Salidroside has been shown to protect diabetic kidney disease (DKD) rats, however, whether it is equally effective in a hypoxic environment and the specific mechanism of action remain unclear.

To observe the effects of salidroside on biochemical parameters, renal tissue pathological lesion, and the expression of cell pyroptosis-related proteins in a rat model of DKD under hypoxia, and explore its mechanisms of action.

From March 2022 to March 2023, forty 6-week-old SPF-grade SD male rats were used, with eight randomly selected as the control group, the remaining were modeled. Twenty-four DKD model rats were randomly divided into three groups of the model group, salidroside group, and salidroside+nod-like receptor protein 3 (NLRP3) activator group for intervention, with 8 in each group. After the intervention, blood was collected from the abdominal aorta for biochemical parameter testing, hematoxylin-eosin (HE) staining, and transmission electron microscopy were used to observe renal pathological changes. Enzyme-linked immunosorbent assay (ELISA) was used to detect serum levels of interleukin (IL) 1β and IL-18. Western blotting was used to measure the expression levels of Caspase-1, Gasdermin D (GSDMD), NLRP3, and transforming growth factor β1 (TGF-β1) in renal tissue.

The body weight of the rats after modeling was significantly lower than that of the control group (P<0.05). Compared to the control group, the levels of triglyceride (TG), total cholesterol (TC), fasting blood glucose (FBG), urinary microalbumin (UMA), blood urea nitrogen (BUN), and serum creatinine (Scr) were significantly higher in the model group (P<0.05). Compared to the model group, the BUN, UMA, and Scr levels were significantly lower in the salidroside group (P<0.05). Compared to the salidroside group, the UMA, BUN, and Scr levels were significantly higher in the salidroside+NLRP3 activator group (P<0.05). HE staining and transmission electron microscopy revealed that renal tissue pathological changes in the salidroside group were significantly reduced than the model group, and aggravated in the salidroside+NLRP3 activator group. Compared to the control group, serum IL-1β and IL-18 levels were significantly higher in the model group (P<0.05) ; these levels were significantly lower in the salidroside group compared to the model group (P<0.05), and higher in the salidroside+NLRP3 activator group compared to the salidroside group (P<0.05). Compared to the control group, the expression of Caspase-1, GSDMD, NLRP3, and TGF-β1 proteins was significantly higher in the model group (P<0.05) ; it was significantly lower in the salidroside group compared to the model group (P<0.05), and higher in the salidroside+NLRP3 activator group compared to the salidroside group (P<0.05) .

Salidroside exerted therapeutic effects on DKD rats in a hypoxic environment without reducing blood glucose and lipid levels, this effect may be related to the inhibition of NLRP3, affecting the NLRP3/IL-1β/TGF-β1 signaling pathway, ultimately improving podocyte pyroptosis injury.

Previous studies on renin-angiotensin-aldosterone system (RAAS) mainly focus on renin, prorenin and prorenin receptor (PRR), which play an important role in cardiovascular, renal and other diseases. The physiological function of PRR has been widely studied. Soluble prorenin receptor (sPRR) is generated by cleavage of extracellular components of PRR by protease and secreted into extracellular space, therefore the change of sPRR level may reflect the change of RAAS in tissue. However, there are limited clinical researchs on sPRR. In recent years, increasing evidences show that sPRR has important biological functions in various pathophysiological processes. This article summarized the recent advances in sPRR in cardiovascular system, kidney diseases, respiratory diseases, endocrine and metabolic diseases, pregnancy complications and cancers, and considered that sPRR may be a new biomarker of multiple diseases, and has potential therapeutic effects on metabolic diseases.

Subclinical Cushing's syndrome (SCS) is a common subtype of adrenal incidentaloma. There are few reports on the correlation between hyperglycemia and hypercortisone secretion and its postoperative change in SCS patients.

To assess the pre- and post-surgical prevalence of hyperglycemia in patients with SCS secondary to adrenal incidentaloma.

The data of 202 patients who consulted in respiratory department of endocrinology, renhe hospital affiliated to shanghai university (shanghai baoshan district renhe hospital). Participants included 36 SCS patients, 41 patients with Cushing's syndrome due to adrenal tumor (CSA), 47 with nonfunctional adrenal tumor (NAT), and 53 controls. OGTT was performed in all of them, and based on the results, HOMA-IR, the area under the curve of blood glucose (AUCGlu) and insulin (AUCIns) were calculated, and plasma cortisol and urinary free cortisol and plasma ACTH were measured, then the values of the parameters were compared between controls and patients. Surgical treatment was given to SCS and CSA patients. The association of hormone and glucose metabolism parameters was assessed using Pearson correlation analysis.

The prevalence of hyperglycemia in SCS, CSA and NAT patients before surgery and in controls was 41.7%, 51.2%, 25.5%, and 24.5%, respectively. The HbA_1c, 2-hour post-load insulin (2 hPIN), AUCGlu and AUCIns in SCS patients were higher than those of controls (P<0.05). CSA patients had higher fasting insulin, AUCIns and HOMA-IR than SCS patients, NAT patients and controls (P<0.05). CSA patients had higher HbA_1c, fasting plasma glucose (FPG), 2-hour post-load plasma glucose (2 hPPG), 2 hPIN and AUCGlu than NAT patients and controls (P<0.05). After controlling for sex and age, in SCS patients, HbA_1c was positively associated with cortisol measured at 8: 00 and 16: 00 on the day after admission, and 24-hour urinary free cortisol (r=0.68, 0.657, 0.522, P<0.05), and so was 2 hPPG (r=0.569, 0.544, 0.369, P<0.05) ; FPG was positively associated with cortisol measured at 8: 00 on the day after admission (r=0.434, P<0.05) ; AUCGlu was positively associated with cortisol measured at 8: 00 and 16: 00 on the day after admission (r=0.397, 0.409, P<0.05). In CSA group, HbA_1c was positively associated with cortisol measured at 8: 00 on the day after admission (r=0.748, P<0.05), and so was FPG, 2 hPPG, AUCGlu, and 2 hPIN (r=0.631, 0.669, 0.602, 0.319, P<0.05). HbA_1c was also positively associated with cortisol measured at 16: 00 on the day after admission (r=0.674, P<0.05), and so was FPG, 2 hPPG, AUCGlu, (r=0.655, 0.640, 0.624, P<0.05). Plasma cortisol and 24-hour urinary free cortisol decreased in SCS and CSA patients after surgery (P<0.05). 2 hPIN and AUCIns decreased in SCS patients after surgery (P<0.05). FIN, 2 hPIN, AUCGlu, AUCIns and HOMA-IR decreased in CSA patients after surgery (P<0.05). The postsurgical prevalence of hyperglycemia SCS and CSA patients was 33.3% and 39.0%, respectively.

The high prevalence of hyperglycemia may be related to high secretion of glucocorticoid in SCS patients, and the hyperglycemic condition was improved after surgical treatment.

Early diagnosis of acute kidney injury (AKI) in neonates is difficult with a high mortality rate. However, there is currently a lack of research on severe neonatal asphyxia complicated with AKI.

To investigate the risk factors and short-term prognosis of neonatal asphyxia complicated with AKI, and analyze the predictive value of related factors, so as to take measures to reduce the occurrence of AKI and improve the success rate of resuscitation of the neonates.

A total of 172 neonates with severe asphyxia who were hospitalized in the Neonatal Intensive Care Unit of the First Affiliated Hospital of Bengbu Medical College from January 2016 to January 2023 were included as the study subjects and divided into AKI group (n=43) and non-AKI group (n=129) according to whether the neonates were complicated with AKI. Clinical data and laboratory results were collected, and the short-term prognosis (survival or death during hospitalization) of the children with AKI was recorded. Multivariate Logistic regression analysis was used to explore the influencing factors of severe neonatal asphyxia complicated with AKI, and receiver operating characteristics (ROC) curve was used to explore the predictive value of related indicators for severe neonatal asphyxia complicated with AKI.

Gestational age, birth weight, 5-min Apgar score and platelet count in AKI group were lower than those in non-AKI group, and the proportions of coma, invasive mechanical ventilation and combined respiratory failure, cystatin C (Cys C) were higher than those in non-AKI group, with statistically significant difference (P<0.05). Multivariate Logistic regression analysis showed that 5-min Apgar score (OR=1.553, 95%CI=1.193-2.021, P=0.001), invasive mechanical ventilation (OR=2.965, 95%CI=1.021-8.611, P=0.046) and blood Cys C value (OR=0.231, 95%CI=0.109-0.487, P<0.001) were the influential factors for severe neonatal asphyxia complicated with AKI. ROC curve analysis showed that the AUC of blood Cys C for predicting AKI was 0.777 (95%CI=0.701-0.854, P<0.05), and the AUC of 5-min Apgar score for predicting AKI was 0.792 (95%CI=0.715-0.869, P<0.05). The hospitalized mortality was 51.2% (22/43) in AKI group and 21.7% (28/129) in non-AKI group, and the mortality in AKI group was higher than that in non-AKI group, the difference was statistically significant (χ²=13.572, P<0.001) .

Low 5-min Apgar score, invasive mechanical ventilation, and high postnatal blood Cys C can increase the risk of AKI in neonates with severe asphyxia. Postnatal blood Cys C and 5-min Apgar Score are reliable predictor of neonatal asphyxia complicated with AKI.

Chronic kidney disease-mineral and bone disorder (CKD-MBD) has a direct impact on patients' quality of life, hospitalization rates and fracture risk. In recent years, osteoblasts and osteoclasts have become central to the pathophysiology of CKD-MBD. Osteoblasts interact with other organs by synthesizing fibroblast growth factor-23 (FGF-23) and sclerostin (SOST), making the skeleton an endocrine organ. Therefore, dysregulation of osteoblast differentiation is an important early event in the pathogenesis of CKD. In this paper, we systematically discuss the metabolic pathways of osteoblasts and the mechanisms related to the altered metabolic reprogramming of osteoblasts in the early CKD-MBD pathology. This paper shows that abnormalities in signaling pathways and metabolites such as Wnt/β-catenin, FGF-23, uremic toxins, metabolic acidosis, can alter the metabolic activity of osteoblasts, causing impaired maturation of the osteogenic spectrum, which in turn affects bone remodeling, which will provide a new way of thinking for explaining the pathological changes in renal bone disease and developing clinical treatment options.

Aldosterone-producing adenoma (APA) is a common type of primary aldosteronism. For those with unilateral adrenocortical adenoma, although expert consensus recommends plasma aldosterone-to-renin ratio (ARR) as a screening indicator for APA, the range of ARR cut-off values varies widely due to the lack of unified detection method and diagnostic process. Therefore, there is a clinical need for a reliable and rapid predictive model to assist in identifying APA.

