Table of Content

05 October 2018, Volume 33 Issue 10

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Development of diagnosis nomenclature in kidney disease related to diabetes

Kang Yingli, Li Ying

2018, 33(10):  829-833.  doi:10.3969/j.issn.1004-583X.2018.10.001

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Diabetic nephropathy is one of the common secondary kidney diseases,  which can lead to chronic renal failure and even uremia. The diagnosis of diabetic nephropathy has been updated several times over the decades,  ranging from KimmelstielWilson syndrome to diabetic nephropathy to more recent diabetic kidney disease. Although the significance of coverage has been crossed,  the description and definition of the disease is more accurate and perfect,  and more suitable for clinical practice. The change of diagnosis nomenclature is also an exploration to the disease itself. This article reviews the development of diagnosis nomenclature in kidney disease related to diabetes.

Clinical features in  chronic kidney diseasemineral and bone disorder

Chen Yunshuang, Yang Xinjun, Lin Jing, Wang Lihui, Wu Guangli

2018, 33(10):  834-838.  doi:10.3969/j.issn.1004-583X.2018.10.002

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Chronic kidney disease(CKD)has become a public health problem with high prevalence,  multiple complications and poor prognosis. Being one of its common complications, while mineral and bone abnormalities can lower the quality of life and safety of  patients with CKD. Early diagnosis is crucial for improving the prognosis of patients. Given  CKDMBD is a complex clinical pathophysiological process with multiple factors involved, the pathogenesis,  clinical evaluation, diagnosis and treatment of mineral and bone metabolic abnormalities caused by CKD will be reviewed. so that useful guidance for improving clinical diagnosis and treatment can be provided.

Role of M-type phospholipase A2 receptor and its antibody in  diagnosis and treatment of idiopathic membranous nephropathy

Lu Yue, Li 　Shaomei

2018, 33(10):  839-845.  doi:10.3969/j.issn.1004-583X.2018.10.003

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M-type phospholipase A2 receptor (PLA2R) has been widely confirmed as a specific autoantibody for Idiopathic membranous nephropathy (IMN),  which has opened up a new train of thought the pathogenesis of IMN . A large number of clinical data indicate that PLA2R and its antibody play an important role in the pathogenesis of IMN,  and are related to the activity,  severity and prognosis of the disease. It can even predict disease recurrence and guide the timing of treatment. This article reviews the application value of PLA2R and its antibody in the diagnosis and treatment of IMN.

LncRNA GAS5 and chronic kidney diseases

Gao Shaohui, Xu Jinsheng

2018, 33(10):  846-848.  doi:10.3969/j.issn.1004-583X.2018.10.004

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Latest studies have reported that growth arrestspecific transcript 5 plays an important role in multiple acute and chronic diseases. The current studies report that GAS5,which is identified as a potential novel tumor suppressor gene regulating vital events, such as cell proliferation, apoptosis, and cell cycle, is closely related to the acute myocardial infarction, ischemic stroke, and hypertension. It is expected that GAS5 can be a new target for precise targeting therapy. The paper reviews the relationship between GAS5 and kidney diseases.

Serum ghrelin and chronic kidney diseases

Wang Zekai, Hu Zhijuan, Dong Chunxia, Niu Kai, Liu Bing

2018, 33(10):  849-853.  doi:10.3969/j.issn.1004-583X.2018.10.005

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Complications of patients treated with  maintenance dialysis threaten their quality of life seriously, of which malnutrition，microinflammation and vascular lesion are interrelated,  increasing the morbidity and mortality . Ghrelin can potently stimulate the release of growth hormone, improve the nutritional status of patients and is involved in the pathophysiological process of cardiovascular disease and inflammation. Detection of ghrelin concentrations could make early intervention for maintenance dialysis patients, which is of great significance for clinical auxiliary diagnosis and treatment. This paper reviews the progress on the relationship between ghrelin and chronic kidney disease complications.

