Objective: To explore the predictive value of combining fecal microbiota 16sRNA high-throughput sequencing with serum albumin (Alb) for the fast peritoneal solute transport rate (PSTR) in PD patients.
Methodology: In this center’s retrospective patient cohort (January 2004-January 2024), patients were divided into non-fast PSTR group and fast PSTR group based on the ratio of dialysate creatinine to serum creatinine from the first peritoneal equilibration test (PET) performed 30 days post-catheter insertion (D/Pcr=0.65). The ability of Alb to predict fast PSTR was analyzed using multivariate Logistic regression and receiver operating characteristic (ROC) analysis, and the external validation of Alb’s predictive capability was conducted using the PSTR empirical formula proposed by David, which includes parameters such as gender, race, Alb, and sodium. On the other hand, from May to October 2024, 50 newly admitted PD patients were recruited, and the first PET was performed 30 days post-catheter insertion. Concurrently, fecal samples were collected, frozen at -80℃, and subsequently subjected to high-throughput sequencing of fecal 16S rRNA. Patients were classified into low transport group (D/Pcr ≤0.49), low average transport group (D/Pcr 0.50-0.64), and fast PSTR group (D/Pcr ≥0.65) based on the D/Pcr ratio. The differences in intestinal microbiota levels among the three groups were compared, and significant differential bacterial genera were identified using linear discriminant analysis, analyzing the discriminative value of differential genera combined with Alb for fast PSTR.
Results: A retrospective cohort study included 1008 patients with PD, among which the fast PSTR group accounted for 26.9%. Logistic regression analysis indicated that the variables independently associated with fast PSTR included systolic blood pressure, uric acid, Alb. Compared to other variables, the level of Alb had the largest area under the ROC curve for determining fast PSTR. The predictive ability of Alb was not statistically significantly different from that of the David formula [AUC 95% CI 0.636 (0.593-0.680) vs 0.629 (0.589-0.670), P=0.480]. The fecal microbiota study included 50 newly admitted PD patients, revealing statistically significant differences in Alb levels among the low transport group, low average transport group and fast PSTR group (P=0.012). However, there were no statistically significant differences in the α and β diversity of intestinal microbiota among the three groups. The composition of the microbiota showed no statistically significant differences at the phylum, class, order, and family levels, but significant differences were observed at the genus and species levels. Linear discriminant analysis revealed that the relative abundance of the genus Ruminococcus in the low transport group was significantly higher than that in the fast PSTR group (P=0.018). Correlation analysis indicated a negative correlation between the relative abundance of Ruminococcus and D/Pcr levels (r=-0.351, P=0.013). The DeLong test demonstrated that the relative abundance of Ruminococcus significantly improved the predictive value of Alb for fast PSTR determination [AUC 95% CI 0.871 (0.733-0.979) vs 0.725 (0.554-0.895), P=0.04]; the predictive capability of fecal bacteria combined with Alb was also significantly superior to that of the David formula [AUC 95% CI 0.668 (0.475-0.860), P<0.001].
Conclusion: Serum Alb levels are independent predictors of peritoneal solute transport function in patients with PD. The relative abundance of Ruminococcus species derived from fecal 16S rRNA high-throughput sequencing, when combined with Alb levels, can significantly enhance the predictive value of the latter in determining the fast PSTR.

