进一步提高高尿酸性肾病的防治水平

高尿酸血症所引起的肾病是相当古老的疾病之一.笔者近期所开展的社区居民横断面筛查结果显示,社区人群高尿酸血症总患病率为19.1%,其中男性患病率为27.7%,女性为15.9%.高尿酸血症人群中慢性肾脏病（CKD）发生率（32.7%）显著高于血尿酸水平正常人群（16.2%）.与80年前1/3的高尿酸血症患者发生肾损害的资料相比,高尿酸血症肾损害的发生率没有显著改善.     

上海浦东近郊居民高尿酸血症流行病学调查及慢性肾脏病相关性分析

目的:筛查并了解高尿酸血症在上海市浦东周康航地区近郊居民中的患病率及高危因素,并进一步探讨高尿酸血症与慢性肾脏病的相关性研究。方法:该调查采用横断面研究和随机抽样方法,调查浦东新区周康航地区共8 230名居民高尿酸血症及慢性肾脏病的患病情况并行相关性分析。结果:高尿酸血症总患病率为16.67%,男性高尿酸患病率高于女性(34.18%比9.56%,P 0.000),且随着年龄的增长,高尿酸血症的患病率也呈上升趋势(P 0.000)。高尿酸血症组男性CKD患病率、女性CKD患病率及总CKD患病率均高于非高尿酸血症组(男性24.7%比14.5%,女性28.6%比8.3%,合计25.9%比10.8%,P 0.05)。女性高尿酸血症患者较男性高尿酸血症患者更易发生CKD(P 0.05)。无论男女,尿酸水平越高越容易发生CKD(P 0.05),但同等尿酸水平女性高尿酸血症患者较男性高尿酸血症患者更易发生CKD(P 0.05)。e GFR与年龄、SUA、Cr、BUN、TG、TC、LDH呈负相关(P 0.000)。结论:浦东新区周康航地区虽地处市郊,但随着区域人民物质生活水平的迅速提高,目前高尿酸血症发病率已达发达国家水平,因此,尽早制定合理的公共卫生政策和有效的干预措施迫在眉睫。     

乌市体检人群高尿酸血症患病率及其肾损害相关分析

目的：探讨新疆乌鲁木齐市健康体检人群中高尿酸血症（HUA）的发病情况及与慢性肾脏病（CKD）的关系.方法：回顾性分析2009年1月-2010年4月在新疆医科大学第一附属医院体检中心进行健康体检的10 025例人群,了解乌市健康体检人群HUA以及危险人群CKD的患病情况.结果：在资料完整的10 025例中,HUA的患病率为14.85%%,其中HUA组CKD的患病率为11.63%,明显高于血尿酸正常组;HUA组蛋白尿的发病率为6.66%,明显高于血尿酸正常组;HUA组eGFR下降的患病率为5.21%,明显高于血尿酸正常组;而两组血尿的发病率差异无统计学意义.多因素Logistic回归提示,高尿酸血症（OR=1.36,95%CI=1.13～1.65）、性别（OR=1.44,95%CI=1.25～1.67）、收缩压≥140 mmHg（OR=1.78,95%CI=1.49～2.73）、高血糖（OR=1.36,95%CI=1.67～2.58）是CKD重要危险因素.结论：乌鲁木齐市健康体检人群中HUA的患病率为14.85%,加强高危群筛查,积极控制血尿酸、血糖、血压可减少CKD的发生和发展.     

