BACKGROUND:The functional implications of renal artery variations-including accessory renal artery (ARA) and early branching-in hypertensive chronic kidney disease remain poorly understood. METHODS:This prospective cohort study enrolled 38 patients with hypertensive chronic kidney disease with unilateral solitary renal artery variation (24 ARA, 14 early branching) undergoing pressure wire-based hemodynamic evaluation and selective segmental renal vein renin sampling; 35 patients completed 2-year follow-up. RESULTS:Mean pressure gradient was higher in variant artery than in ipsilateral main (1.10±3.39 versus -0.15±2.21 mm Hg, P=0.04) and contralateral renal artery (versus -0.10±1.56 mm Hg, P=0.04) in the overall cohort, a difference limited to the ARA subgroup. Plasma renin activity was elevated in ARA-supplied segments compared with the ipsilateral main trunk (1.77±1.86 versus 1.24±1.40 ng/(mL·h), P=0.004) and contralateral artery-supplied segments (versus 1.24±1.37, P=0.002), whereas no significant difference was observed in the early branching subgroup. After multivariable adjustment, variant artery systolic pressure gradient was positively associated with variant-supplied segmental (β=0.41, P=0.02) and peripheral (β=0.37, P=0.04) plasma renin activity, angiotensin II, and nighttime mean arterial pressure. Peripheral aldosterone was associated with lower estimated glomerular filtration rate and higher urinary protein. All adjusted associations represent exploratory signals given limited sample size. Over 2 years, an intragroup estimated glomerular filtration rate decline was observed within the ARA subgroup (-5.2 mL/[min·1.73 m2]; P=0.02) while the early branching subgroup remained stable (P=0.47); however, the group-by-time interaction was not significant (P=0.06), indicating these preliminary trends require larger validation cohorts. CONCLUSIONS:Renal artery variations may alter intrarenal hemodynamics, with functional impairment and segmental renin hypersecretion observed primarily in ARA. This suggests a potential role for functional evaluation.

Chronic Q fever is caused by Coxiella burnetii infection. There are few clinical cases of chronic Q fever, and cases complicated with renal insufficiency are even more rarely reported. At present, there are few reports about this disease both domestically and internationally, and its clinical characteristics and pathogenesis remain unclear. This article reports a case of a chronic Q fever patient with clinical manifestations of nephrotic syndrome and impaired renal function, whose renal biopsy revealed membranoproliferative glomerulonephritis. After treatment with glucocorticoid, cyclophosphamide, hydroxychloroquine combined with doxycycline, the patient’s renal function improved.

Psoriasis is a chronic inflammatory skin disease increasingly recognized for its systemic involvement, particularly renal impairment. However, the pathological spectrum of kidney lesions observed in psoriasis patients remains under-characterized. We conducted a retrospective clinicopathologic study of native kidney biopsies from patients with psoriasis at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine between 2009 and 2025. Clinical characteristics, laboratory data, and renal pathological findings were systematically analyzed. Among 68 patients (55 male [81

Light chain deposition disease (LCDD) is a clonal plasma cell disorder characterized by the deposition of nonamyloid monoclonal light chains in multiple organs. It can affect various systems throughout the body, mainly the kidneys. Symptoms may include renal insufficiency, proteinuria, hematuria, and others. Due to the lack of effective treatment, LCDD patients with kidney involvement often progress to chronic kidney failure, ultimately requiring renal replacement therapy. Daratumumab, an anti-CD38 monoclonal antibody, is primarily used for the treatment of relapsed and refractory multiple myeloma. Recent studies have shown that daratumumab also has an encouraging effect on light-chain amyloidosis. Here, we report the case of an LCDD (κ chain) patient with proteinuria, renal insufficiency, and anemia who was followed up for 3 years, during which he received daratumumab treatment. After the daratumumab treatment, the hematologic response continued progressing to a complete response without any adverse effects and continuous renal function improvement at a low serum free light chain (sFLC) level. This case shows that daratumumab is effective at treating LCDD. For LCDD patients with kidney involvement, frequent monitoring and active control of free light chain levels are necessary, as reaching the lowest sFLC of < 20 mg/L may help to improve kidney function.

