Objective To investigate the clinical characteristics and short-term follow-up outcomes of primary nephrotic syndrome (PNS) children infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the Omicron variant outbreak in Shanghai, and to provide a reliable reference for clinicians in the diagnosis and treatment. Methods It was a case-control study. The clinical data of children with PNS (PNS group) who were diagnosed and followed-up up to 1 year in the nephrology department of four children's medical centers in Shanghai, and the children (control group) who had no underlying diseases and were infected with SARS-CoV-2 in Shanghai Jinshan Public Health Center, including the data when they were infected with SARS-CoV-2, were retrospectively analyzed. Results (1) From March 30th to April 13th, 2022, 6 PNS children in Shanghai were infected with SARS-CoV-2, including 5 boys and 1 girl. The median age was 4.5 (2.0, 11.0) years old. And 30 children were matched by sex, age and disease type as control group, including 20 males and 10 females. The median age was 4.5 (2.0, 9.0) years. There were no significant differences between the PNS group and the control group in clinical symptoms (including fever duration), treatment regimens, vaccine doses and virus clearance time (all P>0.05). (2) The 6 children with PNS included 3 cases of steroid-sensitive type, 3 cases of steroid-resistant type, 2 cases of minimal change disease, 2 cases of focal segmental glomerulosclerosis and 2 cases with no renal biopsy. Before SARS-CoV-2 infection, their primary disease-PNS were stable, and urine protein was negative, four of them were under maintenance treatment with oral steroids or immunosuppressive drugs. At the time of SARS-CoV-2 infection, the symptoms of all of the 6 cases were mild, no severe, critical or fatal cases, and they were all cured and discharged from hospital through medical isolation observation or symptomatic treatment of infections. (3) Five cases of them still had discomfort symptoms such as cough, anorexia, and fatigue after being discharged from the hospital, which lasted for about 1 week. Within 1 year of follow-up, none of the children have suffered from "recurrent positive PCR results" or "secondary infection" of the SARS-CoV-2. (4) Among them, 4 cases of PNS relapsed after SARS-CoV-2 infection, timely addition of steroids was effective, their urine protein quickly turned negative, and there was no recurrence after 1 year of follow-up. (5) Before infection with SARS-CoV-2, the levels of immunoglobulin IgG were lower than the normal reference value in the 4 cases with PNS recurrence. Conclusions During the Omicron variant outbreak in Shanghai, the infection of SARS-CoV-2 in children with PNS are resulted in high transmission among household contacts. Most of them have mild symptoms and good prognosis. PNS is prone to relapse after SARS-CoV-2 infection, and steroid therapy is effective and safe for these relapse. IgG may be a potential marker for the prognosis of PNS children infected with SARS-CoV-2.

Objective To analyze the clinical and pathological features of adolescent- onset primary nephrotic syndrome (PNS) in children (10 years≤age≤18 years), so as to explore the renal biopsy indications in adolescent-onset PNS. Methods It was a single-center retrospective observational study. The clinical and pathological data of adolescent-onset PNS (age≥10 years) who underwent renal biopsy in Children's Hospital Affiliated to Nanjing Medical University from December 2004 to June 2022 were analyzed retrospectively. Results A total of 110 children were included in the study, including 76 males (69.1%) and 34 females (30.9%), with the onset age ranging from 10 years to 14 years and 9 months. Forty-nine cases (44.5%) were accompanied by hematuria, including 14 cases (12.7%) of gross hematuria and 35 cases (31.8%) of microscopic hematuria. Twenty-five cases (22.7%) had hypertension, 19 cases (17.3%) had renal insufficiency, and 4 cases (3.6%) had low complement C3 at the onset. Fifty-two cases (47.3%) were steroid sensitive nephrotic syndrome and 58 cases (52.7%) were steroid resistant nephrotic syndrome. Biopsy results showed that minimal change disease(MCD) was the most common histopathological subtype (47.3%, 52 case), followed by focal segmental glomerulosclerosis (FSGS) in 22 cases (20.0%), IgA nephropathy (IgAN) in 17 cases (15.5%), membranous nephropathy (MN) in 7 cases (6.4%), mesangial proliferative glomerulonephritis in 5 cases (4.5%), IgM nephropathy in 4 cases (3.6%), membranous proliferative glomerulonephritis in 2 cases (1.8%), and C1q nephropathy in 1 case (0.9%). Among 44 children with simple type nephrotic syndrome, the pathological type was mainly MCD (77.3%), and 66 children with nephritic type nephrotic syndrome were mostly non-MCD (72.7%), such as IgAN, FSGS, MN, etc. If there are two or more clinical manifestations of persistent hematuria, hypertension, renal insufficiency or low C3 levels, the proportion of non-MCD would further increase to 92.0%(23/25). The pathological type of patient with gross hematuria or low C3-emia was non-MCD. The frequency of hematuria (69.0% vs. 17.3%, χ²=29.619, P<0.001), hypertension (31.0% vs. 13.5%, χ²=4.821, P=0.028) and renal insufficiency (24.1% vs. 9.6%, χ²=4.047, P=0.044) in non-MCD group was significantly higher than those in MCD group. Conclusions If the clinical manifestation of PNS in adolescent over 10 years old is simple type nephrotic syndrome, the histopathological lesion is mostly MCD, and most of them are steroid sensitive. It is recommended to give hormone treatment first, and then perform renal biopsy if steroid resistance occurs; If the clinical manifestation is nephritic type nephrotic syndrome, the histopathological lesion is mostly non-MCD, especially those with gross hematuria or low C3-emia, or those have two or more clinical manifestations of persistent hematuria, hypertension, renal insufficiency and hypocomplement C3-emia, a kidney biopsy should be performed at onset.

