AIMS:Persistent inflammation is recognized as a major driver of the acute kidney injury (AKI) to chronic kidney disease (CKD) transition, yet upstream macrophage-activation signals remain incompletely understood. Here, we investigated whether the urokinase receptor (uPAR), traditionally linked to matrix remodeling, functions instead as an inflammatory signaling hub that links kidney injury to chronic fibrotic remodeling. RESULTS:In a unilateral renal ischemia-reperfusion injury model, uPAR was induced during the fibrotic phase of postischemic kidney injury. Functional enhancement- and loss-of-function approaches revealed a striking dichotomy: exogenous urokinase (uPA) aggravated renal dysfunction, inflammation, oxidative stress, and fibrosis, whereas uPAR deletion was protective. Mechanistically, uPA/uPAR signaling amplified macrophage inflammatory responses, enhancing M1 polarization, pro-inflammatory cytokine production, reactive oxygen species generation, and NF-κB activation. Molecular docking, mutational modeling, and co-immunoprecipitation analyses revealed a previously underappreciated association between activated uPAR and toll-like receptor 4 (TLR4)-containing complexes. This interaction enhanced myeloid differentiation primary response gene 88-dependent NF-κB signaling and potentiated macrophage inflammatory amplification rather than initiating inflammation independently. NF-κB blockade abolished the pro-inflammatory effects of uPA/uPAR signaling, establishing the functional importance of this pathway. INNOVATION:We demonstrate that uPA-activated uPAR engages TLR4-associated signaling to intensify macrophage-driven inflammation, oxidative stress, and fibrotic remodeling. These findings redefine uPAR as a molecular switch governing maladaptive kidney repair and identify the uPA/uPAR-TLR4 signaling interface as a promising therapeutic target. CONCLUSION:Our findings suggest that the uPA/uPAR-TLR4 axis is involved in regulating the progression from AKI to fibrosis. Targeting this signaling node may represent a novel strategy to interrupt maladaptive repair and prevent CKD following AKI. Antioxid. Redox Signal. 00, 000-000.

Objective Vascular imaging is crucial for medical diagnosis, and it facilitates disease diagnosis, disease progression monitoring, surgical planning and navigation, and patient prognosis evaluation. However, conventional imaging methods encounter challenges in rapid and noninvasively imaging of superficial blood vessels because of the similarities in texture and color with surrounding tissues. In clinical surgery, preoperative superficial vascular imaging and intraoperative vascular display are beneficial for reducing bleeding, facilitating surgical navigation and path planning, and promoting postoperative blood supply recovery. Methods A fluorescent imaging system in the second near- infrared window (NIR-II) to capture images of the forearm vascular network in patients was used in this study. The research involved 12 patients, with indocyanine green serving as a contrast agent for obtaining NIR-II images of the forearm blood vessels. These images were used to observe the anatomical structure of the venous vascular network. Furthermore, computer- aided analysis was employed to improve image quality, support surgical path planning and prognosis prediction, and provide valuable guidance for clinical practitioners. Results and Discussions High-resolution and high-contrast images are captured using NIR-II fluorescence angiography. The clarity of these images are enhanced using artificial intelligence techniques. Computer simulation was employed to simulate venous network reflux. The agreement between the measurement results obtained from this technique and ultrasound was evaluated using the Bland Altman plot and consistency measurements. Conclusions The acquired images are used to examine the anatomical structure of the venous vascular network and combined with blood flow simulation. This integration aims to assist clinicians in determining optimal surgical trajectories and predicting outcomes. The application of NIR-II fluorescence imaging and computational simulation techniques has potential in providing valuable support for surgeons in performing various vascular procedures in the future.

