Current Opinion in Nephrology and Hypertension最新文献_第7页

Antineutrophil cytoplasmic antibody-associated vasculitis. 抗中性粒细胞胞浆抗体相关性血管炎。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2024-09-01 Epub Date: 2024-05-24 DOI: 10.1097/MNH.0000000000001004

Raghunandan Konda, Arun Rajasekaran, Dana V Rizk

{"title":"Antineutrophil cytoplasmic antibody-associated vasculitis.","authors":"Raghunandan Konda, Arun Rajasekaran, Dana V Rizk","doi":"10.1097/MNH.0000000000001004","DOIUrl":"10.1097/MNH.0000000000001004","url":null,"abstract":"Purpose of review: This review focuses on latest developments in managing antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV), a systemic autoimmune condition characterized by inflammation and necrosis of small blood vessels due to circulating autoantibodies that target neutrophilic granules.Recent findings: Our understanding of AAV pathogenesis has evolved in the past decades highlighting the central pathogenic roles of autoantibodies and complement activation. In parallel, the appreciation for glucocorticoid toxicity has led the research on crucial steroid-sparing therapeutic alternatives. Complement inhibitors (like avacopan) that have emerged are associated with better preservation of kidney function in AAV patients with severe kidney impairment. The role of plasma-exchange (PLEX) was revisited in updated guidelines that recommended its potential use in the context of diffuse alveolar hemorrhage associated hypoxia and severe kidney involvement, particularly with a serum creatinine level above 3.4 mg/dl. The ANCA Kidney Risk Score risk prediction and Glucocorticoid Toxicity Index score aid in identifying high-risk patients and individualizing management plans.Summary: Kidney involvement in AAV requires prompt diagnosis and initiation of immunosuppression to prevent irreversible nephron loss. Newer therapeutic targets are on the horizon and offer hope for personalized treatment strategies.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"503-511"},"PeriodicalIF":2.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141087302","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

New insights into renal calcium-sensing receptor activation. 肾脏钙传感受体激活的新发现

IF 3.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2024-07-01 Epub Date: 2024-05-01 DOI: 10.1097/MNH.0000000000000998

Henrik Dimke

{"title":"New insights into renal calcium-sensing receptor activation.","authors":"Henrik Dimke","doi":"10.1097/MNH.0000000000000998","DOIUrl":"10.1097/MNH.0000000000000998","url":null,"abstract":"Purpose of review: Activation of the calcium-sensing receptor (CASR) in the parathyroid gland suppresses the release of parathyroid hormone (PTH). Furthermore, activation of the renal CASR directly increases the urinary excretion of calcium, by inhibiting transepithelial calcium transport in the nephron. Gain-of-function mutations in the CASR gene lead to autosomal dominant hypocalcemia 1 (ADH1), with inappropriately low PTH levels and hypocalcemia, indicative of excessive activation of the parathyroid CASR. However, hypercalciuria is not always observed. The reason why the manifestation of hypercalciuria is not uniform among ADH1 patients is not well understood.Recent findings: Direct activation of the CASR in the kidney has been cumbersome to study, and an indirect measure to effectively estimate the degree of CASR activation following chronic hypercalcemia or genetic gain-of-function CASR activation has been lacking. Studies have shown that expression of the pore-blocking claudin-14 is strongly stimulated by the CASR in a dose-dependent manner. This stimulatory effect is abolished after renal Casr ablation in hypercalcemic mice, suggesting that claudin-14 abundance may gauge renal CASR activation. Using this marker has led to unexpected discoveries regarding renal CASR activation.Summary: These new studies have informed on renal CASR activation thresholds and the downstream CASR-regulated calcium transport mechanisms.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"433-440"},"PeriodicalIF":3.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140862386","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 nephropathy - a population genetics success story. APOL1 肾病--一个群体遗传学的成功故事。

IF 3.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2024-07-01 Epub Date: 2024-02-28 DOI: 10.1097/MNH.0000000000000977

