Nephritis Research Articles

Orthopaedic robot-assisted free vascularised fibular grafting for the treatment of avascular necrosis of the femoral head

Objective To introduce the surgical procedure of orthopaedic robot-assisted vascularised fibular grafting for the treatment of ANFH and report the short-term result. Methods From September, 2016 to November, 2018, 17 patients (21 hips) with ANFH had undergone robot-assisted free fibular grafting. There were 14 males and 3 females, of which, 8 cases were associated with the right side, 5 cases the left side, and 4 cases with both sides. The average age was 35 (ranged from 17 to 55) years. There were 7 patients suffered from idiopathic ischemic necrosis of femoral head, 4 patients who had cannulated screws fixed after a femoral neck fracture, 4 patients who had a history of alcohol consumption, 1 patient who had taken corticosteroids for 6 months to treat nephritis, and 1 patient who had a history of alcohol consumption and had also taken corticosteroids. Seventeen hips were in Ficat stage II, and 4 hips were in Ficat stage III. The orthopaedic surgical robot workstation was used to plan the entry point and target of the guide pin during the operation, to place a cannula in the optimal position. Then a bone window was created and the fibula was placed into the bone tunnel. Using fluoroscopy to monitor each step of the procedure and verify the position of the fibula. Finally, the vessels were anastomosed. The patient remain in bed completely for a week with the use of vasodilator. The follow-up was accomplished with phone call and outpatient clinic, and Harris score was evaluated. Results All 21 surgical procedures were successful. The guide pins and fibula were accurately placed according to the robot’s plan, and the tips of the fibula were placed at the centre of the load-bearing region of the femoral heads, 4 to 6 mm from the articular surface. Conventional anticoagulant, anti-infective therapy was performed after the procedure. Ten patients were followed-up postoperatively more than 1 year, with an average of 15 (from 12 to 24) months. The function of the hip joint recovered smoothly for 9 patients. Frontal and lateral X-ray and CT scans showed that the tips of the fibula were placed at the centre of the load-bearing region, 4 to 6 mm from the articular surface. One patient suffered from bilateral femoral head necrosis and the right side recovered smoothly after operation. However, joint movement was restricted for the left hip and the pain was significant. An arthroscopic examination was performed 1 month after the operation and did not identify any problems such as intraarticular incular infection or articular surface of the femoral head was protruded by the tip of the fibula. The symptoms were alleviated after removing the osteophytes at the rim of the acetabulum. The Harris score was 62.4±13.6 before operation, and 84.5±4.5 at the last time of followed-up after operation. The difference in Harris scores was statisticly significant (P<0.05). Conclusion With the assistance of an orthopaedic robot system, the guide pin can be accurately positioned, thereby allowing the tip of the fibula to be inserted into the optimal anatomical position and maximising its mechanical efficacy. In theory, it is the best choice for performing fibular bone transplantation in ANFH. And the early effect of treatment is good. Key words: Avascular necrosis of femoral head; Orthopaedic robot; Fibula grafting; Microsurgical technique

Clinical effect of double filtration plasmapheresis combined with glucocorticoid and immunosuppressant in treatment of children with severe Henoch-Schönlein purpura nephritis

To study the clinical effect and safety of double filtration plasmapheresis (DFPP) combined with double pulse therapy with methylprednisolone (MP) and cyclophosphamide (CTX) in the treatment of children with severe Henoch-Schönlein purpura nephritis (HSPN). A total of 60 children with severe HSPN who were admitted to the hospital from January 2014 to March 2018 were enrolled and were randomly divided into an observation group and a control group (n=30 each). In addition to routine treatment, the children in the control group were given MP+CTX pulse therapy. Those in the observation group were given DFPP treatment in addition to the treatment in the control group, with three courses of treatment in total. After three courses of treatment, the two groups were compared in terms of 24-hour urinary protein, urinary microproteins, renal function parameters, adverse reactions, and clinical outcome. After three courses of treatment, the observation group had significantly greater reductions in 24-hour urinary protein, urinary albumin, urinary immunoglobulin G, urinary β2-microglobulin, serum creatinine, and blood urea nitrogen than the control group (P<0.05). After the treatment ended, the observation group had a significantly shorter time to achieve remission than the control group (P<0.05). No serious adverse reactions, such as hemorrhagic cystitis, thrombocytopenia, and hemolysis, were observed, and there was no significant difference in the overall incidence rate of adverse reactions between the two groups (P>0.05). Compared with MP+CTX pulse therapy alone in the treatment of severe HSPN in children, DFPP combined with MP+CTX pulse therapy can further alleviate renal injury and improve clinical outcome and does not increase the incidence rate of adverse reactions.

