胎儿多囊肾的磁共振产前诊断

目的探讨胎儿多囊肾（PKD）的产前磁共振（MRI）表现及其诊断价值。方法对14例经超声和病理证实为胎儿多囊肾的MRI资料进行回顾性分析。结果ADPKD1例：双肾体积增大，T2WI见散在多发小囊状信号增高影，皮髓质分界不清，羊水量正常，膀胱可见充盈；ARPKD13例：①13例双肾体积明显均匀增大。②T2WI上，7例双肾信号呈中等以上增高，均匀一致；9例双肾皮髓质内见弥漫性针尖大小信号增高的囊泡影，呈放射状排列，笔者称为“苦瓜样”改变。③羊水无法显示8例，羊水极少5例。④10例未见膀胱显示。⑤合并9种畸形，其中前脑无裂畸形1例，脑积水3例，Dandy-Walker综合症3例，枕部脑膜膨出2例，颅内出血并孔洞脑1例，肺发育不良6例，多发性肝囊肿1例，唇裂1例，MeckebGruber综合征1例。结论PKD的MRI产前表现具有特异性，不受羊水量与胎儿体位的影响，可作为产前超声检查的重要补充手段，可提高其合并畸形的检出率。

Effects of acute hepatic damage on natriuresis and water excretion after acute normal saline loading in rats

AIMS To investigate the relationship between the liver function- al impairment and sodium and water retention. METHODS Acute liver damage model was established with carbon tetrachloride (CCl_4) administration to male Sprague-Daw- ley rats. Twenty-four and 48 hours later after CCl_4 administration, the excretion of acute sodium and water load was examined,and 24 hours later after normal saline administration,the excretion of acute sodium and water load was examined in control group. The concentration of plasma caffeine was analysed with high pressure liquid chromatograph (HPLC). The half life time of plasma caffein (Caft 1/2) sewed as a quantitative index of hepatic function. Plasma ALT was measured with Reitman method. The hepatic tis- sue was sectioned in the same site for water content measurement and pathological observation. The serumal and urinary sodium was measured with flame photometry. RESULTS Twenty-four hours later after CCl_4 administration, plasma alanine aminotransferase (ALT,n=6,37.5±12.6→ 189.4±34.4U,P<0.01) and water content of hepatic tissue (n =6,70.0%±1.1%→73.0%±1.0%,P<0.01) rose significantly,Caft 1/2 was prolonged significantly (94.9±18.9→ 326.4±85.8 minutes,P<0.01 ). The renal function of excretion of acute salt and water load declined obviously (n=6,Na^+: 92.4%±14.1%→50.1%±13.1%,P<0.01;H_2O:86.3%± 14.3%→42.1%±8.8%,P<0.01). Forty-eight hours later, the indexes above somewhat recovered,but were still markedly different from those of the control. Furthermore,the relationships betweenCaft 1/2 andALT (r=0.752,P<0.01),and between Caft 1/2 and excretory rate of sodium (r=-0.634,P<0.05) and water were still significant (r=-0. 612,P<0.01). CONCLUSIONS Caft 1/2 is a good index to assess the degree of hepatic damage. The hepatic dysfunction may be a factor caus- ing the renal excretory impairment to the acute sodium and water load.

The roles of MAPKs in disease

MAP kinases transduce signals that are involved in a multitude of cellular pathways and functions in response to a variety of ligands and cell stimuli. Aberrant or inappropriate functions of MAPKs have now been identified in diseases ranging from cancer to inflammatory disease to obesity and diabetes. In many cell types, the MAPKs ERK1/2 are linked to cell proliferation. ERK1/2 are thought to play a role in some cancers, because mutations in Ras and B-Raf, which can activate the ERK1/2 cascade, are found in many human tumors. Abnormal ERK1/2 signaling has also been found in polycystic kidney disease, and serious developmental disorders such as cardio-facio-cutaneous syndrome arise from mutations in components of the ERK1/2 cascade. ERK1/2 are essential in well-differentiated cells and have been linked to long-term potentiation in neurons and in maintenance of epithelial polarity. Additionally, ERK1/2 are important for insulin gene transcription in pancreatic beta cells, which produce insulin in response to increases in circulating glucose to permit efficient glucose utilization and storage in the organism. Nutrients and hormones that induce or repress insulin secretion activate and/or inhibit ERK1/2 in a manner that reflects the secretory demand on beta cells. Disturbances in this and other regulatory pathways may result in the contribution of ERK1/2 to the etiology of certain human disorders.

