In recent years, ultrasound-guided percutaneous transluminal angioplasty (PTA) has been widely used for the treatment of stenotic or occlusive lesions in hemodialysis vascular access. However, there is currently a dearth of clinical guidelines or expert consensus for this technology. Therefore, it becomes an urgent problem in the field of hemodialysis vascular access how to further standardize the clinical procedures of ultrasound-guided PTA to ensure its efficacy and safety in clinical diagnosis and treatment. For this purpose, Chinese consensus expert group on ultrasound interventional therapy for hemodialysis vascular access has formulated this "Expert consensus on ultrasound interventional therapy for hemodialysis vascular access in China (2024)". The present consensus encompasses several key aspects, including preoperative assessment, ultrasound diagnostic procedures, interventional treatment standards, surgical operating procedures, and strategies for managing complications. It aims to provide practical guidance for clinicians to improve treatment outcomes, mitigate the risk of complications, and enhance patients' quality of life. The promotion of this consensus is expected to facilitate the standardized application and popularization of ultrasound interventional techniques in the treatment of arteriovenous dialysis access.

Rituximab (RTX) is a human mouse chimeric monoclonal antibody that acts on CD20 molecules on the surface of B cells. Currently, its application in the treatment of immune glomerular diseases is becoming increasingly widespread. However, there are still many problems in the application of RTX by clinical physicians. In response to this, we organized multiple rounds of discussions and revisions among national nephrologists on the 50 clinical issues that everyone is most concerned about and formed this article. The content covers the scope of application, evidence-based evidence, therapeutic regimen, drug usage methods and precautions, medication for special populations, and drug safety of rituximab in the treatment of membranous nephropathy, minimal change nephropathy, antineutrophil cytoplasmic antibody (ANCA) associated vasculitis and other immune glomerular diseases. In particular, specific answers are provided to typical questions raised by clinical doctors, aiming to provide practical guidance and reference for the broader clinicians.

IgA nephropathy is the most common primary glomerular disease globally, with the highest incidence in the Asian region, and has a high risk of progressing to end-stage renal disease even in patients with low proteinuria. The treatment paradigm for IgA nephropathy has undergone significant changes. Treatment should aim to reduce pathogenic IgA and IgA immune complex formation, including intestinal mucosal B cell immune modulators such as budesonide enteric-coated capsules, targeted APRIL and BAFF agents, and B cell depletors; it should also manage glomerular inflammation, including corticosteroids, mycophenolate mofetil, hydroxychloroquine, and targeting complement therapy; and it should manage general responses to nephron loss, including lifestyle interventions, renin-angiotensin system inhibitors, sodium-glucose cotransporter-2 inhibitors, and endothelin receptor antagonists. This article provides a comprehensive overview of the treatment paradigm and drug advancements for IgA nephropathy, aiming to provide more rational treatment options for IgA nephropathy patients and improve their outcomes.

Autogenous arteriovenous fistula (AVF) is the preferred vascular access of hemodialysis in maintenance hemodialysis patients. However, due to the influence of various factors, new AVF may show immaturity, which will affect the use and dialysis effect of vascular access. AVF maturation is an important clinical concern. It is important to clarify the physiological and biochemical factors, and biological mechanisms of AVF immaturation. Based on the literature, this review focuses on the biological mechanisms of AVF maturation and the physiological and biochemical factors affecting AVF maturation, including vascular conditions, gender and age, and underlying diseases, to provide reference for improving the clinical maturation rate of AVF and the treatment effect in hemodialysis patients.

Chronic kidney disease-associated pruritus (CKD?aP) is a common complication in patients with end-stage renal disease, which strongly reduces the quality of life. The pathogenesis of CKD?aP is complex, with unclear etiology, and there is no recognized treatment method. This paper reviews the research progress of the pathogenesis of CKD?aP, including the hypotheses of toxin deposition, peripheral neuropathy, immune and inflammatory system disorder, and opioid receptor imbalance, and the treatment of CKD?aP, including adequate dialysis, local skin medication, systemic medication, nutrition, ultraviolet B, and acupuncture.

In recent years, rituximab has been gradually used in the treatment of idiopathic membranous nephropathy (IMN). Compared with traditional treatments, the safety and effectiveness of rituximab in the treatment of IMN have been confirmed, which induces remission in 60%-80% of patients. For the remaining 20%-40% patients, several mechanisms can explain rituximab resistance: decreased rituximab bioavailability; internalized by targeted B cells; the generation of anti-rituximab antibody; chronic and irreversible damage to the glomerular filtration barrier; autoreactive B-cell clones in secondary lymphoid organs that cannot be effectively eliminated. The treatment of patients with rituximab-refractory IMN remains controversial and challenging. The recognition of IMN as an antibody-mediated autoimmune disease has rationalized the use of immunosuppressive drugs such as B cell-targeted therapies, plasma cell-targeted therapies, and complement inhibitors. This review mainly summarizes recent advances in the understanding of the physiological mechanisms of rituximab resistance, and in the management of rituximab-refractory IMN, aiming to aid in the clinical management of IMN.

Common complications related to nutritional metabolism and somatic function in chronic kidney disease patients include protein-energy wasting, sarcopenia, and frailty. These three complications are different and closely related. This article reviews recent research progress on the definitions, epidemiology, diagnosis and evaluation, underlying causes, intervention measures and their differences and connections of chronic kidney disease in conjunction with protein-energy wasting, sarcopenia and frailty, to help clinicians identify them and personalize interventions.

The identification of pathogenic antigens in membranous nephropathy (MN) is a hot topic in the research field of kidney diseases. In recent years, the widespread application of mass spectrometry has brought a breakthrough in the identification of MN-pathogenic antigens. As the antigen spectrum continues to be refined, the diagnosis of MN has evolved from morphological level to molecular level. This article reviewed the research progress of currently identified antigens of MN, such as phospholipase A2 receptor (a major pathogenic antigen of primary MN), thrombospondin type 1 domain-containing 7A (a potential tumor-associated antigen), neural epidermal growth factor-like protein 1 (an antigen associated with various secondary factors), semaphorin 3B (an antigen specific to pediatric MN) and so on, and the pathogenic mechanisms and clinical significance of these antigens.

Objective To explore the clinical feature and genetic variation of NPHS1 variant-associated nephropathy (NPHS1-VAN) in Chinese patients. Methods This study was a case-series analysis. Patients with NPHS1-VAN, who were treated and/or followed in the Department of Pediatrics, Nanfang Hospital, Southern Medical University between 2018 and 2023 were recruited into this study. Genotype, phenotype and their relationship were analyzed. Results Nine NPHS1-VAN patients from 8 non-consanguineous Chinese families were collected, including 5 males and 4 females. There were 7 cases with an onset age within 3 months and 2 cases with an onset age of 6 months and 13 years, respectively. Seven patients harbored compound heterozygous variants, two had homozygous variants, including 8 missense variations,3 frameshift variants, and 1 splicing site variant. Four patients in 3 families harbored missense variant c.928G>A, two of them experienced spontaneous remission of proteinuria at the age of 1 year and 2 years, respectively, another one had persistent proteinuria and entered end stage renal disease (ESRD) at 11 years old. The other one had an onset age of 6 months with no response to steroids initially. She got complete remission by tacrolimus administered, but relapse frequently and partially responded to steroids later. Two patients of this group died, one of them died of respiratory failure 3 days after birth. Excessive amniotic fluid and fetal edema were acknowledged at 28 weeks of gestational age. He harbored compound heterozygous variants of NPHS1, c.1135C>G (R379G) and c.1339G>A (E447K). His mother previously experienced fetal death at 28 weeks gestational age for her first pregnant and stillborn at 36 weeks of gestational age for her second pregnant, respectively. One patient in this study who harbored homozygous variant of c.1339G>A (E447K) presented with a mild phenotype, onset age was 13 years old and didn't progress to ESRD yet at 21 years. Thus, variant E447K was hypothesized to be weakly pathogenic, while R379G may be strongly pathogenic with a risk of death. Five novel variants were identified in this group of patients, 3 missense variants (c.1135C>G, c.1157A>T, c.3197T>A) and 2 frameshift variants (c.709_710delCT, c.3193delG). Renal biopsy was performed in 4 cases, of whom two were focal segmental glomerular sclerosis and another two were minimal change disease. Conclusions NPHS1-VAN possesses remarkable clinical and genetic heterogeneity. Five novel variants were identified. Missense variant is the most common variant type and c.928G>A is the most common one in this group of patients, in consistent with previous report in China. Children harbor c.928G>A may have a mild phenotype with possible spontaneous remission and may be response to steroids and calcineurin inhibitor. Variant c.1135C>G (R379G) may have a strong pathogenicity, and patient who harbors this variant may have a severe phenotype.

Chronic kidney disease (CKD) is one of the most important non-infectious chronic diseases in China, posting a serious threat to the health of older adults. Currently, there is still a lack of guidelines or consensus on the comprehensive management of CKD in older adults, particularly for primary care providers. Therefore, Chinese Society of Gerontology and Geriatrics collaborated with nephrology experts in China to develop a guideline specifically tailored for older CKD patients. This guideline clearly defines CKD in older adults, recommends using CKD Epidemiology Collaboration equation (CKD-EPI) combined serum creatinine-cystatin C (cr-cyst) formula to assess renal function in order to facilitate disease staging and stratified management in this population. It emphasizes the importance of a multidisciplinary team in the comprehensive assessment of the health status in older CKD patients. Regarding treatment strategies, the guideline advocates for first identifying the cause of CKD and then developing personalized precise treatment plans based on clinical and pathological diagnoses, as well as introduces the methods for rational medication use. In terms of patient management, the guideline suggests that older CKD patients should adopt healthy lifestyle and dietary habits, engage in regular physical activities, and receive standardized disease management. It also encourages the integration of traditional Chinese medicine for treatment based on syndrome differentiation in older CKD patients. Additionally, it provides recommendations on referrals and renal replacement therapy. The purpose of this guideline is to offer a comprehensive management strategy for older CKD patients to healthcare providers in primary medical institutions, aiming to enhance their overall management capabilities, postpone disease progression, and ultimately improve the quality of life for older adults in China.

Chronic kidney disease (CKD) is a significant global public health issue. In recent years, several new drugs have shown substantial efficacy in CKD treatment. Sodium-glucose cotransporter 2 inhibitors, nonsteroidal mineralocorticoid receptor antagonists, and glucagon-like peptide-1 receptor agonists improve renal outcomes in CKD patients through various mechanisms, and also demonstrate favorable effects on cardiovascular outcomes. Novel agents, including endothelin receptor antagonists, are accumulating clinical evidence for delaying kidney disease progression, with ongoing development of new therapeutic targets. This article reviewed the latest research progress of these drugs in CKD treatment, offering new perspectives and reference points for comprehensive CKD management.