  Objective:To study the efficacy and safety of finerenone combined with dapagliflozin to improve kidney injury  in  patients  with  type  2  diabetic  nephropathy  （ DN ）   on  the  basis  of  angiotensin⁃converting  enzyme  inhibitor / angiotensin  receptor  blocker  （ ACEI / ARB）   therapy.      Methodology: DN  patients  diagnosed  at  the  National  Clinical Medical Research Center for  Kidney  Diseases  from  August  2016  to  October  2022  and  prospectively  from  August  2023  to December 2023 were retrospectively collected as the control group of ACEI / ARB monotherapy and the observation group of combination therapy with ACEI / ARB， dapagliflozin， and finerenone， respectively.  The general data of patients in the two groups were  collected，  and  kidney  injury⁃related  indexes，  efficacy  and  adverse  reactions  were  observed  at  baseline，  6 months of  treatment  and  12  months  of  treatment，  and  the  factors  affecting  the  efficacy  were  analyzed.  The  primary observation efficacy index was that  urine  microalbumin / creatinine  ratio（ UACR）  decreased≥15%  from baseline， and  the secondary observation efficacy index was that  renal  function  remained  stable  [ estimated  glomerular  filtration  rate（ eGFR） decreased <15%  from  baseline].     Results: There  were  50  cases  in  the  control  group  and  100  cases  in  the  observation group， and there was no difference in baseline data between the two groups. （ 1） Compared with baseline， after 6 months of treatment the UACR of the control group decreased from baseline; in the observation group， 24h urine protein quantification and UACR decreased from baseline， and albumin increased from baseline （ P<0.05）. After 12 months of treatment， UACR further decreased， and eGFR  decreased  from  baseline  in  the  control  group;  in  the  observation  group，  24h  urine  protein quantification and UACR further decreased， hemoglobin  （ Hb），  eGFR  and  albumin  increased  from  baseline  （ P< 0.05）. Compared with the control group， the  change  rates  of 24h  urine  protein  quantification， UACR， and  albumin  at 6  and 12 months of treatment were statistically significant in the observation group; the change rate of Hb was statistically significant after 12 months of treatment （ P< 0.01）. （ 2）  Compared  with  the  control  group，  patients  in  the  observation  group  had  a higher incidence of UACR decline rate≥15%  overall， especially in patients with stage 3 versus stage 4 （ P<0.05）; there was no difference between the  two  groups  in  the  incidence  of  eGFR  decline  rate  < 15%，  the  incidence  of  adverse  events overall and after staging （ P>0.05）.（ 3） Multifactorial binary logistic regression analysis suggested that combination therapy （ OR = 4.782，95%CI 2.172~ 10.529）  promoted the occurrence of UACR decline rate≥15%; high Hb （ OR = 0.981，95% CI 0.964~ 0.999）  was a protective factor for the rate of decline of eGFR≥15%; the combination of other antihypertensive drug treatments （ OR = 3.684，95%CI 1.596 ~ 8.507）， and high triglycerides （ OR = 1.287，95% CI 1.016 ~ 1.630）  were risk factors for eGFR decline rate≥15%.    Conclusion:Compared to ACEI / ARB monotherapy for reducing proteinuria， the combined  treatment  of  ACEI / ARB，  finerenone，  and  dapagliflozin  achieves  a  more   significant   reduction   in   UACR （ particularly in mid⁃to⁃late⁃stage  patients）  and  improves  albumin  levels  in  DN  patients，  while  maintaining  stable  eGFR. Refractory hypertension， anemia， and high triglyceride levels are risk factors for rapid eGFR decline. The combined therapy did not increase the incidence of adverse reactions.

Since  the  first  edition  “ Chinese  guideline  for  the  diagnosis  and  treatment  of  lupus  nephritis”  was published in 2019， a  large  number  of  clinical  studies  have  been  conducted  in  the  diagnosis，   evaluation，   treatment，   and management of lupus nephritis both domestically and internationally， obtaining more new evidence⁃based evidence. In order to update  the  guideline，   a  multidisciplinary  guideline  working  group  was  established，   the  grading  of  recommendation assessment， development and  evaluation  （ GRADE）   system  was  used  to  rate  the  quality  of  evidence  and  the  strength  of recommendations. For  clinical  issues  without  sufficient  evidence⁃based  evidence，   practical  points  were  presented.  In  the updated 2025 Chinese practice  guideline  for  the  diagnosis，   treatment，   and  management  of  lupus  nephritis，   the  guideline expert group developed 20 recommendations and 25 practice points， intended to provide guidance for clinicians in making optimal treatment decisions and disease management. The complete version of the “2025 Chinese practice guideline for the diagnosis， treatment and management  of  lupus  nephritis”  has  been  published  in  the  Chinese  Medical  Journal.  To  further promote and  expand  the  dissemination  and  implementation  of  the  guidelines，   this  journal  has  released  the  executive summary of the “ Chinese practice guideline for the diagnosis， treatment and management of lupus nephritis”.