成都市高尿酸血症患者慢性肾脏病流行病学调查研究

目的分析成都市高尿酸血症患者中慢性肾脏病(chronic kidney disease,CKD)的患病情况及相关危险因素。方法选择2009年9月至2010年12月在成都铁路分局医院进行健康体检且有完整资料的5,326名体检者(分散居住在成都市各区),收集所有体检者的性别、年龄、体质量、吸烟、饮酒、既往病史、血液以及尿液的检测结果等,对资料进行分析、对比。结果5 326名体检者中有1 321例高尿酸血症患者,其中男1 187例(患病率28.76%),女134例(患病率10.93%),平均年龄(44.6±10.2)岁。①高尿酸血症患者白蛋白尿、血尿和eGFR下降的患病率分别为14.00%、1.97%和4.69%。1 321例高尿酸血症患者中CKD患病率为18.09%,知晓率2.93%。高尿酸血症患者白蛋白尿、eGFR下降和CKD的患病率均明显高于无高尿酸患者;高尿酸血症合并高血脂和(或)糖尿病和(或)高血压患者白蛋白尿、eGFR下降和CKD的患病率均明显高于单纯高尿酸血症患者。②血尿酸每升高60μmol/L,白蛋白尿、eGFR下降和CKD的患病率均明显增加;血尿酸与尿微量白蛋白/肌酐比值呈正相关,血尿酸与eGFR呈负相关。③高血压、糖尿病和体质量指数是白蛋白尿的独立危险因素;高尿酸血症患者中的女性是血尿的独立危险因素;高尿酸血症患者中的女性、年龄和高血压是eGFR下降的独立危险因素;高尿酸血症患者中的女性、高血压、糖尿病和体质量指数是CKD独立的危险因素。结论成都市高尿酸血症患者中,CKD的患病率较普通患者高,与血尿酸的水平有关。控制血压、血糖、尿酸、血脂和体质量指数,可减少CKD的发生和发展。     

上海浦东地区高尿酸血症的流行现状及影响因素分析

目的:探讨上海浦东地区常住人群中高尿酸血症的患病率及与慢性肾脏病危险因素的关系。方法:对上海浦东地区一个社区中1 024例常住居民进行问卷调查、尿酸、肌酐及慢性肾脏病相关危险因素的检测。采用多因素Logistic回归分析高尿酸血症发生的影响因素。本研究中以尿酸420μmol/L(男性)、360μmol/L(女性)定义为高尿酸血症。结果:在1 024例资料完整的居民中,年龄(56±14)岁,男女比例为404∶620,CKD患者为116例,高尿酸血症患者为182例(17.77%),其中非CKD患者为34例(18.58%),CKD患者为148例(81.42%),且CKD患者中女性高于男性;对高尿酸血症患者和非高尿酸血症患者CKD相关危险因素比较发现高尿酸血症患者年龄[(60±15)岁vs(55±13)岁,P0.01]、SBP[(135±13)mm Hg vs(128±15)mm Hg,P0.01]、DBP[(85.55±8.31)mm Hg vs(82.99±8.55)mm Hg,P0.01]、BMI(26.26±3.47)kg/m2vs(23.91±3.64)kg/m2,P0.01]、腰/臀围比[(0.88±0.05)vs(0.86±0.06),P0.01]、血BUN[(5.41±1.50)mmol/L vs(4.87±1.27)mmol/L,P0.01]、血清肌酐[(127.83±36.56)μmol/L vs(143.17±38.46)μmol/L,P0.01]高于非高尿酸血症组,e GFR[(127.83±36.56)ml·min-1·1.73 m-2vs(143.17±38.46)ml·min-1·1.73 m-2,P0.01]低于非高尿酸血症组,且高血压病(P0.01)、心血管病(P=0.04)和高脂血症(P0.01)比例高于非高尿酸血症患者。单因素回归分析显示年龄、SBP、DBP、BMI、腰/臀围比、BUN、血肌酐、Hb和e GFR与尿酸水平具有相关性;多因素Logistic回归显示性别、SBP、BMI和血肌酐以及高脂血症与高尿酸血症发生独立相关。结论:在上海社区人群中,高尿酸血症的患病率为17.77%,随着CKD的进展,高尿酸血症的发病率增加;相关危险因素包括性别、SBP、BMI、腰/臀围比、血肌酐。     

