Objective:Several studies indicated that tonsillectomy can improve the prognosis of patients with immunoglobulin A nephropathy(IgAN).However,the relationship between tonsillar immunity and IgAN is still unclear.Method...Objective:Several studies indicated that tonsillectomy can improve the prognosis of patients with immunoglobulin A nephropathy(IgAN).However,the relationship between tonsillar immunity and IgAN is still unclear.Methods:A total of 14 IgAN patients were recruited in the current study from May 2015 to April 2016 in Tongji Hospital.B cells,dendritic cells(DCs),and IgAl positive cells in human tonsils were detected using immunofluorescence and immunohistochemistry.Correlations between these cells and clinicopathologic features were evaluated.展开更多
IGA nephropathy （IgAN） is one of the most commontypes of primary glomerulonephritis, which occursmore frequently in patients of reproductive age.Atypical hemolytic uremic syndrome （aHUS）without diarrhea is rare an...IGA nephropathy （IgAN） is one of the most commontypes of primary glomerulonephritis, which occursmore frequently in patients of reproductive age.Atypical hemolytic uremic syndrome （aHUS）without diarrhea is rare and has a poor prognosis. In theabsence of appropriate therapy, pregnancy-related aHUSis associated with high morbidity and mortality.展开更多
BACKGROUND Identification of myocardial injury has traditionally relied on high-sensitivity troponin T(hs-TnT)levels exceeding the 99th percentile threshold.However,patients with detectable hs-TnT levels below this th...BACKGROUND Identification of myocardial injury has traditionally relied on high-sensitivity troponin T(hs-TnT)levels exceeding the 99th percentile threshold.However,patients with detectable hs-TnT levels below this threshold represent a heterogeneous group with an inadequately characterized risk profile.AIM To investigate the association between hs-TnT levels below the 99th percentile and the presence of diabetic kidney disease(DKD)in patients with diabetes mellitus.METHODS This study analyzed data from the National Health and Nutrition Examination Survey obtained between 1999 and 2004,focusing on adults with type 2 diabetes mellitus.Serum hs-TnT concentrations were evaluated.DKD was defined as impaired glomerular filtration rate(<60 mL/minute/1.73 m^(2)),proteinuria(urinary albumin-to-creatinine ratio of≥30 mg/g),or both conditions in patients with diabetes mellitus.Weighted multivariable logistic regression analysis and restricted cubic spline analyses were employed to examine the independent association between hs-TnT and DKD,with the likelihood ratio test being used to evaluate nonlinearity.RESULTS The study included 2505 patients with a mean age of 55.02(standard error:0.72)years,of whom 44.87%were females.Among the participants,909(32.34%)were diagnosed with DKD.Multivariable logistic regression analysis indicated that,compared to the lowest tertile of hs-TnT(<5.93 ng/L),tertile 2(5.94-9.79 ng/L)had an odds ratio of 1.25(95%confidence interval:0.77-2.02,P=0.350),while tertile 3(9.80-21.88 ng/L)had an odds ratio of 2.07(95%confidence interval:1.13-3.80,P=0.022),with a significant trend(P for trend=0.022).Smoothed curve fitting demonstrated a linear association between hs-TnT levels and DKD in the overall population(P=0.061 for nonlinearity)and in male(P=0.136 for nonlinearity)and female(P=0.067 for nonlinearity)subgroups.Further stratification and sensitivity analyses yielded consistent conclusions.CONCLUSION Our study findings suggest that in individuals with type 2 diabetes,detectable hs-TnT levels below the 99th percentile are associated with DKD.展开更多
Objective:IgA nephropathy(IgAN)is the most common primary glomerular disease in China,but its pathogenesis remains unclear.This study aims to explore the regulatory role of the mammalian target of rapamycin(mTOR)signa...Objective:IgA nephropathy(IgAN)is the most common primary glomerular disease in China,but its pathogenesis remains unclear.This study aims to explore the regulatory role of the mammalian target of rapamycin(mTOR)signaling pathway in autophagy and mesangial proliferation during renal injury in IgA.Methods:The activity of mTOR and autophagy was evaluated in kidney samples from IgAN patients and in an IgAN mouse model induced by oral bovine serum albumin and carbon tetrachloride(CCl4)injection.mTOR inhibitors(rapamycin)and activators[bpV(phen)]were administered to the IgAN mouse model to observe the effects of mTOR on autophagy and renal lesions.In human mesangial cells treated with polymeric IgA1(p IgA1)and mTOR modulators,the expression and distribution of cell cycle proteins