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Abstract

Clinical Nephrology, Vol. 79 – No. 1/2013 (50-56)

Prevalence of chronic kidney disease in Jing adults in China: a village-based study

Chao Xue, Xu D. Ye, Wei Li, Qian Peng, Heng Y. Ding, Ying H. Zhang, Di F. He, Xu Bai, You Huang, Ya S. Song, Ling Pang and Yun H. Liao

Department of Renal, First Affiliated Hospital, Guangxi Medical University, Nanning, China
Aim: Chronic kidney disease (CKD) is increasingly recognized as a predictor of end-stage renal and cardiovascular disease. There is no data on CKD prevalence in numerous minority communities of China such as the Guangxi Jing community. We etermined CKD prevalence and related risk factors in Jing adults. Methods: A stratified cluster random sampling method was used in this study comprising 757 Jing adults. Questionnaires, physical examinations and laboratory tests including measurements of urinary albumin and hematuria, were performed. Estimated glomerular filtration rate (eGFR) was calculated using the improved Chinese population MDRD formula. CKD-related risk factors were also examined. Results: After standardization for age and gender, the prevalence of albuminuria, haematuria and eGFR < 60 ml/min per 1.73 m² was 12.5%, 3.8% and 0.4%, respectively Overall CKD prevalence was 15.3%, while the awareness rate was only 11.6%. Females had a significantly higher (p < 0.05) prevalence of albuminuria, hematuria and eGFR < 60 ml/min compared to males. CKD prevalence tended to increase significantly (< 0.05) with increase in age. Using the standardized age and gender ratios, the prevalence of hypertension, diabetes, hyperlipidemia and hyperuricemia was 14.8%, 5.2%, 38% and 16.2%, respectively, with awareness of 41.0%, 41.2%, 6.6% and 0.9%. Prevalence of overweight or obesity status and metabolic syndrome was 12.1% and 3.0%. Females showed a significantly higher prevalence of hyperuricemia and obesity or overweight status. CKD prevalence was also significantly higher in people with risk diseases. Regression analysis showed that age, gender, hypertension, high cholesterol and diabetes were CKD-related risk factors, while culture (higher education level) was a protective factor. Conclusion: Jing adults showed a high CKD prevalence of 15.3%, with a low awareness rate of 11.6%. Older subjects and females were more susceptible with a high prevalence of hypertension, diabetes, hyperlipidemia, metabolic syndrome etc. being associated closely with CKD. Correspondence to:
Yun.H. Liao, MD
Division of Renal, First Affiliated Hospital
Guangxi Medical University Nanning, China
Email: [email protected]

Abstract

Clinical Nephrology, Vol. 80 – No. 1/2013 (40-46)

Clinical and prognostic implications of serum uric acid levels on IgA nephropathy: a cohort study of 348 cases with a mean 5-year follow-up

Gen-yang Cheng¹*, Dong-wei Liu¹*, Na Zhang², Lin Tang¹, Zhan-zheng Zhao¹ and Zhang-suo Liu¹

¹Department of Nephrology, and ²The First Affiliated Hospital, ZhengZhou University, Zhengzhou, China

*Both authors contributed equally to this work.
Aim: To assess the prognostic implications of serum uric acid levels on patients with IgA nephropathy in a longitudinal 8-year follow-up study and to identify an association between serum uric acid levels and the clinical and pathological phenotypes of IgA nephropathy. Subjects and methods: We reviewed the files of all consecutive patients with IgA nephropathy treated at our hospital between 2001 and 2009. Analyses were performed to investigate the association between the level of serum uric acid and both clinical and pathological phenotypes of IgA nephropathy. Prognosis was assessed based on follow-up data. Results: At the same glomerular filtration rate (GFR), there was no significant difference in the levels of 24 hours proteinuria, blood urea nitrogen (BUN), and serum creatinine between the two groups with different levels of serum uric acid (p > 0.05). The prevalence of glomerular sclerosis as well as the scores of tubulointerstitial and vascular injury was greater in patients with high serum uric acid levels compared to patients with normal levels of serum uric acid (p < 0.05). At the end of the follow-up period, patients with high serum uric acid levels had a higher prevalence of reduced GFR and end stage renal disease (ESRD) than those with normal serum uric acid levels (40.82 vs. 15.70% and 64.71 vs. 35.00%, respectively; p < 0.05). Conclusions: The serum uric acid level in patients with IgA nephropathy affects the pathophysiology and prognosis of the disease. We also identified a correlation between hyperuricemia and a higher risk of renal end points.Correspondence to:
Zhang-suo Liu, MD
Department of Nephrology
The First Affiliated Hospital
ZhengZhou University
No.1 Jianshe Road, Zhengzhou, Henan,450052, China
Email: [email protected]

Abstract

Clinical Nephrology, Vol. 82 – No. 4/2014 (257-262)

IgG4-related disease: a case report and review of cases reported in China

Jian Yang, Wei Liu and Rongjiang Jiang

Department of Urology, Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
IgG4-related inflammatory pseudotumors are lesions characterized by plasma cell-rich histologic pattern, abundant IgG4-positive plasma cells and high serum IgG4 levels. A 64-year-old man was admitted to our hospital for an ultrasound-documented space-occupying lesion of the left kidney. Renal tumor of the left kidney was suspected based upon results of computed tomography and nuclear magnetic resonance, and laparoscopic radical nephrectomy was conducted. The final diagnosis of IgG4-related inflammatory pseudotumor was made based on histopathological examination and IgG4 immunostaining. The patient received steroid therapy. To our knowledge, this is the first case of IgG4-related inflammatory pseudotumor of the kidney reported in China.Correspondence to:
Dr. Rongjiang Jiang
Department of Urology
The Second Affiliated Hospital of Nanjing Medical University
Nanjing 210011, China
Email: [email protected]

