ObjectiveTo investigate the effect and mechanism of simvastatin pretreatment on kidney ischemia reperfusion injury （IRI） in mice. MethodsFifteen male C57BL/6 mice aged 6-8 weeks were divided into three groups： Sham operation group （Sham group）， kidney IRI group （IR group）， and simvastatin pretreatment+kidney IRI group （SIM group）. Hematoxylin-eosin （HE） staining of kidney tissue and detection of serum creatinine （SCr） and lactate dehydrogenase （LDH） were used to evaluate kidney injury. The levels of superoxide dismutase （SOD）， reduced glutathione （GSH）， malondialdehyde （MDA） and reactive oxygen species （ROS） were detected to evaluate oxidative stress. The contents of ferrous iron （Fe²⁺） and ferric iron （Fe³⁺） in kidney tissue were detected， and the morphological changes of mitochondria were observed by transmission electron microscope. The relative expression levels of Kruppel-like factor 2 （KLF2）， glutathione peroxidase 4 （GPX4）， solute carrier family 7 member 11 （SLC7A11）， and acyl-coa synthetase long chain family member 4 （ACSL4） protein in kidney tissue were detected. ResultsCompared with the IR group， the SIM group had significantly reduced renal tubular injury and decreased contents of Scr and LDH in serum （P < 0.001）. It also showed increased expression of SOD and GSH and decreased expression of MDA and ROS （P < 0.01）. Simvastatin pretreatment reduced the contents of Fe²⁺ and Fe³⁺ in the tissues （P < 0.01） and alleviated mitochondrial damage. It also promoted the expression of KLF2 （P < 0.01）， up-regulated the expression of ferroptosis-related protective proteins GPX4 and SLC7A11， and down-regulated the expression of ferroptosis-related damage protein ACSL4 （P < 0.05）. ConclusionSimvastatin pretreatment may inhibit kidney ferroptosis by promoting the expression of KLF2 to alleviate kidney IRI.

Renal ischemia-reperfusion injury (IRI) is an inevitable process in kidney transplantation and certain urological surgeries. IRI causes the release of injury-related molecular patterns by renal tubular epithelial cells, activating innate immune responses and sterile inflammation, leading to the persistence of immune infiltration and tissue remodeling processes, and promoting the transformation of acute kidney injury (AKI) to chronic kidney disease (CKD). CKD is mainly characterized by renal fibrosis, and is associated with the continuous infiltration of immune cells, the release of pro-inflammatory factors and the activation of pro-fibrotic signals. Estrogen receptor (ER) α can regulate the infiltration and activation of immune cells in multiple ways and inhibit renal fibrosis and CKD. This article reviews the specific molecular mechanisms by which ERα regulates immune cell infiltration and inhibits chronic fibrosis after renal IRI, with the aim of providing potential therapeutic targets and scientific basis for future AKI patients.

Acute kidney injury(AKI)is a syn-drome characterized by rapid decline in renal excre-tory function.Its pathogenesis is still unclear.Stud-ies have shown that macrophages are major play-ers in AKI inflammation,regulating tissue damage and regeneration repair.During AKI inflammation,macrophages can be activated into different func-tional phenotypes through molecular and signaling pathways,regulate different molecules and signal-ing pathways,and determine the progression of AKI.In this paper,the activation of macrophages and the molecular signaling pathways involved in the regulation of AKI in the past five years are re-viewed,and the mechanism of action of macro-phages in AKI is determined,which provides ideas for the study of macrophages as therapeutic tar-gets.

Immunotherapy following transplantation has long been a central focus in both anti-rejection strategies and the induction of immune tolerance. Regulatory B cells (Bregs) can directly suppress the immune system via the interaction between programmed cell death protein 1 (PD-1) and its ligand programmed death ligand 1 (PD-L1). Additionally, Bregs exert indirect immunosuppressive effects through the secretion of cytokines such as interleukin-10 (IL-10), transforming growth factor-β (TGF-β), and granzyme B (GrB), among which IL-10 plays a particularly critical role. This review summarizes recent progress in the classification, functional characteristics, and activation mechanisms of Bregs, as well as their potential applications in transplantation immunotherapy, aiming to provide a theoretical foundation for Breg-targeted strategies in transplant immune modulation.

Immune-related kidney disease is one of the causes of end-stage renal disease and an important disease type that threatens public health. Farnesoid X receptor (FXR) is a nuclear receptor activated by bile acids, involved in regulating gene expression related to bile acid, lipid, and glucose metabolism. In recent years, the role of FXR in renal immune regulation has received attention. FXR participates in the occurrence and development of immune-related kidney diseases by regulating the differentiation, polarization, activation, recruitment, adhesion, infiltration, and cytokine release of immune cells such as macrophages, dendritic cells, natural killer cells, T lymphocytes, and B lymphocytes. This article reviews renal immune-regulatory mechanisms of FXR in recent years and its potential role in immune-related kidney diseases, to provide a theoretical basis for the prevention and treatment of immune-related kidney diseases targeting FXR.

