The first working meeting of the 8th Editorial Committee of Chinese Journal of Nephrology was held in Guangzhou, China on November 30, 2023. At the meeting, the list of the 8th Editorial Committee was announced, the work of the journal in the past 5 years was summarized, and the future work of the Editorial Committee was planned and discussed. Jiang Yongmao, former deputy secretary-general of the Chinese Medical Association, Jin Dong, deputy general manager of the Chinese Medical Journals Publishing House Co., Ltd, Lu Quan, editor of the Journal Management Department of Chinese Medical Association, Yu Xueqing, editor-in-chief of the 8th Editorial Committee, Cai Guangyan, Chen Jianghua, Zhao Minghui and Mao Haiping, deputy editor-in-chief of the 8th Editorial Committee, and 69 members of the 8th Editorial Committee, attended the meeting. The meeting came to a successful conclusion, and provided guidance for how to break through the difficulties, publish high-quality content and achieve high-quality development under the new situation.

Objective To analyze the efficacy and safety of daratumumab plus dexamethasone in the treatment of renal injury patients with light chain amyloidosis, and to provide clinical reference. Methods It was a single center retrospective observational study. The clinical data before and after daratumumab treatment of renal injury patients with light chain amyloidosis treated with daratumumab plus dexamethasone from December 2021 to August 2022 were retrospectively collected. The hematologic response, kidney response, prognosis, and adverse events were analyzed. The treatment regimen was 16 mg/kg intravenous infusion of daratumumab on day 1 + 20 mg intravenous push of dexamethasone on day 1-2, once every 2 weeks. The follow-up was up to February 28, 2023. Results The study included 18 patients, with age of (58.4±7.7) years old, and a male to female ratio of 11∶7. Eleven patients were newly diagnosed and 7 patients were retreated. There were 7, 5, 5 and 1 patients, respectively at the stage Ⅰ, Ⅱ, Ⅲ and Ⅳ of light chain amyloidosis according to 2012 Mayo stage criteria. The median course of disease before onset was 2.5 (1.0, 8.0) months and the follow-up time was (8.7±2.8) months. The patients received (10±3) times of treatment. The overall hematologic response rates were 9/13, 11/13 and 13/13 at 1 month, 3 months, and 6 months respectively after treatment, meanwhile 8/13, 10/13 and 12/13 achieved at least very good partial response at 1 month, 3 months, and 6 months respectively (the other 5 patients did not undergo detailed evaluation due to baseline difference of serum free κ and λ light chain <20 mg/L). The median duration of hematologic response was 16 (13, 40) days. At 3 months, 6 months and the end of follow-up, 10, 13 and 13 of 18 patients respectively achieved renal response, and the median duration of response was 66 (26, 182) days. During follow-up, the median difference of serum free κ and λ light chain decreased by 93% (72%, 97%). Until the last follow-up, one patient died of organ hemorrhage. Other infusion reactions, leukopenia, neutropenia and infection all improved after symptomatic treatments. Conclusion Daratumumab plus dexamethasone treatment is effective for light chain amyloidosis nephropathy in inducing hematologic remission and kidney remission, with good safety.

Objective To investigate the correlation between serum sclerostin and sarcopenia-related indicators in chronic kidney disease (CKD) patients, and to find biomarkers and potential therapeutic targets that can take into account both osteoporosis and sarcopenia. Methods It was a single-centre cross-sectional study. The clinical data of CKD stage 5 patients undergoing maintenance hemodialysis regularly and CKD stage 1-5 non-dialysis inpatients in the Hemodialysis Centre of Guangzhou Red Cross Hospital from March 2021 to March 2023 were collected retrospectively. The enzyme-linked immunosorbent assay was used to detect the level of serum sclerostin. The anthropometric data such as height, weight, upper arm circumference, upper arm muscle circumference, skinfold thickness, pinch strength and handgrip strength were measured. Body composition analyzer was used to measure the body composition. The patients were divided into CKD stage 1-3 group, CKD stage 4-5 group, and stage 5 hemodialysis group. One-way ANOVA, Kruskal-Wallis H test, and chi-square test were used to compare the differences of demographics and clinical characteristics in different stages of CKD. Spearman correlation analysis and multiple linear stepwise regression analysis were utilized to analyze the correlation between serum sclerostin and sarcopenia-related indicators in CKD patients. Results The study included 104 patients with CKD stage 5 hemodialysis and 104 patients with CKD stage 1-5 non-dialysis patients, with age of (61.8±13.7) years old and 114 males (54.8%). There were 89 patients (42.8%) with diabetic nephropathy and 67 patients (32.2%) with sarcopenia. As renal injury progressed, serum sclerostin levels were 0.4 (0.3, 0.9) ng/L, 0.5 (0.3, 1.1) ng/L, and 1.1 (0.6, 2.3) ng/L in patients with CKD stage 1-3, stage 4-5, and stage 5 undergoing hemodialysis (χ²=8.934, P<0.001), and the prevalence of sarcopenia was 16.4% (10/61), 34.9% (15/43), and 40.4% (42/104) (χ²=10.312, P=0.006), respectively. Spearman correlation analysis showed that serum sclerostin was negatively correlated with estimated glomerular filtration rate (r=-0.314, P<0.001), pinch strength (r=-0.229, P=0.007), skinfold thickness (r=-0.254, P<0.001), appendicular skeletal muscle index (r=-0.169, P=0.010), body cell mass (r=-0.174, P=0.020), and phase angle (r=-0.264, P<0.001), and positively correlated with serum phosphorus (r=0.227, P=0.002) and intact parathyroid hormone (r=0.297, P<0.001). Multiple linear stepwise regression analysis showed that lg[appendicular skeletal muscle index] was negatively correlated with male (β=0.330, t=5.675, P<0.001) and serum sclerostin (β=-0.125, t=-2.143, P=0.033), and positively correlated with body mass index (β=0.474, t=8.090, P<0.001). Conclusion Serum sclerostin can be used as a good index and a potential therapeutic target for sarcopenia in CKD patients.

