Objective To observe the efficacy of eculizumab in children with atypical hemolytic uremic syndrome. Methods It was a single-center observational study. The clinical data of children diagnosed with atypical hemolytic uremic syndrome and treated with eculizumab in Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2023 to May 2024 were retrospectively collected. Eculizumab was used at the conventional dose based on the children 's weight. Event-free survival (no death or end-stage renal disease) rate, complete remission rate and recurrence rate of thrombotic microangiopathy in children with atypical hemolytic uremic syndrome after eculizumab treatment were analyzed. The complete remission time of estimated glomerular filtration rate, hemoglobin, platelet, lactic dehydrogenase, urine routine and the adverse reactions during the treatment were observed. Whole exome sequencing was used to conduct genetic testing based on blood samples of the children and their parents. Results There were 4 children enrolled in the study. Four children were all Han Chinese, including 3 males and 1 female. The median age of onset was 8 years (ranging from 7 to 10 years). Two patients had complement gene abnormalities, both of which were homozygous deletions of complement factor H-related 1 and complement factor H-related 3. All the patients were free of plasma exchange or perfusion after treatment with eculizumab, and the 6-month event-free survival rate and thrombotic microangiopathy complete remission rate were both 4/4. The complete remission time was 19 (14-28) days. The time for the complete recovery of platelets, lactate dehydrogenase, estimated glomerular filtration rate and hemoglobin in 4 children was 4 (1-5), 19 (14-28), 10 (5-14) and 29 (20-42) days, respectively. Except for 1 patient whose urine routine fluctuated between negative and weakly positive expression, the other 3 patients had normal urine routine. All the patients discontinued eculizumab. Two patients without gene mutations discontinued eculizumab after 7 doses, and there was no recurrence during the 1-year follow-up after drug withdrawal. Two patients with genetic abnormalities discontinued eculizumab after 26 weeks of treatment, and no recurrence was found during the 3-month follow-up after drug withdrawal. One patient developed rash approximately 7 days after receiving the third dose of eculizumab. The rash was relieved after anti-allergic treatment, and there was no recurrence after the continued use of eculizumab. Conclusion Eculizumab is effective and safe in the treatment of children with atypical hemolytic uremic syndrome. Discontinuation of eculizumab can be considered in patients without gene mutations when their condition is stable, but close monitoring and follow-up are needed after drug withdrawal.

Monoclonal gammopathy of renal significance (MGRS) refers to a spectrum of kidney disorders caused directly or indirectly by monoclonal immunoglobulin or its components. Early and precise diagnosis of MGRS, along with targeted therapies against pathogenic B-cell or plasma cell clones, is critical for improving renal prognosis. Renal biopsy remains the gold standard for diagnosis of MGRS, and which is not only essential for definitive diagnosis but also indispensable for precise classification of MGRS. To assist clinicians in the rational and standardized application of renal biopsy for early and accurate diagnosis of MGRS, the expert group of expert recommendations on renal biopsy evaluation of MGRS developed the expert recommendations on renal biopsy evaluation of monoclonal gammopathy of renal significance. This consensus elaborates on updated MGRS classifications, indications for renal biopsy, pathological evaluation, as well as the techniques for monoclonal immunoglobulin detection and clone identification. It further formulates six clinically actionable recommendations, aiming to provide an evidence-based guidance for clinical practice and improve the diagnosis and treatment of MGRS.

Anti-vascular endothelial growth factor (VEGF) drugs inhibit tumor angiogenesis by blocking the VEGF-VEGF receptor signaling pathway and serve as a key therapeutic option for rat sarcoma viral oncogene homolog wild-type metastatic colorectal cancer. However, these drugs may induce kidney damage through mechanisms such as excessive activation of the local complement system, reduced production of prostaglandin E2 and abnormal endothelial cell-podocyte crosstalk. The diagnosis of kidney damage associated with anti-VEGF drugs is based on pathological findings, with thrombotic microangiopathy being a characteristic feature. Given that cancer patients are frequently treated with multiple potentially nephrotoxic drugs, a renal biopsy is recommended when proteinuria or other signs of kidney damage are detected. After confirmation, anti-VEGF drugs should be promptly discontinued, and individualized strategies based on proteinuria severity should be implemented. Since renal impairment may affect cancer therapy, early recognition and intervention are crucial. The current understanding of this disease in China remains limited. This article reviews its pathogenesis, pathological features, and treatment strategies, aiming to provide a reference basis for clinical practice.

Acute kidney injury (AKI), a life-threatening clinical syndrome, lacks effective therapeutic interventions beyond supportive care such as hemodialysis and kidney transplantation. Pathologically, excessive reactive oxygen species -mediated oxidative stress is recognized as a pivotal contributor to AKI progression, positioning reactive oxygen species scavenging as a critical therapeutic target. Emerging nanozymes, nanomaterials with enzyme-mimetic activities, have shown promise in addressing AKI by targeting renal oxidative stress. The article mainly reviewed the content of classification of nanozymes, research findings on nanozymes in treating AKI along with discussions on their mechanisms of action, as well as the current challenges and existing issues in nanozymes-based AKI therapy, to provide enhanced research perspectives for advancing nanozyme applications in the prevention and treatment of AKI.

Objective To investigate the association between serum IgG concentration and renal prognosis in patients with IgA nephropathy (IgAN). Methods It was a multi-center retrospective cohort study, patients with biopsy proven primary IgAN who were recorded in the Chinese IgA Nephropathy Information Registration System between April 1996 and September 2018 were included. Exclusion criteria were: (1) age <18 years; (2) <8 glomeruli in biopsy specimens; (3) estimated glomerular filtration rate (eGFR) <15 ml·min^-1·(1.73 m²)^-1 at biopsy; (4) missing baseline serum IgG values; (5) incomplete follow-up data; (6) follow-up duration <12 months. Enrolled patients were divided into 3 groups according to the baseline tertiles of serum IgG: ≤9.50 g/L (G1 group), 9.51-11.99 g/L (G2 group), and ≥12.00 g/L (G3 group). Clinical, and pathological parameters were compared across groups. The endpoint events were defined as doubled serum creatinine level from baseline, or end-stage renal disease (ESRD). Results A total of 1 976 IgAN patients were included in this study, 631 were in G1 group, 664 in G2 group, and 681 in G3 group. The comparison of baseline clinical data showed that there were statistically significant differences among the three groups in terms of gender, age, microscopic hematuria, edema, body mass index, systolic blood pressure, diastolic blood pressure, hemoglobin, serum creatinine, eGFR, 24-hour urine protein quantity, blood uric acid, blood albumin, serum IgA, serum IgM, the proportion of using immunosuppressants, and the proportion of using glucocorticoids (all P<0.05). In terms of pathology, the higher the serum IgG concentration, the relatively less severe the overall renal pathological damage. The results of univariate Cox regression analysis showed that gender, systolic blood pressure, diastolic blood pressure, hemoglobin, serum creatinine, eGFR, 24-hour urine protein quantity, total protein, serum albumin, globulin, serum IgG, Oxford renal pathological classification, glomerular sclerosis ratio, and glomerular IgM deposition were all associated with the occurrence of renal endpoint events (all P<0.05). Based on clinical practice and previous studies, after adjusting for gender, age, systolic blood pressure, diastolic blood pressure, eGFR, 24-hour urine protein quantity, body mass index, Oxford renal pathological classification, glomerular sclerosis ratio, and the use of renin-angiotensin-aldosterone system inhibitors, glucocorticoids, and immunosuppressants, multivariate Cox regression analysis showed that as a continuous variable, the baseline serum IgG level (HR=0.91, 95% CI 0.87-0.96) was independently associated with the risk of renal endpoint events in IgAN patients; as a categorical variable, with serum IgG ≤ 9.50 g/L as the reference, serum IgG 9.51-11.99 g/L and serum IgG ≥ 12.00 g/L were independent factors for the occurrence of renal endpoint events in IgAN patients (HR=0.69, 95% CI 0.49-0.96, P=0.027; HR=0.50, 95% CI 0.34-0.74, P<0.001). During a median follow-up of 33(21, 53) months started from the date of renal biopsy and continued until December 31, 2019, the median follow-up duration was 33 (21, 53) months, and a total of 232 patients (11.74%) reached the composite endpoint. Kaplan-Meier survival analysis showed that the higher the serum IgG concentration in patients with IgAN, the higher their cumulative renal survival rate (Log-rank test, χ²=47.176, P<0.001). Conclusion The higher level of serum IgG at diagnosis is associated with better clinicopathologic features and renal outcomes, and may portend better renal survival in IgAN patients.

The cardiovascular-kidney-metabolic syndrome (CKM) is a systemic disease caused by the interaction and mutual influence of cardiovascular diseases, chronic kidney disease, and metabolic abnormalities. It severely impairs patients' quality of life, increases the risk of death, and has become a serious global public health issue. Sodium-glucose transporter 2 inhibitor (SGLT2i) is a novel class of oral hypoglycemic agent with both cardiorenal protection and metabolic regulation effects. It has become an emerging strategy to prevent the onset, slow the progression, and improve the prognosis of CKM. This article provides a comprehensive review of the current applications of SGLT2i in CKM and their potential mechanisms for ameliorating metabolic risk factors and conferring cardio-renal protection, thereby offering a theoretical foundation for the clinical use of SGLT2i in patients with this newly defined critical clinical condition.

