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

Early changes in kidney function in young adults: what is the significance? 青壮年肾功能的早期变化：有何意义？

IF 2.4 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2026-05-01 Epub Date: 2026-03-13 DOI: 10.1097/MNH.0000000000001176

Junayd Hussain, Manish M Sood

{"title":"Early changes in kidney function in young adults: what is the significance?","authors":"Junayd Hussain, Manish M Sood","doi":"10.1097/MNH.0000000000001176","DOIUrl":"10.1097/MNH.0000000000001176","url":null,"abstract":"Purpose of review: Early changes in kidney function in young adults - particularly modest declines in estimated glomerular filtration rate (eGFR) and the development of microalbuminuria - are increasingly recognized as predictors of long-term kidney and cardiovascular outcomes. This review summarizes the recent literature to present the clinical relevance of these early changes, highlight emerging insights into underlying mechanisms, and discuss implications for preventive strategies.Recent findings: Even subtle reductions in kidney function in young adults are associated with higher risks of clinically significant adverse outcomes. Advancements in measurement techniques, including the use of novel biomarkers such as cystatin C, have improved early detection of dysfunction in kidney filtration. Risk factors include metabolic, vascular, genetic, and environmental determinants. Evidence suggests early kidney changes are prognostically important and may warrant targeted screening in high-risk populations. Lifestyle interventions and pharmacologic therapies, such as sodium-glucose co-transporter-2 inhibitors, show promise in slowing early progression.Summary: Recognition of early kidney function changes offers a window for intervention to mitigate long-term morbidity. Future research should refine screening thresholds, optimize preventive strategies, and evaluate early interventional therapies to improve outcomes In young adults.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"347-352"},"PeriodicalIF":2.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147456220","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

An update on the epidemiology of chronic kidney disease of uncertain etiology. 病因不明的慢性肾脏病流行病学进展。

IF 2.4 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2026-05-01 Epub Date: 2026-03-17 DOI: 10.1097/MNH.0000000000001177

Sophie E Claudel, Sushrut S Waikar, Madeleine K Scammell

{"title":"An update on the epidemiology of chronic kidney disease of uncertain etiology.","authors":"Sophie E Claudel, Sushrut S Waikar, Madeleine K Scammell","doi":"10.1097/MNH.0000000000001177","DOIUrl":"10.1097/MNH.0000000000001177","url":null,"abstract":"Purpose of review: Chronic kidney disease of uncertain etiology (CKDu) has devastating impacts on individuals and communities in affected regions, but it remains an ill-defined diagnosis of exclusion despite decades of environmental and epidemiologic research. The purpose of this review is to synthesize recent literature describing the global burden of disease and potential causal factors.Recent findings: A large, international prevalence study quantitatively identified Uddanam, India, Northwest Nicaragua, and Anuradhapura, Sri Lanka as prominent CKDu hotspots. Stronger evidence for the role of heat stress in exacerbating kidney function decline among individuals with CKDu now includes validated measurements of core body temperature. Additionally, recent studies use urine metabolomics to support environmental exposure evaluation and generate hypotheses for future pathway analysis. While longitudinal studies remain infrequent, three key longitudinal studies provide greater insight into trajectories of kidney function decline in CKDu.Summary: The cause(s) of CKDu remain uncertain, but greater integration of genetic, translational, biopsy, and longitudinal epidemiologic data hold promise for elucidating mechanistic pathways. Increased standardization of kidney biopsy protocols, epidemiologic definitions, and population surveillance methodologies would strengthen ongoing efforts to identify, treat, and prevent CKDu.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"353-359"},"PeriodicalIF":2.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147473020","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 podocyte slit-diaphragm: target of anti-nephrin antibodies. 足细胞裂膜：抗肾素抗体的靶点。

IF 2.4 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2026-05-01 Epub Date: 2026-02-23 DOI: 10.1097/MNH.0000000000001167