Macrophages are key players in the pathology of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Existing studies and our previous studies have documented the role of CD206-positive M2 macrophages in the inflammatory process of AAV. Inflammasome activation is a critical pathway through which macrophages release inflammatory factors. In this study, we investigate the role of the inflammasome in macrophages in AAV and explore the role of CD206 in this process. We recruit newly diagnosed AAV patients and disease controls from our department. The expression and localization of the NOD-like receptor family, pyrin domain containing 3 (NLRP3) and CD206 in the kidney are determined via immunofluorescence experiments. Myeloperoxidase (MPO)-ANCA immunoglobulin G (MPO-ANCA IgG) is purified from new-onset AAV patients with MPO-ANCA and used to treat lipopolysaccharide (LPS)-primed macrophages in vitro. Our findings reveal that NLRP3 expression is significantly elevated in the kidneys of active AAV patients, accompanied by increased cleaved caspase-1 and N-terminal gasdermin-D (GSDMD) levels in peripheral blood mononuclear cells (PBMCs). In vitro, MPO-ANCA IgG induces NLRP3 inflammasome activation and interleukin (IL)-1β production in macrophages, which is associated with increased MPO expression and JNK signaling pathway activation. Immunofluorescence analysis demonstrates partial colocalization of CD206 and NLRP3 in AAV kidneys. Furthermore, silencing of MRC1 gene, which encodes CD206, reduces inflammasome activation induced by MPO-ANCA IgG. In conclusion, our study provides evidence that MPO-ANCA IgG contributes to NLRP3 inflammasome activation and macrophage pyroptosis, with CD206 playing a critical role in this process. These findings elucidate the mechanisms underlying inflammation in AAV and suggest potential therapeutic targets.

Background: Kidney damage is common in patients with Fabry disease (FD), but more accurate information about the risk of progression to kidney failure is needed for clinical decision -making. In particular, FD patients with mild renal involvement often lack timely intervention and treatment. We aimed to utilize a model to predict the risk of renal progression in FD patients. Methods: Between November 2011 and November 2019, ERT-naive patients with FD were recruited from three medical centers in China. To assess the risk of a 50% decline in the estimated glomerular filtration rate (eGFR) or end -stage kidney disease (ESKD), Cox proportional hazards models were utilized. The performance of these models was assessed using discrimination, calibration, and reclassification. Results: A total of 117 individuals were enrolled. The mean follow-up time was 4.8 years, during which 35 patients (29.9 %) progressed to the composite renal outcomes. Male sex, baseline proteinuria, eGFR and globotriaosylsphingosine (Lyso-Gb3) were found to be independent risk factors for kidney progression by the Cox model, based on which a combined model containing those clinical variables and Lyso-Gb3 and clinical models including only clinical indicators were constructed. The two prediction models had relatively good performance, with similar model fit measured by R2 (59.8 % vs. 61.1 %) and AIC (51.54 vs. 50.08) and a slight increase in the C statistic (0.949 vs. 0.951). Calibration curves indicated closer alignment between predicted and actual renal outcomes in the combined model. Furthermore, subgroup analysis revealed that Lyso-Gb3 significantly improved the predictive performance of the combined model for kidney prognosis in low -risk patients with a baseline eGFR over 60 ml/min/1.73 m2 or proteinuria levels less than 1 g/d when compared to the clinical model. Conclusions: Lyso-Gb3 improves the prediction of kidney outcomes in FD patients with a low risk of progression, suggesting that these patients may benefit from early intervention to assist in clinical management. These findings need to be externally validated.