Objective To investigate the efficacy and prognosis of rituximab (RTX) in the treatment of M-type phospholipase A2 receptor (PLA2R)-associated idiopathic membranous nephropathy (IMN). Methods It was a retrospective cohort study. The clinical data of PLA2R-associated IMN patients who received RTX treatment in the Shenzhen Second People's Hospital from September 2018 to March 2023 were collected. According to remission status of proteinuria, the patients were divided into proteinuria remission group (24-hour urinary protein quantity < 3.5 g) and non-proteinuria remission group (24-hour urinary protein quantity ≥ 3.5 g), and the clinical data between the two groups were compared. According to baseline 24-hour urinary protein quantity and estimated glomerular filtration rate (eGFR), the patients were divided into high-risk disease progression group [24-hour urinary protein quantity ≥ 8 g or eGFR < 60 ml·min^-1·(1.73 m²)^-1] and non-high-risk disease progression group [24-hour urinary protein quantity < 8 g or eGFR ≥ 60 ml·min^-1·(1.73 m²)^-1]. Kaplan?Meier survival curve was utilized to compare the differences of proteinuria remission rates and renal composite endpoint event survival rates between the two groups. Multivariate Cox regression analysis was utilized to identify the influencing factors of proteinuria remission and renal composite endpoint event. Results This study included 46 PLA2R-associated IMN patients, with 31 males (67.4%). The baseline eGFR was (78.4±34.1) ml·min^-1·(1.73 m²)^-1. The 24-hour urinary protein quantity was 8.33 (6.04, 12.85) g. After 14.95 (7.44, 22.15) months of follow-up, 29 patients (63.0%) achieved proteinuria remission, with remission time of 6.0 (5.0, 9.0) months. Six (20.7%) patients relapsed, with relapsed time of 17.25 (11.75, 18.28) months. CD20 in the proteinuria remission group was lower than that in the non-proteinuria remission group (Z=2.270, P=0.023). Eleven (23.9%) patients experienced renal composite endpoint events wtih occurrence time of 16.07 (7.87, 29.63) months. Kaplan-Meier survival curve analysis indicated that there was no statistically significant difference in proteinuria remission rates (log?rank χ²=0.26, P=0.612) and renal composite endpoint event survival rates (log?rank χ²=0.25, P=0.619) between baseline 24-hour urinary protein quantity ≥ 8 g and < 8 g groups. There was no statistically significant difference in proteinuria remission rates after RTX treatment (log?rank χ²=0.77, P=0.381) and renal composite endpoint event survival rates (log?rank χ²=1.41, P=0.236) between eGFR ≥ 60 ml·min^-1·(1.73 m²)^-1 and < 60 ml·min^-1·(1.73 m²)^-1 groups. Multivariate Cox regression analysis showed that hypertension history (HR=0.16, 95% CI 0.05-0.55), immunosuppressive therapy history (HR=0.08, 95% CI 0.01-0.50), baseline eGFR < 60 ml·min^-1·(1.73 m²)^-1 (HR=0.21, 95% CI 0.05-0.92), baseline PLA2R antibody titer ≥ 100 RU/ml (HR=0.20, 95% CI 0.06-0.69), long time between treatment and first diagnosis (HR=1.33, 95% CI 1.12-1.57), high baseline triglyceride (HR=1.46, 95% CI 1.02-2.08), and baseline 24-hour urinary protein quantity ≥ 8 g (HR=8.54, 95% CI 2.08-35.12) were independent influencing factors of proteinuria remission after RTX treatment. The baseline PLA2R antibody titer ≥ 100 RU/ml was an independent influencing factor of reaching the renal composite endpoint event (HR=7.31, 95% CI 1.23-43.62). Conclusions The proteinuria remission rate after RTX treatment of PLA2R-associated IMN is 63.0% and the recurrence rate is 20.7%. The incidence rate of renal composite endpoint event is 23.9%. The hypertension history, immunosuppressant medication history, baseline eGFR < 60 ml·min^-1·(1.73 m²)^-1, baseline PLA2R antibody titer ≥ 100 RU/ml, long time between treatment and first diagnosis, high baseline triglyceride, and baseline 24-hour urinary protein quantity ≥ 8 g are independent influencing factors of proteinuria remission, and baseline PLA2R antibody titer ≥ 100 RU/ml is an independent risk factor of renal poor prognosis in PLA2R-associated IMN patients.

Objective To explore the value of combined detection of urinary kidney injury markers in the diagnosis of early-stage diabetic kidney disease (DKD), and to provide evidence for early-stage DKD screening. Methods It was a retrospective study. The clinical data of patients with type 2 diabetes mellitus (T2DM) from the Second Affiliated Hospital of Hainan Medicine University from January 2022 to August 2023 were collected. According to urinary microalbumin/creatinine ratio (UACR), the patients were divided into three groups: isolated diabetes group (UACR < 30 mg/g), early-stage DKD group (30 mg/g ≤ UACR < 300 mg/g) and clinical DKD group (UACR ≥ 300 mg/g), and the differences of clinical data among three groups were compared. Glomerular injury markers urinary microalbumin, transferrin, immunoglobulin (Ig) and α2 macroglobulin, and renal tubule injury markers α1 microglobulin (α1?MG), β2 microglobulin (β2?MG), retinol-binding protein (RBP), N-acetyl-β-D-glucosidase (NAG), neutrophil gelatinase-associated lipid carrier protein (NGAL) were measured. Spearman correlation method was used to analyze the correlation between urinary kidney injury markers and clinical indicators. Multivariate logistic regression analysis method was used to analyze the risk factors of DKD occurrence (UACR > 300 mg/g). Receiver-operating characteristic curve was used to analyze the value of individual and combined detection of urinary renal injury markers in the diagnosis of early-stage DKD (30 mg/g ≤ UACR < 300 mg/g). Results A total of 116 T2DM patients were enrolled in this study, aged (61.99±12.56) years old (30 to 91 years old), with 79 males (68.1%). There were 44 (37.9%) isolated diabetes patients, 27 (23.3%) early-stage DKD patients, and 45 (38.8%) clinical DKD patients. Serum creatinine (Scr, H=34.183, P<0.001) and blood urea nitrogen (BUN, H=34.082, P<0.001) in clinical DKD group were higher than those in isolated diabetes group and early-stage DKD group. Spearman correlation analysis showed that glomerular injury markers urinary microalbumin, transferrin, Ig and α2 macroglobulin were positively correlated with Scr, BUN and UACR, and negatively correlated with estimated glomerular filtration rate and serum albumin (all P<0.05). Renal tubule injury markers urinary α1?MG, β2?MG, NAG, RBP, and NGAL were positively correlated with Scr, BUN and UACR, and negatively correlated with estimated glomerular filtration rate and serum albumin (all P<0.05). Multivariate logistic regression analysis indicated that systolic blood pressure ≥ 140 mmHg (OR=1.033, 95%CI 1.008-1.060, P=0.010), high urinary microalbumin (OR=1.018, 95%CI 1.007-1.030, P=0.001), high urinary RBP (OR=1.309, 95%CI 1.086-1.577, P=0.005), high urinary NGAL (OR=1.004, 95%CI 1.000-1.008, P=0.037), low serum albumin (OR=0.833, 95%CI 0.749-0.926, P=0.001) and low urinary Ig (OR=0.994, 95%CI 0.990-0.999, P=0.018) were independent influencing factors of DKD occurrence. Receiver-operating characteristic curve revealed that the area under the curve (AUC) was the largest for diagnosing early-stage DKD when urinary microalbumin was detected alone (AUC=0.976, 95%CI 0.955-0.997, P<0.001), with sensitivity and specificity of 95.6% and 90.1%, respectively. The combined detection of urinary microalbumin + Ig + transferrin + α2 macroglobulin + α1-MG + β2-MG + NAG + RBP + NGAL had an AUC of 0.986 (95%CI 0.971-1.000, P<0.001), with sensitivity and specificity of 93.3% and 98.5%, respectively, which was better than each single index. Further optimized detection combination was urinary microalbumin combined with β2-MG and NGAL, which had the best diagnostic efficacy (AUC=0.978, 95%CI 0.958-0.999, P<0.001), with sensitivity and specificity of 95.6% and 93.0%, respectively. Conclusions Compared with the single detection of each index, the combined detection of urinary glomerular injury and renal tubule injury markers has higher value in diagnosing early-stage DKD. The combined detection of urinary microalbumin combined with β2-MG and NGAL has the highest value in diagnosing early-stage DKD.

The peritoneal equilibration test is primarily used to assess peritoneal function, guide the prescription of peritoneal dialysis, and determine the prognosis of peritoneal dialysis patients. This article overviews the peritoneal equilibration testing methods, peritoneal transport function classification, peritoneal membrane dysfunction, and their clinical significance. It also examines the factors that may influence the results of the peritoneal equilibration test and the precautions to be taken when applying it in clinical practice.

Kidney is a highly energy-demanding organ rich in mitochondria. Numerous studies have indicated that mitochondria play a crucial role in maintaining normal kidney function and in the pathogenesis of various kidney diseases. Mitochondrial DNA is the exclusive genome of mitochondria. Damage to mtDNA not only leads to mitochondrial dysfunction and degradation of mitochondrial quality, but also acts as an endogenous inflammatory molecule, activating various inflammatory pathways, which contribute to cellular damage and the progression of kidney diseases. This article reviews the mechanisms of mitochondrial DNA damage and its significant role in triggering inflammatory injury in kidney diseases. Additionally, it summarizes the current research progress on various intervention strategies targeting this type of damage.

Polycystic kidney disease (PKD) is a hereditary kidney disease characterized by the formation of numerous cysts in the kidneys, which progressively impairs renal function over time. PKD is primarily divided into two types: autosomal dominant polycystic kidney disease (ADPKD) and autosomal recessive polycystic kidney disease (ARPKD), with ADPKD being more prevalent. Current treatments primarily focus on symptom relief and disease progression delay, lacking a curative approach. However, the development of gene editing technologies such as clustered regularly interspaced short palindromic repeats (CRISPR) and CRISPR-associated protein 9 (CRISPR-Cas9) and adeno-associated virus (AAV) vectors has offered new therapeutic possibilities for ADPKD and ARPKD. These include approaches like antisense oligonucleotides (ASO), adenovirus-mediated gene knockdown, CRISPR- Cas9, Pkd1 gene enhancement therapy, and the use of induced pluripotent stem cells (iPSCs), which have shown potential efficacy in animal models and early clinical studies. Despite facing technological challenges, ethical and legal issues, and high costs, gene therapy presents an unprecedented hope for PKD treatment. Future interdisciplinary collaboration and international cooperation are essential for developing more effective treatment strategies for PKD patients.

