Nephrology最新文献

We report the case of a 38-year-old Caucasian man with well-controlled HIV on antiretroviral therapy who developed nephrotic syndrome. The patient presented with a maculopapular rash, lymphadenopathy, oral lesions, nasal congestion and bilateral pitting oedema. Laboratory tests revealed hypoalbuminemia, nephrotic range proteinuria and abnormal liver function. Further investigations confirmed secondary syphilis with positive Treponema pallidum serology. Kidney biopsy showed membranous nephropathy. Treatment with Benzathine benzylpenicillin resulted in a rapid resolution of nephrotic syndrome, improved liver function and normalisation of serum albumin levels. This case highlights the rare but recognised link between syphilis and nephrotic syndrome, emphasising the importance of prompt diagnosis and antibiotic treatment to prevent the need for more aggressive treatments. Syphilis can cause a variety of systemic manifestations, and co-infection with HIV is common due to their shared transmission route. Healthcare providers must remain vigilant in considering syphilis as a potential cause of nephrotic syndrome in HIV-positive patients, particularly when other clinical and laboratory features suggest its presence.

Aim: This research examined the role and possible regulatory mechanisms of lncRNA GAS5 in the occurrence and progression of primary nephrotic syndrome (PNS) to provide biomarkers for early screening of PNS in the clinic.

Methods: RT-qPCR was employed to assess the expression levels of GAS5 and miR-144-5p. ROC analysis was conducted to evaluate their predictive capabilities for PNS. The interaction between GAS5 and miR-144-5p was confirmed using a dual-luciferase assay. Following this, GAS5 overexpression plasmids, along with co-transfected plasmids, were introduced into podocytes to examine their impact on the inflammatory factors, oxidative stress index, cell proliferation and apoptosis. Furthermore, we performed GO and KEGG enrichment analyses, along with PPI analysis, on the target genes of miR-144-5p to speculate on its potential functions and to identify critical genes.

Results: The expression levels of GAS5 were decreased while miR-144-5p levels were elevated in PNS patients. The diagnostic approach of serum GAS5 combined with miR-144-5p improved the accuracy of identification. GAS5 was observed to inhibit inflammation and oxidative stress responses and the apoptosis of MPC-5 cells, and enhance cell proliferation. However, the overexpression of miR-144-5p counteracted the effect of GAS5 on podocyte function. Enrichment analysis suggested the miR-144-5p target genes could affect podocyte structure, homeostasis and cell growth. PTEN and STAT3 are identified as critical regulatory targets.

Conclusion: The sponging effect of GAS5 on miR-144-5p caused changes in PTEN mRNA expression and could potentially prevent or mitigate PNS. GAS5 is expected to become a potential target for treating PNS.

Heart transplant remains the treatment of choice for patients with advanced heart failure (HF). However, due to a lack of donor organs, left ventricular assist devices (LVADs) have been used as a bridge until donor organs become available. Recently, we have observed more patients with advanced HF being placed on LVAD as destination therapies, particularly in patients with contraindications to heart transplantation. Acute kidney injury (AKI) post-LVAD implantation is common. Even with renal recovery, these patients are surviving longer and hence it is not uncommon for them to eventually develop chronic kidney disease (CKD), potentially progressing to end-stage kidney disease (ESKD) requiring kidney replacement therapy (KRT). There remains a paucity of published literature to guide prescription and management of LVAD recipients on long-term maintenance KRT, particularly in the community setting. Even the latest international guidelines on mechanical circulatory support (MCS) fail to provide adequate guidance for the management of such patients. We present a case of a patient who was on LVAD for 2 years prior to developing ESKD and share our experience of transitioning her from an inpatient hospital setting to the community haemodialysis centre with the help of a multi-disciplinary care team consisting of the cardiothoracic surgeon, cardiologist, nephrologist, LVAD coordinators, and the community haemodialysis centre nursing team. We aim to share the considerations in management of LVAD recipients on maintenance haemodialysis in a community dialysis centre and how we cared for such a patient. With an increasing prevalence of LVAD patients with renal impairment potentially requiring KRT, a standardised multidisciplinary team approach will be essential to ensure better care for these patients in the immediate post-operative setting and offer these patients the option of eventual discharge to the community.

Aim: Acute kidney injury (AKI) is a common complication in cancer patients and significantly impacts their treatment and prognosis. To better understand the epidemiology and clinical implications of AKI in hospitalised cancer patients, this study was designed to determine the incidence of AKI, identify risk factors for AKI and assess the impact of AKI on in-hospital outcomes.

Methods: Retrospective analysis of 68 379 cancer admissions in 2019. AKI incidence, risk factors (demographics, comorbidities and clinical characteristics), and impact on in-hospital mortality and length of stay were assessed. Logistic regression was employed to identify the risk factors for AKI. Survival analysis was conducted using the Cox proportional hazards model, with log-rank statistics used to assess survival outcome.

Results: Of the 68 379 eligible cancer admissions, 7734 AKI cases were recognised with an incidence rate of 11.3%. The highest rates were observed in renal cancer (40.1%), ureter cancer (27.9%) and multiple myeloma (16.1%). Clinical risk factors such as age > 50 years, body mass index < 18.5 kg/m², and hyperuricemia were significantly associated with hospital-acquired AKI compared to the non-AKI group (p < 0.001). In cases of severe community-acquired AKI, significant differences in hypertension, anaemia and leukocyte elevation were also observed (p < 0.001). The mortality rate was notably higher in AKI patients, especially in the severe AKI subgroup. The length of stay was markedly prolonged in patients with hospital-acquired and severe AKI, further underscoring the clinical burden of this complication.

Conclusion: Hospitalised cancer patients experience a high incidence of AKI. Identifying and mitigating risk factors may improve patient outcomes.

Aim: This study aimed to investigate the contribution of interleukin (IL)-10-producing regulatory B cells (B10 cells) to the pathogenesis of PNS.

Methods: The percentages of B10 cells, CD19⁺CD24^hiCD27⁺ B cells, CD19⁺CD24^hiCD38^hi B cells, CD19⁺CD24^hiCD27⁺IL-10⁺ B cells, CD19⁺CD24^hiCD38^hiIL-10⁺ B cells, Th17 cells, and regulatory T (Treg) cells within the peripheral blood mononuclear cells (PBMCs) from healthy subjects and PNS patients with active disease or in remission were analysed by flow cytometry.

Results: The percentages and IL-10 production of circulating B10 cells and the two subsets were decreased in children with active PNS and returned to normal levels in PNS patients in remission. B10 cells and their subsets were negatively correlated with the Th17/Treg ratio. The percentages of B10pro+B10 cells, CD19⁺CD24^hiCD27⁺IL-10⁺ B cells, CD19⁺CD24^hiCD38^hiIL-10⁺ B cells, Th17 cells, Treg cells, and the Th17/Treg ratio did not significantly differ between groups after CpG and CD40L stimulation. However, in the presence of CpG and anti-CD40L mAb, the percentages of B10pro+B10 cells, CD19⁺CD24^hiCD27⁺IL-10⁺ B cells, CD19⁺CD24^hiCD38^hiIL-10⁺ B cells, and Treg cells were significantly reduced, whereas the Th17 cell percentage and the Th17/Treg ratio were significantly increased. Furthermore, the Th17/Treg ratio correlated negatively, whereas the percentages of B10 cells and their subsets correlated positively with serum immunoglobulin G (IgG) concentration.

Conclusion: Our study demonstrates that the numbers of B10 cells and their ability to produce IL-10 are decreased, leading to an imbalance in the Th17/Treg ratio and low IgG levels, which may then contribute to the pathogenesis of PNS.