Abstract

International Journal of Clinical Pharmacology and Therapeutics, Vol. 52 – No. 2/2014 (95-102)

Treatment of severe IgA nephropathy: mycophenolate mofetil/prednisone compared to cyclophosphamide/prednisone

Xiaowei Liu¹*, Du Dewei²*, Shiren Sun¹, Guoshuang Xu¹, Hongbao Liu¹, Lijie He¹, and Peng Zhang¹

¹Department of Nephrology, Xijing Hospital and ²Department of Nephrology, Tangdu Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
Objective: To compare the efficacy of mycophenolate mofetil (MMF)/prednisone to cyclophosphamide (CYC)/prednisone in the treatment of severe IgA nephropathy. Methods: Patients (n = 84) with severe IgA nephropathy received either MMF/prednisone (MMF group) or CYC/prednisone (CYC group). The MMF induction dose was 1.5 g/d for 6 months and the maintenance dose was 0.75 – 1.0 g/day for 12 months. The CYC induction dose was 0.8 – 1.0 g/month for 6 months and the maintenance dose was 0.8 – 1.0 g/3 months for 12 months. Laboratory tests, clinical remission rate and side effects were investigated. Results: After 18 months of treatment, the total effective rate in the MMF group was significantly higher than that of the CYC group. Patients’ 24-hour urinary protein excretion in the MMF group was lower than the CYC group. Patients’ plasma albumin and total protein in the MMF group was higher than the CYC group. MMF and prednisone reduced serum lipids, while in the CYC group serum lipids remained unchanged. There was also a lower incidence of adverse effects in the MMF group (4.76%) than in the CYC group (26.2%). Conclusion: Combination therapy with MMF and prednisone for severe IgA nephropathy achieved a higher remission rate compared to treatment with CYC and prednisone. This therapy also reduced the 24-hour urinary protein and serum lipids while increasing plasma albumin and improving renal function. The incidence of adverse effects was significantly lower in the MMF group compared to the CYC group.

*These authors have contributed equally to this work.Correspondence to:
Peng Zhang
Department of Nephrology, Xijing Hospital
The Fourth Military Medical University
Xi’an 710032, China
Email: [email protected]

Abstract

International Journal of Clinical Pharmacology and Therapeutics, Vol. 53 – No. 3/2015 (241-246)

Comparison of the effects of dezocine, fentanyl, and placebo on emergence agitation after sevoflurane anesthesia in children

Xiuze Li, Qing Xia, and Wei Li

Department of Anesthesiology, Mianyang Central Hospital, Sichuan, China
Objectives: The purpose of the study was to compare the efficacy and adverse events of dezocine with that of fentanyl or placebo for the control of emergence agitation. Methods: 114 children scheduled for adenotonsillectomy under sevoflurane anesthesia were allocated randomly into 1 of the 3 groups to receive dezocine 0.1 mg×kg^–1 (group D, n = 38), fentanyl 1 μg×kg^–1 (group F, n = 38), or saline (group S, n = 38) just before the end of anesthesia. Emergence agitation scores were assessed. Postoperative pain scores, awakening and extubation times, and the incidence of adverse effects were recorded. Results: Emergence agitation scores, the incidence of emergence agitation and severe emergence agitation were significantly lower in groups D and F than in group S (p = 0.021, p = 0.018, and p = 0.028, respectively). The postoperative pain scores were lower in groups D and F as compared to group S (p = 0.01). Awakening and extubation times in groups D and F were longer than that of group S (p = 0.001 and p = 0.000, respectively). The overall incidence of postoperative complications was higher in group F compared to that in groups D and S (p = 0.01). Conclusions: In children undergoing adenotonsillectomy under sevoflurane anesthesia, a single IV injection of dezocine 0.1 mg×kg^–1 and fentanyl 1 μg×kg^–1 were comparable in decreasing the incidence and severity of emergence agitation. However, the use of dezocine was associated with a lower incidence of postoperative side effects.Correspondence to:
Dr. Xiuze Li
Department of Anesthesiology
Mianyang Central Hospital
12 Changjia Lane, Mianyang, Sichuan 621000, China
Email: [email protected]

Abstract

Trace Elements and Electrolytes, Vol. 33 – No. 1/2016 (41-46)

Investigation of the relationship between mineral element levels and serum biochemical parameters in children in Pingyin, China

Xia Li¹*, Yan-ni Jiao²*, Yu-mei Liu¹, Jia-bing Liang³, Jin-dong Chen², Jing-yang Zhou², Wei Li², Xing-bing Jia⁴, Wan-ping Miao⁴, Shu-yong Zhao⁴, Shi-yong Zhai⁵, Mao-you Hu⁶, and Xi-bao Gao¹

