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Diabetic nephropathy (DN) is a common complication in patients with diabetes and the leading cause of end-stage renal disease. Accumulating evidence shows that transforming growth factor beta-1 (TGF-β1) is a key mediator in the pathogenesis of DN. TGF-β1 binds to its receptors to activate canonical and noncanonical downstream signaling pathways to exert its biological activities. Among them, canonical Smad signaling is the major pathway responsible for the development of DN. In addition to TGF-β1, many stress molecules, such as advanced glycation end products (AGEs), angiotensin II (Ang II), and C-reactive protein (CRP), can also activate Mothers against decapentaplegic homologs (Smads) via the extracellular signal-regulated kinase (ERK)/p38 mitogen-activated protein kinase (MAPK) cross talk mechanism. Furthermore, TGF-β/Smad signaling can also cross talk with nuclear factor kappa B (NF-κB) signaling to regulate renal inflammation via the induction of IκBα by Smad7. In the context of renal fibrosis, Smad3 is pathogenic, while Smad2 and Smad7 are protective. TGF-β signaling also upregulates the pathogenic microRNAs (miRNAs) (namely, miR-21, miR-192, and miR-377) and long noncoding RNAs (lncRNAs) (namely, Erbb4-IR (intron region, IR), LncRNA9884, and Arid2-IR) but downregulates the protective miRNAs (namely, miR-29a/b and miR-200a) to mediate DN. Thus, targeting TGF-β signaling, either by blocking its ligand, its receptor ( i.e ., TGF-β receptor-2 [TGFBR2]), Smad3, and downstream miRNAs/lncRNAs or by overexpressing Smad7, has been shown to improve DN. In addition, pharmaceutically targeting TGF-β signaling using chemical inhibitors and traditional Chinese medicine (TCM), including Tangshen formula, Chaihuang-Yishen granule, and herbal extracts (berberine, asiatic acid, and naringenin), also shows renoprotective effect in diabetes. In summary, TGF-β signaling is a critical pathway leading to DN and may be a therapeutic target for combating DN.

Background The effects of vitamin D receptor (VDR) agonist paricalcitol on the podocyte injury induced by high glucose (HG) were investigated in conditioned immortalized mouse podocytes (MPC-5). Methods (1) Grouped according to different glucose concentrations: normal group (NG): 5.6 mmol/L glucose; HG stimulation group: 25 mmol/L glucose (25HG); high osmotic control group (NG+M): 5.6 mmol/L glucose + 19.4 mmol/L D-mannitol. The expression levels of VDR, podocyte marker proteins podocin, nephrin and mesenchymal marker proteins α-smooth muscle actin (α-SMA), matrix metalloproteinases (MMP9) in MPC-5 were measured, respectively. (2) Effect of VDR agonist-paricalcitol on podocyte epithelial-mesenchymal transition (EMT) induced by HG: cultured podocytes are divided into NG group, NG with dimethylsulfoxide (DMSO) group (NG+D), NG with paricalcitol (0.1 μmol/L) group (NG+P), HG group, HG with DMSO group (HG+D), and HG with paricalcitol (0.1 μmol/L) group (HG+P). The expression levels of VDR, podocyte marker proteins, marker proteins of mesenchymal cells, and the albumin flow in each group were then detected. Results (1) Under HG conditions, the expressions of VDR, podocin, and nephrin were decreased, while the expressions of α-SMA and MMP9 were increased (all P < 0.05). After administration of paricalcitol, the levels of VDR, podocin, and nephrin were increased, while the expressions of α-SMA and MMP9 were decreased compared with the control groups (all P < 0.05). (2) The results of albumin flow showed that the albumin flow of podocytes increased under the condition of HG, while it decreased after the treatment of paricalcitol. Conclusion The podocyte injury induced by HG could be partly rescued by Paricalcitol.

Objectives The application effect of the trans-theoretical model (TTM) of behavior change in diabetic kidney disease (DKD) patients treated with maintenance hemodialysis (MHD) was discussed. Methods According to the random number table method, 80 patients with DKD on MHD were divided into control group and observation group, 40 patients in each group. Results After the intervention for 6 months, the self-rating depression scale (SDS) and self-rating anxiety scale (SAS) scores of patients in the observation group were all lower than those before the intervention and those in the control group ( P < 0.05); the compliance of patients to fluid intake in the observation group was higher than that in the control group while the total incidence rate of associated acute complications of the former was lower than that of the latter ( P < 0.05). The fasting blood glucose (FBG) and 2-h postprandial blood glucose (2hPBG) indexes of the observation group were lower than those of the control group ( P < 0.05), and the laboratory test indexes of serum creatinine (SCr), blood urea nitrogen (BUN), glomerular filtration rate (GFR) were lower than those before the intervention and lower than those of the control group ( P < 0.05). Conclusions The nursing combined with TTM of behavior change can effectively strengthen the compliance of DKD patients subjected to MHD to fluid intake, reduce patients’ negative moods (such as depression and anxiety), and lower the incidence rate of complications, and improve the life quality.

Purpose To investigate the correlation analysis of Tervaert glomerular classification and clinical indicators in patients with type 2 diabetic nephropathy (DN). Methods We collected the renal sections of patients with DN and used immunoglobulin G (IgG), albumin (Alb), PAS, and MASSON staining to observe the extent of glomerular lesions. We simultaneously collected their clinical data for statistics and conducted correlation analysis with Tervaert glomerular classification. Moreover, we collected patients’ urine protein components data and conducted a correlation analysis with Tervaert classification. Results Tervaert classification reflects glomerular changes and was positively related to proteinuria, creatinine (Cr), and blood urea nitrogen but was negatively related to estimated glomerular filtration rate (eGFR). Tervaert classification was also positively related to total protein (TP), transferrin (TRF), retinol binding protein (RBP), N-acetyl-β-D aminoglucosidase (NAG), Alb, cystatin C (Cyc), IgG, β2-microglobulin (β2-MG), α1-microglobulin (α1-MG), Alb/Cr, and TP/Cr in urine. Conclusion Our study reveals that clinical indicators could well reflect glomerular lesions and has great value for the diagnosis and treatment of early DN.