AIM： To evaluate determinants of infammatory mark-ers in chronic renal failure patients according to the level of glomerular fltration rate. METHODS： One hundred ffty four patients （Age： 44 ± 06 years; male/f...AIM： To evaluate determinants of infammatory mark-ers in chronic renal failure patients according to the level of glomerular fltration rate. METHODS： One hundred ffty four patients （Age： 44 ± 06 years; male/female： 66/88） with chronic renal fail-ure （CRF） were divided into 6 groups according to the National Kidney Foundation （NKF） classification. They included 28 primary stage renal failure patients （CRF 1）, 28 moderate stage renal failure patients （CRF 2）,28 severe stage renal failure patients （CRF 3）, 18 end-stage renal failure patients （CRF 4）, 40 hemodialysis （HD） patients, and 12 peritoneal dialysis （PD） patients. Tumor necrosis factor-α （TNF-α）, interleukin-1β （IL-1β）, interleukin-6 （IL-6） and C-reactive protein （CRP） were analyzed by immunosorbent assay kit （ELISA） （Cayman Chemical’s ACETM EIA kit）. Immunoassay methods were used for total homocysteine （tHcy） （fuorescence polarization immunoanalysis HPLC, PerkinEmer 200 series）, transferrin （MININEPHTM human transferin kit： ZK070.R）, ferritin （ADVIA Centaur ） and fbrinogen analysis （ACL 200）. Differences between groups were performed using SPSS 20.0 and data are expressed as the mean ± SD.RESULTS： Results showed that in comparison with CRF 1 group and other groups, TNF-α and IL-6 levels were respectively more elevated in HD （16.38 ± 5.52 pg/mL vs 0.39 ± 0.03 pg/mL, 11.05 ± 3.59 pg/mL vs 8.20 ± 0.22 pg/mL, P 〈 0.001） and PD （14.04 ± 3.40 pg/mL vs 0.39 ± 0.03 pg/mL, 10.15 ± 1.66 pg/mL vs 8.20 ± 0.22 pg/mL, P 〈 0.001）. IL-1β levels were increased in HD （9.63 ± 3.50 pg/mL vs 3.24 ± 0.10 pg/mL, P 〈 0.001） and CRF 4 （7.76 ± 0.66 pg/mL vs 3.24 ± 0.10 pg/mL, P 〈 0.001） patients than in CRF 1 and in the other groups. Plasma tHcy levels were higher in HD （32.27 ± 12.08 μmol/L） and PD （28.37 ± 4.98 μmol/L） patients compared to the other groups of CRF （P 〈 0.001）. The serum CRP level was signifcantly increase展开更多
Background The new Chronic Kidney Disease Epidemiology Collaboration （CKD-EPI） equation was developed to address the systematic underestimation of glomerular filtration rate （GFR） by the Modification of Diet in Re...Background The new Chronic Kidney Disease Epidemiology Collaboration （CKD-EPI） equation was developed to address the systematic underestimation of glomerular filtration rate （GFR） by the Modification of Diet in Renal Disease （MDRD） Study equation in patients with relatively well-preserved kidney function.Performance of the new equation in the Chinese population is unknown.The goal of the present study was to compare performance of these two equations in Chinese patients with chronic kidney disease （CKD）.Methods We enrolled 450 Chinese patients （239 women and 211 men） with CKD in the present study.The renal dynamic imaging method was used to measure the referenced standard GFR （rGFR） for comparison with estimations using the two equations.Their overall performance was assessed with the Bland-Altman method and receiver-operating characteristics （ROC） analysis.Performance of the two equations in lower and higher estimated GFR （eGFR） subgroups was further investigated.Results Both eGFRs correlated well with rGFR （r=0.88,0.81,P〈0.05）.In overall performance,the CKD-EPI equation showed less bias,higher precision and improved accuracy,and was better for detecting CKD.In the higher-eGFR subgroup,the CKD-EPI equation corrected the underestimation of GFR by the abbreviated MDRD equation.Conclusions The CKD-EPI equation outperformed the abbreviated MDRD equation not only in overall performance but also in the subgroups studied.For the present,the CKD-EPI equation appears to be the first-choice prediction equation for estimating GFR.展开更多
Diabetic nephropathy is the kidney disease that occurs as a result of diabetes.Cardiovascular and renal complications share common risk factors such as blood pressure,blood lipids,and glycemic control.Thus,chronic kid...Diabetic nephropathy is the kidney disease that occurs as a result of diabetes.Cardiovascular and renal complications share common risk factors such as blood pressure,blood lipids,and glycemic control.Thus,chronic kidney disease may predict cardiovascular disease in the general population.The impact of diabetes on renal impairment changes with increasing age.Serum markers of glomerular filtration rate and microalbuminuria identify renal impairment in different segments of the diabetic population,indicating that serum markers as well as microalbuminuria tests should be used in screening for nephropathy in diabetic older people.The American Diabetes Association and the National Institutes of Health recommend Estimated glomerular filtration rate(eGFR) calculated from serum creatinine at least once a year in all people with diabetes for detection of kidney dysfunction.eGFR remains an independent and significant predictor after adjustment for conventional risk factors including age,sex,duration of diabetes,smoking,obesity,blood pressure,and glycemic and lipid control,as well as presence of diabetic retinopathy.Cystatin-C(Cys C) may in future be the preferred marker of diabetic nephropathy due differences in measurements of serum creatinine by various methods.The appropriate reference limit for Cys C in geriatric clinical practice must be defined by further research.Various studies have shown the importance of measurement of albuminuria,eGFR,serum creatinine and hemoglobin level to further enhance the prediction of end stage renal disease.展开更多