¹School of Public Health, Shandong University, Jinan, Shandong Province, ²Shandong Center for Disease Control and Prevention, Jinan, Shandong Province, ³People’s Hospital of Ju County, Juxian, Shandong Province, ⁴Pingyin Center for Disease Control and Prevention, Jinan, Shandong Province, ⁵Pingyin Mental Health Center, Jinan, Shandong Province, and ⁶Pingyin Health and Family Planning Commission, Jinan, Shandong Province, China
Objective: The present study was designed to evaluate the relationship between mineral element levels and the health status of children. Material and methods: A total of 610 healthy children aged from 6 to 12 years (327 boys and 283 girls) from five selected villages in the Pingyin County participated in this study. Information including age, gender, height, weight, and blood pressure (BP) were recorded by health professionals. Blood samples of participants were collected and analyzed. Fourteen serum mineral elements were determined by atomic absorption spectrometer (AAS) and inductively coupled plasma mass spectrometry (ICP-MS). The correlations between serum element concentrations and serum biochemical parameters were investigated. Results: No significant gender difference was found for the tested elements. Significant correlations between age and the levels of copper (Cu) (r = –0.132), magnesium (Mg) (r = 0.114), and cadmium (Cd) (r = 0.152) were obtained. A correlation between body mass index (BMI) and serum Cu (r = –0.165) and zinc (Zn) (r = –0.106) was found. Noticeable inverse correlations of systolic blood pressure (SBP) and diastolic blood pressure (DBP) with serum Cu, chromium (Cr), and nickel (Ni) were observed. There was a positive correlation of SBP and DBP with Cd. In addition, DBP was negatively correlated with selenium (Se) and positively correlated with lead (Pb). The fasting blood-glucose (FBG) was significantly correlated with serum Cr (r = –0.326). The concentration of low-density lipoprotein (LDL) was significantly correlated with Cu (r = –0.234), Cr (r = –0.316), and Se (r = 0.301). The level of total cholesterol (TC) was significantly correlated with iron (Fe) (r = –0.186) and Se (r = 0.117). The triglyceride (TG) level was significantly correlated with Se (r = 0.177). Interrelations of elements were as follows: serum Pb was significantly correlated with levels of Zn (r = –0.107), Se (r = –0.486), and Cd (r = 0.465); Se level was significantly correlated with Cd (r = –0.868) and arsenic (As) (r = –0.10); the level of Zn was significantly correlated with Cu (r = –0.105) and Fe (r = 0.137). Conclusions: Serum element concentrations may influence many biochemical parameters. It is important to measure the trace element status in children because changes and interactions may play an important role in the human metabolism.Correspondence to:
Prof. Xi-bao Gao
School of Public Health, Shandong University
Jinan, Shandong, 250012 PR China
Email: [email protected]

Abstract

Clinical Nephrology, Vol. 85 – No. 5/2016 (273-280)

Comparison between patients with IgA nephropathy with minimal change disease and patients with minimal change disease

Xiao-Wei Li¹,², Shui-Qin Cheng², Shao-Shan Liang², Wei-Bo Le², Cai-Hong Zeng², Jin-Quan Wang², and Zhi-Hong Liu²

¹Department of Nephrology, Fuyang People’s Hospital, Fuyang, and ²National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University of Medicine, Nanjing, China
Objective: To compare the clinicopathological characteristics, treatment response, and prognosis between patients with IgAN nephropathy with minimal change disease (MCD-IgAN) and patients with minimal change disease (MCD). Methods: 77 patients with biopsy-proven MCD-IgAN from the Jinling Hospital IgAN Registry and 77 patients with MCD followed up for ≥ 3 years were retrospectively reviewed. Results: MCD-IgAN and MCD patients had similar clinical presentations, both were predominantly young males, the disease mainly manifested as nephrotic syndrome, and the patients rarely presented with microscopic hematuria. Compared with the MCD group, patients with MCD-IgAN had lower levels of baseline serum albumin (p < 0.01) and eGFR (p < 0.05), a higher level of urine n-acetylglucosaminidase (p < 0.01), higher proportion of mesangial hypercellularity (M1), and more severe acute tubulointerstitial lesions in renal pathology (p < 0.01, p < 0.01, respectively). After 8 weeks of corticosteroid therapy, no significant differences were observed in the rate of complete remission, partial remission, and no remission between MCDIgAN and MCD patients (88.3% vs. 90.9%, 10.4% vs. 5.2%, 1.3% vs. 3.9%, p > 0.05). The median time to achieve remission was 4 weeks (range 1 – 24 weeks) and 4 weeks (range 1 – 28 weeks), respectively. No significant difference existed in the efficacy of corticosteroid between the two groups. During 3.96 years (range 3.0 – 8.5 years) of follow-up, no patients in the two groups entered end-stage renal disease (ESRD), only 2 patients (2.6%) with MCD-IgAN had > 50% reduction of eGFR. Conclusions: MCD-IgAN may be controlled well achieving a comparable clinical outcome as MCD but more frequently necessitates additional immunosuppressive medication.Correspondence to:
Dr. Zhihong Liu
National Clinical Research Center of Kidney Diseases
Jinling Hospital, Nanjing University School of Medicine
Nanjing, Jiangsu 210002, China
Email: [email protected]

Abstract

International Journal of Clinical Pharmacology and Therapeutics, Vol. 54 – No. 5/2016 (378-389)

Population pharmacokinetic-pharmacodynamic (PopPK/PD) modeling of risperidone and its active metabolite in Chinese schizophrenia patients

Shuangmin Ji¹#⁴, Dewei Shang⁵, Kehua Wu¹#⁴, Anning Li²#³, Xiwei Li⁷, Chenhui Deng⁶, Liang Li¹#⁴, Tianyan Zhou¹#⁴, Chuanyue Wang²#³*, and Wei Lu¹#²#⁴*

