Objective To investigate the clinicopathological characteristics of IgA nephropathy combined with hyperuricemia in order to reveal the clinical significance of IgA nephropathy associated with hyperuricemia.Methods We retrospectively reviewed the clinical data of 270 patients with IgA nephropathy diagnosed by renal biopsy from June 2006 to December 2012.The patients were divided into the two groups:IgA nephropathy patients with or without hyperuricemia.The sex,age,systolic blood pressure,24-h urine protein,serum uric acid,and serum creatinine were measured.All patients underwent renal pathological examination and Lee’s classification.A comparative analysis of clinical manifestations and renal pathological injuries was performed between the two groups,and the pathological parameters of patients with normal renal function were further analyzed.Results The prevalence of hyperuricemia in patients with IgA nephropathy was 25.19%.The systolic blood pressure,24-h urine protein and serum creatinine level were higher in the hyperuricemia group than in the normal group.The renal pathological changes in the hyperuricemia group were more severe than those in the normal uric acid group.The proportion of renal tubular interstitial lesions and renal artery lesions in the hyperuricemia group was higher than in the normal renal function group.The proportion of renal artery stenosis and renal tubular interstitial chronic lesions in the patients with hyperuricemia group was higher than in normal serum uric acid group.Conclusions The clinical manifestations and renal pathological changes of patients with IgA nephropathy combined with hyperuricemia are more serious than those with normal serum uric acid level,in particular,the effects of renal tubular interstitial lesions and renal vascular lesions were more obvious,and the clinical prognosis is not good.Timely and effective treatments are needed.

Objective Although idiopathic membranous nephropathy（IMN） is a common cause of adult-onset nephrotic syndrome,its treatment remains controversial.Recent studies show tacrolimus is effective in the treatment of IMN.This study was performed to evaluate the efficacy and safety of tacrolimus（TAC） combined with glucocorticoids in patients with IMN.Methods Twenty patients with biopsy-proven IMN were collected in this retrospective study.TAC was given at 0.05-0.1 mg·kg-1·day-1 initially,in combination with oral administration of glucocorticoids(prednisone 0.5 mg·kg-1·day-1 or methylprednisolone 0.4 mg·kg-1·day-1).The primary outcome was the remission rate,whereas the secondary outcomes included the changes in serum albumin levels and daily urinary protein levels,and adverse events.Results After treatment with TAC combined with glucocorticoids for 3 months,the albumin levels had a significant improvement[（23.57 ± 4.51） g/L vs.（33.16 ±6.87） g/L,P<0.05],and the proteinuria had a significant decrease[（6.74 ± 3.08）g vs.（3.69 ±2.65） g,P<0.05].At the 6th month post-therapy,the albumin levels were significantly improved[（23.57 ± 4.51） g/L vs.（36.96 ± 6.63） g/L,P<0.05],and the proteinuria was significantly decreased[（6.74 ± 3.08） g vs.（2.48 ± 2.21） g,P<0.05].At the 12 th month post-therapy,the albumin levels were significantly improved[（23.57 ± 4.51） g/L vs.（37.30 ± 7.62） g/L,P<0.05],and the proteinuria was significantly decreased[（6.74 ± 3.08） g vs.（2.19 ± 2.10） g,P<0.05].At the end of the 18-month therapy,the albumin levels were significantly improved[（23.57 ± 4.51） g/L vs.（39.84 ± 4.31） g/L,P<0.05],and the proteinuria was significantly decreased[（6.74 ± 3.08） g vs.（1.26± 1.42） g,P<0.05].After treatment for 18 months,complete remission（CR） was achieved in 45%（9/20） of the patients and partial remission（PR） in 40%（8/20）,yielding a final response rate of 85%（17/20）.Two patients experienced relapses during the follow-up period of 12 month.There were no significant changes in creatinine,transaminase and glucose in blood.The patients had no serious adverse reactions during the treatment Conclusions In this study,treatment with tacrolimus showed a good efficacy with mild adverse reactions in patients with IMN.

