Parkinson's disease(PD)is a neurodegenerative disorder characterized byα-Synuclein(α-Syn)aggregation and dopaminergic neuron degeneration[1].While traditionally considered a central nervous system(CNS)disorder,g...Parkinson's disease(PD)is a neurodegenerative disorder characterized byα-Synuclein(α-Syn)aggregation and dopaminergic neuron degeneration[1].While traditionally considered a central nervous system(CNS)disorder,growing evidence suggestsα-Syn pathology in the peripheral organs such as skin,minor salivary glands,submandibular glands,and so on[1].Recent studies have primarily focused on the gastrointestinal tract,supporting the hypothesis thatα-Syn may propagate from the gut to the brain in a prion-like manner[2,3].However,in a groundbreaking study published in Nature Neuroscience,Xin Yuan et al.have provided a novel perspective on the peripheral origins of PD,revealing for the first time the critical role of the kidney in the pathological transmission and initiation ofα-Syn(Fig.1)[4].展开更多
Currently, glucocorticoids are the only treatment option for acute gout attacks in patients with chronic kidney disease (CKD) and progressive renal dysfunction. Management becomes particularly challenging when steroid...Currently, glucocorticoids are the only treatment option for acute gout attacks in patients with chronic kidney disease (CKD) and progressive renal dysfunction. Management becomes particularly challenging when steroid therapy is contraindicated, poorly tolerated, or ineffective. IL-1β monoclonal antibodies offer potent, targeted anti-inflammatory effects and have been approved for the treatment of gout, providing new therapeutic hope for this population. Here, we report a case of a patient with CKD and progressively worsening renal function who experienced an acute gout attack requiring dialysis. Treatment with the IL-1β monoclonal antibody Firsekibart produced rapid and remarkable anti-inflammatory and analgesic effects, effectively controlling the gout attack, improving renal function, and allowing discontinuation of dialysis.展开更多
Antibody-mediated rejection(AMR)remains a leading cause of kidney allograft failure,posing significant clinical and economic challenges.Donor-specific antibodies against human leukocyte antigens or non-human leukocyte...Antibody-mediated rejection(AMR)remains a leading cause of kidney allograft failure,posing significant clinical and economic challenges.Donor-specific antibodies against human leukocyte antigens or non-human leukocyte antigens are critical risk factors for AMR and graft loss.The diagnostic criteria and classification of AMR have evolved considerably over the past three decades,driven largely by the Banff classification.The latest Banff 2022 classification introduced two additional subcategories of“microvascular inflammation,donor-specific antibody-negative,C4d-negative”and“probable AMR”.Traditionally,graft monitoring has relied on non-specific markers such as serum creatinine and proteinuria,and the invasive biopsies.Noninvasive tools using blood and urine biomarkers,including cellular assays and molecular profiling,are increasingly being investigated.Technologies such as the Molecular Microscope Diagnostic System show promise,with studies reporting 80%sensitivity and 90%specificity in detecting AMR.Treatment of AMR remains inconsistent.Recent advances,including CD38 antibodies,have demonstrated up to 60%efficacy in reversing AMR,while complement inhibition shows potential in severe early cases.Ongoing clinical trials evaluating high-dose intravenous immunoglobulin,efgartigimod,fostamatinib,and other novel therapies aim to expand treatment options.These developments highlight the need for well-designed clinical trials to validate biomarkers and therapies and to improve long-term outcomes for kidney transplant recipients.展开更多
Cardiovascular disease(CVD)is often accompanied by chronic kidney disease(CKD)and metabolic disorders such as obesity and type 2 diabetes^([1]).The coexistence of these conditions can lead to systemic dysfunction and ...Cardiovascular disease(CVD)is often accompanied by chronic kidney disease(CKD)and metabolic disorders such as obesity and type 2 diabetes^([1]).The coexistence of these conditions can lead to systemic dysfunction and substantially increase adverse cardiovascular outcomes.To describe this interplay,the American Heart Association(AHA)recently proposed the concept of cardiovascular-kidney-metabolic(CKM)syndrome^([1]).However,its risk-enhancing factors and underlying mechanisms remain unclear.展开更多
Background:Acute kidney injury(AKI),characterized by rapid renal dysfunction(KDIGO 2022 criteria:48-hour doubling of serum creatinine or<0.5 mL/kg/h urine output for>6 h),affects 13.3 million people annually wit...Background:Acute kidney injury(AKI),characterized by rapid renal dysfunction(KDIGO 2022 criteria:48-hour doubling of serum creatinine or<0.5 mL/kg/h urine output for>6 h),affects 13.3 million people annually with>20%mortality.Its progression involves metabolic imbalances,toxin accumulation,and multiorgan failure,often culminating in chronic kidney disease.Current therapies(fluid resuscitation,diuretics,renal replacement therapy)remain limited.Inflammation drives AKI pathogenesis:renal insults(ischemia,toxins)trigger tubular cell release of pro-inflammatory mediators(TNF-α,IL-1β,IL-6),activating neutrophil gelatinase-associated lipocalin(NGAL)and dysregulating P38 MAPK/ERK pathways.This cascade promotes leukocyte infiltration,oxidative stress,and apoptosis,exacerbating renal damage.Ononin,a flavonoid from Astragali Radix,shows multi-target potential by suppressing pro-inflammatory cytokines,modulating signaling,and mitigating oxidative stress.Its dual anti-inflammatory/antioxidant properties position it as a promising candidate for AKI intervention.Exploring the ameliorative effect of ononin on the inflammatory response Ameliorative effect of ononin on the inflammatory response in doxorubicin-induced AKI mice.Methods:We used network pharmacology to explore ononin’s target molecules and AKI-related disease molecules,identified their intersections,and predicted potential mechanisms via enrichment analysis,followed by molecular docking verification.For in-vivo validation,50 mice were randomly divided into five groups(n=10/group):Control,Model,Ononin-L(15 mg/kg),Ononin-H(60 mg/kg),and Dexamethasone(2.6 mg/kg).An AKI model was established by intravenous tail-vein injection of Doxorubicin(15 mg/kg).Samples were collected 12 h post-induction.We calculated the renal coefficient,examined renal histopathology using hematoxylin and eosin(HE),periodic acid-Schiff(PAS),and Masson’s trichrome(MASSON)staining,and observed mitochondrial morphology by electron microscopy(EM).ELISA was used to measure NGAL,serum creatinine(Scr),and blood urea nitrogen(BUN)levels in serum.Immunofluorescence(IF)evaluated the expression of P-P38,P-ERK,NGAL,and KIM-1 in renal tissues.RT-qPCR assessed the gene expression of pro-inflammatory cytokines,MAPK pathway components,and renal injury markers in kidney tissues.Western Blot(WB)quantified P-P38,P38 MAPK,P-ERK,ERK,NGAL,and KIM-1 in renal tissues.Results:Network pharmacology analysis suggested that ononin could attenuate AKI through its anti-inflammatory properties and regulation of the MAPK signaling pathway.The Model group exhibited a significantly elevated renal coefficient(P<0.05),severe histopathological damage,and mitochondrial dysfunction compared to controls.Serum levels of NGAL,Scr,and BUN were markedly increased(P<0.05),indicating impaired renal function.Enhanced fluorescence signals of P-P38 MAPK,P-ERK,NGAL,and KIM-1 suggested activation of MAPK pathways and renal injury.Upregulation of pro-inflammatory cytokines(IL-1β,IL-6,TNF-α)and MAPK-related genes(P38 MAPK,ERK)alongside injury markers(NGAL,KIM-1)(P<0.05).Increased ratios of phosphorylated-to-total proteins(P-P38/P38,P-ERK/ERK)and elevated NGAL/KIM-1 protein levels confirmed pathway dysregulation.Treatment significantly reduced the renal coefficient(P<0.05),attenuated histological damage,and restored mitochondrial integrity.NGAL,Scr,and BUN levels were lowered,reflecting functional recovery.Diminished fluorescence intensities of P-P38,P-ERK,NGAL,and KIM-1 indicated suppression of injury pathways.Downregulation of inflammatory cytokines(IL-1β,IL-6,TNF-α),MAPK components(P38 MAPK,ERK),and injury markers(NGAL,KIM-1)(P<0.05).Reduced phosphorylation ratios(P-P38/P38,P-ERK/ERK)and decreased NGAL/KIM-1 protein expression demonstrated therapeutic efficacy.Conclusion:Ononin ameliorates inflammatory responses in AKI mice via the P38 MAPK/ERK pathway.展开更多