To explore the correlation between glomerular filtration rate (GFR) and APA, construct and validate the nomogram prediction model of APA.

A total of 493 patients with with pathologic results of unilateral adrenal mass who underwent surgical treatment after evaluation of adrenal endocrine hormones in the first affiliated hospital of Shihezi University from 2012 to 2022 were collected, 155 patients were ultimately included in the APA group and 113 patients in nonfunctioning adrenal adenoma combined with essential hypertension group according to the diagnostic criteria of APA and nonfunctioning adrenal adenoma. The patients' clinical data and biochemical data were collected. The patients were grouped according to GFR quartiles, and the correlation between GFR and APA was analyzed. The risk factors for APA were screened by multivariate Logistic regression analysis and a nomogram prediction model was constructed. Receiver operating characteristic (ROC) curve was used to analyze the discrimination of the prediction model, a consistency index (C-index) was used to evaluate the predictive accuracy of the model, Hosmer Lemeshow test was used to verify the fit of model, and the diagnostic efficacy of the model was evaluated using decision curve and clinical benefit curve.

The patients were grouped according to GFR quartiles (Q1 to Q4 groups), Q1 group: ≥107.4 mL·min^-1· (1.73 m²) ^-1 (n=67), Q2 group: 99.7-107.3 mL·min^-1· (1.73 m²) ^-1 (n=67), Q3 group: 88.6-99.6 mL·min^-1· (1.73 m²) ^-1 (n=67) and Q4 group: ≤88.5 mL·min^-1· (1.73 m²) ^-1 (n=67), and the proportion of APA in each group was 47.8% (32/67), 53.7% (36/67), 58.2% (39/67) and 71.6% (48/67). Logistic regression trend test suggested that the risk of APA tended to increase as GFR levels decreased (P<0.05). Multivariate Logistic regression analysis showed that systolic blood pressure >160 mmHg (OR=5.209, 95%CI=2.531-10.720), hypertension duration≥59 months (OR=4.326, 95%CI=1.950-9.595), blood potassium<3.25mmol/L (OR=4.714, 95%CI=2.046-10.860), GFR[Q4 gourp: ≤88.5 mL·min^-1· (1.73 m²) ^-1] (OR=4.106, 95%CI=1.492-11.300), basal aldosterone>13.42 ng/dL (OR=8.756, 95%CI=4.320-17.749) were independent risk factors for the occurrence of APA (P<0.050). The Nomogram prediction model was constructed based on the above variables of multivariate regression with an AUC of 0.898 (95%CI=0.859-0.936) and a C-index of 0.898, indicating a good prediction accuracy. The Hosmer-Lemeshow test showed that the model had a good fit (χ²=14.059, P=0.080). The model had a significant predictive efficacy at prediction probability thresholds of 0.10 to 0.90.

The risk of APA prevalence tends to increase with decreasing GFR levels. The APA prediction model constructed based on five factors, including systolic blood pressure, hypertension course, blood potassium, GFR quartile grouping and basal aldosterone, has good predictability, consistency and clinical practicality, which can help identify APA and contribute to clinical decision making.

The elderly tend to coexist with multiple chronic diseases (such as diabetes and hypertension) , while diabetes and hypertension can lead to chronic kidney damage, and fewer studies have been conducted on chronic kidney disease in older adults.

To investigate the proteinuria and renal dysfunction in the elderly population and provide guidance for the management of chronic kidney disease in the community-dwelling older adults by collecting the clinical data of physical examination of the elderly residents in community.

A total of 13 080 elderly residents who underwent physical examination in Zhuanqiao Community Health Service Center of Minhang District, Shanghai from 2020 to 2021 were included as the study objects. General information, physical examination results and laboratory examination data of study objects were collected. Subjects with estimated glomerular filtration rate (eGFR) <60 mL·min^-1· (1.73 m²) ^-1 were included in the abnormal renal function group (n=713) , and subjects with eGFR≥60 mL·min^-1· (1.73 m²) ^-1 were included in the normal renal function group (n=12 367) . The subjects with positive urine protein were included in the proteinuria group (n=1 690) , and the subjects with negative urine protein were included in the non-proteinuria group (n=11 390) . At the same time, the subjects were divided into 60 to 69 years old group (n=6 901) , 70 to 79 years old group (n=4 867) , 80 to 89 years old group (n=1 128) and ≥90 years old group (n=184) according to the age interval of 10 years. Multivariate Logistic regression analysis was used to explore the influencing factors of renal dysfunction and proteinuria in the study population.

There were significant differences in the detection rates of urine protein positive and renal dysfunction in 60 to 69 years old, 70 to 79 years old, 80 to 89 years old and ≥90 years old groups (P<0.05) . The detection rate of urinary protein positive in males aged 60 to 69 years and 70 to 79 years was higher than that in females, the detection rate of renal dysfunction in males aged 60 to 69 years was higher than females, and the detection rate of renal dysfunction in males aged 80 to 89 years was lower than females, the difference was statistically significant (P<0.05) . Age, the proportion of diabetes and hypertension, blood urea nitrogen (BUN) , serum creatinine (Scr) and triglyceride (TG) in the abnormal renal function group were higher than those in the normal renal function group, while total cholesterol (TC) , high-density lipoprotein cholesterol (HDL-C) , low density lipoprotein cholesterol (LDL-C) and hemoglobin (Hb) in the abnormal renal function group were lower than those in the normal renal function group. There was significant difference in urinary, albumin/creatinine ratio (ACR) between the two groups (P<0.05) . Multivariate Logistic regression analysis showed that age, hypertension, diabetes, proteinuria and anemia were the influencing factors of renal dysfunction (P<0.05) , while male, diabetes, obesity, hypertriglyceridemia, Scr and BNU were the influencing factors of proteinuria (P<0.05) .

The detection rates of proteinuria and renal dysfunction in the elderly aged 60 years and above are high, which increase with age. Age, hypertension, diabetes, anemia, hypertriglyceridemia and low HDL-C level are risk factors for renal dysfunction in community-dwelling elderly population (P<0.05) ; male, diabetes, obesity, hypertriglyceridemia, Scr and BUN are risk factors for proteinuria in community-dwelling elderly population.

Diabetic nephropathy (DN) is one of the most common microvascular complications of diabetes, which is highly prevalent and harmful. Early detection of DN is an important task in preventing related diseases. Currently, most of the researches are based on traditional statistical prediction methods, and data need to meet the prerequisites it requires. It is necessary to try to apply new methods such as machine learning in the area of DN prediction for its failing to meet the needs in the field of DN prediction in recent years.

To construct DN prediction model using the LASSO regression and BP neural network optimized by sparrow search algorithm (SSA-BP) .

This study was conducted from April 2023 to August 2023, and the data was obtained from publicly available data on complications of 133 patients with diabetes mellitus in Iran. Univariate analysis was conducted using SPSS 26.0 software, and variables were screened using LASSO regression. Using the presence of DN as the dependent variable, the training and testing sets were divided into 8∶2 and 7∶3 ratios, respectively. The SSA-BP neural network was used for modeling and analysis, and the prediction performance was compared with classical machine learning models to analyze the better DN model. Model evaluation was performed based on accuracy, precision, sensitivity, specificity, F1-score and AUC indicators.

Excluding 9 patients with type 1 diabetes, the effective sample size included in this study was 124 patients with type 2 diabetes mellitus (T2DM) , of which 73 (58.9%) were diagnosed with DN. Univariate analysis of risk factors for type 2 DN showed statistically significant for age, BMI, duration of diabetes, fasting blood glucose (FBG) , glycosylated hemoglobin (HbA_1c) , low-density lipoprotein (LDL) , high-density lipoprotein (HDL) , triacylglycerol (TG) , systolic blood pressure (SBP) and diastolic blood pressure (DBP) (P<0.05) . When the ratio of the training set to the test set was 8∶2, there were 59 DN patients in the training set (n=100) and 14 DN patients in the test set (n=24) . Five influencing factors of age, diabetes duration, HbA_1c, LDL, and SBP were obtained by LASSO regression screening. The accuracy rates of Logistic regression (LR) , K-nearest neighbor (KNN) , support vector machine (SVM) and SSA-BP models in the test set were 83.33%, 79.17%, 79.17%, 87.50%, and 95.83%, with F1-score as 0.846 2, 0.800 0, 0.800 0, 0.888 9, and 0.960 0, respectively. When the ratio of the training set to the test set was 7∶3, there were 52 DN patients in the training set (n=88) and 21 DN patients in the test set (n=36) . Seven influencing factors obtained by LASSO regression screening included age, BMI, diabetes duration, LDL, HDL, SBP, and DBP. The accuracy rates of LR, KNN, SVM, BP, and SSA-BP models in the test set were 86.11%, 86.11%, 86.11%, 72.22%, and 91.67%, with F1-score as 0.871 8, 0.871 8, 0.864 9, 0.705 9, and 0.909 1, respectively.

LR, KNN, and SVM perform better when the training set to the test set is 7∶3, while BP and SSA-BP perform better when the training set to the test set is 8∶2. Compared with the BP neural network and traditional machine learning models, SSA-BP model has the best prediction performance and can timely and accurately identify type 2 DN patients, realize early detection and treatment of DN, thus preventing and mitigating the harm to their bodies.

Diabetes nephropathy (DN) is a common complication of diabetes patients. The prediction and validation of its risk will help identify high-risk patients in advance and take intervention measures to avoid or delay the progress of nephropathy.

To analyze the risk factors affecting the complication of DN in patients with type 2 diabetes mellitus (T2DM) , construct a risk prediction model for the risk of DN in T2DM patients and validate it.

A total of 5 810 patients with T2DM admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2016 to June 2021 were selected as the study subjects and divided into the DN group (n=481) and non-DN group (n=5 329) according to the complication of DN. A 1∶1 case-control matching was performed on 481 of these DN patients and non-DN patients by gender and age (±2 years) , and the matched 962 T2DM patients were randomly divided into the training group (n=641) and validation group (n=321) based on a 2∶1 ratio. Basic data of patients, such as clinical characteristics, laboratory test results and other related data, were collected. LASSO regression was applied to optimize the screening variables, and a nomogram prediction model was developed using multivariate Logistic regression analysis. The discriminability, calibration and clinical validity of the prediction model were evaluated by using the receiver operating characteristic (ROC) curve, Hosmer-Lemeshow calibration curve, and decision curve analysis (DCA) , respectively.

