Type 2 diabetic nephropathy (T2DN) is a major chronic complication of type 2 diabetes mellitus (T2DM) and a leading cause of end-stage kidney disease and cardiovascular disease. It imposes a substantial disease burden on patients and society, representing a growing global public health challenge.

This study aims to analyze the trends in the disease burden of T2DN in China using data from the Global Burden of Disease (GBD), and predict its trajectory to 2050, thus providing evidence for public health policies and prevention and control strategies.

Data on T2DN in China from 1990 to 2021 were extracted from the GBD 2021, including incidence, prevalence, disability-adjusted life years (DALYs), and mortality rates. The estimated annual percentage change (EAPC) was used to evaluate the trends of these indicators by sex and age groups. The autoregressive integrated moving average (ARIMA) and exponential smoothing (ES) models were employed for time-series forecasting. Model prediction accuracy was assessed using the absolute percentage error (APE) .

From 1990 to 2021, the age-standardized incidence rate of T2DN in China showed an increasing trend (EAPC=0.42%, 95%CI=0.34% to 0.50%), while the age-standardized prevalence rate (EAPC=-0.24%, 95%CI=-0.39% to -0.10%), DALY rate (EAPC=-0.70%, 95%CI=-0.80% to -0.60%), and mortality rate (EAPC=-0.57%, 95%CI=-0.66% to-0.49%) showed decreasing trends. Stratified by sex, the increase in age-standardized incidence was greater in females (EAPC=0.6%, 95%CI=0.49% to 0.71%) than in males (EAPC=0.23%, 95%CI=0.17% to 0.29%). The decrease in age-standardized prevalence was more pronounced in males (EAPC=-0.27%, 95%CI=-0.41% to -0.13%) than in females (EAPC=-0.22%, 95%CI=-0.37% to -0.07%). Age-standardized DALY and mortality rates decreased significantly in females (DALY rate EAPC=-1.13%, 95%CI=-1.25% to -1.02%; mortality EAPC=-1.10%, 95%CI=-1.20% to -1.01%), with smaller changes observed in males (DALY rate EAPC=-0.28%, 95%CI=-0.40% to -0.15%; mortality EAPC=-0.06%, 95%CI=-0.19% to 0.08%). Age-specific analysis revealed that all disease burden indicators increased with age, with a heavy burden on the elderly, and incidence and DALY rates showed an upward trend in some older age groups. The ARIMA model predicted that by 2050, the male age-standardized incidence rate, prevalence, DALY rate and mortality rate were predicted to be 27.34/100 000, 877.11/100 000, 140.79/100 000, and 7.64/100 000, respectively. For females, the age-standardized rates were predicted to be 18.17/100 000 (incidence), 938.24/100 000 (prevalence), 69.66/100 000 (DALYs), and 4.77/100 000 (mortality). The ES model predicted that by 2050, male age-standardized rates would be 19.57/100 000 (incidence), 1 055.85/100 000 (prevalence), 140.38/100 000 (DALYs), and 7.30/100 000 (mortality). For females, the age-standardized rates were predicted to be 16.49/100 000 (incidence), 1 092.09/100 000 (prevalence), 105.84/100 000 (DALYs), and 5.16/100 000 (mortality). Model error assessment showed that the ES model had smaller errors for most age-standardized rates and prevalence cases, while the ARIMA model had relatively smaller errors for some case number indicators and the female age-standardized mortality rate.

From 1990 to 2021, the overall age-standardized disease burden of T2DN in China improved, particularly in the mortality and DALY rates. However, the age-standardized incidence rate continued to rise, with an increasingly evident trend of the disease burden concentrating in the elderly population. This study predicts that new cases in China will continue to increase until 2050. Therefore, precision prevention and control strategies targeting high-risk groups (especially the elderly and males) should be developed, and the core role of general practice in chronic disease management must be strengthened to address future public health challenges.

Diabetic nephropathy (DN) is the common microvascular complication of diabetes mellitus, and also one of the main causes of end-stage renal disease. Renal biopsy is the gold standard for the pathological diagnosis of DN. Previous studies on traditional Chinese medicine (TCM) factors influencing DN lack the basis of renal biopsy, potentially leading to an inaccurate participant recruitment (selection bias) .

To investigate the distribution of TCM syndrome types in DN patients and the relevant TCM syndrome elements in those with massive proteinuria and renal insufficiency, thereby providing TCM research directions in the pathogenesis of DN.

From January 2022 to January 2024, TCM and clinical data of 78 patients diagnosed with type 2 diabetes mellitus (T2DM) with a confirmation of DN through renal biopsy in the Department of Nephrology of First Medical Center of Chinese PLA General Hospital were included. The distribution and clinical characteristics of TCM syndrome types were explored. Binary Logistic regression was employed to explore the TCM syndrome elements associated with massive proteinuria (24-hour urinary protein quantification>3.5 g) and estimated glomerular filtration rate (eGFR) <60 mL·min^-1· (1.73 m²) ^-1 in DN patients.

According to the classification of chronic kidney disease (CKD), there were 11 cases in stageⅠgroup, 19 in stageⅡgroup, 22 in stageⅢgroup, 21 in stageⅣgroup, and 5 in stageⅤgroup. There were significant differences in hemoglobin, eGFR, serum albumin, serum creatinine, serum urea nitrogen, and 24-hour urinary protein in DN patients with different CKD stages groups (P<0.05). Based on the TCM syndrome, there were 11 cases of Yin deficiency and dry heat syndrome, 23 of syndrome of deficiency of both Qi and Yin, 15 of liver-kidney Yin deficiency syndrome, and 29 of spleen-kidney Yang deficiency syndrome. Significant differences were found in hemoglobin, eGFR, serum total protein, serum albumin, serum creatinine, and serum urea nitrogen among DN patients with varying TCM syndrome types (P<0.05). There was a significant difference in the distribution of TCM syndrome types among DN patients in stageⅠ-Ⅴ CKD (P<0.05). In the stageⅠ group, the proportions of Yin deficiency and dry heat syndrome (5/11, 45.5%) and syndrome of deficiency of both Qi and Yin (3/11, 27.3%) were relatively high. In the stage Ⅱ group, the proportions of syndrome of deficiency of both Qi and Yin and liver-kidney Yin deficiency syndrome were 42.1% (8/19) and 31.6% (6/19) respectively. In the stageⅢ group, spleen-kidney Yang deficiency syndrome and syndrome of deficiency of both Qi and Yin accounted for 54.5% (12/22) and 31.8% (7/22), respectively. In the stageⅣ group, spleen-kidney Yang deficiency syndrome and liver-kidney Yin deficiency syndrome accounted for 52.4% (11/21) and 28.6% (6/21), respectively. In the stage Ⅴ group, spleen-kidney Yang deficiency syndrome occupied the highest proportion (3/5, 60.0%). Correspondence analysis indicated that Yin deficiency and dry heat syndrome, syndrome of deficiency of both Qi and Yin, and spleen-kidney Yang deficiency syndrome corresponded to CKD stageⅠ, Ⅱ andⅤ, respectively. Yang deficiency syndrome (OR=3.545, 95%CI=1.270-9.895, P=0.016) and heart location of disease (OR=3.208, 95%CI=1.082-9.511, P=0.035) were the influencing factors of DN combined with massive proteinuria. Yang deficiency syndrome (OR=3.000, 95%CI=1.141-7.890, P=0.026) was the influencing factor of DN combined with eGFR<60 mL·min^-1· (1.73 m^{2) -1}.

