Objective To investigate the effect of leflunomide and prednisone in treating refractory nephropathy syndrome.Methods The 60 refractory nephropathy patients in our hospital from Oct,2000 to May,2003 were divided into two groups at random.Paients in test group received leflunomide and prednisone.Patients in control group received mycophenolate mofetil and prednisone.Clinical data were observed in the 2nd,4th,6th,8th,12th,16th,20th,24th and 28th week.Results After receiving leflunomide therapy in the test group,the proteinuria was decreased significantly(P0.05),but rate of showing efficacy in 12th week in Leflunomide group was higher than mycophenolate mofetil group(P

Objective To investigate the efficacy and safety of mycophenolate mofetil combined with methylprednisolone and lamivudine on the treatment of hepatitis B virus associated glomerulonephritis(HBV-GN).Methods Twenty-four patients with hepatitis B virus associated glomerulonephritis were confirmed by renal biopsy and immunohistochemistry,these participant patients were admitted to the Third Affiliated Hospital of Sun Yat-Sen University from Jan,1999 to Jan,2004.They were treated by MMF combined with methylprednisolone and lamivudine.The initial dosage of MMF was 1.0~1.5 g/d.Methylprednisolone at the dosage of 0.4 mg/(kg?d)was used at the beginning of the combined treatment.Lamivudine was in the dosage of 0.1 g/d.The duration of the treatment was six months.Regular test was conducted every two weeks.Results Nine cases had fully remission,11 cases had partial remission and 4 cases had no efficiency;no patient deterioration.Renal and hepatic function remained stable,blood cell didn't decrease and the reproduction of HBV didn't increase during the treatment.Conclusion MMF combined with methylprednisolone and lamivudine is an effective and safe method for HBV-GN.

Objective To investigate the serum leptin levels of chronic hemodialysis patients and its relation to their nutritional status.Methods Twenty-nine maintenance hemodialysis patients were included in the study.TSF(triceps skin fold),BMI(body mass index) and FAT%(content of fat),lymphocyte count,serum albumin,globulin,total iron binding capacity,BUN,creatinine,cholesterol,triglyceride and leptin were measured.Malnutrition-inflammation score(MIS) was used to assess the patients nutritinal status.Results Levels of leptin were positively correlated with BMI,FAT%,TSF and MIS(P

ObjectiveTo evaluate the applicability of glomerular filtration rate estimation equations in elderly Chinese patients with chronic kidney disease(CKD). MethodsA total of 103 elderly CKD patients were investigated. Glomerular filtration rate (GFR) was estimated by Coekcroft -Gault equation, MDRD1 equation, abbreviated MDRD equation, Jellife 1973 equation, Mawer equation, Hull equation, Jellife 1971 equation, plasma creatinine reciprocal equation, Gate equation and Bjornsson equation. The accuracy of estimated GFRs was compared with that of GFR estimated by 99mTe-DTPA-GFR (sGFR)in elderly CKD patients. ResultsBland-Altman analysis demonstrated that GFRs evaluated by Cockcroft -Gault equation, Bjornsson equation and Hull equation were more consistent with sGFR than the other equations. But all the equations were not well consistent with sGFR. Linear regression showed that the slopes of Jellife 1973 equation and Cockcroft-Gault equation were closer to the identical line. Bias of MDRD1 equation was smaller. Accuracy of Bjornsson equation, Jellife 1973 equation and Cockcroft-Gault equation were higher than the other equations. When comparing the bias as well as accuracy of estimated GFRs with sGFR in different stages of CKD, GFR estimated by Bjornsson equation, Coekcroft-Gault equation and Jellife1973 equation showed better Results . ConclusionsWhen plasma creatinine is checked by enzymatic method, GFR estimating equations may show great bias in elderly Chinese CKD patients.

Objective To evaluate the applicability of glomerular filtration rate (GFR) caJcuated by Cock-croft-Gault equation, MDRD1 equation and abbreviated MDRD equation in the chronic glomerulonephritis. Methods 143 chronic kidney disease(CKD) patients diagnosed in our hospital from January 2005 to December 2007 were investigated. Glomerular filtration rate(GFR) was estimated with Cockcroft-Gault equation, MDRD1 equation and ab-breviated MDRD equation. The accuracy of estimated GFRs was compared with 99Tcm-DTPA-GFR in chronic glomer-ulonephritis patients. Results Bland-Altman analysis demonstrated that Cockcroft-Gault equation was more consist-ent with GFR and sGFR than the other equations. Linear regression analysis showed that the slopes of Cockcroft-Gault equation were closer to the identical line,with a smaller bias and higher accuracy . When compared, the bias as well as accuracy of estimated GFRs with sGFR in different stages of CKD,Cockcroft-Gault equation showed good results. Condusion When plasma creatinine is checked with enzymatic method, Cockcroft-Gault equation is more appropriate than MDRD1 equation and abbreviated MDRD equation for estimating renal function in chronic glomeru-lonephritis patients.