 Objective:Assessing whether lupus  nephritis  （  LN ）   is  active  or  not  is  crucial  for  developing  tailored treatment plans and improving patients ＇  prognosis. The objective of this study was to identify novel markers in the circulation of LN patients that can reflect  disease  activity. Methodology:Olink proteomics  was  employed to  detect 92 inflammatory molecules and 92 immune response molecules in the plasma of three cohorts: healthy controls  （  CON1 ，  n = 10 ），  active LN patients  （  ALN1 ，  n = 9 ）   and  inactive  LN  patients   （  ILN1 ，   n = 9 ）.  Additionally，   prospective  cohort  was  included  in  the analysis. The molecules identified through screening were subsequently validated using ELISA in a larger sample size of LN patients  （  n = 99 ）   and in a follow ⁃up cohort （  n = 50 ）.    Results:Compared with the CON1 group and the ILN1 group，  the ALN1 group  had  17  differential  molecules ，   and  the  area  under  the  curve   （  AUC ）   distinguishing  ALN1  from  ILN1  was greater than 0 .8. A cohort study showed that 11 of these molecules decreased with treatment remission. After screening the 11 molecules，  LIFR and BTN3A2 were finally identified as meeting the criteria.  In a larger sample and cohort ，  these two molecules were validated to be significantly higher in active LN patients than in inactive patients. Both LIFR and BTN3A2 were positively  correlated  with  the  SLE ⁃DAI  score，   with  correlation  coefficients  of  0 .557  and  0.468，   respectively.  The cohort  results  showed  that  the  levels  of  these  two  molecules  in  circulation  significantly  decreased  with  disease  remission ， while no changes were obs erved in those who did not achieve remission.    Conclusion:In this study，  we circulating LIFR and BTN3A2 serve as novel biomarkers that mirror LN isease activity.

Objective: Early detection of acute kidney injury in acute pancreatitis is of great significance for treatment and prognosis. The objective of this study was to investigate the predictive value and optimal cut-off value of tissue inhibitor of metalloproteinases-2 (TIMP-2)insulin-like growth factor-binding protein 7 (IGFBP-7) for the occurrence of acute kidney injury (AKI) after admission in patients with acute pancreatitis (AP).
Methodology: The study was a posthoc analysis of a multicenter clinical trial. The clinical data of AP patients who met the eligibility criteria and were admitted to 11 emergency and critical care centers across the country from April 2021 to April 2022 were selected. After admission, blood samples of the patients were collected to measure the levels of [TIMP-2][IGFBP-7]. The area under curve (AUC) was used to evaluate the predictive value of this biomarker for AKI, and the optimal cut-off value in this study was evaluated. Multivariate logistic regression model was used to evaluate the independent risk factors for AKI. The differences in clinical outcomes between the high and low marker groups were compared, which were distinguished by the optimal cut-off value.
Results: A total of 84 patients with AP were included in this study, among whom 19 patients (22.6%) developed AKI. The AUC predicted by [TIMP-2][IGFBP-7] for AKI was 0.83 (the optimal cut-off value was 2.46), the sensitivity was 88.9%, and the specificity was 66.1%. Multivariate logistic regression showed that the Acute Physiology and Chronic Health Evaluation System Ⅱ (APACHE Ⅱ) score and the levels of [TIMP-2][IGFBP-7] were associated with AKI. The proportion of organ failure occurring on the third day of admission was higher in the high-marker group (≥2.46) (P=0.019) and the length of intensive care unit (ICU) stay was longer (P=0.030).
Conclusion: Renal injury biomarker ([TIMP-2]*[IGFBP-7]) can predict the occurrence of AKI after admission in AP patients. The population above the cut-off value was associated with an increased length of stay in the ICU and a higher incidence of organ failure. In the future, this biomarker may help to identify high-risk patients with AKI in AP at an early stage, prompt clinical attention, and enable early intervention, ultimately improving prognosis.