Nonalcoholic fatty liver disease-A multisystem disease?

Non-alcoholic fatty liver disease(NAFLD) is one of the most common comorbidities associated with overweight and metabolic syndrome(Met S). Importantly, NAFLD is one of its most dangerous complications because it can lead to severe liver pathologies, including fibrosis, cirrhosis and hepatic cellular carcinoma. Given the increasing worldwide prevalence of obesity, NAFLD has become the most common cause of chronic liver disease and therefore is a major global health problem. Currently, NAFLD is predominantly regarded as a hepatic manifestation of Met S. However, accumulating evidence indicates that the effects of NAFLD extend beyond the liver and are negatively associated with a range of chronic diseases, most notably cardiovascular disease(CVD), diabetes mellitus type 2(T2DM) and chronic kidney disease(CKD). It is becoming increasingly clear that these diseases are the result of the same underlying pathophysiological processes associated with Met S, such as insulin resistance, chronic systemic inflammation and dyslipidemia. As a result, they have been shown to be independent reciprocal risk factors. In addition, recent data have shown that NAFLD actively contributes to aggravation of the pathophysiology of CVD, T2 DM, and CKD, as well as several other pathologies. Thus, NAFLD is a direct cause of many chronic diseases associated with MetS, and better detection and treatment of fatty liver disease is therefore urgently needed. As non-invasive screening methods for liver disease become increasingly available, detection and treatment of NAFLD in patients with MetS should therefore be considered by both(sub-) specialists and primary care physicians.

Wireless capsule endoscopy in the investigation of patients with chronic renal failure and obscure gastrointestinal bleeding (preliminary data)

AIM： To investigate the role of wireless capsule endoscopy （WCE） in detection of small bowel （SB） pathology in patients with chronic renal failure （CRF） and obscure bleeding. METHODS： Consecutive CRF patients with obscure bleeding were prospectively studied. Patients with normal renal function and obscure bleeding, investigated during the same period with WCE, were used for the interpretation of results. RESULTS： Seventeen CRF patients （11 overt, 6 occult bleeding） and 51 patients （33 overt, 18 occult bleeding） with normal renal function were enrolled in this study. Positive SB findings were detected in 70.6% of CRF patients and in 41.2% of non-CRF patients （P〈0.05）. SB angiodysplasia was identified in 47% of CRF patients and in 17.6% of non-CRF patients. Univariate logistic regression revealed CRF as a significant predictive factor for angiodysplasia （P〈0.05）. Therapeutic measures were undertaken in 66% of the patients with the positive findings. CONCLUSION： According to our preliminary results, SB angiodysplasia was found in an increased prevalence among CRF patients with obscure bleeding. WCE is useful in diagnosis of gastrointestinal pathologies and in planning appropriate therapeutic intervention and, therefore, should be included in the work-up of this group of patients.