Objective To investigate the correlation between complement C3 and urine protein level and proteinuria remission status in patients with primary membranous nephropathy (PMN), and better guide individualized clinical treatment. Methods It was a single-center retrospective study. The clinical data of PMN patients who underwent renal biopsy in the First Affiliated Hospital of Nanjing Medical University from January 2017 to June 2022 were collected. Patients with 24 h urinary protein ≥ 3.5 g were followed up after receiving standard treatment, and the last outpatient or inpatient review was used as the end point of follow-up. 24 h urine protein was collected to evaluate the remission status of proteinuria. Kaplan-Meier method was used to analyze the correlation between serum and renal complements and proteinuria remission. Cox regression analysis method was used to analyze the correlation between serum C3 level and renal tissue C3 deposition and proteinuria remission. Results This study included 507 PMN patients with 312 (61.54%) males, aged 54 (43, 64) years old. Compared with 24 h urinary protein < 3.5 g group, proportion of males (χ²=22.479, P<0.001), age (Z=-2.521, P=0.012), systolic blood pressure (Z=-4.148, P<0.001), diastolic blood pressure (Z=-4.084, P<0.001), serum anti-phospholipase A2 receptor (PLA2R) antibody titer (Z=-7.019, P<0.001), total cholesterol (Z=-8.796, P<0.001), triglyceride (Z=-6.158, P<0.001), low density lipoprotein cholesterol (Z=-8.716, P<0.001), serum creatinine (Z=-7.368, P<0.001), serum C3 (Z=-3.663, P<0.001), serum C4 (Z=-6.560, P<0.001), proportion of glucocorticoid use (χ²=116.417, P<0.001) and proportion of immunosuppressant use (χ²=53.839, P<0.001) were all higher, while serum albumin (Z=12.518, P<0.001), estimated glomerular filtration rate (Z=6.345, P<0.001) and serum IgG (Z=7.321, P<0.001) were all lower in 24 h urinary protein ≥3.5 g group. There were 268 patients included in the follow-up cohort with baseline 24 h urinary protein of 7.15 (5.14, 10.24) g, serum anti-PLA2R antibody titer of 61.44 (14.35, 193.24) RU/ml, serum C3 of 1.005 (0.864, 1.150) g/L, and serum C4 of 0.260 (0.214, 0.317) g/L. Kaplan-Meier survival curve showed that the incomplete remission rate of proteinuria in serum C3 > 1.005 g/L group was lower than that in serum C3 ≤ 1.005 g/L group (log-rank χ²=4.757, P=0.029). There was no significant difference in the incomplete remission rate of proteinuria between serum C4 ≤ 0.260 g/L group and serum C4 > 0.260 g/L group (log-rank χ²=3.543, P=0.060). Renal C1q (log-rank χ²=0.167, P=0.683) and C4 (log-rank χ²=1.927, P=0.165) deposition had no significant effects on proteinuria remission in PMN patients. The incomplete remission rate of proteinuria in patients with renal C3 deposition was higher than that in patients without renal C3 deposition (log-rank χ²=7.018, P=0.008). Univariate Cox regression analysis showed that serum C3 level and C3 deposition in renal tissues were influencing factors of incomplete remission of proteinuria (both P<0.05), while adjusting for gender, age, mean arterial pressure, serum anti-PLA2R antibody, serum albumin and 24 h urinary protein, serum C3 ≤ 1.005 g/L (HR=1.374, 95% CI 1.021-1.849, P=0.036), C3 deposition in renal tissues (HR=1.949, 95% CI 1.098-3.460, P=0.023), and serum C3 ≤ 1.005 g/L combined with C3 deposition in renal tissues (HR=1.472, 95% CI 1.093-1.983, P=0.011) were independent influencing factors of incomplete remission of proteinuria. Conclusions The serum C3 level and C3 deposition in renal tissues are closely related to urinary protein level and proteinuria remission status in PMN patients. The patients with higher urinary protein have higher serum C3. For patients with massive proteinuria, serum C3 ≤ 1.005 g/L, C3 deposition in renal tissues, serum C3 ≤ 1.005 g/L combined with C3 deposition in renal tissues are independent risk factors of incomplete remission of proteinuria.

Objective To explore the relationship between hemoglobin variability (Hb?var) and risk of all-cause death and cardiovascular death in patients with peritoneal dialysis (PD), and to provide basis for reducing the risk of death in PD patients. Methods It was a multicenter retrospective cohort study. The clinical data of regular PD patients from Nanfang Hospital of Southern Medical University, Shunde Hospital of Southern Medical University, Foshan First People's Hospital and Ganzhou People's Hospital from July 1, 2008 to December 31, 2019 were collected. Hb?var was calculated based on hemoglobin at baseline before PD and in the first year after PD. The patients were divided into low Hb?var group, moderate Hb?var group and high Hb?var group according to the tertiles of first year Hb?var, and the differences of baseline clinical data among three groups were compared. Follow-up endpoints included death, transfer to hemodialysis, transfer to kidney transplantation, transfer to other centers, loss of follow-up, or on December 31, 2021. Cox regression analysis model was used to analyze the association of the first-year Hb?var with all-cause death and cardiovascular death. Fine-Gray competitive risk regression model was used to evaluate the impact of competitive events on mortality risk. Results A total of 1 562 patients with PD were included in the study, aged (47.6±13.8) years old, with 821 males (52.6%) and baseline hemoglobin of 81 (69, 94) g/L. Hb?var in the first year of PD was 26.6 (16.7, 40.3) g/L. There were statistically significant differences in age, body mass index, serum albumin, hemoglobin, serum creatinine, serum calcium, serum phosphorus, intact parathyroid hormone and the proportion of renin-angiotensin system inhibitors among low Hb?var group (<20.0 g/L), moderate Hb?var group (20.0-35.5 g/L) and high Hb?var group (≥35.5 g/L, all P<0.05). The follow-up time was 33 (19, 51) months, and 208 patients (13.3%) died, among which 111 patients (53.4%) died of cardiovascular death. Multivariate Cox regression analysis showed that the higher Hb?var in the first year, the lower the risk of all-cause death (HR=0.98, 95%CI 0.97-0.99, P=0.018) and cardiovascular death (HR=0.98, 95%CI 0.97-0.99, P=0.041) in PD patients. Compared with low Hb?var group, the risk of all-cause death (HR=0.56, 95%CI 0.37-0.82, P=0.003) and cardiovascular death (HR=0.54, 95%CI 0.31-0.95, P=0.032) was lowest in the high Hb?var group. The competitive risk regression model analysis showed that Hb?var in the first year was still negatively correlated with the risk of all-cause death (HR=0.98, 95%CI 0.97-0.99, P=0.041) and cardiovascular death (HR=0.98, 95%CI 0.97-0.99, P=0.039). Conclusion High Hb?var in the first year is associated with low risk of all-cause death and cardiovascular death in PD patients with severe anemia at baseline.

Peritoneal dialysis is becoming the preferred dialysis mode for more and more patients with end-stage renal disease. However, the current peritoneal dialysis products cannot meet the ideal peritoneal dialysis treatment needs. Based on the analysis of the incoPat patent database, the Innovation Research Working Group of the China Kidney Innovation Association (CKIA) summarized the peritoneal dialysis patent applications of the past ten years from 46 representative medical institutions in the field of nephrology in 19 provinces and 4 municipalities in China. A total of 271 patents related to peritoneal dialysis were screened, mainly utility model patents (80.1%), and the top three needs included peritoneal dialysis manual fluid exchange, peritoneal dialysis catheter or peritoneal dialysis transfer set, drainage fluid disposal and sampling. The subdivision of patent was summarized, which fully reflects the urgent need to improve the effectiveness, safety and convenience of peritoneal dialysis treatment, improve the achievement ratio of peritoneal dialysis-related surgery and reduce complications, and improve the whole chain of peritoneal dialysis related products to enhance the quality of treatment and meet the personalized needs of patients. At the same time, the report shows that the new diagnosis and treatment methods involved in the patent application for peritoneal dialysis are seriously insufficient, and there is still a considerable gap with the cutting-edge scientific and technological level in the field of kidney. By condensing the technological innovation needs of the whole chain of peritoneal dialysis related products, the working group provides track for the future innovation and transformation of peritoneal dialysis treatment, in order to promote the progress of peritoneal dialysis technology in China.

Objective To explore the impact of intradialytic hypotension (IDH) on brain component volume, as well as its relationship with depression and cognitive function changes in maintenance hemodialysis patients. Method It was a cross-sectional observational study. Clinical data of 119 patients under maintenance hemodialysis in Peking Union Medical College Hospital from July 2013 to July 2014 were collected, retrospectively. Patients were divided into IDH group and non-IDH group. 3.0T Magnetic resonance imaging examination of the head for all patients was completed and the results of volume analysis of each component of the brain were extracted. Cognitive function was assessed by the Chinese version of the simplified mental state examination scale (C-MMSE) and the Chinese version of the Montreal cognitive assessment scale (C-MoCA). Depressive status was assessed by the Hamilton depression scale 17 (HAMD_17) and living ability was assessed by the Alzheimer's disease collaborative study-daily living ability assessment questionnaire. In addition, the Philadelphia word learning test was used to measure memory, the Boston naming test to measure language, the connection test A and B to measure executive ability, and the Stroup test C to measure attention. The differences in brain component volume, cognitive function, emotion, and life ability between two groups of patients were compared, and the correlation between IDH and brain component volume was explored by regression analysis. Result A total of 119 patients were included in this study, of whom 22 (18.5%) had hypotension during dialysis. The volumes of amygdala, cuneiform lobe, and posterior cingulate gyrus in IDH group were significantly smaller than those in the non-hypotension group [ (1.6±0.2) mm³ vs. (1.7±0.2) mm³, t=2.674, P=0.009; (6.9±0.8) mm³ vs. (7.4±1.0) mm³, t=2.187, P=0.031; (6.9±0.8) mm³vs. (7.4±0.9) mm³, t=2.252, P=0.024]. The differences of gray matter, white matter volume between the two groups showed a similar trend but did not reach statistical significance. And lacunar infarction and cerebral microbleeds were more common in IDH group. The daily living ability scores of the two groups were similar (65.51±11.52 vs. 65.71±11.53, Z=-0.456, P=0.648). The proportion of patients with cognitive abnormalities was higher in the IDH group, without statistical significance. The proportion of depression was similar. Univariate linear regression analysis showed that IDH was significantly negatively correlated with the volume of amygdala, cuneiform cortex, and posterior cingulate gyrus, which control emotions in the brain (B=-0.117, 95% CI -0.203--0.030, P=0.009; B=-0.484, 95% CI -0.923--0.046, P=0.031; B=-0.485, 95% CI -0.911--0.058, P=0.026). After multivariate adjustment, decreased amygdala volume was still correlated with IDH (B=-0.111, 95% CI -0.198--0.025, P=0.026). Conclusion Recurrent IDH may lead to atrophy of various brain components, which may be one of the reasons for cognitive and emotional changes in maintenance hemodialysis patients.

