A 25-year-old male patient was admitted to the hospital because of “taking processed traditional Chinese medicine for nearly a year，fatigue for three months with positive urine protein and sugar for two months”. He also had hypokalemia and hypouricemia，uggesting proximal renal tubular impairment，obtained an elevated value of creatinine （SCr 104 μmol／L） and diagnosed with Fanconi syndrome. Renal biopsy suggested focal tubular injury and inflammatory cell infiltration. After excluding other factors such as allergy，intoxication，immunity，tumor，and genetics，it was highly considered to be drug related. The patient was treated with prednisone，potassium supplementation and other therapies，with a significant improvement in fatigue. One year later，the patients stopped prednisone and potassium supplementation，and the renal function and blood potassium returned to normal.

We report a case of an elderly male for the first time in China who was admitted to hospital complaining of repeated edema of both lower limbs for 13 years and recurrence for half a month. This patient had a history of poorly differentiated neuroendocrine carcinoma with unknown primary lesion for 2 years and had undergone two renal biopsies on January 22, 2009 and December 1, 2022, both of which showed membranous nephropathy and no significant difference in light microscopy, immunofluorescence and electron microscopy. The first renal biopsy tissue was positive for phospholipase A2 receptor antibody (PLA2R AB) fluorescence staining and negative for thysopermatin domain containing 7A (THSD7A) staining. The latest renal biopsy tissue was negative for PLA2R staining and positive for THSD7A staining, and the metastatic inguinal lymph node biopsy tissue was positive for THSD7A staining. The final diagnosis was membranous nephropathy secondary to neuroendocrine carcinoma (THSD7A-related) based on clinical, laboratory and pathological findings.

Metabolic diseases such as obesity and chronic kidney disease will be an important chronic disease threatening human health, showing a rapid growth in China. Typical obesity-related glomerulopathy has its special histomorphologic features and clinical manifestations, however, there are also other chronic glomerular and tubulointerstitial kidney disease coexist with obesity. This article focuses on the epidemiologic features of obesity in CKD, possible pathogenic mechanisms, and traditional and innovative therapeutic approaches.

A 19-year-old male presented with repeated increases of blood creatinine and urine protein six years after renal transplantation due to Alport syndrome and CKD stage 5D. Renal biopsy revealed mesangial proliferative glomerulonephritis, and linear deposition of IgG along glomerular basement membrane(GBM), and electron dense deposits in mesangial region on electron microscopy. The final diagnosis was allograft post-transplant anti-GBM nephritis, along with mixed rejection and immune complex nephritis.

Hepatorenal syndrome （HRS） is a type of cirrhosis-related renal damage with a unique pathophysiological mechanism. HRS-AKI is the subtype that needs special attention. In addition to the classical mechanisms of hemodynamic disorders，the occurrence of HRS-AKI also involves a variety of pathophysiological mechanisms such as intestinal bacterial translocation，systemic inflammation，renal microcirculation disorders and cirrhotic cardiomyopathy and so on. Early diagnosis and treatment can improve the poor prognosis of HRS-AKI. Albumin plus terlipressin is a widely recommended first-line treatment，nevertheless liver transplantation is the only definitive treatment for HRS. This article reviews the new definition，diagnostic and grading criteria，pathogenesis，and treatment of HRS-AKI.

Endothelin is closely associated with kidney diseases. Activation of endothelin receptor A promotes vasoconstriction, inflammation, fibrosis, and cell proliferation, leading to kidney damage. By antagonizing the endothelin receptors, renal function can be protected. Currently, endothelin receptor antagonists are primarily used to treat pulmonary arterial hypertension. However, numerous clinical trials have confirmed that endothelin receptor antagonists are significantly effective in reducing proteinuria and protecting renal function. They are promising as a new type of medication for the treatment of various kidney diseases.

Mitochondria play a crucial role in maintaining the normal function of kidney resident cells. Hyperglycemia resulting from diabetes can disrupt mitochondrial homeostasis and increase oxidative stress, leading to damage in kidney cells and contributing to the development of diabetic nephropathy. Therefore, the development of small molecule drugs that target mitochondrial homeostasis imbalance could offer new treatment options for diabetic nephropathy. This paper will provide a comprehensive review of recent research advancements in drugs targeting mitochondrial homeostasis, mitochondrial biogenesis and mitochondrial antioxidants.

