Magaiver Andrade-Silva , Poonam Dhillon , Andrea Sanchez-Navarro , Dhanunjay Mukhi , Hailong Hu , Lakshmi P. Kolligundla , Andrea Bergeson , Amin Abedini , Jonathan Levinsohn , Bernhard Dumoulin , Niels O.S. Câmara , Jonathan J. Miner , Katalin Susztak
{"title":"The critical role of endoplasmic reticulum stress and the stimulator of interferon genes (STING) pathway in kidney fibrosis","authors":"Magaiver Andrade-Silva , Poonam Dhillon , Andrea Sanchez-Navarro , Dhanunjay Mukhi , Hailong Hu , Lakshmi P. Kolligundla , Andrea Bergeson , Amin Abedini , Jonathan Levinsohn , Bernhard Dumoulin , Niels O.S. Câmara , Jonathan J. Miner , Katalin Susztak","doi":"10.1016/j.kint.2024.10.021","DOIUrl":"10.1016/j.kint.2024.10.021","url":null,"abstract":"<div><div>Endoplasmic reticulum (ER) stress is a condition in which the ER is overwhelmed and unable to manage its protein load properly. The precise activation mechanisms and role of ER stress in kidney disease remain unclear. To study this, we performed unbiased transcriptomics analysis to demonstrate ER stress in kidneys of patients with chronic kidney disease and in mouse models of acute and chronic kidney injury (cisplatin and unilateral ureteral obstruction and reanalyzed previously published data on folic acid and mitochondrial transcription factor A(TFAM) knockout mice). Inhibiting the protein kinase RNA-like ER kinase (PERK) arm of ER stress but not activating transcription factor 6 or inositol-requiring enzyme 1, protected mice from kidney fibrosis. The stimulator of interferon genes (STING) was identified as an important upstream activator of ER stress in kidney tubule cells. STING and PERK were found to physically interact, and STING agonists induced PERK activation in kidney tubule cells. Mice with a STING activating mutation presented with ER stress and kidney fibroinflammation. We also generated mice with a tubule specific STING deletion that were resistant to ER stress and kidney fibrosis. Human kidney spatial transcriptomics highlighted a spatial correlation between STING, ER stress and fibrotic gene expression. Thus, our results indicate that STING is an important upstream regulator of PERK and ER stress in tubule cells during kidney fibrosis development.</div></div>","PeriodicalId":17801,"journal":{"name":"Kidney international","volume":"107 2","pages":"Pages 302-316"},"PeriodicalIF":14.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Shaking it off: loss of NHE3-mediated calcium reabsorption is compensated by the distal nephron","authors":"Emma H. Ulrich , R. Todd Alexander","doi":"10.1016/j.kint.2024.11.021","DOIUrl":"10.1016/j.kint.2024.11.021","url":null,"abstract":"<div><div>Sodium reabsorption is tightly coupled to calcium reabsorption in the proximal tubule via the action of the Na<sup>+</sup>/H<sup>+</sup> exchanger isoform 3 (NHE3). Poulsen <em>et al.</em> provide evidence of reduced proximal calcium reabsorption in kidney tubule–specific NHE3-deficient mice that is compensated distally, unaltered phosphate homeostasis, and NHE3 involvement in the hypocalciuric effect of thiazides. These results provide support that gastrointestinal NHE3 inhibitors, used for hyperphosphatemia treatment, are unlikely to cause long-term impact on bone mineralization.</div></div>","PeriodicalId":17801,"journal":{"name":"Kidney international","volume":"107 2","pages":"Pages 222-225"},"PeriodicalIF":14.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Can you have a cake and eat it? Comparing reducing mycophenolate versus switching to everolimus for kidney transplants with new-onset BKPyV-DNAemia","authors":"Hans H. Hirsch","doi":"10.1016/j.kint.2024.10.019","DOIUrl":"10.1016/j.kint.2024.10.019","url":null,"abstract":"<div><div>BK polyomavirus remains a vexing issue in kidney transplantation. There are no antiviral drugs, and solely reducing immunosuppression is recommended for management. However, evidence from randomized controlled studies lacks defining clearance of BK polyomavirus-DNAemia and/or nephropathy as a primary outcome. In this arena of strong opinions, hesitancy, and poor industry interest, Caillard <em>et al.