Background/Aim: CD4+CD25+ regulatory T (Treg) cells are of critical importance for maintenance of tolerance. We showed that the number of CD4+CD25+ Treg cells was significantly lower in tonsils of patients with IgA nephropathy (IgAN); however, the function of tonsillar CD4+CD25+ Treg cells in IgAN has not been reported. The aim of this study was to investigate the effect of tonsillar CD4+CD25+ Treg cells of IgAN patients on experimental IgAN in rats. Methods: Tonsillar CD4+CD25+ Treg cells were isolated by magnetic beads. A total of 2 × 106 CD4+CD25+ Treg cells were transferred into rats that were previously orally immunized over a period of 14 weeks and subsequently received an injection of BSA into the tail vein on 3 consecutive days. Urine protein and erythrocytes were measured. Glomerular injury was assessed by histopathology. Plasminogen activator inhibitor type 1 (PAI-1), interleukin (IL)-6 and transforming growth factor (TGF)-β1 in mesangial cells of rats were examined by reverse transcription PCR. Serum IgA and C3 and supernatants of IL-2, IL-4 and IL-6 in splenic cells were analysed by ELISA. Transferred tonsillar CD4+CD25+ Treg cells were tracked by reverse transcription PCR and flow cytometry. Results: IgA deposition in the mesangial region and the glomerular planar area and the number of cells, levels of serum IgA and supernatant IL-2, IL-4 and IL-6 in splenic cells and PAI-1, IL-6 and TGF-β1 expression in renal mesangial cells of rats that received CD4+CD25+ Treg cells from IgAN patients were significantly higher than in rats that received CD4+CD25+ Treg cells from the control group, although they were dramatically lower compared with rats treated without CD4+CD25+ Treg cells. Transferred tonsillar CD4+CD25+ Treg cells migrated predominantly to secondary lymphoid organs but not to the kidneys. Conclusion: Dysfunction of tonsillar CD4+CD25+ Treg cells may be an important cause of IgAN progression.

Background: Patients undergoing hemodialysis experience inflammation, which is associated with a higher risk of mortality. The lymphocyte-to-C reactive protein ratio (LCR) is a novel marker of inflammation that has been shown to predict mortality in patients with malignant cancer. However, the utility of LCR has not been evaluated in patients undergoing hemodialysis.Methods: We performed a multi-center cohort study of 3,856 patients who underwent hemodialysis as part of the Beijing Hemodialysis Quality Control and Improvement Project between 1 January 2012 and December 2019. The relationship between LCR and all-cause mortality was assessed using a restricted cubic spline model and a multivariate Cox regression model. An outcome-oriented method was used to determine the most appropriate cut-off value of LCR. Subgroup analysis was also performed to evaluate the relationships of LCR with key parameters.Results: Of the 3,856 enrolled patients, 1,581 (41%) were female, and their median age was 62 (53, 73) years. Over a median follow-up period of 75.1 months, 1,129 deaths occurred. The mortality rate for the patients after 60 months was 38.1% (95% confidence interval (CI) 36%–40.1%), resulting in a rate of 93.41 events per 1,000 patient-years. LCR showed an L-shaped dose-response relationship with all-cause mortality. The optimal cut-off point for LCR as a predictor of mortality in hemodialysis patients was 1513.1. An LCR of ≥1513.1 could independently predict mortality (hazard ratio 0.75, 95% CI 0.66–0.85, P<0.001).Conclusions: Baseline LCR was found to be an independent prognostic biomarker in patients undergoing hemodialysis. Implying that it should be a useful means of improving patient prognosis and judging the timing of appropriate interventions in routine clinical practice.

