Non-Diabetic Renal Disease in Patients with Type 2 Diabetes Mellitus with Proteinuria

Background: Diabetes mellitus (DM) is the leading cause of end stage renal disease (ESRD) worldwide. Although DM with proteinuria is the ultimate result of diabetic nephropathy (DN), a wide spectrum of non-diabetic renal diseases (NDRD) can occur in such patients. Objective: To observe the frequency and histological pattern of NDRD in diabetic patients with proteinuria and to explore their association with clinical and laboratory parameters. Methods: This cross-sectional study was conducted in the Department of Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from April 2016 to September 2017. In this study a total of 38 cases of DM with proteinuria (>1 gm/24-hour) were selected purposively. Renal biopsy was done in all patients. Based on histological findings they were categorized into two groups;Group 1 with NDRD and Group II with DN. Their clinical and laboratory parameters were analyzed and compared. Results: Among the total study subjects, 21 (55.3%) were male and 17 (44.7%) were female, mean (±SD) age 43.45 ± 9.99 years in the NDRD group and 41.57 ± 9.50 years in the DN group. Thirty one cases (81.6%) out of thirty eight had NDRD and seven (18.4%) cases had isolated DN;therefore more than two third cases had NDRD. Duration of DM was found to be significantly shorter (p = 0.004) in the NDRD group. Diabetic retinopathy was present in 12.9% cases in NDRD group vs. 57.1% cases in DN group (p = 0.025). Frequency of microscopic hematuria was significantly higher (90.3%) in NDRD patients (p = 0.002). Conclusion: The frequency of NDRD in type 2 diabetic patients other than diabetic nephropathy is relatively high. Membrano proliferative glomeru-lonephritis and membranous nephropathy are more common in NDRD. Absence of diabetic retinopathy, presence of hematuria and shorter duration of DM are markers associated with NDRD in type 2 DM, which are important indicators for renal biopsy in diabetic patients with proteinuria.

Non-Diabetic Kidney Disease in Type 2 Diabetes Mellitus: A Study of 82 Patients and Review of the Literatures

Background: Worldwide, diabetic nephropathy-DN is the leading cause of end-stage kidney disease-ESKD, DN is a common cause of renal failure with a reported frequency of 10% - 15% in type-2-diabetes-mellitus-T2DM patients, however there is a great discrepancy between countries. The aim of the pre-sent study is to evaluate the findings of kidney biopsies performed on diabetic patients. Materials and Methods: We studied native kidney histopathological findings in the period from January 2016 till end of December 2018 done for patients with T2DM with chronic kidney diseases-CKD. Results: A total of 82 DM-patients, 50 males (61%) and 32 females (39%) with age mean (95% CI) of 50.8 (47.1 - 55.2) years for all patients, ranged between 15 to 65 years. Histological findings showed that 57.3% of patients had DN. While focal-segmental-glomerulosclerosis-FSGS was present in 20.7%—primary in 8.6% and secondary in 12.1%. IgA represented 4.9%, while Lupus nephritis, Membranous and drug induced interstitial nephritis were each present in 3.7%. MCD was present in 2.4%. Lastly diffuse proliferative GN, ANCA associated glomerulonephritis, and hypertensive nephrosclerosis accounted for 1.2%. Conclusion: The prevalence of NDKD is remarkably frequent in DM patients who underwent kidney biopsy and FSGS was the most frequent diagnosis. To get a proper histopathological diagnosis, an adequate tissue biopsy is needed with an adequate number of glomeruli. There is a great need for more consideration to biopsy diabetic patients, as the finding of NDKD requires a different therapeutic approach. This, hopefully, will help to manage these patients better and therefore, ameliorate the progression to ESKD over time and therefore delay the need for RRT.