There were significant differences in gender, age, BMI, course of diabetes, white blood cell count, total cholesterol, triacylglycerol, low-density lipoprotein cholesterol, serum creatinine, hypertension, systolic blood pressure, diastolic blood pressure, glycosylated hemoglobin, apolipoprotein B, 24-hour urinary micro total protein, qualitative urinary protein between the DN and non-DN group (P<0.05) . Five predictor variables associated with the risk of DN in patients with T2DM were screened using LASSO regression analysis, and the results combined with multivariate Logistic regression analysis showed that duration of diabetes, total cholesterol, serum creatinine, hypertension, and qualitative urinary protein were risk factors for the complication of DN in T2DM patients (P<0.05) . The area under the ROC curve (AUC) for the risk of DN in the training group of the model was 0.866 (95%CI=0.839-0.894) , and the AUC for predicting the risk of DN in the validation group was 0.849 (95%CI=0.804-0.889) based on the predictor variables. The Hosmer-Lemeshow calibration curve fit was good (P=0.748 for the training group; P=0.986 for the validation group) . DCA showed that the use of nomogram prediction model was more beneficial in predicting DN when the threshold probability of patients was 0.15 to 0.95.

The nomogram prediction model containing five predictor variables (diabetes duration, total cholesterol, serum creatinine, hypertension, qualitative urinary protein) developed in this study can be used to predict the risk of DN in patients with T2DM.

IgA nephropathy (IgAN) is a common primary glomerulonephritis worldwide, and the improvement of glucocorticoid on the renal prognosis of IgAN patients with high risk of CKD progression remains unclear.

To explore the effect of glucocorticoid therapy on the therapeutic response and renal prognosis of IgAN patients with high risk of CKD progression.

IgAN patients with high risk of CKD progression were recruited in the First Affiliated Hospital of Zhengzhou University from January 2017 to October 2021 as study subjects and divided into the glucocorticoid treatment group and supportive treatment group according to whether glucocorticoid therapy was performed. Propensity matching method (PSM) was used to screen patients for cases by 1∶1 matching according to gender, age, 24 h urine protein and eGFR, the clinicopathological data of patients, disease remission, adverse reactions within 1 year were recorded. The patients were followed up from the date of initiation of supportive therapy until October 31, 2022. The primary endpoint event was defined as progression to end-stage renal disease (ESRD) or receiving dialysis. The composite endpoint event was defined as sustained decline in eGFR of more than 30% from baseline, or progression to ESRD, or receiving dialysis or death. Kaplan-Meier method was used to plot survival curves and log-rank test was used to compare differences in the cumulative incidence of the primary/composite endpoint events between the two groups of patients. Cox proportional hazards regression analysis was used to analyze the possible influencing factors of renal prognosis in IgAN patients with high risk of CKD progression.

A total of 236 patients with primary IgAN met the inclusion criteria. After 1∶1 matching, 97 cases in the glucocorticoid treatment group were successfully matched with 97 cases in the supportive therapy group with balanced baseline data. The complete remission rate and partial remission rate of patients in the glucocorticoid treatment group were higher than those in supportive treatment group (χ²=6.171, P=0.013; χ²=3.973, P=0.046) . The median follow-up time was 18.00 (9.75, 28.00) months. Kaplan-Meier survival curve analysis showed that the cumulative incidence of primary endpoint event in the glucocorticoid treatment group was lower than the supportive treatment group (χ²=4.495, P=0.034) and the cumulative survival rate of composite endpoint event in the glucocorticoid therapy group was lower than the supportive therapy group (χ²=4.419, P=0.036) . Among the 236 patients who met the inclusion criteria, there were 177 patients with moderate proteinuria. After 1∶1 matching of the 177 patients on glucocorticoid treatment and supportive treatment by sex, age, 24 h urine protein and eGFR using PSM, 76 cases in each group were successfully matched. Kaplan-Meier survival curve analysis showed that the cumulative incidence of primary endpoint event in the patients on glucocorticoid treatment with moderate proteinuria was lower than those on supportive treatment with moderate proteinuria (χ²=4.127, P=0.042) ; and the cumulative survival rate of composite endpoint event in the patients on glucocorticoid treatment with moderate proteinuria was lower than those on supportive treatment with moderate proteinuria (χ²=4.934, P=0.026) . Multivariate Cox proportional hazard regression analysis showed that hemoglobin (HR=0.982) , serum creatinine (HR=1.019) , eGFR (HR=1.020) and 24-hour urine protein (HR=1.205) were influencing factors of primary endpoints event in IgAN patients with high risk of CKD progression. The incidence of infection in the glucocorticoid treatment group was higher than the supportive treatment group (P<0.05) .

In IgAN patients with high risk of CKD progression, compared with simple supportive treatment, glucocorticoid treatment can significantly improve the renal remission rate and reduce the risk of renal function decline and renal failure. However, it is still necessary to be alert to its adverse reactions.

The prevalence rate of type 2 diabetes is increasing in China. General practitioners play an important role in the prevention and treatment of type 2 diabetes and its complications. Chronic kidney disease (CKD) is a common co-existing disease in patients with diabetes. However, at present, there is little research evidence on type 2 diabetes combined with CKD in primary care in China.

To investigate the obstructive factors in the monitoring and management of type 2 diabetes mellitus with CKD from the perspective of general practitioners.

From May to July 2022, a one-to-half structured interview was conducted with snowball sampling among general practitioners in an urban area of Beijing, and the interview outline was formulated based on the theoretical domains framework (TDF). NVivo 11 software was used to encode and classify the interview contents. Subject frame analysis method was used to sort out and analyze the data, and extract the theme.

13 general practitioners were interviewed in this study, and the years of working in general practice ranged from 8 to 22 years. The study identified barriers related to six domains in TDF, namely knowledge/skills, beliefs about outcomes, motivation and goals, medical background, resources and norms of conduct. After refining again, the themes were lack of systematic knowledge and skills related to CKD, imperfect incentive mechanism of primary medical staff, lack of smooth referral process between primary medical institutions and higher hospitals, poor self-management ability of patients and other obstacles.

There are many factors preventing general practitioners from monitoring and managing patients with type 2 diabetes complicated with CKD in the community. It is necessary to strengthen the knowledge and skills training of general practitioners with diabetes mellitus complicated with CKD, improve the ability of general practitioners to monitor and manage CKD, improve the incentive mechanism of primary medical institutions and establish an effective referral process with superior hospitals, strengthen the health education of patients, improve the self-management ability of patients, and enhance the prevention and treatment ability of primary medical institutions with type 2 diabetes complicated with CKD.

Diabetic nephropathy is one of the most common complications of diabetic microangiopathy, which significantly reduces the quality of life of diabetic patients and is the main cause of end-stage renal failure. As one of the main drugs in the treatment of diabetes mellitus, metformin plays a vital role in the treatment of diabetic nephropathy. In recent years, studies have found that metformin can not only lower blood sugar through a variety of mechanisms, but also prevent diabetic kidney disease from developing into end-stage renal failure. Several studies have found that metformin has clinical efficacy in the treatment of diabetic nephropathy, and drug safety in patients should be evaluated by glomerular filtration rate. This review summarizes the results of the clinical effects and mechanism of metformin in the treatment of diabetic nephropathy, aiming to better understand the therapeutic effect of metformin on diabetic nephropathy, and provide reference for the treatment of diabetic nephropathy.

IgA nephropathy (IgAN) is the most common primary glomerulonephritis in China and worldwide, approximately 25%-30% of patients will progress to end-stage renal disease within 20 years after diagnosis. Currently, there is no effective and safe treatment specifically for IgAN. In recent years, there has been a rapid progress in the research of new drugs for IgAN, among which the targeted delayed-release budesonide capsules is the first allopathic drug for IgAN globally.

To investigate the mechanism of corticosteroid budesonide capsules in the treatment of IgAN based on network pharmacology.

Chemical Book platform was used to screen the targets of budesonide; GeneCards and CTD databases were utilized to obtain the relevant targets of IgAN. The intersection of budesonide targets and IgAN targets was obtained through a Venn diagram. A protein-protein interaction (PPI) network map was constructed, and gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis were performed on the intersecting targets.

A total of 242 targets for budesonide, 1 443 candidate targets for IgAN, and 146 intersecting targets were selected. The 15 core targets in the PPI network included interleukin-6 (IL-6), tumor necrosis factor (TNF), interleukin-10 (IL-10), vascular endothelial growth factor A (VEGFA), epidermal growth factor receptor (EGFR), interleukin-1B (IL-1B), interleukin-4 (IL-4), interleukin-8 (CXCL8), gene on chromosome 1 (JUN), interleukin-13 (IL-13), interleukin-2 (IL-2), chemokine 2 (CCL2), toll-like receptor 4 (TLR4), colony-stimulating factors (CSF2), and albumin (ALB). Enrichment analysis revealed 1 646 GO enrichment results and 174 KEGG signaling pathways. The biological processes (BP) mainly involved positive regulation of phosphorylation, inflammatory response, and positive regulation of cell movement. The cellular components (CC) mainly involved cytoplasmic vesicle lumen, cyst cavity, and secretory granule lumen. The molecular functions (MF) mainly involved receptor signaling activity, receptor regulator activity, and receptor ligand activity. The KEGG signaling pathways mainly included interleukin 17 signaling pathway, cytokine-cytokine receptor interaction, pathways in cancer, and tumor necrosis factor signaling pathway.

This study provides preliminary verified that budesonide can treat IgAN by targeting IL-6, TNF, IL-10, VEGFA, EGFR, and other targets, through multiple signaling pathways, like cytokine-cytokine receptor interaction, interleukin-17 signaling pathway, pathways in cancer, and tumor necrosis factor signaling pathway, providing a theoretical basis for further research and clinical practice of budesonide.

Hyperuricemia (HUA) caused by elevated serum uric acid (SUA) has been shown to be an independent risk factor for the development and progression of chronic kidney disease (CKD). However, there are few cohort studies on the correlation of SUA level with the development and progression of CKD in the elderly of China.

To explore the association of baseline SUA level and its changes with the risk of chronic kidney disease (CKD) and estimated glomerular filtration rate (eGFR) in the elderly in longevity areas of China.

Based on the Healthy Aging and Biomarkers Cohort Study (HABCS), a sub cohort of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), the older adults who received physical examination and with biomedical indicators in 2012 and 2014 were selected as the study subjects from December 2021 to May 2022. The age, gender, blood pressure, blood lipids, blood glucose and other biomedical indicators were collected at baseline and follow-up period. Cox proportional hazards regression model was used to analyze the association of different SUA levels with the risk of CKD. Spearman rank correlation and generalized linear model analysis were used to analyze the association between baseline SUA level and baseline eGFR level and the linear correlation between changes in SUA level and eGFR changes in the elderly, respectively.