OBJECTIVE:To validate and compare the efficacy of two noninvasive diagnostic models for diabetic nephropathy (DN) based on diabetic retinopathy (DR).METHODS:A total of 565 patients with type 2 diabetes undergoing kidney biopsy in the Department of Nephrology, PLA General Hospital from January, 1993 to December, 2014 were studied. The patients were divided into DN group and non-diabetic nephropathy (NDRD) group according to renal pathological diagnosis. The data from the 22-year period were divided into 3 stages based on chronological order: early stage (from 1993 to 2003), middle stage (from 2004 to April, 2012), and late stage (from May, 2012 to December, 2014). The changes in clinical features and pathological diagnosis of the patients with renal biopsy over the 22 years were analyzed. The published DNT model and JDB model, both based on DR, were validated and compared for diagnostic effectiveness of DN, and the characteristics of the misdiagnosed cases were analyzed.RESULTS:The incidences of hypertension and DR and levels of glycosylated hemoglobin (HbA1c), creatinine and 24-h urinary protein were all significantly higher, while hemoglobin and triglyceride levels were lower in DN group than in NDRD group (P<0.05). The proportion of NDRD cases increased gradually over time, with IgA nephropathy and membranous nephropathy as the main pathological types. The AUC of JDB model was 0.946, similar to that of NDT model (0.925; P=0.198). The disease course of diabetes, hematuria and incidence of DR were important clinical features affecting the diagnostic accuracy of the models.CONCLUSION:The clinical features and pathological diagnosis of DR change over time. The non-invasive diagnostic models based on DR have good diagnostic efficacy for DN.

Immune checkpoint inhibitors (ICIs) change the prognosis of many cancer patients. With the increasing use of ICIs, immune-related adverse events are occurring, including acute kidney injury (AKI). This study aimed to assess the incidence of AKI during ICI treatment and its risk factors and impact on mortality. Patients treated with ICIs at the First Medical Center of the Chinese PLA General Hospital from January 1, 2014, to December 30, 2019, were consecutively enrolled, and risk factors affecting AKI development in patients treated with ICIs were analyzed using univariate and multivariate logistic regression. Medical record surveys and telephone inquiry were used for follow-up, and Kaplan–Meier survival analysis and Cox regression were used to analyze independent risk factors for death. Among 1615 patients, 114 (7.1%) had AKI. Multivariate logistic regression analysis showed that anemia, Alb < 30 g/L, antibiotic use, diuretic use, NSAID use and proton pump inhibitor use were independent risk factors for AKI development in patients treated with ICIs. Stage 2 or 3 AKI was an independent risk factor for nonrecovery of renal function after AKI onset. Multivariate Cox regression analysis showed that anemia, Alb < 30 g/L, AKI occurrence, and diuretic use were independent risk factors for death in patients treated with ICIs, while high baseline BMI, other tumor types, ACEI/ARB use, and chemotherapy use were protective factors for patient death. AKI occurs in 7.1% of patients treated with ICIs. Anemia, Alb < 30 g/L, and combined medication use are independent risk factors for AKI in patients treated with ICIs. Anemia, Alb < 30 g/L, AKI occurrence, and diuretic use were independent risk factors for death in patients treated with ICIs.