Background Recently, some studies had shown that elevated serum uric acid （SUA） itself may increase the risk for development of renal disease in patients with diabetes. This study aimed to explore whether SUA was a ...Background Recently, some studies had shown that elevated serum uric acid （SUA） itself may increase the risk for development of renal disease in patients with diabetes. This study aimed to explore whether SUA was a predictor of microalbuminuria and impaired renal function in type 2 diabetes in Chinese patients. Methods This cross-sectional study included 2108 type 2 diabetic patients. Kidney function was estimated using the simplified modification of diet in renal disease （MDRD） equation to obtain estimated glomerular filtration rate. The urine samples were obtained for measuring the albumin-to-creatinine ratio （ACR）. Results According to the ACR level, these patients were divided into two groups, normal ACR （NA） and non-normal ACR （non-NA）. Both SUA and creatinine were significantly higher in the non-NA group than those in the NA group （（318.89±107.52） vs. （283.44±88.64） pmol/L, and （95.08±53.24） vs. （79.63±18.20） μmol/L, respectively）. Logistic regression analysis showed that diabetic duration, systolic blood pressure, creatinine and SUA were the independent predictors of albuminuria. Furthermore, to identify the factors associated with renal function, these patients were divided into two groups according to the MDRD level （MDRD〈90 or MDRD〉90）. Both SUA and creatinine were significantly higher in the lower MDRD group than those in the higher MDRD group （（301.90±96.46） vs. （264.07±84.74） μmol/L, and （89.10±31.00） vs. （66.37±11.15） μmol/L, respectively）. Logistic regression analysis showed that only age and SUA were the independent predictors of MDRD. Conclusion High-normal SUA was associated with albuminuria and impaired glomerular filtration rate in Chinese type 2 diabetic patients.展开更多
Background： Whether there is a relationship between glomerular filtration rate IGFR） and hcnlorrhagic transformation （HT） after acute ischemic stroke （A1S） is still under debate. The aim of our study was to dete...Background： Whether there is a relationship between glomerular filtration rate IGFR） and hcnlorrhagic transformation （HT） after acute ischemic stroke （A1S） is still under debate. The aim of our study was to determine whether the GFR level is a predictor of HT in AIS patients without thrombolytic therapy （TT）. Methods： Consecutive A IS patients without TT were included in this prospective study fiom January 2014 to December 2016 in the First Affiliated Hospital of Chongqiug Medical University. We divided them into two groups （HT and non-HT group） and meticulously collected baseline characteristics and laboratory and imaging data of interested individuals. Multivariate regression analysis was performed to assess the correlation between GFR and HT in stroke patients without TT. Results： Among 426 consecutive patients, 74 （17.3%） presented HT （mean age： 65 ± 12 years, number of male patients： 47） on the follow-up scans. In multivariate regression analysis, HT was significantly associated with low GFR （odds ratio [OR] = 3.708, confidence interval [CI] = 1.326-10.693, P = 0.013）, atrial fibrillation （AF; OR = 2.444, CI= 1.087-5.356, P = 0.027）, large cerebral inthrction （OR = 2.583, CI= 1.236-5.262, P= 0.010）, and hypoalbuminemia （HA OR = 4.814, CI= 1.054 22.153, P = 0.037） for AIS patients without TT. Conclusions： The present study strongly showed that lower GFR is an independently predictor of HT： in addition, large inlhrct volume, AF, and HA are also important risks of HT for AIS patients without TT, which offered a practical information that risk factors should be paid attention or eliminated to prevent HT for stroke patients though the level of evidence seems to be unstable.展开更多
Background The equations for estimating glomerular filtration rate （GFR） based on creatinine have been found to have limitations and have not been generalizable across all populations. Equations based on cystatin C ...Background The equations for estimating glomerular filtration rate （GFR） based on creatinine have been found to have limitations and have not been generalizable across all populations. Equations based on cystatin C provide an alternative method to estimate GFR. Whether the equation based on cystatin C alone or combined creatinine would improve GFR estimates has not been validated among Chinese patients with chronic kidney disease （CKD） and diabetes. The aim of this study was to compare the performance of the modification of diet in renal disease （MDRD） equation based on creatinine with the five cystatin C-based formulae for estimation of GFR in patients with CKD and diabetes. Methods A total of 166 patients with CKD and 91 patients with type 2 diabetes were enrolled in this study. Cystatin C was measured by using the particle-enhanced immunonephelometric method and estimated formulae proposed by five different investigator teams （Stevens, Ma, Rule, Macisaac and Perkins）. The plasma clearance of ^99mTc-DTPA was determined as measured GFR （mGFR）.Results For CKD patients, the bias and accuracy for the Ma and Macisaac equations were superior compared with the MDRD, and the mean results for the Ma formula were closer to mGFR than the other equations in CKD stages 2-5. The differences between Macisaac and mGFR in CKD stages 2-4 were significantly less than those in CKD stage 1 or 5.Stevens and Rule＇s formulae revealed a similar bias and accuracy compared with the MDRD equation. The MDRD formula had a higher accuracy in CKD stages 3-5 as compared with the results in other stages. For diabetic patients, the mean results between Macisaac and mGFR were closer than those of other equations in mGFR≥90 ml·min^-1·1.73 m^-2 stage, in GFR 60-89 ml·min^-1·1.73 m^-2 stage, the MDRD formula showed the smallest difference compared with other equations. All equations overestimated GFR in the cases with GFR 〈60 ml·min^-1·1.73 m^-2 stages. The MDRD formula had a greater accuracy within 50% of mGFR than t展开更多
