Nature Reviews Nephrology最新文献_第6页

The kidney harbours a microbiota that may influence lithogenesis 肾脏中有可能影响岩石形成的微生物群

IF 28.6 1区医学

Nature Reviews Nephrology Pub Date : 2025-01-30 DOI: 10.1038/s41581-025-00937-2

Ellen F. Carney

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Risk-directed management of chronic kidney disease 慢性肾脏疾病的风险导向管理

IF 41.5 1区医学

Nature Reviews Nephrology Pub Date : 2025-01-30 DOI: 10.1038/s41581-025-00931-8

Matthew F. Blum, Brendon L. Neuen, Morgan E. Grams

{"title":"Risk-directed management of chronic kidney disease","authors":"Matthew F. Blum, Brendon L. Neuen, Morgan E. Grams","doi":"10.1038/s41581-025-00931-8","DOIUrl":"https://doi.org/10.1038/s41581-025-00931-8","url":null,"abstract":"The timely and rational institution of therapy is a key step towards reducing the global burden of chronic kidney disease (CKD). CKD is a heterogeneous entity with varied aetiologies and diverse trajectories, which include risk of kidney failure but also cardiovascular events and death. Developments in the past decade include substantial progress in CKD risk prediction, driven in part by the accumulation of electronic health records data. In addition, large randomized clinical trials have demonstrated the effectiveness of sodium–glucose co-transporter 2 inhibitors, glucagon-like peptide 1 receptor agonists and mineralocorticoid receptor antagonists in reducing adverse events in CKD, greatly expanding the options for effective therapy. Alongside angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, these classes of medication have been proposed to be the four pillars of CKD pharmacotherapy. However, all of these drug classes are underutilized, even in individuals at high risk. Leveraging prognostic estimates to guide therapy could help clinicians to prescribe CKD-related therapies to those who are most likely to benefit from their use. Risk-based CKD management thus aligns patient risk and care, allowing the prioritization of absolute benefit in determining therapeutic selection and timing. Here, we discuss CKD prognosis tools, evidence-based management and prognosis-guided therapies.","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"53 1","pages":""},"PeriodicalIF":41.5,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056325","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}

引用次数: 0

Loss of B cell protection in uraemic kidney disease 尿毒性肾病中B细胞保护功能的丧失

IF 28.6 1区医学

Nature Reviews Nephrology Pub Date : 2025-01-29 DOI: 10.1038/s41581-025-00936-3

Monica Wang

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Insights into the burden of CKDu 洞察CKDu的负担

IF 28.6 1区医学

Nature Reviews Nephrology Pub Date : 2025-01-28 DOI: 10.1038/s41581-025-00935-4

Susan J. Allison

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Born too soon: lifelong kidney risks and the importance of early intervention 过早出生：终生肾脏风险和早期干预的重要性

IF 28.6 1区医学

Nature Reviews Nephrology Pub Date : 2025-01-22 DOI: 10.1038/s41581-025-00932-7

Enrico Vidal, Daniele Trevisanuto

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Approaches to raise awareness of CKD among patients and the general population 提高患者和公众对慢性肾脏病认识的方法

IF 28.6 1区医学

Nature Reviews Nephrology Pub Date : 2025-01-20 DOI: 10.1038/s41581-025-00928-3

Delphine S. Tuot, Laura Plantinga

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Managing risk factors and early intervention for chronic kidney disease 慢性肾脏疾病的危险因素管理和早期干预

IF 28.6 1区医学

Nature Reviews Nephrology Pub Date : 2025-01-15 DOI: 10.1038/s41581-025-00930-9

Robert Kalyesubula, Valerie Ann Luyckx

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Clinical practice recommendations for the diagnosis and management of X-linked hypophosphataemia 诊断和治疗 X 连锁低磷血症的临床实践建议

IF 41.5 1区医学

Nature Reviews Nephrology Pub Date : 2025-01-15 DOI: 10.1038/s41581-024-00926-x

Dieter Haffner, Francesco Emma, Lothar Seefried, Wolfgang Högler, Kassim M. Javaid, Detlef Bockenhauer, Justine Bacchetta, Deborah Eastwood, Martin Biosse Duplan, Dirk Schnabel, Philippe Wicart, Gema Ariceta, Elena Levtchenko, Pol Harvengt, Martha Kirchhoff, Oliver Gardiner, Federico Di Rocco, Catherine Chaussain, Maria Luisa Brandi, Lars Savendahl, Karine Briot, Peter Kamenický, Lars Rejnmark, Agnès Linglart