Introduction: Classic hemodialysis schedules present inadequate middle-molecular-weight toxin clearance due to limitations of membrane-based separation processes. Accumulation of uremic retention solutes may result in specific symptoms (e.g., pruritus) and may affect clinical outcome and patient’s quality of life. Hemoperfusion (HP) is a blood purification modality based on adsorption that can overcome such limitations, and thus, it may be interesting to test the efficacy of at least one session per week of HP combined with hemodialysis. This is a randomized, open-label trial, controlled, multicenter clinical study to investigate the effect of long-term HP combined with hemodialysis on middle-molecular-weight toxins and uremic pruritus in maintenance hemodialysis (MHD) patients. Methods: 438 MHD patients from 37 HD centers in China with end-stage kidney disease (63.9% males, mean age 51 years) suffering from chronic intractable pruritus were enrolled in the study. Eligible patients were randomized into four groups: low-flux hemodialysis (LFHD), high-flux hemodialysis (HFHD), HP + LFHD, and HP + HFHD at a 1:1:1:1 ratio. Beta-2 microglobulin (β2M) and parathyroid hormone (PTH) were measured at baseline, 3–6, and 12 months. At the same time points, the pruritus score was evaluated. The primary outcome was the reduction of β2M and PTH, while the secondary outcome was the reduction of the pruritus score. Results: In the two groups HP + LFHD and HP + HFHD, there was a significant decrease of β2M and PTH levels after 12 months compared to the control groups. No significant differences were noted between HP + LFHD and HP + HFHD. Pruritus score reduction was 63% in the HP + LFHD group and 51% in the HP + HFHD group, respectively. Conclusion: The long-term HP + HD can reduce β2M and PTH levels and improve pruritus in MHD patients independently on the use of high- or low-flux dialyzers, showing that the results are linked to the effect of adsorption.

Abstract Background Mesenchymal stem cells (MSCs) have emerged as a promising cell-based therapy for acute kidney injury (AKI). However, the optimal route of MSC transplantation remains controversial, and there have been no comparisons of the therapeutic benefits of MSC administration through different delivery routes. Methods In this study, we encapsulated MSCs into a collagen matrix to help achieve local MSC retention in the kidney and assessed the survival of MSCs in vitro and in vivo. After transplanting collagen matrix-encapsulated-MSCs (Col-MSCs) under the renal capsule or into the parenchyma using the same cell dose and suspension volume in an ischemia/reperfusion injury model, we evaluated the treatment efficacy of two local transplantation routes at different stages of AKI. Results We found that Col-MSCs could be retained in the kidney for at least 14 days. Both local MSC therapies could reduce tubular injury, promote the proliferation of renal tubular epithelial cells on Day 3 and alleviate renal fibrosis on Day 14 and 28. MSC transplantation via the subcapsular route exerts better therapeutic effects for renal functional and structural recovery after AKI than MSC administration via the parenchymal route. Conclusions Subcapsular MSC transplantation may be an ideal route of MSC delivery for AKI treatment, and collagen I can provide a superior microenvironment for cell–cell and cell–matrix interactions to stabilize the retention rate of MSCs in the kidney.

单克隆免疫球蛋白沉积病(monoclonal immunoglobulin deposition disease,MIDD)是以单克隆免疫球蛋白及其游离片段轻链和(或)重链沉积于全身组织和器官并引起功能障碍为特征,其中肾脏是最常累及的器官之一.MIDD分为轻链沉积病(light chain deposition disease,LCDD)、轻重链沉积病(light-heavy chain deposition disease,LHCDD)和重链沉积病(heavy chain deposition disease,HCDD)3种类型.其中,LCDD较为多见,而LHCDD和HCDD罕见[1-3].1993年,HCDD才在国际上首次被报道.迄今为止,HCDD的发病机制尚不十分清楚,可能是B细胞无法分泌与轻链结合的单克隆截断重链引起,其中以γ型重链为多[1-3].

目前我国全科医师的规培单位多数为各地区三级甲等医院.全科医师的培养需要面面俱到,覆盖知识广泛,使其对于各系统疾病有一定充分的认识,同时针对疾病的早期发现、诊疗提出了更高的要求.然而,由于血液透析属于专科性质较强的亚专科,全科医师在血液净化中心的学习培训具有更强的专业性,且全科医师与血液透析专科医师培养模式、培养时间大不相同,且目前无相关文章作过对应的探讨.本文主要探讨全科医师如何在较短的轮转时间内掌握血液透析相关知识为主要目的,进而为相关带教提供借鉴.