Glucocorticoid therapy constitutes an essential and pivotal element in the management of lupus nephritis. Nevertheless, prolonged administration of glucocorticoids may result in systemic toxicities that adversely affect patients' quality of life and elevate mortality rates. Currently, there is a lack of definitive guidelines regarding the timing and methodologies for glucocorticoid tapering. This article aims to summarise the current evidence on glucocorticoid tapering strategies for lupus nephritis from various guidelines and studies to provide enhanced references for clinical practice.

Objective To evaluate the efficacy and safety of rituximab (RTX) in the treatment of idiopathic membranous nephropathy (IMN), explore the influencing factors of the therapeutic effect and construct a nomogram model for predicting the therapeutic effect. Methods A single retrospective study was conducted in IMN patients in the First Affiliated Hospital of Zhejiang University School of Medicine from January 2017 to December 2022. All patients received monotherapy with RTX and were followed up for at least 12 months. RTX regimen adopted a B-cell guided regimen to achieve 0 cells/μl of peripheral blood CD19+ B cells through multiple administrations, followed by monitoring every 2?3 months and adding doses as needed to maintain this state. The complete response rate, partial response rate, and composite response rate at 6 months, 12 months and the end of follow up were analyzed. Logistic stepwise regression and R language were applied to construct a nomogram model for efficacy prediction. The receiver operating characteristic (ROC) curve, calibration curve and Hosmer-Lemeshow test were used to internally validate the nomogram model. Results A total of 147 IMN patients were included in the study, with age of 56 (47, 65) years, 99 (67.4%) males. There were 69 (46.9%) newly treated patients, 78 (53.1%) retreatment patients. The follow-up time was 14.4 (12.0, 15.0) months. The total RTX dose was 1 800 (1 200, 2 400) mg. The composite response rates at 6 months, 12 months and the end of the follow-up were 36.7% (54/147), 59.9% (88/147) and 63.3% (93/147), respectively. The complete remission rates at 6 months, 12 months and the end of the follow-up were 6.1% (9/147), 13.6% (20/147) and 19.7% (29/147), respectively. Logistic stepwise regression analysis showed that age ≥ 65 years (OR=0.335, 95% CI 0.135?0.833), retreatment (OR=0.333, 95% CI 0.144?0.771), high cholesterol (OR=0.716, 95% CI 0.577?0.888), high serum creatinine (OR=0.978, 95% CI 0.963?0.993) and B-cell reconstruction within 6 months (OR=0.273, 95% CI 0.115?0.645) were independent correlated factors affecting composite remission. Based on these factors, a nomogram model for predicting the therapeutic effect of RTX in IMN patients was constructed. The ROC curve indicated that the accuracy of this model in predicting composite remission was good (AUC=0.814, 95% CI 0.744-0.883). The calibration curve showed that the predicted composite response rate had a good fit with the actual response rate (Hosmer-Lemeshow test χ²=11.917, P=0.155). Conclusions RTX has good efficacy and safety as a monotherapy for IMN patients. The constructed nomogram prediction model has high discrimination and accuracy to predict the efficacy of RTX treatment for IMN.

Pheochromocytoma is a neuroendocrine tumor that produces catecholamines, leading to elevated blood pressure and metabolic changes in patients. It can result in serious complications affecting the heart, brain, kidneys, and blood vessels, potentially becoming a primary cause of death. Most pheochromocytoma patients present with atypical symptoms, making misdiagnosis or missed diagnosis common. This article reports a case of pheochromocytoma crisis misdiagnosed as severe viral myocarditis and includes a review of the relevant literature.

TAFRO syndrome is an idiopathic systemic inflammatory disease that overlaps with idiopathic multicentric Castleman disease (iMCD). The clinical features of TAFRO syndrome include thrombocytopenia (T), anasarca (A), fever (F), reticulin fibrosis/renal insufficiency (R) and organomegaly (O). The paper reports a special clinical subtype of iMCD—TAFRO syndrome in a patient, manifested as multiple-system involvement including serous effusion (ascites), fever, thrombocytopenia, anemia, multiple lymphadenopathies, pancreatitis and renal insufficiency. Bone marrow biopsy pathology showed active bone marrow hyperplasia. Renal biopsy revealed renal thrombotic microangiopathy, acute renal tubular interstitial injury combined with chronic lesions. Lymph node biopsy demonstrated lymphoproliferative lesions consistent with Castleman disease (hyaline vascular type). Following diagnosis, glucocorticoids, tacrolimus, rituximab and lenalidomide were administered, resulting in significant symptomatic improvement: ascites disappeared, and urinary findings, erythrocyte counts, renal function and hematological indexes normalized. The paper describes the patient's clinical manifestations, diagnosis and treatment process, and prognosis, and reviews relevant literature, to improve clinicians' understanding of this rare disease.

Calciphylaxis, also known as calcific uremic arteriopathy (CUA), is a rare arteriosclerosis disease characterized by skin ischemia and necrosis with severe pain, which occurs in end-stage renal disease patients. The efficacy of sodium thiosulfate (STS) in CUA has been widely verified and affirmed. However, there is no unified standard for the use of STS at home and abroad.This article introduced a case of severe CUA patient who had achieved good results under different STS usage treatments, and summarized the different STS usage treatments for CUA combined with literature.

Objective To explore the correlation between serum creatinine/cystatin C ratio (Scr/CysC) and muscle mass and muscle strength, and evaluate the predictive value of Scr/CysC for all-cause mortality in peritoneal dialysis patients. Methods It was a prospective cohort study. The patients who received regular peritoneal dialysis treatment for more than 3 months and had stable conditions in the Renal Division of Peking University First Hospital from April 1, 2011 to August 1, 2012 were included, and the clinical data were collected. The patients were divided into the male group and the female group, and the differences of clinical data between the two groups were compared. The lean body mass (LBM) directly measured by the dual-energy X-ray absorptiometry (LBM-DEXA) was used as the reference gold standard and compared with the LBM estimated by the creatinine method (LBM-CK) and the anthropometric method (LBM-A). Muscle strength was measured by a grip strength meter for the dominant hand grip strength. Pearson correlation and multiple linear regression analysis method were used to analyze the correlations between Scr/CysC and LBM as well as grip strength, and subgroup analyses were conducted according to gender groups. Cox regression model was used to analyze the value of Scr/CysC in predicting all-cause mortality in peritoneal dialysis patients. Results A total of 213 peritoneal dialysis patients were included in this study, including 95 males (44.6%) and 118 females (55.4%). The age was (56.46±12.42) years old. The dialysis age was 24.0 (9.0, 52.5) months. The baseline Scr/CysC was (1.77±0.73). LBM-DEXA (t=-17.764, P<0.001), LBM-CK (t=-7.702, P<0.001), LBM-A (t=-16.813, P<0.001), grip strength (t=-11.083, P<0.001) and Scr/CysC (t=-2.965, P=0.003) in the male group were all significantly higher than those in the female group. Pearson correlation analysis showed that Scr/CysC was positively correlated with LBM-DEXA (r=0.204, P=0.003), LBM-CK (r=0.279, P<0.001), LBM-A (r=0.198, P=0.004), and grip strength (r=0.341, P<0.001). Multiple linear regression analysis showed that Scr/CysC wasn't independently correlated with LBM-DEXA, but was independently correlated with grip strength (β=0.134, P=0.006). Cox regression analysis showed that baseline Scr/CysC was not an independent influencing factor of all-cause mortality in peritoneal dialysis patients (HR=1.005, 95% CI 0.751-1.346, P=0.972). Conclusion Scr/CysC is associated with muscle mass and muscle strength in peritoneal dialysis patients, but has no value in predicting all-cause mortality in peritoneal dialysis patients.

Sodium-glucose transporter 2 (SGLT2) encoded by the SLC5A2 gene, is localized on the brush border membrane of renal proximal tubules and mediates the reabsorption of approximately 90% of glucose filtered by the glomeruli. It serves as the molecular basis for familial renal glucosuria (FRG). SGLT2 inhibitors have been widely used to treat diabetes, diabetic nephropathy, chronic kidney disease, and other conditions. The 17 kDa membrane-associated protein (MAP17) regulates SGLT2 function, and mutations in the gene encoding MAP17 can lead to FRG. Investigations into genotype-phenotype correlations in FRG patients and the structural biology of SGLT2 are critical for understanding its physiological mechanisms and pharmacological actions of SGLT2 inhibitors. This review summarizes current knowledge on genotype-phenotype relationships in FRG, advances in SGLT2 protein structure research, and MAP17-mediated regulation of SGLT2. These insights elucidate SGLT2's physiological roles and provide a theoretical foundation for optimizing clinical applications of SGLT2 inhibitors.

A total of 269 non-diabetic chronic kidney disease (CKD) patients were enrolled in this study. Among them, 175 patients (65.1%) were assigned to the control group and received conventional therapy with maximally tolerated doses of renin-angiotensin-aldosterone system inhibitors, while 94 patients (34.9%) were assigned to the dapagliflozin group and received oral dapagliflozin 10 mg/day in addition to the conventional therapy. The results showed that the urine protein quantity in the dapagliflozin group was lower than those in the control group at 3, 6, 12, 18, and 24 months of follow-up (all P<0.05), and the blood albumin level was higher than those in the control group at 18 and 24 months of follow-up (all P<0.05). The Kaplan-Meier survival curve analysis results showed that the cumulative renal survival rate of the dapagliflozin group was significantly higher than that of the control group (Log-rank test, χ ²=5.078, P=0.024). Multivariable Cox regression analysis results revealed that using dapagliflozin was independently associated with a reduced risk of the composite endpoint in non-diabetic CKD patients (HR=0.400, 95%CI 0.163-0.983, P=0.046). There was no statistical difference in adverse reactions between the two groups (all P>0.05). It is indicated that dapagliflozin has a renal protective effect independent of hypoglycemic action and good safety.

