Kidney & blood pressure research最新文献

Introduction: Patients with chronic kidney disease (CKD) often experience symptoms consistent with orthostatic hypotension (OH); however, not much is known about OH in this population. Therefore, study analyzed OH prevalence and risk according to renal function decline.

Methods: A community-based cohort study was conducted using data from the Korean Genome and Epidemiology Study (KoGES). OH prevalence was assessed at baseline and at a 2-year follow-up across three estimated glomerular filtration rate (eGFR) categories: high (≥90 mL/min/1.73 m2, G1), moderate (60-89 mL/min/1.73 m2, G2), and low (<60 mL/min/1.73 m2, G3).

Results: Among 9,597 participants, baseline OH, 2-year OH, and persistent OH were evaluated within each eGFR group: high (n = 6,743), moderate (n = 2,758), and low (n = 96). The low eGFR group demonstrated the highest prevalence of baseline OH (n = 52, p = 0.024) and 2-year OH (n = 42, p = 0.002). This group also exhibited the largest decline in systolic blood pressure at both baseline and follow-up. In adjusted logistic regression, participants aged <50 years with low eGFR had 3.54-fold higher odds of OH (p = 0.035). Additionally, adherence to a low-sodium diet was associated with increased 2-year OH prevalence across groups (p = 0.001).

Conclusion: The low eGFR group showed a higher baseline and follow-up OH prevalence. A low-sodium diet was also associated with elevated OH risk, underscoring the need for careful dietary management in patients with CKD.

Introduction: The morbidity and mortality of acute kidney injury (AKI) are increasing. Epigenetic regulation and immune cell infiltration are thought to be involved in AKI. However, the relationship between epigenetic regulation and immune cell infiltration in AKI has not been elucidated. This study was conducted to identify the differentially expressed genes (DEGs), differentially expressed RNA methylation genes (DEMGs), and infiltrated immune cells in the kidneys of ischemia-reperfusion induced-acute kidney injury (IRI-AKI) models and further explore their relationships in IRI-AKI.

Methods: This is a bioinformatic analysis using R programming language in 3 selected IRI-AKI datasets from the Gene Expression Omnibus (GEO) database, including 16 IRI-AKI kidney tissues and 10 normal kidney tissues. The DEGs were screened, and enrichment pathways were analyzed using gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) database. The DEMGs and core DEMGs were identified using the R package. The ROC curve was plotted to predict disease occurrence of 7 core DEMGs. The correlation of 7 core DEMGs and other genes was analyzed using Pearson's correlation test. The gene set enrichment analysis (GSEA) of each DEMG was conducted using the R package. The upstream miRNAs and transcript factors of 7 core DEMGs were predicted based on the RegNetwork database and Cytoscape software. The STITCH database was used to predict the possible binding compounds of the 7 core DEMGs. Immune cell infiltration in kidney tissues between the IRI-AKI group and control group was evaluated using the R package.

Results: A total of 2,367 DEGs were obtained, including 1,180 upregulated and 1,187 downregulated genes in IRI-AKI kidney associated with the cell structure, proliferation, molecule binding/interaction, and signaling pathways such as the leukocyte migration and chemokine signaling pathways. Ten DEMGs were identified, with Ythdf1, Rbm15, Trmt6, Hnrnpc, and Dnmt1 being significantly upregulated, while Lrpprc, Cyfip2, Mettl3, Ncbp2, and Nudt7 were significantly downregulated in IRI-AKI tissues. The molecules interacting with 7 core DEMGs were identified. Significant changes in the infiltration of 8 types of immune cells were observed in IRI-AKI kidneys compared to normal controls. The significant correlation between 6 core DEMGs and the infiltration of immune cells was observed.

Conclusion: IRI may induce AKI through RNA methylation to regulate the expression of genes involved in immune cell infiltration.

Introduction: Cardiovascular (CV) diseases persist as the foremost cause of morbidity/mortality among chronic kidney disease (CKD) patients. This paper examines the values of coronary artery calcification (CAC) and biomarkers of CV on major adverse CV events (MACE)/CV death in a sample of 425 non-dialysis CKD patients.

