Amount Of Urinary Protein Research Articles

BSR guideline on the management of adults with systemic lupus erythematosus (SLE) 2018: baseline multi-centre audit in the UK

Abstract Objectives To assess the baseline care provided to patients with SLE attending UK Rheumatology units, audited against standards derived from the recently published BSR guideline for the management of adults with SLE, the NICE technology appraisal for belimumab, and NHS England’s clinical commissioning policy for rituximab. Methods SLE cases attending outpatient clinics during any 4-week period between February and June 2018 were retrospectively audited to assess care at the preceding visit. The effect of clinical environment (general vs dedicated CTD/vasculitis clinic and specialized vs non-specialized centre) were tested. Bonferroni’s correction was applied to the significance level. Results Fifty-one units participated. We audited 1021 episodes of care in 1003 patients (median age 48 years, 74% diagnosed >5 years ago). Despite this disease duration, 286 (28.5%) patients had active disease. Overall in 497 (49%) clinic visits, it was recorded that the patient was receiving prednisolone, including in 28.5% of visits where disease was assessed as inactive. Low documented compliance (<60% clinic visits) was identified for audit standards relating to formal disease-activity assessment, reduction of drug-related toxicity and protection against comorbidities and damage. Compared with general clinics, dedicated clinics had higher compliance with standards for appropriate urine protein quantification (85.1% vs 78.1%, P ≤ 0.001). Specialized centres had higher compliance with BILAG Biologics Register recruitment (89.4% vs 44.4%, P ≤ 0.001) and blood pressure recording (95.3% vs 84.1%). Conclusions This audit highlights significant unmet need for better disease control and reduction in corticosteroid toxicity and is an opportunity to improve compliance with national guidelines. Higher performance with nephritis screening in dedicated clinics supports wider adoption of this service-delivery model.

Atrial thrombus as a complication of SLE and APS in an 8-year-old child

BackgroundSystemic lupus erythematosus (SLE) is an autoimmune disease involving multiple systems with various clinical manifestations. Renal involvement is common, but intracardiac thrombus is rarely reported as a complication of antiphospholipid syndrome (APS, also known as anticardiolipin syndrome). Anticoagulant therapy is the first-line treatment, and surgery is performed in severe cases. We report a case to improve clinicians’ understanding of disease diagnosis.Case presentationAn 8-year-old girl was admitted to our hospital because of left costal pain, hematuria and fever. She had obvious edema occult blood 3+, urinary protein 3.2 g/24 h, albumin 17.6 g/L, and total cholesterol 7.21 mmol/L, consistent with a diagnosis of nephrotic syndrome. We continued to track the etiology of nephrotic syndrome and performed a renal biopsy, showing dsDNA 1:10 positivity, low C3, low platelets and hemoglobin, anticardiolipin IgM 12 U/ml, anti-β2-glycoprotein I (β2GPI) 223 U/ml; renal pathology suggested lupus nephritis (LN), and the patient was ultimately diagnosed with SLE, secondary APS and LN. The patient was treated with hormones and immunosuppressants. Sixteen weeks later, her urinary protein was 1+, and the quantity of urine protein was less than 0.5 g/d. Echocardiography showed that the mass in the right atrium was thrombotic. Heparin anticoagulant therapy was effective.ConclusionSLE can involve multiple systems and various complications. Thrombus in the right atrium is a rare complication of APS. Early diagnosis and treatment are key to improving the prognosis of children.

Network Meta-analysis of Huoxue Huayu Chinese medicine injections on hypertensive nephropathy

