OBJECTIVETo explore therapeutic effect and action mechanism of regulating spleen-stomach needling on diabetic nephropathy (DN).

METHODSUsing multi-centric, randomized, controlled and blind principles, 144 cases of DN were divided into an observation group and a control group according to random digital tab, 72 cases in each one. Based on regular treatment of diabetes, the regulating spleen-stomach needling was applied at Zhongwan (CV 12), Quchi (LI 11), Hegu (LI 4) and Xuehai (SP 10), etc. in the observation group while Shenshu (BL 23), Taixi (KI 3), Sanyinjiao (SP 6), Yanglingquan (GB 34), etc. were selected in the control group by reference of Acupuncture and moxibustion. The treatment was given twice a day, six days as a treatment session with interval of one day between sessions. Totally six weeks were required. Changes of clinical symptoms and signs, fast blood glucose (FBG), urinary albumin excretion rate (UAER), beta2-microglobulin (beta2-MG), monocyte chemotactic protein-1 (MCP-1), lymphocyte membrane cholesterol, propanediol (MDA), PCO, 8-hydroxydeoxy guanosine (8-OHdG), superoxide dismutase (SOD), CD3+, CD4+, CD8+, and CD4+/CD8+ were observed before and after treatment in two groups.

RESULTSAs for improving clinical symptoms and signs, total effective rate was 84.29% (59/70) in the observation group and 55.56% (40/72) in the control group, which had statistical difference between two groups (P<0.01). As for regulating glycometabolism [(6.25 +/- 0.32) mmol/L vs (8.09 +/- 0.63) mmol/L], reducing UAER [(154.43 +/- 55.14) mg/24h vs (268.91 +/- 77.65) mg/24h], restraining over-expression of MCP-1 [(137.59 +/- 36.15) pg/mL vs (166.89 +/- 42.82) pg/mL], regulating level of oxidative stress, prohibiting oxidation of protein and adjusting quantity and activity of T lymphocyte subgroup, the observation group was superior to the control group (P< 0.05, P<0.01).

CONCLUSIONThe regulating spleen-stomach needling is an effective method for treatment of DN, which cold improve glycometabolism disturbance-induced progressive kidney injury, recover glomerular filtration, reduce urinary albumin excretion rate, restrain overexpression of MCP-1, adjust level of oxidative stress, prohibit oxidation of protein, increase protectiveness of membrane, adjust quantity and activity abnormity of T lymphocyte subgroup, leading to repairing lymphocyte damage and improving immune expression to delay kidney damage.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Diabetic Nephropathies ; immunology ; physiopathology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Spleen ; physiopathology ; Stomach ; physiopathology

OBJECTIVETo analyze the risk factors affecting the glomerular filtration rate (GFR) in type 2 diabetic patients without albuminuria.

METHODSA total of 131 type 2 diabetic patients with normal urinary albumin excretion rate (UAER) were divided into normal GFR group and decreased GFR group. The factors relevant to GFR were analyzed by multiple factors regression.

RESULTSAge, course of diabetes, systolic blood pressure, prevalence of hypertension, the level of serum creatinine (SCr), blood urea nitrogen (BUN) and uric acid (UA) were significantly higher in decreased GFR group than in normal GFR group. Multivariate regression showed that SCr, age, systolic blood pressure, and UA were negatively correlated to GFR.

CONCLUSIONReduced GFR occurs in some type 2 diabetic patients without albuminuria. SCr, age, systolic blood pressure and UA are the major factors related to decreased GFR. The degree of early renal damage in diabetic patients can be better evaluated by combining GFR and UAER.

Adult ; Aged ; Albuminuria ; complications ; physiopathology ; Diabetes Mellitus, Type 2 ; complications ; epidemiology ; physiopathology ; Diabetic Nephropathies ; physiopathology ; Female ; Glomerular Filtration Rate ; Humans ; Kidney ; physiopathology ; Male ; Middle Aged ; Prevalence ; Risk Factors

OBJECTIVETo examine the renal function changes and mechanisms on rats with diabetes through a sleeve gastrectomy operation.