Ｏｂｊｅｃｔｉｖｅ：To analyse efficacy of short-term use of complement C5 inhibitor eculizumab, and adverse reactions in patients with atypical haemolytic uremic syndrome (aHUS).
Ｍｅｔｈｏｄｏｌｏｇｙ：Five patients with aHUS who were regularly treated in Sichuan Provincial Peoples Hospital between January 2023 and May 2024 were retrospectively collected and analysed for clinical manifestations, laboratory examinations, renal pathological examinations, genetic test results, the therapeutic efficacy of eculizumab and the adverse reactions.
Ｒｅｓｕｌｔｓ：One of the five patients with aHUS was male, with a median age of 40 (17～66) years, etiologu included renal transplantation, malignant hypertension, autoimmune disease, and primary aHUS. All presented clinically with acute renal failure, proteinuria, haematuria, anaemia and thrombocytopenia,dicrease of complement C3. Renal biopsy was performed in 3 cases and showed endothelial cell damage and microthrombosis. 3 cases received dialysis, 3 cases had renal biopsies, all 4 patients were treated with steroids (2 received methylprednisolone pulse therapy), 1 kidney transplant-related case was treated with rabbit anti-human thymus immunoglobulin (ATG), intravenous gammaglobulin, and 1 with CD20 monoclonal antibody (with systemic lupus erythematosus in the primary disease). The median time from diagnosis of aHUS to treatment with eculizumab was 20 (2～37.5) days, with 4～20 times of eculizumab, and a mean of 7(4.5～8.5)days post-treatment all patients achieved haematological remission, 3 patients achieved nephrological remission, and 1 patient was taken off dialysis. At 8~24 weeks months of follow-up creatinine and LDH were significantly lower and eGFR, haemoglobin and platelets were significantly higher than before treatment (P<0.001). No significant adverse reactions were found.
Ｃｏｎｃｌｕｓｉｏｎ：aHUS has diverse clinical manifestations, rapid progression, and poor prognosis, and eculizumab is the first-line treatment option for aHUS. Once diagnosed, treatment can be initiated immediately, which can rapidly improve the haematological indexes and renal function, and the long-term clinical benefits still need to be further studied.

Ｏｂｊｅｃｔｉｖｅ：Analyze the clinicopathological features, treatment strategy, and outcomes of patients suffering from DMO poisoning.
Ｍｅｔｈｏｄｏｌｏｇｙ：This study presented three cases of nephropathy associated with DMO poisoning at our center. Additionally, a literature review was conducted to summarize the clinicopathological features, treatment strategies, and outcomes of acute DMO poisoning.
Ｒｅｓｕｌｔｓ：Three male patients developed severe acute kidney injury (AKI) subsequent to DMO exposure. Renal biopsy confirmed the diagnosis of acute oxalate nephropathy. Following treatment strategies that included hemodialysis, adequate hydration, and anti-inflammatory agents, all patients exhibited improvement in renal function. A literature review of 21 reported cases of DMO poisoning, uia dermal contact or respiratory exposure, revealed that 95.2％ exhibited varying degrees of elevated serum creatinine levels, and 52.4％ were identified with AKI stage 3. 61.9％ of the patients underwent hemodialysis, while 23.8％ were treated with glucocorticoids. 9.5％ of the patients succumbed to multiple organ failure, whereas 71.4％ achieved normal renal function.
Ｃｏｎｃｌｕｓｉｏｎ：DMO poisoning is characterized by acute kidney injury, with oxalate crystals observed in renal pathological findings. Therapeutic interventions such as hemodialysis, hydration, citrate solutions, and low-dose glucocorticoids may offer clinical benefits post-intoxication. The majority of the patients experienced a recovery of kidney function.

Objective:To  investigate  to  the  efficacy  and  safety  of  obinutuzumab  in  the  treatment  of  high  risk  or refractory phospholipase A2 receptor associated membranous nephropathy.    Methodology:Patients with biopsy-proven MN or serum anti-phospholipase A2 receptor antibody （aPLA2Rab） titers≥14 RU/ml treated with obinutuzumab （1 g× 2） in the National Clinical  Medical  Research  Center  for  Renal  Diseases  at  Jinling  Hospital  from  September  2022  to  December 2023 were  retrospectively  analyzed.  High  risk  was  classified  according  to  kidney  disease:  Improving  Global  Outcomes guideline and expert recommendation. Refractory disease was termed as patients received immunosuppressive agents such as cyclophosphamide，  calcineurin  inhibitors  or  Rituximab  with  or  without  steroids  for  more  than  6  months  but  have  not  yet achieved remission  （proteinuria  decline < 50%  and > 3.5  g/24h）.      Results: Our  analysis  included  72  patients  （56 refractory， 16 high risk MN）， baseline proteinuria was 10.2 g/24h. 70 （97%） patients achieved remission at month 12， including 24 （33%） achieved complete remission （CR）. The median time to remission was 3 （3 ~ 6） months.  Remission  

