Objective To investigate the correlation between serum growth differentiation factor 15 (GDF15) and the clinicopathological characteristics of patients with IgA nephropathy (IgAN), and further explore the relationship of GDF15 with the cardiac and renal prognosis of IgAN patients. Methods It was a single-center retrospective cohort study. From January 2018 to December 2022, the relevant data were collected from patients who were diagnosed with primary IgAN at the Department of Nephrology, Beijing Anzhen Hospital Affiliated to Capital Medical University, and regularly followed up for at least 1 year. Serum samples were collected at admission and the baseline level of serum GDF15 was measured. Based on the median GDF15 level, IgAN patients were categorized into high-level GDF15 group and low-level GDF15 group, and their clinicopathological characteristics were compared. A multiple linear regression model was then constructed to identify independent factors associated with serum GDF15 level based on these comparisons. Subsequently, Kaplan-Meier survival analysis was performed to investigate the association between serum GDF15 level and the cardiorenal prognosis of IgAN patients. Results A total of 104 IgAN patients were included in this study. The serum GDF15 level in these IgAN patients was 825.60 (556.84, 1 428.15) ng/L. Serum GDF15 level was positively correlated with 24 h urinary protein (r=0.405, P<0.001), negatively correlated with estimated glomerular filtration rate (eGFR)(r=-0.606, P<0.001). The serum levels of GDF15 in patients with tubular atrophy or interstitial fibrosis (overall comparison among T0, T1, and T2, H=21.866, P<0.001), crescentic lesions (overall comparison among C0, C1, and C2, H=13.787, P=0.001), or intrarenal arteriolar lesions (overall comparison among none, mild, and moderate-to-severe, H=9.856, P=0.007) were significantly different. Compared with IgAN patients without tubular atrophy or interstitial fibrosis, those with Oxford classification T1 (Z=-17.326, P=0.042) or T2 (Z=-42.933, P<0.001) had higher serum GDF15 levels. Compared with IgAN patients without crescentic lesions, those with Oxford classification C2 had higher serum GDF15 levels (Z=-45.929, P=0.001). Compared with IgAN patients without intrarenal arteriolar lesions, those with moderate-to-severe arteriolar sclerosis had higher serum GDF15 levels (Z=-26.686, P=0.005). The median GDF15 was used as the cut-off value to divide IgAN patients into a high-level GDF15 group (≥825.60 ng/L, n=52) and a low-level GDF15 group (<825.60 ng/L, n=52). Compared to low-level GDF15 group, IgAN patients in high-level GDF15 group presented with a higher proportion of diabetes mellitus (χ² =9.420, P=0.002) and cardiovascular disease (χ² =7.792, P=0.005), a higher level of systolic blood pressure (Z=-2.266, P=0.023), body mass index (Z=-2.183, P=0.031), 24 h urinary protein (Z=-3.485, P<0.001), blood total cholesterol (Z=-2.002, P=0.045) and left ventricular mass index (Z=-2.649, P=0.008), and a lower level of blood albumin (Z=-3.053, P=0.002) and eGFR (Z=6.480, P<0.001). Multiple linear regression analysis showed that serum GDF15 level was independently associated with systolic blood pressure (regression coefficient B=29.453, 95% CI 14.139–44.767, P<0.001), blood albumin (B=-81.412, 95% CI -113.084–-49.740, P<0.001) and eGFR (B=-9.797, 95% CI -17.554–-2.040, P=0.014). Moreover, IgAN patients in high-level GDF15 group exhibited significantly poorer cardiac and renal prognosis compared to low-level GDF15 group (χ² =9.955, P=0.002). Conclusion High serum GDF15 level correlates with disease severity in IgAN, and high serum GDF15 level may suggest a poorer cardiorenal prognosis in IgAN patients.

