Perigraft seroma is a relatively rare complication after arteriovenous polytetrafluoroethylene graft implantation, and its exact etiology remains unclear. Currently, it is believed that the pathogenesis may be related to factors such as destruction of porosity, imbalance pressure of porosity, and poor connective tissue incorporated into the graft. Clinically, it often manifests as a non-pulsatile mass occurring at the arterial anastomosis, which may lead to thrombosis, loss of available puncture sites, secondary infection, skin erosion, etc. Simple excision of the seroma is associated with a high risk of recurrence; therefore, concurrent management of the involved segment of the prosthetic graft is required, including creating a new graft bypass, local application of medical adhesive or fibrin glue, or implantation of a covered stent. Delayed treatment of graft thrombosis to assist in the treatment of seroma may be a relatively ideal therapeutic approach. In addition, prevention of seroma is also critical.

Objective To compare the efficacy and safety of obinutuzumab with glucocorticoids combined with cyclophosphamide (CTX) in the treatment of primary membranous nephropathy (PMN). Methods This was a retrospective cohort study. Patients with PMN who received glucocorticoid combined with CTX or obinutuzumab therapy at Huashan Hospital Affiliated to Fudan University from January 2012 to July 2024 were enrolled. The primary endpoint was the overall remission rate, including complete remission (CR) and partial remission (PR). Patients were divided into the obinutuzumab group and glucocorticoid combined with CTX group according to the therapeutic regimen. The differences in overall remission rate and CR rate between the two groups at 3, 6 and 12 months after treatment were compared. Kaplan-Meier survival curve was used to compare the cumulative overall remission rate between the two treatment regimens, and univariate Cox regression analysis was performed to evaluate whether different immunosuppressive regimens were influencing factors for the remission of PMN. Meanwhile, adverse events (AEs) occurring within 12 months after the initiation of treatment were collected, and the differences in AEs between the two groups were compared. Results A total of 61 patients with PMN were enrolled, with an age of (54.3±10.7) years, including 50 males (82.0%). The baseline indicators included an estimated glomerular filtration rate of (85.1±19.6) ml·min?1·(1.73 m2)?1, a serum albumin level of (21.6±5.0) g/L, 24-hour urinary protein excretion of (9.2±3.4) g, and an anti-phospholipase A2 receptor antibody level of 114.0 (46.0, 247.2) RU/ml. Among them, 31 patients (50.8%) received obinutuzumab with a follow-up duration of 12.0(11.0, 20.0) months, and 30 patients (49.2%) received glucocorticoid combined with CTX with a follow-up duration of 18.5 (12.0, 32.3) months. There were no statistically significant differences in baseline estimated glomerular filtration rate, serum albumin or 24-hour urinary protein excretion between the two groups (all P>0.05). At 6 months and 12 months after treatment, the overall remission rates were 67.7% and 80.8% in the obinutuzumab group, and 56.7% and 63.3% in the glucocorticoid combined with CTX group, respectively, with no statistically significant differences between the two group (all P>0.05). However, the 6-month immunological remission rate in the obinutuzumab group was significantly higher than that in the glucocorticoid combined with CTX group (80.0% vs. 50.0%, χ²=4.713, P=0.030). Kaplan-Meier survival analysis showed no statistically significant difference in the cumulative overall remission rate between the two groups during the follow-up period (Log-rank test, χ²=1.656, P=0.198). Univariate Cox regression analysis indicated that age was associated with overall remission in PMN (hazard ratio=0.97, 95% confidence interval 0.94-0.99, P=0.006). Within 12 months after treatment initiation, there was no statistically significant difference in the incidence of AEs between the two groups (50.0% vs. 32.3%, χ²=1.984, P=0.159). Conclusions The efficacy and safety of obinutuzumab in the treatment of PMN may be non-inferior to those of glucocorticoid combined with CTX regimen.

