Kidney diseases are a prevalent health problem around the world.Multidrug therapy used in the current routine treatment for kidney diseases can only delay disease progression.None of these drugs or treatments can reve...Kidney diseases are a prevalent health problem around the world.Multidrug therapy used in the current routine treatment for kidney diseases can only delay disease progression.None of these drugs or treatments can reverse the progression to an end-stage of the disease.Therefore,it is crucial to explore novel therapeutics to improve patients’quality of life and possibly cure,reverse,or alleviate the kidney disease.Stem cells have promising potentials as a form of regenerative medicine for kidney diseases due to their unlimited replication and their ability to differentiate into kidney cells in vitro.Mounting evidences from the administration of stem cells in an experimental kidney disease model suggested that stem cell-based therapy has therapeutic or renoprotective effects to attenuate kidney damage while improving the function and structure of both glomerular and tubular compartments.This review summarises the current stem cell-based therapeutic approaches to treat kidney diseases,including the various cell sources,animal models or in vitro studies.The challenges of progressing from proof-of-principle in the laboratory to widespread clinical application and the human clinical trial outcomes reported to date are also highlighted.The success of cell-based therapy could widen the scope of regenerative medicine in the future.展开更多
Background The occurrence of contrast induced acute kidney injury （CIAKI） has a pronounced impact on morbidity and mortality.The aim of the present study was to appraise the diagnostic efficacy of age,estimated glom...Background The occurrence of contrast induced acute kidney injury （CIAKI） has a pronounced impact on morbidity and mortality.The aim of the present study was to appraise the diagnostic efficacy of age,estimated glomerular filtration rate （eGFR） and ejection fraction （AGEF） score （age/EF（％）＋1 （if eGFR was ＜60 ml·min-1·1.73 m2）） as an predictor of CIAKI in patients with diabetes mellitus （DM） and concomitant chronic kidney disease （CKD）.Methods The AGEF score was calculated for 2 998 patients with type 2 DM and concomitant CKD who had undergone coronary/peripheral arterial angiography.CIAKI was defined as an increase in sCr concentration of 0.5 mg/dl （44.2 mmol/L） or 25％ above baseline at 72 hours after exposure to the contrast medium.Post hoc analysis was performed by stratifying the rate of CIAKI according to AGEF score tertiles.The diagnostic efficacy of the AGEF score for predicting CIAKI was evaluated with receiver operating characteristic （ROC） analysis.Results The AGEF score ranged from 0.49 to 3.09.The AGEF score tertiles were defined as follows：AGEFlow ≤0.92 （n=1 006）; 0.92 ＜AGEFmid ≤1.16 （n=1 000）,and ACEFhigh ＞1.16 （n=992）.The incidence of CIAKI was significantly different in patients with low,middle and high AGEF scores （AGEFlow=1.1％,AGEFmid=2.3％ and AGEFhigh=5.8％,P ＜0.001）.By multivariate analysis,AGEF score was an independent predictor of CIAKI （odds ratio=4.96,95％ CI：2.32-10.58,P ＜0.01）.ROC analysis showed that the area under the curve was 0.70 （95％ CI：0.648-0.753,P ＜0.001）.Conclusion The AGEF score is effective for stratifying risk of CIAKI in patients with DM and CKD undergoing coronary/peripheral arterial angiography.展开更多
