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Influencing factors of delayed graft function after living relative kidney transplantation
YAO Zhiling, LI Zhen
Chinese Journal of Nephrology, Dialysis & Transplantation    2023, 32 (6): 540-545.   DOI: 10.3969/j.issn.1006-298X.2023.06.007
Abstract839)      PDF (829KB)(149)      
Objective:Objective To analyze retrospectively the risk factors of delayed graft function (DGF) after living relative kidney transplantation.
Methodology:205 pairs of donors and recipients receiving kinship living kidney transplantation admitted to our hospital from January 2015 to December 2021 were included in the study, and their clinical data were collected and analyzed. Including the matching of donor and recipient nationality, recipient nationality, gender, age, blood type, population reactive antibody, complement-dependent cytotoxicity, matching number of human leukocyte antigen, dialysis time, concomitant hypertension; Donor sex, age, preoperative creatinine level, donor glomerular filtration rate, concomitant hypertension, donor/recipient surface area ratio, warm and cold ischemia, and etiology of chronic renal failure. Univariate and multivariate logistic regression analysis were used to investigate the risk factors of DGF.
Results:The incidence of DGF in relative living kidney transplantation recipients was 31.21%. Univariate analysis showed that: There were statistically significant differences in recipient nationality, complement-dependent cytotoxicity, donor glomerular filtration rate, donor concomitant hypertension, donor/recipient body surface area ratio, and cold ischemia time among groups (P<0.05). Multivariate regression analysis showed that: Minority recipients (OR=4.386, P=0.003), donor/recipient body surface area ratio <1 (OR=2.611, P=0.033) and donor GFR <40 mL/(min·1.73m2) (OR=9.725, P<0.001) were independent risk factors that directly affected the development of DGF.
Conclusion:Minority recipients, donor/recipient body surface area ratio <1 and donor GFR <40 mL/(min·1.73 m2) are important factors affecting DGF.

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Macrophage to myofibroblast transition in renal fibrosis
YE Tong, ZHU Wei
Chinese Journal of Nephrology, Dialysis & Transplantation    2023, 32 (6): 569-574.   DOI: 10.3969/j.issn.1006-298X.2023.06.014
Abstract706)      PDF (1339KB)(435)      
Renal fibrosis is a pathological repair phenomenon characterized by glomerular sclerosis, tubular atrophy and interstitial fibrosis that occurs in the process of chronic and sustained injury of renal tissue, and is a common pathway for various chronic renal diseases to develop into end-stage renal diseases. Macrophage-to-myofibroblast transition (MMT) is a process in which bone marrow-derived macrophages differentiate into myofibroblasts during kidney injury and promote renal fibrosis. Here, we summarize some evidence and mechanisms of MMT's influence on renal fibrosis, and further understanding of MMT and its potential signal pathways will be helpful in finding therapeutic targets for renal fibrosis.
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Progress in drug development of Alport syndrome
WU Linlin, LIU Dong, DONG Ningning, et al
Chinese Journal of Nephrology, Dialysis & Transplantation    2023, 32 (3): 270-275.   DOI: 10.3969/j.issn.1006-298X.2023.03.015
Abstract678)      PDF (1245KB)(561)      
Alport syndrome (AS) is a kind of hereditary collagen disease with kidney, eye and hearing impairment as primary manifestations, which will lead to end-stage kidney disease (ESKD)in the early stage, and is included in the first batch of rare diseases list in China. At present, there is no cure for AS, but the research and development of drugs for the treatment of AS is accelerating. This article reviews the progress of drug research and clinical trials of AS at home and abroad in the past decade, hoping to provide strategies and ideas for the future drug development and treatment of AS, so as to benefit AS patients and their families.

