Relationship between interventricular septum thickness and renal function in patients with type 2 diabetes mellitus

Objective To investigate the relationship between interventricular septum thickness(IVS) and renal function in patients with diabetes mellitus. Methods Two hundred and sixty-five patients of type 2 diabetes without dialysis were enrolled in a cross-sectional study. According to their IVS, the patients were divided into normal group (IVS≤11 mm) and higher IVS group (IVS＞11 mm). All patients according to evaluated glomerular filtration rate (eGFR) level were divided into eGFR≥60 ml?min-1?(1.73 m2)-1 group and eGFR＜60 ml?min-1?(1.73 m2)-1 group. The demographic characteristic, biochemical examination, eGFR, and proteinuria of different groups were compared. Pearson or spearman correlation was used to analyze the relationship between eGFR, IVS and other parameters. eGFR＜60 ml?min-1?(1.73 m2)-1 and IVS thickening were analyzed by binary logistic regression. Risk factors affect the prognosis of renal function in patients with diabetes mellitus were analyzed by Cox regression analysis. Results Compared with normal group, patients in the higher IVS group had higher systolic pressure (P=0.002), their level of Scr, BUN, 24 h urinary protein were increased (all P＜0.05), while the level of eGFR, albumin (ALB), hemoglobin (Hb) and fasting blood glucose were decreased (all P＜0.05). The prevalence of hypertension was increased (81.16% vs 58.67%, χ2=11.273, P=0.001), and there was also a difference in the proportion of patients in each stage of CKD (χ2=34.593, P＜0.001). Correlation analysis showed that IVS was positively correlated with BMI, systolic BP, Scr, BUN, 24 h urinary albumin, 24 h urinary protein (all P＜0.05), while negative correlation was observed between the thickened degree of IVS and Hb, albumin, eGFR and total calcium (all P＜0.05). It's worth noting that IVS also correlated with history of hypertension and degree of renal injury (all P＜0.01). Logistic regression analysis showed that longer duration of diabetes, higher systolic pressure and BUN were independent risk factors for eGFR＜60 ml?min-1?(1.73 m2)-1 (all P＜0.05), while higher Hb and Alb were independent protective factors for eGFR＜60 ml?min-1?(1.73 m2)-1 (all P＜0.05). Logistic regression analysis also showed that the baseline increased Scr was independent risk factor for interventricular thickening (P＜0.05), while the increase of fasting blood-glucose was independent protective factor for interventricular thickening (P＜0.05). Cox regression analysis showed that interventricular thickening was an independent risk factor in predicting the progression of type 2 diabetes (HR=1.396, 95%CI=1.098-1.774, P=0.006). Conclusion Interventricular septum thickness is closely related to the state of renal function, as well as is an independent risk factor to predict kidney function decline in patients with type 2 diabetes.     

Elevated serum uric acid is an independent risk factor for the loss of renal function

Objective To investigate the relationship between serum uric acid level and renal function decline by retrospective cohort study. Methods Through the physical examination system of the First People's Hospital of Foshan, the physical examination data from 2015 to 2018 of a public institution in Foshan city were obtained. The gender, age, blood cell analysis, liver function, serum creatinine, uric acid, fasting blood glucose were obtained. The change of eGFR (ΔeGFR=eGFR2018-eGFR2015) was analyzed. Results A total of 2505 subjects were followed up for four years. The subjects were divided into ΔeGFR ≥0 group and ΔeGFR＜0 group. There were 845 subjects in ΔeGFR ≥0 group, and 1660 subjects in ΔeGFR＜0 group. Compared with that in ΔeGFR＜0 group, the base-level of uric acid in ΔeGFR ≥ 0 group was higher [(349.48±87.62) μmol/L vs (325.72±82.58) μmol/L, t=6.669, P＜0.001], but the rate of uric acid decline was greater [-15.00(-53.50, 17.00) μmol/L vs 15.50(-18.00, 49.00) μmol/L, Z=-13.470, P＜0.001]. According to the levels of uric acid in 2015 and 2018, then the subjects were divided into four groups, normal to normal group (N-N, 1551 cases), normal change into high uric acid group (N-H, 299 cases), high uric acid drop to normal group (H-N, 238 cases), and high to high uric acid group (H-H, 417 cases). The ΔeGFR was -1.58(-4.17, 1.01) ml?min-1?(1.73 m2)-1 in N-N group, and -3.60(-7.24, -0.98）ml?min-1?(1.73 m2)-1 in N-H group, -0.20(-3.14, 3.27) ml?min-1?(1.73 m2)-1 in H-N group, -0.96(-4.07, 1.93) ml?min-1?(1.73 m2)-1 in H-H group, respectively. The ΔeGFR decreased most significantly in N-H group than the other three groups (χ2=103.130, P＜0.001). Multivariate logistic regression analysis showed that elevated uric acid was an independent risk factor for eGFR decline (OR=1.739, 95%CI 1.587-1.906, P＜0.001), while elevated indirect bilirubin (OR=0.968, 95%CI 0.943-0.993, P=0.013), elevated red blood cells (OR=0.815, 95%CI 0.680-0.976, P=0.026) were independent protective factors for eGFR decline. Conclusion Elevated uric acid is an independent risk factor for the decline of renal function. Good control of hyperuricemia is beneficial to the protection of renal function.     

