Clinical analysis of peritoneal dialysis in the treatment of rapidly progressive glomerulonephritis

Objective To observe the clinical characteristics and prognosis of patients with rapidly progressive glomerulonephritis (RPGN) caused by lupus nephritis, antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis, or primary glomerulonephritis who were treated with peritoneal dialysis (PD) and then withdrew PD because of renal recovery. Methods Data of the above patients were retrospectively analyzed. The patients were diagnosed as RPGN and received PD therapy in Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University from February 2009 to August 2018. The patients were divided into early withdrawal group (PD time≤183 days, n=24) and late withdrawal group (PD time＞183 day, n=24). The differences of clinical characteristics between the two groups were compared. The cumulative incidence of adverse events in both groups was analyzed using Kaplan-Meier curves. Cox proportional hazards model was used to analyze the risk factors influencing the prognosis of patients. Results Forty-eight RPGN patients were included. The median time of maintaining PD was 178(76, 378) days. Compared with the late withdrawal group, the patients in early withdrawal group had lower levels of urine volume, serum albumin and parathyroid hormone, and lower rates of gross hematuria and hypertension at the beginning of PD, and received higher rates of methylprednisolone impulse, combined immunosuppressive agents, and hemodialysis or continuous renal replacement therapy (all P＜0.05). At the time of PD withdrawal, the levels of serum creatinine, serum calcium, serum albumin and parathyroid hormone in the early withdrawal group were significantly lower than those in the late withdrawal group (all P＜0.05). The Kaplan-Meier curves showed that there was no significant difference in the cumulative survival of patients in both groups (log-rank test χ2=3.485, P=0.062). Cox regression analysis revealed serum creatinine≥209 μmol/L at the time of PD withdrawal was an independent risk factor for poor prognosis (HR=5.253，95%CI 1.757-15.702, P=0.003). Conclusions PD can be used for RPGN patients caused by lupus nephritis, ANCA-associated vasculitis and primary nephritis. Serum creatinine≥209 μmol/L at the time of PD withdrawal is an independent risk factor for poor prognosis.     

Corticosteroid therapy does not prevent nephritis in Henoch-Schönlein purpura

Nephritis occurs in 20%–50% of children with Henoch-Schönlein purpura (HSP), and the onset of renal involvement may be delayed for weeks or months in a substantial proportion of patients. The present study was performed to determine whether corticosteroid therapy was effective in preventing delayed nephritis in children with HSP. The medical records of 69 children with HSP were reviewed. Nineteen patients had acute nephritis occurring from 1–12 days after the onset of other signs and symptoms. The remaining 50 patients had no evidence of acute renal involvement. Of these 50 patients, 20 were treated during the acute phase of the illness with corticosteroids, while 30 never received corticosteroid therapy. Delayed nephritis (>3 weeks following an initial normal urinalysis) occurred in 4 of 20 (20%) patients who received prior corticosteroid treatment, and in 6 of 30 (20%) patients who were not treated. These results indicate that early corticosteroid therapy does not prevent delayed nephritis in children with HSP.     

复方肾华治疗大鼠改良慢性血清病肾炎的实验研究

目的　观察复方肾华胶囊对改良大鼠慢性血清病肾炎模型的治疗作用。方法　采取传统大鼠慢性血清病肾炎模型制作方法加上切除大鼠一侧肾脏、隔日饮饲牛血清白蛋白 (BSA)酸化水、腹腔注射大肠杆菌内毒素 (LPS)等措施 ,制作肾炎模型 ,与西药蒙诺作对照 ,观察中药肾华对肾炎大鼠尿蛋白、血生化、凝血指标、肾功能、病理、免疫荧光以及增殖细胞核抗原 (PCNA)表达的作用。结果　肾华胶囊能够显著减轻肾炎大鼠肾脏重量及肾重指数、降低肾炎大鼠尿蛋白、升高血清蛋白、降低胆固醇、甘油三酯、改善肾功能、纠正凝血功能紊乱、减轻肾脏病理改变、减轻免疫荧光变化、减弱PCNA的表达。结论　中药肾华胶囊对大鼠慢性血清病肾炎模型有较好的治疗作用     