Objective To analyze the efficacy of balloon-assisted autologous arteriovenous fistula (AVF) maturation and its effect on patency. Methods It was a single-center prospective cohort study. The patients who underwent balloon-assisted maturation (BAM) due to poor AVF maturation in Haidian Hospital, the Third Hospital of Peking University from November 2020 to May 2021 were enrolled. The clinical data and relevant data before and after BAM were collected, and then the immediate success rate and primary patency rate at 6 and 12 months after BAM were analyzed. Cox regression analysis method was used to identify the risk factors of restenosis of AVF patency after BAM. Results A total of 96 patients treated with BAM due to poor AVF maturation were enrolled, with age of (56.98±13.20) years old, 54 males (56.25%) and 42 females (43.75%). The technical success rate of BAM was 100% (96/96), the clinical success rate of BAM was 96.88% (93/96), and there was no related serious complication. The primary patency rates were 83.33% (80/96) and 59.38% (57/96) at 6 and 12 months, respectively. The internal diameter of anastomotic vein (t=-19.257, P<0.001), internal diameter of anastomotic artery (t=-9.131, P<0.001), internal diameter of brachial artery (t=-5.445, P<0.001) and brachial artery blood flow (t=-22.739, P<0.001) after BAM were higher than those before BAM. Univariate Cox regression analysis results showed that stenosis number, stenosis length ≤2 cm, high-pressure balloons, local anaesthetic were all correlated with restenosis of AVF after BAM (all P<0.05). Multivariate Cox regression analysis results showed that stenosis length ≤2 cm was an independent related factor of restenosis of AVF after BAM at 6 months (HR=0.022, 95% CI 0.006-0.075, P<0.001) and at 12 months (HR=0.027, 95% CI 0.009-0.082, P<0.001). Conclusions BAM is safe and effective for AVF maturation, and has a high success rate and reliable patency. Preoperative stenosis length >2 cm is an independent risk factor of AVF restenosis after BAM.

Objective To study the incidence and risk factors of central vein stenosis (CVS) in chronic kidney disease (CKD) patients who received arteriovenous fistula (AVF) creation for the first time, as well as effects of CVS on patency of ipsilateral AVF. Methods It was a retrospective study. The CKD patients who received AVF creation for the first time in the First Affiliated Hospital of Zhengzhou University from January 2019 to August 2020, with central vein digital subtraction angiography (DSA) results prior to angioplasty were selected as the study subjects. The differences of incidence of CVS in CKD patients with/without a history of cervical catheterization and primary patency rates of AVF between CVS and non-CVS groups were compared. Logistic regression analysis method was applied to analyze the influencing factors of CVS in CKD patients. Kaplan-Meier method was used to analyze the primary patency rate of AVF. Cox regression analysis method was used to analyze the effect of CVS on the primary patency of ipsilateral AVF. Results A total of 283 CKD patients aged (50.45±14.76) years were enrolled in the study, including 165 males (58.3%). The dialysis age was 0.5 (0, 7.0) months. There were 55 patients (19.4%) diagnosed with CVS before AVF, including 39 patients with stenosis <50% and 16 patients with stenosis ≥50%. The incidence of CVS in patients with history of right internal jugular vein central venous catheter insertion was significantly higher than that in those without this history [60.5% (26/43) vs. 9.9% (15/151), χ²=51.274, P<0.001]. Multivariate logistic regression analysis results showed that hemodialysis catheters indwelling time ≥3 months elevated the risk of CVS (OR=4.345, 95% CI 1.540-12.263, P=0.006). A subset of 268 patients who had AVF creation ipsilateral to CVS were analyzed to determine the effects of CVS on patency of AVF. The median follow-up time was 34 months. The primary patency rate of AVF in the moderate to severe CVS group was significantly lower than that in the non-CVS group (5/7 vs. 58/228, χ²=7.720, P=0.005). The primary patency rates of AVF in the subclavian vein stenosis group and superior vena cava stenosis group were significantly lower than those in the brachiocephalic vein stenosis group (4/5 vs. 8/27, χ² =6.974, P=0.008; 6/8 vs. 8/27, χ² =6.908, P=0.009, respectively). Moderate to severe CVS and combined diabetes were independent influencing factors of primary patency of AVF (HR=4.362, 95% CI 1.644-11.574, P=0.003; HR=2.682, 95% CI 1.624-4.431, P<0.001, respectively). Conclusions The incidence of CVS is higher in CKD patients who establish an arteriovenous fistula for the first time. Hemodialysis catheter indwelling time ≥3 months is an independent risk factor of CVS. The moderate to severe CVS is an independent risk factor of primary patency of AVF.

Objective To investigate the correlation between serum anti-phospholipase A2 receptor antibody (SAb) combined with glomerular complement C3 (GC3) deposition and clinicopathologic features and prognosis in patients with idiopathic membranous nephropathy (IMN). Methods It was a retrospective cohort study. The patients diagnosed with IMN in Affiliated Hospital of Qingdao University from July 1, 2019 to April 30, 2022 were enrolled, and the clinical and pathological data were collected and analyzed. The patients were divided into negative SAb and negative GC3 (SAb^-/GC3^-) group, negative SAb and positive GC3 (SAb^-/GC3⁺) group, positive SAb and negative GC3 (SAb⁺/GC3^-) group and positive SAb and positive GC3 (SAb⁺/GC3⁺) group according to the status of SAb titer and GC3 deposition. Clinical and pathological characteristics among the groups were compared. Kaplan-Meier survival curve was used to compare the cumulative renal remission rates of different groups. Cox regression analysis model was used to analyze the related factors of renal remission. Results A total of 143 IMN patients aged (53.35±12.34) years old were included in the study, including 94 males (65.7%). There were 17 patients (11.9%) in the SAb^-/GC3^- group, 30 patients (21.0%) in the SAb^-/GC3⁺ group, 19 patients (13.3%) in the SAb⁺/GC3^- group, and 77 patients (53.8%) in the SAb⁺/GC3⁺ group. Compared with SAb^-/GC3^- group, the level of serum albumin was lower in the SAb⁺/GC3⁺ group, and the level of 24 h urine protein, SAb titer, and the proportions of glomerular anti-phospholipase A2 receptor antigen and renal tubule atrophy were higher in the SAb⁺/GC3⁺ group (all P<0.05). After 26.0 (19.0, 36.0) months of follow-up, a total of 96 patients (67.1%) attained remission. The proportion of patients receiving immunosuppressive therapy in the SAb⁺/GC3⁺ group was higher than that in the SAb^-/GC3^- group [93.5% (72/77) vs. 70.6% (12/17), fisher value=8.974, P=0.016] and the proportion of renal remission rate in the SAb⁺/GC3⁺ group was lower than that in the SAb^-/GC3^- group [49.4% (38/77) vs. 100% (17/17), χ²=25.438, P<0.001]. Kaplan-Meier survival curve result showed that the cumulative renal remission rate in the SAb⁺/GC3⁺ group was significantly lower than that in the SAb^-/GC3^- group (Log-rank χ²=31.538, P<0.01). Multivariate Cox regression analysis result showed that 24 h urine protein level (HR=0.891, 95% CI 0.803-0.988, P=0.029), SAb titer (HR=0.996, 95% CI 0.992-1.000, P=0.042) and SAb⁺/GC3⁺ (with SAb^-/GC3^- group as reference, HR=0.414, 95% CI 0.204-0.827, P=0.013) were independent related factors for renal remission in patients with IMN. Conclusions IMN patients with positive SAb and GC3 deposition have more severe clinical and pathological changes, lower renal cumulative remission rates, and are more likely to have poor prognosis. The combined assessment of SAb and GC3 deposition may be helpful for evaluating prognosis and guiding treatment in IMN patients.

