Study of Interference Treatment by Xuesaitong (血塞通) Soft Capsuleon Patients of Nephrosis Syndrome with Qi Deficiency and Blood Stasisduring Dose Reducing Stage of Corticosteroid

Objective: To observe the effect of Xuesaitong (血塞通, XST) soft capsule in interference treatment on patients of nephrosis syndrome (NS) during corticosteroid (CS) dose reducing stage. Methods: Seventy-one NS patients applying prednisone and initiating dose reducing stage were randomized into trial group and control group. On the basis of conventional prednisone dose reduction of both groups, the trial group was given additionally XST, and the treatment course ended with the reduction to maintenance dose. In the course of observation, those who did not comply with the criteria of observation were excluded. Before and after the dose reduction, TCM syndrome scoring, 24 hrs urinary protein amount, blood β2-microglobulin (β2-MG), urinary β2-MG, blood fibrinogen (Fbg), plasma prothrombin time (PT), blood lipid, etc. were observed. Results: The trial group of XST could obviously lower their urinary protein amount and blood lipid level (P<0.05 or P<0.01), markedly improve the blood coagulation parameters (P<0.01), improve the TCM syndrome and CS induced adverse reaction (P<0.05 or P<0.01), also obviously reduced the recurrence rate of NS (P<0.05). Conclusion: XST could obviously improve the clinical symptoms and renal impairment parameters in NS patients during CS dose reduction stage, improve the CS induced adverse reaction and prevent the recurrence of NS.

miRNAs Expression and Role of Dicer on Podocyte Injury in PAN Nephrosis Rats

Objective: microRNAs (miRNAs) are regulatory RNAs that act as important players in diverse biologic and pathologic processes. Under circumstance as podocye-injury triggering proteinuria, which miRNAs are up-regulated or down-regulated? This experiment aims at detecting miRNAs changes in PAN nephrosis rats based on miRNA arrays and exploring the therapeutic targets of Leizhi capsule. Methods: Fifty male wistar rats were randomly divided into five groups, including control group, model group, leizhi capsule group, Tripterygium glucosides group, and valsartan group. PAN nephrosis models were made by jugular vein injection of PAN (100 mg/kg body weight, dissolve in physiological saline), while control group rats were made by jugular vein injection of physiological saline with equal volume. Other groups rats had been given medicines by irrigating stomach once a day for ten days. Blood and urine samples were collected, and renal tissues were processed after rats being euthanasised. The 24 h urinary protein excretion and blood biochemistry parameters were measured by routine methods. The glomerular morphology and podocyte ultrastructure were observed with light microscopy and transmission electron microscopy respectively. miRNA expression profile was detected by Exiqon miRNA Array. Real time RT-PCR analysis for mature miRNAs was used to validate differentially expressed miRNAs. Results: 1) In day 3 - 5, model rats had decreased urine volume, ascites, malnutrition and wight loss. From day 7 to day 10, the nephrotic syndromes were worst in model rats, but which had no skin edema. Some rats died in serious ascites, the mortality is 3/10. 2) miRNA array detection shows 106 miRNAs up regulated and 62 miRNAs down regulated in PAN nephrosis rats. Fold change (model vs. control group) varies from 1.8 to 7.0. For leizhi capsule group and model sample, there are 90 miRNAs differentially expressed, with 65 miRNAs up and 25 miRNAs down. The most important finding in our research is the discovery of the specific miRNAs related to PAN nephrosis (rno-miR23a, rno-miR-24, rno-miR-30c and rno-miR-300-3p), which have been validated by Real time RT-PCR analysis. 3) Compared with control sample, immune fluorescence intensity of dicer, expression profile of nephrin, podocin and synaptopodin mRNA and protein decrease in PAN nephrosis rats. After treated with Leizhi Capsule, immune fluorescence intensity of the above molecules improved. Conclusion: 1) Characteristic miRNAs of PAN nephrosis were screening. Up-regulated miRNAs (rno-miR-23a, rno-miR-300-3p) may trigger podocyte injury and proteinuria, while down-regulated miRNAs (rno-miR-24, rno-miR-30c) may be protective factors by anti-apoptosis. 2) Dicer and these miRNAs (rno-miR-24, rno-miR-30c, rno-miR-23a) may be are probably key molecules therapeutic targets of Leizhi capsule.

Shen's Experience in Application of the Drugs for Tonifying the Kidney to.Reduce and Withdraw Adrenocortical Hormone

Adrenocortical hormone (ACH) has antiinflammatory and antiallergic actions, changes stress state and controls the attack of some severe and obstinate diseases. The treatment of chronic diseases with ACH often leads to its dependence; especially oral administration of ACH for a long time is liable to inhibit the function of hypothalamus-pituitary-adrenocortical-thymic axis (HPAT), and results in the hypo-reservation of adrenal cortex. Hence, sudden ACH withdrawal or decrease often causes the disease recurrence, even adrenocortical crisis. Academician Shen Ziyin has a wealth of clinical experience in both the withdrawal and reduction of ACH and the keeping of therapeutical effectiveness to form his unique remedy in the application of drugs. Shen's rich experience is described as follows.

