An index of open-access kidney disease content relevant to primary care
Is the Change of Cytokines Related to Renal Damage in Children with IgA Vasculitis？
WANG Mengdi，DU Yue*
Abstract:
The long-term prognosis of IgA vasculitis (IgAV) depends on thedegreeof renal damage. Studies on the pathogenesis of renal injury in IgAV have found that cytokines play an important role in mediating and driving the process of renal damage.
To investigate the significance and value of cytokine in the process of renal damage in IgAV by exploring the changes of serum cytokine level in children with IgAV renal damage.
194 IgAV children hospitalized in the Department of Pediatric, Shengjing Hospital of China Medical University from January 2018 to June 2020 were selected as research subjects. They were divided into IgAV group (n=97) and IgAV renal damage group (n=97) according to the presence or absence of renal damage, and 60 healthy children who underwent physical examination in the pediatric health department of our hospital during the same period were selected as the control group. The cytokines (IL-2, IL-4, IL-6, IL-10, IL-17, IFN-γ, and TNF-α) , absolute lymphocyte count, immunoglobulin A, and immunoglobulin E were collected from the children. Multivariate Logistic regression was used to analyze the factors influencing IgAV renal damage, and the receiver operating curve (ROC) of the diagnostic value of cytokines on the characteristics of IgAV renal damage was drawn.
The IL-2 level in the lgAV group were higher than those in the lgAV renal damage group and the control group, and the IL-2 level in the lgAV renal damage group was higher than that in the control group (P<0.05) ; IL-17 level in the lgAV renal damage group were higher than those in the lgAV group and the control group, and IL-17 level in the lgAV group was higher than that in the control group (P<0.05) ; IL-6, IL-10, and TNF -α level were higher in the lgAV renal damage group than those in the lgAV renal damage group and the control group (P<0.05) ; IFN-γ level were higher in the lgAV renal damage group and the control group than that in the lgAV group (P<0.05) . Multivariate Logistic regression analysis showed that IL-2, IL-17, IFN-γ, and TNF-α were influencing factors in developing IgAV renal damage (P<0.05) . The AUC of IL-12 for predicting IgAV renal damage was 0.589, with a sensitivity of 38.0% and specificity of 47.0%. The AUC of IL-17 for predicting IgAV renal damage was 0.621, with a sensitivity of 47.4% and specificity of 77.3%. The AUC of IFN-γ for predicting IgAV renal damage was 0.688, with a sensitivity of 75.0% and specificity of 55.7%. The AUC of TNF-α for predicting IgAV renal damage was 0.614, with a sensitivity of 42.0% and specificity of 37.0%. The AUC of IL-17 and IFN-γ combined for predicting IgAV renal damage was 0.710, with a sensitivity of 71.1% and specificity of 66.0%.
Serum cytokines IL-17 and IFN-γ are closely associated with the development of renal damage in IgA vasculitisrenal damage, early detection of both levels and dynamic monitoring of their changes can serve as an early warning for early detection of renal involvement and adjustment of treatment plans.
Clinicopathological Manifestations of Kidney Injury in Leukemia
WANG Yina，DONG Bao，LI Xin，SHAO Chunying，ZUO Li，WANG Mei，YAN Yu
Abstract:
Kidney is a major extramedullary organ involved in leukemia, but clinicians have insufficient understanding of it due to rare case reports.
To analyze the clinicopathological manifestations of kidney injury in leukemia.
Five patients with kidney injury in leukemia were recruited from Peking University People's Hospital from June 2010 to June 2020. Their demographics, clinical manifestations, ultrasonic and laboratory examination results, pathological examination results of renal biopsy species, therapeutic regimen and follow-up were retrospectively analyzed.
All these patients were male, with an onset age ranging from 19 to 73 years old. Two of them had B-cell acute lymphoblastic leukemia after allogeneic stem cell transplantation, the remaining three had B-cell chronic lymphocytic leukemia. All of them had acute kidney injury with proteinuria, and pathologically manifestation of acute interstitial nephritis. In addition, two of them also had leukemia-related glomerular disease. Renal pathology indicated extramedullary recurrence in the two cases of B-cell acute lymphoblastic leukemia, and progression in the other three cases of B-cell chronic lymphoblastic leukemia. Four patients received regular chemotherapy, and two of them obtained a reduction in serum creatinine levels, but the other two showed no improvement in renal function.
Kidney injury in leukemia commonly manifests as acute kidney injury clinically, acute interstitial nephritis pathologically, and may be complicated by secondary glomerulopathy. Prompt renal biopsy, especially immunohistochemical staining for renal interstitial infiltrating cells, may be helpful for accurate diagnosis and appropriate treatment guidance.
Mechanism of Bushenhuoxue Herbs Mediating Wnt/β-Catenin Signaling Pathway to Delay the Progression of Compression-induced Degeneration of Intervertebral Disc Cartilage Endplate in a Rabbit Model
HAN Tao1，2，YIN Xunlu1，2，ZHAN Jiawen1，2，WEI Xu1，2，FENG Minshan1，2，YU Jie1，2，LI Xuepeng1，2，CHEN Ming1，2，ZHU Liguo1，2*
Abstract: Background Intervertebral disc degeneration（IDD） is an essential cause of degenerative spine conditions. As endplate plays a vital role in mechanotransduction and nutrient transport in intervertebral discs，endplate degeneration will accelerate IDD. Compound preparations of Chinese Medicine have proven to be uniquely effective for IDD，but the specific mechanism of action is not completely clear. Objective To observe the effect of Bushenhuoxue herbs on vertebral endplate of spinal motion segment in rabbits under pressure，to clarify the characteristics and mechanism of the medicine in regulating endplate chondrocytes to delay IDD progression. Methods Forty healthy New Zealand rabbits were randomly divided into control group，herb group，herb inhibition group and herb activation group，with 10 rabbits in each. The model of IDD was created using an in vitro loading and culturing device for spinal motor segments with independent intellectual property rights. HE staining，immunohistochemistry，RT-PCR and Western blot were used for detecting relevant indicators，respectively. Including proteoglycan，typeⅡ collagen，Wnt-3α，β-catenin. Results （1）Effect of Bushenhuoxue herbs on IDD：① The pathomorphology of the HE stained sample showed that herb group had better dispersion and layer arrangement，and more number of endplate chondrocytes than the control group on the 7th day of culture. The degeneration of endplate cartilage in herb group and control group worsened on the 14th day of culture，but the degree of degeneration of the control group was more obvious. ②Immunohistochemical staining in the sample tissue sections found that herb group had higher level of extracellular matrix proteoglycan expression than control group on the 1st and 3rd days of culture（P<0.05）. On the 7th and 14th days of culture，the level of extracellular matrix proteoglycan expression decreased significantly in herb group and control group compared to the baseline（P<0.05），but showed no significant intergroup differences（P>0.05）. Immunohistochemical staining of type Ⅱ collagen in the sample tissue sections found that herb group had higher level of type Ⅱ collagen expression in extracellular matrix than control group on the 1st and 3rd days of culture（P<0.05）. On the 7th and 14th days of culture，the level of type Ⅱ collagen expression in extracellular matrix declined obviously in herb group and control group compared to the baseline（P<0.05），but it was more reduced in the herb group（P<0.05）. ③The results of RT-PCR showed that compared to the baseline levels，Wnt-3α and β-catenin mRNA expression levels were much lower on the 1st，3rd，7th and 14th days of culture in herb group and control group（P<0.05），and they were more lower in herb group（P<0.05）. ④Western blot test indicated that significant changes were found in Wnt-3α and β-catenin protein expression levels in herb group and control group from baseline to 1，3，7，14 days post-culture（P<0.05）. Herb group demonstrated much higher Wnt-3α protein expression levels and notably lower β-catenin protein expression levels than control group on the 1st，3rd，7th and 14th days of culture（P<0.05）. （2）Mechanism of Bushenhuoxue herbs delaying the progression of IDD：HE staining showed that herb activation group had better integrity and arrangement of endplate cartilage at the 3rd day of culture than herb inhibition group. ②Immunohistochemical staining in the sample tissue sections found that significant differences were found in expression levels of proteoglycan and type Ⅱ collagen in the sample tissue sections between herb group and herb activation group or herb inhibition group（P<0.05）. ③RT-PCR results showed that on the 3rd day of culture，Wnt-3α mRNA expression level showed no significant differences between herb group and herb activation group or herb inhibition group（P>0.05）；the β-catenin mRNA expression level in herb group was much higher than that of herb activation group，but was much lower than that of herb inhibition group（P<0.05）. ④Western blot test indicated that on the 3rd day of culture，the Wnt-3α and β-catenin protein expression levels in herb activation group were similar to those of herb group（P>0.05）. The Wnt-3α protein expression level in herb inhibition group was similar to that of herb group（P>0.05）. The β-catenin protein expression level in herb inhibition group was much higher than that of herb activation group（P<0.05）. Conclusion Bushenhuoxue herbs could delay the progression of IDD by regulating endplate chondrocytes through Wnt/β-catenin signaling pathway.
Effect of Yishen Yangsui Formula on Expression of Neurotrophic Factorsanditsnerve Repair Effect in Spinal Cord of Rats with Cervical Spondylotic Myelopathy
TANG Bin1，YIN He1，YANG Bowen1，JIN Zhefeng1，QIN Xiaokuan1，LIU Zhiwei2，WEI Xu1，SUN Kai1，QI Baoyu1，CHEN Xin1*，ZHU Liguo1，3*
Abstract: Background There are differences in pathological characteristics and treatment strategies between acute spinal cord injury（ASCI） and cervical spondylotic myelopathy（CSM） by chronic compression. Traditional Chinese Medicine （TCM） has unique advantages in the treatment of CSM with extensive clinical application，but there were few studies on the treatment mechanism related to chronic compression of spinal cord. Objective To study the effect of Yishen Yangsui formula Chinese medicine on the mRNA expression levels of nerve growth factor（NGF），neurotrophic factor 3（NT3），glial cell derived neurotrophic factor（GDNF） and the protein expression and distribution of NGF in the spinal cord of chronic spinal cord compression rats（C5-7），in order to explore the mechanism of TCM promoting nerve repair in CSM. Methods A total of 96 SPF female SD rats were selected，of which 72 rats were operated by spinal cord compression with water absorbent swelling material polyvinyl alcohol acrylamide in terpenetrating network hydrogel（provided by College of Chemistry，Beijing Normal University），and the remaining 24 rats were operated under sham operation（sham operation group）. The successfully modeled rats were divided into model group（n=24），high concentration herb formula group（n=16），medium concentration herb formula group（n=16），low concentration herb formula group（n=16）. Each group was given intragastric administration of herb formula according to the corresponding concentration（the dose of intragastric administration of rats was calculated by the conversion coefficient of body surface area coefficient 6.3，high concentration was 16.74，medium concentration was 8.37 g?kg-1?d-1 and low concentration was 4.19 g?kg-1?d-1）. After the liquid was concentrated，it was given by intragastric administration in a volume of 1 ml/100 g. The model group and the sham operation group were given the same amount（1 ml/100 g）
of 0.9% sodium chloride intragastric administration once daily. BBB scores of rats in each group were evaluated at 2，4，6，8 and 10 weeks postoperatively. At 2 weeks，6 weeks and 10 weeks after surgery，the distribution of normal nerve cells in the ventral horn of the spinal cord of rats was observed by Nissl staining. The mRNA of NGF，NT3，GDNF was detected by RT-qPCR，the protein expression and distribution in the anterior horn region of the spinal cord of NGF were analyzed by immunohistochemistry. Results （1）At 2 weeks after operation，BBB score of sham operation group was higher than model group（P<0. 05）；At 4 weeks after operation，BBB score of sham operation group was higher than model group，high concentration herb formula group，medium concentration herb formula group and low concentration herb formula group（P<0.05）；at 6 weeks after operation，BBB score of sham operation group was higher than model group，high concentration herb formula group，medium concentration herb formula group and low concentration herb formula group（P<0.05）；BBB score of model group was lower than that of high concentration herb formula group（P<0.05）；BBB score of high concentration herb formula group was higher than medium concentration herb formula group and low concentration group（P<0.05）；at 8 weeks after operation，BBB score of sham operation group was higher than model group，high concentration herb formula group，medium concentration herb formula group and low concentration herb formula group（P<0.05）；BBB score of model group was lower than high concentration herb formula group（P<0.05）；BBB score of high concentration group was higher than medium concentration herb formula group and low concentration herb formula group（P<0.05）；at 10 weeks after operation，BBB score of sham operation group was higher than model group，high concentration herb formula group，medium concentration herb formula group and low concentration herb formula group（P<0.05）；BBB score of model group was lower than high and medium herb formula concentration group（P<0.05）；BBB score of high concentration herb formula group was higher than low concentration herb formula group（P<0.05）. （2）At 2 weeks after operation，in the sham operation group，the motor neurons in the anterior horn of the spinal cord were normal in shape，with abundant Nissl bodies. In the model group，the neurons in the anterior horn of the spinal cord were small，round and sparsely distributed，and the intracellular Nissl bodies decreased or even disappeared. At 6 and 10 weeks after operation，the neurons in the group of high and medium concentration of herb formula were damaged to a certain extent，but the cell morphology was plump and intracellular Nissl bodies was visible. A small number of vacuoles were observed in the low concentration herb formula group，and the distribution of neuron cells was slightly sparse. The normal cell with Nissl bodies of low concentration herb formula group was less than the high and medium concentration herb formula group（P<0.05）. At 2 weeks after the operation，the number of normal cells in the sham operation group was more than that in the model group（P<0.05）. At 6 weeks after operation，the normal cells in the sham operation group was more than that in the model group，medium concentration herb formula group and low concentration herb formula group（P<0.05）；the normal cell in the model group was less than that in the high herb formula concentration group（P<0.05）；the normal cells in high concentration herb formula group was higher than that in low herb formula concentration group（P<0.05）. At 10 weeks after operation，the normal cells in sham operation group was higher than that in model group and low concentration herb formula group（P<0. 05）；The normal cell in model group was lower than that of high concentration herb formula group（P<0.05）. （3）At 6 weeks after operation，NGF mRNA in high concentration herb formula group was higher than sham operation group，model group and low concentration herb formula group（P<0.05）. NT3 mRNA in high concentration herb formula group was higher than model group（P<0.05）. GDNF mRNA in high herb formula concentration group was higher than sham operation group，model group，medium and low concentration herb formula groups（P<0.05）. （4）The NGF staining of neurons in the anterior horn of spinal cord in the sham operation group and the model group was shallow and sparsely distributed，while the NGF staining of neurons in the anterior horn of spinal cord in the high and medium herb formula concentration groups was obvious and the cell morphology was intact. At 6 weeks after operation，the average integral optical density of NGF in the high herb formula concentration group was higher than that in the sham group and the model group（P<0.05）. Conclusion By increasing the expression levels of NGF，NT3 and GDNF mRNA in the spinal cord，the Yishen Yangsui formula may improve the limb motor function of the rats with CSM，maintain the number of normal motor neurons in the anterior horn of the spinal cord，and achieve the effect of promoting nerve repair.