A total of 981 subjects were included in the study, with the median age of 79 (70, 88) years, the prevalence of HUA of 6.8% (67/981), the cumulative follow-up of 2 029 person-years and the median follow-up of 2.05 years, including 179 new cases of CKD, the cumulative incidence of CKD during the follow-up was 18.2%〔95%CI (15.9%, 20.8%) 〕, and the incidence density was 88.22/1 000 person-years〔95%CI (76.24/1 000 person-years, 101.41/1 000 person-years) 〕. Cox proportional hazards regression analysis with SUA quartile grouping as the independent variable showed that compared with the lowest quartile group of baseline SUA level (Q1), the HR value for the risk of CKD in the highest quartile group of baseline SUA level (Q4) was 2.08〔95%CI (1.27, 3.41), P=0.004〕. Cox proportional hazards regression analysis with SUA level as the independent variable showed that, for every 10 μmol/L increase in baseline SUA level, the risk of CKD in the elderly increased by 4% (P<0.001). Cox proportional hazards regression analysis with HUA as the independent variable showed an increased risk of CKD in elderly with HUA compared to those without HUA, with the HR value of 2.00〔95%CI (1.20, 3.24), P=0.007〕. The median baseline SUA was 270.60 (223.10, 325.90) μmol/L, the median baseline eGFR was 84.07 (73.08, 98.38) mL·min^-1· (1.73 m²) ^-1 in the elderly. Spearman rank correlation analysis showed a negative correlation between the above two (r_s=-0.363, P<0.001). The results of generalized linear model analysis showed that for every 10 μmol/L increase in baseline SUA level, the baseline eGFR decreased by 0.897 mL·min^-1· (1.73 m²) ^-1 (P<0.001). The median change of SUA level was -3.55 (-40.60, 31.90) μmol/L and the median change of eGFR was 3.49 (-8.13, 15.89) mL·min^-1· (1.73 m²) ^-1 in the elderly during the follow-up period of this study, and Spearman rank correlation analysis showed a negative correlation between the above two (r_s=-0.355, P<0.001). The results of the generalized linear model analysis showed that for every 10 μmol/L increase in SUA level in the elderly during the follow-up period, eGFR decreased by 1.027 mL·min^-1· (1.73 m²) ^-1 in the elderly (P<0.001) .

Elevated SUA level in the elderly is associated with an increased risk of CKD and a declined eGFR in China.

Chronic kidney disease (CKD) is a serious risk to the health and longevity of the elderly, and hypertension is closely related to CKD. However, the studies on the correlation of blood pressure levels with the development and progression of CKD in older adults have shown inconsistent results.

To explore the association between blood pressure levels and the risk of CKD among the elderly in longevity areas of China.

From October 2021 to May 2022, a total of 989 older adults who underwent physical examination with biomedical indicators collected in 2012 were selected as subjects based on the subcohort of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) -Healthy Aging and Biomarkers Cohort Study (HABCS) . Age, gender, height, weight, blood pressure, blood lipid, blood glucose, routine blood and urine indicators were collected at baseline, and follow-up monitoring was conducted in 2014. Cox proportional hazards regression model was used to analyze the association between the blood pressure levels and the risk of CKD.

A total of 989 subjects were included in the study, with a median age of 79 (70, 88) years. The cumulative follow-up were 2 046 person-years, with an average follow-up time of (2.07±0.50) years. There were 183 new cases of CKD, the cumulative incidence of CKD was 18.5%〔95%CI (16.1%, 21.1%) 〕, and the incidence density was 89.4/1 000 person-years. During the follow-up, 9.8% (10/102) , 14.0% (47/335) and 22.8% (126/552) of the older adults in the normal blood pressure, high normal blood pressure and hypertension groups developed CKD, respectively, and the difference was statistically significant among the three groups (χ²=16.40, P<0.001) . The results of Cox regression showed that after adjusting for age, sex, BMI, waist circumference, calf circumference, fasting blood glucose, glycosylated serum protein, total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, uric acid, superoxide dismutase, vitamind3, white blood cell count, red blood cell count, platelet count, blood urea nitrogen and history of diabetes, the older adults in the hypertension group had a higher risk of CKD〔HR (95%CI) =2.28 (1.13, 4.60) 〕 than those in the normal blood pressure group; the risk of CKD was 1.83 times〔95%CI (1.02, 3.29) 〕 higher in the older adults with baseline SBP≥140 mmHg (1 mmHg=0.133 kPa) than those with baseline SBP<120 mmHg, and the risk of CKD was 1.55 times〔95%CI (1.02, 2.35) 〕 higher in the older adults with baseline DBP≥90 mmHg than those with baseline DBP<80 mmHg (P<0.05) .

Hypertension is an independent risk factor for CKD in the elderly. It is particularly important to increase screening and prevention of CKD in older adults with predominantly elevated systolic blood pressure.

Renal cell carcinoma (RCC) is characterized by insidious onset, lack of early typical clinical manifestations, metastasis or advanced stage at diagnosis in most patients and poor efficacy of radical nephrectomy. In recent years, with the broadly application of targeted therapies in tumors, the postoperative recurrence and mortality rates have been greatly reduced. However, there is a lack of evidence for the efficacy and safety of clinical treatment due to the existence of certain adverse effects and complications.

To systematically review the efficacy and safety of programmed death-1 (PD-1) /programmed death-1 ligand (PD-L1) inhibitors in the treatment of RCC.

CNKI, Wanfang Data, VIP, PubMed, Web of Science, Embase, Cochrane Library, Clinical Trials and other English databases were searched by computer and manually for the randomized controlled trials of PD-1/PD-L1 inhibitors for RCC from the inception to 2022-09-30. Two researchers independently extracted and collated the data, evaluated the quality of the included literature according to Cochrane 5.3 manual criteria, and performed meta-analysis using RevMan 5.4 software.

A total of 11 papers were finally included, involving 7 895 study subjects with 3 936 cases in the trial group and 3 959 cases in the control group. Meta-analysis results showed that the overall survival (OS) and progression-free survival (PFS) were better in the trial group than in the control group〔HR=0.87, 95%CI (0.84, 0.90), P<0.000 01; HR=0.85, 95%CI (0.78, 0.92), P<0.000 1〕; the objective response rate (ORR), partial response rate (PR), complete response rate (CR), and disease-control rate (DCR) were higher in the trial group than in the control group〔RR=1.72, 95%CI (1.39, 2.12), P<0.000 01; RR=1.56, 95%CI (1.20, 2.01), P=0.000 7; RR=3.05, 95%CI (2.39, 3.09), P<0.000 01; RR=1.12, 95%CI (1.05, 1.20), P=0.000 5〕; the rate of stable disease (SD) was lower in the trial group than in the control group〔RR=0.66, 95%CI (0.62, 0.72), P<0.000 01〕. The differences were not statistically significant when comparing the rate of PD, total rate of adverse events (AEs), rates of grade Ⅰ-Ⅱ adverse events and grade Ⅲ-Ⅴ adverse events between the trial and control groups〔RR=0.73, 95%CI (0.53, 0.99), P=0.05; RR=1.01, 95%CI (0.89, 1.04), P=0.60; RR=1.02, 95%CI (0.88, 1.17), P=0.82; RR=1.02, 95%CI (0.88, 1.19), P=0.80〕. Egger's tests resulted in P>0.05, indicating no significant publication bias among studies.

PD-1/PD-L1 inhibitors for RCC can significantly improve and enhance OS, PFS, ORR, CR, PR and DCR in patients without increasing the incidence of adverse effects in terms of safety, thus confirming the superiority of PD-1/PD-L1 inhibitors for RCC in terms of clinical efficacy and safety.

Chronic kidney disease (CKD) is characterized by abnormal urine test or progressive kidney function decline. Patients with CKD are at a higher risk of COVID-19 infection with higher conversion and mortality rates after infection for their reduced kidney function, long-term use of immunosuppressive agents or combination of underlying diseases. Therefore, rational drug use is particularly important for CKD patients combined with COVID-19 infection. This article summarizes special considerations for the use of relevant medications in patients with CKD by integrating the current evidence of medications for the treatment of COVID-19 infection, including antiviral drugs, anti-inflammatory drugs, antithrombotic drugs, convalescent plasma and neutralizing monoclonal antibodies, as well as commonly used symptomatic drugs of respiratory system (such as antfebrile, antisputum and cough medicine and anti-allergic drugs), high lighting the modified medication regiments according to kidney function levels, in order to provide a reference for clinical professionals, assist in clinical decision-making and rational drug use, and ensure clinical efficacy and safety.

The global population disease burden report shows that atrial fibrillation (AF) and chronic kidney disease (CKD) have emerged as the fast-growing causes of death in the last 20 years. The concept of cardiorenal syndrome suggests that AF may increase the risk of new-onset CKD, however, there are few studies related to the increased risk of new-onset CKD with AF at home and abroad, and the interaction with age remains unclear atpresent.

To investigate whether AF increases the risk of new-onset CKD in northern Chinese population.

The population who attended a comprehensive health check-up for the employees of Kailuan Group in Hebei Province from 2006 to 2010 were selected as study subjects. The general information and laboratory test results of the study subjects were collected, and the study subjects were followed up with the final follow-up date of 2020-12-31 and the end point of new-onset CKD. The included patients were divided into AF group (n=368) and non-AF group (n=110 487) according to the presence or absence of AF. The cumulative incidence of new-onset CKD in patients was calculated using the lifetable method. The Kaplan-Meier method was used to plot the survival curves of the cumulative incidence of new-onset CKD in the AF group and the non-AF group. The Log-rank test was used to compare the differences in the cumulative incidence of CKD between the two groups. The multivariate Cox proportional hazard regression model was used to explore the effect of AF on the risk of new-onset CKD.