BACKGROUND An echocardiogram is an essential tool in the evaluation of potential kidney transplant recipients(KTRs).Despite cardiac clearance,potential KTRs still have structural and functional abnormalities.Identifyi...BACKGROUND An echocardiogram is an essential tool in the evaluation of potential kidney transplant recipients(KTRs).Despite cardiac clearance,potential KTRs still have structural and functional abnormalities.Identifying the prevalence of these abnormalities and understanding their predictors is vital for optimizing pretransplant risk stratification and improving post-transplant outcomes.AIM To determine the prevalence of left ventricular hypertrophy(LVH),left ventricular systolic dysfunction(LVSD),diastolic dysfunction(DD),pulmonary hypertension(PH),and their predictors,and to assess their impact on graft function in pre-transplant candidates.METHODS The study included all successful transplant candidates older than 14 who had a baseline echocardiogram.Binary logistic regression models were constructed to identify factors associated with LVH,LVSD,DD,and PH.RESULTS Out of 259 patients,LVH was present in 64%(166),12%(31)had LVSD,27.5%(71)had DD,and 66(25.5%)had PH.Independent predictors of LVH included male gender[odds ratio(OR):2.51;95%CI:1.17-5.41 P=0.02],PH(OR=2.07;95%CI:1.11-3.86;P=0.02),DD(OR:2.47;95%CI:1.29-4.73;P=0.006),and dyslipidemia(OR=1.94;95%CI:1.07-3.53;P=0.03).Predictors for LVSD included patients with DD(OR=3.3,95%CI:1.41-7.81;P=0.006)and a family history of coronary artery disease(OR=4.50,95%CI:1.33-15.20;P=0.015).Peritoneal dialysis was an independent predictor for DD(OR=10.03;95%CI:1.71-58.94,P=0.011).The presence of LVH(OR=3.32,95%CI:1.05-10.55,P=0.04)and mild to moderate or moderate to severe mitral regurgitation(OR=4.63,95%CI:1.45-14.78,P=0.01)were significant factors associated with PH.These abnormalities had no significant impact on estimated glomerular filtration at discharge,6 months,1 year,or 2 years post-transplant.CONCLUSION Significant echocardiographic abnormalities persist in a potential transplant candidate despite cardiac clearance,although they don’t affect future graft function.Understanding the risk factors associated with these abnormalities may help clinicians address these factors pre-and post-transplant to achieve better outcomes.展开更多
BACKGROUND The use of induction immunosuppression agents has improved kidney transplant outcomes,but selecting the optimal agent remains a point of debate.AIM To compare the long-term outcomes of kidney transplant rec...BACKGROUND The use of induction immunosuppression agents has improved kidney transplant outcomes,but selecting the optimal agent remains a point of debate.AIM To compare the long-term outcomes of kidney transplant recipients receiving alemtuzumab vs basiliximab induction,focusing on graft function,acute rejection,infection,malignancy,post-transplant glomerulonephritis,and survival,using a propensity score matched cohort design.METHODS Kidney transplant recipients who received alemtuzumab or basiliximab induction from 2014 to 2019 across two nephrology centres in Northwest England were evaluated.Propensity score matching at a 1:1.5 ratio ensured comparability between cohorts.Baseline characteristics,immunosuppression regimens,and outcomes were analyzed.Linear,binary logistic and Cox proportional hazard regression models.RESULTS A total of 436 recipients were included,with a median follow-up of 5.2 years.The matched cohort(n=262)had a mean age of 51.1±13.5 years;39%were female and 92%were white.There was no significant difference in the cumulative incidence of acute rejection[odds ratio(OR)=2.10;95%CI:0.9-4.9;P=0.110].Compared with basiliximab,alemtuzumab was associated with lower estimated glomerular filtration rate at 12 months(-6.6 mL/minute/1.73 m2;95%CI:-10.5 to-2.7;P<0.001)and higher risks of cytomegalovirus viremia(OR=3.2;95%CI:1.6-6.5;P<0.001),BK viremia(OR=2.4;95%CI:1.1-5.5;P=0.02),post-transplant malignancy(OR=6.2;95%CI:1.6-29.9;P=0.013),and death-censored graft loss(hazard ratio=3.6;95%CI:1.2-11.4;P=0.03).No significant differences were observed in post-transplant glomerulonephritis or recipient mortality.CONCLUSION In this propensity score-matched analysis,alemtuzumab induction was associated with lower graft function at 12 months and higher risks of viral infection,post-transplant malignancy,and graft loss compared with basiliximab.These findings highlight the need for further studies to confirm the long-term safety and effectiveness of alemtuzumab in kidney transplantation.展开更多
OBJECTIVE:To develop an expert consensus on kidney deficiency syndrome(KDS)in pregnant women and construct a validated self-reported KDS Patient-Reported Measures Pregnancy Scale(KDS-PRMs-Pregnancy Scale)for early ide...OBJECTIVE:To develop an expert consensus on kidney deficiency syndrome(KDS)in pregnant women and construct a validated self-reported KDS Patient-Reported Measures Pregnancy Scale(KDS-PRMs-Pregnancy Scale)for early identification and management.METHODS:The study was conducted in three phases.First,a comprehensive review of Traditional Chinese Medicine(TCM)literature and diagnostic criteria was performed,generating initial KDS symptoms for pregnancy.Second,a two-round Delphi survey,involving 21 experts from TCM,obstetrics,and gynaecology,assessed importance,relevance,and appropriateness of the items.Third,a psychometric evaluation was conducted,including exploratory factor analysis and internal consistency assessment.RESULTS:In the first Delphi round,19 items were flagged for revision or removal due to expert variability,with 12 items deemed irrelevant.In the second round,consensus was reached,resulting in a 25-item scale.After psychometric evaluation,seven items were removed due to poor factor loadings,leaving an 18-item scale.Three factors—physiological discomfort,fatigue&weakness,and excretion abnormalities—accounted for 78.4%of the variance.The final scale demonstrated excellent internal consistency(Cronbach's alpha=0.959).CONCLUSION:The validated 18-item KDS-PRMsPregnancy Scale is a reliable tool for assessing KDS in pregnant women.Future research should focus on validation in diverse populations and exploring its predictive validity for pregnancy outcomes.展开更多
Objective:Robotic-assisted living donor nephrectomy(RALDN)has been shown to be a safe and feasible option,offering enhanced visualization and improved surgical dexterity,allowing for a potential increase in the living...Objective:Robotic-assisted living donor nephrectomy(RALDN)has been shown to be a safe and feasible option,offering enhanced visualization and improved surgical dexterity,allowing for a potential increase in the living donor pool to perform pediatric and adult kidney transplants,even in cases of grafts with anatomical variants.We report our recent experience in using RALDN for open kidney transplantation(OKT).Methods:Between August 2021 and July 2025,122 kidney transplant recipients underwent OKT using RALDN grafts obtained at the Miami Transplant Institute.Clinical outcomes,during the first12 months post-transplant,including the incidence of delayed graft function(DGF),surgical complications,estimated glomerular filtrationrate(eGFR),and graft loss,were evaluated.Results:Sixteen pediatric and 106 adult recipients were included.The median recipient and donor ages were 42.2 yr and 39.5 yr,respectively.Male recipients comprised 63.1%(77/122);female donors comprised 56.6%(69/122).Among the donors,no conversion to open surgery was needed,and no postoperative complications attributed to the RALDN procedure were observed.Thirty-one kidney grafts required back table reconstruction.The median cold and warm ischemia times were 55.5 min and 27.0 min,respectively.One case(0.8%)of DGF was observed.One recipient(0.8%)developed a postoperative vascular complication;five(4.1%)developed a urologic complication.The median eGFRs at 1 mo,3 mo,6 mo,and 12 mo post-transplant were 71.9,77.1,75.1,and 72.1 mL/min/1.73 m2,respectively.No cases of graft failure during the first12 months post-transplant were observed,and one patient died with a functioning graft.Conclusion:RALDN is a safe and effective technique that provides favorable outcomes among both donors and recipients.This minimally invasive approach should be offered as a safe alternative to living donor patients.展开更多
Diabetic kidney disease (DKD)is one of the most common and severe microvascular complications of type 2 diabetes mellitus (T2DM). It is also a major cause of end-stage renal disease (ESRD), making early identification...Diabetic kidney disease (DKD)is one of the most common and severe microvascular complications of type 2 diabetes mellitus (T2DM). It is also a major cause of end-stage renal disease (ESRD), making early identification and intervention crucial. Insulin resistance (IR)is a key pathophysiological mechanism of T2DM and plays a central role in the progression of DKD. In recent years, a series of novel surrogate indicators of IR, such as the triglyceride-glucose (TyG) index, TyG-body mass index (TyG-BMI), triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C), and metabolic score for insulin resistance (METS-IR), have attracted widespread attention due to their simplicity and cost-effectiveness. This article reviews the research progress of novel surrogate indicators of insulin resistance (IR) in type 2 diabetic kidney disease (DKD), aiming to provide references for the early prevention and improved prognosis of DKD.展开更多