Objective To compare the influence of traditional and plan-do-check-action (PDCA)teaching methods on the learning interest of standardized trainees of nephrology.Methods Fifty standardized trainees of nephrology in our hospital from May 2017 to May 2019 were enrolled,who were equally divided into two groups by random number method.The 25 trainees of the control group received the traditional teaching method,while the 25 trainees of the observation group received the PDCA teaching method.The two groups were compared in practical operation,theoretical knowledge assessment,learning interest,and satisfaction of the trainees.Results Compared with the control group,the observation group showed significantly better scores in practical operation and theoretical knowledge assessment,spent more time in self-study and data review,was more active in speaking and questioning during discussions,and had higher degree of satisfaction (96.0％ vs 72.0％) (x2 =5.357,P ＜ 0.05).Conclusions For the standardized trainees of nephrology,the PDCA teaching method effectively improved the academic performance,stimulated the learning enthusiasm,and improve the satisfaction of them.

Objective To observe the effect of red light irradiation on blood phosphorus level of hemodialysis patients. Methods Eighteen patients with maintenance hemodialysis were selected as the subjects and randomly divided into two groups. Twelve subjects were in the treatment group, who received hemodialysis combined with red light irradiation. Six subjects were in the control group, who received hemodialysis combined with placebo irradiation. The dose of red light irradiation treatment was 2 hours/time, 3 times/week for a total of 4 weeks. Blood samples were collected before the first irradiation and after the last irradiation. The blood samples were collected before dialysis, at dialysis for 1 hour, and at dialysis for2 hours for detecting the blood phosphorus level in the patients. The two groups were also compared in the phosphorus-reducing drugs and blood purification modes. Statistical analysis was performed with χ2 test, ttest, or non-parametric test according to the distribution of data. Results There was no significant difference between the two groups in the basic data including age, gender, and primary diseases. There was no significant difference in blood phosphorus level between the two groups before the first red light irradiation[ (2. 16 ± 0. 47) mmol/L vs (2. 44 ± 0. 20) mmol/L, P = 0. 202]. After 4 weeks of treatment with red light irradiation, the serum phosphorus level in the treatment group was significantly lower than that in the control group [ (2. 04 ± 0. 40) mmol/L vs (2. 64 ± 0. 30) mmol/L, P = 0. 007]. The phosphorus binder dose, calcitriol dose, hemodiafiltration frequency, and hemoperfusion frequency were not statistically different between the two groups. Conclusion The red light irradiation combined with hemodialysis treatment might be helpful in reducing the blood phosphorus level of hemodialysis patients.

Objective Assessment and comparison of protein-energy wasting (PEW) in maintenance hemodialysis (MHD) patients of different age groups in order to provide basis for clinical work.Methods A cross-sectional and retrospective study was performed. Assessment and comparison of PEW were made by means of objective score of nutrition on dialysis (OSND) and modified quantitative subjective global assessment (MQSGA) combining questionnaires, anthropometrics, blood biochemistry, and other indicators in the 242 patients of the adult group (aged ＜ 65 years) and the 106 patients of the elderly group (aged ≥65 years). The PEW diagnosis criteria were as follows: the OSND score ≤22 points, the MQSGA score 21 to 35 points, the triceps skinfold thickness (TSF) ＜ 12. 5 mm for males and ＜ 16. 5 mm for females, the mid-upper arm circumference (MAC) ＜ 25. 3 cm for males and ＜ 23. 2 cm for females, albumin (ALB) ＜ 38 g/L, and the body mass index (BMI) ＜ 18. 5 kg/m2. The PEW was divided into mild, medium and severe grades according to the different scores and percentages of OSND, MQSGA, TSF, and MAC. Results The incidence of PEW diagnosed by the OSND score, MQSGA score, TSF, MAC, ALB, and BMI was 79. 3％, 67. 8％, 43. 9％, 23. 0％, 43. 1％, and 19. 5％, respectively in all, but was74. 0％, 62. 2％, 39. 7％, 19. 0％, 25. 6％, and 17. 8％, respectively in the adult group, and was91. 5％, 81. 4％, 53. 8％, 32. 1％, 40. 6％, and 23. 5％, respectively in the elderly group. The incidence of severe PEW diagnosed by OSND, MQSGA, TSF, and MAC was 13. 5％, 6. 9％, 15. 5％, and 3. 7％, respectively. There were statistically significant differences in the incidence of PEW, and multiple baseline nutrition-related indicators between the two groups (P ＜ 0. 05). The high-sensitivity C-reactive protein (hs-CRP) in the elderly group was significantly higher than in the adult group (P ＜ 0. 05).Conclusion Compared with the ones of the adult group, the MHD patients of the elderly group had higher incidence of PEW, lower levels of nutritional indicators, and severer inflammatory status, indicating that PEW status of elderly dialysis patients should be more concerned in clinical work.

