Current Opinion in Nephrology and Hypertension最新文献_第2页

Effect of the allelic background on the phenotype of primary hyperoxaluria type I. 等位基因背景对原发性I型高血氧症表型的影响。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-03-01 Epub Date: 2024-12-06 DOI: 10.1097/MNH.0000000000001057

Giorgia Mandrile, Barbara Cellini, Pietro Manuel Ferraro

{"title":"Effect of the allelic background on the phenotype of primary hyperoxaluria type I.","authors":"Giorgia Mandrile, Barbara Cellini, Pietro Manuel Ferraro","doi":"10.1097/MNH.0000000000001057","DOIUrl":"10.1097/MNH.0000000000001057","url":null,"abstract":"Purpose of review: Primary hyperoxaluria type 1 (PH1) is an autosomal recessive disorder of hepatic glyoxylate metabolism leading to nephrolithiasis and kidney failure. PH1 is caused by mutations on the AGXT gene encoding alanine:glyoxylate aminotransferase (AGT). The AGXT gene has two haplotypes, the major (Ma) and the minor (mi) alleles. This review summarizes the role of the minor allele on the molecular pathogenesis and the clinical manifestations of PH1.Recent findings: PH1 shows high genetic variability and significant interindividual variability. Although the minor haplotype is not pathogenic on its own, it may be crucial for the pathogenicity of some mutations or amplify the effect of others, thus affecting both symptoms and responsiveness to Vitamin B6, the only pharmacological treatment effective in a selected group of PH1 patients.Summary: In the last years, new drugs based on RNA-interference are available for patients nonresponsive to Vitamin B6, but no specific biomarkers are available to predict disease course and severity. Therefore, a clinical assessment of PH1 taking into account molecular analysis of the mutations and the allelic background and the possible synergism among polymorphic and pathogenic variants should be encouraged to promote approaches of personalized medicine that improve the management of available resources.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"177-183"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784438","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 hemodialysis unit: the place where everybody knows your name.

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-03-01 Epub Date: 2025-01-30 DOI: 10.1097/MNH.0000000000001046

David S Goldfarb

引用次数: 0

Targeting aldosterone to improve cardiorenal outcomes: from nonsteroidal mineralocorticoid receptor antagonists to aldosterone synthase inhibitors. 针对醛固酮改善心肾功能：从非类固醇矿皮质激素受体拮抗剂到醛固酮合成酶抑制剂。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-02-28 DOI: 10.1097/MNH.0000000000001067

Wryan Helmeczi, Gregory L Hundemer

{"title":"Targeting aldosterone to improve cardiorenal outcomes: from nonsteroidal mineralocorticoid receptor antagonists to aldosterone synthase inhibitors.","authors":"Wryan Helmeczi, Gregory L Hundemer","doi":"10.1097/MNH.0000000000001067","DOIUrl":"10.1097/MNH.0000000000001067","url":null,"abstract":"Purpose of review: Aldosterone dysregulation plays a major role in the pathogenesis of hypertension, cardiovascular disease, and kidney disease. Traditionally, steroidal mineralocorticoid receptor (MR) antagonists, namely spironolactone and eplerenone, have been the only available options to target aldosterone. Over recent years, a host of promising novel aldosterone-targeted pharmacologic agents have been developed thereby providing new options to mitigate aldosterone-mediated cardiovascular and kidney disease.Recent findings: Recently, a number of nonsteroidal MR antagonists (finerenone, esaxerenone, and ocedurenone) and highly specific aldosterone synthase inhibitors (baxdrostat, lorundrostat, dexfadrostat, and vicadrostat) have been developed. The early clinical data for these novel medications looks promising regarding their efficacy in improving blood pressure control, preventing adverse cardiovascular outcomes, and slowing chronic kidney disease progression. Moreover, they appear to be generally safe and well tolerated.Summary: In the coming years, nonsteroidal MR antagonists and aldosterone synthase inhibitors are likely to play an increasingly large role in routine medical practice to help improve cardiovascular and kidney outcomes.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514984","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

The history and future of online hemodiafiltration and online solutions in North America.