were assessed,along with the effects of mTOR on mesangial cell proliferation and autophagy.Results:Increased mTOR activity and decreased autophagy were observed in kidney tissues from IgAN patients and the mouse model,as evidenced by elevated phosphorylated mTOR(p-mTOR)levels and reduced LC3 expression.In the IgAN mouse model,rapamycin inhibited mTOR,restored autophagy,reduced mesangial IgA deposition,alleviated mesangial cell proliferation,and decreased proteinuria(all P<0.05).In contrast,bpV(phen)activated mTOR,further suppressed autophagy,exacerbated kidney damage,and increased proteinuria(all P<0.05).In vitro,p-IgA1 induced mesangial cell proliferation and inhibited autophagy,effects that were reversed by rapamycin and aggravated by bpV(phen)(all P<0.05).mTOR regulated mesangial cell proliferation by altering cell cycle distribution,with rapamycin inducing G1 phase arrest and bpV(phen)promoting cell cycle progression.Additionally,cyclinD1 expression in renal cortex was up-regulated in the IgAN mouse model,further increased by bpV(phen),and reduced by rapamycin(all P<0.05).Conclusion:Inhibition of the mTOR signaling pathway enhances renal autophagy,reduces mesangial cell proliferation,and improves renal injury in IgAN.展开更多
Background:Immunoglobulin A Nephropathy(IgAN)currently stands as the most prevalent primary chronic glomerular disease worldwide.The latest guidelines recommend the application of renin-angiotensin system inhibitors(R...Background:Immunoglobulin A Nephropathy(IgAN)currently stands as the most prevalent primary chronic glomerular disease worldwide.The latest guidelines recommend the application of renin-angiotensin system inhibitors(RASi)in conjunction with corticosteroids for the treatment of IgAN patients exhibiting persistent proteinuria of≥1 g/d.However,numerous randomized controlled trials(RCTs)have revealed a heightened risk of adverse events associated with corticosteroid treatment.Multi-glycoside of Tripterygium wilfordii Hook.f.(GTW),a traditional Chinese medicine(TCM),has been employed in the treatment of Chronic Kidney Disease(CKD)for an extensive period.Recent years have witnessed an increasing number of RCTs providing evidence supporting the effectiveness of GTW therapy in IgAN.Despite this,there remains a paucity of systematic reviews on the application of GTW therapy for IgAN.Consequently,this study undertakes a systematic review to assess the clinical efficacy and safety of GTW therapy,aiming to elucidate the role of GTW therapy in the treatment of IgAN.Methods:To collect relative information of randomized controlled trials(RCTs)of GTW in the treatment of IgAN,we searched for theses and dissertations publicized before April 10,2023,in PubMed,Embase,the Cochrane Library,China National Knowledge Infrastructure(CNKI),Wanfang Data knowledge service platform(Wanfang Data),Chinese Scientific Journal Database(VIP),and Clinical Trial.The language limitation is English and Chinese.Independently,two reviewers performed literature screening,data extraction,and quality evaluation,and the meta-analysis was carried out with RevMan 5.4 and StataSE 15.0 software.Results:21 RCTs involving 1,405 Chinese patients were included.Compared to ACEI/ARB alone or in combination,GTW with RASi or alone reduced 24 h-Upro,ALB,Scr,GFR,BUN,CD4+,VEGF,ET-1,and improved clinical efficacy.However,no associations were found for TC,Ccr,and adverse events due to limited literature.Conclusion:This study highlights that Multi-glycoside of Tripterygium wilfordii Hook.f.(GTW)exhibits potential in safeguarding renal function and preserving the integrity of the basement membrane in patients with Immunoglobulin A Nephropathy(IgAN).Consequently,GTW emerges as a promising therapeutic option for individuals with IgAN.Nevertheless,it is crucial to acknowledge the limitations stemming from insufficient methodology and a small sample size,which currently obscure the relationships between certain clinical variables,such as total cholesterol(TC)and creatinine clearance(Ccr).Therefore,the substantiation of our findings necessitates more rigorous and expansive trials to enhance the robustness and generalizability of the results.展开更多
