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目的 分析彩色多普勒血流显像(CDFI)与肾活检在移植肾排异中的作用，评估无创性CDFI对移植肾术后的诊断价值。方法 对59例肾移植术后患者行CDFI检查并参照病理诊断，对二维图像、彩色血流图、血流频谱及阻力指数(RI)、搏动指数(PI)、收缩期与舒张期血流速度比(S/D)等参数进行分析。结果 急性排异组的RI值为0．77±0．05，PI值为1．47±0．33，S/D为4．01±1．33；慢性排异组的RI值为0．72±0．07，PI值为1．22±0．51，S/D为2．90±1．01，两组RI值、PI值、S/D明显高于正常组(RI值0．57±0．07；PI值0．87±0．28；S/D为2．33±0．42)。手术后早期急性排异患者CDFI可靠评价移植肾低灌注，RI＜0．72。结论 CDFI监测移植肾后的排异反应快速，准确无创，可早期发现病情变化并指导治疗。

Background This study aims to investigate the potential association of peripheral inflammatory blood cell parameters with the incidence and progression of chronic kidney disease (CKD) in patients with diabetes. Methods The cross‐sectional study included 1192 subjects with diabetes derived from one center. The cohort study included 2060 subjects with diabetes derived from another two centers followed up for 4 years. Logistic regression and Cox proportional hazards models were used to evaluate the association of peripheral inflammatory blood cell with CKD. Results In the cross‐sectional study, neutrophil count performed best as an independent risk factor for CKD (odds ratio 2.556 [95% confidence interval 1.111, 5.879]) even after 1:1 case–control matching for age, gender, history of high blood pressure and duration of diabetes. Spline regression revealed a significant linear association of CKD incidence with continuous neutrophil count in excess of 3.6 × 109/L. In the cohort study, subjects were grouped based on tertile of neutrophil count and neutrophil‐to‐lymphocyte ratio. Cox regression analysis results showed that only neutrophil count was independently associated with CKD progression (the highest group vs. the lowest group, hazard ratio 2.293 [95% confidence interval 1.260, 4.171]) after fully adjusting for potential confounders. The cumulative incidence of CKD progression in patients with diabetes gradually increased with increasing neutrophil count (53 (7.7%) subjects in the lowest group vs. 60 (8.2%) in the middle group vs. 78 (12.2%) in the highest group). Conclusions This study suggested that neutrophil count is an independent risk factor for progression of CKD in patients with diabetes. 摘要 背景 本研究旨在探讨糖尿病人中外周血炎性细胞参数与慢性肾脏疾病(CKD)的发生和发展之间的潜在相关性。 方法 以1192名来自同一研究中心的受试者作为横断面研究。来自另外两个中心的2060名受试者随访4年，进入队列研究。采用Logistic回归和COX比例风险模型评价外周血炎性细胞与CKD的相关性。 结果 在横断面研究中，即使在年龄、性别、高血压病史和糖尿病病程进行1:1病例对照匹配后，中性粒细胞计数仍然是CKD的最相关的独立危险因素(OR 2.556[95%CI 1.111，5.879])。样条回归显示CKD发病率与中性粒细胞计数持续超过3.6×109/L呈显著线性相关。在队列研究中，受试者根据中性粒细胞计数和中性粒细胞/淋巴细胞比率的三分位进行分组。COX回归分析结果显示，在完全校正潜在混杂因素后，只有中性粒细胞计数与CKD进展独立相关(最高组vs.最低组，HR 2.293[95%CI 1.260，4.171])。随着中性粒细胞计数的增加，糖尿病患者CKD进展的累积发生率逐渐增加，最低组53例(7.7%)，中间组60例(8.2%)，最高组78例(12.2%)。 结论 本研究提示中性粒细胞计数是糖尿病患者CKD进展的独立危险因素。 HighlightsNeutrophil count was an independent risk factor for CKD in patients with diabetes, especially when it exceeded 3.6 × 109/L, and increased neutrophil count could predict progression of CKD in patients with diabetes.

Dear Editor, Disease and nutritional status are important factors controlling consumer nutrient requirements [ 1]. An estimated 4 billion people worldwide live primarily on plant-based diets. Approximately 10%- 15% of these people suffer from chronic kidney disease or gastrointestinal （GI） health issues [2].