¹State Key Laboratory of Natural and Biomimetic Drugs, Peking University, ²Center of Schizophrenia, Beijing Institute for Brain Disorders, Laboratory of Brain Disorders (Capital Medical University), ³Beijing Key Laboratory of Mental Disorders, Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, ⁴School of Pharmaceutical Sciences, Peking University, Beijing, ⁵Department of Pharmacy, Guangzhou Brain Hospital, Guangzhou Medical University, Guangzhou, China, ⁶Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden, and ⁷Institute of Clinical Pharmacology, Peking University First Hospital, Beijing, China
Purpose: Risperidone is a second-generation antipsychotic agent commonly used in the treatment of ~ 31.1% of schizophrenia patients in China, it is the most commonly-prescribed antipsychotic agent. Despite the abundant use of risperidone, population pharmacokinetic-pharmacodynamic models of risperidone have not been performed in Chinese schizophrenia patients. The objective of this study was to develop a population pharmacokinetic-pharmacodynamic (PopPK/PD) model to describe the PK behavior and efficacy of risperidone and 9-hydroxy-risperidone (active metabolite) in Chinese patients. Methods: Plasma concentration data (702 measurements from 131 patients) and positive and negative syndrome scale (PANSS) scores (258 observations from 56 patients) were analyzed using a nonlinear mixed-effects modeling (NONMEM) approach with first-order conditional estimation with interaction (FOCEI). The influence of potential covariates was evaluated. Model robustness was assessed using external validation, normalized prediction distribution error, nonparametric bootstrap, and visual predictive check approaches. Results: Risperidone concentration data were well described by a one-compartmental model incorporating an additional compartment that refers to the concentration profiles of 9-hydroxy-risperidone. A complex absorption procedure was incorporated into the model to describe the metabolism of risperidone to 9-hydroxy-risperidone in the gastrointestinal (GI) tract. A binomial distribution in the estimated clearance (CL) of risperidone has been identified in our model. Decrease in PANSS score along with total AUC (AUC_total) of risperidone and 9-hydroxy-risperidone was best characterized by an E_max model with 3 transit compartments describing the delay of drug effect. Conclusions: Considerable differences in PK behavior and drug effect of risperidone have been identified among Chinese extensive metabolizing (EM) and poor metabolizing (PM) patients. This PopPK/PD model may fulfill individualized treatment in clinical practice and may potentially be transferred to other antipsychotic therapies.Correspondence to:
Wei Lu, PhD
State Key Laboratory of Natural and Biomimetic Drugs
Peking University, Beijing, 100191, China
or
Chuanyue Wang, MD
Center of Schizophrenia
Beijing Institute for Brain Disorders
Laboratory of Brain Disorders (Capital Medical University)
Ministry of Science and Technology, Beijing 100088, China
Email: [email protected] or [email protected]

Abstract

Clinical Nephrology, Vol. 86 – No. 2/2016 (70-77)

Development and evaluation of a retroperitoneal dialysis porcine model

Zhamshid Okhunov¹, Renai Yoon, Alberto Perez Lanzac¹, Michael Sgroi², Wei Ling Lau³, Michael del Junco¹, Michael Ordon¹, Austin Drysch¹, Christina Hwang¹, Simone L. Vernez¹, Roy Fujitani², Nii-Kabu Kabutey², Kamyar Kalantar-Zadeh³, and Jaime Landman¹

¹Department of Urology, ²Department of Surgery, and ³Department of Nephrology, University of California, Irvine, CA, USA
Objectives: We attempted to create a surgical model to evaluate the retroperitoneal space for the ability to transfer solutes through the retroperitoneal membrane. Our dual objectives were to develop a technique to assess the feasibility of retroperitoneal dialysis (RPD) in a porcine model. Methods: We incorporated two 35-kg Yorkshire pigs for this pilot study. In the first animal, we clamped renal vessels laparoscopically. In the second animal, we embolized renal arteries. In both animals, we dilated the retroperitoneal space bilaterally and deployed dialysis catheters. We measured serum creatinine (Cr), urea, and electrolytes at baseline 6 hours before the dialysis and every 4 hours after. Results: We successfully created retroperitoneal spaces bilaterally and deployed dialysis catheters in both animals. In the first animal, dialysate and plasma Cr ratio (D/P) on the left and right side were 0.43 and 0.3, respectively. Cr clearance by 40 minutes of dialysis treatment was 6.3 mL/min. The ratio of dialysate glucose at 4 hours dwell time to dialysate glucose at 0 dwell time (D/D₀) for left/rights sides were 0.02 and 0.02, respectively. kt/V_urea was 0.43. In the second animal, D/P Cr for left/right sides were 0.34 and 0.33, respectively. kt/V_urea was 0.17. We euthanized the pigs due to fluid collection in the peritoneal space and rapid increase of serum Cr, urea, and electrolytes. Conclusions: We demonstrated the feasibility of creation of a functionally anephric porcine model with successful development of retroperitoneal spaces using balloon inflation. Notwithstanding minimal clearance and limited diffusion capacity in this experiment, additional studies are needed to examine potential use of retroperitoneal space for peritoneal dialysis.Correspondence to:
Jaime Landman, MD
Professor of Urology and Radiology Chairman
Department of Urology, University of California Irvine
333 City Boulevard West, Suite 2100
Orange, CA 92868, USA
Email: [email protected]

Abstract

Clinical Nephrology, Vol. 87 – No. 4/2017 (196-201)

Clinicopathological features, diagnosis, and treatment of IgA nephropathy with minimal change disease related to exposure to mercury-containing cosmetics: a case report 

Hong-Xin Niu¹*, Shen-Heng Li¹*, Hong-Ying Li¹*, Yi-Hua Chen¹, Wei-Wei Liu², Pei-Lin Li¹, and Hai-Bo Long¹

