American Journal of Kidney Diseases最新文献

{"title":"Intensive Home Blood Pressure Lowering in Patients with Advanced CKD.","authors":"Elaine Ku,Timothy P Copeland,Charles E McCulloch,Divya Seth,Christopher A Carlos,Kerry Cho,Anna Malkina,Lowell J Lo,Raymond K Hsu","doi":"10.1053/j.ajkd.2024.08.010","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.08.010","url":null,"abstract":"RATIONALE & OBJECTIVEOptimal blood pressure (BP) targets in advanced CKD are controversial. More intensive BP lowering in the setting of advanced CKD is thought to be associated with risk of acute kidney injury, hyperkalemia, and ESKD. We aimed to conduct a pilot trial of intensive BP control to determine if lower SBP targets can be safely achieved for patients with CKD through titration of BP medications using in-home measured BP.STUDY DESIGNNon-blinded randomized controlled trial.SETTINGS & PARTICIPANTS108 patients with advanced CKD (eGFR ≤30 mL/min/1.73 m2) and hypertension.INTERVENTIONSParticipants were randomized either to a target home SBP goal of <120 mmHg (N=66) or a less intensive SBP goal (N=42). Antihypertensive medications were titrated to achieve the target home SBP range in the first 4 months of the study and maintained until the end of the study. Home BP was measured using a wireless Bluetooth-enabled monitor that transmitted readings to providers in real-time.OUTCOMESThe primary efficacy outcome was the difference in achieved clinic SBP between the two study arms from months 4-12. Safety outcomes included hyperkalemia, a composite outcome of falls or syncope, and onset of need for dialysis or kidney transplantation.RESULTSThe mean clinic SBP at month 12 was 124.7 mmHg in the intensive SBP group vs. 138.2 mmHg in the less intensive SBP group. Averaged over months 4-12, the achieved mean clinic SBP in the intensive SBP arm was 11.7 mmHg (95% CI 7.5 to 16 mmHg, p<0.001) lower than the mean SBP achieved in the less intensive SBP arm. Primary safety outcomes were not statistically significantly different between the two arms (all p>0.05).LIMITATIONSSmall sample size which may limit our ability to detect clinically significant differences in rates of adverse outcomes; single-center design.CONCLUSIONSA clinic SBP goal of <120 mmHg is feasible to achieve with the help of real-time home BP monitoring and appears to be safe in this study population with advanced CKD. Larger trials to determine optimal BP targets in advanced CKD and the risks and benefits associated with more intensive BP control are warranted.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"124 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142486321","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":"Three Cases of Red Yeast Rice-Containing Supplement-Induced Acute Kidney Injury and Fanconi Syndrome.","authors":"Ayako Chikasue,Kensei Taguchi,Ryuji Iwatani,Koki Kimura,Seiya Okuda,Noriko Uesugi,Kei Fukami","doi":"10.1053/j.ajkd.2024.08.007","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.08.007","url":null,"abstract":"Japan has recently faced a public health crisis owing to \"Beni Koji Choleste Help,\" a product marketed as a dietary supplement. It is made from red yeast rice and has cholesterol-lowering effects. Following the identification of the first case of acute kidney injury (AKI) caused by the product, 76 possibly related deaths and 492 hospitalizations have been reported in Japan. We herein demonstrate three cases of AKI with renal tubular acidosis and Fanconi syndrome following consumption of the product for 2 weeks to 7 months. Kidney biopsy revealed diffuse tubular injury, tubular cell flattening, loss of brush border, sparse debris, and cast formation containing periodic acid-Schiff- and silver stain-positive fluffy material in the tubular lumens with interstitial cell infiltration, together with mild fibrosis. Electron microscopy revealed fluffy materials in the tubular lumen surrounded by necrotic tubular cell debris and intracellular contents. Discontinuation of the supplement and the treatment with prednisolone improved kidney function and Fanconi syndrome. Longitudinal monitoring and surveys are required to detect and prevent the progression to chronic kidney disease in people who have consumed \"Beni Koji Choleste Help.