Objective To investigate the changes of podocyte circadian rhythm in the high-glucose environment and diabetic nephropathy (DN) mouse model and the protective effect of melatonin on podocyte injury in DN. Methods Primary podocytes were cultured in vitro and divided into 3 groups: control group, high glucose (30 mmol/L) group and high glucose (30 mmol/L) treated with melatonin (0.1 mmol/L or 0.5 mmol/L) group. The podocytes were collected every 4 hours for 24 hours, synchronized with dexamethasone (100 nmol/L) for 2 hours, which was recorded as zeitgeber time 0 point. Male C57BL/6J mice aged 6-8 weeks and weighing about 20 g were randomly (randomized block) assigned to three groups: control group, DN (high-fat diet+streptozotocin 120 mg/kg intravenously injected) group, and DN (high-fat diet+streptozotocin 120 mg/kg intravenously) treated with melatonin (20 mg/kg intragastric treatment) group (melatonin group). Real-time quantitative PCR was used to detect the mRNA levels of rhythm genes in podocytes. Western blotting was used to detect the protein expression levels of circadian clock genes (Clock and Bmal1), podocyte marker proteins (Nephrin, Synaptopodin, WT1, and Desmin) and autophagy-related proteins (Beclin1, LC3Ⅱ/Ⅰ and P62). Immunofluorescence staining was used to detect the protein expression level of WT1, and immunohistochemistry was used to analyze the protein expression levels of P62 and cleaved-caspase-3 in renal tissues of mice. The pathological changes of renal glomerulus were observed under electron microscope. Results (1) Dexamethasone reseted the expression and rhythmic oscillation of circadian clock genes in podocytes. The circadian rhythmic oscillations of Clock and Ck1e mRNA in the high glucose group were flattened compared to the control group, and the circadian rhythmic oscillations in Clock and Ck1e mRNA expression were partial recovery in high glucose treated with melatonin group (all P<0.05). (2) Compared with the control group, the protein expression levels of Nephrin, Synaptopodin and WT1 were lower while Desmin was higher in the high glucose group (all P<0.05). The protein expression levels of Nephrin, Synaptopodin and WT1 were higher and the protein expression level of Desmin was lower in the high glucose treated with melatonin (0.5 mmol/L) group compared with the high glucose group (all P<0.05). (3) The invivo experimental results showed that compared with the DN group, melatonin group had higher protein expression levels of glomerular Nephrin and WT1, and lower urinary albumin/creatinine ratio, width of foot process and thickness of glomerular basement membrane (all P<0.05). The protein expression levels of Beclin1 and LC3Ⅱ/Ⅰ in the DN group were lower than those in the control group, and the protein expression level of P62 was higher than that in the control group (all P<0.05). Compared with the DN group, the protein expression levels of Beclin1 and LC3Ⅱ/Ⅰ in the melatonin group were significantly higher, and the protein expression level of P62 was lower (all P<0.05). Conclusions Melatonin can partially restore the circadian rhythm of clock genes in high-glucose environment, improve autophagy and alleviate injury in podocytes.

The study explored the effect of acteoside on renal fibrosis in rats with unilateral ureteral obstruction. Twenty-four healthy adult male SD rats were randomly divided into sham (CON) group, unilateral ureteral obstruction (UUO) group, UUO+acteoside (ACT) group, UUO+benazepril (BZ) group by random number table method. The animal model of renal fibrosis was established by unilateral ureteral ligation. The pathological changes of renal tissues in each group of rats were observed by HE staining and Masson staining. Immunohistochemical method was used to detect the protein expression levels of collagenⅢ, heat shock protein (HSP)-47, connective tissue growth factor (CTGF), α-smooth muscle actin (α-SMA), β-catenin, Bcl-2, and caspase-3. Western blotting was used to detect the protein expression of glucose-regulated protein 78 (GRP78) in renal tissue. Compared with CON group, UUO group had renal tubular dilation and significantly increased interstitial collagen fiber deposition; The degree of renal tubular dilation and interstitial collagen fibers in UUO+ACT group and UUO+BZ group were significantly reduced compared to UUO group, but still significantly heavier than CON group. Compared with CON group, the protein expression levels of collagenⅢ, HSP-47, CTGF, α-SMA, β-catenin and GRP78 in renal tissues of UUO group were significantly higher, while the protein expression level of Bcl-2 was significantly lower (all P<0.05). In comparison with UUO group, the expression levels of Bcl-2 in UUO+ACT group and UUO+BZ group were significantly higher, while the expression levels of other proteins were all significantly lower (all P<0.05). The study shows that acteoside may improve renal fibrosis by decreasing the expression levels of collagenⅢ, HSP-47, CTGF, α-SMA, β-catenin and GRP78, and upregulating the expression level of Bcl-2 in renal tissues.

The article reports a rare case of isolated persistent left superior vena cava (PLSVC) found during the catheterization of a dialysis catheter in an end-stage renal disease patient and the occurrence of guidewire entrapment in Chiari net. The patient was scheduled to have emergency dialysis due to end-stage renal disease and acute left heart failure. And a tunnel-cuffed catheter (TCC) for dialysis insertion was planned. Isolated PLSVC was found firstly by the imaging process. Then the guidewire was entrapped at the right atrium in the further operation. During the operation of the guidewire, the guidewire loosened and withdrawn with a fine fiber, which was considered a possibility of Chiari net. In the follow-up after one week, the TCC worked well, and the heart function improved after dialysis.

The risk factors of acute kidney injury caused by strenuous exercise include dehydration of the body, elevated body temperature, and intake of large amounts of sugary drinks after exercise, etc. The possible mechanism of the injury may be the inflammatory reaction of the body or the kidney itself, and the accumulation of various metabolites causing damage to the structure and function of the kidney under the induction of various risk factors. Repeated exposure to those risk factors not only increase the risk of acute kidney disease, but also may lead to chronic kidney disease. The paper reviews the definition, epidemiology, clinical manifestations, pathogenesis, and prevention measures of exercise-related kidney injury, to provide guidance for the formulation of appropriate exercise programs.

