American Journal of Kidney Diseases最新文献

{"title":"Role of Chimeric Antigen Receptor-Expressing Cell Therapy in Immune-Mediated Kidney Diseases: A Review.","authors":"Jiawen Peng, Yuemiao Zhang, Jingyu Wang, Hong Zhang, Georg Schett","doi":"10.1053/j.ajkd.2025.04.012","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.04.012","url":null,"abstract":"<p><p>Immune-mediated kidney diseases are characterized by an adaptive immune response directed against various self-antigens. B cells, as progenitors of autoantibody-producing plasma cells and as antigen-presenting cells, play a crucial role in the pathogenesis of these diseases. Despite significant advancements in B-cell-targeting therapies, relapses are common among patients. Evidence of insufficient B-cell depletion by monoclonal antibodies such as rituximab, and the inability to deplete plasma cells, suggest that a more robust and complete B-cell depletion may be necessary for immune-mediated kidney diseases. Chimeric antigen receptor (CAR)-expressing cell therapy has emerged as a promising option. In this approach, immune cells like T cells are genetically engineered to recognize specific markers on B cells. By leveraging T cells' natural ability to infiltrate tissues and their high-affinity target binding, this method enables a deeper clearance of B cells than is usually observed with B-cell depleting monoclonal antibodies. This review explores the potential of using B-cell depleting CAR-expressing cell therapy in the treatment of immune-mediated kidney diseases.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245732","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":"Association of Volume Overload With Kidney Function Outcomes Among Patients With Acute Decompensated Heart Failure.","authors":"Amanda I Moises, Hocine Tighiouart, Jeffrey M Testani, Marcelle Tuttle, Run Banlengchit, Tatsufumi Oka, Ki Jung Lee, Katie Ferguson, Hannah Sarnak, Callum Harding, Michael S Kiernan, Mark J Sarnak, Wendy McCallum","doi":"10.1053/j.ajkd.2025.03.026","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.03.026","url":null,"abstract":"<p><strong>Rationale & objective: </strong>Reduced kidney function, as evaluated by estimated glomerular filtration rate (eGFR), is a powerful risk factor for adverse outcomes among patients with decompensated heart failure (ADHF). However, evidence that volume overload is a risk factor for declines in eGFR has been inconsistent. This study examined this association among adults with ADHF.</p><p><strong>Study design: </strong>Retrospective observational study.</p><p><strong>Setting & participants: </strong>Adult patients admitted to a quaternary referral hospital for a primary diagnosis of ADHF requiring right heart catheterization between 2015 and 2021.</p><p><strong>Exposures: </strong>Initial central venous pressure (CVP), pulmonary capillary wedge pressure (PCWP), and change in CVP and PCWP.</p><p><strong>Outcomes: </strong>EGFR when CVP and/or PCWP monitoring began, in-hospital eGFR slope, and initiation of dialysis through March 2022.</p><p><strong>Analytical approach: </strong>Restricted cubic splines and linear mixed models to examine the association of CVP and PCWP with baseline eGFR and in-hospital eGFR slope. Cox proportional hazard regression models were used to examine the association of CVP, PCWP, and changes in CVP and PCWP with initiation of dialysis. Sensitivity analyses treated death as a competing risk.</p><p><strong>Results: </strong>Among 753 patients, higher CVP and PCWP were significantly associated with lower eGFR (β [95%CI]: -5.01 [-6.68, -3.35] and -2.84 [-4.55, -1.13] ml/min/1.73m² per 1 SD higher CVP and PCWP, respectively), and lower in-hospital eGFR slope (-1.13 [-1.57, -0.69] and -0.59 [-1.02, -0.15] ml/min/1.73 m²/week per 1 SD higher). Over a median of 33 (IQR 13, 58) months, 62 (8.2%) required dialysis and 264 (35.1%) died. Higher CVP and PCWP were associated with increased risk for dialysis: aHR (95%CI) per 1 SD higher CVP was 1.49 (1.17, 1.90) and PCWP 1.30 (1.04, 1.62). Associations remained consistent when treating death before dialysis as a competing risk. Change in CVP and PCWP were not associated with concomitantly assessed eGFR or risk of dialysis.