Objective To present the baseline characteristics of serum uric acid level in patients with chronic kidney disease(CKD)in single.centre nephrology clinic and judge the risk factor for decreased renal function of CKD Datients.Methods A cross-sectional study on CKD patients in clinic was carried out for 9 months.Results 780 CKD cases were enrolled in the study.The top four causes of CKD in these patients were primary glomerular disease(59.0%),essential hypertension(7.6%),lupus nephritis(6.4%)and diabetic nephropathy(6.3%).The average age was 41.9.The distribution of CKD stage was 47.8%of CKD1,18.7%of CKD2,14.0%of CKD3,8.1% of CKD4 and 11.4%of CKD5.Multivariate Logistic regression regression analysis indicated that age,proteinuria,hypertension were independently correlated with decreased renal function.Conclusion This is the largest cross-sectional study of CKD in China,which will help to determine the basic status of Chinese CKD patients,laying a basis for further followup.

Objective To investigate if Rac1 GTPase activation plays an important role in hyperpermeability and tyresine phosphorylation of tight junction induced by vascular endothelial growth factor (VEGF) in glomertdar endothelial cells (GEnCs). Methods Primary cultured rat endothelial cells were used as experimental model. The effect of VEGF at different concentrations (5 or 50 μg/L) on endothelial permeability was investigated by transendothelial electrical resistance (TEER). The permeability of GEnCs transfected with wild type Rac1 (wtRacl) or dominant negative Racl (N17Rac1) was also detected. Immune precipitation and immune blotting were used to detect the tyrosine phosphor-occludin in GEnCs. Results VEGF at high concentration (50 μg/L) induced hyperpermeability in GEnCs (P<0.05). At the same time, GTP-binding and membrane-bound Racl GTPase significantly increased(P<0.01)in GEnCs. Tyrosine phosphor-occludin was also increased (P<0.05) under VEGF stimulation. However, transfection of GEnCs with N17Rac1 dramatically attenuated the effect of VEGF on tyrosine phospho-occludin and endothelial cell permeability. Conclusions Increased VEGF can induce hyperpermeability in glomerular endothelial cells, which is related to occludin tyrosine phosphorylation through Racl activation. It provides a framework for understanding the role of VEGF-induced Racl-phospho-occludin pathway in the integrity of barrier function in the diabetic milieu.

Objective To investigate the effects of supernatant of cultured mesangial vcells with serum IgA1 from [gA nephropathy patients on apoptosis of podocyte. Methods Jacalin affinity chromatography and Sephacryl S-200 molecular sieve chromatography were used to isolate IgA1. Apoptosis rate of podocyte was assessed by flow cytometer. Monomeric IgA1 (mIgA1) was transformed to aggregated IgA1(aIgA1) by heating. IgA-mesangial cell supernatant was prepared by collecting spent medium in which growth-arrested mesangial cells were incubated with different aIgA1, then the medium with RPMI 1640 containing 0.5%FBS was cultured with growth-arrested podocyte. Real time PCR was used to detect the mRNA expression of Bcl-2, Bax, Fas and Fas-L. Results Apoptosis rate of podocyte by supematant of cultured mesangial cell with algal from IgAN patients was higher than that from healthy and control groups [(28.5±5.9 ) % vs (22.5± 5.8)%, (20.5±4.5)%, all P<0.05]. Fas mRNA expression of podocyte exposed to supematant of cultured mesangial cells with aIgA1 from IgAN patients increased significantly and was 1.89 folds of control (P<0.05), while Bcl-2 mRNA expression significantly decreased and was 72% of control (P<0.05). The concentrations of Ang Ⅱ and TGF-β in supernatant of cultured mesangial cells with IgA1 from IgA nephropathy were significantly higher than those from healthy control [(13.2±3.4) ng/L vs (8.2±2.3) ng/L, /'<0.05; (15.4±3.4) ng/L vs (10.8±3.2) ng/L, P<0.05]. Conclusion Supernatant of cultured mesangial cells with IgA1 from IgA nephroapthy patients can induce apoptosis of podocyte, which may play a role in the progression of IgAN.