Effects of Nephritis No.3 Recipe on Nitric Oxide,Nitric Oxide Synthase Secreted by Cultured Mesangial Cells in Rats and the Gene Expression of Inducible Nitric Oxide Synthase

Objective:To explore the effect of the Nephritis No.3(N-3)recipe on nitric oxide(NO),nitric oxide synthase(NOS)secreted by cultured mesangial cells(MC)and its gene expression of the in-ducible nitric oxide synthase(iNOS).Methods:The drug(nephritis No.3)-containing serum was preparedwith serum pharmacological technique,and then was applied to react on mesangial cells cultured In fetalcalf serum(FCS)and cells cultured in FCS plus lipopolysaccharide.To observe the secretion of NO andNOS and the gene expression of iNOS by means of RT-PCR.Results:Under the two kinds of culture con-ditions,the content of NO and NOS in the groups with drug-containing serum were higher than thosewithout drug-containing serum(P<0.05,P<0.01),and the expression of iNOS mRNA was up-regula-ted too.Conclusion:The N-3 could significantly promote the secretion of NO and NOS and the mRNA ex-pression of iNOS in rats.     

肾脏固有细胞和浸润细胞在肾小管间质病变中的作用

Tubulointerstitial lesions,occurring in many kinds of renal diseases,have been found to be the predominant factor in the impairment of renal function.The severe and extensive lesions often predict a poor outcome in future.It has been tested recent years that the infiltrating inflammatory cells might play important roles in the onset and deterioration of tubulointerstitial injuries.On the other hand,the resident cells,including the tubular epithelial cells and the fibroblasts,also directly take part in tubulointerstitial inflammation and fibrosis.Researches also dispaly implicated interactions between the infiltrating cells and the resident cells,which contribute to the amplification of inflammation and the progress of fibrosis.     

肾炎益气液对肾毒血清性肾炎大鼠肾脏超微结构的影响

目的:观察肾毒血清性肾炎大鼠肾组织超微结构变化及肾炎益气液对该变化的影响。方法: 采用大鼠肾毒血清性肾炎模型,常规电镜制片、染色,观察肾组织超微结构的变化。结果: 注射肾毒血清(NTS)后,病理组大鼠电镜下可见明显的系膜细胞增生,系膜基质增多,毛细血管腔闭塞及上皮下、内皮下电子致密物沉积等多种病理损伤性变化。而肾炎益气液组上述病变有所减轻。结论: 肾炎益气液有不同程度减轻肾小球电镜下病变的作用。     

被动型Heymann肾炎大鼠外周血淋巴细胞诱生IL－2水平的动态观察

为了检测被动型ｎｅｙｍａｎｎｇ肾炎（ＰＨＮ）大鼠细胞免疫状况，我们将抗肾小管刷状缘的抗体腹腔注射大鼠体内而建立了被动Ｈｅｙｍａｎｎ肾炎模型，在ＰＨＮ的最初２８ｄ，用ＭＴＴ比色法检测了７ｄ．１４ｄ、２８ｄ时外周血淋巴细胞诱生ＩＬ－２水平的变化，结果７ｄ时ＩＬ－２水平为２６．５２±１０．７２Ｕ／ｍｌ，与正常对照组３９．８０±９．４０Ｕ／ｍｌ相比显著差异（Ｐ＜０．０１），１４ｄ时ＩＬ－２水平为３０．６８±１１．７９Ｕ／ｍｌ（Ｐ＜Ｏ．０５），２８ｄ时ＩＬ－２水平为３２．７２±８．７２Ｕ／ｍｌ（Ｐ＜０．０５），提示ＰＨＮ大鼠存在免疫功能紊乱。     