</p><p><strong>Limitations: </strong>Observational design.</p><p><strong>Conclusions: </strong>Volume overload was associated with lower baseline kidney function, greater declines in eGFR, and increased risk of starting dialysis. Changes in the degree of volume overload were not associated with concomitantly assessed changes in eGFR or the risk of dialysis over follow-up.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245729","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":"Association of Ideal Cardiovascular Health Score and Cardiovascular-Kidney Outcomes in Young Adults.","authors":"Hyeok-Hee Lee, Jong Hyun Jhee, Eun-Jin Kim, Dasom Son, Hyeon Chang Kim, Donald M Lloyd-Jones, Hokyou Lee","doi":"10.1053/j.ajkd.2025.03.024","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.03.024","url":null,"abstract":"<p><strong>Rationale & objective: </strong>The linkage between cardiovascular disease (CVD) and kidney disease and the importance of promoting cardiovascular health (CVH) to prevent them are increasingly recognized. This study investigated the associations of ideal CVH and its longitudinal change with cardiovascular-kidney outcomes in young adults.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Setting & participants: </strong>From nationwide health screening data, we identified adults aged 20-39 without prior CVD or kidney disease who underwent baseline health examinations in 2009-2010 (N=3,836,626).</p><p><strong>Exposures: </strong>Using a modified American Heart Association's Life's Simple 7 construct excluding dietary data, participants were categorized according to the number of ideal CVH score components they met. Participants who underwent follow-up health examinations between 2011 and 2014 (N=2,728,675) were additionally categorized by the combination of baseline and follow-up CVH scores.</p><p><strong>Outcome: </strong>A composite of a cardiovascular or kidney event. Cardiovascular events included myocardial infarction, ischemic stroke, heart failure, and death from CVD. Kidney event included incident chronic kidney disease, kidney replacement therapy, and death from kidney disease.</p><p><strong>Analytical approach: </strong>Cause-specific proportional hazards model.</p><p><strong>Results: </strong>During a median follow-up of 12.1 years, 134,317 composite cardiovascular or kidney events occurred. Multivariable-adjusted risk of the event decreased stepwise with higher CVH scores (for a CVH score of 6 vs. 0: HR 0.32 [95% CI, 0.30-0.34]). An increase in CVH score from baseline (2009-2010) to follow-up (2011-2014) examination was associated with lower risk of an event (HR 0.86 [95% CI, 0.86-0.87] per +1 CVH score change). Moreover, the risk was lower in participants who maintained high CVH scores at both baseline and follow-up examinations than in those who newly achieved a high CVH score at follow-up examination (HR 0.87 [95% CI, 0.86-0.87] per +1 baseline CVH score).</p><p><strong>Limitations: </strong>Diet data were not included in CVH score.</p><p><strong>Conclusions: </strong>In young adults, achieving and maintaining high CVH were associated with reduced risk of cardiovascular-kidney outcomes.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245728","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":"Challenges of Vaccine-Induced Thrombotic Thrombocytopenia-Related Kidney Transplantation: Venous Graft Thrombosis in a Pediatric Recipient.","authors":"Marvin Droste, Leonie Kubitza, Jan Wesche, Stefanie Jeruschke, Michael Berger, Moritz Kaths, Hideo A Baba, Andreas Greinacher, Lars Pape, Thomas Thiele, Anja K Büscher","doi":"10.1053/j.ajkd.2025.03.025","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.03.025","url":null,"abstract":"<p><p>During the COVID-19 pandemic, adenoviral vaccines drew attention due to a potential life-threatening coagulation disorder, the vaccine-induced immune thrombotic thrombocytopenia (VITT). Patients deceased of VITT have been accepted as organ donors despite safety concerns regarding the transmission of VITT to recipients. The outcome of adult kidney graft recipients was reported favorable in most cases, however, (thrombotic) complications were observed