Detection of microRNA-33a-5p in serum, urine and renal tissue of patients with IgA nephropathy.

The present study aimed to detect the levels of microRNA (miR)-33a-5p in the renal tissue, serum and urine of patients with primary IgA nephropathy (IgAN), thereby preliminarily exploring the association between the levels of miR-33a-5p and the condition of primary IgAN to provide evidence for the expression of miR-33a-5p in the serum and urine of IgAN patients as a clinical marker. Reverse-transcription quantitative PCR was performed to evaluate the level of miR-33a-5p in IgAN patients according to severity and pathological classification. The results suggested that the levels of miR-33a-5p in the serum, urine and kidney tissues of patients with IgAN were lower than those of the control tissues obtained from cancer patients (0.28±0.25 vs. 1.00±0.45, P<0.05; 0.34±0.28 vs. 1.00±0.53, P<0.05; 0.47±0.27 vs. 1.00±0.38, P<0.05, respectively). Receiver operating characteristic curve analysis suggested that the serum and urine levels of miR-33a-5p may be used as a marker to differentiate renal injury in IgAN patients from healthy individuals. At the same time, according to the estimated glomerular filtration rate (eGFR) and Lee classification of nephropathy, it was determined that with the progression of renal failure and the increase of the pathological grade of kidney tissue, the relative level of miR-33a-5p in kidney tissue also decreased (eGFR <50 ml/min vs. eGFR ≥50 ml/min/1.73 m2 group: 0.38±0.27 vs. 1.00±0.34, P<0.001; Lee grade ≤3 group vs. Lee grade >3: 1.00±0.48 vs. 0.38±0.45, P<0.05). This result suggested that the levels of miR-33a-5p in serum, urine and kidney tissues decreased with the severity of renal injury and the progression of renal failure in patients with IgAN. Hence, miR-33a-5p detected in the serum and urine may be used as a non-invasive biomarker to reflect the progression of renal injury and renal failure in patients with IgAN.

Association between nutrition support and acute gastrointestinal injury in critically ill patients during the first 72 hours.

BACKGROUND & AIMS: The impact of nutrition support on patients with acute gastrointestinal injury (AGI) has not been fully determined. This study aimed to 1) investigate the relationship between nutrition support and AGI, as well as nutrition support and prognosis in critically ill AGI patients and 2) evaluate the prognostic benefits of nutrition support in different severity categories of AGI patients. METHODS: This prospective study included 379 patients in whom AGI occurred in the first 72 h after admission from 12 teaching hospitals in China. Clinical characteristics including demographics, APACHE II score, modified NUTRIC score, SOFA score, calories of nutrition, and 7 and 28-day mortality were recorded. Multiple logistic regression analysis was applied to identify the risk factors for mortality. The survival benefit of nutrition support as reflected by calories of nutrition in 72 h was evaluated for patients categorized according to their APACHE II, modified NUTRIC, and SOFA scores. RESULTS: Patients were classified into Grades I (n = 141), II (n = 173), III (n = 48), and IV (n = 17). Significant differences were observed among different AGI grade cohorts (I-IV) in terms of APACHE II, SOFA, and modified NUTRIC scores and calories of enteral nutrition (EN), parenteral nutrition (PN), and EN + PN. Ordinal logistic regression analysis showed that only SOFA score was an independent risk factor for AGI grades (P < 0.001). APACHE II score, mechanical ventilation (MV), AGI grades, and calories of EN + PN intake were independent risk factors for 28-d mortality. Increased nutritional intake was associated with reduced mortality in severely ill patients with APACHE II scores ≥15 (P = 0.007). CONCLUSIONS: AGI grade affected the intake of calories and was one of the risk factors for 28-d mortality. The nutrition intake of patients with AGI grade III to IV was almost only PN. The positive association between nutrition support and prognosis was more apparent in AGI patients with higher APACHE II scores.

Diagnostic Value of Urinary miR-152-5p in Patients with IgA Nephropathy with Elevated Proteinuria Levels.

BACKGROUND: The current study aims to observe the correlation between the expression of miR-152-5p in urine samples and the condition of IgA nephropathy (IgAN). METHODS: From January 2017 to October 2017, 40 patients with IgAN, 10 patients with mild glomerular lesions, 10 patients with membranous proliferative glomerulonephritis type I, 10 patients with focal segmental glomeruloscle-rosis, 10 patients with Henoch-Schonlein purpura nephritis, and 10 patients with lupus nephritis. Meanwhile, 25 healthy controls were also included in the physical examination center of our hospital. The expression level of miR-152-5p was detected by RT-qPCR. The correlation between the expression level of miR-152-5p and patholog-ical Haas grading and urinary protein was analyzed. RESULTS: The expression level of miR-152-5p in IgA nephropathy patients was higher than that in other types of glomerulonephritis and healthy control group (p < 0.0001). Meanwhile, the level of miR-152-5p in IgAN patients with high score (p < 0.01) was significantly increased. Furthermore, the level of miR-152-5p was positively corre-lated with the level of urinary protein and the degree of renal pathological damage (r2 = 0.89, p < 0.01). CONCLUSIONS: The expression of urinary miR-152-5p is positively correlated with IgA nephropathy, which provides a new way for early diagnosis and treatment of IgA nephropathy with elevated proteinuria.

