2016年 · 第32卷第09期

Well-functioning arteriovenous fistulas are essential for dialysis patients, and vascular stenosis is a common complication of them^[1]。 For the management of fistula stenosis, minimally invasive percutaneous transluminal angioplasty (PTA) is the main first-line treatment at present, including digital subtraction angiography (DSA) and ultrasound-guided two methods. In recent years, ultrasound-guided PTA technology has been widely used internationally with its unique advantages. More and more hospitals in China have tried to carry out ultrasound-guided PTA, and have achieved good curative results^[2]。 Ultrasound monitoring of vascular access can provide not only structural data on vascular anatomy but also functional data on hemodynamics, so it is used to evaluate the effectiveness of vascular access after percutaneous transluminal treatment. Clinically, the effect of PTA is usually monitored and evaluated immediately after PTA. However, many factors such as balloon dilation, local infiltration anesthesia and vasospasm after PTA have influence on blood vessels, so immediate measurement after operation may not be the best time. These influencing factors will gradually disappear over time, so choosing the right evaluation time should be careful. Searching the literature at home and abroad, no relevant reports were found. Therefore, this study intends to use ultrasound technology to monitor the vascular indexes of patients at different time nodes after PTA surgery to determine the best time for evaluation.

Central venous stenosis is a relatively common problem in hemodialysis patients, with an incidence rate of about 25% to 40%^[1]The function of the arteriovenous fistula is seriously affected. Patients with previous history of central vein catheterization are prone to central vein stenosis, but there are few reports of central vein stenosis caused by pacemaker leads. Now, 3 cases of central vein stenosis caused by pacemaker leads in our unit are summarized, and the relevant literature reports are as follows.

IgA nephropathy (IgAN) is a common primary glomerular disease with high incidence and poor prognosis. Its main pathological feature is the deposition of immune complexes in the mesangial region of the glomerulus^[1]。 At present, renal biopsy is still the gold standard for IgAN diagnosis. The onset of IgAN is insidious, while renal biopsy is an invasive examination, which is expensive and risky. Even if IgAN is suspected early in clinical practice, renal biopsy is often not easily accepted by patients. Moreover, the limitation of kidney biopsy can not fully assess the degree of kidney damage; It is also unrealistic to perform repeated renal biopsy to monitor disease activity and evaluate the effect of drug treatment. Patients with end-stage IgAN have a high recurrence rate after renal transplantation, and specific biomarkers are urgently needed to predict the recurrence rate of renal transplantation, optimize renal transplantation strategies, and guide drug therapy before and after transplantation^[2]。 Compared with renal puncture biopsy, peripheral blood detection is convenient, non-invasive, and can be repeatedly collected. It was found that galactose-deficient IgA1 (Gd-IgA1) molecules, circulating immune complexes, and peripheral microRNA (miRNA) in the peripheral blood of IgAN patients were involved in the occurrence and development of IgAN. At present, IgAN is generally believed to be a complex disease mediated by polygenic inheritance and immune mechanism^[3,4,5]These specific molecules will be an important source of biomarkers for studying IgAN.

Precision medicine proposes to use individual genetic information to guide the prevention, diagnosis and treatment of diseases^[1]。 Non-coding RNA (ncRNA) is a massive amount of genetic information mined from the human genome project and plays an important role in the occurrence and development of diabetic nephropathy (DN)^[2,3,4]。 By studying the role of ncRNA in the mechanism of DN, the cause of the disease can be accurately revealed, which is conducive to guiding the transformation of DN from traditional diagnosis and treatment to accurate individualized diagnosis and treatment. This article reviews the latest research progress on the role of ncRNA in the pathogenesis and diagnosis and treatment of DN.

In recent years, the incidence and mortality of chronic kidney disease (CKD) has increased year by year worldwide. The main complications include cardiovascular disease (CVD), mineral and bone disorder (MBD), anemia and malnutrition, etc. The prevention and treatment measures are important factors affecting the survival rate and quality of life of patients. leptin, a protein hormone produced mainly by white adipose tissue, affects energy metabolism by regulating the body's appetite. Recent studies have shown that leptin and its receptors are widely distributed in many tissues and organs of human body, such as hypothalamus, heart, bone, etc., and participate in the regulation of human energy metabolism, hematopoiesis, bone and cardiovascular system and other physiological functions. There was a positive correlation between serum leptin level and hemoglobin concentration in cancer patients^[1]； Low leptin levels can serve as a biomarker of malnutrition in older adults without concomitant thyroid disease, diabetes, edema, or kidney disease^[2]； Leptin is associated with markers of bone metabolism or bone formation in obese patients^[3]； Leptin as a predictor of death in patients with coronary heart disease^[4]。 The above studies have shown that leptin can have effects on nutrient metabolism, hematopoiesis, bone and cardiovascular system. This review presents the origin of leptin and its receptors, the levels of leptin in the blood circulation of patients with CKD, and analyzes its relationship with anemia, nutrition, bone mineral metabolism disorders and cardiovascular diseases.

Muscle exhaustion and muscle weakness are common in people with chronic kidney disease (CKD). Progressive muscle weakness can reduce the physical activity of patients, resulting in disability and reduced quality of life. In recent years, more and more evidence has shown that vitamin D (VitD), in addition to regulating calcium and phosphorus levels and bone metabolic balance, also plays an important non-classical role in various tissues and organs throughout the body, including the effect on muscle. Based on the literature review, we summarize the effects of VitD on muscle volume and muscle strength, and explore the relationship between serum VitD and muscle volume and muscle strength in CKD people.