Glucocorticoids (glucocorticoids, GC) are a kind of steroid hormones secreted by the fasciculate zona in the adrenal cortex, whose main component is cortisol. As glucocorticoids have strong effects of anti-inflammation, immunosuppression, anti-shock, anti-allergy, and anti-toxin, they are now widely used in clinical practice. However, due to their long term use in higher doses and the fact that their therapeutic doses and side effects-causing doses are close to each other, glucocorticoids often bring many side effects to the patients, including Cushing syndrome, severe infections, osteoporosis, skeletal muscle atrophy and necrosis, peptic ulcer, diabetes mellitus, acne, purple striae, and change in behavior and cognition. So it is necessary for us to fully understand the side effects of glucocorticoids and to know their application principles and methods in clinical practice.

Diabetic kidney disease (DKD) is a main cause of chronic renal failure, among which type 2 diabetes-induced kidney disease accounts for the majority. Renal biopsy pathology examination is a "golden standard" for diagnosis, of important value for choice of treatment regimen and prognosis judgement, of important significance for new drug development, and also important basis for epidemiological investigation, determining clinical-pathological relation, and developing noninvasive diagnostic methods for DKD. Therefore, it is of important significance to positively perform renal biopsy examination in diabetic, particularly type 2 diabetic patients with kidney injury.

Dry-weight is an important assessment index for adequacy of hemodialysis, and is vital for improving the survival rate as well as quality of life of patients. With the advances in medical practice, the dry weight definition has developed gradually and the concept evolved. Too high dry weight can affect blood pressure, cardiovascular system stability, and inflammatory factors, while too low dry weight may increase the risk of vascular access obstruction and loss of residual renal function, and increase hypotension-related complications during hemodialysis. Currently clinical methods for evaluation on dry weight includes clinical evaluation, determination for diameter of the inferior vena cava, isotope determination, determination of plasma markers, non-invasive blood volume monitor, and bio-electrical impedance spectra analysis, and so on, but each method has its limitations. Clinically dry weight dissatisfaction is mainly because of patients′ failing to follow the doctor′s advice, short time of hemodialysis, and excess sodium intake, etc. Clinical analysis of patients′ specific conditions should be performed to take targeted measures for achieving the goal of dry weight.

With the development of economy and society, and the improvement of people′s living standard, the prevalence of hyperuricemia increases year by year in China, which can cause multiple organ damage. Uric acid nephropathy is a disease due to deposit of urate crystals in the kidney. At present, integrated traditional Chinese medicine and western medicine have been used in the treatment of uric acid nephropathy. In western medicine, hyperuricemia can be ameliorated by inhibiting uric acid synthesis, promoting excretion of uric acid, and suppressing inflammation, and so on. Uricase is a new class of drugs to reduce uric acid in recent years, including rasburicase and PEG-uricase. Single agents of traditional Chinese medicine, such as iridiod glycosides from paederia scandens, ethanol extract of rhizoma smilasic chinae, quercetin, and rutin, have positive roles in relieving hyperuricemia and protecting kidney. Compounds of traditional Chinese medicine, including Ermiao pill, Simiao decoction, and Siwu decoction combined with Ermiao powder can inhibit the hyperuricemia so as to improve renal function. Therefore, integrated traditional Chinese medicine and western medicine are important in the treatment of uric acid nephropathy.

Volume overload is a common clinical problem in peritoneal dialysis patients, and can directly affect their prognosis and life quality. In order to effectively reduce the volume overload, ensure the adequacy of dialysis, and improve peritoneal dialysis patients′ life quality and survival time, it is greatly needed to establish standard volume management in peritoneal dialysis patients, timely remove causes of volume overload, especially the reversible factors, build rational evaluation flowsheet, and make reasonable and accurate volume assessment.

Acute kidney injury (AKI) is associated with a higher mortality. Some studies have shown that the high mortality of AKI patients is closely related with dysfunction of other organs such as lungs, heart, liver, and nervous system. At present, growing evidence indicates that AKI induces other organs dysfunction by systemic inflammation. Identified pathways include: renal local inflammation; blood uric acid increasing through activation of purine metabolic pathway to amplify the inflammatory response signal resulting in a secondary wave of inflammatory cascade by Toll-like receptors (including release of cytokines, chemokines, and inflammatory and anti-inflammatory factors, etc.); and finally the formation of systemic inflammatory response (taking HMGB1 release into the blood as the representative), which are accompanied by oxidative stress, apoptosis pathway activation, and migration of white blood cells, eventually leading to dysfunction of lungs, heart, liver, and nervous system. This paper has reviewed the latest clinical and experimental studies about AKI and its role in causing injury to distant organs, which will help clinicians to better understand AKI pathophysiological processes leading to the distant organ injury, in order to provide reasonable therapeutic targets for reducing mortality of patients with AKI.

