Objective To investigate whether glomerular density （GD） could be an independent prognostic factor for patients of IgA nephropathy with estimated glomerular filtration rate （eGFR） of 30 to 60 ml/min per 1.73 m2, ...Objective To investigate whether glomerular density （GD） could be an independent prognostic factor for patients of IgA nephropathy with estimated glomerular filtration rate （eGFR） of 30 to 60 ml/min per 1.73 m2, or for patients with time-average proteinuria 〈 0.5 g/d. Methods A total of 173 patients with biopsy-confirmed IgA nephropathy diagnosed from January 2000 to December 2010 were included. All of these patients were followed up for more than 5 years. The endpoint was a 〉 30% of decline in eGFR from baseline after 5-year follow-up. The optimal cut-off value of GD was calculated by ROC curve. Kaplan-Meier method and Cox regression analysis was used for survival analysis. Results A 30% of decline in eGFR occurred in 14.5% of all patients. The optimal diagnostic cut-off value of GD was 1.99/mm2 （AUC = 0.90, sensitivity = 84.0%, specificity = 81.8%） determined by ROC curve. The low GD group （GD 〈 1.99 per mm2） experienced a significant increase in renal endpoint for patients with eGFR of 30 to 60 ml/min per 1.73 m2 （six patients in lower GD group, while one patient in the other group）. For patients with time-average proteinuria 〈 0.5 g/d, the lower GD group showed a higher eGFR decline from baseline （4.5±16.7 ml/min per 1.73 m2 vs. –8.1±21.4 ml/min per 1.73 m2, P = 0.038）; two patients in this group reached the endpoint, while no patients in the higher GD group did. Conclusion GD could be an independent prognostic factor for patients of IgA nephropathy with eGFR at 30 to 60 ml/min per 1.73 m2 of body surface, particularly for those with time-averaged amount of urine protein less than 0.5 g per day.展开更多
1104 patients with Secondary Dyslipidemia and CKD （Chronic Kidney Disease） （females： 387; males： 717; aged： 70 4- 11 years） were given Diflstat with diet to evaluate efficacy and safety. The study lasted two ye...1104 patients with Secondary Dyslipidemia and CKD （Chronic Kidney Disease） （females： 387; males： 717; aged： 70 4- 11 years） were given Diflstat with diet to evaluate efficacy and safety. The study lasted two years. Patients were assigned to three groups （A, B, C） based upon basal renal function. Group A consisted of 180 patients with GFR （glomerular filtration rate） of 67 4- 16 mL/min/m2. TC （Total-Cholesterol） （-31%）, LDLC （LDL-Cholesterol） （-42%）, TG （triglycerides） （-36.8%） levels, and nonHDLC （non HDLC holesterol） （-41%） and TC/HDLC ratio （-40%） were significantly reduced （P 〈 0.001）. GFR （＋2.5%） increased significantly. No significant changes were observed in HDLC （＋13%）. Group B was of 744 patients, 69% （males： 514）, 31% （females： 230） （median age： 70 ± 13 years）, and moderate stage Ill CKD （GFR： 38 ± 12 mL/min/l.73m2）. After 24 months the change of HDLC （＋3.5%） was not significant, while TC （-27%）, TG （-32%）, LDLC （-33%）, non-HDLC （33.4%）, TC/HDLC （-30%）, and GFR （＋2.1%） were statistically significant （P 〈 0.001）. Group C consisted of 180 patients, 51.6% （males： 93）, 48.3% （females： 87） （median age： 72±11 years）, with severe stage IV CKD （GFR： 19 mL/min/l.73m2）. HDLC （＋13%） was not significant, while TC （-32%）, TG （-38%）, LDLC （-35%）, non-HDLC （-38.5%）, TC/HDLC （-40%）, and GFR （＋2.1%） were statistically significant （P 〈 0.001）. An effective but safe lipid-lowering therapy in patients with CKD, may be crucial to prevent cardiovascular events. The treatment with Dill stat~ combined with diet is to be started as soon as possible in patients with CKD in order of improving lipid and lipoprotein profile, and reducing the progression of renal damage.展开更多
