ObjectiveTo develop and validate a nomogram model for predicting extracorporeal circuit clotting risk during continuous renal replacement therapy （CRRT） in elderly patients with chronic renal failure （CRF）， and to provide a basis for the precise assessment and management of the risk of tubing coagulation during CRRT treatment for such patients.MethodsA total of 583 elderly patients with CRF who received CRRT at Changzhi People's Hospital from January 2022 to June 2025 were retrospectively enrolled and randomly assigned in a 7∶3 ratio to a modeling set （n=408） and a validation set （n=175）. In the modeling set， patients were further divided into a clotting group （n=72） and a non-clotting group （n=336） according to whether extracorporeal circuit clotting occurred during treatment. Baseline characteristics were compared between the two groups. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for circuit clotting， and a nomogram was constructed using R software. The predictive performance of the model was evaluated using receiver operating characteristic （ROC） curves， bootstrap calibration curves， and clinical decision curve analysis.ResultsAmong the 408 elderly patients with CRF receiving CRRT， the incidence of extracorporeal circuit clotting was 17.65%. Significant differences were observed between the clotting and non-clotting groups in CRRT mode， filter membrane material， serum phosphorus， fibrinogen （FIB）， mean arterial pressure （MAP）， blood flow rate， and other variables （P<0.05）. Multivariate logistic regression analysis showed that CRRT convection mode （OR=2.000， 95%CI： 1.097-3.647， P=0.024）， hyperphosphatemia （OR=13.356， 95%CI： 4.320-41.292， P<0.001）， and elevated FIB （OR=11.543， 95%CI： 3.697-36.038， P<0.001） were independent risk factors for circuit clotting， whereas higher MAP （OR=0.907， 95%CI： 0.869-0.947， P<0.001） and faster blood flow rate （OR=0.963， 95%CI： 0.948-0.978， P<0.001） were independent protective factors against extracorporeal circuit clotting （P<0.05）. ROC curve analysis showed that the nomogram model for predicting extracorporeal circuit clotting during CRRT in elderly patients with CRF had an area under the curve of 0.819， with a sensitivity of 0.694 and a specificity of 0.798. The calibration curve closely overlapped the ideal curve， indicating good predictive accuracy of the established risk prediction model.ConclusionCRRT convection mode， hyperphosphatemia， and elevated FIB are independent risk factors for extracorporeal circuit clotting in elderly patients with CRF receiving CRRT， whereas higher MAP and faster blood flow rate are independent protective factors. The nomogram constructed based on these indicators demonstrates good predictive performance and may serve as a quantitative tool for the prevention and management of extracorporeal circuit clotting in clinical practice， with a positive role in reducing the incidence of circuit clotting.
Acute kidney injury （AKI） is a common and critical renal disorder in clinical practice. Conventional diagnostic indicators centered on serum creatinine and urine output are markedly delayed， making early warning and precise risk stratification difficult. In addition， single novel biomarkers are limited by specific applicable scenarios and unstable predictive performance. Tissue inhibitor of metalloproteinases-2 （TIMP-2） and insulin-like growth factor binding protein-7 （IGFBP-7） are specific cell cycle arrest biomarkers that reflect stress injury and repair status in renal tubular epithelial cells. Their product can enable early AKI warning by mediating G1 cell-cycle arrest and regulating inflammatory injury and fibrotic progression. It has demonstrated favorable value in early diagnosis and prognosis assessment across multiple AKI etiologies， including sepsis-associated AKI， cardiac surgery-associated AKI， severe acute pancreatitis-associated AKI， contrast-induced AKI， and post-kidney transplantation AKI. Using cut-off values of 0.3 and 2.0 （［μg/L］2·10-3）， AKI risk can be stratified into low-， moderate-， and high-risk categories， thereby enabling precise risk stratification. This approach can also directly guide early renal-protective interventions， the initiation of continuous renal replacement therapy， decisions regarding weaning timing， and dynamic adjustment of treatment strategies， effectively improving AKI management. At present， however， this biomarker still faces several limitations， including insufficient standardization of detection methods， the need for threshold calibration in special populations， and a lack of domestic multicenter interventional studies. Future efforts should focus on the domestication and standardization of detection technologies， validation of population-specific thresholds in local cohorts， and intervention studies targeting hard clinical outcomes， so as to further promote standardized clinical application in precision diagnosis and treatment of AKI.
