Acute kidney injury (AKI)has a rapid onset, but there is no early and sensitive indicator for dynamic monitoring of kidney function. Studies have found ferroptosis occured in various AKI models, and specific proteins and genes involved in ferroptosis are expected to be predictors of the occurrence and development of AKI. Ferroptosis is closely related to the metabolism of iron, amino acids and lipids, and it participates in development of AKI through pathological processes such as inflammation, endoplasmic reticulum stress and autophagy. Studies have confirmed that many kinds of drugs targeting on ferroptosis have achieved good efficacy in the treatment of AKI. This article reviews the mechanism of ferroptosis involved in development of AKI and the latest research progress of drugs for treatment of ferroptosis.

Ｏｂｊｅｃｔｉｖｅ：To analyze the status and influencing factors of vascular access in maintenance hemodialysis (MHD) patients.
Ｍｅｔｈｏｄｏｌｏｇｙ：The clinical data and vascular access status of MHD patients were retrospectively analyzed from January 1, 2020 to December 31, 2020. Stratified analysis was conducted according to gender, age, dialysis age, primary disease, and mortality.
Ｒｅｓｕｌｔｓ：In 2020, there were 570 MHD patients in our center, including 343 males (602％) and 227 females (398％), with an average age of 6825±128 years. Among the 570 patients, there were 351 arteriovenous fistula (AVF) (616％), 30 arteriov enous graft (AVG) (53％), and 189 tunnelcuffed catheter (TCC) (332％). The AVF+AVG ratio of males was significantly higher than that of females (P<005). Grouped by age, the AVF ratios in patients≤44, 45~59, 60~74, and≥75 years were 81％, 796％, 653％, and 401％, respectively. And the AVG ratios were 48％, 62％, 58％, and 37％, respectively. Comparing the groups, the ratio of AVF+AVG in the 45-59 was the same as that in the≤44(P>005); the ratio of AVF+AVG in the≥60 was decreased, and the ratio of TCC was increased(P<005). Grouped by dialysis age, the AVF ratios in the <1, 1~5, 5~10, and>10 years were 326％, 603％, 631％, and 729％, respectively. And the AVG ratios were 0, 56％, 45％, and 76％, respectively. For comparison between groups, the AVF+AVG ratio in the>10 years was the highest, and the lowest in the <1 year(P<005). The AVF+AVG ratio was the same between the 1~5 year and the 5~10 year(P> 005). The top three primary diseases were diabetic nephropathy (DN) (456％), glomerulonephritis (GN) (211％) and hypertensive nephropathy (HTN) (156％). The AVF ratios were 60％, 725％, and 629％, respectively. The AVG ratios were 38％, 92％, and 22％, respectively. Among the groups, the ratio of AVF+AVG in the GN was significantly higher than that in DN and HTN (P<005), and it was the same in DN and HTN (P> 005); the patency of AVF+AVG in GN was significantly longer than that in DN and HTN (P<005), and it was the same in DN and HTN (P> 005). The mortality of TCC was significantly higher than that of AVF+AVG (P<005). The mortality of AVF was slightly higher than that of the AVG, the difference was not statistically significant (P>005).
Ｃｏｎｃｌｕｓｉｏｎ：The choice of vascular access is related to gender, age, dialysis age, and primary disease. DN and HTN patients have a shorter AVF／AVG patency. Reducing the use of TCC may help reduce the mortality of MHD patients.

Systemic lupus erythematosus (SLE) is an autoimmune disease with complex pathogenesis and diverse clinical manifestations. In recent years, as theoretical and technological innovations in the postgenomic era, specifically advances in gene detection techniques, over 30 diseasecausing genes for SLE have been identified and the concept of “Monogenic lupus” has been proposed. This review will focus on the pathogenesis, clinical manifestations and genetic diagnosis of these genes, so as to raise awareness of the genetic contribution to SLE and advance further research.

With the rapid development of genomic medicine and the massive amounts of genetic data springing up, Mendelian randomization (MR) method emerged as the times require.MR integrates genomic data into traditional epidemiological studies to infer causality of risk factors on diseases.It not only largely avoids the influence of confounding factors and reverse causation on results, but also reflects the possible causal relationship between risk factors and diseases through individual's inborn genetic markers. In recent years, this method has been widely used in the etiological inference of kidney diseases, especially chronic kidney disease and diabetic nephropathy, which can provide new ideas for understanding the nature of disease and scientific prevention and treatment. This article reviews MR and its application in chronic kidney disease and diabetic nephropathy.