慢性肾脏病非透析患者高尿酸血症特点分析

目的探索慢性肾脏病(CKD)非透析患者高尿酸血症特点。方法收集2010年1月-2012年11月在南京市第一医院肾内科住院的909例非透析的CKD患者的相关资料,根据性别、年龄及CKD分期进行分组并进行回顾性分析。采用单因素方差分析及卡方检验比较组间尿酸水平或高尿酸血症患病率的差别,同时行Pearson相关性分析比较尿酸水平与相关生化指标间关系。结果 CKD 1期至5期患者的高尿酸血症患病率分别为19. 92%、35. 10%、61. 31%、71. 77%、76. 73%、75. 26%,患病率逐渐升高,CKD 3期以后高尿酸血症患病率超过60%;以不同性别进行分组比较,发现在不同CKD分期中,男性高尿酸血症患病率均高于女性;基于年龄进行分层分析,发现随着患者年龄增加,高尿酸血症患病率逐渐升高,其中80岁以上患者的患病率高达55. 38%。对不同CKD分期患者的尿酸水平进行比较,结果发现,CKD 3a期与3b期患者的尿酸水平无显著差别(P 0. 05),CKD 3a期患者的尿酸水平显著低于4期及5期(P 0. 01),但CKD 3b期与4期及5期患者的尿酸水平无显著统计学差异(P 0. 05)。对患者的尿酸水平与其他指标进行相关性分析,发现尿酸与血红蛋白、游离三碘甲状腺原氨酸呈负相关(r=-0. 209,P 0. 01; r=-0. 125,P 0. 01);与胱抑素C、β2微球蛋白、血肌酐、年龄呈正相关(r=0. 508,P 0. 01; r=0. 424,P 0. 01; r=0. 381,P 0. 01; r=0. 233,P 0. 01)。结论 CKD非透析患者高尿酸血症患病率随CKD进展及年龄增长而升高,男性CKD患者的高尿酸血症患病率高于女性,高尿酸血症与肾损伤标志物及游离三碘甲状腺原氨酸密切相关。     

支气管哮喘患者人群慢性肾脏病流行病学调查

目的 了解支气管哮喘患者人群慢性肾脏病流行病学现状。 方法 选择≥14岁的支气管哮喘患者为研究对象进行问卷调查、体格检查和肾脏损伤及相关危险因素检测。根据相关疾病诊断标准对资料进行分析。 结果 郑州市14岁以上支气管哮喘患者人群蛋白尿、血尿和估算肾小球滤过率（eGFR）下降患病率为别为9.41%、10.37%和3.03%,均高于普通人群。CKD患病率高达17.38%,女性显著高于男性（21.47%比13.99%,χ2 = 6.060,P = 0.014）;CKD1～5期患病率分别为8.61%、5.10%、3.03%、0.48%和0.16%。在哮喘分期中,急性发作期CKD患病率为24.42%,显著高于慢性持续期和临床缓解期（χ2 = 12.445,P = 0.002）;急性发作期蛋白尿和eGFR下降患病率均高于其他两期（χ2 = 19.619,P ＜ 0.01和χ2 = 9.305,P = 0.010）。 结论 支气管哮喘人群具有较高的肾脏损伤发生率,尤其在急性发作期,应重视此人群肾损害的评估。     

上海城市社区成年人群慢性肾脏病流行病学研究

目的 获取上海城市社区成年人群慢性肾脏病流行病学及其高危人群数据，有助于慢性肾脏病的早期发现、早期诊断、早期治疗及有助于国家卫生政策的制定。 方法 采用多阶段整群随机抽样法对上海市长宁区江苏街道中2596名18岁以上常住居民进行问卷调查并检测肾脏损伤指标及相关危险因素，包括体格检查、尿常规+沉渣镜检、尿白蛋白/肌酐比值（ACR）、Scr、BUN、血尿酸、血糖、血胆固醇（Cho）、血三酰甘油（TG）、血红蛋白（Hb）及肾脏B超等。调查员均经过培训及接受技术指导，同时培训社区居委会有关人员，以便与居民的沟通与联络。3个月后对ACR试纸半定量检查阳性者进行复查。 结果 在2554例资料完整的居民中，白蛋白尿患病率为6.3%；肾功能下降为5.8%；镜下血尿为1.2%。该人群中CKD患病率11.8%，知晓率8.2%。多因素Logistic回归提示，CKD的最强烈危险因素为高尿酸血症，其余依次为肾结石、贫血、糖尿病、腹型肥胖、高血压、年龄。 结论 在上海城市社区人群中，CKD患病率为11.8%，知晓率仅为8.2%。CKD的危险因素为高尿酸血症、肾结石、贫血、糖尿病、腹型肥胖、高血压、年龄。     