The acceleration of population ageing develops serious medical challenges to society. With organ dysfunction progresses, various age-related diseases have become increasingly prominent, the most prominent of which is the kidney. After the age of 40, the kidney function begins to wane, and can still maintain normal physiological activities in general conditions; but in case of diseases or under some kind of stress condition, the kidney load is increased, which can lead to occurrence of various kidney diseases. Structural and functional changes in kidney take place with age, as a process of physiological aging, which should be distinguished from the kidney diseases. Due to the age-related changes in kidney, the existing renal assessment methods have certain limitations for the elderly, and there has not been any perfect assessment method suitable for the elderly. In the process of diagnosis for the elderly patients with kidney diseases, it should be made clear first whether the renal function change is a physiological or pathological one, so that the treatment can be individualized based on etiology and physiological characteristics of the elderly.

Diabetic nephropathy (DN) is a common microvascular complication of diabetes, and its pathogenesis is not entirely clear yet. It has been reported that programmed cell death (PCD) is closely associated with the pathogenesis of DN through pathways including endoplasmic reticulum stress, mitochondrial dysfunction, glycosylation products toxicity, and glycogen synthase kinase GSK3, which can lead to autophagy dysfunction, apoptosis increase of renal inherent cells, and PCD of some potential new types of cells. This review summarized the current domestic and international research data of this field.

Steroid-resistant nephrotic syndrome (SRNS) is one of the common difficult kidney diseases in clinical practice, and belongs to intractable nephrotic syndrome. A growing number of scholars have been exploring treatment with integrative traditional Chinese and western medicine so as to improve clinical efficacy and ease the side effects from long-term use of high-dose immunosuppressants. In this article, the author systematically described steroid-resistance mechanism and factors affecting the effect of the steroid, and proposed to pay attention to standardized treatment. The following methods are worth using for reference in treatment of SRNS, including combination of tripterygium wilfordii preparation as "disease" differentiation treatment of traditional Chinese medicine with individualized dialectical treatment, combination of traditional syndrome differentiation and microcosmic syndrome differentiation, and combination of prescription selection with modern research results of traditional Chinese medicine.

In the last 20 years, the population of overweight and obesity has been growing rapidly. And obesity-related glomerulopathy (ORG), which can be directly induced by obesity, has received more and more attention. The pathogenesis of ORG is complex, including hemodynamic dysfunction, kidney hypoxia, insulin resistance, over-activation of sympathetic nerve, and so on, in which podocyte injury appears to play a central role. The typical renal histologic features of ORG consisted of simple obesity-associated glomerular hypertrophy, and obesity- associated focal segmental glomerulosclerosis. The most striking clinical characteristic of ORG is the existence of massive proteinuria with very low incidence of nephrotic syndrome. The treatment for ORG mainly aims at the proper control of the associated risk factors, such as weight control, ameliorating insulin resistance, inhibiting over-activation of RAAS, etc, in order to delay the deterioration of renal functions.

Lipoprotein glomerulopathy is a rare disease characterized by proteinuria, renal function insufficiency, and lipoprotein metabolism dysfunction. The main pathogenesis of the disease is apolipoprotein E (apoE) gene mutation. Lipoprotein glomerulopathy is a rare ridney disease, with its incidence being unknown. This article summarizes the pathophysiology, clinical and pathological manifestations, diagnosis and differential diagnosis of lipoprotein glomerulopathy, as well as the potential effective treatments.

Hypertension is extremely common in patients on peritoneal dialysis (PD), with a prevalence of more than 80%. Moreover, refractory hypertension accounts for the increasing incidence of stroke and cardiovascular events which are the leading causes for death and peritoneal dialysis dropout. The 2015 International Society of Peritoneal Dialysis cardiovascular and metabolic guidelines for adult peritoneal dialysis patients recommended that the target of blood pressure in continuous ambulatory PD patients should be <140 mmHg systolic and <90 mmHg diastolic, irrespective of age. There are various factors that contribute to the poor control of hypertension in PD patients, of which hypervolumia and reduced residual renal function are the most common ones. Therapeutic strategies for blood pressure management in PD patients include 5 aspects: appropriate assessment on volume status, effective protection of residual renal function, flexible adjustment of dialysis prescription, right choice of anti-hypertensive drugs, and patient-centered team management.

C1q nephropathy is a glomerular disorder with prominent mesangial proliferation. It is characterized by mesangial dense deposits under electron microscopy and C1q deposits under immunofluorescence microscopy. The histologic pattern of C1q nephropathy can be divided into three kinds: minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS), and immune-mediated proliferative glomerulonephritis. Its clinical presentation is heterogenous, ranging from nephritic to nephrotic proteinuria, with or without hematuria and renal insufficiency. Glucocorticoids remain the mainstay of treatment. Most studies indicated poor response of C1q nephropathy to glucocorticoids. The treatment of integrated Chinese and western medicine for C1q nephropathy is promising.

