Currently， the treatment for acute kidney injury （AKI） primarily relies on supportive therapy， which yields suboptimal outcomes.Efficient nano-drug delivery system can specifically reach the kidneys and release drugs with precision，providing a new direction for specific treatment of AKI.This article reviewed the research progress of targeted nanomedicine therapy for AKI， with a focus on exploring strategies to improve the renal targeting efficiency of nanomedicine.
This experiment aimed to explore the therapeutic effect of ultrasound microbubble-assisted intrarenal delivery of mesenchymal stem cell-derived exosomes under ultrasound guidance on acute kidney injury in rats.
Methods
Twenty-four male 8-week-old normal SD rats were randomly divided into four groups， with six rats in each group： the control group （normal rats injected with phosphate-buffered saline）， the model group （acute kidney injury rats injected with phosphate-buffered saline）， the exosome group （acute kidney injury rats injected with exosomes）， and the mixed vesicle group（acute kidney injury rats injected with ultrasound microbubble-mixed exosomes）.The rat model of acute kidney injury was established by intravenous injection of cisplatin （5 mg/kg） via the tail vein， while the control group rats received an equal volume of phosphate-buffered saline via the tail vein.On the first day after the establishment of the acute kidney injury model， percutaneous intrarenal injection was performed under ultrasound guidance in each group.A total of 100 μl liquid was injected into the upper and lower poles of the rat kidneys： the control group and the model group being injected with phosphate-buffered saline， while the exosome group was injected with exosomes，and the mixed vesicle group was injected with exosomes mixed with ultrasound microbubbles.Immediately after the above injections， ultrasound was applied with the same parameters for activation.The renal function of each group of rats was monitored daily after the injections，and tissue samples were collected on the 4th day.Kidney tissue pathology was observed， and the number of apoptotic cells as well as the expression of kidney injury molecule-1 （KIM-1） protein were detected.
Results
The ultrasound echogenic imaging effect of the mixed vesicle group was better than that of the exosome group.Moreover， the number of exosomes retained in the kidneys and the number of exosomes in the renal cells were both significantly increased in the mixed vesicle group compared to the exosome group （all P ＜0.05）.The renal function， renal tubular pathological injury score， number of apoptotic cells， and expression of KIM-1 protein in both the exosome group and the mixed vesicle group were better than those in the model group （all P ＜0.05）， and these parameters of the mixed vesicle group were also better than those of the exosome group（P ＜0.05）.
Conclusion
Ultrasound microbubble-assisted intrarenal delivery of mesenchymal stem cellderived exosomes under ultrasound guidance could alleviate acute kidney injury in the rats.
To explore the protective effect and mechanism of epigallocatechin gallate（EGCG） on acute kidney injury （AKI） in mice.
Methods
An AKI model of renal unilateral ischemiareperfusion injury was established in mice.Thirty C57BL/6J mice aged 8-10 weeks were randomly divided into sham operation group， AKI mode solvent group （intraperitoneal injection of equal volume saline for 3 consecutive days）， AKI mode EGCG low-dose group （intraperitoneal injection of 6.25 mg/kg EGCG for 3 consecutive days），AKI mode EGCG medium-dose group （intraperitoneal injection of 12.5 mg/kg EGCG for 3 consecutive days），and AKI mode EGCG high-dose group （intraperitoneal injection of 25 mg/kg EGCG for 3 consecutive days）， with 6 mice in each group.After 3 days of the intervention， samples were taken to measure serum creatinine （Scr） and blood urea nitrogen （BUN） to evaluate renal function， while periodic acid-Schiff staining of renal tissue was used to evaluate the degree of renal tubular injury.Western blot and PCR were used to detect the expression levels of renal injury markers， cell cycle-related senescence markers， and senescence-associated secretory phenotypes.Observation of cellular senescence was performed with β-galactosidase staining in renal tissues.