Background: Patients on hemodialysis have a high-mortality risk. This study analyzed factors associated with death in patients on maintenance hemodialysis (MHD). While some studies used baseline data of MHD patients, this study used the most recent data obtained from patients just prior to either a primary endpoint or the end of the study period to find the characteristics of patients preceding death. Methods: Participants were selected from 16 blood purification centers in China from January 2012 to December 2014. Patients' data were collected retrospectively. Based on survival status, the participants were divided into two groups: survival group and the death group. Logistic regression analysis was performed to determine factors associated with all-cause mortality. Results: In total, 4104 patients (57.58% male, median age 59 years) were included. Compared with the survival group, the death group had more men and more patients with diabetic nephropathy (DN) and hypertensive nephropathy. The patients preceding death also had lower levels of diastolic blood pressure, hemoglobin, serum albumin, serum calcium, serum phosphate, Kt/V, and higher age. Multivariate analysis revealed that male sex (odd ratio [OR]: 1.437, 95% confidence interval [CI]: 1.094–1.886), age (OR: 1.046, 95% CI: 1.036–1.057), and presence of DN (OR: 1.837, 95% CI: 1.322–2.552) were the risk factors associated with mortality. High serum calcium (OR: 0.585, 95% CI: 0.346–0.989), hemoglobin (OR: 0.974, 95% CI: 0.967–0.981), albumin (OR: 0.939, 95% CI: 0.915–0.963) levels, and dialysis with noncuffed catheter (OR: 0.165, 95% CI: 0.070–0.386) were protective factors based on a multivariate analysis. Conclusions: Hemodialysis patients preceding death had lower hemoglobin, albumin, and serum calcium levels. Multivariate analysis showed that male sex, age, DN, low hemoglobin, low albumin, and low serum calcium were associated with death in hemodialysis patients.

Objective:The efficacy of double-filtration plasmapheresis (DFPP), combined with methylprednisolone, to treat diffuse proliferative lupus nephritis (LN) was studied.Methods:Twenty-four patients who were admitted to the hospital and diagnosed with diffuse proliferative LN (LN Class IV-G(A)) through renal biopsy from 2011 to 2013 were recruited as the study subjects. The patients' clinical manifestations were nephritic syndrome and/or renal insufficiency. The pathological features were glomerular diffuse proliferative lesions. The patients were divided into two groups: the treatment group and the control group, with 12 patients in each group. The patients in the treatment group were first treated with DFPP combined with methylprednisolone (0.8-1.0 mg/kg/day); subsequently, they were put on methylprednisolone therapy only. The patients in the control group were first put on methylprednisolone pulse therapy (500-1,000 mg) for 3 days; subsequently, they were treated with methylprednisolone (0.8-1.0 mg/kg/day) combined with mycophenolate mofetil (1.5 g/day). The patients were observed for 24 months. Levels of hemoglobin, platelet, albumin, serum creatinine, 24-h urinary protein, serum C-3, antinuclear antibody (ANA), anti-dsDNA, and anti-Smith were measured at 0, 3, 6, 12, and 24 months. Complete remission and recurrence standards were established. The total dosages of methylprednisolone were calculated. Repeated renal biopsy was performed on several patients.Results:There was no statistical significance in the baseline conditions of the treatment and the control groups. For the treatment group, no plasmapheresis-related complications occurred. The two groups showed no significant difference in complete remission. The patients' edema and serous effusion resolved, urine volume, serum creatinine, and albumin levels returned to normal, urine protein decreased in treatment group more rapidly than the patients in the control group. The mean dose of methylprednisolone received in the treatment group was lower than in the control group. The complement C-3 levels in the treatment group were significantly higher than in the control group. The recurrence rate in the treatment group was lower than in the control group. Repeated renal biopsies on several patients in the treatment group indicated that their pathology improved significantly, changing from LN (IV) to LN(II-III).Conclusions:Appropriate application of DFPP combined with glucocorticoid therapy could accelerate the remission of diffuse proliferative LN, reduce overall glucocorticoid dosage, prevent recurrence, and maintain C-3 level in a higher level. J. Clin. Apheresis 31:375-380, 2016. (c) 2015 Wiley Periodicals, Inc.

