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1.
Kidney Dis (Basel) ; 10(2): 89-96, 2024 Apr.
Article in English | MEDLINE | ID: mdl-38751797

ABSTRACT

Introduction: Venous valve-related stenosis (VVRS) is an uncommon type of failure of arteriovenous fistula among patients with end-stage renal disease (ESRD). There is a paucity of data on the long-term efficacy of ultrasound-guided percutaneous transluminal angioplasty (PTA) for VVRS. Methods: ESRD patients who underwent PTA because of VVRS between January 2017 and December 2021 at the First Affiliated Hospital of Chongqing Medical University were enrolled. Patients were classified into three cohorts (cohort1, VVRS located within 3 cm of the vein adjacent to the anastomosis; cohort2, VVRS located over 3 cm away from the anastomosis; cohort3, multiple stenoses). The patency rates were assessed by the Kaplan-Meier method and compared using the log-rank test. Univariate and multivariate Cox analyses were performed to identify the risk factors. Results: A total of 292 patients were enrolled, including 125 (42.8%), 111 (38.0%), and 56 (19.2%) patients in cohort1, cohort2, and cohort3, respectively. The median follow-up was 34.8 months. The 6-month, 1-year, 2-year, and 3-year primary patency rates were 86.0%, 69.4%, 47.5%, and 35.3%, respectively. The secondary patency rates were 94.5%, 89.4%, 75.5%, and 65.3%, respectively. Cohort1 showed a relatively better primary patency compared to cohort2 and cohort3. The secondary patency rates were comparable in the three cohorts. Duration of dialysis and VVRS type were potential factors associated with primary patency. Conclusions: This study showed acceptable long-term primary and secondary patency rates after PTA for VVRS in ESRD patients, especially for those with VVRS located within 3 cm of the vein adjacent to the anastomosis.

3.
J Vasc Access ; : 11297298231184649, 2023 Jul 18.
Article in English | MEDLINE | ID: mdl-37464769

ABSTRACT

BACKGROUND: Left brachiocephalic vein (LBCV) stenosis is a common complication in hemodialysis patients and is a heterogenous disorder associated with either prior catheterization or extrinsic compression. This study aimed to characterize patients with LBCV stenosis or occlusion with and without a history of central venous catheterization. METHODS: We performed a retrospective study in 84 hemodialysis patients with LBCV stenosis or occlusion with (n = 22) or without (n = 62) prior catheterization. We compared the clinical features, anatomical factors, restenosis after balloon venoplasty, and patency rates of patients in these two groups. RESULTS: In the cohort of 84 patients with LBCV stenosis or occlusion, 73.8% (62 patients) of them had no history of catheterization. Patients without prior catheterization had more stenotic lesions (p < 0.05) but less occlusive lesions (p < 0.05) than patients with prior catheterization. The space between the sternum and the aorta was narrower in patients without prior catheterization than that in patients with prior catheterization (p < 0.05). Percutaneous venography was performed in 81 patients, and the occurrence of recoil after venoplasty in patients without prior catheterization was significantly higher than that in patients with prior catheterization (p < 0.05). The rate of stent implantation was significantly higher in patients without prior catheterization than patients with prior catheterization (p < 0.05), whereas there was no significant difference in primary patency between the two groups. CONCLUSIONS: LBCV stenosis and occlusion are mainly due to extrinsic compression rather than prior central venous catheterization. Stent implantation is frequently required after venoplasty to treat LBCV obstructive lesions in patients without prior catheterization.