Objective: To investigate the characteristics of the gut microbiota in refractory peritoneal dialysis⁃associated peritonitis (PDAP) and provide preliminary evidence for targeting the gut microbiota in its prevention and treatment. Methodology: Fecal specimens were collected from PD patients in the Department of Nephrology, Zhujiang Hospital of Southern Medical University, between January and October 2021. Participants were divided into a refractory PDAP group (n=24) and a control PD group (n=20). 16S rDNA sequencing was employed to analyze differences in species diversity and composition. Results: The flora composition of the refractory PDAP group at the phylum level mainly included Firmicutes (32.5%), Bacteroidetes (27.8%), Proteobacteria (23.2%), and Actinobacteria (13.2%). There were no significant differences in α diversity (P>0.05), but significant differences in β diversity (P=0.008) between the two groups. The refractory PDAP group had more uremic toxin⁃producing gut microbiota (e.g., Corynebacterium, Enterococcus, Pseudomonas, Staphylococcus) and fewer short⁃chain fatty acid⁃producing gut microbiota (e.g., Prevotella, Dialister, Peptococcus, Weissella). Conclusion: Refractory PDAP patients have more uremic toxin⁃producing gut microbiota and fewer short⁃chain fatty acid⁃producing gut microbiota.

Objective:To investigated the gender differences and dynamic changes of the sarcopenia index （ SI） in patients undergoing  peritoneal  dialysis  （ PD）   and  explored  its  clinical  significance.     Methodology: This  single⁃center retrospective study followed adult patients with PD who met the center-s criteria until July 2024. The primary endpoint was all⁃cause mortality. The SI was calculated using the concentrations of serum creatinine （ Cr）   and cystatin C （ CysC）   during the same period， employing the formulas Cr / CysC and Cr×eGFRcys， respectively. First， we analyzed gender differences in the SI values. Subsequently， we  utilized  the  Cox  proportional  hazards  regression  model  and  the  competing  risks  model  to examine the  relationship  between  the  SI  and  all⁃cause  mortality.  Finally，   we  discussed  the  dynamic  changes  of  the  SI following dialysis.    Results:A  total  of  1034  patients  with  PD  were  included  in  the  study，   comprising  563  men  and  471 women. The average age at baseline  was 45.1± 14.2  years， with  a  total  KT / V  of 2.03± 0.64.  The  average  levels  of  Cr / CysC （ 2.03±0.67 vs  1.81 ± 0.59）   and  Cr × eGFRcys  （ 94.2 ± 33.9  vs  86.2 ± 31.5）   in  male  patients  were  significantly higher than those  in  female  patients  （ both  P  <  0.001），   demonstrating  a  very  significant  correlation  between  them  （ r > 0.95， P<0.001）. Using the Cox proportional hazards regression model to analyze continuous and categorical variables for Cr / CysC， it was found that patients with higher Cr / CysC levels had better survival outcomes compared to those with lower levels. However， sex  was  not  statistically  significant  in  this  analysis，   although  the  difference  remained  significant  among male patients. Additionally， in  the  competing  risks  model  analysis，   the  disparity  in  Cr / CysC  levels  continued  to  show  a significant relationship with the survival rate  of  male  patients.  Finally， the  average  Cr / CysC  level  tended  to  decrease  and then increase in the first  year  after  starting  dialysis.    Conclusion:Gender  differences  existed  in  the  SI  levels  of  patients with PD， with male patients exhibiting significantly higher average levels than their female counterparts.  Additionally， the SI level served as  an  independent  predictor  of  prognosis  in  PD  patients，  particularly  among  males.  The  average  SI  level tended to decrease and then increase in the first year after starting dialysis.

