1.Co-management of the liver and the kidney: New prospects in the clinical management of metabolic dysfunction-associated fatty liver disease with chronic kidney disease
Qiongyue FAN ; Danqin SUN ; Chunsun DAI ; Minghua ZHENG
Journal of Clinical Hepatology 2025;41(9):1744-1751
This article investigates the collaborative management of metabolic dysfunction-associated fatty liver disease (MAFLD) and chronic kidney disease (CKD). As major public health issues worldwide, MAFLD and CKD are closely related in terms of epidemiology, pathogenesis, and management strategies, and however, there are still many challenges in the multidisciplinary collaborative management of the two diseases. This article systematically elaborates on the epidemiology of MAFLD and CKD, summarizes their common risk factors such as metabolic disorder, genetic susceptibility, and active metabolites, and reviews the mutual screening strategies and combined management models based on noninvasive imaging, serum markers, FIB-4 score, and liver stiffness measurement. In addition, this article summarizes the advances in the application of lifestyle intervention and new drugs (such as GLP-1 receptor agonists and SGLT-2 inhibitors) and emphasizes the importance of multidisciplinary collaboration in improving the prognosis of patients. Due to the close association between MAFLD and CKD, their joint management is crucial, and therefore, it is necessary to establish a multidisciplinary collaboration mechanism and implement the measures of precise screening, comprehensive treatment, and long-term monitoring, so as to improve the prognosis of patients and reduce the risk of complications. Finally, this article proposes that in the future, more effective combined treatment regimens should be explored to expand the clinical options for the co-management of the liver and the kidney.
2.Monocyte chemoattractant protein-1 expression in renal tissue is associated with monocyte recruitment and tubulo-interstitial lesions in patients with lupus nephritis
Chunsun DAI ; ZhiHong LIU ; Hong ZHOU ; LeiShi LI
Chinese Medical Journal 2001;114(8):864-868
Objective To investigate the pattern of monocyte chemoattractant prolein-1 (MCP-1) distribution in the renal interstitium and evaluate its pathogenic role in tubulo-interstitial lesions in patients with lupus nephritis, the distribution of MCP-1 in renal tissue was observed. Methods Eighteen female patients with biopsy-proven lupus nephritis were enrolled in this study. No intensive immunosuppresive therapy was used in these patients during the 3 months prior to renal biopsy. The distribution of MCP-1, infiltration of CD68+ (macrophage/monocyte), CD4+ and CD8+ cells in the tubulo-interstitium of patients with lupus nephritis was detected using immunohistochemical staining with specific antibodies. Renal specimens from patients with minimal change glomerulonephritis were used as controls. Results MCP-1 protein was widely distributed in the renal tissue of patients with lupus nephritis, mainly located at the baso-lateral surface of tubular epithelial cells (16/18 biopsies), and on the wall of interstitial blood vessels (9/18 biopsies). In contrast, tubular MCP-1 staining was weak and rare in renal tissue from controls (7.4±6.2% vs 26.7±22.8%, P<0.01). Tubulo-interstitial infiltration of CD68+, CD4+ and CD8+ cells was markedly increased in patients with lupus nephritis as compared to controls. The tubular expression of MCP-1 was strongly associated with the amount of CD68+ cell infiltration in the interstitium (r=0.5420, P<0.05) and the extent of interstitial fibrosis. There was no correlation between MCP-1 production in tubules and the degree of urinary protein excretion in patients with lupus nephritis (r=0.0547, P>0.05). Conclusions The expression of MCP-1 in the renal tubules and vascular wall was markedly increased in patients with lupus nephritis. The overproduction of MCP-1 in renal tissue may contribute to monocyte recruitment in the interstitium and thus result in tubulo-interstitial damage in lupus nephritis.

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