Red Blood Cells In Urine Research Articles

Relatives in silent kidney disease screening (RISKS) study: A Chinese cohort study.

Family members of patients with end-stage renal disease (ESRD) have higher risk for chronic kidney disease (CKD). Limited study has examined the risk of developing CKD in relatives of patients in earlier stages of CKD. From January 2008 to June 2009, the Hong Kong Society of Nephrology studied first-degree relatives of stage 1-5 CKD patients from 11 local hospitals. A total of 844 relatives of 466 index CKD patients (stages 1-2: 29.6%; stage 3: 16.7%; stage 4: 10.9%; stage 5: 42.7%) were reviewed for various risk factors of CKD. We also defined a composite marker of kidney damage by the presence of one or more following features: (i) positive urine protein, (ii) spot urine protein-to-creatinine ratio ≥0.15 mg/mg, (iii) hypertension and (iv) estimated glomerular filtration rate (eGFR) ≤60 mL/min per 1.73 m2 and determine its association with participant and index patient factors. Among these 844 relatives, 23.1%, 25.9% and 4.4% of them had proteinuria (urine protein ≥1+), haematuria (urine red blood cell ≥1+) and glycosuria (urine glucose ≥1+), respectively. Proteinuria (P = 0.10) or glycosuria (P = 0.43), however, was not associated with stages of CKD of index patients. Smoking participants had a significantly lower eGFR (102.7 vs. 107.1 mL/min per 1.73 m2 ) and a higher prevalence of proteinuria (33.6% vs. 21.4%). Multivariate analysis showed that older age, male gender, obesity, being parents of index patients and being the relatives of a female index patient were independently associated with a positive composite marker. First-degree relatives of all stages of CKD are at risk of developing CKD and deserve screening. Parents, the elderly, obese and male relatives were more likely to develop markers of kidney damage.

Phytochemical investigation and nephroprotective potential of Sida cordata in rat

BackgroundPlants are an efficient source of natural antioxidant against free radicals causing kidney damages. Sida cordata ethyl acetate fraction has been reported for strong in vitro antioxidant potency, previously. In the present study, our objective was to evaluate its in vivo antioxidant potency against CCl4 induced nephrotoxicity and investigates the bioactive phytochemicals by HPLC-DAD analysis.MethodsPhytochemical analysis was performed by HPLC-DAD methodology. For in vivo study, 42 male Sprague-Dawley rats were treated with alternatively managed doses for 60 days. Group I animals were remained untreated. Group II animals were treated with vehicle (1 mL of olive oil) by intragastric route on alternate days. Group III was treated with 30% CCl4 (1 mL/kg b.w.) i.p. Group IV was treated with 30% CCl4 (1 mL/kg b.w.) i.p and silymarin intragastric. Group V and VI rats were treated with 30% CCl4 and SCEE (150 and 300 mg/kg b.w., respectively) intragastric. Group VII animals were treated with SCEE (300 mg/kg b.w.) intragastrically. Blood parameters, Serum proteins and urine profile were investigated. Activities of tissue enzyme i.e. catalase, peroxidase, superoxide dismutase, glutathione-S-transferase, glutathione reductase, GSH and γ-GT were evaluated. Histopathological observations, total protein contents, lipid peroxidation, DNA damage and relative weight were also analyzed.ResultsGallic acid, catechin and caffeic acid were identified in SCEE fraction by HPLC-DAD. Decrease in the count of red blood cells, neutrophils, eosinophils and concentration of hemoglobin whereas increase in lymphocyte count and estimation of sedimentation rate (ESR) with 1 mL CCl4 (30% in Olive oil) administration (30 doses in 60 days) was restored dose dependently with co-treatment of SCEE (150 and 300 mg/kg b.w.). Treatment of rats with CCl4 markedly (P < 0.01) increased the count of urinary red blood cells and leucocytes, concentration of urea, creatinine and urobilinogen and specific gravity whereas creatinine clearance was reduced. Serum level of total protein, albumin, globulin, nitrite, creatinine and blood urea nitrogen (BUN) was significantly increased (P < 0.01) by CCl4 treatment. The activity of antioxidant enzymes; catalase, superoxide dismutase, glutathione peroxidase, glutathione-S-transferase and glutathione reductase and content of reduced glutathione was decreased (P < 0.01) significantly. However, increased concentration (P < 0.01) of thiobarbituric acid reactive substances and histopathological injuries were noticed in the renal tissues of rats after the treatment with CCl4. Co-administration of SCEE, dose dependently, protected the alterations in the studied parameters of rats at 150 and 300 mg/kg b.w. The present study revealed that SCEE could be used as a possible remedy for renal toxicity abnormalities.ConclusionThese results are an evidence of the renal protective role of S.cordat ethyl acetate fraction against CCl4 induced nephrotoxicity in rats which may be due to its antioxidant compounds.