4.
Food Res Int ; 165: 112411, 2023 03.
Article in English | MEDLINE | ID: mdl-36869465

ABSTRACT

Salted egg yolks (SEY) have a desirable and unique flavor with multiple underlying applications in food processing, and their abundant lipids contribute to a creamy and pleasant aroma. However, it is important to maintain the stability of the SEY flavor, which depends to a large extent on the egg species and the processing method. This study aimed to extract different SEY lipids with conventional solvents, analyze the fatty acid composition, and screen the volatile compounds to elucidate the flavor differences between salted hen eggs and duck eggs. Compared to ethanol extraction, acetone-extracted lipids had lower acid value and viscosity, and almost had no phospholipid content. Fatty acid analysis revealed that the highest content of fatty acid in SEY lipids was oleic acid, followed by palmitic acid and linoleic acid, while there were significant variations of different SEY lipids in the fatty acid profiles. The volatile compounds were identified by headspace solid-phase microextraction-gas chromatography-mass spectrometry (HS-SPME-GC-MS), and the overall odor was detected by the electronic nose (E-nose). A total of 27 volatile compounds were analyzed in SEY lipids and divided into 8 chemical classes. The aldehydes, furans and pyrazines were decreased, and the hydrocarbons were increased compared with untreated SEY. The combination of the physical properties and flavor evaluation of SEY lipids could provide a theoretical basis for the extension of the characteristic flavor matrix in SEY.


Subject(s)
Egg Yolk , Odorants , Animals , Female , Chickens , Eggs , Fatty Acids
5.
J Vasc Access ; 24(6): 1507-1512, 2023 Nov.
Article in English | MEDLINE | ID: mdl-35164596

ABSTRACT

Arteriovenous (AV) grafts are an alternative vascular access for chronic hemodialysis. AV graft failure is often due to stenosis of the feeding artery, graft, or draining vein. We report four cases of AV graft dysfunction and failure rarely caused by graft delamination and dissection. Two males and two females aged 47-67 years had been on chronic hemodialysis. Ultrasound examination detected graft delamination and dissection between 1 and 33 months after Acuseal AV graft implantation. Two cases were successfully treated with stenting and partial graft replacement, respectively. False lumen volume reduction by fluid withdrawal failed to salvage the delaminated graft in one of the patients. The delamination and dissection of another case spontaneously resolved 5 months later. Graft delamination and dissection should be considered as a possible cause for AV graft dysfunction and failure. Stenting and graft replacement may be recommended to treat AV graft dissection and delamination.


Subject(s)
Arteriovenous Shunt, Surgical , Blood Vessel Prosthesis Implantation , Male , Female , Humans , Treatment Outcome , Blood Vessel Prosthesis Implantation/adverse effects , Graft Occlusion, Vascular/diagnostic imaging , Graft Occlusion, Vascular/etiology , Graft Occlusion, Vascular/surgery , Vascular Patency , Arteriovenous Shunt, Surgical/adverse effects , Renal Dialysis/adverse effects , Retrospective Studies , Blood Vessel Prosthesis/adverse effects
6.
Hemodial Int ; 26(4): E44-E47, 2022 10.
Article in English | MEDLINE | ID: mdl-35973968

ABSTRACT

A femoral artery pseudoaneurysm (FAP) is a serious complication of arterial injury. It can cause compression of the surrounding nerves and tissues, rupture and bleeding of the aneurysm, and formation and dislodgement of thrombi, and can lead to distal limb embolism, tissue necrosis, and infection. Computed tomography angiography and ultrasonography are the preferred techniques for diagnosis of FAP. This report describes the successful treatment of an FAP using an ultrasound-guided percutaneous intracavitary injection of a lyophilized human fibrin sealant. This treatment was safe, associated with minimal pain and complications, and clinically effective.


Subject(s)
Aneurysm, False , Femoral Artery , Aneurysm, False/diagnostic imaging , Aneurysm, False/drug therapy , Femoral Artery/diagnostic imaging , Femoral Artery/injuries , Fibrin Tissue Adhesive/therapeutic use , Humans , Renal Dialysis/adverse effects , Thrombin , Treatment Outcome , Ultrasonography , Ultrasonography, Interventional
7.
J Sci Food Agric ; 101(14): 6093-6103, 2021 Nov.
Article in English | MEDLINE | ID: mdl-33904600