\"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"13 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451443","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":"Treatment of Autosomal Dominant Polycystic Kidney Disease.","authors":"Sara S Jdiaa,Reem A Mustafa,Alan S L Yu","doi":"10.1053/j.ajkd.2024.08.008","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.08.008","url":null,"abstract":"Autosomal dominant polycystic kidney disease (ADPKD) is a chronic systemic disease that affects all races and ethnicities. It is the fourth leading cause of end-stage kidney disease, and it has a heterogenous phenotype ranging from mild to severe disease. Identifying patients with ADPKD who are at risk of rapid progression can guide therapeutic decisions. Several tools to predict disease severity are available, based on features such as total kidney volume from magnetic resonance imaging, PKD genotype, eGFR trajectory, and the occurrence of hypertension and urologic complications early in life. Over the past decade, more evidence has emerged regarding optimal ADPKD management. The HALT PKD trial supported intensive blood pressure control in patients younger than 50 years of age with preserved kidney function. A healthy lifestyle, including maintaining a healthy weight, salt restriction and smoking cessation, is likely to be beneficial. Tolvaptan, the only disease-modifying agent for ADPKD patients that are at risk of rapid progression, is gaining wider use, but is still limited by its side-effects. This is an exciting time for the ADPKD community as multiple promising interventions are in the pipeline and being investigated.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"2 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451444","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":"Biomarkers of Rejection in Kidney Transplantation.","authors":"Scott G Westphal,Roslyn B Mannon","doi":"10.1053/j.ajkd.2024.07.018","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.07.018","url":null,"abstract":"Alloimmune injury is a major cause of long-term kidney allograft failure whether due to functionally stable (subclinical) or overt clinical rejection. These episodes may be mediated by immune cells (cellular rejection) or alloantibody (antibody-mediated rejection). Early recognition of immune injury is needed for timely appropriate intervention to maintain graft functional viability. However, the conventional measure of kidney function (i.e., serum creatinine) is insufficient for immune monitoring due to limited sensitivity and specificity for rejection. As a result, there is need for biomarkers that more sensitively detect the immune response to the kidney allograft. Recently, several biomarkers have been clinically implemented into the care of kidney transplant recipients. These biomarkers attempt to achieve multiple goals including (1) more sensitive detection of clinical and subclinical rejection, (2) predicting impending rejection, (3) monitoring for the adequacy of treatment response, and (4) facilitating personalized immunosuppression. In this review, we summarize the findings to date in commercially available biomarkers, along with biomarkers approaching clinical implementation. While we discuss the analytical and clinical validity of these biomarkers, we identify the challenges and limitations to widespread biomarker use, including the need for biomarker-guided prospective studies to establish evidence of clinical utility of these new assays.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"59 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142449332","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":"Blood Pressure Control and the Prevention of Incident CKD: The Disconnect Between Cohort Studies and Randomized Trials","authors":"Rajiv Agarwal","doi":"10.1053/j.ajkd.2024.07.006","DOIUrl":"10.1053/j.ajkd.2024.07.006","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"84 6","pages":"Pages 667-669"},"PeriodicalIF":9.4,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142436113","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":"Why Symptom Burden in Non-Dialysis CKD Matters","authors":"Meike Shedden-Mora ,&nbsp;Birte Jessen ,&nbsp;Tobias B. Huber","doi":"10.1053/j.ajkd.2024.07.005","DOIUrl":"10.1053/j.ajkd.2024.07.005","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"84 6","pages":"Pages 672-674"},"PeriodicalIF":9.4,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142436019","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":"Viral Nephropathies: Core Curriculum 2024","authors":"Amy A. Yau ,&nbsp;Sangeetha Murugapandian ,&nbsp;Ali W. Rizvi ,&nbsp;Anna Gaddy","doi":"10.1053/j.ajkd.2024.06.014","DOIUrl":"10.1053/j.ajkd.2024.06.014","url":null,"abstract":"<div><div>Viral-associated nephropathy is when kidney disease results from active viral replication. Because of the