Objective: To analyze the effect of pain nursing combined with exercise and posture intervention on improving Visual Analogue Scale (VAS) scores in patients after kidney stone surgery. Methods: A sample of 80 patients...Objective: To analyze the effect of pain nursing combined with exercise and posture intervention on improving Visual Analogue Scale (VAS) scores in patients after kidney stone surgery. Methods: A sample of 80 patients who underwent kidney stone surgery from October 2024 to October 2025 was randomly divided into groups using a random number table. Group A received pain nursing combined with exercise and posture intervention, while Group B received conventional nursing. Postoperative recovery time, VAS scores, and postoperative complications were compared between the two groups. Results: The postoperative recovery time in Group A was shorter than that in Group B, with p < 0.05. The VAS scores at 12 hours, 24 hours, and 72 hours postoperatively in Group A were all lower than those in Group B, with p < 0.05. The postoperative complication rate in Group A was lower than that in Group B, with p < 0.05. Conclusion: Pain nursing combined with exercise and posture intervention in postoperative nursing for kidney stone patients can shorten postoperative recovery time and alleviate pain scores.展开更多
Moutan Cortex terpene glycoside is derived from the dried root bark of Paeonia suffruticosa Andr.in the Paeoniaceae family,which holds significant value as a traditional Chinese medicine.This study investigated that M...Moutan Cortex terpene glycoside is derived from the dried root bark of Paeonia suffruticosa Andr.in the Paeoniaceae family,which holds significant value as a traditional Chinese medicine.This study investigated that Moutan Cortex terpene glycoside(MCTG)improved diabetic kidney disease(DKD)by targeting sirtuin 1(SIRT1)mediated autophagy pathway.Mechanistic insights were gained using DKD model rats and human umbilical vein endothelial cells(HUVECs)to delineate how MCTG operated in the treatment of DKD.Furthermore,network pharmacology was used to identify the primary metabolic pathways affected by MCTG,with key targets being confirmed through polymerase chain reaction(PCR),Western blot,Transmission electron microscope,immunofluorescence staining and monodansylcadaverine(MDC)staining.Finally,small interfering RNA transfection testified SIRT1 in advanced glycation end-products(AGEs)-induced HUVECs injury.MCTG effectively decreased blood glucose rise in DKD rats and reduced levels of cytokines and biochemical indicators.Network pharmacology revealed that metabolism was the main pathway of Moutan Cortex,and the main targets were verified by PCR and protein experiments.Based on these results,we found that Moutan Cortex could improve DKD and SIRT1 was a potential target.Furthermore,knockdown of SIRT1 attenuated AGEs-induced the expression of Beclin 1 and microtubule-associated protein 1 light chain 3 II/I(LC3 II/I)in HUVECs.In summary,this study demonstrated that Moutan Cortex could alleviate DKD via down-regulating SIRT1-mediated autophagy pathway.展开更多
Acute kidney injury(AKI)is a critical condition with limited effective therapies.Akkermansia muciniphila(A.muciniphila)is a probiotic with multiple beneficial effects,including the regulation of epithelial cell tight ...Acute kidney injury(AKI)is a critical condition with limited effective therapies.Akkermansia muciniphila(A.muciniphila)is a probiotic with multiple beneficial effects,including the regulation of epithelial cell tight junctions.Since renal pathophysiology is associated with gut barrier integrity,we hypothesized that A.muciniphila may have preventive effects on AKI.We established a lipopolysaccharide(LPS)-induced AKI mouse model to evaluate the effects of A.muciniphila.Our findings showed that pretreatment with A.muciniphila significantly attenuated kidney injury,as evidenced by reduced serum creatinine and urea nitrogen levels,alongside decreased tubular necrosis and apoptosis.A.muciniphila preserved intestinal barrier integrity and induced marked shifts in gut microbial ecology and the metabolome.A.muciniphila notably induced an increase in the relative abundance of the phylum Proteobacteria while decreasing in that of the phylum Bacteroidetes.At the genus level,Prevotella,Faecalibaculum,Moraxella,and Lactobacillus were more abundant in A.muciniphilapretreated mice.Metabolomic analysis revealed that A.muciniphila altered the gut metabolome,with changes involving pathways such as tyrosine metabolism,alanine/aspartate/glutamate homeostasis,cancer-related carbon flux,and GABAergic synaptic signaling.In conclusion,our findings indicate that A.muciniphila exerts renoprotective effects by modulating the gut-kidney axis,thereby establishing a foundation for future studies to explore the connection between gut microbiota and AKI.展开更多
Objective:To explore the application effect of combined exercise intervention based on the hospital-community-family model on intrinsic capacity in elderly patients with diabetes mellitus complicated by chronic kidney...Objective:To explore the application effect of combined exercise intervention based on the hospital-community-family model on intrinsic capacity in elderly patients with diabetes mellitus complicated by chronic kidney disease.Methods:Using convenience sampling,100 elderly patients with diabetes mellitus complicated by chronic kidney disease who received treatment in the endocrinology department of a tertiary A-level hospital from May 2024 to May 2025 were selected as the study subjects.They were randomly divided into an experimental group(50 cases)and a control group(50 cases)using a random number table method.The control group received routine health education and telephone follow-up,while the experimental group,in addition to the control group’s interventions,underwent combined exercise intervention based on the hospital-community-family model.Remote medical guidance was utilized to monitor and study the application effect of exercise intervention on intrinsic capacity in elderly patients with diabetes mellitus complicated by chronic kidney disease.Fasting blood glucose,2-hour postprandial blood glucose,glomerular filtration rate,6-minute walk distance,and scores in five dimensions of intrinsic capacity(exercise,cognition,psychology,vitality,and sensation)were measured before the intervention,at 4 weeks of intervention,and at 12 weeks of intervention for both groups.Results:Before the exercise intervention,there were no statistically significant differences(p>0.05)between the two groups in terms of fasting blood glucose,2-hour postprandial blood glucose,glomerular filtration rate,6-minute walk distance,and scores across five dimensions of intrinsic capacity:mobility,cognition,psychology,vitality,and sensation.After 12 weeks of intervention,the experimental group demonstrated significantly higher scores than the control group in glomerular filtration rate,6-minute walk distance,and the dimensions of mobility,cognition,and vitality within intrinsic capacity,with all differences being statistically significant(p<0.05).Conversely,the experimental group showed significantly lower scores than the control group in fasting blood glucose,2-hour postprandial blood glucose,and the psychological dimension of intrinsic capacity,with these differences also being statistically significant(p<0.05).Conclusion:Continuous nursing care utilizing telemedicine based on a hospital-community-family model combined with exercise intervention can effectively enhance exercise tolerance and intrinsic capacity in elderly patients with diabetes mellitus complicated by chronic kidney disease,thereby improving their quality of life.The effectiveness of the intervention is positively correlated with the duration of the intervention.展开更多
Objective: To analyze the value of high-quality nursing care for patients with kidney stones undergoing percutaneous nephrolithotomy with holmium laser lithotripsy (PCNL). Methods: A total of 72 patients with kidney s...Objective: To analyze the value of high-quality nursing care for patients with kidney stones undergoing percutaneous nephrolithotomy with holmium laser lithotripsy (PCNL). Methods: A total of 72 patients with kidney stones treated with PCNL from November 2024 to November 2025 were selected as samples and randomly divided into groups using a random number table. Group A received high-quality nursing care, while Group B received conventional nursing care. Indicators such as pain, anxiety, nursing satisfaction, and complications were compared between the two groups. Results: The Visual Analog Scale (VAS) scores for pain and Self-Rating Anxiety Scale (SAS) scores for anxiety in Group A were lower than those in Group B (p < 0.05). The nursing satisfaction rate in Group A was higher than that in Group B (p < 0.05). The complication rate of PCNL in Group A was lower than that in Group B (p < 0.05). Conclusion: For patients with kidney stones treated with PCNL, receiving high-quality nursing care can alleviate anxiety, relieve pain, and reduce the risk of postoperative complications.展开更多