Diabetic kidney disease (DKD) is one of the primary causes of end-stage renal disease (ESRD). Early diagnosis is very important in preventing the development of DKD. Urinary albumin excretion rate (UAER) and glomerular filtration rate (GFR) are widely accepted as criteria for the diagnosis and clinical grading of DKD, and microalbuminuria has been recommended as the first clinical sign of DKD. The natural history of DKD has been divided into three stages: normoalbuminuria, microalbuminuria, and macroalbuminuria. However, this clinical paradigm has been questioned recently, as studies have shown that a portion of diabetes mellitus (DM) patients with normoalbuminuria have progressive renal insufficiency, referred to as normoalbuminuric diabetic kidney disease (NADKD) or nonalbuminuric diabetic nephropathy. Epidemiologic research has demonstrated that normoalbuminuric diabetic kidney disease is common, and the large number of NADKD patients suggests that the traditional paradigm needs to be shifted. Currently, the pathogenesis of NADKD remains unclear, but many clinical studies have identified some clinical and pathological features of NADKD. In addition, the long-term outcomes of NADKD patients remain controversial. In this article, we reviewed the latest studies addressing the pathogenesis, pathology, treatment and prevention of NADKD.

摘要 背景: 本研究调查了2型糖尿病患者中性别差异对终末期肾脏疾病(ESKD)和死亡风险的影响, 以及性别对相关因素的调节效应。 方法: 这项多中心观察性队列研究包括4,328名2型糖尿病患者。使用Cox比例风险回归模型调整基线协变量, 估计性别对ESKD和死亡的风险比(HR)和95%置信区间(CI)。为评估风险调节, 使用Cox比例风险回归和泊松回归模型比较性别在患者特征上对ESKD和死亡的风险比和发生率。 结果: 在中位随访7年期间, 276名患者(男性70%)出现了ESKD, 而241名患者(男性68%)死亡。在调整多个协变量后, 男性相比女性患ESKD(HR 1.34; 95% CI 1.02, 1.75; p = 0.034)和死亡(HR 1.64; 95% CI 1.24, 2.16; p = 0.001)的风险更高。在微量白蛋白尿患者中, 相比于无蛋白尿和高度蛋白尿的患者, 男性相比女性患ESKD的风险要高得多(交互作用p值为0.04)。在约为300 mg/g的蛋白尿患者中, 男性的发病率也比女性高。在基线患者亚组中, 没有发现性别和死亡的关联差异。 结论:在2型糖尿病患者中, 男性相比女性患ESKD和死亡的风险更高。中度增加的蛋白尿与性别在发展ESKD方面的差异密切相关。

Diabetic nephropathy （DN） is one of the most common microvascular complications in diabetes mellitus patients and is characterized by thickened glomeruIar basement membrane, increased extracellular matrix formation, and podocyte loss. These phenomena lead to proteinuria and altered glomerular filtration rate, that is, the rate initially increases but progressively decreases. DN has become the leading cause of end-stage renal disease. Its prevalence shows a rapid growth trend and causes heavy social and economic burden in many countries. However, this disease is multifactorial, and its mechanism is poorly understood due to the complex pathogenesis of DN. In this review, we highlight the new molecular insights about the pathogenesis of DN from the aspects of immune inflammation response, epithelial-mesenchymal transition, apoptosis and mitochondrial damage, epigenetics, and podocyte-endothelial communication. This work offers groundwork for understanding the initiation and progression of DN, as well as provides ideas for developing new prevention and treatment measures.

摘要 背景 本研究旨在探讨糖尿病人中外周血炎性细胞参数与慢性肾脏疾病(CKD)的发生和发展之间的潜在相关性。 方法 以1192名来自同一研究中心的受试者作为横断面研究。来自另外两个中心的2060名受试者随访4年，进入队列研究。采用Logistic回归和COX比例风险模型评价外周血炎性细胞与CKD的相关性。 结果 在横断面研究中，即使在年龄、性别、高血压病史和糖尿病病程进行1:1病例对照匹配后，中性粒细胞计数仍然是CKD的最相关的独立危险因素(OR 2.556[95%CI 1.111，5.879])。样条回归显示CKD发病率与中性粒细胞计数持续超过3.6×109/L呈显著线性相关。在队列研究中，受试者根据中性粒细胞计数和中性粒细胞/淋巴细胞比率的三分位进行分组。COX回归分析结果显示，在完全校正潜在混杂因素后，只有中性粒细胞计数与CKD进展独立相关(最高组vs.最低组，HR 2.293[95%CI 1.260，4.171])。随着中性粒细胞计数的增加，糖尿病患者CKD进展的累积发生率逐渐增加，最低组53例(7.7%)，中间组60例(8.2%)，最高组78例(12.2%)。 结论 本研究提示中性粒细胞计数是糖尿病患者CKD进展的独立危险因素。

