Advances in kidney disease and health最新文献

The Pathology of Tubulointerstitial Kidney Disease: A Clinicopathologic Approach to Narrowing the Differential Diagnosis 肾小管间质性肾病的病理：缩小鉴别诊断的临床病理方法

IF 2.6

Advances in kidney disease and health Pub Date : 2025-07-01 DOI: 10.1053/j.akdh.2025.06.003

Leal Herlitz, Michael Kuperman

{"title":"The Pathology of Tubulointerstitial Kidney Disease: A Clinicopathologic Approach to Narrowing the Differential Diagnosis","authors":"Leal Herlitz, Michael Kuperman","doi":"10.1053/j.akdh.2025.06.003","DOIUrl":"10.1053/j.akdh.2025.06.003","url":null,"abstract":"<div><div>Tubulointerstitial kidney disease can be recognized histologically as tubulointerstitial injury that is out of proportion to glomerular or vascular pathology. While recognizable as a histologic entity, determining a more precise underlying etiology for tubulointerstitial disease can be a diagnostic challenge. This review presents a clinicopathologic approach intended to help nephrologists and pathologists narrow the clinical differential diagnosis of tubulointerstitial disease. Inflammatory tubulointerstitial disease can often be subcategorized based on the presence of specific types of inflammatory infiltrates, such as eosinophils, neutrophils or granulomas. Recognition of these inflammatory phenotypes raises and lowers some entities in the differential diagnosis. Broadly speaking, underlying causes of inflammatory tubulointerstitial disease include drug reaction, infection, and autoimmune diseases. The most common causes of acute noninflammatory tubulointerstitial disease are ischemic and toxic tubular injuries. Much of the time there is substantial overlap in the morphology of ischemic and toxic tubular injury, but there are distinctive findings in noninflammatory tubulointerstitial disease, including casts and crystals, that may allow for a more specific histologic diagnosis that maps to a narrower clinical differential diagnosis. Ultimately, understanding the root cause of tubulointerstitial disease requires careful integration of clinical history with histopathologic findings.</div></div>","PeriodicalId":72096,"journal":{"name":"Advances in kidney disease and health","volume":"32 4","pages":"Pages 333-340"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050719","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}

引用次数: 0

Chronic Kidney Disease of Unknown Origin, a Tubulointerstitial Disease 来源不明的慢性肾脏疾病，一种小管间质性疾病

IF 2.6

Advances in kidney disease and health Pub Date : 2025-07-01 DOI: 10.1053/j.akdh.2025.06.004

Magdalena Madero , Sreejith Parameswaran

{"title":"Chronic Kidney Disease of Unknown Origin, a Tubulointerstitial Disease","authors":"Magdalena Madero , Sreejith Parameswaran","doi":"10.1053/j.akdh.2025.06.004","DOIUrl":"10.1053/j.akdh.2025.06.004","url":null,"abstract":"<div><div>Chronic kidney disease of undetermined cause is characterized by distinctive histopathological features predominantly affecting the tubulointerstitial compartment of the kidney. Kidney biopsies from affected individuals consistently demonstrate interstitial fibrosis and tubular atrophy as the hallmark findings, observed in over 80-90% of cases, with severity correlating closely with decreased glomerular filtration rate. Interstitial inflammation is generally mild or absent in early disease stages but may increase in advanced fibrosis, with T lymphocytes and macrophages predominating. Tubulitis and acute tubular injury are rare and usually restricted to patients presenting acutely. Electron microscopy reveals ultrastructural tubular changes such as cell detachment, basement membrane thickening, and collagen fibril deposition, though these are nonspecific. Glomerular abnormalities are typically secondary, including glomerulosclerosis in less than 50% of glomeruli, glomerulomegaly, and periglomerular fibrosis, reflecting compensatory hypertrophy or reduced nephron number. Immune complex deposition is minimal or absent. Vascular changes are generally not prominent. Despite the diagnostic value of kidney biopsy in chronic kidney disease of undetermined cause, clinical use is limited by socioeconomic factors, procedural risks, and lack of targeted therapies. Standardized biopsy protocols and reporting are essential for improving diagnosis, prognosis, and understanding disease mechanisms to guide future research and treatment strategies.</div></div>","PeriodicalId":72096,"journal":{"name":"Advances in kidney disease and health","volume":"32 4","pages":"Pages 350-356"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050777","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}

引用次数: 0

Pathophysiology of Tubulointerstitial Nephritis 肾小管间质性肾炎的病理生理学

IF 2.6

Advances in kidney disease and health Pub Date : 2025-07-01 DOI: 10.1053/j.akdh.2025.07.003

Abraham W. Aron , Anushree C. Shirali

引用次数: 0

Clinical Tools for the Diagnosis of Acute Tubulointerstitial Disease 急性小管间质疾病诊断的临床工具