OBJECTIVE:To assess the clinical effectiveness and safety of Danshen injection(丹参注射液)following immunosuppressive therapy in primary nephrotic syndrome(PNS)with acute kidney injury(AKI)patients.METHODS:PNS with AK...OBJECTIVE:To assess the clinical effectiveness and safety of Danshen injection(丹参注射液)following immunosuppressive therapy in primary nephrotic syndrome(PNS)with acute kidney injury(AKI)patients.METHODS:PNS with AKI patients selected from nephrotic syndrome inpatients between 2012 and 2022 were divided into two groups according to the treatment regimen:the DS group who were treated with the Danshen injection and the SC group who received supportive care.Propensity score matching was used to balance the confounding factors between the two groups.The outcomes were complete and partial renal function recovery for effectiveness analysis and severe bleeding events for safety analysis.Kaplan-Meier curves and logrank tests were used to compare cumulative recovery rates.Outcome risks were assessed using Cox proportional hazard regression models.RESULTS:The study enrolled 441 patients with PNS and AKI from a population of 3873 inpatients with nephrotic syndrome.Among them,95 received Danshen injection,and 346 received supportive care.After propensity score matching,95 patients in the DS group and 285 patients in the SC group were analyzed.No significant difference was observed in the complete recovery rate for the DS group vs SC group(72.9%vs 65.1%,P=0.130)at 6 months.Compared with the SC group,the DS group was associated with a significantly higher partial recovery rate(71.0%vs 37.5%,P=0.011)at 6 months and all recovery rates(93.4%vs 79.1%,P=0.006)at 6 months.CONCLUSION:In this real-world retrospective study of PNS with AKI patients,Danshen injection following immunosuppressive therapy and prophylactic anticoagulation with low molecular heparin significantly increased 6-month partial renal function recovery and had a safety profile.Further randomized clinical trials are warranted to confirm the benefit of Danshen(Radix Salviae Miltiorrhizae)in these patients.展开更多
Objective:To investigate the protective effects of gypenoside XVII(GP-17)against cisplatin-induced acute kidney injury and to elucidate whether its mechanism involves the activation of PINK1/Parkin-mediated mitophagy....Objective:To investigate the protective effects of gypenoside XVII(GP-17)against cisplatin-induced acute kidney injury and to elucidate whether its mechanism involves the activation of PINK1/Parkin-mediated mitophagy.Methods:Sprague-Dawley rats were randomly divided into four groups:control,cisplatin,cisplatin+GP-17,and GP-17 alone.Cisplatin was administered intraperitoneally at 20 mg/kg to induce acute kidney injury,while GP-17 was given orally at 40 mg/kg/day for 7 d.The levels of serum creatinine and blood urea nitrogen,superoxide dismutase activity,and malondialdehyde content were measured.Histopathological analysis and transmission electron microscopy were also performed to evaluate the effects of GP-17 on renal injury.Moreover,the expression of mitophagy-related proteins,including PINK1,Parkin,LC3,and p62,and the mRNA expression of inflammatory markers were determined by Western blot and quantitative RT-PCR assays.Furthermore,human renal tubular epithelial HK-2 cells were treated with cisplatin and GP-17,with or without PINK1 siRNA transfection.Cell viability,apoptosis,reactive oxygen species levels,mitochondrial membrane potential,and the protein expression associated with the PINK1/Parkin pathway were measured.Results:In rats with cisplatin-induced acute kidney injury,GP-17 significantly ameliorated cisplatin-induced elevations in serum creatinine and blood urea nitrogen,attenuated tubular damage and mitochondrial ultrastructural injury,and reduced oxidative stress by increasing superoxide dismutase activity and decreasing malondialdehyde content.GP-17 further upregulated the protein levels of PINK1,Parkin,and LC3-Ⅱ/Ⅰratio while promoting p62 degradation,indicating enhanced mitophagic flux.In HK-2 cells,GP-17(20μM)co-treatment markedly attenuated cisplatin-induced cytotoxicity,apoptosis,reactive oxygen species overproduction,and mitochondrial depolarization.However,all these protective effects of GP-17 were completely abolished upon PINK1 knockdown.Conclusions:GP-17 protects against cisplatin-induced nephrotoxicity by activating PINK1/Parkin-mediated mitophagy,which facilitates the clearance of damaged mitochondria,alleviates oxidative stress,and inhibits renal cell apoptosis.These findings identify GP-17 as a promising candidate for mitigating chemotherapy-induced acute kidney injury.展开更多
Background:Most sepsis patients develop sepsis-associated acute kidney injury(SA-AKI),which poses a significant threat to survival and lacks specific treatment.To date,there are no published randomized controlled tria...Background:Most sepsis patients develop sepsis-associated acute kidney injury(SA-AKI),which poses a significant threat to survival and lacks specific treatment.To date,there are no published randomized controlled trials that have established a link between albumin use and SA-AKI development in sepsis.Therefore,it is unclear whether albumin use may influence the risk of SA-AKI.Methods:The present study employed a target trial emulation using observational data to track adult sepsis patients initially admitted to the intensive care unit at Beth Israel Deaconess Medical Center,Boston,Massachusetts,for a period of 7 d from 2008 to 2022.Immortal time bias was controlled using the clone-censor-weight(CCW)method,along with a new-user design to address current user bias.The exposure variable was the early administration of albumin following the onset of sepsis.Based on albumin use,patients were classified into two groups:the albumin group(n=27,088)and the no albumin group(n=27,088).The primary outcome was the development of SA-AKI,and the secondary outcome was 7-day all-cause mortality.The primary outcome was analyzed using competing risk analyses.Furthermore,sensitivity and subgroup analyses were also performed.Results:Among the 27,088 patients analyzed,albumin administration was associated with a significantly higher SA-AKI risk(relative difference=3.47%,95%CI 1.76-5.23)compared to non-administration.There was no clinically meaningful difference in 7-day survival(relative difference=0.05%,95%CI-2.30 to 2.45).Sensitivity analyses consistently supported these results.All these analyses were conducted on data that were collected after CCW.Conclusions:Early albumin administration may increase the risk of SA-AKI in sepsis patients without conferring a short-term survival benefit.These results underscore the need for a rigorous risk-benefit assessment when incorporating albumin into sepsis resuscitation protocols and highlight the need for further clinical validation.However,it is important to exercise caution when interpreting the conclusions of this study,given its exploratory and preliminary nature.展开更多
Post-kidney transplant rejection is a critical factor influencing transplant success rates and the survival of transplanted organs.With the rapid advancement of artificial intelligence technologies,machine learning(ML...Post-kidney transplant rejection is a critical factor influencing transplant success rates and the survival of transplanted organs.With the rapid advancement of artificial intelligence technologies,machine learning(ML)has emerged as a powerful data analysis tool,widely applied in the prediction,diagnosis,and mechanistic study of kidney transplant rejection.This mini-review systematically summarizes the recent applications of ML techniques in post-kidney transplant rejection,covering areas such as the construction of predictive models,identification of biomarkers,analysis of pathological images,assessment of immune cell infiltration,and formulation of personalized treatment strategies.By integrating multi-omics data and clinical information,ML has significantly enhanced the accuracy of early rejection diagnosis and the capability for prognostic evaluation,driving the development of precision medicine in the field of kidney transplantation.Furthermore,this article discusses the challenges faced in existing research and potential future directions,providing a theoretical basis and technical references for related studies.展开更多
With advances in solid organ transplantation,the option of combined kidney with other solid organ transplantation is an enticing option for patients with advanced kidney disease and concomitant other solid organ failu...With advances in solid organ transplantation,the option of combined kidney with other solid organ transplantation is an enticing option for patients with advanced kidney disease and concomitant other solid organ failure.Kidney allograft dysfunction is well known to be associated with increased adverse outcomes post solitary kidney transplant however,outcomes for patients and the kidney allograft are somewhat understudied in the setting of kidney transplantation when combined with other solid organ transplantation such as in a simultaneous liverkidney transplant.We will provide an overview of the current literature available on kidney allograft clinical outcome measures in combined solid organ transplant recipients such as delayed kidney allograft function,kidney allograft rejection,kidney allograft and patient survival metrics and how they compare to patients with kidney transplants alone.Worse kidney allograft survival outcomes were noted in most combined other organ with kidney transplantation(liver-kidney,heart-kidney,and lung-kidney)due to comorbidities attributed to non-renal organ dysfunction whereas improved kidney allograft survival outcomes were noted for pancreas-kidney transplantation.展开更多
基金supported by the Science,Technology,and Development Foundation of Wuxi City(Y20222026)Postgraduate Research&Practice Innovation Program of Jiangsu Province,China(SJCX25_0136).