rate， CR rate of high risk and refractory MN was 100% and 96%， 56% and 27% respectively. CR rate was significantly high in high-risk group than refractory group （HR = 2.497，95%CI 1.041~ 5.989）. Obinutuzumab significantly reduced 24- hour proteinuria  and  increased  serum  albumin，  estimated  glomerular  filtration  rate  since  week  6.  Complete  depletion  of circulating B cell was maintained in all patients within 3 months and the median time to B cell reconstitution （CD20+ cells

≥5/μL） was  9  （8 ~ 12） months.  67  patients  presented  with  serum  aPLA2Rab≥14  RU/mL  at  baseline  and  complete immunological remission （aPLA2Rab<2 RU/mL）was achieved in 87% and 99% at month 6 and 12 respectively. Infusion- related adverse event was revealed in 28% patients and mostly mild. Pulmonary infections occurred in 2 （2.8%） patients. No patients died or progression into end stage kidney disease.    Conclusion:Obinutuzumab is a promising treatment option for both high risk and refractory  membranous  nephropathy， charactered  by  long  duration  of  B  cell  depletion， high  rate  of clinical and immunological remission. Large prospective studies are needed to validate these preliminary findings.

Catheter-related atrial thrombus（CRAT） is a rare complication in hemodialysis patients，which includes mural thrombus and catheter tip thrombus. CRAT is closely associated with positioning of the catheter tip in the atrium. Repeated mechanical trauma to the atrial wall from catheter tip，the fluid dynamics within right atrium and systemic hypercoagulable state can promote thrombosis. Most of patients with CRAT are asymptomatic，some cases presented with catheter malfunction，cardiovascular abnormalities and other discomforts. However CRAT might bring serious adverse and sometimes fatal events when complications such as embolism and infection occurred. It is mainly diagnosed by cardiac imaging studies including transthoracic echocardiography（TTE），transesophageal echocardiography（TEE），computed tomography angiography（CTA），magnetic resonance imaging（MRI）. According to the size，location of thrombus，general condition of patients and available techniques in medical facilities，therapeutic strategies including catheter-directed therapy，surgical thrombectomy，anticoagulation，systemic thrombolysis，catheter removal and so on can be individually selected. This review summarized the epidemiology，classification，pathogenesis，clinical manifestations，diagnosis and treatments of CRAT in hemodialysis patients.

Hemodialysis is one of the important treatment measures for end-stage diabetes patients with kidney disease. Diabetes patients treated with hemodialysis have significant blood glucose fluctuations，and maintaining stable blood glucose is one of the important strategies to improve the prognosis of patients. Conventional blood glucose testing methods such as self monitoring of blood glucose，glycated hemoglobin，and glycated albumin have certain limitations. The application of continuous blood glucose monitoring system for blood glucose is gradually being recognized，realizing the visualization of blood glucose fluctuations，which is beneficial for guiding treatment and improving patient prognosis.

Acute kidney injury (AKI) is an acute and critical illness with high morbidity and mortality. In recent years, a growing body of studies have shown that renal maladaptation following AKI results in chronic kidney disease (CKD). Ferroptosis, a novel form of non-apoptotic cell death characterized by iron overload and lipid peroxidation, is believed to play a significant role in the progression of AKI to CKD. This article provides a review of the classical regulatory mechanisms of ferroptosis and its potential involvement in the pathological mechanisms in the progression of AKI to CKD.

With the advancement of genomics,genetic testing methods have become more diverse,and the cost of testing has decreased year by year. Recently,a working group from the National Kidney Foundation (NKF) in the United States published an expert consensus,providing comprehensive recommendations for nephrology professionals on how to effectively utilize genetic testing methods to assist in the diagnosis and screening of kidney diseases.

