Current Opinion in Nephrology and Hypertension最新文献_第3页

Agents to treat osteoporosis in chronic kidney disease. 治疗慢性肾脏疾病骨质疏松症的药物。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-05-19 DOI: 10.1097/MNH.0000000000001091

Pascale Khairallah

{"title":"Agents to treat osteoporosis in chronic kidney disease.","authors":"Pascale Khairallah","doi":"10.1097/MNH.0000000000001091","DOIUrl":"https://doi.org/10.1097/MNH.0000000000001091","url":null,"abstract":"Purpose of review: Fracture risk is significantly elevated in patients with chronic kidney disease (CKD), yet the diagnosis and treatment of CKD-associated osteoporosis remain complex. This review addresses the current gaps in managing bone health in CKD and highlights emerging strategies in this high-risk population.Recent findings: Diagnosis of CKD-associated osteoporosis requires integration of imaging, bone turnover markers, and occasionally bone biopsy. Correction of mineral metabolism disturbances is foundational, while bone-targeted therapies must be carefully selected. Treatment strategies are informed by bone turnover status. Antiresorptives such as bisphosphonates and denosumab are used in high-turnover disease, and osteoanabolic agents such as teriparatide and romosozumab are promising for low-turnover disease.Summary: Management of osteoporosis in CKD requires individualized approaches based on bone turnover and mineral metabolism status. While several pharmacologic options exist, evidence from randomized trials in CKD populations is limited. Further research is needed to guide treatment selection, define well tolerated therapeutic targets, and improve skeletal outcomes in this vulnerable group.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076466","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

Calcium-binding protein 39 in with-no-lysine kinase signaling and the modulation of renal tubular transport. 钙结合蛋白39与无赖氨酸激酶信号传导和肾小管运输的调节。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-05-14 DOI: 10.1097/MNH.0000000000001083

Mohammed Z Ferdaus, Eric Delpire

{"title":"Calcium-binding protein 39 in with-no-lysine kinase signaling and the modulation of renal tubular transport.","authors":"Mohammed Z Ferdaus, Eric Delpire","doi":"10.1097/MNH.0000000000001083","DOIUrl":"10.1097/MNH.0000000000001083","url":null,"abstract":"Purpose of review: The regulation of renal tubular transport is essential for maintaining electrolyte balance and blood pressure. Calcium-binding protein 39 (Cab39), also known as mouse protein-25 (MO25), plays a pivotal role in modulating this process through its interaction with WNK (with no lysine) kinases and Ste20-like kinases, including STE20/SPS1-related proline-alanine-rich kinase (SPAK) and oxidative stress response 1 (OSR1). By stabilizing and facilitating the activation of these kinases, Cab39 plays a crucial role in the regulation of key ion transporters, such as the sodium-chloride cotransporter (NCC) and the sodium-potassium-chloride cotransporters (NKCC1 and NKCC2). This review provides a comprehensive analysis of Cab39 structural properties, molecular interactions, and functional roles in renal physiology, emphasizing its significance in ion homeostasis.Recent findings: Studies reveal that Cab39 enhances SPAK activity up to 100-fold. Importantly, the role of Cab39 extends beyond simple kinase activation, as it supports kinase complex assembly and localization, enabling precise control over transporter regulation. Evidence also suggests that Cab39 may influence the regulation of NCC and NKCC2 through similar mechanisms, making it a promising target for therapeutic interventions in disorders such as hypertension and salt-wasting syndromes.Summary: The discovery of a small-molecule Cab39 inhibitor highlights its potential as a pharmacological target. Understanding the multifaceted functions of Cab39 may unlock novel strategies for managing renal and cardiovascular disorders.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962967","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 inhibition in chronic kidney disease. 慢性肾病醛固酮合成酶抑制。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-05-02 DOI: 10.1097/MNH.0000000000001089