Idiopathic membranous nephropathy (IMN) is one of the common pathological types of adult nephrotic syndrome in the world. In China, the proportion of IMN among primary glomerular diseases increased obviously in recent years. Because the etiology and the pathogenesis of IMN are not well-known, and there is a lack of biomarkers for predicting activity of IMN, the economic burden and drugs toxicity caused by the treatment remain to be controversial and challenging. IMN is an organ-specific autoimmune disease, in which non-inflammatory autoantibodies can bind target antigens on podocytes, forming subepithelial in-situ immunocomplex on the outside of the glomerular basement membrane that provokes local complement activation so as to cause podocyte injury and proteinuria. The Heymann nephritis model is a classical animal model for MN. However, megalin, which was the target antigen of this model, was not the cause of human IMN. Then, neutral endopeptidase (NEP) was found to be the target antigen of maternal-fetal alloimmunization with antenatal MN. To 2009, phospholipase A2 receptor (PLA2R) was confirmed as the target antigen of IMN. Anti-PLA2R-IgG4 was detected in serum with high specificity of 100% and sensitivity of 70%-80% in IMN patients. Anti-PLA2R-IgG4 could bind PLA2R antigen. Complement lectin pathway was activated by these in-situ immune complex and C5b-9 was generated. C5b-9 membrane attack complex could cause podocytes injury and production of proteinuria. In addition, the level of anti-PLA2R antibodies can predict the activity of the disease. HLA-DQA1 and PLA2R loci are associated with the onset of IMN, and the risk allels of both genes have additive effects. All in all, many factors are involved in the onset of IMN, such as genetic predisposition, target antigens, autoantibodies and complement, etc. These findings are of great significance for the diagnosis and treatment of IMN .

Vitamin A is a kind of essential fat-soluble vitamin in human body. Retinoic acid (RA), the main metabolite of vitamin A, plays an important role in the formation and differentiation of organs and the proliferation and apoptosis of tissue or cells. The deficiency or excess intake of RA will cause abnormal development of tissues and organs. The present paper has reviewed the molecular structure, metabolism process, receptors of RA, and the interaction between RA and organ development, in order to improve recognization of the relationship between RA and the development of organs.

The use of catheter plays a critical role in peritoneal dialysis (PD). As many as 20% of the transfer from PD to hemodialysis is due to PD catheter-related complications. The incidence of PD catheter-related complications varies with the different structures and shapes of different catheter types. Double-cuffed catheter is better than single-cuffed catheter in reducing the rates of exit-site infection and peritonitis; Swan neck catheter provides better prevention of exit-site/tunnel infection than straight Tenckhoff catheter; the catheter with coiled intraperitoneal portion is associated with lower incidence of catheter-drifting and drainage-disturbance than the catheter with straight intraperitoneal portion. With the improvement of PD and nursing techniques, however, the incidences of various PD catheter-related complications have all been reduced, with no significant differences between the different types of catheters. Therefore, in addition to the selection of catheters, more attention should be paid to the nursing care of skin and PD catheter.

Although hemodialysis has been applied to clinical treatment for more than 90 years and become the main treatment for patients with acute and chronic renal failures, nephrologists are still faced with many problems and challenges. The rapid increase of hemodialysis patients in our country will bring serious challenges to China′s health care, which is in urgent need of being supported by more social capital participation and cultivation of qualified hemodialysis medical workers. There are still controversies. From the basic technical level of hemodialysis: when is the best time for hemodialysis initiation? Is intravascular fistula definitely the first choice of vascular access? What is the suitable calcium concentration of dialysate for hemodialysis patients? Besides, from the aspect of prevention and treatment of hemodialysis complications in dialysis patients: what is the target of blood pressure control? How about the target for parathyroid hormone control? In this article, the existing literature evidence was reviewed in order to provide reference for clinical doctors in clinical practice.

Malnutrition is a risk factor for the decline of quality of life and increased hospitalization and mortality in patients undergoing maintenance hemodialysis (MHD), and is also a problem often faced by blood purification workers. The assessment of malnutrition has important practical significance for its prevention, monitoring, diagnosis, and treatment. This article reviewed the research progress of malnutrition assessment in recent years.

Hypertensive disorders in pregnancy (HDP) is a common and serious clinical syndrome, characterized by hypertension, renal injury, and neurological symptoms in pregnancy, and is a major cause for maternal death. According to 2013 ACOG (American College of Obstetricians and Gynecologists) guideline, HDP is categorized as gestational hypertension, preeclamsia-eclamsia, chronic hypertension, and chronic hypertension complicated with preeclamsia. Patients with blood pressure of ≥160/110 mmHg need antihypertensive therapy of which the first-line drugs are calcium channel blockers and adrenoceptor blocking agents. Renin and angiotensin receptor blockers are contraindicated in the first trimester of pregnancy due to their potential teratogenicity. Patients with mild preeclampsia are suggested to receive expectant management, including antihypertensive medication, symptomatic treatment, and nutritional supportive treatment. HDP has a tendency to spontaneous remission within 12 weeks after delivery. Diagnosis of chronic hypertension is considered if hypertension persists. Renal biopsy should be advised to investigate the underlying chronic kidney disease if proteinuria persists more than six months after delivery.