Methods: At inclusion, patients underwent chest multidetector computed tomography for CAC scoring and biomarkers of CV risk including CRP, mineral metabolism markers, fibroblast growth factor-23 (FGF-23), α-Klotho, osteoprotegerin, tartrate-resistant acid phosphatase 5b (TRAP5b), sclerostin, matrix gla protein (both dephosphorylated uncarboxylated [dp-ucMGP] and total uncarboxylated), and growth differentiation factor-15 (GDF-15) were measured. Patients were followed for a median of 3.61 years (25th-75th percentiles = 1.92-6.70).

Results: Our results reported that CAC was a major independent factor of MACE/CV mortality showing a hazard ratio of 1.71 95% (confidence interval = 1.00-2.93) after adjustment for age, gender, diabetes, and history of CV events for patients with CAC >300. Interestingly, CAC effect was further enhanced in the presence of low levels of 25(OH) vitamin D3 or α-Klotho and high levels of intact parathyroid hormone (PTH), high-sensitive C reactive protein, FGF-23, osteoprotegerin, sclerostin, dp-ucMGP, or GDF-15.

Conclusion: CAC constitutes a significant CV risk, further exacerbated by inflammation, hyperparathyroidism, and regulation of bone molecules implicated in calcification progression. This finding aligns with the original concept of multiple hits. Consequently, addressing the detrimental environment that fosters plaque vulnerability, reducing chronic low-grade inflammation, and normalizing mineral metabolism markers (such as vitamin D and PTH) and bone-regulating molecules may emerge as a viable therapeutic strategy.

Background: Chronic kidney disease (CKD) is a global health concern, with renal fibrosis being a major pathological feature. Empagliflozin (Empa), a sodium-glucose co-transporter-2 inhibitor, has shown promise in protecting the kidney. This study aimed to investigate the effects of Empa on renal fibrosis in a nondiabetic CKD model and to elucidate the underlying mechanisms.

Methods: We established a CKD model using 5/6 nephrectomy (5/6 Nx) rats and divided them into three groups: placebo-treated sham surgery rats, placebo-treated 5/6 Nx rats, and Empa-treated 5/6 Nx rats. Kidney function was assessed by measuring blood urea nitrogen, serum creatinine, and urinary albumin-to-creatinine ratio. Renal fibrosis was evaluated histologically. Single-cell RNA sequencing (scRNA-seq) was performed to analyze intercellular communication networks and identify alterations in ligand-receptor pairs and signaling pathways involved in fibrosis.

Results: Empa treatment significantly improved kidney function and reduced renal interstitial fibrosis in 5/6 Nx rats. scRNA-seq revealed that Empa modulated the TGF-β signaling pathway, inhibited intercellular communication, and reduced the expression of fibrotic genes such as COLLAGEN, FN1, THBS, and LAMININ. Furthermore, Empa downregulated GRN gene expression, weakened signal transmission in the MIF pathway, consequently reduced the interaction between M2 macrophages and other cell types, such as endothelial cells, fibroblasts, and mesangial cells.

Conclusion: This study elucidates the potential mechanisms by which Empa slows the progression of renal fibrosis in nondiabetic CKD. By reducing the number of M2 macrophages and inhibiting signal transduction in both pro-inflammatory and fibrotic pathways, Empa modulates the intercellular communication network in renal cells, offering a promising therapeutic strategy for CKD management.

Objective: The objective of this study was to explore the value of Nutritional Risk Screening 2002 (NRS2002) and Subjective Global Assessment (SGA) scores in diagnosing malnutrition in patients with chronic kidney disease (CKD).

Methods: A retrospective analysis was conducted on 87 patients with CKD admitted to our hospital from July 2023 to July 2024. Patient demographics were collected, and patients were grouped based on age, using 60 years as the cut-off. Clinical data were collected, and the number of cases with malnutrition and normal nutrition assessed by NRS2002 and SGA scores was calculated for different age and gender groups of CKD patients. Spearman's rank correlation analysis was used to assess the correlation between NRS2002 scores, SGA scores, and clinical data among CKD patients of different genders. Binary multivariable logistic regression analysis was performed to analyze the influencing factors of malnutrition in CKD patients evaluated by NRS2002 scores and SGA scores.

Results: Among the CKD patients, 47.13% were classified as malnourished based on BMI, 65.52% based on NRS2002 scores, and 59.77% based on SGA scores. Correlation analysis showed a significant positive correlation between NRS2002 and SGA scores. Furthermore, NRS2002 scores and SGA scores exhibited a significant positive correlation with age (p < 0.001). Binary multivariable logistic regression analysis identified stage IV, age, BMI, RBC, Tp, PA, ALB, and GFR as significant factors associated with malnutrition in CKD patients.