Objective To evaluate the impact of roxadustat on thyroid function and to identify the associated factors in patients undergoing maintenance peritoneal dialysis (PD). Methods This study was a single-center retrospective study. PD patients who received roxadustat or recombinant human erythropoietin (rHuEPO) treatment at Nanjing Drum Tower Hospital between January 2020 and June 2024 were included. The general and clinical information as well as laboratory indexes were collected. Serum free triiodothyronine (FT3), free thyroxine (FT4) and thyroid?stimulating hormone (TSH) were compared before and after treatment initiation. Hemoglobin (Hb) responses were also observed between the two groups. Logistic regression analysis was performed to explore the factors associated with thyroid function changes. Results A total of 120 patients were enrolled, with an age of (55.17±16.42) years, including 66 males (55.0%). There were 81 patients received roxadustat (roxadustat group) and 39 patiens received rHuEPO (rHuEPO group). Compared to the rHuEPO group, the roxadustat group had a higher proportion of patients with diabetes (χ²=4.172, P=0.041), a shorter PD vintage (Z=-3.406, P=0.002), a lower serum level of total cholesterol (Z=-2.082, P=0.037) and a lower level of fasting blood glucose (Z=-2.589, P=0.010). Following treatment with roxadustat, the levels of FT4 (Z=-5.349, P<0.01) and TSH (Z=-3.720, P<0.01) decreased significantly. In contrast, no significant changes in FT4 or TSH levels were observed in the rHuEPO group (both P>0.05). For both roxadustat and rHuEPO groups, there were no significant changes in FT3 levels after treatment (both P>0.05). Multivariate analysis identified that higher baseline TSH (TSH≥2.27 μIU/ml, OR=1.581, 95% CI 1.196-2.089, P=0.001) and roxadustat exposure (OR=3.432, 95% CI 1.410-8.355, P=0.007) as independent associated factors of subsequent TSH decline, and identified that higher baseline FT4 (FT4≥14.9 pmol/L, OR=1.390, 95% CI 1.162-1.662, P=0.001) and roxadustat exposure (OR=5.798, 95% CI 2.225-15.113, P=0.001) as independent associated factors of subsequent FT4 decline. The degrees of hemoglobin changes after roxadustat or rHuEPO treatment did not differ significantly between roxadustat group and rHuEPO group (t=-1.062, P=0.290). Of the 31 patients who underwent a second thyroid function test during roxadustat treatment, 24 continued with the original regimen, while 7 discontinued roxadustat. Among 24 patients who maintained roxadustat treatment, TSH (Z=-0.400, P=0.689) and FT4 (t=0.143, P=0.888) remained stable between the second and third tests. All 7 patients who discontinued roxadustat treatment showed TSH rebound and the changes of TSH levels were more significant than that in continuers (Z=-2.505, P=0.012). FT4 recovery occurred in only 3 of them, with no significant difference in FT4 change between discontinuers and continuers (Z=-0.685, P=0.493). Conclusions Roxadustat commonly suppresses TSH and FT4, but not FT3, in PD patients. Baseline levels of TSH and FT4 are key associated factors of the inhibitory effect of roxadustat on thyroid function. This suppression does not intensify with prolonged exposure and is reversible after discontinuation, with TSH levels normalizing more quickly than FT4. Roxadustat‐induced thyroid suppression does not compromise its efficacy in treating renal anemia.

Akkermansia muciniphila, a probiotic is discovered years earlier, colonizes the human intestinal mucosa. In recent years, researchers have found the correlation between Akkermansia muciniphila and progression of kidney diseases based on the theory of the gut-kidney axis. The abundance of Akkermansia muciniphila in the gut changes during the onset, regression and treatment of renal diseases such as congenital nephrology, chronic kidney disease, complications after renal transplantation. The research on the correlation between Akkermansia muciniphila and renal diseases is still in the initial stage. The review introduces the research progress on the role of Akkermansia muciniphila in renal diseases from three aspects: the biological characteristics of Akkermansia muciniphila, the abundance change in the progression of renal diseases, and their biological effects to provide references for the following research on the mechanisms of Akkermansia muciniphila in renal diseases and the application of clinical renal disease treatment.

Objective To explore the associated factors for membranous nephropathy (MN) patients with IgM deposition, and to construct a prediction model. Methods This study was a retrospective cohort study. Patients diagnosed with MN with IgM deposition by renal biopsy in the Fourth Hospital of Hebei Medical University from February 2017 to December 2023 were retrospectively included. Clinical and pathological data were collected. The study population was randomized into a training set and a validation set at a 7:3 ratio. The endpoint event was defined as the remission of MN, and the patients were divided into remission group and non-remission group to compare the clinical and pathological examination results. Least absolute shrinkage and selection operator regression analysis and Cox regression analysis were used to explore the associated factors of poor prognosis of MN patients with IgM deposition. Internal validation was conducted using the validation set data. The clinical efficacy of the predictive model was evaluated by calculating the area under the receiver operating characteristic (ROC) curve and generating calibration curves. The total nomogram score for each patient was calculated based on the training set data, and the predictive performance was assessed by plotting the ROC curve. Patients were then stratified into low-risk and high-risk groups according to the optimal cut-off value derived from the ROC analysis of the total nomogram score. Kaplan-Meier survival analysis was performed to compare the remission rate between the two groups. Model performance was evaluated using the validation set. Results A total of 200 MN patients with IgM deposition were included, and 49.0% of them achieved clinical remission. In the training set, statistically significant differences were observed in 24-hour urine protein quantification (Z=-2.638, P=0.008), renal arteriolar wall thickening (χ2=6.891, P=0.009), the proportion of patients receiving immunosuppressive therapy (χ2=21.381, P<0.001), and the proportion of patients treated with corticosteroids combined with cyclophosphamide (χ2=10.107, P=0.001). Through least absolute shrinkage and selection operator regression and Cox regression, 2 factors associated with clinical remission in MN patients with IgM deposition were simultaneously identified from 16 potential associated factors, including the use of immunosuppressants (HR=3.823, 95% CI 2.055-7.113, P<0.001), and renal arteriolar wall thickening (HR=0.428, 95% CI 0.221-0.831, P=0.012). Incorporating the clinical measurement of phospholipase A2 receptor (PLA2R) antibodies, a predictive model was established. The performance of the model was evaluated using the training dataset, yielding an area under the ROC curve of 0.731 (95% CI 0.648-0.814), with a sensitivity of 88.7% and a specificity of 55.1%. The optimal cut-off value was a total nomogram score of 41.7 points. The Kaplan-Meier survival analysis showed that the remission rate was significantly higher in the low-risk group than that of the high-risk group (Log-rank test, χ2=33.525, P<0.001). Model validation was performed using the validation dataset, which showed an AUC of 0.715 (95% CI 0.591-0.839), sensitivity of 70.4%, and specificity of 63.6%. Similarly, the Kaplan-Meier survival analysis demonstrated a significantly higher remission rate in the low-risk group than in the high-risk group (Log-rank test, χ2=8.467, P=0.004). Conclusion A nomogram predictive model for remission of MN patients with IgM deposition, based on serum PLA2R antibody levels, the use of immunosuppressive therapy, and renal arteriolar wall thickening is developed. The model demonstrates a moderate clinical applicability.

Objective To evaluate the efficacy and safety of daratumumab in treating patients with monoclonal immunoglobulin deposition disease (MIDD) with renal injury. Methods A case-series analysis study was conducted in MIDD patients with renal injury who received daratumumab treatment at the Department of Nephrology, Ruijin Hospital, affiliated to Shanghai Jiao Tong University School of Medicine, from December 2021 to October 2023. The clinical data of patients at the time of diagnosis and during the follow-up period were collected. Hematological and renal responses were assessed and adverse reaction events were recorded. Results Seven patients diagnosed with MIDD were included in this study, with a male-to-female ratio of 5∶2 and age of 46 (43, 52) years. One patient was light?heavy chain deposition disease, and the remaining 6 patients were light chain deposition disease. Among them, 5 patients had received prior treatment (1-2 lines of treatment with the regimen of cyclophosphamide, bortezomib and dexamethasone), while 2 patients were newly treated, one of whom had already started hemodialysis at diagnosis. Prior to receiving monoclonal antibody treatment, difference of serum free light chain (dFLC) among the 7 patients was 52 (7, 295) mg/L. Excluding 1 patient on dialysis, the remaining 6 patients had 24-hour urinary protein of 1.1 (0.2, 4.7) g, serum creatinine of 178.5 (157.8, 279.8) μmol/L and estimated glomerular filtration rate of 33.9 (24.2, 41.1) ml·min^-1·（1.73 m²）^-1. The daratumumab treatment was 17 (10, 20) infusions, with treatment duration of 17 (9, 23) months and follow-up time of 24 (13, 32) months. After treatment, among 5 previously treated patients, hematological response evaluation showed that 1 patient with baseline dFLC <20 mg/L and minimal residual disease negativity upon re-examination, while the remaining 4 patients achieved hematological responses of complete response or better. Renal response evaluation revealed that, except for 1 patient with partial response, the other 4 patients achieved very good partial response (VGPR) or better. Among 2 newly diagnosed patients, both achieved hematological efficacy at least VGPR, with one achieving renal complete response, while the other one remaining dialysis- dependent. Overall, dFLC of 7 patients was 4.9 (2.1, 11.5) mg/L. Among 6 non-dialysis patients, 24-hour urinary protein was 0.19 (0.06, 0.42) g, serum creatinine was 153.0 (120.8, 188.0) μmol/L and estimated glomerular filtration rate was 40.4 (35.2, 57.3) ml·min^-1·(1.73 m²)^-1. No severe adverse reactions were observed during daratumumab treatment. Conclusion The application of daratumumab in the treatment of MIDD with renal injury is effective and well tolerated, achieving high-quality hematological responses, with high renal responses reaching or exceeding VGPR and improvement of renal function.