OBJECTIVE:To observe the efficacy of a traditional Chinese medicine,Shenzhuo formula,on patients with diabetic kidney disease(DKD).METHODS:Eighty-eight outpatients with DKD were enrolled.Changes in estimated glomerula...OBJECTIVE:To observe the efficacy of a traditional Chinese medicine,Shenzhuo formula,on patients with diabetic kidney disease(DKD).METHODS:Eighty-eight outpatients with DKD were enrolled.Changes in estimated glomerular filtration rate(eGFR),creatinine clearance,serum creatinine,blood-urea-nitrogen,albuminuria,glycosylated hemoglobin(Hb_(A1C)),blood pressure,and lipid profile were measured and analyzed before and after intervention with Shenzhuo formula for 1,3,6,9,12,and 18 months.RESULTS:Compared with the baseline amounts,serum creatinine decreased,and eGFR and creatinine clearance increased,significantly after intervention for 1,3,6,9,12,and 18 months(all P < 0.05).Mean eGFR increased by 2.11 mL/min per 1.73 m7 y after18-month treatment.Urinary protein at 24 h decreased significantly after 1,3,9,and 12 months(P < 0.05).Hb_(A1C) decreased significantly(P < 0.05) after 3,6,9,12,and 18 months,and systolic blood pressure decreased significantly(P < 0.05) after 1,3,and 6 months.Total cholesterol decreased significantly(P < 0.05) after 1,3,6,and 18 months.Triglyceride and low-density lipoprotein-cholesterol decreased significantly(P < 0.05) after 1 and 3 months.CONCLUSION:Shenzhuo formula can improve eGFR and possibly slow DKD progression.Shenzhuo formula can also lower Hb_(A1C),lipid levels and blood pressure.展开更多
Disturbances in the metabolism of lipoprotein profiles and oxidative stress in hemodialyzed （HD） and post-renal transplant （Tx） patients are proatherogenic, but elevated concentrations of plasma high-density lipop...Disturbances in the metabolism of lipoprotein profiles and oxidative stress in hemodialyzed （HD） and post-renal transplant （Tx） patients are proatherogenic, but elevated concentrations of plasma high-density lipoprotein （HDL） reduce the risk of cardiovascular disease. We investigated the concentrations of lipid, lipoprotein, HDL particle, oxidized low-density lipoprotein （ox-LDL） and anti-ox-LDL, and paraoxonase-1 （PON-1） activity in HD （n=33） and Tx （n=71） patients who were non-smokers without active inflammatory disease, liver disease, diabetes, or malignancy. HD patients had moderate hypertriglyceridemia, normocholesterolemia, low HDL-C, apolipoprotein A-I （apoA-I） and HDL particle concentrations as well as PON-1 activity, and increased ox-LDL and anti-ox-LDL levels. Tx patients had hypertriglyceridemia, hypercholesterolemia, moderately decreased HDL-C and HDL particle concentrations and PON-1 activity, and moderately increased ox-LDL and anti-ox-LDL levels as compared to the reference, but ox-LDL and anti-ox-LDL levels and PON-1 activity were more disturbed in HD patients. However, in both patient groups, lipid and lipoprotein ratios （total cholesterol （TC）/HDL-C, LDL-C/HDL-C, triglyceride （TG）/HDL-C, HDL-C/non-HDL-C, apoA-I/apoB, HDL-C/apoA-I, TG/HDL） were atherogenic. The Spearman＇s rank coefficient test showed that the concentration of ox-LDL correlated positively with HDL particle level （R=0.363, P=0.004）, and negatively with TC （R=-0.306, P=0.012）, LDL-C （R=-0.283, P=0.020）, and non-HDL-C （R=-0.263, P=0.030） levels in Tx patients. Multiple stepwise forward regression analysis in Tx patients demonstrated that ox-LDL concentration, as an independent variable, was associated significantly positively with HDL particle level. The results indicated that ox-LDL and de- creased PON-1 activity in Tx patients may give rise to more mildly-oxidized HDLs, which are less stable, easily undergo metabolic remodeling, generate a greater number of smaller pre-13-HDL particles, and thus accelerate reverse cholesterol transport, which may be beneficial for Tx patients. Further studies are necessary to confirm this.展开更多