目的:观察脂肪酸结合蛋白3(FABP3)过度增加对足细胞脂肪代谢的影响. 方法:慢病毒载体转染小鼠永生化足细胞系(HSMPs)以构建稳定过表达FABP3的细胞系.将FABP3-siRNA转染至HSMPs中沉默FABP3,筛选干扰效率最大的FABP3-siRNA片段进行后续干扰实验.实验分组:(1)正常足细胞组;(2) NC-siRNA足细胞组;(3) FABP3-siRNA足细胞组;(4)NC足细胞组;(5)FABP3过表达足细胞组;(6)正常足细胞+棕榈酸(PA)组;(7) NC-siRNA足细胞+PA组;(8) FABP3-siRNA足细胞+PA组;(9)NC足细胞+PA组;(10) FABP3过表达足细胞+PA组.比色法测定细胞内TG和游离脂肪酸的含量.定量PCR法检测各组细胞中过氧化物酶增殖激活受体α(PPARα)、酰基辅酶A氧化酶3(ACOX3) mRNA的表达.Western Blot法检测PPARα、ACOX3蛋白表达水平. 结果:与正常足细胞组相比,FABP3过表达足细胞组细胞内三酰甘油(TG)和游离脂肪酸水平增加(P＜0.05),而FABP3-siRNA足细胞组TG和游离脂肪酸水平下降(P＜0.05).不论在正常环境还是PA环境下,与正常足细胞组相比,FABP3过表达足细胞组PPARα mRNA和蛋白表达均下调(P＜0.05),而ACOX3 mRNA和蛋白表达均上调(P＜0.05);FABP3-siRNA足细胞组PPARα mRNA和蛋白表达均上调(P＜0.05),而ACOX3 mRNA和蛋白表达均下调(P＜0.05).与FABP3过表达足细胞组相比,FABP3-siRNA足细胞组PPARα mRNA和蛋白表达上调(P＜0.05),ACOX3 mRNA和蛋白表达下调(P＜0.05);加入PA后,FABP3过表达足细胞+PA组和FABP3-siRNA足细胞+PA组之间PPARα mRNA和蛋白表达、ACOX3 mRNA和蛋白表达统计学差异显著(P＜0.01). 结论:FABP3过度增加可导致足细胞脂肪代谢紊乱,抑制FABP3过度增加可纠正足细胞脂肪代谢紊乱状态.该研究结果提示抑制FABP3表达可能对代谢因素如糖尿病、肥胖、高脂血症所致的足细胞损伤有一定防御和治疗作用.

To elucidate the incidence of renal impairment in chronic hepatitis B (CHB) patients on adefovir dipivoxil (ADV). We retrospectively enrolled 127 CHB patients on ADV alone (38.6%) or in combination with lamivudine (61.4%) for over 12 months.Renal function was measured by estimated glomerular filtration rate (eGFR). And renal dysfunction was defined as mild ( 50%). During a treatment duration of 12 months, 2 patients (1.6%) developed mild renal impairment.At Month 36, there were 13 patients with renal damage (10.4%) and one case of hypertension with severe renal impairment plus bone pain.The characteristic of renal pathology was tubule injury.Modification of dosing interval or discontinuation of ADV may arrest a further decline of eGFR in CHB patients. Key words: Nucleotides; Nephrosis

选取我院收治的难治性肾病综合征患者34例，随机分为对照组和观察组，分别采用强的松联合环磷酰胺治疗及强的松联合来氟米特治疗，对比观察两组疗效。观察组完全缓解率及不良反应发生率显著优于对照组（P＜0.05），但复发率显著高于对照组（P＞0.05）。难治性肾病综合征采用来氟米特联合激素治疗的疗效显著，但复发率较高，需在用药剂量维持与给药时间进一步探索。

目的 分析乙肝病毒相关性肾炎的临床、实验室指标、病理特点及抗病毒治疗的疗效.方法 对53例乙肝病毒相关性肾炎患者临床表现、肝功能、肾功能、乙肝病毒血清标志物、乙肝病毒DNA以及病理分型进行分析,观察乙肝病毒DNA与临床表现之间的相关性,并根据乙肝病毒复制情况和蛋白尿的水平进行分组,给予核苷类似物抗病毒治疗,观察治疗效果.结果 肾病综合征21例,肾炎综合征32例,48例患者合并血尿,合并肾功能不全患者3例.肾活检病理结果显示膜性肾病占49.06％,膜增生性肾小球肾炎占30.19％,继发性IgA肾病占20.75％.乙肝病毒DNA载量与24 h尿蛋白定量呈正相关.19例患者使用核苷(酸)类似物拉米夫定和恩替卡韦抗病毒治疗6个月,乙肝病毒DNA载量显著下降,乙肝病毒相关性肾炎完全缓解2例,部分缓解6例.结论 乙肝病毒相关性肾炎具有特殊临床表现与肾脏病理特征,乙肝病毒DNA载量与蛋白尿水平呈正相关.抗病毒治疗可在部分患者中获得完全和部分缓解.

目的对比老年糖尿病肾病尿毒症透析患者选择长期导管或自体动静脉内瘘的使用情况。方法回顾性队列研究,92例老年糖尿病肾病透析患者分两组,分别采用长期导管(n=40)与自体动静脉内瘘(n=52)作为血管通路。观察1年内两组患者的血管通路的通畅率情况、营养、贫血纠正情况、并发症发生率、住院次数及住院时间,比较两组差异。结果 (1)两组人血白蛋白、血脂、贫血纠正情况无统计学差异;(2)长期导管组导管的1年通畅率高达95%,内瘘组为78.8%,两组有统计学差异(χ2=4.862,P<0.05);(3)导管组总住院日平均(14.2±5.3)d,明显短于内瘘组总住院日平均(30.0±4.4)d,有统计学差异(t=10.953,P<0.01);(4)超敏C反应蛋白水平导管组为(7.07±8.02)mg/ml,内瘘组为(2.45±2.17)mg/ml,两组差异有统计学意义(t=2.384,P<0.05)。结论老年糖尿病肾病透析患者选择使用长期导管作为血管通路,短期内在住院时间、血管通路的通畅率方面优于使用内瘘患者。

该疾病于1964年首先被Dent报道,患者表现为低分子量蛋白尿、高钙尿症、肾脏钙化、肾结石,亦可呈现与Fanconi综合征一致的肾脏近端小管广泛病变,出现氨基酸尿、糖尿、高磷酸盐尿、尿钾增多和尿酸尿.属X连锁隐性遗传性肾小管疾病,称Dent病(Dent's disease).