The distribution of TCM syndromes of DN transits from Yin deficiency and Qi deficiency to Yang deficiency with the worsening of CKD staging. Yang deficiency syndrome and disease location of heart are factors influencing DN with massive proteinuria, and Yang deficiency syndrome is influencing factor for DN with eGFR<60 mL·min^-1· (1.73 m^{2) -1.} TCM syndrome differentiation combined with modern medicine is conducive to grasping the pathogenesis of DN and advantaging integrated TCM and Western medicine diagnosis and treatment.

Understanding the condition and influencing factors of cognitive impairment in maintenance hemodialysis (MHD) patients could signficantly enhance their quality of life while alleviating the burden on their families and society.

TO investigate the status of cognitive impairment in MHD patients and explore the possible influencing factors.

Using convenience sampling, we selected MHD patients from three hemodialysis centers (including the Department of Nephrology at the First Affiliated Hospital of Shihezi University, the Department of Nephrology at Shihezi People's Hospital, and the Langshen Hemodialysis Center) in Shihezi City between April 2023 and April 2024. We collected data on demographic characteristics, cognitive impairment levels, sleep quality, independent living abilities, serum levels of α-Klotho, β-Klotho, FGF-23, and other common laboratory indicators. Cognitive function was assessed with the Montreal Cognitive Assessment (MoCA), sleep quality was evaluated with the Athens Insomnia Scale (AIS-8), and independent living ability was assessed using the Functional Activities Questionnaire (FAQ). Serum levels of α-Klotho, β-Klotho, and FGF-23 were measured by the ELISA method. Univariate and multivariate Logistic regression analyses were performed to identify influencing factors, which were validated for their predictive value on cognitive impairment using the receiver operating characteristic (ROC) curve. A nomogram was subsequently plotted.

A total of 276 MHD patients were surveyed, revealing a cognitive impairment incidence rate of 76.4% (211/276). Among these, 145 patients had mild cognitive impairment and 66 patients had moderate cognitive impairment. Nearly half of the patients exhibited suspected insomnia (21.4%) or confirmed insomnia (25.4%). Among the patients studied, 14.9% (41 out of 276) lacked the ability to live independently. The multivariate Logistic regression analysis indicated that age (OR=1.038, 95%CI=1.004-1.072) and sleep disorders (OR=1.179, 95%CI=1.051-1.322) were risk factors for cognitive impairment in MHD patients (P<0.05). High serum α-Klotho levels (OR=0.996, 95%CI=0.994-0.998), high serum β-Klotho levels (OR=0.750, 95%CI=0.661-0.852), and higher years of education (OR=0.800, 95%CI=0.699-0.915) were protective factors (P<0.05). The area under the ROC curve (AUC) showed that age (AUC=0.732, 95%CI=0.667-0.797), sleep disorder (AUC=0.710, 95%CI=0.638-0.783), α-Klotho (AUC=0.774, 95%CI=0.709-0.839), β-Klotho (AUC=0.741, 95%CI=0.663-0.819) and years of education (AUC=0.718, 95%CI=0.647-0.789) had predictive value for cognitive impairment in MHD patients. The combination of age, sleep disorder, serum α-Klotho, serum β-Klotho and years of education (P=-0.004×α-Klotho-0.287×β-Klotho+0.370×age-0.223×years of education +0.165×AIS-8 score+6.658) predicted the occurrence of MHD. The AUC of cognitive impairment was 0.894 (95%CI=0.851-0.937, P<0.001), the sensitivity was 82.9%, and the specificity was 78.5%.

The prevalence of cognitive impairment among MHD patients is substantially high, estimated at approximately 76%. Age, sleep disorders, years of education, and levels of α-Klotho and β-Klotho are important influencing factors. Medical staff and patients' families should raise awareness of cognitive impairment, actively screen and intervene in key patients to improve their quality of life and reduce the burden on their families and society.

Finerenone, a nonsteroidal mineralocorticoid antagonist, is a novel therapeutic agent for renal protection in patients with diabetic kidney disease, joining the ranks of angiotensin-converting enzyme inhibitors and sodium-glucose cotransporter 2 inhibitors in providing renal protection for such patients. Recently, two meta-analyses focusing on patients with chronic kidney disease have yielded conflicting conclusions regarding the impact of finerenone on the decline of estimated glomerular filtration rate (eGFR) . In light of this, the present meta-analysis specifically targets the population with type 2 diabetes, aiming to thoroughly investigate the efficacy and safety of finerenone.

To systematically evaluate the efficacy and safety of finerenone in patients with type 2 diabetes and kidney disease.

A computerized search was conducted in the Cochrane Library, Web of Science, Embase, and PubMed databases, covering the period from their inception to April 2024. Literature was screened and data extracted according to the inclusion and exclusion criteria. Meta-analysis was performed using Revman 5.3, comparing indicators such as the urine albumin-to-creatinine ratio and estimated glomerular filtration rate in type 2 diabetes patients treated with finerenone.

A total of 7 articles were ultimately included, involving 15 528 patients. The results showed that compared with the control group, intervention group (using finerenone) had statistically significant differences in the urine albumin-to-creatinine ratio (SMD=-0.46, 95%CI=-0.48 to -0.39, P<0.05) , estimated glomerular filtration rate (SMD=-0.15, 95%CI=-0.19 to -0.10, P<0.05) , renal composite endpoint (OR=0.83, 95%CI=0.75 to 0.92, P<0.05) , all-cause mortality (OR=0.88, 95%CI=0.78 to 0.99, P<0.05) , and end-stage renal disease (OR=0.88, 95%CI=0.78 to 0.99, P<0.05) . Compared with the control group, intervention group significantly increased the risk of hyperkalemia (OR=2.13, 95%CI=1.89 to 2.39, P<0.05) .

Finerenone can significantly improve renal composite endpoint events in patients with type 2 diabetes and kidney disease, reduce the urine albumin-to-creatinine ratio, and slow down the decline of estimated glomerular filtration rate; however, attention should be paid to the risk of hyperkalemia during treatment.