Background Diabetic patients undergoing percutaneous coronary intervention （PCI） have a higher incidence of contrast-induced nephropathy （CIN） than nondiabetic patients, and no pharmacological approach has been de...Background Diabetic patients undergoing percutaneous coronary intervention （PCI） have a higher incidence of contrast-induced nephropathy （CIN） than nondiabetic patients, and no pharmacological approach has been demonstrated to offer consistent protection. Therefore, identifying individuals who are at increased risk becomes essential. This study was designed to assess the predictive role of the ratio of contrast medium volume to estimated glomerular filtration rate （CMV/eGFR） in diabetic patients undergoing elective PCI who developed ClN.Methods We retrospectively investigated clinical factors associated with the development of CIN in 114 diabetic patients who had undergone elective PCI. The risk factors for CIN included age, gender, body mass index （BMI）, left ventricular ejection fraction （LVEF）, hemoglobin （Hb）, fasting plasma glucose （FPG）, hemoglobin A1c （HbA1c）, volume of contrast medium, basic levels of serum creatinine （Scr）, the number of treated vessels and the number of stents used.We conducted a stepwise regression analysis to evaluate the predictive role of these risk factors in the incidence of CIN.Results The incidence of CIN was 18.4% （21/114）. There were no significant differences in age, gender, BMI, LVEF, Hb,FPG, HbA1c, and incidence of hypertension and number of acute myocardial infarction （AMI） in patients between the CIN （n=21） and the non-CIN （n=93） groups. However, the eGFR was significantly lower （（72.0±12.5） ml·min-1·1.73 m-2 vs.（82.0±16.5）ml·min-1·1.7m-2, P=0.010）, and the basic serum creatinine level （（1.07±0.12） mg/dl vs.（0.97±0.19） mg/dlP=0.014） was significantly higher in the CIN group. In addition, the volume of contrast medium was significantly larger （（253±75）ml vs. （211±71）ml, P=0.017） and the CMV/eGFR ratio was significantly greater （3.64±1.26 vs.2.70±1.11, P=0.001） in the CIN group. Stepwise regression analysis showed that the CMV/eGFR ratio was a significant independent pred展开更多
目的:研究西格列汀对早期2型糖尿病肾病患者肾小球、肾小管标志性蛋白/酶的影响。方法:早期2型糖尿病肾病患者72例,随机数字表分为对照组36例、治疗组36例;两组均采用糖尿病饮食管理、运动治疗,在控制血糖、血脂、血压的基础上,治疗组...目的:研究西格列汀对早期2型糖尿病肾病患者肾小球、肾小管标志性蛋白/酶的影响。方法:早期2型糖尿病肾病患者72例,随机数字表分为对照组36例、治疗组36例;两组均采用糖尿病饮食管理、运动治疗,在控制血糖、血脂、血压的基础上,治疗组给予磷酸西格列汀100 mg 1粒/次,1次/天,持续服药6月。观察治疗前、后两组血肌酐(Scr)、尿素氮(BUN)、糖化血红蛋白(Hb A1c)、血脂、空腹血糖(FBG)、餐后2小时血糖(2 h PBG)、血清胱抑素-C(Cys-C)及24 h尿微量白蛋白(24 h UAE)、尿N-乙酰-β-氨基葡萄糖苷酶(NAG)、尿β2-微球蛋白(β2-MG)的变化。结果:治疗后,治疗组血脂、Hb A1c、FBG、2 h PBG较对照组明显下降,差异有显著性(P<0.05)。两组患者24 h UAE、NAG、β2-MG和Cys-C较治疗前均下降,差异有显著性(P<0.05);两组治疗后相比,差异具有统计学意义(P<0.05)。结论:西格列汀可以有效控制早期DN患者的血糖水平,减少血清Cys-C、尿微量白蛋白水平,减轻肾小管损伤,有利于延缓DN的病程和进展。展开更多
Background： Mounts of studies have shown that low estimated glomerular filtration rate （eGFR） is associated with increased risk of adverse outcomes in patients with coronary artery disease. However, high level of e...Background： Mounts of studies have shown that low estimated glomerular filtration rate （eGFR） is associated with increased risk of adverse outcomes in patients with coronary artery disease. However, high level of eGFR was less reported. In the study, we aimed to explore the relationship between the baseline eGFR, especially the high level, and contrast-induced acute kidney injury （CI-AKI） in a Chinese population who underwent an emergency percutaneous coronary intervention （PCI）. Methods： Patients who underwent an emergency PCI from 2013 to 2015 were enrolled and divided into five groups as eGFR decreasing. Baseline characteristics were collected and analyzed. The rates of CI-AKI and the composite endpoint （including nonfatal myocardial infarction, revascularization, stroke, and all-cause death） at 6- and 12-month follow-up were compared. Logistic analysis for CI-AKI was performed.Results： A total of 1061 patients were included and the overall CI-AKI rate was 22.7% （241 / 1061）. The separate rates were 77.8% （7/9） in Group 1 （eGFR 〉 120 ml·min^-1 -1.73 m^-2）, 26.0% （118/454） in Group 2 （120 ml·min^-1·min^-11.73 m^-2〉 eGFR≥90 ml·min^-1 1.73^-2）, 18.3% （86/469） in Group 3 （90 ml·min^-1 1.73 m^-2〉 eGFR 〉60 ml·min^-1·min^-11.73 m^-2）, 21.8% （26/119） in Group 4 （60 ml·min^-1·1.73 m^-2〉 eGFR≥30 ml·min^-1·min^-11.73 m^-2）, and 40.0% （4/10） in Group 5 （eGFR 〈30 ml·min^-1·min^-1·min^-11.73 m^-2）, with statistical significance （χ^2 = 25.19, P 〈 0.001）. The rates of CI-AKI in five groups were 77.8%, 26.0%, 18.3%, 21.8%, and 40.0%, respectively, showing a U-typed curve as eGFR decreasing （the higher the level of eGFR, the higher the CI-AKI occurrence in case ofeGFR_〉60 ml·min^-1·1.73 m^-2）. The composite endpoint rates in five groups were 0, 0.9%, 2.1%, 6.7%, and 0 at 6-month follow-up, respectively, and 0, 3.3%, 3.4%, 16.0%, and 30.0% at 12-month follow-up, respectively, both with significant differences （χ^2 = 展开更多
High intraglomerular pressure is associated with renal hyperf iltration, leading to the initiation and progression of kidney disease in experimental models of diabetes mellitus (DM). In humans, hyperf iltration is ob... High intraglomerular pressure is associated with renal hyperf iltration, leading to the initiation and progression of kidney disease in experimental models of diabetes mellitus (DM). In humans, hyperf iltration is observed in patients with type 1 and type 2 DM, and is also seen in patients with pre-diabetic conditions, such as the metabolic syndrome. From a mechanistic perspective, both vascular and tubular factors likely contribute to the pathogenesis of hyperf iltration. Until now, human studies have primarily focused on the use of medications that inhibit the renin angiotensin system to reduce efferent vasoconstriction and thereby improve hyperfiltration. More recent advances in the development of investigational adenosine antagonists and inhibitors of sodium glucose cotransport may help to elucidate tubular factors that contribute to afferent vasodilatation. In this review, we summarize available data from experimental and human studies of type 1 and type 2 DM and obesity to provide an overview of factors that contribute to the hyperf iltration state. We have focused on the renin angiotensin system, cyclooxygenase-2 system, nitric oxide, protein kinase C and endothelin as vascular determinants of hyperfiltration. We also dis-cuss relevant tubular factors, since experimental models have suggested that inhibition of sodium-glucose cotransport may be renoprotective.展开更多
