The advantages of urgent-start peritoneal dialysis (PD) vis-à-vis urgent-start hemodialysis (HD) are not clear. We performed a systematic review and meta-analysis of studies comparing the two modalities. Databases of PubMed, Embase, Ovoid, and Google Scholar were searched up to November 1, 2020. The primary outcome was mortality, and secondary outcomes were dialysis-related infectious complications and mechanical complications. Risk ratios (RRs) were calculated for all outcomes. Seven studies were included. The pooled analysis revealed a statistically significant reduced risk of all-cause mortality in patients undergoing urgent-start PD as compared to urgent-start HD (RR: 0.61, 95% confidence interval [CI] [0.40, 0.94], I2  = 56.34%). A meta-analysis of dialysis-related infectious complications indicated no statistically significant difference between the two modalities (RR: 0.66, 95% CI [0.29, 1.50], I2  = 69.62%). Our analysis revealed a statistically significant reduced risk of mechanical complications in patients undergoing urgent-start PD (RR: 0.54, 95% CI [0.40, 0.73], I2  = 0%). To conclude, unadjusted data from observational studies are indicative of lower mortality and lower risk of mechanical complications with urgent-start PD versus urgent-start HD. The risk of infectious complications was not different between the two groups. Further studies with a larger sample size using propensity-matched cohorts are needed to strengthen current evidence.

目的 探讨狼疮性肾炎(lupus nephritis,LN)患者血清白细胞介素-32(interleukin-32,IL-32)、肾损伤分子-1(kidney injury molecule-1,KIM-1)水平变化及意义.方法 80例LN患者,根据系统性红斑狼疮疾病活动指数(systemic lupus erythematosus disease activity index,SLEDAI)分为活动期组(SLEDAI评分≥5分)49例和非活动期组(SLEDAI评分＜5分)31例,同期体检健康者50例为对照组.检测3组血清IL-32、KIM-1及血肌酐(serum creatinine,SCr)、红细胞沉降率(erythrocyte sedimentation rate,ESR),免疫比浊法检测24 h尿蛋白,计算估算肾小球滤过率(estimated glomerular filtration rate,eGFR);Pearson相关法分析LN患者血清ID32、KIM-1与SCr、24 h尿蛋白、ESR、eGFR的相关性;ROC曲线分析血清IL-32、KIM-1单独及联合诊断LN活动期的价值.结果 活动期组、非活动期组、对照组血清IL-32[(6.51±0.89)、(3.87±0.92)、(1.39±0.78)ng/L]、KIM-1[(16.28±2.97)、(10.14±3.11)、(5.75±2.64)μg/L]、SCr[(280.22±19.72)、(165.93±16.08)、(52.16±18.57)μmol/L]及24 h尿蛋白[(116.40±6.83)、(62.57±6.19)、(34.58±7.06)g/L]均逐渐降低(P＜0.05),ESR[(9.64±2.08)、(5.87±1.93)、(3.04±1.55) mm/h]逐渐减慢(P＜0.05),eGFR[(42.16±6.58)、(70.33±7.22)、(97.64±7.83)mL/(min·1.73 m2)]逐渐增高(P＜0.05);Pearson相关分析结果显示,活动期组血清IL-32与SCr、24 h尿蛋白、ESR呈正相关(r=0.637,P=0.002;r=0.549,P=0.013;r=0.765,P＜0.001),与eGFR呈负相关(r=-0.782,P＜0.001);血清KIM-1与SCr、24 h尿蛋白、ESR呈正相关(r=0.609,P=0.001;r=0.561,P=0.006;r=0.708,P＜0.001),与eGFR呈负相关(r=-0.736,P＜0.001);非活动期组血清IL-32与SCr、24 h尿蛋白、ESR呈正相关(r=0.609,P=0.004;r=0.561,P=0.008;r=0.722,P＜0.001),与eGFR呈负相关(r=-0.764,P＜0.001),KIM-1与SCr、24 h尿蛋白、ESR呈正相关(r=0.573,P=0.003;r=0.509,P=0.009;r=0.671,P＜0.001),与eGFR呈负相关(r=-0.718,P＜0.001);ROC曲线分析结果显示,血清IL-32以2.64 ng/L为最佳截断值诊断LN活动期的AUC为0.852(95％CI:0.783～0.921,P＜0.001),灵敏度和特异度分别为79.59％和83.87％,准确率为81.25％;血清KIM-1以8.85 μg/L为最佳截断值诊断LN活动期的AUC为0.896(95％CI:0.833～0.959,P＜0.001),灵敏度和特异度分别为83.67％和90.32％,准确率为86.25％;血清IL-32联合KIM-1诊断LN活动期的AUC为0.963(95％CI:0.928～0.998,P＜0.001),灵敏度和特异度分别为89.90％和96.77％,准确率为92.50％.结论 LN患者血清ID-32、KIM-1升高,且与病情严重程度相关,可作为诊断LN活动期的分子标志物.