Interpretation of the Major Updates of Guidelines Regarding Hyperuricemia and Gout in Chronic Kidney Disease
WANG Xu，LUO Dongping，RU Yanhai，GUO Xiaokai，XU Jiayun*
Abstract: The incidence of hyperuricemia（HUA）and gout is increasing significantly，and tends to occur at an early age with the social development and changes in patterns of life. HUA has become the second leading metabolic disease following diabetes mellitus，which is not only a common complication of chronic kidney disease（CKD），but also an important risk factor for CKD. The guidelines for the diagnosis and treatment of HUA and gout have been updated to accommodate newly emerging evidence. We interpreted the essentials of new updates regarding HUA and gout in CKD on the basis of research evidence，including the indication of initial urate-lowering therapy，selection of pharmacologic urate-lowering therapy，gout flare management，alkalinizing urine and use of vitamin C on the basis of research evidence，hoping to provide clinicians with supports for delivering comprehensive and individual therapies.
Comparative Study of Inflammatory Markers in Early Diagnosis of Diabetic Kidney Disease
WU Hong1，WANG Bin1，LI Ting2，NIE Yijun2*
Abstract: Background Diabetic kidney disease （DKD），a common diabetic complication，has become a major cause of end-stage renal disease. There are no comparative studies about the values of six inflammatory laboratory markers，heparin binding protein （HBP），C-reactive protein （CRP），serum amyloid A protein（SAA），procalcitonin （PCT），white blood cell count （WBC） and neutrophil percentage （N%），in early diagnosing DKD. Objective To assess the values of six inflammatory markers（HBP，CRP，SAA，PCT，WBC and N%） in early diagnosis of DKD via comparing the levels of them between type 2 diabetic patients and early DKD patients. Methods Participants were selected from Xianghu Branch，the First Affiliated Hospital of Nanchang University from May to December 2020，including 32 with simple type 2 diabetes，35 with early DKD patients and 30 physical examinees with normal examination results and without organic diseases. Fasting venous blood samples were collected for measuring HBP，CRP，SAA and PCT using quantitative immunofluorescence method，measuring WBC and N% using the automated hematology analyzer. ROC analysis was implemented to evaluate the value of HBP，CRP，and SAA in the early diagnosis of DKD. Results There were no significant differences in mean levels of PCT，WBC，and N% among three groups（P>0.05）. The mean level of HBP was increased in simple diabetic patients compared with that of healthy controls. The mean levels of HBP，CRP，and SAA in early DKD patients were significantly higher than those of other two groups（P<0.05）. In predicting early DKD，the AUC of HBP was 0.908〔95%CI（0.841，0.975）〕 with 71.4% sensitivity，96.7% specificity and Youden index of 0.681；the AUC of CRP was 0.760〔95%CI（0.644，0.875）〕 with 48.6% sensitivity，96.7% specificity and Youden index of 0.452；the AUC of SAA was 0.836〔95%CI（0.738，0.934）〕 with 74.3% sensitivity，86.7% specificity and Youden index of 0.610. Conclusion HBP has proved to be more effective in diagnosing DKD，which could be promoted clinically as a predictor of DKD.
Risk Factors for Type 2 Diabetic Kidney Disease：a Systematic Review
FANG Fengzhen1*，LI Zhuangmiao2，CHEN Tingyu1
Abstract: Background Diabetic kidney disease （DKD） has gradually become a noticeable global issue in recent years. As proved，early assessment and intervention of risk factors can prevent or delay the development of DKD. Objective To systematically review the risk factors of type 2 DKD. Methods The databases of the Cochrane Library，PubMed，Web of Science，SinoMed，CNKI，VIP and Wanfang Data were electronically searched for cohort studies and case-control studies on the risk factors related to type 2 DKD. The retrieval time was from the inception to April 2020. Two researchers screened literature，extracted data，and evaluated the bias risk of the eligible studies separately. RevMan 5.3 was used for Meta-analysis. Results In all， three cohort studies and nine case-control studies were included. Meta-analysis showed that older age〔SMD=0.34，95%CI （0.23， 0.46）〕，male〔OR=1.51， 95%CI （1.20， 1.90）〕，smoking〔OR=1.64， 95%CI （1.30， 2.07）〕，hypertension〔OR=2.01， 95%CI （1.73， 2.34）〕，elevated systolic blood pressure〔SMD=0.37，95%CI （0.12，0.63）〕，elevated glycosylated hemoglobin 〔SMD=0.41，95%CI （0.02，0.80）〕，elevated total cholesterol〔SMD=0.14，95%CI （0.06，0.22）〕，elevated serum creatinine〔SMD=0.73，95%CI （0.39，1.07）〕，vitamin D deficiency〔OR=4.06，95%CI （2.11，7.78）〕，non-alcoholic fatty liver disease〔OR=3.53，95%CI （1.61，7.74）〕，associated retinopathy〔OR=2.16，95%CI （1.55，3.01）〕，and insulin therapy〔OR=2.63， 95%CI （1.79，3.85）〕 were associated with increased risk of type 2 DKD（P<0.05）. The prolonged duration of type 2 diabetes〔SMD=-0.44， 95%CI（-0.54， -0.34）〕 and elevated HDL-C〔SMD=-0.20， 95%CI （-0.30， -0.10）〕 were associated with reduced risk of type 2 DKD（P<0.05）. Conclusion Male，older age，smoking，diabetic retinopathy，hypertension，non-alcoholic fatty liver disease，abnormal somatic factors（including elevated total cholesterol，systolic blood pressure，glycosylated hemoglobin，serum creatinine，as well as vitamin D deficiency） and insulin therapy are risk factors for type 2 DKD，which need to be verified by more high-quality large-sample studies due to limited quality and quantity of included studies.
Relationship of Microbiological and Inflammatory Markers with Poor Prognosis in Elderly Pulmonary Infection Patients with Different Estimated Glomerular Filtration Rate
ZHAO Xiaoqian1，LUO Leiming2*
Abstract: Background Lung infections mostly occur in the elderly， often in the form of comorbidities. Studies have shown that kidney function may affect the prognosis of patients with lung infections， but the mechanism of microbial changes in these patients still remains unclear，and there are few relevant reports in China. Objective To investigate the relationship of specific etiological susceptibility and altered immune function with poor prognosis in elderly pulmonary infection patients with different estimated glomerular filtration rate. Methods This retrospective，controlled and observational study was conducted with a cohort of elderly patients（over 65 years old）who were hospitalized due to pulmonary infection in the Second Medical Center，PLA General Hospital from January 2017 to December 2019. General conditions（gender and age），past medical history（chronic kidney disease，diabetes，dyslipidemia，chronic heart failure），and biochemical parameters detected after admission，including blood urea nitrogen（BUN），serum creatinine（Scr），aspartate aminotransferase（AST），alanine aminotransferase（ALT），serum albumin，estimated glomerular filtration rate（eGFR），routine blood parameters〔hemoglobin，white blood cell count，percentage of neutrophils，percentage of lymphocytes，total platelet count，neutrophil to lymphocyte ratio（NLR）〕and pathogenic microbes detected by sputum culture，as well as outcome（survival or death）acquired by a 90-day follow-up were collected. Multivariate Logistic regression analysis was used to explore the associated factors of death. ROC analysis of eGFR in predicting death was performed，and its optimal cut-off value was used to divide the cases into two groups〔eGFR≥47 ml?min-1?（1.73 m2）-1 and eGFR < 47 ml?min-1?（1.73 m2）-1〕 to compare intergroup differences in the distribution of pathogenic microbes and inflammatory indicators. Results The prevalence of in-hospital death was 13.2%（68/514）. The deceased had younger mean age，lower prevalence of chronic kidney disease，higher mean levels of BUN，Scr，AST，ALT，white blood cell count and NLR，and lower mean levels of albumin，eGFR，hemoglobin and percentage of lymphocytes than survivors（P<0.05）. Multivariate Logistic regression analysis showed that age 〔OR=1.092，95%CI（1.027，1.162）〕，ALT 〔OR=1.013，95%CI（1.001，1.026）〕，albumin level〔OR=0.814，95%CI（0.759，0.873）〕，eGFR 〔OR=0.974，95%CI（0.961，0.988）〕，WBC count 〔OR=1.116，95%CI（1.030，1.210）〕and lymphocyte percentage 〔OR=0.011，95%CI（0，0.521）〕were associated with all-cause death（P<0.05）. The AUC of eGFR in predicting death was 0.614，with 47 ml?min-1?（1.73 m2）-1 was determined as the optimal cutoff value with 36.8% sensitivity，and 84.3% specificity. Compared to patients with eGFR≥47 ml?min-1?（1.73 m2）-1，those with eGFR<47 ml?min-1?（1.73 m2）-1 had higher prevalence of infection with Klebsiella pneumoniae，Escherichia coli，Staphylococcus aureus，and fungi and lower prevalence of infection with Pseudomonas aeruginosa（P<0.05）. Moreover，they also had higher mean percentage of neutrophils and NLR，as well as lower mean percentage of lymphocytes and platelet count（P<0.05）. Conclusion Changes in immune function and susceptibility to Staphylococcus aureus infections in patients with low eGFR may be underlying causes of worsening prognosis in elderly people with pulmonary infection and reduced renal function.