Marieta P Theodorakopoulou, Fotini Iatridi, Pantelis A Sarafidis

{"title":"Aldosterone synthase inhibition in chronic kidney disease.","authors":"Marieta P Theodorakopoulou, Fotini Iatridi, Pantelis A Sarafidis","doi":"10.1097/MNH.0000000000001089","DOIUrl":"https://doi.org/10.1097/MNH.0000000000001089","url":null,"abstract":"Purpose: Chronic kidney disease (CKD) is associated with elevated cardiovascular risk and progression to kidney failure, despite advances in therapy with renin-angiotensin system inhibitors and sodium-glucose-co-transporter-2 inhibitors. Overactivation of the aldosterone pathway contributes to residual cardiorenal risk. Nonsteroidal mineralocorticoid receptor antagonists (MRAs) have shown efficacy in reducing cardiorenal outcomes in patients with albuminuric diabetic kidney disease, providing a rationale to explore broader aldosterone pathway inhibition in CKD.Recent findings: While steroidal MRAs are effective, their use is often limited by hormonal side effects and risk of hyperkalemia. Finerenone, a selective nonsteroidal MRA, showed cardiovascular and renal benefit in CKD patients with diabetes, although with only modest BP-lowering effects. Its role in nondiabetic populations and in those with lower levels of albuminuria remains to be determined. More recently, aldosterone synthase inhibitors (ASIs) have emerged as promising agents that directly suppress aldosterone production. Early-phase studies in patients with CKD, with or without diabetes, have shown reductions in albuminuria and BP, with a favorable safety profile.Summary: Direct inhibition of aldosterone synthesis may provide a novel and complementary strategy to reduce residual cardiorenal risk in CKD. Ongoing phase 3 trials will be key to defining the clinical utility of ASIs and their integration into future treatment paradigms.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989365","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

APOL1 testing in clinical practice and opportunities for new therapies. APOL1在临床实践中的检测和新疗法的机会。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-05-02 DOI: 10.1097/MNH.0000000000001082

Taewoo Lee, Lijun Ma, Barry I Freedman

{"title":"APOL1 testing in clinical practice and opportunities for new therapies.","authors":"Taewoo Lee, Lijun Ma, Barry I Freedman","doi":"10.1097/MNH.0000000000001082","DOIUrl":"https://doi.org/10.1097/MNH.0000000000001082","url":null,"abstract":"Purpose of review: The spectrum of kidney diseases caused by variation in the apolipoprotein L1 (APOL1) gene was identified in 2010 among patients with recent African ancestry. In the United States, inheriting two APOL1 risk variants (high-risk genotypes) markedly increases risk for solidified glomerulosclerosis, focal segmental glomerulosclerosis, collapsing glomerulopathy, lupus nephritis, and sickle cell nephropathy. Kidneys from African American deceased donors with APOL1 high-risk genotypes also fail more rapidly after transplant. One risk variant increases nephropathy risk in Africa. This review focuses on novel therapies targeting APOL1 and the changing landscape of APOL1 genotyping in patients at risk for APOL1-mediated kidney disease (AMKD).Recent findings: Renin-angiotensin-aldosterone system blockade and sodium-glucose cotransporter 2 inhibitors slow nephropathy progression but are not curative. Medications directly targeting APOL1 mRNA and blocking APOL1 protein effects are undergoing clinical trials in AMKD, including APOL1 small molecule inhibitors, an APOL1 antisense oligonucleotide, and a Janus kinase (JAK) signaling inhibitor to reduce APOL1 expression. Early results are promising and provide hope for well tolerated and effective therapies. If successful, more patients will need to be considered for APOL1 genotyping, and our approach to diagnosing and treating chronic kidney disease in populations with recent African ancestry will change dramatically.Summary: Mechanisms of APOL1 risk variant nephrotoxicity remain unclear; nonetheless, specific therapies for AMKD show great promise and may improve understanding of disease processes. With ongoing clinical trials and the potential for effective AMKD treatments, more widespread APOL1 genotyping will likely be needed.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982823","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 : 2025-05-01 Epub Date: 2025-01-22 DOI: 10.1097/MNH.0000000000001063