BACKGROUND AND OBJECTIVES:Malignant hypertension (MHT) characterized by acute hypertension with retinopathy or multiorgan damage, is a severe form of hypertensive emergency and associated with target organ involvement and poor kidney outcome. However, the underlying mechanisms are unclear. METHODS:Eighty-four patients with acute severe hypertension from the Nephrology Department and Emergency Department in a single center during January 2016 and December 2017 were prospectively enrolled and divided into MHT ( n  = 48) and non-MHT ( n  = 36) subgroups according to target organ evaluation. Forty healthy controls were recruited. Serum soluble Fms-like tyrosine kinase-1 (sFlt-1) levels and plasma ADAMTS13 (a disintegrin and metalloprotease with thrombospondin type 1 motif, member 13) activity were examined at baseline and 12-month follow-up. Renal endpoints were defined as a significant decrease in the estimated glomerular filtration rate (eGFR) of more than 40% or the occurrence of end-stage renal disease. RESULTS:Serum sFlt-1 levels were persistently elevated in MHT. Baseline serum sFLT-1 levels were correlated with plasma ADAMTS13 activity and markers of target organ damage. Plasma ADAMTS13 activity was reduced in both MHT and non-MHT patients and recovered to the normal range at 12-month follow-up. During an average follow-up time of 53 ± 13 months, the restoration of reduced ADAMTS13 activity was correlated with the improvement of kidney function and independently reduced the risk of renal endpoints. CONCLUSIONS:Abnormal angiogenesis and endothelial damage are involved in the pathophysiology of hypertensive emergency. Evaluation of ADAMTS13 and sFlt-1 may help in the diagnosis and assessment of MHT. Recovery of ADAMTS13 predicts better renal outcome in patients with hypertensive emergencies.

AIM: To investigate diabetic retinopathy (DR) prevalence in Chinese renal-biopsied type 2 diabetes mellitus (T2DM) patients with kidney dysfunction, and to further evaluate its relationship with diabetic nephropathy (DN) incidence and the risk factors for DR development in this population. METHODS: A total of 84 renal-biopsied T2DM patients were included. Fundus and imaging examinations were employed for DR diagnosis. Demographic information and clinical measures along with renal histopathology were analyzed for comparisons between the DR and non-DR groups. Risk factors on DR development were analyzed with multiple logistic regression. RESULTS: DR prevalence was 50% in total. The incidences of DN, non-diabetic renal disease (NDRD) and mixed-type pathology were 47.6%, 19.0% and 33.3% in the DR group respectively, while 11.9%, 83.3% and 4.8% in the non-DR group. Systolic blood pressure, ratio of urinary albumin to creatine ratio, urinary albumin, 24-hours urinary protein, the incidence and severity of DN histopathology were found statistically increased in the DR group. Multiple logistic regression analysis showed histopathological DN incidence significantly increased the risk of DR development [odds ratio (OR)=21.664, 95% confidential interval (CI) 5.588 to 83.991, P<0.001 for DN, and OR=45.475, 95%CI 6.949 to 297.611, P<0.001 for mixed-type, respectively, in reference to NDRD)], wherein DN severity positively correlated. CONCLUSION: Renal histopathological evidence indicates DN incidence and severity increases the risk of DR development in Chinese T2DM patients inexperienced of regular fundus examinations.