Meta-analysis of the Predictive Value of Lipid Metabolism in Children with Henoch-Schonlei Purpura
HAN Shanshan1，2，DING Ying1，2，DAI Yanlin2，ZHANG Xia1，2*，WANG Long1，2
Abstract: Background Henoch-Schonlein purpura （HSP） is one of the most common vasculitis in children. Some of them may involve the kidney and develop into Henoch Schonlein purpura nephritis，which affects the prognosis. Therefore，it is necessary to find the predictors of renal damage in the early stage of Henoch-Schonlein purpura. In recent years，more and more studies have shown that abnormal lipid metabolism may be a risk factor for HSP renal injury，but there is no systematic evidence-based study. Objective To comprehensively collect relevant literature and evaluate whether lipid abnormalities in the early stage of HSP can be used as a predictor of HSPN. Methods PubMed，EMBase，The Cochrane Library，China National Knowledge Infrastructure（CNKI），Wanfang Data Knowledge Service Platform，VIP and China Biology Medicine disc were searched by computer. The retrieval time were from the establishment of the databases to February 10，2020. The first author，publication year，country，diagnostic criteria，gender，age，number of cases（HSPN group / non HSPN group），observation indexes〔total cholesterol （TC），triglyceride（TG），high density lipoprotein （HDL），low density lipoprotein（LDL），apolipoprotein M（ApoM） in the two groups at the initial stage of onset〕，study type，occurrence （initial onset / recurrence），course of disease and follow-up time were collected to study the risk factors of HSPN in children. Newcastle Ottawa scale （NOS） was used to evaluate the quality of the included literature. Stata 15.1 software was used for Meta-analysis. Results A total of 5 312 cases from 16 literatures were included. Excluding 26 cases lost to follow-up，there were 5 286 children with HSP，and 1 997 cases developed HSPN，with NOS scores ≥6 points. The results of meta-analysis showed that the levels of TC 〔WMD=0.72，95%CI （0.51，0.92）〕，TG 〔WMD=0.61，95%CI （0.45，0.77）〕 and LDL〔WMD=0.65，95%CI （0.41，0.89）〕 in HSPN group were higher than those in non HSPN group，and the level of ApoM 〔OR=0.32，95%CI （0.12，0.85）〕 was lower than those in non HSPN group. Conclusion High levels of TC，TG and LDL may be predictors of HSPN development. The relationship between HDL level and HSPN is still unclear，which needs to be confirmed by further research. ApoM is expected to become a new independent predictor of HSPN.
Congenital Adrenal Hyperplasia Associated with POR Gene Mutation：a Case Report and Literature Review
QI Qi，HU Honglin*，XU Min，WANG Youmin，ZHANG Qiu
Abstract: Congenital adrenal hyperplasia（CAH）is a rare genetic metabolic disorder mainly caused by steroidogenic enzyme gene or cytochrome P450 oxidoreductase（POR）mutations. As its clinical manifestations are similar to those of polycystic ovary syndrome，a differential diagnosis is often needed to distinguish them. We reported a case of CAH associated with POR mutation，who was finally diagnosed with cytochrome P450 oxidoreductase deficiency（PORD）after being detected with homozygous c.1370G>A mutation in exon 12 of POR by gene test. Our study indicates that the key to identifying PORD is comprehensive analysis of results of physical examination，adrenal and sex hormone tests，and in combination with gene analysis for confirmation when necessary，then based on this，delivering precise treatment.
Association of Anemia with Clinicopathological Characteristics and Prognosis in Henoch-Schonlein Purpura Nephritis Patients
SHENG Xiaoxiao，ZHAI Yaling，CHEN Yazhuo，GAO Jingge，YAO Xingchen，WANG Xinnian，SHEN Ya，ZHANG Wenhui，GAO Ge，CHENG Genyang*
Abstract: Background Henoch-Schonlein purpura nephritis（HSPN） is a major cause of chronic kidney disease. Anemia is a common presentation of HSPN，which seriously affects the life quality. Objective To analyze the association of anemia with clinicopathological characteristics and prognosis in HSPN patients. Methods Participants were 195 HSPN patients with and without anemia recruited from the First Affiliated Hospital of Zhengzhou University from December 2014 to July 2019. Clinical data〔including age，gender，baseline extrarenal manifestations（joints/ abdomen），hypertension，white blood cell count，hemoglobin，serum calcium，serum phosphorus，blood urea nitrogen，serum creatinine，serum uric acid，serum total protein，serum albumin，cholesterol，triglyceride，high-density lipoprotein，low-density lipoprotein，estimated glomerular filtration rate （eGFR），24-hour urine protein，urinary RBC count〕 and pathological data（including IgG deposition，IgM deposition，IgA deposition，C3 deposition，renal interstitial fibrosis，renal interstitial inflammation，renal tubule atrophy，arteriolar disease，prevalence of crescent formation，glomerulosclerosis rate，pathological grade） were collected. All of them were followed up as of December 2019. Composite adverse outcomes were also collected. Kaplan-Meier curve was plotted to estimate the renal survival. Log-rank test was used to compare the survival of patients with and without anemia. Multivariate Cox regression analysis was adopted to explore the influence factors for prognosis. Results Patients with anemia（n=63） had older mean age，higher rate of having extrarenal manifestations at admission，and higher mean levels of blood urea nitrogen，24-hour urine protein，and urinary RBC count than those without（n=132）（P<0.05）. Moreover，patients with anemia demonstrated lower mean levels of hemoglobin，serum calcium，total protein，albumin，high-density lipoprotein，and eGFR（P<0.05）. Furthermore，greater severity of arteriolar disease and higher prevalence of crescent formation were found in those with anemia（P<0.05）. Multivariate Cox regression analysis suggested that older age，24-hour urine protein and glomerulosclerosis were associated with increased risks of poor prognosis of HSPN（P<0.05）. Survival analysis showed that patients with anemia had lower cumulative renal survival rate than those without （χ2=4.675，P=0.031） . Conclusion HSPN patients with anemia presented more serious clinicopathological features，and a lower renal cumulative survival rate. Older age，24-hour urine protein and glomerulosclerosis may be influence factors for composite adverse outcomes.
Association of Single Nucleotide Polymorphisms of ARL15 and PGC-1α Genes with Diabetic Kidney Disease
TU Yingye1，ZHANG Hongjiang1，2，KANG Chun1，DU Fei1，2，CUI Jiahui1，SHAO Wei1，2，YUAN Zhimin3，WANG Weijie4*，YANG Kangjuan1*
Abstract: Background ADP-ribosylation factor-like protein 15（ARL15） rs4311394 and peroxisome proliferator-activated receptor-γ coactivator 1α（PGC-1α） rs7656250 have been demonstrated to be closely correlated with dyslipidemia，a key risk factor for diabetic kidney disease （DKD），but whether these gene loci have an association with DKD remains unknown. Objective To explore the association of single nucleotide polymorphisms （SNPs） of ARL15 and PGC-1α genes with DKD. Methods Participants were China's Han and Korean individuals who were enrolled during 2018—2019，including 393 with T2DM（T2DM group，including 205 Han and 188 Korean cases），and 90 with DKD（DKD group，including 55 Han and 35 Korean cases） from Yanbian University Hospital and Yanji Municipal Hospital，and 268 workers with normal glucose tolerance （NGT） undergoing physical examination in Yanbian University Hospital （NGT group，including 137 Han and 131 Korean cases）. Data were collected，comprising physiological and biochemical indicators，alleles and genotypes of ARL15 rs4311394 and PGC-1α rs7656250 detected by single-base extension assay，and levels of ARL15 and adiponectin proteins detected using ELISA. Results The results exhibited no statistically significant differences regarding both allele and genotype frequencies of ARL15 rs4311394 and PGC-1α rs7656250 between Han and Korean cases in the NGT group （P>0.05）. Also，the differences in both allele and genotype frequencies of ARL15 rs4311394 and PGC-1α rs7656250 across three groups were not statistically significant （P>0.05）. In addition，no statistically significant differences were noted in allele and genotype frequencies of ARL15 and PGC-1α gene loci among the three groups （P>0.05）. However，the FPG level was higher in carriers of CT genotype of PGC-1α rs7656250 than in carriers of CC or TT genotype of PGC-1α rs7656250 （P<0.05）. The adiponectin protein level was lower in carriers of CT or TT genotype of PGC-1α rs7656250 than in carriers of CC genotype of PGC-1α rs7656250，and also lower in carriers of TT genotype of PGC-1α rs7656250 than in carriers of CT genotype of PGC-1α rs7656250 （P<0.05）. Besides，the adiponectin protein level in T2DM patients was lower than that in individuals with NGT （P<0.05）. And ARL15 and adiponectin protein levels in DKD patients were higher than those in individuals with NGT and T2DM patients （P<0.05）. Furthermore，Spearman's correlation analysis suggested a positive correlation between ARL15 level and adiponectin level （rs=0.372，P<0.05）. Conclusion Although SNPs in ARL15 and PGC-1α shared no correlation with DKD，the adiponectin protein level was reduced in carriers of CT or TT genotype of PGC-1α rs7656250.
Clinical Efficacy of Dangguibuxue Decoction as an Adjuvant Therapy for Diabetic Nephropathy：a Meta-analysis
CHENG Liying1，WANG Mengxi2，ZHANG Zhu3*，SHAO Fengmin3
Abstract: Background Excessive inflammatory response and renal fibrosis play key roles in the progression of diabetic nephropathy to end-stage renal disease. However，the usual western treatment for diabetic nephropathy has no significant anti-inflammatory and anti-fibrosis effects. Dangguibuxue Decoction（DD） is often used as an adjuvant therapy clinically due to its notable anti-inflammatory and anti-fibrosis effect，but there is a lack of relevant medical evidence. Objective To systematically study the efficacy and safety of DD as an adjuvant therapy for diabetic nephropathy. Methods Databases of CNKI，Wanfang Data，VIP，SinoMed，PubMed，The Cochrane Library，EMBase，ChiCTR，and ClinicalTrials.gov were searched from inception to December 2020 to identify randomized controlled trials（RCTs） regarding diabetic nephropathy patients treated by usual integrated treatment and modified DD compared with those treated by usual integrated treatment.Data extraction of the included RCTs were performed. The Cochrane Collaboration's tool for assessing risk of bias was used to evaluate the methodological quality. Review Manager 5.4 was used for meta-analysis. Results A total of 10 RCTs meeting the inclusion criteria were included，involving 879 patients. The results of meta-analysis found that the combined therapy of usual integrated treatment with modified DD could further improve the overall response rate〔RR=1.18，95%CI（1.10，1.28），P<0.000 1〕，reduce the 24-hour urinary protein quantification〔MD=-69.22，95%CI（-76.96，-61.48），P<0.000 01〕 and urinary albumin excretion rate〔MD=-31.32，95%CI（-59.87，-2.76），P=0.03〕，decrease the levels of serum creatinine〔MD=-10.24，95%CI（-11.51，-8.98），P<0.000 01〕 and urea nitrogen 〔MD=-0.95，95%CI（-1.61，-0.29），P=0.005〕 with no significant effect on adverse events〔RR=1.00，95%CI（0.30，3.34），P>0.05〕. Conclusion The clinical effect of DD in adjuvant treatment of diabetic nephropathy is significant and has good safety.
Effectiveness and Safety of Immunosuppressive Agents Derived from Chinese Medicine with ACEI/ARB in Early- and Middle-stage Diabetic Nephropathy：a Meta-analysis
WU Yu1，2，ZHANG Zheng2，FANG Jinying1，2，WANG Yuedan1，2，LI Wenge1，2*
Abstract: Background For early-and middle-stage diabetic nephropathy（DN），the efficacies of angiotensin-converting enzyme inhibitor（ACEI）and angiotensin Ⅱ receptor antagonist（ARB）are limited although they are used as first-line drugs. As inflammatory response play a key role in the development of DN，immunosuppressive agents derived from Chinese medicine may be used as adjuvant therapies for DN. Objective To perform a meta-analysis of the effectiveness and safety of immunosuppressive agents derived from Chinese medicine with ACEI/ARB in the treatment of early-and middle-stage DN. Methods Randomized controlled trials（RCTs）about effectiveness and safety in early-and middle-stage DN patients treated with immunosuppressive agents derived from Chinese medicine with ACEI/ARB（experimental group）compared with those treated with ACEI/ARB（control group）published in Chinese were screened from databases of CNKI，Wanfang Data，VIP and CBM，and those published in English from databases of Medline，EMBase，the Cochrane Library，Web of Science，from inception to May 5，2020. RevMan 5.3 software was used to complete the meta-analysis. Outcome indicators were the decrease in serum creatinine，24-hour urinary protein quantification and leukocyte count，improvement in serum albumin，and change in glutamic pyruvic transaminase after treatment，incidence of adverse reactions and overall response rate. Results A total of 23 studies were included，involving 1 878 patients. The analysis revealed that compared to the control group，the experimental obtained greater decreases in serum creatinine level〔MD=-6.06，95%CI（-10.89，-1.22）〕，24-hour urinary protein quantification〔MD=-0.70，95%CI（-0.87，-0.53）〕，and white blood cell count〔MD=-0.42，95%CI（-0.76，-0.08）〕as well as improvement of serum albumin level〔MD=2.83，95%CI（1.66，4.01）〕. The experimental group had higher incidence of adverse reactions〔OR=1.87，95%CI（1.26，2.77）〕and overall response rate〔OR=3.05，95%CI（1.87，4.97）〕（P<0.05）. But there was no significant difference in the change of glutamic pyruvic transaminase level between the two groups〔MD=0.51，95%CI（-0.65，1.66），P=0.39〕. Conclusion In patients with early-and middle-stage DN，the combination use of immunosuppressive agents derived from Chinese medicine and ACEI/ARB may effectively improve the renal function，serum albumin level and overall response rate，but it may result in higher risk of adverse reactions such as decreased white blood cell count，so it should be used cautiously in clinic practice.
