Objective:To investigate the expression of HBV X, gene mutation in M type phospholipase 2 receptor (PLA 2R) in hepatitis B associated membranous nephropathy (HBV-MN) and its possible pathogenesis. Methods:According to the result of PLA 2R immunofluorescence detection in renal tissue, 103 patients with HBV-MN confirmed by renal biopsies were divided into two groups: PLA 2R positive group (n=66) and PLA 2R negative group (n=37). T test was used to compare the clinical biochemical measurements between the two groups. According to MN I stages (mild pathological injury) and MN II-III stage (severe pathological injury) of HBV-MN pathological stage, One-way ANOVA analysis was used to compare the pathological injury of kidney between the two groups. Spearman correlation analysis was used to compare the expression intensity of PLA 2R and pathological injury of kidney. Finally, the mutation sites of HBx gene in the two groups were analyzed. Results:There was significant difference in 24 h urinary protein between the two groups ( t=2.803, P=0.006). However, there was no significant difference in serum albumin level ( t=-0.313, P=0.755), serum creatinine ( t=-0.332, P=0.741), cholesterol ( t=0.312, P=0.756) and complement C3 ( t=0.589, P=0.557) between the two groups. There was significant difference between the two groups in MN stage I ( X2=7.449, P=0.006) and MN stage II-III ( X2=10.15, P=0.034). Secondly, the correlation analysis of Spearman between PLA 2R staining intensity and different MN pathological stages was statistically significant ( r=0.325, P=0.008). Finally, the mutation of HBx gene sequence between the two groups was analyzed, and it was found that the mutation at nt1753 site might be related to the expression of PLA2R. Conclusions:The positive expression of PLA 2R in renal tissue was found in 2/3 HBV-MN patients. The PLA 2R positive group was accompanied by the increase of urinary protein excretion and the aggravation of renal pathological injury. At the same time, nt1753 site mutations in HBx gene are related to the expression of PLA 2R, which may be an important pathogenesis of PLA 2R positive HBV-MN.

Objective To investigate the clinical application of percutaneous transluminal angioplasty(PTA)in treating dysfunctional central vein caused by tunnel-cuffed catheter(TCC)under digital subtraction angiography(DS A)guidance.Methods A total of 13 patients with indwelling TCC-related central vein complications,who were admitted to the Department of Nephrology of the Affiliated Hospital of Qingdao University of China between July 2018 and July 2022,were enrolled in this study.The average indwelling duration of TCC was 35.2 months(range of 6-70 months).The dysfunctional TCC was removed with the help of a stiff guide wire,and angiography showed that the central vein was narrowed or occluded.PT A was performed to reopen the central vein,and a new TCC was placed in situ or in another site.Results Of the 13 patients,original TCC was successfully removed in 12,and failure of removal was seen in one.The site of central venous stenosis included the right jugular vein,innominate vein,superior vena cava,and right iliac vein,and successful placement of a new TCC was accomplished in all patients after PTA,and no stent implantation was employed.The average follow-up period was 23.1 months(range of 6-48 months),and the TCC functioned well.Conclusion Under DSA guidance,the recanalization of TCC-related central venous stenosis or occlusion by PT A and the implantation of a new TCC catheter can successfully establish a new dialysis access for patients with poorly functioning TCC,in this way the lifespan of the pathway can be extended.