For a long time， the diagnosis of acute kidney injury （AKI） has mainly relied on serum creatinine and estimated glomerular filtration rate， but the lag in detection often leads to missed optimal diagnosis and treatment opportunities in clinical practice.Contemporary nanotechnology and biomedical developments have brought hope for the early diagnosis of AKI.Point-of-care testing （POCT） for biomarkers such as kidney injury molecule-1， neutrophil gelatinase-associated lipocalin， and microRNAs may make the diagnostic process of AKI faster， simpler， and of lower-cost.This article reviewed the significance of early biomarkers for AKI as well as the current status of their POCT research， and looked ahead to the future challenges and application prospects.

Objective

To establish and compare three animal models of acute kidney disease（AKD） to provide basic research evidence for investigating the pathophysiological mechanisms of AKD.

Methods

Ninety healthy male C57BL/6J mice aged 6-8 weeks were selected， and divided into model groups and control groups （15 mice/group） to establish three AKD models： folic acid model group （given intraperitoneal injection of 0.5% folic acid at 250 mg/kg）， folic acid control group （given intraperitoneal injection of the same amount of 0.3 M sodium bicarbonate）， unilateral ureteral obstruction （UUO） model group （given unilateral ureteral obstruction）， UUO control group （given sham operation）， unilateral ischemia-reperfusion （UIR） model group （given clamping of unilateral renal pedicle for 30 minutes）， and UIR control group （given sham operation）.On day 2， day 8， and day 14 after the modeling， samples were collected to measure serum creatinine， blood urea nitrogen， and proteinuria levels.Renal tissue pathology was observed， and renal injury and collagen deposition were assessed.Western blotting was used to detect the expressions of fibrosis-related proteins such as vimentin and α-smooth muscle actin.RT-qPCR was used to detect renal mRNA expressions of kidney injury molecule-1 （KIM-1） and inflammatory factors including TNF-α， IL-1β， IL-8， and IFN-γ）.

Results

In the folic acid model group， serum creatinine and blood urea nitrogen significantly increased at day 8 after the modeling （both P＜0.05）， while the KIM-1 expression was higher than those in the other two model groups at day 2 after the modelings.At day 8 after the modelings， the expression of KIM-1 in the UUO model group was higher than those in the other two model groups （all P＜0.05）.The tubular injury scores and collagen deposition in the three model groups showed a time-dependent increase， and were all higher than those in their respective control groups.At day 14 after modeling， the UUO model group showed higher tubular injury scores and collagen deposition， as well as higher expressions of vimentin and α-smooth muscle actin than the other two model groups （all P＜0.05）.At day 8 after the modelings， the mRNA expressions of IL-8， IL-1β， TNF-α， and IFN-γ in the three model groups were all higher than those in their respective control groups （all P＜0.05）， while the expressions of these inflammatory factors in the UUO model group were higher than those in the other two model groups （all P＜0.05）.

Conclusion

The folic acid model， UUO model， and UIR model of mice AKD were all established at day8after the modeling operations， among which the renal fibrosis during the disease progression was more severe in the UUO model.

Objective

This study employed transcriptomic sequencing and bioinformatics analyses to identify differentially expressed genes （DEGs） in mesenchymal stem cells （MSCs） treated with ginsenoside Rb1， in order to uncover key genes with potential therapeutic effects on acute kidney injury（AKI）， thereby providing novel insights for AKI treatment.

Methods

In this study， R4.4.2 software was employed to analyze the GSE207667 dataset for identifying DEGs in MSCs after ginsenoside Rb1 treatment.AKI-related key genes were then selected via Gene Ontology （GO） and Kyoto Encyclopedia of Genes and Genomes （KEGG） enrichment analyses.The selected key genes were further examined through functional annotations， literature review， and database analysis.

Results

From the MSCs treated with ginsenoside Rb1， 2969 DEGs were identified， comprising 1567 upregulated genes and 1402 downregulated genes（|log₂FC|＞0.585）.GO enrichment analysis revealed that these DEGs were primarily about biological and molecular functions， including the positive regulation of cell population proliferation and apoptotic cell clearance.KEGG analysis further indicated significant enrichment of DEGs in pathways of cytokine-cytokine receptor interaction， IL-17 signaling， ferroptosis， cell senescence， and efferocytosis （P＜0.05）.Based on functional annotations， this study identified 43 potential key genes related to AKI intervention， and discussed focusing on genes of BMP2， MMP13， ATG5， PTN， and NGF.These genes were implicated in critical biological processes as cell proliferation， apoptosis， inflammation， and tissue repair， and may be closely linked to the mechanism in which MSCs pretreated by ginsenoside Rb1 modulated AKI.