Background Dyslipidemia, a well-known risk factor for cardiovascular disease, is common in patients with kidney disease. Recent studies discerned that dyslipidemias play a critical role in renal damage progression in ...Background Dyslipidemia, a well-known risk factor for cardiovascular disease, is common in patients with kidney disease. Recent studies discerned that dyslipidemias play a critical role in renal damage progression in renal diseases, but the association between dyslipidemias and chronic kidney disease （CKD） in the general population remains unknown. Thus, we assessed whether the growing prevalence of dyslipidemia could increase the risk of CKD.Methods A total of 4779 middle-aged and elderl-yparticipants participated in this study. Dyslipidemias were defined by the 2007 Guidelines in Chinese Adults. Incident CKD was defined as albuminuria and/or reduced estimated glomerular filtration rate （eGFR, 〈60 ml.minl^-1.73 m^2）. Regression analysis was used to evaluate the association between dyslipidemia and albuminuria/reduced eGFR.Results Participants with hypercholesterolemia exhibited a greater prevalence of albuminuria and reduced eGFR （10.0% vs. 6.1%, P=0.001; 4.0% vs. 2.4%, P=0.028, respectively）. Both hypercholesterolemia and low high density lipoprotein cholesterol （HDL-C） were independently associated with albuminuria （odds ratio （OR） 1.49; 95% confidence interval （CI） 1.08-2.07 and OR 1.53; 95% CI 1.13-2.09, respectively）. The multivariable adjusted OR of reduced eGFR in participants with hypercholesterolemia was 1.65 （95% CI 1.03-2.65）. As the number of dyslipidemia components increased, so did the OR of CKD： 0.87 （95% CI 0.65-1.15）, 1.29 （95% CI, 0.83-2.01）, and 7.87 （95% CI, 3.75-16.50） for albuminuria, and 0.38 （95% CI 0.21-0.69）, 1.92 （95% CI 1.14-3.25）, and 5.85 （95% CI 2.36-14.51） for reduced eGFR, respectively.Conclusions Our findings indicate that dyslipidemias increase the risk of CKD in the middle-aged and elderly Chinese population. Hypercholesterolemia plays an important role in reducing total eGFR. Both low HDL-C and hypercholesterolemia are associated with an increased risk for albuminuria.展开更多
In the clinical context of the patients with liver cirrhosis, accurate evaluation of the renal function is potentially crucial. Indeed, it can lead to early diagnosis of both acute kidney injury and chronic kidney dis...In the clinical context of the patients with liver cirrhosis, accurate evaluation of the renal function is potentially crucial. Indeed, it can lead to early diagnosis of both acute kidney injury and chronic kidney disease and to reliable characterization of the renal status of the patient before performing a liver transplantation. Despite some limitations, the assay of serum creatinine (SCr) is universally used to estimate glomerular filtration rate (GFR) because of its wide availability, its simplicity and because it is inexpensive. Nevertheless, several reports show that the value of this assay to estimate GFR is strongly challenged in cirrhotic patients, especially in patients with liver failure and/or severely impaired renal function. This has led to seek new alternatives to estimate more reliably the GFR in these patients. Although the reference methods, based on the utilization of exogenous markers, allow measuring GFR and thereby constitute the “gold standard” to evaluate renal function, they are not feasible in routine clinical practice. Several studies have shown that a cystatin C (CysC) based formula perform better than the SCr-based estimates in cirrhotic patients and the estimation of GFR by these formulas could therefore lead to optimize the management of the patients. A new estimate based on CysC has been recently developed using a large number of patients and the first results regarding the evaluation of its performance are promising, making this new formula the best candidate for a reference estimate of the renal function in cirrhotic patients.展开更多
Background The renoprotective mechanisms of adenosine monophosphate （AMP）-activated protein kinase （AMPK） agonist-metformin have not been stated clearly.We hypothesized that metformin may ameliorate inflammation v...Background The renoprotective mechanisms of adenosine monophosphate （AMP）-activated protein kinase （AMPK） agonist-metformin have not been stated clearly.We hypothesized that metformin may ameliorate inflammation via AMPK interaction with critical inflammatory cytokines The aim of this study was to observe the effects of metformin on expression of nuclear factor-κB （NF-κB）,monocyte chemoattractant protein-1 （MCP-1）,intercellular adhesion molecule-1 （ICAM-1） and transforming growth factor-beta 1 （TGF-β1） induced by high glucose （HG） in cultured rat glomerular mesangial cells （MCs）.Methods MCs were cultured in the medium with normal concentration glucose （group NG,5.6 mmol/L）,high concentration glucose （group HG,25 mmol/L） and different concentrations of metformin （group M1,M2,M3）.After 48-hour exposure,the supernatants and MCs were collected.The expression of NF-κB,MCP-1,ICAM-1,and TGF-β1 mRNA was analyzed by real time polymerase chain reaction.Westem blotting was used to detect the expression of AMPK,phospho-Thr-172 AMPK （p-AMPK）,NF-κB p65,MCP-1,ICAM-1,and TGF-β1 protein.Results After stimulated by HG,the expression of NF-κB,MCP-1,ICAM-1,TGF-β1 mRNA and protein of MCs in group HG increased significantly compared with group NG （P ＜0.05）.Both genes and protein expression of NF-κB,MCP-1,ICAM-1,TGF-β1 of MCs induced by high glucose were markedly reduced after metformin treatment in a dose-dependent manner （P ＜0.05）.The expression of p-AMPK increased with the rising of metformin concentration,presenting the opposite trend,while the level of total-AMPK protein was unchanged with exposure to HG or metformin.Conlusion Metformin can suppress the expression of NF-κB,MCP-1,ICAM-1 and TGF-β1 of glomerular MCs induced by high glucose via AMPK activation,which may partlv contribute to its reno-protection.展开更多
Objectives：To explore the effects and significance of Huanshuai Recipe Oral Liquid（缓衰口服液,HSR）,a formula with supplementing qi,nourishing blood and activating blood on restructuring glomerular microvasculature ...Objectives：To explore the effects and significance of Huanshuai Recipe Oral Liquid（缓衰口服液,HSR）,a formula with supplementing qi,nourishing blood and activating blood on restructuring glomerular microvasculature and expression of vascular endothelial growth factor（VEGF）in subtotal nephrectomized（SNX） rats.Methods：A total of 76 male Wistar rats were randomly divided into four groups：16 in the sham-operated group and fed with tap water 10 mL/kg per day; 20 in the model group were operated with 5/6 SNX and fed with tap water 10 mL/kg per day; 20 SNX rats in the HSR group were treated with HSR 10 mL/kg per day; 20 SNX rats in the losartan group were treated with losartan 40 mg/kg per day.Serum creatinine（SCr）and urinary protein excretion（Upro）were examined at the 2nd,4th,8th,and 12th weeks of the treatment,and the remnant kidneys were harvested.Changes in histological microstructure were evaluated using light microscopy,and the expression of VEGF was detected by using ELISA.Results：Upro,microvasculature injury and glomerulosclerosis were found to be alleviated in HSR and Losartan groups,respectively.The change of VEGF expression showed positive correlation with glomerular capillary area and peritubular capillary number（r=0.448,r=0.422,P〈0.01）, but negative correlation with that of SCr and Upro（r=-0.592,r=-0.481,P〈0.01）.Conclusions：HSR could regulate the VEGF expression,reduce the loss of microvasculature,which demonstrated similar renal protective effects to losartan in SNX rats.Examination of Chinese herbal medicine influence on VEGF signaling and restructuring renal microvasculature may elucidate the molecular mechanism of renal protection to a certain degree.展开更多