Hepcidin and Iron Metabolism in Non-diabetic Obese and Type 2 Diabetic Rats

Summary： The aim of this study was to investigate the changes of iron levels and hepatic regulatory molecules expression involved in iron metabolism in non-diabetic obese/type 2 diabetic rat models. Male Wistar rats were divided into 3 groups： control group, non-diabetic obese group and type 2 dia- betic group （n=20 each）. The rats were evaluated physiologically and biochemically. The hepatic histo- pathological changes were observed using haematoxylin and eosin （HE） staining. The mRNA expres- sion patterns of hepcidin, interleukin-6 （IL-6）, hypoxia-inducible factor （HIF） and ferroportin （Fpn） in the rat liver in control group, non-diabetic obese group and type 2 diabetic group were analyzed by real-time RT-PCR. The protein expression patterns of hepcidin in liver of each group were further ana- lyzed by immunohistochemistry and Western blotting. As compared with control group, the ferritin in non-diabetic obese group and type 2 diabetic group was increased significantly （P〈0.001）. However, there was no significant difference in soluble transferring receptor （sTfR）：ferritin ratio among the three groups （P〉0.05）. The real-time RT-PCR, immunohistochemistry and Western blotting results all re- vealed that the expression levels of hepcidin in non-diabetic obese group and type 2 diabetic group were elevated significantly as compared with those in control group （P〈0.001）. The expression levels of hep- cidin mRNA between non-diabetic obese group and type 2 diabetic group showed no significant differ- ence （P〉0.05）. However, the protein expression levels of hepcidin in type 2 diabetic group were sig- nificantly higher than those in non-diabetic obese group （P〈0.05）. Compared to control group, the ex- pression levels of IL-6 mRNA in non-diabetic obese group and type 2 diabetic group were increased significantly and the expression levels ofFpn mRNA decreased （P〈0.05）. However, the expression lev- els ofHIF mRNA had no significant difference among three groups. It is suggested that iron metabolism is substantially disturbed in non-diabetic obese and type 2 diabetic rats probably by the abnormal ex- pression of hepcidin in chronic inflammatory status. The increased hepcidin may restrain the iron re- lease from the cells by affecting the expression of Fpn, which probably associates with the development of diabetic complication.

A study of the levels of urinary microalbumin in non-diabetic normotensive obese individuals

Diabetes mellitus, hypertension and obesity are associated with endothelial dysfunction. Microalbuminu-ria is an early sign of endothelial dysfunction. The occurrence of microalbuminuria in long standing diabetes mellitus and hypertension is well established. This study intends to find the occurrence of microal-buminuria in non-diabetic normotensive obese individuals. Objectives: To estimate urinary albumin creatinine ratio (UACR) in non-diabetic normotensive obese individuals. Design and Methods: 41 non- diabetic normotensive obese adults with Body Mass Index > 23 kg/m2 were taken as cases and 41 age and sex matched healthy non-obese adults with Body Mass Index < 23 kg/m2 were taken as controls. An-thropometric measurements (Body Mass Index and Waist circumference) and biochemical estimations (fasting blood glucose, lipid profile & spot urinary albumin creatinine ratio) were carried out. Results: urinary albumin creatinine ratio was lesser than the established microalbuminuric range of 30 - 300 mg/g, in both cases and controls irrespective of the values obtained for lipid profile and anthropometric indices. Conclusion: Microalbuminuria may not be present in obese patients without diabetes and/hypertension.

Non-Diabetic Nephropathies among Diabetic Patients of the Nephrology Department of Dakar

Introduction: Diabetic nephropathy is the most common cause of kidney disease in diabetics. However, in some cases the clinical symptoms is not typical and nephropathy may be different from diabetic and require the use of renal biopsy (RB) which is not usually indicated unless non-diabetic nephropathy (NND) is suspected. The objective of this study was to evaluate the prevalence of non-diabetic nephropathy (NDN) among the diabetic patients and to analyse the different predictive factors of its occurrence. Patients and methods: It was a retrospective, descriptive and analytical study which is carried out at the nephrology department of Aristide Le DANTEC hospital of Dakar over a period of 60 months. Diabetics with suspected NDN diagnosis based on renal anomalie that is associated with a recent diabetes, Acute renal failure with rapid progress, Diabetic retinopathy’s absence, and Extrarenal signs (cutaneous, digestive and articular) associated with an acute renal failure. Microscopic haematuria was included. The epidemiological, clinical, biological and histological parameters were collected and analysed using the SPSS, 3.5 version software. Results: Out of 34 biopsied diabetic patients, 12 had NDN that is a prevalence of 35, 3%. The average age was 49.88 ± 4.15 years, 0.78 for the sex-ratio and the mean duration of diabetes is 12.53 ± 4.7 years. Glomerular syndrome was found in 30 patients (88.23%), vascular nephropathy syndrome in 3 patients (8.82%) and tubule-interstitial nephropathy syndrome in only one patient (2.94%). Diabetic retinopathy (DR) and microscopic haematuria (HU) respectively existed in 10 patients (34%) and 15 patients (44. 12%). The Kidney biopsy (KB) indications were renal abnormalities associated with recent diabetes, acute renal failure with rapid progress, absence of DR, extrarenal signs associated with acute renal failure and microscopic haematuria. Twenty-two patients (64.7%) had diabetic nephropathy (DN) and 12 patients (38.2%) presented a NDN. Predictive factors of NDN diagnosis were a shorter diabetes duration (P = 0.0008), high blood pressure (P = 0.0015) and absence of DR (P = 0.005). Conclusion: Our data show that kidney injury in a diabetic is not always diabetic nephropathy. The Kidney biopsy (KB) is often needed in order to adopt an effective management.