Objective To screen bile acid-related characteristic genes in IgA nephropathy (IgAN) based on the feature gene selection algorithm in the machine learning method, aiming to exploring the molecular biological mechanisms and biomarkers of IgAN. Methods The gene expression data and sample grouping information of GSE93798, GSE116626 and GSE35487 were downloaded from the Gene Expression Omnibus (GEO). Bile acid-related gene sequences were obtained from the Molecular Signatures Database (MSigDB). R language was used to identify differentially expressed genes between IgAN samples and healthy control samples. Candidate genes were obtained by intersecting differentially expressed genes and bile acid-related genes. The least absolute shrinkage and selection operator (LASSO) algorithm in machine learning was used to screen the feature genes in the candidate genes as biomarkers, and the feature genes in the training set and validation set were analyzed by the rate of change index. Receiver operating characteristic curve (ROC) method was used to evaluate the diagnostic value of identified bile acid related characteristic genes for IgAN. Gene set enrichment analysis (GSEA) was used to analyze the Spearman correlation between the characteristic genes and all other genes and their related metabolic pathways. The expression of disease-characteristic genes in the kidney tissues of IgAN rats was validated by real-time PCR. Results Gene expression information from kidney tissue samples of 20 IgAN cases and 22 healthy controls were obtained from GEO database. A total of 204 bile acid-related genes including 24 pathways were obtained from MSigDB. The results of gene differential expression analysis showed that 333 genes in the kidney tissues of IgAN patients were differentially expressed compared with those of healthy controls, including 102 up-regulated genes and 231 down-regulated genes, among which 12 differentially expressed genes were related to bile acid genes, as follows: NR1H4,SLC23A1, ALDH8A1, FABP1, ALB, SLC27A2, DIO1, CYP8B1, BBOX1, PIPOX, AKR1C1 and SLC10A2. Five characteristic genes (NR1H4, SLC23A1, FABP1, ALB and AKR1C1) were screened by LASSO regression algorithm.ROC analysis results showed that in GSE93798 cohort genes, the AUC of NR1H4, SLC23A1, FABP1 and ALB genes with differential expression was >0.95 respectively in diagnosing IgAN, and that of AKR1C1 genes with differential expression was >0.85 in diagnosing IgAN. The gene expression data of SLC23A1 in GSE35487 cohort was missing. ROC analysis results of other four genes showed that the AUC of differential expression of ALB gene for IgAN was >0.95 respectively, that of NR1H4 gene was >0.70, and that of both FABP1 and AKR1C1 gene was >0.60. In the GSE116626 cohort genes, the AUC of five disease characteristic genes (NR1H4, SLC23A1, FABP1, ALB, AKR1C1) for diagnosing IgAN was >0.60, respectively. These results suggested that 5 characteristic genes have certain distinguishing ability between IgAN group and control group. GSEA results were displayed that the characteristic genes were related to butyric acid metabolism, propionic acid metabolism, arginine and proline metabolism, valine leucine and isoleucine degradation, fatty acid metabolism, etc. These results suggested that five characteristic genes might be related to IgAN through the above metabolic mechanisms. The verification results of five bile acid characteristic genes in the rat model of IgAN in the kidney tissue showed that the expressions of four genes, NR1H4, SLC23A1, FABP1 and ALB, were higher than those of the control group, and there was no statistical significance in the expression of AKR1C1 gene between the two groups. Conclusions The expression of bile acid-related characteristic genes is abnormal in the kidney tissue of IgAN patients. Four bile acid-related differentially expressed genes, NR1H4, SLC23A1, FABP1 and ALB, are expected to be biomarkers for non-invasive diagnosis and therapeutic targets.

Objective To investigate the different clinical characteristics and prognosis of patients with diabetic nephropathy (DN) accompanied by IgA deposition diagnosed by renal biopsy. Methods The study was a retrospective cohort study. Clinical and pathological data of patients diagnosed with DN through renal biopsy in Beijing Anzhen Hospital affiliated to Capital Medical University from January 1, 2010 to March 31, 2023 were retrospectively collected. The clinical and pathological characteristics and prognosis of DN patients with IgA deposition and DN control group patients without IgA deposition were compared. Immunofluorescence staining was used to detect the intensity of galactose?deficient IgA1 (Gd?IgA1) staining in renal tissue of DN patients with DN IgA deposition, and grouping was performed according to whether the staining intensity was≥2+. Enzyme linked immunosorbent assay was used to detect the serum level of Gd?IgA1 in patients. A 50% decrease in estimated glomerular filtration rate (eGFR) from baseline or progression to end-stage renal disease within 5 years was defined as a renal endpoint event, and Kaplan?Meier survival analysis and Log?rank test were used to compare the difference in cumulative incidence of renal endpoint events between two groups of patients. Results A total of 101 DN patients were enrolled in this study, including 68 males (67.3%) and 33 females (32.7%), with age of (52.2±10.3) years and a median follow-up time of 13.5(4.8, 26.3) months. There were 44 patients with IgA deposition (43.6%) and 57 patients without IgA deposition (56.4%). Compared with DN control group, Kaplan-Meier analysis showed that DN patients with IgA deposition had a higher cumulative incidence of renal endpoint within 5 years (χ²=6.473, P=0.011). The proportion of positive glomerular Gd?IgA1 (KM55) staining in the DN patients with IgA deposition was 54.5% (24/44), and immunofluorescence examination showed consistent distribution of Gd?IgA1 and IgA in the glomerular mesangial and capillary regions. The serum level of Gd?IgA1 in the glomerular Gd?IgA1 positive patients was significantly higher than that in those negative patients [(6 296.4± 1 535.4) μg/L vs. (4 057.4±1 082.0) μg/L, t=-3.037, P=0.010]. In DN patients with IgA deposition, the age of the subgroup with endpoint events was younger [(42.8±6.9) years vs. (53.3±9.4) years, t=-3.440, P=0.002], the duration of proteinuria was shorter [6.0(1.0, 22.0) months vs. 12.0(10.0, 36.0) months, Z=-2.150, P=0.032], and the proportion of patients with glomerular Gd?IgA1 staining intensity ≥2+ was higher [Fisher'exact test, 30.8%(4/13) vs. 0(0/20), P=0.017]. Kaplan-Meier survival analysis showed that patients with glomerular Gd?IgA1 staining intensity≥2+ had a significantly higher cumulative incidence of renal endpoint events (χ²=4.846, P=0.028). Conclusion DN patients with glomerular IgA deposition and Gd?IgA1 positivity may be associated with worse prognosis.