IgA-dominant infection-related glomerulonephritis (IgA-IRGN) is a unique form of infection-associated glomerulonephritis. The main causative organism is staphylococcus. Although IgA-IRGN is rare in children, the prevalence is gradually increasing, and the prognosis is poor in children with immunodeficiency and mucocutaneous barrier dysfunction. The clinical manifestations are varying degrees of hematuria, proteinuria, acute kidney injury and hypocomplementemia. The renal pathology is similar to postinfectious glomerulonephritis, therefore differential diagnosis is challenging. The paper reviews the current research progress of IgA-IRGN to improve the pediatrician's understanding of IgA-IRGN in children and avoid misdiagnosis.

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

Objective To investigate the association between body mass index (BMI) and waist circumference (WC) with all-cause mortality in middle-aged and elderly patients receiving maintenance hemodialysis (MHD). Methods It was a prospective cohort study. The clinical data of MHD patients aged ≥50 years old from eleven hemodialysis centers from April to June 2017 in Beijing were analyzed. The patients were divided into low BMI group [body mass index (BMI)<18.5 kg/m²], normal BMI group (18.5 kg/m²≤BMI <24.0 kg/m²), overweight group (24.0 kg/m²≤BMI<28.0 kg/m²) and obesity group (BMI≥28.0 kg/m²) by BMI, and central obesity group (male ≥85 cm, female ≥80 cm) and normal WC group (male <85 cm, female <80 cm) by WC. Kaplan-Meier survival analysis method was used to compare the difference of all-cause mortality between those groups. Multivariate Cox regression model was used to analyze the association of BMI and WC with all-cause mortality. Results A total of 613 MHD patients were enrolled, with age of (63.82±7.14) years old and 258 (42.09%) females. There were 46 (7.50%) patients in the low BMI group, 303 (49.43%) patients in the normal BMI group, 227 (37.03%) patients in the overweight group and 37 (6.04%) patients in the obesity group. In addition, 346 (56.44%) patients were categorized as central obesity. Kaplan-Meier survival analysis results showed that the all-cause mortality rates of low BMI group (log-rank χ²=13.571, P<0.001) and obesity group (log-rank χ²=6.664 P=0.010) were higher than that of normal BMI group, and the all-cause mortality rate of central obesity group was higher than that of normal WC group (log-rank χ²=5.698, P=0.017). Multivariate Cox regression analysis results showed that， besides the low BMI group and obesity group (with normal BMI group as a reference, HR=5.289, 95% CI 2.318-12.067, P<0.001; HR=5.360, 95% CI 2.088-13.760, P<0.001, respectively), normal BMI and overweight combined with central obesity were also independently correlated with all-cause mortality (with normal WC group as a reference, HR=2.605, 95% CI 1.199-5.663, P=0.016; HR=1.787, 95% CI 1.026-3.732, P=0.031, respectively). Conclusions Lower and higher BMI or combined central obesity are independently associated with all-cause mortality in the middle-aged and elderly patients receiving MHD.

Objective To explore the prevalence and risk factors of sarcopenia in patients with maintenance dialysis (MHD). Methods It was a cross-sectional study. Patients who received MHD treatment in the Blood Purification Center of Hainan Provincial People's Hospital in October 2019 were included as study subjects. The patients were divided into sarcopenia group and non-sarcopenia group according to whether they had sarcopenia or not. Chest CT imaging and laboratory examination data were collected. Dual-energy X-ray absorptiometry was used to measure the skeletal muscle mass. Chi-square test or Mantel-Haenszel trend chi-square test was used to compare the clinical data of patients with and without sarcopenia. Multivariate logistic regression equation was used to analyze the risk factors of sarcopenia. Results A total of 182 MHD patients were enrolled in the study, and the prevalence of sarcopenia was 33.5% (61/182). The proportions of age ≥60 years old, diabetic nephropathy, tunneled-cuffed catheter, body mass index <18 kg/m², serum albumin <40 g/L, low density lipoprotein cholesterol ≥3.37 mmol/L, left ventricular ejection fraction <50%, chest CT-suspected pulmonary tuberculosis (PTB) and PTB in sarcopenia group were higher than those in non-sarcopenia group (all P<0.05). Multivariate logistic regression analysis results showed that left ventricular ejection fraction <50% (≥50% as a reference, OR=3.250, 95% CI 1.035-10.206, P=0.044), low-density lipoprotein cholesterol ≥3.37 mmol/L (<3.37 mmol/L as a reference, OR=6.354,95% CI 1.675-24.108, P=0.007), chest CT-suspected PTB (normal as a reference, OR=7.433, 95% CI 1.531-36.083, P=0.013), and PTB (normal as a reference, OR=28.871, 95% CI 3.208-259.872, P=0.030) were independent influencing factors of sarcopenia in MHD patients. Conclusions The prevalence of sarcopenia is higher in MHD patients. Blood low-density lipoprotein cholesterol ≥3.37 mmol/L, ejection fraction <50%, chest CT-PTB and suspected PTB are independent risk factors of sarcopenia in MHD patients. Correcting left ventricular systolic function, regulating blood lipids and preventing PTB as early as possible can reduce the prevalence of sarcopenia in MHD patients.

Objective To investigate urinary microalbumin to creatinine ratio (ACR) and α1-microglobulin to creatinine ratio (MCR) of people aged 40 years old and above in Shanxi province, and analyze the influencing factors of abnormal ACR and MCR, and to provide evidence for the prevention and control of chronic kidney diseases. Methods It was a cross-sectional study. The data came from a screening study of chronic kidney diseases conducted by Shanxi Provincial People's Hospital from April to November 2019, involving aged 40 years old and above from 10 counties (Ningwu county, Yu county, Yangqu county, Lin county, Shouyang county, Zezhou county, Huozhou city, Hejin city, Linyi county and Ruicheng county) in Shanxi province. The related data were collected through questionnaire surveys, physical examinations, and blood and urine sample collection. Urinary α1-microglobulin, creatinine, and microalbuminuria were measured. Urinary ACR and MCR were calculated using urinary creatinine correction. ACR abnormality was defined as ≥30 mg/g, and MCR abnormality was defined as >23 mg/g. Covariate analysis was used to control confounding factors, and adjusted urinary ACR and MCR of 10 counties were calculated. Spearman correlation analysis and chi-square test were performed to analyze the factors associated with abnormal urinary ACR and MCR. Logistic regression analysis model was used to identify the influencing factors of abnormal urinary ACR and MCR. Results A total of 12 285 residents were enrolled in the study, including 5 206 males (42.4%) and 7 079 females (57.6%). The median age was 58.0 (51.0, 66.0) years old. The median urinary ACR was 7.5 (4.5, 15.7) mg/g, and the median urinary MCR was 10.2 (6.4, 16.2) mg/g. A total of 1 572 individuals (12.80%) had urinary ACR abnormality and 1 450 individuals (11.80%) had urinary MCR abnormality. Yangqu county, Yuxian county, and Ningwu county had higher urinary ACR with (35.58±3.04) mg/g, (34.08±4.50) mg/g and (32.09±3.19) mg/g, respectively. The urinary MCR was generally similar among the 10 counties and Yangqu county had higher urinary MCR with (13.86±0.41) mg/g. In addition to Yu county, female individuals had higher urinary ACR compared to males in other counties, whereas female individuals had lower urinary MCR compared to males in 10 counties. Multivariate logistic regression analysis results showed that elevated triglyceride, fasting blood glucose, glycated hemoglobin, systolic blood pressure, diastolic blood pressure, age, body mass index and gender were independent influencing factors of abnormal urinary ACR and MCR (all P<0.05). Elevated blood homocysteine and low educational level were independent influencing factors of urinary MCR abnormality (both P<0.05). Conclusions There are differences of gender and region in urinary ACR and MCR among individuals aged 40 years old and above in the 10 counties of Shanxi province. Triglyceride, fasting blood glucose, glycated hemoglobin, systolic blood pressure, diastolic blood pressure, age, gender, and body mass index are independent related factors of abnormal urinary ACR and MCR. Blood homocysteine and education level are independent related factors of abnormal urinary MCR.