¹Division of Nephrology, Zhujiang Hospital, Southern Medical University, Guangzhou, and ²Division of Occupational Diseases and Poisoning,  Twelfth Guangzhou People’s Hospital, Guangzhou, China
Aim: Membranous nephropathy and minimal change disease (MCD) have been involved in mercury-induced nephrotic syndrome. IgA nephropathy is not known to be a common pathological type. In the present article, we report a case of IgA nephropathy with MCD following exposure to mercury-containing skin lightening cream. Material and methods: The patient was a 39-year-old woman who presented with nephrotic syndrome. She had a 6-month history of using as many as 8 kinds of skin-lightening creams, and urinary mercury excretion was high. Renal biopsy revealed IgA nephropathy with MCD. The use of cosmetics was stopped and chelation therapy was given. After 4 courses (1 month) of chelation therapy, there was a complete remission of proteinuria and hematuria, and urine tests remained normal during the 5-year follow-up period. Results and conclusions: The unique clinical and pathological features of IgA nephropathy with MCD had raised the controversial question of whether MCD and IgA deposition are separate entities or a common pathophysiology. Repeated renal biopsy and similar cases were helpful and should be carried out as far as possible. 

*These authors contributed equally to this work.Correspondence to:
Hai-Bo Long, MD
Division of Nephrology, Zhujiang Hospital
Southern Medical University
No. 253 Industrial Road, Haizhu District, Guangzhou, 510282
Email: China [email protected]

Abstract

Clinical Neuropathology, Vol. 36 – No. 4/2017 (171-177)

Adult-onset demyelinating neuropathy associated with FBLN5 gene mutation

Si Cheng*, He Lv*, Wei Zhang, Zhaoxia Wang, Xin Shi, Wei Liang, and Yun Yuan

Department of Neurology, Peking University First Hospital, Beijing, China
Rare forms of autosomal-dominant Charcot-Marie-Tooth disease (AD-CMT) may be associated with mutations in Fibulin-5 (FBLN5) as AD-CMT is genetically heterogeneous. Here, we report the first pathological study of an Asian family. The proband was a 46-year-old man with slowly progressive distal numbness and weakness for 12 years. He had a history of diabetes mellitus for 12 years. His mother was 81 years old and had mild polyneuropathy. His 16-year-old daughter was asymptomatic. The nerve conduction velocities (NCVs) and compound muscular action potential (CMAP) amplitudes were moderately to severely reduced in the proband, and moderately reduced in his daughter and mother. A sensory response could not be elicited in the proband and was moderately to severely decreased in the daughter and mother. Nerve ultrasound indicated a general enlargement of the peripheral nerves in the proband, daughter, and mother. A sural nerve biopsy from the proband demonstrated a pronounced depletion of myelinated fibers, thin myelinated fibers, and onion-bulb formations. A reported heterozygous mutation of c.1117C>T in FBLN5 was identified in the proband, mother, and daughter. These findings confirm a novel subtype of AD-CMT 1 due to a mutation in the FBLN5 gene. Correspondence to:
Yun Yuan, MD, PhD
8 Xishenku Ave, Xicheng District,
Beijing 100034, PR China
Email: [email protected]

Abstract

International Journal of Clinical Pharmacology and Therapeutics, Vol. 56 – No. 7/2018 (337-346)

The association between CYP2C9/2C19 polymorphisms and phenytoin maintenance doses in Asian epileptic patients: A systematic review and meta-analysis 

Kai Liao¹#², Yong Liu³, Chun-Zhi Ai⁴#⁵, Xi Yu¹#², and Wei Li¹#²

¹College of Medicine, Yangzhou University, ²Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Yangzhou, ³School of Life Science and Medicine, Dalian University of Technology, Panjin, ⁴Institute for Advanced Study, and ⁵Key Laboratory of Optoelectronic Devices and Systems of the Ministry of Education and Guangdong Province, College of Optoelectronic Engineering, Shenzhen University, Shenzhen, China
Objective: Therapeutic response to phenytoin (PHT), a first-line antiepileptic drug (AED), is highly variable, in part likely due to genetic factors. Genetic polymorphisms in cytochrome P450 (CYP) 2C9 and CYP2C19 are expected to affect the metabolism of PHT and consequently affect its maintenance doses. We aimed to clarify the effects of genetic polymorphisms in both enzymes on daily PHT maintenance dosage in Asian epileptic patients by meta-analysis. Materials and methods: A systematic literature search was conducted in PubMed and EMBASE for relevant studies published prior to April 14, 2017. RevMan 5.2.3 software was used to analyze the relationship between CYP2C9/2C19 polymorphisms and PHT maintenance doses. Results: A total of 6 studies with 993 patients fulfilling the inclusion criteria were included in our meta-analysis. The homozygous and heterozygous CYP2C19 mutation group (i.e., CYP2C19*2/*2, CYP2C19*3/*3, or CYP2C19*2/*3 group) required significant decrease of PHT maintenance dose. The starting maintenance dose suggested in this group is 4.38 mg/kg/day. Patients with heterozygous CYP2C9 or both heterozygous CYP2C9 and CYP2C19 showed a trend but not a statistically-significant decrease of PHT dose, but dosage adjustment was recommended. Conclusion: The meta-analysis indicates that CYP2C9 and CYP2C19 polymorphisms are associated with lower PHT maintenance dosage in Asian epileptic patients. Ethnic differences can influence PHT maintenance dose. Correspondence to:
Wei Li, PhD 
College of Medicine, Yangzhou University
11 Huaihai Road, Yangzhou 225001, China 
Email: [email protected]