P34 Low bone mineral density was associated with lupus nephritis irrespective of duration on steroid treatment in a large observational study of juvenile systemic lupus erythematosus patients

P34 Low bone mineral density was associated with lupus nephritis irrespective of duration on steroid treatment in a large observational study of juvenile systemic lupus erythematosus patients

Clinicopathological feature analysis of IgA nephropathy complicated with acute kidney injury in children

Objective To investigate the clinicopathological features of IgA nephropathy(IgAN) complicated with acute kidney injury (AKI) in children. Methods The clinical and pathological data of children with biopsy-proven primary IgAN and complicated with AKI from January 2012 to December 2016 in the First Affiliated Hospital of Zhengzhou University were analyzed retrospectively, and the data of macroscopic hematuria (MH) associated AKI(15 cases) and other MH without AKI(99 cases) were compared. Results (1) Among 211 patients diagnosed with IgAN, 21 (9.95%) patients were complicated with AKI.Among the 21 cases, the average age was (9.5±2.1) years old, in which 17 cases(80.9%) were males, 19 cases with MH, and the range of the peak serum creatinine was 93-627 μmol/L.In histology, cellular/fibrocellular crescents were found in 11 cases, while high proportion of tubules filled with red blood cell(RBC) casts were observed in 8 cases, and moderate to severe acute tubular injury (ATI) were observed in 16 cases.In 2 cases, extensively mixed inflammatory cell infiltration with eosinophils was present in the interstitium.(2) According to the clinical and pathological characteristics, the 21 cases were divided into 3 groups: 15 cases with MH related AKI, 4 cases with crescentic glomerulonephritis, and 2 cases with acute interstitial nephritis.Compared with MH without AKI group(99 cases), the MH associated AKI group(15 cases) had significantly longer duration of MH, higher proteinuria level, urinary levels of β2-microglobulin (β2-MG) and N-acetyl-β-D-glucosaminidase (NAG), and greater frequency of RBC casts and ATI, and the differences were statistically significant(all P<0.05). In 2 acute interstitial nephritis cases, one had a history of taking weight loss drug with unknown ingredients, while the specific cause of the other was not clear.(3) None of the patients was on dialysis, but corticosteroid was prescribed in 17 cases (including methylprednisolone pulse therapy in 6), and 3 cases were combined with cyclophosphamide.Almost all patients achieved normal renal function except for one who had no response within 2 months after treatment.The median follow-up period was 24 months, in which 1 patient with crescentic glomerulonephritis progressed to end-stage renal disease. Conclusions AKI is commonly seen in children with IgAN, and complete recovery of renal function was seen in all patients with MH associated AKI and acute interstitial nephritis. Key words: IgA nephropathy; Acute kidney injury; Macroscopic hematuria; Child

Clinical Effect of Total Glucosides of Paeonia as the adjuvant therapy on Hematuria and Proteinuria Purpura Nephritis and Its Effect on Serum Cytokines