Peritubular capillaries injury and its association with clinical characteristics and long term renal survival in primary malignant nephrosclerosis patients

Objective To analyze the clinic-pathological data and peritubular capillary (PTC) injuries of malignant nephrosclerosis (MN) patients and their correlations with the long term renal survival. Methods This was a retrospective cohort study of 52 MN patients in Peking Union Medical College Hospital from January 2003 to March 2012. Their clinical data and renal biopsy samples were carefully studied. CD34 staining was performed to evaluate the PTC area, using Benign nephrosclerosis (BN, n=17) patients and glomerular minimal lesions (GML, n=19) patients as controls. Multivariate Cox proportional hazard model was used to identify the potential independent risk factors for long term renal survival. Results Fifty-two MN patients were enrolled. The sex ratio of male to female was 12∶1 and the average age was (34.0±8.2) years. The maximum blood pressure (SBP/DBP) was (230.4±25.0)/(156.4±20.6) mmHg, companied with significant loss of eGFR and proteinuria. Glomerular sclerosis index, tubular atrophy and interstitial fibrosis correlated with eGFR and proteinuria(P＜0.05). After aggressive treatment, BP control rate improved significantly (76.9% vs 3.7%, P＜0.01), Scr [(376.4±263.8) μmol/L vs (486.8±375.7) μmol/L, Wilcoxon test, P＜0.01] and proteinuria [(1.10±0.70) g/24 h vs (2.04±1.26) g/24 h, P＜0.01, n=21] also improved. PTC area in MN patients was significantly lower than those in BN patients and GML patients, and it correlated well with Scr (r=-0.553, P=0.001) and eGFR (r=0.476, P=0.004). The median follow-up time was 74 months, the cumulative renal survival rate at 1 year, 5 year and 10 year was 90%, 64% and 23%, respectively. Kaplan-Meier analysis showed that the patients with higher PTC area had longer renal survival time [(114.8±12.4) months vs (63.0±8.3) months, χ2=5.312, P＜0.05]. Univariate Cox proportional hazard model found that unsatisfied BP control, eGFR＜30 ml?min-1?(1.73 m2)-1 upon discharge, lower PTC area, severer tubular-interstitial damage and anemia were associated with poor renal outcome. Multivariate Cox model showed that unsatisfied BP control (RR=3.89, 95% CI 1.75-8.65, P=0.001), eGFR＜30 ml?min-1?(1.73 m2)-1 upon discharge (RR=4.27, 95%CI 1.40-13.09, P=0.011) were independent risk factors for long-term renal survival. Conclusions The correlation between PTC area and renal functions in MN patients are much better than that of classic vascular changes. Unsatisfied BP control and eGFR＜30 ml?min-1?(1.73 m2)-1 upon discharge are independent risk factors for long-term renal survival.     

Clinical and pathological significance of circadian blood pressure rhythm change in IgA nephropathy patients with hypertension

Objective To investigate whether the clinical and pathological injury of kidney in IgA nephropathy (IgAN) patients with hypertension is associated with circadian blood pressure rhythm change, particularly with elevated nocturnal blood pressure (BP). Methods This study was a retrospective cross-sectional study. Clinic and renal histopathological injury data were obtained from 83 IgAN patients with hypertension. First, 24 h ambulatory BP monitoring (ABPM) data were analyzed. Second, all these IgAN patients were divided into two groups, elevated nocturnal BP group and nocturnal normotensive BP group, and the clinical and pathological differences between this two groups were analyzed. Third, logistic regression analysis was used to analyze the influencing factors of renal tubulointerstitial injury in IgAN patients with hypertension. At last, all these IgAN patients were divided into two groups according to the level of estimated glomerular filtration rate (eGFR), group of patients with eGFR≥60 ml?min-1?(1.73 m2)-1 and the other group with eGFR＜60 ml?min-1?(1.73 m2)-1, and the 24 h ABPM data were compared. Results (1) The proportion of non-dipper circadian rhythm of BP in IgAN patients with hypertension was 79.5%. (2) Compared with nocturnal normotensive BP group, patients in elevated nocturnal BP group had significantly higher levels of 24-hour urinary protein quantity and blood uric acid (both P＜0.05), and lower eGFR and urine osmotic pressure clinically (both P＜0.05). Index of interstitial fibrosis and tubular atrophy was significantly higher in nocturnal normotensive BP group (P＜0.05), while the proportion of glomerular ischemia lesion was not significantly different between two groups. (3) Multivariate logistic regression analysis showed that elevated nocturnal BP was an independent risk factor for severe tubulointerstitial injury of IgAN (OR=1.113, 95%CI 1.038-1.192, P=0.002). (4) Compared with the group of eGFR≥60 ml?min-1?(1.73 m2)-1, 24-hour systolic blood pressure (SBP) and diastolic blood pressure (DBP), daytime SBP and DBP, nocturnal SBP and DBP were significantly higher in group of eGFR＜60 ml?min-1?(1.73 m2)-1 (all P＜0.05). Conclusion The proportion of non-dipper circadian rhythm of BP in IgAN patients with hypertension is as high as 79.5%. Elevated nocturnal BP is associated with the severity of renal damage, and elevated nocturnal BP is an independent risk factor for severe tubulointerstitial injury in IgAN patients with hypertension. Therefore, 24 h ABPM should be emphasized, and elevated nocturnal BP should be well controlled to slow the progression of IgAN.     

Analysis of cardiovascular disorder related factorsin non-dialysis patients with chronic renal failure

Objective To retrospectively analyze the changes of cardiovascular disorder and explore the risk factors in non-dialysis patients with chronic renal failure(CRF). Methods A total of 106 patients with CRF were enrolled in the cross-sectional study. The patients were divided into four groups by estimated glomerular filtration rate (eGFR): ≥45, 30-44, 15-29, ＜15 ml·min-1·(1.73 m2)-1. Clinical data and biochemical indicators were collected. Cardiac ultrasound measurement of cardiac lumen diameter parameters and function were assessed by echocardiography. The associations of different stages of eGFR with changes of cardiac structure and function were analyzed. Results A negative linear correlation was observed by liner regression between eGFR(MDRD) and left ventricular mass index (r=-0.345, P＜0.01). Logistic regressive analysis revealed that categories of eGFR(MDRD) [β=0.940, OR=2.561, 95%CI (1.380, 4.755), P＜0.01], the history of cardiovascular diseases[β=2.156, OR=8.639, 95%CI(1.991, 37.476), P＜0.01], urinary protein/creatinine ratio[β=0.001, OR=1.001，95%CI(1.000, 1.001), P＜0.01] correlated with left ventricular hypertrophy in the chronic renal failure without renal replacement therapy. The prevalence of concentric hypertrophy in eGFR(MDRD)≥45 ml·min-1·(1.73 m2)-1 was 3/3, while in eGFR(MDRD)=15-29 ml·min-1·(1.73 m2)-1 the prevalence was 3/12. The difference between two groups was significant(P＜0.01). There were no significant difference among the four groups in left ventricular diastolic function and systolic function. Left ventricular mass index had a linear correlation with eGFR measured by creatinine and Cystatin C(r=-0.378, P＜0.01). Conclusions Reduced kidney function is associated with increased left ventricular mass index. The type of left ventricular hypertrophy is mainly concentric hypertrophy at early stage of chronic renal failure. Categories of eGFR (MDRD), the history of cardiovascular diease, urinary protein /creatinine ratio may be important risk factors ofleft ventricular hypertrophy in the patients with chronic renal failure without renal replacement therapy.     

