More expression,less function: cleaved dynamin in glomerular kidney disease

The role of dynamin in regulation of kidney filtration barrier is well documented. Dynamin binds to and produces filamentous actin, which is a key component of healthy podocyte foot processes (FPs). Destruction of dynamin, for example by cathepsin L, leads to loss of a functional actin network and uncoordinated membrane signaling, a situation that allows for effacement of FPs and proteinuria. Now, Khalil et al have examined the dynamin expression in kidneys of proteinuric animal models as well as in kidney patients and produced data that further clarifies the role of dynamin in glomerular and tubular proteinuria and may aid in pinpointing patients who are affected by loss of dynamin function and may benefit from appropriate therapeutic approaches. Copyright © 2018 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.     

Lenvatinib-induced renal failure: two first-time case reports and review of literature

Introduction: Lenvatinib (LEN) is a multi-kinase anti-angiogenic drug recently approved in several cancers. LEN is not easily manageable due to its complex safety profile. Proteinuria and renal failure (RF) were reported among the most frequent LEN-induced adverse events (AEs), often leading to discontinuations or dose modifications. Understanding the pathogenesis of these AEs could ameliorate the management of LEN-induced renal toxicity.

Areas covered: We present two cases of LEN-induced renal failure (LIRF) with different pathogenesis. 1) LIRF with severe proteinuria in a man treated for a metastatic papillary thyroid carcinoma. Kidney biopsy showed a glomerular damage secondary to LEN, having excluded other causes of RF. 2) LIRF without proteinuria in a woman with metastatic adenoid cystic carcinoma of minor salivary gland. A tubulointerstitial nephropathy was supposed by clinical evaluation and laboratory tests. Effective management was obtained by oral steroids without interrupting LEN.

Expert opinion: The case 1 presented for the first time the histological picture of LIRF with a classical glomerular damage leading to secondary proteinuria and tubular failure. Case 2 showed an alternative LIRF pattern of likely tubulointerstitial injury without proteinuria. These reports reflect two sides of the same coin, both to be considered in case of LIRF.     

益气活血汤对糖尿病肾病患者血清CRP，IL-8的影响

目的:观察益气活血汤治疗气阴两虚兼血瘀型糖尿病肾病患者的临床疗效,从微炎症角度探讨其作用机制。方法:筛选气阴两虚兼血瘀型糖尿病肾病患者70例,采用随机、平行对照的研究方法,根据患者就诊的先后顺序编号,对应随机数字表随机分为对照组(34例)、治疗组(36例)。两组患者均给予基础方案(饮食控制、降糖、降压、降脂等)配合中药汤剂治疗,对照组予以糖尿病(diabetes mellitus,DM)120方,治疗组予以益气活血汤,疗程为12周。治疗前及治疗后分别检测并比较两组患者的血肌酐、尿素氮、血清白蛋白、肾小球滤过率、尿微量白蛋白/肌酐、血清C反应蛋白(CRP)及白细胞介素-8(IL-8)水平。结果:与治疗前比较,治疗第12周,治疗组患者的血肌酐降低(P0.05),血清白蛋白升高(P0.01),肾小球滤过率升高(P0.01),尿微量白蛋白/肌酐降低(P0.01),血清CRP和IL-8水平亦降低(P0.05);同时,治疗组在降低尿微量白蛋白/肌酐,升高血清白蛋白,下调血CRP,IL-8水平方面均优于对照组(P0.05)。结论:益气活血汤能改善早期糖尿病肾病(DKD)患者的肾功能,降低尿蛋白,具有早期干预糖尿病肾病进展的作用,其机制可能与抑制血CRP,IL-8等炎症因子水平,从而改善DKD机体的微炎症状态有关。     

The role of lipids in the pathogenesis of glomerulosclerosis in the rat following subtotal nephrectomy