Objective To investigate the efficacy of total glucosides of paeony (TGP) in the treatment of hematuria and proteinuria purpura nephritis (HSPN) and serum interleukin-6 (IL-6), interleukin-1 beta (IL-1 beta) and interleukin-18 (IL-18). Methods From June 2017 to December 2018, 64 cases of children with primary hematuria and proteinuria purpura nephritis admitted to the department of pediatrics affiliated hospital of Xuzhou medical university were selected as study subjects, and were divided into control group (33 cases) and observation group (31 cases) according to random number method.The children in the control group were given oral administration of poniasone acetate, and the observation group was treated with TGP on the basis of the control group.Both groups received continuous treatment for 4 weeks.Two groups′ before and after treatment expression level of serum interleukin-6, interleukin-1β and interleukin-18, and level of clinic indicator such as Urinary red biood cell (URBC), 24 hour urinary protein quantity, urinary immune globulin G (IGU), micro-albuminuria (urinary microalbumin, MAU), α-Microglobulin (α1-MG) and urinary transferrin (TFRU) is made a comparison. Results After 4weeks of treatment, the total clinical effective rate of the observation group (93.5% (29/31)) was significantly higher than that of the control group (72.7% (24/33)), and the difference between the two groups was statistically significant (χ2=4.868, P 0.05). After treatment, in the observation group, Serum IL-6 ( (16.68±6.83) ng/L and (32.24±6.99) ng/L, t=12.373), IL-1β((63.83 ±8.97)ng/L and (85.59±9.42) ng/L, t=9.758), IL-18((64.52±5.46) ng/L and (88.50±5.54) ng/Ll, t=18.899), 24 h urinary protein quantification (0.3 (0.21, 0.36) g/24 h and 1.0 (0.65, 1.23) g/24 h, Z=-4.861), URBC (15.30 (3.80, 36.80)×106/L and 168.9 (58.4, 324.0)×106/L, Z=-4.840), were lower than before treatment (all P<0.05); After treatment, in the control group, Serum IL-6 ((23.62±5.95) pg/ml and (33.44±4.68) pg/ml, t=9.149), IL-1β ((68.67±6.31) pg/ml and (86.59±8.71) pg/ml, t=10.617), IL-18((71.25±9.69) pg/ml and (89.87±6.68) pg/ml, t=11.506), 24 h urinary protein quantification (0.42 (0.33, 0.56) g/24 h and 0.94 (0.74, 1.25) g/24 h, Z=-5.013), URBC (57.00 (39.25, 77.50)×106/L and 145.60 (58.20, 360.85)×106/L, Z=-4.762), were lower than before treatment (all P<0.05). The difference between the two groups was statistically significant (P<0.05). Conclusion The adjuvant effect of total glucoside of white peony root on hematuria and proteinuria purpura nephritis is significant, which can reduce the level of hematuria and proteinuria and improve the renal symptoms of children.Its mechanism of action may be to reduce renal inflammation and protect the kidney by down-regulating the expression of serum IL-6, IL-1 and IL-18. Key words: Total glucosides of paeonia; Henoch-Schonlein purpura nephritis; Interleukin1β; Interleukin18; Interleukin6

Histopathological Characteristics of Lupus Nephritis: A 10-year Single Center Experience in Taiwan

目的：狼瘡腎炎（LN）患者間的臨床表徵及腎臟病理結果變化甚大。在此我們回顧性分析臺灣單一醫學中心狼瘡腎炎患者之腎臟組織病理變化。方法：依據2003年ISN/RPS分類，我們分析了自2006年至2017年間接受腎臟切片的164位狼瘡腎炎患者之腎炎分型、急性活性指數（activity index, AI）以及慢性活性指數（chronicity index, CI），並比較各分型間臨床特徵。結果：164位狼瘡腎炎患者，年齡中位數為30.4歲。當中有138例（84.1%）為女性；91例（55.5%）為第四型，23例（14.0%）為第五型，19例（11.6%）為第三型，14例（8.5%）為第三型加第五型，13例（7.9%）為第四型加第五型，第二型有4例（2.4%）。細胞性新月體（cellular crescents）以及壞死性病灶（necrotizing lesions）在第四型LN最常見。第四型LN的AI最高，第四型加上第五型的狼瘡腎炎患者之蛋白尿值高過其餘分型。結論：第四型狼瘡腎炎不僅是最多見，亦是最嚴重的一個分型，需要即時的治療。

Clinical manifestations and pathological characteristics of Henöch-Schönlein purpura nephritis combined with hyperuricemia in children

