Manifestations Of Nephrotic Syndrome Research Articles

Serum 25-hydroxyvitamin D as a predictive biomarker of clinical outcomes in patients with primary membranous nephropathy.

Primary membranous nephropathy (PMN) is an immune-related disease with increased morbidity and the most common cause of adult nephrotic syndrome (NS). The serum 25-hydroxyvitamin D [25(OH)D)], a biomarker of vitamin D (VD) status, tends to decline in patients with kidney disease. However, the relationship between 25(OH)D and PMN is still unclear. Therefore, this study aims to clarify the association between 25(OH)D and disease severity and therapy response of PMN. A total of 490 participants diagnosed with PMN by biopsy from January 2017 to April 2022 were recruited at the First Affiliated Hospital of Nanjing Medical University. The correlations between baseline 25(OH)D and manifestations of nephrotic syndrome (NS) or seropositivity of anti-PLA2R Ab were confirmed by univariate and multivariate logistic analyses. Spearman's correlations were used to examine the associations between baseline 25(OH)D and other clinical parameters. In the follow-up cohort, Kaplan-Meier analysis was used to assess remission outcomes among groups with low, medium, and high levels of 25(OH)D. Furthermore, the independent risk factors for non-remission (NR) were explored by COX regression analysis. At baseline, 25(OH)D was negatively related to 24-h urinary protein and serum anti-PLA2R Ab. The lower level of baseline 25(OH)D was associated with an increased risk for the incidence of NS in PMN (model 2, OR 6.8, 95% CI 4.4, 10.7, P < 0.001) and seropositivity of anti-PLA2R Ab (model 2, OR 2.4, 95% CI 1.6, 3.7, P < 0.001). Furthermore, the lower level of 25(OH)D during follow-up was demonstrated as an independent risk factor for NR even after adjusting age, gender, MBP, 24 h UP, serum anti-PLA2R Ab, serum albumin, and serum C3 [25(OH)D (39.2-62.3 nmol/L): HR 4.90, 95% CI 1.02, 23.53 P = 0.047; 25(OH)D < 39.2 nmol/L: HR 17.52, 95% CI 4.04, 76.03 P < 0.001); vs. 25(OH)D ≥ 62.3 nmol/L]. The Kaplan-Meier survival analysis also demonstrated that the higher level of follow-up 25(OH)D had a higher possibility of remission than the lower one (log-rank test, P < 0.001). Baseline 25(OH)D was significantly correlated with nephrotic proteinuria and seropositivity of anti-PLA2R Ab in PMN. As an independent risk factor for NR, a low level of 25(OH)D during follow-up might serve as a prognostic tool for sensitively identifying cases with a high probability of poor treatment response.

Yi-Shen-Hua-Shi Granule Alleviates Adriamycin-Induced Glomerular Fibrosis by Suppressing the BMP2/Smad Signaling Pathway

Focal segmental glomerulosclerosis (FSGS) is a common clinical condition with manifestations of nephrotic syndrome and fibrosis of the glomeruli and interstitium. Yi-Shen-Hua-Shi (YSHS) granule has been shown to have a good effect in alleviating nephrotic syndrome (NS) in clinical and in animal models of FSGS, but whether it can alleviate renal fibrosis in FSGS and its mechanism and targets are not clear. In this study, we explored the anti-fibrotic effect and the targets of the YSHS granule in an adriamycin (ADR)-induced FSGS model and found that the YSHS granule significantly improved the renal function of ADR-induced FSGS model mice and also significantly reduced the deposition of collagen fibers and the expression of mesenchymal cell markers FN, vimentin, and α-SMA in the glomeruli of ADR-induced FSGS mice, suggesting that the YSHS granule inhibited the fibrosis of sclerotic glomeruli. Subsequently, a network pharmacology-based approach was used to identify the potential targets of the YSHS granule for the alleviation of glomerulosclerosis in FSGS, and the results showed that the YSHS granule down-regulated the expressions of BMP2, GSTA1, GATS3, BST1, and S100A9 and up-regulated the expressions of TTR and GATM in ADR-induced FSGS model mice. We also proved that the YSHS granule inhibited the fibrosis in the glomeruli of ADR-induced FSGS model mice through the suppression of the BMP2/Smad signaling pathway.