Orly Tabachnikov, Karl Skorecki, Etty Kruzel-Davila

{"title":"APOL1 nephropathy - a population genetics success story.","authors":"Orly Tabachnikov, Karl Skorecki, Etty Kruzel-Davila","doi":"10.1097/MNH.0000000000000977","DOIUrl":"10.1097/MNH.0000000000000977","url":null,"abstract":"Purpose of review: More than a decade ago, apolipoprotein L1 ( APOL1 ) risk alleles designated G1 and G2, were discovered to be causally associated with markedly increased risk for progressive kidney disease in individuals of recent African ancestry. Gratifying progress has been made during the intervening years, extending to the development and clinical testing of genomically precise small molecule therapy accompanied by emergence of RNA medicine platforms and clinical testing within just over a decade.Recent findings: Given the plethora of excellent prior review articles, we will focus on new findings regarding unresolved questions relating mechanism of cell injury with mode of inheritance, regulation and modulation of APOL1 activity, modifiers and triggers for APOL1 kidney risk penetrance, the pleiotropic spectrum of APOL1 related disease beyond the kidney - all within the context of relevance to therapeutic advances.Summary: Notwithstanding remaining controversies and uncertainties, promising genomically precise therapies targeted at APOL1 mRNA using antisense oligonucleotides (ASO), inhibitors of APOL1 expression, and small molecules that specifically bind and inhibit APOL1 cation flux are emerging, many already at the clinical trial stage. These therapies hold great promise for mitigating APOL1 kidney injury and possibly other systemic phenotypes as well. A challenge will be to develop guidelines for appropriate use in susceptible individuals who will derive the greatest benefit.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"447-455"},"PeriodicalIF":3.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11139250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139982546","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

Women's health and kidney protective medications. 妇女健康和护肾药物。

IF 3.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2024-05-06 DOI: 10.1097/mnh.0000000000001000

Mythri Shankar, Sehrish Ali, Silvi Shah

引用次数: 0

Cystatin C should be routinely available for estimating kidney function. 胱抑素 C 应作为估测肾功能的常规指标。

IF 3.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2024-05-01 Epub Date: 2024-02-23 DOI: 10.1097/MNH.0000000000000980

Jennifer S Lees, June Fabian, Michael G Shlipak

{"title":"Cystatin C should be routinely available for estimating kidney function.","authors":"Jennifer S Lees, June Fabian, Michael G Shlipak","doi":"10.1097/MNH.0000000000000980","DOIUrl":"10.1097/MNH.0000000000000980","url":null,"abstract":"Purpose of review: In this report, we summarize why the availability of cystatin C is important across a variety of clinical scenarios, the recent literature on when, why and in whom cystatin C testing should be considered, and how nephrologists can take practical steps to incorporate cystatin C testing into their practice.Recent findings: Large intra-individual discrepancies between estimated glomerular filtration rate by creatinine (eGFRcr) and estimated glomerular filtration rate by creatinine eGFRcys (known as eGFRdiff) are observed in at least 1 in 4 people. These differences are seen more commonly among more vulnerable individuals: older adults, females, non-White individuals and those living with multiple medical conditions. A large eGFRdiff, where eGFRcys is lower than eGFRcr, is associated with a plethora of adverse outcomes, including medication-associated adverse events, acute kidney injury, cardiovascular disease, kidney failure and all-cause mortality. Among studies that have measured GFR, eGFRcr-cys usually provides the most accurate estimation of kidney function compared to mGFR, including among participants with large discrepancies between eGFRcr and eGFRcys.Summary: Cystatin C improves sensitivity and specificity of chronic kidney disease diagnosis, improves detection of harmful acute and chronic changes in kidney function, improves precision of treatment eligibility and safety, and may reduce healthcare inequalities. Better education, curiosity, and motivation among nephrologists could substantially improve the availability and utilization of cystatin C.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"337-343"},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139971313","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 and Alport kidney diseases - elucidating the disease spectrum. 阿尔波特综合征和阿尔波特肾病--阐明疾病谱。

IF 3.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2024-05-01 Epub Date: 2024-03-13 DOI: 10.1097/MNH.0000000000000983