Objective To analyze the relationship of clinical manifestations and pathological characteristics of Henoch-Schonlein purpura nephritis combined with hyperuricemia in children. Methods A retrospective study was conducted in 50 children with Henoch-Schonlein purpura nephritis who hospitalized at Department of Nephrology, Affiliated Children′s Hospital, Capital Institute of Pediatrics from January 2014 to May 2018.The differences between the hyperuricemia group(19 cases)and the normal uric acid group(31 cases), were compared in age, sex, blood pressure, serum albumin, 24-hour urinary protein, serum creatinine, triglyceride, cholesterol, high density lipoprotein, low density lipoprotein, serum uric acid, estimated glomerular filtration rate, and renal pathological characteristics, and the short-term prognosis was analyzed. Results (1)The average urinary protein in the hyperuricemia group and the normal uric acid group was (91.67±90.37) mg/(kg·d) and (64.62±43.28) mg/(kg·d), respectively and the difference was statistically significant between the both groups(t=2.04, P=0.047); and the morbidity with massive proteinuria in hyperuricemia group and normal uric acid group was 18/19 cases(94.7%)and 17/31 cases(54.8%), respectively and the difference was statistically significant between the both groups(χ2=8.930, P=0.003). (2)In all cases, there were 4 cases of glomerular pathological grade Ⅱ, 43 cases of grade Ⅲ and 3 cases of grade Ⅳ.The pathological grading of hyperuricemia group and normal uric acid group was mainly grade Ⅲ, including 16/19 cases (84.2%) in hyperuricemia group and 27/31 cases (87.1%) in normal uric acid group, 4 cases of grade Ⅱ in normal uric acid group and 3 cases of grade Ⅳ in hyperuricemia group, the pathological grade of hyperuricemia group was relatively severe (χ2=7.358, P=0.025). There was no significant difference about the degree of global sclerosis and mesangial proliferation between hyperuricemia group and normal uric acid group(χ2=2.426, P=0.119, χ2=0.043, P=0.836, respectively); 7/19 cases (36.8%) had severe foot process lesions in hyperuricemia group, which was significantly higher than that in normal uric acid group [4/31 cases(12.9%)](χ2=3.934, P=0.047). In hyperuricemia group, tubulointerstitial lesions were found in 9/19 cases (47.4%) of (+ ) grade and 10/19 cases (52.6%) of (+ + ) grade, and 12/31 cases (38.7%) had normal tubulointerstitium in normal uric acid group, (+ )and (+ + )grade lesions were also less than those in the hyperuricemia group(χ2=10.694, P=0.005). The mean scores of tubular atrophy and interstitial fibrosis were significantly higher in hyperuricemia group than that in normal uric acid group(t=2.36, P=0.001). (3) The interval from renal biopsy to final visit was 10.0 months and 10.5 monthsin hyperuricemia group and normal uric acid group respectively (P=0.85). In hyperuricemia group, complete remission was found in 5/19 cases (26.3%), slight abnormality in 10/19 cases (52.6%), severe abnormality in 4/19 cases (21.1%). Howe-ver, in normal uric acid group, complete remission was found in 19/31 cases (61.3%), 10/31 cases (32.3%) of slight abnormalities and 2/31 cases (6.5%)of severe abnormalities.The non-remission cases in the hyperuricemia group were significantly higher than those in the normal uric acid group(χ2=7.878, P=0.042). Conclusions Urinary protein was higher in children with Henoch-Schonlein purpura nephritis complicated with hyperuricemia, the pathological of renal tubulointerstitium and glomerulus and the foot process change are more serious than those of patients with normal uric acid.Therefore, hyperuricemia may be used as a risk factor for poor prognosis. Key words: Child; Hyperuricemia; Henoch-Schonlein purpura nephritis; Pathology

Prediction of pathological grading of Henoch-Schönlein purpura nephritis in children based on Fisher stepwise discriminant analysis

Objective To establish the pathological grades of Henoch-Schonlein purpura nephritis(HSPN) in children with diagnostic prediction models by stepwise Fisher discriminant in children. Methods Based on the investigation of 28 clinical indicators from 144 cases with HSPN came from Children′s Hospital of Chongqing Medical University, the sensitive indicators were found and stepwise Fisher discriminant model was established and its accuracy in predicting the pathological classification of HSPN was tested. Results There were 5 laboratory indicators and clinical manifestations with different pathological grades of HSPN.In children with pathological grade Ⅱ, Ⅲ and Ⅳ, 5 indicators were screened (P<0.05) and stepwise Fisher discriminant models were established.And the correct rate of comprehensive diagnosis was (61.371±8.740)% in 100 random sampling diagnostic simulations; in children with pathological grade Ⅲa and Ⅲb, 5 indicators were also screened (P<0.05) and stepwise Fisher discriminant models were established.And the correct rate of comprehensive diagnosis was (68.015±5.736)% in 100 random sampling diagnostic simulations. Conclusions The stepwise Fisher discriminant models established in this research have a better diagnostic accuracy in forecasting for pathological grade of HSPN, and have a certain guiding value on early treatment and prognosis evaluation of children with newly diagnosed HSPN. Key words: Stepwise Fisher discriminant model; Henoch-Schonlein purpura nephritis; Pathology; Child

Comparison of the current status of peritoneal dialysis between Foshan and other relatively developed countries or areas

