Urinary ACE2 could be used as a non-invasive marker to understand the role of renal ACE2 in CKD.

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Background: Angiotensin-converting enzyme (ACE)2 forms angiotensin-1–7 which may protect kidney in a counterregulatory manner to angiotensin II. Recent studies revealed increased ACE and decreased ACE2 expression in kidneys of patients with diabetic nephropathy. However, these changes may not be specific for diabetic nephropathy. We studied ACE and ACE2 expression in patients with IgA nephropathy. Methods: Renal ACE and ACE2 expression was assessed by immunohistochemistry and in situ hybridization in 30 patients with IgA nephropathy and 21 healthy controls. Correlation between ACE and ACE2 expression and levels of various biochemical parameters was also assessed. Gene expression was also assessed in minimal change nephrotic syndrome (MCNS) and membranous nephropathy (MN) as disease controls. Results: Reduced ACE2 expression (p < 0.01) and increased ACE expression in glomeruli (p < 0.001), and reduced ACE2 expression in tubulointerstitium (p < 0.001) were observed in patients with IgA nephropathy compared to healthy controls, although the changes in ACE2 mRNA were not statistically significant. Reduced renal ACE2 expression was also found in MN but not in MCNS. Correlation between renal ACE and ACE2 expression and proteinuria was not observed in IgA nephropathy. Conclusion: IgA nephropathy is associated with increased ACE and decreased ACE2 expression in kidneys, as in diabetic nephropathy.

This study of the relationship between nocturnal scratching and sleep is based on an analysis of 17 overnight polygraphic records of the scratch bouts and EEG of severely itchy patients. Our patients spent little time in deep orthodox sleep (stages 3 and 4), which was absent from 7 of the 17 records. Bouts of scratching were found to occur in all stages of sleep but were most numerous in stage 1 (light orthodox sleep). Sleep tended to remain stable, i.e. in a single sleep stage, for the 40 s immediately before a bout of scratching but had often changed to a more superficial stage by the time the bout had ceased, implying perhaps that scratching itself was the event linked most closely with arousal.

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