Advances in kidney disease and health最新文献

{"title":"Customizing Treatment for Acute Kidney Injury in Distinct Populations.","authors":"Sarah F Sanghavi, Ladan Golestaneh","doi":"10.1053/j.akdh.2026.08.006","DOIUrl":"https://doi.org/10.1053/j.akdh.2026.08.006","url":null,"abstract":"","PeriodicalId":72096,"journal":{"name":"Advances in kidney disease and health","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis of Acute Kidney Injury During Pregnancy.","authors":"Aditi Singh, Sumeska Thavarajah, Nityasree Srialluri","doi":"10.1053/j.akdh.2026.06.004","DOIUrl":"https://doi.org/10.1053/j.akdh.2026.06.004","url":null,"abstract":"<p><p>Pregnancy-related acute kidney injury (PrAKI) is a serious complication causing substantial maternal and fetal morbidity and mortality with long-term sequelae including chronic kidney disease (CKD) and cardiovascular disease. PrAKI affects individuals across high- and low-resource settings, though epidemiology, etiologies, and outcomes differ substantially by context. In low-resource settings, PrAKI remains a leading cause of maternal mortality, precipitated by septic abortion, hemorrhage, and hypertensive disorders compounded by limited access to renal replacement therapy. In high-income countries, PrAKI incidence of is rising due to increasing maternal age, cardiometabolic comorbidities, and hypertensive disorders of pregnancy. PrAKI ranges from transient, reversible dysfunction to severe injury necessitating dialysis, with adverse at each stage. Diagnosis is uniquely challenging because physiological adaptations of pregnancy lower serum creatinine, rendering conventional thresholds less reliable. Current AKI definitions and kidney function estimating equations remain unvalidated in pregnant populations and pre-existing CKD may mask superimposed injury when baseline creatinine values are unknown. Management requires a multidisciplinary approach tailored to gestational age and underlying etiology. In this review, we focus on diagnostic strategies for PrAKI-including gestational age-adjusted creatinine trajectories, proteinuria assessment, and emerging kidney and placental biomarkers-alongside clinical management principles, and current gaps in knowledge.</p>","PeriodicalId":72096,"journal":{"name":"Advances in kidney disease and health","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149018823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Intersection of Venous Congestion and Arterial Underfilling in Cardiorenal Syndromes.","authors":"Jeffrey M Turner, Laura Aponte Becerra, Christopher El Mouhayyar","doi":"10.1053/j.akdh.2026.06.007","DOIUrl":"https://doi.org/10.1053/j.akdh.2026.06.007","url":null,"abstract":"<p><p>The heart and kidneys are connected in both health and disease. Coordinated dysfunction of these organ systems is a result of complex interactions related to vascular and biochemical maladaptations. The historical perspective that kidney dysfunction in heart failure is overwhelmingly a product of reduced cardiac forward flow and arterial underfilling has been challenged by mounting evidence. Efforts in 2004 to introduce the term cardiorenal syndrome were based on observations that increased circulatory volume, specifically venous congestion, play a key role in kidney dysfunction. Contemporary studies done after 2004, as well as revisiting historical renal physiology experiments in a new light, have illuminated some of the pathophysiology of how venous congestion in decompensated heart failure causes the \"congested kidney.\" Cardiorenal syndrome, specifically type 1 occurring in the setting of acute heart failure, in part is defined by the fact that renal venous hypertension drives kidney dysfunction. To illuminate this point further, we compare and contrast the importance of arterial underfilling in cardiogenic shock vs cardiorenal syndrome.</p>","PeriodicalId":72096,"journal":{"name":"Advances in kidney disease and health","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148622760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Artificial Intelligence in Nephrology Education.","authors":"Jing Miao, Charat Thongprayoon, Wisit Cheungpasitporn","doi":"10.1053/j.akdh.2026.06.003","DOIUrl":"https://doi.org/10.1053/j.akdh.2026.06.003","url":null,"abstract":"<p><p>Artificial intelligence (AI) and large language models are increasingly reshaping nephrology education. This review advances a hierarchical framework for understanding AI in nephrology education. At the primary level, AI may represent a scalable educational infrastructure that helps address the mismatch between educational demand and delivery capacity. At the secondary level, 3 mechanisms enable this infrastructure: workflow integration, continuous adaptation, and scalability. At the tertiary level, downstream outcomes include enhanced clinical reasoning, curriculum acceleration, burden reduction, improved patient education, and equitable access. However, safe and effective implementation requires addressing limitations related to accuracy, hallucinations, bias, transparency, privacy, and alignment with evolving clinical guidelines. Emerging innovations, including adaptive tutors, digital twins, and AI-orchestrated curricula, highlight a rapidly evolving educational ecosystem. Overall, AI and large language models hold substantial promise to modernize nephrology education and patient engagement, provided they are integrated with rigorous governance, continuous expert oversight, and ethical safeguards.