Current Opinion in Nephrology and Hypertension最新文献_第8页

Biopsy-based transcriptomics in the diagnosis of kidney transplant rejection. 基于活检的转录组学在肾移植排斥反应诊断中的应用。

IF 3.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2024-05-01 Epub Date: 2024-02-21 DOI: 10.1097/MNH.0000000000000974

Tristan de Nattes, Jack Beadle, Candice Roufosse

{"title":"Biopsy-based transcriptomics in the diagnosis of kidney transplant rejection.","authors":"Tristan de Nattes, Jack Beadle, Candice Roufosse","doi":"10.1097/MNH.0000000000000974","DOIUrl":"10.1097/MNH.0000000000000974","url":null,"abstract":"Purpose of review: The last year has seen considerable progress in translational research exploring the clinical utility of biopsy-based transcriptomics of kidney transplant biopsies to enhance the diagnosis of rejection. This review will summarize recent findings with a focus on different platforms, potential clinical applications, and barriers to clinical adoption.Recent findings: Recent literature has focussed on using biopsy-based transcriptomics to improve diagnosis of rejection, in particular antibody-mediated rejection. Different techniques of gene expression analysis (reverse transcriptase quantitative PCR, microarrays, probe-based techniques) have been used either on separate samples with ideally preserved RNA, or on left over tissue from routine biopsy processing. Despite remarkable consistency in overall patterns of gene expression, there is no consensus on acceptable indications, or whether biopsy-based transcriptomics adds significant value at reasonable cost to current diagnostic practice.Summary: Access to biopsy-based transcriptomics will widen as regulatory approvals for platforms and gene expression models develop. Clinicians need more evidence and guidance to inform decisions on how to use precious biopsy samples for biopsy-based transcriptomics, and how to integrate results with standard histology-based diagnosis.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"273-282"},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10990030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139971312","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

IgA vasculitis nephritis: insights from kidney biopsies. IgA 血管炎肾炎：从肾脏活检中获得的启示。

IF 3.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2024-05-01 Epub Date: 2024-02-19 DOI: 10.1097/MNH.0000000000000972

Mark Haas

{"title":"IgA vasculitis nephritis: insights from kidney biopsies.","authors":"Mark Haas","doi":"10.1097/MNH.0000000000000972","DOIUrl":"10.1097/MNH.0000000000000972","url":null,"abstract":"Purpose of review: To present findings indicating the value of kidney biopsy in assessing prognosis and guiding clinical approach to patients with IgA vasculitis nephritis (IgAVN), including a recent international study examining the value of the Oxford (MEST-C) classification.Recent findings: Historically, kidney biopsies with IgAVN are scored using the International Society for Kidney Diseases in Children (ISKDC) classification. However, this classification has limited prognostic value, and most biopsies fall into just two of the six ISKDC grades. There are few studies examining the clinical value of the Oxford classification, which is well documented to be predictive of kidney outcomes in IgA nephropathy, in IgAVN. However, a recent study of 361 biopsied patients with IgAVN showed that endocapillary hypercellularity (Oxford E1) predicted a subclass of patients showing initial improvement in kidney function with immunosuppressive treatment, followed by a later decline.Summary: Kidney outcome in patients with biopsied IgAVN treated with immunosuppression is determined by clinical factors and endocapillary hypercellularity. The latter is not part of the ISKDC classification and supports including MEST-C scores in biopsy reports of IgAVN. Even patients showing a good initial response to immunosuppression require long-term follow-up due to risk of subsequent kidney function decline.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"298-303"},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139971317","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

Novel indications for referral and care for simultaneous liver kidney transplant recipients. 肝肾同时移植受者转诊和护理的新适应症。

IF 3.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2024-05-01 Epub Date: 2024-02-12 DOI: 10.1097/MNH.0000000000000970

Erik L Lum, Suphamai Bunnapradist, Alexander C Wiseman, Ahmet Gurakar, Antoney Ferrey, Uttam Reddy, Fawaz Al Ammary