ObjectiveTo analyze the clinical and pathological data of patients with isolated mild-to-moderate renal function abnormalities identified during health examinations who underwent renal biopsy， and to explore the clinical value of renal biopsy in this population.MethodsA total of 70 patients identified through health examinations at the General Hospital of Northern Theater Command between August 2013 and August 2024 who had isolated mild-to-moderate renal function abnormalities and underwent renal biopsy were retrospectively included. According to the pathological findings， the patients were divided into a minor disease group （MD group， n=19） and a renal disease group （RD group， n=51）. Multivariate logistic regression and other methods were used to identify independent risk factors for renal parenchymal lesions. Receiver operating characteristic （ROC） curve analysis was performed to determine the optimal cutoff values and diagnostic performance of each indicator.ResultsCompared with the MD group， the RD group had significantly higher levels of blood urea nitrogen （［7.68±2.95］ mmol/L vs ［6.03±1.19］ mmol/L）， serum cystatin C （［1.34±0.34］ mg/L vs ［1.06±0.13］ mg/L）， 24-hour urinary protein （［0.51±0.62］ g vs ［0.13±0.08］ g）， urinary microalbumin/creatinine （uACR） （［188.82±224.49］ mg/g vs ［12.78±14.24］ mg/g）， total cholesterol （［4.63±1.16］ mmol/L vs ［3.81±0.92］ mmol/L）， and complement C3 （［1.11±0.21］ g/L vs ［0.94±0.18］ g/L）， with statistically significant differences （P<0.05）. Multivariate logistic regression showed that serum cystatin C level （OR=1.062， 95%CI： 1.003-1.124， P=0.040） and 24-hour urinary protein level （OR=1.012， 95%CI： 1.002-1.022， P=0.022） were independent predictors of renal parenchymal disease. ROC curve analysis showed that the optimal cutoff value of serum cystatin C for predicting renal parenchymal disease was 1.240 mg/L， with a sensitivity of 56.9% and a specificity of 94.7%； the optimal cutoff value of 24-hour urinary protein was 0.165 g， with a sensitivity of 78.4% and a specificity of 89.5%. When the two indicators were combined， the sensitivity was 90.2% and the specificity was 78.9%.ConclusionsElevated serum cystatin C and 24-hour urinary protein levels are independent predictors of renal parenchymal disease in patients with isolated mild-to-moderate renal function abnormalities. In this population， the presence of abnormalities in these indicators supports the clinical necessity of proceeding with renal biopsy.
ObjectiveTo investigate the association between growth-related endocrine factors and bone metabolism-related indicators in children with primary nephrotic syndrome （PNS）.MethodsA total of 95 newly diagnosed children with PNS admitted to Baoding Hospital of Beijing Children’s Hospital， Capital Medical University， from January 2022 to December 2023， who had not received glucocorticoids， were enrolled in the case group. Sixty healthy children who underwent physical examination during the same period were selected as the healthy group. Serum insulin-like growth factor-1 （IGF-1）， serum 25-hydroxyvitamin D ［25（OH）D］， and bone metabolism indicators （alkaline phosphatase ［ALP］， osteoprotegerin ［OPG］， osteocalcin ［BGP］， procollagen type I N-terminal propeptide ［PINP］， and C-terminal telopeptide of type I collagen ［CTX］）， as well as bone mineral density， were collected and compared between the two groups. Pearson correlation analysis was used to assess the correlations of IGF-1 and 25（OH）D with bone metabolism and bone mineral density. With lumbar spine bone mineral density in children with PNS as the dependent variable， multivariate linear regression analysis was performed to evaluate the associations of IGF-1 and 25（OH）D with bone mineral density.ResultsCompared with the healthy group， the case group had a higher 24-hour urinary protein level （［6.21±2.40］ g/d vs ［0.14±0.01］ g/d）， lower albumin level （［20.83±2.26］ g/L vs ［36.43±2.14］ g/L）， higher serum creatinine level （［119.93±20.40］ μmol/L vs ［55.78±5.70］ μmol/L）， and a greater proportion of children with outdoor activity less than 4 times per week； all differences were statistically significant （P<0.001）. In the case group， IGF-1 （［165.35±37.01］ μg/L vs ［231.44±40.89］ μg/L）， 25（OH）D （［3.98±1.57］ μg/L vs ［7.06±2.12］ μg/L）， ALP （［89.71±37.93］ U/L vs ［121.44±40.17］ U/L）， OPG （［335.37±68.78］ ng/L vs ［473.65±60.73］ ng/L）， BGP （［17.41±3.87］ μg/L vs ［21.77±3.59］ μg/L）， and bone mineral density （［0.18±0.02］ g/cm2 vs ［0.25±0.04］ g/cm2） were all significantly lower than those in the healthy group， with statistically significant differences （P<0.001）. There were no significant differences in PINP or CTX between the two groups （P>0.05）. In children with PNS， IGF-1 and 25（OH）D were significantly positively correlated with ALP， OPG， BGP， and bone mineral density （r=0.583–0.846， P<0.001）， but showed no significant correlation with PINP or CTX （P>0.05）. Both were negatively correlated with 24-hour urinary protein and serum creatinine， and positively correlated with albumin （P<0.001）. After adjustment for sex and age， multivariate linear regression showed that both IGF-1 and 25（OH）D were independent positive predictors of bone mineral density. The standardized regression coefficient for IGF-1 was 0.593， and that for 25（OH）D was 0.306， indicating a more prominent effect of IGF-1 on bone mineral density. The adjusted R2 of the model was 0.741， and the overall F-test was statistically significant （F=68.242， P<0.001）.ConclusionChildren with PNS had lower levels of IGF-1， 25（OH）D， some bone metabolism indicators， and bone mineral density than healthy children. IGF-1 and 25（OH）D were significantly positively correlated with bone metabolism indicators and bone mineral density in children with PNS， and both were independent factors associated with bone mineral density， with IGF-1 showing a stronger effect. In clinical practice， in addition to treating the renal disease， greater attention should be given to monitoring and managing growth-related endocrine factors and bone metabolism status in children with PNS.