METHODSThirty-six rats were induced diabetes through injection of streptozotocin (STZ), and 30 of these diabetic rats that blood glucose levels at the midrange (blood sugar 17.88-23.65 mmol/L, mean: 20.32 mmol/L) were randomly assigned to the sleeve gastrectomy group, Sham-operation group and control group. The serum creatinine, lipid parameters were measured postoperatively. The 24 h urine volume obtained and urine albumin excretion rate (UAER) was calculated. Serum and urinary creatinine were examined and glomerular filtration rate (GFR) was counted. Kidney sections were stained with periodic acid-Schiff, and then the index of mesangial expansion was determined. The expression of synaptopodin for podocytes was also performed through the immunohistochemical procedure. A one-way ANOVA and t-test were performed to evaluate differences between groups and each other.

RESULTSOnly one rat of SG group died after operation. The GFR ((8.44 ± 2.10) ml · g⁻¹ · d⁻¹), 24 h UAER ((36.04 ± 11.10) mg/d), plasma lipids level (total cholesterol (1.66 ± 0.23) mmol/L, triglycerides (1.25 ± 0.17) mmol/L), kidney weight ((1.61 ± 0.06) g), the index of mesangial expansion ((6.14 ± 1.50)%) and synaptopodin expression ((20.44 ± 2.99)%) were improved in the SG group compared with the sham-operation group ((15.05 ± 3.01) ml · g⁻¹ · d⁻¹, (57.01 ± 11.34) mg/d, (2.15 ± 0.29) mmol/L, (1.65 ± 0.23) mmol/L, (1.93 ± 0.07) g, (11.32 ± 2.09)%, (10.34 ± 1.43)%) and control group ((14.79 ± 2.38) ml · g⁻¹ · d⁻¹, (62.71 ± 16.46) mg/d, (2.23 ± 0.21) mmol/L, (1.59 ± 0.20) mmol/L, (1.91 ± 0.06) g, (10.82 ± 1.79)%, (11.13 ± 2.43)%) (t = 0.781-5.025, all P < 0.05).

CONCLUSIONThe sleeve gastrectomy procedure can improve the renal function in a diabetes rat model may be through protecting the podocytes function and preventing the mesangial expansion of glomeruli.

Animals ; Blood Glucose ; Creatinine ; blood ; urine ; Diabetes Mellitus, Experimental ; physiopathology ; Diabetic Nephropathies ; physiopathology ; surgery ; Gastrectomy ; Glomerular Filtration Rate ; Kidney ; physiopathology ; Kidney Function Tests ; Random Allocation ; Rats

