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

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

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 3.1 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":3.1,"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

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 3.1 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":3.1,"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

Treatment of acute metabolic acidosis. 急性代谢性酸中毒的治疗。

IF 2.4 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2026-03-01 Epub Date: 2025-12-01 DOI: 10.1097/MNH.0000000000001143

Nawal Aamir, Kenneth M Ralto

{"title":"Treatment of acute metabolic acidosis.","authors":"Nawal Aamir, Kenneth M Ralto","doi":"10.1097/MNH.0000000000001143","DOIUrl":"10.1097/MNH.0000000000001143","url":null,"abstract":"Purpose of review: Acute metabolic acidosis is a common complication in critically ill patients and is associated with increased morbidity and mortality. Management of acute metabolic acidosis varies widely in clinical practice, with limited randomized trial data to support a standardized approach. This review will provide an overview of the literature regarding the management of acute metabolic acidosis and the potential risks associated with these therapies.Recent findings: Correction of metabolic acidosis with sodium bicarbonate has not been associated with a reduction in mortality, although does reduce the need for kidney replacement therapy in high-risk patients with coexisting moderate to severe acute kidney injury. Additionally, there is not a clear association between correction of acidosis and improvement in overall hemodynamics in critically ill patients. The risks of sodium bicarbonate therapy and kidney replacement therapy are not insignificant and must be thoughtfully weighed against the benefits of correcting a metabolic acidosis.Summary: The management of acute metabolic acidosis should be tailored to the individual patient, with careful consideration of the risks and benefits associated with sodium bicarbonate use and kidney replacement therapy discussed in this review. Additional randomized human trials are needed to better define the role for these therapies in critically ill patients.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"236-242"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145653742","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

Diagnosing acute tubulointerstitial nephritis: novel biomarkers address an important clinical challenge. 诊断急性肾小管间质性肾炎：新的生物标志物解决了一个重要的临床挑战。

IF 2.4 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2026-03-01 Epub Date: 2025-12-29 DOI: 10.1097/MNH.0000000000001147

Sagar Sadarangani, Angela M Victoria-Castro, Dennis G Moledina

{"title":"Diagnosing acute tubulointerstitial nephritis: novel biomarkers address an important clinical challenge.","authors":"Sagar Sadarangani, Angela M Victoria-Castro, Dennis G Moledina","doi":"10.1097/MNH.0000000000001147","DOIUrl":"10.1097/MNH.0000000000001147","url":null,"abstract":"Purpose of review: Acute tubulointerstitial nephritis (ATIN) is a common cause of acute kidney injury (AKI) that requires diagnosis specific management. Currently available diagnostic tests lack accuracy to distinguish ATIN from various other etiologies of AKI increasing reliance on kidney biopsy for diagnosis, which is associated with procedural risks and possible diagnostic and interventional delays. This review highlights the recent efforts focused on identifying diagnostic biomarkers and addressing this important clinical challenge.Recent findings: Numerous research groups have harnessed the increasing knowledge of inflammatory proteins and cytokines upregulated in ATIN to identify reliable diagnostic biomarkers, these include C-X-C motif ligand 9, tumor necrosis factor alpha, interleukin-9, urinary regulated on activation normal T cell expressed and secreted, among others. Parallel work has also focused on identifying imaging and pathological markers associated with ATIN as well as a diagnostic model that combines currently available clinical tests for ATIN diagnosis.Summary: Biomarkers have shown promise as diagnostic tools for ATIN; however, most studies have limitations such as small sample sizes, and lack of external validation. Future progress will rely on larger collaborative efforts to identify the most accurate biomarker or combination of biomarkers for integration into diagnostic workup of ATIN.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"218-225"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145849044","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

From stones to system: integrating kidney stones disease into the cardiovascular-kidney-metabolic continuum. 从结石到系统：将肾结石疾病纳入心血管-肾脏-代谢连续体。

IF 2.4 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2026-03-01 Epub Date: 2026-01-05 DOI: 10.1097/MNH.0000000000001149

