PTP increased dramatically. The D/P TP in treatment group lowered obviously compared with peritonitis group, while the net UF and D/D_0 Glu had not significant difference between treatment group and model group. CONCLUSION: Antibiotic treatment can partly decrease the expression of inflammatory mediators in peritoneum of rats with acute peritonitis and also can improve the protein transport ability to some extent, but can not improve the peritoneal ultrafiltration and the glucose transport function.