Hypertensive nephropathy, a common chronic kidney disease, is a significant contributor to end-stage renal disease. Analyzing and predicting its epidemiological trends is crucial for the prevention and control of chronic kidney disease.

This study aims to analyze the temporal trends in the incidence and mortality of hypertensive nephropathy in China from 1990 to 2021 and to provide a theoretical basis for developing prevention and control strategies.

Data on the incidence and mortality of hypertensive nephropathy in China were obtained from the Global Burden of Disease (GBD) 2021 database. Joinpoint regression models were used to analyze the average annual percentage change (AAPC) in incidence and mortality. Age-period-cohort models were applied to estimate the age, period, and cohort effects by gender. Bayesian age-period-cohort (BAPC) methods were employed to predict the standardized incidence and mortality rates for both genders from 2022 to 2032.

After age standardization, the age-standardized incidence rates (ASIR) for both males and females showed a slight decline from 1990 to 1995, followed by a gradual increase. The age-standardized mortality rate (ASMR) for males decreased from 5.44 per 100 000 in 1990 to 4.72 per 100 000 in 2021, while for females, it decreased from 3.86 per 100 000 to 2.75 per 100 000, with a more pronounced decline in females. Joinpoint regression analysis indicated an overall increasing trend in ASIR (AAPC for males: 0.43%, females: 0.64%, P<0.05). The fastest decline in male ASIR occurred from 1990 to 1992 (APC=-1.62%, P<0.05), while the fastest increase was from 2019 to 2021 (APC=1.30%, P<0.05). For females, the fastest decline in ASIR was from 1990 to 1995 (APC=-1.31%, P<0.05). Overall, the ASMR rate showed a decreasing trend (AAPC for males: -0.51%, females: -1.09%, P<0.05), with a more significant decline in females. The fastest decline in male ASMR was from 2004 to 2007 (APC=-3.26%, P<0.05), while the fastest increase was from 1998 to 2004 (APC=1.30%, P<0.05). For females, the fastest decline in ASMR was also from 2004 to 2007 (APC=-4.47%, P<0.05). Age-period-cohort analysis revealed that males generally had higher incidence and mortality rates than females across all age groups, with rates increasing with age. The incidence growth accelerated after age 60-65, and mortality growth accelerated after age 70. The period effect on incidence risk was slightly higher in females than in males, while the cohort effect showed an overall increasing trend in incidence and a decreasing trend in ASMR for both genders. Predictions from 2022 to 2032 indicate a continued rise in ASIR and a sustained decline in mortality for both genders.

From 1990 to 2021, the ASIR of hypertensive nephropathy in China showed an overall upward trend, while ASMR decreased. Both incidence and mortality increased with age, particularly in the elderly. Over the next decade, ASIR is expected to continue rising, while ASMR will decline slowly. These findings suggest a need to focus on male and elderly patients in developing targeted prevention and control measures.

Arteriovenous fistula is the primary vascular access for patients on maintenance hemodialysis. Mean platelet volume (MPV) is a biomarker for cardiovascular events and MPV has been identified as an independent risk factor for myocardial infarction, stroke, and venous thromboembolism. Whether MPV is a risk factor for vascular access events in patients with maintenance hemodialysis (MHD) is unclear.

To explore the correlation between MPV levels and the risk of vascular access events in MHD patients.

343 patients who underwent MHD at the Blood Purification Center of the Fourth Hospital of Hebei Medical University from September 1st to 15th, 2020 were selected for the study. The follow-up cutoff was 2021-09-15, and the endpoint events were the occurrence of a vascular access event (stenosis or thrombosis of the arteriovenous fistula) or the patient's death. Patients were categorized into 4 groups according to the quartiles of MPV values of the included patients: group Q1 (MPV: 6.1-8.1 fL), group Q2 (MPV: 8.2-8.8 fL), group Q3 (MPV: 8.9-9.6 fL), and group Q4 (MPV: 9.7-14.1 fL). The general conditions, laboratory tests, incidence of arteriovenous fistula thrombosis and stenosis, and other relevant data of MHD patients in the 4 groups were compared. Kaplan-Meier survival curves were used to analyze the incidence of vascular access events in MHD patients, and Log-rank test was used for comparison between groups. The correlation between MPV and the risk of vascular access events in MHD patients was analyzed using multiple Cox proportional risk regression models, and further subgroup analyses were performed based on stratified characteristics.

Vascular access events occurred in 60 (17.5%) of 343 MHD patients, and the incidence rates of vascular access events in MHD patients in the Q4, Q3, Q2, and Q1 groups were 33.7% (29/86), 17.8% (16/90), 12.2% (10/82), and 5.9% (1/85), respectively. The results of the Kaplan-Meier survival curve analyses showed that, when comparing the incidence rates of vascular access events in the 4 groups of MHD patients, the difference was statistically different (χ²=25.693, P<0.05). After correcting for confounders, elevated MPV levels remained a risk factor for the risk of vascular access events in MHD patients (HR=1.59, 95%CI=1.28-1.97, P<0.001). Subgroup analyses showed no interaction between subgroups except for the diabetes subgroup (P_interaction>0.05) .

Elevated MPV levels may be a risk factor for the risk of vascular access events in patients with MHD, providing a reference index for clinicians to predict the risk of vascular access events.

The incidence and prevalence of chronic kidney disease (CKD) remain high. Hypertension and diabetes frequently coexist and jointly accelerate the progression of kidney disease. The lipid accumulation product index (LAPI) is a novel indicator for predicting cardiovascular disease and abnormalities in glucose metabolism, and its relationship with CKD warrants further investigation.

This study aimed to investigate the relationship between LAPI and the risk of developing CKD in patients with hypertension and abnormal glucose metabolism.

A retrospective cohort of 2 033 patients with hypertension and abnormal glucose metabolism admitted to the Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region from January 2012 to May 2019 was enrolled. General patient information and laboratory test indicators were collected. The LAPI was calculated, and the population was divided into four groups based on LAPI quartiles: Q1 (LAPI≤44.03, n=509), Q2 (44.03<LAPI≤64.68, n=508), Q3 (64.68<LAPI≤98.90, n=508), and Q4 (LAPI>98.90, n=508). Patients were followed up, with the endpoint event being CKD. Kaplan-Meier curves were used to analyze the cumulative incidence of CKD at different LAPI levels, and the Log-rank test was used to compare differences. Multivariate Cox regression models were employed to analyze the relationship between LAPI and CKD. Restricted cubic splines were fitted to the multivariate Cox regression model to explore the dose-response relationship between LAPI and CKD. Subgroup analysis and sensitivity analysis were conducted to test the stability of the relationship between LAPI and CKD.