Association of comprehensive geriatric assessment with quality-related care practices during implementation and development of an orthogeriatric hip fracture program

IntroductionThis study was performed to examine the association of a comprehensive geriatric assessment (CGA) with quality-related care practices during the implementation and development of an orthogeriatric hip fracture program. Materials and methodsPopulation-based, prospective data were collected on 1644 consecutive hip fracture patients aged≥65 years between September 2007 and December 2015. The outcome variables were delay from admission to surgery<24h, transfusion of red blood cells and removal of indwelling urinary catheter during the acute period of hospitalization. The adjustments used were age, sex, American Society of Anesthesiologists score, diagnosis of memory disease and prefracture living arrangements and mobility level. ResultsSince beginning the orthogeriatric program, performing the CGA (OR: 1.43, 95% CI 1.36–1.50), delay from admission to surgery<24h (OR: 1.06, 95% CI 1.02–1.11) and urinary catheter removal before discharge (OR: 1.51, 95% CI 1.43–1.58) increased significantly. In the adjusted analysis, interaction of CGA with follow-up time increased urinary catheter removal (OR: 10.0, 95% CI 7.34–13.7) and red blood cell transfusions (OR: 1.32, 95% CI 1.02–1.71), but had no effect on the delay to surgery (OR 1.07, 95% CI 0.83–1.38). ConclusionsImplementation of an orthogeriatric program led to several quality improvements: more patients received CGA, underwent surgery within 24h of admission, and had their urinary catheter removed during the acute period of hospitalisation. Administering the CGA was associated with prompt urinary catheter removal and increased red blood cell transfusions. The timing of surgery improved independent of the CGA.

Treatment of lupus nephritis: current paradigms and emerging strategies.

Lupus nephritis is the most common organ-threatening manifestation of lupus and continues to result in end-stage renal disease. This review describes the contemporary treatment of lupus nephritis as well as emerging therapeutic strategies. Lupus nephritis management consists of an initial (induction) phase and a maintenance (extended) phase in which steroids are used in combination with another immunosuppressive medication. Current treatments are incompletely effective and associated with substantial toxicity. Despite disappointing results of several recent trials, novel therapies targeting diverse immunologic pathways are being actively studied in lupus nephritis. Two promising strategies include the use of B-cell depletion therapy and multitarget therapy with calcineurin inhibitors. In parallel with the conduct of these trials, there are ongoing efforts to improve trial design. Two recent studies of outcome measures reported that a level of proteinuria of less than 0.7-0.8 g at 12 months is most predictive of good long-term renal outcome, and that the inclusion of urine red blood cells worsens the predictive value of proteinuria alone. Improved understanding of lupus nephritis pathogenesis, development of novel therapies, and optimization of clinical trial design are leading the path forward for successful drug development in lupus nephritis. The ultimate goal of these efforts is to treat our patients in a more strategic, personalized manner that improves long-term outcomes.

