13 K idney and Urinary Tract

13 K idney and Urinary Tract

2015098 Role of autophagy in contrast media-induced renal tubu lar epithelial cells in jury.JIAN Yonghong（簡(jiǎn)永紅），etal.Nephrol Div，Renmin Hosp，Wuhan Univ，Wuhan 430060.Chin JNephrol 2014；30（11）：863-869.

Ob jectiveTo observe the effect of contrastmedia on autophagy and apoptosis of renal tubular epithelial cells，evaluate the role of autophagy in contrastmedia-induced renal tubular epithelial cells injury.MethodsNRK-52E cells were exposed to iopromide at different concentration for 1 hour or at50 gl/L for variable incubation time.Rapamycin（1μg/L）and 3-methyadenine（2 mmol/L）were further introduced to investigate the role of autophagy in the process.The formation of autophagy was observed by acridine orange staining and Green fluorescent protein tagged LC3（GFP-LC3）.The expression of autophagy protein LC3 and Beclin-1 was examined by Western blotting，and the apoptosis level was examined by flow cytometry and Hoechst33342-staining.Resu lts（1）Autophagy could be enhanced by contrastmedia in renal tubular epithelial cells.（2）The expression of LC3-Ⅱ/ LC3-Ⅰin renal tubular epithelial cells rose at first and then dropped with the increase of iopromide stimulation time and concentration（P＜0.05）.（3）Iopromide promoted renal tubular epithelial cell apoptosis in dose-and time-dependentmanner（P＜0.05）.（4）Co-culture with rapamycin further increased LC3-Ⅱ/LC3-Ⅰ，Beclin-1 and GFP-LC3 expression，butobviously prevented iopromide-induced apoptosis of renal tubular epithelial cells（P＜0.05）.On the contrary，Co-culturewith 3-methyadenine reduced iopromide-induced LC3-Ⅱ/LC3-Ⅰ，Beclin-1 and GFP-LC3 overexpression，but aggravated the apoptosis induced by iopromide（P＜0.05）.ConclusionContrastmedia can induce renal tubular epithelial cells apoptosis aswell as autophagy.Enhancing autophagy appropriately has a protective effect on iopromide-induced renal tubular epithelial cells apoptosis，which conforms that autophagy plays an important role in antagonizing iopromide-induced renal tubular epithelial cells injury.

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2015099 Exp ression of strom al cell-derived factor 1 in the acute ischem ia-reper fusion in jury and its relationship with macrophages.XIAWenkai（夏文楷），et al.Dept Nephrol，Nanjing 1st Hosp，Nanjing Med Univ，Nanjing 210006.Chin JNephrol 2014；30（11）：851-855.

ObjectiveTo observe the expression of stromal cellderived factor 1（SDF-1）in the kidney after ischemic reperfusion injury（IRI），and explore its relationship with macrophage during the IRI kidney.M ethodsA total of 28 healthy C57BL/6malemicewere used to establish renal IRImodel by clamping both pedicles for 35 min followed by reperfusion.Kidney tissue samples were collected at indicated time points.Renal histological changeswere estimated.The expression of SDF-1 was determined by immunohistochemistry，ELISA and real-time PCR.After the liposomal clodronate was injected intraperitoneally，the location of CD68 was observed by immunofluorescence.Renal histology and protein expression of SDF-1 were also detected.ResultsCompared with shamoperated group，classical tubular damage was found in IRIgroup，accompanied by a large number of inflammatory cells.The expression of total renal SDF-1 peaked on day 1 and decreased to control levels in the following days.SDF-1 in healthy kidney was localized at cortex，but spread to the corticomedullary area of the kidney during IRI.Compared with IRIgroups，elimination ofmacrophage by injection of liposomal clodronate alleviated renal IRI and down-regulated the expressions of CD68 while up-regulating SDF-1.ConclusionSDF-1 expression is up-regulated in IRIkidney and is associated withmacrophage.SDF-1may play a role in the early phase of acute kidney injury and itmay be a new marker in diagnosis of AKI.

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2015100 Role of macrophage on the repair phase of ischem ic/reper fusion renal injury in m ice.WEI Pan（魏盼），et al.Dept Nephrol，1st Nanjing Med Univ，Nanjing 210006.Chin JNephrol2014；30（10）：757-762.