Agnieszka Pozdzik, Khashayar Sakhaee, Ides M Colin

{"title":"From stones to system: integrating kidney stones disease into the cardiovascular-kidney-metabolic continuum.","authors":"Agnieszka Pozdzik, Khashayar Sakhaee, Ides M Colin","doi":"10.1097/MNH.0000000000001149","DOIUrl":"10.1097/MNH.0000000000001149","url":null,"abstract":"Purpose of review: To reposition kidney stone disease within the cardiovascular-kidney-metabolic continuum and synthesize recent evidence on therapeutics, clinician-supervised digital monitoring, and value-based care implementation to modernize prevention and follow-up.Recent findings: Epidemiology shows a rise in kidney stone disease prevalence across cardiovascular-kidney-metabolic stages independent of demographics. Comparative-effectiveness analyses suggest fewer stone events with sodium-glucose cotransporter-2 inhibitor(s) vs. active comparators, while early randomized data demonstrate meaningful reductions in urinary supersaturation in phenotype-matched stone formers. Digital hydration programs using validated connected bottles and just-in-time prompts increase 24-h urine output in feasibility studies; at-home urine pH and urine conductivity measurement offer pragmatic proxies for day-to-day risk. However, clinical validation, privacy governance, and regulatory readiness of software-as-a-medical-device remain variable.Summary: Embedding kidney stone disease prevention within a cardiovascular-kidney-metabolic program supports value-based outcomes. A hybrid \"Care, Remote Monitoring, Medication optimization, Nudges pathway\" links early risk identification to telemonitoring and titration. Integrating urinary lithogenic profiling into cardiovascular-kidney-metabolic screening flags asymptomatic patients with lithogenic profiles before a first stone, enabling prevention of stones and chronic kidney disease progression. Priorities consist in validation of digital urinary biomarkers (time-in-target volume/pH) and deployment of hybrid care. This patient-centred hybrid model can shift current episodic procedures to anticipatory, measurable, and scalable prevention within routine cardiovascular-kidney-metabolic care.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"226-235"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145905801","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 role of artificial intelligence in hypertension management. 人工智能在高血压管理中的作用。

IF 2.4 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2026-03-01 Epub Date: 2026-01-05 DOI: 10.1097/MNH.0000000000001157

Mukesh Dherani, Siegfried K Wagner, Eduard Shantsila

{"title":"The role of artificial intelligence in hypertension management.","authors":"Mukesh Dherani, Siegfried K Wagner, Eduard Shantsila","doi":"10.1097/MNH.0000000000001157","DOIUrl":"10.1097/MNH.0000000000001157","url":null,"abstract":"Purpose of review: Hypertension remains a leading modifiable risk factor for cardiovascular and renal conditions and dementia. Given its rising global prevalence and economic burden, artificial intelligence offers promising solutions across the care continuum, from diagnosis to monitoring. This review highlights recent advances in artificial intelligence-driven diagnosis and monitoring, risk stratification, and predictive modelling of hypertension-related outcomes.Recent findings: Using artificial intelligence-based technologies, validated wearable cuffless monitors are developed, which use electrocardiography, heart sounds, and thoracic impedance data and provide continuous blood pressure (BP) monitoring. Artificial intelligence-generated algorithm have shown promising response to accurately predict BP. The Extreme Gradient Boost has consistently performed as the best algorithms. Additionally, these models have been used in predicting hypertension impact on cardiovascular, renal, and retinal conditions, and in predicting treatment strategies. Emerging applications of Large Language Models are being developed to provide personalized care based on individual patient characteristics.Summary: Artificial intelligence has the potential to transform hypertension management through improved diagnosis, monitoring, and personalized care and prediction of its systemic consequences. However, challenges of model validation, interpretability, generalizability, and ethics persist. Robust prospective trials and equitable implementation strategies can help realise the potential of artificial intelligence in improving hypertension outcomes.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"181-187"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12863580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145905962","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