江苏两个地区老年人群慢性肾脏病的分层随机抽样调查

目的 调查江苏省老年人慢性肾脏病（CKD）的患病率及危险因素。 方法 采用分层随机抽样方法,对江苏省两个地区1404名60岁及以上常住居民进行问卷调查、肾损伤指标及相关危险因素的检测。 结果 1316例资料完整的受访者中,CKD患病率为32.3%。Logistic回归分析显示年龄、性别、高血压、高胆固醇血症及高尿酸血症与CKD患病独立相关。当收缩压（SBP）为140~159 mm Hg、160~179 mm Hg、≥180 mm Hg时,SBP对应CKD的优势比（OR）值分别为0.675、1.330、1.416。当空腹血糖（FBG）为5.6~6.9 mmol/L和≥7.0 mmol/L时,FBG对应CKD的OR值分别为0.628和1.941。 结论 我国江苏地区老年人群CKD患病率较高,危险因素包括年龄、性别、高血压、高胆固醇血症及高尿酸血症,与发达国家相似。     

成都市铁路职工糖尿病人群慢性肾脏病患病情况及相关危险因素

目的探讨成都市铁路职工糖尿病人群慢性肾脏病(chronic kidney disease,CKD)的患病情况及相关危险因素。方法从2009年9月至2013年12月在成都铁路分局医院健康体检的铁路职工(分散居住在成都市各区)的资料中,选取有完整资料的967例糖尿病人群列入本次研究,资料包括问卷调查(性别、年龄、吸烟、饮酒、既往病史)、体格检查(血压、身高和体质量)、血液和尿液检测(尿素氮、血肌酐、血尿酸、血糖、胆固醇、三酰甘油、尿微量白蛋白、尿肌酐和尿常规)等,根据CKD诊断标准[白蛋白尿:尿微量白蛋白/肌酐≥30 mg/g;血尿:尿沉渣红细胞3个/高倍镜;肾小球滤过率(estimated glomerular filtration rate,eGFR)下降:简化肾脏病饮食改良(modification of diet inrenal disease,MDRD)公式计算eGFR60 ml·min~(-1)·(1.73 m~2)~(-1)]对资料进行分析。结果①糖尿病人群白蛋白尿、血尿和eGFR下降的发生率分别为28.02%、1.45%和13.75%。该人群中CKD的患病率为37.64%。糖尿病人群白蛋白尿发生率明显高于糖尿病前期人群和无高血糖的人群。糖尿病合并高血压、高血脂和高尿酸人群白蛋白尿、eGFR下降和CKD的患病率均明显高于单纯高尿酸血症人群。②空腹血糖水平与尿微量白蛋白/肌酐比值呈正直线相关。③年龄、体质量指数、高血压和空腹血糖水平是白蛋白尿的独立危险因素,女性是血尿的独立危险因素,年龄、高尿酸和空腹血糖水平是eGFR下降的独立危险因素,年龄、体质量指数、高血压、高尿酸和空腹血糖水平是CKD的独立危险因素。结论成都市铁路职工糖尿病人群,CKD的患病率与空腹血糖、体质量指数、血压、血尿酸和血脂相关。     

Comparisons of the prevalence and correlation factors of chronic kidney disease between the old urban and rural residents in MinHang district of Shanghai