Objective To explore the combination of high risk screening and family screening for potential patients with Fabry disease in adult hemodialysis population, and to improve the diagnostic efficiency of the disease. Methods It was a cross-sectional investigation study. High-risk screening for Fabry disease was performed on adult hemodialysis patients with end-stage kidney disease who were admitted to Yongkang First People's Hospital of Zhejiang Province between November 2022 and February 2023. Dry blood paper α-galactosidase A (α-Gal A) detection assay was performed in males, or glycosphingolipids (Lyso-GL-3) detection assay was performed in females. GLA genetic assay was performed for further diagnosis after abnormal screening results. Family screening was carried out on the family members of the confirmed Fabry disease patients, and α-Gal A activity and Lyso-GL-3 of peripheral blood were measured. Additionally, urine routine, blood biochemistry, eye examination, hearing test, cranial magnetic resonance imaging, and electrocardiogram were performed to assess organ damage. Results Among 244 hemodialysis patients, 139 (56.97%) were males and 105 (43.03%) were females. The age ranged from 25 to 81 years (with median age of 61 years). One female patient with Fabry disease was identified GLA IVS4+919G>A mutation, resulting in a total prevalence of 0.41%. Pedigree screening was conducted on 41 family members of the patient, leading to the confirmation of 12 patients (including the proband), including 3 males and 9 females. Among them, 9 patients were abnormal in enzyme examination, 10 patients were abnormal in substrate, and 11 patients were abnormal in gene sequencing. None of the 12 patients exhibited limb pain, hypohidrosis, angiokeratoma, corneal opacity, and hearing impairment. Eight patients had heart abnormalities. Nine patients had abnormal urine routine (albuminuria or hematuria) and one patient had abnormal renal function. Four patients had abnormal cranial magnetic resonance imaging findings. Conclusions One GLA IVS4+919G>A mutation family is successfully identified through the combination of high-risk screening and family screening in adult hemodialysis patients, with a total of 12 cases of Fabry disease. The combination of high-risk screening and family screening proves to be effective in detecting potential patients with Fabry disease, and improve the screening efficiency of Fabry disease.

Objective To analyze and summarize the clinical, genotypic and pathological characteristics of children with PAX2 gene mutation in China, and to provide information for the monitoring, treatment and prognosis of the disease. Methods It was a case series analysis study. The clinical data of children with PAX2 gene mutation in Pediatric Nephrology Department, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology from January 2014 to December 2022 were collected, and peripheral blood gene DNA was extracted and sequenced for whole exome sequencing. The clinical, pathological and genotypic characteristics of PAX2 gene variation of children in China were summarized by searching PubMed, Medline, China National Knowledge Infrastructure and Wanfang database and compared with the cases in this single center. Results Among the 13 children with PAX2 gene mutation, there were 9 males and 4 females, 12 patients with abnormal urine tests, 7 patients with small kidney volume by imaging examination, and 5 patients with renal cysts. The clinical phenotypes were congenital renal and urinary tract malformations in 8 cases, renal coloboma syndrome in 1 case, and hematuria or proteinuria in 3 cases. Five patients underwent renal biopsies, showing focal segmental glomerulosclerosis and C3 glomerulopathy in 1 case, focal segmental glomerulosclerosis in 1 case, thin basement membrane lesion in 1 case, and IgA nephropathy in 2 cases. The genetic testing in 13 children showed 9 de novo mutations and 4 new mutations of c.321G>A, c.213-8C>G, c.63C>A and c.449C>T. There were 2 cases of 76dupG (p.V26Gfs*28) mutant. A total of 51 Chinese children with PAX2 gene mutation were found in the literature search. There were 32 males and 19 females, 8 cases with small kidney volume and 12 cases with renal cysts. The clinical phenotypes were congenital anomalies of kidney and urinary tract in 28 cases, renal coloboma syndrome in 17 cases, and hematuria or proteinuria in 6 cases. Seven patients underwent renal biopsies, including 2 cases with focal segmental glomerulosclerosis, 1 case with minimal lesion, 1 case with mesangial proliferative glomerulonephritis, 1 case with IgA nephropathy, 1 case with membranous nephropathy and a case with focal proliferative sclerosing purpura nephritis combined with glomerular hypertrophy. Thirty-four cases were de novo mutations, and 12 mutations were from the father or mother. The father or mother of 5 children had no clinical manifestations, with normal renal function. There were 11 cases of 76dupG (p.V26Gfs*28) mutant. Conclusions The clinical phenotypes and genotypes of PAX2 gene variation in Chinese children are diverse. The most common clinical phenotype of PAX2 gene variation is congenital anomalies of kidney and urinary tract. c.76dupG (p.V26Gfs*28) is the most common of PAX2 gene variant.

Objective To investigate the clinicopathological features and the prognosis of IgA nephropathy (IgAN) in children with massive proteinuria. Methods It was a retrospective cohort study. Clinical data of IgAN children with massive proteinuria admitted to the Department of Nephrology, Children's Hospital Affiliated to Capital Institute of Pediatrics from January 2008 to December 2021 were retrospectively analyzed. Patients were divided into effective group and ineffective group according to whether urine protein turned negative after 6 months of initial treatment. The follow-up endpoint event was defined as a reduction in proteinuria of less than 50% or end-stage renal disease (ESRD) achievement. MedCalc software was used to perform Kaplan-Meier survival analysis, and Log-rank test was used to compare the difference of renal survival between the two groups. Results A total of 127 patients were diagnosed as primary IgAN by renal biopsy, of whom 57 patients with IgAN showed massive proteinuria. These 57 IgAN patients with macroproteinuria accounted for 44.9% of the total IgAN patients and were enrolled in the study. Among the 57 cases, 33 cases (57.9%) were Lee's grade Ⅲ, 11 cases (19.3%) were below Lee's grade Ⅲ, and 13 cases (22.8%) were above Lee's grade Ⅲ. The follow-up time was 4.0 (3.0,5.8) years. In the initial treatment, among 57 patients, 46 (80.7%) were effective (effective group) and 11 (19.3%) were ineffective (ineffective group). Compared with the effective group, the ineffective group had a higher proportion of concurrent AKI at the onset of disease and longer recovery time of renal function, with significant difference (7/11 vs. 13/46, χ²=4.878, P=0.027). Compared with the effective group, the proportion of Lee grade Ⅲ or above was higher in the ineffective group, and the difference was statistically significant (5/11 vs. 8/46, χ²=3.971, P=0.046). There were significant differences in endocapillary hypercellularity (E1), segmental glomerulosclerosis or adhesion (S1) and cellular/fibrocellular crescents (C2) of Oxford classification between IgAN children with Lee grade Ⅲ or below and those over Lee grade Ⅲ (11/13 vs. 20/44, χ²=6.204, P=0.013; 12/13 vs. 17/44, χ²=11.566, P=0.001; 9/13 vs. 7/44, χ²=14.131, P=0.001). Among 57 patients, endpoint events occurred in 2 patients who both were urinary protein unmitigated, and none of the children progressed to ESRD. There was no significant difference in cumulative renal survival between the two groups by Kaplan-Meier survival analysis and Log-rank test (χ²=0.537, P=0.460) after addition of calcineurin inhibitors (CNIs) to the initial treatment ineffective group. Conclusions Macroproteinuria is the prominent manifestation of IgAN in children. The pathological type is mainly Lee grade Ⅲ. Children with macroproteinuria have a good prognosis in the short and medium term after active treatment. For IgAN with macroproteinuria that does not respond well to initial treatment, AKI is more common at onset, and renal function recovery time is longer. The application of CNIs may have a certain effect on improving the renal outcome of IgAN with massive proteinuria.