Objective To investigate the clinical features, treatment strategies and prognosis of adult thrombotic thrombocytopenic purpura (TTP) patients and improve the clinicians' understanding of TTP. Methods It was a case series analysis study. The clinical data of TTP patients admitted to ZhongDa Hospital affiliated to Southeast University from August 2013 to November 2024 were retrospectively collected. The clinical manifestations, laboratory tests, treatment methods and prognosis of TTP patients were analyzed. Kaplan-Meier method and multivariate Cox proportional hazards regression model were utilized to assess the association between rituximab treatment and survival outcomes. Results The study included 24 TTP patients, with age of (58.38±15.03) years (21 to 87 years), 14 females (58.33%) and 10 males (41.67%). The first symptoms were often neurological abnormalities (lethargy, coma, sudden glossolalia or unconsciousness (10 patients, 41.67%). Five patients (20.83%) had the quinary syndrome, including fever, microangiopathic hemolytic anemia, thrombocytopenia, renal insufficiency and neurological symptoms, and 13 patients (54.17%) had the triad syndrome, including neurological syndromes, microangiopathic hemolytic anemia and thrombocytopenia. Twenty-three patients (95.83%) had anemia. Twenty patients (83.33%) presented with neurological abnormalities, among which 10 patients died of neurological events. Renal insufficiency occurred in 14 patients (58.33%). Nine patients (37.50%) presented with large areas of skin ecchymosis. Except for 1 patient complicating with lung adenocarcinoma and 1 patients complicating with bone metastasis tumor, the other patients had no active tumors. All 24 patients had PLASMIC scores ≥ 4 points, of which 11 patients (45.83%) had PLASMIC scores ≥ 6 points. Fourteen patients (58.33%) received the treatment for plasma exchange, and 7 patients (29.17%) did not undergo plasma exchange and received component transfusion and glucocorticoids therapy with poor prognosis due to rapid disease progression, old age or severe disease. Furthermore, 3 patients (12.50%) were only treated with component transfusion and glucocorticoids therapy for economic reasons, and died shortly after hospital discharge. Eight patients received plasma exchange, glucocorticoids combined with rituximab, of which one died, four survived, and three were lost to follow-up. Finally, fifteen patients (62.50%) died, 4 patients survived, and 5 patients were lost to follow-up (still alive before hospital discharge). Kaplan-Meier survival analysis demonstrated that mortality in the rituximab group was significantly lower than that in the non-rituximab group (Log-rank test, χ²=13.185, P<0.001). Multivariate Cox proportional hazards regression analysis further confirmed that no receiving rituximab was an independent correlated factor of death (HR=10.453, 95% CI 1.309-83.436, P=0.027). Conclusions TTP usually starts with neurological symptoms, and can affect multiple systems. The patients with neurological abnormalities have a poor prognosis. The patients with TTP have a rapid disease progression and a high mortality rate. Rapid identification and timely treatment are crucial for improving the prognosis of TTP. Combining rituximab based on plasma exchange and glucocorticoids may reduce mortality of TTP patients.

Patients with chronic kidney disease (CKD) are at increased risk of fractures, and accurate assessment of this risk remains a major clinical challenge. Traditional tools such as bone mineral density and fracture risk assessment tool show limited predictive performance in CKD population. In recent years, novel approaches including trabecular bone score, vertebral fracture assessment, hip structural analysis, quantitative computed tomography, high-resolution peripheral quantitative computed tomography, artificial intelligence, and bone turnover markers have been introduced for fracture risk assessment. These emerging techniques provide more comprehensive evaluation strategies, yet their clinical utility remains to be fully validated. This review summarizes current research progress on fracture risk assessment methods in CKD patients and highlights potential directions for improving risk prediction in CKD population.

This paper presents a rare case of renal amyloidosis complicated with primary minimal change disease. The patient initially presented with edema and proteinuria, accompanied by IgG-λ monoclonal immunoglobulinemia, leading to a diagnosis of primary systemic immunoglobulin light chain amyloidosis with renal involvement. Following treatment, the patient achieved both hematologic and renal remission. However, a renal relapse occurred two years later, presenting as nephrotic syndrome without hematologic disease recurrence. A repeat renal biopsy revealed no obvious change in amyloid deposition, but demonstrated markedly enlarged effacement of podocyte foot processes. Based on these findings, a secondary diagnosis of primary minimal change disease was established. The patient exhibited a rapid response to immunosuppressive therapy, achieving sustained long-term remission. This case underscores the importance of remaining vigilant to etiological changes in the treatment of renal diseases and highlights the role of repeated renal biopsy in refining the diagnosis and guiding treatment.

Autogenous arteriovenous fistula (AVF), compared to other vascular access routes, offers the advantages of stable blood flow, fewer complications, and a longer service life, making it the primary type of vascular access and the first choice for hemodialysis patients. The failure rate of AVF maturation is as high as 20% to 60%, primarily due to intimal hyperplasia following AVF surgery. Currently, the origin, function, and differentiation status of neointimal cells are not well understood, and most knowledge about neointimal cells was inferred from arterial neointima in non-AVF systems. Understanding the source of neointimal cells in AVF is crucial for experimental design and effectively providing strategies to reduce intimal hyperplasia. This article reviews the situation of venous intimal hyperplasia in patients with stage 5 chronic kidney disease, the relationship between changes in venous vessel wall and neointimal cells after AVF surgery, and the effects of outer membrane fibroblasts, local smooth muscle cells, and circulating bone marrow progenitor cells on AVF intimal hyperplasia. It is hoped that this will provide a reference for the treatment of intimal hyperplasia and experimental research.

Objective To investigate the effects and mechanisms of cyclic adenosine monophosphate (cAMP) on cisplatin-induced acute kidney injury (AKI). Methods GSE227970 dataset derived from human renal tubular epithelial cells (HK-2 cells) in the GEO database was downloaded, and Kyoto Encyclopedia of Genes and Genomes and Gene Ontology analysis were performed in normal and cisplatin-damaged cells. Eighteen 8-week-old male C57BL/6J mice with body weight of (22±2) g were randomly divided into normal group, cisplatin group and cAMP group according to random number table method, with 6 mice in each group. cAMP group was intraperitoneally injected with 30 mg/kg glumine cyclic adenosine monophosphate, while normal group and cisplatin group were intraperitoneally injected with the same volume of 0.9% sodium chloride solution for 10 consecutive days. The cisplatin and cAMP groups were intraperitoneally injected with 20 mg/kg cisplatin once on the 8th day. The body weight and kidney weight of mice were weighed, and kidney weight to body weight ratio was calculated. The blood urea nitrogen (BUN) and serum creatinine (Scr) in mice were detected. HE staining was used to evaluate the degree of renal injury. Western blotting was used to detect the protein expression of AMP-activated protein kinase (AMPK)/acetyl-CoA carboxylase (ACC) signaling pathway in renal tissues. In vitro experiments, HK-2 cells were set up in normal group, cisplatin group, cAMP group and cAMP+AMPK inhibitor group. Immunofluorescence was used to detect the protein expression of phosphorylated (p)-AMPK in HK-2 cells. Adenosine triphosphate content and ratio of NAD⁺ to NADH in cells were detected. Flow cytometry was used to detect cell apoptosis. Results Biological signal analysis showed that axon guidance, Ras-related protein 1 signaling pathway and cAMP signaling pathway were significantly changed in cisplatin group. The body weight, kidney weight and kidney weight/body weight ratio in cisplatin group were significantly lower than those in normal group (all P<0.05). However, after cAMP treatment, kidney weight was significantly higher compared with cisplatin group (P<0.05), and body weight and kidney weight/body weight ratio also increased, but the differences were not statistically significant (both P>0.05). BUN, Scr and renal tubular injury score in cisplatin group were significantly higher than those in normal group (all P<0.05). After cAMP treatment, BUN, Scr and renal tubular injury score were significantly lower than those in cisplatin group (all P<0.05). Western blotting results showed that cAMP treatment could significantly increase the decreased AMPK/ACC signaling pathway protein in the renal tissues of cisplatin-induced mice (all P<0.05). In vitro experiments, immunofluorescence detection showed that the expression of p-AMPK protein in cisplatin-induced HK-2 cells decreased, and the addition of cAMP increased the expression of p-AMPK protein in cisplatin-induced HK-2 cells (all P<0.05). cAMP treatment could alleviate cisplatin-induced injury in HK-2 cells, restore the reduction of adenosine triphosphate content and NAD⁺/NADH ratio, and reduce the apoptosis induced by cisplatin (all P<0.05), while AMPK inhibitor could eliminate the protective effect of cAMP on cisplatin-induced injury in HK-2 cells. Conclusion cAMP can play a protective role in renal injury caused by cisplatin, and its mechanism may be related to activation of AMPK/ACC signaling pathway.

