2018年 · 第34卷第12期

Pathological examination of renal biopsy can clarify the pathological changes and pathological types of renal diseases, which is of great significance for the diagnosis, treatment plan formulation and prognosis judgment of renal diseases. At the same time, it can also provide important information and diagnostic basis for revealing the pathogenesis of kidney diseases and discovering new kidney diseases. In addition, pathological examination of renal biopsy is also an important part of clinical research through systematic analysis of renal pathological data, comparison of repeated renal biopsy pathology and as an evaluation index of clinical trial. Therefore, it is very important to standardize the pathological examination and pathological diagnosis of renal biopsy. Routine pathological examination of renal biopsy should include light microscope (light microscope), immunopathology (mainly immunofluorescence) and electron microscope (electron microscope) examination. The three kinds of examinations reflect different emphases of pathological changes, and only by combining and complementing each other can standardized pathological diagnosis be made. In recent years, with the application of new technologies including gene detection and biomass spectrometry in clinical disease diagnosis and research, great progress has been made in the study of etiology and pathogenesis of kidney diseases. Therefore, new pathological classification of kidney diseases and new pathological diagnosis models based on etiology and pathophysiological pathogenesis have been proposed internationally^[1]。 For a long time, the pathology of kidney biopsy in China lacks a unified and standardized pathological diagnosis model. Many units have great differences in the preparation of kidney biopsy tissue specimens and reading diagnosis, which affects the level of kidney biopsy pathological diagnosis, which is not conducive to the treatment of patients, nor is it conducive to clinical research cooperation and academic exchanges at home and abroad. In order to meet the needs of modern diagnosis and treatment mode and precision medicine, and at the same time be in line with the diagnostic concept of international renal pathology, we refer to the pathological diagnosis mode of international renal pathology community, and through systematic literature retrieval and repeated discussion of the material collection and film making technology, pathological observation and diagnosis process and pathological reporting mode of renal biopsy pathological diagnosis by domestic peers, we formulated an expert consensus on standardized diagnosis of renal biopsy pathology for reference by clinical and pathologists, technicians and scientific researchers in China.

Patients with chronic kidney disease (CKD) often suffer from decreased bone mineral density, osteoporosis and vascular calcification, which seriously restrict the quality of life and prognosis of patients. In recent years, it has been found that bone disease and vascular lesions in CKD have the same pathophysiological mechanism, also known as bone-vascular axis dialogue. This review focuses on the pathogenesis and treatment progress of bone (osteoporosis) -vascular (vascular calcification) lesions in CKD, and looks at the interaction between bone and vascular lesions in CKD from the perspective of integrative medicine. It is necessary to intervene at the same time for vascular calcification and osteoporosis lesions, so as to effectively control the disease and improve the prognosis of CKD patients.

monoclonal gammopathies (MGP) are diseases caused by the proliferation of a single clone of B cells or plasma cells that can produce and secrete a large number of unique types of monoclonal immunoglobulin (MIg) or (and) its fragments (light or heavy chains). Its monoclonal components include heavy chains (gamma is most common, with fewer alpha, mu, delta, epsilon) and light chains (kappa or lambda), light chains or, in rare cases, only heavy chains^[1]。 MGP can cause various organ injuries, and the kidney is one of the common organs involved. In 2003, the International Working Group on Myeloma revised the diagnostic and classification criteria for this type of clinical disease^[2], and divided them into 4 different types: (1) monolonal gammopathy of undetermined significance (MGUS): monoclonal components<30 g/L, bone marrow plasma cell proliferation<10%, lack of clinical evidence for diagnosis of myeloma, lymphoma, or amyloidosis; (2) Asymptomatic or quiescent myeloma: monoclonal component ≥30 g/L, bone marrow plasma cell proliferation ≥10%, but no evidence of organ or tissue involvement, no typical tetrad (hypercalcemia, renal involvement, anemia and bone disease); (3) symptomatic myeloma with organ or tissue involvement; In 2014, the following additional criteria were included: proportion of plasma cells in bone marrow ≥60%, ratio of involved to uninvolved serum free light chains ≥100, or imaging [CT, magnetic resonance imaging (MRI), or positron emission computed tomography (PET-CT)] detecting more than one focal lesion; (4) Solitary myeloplasmacytoma, extramedullary plasmacytoma and multiple solitary plasmacytoma.

KlothoIs an anti-aging gene discovered in 1997, encoding the Klotho protein^[1]。 In addition to anti-aging effects, Klotho also has various biological effects such as anti-inflammatory, regulating oxidative stress, inhibiting apoptosis and organ fibrosis. Klotho is mainly synthesized by the kidney, which is also a target organ for its action, so Klotho is closely related to kidney disease. Studies have shown that changes in Klotho levels not only reflect the degree of renal function impairment in kidney diseases including chronic kidney disease (CKD), but also predict the risk of poor renal prognosis in CKD, and are also associated with the development of CKD-related mineral and bone metabolism abnormalities (CKD-MBD). Therefore, Klotho may be used as a novel marker for the assessment of the condition and prognosis of CKD patients and the prevention and treatment of CKD-MBD in the future. This article reviews the advances in the feasibility study of Klotho as a relevant serological marker in patients with CKD.