Kavita Mistry, Roya Best, Christopher T Stueber, Meghan E Sise
{"title":"Diagnosis and treatment of immune checkpoint inhibitor induced kidney disease.","authors":"Kavita Mistry, Roya Best, Christopher T Stueber, Meghan E Sise","doi":"10.1097/MNH.0000000000001215","DOIUrl":"10.1097/MNH.0000000000001215","url":null,"abstract":"<p><strong>Purpose of review: </strong>The use of immune checkpoint inhibitors (ICIs) is expanding in the treatment of a variety of cancer types; however, treatment with ICIs may result in off-target kidney inflammation in 3-5% of patients, most commonly acute interstitial nephritis (AIN). There is a significant unmet need for noninvasive diagnostic tools to facilitate accurate and timely diagnosis, and for targeted therapeutic strategies to more specifically block inflammation in ICI-AIN.</p><p><strong>Recent findings: </strong>The most promising emerging noninvasive diagnostic strategies include novel urinary biomarkers such as C-X-C motif ligand 9 (CXCL9), tumor necrosis factor alpha (TNF-α), interleukin 5 (IL-5), and Fas. There are increasing data to support treatment strategies that may better preserve the antitumor effect of ICIs, including the use of infliximab, as well as shorter corticosteroid courses.</p><p><strong>Summary: </strong>Novel biomarkers have shown great potential, although further studies will be required for validation. Improving scientific understanding of the underlying immunobiology in ICI-AIN and other ICI toxicities may uncover new pathways amenable to more specific therapeutic targeting, such as TNF-α. General nephrologists should be aware of recent advances in biomarker discovery and second-line immunosuppressives, given the increasingly widespread use of ICIs.</p>","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"596-604"},"PeriodicalIF":3.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497379","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}
Anna Faivre, Anders M Kristensen, Ina Maria Schiessl
{"title":"Seeing is believing: unraveling kidney function and remodeling in real time with in vivo imaging.","authors":"Anna Faivre, Anders M Kristensen, Ina Maria Schiessl","doi":"10.1097/MNH.0000000000001216","DOIUrl":"10.1097/MNH.0000000000001216","url":null,"abstract":"<p><strong>Purpose of review: </strong>Live imaging has become a transformative tool in kidney research, enabling real-time visualization of renal structure and function in vivo. With rapid technological progress, particularly in multiphoton microscopy, this review is reassessing how intravital imaging advances our understanding of kidney physiology and disease mechanisms.</p><p><strong>Recent findings: </strong>Recent studies have expanded intravital imaging beyond static morphology to include dynamic functional biomarkers. These approaches now allow simultaneous assessment of cellular behavior, microvascular function, and tissue remodeling in the intact kidney and over time. Integration of structural and functional readouts over time has provided deeper mechanistic insight into kidney disease progression and responses to therapeutic interventions.</p><p><strong>Summary: </strong>Intravital imaging refines the link between renal structure and function, offering a powerful framework for studying disease dynamics and treatment effects. These advances have important implications for both experimental research and the development of more targeted therapeutic strategies in kidney disease.</p>","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"676-688"},"PeriodicalIF":3.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497457","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}
{"title":"Distinct thick ascending limb cell types mediate divalent and monovalent ion transport.","authors":"Jessica Bahena-Lopez, David H Ellison","doi":"10.1097/MNH.0000000000001217","DOIUrl":"10.1097/MNH.0000000000001217","url":null,"abstract":"<p><strong>Purpose of review: </strong>The kidney thick ascending limb (TAL) is typically viewed as comprising a single cell type that expresses a Na-K-2Cl transporter and potassium channel at the apical membrane and a basolateral chloride channel. Together, these generate a lumen-positive transepithelial voltage. This review summarizes recent work revising this view substantially.</p><p><strong>Recent findings: </strong>Very early work suggested that not all TAL cells express potassium channels at the apical membrane. More recently, it became clear that paracellular transport pathways for monovalent and divalent cations exhibit a mosaic pattern, suggesting further diversity. By combining transcriptomics with more established approaches, it has become clear that there are 3 types of TAL cells. One type resembles the classic model. A second type, in the cortex and parts of the outer medulla, however, does not express apical potassium channels and is ringed by claudins that transport calcium and magnesium. A third type, in the inner stripe of the outer medulla, also lacks apical potassium channels but exhibits sodium-permeable claudins within the tight junctions.</p><p><strong>Summary: </strong>Previously unrecognized distinct cell types along the TAL mediate sodium transport and calcium/magnesium transport separately. Each type expresses regulatory pathways to permit differential regulation thereby preserving homeostasis.</p>","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"689-695"},"PeriodicalIF":3.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148725093","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}