AF group was higher than non-AF group in age, male proportion, systolic blood pressure level, diastolic blood pressure level, body mass index, the proportions of education level, participation in physical exercise, hypertension, diabetes, taking hypotensive drugs and hypoglycemic drugs, and high-sensitivity C-reactive protein level (P<0.05) . AF group was lower than non-AF group in the proportion of alcohol consumption, total cholesterol, triacylglycerol and low density lipoprotein cholesterinlevels (P<0.05) . There were statistically significant differences in the incidence and cumulative incidence of new-onset CKD between atrial fibrillation group and non-atrial fibrillation group (P<0.05) . Stratifying the study population by age, there were statistically significant differences in the incidence and cumulative incidence of new-onset CKD in the study subjects aged≤65 years (P<0.05) and statistically significant difference in the incidence of new-onset CKD in the study subjects aged>65 years (P<0.05) . The results of the adjusted multivariate Cox proportional hazard regression analysis showed that AF was a risk factor for new-onset CKD in people aged≤65 years〔HR=1.350, 95%CI (1.038, 1.755) , P=0.025〕.

AF is an independent risk factor for new-onset CKD in northern Chinese population, especially for young and middle-aged populationaged≤65 years.

Early reperfusion therapy for acute myocardial infarction (AMI) is an effective approach to reduce mortality in AMI patients. Percutaneous coronary intervention (PCI) is one of the reperfusion therapy modalities, and contrast-induced acute kidney injury (CI-AKI) after PCI has become one of the common causes of AKI.

To investigate the risk factors for the development of CI-AKI in AMI patients after PCI, establish a risk prediction model for CI-AKI based on risk factors and evaluate its validity.

The clinical data of 1 274 patients who attended the Affiliated Hospital of Xuzhou Medical University diagnosed of AMI and treated with PCI were collected consecutively from 2019 to 2021. According to the chronological order of admission, the included patients were divided into the training group (January 2019 to March 2021, 900 cases) and validation group (April 2021 to December 2021, 374 cases) in a ratio of approximately 7∶3; and divided into the CI-AKI and non-CI-AKI groups according to the diagnostic criteria of CI-AKI. Independent risk factors were screened using univariable Logistic regression analysis, Lasso regression, cross-validation, multivariable Logistic regression analysis, and a nomogram for predicting the risk of CI-AKI was plotted. Their discriminatory power, calibration ability, and clinical application value were evaluated by calculating concordance statistic (C-statistic), plotting calibration curve and decision curve.

Among the 900 patients in the training group, 109 patients (12.1%) developed CI-AKI after PCI; among the 374 patients in the validation group, 27 patients (7.2%) developed CI-AKI. Multivariable Logistic regression analysis showed that LVEF〔OR=0.903, 95%CI (0.873, 0.934) 〕, platelet distribution width〔OR=1.158, 95%CI (1.053, 1.274) 〕, MPVLR〔OR=1.047, 95%CI (1.016, 1.079) 〕, NHR〔OR=1.072, 95%CI (1.021, 1.124) 〕, Scr〔OR=1.006, 95%CI (1.002, 1.011) 〕, and diuretics〔OR=2.321, 95%CI (1.452, 3.709) 〕 were independent influencing factors for CI-AKI after PCI in AMI patients (P<0.05). A prediction model containing 6 risk factors of LVEF, platelet distribution width, MPVLR, NHR, Scr and diuretics was constructed and a nomogram for predicting the risk of CI-AKI was plotted. The C-statistic was 0.794〔95%CI (0.766, 0.820) 〕 for the training group and 0.799〔95%CI (0.774, 0.855) 〕 for the validation group, and the calibration plots showed good consistency between the predicted and actual results; the decision curve and clinical impact curve showed clinical application value of nomogram.

The CI-AKI risk prediction model including LVEF, platelet distribution width, MPVLR, NHR, Scr, and diuretics has good discrimination and accuracy, which can intuitively and independently screen high-risk population and has high predictive value for the development of CI-AKI after PCI in AMI patients.

Azovudine is a widely used antiviral drug for COVID-19 in China, but published trials on its effect on hepaticand renal function are extremely scarce.

To explore the changes of in hepatic and renal function in patients with COVID-19 infection after using Azovudine, so as to provide a reference for thesafe use of Azovudine in patients with renal insufficiency.

Inpatients ina tertiary general hospitalwho used Azovudine for COVID-19 from December 26, 2022 to December 31, 2022 were consecutively included in the retrospective study and divided into the normal group, mild injury group, moderate injury group, severe injury group, and end-stage groupaccording to estimated glomerularrate (eGFR) levels. The changes of biochemical parametersof liver and kidney including alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), albumin (ALB), total bilirubin (TB), serum creatinine (Scr), eGFR were observed in each group; the formula D_FR=D_NL×[1-F_k (1-K_f) ] was used to correct the maintenance dose of Azivudine in patients with eGFR<60 mL·min^-1· (1.73 m²) ^-1. The patients were divided into the corrected group and uncorrected group according to whether they were administered according to this formula, the biochemical parameters of liver and kidney were compared between the two groups.

Among 322 patients who used Azovudine, 190 patients met the inclusion and exclusion criteria. After grouping by the level of eGFR, there were statistically significant differences in the distribution of age, COVID-19 severity, peak procalcitonin (PCT) values, antihypertensive drugs, loop diuretics and Azovudine maintenance dose in each group (P<0.05) ; there were 73 cases (38.4%) with elevated ALT level after Azovudine treatment, and 68 cases (93.2%) with elevated ALT level within one time of the upper normal limit; eGFR decreased in 58 cases (30.5%), of which 7 cases (12.1%) dropped to the next renal function grade; regardless of the grade of renal injury, there were no deterioration in eGFR, ALT, AST, TB, ALP and albumin after the use of conventional dose or corrected dose of Azivudine (P>0.05) ; because the patients with moderate and severe renal injury were dose-corrected with Azivudine, the safety of this population was not compared if the dose was not corrected.

The use of Azivudine is prone to cause the elevation of ALT level and the decrease of eGFR, but the injury with clinical significance is 2.6% and 3.7%, respectively; there was no aggravation of liver and kidney injury in patients with moderate and severe kidney injury after using the corrected dose of Azivudine, however, this conclusion needs to be confirmed in a multicenter randomized controlled study with a large sample.

Acute ischemic stroke (AIS) is the second leading cause of death worldwide after coronary heart disease. Acute kidney injury (AKI) is one serious complication after AIS, and homocysteine (Hcy) may be an important factor associated with kidney injury and accelerated deterioration of renal function. However, there are few studies on the relationship between Hcy and AKI, especially in patients with AIS.

To investigate the relationship between plasma Hcy level and AKI in patients with AIS, and to provide new ideas for the prevention and treatment of AKI.

Baseline clinical data of 1 202 patients with AIS who were admitted to Department of Neurology, the Second Hospital of Tianjin Medical University were collected from the electronic medical record systemfrom January 2018 to April 2021. Patients were divided into normal Hcy (Hcy≤15 μmol/L, n=618), mild hyperhomocysteinemia (HHcy) (16 μmol/L<Hcy≤30 μmol/L, n=459) and moderate-to-severe HHcy (Hcy>30 μmol/L, n=125) groups according to the Expert Consensus on the Diagnosis, Treatment, and Prevention of Hyperhomocysteinemia. Patients were divided into AKI group and non-AKI group by the values of ambulatorily monitored renal function and urine volume within seven days after admission recommended in the KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases. Multivariate Logistic regression was used to explore the effects of Hcy on post-AIS AKI as a continuous variable and a categorical variable, respectively. Subgroup analysis was used to investigate the relationship between Hcy and AKI in subgroups. The nonlinear relation between Hcy and AKI was explored by restricted cubic spline regression.

One hundred and fifty patients (12.48%) developed AKI in all subjects. Multivariate Logistic regression showed that after adjustment for potential confounders, the risk of AKI increased by 1.035 times〔OR=1.035, 95%CI (1.019, 1.052), P<0.05〕 for every 1 μmol/L increase in Hcy. With reference to normal Hcy, mild and moderate-to-severe HHcy has been associated with a 1.770-fold〔OR=1.770, 95%CI (1.150, 2.724), P<0.05〕 and 2.927-fold 〔OR=2.927, 95%CI (1.671, 5.126), P<0.05〕 increased risk of AKI, separately. Subgroup analysis found that the risk of AKI after AIS increased with the increase of Hcy level (used as a continuous variable) in females, those aged ≥75 years, those with hypertension, diabetes or moderate to severe stroke at admission, and those whose stroke type was large-artery atherosclerosis (LAA), small artery occlusion (SAO) or cardio embolism (CE) (P<0.05). When Hcy was analyzed as a categorical variable, mild HHcy was associated with a higher risk of AKI compared with normal Hcy in the male population, those aged<75 years, those with hypertension, diabetes, a history of stroke or mild stroke at admission, and those without coronary heart disease (P<0.05). And moderate-to-severe HHcy was associated with a higher risk of AKI compared with normal Hcy in the female population, those with hypertension, diabetes, or moderate or moderate-to-severe stroke at admission, and those whose stroke type was LAA, SAO or CE regardless of age, coronary heart disease and history of stroke (P<0.05). Restricted cubic regression manifested that there was a nonlinear correlation between Hcy and the risk of AKI, and the curve was convex (P=0.026). The risk of AKI after AIS increased rapidly with the increase of Hcy when admission Hcy was less than 17 mmol/L, but increased slowly with the increase of Hcy when admission Hcy was greater than or equal to 17 mmol/L.

Elevated Hcy is a risk factor for AKI whether as a continuous variable or a categorical variable in AIS patients. So monitoring the level of Hcy is conducive to early identification and prevention of AKI, which is helpful to improve the prognosis in AIS patients.

Immunoglobulin A (IgA) nephropathy (IgAN) is a chronic inflammatory illness involving multiple factors and genes, platelet-albumin ratio (PAR) is regarded as a novel marker of inflammation, but the connection between PAR and IgA nephropathy remains unclear.

To examine the correlation of PAR with the clinicopathological indicators of IgAN and to evaluate the clinical significance of PAR in IgAN.

From October 2019 to August 2020, 210 patients with IgAN diagnosed by percutaneous renal biopsy at the Department of Nephrology of the First Affiliated Hospital of Kunming Medical University were selected as study subjects, general inforamtion of the included patients (gender, age, systolic blood pressure, diastolic blood pressure and disease duration), laboratory indicators〔white blood cell (WBC), absolute neutrophil count (ANC), absolute lymphocyte count (ALC), absolute monocyte count (AMC), platelet count (PLT), serum albumin (ALB), serum uric acid (SUA), blood urea nitrogen (BUN), serum creatinine (Scr), IgA, immunoglobulin M (IgM), immunoglobulin G (IgG), serum complement C3, serum complement C4, urine red blood cell count (URBC), 24 h urinary microalbumin (24 h mALB), 24 h micrototal protein (24 h MTP) 〕, percutaneous renal biopsy pathology results, calculated neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), PAR, immunoglobulin A-to-complement C3 ratio (IgA/C3), immunoglobulin G-to-complement C3 ratio (IgG/C3), complement C3-to-complement C4 ratio (C3/C4), and estimated glomerular filtration rate (eGFR) were collected. The study subjects were divided into three groups: group Q1 (PAR≤5.626 5), group Q2 (5.6265<PAR≤6.984 3) and group Q3 (PAR>6.984 3), each group of 70 cases. The differences in the baseline inforamtion among the three groups were compared, Spearman correlation analysis and Logistic regression analysis were used to explore the correlation between PAR and IgAN clinicopathological indicators of IgAN, receiver operating characteristic (ROC) curves were plotted to analyze the predictive value of PAR on pathological indicators.

