Current Opinion in Nephrology and Hypertension最新文献

{"title":"Optimizing kidney and cardiovascular protection in an era of multiple effective treatments.","authors":"Maarten W Taal","doi":"10.1097/MNH.0000000000001019","DOIUrl":"10.1097/MNH.0000000000001019","url":null,"abstract":"<p><strong>Purpose of review: </strong>After decades of relying on the control of hypertension and treatment with renin angiotensin system inhibitors as the only evidence-based interventions to slow the progression of chronic kidney disease (CKD), we have entered an era when multiple effective treatment options are available. This review considers the mechanisms and benefits of these novel treatments as well as the challenges associated with achieving optimal combination therapy.</p><p><strong>Recent findings: </strong>Over the past 5 years, large clinical trials have provided robust evidence that, when added to renin angiotensin system inhibitors, treatment with sodium glucose cotransporter 2 inhibitors reduces the rate of CKD progression and the risk of cardiovascular events in people with CKD with or without diabetes and with or without albuminuria; nonsteroidal mineralocorticoid antagonists and glucagon-like peptide-1 receptor agonists afford similar benefits in people with type 2 diabetes and CKD. The mechanisms of actions of these novel therapies suggest that combination therapy will produce additive benefits, though specific evidence is sparse.</p><p><strong>Summary: </strong>Further trials are warranted to investigate the benefits of combination therapy with novel treatments in people with CKD. Clinical implementation of optimal combination therapy will require reorganization of services to ensure that patients receive adequate education, support and monitoring.</p>","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"551-556"},"PeriodicalIF":2.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975260","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}

{"title":"Recent advances in the understanding of the peritoneal membrane.","authors":"François Seghers,Michel Tintillier,Johann Morelle","doi":"10.1097/mnh.0000000000001028","DOIUrl":"https://doi.org/10.1097/mnh.0000000000001028","url":null,"abstract":"PURPOSE OF REVIEWThe efficiency of peritoneal dialysis (PD) as a life-sustaining replacement therapy for patients with kidney failure relies on the integrity and function of the peritoneal membrane. Here, we review the most recent advances in the understanding of the peritoneal membrane and its role in PD.RECENT FINDINGSA recent update of the ISPD guidelines proposed a revised definition of membrane dysfunction, emphasizing the importance of fluid balance in patients treated with PD and identified three main mechanisms leading to insufficient peritoneal ultrafiltration (UF). The Bio-PD study, the first genomewide association study in PD, demonstrated that 20% of the interindividual variability in the peritoneal solute transfer rate is genetically determined, and identified several loci of potential relevance for peritoneal transport. A candidate-gene approach identified and characterized a common and functional variant in the promoter of the AQP1 gene associated with water transport and clinical outcomes in PD. Innovative strategies to preserve the integrity of the peritoneal membrane and to enhance UF are also discussed, including the use of gliflozins; steady glucose concentration PD; modulation of GLUT proteins; and cytoprotective additives.SUMMARYA comprehensive understanding of the peritoneal membrane and of the mechanisms driving UF may help individualizing PD prescription and improving outcomes in patients treated with PD.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":"39 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142257390","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}

{"title":"International equity in access to home dialysis.","authors":"Arpana Iyengar,Robert Kalyesubula,Rasha Darwish,Valerie A Luyckx","doi":"10.1097/mnh.0000000000001027","DOIUrl":"https://doi.org/10.1097/mnh.0000000000001027","url":null,"abstract":"PURPOSE OF REVIEWDiscussion of inequalities and inequities in global distribution of and access to home dialysis.RECENT FINDINGSThe majority of patients receiving home dialysis receive peritoneal dialysis, but these are concentrated in few countries across the globe. Peritoneal dialysis as the most common form of home dialysis has many advantages in terms of individual freedoms, similar outcomes to haemodialysis, being less costly in some countries, and more scalable than in-centre haemodialysis. Despite this there are many inequities in access at the patient, clinician, health system and geopolitical levels. Poverty, discrimination and lack of support at home are important drivers of inequities at the patient level. At the clinician and health systems level lack of experience in home dialysis, lack of resources and lack of time drive patients towards in-centre dialysis. At the geopolitical level, high costs associated with procurement and distribution of peritoneal dialysis solutions exacerbate inequities in access.SUMMARYThe challenge of reducing global inequities in access to home dialysis in low- and middle-income countries are vast and would require training of the doctors, nurses, families, patients, leaders and community partners. Once this is achieved, dealing with costs and logistics of supplies is crucial to improve and sustain equitable access.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":"4 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142257393","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}