Conclusion: The NRS2002 and SGA scores are valuable tools for diagnosing malnutrition in CKD patients. Early detection and management of malnutrition can improve patient outcomes in this population.

Introduction: Diabetic nephropathy (DN) is a serious complication of diabetes. In this study, we aimed to develop a diagnostic model for DN based on PANoptosis-related genes.

Methods: PANoptosis-related differentially expressed gene (DEGs) associated with DN were identified in the GSE96804 and GSE142025 datasets. Pairwise correlations among these genes were assessed via Pearson correlation analysis. Immune cell abundance in DN patients versus controls was compared in GSE96804. Feature genes for DN prediction were selected with machine learning, and a diagnostic model was constructed using LASSO regression. High-risk and low-risk groups were established based on risk scores, with GSEA used to explore enriched biological processes and pathways. The association between risk scores and immune cell infiltration was examined using CIBERSORT. Potential therapeutic drugs were investigated via the DGIdb database.

Results: Six PANoptosis-related DEGs were found. Immune cell analysis showed significant differences in dendritic cells, macrophages, mast cells, and neutrophils between DN patients and controls. A diagnostic model using three genes (PDK4, YWHAH, PRKX) achieved high accuracy (area under the curve = 0.8-1.0) across datasets, with a reliable nomogram for DN prediction. Risk stratification linked higher risk scores to distinct immune infiltration patterns and enriched cellular transport and metabolic pathways in high-risk DN patients. Protein-protein interaction network and correlation analyses revealed complex gene interactions. Potential therapeutic targets (PRKX, PDK4) and drugs were identified, and quantitative PCR validated YWHAH upregulation in patient plasma samples.

Conclusion: The integration of PANoptosis-related genes PDK4, YWHAH, and PRKX offers a promising diagnostic model for DN, with YWHAH potentially involved in the pathological progression of DN.

Background: Kidney transplantation was an effective method for treating chronic kidney failure via transplanting a healthy kidney from a donor to a patient with the loss of kidney function. However, clinical studies revealed that the posttransplantation status of patients was associated with a substantial aggregation of risk factors contributing to metabolic syndrome.

Summary: This article provided a comprehensive review of the current researches on metabolic syndrome after kidney transplantation, and the latest advances in the interaction between metabolism and immune cells were also covered.

Key messages: Our aim was to identify and intervene high-risk recipients in time and thus improving the prognosis of recipients.

Introduction: Kidney stone caused by calcium oxalate (CaOx) is a chronic kidney disease. Acyl-coenzyme A thioesterases (ACOTs) serve as the key regulators of fatty acid metabolism. However, ACOTs' effect on CaOx kidney stone formation remains to be explored. Here, we aimed to investigate the effect of ACOTs on CaOx kidney stone formation.

Methods: HK-2 and M-1 cells were cultured in DMEM/F12 medium supplemented with 10% FBS. Cells were treated with varying concentrations of calcium oxalate (CaOx) and transfected with siRNA or plasmid vectors targeting ACOT4 and ACOT6 using Lipofectamine RNAiMAX or Lipofectamine 3000. RT-qPCR and Western blotting were used to analyze gene and protein expression. Cell viability was assessed with CCK-8, and cell apoptosis was measured by flow cytometry. Crystal adhesion was visualized under a microscope. Lactate dehydrogenase (LDH) release was measured using a cytotoxicity assay kit. A kidney stone mouse model was established by injecting glyoxylic acid to induce kidney stones, and tissues were analyzed by Western blotting.

Results: The mRNA and protein levels of several ACOT family members were upregulated in HK-2 cells treated with CaOx (inducing cell injury). Knockdown of ACOT4 and ACOT6 significantly suppressed the activity of CaOx-pretreated HK-2 and M-1 cells, and promoted the crystal formation and LDH release, whereas overexpression of ACOT4 and ACOT6 reduced CaOx crystal-induced kidney cell injury. Furthermore, the levels of p-AKT and p-S6 decreased after ACOT4 and ACOT6 knockdown and increased following ACOT4 and ACOT6 overexpression, suggesting that both ACOT4 and ACOT6 activated Akt/mTOR signaling pathway in HK-2 cells. We also observed that knockdown of ACOT4 and ACOT6 induced the apoptosis of HK-2 cells after CaOx treatment. Inhibition of apoptosis using Z-VAD-FMK reversed the enhanced cell injury caused by CaOx treatment and ACOT4/6 knockdown, suggesting that knockdown of ACOT4 and ACOT6 promoted cell injury via inducing cell apoptosis.