Judy Savige

{"title":"Alport syndrome: an update.","authors":"Judy Savige","doi":"10.1097/MNH.0000000000001063","DOIUrl":"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":"206-211"},"PeriodicalIF":2.2,"publicationDate":"2025-05-01","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

The history and future of online hemodiafiltration and online solutions in North America. 北美在线血液滤过和在线解决方案的历史和未来。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-05-01 Epub Date: 2025-02-18 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":"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":"254-258"},"PeriodicalIF":2.2,"publicationDate":"2025-05-01","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

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 : 2025-05-01 Epub Date: 2025-01-20 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":"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":"185-190"},"PeriodicalIF":2.2,"publicationDate":"2025-05-01","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 : 2025-05-01 Epub Date: 2025-01-10 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":"199-205"},"PeriodicalIF":2.2,"publicationDate":"2025-05-01","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

The boundaries of normal kidney tissue for biomedical research. 生物医学研究中正常肾组织的边界。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-05-01 Epub Date: 2025-03-10 DOI: 10.1097/MNH.0000000000001069

Jeffrey B Hodgin, Rajasree Menon, Markus Bitzer

{"title":"The boundaries of normal kidney tissue for biomedical research.","authors":"Jeffrey B Hodgin, Rajasree Menon, Markus Bitzer","doi":"10.1097/MNH.0000000000001069","DOIUrl":"10.1097/MNH.0000000000001069","url":null,"abstract":"Purpose of review: In this review, we highlight the importance of understanding the inherent biological variability in normal kidney, or healthy reference tissue, to establish an accurate reference point for biomedical research. We explore this and the advantages and limitations of various sources of healthy reference tissue suitable for structural and omics-level studies.Recent findings: Several large consortia are employing omic technologies for diseased and normal kidney tissue, underscoring the importance of utilizing healthy reference tissue in these studies. Emerging approaches, such as artificial intelligence and multiomic analyses, are expanding our understanding of structural and molecular heterogeneity in healthy reference kidney tissue and uncovering new insights.Summary: Biological variability in healthy reference tissue at the functional, structural, and molecular level is complex and remains an active area of study. Thoughtful selection of healthy reference tissue sources is critical, providing the greatest potential for producing high-quality research outcomes.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"218-223"},"PeriodicalIF":2.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957444/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584957","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

Evolving thresholds for the diagnosis of acute T cell mediated rejection. 进化阈值诊断急性T细胞介导的排斥反应。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-05-01 Epub Date: 2025-03-19 DOI: 10.1097/MNH.0000000000001072

Brian J Nankivell

{"title":"Evolving thresholds for the diagnosis of acute T cell mediated rejection.","authors":"Brian J Nankivell","doi":"10.1097/MNH.0000000000001072","DOIUrl":"10.1097/MNH.0000000000001072","url":null,"abstract":"Purpose of review: The Banff schema uses combinations of pathological lesions at predefined thresholds to diagnose of T cell rejection (TCMR) and grade its severity. Constant definitional changes have caused confusion among clinicians and pathologists. This review describes the evolution of lesion definitions and the rationale for the minimal thresholds.Recent findings: The minimal diagnostic threshold for borderline TCMR has been reset to original Banff i1/t1, where isolated tubulitis is now excluded. Arteritis can be mediated by either Grade II TCMR or caused by donor specific antibody as antibody-mediated vascular rejection. The conservative threshold for chronic active TCMR diagnosis uses moderate total and scarred inflammation with tubulitis has been challenged by recent longitudinal data to suggest lower thresholds including i-IFTA=1 as clinically relevant.Summary: Minor changes in the threshold ruleset can cause substantial alterations in the final pathological diagnoses. While minimal thresholds for borderline and active TCMR have now stabilized, future changes are likely for chronic active TCMR pending confirmatory research.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"212-217"},"PeriodicalIF":2.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656394","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