Objective To compare the prevalence and correlation factors of chronic kidney disease (CKD) in urban and rural areas in Minhang district of Shanghai through the social economic and clinical data of the elderly population. Methods Jiangchuan Street and Pujiang town were randomly selected to represent the urban and rural population in Minhang district of Shanghai, respectively. Based on the over-60-year old people health examination program, 6151 objectives with complete clinical-epidemiological data and bio-chemical index were investigated. The prevalence of CKD in urban and rural areas was compared, and the correlation factors for the urban and rural CKD were evaluated by multiple logistic regression analysis. Results (1) The survey objectives with an average age of (69.57±7.04) years, including 4345 cases of the city residents and 1806 cases of rural residents, were enrolled. The age structures of urban and rural showed differences, population over 80 years old account for 13.1% of the rural total, significantly higher than 7.4% in the urban population (P＜0.001). (2) The prevalence rates of diabetes, hyperuricemia, hyperlipidemia and hyperlipidemia in urban residents were higher than those in rural residents, which were 26.4% vs 13.7%, 9.9% vs 2.3%, 53.7% vs 37.4%, 51.4% vs 15.6% (all P＜0.01). The awareness rates of kidney disease and hyperlipidemia showed significant differences in urban and rural areas, which were 32.9% vs 44.2%, 84.6% vs 62.8% (all P＜0.01). Compared with those in rural areas, the treatment rates of hypertension and high blood lipids in urban residents were increased (all P＜0.01). (3) The prevalence of CKD was 23.4%. Female CKD prevalence was higher than male, respectively 26.3% and 18.5% (P＜0.01). In urban CKD prevalence was 22.2%, lower than 25.2% in rural. The prevalence rate of hematuria in urban areas was lower than in rural areas, but the prevalence rate of decline in renal function was higher (all P＜0.05). With the increase of age, the prevalence rate of CKD was increased (P＜0.01). (4) Age (OR=1.072), smoking history (OR=1.543), previous history of kidney disease (OR=1.351), diabetes (OR=1.373), hyperuricemia (OR=2.498), obesity (OR=1.364), history of interventional therapy (OR=1.896) had positive correlation with CKD in city elderly population, while the higher education (OR=0.676, OR=0.604) and drinking (OR=0.585) had negative correlation (all P＜0.05). Age (OR=1.032), female (OR=1.860) had positive correlation with CKD in rural elderly population (all P＜0.05). Conclusions CKD has been a common chronic progressive disease of the aged in Minhang district. The prevalence of CKD is higher in urban areas than in rural. Age is a common factor for CKD in urban and rural. Previous smoking, history of kidney disease, diabetes, hyperuricemia, obesity, history of interventional therapy, education and drinking have correlation with urban CKD patients. Female has correlation with rural CKD population.     

Clinical and pathological features of hyperuricemia in children with IgA nephropathy at a single center

Objective To investigate the clinical, pathological features and risk factors of hyperuricemia in children with IgA nephropathy (IgAN). Methods A retrospective study of 269 primary IgAN children diagnosed between January 1, 2006 to December 31, 2017 at the Children Kidney Disease Center, the First Affiliated Hospital of Sun Yat-sen University, was performed in the hyperuricemia group (uric acid＞350 μmol/L) and the normal uric acid group. The clinical and pathological characteristics were analyzed, and the risk factors of hyperuricemia were analyzed by using multivariate logistic regression analysis. Results There were 185 males and 84 females in the 269 IgAN children with age of (9.2±3.1) years old, among whom there were 70 patients (26.0%) accompanied by hyperuricemia. Clinical indicators such as hypertension, urea nitrogen, serum creatinine, blood lipids, urinary protein in hyperuricemia group were higher than those in normal uric acid group (all P＜0.05), while estimated glomerular filtration rate, serum total protein and albumin were less (all P＜0.05). There were 58 patients (23.0%) and 12 patients (70.5%) associated with hyperuricemia among IgAN children with CKD 1-2 and CKD 3-5. The proportion of hyperuricemia in CKD stage 3-5 IgAN children was statistically higher than that in normal uric acid group (P＜0.01). The hyperuricemia group had a higher proportion of Lee IV and V grade, and a lower proportion of the Lee III grade than the normal uric acid group (all P＜0.05). According to the Oxford pathological classification score, there was no significant difference in total scores of renal lesions, glomerular score, and tubulointerstitial score between the two groups (all P＞0.05). According to the Katafuchi semi-quantitative score, there was no significant difference in the total scores of renal lesions, glomeruli, and tubulointerstitial scores (all P＞0.05), while the hyperuricemia group had higher renal vascular scores than the normal uric acid group (P＜0.01). Multivariate logistic regression analysis showed that hypertension (OR=12.596, 95%CI 1.778-89.243, P=0.011), higher total cholesterol (OR=1.192, 95%CI 1.064-1.336, P=0.002), higher urea nitrogen (OR=1.273, 95%CI 1.104-1.468, P=0.001), proteinuria 3+(OR=1.875, 95%CI 1.309-2.684, P=0.001), proteinuria 4+(OR=1.627, 95%CI 1.241-2.134, P＜0.001) and CKD stage 3 (OR=3.355, 95%CI 1.376-8.181, P=0.008) were the risk factors of hyperuricemia in children with IgAN. Conclusions Twenty-six percent IgAN children patients are accompanied by hyperuricemia, and their clinical parameters and pathological changes are more severe than those in normal uric acid group. Hypertension, higher total cholesterol, higher urea nitrogen, proteinuria 3+/4+ and CKD stage 3 are the risk factors of hyperuricemia in children with IgAN.     