{"title":"Clinical practice recommendations for the diagnosis and management of X-linked hypophosphataemia","authors":"Dieter Haffner, Francesco Emma, Lothar Seefried, Wolfgang Högler, Kassim M. Javaid, Detlef Bockenhauer, Justine Bacchetta, Deborah Eastwood, Martin Biosse Duplan, Dirk Schnabel, Philippe Wicart, Gema Ariceta, Elena Levtchenko, Pol Harvengt, Martha Kirchhoff, Oliver Gardiner, Federico Di Rocco, Catherine Chaussain, Maria Luisa Brandi, Lars Savendahl, Karine Briot, Peter Kamenický, Lars Rejnmark, Agnès Linglart","doi":"10.1038/s41581-024-00926-x","DOIUrl":"https://doi.org/10.1038/s41581-024-00926-x","url":null,"abstract":"X-linked hypophosphataemia (XLH) is a rare metabolic bone disorder caused by pathogenic variants in the PHEX gene, which is predominantly expressed in osteoblasts, osteocytes and odontoblasts. XLH is characterized by increased synthesis of the bone-derived phosphaturic hormone fibroblast growth factor 23 (FGF23), which results in renal phosphate wasting with consecutive hypophosphataemia, rickets, osteomalacia, disproportionate short stature, oral manifestations, pseudofractures, craniosynostosis, enthesopathies and osteoarthritis. Patients with XLH should be provided with multidisciplinary care organized by a metabolic bone expert. Historically, these patients were treated with frequent doses of oral phosphate supplements and active vitamin D, which was of limited efficiency and associated with adverse effects. However, the management of XLH has evolved in the past few years owing to the availability of burosumab, a fully humanized monoclonal antibody that neutralizes circulating FGF23. Here, we provide updated clinical practice recommendations for the diagnosis and management of XLH to improve outcomes and quality of life in these patients.","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"92 1","pages":""},"PeriodicalIF":41.5,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142981176","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}

引用次数: 0

Chronic kidney disease screening in LMICs: benefits and challenges 低收入国家慢性肾脏病筛查：益处与挑战

IF 28.6 1区医学

Nature Reviews Nephrology Pub Date : 2025-01-14 DOI: 10.1038/s41581-025-00929-2

Urmila Anandh, Swarnalatha Guditi

引用次数: 0

Diuretics in patients with chronic kidney disease 慢性肾脏疾病患者的利尿剂

IF 28.6 1区医学

Nature Reviews Nephrology Pub Date : 2025-01-07 DOI: 10.1038/s41581-024-00918-x

Rajiv Agarwal , Ashish Verma, Panagiotis I. Georgianos

{"title":"Diuretics in patients with chronic kidney disease","authors":"Rajiv Agarwal \u0000 , Ashish Verma, Panagiotis I. Georgianos","doi":"10.1038/s41581-024-00918-x","DOIUrl":"10.1038/s41581-024-00918-x","url":null,"abstract":"Diuretic drugs act on electrolyte transporters in the kidney to induce diuresis and are often used in chronic kidney disease (CKD), given that nephron loss creates a deficit in the ability to excrete dietary sodium, which promotes an increase in plasma volume. This rise in plasma volume is exacerbated by CKD-induced systemic and intra-renal activation of the renin–angiotensin–aldosterone-system, which further limits urinary sodium excretion. In the absence of a compensatory decrease in systemic vascular resistance, increases in plasma volume induced by sodium retention can manifest as a rise in systemic arterial blood pressure. Management of sodium and volume overload in patients with CKD is therefore typically based on restriction of dietary sodium intake and the use of diuretic agents to enhance urinary sodium excretion. Thiazide and thiazide-type diuretics are foundational therapies for the management of hypertension, whereas loop diuretics are often needed for volume overload, which might also require combination therapies. Mineralocorticoid receptor antagonists have an important role in the management of diuretic-resistant volume overload or treatment-resistant hypertension. Additionally, diuretics can be used for the diagnosis of kidney diseases and in the management of hyperkalaemia or hypokalaemia, hyponatraemia, hypercalcaemia and hypomagnesaemia. In this Review, the authors examine the diuretic drug class and its use in the treatment of hypertension and volume overload in chronic kidney disease, including dosage and mode of administration. The authors also discuss the mechanisms underlying diuretic resistance and its management, including the use of combination therapy.","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"21 4","pages":"264-278"},"PeriodicalIF":28.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142934923","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}

引用次数: 0