Background: Chronic kidney disease patients are at a greater risk for nephropathy requiring dialysis after percutaneous coronary intervention. Such patients are usually deferred due to fear of “Renalism”.?Objectives...Background: Chronic kidney disease patients are at a greater risk for nephropathy requiring dialysis after percutaneous coronary intervention. Such patients are usually deferred due to fear of “Renalism”.?Objectives This study assesses the outcome of Low dose contrast protocol during PCI in CKD patients whose e-GFR 60 ml/min/1.72 m and investigates a safety margin for contrast use in these high-risk categories.?Methods: Patients were into three groups according to CV/e-GFR ratio: Group (A) low-dose: CV/e-GFR ratio 2.0 Group (B) medium-dose: CV/e-GFR ratio > 2.0 and × bodyweight\s.creatinine). Group (C) high-dose: CV/e-GFR ratio > MACD. Results: A total of 73 patients were enrolled. Average age was 54 ± 8 years,81.4% were male and 18.6% were females and 52% were diabetic. Mean baseline e-GFR was 40 ± 8.0 ml/min/1.73m2. Contrast Volume used in group A was (58.26 ± 15.05) (n = 24), in group B (109.42 ± 17.11) (n = 26) and in group C (304.5 ± 60.30) (n = 23), respectively. The incidences of CI-AKI in the 3 groups were 0%, 11.5% and 35%, respectively (p = 0.02). All-cause death 0%, 17% and introduction of maintenance hemo dialysis was 0%, 11.5% and 26%, respectively (p Conclusion: Low dose contrast protocol is safe, effective and easily applicable technique without CI-AKI or death.展开更多
Cells are endowed with a defensive mechanism against hypoxia, namely hypoxia-inducible factor （HIF） andhypoxia-responsive element （HRE）. Under hypoxic conditions, activation of HIF leads to expression of a variety...Cells are endowed with a defensive mechanism against hypoxia, namely hypoxia-inducible factor （HIF） andhypoxia-responsive element （HRE）. Under hypoxic conditions, activation of HIF leads to expression of a variety of adaptive genes with HRE in a coordinated manner. The amount of HIF is regulated principally by the rate of degradation through post-translational modification by prolyl hydroxylases. Experimental studies utilizing HIF stimulating agents have been effective in a variety of kidney disease models, demonstrating that the HIF-HRE pathway is a promising target of future therapeutic approaches.展开更多
目的探索异甘草酸镁治疗自身免疫样药物性肝损伤的临床疗效和安全性。方法选取首都医科大学附属北京佑安医院2016年7月-2019年1月住院的自身免疫样药物性肝损伤患者53例为观察组,另选不伴有自身免疫现象的药物性肝损伤患者50例为对照组...目的探索异甘草酸镁治疗自身免疫样药物性肝损伤的临床疗效和安全性。方法选取首都医科大学附属北京佑安医院2016年7月-2019年1月住院的自身免疫样药物性肝损伤患者53例为观察组,另选不伴有自身免疫现象的药物性肝损伤患者50例为对照组。所有患者给予异甘草酸镁200 mg/d,治疗4周。观察治疗前后患者肝功能情况,观察治疗前后观察组患者的免疫学指标,记录两组患者的不良反应。治疗结束后每月随访肝功能,随访时间6个月。正态分布计量资料组间比较采用t检验,非正态分布的计量资料采用Mann-Whitney U检验,计数资料组间比较采用χ^2检验或Fisher精确概率检验。结果观察组治疗后与治疗前比较,ALT[35.4(29.2~42.0)U/L vs 289.0(226.6~460.3)U/L,Z=-8.661,P<0.001]、AST[46.3(15.6~183.5)U/L vs 306.3(32.2~589.8)U/L,Z=-5.271,P<0.001]、GGT[77.0(53.2~183.2)U/L vs 129.0(77.8~232.5)U/L,Z=-3.437,P=0.001)]、ALP[83.1(64.9~83.1U/L vs 119.4(104.9~146.9)U/L,Z=-3.485,P<0.001]和TBil[(27.5±10.3)μmol/L vs(59.7±18.6)μmol/L,t=6.673,P<0.001]水平均明显降低;对照组患者治疗后与治疗前比较,ALT[33.1(14.9~106.4)U/L vs 300.6(206.8~679.5)U/L,Z=-8.232,P<0.001]、AST[44.1(20.8~151.6)U/L vs 321.7(36.2~553.2)U/L,Z=-3.549,P<0.001]、GGT[82.7(50.6~168.5)U/L vs 133.5(72.2~254.2)U/L,Z=-2.364,P=0.018]、ALP[87.6(74.3~139.4)U/L vs 128.0(106.3~201.4)U/L,Z=-4.303,P<0.001]和TBil[(23.8±10.9)μmol/L vs(58.3±19.8)μmol/L,t=-8.450,P<0.001]水平也明显降低。但治疗后两组间比较差异均无统计学意义(P值均>0.05)。治疗后观察组患者IgG水平由(15.8±3.2)g/L降至(14.2±2.0)g/L,治疗前IgG水平升高(>16 g/L)患者22例中18例(81.8%)恢复正常。36例ANA阳性患者19例(52.7%)阴转。两组患者均无严重不良反应。行肝穿病理检查患者中,观察组患者中性粒细胞和(或)嗜酸性粒细胞浸润(17/32,53.1%)明显高于对照组(3/17,17.5%)(χ^2=5.785,P=0.016)。结论异甘草酸镁用于治疗自身免疫样药物性肝损伤安全有效,是临床治疗的可选择方案。展开更多
