Organizing Pneumonia in A Patient Double-Positive for ANCA and Anti-GBM Antibodies: A Case Report.

Both anti-glomerular basement membrane (GBM) disease and the anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) are common causes of pulmonary-renal syndrome. Organizing pneumonia (OP), a special pattern of interstitial lung disease, is extremely rare either in AAV or anti-GBM disease. We report an old woman presented with OP on a background of co-presentation with both ANCA and anti-GBM antibodies.

Renal Amyloidosis Secondary to ANCA-Associated Vasculitis: A Case Report.

Renal amyloidosis secondary to anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis is extremely rare. Here, we reported a 77-year-old woman with ANCA-associated vasculitis. Renal biopsy with Masson trichrome staining showed pauci-immune crescentic glomerulonephritis, and electron microscopy showed amyloid deposition in the mesangial area. Immunofluorescence revealed kappa light chain and lambda light chain negative. Bone marrow biopsy revealed no clonal plasma cell. Finally, she was diagnosed as ANCA-associated vasculitis with secondary renal amyloid A amyloidosis.

Construction of novel antiplatelet modified polyethersulfone membrane and study into its blood compatibility.

Blood purification therapy is widely used in patients with renal insufficiency and severe infections, where membrane-associated thrombosis is a side effect. How to improve the hemocompatibility of dialysis membranes and reduce thrombosis is a focus of current research, in which platelets play a key role. However, few dialysis membranes that directly inhibit platelets have been developed to date. In this study, a polyethersulfone (PES) membrane was modified with ticagrelor, a platelet P2Y12 receptor inhibitor, and detailed characterization was performed. The ticagrelor modified PES membrane (TMPES) showed good hydrophilicity and anti-protein adsorption and significantly inhibited platelet adhesion, aggregation, and activation, which demonstrated good antithrombotic properties. In addition, the membrane had excellent red blood cell (RBC) compatibility, anticoagulant, and antiinflammatory effects, which demonstrated superior biosafety in cell and animal experiments. Therefore, the TMPES dialysis membrane could have potential in clinical applications.

Renal Amyloidosis Secondary to ANCA-Associated Vasculitis: A Case Report / 中国医学科学杂志(英文版)

Renal amyloidosis secondary to anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis is extremely rare. Here, we reported a 77-year-old woman with ANCA-associated vasculitis. Renal biopsy with Masson trichrome staining showed pauci-immune crescentic glomerulonephritis, and electron microscopy showed amyloid deposition in the mesangial area. Immunofluorescence revealed kappa light chain and lambda light chain negative. Bone marrow biopsy revealed no clonal plasma cell. Finally, she was diagnosed as ANCA-associated vasculitis with secondary renal amyloid A amyloidosis.

Acute Peritoneal Dialysis System for Neonates with Acute Kidney Injury Requiring Renal Replacement Therapy: A Case Series.

BACKGROUND: Acute kidney injury (AKI) is common in critically ill neonates, and peritoneal dialysis (PD) can be a lifesaving option. In China, however, much of the equipment for PD in neonates is not available. We describe results with a novel system for PD, which has been developed locally to improve access to therapy and care for critically ill neonates requiring PD in China. METHODS: The system comprises a 14-gauge single-lumen central venous catheter serving as a PD catheter, inserted by Seldinger technique, with an adapted twin bag PD system. Ten neonates with AKI were treated using the novel PD system. RESULTS: The 10 patients ranged in age from 1 day to 22 days, with bodyweights between 700 g and 3,300 g. Average time to renal function recovery was between 14 and 96 hours. Complications related to the novel PD system included leak (n = 1), catheter displacement (n = 1), and catheter obstruction (n = 1). There were no complications related to insertion, no cases of peritonitis or exit-site infection, and no subsequent hernias. A comparison of costs indicated that the novel PD system is less expensive than conventional systems involving open insertion of Tenckhoff catheters. CONCLUSIONS: Peritoneal dialysis using the novel PD system is simple, safe, and effective for suitable neonates with AKI in China.

Synthesis and biocompatibility of an argatroban-modified polysulfone membrane that directly inhibits thrombosis.

Anticoagulation therapy plays a vital role in the prevention of blood clot formation during hemodialysis and hemofiltration, especially for critical care patients. Here, we synthesized a novel argatroban (Arg)-modified polysulfone (PSf) membrane for anticoagulation. Arg was grafted onto the PSF membrane via chemical modification to increase membrane hydrophilicity. Protein adsorption, coagulation, as well as activation of platelets and complement systems were greatly reduced on the Arg-modified PSf membrane. Thus, the recalcification time and the activated partial thrombin time (APTT) were increased after the modification. In comparison with the pristine PSf membrane, the Arg-modified PSf membrane showed better hemocompatibility and anticoagulation properties, indicating its potential for applications in hemodialysis and hemofiltration. Modification of the PSf membrane has been investigated in attempts to further enhance the anticoagulation properties of the hemodialysis membranes, including a heparin-modified PSf membrane. However, heparin can inhibit plasma-free thrombin, and cause the occurrence of heparin-induced thrombocytopenia (HIT), which increases the risk of bleeding during dialysis in critical care patients. To address this problem, we modified PSf membrane with as a novel direct thrombin inhibitors, argatroban (Arg). It can reversibly bind to thrombin, inhibiting not only the plasma-free thrombin in the blood, but also clot-bound thrombin.