{"title":"Social and humanitarian issues in nephrology and hypertension.","authors":"Dina A Abdellatif","doi":"10.1097/mnh.0000000000001026","DOIUrl":"https://doi.org/10.1097/mnh.0000000000001026","url":null,"abstract":"PURPOSE OF REVIEWChronic kidney disease and hypertension, two widely prevalent conditions worldwide, present an urgent and pressing need for immediate action. The review describes how social conditions and humanitarian issues can influence hypertension and kidney disease.RECENT FINDINGSUndoubtedly, social determinants of health (SDoH) are key influencers in the development of many noncommunicable diseases, including hypertension and kidney disease. Healthcare professionals, including public health workers, play a crucial role in addressing these issues. Poverty, low education level, poor nutrition, housing, exposure to environmental hazards, and stress-related disorders are all factors that can be addressed, either directly or indirectly, through improved awareness and access to proper healthcare services. Besides personal factors, national, regional, or global factors cause serious apprehension. Disasters, whether natural or man-made, can lead to significant aftermaths on the healthy person and certainly on kidney disease and hypertensive patients. A Global Overview Report, 2023 turned out to be one of the most violent years since the end of the Cold War. In 2023, 59 state-based conflicts were recorded in 34 countries, the highest number registered since 1946. The wars in Ukraine and Gaza were the primary contributors with a significant impact on the kidney population, especially people living on dialysis and transplantation patients. They also yielded many refugees or displaced persons with ongoing suffering.SUMMARYIt is crucial to recognize that social and humanitarian conditions can quickly exacerbate the health of vulnerable populations, particularly those with noncommunicable diseases like hypertension and chronic kidney disease. These patients, who often require continuous follow-up, especially those on dialysis, are particularly vulnerable during difficult times. Their lives depend on uninterrupted access to dialysis or transplantation medications, making the need for special attention and care more pressing. Further research and advocacy are needed to address these issues and ensure the health and well being of these populations.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":"31 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142178118","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}

{"title":"Vasopressin, protein metabolism, and water conservation.","authors":"Joshua S Carty, Jason A Watts, Juan Pablo Arroyo","doi":"10.1097/MNH.0000000000001012","DOIUrl":"10.1097/MNH.0000000000001012","url":null,"abstract":"<p><strong>Purpose of review: </strong>Highlight the mechanisms through which vasopressin and hypertonic stress regulate protein metabolism.</p><p><strong>Recent findings: </strong>Mammals have an 'aestivation-like' response in which hypertonic stress increases muscle catabolism and urea productionVasopressin can directly regulate ureagenesis in the liver and the kidneyIn humans chronic hypertonic stress is associated with premature aging, diabetes, cardiovascular disease, and premature mortality.</p><p><strong>Summary: </strong>There is an evolutionarily conserved 'aestivation-like' response in humans in which hypertonic stress results in activation of the vasopressin system, muscle catabolism, and ureagenesis in order to promote water conservation.</p>","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"512-517"},"PeriodicalIF":2.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11290986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141455781","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}