</p>","PeriodicalId":72096,"journal":{"name":"Advances in kidney disease and health","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148400109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyperammonemia Physiology and Management: A Nephrology-Centered Review.","authors":"Patrick Hofmann, Danielle L Saly","doi":"10.1053/j.akdh.2026.06.001","DOIUrl":"https://doi.org/10.1053/j.akdh.2026.06.001","url":null,"abstract":"<p><p>Hyperammonemia is a rare but life-threatening disorder that arises from hepatic and diverse nonhepatic etiologies and demands prompt physiologic evaluation and intervention to prevent neurologic injury. This review highlights the physiological roles of the intestine, liver, skeletal muscle, brain, and kidneys in ammonia homeostasis, with emphasis on acid-base and potassium regulation. We summarize major causes of hyperammonemia, diagnostic strategies, and nondialytic therapies, review principles guiding kidney replacement therapy selection and dosing, and identify key uncertainties that warrant future study in adult populations.</p>","PeriodicalId":72096,"journal":{"name":"Advances in kidney disease and health","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148378053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New Drugs on the Horizon for Hypertension.","authors":"Geonte G Jackson, James M Luther, Matthew R Alexander","doi":"10.1053/j.akdh.2026.02.005","DOIUrl":"10.1053/j.akdh.2026.02.005","url":null,"abstract":"<p><p>Despite the current therapeutic options including lifestyle modifications and pharmacotherapy, blood pressure remains inadequately controlled in the majority of hypertensive individuals. Several new medications have been recently Food and Drug Administration approved or are in phase 1 or 2 clinical trials for hypertension. This includes the nonselective endothelin receptor antagonist aprocitentan, which was Food and Drug Administration approved in 2024 for uncontrolled hypertension. Aldosterone synthase inhibitors including baxdrostat, lorundrostat, and vicadrostat are in phase 1 or 2 trials for hypertension or chronic kidney disease with evidence of significant blood pressure lowering. Finally, the novel small-interfering RNA-based zilebesiran targeting angiotensinogen represents a new class of antihypertensive medications with durable blood pressure-lowering dosing only every 3 or 6 months. Each of these medications has unique properties that can potentially contribute to improvement in blood pressure control for individual patients and at the population level. Development of these novel antihypertensives promises a welcome set of new options for the treatment of hypertension.</p>","PeriodicalId":72096,"journal":{"name":"Advances in kidney disease and health","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148378339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary Aldosteronism and the Kidneys","authors":"Emily L. Simms,&nbsp;Gregory L. Hundemer","doi":"10.1053/j.akdh.2026.04.001","DOIUrl":"10.1053/j.akdh.2026.04.001","url":null,"abstract":"<div><div>Primary aldosteronism (PA) is the most common and modifiable form of secondary hypertension, being responsible for 5-10% of all cases of hypertension and over 20% of cases of resistant hypertension. PA is characterized by autonomous aldosterone secretion from 1 or both adrenal glands, independent of regulation by renin and angiotensin II. Although the adverse cardiovascular consequences garner the majority of attention in regard to its clinical impact, PA leads to important detrimental effects on kidney health also. This includes early glomerular hyperfiltration followed by albuminuria, steeper longitudinal estimated glomerular filtration rate decline, and a higher risk for CKD. Importantly, early diagnosis and initiation of targeted therapies, namely surgical adrenalectomy and mineralocorticoid receptor antagonist medications, effectively mitigate these kidney disease risks. Although these aldosterone-targeted therapies provide long-term kidney protection, they often “unmask” previously unrecognized CKD due to reversal of the longstanding glomerular hyperfiltration inherent to the pathophysiology of PA. Herein, a teaching case is discussed which highlights the diagnostic and treatment approaches to PA along with commonly encountered kidney manifestations which arise from PA and its treatments.</div></div><div>Primary aldosteronism (PA) is the most common and modifiable form of secondary hypertension, being responsible for 5-10% of all cases of hypertension and over 20% of cases of resistant hypertension. PA is characterized by autonomous aldosterone secretion from 1 or both adrenal glands, independent of regulation by renin and angiotensin II. Although the adverse cardiovascular consequences garner the majority of attention in regard to its clinical impact, PA leads to important detrimental effects on kidney health also. This includes early glomerular hyperfiltration followed by albuminuria, steeper longitudinal estimated glomerular filtration rate decline, and a higher risk for CKD. Importantly, early diagnosis and initiation of targeted therapies, namely surgical adrenalectomy and mineralocorticoid receptor antagonist medications, effectively mitigate these kidney disease risks. Although these aldosterone-targeted therapies provide long-term kidney protection, they often “unmask” previously unrecognized CKD due to reversal of the longstanding glomerular hyperfiltration inherent to the pathophysiology of PA. Herein, a teaching case is discussed which highlights the diagnostic and treatment approaches to PA along with commonly encountered kidney manifestations which arise from PA and its treatments.</div>","PeriodicalId":72096,"journal":{"name":"Advances in kidney disease and health","volume":"33 2","pages":"Pages 135-142"},"PeriodicalIF":3.