Lupus nephritis is an immune complex （IC）-mediated nephritis caused by renal involvement in systemic lupus erythematosus， and it is one of the major causes of death and progression to end-stage renal disease in patients with systemic lupus erythematosus. Early detection， early treatment， and prevention of recurrence are key to delaying the progression of lupus nephritis to end-stage renal disease. To date， the pathogenesis of lupus nephritis has not been fully elucidated， and the triggering factors are complex and diverse. Renal biopsy remains the main diagnostic method for lupus nephritis； however， with advances in research， an increasing number of urinary biomarkers have been identified， making diagnostic and therapeutic strategies more diverse. At present， however， there are relatively few studies at home and abroad on effective urinary biomarkers for evaluating and monitoring lupus nephritis. This article summarizes recent domestic and international studies on urinary biomarkers in the diagnosis and disease assessment of lupus nephritis， with the aim of providing a theoretical basis for early diagnosis， condition monitoring， and personalized treatment of lupus nephritis.
Peritoneal dialysis is one of the important renal replacement therapies for patients with end-stage kidney disease and is comparable to hemodialysis in terms of dialysis adequacy， mortality， and other prognostic parameters. However， peritoneal fibrosis， a common complication， is characterized mainly by injury to peritoneal mesothelial cells and excessive deposition of extracellular matrix， eventually leading to peritoneal failure. As a form of inflammasome-dependent programmed cell death， pyroptosis has recently attracted increasing attention for its regulatory role in a variety of inflammation-related fibrotic diseases. Pyroptosis contributes to the development and progression of peritoneal fibrosis by releasing inflammatory mediators such as interleukin （IL）-1β and IL-18， as well as damage-associated molecular patterns. This article reviews the molecular mechanisms of pyroptosis and elucidates its functional network and clinical significance in peritoneal dialysis-associated fibrosis， aiming to provide new insights for early intervention and targeted therapy for this complication.
Lupus nephritis （LN） is a common and severe complication of systemic lupus erythematosus. Conventional immunosuppressive therapies are limited by low clinical remission rates， high relapse rates， and frequent adverse effects. The development of targeted biologics has provided new therapeutic strategies for this disease； however， there is still a lack of systematic and standardized practical guidance for individualized drug selection， combination and sequential treatment strategies， and implementation in primary care settings. This article systematically reviews the four core pathogenic mechanisms of LN and the corresponding therapeutic targets. According to the graded recommendations， assessment， formulation， and evaluation standards， as well as the evidence grading criteria， it classifies and summarizes the mechanisms of action， China-specific evidence， guideline recommendation levels， and safety profiles of major biologics targeting each pathway. On this basis， a four-dimensional individualized targeted-drug selection framework is established， integrating pathological classification， clinical phenotype， biomarkers， and patient stratification. The article also summarizes standardized strategies for combination and sequential biologic therapy， and discusses the indications and risk management of rescue therapies such as chimeric antigen receptor T-cell therapy and eculizumab， providing practical reference for the standardized and individualized clinical application of targeted and rescue treatments in LN.
ObjectiveTo investigate the protective effect of oleanolic acid （OA） on renal injury in rats with type 2 diabetes mellitus （T2DM） and to explore the underlying mechanism.MethodsUsing the random number table method， 25 rats were randomly selected and fed a high-fat diet to induce T2DM， while the remaining 10 rats were fed a standard diet and assigned to the normal control group （NC group， n=10）. After 8 weeks of modeling， 20 successfully established T2DM rats were divided into the T2DM group （n=6）， low-dose OA group （OAL group， n=6）， and high-dose OA group （OAH group， n=8）. Serum biochemical and inflammatory indicators were measured using enzyme-linked immunosorbent assay kits. Renal pathological changes were observed by histological staining， and renal ultrastructural changes were examined by electron microscopy. The mRNA levels of tumor necrosis factor-α （TNF-α）， interleukin （IL）-6， and IL-10 in renal tissue were detected by polymerase chain reaction （PCR）. The protein expression levels of pyroptosis-related molecules NOD-like receptor protein 3 （NLRP3）， cysteine-aspartic acid protease-1 （Caspase-1）， and Gasdermin D （GSDMD）， as well as inflammatory molecules Toll-like receptor 4 （TLR4） and nuclear factor-kappa B （NF-κB）， were