Objective To investigate the efficacy and mechanism of canagliflozin (Cana) in the treatment of high glucose-induced human podocyte (HPC) injury. Methods The HPCs were divided into 5 groups: normal glucose group (NG group), mannitol group (MA group), high glucose group (HG group), Cana low dose (0.3 μmol/L) group and Cana high dose (1.0 μmol/L) group. Western blotting was used to examine the protein expressions of membrane-associated guanylate kinase inverted-2 (MAGI2), podocyte-associated protein nephrin, sodium-glucose transporter 2 (SGLT2), NOD-like receptor thermal protein domain associated protein 3 (NLRP3), apoptosis- associated speck-like protein containing a CARD (ASC), and cleaved-caspase1 in podocytes. Phalloidin staining of F-actin in podocytes was used to observe cytoskeletal injury. Intracellular reactive oxygen species (ROS) level of HPC was detected by the 2',7'-dichlorodihydrofluorescein diacetate (DCFH-DA) probe. Levels of interleukin (IL)-18 and IL-1β in culture medium of podocytes were detected by enzyme-linked immunosorbent assay (ELISA). Results (1) Compared with the NG group, the protein expressions of MAGI2 and nephrin decreased (both P<0.01), the protein expression of SGLT2 increased ( P<0.01), the changes of cell morphology and cytoskeleton remodeling were obvious, intracellular ROS level increased ( P<0.01), while NLRP3, ASC and cleaved-caspase1 protein expressions decreased in the HG group (all P<0.01). The results of ELISA showed that IL-18 and IL-1β concentrations were higher in the HG group (both P<0.05). (2) Compared with the HG group, in the Cana groups, MAGI2 and nephrin expressions up-regulated (both P<0.01), the changes of cell morphology and cytoskeleton remodeling were alleviated. Meanwhile the Cana groups showed decreased SGLT2 expression ( P<0.05), lower ROS level, down- regulated NLRP3, ASC, cleaved-caspase1 expressions (all P<0.01), and decreased concentrations of IL-18 and IL-1β in culture medium of podocytes (both P<0.05). Conclusion Cana can improve high glucose-induced injury and inflammation in human podocyte, possibly due to the repression of the ROS/NLRP3 signaling pathway.

This study aims to evaluate the accuracy of portable hemoglobinometer (Hemocue Hb 201+ hemoglobin analyzer) in patients with maintenance hemodialysis (MHD) and its diagnostic value for anemia. The data of venous hemoglobulin (Hb) and fingertip capillary hemoglobulin (DHb) in MHD patients from Lingnan Hospital, the Third Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed, and the correlation and difference between DHb and Hb and the accuracy of DHb in the diagnosis of anemia were evaluated. A total of 105 patients were included in the study. There was no significant difference between the paired DHb and Hb [(109±21) g/L vs. (108±20) g/L, t=-1.284, P=0.202]. Pearson correlation analysis showed that DHb was positively correlated with Hb (r=0.929, P<0.001). Linear regression analysis showed that DHb and Hb met the regression equation Hb=0.88×DHb+12.23, and P<0.001. Bland-Altman analysis showed that the differences between the paired DHb and Hb was (1.0±7.8) g/L with the limit of agreement as (-14.2, 16.2) g/L. The mean percentage of the differences in Hb was 1% with limit of agreement as (-13.7%, 15.7%). A DHb of >110 g/L was 0.90 sensitive and 0.83 specific to identify patients with an Hb >110 g/L and its positive and negative predictive values were 0.84 and 0.90, respectively. It suggests that, in MHD patients, Hemocue Hb 201+ analyzer shows good accuracy, and can be used to monitor the Hb trend and serve as a screen method for those reaching target Hb.

The paper reports the treatment of a maintenance hemodialysis patient with pseudoaneurysm (PSA) caused by accidental injury of brachial artery during the puncture of internal fistula. The main treatment methods of PSA include surgical incision and repair, local pressure therapy, ultrasound-guided intraluminal thrombin injection, implantation of covered stent, coil embolization and so on, but they all have some defects. The patient was admitted to hospital due to poor fistula function, and the formation of brachial artery PSA was confirmed by color ultrasound. PSA was successfully treated with ultrasound-guided and balloon-assisted injection of human fibrin sealant. The fistula had good function 3 months after the operation.

The clinical diagnosis of tubulointerstitial nephritis and uveitis (TINU) syndrome combined with Fanconi syndrome is relatively rare. The paper reports a 47-year-old female patient of TINU syndrome with hypokalemia, hypophosphatemia, hypouricemia and renal impairment as initial symptoms followed by uveitis. Serological tests showed that the patient also met the diagnostic criteria of Fanconi syndrome. Renal tissue pathology confirmed tubular interstitial injury, manifested as interstitial nephritis with acute tubular injury. Ophthalmic examination confirmed iritis in the right eye. After excluding other primary diseases, the patient was diagnosed as TINU syndrome with Fanconi syndrome. After glucocorticoid therapy, ocular symptoms, renal impairment and electrolyte disturbance were significantly improved.

Chronic kidney disease-associated pruritus (CKD-aP), one of the most common and intolerable complications in hemodialysis patients, not only seriously affects patients' quality of life and physical and mental health, but also increases the risk of long-term mortality. The pathogenesis of CKD-aP remains unclear, and immune-inflammatory dysregulation, imbalance of endogenous opioid system, abnormal accumulation of metabolites, xerosis, abnormal histamine level as well as hyperparathyroidism, have all been shown to be associated with pruritus. There is a lack of satisfactory and effective treatment strategies for CKD-aP, which mainly include pharmacological treatment, non-pharmacological treatment and dialysis modality modification. This article mainly reviews recent advances in the pathogenesis and pharmacological treatment of pruritus among hemodialysis patients.

