Objective To evaluate the short and long term effectiveness and safety of rapamycin-based immunosuppression regimes with CsA preserving versus CsA withdrawal. Methods We searched MEDLINE, EMBASE, The Cochrane Library and CNKI from Jan. 1995 to Dec. 2005. We identified randomized controlled trials of rapamycin-hased immunosuppression regimes with CsA preserving versus CsA withdrawal for renal transplantation patients. The quality of included trials was evaluated by two reviewers. Meta-analysis was conducted on homogeneous studies. Results Ten studies （1 121 patients） undergoing renal transplantation were included. All included studies were graded in term of randomization, allocation concealment and bhnding. Six studies were graded A and the other 4 were graded B. Meta-analysis results showed CsA withdrawal in sirolimus-based therapy in renal transplantation patients survival rate OR.（95% CI ） values were 0,77（0.17, 3.52）, 1.24（0.48, 3.16）, 1.32（0.57, 3.08）, 1.21（0.60, 2.41） at the end of 6, 12, 24, 36 months respectively; renal allografts survival rate OR. （95% CI） values were 1.79 （0.63, 5.06）, 1.15 （ 0.56, 2.36） , 1.39 （0.68, 2.85）, 1.80（0.99, 3.29）, 2. 13（1.16, 3.89）, 2.01（1.15, 3.51） at the end of 6, 12, 24, 36, 48, 54 months respectively; and acute rejection OP,（95% CI） values were 0.92（0.48, 1.78）, 1.90（1.25, 2.89）, 2. 01 （0.94,4.27）, 1.93（0.93, 4.00）, 1.52（0.77, 3.02） at the end of6, 12, 24, 36, 48 months respectively. Conclusions Available evidence shows that compared with CsA preserving, CsA withdrawal in rapamycin-based immunosuppression regimes can lead to higher incidence rates of acute rejection at the end of one year while there is no statistical difference to survival rate of patients/renal allograft in cases with stabilized renal function post-transplantation. And CsA withdrawal is of benefit to allografts for long term survival rate and is helpful to recovery of renal function. Owing to high possibility of selection bias and measurement bias in included studies, there must be a negative impact on evidence intensity of our results. We expect best evidence from with high quality double blind randomized control trials.
Objective To investigate the risk factors of acute kidney injury（AKI）after onpump coronary artery bypass grafting(on-pump CABG) and off-pump coronary artery bypass grafting (off-pump CABG) in order to provide superior renal protective measure after operation. Methods The clinical data of 849 consecutive patients undergone coronary artery bypass grafting（CABG） in a single institution between January 1990 and August 2006 were retrospectively analyzed. A simplex module and a multivariate logistic regression model were constructed to identify risk factors for the development of AKI. Results AKI were occurred in 61 patients （11.8%，61/518） undergone off-pump CABG and 63 patients （19.0%，63/331） undergone onpump CABG. Peak of serum creatinine (Scr) after operation arrived at the 12th hour and 24th hour in patients undergone off-pump CABG and patients undergone on-pump CABG respectively. The rapidly recovering period of Scr in patients undergone off-pump CABG and on-pump CABG were from the 24th hour to the 48th hour and from the 48th hour to the 72th hour respectively.The results of the multivariate forward stepwise logistic regression analysis found that risk factors for the development of postoperative AKI following isolated CABG were associated with heavy body mass index（OR=1.190，1.179）, emergent procedure（OR=2.737，3.678）, diabetes（OR=1.705，2.042）, peripheral vascular disease（OR=2.002，2.559）,ejection fraction≤30%（OR=2.267，4.606）, and New York Heart Association(NYHA) class Ⅲ and Ⅳ（OR=1.861，1.957） were risk factors for the development of postoperative AKI following offpump and on-pump CABG; pulse pressure≥60mmHg and triplevessel disease were risk factors for the development of postoperative AKI following off-pump CABG. But perioperative and postoperative intra aortic balloon pumping (IABP) could make protective effect on kidney for on-pump CABG （OR=0.146）which could lessen development of AKI. Conclusions It is critical period for AKI that renal protection strategies should be performed from general anesthesia until postoperative 48 hours (off-pump CABG) and 72 hours (on-pump CABG). AKI might be the most important stage in which a positive test should increase the physician’s awareness of the presence of risk for renal injury and then preventive or therapeutic intervention could be performed when the situation still is reversible.