Objective To report two cases of anti-glomerular basement membrane (GBM) disease with IgA nephropathy (IgAN), and summarize the clinical characteristics of these patients through systematic literature review, for providing clinical data for the diagnosis and treatment of this disease. Methods It was a case-series analysis. Clinical data of two cases with anti-GBM disease and IgAN diagnosed in the First Affiliated Hospital of Guangxi Medical University were collected. The course of their diagnosis and treatment was described. Besides, the relevant literature of anti-GBM disease with IgAN cases reported in PubMed and CNKI databases from the establishment of the database to June 30, 2024 were retrived, and the relevant clinical data were extracted for analysis and summary. Patients were divided into end?stage renal disease (ESRD) group and non-ESRD group according to renal outcome, and the differences in age, gender, hemoglobin, creatinine at diagnosis, proportion of hypuria/anuria, qualitative grade of urinary protein, and proportion of renal crescent were compared between the two groups. Results Two patients were both young women. The pathology of renal tissue suggested crescentic glomerulonephritis. The pathological manifestations were linear deposition of IgG along GBM and deposition of immune complex dominated by IgA in mesangial region. At the initial diagnosis, the renal function damage of the case one was not severe. After plasma exchange, glucocorticoid and cyclophosphamide treatment, the renal function recovered. The kidney function of the case two was obviously impaired at the initial diagnosis, and was improved after the above treatment, but aggravated due to infection, and continued to progress into ESRD. Twenty-six literates involving 40 cases of anti-GBM disease with IgAN were retrieved. A total of 42 cases of anti-GBM disease with IgAN, including 2 cases in this report, were analyzed and summarized. The age was (41.3±17.5) years old, 45.2% were male, 39 cases (92.9%) were from Asia. The hemoglobin was (94.4±15.1) g/L, the serum creatinine was 450.8 (284.4, 755.8) μmol/L, 83.3% (35/42) patients had crescent ratio greater than 50% and 37 patients (88.1%) patients were treated with intravenous methylprednisolone and cytotoxic immunosuppressive drugs. Plasma exchange was performed in 34 patients (81.0%) patients, 23 patients (54.8%) had renal function recovered and 17 patients (40.5%) entered ESRD. Compared with the non-ESRD group, the serum creatinine in the ESRD group was higher at initial diagnosis (P<0.01), and the proportion of hypuria/anuria was higher (P=0.03). There were no statistically significant differences in age, sex, hemoglobin, urinary protein and crescent proportion between the two groups (all P>0.05). Conclusions Compared with anti-GBM disease, anti-GBM with IgAN has a smoother course and a better prognosis. Infection should be actively prevented during treatment.

Objective To analyze the target signaling pathway of histone H3K27 methylation-induced podocyte injury, verify the regulatory effect of histone H3K27 methylation on podocyte injury in focal segmental glomerulosclerosis (FSGS) mice through target signaling pathway, and explore the mechanism of abnormal methylation of histone H3K27-induced podocyte injury in FSGS mice. Methods (1) Cell experiments: primary cultured immortalized mouse podocytes MPC5 were cultured in vitro, and divided into control group, adriamycin (ADR) group, ADR+GSK-J4 (histone demethylase, KDM6B inhibitor) group, ADR+coumarin A1 (C-A1, JAK2 agonist) group and ADR+GSK-J4+C-A1 group. The transmission electron microscope was used to observe ultrastructure of podocytes. Immunofluorescence was used to detect the protein expression of H3K27me3 and nephrin in podocytes. The whole genome sequence of podocytes was obtained, the differentially expressed genes were screened, and Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) were used for enrichment analysis. Real time-quantitative PCR and Western blotting were used to detect the gene and protein expression of JAK2-STAT3 signaling pathway in podocytes respectively. Enzyme-linked immunosorbent assay was used to detect interleukin 6 (IL?6), monocyte chemotactic protein 1 (MCP?1), α?smooth muscle actin (α?SMA) and transforming growth factor β1 (TGF?β1). (2) Animal experiments: EZH2 gene knock out(EZH2^podKo)-FSGS (tail vein injection of ADR) mouse models were established, and divided into EZH2^ctrl+control group (n=20), EZH2^ctrl+FSGS (n=20), EZH2^podKo+control group (n=30) and EZH2^podKo+FSGS group (n=30). HE staining was used to observe the morphology of kidney tissues. Immunohistochemistry was used to detect the H3K27me3 protein expression in podocytes. Real time-quantitative PCR and Western blotting were used to verify the gene and protein expression of JAK2-STAT3 signaling pathway respectively. Enzyme-linked immunosorbent assay was used to detect IL?6, MCP?1, α?SMA and TGF?β1 of kidney tissues. Results (1) Cell experiments: Compared with control group, the nucleus shrank and ruptured, the cytoplasm showed vacuole, and mitochondria and endoplasmic reticulum swelled in ADR group, which verified that the podocyte injury model of ADR nephropathy was successfully established. Compared with control group, the protein expression level of H3K27me3 in ADR group was significantly lower (P<0.05). Compared with ADR group, the protein expression level of H3K27me3 in podocytes in ADR+GSK-J4 group was significantly higher (P<0.05), and there were 502 increased genes and 443 decreased genes. GO enrichment analysis showed that the differentially enriched peaks were mainly in ribonucleoprotein complex biogenesis, ribosome biogenesis, establishment of protein localization to organelle, and involved in regulation of receptor signaling pathway via JAK-STAT and receptor signaling pathway via JAK-STAT. Differential expressed genes were Irf1, Tnfrsf1a, Socs1, Notch1, Gadd45a, Hes1 and Socs3, involving in the regulation of JAK-STAT signaling pathway. KEGG enrichment analysis showed that the differentially enriched peaks were mainly in amyotrophic lateral sclerosis, and the target genes were Mcl1, Egfr, Socs1, Cdkn1a, Pdgfa and Socs3, involving in the regulation of JAK-STAT signaling pathway. Compared with ADR group, the mRNA and protein expression levels of JAK2 and STAT3 in the ADR+GSK-J4 group were significantly lower, and the downstream inflammatory factors of IL?6, MCP-1 and α?SMA were significantly higher (all P<0.05). Compared with ADR group, the protein expression level of nephrin in ADR+GSK-J4 group was higher (P<0.05), and the protein expression level of nephrin in ADR+C-A1 group was lower (P<0.05). Compared with ADR+GSK-J4 group, the protein expression level of nephrin in ADR+GSK-J4+C-A1 group was lower (P<0.05). (2) Animal experiments: Compared with EZH2^ctrl+FSGS group, EZH2^podKo+FSGS group showed obvious renal tissue damage, matrix hyperplasia in mesangial area with massive homogeneous substance deposition, apoptosis and necrosis of renal tubular epithelial cells, obvious thickening and extensive fusion of glomerular epithelial cells, basement membrane collapse, and compression and narrowing of capillary structure. Compared with EZH2^ctrl+FSGS group, the protein expression level of H3K27me3 in EZH2^podKo+FSGS group was significantly lower, and the mRNA and protein expression levels of JAK2 and STAT3, and the levels of IL?6, MCP-1, α?SMA and TGF?β1 were higher (all P<0.05). Conclusions Abnormal methylation modification of H3K27 leads to change of target gene expression, activation of JAK2-STAT3 signaling pathway, podocyte injury, glomerulosclerosis and renal tubular injury, participating in the development of FSGS.