文摘Parkinson's disease(PD)is a neurodegenerative disorder characterized byα-Synuclein(α-Syn)aggregation and dopaminergic neuron degeneration[1].While traditionally considered a central nervous system(CNS)disorder,growing evidence suggestsα-Syn pathology in the peripheral organs such as skin,minor salivary glands,submandibular glands,and so on[1].Recent studies have primarily focused on the gastrointestinal tract,supporting the hypothesis thatα-Syn may propagate from the gut to the brain in a prion-like manner[2,3].However,in a groundbreaking study published in Nature Neuroscience,Xin Yuan et al.have provided a novel perspective on the peripheral origins of PD,revealing for the first time the critical role of the kidney in the pathological transmission and initiation ofα-Syn(Fig.1)[4].
文摘Currently, glucocorticoids are the only treatment option for acute gout attacks in patients with chronic kidney disease (CKD) and progressive renal dysfunction. Management becomes particularly challenging when steroid therapy is contraindicated, poorly tolerated, or ineffective. IL-1β monoclonal antibodies offer potent, targeted anti-inflammatory effects and have been approved for the treatment of gout, providing new therapeutic hope for this population. Here, we report a case of a patient with CKD and progressively worsening renal function who experienced an acute gout attack requiring dialysis. Treatment with the IL-1β monoclonal antibody Firsekibart produced rapid and remarkable anti-inflammatory and analgesic effects, effectively controlling the gout attack, improving renal function, and allowing discontinuation of dialysis.
文摘Antibody-mediated rejection(AMR)remains a leading cause of kidney allograft failure,posing significant clinical and economic challenges.Donor-specific antibodies against human leukocyte antigens or non-human leukocyte antigens are critical risk factors for AMR and graft loss.The diagnostic criteria and classification of AMR have evolved considerably over the past three decades,driven largely by the Banff classification.The latest Banff 2022 classification introduced two additional subcategories of“microvascular inflammation,donor-specific antibody-negative,C4d-negative”and“probable AMR”.Traditionally,graft monitoring has relied on non-specific markers such as serum creatinine and proteinuria,and the invasive biopsies.Noninvasive tools using blood and urine biomarkers,including cellular assays and molecular profiling,are increasingly being investigated.Technologies such as the Molecular Microscope Diagnostic System show promise,with studies reporting 80%sensitivity and 90%specificity in detecting AMR.Treatment of AMR remains inconsistent.Recent advances,including CD38 antibodies,have demonstrated up to 60%efficacy in reversing AMR,while complement inhibition shows potential in severe early cases.Ongoing clinical trials evaluating high-dose intravenous immunoglobulin,efgartigimod,fostamatinib,and other novel therapies aim to expand treatment options.These developments highlight the need for well-designed clinical trials to validate biomarkers and therapies and to improve long-term outcomes for kidney transplant recipients.
基金supported by the Natural Science Foundation of Beijing Municipality(Grant No.7234401)the Postdoctoral Research Foundation of China(Grant No.88014Y0226)。
文摘Cardiovascular disease(CVD)is often accompanied by chronic kidney disease(CKD)and metabolic disorders such as obesity and type 2 diabetes^([1]).The coexistence of these conditions can lead to systemic dysfunction and substantially increase adverse cardiovascular outcomes.To describe this interplay,the American Heart Association(AHA)recently proposed the concept of cardiovascular-kidney-metabolic(CKM)syndrome^([1]).However,its risk-enhancing factors and underlying mechanisms remain unclear.
基金supported by Hebei Province Natural Science Foundation(H2023423037)The Government Funded Clinical Program of Hebei Province(No.ZF2025287)+1 种基金Special Project of Hebei Industrial Technology Institute for Traditional Chinese Medicine Preparation(No.YJY2024001)Chinese Medicine Scientific Research Program of Hebei Province(No.2025222).
文摘Background:Acute kidney injury(AKI),characterized by rapid renal dysfunction(KDIGO 2022 criteria:48-hour doubling of serum creatinine or<0.5 mL/kg/h urine output for>6 h),affects 13.3 million people annually with>20%mortality.Its progression involves metabolic imbalances,toxin accumulation,and multiorgan failure,often culminating in chronic kidney disease.Current therapies(fluid resuscitation,diuretics,renal replacement therapy)remain limited.Inflammation drives AKI pathogenesis:renal insults(ischemia,toxins)trigger tubular cell release of pro-inflammatory mediators(TNF-α,IL-1β,IL-6),activating neutrophil gelatinase-associated lipocalin(NGAL)and dysregulating P38 MAPK/ERK pathways.This cascade promotes leukocyte infiltration,oxidative stress,and apoptosis,exacerbating renal damage.Ononin,a flavonoid from Astragali Radix,shows multi-target potential by suppressing pro-inflammatory cytokines,modulating signaling,and mitigating oxidative stress.Its dual anti-inflammatory/antioxidant properties position it as a promising candidate for AKI intervention.Exploring the ameliorative effect of ononin on the inflammatory response Ameliorative effect of ononin on the inflammatory response in doxorubicin-induced AKI mice.Methods:We used network pharmacology to explore ononin’s target molecules and AKI-related disease molecules,identified their intersections,and predicted potential mechanisms via enrichment analysis,followed by molecular docking verification.For in-vivo validation,50 mice were randomly divided into five groups(n=10/group):Control,Model,Ononin-L(15 mg/kg),Ononin-H(60 mg/kg),and Dexamethasone(2.6 mg/kg).An AKI model was established by intravenous tail-vein injection of Doxorubicin(15 mg/kg).Samples were collected 12 h post-induction.We calculated the renal coefficient,examined renal histopathology using hematoxylin and eosin(HE),periodic acid-Schiff(PAS),and Masson’s trichrome(MASSON)staining,and observed mitochondrial morphology by electron microscopy(EM).ELISA was used to measure NGAL,serum creatinine(Scr),and blood urea nitrogen(BUN)levels in serum.Immunofluorescence(IF)evaluated the expression of P-P38,P-ERK,NGAL,and KIM-1 in renal tissues.RT-qPCR assessed the gene expression of pro-inflammatory cytokines,MAPK pathway components,and renal injury markers in kidney tissues.Western Blot(WB)quantified P-P38,P38 MAPK,P-ERK,ERK,NGAL,and KIM-1 in renal tissues.Results:Network pharmacology analysis suggested that ononin could attenuate AKI through its anti-inflammatory properties and regulation of the MAPK signaling pathway.The Model group exhibited a significantly elevated renal coefficient(P<0.05),severe histopathological damage,and mitochondrial dysfunction compared to controls.Serum levels of NGAL,Scr,and BUN were markedly increased(P<0.05),indicating impaired renal function.Enhanced fluorescence signals of P-P38 MAPK,P-ERK,NGAL,and KIM-1 suggested activation of MAPK pathways and renal injury.Upregulation of pro-inflammatory cytokines(IL-1β,IL-6,TNF-α)and MAPK-related genes(P38 MAPK,ERK)alongside injury markers(NGAL,KIM-1)(P<0.05).Increased ratios of phosphorylated-to-total proteins(P-P38/P38,P-ERK/ERK)and elevated NGAL/KIM-1 protein levels confirmed pathway dysregulation.Treatment significantly reduced the renal coefficient(P<0.05),attenuated histological damage,and restored mitochondrial integrity.NGAL,Scr,and BUN levels were lowered,reflecting functional recovery.Diminished fluorescence intensities of P-P38,P-ERK,NGAL,and KIM-1 indicated suppression of injury pathways.Downregulation of inflammatory cytokines(IL-1β,IL-6,TNF-α),MAPK components(P38 MAPK,ERK),and injury markers(NGAL,KIM-1)(P<0.05).Reduced phosphorylation ratios(P-P38/P38,P-ERK/ERK)and decreased NGAL/KIM-1 protein expression demonstrated therapeutic efficacy.Conclusion:Ononin ameliorates inflammatory responses in AKI mice via the P38 MAPK/ERK pathway.