To assess the clinical efficacy of Huoxue Huayu Chinese medicine injections on hypertensive nephropathy by using Network Meta-analysis method. The relative randomized controlled trials(RCTs) of Huoxue Huayu Chinese medicine injections on hypertensive nephropathy were retrieved from CNKI, WanFang, VIP, SinoMed, PubMed, Cochrane Library and Web of Science in November 2019. Two researchers independently conducted literature screening, data extraction and quality evaluation. The data was analyzed by RevMan 5.3, Stata 15.1, ADDIS 1.16.8 software. Finally, 4 518 patients in 50 RCTs were included, involving 5 kinds of Huoxue Huayu Chinese medicine injections. The five Chinese medicine injections were Breviscapine Injection, Danhong Injection, Sodium Tanshinone Ⅱ_A Sulfonate Injection, Ginkgo Dipyridamole Injection, and Salvianolate Injection. Meta-analysis showed that, in terms of renal function protection, urine protein quantification and serum creatinine of each Chinese medicine injections combined with conventional Western medicine group, except Salvianolate Injection combined with conventional Western medicine group, was significantly lower than those of the conventional Western medicine treatment group. Ginkgo Dipyridamole Injection combined with conventional Western medicine had the best effect in reducing urine protein, and Danhong Injection combined with conventional Western medicine had the best effect in reducing serum creatinine. In terms of blood pressure control, the blood pressure of each Chinese medicine injections combined with conventional Western medicine group, except Breviscapine Injection combined with conventional Western medicine group, was significantly lower than that of conventional Western medicine treatment group. Salvianolate Injection combined with conventional Western medicine had the best effect in reducing blood pressure. In terms of safety, no serious adverse reactions were found in all studies. The five kinds of Huoxue Huayu Chinese medicine injections combined with conventional Western medicine had significantly advantages in the treatment of hypertensive nephropathy. Ginkgo Dipyridamole Injection combined with conventional Western medicine is most likely to be the optimal therapy. However, limited by the quantity and quality of the documents included, the conclusion of this study still needs to be verified by more high-quality, multi-center and large-sample RCT.

Tacrolimus in the treatment of idiopathic membranous nephropathy

Objective To investigate the clinical effect of tacrolimus in the treatment of idiopathic membranous nephropathy (IMN). Methods According to the treatment intention, the patients were divided into observation group (28 cases) and control group (16 cases). The observation group was treated with tacrolimus, while the control group was treated with glucocorticoid combined with cyclophosphamide. 24-hour urine protein, creatinine, urea and albumin were measured before treatment, 3 months after treatment and 6 months after treatment. The anti-M-phospholipase A2 receptor 1 antibody (PLA2R- Ab) was determined. The therapeutic effect of the two groups was evaluated after 6 months of treatment. Results 24 h urine protein quantity, ALB, TG and TC in the observation group and the control group were significantly improved after 3 and 6 months of treatment ( P <0.05); and the improvement in the observation group was more obvious than that in the control group ( P <0.05); Scr and BUN in the observation group increased after 6 months of treatment ( P <0.05); FBG and WBC in the control group were significantly increased after 3 and 6 months of treatment ( P <0.05). The blood PLA2R-Ab of the two groups decreased significantly in 3 and 6 months after treatment ( P <0.05); and compared with the three months after treatment, the blood PLA2R-Ab of the two groups decreased more significantly in 6 months after treatment ( P <0.05); the observation group decreased significantly in 3 and 6 months after treatment compared with the control group at the same time ( P <0.05). Six months after treatment, the remission rate of the observation group was 85.7%, and that of the control group was 68.8%. The remission rate of the observation group was significantly higher than that of the control group ( P <0.05). In the observation group, 3 patients showed slight increase of serum creatinine, 1 case of gingival hyperplasia; in the control group, 3 cases of hyperglycemia, 2 cases of nausea and vomiting. Conclusion Tacrolimus is effective in the treatment of IMN, with mild side effects and a significant reduction of blood PLA2R-Ab. 摘要：目的 探讨他克莫司治疗特发性膜性肾病（IMN）临床效果。 方法 根据患者治疗意愿分为观察组 28 例，对 照组 16 例；观察组采用他克莫司治疗，对照组采用激素联合环磷酰胺治疗。测定两组患者治疗前及治疗后 3 个月、6 个 月 24 h 尿蛋白定量、血肌酐、血尿素、血白蛋白和抗 M 型磷脂酶 A2 受体 1 的抗体(PLA2R-Ab)。两组患者均在治疗 6 个 月后评价治疗效果。 结果 两组患者在治疗 3 个月、6 个月后 24 h 尿蛋白定量、血白蛋白、三酰甘油、胆固醇均有明显改 善，差异均有统计学意义（ P <0.05)；并且观察组较对照组改善更明显（ P <0.05）；观察组治疗 6 个月后血肌酐、尿素较治疗 前有升高，差异均有统计学意义（ P <0.05）；对照组空腹血糖、白细胞治疗 3 个月、6 个月后较治疗前升高，差异有统计学 意义（ P <0.05）。两组患者治疗 3 个月、6 个月后血 PLA2R-Ab 均有明显降低，差异均有统计学意义（ P <0.05)；并且与治疗 3 个月比较，两组治疗 6 个月后血 PLA2R-Ab 降低更明显（ P <0.05）；观察组治疗后 3 个月、6 个月后均较对照组同时间降 低更明显（ P <0.05）。治疗后 6 个月，观察组缓解率 85.7%，对照组缓解率 68.8%，缓解率差异有统计学意义（ P <0.05）。 观察组中 3 例患者出现血肌酐轻度增高，1 例牙龈增生；对照组 3 例血糖升高，2 例恶心呕吐。 结论 他克莫司治疗 IMN 效果明显，不良反应轻微，明显降低血 PLA2R-Ab。