IF 2.6

Advances in kidney disease and health Pub Date : 2025-07-01 DOI: 10.1053/j.akdh.2025.06.001

Abinet M. Aklilu , Anusha Sundararajan

{"title":"Clinical Tools for the Diagnosis of Acute Tubulointerstitial Disease","authors":"Abinet M. Aklilu , Anusha Sundararajan","doi":"10.1053/j.akdh.2025.06.001","DOIUrl":"10.1053/j.akdh.2025.06.001","url":null,"abstract":"<div><div>Acute tubulointerstitial nephritis (ATIN) is a common cause of acute kidney injury (AKI), occurring in up to a quarter of kidney biopsies performed for AKI. ATIN can lead to chronic kidney disease if not promptly diagnosed and managed. The most common cause is drugs, with antibiotics being the most commonly reported cause. Widespread use of proton pump inhibitors and increasing use of immuno-oncotherapy, such as immune checkpoint inhibitors, are contributing to increased incidence of ATIN. However, there are diagnostic challenges. The time of onset of AKI in ATIN is variable, and diagnosis is often delayed due to a lack of specific symptoms or clinical findings. No standard diagnostic criteria exist even for histological diagnosis despite kidney biopsy being the gold standard. Additionally, there are no available tools to distinguish between different causes of ATIN, particularly when multiple etiologies are suspected, and to identify those who will benefit from treatment at diagnosis. Particularly with oncotherapy-associated AKI, where discontinuing the drug portends detrimental effects on the patient, diagnostic tools with high accuracy for distinguishing ATIN from other types of AKI are paramount. Herein, we discuss the current evidence on the diagnosis of ATIN with a focus on available clinical, laboratory, and imaging findings.</div></div>","PeriodicalId":72096,"journal":{"name":"Advances in kidney disease and health","volume":"32 4","pages":"Pages 357-366"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050760","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}

引用次数: 0

Management of Acute Tubulointerstitial Nephritis 急性肾小管间质性肾炎的治疗

IF 2.6

Advances in kidney disease and health Pub Date : 2025-07-01 DOI: 10.1053/j.akdh.2025.03.002

Namrata Krishnan , Fernando Caravaca-Fontán , Manuel Praga

{"title":"Management of Acute Tubulointerstitial Nephritis","authors":"Namrata Krishnan , Fernando Caravaca-Fontán , Manuel Praga","doi":"10.1053/j.akdh.2025.03.002","DOIUrl":"10.1053/j.akdh.2025.03.002","url":null,"abstract":"<div><div>Acute tubulointerstitial nephritis (ATIN) is an important cause of acute kidney injury and acute kidney disease globally and is characterized by immune cell infiltration into the renal tubulointerstitium, causing inflammation, tubular injury, and ultimately fibrosis. Drug-induced hypersensitivity is the most common cause (>70%); however, infections and systemic autoimmune conditions are additional triggers, with a small percentage having idiopathic ATIN. Diagnosis requires a high index of suspicion as there can be significant clinical and laboratory overlaps between the various types of ATIN and other etiologies of acute kidney injury. Oligosymptomatic acute kidney injury with a lack of urinary findings is a common presentation, adding to the diagnostic challenge. Kidney biopsy is the gold standard for diagnosis. Management of ATIN focuses on promptly identifying and addressing the underlying trigger. Given that injury is primarily immune-mediated, immunosuppressive therapy has been explored extensively in the treatment of noninfectious ATIN; however, robust randomized controlled trials are lacking to guide specific treatments. With cessation of the immune trigger and prompt treatment initiation, ATIN generally has a favorable renal prognosis. However, delay in diagnosis or increased exposure to the culprit agent can result in irreversible interstitial fibrosis and CKD.</div></div>","PeriodicalId":72096,"journal":{"name":"Advances in kidney disease and health","volume":"32 4","pages":"Pages 373-381"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050762","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}

引用次数: 0

Acute Drug-Induced Tubulointerstitial Nephritis: Current Perspectives on Diagnosis and Treatment 急性药物性肾小管间质性肾炎：诊断和治疗的最新进展

IF 2.6

Advances in kidney disease and health Pub Date : 2025-07-01 DOI: 10.1053/j.akdh.2025.06.002

Javier Azores - Moreno , Clara Cases - Corona , Beatriz Sánchez - Álamo , Maria Maldonado , Lina León - Machado , Begoña Rivas , Cristina Vega , Amir Shabaka , Gema Fernández - Juárez