Acute kidney injury and post-reperfusion syndrome in liver transplantation

In the past decades liver transplantation(LT) has become the treatment of choice for patients with end stage liver disease(ESLD). The chronic shortage of cadaveric organs for transplantation led to the utilization of a greater number of marginal donors such as older donors or donors after circulatory death(DCD). The improved survival of transplanted patients has increased the frequency of long-term complications, in particular chronic kidney disease(CKD). Acute kidney injury(AKI) post-LT has been recently recognized as an important risk factor for the occurrence of denovo CKD in the long-term outcome. The onset of AKI post-LT is multifactorial, with pre-LT risk factors involved, including higher Model for End-stage Liver Disease score, more sever ESLD and pre-existing renal dysfunction, either with intra-operative conditions, in particular ischaemia reperfusion injury responsible for post-reperfusion syndrome(PRS) that can influence recipient's morbidity and mortality. Post-reperfusion syndrome-induced AKI is an important complication post-LT that characterizes kidney involvement caused by PRS with mechanisms not clearly understood and implication on graft and patient survival. Since preLT risk factors may influence intra-operative events responsible for PRS-induced AKI, we aim to consider all the relevant aspects involved in PRS-induced AKI in the setting of LT and to identify all studies that better clarified the specific mechanisms linking PRS and AKI. A Pub Med search was conducted using the terms liver transplantation AND acute kidney injury; liver transplantation AND post-reperfusion syndrome; acute kidney injury AND post-reperfusion syndrome; acute kidney injury AND DCD AND liver transplantation. Five hundred seventy four articles were retrieved on Pub Med search. Results were limited to title/abstract of English-language articles published between 2000 and 2015. Twenty-three studies were identified that specifically evaluated incidence, risk factors and outcome for patients developing PRS-induced AKI in liver transplantation. In order to identify intra-operative risk factors/mechanisms specifically involved in PRSinduced AKI, avoiding confounding factors, we have limited our study to "acute kidney injury AND DCD AND liver transplantation". Accordingly, three out of five studies were selected for our purpose.

EFFECTS OF PROSTAGLANDIN E1 ON THE PROGRESSION OF ARISTOLOCHIC ACID NEPHROPATHY

Objective To investigate the effects of prostaglandin E1 (PGE1) on the progression of aristolochic acid nephropathy (AAN). Methods Twenty-four patients diagnosed as AAN with serum creatinine (Scr) between 1.5 mg/dL and 4 mg/dL during September 2001 to August 2003 were randomly divided into 2 groups. All patients had ingested long dan xie gan wan con-taining aristolochic acid (0.219 mg/g) for at least 3 months. Twelve patients were injected with Alprostadil (10 μg/d for 10 days in one month, summing up to 6 months). Except for PGE1, the other therapy was same in both groups. Renal function was assessed using reciprocal serum creatinine levels (1/Scr). Results The level of Scr and serum hemoglobin (Hgb) was similar in both groups prior to therapy. During follow-up, 1/Scr levels in PGE1 group were significantly higher than control group (P < 0.01), and Hgb levels in PGE1 group were sig-nificantly increased compared with control (P < 0.05).Conclusion PGE1 can slow the progression of renal failure and increase Hgb level of AAN patient.

Clostridium difficile causing acute renal failure: Case presentation and review

AIM: Clostridium difficile infection is primarily a nosocomial infection but asymptomatic carriers of Clostridium difficile can be found in up to 5% of the general population. Ampicillin, cephalosporins and clindamycin are the antibiotics that are most frequently associated with Clostridium difficile-associated diarrhea or colitis. Little is known about acute renal failure as a consequence of Clostridium difficile-associated diarrhea. METHODS: In this case report, we describe the course of Clostridium difficile-associated diarrhea in an 82-year-old patient developing acute renal failure. Stopping the offending agent and symptomatic therapy brought a rapid improvement of diarrhea and acute renal failure, full recovery was gained 18 d after admission. In a systematic review we looked for links between the two conditions. RESULTS: The link between Clostridium difficile-assoaated diarrhea and acute renal failure in our patient was most likely volume depletion. However, in experimental studies a direct influence of Clostridium difficile toxins on renal duct cells could be shown. CONCLUSION: Rapid diagnosis, nonspecific supportive treatment and specific antibiotic treatment, especially in the elderly, may lower excess mortality Clostridium difficile-associated diarrhea and renal failure being possible complications.

