2017年 · 第33卷第01期

calcineurin binding protein 1 (Cabin1) is an endogenous calcineurin (CaN) inhibitor, and there is a p53 binding site at the N-terminal, which is involved in neuronal differentiation, cardiomyocyte hypertrophy, and the regulation of T lymphocyte apoptosis^[1,2]。 We found that Cabin1 was localized to the podocyte nucleus in 5/6 nephrectomy models and in cultured podocytes in vitro, and its protein expression was significantly elevated upon podocyte injury^[3]。 It was found that podocyte injury is closely related to mitochondrial injury, but the specific molecular mechanism is not clear^[4]。 This study aimed to investigate the mechanism of action of Cabin1 in mitochondrial damage of podocytes.

A 65-year-old male was admitted to the hospital because of "peritoneal dialysis catheter leakage for 1 d 7 years after peritoneal dialysis catheter placement". Seven years ago, the patient underwent peritoneal dialysis catheterization in the right lower abdomen due to "obstructive nephropathy, chronic kidney disease stage 5", and was treated with continuous ambulatory peritoneal dialysis (CAPD) after operation. Five years ago, peritoneal dialysis-related peritonitis caused by operative contamination was performed in the left lower abdomen. "2.5% glucose peritoneal dialysis solution 2000 ml ×1 bag +1.5% glucose peritoneal dialysis solution 2000 ml ×3 bags of CAPD night abdominal retention" was treated. One day ago, there was leakage at the skin outlet of the peritoneal dialysis tube and he was admitted to hospital. There was no fever, soft abdomen, mild tenderness and no rebound pain at admission. A little exudate can be seen at the skin outlet of the left lower abdominal peritoneal dialysis catheter about 1 cm, and the perforation of the catheter is about 1 mm ×1 mm. The appearance of the exudate is still clear. Blood routine: white blood cells 6.42×10⁹/L, neutrophil ratio 0.771. Ascites routine: white blood cell count 10×10⁶/L. CRP 7.02 mg/L. Preliminary diagnosis: perforation of peritoneal dialysis catheter; Obstructive nephropathy, chronic kidney stage 5; Post-peritoneal dialysis catheterization.

A 58-year-old female was admitted for "regular dialysis for 5 years and swelling of the right upper limb for 8 months". The patient underwent brachial artery-Guiyao vein fistula in the right upper arm in the external hospital 2 years ago. Eight months ago, he developed swelling of the right upper limb with skin flushing. The anti-infective treatment in the external hospital was not effective. In the past month, the skin of the right forearm appeared ulcerated with local bleeding and exudation, so he was transferred to our hospital. The patient had no previous history of diabetes, vasculitis, etc. Physical examination: body temperature 37.6℃, blood pressure 150/82 mmHg, severe depression and edema of the right upper limb, pigmentation of the right forearm with increased skin temperature, a 3 cm ×3 cm ulcer with irregular edges, with a small amount of pale yellow bleeding and exudation, and no edema on the face and both lower limbs. Blood routine: White blood cell count (WBC) 4.8×10⁹/L, neutrophils 71.9%; Procalcitonin 13.24 μ g/L. Skin breakage secretions were cultured as Staphylococcus aureus, resistant to multiple drugs. Computed tomography (CT) venography of both upper limbs showed obvious thickening and swelling of muscular adipose tissue of the right forearm, edema of the right axilla and enlarged lymph nodes; The right upper extremity vein is tortuous and dilated, the right anonymous vein is subtotal occluded, the right lower jugular vein is significantly narrowed, and the collateral circulation is open, seeFigure 1。 Then, venography of the right upper arm was given, which showed that the superficial vein of the right upper arm was tortuous and dilated. The brachial vein, axillary vein and subclavian vein were not developed, and the collateral vessels were developed around it, and the blood flow was slow, seeFigure 2。 After admission, the patient had repeated fever, with a maximum body temperature of 40.0℃, and was diagnosed as "venous occlusion of right upper arm and skin ulcer of right forearm". The patient was allergic to cephalosporin antibiotics and vancomycin, so he was given moxifloxacin anti-infection, local debridement care, infrared local irradiation and other treatments; Arteriovenous fistula ligation of the right upper arm was performed. The swelling of the right upper limb resolved significantly on the first day after operation. After 1 month of active anti-infective treatment, the patient's body temperature was normal, the rupture point of right forearm healed, and the swelling subsided. The blood routine was reviewed: WBC 3.2×10⁹/L, neutrophils 62.5%; procalcitonin 0.76 μ g/L; Artificial vascular fistuloplasty of the left upper limb was performed, with obvious tremor and clear murmur after operation.