There were significant differences in gender, WBC, ANC, PLT, PLR, PAR, URBC, ALB, IgG/C3, 24 h-mALB, 24 h-MTP, M lesions, Lee classification among the three groups (P<0.05). Spearman correlation analysis showed that PAR was positively correlated with PLT, WBC, ANC, PLR, URBC, 24 h-mALB, 24 h-MTP, M lesions, E lesionsand Lee classification, and negatively correlated with ALB and IgG/C3 (P<0.05). Multivariate Logistic regression analysis showed that PAR〔OR=2.688, 95%CI (1.178, 6.135) 〕 and ALB〔OR=0.736, 95%CI (0.587, 0.923) 〕 were independent influencing factors for M1 lesions in IgAN patients (P<0.05), ALB〔OR=0.896, 95%CI (0.824, 0.973) 〕 was an independent influencing factor for E1 lesions (P<0.05). The ROC curve showed that area-under-curve (AUC) of PAR predicting M1 and E1 lesions in IgAN patients was 0.727 and 0.599, respectively.

PAR was significantly correlated with the clinical manifestations and the degree of M and E lesions of IgAN, which has clinical significance in evaluating IgAN activity. Patients with high PAR levels should be treated more aggressively to inhibit active lesions and improve renal outcomes.

Sarcopenia may be associated with the long-term prognosis of renal transplant recipients, so it is essential to early and rapidly screening for sarcopenia in these patients. Studies suggest that calf circumference may be an effective indicator in early screening for sarcopenia.

To investigate the relationship between calf circumference and sarcopenia, and to explore the feasibility of using calf circumference as a predictive marker for sarcopenia in kidney transplant recipients.

We selected 80 kidney transplant recipients who were treated in the department of organ transplantation of Guangdong Second Provincial General Hospital from October 2021 to June 2022 as the subjects. Demographic information (sex, age, educational attainment, marital status) , anthropometric indicators〔height, weight, body mass index (BMI) , calf circumference, mid-arm circumference (MAC) , triceps skin-fold thickness (TSF) , arm muscle circumference (AMC) , waist circumference, hip circumference, waist-to-hip ratio〕, muscle strength indicators (grip strength, pinch strength) , body composition indicators〔appendicular skeletal muscle mass (ASM) , skeletal muscle mass index (SMI) , 50 kHz phase angle (PhA) , body cell mass (BCM) , intracellular and extracellular fluids〕 were collected. Sarcopenia was diagnosed by the Asian Working Group for Sarcopenia 2019 consensus. Kidney transplant recipients who meet the diagnostic criteria were included in the sarcopenia group, and those who do not meet the diagnostic criteria were included in the non-sarcopenia group. Demographic information, anthropometric indicators, muscle strength indicators, and body composition indicators between sarcopenia and non-sarcopenia patient groups were compared by sex. Pearson correlation analysis and Spearman rank correlation analysis were used to observe the correlation of calf circumference with diagnostic indicators of sarcopenia (ASM, SMI, grip strength) . Univariate and multivariate logistic regression analyses were used to explore the influencing factors of sarcopenia. The predictive value of calf circumference for sarcopenia in kidney transplant of male and female subjects was analyzed by using the receiver operating characteristic (ROC) curve, and the area under the curve (AUC) , sensitivity, specificity and optimal cut-off values were calculated.

A total of 80 patients〔51 men (63.8%) and 29 women (36.2%) 〕 with an average age of (44.3±11.7) years were included, including 19 (23.75%) with sarcopenia, and 61 (76.25%) without. Sex-based analysis found that male patients with sarcopenia group had lower values of weight, BMI, calf circumference, MAC, TSF, hip circumference, grip strength, pinch strength, ASM, SMI, PhA, BCM, extracellular fluid and intracellular fluid than those without (P<0.05) . Female patients with sarcopenia had lower values of weight, BMI, calf circumference, waist circumference, hip circumference, waist-to-hip ratio, ASM, SMI, BCM, extracellular fluid and intracellular fluid than those without (P<0.05) . Correlation analysis showed that the calf circumference had a positive correlation with ASM, SMI and grip strength in both male kidney transplants (r_s=0.545, P<0.001; r_s=0.540, P<0.001; r_s=0.340, P=0.015) and female kidney transplants (r_s=0.499, P=0.006; r_s=0.578, P=0.001; r=0.426, P=0.021) . Multivariate Logistic regression analysis showed that calf circumference was associated with sarcopenia in kidney transplant〔OR=0.699, 95%CI (0.051, 0.975) , P=0.035〕. ROC analysis revealed that the AUC of calf circumference predicting sarcopenia in kidney transplant of male subjects was 0.799, with the optimal cut-off value, sensitivity and specificity of 33.3 cm, 83.3% and 74.4%, respectively. And the AUC of calf circumference predicting sarcopenia in kidney transplant of female patients was 0.851, with the optimal cut-off value, sensitivity and specificity of 32.2 cm, 100.0% and 59.1%, respectively.

Calf circumference is associated with sarcopenia and can be used as a predictive marker for early screening of sarcopenia in kidney transplant recipients. However, its predictive value needs to be verified further by large-sample cohort studies, and thus to better promote early clinical screening of sarcopenia in kidney transplant recipients to effectively improve their quality of life and prognosis.

Klotho is closely related to the occurrence and development of kidney disease. Salt-sensitive hypertension (SSH) is often accompanied by kidney disease. At present, there are few reports on the role and molecules mechanism of klotho in renal injury in SSH.

To investigate the role and molecules mechanism of klotho in renal injury in SSH.

The rat glomerular mesangial cell line HBZY1 was selected as the experimental cells from June 2021 to January 2022, and the experimental cells were divided into the control group and the model group. The model of HBZY1 cell injury induced by NaCl 137 mmol/L and angiotensin Ⅱ (Ang Ⅱ) 10^-6 mmol/L was used to simulate the renal injury in SSH, and the cells were collected. The differences in the expression of klotho mRNA and protein were detected by real-time fluorescent quantitative PCR (qRT-PCR) and Western Blot. The interference vector and overexpression vector of klotho and the overexpression vector of angiotensin Ⅱ type 1 receptor (AT1R) were constructed. The klotho interference experiments were divided into five groups, including the control group, empty group, klotho-siRNA1 group, klotho-siRNA2 group and klotho-siRNA3 group; the klotho overexpression experiments were divided into three groups, including the control group, empty group and klotho overexpression group; the AT1R overexpression experiments were divided into three groups, including the control group, empty group and AT1R overexpression group. The constructed vectors were transfected into cells with verified transfection efficiency. After successful transfection, the experiment was divided into two parts. The first part of the experiment was to verify the renal protective effect of klotho, the experiment subjects were divided into four groups, including the control group, model group, klotho overexpression group and klotho interference group. The second part of the experiment was to explore whether the renal protective effect of klotho was related to AT1R, the experiment subjects were divided into three groups, including the model group, klotho overexpression group and klotho+AT1R overexpression group. After successful transfection, the tests including cell viability detected by cell counting kit-8 (CCK-8) method, reactive oxygen species (ROS) content detected by flow cytometry, malondialdehyde (MDA) and superoxide dismutase (SOD) content in cell supernatant detected by enzyme-linked immunosorbent assay (ELISA) , interaction effect between kltho and AT1R detected by co-immunoprecipitation (Co-IP) .

Compared with the control group, mRNA level and protein expression of klotho in the model group decreased in model group (t=7.102, 7.506; P=0.002, 0.002) , klotho-siRNA2 interference effect was more significant (P<0.001) , the expression of klotho protein in the klotho overexpression group increased significantly (P<0.001) , the expression of AT1R protein in the overexpression group increased significantly (P<0.001) . Effects of klotho on cell viability and oxidative stress injury: compared with the control group, cell viability in the model group decreased (P<0.001) , intracellular ROS and MDA content increased (P<0.001, P=0.004) , and SOD content decreased (P=0.041) ; compared with the model group, cell viability in the klotho overexpression group increased (P<0.001) , intracellular ROS and MDA content decreased and SOD content increased (P<0.001, P=0.003, P=0.018) ; compared with the model group, cell viability in the klotho interference group decreased (P<0.001) , while intracellular ROS and MDA content increased and SOD content decreased (P<0.001, P=0.002, P=0.001) . Effects of klotho on cell viability and oxidative stress injury through AT1R: compared with the model group, cell viability increased (P<0.001) , intracellular ROS and MDA content decreased and SOD content increased (P<0.001, P=0.024, P=0.007) in the klotho overexpression group; compared with the klotho overexpression group, cell viability decreased (P<0.001) , ROS and MDA content increased and SOD content decreased (P<0.001, P=0.001, P=0.002) in the klotho+AT1R overexpression group. Co-IP determined that there was an interaction between klotho and AT1R.

Klotho plays a protective role in renal injury in SSH by inhibiting oxidative stress injury through interaction with AT1R.

Time in range (TIR) is a new indicator of glycemic management in diabetes mellitus which has been thriving in recent years. Studies have confirmed that TIR is closely associated with chronic complications of diabetes. Previous studies have confirmed a close association between TIR and chronic complications of diabetes. Current studies on TIR and diabetic kidney disease (DKD) mainly focus on proteinuria, however the role of glomerular filtration rate (eGFR) in it is often neglected, and there are few studies on the cut points of TIR in evaluating glycemic control.

To investigate the relationship between TIR and the development of DKD in type 2 diabetes mellitus (T2DM), so as to provide theoretical foundations for the timely clinical detection, diagnosis and treatment of DKD in patients with T2DM.

