Current Opinion in Nephrology and Hypertension最新文献_第10页

Rare genetic disorders that impair parathyroid hormone synthesis, secretion, or bioactivity provide insights into the diagnostic utility of different parathyroid hormone assays. 影响甲状旁腺激素合成、分泌或生物活性的罕见遗传疾病为不同的甲状旁腺激素检测方法提供了诊断依据。

IF 3.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2024-05-01 DOI: 10.1097/mnh.0000000000000999

Jakob Höppner, Harald Jüppner

引用次数: 0

New guidelines and therapeutic updates for the management of lupus nephritis. 狼疮肾炎治疗的新指南和疗法更新。

IF 3.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2024-05-01 Epub Date: 2024-02-09 DOI: 10.1097/MNH.0000000000000969

Sheetal B Desai, Rebecca Ahdoot, Fatima Malik, Michele Obert, Ramy Hanna

{"title":"New guidelines and therapeutic updates for the management of lupus nephritis.","authors":"Sheetal B Desai, Rebecca Ahdoot, Fatima Malik, Michele Obert, Ramy Hanna","doi":"10.1097/MNH.0000000000000969","DOIUrl":"10.1097/MNH.0000000000000969","url":null,"abstract":"Purpose of review: Systemic lupus erythematosus (SLE) can be a devastating condition, striking young patients often in their prime reproductive years. Lupus nephritis is a common and serious complication occurring in roughly 50% of SLE cases, indicating a high likelihood of disease progression, morbidity, and mortality. As the early trials of steroid therapy, and later cyclophosphamide (CYC), therapeutic changes had been stagnant. Then came the introduction of mycophenolate mofetil (MMF) in the 2000s. After the Aspreva Lupus Management Study, there had been a dearth of trials showing positive therapy results. Since 2020, new studies have emerged for lupus nephritis involving the use of anti-BLYS agents, novel calcineurin inhibitors, CD20 blockade, and antiinterferon agents. Nephrology and rheumatology society guidelines in the United States and across the world are still catching up.Recent findings: Although therapeutic guidelines are being developed, updates that have come through have focused on improved diagnostic and monitoring guidelines. One theme is the recommendation of increasingly tight proteinuria control and firmer guidelines for the rapid induction of remission. The reality of multitarget therapy and the expectation of rapid induction for a more complete remission are being widely recognized.Summary: The need for more complete and more rapid induction and control of lupus nephritis is undisputed according to the evidence and guidelines, and the medications to achieve this are growing at a rate not seen over the prior two decades. What remains is a stepwise approach to recognize how to best optimize therapy. Based on available evidence, an algorithm for induction and maintenance treatment of lupus nephritis used by the University of California Irvine Lupus Nephritis clinic, is recommended.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"344-353"},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139706323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Emerging evidence for glucagon-like peptide-1 agonists in slowing chronic kidney disease progression. 胰高血糖素样肽-1 激动剂在减缓慢性肾病进展方面的新证据。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2024-05-01 Epub Date: 2024-02-23 DOI: 10.1097/MNH.0000000000000976

Michael W Holliday, Livia Frost, Sankar D Navaneethan

{"title":"Emerging evidence for glucagon-like peptide-1 agonists in slowing chronic kidney disease progression.","authors":"Michael W Holliday, Livia Frost, Sankar D Navaneethan","doi":"10.1097/MNH.0000000000000976","DOIUrl":"10.1097/MNH.0000000000000976","url":null,"abstract":"Purpose of review: Diabetic kidney disease continues to increase, and several novel therapeutic agents have been shown to slow the progression of chronic kidney disease in those with diabetes. This review summarizes more recent data on the role of glucagon-like peptide-1 (GLP-1) receptor agonists and kidney outcomes.Recent findings: Posthoc analysis of cardiovascular outcome trials, as well as several retrospective studies, demonstrate benefits of GLP-1 receptor agonist therapy for chronic kidney disease progression in diabetics. Although limited randomized clinical trials evidence assessing the effects of GLP-1 receptor agonists on kidney outcomes in diabetic chronic kidney disease patients have been published, FLOW-CKD trial was halted based on interim data for efficacy, and results are awaited.Summary: GLP-1 receptor agonism is a promising therapy for slowing the progression of diabetic chronic kidney disease. Recent studies support kidney benefits GLP-1 receptor agonists over insulin and dipeptidyl peptidase-4-inhibitors, and the FLOW-CKD trial would inform the potential benefits for reducing the need for dialysis and kidney-disease related mortality in those with kidney disease.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"331-336"},"PeriodicalIF":2.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11126299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139971315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Has the time come for age-adapted glomerular filtration rate criteria to define chronic kidney disease: how soon is now? 采用适应年龄的肾小球滤过率标准来定义慢性肾病的时机是否已经成熟：现在还有多长时间？