determined by Western blotting.ResultsThe 24 h urine volumes in the NC， T2DM， OAL， and OAH groups were （12.02±2.86） mL， （40.05±7.77） mL， （22.50±2.28） mL， and （14.10±5.32） mL， respectively. Fasting blood glucose levels were （5.29±0.43） mmol/L， （27.23±5.02） mmol/L， （19.02±0.95） mmol/L， and （15.20±1.65） mmol/L， respectively. Triglyceride levels were （0.36±0.16） mmol/L， （3.40±0.58） mmol/L， （2.26±0.40） mmol/L， and （0.95±0.20） mmol/L， respectively. Total cholesterol levels were （1.83±0.26） mmol/L， （4.57±0.47） mmol/L， （2.80±0.33） mmol/L， and （2.14±0.24） mmol/L， respectively. Low-density lipoprotein cholesterol levels were （0.67±0.11） mmol/L， （2.34±0.42） mmol/L， （1.25±0.20） mmol/L， and （0.76±0.10） mmol/L， respectively. High-density lipoprotein cholesterol levels were （1.41±0.15） mmol/L， （0.62±0.17） mmol/L， （1.00±0.13） mmol/L， and （1.29±0.10） mmol/L， respectively. Compared with the T2DM group， all of the above indicators were improved in the OAL and OAH groups， with statistically significant differences （all P<0.05）. Renal pathological staining showed that mesangial cell and mesangial matrix proliferation， as well as vacuolar degeneration of renal tubular epithelial cells， were markedly improved in the OAL and OAH groups. In the OAL and OAH groups， renal tissue mRNA expression of IL-6 and TNF-α was decreased， whereas IL-10 mRNA expression was increased， with statistically significant differences （P<0.001）. The protein expression levels of NLRP3， Caspase-1， GSDMD， TLR4， and NF-κB in renal tissue were significantly reduced in the OAL and OAH groups， with statistically significant differences （P<0.001）.ConclusionOA can alleviate renal injury in rats with diabetic kidney disease by inhibiting the NF-κB/TLR4 and NLRP3/Caspase-1 pathways.
ObjectiveTo investigate changes in functional connectivity （FC） within brain networks and functional network connectivity （FNC） between different networks at rest in patients undergoing peritoneal dialysis （PD）， and to examine the relationship between alterations in large-scale resting-state brain networks and multidimensional cognitive function.MethodsA total of 53 patients with end-stage kidney disease who were hospitalized in the Department of Nephrology of the First Affiliated Hospital of Anhui Medical University and received regular PD treatment from June 2024 to February 2025 were retrospectively included as the PD group， along with 49 demographically matched participants during the same period in the healthy control （HC） group. Resting-state functional magnetic resonance imaging was used to obtain brain functional data. Independent component analysis （ICA） was applied to extract spatial components of brain functional networks. Statistical identification of network components was performed using one-sample t tests， and group-specific differences in intra-/inter-network FC were systematically compared using two-sample t tests. Multidimensional cognitive function was assessed in PD patients.ResultsUsing ICA， seven resting-state brain networks were identified， including the default mode network， sensorimotor network， dorsal attention network， right executive control network， left executive control network， auditory network， and visual network. Compared with the HC group， patients in the PD group showed significantly reduced FC in the attention network in the left postcentral gyrus （HC group： 1.72 ［1.51， 2.11］， PD group： 1.05 ［0.71， 1.55］， P<0.05） and the right postcentral gyrus （HC group： 1.15 ［0.85， 1.60］， PD group： 0.43 ［0.12， 0.87］， P<0.05）， as well as significantly reduced FC in the sensorimotor network in the left precentral gyrus （HC group： 1.93 ［1.59， 2.21］， PD group： 0.30 ［0.10， 0.50］， P<0.05）. In contrast， FC in the executive control network was significantly increased in the left precuneus （HC group： -0.56 ［-0.82， -0.35］， PD group： -0.12 ［-0.37， 0.11］， P<0.05）. In patients with PD， FC between the visual network and the dorsal attention network and sensorimotor network was weakened （P<0.05）， FC between the dorsal attention network and the left and right executive control networks was enhanced （P<0.05）， and FC between the right executive control network and the sensorimotor network was also enhanced （P<0.05）. In addition， FC in the right postcentral gyrus was significantly positively correlated with the Montreal Cognitive Assessment and Mini-Mental State Examination scores in PD patients （P<0.05）. FC in the left postcentral gyrus and left precentral gyrus was positively correlated with hemoglobin levels （P<0.05）. FC in the right postcentral gyrus was negatively correlated with age， whereas FC in the left precuneus was positively correlated with transferrin levels and the calcium-phosphorus product （P<0.05）.ConclusionICA-based neuroimaging analysis revealed multiple abnormalities in resting-state brain network connectivity in patients undergoing PD. These alterations were associated with cognitive impairment， and changes in FC in specific brain regions were related to clinical indicators such as anemia and calcium-phosphorus metabolism disorders.