Characteristics and risk factors of acute kidney injury progressed to chronic kidney disease: a prospective,observational cohort study

Objective To prospectively investigate the characteristics of acute kidney injury (AKI) that progressed to chronic kidney disease (CKD) (AKI to CKD) in patients hospitalized for AKI, determine the risk factors of AKI to CKD, and preliminarily evaluate the performance of clinical risk factor model for predicting AKI to CKD. Methods This was a prospective, observational cohort study. Patients hospitalized for AKI and without a prior CKD [estimated glomerular filtration rate (eGFR)＜60 ml?min-1?(1.73 m2)-1] were enrolled in Nanfang Hospital of Southern Medical University from April 2015 to December 2019. Survived patients were followed 90 days after AKI and the renal function 90 days post AKI was determined. The primary endpoint was AKI to CKD, defined as new-onset CKD [eGFR＜60 ml?min-1?(1.73 m2)-1 90 days post AKI]. According to AKI progressed to CKD or not, AKI patients were divided into two groups (with or without AKI to CKD). The baseline clinical data of demographics, comorbidities, baseline renal function, AKI severity, receiving hemodialysis or not, and other lab parameters were compared between two groups. The logistic regression model was used to analyze the risk factors of AKI to CKD. Finally, receiver operator characteristic (ROC) curve was drawn to evaluate the performance of clinical risk factor model for predicting AKI to CKD. Results A total of 168 patients with AKI was enrolled in this study[male, n=91; female, n=77; age (44.0±18.4) years], in which 64 patients (38.1%) developed new-onset CKD 90 days post AKI and 104 patients (61.9%) did not. Compared to those without AKI to CKD, patients with AKI to CKD were older, and had a higher proportion of hypertension, lower levels of eGFR and hemoglobin, higher proportion of receiving hemodialysis, and higher level of discharged serum creatinine (all P＜0.05). There was no significant difference in the proportion of diabetes and use of RAS inhibitors, urine protein level, and other lab parameters between two groups. Multivariate logistic regression analysis shows that receiving hemodialysis (OR=2.516, 95%CI 1.251-5.060, P=0.010), hypertension (OR=2.446, 95%CI 1.124-5.324, P=0.024), and lower baseline eGFR (OR=0.975, 95%CI 0.950-0.999, P=0.043) were the independent risk factors for AKI to CKD. The clinical risk factor model including age, receiving hemodialysis, hypertension, and baseline eGFR produced moderate performance for predicting AKI to CKD, with the area under ROC curve of 0.712, 95%CI 0.634-0.790. Conclusions AKI survivors are at high risk for developing CKD. Receiving hemodialysis, hypertension, and lower baseline eGFR are independent risk factors for predicting AKI to CKD. More studies are needed to improve the performance of clinical risk factor model for early detecting high risk patients who will develop AKI to CKD.     

Contrast-enhanced ultrasound predicts the long-term prognosis of chronic kidney disease patients

Objective To evaluate the ability of contrast-enhanced ultrasound (CEUS) as a prognostic indicator of renal function in chronic kidney disease (CKD) patients. Methods A total of 122 patients with CKD were collected, and patients with allergies to sulfur hexafluoride, pregnancy, cardiopulmonary insufficiency, urinary calculus and tumour were excluded. These patients were divided into estimated glomerular filtration rate [eGFR, ml?min-1?(1.73 m2)-1]≥60 group, eGFR 30-59 group and eGFR＜30 group. CEUS was performed after an intravenous bolus injection of 1.5 ml SonoVue (BR1; Bracco Milan, Italy). Time-intensity curves (TICs) and quantitative indexes were created using QLAB quantification software. Followed up for 2 years, and patients with eGFR dropped 50%, double serum creatinine and end-stage renal disease (ESRD) were regarded as having kidney failure events. Risk factors related to kidney survival were investigated using a multivariate Cox regression model. Results One hundred patients were enrolled in the study, with 78% patients in CKD 1-2 stages, 16% in CKD 3 stage and 6% in CKD 4-5 stages. Patients were followed for a mean period of 14.1 months, ten (10%) patients exhibited composite kidney failure events. Among 3 groups,significant differences in the left kidney length derived peak intensity (DPI) were noted (P=0.014, P=0.010). Multivariate Cox regression analysis revealed that the DPI was an independent factor of progression of kidney disease. Multiple linear regression showed that age, basic eGFR , peak intensity were associated with eGFR decline rate. Patients with DPI＜12.27 db were less to recover from kidney disease progression as compared with patients with DPI≥12.27 db (P=0.008). The area under the curve (AUC) for DPI was 0.778(95%CI 0.612-0.944, P＜0.05), with a sensitivity of 64% and a specificity of 88%. Conclusions The DPI might be the most valuable CEUS parameter for the evaluation of renal function. The DPI could serve as an independent predictor of the long-term prognosis of CKD patients.     