Laurence H Beck, David J Salant

{"title":"The podocyte slit-diaphragm: target of anti-nephrin antibodies.","authors":"Laurence H Beck, David J Salant","doi":"10.1097/MNH.0000000000001167","DOIUrl":"10.1097/MNH.0000000000001167","url":null,"abstract":"Purpose of review: This review is prompted by substantial new information on the composition and structure of the podocyte slit-diaphragm and the identification of anti-nephrin antibodies in patients with acquired diseases of the glomerular podocyte, including steroid-sensitive nephrotic syndrome of childhood, minimal change disease and some cases of primary focal and segmental glomerulosclerosis (FSGS).Recent findings: New methodologies including multi-epitope affinity purification, high resolution proteomics and cryo-electron tomography reveal that the slit-diaphragm consists of a multi-layered fishnet-like structure made up by nephrin and neph1 homodimers as well as several co-assembled proteins with signaling properties. Insights from clinical studies and experimental models support the concept that pathogenic antibodies engaging the extracellular domain of nephrin disrupt the integrity of the slit-diaphragm and signal changes to the podocyte cytoskeleton that lead to foot process effacement and proteinuria.Summary: These findings raise several questions to be answered experimentally, including the nephrin epitopes targeted by the antibodies and the way in which they alter the slit-diaphragm and podocyte architecture and induce nephrin endocytosis. They also highlight the need for a reliable and widely available assay for anti-nephrin antibodies, which would have diagnostic and therapeutic impact on diagnosis, prognosis and therapy.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"279-286"},"PeriodicalIF":2.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147282639","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

Stopping renin-angiotensin-aldosterone system inhibitors in kidney disease. 肾病患者停用肾素-血管紧张素-醛固酮系统抑制剂。

IF 2.4 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2026-05-01 Epub Date: 2026-03-13 DOI: 10.1097/MNH.0000000000001173

Eva Glenn Lecea, Krystle Frazier, Elaine Ku

{"title":"Stopping renin-angiotensin-aldosterone system inhibitors in kidney disease.","authors":"Eva Glenn Lecea, Krystle Frazier, Elaine Ku","doi":"10.1097/MNH.0000000000001173","DOIUrl":"10.1097/MNH.0000000000001173","url":null,"abstract":"Purpose: The KDIGO guidelines recommend the use of renin-angiotensin system inhibitors (RASi) in chronic kidney disease (CKD) given their kidney and cardiovascular benefits. Despite this recommendation, real-word data suggest low rates of the use of these medications, and RASi are frequently discontinued. The objective of this review is to summarize the outcomes associated with the discontinuation of RASi in individuals with CKD, hyperkalemia, and acute kidney injury (AKI).Recent findings: Trial-grade data suggest that there is no benefit to the discontinuation of RASi in patients with low eGFR on kidney or mortality outcomes. Observational and trial-grade data suggests similar outcomes for the continuation of RASi during the perioperative period as compared to discontinuation of RASi. Observational data also suggest that reinitiation of RASi after AKI and hyperkalemia is associated with improved survival and reduces the risk of progression of kidney disease.Summary: This review highlights outcomes following the discontinuation of RASi, which is generally associated with worse outcomes across the spectrum of CKD, hyperkalemia, and AKI.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"329-336"},"PeriodicalIF":2.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147456261","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

Managing hypertension and cardiovascular risk in resource-limited settings. 在资源有限的环境中管理高血压和心血管风险。

IF 2.4 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2026-05-01 Epub Date: 2026-01-19 DOI: 10.1097/MNH.0000000000001161

Rajeev Gupta

{"title":"Managing hypertension and cardiovascular risk in resource-limited settings.","authors":"Rajeev Gupta","doi":"10.1097/MNH.0000000000001161","DOIUrl":"10.1097/MNH.0000000000001161","url":null,"abstract":"Purpose of review: Hypertension management is a gateway for cardiovascular risk reduction. The status of hypertension treatment and control is low in resource-limited lower income countries and similar settings in middle-income and high-income countries. Implementation of strategies for prevention and management of hypertension can lead to a substantial increase in its control and decline in associated cardiovascular mortality and disease burden.Recent findings: Population-wide and clinical interventions that can be deployed in resource-limited settings globally to improve hypertension control have been summarized in the WHO's Global Report on Hypertension (2025). Focusing on social determinants (poverty, hunger, literacy, clean energy, economic growth, inequalities, sustainable cities, and climate action) can lead to primordial prevention, and risk factor control (such as salt reduction, physical activity, pollution, obesity, and a healthy diet) for primary prevention. Guidelines emphasize simplified medical treatment with algorithm-based single-pill combinations. Specific strategies that focus on nonphysician health worker-led interventions to promote identification and adherence to treatment in low-resource settings ae important. Technology-based interventions for the identification of hypertension and promotion of adherence need more studies.Summary: Primordial and primary prevention of hypertension, combined with interventions that support clinical management and promote adherence to therapies, are important for resource-limited settings to reduce cardiovascular risk.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"373-386"},"PeriodicalIF":2.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146003040","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

