慢性肾脏病（chronic kidney disease，CKD）已成为全球性的公共卫生问题。“肾脏病预后质量倡议（Kidney Disease Outcome Quality Initiative，KDOQI）”和“改善全球肾脏病预后组织（Kidney Disease: Improving Global Outcomes，KDIGO）”工作组先后制定了CKD 临床实践指南。为提高我国CKD防治水平，在参考国外指南基础上，结合中国特点，我们组织上海市肾脏病专家制定了《CKD筛查 诊断及防治指南》，并于2017年发表。该指南对各级全科医师和肾脏病专科医师均有参考价值，有力推动了对CKD的认识和提高了对CKD的管理水平。近年来CKD 研究又取得了很多重大进展，基于临床证据的积累及各种新药的问世，上海市肾内科临床质量控制中心专家组对2017年版《CKD筛查 诊断及防治指南》进行了更新和修订，内容主要包括CKD筛查的对象和方式、进展的评估及防治等方面。

腹膜透析（peritoneal dialysis，PD）是终末期肾病患者替代治疗的方式之一。以葡萄糖为渗透剂的传统腹膜透析液（腹透液）安全、有效的特性已被广泛接受，但由于葡萄糖相对分子质量较小，进入腹腔后易被吸收，难以维持较长时间的渗透梯度而致超滤下降，且生物相容性较差，长期使用可导致腹膜结构和功能的改变。艾考糊精是一种分子质量为13 000~19 000道尔顿的葡萄糖聚合物，不易被腹膜吸收。以艾考糊精为渗透剂的等渗腹透液通过介导胶体渗透压可在PD长留腹时维持稳定的渗透梯度而产生持续超滤。艾考糊精腹透液在国外已使用20多年，除显著的超滤作用外，其在生物相容性、腹膜保护、提高PD技术生存率以及改善患者预后方面积累了大量的证据。本文结合国内外艾考糊精腹透液的最新临床研究数据，重点对其临床优势及获益人群作一综述。

为加强透析前期和初始透析慢性肾脏病（chronic kidney disease，CKD）患者的管理，《中国围透析期慢性肾脏病管理规范》专家组编写了本规范。规范首先提出“围透析期CKD”的概念及特征，其并发症发生率、病死率及治疗费用显著增高，同时肾小球滤过率快速降低，需要强化管理；接着本规范系统全面地阐述了围透析期CKD患者病情评估指标与频率、肾脏替代治疗时机与模式选择、透析充分性评估、围透析期常见并发症的诊断和处理；最后提出了围透析期CKD的未来研究方向。围透析期CKD管理一直是肾脏病临床的难点，本管理规范的制定、宣传及落实能够提高我国围透析期CKD患者的管理水平，从而对改善患者的存活率和生存质量、减轻医疗负担具有重要意义。

连续性肾脏替代治疗（continuous renal replacement therapy，CRRT）是一项持续的血液净化技术，血液经过体外循环时可导致血小板活化并激活内源性、外源性凝血途径导致体外循环凝血发生，不仅导致CRRT治疗中断、治疗效率下降、血细胞消耗，而且导致血管通路并发症增加、医疗费用增加及医源性感染的风险增加。因此，安全有效的抗凝策略在CRRT过程中显得尤为关键。故而，中华医学会肾脏病学分会成立了CRRT抗凝管理指南工作组。指南工作组通过对此领域文献的系统全面检索、数据分析及专业讨论，从CRRT抗凝评估与监测、局部枸橼酸抗凝CRRT、系统性抗凝CRRT及无抗凝剂CRRT 4个方面构建了CRRT的抗凝管理指南。该指南基于CRRT抗凝的循证医学证据及临床经验，有利于规范CRRT抗凝技术，减少CRRT患者的抗凝相关并发症，延长体外循环寿命。

抗中性粒细胞胞质抗体（anti-neutrophil cytoplasmic antibody，ANCA）相关肾炎（ANCA-associated glomerulonephritis，AAGN）是造成中老年肾脏病患者急性肾功能减退的主要原因，病情严重，人肾存活率低。我国AAGN患者的ANCA类型、临床特征及预后与欧美国家的AAGN存在差异。基于我国对AAGN的临床研究证据并借鉴国外相关指南，中华医学会肾脏病学分会组织专家制定了ANCA相关肾炎的诊断和治疗中国指南，在AAGN的诊断和评估、随访管理、诱导期和维持期治疗、顽固性和复发性AAGN的治疗及感染的预防等方面提出了推荐或建议，为规范临床实践和个体化治疗决策的制定提供了指导意见。

心力衰竭（heart failure）是透析（dialysis）患者的第二大心血管疾病。透析患者一旦合并心力衰竭，生存率显著下降。尽管国内外已颁布了多部普通人群心力衰竭相关的临床指南或专家共识，但由于透析患者肾功能极差甚至没有残余肾功能、慢性并发症多，加上血液透析（hemodialysis，HD）和腹膜透析（peritoneal dialysis，PD）治疗本身的特殊性、可变性及局限性，使透析患者与普通人群在心力衰竭诊断、治疗及管理等方面均存在很大的不同。故而现有国内外指南和共识并不完全适用于透析人群，迫切需要透析患者心力衰竭管理的指导性文件，以指导、规范心力衰竭的诊疗。鉴于此，中华医学会肾脏病学分会和中关村肾病血液净化创新联盟组织专家组制定了这部《中国透析患者慢性心力衰竭管理指南》。该指南基于循证医学证据及临床经验，就心力衰竭诊断、危险因素管理、HD管理、PD管理、药物管理及其他管理等问题做了系统的介绍，反映了当今透析患者心力衰竭诊疗的新观点及未来发展趋势，有利于进一步加强临床医生对透析患者心力衰竭的认识、规范透析患者心力衰竭的临床管理流程，对改善透析患者预后具有重要价值。

Continuous renal replacement therapy (CRRT) is an important treatment for critically ill patients. Critically ill patients often need to receive antimicrobials and CRRT treatments at the same time. CRRT affects the pharmacokinetics and pharmacodynamics of antimicrobials, and there is a lack of recommendations and suggestions for the antimicrobial dosing during CRRT. The clinical medicine, pharmacy, intensive care and infectious diseases specialists in China set up an expert group on antimicrobial dosing optimization during CRRT, conducted evidence search around CRRT factors, drug characteristics, patient factors and antimicrobial dosing optimization during CRRT, and fully discussed and formulated the consensus, to provide guiding advices on the rational use of antimicrobials during CRRT.

Diabetes is a major risk factor for chronic kidney disease (CKD). Finerenone, a novel nonsteroidal mineralocorticoid receptor antagonist, has been confirmed to have a definite renal and cardiovascular protective effect on diabetes mellitus with CKD. Long-term use can significantly reduce the urinary albumin to creatinine ratio in patients with diabetes mellitus and has little effect on blood potassium. In order to make the clinical application of finerenone more reasonable and standardized, based on research evidence and clinical practice experience, the expert group formed the Chinese expert consensus on the use of finerenone in patients with diabetes mellitus and CKD after many discussions. The mechanism of action and pharmacological properties of finerenone, evidence-based medical evidence, suitable population, specific usage and precautions were described, and 27 recommendations were formed to provide reference for clinical use of finerenone and benefit patients.