Clinical effects of leflunomide in the treatment of patients with Henoch-Schonlein purpura nephritis who were not response to cyclophosphamide

Objective To evaluate the effect of leflunomide(LEF) in the treatment of adult Henoch-Schonlein purpura nephritis(HSPN) patients with nephrotic syndrome who were not response to cyclophosphamide. Methods 26 patients with nephrotic syndrome HSPN performance treated by CTX therapy, relapse or discontinued due to adverse reactions were selected.LEF joint glucocorticoid treatment was given to the patients for 6 months.Collected the blood routine, urine routine, 24 hours urine protein, urinary red blood cell count, serum albumin, hepatic and renal functions before treatment and 6 months after treatment, and the adverse drug reactions were recorded. Results In 26 patients, 20 cases had clinical remission.After treatment, compared with before treatment, the urinary protein, urinary red blood cell count decreased significantly(P<0.05), and serum albumin increased significantly(P<0.05) in 20 patients, renal function recovered to normal in 6 patients.11 patients achieved complete remission, 9 patients achieved partial remission.Compared with cyclophosphamide treatment was invalid, the clinical remission rate was 76.9%(χ2=6.783, P<0.01). Of 26 patients, 1 patient had mild gastrointestinal symptoms, 1 patient had mild neutropenia, 1 patient had mild liver transaminases elevated, compared with cyclophosphamide side effects incidence rate of 46.2%(12/26), the incidence rate of adverse reactions was 11.5%(3/26)(χ2=5.496, P<0.05), they were relieved after expectant treatments, no patients stop treatment. Conclusion LEF combined with glucocorticoid had good efficacy and mild adverse reactions for adult HSPN patients with nephrotic syndrome. Key words: Purpura, Schoenlein-Henoch; Nephritis; Leflunomide; Cyclophosphamide

Comparison of oral steroids with tonsillectomy plus steroid pulse therapy in patients with IgA nephropathy

Treatment of IgA nephropathy (IgAN) in Japan has recently changed, from oral prednisolone (oPSL) to tonsillectomy plus steroid pulse (TSP) therapy. However, a few studies have compared their efficacy and safety. IgAN patients diagnosed in our institution between 1991 and 2013, treated with TSP or oPSL, aged ≥16years, with ≥1g/day proteinuria, and estimated glomerular filtration rate (eGFR) ≥30ml/min/1.73m2, and no other renal disease were selected. Baseline clinical and histological findings, clinical outcomes, and adverse events were compared. Clinical remission (CR) was defined as <0.3g/day proteinuria and <5 urinary red blood cells per high-powered field. Sixty-six patients were identified; after propensity score adjustment, 26 patients were selected in each group. CR rates were significantly higher at 12 (30.8% vs. 3.9%), 36 (47.3% vs. 7.9%), and 72 (57.8% vs. 20.1%) months (p<0.01), and the renal survival rate, defined as the development of a 25% reduction from baseline eGFR, was significantly higher at 12 (96.2% vs. 69.2%), 36 (96.2% vs. 61.5%), and 72 (96.2% vs. 41.0%) months in the TSP than the oPSL group (p<0.001). Multivariate analysis showed that TSP was the only independent factor associated with CR (hazard ratio, 3.58; 95% confidence interval, 1.32-10.91, p=0.01). The number of patients with adverse events was significant lower in TSP group than in oPSL group (11.5% vs. 34.6%, p=0.04). CR rates are higher; protection of renal function and prevention from adverse events were superior with TSP than with oPSL in patients with IgAN and moderate-to-severe proteinuria.

Interaction of Giardia intestinalis and Systemic Oxidation in Preschool Children in the Western Highlands of Guatemala.