As a new strategy for the application of sacubitril/valsartan (LCZ696) in patients with CKD, much evidence showed that it improved the prognosis of patients with CKD. This review summarizes the efficacy and safety of sacubitril/valsartan in physiology, pathology, pharmacology and clinical application by searching Wanfang, CNKI, PubMed and other databases for related articles on the application of sacubitril/valsartan in CKD patients. Although LBQ657, the active product of sacubitril, has a high drug accumulation in patients with moderate, severe renal injury, and ESRD, it is not cleared in hemodialysis, and has very little eliminated in peritoneal dialysis, which does not affect its safety. Compared with angiotensin converting enzyme inhibitor and angiotensin receptor blocker drugs, LCZ696 could increase the blood pressure control rate, improve cardiac function, slow down the decline of glomerular filtration rate, and significantly improve cardiovascular outcomes without more adverse events. Sacubitril/valsartan can be used in all levels of CKD patients complicated with hypertension and/or heart failure, with reliable safety and tolerance.

Recent studies have revealed that fluid overload is an independent risk factor for increasing renal function impairment, decreasing renal recovery rate and increasing mortality in severe patients with acute kidney injury (AKI), acute respiratory distress syndrome,or sepsis. The damage of fluid overload on renal function may be related to renal venous hypertension and renal interstitial edema, and eventually lead to the decrease of renal blood flow and glomerular filtration rate. However, fluid clearance with diuretics or continuous renal replacement therapy (CRRT) may increase the risk of hypovolemia, hemodynamic instability, and tissue and organ hypoperfusion. Therefore, accurate fluid volume status assessment and management in AKI patients during CRRT is critical. The expert group of Chinese Society of Nephrology formulated this expert consensus on fluid volume assessment and management in CRRT based on evidence-based medical evidence and clinical experience. Through systematic and comprehensive literature search, data analysis and professional discussion in this field, the expert group constructed five special topics on fluid volume management in CRRT: the pathophysiological basis and harm of fluid volume imbalance in AKI patients, the management strategies on fluid volume in AKI patients, the assessment on fluid volume status and reactivity in AKI patients, the grading and application of fluid volume management in CRRT, and the management target and prescription on fluid volume in CRRT. This consensus aims to standardize clinical operations, reduce the incidence of fluid volume imbalances in AKI patients, and improve the patients' prognosis.

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

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

Objective To investigate the changes and associated factors of cerebral blood flow in middle-aged and elderly patients undergoing maintenance hemodialysis (MHD). Methods This was a prospective observational study. End-stage renal disease (ESRD) patients undergoing MHD aged over 50 years at Beijing Shijitan Hospital, Capital Medical University from January 2023 to June 2023 were included. General clinical data of the selected individuals were collected, and dialysis related indicators were recorded and calculated. Mean flow velocity (MFV) of the middle cerebral arterial was measured by transcranial Doppler sonography (TCD) to represent cerebral blood flow throughout dialysis. Hemodialysis-related variables were collected. The MFV values of bilateral middle cerebral artery were measured through temporal windows at 7 time points: 15 minutes before dialysis (T1), 15 minutes (T2), 30 minutes (T3), 60 minutes (T4), 120 minutes (T5), 180 minutes (T6) during dialysis, and the endpoint of dialysis (T7), and the average values were recorded. The ΔMFV was calculated as pre-minus endpoint values of MFV. The Spearman rank correlation method was used to analyze the correlations between ΔMFV and dialysis-related variables, and multiple linear regression method was used to analyze the related factors of the changes in MFV. Results This study included a total of 123 patients undergoing MHD, aged (63.63±8.44) years (range 50-85 years), including 99 males (80.5%). TCD examination demonstrated a decline trend in MFV throughout dialysis. The MFV at T7 was significantly lower than that at T1 (Z=-7.650, P<0.001). The Spearman correlation analysis showed that the decline in MFV was correlated with ultrafiltration volume (r=0.356), ultrafiltration rate (r=0.371), the difference in systolic pressure (pre-analysis minus post-dialysis, r=0.251), the difference in mean arterial pressure (pre-dialysis minus post-dialysis, r=0.194), combined diabetes (r=0.293), dialysis vintage (r=0.220), Kt/V (r=0.287), and serum albumin (r=-0.295). Multiple linear regression analysis showed that combined with diabetes (B=3.889, 95% CI 1.373-6.405, P=0.003), decreased serum albumin (B=-0.456, 95%CI -0.877--0.036, P=0.034), increased ultrafiltration rate (B=11.099, 95% CI 6.402-15.797, P<0.001) and the decline in systolic pressure (B=0.062, 95% CI 0.008-0.116, P=0.026) were significantly associated with the decline in MFV throughout dialysis. Conclusions In middle and elderly patients with ESRD undergoing hemodialysis, there is a decline trend in cerebral blood flow during hemodialysis. The combination of diabetes, lower serum albumin, higher ultrafiltration rate, and intradialytic systolic pressure decline are the risk factors influencing the intradialytic decline of cerebral blood flow.

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

Objective To investigate the changes of exam scores of retrained peritoneal dialysis (PD) operators (patients, family members, or nannies) with an internal of one year during COVID-19 epidemic and provide basis for targeted training. Methods It was a cross-sectional survey study. The maintenance PD patients who participated in two trainings with an interval of one year during COVID-19 epidemic from November 1, 2019 to February 28, 2021 in Department of Nephrology in Peking University People's Hospital were enrolled. During COVID-19 epidemic, retraining was extended from once every six months to once a year. The clinical data were collected, the self-designed training exam score table including theoretical knowledge and operational skills assessment was used to investigate the exam scores of two trainings, and the total exam scores and sub-item scores of PD operators before and after one year were compared. Logistic regression analysis was used to analyze the associated factors of the reduction of exam scores. Results A total of 59 patients were enrolled, with 35 males (59.32%), age of (58.41±14.52) years, and dialysis duration of 42 (12, 84) months. There were 54 patients (91.53%) operating by themselves, 22 operators (37.29%) having college degree or above, and 35 operators (59.32%) having decreased exam scores. The total exam scores were 83.17±7.90 and 80.61±8.20 before and after one year, respectively (t=2.732, P=0.008). In the six contents of itemized scoring, compared with one year ago, the exam scores of complication treatment (t=4.928, P<0.001) and self-monitoring (t=3.222, P=0.002) were significantly decreased. There was no statistically significant difference in the exam scores of environment and hygiene, dialysate replacement operation, exit nursing and diet before and after one year (all P>0.05). The total exam scores in patients with dialysis duration <12 months and 36-60 months after one year were significantly lower than before one year (t=2.309, P=0.041; t=3.086, P=0.009). There was no statistically significant difference in the exam scores of PD operators with dialysis duration of 12-<36 months and >60 months before and after one year (both P>0.05). Logistic regression analysis showed that dialysis duration was an independent associated factor of exam scores reduction (dialysis duration 36-60 months/>60 months, OR=6.233, 95%CI 1.035-37.529, P=0.046). Conclusions During COVID-19 epidemic, the reduced frequency of retraining reduces the training exam scores of PD operators, especially in patients with dialysis duration of 36-60 months. The weak points are focused on complication management and self-monitoring. Training should be strengthened for key patients and key contents if regular retraining is not possible due to special circumstances.