Biological Association and Expressions of NOS3 &SOD2 in Non-Diabetic Senile Cataractogenesis

Aim: To evaluate the functional relationship between the nitric oxide synthase (NOS) and superoxide dismutase (SOD) enzymes in the pathogenesis of human senile cataract lenses of non-diabetic patients. Methods: Total solubilized proteins from human cataract lens were compared with normal lens (control) by 2-Dimenstional gel electrophoresis (2-DE). Proteins with different abundances were identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS). Western blot analysis was used to verify the changes in expression of NOS3 and SOD2. A further functional association of NOS3 with SOD2 and other proteins was seen by STRING 8.3 databases. Results: In the 2-DE maps, the cataract and normal lens proteins migrated in the region of pH 3 - 10 with a relative molecular weight of 20 - 130 kDa. Approximately two protein spots with differential intensity were detected as NOS3 and SOD2 using MALDI-TOF-MS. Western blot analysis showed high expression of NOS3 in cataract and SOD2 in normal lens samples. String interaction network revealed strong interactions between NOS3 and SOD2 at high confidence score, which is helpful in characterization of functional abnormalities that may be a causative factor in the pathogenesis of cataract. Conclusion: This study will offer new avenues for mechanistic evaluation and future prevention of cataractogensis. However, large scale studies will be required to evaluate the effect of this interaction on the clinical outcome in human cataract.

维持性血液透析患者血清Hepcidin、sTfR测定在铁缺乏中的应用价值

目的检测维持性血液透析患者(MHD)、非透析终末期肾脏疾病患者(ESRD)血清中铁调素(hepcidin)和血清转铁蛋白受体(serum transferring receptor,sTfR)的水平变化,探讨其在肾性贫血铁缺乏中的作用。方法选择维持性血液透析患者80例、非透析终末期肾脏疾病患者80例,健康体检者80例作为对照组。ELISA法检测血清Hepcidin、sTfR、总铁结合力(TIBC),同时测定血清铁(Fe)、铁蛋白(FER)、血清转铁蛋白(TRF),比较组间差异。结果 1维持性血液透析患者和非透析终末期肾脏疾病患者血清hepcidin和sTfR水平均明显升高,差异有统计学意义(P<0.01)。2与非透析ESRD组相比,MHD组的血清hepcidin和sTfR水平显著升高,差异有统计学意义(P<0.05)。3相关分析显示,血清hepcidin与Scr、hs-CRP、血清铁(Fe)、铁蛋白(FER)呈正相关,r分别为0.515、0.312、0.290、0.286,P均<0.01;与HGB、eGFR、HCT、TRF、TIBC呈负相关,r分别为-0.466、-0.362、-0.285、-0.248、-0.224,P<0.05。4血清sTfR水平与铁蛋白、转铁蛋白饱和度(TSAT)有相关性,相关系数分别为-0.764、-0.519,P均<0.01;与血红蛋白和红细胞压积有相关性,相关系数分别为0.378和0.514,P均<0.01。5血清hepcidin、sTfR联合铁蛋白或转铁蛋白饱和度诊断缺铁时,绘制受试者工作特征曲线(receiver operating characteristic curve,ROC),曲线下面积为90.8%,对应的灵敏度为93.3%,特异度为77%。结论血清hepcidin、sTfR联合铁蛋白或转铁蛋白饱和度对于ESRD患者合并肾性贫血铁缺乏的评估及治疗有重要意义。