This project was designed to investigate the role of angiotensin converting enzyme 2 (ACE2) in the diabetic renal injury by observing the expression of ACE2 in the kidney and the level of angiotensin II (AngII) in the circulatory system and kidney tissue of rats with diabetes. SD rats were randomly divided into control group and diabetes group. Diabetic nephropathy model was established by i.p. injection of streptozotocin (STZ). The rats were sacrificed separately on the 15th or 30th day after STZ injection. Biochemical parameters including blood glucose and renal function were examined. The expression of ACE2 in the kidney was detected by real-time PCR and Western blot. The contents of AngII in plasma and kidney were detected by radioimmunoassay. The results are as follows: (1) 48-72 h after STZ injection, the rats showed polyuria, polydipsia and their activity reduced. (2) Blood glucose levels were 4.9-6.5 mmol/L in the control rats, 14.0-17.5 mmol/L in the diabetes group rats on the 15th day, and higher than 24 mmol/L in the diabetes group rats on the 30th day; (3) There was a significant increase of urine glucose level (P < 0.05), and a slight but not significant increase of urine protein level (P > 0.05) in the diabetes group on the 15th day; On the 30th day, the levels of urine glucose and urine protein were significantly higher than those in the control group (P < 0.01); (4) Compared with the control group, the expression of ACE2 mRNA was slightly increased (P > 0.05), and the expression of ACE2 protein was significantly increased (P < 0.05) in the rats of diabetic model group on the 15th day; however, on the 30th day, ACE2 mRNA expression in the rats of diabetic model group was significantly lower than the control group (P < 0.05), and the expression of ACE2 protein was slightly lower than the control group (P = 0.0718). (5) Compared with the control group, the levels of AngII in plasma and kidney of the diabetic rats increased slightly on the 15th day (P > 0.05); while the AngII levels in diabetic model group rats were significantly higher (P < 0.05) than that in control rats on the 30th day. These results suggest that ACE2 plays a positive role in the protection against the pathogenesis of early renal damage. ACE2 expression is reduced gradually with the deepened degree of diabetic kidney damage, leading to the accumulation of AngII in the kidney, thereby increasing the renal injury.
Angiotensin II ; blood ; metabolism ; Animals ; Blood Glucose ; Diabetes Mellitus, Experimental ; enzymology ; physiopathology ; Diabetic Nephropathies ; enzymology ; physiopathology ; Kidney ; enzymology ; physiopathology ; Peptidyl-Dipeptidase A ; metabolism ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo investigate the relationship of Chinese medicine syndrome pattern with urinary albumin excretion rate (UAER) and its related factors in patients with diabetic nephropathy (DN).

METHODSSixty-three early stage DN patients were subjected to the study, the Chinese medicine syndrome patterns were differentiated, and their condition of methylene tetrahydrofolate reductase (MTHFR) C677T mutation was detected (shown by gene polymorphism of 677 base pairs). Meantime, plasma levels of homocysteine (Hcy), folic acid, fasting and postprandial glucose (FG and PG), glycohemoglobin (HbA1c), blood lipids as well as UAER were measured.

RESULTSSyndrome pattern was differentiated as yin-deficiency with heat-flourishing in 17 patients, qi-yin deficiency in 24, and yin-yang deficiency in 22; while accompanied blood stasis syndrome (BSS) was found in 35. Gene polymorphism detection indicated that 19 patients were of CC-type, 17 of TT-type, and 27 of CT-type. Analysis showed that higher UAER level often revealed in patients with BSS, as compared with that in patients of non-BS pattern, the difference was statistically significant (P < 0.05). UAER levels in patients of different genotypes were insignificantly different (P > 0.05), but showed a linear regressive relation, namely positively correlated with Hcy level in patients of isogeneic type (r = 0.674, P < 0.05). No statistical significance was found between levels of UAER and other related factors (P > 0.05).

CONCLUSIONUAER level in early stage DN patients of BSS pattern is rather higher, and it shows a linear regression relationship (positive correlation) with Hcy level in patients of isogeneic type.

Adult ; Aged ; Albuminuria ; physiopathology ; Diabetic Nephropathies ; genetics ; physiopathology ; urine ; Diagnosis, Differential ; Female ; Homocysteine ; blood ; Humans ; Male ; Medicine, Chinese Traditional ; Methylenetetrahydrofolate Reductase (NADPH2) ; genetics ; Middle Aged ; Polymorphism, Genetic

BACKGROUNDThe incidence of diabetic nephropathy (DN) increases year by year. However, clinical characteristics of DN patients on maintenance hemodialysis (MHD) were rarely reported in China. The purpose of this study was to examine the clinical characteristics of the DN patients on MHD in Anhui Province, Eastern China.

METHODSThe clinical data of MHD patients in the hemodialysis centers of 26 hospitals in Anhui Province from January 1, 2014, to March 31, 2014, were examined. The differences between DN patients and non-DN patients were compared regarding vascular access, nutritional status, mineral and bone disorder, and other indexes.