EFFECT OF HIGH-LIPID DIET ON GLOMERULAR MESANGIAL MATRIX IN ADRIAMYCIN-INDUCED NEPHROTIC RATS

OBJECTIVE: To determine the effect of hypercholsterolemia induced by a high-lipid diet on glomerulosclerosis. METHODS: Twenty nephrotic syndrome (NS) Wistar rats administrated adriamycin (ADR) with a single intravenous dose of 5 mg/kg body weight, were divided into the standard and high-lipid chow groups. Another 20 weight-matched non-NS rats that received a vehicle alone were grouped as control. Urinary protein excretion and serum cholesterol were assayed; image analysis and techniques of pathology, immunohistochemistry, and molecular biology were used to determine morphological changes in glomeruli and the production of glomerular mesangial matrices in different groups. RESULTS: The serum total cholesterol level was significantly higher in rats with high-lipid chow in both non-NS [(2.2 +/- 0.3) g/L vs. (0.9 +/- 0.1) g/L, P

Prognostic value of red cell distribution width in elderly patients undergoing maintenance hemodialysis

Objective:To investigate the predictive value of red blood cell distribution width(RDW)for all-cause mortality in elderly patients undergoing maintenance hemodialysis(MHD).Methods:We retrospectively analyzed the data of 172 elderly patients who initiated maintenance hemodialysis from June 2013 to June 2018.Basic data on demographic,dialysis,laboratory data and clinic outcomes were recorded.Compare the basic information of death and survival groups,such as general characteristics baseline laboratory data,baseline RDW and time average RDW during the follow-up;Cox regression analysis was used to analyze the risk factors of all-cause mortality,and predictive value of RDW for all-cause death in elderly maintenance hemodialysis patients.Results:A total of 172 elderly MHD patients were inrolled in this study with age of(66.3±6.1)years old and the dialysis duration of(27.3±15.3)months,including 94 males(54.6%).37 patients died during the follow-up period.Non-survivors had higher levels of RDW at baseline,higher time-average RDW,higher blood PTH,higher blood C-reactive protein(CRP),higher blood brain natriuretic peptide(BNP)(P<0.05)and lower albumin(P<0.05).Multivariate Cox regression analysis suggested that RDW,serum albumin,serum CRP,and serum BNP were independent risk factors for all-cause mortality in elderly patients with MHD.The receiver operating characteristic curve(ROC)showed that RDW=14.75%was the best cut-off point for predicting all-cause mortality in elderly patients undergoing MHD(P<0.01).Conclusions:High RDW is an independent risk factor for all-cause mortality in elderly patients with MHD,and it has important value for prognosis.

Qiguiyishen decoction reduced the accumulation of extracellular matrix in the kidneys of rats with adriamycin-induced nephropathy

OBJECTIVE： To investigate the effect of Qiguiyish- en decoction （QGYS） on the severity of nephropa- thy. METHODS： Twenty-four rats were randomly divid- ed into four groups （ Ⅰ,Ⅱ,Ⅲ, IV） according to the random number table. Group I as control group did not establish nephropathy model. Groups Ⅱ, Ⅲ, and IV were intravenously administered Adria- mycin （7.5 mg/kg） through the tail vein to establish nephropathy model. QGYS was prepared with the extracts of Huangqi （RadixAstragali Mongolici）, Dan- ggui （Radix Angelicae Sinensis）, Niuxi （Radix Achyran-this Bidentatae）, and Chuanxiong （Rhizoma Chuanx- iong）. Group IV was administered QGYS （2 mL. kg^-1· d^-1）, groupⅢ was administered benazepril （10 mL. kg^-1·d^-1）, and group ⅠⅡ was administered water （2 mL. kg·^-1. d^-1） once daily for eight weeks. RESULTS： QGYS reduced the excretion of urinary protein and N-acetyH3-D-glucosaminidase and alle- viated the accumulation of extracellular matrix （ECM） in renal tissue. Additionally, QGYS effectively regulated the levels of transforming growth factor, tissue inhibitor of matrix metalloproteinase, and matrix metalloproteinases in the kidney of the rats. CONCLUSION-＂ QGYS may reduce the accumulation of ECM in the kidneys of rats with Adriamycin-in- duced nephropathy.

贫血对冠心病患者冠状动脉介入治疗术后急性造影剂肾损伤的影响(英文)

Objective The aim of the present study was to assess the influence of anemia on development of contrast-induced acute kidney injury (AKI) after percutaneous coronary intervention.Methods The subject group consisted of 1026 patients who had undergone coronary intervention procedure between January 1,2008 and October 31,2009.A nonionic,low osmolality contrast agent was used in our laboratory at this time.Serum creatinine values were measured before and within 48 h of administration of contrast agents.Contrast-induced nephropathy was defined as an increase of 0.5 mg/dl or 25% in serum creatinine concentration over baseline within 48 h of angiography,anemia as hemoglobin (Hb) <120 g/L in women and <130 g/L in men.Results Among the 1026 patients studied,32(3.1%) experienced AKI after procedure.AKI occurred in 6.3% of the anemic patients and 2.2% of the non-anemic patients (P<0.01).The incidence of AKI increased with decreasing of baseline estimated glomerular filtration rate (eGFR)in both the anemia and non-anemia groups.In patients with baseline eGFR<30 ml·min-1·(1.73 m2)-1,a high proportion of both anemic and non-anemic patients experienced (24.6% vs.18.5%).When baseline eGFR was 30-59 ml·min-1·(1.73 m2)-1,the incidence of in anemic patients was 2-fold higher than in non-anemic patients (7.9% vs.3.8%;P<0.05).The amount of the contrast agent administered was similar for AKI and non-AKI patients [(182±46)ml vs.(176±48) ml,P>0.05) ].Multivariate Logistic regression analysis found that baseline eGFR and baseline hemoglobin were independent predictors of AKI.When presence of anemia was introduced into the multivariate model instead of baseline hemoglobin,it was also showed a significant association with AKI.Conclusions Anemia increases the incidence of AKI in patients with moderate renal dysfunction.Patients with both preexisting renal insufficiency and anemia are at high risk of AKI.Baseline eGFR and baseline hemoglobin (or anemia) are independent predictors of AKI.