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Zhao Y, Liu L, Zuo L, Zhou X, Wang S, Gao H, Yu F, Zhang X, Wang M, Chen L, Zhang R, Zhang F, Bi S, Bai Q, Ding J, Yang Q, Xin S, Chai S, Chen M, Zhang J. A Novel Risk Score Model for the Differential Diagnosis of Type 2 Diabetic Nephropathy: A Multicenter Study. J Diabetes Res 2023; 2023:5514767. [PMID: 38155834 PMCID: PMC10754636 DOI: 10.1155/2023/5514767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/20/2023] [Accepted: 12/09/2023] [Indexed: 12/30/2023] Open
Abstract
Introduction DN is a common complication of diabetes. However, diabetes combined with renal injury may involve DN or NDKD, with different treatment schemes. The purpose of our study was to determine the independent risk factors of DN and establish a risk score model to help differentiate DN and NDKD, providing a reference for clinical treatment. Methods A total of 678 T2D patients who had undergone renal biopsy in four affiliated hospitals of Peking University were consecutively enrolled. Patients were assigned to the DN group and NDKD group according to histopathological results. Seventy percent of patients from PKUFH were randomly assigned to the training group, and the remaining 30% were assigned to the internal validation group. Patients from the other three centers were assigned to the external validation group. We used univariate and multivariate logistic regression analyses to identify independent risk factors of DN in the training group and conducted multivariate logistic regression analysis with these independent risk factors in the training group to find regression coefficients "β" to establish a risk score model. Finally, we conducted internal and external validation of the model with ROC curves. Results Diabetic retinopathy, diabetes duration ≥ 5 years, eGFR < 30 ml/min/1.73 m2, 24 h UTP ≥ 3 g, and no hematuria were independent risk factors (P < 0.05), and each factor scored 2, 1, 1, 1, and 1. We assigned the patients to a low-risk group (0-1 points), a medium-risk group (2-3 points), and a high-risk group (4-6 points), representing unlikely DN, possibly DN, and a high probability of DN, respectively. The AUCs were 0.860, 0.924, and 0.855 for the training, internal validation, and external validation groups, respectively. Conclusion The risk score model could help differentiate DN and NDKD in a noninvasive manner, reduce the number of renal biopsies, and provide a reference for clinical treatment.
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Affiliation(s)
- Yuetong Zhao
- Department of Endocrinology, Peking University First Hospital, Beijing, China
- Department of Clinical Nutrition, Peking University First Hospital, Beijing, China
| | - Lin Liu
- Department of Endocrinology, Peking University First Hospital, Beijing, China
| | - Li Zuo
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Xianghai Zhou
- Department of Endocrinology, Peking University People's Hospital, Beijing, China
| | - Song Wang
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - Hongwei Gao
- Department of Endocrinology, Peking University Third Hospital, Beijing, China
| | - Feng Yu
- Department of Nephrology, Peking University International Hospital, Beijing, China
| | - Xiaomei Zhang
- Department of Endocrinology, Peking University International Hospital, Beijing, China
| | - Mi Wang
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Ling Chen
- Department of Endocrinology, Peking University People's Hospital, Beijing, China
| | - Rui Zhang
- Department of Endocrinology, Peking University People's Hospital, Beijing, China
| | - Fang Zhang
- Department of Endocrinology, Peking University People's Hospital, Beijing, China
| | - Shuhong Bi
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - Qiong Bai
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - Jiaxiang Ding
- Department of Nephrology, Peking University International Hospital, Beijing, China
| | - Qinghua Yang
- Department of Nephrology, Peking University International Hospital, Beijing, China
| | - Sixu Xin
- Department of Endocrinology, Peking University International Hospital, Beijing, China
| | - Sanbao Chai
- Department of Endocrinology, Peking University International Hospital, Beijing, China
| | - Min Chen
- Department of Nephrology, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
| | - Junqing Zhang
- Department of Endocrinology, Peking University First Hospital, Beijing, China
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Mao X, Xu DQ, Yue SJ, Fu RJ, Zhang S, Tang YP. Potential Medicinal Value of Rhein for Diabetic Kidney Disease. Chin J Integr Med 2023; 29:951-960. [PMID: 36607584 DOI: 10.1007/s11655-022-3591-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 01/07/2023]
Abstract
Diabetic kidney disease (DKD) is the primary cause of mortality among diabetic patients. With the increasing prevalence of diabetes, it has become a major concern around the world. The therapeutic effect of clinical use of drugs is far from expected, and therapy choices to slow the progression of DKD remain restricted. Therefore, research on new drugs and treatments for DKD has been a hot topic in the medical field. It has been found that rhein has the potential to target the pathogenesis of DKD and has a wide range of pharmacological effects on DKD, such as anti-nephritis, decreasing blood glucose, controlling blood lipids and renal protection. In recent years, the medical value of rhein in the treatment of diabetes, DKD and renal disease has gradually attracted worldwide attention, especially its potential in the treatment of DKD. Currently, DKD can only be treated with medications from a single symptom and are accompanied by adverse effects, while rhein improves DKD with a multi-pathway and multi-target approach. Therefore, this paper reviews the therapeutic effects of rhein on DKD, and proposes solutions to the limitations of rhein itself, in order to provide valuable references for the clinical application of rhein in DKD and the development of new drugs.