Crescentic  glomerulonephritis  （ CGN）   is  a  serious  renal  disease  characterized  by  rapidly  progressive glomerulonephritis with  histologic  features  of  crescent  formation.  Crescents  play  an  important  role  in  a  variety  of  renal diseases and are often strongly associated with poor prognosis. The formation of crescents and the development of CGN are the result  of  multiple  complex  upstream  molecular  mechanisms，   which  are  important  for  optimizing  the  diagnosis  and treatment of CGN. In this paper， we review the critical molecular mechanisms of crescent formation and CGN development and their  related  biomarkers，   aiming  to  deepen  the  understanding  of  the  pathological  role  and  clinical  significance  of crescent in renal diseases， and to provide a new theoretical basis and research direction for the diagnosis and treatment of CGN.

 Type 2 diabetes mellitus （ T2DM）  is a common cause of chronic kidney disease （ CKD）  and increases the risk  of  cardiovascular  diseases.  On  the  basis  of  renin⁃angiotensin⁃aldosterone  system  inhibitors  （ RAASi）  therapy， sodium⁃glucose cotransporter2 inhibitors  （ SGLT2i）  and  non⁃steroidal  mineralocorticoid  receptor  antagonists  （ MRA）  can both delay the progression of CKD and reduce the incidence of cardiovascular events. However， patients still face a higher risk of  adverse  cardiorenal  outcomes.  With  the  introduction  of  “ multifactorial  therapy，”  the  combination  of  RAASi， SGLT2i， and  non⁃steroidal  MRA  has  emerged  as  a  promising  therapeutic  option.  This  review  primarily  discusses  the mechanisms of  action  of  non⁃steroidal  MRA  and  SGLT2i  on  the  heart  and  kidneys，  as  well  as  the  impact  of  their combination on major clinical outcomes in T2DM patients.

Objective: To evaluate the efficacy and safety of peripheral cutting balloon (PCB) in the treatment of arteriovenous fistula (AVF) anastomotic area stenosis.
Methodology: A single-center, retrospective observational study. 69 patients received percutaneous transluminal angioplasty (PTA) treatment due to intra-arteriovenous fistula stenosis received at the renal Department of Haidian Hospital, Peking University Third Hospital from March 2022 to March 2023. Clinical data and postoperative follow-up data were collected, and the patency rate of 6 and 12 months after surgery was calculated, and the related risk factors affecting the patency after PCB surgery were analyzed accordingly.
Results: A total of 69 patients were included, and the technical success rate after PCB operation was 97.14%, and the clinical success rate was 100%. Kaplan-Meier survival analysis showed that 6 cases of restenosis occurred within 6 months after PCB treatment, and the primary patency rate was 91.3%. Restenosis occurred in 18 cases within 12 months, and the primary patency rate was 71.4%. The secondary patency rate at 6 months and 12 months was 100%. The 12-month Kaplan-Meier survival curve indicated that the patency rate of the anastomotic artery was higher (Log-rank χ²=19.98, P<0.001), and the patency rate of the lesion length less than 2 cm was higher (Log-rank χ²=10.13, P=0.001). COX multivariate regression analysis showed that: The stenosis of the anastomotic artery [HR 0.081 (0.015,0.430), P=0.003], the length of the lesion less than 2cm [HR 0.235 (0.062,0.893), P=0.034], preoperative narrowest inner diameter [HR 4.060 (1.160,14.300), P=0.029], hemoglobin [HR 11.000 (1.960,62.100), P=0.007] and platelet [HR 3.270 (1.070,9.970), P=0.037] are the main risk factors affecting the stenosis clearance rate of the anastomotic area in the cutting balloon treatment.
Conclusion: PCB angioplasty is an effective method for the treatment of AVF anastomotic stenosis, with high immediate success rate, good long-term patency rate, safe and reliable. Has a high success rate and reliable patency. The results of COX multivariate analysis can be understood as independent risk factors, adding preoperative vascular stenosis site, length, preoperative narrowest inner diameter, hemoglobin, platelet.

