Approximately 20 to 30 percent of patients with acute kidney injury (AKI) progress to chronic kidney disease (CKD). The mechanisms underlying this AKI-to-CKD transition mainly involve cellular damage, oxidative stress, mitochondrial dysfunction, and abnormal immune cell activation. Macrophages, as the primary immune effector cells infiltrating the kidney after AKI, exhibit high heterogeneity and plasticity in their phenotypes, mediating processes including renal injury, inflammation, repair, and fibrosis. Given the lack of specificity in broad-spectrum macrophage intervention strategies, which may disrupt protective macrophage subpopulations, it is imperative to develop therapeutic agents targeting pathogenic macrophage subsets in the kidney. Nanomedicines demonstrate advantages in treating kidney diseases by targeting pathogenic macrophages, leveraging their tunable physicochemical properties, superior biocompatibility, and biological barrier penetration capabilities. This article primarily introduced the phenotypic changes and functional heterogeneity of macrophages during the transition from AKI to CKD, the application methods of nanomedicines targeting renal macrophages, and the impact of the glomerular filtration barrier on the filtration of nanomedicines targeting renal macrophages.

To explore the clinical characteristics and influencing factors of 90-day outcome in patients with sepsis-associated acute kidney.

A retrospective analysis was conducted on patients with SA-AKI who were admitted to the ICU of the Chinese PLA General Hospital from January 2018 to December 2022. The patients were divided into a deceased group and a survival group based on their survival status at 90 days after the occurrence of AKI. The multi-factor Cox model regression method was used to analyze the outcome-influencing factors.

A total of 304 patients with SA-AKI were included, with a median age of 61 years (range 48-68 years), including 208 males (68.4%). According to the KDIGO staging criteria, there were 44 patients (14.5%) with AKI stage 1, 76 patients (25.0%) with AKI stage 2, and 184 patients (60.5%) with AKI stage 3. According to the recovery status of renal function within 48 hours after AKI, 44 patients (14.5%) had transient AKI, and 260 patients (85.5%) had persistent AKI. And 244 patients (80.3%) underwent continuous renal replacement therapy (CRRT). By 90 days after AKI onset, 116 patients (38.2%) had died. Compared with the deceased group, the survival group had higher levels of mean arterial pressure [(82±11) mmHg vs. (78±15) mmHg, P=0.005] and serum albumin [(29.4±6.4) g/L vs. (27.6±5.2) g/L, P=0.013], and lower levels of serum creatinine (135.5 μmol/L vs. 159.1 μmol/L, P=0.013), blood urea nitrogen (12.5 mmol/L vs. 13.8 mmol/L, P=0.009), and blood lactate (1.8 mmol/L vs. 4.1 mmol/L, P<0.01). Furthermore, the survival group exhibited lower rates of oliguria (21.3% vs. 37.9%, P=0.002), persistent AKI (79.3% vs. 89.4%, P=0.016), administration of vasopressors (68.1% vs. 86.2%, P<0.01), and receipt of CRRT (74.5% vs. 89.7%, P=0.001) compared to the deceased group. Multivariate Cox regression analysis showed that age (HR=1.034, 95%CI: 1.020-1.048, P<0.01), body mass index (HR=0.908, 95%CI: 0.860-0.958, P<0.01), mean arterial pressure (HR=0.968, 95%CI: 0.953-0.984, P<0.01), blood lactate (HR=1.158, 95%CI: 1.099-1.220, P<0.01), and CRRT (HR=2.757, 95%CI: 1.450-5.239, P=0.002) were independent factors affecting the 90-day outcome of the SA-AKI patients.

The 90-day mortality rate of the SA-AKI patients was 38% while its independent influencing factors included age, body mass index, mean arterial pressure, blood lactate, and CRRT.

To analyze the influencing factors of long-term renal prognosis in patients with preeclampsia PE.

A retrospective cohort analysis was conducted on patients diagnosed with PE who were admitted to the general obstetrics ward of Xuanwu Hospital of Capital Medical University from January 2009 to February 2021 (excluding those with baseline comorbidity as chronic kidney disease). The follow-up was completed until November 2021. The patients′ data were collected including demographic information, general information, and laboratory examination indicators. Based on their blood pressure at the end of follow-up, the patients were divided into a residual hypertension group and a normotensive group. And based on their urinary protein status at the end of follow-up, the patients were divided into a residual proteinuria group and a negative urinary protein group. The Kaplan-Meier curve and Cox regression model were employed to analyze the influencing factors of long-term residual hypertension and long-term residual proteinuria in the patients with PE.

A total of 604 patients with PE completed the follow-up, including 251 patients with non-severe PE and 353 patients with severe PE. The median follow-up duration was 8.19 years. At the end of follow-up, 65 patients (10.8%) had residual hypertension, and 29 patients (4.8%) had residual proteinuria. Compared with the normotensive group, the residual hypertension group had a significantly shorter gestational age at the onset of PE, but significantly higher age, baseline systolic blood pressure, and hemoglobin at the end of follow-up (P<0.05). Multivariate COX regression analysis showed that body mass index ≥30 kg/m² (HR=2.57, 95%CI: 1.36-4.85, P=0.004), baseline systolic blood pressure ≥160 mmHg (HR=2.80, 95%CI: 1.55-5.07, P=0.001), baseline hemoglobin ≥120 g/L (HR=2.07, 95%CI: 1.17-3.67, P=0.012), and baseline serum albumin <30 g/L (HR=2.23, 95%CI: 1.18-4.21, P=0.013) were independent influencing factors of the long-term residual hypertension in the patients with PE. At the end of follow-up, the body mass index and baseline systolic blood pressure of the residual proteinuria group were significantly higher than those of the negative urinary protein group. Multivariate COX regression analysis showed that the baseline systolic blood pressure≥160 mmHg(HR=2.70, 95%CI: 1.14-6.38, P=0.024)was an independent influencing factor for the residual proteinuria.