Background:To systematically evaluate the efficacy and safety of activating blood and resolving stasis in patients with IgA nephropathy.Methods:From inception to May 2022,databases including PubMed,Embase,the Cochrane...Background:To systematically evaluate the efficacy and safety of activating blood and resolving stasis in patients with IgA nephropathy.Methods:From inception to May 2022,databases including PubMed,Embase,the Cochrane Library,Web of Science,WanFang database,Chinese Biomedical Database,VIP,and China National Knowledge Infrastructure were searched for randomized controlled trials about enhancing blood circulation and removing stasis for IgA nephropathy.For the articles that satisfied the requirements,quality assessment and meta-analysis were done.Results:Seventeen randomized controlled trials with a total of 1653 patients were included.Meta-analysis showed that activating blood and resolving stasis could increase therapeutic effectiveness(risk ratio(RR)=-0.47,95%confidence interval(CI)(-0.37,-0.2),P=0.0006)and decrease levels of serum creatinine(RR=-0.47,95%CI(-0.37,-0.2),P=0.0006),urea nitrogen(RR=0.85,95%CI(1.44,0.26),P=0.005),24-hour urinary protein quantification(RR=1.6,95%CI(2.44,0.95).P=0.00001),and urine red blood cell count(RR=1.7,95%CI(2.57,0.82),P=0.0001).There was no significant difference between the two groups in terms of security(RR=0.6,95%CI(0.36,1.01),P=0.05).Conclusion:Western medicine combined activating blood and resolving stasis is more efficient than Western medicine therapy alone in treating IgA nephropathy,but it still needs to be supported by additional large-scale,multi-center randomized controlled clinical trials due to the poor quality of the included trials.展开更多
基金This project was supported by the National Natural Science Foundation of China(No.82000658,No.81770686,and No.81970591)and Huazhong University of Science and Technology research funds for self-dependent innovation(No.2017KFYXJJ101).
文摘Objective:Several studies indicated that tonsillectomy can improve the prognosis of patients with immunoglobulin A nephropathy(IgAN).However,the relationship between tonsillar immunity and IgAN is still unclear.Methods:A total of 14 IgAN patients were recruited in the current study from May 2015 to April 2016 in Tongji Hospital.B cells,dendritic cells(DCs),and IgAl positive cells in human tonsils were detected using immunofluorescence and immunohistochemistry.Correlations between these cells and clinicopathologic features were evaluated.
文摘IGA nephropathy （IgAN） is one of the most commontypes of primary glomerulonephritis, which occursmore frequently in patients of reproductive age.Atypical hemolytic uremic syndrome （aHUS）without diarrhea is rare and has a poor prognosis. In theabsence of appropriate therapy, pregnancy-related aHUSis associated with high morbidity and mortality.
基金This study was approved by the Medical Ethics Committee of the Second Affiliated Hospital of Gannan Medical University(approval No.EFYJ20240113007).
文摘BACKGROUND Identification of myocardial injury has traditionally relied on high-sensitivity troponin T(hs-TnT)levels exceeding the 99th percentile threshold.However,patients with detectable hs-TnT levels below this threshold represent a heterogeneous group with an inadequately characterized risk profile.AIM To investigate the association between hs-TnT levels below the 99th percentile and the presence of diabetic kidney disease(DKD)in patients with diabetes mellitus.METHODS This study analyzed data from the National Health and Nutrition Examination Survey obtained between 1999 and 2004,focusing on adults with type 2 diabetes mellitus.Serum hs-TnT concentrations were evaluated.DKD was defined as impaired glomerular filtration rate(<60 mL/minute/1.73 m^(2)),proteinuria(urinary albumin-to-creatinine ratio of≥30 mg/g),or both conditions in patients with diabetes mellitus.Weighted multivariable logistic regression analysis and restricted cubic spline analyses were employed to examine the independent association between hs-TnT and DKD,with the likelihood ratio test being used to evaluate nonlinearity.RESULTS The study included 2505 patients with a mean age of 55.02(standard error:0.72)years,of whom 44.87%were females.Among the participants,909(32.34%)were diagnosed with DKD.Multivariable logistic regression analysis indicated that,compared to the lowest tertile of hs-TnT(<5.93 ng/L),tertile 2(5.94-9.79 ng/L)had an odds ratio of 1.25(95%confidence interval:0.77-2.02,P=0.350),while tertile 3(9.80-21.88 ng/L)had an odds ratio of 2.07(95%confidence interval:1.13-3.80,P=0.022),with a significant trend(P for trend=0.022).Smoothed curve fitting demonstrated a linear association between hs-TnT levels and DKD in the overall population(P=0.061 for nonlinearity)and in male(P=0.136 for nonlinearity)and female(P=0.067 for nonlinearity)subgroups.Further stratification and sensitivity analyses yielded consistent conclusions.CONCLUSION Our study findings suggest that in individuals with type 2 diabetes,detectable hs-TnT levels below the 99th percentile are associated with DKD.
