13 Kidney and Urinary Tract

13 Kidney and Urinary Tract

2015225 Systolic blood pressure and progression of renal dysfunction in the elderly patients with moderate to severe chronic kidney disease：a cohort study from a tertiary hospital.ZHAO Hui（趙慧），et al. Renal Div，Dept Med，Peking Univ 1st Hosp，Instit Nephrol，Peking Univ，Beijing 100034.Chin J Intern Med 2015；54（3）：181-187.

Objective To study the effect of blood pressure （BP）control on the progression of renal function in elderly patients with chronic kidney disease（CKD）stages 3 and 4.Methods Patients aged 65 years or older in our CKD clinic with baseline CKD stages 3 and 4 and with more than one-year follow up until February 2014 were included in this study.Those who had an annual loss of epidermal growth factor receptor（eGFR）for more than 5 ml·min-1·1.73 m-2，or reached CKD stage 5，and/or initiated renal replacement therapy were regarded as progression of CKD.Cox regression was used to analyze the effect of BP control on the progression of CKD.Results A total of 118 patients［57 men，mean age（73.8± 5.1）years］were enrolled in the final analysis with median baseline eGFR of 37.9（29.3，46.7）ml·min-1· 1.73 m-2.The baseline BP was（137.0±18.0）/ （72.5±10.3）mmHg（1 mmHg=0.133 kPa）.During the median 26 months（12-94 m）follow-up period，the average treated BP was（136.2±12.1）/（70.5±6.9）mmHg.Among all the subjects，64.4%of them reached the BP target（＜140/90 mmHg）and 23.7%had progression of CKD.Treated systolic BP（HR=1.504，95% CI 1.023-2.212）and baseline eGFR（HR=0.923，95%CI 0.872-0.977）were independent risk factors for renal function progression in multivariate Cox analysis.Patients with treated systolic BP over 140 mmHg had higher risk to develop progression of CKD compared with those with systolic BP≤140 mmHg（HR=2.505，95% CI 1.090-5.756）.Conclusion Tight blood pressure control is important in the routine case of elderly patients with CKD stage 3 and stage 4.

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2015226 Role of prolyl hydroxylases 2 in the cellular response to hypoxia activated autophagy in human renal epithelial cell model.ZHANG Hui（張慧），et al.Dept Nephrol，Zhongshan Hosp，Fudan Univ，Shanghai 200032.Chin J Nephrol 2015；31（3）：214-221.

Objective To test the hypothesis of autophagy that silencing PHD2 gene could increase hypoxia inducible factor（HIF）-1α levels in the renal medulla and attenuate hypoxia injury in cultured human renal proximal tubular epithelial cell（HK-2）under cobalt dichloride（CoCl2）exposure.Methods HK-2 cells were harvested at hour 0，6，12，24，36 and 48 after exposure to CoCl2（200 μmol/L）.The role of HIF/PHD pathway in CoCl2-induced cell apoptosis/autophagy was studied by employing small-interfering RNA（siRNA）.Dynamic profiles of apoptosis markers（Bax，Bcl-xl）and autophagy marker （LC3）of HK-2 cells within 48 h after exposing to CoCl2were recorded.Alamar Blue assay was used for quantitative analysis of cellular growth and viability.Electron microscopy analysis was employed to evaluate the changes in autophagic structures.Results The protein expressions of PHD2 were gradually increased after exposing to CoCl2（200 μmol/L），with statistic significance at 24 h and reached the peak at 48 h（both P＜0.01）.PHD2 siRNA reduced PHD2 levels by＞60%and significantly increased HIF-1α protein levels（P＜0.01），but had little effect on HIF-2α.The protein expression of Bcl-xl was significantly up-regulated，while the levels of Bax and LC3-Ⅱ/LC3-Ⅰ were down-regulated in PHD2 siRNA group（all P＜0.01），compared with the negative control group.Meanwhile，either 3-Methyladenine（an autophagy inhibitor）treatment or PHD2 knockdown rescued cell death and increased cell viability through autophagy in activation.The ratio of LC3-Ⅱ/LC3-Ⅰand the quantity of autophagosomes were decreased，and the cell ultrastructure was also relatively more intact than the negative control group.Of interest，co-administration of HIF-1α siRNA with PHD2 siRNA abrogated renoprotective effect conveyed by PHD2 siRNA alone，suggesting that activation of endogenous HIF-1α-dependent pathways mediated the autophagy inactivation effects of PHD2 silencing.Conclusion Direct inhibition of PHD2 promotes renal epithelia cell survival against CoCl2-induced cell apoptosis/autophagy.Activation of the HIF-1α signaling pathway is required to reduce apoptosis and autophagy via up-regulating the expression of Bcl-xl protein.