Objective To investigate the impact of different bed rest time on the safety and comfort of low bleeding risk patients after ultrasound-guided percutaneous renal biopsy, and to evaluate the safety and feasibility of shortening the bed rest time. Methods This was a single-center retrospective cohort study. Patients at low risk of bleeding who underwent ultrasound-guided percutaneous renal biopsy in the Department of Nephrology, Peking University First Hospital between August 17, 2023, and September 29, 2024, were included, and their relevant data were collected. Patients were divided into two groups based on post-procedure bed rest time: an 8-hour group and a 24-hour group. Propensity score matching (PSM) was performed with a caliper value of 0.2 at a 1:1 ratio. The incidence of bleeding events, maximum postoperative pain scores, comfort scores, and the incidence of bleeding-related complications (low back pain, hematuria, infection) within 30 days post-biopsy were compared between the two groups. Univariate logistic regression analysis was used to assess the risk of shortened bed rest time on bleeding events after renal biopsy. Inverse probability of treatment weighting (IPTW) was used for sensitivity analysis. Results A total of 513 low bleeding risk patients were included in the analysis. After PSM, a total of 308 patients were included, with 154 patients in the 8-hour bed rest group and 154 patients in the 24-hour bed rest group. There were no statistically significant differences in baseline characteristics between the 8-hour and 24-hour bed rest groups (all P>0.05). The incidence of bleeding events showed no significant difference between the two groups (21.43% vs. 24.68%, χ2=0.458, P=0.499). Compared to the 24-hour group, patients in the 8-hour group had significantly lower maximum postoperative pain scores [1(0, 1) vs. 1(0,2), Z=3.868, P<0.001] and higher comfort scores [(92.7±11.2) vs. (87.8±10.0), t=-4.027, P<0.001]. The incidence of bleeding-related complications within 30 days post-biopsy was not statistically different between the two groups (all P>0.05). Logistic regression analysis indicated that shortened bed rest time was not a relevant factor for bleeding events after renal biopsy [odds ratio (OR)=0.833, 95% confidence interval (CI) 0.488-1.416, P=0.499]. IPTW-weighted univariate logistic regression analysis also showed no significant association between shortened bed rest time and bleeding events (OR=0.914, 95% CI 0.664-1.269, P=0.586). Conclusion Shortening post-renal-biopsy bed rest to 8 hours demonstrates no significant increase in bleeding risk among low-bleeding-risk patients, and can improved patient pain scores and comfort levels.

Objective To investigate the gene mutation spectrum in patients with autosomal dominant polycystic kidney disease (ADPKD), analyze the correlation between clinical phenotypes and disease progression indicators, evaluate the relationship between gene mutation types and the estimated age of end-stage renal disease (ESRD), and provide a comprehensive genetic basis for expanding the ADPKD variant database, precise diagnosis, prognosis assessment, and individualized management. Methods It was a single-center retrospective study. This retrospective study included 120 ADPKD patients followed at the Department of Nephrology, the Second Affiliated Hospital of Dalian Medical University, from June 2017 to December 2024. Demographic, clinical phenotype, and genetic data were collected. Estimated glomerular filtration rate (eGFR), total kidney volume (TKV), and estimated ESRD age were served as primary outcome indicators for disease progression. TKV was measured by magnetic resonance imaging, and eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Spearman correlation analysis was used to assess the associations between eGFR, TKV, and estimated ESRD age and clinical indicators. Patients were stratified into truncating and non-truncating mutation groups based on PKD1 mutation type, and into single-site and multi-site mutation groups based on the number of PKD1 mutation sites. Differences in estimated ESRD age between the groups were compared. Results Among 120 patients (53 males, 44.2%; 67 females, 55.8%), 84 of 110 (76.4%) had a family history of ADPKD, 53 of 115 (46.1%) reported renal pain, 64 of 86 (74.4%) had polycystic liver disease, 79 of 116 (68.1%) had hypertension, and 11 of 97 (11.3%) had proteinuria. Genetic testing in 78 patients identified PKD1 mutations in 67 (85.9%), PKD2 mutations in 6 (7.7%), and both in 5 (6.4%). Among PKD1 mutations, 45 of 67 (67.2%) were truncating and 22 of 67 (32.8%) were non-truncating. A total of 97 mutation sites were detected: 89.7% in PKD1 and 10.3% in PKD2. Missense mutations were the most common PKD1 variant (34.5%). Compared with the ADPKD variant database, 52 novel and 45 known mutation sites were identified. eGFR correlated negatively with TKV (r_s =-0.526, P<0.001), age (r_s =-0.706, P<0.001), hypertension (r_s =-0.496, P<0.001), polycystic liver disease (r_s =-0.268, P=0.013), serum uric acid (r_s =-0.350, P<0.001), blood urea nitrogen (r_s =-0.646, P<0.001), triglycerides (r_s =-0.208, P=0.040), and male (r_s =-0.188, P=0.041), and positively with hemoglobin (r_s =0.268, P=0.013) and blood platelet count (r_s =0.231, P=0.033). TKV correlated positively with age (r_s =0.391, P<0.001), hypertension (r_s =0.312, P=0.005), serum creatinine (r_s =0.506, P<0.001), uric acid (r_s =0.222, P=0.044), and blood urea nitrogen (r_s =0.357, P<0.001), and negatively with eGFR (r_s =-0.526, P<0.001) and blood platelet count (r_s =-0.247, P=0.049). Estimated ESRD age correlated negatively with hypertension (r_s =-0.248, P=0.026), body weight (r_s =-0.227, P=0.040), uric acid (r_s =-0.402, P<0.001), and blood urea nitrogen (r_s =-0.320, P=0.003), and positively with eGFR (r_s =0.462, P<0.001). The estimated ESRD age was significantly earlier in the PKD1 truncating mutation group than that in the non-truncating group [(59.40±12.46) years vs. (71.44±14.71) years, t=-3.147, P=0.003], and no significant difference was found between single-site and multi-site mutation groups [(64.80±12.90) years vs. (64.03±15.09) years, t=-0.149, P=0.883]. Conclusions This study identified 52 novel ADPKD mutation sites. Hypertension and elevated serum uric acid are the key clinical indicators associated with disease progression. Patients with PKD1 truncating mutations have an earlier estimated ESRD onset than those with non-truncating mutations.