Objective To investigate the efficacy of rituximab (RTX) monotherapy in the treatment of adult minimal change disease (MCD). Methods This study was a case series analysis. The clinical data of 10 MCD patients who received RTX monotherapy at the Department of Nephrology, Zhongda Hospital, Southeast University, from January 2021 to October 2023 were retrospectively conducted. Results The onset age of the 10 patients was (48.4±21.2) years old, including 7 males and 3 females. Four patients (4/10) were aged 60 or above. One patient (1/10), 6 patients (6/10) and 3 patients (3/10) were treated with rituximab once, 2 times and 3 times, respectively. The follow-up duration was (327.1±141.6) d. All 10 patients achieved complete remission within 3 months, with 4 cases (4/10) achieving complete remission within 1 month. The mean time to remission was 35.7 d. During the follow-up period, none of the 10 patients experienced relapse. No significant adverse reactions were observed during treatment and follow-up. Conclusion Rituximab monotherapy demonstrates effective treatment outcomes in patients with MCD, but multi-center, large sample clinical validation is required. Long-term follow-up is necessary to assess its sustained efficacy and safety.

The study was a prospective observational study. A total of 24 patients who underwent maintenance hemodialysis (MHD) at Haidian Hospital in Beijing from May 2024 to June 2024 were included as the study subjects. The safety and efficacy of a new single-needle dialysis in MHD patients were evaluated. The reasons for using single-needle dialysis included waiting for the maturity of internal fistula(7 cases, 29.17%), autogenous arteriovenous fistula thrombosis occurred (6 cases, 25.00%), puncture difficulty occurred (7 cases, 29.17%), and pain sensitivity or elderly (4 cases, 16.67%). The results showed that the average blood flow was (155.65±5.90) ml/min, total blood volume was (35.92±2.65) L during single-needle dialysis. One patient had slight puncture leakage, and the puncture success rate was 95.83%. Relevant indicators of dialysis adequacy showed that the average urea clearance (Kt/V) was 0.90±0.42, urea reduction ratio was 58.31%±7.93%, and online real-time Kt/V monitoring average value was 0.98±0.55. The results suggest that the application of the new improved single-needle dialysis mode in MHD patients is safe and effective.

Objective To analyze the clinical application of different diagnostic methods for heart failure with preserved ejection fraction (HFpEF) in maintenance hemodialysis (MHD) patients. Methods It was a single-center retrospective cohort study. Uremia patients who underwent hemodialysis at Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from July 2020 to June 2021 were enrolled. The demographic characteristics, laboratory indicators, and echocardiography parameters were collected. The 2016 European Society of Cardiology (ESC) criteria, H₂FPEF score [composite score based on weighted scores of heavy (H), hypertensive (H), atrial fibrillation (F), pulmonary hypertension (P), elder (E), and filling pressure (F)], and Heart Failure Association (HFA) -PEFF score [including pre-test assessment (P), echocardiography and natriuretic peptide score (E), functional testing (F) and final aetiology (F)] were used to diagnose HFpEF, respectively, and the difference of three diagnostic methods was compared. The association between HFpEF diagnosed by the three methods and poor outcomes (all-cause death, cardiovascular death) was analyzed. Results A total of 160 MHD patients were included, whose age was (58.5±13.4) years, median dialysis age was 5.0 (2.3, 9.6) years, median H₂FPEF score was 2 (1, 3), median HFA?PEFF score was 4 (3, 5), and 92 (57.5%) were males. Of these patients, 118 patients (73.8%) met the 2016 ESC criteria for diagnosis of HFpEF, 4 (2.5%) met H₂FPEF score for diagnosis of HFpEF, and 56 (35.0%) met HFA?PEFF score for diagnosis of HFpEF. The consistency of three methods in diagnosing HFpEF was poor with κ values of 0.018 between ESC criteria and H₂FPEF score, 0.322 between ESC criteria and HFA?PEFF score, and 0.056 between H₂FPEF score and HFA?PEFF score. After a median follow-up of 2.6 years, 20 (12.5%) of the 160 MHD patients died. The Kaplan?Meier survival analysis showed a significant difference in mortality between patients diagnosed with HFpEF and those without using the H₂FPEF score (Log?rank test, χ²=6.95, P=0.008). After adjusting for demographic and clinical parameters, multivariate Cox regression analysis showed that HFpEF diagnosed by HFA?PEFF score was associated with all-cause mortality (HR=2.73, 95%CI 1.07-6.98, P=0.036) and cardiovascular mortality (HR=4.77, 95%CI 1.31-17.30, P=0.018). Conclusions The 2016 ESC criteria, H₂FPEF score, and HFA?PEFF score have high heterogeneity and poor consistency in diagnosing HFpEF in MHD patients. Among the three diagnostic methods, only the diagnosis based on HFA?PEFF score is associated with the prognosis of MHD patients. The HFA?PEFF score can be used to assess the risk of HFpEF in MHD patients, and more clinical studies are needed to further verify it in the future.

Objective To explore the incidence and risk factors of severe bleeding after percutaneous renal biopsy (PRB) in patients with advanced chronic kidney disease (CKD). Methods The study was a retrospective cohort analysis. The data were collected from patients with advanced CKD who were hospitalized in the Department of Nephrology, Nanfang Hospital, Southern Medical University and underwent PRB between January 2010 and December 2020. Severe bleeding after PRB was defined by any of the following criteria: a postoperative hemoglobin decrease of ≥20 g/L within 48 hours, a maximum diameter of perirenal hematoma ≥5 cm postoperatively, or the need for posterior pituitary hormone, blood transfusion, or renal vascular intervention post-surgery. The occurrence of severe bleeding following PRB served as the primary endpoint for this study. Logistic regression model was used to analyze the risk factors associated with severe bleeding in patients with advanced CKD undergoing PRB. Results A total of 895 patients aged (46.1±14.1) years were encompassed in the study. Among them, 60.1%(538/895) were male, 15.9%(142/895) were afflicted with diabetes, and 57.9%(518/895) suffered from hypertension. The estimated glomerular filtration rate (eGFR) was (40.1±13.2) ml?min^-1?(1.73 m²)^-1, and the 24-hour urine protein excretion was 2.5(1.1, 4.9) g. After PRB, 22.9%(205/895) of the patients encountered severe bleeding, including 30 patients (14.6%) who received postoperative somatostatin, 10 patients (4.9%) who underwent postoperative blood transfusion, 1 patient (0.5%) who underwent postoperative renal vascular intervention for hemostasis, and no fatalities occurred. Compared to the non-severe bleeding group, patients in the severe bleeding group after PRB exhibited a higher proportion of hypertension [64.4%(132/205) vs. 55.9%(386/690), χ2=4.627, P=0.031]. Additionally, preoperative serum creatinine levels and mean arterial pressure were significantly elevated [(193.9±106.6) μmol/L vs. (180.8±102.6) μmol/L, t=-2.559, P=0.011; (95.8±10.9) mmHg vs. (93.9±11.0) mmHg, t=-2.134, P=0.033]. Furthermore, platelet counts were lower in the severe bleeding group [(227.5±70.3) ×10⁹/L vs. (247.5±74.8) ×10⁹/L, t=-3.788, P<0.001]. No statistically significant differences were observed between the two groups regarding age, gender distribution, prevalence of diabetes mellitus, as well as preoperative serum albumin level, hemoglobin concentration, other coagulation function indicators and pathological histological type (all P>0.05). Multivariate logistic regression analysis indicated that body mass index (OR=0.936, 95% CI 0.891–0.984, P=0.010), eGFR (OR=0.985, 95% CI 0.971–0.999, P=0.034), serum albumin level (OR=1.041, 95% CI 1.011–1.072, P=0.007), 24 hours urinary protein excretion (OR=1.092, 95% CI 1.030–1.158, P=0.003), and platelet count (OR=0.996, 95% CI 0.994–0.999, P=0.002) were independently associated with the severe bleeding following PRB in patients with advanced CKD. In the PRB cohort analyzed, the six most prevalent renal histological types were as follows: IgA nephropathy (46.3%, 414/895), membranous nephropathy (11.1%, 99/895), focal segmental glomerulosclerosis (8.5%, 76/895), diabetic nephropathy (7.6%, 68/895), sclerotic kidney disease (6.9%, 62/895), and vascular sclerosis of the kidneys (4.9%, 44/895). Conclusions Patients with advanced CKD exhibit a heightened risk of severe bleeding following PRB, estimated at approximately 22.9%. Independent risk factors for the occurrence of severe bleeding complications in these patients include low body mass index, reduced eGFR, decreased platelet count, elevated serum albumin, and increased urinary protein level.