Protective or deleterious role of Wnt/beta-catenin signaling in diabetic nephropathy: An unresolved issue.

In recent years, the Wnt/ß-catenin signaling has gained tremendous attention due to its ability to modulate a number of diseases including diabetic nephropathy. Studies have shown that there is decrease in the secretion of Wnt proteins including Wnt4, 5a and Wnt 6 during high glucose concentration or diabetic conditions, which leads to decreased translocation of ß-catenin to nucleus. The down-regulation of Wnt/ß-catenin signaling leads to detrimental effects on kidney including increased apoptosis of mesangial cells and increased deposition of fibrous tissue in mesangium. The pharmacological modulators such as spironolactone, NO donor and antioxidant are shown to produce beneficial effects in diabetic nephropathy by up regulating the expression of Wnt proteins and activation of diabetes-induced suppressed Wnt/ß-catenin signaling. On the other hand, it is documented that diabetes leads to overactivation of Wnt1/ß-catenin signaling, which promotes podocyte injury, induce epithelial-mesenchymal transition of podocytes along with renal injury and fibrosis. Accordingly, different interventions aimed to suppress overactivated Wnt/ß-catenin signaling are reported to improve the condition and symptoms associated with diabetic nephropathy. The present review discusses the dual role of Wnt/beta-catenin signaling in the pathogenesis of diabetic nephropathy.

[An application of arterial pressure-based cardiac output measurements in fluid management strategies of critically ill patients].

OBJECTIVE: To discuss the clinical significance of fluid management of severe patients according to arterial pressure-based cardiac output (APCO) monitoring volume responsiveness index. METHODS: A retrospective cohort study was conducted. The severe patients were selected from the intensive care unit (ICU) of the First Hospital of Jilin University from June 1st, 2012 to December 31st, 2013. The hemodynamic parameters were monitored by APCO, and the fluid resuscitation was managed by stroke volume variation (SVV) and passive leg-raising test (PLR) when the acute physiology and chronic health evaluation II (APACHEII) score ≥ 15, heart rate >100 bpm with the result that the preload and heart function could not be evaluated. The heart rate, SVV, lactic acid (Lac) and central venous pressure (CVP) and curative effect were recorded before and after carrying out fluid management strategy. The criteria of clinical effective was defined as heart rate decreased and (or) stroke volume (SV) increased ≥ 10%, accompanied by blood Lac and SVV decreased, other than, the cases did not meet above criteria were considered ineffective. RESULTS: Sixty-eight patients were enrolled in the study. (1) Before carrying out fluid management strategy: 40 cases with CVP>12 cmH2O (1 cmH2O=0.098 kPa), and 16 cases with 5-12 cmH2O, 12 with <5 cmH2O. SVV>13% in 35 cases, SVV <13% in 9 cases. PLR positive in 18 cases, and PLR negative in 6 cases. It was implicated that the patients with poor preload (SVV>13% and PLR positive) accounted by 77.9% (53/68). (2) There were 49 effective cases and 19 ineffective cases 4 hours after carrying out fluid management strategy, and the effective rate was 72.06% (49/68). While there were 56 effective cases and 12 ineffective cases after 12 hours, and the total effective rate was 82.35% (56/68). (3) In effective group, heart rate, SVV, Lac after fluid management strategy were significantly lower than those before fluid management strategy [4 hours after fluid management strategy: heart rate (bpm) 112.45 ± 13.53 vs. 129.55 ± 15.49, SVV (15.47 ± 6.32)% vs. (21.20 ± 7.40)%, Lac (mmol/L) 4.16 ± 3.12 vs. 6.21 ± 4.11; 12 hours after fluid management strategy: heart rate (bpm) 110.02 ± 13.92 vs. 129.61 ± 14.93, SVV (14.61 ± 15.52)% vs. (20.66 ± 7.40)%, Lac (mmol/L) 3.35 ± 2.26 vs. 6.11 ± 4.02, P<0.05 or P<0.01], while there was no significant difference in those markers between before and after fluid management strategy in ineffective group [4 hours after fluid management strategy: heart rate (bpm) 119.53 ± 11.68 vs. 125.79 ± 11.58, SVV (16.95 ± 6.48)% vs. (18.47 ± 4.96)%, Lac (mmol/L) 5.55 ± 3.80 vs. 6.54 ± 3.72; 12 hours after fluid management strategy: heart rate (bpm) 115.92 ± 11.71 vs. 123.40 ± 11.59, SVV (17.17 ± 6.09)% vs. (19.42 ± 8.25)%, Lac (mmol/L) 6.33 ± 3.40 vs. 7.21 ± 3.81, all P>0.05]. CVP only at 12 hours after fluid management strategy in effective group was significantly higher than that before fluid management strategy (cmH2O: 12.8 8 ± 3.38 vs. 11.27 ± 4.97, P<0.05). CONCLUSIONS: SVV monitored by APCO is a good indicator of volume responsiveness index, which can be used as an important reference combined with PLR for fluid management of severe patients.