Hypochlorous acid (HClO) is an important reactive oxygen species (ROS) and plays a significant role in living organisms. Highly selective and lysosome-targetable probes for sensing hypochlorous acid are rare. In this article, we designed and prepared a new lysosome-targeting and ratiometric fluorescent probe for monitoring the levels of hypochlorous acid. 4-Aminonaphthalimide was chosen as the fluorescent group and (2-aminoethyl) thiourea group was used as a specific recognition group for HClO. A morpholine unit was employed as a lysosome-targeting group. In the absence of HClO the probe underwent intramolecular charge transfer (ICT) and showed a green emission. When excess HClO is present, the ICT process was interrupted which caused a 57 nm blue-shift of fluorescence emission from 533 nm to 476 nm. The ratiometric fluorescent probe showed outstanding selectivity toward HClO over other various bioactive species. Furthermore, the ratiometric fluorescent probe exhibited rapid response time and ability of working in a wide pH range. The linear response of I476nm/I533nm toward HClO was obtained in a concentration range of HClO from 1.0 × 10-6 to 1.0 × 10-4 mol·L-1. The detection limit was estimated to be 8.0 × 10-7 mol·L-1 for HClO. Moreover, the probe showed a perfect lysosome-targeting ability, and has been successfully used to the confocal imaging of HClO in lysosomes of HepG2 cells with little cell toxicity. All of such good properties illustrated that it could be applied to determine HClO at lysosomes in living cells.

Objective:To observe the effect of Tangshenqing No.1 high,medium and low doses (traditional Chinese medicine) on the expression of group CC cytokines in renal tissues of rats with diabetic nephropathy.Method:Diabetic nephropathy rat model was established,and then the rats were divided into normal control group,model control group,Captopril group,Tangshenqing No.1 high,medium and low dose treatment groups.The rats in normal control group and model control group received intragastric administration of 10 mL·kg-1 deionized water daily;captopril 2.33 mg·kg-1 was given daily in Captopril group;Tangshenqing No.1 high,medium and low dose groups respectively received 187,93.5,46.75 mg·kg-1 Tangshenqing No.1.Samples were taken after 12 weeks of successive administration.The mRNA transcription of monocyte chemoattractant protein-1 (MCP-1) and regulated upon activation normal T cell expressed and secreted (RANTES) in renal tissues were detected by Real-time polymerase chain reaction (Real-time PCR).The expression level of MCP-1 protein was detected by Western blot,while the expression level of RANTES protein was determined by enzyme linked immunosorbent assay (ELISA).Result:Tangshenqing No.1 could down-regulate the mRNA transcription and protein expression levels of MCP-1 and RANTES in renal tissues (P ＜ 0.05,P ＜ 0.01) in a dose-dependent manner.The expression levels of MCP-1 and RANTES in renal tissues were as follows:Tangshenqing No.1 high dose group ＜ middle dose group ＜ low dose group.The curative effect was most obvious in Tangshenqing No.1 high dose group among the Chinese medicine treatment groups.Conclusion:Tangshenqing No.1 can inhibit the occurence and development of diabetic nephropathy by inhibiting the expression of MCP-1,RANTES mRNA and protein in renal tissues.

