Clinical And Empirical Study Of Nutcracker Syndrome And Renal Lesion

Section one Clinical and pathological analysis of glomerular nephritis complicated by patients with nutcracker syndromeObjective:To investigate mutual relationship between nutcracker syndrome and glomerular disease of patients with manifestation of hematuria and/or proteinuria. Methods:To analysis clinical and pathological data of 39 patients with nutcracker syndrome complicating glomerular nephritis,including 17 hematuria patients,4 proteinuria patients and 18 hematuria complicating proteinuria patients.All patients accepted ultrasonic examination by Doppler's method. Urine routine,red blood cell count and phase observation of urinary sediment were examined ante- and post-exercise. 24 hours urinary protein and albumin quantitation were detected,urinary complement 3,lysozyme,retinol binding protein,protein electrophoresis were tested postexercise. Among them,30 patients accepted renal needle biopsy.Results:All patients were diagnosised as nutcracker syndrome. Some patients urinary routine examination were normal or had homogenicity hematuria ,microalbuminuria ante-exercise. All had hematuria and/or proteinuria of different degree postexercise,most of them aggravated after exercise. Renal biopsy of 30 patients manifestated multiformity and had no relevance with urinary examination results. All patients were made a definite diagnosis through clinical,laboratory examination and renal biopsy to be glomerular nephritis complicated by nutcracker syndrome. Conclusions:Nut cracker phenomenon could coexist with glomerular disease. Nutcracker syndrome patients with manifestation of hematuria and/or priteinuria should be noted whether coexisted with delitescence glomerular nephritis or not. in order to avoid affecting patient's condition adversely,renal needle biopsy should be carried out when needed.Section Two Rats model established for studying congestive damage of renal tissue caused by left renal vein constrictionObjective:To observe the left renal lesions in rats caused by left renal vein constriction of several degree,to provide suitable animal model for studying congestive damage of renal tissue caused by left renal vein compression.Methods: The rat model of left renal vein constriction was established by left renal vein partial deligation operation.SD rats were randomly devided into 4 groups,sham-operation group,left renal vein stenosis 1.0mm model group,0.7mm model group,and 0.5mm model group. All animals were killed at the end of the 7th week. Urine routine,red blood cell phase of urinary sediment,24 hours urinary protein quantitation,urinary complement 3 quantitation,lysozyme quantitation,retinol binding protein quantitation , protein electrophoresis were were all examined. Nephridial tissue was detected pathological changes. Renal cortex was homogenated to detect content of malonaldehyde (MDA) and activity of superoxide dismutase (SOD).Results:Urinary protein excretion increased in 3 model group,and its amplitude increased along with the degree of stegnosis. Urinary red blood cell phase were all homogenicity. Urinary protein electrophoresis showed that the major zone was low molecule protein,proportion of albumin increased along with the degree of stegnosis. Model groups showed nephridial tissue pathological damage of glomerular mesangial region hyperplasia and tubule,interstitium cell infiltration and fibrosis,more stegnosis,more severe.Left renal cortex MDA content elevated,SOD activity reduced significantly in 3 model groups compared to those in sham-operation group,and its amplitude increased along with the degree of stegnosis.Conclusions:When stegnosis at 0.7mm,all observation datas of left renal vein constriction rats appeared to approach the clinical status of nutcracker syndrome patients mostly,while stegnosis at 1.0mm and 0.5mm appeared slight and severe relatively. It seemed that 0.7mm model group would be the most suitable rat model for studying congestive damage of renal tissue caused by left renal vein constriction.Section Three Effect of operation on congestive damage of renal tissue in left renal vein constriction ratsObjective:To explore the curative effect of renal tissue fibrosis and peroxidative condition with operation on left renal vein constriction rats,thus to provide the experimental basis for clinical treating left renal vein entrapment syndrome by operation.Methods:SD rats were randomly devided into 4 groups,sham-operation group,7 weeks model group,12 weeks model group,and operation treating group.The rat model of left renal vein constriction was established by left renal vein partial deligation operation.Rats in treating group were disengage from deligation by operation at the end of the 7th week. After 5 weeks of the second operation,all animals were killed. Urine was collected for 24 hours urinary protein quantitation. Nephridial tissue was detected pathological changes. Renal cortex was homogenated to detect content of malonaldehyde (MDA) and activity of superoxide dismutase (SOD).The expression level of PAI-1,TGF-β1 mRNA and protein was detected by RT-PCR and immunohistochemical method.Results:Urinary protein excretion increased,left renal cortex MDA content elevated,SOD activity reduced significantly and the expression of PAI-1 and TGF-β1 mRNA increased in two model groups compared to those in sham-operation group. Model groups showed nephridial tissue pathological damage.Between two groups,changes in 12 weeks model group were more predominance than 7 week model group. Treating by operation could improve SOD activity,decrease MDA content and decrease the expression of PAI-1 and TGF-β1 mRNA,lessen pathological damage.Conclusions:Left renal vein constriction rats appeared pathological damage and tissue fibrosis. generation of oxygen free radical increased,and ability of anti oxidisity decreased,promoting fibrosis factors as TGF-β1 and PAI-1 expression level appeared up-regulation. Renal lesions aggravated when stegnosis longer. Operation could lighten pathological damage and tissue fibrosis,and improve peroxidative condition.Section Four Effect of salvia miltiorrhiza on congestive damage of renal tissue in left renal vein constriction ratsObjective:To explore the curative effect of renal peroxidative damage and fibrosis with Salvia Miltiorrhiza on left renal vein constriction rats to provide the experimental basis for the clinical therapy with drug of nutcracker syndrome.Methods:SD rats were randomly devided into 4 groups,sham-operation group,model group,salvia miltiorrhiza treating group and operation treating group.The rat model of left renal vein constriction was established by left renal vein partial deligation operation.After 7 weeks,rats in salvia miltiorrhiza treating group begain to be intervened by salvia miltiorrhiza. Rats in treating group were disengage from deligation by operation at the same time. All animals were killed at the end of the 12th week. Urine was collected for 24 hours urinary protein quantitation. Nephridial tissue was detected pathological changes. Renal cortex was homogenated to detect content of malonaldehyde (MDA) and activity of superoxide dismutase (SOD) . The expression level of PAI-1,TGF-β1 mRNA and protein was detected by RT-PCR and immunohistochemical method.Results:Urinary protein excretion increased,left renal cortex MDA content elevated,SOD activity reduced significantly and the expression of PAI-1 and TGF-β1 mRNA increased in model group compared to those in sham-operation group. Model groups showed nephridial tissue pathological damage. Both treating with salvia miltiorrhiza and by operation could improve SOD activity,decrease MDA content and decrease the expression of PAI-1 and TGF-β1 mRNA , lessen pathological damage.Between two groups,curative effects of operation treating group were more predominance than salvia miltiorrhiza treating group.Conclusions:Generation of oxygen free radical in left renal vein constriction rats increased,ability of anti oxidisity decreased,promoting fibrosis factors as TGF-β1 and PAI-1 expression level up-regulated and renal tissue fibrosis increased.Salvia miltiorrhiza has protective effect on left renal vein constriction rats,through blocking the oxygen free radical generation,elevating the ability of anti-oxidisity and decreasing tissue fibrosis. Although the curative effects of salvia miltiorrhiza treating group were not as fine as operation treating group,treating with salvia miltiorrhiza was still a suitable choice.