ObjectiveTo develop a prognostic prediction model for intensive care unit （ICU） patients with acute kidney injury （AKI） using a machine learning algorithm based on the least absolute shrinkage and selection operator combined with binary multivariable logistic regression （LASSO-Logistic dual regression model）， and to validate its clinical applicability.MethodsClinical data from 410 ICU patients with AKI admitted to Mianzhu People's Hospital from October 2023 to October 2025 were retrospectively collected. The patients were stratified and randomly assigned in a 7：3 ratio to a training set （n=287） and a validation set （n=123）. According to 28-day outcomes in the training set， patients were divided into a survival group （n=193） and a death group （n=94）. Relevant data were compared between the two groups in the training set， and the LASSO-Logistic dual regression model was used to identify independent prognostic factors in ICU patients with AKI. A nomogram model was constructed using R software， and the predictive performance of the model was assessed by receiver operating characteristic （ROC） curve analysis.ResultsThe LASSO-Logistic dual regression model showed that age， history of diabetes， hypertension， multiple organ dysfunction syndrome （MODS）， AKI stage （stage 2 to stage 3）， mechanical ventilation， continuous renal replacement therapy （CRRT）， neutrophil count， platelet count， fibrinogen （FIB）， oxygenation index， Sequential Organ Failure Assessment （SOFA） score， serum cystatin C （Cys C）， and Nutritional Risk Screening 2002 （NRS 2002） score were all factors associated with prognosis in ICU patients with AKI （P<0.05）. The Hosmer-Lemeshow test showed good agreement between model-predicted and observed values （Chi=3.523， P=0.897）. Internal validation using the bootstrap method showed that the direction and significance of the model effects remained consistent with those of the original model （P<0.05）， confirming good model stability. ROC analysis showed that the area under the curve （AUC） of the nomogram for predicting prognosis in ICU patients with AKI was 0.996 （95%CI： 0.991-0.999） in the training set and 0.984 （95%CI： 0.969-0.999） in the validation set. The calibration curves in both groups were in good agreement with the ideal diagonal line， indicating satisfactory calibration. Decision curve analysis showed that the model provided a high net clinical benefit within the threshold probability range of 0.1-0.9.ConclusionAge， history of diabetes， hypertension， MODS， AKI stage （stage 2 to stage 3）， mechanical ventilation， CRRT， neutrophil count， platelet count， FIB， oxygenation index， SOFA score， Cys C， and NRS 2002 score are prognostic factors in ICU patients with AKI. The nomogram prediction model constructed based on these factors demonstrates excellent discrimination， calibration， and clinical utility， and may provide a reference for prognostic assessment and individualized intervention strategies in patients with AKI.
Objective To investigate the clinical efficacy of the Jianpi Yishen Gujing Formula combined with conventional Western medicine in the treatment of early diabetic kidney disease(DKD)with spleen-kidney deficiency,to observe its effects on traditional Chinese medicine(TCM)syndrome scores,renal function,and related pathological indicators,and to use data mining to identify key factors influencing efficacy and verify the clinical significance of the core pathogenesis of spleen-kidney defi-ciency.Methods A total of 265 patients with early DKD of the spleen-kidney deficiency type,treated at Tangshan Hospital of Traditional Chinese Medicine from January 2020 to April 2025,were enrolled.Us-ing a block randomization method,the patients were assigned to a control group(132 cases,conventional Western medicine treatment)and a study group(133 cases,Jianpi Yishen Gujing Formula combined with conventional Western medicine treatment).TCM syndrome scores,renal function indicators,in-flammatory factors,oxidative stress and pro-fibrotic factors,clinical efficacy,and adverse reactions were compared between the two groups.A classification and regression tree(CART)model was used for data mining to analyze the key factors affecting treatment efficacy.Results After 6 months of treatment,TCM syndromes,renal function,inflammation,oxidative stress,and fibrosis indicators improved signifi-cantly in both groups compared with baseline(P values all<0.05).Between-group comparisons showed that the study group had significantly lower scores for major symptoms([2.42±0.82]points vs.[3.89±0.95]points)and minor symptoms([1.26±0.44]points vs.[1.50±0.50]points)than the con-trol group(P values all<0.001).In terms of renal function,the study group had significantly lower 24 h urinary protein excretion([1.50±0.25]mg vs.[1.97±0.30]mg),serum creatinine(Scr)([95.57±9.27]μmol/L vs.[108.72±11.34]μmol/L),urinary albumin excretion rate(UAER)([110.94±14.43]μg/min vs.[130.30±17.24]μg/min),and blood urea nitrogen(BUN)([6.68±1.54]mmol/L vs.[7.80±1.55]mmol/L)than the control group(P values all<0.001).Regarding inflammatory and fibrotic indicators,the study group had significantly lower interleukin(IL)-17([26.91±5.11]μg/L vs.[36.48±6.23]μg/L),transforming growth factor-β1(TGF-β1)([12.34±2.13]μg/L vs.[19.44±3.13]μg/L),and high-sensitivity C-reactive protein(hs-CRP)([6.34±1.17]mg/L vs.[9.22±1.18]mg/L)than the control group(P values all<0.001).For oxidative stress indicators,the study group showed significantly higher glutathione peroxidase(GSH-Px)([232.89±25.82]U/L vs.[177.87±23.36]U/L)and superoxide dismutase(SOD)([84.42±3.34]U/mL vs.[79.24±3.14]U/mL)than the control group(P values all<0.001).The overall clinical effective rate was 95.49%in the study group,significantly higher than 84.85%in the control group(P=0.004).There was no statistically sig-nificant difference in the incidence of adverse reactions between the two groups(17.29%vs.21.97%,P=0.338).The CART model achieved an overall accuracy of 88.3%in predicting efficacy.Pre-treatment GSH-Px level,treatment method,and pre-treatment UAER level were the core factors affecting the effi-cacy of this prescription,with importance scores of 0.219,0.213,and 0.129,respectively.Conclusion The Jianpi Yishen Gujing Formula combined with conventional Western medicine is effective in treating early DKD with spleen-kidney deficiency.It can significantly improve clinical symptoms,reduce protein-uria,protect renal function,alleviate inflammation,regulate oxidative stress,and inhibit fibrosis,with good safety.Data mining further verified spleen-kidney deficiency as the core pathogenesis of this dis-ease.Pre-treatment GSH-Px level,treatment method,and pre-treatment UAER level may serve as key indicators for efficacy prediction and precision medication of the Jianpi Yishen Gujing Formula,providing a basis for precise syndrome differentiation and treatment in clinical practice.