{"title":"Multimorbidity after renal transplantation: incidence and implications for patients.","authors":"Samuel Strain, Lisa Crowley","doi":"10.1097/MNH.0000000000001213","DOIUrl":"10.1097/MNH.0000000000001213","url":null,"abstract":"<p><strong>Purpose of review: </strong>Kidney transplant recipients are living longer with functioning grafts while remaining vulnerable to accumulating chronic conditions driven by preexisting CKD-related disease burden, ageing, and long-term immunosuppression. Multimorbidity is increasingly recognized as a determinant of survival, healthcare utilization, treatment burden, and quality of life, yet its trajectory after transplantation remains poorly characterized.</p><p><strong>Recent findings: </strong>Recent literature shows that multimorbidity is common at transplantation and likely increases further afterwards, although posttransplant longitudinal data are scarce. Current themes include heterogeneity in how to define and measure multimorbidity, the contribution of immunosuppression and metabolic complications, associations with mortality and graft loss, and growing recognition of the importance of patient-reported outcomes and socioeconomic disadvantage.</p><p><strong>Summary: </strong>Multimorbidity should be considered an impactful component of long-term transplant outcomes. Research priorities include standardized definitions and characterization of the burden and trajectory of multimorbidity after transplant from longitudinal cohort studies and routinely collected data, and interventions that reduce treatment burden while improving graft, patient, and quality-of-life outcomes. Clinical practice should emphasize integrated, patient-centred management and careful risk-factor modification.</p>","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"619-625"},"PeriodicalIF":3.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497426","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}
{"title":"Kidney care for children: their needs are different.","authors":"Ayşe Balat","doi":"10.1097/MNH.0000000000001214","DOIUrl":"10.1097/MNH.0000000000001214","url":null,"abstract":"<p><strong>Purpose of review: </strong>Children differ significantly from adults, and their biological characteristics make them the most vulnerable group in terms of disease. Childhood kidney disease exemplifies health inequality at nearly every stage of life. This is because informed caregiver support, early diagnosis, appropriate follow-up, and effective treatment can greatly influence these children's development. This study will explore the main inequalities in the care of childhood kidney diseases from the existing literature.</p><p><strong>Recent findings: </strong>Research indicates that inequalities in childhood kidney health stem from overlapping social, structural, and health-system factors rather than biological differences. Issues such as poverty, limited health knowledge, geographic barriers, and the predominance of nonchild-centered health systems restrict access to kidney disease prevention, early diagnosis, and kidney replacement therapies. These inequalities are exacerbated in resource-limited settings and in difficult geographic conditions, leading to delayed diagnoses, poorer clinical outcomes, impaired growth and development, and lifelong negative impacts on individuals.</p><p><strong>Summary: </strong>Inequity in pediatric care is a reality, and addressing it requires coordinated, multisectoral strategies that go beyond medical care. These strategies should prioritize improving health literacy, implementing early interventions, creating equitable health systems, strengthening the pediatric nephrology workforce and infrastructure, and enacting policies that address the social determinants of health.</p>","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"635-640"},"PeriodicalIF":3.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497415","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}
