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

Thrombotic microangiopathy - the importance of a multidisciplinary approach. 血栓性微血管病-多学科方法的重要性。

IF 3.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2024-03-01 Epub Date: 2023-11-29 DOI: 10.1097/MNH.0000000000000954

Minh-Ha Tran, Samir Patel, Sheetal Desai, Stefan Ciurea, Benjamin J Lee, Ramy Hanna

{"title":"Thrombotic microangiopathy - the importance of a multidisciplinary approach.","authors":"Minh-Ha Tran, Samir Patel, Sheetal Desai, Stefan Ciurea, Benjamin J Lee, Ramy Hanna","doi":"10.1097/MNH.0000000000000954","DOIUrl":"10.1097/MNH.0000000000000954","url":null,"abstract":"Purpose of review: The purpose of this review is to highlight the importance of a multidisciplinary thrombotic microangiopathies (TMA) Team. This goal will be accomplished through review of the complement system, discuss various causes of thrombotic microangiopathies (TMA), and aspects of their diagnosis and management. In so doing, readers will gain an appreciation for the complexity of this family of disorders and realize the benefit of a dedicated multidisciplinary TMA Team.Recent findings: TMA causes derive from multiple specialty areas, are difficult to timely recognize, pose complex challenges, and require multidisciplinary management. Hematopoietic stem cell transplant-associated TMA (TA-TMA) and TA-TMA related multiorgan dysfunction syndrome (TA-TMA MODS) are areas of burgeoning research; use of complement testing and eculizumab precision-dosing has been found to better suppress complement activity in TA-TMA than standard eculizumab dosing. Newer tests are available to risk-stratify obstetric patients at risk for severe pre-eclampsia, whose features resemble those of TA-TMA MODS. Numerous disorders may produce TMA-like findings, and a systematic approach aids in their identification. TMA Teams elevate institutional awareness of increasingly recognized TMAs, will help expedite diagnostic and therapeutic interventions, and create pathways to future TMA-related research and facilitate access to clinical trials.Summary: Establishment of a TMA-Team is valuable in developing the necessary institutional expertise needed to promptly recognize and appropriately manage patients with TMA.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"247-256"},"PeriodicalIF":3.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138451097","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

Interferon gamma in the pathogenesis of hypertension - recent insights. 高血压发病机制中的γ干扰素--最新见解。

IF 3.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2024-03-01 Epub Date: 2024-01-04 DOI: 10.1097/MNH.0000000000000966

Lance N Benson, Shengyu Mu

{"title":"Interferon gamma in the pathogenesis of hypertension - recent insights.","authors":"Lance N Benson, Shengyu Mu","doi":"10.1097/MNH.0000000000000966","DOIUrl":"10.1097/MNH.0000000000000966","url":null,"abstract":"Purpose of review: The mounting body of evidence underscores the pivotal role of interferon gamma (IFNγ) in the pathogenesis of hypertension, prompting exploration of the mechanisms by which this cytokine fosters a pro-inflammatory immune milieu, subsequently exacerbating hypertension. In this review, we delve into recent preclinical and clinical studies from the past two years to elucidate how IFNγ participates in the progression of hypertension.Recent findings: IFNγ promotes renal CD8 + T cell accumulation by upregulating tubular PDL1 and MHC-I, intensifying cell-to-cell interaction. Intriguingly, a nucleotide polymorphism in LNK, predisposing towards hypertension, correlates with augmented T cell IFNγ production. Additionally, anti-IFNγ treatment exhibits protective effects against T cell-mediated inflammation during angiotensin II infusion or transverse aortic constriction. Moreover, knockout of the mineralocorticoid receptor in T cells protects against cardiac dysfunction induced by myocardial infarction, correlating with reduced IFNγ and IL-6, decreased macrophage recruitment, and attenuated fibrosis. Interestingly, increased IFNγ production correlates with elevated blood pressure, impacting individuals with type 2 diabetes, nondiabetics, and obese hypertensive patients.Summary: These revelations spotlight IFNγ as the critical mediator bridging the initial phase of blood pressure elevation with the sustained and exacerbated pathology. Consequently, blocking IFNγ signaling emerges as a promising therapeutic target to improve the management of this 'silent killer.'","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"154-160"},"PeriodicalIF":3.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10842676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139073615","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

Nephrologists should talk to their patients about climate change. 肾脏科医生应与病人谈论气候变化。