{"title":"Acute Drug-Induced Tubulointerstitial Nephritis: Current Perspectives on Diagnosis and Treatment","authors":"Javier Azores - Moreno , Clara Cases - Corona , Beatriz Sánchez - Álamo , Maria Maldonado , Lina León - Machado , Begoña Rivas , Cristina Vega , Amir Shabaka , Gema Fernández - Juárez","doi":"10.1053/j.akdh.2025.06.002","DOIUrl":"10.1053/j.akdh.2025.06.002","url":null,"abstract":"<div><div>Acute tubulointerstitial nephritis (ATIN) is one of the leading causes of acute kidney injury (AKI), accounting for approximately 15-27% of biopsy-proven cases of AKI. While some patients recover kidney function with timely intervention, a subset of patients may progress to chronic kidney disease and around one-third of the patients will require chronic dialysis. Drug-induced ATIN is the most common form and is often associated with nonsteroidal anti-inflammatory drugs, antibiotics, and proton pump inhibitors. Infections, autoimmune disorders, such as Sjögren's syndrome and sarcoidosis contribute to a smaller proportion of cases. Clinically, ATIN presents with a wide spectrum of symptoms ranging from asymptomatic AKI to systemic manifestations such as fever, rash, arthralgia, and eosinophilia. Urinalysis often reveals sterile pyuria, hematuria, and occasionally, white blood cell casts. Proteinuria is typically mild (<1.5 g/24 hours. Definitive diagnosis requires kidney biopsy, which reveals the presence of an extensive interstitial infiltrate, mainly composed of lymphocytes and monocytes, along with interstitial edema, and varying degrees of tubular injury. Early identification and management are critical to prevent irreversible kidney damage. So far, the optimal treatment of this entity is not yet well characterized but treatment strategies for ATIN must focus on prompt discontinuing the offending agent, supportive care, and corticosteroid therapy.</div></div>","PeriodicalId":72096,"journal":{"name":"Advances in kidney disease and health","volume":"32 4","pages":"Pages 341-349"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050720","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}

引用次数: 0

Prognosis and Outcomes of Acute and Chronic Tubulointerstitial Nephritis 急慢性肾小管间质性肾炎的预后和转归

IF 2.6

Advances in kidney disease and health Pub Date : 2025-07-01 DOI: 10.1053/j.akdh.2025.07.005

Nina Weber , Dries Deleersnijder , Abhijat Kitchlu , Ben Sprangers

{"title":"Prognosis and Outcomes of Acute and Chronic Tubulointerstitial Nephritis","authors":"Nina Weber , Dries Deleersnijder , Abhijat Kitchlu , Ben Sprangers","doi":"10.1053/j.akdh.2025.07.005","DOIUrl":"10.1053/j.akdh.2025.07.005","url":null,"abstract":"<div><div>Tubulointerstitial nephritis (TIN) is a rare heterogenous kidney disease and outcomes depend upon many factors including patient characteristics, clinical presentation and histopathological features on kidney biopsy. When considering short-term kidney outcomes, about 20% of adult patients with acute TIN will require dialysis, although many will fully or partially recover without need for maintenance kidney replacement therapy. However, current evidence suggests that long-term kidney outcomes of patients with TIN are far less favorable than originally thought. Risk factors for adverse kidney outcomes include patient characteristics (e.g., older age, hypertension), a higher degree of proteinuria, recurrent acute TIN episodes and signs of disease chronicity or granulomatous interstitial nephritis on kidney biopsy. Pediatric patients have a better long-term prognosis, although a significant proportion of patients will develop CKD as well. In general, drug-induced acute TIN has a better prognosis when compared with autoimmune etiologies, particularly if the inciting drug is discontinued early in the disease course and re-exposure is avoided. Autoimmune etiologies frequently cause CKD, partially because they are associated with recurrent acute TIN episodes. In this review, we summarize the available data regarding prognosis and outcomes of acute and chronic TIN for various etiologies of TIN.</div></div>","PeriodicalId":72096,"journal":{"name":"Advances in kidney disease and health","volume":"32 4","pages":"Pages 382-391"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050763","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}

引用次数: 0

Biomarkers for Diagnosis of Acute Tubulointerstitial Nephritis 诊断急性肾小管间质性肾炎的生物标志物

IF 2.6

Advances in kidney disease and health Pub Date : 2025-07-01 DOI: 10.1053/j.akdh.2025.07.004