高通量血液透析治疗终末期肾病病死率Meta分析

目的评价高通量血液透析及低通量血液透析治疗终末期肾病的效果。方法检索Pub Med、EMBase、Cochrane Library中有关采用高通量和低通量血液透析法治疗终末期肾病的对照研究文献,并依据纳入和剔除标准进行严格筛选。采用Meta分析的方法合并效应量(RR);文献质量评价采用Cochrane协作网推荐的偏倚风险评估工具;应用Q检验及I2评估研究异质性的大小;发表性偏倚评估采用Begg检验;应用敏感性分析评估结果的稳健性。结果本研究共筛选出相关文献11篇,总样本4 233例。采用随机效应模型进行Meta分析,结果显示,与低通量血液透析比较,高通量血液透析能降低终末期肾病的全因病死率(RR=0.71,95%可信区间0.57~0.89)。亚组分析发现,与低通量血液透析比较,高通量血液透析能降低终末期肾病患者因心血管疾病导致的病死率(RR=0.74,95%可信区间0.62~0.88),但并不能降低因感染导致的病死率(RR=0.90,95%可信区间0.71~1.14)。结论高通量血液透析较低通量血液透析能够改善终末期肾病患者的存活时间,但部分伴感染人群并不能从中受益。

Noninvasive identificational diagnosis of diabetic nephropathy and non-diabetic renal disease based on clinical characteristics of Traditional Chinese Medicine symptom pattern and conventional medicine

OBJECTIVE:To study the clinical characteristics relating to differential diagnosis of diabetic nephropathy(DN) and non-diabetic renal disease(NDRD).METHODS:The subjects were patients with type 2 diabetes mellitus(T2DM) complicated with chronic kidney disease(CKD).Western medical history data and Traditional Chinese Medicine(TCM) symptom pattern were collected,and logistic regression was used to analyze.RESULTS:Blood deficiency pattern [odds ratio(OR) = 2.269,P = 0.017] and Qi stagnation pattern(OR = 1.999,P = 0.041) are independently related to DN.CONCLUSIONS:TCM factors blood deficiency pattern and Qi stagnation pattern are relating to differential diagnosis of DN and NDRD.

Gender differences in the relationship between plasma lipids and fasting plasma glucose in non-diabetic urban Chinese popula- tion： a cross-section study

The association between dyslipidemia and elevated fasting glucose in type 2 diabetes is well known. In non-diabetes, whether this association still exists, and whether dyslipidemia is an independent risk factor for high fasting plasma glucose （FPG） levels are not clear. This cross-sectional study recruited 3460 non-diabetic Chinese subjects （1027 men, and 2433 women, aged 35-75 years old） who participated in a health survey. Men and women were classified into tertiles by levels of plasma lipids respectively. In women, the prevalence of impaired fasting glucose （IFG） was decreased with increased HDL-C. A stepwise increase in HDL-C was associated with decreasing FPG levels （lowest tertiles, FPG： 5.376 ± 0.018; middle tertiles, 5.324± 0.018; highest tertiles, 5.276±0.018mmol/L; P = 0.001）. Reversely, FPG levels increased from lowest tertiles to highest tertiles of LDL-C, TC, and TG. we found that women in the first tertile with lower HDL-C level had a 1.75-fold increase in risk of IFG compared with non-diabetic women in the third tertile with higher HDL-C level （OR： 1.75; 95% CI： 1.20-2.56）. In men, no significant association was found. We took age, BMI, waist/hip ratio, education, smoking, alcohol drinking, and physical exercise as adjusted variables. In Chinese non-diabetic women, dyslipidemia is independently associated with high levels of FPG; TG, HDL-C, and LDL-C are predictors of IFG independent of BMI and waist/hip ratio.