利妥昔单抗（rituximab，RTX）是一种作用于B细胞表面CD20分子的人鼠嵌合单克隆抗体，靶向诱导B细胞凋亡，减少自身抗体的产生，对系统性红斑狼疮、肾小球肾炎等与自身抗体致病相关的疾病治疗存在理论基础。改善全球肾脏病预后组织（Kidney Disease: Improving Global Outcomes，KDIGO）指南也建议把RTX用于治疗膜性肾病、微小病变肾病、狼疮肾炎等肾小球疾病。目前，RTX治疗肾小球肾炎在我国尚处于起步阶段，存在临床适应证不一、治疗方案多样等问题，导致疗效评估和分析存在困难。为此，中华医学会肾脏病学分会专家组通过阅读相关文献，并结合我国临床诊疗现状，对RTX治疗肾小球肾炎的适应证、治疗方案及随访管理注意事项等形成专家共识，以指导临床医生的工作实践，并为未来制定临床指南提供基础。

Objective To compare the advantages and disadvantages of several formulas for estimated glomerular filtration rate (eGFR) based on serum creatinine in elderly patients with chronic kidney disease (CKD) over 60 years old. Methods CKD patients aged≥60 years old in Beijing Hospital from January 2012 to October 2017 were selected as subjects. Measured glomerular filtration rate (mGFR) was detected by ^99mTc-DTPA renal dynamic imaging and used as a reference standard. According to the mGFR value, the patients were divided into 4 groups: mGFR<30 ml·min^-1·(1.73 m²)^-1 group, 30≤mGFR<45 ml·min^-1·(1.73 m²)^-1 group, 45≤mGFR<60 ml·min^-1·(1.73 m²)^-1 group and mGFR≥60 ml·min^-1·(1.73 m²)^-1 group. The deviation of each formula was compared by Bland-Altman scatter chart, and the accuracy of each formula was evaluated by the proportion of eGFR within mGFR (1±30%) (P30) and root mean square error (RMSE). Wilcoxon paired rank sum test was used to compare the deviation of each formula, and McNemar test was used to compare the difference of P30 among these formulas. Results A total of 628 patients with CKD were enrolled in this study. The median age was 76.0(71.0, 81.0) years old. The median serum creatinine and mGFR were 110.0(86.0, 152.0) μmol/L and 42.90(29.88, 55.68) ml·min^-1·(1.73 m²)^-1, respectively. Each eGFR formula based on serum creatinine overestimated glomerular filtration rate in varying degrees. Among them, the accuracy of Berlin Initiative Study (BIS) formula and full age spectrum (FAS) formula was the best (P30 were 68.3% and 68.0% respectively), followed by the Chinese race coefficient of Chronic Kidney Disease Epidemiology Collaboration (C-CKD-EPI) formula (P30 was 65.4%). The accuracy of the other formulas was poor. In terms of deviation, C-CKD-EPI formula was the best (0.27). In the group of mGFR<30 ml·min^-1·(1.73 m²)^-1, the accuracy of all formulas was poor, and the accuracy of FAS formula was slightly better than that of other formulas (P30 was 51.0%). In the group of 30≤mGFR<45 ml·min^-1·(1.73 m²)^-1, the deviation of C-CKD-EPI formula was the smallest (3.11). In terms of accuracy, BIS and FAS formulas were better than others, and the P30 were 64.6% and 63.0% respectively. In the group of 45≤mGFR<60 ml·min^-1·(1.73 m²)^-1, the deviation of C-CKD-EPI formula was also the smallest (0.72), and the accuracy of BIS formula was the best (P30 was 82.5%), followed by FAS formula (P30 was 79.7%). In the group of mGFR≥60 ml·min^-1·(1.73 m²)^-1, the deviation and accuracy of Xiangya formula were the best (the deviation and P30 were -0.53 and 96.5% respectively), and the P30 of BIS and C-CKD-EPI formulas were 87.6% and 87.6%, respectively. Conclusions In the elderly patients with CKD over 60 years old, the accuracy of eGFR based on serum creatinine increases with the increase of mGFR. BIS and FAS formulas are recommended first. The accuracy of each formula is poor in patients with severe renal insufficiency.

终末期糖尿病肾脏病患者常见，其包含两种情况：一是由糖尿病引起的终末期肾病（end-stage renal disease，ESRD），又称之为糖尿病肾病；二是慢性肾脏病合并糖尿病，但糖尿病不是ESRD的病因，称之为合并糖尿病的ESRD。终末期糖尿病肾脏病患者行肾替代治疗的心脑血管事件发生率高、外周血管条件差、感染等并发症的风险高，治疗时血糖波动大，管理难度大。专家组对终末期糖尿病肾脏病肾替代治疗的时机、方式选择、腹膜透析、血液透析、肾移植治疗要点进行总结并提出有关建议，希望能引起广大肾科医师重视，不断提高治疗水平。

In recent years, the incidence rate of end-stage kidney disease (ESKD) in China has increased year by year. About 2% of patients enter ESKD every year. Peritoneal dialysis (PD) has been widely used in ESKD patients all over the world, especially in developing countries, because of its simple, safe, effective and home based treatment. Since continuous ambulatory peritoneal dialysis was introduced to China in 1978, Chinese nephrology professionals have made remarkable achievements in PD management after decades of joint efforts. However, they still face many challenges. In order to investigate the status of quality indicators of PD centers, the construction of centers, PD prescriptions and adjustments, diagnosis and treatment of complications, adequacy assessment, long-term follow-up status of patients, disease burden and risk perception of chronic kidney disease in China, the project group of the white paper carried out three rounds of questionnaires nationwide, objectively and comprehensively analyzed the survey results, and organized experts to prepare the white paper. The white paper clearly reviewed the current situation of PD construction and management in China, and also found some problems that need to be solved. It still needs to further standardize the staffing of PD centers, strengthen the training of PD professionals, expand the full-time medical staff, pay attention to quality management, reduce the incidence of PD related complications, and improve the long-term survival rate and quality of life of PD patients.

托伐普坦（tolvaptan）已被多个国家批准用于常染色体显性多囊肾病（autosomal dominant polycystic kidney disease，ADPKD）的治疗，并实现了国产化。为帮助国内肾科医师有效、安全地使用托伐普坦治疗ADPKD患者，专家组依托已有文献结合国内ADPKD患者诊疗现状编写了本部共识，以供临床医师实践参考。共识首先描述ADPKD及快速进展型ADPKD的诊断方法与标准，概述ADPKD一般治疗与对症治疗，进而详细阐述了托伐普坦治疗ADPKD的适应证与禁忌证、个体化治疗前评估与剂量滴定办法、药物不良反应及处置办法、联合用药注意事项及终止治疗时机，总结了规范化应用托伐普坦治疗ADPKD的全流程。该共识的制定将有助于提高肾科医师应用托伐普坦治疗ADPKD的规范化和有效性，有助于提高患者治疗的依从性和安全性。