The efficacy of taking traditional Chinese medicine orally in renal interstitial fibrosis: A protocol for a systematic review and meta-analysis.

Background:By now, the incidence of chronic kidney disease (CKD) is increasing. The development of various CKD is attributed to the continuous aggravation of renal interstitial fibrosis (RIF) in the process of end-stage renal disease (ESRD). Oral treatment of traditional Chinese medicine (TCM) is one of the therapies for RIF. Randomized controlled trials (RCTs) of TCM treatment RIF have been reported, but its effectiveness and safety have yet been systematically investigated. Therefore, through the systematic analysis and meta-analysis, our study will summarize the effectiveness and safety of oral treatment RIF of TCM, in order to provides scientific reference for clinical practice.Methods:This protocol follows Preferred Reporting Items for Systematic Evaluation and Meta-Analysis. RCTs will be only selected. Such databases as the PubMed, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), Excerpt Medical Database (Embase), WanFan Data, Chinese Biomedical Literature Database (CBM), WHO International Clinical Trials Registry Platform will be searched from the inception to June, 2020 to collect the RCTs about taking TCM orally in treating RIF. The literature according to the inclusion and exclusion criteria, data-extracted and the methodological quality evaluated will be performed independently by 2 reviewers. The clinical outcomes including renal function indices (Scr, BUN, 24-hour urinary protein quantity) and Indicators of RIF (TGF-β1, Notch1, Jagged-1). The risk of bias included in the RCTs will be evaluated by the bias risk assessment tool provided in the Cochrane System Evaluation Manual 5.1.0. Review Manager 5.3 provided by the Cochrane collaboration network will be used to process the data.Results and conclusion:Some more targeted and practical results about the efficacy of taking TCM orally in RIF have been provided by our study. The available evidence suggests that the therapeutic effects of combining TCM with Western medicine therapies is much better for RIF than Western medicine therapies only.

Associations between the concentrations of CD68, TGF-β1, renal injury index and prognosis in glomerular diseases.

The present study aimed to investigate the association between the concentrations of CD68, TGF-β1, renal injury index and prognosis in glomerular diseases. Altogether 218 patients with glomerular diseases admitted to Weifang People's Hospital from January, 2014 to March, 2017 were used as the study group. A total of 100 healthy individuals who visited Weifang People's Hospital for a physical examination during the same time period were used as the control group. The levels of CD68 in peripheral blood obtained from the 2 groups of subjects were detected by flow cytometry, and the expression of TGF-β1 in serum was detected by enzyme-linked immunosorbent assay (ELISA). The concentrations of CD68 and TGF-β1 between the 2 groups were compared. The correlation between the concentrations of CD68, TGF-β1 and renal injury indexes in the study group was analyzed, as well as prognostic significance. The diagnostic value of CD68 and TGF-β1 in patients with glomerular disease was analyzed using a ROC curve, and the recovery of the patients was observed. The serum concentrations of CD68 and TGF-β1 in the study group were higher than those in the control group (P<0.05). The concentrations of CD68 and TGF-β1 in the study group positively correlated with the renal injury indexes, such as blood urea nitrogen (BUN), serum creatinine (SCR), uric acid (UA) and the 24-h urinary protein quantity (P<0.05). ROC curve analysis revealed that the area under the curve of CD68 and TGF-β1 as regards the diagnostic value in patients with glomerular disease was 0.808 and 0.738, respectively, while the area under the combined detection curve was 0.866. Multivariate unconditional logistic regression analysis revealed that the clinical classification and the concentrations of CD68 and TGF-β1 were independent prognostic factors in the study group. On the whole, the findings of the present study demonstrate that clinical classification, and the CD68 and TGF-β1 concentrations are independent prognostic factors for patients with glomerular disease. CD68 and TGF-β1 have certain value in the diagnosis of glomerular diseases, and may thus be used as predictors of the diagnosis and recovery of glomerular disease.