AimNPHS2 is the coding gene of podocin. This study aims to investigate the association between NPHS2 p.R229Q (rs61747728), the most frequently reported missense variant of NPHS2, and focal segmental glomerular sclerosis (FSGS) or steroid-resistant nephrotic syndrome (SRNS) based on typing the variant in a Chinese FSGS/SRNS cohort and conducting a meta-analysis.MethodWe recruited patients with FSGS or SRNS and healthy individuals. To conduct a meta-analysis, all studies on p.R229Q and FSGS/SRNS were searched from public databases.ResultsIn total, we enrolled 204 patients with FSGS, 61 patients with SRNS [46 with FSGS, 9 with minimal change disease (MCD), and six patients with IgA nephropathy (IgAN)], and 100 healthy controls. Unexpectedly, p.R229Q was absent in the patients from our cohort. By meta-analysis of 21 studies including 2,489 patients with FSGS/SRNS and 6,004 healthy controls, we confirmed that the A allele of p.R229Q was significantly associated with increased risk of FSGS/SRNS (allelic OR = 1.9, 95% CI = 1.44-2.52, P < 0.001). However, the subgroup analysis showed that the association between p.R229Q and FSGS/SRNS was true only in Caucasians (allelic OR = 2.14, 95%CI = 1.54-2.98, P < 0.001) and in early-onset patients (allelic OR: 2.13, 95% CI = 1.21-3.76, P = 0.009).ConclusionNPHS2 p.R229Q may play an important role in enhancing the susceptibility of FSGS/SRNS, especially in ethnicity of Caucasian and age of early-onset patients.

Abstract Objective Cardiovascular involvement in patients with antineutrophil cytoplasmic antibody (ANCA) associated glomerulonephritis (AGN) could be asymptomatic but is closely associated with patients’ prognosis. The aim of this study was to evaluate the cardiovascular involvement using standard echocardiographic measurements and determine echocardiographic predictors for cardiovascular mortality in those patients. MethodsPatients with newly diagnosed AGN from Department of Nephrology, Ruijin Hospital undergoing transthoracic echocardiography were retrospectively studied. Cox proportional hazards models were used to investigate baseline variables associated with cardiovascular mortalities. Results Of 319 patients enrolled in our study, 221 patients had echocardiographic abnormalities. Valvular abnormalities were the most common presentation of cardiovascular involvement and valvular regurgitation was the most commonly presentation of echocardiographic abnormality. Patients with echocardiographic abnormalities had more severe renal involvement. And patients with more advanced age and more severe renal involvement had worse cardiovascular outcome. Kaplan-Meier estimator showed a 3.4-time higher risk of cardiovascular mortality in patients with echocardiographic abnormalities than those without (p<0.01). Left ventricular end diastolic volume (LVEDV, HR=1.63, p<0.001), left ventricular end systolic volume (LVESV, HR=1.47, p<0.001) and left ventricular ejection fraction (LVEF, HR=0.72, p<0.05), are independent predictors of cardiovascular mortality. Conclusions Cardiac involvement was prevalent in patients with AGN. LVEDV, LVESV and LVEF assessed by echocardiography at disease onset are independent prognostic factors for cardiovascular mortality in AGN patients. Our results suggest that echocardiography is a sensitive and non-invasive tool to evaluate cardiovascular abnormalities in AGN patients which could be applied to detect those abnormalities in early stages.

Background Antineutrophil Cytoplasmic Antibodies (ANCA) associated glomerulonephritis (AGN) is a group of autoimmune diseases and mono-macrophages are involved in its glomerular injuries. In this study, we aim to investigate the role of CD206 + mono-macrophages in AGN. Methods 27 AGN patients (14 active AGN, 13 remissive AGN) together with healthy controls (n = 9), disease controls (n = 6) and kidney function adjusted controls (n = 9) from Department of Nephrology, Ruijin hospital were recruited. Flow cytometry was used to study proportion of CD206 + cells in peripheral blood. Immunohistochemistry for CD206 staining was performed and CD206 expression was scored in different kidney regions. Serum soluble CD206 (sCD206) was measured by enzyme-linked immunosorbent assay (ELISA). We also generated murine myeloperoxidase (MPO) (muMPO) ANCA by immunizing Mpo −/− mice. Mouse bone marrow-derived macrophages (BMDMs) from wild C57BL/6 mice and peripheral blood mononuclear cell (PBMC) derived macrophages from healthy donors were treated with MPO ANCA with or without its inhibitor AZD5904 to investigate the effects of MPO-ANCA on CD206 expression. Results The proportion of peripheral CD206 + CD68 + cells in active AGN patients were significantly higher than that in remissive patients ( p < 0.001), healthy controls ( p < 0.001) and kidney function adjusted controls ( p < 0.001). Serum sCD206 level in active AGN patients was higher than that in healthy controls ( p < 0.05) and remissive patients ( p < 0.01). Immunohistochemistry showed CD206 was highly expressed in different kidney regions including fibrinoid necrosis or crescent formation, glomeruli, periglomerular and tubulointerstitial compartment in active AGN patients in comparison with disease controls. Further studies showed MPO ANCA could induce CD206 expression in BMDMs and PBMC derived macrophages and such effects could be reversed by its inhibitor AZD5904. Conclusion ANCA could induce CD206 expression on mono-macrophages and CD206 + mono-macrophages are activated in AGN. CD206 might be involved in the pathogenesis of AAV and may be a potential target for the disease.