This study was a single-center cross-sectional investigation aimed at identifying risk factors for cognitive dysfunction in patients undergoing maintenance hemodialysis (MHD), with the goal of providing a basis for improving patient prognosis. Patients receiving MHD in the Blood Purification Center of Hainan Provincial People's Hospital from June 1 to June 30, 2023, were enrolled. Cognitive function was assessed using the Mini-Mental State Examination (MMSE), and potential risk factors for cognitive impairment were analyzed by using Logistic regression. A total of 278 patients were included, 69 patients (24.8%) of whom had cognitive impairment. Multivariate Logistic regression analysis indicated that the history of cerebrovascular disease (OR=3.109, 95% CI 1.310-7.378, P=0.010), old age (OR=1.077, 95% CI 1.040-1.115, P<0.001), low dialysis frequency (OR=0.270, 95% CI 0.120-0.606, P=0.001), low academic qualification (using college/university as the control group: primary school group OR=26.960, 95% CI 7.519-96.673, P<0.001; Junior high school/technical secondary school group OR=4.264, 95% CI 1.330-13.650, P=0.015; High school group OR=9.554, 95% CI 2.861-31.904, P<0.001), high β2-microglobulin (OR=1.609, 95% CI 1.044-2.480, P=0.031) and high C-reactive protein/albumin (OR=2.672, 95% CI 1.226-5.826, P=0.013) were independent risk factors for cognitive impairment in MHD patients.

This paper presented a case that a cryopreserved allogeneic vessel (iliac artery) was used to establish an arteriovenous graft fistula. It was the first case in China of creating an arteriovenous graft fistula using a cryopreserved allogeneic vessel. The surgery was successful, and the fistula was functioning. Allogeneic vessels processed using cryopreservation are characterized by low antigenicity, excellent biocompatibility, the capacity for integration with the patient's own tissues within the transplanted vessel, and a notable resistance to infection. For patients who are unsuitable for or have failed arteriovenous fistula creation, using cryopreserved allogeneic vessels for fistula establishment can be an alternative option, especially for patients with a history of multiple failed fistula surgeries and recurrent infections.

This paper reported a case of severe lupus nephritis in an adolescent with progressive hemolytic anemia, thrombocytopenia, and multiple organs involvement, in which renal damage was characterized by sustained elevation of serum creatinine and oliguria. Accurate diagnosis of lupus nephritis complicated with thrombotic microangiopathy was achieved through genetic testing and molecular technology. The use of double filtration plasmapheresis, blocking B-cell targets and complement activation targets, and supplementing frozen plasma provided more accurate, safe and effective treatment options for patients, which significantly improved prognosis.

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

Acute kidney injury (AKI) is one of the common critical illnesses characterized by a higher incidence, poor prognosis and limited effective therapeutics in clinical practice. Early diagnosis, etiologic differentiation and prognostic evaluation are crucial for improving outcomes and key components of integrated AKI management. However, the lack of ideal markers and intervention targets poses significant challenges in these aspects. Klotho, a protein predominantly synthesizes and secretes by renal tubular epithelial cells, has been shown to exert various protective effects on the kidney. Recent evidence suggests that abnormal Klotho levels are implicated in the pathogenesis and development of AKI, and hold promise for application in early diagnosis, etiologic recognition, and prognostic evaluation of AKI. Additionally, administration of exogenous Klotho protein or upregulation of endogenous Klotho expression has demonstrated preventive and therapeutic efficacy against AKI caused by a variety of etiologies. This paper reviewed the alterations in Klotho levels during AKI and evaluated its potential role in enhancing the integrated diagnosis and treatment of AKI.