Oxidative stress plays a key role in acute kidney injury (AKI). 8-Oxo-7,8-dihydroguanosine (8-oxo-Gsn) can reflect the overall level of oxidative stress in the body. The levels of urinary 8-oxo-Gsn and renal function-related indicators in 62 patients who underwent video-assisted thoracic surgery (VATS) or open-chest surgery were measured during the perioperative period. The results showed that urinary 8-oxo-Gsn increased 24 hours after surgery and decreased 48 hours after surgery as the condition improved. In 10 patients with severe complications, urinary 8-oxo-Gsn continued to rise. The level of urinary 8-oxo-Gsn in the VATS group recovered faster than that in the open-chest surgery group (P<0.05). There was a certain correlation between the level of urinary 8-oxo-Gsn and postoperative renal injury in thoracic surgery, suggesting that RNA oxidative stress may play an important role in the pathogenesis of surgery-related AKI.

Wiskott?Aldrich syndrome (WAS) is a rare X-linked recessive genetic disorder characterized by thrombocytopenia, eczema, recurrent infections, and susceptibility to autoimmune diseases. The renal complication of WAS is mainly manifested as IgA nephropathy. Membranous nephropathy (MN) in children mostly has secondary factors, and its occurrence is related to immune disorders. This paper reports a case of WAS in an infant with bleeding tendency and recurrent infections, complicated with nephrotic syndrome during the course, confirmed as MN by pathological examination. After treatment with glucocorticoids, tacrolimus and hematopoietic stem cell transplantation, nephrotic syndrome was manifested as steroid-resistant and partially sensitive to tacrolimus. Proteinuria continued to relieve 3 months after hematopoietic stem cell transplantation and renal function remained stable. WAS complicated with MN is extremely rare, and its renal prognosis is still unclear, which deserves the attention of clinicians.

Mitochondrial DNA depletion syndrome (MDS) is a group of genetic diseases in which the number of mitochondrial DNA copies is severely decreased due to mutations in nuclear genes and affects energy metabolism in several tissues and organs. Renal involvement of MDS is often manifested as proximal renal tubular disease, while MDS combined with nephrotic syndrome is rare. This paper report a case of child with mitochondrial DNA depletion syndrome 8A (MTDPS8A) complicated with nephrotic syndrome due to compound heterozygous variants of RRM2B gene. The child mainly presented with epilepsy, auditory dysfunction, and nephrotic syndrome as clinical manifestations. The histopathological findings indicated focal segmental glomerulosclerosis (collapsing variant). The child was treated with glucocorticoid combined with immunosuppressant, energy support and symptomatic treatment, while the effect was not significant. He continued to experience progressive deterioration of renal function during the six-month follow-up period and had a long-term peritoneal dialysis for maintenance therapy.

The paper summarizes the treatment experience of surgical repair combined with automated peritoneal dialysis in a maintenance peritoneal dialysis patient complicated with thoracoabdominal fistula. Through the close participation of medical and patients, the diagnosis method and peritoneal dialysis scheme were optimized continuously. The thoracoabdominal fistula repair operation was successfully implemented by a multidisciplinary team, and the patient's condition was improved and was discharged. This case suggests that standardized diagnosis process and optimized diagnosis method can be applied to improve the sensitivity and specificity of diagnosis, and strive for early diagnosis and intervention; multi-disciplinary teams can be actively formed and the patients can be encouraged to participate in decision-making, to improve treatment confidence; the advantages of automated peritoneal dialysis can be made full use to reduce complications and improve the life quality of the patient.

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

Blood pressure and volume management are the key to peritoneal dialysis treatment, so selecting appropriate blood pressure measurement methods can help patients evaluate volume status and risk of clinical adverse events. Blood pressure measurement methods mainly include office blood pressure, ambulatory blood pressure and home blood pressure. Different blood pressure measurement methods have their own characteristics and application values. The paper reviews the clinical significance of above three blood pressure measurement methods from three aspects: reliability, convenience and correlation between blood pressure and clinical prognosis.