ABSTRACT

BACKGROUND: The texture and structure of the duck egg white (DEW) gel under salt and heat treatment are crucial to its digestibility. Specifically, the structural changes of food protein gels have been recognized for their potential to regulate in vitro digestion. In this study, the effects of gel characteristics and simulated in vitro gastrointestinal digestion of DEW under combined salt and heat treatment were investigated. RESULTS: With the increase in salting time and temperature, a porous opaque gel with large particles was formed, the moisture content of DEW showed a downward trend, and the same was true for hardness changes. The microstructure suggested that, with the penetration of NaCl, DEW proteins were denatured, and the protein molecules gradually unfolded and then aggregated after 7 days. The secondary structure revealed that, as the salting time and temperature increased, the proportion of intermolecular ß-sheets and α-helices decreased. In terms of in vitro digestion, the highest digestibility was obtained at 14 days of salting combined with 100 °C heat treatment, and the digestibility was the lowest when marinated for 7 days at 121 °C. Liquid chromatography and tandem mass spectrometry (LC-MS/MS) indicated that the number of different types of peptides and specific peptides was positively correlated with the salting time and temperature of the DEW at the end of gastric digestion. CONCLUSIONS: Heat treatment at 100 °C has a higher in vitro digestibility than at 121 °C. Gels with low hardness, large pores, and rough textures are easier to digest by pepsin and release more peptides. © 2021 Society of Chemical Industry.


Subject(s)
Egg Proteins/metabolism , Egg White/chemistry , Food Handling/methods , Animals , Chromatography, Liquid , Digestion , Ducks , Egg Proteins/chemistry , Food Handling/instrumentation , Gastrointestinal Tract/metabolism , Gels/chemistry , Gels/metabolism , Hot Temperature , Humans , Peptides/chemistry , Peptides/metabolism , Protein Conformation, alpha-Helical , Sodium Chloride/analysis , Tandem Mass Spectrometry , Temperature
8.
J Vasc Surg ; 74(1): 217-224, 2021 07.
Article in English | MEDLINE | ID: mdl-33340700

ABSTRACT

OBJECTIVE: Arteriovenous fistula (AVF) is the preferred access for hemodialysis. Percutaneous transluminal angioplasty (PTA) has become a choice for AVF stenosis, and ultrasound has been used in PTA more frequently. METHODS: This single-center retrospective cohort study analyzed 129 patients who underwent PTA in the First Affiliated Hospital of Chongqing Medical University from January 2016 to December 2016. Angioplasty was performed using a noncompliant high-pressure balloon. The process was visualized by duplex scan. Our inclusion criteria were as follows: (1) stenoses or occlusions were located at the juxta-anastomosis site: the first 5 cm of the vein distal to the anastomosis; (2) stenosis was confirmed with the following conditions: (a) flow rates are <500 mL/min in the brachial artery and <200 mL/min in the fistula during dialysis, and (b) the stenosis diameter is <1.7 mm. We used the Kaplan-Meier curve to show the postintervention primary and secondary patency rates of patients with stenosis and occlusion. RESULTS: Altogether, 129 patients with 76 males were analyzed. Moreover, 104 have AVFs on the left arm, and only one patient had an ulnar-basilic AVF, whereas others had a radial-cephalic AVF. The postintervention primary patency rates are better in occlusion cases (P < .05), whereas secondary patency rates have no difference. The postintervention primary patency rates are better in patients without diabetes mellitus (P < .05), whereas the secondary patency rates had no difference. CONCLUSIONS: For juxta-anastomosis site stenosis or occlusion, PTA can be used to obtain satisfactory results.


Subject(s)
Angioplasty, Balloon , Arteriovenous Shunt, Surgical/adverse effects , Graft Occlusion, Vascular/therapy , Renal Dialysis , Ultrasonography, Doppler, Duplex , Ultrasonography, Interventional , Upper Extremity/blood supply , Vascular Patency , Adult , Aged , Angioplasty, Balloon/adverse effects , Female , Follow-Up Studies , Graft Occlusion, Vascular/diagnostic imaging , Graft Occlusion, Vascular/etiology , Graft Occlusion, Vascular/physiopathology , Humans , Male , Middle Aged , Retrospective Studies , Time Factors , Treatment Outcome
9.
BMC Nephrol ; 21(1): 234, 2020 06 22.
Article in English | MEDLINE | ID: mdl-32571240