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Advances in pathogenesis, diagnosis and treatment of thrombotic microangiopathy in transplanted kidney
SUN Haojie, WANG Suogang
Chinese Journal of Nephrology, Dialysis & Transplantation    2023, 32 (3): 286-290.   DOI: 10.3969/j.issn.1006-298X.2023.03.018
Abstract578)      PDF (952KB)(436)      
Thrombotic microangiopathy (TMA) is a lethal complication of renal transplantation that severely affects the long-term survival of the renal transplant recipient and the transplanted kidney. Transplant renal thrombotic microangiopathy can be divided into de novo TMA and recurrent atypical haemolytic uremic syndrome (aHUS). De novo TMA is more common and has a worse prognosis than recurrent aHUS. At this stage, the clinical manifestations of TMA in transplanted kidneys are varied and specific tests are lacking. Therefore, the diagnosis of TMA in transplanted kidneys relies heavily on kidney tissue biopsy. No precise individualised treatment protocols with proven efficacy have been studied. This paper reviews the recent research progress in the pathogenesis and treatment of TMA in transplanted kidneys, providing new ideas for the accurate diagnosis and effective treatment of TMA in transplanted kidneys in the future.

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Characteristics and prognosis of COVID-19 infection in renal transplant recipients
XIE Kenan, CHENG Dongrui, NI Xuefeng, JIANG Jing, LI Xue, CHEN Jinsong
Chinese Journal of Nephrology, Dialysis & Transplantation    2023, 32 (4): 308-312.   DOI: 10.3969/j.issn.1006-298X.2023.04.002
Abstract504)      PDF (823KB)(231)      
Objective:To analyze the clinical characteristics and prognosis of hospitalized renal transplant recipients infected with Coronavirus Disease 2019 (COVID-19).
Methodology:The renal transplant recipients with COVID-19 who were hospitalized in National Clinical Research Center of Kidney Diseases, Jinling Hospital during the peak period of COVID-19 in China from December 2022 to February 2023 were retrospectively observed, the general information of patients, comorbidities, immunosuppressants, laboratory findings, and prognosis were collected and analyzed.
Results:A total of 72 cases were observed, including 42 moderate cases (58.3%), 16 severe cases (22.2%), and 14 critically severe cases (19.5%), with an average age of 48.6. 80.6% patients had hypertension, 33.3% had diabetes. 91.7% of the patients had decreased lymphocytes. As the severity of the disease worsen, proportion of concurrent fungal and bacterial infections gradually increased. Eight patients (11.1%) died, all of whom were critically severe group. Regression analysis found that fungal infection (HR 10.55,95%CI 1.040~107.112, P=0.046) and bacterial infection (HR 26.934,95%CI 2.084~348.161, P=0.012) were risk factors for death.
Conclusion:Renal transplant recipients with COVID-19 observed in our research had many comorbidities and severe lymphopenia, concurrent of fungal and bacterial infection were risk factors for death.

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Mitochondrial disease associated with m.3243A>G mutation in MT-TL1 gene#br#
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LIANG Shaoshan, ZHANG Jiong, ZENG Caihong
Chinese Journal of Nephrology, Dialysis & Transplantation    2023, 32 (5): 492-495.   DOI: 10.3969/j.issn.1006-298X.2023.05.019
Abstract464)      PDF (1292KB)(604)      
A 19-year-old female patient was referred to our hospital with asymptomatic proteinuria, normal renal function, hyperuricemia. Extrarenal manifestations included short stature, diabetes mellitus, hearing loss, pre-excitation syndrome. Her mother was also short stature. The kidney biopsy revealed focal segmental glomerulosclerosis (FSGS), with dysmorphic abnormal mitochondria in the podocytes, parietal epithelial cells and renal tubular epithelial cells on electron microscopy. Gene testing revealed a m.3243A>G mutation in mitochondrial MT-TL1 gene, maternal inherited. The final diagnosis was mitochondrial disease associated with m.3243A>G mutation.