基金the Roche Organ Transplantation Research Foundation Grant 608390948 awarded to Dr. Kim Solez which allowed establishing the Banff Foundation for Allograft Pathology+15 种基金the receipt of sponsorship from Astellas Alexion Novartis One Lambda Renal Pathology Society American Society of Transplantation Wiley Qiagen Canadian Institute for Health Research Immucor Bridge to Life Organ Recovery Systems Transplant Connect Glycorex Transplantation Transpath Inc.the University of Alberta
文摘AIM： To evaluate determinants of infammatory mark-ers in chronic renal failure patients according to the level of glomerular fltration rate. METHODS： One hundred ffty four patients （Age： 44 ± 06 years; male/female： 66/88） with chronic renal fail-ure （CRF） were divided into 6 groups according to the National Kidney Foundation （NKF） classification. They included 28 primary stage renal failure patients （CRF 1）, 28 moderate stage renal failure patients （CRF 2）,28 severe stage renal failure patients （CRF 3）, 18 end-stage renal failure patients （CRF 4）, 40 hemodialysis （HD） patients, and 12 peritoneal dialysis （PD） patients. Tumor necrosis factor-α （TNF-α）, interleukin-1β （IL-1β）, interleukin-6 （IL-6） and C-reactive protein （CRP） were analyzed by immunosorbent assay kit （ELISA） （Cayman Chemical’s ACETM EIA kit）. Immunoassay methods were used for total homocysteine （tHcy） （fuorescence polarization immunoanalysis HPLC, PerkinEmer 200 series）, transferrin （MININEPHTM human transferin kit： ZK070.R）, ferritin （ADVIA Centaur ） and fbrinogen analysis （ACL 200）. Differences between groups were performed using SPSS 20.0 and data are expressed as the mean ± SD.RESULTS： Results showed that in comparison with CRF 1 group and other groups, TNF-α and IL-6 levels were respectively more elevated in HD （16.38 ± 5.52 pg/mL vs 0.39 ± 0.03 pg/mL, 11.05 ± 3.59 pg/mL vs 8.20 ± 0.22 pg/mL, P 〈 0.001） and PD （14.04 ± 3.40 pg/mL vs 0.39 ± 0.03 pg/mL, 10.15 ± 1.66 pg/mL vs 8.20 ± 0.22 pg/mL, P 〈 0.001）. IL-1β levels were increased in HD （9.63 ± 3.50 pg/mL vs 3.24 ± 0.10 pg/mL, P 〈 0.001） and CRF 4 （7.76 ± 0.66 pg/mL vs 3.24 ± 0.10 pg/mL, P 〈 0.001） patients than in CRF 1 and in the other groups. Plasma tHcy levels were higher in HD （32.27 ± 12.08 μmol/L） and PD （28.37 ± 4.98 μmol/L） patients compared to the other groups of CRF （P 〈 0.001）. The serum CRP level was signifcantly increase
文摘Background The new Chronic Kidney Disease Epidemiology Collaboration （CKD-EPI） equation was developed to address the systematic underestimation of glomerular filtration rate （GFR） by the Modification of Diet in Renal Disease （MDRD） Study equation in patients with relatively well-preserved kidney function.Performance of the new equation in the Chinese population is unknown.The goal of the present study was to compare performance of these two equations in Chinese patients with chronic kidney disease （CKD）.Methods We enrolled 450 Chinese patients （239 women and 211 men） with CKD in the present study.The renal dynamic imaging method was used to measure the referenced standard GFR （rGFR） for comparison with estimations using the two equations.Their overall performance was assessed with the Bland-Altman method and receiver-operating characteristics （ROC） analysis.Performance of the two equations in lower and higher estimated GFR （eGFR） subgroups was further investigated.Results Both eGFRs correlated well with rGFR （r=0.88,0.81,P〈0.05）.In overall performance,the CKD-EPI equation showed less bias,higher precision and improved accuracy,and was better for detecting CKD.In the higher-eGFR subgroup,the CKD-EPI equation corrected the underestimation of GFR by the abbreviated MDRD equation.Conclusions The CKD-EPI equation outperformed the abbreviated MDRD equation not only in overall performance but also in the subgroups studied.For the present,the CKD-EPI equation appears to be the first-choice prediction equation for estimating GFR.
文摘Diabetic nephropathy is the kidney disease that occurs as a result of diabetes.Cardiovascular and renal complications share common risk factors such as blood pressure,blood lipids,and glycemic control.Thus,chronic kidney disease may predict cardiovascular disease in the general population.The impact of diabetes on renal impairment changes with increasing age.Serum markers of glomerular filtration rate and microalbuminuria identify renal impairment in different segments of the diabetic population,indicating that serum markers as well as microalbuminuria tests should be used in screening for nephropathy in diabetic older people.The American Diabetes Association and the National Institutes of Health recommend Estimated glomerular filtration rate(eGFR) calculated from serum creatinine at least once a year in all people with diabetes for detection of kidney dysfunction.eGFR remains an independent and significant predictor after adjustment for conventional risk factors including age,sex,duration of diabetes,smoking,obesity,blood pressure,and glycemic and lipid control,as well as presence of diabetic retinopathy.Cystatin-C(Cys C) may in future be the preferred marker of diabetic nephropathy due differences in measurements of serum creatinine by various methods.The appropriate reference limit for Cys C in geriatric clinical practice must be defined by further research.Various studies have shown the importance of measurement of albuminuria,eGFR,serum creatinine and hemoglobin level to further enhance the prediction of end stage renal disease.