IF 3.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2024-03-01 Epub Date: 2024-02-01 DOI: 10.1097/MNH.0000000000000956

David S Goldfarb

引用次数: 0

The times they are K+-changin': bringing the potassium curriculum out of the 20th century. 时代正在改变:把钾课程带出20世纪。

IF 3.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2024-03-01 Epub Date: 2023-12-04 DOI: 10.1097/MNH.0000000000000958

Melanie P Hoenig, Stewart H Lecker, Jeffrey H William

{"title":"The times they are K+-changin': bringing the potassium curriculum out of the 20th century.","authors":"Melanie P Hoenig, Stewart H Lecker, Jeffrey H William","doi":"10.1097/MNH.0000000000000958","DOIUrl":"10.1097/MNH.0000000000000958","url":null,"abstract":"Purpose of review: Although most of the current medical education literature has focused on teaching strategies, little attention has been devoted to selecting appropriate course content. Despite elegant descriptions of physiologic mechanisms in recent decades, medical school curricula and students continue to rely on outdated textbooks and certification examination study aids composed to fit an antiquated exam blueprint.Recent findings: Advances in our understanding of potassium physiology offer multiple examples of key concepts that deserve to be included in the modern-day renal physiology curriculum, including the relationship of potassium to blood pressure and the potassium 'switch', the aldosterone paradox, and novel pharmacologic agents that target dietary potassium absorption and potassium handling in the kidney.Summary: Key advances in our understanding and application of renal physiology to patient care have not been readily integrated into the nephrology curriculum of medical students. Difficult questions remain regarding when new concepts are sufficiently established to be introduced to medical students in the preclinical years.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"186-191"},"PeriodicalIF":3.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138476969","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

Let's stop talking about 'citrate toxicity'. 让我们停止谈论“柠檬酸盐毒性”。

IF 3.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2024-03-01 Epub Date: 2023-11-14 DOI: 10.1097/MNH.0000000000000953

Avantika Israni, David S Goldfarb

{"title":"Let's stop talking about 'citrate toxicity'.","authors":"Avantika Israni, David S Goldfarb","doi":"10.1097/MNH.0000000000000953","DOIUrl":"10.1097/MNH.0000000000000953","url":null,"abstract":"Purpose of review: Continuous renal replacement therapy (CRRT) is a vital medical intervention used in critically ill patients with acute kidney injury (AKI). One of the key components of adequate clearance with CRRT is the use of anticoagulants to prevent clotting of the extracorporeal circuit. Regional citrate anticoagulation is the most often recommended modality. The term 'citrate toxicity' is used to describe potential adverse effects of accumulation of citrate and subsequent hypocalcemia. However, citrate is itself not inherently toxic. The term and diagnosis of citrate toxicity are questioned in this review.Recent findings: Citrate is being increasingly used for regional anticoagulation of the CRRT circuit. Citrate accumulation is infrequent and can cause hypocalcemia and metabolic alkalosis, which are potential adverse effects. Citrate itself, however, is not a toxic molecule. The term 'citrate toxicity' has been used to denote hypocalcemia and metabolic acidosis. However, citrate administration is well known to cause systemic and urinary alkalinization and under certain circumstances, metabolic alkalosis, but is not associated itself with any 'toxic' effects.We review the existing literature and debunk the perceived toxicity of citrate. We delve into the metabolism and clearance of citrate and question current data suggesting metabolic acidosis occurs as the result of citrate accumulation.Summary: In conclusion, this article calls into question prevailing concerns about 'citrate toxicity'. We emphasize the need for a more nuanced understanding of its safety profile. We recommend discarding the term 'citrate toxicity' in favor of another frequently used, but more meaningful term: 'citrate accumulation'.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"181-185"},"PeriodicalIF":3.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92153143","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

Kidney function assessment in the geriatric population. 老年人群肾功能评估。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2024-03-01 Epub Date: 2023-11-15 DOI: 10.1097/MNH.0000000000000955

Abimereki Muzaale, Adnan Khan, Richard J Glassock, Ekamol Tantisattamoa, Rebecca S Ahdoot, Fawaz Al Ammary