Objective To investigate whether high glucose can induce endothelial-mesenchymal transition (EndMT) in glomerular endothelial cells and the role of TGF-β in the process.Methods Rat glomerular endothelial cells were divided into five groups:normal glucose (NG,5.5mmol/L),high glucose (HG,15,30 mmol/L),TGF-β inhibition (HG+ LY36,30 mmol/L glucose + 10 μmol/L LY364947),hyperosmotic control (M,5.5 mmol/L glucose+25.5 mmol/L mannitol) and solvent control (D,5.5 mmol/L glucose + 1 ml/L DMSO).Western blotting was performed to detect relative protein quantities of endothelial marker claudin 5 and mesenchymal marker α-smooth muscle actin (α-SMA).TGF-β1 and TGF-β2 mRNA levels were measured by real-time PCR.Vascular endothelial marker VE-cadherin and mesenchymal marker α-SMA were detected by immunofluorescent stain and observed by confocal microscopy.Results Compared with NG,the expression of claudin5 protein in HG (15 or 30 mmol/L) was up-regulated while expression of α-SMA protein was down-regulated (P ＜0.05).Both TGF-β1 and TGF-β2 mRNA levels increased as well (P ＜ 0.05).However,when compared with HG,the claudin 5 levels increased while α-SMA decreased in TGF-β inhibition group.No significant changes were observed in hyperosmotic or solvent control group.Confocal microscopy showed the transformation of cells from a cobblestone-liked shape to a spindle one,and a decreasing expression of VE-cadherin while an increasing α-SMA in HG group (P ＜ 0.05),whereas TGF-β inhibition partly attenuated those changes in both morphological and protein levels.Conclusions High glucose treatment of glomerular endothelial cells results in an increase in the level of TGF-β1 and TGF-β2 mRNA and leads to endothelial-mesenchymal transiton.Inhibition of TGF-β partly prevents this process,indicating that TGF-β plays a crucial role in high-glucose-induced glomerular endothelial-mesenchymal transiton.

Objective To analyze the prevalence,risk factors of kidney disease in type 2 diabetic patients with KDIGO classification of chronic kidney disease,also to study cardiovascular and cerebrovascular diseases and death in these patients,so as to investigate the significance of the KDIGO classification system.Methods One thousand six hundred and forty-five type 2 diabetic patients who were in hospitalization from June 2008 to December 2012 were grouped according to the KDIGO classification of chronic kidney disease and the incidence of vascular disease was analyzed based on the classification.Clinical features were compared between patients with or without kidney disease.The risk factors of kidney disease and the death of diabetic patients were also investigated.Results There were 915 male and 730 female,aged a median (57.86±12.54) years with (6.35±6.30) years duration of diabetes mellitus among the 1645 cases,and 37.2％ of patients had concomitant kidney disease.According to the classi fi cation of CKD,patients in CKD group 3a,group 3b and CKD group 4-5 accounted for 5.7％,3.5％ and 7.6％,while 33.4％ of patients had proteinuria,among which 19.5％ with microalbuminuria,13.5％ with macroalbuminuria.On complications,patients with hypertension accounted for 49.5％,hyperlipidemia 67.7％,diabetic retinopathy 27.4％,cardiovascular and cerebrovascular diseases 18.5％ (coronary artery disease 16.5％,cerebrovascular diseases 8.8％).Statistical difference was detected in the incidence of diabetic retinopathy,coronary artery disease and cerebrovascular diseases between CKD group 3a and 3b (P ＜ 0.05).The duration of diabetes,concomitant hypertention especially with elevated systolic blood pressure,diabetic retinopathy and hyperuricemia were the independent risk factors for type 2 diabetic patients with kidney disease.Age,Scr,complicating cardiovascular and cerebrovascular diseases and advanced CKD stage were the independent risk factors for the death of type 2 diabetic patients with kidney disease.Conclusion KDIGO classification of chronic kidney disease enables better staging of kidney diseases in diabetic patients for management and prognosis.Diabetic patients have a higher prevalence of renal diseases and cardiovascular and cerebrovascular events than the general population.Early control of factors such as blood pressure and serum uric acid can delay the progression of kidney disease,and the predictive role of diabetic retinopathy should be emphasized.