Objective To explore the predictive value of baseline complete blood count derivative marker levels for the occurrence of the first peritonitis in patients undergoing peritoneal dialysis (PD). Methods This study was a retrospective cohort study. The data of inpatients who underwent PD catheterization in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from April 1, 2005 to February 29, 2024 were collected and followed up until June 1, 2024. According to the 2022 International Society for Peritoneal Dialysis guidelines for peritonitis prevention and treatment, the patients were divided into the peritonitis group and the non-peritonitis group. Basic demographic data and laboratory parameters of the patients were collected, and inflammatory markers derived from complete blood count were calculated, including the comprehensive index of systemic inflammation, the systemic inflammation response index (SIRI), the ratio of hemoglobin to platelets (HPR), and the ratio of monocytes to lymphocytes (MLR). Cox regression analysis was conducted to identify factors associated with the occurrence of peritonitis. Results A total of 824 PD patients aged ≥18 years were included in this study. Among them, there were 398 males (48.30%), with an age of 42.06 (33.04, 52.01) years, and the follow-up time was 595.00 (173.50, 1 158.00) d. The proportion of conversion to hemodialysis or death in the peritonitis group was higher than that in the non-peritonitis group (40.91% vs. 13.58%, χ² =56.173, P<0.001). The age of the peritonitis group was greater than that of the non-peritonitis group [45.05(34.92, 52.99) year old vs. 41.11(32.89, 51.46) year old, Z=-1.978, P=0.048], and the follow-up time was lower than that in the non-peritonitis group [529.50(146.25, 861.00) d vs. 627.00(177.00, 1 222.50)d, Z=-2.260, P=0.024]. A multivariate Cox analysis model was constructed based on the univariate Cox analysis. After adjusting for covariates, the results showed the comprehensive index of systemic inflammation (HR=0.997, 95% CI 0.995-0.998, P<0.001), HPR (HR=0.520, 95% CI 0.271-0.995, P=0.048), MLR (HR=7.027, 95% CI 1.468-33.636, P=0.015) and SIRI (HR=2.673, 95% CI 1.302-5.488, P=0.007) were the related factors for the first occurrence of peritonitis. Conclusion The levels of inflammatory markers derived from baseline complete blood count, especially MLR, SIRI and HPR, are the independent influencing factors for the occurrence of the first peritonitis in patients with PD.

Protein-energy wasting and loss of muscle mass are prevalent in chronic kidney disease (CKD) patients and are strongly associated with adverse clinical outcomes, necessitating the development of simple and efficient assessment tools. Cystatin C, a cathepsin protease inhibitor, is produced consistently by nucleated cells and exhibits less dependence on muscle mass compared to creatinine. Emerging evidence suggests that combining serum cystatin C with serum creatinine enhances the evaluation of muscle mass and strength in CKD patients, while also demonstrating significant clinical prognostic utility. This article synthesizes current knowledge on biological characteristics and metabolic pathways of cystatin C, recent advances on its combined use with serum creatinine for assessing muscle mass, and its predictive value for clinical prognosis in CKD. The review aims to inform future research directions and clinical applications.

Objective To investigate the risk factors associated with 90-day mortality in critically ill patients receiving continuous renal replacement therapy (CRRT), with a particular focus on the association between hypotension within the first hour of CRRT initiation and 90-day mortality after hospital admission. Methods This study was a post hoc analysis of a prospective cohort study investigating the impact of colloid versus crystalloid priming solutions on early hemodynamics in critically ill patients undergoing CRRT. The study enrolled intensive care unit patients who received CRRT at West China Hospital of Sichuan University from January 2024 to May 2024. The data were collected including demographic characteristics, laboratory tests, CRRT-related parameters, blood pressure, heart rate, sequential organ failure assessment scores, and vasoactive-inotropic score, etc. The 90-day survival outcome after hospital admission of critically ill patients aged 18-80 years who received continuous veno-venous hemodiafiltration was used as the primary outcome indicator. A Cox proportional hazards model analysis was conducted, and the predictive ability of the model was evaluated along with the test of the proportional hazards assumption. The risk factors associated with the 90-day mortality after hospital admission of critically ill patients receiving CRRT were explored, with a particular focus on whether hypotension occurring within the first hour of CRRT initiation was one of these risk factors. Results A total of 208 patients were included in this study. Within 90 days after hospital admission, 141 patients (67.8%) died, among whom 102 were male (72.3%) and the median age was 61.0 (50.0, 71.5) years; 67 patients (32.2%) survived, among whom 53 were males (79.1%) and the median age was 56.0 (47.0, 68.0) years. The incidence of hypotension within the first hour of CRRT initiation was significantly higher in the death group than in the survival group [29.8% (42/141) vs. 16.4% (11/67), χ²=4.275, P=0.039]. Moreover, The mortality rate of the group with hypotension within the first hour of CRRT initiation was higher than that of the group without hypotension [79.2% (42/53) vs. 63.9% (99/155), χ²=4.275, P=0.039]. The Kaplan-Meier survival analysis showed that the median survival time of patients without hypotension within the first hour of CRRT initiation [39.0 d (95% CI 23.2-54.8)] was longer than that of patients with hypotension [26.0 d (95% CI 18.9-33.1)], and the 90-day cumulative survival rate after hospital admission of patients without hypotension was significantly higher than that of patients with hypotension (Log-rank test, χ²=5.100, P=0.024). Univariate and multivariate Cox proportional hazards analyses demonstrated that serum albumin (HR=0.964, 95% CI 0.933-0.997, P=0.030), sequential organ failure assessment score (HR=1.064, 95% CI 1.012-1.118, P=0.015), and the use of mechanical ventilation (HR=8.272, 95% CI 1.145-59.743, P=0.036) were significantly associated with 90-day mortality in critically ill patients undergoing CRRT. In contrast, the vasoactive-inotropic score (HR=1.004, 95% CI 0.999-1.008, P=0.079) and the presence of hypotension within the first hour of CRRT initiation (HR=1.236, 95% CI 0.833-1.835, P=0.293) were not significantly associated with 90-day mortality in critically ill patients undergoing CRRT. The consistency index of this model was 0.654 (95% CI 0.617-0.691), the area under the receiver operating characteristic curve was 0.724 (95% CI 0.658-0.800), and the calibration curve showed that the predicted values of the model were well fitted to the actual observations, suggesting that the predictive effect of this model was relatively ideal. Conclusions In critically ill patients undergoing CRRT, the occurrence of hypotension within the first hour of CRRT initiation was not significantly associated with 90-day mortality after hospital admission. Lower serum albumin levels, higher sequential organ failure assessment scores, and the use of mechanical ventilation may be the risk factors for 90-day mortality in this population.

Objective To develop a predictive model for adverse pregnancy outcomes in patients with pregnancy-related acute kidney injury (Pr?AKI) using machine learning methods. Methods This study was a single-center retrospective study. Patients with Pr?AKI in the First Affiliated Hospital of Xinjiang Medical University from January 2013 to December 2020 were included. Demographic characteristics, laboratory parameters, and fetal outcomes for comparative analysis between adverse pregnancy outcome group and favorable pregnancy outcome group were collected. Adverse pregnancy outcomes were defined as the occurrence of any one or more of the following events: stillbirth, perinatal death, preterm birth (reaching 28 weeks but less than 37 weeks), and low birth weight (< 2.5 kg). Conversely, an ideal pregnancy outcome was defined as the absence of any adverse pregnancy outcome events. The dataset was randomly divided into a training set (70%) and a validation set (30%). Logistic regression, decision tree, random forest, K-nearest neighbor, support vector machine, and lightweight gradient boosting algorithms were employed on the training set to develop predictive models for adverse pregnancy outcomes in patients with Pr?AKI. Receiver operating characteristic curves were plotted, and the area under the curves (AUC) were calculated. Recall, precision, accuracy, and F1 scores were used to evaluate the predictive performance of each model. The optimal machine learning model was selected for subsequent analysis. Predictive model variables were screened and compressed by visualizing SHAP (SHapley additive exPlanations) with recursive feature regression. Furthermore, the efficacy of each model was evaluated through calibration curves and clinical decision curves. The optimal predictive model was selected for internal validation using the validation set, and data of in-hospital Pr-AKI patients (72 cases) in the hospital from January 2021 to June 2023 were collected for validation (time series validation set). Results A total of 458 pregnancies in 441 patients were included in the present analysis, among which 277 cases (60.5%) resulted in adverse pregnancy outcomes. Utilizing the training set, 21 feature variables were selected for model construction. Among the 6 models, the random forest model performed the best (AUC=0.860, recall=0.784, precision=0.813, F1-score=0.790, accuracy=0.806). With subsequent feature refinement proceeding, a total of 12 clinical indicators were selected to construct the model. Among them, proteinuria, systolic blood pressure, and the highest serum creatinine were the top three related factors, and the other related factors included: severe preeclampsia, baseline serum creatinine, serum albumin, diastolic blood pressure, aspartate aminotransferase, blood uric acid, white blood cell count, serum cystatin C, and cholesterol. Among various machine learning models, the random forest model demonstrated optimal net benefits and the widest clinical utility range, showing robust performance in both internal validation set (AUC=0.80) and the time series validation set (AUC=0.72). Conclusions In this study, different machine learning algorithms are successfully applied to develop predictive models for adverse pregnancy outcomes in patients with Pr-AKI. The random forest model is translated into a clinically applicable tool, providing a reference for the convenient and rapid identification of adverse pregnancy outcomes in Pr-AKI patients.

