Objective To discuss clinical effects of transurethral electrovaporization of the prostate(TUVP) for the treatment of large benign prostatic hyperplasia(BPH).Methods A total of 126 cases of large BPH were treated with TUVP.Two longitudinal trenches were made at the position of 6 and 12 o'clock,respectively.Then the lateral lobe was retrogradely dissected from the proximal end of the seminal colliculus and was removed.Results The international prostate symptom scores(IPSS) decreased from 28.6?4.5 preoperatively to 10.7?2.6 postoperatively(t=38.661,P=0.000);the quality-of-life scores(QOL) decreased from 5.3?0.7 preoperatively to(2.0?)0.5 postoperatively(t=43.061,P=0.000);the maximum urinary flow rate(Qmax) increased from 5.7?3.6 ml/s preoperatively to 18.2?4.2 ml/s postoperatively(t=-25.365,P=0.000);the resident urine(RU) decreased from 312.4?56.6 ml preoperatively to 32.8?9.2 ml postoperatively(t=54.732,P=0.000).There were significant differences in all these parameters between preoperatively and postoperatively.Threatened transurethral resection syndrome(TURS) occurred during operation in 2 cases.Postoperatively,transient urinary incontinence was observed in 5 cases.Conclusions Transurethral electrovaporization of the prostate for the treatment of large BPH is effective and safe.

Objective To study the expression of nephrin, podocin and ? actinin in glomeruli in puromycin aminonucleoside (PAN) nephrosis rat,and to disclose the possible association of these molecules with the development of proteinuria and the relation among these molecules′changes. Methods PAN nephrosis rat models were established by a single intraperitoneal injection of PAN. Indirect immunofluorescence (IF) staining and real time quantitative reverse PCR were used to study the expression of nephrin, podocin and ? actinin in glomeruli of model rats at 12 hours, 1 day, 36 hours,2 days, 5 days, 10 days, 15 days and 20 days after PAN injection. Results (1)In PAN rats, the urinary protein reached the peak level (P=0 02) at the 10th day and decreased back to control level at the 20th day. (2)The IF intensity of podocin decreased significantly at the 36th hr (P=0 04), the 2nd day(P=0 03), the 5th day(P=0 04) and the 10th day(P=0 006),while at the 15th day,the intensity began to recover (P=0 007)and reached to the control level at the 20th day. The distribution of podocin showed a linear pattern along the glomerular capillary wall (GCW) in control rats and discontinuous in PAN rats. (3)The intensity of nephrin staining decreased significantly at the 5th day (P=0 002), 10th day (P=0 007) and began to recover at the 15th day (P=0 04), while still abnormal at the 20th day(P=0 02). The distribution of nephrin in control rats showed a linear pattern along the GCW whereas a discontinuous pattern in PAN rats from the first day throughout the course. (4)The intensity of ? actinin in PAN rats increased significantly at the 20th day(P=0 009) accompanied by the increase of area ratio (P=0 007). (5)The mRNA of nephrin decreased(P =0 02)at the 5th day and recover at the 10th day. Conclusions Nephrin and podocin change prior to the presence of heavy proteinuria, which suggests their causative effects to proteinuria in PAN nephrosis. The distribution changes of nephrin and podocin occurre before the decrease of their expression level and seem to be an initial trigger factor of proteinuria. The significant decrease and recovery of podocin presents earlier than those of nephrin.The proteinuria level is correlated with the expression of podocin and nephrin.

Objective: To investigate the association between nephrin, podocin and ? actinin of the glomerular podocyte molecules, the morphometric change of podocyte foot process and the development of proteinuria. Methods: Puromycin aminonucleoside (PAN) nephrosis was established. Immunofluorescence staining, image analysis and real time quantitative PCR were employed to study the distribution and quantitation of glomerular expression of nephrin, podocin and ? actinin. Morphometric methods were applied to evaluate the morphology change of podocyte foot processes under electron microscopy. Results: (1) Before the onset of proteinuria, 2 days after PAN injection, the podocyte foot process became swollen;nephrin and podocin staining were changed into discontinuous pattern accompanied by the decrease of podocin staining intensity. The foot process became more swollen on day 5,and podocin intensity continued to decrease. Meanwhile, nephrin decreased significantly both in protein intensity and at mRNA level. (2) When heavy proteinuria [(130.8?30.7) mg/d, P =0.02]occurred, complete effacement of podocyte foot processes was revealed; both podocin and nephrin staining intensity decreased dramatically( P