Pongpratch Puapatanakul, Jeffrey H Miner

{"title":"Alport syndrome and Alport kidney diseases - elucidating the disease spectrum.","authors":"Pongpratch Puapatanakul, Jeffrey H Miner","doi":"10.1097/MNH.0000000000000983","DOIUrl":"10.1097/MNH.0000000000000983","url":null,"abstract":"Purpose of review: With the latest classification, variants in three collagen IV genes, COL4A3 , COL4A4 , and COL4A5 , represent the most prevalent genetic kidney disease in humans, exhibiting diverse, complex, and inconsistent clinical manifestations. This review breaks down the disease spectrum and genotype-phenotype correlations of kidney diseases linked to genetic variants in these genes and distinguishes \"classic\" Alport syndrome (AS) from the less severe nonsyndromic genetically related nephropathies that we suggest be called \"Alport kidney diseases\".Recent findings: Several research studies have focused on the genotype-phenotype correlation under the latest classification scheme of AS. The historic diagnoses of \"benign familial hematuria\" and \"thin basement membrane nephropathy\" linked to heterozygous variants in COL4A3 or COL4A4 are suggested to be obsolete, but instead classified as autosomal AS by recent expert consensus due to a significant risk of disease progression.Summary: The concept of Alport kidney disease extends beyond classic AS. Patients carrying pathogenic variants in any one of the COL4A3/A4/A5 genes can have variable phenotypes ranging from completely normal/clinically unrecognizable, hematuria without or with proteinuria, or progression to chronic kidney disease and kidney failure, depending on sex, genotype, and interplays of other genetic as well as environmental factors.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"283-290"},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10990029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140109598","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

Rare genetic disorders that impair parathyroid hormone synthesis, secretion, or bioactivity provide insights into the diagnostic utility of different parathyroid hormone assays. 影响甲状旁腺激素合成、分泌或生物活性的罕见遗传疾病为不同的甲状旁腺激素检测方法提供了诊断依据。

IF 3.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2024-05-01 DOI: 10.1097/mnh.0000000000000999

Jakob Höppner, Harald Jüppner

引用次数: 0

New guidelines and therapeutic updates for the management of lupus nephritis. 狼疮肾炎治疗的新指南和疗法更新。

IF 3.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2024-05-01 Epub Date: 2024-02-09 DOI: 10.1097/MNH.0000000000000969

Sheetal B Desai, Rebecca Ahdoot, Fatima Malik, Michele Obert, Ramy Hanna

{"title":"New guidelines and therapeutic updates for the management of lupus nephritis.","authors":"Sheetal B Desai, Rebecca Ahdoot, Fatima Malik, Michele Obert, Ramy Hanna","doi":"10.1097/MNH.0000000000000969","DOIUrl":"10.1097/MNH.0000000000000969","url":null,"abstract":"Purpose of review: Systemic lupus erythematosus (SLE) can be a devastating condition, striking young patients often in their prime reproductive years. Lupus nephritis is a common and serious complication occurring in roughly 50% of SLE cases, indicating a high likelihood of disease progression, morbidity, and mortality. As the early trials of steroid therapy, and later cyclophosphamide (CYC), therapeutic changes had been stagnant. Then came the introduction of mycophenolate mofetil (MMF) in the 2000s. After the Aspreva Lupus Management Study, there had been a dearth of trials showing positive therapy results. Since 2020, new studies have emerged for lupus nephritis involving the use of anti-BLYS agents, novel calcineurin inhibitors, CD20 blockade, and antiinterferon agents. Nephrology and rheumatology society guidelines in the United States and across the world are still catching up.Recent findings: Although therapeutic guidelines are being developed, updates that have come through have focused on improved diagnostic and monitoring guidelines. One theme is the recommendation of increasingly tight proteinuria control and firmer guidelines for the rapid induction of remission. The reality of multitarget therapy and the expectation of rapid induction for a more complete remission are being widely recognized.Summary: The need for more complete and more rapid induction and control of lupus nephritis is undisputed according to the evidence and guidelines, and the medications to achieve this are growing at a rate not seen over the prior two decades. What remains is a stepwise approach to recognize how to best optimize therapy. Based on available evidence, an algorithm for induction and maintenance treatment of lupus nephritis used by the University of California Irvine Lupus Nephritis clinic, is recommended.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"344-353"},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139706323","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