Objective To access the clinical efficacy and safety of hydroxychloroquine (HCQ) in treatment of IgA nephropathy (IgAN). Methods The data of IgAN patients who were diagnosed by renal biopsy in the First Affiliated Hospital, College of Medicine, Zhejiang University from May 2016 to August 2020 and had been treated with HCQ for more than 6 months without other immunosuppressants were retrospectively analyzed. The efficacy and side effects were compared between groups according to the baseline urine protein/creatinine ratio (UPCR) or whether combined with renin-angiotensin-aldosterone system inhibitor (RAASi). Results A total of 121 patients were enrolled, including 45 males (37.19%). At baseline, the median UPCR was 0.69(0.45, 1.00) g/g; the median estimated glomerular filtration rate (eGFR) was 93.46(73.14, 115.67) ml·min^-1·(1.73 m²)^-1; the median serum creatinine was 80.00(61.00, 98.00) μmol/L, and the serum albumin was (44.39±3.36) g/L. After HCQ treatment, UPCR and red blood cells were significantly decreased compared with baseline (all P<0.05). Triglyceride, total cholesterol and low-density lipoprotein cholesterol were also significantly decreased during the follow-up period. Serum creatinine, eGFR, serum albumin and serum uric acid remained stable. After 6 months of follow-up, the total remission rate was 56.88%, including 15.60% of partial remission and 41.28% of complete remission; at the end of follow-up, the median follow-up time was 280.00(214.00, 411.00) days and the total remission rate was 56.20%, including 9.92% of partial remission and 46.28% of complete remission. Group analysis showed that the remission rate was 60.53% (n=76) and 48.48% (n=33) at 6 months (Mann-Whitney U test, Z=-2.331, P=0.020) and 57.65% (n=85) and 52.78% (n=36) at the end of follow-up (Mann-Whitney U test, Z=-1.673, P=0.094) between patients with baseline UPCR<1 g/g and patients with baseline UPCR≥1 g/g; and the remission rate was 66.67% (n=30) and 53.16% (n=79) at 6 months (Mann-Whitney U test, Z=1.062, P=0.288) and 61.29% (n=31) and 54.44% (n=90) at the end of follow-up (Mann-Whitney U test, Z=0.930, P=0.352) between patients with single HCQ and patients with HCQ+RAASi. For side effects, the eGFR of 2 patients decreased by more than 30% compared with baseline, 1 patient relapsed and 1 patient developed blurred vision. Conclusions HCQ is safe and effective for the treatment of IgAN.

IgA肾病（IgA nephropathy，IgAN）是全球最常见的原发性肾小球肾炎并且可进展至终末期肾病，IgA1分子沉积在肾小球系膜是其区别于其他原发性肾小球肾炎的明显特征。近年来，IgAN在机制研究、基因组学、临床研究等方面取得了不错的进展，并发现半乳糖缺陷型IgA1（galactose deficient-IgA1，Gd-IgA1）参与了疾病的发生发展。本文结合国内外最新的研究成果，详细回顾了Gd-IgA1分子的产生机制、免疫复合物形成及下游致病机制，同时讨论了目前Gd-IgA1在临床研究中所提示其与疾病病理及进展之间的关系，以提高读者对IgA肾病发病机制的理解，为疾病研究和临床诊治提供新的思路。

Objective To determine the prevalence of sarcopenia and explore related influencing factors of sarcopenia in maintenance hemodialysis (MHD) patients. Methods MHD patients aged ≥18 years old and receiving therapies of ≥3 months from March 2019 to December 2019 in Blood Purification Centre of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were retrospectively enrolled in this study. General data of the patients were collected. Grip strength was measured by the Jamar dynamometer and the chair stand was measured by a chair of standard height to assess skeletal muscle strength and appendicular skeletal muscle mass was measured by dual energy X-ray absorptiometry. Baseline data between MHD patients with and without myasthenia were compared. Logistic regression analysis method was used to analyze the influencing factors for sarcopenia in MHD patients. Results A total of 125 MHD patients were enrolled, with 68 males (54.4%), age of (59.4±14.9) years and median dialysis age of 51.0(23.5, 101.0) months. Sarcopenia was diagnosed in 39 cases (31.2%). Compared with MHD patients without sarcopenia, age, tumor necrosis factor-α, von Willebrand factor (vWF) and proportion of using α ketones were higher, and serum carbondioxide combining power (CO₂CP), prealbumin, albumin and proportion of regular exercise were lower in MHD patients with sarcopenia (all P<0.05). Multivariable logistic regression analysis results showed that low CO₂CP (OR=0.717, 95%CI 0.576-0.892, P=0.003), high vWF (OR=1.037, 95%CI 1.016-1.058, P<0.001) and no regular exercise (OR=0.309, 95%CI 0.118-0.810, P=0.017) were independent influencing factors of sarcopenia in MHD patients. Conclusions The prevalence of sarcopenia in MHD patients is high. Low CO₂CP, high vWF and no regular exercise are independent influencing factors for sarcopenia in MHD patients.

随着影像技术的不断发展，碘对比剂在介入治疗、血管造影等领域的应用日益增多。虽然碘对比剂的临床应用大大提高了疾病的诊疗水平，但其引起的急性肾损伤不容忽视。为降低碘对比剂诱导的急性肾损伤的发生率，中华医学会临床药学分会、中国药学会医院药学专业委员会和中华医学会肾脏病学分会组织国内专家，成立《碘对比剂诱导的急性肾损伤防治的专家共识》编写委员会，在参考国内外相关指南、共识及研究进展的基础上，结合我国的实际情况，针对碘对比剂的结构和分类、已上市的碘对比剂品种及理化性质、碘对比剂的应用现状、碘对比剂诱导的急性肾损伤的定义、流行病学、生物标志物、病理特征、危险因素与风险评估、预防措施和治疗手段等方面进行证据检索和评价，并充分讨论，制定了本共识，为临床医、药、护、技更有效、更安全地合理使用碘对比剂提供指导建议。

糖尿病肾脏疾病（diabetic kidney disease，DKD）是糖尿病的常见慢性并发症，也是慢性肾脏病（chronic kidney disease，CKD）和终末期肾病（end-stage renal disease，ESRD）的重要原因。明晰DKD的诊断、鉴别诊断以及对疾病进展风险的评估有助于对患者的分层管理和个体化治疗。白蛋白尿和估算肾小球滤过率（estimated glomerular filtration rate，eGFR）是DKD的主要诊断依据，而新型生物标志物在辅助DKD诊断和预后评估方面亦显现出重要价值。目前，临床实践中关于DKD诊断、预后评估及生物标志物的认识尚存在不足。为此，基于国内外DKD临床研究进展，中华医学会肾脏病学分会组织有关专家制定了这部共识，目的是加强相关从业人员、尤其是基层医务人员在临床实践中对DKD诊断、预后评估和生物标志物的认识，改善DKD的防治水平。

腹膜透析（peritoneal dialysis，PD）相关性腹膜炎（PD-associated peritonitis，PDAP）是PD的严重并发症，防治PDAP对降低患者的发病率和病死率至关重要。近期发布的2022版国际腹膜透析协会（International Society for Peritoneal Dialysis，ISPD）有关PDAP防治指南中，对于难治性腹膜炎（refractory peritonitis）、再发性腹膜炎（recurrent peritonitis）、复发性腹膜炎（relapsing peritonitis）、重现性腹膜炎（repeat peritonitis）、腹膜炎相关导管拔除（peritonitis-associated catheter removal）、腹膜炎相关转血液透析（peritonitis-associated haemodialysis transfer）、腹膜炎相关死亡（peritonitis-associated death）、腹膜炎相关住院（peritonitis-associated hospitalisation）等概念均赋以明确定义，提出了一些新的腹膜炎类型和预后概念，如PD前腹膜炎（pre-PD peritonitis）、肠源性腹膜炎（enteric peritonitis）、导管相关性腹膜炎（catheter-related peritonitis）及腹膜炎的临床治愈（medical cure）。新指南建议PDAP的总体发生风险应低于0.4例次/患者年，每年无腹膜炎患者占比应高于80%。对于PD系统污染的处理、侵入性操作的抗生素预防、PD培训与再评估以及腹膜炎可预防的风险因素如豢养宠物、H2受体拮抗剂等热点问题均在新指南中给予了阐释。经验性抗生素的选择和剂量，及针对特殊病原菌口服N-乙酰半胱氨酸辅助减轻氨基糖苷类耳毒性的新方法也在新指南中进行了介绍。最后，指南对未来腹膜炎防治的研究方向给出了建议。