文摘Background Recently, some studies had shown that elevated serum uric acid （SUA） itself may increase the risk for development of renal disease in patients with diabetes. This study aimed to explore whether SUA was a predictor of microalbuminuria and impaired renal function in type 2 diabetes in Chinese patients. Methods This cross-sectional study included 2108 type 2 diabetic patients. Kidney function was estimated using the simplified modification of diet in renal disease （MDRD） equation to obtain estimated glomerular filtration rate. The urine samples were obtained for measuring the albumin-to-creatinine ratio （ACR）. Results According to the ACR level, these patients were divided into two groups, normal ACR （NA） and non-normal ACR （non-NA）. Both SUA and creatinine were significantly higher in the non-NA group than those in the NA group （（318.89±107.52） vs. （283.44±88.64） pmol/L, and （95.08±53.24） vs. （79.63±18.20） μmol/L, respectively）. Logistic regression analysis showed that diabetic duration, systolic blood pressure, creatinine and SUA were the independent predictors of albuminuria. Furthermore, to identify the factors associated with renal function, these patients were divided into two groups according to the MDRD level （MDRD〈90 or MDRD〉90）. Both SUA and creatinine were significantly higher in the lower MDRD group than those in the higher MDRD group （（301.90±96.46） vs. （264.07±84.74） μmol/L, and （89.10±31.00） vs. （66.37±11.15） μmol/L, respectively）. Logistic regression analysis showed that only age and SUA were the independent predictors of MDRD. Conclusion High-normal SUA was associated with albuminuria and impaired glomerular filtration rate in Chinese type 2 diabetic patients.
文摘Background： Whether there is a relationship between glomerular filtration rate IGFR） and hcnlorrhagic transformation （HT） after acute ischemic stroke （A1S） is still under debate. The aim of our study was to determine whether the GFR level is a predictor of HT in AIS patients without thrombolytic therapy （TT）. Methods： Consecutive A IS patients without TT were included in this prospective study fiom January 2014 to December 2016 in the First Affiliated Hospital of Chongqiug Medical University. We divided them into two groups （HT and non-HT group） and meticulously collected baseline characteristics and laboratory and imaging data of interested individuals. Multivariate regression analysis was performed to assess the correlation between GFR and HT in stroke patients without TT. Results： Among 426 consecutive patients, 74 （17.3%） presented HT （mean age： 65 ± 12 years, number of male patients： 47） on the follow-up scans. In multivariate regression analysis, HT was significantly associated with low GFR （odds ratio [OR] = 3.708, confidence interval [CI] = 1.326-10.693, P = 0.013）, atrial fibrillation （AF; OR = 2.444, CI= 1.087-5.356, P = 0.027）, large cerebral inthrction （OR = 2.583, CI= 1.236-5.262, P= 0.010）, and hypoalbuminemia （HA OR = 4.814, CI= 1.054 22.153, P = 0.037） for AIS patients without TT. Conclusions： The present study strongly showed that lower GFR is an independently predictor of HT： in addition, large inlhrct volume, AF, and HA are also important risks of HT for AIS patients without TT, which offered a practical information that risk factors should be paid attention or eliminated to prevent HT for stroke patients though the level of evidence seems to be unstable.
文摘Background The equations for estimating glomerular filtration rate （GFR） based on creatinine have been found to have limitations and have not been generalizable across all populations. Equations based on cystatin C provide an alternative method to estimate GFR. Whether the equation based on cystatin C alone or combined creatinine would improve GFR estimates has not been validated among Chinese patients with chronic kidney disease （CKD） and diabetes. The aim of this study was to compare the performance of the modification of diet in renal disease （MDRD） equation based on creatinine with the five cystatin C-based formulae for estimation of GFR in patients with CKD and diabetes. Methods A total of 166 patients with CKD and 91 patients with type 2 diabetes were enrolled in this study. Cystatin C was measured by using the particle-enhanced immunonephelometric method and estimated formulae proposed by five different investigator teams （Stevens, Ma, Rule, Macisaac and Perkins）. The plasma clearance of ^99mTc-DTPA was determined as measured GFR （mGFR）.Results For CKD patients, the bias and accuracy for the Ma and Macisaac equations were superior compared with the MDRD, and the mean results for the Ma formula were closer to mGFR than the other equations in CKD stages 2-5. The differences between Macisaac and mGFR in CKD stages 2-4 were significantly less than those in CKD stage 1 or 5.Stevens and Rule＇s formulae revealed a similar bias and accuracy compared with the MDRD equation. The MDRD formula had a higher accuracy in CKD stages 3-5 as compared with the results in other stages. For diabetic patients, the mean results between Macisaac and mGFR were closer than those of other equations in mGFR≥90 ml·min^-1·1.73 m^-2 stage, in GFR 60-89 ml·min^-1·1.73 m^-2 stage, the MDRD formula showed the smallest difference compared with other equations. All equations overestimated GFR in the cases with GFR 〈60 ml·min^-1·1.73 m^-2 stages. The MDRD formula had a greater accuracy within 50% of mGFR than t