Clinical characteristics of hospitalized patients with 2019 novel coronavirus disease indicate potential proximal tubular dysfunction.

Clinical characteristics of hospitalized patients with 2019 novel coronavirus disease indicate potential proximal tubular dysfunction.

Myeloid-Derived Suppressor Cells Promote the Progression of Primary Membranous Nephropathy by Enhancing Th17 Response

Several studies have confirmed that the myeloid-derived suppressor cells (MDSCs) are closely associated with autoimmune diseases, but their exact role in these processes remains largely unclear. Here, we investigated the role MDSCs in patients with primary membranous nephropathy (PMN). Compared to healthy controls (HCs), PMN patients showed significantly increased number of HLA-DR−CD11b+CD33+ MDSCs in the peripheral blood, including both CD14+CD66b− monocytic and CD14−CD66b+ granulocytic MDSCs. The frequency of MDSCs was positively correlated with the level of serum anti-phospholipase A2 receptor (anti-PLA2R), 24-h urine protein quantification, and disease activity in PMN patients. Consistently, enhanced T helper 2 (Th2) and T helper 17 (Th17) immune responses were positively associated with plasma anti-PLA2R levels, 24-h urine protein quantification, and the disease activity in PMN patients. Moreover, compared to HCs, MDSCs from PMN patients exhibited significantly elevated arginase-1 (ARG-1) production and increased potential to promote Th17 differentiation in vitro in an ARG-1–dependent manner. This study directly demonstrates a pathogenic role for MDSCs in human PMN and provides a molecular mechanism for the pathogenesis of PMN. Our data show that MDSCs may promote PMN disease progression mainly by enhancing Th17 response. Therefore, MDSCs may be an important diagnostic, therapeutic, and prognostic marker for PMN diseases.

Therapeutic effect of tonsillectomy on IgA nephropathy after kidney transplantation

Objective: To observe the clinical effect of tonsillectomy on IgA nephropathy (IgAN) after renal transplantation. Methods: From March 2011 to July 2018, 201 kidney transplantation recipients who were diagnosed of IgAN by transplant renal biopsy in the Department of Organ Transplantation of the First Affiliated Hospital of Sun Yat-sen University were retrospectively reviewed, of which 18 patients underwent tonsillectomy after renal biopsy. The clinical data of the 18 patients were collected, patient and kidney survival time and function of the transplanted kidney were analyzed. Results: Of the 18 recipients, 13 were male and 5 were female, with an average age of (36.0±10.9) years. All 18 patients survived during follow-up. Two patients returned to dialysis treatment 10 months and 14 months after tonsillectomy, respectively. The creatinine was 94 (78, 133) μmol/L, 95 (74, 139) μmol/L, 106 (87, 158) μmol/L and 95(81, 147) μmol/L before tonsillectomy, 3 months, 1 year and 2 years after tonsillectomy, respectively (P=0.206). Urinary protein quantification was 0.31 (0.16, 1.38) g/24 h, 0.34 (0.10, 1.42) g/24 h, 0.33 (0.11, 0.56) g/24 h and 0.25 (0.10, 0.50) g/24 h at the same time points, respectively (P=0.104). The two patients who returned to dialysis were diagnosed of IgAN by transplant renal biopsy because of elevated creatinine, proteinuria and hematuria, 9 years and 4 years after kidney transplant respectively. Renal biopsy suggested that glomerular and segmental sclerosis were 7/24, 5/24 and 1/6, 2/6, respectively. Additionally, interstitial fibrosis and tubular atrophy (IF/TA) were both occupied 30% in the biopsies, and tonsillectomy was performed 461 days and 1 077 days after diagnosis of IgAN, respectively. Conclusions: Tonsillectomy can maintain the stability of renal function and prevent the aggravation of proteinuria in IgAN patients after renal transplantation. However, if pathology suggests obvious glomerulosclerosis or IF/TA, tonsillectomy may not be effective.

The combination of HPLC and biological analysis to determine the quality markers and its structural composition of Eclipta prostrata L.

