Blood pressure targets in patients with chronic kidney disease:Comments and controversies

According to the Global Burden of Disease Study 2017,there are 132 million patients with chronic kidney disease(CKD)in China,^([1])and the prevalence of hypertension in Chinese patients with CKD(67.3%)is significantly higher than that in the general population(23.2%).^([2,3])CKD is both a cause and a consequence of hypertension,and these two conditions form a vicious cycle that leads to the high prevalence rate of hypertension in patients with CKD.Uncontrolled hypertension accelerates the deterioration of renal function,which significantly increases the risk of developing end-stage renal disease(ESRD),as well as cardiovascular and cerebrovascular diseases,leading to poor patient outcomes.

Understanding autoimmune response after SARS-CoV-2 infection and the pathogenesis/mechanisms of long COVID

COVID-19 posed a major challenge to the healthcare systemandresourcesworldwide.Thepopularizationofvaccines and the adoption of numerous prevention and control measures enabled the gradual end of the COVID-19 pandemic.However,successive occurrence of autoimmune diseases in patients with COVID-19cannot beoverlooked.Long COVID has been themajor focus of research due to the long duration of different symptoms and the variety of systems involved.Autoimmunity may play a crucial role in the pathogenesis of long COVID.Here,we reviewed several autoimmune disorders occurring after COVID-19 infection and the pathogenesis of long COVID.

团队学习法在老年慢性肾功能不全教学中的应用

老年慢性肾功能不全是肾脏病教学中的重点和难点内容。为了提高肾脏病学的教学质量,我们采用团队学习法(TBL)替代传统教学法。TBL教学法主要包括:组建团队、管理团队、反馈问题、解决问题、学生互评等方面。TBL教学法能够增强学生参与感,增加学生的学习兴趣,有助于培养学生的自主学习能力,从而促进其对临床知识与技能的掌握。

Comparative risk of acute kidney injury among cancer patients treated with immune checkpoint inhibitors

With the development and introduction of immune checkpoint inhibitors(ICIs)in cancer patients,immune-related side effects have increasingly attracted attention.However,the risks of immune-related renal toxicity are poorly characterized.In this study,we performed a network meta-analysis(NMA)of ICI-related randomized clinical trials(RCTs)to elucidate the comparative risk of acute kidney injury(AKI)in cancer patients receiving different ICIs.We also sought to identify other factors potentially affecting the risk of AKI.PubMed and EMBASE were searched for peer-reviewed trial reports published between January 2000 and May 2021.Eligible studies were RCTs studying ICIs in cancer patients and reporting AKI data.We performed a frequentist NMA to evaluate the risk ratios for grade 1-5 and grade 3-5 AKI between the treatment groups.We also assessed the absolute incidence of AKI in the ICI-containing arm using traditional direct meta-analysis.Once significant heterogeneity was detected in a traditional direct meta-analysis,multivariable meta-regression analysis was applied to identify factors that significantly affected the absolute incidence of AKI.A total of 85 RCTs were included in this study.In the NMA for the risk of grade 1-5 and 3-5 AKI,ipilimumab showed a significantly higher risk than avelumab and durvalumab,whereas 1 mg/kg nivolumab plus 3 mg/kg ipilimumab(N1I3)showed a significantly higher risk than other groups.In terms of treatment ranking,durvalumab±low-dose tremelimumab and avelumab were consistently among the top three safest treatments for grade 1-5 or 3-5 AKI,whereas N1I3,ipilimumab and tremelimumab were consistently among the top three treatments with the highest risk for grade 1-5 or 3-5 AKI.Compared with other cancers,renal cell carcinoma and urothelial carcinoma showed a significantly higher risk of AKI.The incidence of AKI was significantly higher with ICI+chemotherapy than with ICI monotherapy.In this NMA involving largescale up-to-date ICI trials,we demonstrated the comparative safety of existing ICI drugs for grade 1-5 and grade 3-5 AKI.Based on data from the ICI arms of these trials,we also revealed several potential risk factors for immune-related AKI,including tumor type and treatment paradigm.