Ｏｂｊｅｃｔｉｖｅ：To discuss the shortterm clinical efficacy and safety of belimumab combined with standard therapy in treatment of severe active lupus nephritis(LN).
Ｍｅｔｈｏｄｏｌｏｇｙ：2 patients with severe active LN who were dignosed and treated in the National Clinical Research Center of Kidney Disease were prospectively observed.They accepted belimumab in combination with standard therapy for 24 week. The disease outcome and clinical medication of 2 patients were evaluated.
Ｒｅｓｕｌｔｓ：Two patients with LN observed in this study were female and newly diagnosed, the age was 22 and 27 years old respectively, SLEDAI were 15 and 17, and the pathological types of LN were IVG (A) (AI 13,CI 0) and IVG (AI 12,CI 0). Both patients received methylprednisolone pulse(MP) therapy (25g, 15g), followed by oral prednisone (45 mg／d, 30 mg), and received multitarget therapy or mycophenolate mofetil (MMF) as induction therapy. Both patients started beilimumab regimen(10mg／kg infuse on weeks 0,2,4,then every 4 weeks until weeks 24) within 2 weeks after MP. After 24 weeks of treatment, 1 case achieved complete renal remission, SLEDAI decreased to 2 (complement C3 0593 g／L), 1 case achieved partial renal remission, and SLEDAI decreased to 8 (proteinuria 078 g／24h, urinary sediment red blood cell count 158／HPF). To the week 24, dosage of prednisone in the two patients was reduced to 15 mg and 10 mg respectively, and there was no infection or deterioration of renal function.
Ｃｏｎｃｌｕｓｉｏｎ：Belimumab combined with standard therapy is effective in treatment of adult severe active LN. The scores of SLEDAI and renal damage are relieved obviously, and oral prednisone can be reduced to a lower dose.

Focal segmental glomerulosclerosis (FSGS) is a common glomerular disease leading to end stage renal disease, and podocyte injury is the main cause of it.The pathogenesis of podocyte injury in idiopathic FSGS is still unknown. Idiopathic FSGS is easy to relapse and the overall prognosis is poor，except for glucocorticoids and calcinurin inhibitors, there are still lack of effective treatments.Several literatures have reported that rituximab (RTX) can obtain beneficial effects in idiopathic FSGS. As a B cell depletion agent, how RTX plays a role in treatment of idiopathic FSGS, its immunological efficacy and cytoprotective mechanism are still being study. Therefore, based on the drug characteristics of RTX, this paper reviews the main clinical studies and related researches in the field of podocyte injury in recent years ,presenting the immunological mechanism and podocyte protective mechanism of RTX in the treatment of idiopathic FSGS.

A 48-year-old male patient was admitted to the hospital for proteinuria with more than 3 years. Clinical manifestations were moderate proteinuria,no microscopic hematuria or renal dysfunction Renal biopsy showed renal amyloidosis with positive staining of κ light chain and IgG1. The proportion of bone marrow plasma cells was normal,a small number of monoclonal plasma cells was detected in immunophenotyping,the absolute value and ratio of serum free light chain were normal,urinary free κ light chain increased,M protein was not detected in serum and urine,and there was no evidence of involvement of heart,gastrointestinal tract or skin. It was diagnosed as heavy and light chain renal amyloidosis. The patients were treated with bortezomib-based regimen. 

Autologous arteriovenous fistula (AVF) is the lifeline for hemodialysis patients with endstage renal disease, and AVF failures are most often caused by venous stenotic lesions. Neointimal hyperplasia (NIH) is the main pathological change of venous stenotic lesions in failed AVFs, though its precise mechanism remains unclear. Vasa vasorum refers to the network of microvessels which penetrates the tunica adventitia and media of large blood vessels, supplying them with oxygen and nutrients and removing metabolic waste. This paper reviews the possible mechanisms of vasa vasorum participating in development of NIH to provide new theoretical explanations and new therapeutic targets for prevention and treatment of AVF failures.

Type Ⅳ collagen is a vital component of basement membrane. Normal structure and function of type Ⅳ collagen is essential to maintain the integrity of glomerular filtration barrier. Mutations of type Ⅳ collagen genes cause a variety of kidney diseases, such as Alport Syndrome, thin basement membrane nephropathy, focal segmental glomerulosclerosis, and tubulointerstitial injury. Therefore, systematic analysis and clarification of the structure and function of type Ⅳ collagen, and the spectrum of kidney diseases caused by mutations in the type Ⅳ collagen genes play an important role in clinical diagnosis and treatment of these diseases.