{"title":"Key considerations in the design, conduct, analysis, and interpretation of observational studies in dialysis.","authors":"Rob R Quinn, Ngan N Lam","doi":"10.1097/MNH.0000000000001228","DOIUrl":"https://doi.org/10.1097/MNH.0000000000001228","url":null,"abstract":"<p><strong>Purpose of review: </strong>In this review, key considerations in the design, conduct, and analysis of observational studies in dialysis research are explored in a unique patient population for which interventional trials are challenging and limited.</p><p><strong>Recent findings: </strong>The use of target trial emulation is increasing and provides a conceptual framework for the design of observational studies. A target trial is a hypothetical trial that would be conducted to answer a research question. It requires investigators to ask a clinically relevant question and then specify eligibility criteria, the treatment strategies that will be compared, the follow-up period, outcomes of interest, and the causal contrast (intention-to-treat vs. per-protocol analysis). The protocol for an observational study is then created to mirror the target trial. In doing so, the question is clear, bias is reduced, and underlying assumptions are made transparent. Illustrative examples are used to highlight common pitfalls in dialysis research.</p><p><strong>Summary: </strong>In conclusion, randomized controlled trials are not always feasible or even the ideal approach for answering certain questions. However, observational studies are challenging and require careful planning and execution to ensure robust, unbiased results. Target trial emulation provides a blueprint to improve the quality of observational study design.</p>","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220068","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}
{"title":"Role of the calcium-sensing receptor in regulating calcium transport in the thick ascending limb.","authors":"Milos Bogdanovic, Henrik Dimke","doi":"10.1097/MNH.0000000000001204","DOIUrl":"10.1097/MNH.0000000000001204","url":null,"abstract":"<p><strong>Purpose of review: </strong>The calcium-sensing receptor (CASR) is a principal regulator of calcium balance. In the kidney, it directly modulates calcium reabsorption in the thick ascending limb (TAL). This review focuses on the CASR in TAL, its role in regulating renal calcium transport and hence systemic calcium homeostasis.</p><p><strong>Recent findings: </strong>Functional studies demonstrate that hypercalcemia-induced increases in urinary calcium excretion depend on renal CASR signaling, primarily through reduced paracellular calcium permeability in the TAL. Loss of the renal Casr in mice impairs urinary calcium excretion in conditions of hypercalcemia. Microperfusion shows reduced calcium permeability in cortical TALs from hypercalcemic wildtype mice, a response absent in Casr -deficient mice. CASR activation upregulates claudin-14 (CLDN14), a tight junction protein that selectively blocks paracellular divalent cation reabsorption. Single cell RNA-seq and protein expression studies reveal substantial TAL cell-type heterogeneity, identifying distinct transporter- and claudin- expressing populations. This mosaic organization of paracellular pathways provides a framework for understanding TAL-specific regulation of renal calcium handling.</p><p><strong>Summary: </strong>The TAL CASR acts as a sensor of blood calcium and adjusts paracellular transport by reducing tight junction permeability. While protective against hypercalcemia, sustained activation may promote hypercalciuria and nephrolithiasis.</p>","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"568-575"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148204479","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}
Dinesh Jothimani, Sarah Khan, Sravanthi Devireddy, Mohamed Rela, Patrick Kamath
{"title":"Advances in the management of Hepatorenal syndrome.","authors":"Dinesh Jothimani, Sarah Khan, Sravanthi Devireddy, Mohamed Rela, Patrick Kamath","doi":"10.1097/MNH.0000000000001212","DOIUrl":"10.1097/MNH.0000000000001212","url":null,"abstract":"<p><strong>Purpose of review: </strong>Hepatorenal syndrome (HRS) is the extreme manifestation of acute renal dysfunction in patients with cirrhosis, resulting from systemic vasodilation and renal vasoconstriction, leading to a reduction in the glomerular filtration rate.</p><p><strong>Recent findings: </strong>The diagnostic criteria redefined diagnostic criteria for HRS-AKI (Hepatorenal syndrome -Acute kidney injury) as our understanding of disease progression has improved. This understanding of the HRS disease process guides current management, with the combination of intravascular volume expansion and vasoconstrictor therapy being the cornerstone of treatment. In addition to treatment selection, timing of treatment initiation, duration, dosage, and monitoring during treatment are decisive factors in HRS outcomes. Pathogenesis of HRS-AKI may be different in patients with acute-on-chronic liver failure (ACLF) in comparison to decompensated cirrhosis. Unfortunately, outcomes remain poor with medical therapies alone and a high risk of disease recurrence exists for HRS-AKI with persistence of the cirrhotic milieu. Liver transplantation remains the only definitive treatment of HRS-AKI. Given the critical nature of HRS-AKI, a multidisciplinary approach involving hepatologists, nephrologists, and intensive care physicians is essential for optimal clinical management.