1病历资料 患者男性,37岁,因"皮肤色素沉着变硬2年余,意识丧失伴血肌酐(SCr)进行性升高10 d",于2016年3月17日收入上海交通大学医学院附属瑞金医院肾内科.患者2014年2月无明显诱因出现皮肤色素沉着,起初以头颈部为重,后逐渐蔓延至下肢膝关节,伴明显皮肤变硬,四肢关节疼痛,于2015年11月在我院皮肤科行皮肤活检后诊断为"硬皮病",予以强的松(20 mg/d)、青霉胺治疗,当时患者肾功能正常,出院后未规律随访.2016年3月7日患者无明显诱因下突发意识丧失,肢体抽搐,血压升高(200/160 mmHg)(1 mmHg=0.133 kPa),外院查 SCr 196μmol/L,予以对症处理后患者神志转清.3月15日患者出现腹痛,伴尿量减少,于我院急诊科就诊,SCr 661 μmol/L,收入我科.患者否认高血压、糖尿病、冠心病史,有19年吸烟史.

This study aimed to evaluate the efficacy and safety of mycophenolate mofetil (MMF) or tacrolimus (TAC) compared with azathioprine (AZA) as maintenance therapy for active lupus nephritis (ALN). Patients with ALN who responded to 24 weeks of induction treatment were enrolled. Patients who received MMF or TAC as induction therapy continued MMF or TAC treatment during the maintenance period, whereas those who received intravenous cyclophosphamide were subjected to AZA treatment. The primary endpoint was the incidence of renal relapse. Secondary endpoints included extrarenal flares and composite endpoints (deaths, end-stage renal disease, or doubling of serum creatinine levels). A total of 123 ALN patients (47 in the MMF group, 37 in the TAC group, and 39 in the AZA group) were enrolled. The median follow-up time was 60 months. Ten MMF-treated patients, ten TAC-treated patients, and eight AZA-treated patients experienced renal relapses (P = 0.844). The cumulative renal relapse rates in the MMF group (P = 0.934) and TAC group (P = 0.673) were similar to the renal relapse rate in the AZA group. No significant difference in the incidence of severe adverse event was observed among the groups. Long-term maintenance therapies with MMF or TAC might have similarly low rates of renal relapse and similar safety profiles compared with AZA.