Acute Renal Failure with Hypercalcemia Caused by Dihydrotachysterol in Hypoparathyroidism：a Case Analysis
ZHOU Jiayan，JIANG Xiaohong*，WANG Long
Abstract: Hypercalcemia induced by dihydrotachysterol（DHT） poisoning is very rare，which is diagnosed based exclusively on medical history and medication history in general. We reported a case of acute renal failure and hypercalcemia caused by DHT poisoning with fatigue and anorexia as the first symptoms. This patient previously received surgery for benign thyroid nodules and suffered from postoperative hypoparathyroidism. Later she changed the medication regimen to DHT（ 0.5 mg/d） combined with calcium carbonate-vitamin D3（3 tablets/d） by herself. During the whole medication treatment，the serum calcium（SCa） level was not monitored. The patient was admitted to our hospital due to fatigue and anorexia without obvious inducers，who was diagnosed with acute renal failure according to serum creatinine （Scr） （458 μmol/L） and SCa（5.1 mmol/L） levels. After excluding other causes for hypercalcemia，DHT poisoning was considered. After terminating the treatment of DHT and calcium carbonate-vitamin D3，and receiving treatment with fluid replacement，diuresis，and calcitonin，the patient's Scr and SCa levels gradually returned to the reference range. So there are suggestions for clinicians and patients that during the treatment of DHT，especially treating for complex conditions（for example，comorbidities），or using DHT with other drugs，it is still necessary to regularly monitor the SCa，even if it has been controlled within the reference range before，thereby preventing the occurrence of hypercalcemia.
Adrenal Crisis Provoked by Levothyroxine in Autoimmune Polyglandular Syndrome TypeⅡ：a Case Report and Literature Review
YUAN Haixia1，GAO Xuan2，ZHANG Jing2，HE Chunyan2，ZHOU Feng2*
Abstract: Adrenal crisis is a life-threatening state of adrenal insufficiency that requires immediate treatment. Adrenal insufficiency is usually dividen into primary，secondary and tertiary. Addison's disease is the commonest cause of primary adrenal insufficiency，and is an important component of autoimmune polyglandular syndrome（APS）. APS is a rare endocrine disease with presence of autoimmune damage of more than one endocrine glands，which includes APS typeⅠ and APS type Ⅱ. This article reported a APS type Ⅱ patient with levothyroxine-induced adrenal crisis，with detailed analysis of the causes，hoping to offer more information for clinical practice.
Association of Plasma Renin Activity and Early Renal Damage in Essential Hypertensive Patients
LI Yu1，WU Ting2，ZHAO Xin2，LI Nanfang2*
Abstract: Background Kidney injury is one of the most common target organ damages in essential hypertension. Early detection and intervention will possibly reverse or even eliminate underlying renal damage. Previous studies have shown that plasma renin activity（PRA）plays an important role in appropriate treatment and prognosis evaluation of essential hypertensive patients，but it is unclear whether PRA can predict early hypertensive renal damage. Objective To investigate the relationship of PRA with early renal damage in essential hypertensive patients. Methods A total of 1 614 Han Chinese inpatients with essential hypertension were recruited between January 2007 and October 2014 from Department of Hypertension，People's Hospital of Xinjiang Uygur Autonomous Region. Data including gender，age，BMI，course of hypertension，blood pressure，fasting blood glucose，blood lipid，plasma aldosterone（PAC），and renal function indicators（urea nitrogen，creatinine，Cyst C，24-hour urine protein，24-hour urine microalbuminuria）were compared between sitting PRA quartiles 〔low renin（Q1，<0.44 μg?L-1?h-1），medium renin 1（Q2，0.44-1.07 μg?L-1?h-1），medium renin 2（Q3，1.08 -2.36 μg?L-1?h-1）and high renin（Q4，>2.36 μg?L-1?h-1）〕. Multivariate Logistic regression was used to explore factors associated with early hypertensive renal function damage. Results Q1 group had lower male proportion，and lower levels of mean DBP，PRA and TG，and greater mean age and ARR ratio than other groups（P<0.05）. This group also showed lower levels of mean PAC，TC and LDL-C and longer mean course of hypertension than Q3 and Q4 groups（P<0.05）. Q2 group had greater mean age and longer mean course of hypertension as well as lower mean level of PRA than Q3 group（P<0.05）. Q2 group had lower male proportion，and lower mean DBP，greater mean age and longer mean course of hypertension，lower mean PRA and PAC，and higher mean ARR ratio than Q4 group（P<0.05）. Q3 group had lower male proportion，and lower mean DBP，PRA and PAC as well as greater mean age than Q4 group（P<0.05）. Q1 group had lower mean level of creatinine than Q2 and Q3 groups（P<0.05）. Q1 group showed lower mean levels of creatinine and Cyst C than Q4 group，so did Q3 group（P<0.05）. Multivariate Logistic regression analysis showed that gender，course of hypertension，BMI，SBP，DBP and PRA level were associated with early renal damage（P<0.05）. Conclusion In Xinjiang Han Chinese people with essential hypertension，female，overweight，longer course of hypertension，higher blood pressure and higher PRA were risk factors for early renal damage.
Advances in the Treatment of Primary IgA Nephropathy
YU Baisong，LIU Bing*
Abstract: Primary IgA nephropathy is the most common type of primary glomerulonephritis，with pathological features of mesangial deposition of IgA. With increasingly intensive understanding of primary IgA nephropathy，it is found that it is not a benign kidney disease. In about 20 years，30%-40% of primary IgA nephropathy develops into end-stage renal disease，requiring kidney replacement therapy. Therefore，primary IgA nephropathy needs effective and precise treatment to delay its progression. This article mainly reviews the advances in the treatment of primary IgA nephropathy：supportive therapy has become the main treatment. Besides，tonsillectomy，hormone therapy，immunosuppressive therapy and other treatments can be used under certain circumstances. Recently emerged treatments can also be used as treatment options for choice.
Prognostic Value of Partial Ephrectomy in Patients with Localized Ⅰ Clear Cell Renal Cell Carcinoma
CAI Menghui，LIU Feng，GE Tianyu，FENG Zihao，HUANG Kunping，GE Bo*
Abstract: Background At present，partial nephrectomy（PN）is preferred for patients with localized T1a clear cell renal cell carcinoma（ccRCC）.However，it remains controversial whether PN is the first-choice surgical procedure for patients with localized T1b ccRCC.Objective To estimate the effects of PN on overall survival（OS）and cancer-specific survival（CSS）of patients with localized Ⅰ ccRCC.Methods From April to May 2020，we downloaded the clinicopathological data of patients diagnosed with ccRCC pathologically from 1975 to 2016（year of diagnosis，age，sex，race，marital status，tumor laterality，pathological stage，T stage，surgical method）from SEER after getting permission to use the database.According to the use of surgical techniques，the patients were divided into PN group and radical nephrectomy（RN）group.Cox proportional hazards regression model was used to identify independent prognostic factors of CSS in patients with localized I ccRCC.Multivariate Logistic regression analysis was used to explore the the influencing factors of surgical methods in patients with ccRCC.Propensity score matching method was used to adjust samples.Kaplan-Meier curve and multivariate Cox proportional hazards regression model were used to estimate the effects of two surgical methods on the OS and CSS of patients before and after matching.Results The results of univariate Cox proportional hazard regression model showed that age，marital status，pathological stage，T stage and surgical method were factors associated with CSS in patients with localized ⅠccRCC（P<0.05）.The results of multivariate Cox proportional hazard regression model showed that age，marital status，pathological stage，T stage and surgical method were all independent factors for CSS in patients with localizedⅠ ccRCC（P<0.05）.In terms of evaluating the prognostic value of surgical method by overall survival population and tumor specific survival population，localized T1b stage ccRCC with PN and those with RN had statistically significant differences in the year of diagnosis，age，tumor laterality and pathological stage（P<0.05）.Multivariate Logistic regression analysis revealed that year of diagnosis，age，tumor laterality and pathological stage were associated with the use of surgery method in patients with localized T1b stage ccRCC（P<0.05）.Kaplan-Meier survival analysis found that either before or after propensity score matching，PN significantly prolonged the OS（P<0.05），but showed similar effect on the CSS（P>0.05）of patients compared with RN.After propensity score matching，multivariate Cox regression analysis found that PN was independently associated with prolonged OS of patients（HR=0.695，P=0.009），but was not significantly associated with CSS（HR=0.804，P=0.301）.Conclusion When surgery is feasible，PN is recommended as the first-choice surgical mode for patients with stage ⅠccRCC in light of long-term survival.
The Value of Simplified Calculation of CT Enhanced Washout Rate in Distinguishing Adrenal Metastasis and Adrenal Adenoma Less Than 4 cm
DAI Guojiao，ZHENG Hailan，ZHENG Yongfei，HUANG Danjiang*
Abstract: Background Among incidental adrenal tumors，adrenal metastases need to be distinguished from the most common benign adrenal tumors （adrenal adenomas）.It is recommended to delay the scan for 15 minutes to calculate the absolute percentage washout and relative percentage washout，but the scanning time is too long.Objective To explore the value of simplified calculation of CT enhanced washout rate in distinguishing adrenal metastases and adrenal adenomas less than 4 cm.Methods 78 patients with adrenal metastasis and 50 patients with adrenal adenoma who were confirmed by clinical follow-up or suspected to be diagnosed as non-adrenal adenoma lesions followed by surgical pathology and enhanced CT scanning in Taizhou First People's Hospital from January 2014 to December 2019 were selected.According to the inclusion and exclusion criteria，37 patients with adrenal metastasis（adrenal metastasis group） and 47 patients with adrenal adenoma （adrenal adenoma group） were finally included in this study；among them，patients with adrenal metastases included 16 patients with lung cancer as the primary tumor and 21 patients with other tumors as the primary tumor （4 patients with liver cancer，14 patients with gastrointestinal cancer，1 patient with pancreatic cancer，1 patient with bladder cancer，1 patient with salivary gland cancer），and patients with adrenal adenomas included 15 patients with lipid-poor adrenal adenoma and 32 patients with lipid-rich adrenal adenoma.The age，sex，occurrence of hypertension，lesion location （left/right） and tumor size of patients were collected and CT attenuation value of plain scan，arterial phase and portal venous phases were measured to calculate simplified absolute percentage washout and relative percentage washout.Receiver operating characteristic curves （ROC） were used to assess the efficacy of statistically significant variables between groups including adrenal metastasis and adrenal adenoma groups，adrenal metastasis and lipid-poor adrenal adenoma groups，adrenal metastasis and lipid-rich adrenal adenoma groups，adrenal metastasis of lung cancer and lipid-poor adrenal adenoma groups respectively.Results There were no statistical differences in age，gender，occurrence of hypertension，and the location and size of lesions between groups including adrenal metastasis and adrenal adenoma groups，adrenal metastasis and lipid-poor adrenal adenoma groups，adrenal metastasis and lipid-rich adrenal adenoma groups，adrenal metastasis of lung cancer and lipid-poor adrenal adenoma groups（P>0.05）.The plain CT value of patients in the adrenal metastasis group was higher than the adrenal adenoma group （P<0.001）.The plain CT value of patients in the adrenal metastasis group was higher than the lipid-poor adrenal adenoma group and the absolute percentage washout and relative percentage washout of patients in the adrenal metastasis group was lower than the lipid-poor adrenal adenoma group （P<0.05）.The plain CT value and relative percentage washout of patients in the adrenal metastasis group were higher than the lipid-rich adrenal adenoma group（P<0.05） and there was no significant difference in the absolute percentage washout between the adrenal metastasis group and the lipid-rich adrenal adenoma group （P>0.05）.The plain CT value of patients in the lung cancer adrenal metastasis group was higher than the lipid-poor adrenal adenoma group，and the absolute percentage washout and relative percentage washout of patients in lung cancer adrenal metastasis group were lower than the lipid-poor adrenal adenoma group （P<0.05）.In the ROC curve analysis of adrenal metastasis and adrenal adenoma，the cut-off value of plain CT value was 21.00 HU，and the AUC，sensitivity，and specificity were 0.894，81.1%，and 89.4%，respectively.In the ROC curve analysis of adrenal metastasis and lipid-poor adrenal adenoma，the cut-off value of plain CT value was 28.50 HU，and the AUC，sensitivity，and specificity were 0.746，64.9%，and 86.7%，respectively.The cut-off value of the absolute percentage washout was -21.54%，and the AUC，sensitivity，and specificity were 0.733，80.0%，and 83.8%，respectively.The cut-off value for the relative percentage washout was -9.65%，and the AUC，sensitivity，and specificity were 0.760，73.3%，and 89.2%，respectively.In the ROC curve analysis of adrenal metastasis and lipid-rich adrenal adenoma，the cut-off value of plain CT value was 11.50 HU，and the AUC，sensitivity and specificity were 0.964，91.9% and 100.0%，respectively.The cut-off value of the relative percentage washout was -64.10%，and the AUC，sensitivity and specificity were 0.677，89.2% and 53.1%，respectively.In the ROC curve analysis of lung cancer adrenal metastasis and lipid-poor adrenal adenoma，the cut-off value of plain CT value was 29.50 HU，and the AUC，sensitivity，and specificity were 0.881，81.3%，and 93.3%，respectively.The cut-off value of the absolute percentage washout was -24.89%，the AUC，sensitivity，and specificity were 0.721，80.0%，and 81.3%，respectively.The cut-off value for relative percentage washout was -10.58%，the AUC，sensitivity，and specificity were 0.733，73.3%，and 87.5%，respectively.Conclusion Simplified calculation of CT enhanced absolute percentage washout and relative percentage washout is of great value in distinguishing adrenal metastases and adrenal adenomas less than 4 cm.