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

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

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

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

Objective To investigate the effect of circular RNA (circRNA)_005987 on contrast-associated acute kidney injury (CA-AKI) and its mechanism, and provide new ideas for the prevention and treatment of CA-AKI. Methods CA-AKI rat models and HK-2 cell injury models were established using iopromide, and CA-AKI-related circRNA_005987 was screened based on circRNA expression chip and real-time quantitative PCR (RT-qPCR). Knockdown and overexpression of circRNA_005987 were performed in HK?2 cell model, respectively. Cell counting kit?8 (CCK-8) and Edu staining assays were used to evaluate cell proliferation. Western blotting was used to detect the protein expression of autophagy-related protein microtubule?associated protein 1 light chain 3B (LC3B), P62, beclin?1 and autophagy-related gene 14 (ATG14). Immunofluorescence staining was used to detect protein expression of LC3B. Electron microscope was used to observe the autophagosome formation. Autophagy activator rapamycin and autophagy inhibitor 3-methyladenine were used for in vitro rescue experiments to observe the changes of the above indicators. Mechanistically, bioinformatics analysis was applied to analyze the binding site among circRNA_005987, miR-129-5p and ATG14, and dual luciferase reporter assay was used to verify their interactions. CircRNA_005987 was knocked down and overexpressed in HK?2 cell model, and RT-qPCR was used to detect the expression of miR-129-5p. HK?2 cells were treated with miR-129-5p inhibitor and mimic, Western blotting was used to detect the protein expression of ATG14, and CCK8 and Edu staining assays were used to evaluate cell proliferation. Results CircRNA_005987 expression was up-regulated in vitro and vivo CA-AKI models (both P<0.05). Overexpression of circRNA_005987 inhibited cell proliferation and promoted cell autophagy, while knockdown of circRNA_005987 had opposite effects (all P<0.05). In vitro rescue experiments confirmed that circRNA_005987 inhibited cell proliferation by activating autophagy (P<0.05). The dual luciferase reporter assay suggested that there was an interaction between circRNA_005987, miR-129-5p and ATG14. Knockdown of circRNA_005987 increased miR-129-5p expression, while overexpression of circRNA_005987 inhibited miR-129-5p expression (both P<0.05). Knockdown of miR-129-5p inhibited cell proliferation, while overexpression of miR-129-5p reversed the effect (both P<0.05). Conclusion CircRNA_005987 promotes CA-AKI through activating autophagy via sponging miR-129-5p, suggesting that circRNA_005987 plays an important role in the pathological process of CA-AKI.

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

Anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) induced by anti-thyroid drugs has been reported occasionally, but methimazole-induced AAV is not as frequently reported. This case report described a 54-year-old male who developed AAV and multiple organ failure after more than 20 days of methimazole treatment. After timely discontinuation of the disease-causing drug methimazole, the patient received methylprednisolone shock, cyclophosphamide immunosuppression, renal replacement therapy, and other supportive treatments, and the disease was alleviated without recurrence.

Gaucher disease is an autosomal recessive genetic disorder, with membranoproliferative glomerulonephritis (MPGN) being a rare complication. Here we present a case of type I Gaucher disease complicated with MPGN to improve the understanding of this disease. For patients presenting with abdominal distension, hepatosplenomegaly and myelofibrosis, Gaucher disease should be considered to avoid misdiagnosis and inappropriate treatment. The detection of β-glucosidase, genetic mutation analysis and histopathological examination can play crucial roles in the diagnosis of Gaucher disease. Treatment with glucocorticoids combination with immunosuppressants can improve patient's prognosis.

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

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

Piezo is a newly discovered mechanosensitive ion channel (MSC) in mammals, characterized by a unique homotrimeric three-leaf propeller-shaped structure that converts mechanical signals into biological and electrical signals, thus participating in the regulation of various physiological and pathological processes. In recent years, an increasing number of studies have demonstrated the crucial role of Piezo channel in renal physiology and pathophysiology. This article aims to provide new perspectives and targets for the prevention and treatment of renal diseases by reviewing the recent research advances in the structure, kinetics and pharmacology of Piezo channel, especially their expression and physiopathologic roles in the kidney.

Objective To investigate the association between blood pressure variability (BPV) and all-cause mortality and cardiovascular events in patients undergoing continuous ambulatory peritoneal dialysis (CAPD), and provide reference for clinical management in CAPD patients. Methods This retrospective cohort study included patients who received CAPD at Guangdong Provincial People's Hospital between May 1, 2010, and July 31, 2023. Baseline and clinical data of the patients were collected. Coefficient of variation of systolic blood pressure (CVSBP) was used to assess BPV. The patients were divided into CVSBP T1, CVSBP T2 and CVSBP T3 groups based on CVSBP tertiles, and the differences among the three groups were compared. Diastolic blood pressure and mean arterial pressure were used to further assess BPV and sensitivity analysis was conducted. The primary endpoint was the composite outcome of all-cause mortality and cardiovascular events. Kaplan-Meier survival curve and Cox regression analysis were used to analyze the association between CVSBP and the primary endpoint. Results A total of 358 CAPD patients were included, with age of (43.6±13.3) years, and 197 males (55.0%). The proportion of males, proportion of smoking, baseline blood urea nitrogen, serum creatinine and serum albumin in CVSBP T2 (9.08%≤CVSBP<12.55%, n=120) group and CVSBP T3 (CVSBP≥12.55%, n=119) group were lower than those in CVSBP T1 group (CVSBP<9.08%, n=119), and baseline systolic blood pressure, residual kidney Kt/V and total Kt/V were higher than those in CVSBP T1 group, with statistically significant difference among the three groups (all P<0.05). During follow-up of 37(23, 76) months, 49 patients (13.7%) experienced the composite endpoint events, including 12 patients (3.4%) of all-cause deaths and 42 patients (11.7%) of cardiovascular events. Kaplan-Meier survival analysis showed that the incidence of composite endpoint events in CVSBP T3 group was higher than that in CVSBP T1 group and CVSBP T2 group, but the difference was not statistically significant (Log-rank χ²=3.795, P=0.150). Multivariate Cox regression analysis showed that, after adjusting for age, sex, diabetes, baseline systolic blood pressure, residual renal function, and serum albumin, as a continuous variable, CVSBP was not associated with the risk of composite outcome in CAPD patients (HR=1.058, 95% CI 0.985?1.135, P=0.122); as a categorical variable, with CVSBP T1 group as reference, CVSBP T2 group and CVSBP T3 group were not associated with the risk of composite outcome (HR=1.222, 95% CI 0.471?3.167, P=0.681; HR=1.827, 95% CI 0.737?4.530, P=0.193). The sensitivity analysis showed that increased variability of diastolic blood pressure (HR=1.162, 95% CI 1.063?1.270, P=0.021) and increased variability of mean arterial pressure (HR=1.114, 95% CI 1.030?1.204, P=0.007) were correlated with higher risk of composite outcome in CPAD patients. Conclusions Systolic blood pressure variability during follow-up is not associated with risk of composite outcome of all-cause mortality and cardiovascular events in CAPD patients. Increased variability of diastolic blood pressure and increased variability of mean arterial pressure are associated with a higher risk of composite outcome in CPAD patients. Interventions to reduce BPV may be helpful to improve the long-term prognosis of CAPD patients.