Objective To explore the relationship between urinary exosomal microRNA (exo-miR) - 155 in patients with type 2 diabetes mellitus (T2DM) and the onset and severity of diabetic kidney disease (DKD). Methods From January to May 2019, 5 patients with T2DM normoalbuminuria and 5 patients with type 2 DKD were recruited from the Department of Endocrinology and Metabolism of Chongming Hospital of Shanghai Health Medical College as a microRNA screening cohort. Urine samples were collected to extract urinary exosomes, and the urine exo-miR spectrum was detected and analyzed using the miRCURY LNA array. From June 2019 to October 2022, 351 patients with T2DM who met the enrollment criteria and were matched by age and sex were included in the validation cohort in the Department of Endocrinology and Metabolism of the hospital. Patients were divided into 3 groups according to urinary albumin/creatinine ratio (UACR): normoalbuminuria group (UACR<30 mg/g, n=143), microalbuminuria group (30 mg/g≤UACR≤300 mg/g, n=171) and macroalbuminuria group (UACR>300 mg/g, n=37). According to DKD diagnostic guidelines, microalbuminuria group and macroalbuminuria group were classified into DKD group. Real-time fluorescence quantitative PCR was used to detect the expression level of exo-miR-155 in urine. Results The results of transmission electron microscopy, nanoparticle tracking analysis, and Western blotting showed that the extraction of exosome vesicles was successful. In the screening cohort, according to the screening criteria of P<0.05 and fold changes (FC)>1.5, 226 differentially expressed miRNAs were identified from the urinary exosomes of the DKD group compared to the T2DM group. Among them, miR-155 ranged highest (FC=32.75, P<0.001). In the validation cohort, compared with the normoalbuminuria group [0.76 (0.55, 0.95)], the macroalbuminuria group [1.84 (1.18, 2.42)] had the most significant increase in urinary exo-miR-155 level (Z=-7.411, P<0.001), followed by the microalbuminuria group [0.86 (0.69, 1.25)] (Z=-4.092, P<0.001), and the urinary exo-miR-155 level in the macroalbuminuria group was significantly higher than that in the microalbuminuria group (Z=-5.841, P<0.001). The correlation analysis showed that urinary exo-miR-155 level was positively correlated with UACR (r_s =0.329, P<0.001) and negatively correlated with estimated glomerular filtration rate (r_s =-0.249, P=0.015). The results of receiver operating characteristic curve analysis showed that the area under the curve of urinary exo-miR-155 level predicted DKD progression in T2DM patients was 0.892 (95% CI 0.859-0.925), corresponding cutoff value was 0.982, and the sensitivity and specificity were 71.9% and 87.7%, respectively. Multivariate logistic regression analysis showed that urinary exo-miR-155≥0.982 was an independent risk factor for progression to DKD in T2DM patients (OR=3.310, 95% CI 1.981-5.530, P<0.001). Conclusion The expression level of urinary exo-miR-155 is increased in T2DM patients with microalbuminuria and macroalbuminuria, which is related to the degree of albuminuria, and can be used as a predictive marker to identify potential DKD.

Objective To investigate the role of recombinant phospholipase A2 receptor (PLA2R) tandem dominant epitopes (PLA2RTD) in the removal of anti-PLA2R autoantibodies (anti-PLA2R) from primary membranous nephropathy (PMN). Methods The recombinant protein PLA2RTD (cysteine-rich domain, C-type lectin like domain 1 and C-type lectin like domain 7) was expressed in bacmid-insect cell expression system. Circular dichroism was used to determine the secondary structure of PLA2RTD. Enzyme-linked immunosorbent assay and immunofluorescence were used to determine the biological activity of PLA2RTD. Epoxy activation method was used to couple the recombinant PLA2RTD and agarose gel CL-6B microspheres for preparing specific immune adsorbent of anti-PLA2R. Results The study achieved the expression of PLA2RTD in the first time from the bacmid-insect cell system, demonstrating the good immunogenicity and high binding specificity of PLA2RTD. A single in vitro adsorption of PLA2RTD could averagely eliminate 76.66% of anti-PLA2R [(6.66±0.30) RU/ml vs. (28.54±2.10) RU/ml], the changes of IgG, IgA, albumin, β2 microglobulin, interleukin 6, and tumor necrosis factor α were all less than 4% after completion of adsorption, and the second or third repeated use of PLA2RTD could maintain the adsorption efficiency of about 65%. Conclusion PLA2RTD-based specific immunosorbent can effectively remove anti-PLA2R in plasma, which provides a new way to specifically remove PMN-related autoantibodies.