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Affiliation(s)
- Xi Mao
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, Shaanxi University of Chinese Medicine, Xi'an, 712046, China
| | - Ding-Qiao Xu
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, Shaanxi University of Chinese Medicine, Xi'an, 712046, China
| | - Shi-Jun Yue
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, Shaanxi University of Chinese Medicine, Xi'an, 712046, China
| | - Rui-Jia Fu
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, Shaanxi University of Chinese Medicine, Xi'an, 712046, China
| | - Sai Zhang
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, Shaanxi University of Chinese Medicine, Xi'an, 712046, China
| | - Yu-Ping Tang
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, Shaanxi University of Chinese Medicine, Xi'an, 712046, China.
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Lekskulchai V. Use of Estimated Glomerular Filtration Rate and Urine Albumin-to-Creatinine Ratio Based on KDIGO 2012 Guideline in a Thai Community Hospital: Prevalence of Chronic Kidney Disease and its Risk Factors. Med Sci Monit Basic Res 2022; 28:e938176. [PMID: 36542497 PMCID: PMC9745955 DOI: 10.12659/msmbr.938176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Kidney disease is hard to detect at its early stage; therefore, the Kidney Disease: Improving Global Outcomes (KDIGO) 2012 guideline was developed for improving care and outcomes of patients with kidney disease. This study aimed to determine clinical outcomes from applying this guideline in a community hospital service. MATERIAL AND METHODS The patients' data were extracted from their medical records and analyzed for outcomes of using the estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (UACR) for detecting kidney disease. RESULTS The eGFR was utilized in 36 172 patients aged ≥18 years, and 76.86% of them had normal kidney function. The prevalence of chronic kidney disease (CKD) was 8.20%; most patients (68%) with CKD were in stages 3a and 3b. The most common causes of CKD were diabetes and hypertension. The UACR was mainly used in patients with diabetes. The percentage of patients with UACR ≥3 mg/mmol creatinine alone was significantly higher than that of patients with eGFR.
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Zhang R, Chen J, Xiong Y, Wang L, Huang X, Sun T, Zha B, Wu Y, Yan C, Zang S, Zhou Q, Huang Z, Liu J. Increased neutrophil count Is associated with the development of chronic kidney disease in patients with diabetes. J Diabetes 2022; 14:442-454. [PMID: 35789114 PMCID: PMC9310049 DOI: 10.1111/1753-0407.13292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/31/2022] [Accepted: 06/13/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND This study aims to investigate the potential association of peripheral inflammatory blood cell parameters with the incidence and progression of chronic kidney disease (CKD) in patients with diabetes. METHODS The cross-sectional study included 1192 subjects with diabetes derived from one center. The cohort study included 2060 subjects with diabetes derived from another two centers followed up for 4 years. Logistic regression and Cox proportional hazards models were used to evaluate the association of peripheral inflammatory blood cell with CKD. RESULTS In the cross-sectional study, neutrophil count performed best as an independent risk factor for CKD (odds ratio 2.556 [95% confidence interval 1.111, 5.879]) even after 1:1 case-control matching for age, gender, history of high blood pressure and duration of diabetes. Spline regression revealed a significant linear association of CKD incidence with continuous neutrophil count in excess of 3.6 × 109 /L. In the cohort study, subjects were grouped based on tertile of neutrophil count and neutrophil-to-lymphocyte ratio. Cox regression analysis results showed that only neutrophil count was independently associated with CKD progression (the highest group vs. the lowest group, hazard ratio 2.293 [95% confidence interval 1.260, 4.171]) after fully adjusting for potential confounders. The cumulative incidence of CKD progression in patients with diabetes gradually increased with increasing neutrophil count (53 (7.7%) subjects in the lowest group vs. 60 (8.2%) in the middle group vs. 78 (12.2%) in the highest group). CONCLUSIONS This study suggested that neutrophil count is an independent risk factor for progression of CKD in patients with diabetes.