糖尿病肾病是糖尿病常见的并发症之一，发生机制较为复杂。脂代谢紊乱在糖尿病肾病的发生和发展中起着重要作用，三酰甘油和胆固醇沉积于肾脏并影响肾功能，导致肾小球硬化。此外，线粒体功能障碍和活性氧生成也是糖尿病肾病发生机制中不可缺少的一环。我们从脂代谢调控网络及脂代谢障碍对线粒体功能的影响两个方面，探讨脂代谢障碍在糖尿病肾病发生发展的作用。

IgA肾病（IgA nephrology，IgAN）是世界范围内最常见的原发性肾小球肾炎，我国为该病的高发国家。目前IgAN的发病机制尚未得到完全阐明，治疗策略相对有限。许多学者针对IgAN进行了不断的探索与研究，并建立了大量实验动物模型。本综述基于IgAN已知的不同发病机制，介绍目前国内外常见IgAN实验动物模型，并就其各自的特点进行说明，旨在为IgAN相关研究提供参考。

利妥昔单抗治疗IgA肾病的疗效仍不确定。本文报道利妥昔单抗治疗难治性IgA肾病1例并进行文献复习。患者肾病综合征5年余，经糖皮质激素、环孢素、他克莫司、环磷酰胺等治疗病情短期好转，但于药物减量或感染后反复复发，肾活检明确为IgA肾病，给予利妥昔单抗治疗后肾病综合征获得完全缓解，并长期稳定无复发。

慢性肾脏病（chronic kidney disease，CKD）是世界范围内的严重健康问题，而血管钙化（vascular calcification）对CKD患者的高心血管事件发病率和病死率起着重要促进作用。基于其所带来的巨大的卫生、经济负担，探索其发生机制及防治手段任务迫切且艰巨。我们综述文献发现，多种细胞如平滑肌细胞、内皮细胞、巨噬细胞等参与血管钙化发生发展，同时细胞间对话等相互作用在此过程中同样发挥重要作用；矿物质代谢紊乱及相关激素失调、钙化抑制剂缺失、微小RNA以及其他分子机制如细胞外囊泡、骨-血管轴等均参与调节CKD患者血管钙化的发生发展。

Sodium-glucose transporter 2 (SGLT2) inhibitors are a novel type of oral hypoglycemic agent. Clinical trials have found that these drugs not only help control diabetes but also provide additional benefits for heart and kidney outcome. They have shown cardiorenal protection in patients with type 2 diabetes and can improve outcomes in non-diabetic patients with chronic kidney disease (CKD), and the overall safety performance is good. Therefore, SGLT2 inhibitors have become important drugs for cardiorenal protection in CKD patients. The consensus expert group undertook an extensive process to develop this consensus on the use of SGLT2 inhibitor drugs in managing CKD. They engaged multidisciplinary experts from nephrology, endocrinology, and cardiology to ensure a comprehensive and standardized approach. The expert group utilized existing evidence-based evidence and the expertise of the participating clinicians to formulate this consensus through consultation, voting and discussion. The consensus includes the recommended population for SGLT2 inhibitors use, the risk assessment of adverse reactions before use, the recommendation of combination administration, and the monitoring and management of adverse reactions during use. This collaborative effort aims to provide physicians with a reliable and practical framework for the rational use of SGLT2 inhibitor drugs in clinical practice.

儿童激素耐药型肾病综合征（steroid-resistant nephrotic syndrome，SRNS）是临床上比较棘手的问题，治疗难度大，并发症多发。中华医学会儿科学分会肾脏学组2016年制定了儿童SRNS诊疗指南，2020年国际儿科肾脏病学会（International Pediatric Nephrology Association，IPNA）发布了儿童SRNS临床实践建议。两者在儿童SRNS的治疗、基因诊断和预防接种方面存在一定的差异，现将两项指南中与临床联系密切的内容进行比较，为SRNS儿童的临床管理提供依据。

免疫性肾小球疾病是导致终末期肾病的主要原因之一。除了传统的糖皮质激素及免疫抑制治疗方案外，生物制剂越来越多地应用于免疫性肾小球疾病的临床治疗，显著改善了患者的临床症状及生存质量，为这类疾病的靶向治疗带来了曙光。然而，生物制剂在免疫性肾小球疾病中的应用尚缺乏统一的规范，制定既符合国际指南标准又贴近中国临床实践的免疫性肾小球疾病生物制剂治疗共识势在必行。为此，我国肾脏病领域专家依据国内外研究数据和临床经验，结合中国肾脏疾病患者的特点，在深入讨论的基础上制定了本共识。本共识内容包括免疫性肾小球疾病的分类及其发病机制，常用生物制剂及其作用机制，生物制剂的应用原则与方法、疗效与安全性、患者的选择与监测、常见问题与对策以及特殊人群应用的注意事项等方面，以期为临床医师提供具体的指导意见。

“脂质肾毒性”假说将脂质代谢引入慢性肾脏病（chronic kidney disease，CKD）的研究领域。脂质的重要组分胆固醇在病理状态下可异位沉积于肾脏及足细胞中，参与CKD发生和进展的病理生理过程。诸多研究已揭示足细胞胆固醇代谢异常的机制及其在足细胞功能改变和肾脏损害中的作用。本文通过总结足细胞胆固醇稳态的调节途径、足细胞胆固醇代谢与CKD的关系，阐述了胆固醇代谢紊乱导致足细胞损伤的新机制，并探讨了针对足细胞胆固醇代谢紊乱治疗的新策略。

本研究为单中心、回顾性研究，纳入2005年11月1日至2014年9月30日在南昌大学第一附属医院置管并进行规律腹膜透析的585例患者，分为长透析龄组（持续透析5年及以上，n=217）及短透析龄组（5年之内终止透析，n=368）。结果显示，与短透析龄组相比，长透析龄组患者男性比例、年龄、收缩压、糖尿病肾病比例、合并糖尿病比例、透析后心血管事件比例较低，血白蛋白、血肌酐、血尿素氮、血尿酸及全段甲状旁腺素水平均更高（均P<0.05）。多因素Logistic回归分析结果显示，男性（HR=0.579，95%CI 0.392~0.877，P=0.008）、年龄>60岁（OR=0.582，95%CI 0.354~0.951，P=0.030）、合并糖尿病（HR=0.283，95%CI 0.151~0.532，P<0.001）与短透析龄独立相关。作者认为，女性、≤60岁、非糖尿病腹膜透析患者更易拥有长腹膜透析龄。

细胞骨架相关蛋白4（cytoskeleton-associated protein 4，CKAP4）定位于内质网，是一种Ⅱ型跨膜蛋白。CAKP4作为各种配体的膜受体，是诊断和治疗疾病的新型分子靶标。本文综述了CKAP4的生物学功能及其在慢性肾脏病（chronic kidney disease，CKD）血管钙化中的作用，探讨CAKP4作为CKD治疗靶向分子的可能性。