{"title":"Kidney function assessment in the geriatric population.","authors":"Abimereki Muzaale, Adnan Khan, Richard J Glassock, Ekamol Tantisattamoa, Rebecca S Ahdoot, Fawaz Al Ammary","doi":"10.1097/MNH.0000000000000955","DOIUrl":"10.1097/MNH.0000000000000955","url":null,"abstract":"Purpose of review: Kidney function declines with normal aging. But it also declines with the progression of some diseases. This review calls for a more nuanced interpretation of kidney function in the geriatric population, who may have frailty and comorbidities.Recent findings: GFR declines with healthy aging kidneys. Aging kidney changes include decreased cortical volume, senescent global glomerulosclerosis, and reduced nephron numbers. Yet normal aging is not associated with increased glomerular volume or single-nephron GFR. The prevalence of GFR less than 60 ml/min/1.73 m 2 in the geriatric population is high. However, the decline in GFR with normal aging may not reflect true CKD without albuminuria. Although the risk of ESKD and mortality increases in all age groups when eGFR less than 45 ml/min/m 2 , there is no significant increased relative risk of ESKD and mortality in the geriatric population when eGFR 45-59 ml/min/m 2 in the absence of albuminuria. Innovative approaches are needed to better estimate GFR and define CKD in the geriatric population.Summary: The expected GFR decline in the geriatric population is consistent with normal aging kidney changes. To avoid CKD overdiagnosis and unnecessary referrals to nephrology for possible CKD, age-adapted definitions of CKD in the absence of albuminuria are needed.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"267-271"},"PeriodicalIF":2.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10872478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"107590498","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

The TMEM16A channel as a potential therapeutic target in vascular disease. 作为血管疾病潜在治疗靶点的 TMEM16A 通道。

IF 3.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2024-03-01 Epub Date: 2024-01-08 DOI: 10.1097/MNH.0000000000000967

Rumaitha Al-Hosni, Rachel Kaye, Catherine Seoyoun Choi, Paolo Tammaro

{"title":"The TMEM16A channel as a potential therapeutic target in vascular disease.","authors":"Rumaitha Al-Hosni, Rachel Kaye, Catherine Seoyoun Choi, Paolo Tammaro","doi":"10.1097/MNH.0000000000000967","DOIUrl":"10.1097/MNH.0000000000000967","url":null,"abstract":"Purpose of review: The transmembrane protein 16A (TMEM16A) Ca 2+ -activated Cl - channel constitutes a key depolarising mechanism in vascular smooth muscle and contractile pericytes, while in endothelial cells the channel is implicated in angiogenesis and in the response to vasoactive stimuli. Here, we offer a critical analysis of recent physiological investigations and consider the potential for targeting TMEM16A channels in vascular disease.Recent findings: Genetic deletion or pharmacological inhibition of TMEM16A channels in vascular smooth muscle decreases artery tone and lowers systemic blood pressure in rodent models. Inhibition of TMEM16A channels in cerebral cortical pericytes protects against ischemia-induced tissue damage and improves microvascular blood flow in rodent stroke models. In endothelial cells, the TMEM16A channel plays varied roles including modulation of cell division and control of vessel tone through spread of hyperpolarisation to the smooth muscle cells. Genetic studies implicate TMEM16A channels in human disease including systemic and pulmonary hypertension, stroke and Moyamoya disease.Summary: The TMEM16A channel regulates vascular function by controlling artery tone and capillary diameter as well as vessel formation and histology. Preclinical and clinical investigations are highlighting the potential for therapeutic exploitation of the channel in a range of maladaptive states of the (micro)circulation.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"161-169"},"PeriodicalIF":3.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10842660/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139402236","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

Dendritic cell epithelial sodium channel induced inflammation and salt-sensitive hypertension. 树突状细胞上皮钠通道诱导炎症和盐敏感性高血压。

IF 3.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2024-03-01 Epub Date: 2024-01-05 DOI: 10.1097/MNH.0000000000000963