Changes in Glomerular Filtration Rate and Urinary Albumin in Type 2 Diabetes in a Community
LU Changan1，WANG Jian1，LUO Jinbing1，XIA Lijun1，HAO Shiwei1，ZHAO Ruiquan1，WANG Meng1，SONG Fei1，ZHANG Mingbao1，YANG Guangran2*
Abstract: Background Estimated glomerular filtration rate （eGFR） and urinary albumin excretion rates （UAER） are indicators of kidney function and kidney damage.It is still not completely clear whether the changes of these two indicators in type 2 diabetes patients are consistent.Objective To follow up the changes of eGFR and UAER levels in patients with type 2 diabetes for 5 years，and to analyze the related factors.Methods Patients with type 2 diabetes in Tuanjiehu Community，Chaoyang District，who were involved in the Beijing Community Diabetes Study from March 2013 to December 2018，were selected，and they were followed up annually for 5 years.The follow-up indicators include duration of diabetes，body mass index （BMI），triglyceride （TG），total cholesterol （TC），high density lipoprotein cholesterol （HDL-C），low density lipoprotein cholesterol （LDL-C），glycosylated hemoglobin （HbA1c），systolic blood pressure （SBP），diastolic blood pressure （DBP），eGFR and UAER.The eGFR progression was defined as decreased eGFR combined with developed chronic kidney disease （CKD） stage，and UAER progression was defined as newly present proteinuria or progression from microalbuminuria to macroalbuminuria.Results A total of 66 patients were followed up annually from 2013 to 2018 with completed data of UAER and eGFR.The results showed that the differences in DBP，UAER and eGFR levels of patients at baseline and 5 years of follow-up were statistically significant （P<0.05）.According to the changes of eGFR and UAER at the 5th year of follow-up，37 cases （56.1%） of 66 patients had eGFR progression and 10 cases（15.2%） had UAER progression.The changes of eGFR and UAER were consistent in 37 patients（56.1%），while the progression of UAER and eGFR was not parallel in 29 patients（43.9%）.There were no significant differences in BMI，age，TG，TC，HDL-C，LDL-C，HbA1c，SBP，and DBP between the UAER and eGFR progression parallel group and UAER and eGFR progression non-parallel group （P>0.05）.The duration of diabetes in UAER and eGFR progression parallel group was longer than that in UAER and eGFR progression non-parallel group（P<0.05）.Conclusion Through a 5-year follow-up of patients with type 2 diabetes，it was found that eGFR gradually decreased and UAER gradually increased with the extension of diabetes duration.In 43.9% of patients，the UAER progression and eGFR progression were not parallel，suggesting that during clinical observation of kidney damage in diabetic patients，both eGFR and UAER examinations should be performed simultaneously，especially in patients with diabetic duration less than 10 years.
Preventive Effect of Different Chinese Patent TCM Injections for Activating Blood Circulation and Removing Blood Stasis with Usual Hydration on Contrast-induced Nephropathy：a Network Meta-analysis
HUANG Yingjie1，LIU Jiayue1，ZHAN Qunzhang1，HUANG Lei1，YE Jiajia1，ZHANG Yueyao1，HE Yuchun1，LI Junzhe2*
Abstract: Background Many clinical trials have confirmed that a variety of Chinese patent TCM injections for activating blood circulation and removing blood stasis with usual hydration may prevent contrast-induced nephropathy（CIN）to some extent，but there is a lack of systematic review.Objective To evaluate the effect of different Chinese patent TCM injections for activating blood circulation and removing blood stasis with usual hydration on preventing CIN，providing evidence-based evidence for clinical rational use of such medicines.Methods Databases including Cochrane Library，EMBase，PubMed，CNKI，SinoMed，CQVI and Wanfang Data were searched for RCTs about different Chinese patent TCM injections for activating blood circulation and removing blood stasis with hydration（test group）versus usual hydration（control group）in preventing CIN from inception to November 2019.Stata 15.0 was used to conduct network meta-analysis.Results A total of 19 RCTs were included，involving 2 433 patients.The analysis revealed that，the therapies were ranked as follows in terms of effect of decreasing the incidence of CIN：Ligustrazine injection with usual hydration>Xuebijing injection with usual hydration>Ginseng and aconite injection with usual hydration>Danhong injection with usual hydration>Erigeron breviscapus injection with usual hydration>Miltiorrhizae and ligustrazine injection with usual hydration>Miltiorrhizae and ligusticum wallichiiand glucose injection with usual hydration>Shenkang injection with usual hydration>Sofren injection with usual hydration>Miltiorrhizae polyphenolate injection with usual hydration>Yinxingdamo injection with usual hydration> usual hydration.For decreasing the Ccr after CAG/PCI，the ranking results were：Miltiorrhizae and ligusticum wallichiiand glucose injection with usual hydration>Erigeron breviscapus injection with usual hydration>Yinxingdamo injection with usual hydration>Sofren injection with usual hydration>Xuebijing injection with usual hydration>Miltiorrhizae and ligustrazine injection with usual hydration>Ginseng and aconite injection with usual hydration>Danhong injection with usual hydration>usual hydration.For decreasing the Scr after CAG/PCI，the ranking results were：Erigeron breviscapus injection with usual hydration>Miltiorrhizae and ligusticum wallichiiand glucose injection with usual hydration>Ligustrazine injection with usual hydration>Miltiorrhizae and ligustrazine injection with usual hydration>Sofren injection with usual hydration>Yinxingdamo injection with usual hydration>Shenkang injection with usual hydration>Ginseng and aconite injection with usual hydration>Xuebijing injection with usual hydration>Danhong injection with usual hydration>usual hydration.For decreasing the BUN after CAG/PCI，the ranking results were：Ginseng and aconite injection with usual hydration>Miltiorrhizae and ligustrazine injection with usual hydration>Sofren injection with usual hydration>Danhong injection with usual hydration>usual hydration.Conclusion The available literature evidence indicates that，Ligustrazine injection with usual hydration may be an optimal therapy for decreasing the incidence of CIN；Miltiorrhizae and ligusticum wallichiiand glucose injection with usual hydration may be an optimal therapy for decreasing Ccr after CAG/PCI；Erigeron breviscapus injection with usual hydration may be the best therapy in decreasing Scr after CAG/PCI，and Ginseng and aconite injection with usual hydration may be the best therapy in decreasing BUN after CAG/PCI.
Clinical Diagnosis and Treatment of Monoclonal Gammopathy of Renal Significance
WEI Yujun，LI Xin，SHEN Man，ZHANG Jiajia，ZHAN Xiaokai，TANG Ran，HUANG Zhongxia*
Abstract: Monoclonal gammopathy of renal significance（MGRS） is a kind of renal damage mediated by monoclonal immunoglobulin（Ig） secreted by low-grade lymphoplasmacytic proliferative diseases.It is an early stage of the disease and is not enough to diagnose multiple myeloma（MM） or lymphoma.This paper analyzed the clinical characteristics，diagnosis and treatment process with a differential diagnosis of renal damage of 1 case of MM with renal damage and 3 cases of different types of MGRS admitted to Department of Hematology，West Hospital of Beijing Chao-yang Hospital from March 2018 to February 2020.Following that，a systematic review was conducted based on the case report and related literature，and recommendations were obtained，such as bortezomib-based option is recommended for patients with abnormal plasma cell clone and rituximab-based option is recommended for those with abnormal proliferation of B lymphocyte clone.It is suggested that for a patient with monoclonal Ig or unexplained renal disease，early renal biopsy is needed to confirm whether he has MGRS.If MGRS is confirmed，then its classification should be determined following the diagnosis consensus and process proposed by the International Kidney and Monoclonal Gammopathy Research Group，which will contribute to early delivery of clone-directed targeted therapy，thereby improving the renal function and prognosis of the patient.
Application Prospect and Renal Outcomes of Novel Antidiabetic Agents in Patients with Type 2 Diabetes
YANG Guangran
Abstract: Diabetic nephropathy，a common microvascular complication of type 2 diabetes，has become one of the common causes of end-stage renal disease in China.Several randomized controlled studies conducted in recent years found that，some novel anti-diabetic agents including dipeptidyl peptidase-4 inhibitor，sodium-glucose cotransporter 2 inhibitor and glucagon-like peptide-1 receptor agonist，have significant renal protection outcomes beside hypoglycemia effect in patients with type 2 diabetes，moreover sodium-glucose cotransporter 2 inhibitor and glucagon-like peptide-1 receptor agonist were recommended by clinical guideline or consensus in the prevention and delay of diabetic kidney disease.This paper summarized and analyzed the outcome of novel anti-diabetic agents in renal protection outcomes in patients with type 2 diabetes based on recent clinical guidelines and related randomized controlled trials，in order to provide a reference for the better application of novel anti-diabetic agents in practice.
Causes and General-specialty Prevention Strategies for Drug-induced Renal Injury in the Elderly
WEI Shan，LIU Yingli*
Abstract: Drug-induced kidney injury（DKI）is a drug-induced kidney disease caused by adverse drug events or reactions，which may result in acute or chronic renal failure，seriously reducing the patients' quality of life，and increasing the economic burden on families and society. So the prevention of DKI has important clinical and social significance. The elderly is a high-risk group of DKI，among whom the incidence of DKI is about 10% to 65%.Therefore，identifying the causes of DKI，studying the special clinical medication characteristics，and strengthening medication education and management in the elderly are extremely important to promote medication safety and prevent DKI in this group. This review discusses the pathophysiological mechanism，risk factors，causes and general-specialty prevention strategies for DKI in the elderly.
Clinical Efficacy of Dexamethasone Combined with CTX in the Treatment of Middle-aged and Elderly Type 2 Diabetic Patients with Idiopathic Membranous Nephropathy
TAO Zhihu*，CHEN Jiahe，LI Xiaojian，MO Chao，SU Chaodong，HUANG Xuexia
Abstract: Background Glucocorticoids combined with immunosuppressive agents is are common treatment for idiopathic membranous nephropathy（IMN），but the use of short-term，long-acting hormones combined with cyclophosphamide（CTX）to treat diabetes with idiopathic membranous nephropathy has been rarely reported.Objective To explore the clinical efficacy of dexamethasone combined with CTX in the treatment of middle-aged and elderly type 2 diabetes patients with IMN，and evaluate its safety and pharmacoeconomic value.Methods According to the random number table method，86 patients hospitalized in the Department of Nephrology，the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine from 2014 to 2016 with type 2 diabetes and IMN who were divided into treatment group（41 cases）and control group（45 cases）.In the control group，2 patients had serious adverse reactions and withdrew from the trial，and finally 43 patients were included.The treatment group received 10 mg of dexamethasone sodium phosphate injection and 100 ml of 0.9% sodium chloride injection by intravenous drip every month，once a day，for 3 consecutive days；0.4 g of CTX for injection was added to 250 ml 0.9% sodium chloride injection by intravenous drip 1 time/d，for 2 consecutive days，the monthly dosage is 0.8 g，and the total amount reaches 8 g.The control group was given prednisone 1 mg?kg-1?d-1 combined with tacrolimus capsule 0.05 mg?kg-1?d-1，and the tacrolimus blood concentration need to maintain at 3-5 μg/L.After 8 weeks，the dose of prednisone was gradually reduced by 5 mg every 2 weeks until it reduced to 0.5 mg?kg-1?d-1 for maintaining 4 weeks，and the dose reduction was stopped at 10 mg/d for no less than 6 months.Test the liver function，blood routine，24 hour urinary protein，plasma albumin，serum creatinine（Scr），blood sugar，glycosylated hemoglobin and other indicators before treatment and 1，3，and 6 months after treatment，and compare the clinical efficacy，conduct drug reactions and pharmacoeconomic value between the two groups.Results The incidence of adverse reactions in the treatment group 〔12.02%（5/41）〕was lower than that in the control group 〔44.2%（19/43）〕（χ2=10.525，P=0.001）.The 24 hour urinary protein of the treatment group was higher than the control group after 1 month and 3 months of treatment，and the plasma albumin level was lower than the control group（P<0.05）；the 24 hour urinary protein of the treatment group was lower than the pre-treatment after 3 months and 6 months of treatment，plasma albumin was higher than the pre-treatment（P<0.05）；24 hour urinary protein in the control group was lower than the pre-treatment after 1 month，3 months and 6 months of treatment，and plasma albumin was higher than pre-treatmen（P<0.05））.The blood glucose levels of patients of the treatment group were lower than the control group after 1 month，3 months of treatment（P<0.05）；the blood glucose and HbA1c levels of the control group were higher than pre-treatment（P<0.05）after 1 month and 3 months of treatment.The complete remission rate and total effective rate of the treatment group after 3 months of treatment were lower than the control group，and the inefficiency was greater than the control group（P<0.05）.There was no significant difference in each index and clinical efficacy between the two groups after 6 months of treatment（P>0.05）. The cost-effectiveness analysis results showed that the control group had a significantly higher cost-effectiveness ratio（164.75）than the treatment group（30.51）.Conclusion The clinical efficacy of dexamethasone combined with CTX in the treatment of middle-aged and elderly patients with type 2 diabetes with IMN is equivalent to that of hormone combined with tacrolimus，C/E is significantly reduced，and the effect on blood sugar is small.
