Objective To investigate the role of transmission electron microscopy (TEM) on the diagnosis of cryoglobulinemia related glomerulonephritis. Methods Sixteen cases which showed glomerular organized deposits by TEM in the renal biopsy specimens were collected in our hospital during last six years. Their clinical data, renal pathological features and ultrastructural morphology were analysed. Results Four cases had positive serum cryoglobulin were diagnosed as cryoglobulinemia related glomerulonephritis. Serum cryoglobulin was not available in the other 12 cases, who were suspected as cryoglobulinemia related glomerulonephritis. All patients had proteinuria with microscopic hematuria,and some cases had nephrotic syndrome, hypertension and mild to moderate renal insufficency. The main pathological pattern was membranoproliferative glomerulonephritis.Endocapillary proliferation with an infiltration of monocytes was observed in these cases. Glomerular subendothelial deposits and intraluminal thrombi was their prominent features. Organized electron-dense deposits were identified by TEM, whose deposits organized into microtubular, fibrillary, crystalline-like and granular structures, and were demonstrated mainly in glomerular subendothelia and capillary lumen. Most of cases were considered as cryoglobulinemia related glomerulonephritis by the ultrastructural findings of glomerular organized deposits. Conclusion Glomerular organized deposits identified by TEM provide important diagnostic implications for cryoglobulinemia related glomerulonephritis.

Objective:To investigate and compare the effect and the possible mechanisms of 2 hypoxia-inducible factors(HIF) 1? and 2? on renal cell carcinoma(RCC) by RNA interference(RNAi) method.Methods: Chemically synthesized HIF-1? and HIF-2? RNAi were transfected into RCC cell line A498 by liposome transient transfection.Normal proximal tubule cell line HK-2 and A498 were separately treated with medium and liposome as controls.The expressions of VEGF,ET-1,bcl-2 and Ki67 were observed by RT-PCR or Western blot 24 h after RNAi.Cell apoptosis was detected by flow cytometry and fluorescence microscopy.Results: Expressions of HIF-1? and HIF-2? RNAi were higher in A498 than those in HK-2,and the 2 genes were successfully blocked after RNAi.HIF-1? RNAi resulted in a significant decrease of ET-1,bcl-2 and Ki67 expression,with increased apoptosis and necrosis of cells.HIF-2? RNAi only resulted in a decrease of VEGF.Conclusion: Both HIF-1? and HIF-2? play important roles in regulation of angiogenesis; moreover,HIF-1? might also regulate proliferation of tumor cells,possibly through regulating anti-apoptotic genes.It is implied the existance of different transcription regulation functions and gene combining sites between HIF-1? and HIF-2?.

Objective To evaluate the effects of fentanyl transdermal system on intractable postherpetic neuralgia .Methods 30 patients(after 1 course of conventional drugs with nerve block therapy ,VAS score>5 points)were randomly divided into tramadol group(group T ) and fentanyl group(group F) ,15 cases in each group .Results VAS of the two groups decreased after treatment (P<0 .05) ,group F decreased more significantly(P<0 .05) .The quality of life scores after treatment in two groups were signifi-cantly increased(P<0 .05) ,group F scoring was higher(P<0 .05) .The incidence of side reaction ,nausea and vomiting was lower in group F(P>0 .05) .The incidence of dysuria was 26 .67% in group T ,and there was no dysuria in group F(P<0 .05) .Constipation of group T was 40% after treatment(P<0 .05) .The incidence of somnolence of group F was higher than T group(P<0 .05) .The two groups were no respiratory depression .Conclusion Fentanyl transdermal system for intractable postherpetic neuralgia has good analgesic effect ,less side effect ,and well-tolerated .

Objective: To detect the localization of HBV DNA in kidneys of HBV-associated glomerulonephritis, and investigate the pathogenesis of HBV-associated glomerulonephritis. Methods: 45 cases of renal biopsy specimens (38 cases had glomerular deposition of HBV antigens, 7 cases were negative for serologic and histologic HBV antigens) were examined for HBV DNA by in situ hybridization (ISH) and in situ PCR (IS-PCR). Results: The positive rate of HBV DNA in renal biopsy was 71% (27/38) in patients with glomerular deposition of HBV antigens. HBV DNA was found in 19 cases (19/26, 73%) of HBV-associated glomerulonephritis; and in 8 cases (8/12, 67%) of IgA nephropathy and lupus nephritis with glomerular deposition of HBV antigens. HBV DNA was detected mainly in the cytoplasm of tubular epithelia with ISH; IS-PCR showed that HBV DNA was localized not only in cytoplasm of tubular epithelia, but also in nuclei of tubular epithelia, in nuclei and cytoplasm of glomerular epithelia and mesangial cells, and in GBM. Conclusion: Our study suggested the presence of HBV infection and replication in glomerular cells and renal tubular epithelia, indicating an etiologic role of HBV in HBV-associated glomerulonephritis.