Guatemala is a country with the highest prevalence of stunting in under-5 children in the Americas, with a national average of 49.8%. Asymptomatic intestinal colonization with Giardia intestinalis is common in Guatemalan preschoolers and has been implicated as a factor in linear growth retardation. The potential mechanisms of any giardiasis-growth interaction have not been exhaustively explored. The aim of the present study was to describe urine oxidative stress biomarkers and erythrocyte antioxidant enzyme activity, and to explore any association with prevalence or intensity of G intestinalis infection in preschoolers attending 3 government-subsidized day care centers in the Guatemalan Western Highlands. Samples of feces, urine, and red blood cell (RBC) hemolysate were collected in a total of 74 preschoolers enrolled in 3 day care centers. Giardia prevalence and a proxy index for intensity were assessed by enzyme-linked immunosorbent assay (ELISA). Urinary biomarkers of oxidative damage to DNA (8-hydroxydeoxyguanosine [8-OHdG]) and to lipid (F2t 15-Isoprostane [F2-Iso]) were measured by ELISA. The erythrocyte activity of catalase (CAT), superoxide dismutase (SOD), glutathione reductase (GSR), and glutathione peroxidase (GPX) were measured by respective spectroscopic substrate-based reaction assays. Median values of RBC CAT activity (P = 0.016) and urine F2-Iso (P = 0.023) differed between children who were positive (n = 39) and negative (n = 35) for Giardia. Similarly, G intestinalis intensity was significantly and positively associated with urinary F2-Iso (r = 0.446, P < 0.001), RBC SOD (r = 283, P = 0.014), and RBC CAT (r = 0.260, P = 0.025). The optical density reading of the fecal ELISA assay for G intestinalis has potential as a proxy for the intensity of infestation. In this respect, there exists an association of this intensity with indicators of the systemic oxidation.

Clinicopathological features and prognosis of Kimura's disease with renal involvement in Chinese patients.

Kimura's disease (KD) with renal involvement is a rare disease. Optimal treatments are still not well established. It is necessary to analyze clinicopathological features, treatment responses, and prognosis for improving KD diagnosis and treatment. Clinicopathological data, treatment responses, and prognosis were collected and analyzed retrospectively. The patients consisted of 27 males and 2 females, with an average age of 35.5 ± 15.1 (13 - 61) years. 27 exhibited proteinuria ranging from 0.730 to 14.1 g/24 h (5.98 ± 3.40 g/24 h). Hypertension, renal insufficiency (serum creatinine (Scr) > 1.24 mg/dL), and microhematuria occurred in 4 (13.8%), 11 (37.9%), and 13 (44.8%) cases, respectively. Light microscopy (LM) identified mesangium proliferation, minimal change, focal and segmental glomerulosclerosis (FSGS), membranous glomerulonephritis, membranoproliferative glomerulonephritis (MPGN), and acute tubular necrosis in 14, 8, 3, 2, 1, and 1 cases, respectively. All were treated with Tripterygium wilfordii (TW), prednisone, leflunomide (LEF), tacrolimus (FK506), myophenolate mofetil (MMF), or renin-angiotensin system blockers (RASI). 26 patients were followed up for 1.60 - 108.7 months (39.6 ± 28.7). After treatments, urinary red blood cells (RBC) decreased in all. The amount of 24-hour urinary protein (24-hUPE) decreased in 24 patients. 22 reached complete remission (CR), 4 partial remissions (PR). The patients who did not relapse were younger than those who relapsed. KD with renal involvement occurs predominantly among 35 - 50 year old Chinese patients with male predilection. The most common features are proteinuria, hypertension, micro hematuria with minimal change, and mesangial proliferative glomerulonephritis. Most were responsive to treatment, but could relapse. Gender, age, and hypertension are associated with KD recurrence. The prognosis is good mostly.