High-Flux Hemodialysis Benefits Hemodialysis Patients by Reducing Serum FGF-23 Levels and Reducing Vascular Calcification.

BACKGROUND: High- and low-flux hemodialysis (HFHD and LFHD, respectively) are dialysis procedures designed to eliminate blood toxins that accumulate in end-stage renal disease. HFHD may reduce vascular calcification by removing serum fibroblast growth factor 23 (FGF-23). However, whether HFHD is better than LFHD is still under debate. We therefore compared the efficacy of HFHD and LFHD in controlling FGF-23 and vascular calcification. MATERIAL AND METHODS: Fifty hemodialysis patients were recruited and randomly treated with either HFHD or LFHD. Fasting venous blood was collected at baseline, six months, and twelve months after the treatment. We then measured levels of FGF-23, calcium, phosphorus, parathyroid hormone, and alkaline phosphatase. Further, abdominal lateral radiographs were taken to calculate aorta abdominalis calcification scores (AACs). RESULTS: Compared to the LFHD group, FGF-23 and AACs in the HFHD group significantly decreased after 12 months treatment (p=0.049 and p=0.002, respectively). AACs were positively correlated with FGF-23 in all patients (p=0.004), the HFHD group alone (p=0.040), and the LFHD group alone (p=0.037). We also found that older patients, patients with higher blood phosphorus levels, and higher FGF-23 levels had an increased risk of aorta abdominalis calcification (p=0.048, p=0.003, p=0.001, respectively). HFHD was more able to reduce the risk of aorta abdominalis calcification than LFHD (p=0.003). CONCLUSIONS: FGF-23 is an independent risk factor for the development of vascular calcification. HFHD may benefit hemodialysis patients by reducing serum FGF-23 levels and controlling vascular calcification.

[Effect of integrin-linked kinase on renal tubular epithelial cell transdifferentiation in diabetic rats].

OBJECTIVE: To determine the effect of integrin-linked kinase(ILK) in renal tubular epithelial cells and its relation to tubular epithelial-myofibroblast transdifferentiation. METHODS: Wistar rats were randomly divided into 3 groups, Group normal control (n=10), Group diabetic without therapy(n=10) and Group diabetic with Losartan 20mg/(kg . d)(n=10). Five rats were killed in each group at the 8th and 16th week. The left kidneys were kept for HE and Masson staining to observe the pathological variations in the renal interstitium. ILK, alpha-SMA and Vimentin in renal tubular epithelial cells were detected by immunohistochemistry analysis. RESULTS: Compared with the control group, ILK, alpha-SMA and Vimentin in renal tubular epithelial cells in Group diabetes gradually increased in immunohistochemistry (P<0.01); ILK was consistent with the pathological variation of renal interstitium and was positively correlated to alpha-SMA(rs=0.621, P<0.05). In comparison with the Group diabetes, the expression of ILK, alpha-SMA and Vimentin in renal tubular epithelial cells was apparently declined (P<0.01) in Group diabetes with Losartan. CONCLUSION: Tubular epithelial myofibroblast transdifferentiation and the over-expression of ILK, between which there may be significant connections, are important events in the progression of diabetic nephropathy. Losartan, a blocker of angiotension II type I receptor, which may down-regulate the expression of ILK in diabetic renal tubular epithelial cells, can restrain the procession of epithelial-myofibroblast transdifferentiation.

Level of asymmetric dimethylarginine and carotid atherosclerosis in patients with chronic kidney disease.

OBJECTIVE: To determine the association between asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide (NO) synthase, with atherosclerosis in patients with chronic kidney disease (CKD). METHODS: One hundred thirty-eight CKD patients were enrolled in this study. Serum levels of L-arginine, ADMA, and SDMA were measured by high-performance liquid chromatography (HPLC). Common carotid arteries intimae-medial thickness (CCA-IMT), cross-sectional calculated intimae-medial thickness (cIM area) and atherosclerotic plaque were detected by noninvasive high-resolution B-mode ultrasonography. RESULTS: Serum levels of ADMA and SDMA were significantly increased in CKD patients (n=138) compared with age matched healthy subjects (n=42, P<0.01). ADMA and SDMA levels increased with the progression of renal dysfunction and were negatively related to creatinine clearance (Ccr) in pre-dialysis patients (r=-0.315, P<0.05; r=-0.426, P<0.01). Serum levels of ADMA and SDMA in dialysis patients (n=74) were significantly higher than those in pre-dialysis patients (P<0.05). Patients with carotid artery plaques showed significantly higher levels of ADMA compared with those without plaques. Serum levels of ADMA closely correlated with the mean IMT (r=0.471, P<0.01) and cIM area value (r=0.430, P<0.01). These correlations remained significant even after adjusting GFR, age, gender ,and other risk factors for atherosclerosis in the multiple regression analysis. CONCLUSION: Serum levels of ADMA increased with the progression of CKD and may play a role in the pathogenesis of accelerated atherosclerosis in CKD patients.