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-02-19 DOI: 10.1097/MNH.0000000000001051

Clement Leduc, Narumi Tomisawa, Claudio Ronco, Kamyar Kalantar-Zadeh

{"title":"The history and future of online hemodiafiltration and online solutions in North America.","authors":"Clement Leduc, Narumi Tomisawa, Claudio Ronco, Kamyar Kalantar-Zadeh","doi":"10.1097/MNH.0000000000001051","DOIUrl":"https://doi.org/10.1097/MNH.0000000000001051","url":null,"abstract":"Purpose of review: Online hemodiafiltration (OL-HDF) is a type of outpatient intermittent dialysis therapy using purified online dialysis fluid sourced from the city water supply. OL-HDF has been widely practiced in Europe and Japan, and its clinical effects have been reported for prevention of dialysis amyloidosis, inflammation, and dialysis hypotension.Recent findings: A randomized controlled trial of all-cause mortality in postdilution OL-HDF and high-flux hemodialysis groups with replacement fluid volumes >23 l/session (CONVINCE study) reported a lower risk of all-cause mortality with OL-HDF compared to conventional hemodialysis. Whereas USA had not previously adopted OL-HDF, in February 2024 Fresenius' 5008K received 510K FDA approval, Although efforts to purify dialysis water and systems using dialysis fluid for HDF, such as those from Aksys (2002) and Nephros (2012), had been made in the past in the USA, they did not gain widespread adoption. Neighboring Canada has been conducting OL-HDF using the Gambro AK200 (1999), Baxter Artis (2009), B. Braun Dialog+ (2010), B. Braun Dialog IQ (2021) and the Fresenius 5008 (2013), all of which have received Health Canada approval for OL-HDF.Summary: OL-HDF's introduction to the USA represents both a challenge and an opportunity for patient care and the nephrology community. As a potentially superior treatment for ESRD patients, OL-HDF enables larger volumes of exchange, reduces costs by creating online solutions to replace expensive offline fluids, makes HDF therapy affordable for outpatient setting, and may improve survival and quality of life. However, significant barriers - ranging from regulatory and reimbursement hurdles to infrastructural inadequacies - must be addressed. Whether OL-HDF can finally emerge as a transformational renal replacement therapy after its entry to the US healthcare system remains to be determined.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440163","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

Metabolic dysfunction associated steatotic liver and kidney stones: what is going on?

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-01-31 DOI: 10.1097/MNH.0000000000001062

Owen P Cunneely, Anne Roberts, Sonia Fargue, John Knight, Dean G Assimos, Kyle D Wood

{"title":"Metabolic dysfunction associated steatotic liver and kidney stones: what is going on?","authors":"Owen P Cunneely, Anne Roberts, Sonia Fargue, John Knight, Dean G Assimos, Kyle D Wood","doi":"10.1097/MNH.0000000000001062","DOIUrl":"https://doi.org/10.1097/MNH.0000000000001062","url":null,"abstract":"Purpose of review: Metabolic dysfunction associated steatotic liver disease (MASLD) is increasing throughout the world, affecting nearly one in three individuals. Kidney stone disease, which is also increasing, is associated with MASLD. Common risk factors for both, including obesity, diabetes, dyslipidemia, hypertension, and metabolic syndrome, are likely drivers of this association. We present here a review of the associations and possible interconnections between these two common disease processes.Recent findings: Epidemiological studies are discordant regarding the impact of sex on this association and on the impact of MASLD on incident stone risk. The nature of kidney stones is rarely taken into account.A favorable milieu for uric acid kidney stone formation may be created by a lower urine pH resulting from defective ammonium production associated with insulin resistance, common in MASLD.Endogenous oxalate synthesis, a major risk factor for calcium oxalate kidney stones, may be increased in MASLD via decline in the activity of enzymes involved in the detoxification of glyoxylate, the immediate precursor of oxalate.Summary: The nature of kidney stones associated with MASLD and factors driving this association remain to be elucidated. Potential mechanisms identified underlying this include an increase in the risk factors for both uric acid and calcium oxalate kidney stones.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064252","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