Reimagining kidney value-based care: leveraging data science for dynamic, clinician-level risk prediction. 重新构想基于肾脏价值的护理：利用数据科学进行动态的临床水平的风险预测。

IF 2.4 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2026-05-01 Epub Date: 2026-01-29 DOI: 10.1097/MNH.0000000000001162

Derek J Baughman, Paul Nagy, Chirag R Parikh

{"title":"Reimagining kidney value-based care: leveraging data science for dynamic, clinician-level risk prediction.","authors":"Derek J Baughman, Paul Nagy, Chirag R Parikh","doi":"10.1097/MNH.0000000000001162","DOIUrl":"10.1097/MNH.0000000000001162","url":null,"abstract":"Purpose of review: Chronic kidney disease (CKD) remains one of the costliest conditions in healthcare, yet value-based payment (VBP) reforms have produced limited improvements in cost or quality. Existing renal payment models rely on annual benchmarks that fail to reflect the longitudinal reality of CKD care. This precludes the possibility of observing a dose-response relationship in clinician-level interventions, effectively invisible in current VBP structures.Recent findings: Advances in clinical informatics and predictive modeling demonstrate the feasibility of sub-annual, patient-level risk estimation for CKD outcomes and costs. Standardized electronic health record and claims data enable longitudinal, clinician-level analysis. This can transform retrospective, aggregate VBP into dynamic forecasting systems reflecting real-world care delivery. Short-horizon prediction reveals temporal, dose-response relationships between guideline-aligned interventions and downstream events that remain obscured by annualized VBP frameworks.Summary: CKD is a clinically and economically compelling testbed for next-generation VBP design. Patient-level modeling with sub-annual risk prediction is the next step in modernizing payment frameworks to align incentives. Future VBP policy should shift models beyond static, annual metrics toward EHR-native, temporally precise evaluation frameworks that reward meaningful preventive care for patients, clinicians, and payers.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"360-366"},"PeriodicalIF":2.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146104213","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

Aldosterone synthase inhibitors in hypertension and chronic kidney disease: double the benefit? 醛固酮合成酶抑制剂治疗高血压和慢性肾病：获益加倍？

IF 2.4 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2026-05-01 Epub Date: 2026-03-12 DOI: 10.1097/MNH.0000000000001175

Alessio Mazzieri, Sara Battistoni, Gianpaolo Reboldi

{"title":"Aldosterone synthase inhibitors in hypertension and chronic kidney disease: double the benefit?","authors":"Alessio Mazzieri, Sara Battistoni, Gianpaolo Reboldi","doi":"10.1097/MNH.0000000000001175","DOIUrl":"10.1097/MNH.0000000000001175","url":null,"abstract":"Purpose of review: Aldosterone synthase inhibitors (ASIs) are novel drugs for cardiorenal protection. These compounds block aldosterone production and lower blood levels by targeting its biosynthesis pathway. ASIs induce a complete suppression of both genomic and nongenomic aldosterone effects, while reducing the risks of hyperkalaemia and aldosterone escape. In the present review, we will summarize the clinical potential of current ASIs in hypertension and chronic kidney disease (CKD).Recent findings: Selective ASIs have been extensively evaluated in patients with both primary and resistant hypertension, and are promising therapeutic agents in CKD. Baxdrostat and lorundrostat effectively lowered blood pressure in patients with resistant or uncontrolled hypertension and showed favourable effects on renal outcomes. In CKD patients, vicadrostat determined a dose-dependent reduction of albuminuria and additive beneficial effects when used on top of empagliflozin.Summary: In randomized controlled trials, patients assigned to second generation ASIs had beneficial effects on blood pressure and albuminuria, with enhanced safety profiles. Although long-term clinical outcomes are still under investigation, ASIs have the potential to narrow critical gaps in cardiorenal care.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"337-346"},"PeriodicalIF":2.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147431342","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