文摘Kidney diseases are a prevalent health problem around the world.Multidrug therapy used in the current routine treatment for kidney diseases can only delay disease progression.None of these drugs or treatments can reverse the progression to an end-stage of the disease.Therefore,it is crucial to explore novel therapeutics to improve patients’quality of life and possibly cure,reverse,or alleviate the kidney disease.Stem cells have promising potentials as a form of regenerative medicine for kidney diseases due to their unlimited replication and their ability to differentiate into kidney cells in vitro.Mounting evidences from the administration of stem cells in an experimental kidney disease model suggested that stem cell-based therapy has therapeutic or renoprotective effects to attenuate kidney damage while improving the function and structure of both glomerular and tubular compartments.This review summarises the current stem cell-based therapeutic approaches to treat kidney diseases,including the various cell sources,animal models or in vitro studies.The challenges of progressing from proof-of-principle in the laboratory to widespread clinical application and the human clinical trial outcomes reported to date are also highlighted.The success of cell-based therapy could widen the scope of regenerative medicine in the future.
文摘Background The occurrence of contrast induced acute kidney injury （CIAKI） has a pronounced impact on morbidity and mortality.The aim of the present study was to appraise the diagnostic efficacy of age,estimated glomerular filtration rate （eGFR） and ejection fraction （AGEF） score （age/EF（％）＋1 （if eGFR was ＜60 ml·min-1·1.73 m2）） as an predictor of CIAKI in patients with diabetes mellitus （DM） and concomitant chronic kidney disease （CKD）.Methods The AGEF score was calculated for 2 998 patients with type 2 DM and concomitant CKD who had undergone coronary/peripheral arterial angiography.CIAKI was defined as an increase in sCr concentration of 0.5 mg/dl （44.2 mmol/L） or 25％ above baseline at 72 hours after exposure to the contrast medium.Post hoc analysis was performed by stratifying the rate of CIAKI according to AGEF score tertiles.The diagnostic efficacy of the AGEF score for predicting CIAKI was evaluated with receiver operating characteristic （ROC） analysis.Results The AGEF score ranged from 0.49 to 3.09.The AGEF score tertiles were defined as follows：AGEFlow ≤0.92 （n=1 006）; 0.92 ＜AGEFmid ≤1.16 （n=1 000）,and ACEFhigh ＞1.16 （n=992）.The incidence of CIAKI was significantly different in patients with low,middle and high AGEF scores （AGEFlow=1.1％,AGEFmid=2.3％ and AGEFhigh=5.8％,P ＜0.001）.By multivariate analysis,AGEF score was an independent predictor of CIAKI （odds ratio=4.96,95％ CI：2.32-10.58,P ＜0.01）.ROC analysis showed that the area under the curve was 0.70 （95％ CI：0.648-0.753,P ＜0.001）.Conclusion The AGEF score is effective for stratifying risk of CIAKI in patients with DM and CKD undergoing coronary/peripheral arterial angiography.