IF 3.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2024-05-01 Epub Date: 2024-02-23 DOI: 10.1097/MNH.0000000000000971

Gregory L Hundemer, Ayub Akbari, Manish M Sood

{"title":"Has the time come for age-adapted glomerular filtration rate criteria to define chronic kidney disease: how soon is now?","authors":"Gregory L Hundemer, Ayub Akbari, Manish M Sood","doi":"10.1097/MNH.0000000000000971","DOIUrl":"10.1097/MNH.0000000000000971","url":null,"abstract":"Purpose of review: The conventional definition of chronic kidney disease (CKD) primarily relies on the identification of albuminuria or a decline in estimated glomerular filtration rate (eGFR). For many years, a straightforward eGFR threshold of <60 ml/min/1.73 m 2 has been widely adopted as the standard for defining CKD. Nonetheless, this criterion fails to consider the natural aging process of the kidney, and this oversight may affect the accurate diagnosis of kidney disease particularly at the extremes of age.Recent findings: The fixed eGFR threshold of <60 ml/min/1.73 m 2 for defining CKD misses crucial opportunities for risk prevention. Studies have revealed that the eGFR threshold at which the risks for adverse long-term health outcomes such as mortality, cardiovascular events, and kidney failure begin to rise varies substantially by age. Specifically, this threshold is lower for the elderly and higher for young adults. Consequently, this results in the over-diagnosis of kidney disease in the elderly and the under-diagnosis of kidney disease in young adults.Summary: To address these limitations of the current CKD definition, we discuss a number of proposed age-adapted eGFR criteria and weigh their pros and cons against the current, simple, and universally accepted approach.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"318-324"},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139971316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Biopsy-based transcriptomics in the diagnosis of kidney transplant rejection. 基于活检的转录组学在肾移植排斥反应诊断中的应用。

IF 3.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2024-05-01 Epub Date: 2024-02-21 DOI: 10.1097/MNH.0000000000000974

Tristan de Nattes, Jack Beadle, Candice Roufosse

{"title":"Biopsy-based transcriptomics in the diagnosis of kidney transplant rejection.","authors":"Tristan de Nattes, Jack Beadle, Candice Roufosse","doi":"10.1097/MNH.0000000000000974","DOIUrl":"10.1097/MNH.0000000000000974","url":null,"abstract":"Purpose of review: The last year has seen considerable progress in translational research exploring the clinical utility of biopsy-based transcriptomics of kidney transplant biopsies to enhance the diagnosis of rejection. This review will summarize recent findings with a focus on different platforms, potential clinical applications, and barriers to clinical adoption.Recent findings: Recent literature has focussed on using biopsy-based transcriptomics to improve diagnosis of rejection, in particular antibody-mediated rejection. Different techniques of gene expression analysis (reverse transcriptase quantitative PCR, microarrays, probe-based techniques) have been used either on separate samples with ideally preserved RNA, or on left over tissue from routine biopsy processing. Despite remarkable consistency in overall patterns of gene expression, there is no consensus on acceptable indications, or whether biopsy-based transcriptomics adds significant value at reasonable cost to current diagnostic practice.Summary: Access to biopsy-based transcriptomics will widen as regulatory approvals for platforms and gene expression models develop. Clinicians need more evidence and guidance to inform decisions on how to use precious biopsy samples for biopsy-based transcriptomics, and how to integrate results with standard histology-based diagnosis.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"273-282"},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10990030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139971312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

IgA vasculitis nephritis: insights from kidney biopsies. IgA 血管炎肾炎：从肾脏活检中获得的启示。

IF 3.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2024-05-01 Epub Date: 2024-02-19 DOI: 10.1097/MNH.0000000000000972