The diversity and complexity of components are important reasons for the unstable efficacy and safety of Chinese materia medica (CMM) in quality control. The good and stable quality control may be related to the quality markers with structural composition of multi-components. In the present study, we take Eclipta prostrata L. as a representative example. The 11 samples were collected from the different areas in China, and the discrepancy in bioactivity and chemical composition of these samples were compared. DOX (doxorubicin hydrochloride)-induced ICR mice were established for in vivo nephrotic syndrome experiments. The biochemical indicators including 24-h urine protein, triglyceride (TG), etc. were measured and the pathological change of kidney tissue was observed. MPC-5 cells damage model was induced to compare the difference of these samples in bio-activity. High-performance liquid chromatography (HPLC) method for 11 EEP (extract of Eclipta prostrata L.) samples were performed to analyse the content of the quality markers. In vivo experiments, EEP could mitigate the content or activity of urine protein, TG, etc. compared with the positive group (TG content was 2.53 ± 0.39 mmol/L, urinary protein quantification on 35th day was 16.79 ± 2.32 mg). In vitro experiments, CCE (coumestans component of Ecliptae) and EEP had equivalent effects on biochemical indicators such as cell viability, etc. According to the HPLC analysis, the content of wedelolactone was 45.88% and demethylwedelolactone was 23.74% in CCE. The CCE with a ratio of 2:1 can be considered as a quality marker of Eclipta prostrata L.. This research may provide a perspective for quality control of CMM.

Anesthesia Management in Caesarean Section with Preeclampsia and Partial HELLP Syndrome

ABSTRACT&#x0D; Introduction. Pre-eclampsia is a significant cause of maternal and fetal mortality and morbidity. Pre-eclampsia is characterized by hypertension (blood pressure ≥ 140/90 mmHg), oedema and amount of protein in urine 300 mg in the 24-hour, which appears after 20 weeks of gestation. Pre-eclampsia can cause complications, one of which is HELLP syndrome. This case report discusses the use of anaesthesia in a patient who underwent a cesarean section with indications for pre-eclampsia and partial HELLP syndrome.Case Presentation. A woman, 41 years old, G4P3A0 34 weeks pregnant with pre-eclampsia + syndrome HELLP will undergo emergency cesarean section with ASA IIE physical statusLabouror pain management was carried out using regional spinal anaesthesia technique, using bupivacaine 0.5% hyperbaric agent 12.5 mg. The operation lasted for 1 hour 30 minutes, with 300 ml bleeding, hemodynamically stable.Conclusion. Difficult intubation in emergency cases can be avoided by choosing of neuraxial anaesthesia technique is recommended. It will lead to better uteroplacental perfusion, good analgesia/anaesthesia quality, reducing surgical stress, reducing drugs that enter the uteroplacental circulation, and maternal psychological to be able to see the baby at birth.

Hippocampal Atrophy in Systemic Lupus Erythematosus Patients without Major Neuropsychiatric Manifestations.

This study was conducted to explore hippocampal structural changes and their possible associations with clinical characteristics, emotional status, and treatment regimens in patients with systemic lupus erythematosus (SLE) without major neuropsychiatric manifestations (non-NPSLE). Eighty-five non-NPSLE patients with normal conventional magnetic resonance imaging (MRI) and seventy-seven matched healthy control (HC) subjects were recruited. All participants underwent the standard high-resolution volumetric MRI. The bilateral hippocampal volume (HIPV) and hippocampal density (HIPD) were calculated, respectively, for each participant. We found that the bilateral HIPV and HIPD of the SLE patient group were significantly less than those of the HC group. The bilateral HIPV of female patients were significantly less than those of male patients. The SLE disease activity index (SLEDAI) was negatively correlated with the bilateral HIPV and the right HIPD. Urine protein quantity was negatively correlated with the bilateral HIPV and HIPD. Hydroxychloroquine (HCQ) showed a protective effect on right HIPV. In conclusion, we found that the early hippocampal atrophy could occur before obvious neuropsychiatric manifestations and might be associated with SLE disease activity and organ damages. Early detection and intervention of hippocampal damage might prevent the progression to NPSLE. More studies are needed to fully understand the underlying mechanisms of hippocampal atrophy in SLE.