Circulating serum anti-C1q antibody: correlation with clinical and histopathological activity in patients with proliferative lupus nephritis

In systemic lupus erythematosus (SLE) the prevalence of anti-C1q antibodies (Abs) varies from 30 to 50% and is associated with high clinical activity and, particularly, with renal involvement. Moreover, in the absence of anti-C1q auto-Abs, no lupus nephritis occurs, whereas at least 50% of patients with anti-C1q auto-Abs have or develop lupus nephritis. For lupus nephritis, anti-C1q Abs are as specific as high-avidity dsDNA Ab and capable of closing a diagnostic gap in some cases. The present study was conducted on 40 patients with SLE. Patients were classified into group I (20 patients with active proliferative lupus nephritis (LN)), group II (10 patients with inactive LN), and group III (10 patients without nephritis). Laboratory investigations were carried out, including complete blood picture, renal functions (blood urea, serum creatinine, and creatinine clearance), complete urine analysis and urine analysis for dysmorphic red blood cells (RBCs), measurement of 24 h urinary proteins, erythrocyte sedimentation rate (ESR), antinuclear antibody (ANA), and anti-dsDNA, and measurement of serum anti-C1q. Renal biopsy was taken from all patients of group I. Anti-C1q Abs were significantly higher in group I than in other groups. There were statistically significant positive correlations between anti-C1q Ab level, anti-dsDNA, and percentage of dysmorphic RBCs in urine in group I. There was also a statistically significant positive correlation between anti-C1q Ab level and cellular crescents, leukocyte infiltration, and endocapillary cellularity in the activity index. Anti-C1q Ab can be used as an indicator of renal activity in patients with lupus nephritis.

Effect of hematuria on the outcome of immunoglobulin A nephropathy with proteinuria.

Background: The relationship between hematuria and histological lesions, the effect of hematuria on response to steroid therapy, and the outcome in patients with immunoglobulin A nephropathy (IgAN) remain undetermined. Objectives: The aim of this study was to clarify the effect of hematuria on histological findings, response to steroid treatment, and the outcome in IgA nephropathy. Patients and Methods: Seventy-five patients with IgAN and proteinuria > 1 g/day and treated with prednisolone were divided into two groups: those with low (≤20/high-power field [HPF]) urinary red blood cell (U-RBC) counts (L-RBC group, n=55) and those with high (>20/HPF) U-RBC counts (H-RBC group, n=20). Their clinical and histological characteristics, the relationship between hematuria and histological lesions, renal outcomes, and risk factors for progression were compared. Results: Except for U-RBC counts, the clinical and histological findings according to the Oxford classification of the two groups were similar. U-RBC counts were not correlated with active histological lesions. Median proteinuria in both groups decreased soon after starting steroid therapy. Median U-RBC also decreased after starting steroids, and it became similar between both groups at 2 years after treatment. The 20-year renal survival rate was also similar between the H-RBC and the L-RBC group (45.2% versus 58.0%, P=0.5577). Multivariate Cox regression analysis showed that the lower estimated glomerular filtration rate (eGFR) was an independent risk factor for progression. Conclusions: A higher degree of hematuria at renal biopsy in patients with IgAN was not associated with active pathological lesions, such as cellular and fibro-cellular crescents, resistance to steroid treatment and poor outcome.

Preliminary analysis of distribution and effect on IgG avidity and subclass of anti double-stranded DNA antibody in lupus nephritis

Objective The aim of this study was to estimate the distribution and effect of anti dsDNA antibody on avidity and IgG subclass in lupus nephritis (LN). Methods Case control study. A total of 148 patients first diagnosed as LN was enrolled from February 2012 to May 2014. 91 patients in renal department received renal biopsy. The avidity as well as IgG subclass of anti dsDNA antibody in serum were detected by ELISA. Renal involvements were classified according to the pathological results. The disease activity, including white blood cell count, urinary red blood cell count, urinary protein, serum creatinine, C3, SLEDAI score, and pathology activity index (AI), chronicity index (CI) was recorded. The relationship between activity and avidity as well as IgG subclass was assessed by Spearman correlation. Results Avidity index of anti-dsDNA IgG antibody in LN patients was 33.7 (19.2-51.1). It was higher in IIF positive group than in IIF negative group (H=15.13, P=0.0001). Anti-dsDNA IgG3 (24 cases, 26.4%) was the predominant subclass, followed by all of four subclasses positive (10 cases, 11.0%). Anti-dsDNA antibody avidity was not associated with any indicator. IgG3 subclass was correlated with AI negatively (R=-0.42, P=0.03). Conclusions IgG avidity of anti-dsDNA antibody was not related with renal involvement. IgG3 is the main subclass of LN patients and associated with pathology AI. IgG3 can be used as an indirect indicator of renal involvement in LN. (Chin J Lab Med, 2015, 38: 809-812) Key words: Lupus nephritis; Immunoglobulin G; Antibody affinity; DNA

