Objective:To explore the relationship of cytokines of peripheral blood helper T (Th) cells and regulatory T (Treg) cells with renal damage in children suffering from Henoch-Sch?nlein purpura (HSP).Methods:This was a cross-sectional study. From January 2021 to September 2022, 315 children with HSP admitted to the hospital were divided into a renal damage group (110 cases) and a non-renal damage group (205 cases). Detection and comparison were performed in cytokines of peripheral blood Th and Treg cells, including interferon-γ (IFN-γ), interleukin-4 (IL-4), interleukin-17 (IL-17), and transforming growth factor-β1 (TGF-β1). Pearson method was used to analyze the correlation between peripheral blood Th and Treg cells cytokines and renal damage, while logistic regression was used to analyze the influencing factors of renal damage.Results:Serum levels of IL-4 and IL-17 were positively correlated with levels of serum N-acetyl-β-aminoglucosidase (NAG), urinary microalbumin (mAlb), α1-microglobulin (α1-MG), and β2-microglobulin (β2-MG) (P<0.05). Serum levels of IFN-γ and TGF-β1were negatively correlated with levels of serum NAG, urinary mAlb, α1-MG, and β2-MG (P<0.05). The renal damage group showed higher levels of serum total IgE, ESR, ASO, IL-4, and IL-17, but lower levels of IFN-γ and TGF-β1, than the non-renal damage group (P<0.05). Elevated levels of total IgE, ESR, ASO, serum IL-4, and IL-17 were risk factors for renal damage, while serum IFN-γ and TGF-β1 were the protective factors.Conclusion:In the children with HSP, serum levels of IL-4 and IL-17 were increased, while levels of IFN-γ and TGF-β1 were decreased, suggesting that cytokines of Th and Treg cells might be involved in the development of HSP nephritis.
Objective:To establish a rat model of crush syndrome (CS) and preliminarily clarify the injury characteristics and functional changes in kidney, heart, and lung.Methods:Sixteen male SD rats were randomly divided into the sham group and CS group with 8 rats each. In the CS group, the hind limbs of rats were crushed under a pressure of 3 kg for 12 h by means of a digital animal crush injury simulation platform to establish the CS model. Twenty-four hours after successful model establishment, the rats were measured in the levels of serum creatine kinase, creatinine, urea nitrogen, and troponin, etc. The bronchoalveolar lavage fluid were detected for the number of cells, protein concentration, and myeloperoxidase (MPO) activity. Echocardiography was performed to detect the changes of cardiac function. Staining methods of PAS and HE were used to observe the histopathological changes in kidney, lung, and heart of the rats.Results:Compared with the sham group, the CS group showed higher levels of serum creatine kinase, creatinine, and urea nitrogen (all P<0.05). The CS group also displayed significant increase in cell numbers (P=0.032), protein concentration, and MPO activity (P=0.015) in the bronchoalveolar lavage fluid. And the CS group diclosed obvious cardiac diastolic dysfunction as well (P<0.05). Besides, histopathological observations found detachment of renal tubular epithelial cells, expansion of renal tubules, renal tubular cast, and increase in the number of pulmonary interstitial cells.Conclusion:Twenty-four hours after the crush injury, the rats showed significant dysfunction in the kidneys, heart, and lung, and the pathological damage to the kidney and lung was obvious.