Significant differences were observed in age, gender, BMI, waist circumference, heart rate, diastolic blood pressure, smoking, alcohol consumption, uric acid, total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, glycated hemoglobin, fasting blood glucose, use of calcium channel blockers, and hypoglycemic treatment among the 4 groups (P<0.05). Log-rank test results indicated that the cumulative risk of CKD increased with elevating LAPI levels (χ²=14.48, P<0.001). Multivariate Cox regression analysis revealed that for each standard deviation increase in LAPI, the hazard ratio (HR) for CKD increased by 12.5% (HR=1.125, 95%CI=1.035-1.223, P=0.005) ; compared to the Q1 group, the Q4 group had a 54.9% higher risk of CKD (HR=1.549, 95%CI=1.129-2.125, P=0.007). Restricted cubic spline regression analysis showed that LAPI>65.59 was a risk factor for CKD (P=0.007). Interaction and subgroup analyses revealed that the association between LAPI and the risk of developing CKD remained stable.

In patients with hypertension and abnormal glucose metabolism, a higher LAPI in the early stages increases the risk of developing CKD.

Previous studies have found that increased neutrophil and monocyte counts and decreased high-density lipoprotein cholesterol are associated with ST-segment elevation myocardial infarction (STEMI), however, the correlation of Neutrophil-to-lymphocyte ratio (NLR) and Monocyte count-to-high-density lipoprotein cholesterol ratio (MHR) with the occurrence of contrast nephropathy (CIN) in emergency percutaneous coronary intervention (PCI) has been less well studied.

To investigate the predictive value of NLR, MHR, and the combination of both on CIN after emergency PCI in STEMI patients.

437 STEMI patients who underwent emergency PCI at Northern Jiangsu People's Hospital Affilated to Yangzhou University from 2019 to 2022 were selected for the study, and the enrolled patients were divided into the CIN group (65 patients) and the non-CIN group (372 patients) according to whether they developed CIN after surgery. The general data and laboratory examination indexes of patients were collected, the values of NLR and MHR were calculated, and the clinical data of patients in the 2 groups were compared. Univariate and multivariate Logistic regression analyses were used to screen the independent risk factors for the development of CIN after PCI in STEMI patients. The working characteristics (ROC) curves of subjects with NLR, MHR and both in combination were plotted to predict the occurrence of CIN after PCI in STEMI patients, and the area under the ROC curve (AUC) was calculated to assess the predictive efficacy of NLR, MHR and both in combination for the occurrence of CIN.

Patients in the CIN group had higher levels of history of type 2 diabetes, diuretic use, leukocyte counts, neutrophil counts, monocyte counts, fasting glucose, NLR, and MHR than those in the non-CIN group, and lower levels of hemoglobin, lymphocyte counts, and creatinine than those in the non-CIN group (P<0.05). The results of multivariate Logistic regression analysis showed that the history of type 2 diabetes (OR=1.997, 95%CI=1.063-3.751, P=0.032), monocyte count (OR=2.372, 95%CI=1.060-5.310, P=0.036), NLR (OR=1.311, 95%CI=1.171-1.468, P<0.001), and elevated levels of MHR (OR=7.075, 95%CI=1.893-26.439, P=0.004) as independent risk factors for postoperative CIN after emergency PCI in patients with STEMI. The results of the ROC curves showed that the NLR, MHR, and the combination of the two predicted postoperative CIN after emergency PCI in patients with STEMI with an AUC were 0.733 (95%CI=0.669-0.796, P<0.001), 0.706 (95%CI=0.633-0.779, P<0.001), and 0.796 (95%CI=0.740-0.852, P<0.001), respectively; and the sensitivities were 66.2%, 60.0%, and 69.2%, respectively; The specificity was 71.8%, 75.3%, and 73.1%, respectively.

History of type 2 diabetes, elevated monocyte count, NLR, and MHR levels are independent risk factors for the development of CIN after emergency PCI in STEMI patients; NLR, MHR, and the combination of both can be used as early biomarkers to effectively identify the development of CIN after emergency PCI in STEMI patients.

Acute kidney injury (AKI) is one of the most common complications of acute respiratory distress syndrome (ARDS) and significantly increases the mortality rate of ARDS patients. Currently, the clinical understanding of ARDS complicated with AKI, effective prevention and treatment measures are not enough. Exploring the possible predictors is significant for early evaluation and effective intervention measures to reduce the incidence and mortality of AKI in ARDS.

To systematically evaluate the risk factors of AKI in ARDS.

PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data, VIP and SinoMed were searched for literatures on risk factors of AKI in ARDS from inception to December 2023. Two researchers independently screened the literatures according to the inclusion and exclusion criteria, extracted data and assessed the quality of included literatures. RevMan 5.3 software was used for Meta-analysis.

A total of 17 studies involving 6 160 patients were included. Meta-analysis demonstrated that: being older (OR=1.02, 95%CI=1.00-1.03, P=0.007), higher Sequential Organ Failure Assessment (SOFA) scores (OR=1.17, 95%CI=1.05-1.30, P=0.004), diabetes (OR=1.40, 95%CI=1.09-1.80, P=0.008), hypertension (OR=1.56, 95%CI=1.26-1.93, P<0.001), atrial fibrillation (OR=1.76, 95%CI=1.09-2.85, P=0.020), chronic kidney disease (OR=10.31, 95%CI=3.30-32.19, P<0.001), higher neutrophil to lymphocyte ratio (NLR) (OR=1.02, 95%CI=1.00-1.05, P=0.030), higher angiopoietin 2 (Ang-2) (OR=1.84, 95%CI=1.73-1.95, P<0.001), aspartate aminotransferase (AST) >40 U/L (OR=2.27, 95%CI=1.56-3.31, P<0.001), lower arterial blood pH (OR=0.83, 95%CI=0.75-0.92, P=0.000 6), lower glomerular filtration rate (GFR) (OR=0.92, 95%CI=0.75-0.99, P=0.020), mechanical ventilation (OR=2.53, 95%CI=1.96-3.26, P<0.001) and extracorporeal membrane oxygenation (ECMO) (OR=1.81, 95%CI=1.43-2.28, P<0.001) were risk factors for AKI in ARDS. However, gender (OR=1.17, 95%CI=0.82-1.67, P=0.390), BMI (OR=1.27, 95%CI=0.77-2.09, P=0.350), obesity (OR=5.88, 95%CI=0.51-68.28, P=0.160), Acute Physiology and Chronic Health Evaluation Ⅱ scores (OR=1.20, 95%CI=0.99-1.46, P=0.060), heart failure (OR=4.49, 95%CI=0.58-34.70, P=0.150), disturbance of consciousness (OR=1.83, 95%CI=0.88-3.84, P=0.110), pleural effusion (OR=1.16, 95%CI=0.81-1.65, P=0.410), oxygenation index (OR=4.30, 95%CI=0.69-26.77, P=0.120), procalcitonin (OR=1.08, 95%CI=0.95-1.23, P=0.230), white blood cell count (OR=1.56, 95%CI=0.51-4.80, P=0.440) and plasma albumin (OR=1.07, 95%CI=0.97-1.17, P=0.170) were not related to AKI in ARDS.