目的观察NF-κBp65反义寡核苷酸（AS-ODN）对高糖诱导体外培养HK-2细胞外基质表达的影响,探讨NF-κB在糖尿病肾病（DN）肾小管间质纤维化中的作用。方法体外培养HK-2,予以正常糖（NG组）、高糖（HG组）培养液培养。在高糖培养后应用梭华-SofastTM转染NF-κB p65AS-ODN（ODNL、ODNH组）。免疫细胞化学检测细胞NF-κBp65蛋白的表达;ELISA检测细胞培养上清液Fn、ColⅢ浓度。结果 NG组HK-2细胞呈基础量地表达NF-κBp65蛋白;与NG组比较,HG组细胞NF-κBp65蛋白的表达显著增加,细胞上清液FN、ColⅢ蛋白浓度亦显著增加,差异有统计学意义（P＜0.01）;与HG组比较,ODNL及ODNH组细胞NF-κBp65蛋白的表达显著减弱,培养上清液FN、ColⅢ蛋白水平也显著降低,两者差异均有统计学意义（P＜0.05或P＜0.01）。结论 NF-κB反义寡核苷酸可抑制高糖诱导的HK-2细胞NF-κBp65、FN、ColⅢ的表达;通过抑制NF-κB的活化可能有助于DN肾脏纤维化的防治。

Objective:To explore the effect and mechanism of all-trans retinoic acid(atRA) on the fibrosis of kidney in STZ-induced diabetic rats.Methods:38 rats injected with streptozotocin(STZ) were randomly divided into model group(DM)and therapy group(DM+atRA).Other 12 normal rats were used as control group(NC).The rats in DM+atRA group were administrated atRA at a dosage of 20 mg·kg-1·d-1,and other rats were treated with normal saline.24 h urinary protein(Ualb),blood urea nitrogen(BUN),creatinine clearance(Ccr),the ratio of renal weight/body weight(KW/BW)and renal pathological changes was evaluated.The expression of collagen were tested by immunohistochemisty technique 8 and 12 weeks after treated.Results:24h Ualb、BUN、Ccr,the ratio of left renal weight/body weight were significantly lower in DM+atRA group than in DM group(P<0.05).The expressions of collagen Ⅲ and Ⅳ of kidney in DM+atRA group were significantly lower than those in DM group(P<0.01).AtRA improved obviously the renal pathological changes in rats with diabetic nephropathy.Conclusion:AtRA can relieve renal injury and inhibit renal fibrosis in rats with diabetic nephropathy induced by STZ,which might be related to the down-regulation of the expression of collagen Ⅲ and Ⅳ in kidney.

目的:研究人血白蛋白对人近端肾小管上皮细胞(HK-2)血管紧张素转换酶2(ACE2)及血管紧张素转换酶(ACE)表达的影响,探讨白蛋白对肾脏损害的机制。方法:不同浓度人血白蛋白(0、1、5、10、15g/L)分别加入到培养的人近端肾小管上皮细胞培养48h,用RT-PCR法和Western blotting法分别检测HK-2细胞ACE2和ACEmRNA和蛋白表达。结果:正常培养状态下HK-2细胞(空白对照组)存在ACE2mRNA和蛋白表达,加入不同浓度(5-15g/L)的人血白蛋白剂量依赖抑制HK-2细胞ACE2mRNA和蛋白表达(P<0.01)。正常培养状态下HK-2细胞ACEmRNA和蛋白表达水平较低,随着加入白蛋白浓度的增加其表达水平逐渐升高,10g/L白蛋白显著促进了HK-2细胞ACEmRNA和蛋白表达(P<0.05)。结论:在体外培养的HK-2细胞存在ACE及ACE2mRNA和蛋白表达,人血白蛋白可抑制其ACE2表达而促进ACE表达,这可能是白蛋白促肾小管间质损伤及肾小球硬化、间质纤维化的机制之一。

ANCA相关性小血管炎是中老年人继发性肾损害的自身免疫性疾病.自1998年至今,我们共诊断了7例,现总结如下.

近年来组织型转谷氨酰胺酶(tTG)在组织纤维化的发生和发展中的作用受到了关注.本实验通过观察TGF-β1对体外培养的人肾间质成纤维细胞tTG表达的影响,探讨TGF-β1与tTG的相互关系及其在肾间质纤维化中可能的作用.