慢性肾脏病3期合并高尿酸血症的临床分析

目的探讨慢性肾脏病3期高尿酸血症与慢性肾脏病及相关危险因素的关系。方法对178例慢性肾脏病3期患者进行回顾性研究,根据血尿酸水平,将其分为高尿酸组和尿酸正常组,分析蛋白尿、肾功能及相关危险因素的差异。结果178例慢性。肾脏病3期患者中发生高尿酸血症137例（高尿酸组）,发生率为76．9％;尿酸正常者41例（尿酸正常组）。女性患者高尿酸发生率为85．6％,较男性患者高尿酸发病率高,差异有统计学意义（P〈0．05）。高尿酸组与尿酸正常组的蛋白尿、肾功能、血压、血脂比较,差异均无统计学意义（P均〉0．05）。结论高尿酸血症在慢性肾脏病3期患者中发生率高,但高尿酸血症在肾功能受损患者中的致病性有待进一步研究。     

Study on the prevalence of hyperuricemia and its relationship with chronic kidney disease in the urban residents of Yunnan plateau area

Objective To investigate the prevalence of hyperuricemia (HUA) and its relationship with chronic kidney disease (CKD) among the population of Yunnan Plateau area. Methods Residents aged over 18 years old (n=4581) in the city of Yuxi, a community where original inhabitants were relatively concentrated, were randomly chosen for screening cross-sectional. Fasting blood and urine samples were collected to detect blood and urine parameters. Results The prevalence of HUA in the community residents was 25.91％, of which the prevalence of HUA was 34.15% in male and 15.55% in female. The prevalence of HUA in men was higher than that in women, and the difference was statistically significant (P＜0.01). In the age of 30-49 years old, the prevalence of HUA was higher than that in other age groups (P＜0.01). Multivariate logistic regression analysis showed that HUA, age, gender, hyperglycemia, low HDL levels were independently associated with CKD (P＜0.05). In addition, high blood uric acid (≥404 μmol/L) group has a higher risk of CKD than low blood uric acid (≤282 μmol/L) group, when divided into four groups according to the blood uric acid level (OR=3.447, 95%CI 2.218-5.375, P＜0.01). Conclusions HUA is independently associated with CKD. The prevalence of HUA in community residents of Yunnan Plateau (Yuxi) is different from their counterparts in eastern coastal area and the data of developed regions reported by studies in past 10 years.     

Related factors of hyperuricemia in IgA nephropathy patients

Objective To investigate the influencing factors of hyperuricemia in patients with IgA nephropathy (IgAN). Methods A retrospective study was performed in patients with renal biopsy diagnosed as IgAN in the Department of Nephrology, Provincial Hospital of Anhui Medical University from January 2016 to October 2018. According to the blood uric acid level, they were divided into two groups: patients with hyperuricemia and patients without hyperuricemia. The general clinical indicators and renal pathological data were compared between the two groups. Logistic regression model was used to analyze the influencing factors of hyperuricemia in IgAN patients. Results A total of 125 IgAN patients with age of (35.70±11.16) years old were enrolled, including 63 males and 62 females. The morbidity of hyperuricemia was 44.0%(55/125). Compared with the normal blood uric acid group, the blood urea nitrogen, serum creatinine and the proportion of chronic kidney disease (CKD) stage 3-5, small arterial wall thickening, fibrous crescents/globules, renal interstitial fibrosis, renal tubular atrophy, glomerular sclerosis and inflammatory cell infiltration in the hyperuric acid group were higher, while the level of estimated glomerular filtration rate (eGFR) was lower. And the differences were statistically significant (all P＜0.05). Multivariate logistic regression analysis showed that the level of serum creatinine was an independent related factor of hyperuricemia in IgAN patients (OR=1.034, 95%CI 1.005-1.064, P=0.021). Conclusions IgAN patients with hyperuricemia presented more severe glomerular, tubular and interstitial lesions, and the level of serum creatinine is an independent related factor of hyperuricemia in IgAN patients. High uric acid level may have an important influence on the progression of IgAN, so good control of serum uric acid may improve the prognosis of patients with IgAN.     