Natural history of a randomized trial comparing distal spleno-renal shunt with endoscopic sclerotherapy in the prevention of variceal rebleeding:A lesson from the past

AIM: To compare endoscopic sclerotherapy (ES) with distal splenorenal shunt (DSRS) in the prevention of recurrent variceal bleeding in cirrhotic patients during a long-term follow-up period. METHODS: In 1984 we started a prospective, controlled study of patients with liver cirrhosis. Long-term follow-up presents a natural history of liver cirrhosis complicated by advanced portal hypertension. In this study the effects of 2 types of treatment, DSRS or ES, were evaluated. The study population included 80 patients with cirrhosis and portal hypertension referred to our department from October 1984 to March 1991. These patients were drawn from a pool of 282 patients who underwent either elective surgery or ES during the same period of time. Patients were assigned to one of the 2 groups according to a random number table: 40 to DSRS and 40 to ES using polidocanol. RESULTS: During the postoperative period, no DSRS patient died, while one ES patient died of uncontrolled hemorrhage. One DSRS patient had mild recurrent variceal hemorrhage despite an angiographically patent DSRS and another patient suffered duodenal ulcer rebleeding. Eight ES patients suffered at least one episode of gastrointestinal bleeding: 4 from varices and 4 from esophageal ulcerations. Eight ES patients developed transitory dysphagia. Long-term follow- up was completed in all patients except for 5 cases (2 DSRS and 3 ES patients). Five-year survival rates for shunt (73%) and ES (56%) groups were statistically different: in this follow-up period and in subsequent follow-ups this difference decreased and ceased to be of statistical relevance. The primary cause of deathbecame hepatocellular carcinoma (HCC). Four DSRS patients rebled due to duodenal ulcer, while eleven ES patients had recurrent bleeding from esophago-gastric sources (seven from varices, three from hypertensive gastropathy, one from esophageal ulcerations) and two from unknown sources. Nine DSRS and 2 ES patients developed a chronic encephalopathy; 13 DSRS and 5 ES patients suffered at least one episode of acute encephalopathy. Five ES patients had esophageal stenoses, which were successfully dilated. CONCLUSION: In a subgroup of patients with good liver function, DSRS with a correct portal-azygos disconnection more effectively prevents variceal rebleeding than ES. However, this positive effect did not influence the long-term survival because other factors (e.g. HCC) were more important in deciding the fate of the cirrhotic patients with portal hypertension.

Mistletoe alkali inhibits peroxidation in rat liver and kidney

AIM： To explore the antioxidant and free radica scavenger properties of mistletoe alkali （MA）. METHODS： The antioxidant effect of mistletoe alkali on the oxidative stress induced by carbon tetrachloride （CCh） in rats was investigated. The rats were divided into four groups （n = 8）： CCh-treated group （1 mL/kg body weight）, MA -treated group （90 mg/kg）, CCh＋MA-treated group and normal control group. After 4 wk of treatment, the level of malondialdehyde （MDA）, a lipid peroxidation product （LPO） was measured in serum and homogenates of liver and kidney. Also, the level of glutathione （GSH）, and activities of glutathione reductase （GR）, glutathione peroxidase （GSPx）, superoxide dismutase （SOD）, and glutathione-S-transferase （GST） in liver and kidney were determined. Scavenging effects on hydroxyl free radicals produced in vitro by Fenton reaction were studied by ESR methods using 5,5-dimethyl-1-pyrroline-N-oxide （DMPO） as a spin trap reagent and H2O2/UV as the OH· source. Urinary 8-hydroxydeoxyguanosine （8-OHdG） was determined by competitive ELISA. RESULTS： In CCh-treated group, the level of LPO in serum of liver and kidney was significantly increased compared to controls. The levels of GSH and enzyme activities of SOD, GSPx and GR in liver and kidney were significantly decreased in comparison with controls. In CCl4＋MA-treated group, the changes in the levels of LPO in serum of liver and kidney were not statistically significant compared to controls. The levels of SOD, GSPx and GR in liver and kidney were significantly increased in comparison with controls. There was a significant differ- ence in urinary excretion of 8-OHdG between the CCh- treated and MA-treated groups. CONCLUSION： Oxidative stress may be a major mechanism for the toxicity of CCh. MA has a protective effect against CCl4 toxicity by inhibiting the oxidative damage and stimulating GST activities. Thus, clinical application of MA should be considered in cases with carbon tetrachloride-induced injury.