Conclusion

Ginsenoside Rb1 may exert therapeutic effects on AKI by modulating biological processes of cell proliferation and apoptosis in MSCs.The five key genes identified in this study （BMP2， MMP13， ATG5， PTN， and NGF） may offer potential targets for the application of ginsenoside Rb1-treated MSCs in AKI therapy.

Chronic kidney disease-mineral and bone disorder （CKD-MBD） is one of the most common and important complications of chronic kidney disease.With the progression of renal failure， the patients' calcium and phosphorus regulation becomes imbalanced.The patients may experience vitamin D deficiency， hyperphosphatemia， hypocalcemia， secondary hyperparathyroidism， and calcification of blood vessels and soft tissues.These conditions increase the risk of fractures and cardiovascular events， reduce quality of life， and increase the risk of death.Active treatment of secondary hyperparathyroidism， prevention and treatment of osteoporosis and vascular calcification， and control of blood phosphorus are important measures in the treatment of CKD-MBD.This article reviewed the new progress in research on the drug treatment of CKD-MBD.

Heat stress-induced kidney injury is a renal dysfunction caused by high-temperature environments or intense activities in hot environments. However， its specific molecular mechanisms have not been fully elucidated. This article reviewed the risk factors， pathogenesis， early warning indicators， early diagnostic criteria， and main prevention and treatment measures for heat stress-induced kidney injury， in order to provide references for the clinical prevention and treatment of heat stress-induced kidney injury.

Objective

To investigate the impact of gender differences on the prognosis of elderly patients with IgA nephropathy （IgAN） by examining their clinical indices and pathological characteristics.

Methods

A retrospective analysis of primary IgAN patients aged ≥ 60 years diagnosed by renal biopsy at the First Medical Center of PLA General Hospital from January 2004 to August 2022.The follow-up deadline was September 2023.The endpoint events were end-stage renal disease （ESRD）， regular renal replacement therapy， or decrease of eGFR by no less than 50%.The effective follow-up duration was 1 year.The clinical and pathological characteristics of the patients were observed.Kaplan-Meier survival analysis method was used to compare the differences in renal survival rate between the male and female elderly patients with IgAN.And Cox regression model was used to analyze the prognostic factors of the elderly patients with IgAN.

Results

This study included 135 patients with a median age of 64 years， among whom there were 81 males and 54 females.Compared with the female patients， the male patients showed higher levels of serum creatinine， blood urea nitrogen， blood uric acid， mesangial cell proliferation， and tubular atrophy/interstitial fibrosis， but lower levels of serum IgA， triglycerides， and total cholesterol （all P＜0.05）.During a median follow-up of 58 months， a total of 32 patients （23.7%） had endpoint events， including 23 males （28.3%）and 9 females （16.7%）.Kaplan-Meier survival analysis showed that the renal survival rate of the male patients was significantly lower than that of the female patients （P=0.01）.Cox regression analysis showed that the male gender （HR=3. 689， 95%CI： 1. 517-8. 977， P= 0.004） was a risk factor for the poor prognosis of the elderly patients with IgAN.

Conclusion

The male gender was an independent risk factor for the poor prognosis in the elderly patients with IgAN.

Renal tubulointerstitial fibrosis represents a universal pathway in the progression of various types of chronic kidney disease to end-stage renal disease， and its severity serves as a critical pathological predictor for renal function and prognosis. With significant progress in the study of the mechanism of occurrence and development of renal tubulointerstitial fibrosis， more and more biomarkers have been discovered and become a new auxiliary tool for judging the degree of renal tubulointerstitial fibrosis，showing early diagnostic advantages. This article aimed to review the blood and urine biomarkers related to renal tubulointerstitial fibrosis from the perspective of renal pathological characteristics and pathophysiological mechanisms combining with animal experiments and clinical research results， in order to provide reference for in-depth research on early and non-invasive diagnosis of renal tubulointerstitial fibrosis and the prognosis of kidney diseases.