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Efficacy and safety of daratumumab in treatment of refractory monoclonal gammopathy of renal significance
REN Guisheng, GUO Jinzhou, CHEN Wencui, ZHAO Liang, XU Weiwei, ZHANG Yangyang, HUANG Xianghua
Chinese Journal of Nephrology, Dialysis & Transplantation    2023, 32 (5): 401-405.   DOI: 10.3969/j.issn.1006-298X.2023.05.001
Abstract447)      PDF (907KB)(544)      
Objective:To observe the clinical efficacy and safety of daratumumab in  treatment of relapse/refractory monoclonal gammopathy of renal significance(MGRS).
Methodology:Patients suffered relapse/refractory MGRS and received the treatment of daratumumab from Septmeber 2021 to January 2023 were enrolled in the study. The clinical data was collected to evaluate hematological and renal responses, adverse reactions were analyzed.
Results:Five patients were enrolled, with a median age of 51 (50, 57) years and a median disease duration of 58 (23, 59) months. Two patients were diagnosed light chain deposition disease (LCDD), two patients were diagnosed proliferative glomerulonephritis with monoclonal immunoglobulin deposition (PGNMID) and the other one was monoclonal immunoglobulin-related C3 glomerulopathy. After receiving of daratumumab, one of the two patients with difference free light chain>50 mg/L achieved hematological complete response and the other one achieved partial response, while two of the three patients with difference free light chain between 20~50 mg/L decreased to <10 mg/L. After a follow-up of 10 (9, 12) months, all five patients were alive, and two achieved renal response. Infusion-related adverse reactions included cough, chills and throat discomfort, and all were classified to grade 1. In addition, one patient had low degree fever unrelated to infection, and mild neutropenia occured in one patient.
Conclusion:Daratumumab is effective and safe in treatment of relapse/refractory MGRS, the hematological response rate was high, and renal response was observed in some patients.

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COVID-19 infection induced anti-glomerular basement membrane nephritis with immune thrombocytopenia
MA Yuchen, ZHANG Chengning, CUI Hongqing, et al
Chinese Journal of Nephrology, Dialysis & Transplantation    2024, 33 (2): 192-196.   DOI: 10.3969/j.issn.1006-298X.2024.02.018
Abstract378)      PDF (1827KB)(255)      
This case reports one 34-year-old female patient who was admitted to the hospital with “nausea and vomiting for more than a month, gross hematuria with elevated serum creatinine for more than 20 days”. The patient was diagnosed with COVID-19 infection and gastroenteritis in the local hospital prior to admission. Subsequently,the patient developed gross hematuria, decreased urine output with anemia, thrombocytopenia, progressive elevation of serum creatinine requiring renal replacement therapy, positive anti-glomerular basement membrane (GBM) antibody, and positive platelet-specific antibodies. Renal biopsy was anti-GBM nephritis. After being given anti-infective drugs, glucocorticoids, rituximab, cyclophosphamide and protein A immunoadsorption therapy, the patient's condition improved and she withdrew from dialysis.

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Application of artificial intelligence-based analytic renal pathology system in patients with membranous nephropathy
LIANG Dongmei, LEI Qunjuan, LIU Xumeng, et al
Chinese Journal of Nephrology, Dialysis & Transplantation    2023, 32 (3): 201-206.   DOI: 10.3969/j.issn.1006-298X.2023.03.001
Abstract369)      PDF (2531KB)(912)      
Objective:To explore the application of artificial intelligence-based analytic renal pathology system (ARPS) in patients with primary membranous nephropathy (PMN).
Methodology:Patients with biopsy-proven PMN in our center from January 2018 to December 2019 were enrolled. Their clinical and pathological data were collected. ARPS was applied to identify glomeruli lesions including global glomerular sclerosis (GS), segmental glomerular sclerosis (SS), crescents (C), and none of the above (NOA), and then quantify intraglomerular features, including intrinsic glomerular cells (M: mesangial cells; E: endothelial cells; P: podocytes) and glomerular area. The performance of ARPS was evaluated. The relationships between ARPSbased intraglomerular features and prognosis were further analyzed.
Results:A total of 123 patients (65.0% males) were included. The average age was 47.1±14.0 years at biopsy. For the identification of glomerular lesions, ARPS achieved the best effect in NOA with 0.967 F1-score; followed by GS with 0.811 F1-score and SS with 0.545 F1-score. The F1-scores of ARPS on identifying intrinsic cells were greater than 0.950. The glomerular area was larger in no response (NR) patients than that in partial remission (PR) and complete remission (CR) patients; the number, density and ratio of podocytes were higher in CR patients than that in PR and NR patients. The remission rate of urinary protein was higher in patients with higher podocytes number or density than that in patients with lower podocytes number or density. Renal phospholipase A2 receptor (PLA2R) and podocyte number were independent predictors of urinary protein remission.
Conclusion:ARPS performed well in the identification of glomerular lesions and intrinsic cell types in PMN. The ARPSbased intraglomerular characteristics were significantly correlated with prognosis in PMN patients.