Objective To analyze the application effect of the information-based management model in patients undergoing peritoneal dialysis (PD), clarify the impact of this model on the core indicators related to patients' treatment; to explore the incidence rate and main causes of technical failure in PD patients under the information-based management model, so as to provide a new management model for improving the quality of clinical treatment. Method This was a single-center, prospective study. A total of 409 PD patients who underwent regular follow-up at Foshan First People's Hospital in 2022 were enrolled as research subjects, and an information-based intensive management model was adopted to strengthen patient management. General patient data, biochemical indicators, follow-up data, and other relevant information were collected, with follow-up conducted until December 31, 2024. PD technical failure was defined as catheter removal followed by transfer to hemodialysis or patient death. Changes in the quality of treatment and the occurrence of PD technical failure in PD patients under the information-based management model were analyzed. A Cox regression model was used to explore the factors affecting the prognosis of PD patients. Patients were divided into a low N?terminal proB?type natriuretic peptide (NT?proBNP) group and a high NT?proBNP group based on the mean NT‐proBNP value at enrollment; they were also divided into a low hypersensitive C-reactive protein (hsCRP) group and a high hsCRP group according to the mean hsCRP value at enrollment. The Kaplan-Meier method was applied to compare differences in PD technical survival rates between the two groups (for NT?proBNP and hsCRP classifications, respectively). Result A total of 329 peritoneal dialysis (PD) patients were enrolled in the study, with a median age of 47.0 (37.0, 57.5) years, including 153 males (46.5%). By December 31, 2024, 25 PD patients had died, 53 had switched to hemodialysis, and there were 78 cases of technical failure (23.7%). Compared with 2022, PD patients had higher hemoglobin levels in 2024 (t=-3.550, P<0.001). Compared with the continuous peritoneal dialysis group (n=251), the technical failure group (n=78) had significantly higher age (Z=-2.410, P=0.016), NT?proBNP (Z=-3.819, P<0.001), TyG index (t=2.508, P=0.013), and hypersensitive C-reactive protein (hsCRP) (Z=-4.315, P<0.001) at enrollment. Cox regression analysis showed that male sex [hazard ratio (HR)=1.653, 95% confidence interval (CI) 1.041-2.624, P=0.033), age (HR=1.031, 95% CI 1.011-1.052, P=0.002), NT?proBNP >4 164.3 ng/L (HR=2.286, 95% CI 1.405-3.720, P=0.001), and hsCRP >3.6 mg/L (HR=1.868, 95% CI 1.147-3.041, P=0.012) were the relevant factors for technical failure in PD patients. Conclusion Under the information-based management model, hemoglobin levels in PD patients are improved. Male, increasing age, NT?proBNP >4 164.3 ng/L, and hsCRP >3.6 mg/L are the relevant factors for technical failure in PD patients.