Conclusions: ACOT4 and ACOT6 could be protecting factors for kidney cell injury induced by CaOx via reducing apoptosis and activating Akt/mTOR signaling pathway. The study of the role of ACOT4 and ACOT6 in kidney cell injury provides a new insight into the cause of CaOx kidney stone formation. Its in-depth study may provide new targets for stone treatment.

Introduction: IgA nephropathy (IgAN) is characterized by hematuria but can present with different clinical presentations. Proteinuria has been reported as the most important risk factor for the progression of IgAN and it may be related to podocyte injury.

Methods: The kidney biopsy samples from patients with IgAN were analyzed using immunohistochemistry for WT1 to determine podocyte density and transmission electron microscopy to assess ultrastructural changes in podocytes and adjacent structures. A comparative group of patients diagnosed with minimal change disease (MCD) and a control group of autopsy samples without kidney disease were included.

Results: Slit diaphragm density was lower in IgAN cases compared to controls but higher than in MCD cases. Podocyte density was significantly lower in the IgAN and MCD groups compared to controls, with the MCD group showing even lower density than the IgAN group. Podocyte density was lower in cases with nephrotic proteinuria both in MCD and IgAN. A significant negative correlation was detected between podocyte density and proteinuria in both conditions. A significantly lower proportion of detached podocytes was observed in cases with isolated autophagy and cases with autophagy showed a lower frequency of hematuria and a higher percentage of T0.

Conclusion: We demonstrated that podocyte alterations in IgAN correlate with clinical parameters, including nephrotic proteinuria, hematuria, and interstitial fibrosis. Podocyte loss was associated with necrosis and mitotic catastrophe, while autophagy was prevalent but not apoptosis. Autophagy appears to protect against podocyte detachment. These findings highlight pathophysiological mechanisms relevant to diagnostic and clinical practice.

Background: The pathogenesis of systemic lupus erythematosus (SLE) remains complex, and studies have found that abnormal lipid metabolism may be involved in the disease. Therefore, we aim to investigate the dyslipidemia in SLE patients and analyze the relationship between lipid metabolism and the disease activity.

Methods: A total of 174 patients diagnosed with SLE were enrolled in Henan Provincial People's Hospital from December 2016 to September 2022. Clinical data and laboratory indicators were collected, and SLE patients were grouped according to the levels of serum lipid. SPSS 26.0 statistical software was used for comparative analysis of SLE patients.

Results: The prevalence of dyslipidemia was about 92.53% (161/174), mainly with decreased high-density lipoprotein cholesterol (HDL; 125/174, 77.64%) and increased triglyceride (TG; 86/174, 53.42%). The lipids were positively correlated with inflammatory indexes, such as white blood cell (WBC), neutrophil, systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and so on. Furthermore, the blood lipid levels were significantly correlated with SLEDAI-2K, erythrocyte sedimentation rate, C3, C4, blood urea nitrogen (BUN), serum creatinine (Scr), and 24-h urine protein (p < 0.05). With the increasing types of dyslipidemia, the value of inflammatory indicators such as WBC and SII were higher, as well as the rate of kidney involvement. This is manifested by the elevation of renal function parameters such as BUN, Scr, eGFR and 24-h urine protein levels, while the levels of IgG, total protein and albumin decrease accordingly. The area under the curve (AUC) values of total cholesterol (TC), TG and low-density lipoprotein cholesterol (LDL) predicting lupus nephritis were 0.759, 0.713, and 0.729, which provided 69.6%, 81.4% and 63.7% sensitivity, and 76.4%, 56.9% and 73.6% specificity, respectively. With an AUC of 0.771, the combined detection of TC, TG, HDL, and LDL exhibited a greater potential for discrimination than any separate measurements.

Conclusions: Dyslipidemia is prevalent among SLE patients, and the levels of lipid can be informative in predicting renal involvement in SLE. It is crucial to monitor lipid levels and inflammation indexes and take lipid-lowering therapy along the discourse of SLE.