Residual hypertension occurred in 10.8% of the PE patients, and residual proteinuria in 4.8% of the PE patients. Obesity before childbirth, higher hemoglobin, and hypoproteinemia were independently associated with the residual hypertension of the patients. Higher systolic blood pressure was an independent influencing factor for both residual hypertension and residual proteinuria in the patients with PE.

To investigate the relationship between circadian syndrome (CircS) and albuminuria in adults.

A cross-sectional study design was applied, utilizing data from the American National Health and Nutrition Examination Survey (NHANES) conducted from 2007 to 2016. The diagnostic criteria for CircS were meeting no less than 4 of the following components: increased waist circumference, hyperglycemia, elevated triglycerides, reduced high-density lipoprotein cholesterol, hypertension, short sleep duration, and depressive symptoms. Participants were stratified into a normal group and an albuminuria group based on their albuminuria status. Weighted logistic regression and subgroup analysis were employed to investigate the association between CircS and albuminuria. A weighted logistic regression model was then used to analyze the relationship between CircS and macroalbuminuria, in order to test the sensitivity of the results.

A total of 10, 828 participants was included in this study, with a prevalence of albuminuria of 9.89%. Weighted multivariable logistic regression analysis revealed that, after adjusting for confounding factors, the participants with CircS had a higher risk of albuminuria compared to those without CircS (OR=2.031, 95%CI: 1.675-2.461, P<0.01). Subgroup analysis revealed that age and gender interacted with CircS (P<0.01), potentially influencing the risk of albuminuria. Excluding those with coronary heart disease, the association between CircS and albuminuria was significant in all the subgroups (P<0.01 in all cases). Sensitivity analysis revealed that CircS was still positively associated with macroalbuminuria (OR=2.287, 95%CI: 1.419-3.688, P<0.01).

CircS was robustly associated with albuminuria in adults, indicating that CircS populations should be identified early in clinical practice, in whom albuminuria screening should be strengthened.

To analyze the multiple mediating effects of hope and family function on anxiety and sleep quality in patients with maintenance hemodialysis (MHD).

This study was designed as a cross-sectional study, enrolling MHD patients who underwent regular treatment in our hospital from September 2023 to September 2024. A questionnaire survey was conducted to assess the patients′ hope, family functioning, anxiety, and sleep quality, and various statistical methods were employed for analysis.

A total of 127 MHD patients were included in the study. The assessment analysis revealed that the higher the anxiety level of the patients, the worse their hope level (r=-0.414, P<0.01), family functioning (r=-0.475, P<0.01), and sleep quality (as assessed by the Athens insomnia scale, r=0.477, P<0.01). The patients′ hope was positively correlated with their family functioning (r=0.467, P<0.01). As assessed by the Athens insomnia scale, the higher the patient′s hope level (r=-0.585, P<0.01) and family functioning (r=-0.652, P<0.01), the better their sleep quality. The mediation effect analysis indicated that the hope level and family functioning of the patients played a mediating role between their anxiety and sleep quality, with a total indirect effect value of 0.352 (95%CI: 0.144-0.549), accounting for 71.69% of the total effect. The mediating paths included: anxiety-hope-sleep quality (effect size 0.052), anxiety-family functioning-sleep quality (effect size 0.176), and anxiety-hope-family functioning-sleep quality (effect size 0.087).

The increased anxiety level in the patients with MHD was correlated with decreased sleep quality, and raising the patients′ hope level and family functioning may indirectly improve their sleep quality.

Mitochondrial homeostasis is crucial for maintaining normal kidney function. This article reviewed the research progress on the role of mitochondrial biogenesis, bioenergetics, kinetics, autophagy, and other mitochondrial homeostasis regulatory factors in the pathogenesis of chronic kidney disease, and elaborated on the current status and prospects of drug development for treating chronic kidney disease by restoring mitochondrial homeostasis.

Acute kidney injury (AKI) is a common clinical complication closely related to chronic kidney disease. The unique physicochemical properties of nanomedicines provide advantages such as prolonging circulation time, enhancing delivery efficiency, bypassing the glomerular filtration barrier, and increasing renal accumulation of drugs, presenting new opportunities for the treatment of AKI. This article provided an overview of the pathophysiological processes of AKI, the preparation of biomimetic nanomedicines, the enhancement of drug targeting through surface modification of nanocarriers, the development of nanocarrier delivery systems responsive to AKI microenvironment stimuli, the prolongation of nanomedicine retention time in the kidney, and the enhancement of synergistic therapeutic effects of nanomedicines, offering a basis and new ideas for the development of effective nanomedicines for the treatment of AKI.