Clinicopathological features and renal outcomes of IgA nephropathy with acute tubulointerstitial nephropathy

Objective To evaluate the clinicopathological characteristics and outcomes of IgA nephropathy (IgAN) with acute tubulointerstitial nephropathy (ATIN). Methods Patients who were diagnosed as IgAN with ATIN and IgAN without ATIN by renal biopsy in Peking University First Hospital were enrolled. There were 74 cases of IgAN with ATIN, and seventy-four cases of IgAN without ATIN were enrolled based on stratified sampling (chosen by 1∶1). The two groups were well matched with age, gender, follow-up time, mesangial hypercellularity(M), endocapillaryhypercellularity(E), segmental glomerulosclerosis(S), tubular atrophy/interstitial fibrosis(T) and cellular/fibrocellular crescent(C). The clinicopathological characteristics and outcomes of two groups were retrospectively analyzed. A composite end point, defined as 30% or 50% estimated glomerular filtration rate (eGFR) decline and end stage renal disease (ESRD) was used. Renal function and proteinuria during follow-up were observed. Renal survival was calculated by Kaplan-Meier survival analysis and risk factors of progression were analyzed by using univariate and multivariate Cox regression models. Results Seventy-four cases of IgAN with ATIN and seventy-four cases of IgAN without ATIN were enrolled. Serum creatinine [(185.6±83.2) μmol/L vs (146.3±69.2) μmol/L, P=0.010] and incidence of acute kidney disease (AKD) (31.1% vs 5.4%, P＜0.001) were higher in IgAN with ATIN group than those in IgAN without ATIN group. Patients in ATIN group received more immunosuppressive treatment (86.5% vs 58.1%, P＜0.001). During 1 year after biopsy, mean eGFR increased significantly in IgAN with ATIN group [(39.7±14.6) ml?min-1?(1.73 m2)-1 vs (47.2±19.9) ml?min-1?(1.73 m2)-1, P=0.017], but mean eGFR was not statistic different in IgAN without ATIN group [(60.0±30.5) ml?min-1?(1.73 m2)-1 vs (59.0±31.7) ml?min-1?(1.73 m2)-1, P=0.567]. Median follow-up was 23.0 months in IgAN with ATIN group, and Median follow-up was 30.0 months in IgAN without ATIN group. Incidence of composite end point had no significant differences between two groups. IgAN with ATIN was not the independent risk factor for end point. IgAN patients with ATIN were divided into two groups (with AKD and without AKD), then renal survival rate was higher (Log-rank test, χ2=5.293, P=0.021) and the risk for composite end point decreased by 79.2% (HR=0.208, 95%CI 0.046-0.939, P=0.041) in the group with AKD. Conclusions In IgAN, there is a subgroup of patients with the specific pathological phenotype combined with ATIN. Compared with those without AKD, the risk for composite end point of IgAN patients with ATIN and AKD showed a 79.2% decrease.     

Analysis of association between segmental glomerulosclerosis and renal function decline in IgA nephropathy

Objective To explore the relationship between segmental glomerulosclerosis and the change of renal function in IgA nephropathy (IgAN). Methods It was a single-center retrospective cohort study. The patients with biopsy-proven primary IgAN who were hospitalized in Shenzhen Second People's Hospital from January 1, 2011 to December 31, 2018 were included. Participants with a secondary cause of IgAN, without baseline serum creatinine or renal pathology data for Oxford classification, baseline estimated glomerulofiltration rate (eGFR)＜30 ml?min-1?(1.73 m2)-1, follow-up time＜6 months, or less than three times measurements of followed-up serum creatinine were excluded. The clinical data, laboratory tests and renal pathology data and so on were collected. Patients were divided into absence of segmental glomerulosclerosis (S0) group and segmental glomerulosclerosis (S1) group according to the Oxford classification. The generalized additive mixed model was used to analyze the associations of segmental glomerulosclerosis and longitudinal renal function decline (Renal function was evaluated by using the eGFR). Results There were 280 patients included in this study, with 199 patients in S0 group, and 81 patients in S1 group. Compared with S0 group, patients in S1 group exhibited higher levels of triglyceride, serum uric acid as well as 24-hour urinary protein, and a lower level of eGFR, and had higher proportions of tubular atrophy and interstitial fibrosis (T) (all P＜0.05). After adjusting for age, gender, mean arterial pressure, 24-hour urinary protein, mesangial hypercellularity (M), endocapillary hypercellularity (E), T and crescent (C) in the generalized additive mixed model, the effect value of S1 (the difference of baseline eGFR between S1 group and S0 group) was -14.09 ml?min-1?(1.73 m2)-1. For every additional year, the eGFR of S0 group decreased 1.29 ml?min-1?(1.73 m2)-1 (95% CI 0.47-2.12, P=0.002) in average, and eGFR decline in S1 group had 2.85 ml?min-1?(1.73 m2)-1 more than that in S0 group [95%CI 1.05-4.64, P=0.002]. Conclusion Segmental glomerulosclerosis is independently associated with the longitudinal decrease in renal function in patients with IgAN, which suggests therapies targeted for improving the early damages of segmental glomerulosclerosis may be essential to delay the renal function decline progression.     