RESULTSAmong the selected 2768 adult MHD patients, 427 had DN. The incidence of hypertension, coronary heart disease, and cerebral thrombus in DN patients was 94.1%, 21.5%, and 15.0%, respectively, which were higher than those in non-DN patients (P < 0.001). Category of vascular access for hemodialysis in DN patients was arteriovenous fistula (AVF) (87.4% [373/427]) and tunneled cuffed catheter (TCC) (11.2% [48/427]). The percentage of AVF was significantly lower than that of non-DN patients (P < 0.001), and percentage of TCC was significantly higher than that of non-DN patients (P < 0.001). Hemoglobin achievement rate in DN patients was 32.0%. The incidence of hypoalbuminemia was 24.7%, significantly higher than that in non-DN patients (P < 0.001). The achievement rate of the target range in mineral values was 55.9% in corrected serum calcium level, 30.1% in serum phosphorus level, and 49.3% in intact parathyroid hormone (iPTH) level in DN patients. Compared with non-DN patients, the achievement rate of serum phosphorus was significantly higher in DN patients.

CONCLUSIONSDN patients on MHD in Anhui province exhibited different clinical characteristics compared to non-DN hemodialysis patients. They presented higher percentage in TCC use and cardiovascular complication, lower serum albumin and iPTH levels than those in non-DN patients.

Aged ; Calcium ; blood ; China ; Coronary Disease ; blood ; epidemiology ; physiopathology ; Cross-Sectional Studies ; Diabetic Nephropathies ; blood ; epidemiology ; physiopathology ; Female ; Humans ; Hypertension ; blood ; epidemiology ; physiopathology ; Intracranial Thrombosis ; blood ; epidemiology ; physiopathology ; Male ; Middle Aged ; Parathyroid Hormone ; blood ; Phosphorus ; blood ; Renal Dialysis

OBJECTIVETo explore the relationship between Chinese medicine syndrome patterns (CMSP) and their associated factors in patients with type 2 diabetic nephropathy stage III (DN2-3).

METHODSRetrospective analysis was conducted on 209 patients with type 2 diabetes mellitus (T2DM). The patients were allocated into two groups, the DN2-3 group and the control group. Some related clinical materials and laboratory indexes, including age, course of disease, body mass index (BMI), glycosylated hemoglobin A1c (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP), blood levels of total cholesterol (TC), triglyceride (TG), high and low density lipoprotein (HDL and LDL), serum creatinine (Scr) and microalbuminuria (MALB) as well as their CMSP (both the essential syndrome and the superficial syndrome) in the DN2-3 group were collected and compared.

RESULTSSignificant differences were found between the DN2-3 group and the control group in aspects of course of disease (months, 107.74 +/- 96.19 vs. 82.03 +/- 79.10), BMI (kg/m2, 26.25 +/- 4.02 vs. 24.95 +/- 3.56) and Scr level (mmoL/L, 71.93 +/- 24.24 vs. 65.91 +/- 13.70, P < 0.05). The qi-yin deficiency SP (38 cases, 36.19%), and the blood stasis (51 cases, 48.58%) presented as the dominant essential and superficial CM-SP respectively in DN2-3 patients, holding the highest proportion. Analysis on the relationship of associated indices among patients with different CMSP showed statistical differences presented in level of MALB, i.e. which in pi-shen qi-deficiency SP (128.77 +/- 103.59 mg/24 h) was higher than in yin-deficiency dryness-fire SP and qi-yin deficiency SP (88.43 +/- 68.93 mg/24h and 82.60 +/- 55.22 mg/24 h, P < 0.05); it also presented in HbA1c (%) and TG levels(mmol/L), those in stasis SP were 10.73 +/- 2.71 and 2.29 +/- 1.58 ), in dampness SP were 8.80 +/- 2.19% and 4.37 +/- 5.92, and in stasis-phlegm SP were 8.83 +/- 2.09 and 2.40 +/- 2.18 (all P < 0.05).