high global burden of viral infections, clinicians should be aware of their incidence, kidney manifestations, mechanism of injury, and management. Some viruses, such as hepatitis B, hepatitis C, human immunodeficiency virus (HIV), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can lead to nephropathy more commonly than other endemic viruses, such as Epstein-Barr virus, cytomegalovirus, and polyoma virus which are more important causes of nephropathy in the immunosuppressed patient. Other viruses, such as hantavirus and dengue virus, have a high global infectivity rate with rare but severe kidney manifestations. Advances over the past decades have offered us a better understanding of the pathogenesis of viral-associated nephropathies and antiviral therapy options. The patterns of kidney injury include glomerular and tubulointerstitial lesions in the setting of acute and chronic infection. Direct viral infection of kidney parenchymal cells may drive pathologic findings, but kidney pathology may also result from indirect mechanisms due to activation of the innate and adaptive immune system. Some viruses can cause kidney injury due to altered hemodynamics from liver dysfunction or shock. More information about the role of genetics, specifically <em>APOL1</em> polymorphisms, has come to light in regard to HIV-associated nephropathy and SARS-CoV-2–associated nephropathy. Advances in antiviral therapy help reduce nephrotoxicity and improve morbidity and mortality. In this Core Curriculum, we review common viruses responsible for kidney disease worldwide, discuss mechanisms of pathogenesis, and highlight specific management principles of viral nephropathies. We also discuss other viruses with high endemicity despite low incidence of kidney disease in the immunocompetent and immunosuppressed host.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"84 6","pages":"Pages 767-779"},"PeriodicalIF":9.4,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142455778","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":"The OPTN Expeditious Task Force: Improved Organ Utilization and Efficiency to Drive Transformational Growth in Solid Organ Transplant in the United States.","authors":"Alden Doyle, David Marshman","doi":"10.1053/j.ajkd.2024.07.015","DOIUrl":"10.1053/j.ajkd.2024.07.015","url":null,"abstract":"<p><p>The Organ Procurement and Transplant Network (OPTN) Expeditious Task Force (ETF) was conceived and initiated in response to a need to move quickly to greatly expand successful deceased-donor transplant across the United States. The ETF, using data from the top 20% of transplant programs ranked by ability to manage successful growth in transplant volume, came up with a bold aim of facilitating 60,000 successful transplants by 2026 to save more lives. In order to achieve this transformational growth, the ETF will use a data-driven approach, partnering with key stakeholders across the transplant system to secure commitments, reduce barriers, obtain data, align metrics, evaluate new technologies, and run short trials that will better inform future policy developments. To achieve this growth, the 2 primary aims of the ETF are increasing system efficiency and improving organ and donor utilization. The initial ETF work streams will focus on 6 areas: (1) assessments of organ nonutilization (where donors are consented but organs not recovered) and nonuse (where organs are recovered but not transplanted), (2) facilitating community events to address challenges in utilization and efficiency, (3) hosting transplant growth collaboratives focused on securing resources needed for transformational growth, (4) creating tools for patient empowerment, (5) evaluating OPTN policies to remove barriers, and (6) designing short trials of rescue pathways for organs at risk for nonuse.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387232","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":"A Case of Severe Acute Kidney Injury Due to an Antibiotic-Loaded Cement Spacer for Infected Knee Arthroplasty.","authors":"Evan Finger, Larab Giniyani, Yevgeniy A Korshunov, Jordan L Rosenstock","doi":"10.1053/j.ajkd.2024.07.012","DOIUrl":"10.1053/j.ajkd.2024.07.012","url":null,"abstract":"<p><p>The treatment for periprosthetic joint infection frequently involves the placement of a high-dose antibiotic-loaded bone cement spacer (ALCS) into the debrided joint. Typical antibiotics in the spacer include aminoglycosides and vancomycin. It has been believed that systemic absorption of intraarticular antibiotics would be low, and early experience