目的:探析彩色多普勒超声对老年动脉粥样硬化性肾动脉狭窄(A R A S)诊断的临床价值.方法:选择2014年10月至2018年1月我院收治的65例ARAS老年患者(共130根肾动脉)作为研究对象,均进行彩色多普勒超声检查,并以肾动脉造影结果为金标准,分析彩超对老年A R A S的诊断价值.结果:(1)肾动脉造影结果显示:130根肾动脉中有83根狭窄动脉,其中19根轻度狭窄,29根中度狭窄,35根重度狭窄;(2)彩色多普勒超声检查显示:130根肾动脉中76根狭窄动脉,其中15根轻度狭窄,26根中度狭窄,35根重度狭窄.(3)彩色多普勒超声检查诊断老年A R A S的敏感性为81.93%,特异度为82.98%,且随动脉狭窄程度的增加峰值血流速度(P S V)、舒张末期流速(E D V)也在显著增加(P<0.05),而R I则随狭窄程度的增加而逐渐降低,差异有统计学意义(P<0.05).结论:彩色多普勒超声诊断老年ARAS的效果较好,且其具有操作简单、安全无创、经济等优点,可作为ARAS早期筛查诊断的主要手段.

The main causes of IgA nephropathy of internal and external causes,involving organs except common kidney,heart,still involve the lungs,liver;pathological factors mainly heat evil,it is divided into excess heat and deficiency heat,and the pathological factors throughout the pathogenesis of the disease.Therefore,the pathogenesis of IgA nephropathy can be summed up as "two aspects,four viscera,a mainline".Through the study of this theoretical framework,we can understand the disease more comprehensively,and provide reference for clinical diagnosis and treatment.

Diabetic nephropathy (DN) is a common and severe complication of diabetes. Tripterygium Wilfordii has dual roles in immune suppression and anti-inflammation, whilst catalpol can resist inflammation and oxidation. The effect of Tripterygium Wilfordii combined with catalpol in treating DN, has not been reported. Wistar rats were treated with Tripterygium Wilfordii polyglycoside and or catalpol after DN model was established. Serum levels of creatine (Scr), urea nitrogen (BUN), urea albumin (UAlb), lactate hydrogenase (LDH) and superoxide peroxidase (SOD) were measured at 4 weeks after treatment. Real-time PCR was employed for detecting the mRNA level of transformation growth factor (TGF)-beta 1, whilst caspase 3 activity, secretion of tumor necrosis factor (TNF)-alpha and interleukin (IL)-1 beta were measured by ELISA. DN rats had elevated levels of Scr, BUN and UAlb, plus enhanced expression of TGF-beta 1, TNF-alpha and IL-1 beta. Caspase 3 and LDH activity were also increased, with lower SOD level (p<0.05 compared with control group). Either Tripterygium Wilfordii polyglycoside or catalpol treatment significantly decreased the levels of Scr, BUN or UAlb, suppressed Caspase 3 activity, decreased expression of TGF-beta 1, TNF-a and IL-1 beta expression, suppressed LDH activity whilst increased SOD level (p<0.05 compared with DN model rats). Combined treatment group had better improvements than single usage (p<0.01). In conclusion, both Tripterygium Wilfordii polyglycoside and catalpol can regulate the balance between oxidation and anti-oxidation, suppress apoptosis and inflammation, with combined therapy having better efficiency.

Although a number of studies have been conducted on the association between plasminogen activator inhibitor-1 (PAI-1) 4G/5G polymorphism and diabetic nephropathy (DN) in Chinese population, this association remains elusive and controversial. To further assess the effects of PAI-1 4G/5G polymorphism on the risk of DN, a meta-analysis was performed in the Chinese population.

Objective To observe the protective effect of Tangshenqing Formula II ( TSQF) on the renal function of mice with type 2 diabetes mellitus ( DM) . Methods KK-Ay mice, a spontaneous DM mod-el, were fed with fat-enriched diet for three weeks. Based on their serum glucose ( Glu) and body weight ( BW) , the mice were divided into model group, valsartan group, high, middle, and low dose of TSQF ( high-, mid-, low- dose ) group ( n =6 each ) and were treated for consecutive 12 weeks. And six C57BL/6J mice were included into control group. At the timepoint of Week 0, 4, 8, 12, Glu, urine al-bumin ( Alb) , urine creatine ( Cr) , Alb/Cr( ACR) and 24-h urine protein ( pr/24 h) were detected. At the end of Week 12, all the mice were sacrificed and their serum samples were collected. And the serum levels of TG, TC, Scr, BUN and β2-MG were measured. Results Compared with the control group, the levels of pr/24 h, ACR, Scr, TG and TC in the model group significantly increased ( P<0. 05 or P<0. 01), While BUN,β2-MG and ratio of kidney weight to body weight showed no statistcal differences (P>0. 05). Compared to the model group, the levels of Scr, TG and ACR in valsartan group and three TSQF groups significantly decreased (P<0. 05 or P<0. 01), and those of TC, Glu, and pr/24 h de-creased at different degree. Conclusion TSQF could reduce the serum levels of Glu, Scr and TG of kk-Ay mice, and alleviate the kidney injuries to reduce the progression of diabetic nephropathy.