CONCLUSIONSThe risk factors for occurrence of DN2-3 may be the course of disease, BMI and Scr. Qi-yin deficiency with blood-stasis is the most commonly encountered syndrome in patients with DN2-3. Relations of MALB with Pi-Shen qi-deficiency pattern; HbA1c with blood-stasis pattern, and TG with dampness syndrome are distinctly exhibited in them.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Albuminuria ; physiopathology ; Diabetes Mellitus, Type 2 ; physiopathology ; Diabetic Nephropathies ; physiopathology ; Diagnosis, Differential ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Retrospective Studies ; Young Adult

OBJECTIVETo probe into clinical therapeutic effect of acupuncture on diabetic nephropathies and the mechanism.

METHODSUsing multi-central, randomized and blind methods, 130 cases of diabetic nephropathy were divided into an observation group and a control group, 65 cases in each group. They were treated by routine diabetic therapy, and in the observation group, acupuncture at Quchi (LI 11), Zhigou (TE 6), Hegu (LI 4), Xuehai (SP 10), Zusanli (ST 36), Yinlingquan (SP 9), Fenglong (ST 40), Diji (SP 8), Sanyinjiao (SP 6), Taichong (LR 3), Tianshu (ST 25), Gaohuang (BL 43), Shenshu (BL 23), Zhongwan (CV 12), Zhongji (CV 3) were added with needling method of harmonizing spleen-stomach. While in the control group, acupuncture at Shenshu (BL 23), Taixi (KI 3), Sanyingjiao (SP 6), Yanglingquan (GB 34), Xuanzhong (GB 39), Guanyuan (CV 4), Shousanli (LI 10), Waiguan (TE 5), Yangxi (LI 5), Liangqiu (ST 34), Shangjuxu (ST 37), Neiting (ST 44), Huaroumen (ST 24), Dachangshu (BL 25). The treatment was given twice a day in the two groups. Clinical therapeutic effects were assessed according to clinical symptoms and signs, blood sugar, blood lipids, urinary albumin excretion rate, urinary monocyte chemotactic protein-1 (MCP-1), glomerular filtration rate (GFR), renal blood flow, etc..

RESULTSThe needling method of harmonizing spleen-stomach not only could improve symptoms and signs of the patients, and also had benign regulative action on metabolism of blood sugar and lipids, and GFR, renal blood flow and urinary albumin level, with significant or very significant differences as compared with the control group ( P < 0.05 or P < 0.01).

CONCLUSIONThe needling method of harmonizing spleen-stomach is an effective method for diabetic nephropathies, which can improve progressive renal lesion induced by abnormal metabolism of blood sugar and lipids, improve renal blood flow and GFR, decrease urinary albumin secretion, inhibit over expression of MCP-1, protect glomerulus and renal tubules, so as to improve renal function and delay renal lesion.

Acupuncture Therapy ; methods ; Aged ; Blood Glucose ; analysis ; Blood Urea Nitrogen ; Diabetic Nephropathies ; therapy ; Female ; Glomerular Filtration Rate ; Humans ; Kidney ; physiopathology ; Lipids ; blood ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Spleen ; physiopathology ; Stomach ; physiopathology

