ObjectiveTo analyze the effects of different peritoneal dialysis catheter placement techniques on short-term postoperative complications.MethodsA retrospective analysis was performed on 169 patients with end-stage renal disease who underwent peritoneal dialysis catheter placement for the first time in the Department of Nephrology， the Second Affiliated Hospital of Kunming Medical University， from January 2020 to May 2025. According to the peritoneal dialysis catheter placement method， patients were divided into an open surgical catheter placement group （n=33）， a percutaneous catheter placement group （n=88）， and a laparoscopic catheter placement group （n=48）. Clinical baseline data and laboratory test results were collected， and postoperative complications within 1 month and catheter technical survival were recorded. Univariate and multivariate logistic regression analyses were used to identify factors associated with complications， and Kaplan-Meier analysis was used to compare catheter technical survival among the three groups.Results（1） The incidence of postoperative complications in the percutaneous catheter placement group （28.4%） was higher than that in the open surgical catheter placement group （21.2%） and the laparoscopic catheter placement group （14.6%）， but the difference was not statistically significant （P>0.05）. The incidence of pericatheter leakage and poor drainage in the laparoscopic catheter placement group was lower than that in the percutaneous catheter placement group and the open surgical catheter placement group， but the difference was not statistically significant （P>0.05）. （2） Univariate logistic regression analysis showed that the interval from peritoneal dialysis catheter insertion to initiation of peritoneal dialysis， white blood cell count， and interleukin-6 level were associated with short-term postoperative complications （P<0.10）. Multivariate logistic regression analysis showed no significant association between the three catheter placement methods and short-term postoperative complications （P>0.05）. （3） Kaplan-Meier survival analysis showed no statistically significant difference in catheter technical survival curves among the three groups （P>0.05）.ConclusionThe catheter placement method is not a factor influencing short-term postoperative complications after peritoneal dialysis catheter placement. The interval from peritoneal dialysis catheter insertion to initiation of peritoneal dialysis， white blood cell count， and interleukin-6 level are factors associated with short-term postoperative complications after peritoneal dialysis catheter placement.
ObjectiveTo investigate the predictive value of the urinary decoy receptor 2 （DcR2）-to-creatinine （Cr） ratio for kidney prognosis in patients with diabetic kidney disease （DKD）.MethodsA retrospective study was conducted. A total of 128 patients with DKD treated at the Zhangjiagang Hospital Affiliated to Soochow University （Zhangjiagang First People’s Hospital） from February 2022 to January 2025 were included. The urinary DcR2/Cr ratio was measured， and based on the Youden index （380.00 ng/g Cr）， patients were divided into a low-level group （n=61） and a high-level group （n=67）. General data were collected， including age， sex， duration of diabetes， blood pressure， blood glucose， blood lipids， and renal function indicators， and were compared between the two groups. All patients received routine interventions during hospitalization. After discharge， patients were followed up for 6 months， and the occurrence of adverse kidney prognosis events was recorded. According