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

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

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

Objective To investigate the psychological status of HD nursing staff in hospitals in Guangdong province and its influential factors. Methods 1 630 nursing staff in HD rooms of 71 hospitals or units in Guangdong Province in February and March 2020 were evaluated by using the 10?item Kessler psychological distress scale (Kessler 10), General self?efficacy scale (GSES) and Connor?Davidson resilience scale (CD?RISC) to conduct a questionnaire survey on their psychological status. Insomnia severity index (ISI) and Fatigue scale?14 (FS?14) were used to investigate their degree of insomnia and fatigue. General information on gender, age, educational level, marital status, economic income, professional title, HD working hours, average weekly overtime times and hours, total number of HD patients per day, and whether holding other positions were collected. Results A total of 1 630 questionnaires were collected, among which 1 629 were valid, with an effective recovery rate of 99.9%. The scores of the three scales were (20.16±7.47), (27.03±4.45) and (58.37±15.75), respectively. According to the Kessler 10, 835 people (51.2%) had mental disorders. Univariate analysis showed that age, educational level, economic income, type of work unit, total number of HD patients per day and living status in recent one week were related with Kessler 10 score (all P<0.05). Economic income, type of work unit, whether holding other positions, total number of HD patients per day and living status in recent one week were related with GSES scores (all P<0.05). Age, marital status, economic income, professional title, type of work unit, whether holding other positions and living status in recent one week were related to CD-RISC score (all P<0.05). Spearman rank correlation analysis showed that the number of HD machines (r=0.100, P<0.001), the number of nurses (r=0.082, P=0.001), average weekly overtime times (r=0.142, P<0.001) and overtime hours (r=0.136, P<0.001), ISI score (r=0.572, P<0.001) and FS-14 score (r=0.635, P<0.001) were correlated with Kessler 10 score. ISI score (r=-0.311, P<0.001) and FS-14 score (r=-0.335, P<0.001) were correlated with GSES score. Working years of HD service (r=0.112, P<0.001), ISI score (r=-0.289, P<0.001) and FS-14 score (r=-0.314, P<0.001) were correlated with CD-RISC score. Multiple linear regression analysis showed that the economic income in 5 001-10 000 yuan (with<3 000 yuan as reference, B=-1.603, 95% CI -3.036--0.169, P=0.028) and the total number of HD patients per day >200 (with ≤50 as reference, B=-1.153, 95% CI -2.242--0.065, P=0.038) were negatively correlated with Kessler 10 score, and average weekly overtime times (B=0.221, 95% CI 0.069-0.374, P=0.004), ISI score (B=0.518, 95% CI 0.454-0.582, P<0.001) and FS-14 score (B=1.166, 95% CI 1.066-1.265, P<0.001) were positively correlated with Kessler 10 score. The economic income (with<3 000 yuan as reference) in 3 001-5 000 yuan (B=1.930, 95% CI 0.847-3.013, P<0.001), 5 001-10 000 yuan (B=1.949, 95% CI 0.887-3.012, P<0.001), 10 001-15 000 yuan (B=1.482, 95% CI 0.318-2.647, P=0.013), >20 000 yuan (B=4.300, 95% CI 2.463-6.136, P<0.001), secondary hospital (with primary hospitals as reference, B= 1.078, 95% CI 0.005-2.152, P=0.049) and holding other positions (B=0.729, 95% CI 0.277-1.181, P=0.002) were positively correlated with GSES score, and ISI score (B=-0.169, 95% CI -0.217--0.120, P<0.001) and FS-14 score (B=-0.403, 95% CI -0.478--0.328, P<0.001) were negatively correlated with GSES score. The economic income (with<3 000 yuan as reference) in 3 001-5 000 yuan (B=7.631, 95% CI 3.753-11.509, P<0.001), 5 001-10 000 yuan (B=9.236, 95% CI 5.362-13.110, P<0.001), 10 001-15 000 yuan (B=9.039, 95% CI 4.735-13.342, P<0.001), 15 001-20 000 yuan (B=8.639, 95% CI 2.989-14.289, P=0.003), >20 000 yuan (B=16.101, 95% CI 9.162-23.039, P<0.001) and holding other positions (B=3.228, 95% CI 1.510-4.945, P<0.001) were positively correlated with CD-RISC score, and ISI score (B=-0.593, 95% CI -0.765--0.420, P<0.001) and FS-14 score (B=-1.258, 95% CI -1.525--0.992, P<0.001) were negatively correlated with CD-RISC score. Conclusion The psychological status of nursing staff in HD rooms of hospitals in Guangdong Province needs to be improved. Effective preventive measures should be taken to provide timely psychological support, counseling and intervention to nursing staff with psychological abnormalities, and encourage them to take the initiative to seek psychological counseling when necessary, so as to promote their physical and mental health.

Objective To evaluate the efficacy of homodimer neutrophil gelatinase- associated lipocalin (H?NGAL) rapid test kit in diagnosing peritoneal dialysis (PD)-associated peritonitis (PDAP). Methods It was a multicenter prospective observational study. The PD patients from the nephrology clinics or wards at four hospitals: the First Affiliated Hospital of Nanchang University, the Third Hospital of Hebei Medical University, Taian Central Hospital, and Weifang People's Hospital from December 27, 2021, and July 18, 2022 were enrolled. The patients were categorized into PDAP and non-PDAP groups based on whether PDAP occurred at the time of enrollment. PD effluent samples were collected, and H?NGAL test was performed. The patients or their families used cassette-type, strip-type, and pen-type H?NGAL test kits to detect H?NGAL. Healthcare professionals only used the cassette-type H?NGAL kit to detect H?NGAL. All participants completed a questionnaire regarding the instructions for use of H?NGAL kit before testing, and a summary of patient experience and evaluation questionnaires after testing. The sensitivity, specificity, compliance rate, and 95% confidence interval (CI) of H?NGAL rapid test kit for diagnosing PDAP were calculated using clinical diagnosis as the standard. Kappa test was used to assess the consistency between H?NGAL detection results and clinical diagnoses. Results A total of 221 PD patients were enrolled, with 42 PDAP patients and 179 non-PDAP patients. The sensitivity and specificity of H?NGAL rapid test kit for diagnosing PDAP were 100% (95% CI 91.62%-100%) and 99.44% (95% CI 96.90%-99.90%), respectively, with accuracy rate of 99.55% (95% CI 97.48%-99.92%). The positive agreement rate was 97.67% (95% CI 87.94%-99.59%), and the negative agreement rate was 100% (95% CI 97.89%-100%). The consistency evaluation results showed that kappa value was 0.985 (95% CI 0.956-1.000). The results obtained by patients and their families using the H?NGAL rapid test kits were consistent across all three methods (cassette, strip, and pen-type H?NGAL test kits), and the results obtained by using the H?NGAL rapid test kits were also consistent between non-healthcare professionals and healthcare professionals. The kit instruction questionnaire and the experience and evaluation questionnaire showed that the overall satisfaction of patients with the H?NGAL rapid test kits was very good. Conclusions H?NGAL rapid test kit exhibits high sensitivity and specificity in diagnosing PDAP and can serve as a rapid diagnostic method for PDAP.