Objective To investigate the current status of peritoneal dialysis (PD)patients in the hospital and to improve the treatment and management of PD. Methods Data of 178 patients undergoing PD were retrospectively analyzed, who underwent dialysis more than three months in five years and then compared with those from other relatively developed countries or areas. Results Compared with other relatively developed countries or areas, the PD patients were younger, the average age was 50.1 years, and the male patients accounted for 48.9%, the female patients accounted for 51.1%.The primary disease was chronic nephritis(54.5%), the incidence of peritonitis was lower(1 person/56 months), the pathogenic bacteria was mainly Gram-positive bacteria, accounting for 40.9%.There were 94 cases of erythroprotein less than 110 g/L(52.8%), 37 cases of serum protein less than 35 g/L(21%), 92 cases of calcium and phosphorus metabolism abnormality(51.5%), and 59.7% PD patients were KT/V>2.0 mmol/L, and peritoneal equilibration test(PET) showed high average transhipment accounted for 49.4%. Conclusions The patients with PD in our center are significantly different from those in developed countries or regions. Key words: Peritoneal Dialysis; GUANGDONG

Study on correlation between serum uric acid level and brachial ankle pulse wave velocity in patients with systemic lupus erythematosus

Objective To investigate the relationship between serum uric acid (UA) level and brachial-ankle pulse wave velocity (baPWV) in patients with systemic lupus erythematosus (SLE) and lupus nephritis (LN). Methods A total of 110 hospitalized, out-patient and healthy examinees from January 2017 to September 2017 were selected from Kailuan General Hospital.They were divided into three groups: (1)Fifty-five healthy controls were examined at the same time, and those who had no history of hypertension, myocardial infarction and stroke were excluded by physical examination.(2)Thirty-four SLE patients without LN were diagnosed according to the SLE classification standard revised by the American Society of Rheumatology (ACR) in 1997, excluding those with lupus nephritis.(3)21 SLE patients with LN were diagnosed according to the SLE classification standard revised by the American Society of Rheumatology (ACR) in 1997.Pearson correlation coefficient and multivariate linear regression model were used to analyze the related factors affecting baPWV. Results The level of baPWV and the proportion of baPWV (≥1400 cm/s) in SLE without LN group and SLE with LN group were higher than those in healthy control group (all P<0.05). In SLE without LN group, baPWV was positively correlated with age, systolic blood pressure(SBP)and total cholesterol(CHOL)(r=0.623, 0.528, 0.402, P<0.01 or P<0.05), and negatively correlated with blood uric acid(UA) (r=-0.371, P<0.05), but the correlation was not significant.The correlation between UA and baPWV disappeared after after correction of age, SBP, diastolic blood pressure (DBP) by partial correlation analysis.In SLE with LN group, baPWV was positively correlated with SBP, DBP and serum creatinine(Cr) (r=0.815, 0.725, 0.464, P<0.01 or P<0.05). Multivariate stepwise regression analysis showed that SBP was independently correlated with baPWV in SLE group (t=2.54, P=0.026); UA in SLE group without LN was independently negatively correlated with baPWV(t=-2.96, P=0.042); UA(t=4.24, P=0.013) and SBP(t=7.70, P=0.002) were independently positively correlated with baPWV in SLE group with LN.Logistic regression analysis showed that SLE was a risk factor for baPWV (≥1 400 cm/s), and the OR (95% CI) was 4.31 (1.56-11.88), P=0.005, and there was statistical significance after adjusting for age, SBP, DBP, body mass index (BMI). However, UA was not a risk factor for baPWV (≥ 1 400 cm/s) (P values were 0.163 and 0.519, respectively). Conclusion The degree of arteriosclerosis in SLE patients is higher than that in normal subjects, and the level of UA in SLE patients may be related to baPWV. Key words: Systemic lupus erythematosus; Lupus nephritis; Blood uric acid; Brachial-ankle pulse wave velocity

Isolation and genome sequences of two Feline Morbillivirus genotype 1 strains from Italy.

Feline morbillivirus (FeMV) is a novel viral paramyxovirus detected in cats. FeMV is suspected to be associated to tubulointerstitial nephritis, but its pathogenic role is far to be clearly understood. In this short communication, we report the whole genome coding sequences of the first two FeMV strains isolated in Italy.