Objective To investigate the relationship between monocyte/high-density lipoprotein ratio (MHR) and clinical parameters and the prognosis of patients with chronic kidney disease (CKD). Methods Clinical data were collected of CKD patients who were diagnosed and followed up regularly in Henan Provincial People's Hospital from January 1, 2017 to June 30, 2020. According to the median baseline MHR of the selected patients, they were divided into two groups: low-level MHR group (MHR≤0.347 8) and high-level MHR group (MHR>0.347 8). The patients were regularly followed up for 3-42 months, the renal adverse prognostic events were defined as serum creatinine doubled, estimated glomerular filtration rate (eGFR) reduced to at least 50% of the original, new entry into end-stage renal disease (ESRD), starting renal replacement therapy, death due to renal or cardiovascular events. The Kaplan-Meier method was used to compare the differences in survival rates between the two groups, and Cox regression analysis method was used to explore the influencing factors of renal adverse prognosis in CKD patients. Stratified analysis was used to find special factors that might affect the relationship between MHR and renal adverse prognosis in CKD patients. Results A total of 405 patients were included in this study. Their age was (49.77±14.82) years old. Body mass index was (25.18±4.22) kg/m². Women accounted for 30.62%(124/405). The proportion of patients with smoking, drinking, hypertension and diabetes was 39.51%(160/405), 35.06%(142/405), 73.33%(297/405) and 38.27%(155/405), respectively. Compared with the low-level MHR group (n=202), the high-level MHR group (n=203) had more people in late CKD, males, and hypertension (all P<0.01), and body mass index, white blood cells, monocytes, serum creatinine, serum uric acid, serum urea nitrogen, retinol binding protein, cystatin C, blood phosphorus were higher (all P<0.05), while hemoglobin, high density lipoprotein and eGFR were lower (all P<0.05). Spearman rank correlation results show that MHR level was positively correlated with white blood cells, serum creatinine, serum uric acid, serum urea nitrogen, retinol-binding protein, cystatin C, serum phosphorus (all P<0.01), and negatively correlated with hemoglobin and eGFR (both P<0.01). The median follow-up time was 8(4, 16) months. To the end of the follow-up, 113 patients (27.90%) had renal adverse prognostic events. Kaplan-Meier survival analysis results showed that the renal cumulative survival rate of the high-level MHR group was lower than that of the low-level MHR group (χ²=8.277, P=0.004). Multivariate Cox regression analysis showed that high MHR level was an independent influencing factor for poor renal prognosis in CKD patients (HR=1.628, 95%CI 1.050-2.523, P=0.029). Stratified analysis showed that, without hypertension, MHR had a more significant effect on the prognosis of the kidneys (HR=3.414, 95%CI 1.091-10.686, P for interaction=0.001). Conclusions The level of MHR is related to the severity and poor renal prognosis of CKD, and the high MHR level is an independent predictor for poor renal prognosis in CKD patients.

肾脏是新型冠状病毒（2019-nCoV）感染影响的主要器官之一，但是2019-nCoV感染合并的肾损伤不能全部归咎于病毒感染。目前文献表明，2019-nCoV感染可能诱发微小病变性肾病、塌陷型局灶节段性肾小球硬化症、膜性肾病、抗肾小球基底膜病等肾小球损伤、肾小管损伤和血栓性微血管病。管网状包涵体可能是2019-nCoV感染相关肾小球损伤的标志物。

Objective To investigate the effects of hyperuricemia on the prognosis of IgA nephropathy (IgAN) using propensity score matching (PSM) method. Methods IgAN patients proven by biopsy were included. PSM was used to match patients. Kaplan-Meier method was used for survival analysis, and Cox regression analysis was used to analyze the effects of hyperuricemia on IgAN prognosis. Primary outcome events were defined as death, or end-stage renal disease (dialysis, transplantation), or a decrease in estimated glomerular filtration rate (eGFR) greater than 40%. Renal outcome was defined as end-stage renal disease (dialysis, transplantation), or a decrease in eGFR greater than 40%. Results A total of 1 454 IgAN patients were included in this study, including 850 females and 604 males. Uric acid level was (368.26±92.87) μmol/L in the males, and (277.23±92.71) μmol/L in the females. The median follow-up time was 85.00(56.10, 106.33) months. During the follow-up period, a total of 134 patients reached the primary outcome events, including 5 deaths, 24 dialysis patients, 5 kidney transplant patients, and 100 patients with eGFR decreased by more than 40%. After 1∶1 matching, 131 males and 159 females in the hyperuricemia group were successfully matched with 131 males and 159 females in the normal uric acid group, and there was no significant statistical difference in each parameter in baseline between the hyperuricemia group and normal uric acid group after matching. Kaplan-Meier survival analysis showed that either before or after matching, the incidence of primary outcome events in male or female patients with hyperuricemia was higher than those with normal uric acid, but there was no statistically significant difference in incidence of primary outcome events between female hyperuricemia group and female normal uric acid group after matching (Log-rank test, χ²=3.586, P=0.058). Cox proportional hazard regression model showed that, in the pre-match fully adjusted model, the hazard ratio (HR) of entering primary outcome events was 2.29-fold (95%CI 1.27-4.11, P=0.006) for men with hyperuricemia and 1.85-fold (95%CI 1.01-3.37, P=0.045) for women with hyperuricemia compared with those with normal uric acid. In the post-match fully adjusted model, the HR of entering primary outcome events was 2.41-fold (95%CI 1.18-4.93, P=0.016) for men with hyperuricemia and 1.83-fold (95%CI 0.91-3.67, P=0.091) for women with hyperuricemia compared with those with normal uric acid. In the pre-match fully adjusted model, the HR of entering renal outcome events was 2.68-fold (95%CI 1.47-4.88, P=0.001) for men with hyperuricemia and 1.81-fold (95%CI 0.99-3.33, P=0.056) for women with hyperuricemia compared with those with normal uric acid. In the post-match fully adjusted model, the HR of entering renal outcome events was 2.89-fold (95%CI 1.36-6.15, P=0.006) for men with hyperuricemia and 1.81-fold (95%CI 0.88-3.72, P=0.106) for women with hyperuricemia compared with those with normal uric acid. Conclusion Hyperuricemia may be associated with IgAN progression, and it has a more significant effect on male IgAN patients.

Objective To investigate the clinical practice of chronic kidney disease-mineral and bone disorder (CKD-MBD) in maintenance hemodialysis patients in Shanghai, and to better understand the changes of clinical practice for CKD-MBD. Methods Sixty-four hospitals with qualified dialysis center in Shanghai were selected for questionnaire survey as of March 2019. The survey questionnaire included the number of hemodialysis and peritoneal dialysis patients, the implementation of CKD-MBD guidelines, the learning of CKD-MBD guidelines, the detection and distribution of CKD-MBD biochemical indicators, the treatment of hyperphosphatemia, the treatment of secondary heperparathyroidism (SHPT) and renal bone disease, and the concentration of calcium ion in dialysate. The results were compared with previous survey data in 2011. Results There were sixty-three hospitals included in this study, with 10 168 maintenance hemodialysis patients and 4 610 maintenance peritoneal dialysis patients in Shanghai. 84.1%(53/63) hospitals implemented the guidelines smoothly, which increased by 28.5% compared with the rate (55.6%) of 2011. The successful implementation rates for guidelines in secondary and tertiary hospitals were 83.3%(25/30) and 84.8%(28/33), which increased by 44.0% and 11.7% respectively (39.3% of secondary hospitals and 73.1% of tertiary hospitals in 2011). All hospitals carried out the detection for serum calcium and phosphorus. The rate for parathyroid hormone (PTH), total alkaline phosphatase (AKP), bone specific alkaline phosphatase (BAP), 25-hydroxy vitamin D[25(OH)D], and other bone metabolism-related biomarkers were 98.4%(62/63), 90.5%(57/63), 19.0%(12/63), 90.5%(57/63) and 42.9%(27/63), respectively; coronary artery CT, lumbar lateral X-ray plain, echocardiography, bone mineral density, and vascular ultrasound were carried out in 68.3%(43/63), 74.6%(47/63), 100.0%(63/63), 68.3%(43/63)and 69.8%(44/63), respectively. Compared with 2011, the proportion of detection for PTH, AKP, BAP, 25(OH)D, coronary artery CT, lumbar lateral film and echocardiography increased by 2.1%, 1.6%, 0.5%, 47.9%, 14.6%, 20.9% and 1.9%, respectively. The proportion of patients with serum phosphorus ranging in 0.80-1.45 mmol/L(KDIGO guideline), serum phosphorus ranging in 0.80-1.78 mmol/L(KDOQI guideline), calcium ranging in 2.10-2.54 mmol/L, and PTH ranging in 150-600 ng/L were 37.0%(3 323/8 969), 50.7%(4 571/9 018), 60.2%(5 568/9 244) and 33.2%(3 018/9 087). Compared with 2011(39.6%, 53.5% and 34.1%), the proportion of patients with ideal serum phosphorus (0.80-1.78 mmol/L) and calcium (2.10-2.54 mmol/L) levels increased by 11.1% and 6.7% respectively, and the proportion with PTH 150-300 ng/L decreased by 0.9%. The proportion of hospitals for using non-calcium phosphate binders (lanthanum carbonate from 1.9% to 87.3% and sevelamer carbonate from 14.8% to 63.5%) and surgical treatment (from 38.9% to 68.3%) for SHPT dramatically increased. Conclusions Through the availability of medicine increases, and nephrologists gain deeper understanding in management and treatment of CKD-MBD, the detection rate for CKD-MBD indicators and the eligible rate have significantly improved compared with those in 2011. However, the comprehensive management of CKD-MBD in Shanghai still faces great challenges. It is still necessary to further improve eligible rate for serum phosphorus and iPTH, so as to provide more evidences and management strategies for integrated management of end-stage renal disease and prevention of abnormal calcium and phosphorus metabolism in patients.