It was a retrospective cohort study. Eighty maintenance hemodialysis (MHD) patients with corona virus disease 2019 (COVID-19) were enrolled, among whom 48 patients survived and 32 died. The clinical data between the survival and death groups were compared. The Cox regression model was used to analyze the risk factors of death in MHD patients with COVID-19, and a survival prediction model was constructed. The results showed that age, lesion-cumulative number of lung segments, C-reactive protein, procalcitonin, serum ferritin, interleukin-6, D-dimer, serum phosphorus, and proportions of males, diabetes and hypoxemia in the death group were higher than those in the survival group (all P<0.05). Increased age (HR=1.039, 95% CI 1.007-1.072, P=0.017), diabetes (HR=2.688, 95% CI 1.018-6.991, P=0.046), increased C-reactive protein (HR=1.006, 95% CI 1.001-1.011, P=0.012), and increased serum phosphorus (HR=1.573, 95% CI 1.015-2.438, P=0.043) were independent influencing factors of death in MHD patients with COVID-19. The survival prediction model was established based on age, diabetes, C-reactive protein and blood phosphorus. The area under the receiver operating characteristic curve of the combined model for survival time at 7-day, 14-day, and 21-day were 0.751 (95% CI 0.690-0.811), 0.768 (95% CI 0.712-0.824), and 0.780 (95% CI 0.729-0.831), respectively. The concordance index of cross- validation as internal validation was 0.797 (95% CI 0.757-0.837). Increased age, diabetes, elevated C-reactive protein and elevated blood phosphorus are independent risk factors of COVID-19 death in MHD patients, and the survival prediction model built by those factors has good efficacy.

The paper reported a case of a young male patient, with graft-versus-host disease (GVHD) multi-organ involvement lesions after allo-hematopoietic stem cell transplantation. The patient had diverse clinical manifestations, and overlapping acute and chronic disease processes. Acute GVHD were mainly hyperbilirubinemia, with or without elevated transaminase, bloody watery stools; chronic GVHD were highlighted by extensive skin depigmentation, oral mucosal ulcer, sick nails, etc., and chronic signs, such as membranous nephropathy, polyserositis and pulmonary restrictive ventilatory insufficiency. The diagnosis of chronic GVHD mainly relies on medical history combined with clinical manifestations, and it's needed to exclude infections, drugs and tumors. Besides, the rate of missed diagnosis and misdiagnose is high, and it requires multidisciplinary diagnosis and treatment. Combined with the literature review, it indicates that there is a greater risk of GVHD in the male recipient with female donor, and peripheral blood stem cell transplant patients have a higher incidence than bone marrow transplant patients after hematopoietic stem cell transplantation, but the effect of the graft-versus-leukemia exists. Currently, glucocorticoids therapy with or without calcineurin inhibitors are the first-line treatment for GVHD, but the overall prognosis is poor.

SARS-CoV-2 infection can lead to rhabdomyolysis and even acute kidney injury, which is rare in clinical practice. The paper reports a case of SARS-CoV-2 infection with clinical manifestations of fever, myalgia, soy urine, oliguria, and significantly increased serum creatine kinase and creatinine. The symptoms improved and renal function returned to normal after hemodialysis, fluid replenishment and liver protection treatment. The paper summarizes the clinical characteristics and pathogenesis of the disease based on literature review.

The global pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has had a catastrophic impact on human life and economic life. Due to the combination of multiple underlying diseases and low vaccination rates, dialysis patients are susceptible to SARS-CoV-2 infection and are likely to have more severe illness and even death. Moreover, dialysis patients with SARS-CoV-2 infection may initially present as asymptomatic or with mild symptoms, which makes it very difficult to identify severe patients at an early stage. Here, the epidemiology, clinical characteristics, risk factors for prognosis, vaccination and therapeutic strategies of dialysis patients with SARS-CoV-2 infection were summarized and analyzed, and it is hoped to provide a reference for the diagnosis and treatment of SARS-CoV-2 infection in this special group of patients.

Chronic kidney disease (CKD)-mineral and bone disorder (CKD-MBD) is a common complication of CKD, which seriously affects the prognosis of patients. It is a series of abnormal mineral and bone metabolism syndrome caused by chronic renal function decline. The clinical manifestations are mainly decreased or increased serum calcium, increased serum phosphorus, increased intact parathyroid hormone, osteoporosis, and vascular calcification, etc. The paper reviews the research progress in the diagnosis, treatment and management based on the basic and clinical studies of hyperphosphatemia, secondary hyperparathyroidism, renal osteodystrophy and vascular calcification, etc.

Relapsing is the clinical characteristic of nephrotic syndrome (NS) in children, and some steroid-sensitive NS (SSNS) children have frequently relapsing NS and steroid-dependent NS. The long-term and frequent uses of glucocorticoids, as well as the adverse effects of immunosuppressants, seriously affect the quality of life in children with NS. The International Pediatric Nephrology Association released the clinical practice recommendation for SSNS in children in 2022. Based on the guideline for the diagnosis and treatment of steroid-sensitive, frequently- relapsing/dependent NS in children (2016) formulated by the Nephrology Group of Pediatrics Society of Chinese Medical Association, we interpreted the guideline on clinical treatment and management suggestions of SSNS, to provide references for the diagnosis and treatment of SSNS in children.

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

Objective To investigate the clinical characteristics and vaccination of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in maintenance hemodialysis (MHD) patients. Methods It was a cross-sectional survey. Through wechat questionnaire star mode, the status of SARS-CoV-2 infection, clinical manifestation after infection and vaccination of MHD patients in Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine between December 8, 2022 and January 12, 2023 were retrospectively collected during the period that SARS-CoV-2 infection was managed with measures against class B infectious diseases. The patients were grouped according to whether they were infected with SARS-CoV-2 and whether they were complicated with pneumonia after infection during the study period. Logistic regression analysis was used to analyze the risk factors of SARS-CoV-2 infection combined with pneumonia or persistent symptoms after SARS-CoV-2 turning negative. Results A total of 241 questionnaires were issued, and 223 valid questionnaires were returned, of which 175 patients (78.5%) were infected with SARS-CoV-2 during the study period. The time of negative conversion of antigen or nucleic acid after SARS-CoV-2 infection was 10 (7,14) days. Asymptomatic infections accounted for 10.3% (18/175). Symptomatic infections accounted for 89.7% (157/175), and the top five most frequent symptoms were cough (70.1%, 110/157), fever (64.3%, 101/157), pharyngeal pain (35.0%, 55/157), muscle pain (28.7%, 45/157), and nasal obstruction (21.0%, 33/157). Pneumonia was reported in 54.3% (95/175) of infected patients. There were no statistically significant differences in age, gender distribution, proportion of diabetes mellitus, and proportion of history of tumors between SARS-CoV-2-infected and uninfected patients (all P>0.05). Compared with the non-pneumonia group, the proportions of dyspnea (12.6% vs. 1.3%, χ²=8.181, P=0.004) and chest tightness (23.2% vs. 10.0%, χ²=5.293, P=0.021) in the pneumonia group were both higher. There were no significant differences in age, gender distribution, time of negative SARS-CoV-2 transition, number of symptoms and SARS-CoV-2 vaccination rate,and proportions of diabetes mellitus and tumors between the pneumonia group and the non-pneumonia group (all P>0.05). There were 48.6% (85/175) infected patients having long-lasting clinical symptoms after SARS-CoV-2 turning negative. Logistic regression analysis results showed that diarrhea was an independent influencing factor of pneumonia in MHD patients infected with SARS-CoV-2 [OR (95% CI)=6.323 (1.061-37.682), P=0.043]. The number of symptoms at onset [OR (95% CI)=1.571 (1.318-1.873), P<0.001] and history of tumors [OR (95% CI)=0.206 (0.054-0.777), P=0.020] were independent influencing factors of long-lasting clinical symptoms. The SARS-CoV-2 vaccination rate was 7.2% (16/223) in MHD patients due to safety concerns (81.2%, 164/202). Conclusions MHD patients are SARS-CoV-2-susceptible population. The clinical symptoms after infection are diverse, heterogeneous, and the proportion of complicated pneumonia is high. Diarrhea is an independent influencing factor of pneumonia in SARS-CoV-2-infected MHD patients. Nearly half of patients experience long-lasting clinical symptoms after SARS-CoV-2 turning negative. The low rate of vaccination in the MHD population necessitates increased awareness about the safety and efficacy of SARS-CoV-2 vaccine.