Effects of Helicobacter pylori infection on gastric epithelial cell kinetics in patients with chronic renal failure

AIM： To evaluate the effects of Helicobacter pylori infection on gastric epithelial cell kinetics in patients with chronic renal failure （CRF）. METHODS： Forty-four patients were enrolled in this study and divided into four groups with respect to their Helicobacter pylori （H pylori） and CRF status. Groups were labeled as follows： la： normal renal function, H pylori negative （n = 12）, lb： normal renal function, H pylori positive （n = 11）, 2a： CRF, H pylori negative （n = 10）, 2b： CRF, H pylori positive （n = 11）. Upper gastrointestinal endoscopy was done in all the patients involved in the study. During endoscopical investigation, antral biopsy specimens were taken from each patient. In order to evaluate the cell apoptosis and proliferation in gastric epithelial cells, Bax and proliferating cell nuclear antigen （PCNA） labeling indexes （LI） were assessed with immunohistochemical staining method. RESULTS： For groups la, lb, 2a, and 2b, mean Bax LI was identified as 34.4±13.7, 44.1±16.5, 46.3±20.5, 60.7±13.8, respectively and mean PCNA LI was identified as 36.2±17.2, 53.6±25.6, 59.5±25.6, 67.2±22, respectively. When the one-way ANOVA test was applied, statistically significant differences were detected between the groups for both Bax LI （P = 0.004 〈0.01） and PCNA LI （P = 0.009 〈0.01）. When groups were compared further in terms of Bax LI and PCNA LI with Tukey＇s HSD test for multiple pairwise comparisons, statistically significant difference was observed only between groups la and 2b （P = 0.006 〈0.01）.CONCLUSION： In gastric epithelial cells, expression of both the pre-apoptotic protein Bax and the proliferation marker PCNA increase with H pylori infection. This increase is more evident in patients with uremia. These findings suggest that uremia accelerates apoptosis and proliferation in gastric epithelial cells.

Effects of mindfulness meditation on trait mindfulness,perceived stress,emotion regulation,and quality of life in hemodialysis patients:A randomized controlled trial

Objective:This study aimed to examine the effects of mindfulness meditation on trait mindfulness,perceived stress,emotion regulation,and quality of life in end-stage renal disease patients undergoing hemodialysis.Methods:An experimental study with repeated measures design was conducted among a sample of 74 end-stage renal disease patients undergoing hemodialysis between January and May 2021 in the dialysis center at Jahra hospital,Kuwait.The patients were randomly assigned to the experimental(n?37)and control groups(n?37).The experimental group participated in 30-min mindfulness meditation sessions(three sessions a week for five weeks)held during their hemodialysis sessions;the participants in the control group were instructed to sit with their eyes closed and relaxed for 30 min three times a week for five weeks during hemodialysis sessions.The dependent variables of both groups were measured at baseline(T0),middle of intervention(T1),and end of intervention(T2)using the Mindful Attention Awareness Scale(MAAS),Perceived Stress Scale(PSS),Emotion Regulation Questionnaire(ERQ),and Kidney Disease Quality of Life(KDQOL-36)questionnaire.The study was registered in the ClinicalTrial.gov(Identifier:NCT05176730).Results:The repeated measures ANOVA(within-subject)results for the experimental group showed that mindfulness meditation had significantly decreased perceived stress by the end of the intervention.Also,mindfulness meditation improved mindfulness,emotion regulation,and kidney disease-related quality of life in the experimental group,and this improvement occurred significantly at both T1 and T2.The repeated measures ANOVA(within and between-subject)results showed that the experimental group,as compared to the control group,had lower perceived stress,higher trait mindfulness,higher emotional regulation,and higher kidney disease-related quality of life over time.Conclusions:The positive findings of this study offer health policy-makers and hospital administrators a promising tool to use with patients undergoing hemodialysis as a way to manage stress and improve quality of life.However,this study should be replicated in multiple settings with follow-up assessments.