ABSTRACT

BACKGROUND: Previous studies have not described the relationship between reducing radial artery diameter as well as increasing age and functional maturation of the radio-cephalic arteriovenous fistula (RCAVF) and no data identify these as linear relationship. The objective of this study was to perform trend analysis to assess these aspects. METHODS: Our retrospective cohort study enrolled and analyzed 353 follow-up cases that underwent first AVF creation. The artery and vein sizes were measured by ultrasound. We performed follow-up, a minimum of 3 months after surgery. Multivariable logistic regression analysis was used to identify independent risk factors inmaturation. Participant age was categorized into four groups (age ≤ 29, 30-49, 50-69, and 70-90 years). Radial artery diameter was categorized into four groups (≤ 1.9, >1.9 and ≤ 2.1, >2.1 and ≤ 2.4, >2.4 mm) according to median and interquartile ranges. We adjusted for confounders in four logistic models, and primary analyses were based on building ordered category models and tested P values for trends to estimate the relationship of radial artery diameter and each 20-year increase in age with risk of maturation. RESULTS: The mature RCAVF group included 301 cases, and the immature group included 52 cases. Radial artery diameter, age, and diabetes were independent risk factors of maturation. Odds ratios (ORs) associated with maturation reduced with increasing age, while ORs increased with increasing radial artery diameter. P values for trends(<0.05) were observed in all four models. A reduction in radial artery diameter and higher age were significantly associated with a higher incidence of immaturity after adjusting the multivariate models. The risks of immaturation were increased by more than 1.54 fold for each 20-year increase and increased by more than 1.34 fold for the smaller radial artery diameter group. CONCLUSION: Our findings suggest that a significantly higher immaturity risk of RCAVF was associated with increasing age and a reduction in radial artery diameter. Our study identified a linear exposure-response relationship of age and radial artery diameter with immaturity incident. A careful selection of patients will be helpful in improving AVF functional maturation.


Subject(s)
Arteriovenous Shunt, Surgical , Kidney Failure, Chronic/therapy , Radial Artery/diagnostic imaging , Renal Dialysis , Adult , Age Factors , Aged , Aged, 80 and over , Female , Hand/blood supply , Humans , Logistic Models , Male , Middle Aged , Multivariate Analysis , Organ Size , Radial Artery/pathology , Retrospective Studies , Ultrasonography
10.
BMC Nephrol ; 21(1): 112, 2020 03 31.
Article in English | MEDLINE | ID: mdl-32234034

ABSTRACT

BACKGROUND: The purse-string suture has been widely used for bleeding control after percutaneous interventions through arteriovenous fistula (AVF) and graft (AVG), and it requires suture removal the next day. This study aimed to introduce a simple method using a tourniquet to facilitate hemostasis following AVF or AVG sheath removal after percutaneous procedures. METHODS: Data were retrospectively collected and included all the consecutive patients who received bleeding control with a tourniquet after percutaneous AVF or AVG interventions. Hemostasis was facilitated using the tourniquet technique after sheath removal. RESULTS: A total of 1966 patients who received the tourniquet technique for bleeding control after percutaneous AVF or AVG interventions were included. Bleeding control was successfully achieved in all patients. Regarding complications, hematoma, thrombosis, and rebleeding occurred in 57 (2.9%), 11 (0.6%), and 8 (0.4%) patients, respectively. Neither pseudoaneurysm nor infection occurred in the patients. Age, gender, pre-existing diseases (including diabetes and hypertension), procedure count, sheath size, hemodialysis access type, and canalization route were similar between patients with and without complications. The primary patency rates at 6,12, 24, and 36 months were 85.0, 64.6, 53.8, and 41.6%, respectively. CONCLUSIONS: The tourniquet technique is an effective and safe approach for facilitating hemostasis after catheter-based percutaneous interventions of hemodialysis accesses.