Abstract 13392: Clinical Significance of Hematuria in Patients With Atrial Fibrillation Receiving Oral Anticoagulation Therapy

Introduction: The presence of hematuria is frequently related with underlying genitourinary pathologies such as urolithiasis or malignancies. Although hematuria is an important and common complication in atrial fibrillation (AF) patients taking oral anticoagulation therapy (OAT), its clinical implication is not fully elucidated. Objectives: We evaluated the clinical significance of hematuria and its relationship with genitourinary disease in patients with AF. Methods: This study included 18,086 consecutive AF patients with (OAT+, n=11,432) or without OAT (OAT-, n=6,654) who visited to a tertiary Hospital from January 2005 to April 2015. The degree of urinary red blood cells (RBC) was reported to range from 0 to 3+ on random urinalyses. The incidence of cancer or stone in the genitourinary tract (kidney, ureter, and bladder) was evaluated. All data were obtained from the Clinical Data Repository System. Results: Overall, 144 (0.8%) patients had malignancies and 164 (0.9%) patients had stones in the genitourinary tract. Hematuria was observed in 3,737 (32.7%) and 2,017 (30.3%) in patients with and without OAT (p=0.001), and the large (≥ urine RBC 3+) hematuria was observed in 1,382 (12.1%) and 666 (10.0%) patients with and without OAT, respectively (p&lt;0.001). While 39 (2.8%) OAT+ patient with large hematuria had malignancies, 8 (1.2%) OAT- patient had (p=0.026). However, if the patients had small hematuria (urine RBC 1+ or 2+), the incidence of genitourinary cancer was not different between OAT+ and OAT- groups (p=0.266). The incidence of genitourinary tract stone in patients with large or small hematuria was comparable between OAT+ and OAT- groups. Conclusions: Large hematuria was associated with higher incidence of cancer in the genitourinary tract in OAT+ group, but not in OAT- group. A meticulous evaluation of the cause of hematuria is needed, if AF patients receiving OAT had large hematuria.

A proteinuria cut-off level of 0.7 g/day after 12 months of treatment best predicts long-term renal outcome in lupus nephritis: data from the MAINTAIN Nephritis Trial

BackgroundAlthough an early decrease in proteinuria has been correlated with good long-term renal outcome in lupus nephritis (LN), studies aimed at defining a cut-off proteinuria value are missing, except a...

Clinical pathological features of IgA nephropathy with nephrotic syndrome and the risk factors for impairment of renal pathology

Objective To investigate the clinical pathological features of IgA nephropathy with nephrotic syndrome and risk factors for impairment of renal pathology. Methods 121 cases of IgA nephropathy with nephrotic syndrome were selected, all patients had been diagnosed with biopsy.The clinical pathological features wer analyzed, they were divided into two groups according to different kidney disease.The minor pathological changes which Lee's classification grade Ⅰ and grade Ⅱ patients belong to group A, with a total of 36 cases, while Lee's pathology heavier grade for grade Ⅲ, Ⅳ and Ⅴ grade level in patients belonging to group B, with a total of 85 cases.Clinical characteristics and clinical laboratory indicators of two groups were compared, and risk factors for renal pathological damage were analyzed in multivariate analysis. Results The average duration of group B was significantly longer than the average duration of group A, the difference was statistically significant (t=12.74, P 5.0×107/L were dangerous aggravating factors. Conclusion Hemoglobin protective factors for IgA nephropathy with nephrotic syndrome, the mean arterial pressure, 24h urinary protein excretion and urine red blood cells are their risk aggravating factors, they can make a more accurate judgment of the patient's condition. Key words: Nephrotic syndrome; IgA nephropathy; Pathology, clinical; Factor analysis, statistics