Hepatorenal syndrome

Hepatorenal syndrome (HRS) is a "functional" and reversible form of renal failure that occurs in patients with advanced chronic liver disease. The distinctive hallmark feature of HRS is the intense renal vasoconstriction caused by interactions between systemic and portal hemodynamics. This results in activation of vasoconstrictors and suppression of vasodilators in the renal circulation. Epidemiology, pathophysiology, as well as current and emerging therapies of HRS are discussed in this review.

Complement activation in progressive renal disease

Chronic kidney disease(CKD) is common and the cause of significant morbidity and mortality. The replacement of functioning nephrons by fibrosis is characteristic of progressive disease. The pathways that lead to fibrosis are not fully understood, although chronic non-resolving inflammation in the kidney is likely to drive the fibrotic response that occurs. In patients with progressive CKD there is histological evidence of inflammation in the interstitium and strategies that reduce inflammation reduce renal injury in pre-clinical models of CKD. The complement system is an integral part of the innate immune system but also augments adaptive immune responses. Complement activation is known to occur in many diverse renal diseases, including glomeruloneph-ritis, thrombotic microangiopathies and transplant rejection. In this review we discuss current evidence that complement activation contributes to progression of CKD, how complement could cause renal inflammation and whether complement inhibition would slow progression of renal disease.

Association between Helicobacter pylori and end-stage renal disease: A meta-analysis

To investigate the prevalence and association of Helicobacter pylori (H. pylori) with end-stage renal disease (ESRD).METHODSSA comprehensive literature search was completed from inception until October 2016. Studies that reported prevalence, relative risks, odd ratios, hazard ratios or standardized incidence ratio of H. pylori among ESRD patients were included. Participants without H. pylori were used as comparators to assess the association between H. pylori infection and ESRD. Pooled risk ratios and 95%CI was calculated using a random-effect model. Adjusted point estimates from each study were combined by the generic inverse variance method of DerSimonian and Laird.RESULTSOf 4546 relevant studies, thirty-seven observational studies met all inclusion criteria. Thirty-five cross-sectional studies were included in the analyses to assess the prevalence and association of H. pylori with ESRD. The estimated prevalence of H. pylori among ESRD patients was 44% (95%CI: 40%-49%). The pooled RR of H. pylori in patients with ESRD was 0.77 (95%CI: 0.59-1.00) when compared with the patients without ESRD. Subgroup analysis showed significantly reduced risk of H. pylori in adult ESRD patients with pooled RR of 0.71 (95%CI: 0.55-0.94). The data on the risk of ESRD in patients with H. pylori were limited. Two cohort studies were included to assess the risk of ESRD in patients with H. pylori. The pooled risk RR of ESRD in patients with H. pylori was 0.61 (95%CI: 0.03-12.20).CONCLUSIONThe estimated prevalence of H. pylori in ESRD patients is 44%. Our meta-analysis demonstrates a decreased risk of H. pylori in adult ESRD patients.

Systemic abnormalities in liver disease

Systemic abnormalities often occur in patients with liver disease. In particular, cardiopulmonary or renal diseases accompanied by advanced liver disease can be serious and may determine the quality of life and prognosis of patients. Therefore, both hepatologists and non-hepatologists should pay attention to such abnormalities in the management of patients with liver diseases.

Asymptomatic hyperuricemia following renal transplantation

in the genesis and progression of kidney disease, and a few studies are beginning to show a possible benefcial effect of urate-lowering therapy. Whether this holds true for renal allograft recipients is not clear. In this short review evidence from epidemiological as well as intervention studies is summarized and discussed, with some practical considerations presented at the end.