急性肾损伤（acute kidney injury，AKI）是威胁人类健康的主要疾病之一，其进一步发展可导致终末期肾病。胆碱能抗炎通路（cholinergic anti-inflammatory pathway，CAP）在多器官炎症中的保护作用已有研究，迷走神经可通过CAP激活胆碱能受体进而抑制炎性因子的释放。CAP主要通过α7烟碱型乙酰胆碱受体发挥作用，但是有关CAP在AKI中的保护作用，尤其是CAP治疗在AKI进展中的应用和临床指导意义研究尚少。因此，本文就CAP在AKI中的应用作一简要综述，旨在为AKI的发病机制研究和诊疗提供新的思路。

Objective To investigate the clinicopathological characteristics of renal light and heavy chain amyloidosis (AHL). Methods Ten patients with renal AHL diagnosed by renal biopsy in Peking University First Hospital and Institute of Nephrology of Peking University from January 2015 to June 2020 were enrolled. Clinicopathological data of these patients was collected and reviewed. Results AHL typically affected older patients, with a male/female ratio of 7∶3. The clinical manifestations were mainly edema and heavy proteinuria. At the same time, 7/10 of patients presented with nephrotic syndrome, 7/10 presented with microscopic hematuria, and 3/10 presented with renal insufficiency. Laboratory examinations showed monoclonal immunoglobulin in blood and urine in all patients, and IgGλ was the most common one (5/10). Decreased serum complement could be seen in some patients. The ratio of serum free κ light chain and free λ light chain was abnormal in all patients who underwent serum free light chain test. None of the 10 patients met the diagnostic criteria of multiple myeloma. Except for one of the 10 patients who was diagnosed as Waldenstrom's macroglobulinemia, the rest were diagnosed as monoclonal gammopathy of renal significance (MGRS). Bone marrow of 2/6 of patients were positive for amyloid. Cardiac involvement was confirmed in only one patient. Renal biopsy demonstrated amorphous eosinophilic material, which was Congo red positive, was deposited in glomerular mesangial area (10/10), capillary vessels (8/10), renal interstitium (9/10), peritubular capillary walls (9/10) and arterioles (8/10). This material showed apple green birefringence under polarized light. Immunofluorescence showed that single heavy chain and single light chain were positive at the same time, which was consistent with the results of mass spectrometry analysis. Ultrastructural evaluation revealed randomly oriented, non-branching fibrils with a diameter of 8-12 nm. Conclusions Main clinical manifestations of AHL amyloidosis are edema and massive proteinuria, along with a high incidence of hematuria, a low portion of heart involvement and high frequency of whole molecule of monoclonal immunoglobulin (IgGλ dominant) by serum immunofixation electrophoresis. Renal pathology shows the commonly involved kidney compartments of amyloid deposits are glomerular capillary walls and peritubular capillary walls in patients with AHL amyloidosis.

Objective To investigate the predictive value of abnormal heart rate circadian rhythm for all-cause mortality in stage 5 chronic kidney disease (CKD 5) patients. Methods The retrospective study was performed in CKD 5 patients enrolled from the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital) and the Affiliated BenQ Hospital of Nanjing Medical University from February, 2011 to December, 2019. A total of 159 healthy volunteers were enrolled as the healthy control group during the same period. The circadian rhythm of heart rate was monitored by 24-hour Holter. Related indices (including 24-hour, daytime and nighttime mean heart rate, night/day heart rate ratio, 24-hour maximum heart rate, 24-hour minimum heart rate and difference between maximum and minimum of 24-hour heart rate) were calculated. Non-dipping heart rate was defined as night/day heart rate ratio greater than 0.9. Cox regression model was used to analyze the risk factors of all-cause mortality in CKD 5 patients. Kaplan-Meier survival curve and Log-rank test were used to compare the differences of cumulative mortality between high ratio group (night/day heart rate ratio>0.91) and low ratio group (night/day heart rate ratio≤0.91). The nonlinear relationship between night/day heart rate ratio and all-cause mortality was analyzed by restricted cubic spline plot. Time-dependent receiver operating characteristic (ROC) curve was used to analyze the predictive value of night/day heart rate ratio for all-cause mortality in CKD 5 patients. Results A total of 159 healthy volunteers and 221 CKD 5 patients were included in this study. There were 123 males (55.66%) and the age was (52.72±13.13) years old in CKD 5 patients. The total median follow-up time was 50.0 months. Compared with controls, 24-hour, nighttime mean heart rate, 24-hour minimum heart rate in CKD 5 patients were increased (all P<0.05), furthermore, the night/day heart rate ratio was higher [(0.91±0.09) vs (0.81±0.08), P<0.001], showing "non-dipping heart rate". However, the 24-hour maximum heart rate and the difference between maximum and minimum of 24-hour heart rate in CKD 5 patients were lower than controls (both P<0.05). Multivariate Cox regression analysis showed that the increased night/day heart rate ratio (per 0.1 increase, HR=1.557, 95%CI 1.073-2.258, P=0.020) was an independent influencing factor for all-cause mortality in CKD 5 patients. Kaplan-Meier survival curve analysis showed that the cumulative mortality of the high ratio group was significantly increased than that of the low ratio group (Log-rank test χ²=7.232, P=0.007). From the restricted cubic spline plot, there was a linear effect between night/day heart rate ratio and all-cause mortality (P=0.141), and when night/day heart rate ratio was above 0.91, the risk of all-cause mortality was significantly increased in CKD 5 patients. According to time-dependent ROC curve, the accuracy of night/day heart rate ratio in predicting all-cause mortality was 70.90% even when the survival time was up to 70.0 months. Conclusions The circadian rhythm of heart rate in CKD 5 patients displays "non-dipping" state. High night/day heart rate ratio is an independent influencing factor for all-cause mortality in CKD 5 patients.