Objective: To construct a model for predicting the probability of renal response at 6 months after immunosuppressive therapy in patients with membranous nephropathy (MN).
Methodology: A total of 115 MN patients confirmed by renal pathology were enrolled, and serum samples from 69 patients were collected 6 months after immunosuppressive therapy to measure phospholipase A2 receptor (PLA2R) and domain-specific antibody levels. LASSO regression was used to screen variables, and a multivariate logistic regression model was constructed. The predictive ability of the model was evaluated using ROC curves.
Results: LASSO regression identified lnCTLD1-IgG-M0 and lnCTLD1-IgG4-M0 as independent risk factors affecting renal response in MN patients after 6 months of treatment. The composite predictive model outperformed conventional PLA2R antibody indices in predictive capability.
Conclusion: lnCTLD1-IgG-M0 and lnCTLD1-IgG4-M0 are the main risk factors for predicting renal remission in MN patients. The prediction model based on PLA2R domain-specific antibodies exhibits excellent discriminative and calibration abilities, providing a valuable predictive tool for clinical practice to improve renal outcomes in MN patients.

unnel⁃cuffed  catheter  （ TCC）  is  an  important  vascular  access  for  hemodialysis  patients.  A  full understanding of the catheter structural design and function by the clinical operator is conducive to rational selection. The article mainly introduces the  TCC  materials，  coatings，  and  body  structures.  Currently，  TCC  material  is  mainly  carbonate polyurethane， and optimized polyurethane copolymer is  the  direction of  development.  Among  catheter  coatings， antibiotic⁃ coated and silver⁃coated catheters both reported inconsistent results， and micropatterning maybe an exploratory direction to improve the surface characteristics. Catheter tips come in a variety of forms， while symmetric tip likely perform better than stepped and bifurcated tip.  The  design  of  side  holes  is  controversial，  strategies  of  size，  shape，  and  arrangement  are  still being explored. After reviewing literatures， it is still difficult to recommend a particular TCC for hemodialysis patients， and clinical operators should pay more attention to the catheter comprehensive performance when applying.

This  case  reports  a  47⁃year⁃old  male  patient  who  was  diagnosed  with  cryoglobulinemia  and  received treatments  including  antiviral  therapy  for  hepatitis  B  virus  （ HBV ），  glucocorticoids，  cyclophosphamide，  and  plasma exchange. However， his condition relapsed. Subsequently， he was treated with the RVD regimen targeting abnormal B cells and plasma cells in the bone marrow， but resulted in increased proteinuria and progression of renal function. After repeated renal  and  bone  marrow  biopsies  and  exclusion  of  heavy  metal  poisoning，  he  was  diagnosed  with  HBV⁃associated cryoglobulinemia. Following retreatment with glucocorticoids combined with cyclophosphamide， his symptoms improved with stabilized renal  function，  absence  of  gross  hematuria，  and  improved  complement  levels，  but  cryoglobulinemia  remained positive.

Objective: To explore the role and mechanism of ferroptosis in renal fibrosis through an adenine-induced rat model of CKD combined with in vitro experiments.
Methodology: 5~6-week-old male SPF-grade SD male rats (190-230 g) were randomly divided into Control group (n=15) and CKD group (n=18), and the CKD model was constructed by adenine gavage. At the end of the 2nd, 4th and 6th weekends, 5 rats were randomly selected from each group to be executed, and iron content, malondialdehyde (MDA) content and glutathione (GSH) content were detected. RT-PCR and immunohistochemistry were used to detect the expression of renal ferroptosis and fibrosis-associated factors. In vitro experiments, ferroptosis was induced in human renal tubular epithelial cells (HK-2) by ferroptosis inducer (RSL3) and inhibited by ferroptosis inhibitor (Ferrostatin-1, Fer-1). Cell viability, ferroptosis-related markers, and fibrosis-associated factors were measured after intervention.
Results: The CKD group showed increased iron content, MDA content, and decreased GSH levels. The expression levels of α-smooth muscle actin (α-SMA) and alpha 1 type I collagen (COL1A1) increased, transferrin receptor 1 (TFR-1) and ferroportin (FPN) initially increased and then decreased; ferritin heavy chain (FTH) and 4-hydroxynonenal (4-HNE) levels increased; and GPX4 expression decreased. The above changes showed dynamic progression over time. GPX4 expression level was negatively correlated with α-SMA and COL1A1 levels. RSL3-treated HK-2 cells exhibited reduced viability, increased reactive oxygen species (ROS), decreased GSH content and GPX4 expression, and upregulated α-SMA and COL1A1. The above changes could be reversed by Fer-1.
Conclusion: Ferroptosis was involved in the fibrotic process of adenine-induced CKD rats and contributes to the progression of fibrosis, which may be related to ferroptosis-stimulated transdifferentiation of renal tubular epithelial cells.