Kidneys in chronic liver diseases

Acute kidney injury(AKI),defined as an abrupt increase in the serum creatinine level by at least 0.3 mg/dL,occurs in about 20% of patients hospitalized for decompensating liver cirrhosis.Patients with cirrhosis are susceptible to developing AKI because of the progressive vasodilatory state,reduced effective blood volume and stimulation of vasoconstrictor hormones.The most common causes of AKI in cirrhosis are pre-renal azotemia,hepatorenal syndrome and acute tubular necrosis.Differential diagnosis is based on analysis of circumstances of AKI development,natriuresis,urine osmolality,response to withdrawal of diuretics and volume repletion,and rarely on renal biopsy.Chronic glomerulonephritis and obstructive uropathy are rare causes of azotemia in cirrhotic patients.AKI is one of the last events in the natural history of chronic liver disease,therefore,such patients should have an expedited referral for liver transplantation.Hepatorenal syndrome(HRS) is initiated by progressive portal hypertension,and may be prematurely triggered by bacterial infections,nonbacterial systemic inflammatory reactions,excessive diuresis,gastrointestinal hemorrhage,diarrhea or nephrotoxic agents.Each type of renal disease has a specific treatment approach ranging from repletion of the vascular system to renal replacement therapy.The treatment of choice in type 1 hepatorenal syndrome is a combination of vasoconstrictor with albumin infusion,which is effective in about 50% of patients.The second-line treatment of HRS involves a transjugular intrahepatic portosystemic shunt,renal vasoprotection or systems of artificial liver support.

Lipid abnormalities in kidney disease and management strategies

Patients with kidney diseases continue to experience significant cardiovascular disease(CVD) morbidity and mortality. Although there are many important risk factors playing a role in the pathogenesis of CVD in chronic kidney disease(CKD) patients, dyslipidemia(elevated triglycerides, elevated oxidized low-densitylipoprotein and low/dysfunctional low high-density) represents one of the modifiable risk factors. Renal failure patients have unique lipid abnormalities which not only have complex role in pathogenesis of CVD but also cause relative resistance to usual interventions. Most of the randomized trials have been in hemodialysis population and data from CKD non-dialysis, peritoneal dialysis and renal transplant populations is extremely limited. Compared to general population, evidence of mortality benefit of lipid lowering medications in CKD population is scarce. Future research should be directed towards establishing long term benefits and side effects of lipid lowering medications, through randomized trials, in CKD population.

Soy-based renoprotection

Chronic kidney disease （CKD） is a significant public health problem as risk factors such as advanced age, obesity, hypertension and diabetes rise in the global po-pulation. Currently there are no effective pharmacologic treatments for this disease. The role of diet is important for slowing the progression of CKD and managing symptoms in later stages of renal insuffciency. While low protein diets are generally recommended, maintaining adequate levels of intake is critical for health. There is an increasing appreciation that the source of protein may also be important. Soybean protein has been the most extensively studied plant-based protein in subjects with kidney disease and has demonstrated renal protective properties in a number of clinical studies. Soy protein consumption has been shown to slow the decline in estimated glomerular filtration rate and significantly improve proteinuria in diabetic and non-diabetic patients with nephropathy. Soy’s beneficial effects on renal function may also result from its impact on certain phy-siological risk factors for CKD such as dyslipidemia, hypertension and hyperglycemia. Soy intake is also associated with improvements in antioxidant status and systemic infammation in early and late stage CKD pati-ents. Studies conducted in animal models have helped to identify the underlying molecular mechanisms that may play a role in the positive effects of soy protein on renal parameters in polycystic kidney disease, metabolically-induced kidney dysfunction and age-associated prog-ressive nephropathy. Despite the established relationship between soy and renoprotection, further studies are needed for a clear understanding of the role of the cellular and molecular target（s） of soy protein in main-taining renal function.