Rethinking the necessity of low glucose intervention for cerebral ischemia/reperfusion injury

Glucose is the essential and almost exclusive metabolic fuel for the brain.Ischemic stroke caused by a blockage in one or more cerebral arteries quickly leads to a lack of regional cerebral blood supply resulting in severe glucose deprivation with subsequent induction of cellular homeostasis disturbance and eventual neuronal death.To make up ischemiamediated adenosine 5′-triphosphate depletion,glucose in the ischemic penumbra area rapidly enters anaerobic metabolism to produce glycolytic adenosine 5′-triphosphate for cell survival.It appears that an increase in glucose in the ischemic brain would exert favorable effects.This notion is supported by in vitro studies,but generally denied by most in vivo studies.Clinical studies to manage increased blood glucose levels after stroke also failed to show any benefits or even brought out harmful effects while elevated admission blood glucose concentrations frequently correlated with poor outcomes.Surprisingly,strict glycaemic control in clinical practice also failed to yield any beneficial outcome.These controversial results from glucose management studies during the past three decades remain a challenging question of whether glucose intervention is needed for ischemic stroke care.This review provides a brief overview of the roles of cerebral glucose under normal and ischemic conditions and the results of managing glucose levels in non-diabetic patients.Moreover,the relationship between blood glucose and cerebral glucose during the ischemia/reperfusion processes and the potential benefits of low glucose supplements for non-diabetic patients are discussed.

Pathological Observation of Blood Stasis Syndrome in Non-diabetic Peripheral Neuropathies:A Retrospective Analysis Based on Nerve Biopsy

Objective To investigate the pathological features of blood stasis syndrome(BSS)in non-diabetic peripheral neuropathy.Methods Clinical data of 31 patients with non-diabetic peripheral neuropathy who had undergone nerve biopsy during December 2004 and December 2010 in Xuanwu Hospital Capital Medical University were retrospectively analyzed.According to Chinese medicine(CM)syndrome differentiation and signs,26 patients were blood stasis type and 5 patients were non-blood stasis type.Clinical and pathological data were compared in detail.Results Clinically,although both groups shared similar symptoms of limb numbness,weakness and sensory disturbances,the prevalence of neuralgia was much grievous in BSS group(73.1%,26/31)compared with the non-BSS group(0%,0/5).As for signs,dermal nutrients disturbance(84.6%,22/26),dark or purple tongue(100.0%,26/26),and sublingual varices(80.7%,21/26)were more common in the BSS group than the non-BSS group(0%,60%,20%,respectively).The prevalence of qi deficiency cases(19/26)in the BSS group was significantly higher compared with the non-BSS group(1/5).The unique histological manifestations of BSS were axonal degeneration(16/26 vs 2/5 in non-BSS group),which was the hallmark of ischemia.Cases with BSS had prominent microangiopathy(61.5%,16/26),manifested as epineurium vasculitis(inflammatory cell infiltrated to the vessel wall,obliteration and recanalization,vascular proliferation,extravascular hemosiderin deposition),angiotelectasis,proliferation and hyaline degeneration of endoneurium capillary.In the BSS group,impaired blood-nerve barrier was indicated by sub-perineurial edema(46.2%,11/26)and endoneurial edema(15.4%,4/26).The Renaut body(15.4%,4/26)and amyloid deposition(3.8%,1/26)found in the BSS group were absent in the non-BSS group.Conclusions BBS was common in non-diabetic peripheral neuropathies.The nerves exhibited ischemic alteration of primary axon degeneration and secondary demyelination.The interstitial tissue revealed microcirculation impairment,blood-nerve barrier disturbance,amyloid deposition and proliferation changes.The high prevalence of qi deficiency also highlights the therapy of promotion of blood circulation and removal of blood stasis.

糖尿病患者合并非糖尿病肾损害的临床病理分析及评价

目的:分析糖尿病患者合并非糖尿病肾损害(non-diabetic renal diseases,NDRD)的临床病理特点.方法:按照年龄将我院收治的165例糖尿病合并NDRD患者分为<35岁组27例、35-59组110例和≥60岁组28例,回顾性分析3组患者一般情况、临床表现和肾脏病理类型的分布特点.结果:3组患者之间平均年龄和平均病程相互比较(28.82岁±4.53岁vs 48.57岁±6.76岁vs66.77岁±5.05岁)、(1.06年±1.79年vs 3.02年±3.57年vs 4.64年±4.89年),差异具有统计学意义(P<0.05或P<0.01);3组患者之间空腹血糖(fasting blood-glucose,FBG)水平和糖尿病视网膜病变(diabetic retinopathy,DR)发生率比较(8.02 mmol/L±4.70 mmol/L vs 7.10 mmol/L±2.43 mmol/L vs 6.82 mmol/L±2.16mmol/L)、(18.52%vs 13.64%vs 7.14%),差异无统计学意义(P>0.05);3组患者间各临床表现所占比例比较(40.74%vs 35.45%vs 17.86%)、(22.22%vs 27.27%vs 32.14%)、(18.52%vs14.55%vs 10.71%)、(11.11%vs 5.45%vs14.29%)、(7.41%vs 17.27%vs 25.00%),差异无统计学意义(P>0.05);≥60岁组患者IgA肾病(IgA nephropathy,IgAN)发生率明显低于<35岁组和35-59组,(3.57%vs 37.04%)、(3.57%vs 42.73%),差异具有统计学意义(P<0.01);≥60岁组患者高血压性肾损害(hypertensive renal impairment,HRL)发生率明显高于35-59组(10.71%vs 1.82%),差异具有统计学意义(P<0.01).结论:糖尿病合并NDRD患者中青年患者多为CNS,中年患者临床表现多样,老年患者多为NS和CRF,青中年患者病理类型多为IgAN,老年患者多为膜性肾病.