 In adolescents with steroid⁃resistant nephrotic syndrome， the possibility of genetic mutations should be suspected. Mutations in the gene encoding TBC1 domain family member 8B （ TBC1D8B）  can affect podocyte function. We report two young male patients: one presented with nephrotic syndrome accompanied by acute kidney injury （ AKI）， while the other  exhibited  mild  urinary  abnormalities，  AKI，  developmental  delay，  and  epilepsy.  Renal  biopsy  of  both  patients revealed focal  segmental  glomerulosclerosis  combined with tubulointerstitial  injury， both of  whom were  resistant  to  steroid therapy.  Whole⁃exome  sequencing  identified  hemizygous  mutations  in  the  TBC1D8B  gene，  specifically  c. 659T > A  （ p. I220N）  and c.1028T>C （ p.L343P）; both mutations were novel.

Diabetic nephropathy (DN) is the most prevalent complication of type 2 diabetes mellitus, and is characterized by a complex pathogenesis. Post-translational modifications (PTM) refer to the processes by which chemical groups are covalently added to proteins following synthesis, thereby altering their structure and function. These modifications include acetylation, malonylation, succinylation, lactylation, among others. The PTMs of key proteins can significantly influence cellular metabolic reprogramming and critical signaling pathways, participating processes such as signal transduction, cycle regulation, and metabolic regulation. An increasing body of research has demonstrated that multiple PTMs play significant roles in the pathological processes of DN, including injury to intrinsic renal cells and tubulointerstitial fibrosis. This article reviews the research progress regarding the relationship between PTM and DN.