ObjectiveTo develop a risk early-warning model for post-biopsy bleeding after renal biopsy based on pre-puncture clinical characteristic parameters， and to provide a quantitative risk assessment tool for clinical practice.MethodsA retrospective analysis was conducted on the clinical data of 846 patients who underwent renal biopsy in the Department of Nephrology of the First Affiliated Hospital of Xi'an Jiaotong University from January 2022 to January 2025. According to whether postoperative bleeding occurred， the patients were divided into a non-bleeding group （n=794） and a bleeding group （n=52）. Baseline characteristics were compared between the two groups. Univariate analysis and LASSO regression were used to screen risk factors for postoperative bleeding. Independent influencing factors were identified by binary logistic regression， and a prediction model was constructed. The model performance was evaluated using the bootstrap method， receiver operating characteristic （ROC） curves， and decision curve analysis.ResultsUnivariate analysis showed that， compared with the non-bleeding group， the bleeding group had a higher proportion of patients with ≥2 punctures， a higher proportion of nephrotic syndrome， higher 24-hour urinary protein， activated partial thromboplastin time （APTT）， and D-dimer levels （13.46% vs 3.65%， 65.38% vs 44.33%， ［3.79±0.32］ g vs ［2.68±0.54］ g， ［34.19±3.62］ s vs ［32.68±3.59］ s， and ［0.48±0.12］ mg/L vs ［0.42±0.10］ mg/L， respectively）. Hemoglobin （Hb） and estimated glomerular filtration rate （eGFR） were lower in the bleeding group （［108.59±6.23］ g/L vs ［115.67±5.15］ g/L and ［76.34±4.18］ mL·min-1·［1.73 m2］-1 vs ［81.65±4.65］ mL·min-1·［1.73 m2］-1）， with statistically significant differences （all P<0.05）. The univariate indicators were entered into LASSO regression for dimensionality reduction to identify key predictive factors. Ultimately， 14 predictive variables were selected， and multicollinearity was assessed； the results showed that all variance inflation factors were <5. Binary logistic regression showed that Z-score（Hb） （OR=0.141， 95%CI： 0.074-0.267， P<0.001）， Z-score（APTT） （OR=6.331， 95%CI： 3.381-11.856， P<0.001）， Z-score（eGFR） （OR=0.134， 95%CI： 0.064-0.277， P<0.001）， and Z-score（D-dimer） （OR=5.564， 95%CI： 2.862-10.818， P<0.001） were independent factors influencing post-biopsy bleeding after renal biopsy （all P<0.05）. These variables were used as predictors to construct a regression-based prediction model for post-biopsy bleeding risk after renal biopsy. The model was validated using the bootstrap method. The area under the curve of the prediction model was 0.954， 95%CI： 0.917-0.922. The accuracy was 0.907 （95%CI： 0.885-0.925）， sensitivity was 0.885 （95%CI： 0.798-0.971）， specificity was 0.908 （95%CI： 0.888-0.928）， positive predictive value was 0.387 （95%CI： 0.299-0.474）， and negative predictive value was 0.992 （95%CI： 0.985-0.998）.ConclusionPost-biopsy bleeding risk after renal biopsy can be effectively predicted based on pre-puncture clinical characteristic parameters， providing a scientific basis for developing individualized preventive strategies and demonstrating good application value.