Abstract

Clinical Nephrology – Case Studies, Vol. 6/2018 (11-15)

Malignant renal epithelioid angiomyolipoma with TFE3 gene amplification mimicking renal carcinoma

Haili Wang¹, Haiyu Zhan¹, Zhigang Yao², and Qingwei Liu¹

¹Department of Radiology and ²Department of Pathology, Provincial Hospital, Affiliated to Shandong University, Shandong Province, China
Malignant renal epithelioid angiomyolipoma (EAML) is an extremely rare disease with a poor prognosis, and currently there are no uniform criteria for its biological behavior. Here, we present a case of malignant renal EAML with TFE3 gene amplification in a 53-year-old woman. Four months after surgery, unenhanced computed tomography scans showed recurrence as well as metastasis in the abdomen and lung. The patient succumbed to rapid neoplastic progression of the disease 6 months later.Correspondence to:
Dr. Qingwei Liu, Department of Radiology, Provincial Hospital, Affiliated to Shandong University, Jingwu Road 324#, Jinan City, Shandong Province 250021, China
Email: [email protected]

Abstract

Clinical Nephrology, Vol. 91 – No. 3/2019 – Letter to the editor

Renal cell carcinoma associated with Xp11.2 translocations/TFE3 gene fusion: Report of 5 cases and literature review

Haili Wang¹, Haiyan Jing², Zhixin Cao², and Qingwei Liu¹

¹Department of Radiology and ²Department of Pathology, Shandong Provincial Hospital affiliated to Shandong University, Jinan City, Shandong Province, China
Correspondence to:
Dr. Qingwei Liu
Department of Radiology, Shandong Provincial Hospital
affiliated to Shandong University
Jingwu Road 324#
Jinan City, Shandong Province 250021, China
Email: [email protected]

Abstract

Clinical Nephrology, Vol. 91 – No. 3/2019 (155-161)

Changes in primary glomerulonephritis in Singapore over four decades 

Keng-Thye Woo¹, Choong-Meng Chan¹, Cynthia Lim¹, Jason Choo¹, Yoke Mooi Chin¹, Wei Ling Teng¹, Alwin H.L. Loh³, Hui-Lin Choong¹, Han-Kim Tan¹, Kok-Seng Wong¹, Grace S.L. Lee¹, Evan J.C. Lee², Stephanie Fook-Chong⁴, Puay Hoon Tan¹, and Marjorie Foo¹

¹Department of Renal Medicine, Singapore General Hospital,  ²Department of Nephrology, National University of Singapore,  ³Department of Pathology, Singapore General Hospital, and  ⁴Department of Clinical Research, Singapore General Hospital, Singapore
This review of 3,289 native kidney biopsies over the past four decades in Singapore documents the changing pattern of biopsy-proven glomerulonephritis (GN)from that of a third world country to that of a developed nation. In the 1^st decade, mesangial proliferative GN was the most common form of primary GN, similar to the Asian region. In the 2^nd decade, the percentage of mesangial proliferative GN decreased, but membranous GN became more common, as was seen in China and Thailand. In the 3^rd decade, focal segmental glomerulosclerosis (FSGS) and membranous nephropathy continued to rise, but it was only recently, in the 4^th decade, that FSGS prevalence increased dramatically, although membranous nephropathy continues to increase in some Asian countries. In the last decade in Singapore, Malaysia, and Japan, prevalence of IgA nephritis has decreased but remains the most common GN. The percentage of FSGS continues to increase in many countries like in Italy, United States of America, United Kingdom, China, and Malaysia. We surmise that socioeconomic factors play significant roles in the evolution of the renal biopsy pattern. Correspondence to:
Prof. Keng-Thye Woo, FRACP,
Department of Renal Medicine
Singapore General Hospital
Outram Road,  Singapore 169608
Email: woo.keng.thye@ sgh.com.sg

Abstract

Clinical Nephrology, Vol. 92 – No. 6/2019 (312-318)

Suspension precipitation: A simple sediment-collecting method for microbiological culturing in diagnosis of peritonitis 

Peiyi Ye¹*, Huizhen Ye¹*, Li Zhang¹, Cuiyan Yu¹, Zijie Liang¹, Zhe Zhang¹, Wei Li¹, Kuihai Wu², and Yaozhong Kong¹

¹Department of Nephrology and ²Medical Laboratory, The First People’s Foshan Hospital, Foshan, Guangdong, China
Background: Rapid and accurate microbiological detection is crucial for effective treatment of peritonitis patients with peritoneal dialysis (PD). Although centrifugation of dialysis effluents can increase the pathogen culture-positive rate, a lack of both centrifugation facilities and experienced staff has prevented its widespread implementation, particularly in basic-level hospitals in developing countries. Thus, we developed a simple peritoneal sediment-collecting method, suspension precipitation method, for microbiological diagnosis of peritonitis.
Materials and methods: In the suspension precipitation method, drained effluent bags from individual patients were hung for 1 hour to allow the suspension to drip to the bottom layer of the bag for sediment collection. Sediments obtained by centrifugation from the same batch of dialysis effluent were used as positive controls. Both sediment sample types were then cultured in blood-culture bottles. Subsequent analysis of the pathogen-positive detection rate and species comparison between the two methods were undertaken.
Results: Among 90 PD patients, the pathogen positive-detection rate between methods was comparable, as demonstrated by 75 (83.33%) with the suspension precipitation method and 77 (85.56%) by the centrifugation method. Their positive pathogen species were also similar, and the concordance rate was 97.78%.
Conclusion: The suspension precipitation method is a simple, convenient, and reliable peritoneal sediment-collecting method that is suitable for a wide array of uses, particularly in basic-level hospitals without centrifugation technology.