to whether adverse kidney prognosis events occurred during follow-up， patients were divided into a kidney prognosis-poor group and a kidney prognosis-good group. Overall survival （OS） was calculated， and survival curves were drawn using the Kaplan-Meier method； survival analysis was performed with the Log-rank test. Cox proportional hazards regression was used to identify independent risk factors for adverse kidney prognosis events in DKD patients. Spearman correlation analysis was used to assess correlations between each indicator and prognosis.ResultsThere were no statistically significant differences between the two groups in age， sex， body mass index， smoking history， and drinking history （P>0.05）. The high-level group had longer duration of diabetes （11.00 ［9.00， 13.00］ years vs 8.00 ［6.00， 10.00］ years）， higher fasting blood glucose （8.50 ［7.50， 9.50］ mmol/L vs 7.25 ［6.50， 8.00］ mmol/L）， higher glycated hemoglobin A1c （HbA1c） （9.00 ［8.00， 9.80］% vs 7.80 ［7.00， 8.50］%）， higher total cholesterol （5.20 ［4.50， 5.80］ mmol/L vs 4.50 ［4.00， 5.00］ mmol/L）， higher triglycerides （2.20 ［1.80， 2.80］ mmol/L vs 1.60 ［1.20， 2.00］ mmol/L）， higher serum creatinine （Scr） （110.00 ［90.00， 130.00］ μmol/L vs 75.00 ［60.00， 90.00］ μmol/L）， higher blood urea nitrogen （BUN） （8.00 ［7.00， 9.50］ mmol/L vs 6.00 ［5.00， 7.00］ mmol/L）， higher uric acid （400.00 ［360.00， 450.00］ μmol/L vs 320.00 ［280.00， 360.00］ μmol/L）， and higher uDcR2/Cr （785.40 ［682.15， 865.22］ ng/g Cr vs 372.15 ［310.62， 425.38］ ng/g Cr） （P<0.05）. The high-level group had lower high-density lipoprotein cholesterol （0.90 ［0.80， 1.05］ mmol/L vs 1.10 ［0.95， 1.25］ mmol/L）， lower albumin （Alb） （36.00 ［34.00， 38.00］ g/L vs 40.00 ［38.00， 42.00］ g/L）， and lower estimated glomerular filtration rate （65.00 ［50.00， 80.00］ mL·min-1·［1.73 m2］-1 vs 90.00 ［75.00， 105.00］ mL·min-1·［1.73 m2］-1） （P<0.05）. During the 6-month follow-up， 45 of 128 patients （35.16%） experienced adverse kidney prognosis events， and 83 patients （64.84%） had good prognosis. In the low-level group， 12 patients （19.67%） had adverse kidney prognosis events and 49 patients （80.33%） had good prognosis， with an OS time of 4 （1， 6） months. In the high-level group， 33 patients （49.25%） had adverse kidney prognosis events and 34 patients （50.75%） had good prognosis， with an OS time of 2 （1， 4） months. The incidence of adverse kidney prognosis events in the low-level group was significantly lower than that in the high-level group （χ2=36.459， P<0.001）. Compared with the kidney prognosis-good group， the kidney prognosis-poor group had higher HbA1c （8.89 ［7.40， 10.60］% vs 8.06 ［6.82， 9.80］%）， Scr （128 ［101， 138］ μmol/L vs 124 ［98， 135］ μmol/L）， BUN （8.82 ［7.65， 9.07］ mmol/L vs 6.74 ［4.58， 7.34］ mmol/L）， and a higher proportion of uDcR2/Cr ≥380.00 ng/g Cr （33/45 vs 34/83） （P<0.05）. Cox regression analysis showed that uDcR2/Cr ratio ≥380.00 ng/g Cr， elevated HbA1c， increased Scr， and increased BUN were risk factors for adverse kidney prognosis events in DKD patients （P<0.05）. Spearman rank correlation analysis showed that adverse kidney prognosis in DKD patients was positively correlated with uDcR2/Cr ratio， HbA1c， Scr， and BUN （P<0.05）.ConclusionThe urinary DcR2/Cr ratio is an independent predictor of kidney prognosis in DKD patients. An increased ratio indicates a higher risk of poor prognosis. When the urinary DcR2/Cr ratio is ≥380.00 ng/g Cr， enhanced clinical monitoring and intervention should be implemented. This biomarker， combined with traditional risk factors， can improve the accuracy of kidney prognosis assessment in DKD patients.