SP190IgA VASCULITIS WITH NEPHRITIS : ABOUT 34 OBSERVATIONS

SP190IgA VASCULITIS WITH NEPHRITIS : ABOUT 34 OBSERVATIONS

Characteristics and diagnostic value of temporal retinal thinning in young patients with Alport syndrome

Objective To observe the features of temporal macular thinning and its value for the diagnosis of Alport syndrome (AS) in young patients. Methods Eighty-one young patients with AS (81 eyes) from Peking University First Hospital during January 2016 and July 2017 were included in this study. There were 67 males (67 eyes) and 14 females (14 eyes),the aged from 3 to 17 years, with the mean age of 9.6 years. Among 81 patients (81 eyes), there were 64 patients with X-linked AS (XLAS, including 53 males and 11 females), 17 patients with autosomal recessive AS (ARAS, including 14 males and 3 females). One hundred healthy subjects aged 4 to 17 years were included as controls. Clinical data were retrospectively evaluated, including visual acuity, slit-lamp microscopy, dilated fundus photography, and OCT. Retinal thickness was measured with an OCT scan and the temporal thinning index (TTI) was calculated as stated in a previous study. The TTI values of each group was compared by One-way ANOVA or independent sample t test. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic effectiveness for AS. Results The TTI of the control group, XLAS and ARAS patients were 6.46±1.58, 10.93±3.77, 12.14±4.05, respectively. Compared with the control group, the TTI value of males were larger in the XLAS and ARAS group (F=45.056, P<0.001), the TTI value of females were larger in the ARAS group (F=26.541, P<0.001). The difference of TTI value in females was significant between the XLAS and ARAS groups (F=26.541, P<0.001). In males, the area under the ROC curve was 0.896 (95%CI 0.837−0.955, P<0.001). The optimal cutoff value of the TTI was determined as 9.47, with a sensitivity of 73.1% and a specificity of 100%. Conclusions TTI is a common ocular finding in young patients with AS. In males, a TTI > 9.47 may differentiate AS from normal males. Key words: Nephritis, hereditary; Tomography, optical coherence; Temporal macular thinning

Urinary neutrophil gelatinase-associated lipocalin and nephrology in children

Urinary neutrophil gelatinase-associated lipocalin (uNGAL) characterizes with obvious indication of urinary epithelial injury.It is induced significantly and secreted predominantly by the injured epithelial cells of the kidney.Recent published reports have described additional utility of uNGAL in various pathologic conditions within the pediatric urinary tract, including urinary tract infection, vesicoureteral reflux, renal scarring, and obstructive uropathy.And it was recommended as a good biomarker for diagnosis and treatment monitoring of acute pyelonephritis in children.Furthermore, uNGAL is one of the earliest and most indicative biomarkers of acute kidney injury. Recent studies suggested that uNGAL excretion could be helpful in diagnosis and monitoring of treatment and progressing of various renal diseases, such as nephrotic syndrome, diabetes nephropathy, immunoglobulin A(IgA) vasculitis nephritis, lupus nephritis, et al.Additionally, the ability to assay the marker noninvasively in urine represents a significant advantage over current methods, especially for the pediatric population.These improvements will increase the clinical utility of uNGAL and may lead to more effective and personalized treatments for children with uropoietic system diseases.The role of uNGAL in the diagnosis and treatment of children′s kidney disease is systematically described in this article, so as to provide a reference for clinicians in their daily work. Key words: Urinary neutrophil gelatinase-associated lipocalin; Nephrology; Child

Levels and clinical significance of S100A8/A9 in serum of patients with lupus nephritis

Objective To investigate level of S100A8/A9 in serum of patients with lupus nephritis(LN) and analyze the relation between S100A8/A9 and clinical parameters. Methods There were 50 female patients and 8 male patients with LN. Patients with LN (LN group) were divided into LN active group with more than 10 points(n=38)and LN inactive group with less than 10 points(n=20)by systemic lupus erythematosus disease activity index. Thirty healthy controls (control group) were individually matched for sex, age and body mass index. Serum levels of S100A8/A9 of LN patients were detected by enzyme-linked immunosorbent assay, the clinical data of LN patients were collected. Results ①Serum level of S100A8/A9 was significantly higher in LN group than those of control group (P 0.05). ③Serum level of S100A8/A9 was positively correlated with anti-dsDNA, C-reactive protein, serum creatinine, 24-hour urine protein and SLEDAI scores(r=0.27, P=0.04; r=0.4, P=0.002; r=0.38, P=0.003; r=0.30, P=0.02; r=0.90, P=0.000). Serum level of S100A8/A9 was negatively correlated with complement C3, C4 and creatinine clearance(r=-0.28, P=0.036; r=-0.38, P=0.036; r=-0.322, P=0.014). There was no correlation between serum level of S100A8/A9 and erythrocyte sedimentation rate (r=0.098, P=0.464). Conclusions S100A8/A9 may be involved in the occurrence and development of lupus nephritis. Dynamic observation of serum S100A8/A9 level contributes to monitor LN activity, evaluates the severity of kidney damage, which has clinical significances for treatment options, efficacy evaluation in LN patients in a way. Key words: Lupus Nephritis; S100 Proteins