Predictive Values of Blood and Urine Analyses for Renal Colic and Appendicitis
CHEN Xiaobing*，WU Guichang
Abstract: Background Appendicitis and renal colic are two common causes of acute non-traumatic abdominal pain.Whether they can be diagnosed by common laboratory blood and urine analyses has become a focus of medical institutions with limited medical resources.Objective To explore the predictive value of blood and urine analyses for renal colic and appendicitis.Methods From January to December 2019，117 patients with a definite diagnosis of appendicitis or renal colic were recruited from The Sixth Affiliated Hospital of Sun Yat-sen University.General clinical data，results of laboratory blood and urine analyses were collected.Laboratory blood indicators〔white blood cell（WBC） count，red blood cell（RBC） count，neutrophil（NEUT） count，neutrophil percentage（NEUT%），ratio of WBCs to RBCs〕，and urine indicators〔WBC count，RBC count and ratio of WBC count to RBC count in urine〕 were compared between appendicitis and renal colic patients，and the predictive value of indicators with significant intergroup differences for renal colic and appendicitis was estimated using the receiver operating characteristic（ROC） curve analysis.Results Appendicitis and renal colic patients demonstrated no significant differences in mean WBC count，RBC count and NEUT count，NEUT% and ratio of WBC count to RBC count（P>0.05）.But appendicitis patients had lower mean RBC count and WBC count in urine，and higher ratio of WBC count to RBC count in urine（P<0.05）.So the ROC curve for estimating the predictive value of RBC count，WBC count，and ratio of WBC count to RBC count in urine for renal colic was plotted and the analysis revealed that the AUC of RBC count in urine was 0.921〔95%CI（0.877，0.964），P<0.01〕，with 0.892 sensitivity，0.864 specificity when the optimal cut-off value was chosen as 14.52/μl；the AUC of WBC count in urine was 0.705〔95%CI（0.628，0.782），P<0.01〕，with 0.486 sensitivity，0.864 specificity when the optimal cut-off value was chosen as 16.5/μl.The ROC curve for estimating the predictive value of RBC count，WBC count and ratio of WBC count to RBC count in urine for appendicitis was plotted and the analysis demonstrated that the AUC of ratio of WBC count to RBC count in urine was 0.742〔95%CI（0.662，0.822），P<0.01〕，with 0.838 sensitivity，0.606 specificity when the optimal cut-off value was chosen as 0.922.Conclusion RBC count，WBC count in urine may have good diagnostic value for renal colic，and the ratio of WBC count to RBC count in urine may have good diagnostic value for appendicitis.
Effects of Remote Diet Record versus Paper-based Three-day Diet Record on Nutritional Management Compliance of Patients with CKD
ZHANG Xianlong1，LIU Xusheng2，FU Lizhe2，TANG Fang2，ZHANG Dingjun1，WANG Linglan1，XIA Bingqing1，DONG Chendi1，WU Yifan2*
Abstract: Background Chronic kidney disease（CKD） and its complications greatly affect patients with CKD.There is evidence that nutrition management is a good adjuvant treatment for CKD，but patients' compliance is the difficulty of management.Remote management may improve compliance，but its effect is not clear.Objective To compare the effects of remote diet record and paper-based three-day diet record on the nutrition management compliance of CKD patients.Methods From November 1，2017 to December 31，2018，91 cases of CKD stage 3-5 patients（n=91） without dialysis treatment were recruited from Guangdong Provincial Hospital of Chinese Medicine.According to the random number table，they were divided into remote group and paper group.Essential treatment and nutrition management were given to them，and the information about three-day diet of 43 cases was collected and recorded via using the remote follow-up system in the remote group，and that of other 48 cases was collected by face-to-face interviews and was noted down as paper records in the paper group.The observation time was 48 weeks，during which a total of 12 follow-ups（a follow-up once every 4 weeks） were conducted.The compliance indices of the two groups during intervention were compared，including diet protein intake calculated based on diet dairy（dietary task-DPI），diet protein intake calculated based on normalized protein equivalent of nitrogen appearance rate（nPNA-DPI），and daily energy intake calculated based on diet diary（dietary task-DEI）.Results The analysis using the mixed linear model found that，the model with dietary task-DPI was influenced by grouping and follow-up time（Fgrouping=58.046，P<0.001；Ffollow-up=22.236，P<0.001），and so was the model with nPNA-DPI（Fgrouping=95.096，P<0.001；Ffollow-up=14.420，P<0.001）.And the grouping was the influencing factor of dietary task-DEI as well（Fgrouping=234.715，P<0.001）.Compared to paper group，the remote group showed significantly lower average nPNA-DPI at the 9th and 12th follow-ups（t=-2.142，-2.191；P=0.035，0.031）.Moreover，the remote group showed much higher qualified rate of dietary task-DPI at the 6th follow-up（χ2=5.099，P=0.024），and much higher qualified rate of nPNA-DPI at the 3rd，6th and 12th follow-ups（χ2=4.317，6.889，6.920；P=0.038，0.009，0.009）.There were no significant differences in estimated glomerular filtration rate，waist-to-hip ratio，total body moisture，fat-free body mass，upper arm circumference，upper arm muscle circumference，hemoglobin，albumin，total cholesterol and triglyceride between the two groups at the 12th follow-up（P>0.05）.Conclusion The protein and calorie intake of CKD patients can be optimized by remote diet record or paper-based three-day diet diary.In some aspects，the method of remote follow-up may be better than the paper record and offline follow-up.This suggests the importance of chronic disease management combined with the current progress of mobile medicine.
Effect of Tongluo Digui Decoction on Non-dipper Blood Pressure，Urinary Sodium Excretion，and Renin-angiotensin-aldosterone System in Patients with Stage Ⅳ Diabetic Kidney Disease
PANG Xinxin1，SHI Xiujie2，ZHANG Yage2，PENG Zining2，XING Yufeng2，HAN Jiarui2*
Abstract: Background Diabetic kidney disease（DKD）has become the leading cause of end-stage renal disease worldwide，whose development is independently associated with non-dipper blood pressure，but there is a lack of curative treatments.Traditional Chinese medicine treatment is considered to have potentials to treat DKD and non-dipper blood pressure.Objective To explore the effect of Tongluo Digui decoction on non-dipper blood pressure，urinary sodium excretion，and renin-angiotensin-aldosterone system（RAAS）in patients with stage Ⅳ DKD.Methods From January 2019 to March 2020，a total of 80 outpatients and inpatients with stage Ⅳ DKD were selected from the Departments of Nephrology and Endocrinology，Henan Province Hospital of TCM /The Second Affiliated Hospital of Henan University of Chinese Medicine，and were equally randomized into control group and observation group by random number table，receiving conventional Western treatment，and conventional Western treatment with Tongluo Digui decoction for 8 weeks，respectively.Pre- and post-treatment indicators of renal function（including Scr，BUN，24-hour urine protein quantification and eGRF），HbA1c，24-hour ambulatory blood pressure，blood pressure variability，percentage of non-dipper blood pressure，24-hour urinary sodium，and plasma levels of renin，angiotensin Ⅱ receptor and aldosterone as well as calculated reverse rate of non-dipper blood pressure were compared between the two groups.The incidence of adverse reactions during treatment was recorded.Results There were no dropouts，all cases completed the follow-up.Compared to baseline，mean levels of post-treatment Scr，BUN，24-hour urine protein quantification，HbA1c，24 hSBP，dSBP，dSBPCV and nSBPCV significantly lowered but eGFR increased in the two groups，moreover mean levels of post-treatment nSBP，nDBP，24 hSBPCV and nDBPCV significantly lowered in observation group（P<0.05）.The mean levels of post-treatment Scr，24-hour urine protein quantification，24 hDBP，nSBP，nDBP，nSBPCV and nDBPCV lowered more significantly and mean post-treatment eGFR level increased more notably in observation group than those in control group（P<0.05）.The observation group showed a lowered percentage of non-dipper blood pressure after treatment（P<0.05）.The post-treatment percentage of non-dipper blood pressure in observation group was lower than that in control group，so did the reverse rate of non-dipper blood pressure（P<0.05）.Plasma aldosterone level decreased significantly in both groups after treatment（P<0.05）.The post-treatment 24-hour urinary sodium showed a significant increase in observation group（P<0.05）.No one in the two groups occurred any obvious adverse reactions during treatment.Conclusion In patients with stage Ⅳ DKD，Tongluo Digui decoction based on conventional Western treatment is more helpful to improve the renal function，reduce the nocturnal blood pressure and blood pressure variability，as well as percentage of non-dipper blood pressure，improve the reverse rate of dipper blood pressure and 24 urinary sodium excretion，with relatively high safety and without significant effect on RAAS.
Interpretation of the KDOQI Clinical Practice Guideline for Nutrition in CKD：2020 Update
CHENG Gaiping1，QIN Wei2，LIU Jing1，LIU Yuan1*
Abstract: In September 2020，The National Kidney Foundation's Kidney Disease Outcomes Quality Initiative（KDOQI）updated its clinical practice guideline for nutrition in CKD.Since the publication of the initial KDOQI nutrition guideline 20 years ago，there has been a great accumulation of new evidence about the nutritional management of kidney disease.The guideline was expanded to include patients with end-stage kidney disease or advanced CKD，patients with stages 1-5 CKD without ongoing dialysis and patients with a functional kidney transplant.The updated guideline statements cover 6 primary areas：nutritional assessment，medical nutrition therapy，dietary protein and energy intake，nutritional supplementation，micronutrients，and electrolytes.The guidelines mainly include dietary management rather than all possible nutritional interventions.Focusing on the main contents of the guideline，the paper interpreted main recommendations and discussed the application in light of the actual situation in China.