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148378294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypertension in Advanced Chronic Kidney Disease: Saving the Kidneys or the Heart?","authors":"Ekamol Tantisattamo,&nbsp;Elaine Ku","doi":"10.1053/j.akdh.2026.02.003","DOIUrl":"10.1053/j.akdh.2026.02.003","url":null,"abstract":"<div><div>As one of the known modifiable risk factors for cardiovascular disease, hypertension control is an attractive strategy for mitigating the risk of chronic kidney disease progression and cardiovascular disease. However, trial data have not always been consistent in terms of the cardiovascular and kidney benefits of intensive blood pressure lowering in patients with advanced kidney dysfunction. Here, we provide an overview of the trial-grade evidence for intensive blood pressure lowering and the use of different antihypertensive agents to achieve blood pressure control, focusing on cardiorenal outcomes. The evolution of the field from the reliance on renin-angiotensin system inhibition as the first-line agent to control blood pressure to the approval of several newer therapies with proven kidney and cardiovascular benefits including sodium glucose co-transporter 2 inhibitors, nonsteroidal aldosterone antagonists, and glucagon-like peptide-1 agonists has advanced the care of patients with hypertension and CKD. However, evidence for these therapies remains more limited in those with advanced CKD. Further studies are needed in patients with advanced CKD who are at high risk for adverse side effects from antihypertensive therapy.</div></div><div>As one of the known modifiable risk factors for cardiovascular disease, hypertension control is an attractive strategy for mitigating the risk of chronic kidney disease progression and cardiovascular disease. However, trial data have not always been consistent in terms of the cardiovascular and kidney benefits of intensive blood pressure lowering in patients with advanced kidney dysfunction. Here, we provide an overview of the trial-grade evidence for intensive blood pressure lowering and the use of different antihypertensive agents to achieve blood pressure control, focusing on cardiorenal outcomes. The evolution of the field from the reliance on renin-angiotensin system inhibition as the first-line agent to control blood pressure to the approval of several newer therapies with proven kidney and cardiovascular benefits including sodium glucose co-transporter 2 inhibitors, nonsteroidal aldosterone antagonists, and glucagon-like peptide-1 agonists has advanced the care of patients with hypertension and CKD. However, evidence for these therapies remains more limited in those with advanced CKD. Further studies are needed in patients with advanced CKD who are at high risk for adverse side effects from antihypertensive therapy.</div>","PeriodicalId":72096,"journal":{"name":"Advances in kidney disease and health","volume":"33 2","pages":"Pages 153-159"},"PeriodicalIF":3.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148378148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood Pressure Management in the Inpatient and Acute Care Setting","authors":"Kevin Murphy,&nbsp;Elaine Peplow,&nbsp;Holly Kramer","doi":"10.1053/j.akdh.2026.03.002","DOIUrl":"10.1053/j.akdh.2026.03.002","url":null,"abstract":"<div><div>Existing recommendations for blood pressure goals and treatment accumulated from decades of clinical trials and observational studies in which a resting blood pressure was measured in an outpatient setting and participants were followed for years. Consequently, existing guidelines for hypertension do not address day-to-day blood pressure control in an inpatient setting. When a patient is admitted, home blood pressure–lowering medications are often held, and the unfamiliar environment, clinical testing, and noise stress patients and heighten blood pressure. In this review, we describe the natural history of blood pressure changes during hospitalization and the reasons why blood pressure may increase in some patients. Due to lack of guidance, clinician management of elevated blood pressure among hospitalized patients varies widely, and we review observational studies that discuss outcomes with use of intravenous and/or oral blood pressure lowering medications to treat asymptomatic inpatient blood pressure elevations. Although clinical trials are needed for determining best practices, our review provides a suggested plan to address asymptomatic elevated blood pressure among patients hospitalized for noncardiovascular diseases.</div></div><div>Existing recommendations for blood pressure goals and treatment accumulated from decades of clinical trials and observational studies in which a resting blood pressure was measured in an outpatient setting and participants were followed for years. Consequently, existing guidelines for hypertension do not address day-to-day blood pressure control in an inpatient setting. When a patient is admitted, home blood pressure–lowering medications are often held, and the unfamiliar environment, clinical testing, and noise stress patients and heighten blood pressure. In this review, we describe the natural history of blood pressure changes during hospitalization and the reasons why blood pressure may increase in some patients. Due to lack of guidance, clinician management of elevated blood pressure among hospitalized patients varies widely, and we review observational studies that discuss outcomes with use of intravenous and/or oral blood pressure lowering medications to treat asymptomatic inpatient blood pressure elevations. Although clinical trials are needed for determining best practices, our review provides a suggested plan to address asymptomatic elevated blood pressure among patients hospitalized for noncardiovascular diseases.</div>","PeriodicalId":72096,"journal":{"name":"Advances in kidney disease and health","volume":"33 2","pages":"Pages 168-177"},"PeriodicalIF":3.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148377459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating Pediatric and Adult Hypertension: Advances in Mechanisms, Therapeutics, and Clinical Care","authors":"Rahul Chanchlani,&nbsp;Swapnil Hiremath","doi":"10.1053/j.akdh.2026.08.004","DOIUrl":"10.1053/j.akdh.2026.08.004","url":null,"abstract":"","PeriodicalId":72096,"journal":{"name":"Advances in kidney disease and health","volume":"33 2","pages":"Pages 127-128"},"PeriodicalIF":3.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}