Therapeutic effects of baicalin on lupus nephritis in a lupus-prone mouse model and its regulatory role in follicular helper T cell differentiation

Objective To evaluate the therapeutic effect of baicalin on lupus nephritis in a lupus-prone mouse model, and to investigate its regulatory role in the differentiation of follicular helper T (Tfh) cells. Methods Eight 12-week-old female MRL/lpr lupus-prone mice were randomly and equally divided into two groups by a random number table i.e., baicalin group and control group intraperitoneally injected with 200 mg/kg baicalin sodium and chloride physiological solution, respectively, once every day for 4 weeks. After the end of treatment, Coomassie brilliant blue staining was performed to detect the level of 24-hour urine protein. Then, the mice were sacrificed, and the spleens were resected and weighed. Mononuclear cells were isolated from these spleens, and flow cytometry was conducted to determine the proportion of Tfh cells. Additionally, the kidneys were resected and subjected to hematoxylin and eosin (HE) staining for the evaluation of kidney impairment. Moreover, some other mononuclear cells were isolated from the spleens of the lupus-prone mice in the control group, and magnetic activated cell sorting (MACS) was performed to isolate naive CD4+ T cells, which were divided into 3 groups: blank control group receiving no treatment, induction group treated with 10 μg/L anti-interleukin (IL) -21 and anti-IL-6 antibodies and 3 μg/L anti-CD3 and anti-CD28 antibodies for 5 days, and intervention group additionally treated with 40 μmol/L baicalin for 5 days besides the above treatment. Then, 50 μg/L phorbol ester, 750 μg/L ionomycin and 20 mg/L brefeldin A were used to stimulate some cultured naive CD4+ T cells in the above groups. Flow cytometry was conducted to determine the proportion of CD4+CXCR5+PD-1+ cells and CD4+IL-21+ cells. Statistical analysis was carried out with SPSS20.0 software by using one-way analysis of variance (ANOVA) and student t test for the comparison of quantitative data between groups. Results The baicalin treatment could effectively improve the kidney impairment in the lupus-prone mice. Compared with the control group, the baicalin group showed significantly decreased 24-hour urine protein level ([1 416 ± 171] vs. [2 623 ± 278] μg/24 h, P = 0.022) , and significantly decreased proportion of Tfh cells in the spleen (12.6% ± 2.3% vs. 40.2% ± 1.1%, P = 0.005) . In vitro baicalin could further inhibit the differentiation of Tfh cells. Compared with the induction group, the intervention group showed significantly decreased proportion of CD4+CXCR5+PD-1+ Tfh cells (13.3% ± 0.8% vs. 17.6% ± 0.9%, P = 0.04) and CD4+IL-21+ cells (1.0% ± 0.4% vs. 2.7% ± 0.2%, P < 0.01) . Conclusion Baicalin can effectively ameliorate lupus nephritis, which may be associated with the inhibition of Tfh cell differentiation. Key words: Lupus erythematosus, systemic; Lupus nephritis; Baicalin; Disease models, animal; Follicular helper T cells; Interleukin-21

Evaluation of ovarian reserve function in patients with systemic lupus erythematosus by anti-Mueller hormone