外泌体是直径40~160 nm的细胞外囊泡，含有DNA、RNA、蛋白、脂类等丰富的生物学信息，参与多种病理生理学过程。近年来研究发现，外泌体存在于机体多种体液中，其作为疾病生物标志物具有巨大潜力。尿液外泌体由于收集的无创性、来源细胞的多样性、稳定性等特点，在疾病诊断中显示出重要的应用价值。因此，开发适用于临床的高效、新型外泌体分离技术近年来也日益受到关注。目前对于外泌体的提取尚缺乏标准化的方法，本文综述了传统及新型的外泌体分离提取方法及尿外泌体组学和生物标志物的研究进展。

Objective To analyze the weight score and clinical application of 2019 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) systemic lupus erythematosus (SLE) classification criteria in lupus nephritis patients. Methods Lupus nephritis patients with renal biopsy results who were admitted in the First Affiliated Hospital of Zhejiang University College of Medicine between January 2014 and December 2018 were enrolled retrospectively. According to whether these patients were treated with glucocorticoids and/or immunosuppressants at the time of renal biopsy, they were divided into untreated group and post-treatment group. The weight scores were compared between the two groups, and the relationship between each weight score and remission after treatment was analyzed. Taking no remission as the end event, Cox regression analysis was used to analyze the influence of each weighted integral on the end event. Results A total of 153 patients were enrolled, including 131 (85.6%) females. These were 70 (45.8%) patients in the untreated group and 83 (54.2%) patients in the post-treatment group. The patients in the untreated group had higher scores of fever (>38.3℃), blood system involvement, low complement and positive specific antibodies than those in post-treated group (all P<0.05). In a median follow-up of 34 (6-50) months, 99 patients (64.7%) achieved complete remission, 38 patients (24.8%) achieved partial remission and 16 patients (10.5%) had no remission. With no remission as the endpoint event, univariate Cox regression analysis showed that proliferative lupus nephritis (renal score of 10 points vs 8 points) and neuropsychiatric involvement were the risk factors (both P<0.05), while multivariate Cox regression analysis showed that neuropsychiatric involvement (HR=4.758, 95%CI 1.324-17.101, P=0.017) was an independent risk factor. Conclusion The weight scores of 2019 EULAR/ACR SLE classification diagnostic criteria have certain predictive value for remission of patients with lupus nephritis.

近年来，局部枸橼酸抗凝（regional citrate anticoagulation，RCA）在血液净化领域得到广泛应用，对于存在出血高危风险及活动性出血的患者有其独特优势。本文回顾分析近年来国内外RCA在临床血液净化领域中的应用，其抗凝安全、有效，与全身性抗凝相比RCA可以延长滤器寿命、减少出血并发症，适宜在临床广泛开展。

Objective To evaluate perirenal adipose tissue inflammation in obesity-related glomerulopathy induced by a high-fat diet in C57BL/6J mice and further explore its probable mechanism. Methods Twelve 8-10-week-old male C57BL/6J mice were divided into normal diet group (ND, n=6) and high-fat diet group (HFD, n=6) using simple random sampling method. After 14 weeks, the blood and kidney tissue were sampled, and the pathological change in the kidney and perirenal adipose tissue was observed by hematoxylin-eosin, periodic acid-Schiff, and Masson staining. The mRNA expression of tumor necrosis factor -α (TNF-α), M1-type macrophage marker CD11c, interleukin (IL)-1β, monocyte chemotactic protein-1 (MCP-1), IL-10, transforming growth factor -β1, M2-type macrophage marker CD206 and fibronectin 1 in perirenal fat was detected by real-time fluorescence quantitative PCR. The expression of macrophages marker F4/80, CD68 and leukocyte common antigen (LCA) in the kidney and perirenal adipose tissue was detected by immunohistochemistry. Results After 14 weeks of feeding, compared with mice in the ND group, the weight of mice in the HFD group was significantly higher [(35.83±1.19) g vs (24.06±0.37) g, P<0.05]. In the HFD group, perirenal adipocyte hyperplasia, accompanied by glomerular hyperplasia, mesangial matrix hyperplasia and renal interstitial fibrosis, and other pathological changes was observed (all P<0.05). The level of blood glucose, blood lipid, serum creatinine and blood urea nitrogen was also significantly higher (all P<0.05). The mRNA expression of TNF-α, CD11c, IL-1β and MCP-1 related to M1 macrophages in the perirenal adipose tissue was higher (all P<0.05), and immunohistochemistry showed that the expression of F4/80, CD68 and LCA in the perirenal adipose tissue was higher in HFD group (all P<0.05). The above results showed that the number of macrophages and inflammatory cells in the perirenal adipose tissue was significantly greater in the HFD group than those in the ND group. Pearson linear correlation analysis showed that the average perirenal fat area was positively correlated with macrophages number in perirenal adipose tissue, several morphological indexes such as glomerular cross-sectional area and renal function injury indexes such as blood urea nitrogen (all P<0.05). Conclusion The C57BL/6J mice model of obesity-related glomerulopathy induced by a high-fat diet is successfully established, and the perirenal adipose tissue shows an obvious inflammatory response, with the macrophages significantly polarized mainly in the pro-inflammatory direction towards the M1-type macrophages.

盐皮质激素受体的过度激活可促进氧化应激、炎性反应和纤维化，在心血管疾病和慢性肾脏病（chronic kidney disease，CKD）的发生发展中发挥了重要的作用。传统甾体类盐皮质激素受体拮抗剂因低选择性、低亲和力及组织分布带来的不良反应，限制了其临床应用。一系列针对CKD，尤其是CKD合并糖尿病患者的临床研究证实，新型非甾体型高选择性盐皮质激素受体拮抗剂非奈利酮（finerenone）可显著减少心肾终点事件的发生，有望成为治疗CKD的新手段。

急性肾损伤（acute kidney injury，AKI）是化疗药物顺铂的常见不良反应。顺铂诱导的AKI的发病机制复杂，与细胞摄取和外排、氧化应激、细胞死亡以及免疫与炎性反应有关。经历了数十年的研究，目前仍然没有理想的缓解顺铂相关AKI的治疗方案，主要原因是顺铂诱导的AKI的发病机制仍不明确。本文综述了近年来顺铂诱导的AKI的病理生理机制及其药理学和遗传学改变的相关文献，以期为顺铂相关AKI的治疗提供新思路。

Objective To observe heart rate circadian rhythm in patients with chronic kidney disease (CKD) stage 5 and to analyze the effects of parathyroidectomy (PTX) on heart rate circadian rhythm in severe secondary hyperparathyroidism (SHPT) patients. Methods A cross-sectional observation was performed in 213 patients with CKD stage 5 and 96 controls, and the patients were divided into those with severe SHPT (PTX group, n=70) and without severe SHPT (non-PTX group, n=143). Forty-six PTX patients were followed up prospectively. The baseline data were compared among these groups. Holter electrocardiogram was performed for each participant. Non-dipping heart rate was defined as night/day heart rate ratio greater than 0.9. Multiple linear regression analysis was used to analyze the related factors of heart rate circadian rhythm in patients with CKD stage 5. Results The 24-hour, daytime and nighttime mean heart rate in patients with CKD stage 5 were all higher than those in controls, especially in PTX group (all P<0.05). The night/day heart rate ratios of controls and CKD stage 5 patients were (0.81±0.08) and (0.91±0.08) respectively (P<0.01). Correlation analysis showed 24-hour and daytime or nighttime mean heart rate in patients with CKD stage 5 were positively correlated with serum levels of phosphorus and ln(alkaline phosphatase), while nighttime mean heart rate and night/day heart rate ratio were positively related with serum intact parathyroid hormone level. After adjusting with postoperative follow-up period (median time: 10.9 months), 24-hour and nighttime mean heart rate, and night/day heart rate ratio in PTX patients all decreased significantly (all P<0.01). Conclusions Heart rate is increased and circadian rhythm is abnormal in patients with CKD stage 5, which are related with mineral and bone disorder. PTX significantly decreases 24-hour and nighttime mean heart rate in severe SHPT patients, and improves the heart rate circadian rhythm.