Mark Haas

{"title":"IgA vasculitis nephritis: insights from kidney biopsies.","authors":"Mark Haas","doi":"10.1097/MNH.0000000000000972","DOIUrl":"10.1097/MNH.0000000000000972","url":null,"abstract":"Purpose of review: To present findings indicating the value of kidney biopsy in assessing prognosis and guiding clinical approach to patients with IgA vasculitis nephritis (IgAVN), including a recent international study examining the value of the Oxford (MEST-C) classification.Recent findings: Historically, kidney biopsies with IgAVN are scored using the International Society for Kidney Diseases in Children (ISKDC) classification. However, this classification has limited prognostic value, and most biopsies fall into just two of the six ISKDC grades. There are few studies examining the clinical value of the Oxford classification, which is well documented to be predictive of kidney outcomes in IgA nephropathy, in IgAVN. However, a recent study of 361 biopsied patients with IgAVN showed that endocapillary hypercellularity (Oxford E1) predicted a subclass of patients showing initial improvement in kidney function with immunosuppressive treatment, followed by a later decline.Summary: Kidney outcome in patients with biopsied IgAVN treated with immunosuppression is determined by clinical factors and endocapillary hypercellularity. The latter is not part of the ISKDC classification and supports including MEST-C scores in biopsy reports of IgAVN. Even patients showing a good initial response to immunosuppression require long-term follow-up due to risk of subsequent kidney function decline.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"298-303"},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139971317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Novel indications for referral and care for simultaneous liver kidney transplant recipients. 肝肾同时移植受者转诊和护理的新适应症。

IF 3.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2024-05-01 Epub Date: 2024-02-12 DOI: 10.1097/MNH.0000000000000970

Erik L Lum, Suphamai Bunnapradist, Alexander C Wiseman, Ahmet Gurakar, Antoney Ferrey, Uttam Reddy, Fawaz Al Ammary

{"title":"Novel indications for referral and care for simultaneous liver kidney transplant recipients.","authors":"Erik L Lum, Suphamai Bunnapradist, Alexander C Wiseman, Ahmet Gurakar, Antoney Ferrey, Uttam Reddy, Fawaz Al Ammary","doi":"10.1097/MNH.0000000000000970","DOIUrl":"10.1097/MNH.0000000000000970","url":null,"abstract":"Purpose of review: Kidney dysfunction is challenging in liver transplant candidates to determine whether it is reversible or not. This review focuses on the pertinent data on how to best approach liver transplant candidates with kidney dysfunction in the current era after implementing the simultaneous liver kidney (SLK) allocation policy and safety net.Recent findings: The implementation of the SLK policy inverted the steady rise in SLK transplants and improved the utilization of high-quality kidneys. Access to kidney transplantation following liver transplant alone (LTA) increased with favorable outcomes. Estimating GFR in liver transplant candidates remains challenging, and innovative methods are needed. SLK provided superior patient and graft survival compared to LTA only for patients with advanced CKD and dialysis at least 3 months. SLK can provide immunological protection against kidney rejection in highly sensitized candidates. Post-SLK transplant care is complex, with an increased risk of complications and hospitalization.Summary: The SLK policy improved kidney access and utilization. Transplant centers are encouraged, under the safety net, to reserve SLK for liver transplant candidates with advanced CKD or dialysis at least 3 months while allowing lower thresholds for highly sensitized patients. Herein, we propose a practical approach to liver transplant candidates with kidney dysfunction.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"354-360"},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10990015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139722014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Deep learning applications for kidney histology analysis. 深度学习在肾脏组织学分析中的应用

IF 3.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2024-05-01 Epub Date: 2024-02-19 DOI: 10.1097/MNH.0000000000000973

Pourya Pilva, Roman Bülow, Peter Boor

{"title":"Deep learning applications for kidney histology analysis.","authors":"Pourya Pilva, Roman Bülow, Peter Boor","doi":"10.1097/MNH.0000000000000973","DOIUrl":"10.1097/MNH.0000000000000973","url":null,"abstract":"Purpose of review: Nephropathology is increasingly incorporating computational methods to enhance research and diagnostic accuracy. The widespread adoption of digital pathology, coupled with advancements in deep learning, will likely transform our pathology practices. Here, we discuss basic concepts of deep learning, recent applications in nephropathology, current challenges in implementation and future perspectives.Recent findings: Deep learning models have been developed and tested in various areas of nephropathology, for example, predicting kidney disease progression or diagnosing diseases based on imaging and clinical data. Despite their promising potential, challenges remain that hinder a wider adoption, for example, the lack of prospective evidence and testing in real-world scenarios.Summary: Deep learning offers great opportunities to improve quantitative and qualitative kidney histology analysis for research and clinical nephropathology diagnostics. Although exciting approaches already exist, the potential of deep learning in nephropathology is only at its beginning and we can expect much more to come.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"291-297"},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139971314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

