Diabetic Kidney Disease (DKD) is one of the most common microvascular complications of diabetes mellitus and an important cause of end-stage renal disease, with a complex pathogenesis and a lack of effective treatment. Lipid metabolism disorders play a key role in the progression of DKD, mainly by inducing mitochondrial dysfunction which in turn promotes renal injury. In recent years, natural products have shown great promise in improving lipid metabolism and mitochondrial homeostasis by virtue of their advantages of multi-targeting and low toxicity. In this article, we review the mechanism of mitochondrial dysfunction induced by lipid metabolism disorders in DKD, and the intervention strategies of natural products.

Diabetic kidney disease (DKD), one of the most prevalent microvascular complications of diabetes mellitus, is characterized by a complex pathogenesis in which lipid metabolism dysregulation plays a central role. Increasing evidence indicates impaired lipophagy, a selective autophagic process responsible for degrading lipid droplets, contributes substantially to renal lipid accumulation and subsequent kidney injury in DKD. Natural medicines, leveraging their multi-target and multi-pathway regulatory properties, exert considerable therapeutic potential through modulation of lipophagy and restoration of lipid homeostasis. This review synthesizes current studies on the efficacy of natural medicines in enhancing renal lipophagy and attenuating lipid-mediated kidney injury in DKD. We systematically analyze major classes of natural medicines, including flavonoids, polyphenols, terpenoids, alkaloids, and polysaccharides, and discuss their mechanisms of action through key signaling pathways such as AMPK/mTOR, PPARα/γ, and SIRT1/FoxO1. These natural medicines effectively reduce renal lipid accumulation, mitigate oxidative stress and inflammation, and alleviate pathological damage in various DKD models. Their pleiotropic effects suggest promising therapeutic avenues for DKD through the restoration of lipophagic flux and lipid homeostasis. Nonetheless, significant challenges remain, including incomplete elucidation of precise molecular mechanisms and a scarcity of robust clinical validation. Future research must prioritize the rigorous identification of natural medicines, detailed mechanistic exploration, and well-designed clinical trials to translate the potential of natural medicine-mediated lipophagy regulation into effective therapeutic strategies for DKD.

Background: Anemia is one of the main complications of chronic kidney disease especially kidney failure, which includes treatment with erythropoiesis-stimulating agents and iron supplementation, including intravenous and oral iron. However, intravenous iron may pose limitations, such as potential infusion reactions. Oral iron is mainly composed of divalent iron, which can excessively stimulate the gastrointestinal tract. Iron polysaccharide complex capsules are a novel oral iron trivalent supplement with higher iron content and lower gastrointestinal irritation. However, since high-quality evidence-based medicinal support is lacking, it is necessary to conduct clinical studies to further evaluate the effectiveness and safety of oral iron polysaccharide complex in chronic kidney disease patients. Methods: This randomized controlled trial uses an open-label, parallel group design, where the efficacy and safety of maintenance hemodialysis (MHD) participants is evaluated. The experimental group is assigned erythropoietins and iron polysaccharide complex (two capsules each time, bid), and the control group is assigned erythropoietin and sucrose iron (100mg, 2w) injection. Participants (aged 18–75 years) undergoing maintenance hemodialysis were considered for screening. Inclusion criteria included hemoglobin (Hb) ≥110g/L and < 130g/L, transferrin saturation (TSAT) > 20% and < 50%, and serum ferritin (SF) > 200μg/L and < 500μg/L. Exclusion criteria included acute or chronic bleeding, serum albumin < 35g/L, hypersensitive C-reactive protein (HsCRP) > 10 mg/L, and severe secondary hyperparathyroidism (iPTH ≥ 800 pg/mL). Full inclusion and exclusion criteria are described in the “Methods” section. The primary endpoint is TSAT of the participants at week 12. Secondary endpoints include Hb, SF, hematocrit (Hct), HsCRP, pharmacoeconomic evaluation, drug costs, quality of life, and indicators of oxidative stress. The treatment will last for 24 weeks with a follow-up visit at baseline (within 7 days prior to initial treatment) and weeks 4, 8, 12, 16, 20, and 24 after initial treatment. This clinical research includes 9 hemodialysis centers in mainland China and plans to enroll 186 participants. Discussion: It is expected that it will provide strong evidence to reveal the clinical efficacy and safety of oral iron in the treatment of chronic CKD-related anemia in MHD patients through this clinical trial. Trial registration: Chinese Clinical Trial Registry ChiCTR2000031166. Registered on March 23, 2020

Background: Cases of severe pneumonia complicated by empyema due to normal anaerobic flora from the oral cavity are infrequent. Diagnosing anaerobic infections through conventional microbiological test (CMT) is often challenging.Case presentation: This study describes the case of a 67-year-old man, bedridden long-term, who developed severe pneumonia with empyema caused by multiple anaerobic bacterial infections. The patient was hospitalized with a 5-day history of cough, sputum and fever, accompanied by a 2-day history of dyspnea. Despite CMT, the specific etiology remained elusive. However, metagenomic next-generation sequencing (mNGS) identified various anaerobic bacteria in bronchoalveolar lavage fluid (BALF), blood and pleural effusion. The patient was diagnosed with a polymicrobial infection involving multiple anaerobic bacteria. Following treatment with metronidazole and moxifloxacin, the patient’s pulmonary symptoms improved.Conclusion: mNGS serves as a valuable adjunctive tool for diagnosting and managing patients whose etiology remains unidentified following CMT.