Microvascular inflammation in the kidney transplant, beyond acute antibody-mediated rejection. 肾移植中的微血管炎症，超越急性抗体介导的排斥反应。

IF 2.4 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2026-05-01 Epub Date: 2026-01-29 DOI: 10.1097/MNH.0000000000001165

Aurélie Sannier, Louise Benning, Alexandre Loupy

{"title":"Microvascular inflammation in the kidney transplant, beyond acute antibody-mediated rejection.","authors":"Aurélie Sannier, Louise Benning, Alexandre Loupy","doi":"10.1097/MNH.0000000000001165","DOIUrl":"10.1097/MNH.0000000000001165","url":null,"abstract":"Purpose of review: Microvascular inflammation (MVI) is a central feature of allograft rejection, traditionally associated with antibody-mediated rejection (AMR), but its mechanisms and clinical impact extend beyond this framework. This review highlights recent updates in the Banff classification, insights into the mechanisms underlying MVI, and how these developments may refine diagnostic approaches and guide the development of therapeutic strategies.Recent findings: The spectrum of MVI has been refined, with DSA-negative C4d-negative MVI and probable AMR now recognized as distinct entities associated with adverse graft outcomes. Mechanistic studies highlight the complementary roles of non-HLA antibodies, NK-cell-driven alloreactivity, and T-cell mediated injury. Molecular diagnostics have advanced our understanding of rejection phenotypes, while donor-derived cell-free DNA has emerged as the most robust and noninvasive biomarker of active microvascular injury. Novel therapies, particularly CD38-directed treatments such as felzartamab, have shown promising results in AMR but their efficacy across all MVI phenotypes remains to be established.Summary: MVI represents a heterogeneous spectrum of alloimmune injuries that extends beyond the traditional AMR framework. Combining histology with emerging artificial intelligence tools, molecular diagnostics, and noninvasive biomarkers, will offer a more integrated approach to diagnosis, risk stratification, and development of novel therapies.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"316-322"},"PeriodicalIF":2.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146104139","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

Update on antineutrophil cytoplasmic antibody vasculitis: Erratum. 抗中性粒细胞细胞质抗体血管炎的最新进展：勘误。

IF 2.4 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2026-05-01 Epub Date: 2026-03-26 DOI: 10.1097/MNH.0000000000001182

Dan A Mandel, Nishitha Shekhar, Ramy Hanna, Uttam Reddy

引用次数: 0

Parathyroid hormone levels: the lower the better the outcomes. 甲状旁腺激素水平：越低效果越好。

IF 2.4 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2026-04-30 DOI: 10.1097/MNH.0000000000001188

Hirotaka Komaba

{"title":"Parathyroid hormone levels: the lower the better the outcomes.","authors":"Hirotaka Komaba","doi":"10.1097/MNH.0000000000001188","DOIUrl":"https://doi.org/10.1097/MNH.0000000000001188","url":null,"abstract":"Purpose of review: Secondary hyperparathyroidism (SHPT) is a common complication of chronic kidney disease, particularly in patients receiving dialysis. Conventional management has emphasized avoiding excessively low PTH levels to prevent low-turnover bone disease, yet recent evidence challenges this approach. This review examines the potential of more intensive PTH control to improve skeletal and clinical outcomes.Recent findings: Although excessive suppression of PTH or low-turnover bone has been thought to impair bone strength, recent evidence indicates that intensive PTH reduction does not compromise bone integrity and may even reduce fracture risk. PTH-lowering interventions appear to limit further progression of SHPT-associated cortical porosity but cannot reverse established structural damage, underscoring the importance of early intervention. Low-turnover bone has also been hypothesized to impair calcium buffering and promote vascular calcification; however, its clinical impact seems limited in the era of widespread calcimimetic use or following parathyroidectomy. Furthermore, there is no clear evidence that excessive PTH suppression adversely affects nonskeletal organs influenced by SHPT.Summary: These findings suggest that the benefits of more intensive PTH control may outweigh potential risks, supporting a proactive management approach. Prospective interventional studies are needed to confirm whether this strategy can reduce fractures and improve survival without safety concerns.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812189","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