ВПЛИВ ГЛУТАТІОНУ НА БІОХІМІЧНІ ПОКАЗНИКИ СИРОВАТКИ КРОВІ ПРИ ЕКСПЕРИМЕНТАЛЬНІЙ НЕФРОПАТІЇ

Вступ.Захворювання нирок – одна з найпоширеніших та найактуальніших проблем сучасної медицини. В останні десятиліття активно вивчають нефропротекторні властивості різноманітних антиоксидантів з метою попередження та корекції порушень функцій нирок, однак дані щодо ролі різних антиоксидантів є фрагментарними і потребують подальших досліджень. &#x0D; Мета дослідження– вивчити вплив глутатіону на зміну біохімічних показників крові за умов експериментальної нефропатії.&#x0D; Методи дослідження. Досліди проводили на 90 білих статевозрілих щурах-самцях масою 0,16–0,18 кг. У двох серіях експериментів нефропатію викликали шляхом одноразового внутрішньочеревного введення фолієвої кислоти в дозах 200 та 250 мг/кг. Глутатіон вводили інтрагастрально в дозі 100 мг/кг упродовж трьох та семи днів. Для оцінки функціонального стану нирок проводили біохімічне дослідження крові з визначенням концентрації креатиніну, сечовини, альбуміну, загального білка, активності γ-глутамілтранс­пептидази та аланіламінотранспептидази.&#x0D; Результати й обговорення.За умов нефропатії спостерігали збільшення вмісту сечовини порівняно з контрольною групою: на 27 % – на третій день експерименту, на 15 % – на сьомий. Введення глутатіону сприяло нормалізації досліджуваного показника. Було відзначено підвищення, порівняно з контрольною групою, рівня креатиніну в сироватці крові щурів із нефропатією в 1,5 раза при застосуванні фолієвої кислоти в дозі 200 мг/кг. На сьомий день експерименту він збільшився лише на 17 %. У групі тварин, в яких нефропатію викликали фолієвою кислотою в дозі 250 мг/кг, концентрація креатиніну підвищилась порівняно з контрольною групою: у 2,4 раза – на третій день експерименту, на 30 % – на сьомий. Семиденне введення глутатіону прирівнювало показники креатиніну піддослідних тварин до показників контрольної групи. Про загальну інтоксикацію організму під впливом високої концентрації фолієвої кислоти свідчили зниження білоксинтезувальної функції печінки, зростання активності γ-глутамілтранспептидази та аланіламінотранспептидази.&#x0D; Висновки.Глутатіон проявляє нефропротекторні властивості, що підтверджується зниженням проявів нефротичного синдрому та поліпшенням функціональних показників нирок. Найбільш чутливий біохімічний показник за умов нефропатії – креатинін, вміст якого залежить від концентрації токсиканта, можна використовувати для діагностування стану нирок та підтвердження моделі нефропатії.

Nephrotic Syndrome and Stroke

The hypercoagulability of patients with nephrotic syndrome could be an important trigger for arterial and venous thrombotic events. Arterial thromboses are less frequent than venous thromboses and the most common locations are femoral arteries. The association of stroke and nephrotic syndrome is extremely rare. Here we report the case of a patient with stroke as first manifestation of nephrotic syndrome. Ischemic stroke can be the first manifestation of nephrotic syndrome and should be considered as a possible complication of the syndrome, when the commonest causes of ischemic stroke are excluded and especially in presence of pre-existing glomerular disease.

Combined furosemide and human albumin treatment for diuretic-resistant edema.

To evaluate the clinical usefulness of combined furosemide and human albumin for the treatment of diuretic-resistant edema in patients with nephrotic syndrome and cirrhosis. Clinical literature was accessed through MEDLINE (1966-May 2002). Key search terms included furosemide, albumin, human albumin solution, nephrotic syndrome, and cirrhosis. Hypoalbuminemia, edema, and ascites are often manifestations of nephrotic syndrome and cirrhosis of the liver. Many patients with these conditions are resistant to the effects of diuretics. The combination of furosemide and human albumin solution is occasionally used in these patients. An evaluation of published studies focusing on combined furosemide and albumin in the management of nephrotic syndrome and cirrhosis was conducted. Published studies report conflicting results regarding the efficacy of combined furosemide and albumin. Although it is difficult to generate firm conclusions, it appears the combination may provide clinical benefits for select patients. Given these findings, we believe that the addition of albumin to enhance diuretic efficacy should be reserved for patients with recalcitrant edema or ascites in whom diuretic doses have been maximized and those with severe hypoalbuminemia.

Membranous nephropathy associated with spinal schwannoma

Clinical cure was effected in a patient with biopsy-proven membranous nephropathy associated with spinal schwannoma. The renal manifestation of nephrotic syndrome antedated the clinical presentation of the spinal tumor. The proteinuria and edema subsided 4 mths after the complete resection of the intradural component and partial removal of the extradural component of the schwannoma. Careful workup in patients with membranous nephropathy should include not only malignant but also benign tumors.

Use of Angiotensin Converting Enzyme Inhibitors for the Treatment of Focal Segmental Glomerulosclerosis

Sir.—Angiotensin converting enzyme (ACE) inhibitors have been shown to limit proteinuria and preserve renal function in adult patients with chronic renal insufficiency.1-4Recent data by Trachtman and Gauthier5demonstrated that short-term captopril therapy reduced urinary protein excretion in children with nephrotic range proteinuria of varying origins. We reviewed charts of all patients less than 21 years of age who have been seen at The Children's Hospital of The Cleveland (Ohio) Clinic Foundation between January 1981 and October 1989 with a diagnosis of either nephrotic syndrome or asymptomatic proteinuria. Patients with biopsyproved focal segmental glomerulosclerosis were identified and categorized as having nephrotic syndrome as defined by the International Study of Kidney Disease in Children6or proteinuria without the other manifestations of nephrotic syndrome. We chose this disease because of its resistance to usual therapy and progression to renal insufficiency. The following characteristics of the patients were analyzed:

The Two Cases of SLE Sine Lupo with only Manifestation of Nephrotic Syndrome

The Two Cases of SLE Sine Lupo with only Manifestation of Nephrotic Syndrome