基金supported by the Key Funding Project of Hunan Provincial Health Commission(A202303057091)the Nephrology Medical Development Research Fund Project(20220316ZN),China.
文摘Objective:IgA nephropathy(IgAN)is the most common primary glomerular disease in China,but its pathogenesis remains unclear.This study aims to explore the regulatory role of the mammalian target of rapamycin(mTOR)signaling pathway in autophagy and mesangial proliferation during renal injury in IgA.Methods:The activity of mTOR and autophagy was evaluated in kidney samples from IgAN patients and in an IgAN mouse model induced by oral bovine serum albumin and carbon tetrachloride(CCl4)injection.mTOR inhibitors(rapamycin)and activators[bpV(phen)]were administered to the IgAN mouse model to observe the effects of mTOR on autophagy and renal lesions.In human mesangial cells treated with polymeric IgA1(p IgA1)and mTOR modulators,the expression and distribution of cell cycle proteins were assessed,along with the effects of mTOR on mesangial cell proliferation and autophagy.Results:Increased mTOR activity and decreased autophagy were observed in kidney tissues from IgAN patients and the mouse model,as evidenced by elevated phosphorylated mTOR(p-mTOR)levels and reduced LC3 expression.In the IgAN mouse model,rapamycin inhibited mTOR,restored autophagy,reduced mesangial IgA deposition,alleviated mesangial cell proliferation,and decreased proteinuria(all P<0.05).In contrast,bpV(phen)activated mTOR,further suppressed autophagy,exacerbated kidney damage,and increased proteinuria(all P<0.05).In vitro,p-IgA1 induced mesangial cell proliferation and inhibited autophagy,effects that were reversed by rapamycin and aggravated by bpV(phen)(all P<0.05).mTOR regulated mesangial cell proliferation by altering cell cycle distribution,with rapamycin inducing G1 phase arrest and bpV(phen)promoting cell cycle progression.Additionally,cyclinD1 expression in renal cortex was up-regulated in the IgAN mouse model,further increased by bpV(phen),and reduced by rapamycin(all P<0.05).Conclusion:Inhibition of the mTOR signaling pathway enhances renal autophagy,reduces mesangial cell proliferation,and improves renal injury in IgAN.
文摘目的探讨原发性IgA肾病(IgA nephropathy,IgAN)患者不同IgM沉积强度与肾小球超微结构病变及临床病理的关系。方法收集155例IgAN患者的临床病理资料。分为IgM阴性(51例)、轻度(89例)和中度及以上沉积(15例)3组。比较3组间肾小球超微特征性结构、临床指标、MEST-C评分差异并分析与IgM沉积强度的影响因素。结果与IgM阴性、IgM轻度沉积组相比,IgM中度及以上沉积组24 h尿蛋白水平、IgG沉积、肾小管萎缩/间质纤维化(T)评分、足突融合(foot process effacement,FPE)程度更高,血白蛋白水平、淋巴细胞计数更低(P<0.05)。logistic结果显示FPE程度、T评分是IgM沉积强度的独立影响因素。结论IgM沉积强度与原发性IgAN患者FPE程度相关。FPE程度可协同临床病理评分更精准评估肾组织损伤及制定治疗方案。
基金supported by the Foundation.The authors are grateful to Dr.Jia Yingjie for his help with the preparation of the ideas in this paper.