Objective: To  evaluate  coronary  artery  calcification  in  patients  with  secondary  hyperparathyroidism （ SHPT），   analyze  its  risk  factors  and  compare  the  effects  of  parathyroidectomy （ PTX ）   on  it.       Methodology: A retrospective analysis was performed in 346  patients  who  received  PTX  in  our  hospital  due  to  severe  SHPT.  Preoperative coronary artery CTA and biochemical  examinations  of  the  patients  were  completed  for  further  statistical  analysis， so  as  to understand the  situation  of  coronary  artery  calcification  and  its  risk  factors  in  patients  with  SHPT.  The  changes  and influencing factors of coronary calcification before  and after  PTX were  compared in 31 patients 1 to 2  years  after  PTX. Results:Among the 346 patients， there were 147 female patients， with an average age of 48.54±10.30 years and a dialysis age of 100.08± 48.90  months.  A  total  of  102  patients  had  been  treated  with  calcium⁃based  phosphate  binder，   and  184 patients had been treated with active vitamin D shock therapy. Among the 346 patients， 288 cases （ 83.23%） had coronary artery calcification.  The  calcification  score ≥400  was  considered  as  the  severe  coronary  artery  calcification  group  （ 183 cases， 52.89%）， and the score < 400  was  considered  as  the  non⁃severe  coronary  artery  calcification  group  （ 163  cases， 47.11%）. In the severe coronary artery calcification group， there were more males， older age， longer dialysis age， higher preoperative iPTH， higher proportion  of  diabetes，  higher  troponin  T，  and  higher  NT⁃proBNP.  Among  all  coronary  artery calcification stenosis， the anterior  descending  branch  （ 77.1%），  right  coronary  artery  （ 65.6%）  and  circumflex  branch （ 51.5%）   were  most  commonly  involved，  with  the  proportion  of  severe  stenosis  in  the  anterior  descending  branch （ 16.2%）， right coronary artery （ 13.5%）  and  circumflex  branch  （ 7.6%）.  Binary  Logistic  regression  was  performed  for the presence OR absence of  severe  coronary  calcification， and  it  was  found  that  the  male  （ OR = 2.273，95% CI  1.425 ~ 3.628，P = 0.001）， the older the age（ OR = 1.047，95%CI 1.022~ 1.073，P<0.001）， the higher preoperative iPTH （ OR= 1.001，95%CI 1.000~ 1.001，P = 0.001）， the patients with diabetes（ OR = 5.713，95%CI 1.595~ 20.465，P = 0.007）， the more likely it was to have severe coronary calcification. Biochemical and coronary CTA indicators were re⁃examined 1 to 2 years  after  PTX.  Parathyroid  hormone，  blood  calcium，  blood  phosphorus  and  alkaline  phosphatase  were  significantly decreased compared with those before surgery， and the changes in coronary calcium score were not statistically significant. Conclusion:Coronary artery calcification exists in most SHPT patients. Male， old age， long dialysis age and high iPTH are risk factors for severe coronary artery calcification. There was no significant change in coronary artery calcification after PTX， but  high  cholesterol  and  large  dose  of  calcium  supplementation  were  the  factors  that  aggravated  coronary  artery calcification.

Chimeric antigen  receptor  （ CAR） T  cell  therapy  has  made  revolutionary  progress  in  the  treatment  of hematologic malignancies， particularly  showing  promising  efficacy  in  patients  with  acute  lymphoblastic  leukemia，  diffuse large B⁃cell lymphoma， follicular lymphoma， and multiple myeloma. However， most patients eventually develop resistance to this therapy. The main mechanisms of resistance to CAR⁃T cell therapy include CAR⁃T cell dysfunction， antigen escape， and the immunosuppressive tumor microenvironment. Strategies to overcome these resistance mechanisms include improving T cell function in vivo， optimizing CAR⁃T cell products， and modulating the immunosuppressive tumor microenvironment.

Objective: To evaluate the incidence of falls in middle-aged and elderly (≥45 years old) patients with chronic kidney disease (CKD) in China and build a prediction model.
Methodology: Based on the database of China Health and Retirement Longitudinal Study (CHARLS), the end result is a fall within 2 years. The influence of CKD on falls was analyzed by propensity score matching (PSM) and logistic regression. According to the ratio of 7∶3, CKD patients were randomly divided into training sets or verification sets, and logistic regression was used to explore the independent influencing factors of their falls and build a prediction model. Receiver operating characteristic curve (ROC), area under curve (AUC), calibration curve and decision curve analysis (DCA) were used to evaluate the discrimination, accuracy, and clinical application value of the model.
Results: A total of 7352 people were included. Compared to non-CKD patients, CKD patients had a higher fall rate (24.47% vs 15.50%, P<0.05) and a higher risk of falling (OR=1.62, 95% CI 1.21~2.17, P=0.001). Activities of daily living and depression were independent influencing factors of falls. ROC curve shows that the AUC values of the training set and verification set are 0.67 (95% CI 0.61~0.73) and 0.68 (95% CI 0.60~0.77), respectively, indicating that the model has a certain degree of discrimination. The calibration curve indicates that the model has a good calibration degree. DCA curve display has potential for clinical application value.
Conclusion: Middle-aged and elderly patients with CKD are more likely to fall. The prediction model constructed in this study has certain prediction efficiency and clinical application value, which is helpful for doctors to formulate better treatment and prevention strategies, reducing patient mortality, and improving quality of life.