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Attention should be paid to magnesium in hemodialysis patients with end-stage kidney disease
JIA Fengyu
Chinese Journal of Nephrology, Dialysis & Transplantation    2023, 32 (3): 281-285.   DOI: 10.3969/j.issn.1006-298X.2023.03.017
Abstract358)      PDF (845KB)(597)      
Magnesium is an ion with important physiological and biochemical effects. The serum magnesium of hemodialysis patients with endstage kidney disease is affected by residual renal function, dialysis clearance, drug and nutritional status.Hypermagnesemia is common but rarely accompanied by clinical symptoms,well hypomagnesemia is associated with increased hypotension, arrhythmia, muscle spasm, cardiovascular mortality, and all-cause mortality in hemodialysis patients. Mild hypermagnesemia can improve the parathyroid hormone level, vascular calcification and bone health of hemodialysis patients to a certain extent. Proton pump inhibitors, high-dose loop diuretics and malnutrition can reduce the serum magnesium concentration. It is safe and convenient to use dialysate with higher magnesium concentration to supplement. Magnesium is related to the survival status and prognosis of dialysis patients. Although it is not clear whether the relationship between magnesium and the clinical outcome of dialysis patients is causal, serum magnesium slightly higher than the physiological level seems to benefit patients more. It is necessary to further study metabalism of magnesium in hemodialysis patients to explore whether there is an optimal range of serum magnesium, so as to optimize the bone health, cardiovascular outcomes and survival rate of patients.

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Dynamic prediction of end stage kidney disease for patients with IgA nephropathy
LE Weibo, SHI Jingsong, ZENG Caihong, LIANG Shaoshan, LI Zhe, LIU Zhihong
Chinese Journal of Nephrology, Dialysis & Transplantation    2024, 33 (1): 1-9.   DOI: 10.3969/j.issn.1006-298X.2024.01.001
Abstract338)      PDF (4022KB)(289)      
Objective:To develop a personalized dynamically model to predict the risk of kidney failure for patients with IgA nephropathy (IgAN) using updates of longitudinal data at each follow-up visit.
Methodology:Three joint models were fitted to analyze the longitudinal data at each visit. We defined the baseline as the time of the kidney biopsy and fitted a clinical joint Model A, which included variables such as sex, age, eGFR, ALB, and proteinuria. We also constructed a clinical-pathological Model B, which incorporated both clinical and histological MEST features. Model C was fitted using parameters identical to those in Model A, however, the baseline was defined as the time of the clinical visit instead of the biopsy.
Results:A total of 866 patients were included (650 in the development cohort and 216 in the validation cohort) and contributed 10 565 patient-years of data, and 22 533 eGFR and proteinuria measurements. Models A and B performed similarly with high predictive ability. However, the inclusion or exclusion of pathological variables did not significantly increase or decrease the accuracy of the joint models for predicting kidney failure risk. As follow-up time increased, model A's predictive performance continued to improve, reaching optimal performance around 5 years after kidney biopsy. The AUC value increased from 0.864 at kidney biopsy to 0.956 at 5 years after biopsy, and the Brier score decreased from 0.124 at the time of biopsy to 0.058 at 5 years after biopsy. The model C achieved similar results. All predictive performances were confirmed in the validation cohort. To facilitate clinical practice, we utilized the Shiny package to implement dynamic prediction. The R objects and source code have been made publicly available online.
Conclusion:The Joint model can be utilized for the longitudinal data generated from visits of IgAN patients, providing a high-performance dynamic prediction of kidney failure for IgAN patients. This helps achieve the objective of individualized dynamic prediction.