Effect of Chinese medicine prescription on nephrotic syndrome

Background:Nephrotic syndrome (NS) is a common chronic recurrent kidney disease. Many trials have shown that Chinese medicine prescription (CMP) can effectively treat NS. The program aims to evaluate the efficacy and safety of CMP for NS.Methods:This systematic evaluation will entail an electronic and manual search of all CMP for NS from inception to February, 2020, regardless of the publication status or language. Databases include PubMed, Embase, Springer, Web of Science, the Cochrane Library, the World Health Organization International Clinical Trial Registration Platform, the Chinese Medicine Database, the China National Knowledge Infrastructure, the Chinese Biomedical Literature Database, the China Science Journal Database, and the Wanfang Database. Other sources of information, including bibliographies and meeting minutes for identified publications, will also be searched. A manual search for grey literature, including unpublished conference articles will be performed. Additionally, any clinical randomized controlled trials related to CMP for NS, regardless of the publication status and language limitations, will be included in the study. Study selection, data extraction, and research quality assessments will be conducted independently by 2 researchers. The main result was the total clinical efficacy rate or other validated scales after at least 2 weeks of treatment. Secondary outcomes included 24-hour urine protein quantification, blood urea nitrogen, serum creatinine, C-reactive protein, tumor necrosis factor-α, and interleukin 6, recurrence rates and adverse events during follow-up. Implement the Cochrane RevMan V5.3 bias assessment tool to assess bias risk, data integration risk, meta-analysis risk, and subgroup analysis risk (if conditions are met). Mean difference, standard mean deviation and binary data will be used to represent continuous results.Results:This study will provide a comprehensive review and evaluation of CMP for the treatment of NS.Conclusion:This study will provide new evidence for evaluating the effectiveness and side effects of CMP on NS. Since the data is not personalized, formal ethical approval is not required.INPLASY registration number:INPLASY202040181.

P1614ANTIAPOPTOTIC EFFECS OF CATECHIN AND GEMIGLIPTIN ON TACROLIMUS-INDUCED RENAL INJURY IN MICE

Abstract Background and Aims The aim of this study was to investigate the anti-apoptotic effects of catechin (CA) and dipeptidyl peptidase IV (DPP IV) inhibitor gemigliptin on tacrolimus (TAC)-induced nephropathy in mice. Method The mice (n=30) were divided into 5 groups (n=6/group); control group were intraperitoneally (IP) injected 0.9% saline, TAC group were IP injected TAC 2.5 mg/kg, DPP IV inhibitor group were given in addition gemigliptin 20 mg/kg (G20) by oral gavage. TAC-CA group were given TAC by IP injection and CA 100 mg/kg by subcutaneous injection. TAC-TA-G20 group were given with same dosages. Results The 24 hours urine protein amounts were significantly increased in TAC group (46.1±10.9mg/day) compared to control group (11.3 ±4.4mg/day) and significantly decreased in TAC-CA-G20group (13.1 ±5.9mg/day, P &amp;lt;0.01) compared to TAC group. Serum creatinine levels were significantly increased in TAC group (1.03 ± 0.26 mg/dL) compared to control group (0.17 ± 0.02 mg/day) and significantly decreased in TAC-CA-G20group (0.23 ± 0.05 mg/day, p=0.008) compared to TAC group. In Western blot analysis of apoptotic protein, the BCL-2 protein expression by TAC was significantly suppressed by CA and gemigliptin injection but, the p53 protein expression by TAC was significantly resolved by CA and DPP IV inhibitor. There are proximal tubular edema and mild interstitial inflammation in the kidney of mice after TAC injection but no significant pathologic changes by CA injection and DPP IV inhibitor injected group. Conclusion Catechin and DPP IV inhibitor gemigliptin treatment has beneficial antiapoptotic effects on acute TAC-induced renal injury in mice.

Construction and validation of pregnancy risk prediction model for pregnant women with chronic kidney disease

Objective: To construct the pregnancy risk prediction model of chronic kidney disease (CKD) pregnant women by analyzing their renal function and pregnancy outcome in the first trimester. Method: Totally 313 CKD women with 322 pregnancies who had deliveries in Peking University First Hospital from March 2009 to December 2018 were retrospectively analyzed. The history of kidney disease and renal function in the first trimester were collected, and the relationship between CKD and premature delivery, low birth weight infants, severe preeclampsia and fetal loss were analyzed. Result: Among 322 pregnancies with CKD, 120 (37.3%, 120/322) had adverse pregnancy outcomes. CKD stage, serum creatinine, urea, albumin, hemoglobin, 24-hour urine protein quantity and whether complicated with hypertension were independent predictors of adverse pregnancy outcome. A prediction model logit (P)=2.107+0.255×24-hour urine protein quantitative (g/24-hour)-0.107×albumin (g/L)+1.677×whether complicated with hypertension (1 or 0)+ 0.639×CKD stage was established. The area under curve value of the model was 0.812, the best threshold, sensitivity, specificity and Yoden index were 0.436, 0.658, 0.856 and 0.802, respectively. Conclusion: CKD stage, serum albumin, 24-hour urine protein quantity in the first trimester and hypertension are the main risk factors of adverse pregnancy outcome, which could predict the occurrence of adverse pregnancy outcome of CKD pregnant women and deserve further study.