Objective To explore the effects of ulinastatin (UTI) on renal apoptosis and expression of bcl-2 in rats with severe acute pancreatitis (SAP). Methods Sixty rats weighing 250-300 g were randomized divided into 3 groups: pseudo-operation group (SO group, n=20), SAP group (n=20) and UTI treated group (UTI group, n=20). The model of SAP was established by retrograde injection of 5% sodium taurocholate solution into the biliopancreatic duct in the rats. Serum Cr and BUN were determined. The left kidneys were resected for light and electronic microscopic study. Renal cell apoptosis was determined by TUNEL. Expression of bcl-2 was detected by immunohistochemical staining of SABC. Results Serum Cr, BUN, renal cell apoptotic index and bcl-2 expression were markedly increased in SAP group compared with SO group （P＜0.05， P＜0.01）, Renal tissue injuries were aggravated in SAP group under light and electronic microscopic study as well. In UTI group, serum Cr, BUN and renal cell apoptotic index were decreased significantly while the expression of bcl-2 increased remarkably and renal tissue injuries relieved compared with SAP group （P＜0.05）. Positive correlations were found between the renal cell apoptotic index and BUN as well as Cr (r=0.807, P＜0.05; r=0.812, P＜0.05). Conclusion The protective effect of UTI on SAP renal injury is probably through increasing bcl-2 expression and decreasing apoptosis.
ObjectiveTo observe the effect of thermal damage in the fresh isolated kidneys of New Zealand white rabbits caused by domestic holmiumlaser. MethodsIn the operation room (constant temperature 22℃, humidity 60%), Guangdong electric (POTENT) domestic holmium laser equipment was chosen. The fresh isolated kidney of New Zealand white rabbit was put into a disposable sterilized syringe with 50 mL normal saline, then the holmium laser optical fiber (550 μm) was put into it, and the temperature of normal saline was measured by a mercury thermometer. The parameters of holmium laser were setted as frequency 20 Hz, energy 2 J, stimulating time 15 seconds, intermittent time 5 seconds, which was repeated. The temperature was measured 2, 5 and 7 minutes after stimulation. Then the kidney was dissected, phtographed, haematoxylin-eosin stained, and pathologically examined.ResultsAt the 2nd minute of stimulation, the temperature of normal saline in the syringe increased from 22℃ to 38℃; the cortex and medulla of rabbit kidney were ruddy, and the cortex, medulla and ureter were almost normal in pathological section. At the 5-minute point, the temperature increased to 57℃, and the cortex turned to be white, while the medulla remained ruddy, but the demarcation between the cortex and medulla was not very clear. At the 7th minute, the temperature was 78℃, and the cortex and medulla were both white and solidification with no clear demarcation. Pathological examination showed severe degeneration and necrosis of glomerulus and renal tubule.ConclusionCommon power of domestic holmium laser would produce increasing thermal damage, which may cause tissue damage in the human body when the temperature increases above 50℃.
Objective To establish a new method for detection of β-glucuronidase (β-G) mRNA in human liver and kidney tissues. Methods β-G mRNA expression was detected by reverse transcription polymerase chain reaction(RT-PCR) in 10 cases of normal liver tissues, 10 cases of normal kidney tissues and 8 cases of hepatocellular carcinoma tissues. Results The expand products of β-G mRNA were expressed in liver and kidney tissues with similar size of 422 bp. The expression contents of β-G mRNA in liver and kidney normal tissues were different (1.71±0.32 vs 1.83±0.22) but without statistical significance (Pgt;0.05). However, the expression content of β-G mRNA in hepatocellular carcinoma tissues was 3.88±0.86， which was significantly higher (P＜0.01) than that in normal liver tissues. Conclusion β-G mRNA determination is feasible by checking β-G gene alignment in gene bank and designing draw matter in the tissue of liver and kidney. It may be very significant to explore the change of β-G mRNA in various tissues in studying of molecular mechanism.
ObjectiveTo investigate the renal impairment and the risk factors of renal impairment in patients with OSA. MethodsData from patients who underwent polysomnography (PSG) in our department from July 2022 to January 2023 were collected, totaling 178 cases. Based on the results of the polysomnography, the patients were divided into an OSA group (145 cases) and a non-OSA group (33 cases). According to the severity of the condition, the OSA group was further divided into mild OSA (21 cases), moderate OSA (28 cases), and severe OSA (96 cases). The Pearson correlation analysis was further conducted to analyze the relationships between serum urea nitrogen (BUN), serum cystatin C (Cys-C) concentrations, and estimated Glomerular Filtration Rate (eGFR) with various risk factors that may influence renal impairment. Moreover, multiple linear regression analysis was used to identify the risk factors affecting BUN, Cys-C, and eGFR. ResultsWhen comparing the two groups, there were statistically significant differences in age, weight, BMI, neck circumference, waist circumference, eGFR、Cys-C、BUN, LSaO2, CT90% (all P<0.05). Univariate analysis of variance was used to compare differences in BUN, Serum creatinine (SCr), Cys-C, and eGFR among patients with mild, moderate, and severe OSA, indicating that differences in eGFR and Cys-C among OSA patients of varying severities were statistically significant. Further analysis with Pearson correlation was conducted to explore the associations between eGFR, BUN, and Cys-C with potential risk factors that may affect renal function. Subsequently, multiple linear regression was utilized, taking these three indices as dependent variables to evaluate risk factors potentially influencing renal dysfunction. The results demonstrated that eGFR was negatively correlated with age, BMI, and CT90% (β=−0.95, P<0.001; β=−1.36, P=0.01; β=−32.64, P<0.001); BUN was positively correlated with CT90% (β=0.22, P=0.01); Cys-C was positively correlated with CT90% (β=0.58, P<0.001. Conclusion Chronic intermittent hypoxia, age, and obesity are risk factors for renal dysfunction in patients with OSA.