Mert Demirci, Antentor Hinton, Annet Kirabo

{"title":"Dendritic cell epithelial sodium channel induced inflammation and salt-sensitive hypertension.","authors":"Mert Demirci, Antentor Hinton, Annet Kirabo","doi":"10.1097/MNH.0000000000000963","DOIUrl":"10.1097/MNH.0000000000000963","url":null,"abstract":"Purpose of review: Salt sensitivity of blood pressure (SSBP) is an independent risk factor for cardiovascular disease. Epithelial sodium channel (ENaC) plays a critical role in renal electrolyte and volume regulation and has been implicated in the pathogenesis of SSBP. This review describes recent advances regarding the role of ENaC-dependent inflammation in the development of SSBP.Recent findings: We recently found that sodium enters dendritic cells via ENaC, a process regulated by serum/glucocorticoid-regulated kinase 1 and epoxyeicosatrienoic acid 14,15. Sodium entry activates NADPH oxidase, leading to the production of isolevuglandins (IsoLGs). IsoLGs adduct self-proteins to form neoantigens in dendritic cells that activate T cells and result in the release of cytokines promoting sodium retention, kidney damage, and endothelial dysfunction in SSBP. Additionally, we described a novel mechanistic pathway involving ENaC and IsoLG-dependent NLRP3 inflammasome activation. These findings hold promise for the development of novel diagnostic biomarkers and therapeutic options for SSBP.Summary: The exact mechanisms underlying SSBP remain elusive. Recent advances in understanding the extrarenal role of ENaC have opened a new perspective, and further research efforts should focus on understanding the link between ENaC, inflammation, and SSBP.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"145-153"},"PeriodicalIF":3.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10842661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139097470","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

Dialysis initiation for patients with decompensated cirrhosis when liver transplant is unlikely. 失代偿性肝硬化患者在肝移植后不太可能开始透析。

IF 3.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2024-03-01 Epub Date: 2023-12-01 DOI: 10.1097/MNH.0000000000000959

Amar D Bansal, Arpan A Patel

{"title":"Dialysis initiation for patients with decompensated cirrhosis when liver transplant is unlikely.","authors":"Amar D Bansal, Arpan A Patel","doi":"10.1097/MNH.0000000000000959","DOIUrl":"10.1097/MNH.0000000000000959","url":null,"abstract":"Purpose of review: The purpose of this review is to describe an approach that emphasizes shared decision-making for patients with decompensated cirrhosis and acute kidney injury when liver transplantation is either not an option, or unlikely to be an option.Recent findings: When acute kidney injury occurs on a background of decompensated cirrhosis, outcomes are generally poor. Providers can also be faced with prognostic uncertainty. A lack of guidance from nephrology and hepatology professional societies means that providers rely on expert opinion or institutional practice patterns.Summary: For patients who are unlikely to receive liver transplantation, the occurrence of acute kidney injury represents an opportunity for a goals of care conversation. In this article, we share strategies through which providers can incorporate more shared decision-making when caring for these patients. The approach involves creating prognostic consensus amongst multidisciplinary teams and then relying on skilled communicators to share the prognosis. Palliative care consultation can be useful when teams need assistance in the conversations.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"212-219"},"PeriodicalIF":3.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138458448","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

Chronic kidney disease associated cardiomyopathy: recent advances and future perspectives. 慢性肾病相关心肌病：最新进展与未来展望。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2024-03-01 Epub Date: 2024-01-05 DOI: 10.1097/MNH.0000000000000952

Mirela A Dobre, Shruti Ahlawat, Jeffrey R Schelling

{"title":"Chronic kidney disease associated cardiomyopathy: recent advances and future perspectives.","authors":"Mirela A Dobre, Shruti Ahlawat, Jeffrey R Schelling","doi":"10.1097/MNH.0000000000000952","DOIUrl":"10.1097/MNH.0000000000000952","url":null,"abstract":"Purpose of review: Cardiomyopathy in chronic kidney disease (CKD) is a complex condition with multiple triggers and poor prognosis. This review provides an overview of recent advances in CKD-associated cardiomyopathy, with a focus on pathophysiology, newly discovered biomarkers and potential therapeutic targets.Recent findings: CKD is associated with a specific pattern of myocardial hypertrophy and fibrosis, resulting in diastolic and systolic dysfunction, and often triggered by nonatherosclerotic processes. Novel biomarkers, including amino-terminal type III procollagen peptide (PIIINP), carboxy-terminal type I procollagen peptide (PICP), FGF23, marinobufagenin, and several miRNAs, show promise for early detection and risk stratification. Treatment options for CKD-associated cardiomyopathy are limited. Sodium glucose cotransporter-2 inhibitors have been shown to reduce left ventricle hypertrophy and improve ejection fraction in individuals with diabetes and mild CKD, and are currently under investigation for more advanced stages of CKD. In hemodialysis patients calcimimetic etelcalcetide resulted in a significant reduction in left ventricular mass.Summary: CKD-associated cardiomyopathy is a common and severe complication in CKD. The identification of novel biomarkers may lead to future therapeutic targets. Randomized clinical trials in individuals with more advanced CKD would be well posed to expand treatment options for this debilitating condition.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"203-211"},"PeriodicalIF":2.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10872957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139402235","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