ObjectiveTo investigate abnormal changes in brain entropy and functional connectivity in patients undergoing peritoneal dialysis （PD） using resting-state functional magnetic resonance imaging （rs-fMRI）， and to characterize cognitive impairment and its influencing factors in combination with neuropsychological scales， thereby providing new evidence for mechanistic research and clinical intervention in PD-related cognitive impairment.MethodsA total of 53 patients receiving PD at the First Affiliated Hospital of Anhui Medical University from June 2024 to March 2025 were enrolled as the study group. In the same period， 49 demographically matched healthy volunteers were included as the healthy control group. Clinical data， laboratory indicators， and neuropsychological assessment data were collected for all participants， followed by head rs-fMRI and three-dimensional T1-weighted structural imaging. Whole-brain entropy was calculated， and brain regions showing intergroup differences were selected as regions of interest for whole-brain resting-state functional connectivity analysis. Spearman correlation analysis was performed to explore the relationships of cognitive impairment， emotional dysfunction， brain entropy， functional connectivity， and biochemical indicators in patients with PD.ResultsCompared with the healthy control group， patients in the PD group had significantly lower scores on the Montreal Cognitive Assessment （MoCA） and Mini-Mental State Examination （MMSE） （both P<0.01）， with multidimensional cognitive impairment involving memory， attention， executive function， and other domains. Brain entropy analysis showed significantly reduced entropy in the right middle occipital gyrus （t=-4.8164） and left caudate nucleus （t=-4.6978）， and significantly increased entropy in the left middle temporal gyrus （t=5.1632） and right postcentral gyrus （t=5.1800） in the PD group （P<0.05）. Functional connectivity analysis indicated weakened connectivity between the right middle occipital gyrus and the right fusiform gyrus （t=-6.3493）， right middle frontal gyrus （t=-4.6587）， and right precuneus （t=-4.9915） in the PD group （P<0.01）. Correlation analysis showed that entropy in the right middle occipital gyrus was negatively correlated with scores on the Self-Rating Anxiety Scale （SAS） （r=-0.304， P=0.027） and Self-Rating Depression Scale （SDS） （r=-0.418， P=0.002）. Entropy in the left middle temporal gyrus was positively correlated with the negative emotion scale and the abstraction domain of MoCA （r=0.286， P=0.038） （P<0.05）. Functional connectivity between the right middle occipital gyrus and fusiform gyrus was positively correlated with MMSE orientation （r=0.290， P=0.035） and structural ability （r=0.274， P=0.047） （P<0.05）.ConclusionPatients undergoing PD exhibit abnormal brain entropy in multiple regions and disrupted functional connectivity within specific brain networks. Their multidimensional cognitive impairment is closely related to brain functional reorganization， and brain dysfunction is significantly associated with emotional disturbances in a region-specific manner.
Context: Acute kidney injury is a serious and frequently encountered condition in hospital settings, with an increasing incidence. Given the increasing number of evidence reporting the benefits of specialized and early nephrology care, the Ad Hoc Consultancy Opinion regains a crucial interest in the nephrology care pathway. In the Ivory Coast, data concerning this activity are rare. The objective of this study was therefore to evaluate the Ad Hoc Consultancy Opinion impacts under our practice conditions. Methods: Our study will focus on all patients of the CHU Treicheville without a history of kidney disease seen in the Ad Hoc Consultancy Opinion by the nephrology team of said center over the period from October 1, 2022, to March 31, 2023. Results: The consultative nephrology service involved 106 patients with an average age of 45.1 +/- 21.1 years. The average delay for requesting the consultation was 2.6 +/- 2.5 days. Acute kidney injury was at stage 3 of the KDIGO classification in 73.6% (n = 78). Emergency hemodialysis accounted for 59.4% of the indications. The mortality was 22.6%, and the risk of death was associated with coma (p = 0.014), left heart failure (p = 0.009), ARDS (p = 0.035), the severity of AKI (p = 0.024), and the Ad Hoc Consultancy Opinion delay > 3 days (p = 0.010). Conclusion: Our study adds weight to the claims that early specialized management of kidney disease affects the nephrological outcome and survival of patients.
近年来,中国糖尿病患者的数量逐年增高,据2021 年中国心血管健康与疾病报告,目前患病率已高达12.4％[1],糖尿病合并慢性肾脏病的患病率也随之增高.糖尿病是慢性肾脏病的主要危险因素,据统计,约35％ 的糖尿病患者会进展为Ⅳ期糖尿病肾脏疾病,最终导致尿毒症的发生,严重危害患者健康.
Renal anemia is one of the common complications in patients with chronic kidney disease （CKD） and is also an independent risk factor for cardiovascular events in this population. At present， the diagnostic criteria and treatment targets for renal anemia are mainly based on studies in the general population， while epidemiological investigations of renal anemia in CKD patients living at high altitude remain limited. In recent years， with advances in medical research， significant progress has been made in the treatment of renal anemia. The application of novel agents such as hypoxia-inducible factor prolyl hydroxylase inhibitors has provided patients with more options. However， anemia management in CKD patients at high altitude still primarily relies on erythropoiesis-stimulating agents and iron supplements， and whether their efficacy and safety are affected by the hypoxic environment remains to be further investigated. This review summarizes the epidemiological characteristics and treatment advances of renal anemia in CKD patients in high-altitude regions in recent years， aiming to provide new insights for the clinical management of this special population.
