Clinical Trials Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 16, 2022; 10(32): 11766-11774
Published online Nov 16, 2022. doi: 10.12998/wjcc.v10.i32.11766
Endothelial injury and inflammation in patients with hyperuricemic nephropathy at chronic kidney disease stages 1-2 and 3-4
Li Xu, Li-Li Lu, Ya-Ting Wang, Jia-Bao Zhou, Chuan-Xu Wang, Jia-Dong Xin, Jian-Dong Gao
Li Xu, Li-Li Lu, Ya-Ting Wang, Jia-Bao Zhou, Chuan-Xu Wang, Jia-Dong Xin, Jian-Dong Gao, Department of Nephrology, Shuguang Hospital Affiliated to the Shanghai University of Traditional Chinese Medicine, TCM Institute of Kidney Disease, Shanghai University of Traditional Chinese Medicine, Key Laboratory of Liver and Kidney Diseases (Shanghai University of Traditional Chinese Medicine), Ministry of Education, Shanghai Key Laboratory of Traditional Chinese Clinical Medicine, Shanghai 201203, China
Author contributions: Xu L, Lu LL, Wang YT, Zhou JB, Wang CX, Xin JD, and Gao JD contributed to the conception, acquisition, and interpretation of the data; Xu L is responsible for writing the manuscript, data analysis, and document retrieval; Gao JD is responsible for expert input and supervision; All authors reviewed and agreed to the final version of the manuscript.
Supported by National Natural Science Foundation of China, No. 8187150391 and No. 81904126; Science and Technology Commission of Shanghai Municipality, No. 20Y21901800.
Institutional review board statement: The study was reviewed and approved by the Shuguang Hospital affiliated with Shanghai University of TCM Institutional Review Board (Approval No. 2021-942-17-01).
Clinical trial registration statement: This study is registered at http://www.chictr.org.cn/index.aspx. The registration identification number is ChiCTR2100049048.
Informed consent statement: Informed written consent was obtained from the patient and her family for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at jiandong.gao@shutcm.edu.cn.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian-Dong Gao, PhD, Professor, Department of Nephrology, Shuguang Hospital Affiliated to the Shanghai University of Traditional Chinese Medicine, TCM Institute of Kidney Disease, Shanghai University of Traditional Chinese Medicine, Key Laboratory of Liver and Kidney Diseases (Shanghai University of Traditional Chinese Medicine), Ministry of Education, Shanghai Key Laboratory of Traditional Chinese Clinical Medicine, No. 528 Road Zhangheng, Shanghai 201203, China. jiandong.gao@shutcm.edu.cn
Received: August 7, 2022
Peer-review started: August 7, 2022
First decision: September 5, 2022
Revised: September 15, 2022
Accepted: October 17, 2022
Article in press: October 17, 2022
Published online: November 16, 2022
Processing time: 93 Days and 5.5 Hours
ARTICLE HIGHLIGHTS
Research background

Chronic kidney disease (CKD) has been threatening people’s lives. Without any intervention, CKD can progress to end-stage renal disease. Previously, researchers focus more on diabetic nephropathy, however there are no reports about hyperuricemic nephropathy (HN) patients. It is important to figure out the pathological difference between patients with HN in early stage and middle and late stage with CKD.

Research motivation

As reported, there are currently lots of classic and new biomarkers of endothelial injury and inflammation which can be tested in the blood and urine samples of CKD patients.

Research objectives

Through testing biomarkers, we have a clear idea of the difference in endothelial injury and inflammation between patients with HN in CKD 1-2 and CKD 3-4.

Research methods

This study is a baseline data of randomized double-blinded controlled trial. During patients’ first care visit, general information and urine and plasma samples were collected. Enzyme-linked immunosorbnent assay were used to detect endothelial injury and inflammation biomarkers including plasma heparan sulfate, plasma endocan, plasma oxidized low-density lipoprotein (Ox-LDL), plasma E-selectin, plasma soluble intercellular adhesion molecule-1 (slCAM1), urinary Lipocalin-type prostaglandin D synthase (L-PGDS), plasma interleukin (IL)-1β, plasma IL-6, urinary IL-1β, and urinary IL-6 levels.

Research results

Comparison between patients with HN at CKD 1-2 and those with HN at CKD 3-4 showed that age and disease course were significant factors (P < 0.001 and P < 0.010, respectively). There were no statistical differences in sex, heart rate, body mass index, and systolic and diastolic blood pressures. The incidence of hypertension was also significant (P = 0.03). Plasma levels of heparin sulfate (P < 0.001), endocan (P = 0.034), E-selectin (P < 0.001), slCAM1 (P < 0.001), IL-1β (P = 0.006), and IL-6 (P = 0.004) and the urine levels of L-PGDS (P < 0.001), IL-1β (P = 0.003), and IL-6 (P < 0.001) were high in patients with HN at CKD 3-4 than in those with HN at CKD 1-2. The difference in plasma Ox-LDL levels was not significant (P = 0.078).

Research conclusions

Vascular endothelial injury and inflammatory state of patients with HN in CKD 3-4 were higher than those of patients in CKD 1-2. Plasma heparin sulfate and plasma slCAM1 levels are synergistic risk factors for CKD staging in HN.

Research perspectives

We now concluded that levels of biomarkers endothelial injury and inflammation are significantly different between patients with HN in CKD 1-2 and CKD 3-4. In the future assessment, heathy subjects, and HN patients in CKD 5 should also be involved.