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Research progress of acute kidney injury related to diabetic ketoacidosis
WU Xiaofeng, LIU Dongwei, LIU Zhangsuo, et al
Chinese Journal of Nephrology, Dialysis & Transplantation    2023, 32 (3): 276-280.   DOI: 10.3969/j.issn.1006-298X.2023.03.016
Abstract331)      PDF (1073KB)(720)      
TThe incidence of diabetes is increasing in China. Diabetic ketoacidosis (DKA) is one of the most serious acute complications of diabetes, its incidence and hospitalization rate are also increasing.The occurrence of DKA is mostly caused by insulin deficiency or insufficient dose in diabetes patients, and the release of glucocorticoids such as adrenaline, cortisol and growth hormone leads to further increase of blood glucose.The high risk of acute kidney injury (AKI) due to the disturbance of acid-base balance, electrolyte balance and mass loss of body fluid in patients with DKA. AKI can cause acute of renal failure in a short time, endangering the lives of patients. The purpose of this study was to investigate the mechanism of DKA induced renal injury, so as to prevent or reverse AKI in diabetic patients with DKA.

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Epidemiological investigation of pruritus in maintenance hemodialysis patients
SHI Wen, LIU Yuqiu, ZHANG Liuping, et al
Chinese Journal of Nephrology, Dialysis & Transplantation    2023, 32 (3): 220-225.   DOI: 10.3969/j.issn.1006-298X.2023.03.004
Abstract330)      PDF (976KB)(547)      
Objective:To investigate the prevalence and risk factors of pruritus in maintenance hemodialysis (MHD) patients, and to explore risk factors of pruritus.
Methodology:A questionnaire survey involving skin pruritus and clinical data was conducted among MHD patients from 24 hemodialysis centers which were selected by stratified sampling in Jiangsu Province from October 2018 to October 2019. The relevant factors of pruritus were analyzed.
Results:A total of 3819 MHD patients were included. The prevalence of pruritus and moderate-to-extreme pruritus was 2755% and 18.02%, respectively. The median duration of pruritus was 12.00 months. Among patients with pruritus, the proportion of occasional and slight scratching was the highest, and more than half of the patients had scratches. The effective rate of conventional drug treatment was 42.21%. Multivariate regression analysis showed that age≥45 years, increased body surface area, low diastolic blood pressure, smoking, drinking, history of secondary hyperparathyroidism, warfarin, muscle weakness, bone pain, metastatic calcification, osteoporosis, serum calcium and serum phosphorus levels are risk factors for pruritus in MHD patients.
Conclusion:The degree of pruritus in MHD patients is mild while the effective rate of treatment is 42.21%. Nephrologists should pay attention to pruritus in dialysis patients, and timely intervention should be given to patients' living habits, comorbidities, chronic kidney diseasemineral and bone disorders, so as to relieve pruritus and improve their quality of life.

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Clinicopathological and genetic features of lupus nephritis patients with G6PD variants
JIN Ying, LUO Xiaoxin, LIANG Dandan, et al
Chinese Journal of Nephrology, Dialysis & Transplantation    2023, 32 (3): 207-213.   DOI: 10.3969/j.issn.1006-298X.2023.03.002
Abstract317)      PDF (1794KB)(578)      
Objective:To summarize the clinical and pathological characteristics of 3 patients with lupus nephritis who carried the missense variants of glucose 6-phosphate dehydrogenase (G6PD) and to discuss the clinical value of G6PD variants detection in systemic lupus erythematosus.
Methodology:We collected the clinical and pathological data of 3 patients with lupus nephritis in Jinling Hospital. Pathogenic variants was screened by whole-exome sequencing (WES) in the patients and validated by Sanger sequencing in family members. G6PD/6PGD ratio method was used to test the G6PD enzyme activity. Quantitative polymerase chain reaction (qPCR) and cytometric bead array (CBA) was used to detect inflammatory signatures in two patients.
Results:All the 3 patients had a history of pancytopenia. Coombs tests were negative, but the red blood cell fragments were all positive. WES identified two kinds of variants in G6PD gene. Two males had a hemizygous variant of c.G1466T (p.R489L) inherited from their mother, while the female patient had a compound heterozygous variant of c.G1466T (p.R489L) and c.G1478A (p.R493H) inherited from the parents. The G6PD enzyme activity were all deficient. We further identified hyperactivation signatures of type I interferon signaling and overproduction of pro-inflammatory cytokines in the blood of two patients. Compared with the normal controls, the expression of in terferon-stimulated genes IFIT1, IFI44L, OAS1 and MX2 in blood cells of two patients was significantly higher, as well as the serum IL-8 and IP-10 levels.
Conclusion:Lupus nephritis patients with G6PD gene variants may present with anemia as the first or prominent clinical manifestation, accompanied by excessive activation of type I interferon signal pathway and excessive production of inflammatory cytokines in the blood. Its role in the pathogenesis of SLE deserves further study.