慢性淋巴细胞白血病(chronic lymphocytic leukemia，CLL)是一种单克隆小淋巴细胞疾病，在我国较为少见，更少见肾脏受累。本文报道1例老年男性慢性淋巴细胞白血病浸润肾脏导致急性肾衰竭而行血液透析治疗的病例，此患者同时存在免疫球蛋白重链(immunoglobulin heavy chain, IGH)基因V区、免疫球蛋白轻链κ链(immunoglobulin light chain κ chain, IGK)基因及免疫球蛋白轻链λ链(immunoglobulin light chain λ chain, IGL)基因单克隆重排，提示为双克隆慢性淋巴细胞白血病。
Objective:To explore the relationship between markers of bone turnover metabolism and renal function in the elderly people.Methods:A cross-sectional study design was conducted, and 474 elderly individuals who underwent health examinations at the hospital from 2015 to 2021 were selected. Based on their glomerular filtration rates, the subjects were divided into the normal renal function group and the abnormal renal function group. Statistical analysis was conducted with the JASP 16.0.0 software, and multivariate logistic regression analysis was conducted to investigate the relationship between bone turnover metabolic markers and renal function.Results:The average age of the 474 elderly people was 78.52±3.17 years old, with a male population accounting for 61.8%. The renal dysfunction rate in the male was significantly lower than that in the female 37.4% vs 62.6%, P<0.001). After adjusting for age, gender, body mass index, diastolic blood pressure, total cholesterol, fasting blood glucose, homocysteine, 25-hydroxyvitamin D3, procollagen type 1 amino-terminal propeptide (PINP), β-cross-linked C-telopeptide of type I collagen (β-CTX), intact parathyroid hormone, and osteocalcin, the results of multivariate logistic regression analysis showed that higher level of 25-hydroxyvitamin D3 (P<0.05) were associated with a lower incidence of renal dysfunction in the elderly people. Compared to the group with β-CTX ≤ 0.36 pg/ml, the group with β-CTX>0.37 pg/ml showed a higher incidence of renal dysfunction (P<0.05) and a lower incidence of hyperuricemia (P<0.05). In the female population, 25-hydroxyvitamin D3 decrease and β-CTX increase were correlated with the renal dysfunction (P<0.05).Conclusion:Higher level of β- CTX and lower level of 25-hydroxyvitamin D3 were associated with the decreased renal function in the elderly people.
Membrane nephropathy (MN) is a specific autoimmune disease mediated by antibodies. Its pathogenesis is mainly the activation of complements by the binding of autoantibodies to target antigens, leading to damage to the glomerular filtration barrier and proteinuria. In recent years, multiple target antigens of MN have been discovered, including M-type phospholipase A2 receptor (PLA2R), thrombospondin type 1 domain-containing 7A (THSD7A), exostosin 1/2 complex (EXT1/2), neural epidermal growth factor-like 1 protein (NELL-1), high temperature requirement factor A1 (HTRA1), semaphorin 3B (Sema3B), neural cell adhesion molecule 1 (NCAM1), procalcadherin 7 (PCDH7), transforming growth factor β receptor 3 (TGFBR3), and contactin 1 (CNTN1), etc. Research on these target antigens is of great significance in the diagnosis and treatment monitoring of MN. This article reviewed the research progress on target antigens in MN so as to provide reference for its clinical diagnosis and treatment.
This paper summarized the important progress in the basic and clinical research fields of acute kidney injury (AKI) in 2022. The basic research progress mainly included the pathogenesis of renal tubular injury, the microenvironment of immune inflammation, and the cross-talk between cells. The clinical research progress mainly included further understanding of the epidemiology, diagnosis and biomarkers, and timing of renal replacement therapy in AKI of various clinical types. These research advances provide critical evidence for understanding of the pathogenesis, pathophysiological process, diagnosis, prognosis, as well as guiding treatment of AKI.