Abstract. Similarities between atherosclerosis and glomerulosclerosis suggest that hyperlipidaemia may contribute to glomerular injury. Dietary supplementation with 4% cholesterol +1% cholic acid was administered to rats 4 weeks after 1 1/3 nephrectomy and continued for 7 weeks. There was a significant increase in serum cholesterol (peak= 11.52 ±1.09 mmol 1^-1 vs. 4.73 ± 0.31 on control diet, < 0.001) and triglyceride concentrations (peak = 2.31 ± 0.27 mmol 1^-1 vs. 1.41 ±0.29, <0.05) and a marked increase in βmigrating lipoproteins. The severity of hypercholester-olaemia was significantly correlated with proteinuria (control diet: r = 0.600, cholesterol diet: r = 0.672, < 0.0001) as was hypertriglyceridaemia (control diet: r = 0.544, cholesterol diet: r = 0.678, <0.0001). The percentage of glomeruli containing lipid deposits was increased from 21% to 60% (<0.05). The kidney total cholesterol content was increased from 29.2 ±0.8 to 47.7 ± 3.3 μmols g^-1 dry weight (<0.0001), with esterified cholesterol increasing from 7.5 ± 0.4% to 14.5 ± 2.1% of total (<0.01). Serum cholesterol concentration was significantly correlated with both glomerular lipid deposition ( r _s= 0.7195, <0.0001) and tissue total cholesterol content ( r _s= 0.6053, <0.001). Lipid vacuolation was prominent in the paramesangium and within mesangial cells. Despite these changes hypertension, uraemia, proteinuria and glomerulosclerosis were not significantly increased on the cholesterol diet. Cholesterol deposition in the glomeruli occurs secondary to hyperlipidaemia in rats following subtotal nephrectomy but over 7 weeks no exacerbation of glomerulosclerosis is detectable.     

名中医傅晓骏论治肾性蛋白尿经验

目的总结名中医傅晓骏论治肾性蛋白尿思路方法,用药规律,以推广其临证学术思想及用药经验。方法通过临证跟随傅晓骏教授中医经典查房,整理其病案医案,从文献认识、药理研究等多方面,阐述傅晓骏教授论治肾性蛋白尿。结果傅晓骏教授治疗肾性蛋白尿,特别重视从瘀论治,临床注重辨证论治思维,并擅用虫类药物、风类药物以诊治顽固性蛋白尿患者。结论傅晓骏教授论治肾性蛋白尿经验,临床效果明显,临床上行之有效,具有推广应用的价值。     

“中气不足,溲便为之变”在肾系疾病中的应用

“中气不足,溲便为之变”这一理论在治疗肾系疾病中具有很大的指导意义,本文通过医案举例、分析,强调“中气不足,溲便为之变”这一理论在实际指导临床中的重大意义,强调该理论在病因分析、疾病治疗方面取得的良好效果,理论指导临床,为治疗疾病,研究病因,开阔了思路。     

Immunoglobulin A nephropathy in horseshoe kidney: Case reports and literature review

Horseshoe kidney is the most common congenital renal fusion anomaly. Immunoglobulin A nephropathy is a common glomerulonephritis worldwide. However, the co‐occurrence of these diseases had not been reported in the literature. We report the first two cases with the occurrence of immunoglobulin A nephropathy in horseshoe kidney. The first case was a 26‐year‐old male with hypertension and proteinuria (1.4 g/24 h), his pathological finding was primary immunoglobulin A nephropathy. The second case was a 15‐year‐old female who presented with recurrent peliosis on bilateral lower extremities, haematuria and proteinuria (1.7 g/24 h). Her renal biopsy finding was Henoch–Schonlein purpura nephritis (secondary immunoglobulin A nephropathy). In both cases, renal biopsy was performed by experienced doctors under ultrasonic guidance at the renal upper pole and no postoperative complications were observed. After they were treated based on the renal pathological findings for 6 months, urine protein excretion decreased significantly and blood pressure and serum creatinine stabilized. It is possible that immunoglobulin A nephropathy occurs in a horseshoe kidney patient. Renal biopsy may be valuable and viable for horseshoe kidney patients with heavy proteinuria to identify pathologic type of glomerulopathy and to guide treatment, if renal biopsy is performed by experienced doctors at the renal upper pole under renal ultrasonic guidance.