Objective To construct an early prediction model for post cardiopulmonary resuscitation-acute kidney injury (PCPR?AKI) by machine learning and provide a basis for early identification of acute kidney injury (AKI) high?risk patients and accurate treatment. Methods It was a single-center retrospective study. The clinical data of patients admitted to Tianjin Medical University General Hospital after cardiopulmonary resuscitation following cardiac arrest from January 1, 2016 to October 31, 2023 were collected. The end-point event of the study was defined as AKI occurring within 48 hours after cardiopulmonary resuscitation. The patients were divided into AKI group and non-AKI group according to the AKI diagnostic criteria, and the differences of baseline clinical data between the two groups were compared. The patients who met the inclusion criteria were randomly (using the train_test_split function, set the random seeds to 1, 2, and 3) divided into training and validation sets at a ratio of 7∶3. Random forest (RF), support vector machine, decision tree, extreme gradient boosting and light gradient boosting machine algorithm were used to develop the early prediction model of PCPR?AKI. The receiver-operating characteristic curve and decision curve analysis were used to evaluate the performance and clinical practicality of the predictive models, and the importance of variables in the optimal model was screened and ranked. Results A total of 547 patients were enrolled, with age of 66 (59, 70) years old and 282 males (51.6%). There were 238 patients (43.5%) having incidence of AKI within 48 hours after cardiopulmonary resuscitation. In the AKI group, 182 patients (76.5%) were in stage 1, 47 patients (19.7%) were in stage 2, and 9 patients (3.8%) were in stage 3. There were statistically significant differences in the age, time to reach resuscitation of spontaneous circulation, time from cardiac arrest to starting cardiopulmonary resuscitation, proportion of initial defibrillation rhythm, proportion of electric defibrillation, proportion of mechanical ventilation, adrenaline dosage, sodium bicarbonate dosage, proportion of coronary heart disease, proportion of hypertension, proportion of diabetes, serum creatinine, blood urea nitrogen, blood lactic acid, blood potassium, brain natriuretic peptide, troponin, D-dimer, neuron specific enolase, and 24 hours urine volume after cardiopulmonary resuscitation between AKI group and non-AKI group (all P<0.05). Among the five machine learning algorithms, RF model achieved the best performance and clinical practicality, with area under the curve of 0.875, sensitivity of 0.863, specificity of 0.956, and accuracy rate of 90.7%. In the variable importance ranking of RF model, the top 10 variables were as follows: time to reach resuscitation of spontaneous circulation, time from cardiac arrest to starting cardiopulmonary resuscitation, initial defibrillable rhythm, serum creatinine, mechanical ventilation, blood lactate acid, adrenaline dosage, brain natriuretic peptide, D-dimer and age. Conclusions An early predictive model for PCPR?AKI is successfully constructed based on machine learning. RF model has the best predictive performance. According to the importance of the variables, it can provide clinical strategies for early identification and precise intervention for PCPR?AKI.

Objective To investigate the role of hepatitis B virus X protein (HBx) in glomerular podocyte immune disorder and its regulatory mechanism. Methods Fourteen 6-week-old male hepatitis B virus (HBV) transgenic (HBV?Tg) mice were selected, and age-matched wild type (WT) mice were as controls. They were fed to different weeks, and 24 h urinary protein, blood biochemistry, renal pathology and podocyte changes under electron microscope were detected. The expression of HBx and the infiltration of immune cells in kidney tissue of HBV?Tg mice were observed by immunohistochemistry. Human podocyte cell line was transfected with pcDNA3.1/myc-HBx plasmid, and the localization of HBx and Nephrin in podocytes was detected by immunofluorescence. The expression of major histocompatibility complex Ⅱ (MHC-Ⅱ) and co- stimulatory molecule CD40 on the cell surface was detected by flow cytometry. The contents of multiple cytokines in cell culture supernatants were determined by enzyme-linked immunosorbent assay. Transcriptome sequencing (RNA-seq) was used to screen the downstream related genes regulated by HBx, and real-time quantitative PCR was used to verify their expressions. After overexpression or silencing of Notch1 gene with overexpressed plasmids or short hairpin RNA (shRNA) in podocytes, the effects on the expression of immune molecules and cytokines secretion was observed. The Notch receptor inhibitor N-[N-(3, 5-difluorophenyl-l- alanyl)]-(s)-phenylglycine tert-butyl ester (DAPT) was used to block Notch1 signaling pathway in HBV?Tg mice, and then blood biochemistry, renal pathological changes and infiltration of immune cells in kidney tissue were observed. Results Twenty-four-hour urine protein, serum creatinine and urea nitrogen levels were markedly increased (all P<0.05) and renal pathological injury was significantly aggravated in HBV?Tg mice than those in WT mice. Also, HBx was up-regulated and immune cells infiltrated in the glomerulus of HBV?Tg mice. After transfection with HBx in podocytes, the expression of MHC-Ⅱ and CD40 on the cellular surface was up-regulated (all P<0.05), the contents of monocyte chemotactic protein?1 (MCP-1), tumor necrosis factor ?α (TNF-α) and interleukin (IL)-1β in the supernatants were increased (all P<0.05), and the secretion of IL-4 and interferon γ (IFN-γ) was unbalanced. RNA-seq screened downstream genes of HBx, such as Notch1, PLA2R, TLR4, etc; and further confirmed that HBx could promote the up-regulation of Notch1 mRNA and protein (all P<0.05). After over-expression of Notch1 gene, HBx-induced expression of MHC-Ⅱ and CD40 on the cellular surface was significantly up-regulated (all P<0.05), and the contents of MCP-1, TNF-α and IL-1β in the supernatants were obviously increased (all P<0.05), and the imbalance of IL-4/IFN-γ was further aggravated. After Notch1 gene silencing, the above results showed the opposite changes. In vivo, the results indicated that serum creatinine levels were obviously decreased (all P<0.05), renal pathological injury and immune cell infiltration were significantly alleviated in HBV?Tg+DAPT group than those in HBV?Tg+DMSO group. Conclusions HBx protein can promote the up-regulation of Notch1 signaling pathway in podocytes. And Notch1 signaling pathway promotes the expression of immune molecules on the surface of podocytes and regulates the imbalance of cytokines, then causes glomerular injury and dysfunction of immune microenvironment.

This study retrospectively analyzed the risk factors of hyperkalemia in patients with chronic kidney disease (CKD), established a risk assessment model, and validated it. It was a retrospective study. Data from 505 CKD patients who visited the Department of Nephrology at Linping First People's Hospital from June 2022 to January 2024 were retrospectively collected. Patients were divided into a modeling set (n=354) and a validation set (n=151) in a 7∶3 ratio. The independent risk factors for hyperkalemia in CKD patients were screened using least absolute shrinkage and selection operator (Lasso) regression, and a risk prediction model was constructed using multivariate Logistic regression. Hosmer?Lemeshow test was used to judge the fit degree of the prediction model, and the nomogram, the receiver operating characteristic curve, the calibration curve and clinical decision curve were drawn. The results showed that 155 out of 505 CKD patients developed hyperkalemia, with an incidence rate of 30.69%. Lasso regression and multivariate logistic regression analysis showed that serum albumin, blood sodium, blood phosphorus, parathyroid hormone, and risk score X (the value was based on the CKD hyperkalemia risk prediction model established in China in 2020) were the independent factors associated with hyperkalemia in CKD patients (all P<0.05). The analysis of the receiver operating characteristic curve of the subjects showed that the area under the modeling set curve was 0.840 (95% CI 0.796-0.884), and the area under the validation set curve was 0.849 (95% CI 0.784-0.915). The calibration curve suggested good consistency between the predicted and actual results of the model, and the decision curve analysis suggested that the model could increase patient benefits. Finally, the authors drew a visual nomogram of the model. The authors believe that the column chart prediction model for hyperkalemia in CKD patients constructed based on the predictive variables selected by Lasso regression ha good predictive ability and is helpful for clinical medical personnel to detect and manage hyperkalemia early in CKD patients.