ObjectiveTo assess the effect of plasmid-mediated short hairpin RNA (shRNA) on Klotho gene in mice medullary collecting duct (IMCD3) cells. MethodsThree pairs of shRNA for Klotho (the first, second, and third pairs of shRNA) were designed and pRNAU6-Klotho were constructed, which were transfected into IMCD3 cells by Lipofactine2000. The negative control group and untreated group were set up at the same time. After 24 hours, the expressions of Klotho mRNA and protein levels were detected by reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting, respectively. ResultsThe second pairs of shRNA had the best interference effect compared with the control group according to RT-PCR (P<0.01). The results of Western blotting showed that the Klotho protein levels in the second pairs of shRNA group differed much from all the other 4 groups (P<0.001). ConclusionPlasma-mediated shRNA can highly inhibit the expression of Klotho, which suggests that it may be potential to study the pathogenesis in kidney disease.
ObjectiveTo explore the protective mechanism and effect of the resveratrol for kidney injury of obstructive jaundice. MethodsThe rats were randomly divided into three groups: sham operation group receiving laparotomy without bile duct ligation (BDL), the obstructive jaundice group with BDL, and the obstructive jaundice + resveratrol group given resveratrol following BDL. The levels of total bilirubin (TBIL), direct bilirubin (DBIL), blood urea nitrogen (BUN), and creatinine (Cr) in the serum were tested. The superoxide dismutase (SOD) activity, malondialdehyde (MDA) content, glutathione (GSH) level in the renal tissues were detected. The expressions of the silent information regulator 1 (SIRT1) and nuclear factor-κB (NF-κB) proteins were tested by Western blot. The expression of SIRT1 mRNA was detected by RT-PCR and the renal cell apoptosis was examined by TUNEL staining. Results①Compared with the sham operation group, the levels of serum TBIL, DBIL, BUN and Cr were significantly higher (P < 0.05); the activity of SOD and level of GSH, and the expressions of SIRT1 mRNA and SIRT1 protein in the renal tissues were signi-ficantly lower (P < 0.05); the content of MDA, the expression of NF-κB protein, and the rate of cell apoptosis in the renal tissues were significantly higher (P < 0.05) in the obstructive jaundice group.②Compared with the obstructive jaundice group, the levels of serum TBIL, DBIL, BUN and Cr were significantly lower (P < 0.05); the activity of SOD and level of GSH, and the expressions of SIRT1 mRNA and SIRT1 protein in the renal tissues were significantly higher (P < 0.05); the content of MDA, the expression of NF-κB protein, and the rate of cell apoptosis in the renal tissues were significantly lower (P < 0.05) in the obstructive jaundice+resveratrol group. ConclusionThe resveratrol could alleviate renal damage and play a beneficial role to resist inflammation, oxidation, and apoptosis by activating the SIRT1 which probably inhibits the expression of NF-κB protein and promotes the activity of SOD in cholestatic kidney injury.
ObjectiveTo systematically review the correlation between type 2 diabetes mellitus (T2DM) and the risk of kidney cancer. MethodsPubMed, EMbase, Web of Science, CBM, VIP and CNKI databases were electronically searched to collect cohort studies on the association between T2DM and kidney cancer from inception to August 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis then performed by using Stata 15.0 software. ResultsA total of 17 cohort studies involving 2 003 165 T2DM patients were included. The results of meta-analysis showed that patients with T2DM had a higher kidney cancer risk than controls (RR=1.51, 95%CI 1.39 to 1.64, P<0.001). Subgroup analysis showed that the incidence of kidney cancer in T2DM patients was higher in different gender, region, population, follow-up time, diabetes assessment method and other subgroups. ConclusionsCurrent evidence shows that T2DM is a risk factor for kidney cancer.
To elucidate the mechanism of renal injury following intestinal ischemia/reperfusion, reactive oxygen metabolites in kidney and plasma were examined in 20 rats following intestinal ischemia/reperfusion by measurement of lipid proxidation (LP).The plasma lipid peroxide concentration after reperfusion was higher than that of the contol group (Ｐ＜0.01),the LP in kidney homogenate was also significantly higher (Ｐ＜0.01) following intestinal ischemia/reperfusion.Our study suggests that reactive oxygen metabolites after intestinal ischemia/reperfusion plays an important role in kidney injury.