Objective To observe the effect of Compoud Qingqin Liquids on renal function of rat model of uric acid nephropathy,and to discuss its protection of renal function.Methods The rat model was induced by gavaging adenine and feeding yeast.SD rats were randomly divided into control group,model group,positive group,and high-,medium-,low-dose groups of Chinese medicine.Blank control group and model group were daily gavaged with distilled water,positive control group was daily gavaged with allopurinol by 9.33 mg/kg,and high-,medium-,low-dose group of Chinese medicine was daily gavaged with Compound Qinggin Liguids by 3.77,1.89,0.09 g/(kg.d) respectively for 6 weeks.General condition of rats were observed,renal pathological changes were observed with light and electron microscope.Urine protein concentration,blood uric acid,blood urea nitrogen,creatinine and kidney weight index were respectively tested before and after treatment.Results There were no significant differences in eating,drinking and body weight between before and after modeling.Compoud Qingqin Liquids can obviously decrease the concentration of urine protein,blood uric acid,serum creatinine,blood urea nitrogen,and kidney weight index(P 0.05) of rats with uric acid nephropathy.Renal tubular epithelial cells atrophy and renal interstitial fibrosis of high-dose group of Chinese medicine were not evident.Conclusion Compoud Qingqin Liquids can protect the rats renal function against uric acid renal injury.

Objective:To investigated the pathology effect of compound Qingqin on kidneys of rats with gouty nephropathy.Method:Male SD rats were randomly divided into 2 groups:normal group and model group.The model rats were induced by adenine.After the model was determined successfully,all model rats were divided into model group,allopurinol group,compound Qingqin 377 mg·kg-1group,Qingqin 188.50 mg·kg-1 group and Qingqin 94.25 mg·kg-1group,each consisting of 5 animals.Each group was given the corresponding drugs for 6 weeks.All rats were killed at 16 h after last dosing,then kidneys were taken out and fixed immediately with 10% formalin,embedded with paraffin,serially sectioned and stained with hematoxylin eosin(H.E) and periodic acid-sliver(PAS).To be classified and scored the renal lesions under the light microscope and the relative area of mesangium matrix was measared by under the PAS dyeing.Result:The renal tubular cells degeneration necrosis and uric-acid salts crystals lesions in the compound Qingqin 377 mg·kg-1 group was significantly lightened than the model group(P0.05),while its mesangium matrix relative area was no obvious difference from the model group.Conclusion:The compound Qingqin can significantly lighten the renal lesions of rats with gouty nephropathy after it is taken for 6 weeks by 377 mg·kg-1 and it has a protective effect to kidney.

Objective To observe the changes of oxyhemoglobin saturation before and after hemodialysis.Methods The patients(n=102) with maintained hemodialysis were divided into the group of spleen-kidney qi deficiency(n=16),group of spleen-kidney yang deficiency(n=12),group of liver-kidney yin deficiency(n=25),group of dual deficiency of qi and yin(n=13),group of dual deficiency of yin and yang(n=21) and group of dampness turbidity accumulating in interior(n=15).The oxyhemoglobin saturation was detected and compared in the patients respectively before and after hemodialysis.Results The oxyhemoglobin saturation was lower in all groups after hemodialysis than before and the difference was statistically significant(P0.05).In the group of spleen-kidney yang deficiency,the oxyhemoglobin saturation was significantly lower than that in the other groups(P0.05) after hemodialysis.Conclusion The oxyhemoglobin saturation was significantly lower in the patients of spleen-kidney yang deficiency after hemodialysis than that in the patients of other syndrome types.