ObjectiveTo investigate the regulatory role of the growth arrest-specific protein 6 （Gas6）/Axl receptor tyrosine kinase （Axl） signaling pathway in macrophage polarization， and to further elucidate its role and underlying mechanisms during the progression of interstitial fibrosis in immunoglobulin A nephropathy （IgAN）.MethodsM0-type macrophages were transfected with Axl-targeting small interfering RNA （siRNA） and negative control （NC） siRNA， respectively. Quantitative real-time polymerase chain reaction （qPCR） and Western blotting were used to detect the expression of Axl and M2-type macrophage-specific factors including cluster of differentiation 206 （CD206）， arginase-1 （Arg-1）， transforming growth factor-β （TGF-β）， and interleukin-10 （IL-10）. Flow cytometry was used to detect the proportions of M1- and M2-type macrophages. A co-culture system of human kidney-2 （HK-2） cells and M0-type macrophages was established and divided into a control group， a TGF-β1 group， a TGF-β1＋siRNA-NC group， and a TGF-β1＋siRNA-Axl group. Enzyme-linked immunosorbent assay （ELISA） was used to measure collagen （COL）1 and COL3 levels in culture supernatants. Immunofluorescence staining was used to observe α-smooth muscle actin （α-SMA） expression in HK-2 cells. Western blotting was used to detect α-SMA， fibronectin （FN）， Gas6， phosphorylated protein kinase B （p-Akt）， and protein kinase B （Akt） protein expression， and the p-Akt/Akt ratio was calculated. For the animal experiment， 10 wild type （WT） mice and 10 Axl gene knockout （Axl-/-） mice were randomly assigned （5 mice per group） into four groups： WT control group， WT IgAN group， Axl-/- control group， and Axl-/- IgAN group. Hematoxylin and eosin （HE） and Masson staining were used to assess renal pathological injury and fibrosis. Western blotting was used to detect α-SMA and FN protein expression. Immunofluorescence double staining was used to evaluate M2-type macrophage infiltration.ResultsIn vitro experiments showed that compared with the control group and siRNA-NC group， the siRNA-Axl group had lower relative Axl mRNA expression （0.28±0.02 vs 1.00±0.06， 1.02±0.08） and lower relative Axl protein expression （0.07±0.01 vs 0.35±0.03， 0.32±0.04）. The proportion of M1-type macrophages increased （［73.50±7.65］% vs ［50.00±6.02］%， ［51.00±4.98］%）， while the proportion of M2-type macrophages decreased （［25.50±2.71］% vs ［49.70±5.13］%， ［49.10±5.01］%）. The mRNA and protein expression of CD206， Arg-1， TGF-β， and IL-10 decreased （all P<0.05）. After co-culture of HK-2 cells with macrophages， compared with the control group， the TGF-β1 group showed increased COL1 （［2.07±0.21］ μg/L vs ［0.54±0.04］ μg/L） and COL3 （［1.53±0.14］ μg/L vs ［0.42±0.04］ μg/L）， enhanced α-SMA immunofluorescence expression， and increased relative expression of α-SMA （0.72±0.06 vs 0.11±0.01）， FN （0.70±0.08 vs 0.09±0.01）， and Gas6 （0.68±0.07 vs 0.06±0.01）， as well as an increased p-Akt/Akt ratio （0.34±0.03 vs 0.12±0.01）. Compared with the TGF-β1＋siRNA-NC group， the TGF-β1＋siRNA-Axl group showed decreased COL1 （［1.01±0.08］ μg/L vs ［2.06±0.21］ μg/L） and COL3 （［0.73±0.06］ μg/L vs ［1.53±0.14］ μg/L）， weakened α-SMA immunofluorescence expression， and decreased relative protein expression of α-SMA （0.15±0.02 vs 0.74±0.08）， FN （0.17±0.02 vs 0.73±0.08）， and Gas6 （0.15±0.01 vs 0.66±0.07）， as well as a decreased p-Akt/Akt ratio （0.21±0.02 vs 0.32±0.03） （all P<0.05）. In animal experiments， compared with the WT control group， the WT IgAN group showed increased renal interstitial fibrosis area （［12.46±1.34］% vs ［1.23±0.14］%）， increased relative protein expression of α-SMA （1.27±0.13 vs 0.43±0.04） and FN （0.93±0.10 vs 0.14±0.01）， and increased M2-type macrophage proportion （［21.50±2.24］% vs ［6.34±0.65］%）. Compared with the Axl-/- control group， the Axl-/- IgAN group showed increased renal interstitial fibrosis area （［7.54±0.80］% vs ［1.01±0.11］%）， increased relative protein expression of α-SMA （0.63±0.06 vs 0.42±0.04） and FN （0.47±0.05 vs 0.13±0.01）， and increased M2-type macrophage proportion （［17.83±1.84］% vs ［6.81±0.67］%）. Compared with the WT IgAN group， the Axl-/- IgAN group showed decreased renal interstitial fibrosis area （［7.54±0.80］% vs ［12.46±1.34］%）， decreased relative protein expression of α-SMA （0.63±0.06 vs 1.27±0.13） and FN （0.47±0.05 vs 0.93±0.10）， and decreased M2-type macrophage proportion （［17.83±1.84］% vs ［21.50±2.24］%） （P<0.05）.ConclusionThe Gas6/Axl signaling pathway participates in the progression of interstitial fibrosis in IgAN by regulating macrophage polarization. Axl silencing or knockout can alleviate renal interstitial fibrosis injury， providing a potential target for IgAN treatment.