抗胸腺细胞血清性肾炎模型大鼠肾小球中C5b-9的沉积及NO、TNFα含量分析

目的: 探讨抗胸腺细胞血清性肾炎(ATSN)大鼠肾小球内C5b-9复合物的沉积与某些炎症介质和细胞因子如:一氧化氮(NO)和肿瘤坏死因子α(TNFα)的含量情况。 方法: 大鼠一次性静脉注射抗胸腺细胞抗血清(ATS)建立ATSN模型,定期对ATSN大鼠肾小球中的补体C5b-9复合物进行免疫组化染色定位、显微图像扫描半定量分析;并对有C5b-9包绕的肾小球系膜细胞(MC)进行计数。测定ATSN大鼠肾中诱生型NO合酶(iNOS) mRNA的表达、尿液中NO的代谢产物(NO^-₂／NO^-₃)及TNFα的排泄量。 结果: ATSN模型大鼠肾小球MC先溶解坏死后继发增生,病变早期(溶解时相)补体C5b-9复合物主要定位于肾小球系膜区及MC表面;随着病程的进展,被C5b-9包绕的MC逐渐减少, 病程初期ATSN大鼠肾小球MC有明显的 iNOS mRNA表达, 尿液中NO^-₂／NO^-₃ 和TNFα的排泄量也明显增加。在ATSN病变的增生阶段(一般7 d后),上述指标的变化逐渐趋缓。 结论: ATSN模型大鼠肾小球中MC逐渐溶解与补体C5b-9沉积及NO和TNFα的合成与释放有一定关系。     

IL—18对狼疮性肾炎患者外周血淋巴细胞凋亡及相关基因表达的研究

目的：研究LN患者外周血淋巴细胞（PBL）在IL－18刺激下细胞凋亡及凋亡相关基因表达情况。方法：Anniexin V联合PI染色定量法及免疫荧光染色法,分析了12例活动期和26例非活动期狼疮性肾炎患者PBL在IL－18刺激培养后凋亡发生率,凋亡相关基因bcl-2和Fas蛋白的表达以及疾病活动性与淋巴细胞凋亡发生率的相关性。结果：在IL－18刺激培养作用下,活动期LN淋巴细胞凋亡发生率明显增高（P＜0．01）,而非活动期则无明显区别（P＞0．05）,疾病活动性与体外淋巴细胞凋亡率呈正相关（P＜0．01）。bcl-2表达活动期显著性升高（P＜0．05）,非活动期无显著性差异（P＞0．05）。Fas表达活动期显著升高（P＜0．001）,非活动期明显升高（P＜0．05）。结论：IL－18可引起LN患者外周血淋巴细胞凋亡率的增高,表明IL－18在体内凋亡或凋亡相关性免疫机制中起着一定的作用。     

慢性马兜铃酸肾病动物模型的建立及其意义

目的探讨建立马兜铃酸引起的大鼠慢性肾间质纤维化动物模型.方法将雌性wistar大鼠分为马兜铃酸组与对照组.马兜铃酸组大鼠腹膜内注射马兜铃酸5mg@kg-1@d-1共16周,开始用药后8、12、16、20、24周分别处死6只大鼠.对照组大鼠(5只)腹膜内注射生理盐水2ml/d,共16周,24周时处死.两组动物处死时分别留取血、尿、肾组织标本,分别作生化、病理(光镜,免疫荧光,电镜)等方面的检查及应用电脑软件测定肾小管-间质面积.结果马兜铃酸组大鼠用药后16、20、24周体重明显低于对照组;用药后16周血尿素氮、血清肌酐明显高于对照组,24周时肾功能损伤进一步加重.光镜检查可见马兜铃酸组大鼠有明显肾小管-间质损伤,16周时肾小管面积明显增加,管腔面积明显小于对照组;24周时出现明显肾小管萎缩,肾小管面积明显缩小,而肾间质面积明显增加,肾间质呈多灶性纤维化.电镜检查16周时肾小管上皮细胞胞质内初级溶酶体、次级溶酶体明显增加,部分肾小管上皮细胞刷状缘消失;20、24周时可见胞质内次级溶酶体和髓样小体堆积.结论建立了慢性马兜铃酸肾病动物模型.马兜铃酸具有慢性肾毒性作用,可引起大鼠慢性肾间质纤维化.