Clinicopathological Characteristics and Prognosis of Minimal Change Nephropathy with Type 2 Diabetes Mellitus
YAO Xingchen1，2，ZHAI Yaling1，2，GAO Jingge1，2，CHEN Yazhuo1，2，WANG Xinnian1，2，LU Shan1，2，ZHAO Zhanzheng1，2*
Abstract: Background In recent years，type 2 diabetes（T2DM）incidence is increasing in the young population，and minimal change disease（MCD）combined with T2DM is becoming less uncommon clinically.But the clinical and pathological characteristics and prognosis of MCD with T2DM are still unclear.Objective To analyze the clinical and pathological characteristics and prognosis of patients with MCD combined with T2DM.Methods Participants with renal biopsy-confirmed MCD were recruited from Department of Nephrology，the First Affiliated Hospital of Zhengzhou University during from June 1，2017 to June 1，2018，including 20 with MCD and T2DM（MCD with T2DM group），and 100 with MCD（MCD group）from 306 with simple MCD using a random number table generated by the SPSS 22.0.The clinicopathological and follow-up data of all patients（follow up from the first renal biopsy to recurrence or to June 2019）were collected，and clinical manifestations，pathological characteristics and prognosis were retrospectively analyzed.Univariate and multivariate logistic regression analyses were used to explore the independent risk factors of MCD with T2DM.Log-rank test was used to compare the cumulative complete remission rate and cumulative relapse-free survival rate of MCD and MCD with T2DM groups.Results Compared with the MCD group，the median age，systolic blood pressure（SBP），fasting blood glucose，serum glycosylated hemoglobin（HbA1c），albumin（ALB）and serum IgG levels and prevalence of hypertension were higher，and male ratio，median levels of total cholesterol（TC），high-density lipoprotein（HDL），low-density lipoprotein（LDL）erythrocyte sedimentation rate（ESR），and 24-hour quantitative proteinuria were lower in MCD with T2DM group（P<0.05）.Moreover，MCD with T2DM group also showed higher rates of having higher severity of vascular injury and renal tubular atrophy，and higher prevalence of renal interstitial fibrosis，renal interstitial inflammation and glomerular sclerosis（P<0.05）.Univariate Logistic regression analysis showed that sex〔OR=5.108，95%CI（1.717，15.200）〕，age〔OR=1.068，95%CI（1.006，1.133）〕，hypertension〔OR=6.000，95%CI（1.982，18.165）〕，HbA1c〔OR=84.019，95%CI（12.465，566.317）〕，ALB〔OR=1.173，95%CI（1.100，1.250）〕，TC〔OR=0.730，95%CI（0.619，0.861）〕，ESR〔OR=0.978，95%CI（0.960，0.996）〕，24-hour quantitative proteinuria〔OR=0.818，95%CI（0.705，0.948）〕，IgG〔OR=1.568，95%CI（1.288，1.908）〕，prevalence of glomerular sclerosis〔OR=13.286，95%CI（4.142，42.614）〕，the severity of vascular injury，renal tubular atrophy and interstitial fibrosis〔OR=17.000，95%CI（4.833，59.794）〕 and renal interstitial inflammation〔OR=10.111，95%CI（2.684，38.087）〕were associated with MCD combined with T2DM（P<0.05）.Multivariate logistic regression analysis showed that IgG level〔OR=1.476，95%CI（1.190，1.831）〕and the severity of vascular injury and renal interstitial fibrosis〔OR=12.433，95%CI（2.032，76.065）〕were associated with MCD combined with T2DM（P<0.05）.Log-rank test showed that the cumulative complete remission rate of MCD with T2DM group was significantly lower than that of MCD group（P=0.027）.However，there was no significant difference in cumulative relapse-free survival rate of between the two groups（P=0.318）.Conclusion Compared with the MCD group，the clinical manifestations of MCD with T2DM group are relatively slighter，but the pathological manifestations are more serious，which indicates the importance of renal biopsy by clinicians.Renal interstitial fibrosis，severe vascular injury，and elevated IgG level are risk factors for MCD combined with T2DM.The prognosis of MCD combined with T2DM is poor.
Efficacy and Safety of Different Pharmacological Interventions for Progressive IgA Nephropathy：a Network Meta-analysis
LIU Tongtong，WANG Yuyang，YANG Liping，MAO Huimin，ZHAN Yongli*
Abstract: Background Patients with progressive IgA nephropathy （IgAN）have a significantly increased risk of developing end-stage renal disease.However，many available treatments for progressive IgAN have a high rate of side effects and insignificant long-term benefits.So choosing an appropriate regimen with good safety and efficacy is essential for the treatment of this disease.Objective To evaluate the efficacy and safety of different pharmacological interventions in the treatment of progressive IgAN by network meta-analysis.Methods Randomized controlled trials （RCTs）about different pharmacological interventions for progressive IgAN were searched in PubMed，EMBase，The Cochrane Library，CNKI，Wanfang Data，CBM and VIP databases from inception to March 31，2020.Literature screening，data extraction and risk of bias evaluation were performed by two reviewers independently.Stata 14.0 and GeMTC 0.14.3 were used to conduct a network Meta-analysis of the efficacy，improvement in 24 h urinary protein and creatinine levels and treatment-emergent adverse events in these patients with different pharmacological interventions.Results A total of 38 RCTs were included，including 3 034 patients，and 10 intervention programs：Prednisone （Pred），mycophenolate mofetil （MMF）combined with Pred，cyclophosphamide （CTX）combined with Pred，leflunomide （LEF）combined with Pred，cyclosporine （CsA）combined with Pred，traditional Chinese medicine （TCM）combined with immunosuppressant （ISD），TCM，MMF，LEF and supportive treatment.Network meta-analysis showed that：（1）In terms of the overall resonse，TCM combined with ISD was more superior to TCM〔RR=2.27，95%CI（1.14，4.65）〕，LEF combined with Pred〔RR=2.14，95%CI（1.05，4.45）〕，CTX combined Pred〔RR=3.92，95%CI（2.06，7.37）〕，Pred〔RR=3.57，95%CI（2.11，6.32）〕，LEF〔RR=5.88，95%CI（1.03，37.17）〕and supportive support treatment 〔RR=6.25，95%CI（2.86，13.82）〕（P<0.05）.Compared with CTX combined with Pred，CSA combined with Pred 〔RR=3.73，95%CI（1.54，9.10）〕 and MMF combined with Pred 〔RR=2.37，95%CI（1.33，4.44）〕 had more favorable overall resonse（P<0.05）.Compared with Pred，CSA combined with Pred 〔RR=3.37，95%CI（1.52，8.13）〕 and MMF combined with Pred 〔RR=2.13，95%CI（1.24，4.13）〕 had more favorable overall resonse（P<0.05）.（2）The incidence of adverse reactions of MMF combined with Pred〔RR=0.21，95%CI（0.09，0.49）〕，LEF combined with Pred〔RR=0.16，95%CI（0.08，0.34）〕，TCM combined with ISD〔RR=0.31，95%CI（0.13，0.72）〕，TCM〔RR=0.05，95%CI（0.01，0.22）〕，Pred〔RR=0.37，95%CI（0.18，0.73）〕and supportive treatment〔RR=0.24，95%CI（0.06，0.87）〕was lower than that of CTX combined with Pred（P<0.05）.LEF combined with Pred had a lower incidence of adverse reactions than CsA combined with Pred〔RR=0.28，95%CI（0.09，0.90）〕（P<0.05）.（3）For reducing 24 h urinary protein，MMF combined with Pred was more superior to CTX combined with Pred〔MD=0.55，95%CI（0.25，0.85）〕，LEF combined with Pred〔MD=0.53，95%CI（0.10，0.97）〕，supportive treatment〔MD=0.72，95%CI（0.24，1.20）〕，TCM〔MD=0.66，95%CI（0.16，1.15）〕，and MMF〔MD=0.62，95%CI（0.02，1.22）〕（P<0.05）.TCM combined with ISD lowered proteinuria level more significantly than CTX combined with Pred〔MD=0.42，95%CI（0.09，0.75）〕，LEF combined with Pred〔MD=0.40，95%CI（0.03，0.79）〕，Pred〔MD=0.41，95%CI（0.15，0.67）〕，TCM〔MD=0.53，95%CI（0.08，0.98）〕，and supportive treatment〔MD=0.59，95%CI（0.19，0.99）〕（P<0.05）.Compared with CTX combined with Pred〔MD=0.55，95%CI（0.04，1.06）〕，Pred〔MD=0.53，95%CI（0.07，1.01）〕，and supportive treatment〔MD=0.71，95%CI（0.11，1.32）〕，CsA combined with Pred had better effect on reducing proteinuria level （P<0.05）.（4）For reducing serum creatinine level，TCM combined with ISD was better than LEF combined with Pred 〔MD=19.69，95%CI（0.68，39.49）〕 and Pred 〔MD=14.50，95%CI（1.49，28.04）〕（P<0.05）.MMF combined with Pred showed better effects on lowering serum creatinine level than MMF〔MD=45.66，95%CI（0.40，91.16）〕（P<0.05）.Conclusion Considering the results，MMF combined with Pred，TCM combined with ISD， LEF combined with Pred have better clinical efficacy and higher safety in the treatment of progressive IgAN.
Continuous Renal Replacement Therapy for Exogenous Insulin Antibody Syndrome with Diabetic Ketoacidosis：a Case Report
FAN Yaqing，JIN Xiuping*
Abstract: Exogenous insulin antibody syndrome （EIAS） is associated with insulin antibodies （IAB） induced by exogenous insulin in diabetic patients.Its main characteristic is body's resistance to insulin，with decreased glycemic control effect produced by a given concentration of insulin.Severe insulin resistance is defined as insulin requirements > 200 U/d.This article reports a 62-year-old woman with type 2 diabetes，who suffered from insulin resistance after treatment with insulin aspart 30 （NovoRapid 30 Mix） for 24 days，which further induced severe ketoacidosis，with the insulin requirement up to 100 U/h.Finally，continuous renal replacement therapy （CRRT） was used for 63 hours to treat serious acidosis，abidance hyperglycemia，and remove the circulating antibodies，and the patient's condition improved gradually.This report suggests that patients with EIAS and diabetic ketoacidosis should be treated with CRRT early，when using glucocorticoids and increasing insulin doses can not control the symptoms of acidosis and hyperglycemia，by which a poor prognosis may be prevented
New Risk Factors of Cardiac Valve Calcification in Patients with Chronic Kidney Disease
TANG Rining1，2，3*，WANG Xiaochen2，WANG Liting2，CHEN Sijie2，ZHANG Yuxia2，ZHANG Shuofan2
Abstract: Background Cardiac valve calcification（CVC）may maximally increase the risk of developing cardiovascular disease in patients with chronic kidney disease（CKD）.Increasing understanding of bone mineral metabolism and the use of new non-calcium phosphate binders and calcimimetic agents in CKD patients，requires a new analysis of clinical characteristics of this population.And there are few studies on CVC in CKD patients as a risk factor for cardiovascular disease.Objective To explore the prevalence and risk factors of CVC in patients with CKD stages 3-5.Methods Patients with CKD stages 3-5 with and without dialysis treated in Department of Nephrology，Zhongda Hospital，Southeast University from August 2014 to July 2019 were selected and their demographic，serological and imaging data were collected.According to the presence of CVC，they were divided into calcification group and non-calcification group.Logistic regression and subgroup analyses were used to explore the risk factors of CVC.Results Of the included 1 383 cases，619（44.8%）were identified with CVC，of whom 426（30.8%）with aortic valve calcification（AVC），37（2.7%）with mitral valve calcification（MVC），150（10.9%）with both AVC and MVC，and 6（0.4%）with other diseases.Compared to non-calcification group，calcification group had higher proportions of women，dialysis recipients，previous or present users of statins，and cases with elevated C-reactive protein（more than 3 mg/L），greater mean age，higher prevalence of concomitant diabetes，concomitant hypertension，concomitant coronary heart disease，concomitant cerebral infarction and left ventricular hypertrophy，and higher mean levels of serum calcium，albumin and alkaline phosphatase（P<0.05）.Calcification group also showed lower proportion of previous or present users of calcium carbonate，and lower mean levels of creatinine，triglyceride，total cholesterol and low-density lipoprotein（P<0.05）.In multivariate logistic regression analysis，older age 〔OR=1.065，95%CI（1.053，1.077）〕，dialysis 〔OR=1.917，95%CI（1.423，2.582）〕，concomitant coronary heart disease 〔OR=1.608，95%CI（1.134，2.281）〕，lower level of hemoglobin 〔OR=0.993，95%CI（0.987，0.999）〕，higher level of alkaline phosphatase 〔OR=1.002，95%CI（1.000，1.003）〕 and elevated C-reactive protein（more than 3 mg/L）〔OR=1.478，95%CI（1.095，1.995）〕 were significantly associated with the presence of CVC in patients with CKD（P<0.05）.Advanced age 〔OR=1.078，95%CI（1.057，1.099）〕 and history of statins use 〔OR=1.853，95%CI（1.003，3.424）〕 were risk factors of CVC in non-dialysis patients with 3-5 stages of CKD（P<0.05）.Advanced age 〔OR=1.081，95%CI（1.061，1.101）〕，long dialysis duration 〔OR=1.123，95%CI（1.067，1.181）〕，hypertension 〔OR=3.071，95%CI（1.453，6.490）〕 and history of calcium carbonate use〔OR=0.515，95%CI（0.300，0.882）〕 were risk factors for CVC in patients with CKD stage 5D and dialysis duration more than one year（P<0.05）.Conclusion The prevalence of CVC in patients with CKD stages 3-5 was 44.8% in our study.And the prevalence of AVC was higher than that of MVC.Elevated alkaline phosphatase，lower level of hemoglobin，older age，dialysis，concomitant coronary heart disease and elevated C-reactive protein may be potential risk factors of CVC in these patients.