Effect of urate-lowering therapy on renal function in chronic kidney disease stages 2-5

Objective To investigate the effect of urate-lowering therapy on renal function in chronic kidney disease (CKD) stages 2-5 patients with hyperuricemia (HUA). Methods A total of 132 patients of CKD stages 2-5 with HUA between July 2016 and December 2017 in Department of Nephrology of the Second Affiliated Hospital of Anhui Medical University were prospectively and self-controlled analyzed. Serum uric acid (SUA), estimated glomerular filtration rate (eGFR) and other clinical parameters were measured at baseline and after 1-6 months treatment. The patients were divided into group A (CKD stages 2-3a) and group B (CKD stages 3b-5) on the baseline value of eGFR. The changes of SUA and eGFR before and after treatment were compared. According to the level of SUA after 6 months treatment, patients were divided into attainment group (SUA＜360 μmol/L) and nonattainment group (SUA≥360 μmol/L). The difference of renal function in pre-treatment and post-treatment was compared. Multiple stepwise linear regression was used to analyze the relationship among the change of eGFR after receiving 6 months' treatment (deGFR) and SUA level, baseline eGFR and other indexes. Results After 1, 3, 6 months treatment, the average levels of SUA, Scr and urea nitrogen of all patients were decreased significantly while eGFR value was increased significantly (all P＜0.050) than those in pre-treatment period. After six-month-therapy, proteinuria and hematuria were improved significantly in all patients (P＜0.001, P=0.001). Compared with pre-treatment period, both the SUA levels of group A and group B were declined significantly while eGFR had a significant rise after treatment (P＜0.001). The change of eGFR post-treatment in group A was significantly higher than that of group B [(13.64±15.35) vs (8.97±9.79) ml?min-1?(1.73 m2)-1, P=0.044]. At 6 months after treatment, the eGFR value increased markedly in both attainment group and nonattainment group compared with pre-treatment period (P＜0.001). After six-month-therapy, the eGFR value in attainment group was increased more obviously than that of nonattainment group [(13.96±14.64) vs (8.03±9.69) ml?min-1?(1.73 m2)-1, P=0.021]. Multiple stepwise linear regression analysis showed that the baseline eGFR value was an influencing factor of deGFR (b=0.161, P=0.020). Conclusions The renal function of CKD stages 2-5 patients with HUA can be significantly improved by urate-lowering therapy, which can effectively reduce proteinuria and hematuria.     

Clinicopathological and prognostic analysis of IgA nephropathy patients with anemia

Objective To analyze the clinicopathological features of IgA nephropathy (IgAN) patients with anemia and the influencing factors of prognosis. Methods The clinical and pathological data of patients diagnosed with primary IgAN at the First Affiliated Hospital of Fujian Medical University from January 1, 2006 to December 31, 2016 were retrospectively analyzed. The patients were divided into anemia group and non-anemia group according to whether the patient was anemia or not. The clinical and pathological data of the two groups were collected. All of them were followed up from the date of renal biopsy to January 1, 2018. Survival curves of the two groups were drawn by Kaplan-Meier method, and compared by Log-rank test. Multivariate Cox proportional hazards regression model was adopted to explore the influencing factors of prognosis in IgAN patients. Results A total of 231 subjects were enrolled, including 122 males (52.8%), and the male-female ratio was 1.12∶1. Their age was (34.8±10.1) years (15-68 years). There were 70 patients (30.3%) in anemia group, 161 cases (69.7%) in non-anemic group. Compared with non-anemia group, anemia group had higher proportion of females, lower serum albumin, higher proportion of tubular atrophy/interstitial fibrosis (T1/2), endothelial cell proliferation (E1) and crescent formation (C1/2), which were statistically significant (all P＜0.05). The patients had a median follow-up time as 6.3 years (0.3-12.9 years). Survival analysis showed that patients in anemia group had lower cumulative renal survival rate than that in non-anemia group ( χ2=15.234, P＜0.001). Multivariate Cox hazards regression analysis revealed that anemia (HR=3.820, 95%CI 1.674-8.719, P=0.001), tubular atrophy/interstitial fibrosis (T1/2) (HR=3.770, 95%CI 1.026-13.852, P=0.046), glomerular segmental sclerosis/adhesion (S1) (HR=4.211, 95%CI 1.139-15.576, P=0.031), hypertension (HR=2.988, 95%CI 1.276-6.999, P=0.012), increased 24 h urinary protein (HR=1.103, 95%CI 1.046-1.163, P＜0.001) and estimated glomerular filtration (eGFR)＜60 ml?min-1?(1.73 m2)-1 (HR=3.725, 95%CI 1.639-8.462, P=0.002) were the independent risk factors for poor renal prognosis in patients with IgAN. Conclusions The clinicopathological features of IgAN patients with anemia are relatively serious, and the renal cumulative survival rate is lower. Anemia, tubular atrophy/interstitial fibrosis (T1/2), glomerular segmental sclerosis/adhesion (S1), hypertension, increased urinary protein and eGFR＜60 ml?min-1?(1.73 m2)-1 are the independent risk factors for poor renal prognosis in patients with IgAN.     

Pregnancy in patients with IgA nephropathy: a retrospective study for 20 years

Objective To analyze prognosis of pregnancy and kidney disease, and evaluate effects of renal pathology on pregnant outcomes and clinical risk factors of adverse outcomes of pregnancy in IgA nephropathy (IgAN) patients. Methods IgAN patients with more than 20 weeks of pregnancy were included, by retrieving the medical database in Peking Union Medical College Hospital from January 1996 to December 2015. Their detailed information during hospitalization and follow-up was recorded, and outcomes of pregnancy and kidney diseases in IgAN patients were assessed. According to Lee's renal pathological grade system, patients were divided into gradeⅣ&Ⅴ group and below grade Ⅳ group to compare their pregnant prognosis. IgAN patients were divied into fetus survival group and fetus death group according to their pregnancy outcomes. The fetal survival factors were analyzed by single factor and multivariate regression. Results A total of 64 pregnancies in 62 patients were included with a mean age of (30.31±4.05) years. The fetus survival rate was 87.5% and the average gestational periods was (35.41±5.10) weeks (ranging from 20-40 weeks). The incidence of pregnancy-induced hypertension syndrome is 17.2% (11 cases). The preterm birth rate was 24.1% (14 cases) among the live births. Serum creatinine increased in 18 cases (28.1%) during pregnancy with median increment of 38.5 μmol/L, and 72.2% patients completely recovered to the level before pregnancy in the postpartum period of 6 months. The incidence of fetus death (38.1% vs 0.0%, P＜0.01), low birth weight infant (46.2% vs 11.1%, P＜0.05) and pregnancy-induced hypertension syndrome (33.3% vs 11.1%, P＜0.05) in Lee's grade Ⅳ&Ⅴ group was higher than those in below grade Ⅳ group. The serum creatinine, urine protein excretion, renal hypertension before pregnancy and renal segmental glomerular sclerosis were significantly increased in fetus death group as compared with those in fetus survival group (all P＜0.05). Logistic regression showed that in all patients an estimated glomerular filtration rate (eGFR)＜60 ml?min-1?(1.73 m2)-1 (OR=76.978, 95%CI 3.327-1780.939, P=0.007) and renal hypertension (OR=14.464,95%CI 1.245-168.053, P=0.033) before pregnancy were the independent risk factors for fetus death, while multipara was a protective factor (OR=0.063, 95%CI 0.005-0.876, P=0.040). Conclusions The fetus survival and kidney prognosis in IgAN patients are closely related to the severity of clinical and pathological changes before pregnancy. Reduced eGFR and complication of renal hypertension are the independent risk factors for adverse prognosis of pregnancy.     