目的:探讨糖尿病、高血压、原发性慢性肾小球肾炎三种不同原发病所致的早中期慢性肾衰的症状特点,以期进一步探讨其不同的中医证候特点.方法:采用横断面调查方式,对符合纳入标准的100例慢性肾衷患者进行临床流行病学问卷调查,归纳、分析其症状特点.结果:糖尿病、高血压、原发性慢性肾小球肾炎三种不同原发病所致的旱中期慢性肾衰各症状出现的频次存在差异,两两比较其症状积分亦存在不同的差异.结论:不同原发病所致早中期慢性肾衰存在不同的症状特点,提示其中医证候亦存在差异性.

Objective:To study syndrome characteristics of chronic renal failure( CRF) at early and middle stage caused by di-abetes,hypertension and primary chronic glomerulonephritis,and reveal the differences and unity on syndrome characteristics of CRF at early and middle stage caused by different primary diseases. Methods:To use cross sectional epidemiological investigation,98 CRF patients accorded with the inclusive criteria were investigated. We make summary and analysis on the symptoms and syndromes,and summarize and compare the syndrome characteristics of CRF at early and middle stage caused by different primary diseases. Results:In primary asthenia syndrome of diabetic nephropathy,kidney-spleen qi-yin deficiency and kidney-spleen yang deficiency are predominant at early stage,and kidney-spleen yang deficiency is predominant at middle stage. In secondary sthenia syndrome,damp-heat and blood stasis are predominant at early stage,and damp turbidity and damp-heat are predominant at middle stage. In primary asthenia syndrome of hypertensive nephropathy,liver-kidney yin deficiency and kidney-spleen qi deficiency are predominant at early stage,and kidney-spleen yang deficiency and kidney-spleen qi deficiency are predominant at middle stage. In secondary sthenia syndrome,damp-heat and blood stasis are predominant. In primary asthenia syndrome of CRF caused by chronic glomerulonephritis,kidney-spleen yang deficiency is predominant at early stage,and yang deficiency is more seriousness. In secondary sthenia syndrome,blood stasis and damp-heat are predominant. Conclusion:There exist differential syndrome characteristics of CRF at early and middle stage caused by diabetes,hypertension and primary chronic glomerulonephritis.

Objective: To make the related clinical research on syndrome differentiation in TCM deficiency-syndrome of 57 cases with lgA nephropathy. Methods: To investigate 57 patients of lgA nephropathy,we give the scores of symptoms,clinical indexes and pathological changes.Then we add up the frequency and integration and compare and analyze the results using SPSS statistical software. Results: The distribution of deficiency-syndrome types shows that qi and yin deficiency syndrome is the most type. Hematuria is often seen in yin deficiency syndrome and qi and yin deficiency syndrome. The occurrence of hypoproteinemia and 24h urinary protein excretion are closely related to spleen-kidney qi deficiency syndrome. The incidence rate of hypertension is higher in fiver-kidney yin deficiency syndrome than in spleen-kidney qi deficiency syndrome and qi and yin deficiency syndrome. Pathological damage is the lowest in fiver-kidney yin deficiency syndrome, and it is obviously lower than spleen-kidney qi deficiency syndrome and qi and yin deficiency syndrome (P<0.05). Conclusion: There were significant differences of clinical indexes and pathological changes between three types of TCM deficiency-syndrome of IgA nephropathy.

目的:观察寒热错杂证在反复尿路感染中证候学特点。方法:对纳入研究的患者进行问卷调查,并对调查结果采用统计描述的方法进行统计分析。结果:100例反复尿路感染患者中,平均年龄(56.5±14.7)岁,寒热错杂证73例,40~79岁年龄段寒热错杂证患者在所有反复尿路感染患者中所占比例为64%,在寒热错杂证中所占比例为88%。结论:寒热错杂证在反复尿路感染患者非常普遍,反复尿路感染及其中寒热错杂证均具年龄分布特点。

多年来雷公藤多甙的应用一直沿袭常规剂量(1mg*kg-1*d-1),但作用缓慢,不如激素快捷,即使微小病变型肾病综合征也常常首选激素,雷公藤多甙只是作为维持阶段的辅助性治疗[1].我科应用双倍剂量雷公藤多甙(2mg*kg-1*d-1),观察了20例原发性肾病综合征的近期疗效和副反应,报道如下.