文摘Background:Immunoglobulin A Nephropathy(IgAN)currently stands as the most prevalent primary chronic glomerular disease worldwide.The latest guidelines recommend the application of renin-angiotensin system inhibitors(RASi)in conjunction with corticosteroids for the treatment of IgAN patients exhibiting persistent proteinuria of≥1 g/d.However,numerous randomized controlled trials(RCTs)have revealed a heightened risk of adverse events associated with corticosteroid treatment.Multi-glycoside of Tripterygium wilfordii Hook.f.(GTW),a traditional Chinese medicine(TCM),has been employed in the treatment of Chronic Kidney Disease(CKD)for an extensive period.Recent years have witnessed an increasing number of RCTs providing evidence supporting the effectiveness of GTW therapy in IgAN.Despite this,there remains a paucity of systematic reviews on the application of GTW therapy for IgAN.Consequently,this study undertakes a systematic review to assess the clinical efficacy and safety of GTW therapy,aiming to elucidate the role of GTW therapy in the treatment of IgAN.Methods:To collect relative information of randomized controlled trials(RCTs)of GTW in the treatment of IgAN,we searched for theses and dissertations publicized before April 10,2023,in PubMed,Embase,the Cochrane Library,China National Knowledge Infrastructure(CNKI),Wanfang Data knowledge service platform(Wanfang Data),Chinese Scientific Journal Database(VIP),and Clinical Trial.The language limitation is English and Chinese.Independently,two reviewers performed literature screening,data extraction,and quality evaluation,and the meta-analysis was carried out with RevMan 5.4 and StataSE 15.0 software.Results:21 RCTs involving 1,405 Chinese patients were included.Compared to ACEI/ARB alone or in combination,GTW with RASi or alone reduced 24 h-Upro,ALB,Scr,GFR,BUN,CD4+,VEGF,ET-1,and improved clinical efficacy.However,no associations were found for TC,Ccr,and adverse events due to limited literature.Conclusion:This study highlights that Multi-glycoside of Tripterygium wilfordii Hook.f.(GTW)exhibits potential in safeguarding renal function and preserving the integrity of the basement membrane in patients with Immunoglobulin A Nephropathy(IgAN).Consequently,GTW emerges as a promising therapeutic option for individuals with IgAN.Nevertheless,it is crucial to acknowledge the limitations stemming from insufficient methodology and a small sample size,which currently obscure the relationships between certain clinical variables,such as total cholesterol(TC)and creatinine clearance(Ccr).Therefore,the substantiation of our findings necessitates more rigorous and expansive trials to enhance the robustness and generalizability of the results.
文摘Background:To systematically evaluate the efficacy and safety of activating blood and resolving stasis in patients with IgA nephropathy.Methods:From inception to May 2022,databases including PubMed,Embase,the Cochrane Library,Web of Science,WanFang database,Chinese Biomedical Database,VIP,and China National Knowledge Infrastructure were searched for randomized controlled trials about enhancing blood circulation and removing stasis for IgA nephropathy.For the articles that satisfied the requirements,quality assessment and meta-analysis were done.Results:Seventeen randomized controlled trials with a total of 1653 patients were included.Meta-analysis showed that activating blood and resolving stasis could increase therapeutic effectiveness(risk ratio(RR)=-0.47,95%confidence interval(CI)(-0.37,-0.2),P=0.0006)and decrease levels of serum creatinine(RR=-0.47,95%CI(-0.37,-0.2),P=0.0006),urea nitrogen(RR=0.85,95%CI(1.44,0.26),P=0.005),24-hour urinary protein quantification(RR=1.6,95%CI(2.44,0.95).P=0.00001),and urine red blood cell count(RR=1.7,95%CI(2.57,0.82),P=0.0001).There was no significant difference between the two groups in terms of security(RR=0.6,95%CI(0.36,1.01),P=0.05).Conclusion:Western medicine combined activating blood and resolving stasis is more efficient than Western medicine therapy alone in treating IgA nephropathy,but it still needs to be supported by additional large-scale,multi-center randomized controlled clinical trials due to the poor quality of the included trials.