【内容简介】老年患者慢性肾脏病（chronic kidney disease， CKD）与肌少症之间存在着紧密且复杂的联系。 肌少症是一种以进行性、广泛性的骨骼肌质量减少和力量或功能下降为特征的综合征。 在CKD 患者中，肌少症的发生率显著升高。 这是因为CKD 患者常存在慢性炎症状态、代谢紊乱、营养缺乏以及活动量减少等问题，这些因素均会促进肌少症的发生发展；而肌少症又会进一步影响CKD 患者的预后，增加患者的死亡风险和住院率。

衰弱和肌少症对CKD 患者肾功能评估有着重要影响。 衰弱是一种生理储备下降、机体易损性增加的状态，与肌少症常常并存。 在评估CKD 患者肾功能时，由于衰弱和肌少症导致的肌肉量减少，会使基于血清肌酐水平的传统肾功能评估方法出现偏差。 例如，血清肌酐生成减少，会使估算的肾小球滤过率（eGFR）偏高，从而导致对患者肾功能的误判。 对此，干预策略包括积极治疗原发病、改善营养状况，补充足够的蛋白质和维生素D 等营养物质，同时鼓励患者进行适当的运动锻炼，以增加肌肉量和改善肌肉功能。

在评估肌少症患者的肾小球滤过率方面，CKD 流行病学合作研究（CKD-EPI）公式展现出了较好的适用性。 传统的评估公式在面对肌少症患者时，由于肌肉量异常改变了血清肌酐水平，难以准确评估肾功能。 而CKD-EPI 公式综合考虑了性别、年龄、血清肌酐及种族等因素，能更精准地估算肌少症患者的肾小球滤过率，为临床医生制定合理的治疗方案提供更可靠的依据，有助于改善肌少症合并CKD 患者的管理和预后。

Objective

To evaluate the impact of statins on the prognosis of sepsis-associated acute kidney injury （SA-AKI） patients with elevated triglyceride-glucose index.

Methods

This study was a retrospective cohort study that included SA-AKI patients with elevated triglyceride-glucose index. Patients were divided into a statin group （with use of statins） and a non-statin group （no use of statins） based on whether they received statins. The primary outcome was the 28-day all-cause mortality rate. Survival analysis was performed with the Kaplan-Meier curve， and the log-rank test was used to compare survival rates. Univariate and multivariate Cox regression models were used to identify risk factors for the death endpoint， and subgroup analysis was conducted to explore the relationship between statin use and 28-day mortality rate.

Results

A total of 835 patients were included， with 366 patients in the statin group and 469 in the non-statin group. Compared with the non-statin group， the statin group showed lower levels in inhospital mortality rate， 28-day mortality rate， and 90-day mortality rate （all P＜0.05）. The Kaplan-Meier survival curve showed that the difference in survival rates between the two groups was statistically significant（P＜0.05）. Multivariate Cox regression analysis showed that the use of statins was an independent protective factor for 28-day mortality rate （HR=0.59， 95%CI： 0.43-0.81， P=0.001）. Subgroup analysis showed that the use of statins was associated with a reduced risk of 28-day mortality， which was consistent across subgroups stratified by age， gender， sequential organ failure assessment score， acute kidney injury stage，lactate levels， body mass index≥28， complication of diabetes mellitus， mechanical ventilation， and continuous renal replacement therapy.

Conclusion

The use of statins significantly reduced in-hospital mortality rate and improved short-term survival rate in the SA-AKI patients with elevated triglyceride-glucose index.

Objective

To explore the role of non-invasive assessment in fluid volume management of patients with acute kidney injury （AKI） treated with continuous renal replacement therapy （CRRT） by combining the ultrasonic cardiac output monitor （USCOM） and the body composition monitor （BCM）.

Methods

This study adopted a single-center， randomized， parallel-controlled method. Patients with AKI who underwent CRRT in the intensive care unit of the Department of Nephrology， First Medical Center of Chinese PLA General Hospital from April 2022 to October 2023 were included. The patients were divided into a control group and a test group according to the volume assessment methods. In the control group，traditional parameters such as central venous pressure and blood pressure were used to guide fluid volume management， while in the test group， non-invasive assessment with the ultrasonic cardiac output monitor combined with the body composition monitor was used to guide fluid volume management. The clinical baseline characteristics， hemodynamic parameters， incidence of complications， and hospital outcomes of the two groups of patients before and after CRRT were compared.

Results

A total of 50 patients were included，with 25 patients in each group. There were no statistically significant differences in baseline characteristics such as age， gender， etiology of AKI， underlying diseases， severity scores， and laboratory examinations between the two groups （all P＞0.05）. Compared with the control group， the test group after CRRT showed higher levels in the mean arterial pressure， stroke volume， and extracellular water （all P＜0.05）， but lower levels in the incidences of complications such as heart failure， hypotension， and muscle spasm， the total number of hospitalization days， the number of ICU hospitalization days， the total treatment time of CRRT，and the in-hospital mortality rate （all P＜0.05）.