Lysosomes play a crucial role in the degradation and recycling of cellular waste. Misfolded proteins, pathogens, and damaged organelles are transported to the lysosomes for degradation. Additionally, they serve as a central signaling hub for sensing and coordinating cellular metabolism, immune responses, signal transduction, and plasma membrane repair. Lysosomal dysfunction can lead to the accumulation of substrate within the lysosomes, giving rise to lysosomal-related diseases. Kidney cells are rich in lysosomes and previous studies have shown that abnormalities in lysosomal structure or dysfunction in kidney cells are associated with various kidney diseases. This article describes the roles of lysosomes and reviews recent studies concerning the involvement of lysosomal homeostasis disruption in kidney diseases.

Objective: To  investigate  the  gene  mutation  characteristics  and  clinicopathological  manifestations  of patients with TRPC6  gene  mutation.     Methodology: We  screened  our  patients  with  TRPC6  gene  mutation  confirmed  by whole exon or  nephropathy  panel  gene  detection  in  the  National  Clinical  Research  Center  for  kidney  Disease,  and  then analyzed the gene mutation characteristics, clinicopathology and prognosis of the patients.    Results:A total of 10 patients were included in the study, of which 50%  were male and 50% were female. 8 heterozygous mutations of TRPC6 gene were detected in the 10 patients, of which 6 were missense mutations, and c.2683C>T(p.R895C) was the most common.  There were 9 cases with positive family history of kidney disease.  The onset age of the patients was 16- 35 years old, and all of them were onset with proteinuria, even 4 cases showed nephrotic syndrome (NS). All patients were treated with angiotensin II receptor blockers (ARB), of which 5 patients were treated with hormone combined with calcineurin inhibitors (CNI), and 2 patients were treated with moderate hormone. 6 patients progressed to end⁃stage kidney disease (ESKD) in the course of 1 - 17  years.  The  pathological  manifestations  of  renal  biopsy  in  6  patients  were  focal  segmental  glomerulosclerosis  (FSGS), with 4 cases of foot process extensive fusion (50%-80%) and 2 cases of segmental fusion (30%-50%), and no glomerular basement membrane lesions.    Conclusion:The mutation of TRPC6 gene is mainly missense mutation, and the most common mutation site is c.2683C> T (p.R895C). The clinical manifestations of patients with related nephropathy are mainly proteinuria, most of which are NS. Renal pathology was mainly FSGS, and podocyte foot process fusion was obvious. Most patients  have  poor  efficacy  on  ARB  and  CNIs,  and  eventually  progress  to  ESKD.  The  early  diagnosis  and  timely specific intervention of the disease may be the key to improve the prognosis of patients.

Ｏｂｊｅｃｔｉｖｅ：Use machine learning method to analyze the impact of two continuous assessment methods of dialysis quality indicators on the prognosis of maintenance hemodialysis (HD) patients.
Ｍｅｔｈｏｄｏｌｏｇｙ：A total of 240 patients who received HD treatment at the Eastern Theater Command General Hospital in January 2016 were screened, and dialysis quality was assessed more than three times a year. The follow-up period ends in October 2022, and the endpoint is death from all causes. The indicator time-to-standard ratio and indicator fluctuation value were used as the evaluation methods for the continuous achievement of nine dialysis quality indicators. Dialysis quality indicators include interdialytic weight gain、pre-dialysis systolic blood pressure、hemoglobin、albumin、total carbon dioxide、calcium、phosphorus、parathyroid hormone and spKt／V.A prediction model for survival or death of HD patients after 1 year was constructed based on a machine learning algorithm, and the optimal probability threshold of the model was obtained.
Ｒｅｓｕｌｔｓ：After 94 months of follow-up, 60 patients (25.0%) died. Six machine learning methods, KNN, RandomForest, ExtraTrees, XGBoost, AdaBoost and DecisionTree, are used to build prediction models based on the indicator time-to-standard ratio and the indicator fluctuation value. The ExtraTrees model based on the indicator time-to-standard ratio has the best prediction effect, with its accuracy, precision, recall, F1 score and area under the receiver operating curve reaching 0.92, 0.86, 0.96, 0.91 and 0.9 respectively, while confirming 0.65 as the optimal probability threshold for the model.
Ｃｏｎｃｌｕｓｉｏｎ：The machine learning model based on the indicator time-to-standard ratio has a good prediction effect on the prognosis of HD patients.