Objective To investigate the clinical and pathological characteristics of IgAN with moth-eaten lesions of GBM.Methods Seven hundred and fifty-six primary IgAN patients(from 1997.1 to 2003.12)were divided into two groups according to the ultrastructural changes of GBM:the IgAN with moth-eaten GBM lesions group(24 cases)and the IgAN without moth-eaten GBM lesions group(101 cases randomly selected).The moth-eaten GBM lesions revealed a local dilatation of irregular outline.Small fragments of the splitting or branching lamina densa were occasionally seen in the swollen GBM.Results The incidence of moth-eaten GBM lesions in IgAN were 3.1%.There were more severe hematuria and proteinuria[(3.5?2.5)g/d vs(2.1?2.4)g/d]and higher percentage of glomerular sclerosis(62.5% vs 49.5%)in moth-eaten GBM lesions group than in the non-moth-eaten GBM lesions group(P﹤0.05).During mean 27 months'follow-up in the 17 patients,none of them showed worse outcome.Conclusion This result suggests that moth-eaten GBM lesions relate to more severe clinical manifestations and pathological changes but further studies are required to clarify the influence of moth-eaten GBM lesions on the prognosis of IgAN.

Objective To investigate recurrent spontaneous abortion patients received bends the clinical application effect of nursing intervention during progesterone treatment. Methods Two patients with recurrent spontaneous abortion group were treated with progesterone treatment, the control group in the conventional nursing service only provides flexor progesterone treatment on the basis of comprehensive nursing service study group progesterone treatment on the basis of routine the combination of nursing and nursing intervention in the 2 groups of patients with recurrent spontaneous abortion. The success rate of pregnancy were recorded, the rate of abortion, the data will be given the statistical analysis (using SPSS software) after the conclusion. Results The study group of patients with recurrent spontaneous abortion pregnancy success rate (95.45%) and control group (90.91%) there is no significant difference between the study group of patients with recurrent spontaneous abortion abortion rate (6.82%) was significantly lower than the control group (34.09%), there was significant difference between the groups, P<0.05. Conclusion Recurrence During the treatment of flexor progesterone abortion were given routine nursing and nursing intervention combined with the comprehensive clinical nursing service can obtain ideal success rate of pregnancy, to reduce the rate of abortion is also of positive significance, is conducive to the protection of patients' quality of life, physical and mental health.

Objective To detect the proteins structure encoded by COL4A4 gene with different missense mutations of thin basement membrane nephropathy (TBMN) and to analyze the effect of gene mutation on the secondary structure of α4 (Ⅳ) chain and its association with phenotype. Methods A COL4A4-linked TBMN patient with FSGS by a missense mutation (g. 1214G>A resulting in p. G405E) diagnosed by clinical manifestations, family history and renal biopsy examination, as well as two controls (one healthy, one pure TBMN carrying a g. 1550G>A mutation resulting in p. G448S) were enrolled in this study. The fragments of cDNA with the two mutations and that of corresponding cDNA from the healthy control were expressed in E. coll. The secondary structures of recombinant polypeptides were analyzed by circular dichroism (CD) spectroscopy. Results CD spectra of healthy control exhibited a negative peak near 208 nm whereas that of TBMN patient with FSGS exhibited a negative peak near 220 nm. Furthermore, the magnitude of the negative peak of this patient decreased as compared with that of healthy control. CD spectra of pure TBMN control was slightly changed with the negative peak remaining near 208 run and the magnitude slightly decreased as compared with that of healthy control. In addition, the secondary structure of pelypeptide from healthy control was composed of about 1/4 α-helix and 1/4 β-sheet, whereas that from the patient presented about 1/3 α-helix without any β-sheet. The secondary structure of polypeptide from pure TBMN control was almost the same as the healthy control, except a shght reduction of α-helix and a slight increase of β-sheet. Conclusions Although the glycine substitutions exists in the nearby domain of α4 (Ⅳ)chain, the TBMN patient complicating FSGS with severe phenotype and g. 1214G>A mutation and the pure TBMN control with the mild phenotype and g. 1550G>A mutation are revealed with different secondary structures of α4 (Ⅳ)chain. Moreover, the secondary structure change of α4 (Ⅳ) chain is consistent with their corresponding phenotype severity.