Renal biopsy in diagnosis of diabetic kidney disease

Yang Han, Li Shaomei

2018, 33(10):  854-858.  doi:10.3969/j.issn.1004-583X.2018.10.006

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Renal pathological manifestations of diabetic nephropathy are complicated, and nondiabetic nephropathy is not uncommon. It is quite different from the treatment and prognosis of diabetic kidney disease, and early diagnosis is of great significance.Solely relying on clinical manifestations and biochemical indicators to diagnose renal lesions and prognosis exists great limitations. Renal biopsy, as a relatively safe procedure, Compared with the new biomarkers which remains to be studied, renal biopsy,  as a relatively safe procedure, is recommended for the diagnosis, differential diagnosis,  treatment planning and prognosis evaluation of diabetic kidney disease.

Hepatokines in pathogenesis of diabetic nephropathy

Gao Yan1, Li Linqian2, Wang Qian2, Zhang Si2, Zhang Haisong1

2018, 33(10):  859-862.  doi:10.3969/j.issn.1004-583X.2018.10.007

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Hepatokines is a protein excreted into the blood only or mainly by the liver that directly affects glycolipid metabolism. It can accelerate and delay the occurrence and development of diabetic nephropathy,  especially in the pathophysiological mechanism of insulin resistance.It directly affects lipid metabolism. Our understanding towards them is of great significance for the early diagnosis and treatment of diabetic nephropathy. In this paper, recent advances on the pathogenesis of hepatokines in diabetic nephropathy are summarized.

Therapeutic effect of different doses and routes of administration of calcitriol on hemodialysis patients with severe secondary hyperparathyroidism

Huang Xudong, Chen Yunshuang, Yang Xinjun, Wang Lihui, Zhao Wei,

2018, 33(10):  863-866,872.  doi:10.3969/j.issn.1004-583X.2018.10.008

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Objective  To investigate the efficacy of calcitriol at different doses and routes of administration for hemodialysis with severe secondary hyperparathyroidism.Methods  Sixty patients with hemodialysis and severe secondary hyperparathyroidism were randomly divided into the control group (conventional dose of oral calcitriol),  the shock treatment group (large dose of calcitriol) and the intravenous drug group (intravenous administration of calcitriol after dialysis),  serum iPTH,  calcium and phosphorus were detected every 4 weeks,  and adverse reactions were observed.Results  After 12 weeks of treatment,  the level of parathyroid hormone in the conventional dose of calcitriol treatment group was (697.5±164.3)  pg/ml,  which was not significantly different from that before treatment (761.4±184.6  pg/ml,P>0.05).The highdose calcitriol shock treatment was moreeffectivethan theconventional dose of calcitriol,  but some patients had hypercalcemia. The intravenous medication had the best effect on severe secondary hyperparathyroidism(before treatment: 814.7±197.8, after treatment: 227.4±106.4, P<0.01),  and hypercalcemia was rare. Conclusion  At present, calcitriol injection can be prioritized in terms of the treatment of hemodialysis patients with severe secondary hyperparathyroidism. 

Clinical significance of serum antiPLA2R antibody test and IgG subclass test in elderly patients with idiopathic membranous nephropathy