Objective To analyze the impact of post?dialysis blood pressure (Post?BP) on the long-term survival prognosis of maintenance hemodialysis (MHD) patients and the related risk factors. Methods It was a retrospective cohort study. The data of patients who underwent their first hemodialysis (HD) from January 1, 2007, to June 30, 2021, as recorded in the dialysis registration system of the Kidney Disease Center, the First Affiliated Hospital, Zhejiang University School of Medicine was retrospectively analyzed. The mean Post?BP was calculated for each HD session 4-6 months after hemodialysis. According to the mean value of post?dialysis diastolic pressure (Post?DBP) at 4-6 months after dialysis, patients were divided into 3 groups (Post?DBP<80 mmHg, 80 mmHg≤Post?DBP<90 mmHg, Post?DBP≥90 mmHg). According to whether the mean value of post?dialysis systolic pressure (Post?SBP) was ≥140 mmHg and whether the mean value of Post?DBP was ≥80 mmHg, patients were divided into 4 groups (Post?SBP<140 mmHg, Post?DBP≥80 mmHg; Post?SBP≥140 mmHg, Post?DBP≥80 mmHg; Post?SBP<140 mmHg, Post?DBP<80 mmHg; Post?SBP≥140 mmHg, Post?DBP<80 mmHg). Patients' first dialysis time was used as the starting point of follow-up, and the end point of follow-up was death or conversion to peritoneal dialysis or kidney transplantation or up to December 31, 2021. Kaplan?Meier survival analysis, Log?rank test, and multivariate Cox regression model were used to analyze the relationship between Post?BP and survival rate and the related factors of prognosis in MHD patients. Results According to inclusion criteria, a total of 1 213 patients were included. Kaplan?Meier survival curve showed that the long-term survival rate had statistically significant differences among Post?DBP<80 mmHg, 80 mmHg≤Post?DBP<90 mmHg and Post?DBP≥90 mmHg groups (Log?rank test, χ²=58.838, P<0.001), and Post?DBP<80 mmHg group was the lowest. Further comparing the cardiovascular diseases (CVD) mortality among the three groups, the curve showed a statistically significant difference (Log?rank test, χ²=27.926, P< 0.001), and the highest CVD mortality was found in the Post?DBP<80 mmHg group. Multivariate Cox regression model analysis showed that Post?DBP<80 mmHg was an independent associated factor for death in MHD patients (with Post?DBP mmHg≥90 group as reference, HR=4.197, 95% CI 1.452-12.197, P=0.008). When patients were divided into 4 groups according to whether the mean value of Post?SBP was ≥140 mmHg and whether the mean value of Post?DBP was ≥80 mmHg, Kaplan?Meier survival analysis showed a statistically significant difference in long-term survival rate among the four groups (Log?rank test, χ²=65.636, P<0.001), among which Post?SBP≥140 mmHg, Post?DBP<80 mmHg group had the lowest long-term survival rate. Further comparing the CVD mortality rate among the four groups, the curve showed a statistically significant difference (Log?rank test, χ²=29.784, P<0.001), and the highest CVD mortality rate was found in the Post?SBP≥140 mmHg, Post?DBP<80 mmHg group. Multivariate Cox regression analysis revealed that regardless of whether the average Post?SBP was ≥140 mmHg, Post?DBP<80 mmHg was an independent associated factor for death in MHD patients(with Post?SBP<140 mmHg, Post?DBP≥80 mmHg group as reference, Post?SBP≥140 mmHg, Post?DBP<80 mmHg group: HR=3.416, 95% CI 1.294-9.019, P=0.013; Post?SBP<140 mmHg, Post?DBP<80 mmHg group: HR=3.574, 95% CI 1.451-8.802, P=0.006). Conclusions The long-term survival rate of the group with Post?SBP≥140 mmHg and Post?DBP<80 mmHg is significantly lower. Post?DBP<80 mmHg is an independent risk factor for death in MHD patients regardless of whether the average Post?SBP is ≥140 mmHg.

Objective To evaluate the relationship between prognostic nutritional index (PNI) and risk of functional dependence in patients receiving maintenance hemodialysis (MHD). Methods It was a cross-sectional survey study. The clinical data of MHD patients in the Second Affiliated Hospital of Soochow University from June to December 2023 were collected. The Katz and Lawton?Brody questionnaires were used to assess the functional status. The patients were divided into normal functional status group and functional dependence group, and the differences of the clinical data between the two groups were compared. Serum albumin and lymphocytes were used to determine PNI, and the patients were divided into four subgroups: Q1 group (PNI≤44.3), Q2 group (44.3<PNI≤47.2), Q3 group (47.2<PNI≤49.8) and Q4 group (PNI>49.8) according to the quartile of PNI. Logistic regression analysis method was used to analyze the relationship between PNI and risk of functional dependence in MHD patients, and subgroup analysis was conducted. The receiver-operating characteristic (ROC) curve was used to assess the efficacy of PNI, serum albumin, and lymphocytes in predicting the risk of functional dependence in MHD patients. Results A total of 206 MHD patients were included in this study, with age of (58.35±0.98) years old, and 132 (64.1%) males. There were 58 (28.2%) patients with diabetes, 179 (86.9%) patients with hypertension, and 36 (17.5%) patients with cardiovascular diseases. There were 95 (46.1%) patients developing functional dependence. Compared with normal functional status group, functional dependence group had higher age (t=-6.87, P<0.001), proportion of diabetes (χ²=6.58, P=0.010), and pulse pressure (t=-3.17, P=0.002), and lower diastolic pressure (t=3.88, P<0.001), serum creatinine (t=3.44, P=0.001), serum albumin (t=4.09, P<0.001) and PNI (t=3.92, P<0.001). The incidence of functional dependence in PNI Q1 group (69.2%, 36/52) was significantly higher than those in Q2 group (49.0%, 25/51), Q3 group (34.0%, 18/53) and Q4 group (32.0%, 16/50), and the differences among groups were statistically significant (all P<0.05). Logistic regression analysis showed that after adjusting for confounding factors: age, diabetes, pulse pressure, and serum creatinine, the risk of functional dependence of PNI Q1 group was 3.217 folds higher than that in Q4 group (OR=3.217, 95%CI 1.229-8.422, P=0.017). The risk probability model of PNI predicting the occurrence of functional dependence in MHD patients: logit (odds)=5.854-0.128 3×PNI. The area under the ROC curve (AUC) for PNI predicting the risk of functional dependence in MHD patients was 0.66 (95%CI 0.58-0.73, P<0.001), slightly higher than that of serum albumin (AUC=0.64, 95%CI 0.54-0.73, P<0.001). The optimal cutoff value of PNI predicting the occurrence of functional dependence was 46.15, with sensitivity of 72.07% and specificity of 57.89%. Conclusion Low PNI is associated with high risk of functional dependence in MHD patients.

Objective To investigate the risk factors and prognosis of mitral regurgitation (MR) in patients with chronic kidney disease (CKD). Methods Clinical data were collected from CKD patients who were hospitalized at the Department of Nephrology, Xuanwu Hospital, Capital Medical University, from January 1, 2018, to December 31, 2019, and underwent echocardiography. Patients were followed up until November 1, 2021, with the endpoint being all-cause mortality.Logistic regression was used to analyze the risk factors of MR in CKD patients. Kaplan-Meier survival analysis was performed to plot the survival curve, with the Log?rank test comparing the survival rate. Multivariate Cox regression analysis was used to identify the risk factors of death in CKD patients. Results It was a retrospective single-center study. A total of 555 CKD patients were included, with 262 patients developing MR. Of whom, 212 patients had mild MR (80.9%), 44 patients had modreate MR (16.8%), 6 patients had severe MR (2.3%). The prevalence of MR among patients with CKD stages 1 to 5 was 21.9%, 33.0%, 45.9%, 51.9%, and 64.6%, and the prevalence of moderate to severe MR was 0, 5.6%, 7.4%, 10.1%, and 15.9%. Multivariate logistic regression analysis revealed that male sex (OR=1.579, 95% CI 1.008-2.476, P=0.046), presence of chronic heart disease (OR=2.263, 95% CI 1.398-3.662, P=0.001), CKD stage 4-5 (with CKD stage 1-3 as reference, OR=1.744, 95% CI 1.007-3.019, P=0.047), and decreasing hemoglobin levels (OR=0.985, 95% CI 0.975-0.996, P=0.006) were the associated factors for MR in CKD patients. Kaplan-Meier survival analysis indicated higher all-cause mortality (Log-rank, χ2=8.094, P=0.004) in the MR group compared to the non-MR group. Multivariate Cox regression analysis showed that increasing age (HR=1.072, 95% CI 1.042-1.104, P<0.001), elevating blood phosphorus (HR=2.782, 95% CI 1.122-6.895, P=0.027), MR (HR=1.962, 95% CI 1.002-3.839, P=0.049) and decreasing albumin (HR=0.927, 95% CI 0.886-0.970, P=0.001) were independent associated factors for all-cause death in CKD patients. Conclusions The overall prevalence of MR and the prevalence of moderate to severe MR are increasing with the progression of CKD. Male sex, presence of chronic heart disease, CKD stage 4-5 and decreasing hemoglobin levels are risk factors for MR in CKD patients. MR is an independent risk factor for all-cause mortality in CKD patients.

Objective To preliminarily explore the role of silent information regulator 3 (SIRT3) in ferroptosis induced by high glucose in renal tubular epithelial cells, and to provide a new theoretical basis and treatment ideas for renal tubular injury in diabetic kidney disease patients. Methods The single-cell transcriptomic analysis from "Tabula-muris" database was used to evaluate the expression of SIRT3 gene in different cellular subtypes of kidney tissues. HK-2 cells, a human immortalized proximal tubule epithelial cell line, were cultured in vitro and divided into following groups: (1) control group, mannitol group and high glucose group; (2) control group, negative control group, SIRT3 overexpression group, high glucose group and SIRT3 overexpression + high glucose group; (3) control group, negative control group, SIRT3 knockdown group, high glucose group and SIRT3 knockdown + high glucose group; (4) control group, Erastin intervention group and SIRT3 overexpression + Erastin intervention group. Normal glucose was 5.5 mmol/L, high glucose was 30 mmol/L, mannitol was 24.5 mmol/L, Erastin was 10 μmol/L, and the intervention time was 48 h. Cell counting kit-8 proliferation and cytotoxicity assay was used to determine cell viability. Real-time quantitative PCR and Western blotting were performed to assess the expression of SIRT3, kidney injury molecule-1 (KIM-1), and ferroptosis-related proteins acyl?CoA synthetase long chain family member 4 (ACSL4) and glutathione peroxidase 4 (GPX4) at the mRNA and protein levels. The malondialdehyde, glutathione, and iron levels were measured to evaluate the degree of cellular ferroptosis. DCFH-DA was used to analyze the intracellular reactive oxygen species level, while the JC-1 staining method was employed to evaluate alterations of mitochondrial membrane potential in HK-2 cells. Results (1) The results of single-cell transcriptomic database analysis demonstrated that SIRT3 gene was expressed at the highest level in the subtypes of proximal tubule epithelial cells of kidney tissues. (2) Compared with the control group, the expression levels of KIM-1 and ACSL4 were higher, and the expression levels of SIRT3 and GPX4 and cell viability were lower in the high glucose group (all P<0.05), while there was no statistically significant difference of the aforementioned indicators between the mannitol group and the control group (all P>0.05). (3) Compared with the high glucose group, HK-2 cell vitality, GPX4 expression and intracellular glutathione were higher, ACSL4 expression, intracellular iron, malondialdehyde and reactive oxygen species were lower, mitochondrial membrane potential partially recovered in SIRT3 overexpression + high glucose group (all P<0.05). Compared with the high glucose group, HK?2 cell vitality and GPX4 expression were lower, ACSL4 expression was higher in SIRT3 knockdown + high glucose group (all P<0.05), and there were no statistically significant differences in intracellular iron, malondialdehyde and glutathione (all P>0.05). (4) Compared with the control group, Erastin intervention group had upregulated ACSL4 expression and downregulated GPX4 expression in HK-2 cells (all P<0.05). Compared with the Erastin intervention group, SIRT3 overexpression + Erastin intervention group had upregulated GPX4 expression and downregulated ACSL4 expression (all P<0.05). Conclusions High glucose can decrease SIRT3 expression and mitochondrial membrane potential, and increase oxidative stress and ferroptosis in HK-2 cells. Overexpression of SIRT3 may reduce oxidative stress and alleviate mitochondrial dysfunction, thereby mitigating glucose-induced ferroptosis in HK-2 cells.