Objective To investigate the epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with maintenance hemodialysis (MHD) in Jiangsu province during SARS-CoV-2 pandemic in China from December 7, 2022 to January 27, 2023, and to analyze the influencing factors of all-cause death. Methods It was a multi-center cross-sectional investigation. Structured questionnaire was used to collect patient information by medical staff of each hemodialysis center (room) as investigators. Part of the demography data and laboratory examination data came from the Jiangsu Province Hemodialysis Data Information System. MHD patients from hemodialysis centers (rooms) at all levels of medical institutions and independent hemodialysis institutions in Jiangsu province during the outbreak of SARS-CoV-2 infection were included, and the clinical characteristics and all-cause mortality of confirmed and suspected cases of SARS-CoV-2 infection were analyzed. Results Questionnaire surveys and data analysis on 57 278 patients in 407 hemodialysis centers (rooms) were completed, accounting for 90.41% of the total number of MHD patients (63 357 cases) in Jiangsu province during the same period. There were 24 038 cases (41.97%) of SARS-CoV-2 infection and 14 805 cases (25.85%) of suspected infection, which were widely distributed in all dialysis centers in Jiangsu province. After clinical classification of 38 843 confirmed and suspected SARS-CoV-2 infection cases, 3 662 cases were severe and critical cases, accounting for 9.43% of the infected and suspected cases. Among the patients who had completed the questionnaires, there were 1 812 all-cause deaths, with an all-cause mortality rate of 3.16%. Multivariate logistic regression analysis showed that elderly (taking ≤50 years as a reference, 51-59 years: OR=1.583, 95% CI 1.279-1.933, P=0.001; 60-69 years: OR=3.972, 95% CI 3.271-4.858, P<0.001; 70-79 years: OR=7.236, 95% CI 5.917-8.698, P<0.001; ≥80 years: OR=11.738, 95% CI 9.459-14.663, P<0.001), male (OR=1.371, 95% CI 1.229-1.529, P<0.001), and co-infection with hepatitis B virus (HBV) (positive serum HBV surface antigen, OR=0.629, 95% CI 0.484-0.817, P<0.001) were independent influencing factors for all cause mortality. Receiver-operating characteristic curve analysis showed that the area under the curve for male, age and current HBV infection prediction of all-cause death was 0.529 (P<0.001), 0.724 (P<0.001) and 0.514 (P=0.042), respectively, and the cut-off value for age prediction of all-cause death was 65.5 years old. Compared with patients without HBV infection, MHD patients with HBV infection significantly reduced the proportion of severe and critically ill patients, all-cause hospitalizations and all cause deaths when infected with SARS-CoV-2 (4.99% vs. 6.41%, χ²=6.136, P=0.013; 8.90% vs. 11.44%, χ²=11.662, P<0.001; 2.01% vs. 3.37%, χ²=10.713, P=0.001, respectively). Conclusion The MHD patients in Jiangsu province are susceptible to SARS-CoV-2. Elderly age and male gender are independent risk factors for death in MHD patients during the epidemic, while the HBV infection may be a protective factor for death of MHD patients infected with SARS-CoV-2.

Objective To detect and analyze the gene variation types of 64 unrelated pedigrees affected with autosomal dominant polycystic kidney disease (ADPKD), and explore the detection efficiency of multiple gene analysis techniques and variation characteristics. Methods It was a cross-sectional study. The clinical data of 64 pedigrees with ADPKD from Nephrology Department or Genetic and Prenatal Diagnosis Center of the First Affiliated Hospital of Zhengzhou University from December 2017 to August 2020 were retrospectively analyzed. The blood samples of probands and other family members were collected. Genetic analysis was carried out by next generation sequencing, and suspected mutations were verified by multiplex ligation-dependent probe amplification, or long-range PCR combined with Sanger sequencing. Prenatal diagnosis for high-risk fetuses was performed by fetal villi or amniotic fluid cells after genotyping without maternal genomic DNA contamination. Results Among detected 64 pedigrees, 57 pedigrees (89.06%) had genetic variants in PKD1/PKD2. A total of 49 pathogenic/likely pathogenic variants in PKD1/PKD2 were identified in 51 pedigrees (79.69%), including 14 nonsense variants (28.57%), 14 frameshift variants (28.57%), 11 missense variants (22.45%), 5 splicing variants (10.20%) and 5 deletion variants (10.20%). Of these variants, 87.76% (43/49) were in PKD1 and 12.24% (6/49) were in PKD2. Totally, 14 novel variants in PKD1/PKD2 were identified, including 7 frameshift variants, 3 splicing variants, 2 nonsense variants, 1 deletion variant and 1 missense variant, of which 11 variants were in PKD1 and 3 variants were in PKD2. Twenty high-risk fetuses from 17 pedigrees received prenatal diagnosis, in whom 6 fetuses had PKD1 variation, and other 14 fetuses had no PKD1/PKD2-genetic variation. Conclusions The combination of next-generation sequencing, multiplex ligation-dependent probe amplification, and long-range PCR combined with Sanger sequencing can be helpful for rapid, efficient and accurate genetic diagnosis of ADPKD pedigrees. Point mutations are the most common types in PKD1/PKD2. Fourteen novel variants in PKD1/PKD2 extend its pathogenic variant spectrum and can provide basis for genetic counseling and prenatal diagnosis of ADPKD pedigrees.