文摘Background Diabetic patients undergoing percutaneous coronary intervention （PCI） have a higher incidence of contrast-induced nephropathy （CIN） than nondiabetic patients, and no pharmacological approach has been demonstrated to offer consistent protection. Therefore, identifying individuals who are at increased risk becomes essential. This study was designed to assess the predictive role of the ratio of contrast medium volume to estimated glomerular filtration rate （CMV/eGFR） in diabetic patients undergoing elective PCI who developed ClN.Methods We retrospectively investigated clinical factors associated with the development of CIN in 114 diabetic patients who had undergone elective PCI. The risk factors for CIN included age, gender, body mass index （BMI）, left ventricular ejection fraction （LVEF）, hemoglobin （Hb）, fasting plasma glucose （FPG）, hemoglobin A1c （HbA1c）, volume of contrast medium, basic levels of serum creatinine （Scr）, the number of treated vessels and the number of stents used.We conducted a stepwise regression analysis to evaluate the predictive role of these risk factors in the incidence of CIN.Results The incidence of CIN was 18.4% （21/114）. There were no significant differences in age, gender, BMI, LVEF, Hb,FPG, HbA1c, and incidence of hypertension and number of acute myocardial infarction （AMI） in patients between the CIN （n=21） and the non-CIN （n=93） groups. However, the eGFR was significantly lower （（72.0±12.5） ml·min-1·1.73 m-2 vs.（82.0±16.5）ml·min-1·1.7m-2, P=0.010）, and the basic serum creatinine level （（1.07±0.12） mg/dl vs.（0.97±0.19） mg/dlP=0.014） was significantly higher in the CIN group. In addition, the volume of contrast medium was significantly larger （（253±75）ml vs. （211±71）ml, P=0.017） and the CMV/eGFR ratio was significantly greater （3.64±1.26 vs.2.70±1.11, P=0.001） in the CIN group. Stepwise regression analysis showed that the CMV/eGFR ratio was a significant independent pred
文摘目的:研究西格列汀对早期2型糖尿病肾病患者肾小球、肾小管标志性蛋白/酶的影响。方法:早期2型糖尿病肾病患者72例,随机数字表分为对照组36例、治疗组36例;两组均采用糖尿病饮食管理、运动治疗,在控制血糖、血脂、血压的基础上,治疗组给予磷酸西格列汀100 mg 1粒/次,1次/天,持续服药6月。观察治疗前、后两组血肌酐(Scr)、尿素氮(BUN)、糖化血红蛋白(Hb A1c)、血脂、空腹血糖(FBG)、餐后2小时血糖(2 h PBG)、血清胱抑素-C(Cys-C)及24 h尿微量白蛋白(24 h UAE)、尿N-乙酰-β-氨基葡萄糖苷酶(NAG)、尿β2-微球蛋白(β2-MG)的变化。结果:治疗后,治疗组血脂、Hb A1c、FBG、2 h PBG较对照组明显下降,差异有显著性(P<0.05)。两组患者24 h UAE、NAG、β2-MG和Cys-C较治疗前均下降,差异有显著性(P<0.05);两组治疗后相比,差异具有统计学意义(P<0.05)。结论:西格列汀可以有效控制早期DN患者的血糖水平,减少血清Cys-C、尿微量白蛋白水平,减轻肾小管损伤,有利于延缓DN的病程和进展。
文摘Background： Mounts of studies have shown that low estimated glomerular filtration rate （eGFR） is associated with increased risk of adverse outcomes in patients with coronary artery disease. However, high level of eGFR was less reported. In the study, we aimed to explore the relationship between the baseline eGFR, especially the high level, and contrast-induced acute kidney injury （CI-AKI） in a Chinese population who underwent an emergency percutaneous coronary intervention （PCI）. Methods： Patients who underwent an emergency PCI from 2013 to 2015 were enrolled and divided into five groups as eGFR decreasing. Baseline characteristics were collected and analyzed. The rates of CI-AKI and the composite endpoint （including nonfatal myocardial infarction, revascularization, stroke, and all-cause death） at 6- and 12-month follow-up were compared. Logistic analysis for CI-AKI was performed.Results： A total of 1061 patients were included and the overall CI-AKI rate was 22.7% （241 / 1061）. The separate rates were 77.8% （7/9） in Group 1 （eGFR 〉 120 ml·min^-1 -1.73 m^-2）, 26.0% （118/454） in Group 2 （120 ml·min^-1·min^-11.73 m^-2〉 eGFR≥90 ml·min^-1 1.73^-2）, 18.3% （86/469） in Group 3 （90 ml·min^-1 1.73 m^-2〉 eGFR 〉60 ml·min^-1·min^-11.73 m^-2）, 21.8% （26/119） in Group 4 （60 ml·min^-1·1.73 m^-2〉 eGFR≥30 ml·min^-1·min^-11.73 m^-2）, and 40.0% （4/10） in Group 5 （eGFR 〈30 ml·min^-1·min^-1·min^-11.73 m^-2）, with statistical significance （χ^2 = 25.19, P 〈 0.001）. The rates of CI-AKI in five groups were 77.8%, 26.0%, 18.3%, 21.8%, and 40.0%, respectively, showing a U-typed curve as eGFR decreasing （the higher the level of eGFR, the higher the CI-AKI occurrence in case ofeGFR_〉60 ml·min^-1·1.73 m^-2）. The composite endpoint rates in five groups were 0, 0.9%, 2.1%, 6.7%, and 0 at 6-month follow-up, respectively, and 0, 3.3%, 3.4%, 16.0%, and 30.0% at 12-month follow-up, respectively, both with significant differences （χ^2 =
基金Supported by A Canadian Diabetes Association-KRESCENT Program Joint New Investigator Awardthe CIHR and the Heart and Stroke Foundation of Canada to Cherney ZID
文摘 High intraglomerular pressure is associated with renal hyperf iltration, leading to the initiation and progression of kidney disease in experimental models of diabetes mellitus (DM). In humans, hyperf iltration is observed in patients with type 1 and type 2 DM, and is also seen in patients with pre-diabetic conditions, such as the metabolic syndrome. From a mechanistic perspective, both vascular and tubular factors likely contribute to the pathogenesis of hyperf iltration. Until now, human studies have primarily focused on the use of medications that inhibit the renin angiotensin system to reduce efferent vasoconstriction and thereby improve hyperfiltration. More recent advances in the development of investigational adenosine antagonists and inhibitors of sodium glucose cotransport may help to elucidate tubular factors that contribute to afferent vasodilatation. In this review, we summarize available data from experimental and human studies of type 1 and type 2 DM and obesity to provide an overview of factors that contribute to the hyperf iltration state. We have focused on the renin angiotensin system, cyclooxygenase-2 system, nitric oxide, protein kinase C and endothelin as vascular determinants of hyperfiltration. We also dis-cuss relevant tubular factors, since experimental models have suggested that inhibition of sodium-glucose cotransport may be renoprotective.