文摘BACKGROUND An echocardiogram is an essential tool in the evaluation of potential kidney transplant recipients(KTRs).Despite cardiac clearance,potential KTRs still have structural and functional abnormalities.Identifying the prevalence of these abnormalities and understanding their predictors is vital for optimizing pretransplant risk stratification and improving post-transplant outcomes.AIM To determine the prevalence of left ventricular hypertrophy(LVH),left ventricular systolic dysfunction(LVSD),diastolic dysfunction(DD),pulmonary hypertension(PH),and their predictors,and to assess their impact on graft function in pre-transplant candidates.METHODS The study included all successful transplant candidates older than 14 who had a baseline echocardiogram.Binary logistic regression models were constructed to identify factors associated with LVH,LVSD,DD,and PH.RESULTS Out of 259 patients,LVH was present in 64%(166),12%(31)had LVSD,27.5%(71)had DD,and 66(25.5%)had PH.Independent predictors of LVH included male gender[odds ratio(OR):2.51;95%CI:1.17-5.41 P=0.02],PH(OR=2.07;95%CI:1.11-3.86;P=0.02),DD(OR:2.47;95%CI:1.29-4.73;P=0.006),and dyslipidemia(OR=1.94;95%CI:1.07-3.53;P=0.03).Predictors for LVSD included patients with DD(OR=3.3,95%CI:1.41-7.81;P=0.006)and a family history of coronary artery disease(OR=4.50,95%CI:1.33-15.20;P=0.015).Peritoneal dialysis was an independent predictor for DD(OR=10.03;95%CI:1.71-58.94,P=0.011).The presence of LVH(OR=3.32,95%CI:1.05-10.55,P=0.04)and mild to moderate or moderate to severe mitral regurgitation(OR=4.63,95%CI:1.45-14.78,P=0.01)were significant factors associated with PH.These abnormalities had no significant impact on estimated glomerular filtration at discharge,6 months,1 year,or 2 years post-transplant.CONCLUSION Significant echocardiographic abnormalities persist in a potential transplant candidate despite cardiac clearance,although they don’t affect future graft function.Understanding the risk factors associated with these abnormalities may help clinicians address these factors pre-and post-transplant to achieve better outcomes.
文摘BACKGROUND The use of induction immunosuppression agents has improved kidney transplant outcomes,but selecting the optimal agent remains a point of debate.AIM To compare the long-term outcomes of kidney transplant recipients receiving alemtuzumab vs basiliximab induction,focusing on graft function,acute rejection,infection,malignancy,post-transplant glomerulonephritis,and survival,using a propensity score matched cohort design.METHODS Kidney transplant recipients who received alemtuzumab or basiliximab induction from 2014 to 2019 across two nephrology centres in Northwest England were evaluated.Propensity score matching at a 1:1.5 ratio ensured comparability between cohorts.Baseline characteristics,immunosuppression regimens,and outcomes were analyzed.Linear,binary logistic and Cox proportional hazard regression models.RESULTS A total of 436 recipients were included,with a median follow-up of 5.2 years.The matched cohort(n=262)had a mean age of 51.1±13.5 years;39%were female and 92%were white.There was no significant difference in the cumulative incidence of acute rejection[odds ratio(OR)=2.10;95%CI:0.9-4.9;P=0.110].Compared with basiliximab,alemtuzumab was associated with lower estimated glomerular filtration rate at 12 months(-6.6 mL/minute/1.73 m2;95%CI:-10.5 to-2.7;P<0.001)and higher risks of cytomegalovirus viremia(OR=3.2;95%CI:1.6-6.5;P<0.001),BK viremia(OR=2.4;95%CI:1.1-5.5;P=0.02),post-transplant malignancy(OR=6.2;95%CI:1.6-29.9;P=0.013),and death-censored graft loss(hazard ratio=3.6;95%CI:1.2-11.4;P=0.03).No significant differences were observed in post-transplant glomerulonephritis or recipient mortality.CONCLUSION In this propensity score-matched analysis,alemtuzumab induction was associated with lower graft function at 12 months and higher risks of viral infection,post-transplant malignancy,and graft loss compared with basiliximab.These findings highlight the need for further studies to confirm the long-term safety and effectiveness of alemtuzumab in kidney transplantation.
基金Supported by the National Natural Science Foundation of China:to Explore the Intergenerational Effects of Bu-Shen-Tian-Jing Therapeutic Principle on the Offspring of Hyper-Androgenic Polycystic Ovary Syndrome Based on Regulating Rhythmic Iron Death in the Ovarian Granulosa Cells Mediated by Fos Proto-OncogeneRetinoic Acid Receptor-Related Orphan Receptor A-Solute Carrier Family 7 Member 11(No.82274564)the National Natural Science Foundation of China:the Underlying Mechanism of Bu-Shen-Jian-Pi Therapeutic Principle in Regulating Ovarian Granulosa Cells Autophagy Mediated by Short-chain Fatty Acids-forkhead Box O1 Pathway and its Effects on the Development of Offspring of Polycystic Ovary Syndrome(No.82074476)the Open Fund Project of Zhejiang Key Laboratory of Maternal and Infant Health,Women’s Hospital,School of Medicine,Zhejiang University:Mediating Role of Kidney Deficiency in the Relationship between Fear of Childbirth and Delivery Modes:an Exploratory Investigation Grounded in the Classic Traditional Chinese Medicine Theories of“Fear Injuring Kidney”and“Kidney Storing Essence”(No.ZDFY2024-MI-2)。
文摘OBJECTIVE:To develop an expert consensus on kidney deficiency syndrome(KDS)in pregnant women and construct a validated self-reported KDS Patient-Reported Measures Pregnancy Scale(KDS-PRMs-Pregnancy Scale)for early identification and management.METHODS:The study was conducted in three phases.First,a comprehensive review of Traditional Chinese Medicine(TCM)literature and diagnostic criteria was performed,generating initial KDS symptoms for pregnancy.Second,a two-round Delphi survey,involving 21 experts from TCM,obstetrics,and gynaecology,assessed importance,relevance,and appropriateness of the items.Third,a psychometric evaluation was conducted,including exploratory factor analysis and internal consistency assessment.RESULTS:In the first Delphi round,19 items were flagged for revision or removal due to expert variability,with 12 items deemed irrelevant.In the second round,consensus was reached,resulting in a 25-item scale.After psychometric evaluation,seven items were removed due to poor factor loadings,leaving an 18-item scale.Three factors—physiological discomfort,fatigue&weakness,and excretion abnormalities—accounted for 78.4%of the variance.The final scale demonstrated excellent internal consistency(Cronbach's alpha=0.959).CONCLUSION:The validated 18-item KDS-PRMsPregnancy Scale is a reliable tool for assessing KDS in pregnant women.Future research should focus on validation in diverse populations and exploring its predictive validity for pregnancy outcomes.
文摘Objective:Robotic-assisted living donor nephrectomy(RALDN)has been shown to be a safe and feasible option,offering enhanced visualization and improved surgical dexterity,allowing for a potential increase in the living donor pool to perform pediatric and adult kidney transplants,even in cases of grafts with anatomical variants.We report our recent experience in using RALDN for open kidney transplantation(OKT).Methods:Between August 2021 and July 2025,122 kidney transplant recipients underwent OKT using RALDN grafts obtained at the Miami Transplant Institute.Clinical outcomes,during the first12 months post-transplant,including the incidence of delayed graft function(DGF),surgical complications,estimated glomerular filtrationrate(eGFR),and graft loss,were evaluated.Results:Sixteen pediatric and 106 adult recipients were included.The median recipient and donor ages were 42.2 yr and 39.5 yr,respectively.Male recipients comprised 63.1%(77/122);female donors comprised 56.6%(69/122).Among the donors,no conversion to open surgery was needed,and no postoperative complications attributed to the RALDN procedure were observed.Thirty-one kidney grafts required back table reconstruction.The median cold and warm ischemia times were 55.5 min and 27.0 min,respectively.One case(0.8%)of DGF was observed.One recipient(0.8%)developed a postoperative vascular complication;five(4.1%)developed a urologic complication.The median eGFRs at 1 mo,3 mo,6 mo,and 12 mo post-transplant were 71.9,77.1,75.1,and 72.1 mL/min/1.73 m2,respectively.No cases of graft failure during the first12 months post-transplant were observed,and one patient died with a functioning graft.Conclusion:RALDN is a safe and effective technique that provides favorable outcomes among both donors and recipients.This minimally invasive approach should be offered as a safe alternative to living donor patients.
文摘Diabetic kidney disease (DKD)is one of the most common and severe microvascular complications of type 2 diabetes mellitus (T2DM). It is also a major cause of end-stage renal disease (ESRD), making early identification and intervention crucial. Insulin resistance (IR)is a key pathophysiological mechanism of T2DM and plays a central role in the progression of DKD. In recent years, a series of novel surrogate indicators of IR, such as the triglyceride-glucose (TyG) index, TyG-body mass index (TyG-BMI), triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C), and metabolic score for insulin resistance (METS-IR), have attracted widespread attention due to their simplicity and cost-effectiveness. This article reviews the research progress of novel surrogate indicators of insulin resistance (IR) in type 2 diabetic kidney disease (DKD), aiming to provide references for the early prevention and improved prognosis of DKD.