[Extracorporeal membrane oxygenation treatment with high-volume hemofiltration in patients with multiple organ dysfunction syndrome].

OBJECTIVE: To evaluate whether extracorporeal membrane oxygenation (ECMO) with high-volume hemofiltration (HVHF) improves hypoxemia and renal function in patients with multiple organ dysfunction syndrome (MODS). METHODS: The study was executed in 8 MODS patients with acute respiratory distress syndrome (ARDS) and acute renal failure (ARF). They were randomly assigned to either 8 hours of HVHF combined with ECMO or HVHF alone in random order. The changes in arterial oxygen pressure(PO(2)), pulse oxygen saturation (SpO(2)), arterial carbon dioxide pressure (PCO(2)), serum creatinine (SCr) and blood urea nitrogen (BUN) levels were measured. RESULTS: Compared with that of before the treatment, PO(2) was increased significantly at 1, 4, 8 hours, and SpO(2) was increased significantly at 4, 8 hours after ECMO with HVHF in MODS patients, the changes of PO(2), SpO(2)and PCO(2)were not significantly during HVHF (all P>0.05). The average concentrations of BUN and SCr were decreased significantly after HVHF or HVHF with ECMO therapy in MODS patients. CONCLUSION: HVHF with ECMO, which can improve hypoxemia significantly, may be a better option for the treatment of MODS patients.

[Effects of high-volume hemofiltration on serum levels of tumor necrosis factor and its receptors in patients with multiple organ dysfunction syndromes].

OBJECTIVE: To investigate whether serum tumor necrosis factor-alpha (TNF-alpha) and its receptors can be removed by high-volume hemofiltration (HVHF) or continuous veno-venous hemofiltration (CVVH). METHODS: The study was performed in 12 multiple organ dysfunstion syndrome (MODS) patients with acute renal failure (ARF). They were randomized to receive either CVVH (n=10) or HVHF (n=8). TNF-alpha and soluble tumor necrosis factor-receptor (sTNF-R1 and sTNF-R2) concentrations were measured in serum by enzyme-linked immunoadsorbent assay (ELISA). RESULTS: Compared with that before the therapy, the average concentrations of plasma creatinine and urea were decreased significantly 8 hours after HVHF or CVVH in MODS patients with ARF (P<0.001). In patients on HVHF, the serum TNF-alpha concentrations were significantly lower 8 hours after treatment (P<0.01) compared with that before treatment, 1 hour and 4 hours after treatment. There were not significant changes in the serum TNF-alpha concentrations in patients on CVVH and the serum sTNF-R1 and sTNF-R2 concentrations in patients on CVVH or HVHF. CONCLUSION: In MODS patients with ARF undergoing HVHF, the serum TNF-alpha concentrations dropped significantly, but the serum sTNF-R1 and sTNF-R2 concentrations do not change significantly. Our study suggests that HVHF may be the better option for the treatment of MODS patients.

[Expression and significance of monocyte chemoattractant protein-i in rat kidney with unilateral ureteral obstruction].

OBJECTIVE: To investigate the renal expression of monocyte chemoattractant protein-1 (MCP-1) in rat with unilateral ureteral obstruction (UUO) and its association with macrophages infiltration in renal interstitium. METHODS: Sixty female Sprague-Dawley rats were randomized into UUO and sham-operation (SOR) groups. The kidneys were harversted at 1, 4, 7, 10 and 14 d after the operation. Immunohistochemistry was used on the renal tissue for MCP-1 and ED-1 which was a marker of macrophage. Histological changes were also observed by HE and Masson staining. RESULTS: Compared with the SOR group, there was a significant increase in MCP-1, ED-1 expression in the UUO group (P < 0.05). The expression intensity of MCP-1 was correlated with the interstitial macrophages accumulation and interstitial fibrosis (r = 0.865, 0.928, 0.858, 0.893, and 0. 873; r = 0.856, 0.896, 0.686, 0.820, and 0.867, respectively; P < 0.05). Interstitial macrophage infiltration was correlated with the grade of interstitial fibrosis too (r = 0.942, 0.898, 0.920, 0.914, and 0.829, P < 0.05). CONCLUSION: Elevated MCP-1 expression might be responsible for the macrophages infiltration and interstitial fibrosis in the obstructed kidney.