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Clinical characteristics and prognosis of multiple myeloma patients associated light chain amyloidosis
HONG Yi, GUO Jinzhou, CHEN Wencui, ZHAO Liang, HUANG Xianghua, LIU Zhihong
Chinese Journal of Nephrology, Dialysis & Transplantation    2023, 32 (5): 406-411.   DOI: 10.3969/j.issn.1006-298X.2023.05.002
Abstract306)      PDF (1136KB)(313)      
ABSTRACTObjective:To analyze the clinical features, treatment and prognosis of multiple myeloma patients associated with systemic light chain (AL) amyloidosis. 
Methodology:Multiple myeloma patients associated with AL amyloidosis confirmed by biopsy at Jinling Hospital from July 2009 to December 2022 were studied. We retrospectively analyzed the clinical features, treatment and prognosis of the patients. 
Results:Among the 71 patients, the primary presenting symptom was edema (84.5%), with IgG type M protein being the most common. The median plasma cell proportion was 15%. The majority of patients received treatment regimens containing bortezomib (32.4%) or thalidomide (25.4%). The overall hematologic response rate in the evaluated patients was 75.0%, including a complete response rate of 8.3%, a very good partial response rate of 389%, and a partial response rate of 27.8%. One (1/15, 6.7%) patient achieved cardiac response and 15 (15/36, 41.7%) patients achieved renal response. The median follow-up time was 16 (1.0~120.0) months, and the median survival time was 34 months. The survival rates at 6 months, 1 year, 2 years, and 4 years were 83.6%, 75.2%, 62.2%, and 43.0%, respectively. Age, plasma cell ratio, and N-terminal probrain natriuretic peptide levels were independently associated with patient prognosis.
Conclusion:Patients with multiple myeloma associated with AL amyloidosis have a dismal overall prognosis. Antiplasma cell therapy is effective but organ response rates are low. Age, severity of cardiac involvement, and tumor burden are independent risk factors for patient outcome.

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Clinical features and prognosis of COVID-19 in patients with chronic kidney disease
LI Zhe, ZUO Ke, WANG Jingjing, ZHOU Houan, JIN Ying, CHEN Guang, LI Shijun, CHENG Zhen, WANG Jinquan, LIU Zhengzhao, XIE Honglang, HU Weixin
Chinese Journal of Nephrology, Dialysis & Transplantation    2023, 32 (4): 301-307.   DOI: 10.3969/j.issn.1006-298X.2023.04.001
Abstract304)      PDF (836KB)(423)      
Objective:This retrospective study was to evaluate the clinical characteristics and prognosis of chronic kidney disease (CKD) patients complicated with novel coronavirus pneumonia (NCP).
Methodology:We retrospectively analyzed the clinical and imaging features before and after coronavirus disease 2019 (COVID-19) of CKD patients complicated with NCP who were admitted to the National Clinical Research Center of Kidney Diseases, Jinling Hospital from December 2022 to June 2023.
Results:Among the 72 CKD patients with NCP, the median age at COVID19 was 64 (39, 76) years old, and the median duration of CKD course was 36 (7, 120) months. The top four original diseases for CKD were diabetic nephropathy (22.22%), lupus nephritis (12.50%), membranous nephropathy (9.72%) and ANCA associated glomerulonephritis (9.72%), and the coverage rate of COVID-19 vaccine was 18.06%. 51.39% of NCP were medium, 20.83% were severe and 27.78% were critical. The in-hospital mortality rate was 19.44%. The inflammatory index, proportion of fungal infection, heart failure, hepatic injury, and pneumothorax in the death group were higher than those in the survival group, and the lymphocyte subsets were lower than those in the survival group (P<0.05). Multivariate COX model showed that age, lactic dehydrogenase, CD4+T lymphpocyte and C-reactive protein during COVID-19 were independent risk factors for death in CKD patients complicated with NCP.
Conclusion:CKD patients with NCP have a high proportion of DN, a low vaccination rate and more concomitant diseases. Patients with advanced age, hypoxia, immunodeficiency and strong inflammatory response have a poor prognosis. Coinfections or superinfections of fungus and multiple organ failure are common during NCP treatment.