Objective To evaluate the efficacy and safety of rabbit anti-human thymocyte immuneglobulin(rATG)induction therapy in kidney transplant recipients from donation after cardiac death in China.Methods This was a prospective,multicenter,single-arm and interventional study conducted in China(NCT03099122).Adult patients who underwent kidney transplantation from donation after cardiac death and received rATG induction therapy(cumulative dose of 5 mg/kg)were included.Univariate and multivariate logistic regression analyses were used to identify factors associated with acute rejection(AR),delayed graft function(DGF),graft failure and patient death.The occurrence of adverse events was also analyzed.Results A total of 115 adult patients were enrolled in the study,of whom 107 were evaluable for efficacy.The incidence of biopsy-proven acute rejection(BPAR)and acute rejection(AR)was 2.8%(95%confidence interval 0.6%-8.0%)and 4.7%(95%confidence interval 1.5%-10.6%),respectively.The incidence of delayed graft function(DGF)was 13.1%(95%confidence interval 7.3%-21.0%).Graft and patient survival rates were 97.2%(95%confidence interval 92.0%-99.4%)and 99.1%(95%confidence interval 94.9%-100%),respectively.Multivariate logistic regression analysis showed that donor serum creatinine and recipient panel reactive antibodies were risk factors for DGF(both P<0.05).Common treatment-emergent adverse events(incidence>5%)included anemia(8.7%),infectious pneumonia(8.7%),and urinary tract infection(8.7%).Conclusions Standard-dose rATG induction therapy demonstrates low incidences of BPAR,AR,and DGF,and good safety in kidney transplant recipients from donation after cardiac death in China.

Chronic kidney disease(CKD)is a chronic renal structural and functional disorder caused by multiple causes(history of kidney injury>3 months),with complex etiology and high inci-dence,which will eventually lead to end-stage re-nal disease(ESRD).Common chronic kidney diseas-es include diabetic nephropathy,polycystic ne-phropathy,nephrogenic diabetes insipidus and re-nal fibrosis.At present,there is still a lack of effec-tive specific treatment for chronic kidney disease.The Apelin system is an endogenous physiological regulator.Studies have shown that Apelin is in-volved in the occurrence and development of the above diseases mainly through the regulation of kidney body fluids and blood vessels,and the regu-lation of kidney glucose and lipid metabolism and immunity.This article aims to review the role of Apelin in chronic kidney diseases in recent years,and provide ideas for the treatment and drug de-velopment of kidney diseases with Apelin as a new target.

Objective To evaluate the efficacy and safety of rabbit anti-human thymocyte immuneglobulin(rATG)induction therapy in kidney transplant recipients from donation after cardiac death in China.Methods This was a prospective,multicenter,single-arm and interventional study conducted in China(NCT03099122).Adult patients who underwent kidney transplantation from donation after cardiac death and received rATG induction therapy(cumulative dose of 5 mg/kg)were included.Univariate and multivariate logistic regression analyses were used to identify factors associated with acute rejection(AR),delayed graft function(DGF),graft failure and patient death.The occurrence of adverse events was also analyzed.Results A total of 115 adult patients were enrolled in the study,of whom 107 were evaluable for efficacy.The incidence of biopsy-proven acute rejection(BPAR)and acute rejection(AR)was 2.8%(95%confidence interval 0.6%-8.0%)and 4.7%(95%confidence interval 1.5%-10.6%),respectively.The incidence of delayed graft function(DGF)was 13.1%(95%confidence interval 7.3%-21.0%).Graft and patient survival rates were 97.2%(95%confidence interval 92.0%-99.4%)and 99.1%(95%confidence interval 94.9%-100%),respectively.Multivariate logistic regression analysis showed that donor serum creatinine and recipient panel reactive antibodies were risk factors for DGF(both P<0.05).Common treatment-emergent adverse events(incidence>5%)included anemia(8.7%),infectious pneumonia(8.7%),and urinary tract infection(8.7%).Conclusions Standard-dose rATG induction therapy demonstrates low incidences of BPAR,AR,and DGF,and good safety in kidney transplant recipients from donation after cardiac death in China.

Chronic kidney disease(CKD)is a chronic renal structural and functional disorder caused by multiple causes(history of kidney injury>3 months),with complex etiology and high inci-dence,which will eventually lead to end-stage re-nal disease(ESRD).Common chronic kidney diseas-es include diabetic nephropathy,polycystic ne-phropathy,nephrogenic diabetes insipidus and re-nal fibrosis.At present,there is still a lack of effec-tive specific treatment for chronic kidney disease.The Apelin system is an endogenous physiological regulator.Studies have shown that Apelin is in-volved in the occurrence and development of the above diseases mainly through the regulation of kidney body fluids and blood vessels,and the regu-lation of kidney glucose and lipid metabolism and immunity.This article aims to review the role of Apelin in chronic kidney diseases in recent years,and provide ideas for the treatment and drug de-velopment of kidney diseases with Apelin as a new target.

Acute kidney injury(AKI)is a syn-drome characterized by rapid decline in renal excre-tory function.Its pathogenesis is still unclear.Stud-ies have shown that macrophages are major play-ers in AKI inflammation,regulating tissue damage and regeneration repair.During AKI inflammation,macrophages can be activated into different func-tional phenotypes through molecular and signaling pathways,regulate different molecules and signal-ing pathways,and determine the progression of AKI.In this paper,the activation of macrophages and the molecular signaling pathways involved in the regulation of AKI in the past five years are re-viewed,and the mechanism of action of macro-phages in AKI is determined,which provides ideas for the study of macrophages as therapeutic tar-gets.