Abstract BackgroundAntineutrophil Cytoplasmic Antibodies (ANCA) associated glomerulonephritis (AGN) is a group of autoimmune diseases and mono-macrophages are involved in its glomerular injuries. We investigate role of CD206+ mono-macrophages in AGN to provide therapeutic targets for the disease. Methods 27 AGN patients (14 active AGN, 13 remissive AGN) together with healthy controls (n=9), disease controls (n=6) and kidney function adjusted controls (n=9) from Department of Nephrology, Ruijin hospital were recruited. Flow cytometry was used to study proportion of CD206+ cells in peripheral blood. Immunohistochemistry for CD206 staining was performed in kidney tissues. Serum soluble CD206 (sCD206) was measured by enzyme-linked immunosorbent assay (ELISA). We also generated murine myeloperoxidase (MPO) (muMPO) ANCA by immunizing Mpo-/- mice. Mouse bone marrow-derived macrophages (BMDMs) and peripheral blood mononuclear cell (PBMC) derived macrophages were treated with MPO ANCA with or without its inhibitor AZD5904 to investigate the effects of MPO-ANCA on CD206 expression.ResultsThe proportion of peripheral CD206+CD68+ cells in active AGN patients were significantly higher than that in remissive patients (p<0.001), healthy controls (p<0.001) and kidney function adjusted controls (p<0.001). Serum sCD206 level in active AGN patients was higher than that in healthy controls (p<0.05) and remissive patients (p<0.01). Immunohistochemistry showed CD206 was highly expressed in the kidney tissues in active AGN patients in comparison with disease controls. Further studies showed MPO ANCA could induce CD206 expression in BMDMs and PBMC derived macrophages and such effects could be reversed by its inhibitor AZD5904. Conclusion ANCA could induce CD206 expression on mono-macrophages and CD206+ mono-macrophages are activated in AGN. Serum sCD206 correlates to disease activity and it could serve as a potential therapeutic target for the disease.

OBJECTIVES Renal risk score (RRS) and chronicity score (CS) are both newly proposed tools to predict end stage renal disease (ESRD) which could be applicable in antineutrophil cytoplasmic antibody (ANCA)-associated renal vasculitis patients. Their predictive value has not been fully studied and compared. METHODS 252 patients with newly biopsy-proven ANCA-associated renal vasculitis were retrospectively studied at the Department of Nephrology, Ruijin Hospital, China. Patients were evaluated with RRS and CS for clinical factors, pathological lesions and outcome. Their predictive value of renal survival was also compared. RESULTS The median RRS score point at diagnosis was 6 (interquartile range [IQR] 0-9) and CS score point was 4 (IQR 3-7). In accordance with severity of RRS category and CS grade, percentage of hypertensive patients, dialysis dependency, and level of proteinuria increased accordingly. Significant differences were found regarding dialysis dependency within RRS and CS groups (p<0.001 and p<0.01 respectively). The addition of RRS or CS scoring scheme to the base model of dialysis dependency significantly improved discrimination. The C statistic, integrated discrimination improvement and net reclassification improvement were significantly increased by adding either RRS/CS or both. Furthermore, RRS had better ROC. CONCLUSIONS Among ANCA associated renal vasculitis patients, RRS and CS achieved similar discrimination, but the discrimination of RRS was superior.

Introduction: Type I cryoglobulinemia is a rare disease which affects the skin, central nervous system and kidneys. It is usually associated with lymphoproliferative disorders such as multiple myeloma, lymphoma and monoclonal gammopathy of renal significance. Proteinuria and membranoproliferative glomerulonephritis are the most common renal manifestations; Case presentation: Here we report the case of a female patient in her late 40 s who had proteinuria accompanied by Raynaud’s phenomenon, high blood and plasma viscosity, hearing loss, and cardiac and central nervous system involvement. Monoclonal immunoglobulin G-λ protein was detected and serum was positive for cryoglobulin. Renal biopsy revealed massive cryo-plugs with unique ultrastructural appearance in the glomerular and peritubular capillary lumina. Immunofluorescence showed predominant IgG3/λ deposition in cryo-plugs. As reported, the clinical manifestations of this patient resulted from cryoprecipitate and hyperviscosity syndrome; Conclusion: Cryoglobulinemia should be considered as a possible diagnosis in patients with Raynaud’s phenomenon, hyperviscosity syndrome and monoclonal immunoglobulin.