Conclusion

For patients with AKI undergoing CRRT， the combination of the USCOM and the BCM could quickly and non-invasively assess the fluid volume overload，guide the prescription dosage of CRRT， achieving the precise volume management.

In recent years， significant advances in understanding the pathophysiological mechanisms of membranous nephropathy （MN） have revealed its underlying pathogenesis， primarily characterized by the interaction between autoantibodies and podocyte target antigens.Concurrently， the epidemiological features of MN have demonstrated regional variations and dynamic trends， offering novel insights for disease prevention and clinical management.This review systematically summarizes the latest progress in MN research， with a particular focus on the discovery of target antigens and innovative therapeutic approaches represented by targeted therapy，including anti-CD20 monoclonal antibodies， complement inhibitors， and proteasome inhibitors， in order to provide reference for the follow-up research and clinical diagnosis and treatment of membranous nephropathy.

Objective

To explore the relationship between serum β2-microglobulin and all-cause death in patients undergoing maintenance hemodialysis （MHD）.

Methods

A retrospective analysis was conducted in the MHD patients （dialysis vintage ≥3 months） admitted to the Hemodialysis Center of Beijing Civil Aviation General Hospital from January 2018 to December 2023. The patients were divided into a low β2-MG group （β2-MG ＜ 28.0 mg/L） and a high β2-MG group （β2-MG ≥ 28.0 mg/L）. Their general information， biochemical indicators， and prognosis data were collected. The differences in indicator levels and mortality rates between the two groups were analyzed and compared. Kaplan-Meier survival curves were used for survival analysis， and Cox regression model for the relationship analysis between β2-MG and allcause mortality in the MHD patients. Logistic regression method was applied to analyze the risk factors for the high level of β2-MG.

Results

A total of 370 patients were included， with an age of 65.24±13.22 years， a median dialysis vintage of 73.0 （35.0， 129.3） months， a median follow-up time of 51.5（30.0， 69.0） months， and β2-MG level of 28.0 ± 5.45 mg/L. There were 175 patients in the low β2-MG group and 195 patients in the high β2-MG group. Compared with the high β2-MG group， the low β2-MG group had lower levels of dialysis vintage， β2-MG， CRP， iPTH levels， and serum uric acid （all P＜0.05），but higher levels of serum albumin， serum phosphorus， hemoglobin， serum creatinine， and blood urea nitrogen， as well as a higher proportion of patients complicated with diabetes （all P＜0.05）. The mortality rate in the low β2-MG group was lower than that in the high β2-MG group （χ²=5.694， P=0.017）. Kaplan-Meier curve analysis showed that the survival rate in the low β2-MG group was significantly higher than that in the high β2-MG group （χ²=25.292， P＜0.001）. Multivariate Cox regression model analysis showed that β2-MG （HR=1.056， 95%CI： 1.016-1.097， P=0.048）， age （HR=1.026，95%CI： 1.009-1.043， P=0.002）， concomitant diabetes （HR=1.680， 95%CI： 1.149-2.457， P=0.007）， and CRP （HR=1.015， 95%CI： 1.002-1.029， P=0.014） were independent risk factors for allcause mortality in the MHD patients. The risk of death was higher in the high β2-MG group （HR=1.142，95%CI： 1.014-1.431， P=0.030）.

Conclusion

β2-MG was an independent risk factor for the all-cause death in the MHD patients. High β2-MG was associated with an increased risk of all-cause death in the MHD patients.

Objective

To explore the feasibility of establishing a microfluidic technology for detecting potassium in finger blood of hemodialysis patients.

Methods

Eighteen hemodialysis patients were enrolled， from each of whom 100 μl of finger blood was collected for potassium detection using the microfluidic technology， and 2 ml of venous blood was sent to the laboratory for potassium detection.The difference and correlation between the blood potassium concentrations measured by the two methods were analyzed.The receiver operating characteristic （ROC） curves were drawn to analyze the diagnostic and therapeutic value of finger blood potassium ＞5.0 mmol/L for dialysis patients.

Results

The difference between the finger blood potassium concentration detected by microfluidic technology and the venous blood potassium concentration measured by the laboratory was about 10% （r=0.774， P＜0.05）.The area under the ROC curve with the finger blood potassium＞5.0 mmol/L being the indicator was 0.938.

Conclusion

The finger blood potassium concentration detected by microfluidic technology was linearly correlated to the venous blood potassium concentration detected by the laboratory.The finger blood potassium detection method based on microfluidic technology may have certain value for monitoring the blood potassium concentration of dialysis patients.