文摘Background Dyslipidemia, a well-known risk factor for cardiovascular disease, is common in patients with kidney disease. Recent studies discerned that dyslipidemias play a critical role in renal damage progression in renal diseases, but the association between dyslipidemias and chronic kidney disease （CKD） in the general population remains unknown. Thus, we assessed whether the growing prevalence of dyslipidemia could increase the risk of CKD.Methods A total of 4779 middle-aged and elderl-yparticipants participated in this study. Dyslipidemias were defined by the 2007 Guidelines in Chinese Adults. Incident CKD was defined as albuminuria and/or reduced estimated glomerular filtration rate （eGFR, 〈60 ml.minl^-1.73 m^2）. Regression analysis was used to evaluate the association between dyslipidemia and albuminuria/reduced eGFR.Results Participants with hypercholesterolemia exhibited a greater prevalence of albuminuria and reduced eGFR （10.0% vs. 6.1%, P=0.001; 4.0% vs. 2.4%, P=0.028, respectively）. Both hypercholesterolemia and low high density lipoprotein cholesterol （HDL-C） were independently associated with albuminuria （odds ratio （OR） 1.49; 95% confidence interval （CI） 1.08-2.07 and OR 1.53; 95% CI 1.13-2.09, respectively）. The multivariable adjusted OR of reduced eGFR in participants with hypercholesterolemia was 1.65 （95% CI 1.03-2.65）. As the number of dyslipidemia components increased, so did the OR of CKD： 0.87 （95% CI 0.65-1.15）, 1.29 （95% CI, 0.83-2.01）, and 7.87 （95% CI, 3.75-16.50） for albuminuria, and 0.38 （95% CI 0.21-0.69）, 1.92 （95% CI 1.14-3.25）, and 5.85 （95% CI 2.36-14.51） for reduced eGFR, respectively.Conclusions Our findings indicate that dyslipidemias increase the risk of CKD in the middle-aged and elderly Chinese population. Hypercholesterolemia plays an important role in reducing total eGFR. Both low HDL-C and hypercholesterolemia are associated with an increased risk for albuminuria.
文摘In the clinical context of the patients with liver cirrhosis, accurate evaluation of the renal function is potentially crucial. Indeed, it can lead to early diagnosis of both acute kidney injury and chronic kidney disease and to reliable characterization of the renal status of the patient before performing a liver transplantation. Despite some limitations, the assay of serum creatinine (SCr) is universally used to estimate glomerular filtration rate (GFR) because of its wide availability, its simplicity and because it is inexpensive. Nevertheless, several reports show that the value of this assay to estimate GFR is strongly challenged in cirrhotic patients, especially in patients with liver failure and/or severely impaired renal function. This has led to seek new alternatives to estimate more reliably the GFR in these patients. Although the reference methods, based on the utilization of exogenous markers, allow measuring GFR and thereby constitute the “gold standard” to evaluate renal function, they are not feasible in routine clinical practice. Several studies have shown that a cystatin C (CysC) based formula perform better than the SCr-based estimates in cirrhotic patients and the estimation of GFR by these formulas could therefore lead to optimize the management of the patients. A new estimate based on CysC has been recently developed using a large number of patients and the first results regarding the evaluation of its performance are promising, making this new formula the best candidate for a reference estimate of the renal function in cirrhotic patients.
基金This work was supported by grants from the Natural Science Foundation （No. 11040606M 159） and Natural Science Research Project （No. K J2011A157） of Anhui Province, China.
文摘Background The renoprotective mechanisms of adenosine monophosphate （AMP）-activated protein kinase （AMPK） agonist-metformin have not been stated clearly.We hypothesized that metformin may ameliorate inflammation via AMPK interaction with critical inflammatory cytokines The aim of this study was to observe the effects of metformin on expression of nuclear factor-κB （NF-κB）,monocyte chemoattractant protein-1 （MCP-1）,intercellular adhesion molecule-1 （ICAM-1） and transforming growth factor-beta 1 （TGF-β1） induced by high glucose （HG） in cultured rat glomerular mesangial cells （MCs）.Methods MCs were cultured in the medium with normal concentration glucose （group NG,5.6 mmol/L）,high concentration glucose （group HG,25 mmol/L） and different concentrations of metformin （group M1,M2,M3）.After 48-hour exposure,the supernatants and MCs were collected.The expression of NF-κB,MCP-1,ICAM-1,and TGF-β1 mRNA was analyzed by real time polymerase chain reaction.Westem blotting was used to detect the expression of AMPK,phospho-Thr-172 AMPK （p-AMPK）,NF-κB p65,MCP-1,ICAM-1,and TGF-β1 protein.Results After stimulated by HG,the expression of NF-κB,MCP-1,ICAM-1,TGF-β1 mRNA and protein of MCs in group HG increased significantly compared with group NG （P ＜0.05）.Both genes and protein expression of NF-κB,MCP-1,ICAM-1,TGF-β1 of MCs induced by high glucose were markedly reduced after metformin treatment in a dose-dependent manner （P ＜0.05）.The expression of p-AMPK increased with the rising of metformin concentration,presenting the opposite trend,while the level of total-AMPK protein was unchanged with exposure to HG or metformin.Conlusion Metformin can suppress the expression of NF-κB,MCP-1,ICAM-1 and TGF-β1 of glomerular MCs induced by high glucose via AMPK activation,which may partlv contribute to its reno-protection.
基金Supported by Special Projects of Chinese Medicine Science and Technology Research,State Administration of Traditional Chinese Medicine(No.04-05JQ07)
文摘Objectives：To explore the effects and significance of Huanshuai Recipe Oral Liquid（缓衰口服液,HSR）,a formula with supplementing qi,nourishing blood and activating blood on restructuring glomerular microvasculature and expression of vascular endothelial growth factor（VEGF）in subtotal nephrectomized（SNX） rats.Methods：A total of 76 male Wistar rats were randomly divided into four groups：16 in the sham-operated group and fed with tap water 10 mL/kg per day; 20 in the model group were operated with 5/6 SNX and fed with tap water 10 mL/kg per day; 20 SNX rats in the HSR group were treated with HSR 10 mL/kg per day; 20 SNX rats in the losartan group were treated with losartan 40 mg/kg per day.Serum creatinine（SCr）and urinary protein excretion（Upro）were examined at the 2nd,4th,8th,and 12th weeks of the treatment,and the remnant kidneys were harvested.Changes in histological microstructure were evaluated using light microscopy,and the expression of VEGF was detected by using ELISA.Results：Upro,microvasculature injury and glomerulosclerosis were found to be alleviated in HSR and Losartan groups,respectively.The change of VEGF expression showed positive correlation with glomerular capillary area and peritubular capillary number（r=0.448,r=0.422,P〈0.01）, but negative correlation with that of SCr and Upro（r=-0.592,r=-0.481,P〈0.01）.Conclusions：HSR could regulate the VEGF expression,reduce the loss of microvasculature,which demonstrated similar renal protective effects to losartan in SNX rats.Examination of Chinese herbal medicine influence on VEGF signaling and restructuring renal microvasculature may elucidate the molecular mechanism of renal protection to a certain degree.