Objective To observe the incidence of early blood eosinophils (Eos) elevation in patients with peritoneal dialysis (PD), analyze its related factors, and its relationship with early-onset peritonitis in PD patients. Methods This study was a retrospective observational cohort study. Patients who underwent PD catheterization in Peking University People's Hospital from January 2012 to December 2022 were included. After surgery, PD treatment was started immediately and followed up regularly ≥12 months. The general information and laboratory indexes collected 1 week before catheterization, and at 1, 3, 6 and 12 months after catheterization were recorded. The occurrence of elevated blood Eos (≥0.5×10⁹/L) during the early stage of PD, the related factors of Eos elevation (≥0.5×10⁹/L) and the relationship with early-onset peritonitis (within 12 months after PD initiation) were analyzed. Results (1) A total of 235 patients were enrolled, with an age of (57.9.±13.9) years, including 136 males (57.9%). The primary diseases were predominantly chronic glomerulonephritis (111/235, 42.7%) and diabetic nephropathy (83/235, 35.3%). During the 12-month follow-up period, 73 patients had elevated blood Eos (31.1%), of which 37 cases (50.7%) occurred within 1 month after PD catheterization, 21 cases (28.7%) occurred 2-3 months after PD catheterization, 12 cases (16.4%) occurred 4-6 months after PD catheterization, and 3 cases (4.1%) occurred 7-12 months after PD catheterization. In 73 patients with elevated Eos, 69 cases (94.5%) were mildly elevated, 4 cases (5.5%) were moderately elevated. As for the duration of elevated blood Eos, 28 cases (38.4%) lasted less than 1 month, 27 cases (37.0%) lasted 1-3 months, and 18 cases (24.7%) lasted more than 3 months. (2) In patients with elevated blood Eos, the proportion of male patients (71.4% vs. 52.1%, χ² =7.515, P=0.006), the proportion of diabetes mellitus (55.7% vs. 41.2%, χ² =4.168, P=0.046), and the proportion of combined vascular disease (32.9% vs. 18.2%, χ² =6.060, P=0.017) were significantly higher than those patients in normal blood Eos group. (3) Multivariate Logistic regression analysis showed that male was an independent related factor for elevated blood Eos (≥0.5×10⁹/L) in the early stages of PD (OR=2.044, 95% CI 1.101- 3.794, P=0.023). (4) Diabetes mellitus (OR=3.363, 95% CI 1.087-10.405, P=0.035), lower baseline hemoglobin level (OR=0.941, 95% CI 0.903-0.980, P=0.004) and elevated blood Eos (with serum Eos<0.5×10⁹/L as reference, OR=2.917, 95% CI 1.022-8.326, P=0.045) were the independent related factors of early-onset peritonitis. Conclusion Blood Eos elevations are common in early stage of PD patients, mainly occuring within 6 months after PD catheterization, and most of them are slightly increased and last less than 3 months. Male sex is an independent related factor for the elevation of blood Eos in the early stage of PD. Elevated blood Eos is an independent related factor for early-onset peritonitis.

Objective To investigate the effect of intradialytic cerebral blood flow (CBF) fluctuation on cognitive decline in middle-aged and elderly maintenance hemodialysis (MHD) patients. Methods It was a prospective cohort study. MHD patients aged ≥50 years from Beijing Shijitan Hospital were enrolled from January 2023 to June 2023. Middle cerebral artery mean flow velocity (MFV) was serially monitored via transcranial Doppler (TCD) during dialysis sessions. Cognitive function was assessed at baseline and after 12-month follow-up using standardized neuropsychological tests: montreal cognitive assessment (MoCA), auditory verbal learning test (AVLT 5), complex figure test (CFT), trail making test-B (TMT-B), Stroop color and word test (SCWT), and symbol digit modalities test (SDMT). ΔMFV was calculated as pre-to-post dialysis MFV difference. Multivariable linear regression was used to analyze the association of ΔMFV and cognition. Results A total of 121 MHD patients were recruited with an age of (63.63±8.44) years. There were 97 males (80.2%), and the dialysis vintage was (55.08±54.73) months. Significant intradialytic MFV reductions were observed (P<0.05). At 12 months, cognitive decline manifested in global cognition (MoCA), memory (CFT-memory), executive function (TMT-B, SCWT-C, SCWT-T), attention (SDMT), visuospatial ability (CFT-copy)(all P<0.05). Multivariable linear regression analysis revealed ΔMFV independently predicted declines in: MoCA (B=0.066, 95% CI 0.018-0.113, P=0.007), AVLT5 (B=0.050, 95% CI 0.004-0.097, P=0.035), TMT-B (B=-1.955, 95% CI -3.453--0.457, P=0.011), SCWT-C (B=0.298, 95% CI 0.112-0.484, P=0.002), SCWT-T (B=-1.371, 95% CI -2.303--0.439, P=0.004). Conclusions Hemodialysis induces acute CBF reductions detectable by TCD. Cumulative intradialytic CBF fluctuations may accelerate cognitive deterioration in middle-aged and elderly MHD populations, particularly affecting memory and executive domains.