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Sacubactril valsartan in hypertension without heart failure in chronic kidney disease patients
ZHU Mengyuan, HUO Shuai, YOU Zhenzhen, FAN Xiaoguang, SHAO Fengmin, ZHANG Zhu
Chinese Journal of Nephrology, Dialysis & Transplantation    2024, 33 (4): 321-326.   DOI: 10.3969/j.issn.1006-298X.2024.04.004
Abstract302)      PDF (856KB)(162)      
Objective:To observe the efficacy of sacubactril valsartan and the change of inflammatory factors in chronic kidney disease (CKD) complicated with hypertension and non-heart failure.
Methodology:CKD patients with hypertension and non-heart failure in our hospital from January 2021 to June 2023 were collected. The control group was treated with Valsartan, and the treatment group was treated with sacubactril valsartan. The cardiac indicators, renal indicators and inflammatory cytokines, early deterioration of renal function(eGFR decreased by more than 20% from baseline) were followed up after 6 months.
Results:A total of 60 CKD(the percentage of CKD 3~4 stage is 76.7%) patients were included. (1)There was no significant difference of the clinical data, cardiac and renal parameters between the treatment group (n=30) and the control group (n=30) before treatment (P>0.05). (2) Compared with baseline, the blood pressure of both groups decreased, and the decline was even greater in treatment group (P<0.05). Compared with baseline, 24-hour urinary protein, serum creatinine and N-terminal pro-B-type natriuretic peptide (NT-proBNP) decreased; estimated glomeruar filtration rate (eGFR), left ventricular ejection fraction (LVEF) and serum albumin increased in the treatment group (P<0.05), While serum creatinine increased and eGFR decreased after 6 months of Valsartan treatment (P<0.05). The change percentage of serum creatinine, eGFR, NT-proBNP and LVEF between two groups have statistical significance (P<0.05). (3) In the treatment group, IL-1β, IL-2R, IL-6 and IL-8 decreased (P<0.05), while IL-10 and TNF-α had no change (P>0.05). The above inflammatory factors had no significant difference after treatment in the control group. (4) The renal function deterioration incidence of renal function of treatment group was significantly lower than that control group (3.3% vs 33.3%,P<0.05). Sacubactril valsartan treatment (OR=0.013 95%CI 0.000,0.562) and the baseline 24-hour urinary protein quantity (OR=2.268, 95%CI 1.313,3.919) were independent influencing factors for renal function deterioration events. (5)There was no significant difference in the incidence of hyperkalemia between two groups (10% vs 6.7%, P>0.05). No obvious adverse reactions such as hypotension, cough and angioneurotic edema occured in both groups.
Conclusion:Sacubactril valsartan can effectively induce blood pressure, proteinuria and inflammation, improve the cardiac function, renal function and renal prognosis in CKD 1~4 stage with hypertension and non-heart failure patients.