文摘Background: Chronic kidney disease patients are at a greater risk for nephropathy requiring dialysis after percutaneous coronary intervention. Such patients are usually deferred due to fear of “Renalism”.?Objectives This study assesses the outcome of Low dose contrast protocol during PCI in CKD patients whose e-GFR 60 ml/min/1.72 m and investigates a safety margin for contrast use in these high-risk categories.?Methods: Patients were into three groups according to CV/e-GFR ratio: Group (A) low-dose: CV/e-GFR ratio 2.0 Group (B) medium-dose: CV/e-GFR ratio > 2.0 and × bodyweight\s.creatinine). Group (C) high-dose: CV/e-GFR ratio > MACD. Results: A total of 73 patients were enrolled. Average age was 54 ± 8 years,81.4% were male and 18.6% were females and 52% were diabetic. Mean baseline e-GFR was 40 ± 8.0 ml/min/1.73m2. Contrast Volume used in group A was (58.26 ± 15.05) (n = 24), in group B (109.42 ± 17.11) (n = 26) and in group C (304.5 ± 60.30) (n = 23), respectively. The incidences of CI-AKI in the 3 groups were 0%, 11.5% and 35%, respectively (p = 0.02). All-cause death 0%, 17% and introduction of maintenance hemo dialysis was 0%, 11.5% and 26%, respectively (p Conclusion: Low dose contrast protocol is safe, effective and easily applicable technique without CI-AKI or death.
文摘Cells are endowed with a defensive mechanism against hypoxia, namely hypoxia-inducible factor （HIF） andhypoxia-responsive element （HRE）. Under hypoxic conditions, activation of HIF leads to expression of a variety of adaptive genes with HRE in a coordinated manner. The amount of HIF is regulated principally by the rate of degradation through post-translational modification by prolyl hydroxylases. Experimental studies utilizing HIF stimulating agents have been effective in a variety of kidney disease models, demonstrating that the HIF-HRE pathway is a promising target of future therapeutic approaches.
文摘目的探索异甘草酸镁治疗自身免疫样药物性肝损伤的临床疗效和安全性。方法选取首都医科大学附属北京佑安医院2016年7月-2019年1月住院的自身免疫样药物性肝损伤患者53例为观察组,另选不伴有自身免疫现象的药物性肝损伤患者50例为对照组。所有患者给予异甘草酸镁200 mg/d,治疗4周。观察治疗前后患者肝功能情况,观察治疗前后观察组患者的免疫学指标,记录两组患者的不良反应。治疗结束后每月随访肝功能,随访时间6个月。正态分布计量资料组间比较采用t检验,非正态分布的计量资料采用Mann-Whitney U检验,计数资料组间比较采用χ^2检验或Fisher精确概率检验。结果观察组治疗后与治疗前比较,ALT[35.4(29.2~42.0)U/L vs 289.0(226.6~460.3)U/L,Z=-8.661,P<0.001]、AST[46.3(15.6~183.5)U/L vs 306.3(32.2~589.8)U/L,Z=-5.271,P<0.001]、GGT[77.0(53.2~183.2)U/L vs 129.0(77.8~232.5)U/L,Z=-3.437,P=0.001)]、ALP[83.1(64.9~83.1U/L vs 119.4(104.9~146.9)U/L,Z=-3.485,P<0.001]和TBil[(27.5±10.3)μmol/L vs(59.7±18.6)μmol/L,t=6.673,P<0.001]水平均明显降低;对照组患者治疗后与治疗前比较,ALT[33.1(14.9~106.4)U/L vs 300.6(206.8~679.5)U/L,Z=-8.232,P<0.001]、AST[44.1(20.8~151.6)U/L vs 321.7(36.2~553.2)U/L,Z=-3.549,P<0.001]、GGT[82.7(50.6~168.5)U/L vs 133.5(72.2~254.2)U/L,Z=-2.364,P=0.018]、ALP[87.6(74.3~139.4)U/L vs 128.0(106.3~201.4)U/L,Z=-4.303,P<0.001]和TBil[(23.8±10.9)μmol/L vs(58.3±19.8)μmol/L,t=-8.450,P<0.001]水平也明显降低。但治疗后两组间比较差异均无统计学意义(P值均>0.05)。治疗后观察组患者IgG水平由(15.8±3.2)g/L降至(14.2±2.0)g/L,治疗前IgG水平升高(>16 g/L)患者22例中18例(81.8%)恢复正常。36例ANA阳性患者19例(52.7%)阴转。两组患者均无严重不良反应。行肝穿病理检查患者中,观察组患者中性粒细胞和(或)嗜酸性粒细胞浸润(17/32,53.1%)明显高于对照组(3/17,17.5%)(χ^2=5.785,P=0.016)。结论异甘草酸镁用于治疗自身免疫样药物性肝损伤安全有效,是临床治疗的可选择方案。