Objective To compare the application effects of upper arm autogenous arteriovenous fistula (AVF) and forearm arteriovenous graft (AVG) in maintenance hemodialysis (MHD) patients, and to analyze the factors influencing the long-term patency rate of arteriovenous fistulas in MHD patients. Methods It was a retrospective cohort study. The data of MHD patients treated in the First Affiliated Hospital of Zhejiang University School of Medicine from January 2021 to May 2023 was collected. Participants were stratified into two groups: forearm AVG and upper arm AVF. The parameters including urea clearance index (Kt/V), serum C-reactive protein (CRP), albumin levels, access-related costs, complication rates, and long-term primary patency were compared. The end event was defined as arteriovenous fistula failure, that was, the arteriovenous fistula could not be used for dialysis puncture, or the arteriovenous fistula lost function after adequate blood flow was achieved. Kaplan-Meier survival curves with log-rank tests were employed to compare access survival, while multivariable Cox regression was used to analyze the independent associated factors of patency. Results A total of 71 MHD patients were enrolled in this study, including 35 males, with age of (64.9±11.7) years and fistula establishment time of 30.0(17.0, 58.0) months. There were 32 cases (45.1%) in the forearm AVG group and 39 cases (54.9%) in the upper arm AVF group. Compared with the forearm AVG group, the upper arm AVF group had higher serum albumin levels [38.9 (37.0, 42.1) g/L vs. 38.0 (34.6, 40.0) g/L, Z=-2.364, P=0.018], higher pain scores [3.0(2.0, 5.0) points vs. 2.0(1.0, 3.0) points, Z=-3.012, P=0.003], and higher long-term patency rates of arteriovenous fistulas (at 3, 6, 12, and 24 months, all P<0.01), while the complication rate[61.5% (24/39) vs. 93.7% (30/32), χ²=10.015, P=0.002], the cost of the access [0 (0, 9,117.0) yuan·year^-1·person^-1vs. 10 380.5 (7 186.0, 30 228.5) yuan·year^-1·person^-1, Z=-4.094, P<0.001] were lower, and the length of the available puncture vessel segment was shorter [3.5(3.0, 5.0) cm vs. 6.5(6.0, 8.0) cm, Z=-6.477, P<0.001].The Kaplan-Meier survival analysis results showed that the primary patency rate of the upper arm AVF group was significantly higher than that of the forearm AVG group (Log-rank test, χ²=23.690, P<0.001). The multivariate Cox regression analysis results indicated that the type of fistula being forearm AVG (with upper arm AVF as reference, HR=4.907, 95% CI 1.740-13.840) and increased complications number (HR=1.234, 95% CI 1.040-1.464) were the independent factors promoting the arteriovenous fistula failure in MHD patients. Conclusions The type of internal fistula and the complications are the factors affecting the long-term patency rate of internal fistula in MHD patients.Upper arm AVF offers cost-effectiveness and sustained patency advantages over forearm AVG but requires careful consideration of puncture challenges and patient discomfort. Individualized access selection should balance anatomical constraints with clinical priorities.

Objective To analyze the risk factors for muscle cramps in maintenance hemodialysis patients and construct a nomogram prediction model. Methods It was a retrospective cohort study. Patients undergoing regular hemodialysis at the Blood Purification Center of the Fourth Hospital of Hebei Medical University (West and East Campuses) from June 2023 to December 2023 were enrolled in this study. Patients were divided into a muscle cramps group and a non-muscle cramps group based on whether cramps occurred during or after dialysis. Patients from the West Campus were allocated to the training set, while those from the East Campus were assigned to the validation set, with an approximately 5∶1 ratio. Multivariate logistic regression analysis was used to identify risk factors for muscle cramps in the training set. A nomogram prediction model was constructed using R software. Model performance was evaluated using the receiver operating characteristic curve (ROC), calibration curve, and decision curve analysis in both the training and validation sets. Results A total of 498 maintenance hemodialysis patients were enrolled, including 409 in the training set (22.98% incidence of muscle cramps) and 89 in the validation set. Multivariate logistic regression analysis revealed that heart failure history (OR=8.566, 95% CI 2.448-29.979, P=0.001), pre-dialysis corrected narrowed inferior vena cava width (OR=0.531, 95% CI 0.433-0.650, P<0.001), increased ultrafiltration rate (OR=1.002, 95% CI 1.001-1.003, P=0.002), decreased hemoglobin level (OR=0.971, 95% CI 0.948-0.994, P=0.014), and decreased serum albumin (OR=0.886, 95% CI 0.799-0.982, P=0.021) were independent associated factors for muscle cramps in the training set. The nomogram model based on these factors demonstrated an area under the ROC curve (AUC) of 0.813 (95% CI 0.760-0.866, P<0.001) in the training set, with a Brier score of 0.129, indicating stable predictive performance. In the validation set, the area under of the ROC curve was 0.821 (95% CI 0.731-0.911, P<0.001) with a Brier score of 0.142. The decision curve showed that the model provided high clinical net benefit when the risk threshold probability for muscle cramps ranged from 0.22 to 0.77. Conclusion Combined heart failure, narrowed inferior vena cava width, increased ultrafiltration rate, and decreased hemoglobin and serum albumin levels were the independent correlated factors for muscle spasm in maintenance hemodialysis patients. The nomogram model constructed based on these risk factors holds significant clinical value for predicting muscle cramps in maintenance hemodialysis patients.