Prevalence of Diabetes and Its Effect on the Course and Treatment of Frozen Shoulder

Background: Frozen shoulder is a painful condition that can lead to long-term disability. The frequency of frozen shoulder among diabetic patients is about 10% to 39%. Diabetics have a higher prevalence of frozen shoulder than the general population, and these individuals are less responsive to therapy and have a larger range of motion limitation. Aim: The aim of this thesis is to determine the prevalence of diabetes among patients with frozen shoulder and to compare them in terms of demographics, clinical and treatment features. Method: This study was performed on patients who had been diagnosed with frozen shoulder at an orthopedic center in Mashhad, Iran, from 2012 to October 2021. The frequencies and cross tabulations were used to analyze the data by SPSS to determine the significance of relationships. The chi-square and t-tests have been used with a p-value less than 0.05 as the alpha level of significance. Results: Among the patients, the average age was 56 years old. Among 310 patients with Frozen shoulder, 36% were diabetic. There was no statistically significant difference in gender and level of activity between patients with and without diabetes. In contrast, the side of the affected shoulder, duration of frozen shoulder, stage of frozen shoulder and treatment of frozen shoulder were statistically significantly different between the two groups (p p Conclusion: Based on this study, around one-third of frozen shoulder patients have diabetes. Although there was a statistically significant difference in the treatment of frozen shoulder between patients with and without diabetes groups, diabetic individuals have a more severe course of illness, and their treatment is less effective.

IVUS-guided PCI decreases the risk of in-stent restenosis within 1 year in non-diabetic elderly men

Background Previous studies have shown that drug-eluting stents(DES)implantation guided by intravascular ultrasound(IVUS)could significantly decreased the major adverse cardiac events(MACEs),stent thrombosis,and in-stent restenosis.However,it is unclear whether IVUS-guided single-vessel implantation in elderly without diabetes reduces the risk in-stent restenosis within 1 year.The purpose of our study was to determine whether IVUS-guided percutaneous coronary intervention(PCI)reduces the risk of in-stent restenosis within 1 year in elderly non-diabetic men.Methods 204 elderly non-diabetic males with unstable angina,aged 60-70 years,were taken into our study.All patients underwent coronary angiography(CAG)and left anterior descending branch DES implantation.After that,100 mg aspirin and 75 mg clopidogrel were taken daily.The patients received routine reexamination in the outpatient department,and coronary angiography was performed one year after PCI.102 patients were assigned to PCI+IVUS group(under IVUS guidance)and 102 patients were assigned to PCI group(without IVUS guidance).Two groups were completely matched by age.Multiple logistic analysis and receiver operating characteristic(ROC)curve were conducted to investigate the prevalence rate of in-stent restenosis and MACEs.Results In the PCI group,the level of lipoprotein(a)[Lp(a)]and low density lipoprotein cholesterol(LDL-C),and the number of smokers were obviously higher than that in the PCI+IVUS group.The instent restenosis rate[4(3.92%)vs.13(12.75%),P=0.040]and the risk of in-stent restenosis(OR:0.298,95%CI:0.092-0.969,P=0.040)in the PCI+IVUS group were significantly lower than that in the PCI group.The ROC curve indicated that IVUS was a sensitive and specific factor to decrease the risk of in-stent restenosis[area under the curve(AUC)=0.66,P=0.049].Conclusions IVUS-guided PCI may be an effective method for reducing instent restenosis within 1 year in non-diabetic elderly men.