Background： Urine output （UO） is an essential criterion of the Kidney Disease Improving Global Outcomes （KD1GO） definition and classification system tbr acute kidney injury （AKI）, of which the diagnostic value has not been extensively studied. We aimed to determine whether AKI based on KDIGO UO criteria （KDtGOLro） could improve the diagnostic and prognostic accuracy, compared with KDIGO serum creatinine criteria （KDIGOscr）.Methods： We conducted a secondary analysis of the database of a previous study conducted by China Critical Care Clinical Trial Group （CCCCTG）, which was a 2-month prospective cohort study （July 1,2009 to August 31,2009） involving 3063 patients in 22 tertiary Intensive Care Units in Mainland of China. AKI was diagnosed and classified separately based on KDIGOt,o and KDlGOsc,. Hospital mortality of patients with more severe AKI classification based on KDIGOvo was compared with other patients by univariate and multivariate regression analyses. Results： The prevalence of AKl increased from 52.4% based on KDIGOscr to 55.4% based on KD1GOsc~ combined with KDIGOuo. KDIGOv~~ also restllted in an upgrade of AKI classification in 7.3% of patients, representing those with more severe AK1 classification based on KDIGOvo. Compared with non-AKI patients or those with maximum AKI classification by KDIGOscr, those with maximum AKI classification by KDIGOuo had a significantly higher hospital mortality of 58.4% （odds ratio [OR]： 7.580, 95% confidence interval [CI]： 4.141-13.873, P 〈 0.001）. In a multivariate logistic regression analysis, AKI based on KDIGOuo （OR： 2.891, 95% CI： 1.964-4.254, P 〈 0.001）, but not based on KDIGOscr （OR： 1.322, 95% CI： 0.902-1.939, P = 0.152）, was an independent risk factor for hospital mortality. Conclusion： UO was a criterion with additional value beyond creatinine criterion for AKI diagnosis and classification, which can help identify a group of patients with high risk of death.

Objective：In the upcoming era of precision medicine,searching for the early,noninvasive biomarkers has been the cornerstone and major challenge in the management of chronic kidney disease （CKD）.Urine contains rich biological information which could be the ideal source for noninvasive biomarkers of CKD.This review will discuss the recent advance in urinary biomarker.Data Sources：This review was based on data in articles published in the PubMed databases up to June 20,2017,with the following keywords：＂Chronic kidney disease＂,＂Biomarker＂,and ＂Urine＂.Study Selection：Original articles and important reviews on urinary biomarker were selected for this review.Results：Urinary biomarker studies of CKD mainly focused on urine sediment,supernatant,and urinary extracellular vesicles.The gene transcript （microRNA [miRNA],messenger RNA [mRNA]） biomarkers have been recently shown with diagnostic potential for CKD reflecting kidney function and histological change.However,challenges regarding technique and data analysis need to be resolved before translation to clinic.Conclusions：Different fractions of urine contain rich information for biomarker discovery,among which urine （extracellular vesicles） mRNA,miRNA,might represent promising biomarker for CKD.

Nephrin is a key molecule in podocytes to maintain normal slit diaphragm structure. Nephin interacts with many other podo- cyte and slit diaphragm protein and also mediates important cell signaling pathways in podocytes. Loss of nephrin during the development leads to the congenital nephrotic syndrome in children. Reduction of nephrin expression is often observed in adult kidney diseases including diabetic nephropathy and HIV-associated nephropathy. The critical role of nephrin has been confirmed by different animal models with nepbrin knockout and knockdown. Recent studies demonstrate that knockdown of nephrin expression in adult mice aggravates the progression of＇ unilateral nephrectomy and Adriamycin-induced kidney disease In addition to its critical role in maintaining normal glomerular filtration unit in the kidney, nephrin is also expressed in other organs. However, the exact role of nephrin in kidney and extra-renal organs has not been well characterized. Future studies are required to determine whether nephrin could be developed as a drug target to treat patients with kidney disease.