Objective To investigate the etiology composition of end-stage renal disease (ESRD) in children,in order to provide reference for the prevention and treatment.Methods The children with ESRD who were diagnosed in Peking University First Hospital from January 2005 to October 2013 were selected,and the etiology composition and incidence of the children with ESRD were retrospectively analyzed.Diagnostic criteria for children with ESRD refer to the clinical practice guidelines for chronic renal disease (NKF/KDOQI),developed by the American kidney foundation in 2002.Results Eighty-six children with ERSD were enrolled including 53 cases of males,33 cases of females,with the male to female ratio of 1.61 ∶ 1.00 and the mean onset age was (7.08 ± 4.23) years old,and their average diagnosis age was(9.25 ±4.17) years old.The median duration of ERSD before diagnosis was 0.84(0.01-13.67)years.The main cause of ESRD was acquired renal disease,accounting for 43.02％ (37/86 cases),mainly the chronic glomerulonephritis (18/86 cases,20.93％) and nephrotic syndrome (16/86 cases,18.60％);followed by urinary congenital abnormity,accounting for 40.70％ (35/86 cases),in which the most common were renal dysplasia (18/86 cases,20.93％) and cystic renal disease (11/86 cases,12.79％).Children under 3 years old mainly showed congenital urinary tract abnormalities(6/10 cases,60.00％).But children over 3 years old mainly showed acquired renal diseases (37/76 cases,48.7％),and pathologic classification of glomerular disease were proliferative mesangial glomerulonephritis (6/23 cases,26.09％),focal segmental glomerulosclerosis (5/23 cases,21.74％) and interstitial nephritis(3/23 cases,13.04％).Conclusions The main etiology of ESRD is glomerular disease and congenital abnormal development of urinary system,therefore,more attention should be paid on the ultrasound screening of the urinary tract in the perinatal period and urine screening in children.There are great significances in reducing the incidence of ESRD and intervening actively the progression to chronic kidney disease.

OBJECTIVETo investigate the clinical characteristics, renal pathology, treatment and prognosis of children with atypical hemolytic uremic syndrome associated with H factor antibody.

METHODFour children less than 18 yr of age admitted from Nov. 2010 to May 2011 in Peking University First Hospital were included. They all met the criteria for atypical hemolytic uremic syndrome and with positive serum anti factor H antibody. They aged from 5 to 11 yr. Data on clinical manifestations, renal pathology, treatment and prognosis were analyzed.

RESULTAll of the 4 cases had gastrointestinal symptoms such as vomiting, abdominal pain, or abdominal distension. None of them had diarrhea. Two children had hypertension. One child had episodes of convulsion. One child had history of atypical hemolytic uremic syndrome. All of them had low serum complement C3. Three of them had low serum factor H (38.0, 88.4, 209.4 mg/L). All of them had serum antibody to factor H (1: 7 068, 1: 1 110, 1: 174, and 1: 869). Three of them received renal biopsy, all of them showed thrombotic microangiopathy. All of them were treated with steroid combined with mycophenolate mofetil. Two children received plasma exchange. They were followed up for 8 to 29 months. The renal function became normal and proteinuria relieved in all of them. The serum factor H concentration increased to 405.8, 155.8 and 438.4 mg/L, respectively. The titer of anti factor H antibody decreased to 1: 119, 1: 170, 1: 123, and 1: 674, respectively.

CONCLUSIONGastrointestinal symptom is common in children with atypical hemolytic uremic syndrome associated with H factor antibody. Hypocomplementemia was observed in all of them. Steroid combined with mycophenolate mofetil seemed to be effective for them. The monitoring of serum factor H and antibody to factor H may help diagnosis and treatment.

Atypical Hemolytic Uremic Syndrome ; Autoantibodies ; blood ; immunology ; Child ; Child, Preschool ; Complement Factor H ; immunology ; Creatinine ; blood ; Female ; Hemolytic-Uremic Syndrome ; drug therapy ; immunology ; pathology ; Humans ; Kidney ; pathology ; physiopathology ; Kidney Function Tests ; Male ; Mycophenolic Acid ; administration & dosage ; analogs & derivatives ; therapeutic use ; Plasma Exchange ; Prednisolone ; administration & dosage ; therapeutic use ; Prognosis ; Retrospective Studies

OBJECTIVETo analyze the clinical and genetic features of X-linked Alport syndrome (XLAS) in men positive for the collagen α5(Ⅳ) chain in epidermal basement membrane.

METHODThis was a retrospective study. Totally 725 families were diagnosed as Alport syndrome in Department of Pediatrics of Peking University First Hospital during January 1998 to December 2014, among them 450 patients were males with XLAS. Patients who met both of the following two criteria were included in this study. (1)Patients underwent α5(Ⅳ) chain staining in the epidermal basement membrane. (2)Mutations in COL4A5 gene were detected.Mann-Whitney test and χ(2) test were used.

RESULTTotally 140 males with XLAS were included in this study, 18 cases were α5 (Ⅳ)-positive and 122 cases were α5 (Ⅳ)-negative. The two groups of patients were compared, the median age at analysis was 11.0 vs. 7.2 years (Z = -1.839, P = 0.066), the 24-hour urine protein was 1.50 vs. 0.57 g/d (Z = -1.212, P = 0.226), the rate of hearing loss was 28% vs. 53% (χ(2) = 3.619, P = 0.067), the number of patients progressed to end stage renal disease (ESRD) was 4 vs. 12 (χ(2) =2.377, P = 0.128), the median age of ESRD was 31.0 vs. 16.6 years (Z = -2.554, P = 0.011), the rate of missense mutations in COL4A5 gene was 67% vs. 52% (χ(2) = 1.424, P = 0.313).

CONCLUSIONCompared the two groups of patients with positive and negative staining for the collagen Ⅳ α5 chain in epidermal basement membrane, there was no significant difference in the proteinuria level, the rate of hearing loss and genotype of COL4A5 gene. But the patients with positive staining progressed to ESRD significantly later than the patients with negative staining.

Basement Membrane ; pathology ; Child ; Collagen Type IV ; genetics ; DNA Mutational Analysis ; Deafness ; Humans ; Kidney Failure, Chronic ; Male ; Mutation, Missense ; Nephritis, Hereditary ; genetics ; pathology ; Proteinuria ; Retrospective Studies