基金Supported by the Key Projects in the National Science and Technology Pillar Program During the Twelfth Five-year Plan Period(2011BAI10B03)
文摘Objective To investigate whether glomerular density （GD） could be an independent prognostic factor for patients of IgA nephropathy with estimated glomerular filtration rate （eGFR） of 30 to 60 ml/min per 1.73 m2, or for patients with time-average proteinuria 〈 0.5 g/d. Methods A total of 173 patients with biopsy-confirmed IgA nephropathy diagnosed from January 2000 to December 2010 were included. All of these patients were followed up for more than 5 years. The endpoint was a 〉 30% of decline in eGFR from baseline after 5-year follow-up. The optimal cut-off value of GD was calculated by ROC curve. Kaplan-Meier method and Cox regression analysis was used for survival analysis. Results A 30% of decline in eGFR occurred in 14.5% of all patients. The optimal diagnostic cut-off value of GD was 1.99/mm2 （AUC = 0.90, sensitivity = 84.0%, specificity = 81.8%） determined by ROC curve. The low GD group （GD 〈 1.99 per mm2） experienced a significant increase in renal endpoint for patients with eGFR of 30 to 60 ml/min per 1.73 m2 （six patients in lower GD group, while one patient in the other group）. For patients with time-average proteinuria 〈 0.5 g/d, the lower GD group showed a higher eGFR decline from baseline （4.5±16.7 ml/min per 1.73 m2 vs. –8.1±21.4 ml/min per 1.73 m2, P = 0.038）; two patients in this group reached the endpoint, while no patients in the higher GD group did. Conclusion GD could be an independent prognostic factor for patients of IgA nephropathy with eGFR at 30 to 60 ml/min per 1.73 m2 of body surface, particularly for those with time-averaged amount of urine protein less than 0.5 g per day.
文摘1104 patients with Secondary Dyslipidemia and CKD （Chronic Kidney Disease） （females： 387; males： 717; aged： 70 4- 11 years） were given Diflstat with diet to evaluate efficacy and safety. The study lasted two years. Patients were assigned to three groups （A, B, C） based upon basal renal function. Group A consisted of 180 patients with GFR （glomerular filtration rate） of 67 4- 16 mL/min/m2. TC （Total-Cholesterol） （-31%）, LDLC （LDL-Cholesterol） （-42%）, TG （triglycerides） （-36.8%） levels, and nonHDLC （non HDLC holesterol） （-41%） and TC/HDLC ratio （-40%） were significantly reduced （P 〈 0.001）. GFR （＋2.5%） increased significantly. No significant changes were observed in HDLC （＋13%）. Group B was of 744 patients, 69% （males： 514）, 31% （females： 230） （median age： 70 ± 13 years）, and moderate stage Ill CKD （GFR： 38 ± 12 mL/min/l.73m2）. After 24 months the change of HDLC （＋3.5%） was not significant, while TC （-27%）, TG （-32%）, LDLC （-33%）, non-HDLC （33.4%）, TC/HDLC （-30%）, and GFR （＋2.1%） were statistically significant （P 〈 0.001）. Group C consisted of 180 patients, 51.6% （males： 93）, 48.3% （females： 87） （median age： 72±11 years）, with severe stage IV CKD （GFR： 19 mL/min/l.73m2）. HDLC （＋13%） was not significant, while TC （-32%）, TG （-38%）, LDLC （-35%）, non-HDLC （-38.5%）, TC/HDLC （-40%）, and GFR （＋2.1%） were statistically significant （P 〈 0.001）. An effective but safe lipid-lowering therapy in patients with CKD, may be crucial to prevent cardiovascular events. The treatment with Dill stat~ combined with diet is to be started as soon as possible in patients with CKD in order of improving lipid and lipoprotein profile, and reducing the progression of renal damage.