OBJECTIVES: Several reports suggest that enhanced generation or actions of nitric oxide (NO) have been implicated in the pathogenesis of glomerular hyperfiltration and hyperperfusion that occurs in early diabetes. However, the precise role of altered NO generation in the pathogenesis of diabetic nephropathy is unclear. The present study was aimed at investigating the role of nitric oxide in the pathogenesis of glomerular hyperfiltration and hyperperfusion in streptozotocin-induced diabetic rats. METHODS: To evaluate the role of NO in diabetic hyperfiltration, we measured plasma and urine concentrations of NO2-/NO3-, stable metabolic products of NO and protein expressions of three isoforms of nitric oxide synthase (NOS) in streptozotocin-induced diabetic rats. We also investigated renal hemodynamic changes, such as glomerular filtration rate (GFR) and renal plasma flow (RPF), in responses to acute and chronic administration of NO synthesis inhibitor, nitro-L-arginine methyl ester (L-NAME), in diabetic and control rats. RESULTS: Diabetic rats exhibited significantly elevated plasma and urinary NO2-/NO3- levels at 28 days after streptozotocin injection, and total excretion of NO2-/NO3- was approximately five-fold higher in diabetic rats than controls. Insulin and L-NAME treatment prevented the increases in plasma and urinary NO2-/NO3- concentrations in diabetic rats, respectively. The three isoforms of NOS (bNOS, iNOS, and ecNOS) were all increased in the renal cortex, whereas they remained unaltered in the renal medulla at day 28. GFR and RPF were significantly elevated in diabetic rats, and acute and chronic inhibition of NO synthesis by L-NAME attenuated the renal hemodynamic changes (increases in GFR and RPF) in diabetic rats, respectively. CONCLUSIONS: NO synthesis was increased due to enhanced NOS expression in diabetic rats, and chronic NO blockade attenuated renal hyperfiltration and hyperperfusion in diabetic rats. In addition, diabetic rats exhibited enhanced renal hemodynamic responses to acute NO inhibition and excreted increased urinary NO2-/NO3-. These results suggest that excessive NO production may contribute to renal hyperfiltration and hyperperfusion in early diabetes.
Animal ; Diabetes Mellitus, Experimental/physiopathology ; Diabetes Mellitus, Experimental/complications ; Diabetic Nephropathies/physiopathology ; Diabetic Nephropathies/etiology* ; Enzyme Inhibitors/pharmacology ; Male ; NG-Nitroarginine Methyl Ester/pharmacology ; Nitric Oxide/biosynthesis* ; Nitric-Oxide Synthase/antagonists & inhibitors ; Rats ; Rats, Sprague-Dawley ; Renal Circulation/drug effects ; Support, Non-U.S. Gov't

BACKGROUND/AIMS: Thiazolidinediones reduce urinary albumin excretion and may prevent the development of renal injury. We evaluated the long-term effects of rosiglitazone on the progression of renal dysfunction in patients with type 2 diabetes mellitus. METHODS: We enrolled patients with type 2 diabetes mellitus who initially had normal or mildly impaired renal function, defined as an estimated glomerular filtration rate (eGFR) of 60-120 mL/min per 1.73 m2, and normoalbuminuria. Patients were divided into two groups according to their use of rosiglitazone during 3 years of follow-up: those treated with rosiglitazone (rosiglitazone group, n=52) and those treated without rosiglitazone (control group, n=85). Progression of renal dysfunction was defined as a decrease in eGFR of > or =9 mL/min per 1.73 m2 after 3 years. RESULTS: A greater difference was observed in the decrease in eGFR between the rosiglitazone and control groups after 3 years (3.8+/-9.9 vs. 12.6+/-10.5 mL/min per 1.73 m2, p<0.001). Seventeen of 52 (32.7%) patients in the rosiglitazone group and 53 of 85 (62.3%) patients in the control group showed progression of renal dysfunction (p=0.001). The progressors had a longer duration of diabetes (6.7+/-5.9 vs. 3.9+/-4.1 years, p=0.002), higher HbA1c levels (7.4+/-1.8 vs. 6.8+/-1.3%, p=0.023), and less frequent use of rosiglitazone (24.2 vs. 52.2%, p<0.001) compared to non-progressors. Multiple logistic regression analysis revealed that the use of rosiglitazone was a significant and independent predictor of the progression of renal dysfunction. CONCLUSIONS: This study suggests that rosiglitazone theatment slows the progressive deterioration of renal function in patients with type 2 diabetes.
Adult ; Aged ; Diabetes Mellitus, Type 2/*drug therapy/physiopathology ; Diabetic Nephropathies/*prevention & control ; Female ; Glomerular Filtration Rate ; Humans ; Hypoglycemic Agents/*therapeutic use ; Kidney/*physiopathology ; Male ; Middle Aged ; Retrospective Studies ; Thiazolidinediones/*therapeutic use