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The first time a patient handed me a health report generated with artificial intelligence (AI), I paused in disbelief. It wasn't the creatinine level that unsettled me--it was the conclusion at the end: \"89% probability of reversible kidney injury with herbal regimen. Dialysis not recommended.\" Mrs. Wu, a 62-year-old grandmother with diabetic nephropathy, smiled and tapped her phone in triumph. \"See? Even the computer thinks our usual treatments are too harsh,\" she said. Beneath the buzzing fluorescent lights of the clinic, her swollen ankles quietly contradicted the algorithm's optimistic message.

Immunoglobulin A nephropathy (IgAN), the most prevalent primary glomerular disease, is a major cause of end-stage renal disease. Ferroptosis, a novel cell death mode induced by iron-dependent phospholipid peroxidation, has been implicated in the progression of chronic kidney disease. Whereas, Acyl-CoA synthetase long-chain family member 4 (ACSL4) is a key enzyme in pro-ferroptotic lipid metabolism that plays a critical role in ferroptosis. In this study, the role of ACSL4-mediated ferroptosis in IgAN progression was investigated by identifying the cell subset ACSL4 + Loop of Henle cells (LOHs) in IgAN via single-cell RNA sequencing (scRNA-seq). LOH cell populations were screened by dimensionality reduction with Uniform Manifold Approximation and Projection (UMAP), and ACSL4 + LOHs were annotated using cell marker genes. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes (GO/KEGG) pathway enrichment analyses were performed based on marker genes of ACSL4 + LOHs. Cell-cell communication networks were established to infer interactions between ACSL4 + LOHs and other cell types. Pathological changes and LOH proportions in IgAN and normal kidney tissues were observed by hematoxylin and eosin (H&E) and Masson staining. Expression levels of ACSL4 in LOHs were determined by immunofluorescence to further investigate its effect on cell function. The proportion of LOHs was significantly elevated in the IgAN group compared to the Control group, and ACSL4 expression was significantly upregulated in LOHs. ACSL4 + LOHs were highly expressed in the IgAN group and enriched in the Ferroptosis pathway. Cellular communication between ACSL4 + LOHs and ECs, MEs, and PTCs was significantly enhanced in interleukin-6 (IL6) ligand-receptor pairs (IL6R + IL6ST). The proportion of LOHs was elevated, and ACSL4 expression was significantly increased in LOHs in the IgAN group. High expression of ACSL4 + LOHs, as revealed by scRNA-seq analysis, may enhance ferroptosis in IgAN and trigger inflammatory responses, thereby contributing to disease progression. This study is expected to provide insights into the mechanisms underlying the progression of IgAN.

Background Post-acute care is rapidly developing in China; yet, a payment method for post-acute care has not been established. The Patient Driven Payment Model (PDPM) is a new case-mix system developed in the United States of America for classification of skilled nursing facility patients. This study aimed to examine the validity of an adapted version of PDPM for classifying post-acute care patients in China. Methods First, 13,496 post-acute care patients in seven facilities of Jinhua City from January 2018 to December 2020 were sampled and assigned to PDPM groups according to their clinical characteristics, functional status, and special care needs. Then, the effectiveness of grouping was analyzed by the percentage of variance in resource use explained by the classification (R 2 ), the reduction in variance (RIV), the class-specific coefficients of variation (CVs), and the weighted means for each group (case-mix indexes, CMIs). Results Under the adapted version of PDPM, each patient is classified into a group for each of the four case-mix adjusted components: (1) physical therapy and occupational therapy (PT&OT), (2) speech-language pathology (SLP), (3) nursing, and (4) non-therapy ancillary (NTA). Each component utilizes different criteria for classification. The adapted PDPM explained 11.1%, 6.1%, 14.0%, and 10.6% of the variance in PT&OT, SLP, nursing, and NTA cost per day, respectively, for the sample patients (all p  < 0.001), which were similar to the results in the United States of America. The CV achieved good homogeneity in 10 PT&OT groups (CV: 0.17–0.69), 12 nursing groups (CV: 0.09–0.66), and 6 NTA groups (CV: 0.38–0.64). The CMIs of groups spanned a 9-fold range in PT&OT (CMI: 0.22–1.96), 11-fold range in nursing (CMI: 0.59–6.33), and 4-fold range in NTA (CMI: 0.72–2.91). Conclusions Our findings provide preliminary evidence that the PDPM is a reliable and valid case-mix system for classifying post-acute care patients in China, which could inform future payment policy for post-acute care in China.