Objective To investigate the effect of phosphorus-containing replacement solution for the prevention and treatment of hypophosphatemia during continuous renal replacement therapy (CRRT) in critically ill patients with blood phosphorus level ≤1.45 mmol/L, and to provide clinical reference. Methods It was a historical prospective cohort study. The critically ill patients receiving CRRT with blood phosphorus ≤ 1.45 mmol/L in the intensive care unit of Henan Provincial People's Hospital from October 2021 to January 2023 and from April 2023 to January 2024 was selected as the study subjects. The patients were divided into test group (from April 2023 to January 2024) and control group (from October 2021 to January 2023) according to whether phosphate (1.0 mmol/L) was added to the replacement solution during CRRT, and the differences of clinical data before and after CRRT between the two groups were compared. The patients were divided into hypophosphatemia group and non-hypophosphatemia group according to whether blood phosphorus < 0.81 mmol/L within 24 h after the end of CRRT, and the differences of clinical data between the two groups were compared. Logistic regression analysis was used to analyze the related factors of hypophosphatemia. Results A total of 149 critically ill patients with blood phosphorus level ≤1.45 mmol/L undergoing CRRT were enrolled in the study, with age of 64(47, 75) years and 87 males (58.4%). Among 149 patients, 84(56.4%) had hypophosphatemia after CRRT, and no hyperphosphatemia occurred. The incidence of hypophosphatemia in test group and control group was 40.0% (30/75) and 73.0% (54/74), respectively. There was no statistically significant difference in baseline clinical data before CRRT between test group and control group (all P>0.05). C-reactive protein (Z=-3.356, P=0.001), blood calcium (Z=-3.835, P<0.001) and proportion of hypophosphatemia (χ²=16.467, P<0.001) in the test group were lower than those in the control group, and blood phosphorus (Z=3.886, P<0.001) in the test group was higher than that in the control group within 24 h after CRRT. Compared with non-hypophosphatemia group, the proportion of parenteral nutrition (χ²=6.802, P=0.009) and blood calcium within 24 h after CRRT (Z=-2.515, P=0.012) in the hypophosphatemia group were higher, and blood phosphorus within 24 h after CRRT (Z=-10.451, P<0.001), blood phosphorus after 24 h after CRRT treatment (Z=-5.331, P<0.001) and the proportion of applied replacement solution containing phosphorus (χ²=16.467, P<0.001) in the hypophosphatemia group were lower. The results of multivariate logistic regression analysis showed that parenteral nutrition (OR=2.521, 95% CI 1.228-5.175, P=0.012) and application of phosphorus- containing replacement solution (OR=0.241, 95% CI 0.119-0.491, P<0.001) were independent relevant factors of hypophosphatemia after CRRT in the whole cohort of patients. Conclusions The application of phosphorus-containing replacement solution in critically ill patients with blood phosphorus level ≤1.45 mmol/L undergoing CRRT is safe and effective, and the incidence of hypophosphatemia is low. Application of phosphorus-containing replacement solution in critically ill patients with blood phosphorus level ≤1.45 mmol/L undergoing CRRT can reduce the incidence risk of hypophosphatemia after CRRT.

Pruritus is one of the common comorbidities in patients with chronic kidney disease, significantly reducing life quality and increasing the risks of depression and mortality. This report presents the treatment process of a patient undergoing maintenance hemodialysis with pruritus. The patient successively received an optimized dialysis prescription, management of chronic kidney disease-related mineral and bone disorder, correction of secondary hyperparathyroidism, enhanced skin care, and administration of gabapentin. However, pruritus symptoms of this patient persisted. Subsequently, the patient was treated with nalfurafine hydrochloride, resulting in significant relief of pruritus symptoms without any adverse reaction. This case provides new insights and references for the treatment of chronic kidney disease-associated pruritus.

Allogeneic haemopoietic stem cell transplantation (allo-HSCT)-related nephrotic syndrome is a rare complication, recognized as a clinical manifestation of chronic graft versus host disease (GVHD). T cell dysfunction is thought to play a significant role in the pathogenesis of allo-HSCT-related nephrotic syndrome, but the precise mechanism remains unclear. This paper reported a case of X-linked adrenoleukodystrophy (X-ALD) who had good control of the disease after allo-HSCT, but developed proteinuria and progressed to nephrotic syndrome after immunosuppressive therapy was tapered. Kidney biopsy revealed secondary membranous nephropathy, which responded well to treatment with glucocorticoids and tacrolimus. Limited literature exist on allo-HSCT-related nephrotic syndrome in children. This study provides a comprehensive summary of its mechanism, clinical features, pathology, diagnosis,and treatment, offering valuable insights for diagnosing and managing allo-HSCT-related nephrotic syndrome in pediatric patients.

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

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