Objective

To explore the impact of hypernatremia on the short-term prognosis of elderly patients with in-hospital acute kidney injury （AKI）.

Methods

Retrospective analysis of elderly patients who developed AKI during their hospitalization in the geriatric ward of Chinese PLA General Hospital from January 2015 to December 2022. According to the serum sodium levels at time of the diagnosis of AKI， the patients were divided into low blood sodium group （blood sodium＜135 mmol/L）， normal blood sodium group A （135 mmol/L≤blood sodium＜140 mmol/L）， normal blood sodium group B （140 mmol/L≤blood sodium≤145 mmol/L）， and high blood sodium group （blood sodium＞145 mmol/L）. Data were collected including the patients’ demographic data， comorbidities， laboratory test data， and outcome data （all-cause mortality after 28 and 90 days）. The Cox proportional hazards regression model was applied to evaluate the relationship between serum sodium concentration and all-cause mortality after 28 and 90 days.

Results

A total of 661 elderly patients with in-hospital AKI were included， with an average age of 90 （87， 94） years and a male proportion of 74.20%. There were 133 cases （20.12%） in the hyponatremia group， 210 cases（31.77%） in the normal natremia group A， 168 cases （25.42%） in the normal natremia group B， and 150 cases （22.69%） in the hypernatremia group. Within 28 days after AKI， 135 cases （20.42%） died， among whom the mortality rate of normal sodium group A was the lowest （11.9%）， and the mortality rate of the hypernatremia group was the highest （39.3%）， while the Cox regression analysis showed that the risk of mortality in the hypernatremia group was higher than that of the normal sodium group A， （adjusted OR： 3.10，95%CI： 1.896-5.067， P＜0.001）. Within 90 days after AKI， 228 cases （34.50%） died， among whom the mortality rate of normal sodium group A was the lowest （24.8%）， and the mortality rate of hypernatremia group was the highest （57.3%）， while the Cox regression analysis also showed that the risk of mortality in the hypernatremia group was higher than that of the normal sodium group A （adjusted OR： 2.18， 95%CI： 1.501-3.162， P＜0.001）.

Conclusion

Hypernatremia is a common complication in the elderly patients with inhospital AKI， and may be associated with an increased risk of mortality for the patients in the short term.

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.

Diabetic nephropathy （DKD）， as a characteristic microvascular complication of diabetes， has become the leading cause of chronic kidney disease. However， there is still a lack of effective means to prevent its progression to end-stage renal disease （ESRD）. Recent studies have suggested that endoplasmic reticulum stress （ERS） was involved in the occurrence and progression of DKD， and the ERS signaling pathway may become a new target for the treatment of DKD. This article reviewed the research progress on treating DKD by regulating the endoplasmic reticulum stress signaling pathway.

Objective

To explore the predictive role of neutrophil to lymphocyte ratio （NLR） in cardiovascular disease （CVD） morality risk of peritoneal dialysis （PD） patients with diabetes mellitus（DM）.

Methods

A retrospective analysis of clinical data of DM patients who underwent PD catheterization at the General Hospital of Northern Theater Command from January 2013 to September 2021 was conducted.By using receiver operating characteristic （ROC） curves to determine the optimal cutoff value for NLR， the study subjects were divided into low NLR and high NLR groups.Kaplan-Meier method was used for survival analysis， and a multivariate Cox regression proportional hazards model was used to analyze the risk factors affecting CVD mortality of the patients.

Results

A total of 201 PD patients with DM were included.The ROC curve showed that the optimal cut-off value of NLR for predicting CVD morality was 3.36.Therefore，the subjects were divided into a low NLR group （n=52） and a high NLR group （n=149）.Compared with the low NLR group， the high NLR group had higher level of neutrophils but lower levels of body mass index（BMI） and lymphocytes.Kaplan-Meier curve analysis showed that the overall survival rate of patients in the high NLR group was lower than that in the low NLR group （16.70% vs. 71.90%， χ²=5.765， P=0.016）.After adjusting for confounding factors， the results of the multivariate Cox regression model analysis showed that NLR （HR= 1. 082， 95%CI： 1. 013-1. 155， P= 0.019） was an independent risk factor for CVD mortality risk in the DM patients undergoing PD， while BMI （HR=0. 847， 95%CI： 0. 770-0. 933， P=0.001） was a protective factor.

Conclusion

NLR was an independent risk factor for CVD mortality risk in the DM patients undergoing PD， which may have certain reference value for clinical work.

Objective

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.