Gao Yan1, Wang Qian2, Li Linqian2, Zhang Si2, Zhang Haisong1

2018, 33(10):  867-872.  doi:10.3969/j.issn.1004-583X.2018.10.009

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Objective  To explore  clinical significance of serum antiPLA2R antibody test and IgG subclass test in elderly patients with idiopathic membranous nephropathy(IMN).Methods  Clinical manifestations of nephrotic syndrome were collected and confirmed as IMN (46 cases), secondary membranous nephropathy (46 cases) and atypical membranous nephropathy (46 cases).Serum biochemical indicators and urine protein quantification were detected.  Serum PLA2RAB and IgG subclasss were detected by indirect immunofluorescence, and the expression distribution of PLA2R and IgG subclasss in renal pathology was detected by immunofluorescence method. The serum antiPLA2R antibody test and IgG subclass level were analyzed in elderly patients with IMN and secondary membranous nephropathy, and the differences in the distribution of glomeruli and IgG subclasss.Results  The sensitivity and specificity of serum antiPLA2R antibody for IMN diagnosis were 77.4% and 89.9%, respectively.The sensitivity and specificity of the glomerular PLA2R diagnostic IMN were 66.5% and 94.8%, respectively,  those of the glomerular igg14 diagnostic IMN were 80.6%,  60.2%, 42.0%, 93.8% and 78.5%, 83.6%,84.6% and 89.7%.Conclusion  Combined detection of antiPLA2R antibody and IgG subclass expression  in elderly patients is helpful to improve the differentiation of  IMN and secondary membranous  nephropathy,  and to guide clinical treatment and prognosis evaluation.

The clinical significance of serum antibodies of PLA2R and THSD7A in idiopathic membranous nephropathy

Zhang Wenxian, Tian Menglei, Zhao Song, Chi Yanqing, Liu Maodong, Li Ying

2018, 33(10):  873-877,882.  doi:10.3969/j.issn.1004-583X.2018.10.010

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Objective  To explore the significance of both the IMN diagnosis and the evaluation of the disease by detecting the serum PLA2R and THSD7A antibody levels in IMN patients. Methods  A total of 137 patients who were diagnosed with renal biopsy in the third hospital of Hebei medical university from September  2016  to December 2017 were selected. Among them,  114 patients with IMN were treated as experimental group,  and the rest patients, including (7 cases of Vtype lupus nephritis and 16 cases of IgA nephropathy) as control group. The serum PLA2R and THSD7A antibody titer were determined by enzymelinked immuno sorbent assay (ELISA),  then the relationship between them and clinical indicators were analyzed. Results  ①The positive rate of serum PLA2R antibody in IMN patients is 57.0% (65/114). Vtype lupus nephritis and IgA nephropathy are negtive; the difference has been statistically significant (P＜0.05). The positive rate of serum THSD7A antibody in IMN patients is 9.6% (11/114),  Vtype with lupus nephritis and IgA nephropathy THSD7A antibody are negtive, the difference is statistically significant. The double positive rate in IMN group is 4.4% (5/114). ② In the IMN group,  24 h urine protein is quantitatively 9.4(4.9~14.0) g/d and blood albumin (21.2±3.7) g/L. PLA2R antibody positive 24 h urine protein quantification ［4.9(0.914.2)］  g/d,  blood albumin (24.4±5.6) g/L; The serum albumin (25.5±6.6) g/L is found in patients with positive THSD7A antibody 7.1(2.1~14.0) g/d. The results showed that there are statistically significant differences between the serum albumin and the serum albumin (P<0.05), so are the differences in blood albumin (P<0.05); while the quantitative difference of 24 h urine protein in patients with positive THSD7A antibody (P＞0.05) are of no statistical difference. ③There is a positive correlation between PLA2R antibody and 24 h urine protein (r=0.318,P=0.001),  which is negatively correlated with serum albumin level (r=-0.207, P=0.027).Conclusion  PLA2R and THSD7A antibody are specific indicators for the diagnosis of IMN. PLA2R antibody can assess the patient's condition; the urinary protein of the patients is high while their albumin is low, with double antibody being positive; However, whether THSD7A can assess the patient's condition and whether the combination can better predict the patient's condition remains to be further studied.