Evaluation of Predictive Parameters of Urinary Tract Infection in Patients with Acute Renal Colic
CHEN Chunlan，XU Heping*，ZHUO Xiaoan，KUANG Lei，LI Jindie
Abstract: Background Acute renal colic（ARC） is an emergency that can be treated conservatively，but its combination with urinary tract infection（UTI） can be life-threatening.Infection evaluation parameters include white blood cell count（WBC） and C-reactive protein（CRP） levels，but they may not significant increase.Objective To evaluate the prevalence of UTI in ARC patients diagnosed based on urine culture，and the predictive value of emergency routine blood and urine tests in ARC with UTI.Methods 200 consecutive patients with ARC due to ureteral calculi were recruited from Emergency Department，Hainan General Hospital from December 2017 to December 2018，196 ARC patients met the inclusion and exclusion criteria，including 26 with UTI（infected group） and 170 without（non-infected group） diagnosed by 3 times of urine culture.General information，including gender，age，time from onset of symptoms to emergency visit，average temperature，history of diabetes and immunodeficiency was collected.White blood cell count，and serum CRP were measured，and nitrite urine test and midstream urine culture were performed.Multivariate logistic regression analysis was used to explore the influencing factors of emergency ARC with UTI.ROC curve analysis was used to evaluate the clinical value of predictive parameters in emergency ARC with UTI.Results The infected group had higher age，higher prevalence of positive result of nitrite in urine and higher average serum CRP than non-infected group（P<0.05）.Multivariate Logistic regression analysis showed that age，nitrite in urine，and CRP were the influencing factors of UTI in ARC patients（P<0.05）.For the prediction of UTI in ARC，the AUC of age was 0.754〔95%CI（0.688，0.813）〕 with 65.4% sensitivity，76.5% specificity，93.5% negative predictive value（NPV） and 29.8% positive predictive value（PPV） when the optimal cut-off point was determined as 56 years old，the AUC of serum CRP was 0.682〔95%CI（0.612，0.747）〕 with 53.9% sensitivity，80.6% specificity，91.9% NPV and 29.8% PPV when the optimal cut-off point was determined as 8.3 mg/L，and the AUC of positive result of nitrite in urine was 0.698〔95%CI（0.597，0.905）〕 with 69.2% sensitivity，93.0% specificity，94.2% NPV，and 30.3% PPV.Conclusion Age，nitrite in urine，and serum CRP are associated with UTI in ARC.≥56 years old，serum CRP≥8.3 mg/L，and positive nitrite result in urine may have higher predictive value for UTI in ARC.
Relationship between Blood Pressure Level and Renin-aldosterone System Activity in Patients with Essential Hypertension：a Meta-analysis
YUAN Bo1，MA Qing 2，LI Wenfei3，LI Zhipeng2*
Abstract: Background Increased aldosterone is an important risk factor for cardiac hypertrophy，heart failure and renal impairment，leading to more serious damage to the target organs of hypertension such as heart and kidney.Except for primary aldosteronism（PA），clinical evidence shows that plasma rennin activity and aldosterone are elevated in some patients with essential hypertension.However，there are few studies on the correlation between blood pressure level and plasma renin activity and aldosterone levels in patients with essential hypertension，and the conclusions are also inconsistent.Objective To investigate the relationship between blood pressure and renin-aldosterone system activity，and the potential pathophysiological mechanism of hyperaldosteronemia in essential hypertension patients，to provide a theoretical basis for early treatment of essential hypertension and delaying the development of related target organ damages.Methods The databases of PubMed，Embase，CNKI，CQVIP and Wanfang Data Knowledge Service Platform were searched from inception to January 2020 to identify articles about the relationship between blood pressure and renin-aldosterone system activity in patients with essential hypertension.Two researchers independently screened the literature based on the inclusion and exclusion criteria，extracted the data，and evaluated the quality using the Newcastle-Ottawa Scale.RevMan 5.2 was used to conduct meta-analysis.Results A total of 16 articles with Chinese essential hypertensive individuals（n=1 885）compared to healthy controls（n=1 438）as the participants were included.All scored above 5 points on the Newcastle-Ottawa Scale.The results of meta-analysis showed that plasma renin activity〔MD=0.40，95%CI（0.04，0.76）〕in essential hypertensive individuals was significantly higher〔MD=60.03，95%CI（22.28，97.79）〕than that of controls in general（P<0.05）.But the supine and standing values of plasma renin activity 〔MD=-1.27，95%CI（-1.37，-1.16）；MD=-1.67，95%CI（-1.88，-1.46）〕were lower in essential hypertensive individuals（P<0.05）.Essential hypertensive individuals had higher plasma aldosterone level than the controls 〔MD=60.03，95%CI（22.28，97.79）〕on the whole.They also showed higher supine and standing plasma aldosterone levels〔MD=0.07，95%CI（0.06，0.09）；MD=0.22，95%CI（0.05，0.39）〕（P<0.05）.Conclusion （1）Plasma renin activity and aldosterone levels in patients with essential hypertension were different from those with normal blood pressure.The supine and standing values of plasma renin activity were decreased，and supine and standing values of plasma aldosterone were elevated in essential hypertensive patients.（2）In some patients with essential hypertension，the changes of plasma renin and aldosterone are inconsistent，suggesting that elevated aldosterone may be not renin-dependent in essential hypertension，and mineralocorticoid receptor antagonists should be chosen for antihypertension.
Recent Advances in Chinese and Western Medicine Treatments for Diabetic Kidney Disease
Ying WANG1,1, Jingwei ZHOU1,1, Zhen WANG1,1, Yingxia YANG1,1, Yaoxian WANG2,2
Abstract: Diabetic kidney disease (DKD) is a leading cause of chronic kidney disease in China, which greatly negatively impacts public health and patients' quality of life. Recently, multiple guidelines have updated their recommendations to optimize the treatment and management of individuals with DKD. New antihyperglycemic drugs offer new options for DKD. Traditional Chinese medicine (TCM) has a long history in treating DKD, and relevant theories have been continuously enriched and developed. Along with the increasing application of evidence-based medicine in TCM research, the benefits of TCM treatments in DKD have been gradually recognized and valued, such as relieving fatigue, edema, backache and other symptoms, lowering protein in the urine, protecting kidney function, enhancing treatment efficiency, reducing the risk of end-stage renal disease, and improving the long-term prognosis. This article gave a summary and strengths analysis of the latest advances in TCM and Western medicine treatments for DKD.
Influencing Factors of Anemia in Patients with Diabetic Kidney Disease
Shili SHANG, Zijuan SUN, Lina BI, Wenjing ZHOU, Daiyu SHEN, Jingshan CHEN, Sha LUO, Yuerong FENG, Qian YANG, Jun LI
Abstract:
Background
Patients with diabetic kidney disease (DKD) are more prone to anemia than those with non-diabetic kidney disease. Anemia quickens the progression of DKD, and is closely associated with cardiovascular disease and other complications. So studying the influencing factors of anemia in DKD is of great importance to the reduction of anemia incidence and the delaying of DKD progression.
Objective
To investigate the influencing factors of anemia in DKD.
Methods
Two hundred and fifty-four inpatients with DKD were selected from Department of Nephrology, First Affiliated Hospital of Kunming Medical University from January 2019 to September 2020. Data of them were retrospectively collected, including demographic information 〔gender, age, height, weight, blood pressure, duration of diabetes, calculated body mass index (BMI) , and smoke prevalence〕, and laboratory test indices 〔red blood cells (RBC) , serum hemoglobin (Hb) , total protein (TP) , albumin (ALB) , globulin (GLB) , alkaline phosphatase (ALP) , cholinesterase (CHE) , uric acid (SUA) , blood urea nitrogen (BUN) , creatinine (Scr) , cystatin C (Cys C) , retinol binding protein (RBP) , fasting plasma glucose (FPG) , calcium (Ca) , phosphorus (P) , magnesium (Mg) , zinc (Zn) , iron, unsaturatediron binding capacity (UIBC) , total iron binding capacity (TIBC) , ferritin, transferrin (TRF) , C-reactive protein (CRP) , and erythrocyte sedimentation rate (ESR) , glycated hemoglobin (HbA1c) , UALB/CRE, 24-hour urine for microalbumin (24 h-mALB) , 24-hour urine for total protein (24 h-MTP) 〕 and estimated glomerular filtration rate (eGFR) . One hundred and sixteen cases were diagnosed with anemia, and 138 without (anemia was defined as serum Hb≤130 g/L for men, and ≤120 g/L for women) . Spearman rank correlation analysis and multiple linear regression analysis were used to explore the factors associated with anemia in DKD.
Results
Compared with patients without anemia, those with anemia had higher systolic blood pressure, and longer duration of diabetes (P<0.05) . Moreover, anemia patients had lower levels of RBC, Hb, TP, ALB, GLB, CHE, eGFR, serum Ca, Zn, iron, UIBC, TIBC, ferritin, and TRF, and higher levels of BUN, Scr, Cys C, RBP, FPG, serum P, Mg, CRP, ESR, and HbA1c, UALB/CRE, 24 h-mALB, as well as 24 h-MTP (P<0.05) . Spearman rank correlation analysis showed that Hb was positively correlated with TP, ALB, CHE, eGFR, FPG, serum Zn, and iron, UIBC, TIBC, and ESR (P<0.05) and negatively correlated with SBP, duration of diabetes, BUN, Scr, serum Cys C, P, CRP, HbA1c, UALB/CRE, 24 h-mALB, and 24 h-MTP (P<0.05) . Multiple linear regression analysis showed that duration of diabetes (β=-0.060) , ALB (β=0.755) , CHE (β=1.512) , Zn (β=1.173) , and HbA1c (β=-5.766) in serum, and eGFR (β=0.341) were independently associated with serum Hb in DKD (P<0.05) .
Conclusion
Anemia in DKD may be associated with the duration of diabetes, serum levels of ALB, CHE, Zn and HbA1c, as well as eGFR. The above-mentioned influencing factors should be actively corrected to reduce the incidence of anemia and to improve the quality of life in DKD patients.
Moxibustion on Governor Vessel Acupoints Improves the Cognitive Function and TCM Symptoms in Patients with Post-stroke Mild Cognitive Impairment Due to Deficiency of Kidney Essence
Yan WANG1,1, Yanjie BAI2,2(), Ming ZHANG2,2, Xiaoxiao LI1,1, Yongchuang ZHANG1,1
Abstract:
Background
Post-stroke mild cognitive impairment (PSMCI) is a common complication after stroke, which negatively affects patients' full recovery from stroke and imposes financial and emotional pressure on their families.
Objective
To observe the clinical efficacy of moxibustion on Governor vessel on the cognitive function and TCM syndromes in PSMCI due to deficiency of kidney essence.
Methods
Eligible patients with PSMCI (n=60) who were treated in Rehabilitation Center, the First Affiliated Hospital of Henan University of CM from July 2020 to July 2021 were selected, and evenly randomized to a control group (routine basic treatment plus routine cognitive rehabilitation training) and a moxibustion group 〔routine basic treatment plus routine cognitive rehabilitation training and moxibustion on the Governor vessel acupoints (once daily, five times per week) 〕, received four consecutive weeks of treatment. The Mini-Mental State Examination (MMSE) , and Montreal Cognitive Assessment (MoCA) were used to assess the cognitive function. Symptoms of kidney essence deficiency was assessed by the Scale for the Differentiation of Syndromes of Vascular Dementia (SDSVD) . And quality of life was measured by the Specifications for Stroke-Quality of Life (SS-QOL) . The overall clinical efficacy and safety of the two treatments were evaluated.
Results
Pre- and post-treatment comparisons of scores of MMSE and MoCA, SDSVD, and SS-QOL revealed that moxibustion group patients group had greater improvements in cognitive function, symptoms of kidney essence deficiency, and quality of life than control group patients (P<0.05) . Moreover, moxibustion group patients had better clinical outcomes (P<0.05) . The safety of treatment showed no significant intergroup differences (P>0.05) .
Conclusion
Moxibustion of the Governor vessel helps to better improve the cognitive function and TCM symptoms of PSMCI patients due to deficiency of kidney essence with good clinical efficacy and safety.
Advances in Diagnosis and Management of Acute Kidney Injury Induced by Crush Syndrome
WANG Jinxiang，DONG Yuxin，ZHAO Yibo，MENG Xianglong，CHAI Yanfen，JIN Heng*
Abstract:
Crush syndrome (CS) often occurs in victims of natural disasters, trauma and traffic accidents, which mainly manifests as hypovolemic shock, acute kidney injury (AKI) , hyperkalemia, and acidosis, among which AKI is a major cause of the continuing high mortality of CS. Current treatments for AKI induced by CS include early rehydration, symptomatic treatment and renal replacement therapy, but the effects are not satisfactory. There are no standard treatment options for CS-related AKI, so identifying the pathogenesis of this disease and formulating an effective treatment regimen may be problems need to be solved urgently. This article reviews the latest advances in pathogenesis and treatment strategies of CS-related AKI.