Subject(s)
Arteriovenous Shunt, Surgical , Hemorrhage , Hemostatic Techniques , Renal Dialysis/methods , Tourniquets , Vascular Grafting , Arteriovenous Shunt, Surgical/adverse effects , Arteriovenous Shunt, Surgical/methods , China , Female , Graft Occlusion, Vascular/etiology , Graft Occlusion, Vascular/prevention & control , Hematoma/etiology , Hematoma/prevention & control , Hemorrhage/etiology , Hemorrhage/prevention & control , Hemostatic Techniques/adverse effects , Hemostatic Techniques/instrumentation , Humans , Kidney Failure, Chronic/therapy , Male , Middle Aged , Retrospective Studies , Risk Adjustment/methods , Vascular Grafting/adverse effects , Vascular Grafting/methods , Vascular Patency
11.
Int J Biol Macromol ; 155: 588-597, 2020 Jul 15.
Article in English | MEDLINE | ID: mdl-32234445

ABSTRACT

In the current study, we found an interesting phenomenon that fresh egg white (EW) undergo the sol-gel-sol transition with alkali treatment. The transformation behavior at different alkalinity (1.5%, 2.0%, and 2.5%) was investigated. As the gel formed, the hardness, lightness, surface hydrophobicity and the total number of identified peptides increased, and then, remarkable reduction when the gel collapsed. Rheological behavior indicated that the viscosity varied with shear rate. Fourier transform infrared spectroscopy (FTIR) showed that ß-sheets gradually decreased as the α-helices increased during gel-sol transformation. The quantification of EW peptides analysis revealed that there was no dramatic correlation between the number of identified peptides and alkalinity. It was concluded that the sol-gel-sol transition was strongly dependent on alkali levels, moreover, high concentration promoted gel formation as well as liquefaction. The EW transformation behavior induced by alkali had a significant effect on protein aggregation and denaturation, and further changed physicochemical properties.


Subject(s)
Alkalies/chemistry , Egg Proteins/chemistry , Egg White/chemistry , Gels/chemistry , Phase Transition , Animals , Ducks , Hydrophobic and Hydrophilic Interactions , Rheology , Viscosity
12.
Kidney Blood Press Res ; 41(2): 158-67, 2016.
Article in English | MEDLINE | ID: mdl-26919366

ABSTRACT

BACKGROUND/AIMS: Sinomenine, a pure alkaloid extracted from the Chinese medicinal plant Sinomenium acutum, and sinomenine hydrochloride (SN) has been successfully used for the therapy of rheumatoid arthritis (RA) and kidney diseases. Autophagy is a cytoprotective mechanism used by podocytes and other cells to alleviate the effects of oxidative stress, and angiotensin II (Ang II) significantly promotes podocyte autophagy. However, excessive autophagy may lead to cell death and podocyte depletion. The present study evaluated the effect of SN in podocytes induced by Ang II. METHODS: Podocytes were pretreated with graded concentrations (10(-8) M ∼ 10(-4) M) of SN and then stimulated with Ang II. The LC3B protein and the p47-phox membrane fraction were measured by Western blot. Autolysosomes were assessed by transmission electron microscopy. FACS was used to quantify the ROS produced by podocytes. The translocation of p47-phox to the membrane was investigated by immunofluorescence. RESULTS: The 10(-8) M ∼ 10(-4) M of SN alone did not effect ROS generation or podocyte autophagy. The 10(-8) M and 10(-6) M SN attenuated Ang II-induced autophagy in podocytes. Furthermore, SN decreased the level of ROS generation in Ang II-induced podocytes via inhibition of NOX subunit p47-phox translocation to the membrane. CONCLUSION: The appropriate concentration of SN attenuated Ang II-induced podocyte autophagy through ROS generation, at least in part, by regulating NOX subunit p47-phox translocation to the membrane.


Subject(s)
Angiotensin II/toxicity , Autophagy/physiology , Morphinans/pharmacology , NADPH Oxidases/metabolism , Podocytes/metabolism , Reactive Oxygen Species/metabolism , Autophagy/drug effects , Cell Line, Transformed , Exocytosis/drug effects , Exocytosis/physiology , Humans , NADPH Oxidases/antagonists & inhibitors , Oxidative Stress/drug effects , Oxidative Stress/physiology , Podocytes/drug effects , Podocytes/ultrastructure
13.
Medicine (Baltimore) ; 95(4): e2580, 2016 Jan.
Article in English | MEDLINE | ID: mdl-26825903