Objective To investigate the role and mechanism of budding uninhibited by benzimidazole 1 (BUB1) protein kinase in renal fibrosis in mice, and to provide new theoretical basis and treatment ideas for chronic renal fibrosis treatment. Methods (1) The expression level of BUB1 gene in unilateral ischemia-reperfusion (UIR) renal tissues was queried through the RNA-seq results of the UIR model and analyzed by the Kidney Interactive Transcriptomics online. (2) Eight-week-old 20-25 g male C57BL/6J mice were used to establish the UIR model. The mice were divided into sham-operated group (sham group), UIR model group (UIR group), and UIR combined with BAY-1816032 treatment group (UIR+BAY group). Western blotting and real-time quantitative PCR were used to detect the protein and mRNA expression levels of renal fibrosis-related factors. Sirius Red staining and Masson staining were used to assess the renal pathological changes. mRNA transcriptome sequencing analysis was performed to screen for differentially expressed genes between the UIR group and the UIR+BAY group. (3) An in vitro partial epithelial mesenchymal transition (pEMT) model was established in mouse TKPT cells. The gene knockdown experiments set up negative control group, BUB1 knockdown group (shBUB1 group), transforming growth factor-β1 (TGF-β1) group, and TGF-β1+shBUB1 group. The gene overexpression experiments set up control group, BUB1 overexpression group (BUB1 group), TGF-β1 group, TGF-β1+BUB1 group, and TGF-β1+BUB1+FBJ murine osteosarcoma viral oncogene homolog (c-Fos) inhibitor T-5224 group. The expression of fibrosis-related indicators was observed. Results (1) RNA-seq and single cell transcriptome database analysis of kidney showed that the expression of BUB1 was significantly increased in the UIR model (all P<0.05), and it was expressed in the cytoplasm and nucleus of various cells in kidney tissue. (2) Compared with the sham group, the mRNA and protein expression of BUB1 in the UIR group was significantly increased (all P<0.05). Compared with the UIR group, the UIR+BAY group showed downregulated mRNA and protein expression of fibrosis-related factors fibronectin and α-SMA, as well as downregulated mRNA expression of collagenⅠ and collagenⅢ in renal tissues. Pathological examination revealed significantly alleviated renal tubular epithelial cell injury and extracellular matrix deposition (all P<0.05). (3) In TKPT cells, compared with the TGF-β1 group, the expression of the fibrosis-related factors was significantly downregulated in the TGF-β1+shBUB1 and TGF-β1+BAY groups (all P<0.05). (4) RNA transcriptome sequencing analysis of differentially expressed genes between the UIR and UIR+BAY groups identified c?Fos gene as the most significantly altered (P<0.05). Validation in vivo and in vitro showed that c?Fos protein levels were significantly upregulated after UIR and TGF-β1 induction but markedly decreased after BAY treatment (all P<0.05). Overexpression of BUB1 significantly upregulated c?Fos expression level, while knockdown of BUB1 significantly reduced c-Fos expression level (both P<0.05). Overexpression of BUB1 exacerbated TGF-β1-induced fibrotic injury in mice, whereas treatment with the c?Fos inhibitor T-5224 significantly ameliorated this process (all P<0.05). Conclusions BUB1 is significantly upregulated in renal fibrosis injury in mice. Inhibiting BUB1 can reduce pEMT of renal proximal tubular epithelial cells and alleviate the level of renal fibrosis, and this effect may be achieved by regulating the c?Fos signaling pathway.

The patients newly diagnosed with maintenance hemodialysis (MHD) were retrospectively enrolled in this study from April 2023 to March 2024 at Haihe Hospital, Tianjin University, and were followed up for one year, to investigate the relationship between serum free triiodothyronine (T3) and major adverse cardiovascular events (MACE) in patients undergoing MHD. During the follow-up period, the patients were divided into the MACE group and the non-MACE group based on whether new MACE occurred. The differences in clinical data between the two groups were compared.The results showed that a total of 188 patients were included, with age of (57.98±11.87） years old, and 114 males (60.64%). During the follow-up period, 82 patients (43.62%) developed MACE. The age (t=4.753, P<0.001), proportion of diabetes mellitus (χ ²=15.623, P<0.001), proportion of low T3 syndrome (χ ²=5.040, P=0.025), parathyroid hormone (t=4.101, P<0.001), and low-density lipoprotein cholesterol (t=2.713, P=0.007) in the MACE group were all higher than those in the non-MACE group, and the left ventricular ejection fraction (Z=-2.420, P=0.016) and free T3 (t=-5.745, P<0.001) were lower than those in the non-MACE group. Multivariate logistic regression analysis results showed that age [odds ratio (OR)=1.063, 95% confidence interval (CI) 1.024-1.103], diabetes mellitus (OR=4.262, 95% CI 1.941-9.357), parathyroid hormone (OR=1.019, 95% CI 1.010-1.029), left ventricular ejection fraction (OR=0.957, 95% CI 0.918-0.996), and free T3 (OR=0.334, 95% CI 0.207-0.538) were the independent correlated factors of MACE in MHD patients. Receiver operating characteristic curve analysis indicated that free T3 level had predictive value for MACE. The area under the curve was 0.743 (95% CI 0.672-0.814), and the optimal cut-off value was 3.21 pmol/L with the sensitivity of 76.83% and the specificity of 66.04%. The study suggests that reduced free T3 is closely associated with the occurrence of MACE in MHD patients, and diabetes mellitus, increased age, elevated parathyroid hormone, decreased left ventricular ejection fraction, and decreased free T3 are the independent related factors of MACE in MHD patients.