New therapies for immunoglobulin A nephropathy: what's the standard of care in 2023? 免疫球蛋白 A 肾病的新疗法：2023 年的治疗标准是什么？

IF 3.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2024-05-01 Epub Date: 2024-02-23 DOI: 10.1097/MNH.0000000000000979

Bryce Barr, Sean Barbour

{"title":"New therapies for immunoglobulin A nephropathy: what's the standard of care in 2023?","authors":"Bryce Barr, Sean Barbour","doi":"10.1097/MNH.0000000000000979","DOIUrl":"10.1097/MNH.0000000000000979","url":null,"abstract":"Purpose of review: As the most common primary glomerulonephritis, immunoglobulin A (IgA) nephropathy (IgAN) is an important cause of kidney failure and mortality. Until recently, therapeutic options were limited. Fortunately, there have been numerous recent clinical trials demonstrating efficacy of new therapies in slowing chronic kidney disease (CKD) progression at varying stages of disease.Recent findings: The TESTING trial has provided high-quality evidence for slowing estimated glomerular filtration rate (eGFR) decline with a reduced-dose glucocorticoid regimen, while demonstrating an improved safety profile. Targeted-release budesonide represents a well tolerated therapy for reducing eGFR decline. Mycophenolate mofetil may reduce CKD progression in some populations, while hydroxychloroquine is efficacious in reducing proteinuria. Sodium-glucose cotransporter (SGLT2) inhibitors and sparsentan are effective therapies for CKD due to IgAN, but should not be used in lieu of disease-modifying immunosuppressive therapy. Many new therapies are approaching readiness for clinical use.Summary: Numerous therapeutic options now exist and include disease-modifying and nephroprotective drugs. Identifying the right treatment for the right patient is now the clinical challenge and, with new drugs on the horizon, represents the primary unmet research need in this rapidly-developing field.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"311-317"},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139971318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A basic solution for a complex problem: does treatment of metabolic acidosis slow CKD progression? 复杂问题的基本解决方案：治疗代谢性酸中毒能减缓慢性肾脏病的进展吗？

IF 3.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2024-05-01 Epub Date: 2024-02-29 DOI: 10.1097/MNH.0000000000000978

Kevin Bodker, Natalie Freidin, Nayan Arora

{"title":"A basic solution for a complex problem: does treatment of metabolic acidosis slow CKD progression?","authors":"Kevin Bodker, Natalie Freidin, Nayan Arora","doi":"10.1097/MNH.0000000000000978","DOIUrl":"10.1097/MNH.0000000000000978","url":null,"abstract":"Purpose of this review: Metabolic acidosis is frequently encountered in patients with chronic kidney disease (CKD), with increasing prevalence as kidney function worsens. Treating electrolyte disturbances is the sine qua non of Nephrologists, and alkali therapy to normalize serum bicarbonate levels and slow progression of kidney disease has been embedded in clinical practice guidelines for decades on the basis of animal models and controversial clinical trials. This review will critically appraise the literature base for this recommendation and determine whether the available evidence supports this common practice, which is a timely endeavor considering the impending demotion of metabolic acidosis treatment from recommendation to practice point in forthcoming KDIGO guidelines.Recent findings: Earlier, open-label, studies supporting the utility of sodium bicarbonate therapy to slow progression of chronic kidney disease have been challenged by more recent, blinded, studies failing to show benefit on CKD progression. This was further demonstrated in the absence of concomitant sodium administration with the hydrochloric acid binder veverimer, which failed to demonstrate benefit on renal death, end stage kidney disease or 40% reduction in estimated glomerular filtration rate in a large multicenter trial.Summary: The current body of literature does not support the routine treatment of metabolic acidosis in patients with CKD and the authors agree with the forthcoming KDIGO guidelines to de-emphasize this common practice.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"304-310"},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139989579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0