Anemia is one of the most common clinical manifestations in the population and a public health problem with the highest prevalence and high concern globally. Anemia is very common in patients with chronic kidney disease (CKD), which not only increases patients' medical expenses, reduces their quality of life, but may even affect their long-term prognosis. Supplementation of erythropoietin (EPO) and iron is an effective means to correct anemia. However, several clinical trials suggest that high-dose EPO may increase the risk of cardiovascular disease and mortality in patients with CKD^[1,2,3]and even promote tumor progression^[4]There is also a risk of adverse gastrointestinal reactions and iron overload. Faced with the above risks and challenges, the research and development of new drugs for anemia has received more attention, among which drugs related to the hypoxia-inducible factor (HIF) pathway have become research hotspots. By reviewing the mechanism of EPO and iron metabolism in increasing erythrocyte synthesis, the mechanism and clinical application of hypoxia-inducible factor and erythrocyte synthesis were reviewed.

According to the World Health Organization, around 185 million people worldwide are infected with hepatitis C virus (HCV), with an estimated infection rate of 2.8%^[1]。 Among hemodialysis (hemodialysis) patients, this number reaches 3.6% to 15.0%^[2,3,4]。 Although medical institutions have strengthened the supervision of blood products in recent years and conducted zoned hemodialysis for patients, the base of patients infected with HCV is still huge. Compared with patients with normal renal function, patients with renal insufficiency have a more rapid progression of liver disease after HCV infection and a higher liver disease-related mortality rate. HCV infection is an independent risk factor for chronic kidney disease and end-stage kidney disease (ESRD)^[5]It can be seen that the relationship between the two is close. Studies have shown that effective antiviral therapy can reduce proteinuria and stabilize creatinine levels^[6]。 Therefore, antiviral therapy is particularly important for people with renal insufficiency and HCV infection. Since 2002, the treatment regimen of peginterferon combined with ribavirin has become the global standard regimen against HCV, and it is also the main treatment option for patients with hepatitis C virus (Hepatitis C) in China^[7]However, in patients with renal insufficiency complicated with HCV infection, there is often intolerance to interferon and the need to reduce the dose of ribavirin, and the sustained virologic response rate (SVR) is significantly reduced^[8]。 Tseng et al.^[9]A study showed that 26 hemodialysis patients receiving peginterferon combined with ribavirin for 24 to 48 weeks (according to different viral genotypes) had an SVR of 62% and a severe anemia incidence of 58%. Liu et al.^[10]A 2013 study showed that 103 hemodialysis patients who received a combination treatment regimen, for a total of 48 weeks, had an SVR of 64%, and needed larger and longer erythropoietin therapy. In recent years, direct-acting antiviral agents (DAAs) have been introduced as landmark drugs, which can achieve a cure rate of>90% and a low incidence of adverse reactions in patients with normal renal function^[11]。 Therefore, people began to gradually explore the application of DAAs in antiviral treatment of special populations.

hemodialysis access-induced distal ischemia (HAIDI) refers to a series of clinical symptoms caused by hypoperfusion of the distal limb due to local hemodynamic changes after the establishment of dynamic and static internal fistula, which is characterized by cold, pale, numbness, pain, etc. in the distal limb. In severe cases, ulcer or even necrosis of the finger tip or extremity may occur. HAIDI is a rare but serious complication of arteriovenous fistula and should be given sufficient attention. This article will review the clinical manifestations, auxiliary examination and treatment of HAIDI.