The Spectrum of Kidney Disease in Type Two Diabetic Patients: A Single-Center Study

Background: Diabetic nephropathy (DN) is the dominant reason for end-stage kidney disease linked with a rise in cardiovascular mortality rate. However, besides DN, type 2 diabetic patients may also suffer from various non-diabetic renal diseases (NDRD). Aim: The objective of the current research was to assess the occurrence and type of NDRD diagnosed by kidney biopsy in type 2 diabetic subjects, evaluate the association of various clinical and laboratory characteristics with histopathology findings, and identify essential predictors of NDRD. Methods: Retrospective analysis has been performed through medical record revision of 101 patients with type 2 diabetes undergoing percutaneous renal biopsy at Qilu Hospital of Shandong University (Jinan, China) between January 2015 and December 2020. Results: Renal biopsy results showed that NDRD was found in 59 patients (58.42%), while DN existed in 32 patients (31.68%) and 10 patients (9.90%) showed DN complicated with NDRD. Membranous nephropathy was prevailing NDRD (42%), followed by focal segmental glomerulosclerosis (11.6%) and IgA nephropathy (10.1%). In univariate analysis, patients with NDRD had older age (p Conclusions: Clinical parameters such as short duration of diabetes, older age, higher hemoglobin level, and lower proteinuria might be associated with NDRD in type 2 diabetic patients. An early diagnosis of NDRD poses a favorable renal prognosis because it requires a different approach than DN, further larger multicenter randomized prospective investigations focused on identifying possible risk markers of NDRD are still in priority.

Relation of combined non-high density lipoprotein cholesterol and apolipoprotein B with Gensini Score of coronary atherosclerosis in non-diabetic acute coronary syndrome

Background Non-high-density lipoprotein cholesterol （non-HDL-C） and Apolipoprotein B （apoB） increase car- diovascular disease （CVD） risk, but few studies have explored the correlations of non-HDL-C and apoB with cor- onary atherosclerosis in non-diabetes acute coronary syndrome （ACS）. Methods The study enrolled 443 sub- jects with non-diabetic ACS, and all subject check coronary angiography, and coronary atherosclerosis were eval- uated using Gensini Score （GS） scale including small （GS 1-15）, middle （GS16-43）, and severe （GS≥44）. All sub- jects were classified into 4 groups： High apoB （≥90 mg/dL） and High non-HDL-C （≥130 mg/dL）, High non-HDL -C alone, High apoB alone, and normal apoB and non-HDL-C. Results After adjusted for risk factors, non-HDL -C and apoB were positively correlated with GS （ r = 0.075, P = 0.002 and r = 0.092, P 〈 0.001）. In the GS 0-15, high non-HDL-C ＋ high apoB group 29.3% and high apoB alone group 28.2% were significantly lower than nor- mal non-HDL-C＋ normal apoB group 48% （p = 0.010）. In the GS 16-43, high non-HDL-C alone group 50.4% and high apoB alone group 47.6% were significantly more than high non-HDL-C＋ high apoB group 34.1% （P = 0.036）. In the GS ≥44, high non-HDL-C＋ high apoB group 36.6% was significantly higher than high non-HDL- C alone group 16% and normal non-HDL-C＋ normal apoB 14.2%（P 〈 0.001）. Conclusions The high non-HDL- C and apoB are the risk factors for coronary artery atherosclerosis in non-diabetic ACS.

NP-10 Potential Mechanism for Higher Stroke Risk in Diabetes

World Health Organization data show that the risk of cardiovascular and cerebrovascular disease in diabetic patients is 2 to 3 times that of non-diabetic patients,and 50%to 80%of diabetic patients eventually die of heart and cerebrovascular complications.Type 2 diabetes is currently considered as an independent risk factor for cerebral ischemic diseases,and about 20%of ischemic brain diseases are currently considered to be related to diabetes.The application of sulfonylurea drugs has been more than 60 years old.Although sulfonylurea drugs as a proportion of oral hypoglycemic drugs have declined with the continuous R&D and marketing applications of new hypoglycemic drugs,they currently account for the proportion still exceeds 40%and is the most widely used oral hypoglycemic drug.The correlation between the use of rosiglitazone and cardiovascular risk has led to uncertainty about the cardiovascular safety of different hypoglycemic drugs.With the increasing incidence of type 2 diabetes,it has become very important to clarify the vascular effects and safety of hypoglycemic drugs.We discuss the risk of stroke in patients with type 2 diabetes using sulfonylureas.