The Relationship between sclerostin and vascular calcification in maintenance hemodialysis patients

Shen Lei, Feng Xue, Wang Lihua, Hou Jingjing, Gao Yongning

2018, 33(10):  878-882.  doi:10.3969/j.issn.1004-583X.2018.10.011

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Objective  To observe the calcification of cardiac valves in patients undergoing maintenance hemodialysis (MHD), to investigate the factors affecting sclerostin and analyze the correlations between sclerostin and valves calcifications. Methods  A total of  50 patients undergoing MHD at the Second Hospital of Hebei Medical University were selected as experiment group subjects, and 35 healthy persons were selected as the control group. Clinical data were collected, and  ELISA were applied to measure the serum sclerostin level and cardiac doppler ultrasound were used to assess the calcification of cardiac valves.  The correlation analysis was applied to the results.Results  Significant difference on cardiac valves calcification was observed between experimental and control groups (40% vs 8.6%, P<0.05). The serum sclerostin level was negatively correlated to intact parathyroid hormone(iPTH)(r=-0.283,P=0.046) and alkaline phosphatase(r=-0.407,P=0.003), positively correlated to the rate of cardiac valves calcifications (r=0.408, P=0.046).The average age of patients with and without valves calcification is  47.5(33.8~62.3)  vs  69.5（56.577.5）. Serum sclerostin level are lower in patients without valves calcification than that of patients with valves calcification  ［5.66（4.398.09） ng/ml vs  8.28（6.4012.37）  ng/ml］, while the serum phosphate level is higher(2.14±0.55 mmol/L vs 1.81±0.56 mmol/L), the difference is statistically significant. The age and serum sclerostin level are the independent risk factors of cardiac valves calcification, OR values are 6.794，95%CI=1.47431.318（P=0.014）；6.74，95%CI=1.61328.157（P=0.021）, respectively. The iPTH and ALP level are significantly higher in group with lower sclerostin level, 252（168524.5）  pg/ml vs 139（59.5343） pg/ml and 78.0(63.6~81.0)  U/L vs 62.0（59.069.0）U/L，the difference is statistically significant (P<0.05). For calcification, the rate of abdominal aortic valve and cardiac valve calcification is higher in patients with higher serum sclerostin level, （84% vs 44% and 60% vs 20%). The difference is statistically significant (P<0.05).Conclusion  The rate of vascular calcification is higher in MHD patients, and cardiac valve calcification is positively correlated to serum sclerostin level. Both age and serum sclerostin level are risk factors of cardiac valve calcification. Sclerostin can be used as a new biomarker for vascular calcification in MHD patients.

Correlation between vitamin D level and vascular calcification in peritoneal dialysis patients

Yang Fang, Pei Huaying, Yang Liuyang, Lu Suyu, Wu Xiaolei, Wang Min

2018, 33(10):  883-888.  doi:10.3969/j.issn.1004-583X.2018.10.012

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Objective  To investigate the level of blood 1,25(OH)2D3 and vascular calcification in patients with continuous ambulatory peritoneal dialysis (CAPD),  and to explore the factors for serum calcium calcification and blood 1,25(OH)2D3 in patients with CAPD. The role of blood 1,25(OH)2D3 in abdominal aortic calcification(AAC) and significance were explored. Methods  A total of 84 patients with CAPD for more than 3 months were enrolled,  and clinical data were collected. Lateral radiographic calcification was performed and AAC score (AACs) was calculated. Serum 1,25(OH)2D3 concentration was measured by ELISA. Correlation analysis was used to analyze the relationship between 1,25(OH)2D3 and AACs,  logistic regression and multiple regression analysis for risk factors of vascular calcification,  and receiver operating curve (ROC) evaluation of 1,25(OH)2D3 for the accuracy of AAC.Results  Of 84 patients with CAPD,  34 cases(42.5%) had AAC. The serum level of  1,25(OH)2D3 was lower in CAPD patients,  which was negatively correlated with AAC. Oral calcitriol increased serum 1,25(OH)2D3 concentration. Logistic regression analysis showed that elderly patients with diabetes,  taking calcitriol,  high total cholesterol,  high P,  high blood uric acid,  and low 1,25(OH)2D3 were risk factors for vascular calcification (P<0.05). Multiple regression analysis showed that age,  serum phosphorus,  and 1,25(OH)2D3 were independent factors for AAC progression (P<0.05). 1,25(OH)2D3 ROC curve area (AUC) was 0.652 (95%CI=0.4420.696,  P<0.05),  suggesting that 1,25(OH)2D3 predicted the accuracy of   AAC. When  1,25(OH)2D3 was 250.43 pg/ml as the cutoff point,  the sensitivity of  AAC was 55.9%,  the specificity 66%,  and Yoden index  0.219. Conclusion  Serum 1,25(OH)2D3 level in CAPD patients is negatively correlated with the degree of  AAC. Low serum 1,25(OH)2D3 level was one of the independent risk factors for AAC. Oral calcitriol can improve 1,25(OH)2D3 levels in patients with CAPD,  but  in can also increases the risk of vascular calcification,  and monitoring on the 1,25(OH)2D3 level should be performed to prevent the risk of vascular calcification.