多中心联合病例汇报与讨论教学法在肾脏病科继续医学教育中的应用

肾脏病学是一门涉及多学科、较为复杂的学科,继续医学教育的难度较大。在肾脏病专业年轻医师临床实践能力和综合素质的培养中,现有的继续教育模式相对滞后。本文率先提出、实施一种新型多中心联合病例教学法:利用互联网视频会议方式与多家医院联合进行病例汇报、专家讨论与点评。与传统教学查房和单中心病例汇报相比,该新型教学模式能促使汇报人更加积极地参与到病史采集、初步诊断与鉴别诊断、治疗方案制定和最新研究文献检索等过程,并通过讨论和争鸣更牢固地掌握和拓展知识技能,从而提高临床诊治水平。

Netrin-1 works with UNC5B to regulate angiogenesis in diabetic kidney disease

Netrin-1,an axon guidance factor,and its receptor UNC5B play important roles in axonal development and angiogenesis.This study examined netrin-1 and UNC5B expression in kidneys with diabetic kidney disease (DKD) and investigated their roles in angiogenesis.Netrin-1 and UNC5B were upregulated in streptozotocininduced DKD Wistar rats,and their expression was compared with that in healthy controls.However,exogenous netrin-1 in UNC5B-depleted human renal glomerular endothelial cells (HRGECs) inhibited cell migration and tubulogenesis.This effect was likely associated with SRC pathway deactivation.Netrin-1 treatment also eliminated the pro-angiogenic effects of exogenous VEGF-165 on UNC5B-silenced HRGECs.These results indicate that UNC5B antagonizes netrin-1 and that UNC5B upregulation contributes partly to enhancing angiogenesis in DKD.Therefore,introducing exogenous netrin-1 and depleting endogenous UNC5B are potential strategies for reducing the incidence of early angiogenesis and mitigating kidney injury in DKD.

The role of transcriptional factor D-site-binding protein in circadian CCL2 gene expression in anti-Thy1 nephritis

Mesangial proliferative glomerulonephritis(MsPGN)is an inflammatory disease,but both the nature of disease progression and its regulation remain unclear.In the present study,we monitored the course of anti-Thy1 nephritis from days 1 to 5 and established gene expression profiles at each time point using microarrays to explore the development of inflammation.According to the gene expression profiles,macrophage infiltration(triggered by CCL2 activation)was evident on day 1 and enhanced inflammation over the next few days.We screened for genes with expression levels similar to CCL2 and found that the upregulation of the circadian gene albumin D-site-binding protein(DBP)was involved in CCL2 activation in mesangial cells.More importantly,CCL2 expression showed oscillatory changes similar to DBP,and DBP induced peak CCL2 expression at 16:00 a clock on day 1 in the anti-Thy1 nephritis model.We knocked down DBP through transfection with a small interfering RNA(siRNA)and used RNA sequencing to identify the DBP-regulated TNF-α-CCL2 pathway.We performed chromatin immunoprecipitation sequencing(ChIP-Seq)and the dual luciferase assay to show that DBP bound to the TRIM55 promoter,regulating gene expression and in turn controlling the TNF-α-CCL2 pathway.In conclusion,DBP-regulated circadian CCL2 expression by the TRIM55-TNF pathway in injured mesangial cells at an early stage,which promoted macrophage recruitment and in turn triggered infiltration and inflammation in a model of anti-Thy1 nephritis.

Comparative analysis of membranous and other nephropathy subtypes and establishment of a diagnostic model

This study aimed to compare clinical features between membranous nephropathy (MN) and nonmembranous nephropathy (non-MN), to explore the clinically difTerential diagnosis of these two types, and to establish a diagnostic model of MN. After renal biopsy was obtained, 798 patients were divided into two groups based on their examination results: primary MN group (n = 248) and non-MN group (n = 550). Their data were statistically analyzed. Logistic regression analysis indicated that anti-PLA2R antibodies, IgG, and Cr were independently correlated with MN, and these three parameters were then used to establish the MN diagnostic model. A receiver operating characteristic (ROC) curve confirmed that our diagnostic model could distinguish between patients with and without MN, and their corresponding sensitivity, specificity, and AUC were 79.9%, 89.4%, and 0.917, respectively. The cutoff value for this combination in MN diagnosis was 0.34. The established diagnostic model that combined multiple factors shows a potential for broad clinical applications in differentiating primary MN from other kidney diseases and provides reliable evidence supporting the feasibility of noninvasive diagnosis of kidney diseases.

Single-cell RNA-Seq analysis identified kidney progenitor cells from human urine

Dear Editor,Urine passes through the entire kidney and urinary tract system starting from the glomerulus and ending to the urethra.Cells in the kidney and urinary tract could be exfoliated from the epithelium into the urine,while leukocyte could infiltrate from the local tissue into the urine,which makes the urine a useful subject for clinical evaluation of relevant diseases.

Hypertension in patients with CKD in China： clinical characteristics and management

Chronic kidney disease （CKD） is a life-threatening disease that results in end-stage renal disease （ESRD） and consumes substantial health resources. In China, the prevalence of CKD in the general population is 10.8% and increases gradually with age [1]. CKD also causes hypertension.