Results
Compared with the sham operation group， the AKI mode solvent group showed significantly elevated levels of Scr and BUN， as well as more severe renal tubular injury （all P ＜0.05）.Compared with the AKI mode solvent group， the AKI mode EGCG medium-dose group exhibited significantly reduced levels of Scr and BUN， and reduced degree of renal tubular injury （all P ＜0.05）.In contrast， both the AKI mode EGCG low-dose group and the AKI mode EGCG high-dose group did not show any improvement in the above indicators.Additionally， compared with the AKI mode solvent group， the AKI mode EGCG medium-dose group also displayed significantly downregulated expression levels of renal injury markers， cell cycle-related senescence markers， and senescence-associated secretory phenotypes （all P ＜0.05）， and the positive area of β-galactosidase staining was also reduced apparently （P ＜0.05）.
Conclusion
Medium dose （12.5 mg/kg） of EGCG could effectively alleviate the renal unilateral ischemia-reperfusion AKI in mice， and its protective mechanism might be related to the inhibition of the renal tubular senescence.
To investigate the association of monocyte/high-density lipoprotein cholesterol ratio （MHR） and platelet/high-density lipoprotein cholesterol ratio （PHR） with the risk of acute ischemic stroke （AIS） in maintenance hemodialysis patients.
Methods
A retrospective analysis was conducted on patients who underwent maintenance hemodialysis at Beijing Chao-Yang Hospital from January 1，2015 to June 30， 2023， and the patients were divided into the AIS group and the non-AIS group.The univariate and multivariate Cox regression models were used to analyze the predictive value of MHR and PHR for stroke risk in the patients.
Results
A total of 258 maintenance hemodialysis patients were included，with 67 patients in the AIS group and 191 patients in the non-AIS group.The median follow-up time was 63 months.There were significant differences between the AIS group and the non-AIS group in age，hypertension history， diabetes history， smoking history， MHR， and PHR （P ＜0.05）.The univariate Cox regression model analysis showed that the patients with high MHR （HR=7.439， P=0.001） and high PHR（HR=1.006， P ＜0.001） had a high risk of ischemic stroke.After adjusting for confounding factors， high MHR （HR=7.277， P=0.004） and high PHR （HR =1.007， P ＜0.001） remained the independent risk factors for AIS in the maintenance hemodialysis patients.
Conclusion
MHR and PHR were the independent risk factors for the AIS in the maintenance hemodialysis patients， and might have certain predictive value.
To explore the weight changes and their influencing factors in patients undergoing hemodialysis via different vascular accesses.
Methods
A retrospective analysis was conducted on the patients who received hemodialysis treatment in our hospital from January 2023 to December 2023.The patients were divided into the arteriovenous fistula group and the central venous catheter group according to the vascular access.The interdialytic weight gain （IDWG） of the patients in the two groups was compared.Then， the patients were again divided into the excessive IDWG group and the normal IDWG group.The differences among the groups were compared， and the influencing factors of IDWG in the patients were analyzed by the multivariate logistic regression method.
Results
A total of 238 patients undergoing hemodialysis were included， among which there were 211 patients in the arteriovenous fistula group and 27 patients in the central venous catheter group.There were 81 patients in the excessive IDWG group and 157 patients in the normal IDWG group.In the arteriovenous fistula group，68 patients had excessive IDWG and 143 patients had normal IDWG， while in the central venous catheter group，13 patients had excessive IDWG and 14 patients had normal IDWG.The average age， albumin level， and hemoglobin level of the excessive IDWG group were all lower than those of the normal IDWG group （all P ＜0.05）， while their average dialysis vintage， urea clearance index， serum phosphorus level， and C-reactive protein level were all higher than those of the normal IDWG group （all P ＜0.05）.The multivariate logistic regression analysis results showed that among all the patients， age， dialysis vintage， urea clearance index， serum phosphorus level，and C-reactive protein level were the influencing factors for IDWG.Among the patients in the arteriovenous fistula group， age， dialysis vintage， urea clearance index， albumin level， serum phosphorus level， and Creactive protein level were the influencing factors for IDWG， while among the patients in the central venous catheter group，age，dialysis vintage，albumin level，and serum phosphorus level were the influencing factors for IDWG （all P ＜0.05）.