A total of 214 T2DM patients admitted to the Department of Endocrinology in Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from July 2021 to December 2021 were included. The general data, laboratory indices and medication use were collected. The included patients were divided into group of DKD〔UACR ≥ 30 mg/g and/or eGFR < 60 ml·min^-1 (1.73 m²) ^-1, n=58〕 and group of T2DM alone〔UACR<30 mg/g and eGFR≥60 ml·min^-1 (1.73 m²) ^-1, n=156〕 based on the urinary albumin/creatinine ratio (UACR) and eGFR results, the included patients were further divided into TIR1 group (TIR>85%, n=90), TIR2 group (70%<TIR≤85%, n=51), TIR3 group (40%<TIR≤70%, n=57), and TIR4 group (TIR≤40%, n=16) using TIR values of 40%, 70%, and 85% as the cut points. Multivariate Logistic regression analysis was used to analyze the relationship between TIR and the development of DKD in T2DM patients.

The detection rate of DKD in T2DM patients tended to increase with decreasing TIR levels (P_trend <0.05). The results of multivariate Logistic regression analysis showed that TIR was an influencing factor for the development of DKD in T2DM patients after adjusting for variables〔OR=0.976, 95%CI (0.953, 0.999), P=0.047〕; TIR3 and TIR4 groups were influencing factors for the development of DKD in T2DM patients compared to TIR1 group〔OR=5.287, 95%CI (1.897, 14.737), P=0.001; OR=4.712, 95%CI (1.143, 19.424), P=0.032〕 after adjusting for various confounding variables, and the incidence risk of DKD in T2DM patients tended to increase with decreasing TIR levels (P_trend=0.010) .

TIR is an influencing factor for the development of DKD in T2DM patients; the incidence rate of DKD in T2DM patients increases significantly with the decreasing levels of TIR.

Diabetic kidney disease (DKD) is a common diabetic complication, which is mainly characterized by damage in renal microvessels. Early diagnosis and active prevention of DKD are the key to improving the prognosis. The blood inflammatory index may be related to DKD.

To explore the value of systemic immune-inflammation index (SII) for the diagnosis of DKD in elderly type 2 diabetes mellitus (T2DM) patients in the community.

A retrospective study was conducted with 327 elderly patients with T2DM who underwent routine physical examination in Community Medical Department, Beijing Chao-yang Hospital (West Branch), Capital Medical University from January to December 2021. They were divided into non-DKD group (n=112) and DKD group (n=215) by the prevalence of DKD. The general data and laboratory examination data of the two groups were collected and compared. Pearson correlation analysis and Spearman rank correlation analysis were used to assess the correlation of urinary albumin/creatinine ratio (UACR) with other various indicators. Multivariate Logistic regression analysis was used to explore the influencing factors of DKD in the patients. The diagnostic value of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and SII for DKD in these patients was evaluated by using the receiver operating characteristic (ROC) curve, and the area under the curve (AUC) with corresponding 95%CI was calculated.

The course of T2DM in DKD group was longer than that in non-DKD group (P<0.05). Moreover, the proportion of patients with hypertension history, fasting plasma glucose (FPG), low-density lipoprotein (LDL), blood urea nitrogen, serum creatinine (Scr), UACR, neutrophils, platelets, NLR, PLR and SII in DKD group were higher than those in non-DKD group (P<0.05). Correlation analysis showed that course of T2DM, FPG, triacylglycerol, LDL, neutrophils, platelets, NLR, PLR and SII were positively related with UACR (r=0.716, 0.114, 0.113, 0.144, 0.533, 0.226, 0.538, 0.430, 0.494, P<0.05). Multivariate Logistic regression analysis showed that course of T2DM〔OR=1.300, 95%CI (1.173, 1.441), P<0.001〕, LDL〔OR=2.565, 95%CI (1.320, 4.985), P=0.005〕, Scr〔OR=1.093, 95%CI (1.046, 1.143), P<0.001〕, NLR〔OR=2.565, 95%CI (1.320, 4.985), P=0.005〕and SII〔OR=1.011, 95%CI (1.007, 1.015), P<0.001〕were associated with DKD in elderly. In diagnosing DKD in these patients, the AUC of NLR was 0.755〔95%CI (0.696, 0.814) 〕, the optimal cut-off value was 2.49, with a sensitivity of 72.1% and a specificity of 70.5%; the AUC of PLR was 0.689〔95%CI (0.624, 0.754) 〕, the optimal cut-off value was 112.81, with a sensitivity of 90.2%, and a specificity of 43.8%; the AUC of SII was 0.836〔95%CI (0.791, 0.881) 〕, the optimal cut-off value was 492.08, with a sensitivity of 80.5% and a specificity of 73.2%.

The course of T2DM, LDL, Scr, NLR and SII may be the influencing factors of DKD in community-dwelling elderly T2DM patients. Moreover, SII has great clinical diagnostic value for DKD in this population.

The immunoglobulin (Ig) G subtype deposited pathologically in patients with idiopathic membranous nephropathy (IMN) is mainly IgG4, and the deposition of IgG1, IgG2 and IgG3 can also be detected. At present, there has been no report on the damage effect of different IgG subtypes in IMN on the pathological of kidney.

The purpose of the study was to investigate the clinicopathological characters and short-term prognosis in IMN patients with IgG4 combined with other different IgG subtypes deposition.

604 patients diagnosed with IMN in the First Affiliated Hospital of Zhengzhou University from January 2015 to June 2018 were included in the study, the baseline information, pathological test results of renal tissue specimens and treatment protocols of the patients were collected. According to the test results of IgG subtypes in renal pathology, the patients were divided into the simple IgG4 deposition group (n=259) , IgG4 combined with IgG1 deposition group (n=259) , IgG4 combined with IgG2 deposition group (n=29) , and IgG4 combined with IgG3 deposition group (n=57) . Starting from the date of percutaneous renal biopsy, the follow-up was performed until 2018-11-06. Kaplan-Meier survival curves of patients with different IgG subtypes were plotted, Log-rank test was used for survival curve comparison.

24-h urine protein in IgG4 combined with IgG1 deposition group was higher than that in the simple IgG4 deposition group (P<0.05) ; the white blood cell count, neutrophil count, monocyte count and 24-h urine protein in the IgG4 combined with IgG3 deposition group were higher than those in the simple IgG4 group (P<0.05) . The positive deposition rates of C3, C4 and λ in the IgG4 combined with IgG1 deposition group were higher than those in the simple IgG4 deposition group (P<0.05) ; the positive deposition rate of C3 in the IgG4 combined with IgG2 deposition group was higher than that in the simple IgG4 deposition group (P<0.05) ; the positive deposition rates of C3, C4 and C1q, semi-quantitative scores of renal tubular atrophy and renal interstitial fibrosis were significantly different between the IgG4 combined with IgG3 deposition group and the simple IgG4 deposition group (P<0.05) . Log-rank test results showed no significant difference in cumulative response rates among the four groups (χ²=0.684, P=0.408) .

The renal clinical and pathological changes were more serious in IgG4 combined with other different IgG subtypes patients than those with IgG4 alone, patients with IgG3 deposition had a more prominent clinicopathological phenotype. There was no significant difference in remission rate after 6 months of follow-up, which may be related to the different intensity of inflammatory response caused by different capacities to fix complement of different IgG subtypes.

Congenital adrenal hyperplasia (CAH) is an autosomal recessive genetic disease encompassing enzyme deficiencies in the process of adrenal steroidogenesis, which leads to adrenal cortex dysfunction. Hypersecretion of corticotrophin-releasing hormone and insufficient cortisol production often lead to enlarged adrenal glands. Existing studies have reported that most of space-occupying adrenal masses in CAH are benign, only very few are malignant. It is difficult for clinicians to distinguish the nature of space-occupying adrenal masses, and physicians have insufficient experiences in treating the disease. We reported a phenotypically male case of CAH with huge space-occupying adrenal masses and reviewed relevant literature, aiming to provide evidence on the diagnosis and treatment of this disease for clinicians. The space-occupying adrenal masses in CAH often show tumor-like hyperplasia before diagnosis and treatment or effective hormone replacement therapy, but most of them will be significantly reduced or disappear after glucocorticoid replacement therapy. But a follow-up of several years showed that space-occupying adrenal masses in the CAH patient encountered by us had no significant changes and no significant impact on the patient's body, even without effective drug intervention.

Imbalanced gut flora caused by changes in gut microecological structure and diversity plays an important role in the interaction between diabetes and chronic kidney disease. Rational application of probiotics, prebiotics and other microbiota-modulating agents is contributive to the improvement of gut microbial flora environment and chronic inflammation, as well as the delay of deterioration of renal function in patients with diabetic nephropathy (DN) .

To understand the effect of probiotics, a microbiota-modulating agent, administered based on gut flora status in patients with DN.

Participants were selected from Shanghai Yinhang Community Health Center by use of stratified random sampling in 2019, including 115 patients with DN were randomly divided into control group (57 with usual treatment) and treatment group (58 with treatment with microbiota-modulating agents) . Laboratory test indices and intestinal bacterial culture results were compared between the two groups after eight weeks of treatment to assess the effect of microbiota-modulating agents on improving gut flora in DN.

Among 115 patients with DN, there were 28 males and 87 females, the mean age was (62.9±10.0) years, and the duration of diabetic nephropathy was (14.3±7.1) years. There were no significant differences in the proportion of males, mean age, body mass index, proportion of early DN, and duration of DN between DN patients with usual treatment and those with microbiota-modulating agents treatment (P>0.05) . Compared with DN patients with usual treatment, DN patients with microbiota-modulating agents treatment had decreased levels of glucose, triglyceride, blood urea nitrogen, serum creatinine, albumin to creatinine ratio, Cystatin C, C-reactive protein, interleukin-1β, and tumor necrosis factor-α, and increased levels of high-density lipoprotein and estimated glomerular filtration rate after treatment (P<0.05) . Moreover, DN patients with microbiota-modulating agents treatment showed lower numbers of Enterococcus (Z=16.482, P<0.001) and Enterobacter (Z=5.138, P<0.001) colonies, and higher numbers of Bifidobacterium (Z=2.470, P=0.014) , and Lactobacillus (Z=8.384, P<0.001) colonies after treatment.

The number of Enterococcus and Enterobacter colonies decreased and that of Bifidobacterium and Lactobacillus colonies increased in DN patients after treatment with microbiota-modulating agents, indicating that these agents could improve the gut flora.

The quality of life of patients with nephrotic syndrome requires a lot of focus, and improvements. A relevant scale can be used to measure it, but there is no nephrotic syndrome-specific quality of scale.

To develop a Quality of Life Instruments for Chronic Diseases-Nephrotic Syndrome〔QLICD-NS (V2.0) 〕 combined with QLICD-GM (V2.0), then verify it using the classical test theory.