基金Supported by the National Basic Research Program:the Basic Research of the Classical Prescription Basing on the Dose-Effect Relationship(973 ProgramNo.2010CB530601)the Special Fund for Traditional Chinese Medicine Scientific Research in the Public Interest:the Research,Application and Primotion of the Community-Based Traditional Chinese Medicine Treatment for Diabetes Mellitus(No.201007004)
文摘OBJECTIVE:To observe the efficacy of a traditional Chinese medicine,Shenzhuo formula,on patients with diabetic kidney disease(DKD).METHODS:Eighty-eight outpatients with DKD were enrolled.Changes in estimated glomerular filtration rate(eGFR),creatinine clearance,serum creatinine,blood-urea-nitrogen,albuminuria,glycosylated hemoglobin(Hb_(A1C)),blood pressure,and lipid profile were measured and analyzed before and after intervention with Shenzhuo formula for 1,3,6,9,12,and 18 months.RESULTS:Compared with the baseline amounts,serum creatinine decreased,and eGFR and creatinine clearance increased,significantly after intervention for 1,3,6,9,12,and 18 months(all P < 0.05).Mean eGFR increased by 2.11 mL/min per 1.73 m7 y after18-month treatment.Urinary protein at 24 h decreased significantly after 1,3,9,and 12 months(P < 0.05).Hb_(A1C) decreased significantly(P < 0.05) after 3,6,9,12,and 18 months,and systolic blood pressure decreased significantly(P < 0.05) after 1,3,and 6 months.Total cholesterol decreased significantly(P < 0.05) after 1,3,6,and 18 months.Triglyceride and low-density lipoprotein-cholesterol decreased significantly(P < 0.05) after 1 and 3 months.CONCLUSION:Shenzhuo formula can improve eGFR and possibly slow DKD progression.Shenzhuo formula can also lower Hb_(A1C),lipid levels and blood pressure.
基金Project(Nos.PW 55/09 and DS 41/10) supported by the Department of Laboratory Diagnostics,Medical University of Lublin,Poland
文摘Disturbances in the metabolism of lipoprotein profiles and oxidative stress in hemodialyzed （HD） and post-renal transplant （Tx） patients are proatherogenic, but elevated concentrations of plasma high-density lipoprotein （HDL） reduce the risk of cardiovascular disease. We investigated the concentrations of lipid, lipoprotein, HDL particle, oxidized low-density lipoprotein （ox-LDL） and anti-ox-LDL, and paraoxonase-1 （PON-1） activity in HD （n=33） and Tx （n=71） patients who were non-smokers without active inflammatory disease, liver disease, diabetes, or malignancy. HD patients had moderate hypertriglyceridemia, normocholesterolemia, low HDL-C, apolipoprotein A-I （apoA-I） and HDL particle concentrations as well as PON-1 activity, and increased ox-LDL and anti-ox-LDL levels. Tx patients had hypertriglyceridemia, hypercholesterolemia, moderately decreased HDL-C and HDL particle concentrations and PON-1 activity, and moderately increased ox-LDL and anti-ox-LDL levels as compared to the reference, but ox-LDL and anti-ox-LDL levels and PON-1 activity were more disturbed in HD patients. However, in both patient groups, lipid and lipoprotein ratios （total cholesterol （TC）/HDL-C, LDL-C/HDL-C, triglyceride （TG）/HDL-C, HDL-C/non-HDL-C, apoA-I/apoB, HDL-C/apoA-I, TG/HDL） were atherogenic. The Spearman＇s rank coefficient test showed that the concentration of ox-LDL correlated positively with HDL particle level （R=0.363, P=0.004）, and negatively with TC （R=-0.306, P=0.012）, LDL-C （R=-0.283, P=0.020）, and non-HDL-C （R=-0.263, P=0.030） levels in Tx patients. Multiple stepwise forward regression analysis in Tx patients demonstrated that ox-LDL concentration, as an independent variable, was associated significantly positively with HDL particle level. The results indicated that ox-LDL and de- creased PON-1 activity in Tx patients may give rise to more mildly-oxidized HDLs, which are less stable, easily undergo metabolic remodeling, generate a greater number of smaller pre-13-HDL particles, and thus accelerate reverse cholesterol transport, which may be beneficial for Tx patients. Further studies are necessary to confirm this.