Alport syndrome: an update. 阿尔波特综合症：最新进展。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-01-23 DOI: 10.1097/MNH.0000000000001063

Judy Savige

{"title":"Alport syndrome: an update.","authors":"Judy Savige","doi":"10.1097/MNH.0000000000001063","DOIUrl":"https://doi.org/10.1097/MNH.0000000000001063","url":null,"abstract":"Purpose of review: The recent widespread availability of genetic testing has resulted in the diagnosis of many more people with Alport syndrome. This increased recognition has been paralleled by advances in understanding clinical consequences, genotype-phenotype correlations and in the development of new therapies.Recent findings: These include the international call for a change of name to 'Alport spectrum' which better reflects the diverse clinical features seen with autosomal dominant and X-linked Alport syndrome; the demonstration of how common Alport syndrome is in people with haematuria, proteinuria, or kidney failure; the inability of current genetic testing to detect all pathogenic variants in suspected Alport syndrome; the different genotype-phenotype correlations for autosomal dominant and X-linked disease; and the novel treatments that are available including SGLT2 inhibitors for persistent albuminuria despite renin-angiotensin-aldosterone blockade, as well as early studies of gene-modifying agents.Summary: Autosomal dominant Alport syndrome is the commonest genetic kidney disease and X-linked Alport syndrome is the second commonest genetic cause of kidney failure. Both these diseases are frequently seen in the renal clinic, and clinicians should be aware of their likelihood in a person with persistent glomerular haematuria, proteinuria or kidney failure. Autosomal dominant Alport syndrome is so common that it also occurs coincidentally in other kidney diseases especially IgA nephropathy.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001820","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

Challenges in standardizing preimplantation kidney biopsy assessments and the potential of AI-Driven solutions. 标准化植入前肾活检评估的挑战和人工智能驱动解决方案的潜力。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-01-21 DOI: 10.1097/MNH.0000000000001064

Karolien Wellekens, Priyanka Koshy, Maarten Naesens

{"title":"Challenges in standardizing preimplantation kidney biopsy assessments and the potential of AI-Driven solutions.","authors":"Karolien Wellekens, Priyanka Koshy, Maarten Naesens","doi":"10.1097/MNH.0000000000001064","DOIUrl":"https://doi.org/10.1097/MNH.0000000000001064","url":null,"abstract":"Purpose of review: This review explores the variability in preimplantation kidney biopsy processing methods, emphasizing their impact on histological interpretation and allocation decisions driven by biopsy findings. With the increasing use of artificial intelligence (AI) in digital pathology, it is timely to evaluate whether these advancements can overcome current challenges and improve organ allocation amidst a growing organ shortage.Recent findings: Significant inconsistencies exist in biopsy methodologies, including core versus wedge sampling, frozen versus paraffin-embedded processing, and variability in pathologist expertise. These differences complicate study comparisons and limit the reproducibility of histological assessments. Emerging AI-driven tools and digital pathology show potential for standardizing assessments, enhancing reproducibility, and reducing dependence on expert pathologists. However, few studies have validated their clinical utility or demonstrated their predictive performance for long-term outcomes.Summary: Novel AI-driven tools hold promise for improving the standardization and accuracy of preimplantation kidney biopsy assessments. However, their clinical application remains limited due to a lack of proven associations with posttransplant outcomes and insufficient evaluation of predictive performance metrics. Future research should prioritize longitudinal studies using large-scale datasets, rigorous validation, and comprehensive assessments of predictive performance for both short- and long-term outcomes to fully establish their clinical utility.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001823","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