Heparin calcium treated Henoch–Schönlein purpura nephritis in children through inhibiting hyperfibrinolysis

Aim: To explore the underlying mechanism of low-molecular-weight heparin calcium therapy on Henoch–Schönlein purpura nephritis (HSPN). Methods: Eighty-nine children with severe HSPN were randomized into control group (treated with conventional therapy, n = 45) and treatment group (treated with conventional therapy plus low-molecular-weight heparin calcium, n = 44). The concentrations of plasma fibrinogen (Fg), d-dimer and fibrin degradation products (FDPs) were detected before and after treatment. The urinary red blood cell (RBC) and 24 h proteinuria were determined weekly for assessing the children’s kidney function. Results: Two groups were well-matched at baseline. After 8 weeks of treatment, the clinical outcomes of HSPN and outcome of proteinuria of the treatment group were better than the control group (p < 0.05); the content of Fg, d-dimer and FDP in plasma of the treatment group were lower than the control group (p < 0.05); but there was no difference about the curative effect of hematuria and the coagulation function between the two groups (p > 0.05). Conclusions: Fibrinolytic system may participate in the kidney injury of HSPN children and low-molecular-weight heparin calcium could correct blood hypercoagulability through inhibiting hyperfibrinolysis, and thus improving the blood supply of kidney.

Protocolo de evaluación de la hematuria

We define Non visible hematuria the presence of three or more red blood cells in high powered field (HPF) in a properly collected urine specimen in the absence of an obvious benign cause. Urine dipstick has a high sensitivity and specificity to detect red blood cells in urine. From urologic point of view benign prostatic hyperplasia, urinary infection and urinary lithiasis are the most frequent causes for hematuria.

Predictors of long-term renal outcome in lupus nephritis trials: lessons learned from the Euro-Lupus Nephritis cohort.

There is a need to determine which response measures in lupus nephritis trials are most predictive of good long-term renal function. We used data from the Euro-Lupus Nephritis Trial to evaluate the performance of proteinuria, serum creatinine (Cr), and urinary red blood cells (RBCs) as predictors of good long-term renal outcome. Patients from the Euro-Lupus Nephritis Trial with proteinuria, serum Cr, and urinary RBC measurements at 3, 6, or 12 months and with a minimum of 7 years of followup were included (n = 76). We assessed the ability of these clinical biomarkers at 3, 6, and 12 months after randomization to predict good long-term renal outcome (defined as a serum Cr value ≤1.0 mg/dl) at 7 years. Receiver operating characteristic curves were generated to assess parameter performance at these time points and to select the best cutoff for individual parameters. Sensitivity and specificity were calculated for the parameters alone and in combination. A proteinuria value of <0.8 gm/day at 12 months after randomization was the single best predictor of good long-term renal function (sensitivity 81% and specificity 78%). The addition of serum Cr to proteinuria as a composite predictor did not improve the performance of the outcome measure; addition of urinary RBCs as a predictor significantly decreased the sensitivity to 47%. This study demonstrates that the level of proteinuria at 12 months is the individual best predictor of long-term renal outcome in patients with lupus nephritis. Inclusion of urinary RBCs as part of a composite outcome measure actually undermined the predictive value of the trial data. We therefore suggest that urinary RBCs should not be included as a component of clinical trial response criteria in lupus nephritis.

Effects of Tripterygium wilfordii glycosides on regulatory T cells and Th17 in an IgA nephropathy rat model.