随着慢性肾脏病育龄期妇女肾功能逐渐下降，其受孕及生育健康胎儿的机率逐渐降低，在终末期肾病及透析阶段已被认为是妊娠的相对禁忌时期。随着血液净化技术的不断提高，产科高危妊娠管理规范化及早产儿救治水平的提高，近年来国内外相继有透析患者成功妊娠的个案报道。透析女性分娩健康新生儿的比例由上世纪80年代的15~20%上升至75%。为帮助终末期肾病及透析患者孕期平稳渡过并安全分娩，获得最佳妊娠结局，孕期科学、规范管理至关重要。影响终末期肾病患者妊娠结局的因素包括生育力下降、孕期不良事件、胎儿发育异常、羊水过多、高血压、贫血，以及原发疾病如抗磷脂抗体综合征(antiphospholipid syndrome，APS)、系统性红斑狼疮(systemic lupus erythematosus, SLE)和特殊药物对妊娠的影响。对透析妊娠患者的孕期规范性管理应主要围绕透析患者妊娠的诊断，妊娠期透析方式的选择，透析处方设定(包括血液透析处方及腹膜透析处方)，并发症的管理(包括贫血、血压、电解质、膳食及体重管理、先兆子痫的预防与处理)，产科管理及胎儿监测，分娩及产后管理等方面。肾脏内科(透析中心)、产科、生殖科、儿科、药剂科、营养科、心理科等多学科团队的参与是透析患者孕期管理重要保障。多学科团队通过对患者进行全面评估、制定并落实包括母胎监测、精准治疗、用药管理、营养管理、生活方式及心理干预等多学科管理措施，帮助透析患者孕期平稳度过并安全分娩，获得最佳妊娠结局。
华氏巨球蛋白血症(Waldenstr?m macroglobulinemia，WM)是一种原因未明的B淋巴细胞异常增殖性疾病，伴单克隆IgM升高，可累及皮肤、呼吸系统、消化系统及神经系统，累及肾脏者少见，现将我科收治的1例以肾病综合征为主要表现的巨球蛋白血症病例报到如下。
Objective:To explore the influencing factors of short-term mortality in elderly maintenance hemodialysis (MHD) patients and the predictive role of nomogram prediction model.Methods:The clinical data of 344 elderly patients who received MHD treatment in our hospital from January 2018 to August 2021 were retrospectively analyzed. According to the patients′ survival within one year after starting hemodialysis treatment, they were divided into a death group and a survival group. The two groups were compared in the clinical data. Logistic regression model was used to analyze influencing factors of short-term mortality in the elderly MHD patients. And a nomogram model was constructed by the R software. The area under the curve (AUC) of the receiver operating curve (ROC) was applied to evaluate the predictive effect of the model, and the goodness-of-fit test was also carried out.Results:After starting hemodialysis, 84 patients (24.42%) died within one year. There were significant differences between the two groups in terms of hemodialysis starting age, vascular access type, the proportion of Charlson comorbidity index (CCI) >3, systolic blood pressure (SBP), fasting plasma glucose (FPG), serum albumin (Alb), estimated glomerular filtration rate (eGFR), and the proportion of urea clearance index (Kt/V) <1.3 (P<0.05). Logistic regression analysis showed that the main influencing factors for short-term mortality in the elderly MHD patients included hemodialysis starting age(OR 1.263, 95%CI: 1.010-1.534), vascular access type(OR 2.097, 95%CI: 1.025-4.774), Alb(OR 0.463, 95%CI: 0.262-0.817), eGFR(OR 0.416, 95%CI: 0.269-0.644), and Kt/V(OR 2.254, 95%CI: 1.292-5.252). After the above five main influencing factors were introduced into the R software to construct a nomogram model, the analysis results showed that the AUC was 0.820(95%CI: 0.775-0.866) while the goodness-of-fit test displayed good fitting effect (χ2=6.208, P=0.624).Conclusion:The nomogram model constructed based on five main influencing factors including hemodialysis starting age, vascular access type, Alb, eGFR, and Kt/V might have a role for predicting the risk of short-term mortality in the elderly MHD patients.