Objective Serratia plymuthica(S.plymuthica) is a genus of Gram-negative bacilli(Enterobacteriaceae) that is prevalent found in soil,air,and water.The infection of human is very rare,and it often shows resistance to lots of antibiotics.Currently,there is no clinical specific detection method for S.plymuthica.To discusses the application of next-generation sequencing and mass spectrometry for clinical diagnosis with a case diagnosed of S.plymuthica infection by the method.Methods A patient who was admitted for IgA nephropathy with clinical symptoms of fever,myalgia,and muscle swelling as well as multiple negative test results including blood cultures was diagnosed with S.plymuthica infection after the use of next-generation sequencing and mass spectrometry.Results Results of mass spectrometry showed numerous of proteins associated with inflammation,immunity and bacterias including S.plymuthica were higher expressed when the patienfs body temperature was increased.Besides,lots of signal pathways associated with DNA replication as well as growth factors and apoptosis were activated.In the results of next-generation sequencing,multiple bacterias including Serratia,Escherichia,Yersinia,Pectobacterium,Salmonella,Burkholderia,Klebsiella,Pantoea and Mycobacterium showed higher expression levels of gene fragments when the patienfs body temperature increased.The reads associated with S.plymuthica were significantly higher than those of the others which was 72 726(63.5%).For no response to multiple anti-infection treatments,compound sulfamethoxazole was given to the patient After that,the patients symptoms including fever,myalgia,and muscle swelling were all relieved.Conclusions The combined use of next-generation sequencing and mass spectrometry can be considered in diseases that are difficult to diagnose clinically..These techniques are especially useful for diagnosis of infectious diseases.

Although the current education for medical students has combined various teaching methods,cramming education is still the main way essentially,with relatively weak cultivation of innovative ability.The speed and strength of innovative education reform cannot meet the tremendous needs for talent-development.Education for innovation-type of medical talents will promote the emerging of excellent medical technology and medical means for development of the clinical medicine in China.Teachers should adequately recognize the importance of creative education for cultivating the innovative ability of medical students,and foster the education for innovation-type of medical talents by means of various education modes.

We herein report the case of an elderly woman with bone pain and proteinuria as the main clinical manifestations. The patient was diagnosed with the IgG κ type of multiple myeloma. Her renal pathology consisted of widespread κ light chain protein deposition associated with the formation of large quantities of rod-like crystals in podocytes. This phenomenon is very rare. We explored the significance of this crystal formation via a detailed and descriptive analysis and also performed a literature review, thus providing data to increase the available information about this type of disease.