Relationship between interventricular septum thickness and renal prognosis in IgA nephropathy patients

Objective To investigate the relationship between interventricular septum thickness (IVST) and renal prognosis in IgA nephropathy patients. Methods A total of 213 patients with IgA nephropathy proven by biopsy from Department of Nephrology of Shenzhen Second People's Hospital were enrolled in this study, and these participants were divided into normal IVST group (＜11 mm) and higher IVST (≥11 mm) group according to IVST. The demographic characteristics, clinical biochemical indexs, CKD stage and pathologic characteristics in these two groups were compared. Binary logistic regression analysis was used to analyze the influencing factors of eGFR＜60 ml?min-1?(1.73 m2)-1, and Kaplan-Meier survival curve was used to analyze the effect of IVST on renal prognosis. Results Compared with IVST normal group, the patients in IVST higher group were more male sex, older, and had higher level of systolic pressure, Hb, Scr, BUN, UA, 24 h urine protein excretion, urinary protein creatinine ratio, triacylglycerol, total cholesterol, LDL, Serum C3, C4, and had more serious mesangial proliferation, tubular atrophy (all P＜0.05). However, the levels of eGFR and HDL were decreased in IVST higher group (both P＜0.05). There were a significant difference in CKD staging distributions and IgA Lee grade between two groups (both P＜0.01). Spearman and Pearson correlation analysis indicated that IVST was negatively correlated with eGFR and positively correlated with proteinuria level in IgA nephropathy patients. Baseline IVST was an independent risk factor of eGFR＜60 ml?min-1?(1.73 m2)-1 in IgA nephropathy patients. Serum C3, UA and hemoglobin were independent influential factors of eGFR decline (all P＜0.05). Kaplan-Meier survival curve indicated that the renal function was worse in patients with thickened interventricular septum. Conclusion The IgA nephropathy patients with thicker interventricular septum has a poor renal prognosis.     

Effects of timing of dialysis initiation on the prognosis of peritoneal dialysis patients: a retrospective cohort study

Objective To analyze the effects of dialysis therapy initiation on the prognosis of peritoneal dialysis (PD) patients. Methods PD patients who were newly catheterization and long-term followed-up in Peking University Shenzhen Hospital from January 1, 2012 to March 25, 2019 were retrospectively analyzed. According to the estimate glomerular filtration rate (eGFR) at the time of patients catheterization, the patients were divided into early-dialysis group [eGFR＞5.5 ml?min-1?(1.73 m2)-1] and late-dialysis group [eGFR≤5.5 ml?min-1?(1.73 m2)-1]. The endpoint events were transferred to other renal replacement therapy (such as hemodialysis, kidney transplantation) or death. Kaplan-Meier method was used to draw survival curve, and log-rank test was used to compare the difference of survival rate between the two groups. Cox proportional hazard model was used to analyze the influencing factors of all-cause death and technical death in PD patients. Results A total of 342 PD patients were enrolled in this study, and there were 165 cases and 177 cases in the early-dialysis and the late-dialysis group respectively. Compared with the early-dialysis group, the proportion of patients with diabetes and men, and the level of hemoglobin, serum calcium and CO2 binding capacity in the late-dialysis group were lower, while the incidence of hypertension, serum phosphorus, blood uric acid and blood urea nitrogen level were higher in the late-dialysis group (all P＜0.05). The median follow-up time was 33(16, 57) months. Kaplan-Meier survival analysis showed that the cumulative survival rate of late-dialysis group was significantly higher than that of early-dialysis group (Log-rank χ2=12.004, P＜0.001). After adjusting for gender, age of catheterization, body mass index (BMI), diabetes mellitus and hypertension, the risk ratio of all-cause death in the early-dialysis group was 1.950 times higher than that in the late-dialysis group (HR=1.950, 95%CI 1.019-3.730, P=0.044). Subgroup analysis showed that the timing of dialysis and the risk of end-point events were not affected by BMI, diabetes stratification and other factors (interactive P＞0.05), but there was interaction between dialysis time and catheter age (interactive P＜0.05). According to the age of catheterization, the risk of all-cause death were higher in the early dialysis group at a young age (≤48 years old) (HR=21.287, 95%CI 2.609-173.665, P=0.004). Conclusions The mortality rate of PD patients is higher in early-dialysis group, which is independent of gender, age, BMI, diabetes and hypertension. The difference is more distinct in low age group.     