ABSTRACT

Few studies have analyzed the clinicopathologic characteristics and outcomes of lupus nephritis (LN) patients with antineutrophil cytoplasmic antibody (ANCA). The clinical and renal histopathologic data of 154 patients with biopsy-proven LN from 2011 to 2013 were analyzed retrospectively. The patients were followed up for a median period of 16.8 ±â€Š9.4 months, and their outcomes were analyzed. Multivariate Cox analysis was used to evaluate the independent factors for poor outcomes. Among the 154 LN patients, 26 (16.88%) were seropositive for ANCA. The incidences of alopecia, oral ulcer, photosensitivity and skin lesion, and psychosomatic manifestations in the ANCA-positive group were significantly higher than in the ANCA-negative group (P = 0.007, 0.02, 0.02, and 0.03, respectively). Compared with the ANCA-negative group, the ANCA-positive group had significantly lower levels of complement C3 (P = 0.03). Additionally, the positive rate of antinucleosome antibodies, antihistone antibodies, antimitochondrial antibody M2, and anticardiolipin antibodies were higher significantly in the ANCA-positive patients than in the ANCA-negative patients (P = 0.001, 0.001, 0.03, 0.005, respectively). The ANCA-positive group had a notably higher chronic index than the ANCA-negative group (P = 0.01). During the follow-up, the complete remission rate in the ANCA-negative group was higher than that in the ANCA-positive group (P = 0.01). The cumulative renal survival rate in the ANCA-positive group was significantly lower than in the ANCA-negative group (log-rank = 6.59, P = 0.01). Multivariate Cox analysis revealed that the reduced estimated glomerular filtration rate (HR, 1.02; 95% confidence interval, 1.01 to 1.03; P = 0.005), NLR (HR, 1.20; 95% confidence interval, 1.02 to 1.40; P = 0.03), and ANCA (HR, 3.37; 95% confidence interval, 1.12 to 10.09; P = 0.03) were independent risk factors for patients' renal survival after adjusting for age, sex, crescent formation, and glomerulosclerosis. The study found ANCA in LN patients is not rare, and patients with ANCA present with more severe clinicopathologic injuries. Thus, ANCA is an independent risk factor for poor renal outcomes in LN patients.


Subject(s)
Antibodies, Antineutrophil Cytoplasmic/blood , Lupus Nephritis/pathology , Lupus Nephritis/physiopathology , Adult , Alopecia/complications , Antibodies, Anticardiolipin/blood , Complement C3/metabolism , Female , Follow-Up Studies , Glomerular Filtration Rate , Histones/immunology , Humans , Lupus Nephritis/complications , Lymphocyte Count , Male , Middle Aged , Mitochondria/immunology , Neutrophils , Nucleosomes/immunology , Oral Ulcer/complications , Photosensitivity Disorders/complications , Prognosis , Psychophysiologic Disorders/complications , Retrospective Studies , Survival Rate , Young Adult
14.
Clin Nephrol ; 84(3): 156-64, 2015 Sep.
Article in English | MEDLINE | ID: mdl-26249551

ABSTRACT

BACKGROUND: There are few reports of IgA nephropathy (IgAN) with antineutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis. METHODS: The authors report the clinical and pathological findings in 14 patients with IgAN and ANCA seropositivity. RESULTS: These retrospective cases consisted of 4 men and 10 women with a mean age of 44.4 ± 12.7 years. ANCA-positivity was documented by EUROBlot kits and indirect immunofluorescence in all patients. The results of EUROBlot kits were positive in 14 patients (12 MPO-ANCA, 2 PR3-ANCA). Indirect immunofluorescence was positive in 14 patients (12 P-ANCA, 2 C-ANCA). Three of 14 IgAN with ANCA-positive patients showed severe clinical manifestations with crescents involving a mean of 56% glomeruli, including heavy proteinuria (mean 24-hour urine protein: 3.8 g/d), hematuria and acute renal failure (mean creatinine: 4.5 ± 3.7 mg/dL). The remaining 11 patients with no crescents showed various degrees of proteinuria (mean 24-hour urine protein: 2.4 ± 2.4 g/d), hematuria and serum creatinine levels (median creatinine: 0.9 (IQR, 0.5 - 1.4) mg/dL). The follow-up period for 10 patients had an average length of 14.0 ± 11.2 months. Among the three patients with crescents who had been treated with steroids and cyclophosphamide, one patient became dialysis dependent at the time of biopsy and remained on dialysis after treatment, another died of acute heart failure, and the last one showed improvement in renal function after treatment and did not develop end-stage renal disease (ESRD) 26 months after renal biopsy. The remaining 7 patients with no crescents were treated with steroids, cyclophosphamide, renin-angiotensin system inhibitors, and/or Traditional Chinese Medicine; 6 had stabilized or improved renal function and one progressed to ESRD with worsening renal function. CONCLUSIONS: These findings suggest not all ANCAs are involved in the pathology of IgAN. In patients with IgAN and ANCAs, identification of pathogenic vs. non-pathogenic ANCAs is recommended.