{"title":"Novel indications for referral and care for simultaneous liver kidney transplant recipients.","authors":"Erik L Lum, Suphamai Bunnapradist, Alexander C Wiseman, Ahmet Gurakar, Antoney Ferrey, Uttam Reddy, Fawaz Al Ammary","doi":"10.1097/MNH.0000000000000970","DOIUrl":"10.1097/MNH.0000000000000970","url":null,"abstract":"Purpose of review: Kidney dysfunction is challenging in liver transplant candidates to determine whether it is reversible or not. This review focuses on the pertinent data on how to best approach liver transplant candidates with kidney dysfunction in the current era after implementing the simultaneous liver kidney (SLK) allocation policy and safety net.Recent findings: The implementation of the SLK policy inverted the steady rise in SLK transplants and improved the utilization of high-quality kidneys. Access to kidney transplantation following liver transplant alone (LTA) increased with favorable outcomes. Estimating GFR in liver transplant candidates remains challenging, and innovative methods are needed. SLK provided superior patient and graft survival compared to LTA only for patients with advanced CKD and dialysis at least 3 months. SLK can provide immunological protection against kidney rejection in highly sensitized candidates. Post-SLK transplant care is complex, with an increased risk of complications and hospitalization.Summary: The SLK policy improved kidney access and utilization. Transplant centers are encouraged, under the safety net, to reserve SLK for liver transplant candidates with advanced CKD or dialysis at least 3 months while allowing lower thresholds for highly sensitized patients. Herein, we propose a practical approach to liver transplant candidates with kidney dysfunction.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"354-360"},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10990015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139722014","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

Deep learning applications for kidney histology analysis. 深度学习在肾脏组织学分析中的应用

IF 3.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2024-05-01 Epub Date: 2024-02-19 DOI: 10.1097/MNH.0000000000000973

Pourya Pilva, Roman Bülow, Peter Boor

{"title":"Deep learning applications for kidney histology analysis.","authors":"Pourya Pilva, Roman Bülow, Peter Boor","doi":"10.1097/MNH.0000000000000973","DOIUrl":"10.1097/MNH.0000000000000973","url":null,"abstract":"Purpose of review: Nephropathology is increasingly incorporating computational methods to enhance research and diagnostic accuracy. The widespread adoption of digital pathology, coupled with advancements in deep learning, will likely transform our pathology practices. Here, we discuss basic concepts of deep learning, recent applications in nephropathology, current challenges in implementation and future perspectives.Recent findings: Deep learning models have been developed and tested in various areas of nephropathology, for example, predicting kidney disease progression or diagnosing diseases based on imaging and clinical data. Despite their promising potential, challenges remain that hinder a wider adoption, for example, the lack of prospective evidence and testing in real-world scenarios.Summary: Deep learning offers great opportunities to improve quantitative and qualitative kidney histology analysis for research and clinical nephropathology diagnostics. Although exciting approaches already exist, the potential of deep learning in nephropathology is only at its beginning and we can expect much more to come.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"291-297"},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139971314","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 therapies for immunoglobulin A nephropathy: what's the standard of care in 2023? 免疫球蛋白 A 肾病的新疗法：2023 年的治疗标准是什么？

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.0000000000000979

Bryce Barr, Sean Barbour

{"title":"New therapies for immunoglobulin A nephropathy: what's the standard of care in 2023?","authors":"Bryce Barr, Sean Barbour","doi":"10.1097/MNH.0000000000000979","DOIUrl":"10.1097/MNH.0000000000000979","url":null,"abstract":"Purpose of review: As the most common primary glomerulonephritis, immunoglobulin A (IgA) nephropathy (IgAN) is an important cause of kidney failure and mortality. Until recently, therapeutic options were limited. Fortunately, there have been numerous recent clinical trials demonstrating efficacy of new therapies in slowing chronic kidney disease (CKD) progression at varying stages of disease.Recent findings: The TESTING trial has provided high-quality evidence for slowing estimated glomerular filtration rate (eGFR) decline with a reduced-dose glucocorticoid regimen, while demonstrating an improved safety profile. Targeted-release budesonide represents a well tolerated therapy for reducing eGFR decline. Mycophenolate mofetil may reduce CKD progression in some populations, while hydroxychloroquine is efficacious in reducing proteinuria. Sodium-glucose cotransporter (SGLT2) inhibitors and sparsentan are effective therapies for CKD due to IgAN, but should not be used in lieu of disease-modifying immunosuppressive therapy. Many new therapies are approaching readiness for clinical use.Summary: Numerous therapeutic options now exist and include disease-modifying and nephroprotective drugs. Identifying the right treatment for the right patient is now the clinical challenge and, with new drugs on the horizon, represents the primary unmet research need in this rapidly-developing field.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"311-317"},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139971318","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