The risk factors of AKI in ARDS involve many aspects, including general factors (being older), overall assessment (high SOFA scores), disease factors (combined with diabetes, hypertension, atrial fibrillation and chronic kidney disease), laboratory indicators (higher NLR, higher Ang-2, AST>40 U/L, lower arterial blood pH and GFR), and treatment (mechanical ventilation, ECMO). Due to the limited quantity and quality of the included studies, the above conclusion still needs to be verified by more high-quality studies in the future.

The transition stage from acute kidney injury (AKI) to chronic kidney disease (CKD) is referred to as acute kidney disease (AKD). Currently, there are relatively few studies on the intervention of traditional Chinese medicine in the progression of AKI to AKD in children.

To explore the intervention effect and impact on prognosis of Modified Shengjiang Powder on AKI and AKD in children.

A total of 136 children with AKI admitted to the Department of Pediatrics of Jinling Hospital Affiliated to Medical College of Nanjing University from June 2017 to June 2022 were selected and divided into the treatment group (65 cases) and the control group (71 cases) by random number method. The control group was treated with conventional Western medicine, while the children in the treatment group were treated with oral Modified Shengjiang Powder decoction in addition to Western medicine. Laboratory examination indicators were collected from the children at 7 days and 14 days after treatment, and the TCM syndrome score was evaluated at 14 days after treatment. The AKI children were re-evaluated after 7 days of treatment. The children were followed up for 3 to 60 months after treatment. Univariate and multivariate Cox regression analyses were used to explore the risk factors for AKI children progressing to AKD and the risk factors for AKD children progressing to CKD stage 3. The Kaplan-Meier method was used to draw the survival curve of the cumulative survival rate of the children, and the Log-rank test was used for survival curve comparison.

A total of 136 AKI children were included, including 81 boys and 55 girls, with an average age of (12.6±4.5) years. After 7 days of treatment, a total of 67 children progressed to AKD, among which 26 children in the treatment group and 41 children in the control group progressed to AKD. According to the previous AKI grouping and treatment results, the AKD children were divided into the AKD treatment sub-group (26 cases) and the AKD control sub-group (41 cases) again. After treatment, the levels of serum creatinine (Scr), blood urea nitrogen (BUN), uric acid (UA), urinary N-acetyl-β-D-glucosaminidase (NAG) enzyme, urinary retinol-binding protein (RBP), urinary neutrophil gelatinase-associated lipocalin (NGAL), TCM syndrome score, and the proportion of CKD stage 3 in the treatment group were lower than those in the control group, while the estimated glomerular filtration rate (eGFR) and the proportion of complete recovery of AKI were higher than those in the control group (P<0.05). After 14 days of treatment for AKD children, the levels of Scr, urinary NAG enzyme, urinary NGAL, the proportion of CKD stage 3, and end-stage renal disease (ESRD) in the AKD treatment sub-group were lower than those in the AKD control sub-group (P<0.05). The results of multivariate Cox regression analysis showed that urinary NAG enzyme≥9.7 U·g^-1·Cr^-1 was a risk factor for AKI children progressing to AKD (HR=2.724, 95%CI=1.886-4.519, P=0.007), and traditional Chinese medicine treatment was a protective factor for AKI children progressing to AKD (HR=0.482, 95%CI=0.319-0.843, P=0.008) ; stage 3 of AKD was a risk factor for AKD children progressing to CKD stage 3 (HR=2.865, 95%CI=2.213-3.619, P=0.011), and traditional Chinese medicine treatment was a protective factor for AKD children progressing to CKD stage 3 (HR=0.665, 95%CI=0.422-0.953, P=0.040). At the end of the treatment course, the risk of progression to AKD in the AKI treatment group was lower than that in the AKI control group (χ²=5.343, P=0.021) ; at 90 days of follow-up, the risk of progression to CKD stage 3 in the AKI treatment group was lower than that in the AKI control group (χ²=4.623, P=0.032), and the risk of progression to CKD stage 3 in the AKD treatment group was lower than that in the AKD control group (χ²=7.409, P=0.006) ; at the end of the follow-up, the renal survival rate in the AKD treatment group was higher than that in the AKD control group (χ²=8.133, P=0.004) .

MLD can delay the progression of AKI and AKD, protect renal function and improve prognosis.

Chronic kidney disease (CKD) is a public health problem that cannot be ignored in China and even in the world. At present, relevant studies on the prediction of the incidence trends of different subtypes of chronic kidney disease are rare in China.

To predict the incidence trend of five subtypes of CKD in China from 2020 to 2040, and provide reference for the prevention and control of CKD.

The age standardized incidence rate (ASIR) and cases of five subtypes of CKD in China from 1990 to 2019 were derived from the Global Burden of Disease Study (GBD) database (April 2023 to May 2023). The incidence trend of five subtypes of CKD was described and analyzed by the percentage change (%) and the average annual percentage change (AAPC). The Prophet model was used to predict the ASIR and cases of five subtypes of CKD in China from 2020 to 2040.

From 1990 to 2019, The ASIR and cases of five subtypes of CKD in China showed an upward trend. The upward trend of CKD due to hypertension is the most obvious (AAPC=0.75, P<0.05). In 2019, the ASIR and cases of CKD due to diabetes mellitus type 2, diabetes mellitus type 1, glomerulonephritis and hypertension in male were higher than female, while the ASIR and cases of CKD due to other causes in female were higher than male. The cases of CKD due to diabetes mellitus type 2, hypertension and other causes is the highest in the age group of 65-74 years old. The cases of CKD due to diabetes mellitus type 1 and glomerulonephritis were mostly concentrated in the age group under 5 years old. The prediction results showed that in 2040, the ASIR and cases of CKD due to diabetes mellitus type 2 are 23.27/10⁵ (80%UI=20.64/10⁵-26.08/10⁵) and 755 375 (80%UI=702 827-811 409) respectively, the ASIR and cases of CKD due to diabetes mellitus type 1 are 0.60/10⁵ (80%UI=0.47/10⁵-0.73/10⁵) and 10 625 (80%UI=9 519-11 787) respectively, the ASIR and cases of CKD due to glomerulonephritis were 3.88/10⁵ (80%UI=3.01/10⁵-4.79/10⁵) and 87 050 (80%UI=74 470-100 460) respectively, the ASIR and cases of CKD due to hypertension were 15.35/10⁵ (80%UI=13.53/10⁵-17.29/10⁵) and 470 214 (80%UI=437 598-504 817) respectively, and the ASIR and the CKD due to other causes were 127.68/10⁵ (80%UI=102.41/10⁵-154.68/10⁵) and 3 901 317 (80%UI=3 622 415-4 198 720) respectively.