Conclusion
There was no significant difference in the IDWG among patients undergoing hemodialysis via different vascular accesses.Age， dialysis vintage， basic nutritional level， and inflammatory level were closely related to the IDWG of the patients.
To investigate the relationship between the systemic immune-inflammation index （SII） and the risk of acute coronary syndrome （ACS） in maintenance hemodialysis patients.
Methods
A retrospective analysis was conducted on patients who underwent maintenance hemodialysis at Beijing Chao-Yang Hospital from January 1，2015 to January 1，2024.They were divided into an ACS group and a non-ACS group.Multivariate logistic regression analysis， receiver operating characteristic （ROC） curve， and the area under the curve were used to explore the relationship between SII and the risk of ACS.
Results
A total of 314 patients with a mean age of 59.31 ±12.82 years were included，among whom 171 patients were males（54.5%） and 143 patients females （45.5%）.There were 70 cases （22.3%） in the ACS group and 244 cases （77.7%） in the non-ACS group.Significant differences were found between the two groups in smoking history， diabetes history， blood pressure， parathyroid hormone， and SII （P ＜0.05）.After adjusting for confounding factors，the multivariate logistic regression analysis showed that SII was significantly associated with ACS in the patients （OR=1.002， 95%CI： 1.001-1.003，P ＜0.001）.Besides， the area under the ROC curve of SII in predicting ACS was 0.783 （95% CI： 0. 723-0. 843， P ＜0.001）.
Conclusion
There was a correlation between SII and ACS in the maintenance hemodialysis patients，suggesting that SII might have certain predictive value.
Renal fibrosis is the end-stage manifestation of chronic kidney disease， with a complex mechanism involving multiple pathogenic mechanisms and signaling pathways.The signaling pathways include classical transforming growth factor-β （TGF-β）/mammals maternal against decapentaplegic （Smad）pathway， non-classical TGF-β/Smad pathway， and wingless/integrated （Wnt） gene/β-catenin pathway.The pathogenesis mainly includes excessive deposition of extracellular matrix as well as transformation and activation of myofibroblasts.This article started with the classic TGF-β/Smad signaling pathway and reviewed the relevant clinical trials and preclinical research progress， aiming to provide new ideas and references for preventing and treating renal fibrosis.
Patients with chronic kidney disease （CKD） have a high prevalence of cognitive impairment， which is often overlooked and severely impacts their quality of life and survival time.Uremic toxins play an important role in the occurrence and development of cognitive impairment in CKD patients.Gut microbiota dysbiosis and the gut-derived uremic toxins （GUTs） produced due to their catabolism accelerate the progression of cognitive impairment in the patients.This article focused on discussing the potential role of key GUTs in the pathogenesis of cognitive impairment in CKD patients， and elaborated on relevant prevention and treatment measures， providing a reference for the clinical diagnosis and treatment of cognitive impairment in CKD patients.
To investigate the effectiveness of the application of flipped classroom teaching method based on gamification concept in standardized training of nephrology.
Methods
Master students who received standardized residency training in the Department of Nephrology of the Affiliated Hospital of Qingdao University from March 2023 to August 2023 were selected as the research subjects， who were randomly divided into three groups： control group （group A， using traditional teaching mode）， test group 1 （group B， using flipped classroom teaching mode）， and test group 2 （group C， using flipped classroom teaching mode based on gamification concept）.The teaching effectiveness was evaluated through teaching assessments and classroom satisfaction surveys， the differences of which were analyzed and compared among the groups.
Results
A total of 72 professional master students were included in the standardized training for resident physicians，with 24 students in each group.The teaching assessment results showed that the evaluation of medical record writing and the scores of the exit examinations in group C were higher than those in group A or group B.group C the medical record writing evaluation and graduation assessment scores of participating graduate students were obviously higher than those of group A or group B（P ＜0.001）.The survey results on classroom satisfaction revealed that trainees in group C reported higher satisfaction level than those in group A or group B （with satisfaction rates of 91.7%，41.3%， and 66.7%，respectively， P =0.03）.
Conclusion
The application of gamification-based flipped classroom teaching method in standardized training for nephrology could achieve better outcomes.