suggested that the risk of acute kidney injury (AKI) from ALCS was minimal. However, recent case reports and case series have suggested a risk of AKI owing to antibiotic absorption, though confounding factors are common. We report a case of severe AKI requiring hemodialysis with extremely high systemic tobramycin levels after the placement of an ALCS with increased dosing of antibiotics after previous failure to resolve a periprosthetic joint infection with a prior ALCS. There was no concomitant use of intravenous nephrotoxic antibiotics, nor were there other confounding factors. Despite dialysis, the patient needed urgent removal of the ALCS to control tobramycin levels, with subsequent resolution of the AKI. This case highlights the potentially serious nephrotoxicity of ALCSs, the importance of antibiotic type and dosing, and the value of close monitoring after ALCS placement, especially in a patient with chronic kidney disease.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142370732","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":"Urea to Treat Hyponatremia Due to Syndrome of Inappropriate Antidiuretic Hormone Secretion: A Systematic Review and Meta-Analysis.","authors":"Subhash Chander, Roopa Kumari, Abhi Chand Lohana, Zubair Rahaman, Om Parkash, Sheena Shiwlani, Yaqub Nadeem Mohammed, Hong Yu Wang, Hao Chi, Wenchy Tan, Sanjay Kirshan Kumar, Fnu Sindhu","doi":"10.1053/j.ajkd.2024.07.011","DOIUrl":"10.1053/j.ajkd.2024.07.011","url":null,"abstract":"<p><strong>Rationale & objective: </strong>The use of urea to treat hyponatremia related to the syndrome of inappropriate antidiuretic hormone secretion (SIADH) has not been universally adopted due to questions about effectiveness, safety, and tolerability. This systematic review and meta-analysis of observational studies addresses these questions.</p><p><strong>Study design: </strong>This PRISMA-guided study examined published research across 4 electronic databases.</p><p><strong>Study populations: </strong>Patients with SIADH-related hyponatremia.</p><p><strong>Selection criteria: </strong>Clinical trials and observational studies reporting at least 1 outcome related to serum sodium concentration, symptom resolution, or adverse effects after oral or nasogastric urea administration.</p><p><strong>Data extraction: </strong>Data extraction was performed independently by 2 reviewers using a standardized form recording study characteristics, participant demographics, intervention details, and treatment outcomes.</p><p><strong>Analytical approach: </strong>A meta-analysis was conducted using the restricted maximum likelihood method for the random effects model to assess the effect of urea treatment on serum sodium and serum urea compared with other treatment modalities. Subgroup analyses were conducted based on treatment duration and SIADH severity.</p><p><strong>Results: </strong>Urea treatment significantly increased serum sodium (mean difference [MD], 9.08 [95% CI, 7.64-10.52], P<0.01) and urea (MD, 31.66 [95% CI, 16.05-47.26], P<0.01) in patients with SIADH, albeit with significantly high heterogeneity. Subgroup analysis based on the treatment duration showed a significant rise in the serum sodium level after 24 hours and 2, 5, 7, and 14 days, as well as after 1 year of treatment. Greater increases in serum sodium levels after treatment with urea occurred in patients with severe (<120 mEq/L) (MD, 18.04 [95% CI, 13.68-22.39]) than with moderate (120-129 mEq/L) (MD, 7.86 [95% CI, 6.78-8.94]) or mild (130-135 mEq/L) (MD, 8.00 [95% CI, 7.31-8.69]) SIADH-induced hyponatremia. Urea treatment was comparable to fluid restriction (MD, 0.81 [95% CI, -0.93 to 2.55], P = 0.4) and vaptans (MD, -1.96 [95% CI, -4.59 to 0.66], P=0.1) but superior to no treatment (MD, 7.99 [95% CI, 6.25-9.72], P<0.01). Urea was associated with minor adverse events, with poor palatability being the most common.</p><p><strong>Limitations: </strong>As no randomized controlled trials investigating urea as a treatment for hyponatremia were identified for inclusion, these analyses were based on observational studies.</p><p><strong>Conclusions: </strong>Urea is safe and effective for managing SIADH-induced hyponatremia. These finding suggest that urea may be a useful treatment modality in resource-limited settings or when other treatments are contraindicated or poorly tolerated.</p><p><strong>Trial registration: </strong>Registered at PROSPERO with study number CRD42024511685.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142370735","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}