文摘Objective: To analyze the effect of pain nursing combined with exercise and posture intervention on improving Visual Analogue Scale (VAS) scores in patients after kidney stone surgery. Methods: A sample of 80 patients who underwent kidney stone surgery from October 2024 to October 2025 was randomly divided into groups using a random number table. Group A received pain nursing combined with exercise and posture intervention, while Group B received conventional nursing. Postoperative recovery time, VAS scores, and postoperative complications were compared between the two groups. Results: The postoperative recovery time in Group A was shorter than that in Group B, with p < 0.05. The VAS scores at 12 hours, 24 hours, and 72 hours postoperatively in Group A were all lower than those in Group B, with p < 0.05. The postoperative complication rate in Group A was lower than that in Group B, with p < 0.05. Conclusion: Pain nursing combined with exercise and posture intervention in postoperative nursing for kidney stone patients can shorten postoperative recovery time and alleviate pain scores.
基金supported by grants from the National Natural Science Foundation of China(82474093,81973536)Jiangsu Province“Blue and Green Project”(184080H10240)+2 种基金Graduate Research Innovation Program of Jiangsu(KYCX23_0871)the National Natural Science Foundation of the Youth Science Fund Project(81703775)Health Research Program of Wuxi Municipal Health Commission(Q202107).
文摘Moutan Cortex terpene glycoside is derived from the dried root bark of Paeonia suffruticosa Andr.in the Paeoniaceae family,which holds significant value as a traditional Chinese medicine.This study investigated that Moutan Cortex terpene glycoside(MCTG)improved diabetic kidney disease(DKD)by targeting sirtuin 1(SIRT1)mediated autophagy pathway.Mechanistic insights were gained using DKD model rats and human umbilical vein endothelial cells(HUVECs)to delineate how MCTG operated in the treatment of DKD.Furthermore,network pharmacology was used to identify the primary metabolic pathways affected by MCTG,with key targets being confirmed through polymerase chain reaction(PCR),Western blot,Transmission electron microscope,immunofluorescence staining and monodansylcadaverine(MDC)staining.Finally,small interfering RNA transfection testified SIRT1 in advanced glycation end-products(AGEs)-induced HUVECs injury.MCTG effectively decreased blood glucose rise in DKD rats and reduced levels of cytokines and biochemical indicators.Network pharmacology revealed that metabolism was the main pathway of Moutan Cortex,and the main targets were verified by PCR and protein experiments.Based on these results,we found that Moutan Cortex could improve DKD and SIRT1 was a potential target.Furthermore,knockdown of SIRT1 attenuated AGEs-induced the expression of Beclin 1 and microtubule-associated protein 1 light chain 3 II/I(LC3 II/I)in HUVECs.In summary,this study demonstrated that Moutan Cortex could alleviate DKD via down-regulating SIRT1-mediated autophagy pathway.
基金funded by the National Natural Science Foundation of China(Grant No.82470766 to H.M.)the Jiangsu Provincial Medical Key Discipline(Laboratory)Cultivation Unit(Grant No.JSDW202206 to C.X.)the First Affiliated Hospital of Nanjing Medical University Clinical Capacity Enhancement Project(Grant No.JSPH-MC-2022-18 to C.X.).
文摘Acute kidney injury(AKI)is a critical condition with limited effective therapies.Akkermansia muciniphila(A.muciniphila)is a probiotic with multiple beneficial effects,including the regulation of epithelial cell tight junctions.Since renal pathophysiology is associated with gut barrier integrity,we hypothesized that A.muciniphila may have preventive effects on AKI.We established a lipopolysaccharide(LPS)-induced AKI mouse model to evaluate the effects of A.muciniphila.Our findings showed that pretreatment with A.muciniphila significantly attenuated kidney injury,as evidenced by reduced serum creatinine and urea nitrogen levels,alongside decreased tubular necrosis and apoptosis.A.muciniphila preserved intestinal barrier integrity and induced marked shifts in gut microbial ecology and the metabolome.A.muciniphila notably induced an increase in the relative abundance of the phylum Proteobacteria while decreasing in that of the phylum Bacteroidetes.At the genus level,Prevotella,Faecalibaculum,Moraxella,and Lactobacillus were more abundant in A.muciniphilapretreated mice.Metabolomic analysis revealed that A.muciniphila altered the gut metabolome,with changes involving pathways such as tyrosine metabolism,alanine/aspartate/glutamate homeostasis,cancer-related carbon flux,and GABAergic synaptic signaling.In conclusion,our findings indicate that A.muciniphila exerts renoprotective effects by modulating the gut-kidney axis,thereby establishing a foundation for future studies to explore the connection between gut microbiota and AKI.
基金2024 Medical Science Research Project Plan of Hebei Province:Research on the Rehabilitation Effect of Combined Exercise Intervention Based on a Hospital-Community-Family Model for Elderly Patients with Chronic Diseases(Project No.:20240083)Youth Science and Technology Project of the Hebei Provincial Health Department:Research on the Standardization Level of Self-Management in Patients with Diabetic Foot and Related Factors Affecting Wound Healing(Project No.:20190002)。
文摘Objective:To explore the application effect of combined exercise intervention based on the hospital-community-family model on intrinsic capacity in elderly patients with diabetes mellitus complicated by chronic kidney disease.Methods:Using convenience sampling,100 elderly patients with diabetes mellitus complicated by chronic kidney disease who received treatment in the endocrinology department of a tertiary A-level hospital from May 2024 to May 2025 were selected as the study subjects.They were randomly divided into an experimental group(50 cases)and a control group(50 cases)using a random number table method.The control group received routine health education and telephone follow-up,while the experimental group,in addition to the control group’s interventions,underwent combined exercise intervention based on the hospital-community-family model.Remote medical guidance was utilized to monitor and study the application effect of exercise intervention on intrinsic capacity in elderly patients with diabetes mellitus complicated by chronic kidney disease.Fasting blood glucose,2-hour postprandial blood glucose,glomerular filtration rate,6-minute walk distance,and scores in five dimensions of intrinsic capacity(exercise,cognition,psychology,vitality,and sensation)were measured before the intervention,at 4 weeks of intervention,and at 12 weeks of intervention for both groups.Results:Before the exercise intervention,there were no statistically significant differences(p>0.05)between the two groups in terms of fasting blood glucose,2-hour postprandial blood glucose,glomerular filtration rate,6-minute walk distance,and scores across five dimensions of intrinsic capacity:mobility,cognition,psychology,vitality,and sensation.After 12 weeks of intervention,the experimental group demonstrated significantly higher scores than the control group in glomerular filtration rate,6-minute walk distance,and the dimensions of mobility,cognition,and vitality within intrinsic capacity,with all differences being statistically significant(p<0.05).Conversely,the experimental group showed significantly lower scores than the control group in fasting blood glucose,2-hour postprandial blood glucose,and the psychological dimension of intrinsic capacity,with these differences also being statistically significant(p<0.05).Conclusion:Continuous nursing care utilizing telemedicine based on a hospital-community-family model combined with exercise intervention can effectively enhance exercise tolerance and intrinsic capacity in elderly patients with diabetes mellitus complicated by chronic kidney disease,thereby improving their quality of life.The effectiveness of the intervention is positively correlated with the duration of the intervention.
文摘Objective: To analyze the value of high-quality nursing care for patients with kidney stones undergoing percutaneous nephrolithotomy with holmium laser lithotripsy (PCNL). Methods: A total of 72 patients with kidney stones treated with PCNL from November 2024 to November 2025 were selected as samples and randomly divided into groups using a random number table. Group A received high-quality nursing care, while Group B received conventional nursing care. Indicators such as pain, anxiety, nursing satisfaction, and complications were compared between the two groups. Results: The Visual Analog Scale (VAS) scores for pain and Self-Rating Anxiety Scale (SAS) scores for anxiety in Group A were lower than those in Group B (p < 0.05). The nursing satisfaction rate in Group A was higher than that in Group B (p < 0.05). The complication rate of PCNL in Group A was lower than that in Group B (p < 0.05). Conclusion: For patients with kidney stones treated with PCNL, receiving high-quality nursing care can alleviate anxiety, relieve pain, and reduce the risk of postoperative complications.
