Background Diagnostic status of chronic kidney disease (CKD) and its underlying reasons provide evidence to improve the CKD management. However, situation in developing countries remains under-investigated. Methods Adults with electronic health records (EHRs)(2008-2019) in Yinzhou, China were included. Gold standard for CKD was defined as having persistently reduced estimated glomerular filtration rate (eGFR), albuminuria/proteinuria, hematuria, or a history of CKD. CKD stages(G1-G5) were defined by eGFR. Clinical diagnosis of CKD in real-world was evaluated using international classification of diseases-10(ICD-10) codes related to primary cause or stages of CKD. The specialty of doctors who administered the serum creatinine(SCr) tests and who made the primary-cause/CKD-staging diagnoses was analyzed. Accuracy of CKD-staging codes was assessed. Results Altogether 85,519 CKD patients were identified from 976,409 individuals with EHRs. Of them, 10,287(12.0%) having persistently urinary abnormalities did not received SCr tests within 12 months before or after the urine tests. Among 75,147 patients received SCr tests, 46,150(61.4%) missed any CKD-related codes, 6,857(35.7%) were merely labelled with primary-cause codes, and only 2,140(2.9%) were labelled with CKD-staging codes. The majority of CKD patients(51.6%-91.1%) received SCr tests from non-nephrologists whereas CKD-staging diagnoses were mainly from nephrologists(52.3%-64.8%). Only 3 of 42 general hospitals had nephrologists. The CKD-staging codes had high specificity(>99.0%) but low sensitivity(G3-G4: <10.0%). Conclusions Under-perception of CKD among doctors, instead of unsatisfied health-seeking behavior or low detection rates, was the main cause of under-diagnosis of CKD in China. Intensification of CKD education among doctors with different specialties might bring about immediate effectiveness on improving the diagnosis and awareness of CKD.

BackgroundRadix puerariae (RP) is a herbal medicines for diabetes, mainly because of anti-oxidative, insulin resistance and hypoglycemic effect. Fructus crataegi (FC) also possesses strong antioxidant activity in vitro. This study focused on the effects of herbal mixture of RP and FC (RPFC) on renal protection through a diabetic rat model.MethodsType 2 Diabetic model was established with high fat diet followed by injecting rats a low dose of STZ (25 mg/kg body weight). Rats were randomly divided into five groups: normal, high fat diet, diabetes mellitus, high fat diet plus RPFC prevention, and RPFC prevention before diabetes mellitus. RPFC was given to rats daily by intragastric gavage. The blood bio-chemical index and renal pathological changes were examined. The later includes hematoxylin and eosin staining, periodic acid schiff staining, and Masson trichrome staining. Protein levels of were determined by Western blot and immunohistochemical staining. mRNA levels were detected by RT-PCR.ResultsRats prevented with RPFC resulted in decreasing blood glucose with corresponding vehicle treated rats. Glomerulus mesangial matrix expansion, renal capsule constriction, and renal tubular epithelial cell edema were less severe following RPFC prevention. Moreover, RPFC prevention reduced protein levels of PI3K, AKT, α-SMA and collagen IV in the kidney of diabetic rats.ConclusionCombined prevention with RPFC may inhibit the PI3K/AKT pathway in the kidney, thereby prevent renal injury in diabetic rats.

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Two new ent-kaurane diterpenoids, dayecrystals D-E (1-2), together with nine known compounds, isojaponin A (3), rabdosin A (4), lushanrubescensin J (5), wikstroemioidin B (6), maoyecrystal C (7), rabdosin B (8), isodonal (9), shikokianin (10), and effusanin A (11), were isolated from the leaves of Isodon macrophyllus. The structures of the new compounds were elucidated using 1D and 2D NMR spectroscopy. The (13)C-NMR spectral data of compound 4 are reported for the first time. All of the compounds were tested for their cytotoxicities against DU145 and LoVo human tumor cells. Compounds 4, 10, and 11 showed inhibitory effects on DU145 cells with IC(50) values 5.90, 4.24, and 3.16 microM, and LoVo cells with IC(50) values 14.20, 17.55, and 3.02 microM, respectively.