Sagar Sadarangani , Kavita Mistry , Meghan E. Sise , Dennis G. Moledina

{"title":"Biomarkers for Diagnosis of Acute Tubulointerstitial Nephritis","authors":"Sagar Sadarangani , Kavita Mistry , Meghan E. Sise , Dennis G. Moledina","doi":"10.1053/j.akdh.2025.07.004","DOIUrl":"10.1053/j.akdh.2025.07.004","url":null,"abstract":"<div><div>Acute tubulointerstitial nephritis (ATIN) is a common cause of acute kidney injury among patients who require a kidney biopsy. ATIN is an inflammatory reaction affecting the renal tubulointerstitium that occurs in response to medications, autoimmune diseases, or infections. ATIN is treated by removing the inciting agent and/or initiating immunosuppressive therapy. Kidney biopsy is often required to establish this diagnosis due to lack of pathognomonic clinical features and nonspecific clinical tests but carries a significant bleeding risk and may delay initiation of therapy. Thus, there is an important, unmet need for novel biomarkers that may facilitate the noninvasive diagnosis of ATIN. Since ATIN is characterized by renal tubulointerstitial inflammation, many immune-related soluble factors have been investigated as biomarkers for its diagnosis, including C-X-C motif ligand 9, tumor necrosis factor alpha, interleukin (IL)-9, regulated on activation, normal T cell expressed and secreted, monocyte chemoattractant protein-1, soluble IL-2 receptor alpha, IL-5, Fas receptor, and others. Imaging studies that reflect kidney inflammation have also been investigated. This review highlights the limitations of currently available tests for ATIN, the biomarkers currently under investigation, and the challenges associated with development and validation for their use in clinical practice.</div></div>","PeriodicalId":72096,"journal":{"name":"Advances in kidney disease and health","volume":"32 4","pages":"Pages 367-372"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050761","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}

引用次数: 0

The Tubulointerstitium in Health and Disease: More Than What Meets the Eye 健康和疾病中的小管间质：比眼睛看到的更多

IF 2.6

Advances in kidney disease and health Pub Date : 2025-07-01 DOI: 10.1053/j.akdh.2025.07.002

Mark A. Perazella, Pranav S. Garimella

{"title":"The Tubulointerstitium in Health and Disease: More Than What Meets the Eye","authors":"Mark A. Perazella, Pranav S. Garimella","doi":"10.1053/j.akdh.2025.07.002","DOIUrl":"10.1053/j.akdh.2025.07.002","url":null,"abstract":"<div><div>The tubulointerstitium is a critical component of the nephron. It is a highly vascularized compartment that plays an important part in kidney health and function. The tubulointerstitium orchestrates the clinical effects of volume control, electrolyte and acid–base balance, medication and toxin secretion, hormone production, immunological and inflammatory processes, and tubular repair processes. These important interconnected processes within the tubulointerstitial compartment that are independent of glomerular filtration require an intact tubulointerstitium to achieve optimal kidney function. When cellular injury occurs due to toxic, oxidative, inflammatory, and other insults and the repair processes to address this damage are incomplete, absent or untoward, acute and chronic tubulointerstitial disease develops. Direct tubular injury and deleterious inflammatory processes play important roles in tubulointerstitial nephritis. Over time, tubular atrophy, interstitial fibrosis and eventually glomerulosclerosis occurs. It is therefore not surprising that various forms of injury in this compartment can impair the previously described homeostatic processes.</div></div>","PeriodicalId":72096,"journal":{"name":"Advances in kidney disease and health","volume":"32 4","pages":"Pages 319-322"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050717","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}

引用次数: 0

Sex-Based Disparities in Acute Kidney Injury 急性肾损伤的性别差异

IF 2.6

Advances in kidney disease and health Pub Date : 2025-05-01 DOI: 10.1053/j.akdh.2024.11.005

Rolando Claure-Del Granado , Sally Neugarten , Ladan Golestaneh

{"title":"Sex-Based Disparities in Acute Kidney Injury","authors":"Rolando Claure-Del Granado , Sally Neugarten , Ladan Golestaneh","doi":"10.1053/j.akdh.2024.11.005","DOIUrl":"10.1053/j.akdh.2024.11.005","url":null,"abstract":"<div><div>Sex-based disparities in acute kidney injury are related to differential access to diagnostic tests, testing thresholds, and nonharmonized data collection and acute kidney injury reporting across the globe. Differential exposure to acute kidney injury risk factors and sex-based social risk and discrimination, affect accurate acute kidney injury reporting. In animal models of acute kidney injury, males are at consistently higher risk likely driven by hormonal, genetic, and epigenetic factors. Female protection generally wanes in older animals; however, in humans, the risk of acute kidney injury is more difficult to describe because of inconsistent definitions, inconsistent statistical and reporting techniques, and lack of sex-stratified gold standard tests. Hospital-acquired, including acute kidney injury requiring dialysis, and community-acquired acute kidney injury studies show a higher propensity among men, except for certain specific circumstances. The recent use of standardized acute kidney injury definitions and careful comorbidity adjustment has debunked the notion that women are at higher acute kidney injury risk as reported in past studies referencing certain clinical scenarios. The heterogeneity of epidemiologic reports from around the world does not allow for reliable inferences about sex-based acute kidney injury risk. In this review we present a summary of the greater literature on biologic drivers of acute kidney injury sex differences and the various complexities involved in describing epidemiologic sex-based acute kidney injury patterns.</div></div>","PeriodicalId":72096,"journal":{"name":"Advances in kidney disease and health","volume":"32 3","pages":"Pages 221-228"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842920","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}

引用次数: 0