Prevalence and risk factors of hyperuricemia in patients with lupus nephritis

Objective To investigate the prevalence and related risk factors of hyperuricemia in patients with lupus nephritis (LN) in Southern China. Methods A single center retrospective study, 959 adult LN patients diagnosed with biopsy-proven, who admitted to The First Affiliated Hospital, Sun Yat-sen University from 1998.01 to 2010.12 were recruited. Results Among this cohort, the prevalence of hyperuricemia was 57.7%. The prevalence of hyperuricemia for CKD stage 1, 2, 3, 4, 5 was 44.1%, 65.7%, 74.7%, 77.6%, 73.9%, respectively. Logistic regression analysis showed that increased serum triglyceride level and endothelial proliferation (≥50%) were independent risk factors of hyperuricemia in LN patients; Also, increased serum triglyceride level was an independent risk factor of hyperuricemia in LN patients of CKD stage 1-2; Positive dsDNA and positive anticardiolipin antibody were independent risk factors of hyperuricemia in LN patients of CKD stage 3-5. Conclusion The prevalence of hyperuricemia in LN patients from this cohort is 57.7%. Increased level of serum triglyceride is an independent risk factor associated with hyperuricemia in both overall LN patients and those of CKD stages 1-2. Therefore, the present study indicates that metabolic factors may influence each other, and should be paid more attention in the clinical practice of LN care.     

Risk factors of bone density disorder and vascular calcification in non-dialysis chronic kidney disease patients

Objective To explore the risk factors of bone density disorder and vascular calcification in non-dialysis chronic kidney disease (CKD) patients. Methods Clinical data of non-dialysis CKD patients who were admitted to the First Affiliated Hospital of Fujian Medical University between January 2013 and June 2014 were retrospectively analyzed. Using dual energy X-ray absorptiometry to evaluate their bone mineral density (BMD) and T value. Patients were divided into normal BMD group (T≥-1), osteopenia group (-2.5＜T＜-1) and osteoporosis group (T≤-2.5). The vascular calcification was evaluated by pectoral computed tomography. Multi-factor stepwise logistic regression analysis was used to assess the risk factors for low bone density and vascular calcification in non-dialysis CKD patients. Results A total of 337 non-dialysis CKD patients were enrolled. There were 110 (32.6%) patients with normal BMD, and 146(43.3%) patients with osteopenia, and 81(24.0%) patients with osteoporosis. Gender, history of hypertension, 25-hydroxy vitamin D and N-terminal osteocalcin shown statistical differences among three groups (all P＜0.05). The incidence rate of 25-hydroxy vitamin D deficiency shown statistical difference among three groups (P=0.012). Further, the rates were increased with the decreased bone mass (χ2=7.100, P=0.008). The other mineral bone disorders, such as hypocalcemia, hyperphosphatemia, low intact parathyroid hormone (iPTH) and high iPTH had no statistical difference among three groups (all P＞0.05). Multi-factor stepwise logistic regression analysis revealed that increased iPTH (OR=1.938), and low bone density (OR=1.724) were independent risk factors for CKD patients with vascular calcification (all P＜0.05), while women (OR=3.312) and vascular calcification (OR=1.742) were independent risk factors for CKD patients with low bone density (all P＜0.05). Conclusion Increased iPTH and low bone density are independent risk factors for non-dialysis CKD patients with vascular calcification, while women and vascular calcification are independent risk factors for non-dialysis CKD patients with low bone density.     

Review article: Early detection of chronic kidney disease in Australia: Which way to go?