Ｏｂｊｅｃｔｉｖｅ：The Study delves into the clinical efficacy of sodium zirconium cyclosilicate for treatment of chronic hyperkalemia in maintenance hemodialysis (MHD) patients.
Ｍｅｔｈｏｄｏｌｏｇｙ：A prospective, singlecenter, clinical observational study was conducted. MHD patients with predialysis serum potassium>55 mmol／L after the short interdialytic interval were enrolled. Patient education and dietary management were carried out. Sodium zirconium cyclosilicate 5g once daily on nondialysis days, and titrated towards maintaining normokalemia over 4 weeks, in 5 g／d increments to a maximum of 15 g／d. The drug dose remained stable during the observation period (8 weeks). The primary end point was proportion of patients during the therapeutic observation period who maintained predialysis serum potassium of 40~50 mmol／L during at least three of four hemodialysis treatments,the secondary end points were the serum potassium level before dialysis and the difference of serum potassium concentration before and after hemodialysis.
Ｒｅｓｕｌｔｓ：90 (292％) MHD patients were eligible for chronic hyperkalemia. Of the 25 patients (17 males and 8 females) with predialysis potassium≥55 mmol／L were enrolled, with the mean age of 542±128 years old and mean dialysis duration of 117(74,171) months. During the observation period, 68％ of the patients met the primary efficacy end point. The predialysis serum potassium was maintained at 475±036 mmol／L,which was significantly decreased compared with predialysis serum potassium at baseline(614±057 mmol／L).Intradialytic potassium shift values were significantly lower than that at baseline. The maintenance dose of sodium zirconium cyclosilicate was 5 g／d in 11 patients, 10 g／d in 13 patients, and 15 g／d in 1 patient, respectively. 3 patients experienced gastrointestinal reactions during the does titration duration.
Ｃｏｎｃｌｕｓｉｏｎ：Sodium zirconium cyclosilicate effectively reduced predialysis potassium after the short interdialytic interval in MHD patients with chronic hyperkalemia, and reduced the fluctuation of serum potassium preand postdialysis.

Ｏｂｊｅｃｔｉｖｅ：To observe the antihypertensive effect and safety of sacubitril／valsartan(SV)in maintenance hemodialysis (MHD) patients with hypertension.
Ｍｅｔｈｏｄｏｌｏｇｙ：In a selfcontrol study, 31 cases of hypertensive MHD patients treated with SV in Blood Purification Center of the First Affiliated Hospital of Zhengzhou University were selected, including 21 patients with refractory hypertension.Among the 31 patients,11 patients changed angiotensin receptor blockers (ARB) to SV.Blood pressure, blood routine, blood biochemistry were analyzed before and after treatment.
Ｒｅｓｕｌｔｓ：The antihypertensive effects of 31 patients were as follows: 4 weeks and 12 weeks after taking SV,systolic blood pressure(SBP)before HD decreased compared with that before treatment.The SBP during HD and after HD all decreased compared with that before treatment at 1 week, 4 weeks and 12 weeks after treatment.12 weeks after the treatment,the diastolic blood pressure(DBP) before HD was lower than that before treatment.At 1 week, 4 weeks and 12 weeks after treatment, DBP during and after HD all decreased compared with that before treatment (P<005).Aftertreatment,defined daily dose of other antihypertension drugs decreased ［249±158 vs 342±181,P<005］. The blood pressure of before,during and after HD of 11 patients who changed ARB to SV also decreased at 1 week, 4 weeks and 12 weeks after treatment. No adverse reactions related to SV were found during the treatment.
Ｃｏｎｃｌｕｓｉｏｎ：The comination of SV is a safe and effective therapy of hypertension in MHD patients.

Artificial intelligence （AI） is a new subject with rapid development in recent years, which is widely used in many fields of medicine. Renal pathology is the gold standard for the diagnosis of kidney disease. Many studies have shown that AI can be well applied in renal pathology, including the structure and lesion recognition of glomeruli, tubules, stroma, arteries, etc, prediction of renal pathological classification (grade) and prognosis, which will realize automatic quantification of features, pathological classification and prognosis evaluation. This article reviews the current progress of AI in renal pathology.