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Progress on target antigens and molecular biomarkers in membranous nephropathy
CHEN Zige, LI Yi, BAO Hao
Chinese Journal of Nephrology, Dialysis & Transplantation    2023, 32 (5): 460-465.   DOI: 10.3969/j.issn.1006-298X.2023.05.013
Abstract298)      PDF (826KB)(466)      
Membranous nephropathy (MN) is a glomerular disease closely associated with immune system dysregulation. The pathogenic cornerstone of MN lies in the generation of autoantibodies targeting specific antigens located on podocytes, culminating in the formation of immune complexes. Recent advancements in high-resolution liquid chromatography-tandem mass spectrometry (LC-MS/MS), laser microdissection-mass spectrometry (LMD-MS), immunohistochemistry, and immunofluorescence microscopy have enabled the identification and validation of a series of target antigens from complex biological samples. In addition, the levels of certain proteins, metabolites and ncRNA in urine and blood samples of MN were different from those in healthy controls, and these molecular biomarkers were of significant significance in the diagnosis, disease monitoring and prognosis assessment of MN.

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Circadian rhythm disorder in chronic kidney disease
LU Chunyu, CHENG Shuiqin, WANG Jinquan
Chinese Journal of Nephrology, Dialysis & Transplantation    2023, 32 (3): 265-269.   DOI: 10.3969/j.issn.1006-298X.2023.03.014
Abstract293)      PDF (1095KB)(489)      
Circadian rhythm disorder can increase the risk of diseases including chronic kidney disease (CKD), cancers, diabetes, hypertension, neurological diseases and cardiovascular diseases. Although the treatment of CKD has made great progress,CKD remains a global public health problem and an important cause of cardiovascular death. Therefore, it is necessary to explore new treatments. As a major organ of the peripheral clock system, kidney participates in regulating the formation of circadian rhythms. This article reviews the association between circadian rhythm disruption and CKD, and related interventions such as circadian therapeutics, to provide new strategy for the prevention and treatment of CKD.

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Clinical characteristics and risk factors of COVID19 in peritoneal dialysis patients
CHENG Shuiqin, ZHANG Man, ZHOU Tingting, ZHANG Zhihong, YU Le, CHEN Yunmin, CUI Jingjing, ZHOU Jian, YU Yusheng
Chinese Journal of Nephrology, Dialysis & Transplantation    2023, 32 (4): 313-317.   DOI: 10.3969/j.issn.1006-298X.2023.04.003
Abstract288)      PDF (816KB)(177)      
Objective:To observe clinical characteristics of peritoneal dialysis (PD) patients infected COVID-19, and risk factors of infection.
Methodology:A cohort of PD patients who were prospectively observed in our center from December, 2022 to January, 2023, and the clinical data and risk factors of COVID-19 were analyzed.
Results:Of 404 patients performing PD in this cohort study, 112 patients (27.7%) experienced COVID-19, 10 patients were suspected of infection, 282 patients(69.8%) had no infection. Among the infected patients, 22 cases(19.6%) were positive for SARS-CoV-2 nucleic acid, 90 cases(80.4%) were positive for SARS-CoV-2 antigen. The most common symptoms were fever (112 cases, 100%), cough (101 cases, 90.2%), sore throat (98 cases, 87.5%), fatigue (97 cases, 86.6%), myalgia (73 cases, 65.2%), headache (69 cases, 61.6%),anorexia (62 cases, 55.4%) and anxiety (60 cases, 53.6%). Five hospitalized patients with novel coronavirus pneumonia had a good recovery and were discharged after treatment,none of the patients died. The indexes of the last follow-up pre-COVID-19 were analyzed, the levels of body mass index(BMI), normalized protein catabolic rate(nPCR), serum albumin, serum pre-albumin, lymphocyte count, vaccination rate and home quarantine rate in the infected group were lower than those in the uninfected group (P<0.05). The levels of C-reactive protein (CRP), high sensitivity CRP and interleukin-6 (IL-6) in the infected group were higher than those in the uninfected group (P<0.05). Logistic regression analysis showed that low BMI, nPCR, lymphocyte count and home quarantine rate, high sensitivity CRP were independent risk factors of COVID-19 in PD patients.
Conclusion:The most common symptoms of PD patients infected COVID-19 were fever, cough, sore throat and fatigue, and the short-term prognosis was good. Low body weight, poor nutritional status, poor immune function and microinflammation were independent risk factors of COVID-19 in PD patients. Home quarantine could prevent COVID-19.

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