基金Supported by Key Project of Science and Technology Program Coconstructed by the Science and Technology Department of the National Administration of Traditional Chinese Medicine of China and Administration of Traditional Chinese Medicine of Zhejiang Province:A Study on the Efficacy and Safety of Danshen(Radix Salviae Miltiorrhizae)in Treating Acute Kidney Injury in Patients with Primary Nephrotic Syndrome(GZY-ZJ-KJ-23085)Basic Research Project of Wenzhou Science and Technology Bureau:the Mechanism of Hypoxia Induicible Factor-1 alpha Down-regulating Angiotensinconverting Enzyme 2 in Proximal Renal Tubular Epithelial Cells Leading to Brush Border Shedding in Early Acute Kidney Injury Induced by Sepsis(Y20240071)。
文摘OBJECTIVE:To assess the clinical effectiveness and safety of Danshen injection(丹参注射液)following immunosuppressive therapy in primary nephrotic syndrome(PNS)with acute kidney injury(AKI)patients.METHODS:PNS with AKI patients selected from nephrotic syndrome inpatients between 2012 and 2022 were divided into two groups according to the treatment regimen:the DS group who were treated with the Danshen injection and the SC group who received supportive care.Propensity score matching was used to balance the confounding factors between the two groups.The outcomes were complete and partial renal function recovery for effectiveness analysis and severe bleeding events for safety analysis.Kaplan-Meier curves and logrank tests were used to compare cumulative recovery rates.Outcome risks were assessed using Cox proportional hazard regression models.RESULTS:The study enrolled 441 patients with PNS and AKI from a population of 3873 inpatients with nephrotic syndrome.Among them,95 received Danshen injection,and 346 received supportive care.After propensity score matching,95 patients in the DS group and 285 patients in the SC group were analyzed.No significant difference was observed in the complete recovery rate for the DS group vs SC group(72.9%vs 65.1%,P=0.130)at 6 months.Compared with the SC group,the DS group was associated with a significantly higher partial recovery rate(71.0%vs 37.5%,P=0.011)at 6 months and all recovery rates(93.4%vs 79.1%,P=0.006)at 6 months.CONCLUSION:In this real-world retrospective study of PNS with AKI patients,Danshen injection following immunosuppressive therapy and prophylactic anticoagulation with low molecular heparin significantly increased 6-month partial renal function recovery and had a safety profile.Further randomized clinical trials are warranted to confirm the benefit of Danshen(Radix Salviae Miltiorrhizae)in these patients.
基金supported by grants from the Health Commission of Zigong High-Level Talent Development Project(WJW-GCCRC007).
文摘Objective:To investigate the protective effects of gypenoside XVII(GP-17)against cisplatin-induced acute kidney injury and to elucidate whether its mechanism involves the activation of PINK1/Parkin-mediated mitophagy.Methods:Sprague-Dawley rats were randomly divided into four groups:control,cisplatin,cisplatin+GP-17,and GP-17 alone.Cisplatin was administered intraperitoneally at 20 mg/kg to induce acute kidney injury,while GP-17 was given orally at 40 mg/kg/day for 7 d.The levels of serum creatinine and blood urea nitrogen,superoxide dismutase activity,and malondialdehyde content were measured.Histopathological analysis and transmission electron microscopy were also performed to evaluate the effects of GP-17 on renal injury.Moreover,the expression of mitophagy-related proteins,including PINK1,Parkin,LC3,and p62,and the mRNA expression of inflammatory markers were determined by Western blot and quantitative RT-PCR assays.Furthermore,human renal tubular epithelial HK-2 cells were treated with cisplatin and GP-17,with or without PINK1 siRNA transfection.Cell viability,apoptosis,reactive oxygen species levels,mitochondrial membrane potential,and the protein expression associated with the PINK1/Parkin pathway were measured.Results:In rats with cisplatin-induced acute kidney injury,GP-17 significantly ameliorated cisplatin-induced elevations in serum creatinine and blood urea nitrogen,attenuated tubular damage and mitochondrial ultrastructural injury,and reduced oxidative stress by increasing superoxide dismutase activity and decreasing malondialdehyde content.GP-17 further upregulated the protein levels of PINK1,Parkin,and LC3-Ⅱ/Ⅰratio while promoting p62 degradation,indicating enhanced mitophagic flux.In HK-2 cells,GP-17(20μM)co-treatment markedly attenuated cisplatin-induced cytotoxicity,apoptosis,reactive oxygen species overproduction,and mitochondrial depolarization.However,all these protective effects of GP-17 were completely abolished upon PINK1 knockdown.Conclusions:GP-17 protects against cisplatin-induced nephrotoxicity by activating PINK1/Parkin-mediated mitophagy,which facilitates the clearance of damaged mitochondria,alleviates oxidative stress,and inhibits renal cell apoptosis.These findings identify GP-17 as a promising candidate for mitigating chemotherapy-induced acute kidney injury.
基金supported by grants from the National Institute of Biomedical Imaging and Bioengineering(NIBIB)of the National Institutes of Health(NIH)under award numbers R01-EB001659(2003-2013)and R01-EB017205(2014-2018)approved by the Institutional Review Boards of Beth Israel Deaconess Medical Center(Boston,MA)and the Massachusetts Institute of Technology(Cambridge,MA).
文摘Background:Most sepsis patients develop sepsis-associated acute kidney injury(SA-AKI),which poses a significant threat to survival and lacks specific treatment.To date,there are no published randomized controlled trials that have established a link between albumin use and SA-AKI development in sepsis.Therefore,it is unclear whether albumin use may influence the risk of SA-AKI.Methods:The present study employed a target trial emulation using observational data to track adult sepsis patients initially admitted to the intensive care unit at Beth Israel Deaconess Medical Center,Boston,Massachusetts,for a period of 7 d from 2008 to 2022.Immortal time bias was controlled using the clone-censor-weight(CCW)method,along with a new-user design to address current user bias.The exposure variable was the early administration of albumin following the onset of sepsis.Based on albumin use,patients were classified into two groups:the albumin group(n=27,088)and the no albumin group(n=27,088).The primary outcome was the development of SA-AKI,and the secondary outcome was 7-day all-cause mortality.The primary outcome was analyzed using competing risk analyses.Furthermore,sensitivity and subgroup analyses were also performed.Results:Among the 27,088 patients analyzed,albumin administration was associated with a significantly higher SA-AKI risk(relative difference=3.47%,95%CI 1.76-5.23)compared to non-administration.There was no clinically meaningful difference in 7-day survival(relative difference=0.05%,95%CI-2.30 to 2.45).Sensitivity analyses consistently supported these results.All these analyses were conducted on data that were collected after CCW.Conclusions:Early albumin administration may increase the risk of SA-AKI in sepsis patients without conferring a short-term survival benefit.These results underscore the need for a rigorous risk-benefit assessment when incorporating albumin into sepsis resuscitation protocols and highlight the need for further clinical validation.However,it is important to exercise caution when interpreting the conclusions of this study,given its exploratory and preliminary nature.
文摘Post-kidney transplant rejection is a critical factor influencing transplant success rates and the survival of transplanted organs.With the rapid advancement of artificial intelligence technologies,machine learning(ML)has emerged as a powerful data analysis tool,widely applied in the prediction,diagnosis,and mechanistic study of kidney transplant rejection.This mini-review systematically summarizes the recent applications of ML techniques in post-kidney transplant rejection,covering areas such as the construction of predictive models,identification of biomarkers,analysis of pathological images,assessment of immune cell infiltration,and formulation of personalized treatment strategies.By integrating multi-omics data and clinical information,ML has significantly enhanced the accuracy of early rejection diagnosis and the capability for prognostic evaluation,driving the development of precision medicine in the field of kidney transplantation.Furthermore,this article discusses the challenges faced in existing research and potential future directions,providing a theoretical basis and technical references for related studies.
文摘With advances in solid organ transplantation,the option of combined kidney with other solid organ transplantation is an enticing option for patients with advanced kidney disease and concomitant other solid organ failure.Kidney allograft dysfunction is well known to be associated with increased adverse outcomes post solitary kidney transplant however,outcomes for patients and the kidney allograft are somewhat understudied in the setting of kidney transplantation when combined with other solid organ transplantation such as in a simultaneous liverkidney transplant.We will provide an overview of the current literature available on kidney allograft clinical outcome measures in combined solid organ transplant recipients such as delayed kidney allograft function,kidney allograft rejection,kidney allograft and patient survival metrics and how they compare to patients with kidney transplants alone.Worse kidney allograft survival outcomes were noted in most combined other organ with kidney transplantation(liver-kidney,heart-kidney,and lung-kidney)due to comorbidities attributed to non-renal organ dysfunction whereas improved kidney allograft survival outcomes were noted for pancreas-kidney transplantation.
