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Background: The association between loop diuretics and acute kidney injury (AKI) remains unclear. Methods: The population studied was selected from the Epidemiology of AKI in Chinese Hospitalized patients (EACH) study. Exposure to loop diuretics was defined as any filled prescription prior to the date when AKI was detected in patients with HA-AKI, and prior to the last date of SCr testing in those without AKI. The outcome was AKI, defined by the Kidney Disease Improving Global Outcomes criteria. Associations between loop diuretics and HA-AKI were examined by Cox proportional hazards models adjusted for baseline and time-dependent covariates. Results: Of the 150,020 patients, 16,437 (11.0%) were prescribed loop diuretics, and 5717 (3.8%) experienced HA-AKI events. The crude rates of HA-AKI in patients who were and were not prescribed loop diuretics were 1632 (9.9%) and 3262 (2.8%), respectively. A multivariate cox proportional hazards analysis showed that exposure to loop diuretics was associated with significantly increased risks of HA-AKI compared with non-users (hazard ratio (HR), 1.61; 95% CI (confidence interval), 1.55–1.67), other diuretics (HR, 1.09; 95% CI, 1.03–1.15), and osmotic diuretics (HR, 1.30; 95% CI, 1.20–1.42). Compared with other diuretics, the use of loop diuretics was associated with higher risks of HA-AKI in women, in patients without hypertension, in patients without heart failure, in patients without liver cirrhosis, and in patients not requiring surgery. Conclusions: Loop diuretics are widely used and are associated with increased risks of HA-AKI in hospitalized adults. Renal function should be more closely monitored during the use of loop diuretics.

Challenges in achieving valid risk prediction and stratification impede treatment decisions and clinical research design among patients with glomerular diseases. This study evaluated whether chronic histologic changes, when complementing other clinical data, improved the prediction of disease outcomes across a diverse group of glomerular diseases.Multicenter retrospective cohort study.4,982 patients with biopsy-proven glomerular disease who underwent native biopsy at eight tertiary care hospitals across China from 2004 to 2020.Chronicity scores (CS) depicted as 4 categories of histological chronic change, as well as baseline clinical and demographic variables.Progression of glomerular disease defined as a composite of kidney failure or a ≥40% decline in eGFR from the value at the time of biopsy.Multivariable Cox proportional hazard models. The performance of predictive models was evaluated by C statistic, time-dependent AUC, net reclassification index, integrated discrimination index, and calibration plots.The derivation and validation cohorts included 3,488 and 1,494 patients, respectively. Over a median of 31 months of follow-up, a total of 444 (8.9%) patients had disease progression in two cohorts. For predicting the 2-year risk of disease progression, the AUC of the model combining CS and the Kidney Failure Risk Equation (KFRE) in the validation cohort was 0.76 (95% CI, 0.65-0.87), significantly better than the KFRE model (AUC, 0.68; 95% CI, 0.56-0.79; P=0.04). The combined model also had a better fit with lower AIC and a significant improvement in reclassification as assessed by the IDI and NRI. Similar improvements in predictive performance were observed in subgroups and sensitivity analyses.Selection bias, relatively short follow-up, lack of external validation.Adding histologic chronicity scores to the KFRE model improved the prediction of kidney disease progression at the time of kidney biopsy in patients with glomerular diseases.

There is uncertainty about whether piperacillin/tazobactam (PT) increases the risk of acute kidney injury (AKI) in patients without concomitant use of vancomycin. This study compared the risk of hospital-acquired AKI (HA-AKI) among adults treated with PT or antipseudomonal β-lactams (meropenem, ceftazidime) without concomitant use of vancomycin.This real-world study analysed the data from China Renal Data System and assessed the risk of HA-AKI in adults hospitalized with infection after exposure to PT, meropenem or ceftazidime in the absence of concomitant vancomycin. The primary outcome was any stage of HA-AKI according to the Kidney Disease Improving Global Outcomes guidelines. A multi-variable Cox regression model and different propensity score (PS) matching models were used.Among the 29,441 adults [mean (standard deviation) age 62.44 (16.84) years; 17,980 females (61.1%)] included in this study, 14,721 (50%) used PT, 9081 (31%) used meropenem and 5639 (19%) used ceftazidime. During a median follow-up period of 8 days, 2601 (8.8%) develped HA-AKI. The use of PT was not associated with significantly higher risk of HA-AKI compared with meropenem [adjusted hazard ratio (aHR) 1.07, 95% confidence interval (CI) 0.97-1.19], ceftazidime (aHR 1.09, 95% CI 0.92-1.30) or both agents (aHR 1.07, 95% CI 0.97-1.17) after adjusting for confounders. Results were consistent in stratified analyses, PS matching using logistic regression or random forest methods to generate a PS, and in an analysis restricting outcomes to AKI stage 2-3.Without concomitant use of vancomycin, the risk of AKI following PT therapy is comparable with that of meropenem or ceftazidime among adults hospitalized with infection.

Aiming at the scientific research of lakes on the Tibetan Plateau, tow portable AUVs (Autonomous Underwater Vehicle) TS-100 were used to survey Karakul Lake. The lakebed terrain of Karakul was mapped, and the water profile parameters from inlet to outlet of the lake were observed continuously by a multiparameter sonde. In this paper, the TS-100 AUV is introduced firstly, and then describe the deployment of this vehicle on the lake. Finally, a method of original survey data processing is proposed based on the Kriging method, a 3D model of the lake was built, and the lake capacity was calculated by using this method.