Ob jectiveTo study the effect ofmacrophage on the repair phase of ischemic/reperfusion（IR）renal injury in mice.MethodsA total of 24 C57BL/6 mice aged 6-8 week-old were divided into 4 groups：the Sham group，IR group，LC group and Control group.For all the groups，the bilateral renal pedicles of the mice were clipped after dorsal skin dissection，except for the Sham group，then unclipped them 25 minutes to restore blood flow to the kidney and collected the renal specimens after 3 days.The LC group and the control group each were injected intraperitoneally with 0.15-0.20 ml/20 g per day before kidney specimenswere taken.Themorphology changes of renal tissues were evaluated by HE staining.Immunohistochemical testing was performed to detect the infiltration of macrophages，the expression change of Ki67，TNF-αand IL-10.In addition TNF-α，IL 10 were measured using Western blotting.Resu ltsCompared to the IR group and the control group，the infiltration of macrophages was markedly decreased，the damage of renal pathology was aggravated，the cell proliferation was significantly decreased，and the expression of IL-10 was also decreased（P＜0.05），while the expression of TNF-αwere increased（P＜0.05）.ConclusionIntraperitoneal LC injection can aggravate kidney damage on the repair phase of renal ischemic/reperfusion injury in mice，which is possibly related its inhibition of proinflammatory cytokines TNF-αand the secretion of anti-inflammatory cytokine IL-10.

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2015101 Association between body-mass index and survival in peritoneal dialysis patients.WANG Yi（王奕），et al.Dept Nephrol，Shanghai East Hosp Affil，Tongji Univ，Shanghai，200120.Chin JNephrol 2014；30（10）：744-750.

ObjectiveTo evaluate the association between bodymass index and prognosis in peritoneal dialysis（PD）patients.M ethodsIn this observational study of single nephrology unit in Shanghai East Hospital，81 incident continuous ambulatory peritoneal dialysis（CAPD）patients were included from Jan 2008 to Dec 2013，who were followed-up by 36 months or until death.The patientswere classified as underweight（BMI＜18.5 kg/ m2）；normal weight（18.5～23.9 kg/m2）；overweight（24-27.9 kg/m2）and obese（BMI≥28 kg/m2）.The patients and technique survival rates were estimated by Kaplan-Meieranalysis.Cox proportionalhazards analyses were used to elucidate relationship between BMIand allcausemortality and technique failure in PD patients.Resu ltsThe overall survival ratewas similar between normal and overweight groups（P=0.96），but significantly lower in underweight group and obese group（P＜0.01 respectively）.The overall technical survival rate of obese group was lower compare with the normal group（P＜0.01）.Themain cause of technical failure was peritonitis（81.3%）.BMIwas positively correlated with albumin（r=0.24，P＜0.05），hemoglobin（r=0.56，P＜0.01），glucose（r=0.23，P＜0.05）and cholesterol（r=0.41，P＜0.01），but negatively correlated with Kt/V（r=-0.36，P＜0.01）and Ccr（r=-0.34，P＜0.01）.In adjusted Cox proportional hazard mode 3，obese was independently associated with all-causemortality（HR：5.93，95%CI：1.10-31.79）.Obese and peritonitiswere independently associated with technical failure（HR：10.33，95%CI：1.04-78.02 and HR：2.74，95%CI：1.17-6.40 respectively）.ConclusionUnderweight and obese CAPD patients have poorer outcome. Obese CAPD patients also have lower technical survival rate.Obesity was an independent risk factor for all-cause mortality in CAPD patients.

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2015102 C linical analysis of 1 371 patients w ith acute kidney injury after acutem yocardial infarction.SUN Yanbei（孫妍蓓），et al.Dept Nephrol，1st People's Hosp Changzhou，Affil Hosp，Soochow Univ，Changzhou，213000.Chin J Nephrol 2014；30（10）：725-731.

ObjectiveTo investigate the risk factors of acutekidney injury（AKI）in patients after acute myocardial infarction（AMI）.M ethodsA total of 1 371 adult patients diagnosed AMI in the First People's Hospital of Changzhou from January 2008 to December 2012 were analyzed retrospectively.AKIwas defined according to the 2012 KDIGO AKI criteria.Based on the occurrence of AKI，the patients were divided into AKI group and non-AKI group.According to the AKI timing，the patientswere divided into subgroups including conservative treatment groups，coronary angiography（CAG）groups and coronary artery bypass grafting（CABG）groups，respectively.Related risk factors of AKIwere analyzed by univariate andmultivariate logistic regression.ResultsOf the 1 371 patients，410（29.9%）developed AKI.Compared to the non-AKI group，in-hospital mortality increased significantly in the AKI group（17.1%vs 3.9%，χ2=68.0，P＜0.001）.Multifactor retrospective analysis showed that decreased baseline eGFR（OR= 2.049，95%CI：1.246-3.370），increased fasting plasma glucose（FPG）（OR=1.070，95%CI：1.018-1.124），diuretics（OR=1.867，95%CI：1.220-2.856）and Killip class 4 status（OR=1.362，95%CI：1.059-3.170）were all independent risk factors of AKI，while increased DBP on admission was a protective factor（OR=0.986，95%CI：0.974-0.998）for the conservative management group.Decreased baseline eGFR（OR=2.371，95%CI：1.500-3.747），increased FPG（OR=1.009，95%CI：1.005-1.012），diuretics（OR=1.674，95%CI：1.042-2.690），intraoperative hypotension（OR=2.276，95%CI：1.324-3.575）and acute infection（OR=1.678，95%CI：1.023-2.754）were independent risk factors of AKI for the CAG group. Decreased baseline eGFR（OR=2.246，95%CI：1.340 -3.981），increased FPG（OR=1.059，95%CI：1. 018-1.124），diuretics（OR=1.723，95%CI：1.122 -2.650），and low cardiac output syndrome after operation（OR=2.331，95%CI：1.277-3.286）were independent risk factors of AKI for CABG group.ConclusionAKI is a common complication and associated with increased mortality after AMI.Decreased baseline renal function，increased FPG and diuretics were common independent risk factors of AKIafter AMI.