Insights into proliferative glomerulonephritis with monoclonal immunoglobulin deposits - is it really monoclonal or not? 对单克隆免疫球蛋白沉积的增生性肾小球肾炎的认识——它真的是单克隆的吗？

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-01-07 DOI: 10.1097/MNH.0000000000001061

Samih H Nasr, Vincent Javaugue

{"title":"Insights into proliferative glomerulonephritis with monoclonal immunoglobulin deposits - is it really monoclonal or not?","authors":"Samih H Nasr, Vincent Javaugue","doi":"10.1097/MNH.0000000000001061","DOIUrl":"10.1097/MNH.0000000000001061","url":null,"abstract":"Purpose of review: Proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID), is a disease defined by the presence of glomerulonephritis with nonorganized mono-isotypic immunoglobulin (Ig) deposits. This review will discuss the pathogenesis of PGNMID and address novel techniques for detection of monoclonal Ig and pathologic B-cell clones and for distinguishing monoclonal from oligoclonal Ig deposits.Recent findings: Because of low detection rate of circulating monoclonal Ig and nephritogenic B-cell clones and emerging reports of PGNMID-IgG in children, it has been recently argued that many PGNMID-IgG3 cases may not be monoclonal lesions. A mass spectrometry-based method, serum matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry, has been shown to have superior sensitivity than immunofixation for detection of monoclonal Ig in PGNMID and other monoclonal gammopathy of renal significance (MGRS) lesions. Two novel sequencing techniques, RNA-based immunoglobulin repertoire sequencing and single-molecule real-time sequencing of monoclonal immunoglobulin, enable identification of the full-length variable sequence of monoclonal Ig, even in MGRS patients with low tumor burden and undetectable monoclonal Ig by conventional methods. Finally, staining of kidney biopsy for Ig light chain variable domain subgroups may allow for separation of true monoclonal from oligoclonal PGNMID.Summary: Novel sequencing, mass spectrometry, and immunofluorescence techniques have the potential to increase the detection rate of nephritogenic monoclonal Ig/B-cell clone and distinguish monoclonal from oligoclonal deposits in PGNMID.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930833","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

Staying home when peritoneal dialysis ends: the integrated home dialysis approach. 腹膜透析结束后留在家中：综合家庭透析法。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-01-01 Epub Date: 2024-11-02 DOI: 10.1097/MNH.0000000000001034

Alex Pecce, Léa Belhumeur, Annie-Claire Nadeau-Fredette

{"title":"Staying home when peritoneal dialysis ends: the integrated home dialysis approach.","authors":"Alex Pecce, Léa Belhumeur, Annie-Claire Nadeau-Fredette","doi":"10.1097/MNH.0000000000001034","DOIUrl":"10.1097/MNH.0000000000001034","url":null,"abstract":"Purpose of review: Home dialysis has been promoted for several years for patients starting dialysis. Although incident use of peritoneal dialysis (PD) and home hemodialysis (HHD) is increasing in several regions, patients on home dialysis remain at high risk of transfer to facility-hemodialysis (HD). The integrated home dialysis model, where patient start dialysis on PD and eventually transition to HHD when PD cannot be optimally continued has gain interest from dialysis stakeholders.Recent findings: Transfers from PD to HHD are infrequently used among patients ending PD, representing between 2% and 6% of transfers to HD in registry studies. Nonetheless, this approach is associated with several clinical benefits as well as favorable cost-effectiveness.Summary: In this review, we will present data pertaining to home dialysis and the integrated home dialysis model, with broad discussion of the implementation challenges, including identifying patients who could most benefit from this approach, timely planning of the transitions and challenges relating to unexpected PD endings.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"104-111"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567494","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

Editorial introductions. 编辑介绍。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-01-01 Epub Date: 2024-11-28 DOI: 10.1097/MNH.0000000000001041

引用次数: 0