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2015227 CT and MR findings of retroperitoneal ectopic pheochromocytoma.ZHU Zheng（朱正），et al.Dept Diag Radiol，Cancer Hosp，CAMS&PUMC，Beijing 100021.Chin J Oncol 2015；37（3）：181-185.

Objective To evaluate the CT and MR findings of retroperitoneal ectopic pheochromocytoma.Methods To analyze retrospectively the CT and MR images of 32 patients withretroperitonealectopicpheochromocytoma proved by pathology.Results The lesions（benign=28，malignant=4）were located in the anterior pararenal space（ABS）（n=12），the perirenal space（PS）（n= 13）and the posterior pararenal space（PRS）（n=7）. The tumors showed heterogeneous density on unenhanced CT（n=25）.Among the 23 cases with enhanced CT imaging，19 cases had marked contrast and 4 had mild contrast.The enhancement patterns included whole enhancement（n=19），solid area enhancement（n=12），peripheral enhancement（n=1），and spotted enhancement（n=1）.The tumors had heterogeneous signal on unenhanced MR（n=23），and usually showed enhancement at arterial，portal and delayed phases on 22 enhanced MR，while cystic area with no enhancement.The lesions usually had cystic changes（n=18），septa（n= 16），vessels inside（n=9），hemorrhage（n=3），and calcification（n=3）.Morphology had statistical significance in differential diagnosis of benign and malignant retroperitoneal ectopic pheochromocytomas（n=0.013），other indexes did not（P＞0.05）.Conclusion Retroperitoneal ectopic pheochromocytomas have some CT and MR features，usually revealed as an oval mass，growing along the paravertebral axis，and often with cystic changes.Those signs combined with hypertension and elevated catecholamine level may lead to a correct diagnosis.

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2015228 Effect of macrophage polarization on interstitial fibrosis in mouse unilateral ureteral obstruction model.JIANG Yali（姜亞麗），et al.Div Nephrol，1st Affil Hosp，4th Milit Med Univ，Xian 710032.Chin J Nephrol 2015；31（3）：208-213.

Objective To investigate the effect of macrophage polarization on tubulointerstitial fibrosis of mouse unilateral ureteral obstruction（UUO）model.Methods Twelve male C57BL/6J mice were employed，each of which with an age of 8 to 10 weeks.UUO model was established with these mice with the method of unilateral ureteral ligation.Mice were then sacrificed on the 7th and the 14th day respectively after operation，and renal tissue specimens were obtained.The authors detected collagen deposition by Masson staining，and alpha smooth muscle actin（alpha SMA）as well as collagen typeⅠ（Coll-1）mRNA by real-time quantitative PCR.The authors also detected the degree of renal interstitial macrophages infiltration and expression changes of polarization by immunofluorescence staining.Results Compared with the mice that were observed on the 7th day after operation，the degree of renal interstitial fibrosis in mice observed on the 14th day after operation was comparatively serious，the difference shown by semi-quantitative results was statistically significant（P＜0.05）.Moreover，mice observed on the 14th day after operation had more M2 macrophages，the difference between two groups of mice was statistically significant（P＜0.05）.On the contrary，there was no statistically significant difference in the degree of M1 macrophages infiltration between these two groups of mice.Conclusion In the renal interstitial fibrosis model induced by UUO，the degree of macrophage infiltration increased significantly，mainly resulted from M2 macrophage infiltration，suggesting that M2 macrophages were involved in the formation of renal fibrosis.