Objective: To investigate the morphological characteristics and expression of cell cycle regulatory proteins in cellular variants of idiopathic focal segmental glomerulosclerosis (FSGS). Methods: Seventeen cases of cellular variants of FSGS were studied by light microscopy, immunofluorescence (IF), and electron microscopy (EM). The immunohistochemistry and immunoelectron microscopy for the detection of cyclins (cyclin D1, cyclin E, cyclin A, cyclin B1) and cyclin dependent kinase inhibitors (CKIs, including p21, p27, p57) were performed in these cases. Results: The hypertrophy and hyperplasia of epithelial cells overlying sclerotic or collapsed glomerular tufts were the prominent characteristics of cellular variants of FSGS; IF showed segmental deposits of IgM; hyperplastic epithelial cells possessed the features of both podocyte and parietal epithelial cells ultrastructurally. Hyperplastic epithelial cells of cellular lesions showed positive staining for cyclin E, cyclin A, cyclin B1 and p21, and negative staining for cyclin D1, p27 and p57. Conclusion: The hyperplastic epithelial cells in cellular variants of FSGS may be derived from damaged podocytes, which mimic the immature podocytes, re engage the cell cycle to proliferate and form the cellular lesions. The up regulation of cyclins (cyclin E, cyclin A, cyclin B1) concurrent with the loss of CKIs (p27, p57) contributes to the cell cycle regulation of cellular lesions of FSGS.

Objective To investigate the elinicopathoiogical features of Castleman disease with kidney injury. Methods Clinicopathological data of 10 Castleman disease patients with kidney injury from Peking University First Hospital and China-Japan Friendship Hospital were analyzed retrospectively. All the cases received biopsies of lymph node and kidney. Their renal tissues were examined by light microscopy, immunofluorescence and electron microscopy. Results Ten patients were all male with mean age (493:14) years. They presented edema and proteinuria, with mean urinary protein at (2.79±3.56) g/24 h, including one nephrotie syndrome (NS). Hematuria occurred in 8 cases, acute renal insufficiency in 6 cases, hypertension in 4 cases. Most of the patients had fever, fatigue, anorexia, weight loss, increased ESR and CRP, hypergammaglobulinaemia and decreased complements. Other abnormalities included anemia, thrombocytopenia, pleural effusion, hepatomegaly, splenomegaly, hypothyroidism, etc. Two cases demonstrated POEMS syndrome, one presented Sjogren syndrome. The enlargement of multiple cervical, axillary and inguinal lymph nodes were identified in all the patients. The pathological patterns of lymph node were plasma cell type in 4 cases, hyaline-vascular type in 3 cases, and mixed type in 3 cases. Pathological examination of renal biopsy showed thrombotic microangiopathy in 5 cases, crescentic glomerulonephritis in 2 cases, renal amyloidosis, minimal change disease and chronic tubular interstitial nephropathy in 1 case respectively. After immunosupressive reagents or COP therapy, lymph nodes became smaller, systemic symptoms were alleviated, proteinuira was decreased or disappeared, and renal function was recovered in most of patients. Conclusions Castleman disease with kidney injury manifests various symptoms with high prevalence of renal insufficiency and multiple systemic damage. Renal lesions present many patterns of pathological change with a higher frequency of thrombotic microangiopathy. It is necessary to examine the lymph nodes by ultrasound, radiology or biopsy for the patients of renal diseases with multiple systemic symptoms.

Objective To investigate the association between podocytes and proteinuria in children with Alport syndrome. Methods Twenty-one children including 13 boys and 8 girls with Alport syndrome were divided into 3 groups according to 24-hour urinary protein, ＜30 mg/kgas the mild proteinuria group (10 patients), 30 to 50 mg/kg as the moderate proteinuria group (4 patients) and ＞50 wg/kg as the heavy proteinuria group (7 patients). The correlation between foot process width and the degree of proteinuria was analyzed. By immunoperoxidase staining on renal tissue, the key slit diaphragm molecules nephrin, podocin and podocyte cytoskeleton-associated molecule synaptopodin were studied. Results The foot process width (420-2270 nm) in patients with Alport syndrome was positively correlated with proteinuria significantly (r=0.765, P＜0.01).Foot process width was significantly lower in patients with mild proteinuria [475 (420-900) nm)compared with that in patients with heavy proteinuria [1520 (480-2270) nm] (P＜0.05). In Alport syndrome children with heavy proteinuria, the distribution of nephrin and podocin changed dramatically. In two children with shorter proteinuria period (1 year), dramatic distribution change of nephrin and podocin occurred, however, the foot process along with synaptopodin preserved.Conclusions Podocyte foot process effacement and injury of slit diaphragm participate in the mechanism of proteinuria in Alport syndrome. The injury of slit diaphragm seems to be an early event in the development of foot process effacement in Alport syndrome, which may guarantee early treatment.