Objective To compare the differences of long-term survival rates between hemodialysis (HD) and peritoneal dialysis (PD) in the oldest old end?stage renal disease (ESRD) patients, and analyze the influencing factors of mortality. Methods It was a retrospective cohort study. The clinical data from the oldest old patients (≥80 years old) who underwent HD or PD for the first time and maintained dialysis treatment for ≥3 months in the Zhejiang Dialysis Registration System from January 1, 2008 to December 31, 2021 were collected. The follow?up endpoint was until the patients' death or December 31, 2022. The propensity score matching method was used to match groups. Kaplan-Meier method and log-rank test were used to compare the differences of long-term survival rates between the two groups. Cox regression analysis was used to analyze the risk factors of mortality. Results A total of 5 880 the oldest old dialysis patients were included in this study, with 5 363 patients in the initial HD group and 517 patients in the initial PD group. After matching, there were 517 patients in the HD group and 517 patients in the PD group. The median survival time of HD group before matching was 39.9 months, with 1-year, 3-year, and 5?year survival rates of 85.4%, 54.9%, and 30.0%, respectively. The median survival time of PD group was 32.9 months, with 1?year, 3-year, and 5?year survival rates of 82.5%, 47.1%, and 22.3%, respectively. After matching, the median survival time of HD group was 40.3 months, and the 1-year, 3-year, and 5-year survival rates were 86.1%, 57.8%, and 29.1%, respectively. The survival rate of PD group remained unchanged. The difference of 1-year survival rate between the two groups was not statistically significant, but the 2-year, 3-year, 4-year, 5-year, and overall survival rates in HD group were higher than those in PD group (Log‐rank test, χ²=4.897, P=0.027; χ²=9.693, P=0.002; χ²=10.194, P=0.001; χ²=7.868, P=0.005; χ²=12.510, P<0.001). Multivariate Cox regression analysis showed that HD (HD/PD, HR=0.794, 95% CI 0.669-0.943, P=0.009), increasing age (HR=1.069, 95% CI 1.038-1.110, P<0.001), comorbidity with chronic obstructive pulmonary disease (HR=1.510, 95% CI 1.065-2.139, P=0.021) and serum albumin <35 g/L (HR=1.393, 95% CI 1.165-1.665, P<0.001) were independent correlated factors of mortality. Conclusions There is no significant difference in the 1-year survival rate between HD and PD groups. The survival rate for more than 1 year in HD patients is higher than that in PD patients. HD is an independent protective factor of survival, and increasing age, comorbidities of chronic obstructive pulmonary disease, and serum albumin <35 g/L are independent risk factors affecting the survival in the oldest old dialysis patients.

Artificial intelligence (AI) has been applied across numerous fields of nephrology, assisting physicians in optimizing clinical diagnosis and treatment, hemodialysis prescriptions, renal histopathology, and transplant patient management. In renal pathology, AI utilizes deep learning models to achieve precise identification and quantification of glomerular and tubulointerstitial lesions, thereby predicting disease progression. In clinical practice, AI models demonstrate significant value in the early warning of acute kidney injury, prognosis assessment of IgA nephropathy and chronic kidney disease, as well as in the management of hemodialysis processes and comorbidity treatment. Furthermore, AI is also applied in predicting transplant kidney survival, assisting in the screening of rare diseases, and accelerating drug development. However, many nephrologists remain unfamiliar with the fundamental principles of medical AI, and challenges persist in areas such as data privacy, algorithm transparency, and ethical regulation. This review aims to outline the advances in the application of AI across various domains of nephrology and to discuss its future prospects and unresolved issues.

Objective To investigate the therapeutic effect of faecal microbiota transplantation (FMT) on IgA nephropathy (IgAN) in rats and the potential mechanisms. Methods Eighteen 6-week-old female Sprague-Dawley rats were divided into three groups by random number table method: the control group, IgAN group and IgAN+FMT group. IgAN models were established in the IgAN and IgAN+FMT groups using bovine serum albumin, a 5∶1 mixture of castor oil and carbon tetrachloride, and lipopolysaccharide. The control group received equivalent volume of distilled water or 0.9% sodium chloride solution. The IgAN+FMT group underwent FMT via enema with microbiota derived from control group rats. Both the control and IgAN groups received equivalent 0.9% sodium chloride solution via enema. After the intervention was completed, at the end of the experiment, the urine of rats was collected. Rats were then euthanized via intraperitoneal injection of 2% pentobarbital (100 mg/kg) for collection of renal and ileal tissues. Changes in urinary red blood cells were observed under a light microscope and the protein levels were detected. HE staining, PAS staining and immunofluorescence were employed to observe the effects of FMT on the kidney tissues and intestinal tissues of IgAN rats. Microbiome analysis was used to evaluate the impact of FMT on the gut microbiota of IgAN rats. α diversity analysis was used to assess the community diversity of individual sample. β diversity analysis was performed using principal coordinates analysis (PCoA) and non-metric multidimensional scaling (NMDS) to assess community differences between groups. Results Compared with the control group, the IgAN group exhibited significantly higher urinary red blood cell count and protein level (both P<0.05). In comparison with the IgAN group, the IgAN+FMT group showed markedly lower urinary red blood cell count and protein level (both P<0.05), suggesting that IgAN model was successfully constructed and FMT had a certain effect on reducing urine protein in IgAN rats. HE and PAS staining revealed normal glomerular and tubular structures in control group, whereas the IgAN group exhibited mesangial hyperplasia, increased mesangial matrix, thickened tubular basement membrane, and arcuate deep-staining substances in the mesangial and paramesangial areas. After FMT intervention, these symptoms were alleviated. Immunofluorescence showed that compared with control group, IgAN group demonstrated diffuse IgA deposition in glomeruli, while IgAN+FMT group showed significantly weaker IgA deposition intensity than IgAN group (both P<0.05). Intestinal HE staining showed intact architecture without inflammatory in controls, but structural damage, glandular distortion, goblet cell lost, and inflammatory infiltration in the IgAN group. After FMT treatment, the intestinal wall structure in the rats improved, the degree of glandular distortion decreased, and only a small number of inflammatory cells infiltrated. In the α diversity analysis, control group rats exhibited higher community diversity, IgAN group showed lower community diversity, while some samples in IgAN+FMT group displayed increased species richness and evenness. In the β diversity analysis, non-metric multidimensional scaling showed that there was a significant separation among different groups of samples, suggesting that there were significant differences in the composition of microbial communities. The stress values were all less than 0.2, confirming that the results had high reliability and could effectively reflect the relative differences among groups. Conclusion FMT can alleviate the pathological damage of intestinal and renal tissues in IgAN model rats, and reduce the deposition of IgA in renal tissues and the levels of urinary red blood cells and protein. FMT may exert a therapeutic effect by regulating the structure of intestinal microbial community.

Central venous lesion represents one of the common complications affecting vascular access in hemodialysis patients, potentially compromising hemodialysis efficacy. The management of symptomatic central venous lesion remains a critical challenge in clinical practice. Current primary treatment strategies include percutaneous transluminal angioplasty and percutaneous transluminal stenting. Advances in techniques such as sharp recanalization and the mother-child platform approach, along with the development of high-pressure balloons, paclitaxel- coated balloons, and covered stents, have significantly improved procedural success rates. However, unresolved issues persist, including standardized treatment protocols, technical considerations for lesion traversal, and optimal stent selection criteria. This article comprehensively reviews the treatment principles, lesion passage techniques, treatment techniques, and recent advancements of central venous lesion.

Objective To investigate the correlation between statins and contrast-induced acute kidney injury (CI?AKI) and provide a reference basis for clinical practice. Methods It was a retrospective cohort study. The adult patients were admitted to Peking University First Hospital from January 1, 2018, to December 31, 2020, and received at least one intravascular iodinated contrast administration during hospitalization. The clinical data of the patients were collected. The enrolled patients were divided into statin group and non-statin group according to statin exposure. The exposure of statins was defined as use of any type of statins within 48 hours before iodinated contrast administration. The primary outcome was in-hospital AKI defined as AKI developed after contrast administration and before discharge, with 30 days as the endpoint observation time, and the secondary outcome was post-contrast AKI (PC?AKI) defined as AKI onset within 72 hours after contrast administration. Cox regression model was applied to investigate the correlation between statin prescription prior to contrast administration and clinical outcomes. Pre-specified interaction analysis was conducted to examine modification effect of age, gender, baseline estimated glomerular filtration rate (eGFR), diabetes and the injection method of contrast. Results Among 10 321 enrolled patients, the age was 63 (54, 71) years old, and 6 274 (60.8%) patients were males. There were 2 372 (23.0%) patients taking statins before the use of iodinated contrast agents, and the person-time incidence rate of in-hospital AKI was 2.5 per 1 000 person-days. The person-time incidence rate of statin users and statin non-users was 3.2 and 2.4 per 1 000 person-days, respectively. Compared with the non-statin group, age, serum creatinine and the proportions of males, admitted to the intensive care unit, lipid metabolism disorder, hypertension, diabetes, cerebrovascular diseases, cardiovascular diseases, using renin-angiotensin- aldosterone inhibitors, using diuretics, using non-steroidal anti-inflammatory drugs, using proton pump inhibitors, iodinated contrast administration via artery, eGFR<60 ml·min^-1·(1.73 m²)^-1 were higher, while the proportions of general anesthesia surgery, severe liver diseases and tumors, and eGFR were lower in the statin group (all P<0.05). Among 10 321 patients, 5 867 patients had serum creatinine measurement within 72 hours after iodinated contrast administration, among which 70 patients (4.0 per 1 000 person-days) developed PC?AKI. Multivariate Cox regression analysis showed that statin use was an independent protective factor for in-hospital AKI (HR=0.65, 95% CI 0.45?0.93, P=0.017) and PC?AKI (HR=0.44, 95% CI 0.22?0.88, P=0.020). Subgroup analysis showed the significant interaction between diabetes and statin use (P for interaction=0.039), and the protective effect of statins against in-hospital AKI was only observed in non-diabetic group (HR=0.45, 95% CI 0.26?0.77). There were no significant differences in subgroups stratified by age, sex, baseline eGFR and the injection method of contrast (all P for interaction>0.05). Conclusions Statin use prior to iodinated contrast administration is correlated with reduced risks of in-hospital AKI and PC-AKI in hospitalized patients, and the correlation between statin use and in-hospital AKI is more significant in non-diabetic patients. It is suggested that statin use before the application of iodinated contrast agents in hospitalized patients may prevent the occurrence of AKI.