Calciphylaxis is a rare ischemic necrotic skin disease characterized by skin ischemia, necrosis, and severe pain. Histopathological features include systemic arteriolar media calcification, intimal fibrosis, and thrombosis. While calciphylaxis is predominantly found in uremic patients, there have been a few case reports in non-uremic patients. This article presented a case of a non-uremic patient with primary hyperparathyroidism who underwent parathyroidectomy and subsequently developed severe calciphylaxis. The patient presented with symptoms of lower limb dermatalgia and ulceration, consistent with the classic clinical features of calciphylaxis. Following a systematic therapeutic approach in accordance with the "Zhongda Scheme", a complete remission of the condition was achieved. At the same time, the authors reviewed the relevant literature on the risk factors and possible mechanisms of non-uremic calciphylaxis based on this case.

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

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

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

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

Objective To investigate the distribution and drug resistance of common pathogens causing urinary tract infection (UTI) in children in Beijing, so as to provide reference for clinical rational use of antibiotics. Methods It was a retrospective cohort study. The results of clinical data, urine culture and drug sensitivity in children with urinary infection treated in the Department of Nephrology, Children's Hospital Affiliated to Capital Institute of Pediatrics from June 2018 to June 2018 were retrospectively analyzed. According to the diagnostic criteria of "Chinese expert consensus on the diagnosis and treatment of UTI (2015 edition) - Complicated urinary tract infection", the children were divided into complex group and simple group according to whether they had complicated factors, and the pathogenic factors of the complex group were analyzed. The χ² test was used to compare the distribution of pathogenic bacteria in urine culture and the resistance rate of Escherichia coli to common antibiotics between the two groups. Results A total of 187 children with UTI were enrolled in this study. The age ranged from 1 month after birth to 17 years old, and the median age was 8 months. There were 88 males (47.1%) and 99 females (52.9%), and the male/female ratio was 1:1.125. Male infants accounted for 79.5% (70/88) of male infants and female infants accounted for 48.5% (48/99) of female infants. There were 45 cases (24.1%) in the simple UTI group and 142 cases (75.9%) in the complicated UTI group. A total of 216 strains of pathogens were isolated, mainly Gram-negative bacteria (151/216, 69.9%), of which Escherichia coli was the most common (86/216, 39.8%). The second was gram-positive bacteria (57/216, 26.4%), among which Enterococcus faecium (37/216, 17.1%) was the most common. The positive rate of Escherichia coli infection in the simple UTI group was significantly higher than that in the complicated UTI group [71.1% (32/45) vs. 31.6% (54/171), χ²=23.234, P<0.001], and the positive rate of Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecium and fungal infection in the simple UTI group was significantly lower than those in the complicated UTI group. However, the differences were not statistically significant (all P>0.05). The resistance rate of Escherichia coli to ampicillin was the highest in children with UTI [91.9% (79/86)], and it was sensitive to amikacin, meropenem, imipenem, piperacillin/tazobactam, cefepime, piperacillin, cefazolin, cefoperazone/sulbactam. The drug resistance rates were 5.8% (5/86), 5.8% (5/86), 9.3% (8/86), 10.5% (9/86), 14.0% (12/86), 15.1% (13/86), 18.6% (16/86) and 18.6% (16/86), respectively. The resistance rate of Escherichia coli infection to ceftriaxone in the complicated UTI group was significantly higher than that in the simple UTI group [59.3% (32/54) vs. 24.4% (11/32), χ²=4.977, P=0.026]. Eight fungi (3.7%) were susceptible to fluconazole, voriconazole, itraconazole and amphotericin B. Conclusions The main pathogens of UTI in children are Gram-negative bacteria, among which Escherichia coli is the most common pathogen, but the proportion of infection has a downward trend in recent years. The resistance rate of ceftazidime and ceftriaxone is relatively low, which can be used as empirical drugs for children with UTI in this region.

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

Objective To observe the role of complement C3 in the process of renal interstitial fibrosis. Methods Renal interstitial fibrosis model was established by unilateral ureteral obstruction (UUO) in male C3-deficient (C3KO) mice and age-matched C57BL/6 wild type (WT) mice (8-12 weeks of age). Mice were randomly divided into 4 groups, including sham operation in WT group (WTcontrol) (n=6), UUO operation in WT group (WTuuo) (n=6), sham operation in C3-deficient group (C3KOcontrol) (n=6), and UUO operation in C3-deficient group (C3KOuuo) (n=6). Tubular interstitial fibrosis was observed by both HE staining and Masson staining. The expression of C3, trypsin (tryptase), angiotensinⅡ (AngⅡ), transforming growth factor β1 (TGF-β1), and matrix metalloproteinase-9 (MMP?9) was detected by immunohistochemical staining. Chymase level were assessed by immunofluorescence staining. The levels of AngⅡ and C3 cleavage fragments C3a and MMP?9 were determined by enzyme-linked immunosorbent assay. The change in renin mRNA was determined by real-time PCR. The changes of chymase, renin, and TGF-β1 were detected by Western blotting. Results Compared with the WTcontrol group mice, the WTuuo group mice showed significant renal tubular injury, renal interstitial fibrosis, increased infiltration of mast cells, and significantly increased expression of C3, C3a, chymase, renin, AngⅡ, TGF-β1, and MMP?9 in the renal tissue (all P<0.05). Compared with the WTuuo group mice, the renal tubular injury and renal interstitial fibrosis in the C3KOuuo group mice were significantly reduced, and C3 and C3a were not detected in renal tissue. Mast cells infiltration was reduced, and the expression of chymase, renin, AngⅡ, TGF-β1, and MMP?9 was weakened (all P<0.05). Conclusion C3/C3a can participate in the recruitment and activation of mast cells to release chymase in kidney interstitial fibrosis, and promote the expression of renin, AngⅡ, TGF-β1, MMP 9 and other substances, thus aggravating kidney injury.