Objective:To establish a mouse model of severe exertional heat stroke-related acute kidney injury (EHS-AKI) in order to provide support for research on the pathogenesis and treatment.Methods:C57BL/6 male wild-type mice aged 6-8 weeks were randomly divided into 6 groups: saline blank control group (n=8), saline-normal temperature-exercise group (n=40), saline-high temperature-high humidity-exercise group (n=80), glycerol blank control group (n=8), glycerol-normal temperature-exercise group (n=40), and glycerol-high temperature-high humidity-exercise group (n=120). The success criteria for modeling EHS included that the mice had rectal temperature ≥ 42.5 ℃ and lost consciousness. At 6 hours, 12 hours, 1 day, 2 days, and 3 days after the exercise, the mice were sacrificed and specimens were taken. Measurement was performed for serum creatinine (Scr), urea nitrogen (BUN), interleukin-6 (IL-6), creatine kinase (CK), myoglobin (MYO), and renal pathological lesions. AKI diagnostic criteria was according to the KDIGO guidelines in Scr elevation ≥ 26.5 within 48 hours μmol/L accompanied by significant renal pathological lesions.Results:Mice of both the saline-normal temperature-exercise group and the glycerol-normal temperature-exercise group survived at 3 days after exercise without significant change in the renal function. At 6 h, 12 h, 1 d, 2 d, and 3 d after the exercise, the survival rates of the saline-high temperature-high humidity-exercise group were 80%, 70%, 60%, 60%, and 60%, respectively, while the survival rates of the glycerol-high temperature-high humidity-exercise group were 60%, 50%, 40%, 30%, and 30%, respectively. At 12 hours after exercise, in the saline-high temperature-high humidity-exercise group, the level of Scr was briefly increased (P<0.05), while at 6 hours after exercise, in the glycerol-high temperature-high humidity-exercise group, levels of Scr, BUN, IL-6, CK, and MYO significantly increased, and peaked at 1 day after the exercise. In the saline-normal temperature-exercise group, the saline-high temperature-high humidity-exercise group, and the glycerol-normal temperature-exercise group, there were only occasional renal interstitial infiltration of inflammatory cells, without other pathological lesion changes such as renal tubular dilation and edema. In the glycerol-high temperature-high humidity-exercise group, the mice showed loss of brush border of renal tubular epithelial cells, detachment of tubular epithelial cells, exposure of the basement membrane, and tubular cast, etc. At 6 h, 12 h, 1 d, 2 d, and 3 d after exercise, the scores of renal pathological lesions in this group were 0.8±0.5, 1.6±0.6, 3.0±1.1, 1.3±0.5, and 1.1±0.5, respectively.Conclusion:A mouse model of severe EHS-AKI was successfully established through low-dose glycerol intramuscular injection and exercise in high-temperature and high humidity, which may provide support for further research on the pathogenesis and treatment.
The skin lesion is one of the common complications in patients with uremia, and their pathogenesis has not been fully elucidated. Recent studies have shown that there is a close relationship between the gut and skin lesions in that they both interact and influence each other, forming the "gut-skin axis" . This article reviewed the research progress on the relationship between the "gut-skin axis" and uremic skin lesions so as to explore the potential therapeutic methods.
Antiviral drugs are commonly used in clinical practice, and may lead to acute kidney injury through a variety of mechanisms, including renal hypoperfusion, direct renal tubular toxicity, crystal nephropathy, and thrombotic microangiopathy, etc. The pandemic of COVID-19 has brought antiviral drug-associated kidney injury to extensive clinical focus. This article reviewed the performances of antiviral drugs in COVID-19 treatment and their effect on the kidney, and summarized the clinical manifestations and pathological mechanisms of antiviral drug-associated acute kidney injury.
Objective:To perform a bibliometric analysis of research on artificial kidney for the purpose of exploring the status and trend of research in this field.Methods:From the web of science core collection (WoSCC), artificial kidney-related literature from 2000 to 2022 were taken as samples, and the CiteSpace and VOSviewer softwares were applied to statistically analyze the number of publications, as well as country, institution, author, journal, and key words, etc.Results:A total of 382 articles related to artificial kidney were obtained after screening and de-duplication. The United States was the country with the largest contribution, and University of Twente was the leading institution. Artificial Organs was the most active journal in this field. Claudio Ronco was the author with the highest number of publications and ranked first among co-cited authors. Wearable artificial kidney, hemodialysis, peritoneal dialysis, and bioartificial kidney were the keywords that appeared with high frequency. Adsorption and removal were the main burst key words.Conclusion:Annual publications related to artificial kidney have been increasing year by year for the last two decades. Wearable artificial kidney and bioartificial kidney were continuously popular research directions. The recent high interest in the function of artificial kidney to adsorb and remove metabolites suggested that it may be recent hotspots in this field.