A contrast on the effectiveness and safety  betweenCyclosporine A combined androgen and androgen alone for aplastic anemia in china: a metaanalysis

Yang Bingxue, Cheng Danfeng, Qiu Chenxi, Liao Jianrong, Liu Tingbo

2018, 33(10):  889-896,903.  doi:10.3969/j.issn.1004-583X.2018.10.013

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Objective  To assess the efficacy and safety of  Cyclosporine A(CsA) combined androgen and androgen alone in the treatment of  Aplastic Anemia (AA) with Chinese patients. Methods  Randomized controlled trails (RCT) of CsA for AA were collected from CNKI, WANFANG, and VIP. Other relevant hematological journals were also hand searched. The methodological quality of included studies was evaluated, and data analyses were performed with the software StataSE 12.0. Results  A total of 50 RCT with 3099 patients were included.The metaanalysis showed that,as for the total effective rate and complete remission rate, significant differences were noted between CsA+ androgen and androgen alone, ［total effective rate: RR and 95%CI were 1.37(1.31 to 1.43); complete remission rate: RR and 95%CI were 1.87(1.62 to 2.15)］. Conclusion  According to the domestic evidence, treatment with CsA combined androgen for AA may improve the clinical effectiveness,compared with androgen alone.

A systematic review and metaanalysis of the incidence of readmission into cardiac intensive care unit

Ma Jing, Guo Jianhua, Ye Wei, Zhang Tao

2018, 33(10):  897-903.  doi:10.3969/j.issn.1004-583X.2018.10.014

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Objective  To evaluate the incidence and mortality of  reentry ICU after cardiac surgery，and to analyze them by stratification.Methods  The inclusion criteria and retrieval strategy of original literature were established. Such databases as Chinese Periodical Full Text Database, Chinese BioMedical Literature Database, Full Text Database of Chinese SciTech Periodical, Wanfang Database, PubMed and Elsevier were searched electronically to extract valid data. Associations between the incidence and mortality of reentry ICU, the perioperative risk factors such as circulatory and respiratory complications, were stratified by geographical, age, diseases and different time periods.  All the data were analyzed with RevMan 5.3 software. Results  A total of 22 articles were included in this study, and  89 981  patients were enrolled. The number of readmission and deaths were 2 717 and 478 respectively. The total incidence of reentry ICU was 3%(95%CI=0.030.04，P＜0.01); reentry ICU rate for respiratory reason was 39%(95%CI=0.330.44，P＜0.01), and for circulatory reason was 29%(95%CI=0.250.34，P＜0.01). The rate of reentry ICU was lower athome than that abroad, lower in children than that among adults,lower after 2011 than that before 2010, and lower in congenital heart disease than that in CABG. The total mortality of reentry ICU cases was 18%(95%CI=0.150.21，P＜0.01). The mortality abroad was higher than that at home,and the mortality in congenital heart disease is lower than in CABG. Conclusion  The rate of readmission into cardiac intensive care unit is  low, but the mortality of the ones that have been readmitted is quite high.