Objective To explore the efficacy and its related factors of rituximab (RTX) in the treatment of children with frequently relapsing nephrotic syndrome/steroid-dependent nephrotic syndrome (FRNS/SDNS). Methods It was a single-center retrospective study. The clinical data of FRNS/SDNS children first treated with RTX in the First Affiliated Hospital of Sun Yat-sen University from November 1, 2016 to September 1, 2023 were collected. The number of relapse within 1 year before and after RTX treatment, the time to first relapse after RTX treatment, and the time to B-cell reconstitution were analyzed. At the first treatment, a single dose of RTX was given at 375 mg/m², with a maximum dose of 500 mg, once a week, for 1 to 4 doses. The count of CD19⁺ lymphocytes in the peripheral blood of the children was continuously monitored. If B-cell reconstruction was performed, the decision on whether to proceed to the next course of RTX treatment was made based on clinical manifestations. Kaplan-Meier method was used to analyze relapse-free survival rate after receiving RTX. Cox proportional hazards regression model was used to analyze the related factors of relapse after RTX treatment. Results A total of 98 FRNS/SDNS children receiving RTX treatment were enrolled, including 75 males (76.5%). The age at onset was 4.0 (1.9, 7.1) years and age of receiving RTX was 11.3 (8.5, 13.5) years. There were 90 children (91.8%) achieving complete remission, while 8 patients (8.2%) did not respond to RTX treatment, and 3 patients (3.1%) progressed to end-stage kidney disease after receiving RTX. The relapse-free survival rates at 6 months and 1 year after RTX treatment were 83.3% (75/90) and 57.9% (22/38), respectively. The frequency of relapse 1 year after RTX treatment decreased compared to 1 year before RTX treatment (Z=-7.398, P<0.001). Compared with children without relapse during the period of B-cell depletion, relapsed children had a higher number of relapse within one year after RTX treatment (Z=5.246, P<0.001). The time to first relapse after RTX treatment was 8.3 (4.6, 13.9) months in 51 relapse patients. Compared with children receiving 1 dose of RTX in the first course, those receiving 2 or more doses had a longer time to the first relapse (Z=2.983, P=0.003). There was no statistically significant difference in time to the first relapse between children who received mycophenolate mofetil therapy after RTX treatment and those who didn't (P>0.05). The reconstruction time of B cells after the first course of RTX was 6.9 (5.3, 9.0) months. Compared to children receiving one dose of RTX in the first course, those receiving two or more doses had a longer B-cell reconstitution time (Z=2.739, P=0.006). There was no statistically significant difference in B-cell reconstitution time between children who received mycophenolate mofetil therapy after RTX treatment and those who didn't (P>0.05). Univariate Cox regression analysis showed that recurrence after calcineurin inhibitor (CNI) treatment before RTX treatment and the number of recurrence in one year before RTX treatment were correlated factors of recurrence after RTX treatment (both P<0.05). Multivariate Cox regression analysis showed that recurrence after CNI treatment before RTX treatment was an independent correlated factor of relapse after RTX therapy (HR=3.496, 95% CI 1.245-9.818, P=0.018). Infusion reactions occurred in 10 patients (10.2%) and infections were observed in 24 patients (24.5%) during B cell depletion. No serious adverse events occurred. Conclusions RTX is well tolerated and effective in treating FRNS/SDNS. Recurrence after CNI treatment before RTX treatment may be an independent related factor of relapse after RTX treatment.

Objective To evaluate effectiveness of finerenone in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) in the real world, and to analyze the associated factors of renal function progression during treatment. Methods It was a single-center retrospective study. The patients diagnosed with T2DM and CKD who received finerenone treatment for 3 months in Beijing Anzhen Hospital, Capital Medical University between April 1 and October 1, 2023 were included. The clinical data before and after finerenone treatment were collected. Based on urinary albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR), the patients were divided into different groups, and the differences of clinical data before and after treatment were compared respectively. Logistic regression models was used to analyze the correlated factors of renal function changes during the treatment. Results A total of 151 patients were included with age of 63 (54, 70) years, and 103 males accounted for 68.2%. UACR level after 3 months of finerenone treatment was significantly lower than those before treatment (Z=-5.051, P<0.001), whereas there was no statistically significant change in eGFR (P>0.05). Both patients with baseline eGFR ≥60 ml·min^-1·(1.73 m²)^-1 (Z=-4.543, P<0.001) and those with baseline eGFR <60 ml·min^-1·(1.73 m²)^-1 (Z=-2.610, P=0.009) showed significant reductions in UACR after treatment. Both patients with baseline UACR ≥300 mg/g (Z=-4.681, P<0.001) and those with baseline UACR <300 mg/g (Z=-1.979, P=0.048) exhibited significantly lower UACR levels after treatment. The percentage reduction in UACR was greater in patients with baseline UACR ≥300 mg/g than in those with baseline UACR <300 mg/g (Z=-2.102, P=0.036).After 3 months of finerenone therapy, serum potassium level was slightly higher than baseline, but the difference was not statistically significant (P>0.05).The incidence of hyperkalemia after treatment was higher than baseline in patients with baseline eGFR <60 ml·min^-1·(1.73 m²)^-1 (χ² =2.558, P=0.039). During the treatment, 74 patients (49.0%) experienced renal function progression. Multivariate logistic regression analysis identified increased baseline serum albumin <45 g/L was an independent correlated factor of renal function progression during finerenone therapy (OR=1.934, 95% CI 1.157-3.231, P=0.012). Conclusions UACR in patients with T2DM and CKD can be reduced significantly after short-term treatment of finerenone. Increased baseline serum albumin level <45 g/L is independently associated with renal function progression during finerenone therapy.

Objective To explore the correlation between the intensity of net ultrafiltration in continuous renal replacement therapy (CRRT) and the survival prognosis in critically ill patients with acute kidney injury (AKI), and provide evidence-based references for establishing optimal net ultrafiltration target during CRRT. Methods This was a retrospective observational study. Demographic and clinical data of critically ill AKI patients who received CRRT in the Intensive Care Unit of West China Hospital, Sichuan University from May 2021 to September 2023 were collected. Net ultrafiltration was defined as the hourly fluid clearance volume in the 72 hours prior of CRRT. This variable was converted into a categorical variable, including low net ultrafiltration <1.01 ml·kg^-1·h^-1, moderate net ultrafiltration 1.01-1.38 ml·kg^-1·h^-1 and high net ultrafiltration >1.38 ml·kg^-1·h^-1, and the differences of baseline characteristics and clinical treatment conditions among the three groups were compared. Kaplan-Meier survival curve and log-rank test were used to compare the survival conditions among the three groups in patients at 28 days and 60 days after CRRT. Logistic regression analysis method was used to analyze the related factors of mortality in patients 28 days and 60 days after CRRT. Results This study included a total of 661 critically ill AKI patients who underwent CRRT for more than 72 hours. The age was 56.00 (43.00, 68.00) years, and 488 patients (73.83%) were males. The net ultrafiltration rate was 1.36 (0.94, 1.89) ml·kg^-1·h^-1. Among them, 188 patients (28.44%) were in the low net ultrafiltration group, 152 patients (23.00%) were in the medium net ultrafiltration group, and 321 patients (48.56%) were in the high net ultrafiltration group. There were statistically significant differences among the three groups in terms of gender distribution (χ²=17.81, P<0.001), body mass index (H=32.37, P<0.001), urine volume 24 hours before admission (H=9.41, P=0.009), fluid overload (H=6.02, P=0.049), platelets (H=13.49, P=0.001), pro?B type natriuretic peptide (H=14.18, P<0.001), serum creatinine (H=9.66, P=0.008), lactate (H=9.83, P=0.007), AKI stage distribution (χ²=15.51, P=0.004), admission indication (P<0.001), total CRRT duration (H=8.45, P=0.015), ultrafiltration (H=456.10, P<0.001), net ultrafiltration (H=561.20, P<0.001), and vasoactive?inotropic score at 72 hours of CRRT treatment (H=10.42, P=0.005). Kaplan-Meier survival analysis showed that there were statistically significant differences in the 28-day (Log-rank test, χ2=10.89, P=0.004) and 60-day (Log-rank test, χ2=8.55, P=0.014) survival rates among the three groups in patients after CRRT. Multivariate logistic regression analysis showed age (OR=1.03, 95% CI 1.02-1.04, P<0.001), mean arterial pressure (OR=0.98, 95% CI 0.97-1.00, P=0.011), bilirubin (OR=3.02,95% CI 1.39-5.59, P=0.006), 72-hour vasoactive?inotropic score (OR=1.01, 95% CI 1.00-1.02, P=0.004), low net ultrafiltration group (medium net ultrafiltration group as a reference, OR=1.66, 95% CI 1.02-2.72, P=0.042), and high net ultrafiltration group (medium net ultrafiltration group as a reference, OR=1.78, 95% CI 1.14-2.78, P=0.011) were independent correlated factors of 28-day mortality after CRRT. Age (OR=1.02，95% CI 1.01-1.04， P<0.001), mean arterial pressure (OR=0.98， 95% CI 0.97-1.00， P=0.016), fluid overload (OR=1.10, 95% CI 1.02-1.19, P=0.012), bilirubin (OR=4.96， 95% CI 1.00-17.80， P=0.013), 72-hour vasoactive?inotropic score (OR=1.02， 95% CI 1.01-1.03， P=0.003), and high net ultrafiltration group (medium net ultrafiltration group as a reference, OR=1.91，95% CI 1.22-3.00， P=0.005) were independent correlated factors of 60-day mortality after CRRT. Conclusions During the first 72 hours of CRRT, net ultrafiltration > 1.38 ml·kg^-1·h^-1 and net ultrafiltration < 1.01 ml·kg^-1·h^-1 are associated with a higher mortality rate at 28 days or 60 days after CRRT. Net ultrafiltration of 1.01-1.38 ml·kg^-1·h^-1 may be a relatively safe range.