Objective:To investigate the effects of rituximab on lymphocytes and immunoglobulin in the treatment of focal segmental glomerulosclerosis (FSGS) and minimal change disease (MCD).Methods:The subjects were FSGS and MCD patients admitted to Ruijin Hospital affiliated to Shanghai Jiaotong University on July 1, 2014 and July 1, 2019. All the enrolled patients were confirmed by clinical examination and renal biopsy, and received rituximab treatment (4 infusions of 375 mg/m 2 with the interval of 7-14 d). The levels of immunoglobulin IgA, IgG, IgM, and lymphocytes of CD19 +, CD20 +, CD3 +, CD3 +CD4 +, CD3 +CD8 + and natural killer cells (CD56 +CD16 +) were compared between baseline and the third month, the sixth month, the ninth month and the twelfth month after treatment. Results:Ninety-six patients with FSGS or MCD were enrolled in this study. The midian age was 28 years old (14-77 years old). The ratio of men to woman was 1.8∶1. There were 65 cases of MCD and 31 cases of FSGS. After rituximab treatment, the 24 h-proteinuria was significantly lower than that before treatment, and the serum albumin level was increased (both P<0.05). After rituximab treatment of 3 months, 6 months, 9 months and 12 months, CD19 + and CD20 + lymphocyte counts were significantly decreased (all P<0.01), and gradually recovered after 6 months. Compared with baseline, at 3, 6, 9, 12 months after rituximab treatment, the level of blood IgG was significantly increased ( P=0.004,<0.001,<0.001,<0.001, respectively), and the level of blood IgM was significantly decreased ( P<0.001, =0.008, =0.005,<0.001, respectively) but the median level still within the normal range (400-3 450 mg/L). The level of blood IgA was not significantly changed (all P<0.05). T lymphocytes (CD3 +, CD3 +CD4 + and CD3 +CD8 +) and natural killer cells (CD56 +CD16 +) showed no significant difference from baseline (all P>0.05). Conclusions:Rituximab can effectively eliminate CD19 + and CD20 + lymphocytes, and has little influence on peripheral blood lymphocyte count and immunoglobulin level except CD19 + and CD20 + lymphocytes. The standard administration of rituximab is safe for patients with FSGS and MCD.

目的:比较住院医师规范化培训(规培)中不同的轮转时间及出科考核方式对住院医师培养的效果.方法:入选2018年8月至2020年7月在上海交通大学医学院附属瑞金医院肾脏内科轮转接受规培的住院医师(规培生),根据轮转时间分为规培1个月组和规培2个月组.2组规培生进入肾脏内科后严格按照轮转要求,均给予小讲课、教学查房、病例讨论等教学模式,出科考核方式分为传统考核方式(出科口试、理论考试、临床评分)和APP软件虚拟病例分析考核方式.以传统出科考核得分和APP软件虚拟病例分析考核得分作为主要观察指标,比较分析两者间的相关性.结果:96名规培生被纳入本研究,男女比例为0.2:1.0(19/77),规培2个月组共54人,1个月组共42人.所有住院医师传统出科考核总分中位数为90.1分(68.9～97.6分),规培1个月组明显低于2个月组(88.6分比90.9分,P=0.003);出科口试评分(10分制)中位数为9.0分(6.5～9.8分),规培1个月组的成绩亦明显低于2个月组(8.8分比9.0分,P<0.001);理论考核平均分为(78.8±9.8)分,1个月组与2个月组间差异无统计学意义(P=0.55);APP软件行病例分析考核及临床评分,1个月组的成绩同样低于2个月组(P<0.05).APP软件虚拟病例考核结果显示,在4个重要维度(系统性、逻辑性、精准性和经济性)上,规培生对经济性考虑最少,其次为逻辑性,且规陪1个月组均明显低于2个月组(P<0.01);系统性和精准性方面2组均较好,且组间差异无统计学意义(P>0.05).APP软件虚拟病例考核与传统出科考核有一定相关性,ROC曲线下面积为0.718(95％CI为0.615～0.822,P<0.001).结论:规培生进入肾脏内科轮转接受规培的时间为2个月更佳,且所有规培生在经济性和逻辑性上的能力均有待进一步提高,尤其是规培1个月的规培生,APP软件虚拟病例分析考核可作为一种新的出科考核方式,应用于平时住院医师内科规培的教学考核工作中.