{"title":"Aldosterone-independent regulation of K + secretion in the distal nephron.","authors":"John Demko, Robert Weber, David Pearce, Bidisha Saha","doi":"10.1097/MNH.0000000000001006","DOIUrl":"10.1097/MNH.0000000000001006","url":null,"abstract":"<p><strong>Purpose of review: </strong>Maintenance of plasma K + concentration within a narrow range is critical to all cellular functions. The kidneys are the central organ for K + excretion, and robust renal excretory responses to dietary K + loads are essential for survival. Recent advances in the field have challenged the view that aldosterone is at the center of K + regulation. This review will examine recent findings and propose a new mechanism for regulating K + secretion.</p><p><strong>Recent findings: </strong>Local aldosterone-independent response systems in the distal nephron are increasingly recognized as key components of the rapid response to an acute K + load, as well as playing an essential role in sustained responses to increased dietary K + . The master kinase mTOR, best known for its role in mediating the effects of growth factors and insulin on growth and cellular metabolism, is central to these aldosterone-independent responses. Recent studies have shown that mTOR, particularly in the context of the \"type 2\" complex (mTORC2), is regulated by K + in a cell-autonomous fashion.</p><p><strong>Summary: </strong>New concepts related to cell-autonomous K + signaling and how it interfaces with aldosterone-dependent regulation are emerging. The underlying signaling pathways and effectors of regulated K + secretion, as well as implications for the aldosterone paradox and disease pathogenesis are discussed.</p>","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"526-534"},"PeriodicalIF":2.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11290980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141418208","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}

{"title":"The role of claudins in renal transepithelial transport and kidney disease.","authors":"Arnold Tsamo Tetou, Dorothee Günzel","doi":"10.1097/MNH.0000000000001003","DOIUrl":"10.1097/MNH.0000000000001003","url":null,"abstract":"<p><strong>Purpose of review: </strong>25 years after the discovery of claudins as the central constituents of tight junctions, the \"hunter-gatherer phase\" of claudin research is coming to an end. Deficiency in individual claudins as a cause of rare hereditary diseases is well documented. However, knowledge about the involvement of renal claudins in common kidney diseases and strategies to utilize claudins or their regulators for intervention are still scarce. The present review summarizes novel approaches to address these questions.</p><p><strong>Recent findings: </strong>Publicly accessible omics data provide new insights not only into general claudin expression patterns along the nephron, but also into sex-specific differences in claudin expression and into claudin dysregulation in renal injury. Computational association studies identify claudin variants as risk factors for kidney disease such as nephrolithiasis or loss of filtration capacity. The establishment of innovative cell culture and organoid models contributes to a better understanding of junctional and extra-junctional functions of individual claudins.</p><p><strong>Summary: </strong>The current studies lay the foundation for the identification of upstream regulators of renal claudin expression and thus for the development of new concepts for the treatment of kidney disease.</p>","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"535-542"},"PeriodicalIF":2.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140897504","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}

{"title":"Cancer drugs and acute kidney injury: new therapies and new challenges.","authors":"Ittamar Gork, Fei Xiong, Abhijat Kitchlu","doi":"10.1097/MNH.0000000000001001","DOIUrl":"10.1097/MNH.0000000000001001","url":null,"abstract":"<p><strong>Purpose of review: </strong>Cancer therapies continue to evolve at a rapid pace and although novel treatments, including immunotherapies and targeted therapies have allowed for substantial improvements in cancer survival, they carry associated risks of acute kidney injury (AKI). We aim to summarize the existing literature on AKI associated with the spectrum of systemic cancer treatments, including conventional chemotherapies, newer immunotherapies, and the growing number of targeted cancer therapies, which may be associated with both AKI and 'pseudo-AKI'.</p><p><strong>Recent findings: </strong>Conventional cytotoxic chemotherapies (e.g. cisplatin and other platinum-based agents, methotrexate, pemetrexed, ifosfamide, etc.) with well recognized nephrotoxicities (predominantly tubulointerstitial injury) remain in widespread use. Immunotherapies (e.g., immune checkpoint inhibitors and CAR-T therapies) may be associated with kidney immune-related adverse events, most often acute interstitial nephritis, and rarely, glomerular disease. Recently, multiple targeted cancer therapies have been associated with reduced renal tubular secretion of creatinine, causing elevations in serum creatinine and apparent 'pseudo-AKI'. To complicate matters further, these agents have had biopsy-proven, 'true' kidney injury attributed to them in numerous case reports.</p><p><strong>Summary: </strong>Clinicians in nephrology and oncology must be aware of the various potential kidney risks with these agents and recognize those with clinically meaningful impact on both cancer and kidney outcomes.</p>","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"474-485"},"PeriodicalIF":2.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140850798","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}