From 1990 to 2019, The ASIR and cases of five subtypes of CKD in China showed an upward trend. From 2020 to 2040, The ASIR and cases of CKD due to diabetes mellitus type 2, hypertension and other causes in China will still show an upward trend. Though cases of CKD due to diabetes mellitus type 1 and glomerulonephritis will increase year by year, the collective ASIR will show a downward trend. In the future, relevant prevention and control strategies should be developed for different subtypes of CKD.

Chronic kidney disease (CKD) is a worldwide public health problem, stage 4 CKD is a critical stage during the course of CKD, marking the significant decline of kidney function and the obvious appearance of symptoms. Although fermented cordyceps sinensis powder has been used in the treatment of chronic kidney disease for a long time, its prognostic effect on CKD, especially the curative effect of stage 4 CKD, lacks evidence-based medical evidence.

To explore the long-term prognosis of stage 4 CKD patients treated with fermented cordyceps sinensis powder and the potential related factors affecting the prognosis.

A total of 631 patients diagnosed with stage 4 CKD in the nephrology Department of Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from 2013 to 2022 were collected. Based on standardized integrated Chinese and Western medicine treatment, patients were divided into cordyceps treatment group (339 cases) and integrated Chinese and Western medicine treatment group (252 cases) according to whether fermented cordyceps sinensis powder was used. Data such as patients' basic information, whether they were accompanied by diabetes, the occurrence and time of endpoint events, the time of diagnosis of stage 4 CKD, and relevant laboratory indicators at diagnosis were collected. After eliminating baseline differences between groups with propensity score matching, COX regression analysis was conducted to analyze potential prognostic factors. Survival curve was drawn by Kaplan-Meier method, and the difference of survival between groups was compared by Log-rank test.

A total of 378 patients were included after matching at a ratio of 1:1. Multivariate Cox proportional hazard regression analysis showed that the using of fermented cordyceps sinensis powder (HR=0.79, 95%CI=0.64-0.98, P=0.030), the increased level of estimated glomerular filtration (HR=0.97, 95%CI=0.94-1.00, P=0.025) and serum albumin (HR=0.97, 95%CI=0.96-0.99, P=0.002) prolonged the survival time of stage 4 CKD patients; male (HR=1.37, 95%CI=1.09-1.71, P=0.006), the increased level of brain natriuretic peptide (HR=1.00, 95%CI=1.00-1.00, P=0.003), blood phosphorus (HR=2.44, 95%CI=1.63-3.67, P<0.001) and 24 h urinary protein (HR=1.00, 95%CI=1.00-1.00, P<0.001) shortened the survival time of patients with stage 4 CKD. The results of survival curve analysis showed that cumulative survival rate of cordyceps treatment group was higher than that of integrated Chinese and Western medicine treatment group (HR=0.70, 95%CI=0.57-0.86, P<0.001). The cumulative survival rate in the low protein level subgroup was higher in the cordyceps treatment patients than in the integrated Chinese and western medicine treatment patients (HR=0.67, 95%CI=0.52-0.85, P<0.001). In the high urinary protein level subgroup, there was no significant difference in cumulative survival between the two treatment groups (P=0.518) .

Long-term use of fermented cordyceps sinensis powder can prolong the progression of renal function in patients with stage 4 CKD, and can play a better clinical effect under the premise of active control of urinary protein. Relatively low levels of brain natriuretic peptide and serum phosphorus, and relatively high levels of serum albumin are also potential factors for good prognosis in patients with stage 4 CKD.

Cardiovascular disease (CVD) is the primary cause of death in patients undergoing peritoneal dialysis (PD) , with malnutrition being one of the significant risk factors for both CVD and mortality. The prognostic nutritional index (PNI) serves as a comprehensive indicator of a patient's immune, inflammatory, and nutritional status. Due to its convenience and reliability, PNI has been widely used in prognostic assessments across various diseases, including cancer. Recent studies have indicated that PNI not only reflects the prognosis of PD patients but is also closely related to their cardiovascular health. However, the relationship between nutritional status at different time points and the prognosis of PD patients requires further exploration.

To explore the relationship between first-year PNI and CVD mortality in PD patients.

This multicenter, retrospective observational cohort study included 1 640 PD patients who initiated treatment between January 1, 2000, and July 1, 2019, at four medical centers: Nanfang Hospital, Southern Medical University, Shunde Hospital of Southern Medical University, the First People's Hospital of Foshan, and Ganzhou People's Hospital. Patients were followed up until July 1, 2021, with the primary endpoint being CVD mortality. A restricted cubic spline (RCS) was used to further examine the non-linear association between PNI and the risk of CVD mortality. Survival curves were generated using the Kaplan-Meier method, and receiver operating characteristic (ROC) curves for predicting CVD mortality based on PNI were analyzed, with an optimal cut-off of 40.46 dividing patients into low PNI (703 patients) and high PNI (937 patients) groups. The impact of PNI on CVD mortality was assessed using Log-rank tests and Cox regression analysis.

The median follow-up period was 30 months, during which 148 patients died, 73 of whom from CVD (49.32%) . RCS results indicated a linear association between PNI and CVD mortality events (P for Nonlinear=0.655) . The area under the ROC curve (AUC) for PNI predicting CVD mortality was 0.717 (95%CI=0.659-0.775, P<0.001) , with a sensitivity of 74.0% and a specificity of 58.6%. Kaplan-Meier analysis showed statistically significant differences in CVD survival curves between the low and high PNI groups (χ²=26.685, P<0.001) . Multivariable Cox regression analysis, adjusted for gender, age, and history of CVD, indicated that a low PNI remains an independent predictor of CVD mortality (HR=7.76, 95%CI=1.72-35.06, P=0.008) . Subgroup analysis confirmed the robustness of these findings without significant interaction effects.

A reduced PNI is an independent factor influencing CVD mortality in PD patients, making the first-year PNI score a valuable tool for prognostic assessment in PD management.

Acute kidney injury (AKI) is a common complication of sepsis. Immune-inflammatory markers are commonly used to assess the prognosis of these patients. However, studies evaluating microRNAs (miR) in this context are scarce, indicating a need for further clinical investigation.

To investigate the expression of serum amyloid A (SAA), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), and miR in pediatric patients with sepsis-induced AKI and analyze their prognostic assessment value.

This study included 100 pediatric patients with sepsis-induced AKI admitted to the First People's Hospital of Pingdingshan from March 2020 to March 2023 as the observation group, and 80 pediatric patients with sepsis alone as the control group. General patient data were collected, and serum levels of SAA, IL-6, and TNF-α were measured using enzyme-linked immunosorbent assay (ELISA). The relative expression of miR-21-3p, miR-182-5p, and miR-128-3p was quantified using real-time quantitative PCR. The Sequential Organ Failure Assessment (SOFA) score and the Acute Physiology and Chronic Health EvaluationⅡ (APACHE Ⅱ) score were compared between the groups. Pearson correlation analysis was used to evaluate the relationship between the levels of serum SAA, IL-6, TNF-α, and miRs and the SOFA and APACHEⅡ scores. Receiver operating characteristic (ROC) curves were plotted to explore the predictive value of these markers for mortality in pediatric patients with sepsis-induced AKI and to calculate the area under the ROC curve (AUC) .