*Peiyi Ye and Huizhen Ye contributed equally to this work.Correspondence to:
 Dr. Yaozhong Kong
 81# North of Lingnan Road, Foshan City
Guangdong Province, 528000, China
Email: [email protected]

Abstract

International Journal of Clinical Pharmacology and Therapeutics, Vol. 58 – No. 11/2020 (664-674)

A simplified and sensitive LC-APCI-MS/MS method for the quantification of propofol: Application to a bioequivalence study in healthy Chinese subjects 

Ling Tang¹#³, KeLi Wang³, Chun Peng¹#³, XuanWei Li²#³, Le Li²#³, Yan Wang¹,and Li Ding²#³

¹College of Pharmacy and Chemistry, Dali University, Dali, ²Department of Pharmaceutical Analysis, China Pharmaceutical University, and ³Nanjing Clinical Tech Laboratories Inc., Nanjing, China
Objectives: Propofol has become the preferred anesthetic in recent years due to its desirable pharmacologic properties. However, propofol possesses a very narrow therapeutic window between the favorable clinical effect and potentially lethal toxicity, therefore, a rapid, simplified, and sensitive liquid chromatography-atmospheric pressure chemical ionization tandem mass spectrometry (LC-APCI-MS/MS) method is presented in this study for the quantification of propofol in human plasma using the isotope-labeled internal standard (IS) of propofol-d17, and then applied in a bioequivalence study.
Materials and methods: Sample preparation was accomplished through simple one-step precipitation of plasma protein with acetonitrile. Chromatographic separation was acquired on an ACE Excel 3 Super C₁₈ column (2.1 × 50 mm, 3 µm) using gradient elution at a flow rate of 0.5 mL/min. The MS detection was achieved in the negative ion APCI by multiple reaction monitoring (MRM) mode using the transitions of m/z 177.2 → 161.0 for propofol and m/z 194.2 → 174.2 for IS, respectively. 30 healthy Chinese subjects were enrolled in the open-label, randomized, two-period, two-sequence, cross-over bioequivalence study after single-dose intravenous administration of propofol medium-chain triglyceride and long-chain triglyceride (MCT/LCT).
Results: The current method was precise and accurate at a linearity range of 4.00 – 1,000 ng/mL without severe interference from the plasma matrix. The inter- and intra-batch precision (2.3 to 15.8%) and accuracy (–4.4 to 3.0%), IS-normalized matrix effect (coefficient of variation ≤ 4.6%), extraction recovery (107.1 – 117.1%), stability (coefficient of variation ≤ 8.0%), and dilution integrity were all within the acceptable range. The 90% confidence intervals (CIs) of the ratios of the geometric means (test/reference) were 86.44 – 104.88% for C_max, 96.30 – 104.52% for AUC_0–t, and 96.56 – 105.05% for AUC_0–∞, which were all within the predefined bioequivalence range of 80 – 125%. Besides, both propofol MCT/LCT preparations were well tolerated in healthy Chinese subjects, and there were no serious adverse events during the study.
Conclusion: The method is more simplified and sensitive than the previously reported modes of propofol detection. The two propofol MCT/LCT preparations were considered to be bioequivalent.Correspondence to:
 Yan Wang, MD, PhD 
College of Pharmacy and Chemistry,  Dali University
Dali, 671000, China
Email: [email protected]

Abstract

Clinical Nephrology, Vol. 95 – No. 5/2021 (256-272)

Evolution of IgA nephropathy in Singapore over four decades and a comparison of two cohorts from the first and fourth decade 

Keng Thye Woo¹, Choong Meng Chan¹, Marjorie Foo¹, Cynthia Lim¹, Jason Choo¹, Yok Mooi Chin¹, Esther Wei Ling Teng¹, Permeen A. Mohamed Yusoff⁴, Irene Mok¹, Jia Liang Kwek¹, Hui Zhuan Tan¹, Alwin H.L. Loh³, Hui Lin Choong¹, Han Khim Tan¹, Kok Seng Wong¹, Grace S.L. Lee¹, Evan Lee², Puay Hoon Tan², and Chieh Suai Tan¹

¹Department of Renal Medicine, Singapore General Hospital, ²Department of Renal Medicine, National University of Singapore, ³Division of Pathology, Singapore General Hospital, ⁴Research Office, Singapore General Hospital, Singapore
Objective: In this study, we trace the changes in the clinical and histological pattern of IgA nephritis (IgAN) in Singapore as it has evolved over 4 decades and compare the clinical, demographic, histological, and renal outcome of patients with IgAN from the 1^st decade and the 4^th decade.
Materials and methods: This is a retrospective study of all histologically proven IgAN diagnosed between 1976 and 2018. Clinical, laboratory, and histological characteristics between the 1^st and the 4^th decade, including treatment which could influence the disease progression and renal outcome of these two groups, were compared. We used the Oxford classification to compare the renal biopsy changes for these 2 decades as we were able to retrieve 125 renal biopsy tissues for the 1^st cohort of IgAN studied in the 1970s for the comparative study.
Results: The commonest clinical presentation throughout the first 3 decades was asymptomatic hematuria and proteinuria (63, 52, and 49%, respectively). In the 4^th decade, nephrotic syndrome (31%) was the commonest followed by asymptomatic hematuria and proteinuria (30%), hypertension (21%), and chronic renal failure (11%). The data showed that treatment can modify the Oxford MEST – Crescent scores. Renin-angiotensin system (RAS) blockers modified the S scores, immunosuppressants modified the T and C scores, and combination therapy with RAS blockers and immunosuppressants modified the E, S, and T scores.
Conclusion: The Oxford MEST classification offers a robust and expressive classification for early and late disease progression with respect to the development of end-stage renal disease (ESRD). E and S seem to be indices of continuing disease activity with progressive glomerulosclerosis, probably still amenable to therapy, but T was a predictive indicator for those destined for ESRD and no longer amenable to therapy.Correspondence to:
Prof. Keng-Thye Woo
Department of Renal Medicine
Singapore General Hospital
Outram Road, 169608 Singapore
Email: woo.keng.thye@ sgh.com.sg