Ethical challenges in kidney transplantation. 肾移植中的伦理挑战。

IF 2.4 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2026-03-01 Epub Date: 2025-11-27 DOI: 10.1097/MNH.0000000000001141

Avantika Israni, Abhishek Israni, Judith Benstein

引用次数: 0

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

IF 2.4 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2026-03-01 Epub Date: 2025-12-29 DOI: 10.1097/MNH.0000000000001146

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

{"title":"Update on antineutrophil cytoplasmic antibody vasculitis.","authors":"Dan A Mandel, Nishitha Shekhar, Ramy Hanna, Uttam Reddy","doi":"10.1097/MNH.0000000000001146","DOIUrl":"10.1097/MNH.0000000000001146","url":null,"abstract":"Purpose of review: The purpose of this review is to discuss antineutrophil cytoplasmic antibody (ANCA) vasculitis (microscopic polyangiitis and granulomatosis with polyangiitis) and how we have arrived at our current guidelines and treatment methods. The goal is to offer a greater understanding of major clinical trials in the field, and how they have enabled treatment options which have led to reduced morbidity and improved survival for patients.Recent findings: Our understanding and treatment of ANCA vasculitis has changed tremendously over the past 40 years, from a condition with a high mortality without significant treatment options, to a treatable condition. We have moved from the use of more toxic therapies such as Cyclophosphamide towards more common use of rituximab for both induction and maintenance regimens. More recently, the focus has been on attempting to reduce steroid burden and toxicity. The approval of avacopan (a C5a inhibitor) enables a more rapid steroid taper regimen along with usual induction therapy with rituximab or cyclophosphamide. Readers will have the chance to learn about new targets being evaluated for the treatment of ANCA vasculitis.Summary: ANCA Vasculitis is complex with varying presentations. Through collaboration among multiple specialists, including nephrologists, rheumatologists, pulmonologists, ENT specialists, and neurologists, we are able to achieve a diagnosis and offer organ and life-saving treatments for our patients.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"270-277"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145849094","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

Hemodiafiltration: balancing clinical efficacy with planetary health. 血液滤过：平衡临床疗效与地球健康。

IF 3.1 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2026-03-01 Epub Date: 2026-01-08 DOI: 10.1097/MNH.0000000000001160

Ankur D Shah, David S Goldfarb

{"title":"Hemodiafiltration: balancing clinical efficacy with planetary health.","authors":"Ankur D Shah, David S Goldfarb","doi":"10.1097/MNH.0000000000001160","DOIUrl":"10.1097/MNH.0000000000001160","url":null,"abstract":"Purpose of review: The 2023 CONVINCE trial demonstrated improved survival with high-dose hemodiafiltration (HDF), prompting discussions about widespread adoption. However, this clinical advancement occurs amid growing awareness of healthcare's environmental impact, particularly dialysis treatments that consume extensive water and energy resources. This review examines the environmental implications of HDF adoption, synthesizing recent evidence on resource consumption and emerging sustainability solutions in the context of the climate crisis facing nephrology.Recent findings: Life cycle assessments indicate HDF has a carbon footprint 30-40% higher than conventional hemodialysis, consuming an additional 10 300 L of water per patient annually. However, recent technological innovations show promise: expanded hemodialysis (HDx) using medium cut-off membranes reduces water usage by >20% and energy consumption by >30% compared to HDF while potentially achieving similar clinical outcomes. Water conservation technologies, including reverse osmosis, reject water reuse and reduced dialysate flow protocols, can decrease environmental impact by 30-50% without any difference in patient outcomes.Summary: The adoption of HDF represents a critical test case for sustainable healthcare innovation. While the potential benefits should not be ignored, technology is not static and, if confirmed, additional sustainability work and comprehensive policy frameworks integrating environmental impact assessments into technology evaluation are urgently needed. The nephrology community must balance clinical excellence with planetary stewardship through technological innovation, resource optimization, and evidence-based environmental guidelines that benefit, not compromise, patient care.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"254-261"},"PeriodicalIF":3.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145951627","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