The observation group showed significantly higher SOFA scores, APACHE Ⅱ scores, and levels of serum SAA, IL-6, TNF-α, miR-21-3p, miR-182-5p, and miR-128-3p compared to the control group (P<0.05). After 28 days of hospitalization, 74 patients in the observation group survived, while 26 died. Surviving patients had lower levels of serum SAA, IL-6, TNF-α, miR-21-3p, miR-182-5p, and miR-128-3p compared to those who died (P<0.05). Levels of serum SAA, IL-6, TNF-α, miR-21-3p, miR-182-5p, and miR-128-3p were positively correlated with SOFA and APACHEⅡ scores (P<0.05). ROC curve results showed a combined predictive AUC of 0.926 (95%CI=0.856-0.969, P<0.05) .

The serum levels of SAA, IL-6, TNF-α, miR-21-3p, miR-182-5p, miR-128-3p are abnormally high in children with sepsis complicated with AKI. Clinical detection of these indicators has a high value and early warning effect on the prognosis of children.

Acute ST-elevation myocardial infarction (STEMI) represents a critical cardiovascular emergency, with percutaneous coronary intervention (PCI) being the preferred treatment. Post-PCI, patients are prone to developing contrast-induced nephropathy (CIN), significantly increasing the risk of adverse events. Thus, early diagnosis and treatment are crucial.

This study aims to investigate the diagnostic value of serum levels of NOD-like receptor pyrin domain-containing 3 (NLRP3) and the dosage of contrast agents for CIN following PCI in patients with STEMI.

The study included 257 patients diagnosed with STEMI and undergoing emergency PCI at the First People's Hospital of Kashi from June to December 2022. Based on the occurrence of CIN within 24 to 48 hours post-PCI, participants were divided into two groups: 61 in the CIN group and 196 in the non-CIN group. Basic clinical data of patients were collected, along with the dosage of contrast agents used during the procedure. On the second day of hospitalization, fasting venous blood was drawn to assess renal function indicators, lipid profiles, blood glucose, and serum NLRP3 levels, alongside echocardiographic evaluation of the left ventricular ejection fraction (LVEF). Multivariate Logistic regression analysis was utilized to explore factors influencing CIN development. Receiver operating characteristic (ROC) curves were drawn to evaluate the diagnostic value of serum NLRP3 levels and contrast agent dosage for CIN.

The CIN group showed a lower proportion of males, lower preoperative levels of uric acid and albumin, and higher levels of contrast agent dosage and NLRP3 compared to the non-CIN group (P<0.05). The multivariate Logistic regression analysis indicated that increased contrast agent dosage (OR=1.008, 95%CI=1.001-1.015, P=0.017) and elevated serum NLRP3 levels (OR=1.139, 95%CI=1.054-1.230, P=0.001) are risk factors for CIN. ROC curve analysis revealed that the area under curve (AUC) for contrast agent dosage, serum NLRP3 levels, and their combined use in diagnosing CIN post-PCI in acute myocardial infarction were 0.797 (95%CI=0.716-0.879), 0.885 (95%CI=0.828-0.942), and 0.939 (95%CI=0.896-0.981), respectively.

In patients with STEMI, contrast agent dosage and serum NLRP3 levels are risk factors for CIN following PCI and can serve as predictive indicators. The combined use of these factors offers a more definitive diagnostic value for CIN.

Chronic kidney disease (CKD) is the eleventh leading cause of death globally, and the burden of disease and economic impact caused by it is increasing rapidly. Its disability and mortality rates have exhibited the highest increase among all chronic diseases. Insulin resistance (IR) and obesity are closely associated with the onset and progression, and triglyceride-glucose (TyG) index can serve as a substitute indicator for IR. Nevertheless, the exact relationship between the TyG index and the development of CKD remains to be fully elucidated.

Through a cohort study, we aim to investigate the relationship between triglyceride-glucose (TyG) index and its combination with obesity indices in relation to the occurrence of CKD.

This retrospective cohort study selected 4 921 adult participants who underwent annual physical examinations at the Sichuan Provincial People's Hospital Health Management & Physical Examination from January 2015 to November 2022, according to specific inclusion and exclusion criteria. The study cohort was categorized into four groups based on quartiles of the baseline triglyceride-glucose (TyG) index: Q1 (5.43-6.66) , Q2 (6.67-7.04) , Q3 (7.05-7.43) , and Q4 (7.43-9.97) , with sample sizes of 1 230, 1 231, 1 230 and 1 230, respeciyvely Obesity-related indices including waist circumference (WC) , BMI, and waist-to-hip ratio (WHR) , were combined with the TyG index to form TyG-WC, TyG-BMI, and TyG-WHR indices. Based on the quartiles of the baseline TyG-WC index, the study subjects were divided into 4 groups, Q1 (204.49-523.14) , Q2 (523.15-593.21) , Q3 (593.22-657.16) , and Q4 (657.17-992.75) , with sample sizes of 1 230, 1 232, 1 229 and 1 230, respectively. Based on the quartiles of the baseline TyG-BMI index, the study subjects were divided into 4 groups, Q1 (92.43-149.16) , Q2 (149.17-168.43) , Q3 (168.49-188.92) , and Q4 (88.93-306.64) , with sample sizes of 1 228, 1 231, 1 232 and 1 230, respectively. Based on the quartiles of the baseline TyG-WHR index, the study subjects were divided into 4 groups, Q1 (2.76-5.66) , Q2 (5.67-6.26) , Q3 (6.27-6.83) , and Q4 (6.84-9.67) , with sample sizes of 1 230, 1 230, 1 231 and 1 230, respectively. The relationship between the TyG index and its combination with obesity indices and the incidence risk of CKD was examined by a Cox proportional hazards model, while a restricted cubic spline regression (RCS) was used to assess dose-response relationships.

At the end of follow-up, there were 139 new cases of CKD in the study cohort, with an incidence rate of 2.8%. After accounting for potential confounding factors, the results showed that compared to the TyG index Q1 group, the TyG index Q4 group exhibited a significantly elevated risk of CKD incidence (HR=1.756, 95%CI=1.010-3.054) . Compared to the TyG-WC index Q1 group, the TyG-WC index Q4 group demonstrated a significantly higher risk of CKD incidence (HR=2.532, 95%CI=1.210-5.296) , with P<0.05. There was a non-linear dose-response relationship between the TyG index and the risk of CKD incidence (P_nonlinearity=0.048) , with higher TyG index values (>6.93) associated with a greater risk of CKD incidence. The TyG-WC index had a linear dose-response relationship with the risk of CKD incidence (P_nonlinearity=0.078) , with an increasing trend of CKD incidence risk with increasing TyG-WC index values.