Objective To evaluate the effect of anti-Mueller hormone on ovarian reserve in female patients with systemic lupus erythematosus(SLE). Methods The clinical data of 80 women with SLE in the Department of Rheumatism of Zaozhuang Municipal Hospital from June 2015 to June 2018 were collected.The patients used cyclophosphamide before entering the group were selected as A group(35 cases), and patients who didn't use cyclophosphamide were selected as B group(45 cases), and 30 healthy female volunteers were selected as the control group at the same time.All of them were normal menstrual cycle.At the third day of the menstrual cycle, the levels of anti-Mueller hormones were detected by enzyme linked immunosorbent assay.The serum levels of estrogen and alveolar hormone were detected by microparticle enzyme immunoassay, and the number of ovarian sinus follicles in each group was recorded by transvaginal ultrasound. Results The incidence rate of thrombocytopenia, nephritis, hemolytic anemia and neuropsychiatric manifestations in A group were 54.29%(19/35), 85.71%(30/35), 37.14%(13/35) and 22.86%(8/35), respectively, which were significantly higher than those in B group[48.89%(22/45), 53.33%(24/45), 13.33%(6/45), 0.00%(0/45)](χ2=6.33, 9.41, 6.16, 9.03, all P 0.05). The level of anti-Mueller hormone in patients with SLE aged>30 years[(0.98±0.31)g/L]was significantly lower than patients ≤30 years old[(1.86±0.60)g/L], and the level of anti-Mueller hormone in patients with cyclophosphamide accumulation>10 g[(0.36±0.11)g/L]was significantly lower than that of 10 g[(1.76±0.52)g/L](t=7.54, 11.30, both P<0.01). The results of Pearson correlation analysis showed that the anti-Mueller hormone showed negative correlation with the age of SLE and the accumulation of cyclophosphamide(r=-0.56, -0.45, both P<0.01). Conclusion The use of anti-Mueller hormone has good evaluation value for ovarian reserve function in female patients with SLE, and the level of anti-Mueller hormone is closely related to the age and the accumulation of cyclophosphamide.Therefore, cyclophosphamide should be used carefully in patients who are over 30 years old and the cumulative amount of cyclophosphamide over 10 g. Key words: Anti-mueller hormone; Lupus erythematosus, systemic; Ovarian function tests; Cyclophosphamide; Estrogens; Follicle stimulating hormone; Ovarian sinusoidal follicles; Age groups; Female

Progress in treatment of henoch-schonlein purpura in children

Henoch-schonlein purpura is a common immune-mediated systemic vasculitis in childhood, and its clinical manifestations are mainly skin purpura, arthritis, gastrointestinal symptoms and acute glomerulonephritis.Clinically, purpura nephritis caused by henoch-schonlein purpura has seriously jeopardized children's life and health.At present, there is still no uniform treatment standard for the treatment of this disease.This article reviews the progress of the treatment of anaphylactoid purpura in children from two aspects of western medicine and traditional Chinese medicine. Key words: Henoch-schonlein purpura; Child; Therapy

Therapy strategy and prognosis in pediatric patients with severe Henoch-Schönlein purpura nephritis

Henoch-Schonlein purpura nephritis(HSPN)is one of the most common types of secondary glomerulonephritis in children.Patients with severe HSPN are at distinctively higher risk of poor prognosis.Currently, no unified therapeutic method is adopted to treat severe HSPN, and disagreements exist in prognostic factors.This paper reviews the treatment measures including steroid, multiple immunosuppressive agents, rituximab and plasmapheresis for severe HSPN.Relevant factors for long-term prognosis of HSPN are discussed, which provide reference for clinical treatment and management. Key words: Severe Henoch-Schonlein purpura nephritis; Children; Therapy; Prognosis

Comparison of effects of different regimens in the treatment of acute interstitial nephritis

目的 比较不同治疗方案治疗急性间质性肾炎的临床效果。 方法 选取2016年2月至2017年4月苏州大学附属常熟医院收治的急性间质性肾炎患者153例为研究对象，采用随机数字表法分为A、B、C三组，每组51例。给予A组患者常规血液透和营养支持，给予B组常规血液透析、营养支持与泼尼松免疫透析综合治疗，给予C组常规血液透析、营养支持与环孢菌素免疫透析综合治疗。对比三组患者治疗总有效率、不良反应发生率与各项生化指标水平。 结果 B组和C组患者治疗总有效率和各项生化指标参数均明显优于A组[血尿氮素：A组(10.43±4.28)mmoL/L，B组(6.04±1.64)mmoL/L，C组(6.17±1.75)mmoL/L；血肌酐：A组(143.15±40.35)mg/24 h，B组(91.22±34.21)mg/24 h，C组(92.04±36.83)mg/24 h；尿β2微球蛋白水平：A组(0.37±0.13)mg/L，B组(0.21±0.23)mg/L，C组(0.25±0.07)mg/L；24小时尿蛋白定量：A组(1.23±0.53)g/24 h，B组(0.34±0.26)g/24 h，C组(0.38±0.06)g/24 h](t＝1.26、4.83、0.97、4.17、2.36、2.87、3.12、4.55，均P 0.05)；三组不良反应发生率差异无统计学意义(P>0.05)。 结论 应用免疫抑制剂辅助治疗急性间质性肾炎可有效提高其临床疗效，且用药安全性较高，值得临床推广。