This article reports a case of myosin heavy chain 9-related disease (MYH9-RD) accompanied by kidney damage. A 25-year-old female presented with thrombocytopenia and was initially diagnosed with immune thrombocytopenic purpura at another hospital. She was treated with glucocorticoids and human immunoglobulin but showed poor response. During the disease course, she developed renal impairment, hearing loss, and cataracts. Renal biopsy revealed focal segmental glomerulosclerosis. Genetic testing identified a heterozygous mutation in the MYH9 gene, leading to a final diagnosis of MYH9-RD. After a definitive diagnosis, treatment involved tapering prednisone and administering eltrombopag to increase the platelet count. However, the patient independently discontinued all medications following discharge and ultimately progressed to end-stage renal disease, necessitating maintenance hemodialysis. As MYH9-RD is a rare disorder, this case underscores the importance of enhancing clinicians' awareness to avoid misdiagnosis.

IgA nephropathy is a common primary glomerulonephritis, and currently there is no definitively effective and safe therapeutic strategy. Budesonide enteric-coated capsule is a causal treatment for IgA nephropathy. This patient mainly presented gross hematuria and proteinuria, accompanied by abnormal renal function. Based on renal biopsy pathology, the diagnosis was made as mild to moderate mesangial proliferative IgA nephropathy with acute kidney injury. After treatment with budesonide enteric-coated capsule and angiotensinⅡreceptor blocker, the patient's urine protein gradually decreased and eventually disappeared, and the renal function was significantly improved. This case demonstrates the favorable efficacy of budesonide enteric- coated capsule in the treatment of IgA nephropathy, and underscores the crucial importance of timely treatment for improving prognosis, providing a reference for clinical practice.

Peritoneal dialysis (PD)-associated peritonitis remains the most common and serious infectious complication in PD patients, increasing the risk of hospitalization, technique failure, and mortality. Although empirical antibiotic regimens are widely adopted, their comparative effectiveness is inconclusive, and management strategies differ considerably among centres. This paper systematically reviewed publications from the past 20 years that compared empirical antibiotic therapies for PD-related peritonitis. The results indicated that: (1) For Gram-positive bacterial infections, no significant difference in clinical outcomes was found between cefazolin- and vancomycin-based regimens. (2) Multiple classes of anti-Gram-negative agents (third-generation cephalosporins, aminoglycosides, and fluoroquinolones) had been used, but current evidence did not demonstrate the superiority of any single option. (3) Prophylactic anti-fungal therapy appeared to reduce the incidence of secondary fungal peritonitis; however, supporting data was limited. This synthesis summarises the best available evidence to guide the selection of empirical antibiotics and to improve the prognosis of patients with PD-associated peritonitis.

Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disease. In China, approximately 700,000 individuals are affected by ADPKD, with about half progressing to end-stage kidney disease (ESKD) between the ages of 50 and 60 years. ADPKD is the fourth leading cause of ESKD. In addition to causing renal lesions, the disease also involves multiple extrarenal organs, including liver cysts, intracranial aneurysms, valvular heart disease, etc., bringing heavy disease burden to individuals, families and society. Therefore, ADPKD has always been a research hotspot in the field of nephrology worldwide. In recent years, the basic and clinical research of ADPKD has made continuous progress, which has brought new theories, new technologies and new therapies to the clinical management of ADPKD. In order to improve the understanding and management of ADPKD among medical staff in China, the Clinical Practice Guidelines Working Group, Nephrology and Dialysis Association of Chinese Non-government Medical Institution Association has developed this Clinical practice guideline for ADPKD in China (2026). Based on evidence-based medicine evidence and clinical experience, the guideline systematically expounds the diagnosis and evaluation of ADPKD, measures to delay disease progression, treatment of renal and extrarenal complications, management of special ADPKD patients and other contents, comprehensively reflecting the forefront of clinical diagnosis and treatment of ADPKD and patient management strategies. This will serve as an important reference for standardizing the diagnosis, evaluation and treatment of ADPKD.