A nomogram to predict the renal prognosis of patients with lupus nephritis

Objective To develop a nomogram for the use of predicting renal outcomes of Chinese lupus nephritis (LN) patients. Methods From January 1, 2005 to October 1, 2015, 513 patients with biopsy-proven LN in the First Affiliated Hospital of Sun Yat-Sen University were enrolled into this study. Renal outcomes were defined as end-stage renal disease or doubling of serum creatinine. Demographic characteristics, laboratory data, and pathologic data were recorded and included for analysis. Nomograms were designed using multivariate Cox proportional hazards regression to predict the non-outcome renal survival in 5 and 8 year according to the Akaike information criterion (AIC) and continuous reclassification net improvement (cNRI). Predictive accuracy and discriminative ability of the models were determined by concordance index (C-index) and calibration curve. Results During a median follow up of 48 (24,71) months, 44 patients (8.58%) reached the endpoint. 1-year, 5-year and 8-year non-outcome renal survival were 97.57%, 92.89%, 79.89% respectively. According to multivariate Cox regression, four nomograms including index for baseline renal function, pathologic severity, and response to treatment were designed. The best model, within which included eGFR was lower than 30 ml?min-1?(1.73 m2)-1(HR=4.44, 95%CI 2.16-9.13, P＜0.01), percentage of global glomerulosclerosis was higher (HR=12.28, 95%CI 3.58-42.13, P＜0.01) and partial remission occurred after 6-month induction treatment (HR=9.16, 95%CI 4.71-17.82, P＜0.01) demonstrated good discrimination to predict 5-year and 8-year non-outcome renal survival [C-index, 0.80(95%CI 0.81-0.91), 0.76(95%CI 0.68-0.85), respectively]. The nomogram based on above model also performed good calibration. Conclusion The nomogram based on patients’ baseline eGFR, percentage of global glomerulosclerosis, and treatment reaction after 6-month induction therapy can accurately predict 5-year and 8-year non-outcome renal survival in Chinese lupus nephritis patients.     

来氟米特联合中小剂量激素治疗IgA肾病的疗效观察

目的 比较来氟米特联合中小剂量激素与足量激素治疗IgA肾病的短期与长期疗效及安全性评估。 方法 研究人群 18~65周岁,纳入标准 eGFR≥30 ml?min-1?(1.73 m2)-1且24 h尿蛋白量＞0.5 g的原发性IgA肾病患者。所有入选患者经计算机随机进入来氟米特联合中小剂量激素组（LEF组）和单用激素组（激素组）;研究的主要终点为：（1）进入ESRD或透析治疗;（2）Scr升高超过基线值的50%;次要终点为蛋白尿缓解。 结果 完成随访的患者共90例,LEF组40例,激素组50例,基线24 h尿蛋白量LEF组和激素组分别为2.00（1.10,2.88） g和1.87（1.13,3.08） g,两组患者尿蛋白在治疗6个月[分别为0.30（0.11,0.93） g,0.30（0.14,1.33） g]和12个月[分别为0.30（0.09,0.82） g,0.32（0.14,0.66） g]时较治疗前均有好转（P＜0.05）。激素组治疗后eGFR较治疗前升高[治疗前（80.39±28.56）、6个月（87.12±28.70）、12个月（88.20±30.26） ml?min-1?(1.73 m2)-1,P＜0.05],LEF组eGFR治疗前后差异无统计学意义[治疗前（87.63±27.35）、6个月（86.91±32.45）、12个月（90.06±30.00） ml?min-1?(1.73 m2)-1,P＞0.05],但治疗6个月及12个月时两组间比较尿蛋白、血肌酐、eGFR差异均无统计学意义（P＞0.05）。治疗期间两组不良反应发生率（LEF组9/40例,激素组11/50例）差异无统计学意义（P＞0.05）。平均随访79个月发现两组肾脏预后差异无统计学意义。Cox回归分析提示基线血肌酐及肾脏间质炎性细胞浸润程度是IgA肾病疾病进展的独立危险因素。 结论 来氟米特联合中小剂量激素对进展性IgA肾病的疗效与足量激素相当,治疗期间未增加不良事件发生率。     

The urate-lowering efficacy of febuxostat and its effect on renal function in hyperuricemic patients with chronic kidney disease stages 3-5

Objective To investigate the urate-lowering efficacy and renal effect of febuxostat in hyperuricemic patients with chronic kidney disease (CKD) stages 3-5. Methods A prospective, randomized, controlled trial of CKD stages 3-5 patients with hyperuricemia was conducted from June 2015 to June 2016. Patients were randomly assigned to either febuxostat group (treatment group) or allopurinol group (control group). Patients in treatment group received febuxostat 40 mg/d after study initiation, and the dosage was changed to 20 mg/d if serum uric acid (sUA)＜360 μmol/L. Patients in control group were administered a dose of 100 mg/d of allopurinol. Serum uric acid, serum creatinine and other clinical parameters were measured at baseline and 1-6 months after treatment. The rate of achieving target sUA level and the change of eGFR in two groups were performed using SPSS 21.0. Results A total of 98 patients met the inclusion criteria and completed the trial. The treatment group and the control group had 51 cases and 47 cases, respectively. There was no significant difference between the two groups in age, sex, body mass index (BMI), blood pressure, serum creatinine, eGFR, sUA and renal diseases (P＞0.05). At month 1-6, there were significant differences between treatment group and control group in the rate of achieving target sUA level (P＜0.01). At month 1 and month 3, no statistical difference was observed in the change of eGFR between the two groups (P=0.624, P=0.319). At month 6, the changes in eGFR were +2.23 ml?min-1?(1.73 m2)-1 and -4.36 ml?min-1?(1.73 m2)-1 in the treatment and control group, respectively, and the difference between the two groups was significant (P=0.037). In patients with CKD stages 3-5, generalized estimating equation showed that after adjusting for confounding variables, the eGFR increased 1.149 ml?min-1?(1.73 m2)-1 (P=0.003) and 24-hour urinary protein decreased 0.019 g/d (P=0.037) when per 60 μmol/L decreased in sUA. Febuxostat 20 mg/d was able to keep target sUA levels in 90.2% patients with CKD stages 3-5 within half a year and no serious adverse effects appeared. Conclusions Febuxostat performs better than allopurinol in lowering urate and delaying progression of renal function in patients with CKD stages 3-5 and HUA. Febuxostat 20 mg/d may be the effective and safe maintenance dose to maintain target sUA level in patients with CKD stages 3-5, but whether it can be used as the best long-term maintenance dose needs to be further studied.     