Clinical research of fractional excretion of IgG on predicting drug responsiveness in patients with idiopathic membranous nephropathy

Objective To explore the predictive value of fractional excretion of IgG (FE IgG) on drug responsiveness and remission in patients with idiopathic membranous nephropathy (IMN). Methods Retrospective analysis of 82 patients with IMN diagnosed by clinical and pathological data and regularly followed up from April 2014 to August 2017. Receiver operating characteristic (ROC) curve was used to determine the FE IgG threshold. Comparing the difference of remission time under different baseline levels of FE IgG, and analyzing the effect of different levels of FE IgG on the drug responsiveness of immunosuppressive therapy (tacrolimus or cyclophosphamide) and supportive therapy. Results Areas under the curve (AUC) of estimated glomerular filtration rate (eGFR), 24-hour urinary protein quantity and FE IgG were 0.509, 0.701 and 0.948, respectively. Before treatment, there was no significant difference in gender, age, mean arterial pressure and eGFR between the high FE IgG group (FE IgG>0.029) and low FE IgG group (FE IgG 0.05). The remission time of high FE IgG group was (18.75±6.81)months, while it was (8.46±3.74)months in low FE IgG group, with significant difference (P<0.01). There was no difference in remission time of immunosuppressive therapy and supportive therapy in low FE IgG group (P=0.265), bo-th of which were lower than the high-level immunosuppressive therapy group (P<0.001). The remission time of tacrolimus was shorter than that of cyclophosphamide in high FE IgG group, but with no significant difference (P=0.131). There was significant difference in the remission time of tacrolimus between the high and low level groups of FE IgG (P<0.01). Under electron microscope, the ratio of foot process fusion and podocyte diffuse vacuolar degeneration in the high level group of FE IgG was higher than that in the low level group (P<0.01). Conclusions FE IgG can be used as a clinical indicator for predicting drug responsiveness and remission in patients with IMN, and is essential for early identification of high-risk patients and for making clinical decisions. Patients with high FE-IgG may benefit from early initiation of immunosuppressive therapy. Key words: Immunoglobulin G; Renal elimination; Remission time; Urinary protein; Idiopathic membranous nephropathy

Prevalence of hypothyroidism in Japanese chronic kidney disease patients

Background Major symptoms of progressive chronic kidney disease (CKD) are similar to those of hypothyroidism. Hidden symptoms of hypothyroidism underlying CKD are often observed in clinical practice. This study aimed to ascertain the frequency of hypothyroidism complicated by CKD, and to analyze factors impacting thyroid function. Methods During the period from April 2012 through October 2016, 510 CKD patients at our outpatient clinic were measured thyroid and kidney function for diagnosing hypothyroidism (overt hypothyroidism, OH; subclinical hypothyroidism, SH; non-thyroidal illness, NTI) and evaluating the stage of CKD. All patients were over 15 years of age. Results There were significant differences in age, estimated glomerular filtration rate (eGFR), urinary protein (UP), and serum albumin (Alb) among patients with OH, SH, and NTI compared to the normal group in univariate and multivariate analyses. UP showed the highest odds ratio of OH, SH, and NTI but no differences were recognized in gender in each group. Frequency distribution showed that the prevalence of thyroid dysfunction was greater among more severe stage of CKD with higher amount of UP. OH and SH did not show high positive ratio of anti-thyroglobulin antibody (TgAb) and anti-thyroid peroxidase antibody (TPOAb). NTI and normal subjects showed higher positive ratio as 50.0% and 42.9% of TgAb and TPOAb than OH and SH. Conclusions Hypothyroidism complicated by CKD exhibited a high prevalence. Age, eGFR, UP, and serum Alb were related to the prevalence of hypothyroidism, whereas gender was not and this was contradicted to the prevalence of hypothyroidism in general population. The prevalence of OH and SH was higher among patients with higher stage of CKD with increased UP. Hypothyroidism complicated by CKD may involve different onset mechanisms unrelated to antithyroid antibodies (ATAb). In CKD patients, assessments of OH and SH, as well as NTI, are needed for proper diagnosis.