Objective To investigate the relationship between single nucleotide polymorphic (SNP) loci of PLCE1 gene and primary nephrotic syndrome (PNS) and its response to glucocorticoid therapy in Guangxi Zhuang children. Methods It was a retrospective cohort study. One hundred and fifty-five Guangxi Zhuang children with PNS in the Affiliated Hospital of Youjiang Ethnic Medical College from October 2020 to May 2022, and 100 healthy Zhuang children during the same period as controls were included. Four SNP loci including rs17109674, rs10786156, rs3740360 and rs2274224 of PLCE1 gene were selected and high-throughput sequencing was used to analyze the genotypes. Logistic regression analysis model was used to analyze the correlation between each SNP locus and onset of PNS and steroid-resistant nephrotic syndrome. The SHEsis online software was used to analyze the link disequilibrium of each SNP locus, and construct the haploid type. Results (1) Logistic regression analysis results showed that AC+CC genotype (AA as reference, OR=0.449, 95% CI 0.256-0.786, P=0.005), AC genotype (AA as reference, OR=0.354, 95% CI 0.188-0.667, P=0.001) and C allele gene (A as reference, OR=0.615, 95% CI 0.390-0.971, P=0.037) of rs3740360 were correlated with the risk of PNS in children. The genotypes and allele genes of rs17109674, rs10786156, rs3740360 and rs2274224 were not associated with the risk of steroid-resistant nephrotic syndrome in children (all P>0.05). (2) Strong linkage disequilibrium existed between rs10786156 and rs2274224 (D'=0.702, r²=0.484). rs17109674 and rs10786156 (D'=0.128, r²=0.007), rs17109674 and rs3740360 (D'=0.142, r²=0.007), rs17109674 and rs2274224 (D'=0.045, r²=0.001), rs10786156 and rs3740360 (D'=0.255, r²=0.023), and rs3740360 and rs2274224 (D'=0.281, r²=0.028) all had weak linkage disequilibrium. (3) The haploid AGCG (OR=0.282, 95% CI 0.079-1.008, P=0.038), GGCC (OR=0.327, 95% CI 0.111-0.967, P=0.034) and GGAG (OR=4.616, 95% CI 1.179-18.069, P=0.016) were all correlated with the risk of PNS in children. Conclusions AC genotype, AC+CC genotype, and C allele gene of rs3740360 SNP locus may reduce the risk of PNS in Guangxi Zhuang children. Haploid AGCG and GGCC may be associated with decreased incidence of PNS, while GGAG may be associated with increased incidence of PNS in Guangxi Zhuang children. The genotypes and alleles of 4 SNP loci are not associated with the risk of steroid-resistant nephrotic syndrome.

Objective To investigate the graft survival rate after total parathyroidectomy (TPTX) plus forearm muscle auto-transplantation in patients with secondary hyperparathyroidism (SHPT) and evaluate the effect of graft survival status on calcium and phosphorus metabolism. Methods It was a retrospective cohort study. The end-stage renal disease patients who were diagnosed with SHPT and underwent TPTX plus forearm muscle auto-transplantation from November 2015 to December 2018 at the First Affiliated Hospital of Zhejiang University School of Medicine were enrolled. The clinical data including serum calcium, phosphorus, intact parathyroid hormone and alkaline phosphatase preoperative and postoperative 1 week, 1 month and 6 months, and cumulative requirements of calcium carbonate and calcitriol in postoperative 1 month and 6 months were collected. The graft survival rate was summarized and the differences of serum calcium, phosphorus, and supplementation dosage of calcium and calcitriol after surgery between the graft survival group and the graft non-survival group were compared. Results A total of 191 patients were included in the study, with 95 males (49.7%), and 172 patients of age <60 years old. There were 154 grafts surviving with a graft survival rate of 80.6%. There were no significant differences in the levels of serum calcium, phosphorus, alkaline phosphatase at 1 week, 1 month and 6 months after surgery, and cumulative dosage of calcium carbonate at 1 month and 6 months after surgery between the two groups (all P>0.05). The dose of calcitriol in the graft non-survival group was significantly higher than that in the graft survival group within 1 month after surgery [41.50 (30.00, 45.00) μg vs. 32.75 (25.50, 40.50) μg, Z=-2.307, P=0.021]. However, there was no significant difference in cumulative calcitriol supplementation between the two groups within 6 months after surgery (P>0.05). Conclusions The graft survival rate after TPTX plus forearm muscle auto-transplantation is high in SHPT patients. Within 6 months after surgery, there is no significant difference in serum calcium, phosphorus and cumulative supplemental doses of calcium and calcitriol between the graft survival and non-survival groups.

Renal replacement therapy and perioperative management have difficulties in hemophilia patients with end-stage renal disease. The paper summarized the diagnosis and treatment experience of six hemophilia patients complicated with end-stage renal disease from January 1, 2000 to March 31, 2023 in Peking Union Medical College Hospital. Among 6 patients treated with peritoneal dialysis, 3 were treated with hemodialysis or continuous venous-venous hemodialysis. Altogether 11 dialysis access procedures were conducted successfully, and no serious bleeding or thrombotic events. In further conjunction with literature review, the paper summarized the key points of dialysis access appliance relevant to such patients, to provide reference for renal replacement treatment paths.

Parathyroid carcinoma (PC) is a rare endocrine malignancy. We report a case of lung metastases of PC in a maintenance hemodialysis patient with renal allograft loss and review the relevant literature. The patient developed hyperparathyroid hormone and hypercalcemia 4 years after hemodialysis treatment. CT examination showed that a round-shaped, soft tissue density shadow without typical enhancement was located in infero-posterior left lobe of thyroid gland. Dual-phase ^99mTc-MIBI parathyroid imaging showed abnormal ^99mTc-MIBI uptake behind the left lobe of the thyroid gland on both early and delayed imaging. The patient underwent subtotal parathyroidectomy under general anesthesia. Histopathological diagnosis was parathyroid adenoma and parathyroid hyperplasia. The serum parathyroid hormone decreased significantly, but remained above normal, and the serum calcium returned to normal range after the surgery. However, the parathyroid hormone level gradually increased several months after the surgery. ^99mTc-MIBI parathyroid imaging showed multiple low-density nodules with increased uptake of ^99mTc-MIBI in superior lobe of both lungs one year after the surgery. Ultimately, pulmonary metastasis of PC was confirmed by pathological examination.