目的 研究时钟基因-白蛋白D位点结合蛋白(albumin D site-binding protein,DBP)基因在抗Thy-1肾炎模型中随时钟的表达变化,以证明时钟基因参与系膜增殖性肾炎发病进程的调控.方法 利用尾静脉注射抗Thy-1抗体制备SD大鼠系膜增殖性肾炎模型;于注射抗体后3d和5d的10:00、16:00处死动物,正常对照组注射PBS溶液,并于0d的10:00、16:00处死.每个时间点需要5只大鼠.利用PAS染色检测系膜增殖和细胞外基质积聚,利用Trizol方法提取RNA,利用qRT-PCR检测DBP基因的表达变化.结果 抗Thy-1肾炎模型肾小球自1d起出现系膜溶解,炎症细胞浸润,至3d溶解最为明显,5d溶解消失,系膜细胞开始明显增殖,系膜基质明显增多.抗Thy-1模型的肾小球中,3d和5d10:00的DBP mRNA相对表达量高于正常大鼠,且5d的16:00时DBP mRNA相对表达量明显高于正常大鼠.但是在肾皮质中,抗Thy-1模型组与正常大鼠相比,DBP mRNA相对表达量并无显著差异.结论 DBP在抗Thy-1肾炎模型肾小球中表达上调,提示时钟基因参与了系膜增殖性肾炎的疾病进展过程.

Objective:Clarify the value of different standards hematuria in differential diagnosis of diabetic nephropathy and non-diabetic renal disease in type 2 diabetics. Analysis related factors of hematuria in diabetic nephropathy patients. Methods:Mi-croscopic hematuria was defined as ﹥3,﹥10 red blood cells per high-power field( RBCs/hpf). Glomerular hematuria was diag-nosed as dysmorphic erythrocytes ﹥80%. Analysis their respective value of differential diagnosis. Use multiple logistic regression an-alyses to screen the related factors of hematuria. Results:There were 100 patients in diabetic nephropathy group,200 patients in non-diabetic renal disease group. There were differences between both groups in three kinds of hematuria. Glomerular hematuria had the maximum value of specificity(94%),positive predictive value(90. 16%)and AUC. Nephrotic syndrome was an independent risk factor for hematuria(OR=2. 411,P=0. 04). Conclusion:Glomerular hematuria were superior to microscopic hematuria for predic-ting non-diabetic renal disease in type 2 diabetics. Patients with nephrotic syndrome were more likely to appear hematuria.

Aims: Non-diabetic renal diseases (NDRDs) are associated with better renal outcomes than diabetic nephropathy (DN). This study was conducted to determine the common clinical markers predicting NDRDs in type 2 diabetes patients.Methods: Patients with type 2 diabetes mellitus who underwent a renal biopsy were screened. Eligible patients were categorized into two groups: DN group and NDRD group. Patient's clinical characteristics and laboratory data were collected. Logistic regression analysis was performed to identify risk factors for NDRD development, and the diagnostic performance of these variables was evaluated.Results: The study included 248 patients, 96 (38.71%) in the DN group and 152 (61.29%) in the NDRD group. Patients in the NDRD group had a shorter duration of DM and higher hemoglobin, estimated glomerular filtration rate, and urine osmotic pressure values as well as a higher incidence of glomerular hematuria than patients in the DN group. In the NDRD patients, the most common pathological type was membranous nephropathy (55, 36.18%). Absence of retinopathy (OR, 44.696, 95% CI, 15.91-125.566), glomerular hematuria (OR, 9.587, 95% CI, 2.027-45.333), and DM history <= 5 years (OR, 4.636, 95% CI, 1.721-12.486) were significant and independent risk factors for the development of NDRD (P < 0.01). Absence of retinopathy achieved the overall highest diagnostic efficiency with a sensitivity of 92.11% and specificity of 82.29%. Glomerular hematuria had the highest specificity (93.75%).Conclusion: Shorter duration of diabetes (<= 5 years), absence of retinopathy, and presence of glomerular hematuria were independent indicators associated with NDRDs, indicating the need for renal biopsy. (C) 2016 Elsevier Ireland Ltd. All rights reserved.