The increasing focus and research on ectopic fat deposition, especially the locally impactful liver and cardiac fat, have been extensively studied. However, there has been relatively less research on renal sinus fat. The increased ectopic deposition of renal sinus fat has an independent effect on renal damage, but the underlying mechanism remains unclear. Therefore, this article will integrate current research to provide a comprehensive review of renal sinus ectopic fat deposition, covering its related imaging diagnosis, potential mechanisms influencing renal damage (mechanical pressure generated by renal sinus fat, lipotoxicity), and current interventions for renal sinus ectopic fat deposition. This is aimed at attracting more attention in clinical research to the role of renal sinus ectopic fat deposition in the occurrence and development of kidney-related diseases.

Objective To investigate the current status of vascular access team building and analysis its related factors in hemodialysis centers in China. Methods The study was a cross-sectional survey. Using a convenience sampling method, a questionnaire was designed to investigate the clinical practice of vascular access teams in 527 hemodialysis centers in China from March to April 2022. The related factors of the formation of vascular access teams and the setting up of vascular access coordinators (VAC) were analyzed by multivariate logistic regression method. Results A total of 506 valid questionnaires were recovered, with a recovery rate of 96.02%. There were 247 (48.81%) and 193 (38.14%) hemodialysis centers respectively across China that had built vascular access teams and set up VAC. Hemodialysis centers with more than 10 years of practice had higher rate of implementation than those in hemodialysis centers with practice years less or equal than 10 years in developing standardized procedures for vascular access management (χ² =8.288, P=0.004), holding continuous quality improvement meetings on vascular access (χ² =8.210, P=0.004), establishing vascular access teams (χ² =33.805, P<0.001) and setting up vascular access coordinators (χ² =16.038, P<0.001), and the difference was statistically significant. The results of multivariate logistic regression analysis showed that the number of dialysis machines (OR=2.221, 95% CI 1.118-4.415, P=0.023), the number of patients on dialysis(OR=2.946, 95% CI 1.375-6.310, P=0.005), and the establishment of VAC positions (OR=9.463, 95% CI 5.307-16.874, P<0.001), and the standardized vascular access management process (OR=3.383, 95% CI 2.012-5.687, P<0.001) were the related factors of vascular access team building. The related factors of setting up a VAC position in hemodialysis center were opening vascular access clinic (OR=2.704,95% CI 1.382-5.290, P=0.004), the formation of a vascular access team (OR=9.464, 95% CI 5.312-16.860, P<0.001), and constructing standardized procedures for vascular access management (OR=3.663, 95% CI 2.243-5.982, P<0.001). Conclusion The implementation rates of vascular access team and VAC position in hemodialysis centers were 48.81% and 38.14%, respectively. The number of dialysis machines, the number of patients on dialysis, the standardized procedures for vascular access management, the vascular access clinic, the vascular access team, and the VAC position were the relevant factors of the team building for vascular access.

Objective To explore the risk factors of recent cardiovascular and cerebrovascular events and long-term all-cause mortality in hemodialysis (HD) patients. Methods The clinical data of two groups of retrospective cohort study, which included newly admitted HD (group A) and maintenance HD (group B) patients respectively, were sourced from the HD Center of Beijing Anzhen Hospital, Capital Medical University. The endpoint events were defined as occurrence of cardiovascular or cerebrovascular events or all-cause mortality at less than 12 mouths of dialysis age in group A, and all-cause mortality in group B. The patients were divided into event group and non-event group based on whether endpoint events occurred during the follow-up period. The baseline and follow-up clinical data within the two groups were compared. Cox regression model was used to analyze the risk factors of endpoint events in HD patients. Results A total of 104 HD patients were enrolled in group A, with 70 males (67.3%), aged (61.54±14.97) years old. The follow-up time was 12.0 (10.0,12.0) months, and 29 patients (27.9%) had endpoint events. In group A, the event group had a higher proportion of peripheral arterial disease (χ²=6.067, P=0.014), and lower low-density lipoprotein-cholesterol (t=-2.316, P=0.023) and body mass index (t=-2.245, P=0.028) than those in the non-event group. A total of 116 HD patients were enrolled in group B, with 86 males (74.1%), aged (65.89±10.06) years old. The follow-up time was 37.5 (21.0, 59.0) months, and 40 patients (34.5%) had endpoint events. In group B, the event group had lower serum albumin (t=-3.182, P=0.002) and potassium (t=-2.532, P=0.013) than those in the non-event group. Multivariate Cox regression analysis showed that high hemoglobin compliance rate (HR=0.977, 95%CI 0.957-0.998, P=0.031) and high serum albumin (HR=0.836, 95%CI 0.776-0.901, P<0.001) were protective factors of all-cause mortality in maintenance HD patients. Conclusions The presence of peripheral arterial disease, low low-density lipoprotein-cholesterol and low body mass index may increase the risk of recent cardiovascular and cerebrovascular events in newly HD patients. Substandard hemoglobin and serum albumin may increase the risk of long-term all-cause mortality in maintenance HD patients.

Henoch-Sch?nlein purpura is also known as IgA vasculitis. The kidney involvement, namely Henoch-Sch?nlein purpura nephritis (HSPN), is one of IgA vasculitis's main clinical manifestations. Galactose-deficient IgA1 plays an important role in the pathogenesis of HSPN, which not only is similar to the "four-hits hypothesis" of IgA nephropathy, leading to IgA1 deposit in the mesangial region of the kidney, but also is closely related to inflammation with more complicated compositions of its immune complex. Therefore, abnormal glycosylation of IgA1 is expected to be a biomarker for diagnosis and prediction of HSPN pathogenesis, disease activity determination and prognosis prediction. Here, the paper reviews the research progress on the pathogenesis and clinical application of abnormal glycosylation of IgA1 in HSPN.

Ferroptosis is a type of programmed cell death characterised by iron-dependent accumulation of lipid reactive oxygen species, which is closely related to intracellular metabolism of amino acids, lipids, and iron, and regulation of ferroptosis can intervene and treat certain diseases. Diabetic kidney disease (DKD) is a chronic microvascular complication of diabetes.Although the exact pathogenesis of DKD is not clear, the results of the existing studies have proved that ferroptosis participates in the development of diabetic kidney injury, and plays an important role in kidney tubular injury in particular, and the inhibition of ferroptosis may be one of the directions for the treatment of DKD. In recent years, researchers have conducted a lot of studies on ferroptosis through animal models of DKD, but the specific pathogenesis and therapeutic effects regarding ferroptosis have not been fully revealed. This article introduces ferroptosis and its connection with apoptosis, autophagy and other forms of cell death, as well as the main mechanisms regulating the development of ferroptosis through systematic Xc-GSH-GPX4 axis, NADPH-FSP1-CoQ10 axis, GCH1-BH4- phospholipid axis and various regulatory factors, and provides an overview of its role in kidney tubular injury of DKD. Through the review of these contents, the possibility of ferroptosis as a therapeutic target for DKD is discussed, in order to provide reference for the basic research and clinical treatment of DKD.

Objective To explore the effects of G protein-coupled receptor 55 (GPR55) antagonist CID16020046 on renal fibrosis in mice, and provide a new method and idea for the treatment of renal fibrosis. Methods (1) GPR55 overexpression and GPR55 antagonist CID16020046 were used in renal fibroblasts (NRK?49F) of rats, respectively. Meanwhile,transforming growth factor-β1 (TGF?β1) was applied in the NRK?49F cells to observe the expression of fibrosis-related factors and inflammatory factors. (2) A mouse model of renal fibrosis with unilateral ureteral obstruction (UUO) was established in vivo. Eight-week-old male C57BL/6J mice (20-25 g) were randomly divided into three groups according to the random number table method: sham group (n=6), model group (UUO group, n=7), model + CID16020046 drug (UUO+CID group, n=8). The drug CID16020046 (10 mg/kg) was intraperitoneally injected 1 day before modeling, on the day of modeling and every day after surgery in UUO+CID group, and the corresponding dose of 0.9% normal saline was injected intraperitoneally in sham and UUO groups.The mice were sacrificed for sampling 7 days after UUO surgery, and their renal function indicators, liver transaminase, and cardiac markers were examined. Western blotting and quantitative real-time PCR were used to detect the expression of renal fibrosis-related factors and inflammatory factors. Immunohistochemistry staining, Sirius red staining and Masson trichrome staining were used to detect the pathological changes of renal tissues. Results (1) After NRK?49F cells were stimulated by TGF?β1, the mRNA and protein expression levels of GPR55 were significantly increased (both P<0.05). There was no statistically significant difference in the mRNA expression of fibrosis-related factors fibronectin and collagen Ⅰ, and inflammatory factors interleukin-1β and tumor necrosis factor-α between TGF?β1 group and TGF?β1 + GPR55 overexpression group (all P>0.05). Compared with the TGF?β1 group, the protein expression levels of fibrosis-related factors alpha-smooth muscle actin (α?SMA) and vimentin, and the mRNA expression levels of collagen Ⅰ and α?SMA were lower in the TGF?β1 + CID group (all P<0.05). (2) Compared with sham group, the mRNA and protein expression levels of GPR55 in UUO group were higher (both P<0.05). The serum creatinine in the UUO+CID group was lower compared to the UUO group (P<0.05). There was no statistically significant difference in blood urea nitrogen, alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase and creatine kinase isoenzyme between UUO group and UUO+CID group (all P>0.05). Compared with the UUO group, the protein expression levels of renal fibrosis-related factors fibronectin, collagen Ⅰ and vimentin, and the mRNA expression levels of fibronectin, collagen Ⅰ, collagen Ⅲ and α?SMA were lower in the UUO+CID group (all P<0.05). The degree of renal tubular dilation and interstitial collagen fiber deposition in the UUO+CID group was significantly reduced compared to the UUO group (all P<0.05). Conclusions CID16020046 can reduce serum creatinine in UUO mice, protect renal function, and simultaneously decrease the expression of fibrosis-related factors in renal fibroblasts and mouse kidney tissues, thereby alleviating renal fibrosis.

The paper reports a rarely case of hemophagocytic syndrome complicated with thrombotic microangiopathy, first presented with fever of unknown origin. A 37-year-old female patient mainly presented with fever, hemolytic anemia, thrombocytopenia, and progressive decline in renal function. After infusion of fresh frozen plasma and high dose of glucocorticoid after double plasma exchange, the patient showed good prognosis, no further fever or hemolysis occurred, recovered platelet and renal function. After acute episode phase, kidney biopsy was performed and acute tubular necrosis was diagnosed. During the follow-up period, the disease did not recur, and the renal function was normal.