The paper reports a case of Fabry disease in a child with non-singular nocturnal enuresis as the first symptom. The boy developed unexplained nocturnal enuresis with frequent daytime urination since the age of 6. Fabry disease was detected and diagnosed by chance through high-risk screening. The activity of α-galactosidase A by dry blood spot was 1.97 μmol·L^-1·h^-1 , and there was c.640-801G>A mutation in GLA gene. Urine routine, urinary microprotein and renal function were normal. However, there were mulberry bodies found in urine deposition microscopy, suggesting the presence of kidney injury. This case suggests that enuresis can be the first symptom of Fabry disease, and mulberry bodies can be seen in the urine at the early stage of the disease.

IgA nephropathy (IgAN) is the most common primary glomerulonephritis. Mesangial hyperplasia and deposition of IgA immune complex are typical pathological changes of IgAN. Animal model is an important tool to explore the pathogenesis, diagnosis and treatment plan, and evaluate the safety and efficacy of drugs. At present, there are many kinds of IgAN animal models, including humanized animal models and non-humanized animal models, and there are great differences in the modeling principle, method, time and pathological changes. The humanized animal model is closer to the pathogenesis of IgAN in humans and has gradually become a research hotspot. In this paper, common animal models of IgAN in detail from the aspects of modeling method and time, characteristics and significance of each model, and the research progress of anthropomorphic animal models are reviewed to provide reference and inspiration for the basic research of IgAN.

Objective To evaluate the expression of tertiary lymphoid structures (TLS) in renal tissues, and the relationship between TLS and clinicopathological changes and prognosis in idiopathic membranous nephropathy (IMN) patients. Methods It was a single center retrospective study. The patients with IMN diagnosed by renal biopsy at Shengjing Hospital Affiliated to China Medical University from January 2018 to December 2020 were enrolled, and their clinicopathological data were collected. Immunohistochemistry was used to evaluate the expression of TLS in renal tissues. According to whether TLS expression in renal tissues was positive or not, the patients were divided into TLS-positive group and TLS-negative group, and the baseline differences in clinicopathological data between the two groups were compared. The clinical remission included complete remission and partial remission. Logistic regression analysis was used to analyze the correlation between serum phospholipase A2 receptor (PLA2R) antibody titer and positive TLS expression in renal tissues. Kaplan-Meier survival curve and log-rank test were performed to analyze the differences of proteinuria remission rates between TLS-positive and TLS-negative groups. Cox regression analysis was employed to identify the related factors of proteinuria remission. The receiver operating characteristic (ROC) curve was used to evaluate the value of TLS in predicting proteinuria remission. Results A total of 120 IMN patients were included in this study, with age of 50.00 (40.00, 57.75) years and 78 (65.00%) males. The 24-hour urinary protein was (7.54±4.14) g, 89 (74.17%) patients were positive for serum PLA2R antibody, and the serum PLA2R antibody titer was 90.49 (48.88, 155.33) RU/ml. Immunohistochemical results showed that TLS was mainly distributed in the renal cortex glomeruli or around renal blood vessels in renal tissues. There were 43 patients in the TLS-positive group and 77 patients in the TLS-negative group. The positive rate of serum PLA2R antibody in the TLS-positive group was 83.72% (36/43). Compared with the TLS-negative group, the TLS-positive group had lower serum albumin (t=-3.474, P<0.001) and estimated glomerular filtration rate (Z=-2.076, P=0.045), while serum creatinine (t=2.006, P=0.028), 24-hour urinary protein (t=4.140, P<0.001), serum PLA2R antibody titer (Z=4.628, P=0.001), glomerulosclerosis degree (Z=2.403, P=0.019), and proportions of hypertension (χ2=6.511, P=0.011), renal interstitial fibrosis (χ2=4.088, P=0.043), renal interstitial inflammatory cell infiltration (χ2=9.261, P=0.002), tubular atrophy (χ2=4.936, P=0.026) and extremely high-risk of kidney disease progression (χ2=9.352, P=0.002) were higher. Multivariate logistic regression analysis showed that serum PLA2R antibody titer was an independent factor correlated with positive TLS expression in renal tissues (OR=1.014, 95% CI 1.007-1.021). The median follow-up time was 18.00 (95% CI 16.07-19.93) months. Kaplan-Meier survival curve showed that the proteinuria remission rate in the TLS-positive group was lower than that in the TLS-negative group (Log-rank χ2=9.339, P=0.002). Cox regression analysis showed that positive TLS expression was an independent factor correlated with proteinuria remission (HR=0.228, 95% CI 0.177-0.297). ROC curve showed that TLS had a certain clinical predictive value for proteinuria remission (AUC=0.703, 95% CI 0.608-0.798). Conclusions IMN patients with positive TLS expression in renal tissues have a lower proteinuria remission rate, more severe pathological damage, and a higher risk of disease progression. TLS is expected to become a pathological marker for predicting the severity and prognosis of IMN.

Objective To investigate the relationship between thoracic aortic calcification (TAC) and autonomic nervous system (ANS) function in patients receiving continuous ambulatory peritoneal dialysis (CAPD). Methods It was a cross-sectional study. The CAPD patients with dialysis duration >6 months between January and December 2022 were retrospectively enrolled. The baseline clinical data, heart rate variability (HRV) data such as standard deviation of all normal to normal intervals (SDNN), root mean square of successive differences between adjacent normal?to?normal intervals (RMSSD), high frequency (HF), very low frequency (VLF), low frequency (LF), LF/HF, acceleration capacity (AC) and deceleration capacity (DC), and skin sympathetic nerve activity (SKNA) were collected. TAC was defined as TAC score (TACS) >100 AU. The patients were divided into TACS >100 AU group and TACS≤100 AU group based on whether the thoracic aorta was calcified. The differences of those data between the two groups were compared. Logistic regression model was used to analyze the related factors of TAC. Spearman correlation analysis method was used to analyze the correlation between peripheral blood neuropeptide Y, ANS parameters, average amplitude SKNA (aSKNA) and TACS.　Cox regression model was used to analyze the risk factors of all-cause mortality in patients with CAPD. Results The study included 106 CAPD patients with 50 males (47.2%), age of (46.04±11.10) years and dialysis duration of (41.55±30.52) months. TACS>100 AU group exhibited significantly lower heart rate (t=2.015, P=0.046), DC (t=2.131, P=0.035), LF/HF (Z=3.332, P<0.001) and ln(LF/HF) (t=3.326, P=0.001), and higher AC (t=-2.392, P=0.019) than TACS≤100 AU group. Multivariate logistic regression analysis results showed that after adjusting for age and eosinophil count, lnVLF (OR=0.66, 95% CI 0.45-0.98, P=0.038), lnLF (OR=0.69, 95% CI 0.49-0.97, P=0.032), DC (OR=0.79, 95% CI 0.64-0.99, P=0.039) and AC (OR=1.32, 95% CI 1.04-1.68,P=0.021) were independently correlated with the risk of TAC. Spearman correlation analysis showed that neuropeptide Y level in peripheral blood was correlated with aSKNA (r=0.23, P=0.017), lnSDNN (r=-0.20, P=0.036) and TACS (r=0.19, P=0.048). During the follow-up period of (25.8±4.2) months, 5 patients (4.72%) died, including 1 patient in the TACS≤100 AU group and 4 patients in the TACS>100 AU group. Compared with the survival group, the death group had higher TACS (Z=-2.262, P=0.024) and lower LF/HF (Z=-2.750, P=0.006). Cox regression analysis results showed that increased ln(LF/HF) was an independent influencing factor for all-cause mortality in CAPD patients (HR=0.22, 95% CI 0.05-0.83, P=0.026). Conclusions HRV parameters (lnVLF, lnLF, AC and DC) of CAPD patients are independently associated with TAC. The dysfunction of ANS in CAPD patients (especially the decreased vagus nerve activity) may promote TAC.

Renal anemia is one of the most common complications of chronic kidney disease. Recently, the development of hypoxia-inducible factor-prolyl hydroxylase inhibitors (HIF?PHI) has provided new therapeutic options for patients with renal anemia. This article systematically reviews the mechanisms of action of HIF?PHIs, comprehensively elaborates on the pharmacological characteristics of different drugs, and summarizes the overall efficacy and safety data from clinical studies. In addition, based on clinical practice in nephrology, it addresses key issues and considerations in the application of HIF?PHIs, aiming to support rational clinical use.