Subject(s)
Antibodies, Antineutrophil Cytoplasmic/blood , Glomerulonephritis, IGA , Acute Kidney Injury , Adult , Female , Glomerulonephritis, IGA/blood , Glomerulonephritis, IGA/epidemiology , Glomerulonephritis, IGA/physiopathology , Hematuria , Humans , Male , Middle Aged , Retrospective Studies
15.
Arthritis Res Ther ; 15(5): R161, 2013 Oct 24.
Article in English | MEDLINE | ID: mdl-24286516

ABSTRACT

INTRODUCTION: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is characterised by the autoinflammation and necrosis of blood vessel walls. The renal involvement is commonly characterised by a pauci-immune crescentic glomerulonephritis (PiCGN) with a very rapid decline in renal function. Cathelicidin LL37, an endogenous antimicrobial peptide, has recently been implicated in the pathogenesis of autoimmune diseases. To assess whether serum LL37 reflects renal crescentic formation, we measured the serum levels of LL37 in AAV patients with and without crescentic glomerulonephritis (crescentic GN) as compared to healthy controls (HCs). We also analysed the correlation of the serum levels of LL37 and interferon-α (IFN-α) with the clinical characteristics of the patients. METHODS: The study population consisted of 85 AAV patients and 51 HCs. In 40 ANCA-positive patients, a parallel analysis was performed, including the assessment of LL37 and IFN-α levels in the serum and renal biopsies. Of those studied, 15 AAV patients had biopsy-proven crescentic GN, and 25 AAV patients lacked crescent formation. The serum levels of cathelicidin LL37 and IFN-α were both measured by ELISA, and the clinical and serological parameters were assessed according to routine procedures. Immunofluorescence staining was performed on frozen sections of kidney needle biopsies from AAV patients with crescentic GN. RESULTS: The serum levels of LL37 and IFN-α were significantly increased in AAV patients with crescentic GN compared to AAV patients without crescentic formation and HCs, and patients with high LL37 and IFN-α levels were more likely to be in the crescentic GN group. The LL37 levels were positively correlated with the IFN-α levels, and both LL37 and IFN-α levels showed a positive correlation with serum creatinine and no correlation with complement C3. The renal tissue of crescentic GN patients showed expression of LL37 and IFN-α at the Bowman's capsule and extracellular sites, suggesting the active release of LL37 and IFN-α. CONCLUSIONS: Significantly higher levels of LL-37 and IFN-α were observed in AAV patients, particularly those with crescentic formation, and LL37 and IFN-α were expressed in the renal tissue of patients with crescentic GN. These data suggest that serum levels of LL37 and IFN-α may reflect both local renal inflammation and systemic inflammation.


Subject(s)
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/blood , Cathelicidins/blood , Glomerulonephritis/complications , Peptide Fragments/blood , Adolescent , Adult , Aged , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/complications , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/immunology , Antibodies, Antineutrophil Cytoplasmic/immunology , Biopsy , Cells, Cultured , Child , Enzyme-Linked Immunosorbent Assay , Female , Glomerulonephritis/pathology , Humans , Interferon-alpha/blood , Kidney/pathology , Male , Microscopy, Confocal , Microscopy, Electron, Scanning , Middle Aged , Neutrophils/immunology , Neutrophils/metabolism , Neutrophils/ultrastructure , Young Adult
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