Objective To evaluate the efficacy and safety of rituximab (RTX) in children with steroid resistant nephrotic syndrome (SRNS). Methods The was a retrospective observational study. A retrospective analysis was conducted on the clinical data of 14 children with SRNS who received RTX treatment in the Department of Nephrology, Children's Hospital Affiliated to Capital Institute of Pediatrics from July 2021 to August 2023. The changes in urinary protein content, renal function, serum albumin, immunoglobulin and other indicators before and after RTX medication were compared to evaluate the clinical efficacy and safety of RTX treatment for SRNS. Results A total of 14 children with SRNS were selected for this study, with a male to female ratio of 6:8. The age of onset of kidney disease was (4.36±3.12) years, and 8 of them underwent kidney biopsy. Among them, 6 cases showed focal segmental glomerulosclerosis in renal pathology, and 2 cases showed minimal change disease. The age of 14 children who first used RTX was (8.45±3.98) years old, with a dose of 375 mg/m² and a maximum dose of 500 mg. The number of children who had used 2, 3, 4, and 5 doses of RTX was 6, 6, 1, and 1, respectively. RTX was administered orally with compound sulfamethoxazole to prevent infection. Glucocorticoids and immunosuppressants were discontinued 4.0(2.5, 6.5) months after the first dose of RTX. The median follow-up time was 10.5(6.0, 18.3) months. By the end of the 3-month, 6-month, and follow-up endpoints, the complete remission rates of kidney disease in the children were 100.0%(14/14), 85.7%(12/14), and 64.3%(9/14), respectively. Five children experienced kidney disease recurrence. Compared with before the first dose of RTX treatment, the serum albumin and height significantly increased, while body mass index significantly decreased at the end of follow-up (all P<0.05). There was no statistically significant difference in urinary protein content, renal function, and IgG (all P>0.05). During the RTX treatment, all 14 children did not experience any infusion reaction, and there were no serious infections during follow-up. One case was diagnosed with hypogammaglobulinemia. Conclusions RTX can improve the remission rate and recurrence rate of SRNS children, reduce the dosage of glucocorticoids and related drug untoward reaction, significantly improve patient height and BMI, with minimal side effects. Especially for SRNS patients who cannot be relieved by the combination of glucocorticoids and immunosuppressants, RTX may be considered.

Objective To investigate the efficacy and safety of peripheral cutting balloon (PCB) in the treatment of long stenosis of arteriovenous fistula, and to explore the influencing factors of restenosis after PCB treatment. Methods It was a single-center retrospective study. The patients with long stenosis (>2 cm) of arteriovenous fistula who received PCB treatment of percutaneous transluminal angioplasty (PTA) in Haidian Hospital, the Third Hospital of Peking University from August to November 2021. The clinical and follow-up data after PTA operation were collected and analyzed, and the primary patency rate and primary assist patency rate of fistula at 3, 6 and 12 months after PTA operation were calculated. Kaplan?Meier method was used to draw the survival curve of the primary patency rate of fistula, and log-rank test was used to compare the differences of primary patency rates of fistula between two groups. Multivariate Cox regression analysis was used to analyze the influencing factors of fistula restenosis after PCB treatment. Results A total of 65 patients aged (62.57±11.55) years old were included in this study, including 42 males (64.62%), 61 (93.85%) autologous arteriovenous fistula and 4 (6.15%) arteriovenous graft. The narrowest diameter of fistula stenosis (t=-41.731, P<0.001) and brachial artery blood flow (t=-12.510, P<0.001) after PCB treatment were significantly higher than those before PCB treatment. The resistance index of fistula after PCB treatment was significantly lower than that before PCB treatment (t=9.241, P<0.001). The technical success rate of PTA was 100% (65/65), and the clinical success rate of PTA was 96.92% (63/65). Only 2 patients failed to complete hemodialysis after PCB treatment, and no serious postoperative complications occurred. The follow-up time was 12 (7, 13) months. Fistula dysfunction occurred in 24 patients (36.92%) within 12 months. Kaplan?Meier survival analysis showed that the primary patency rates were 90.77%, 81.54% and 63.08% at 3, 6, and 12 months, respectively, and the primary assist patency rate at 12 months was 100% (65/65). The risk of fistula restenosis in patients with long stenosis ≥36 mm was significantly higher than that in patients with long stenosis <36 mm (log-rank χ²=6.007, P=0.014). Multivariate Cox regression analysis showed that increased stenosis length (HR=1.022, 95% CI 1.001-1.045, P=0.042) was an independent influencing factor of fistula restenosis within 12 months after PCB treatment. Conclusions PCB is safe and effective in the treatment of long segment stenosis associated with fistula. The increased stenosis length is an independent influencing factor of restenosis in fistula after PCB treatment.

Objective To identify and validate the key genes of ferroptosis in phospholipase A2 receptor (PLA2R) associated membranous nephropathy through bioinformatics analysis and in vitro experiments, and to explore the potential role of ferroptosis in PLA2R associated membranous nephropathy (PMN). Methods The GSE115857 dataset obtained by retrieving the Gene Expression Omnibus (GEO) database and the ferroptosis-related genes obtained by retrieving the FerrDb database were intersected. The intersected genes were subjected to Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis. The key ferroptosis genes associated with PMN were identified by intersecting genes selected using support vector machines-recursive feature elimination and least absolute shrinkage and selection operator regression. The results were validate by real-time PCR, cell counting kit-8, Western blotting and immunofluorescence in human renal podocyte line AB 8/13 from both the control group and model group. Results A total of 25 genes related to ferroptosis of PMN were obtained, and GO and KEGG analysis showed that these genes were mainly involved in cell ferroptosis metabolism. The key ferroptosis genes of PMN obtained by machine learning method were activating transcription factor 3 (ATF3) and coiled coil domain containing 6 (CCDC6). The results of in vitro experiments showed that the human renal podocyte line AB 8/13 in the model group was significantly deformed and retracted compared with the control group. The surface area density of foot processes was significantly reduced, and the podocyte cytoskeleton was allosteric. The morphology of F-actin was disordered and the expression of synaptopodin was decreased. The cell proliferation activity was significantly decreased (P<0.05). The expression of PLA2R protein was increased (P<0.05), and the expression of GPX4 protein was decreased (P<0.01). The protein and mRNA levels of ATF3 and CCDC6 were significantly up-regulated (all P<0.05). Conclusions Ferroptosis may be one of the key mechanisms in the occurrence and development of PMN. In vitro experiments show that ATF3 and CCDC6 are the key genes in the ferroptosis of PMN podocytes, which provides new insights and ideas for the pathogenesis of PMN.

Objective To investigate the application of virtual reality (VR) technology on intraoperative pain in patients undergoing peritoneal dialysis (PD)-related procedures with local infiltration anesthesia and the satisfaction. Methods It was a single-center, prospective, concurrent controlled study. Patients were divided into two groups: VR group and control group. In the VR group, patients wore a VR headset to watch soothing audio and video content during surgery, while the control group underwent routine procedures. Intraoperative pain and satisfaction were assessed using the visual analog scale (VAS) and a 5-point satisfaction scale within 30 minutes of surgery. In addition, tolerance of the VR experience in the VR group was assessed using the VR sickness questionnaire. Results A total of 43 patients were included in the study, including 25 males (58.1%). Chronic glomerulonephritis [17 cases (39.5%)] and diabetic nephropathy [6 cases (14.0%)] were the main primary diseases. There were 23 cases in the control group and 20 cases in the VR group. There were no significant differences between the two groups in age, sex ratio, proportion of primary disease, diabetes, hypertension, distribution of operation methods, preoperative vital signs and operation time (all P>0.05). VAS pain score was significantly lower in the VR group than that in the control group (5.90±2.38 vs. 7.43±1.67, t=2.469, P=0.018). The percentage of patients who were satisfied was 89.5% (17/19) in the VR group and 78.3% (18/23) in the control group, but there was no significant difference (chi-square test for continuity correction, χ2=0.308, P=0.579). Three patients in the VR group withdrew from the study due to severe discomfort, while the remaining participants found the VR experience to be tolerable. Common adverse effects included fatigue and blurred vision. Conclusions The application of VR technology in PD-related procedures has been effective in reducing intraoperative pain when combined with local infiltration anesthesia. Furthermore, the utilization of VR technology in PD-related procedures is associated with a safe and tolerable outcome, despite the observation of some adverse effects.

There are numerous novel therapies available for heart failure (HF) nowadays, but the condition of HF patients with diuretic resistance is notably complicated and severe, and its treatment is challenging. The main mechanisms of diuretic resistance in HF patients were the decrease of body's response to diuretics due to various reasons, and the retention of water and sodium. Peritoneal dialysis stands out as a safe and effective choice for the treatment of diuretic resistance in HF patients because of its advantages of ultrafiltration, sodium excretion, improvement of cardiac function, and preservation of residual renal function. This review outlines the rationale and clinical application of peritoneal dialysis in treating HF patients with diuretic resistance, to provide clinical guidance.

The α?Klotho protein is an anti-aging protein encoded by the Klotho gene and mainly exists in the renal tubules in the form of type 1 membrane protein (membrane-boundform). The extracellular domain of the membrane-bound α?Klotho protein can be cleaved and secreted into the circulation, which is called soluble α?Klotho. Soluble α?Klotho is the main form that can be detected in the body fluid. This paper mainly reviews the biological functions of soluble α?Klotho in the kidney and its possible molecular biological mechanisms, and also summarizes the role of soluble α?Klotho in various kidney diseases and the effects of α?Klotho on the other organs.