A basic solution for a complex problem: does treatment of metabolic acidosis slow CKD progression? 复杂问题的基本解决方案：治疗代谢性酸中毒能减缓慢性肾脏病的进展吗？

IF 3.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2024-05-01 Epub Date: 2024-02-29 DOI: 10.1097/MNH.0000000000000978

Kevin Bodker, Natalie Freidin, Nayan Arora

{"title":"A basic solution for a complex problem: does treatment of metabolic acidosis slow CKD progression?","authors":"Kevin Bodker, Natalie Freidin, Nayan Arora","doi":"10.1097/MNH.0000000000000978","DOIUrl":"10.1097/MNH.0000000000000978","url":null,"abstract":"Purpose of this review: Metabolic acidosis is frequently encountered in patients with chronic kidney disease (CKD), with increasing prevalence as kidney function worsens. Treating electrolyte disturbances is the sine qua non of Nephrologists, and alkali therapy to normalize serum bicarbonate levels and slow progression of kidney disease has been embedded in clinical practice guidelines for decades on the basis of animal models and controversial clinical trials. This review will critically appraise the literature base for this recommendation and determine whether the available evidence supports this common practice, which is a timely endeavor considering the impending demotion of metabolic acidosis treatment from recommendation to practice point in forthcoming KDIGO guidelines.Recent findings: Earlier, open-label, studies supporting the utility of sodium bicarbonate therapy to slow progression of chronic kidney disease have been challenged by more recent, blinded, studies failing to show benefit on CKD progression. This was further demonstrated in the absence of concomitant sodium administration with the hydrochloric acid binder veverimer, which failed to demonstrate benefit on renal death, end stage kidney disease or 40% reduction in estimated glomerular filtration rate in a large multicenter trial.Summary: The current body of literature does not support the routine treatment of metabolic acidosis in patients with CKD and the authors agree with the forthcoming KDIGO guidelines to de-emphasize this common practice.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"304-310"},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139989579","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

Prediction models for earlier stages of chronic kidney disease. 慢性肾脏病早期阶段的预测模型。

IF 3.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2024-05-01 Epub Date: 2024-02-29 DOI: 10.1097/MNH.0000000000000981

Mackenzie Alexiuk, Navdeep Tangri

{"title":"Prediction models for earlier stages of chronic kidney disease.","authors":"Mackenzie Alexiuk, Navdeep Tangri","doi":"10.1097/MNH.0000000000000981","DOIUrl":"10.1097/MNH.0000000000000981","url":null,"abstract":"Purpose of review: Identifying patients with risk of developing progressive chronic kidney disease (CKD) early is an important step in improving kidney care. This review discusses four recently developed models, two which predict risk of new onset disease, and two which predict progression earlier in the course of disease.Recent findings: Several models predicting CKD incidence and progression have been recently developed and externally validated. A connecting theme across these models is the use of data beyond estimated glomerular filtration rate, allowing for greater accuracy and personalization. Two models were developed with stratification by diabetes status, displaying excellent model fit with and without variables like use of diabetes medication and hemoglobin A1C. Another model was designed to be patient facing, not requiring the knowledge of any laboratory values for use. The final model was developed using lab data and machine learning. These models demonstrated high levels of discrimination and calibration in external validation, suggesting suitability for clinical use.Summary: Models that predict risk of CKD onset and progression have the potential to significantly reduce disease burden, financial cost, and environmental output from CKD through upstream disease prevention and slowed progression. These models should be implemented and evaluated prospectively in primary care settings.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"325-330"},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139989580","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

Lysine and salt-sensitive hypertension. 赖氨酸与盐敏感性高血压

IF 3.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2024-04-22 DOI: 10.1097/mnh.0000000000000994

Lashodya V Dissanayake, Oleg Palygin, Alexander Staruschenko

引用次数: 0

A molecular journey on the pathogenesis of primary hyperoxaluria. 原发性高草酸尿症发病机制的分子之旅。

IF 3.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2024-04-12 DOI: 10.1097/mnh.0000000000000987

Barbara Cellini

引用次数: 0

The role of hypoxia in chronic kidney disease: a nuanced perspective. 缺氧在慢性肾脏病中的作用：一个细致入微的视角。