ObjectiveTo investigate the value of baseline platelet/lymphocyte ratio （PLR）， neutrophil/lymphocyte ratio （NLR）， and complement C3 in assessing the severity of renal pathological injury in patients with immunoglobulin A （IgA） nephropathy （IgAN）.MethodsBaseline clinical and pathological data were retrospectively collected from 130 patients with primary IgAN confirmed by renal biopsy in the Department of Nephrology of Xiangyang No.1 People’s Hospital Affiliated to Hubei University of Medicine from January 1， 2020 to December 31， 2024. According to the Oxford pathological classification of IgAN， patients were divided into a mild renal pathological injury group （<3 pathological lesions， n=67） and a severe group （≥3 pathological lesions， n=63）. Differences in PLR， NLR， complement C3， and other clinical indicators were compared between the two groups. Logistic regression was used to identify risk factors affecting IgAN pathological grading. Using the median PLR as the cutoff， patients were divided into a low PLR group （n=65） and a high PLR group （n=65）. Using the median NLR as the cutoff， patients were divided into a low NLR group （n=65） and a high NLR group （n=65）. Using the mean complement C3 as the cutoff， patients were divided into a low complement C3 group （n=65） and a high complement C3 group （n=65）. The differences in the proportions of MESTC components among the groups were compared. Receiver operating characteristic （ROC） curves were used to evaluate the predictive value of the variables for severe IgAN pathological injury.ResultsA total of 130 patients with IgAN were included in this study， including 69 men （53.07%）. According to the Oxford pathological classification of IgAN， 67 patients were in the mild renal pathological injury group and 63 were in the severe group. Compared with the mild group， patients in the severe group had lower hemoglobin （Hb） （［126.83±2.93］ g/L vs ［135.49±2.58］ g/L）， albumin （Alb） （37.90 ［32.90， 40.48］ g/L vs 40.80 ［37.00， 44.12］ g/L）， estimated glomerular filtration rate （eGFR） （70.33 ［51.25， 101.77］ mL·min-1·［1.73 m2］-1 vs 97.56 ［68.72， 120.94］ mL·min-1·［1.73 m2］-1）， and complement C3 level （［1.24±0.03］ g/L vs ［1.39±0.03］ g/L） （all P<0.05）， but higher PLR （133.95 ［110.00， 188.34］ vs 113.97 ［89.25， 144.67］）， NLR （2.30 ［1.63， 3.22］ vs 1.98 ［1.33， 2.68］）， microscopic hematuria （78.00 ［30.00， 260.00］ cells/μL vs 37.00 ［7.00， 115.00］ cells/μL）， and 24-h urine protein （2999.04 ［1419.47， 5296.00］ mg vs 1240.00 ［677.69， 2487.30］ mg） （all P<0.05）. Univariate logistic regression showed that Hb， PLR， NLR， eGFR， and complement C3 were associated with the severity of pathological injury in patients with IgAN. Multivariate logistic regression showed that PLR， complement C3， and eGFR were independent factors affecting the severity of pathological injury in patients with IgAN. The proportion of S1 lesions （segmental glomerulosclerosis） was higher in the high PLR group than in the low PLR group （χ2=4.552， P=0.033）. The proportion of S1 lesions was also higher in the high NLR group than in the low NLR group （χ2=4.333， P=0.037）. In the low complement C3 group， the proportions of M1 lesions （mesangial hypercellularity） （χ2=17.979， P<0.001） and S1 lesions （χ2=5.370， P=0.020） were both higher than those in the high complement C3 group. ROC curve analysis further evaluated the role of PLR， complement C3， eGFR， and their combination in predicting severe renal pathological injury in IgAN. The results showed that PLR， complement C3， and eGFR all had relatively good predictive performance for severe IgAN pathological injury， while their combined model achieved the best predictive efficacy， with an area under the curve of 0.748 （95%CI： 0.666-0.830）.ConclusionElevated PLR， decreased complement C3， and decreased eGFR are independent risk factors for aggravated pathological injury in IgAN. The combined model of these three indicators has good predictive value for pathological grading in IgAN.
Exosomes are small vesicular structures,30-150 nm in diameter,released into the extracellular space after the fusion of multivesicular bodies with the cell membrane.They are widely pres-ent in various human body fluids,such as urine,blood,saliva,and amniotic fluid.Exosomes mainly con-tain bioactive substances such as proteins,lipids,and nucleic acids(DNA,RNA),among which RNA is predominantly non-coding RNA.In recent years,non-coding RNA has become a research focus be-cause of its key role in regulating transcription of coding genes.This article reviews the concept of exo-somal non-coding RNA and the roles of non-coding RNA derived from exosomes of different sources in chronic glomerulonephritis,aiming to provide a reference for slowing the progression of chronic glomeru-lonephritis and for developing new diagnostic and therapeutic strategies for this disease.
Hyperuricemic nephropathy （HN） refers to a disease in which excessive deposition of uric acid in the kidneys leads to renal dysfunction. It is a common secondary complication of hyperuricemia， and delayed treatment may exacerbate kidney injury. In China， the incidence of HN has been increasing year by year， a trend closely linked to the rapid development of the economy. This article reviews recent advances in the treatment of HN from the perspectives of its background， pathophysiological mechanisms， and therapeutic strategies.