In this study, we examined the effects of Tripterygium wilfordii glycosides (TWGs) on Th17 and regulatory T cells (Tregs) in an immunoglobulin A nephropathy (IgAN) rat model. IgAN model rats were randomly divided into the model group, TWG treatment group, and prednisone group. Normal rats were included as controls. There were 6 rats in each group. The urine protein levels and the number of red blood cells in urine were analyzed at 24 h. IgA deposition in renal tissue was detected by fluorescence microscopy. The concentration of interleukin-17 in serum was detected by an enzyme-linked immunosorbent assay and the number of Tregs in blood was analyzed by flow cytometry. TWGs and prednisone significantly reduced urine protein levels and urine red blood cells at 24 h in IgAN model rats (P < 0.01), but prednisone had a greater effect than did TWGs (P < 0.05). TWGs and prednisone reduced IgA deposition in renal tissue, but prednisone had a greater effect than TWGs. T. wilfordii glycosides and prednisone significantly decreased the serum IL-17 level in an IgAN rat model and increased the number of Tregs in the blood (P < 0.01). There was no significant difference between prednisone and TWGs (P > 0.05). In conclusion, TWGs had therapeutic effects on IgAN model rats and may regulate the immune balance of Th17 and Tregs.

Prevalence and factors associated with chronic kidney disease among military aircrews

Background: Recently, the number of patients diagnosed with end-stage renal disease (ESRD) in Taiwan has been rising. ESRD is known to typically develop from chronic kidney disease (CKD). The objectives of the study were to describe the prevalence of CKD and to evaluate the associated factors among military aircrews. Materials and Methods: In this study, military aircrews that received physical examinations in four military hospitals between 2004 and 2010 were selected. The abbreviated modification of diet in renal disease (aMDRD) formula was used to calculate glomerular filtration rates (GFRs). Urine protein, urine red blood cells, and urine pH values were used to define whether patients had CKD. This study analyzed 1317 cases. Results: The prevalence of CKD was 10.4% in the military aircrews. The risk of CKD was statistically significant higher in positive urine occult blood, high bilirubin, hyperuricemia, high total cholesterol, and each additional 1-year of age with odds ratio (95% confidence interval): 6.53 (3.86-11.06), 2.62 (1.28-5.37), 1.95 (1.11-3.42), 1.76 (1.05-2.95), and 1.03 (1.00-1.07), respectively. Conclusions: The majority of the participants diagnosed with CKD were in the early stages of the disease. The aMDRD formula could be calculated from annual physical examination results for using to understand GFRs and increase awareness of the kidney function, thereby delaying disease progression.

Value of a commercial kit for detecting anti-C1q autoantibodies and correlation with immunological and clinical activity of lupus nephritis.

The association of anti-C1q antibodies (anti-C1q) with the renal activity of lupus nephritis (LN) and the methods for their determination is still a matter of debate. In 116 serum samples of 66 patients with biopsy proven LN, we aimed: 1) to compare the results of the determination of anti-C1q obtained by a commercial kit with a clinically validated in-house ELISA; 2) to evaluate the correlation of anti-C1q with the most important immunological and clinical parameters employed in LN, i.e., antibodies to dsDNA (anti-dsDNA), C3 and C4 complement component, haemoglobin and haematuria. Good correlation and agreement between the two methods (r=0.81, p<0.0001; contingency coefficient=0.70, p<0.0001, respectively) were demonstrated. No differences were observed between the two assays by ROC curves comparison. Anti-C1q levels were significantly higher in patients with active LN [44 arbitrary units (AUs)] in comparison to those with inactive LN (23 AUs, p=0.047) and significantly correlated with anti-dsDNA (r=0.44, p<0.0001), complement fractions (C3: r=-0.33, p=0.001; C4: r=-0.29, p=0.003), haemoglobin levels (r=-0.34, p=0.0004) and the number of urinary red blood cells (r=0.26, p=0.01). Our results suggest the validity of this commercial assay in detecting anti-C1q and confirm the association of anti-C1q with renal involvement of LN and the importance of introducing this parameter in the analytical panel for the evaluation of LN activity.