</p><p><strong>Summary: </strong>Patients with HRS-AKI should be managed ideally in tertiary care centers and referred for liver transplantation promptly when eligible.</p>","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"526-537"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497381","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}
Isaac Chung, Mimi Chen, Lisa Anderson, Debasish Banerjee
{"title":"Updates in management of cardiorenal syndrome.","authors":"Isaac Chung, Mimi Chen, Lisa Anderson, Debasish Banerjee","doi":"10.1097/MNH.0000000000001209","DOIUrl":"10.1097/MNH.0000000000001209","url":null,"abstract":"<p><strong>Purpose of review: </strong>Cardiorenal syndrome is common, increasing in prevalence mainly due to increases in obesity, diabetes, hypertension and chronic kidney disease. The patients with cardiorenal syndrome are often frail and elderly suffering from poor quality of life, multiple hospital admissions, and death. There has been an increase in the number of evidence-based medications available for prevention and treatment of cardiorenal syndrome; however, implementation remains a challenge.</p><p><strong>Recent findings: </strong>In ambulatory patients, we discuss emerging evidence-based therapies such as nonsteroidal mineralocorticoid antagonists and glucagon-like peptide-1 receptor agonists for cardiorenal syndrome across all stages of chronic kidney disease, alongside the challenges of electrolyte imbalance and kidney function decline. In admitted patients, recent advances focus on optimization of volume status, including saline replacement during diuresis when appropriate and the use of adjuncts to loop diuretics (e.g. thiazide-type diuretics) to overcome diuretic resistance.</p><p><strong>Summary: </strong>These findings highlight the growing range of novel therapies expanding the cardiorenal physician's armamentarium, offering greater flexibility in managing cardiorenal syndrome across its spectrum to improve outcomes and improve the quality of life of patients suffering from cardiorenal syndrome.</p>","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"515-525"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148396238","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}
{"title":"WNK1 is a central osmolality sensor that regulates arginine vasopressin secretion.","authors":"Xin Jin, Mohammad Amir, Jian Xie, Chou-Long Huang","doi":"10.1097/MNH.0000000000001211","DOIUrl":"10.1097/MNH.0000000000001211","url":null,"abstract":"<p><strong>Purpose of review: </strong>Maintaining constant cellular osmolality is essential for physiological function in terrestrial animals. However, the molecular identity of the brain sensor(s) that detect extracellular hypertonicity and trigger arginine vasopressin (AVP) release has remained elusive. Early hypotheses emphasized the involvement of membrane mechanosensitive channels. More recent studies using purified proteins and heterologous expression systems have revealed that intracellular with-no-lysine (K) kinases (WNKs) possess intrinsic osmosensitivity. This review highlights emerging insights into how WNK1 senses environmental changes and regulates AVP secretion, thereby contributing to the maintenance of systemic water homeostasis.</p><p><strong>Recent findings: </strong>Recent studies have identified WNK1 as an intracellular osmolality sensor that detects changes in extracellular tonicity and regulates AVP release. Specifically, the catalytic activity of WNK1 in neurons of the brain's circumventricular organs is enhanced by physiological increases in extracellular osmolality. This activation of WNK1 stimulates the downstream OSR1/SPAK kinase cascade and modulates Kv3.1 channel activity, ultimately increasing neuronal excitability and action potential firing. Consequently, these signaling events promote AVP release, contributing to the maintenance of systemic water homeostasis.</p><p><strong>Summary: </strong>These findings underscore the critical role of intracellular kinase signaling in osmolality sensing, offering a new conceptual framework for understanding the regulation of water balance and identifying potential therapeutic targets for disorders associated with impaired osmoregulation.</p>","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"538-544"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497418","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}