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2015103 M eta analysis for the long-term efficacy and safety of immunosupp ression on the p rogression of IgA nephropathy.TIAN Lei（田磊），et al.Dept Nephrol，RenJi Hosp，Med Sch，Shanghai Jiaotong Univ，Shanghai200127.Chin JNephrol 2014；30（11）：833-840.

Ob jectiveTo access the long-term efficacy and safety of immunosuppression on the progression of IgA nephropathy（IgAN）by Meta analysis.MethodsDatabases EMBASE，Pubmed，Elsevier Science Direct，Scopus，Web of Science，Google Scholar，Cochrane Library，China National Knowledge Infrastructure，WanFang and VIP Data were retrieved to collect the randomized controlled trials（RCTs）at least 3 years follow-up on immunosuppression for IgAN published before May 2014.The literatureswere screened independently by two reviewers according to the inclusion and exclusion criteria，and the methodological quality was assessed.Statistic software State 12.0 was used to conduct analysis.ResultsNine articles were included in this studywith a totalof568 patients.Immunosuppression could lowered the risk for the progression to ESRD（RR=0.32，95%CI：0.20-0.49，P＜0.01）.As far as the efficacy of immunosuppression，subgroup analysis indicated that three studies with more than 7 year follow-up（RR=0.28，95%CI：0.13-0.59，P＜0.01）were similar with 7 studies followed by for less than 7 years（RR=0.34，95%CI：0.19-0.59，P＜0.01）；six adopted immunosuppressor monotherapy（RR=0.29，95%CI：0.15-0.58，P＜0.01）were similar to two used corticosteroids plus other immunosuppression（RR=0.33，95%CI：0.18-0.59，P＜0.01）；There were no significant differences between four studies from Europe（RR=0.27，95%CI：0.14-0.53，P＜0.01）and five from Asia（RR=0.35，95%CI：0.19-0.65，P＜0.01）.Immunosuppression was associated with an increased risk for adverse events（RR=2.33，95%CI：1.33-4.09，P＜0.01）.ConclusionImmunosuppression for IgAN may reduce longterm risk of progression to ESRD，but increase the risk of adverse events to some extent.

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2015104 Relationship between insu lin resistance and increased carotid artery intima-media thickness innon-diabetic kidney disease patients.WANG Qianqian（王倩倩），et al.Dept Nephrol，3rd Affil Hosp，Sun Yat-sen Univ，Guangzhou 510630.Chin J Nephrol 2014；30（11）：825-832.