Emerging evidence for glucagon-like peptide-1 agonists in slowing chronic kidney disease progression. 胰高血糖素样肽-1 激动剂在减缓慢性肾病进展方面的新证据。

IF 3.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2024-05-01 Epub Date: 2024-02-23 DOI: 10.1097/MNH.0000000000000976

Michael W Holliday, Livia Frost, Sankar D Navaneethan

{"title":"Emerging evidence for glucagon-like peptide-1 agonists in slowing chronic kidney disease progression.","authors":"Michael W Holliday, Livia Frost, Sankar D Navaneethan","doi":"10.1097/MNH.0000000000000976","DOIUrl":"10.1097/MNH.0000000000000976","url":null,"abstract":"Purpose of review: Diabetic kidney disease continues to increase, and several novel therapeutic agents have been shown to slow the progression of chronic kidney disease in those with diabetes. This review summarizes more recent data on the role of glucagon-like peptide-1 (GLP-1) receptor agonists and kidney outcomes.Recent findings: Posthoc analysis of cardiovascular outcome trials, as well as several retrospective studies, demonstrate benefits of GLP-1 receptor agonist therapy for chronic kidney disease progression in diabetics. Although limited randomized clinical trials evidence assessing the effects of GLP-1 receptor agonists on kidney outcomes in diabetic chronic kidney disease patients have been published, FLOW-CKD trial was halted based on interim data for efficacy, and results are awaited.Summary: GLP-1 receptor agonism is a promising therapy for slowing the progression of diabetic chronic kidney disease. Recent studies support kidney benefits GLP-1 receptor agonists over insulin and dipeptidyl peptidase-4-inhibitors, and the FLOW-CKD trial would inform the potential benefits for reducing the need for dialysis and kidney-disease related mortality in those with kidney disease.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"331-336"},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11126299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139971315","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

Has the time come for age-adapted glomerular filtration rate criteria to define chronic kidney disease: how soon is now? 采用适应年龄的肾小球滤过率标准来定义慢性肾病的时机是否已经成熟：现在还有多长时间？

IF 3.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2024-05-01 Epub Date: 2024-02-23 DOI: 10.1097/MNH.0000000000000971

Gregory L Hundemer, Ayub Akbari, Manish M Sood

{"title":"Has the time come for age-adapted glomerular filtration rate criteria to define chronic kidney disease: how soon is now?","authors":"Gregory L Hundemer, Ayub Akbari, Manish M Sood","doi":"10.1097/MNH.0000000000000971","DOIUrl":"10.1097/MNH.0000000000000971","url":null,"abstract":"Purpose of review: The conventional definition of chronic kidney disease (CKD) primarily relies on the identification of albuminuria or a decline in estimated glomerular filtration rate (eGFR). For many years, a straightforward eGFR threshold of <60 ml/min/1.73 m 2 has been widely adopted as the standard for defining CKD. Nonetheless, this criterion fails to consider the natural aging process of the kidney, and this oversight may affect the accurate diagnosis of kidney disease particularly at the extremes of age.Recent findings: The fixed eGFR threshold of <60 ml/min/1.73 m 2 for defining CKD misses crucial opportunities for risk prevention. Studies have revealed that the eGFR threshold at which the risks for adverse long-term health outcomes such as mortality, cardiovascular events, and kidney failure begin to rise varies substantially by age. Specifically, this threshold is lower for the elderly and higher for young adults. Consequently, this results in the over-diagnosis of kidney disease in the elderly and the under-diagnosis of kidney disease in young adults.Summary: To address these limitations of the current CKD definition, we discuss a number of proposed age-adapted eGFR criteria and weigh their pros and cons against the current, simple, and universally accepted approach.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"318-324"},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139971316","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