ObjectiveTo address the clinical gap in predicting acute kidney injury （AKI） in children with type 1 diabetes mellitus （T1DM） complicated by diabetic ketoacidosis （DKA）， and to systematically investigate the predictive value of serum cathepsin S （CTSS） and urinary kidney injury molecule 1 （KIM-1） using least absolute shrinkage and selection operator （LASSO）-logistic regression and random forest algorithms， thereby providing a basis for early identification of high-risk children in clinical practice.MethodsA retrospective study included 106 children aged 5-14 years with T1DM complicated by DKA who were admitted to Tianjin Children’s Hospital （Children's Hospital， Tianjin University） from January 2022 to January 2024. According to Kidney Disease： Improving Global Outcomes criteria， the patients were divided into an AKI group （27 cases） and a non-AKI group （79 cases）. General clinical data and laboratory indicators were collected. Serum CTSS and urinary KIM-1 levels were measured using enzyme-linked immunosorbent assay. LASSO regression was used for variable selection， and Logistic regression was applied to identify independent influencing factors. A random forest algorithm was used to construct the prediction model. Receiver operating characteristic （ROC） curves were used to evaluate the predictive value of serum CTSS and urinary KIM-1 for AKI in children with T1DM complicated by DKA.ResultsCompared with the non-AKI group， the AKI group had higher levels of albumin （［46.16±5.95］ g/L vs ［41.97±5.41］ g/L）， blood glucose （［33.29±8.06］ mmol/L vs ［26.27±7.31］ mmol/L）， uric acid （462.94 ［380.35， 556.11］ μmol/L vs 305.28 ［245.85， 396.21］ μmol/L）， serum creatinine （73.62 ［68.25， 80.34］ μmol/L vs 41.18 ［37.38， 45.92］ μmol/L）， blood urea nitrogen （9.32 ［6.83， 12.52］ mmol/L vs 4.82 ［3.41， 5.87］ mmol/L）， corrected serum sodium （［140.56±5.67］ mmol/L vs ［135.84±5.49］ mmol/L）， and hematocrit （［43.05±4.85］% vs ［36.97±4.28］%）， with statistically significant differences （P<0.05）. Serum CTSS （1643.42 ［740.28， 1888.60］ ng/L vs 461.57 ［379.09， 569.24］ ng/L） and urinary KIM-1 （862.65 ［760.72， 1005.95］ ng/L vs 397.52 ［342.52， 463.98］ ng/L） were also significantly higher in the AKI group than in the non-AKI group （P<0.05）. Multivariable Logistic regression showed that uric acid （OR=1.019， 95%CI： 1.002-1.036）， hematocrit （OR=1.419， 95%CI： 1.026-1.964）， CTSS （OR=1.003， 95%CI： 1.000-1.005）， and urinary KIM-1 （OR=1.009， 95%CI： 1.002-1.016） were independent factors associated with AKI in children with T1DM complicated by DKA （all P<0.05）. In the random forest model， the importance of variables in descending order of predictive contribution was urinary KIM-1， hematocrit， uric acid， CTSS， blood glucose， corrected serum sodium， and albumin. ROC analysis showed that both CTSS ［area under the curve （AUC）=0.849］ and urinary KIM-1 （AUC=0.850） had good predictive value， and their combined prediction of AKI in children with T1DM complicated by DKA improved the AUC to 0.939 （both P<0.05）.ConclusionSerum CTSS and urinary KIM-1 can serve as effective predictive indicators for AKI in children with T1DM complicated by DKA， and their combined use can significantly improve predictive accuracy， providing a reference for early clinical intervention.