This study aimed to re-evaluate the prognostic value of inflammation and nutrition-related indices in a large multicenter cohort of hemodialysis patients from 138 dialysis centers in Beijing. This retrospective cohort study included 6,679 hemodialysis patients. Indices were calculated from routine laboratory parameters. Survival analyses included Kaplan-Meier curves and multivariate Cox models. C-index, receiver operating characteristic curves and decision curve analysis were used to evaluate the predictive ability of the different indicators. All indicators (including Prognostic Nutritional Index [PNI], Lymphocyte-to-CRP Ratio [LCR], CRP-to-Albumin Ratio [CAR], Systemic Immune-Inflammation Index [SII], Platelet-to-Lymphocyte Ratio [PLR], and Neutrophil-to-Lymphocyte Ratio [NLR]) except for PLR were identified as independent predictors of OS (overall survival). Among these indicators, the PNI consistently demonstrated superior discriminatory ability in predicting outcomes among hemodialysis patients. Multivariate Cox regression analysis showed that the risk of mortality in hemodialysis decreased with an increase in PNI (adjusted HR 0.78, 95% CI: 0.75–0.82, P < 0.01). The optimal cut-off value for PNI was determined to be 42.3. PNI has demonstrated better reliability as a prognostic indicator for hemodialysis patients compared with LCR, CAR, SII, PLR and NLR. The efficient assessment of PNI effectively identifies high-risk individuals and highlights its significance as a valuable prognostic tool in clinical settings.

Aim: The purpose of the present study was to detect bacterial strains and antibiotic susceptibility in chronic tonsillitis patients with IgA nephropathy (IgAN) and without nephritis, in order to provide evidence for clinical therapy and pathogenesis of IgAN. Methods: A total of 53 patients with IgAN (group A) and 53 chronic tonsillitis patients without nephritis (group B) underwent tonsillectomy. The tonsil tissues of patients were collected under sterile condition. The bacteria in the tonsil crypt of patients in both groups were isolated and identified for antibiotic susceptibility test by the manual routine of the laboratory and also with the autoScan/Microscan system. Results: There were bacteria in each specimen in both groups. The bacteria detection rate was 100%, but there was no significant difference between two groups (p > 0.05). The 522 strains of bacteria in group A and 494 strains of bacteria in group B were isolated. Streptococcus. Neisseria, Hemophilus parainfluenzae. Staphylococcus. Bacillus proteus and Streptococcus pneumoniae were detected in both groups, but there was no significant difference in the types of bacteria between the two groups (all p > 0.05). Alpha streptococcus was the most common in both groups. The antibiotic susceptibility test showed that there was no significant difference in the susceptibility to penicillin, chloramphenicol, macrolides, cephalosporin, gentamicin, amikacin sulphate, norfloxacin, ciprofloxacin, rifampicin and vancomycin between two groups (all p > 0.05). Conclusions: Alpha streptococcus in both two groups can be detected and is the most common. There was no significant difference in bacterial strains and antibiotic susceptibility between two groups.

CD4⁺CD25⁺T cells are critical for maintenance of immunologic self-tolerance. We measured the number of CD4⁺CD25⁺cells in the patients with primary malignant hypertension related kidney injury, to explore the molecular pathogenesis of this disease. We selected 30 patients with primary malignant hypertension related kidney injury and 30 healthy volunteers. Information on clinical characteristics and laboratory tests was obtained from each subject. The number of CD4⁺CD25⁺cells and glomerular injury were assessed by flow cytometry and histopathology, respectively. Both serum IL-2, IL-4, and IL-6 and endothelial cell markers were analyzed by ELISA. ADAMTS13 antibody was detected by Western blotting. CD4⁺CD25⁺cells were significantly reduced in patients with primary malignant hypertension related kidney injury compared to controls (P < 0.05). The number of CD4⁺CD25⁺cells was negatively related to blood urea nitrogen, serum uric acid, proteinuria, and supernatant IL-4; whereas positively associated with estimated glomerular filtration rate in patients. Gradually decreasing CD4⁺CD25⁺cells were also found as increasing renal injury. Additionally, patients exhibited increasing supernatant IL-4, serum IL-2 and IL-6, endothelial cell markers, and anti-ADAMTS13 antibody compared with controls (allP < 0.05). CD4⁺CD25⁺cells may play a key role in the pathogenesis of primary malignant hypertension related kidney injury.