Abstract

Clinical Nephrology, Vol. 95 – No. 6/2021 (312-322)

The therapeutic effect of plasma exchange on ANCA-associated vasculitis: A meta-analysis 

Yan Zhu¹#², Jinlan Rao¹, Liu Liu¹, Jihong Ou², Wei Li¹, and Chao Xue¹

¹Department of Nephrology, The Second Affiliated Hospital of The Guangxi Medical University, Nanning, and ²Department of Nephrology, The First Affiliated Hospital of University of South China, Hengyang, China
Aims: The therapeutic effect of plasma exchange (PLEX) combined with conventional treatment in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) remains controversial.
Materials and methods: We searched PubMed, Embase, Cochrane Library, and China National Knowledge Infrastructure for randomized controlled trials (RCTs) and cohort studies that compared PLEX added to conventional therapy with conventional therapy only in active AAV.
Results: 19 studies were included for the meta-analysis. Compared with the conventional therapy group, the PLEX group had a significantly reduced risk of end-stage renal disease (ESRD) at 3 months (odds ratio (OR) = 0.32, 95% confidence interval (CI) = 0.16 – 0.66, p = 0.002, I² = 0%), and the ANCA titerwas also decreased (OR = 40.99, 95% Cl = 23.56 – 58.43, p < 0.00001, I² = 42%). The plasma and non-plasma exchange groups had no substantial differences in terms of short- and long-term outcomes, including all-cause mortality, ESRD risk at 12 months and 5 years, remission rate, serum creatine levels, or serious adverse events.
Conclusion: PLEX therapy was not associated with favorable long-term outcomes, although the results showed benefits in the incidence of ESRD rate at 3 months and ANCA titers in patients with AAV. No advantage of PLEX added to conventional therapy on mortality and complete remission was observed in patients with diffuse alveolar hemorrhage. Further high-quality multicenter RCTs with a high number of participants are required to assess the potential efficacy of PLEX in active AAV.Correspondence to:
Dr. Chao Xue 
Department of Nephrology
The Second Affiliated Hospital of
 The Guangxi Medical University
Nanning, China
Email: [email protected]

Abstract

International Journal of Clinical Pharmacology and Therapeutics, Vol. 60 – No. 3/2022 (146-158)

Association between ABCB1 C3435T polymorphism and antiepileptic drug resistance in epilepsy: An updated meta-analysis based on 62 studies 

Yue-Yue Chen¹, Yu-yi Feng², Yin-Nan Chen¹, Yun-Ming Cao¹, Chun-zhi Ai³, Cai-Li Bi¹, Yong Liu², and Wei Li¹#⁴#⁵

¹Translational Medicine Research Institute, College of Medicine, Yangzhou University, Yangzhou, ²School of Life and Pharmaceutical Sciences, Dalian University of Technology, Panjin, ³State Key Laboratory for the Chemistry and Molecular Engineering of Medicinal Resources, School of Chemistry and Pharmaceutical Sciences, Guangxi Normal University, Guilin, ⁴Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, and ⁵Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, College of Veterinary Medicine, Yangzhou University, Yangzhou, China
Objective: Previous clinical studies and meta-analyses have shown controversial results on the association between C3435T polymorphism of the ABCB1 gene and anti-epileptic drug (AED) resistance. Based on the fact that sample size and confounding factors could contribute to the inconsistency, we performed an updated meta-analysis by including the most recent studies, and subgroup analysis was conducted to evaluate the effect of confounding factors on the association. Materials and methods: We searched articles in 6 electronic databases including PubMed, Medline, Embase, Web of science, Cochrane Library, CNKI (China National Knowledge Infrastructure) for relevant articles up to June 2020.
Results: The current analysis showed that the C allele of C3435T variant was a risk factor for drug resistance in the overall populations (C allele vs. T allele, OR: 1.13; 95% CI: 1.02 – 1.25; p = 0.02) and in the Caucasians (C allele vs. T allele, OR: 1.09; 95% CI: 1.09 – 1.43; p = 0.002), while no association was observed in Asians and Indians. Particularly, our study reported for the first time that the 3435T allele was more common in epilepsy patients with drug resistance in the Tunisian population (C allele vs. T allele, OR: 0.31; 95% CI: 0.15 – 0.65; p = 0.002). In addition, our present analysis suggested an association between C3435T and AED resistance in cryptogenic, symptomatic, but not in idiopathic patients. Subgroup studies based on age and gender showed no association.
Conclusion: AED resistance in Caucasian and Tunisian populations may benefit from ABCB1 C3435T genotyping. We recommend that more details, such as gender and etiology of epilepsy, should be taken into account to draw a reliable conclusion in future studies.Correspondence to:
Wei Li, PhD
Translational Medicine Research Institute
College of Medicine, Yangzhou University
Yangzhou 225001, China
Email: [email protected]

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