Nuclear factor erythroid 2-related factor 2 (Nrf2) regulates many critical genes associated with iron storage and transportation, the activity of which is influenced by E3 ligase-mediated ubiquitination. We wondered whether there is a deubiquitinase that mediates the deubiquitination of Nrf2 to stabilize Nrf2 expression and further prevent diabetic kidney disease (DKD). High glucose (HG) was applied to induce an model of DKD. The effects of HG on HK-2 cell viability, apoptosis, Fe level, Nrf2, and ubiquitin-specific protease 9X (USP9X) were assessed by cell counting kit-8 (CCK-8) assay, flow cytometry, iron assay, and Western blot. The direct interaction between Nrf2 and USP9X was analyzed using co-immunoprecipitation and ubiquitination assay. After transfection and ferrostatin-1 (Fer-1) intervention, Nrf2 and USP9X levels, cell viability, apoptosis, and Fe level were tested again. Reactive oxygen species (ROS), malondialdehyde (MDA), glutathione (GSH) contents, and ferroptosis-related markers were assessed by ROS assay kit, ELISA, and Western blot. HG reduced cell viability and levels of USP9X and Nrf2, while elevating apoptosis and Fe level. An interaction between USP9X and Nrf2 has been verified and USP9X deubiquitinated Nrf2. Nrf2 up-regulation augmented the viability, GSH content, and ferroptosis-related protein expressions, while suppressing the apoptosis, Fe level, MDA, and ROS content in HG-mediated HK-2 cells, which was reversed by USP9X silencing. Fer-1 offset the combined modulation of Nrf2 and siUSP9X on HG-induced HK-2 cells. USP9X mediates Nrf2 deubiquitinase to hamper the ferroptosis in DKD .

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a systemic autoimmune disease characterized by necrotizing small-vessel inflammation, frequently complicated by severe anemia and progressive renal injury. Anemia, affecting 73-92% of AAV patients, arises from multifactorial mechanisms including renal dysfunction, chronic inflammation, and iron dysregulation. Despite conventional immunosuppressive therapies, refractory anemia remains a significant challenge, with limited strategies targeting inflammation-driven hepcidin dysregulation. A 56-year-old woman presented with myeloperoxidase-specific antineutrophil cytoplasmic antibody (MPO-ANCA) positive AAV, transfusion-dependent anemia (hemoglobin: 56 g/L), and advanced chronic kidney disease with 55% tubulointerstitial atrophy. Initial management included cyclophosphamide, glucocorticoids, erythropoietin, and transfusions, yielding only a transient rise in hemoglobin (Hb) that rapidly declined despite treatment. Following the initiation of rituximab (RTX), her Hb level improved to 88 g/L within four weeks and normalized to 127 g/L after four biweekly infusions (500 mg each). Concurrently, MPO-ANCA titers decreased from 1:1280 to 1:80, and pulmonary infiltrates resolved. However, renal function remained impaired (serum creatinine: 229 µmol/L) due to irreversible fibrosis. This case demonstrates RTX's dual efficacy in suppressing autoimmunity and alleviating anemia, potentially through indirect effects on inflammatory pathways and iron metabolism. Early RTX use may reduce transfusion dependency and help stabilize renal function in refractory AAV, though advanced fibrosis limits recovery. These findings support RTX as a first-line option in AAV patients with severe anemia and evolving renal injury.

Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated fibrous inflammatory disease. Recently, an association between IgG4-RD and tuberculosis (TB) has been reported. We report a 56-year-old man complaining of a cough and poor appetite for 2 months and oliguria for 1 day. The patient was diagnosed with TB due to a manifestation of lymphatic TB and the radiological alterations of acute miliary pulmonary TB. He also presented with greatly elevated serum creatinine, non-albumin proteinuria, immunoglobulin subgroup IgG4, and immunoglobulin free light chain (FLC) levels. A diagnosis of IgG4-RKD was suggested by a renal biopsy. We then administered the patient glucocorticoid and anti-TB treatment for 4 months. The patient's renal function was completely restored and the manifestations of TB were alleviated. The necessity and complexity of differential diagnosis in patients with coexisting IgG4-RD and TB remains challenging. Early recognition and timely treatment are important for averting its progression. Long-term monitoring is required to assess for recurrence of IgG4-RD and TB activity.

Post-acute care is fast developing in China, yet a payment system for post-acute care has not been established. As stroke is the leading cause of mortality and disability in China, patients constitute a large share of post-acute-care patients among all hospitalized patients. This study was to identify the cost determinants and establish a case-mix classification of the post-acute care system for stroke patients in China. A total of 5401 post-acute stroke patients in seven hospitals of Jinhua City from January 2018 to December 2020 were selected. Demographic characteristics, medical status, functional measures (eg, the Barthel Index, Mini-Mental State Examination, Gugging Swallowing Screen, Hamilton Depression Scale), and cost data were extracted. Generalized linear model (GLM) and quantile regression (QR) were conducted to determine the predictors of cost, and a case-mix classification model was established using the decision-tree analysis. The GLM regression revealed that gender, tracheostomy, complication or comorbidity (CC), activities of daily living (ADL), and cognitive impairment were the main variables significantly affecting the hospitalization expenses of post-acute stroke patients. The QR model showed that the gender, tracheostomy and CC factors had a more significant impact on per diem costs on the upper quantiles. In contrast, cognitive impairment had a more substantial effect on the lower quantiles, and ADL significantly impacted the central quantile. Using tracheostomy, CC, and ADL as node variables of the regression tree, 12 classes were generated. The case-mix classification performed reliably and robustly, as measured by the reduction in the variation statistic (RIV=0.46) and class-specific coefficients of variation (CV less than 1.0; range: 0.18-0.81). QR has strengths in comprehensively identifying cost predictors across cost groups. Tracheostomy, CC, and ADL significantly can predict the expenses of post-acute care for stroke patients. The established case-mix classification system can inform the future payment policy of post-acute care in China.