Objective To investigate the epidemiology features, intervention effects and influencing factors of thrombosis in arteriovenous graft (AVG), and to provide reference for optimizing vascular access scheme in hemodialysis patients. Methods It was a retrospective study. The clinical and follow-up data of patients with AVG constructed in the Blood Purification Center, the First Affiliated Hospital of Zhengzhou University from January 2018 to December 2022 were analyzed. According to whether AVG thrombosis occurred during the follow-up period, they were divided into thrombosis group and non-thrombosis group, and the epidemiology status, influencing factors and patency rates of AVG thrombosis were analyzed. AVG was followed up until June 30, 2023 or abandonment or death of patient or loss of follow-up. Kaplan?Meier method was used to analyze the patency rates of AVG. Log?rank test was used to compare the differences of patency rates between groups. Logistic regression model was used to analyze the influencing factors of AVG thrombosis. Results The study included 475 AVG from 464 patients, with age of (55.50 ± 11.85) years old, 193 males (40.6%), 185 diabetes patients (38.9%) and dialysis age of 24 (1, 68) months. One hundred and fifty-four AVG (32.4%) had a total of 307 AVG thrombotic events during the follow-up of 602 (380, 920) days, with a standardized incidence of 0.34 times per patient-year. Among them, 60 cases (19.5%, 60/307) had frequent thrombosis. Kaplan?Meier survival analysis showed that AVG secondary patency rates at 2-years and 3-years in the thrombosis group and frequent thrombosis subgroup were inferior to those in the non-thrombosis group (84.0% vs. 92.5%, P=0.017; 66.5% vs. 85.7%, P<0.001; 78.9% vs. 92.5%, P=0.030; 54.6% vs. 85.7%, P<0.001). Two hundred and sixty-nine AVG thrombotic events were analyzed to evaluate the treatment effects. Endovascular interventional surgery was used for thrombectomy in 215 cases (79.9%), and hybrid surgery (endovascular interventional surgery combined with surgical incision) was used in 54 cases (20.1%), with a technical success rate of 98.9% (266/269) and a clinical success rate of 98.1% (264/269). Kaplan?Meier survival analysis showed that there were no statistically significant differences in the primary post-intervention patency rates at 90 days and 365 days, respectively (all P>0.05), and there was statistically significant difference in the primary post-intervention patency rate at 180 days (45.1% vs. 26.5%, Z=2.563, P=0.015). Multivariate logistic regression analysis showed that graft-applied type (intering as the reference, propaten OR=1.953, 95%CI 1.139-3.350, P=0.015; acuseal OR=2.628, 95%CI 1.438-4.800, P=0.002), body mass index < 18.5 kg/m² (18.5-24.0 kg/m² as the reference, OR=0.291,95%CI 0.090-0.943,P=0.040), serum albumin < 40 g/L (OR=1.579, 95%CI 1.019-2.445, P=0.041), serum ferritin < 200 μg/L (OR=1.818, 95%CI 1.162-2.845, P=0.009) and mean arterial pressure < 70 mmHg (OR=7.180, 95%CI 1.339-38.501, P=0.021) were the independent influencing factors of AVG thrombosis. Conclusions The incidence of AVG thrombotic events is 0.34 times per patient-year, mainly concentrated in a small number of patients. Thrombosis reduces the secondary patency rate of AVG. AVG thrombosis treatment with endovascular interventional surgery or hybrid surgery has a high technical success rate and a clinical success rate. The thrombosis is related to graft-applied types, nutritional status of patients and mean arterial pressure level.

This article reports a rare case of proliferative glomerulonephritis with monoclonal immunoglobulin deposits. The patient, a middle-aged woman, exhibited clinical manifestations including nephrotic syndrome, microscopic hematuria, renal insufficiency, hyperglycemia, and bilateral diabetic retinopathy. Notably, monoclonal bands were absent in both blood and urine immunofixation electrophoresis. Renal biopsy revealed membranoproliferative glomerulonephritis, with immunofluorescence revealing exclusive petal-like deposition of IgG3 subtype along the capillary loop. Electron microscopy demonstrated segmental thickening of the glomerular basement membrane, along with electron dense deposits in the subendothelial and mesangial areas, lacking discernible substructure. The diagnosis comprised proliferative glomerulonephritis with monoclonal immunoglobulin deposition concurrent with diabetic nephropathy. Subsequent sequential treatment with daratumumab and cyclophosphamide over 6 months led to partial remission of nephrotic syndrome, normalization of renal function, and significant improvement of anemia. During the 24-month follow-up period, no serious adverse reactions occurred.

Objective To describe the incidence of peritoneal dialysis (PD) catheter exit site infection (ESI) and to analyze its pathogenic bacteria characteristics. Methods The clinical data of PD patients with ESI in Nanfang Hospital of Southern Medical University from 2020 to 2022 was reviewed to describe the dynamic changes in the incidence of ESI, and to analyze the distribution of ESI pathogens, antimicrobial sensitivity analysis of topical antibiotics and treatment outcomes. Results A total of 187 ESI episodes occurred in 159 PD patients. The proportion of gram-positive and gram-negative ESI were 80.7% and 18.3%, respectively. The main gram-positive and gram-negative pathogen were coagulase negative Staphylococcus (51.1%) and Pseudomonas aeruginosa (60.0%). Rifampicin (sensitivity rate of gram-positive organisms was 88.9%; gram-negative organisms was 100.0%) and gentamicin (sensitivity rate of gram-positive organisms was 83.6%; gram-negative organisms was 93.3%) is the main topical sensitive antibiotics. 137 cases (73.3%) of ESI were cured within 2 weeks after treatment. Among the 50 cases (26.7%) of refractory ESI, 22.0% of cases were associated with tunnel infection, 10.0% with tunnel reconstruction, and only 4.0% with removal of PD catheter. Conclusion Monitoring and reporting of ESI is an important part to improve the quality of PD management. By reviewing the incidence of ESI, pathogenic bacteria characteristics and treatment effects, real and reliable observational data for the formulation of relevant guidelines and clinical diagnosis and treatment can be provided.

This article reports two cases of proteinuria caused by anti-vascular endothelial growth factor (VEGF) drugs in the treatment of liver cancer and ovarian cancer, respectively. Hypertension, massive albuminuria and renal insufficiency occurred in the patient with liver cancer during the use of toripalimab/camrelizumab combined with lenvatinib and regorafenib, and urinary protein was 4.02 g/24 h. The patient with ovarian cancer developed hypertension, proteinuria and 1.13 g/24 h urinary protein during the use of bevacizumab. Renal biopsy showed thrombotic microangiopathy in the glomeruli of both patients. Anti-VEGF drugs-associated glomerular microangiopathy was considered. The patient with liver cancer had no improvement after halving the dose of lenvatinib, and the effect was not good after treatment with low-dose corticosteroids combined with renin-angiotensin-aldosterone system inhibitors. After stopping anti-VEGF drugs, the proteinuria in both patients turned negative.

Objective To detect and analyze the α-galactosidase A (GLA) gene mutations in Fabry disease patients and their family members, observe the clinical phenotype of the patients, and assess the therapeutic effect of agalsidase alpha. Methods It was a case series analysis. A total of 5 Fabry disease patients was diagnosed at the First Affiliated Hospital of Sun Yat-sen University from March 2022 to April 2023, and the clinical data and blood samples of the patients and their family members were collected. Genetic testing was performed using whole exome sequencing. GLA activity and substrate concentration were measured using the liquid chromatography-tandem mass spectrometry. Patients' clinical manifestations, family history, and auxiliary examination results were collected, and the therapeutic efficacy of agalsidase alpha and disease progression were followed up. Results A total of 5 GLA gene mutations were identified by gene sequencing, including 1 novel mutation. Among them, 4 mutations were missense mutation, and the other one was nonsense mutation. Common clinical manifestations included edema (4/5) and reduced sweating (4/5). Renal pathology biopsy of 4 patients showed varying degrees of kidney damage, one of which was combined with IgA nephropathy. Auxiliary examinations revealed ocular involvement in 4 patients, cardiac involvement in 4 patients, and hearing impairment in 2 patients. All 5 patients received agalsidase alpha treatment, with 4 male patients receiving (16.8±5.9) times administrations of agalsidase alpha, and their globotriaosylsphingosine (Lyso?GL?3) levels decreased by 45.6%±15.5% from baseline. Conclusions One novel GLA gene mutation is detected, which enriches the human gene mutation database. Fabry disease can be accompanied by kidney disease such as IgA nephropathy. When patients present with unexplained proteinuria combined with extrarenal manifestations such as reduced sweating, Fabry disease should be considered. Agalsidase alpha treatment can reduce Lyso?GL?3 concentration, and improve clinical symptoms.

The paper reports a rare case of idiopathic multicentric Castleman's disease with nephrotic syndrome as the first presentation. The patient was a 68-year-old male, presented with edema at admission. His clinical manifestations included nephrotic syndrome, and multiple enlarged lymph nodes. Renal biopsy showed minimal change disease, and cervical lymph node biopsy showed Castleman's disease. The patient received treatment of glucocorticoid combined with tocilizumab, and then rituximab. After 14 months of follow-up, the patient achieved remission of nephrotic syndrome.

Objective To analyze the clinical and pathological data of 15 patients with light chain amyloidosis initially diagnosed with other kidney diseases, and identify possible misdiagnosis reasons. Methods It was a retrospective observational study. The clinical and pathological data of 15 patients, whose initial kidney biopsies failed to diagnose light chain-amyloidosis but were confirmed by a subsequent kidney biopsy or pathology consultation at Peking University First Hospital from January 2010 to December 2022 were collected. The results of immunofluorescence, Congo red staining, and electron microscopy of two renal biopsies were analyzed. Results The median age of 15 patients was 56 years old, with a male-to-female ratio of 7∶8. The main clinical manifestation was massive proteinuria with normal kidney function, and there were 10 cases presenting as nephrotic syndrome. The initial diagnosis based on the first kidney biopsy included minimal change disease (8 cases), IgA nephropathy (3 cases), membranous nephropathy (3 cases), and type Ⅲ collagen glomerulonephritis (1 case). M proteinemia was not evaluated in 13 patients during the first kidney biopsy. Light chain immunofluorescence staining was not performed in 12 cases. Congo red staining was not performed in 13 cases. All fifteen patients received glucocorticoids combined with immunosuppressive therapy after their initial diagnosis, and 5 patients developed severe infection. After 12.0 (7.5, 20.0) months of treatment, none of them achieved clinical remission. Thirteen had evidences for M protein before the second kidney biopsy. The renal tissues of all patients underwent immunofluorescence light chain examination, Congo red staining, and immunoelectron microscopy examination when necessary. The repeat kidney biopsies of 14 cases and pathology consultation of one case consistently indicated light chain-amyloidosis. The kidney tissues in 13 cases were confirmed to be light chain restricted, 11 cases by immunofluorescence, and 2 cases by immune electron microscopy. After diagnosis of light chain-amyloidosis, all patients received targeted plasma cell therapy except for 1 patient lost to follow-up, 6 patients achieved hematologic remission, 5 patients achieved renal remission, 1 patient entered end-stage renal disease, and 3 patients died. Conclusions In middle and elderly-aged patients with nephrotic syndrome, if conventional immunosuppressive therapy yields unsatisfactory results, it is crucial to focus on identifying evidences of monoclonal immunoglobulinemia, if necessary, kidney biopsy should be actively repeated. Kidney biopsy pathology should include comprehensive examinations such as light chain immunofluorescence, Congo red staining, and electron microscopy to avoid misdiagnosis of light chain-amyloidosis.