{"title":"Therapeutic approaches for pulmonary hypertension in patients with chronic kidney disease.","authors":"Marcelle Tuttle, Mark J Sarnak, Sankar D Navaneethan","doi":"10.1097/MNH.0000000000001008","DOIUrl":"10.1097/MNH.0000000000001008","url":null,"abstract":"<p><strong>Purpose of review: </strong>Pulmonary hypertension is a common comorbidity in patients with chronic kidney disease (CKD), but therapeutic options are limited. We discuss the epidemiology of pulmonary hypertension in patients with CKD and review therapies for pulmonary hypertension with a focus on emerging treatments for pulmonary arterial hypertension (PAH).</p><p><strong>Recent findings: </strong>The definition of pulmonary hypertension has been updated to a lower threshold of mean pulmonary artery pressures of more than 20 mmHg, potentially leading to more patients with CKD to qualify for the diagnosis of pulmonary hypertension. Endothelin receptor antagonists, a class of medications, which demonstrated efficacy in patients with PAH, have been shown to slow progression of CKD, but their efficacy in lowering pulmonary artery pressures and their effects on reducing cardiovascular mortality in this population remains unproven. Sotatercept, a novel activin signaling inhibitor, which was previously studied in dialysis patients has been shown to increase exercise capacity in patients with PAH. These studies may lead to new specific therapies for pulmonary hypertension in patients with CKD.</p><p><strong>Summary: </strong>Pulmonary hypertension is common in patients with CKD. Although our understanding of factors leading to pulmonary hypertension in this population have evolved, evidence supporting disease-specific therapy in CKD is limited arguing for larger, long-term studies.</p>","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"494-502"},"PeriodicalIF":2.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11290985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141426576","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}

{"title":"Postnatal renal tubule development: roles of tubular flow and flux.","authors":"Yi-Jing G Cheng, Chien-Chou Chen, Chih-Jen Cheng","doi":"10.1097/MNH.0000000000001007","DOIUrl":"10.1097/MNH.0000000000001007","url":null,"abstract":"<p><strong>Purpose of review: </strong>Postnatal renal tubule development is critical to adult kidney function. Several postnatal changes regulate the differentiation and proliferation of renal tubular cells. Here, we review the literature and our efforts on thick ascending limb (TAL) development in Bartter syndrome (BS).</p><p><strong>Recent findings: </strong>Glomerular filtrate quickly increases after birth, imposing fluid shear stress and circumferential stretch on immature renal tubules. Recent studies showed that kidney organoids under flow (superfusion) have better development of tubular structures and the expression of cilia and solute transporters. These effects are likely mediated by mechanosensors, such as cilia and the piezo1 channel. Improved renal oxygenation and sodium pump-dependent active transport can stimulate mitochondrial respiration and biogenesis. The functional coupling between transport and mitochondria ensures ATP supply for energy-demanding reactions in tubular cells, including cell cycle progression and proliferation. We recently discovered that postnatal renal medulla maturation and TAL elongation are impaired in Clc-k2-deficient BS mice. Primary cultured Clc-k2-deficient TAL cells have G1-S transition and proliferation delay. These developmental defects could be part of the early pathogenesis of BS and worsen the phenotype.</p><p><strong>Summary: </strong>Understanding how tubular flow and transepithelial ion fluxes regulate renal tubule development may improve the treatment of congenital renal tubulopathies.</p>","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"518-525"},"PeriodicalIF":2.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11290981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141442246","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}