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Affiliation(s)
- Rui Zhang
- Department of EndocrinologyShanghai Fifth People's Hospital, Fudan UniversityShanghaiChina
| | - Jin Chen
- MaQiao Community Health Service CenterShanghaiChina
| | - Yanqin Xiong
- Gumei Community Health Service CenterShanghaiChina
| | - Lihong Wang
- Department of EndocrinologyShanghai Fifth People's Hospital, Fudan UniversityShanghaiChina
| | - Xinmei Huang
- Department of EndocrinologyShanghai Fifth People's Hospital, Fudan UniversityShanghaiChina
| | - Tiange Sun
- Department of EndocrinologyShanghai Fifth People's Hospital, Fudan UniversityShanghaiChina
| | - Bingbing Zha
- Department of EndocrinologyShanghai Fifth People's Hospital, Fudan UniversityShanghaiChina
| | - Yueyue Wu
- Department of EndocrinologyShanghai Fifth People's Hospital, Fudan UniversityShanghaiChina
| | - Cuili Yan
- Department of EndocrinologyShanghai Fifth People's Hospital, Fudan UniversityShanghaiChina
| | - Shufei Zang
- Department of EndocrinologyShanghai Fifth People's Hospital, Fudan UniversityShanghaiChina
| | - Qin Zhou
- Kidney Disease Center, the First Affiliated Hospital, College of MedicineZhejiang UniversityHangzhouChina
- Key Laboratory of Disease Prevention and Control TechnologyHangzhouChina
- National Key Clinical Department of Kidney DiseaseHangzhouChina
- Institute of NephrologyZhejiang UniversityHangzhouChina
- The Third Grade Laboratory under the National State, Administration of Traditional Chinese MedicineHangzhouChina
| | - Zhe Huang
- Department of Genetics and Developmental ScienceSchool of Life Sciences and Biotechnology, Shanghai Jiao Tong UniversityShanghaiChina
| | - Jun Liu
- Department of EndocrinologyShanghai Fifth People's Hospital, Fudan UniversityShanghaiChina
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Fu T, Mohan M, Brennan EP, Woodman OL, Godson C, Kantharidis P, Ritchie RH, Qin CX. Therapeutic Potential of Lipoxin A 4 in Chronic Inflammation: Focus on Cardiometabolic Disease. ACS Pharmacol Transl Sci 2020; 3:43-55. [PMID: 32259087 DOI: 10.1021/acsptsci.9b00097] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Indexed: 02/07/2023]
Abstract
Several studies have shown that failure to resolve inflammation may contribute to the progression of many chronic inflammatory disorders. It has been suggested targeting the resolution of inflammation might be a novel therapeutic approach for chronic inflammatory diseases, including inflammatory bowel disease, diabetic complications, and cardiometabolic disease. Lipoxins [LXs] are a class of endogenously generated mediators that promote the resolution of inflammation. Biological actions of LXs include inhibition of neutrophil infiltration, promotion of macrophage polarization, increase of macrophage efferocytosis, and restoration of tissue homeostasis. Recently, several studies have demonstrated that LXs and synthetic analogues protect tissues from acute and chronic inflammation. The mechanism includes down-regulation of pro-inflammatory cytokines and chemokines (e.g., interleukin-1β and tumor necrosis factor-α), inhibition of the activation of the master pro-inflammatory pathway (e.g., nuclear factor κ-light-chain-enhancer of activated B cells pathway) and increased release of the pro-resolving cytokines (e.g., interleukin-10). Three generations of LXs analogues are well described in the literature, and more recently a fourth generation has been generated that appears to show enhanced potency. In this review, we will briefly discuss the potential therapeutic opportunity provided by lipoxin A4 as a novel approach to treat chronic inflammatory disorders, focusing on cardiometabolic disease and the current drug development in this area.
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Affiliation(s)
- Ting Fu
- Heart Failure Pharmacology, Baker Heart and Diabetes Institute, Melbourne, Victoria 3004, Australia.,Department of Pharmacology and Therapeutics, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Muthukumar Mohan
- Department of Diabetes, Central Clinical School, Monash University, Clayton, Victoria 3800, Australia
| | - Eoin P Brennan
- UCD Diabetes Complications Research Centre, UCD Conway Institute, UCD School of Medicine, University College Dublin, Dublin, 4, Ireland
| | - Owen L Woodman
- Heart Failure Pharmacology, Baker Heart and Diabetes Institute, Melbourne, Victoria 3004, Australia
| | - Catherine Godson
- UCD Diabetes Complications Research Centre, UCD Conway Institute, UCD School of Medicine, University College Dublin, Dublin, 4, Ireland
| | - Phillip Kantharidis
- Department of Diabetes, Central Clinical School, Monash University, Clayton, Victoria 3800, Australia
| | - Rebecca H Ritchie
- Department of Diabetes, Central Clinical School, Monash University, Clayton, Victoria 3800, Australia.,Heart Failure Pharmacology, Baker Heart and Diabetes Institute, Melbourne, Victoria 3004, Australia.,Department of Pharmacology and Therapeutics, University of Melbourne, Parkville, Victoria 3010, Australia.,Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria 3052, Australia
| | - Cheng Xue Qin
- Heart Failure Pharmacology, Baker Heart and Diabetes Institute, Melbourne, Victoria 3004, Australia.,Department of Pharmacology and Therapeutics, University of Melbourne, Parkville, Victoria 3010, Australia.,Department of Diabetes, Central Clinical School, Monash University, Clayton, Victoria 3800, Australia
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