From 2017 to 2021, an item pool was established according to literature review and the results of a semi-structured questionnaire, then the items were screened in accordance with a pre-test and importance score rated by physicians and patients, after that, the draft of the QLICD-NS (V2.0) was developed. The draft version was tested using onsite interview and questionnaire survey in nephrotic syndrome patients treated in Department of Nephrology, the Affiliated Hospital of Guangdong Medical University from March to November 2021. The first measurement was conducted on the day of admission, the second measurement was conducted with some of the patients, and the third measurement was conducted on the day of discharge. The coefficient of variation, correlation coefficient and Cronbach's α, factor analysis and classical test theory were used to evaluate QLICD-NS (V2.0) .

The QLICD-NS (V2.0) contains 15 items, belonging to three domains of clinical symptoms, adverse drug reactions and psychological effects. The Cronbach's α measuring the split-half reliability was greater than 0.7 for the scale and each of the three domains. With the Chinese version of SF-36 as the calibration standard, the domains of the QLICD-NS (V2.0) were highly correlated with their counterpart domains of the Chinese version of SF-36. The standardized response mean was greater than 0.80 for all domains and items (except for the cognition and social support items), indicating that the responsiveness of the QLICD-NS (V2.0) was good. Scanning the QR code in the text can obtain the detailed evaluation of the scale.

The QLICD-NS (V2.0) compiled by us includes 15 items, and has proven with good reliability, validity and responsiveness.

From previous studies, the frequency of administration of recombinant human erythropoietin injection (rHuEPO) has no association with its therapeutic effect in renal anemia in chronic kidney disease (CKD), and there is no significant difference in the efficacy between weekly single dosing and divided dosing. Most hemodialysis patients are clinically treated with moderate-dose rHuEPO, but there is a lack of research on the safety of single and divided administration of moderate-dose rHuEPO.

To compare the safety between weekly single and divided administration of moderate-dose rHuEPO for renal anemia in maintenance hemodialysis patients.

This study was designed as a randomized, parallel-group controlled, non-inferiority clinical trial. Eighty-eight patients with renal anemia who underwent maintenance hemodialysis at the Hemodialysis Room, Tongzhou Branch, Dongzhimen Hospital, Beijing University of Chinese Medicine from January 2019 to May 2021 were selected and randomly divided into an experimental group and a control group with 44 in each. For comparing the safety and efficacy of weekly single and divided administration of moderate-dose rHuEPO, 29 cases (experimental subgroup 1) and other 15 cases (experimental subgroup 2) in the experimental group received an rHuEPO dose of 6 000 U, and an rHuEPO dose of 4 000 U, once a week, respectively; 30 cases (control subgroup 1) in the control group received a single rHuEPO dose of 2 000 U, three times a week (6 000 U per week in total), and other 14 cases (control subgroup 2) received a single rHuEPO dose of 2 000 U, twice a week (4 000 U per week in total) .

Safety analysis: two-factor repeated-measures ANOVA showed that the type of intervention scheme and duration had no interaction effects on systolic blood pressure, diastolic blood pressure, mean arterial pressure, and pre-dialysis serum potassium between experimental subgroup 1 and control subgroup 1, and between experimental subgroup 2 and control subgroup 2 (P>0.05), and produced no main effects on systolic blood pressure, diastolic blood pressure, mean arterial pressure, and pre-dialysis serum potassium in experimental subgroup 1 and control subgroup 1, and between experimental subgroup 2 and control subgroup 2 (P>0.05). The serum levels of AST, ALT and TBiL were similar between experimental subgroup 1 and control subgroup 1 at baseline and 12 weeks of treatment (P>0.05). Likewise, they were similar between experimental subgroup 2 and control subgroup 2 at baseline and 12 weeks of treatment (P>0.05). No thromboembolic, cardiovascular or cerebrovascular events and gastrointestinal reactions related to rHuEPO occurred in any of the subgroups during the 12-week treatment. Efficacy analysis: the hemoglobin level (reference range was 110-130 g/L) in experimental subgroup 1 〔65.5% (19/29) 〕was similar to that in control subgroup 1 〔73.3% (22/30) 〕at 12 weeks of treatment (χ^2=0.425, P=0.514). The serum levels of hemoglobin were similar between experimental subgroup 2 and control subgroup 2 at 12 weeks of treatment (P>0.05). The levels of red blood cell count, hematocrit, percentage and absolute number of reticulocytes, ferritin and transferrin saturation did not vary between experimental subgroup 1 and control subgroup 1, and between experimental subgroup 2 and control subgroup 2 either at baseline or 12 weeks of treatment (P>0.05) .

Weekly single and divided administration of moderate-dose erythropoietin had no significant difference in medication safety in the treatment of renal anemia in maintenance hemodialysis patients.

As the most common clinical manifestation and a major complication in chronic kidney disease, anemia affects the patients' quality of life, increases the risk of renal disease progression and death. Hence, it is important to improve anemia, and monitor and evaluate drug efficacy and safety in the treatment of renal anemia.

To compare the efficacy and safety between roxadustat and erythropoiesis stimulating agents (ESAs) in treating renal anemia in patients with dialysis-dependent chronic kidney disease.

We searched PubMed, FMRS, Wanfang Data and ClinicalTrials.gov from inception to January 19, 2022 for randomized controlled trials (RCTs) about maintenance hemodialysis patients with dialysis duraion≥3 months treated with oral roxadustat (experimental group), versus injection of ESAs (control group). Two researchers independently conducted literature screening, data extraction and quality evaluation. Meta-analysis was performed using Review Manager 5.3.

A total of 5 studies with 6 RCTs were included, involving 901 patients (549 in the experimental group and 352 in the control group). Meta-analysis showed that roxadustat was superior to ESAs in improving the levels of serum iron〔MD=2.49, 95%CI (0.82, 4.16), P=0.004〕, transferrin〔MD=0.31, 95%CI (0.17, 0.44), P<0.000 01〕, total iron-binding capacity〔MD=7.51, 95%CI (5.01, 10.01), P<0.000 01〕. The incidence of adverse events did not differ significantly between the two groups〔RR=1.10, 95%CI (0.99, 1.22), P=0.07〕.

Roxadustat demonstrates better effects than ESAs in increasing the levels of serum iron, transferrin and total iron-binding capacity, without increasing the risk of adverse events during a short-term duration of use.

The number of studies about the status of intestinal flora in children with Henoch-Sch?nlein purpura (HSP) is limited, and there are no reports on changes of intestinal flora in children with Henoch-Sch?nlein purpura nephritis (HSPN) at the early stage of the disease.

To investigate the changes of intestinal flora in HSPN children and their association with the development of the disease.

Thirty-seven newly treated children with HSP (test group) were selected from Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University from July to September 2019, and compared to 12 healthy children (control group) in terms of the status of intestinal flora. The test group was further divided into non-renal injury subgroup (13 cases) and renal injury subgroup (24 cases) according to the prevalence of renal injury during a 6-month follow-up. General data and stool specimens were collected from the affected children and healthy children. High-throughput sequencing was used to sequence and analyze the intestinal flora of all subjects. Alpha diversity (Shannon index, Chao1 index, ACE index) analysis was used to explore the richness and diversity of the microbial communities within the samples. Principal coordinate analysis (PCoA) was used to explore the differences in community structure among the groups, linear discriminant analysis effect size (LEfSe) analysis were used to identify species with significant differences.

Alpha diversity analysis results showed that there was no statistically significant difference in Shannon index, Chao1 index and ACE index among the three groups (P>0.05). PCoA showed that the composition of intestinal flora varied across renal injury and non-renal injury subgroups and the control group (P<0.05). Further Adonis analysis revealed that the intestinal flora composition varied significantly between non-renal injury subgroup and the control group (F=2.172, P=0.006), and between renal injury subgroup and the control group (F=2.217, P=0.006), as well as between renal injury and non-renal injury subgroups (F=1.590, P=0.045). LEfSe analysis showed, compared with the control group, the test group had significantly decreased abundance of Blautia, Chryseobacterium, Agathobacter and Roseburia (P<0.05), and significantly increased abundance of Megamonas and Enterococcus (P<0.05). Compared with non-renal injury subgroup, renal injury subgroup had significantly reduced abundance of Christensenella and Bacteroides (P<0.05), and significantly increased abundance of Lactobacillus and Rothia (P<0.05) .

Intestinal flora disorders were found in HSP children, the intestinal flora of children with HSPN at the early stage of the disease were different from those of HSP children without renal injury, suggesting that the intestinal flora disorder at the early stage of the disease may be closely related to the development of HSPN.

Estimated glomerular filtration rate (eGFR) is a quantitative indicator assessing the severity of chronic kidney disease. Studies have shown that elevated glucose in prediabetic period increases the risk of chronic kidney disease, but its direct effect on eGFR has been less reported.

To investigate the effect of fasting blood glucose level on eGFR in a community-dwelling population with impaired fasting glucose (IFG) .

Participants (n=28 601) were selected from a group of physical examinees from Physical Examination Center, the Second Affiliated Hospital of Nanchang University during January to December 2020 according to the inclusion criteria and exclusion criteria. Demographic and clinical data〔past medical history, sex, age, BMI, blood pressure, serum uric acid, lipids, and creatinine, fasting plasma glucose (FPG) , routine urine parameters〕were collected and compared between subjects with elevated FPG (5.6 mmol/L≤FPG<7.0 mmol/L) and those with normal FPG (3.9 mmol/L≤FPG<5.6 mmol/L) . The influence of FPG on eGFR was assessed by the Mann-Whitney U-test comparing multiple factors〔sex, age, mean arterial pressure (MAP) , serum uric acid, total cholesterol, BMI〕 between subjects with elevated and normal FPG after matching. The correlation between FPG and eGFR was assessed in subjects with elevated and normal FPG before and after matching.

There were 25 539 individuals with normal FPG, and 3 062 with elevated FPG. There were significant difference in age, MAP, serum uric acid, total cholesterol, BMI and eGFR between the two groups (P<0.05) . Individuals with elevated FPG had higher eGFR than those with normal eGFR (P<0.05) after matching age, MAP, serum uric acid, total cholesterol, and BMI between the two groups (P<0.05) . Correlation analysis showed that FPG had a weak negative correlation with eGFR in all participants (r_s=-0.047, P<0.05) , but had a weak positive correlation with eGFR in the matched population (r_s=0.065, P<0.05) , and the correlation coefficient increased further in the matched individuals with elevated FPG (r_s=0.127, P<0.05) .

IFG may be associated with elevated eGFR, which provides a possible basis for the glomerular hyperfiltration state that occurs with elevated glucose in prediabetes.