Renal outcomes of treatment with telmisartan in patients with stage 3-4 chronic kidney disease: A prospective, randomized, controlled trial (JINNAGA).

Objectives:Although angiotensin II receptor blockers are effective for patients with chronic kidney disease, dose-dependent renoprotective effects of angiotensin II receptor blockers in patients with moderate to severe chronic kidney disease with non-nephrotic proteinuria are not known. Our aim was to elucidate the dose-dependent renoprotective effects of angiotensin II receptor blockers on such patients.Methods:A multicenter, prospective, randomized trial was conducted from 2009 to 2014. Patients with non-nephrotic stage 3–4 chronic kidney disease were randomized for treatment with either 40 or 80 mg telmisartan and were observed for up to 104 weeks. Overall, 32 and 29 patients were allocated to the 40 and 80 mg telmisartan groups, respectively. The composite primary outcome was renal death, doubling of serum creatinine level, transition to stage 5 chronic kidney disease, and death from any cause. Secondary outcomes included the level of urinary proteins and changes in the estimated glomerular filtration rate.Results:There was no difference in the primary outcome (p = 0.78) and eGFR (p = 0.53) between the two groups; however, after 24 weeks, urinary protein level was significantly lower in the 80 mg group than in the 40 mg group (p < 0.05). No severe adverse events occurred in either group, and the occurrence of adverse events did not significantly differ between them (p = 0.56).Conclusion:Our findings do not demonstrate a direct dose-dependent renoprotective effect of telmisartan. The higher telmisartan dose resulted in a decrease in the amount of urinary protein. Even though high-dose angiotensin II receptor blockers may be preferable for patients with stage 3–4 chronic kidney disease, the clinical importance of the study results may be limited. The study was registered in the UMIN-CTR (https://www.umin.ac.jp/ctr) with the registration number UMIN000040875.

Effect of febuxostat on renal function in patients from South China with CKD3 diabetic nephropathy.

ABSTRACTObjective:To investigate the efficacy and safety of febuxostat on renal function in CKD stage 3 diabetic nephropathy patients.Methods:Patients in our hospital with chronic kidney disease (CKD) stage 3 diabetic nephropathy (DN) complicated by high serum uric acid (360 µmol/L) were recruited. Patients were then divided into treatment group and control group according to the random number table method. All the patients received low purine diet, renin-angiotensin-aldosterone system (RAAS) inhibitors, and adequate routine hypoglycemic treatment. Febuxostat was employed only in the treatment group. The levels of blood uric acid (sUA), serum creatinine (Scr), cystatin C (cys-c), eGFR, 24-hour urine protein quantification, albuminuria, and creatinine ratio (ACR) were evaluated in all patients before and after treatment at 4, 8, 12, and 24 week.Results:No difference was found before treatment between the two groups. After treatment at 4, 8, 12, and 24 week, the levels of sUA, SCr, cys-c, and eGFR between the two groups were significant different (P<0.05). There was no difference in 24-hour urine protein quantification, albuminuria, and creatinine ratio between two groups before treatment, and significant differences were observed after treatment. Fifty percent of patients from the treatment group achieved the treatment goal with 20 mg febuxostat at 4 weeks. Tubular markers were also decreased with the treatment.Conclusions:Febuxostat can reduce uric acid and improve renal function effectively in patients with CKD stage 3 diabetic nephropathy, while being well tolerated. However, the conclusion is still uncertain due to the short term of the study.

Evaluating hypercoagulability in new-onset systemic lupus erythematosus patients using thromboelastography.

BackgroundThromboelastography (TEG) can reflect the coagulation status in vivo, from clot formation to clot lysis. In the present study, we aimed to evaluate the function of TEG in detecting coagulation in patients with SLE and sought to explore the correlation between clinical and laboratory data.MethodsA total of 41 patients with new‐onset SLE who had not undergone treatment and 56 healthy controls were included. TEG and other laboratory tests were performed, and clinical data were collected.ResultsA significant difference in the TEG reaction time and TEG achievement of clot firmness was observed between the groups. Moreover, these parameters were correlated with the lupus anticoagulant levels, platelet count, 24‐hour urinary total protein quantity, and systemic lupus erythematosus disease activity index.ConclusionOur study demonstrated the prospective value of TEG in evaluating hypercoagulability in patients with SLE.