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2015229 Serum anti-phospolipase A2 receptor antibodies and glomerular IgG4 in the diagnosis of membranous nephropathy.GUAN Yin（管音），et al.Dept Nephrol，PUMC Hosp，Beijing 100730.Chin J Nephrol 2015；31（3）：198-202.

Objective To discuss the relationship between serum anti-Phosphalipase A2 receptor（PLA2R）antibodies and glomerular IgG4 subclass in patients with membranous nephropathy and evaluate the diagnostic value of the two markers.Methods Patients diagnosed as membranous nephropathy from October 2011 to April 2014 in Peking Union Medical College Hospital were included and divided into IMN and SMN groups accoding to their clinical diagnosis.Serum anti-PLA2R antibodies a nd glomer-ular IgG subclasses were both detected by indirect immunofluorescence assay.Receiver operator characteristic curves were used to evaluate the diagnostic efficiency of anti-PLA2R antibodies and glomerular IgG4.Results Prevalence of serum anti-PLA2R antibodies of IMN patients was 69.5%（41/59）；prevalence of MLN patients was 4.8%（1/21）.Within the IMN group，thirty-five patients showed positive results of both serum anti-PLA2R antibodies and glomerular IgG4；Six patients were positive for serum anti-PLA2R antibodies but negative for glomerular IgG4；Seventeen patients were positive for glomerular IgG4 but negative for serum anti-PLA2R antibodies；one patient was negative for both tests.The sensitivity of serum anti-PLA2R antibody was 69.5%and the specificity was 95.2%；the sensitivity of glomerular IgG4 was 89.8%and the specificity was 52.3%.The sensitivity of the combined marker consisting of serum anti-PLA2R antibody and glomerular IgG4 was 59.3%and the specificity was 100%.Four out of the six patients secondary to HBV infection，one out of the three patients secondary to Sj?gren syndrome，one out of the three patients secondary to malignant tumor showed positive results of serum anti-PLA2R antibodies. Conclusion Serum anti-PLA2R antibodies were of high prevalence among IMN patients；the prevalence among SMN patients varied with etiologies.Results of serum anti-PLA2R antibodies and glomerular IgG4 were helpful to rule out secondary etiologies in the diagnosis of membrnous nephropathy.

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2015230 Assessment and appraisal of biomarkers in patients with septic kidney injury.JIA Hongyan（賈洪艷），et al.Intensive Care Unit，Tianjin Hosp，Tianjin 300211.Chin J Emerg Med 2015；24（2）：151-154.

Objective To determine the diagnostic significance of serum Cystatin C（Cys C），neutrophil gelatinase-associated lipocalin（sNGAL），urinary kidney injury moleculel（uKIM-1）and urinary interleukin-18（uIL-18）in patients with septic acute renal injury.Methods A total of 62 adult patients with sepsis admitted to the Intensive Care Unit over 24 hours in the Tianjin Hospital between August 2012 and March 2013 were divided into acute renal injury group（n=39）and non-acute renal injury group（n=23）according RIFLE diagnostic criteria. Measurements of Cys C，sNGAL，uKIM-1 and uIL-18 were performed.The diagnostic values of the biomarkers were assessed by comparing their levels between the patients of different groups.Results The levels of Cys C （2.27±0.93）μg/L，sNGAL（275.04±79.37）μg/L，uKIM-1（2.52±1.06）μg/L in acute renal injury group were higher than Cys C（1.19±0.77）μg/L，sNGAL （137.51±99.33）μg/L，uKIM-1（1.27±0.62）μg/L in non-acute renal injury group（P＜0.05）.There was no significant difference in uIL-18 between the acute renal injury group（374.87±70.23）ng/L and the non-acute renal injury group（354.09±66.42）ng/L（P＞0.05）.The area under ROC curve for diagnostic values of serum Cystatin C，sNGAL and uKIM-1 in acute renal injury were 0.84（0.74-0.95），0.90（0.79-1.00），0.87（0.78-0.96）.Conclusion Cys C，sNGAL and UKM-1 might be effective as diagnostic biomarkers of septic acute renal injury.

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