Both TyG and TyG-WC are risk factors for CKD, controlling for TyG and WC can effectively prevent and manage CKD, this finding holds great importance for the prevention and treatment of CKD.

Dapagliflozin is an effective drug for the treatment of type 2 diabetes mellitus (T2DM), which can also reduce the risk of nephropathy progression, decrease urinary protein and protect the heart. However, whether dapagliflozin can reduce the incidence of contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) in T2DM patients remain unclear.

To investigate the impact of dapagliflozin on the incidence of CIN in patients with T2DM underwent PCI.

According to the principle of 1∶1 propensity matching based on the use of dapagliflozin, a total of 484 T2DM patients who underwent PCI in the Department of Cardiology, Tianjin Chest Hospital from 2021 to 2023 were retrospectively consecutively enrolled in the study, of which 242 cases were in the dapagliflozin group and 242 cases were in the control group. The pre-PCI clinical data of the two groups were collected and compared, and the renal functions of the two groups were recorded before PCI, 48 hours after PCI and 1 week after PCI, including blood urea nitrogen (BUN), serum creatinine (Scr), creatinine clearance rate (Ccr), cystatin C (Cys-C), β2- microglobulin (β2-MG), and neutrophil gelatinase associated apolipoprotein (NGAL). The primary study endpoint was the incidence of CIN, and the secondary study endpoint was the change in renal function during the perioperative period of PCI. Multivariate Logistic regression was used to analyze the effect of dapagliflozin on the incidence of CIN after PCI in patients with T2DM.

The incidence of CIN in patients in the dapagliflozin group was 6.2% lower than that in patients in the control group (12.0%). The difference was statistically significant (χ²=4.900, P=0.039). The CIN risk score and B-type natriuretic peptide of patients in the dapagliflozin group were higher than those in the control group (P<0.05). There was no statistically significant difference in BUN, Scr, Ccr, Cys-C, β2-MG, and NGAL levels between 2 groups before and 1 week after PCI (P>0.05). At 48 hours after PCI, the levels of Cys-C, β2-MG, and NGAL in the dapagliflozin group were lower than those in the control group (P<0.05). Multivariate Logistic regression analysis showed that high CIN risk score (OR=1.213, 95%CI=1.085-1.358, P=0.001) and B-type natriuretic peptide levels (OR=3.940, 95%CI=1.479-10.494, P=0.006) were independent risk factors for CIN after PCI in patients with T2DM, and the use of dapagliflozin (OR=0.338, 95%CI=0.159-0.717, P=0.005) was an independent protective factor for the development of CIN after PCI in patients with T2DM.

The use of dapagliflozin is an independent protective factor against the development of CIN after PCI in patients with T2DM, and dapagliflozin does not increase the risk of developing acute kidney injury after PCI in patients with T2DM and may reduce the incidence of CIN.

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.

Fibrinogen (FIB) is often elevated in children with Henoch Schonlein purpuric nephritis (HSPN), but the correlation between FIB and renal lesions has been less studied.

To explore the correlation between FIB in children with HSPN and the International Study Group on Pediatric Kidney Disease (ISKDC) pathology grading and micropathological changes in parts of renal units, and to clarify whether FIB can assess the severity of renal injury in children with HSPN.

In total, 922 children with HSPN who were hospitalized in the First Affiliated Hospital of Henan University of Chinese Medicine in the pediatric nephrology ward and underwent kidney biopsy at the same time from December 2017 to December 2022 were collected, and the clinical information, FIB and renal pathological information during renal biopsy were summarized, and based on the FIB level, the children were categorized into group A (low) <2.38 g/L, group B (standard) 2.38-4.98 g/L, and group C (high) >4.98 g/L. The correlation between FIB and ISKDC pathological grades, glomerular mesangial hyperplasia ratio, the crescentic bodies ratio and the nature of the glomerular lesions from acute to chronic was investigated by Spearman rank correlation analysis, and the prediction of FIB on the micropathological changes of renal units was analyzed by the subject's work characteristic (ROC) curve.

Among 922 children with HSPN who had undergone renal biopsy, the FIB was (3.48±1.01) g/L. 113 cases in group A had a low FIB rate of 12.26%; 734 cases in group B had a standardized FIB rate of 79.61%; and 75 cases in group C had a high FIB rate of 8.13%. The ISKDC pathology classification was type Ⅱa in 173 cases (18.76%), type Ⅱb in 29 cases (3.15%), 466 cases (50.54%) of type Ⅲa, 232 cases (25.16%) of type Ⅲb, and 22 cases (2.39%) of type Ⅳ and above (including 2 cases of type Ⅳa, 18 cases of type Ⅳb, and 2 cases of type Ⅴ). The results of the Spearman's rank correlation analysis showed that the FIB and the grouping of the FIB of the children with HSPN were positively related to the renal pathology ISKDC grading (r_s=0.146, P<0.001; r_s=0.129, P<0.001). 911 (98.80%) of 922 children with HSPN were mesangial proliferative, and 655 (71.04%) had crescentic hyperplasia. Spearman rank correlation analysis showed a weak positive correlation between FIB and FIB subgroups and the rate of mesangial hyperplasia (r_s=0.092, P=0.005; r_s=0.096, P=0.003), and a positive correlation with the rate of crescentic bodies (r_s=0.132, P<0.001; r_s=0.830, P=0.012). 922 children with HSPN had glomerular acute lesions in 763 cases (82.75%), acute chronic lesions in 97 cases (10.52%), and chronic lesions in 62 cases (6.73%). In addition, FIB gradually increased with the nature of the glomerular lesions from acute to chronic (r_s=0.145, P<0.001). At the same time, comparison of some renal biopsy indexes FIB in HSPN children showed statistically significant difference (P<0.05). The ROC curves showed that the FIB had the highest sensitivity for glomerulosclerosis (sensitivity=0.900, specificity=0.303), and the optimal cutoff value for FIB was 2.835 mg/L; the area under the ROC curve (AUC) of FIB for the positive prediction of tubulointerstitial fibrosis=0.623, and that of FIB for the reverse prediction of tubulointerstitial cellular granulomatous degeneration=0.641.

FIB can be used as a laboratory index reflecting the severity of renal pathological changes in patients with HSPN, can reflect the severity of renal pathological grading, is closely related to irreversible lesions according to renal microscopic indicators such as glomerular sclerosis and balloon adhesion, and can assist clinical diagnosis and 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.

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.

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.

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.

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.

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.