帕立骨化醇对慢性肾脏病患者肾小球滤过率及尿蛋白影响的Meta分析

目的 系统评价帕立骨化醇对非透析慢性肾脏病患者估算肾小球滤过率(eGFR)及尿蛋白的影响.方法 计算机检索PubMed、Cochrane、Embase、万方、CNKI、维普等数据库,检索时限均为建库至2014年3月;手工检索美国肾脏病学会、世界肾脏病大会、中华医学会肾脏病学分会年会的会议论文、摘要等.纳入帕立骨化醇对非透析肾脏病患者eGFR及尿蛋白影响的临床随机对照试验研究.由两名评价员独立对纳入的文献进行质量评价和数据提取,用Rev Man 5.2软件进行Meta分析.结果 共纳入7项随机对照试验,共834例患者(其中试验组508例,安慰剂组326例).Meta分析结果显示,与安慰剂组比较,小剂量组(帕立骨化醇＜2 μg/d)对慢性肾脏病患者eGFR的影响差异无统计学意义[标准均数差(SMD)为-0.10,95％CI:-0.28 ～ 0.07,P=0.26];大剂量组(帕立骨化醇2μg/d)eGFR下降差异有统计学意义[SMD=-0.45,95％CI:-0.63-0.27,P＜0.01].与安慰剂组比较,大小剂量组均有降尿蛋白作用[OR(95％CI):2.09(1.52～2.58),P＜0.01],大小剂量组组间降尿蛋白作用的差异无统计学意义[OR(95％CI):1.09(0.62～ 1.91),P=0.77].与安慰剂组比较,小剂量组[OR (95％CI):0.93 (0.57～1.52),P=0.76]和大剂量组[0R(95％CI):2.08 (0.70～ 6.18),P=0.19]均未显著增加不良事件发生率.结论 小剂量帕立骨化醇可减少非透析慢性肾脏病患者尿蛋白,同时对eGFR无影响.大剂量帕立骨化醇(2μg/d)无进一步减少尿蛋白的疗效,且可能带来eGFR下降风险.     

Effect of serum uric acid level on renal function in elderly hypertensive patients: a retrospective cohort study

Objective To explore the relationship of serum uric acid level with estimated glomerular filtration rate (eGFR) of elderly patients with hypertention based on a retrospective cohort study. Method The subjects included 465 cases who had a readmission after 3 years of follow-up in an original cohort of 1648 patients with diagnosis of essential hypertension in Fujian Provincial Hospital from August 2007 to September 2009. Multiple regression analysis was performed to examine the effect of serum uric acid level on renal function. Results Four hundred and sixty-five subjects were followed up for an average of 3.9 years. Mean patient age was 68.3±9.7 years. There was no significant difference in uric acid between the baseline and 3 years later (P＞0.05). Multiple regression analysis showed that after adjustment for age, gender, diabetes, body mass index, blood pressure etc, each 100 μmol/L-higher uric acid at baseline was associated with 4.40 ml•min-1•(1.73m2)-1 decrease in eGFR[95% confidence interval (CI): -6.25--2.55, P＜0.01]. According to the alteration of the serum uric acid, all patients were divided into the group with decreased uric acid and the group with increase uric acid. The eGFR was lower in patients with increased uric acid than that in patients with decreased uric acid 3 years later [(70.63±21.54) ml•min-1•(1.73m2)-1 vs (79.62±21.16) ml•min-1•(1.73 m2)-1, P＜0.01] and there was no significant difference at baseline between the two groups (P＞0.05). Multiple logistic regression analysis showed that after adjusting for aging, gender, diabetes, alteration of blood pressure etc, baseline uric acid was associated with a higher risk for eGFR decreasing more than 10 ml•min-1•(1.73m2)-1 3 years later [hazard ratio (HR)=2.11, 95%CI: 1.24-3.59, P＜0.01]; increased uric acid 3 years later resulted in a higher risk for renal function deterioration (HR=2.60, 95%CI: 1.67-4.07, P＜0.01). Conclusions Elderly hypertensive patients with baseline hyperuricemia have a lower eGFR, resulting an increased risk of chronic kidney disease. While the patients with declined uric acid had a lesser imparied renal function. It suggests that the improvement of uric acid may help to slow down the deterioration of renal function in elderly hypertensive patients.     

Relationship between renal phospholipase A2 receptor expression and clinical characteristics,prognosis in idiopathic membranous nephropathy patients

Objective To explore the relationship of phospholipase A2 receptor (PLA2R) expression in renal tissue with clinical characteristics, prognosis of idiopathic membranous nephropathy(IMN) patients. Methods 134 patients diagnosed as nephropathy proven by biopsy was selected as subjects of this research, including 98 patients with IMN patients, 10 patients with secondary membranous nephropathy and 26 patients with other renal glomerular diseases. The expression of PLA2R antigen in renal tissue was detected by immuno-fluorescence chemistry staining. Results The positive rate of renal PLA2R expression in IMN patients was higher than that in SMN patients (91.84% vs 40.00%, P＜0.01), whereas there is no expression in other glomerular diseases. The PLA2R negative group were mainly stage I membranous nephropathy, and positive group was mainly in stage II. The distribution of pathological stage between the two groups was statistically significant (P＜0.01). Compared with the positive group, the negative group was manifested with higher eGFR[(115.91±23.32) ml?min-1?(1.73 m2)-1 vs (94.06±27.38) ml?min-1?(1.73 m2)-1, P=0.031], associated with the higher 12-month complete remission rate (87.50% vs 44.07%, P=0.021). Conclusions The expression of PLA2R antigen in renal tissue plays an important role in the diagnosis, disease evaluation and prognosis of IMN. The negative PLA2R in kidney tissue of IMN may indicate a good clinical prognosis.