Objective To investigate the clinical features and associated influencing factors of cognitive impairment in middle-aged and elderly Chinese adult patients undergoing maintenance hemodialysis (HD). Methods A cross-sectional study was conducted among HD patients from 11 centers in Beijing city from April 2017 to June 2017. A neuropsychological battery covering domains of attention/processing speed, executive function, memory, language, and visuospatial function was applied in cognitive function assessment. Patients were classified as normal cognitive function group and cognitive impairment group according to the fifth version of the diagnostic and statistical manual of mental disorders criteria (DSM-V). Multivariate binary logistic regression was used to analyze the independent influencing factors of cognitive impairment. Results A total of 613 HD patients were included in the study, and the prevalence of cognitive impairment was 80.91%(496/613). Attention impairment (81.05%) and memory impairment (63.51%) were the most common impaired domains, and 79.23% was concomitant impairment across two or more cognitive domains among those with cognitive impairment. Compared with the patients in the normal cognitive function group, the patients in the cognitive impairment group had senior age, longer dialysis vintage, higher proportion of diabetes, hypertension, and stroke, higher level of serum intact parathyroid hormone (iPTH), lower education level, and lower urea clearance index (Kt/V) (all P<0.05). Factors were independently associated with cognitive impairment including increasing age (OR=1.110, 95%CI 1.072-1.150, P<0.001), education time>12 years (with education time<6 years as reference, OR=0.323, 95%CI 0.115-0.909, P=0.032), history of diabetes (OR=2.151，95%CI 1.272-3.636, P=0.004), history of stroke (OR=2.546, 95%CI 1.244-5.210, P=0.011), increased dialysis vintage (OR=1.016, 95%CI 1.010-1.022, P<0.001), reduced Kt/V(OR=0.008, 95%CI 0.002-0.035, P<0.001), and increased iPTH level (OR=1.002, 95%CI 1.002-1.003, P=0.012). Conclusions The prevalence of cognitive impairment in middle-aged and elderly adult Chinese patients undergoing HD is high. Memory and attention are the most commonly impaired domains. Increasing age, low education level, history of diabetes and stroke, increased dialysis vintage, reduced Kt/V and increased serum iPTH are the independent influencing factors associated with cognitive impairment.

Objective To evaluate the efficacy and safety of rituximab in the treatment of adult primary focal segmental glomerulosclerosis (FSGS). Methods Adult FSGS patients treated with rituximab in the First Affiliated Hospital of Zhejiang University College of Medicine were retrospectively enrolled. One or two doses of rituximab (375 mg/m²) were used aiming to achieve B cell depletion (defined as<5 B cells per microliter in peripheral blood) and the interval between the two doses was 2 weeks. The evaluated major outcomes were remission and relapse of nephropathy, and the secondary outcome measures were adverse events and renal outcomes. Results A total of 14 patients (9 males) were enrolled, among whom 7 cases were steroid-dependent nephrotic syndrome (SDNS) or frequently relapsing nephrotic syndrome (FRNS), 6 cases were steroid-resistant nephrotic syndrome (SRNS) and one patient was new onset FSGS with contraindication to steroid. After treatment with rituximab, 7 patients with SDNS/FRNS achieved complete remission. At 6 months, the daily oral steroid dose reduced significantly compared with the baseline [(33.3±5.2) mg/d vs (6.7±6.6) mg/d, P<0.01]; while one patient still received tacrolimus 1.0 mg/d, the other 6 patients stopped using immunosuppressants; and the total number of relapse/total follow-up months decreased from 0.257 times/month to 0.058 times/month after the use of rituximab. For the other 6 SRNS patients and one patient with contraindication to steroid, three SRNS patients achieved partial remission and one patient with contraindication to steroid achieved complete remission at 34.50(20.25, 95.25) days after use of rituximab, and the other 3 SRNS patients failed to achieve remission, of whom one patient developed end stage renal disease at 23 months. Conclusions Rituximab may reduce the risk of relapse and help steroid or immunosuppressant-tapering in adult steroid-dependent/frequently relapsing idiopathic FSGS. However, it is not effective in SRNS patients.

Objective To investigate the relationship between hemoglobin levels and renal prognosis in patients with IgA nephropathy (IgAN). Methods The clinical data and pathological examination results of IgAN patients diagnosed by renal biopsy at the Second People's Hospital of Shenzhen from February 25, 2010 to September 9, 2020 were retrospectively collected and analyzed. The patients were divided into anemic group and non-anemic group according to the anemia diagnostic criteria (The hemoglobin levels were<120 g/L and<110 g/L in males and females respectively at sea level area). Endpoint event was defined as a decrease in estimated glomerular filtration rate (eGFR) of>50% from baseline and/or progression to stage 5 chronic kidney disease [eGFR<15 ml·min^-1·(1.73 m²)^-1]. Cox regression analysis was used to analyze the factors affecting the poor renal prognosis. The relationship between hemoglobin and renal function prognosis was analyzed by smoothing curve fitting and threshold effect. Kaplan-Meier survival curve was used to compare and analyze the difference of renal survival rate between the anemic and non-anemic IgAN patients. Results A total of 1 263 IgAN patients were included in this study, 255(20.19%) patients were in the anemia group and 1 008 (79.81%) patients were in the non-anemia group. The anemia group had lower body mass index, baseline eGFR, serum albumin, and triglyceride than those in the non-anemia group (all P<0.05). The proportion of females, 24 h urinary protein content, and the proportion of renal tubule atrophy/interstitial fibrosis, segmental sclerosis and crescents in the anemia group were higher than those in the non-anemia group (all P<0.05). Multivariate Cox regression analysis showed that low hemoglobin was an independent influencing factor for renal endpoint event (HR=0.25, 95%CI 0.07-0.90, P=0.022). Smoothing curve fitting analysis and threshold effect analysis showed that a curving relationship was detected between hemoglobin and relative risk of renal endpoint event. As hemoglobin increased, there was a protective effect on renal function when hemoglobin level was lower than 147 g/L (β=0.96, 95%CI 0.94-0.99, P=0.008). Kaplan-Meier survival curve analysis suggested that patients with anemia had a lower cumulative renal survival rate than that of patients without anemia (Log-rank test χ²=10.106, P=0.002). Conclusions Low hemoglobin is an independent influencing factor for poor prognosis of renal function in IgAN patients. Cumulative renal survival rate is lower in IgAN patients with anemia than that of patients without anemia.

肾纤维化是各种病因导致的慢性肾脏病（chronic kidney disease，CKD）进展至终末期肾病的共同病理变化，其治疗研究一直受到广泛关注，改善肾纤维化所致的肾功能障碍被认为是治疗CKD的重要策略。自噬作为一种进化上高度保守的细胞内降解系统，已被证实与肾纤维化的发生发展密切相关。其中，肾脏固有细胞自噬变化对肾纤维化的影响被研究得较多；然而，自噬对肾纤维化的作用可能是细胞特异性及疾病环境依赖性的，即在不同的细胞或不同的疾病模型可能有截然相反的作用。因此，自噬对肾纤维化的作用仍然存在一定的争议。本文就肾脏固有细胞自噬在不同疾病条件下对肾纤维化作用的研究进展进行综述。