Vascular calcification (VC) is an important factor for the increase of both incidence of cardiovascular events and mortality in patients with chronic kidney disease (CKD). Previous studies have shown that macrophages played a key regulatory role in the occurrence, development, and regression of VC. However, the role and mechanism of macrophages in VC of CKD patients are not fully understood. This article reviewed the progress of research on the role and mechanism of macrophages in CKD-related VC with the aim of providing new ideas for the prevention and treatment of VC in CKD patients.
Objective:To investigate the role of color Doppler ultrasound guidance in establishing vascular access for hemodialysis in patients with chronic renal failure (CRF).Methods:A total of 160 CRF patients admitted to our hospital from January 2019 to January 2020 were selected, and randomly divided into an observation group and a control group with 80 cases each. The vascular access of patients in the observation group was established under the guidance of color Doppler ultrasound, while the vascular access of patients in the control group was established by physicians based on clinical experience. The two groups were compared in the success rate of the first puncture, vascular patency rate, as well as the diameter of the cephalic vein, diameter of the radial artery, diameter of the anastomosis, and arterial blood flow at 1 week and 6 months after establishment of the vascular access. Besides, the two groups were also compared in the incidence of complications such as subcutaneous hematoma, thrombosis, and local vascular sclerosis.Results:The success rate of first puncture and vascular patency rate in the observation group were higher than those in the control group (P< 0.05). The diameters of the cephalic vein, radial artery, and anastomosis, as well as blood flow of them were significantly greater at six months than at one week after establishing the vascular access (P<0.05). Besides, these were also higher in the observation group than in the control group at the same time points (P<0.05). The total incidence of complications in the observation group was also lower than that in the control group (P<0.05).Conclusion:Color Doppler ultrasound guidance could significantly improve establishing vascular access for hemodialysis in the CRF patients, with fewer complications.
Objective:To investigate the effect of Niaoduqing granules on residual renal function (RRF) and levels of fibronectin (FN) and TGF-β1 in peritoneal dialysate of peritoneal dialysis patients.Methods:A total of 103 end-stage kidney disease patients who underwent PD treatment in the four hospitals were enrolled, and randomly divided into an experimental group of 52 cases and a control group of 51 cases. The control group received PD treatment, while the experimental group received oral Niaoduqing granules on the basis of PD treatment for 12 months. The two groups were compared in changes of RRF, urine volume, residual Kt/V, residual creatinine clearance rate (Ccr), FN, and TGF-β1 before and after the treatment.Results:After 12 months of treatment, the levels of RRF, residual Kt/V, and residual Ccr were lower in both groups (P<0.05), but were higher in the experimental group than in the control group (P<0.05). In addition, after treatment, the levels of FN and TGF-β1 in the peritoneal dialysate of the experimental group decreased significantly, and were also lower than those of the control group (all P<0.01).Conclusion:Niaoduqing granules improved the RRF of the PD patients, and reduced the expression of FN and TGF-β1 implicating that Niaoduqing granules might also have an inhibitory effect on peritoneal fibrosis.
Studies have found that AKI could lead to gut microbiota imbalance, while the imbalance of gut microbiota could aggravate the progression of AKI, forming a gut-kidney vicious cycle. Probiotics and their metabolites might inhibit the progression of AKI by blocking the gut-kidney vicious cycle, which may become a new therapy for AKI. This article reviewed the progress of research on the role of gut microbiota in AKI.