Diabetic nephropathy (DN) is a common complication of diabetes and is currently one of the main cause of endstage renal disease, the pathogenesis of which is still unclear. In recent years, many animal experiments and clinical studies have found that cellular senescence plays a pivotal role in the development of DN. The mechanisms of cellular senescencerelated damage such as telomere attrition, mitochondrial dysfunction, autophagy, inflammatory response, mTOR signaling pathway, Sirtuins activation, and coagulation factors release are important for the disease progression of DN. In this paper, we focus on the factors related to cellular senescence in the process of DN. Moreover, we emphasize the potential therapeutic targets of cellular senescence in DN to provide new research ideas for its treatment.

Ｏｂｊｅｃｔｉｖｅ：To investigate the effect of Roxadustat on anemia in maintenance hemodialysis (MHD) patients with different iron metabolism status.
Ｍｅｔｈｏｄｏｌｏｇｙ：A prospective study, 96 MHD patients with renal anemia from 10 dialysis centers in Sichuan Province were selected. According to the baseline serum ferritin (SF) level, the patients were divided into normal SF group (SF≤500 ng／L) and iron overload group (SF>500 ng／L). All subjects were treated with Roxadustat for 12 weeks according to their body weight. Hemoglobin (Hb), iron metabolism indexes ［SF, transferrin saturation (TSAT), total iron binding capacity (TIBC)］ were detected before and after treatment, and adverse reactions were monitored during treatment.
Ｒｅｓｕｌｔｓ：Hb in normal SF and iron overload group increased significantly compared with that before treatment(P<0001), and there was no significant difference in Hb changes between the two groups(P=0897). After treatment, SF decreased and TIBC increased in both groups, and the difference was statistically significant; however, SF decreased greatly and TIBC increased slightly in iron overload group. TSAT remained stable in both groups. No severe adverse reactions were found during the treatment.
Ｃｏｎｃｌｕｓｉｏｎ：Roxadustat can effectively correct anemia and improve iron metabolism in different iron metabolism states, but there are different improvement degrees for iron metabolism.

Chronic kidney diseaseassociated pruritus (CKDaP) is a common,troubling problem for patients with CKD.Despite a prevalence rate of approximately 20％~40％ in CKD, and a clear association with poorer psychosocial and medical outcomes, this condition is often ignored or underreported by patients or health care providers. This is likely due to uncertainty regarding its pathogenesis and treatment. CKDaP is attributed to toxin buildup, peripheral neuropathy, immune system dysregulation, or opioid dysregulation.Recently, targeting opioid dysregulation have yielded promising results. These trials have spurred new hope for understanding and treating this condition.

Antiphospholipid syndrome(APS), which can present with a variety of clinical phenotypes, including thromboembolism related events and morbid pregnancy, is a kind of autoimmune disease assiociated with antiphospholipid antibodies (aPLs). The traditional antibodies in the diagonostics of APS are lupus anticoagulant, anticardiolipin antibody and β2glycoproteinⅠ antibody. However some patients are still highly suspected of antiphospholipid syndrome, but the above three standard antibodies are negative. In current, studies have shown that many other antibodies related to phospholipid components can also be found in patients with antiphospholipid syndrome, and have certain clinical diagnostic value. This article reviews the potential antibodies associated with antiphospholipid antibody syndrome and their clinical application.

Diabetic kidney disease (DKD) is the main cause of endstage renal disease. At present, multidisciplinary therapeutic strategies based on reninangiotensin system inhibitors and sodiumglucose cotransporter 2 inhibitors is effective for DKD. In recent years, incretinrelated drugs have reported renal function protection in clinical trials. Hypoxiainducible factor prolyl hydroxylase inhibitors may be renoprotective since they improve tubulointerstitial hypoxia. In addition, new drugs, including NFE2related factor 2 agonists, glycation end products (AGE) inhibitors, may also have potential therapeutic effects in DKD. Epigenetic regulation plays an critical role in renal injury and renal function progression in DKD. Molecules with epigenetic regulation such as histone modification inhibitors may become a new way of intervention for DKD in the future.

Gene detection has been widely used in infection, tumor, genetic disease, drug application and many other aspects, and has been gradually playing a greater role in chronic disease management in recent years. European Renal AssociationEuropean Dialysis and Transplant Association lately published the first international recommendation on the application of genetic testing in diagnosis of chronic kidney disease. We interpret the recommendation with relevant literature to arouse the resonance of domestic counterparts and apply genetic testing in prevention and treatment of chronic kidney disease in a reasonable and standardized frame.