碳酸镧治疗终末期肾脏病高磷血症的Meta分析

目的系统评价碳酸镧治疗终末期肾脏病（ESRD）高磷血症的有效性及安全性。方法通过计算机检索Cochrane图书馆、MEDLINE、EMBASE、CNKI、万方数据库，文献检索起止时间为1996年1月至2011年12月。收集碳酸镧治疗ESRD高磷血症的随机对照试验（RCT），应用RevMan5．1软件对数据进行Meta分析。结果共纳入6篇文献，12个RCT，包括1688例患者。Meta分析结果显示，有效性分析：碳酸镧组血磷达标率与碳酸钙组相似[RR=1．00，95％CI（0．92～1．09），P=0．97]，高于安慰剂组[RR=4．69，95％CI（2．63～8．39），P〈O．01]（剂量≤1500mg）及[RR=18．92，95％CI（7．42～48．22），P〈0．01]（剂量〉1500mg）；碳酸镧组血钙磷乘积降低幅度与碳酸钙组相似[MD=-0．91，95％CI（-7．18—5．36），JP=0．781，大于安慰剂组[MD=-10．50，95％CI（-15．89—-5．10），P〈0．011。安全性分析：碳酸镧组高钙血症发生率低于碳酸钙组[RR=0．06，95％CI（0．01～0．72），P=0．03]。常见消化道不良反应中，碳酸镧组恶心【RR=1．80，95％CI（0．70—4．64），P=0．22]、呕吐[RR=3．94，95％CI（0．45—34．38），P=0．22]、便秘[RR=0．82，95％CI（0．49—1．37），P=0．45]发生率与碳酸钙组相似，与安慰剂相比，恶心[RR=1．55，95％Ct（0．50—4．78），P=0．44]、呕吐[RR=2．07，95％CI（0．38—11．30），P=0．40]发生率相似，便秘[RR=0．19，95％CI（0．06—0．59），P〈0．01]发生率低。结论应用碳酸镧治疗ESRD高磷血症的有效性与碳酸钙相似；与碳酸钙治疗组相比，碳酸镧治疗组高钙血症发生率较低，恶心、呕吐、便秘等常见消化道不良反应发生率相似。

温州地区终末期马兜铃酸肾病患者伴发肿瘤的研究

目的探讨因终末期马兜铃酸肾病（AAN）行肾脏替代治疗的患者发生肿瘤的情况。方法收集2004年至2013年诊断为终末期AAN并在本院接受替代治疗的患者共102例，研究肿瘤特点及相关因素。结果（1）伴发肿瘤患者共42例，占41．2％，39例（92．9％）为泌尿系肿瘤，其中8例发生转移，11例膀胱癌反复复发。肿瘤组患者病死率升高（13／42比7／60，P=0．022）。（2）其中13例患者在进入终末期肾病（ESRD）前即已发生肿瘤，另外29例患者在肾脏替代治疗后的1～13年【平均（4．62±3．31）年】相继发生肿瘤。（3）对29例进入肾脏替代治疗后发生肿瘤的患者进行logistic回归分析发现，肿瘤发病风险仅与马兜铃酸（aA）类药物剂量相关（P=0．091），相对木通剂量〈60g组，木通剂量〉200g组发病风险增加4．26倍（95％CI1．02，17．83）；而3种替代治疗方式的患者发生肿瘤的差异无统计学意义，但泌尿系肿瘤具体部位有所不同，其中血液透析患者单纯膀胱癌比例最高（72．72％），腹膜透析患者上尿路癌居多（66．67％），而移植患者复合性尿路癌比例相对较高（40．00％）。结论温州地区终末期AAN患者中，泌尿系肿瘤发生率高，且表现为复合、多发、复发等特点。肿瘤的发生与肾功能存在分离现象，且呈现较明显的剂量依赖性。不同肾脏替代治疗方式对AAN患者肿瘤的发生无明显影响，但可能导致肿瘤发病部位有所不同。