</em> from 16 centers in France take the bull by the horns and present compelling data on clearance of new-onset BK polyomavirus-DNAemia at 6 months after randomizing 130 kidney transplant patients 1:1 to reduced calcineurin inhibitors <em>plus</em> reduced mycophenolate or switching to everolimus. Although both protocols preserve renal allograft function, the mycophenolate arm performs better numerically and kinetically. Thus, everolimus cannot unfold its presumed antiviral effect. The study has potential to serve as new reference for reducing immunosuppression, being neither “mycophenolate first” nor “calcineurin inhibitors first,” but “first both.” The bar has been set very high now for other interventions alone or on top of “first both.”</div></div>","PeriodicalId":17801,"journal":{"name":"Kidney international","volume":"107 2","pages":"Pages 230-233"},"PeriodicalIF":14.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143028359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Filgrastim-associated extramedullary hematopoiesis in the allograft kidney","authors":"Miroslav Sekulic , Joseph U. Singh","doi":"10.1016/j.kint.2024.08.017","DOIUrl":"10.1016/j.kint.2024.08.017","url":null,"abstract":"","PeriodicalId":17801,"journal":{"name":"Kidney international","volume":"107 2","pages":"Page 362"},"PeriodicalIF":14.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143028999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
An S. De Vriese , Sanjeev Sethi , Fernando C. Fervenza
{"title":"Lupus nephritis: redefining the treatment goals","authors":"An S. De Vriese , Sanjeev Sethi , Fernando C. Fervenza","doi":"10.1016/j.kint.2024.10.018","DOIUrl":"10.1016/j.kint.2024.10.018","url":null,"abstract":"<div><div>The course of proliferative lupus nephritis is characterized by flares of activity alternating with periods of quiescence against a background of chronic immune dysregulation. An accurate assessment of disease activity is of unassailable importance to tailor therapy. In the present communication, we discuss the available clinical, serologic, and histologic tools to evaluate disease activity and how they may be applied to redefine the treatment goals in lupus nephritis. Traditionally, treatment response is judged by the degree of proteinuria reduction and improvement of kidney function, but this fails to differentiate ongoing inflammatory disease from chronic damage. Despite intensive research, no novel biomarker has proved useful for clinical practice, and we continue to rely on anti–double-stranded DNA antibody levels to assess serologic activity. Repeat kidney biopsies sometimes reveal persistent inflammation despite apparent clinical remission, giving credibility to the conviction that histologic remission should be a treatment goal and protocol biopsies be part of the decision-making process. However, the discrepancies between clinical and histologic responses to therapy can be explained by persistent systemic autoimmunity with low-grade immune complex deposition or, alternatively, by delayed clearance of intrarenal inflammation once immunologic remission has been achieved. Because persistent immune dysregulation is the motor of disease activity in lupus nephritis, it should be the principal focus of therapy and monitoring. We propose to replace the traditional induction-remission maintenance protocol by a more dynamic and individualized approach and aim for 3 treatment goals, concomitantly rather than sequentially: (i) clinical remission, by attenuating renal inflammation, using microscopic hematuria, proteinuria, estimated glomerular filtration rate, and complement levels as biomarkers; (ii) immunologic remission, by decreasing immune complex generation, using anti–double-stranded DNA antibody as a biomarker; and (iii) preservation of kidney function, by curtailing chronic kidney damage, using estimated glomerular filtration rate slope as a biomarker.</div></div>","PeriodicalId":17801,"journal":{"name":"Kidney international","volume":"107 2","pages":"Pages 198-211"},"PeriodicalIF":14.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Kidney function as a predictor of relapse in ANCA-associated vasculitis","authors":"Khin Zar Li Lwin , Shi Yun Tan , Cynthia C. Lim","doi":"10.1016/j.kint.2024.03.034","DOIUrl":"10.1016/j.kint.2024.03.034","url":null,"abstract":"","PeriodicalId":17801,"journal":{"name":"Kidney international","volume":"107 2","pages":"Page 359"},"PeriodicalIF":14.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}