腹膜透析相关腹膜纤维化是终末期肾脏病患者退出腹膜透析治疗最关键的原因，但尚缺乏有效防治方法。间充质干细胞(mesenchymal stem cells, MSCs)作为作为一种多能干细胞，可以减轻腹透动物模型腹膜损伤和纤维化，改善腹膜功能。MSCs主要是通过释放大量外泌体转移至病灶发挥重要作用。重庆陆军军医大学大坪医院肾内科通过临床前实验明确MSCs外泌体治疗的时机、剂量及疗程，并发现其在改善腹膜炎症、纤维化、血管新生、腹膜功能等方面具有较好的治疗效果，具有广阔的应用前景。并通过体内外实验揭示间充质干细胞外泌体对腹透相关性腹膜损伤修复及抗纤维化关键分子及通路的作用机制。未来基于腹透腹膜损伤关键机制，探寻腹透腹膜损伤早期的敏感且特异评价方法和有效干预措施，是进一步提高腹透技术存活率和改善患者生存质量及远期预后的重要任务。
Objective:To investigate the outcomes and influencing factors of elderly patients with acute kidney injury (AKI) after continuous renal replacement therapy (CRRT).Methods:Data of elderly AKI patients aged≥80 were collected who received CRRT treatment for 90 days in the hospital from January 2016 to January 2023. Analysis was performed in their survival status, treatment dose, and scores of acute physiological and chronic health evaluation Ⅱ(APACHE Ⅱ) and sequential organ failure assessment (SOFA).Results:After 90 days of CRRT in 43 AKI patients aged (91.3±6.6), 12 patients survived and 31 died, with a total mortality rate of 72.1%. The APACHE Ⅱ scores of the dead patients (27.2±4.2) were significantly higher than those of the surviving patients (24.0±5.0) (P<0.05). The cumulative survival rates of CRRT treatment for 15 days, 30 days, and 45 days were 71.8%, 56.8%, and 43.2%, respectively. Logistic regression analysis showed that APACHE Ⅱ score and SOFA score were independent influencing factors to affect the prognosis of the patients (P<0.05).Conclusion:The mortality rate of the elderly AKI patients after the CRRT treatment increased with the increase of APACHE Ⅱ score. The APACHE Ⅱ score and SOFA score were the influencing factors in the initiation of CRRT treatment and prognosis for the elderly AKI patients.
Objective:To explore the change and its significance of serum interleukin-22 (IL-22), hydrogen sulfide (H2S), and osteoprotegerin (OPG) levels in patients with hypertensive disorders of pregnancy (HDP) complicated with acute kidney injury (AKI).Methods:From May 2020 to December 2021 in the department of obstetrics of the hospital, 50 patients with HDP were selected as HDP group, and 50 HDP patients complicated with AKI were selected as HDP-AKI group, while 50 healthy pregnant women were selected as control group. The enzyme-linked immunosorbent assay (ELISA) method was used to measure the levels of serum IL-22, H2S, OPG, creatinine, blood urea nitrogen, and urine protein. The Pearson method was applied to analyze the correlation among IL-22, H2S, and OPG. Logistic regression analysis was performed to screen the influencing factors in the outcomes of the HDP patients complicated with AKI.Results:Compared with the control group, the HDP group showed higher levels of serum IL-22, OPG, serum creatinine, and blood urea nitrogen as well as urinary protein, but showed lower level of H2S (P<0.05). Compared with the HDP group, the HDP-AKI group also had higher levels of IL-22, OPG, creatinine, and blood urea nitrogen as well as urinary protein, but had lower level of H2S (p<0.05). In the HDP-AKI group, IL-22 was positively correlated with OPG (r=0.386, P<0.001), while IL-22 was negatively correlated with H2S (r=-0.306, P<0.001), and OPG was also negatively correlated with H2S (r=-0.312, P<0.001). Age, body mass index (BMI), serum H2S, IL-22, OPG, serum creatinine, and blood urea nitrogen as well as urinary protein were all influencing factors in the pregnancy outcome of HDP patients complicated with AKI (P<0.05).Conclusion:The HDP patients complicated with AKI had higher levels of serum IL-22 and OPG, but lower level of H2S, which might have a certain impact on the pregnancy outcomes.