Early detection of chronic kidney disease (CKD) followed by appropriate clinical management appears the only means by which the increasing burden on the health-care system and affected individuals will be reduced. The asymptomatic nature of CKD means that early detection can only occur through testing of individuals. The World Health Organization principles of screening for chronic disease can now be largely fulfilled for CKD. The risk groups to be targeted, the expected yield and the tests to be performed are reviewed. For a screening programme to be sustainable it must carry a greater benefit than risk of harm for the participant and be shown to be cost-effective from the community point of view. Whole population screening for CKD is impractical and is not cost-effective. Screening of those at increased risk of CKD could occur either through special events run in the community, workplace or in selected locations such as pharmacies or through opportunistic screening of high-risk people in general practice. Community screening programmes targeted at known diabetics, hypertensives and those over 55 years have been described to detect 93% of all CKD in the community. The yield of CKD stages 3–5 from community screening has been found to vary from 10% to 20%. The limitations of screening programmes including the cost and recruitment bias are discussed. The most sustainable and likely the most cost-efficient model appears to be opportunistic general practice screening. The changing structure of general practice in Australia lends itself well to the requirements for early detection of CKD.     

穿通支原体感染与IgA肾病临床病理的关系

目的 研究穿通支原体（Mycoplasma penetrans,Mpe）感染与IgA肾病（IgAN）患者临床病理改变的关系。 方法 采集经病理检查确诊的IgAN患者118例、健康体检者89例和慢性肾脏病（CKD）90例的血液标本,用试剂盒方法提取血清DNA。用PCR技术检测Mpe p35脂蛋白,对阳性标本采用Southern 印迹方法进行验证。根据IgAN患者Mpe感染情况分为阳性组和阴性组,结合患者的临床病理资料进行分析。 结果 89例健康体检者中仅1例Mpe p35脂蛋白为阳性,阳性率为1.1%。90例CKD患者中2例阳性,阳性率为2.2%。118例IgAN患者中19例阳性,阳性率为16.0%,显著高于健康组及CKD组,差异均有统计学意义（均P ＜ 0.01）。Mpe阳性组42.1%患者临床表现为肉眼血尿,显著高于Mpe阴性组（P ＜ 0.01）。Mpe阴性组24 h尿蛋白量、Scr、Lee病理分级显著高于阳性组,差异均有统计学意义（均P ＜ 0.05）。两组间肾小管、肾间质及肾血管积分差异无统计学意义。 结论 IgAN患者的Mpe检出率显著高于健康体检者和CKD患者。Mpe阳性患者更多表现为发作性肉眼血尿。Mpe感染可能与IgAN的发病有关。     

广西城镇与农村慢性肾脏病的流行病学状况比较

目的 了解广西城镇和农村居民慢性肾脏病（CKD）流行情况及危险因素,为临床积极做好CKD防治工作提供有力依据。 方法 采用分层多级抽样方法,对广西18～74岁常住居民进行CKD抽样调查。被调查者均接受问卷调查,检测尿白蛋白/肌酐比值、血尿(离心后尿沉渣显微镜检查)和肾脏B超,结果异常者3个月后进行复查。用国人校正的简化MDRD公式计算估计肾小球滤过率（eGFR）。同时调查CKD的相关危险因素。 结果 城镇和农村居民白蛋白尿标化患病率（5.22%比5.47%）和血尿标化患病率（1.07%比1.11%）差异无统计学意义（均P > 0.05）。农村居民肾结石患病率高于城镇（10.54%比6.95%,P < 0.05）。城镇与农村居民肾功能下降患病率（3.87%比4.04%）和CKD患病率（9.58%比9.42%）差异均无统计学意义（均P > 0.05）。城镇与农村白蛋白尿患病率按年龄分布趋势不同,城镇随年龄增加而增高,农村则有两个发病高峰,年龄分别为30～40岁和60～74岁年龄段。根据Logistic回归分析,广西居民白蛋白尿的危险因素是糖尿病、高尿酸血症、心血管疾病史、慢性扁桃体炎、HBsAg阳性;肾功能下降的危险因素是年龄、高尿酸血症、高血压、糖尿病、肾结石和心血管疾病史。城镇居民CKD知晓率高于农村（14.45％比6.27％,P < 0.05）。 结论 广西城镇与农村居民CKD患病率差异无统计学意义,城镇居民CKD知晓率高于农村,需要加强农村CKD防治工作。