ObjectiveTo evaluate the relationship of insulin resistance（IR）and carotid artery intima-media thickness（CA-IMT），plaque status in non-diabetic non-dialysis chronic kidney disease（CKD）patientswith different stages.MethodsOne hundred and seventeen non-diabetes non-dialysis CKD patients were enrolled into this crosssectional observational study.Insulin resistance index（HOME-IR）was assessed by the homeostasismodel assessment.Patients with HOME-IR≥1.73 were defined as insulin resistance.And patients with CA-IMT≥0.9 mm were defined as thickening.The blood pressure measurement，heart Doppler ultrasound，bilateral carotid artery ultrasound examination，blood biochemistry and urine protein testwere performed，and eGFR was calculated by EPI formula.Resu ltsThe prevalence of IR was 17.01%in 117 non-diabetic non-dialysis CKD patients，and itwas 35.71%，50.00%and 54.55%in eGFR≥60 ml·min-1·（1.73 m2）-1group，30≤eGFR＜60 ml·min-1·（1.73 m2）-1group，and eGFR＜30 ml·min-1·（1.73 m2）-1group separately.In eGFR＜30 m l·min-1·（1.73 m2）-1group，cystain C，homocysteine，parathyroid hormone，Scr，BUN，uric acid，interventricular septal thickness，left ventricular dimension，left ventricular posterior wall thickness were significantly higher than that in the other two groups（P＜0.01），while the level of hemoglobin was significantly lower（P＜0.01）；then the levels of serum albumin and systolic pressure were higher than that in the eGFR≥60 ml·min-1·（1.73 m2）-1group，however，the levels of total cholesterol and low-density lipoprotein-cholesterolwere lower than that in the eGFR≥60 ml·min-1·（1.73 m2）-1group.Correlation analysis showed that insulin resistance index was significantly correlated with CA-IMT（r=0.444，P=0.006）in the eGFR＜30 ml· min-1·（1.73 m2）-1group，however，there wasn't correlation in other two groups.And although insulin resistance wasn't correlated with soft plaque，it was significantly correlated with hard plaque（χ2=6.476，P= 0.011）in the eGFR＜30 ml·min-1·（1.73 m2）-1group.The Logistic regression analysis results displayed aging increase was the independent risk factor of the CAIMT thickening for non-diabetes non-dialysis CKD patients but not insulin resistance.ConclusionHOMA-IR is correlated with CA-IMT and hard plaque when eGFR＜30m l·min-1·（1.73 m2）-1in non-diabetes non-dialysis CKD patients.However，the insulin resistance isn't the independent risk factor of the CA-IMT thickening for non-diabetes non-dialysis CKD patients.

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2015105 Role of RAS inhibitor in the treatm ent of lupus nephritisw ith thrombotic m icroangiopathy.LI Chao（李超），et al.Dept Nephrol，PUMC Hosp，Beijing 100730.Chin JNephrol 2014；30（11）：819-824.

Ob jectiveTo investigate whether RAS inhibitors can improve renal function in the treatment of lupus nephritis（LN）with thrombotic microangiopathy（TMA）.M ethodsA total of 15 LN patients with TMA proven by renal pathology，from January 2000 to December 2013 in PUMCH，were included.The serum creatinine（Scr）and blood pressure（BP）before and after using RAS inhibitors were analyzed.Resu lts（1）Male/female ratio was1∶14.All of the patients had renal dysfunction，and median peak value of Scr was 396μmol/L（160-643 μmol/L）.5 cases（33.3%）required acute dialysis during hospitalization.Hypertension occurred in 15 patients，while 6 cases（40.0%）were diagnosed malignanthypertension.（2）Anemia and thrombocytopenia occurred in 15 and 14 cases，respectively.Three cases（20.0%）were diagnosed MAHA definitely and 5 cases（33.3%）were diagnosed MAHA probably.（3）Renal biopsy showed classⅡin 1 case，Ⅲin 4 cases，Ⅳ-（G）in 2 cases，Ⅳ（S）in 5 cases andⅣ+Ⅴin 3 cases.Active lesions were predominant in both glomeruli and renal vasculopathy.（4）All the patients received steroid and immunosuppressive therapy，ofwhom 9 cases were given steroid pulse therapy.Thirteen cases received cyclophosphamide，and the rest 2 cases received cyclophosphamide and mycophenolate.After steroid pulse therapy，there were only 5 patients（55.6%）who got decreased Scr.In 13 patients（86.7%），hypertension was ameliorated and Scr decreased within one week after implementing RAS inhibitors，which fell medianly 15.8%and 17.0%，respectively.（5）Eleven of the 15patientswere followed from 8 to 135 months（median 32 months），and the other 4 patients were lost.Five cases who was on dialysis during hospitalization became independentof renal replacement therapy，while the other cases also got improved renal function.ConclusionPatients of LN with TMA who develop AKI and refractory hypertension should be treated with RAS inhibitors.Improved renal survival and successful discontinuation of dialysis are possible benefits when RAS inhibitors are used to treat LN with TMA.

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2015106 Prevalence and risk factors of hyperuricem ia in patients w ith lupus nephritis.OM Shankar（歐姆），et al.Dept Nephrol，1st Affil Hosp，Sun Yat-sen Univ，Guangzhou 510080.Chin J Nephrol 2014；30（11）：805-812.

Ob jectiveTo investigate the prevalence and related risk factors of hyperuricemia in patients with lupus nephritis（LN）in Southern China.M ethodsA 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.ResultsAmong this cohort，the prevalence of hyperuricemia was 57.7%.The prevalence of hyperuricemia for CKD stage 1，2，3，4，5 was44.1%，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 factorofhyperuricemia 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.ConclusionThe prevalence of hyperuricemia in LN patients from this cohort is57.7%.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 thatmetabolic factorsmay influene each other，and should be paidmore attention in the clinical practice of LN care.

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