more frequently. We present two pediatric recipients of kidney grafts from VITT-deceased patients. Both donors (38 and 34 years old, male, body mass index each 23 kg/m²) experienced VITT-related symptoms 22 and 12 days after first dose of Vaxrevia® and Vaccine Janssen®, respectively. Neither had a prior history of other prothrombotic conditions (e.g., history of smoking, arterial hypertension, or prior thrombosis). The graft function was excellent for up to 36 months in the recipient in Case 1 (14-year-old girl, hemodialysis, kidney failure caused by methylmalonic acidemia). However, the recipient in Case 2 (4-year-old boy, peritoneal dialysis, kidney failure caused by abnormal urethral valves) experienced immediate and recurrent renal vein thrombosis. Histopathology of the explanted organ revealed extended platelet-enriched thrombus formation. VITT-causing antibodies against platelet factor 4 were detected in the organ perfusate of both allografts during cold storage with significantly higher concentrations in the latter patient. Our findings emphasize the need for careful evaluation of donor organs from VITT-deceased patients especially in high-risk patients, such as young children.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245730","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":"Native American Ancestry and Susceptibility to Mesoamerican Nephropathy.","authors":"Yuka Sato, Joseph Yracheta, Carlos Roncal, Amy Li, Richard J Johnson","doi":"10.1053/j.ajkd.2025.05.003","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.05.003","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245731","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":"Giving Grace.","authors":"Alan Finkelstein","doi":"10.1053/j.ajkd.2025.03.015","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.03.015","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186207","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":"Erratum regarding the National Kidney Foundation 2025 Spring Clinical Meeting Abstracts (Am J Kid Dis. 2025;85(4S1):S1-S192)","authors":"","doi":"10.1053/j.ajkd.2025.04.005","DOIUrl":"10.1053/j.ajkd.2025.04.005","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 6","pages":"Page 806"},"PeriodicalIF":9.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144105323","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":"Pretty Outside, Ugly Inside—A Patient With Refractory Hypercalcemia: A Quiz","authors":"Paavana Varanasi ,&nbsp;Evamaria Anvari","doi":"10.1053/j.ajkd.2024.10.016","DOIUrl":"10.1053/j.ajkd.2024.10.016","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 6","pages":"Pages A14-A16"},"PeriodicalIF":9.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144105385","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":"Sex Inequities in Kidney Transplantation: A Persistent and Multifaceted Challenge","authors":"Priti Meena ,&nbsp;Silvi Shah","doi":"10.1053/j.ajkd.2025.04.007","DOIUrl":"10.1053/j.ajkd.2025.04.007","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 1","pages":"Pages 7-9"},"PeriodicalIF":9.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144114232","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":"Understanding Rare Kidney Stone Diseases: A Review.","authors":"Michelle A Baum,Mallory Mandel,Michael Jg Somers","doi":"10.1053/j.ajkd.2025.03.023","DOIUrl":"https://doi.org/10.1053/j.ajkd.2025.03.023","url":null,"abstract":"Rare kidney stone diseases typically present with nephrolithiasis or nephrocalcinosis in childhood or adolescence. Affected individuals might face kidney injury and even kidney failure related to associated complications. Screening blood and urine tests recommended for patients with nephrolithiasis/nephrocalcinosis help guide further evaluation, and the increased availability and decreased costs of genetic testing can facilitate the diagnosis of hereditary stone conditions. Genetic testing should be considered when there are clinical clues of an increased likelihood of an inherited condition such as consanguinity, nephrolithiasis in young children, nephrolithiasis in multiple family members, repeated episodes of nephrolithiasis, or kidney failure with nephrolithiasis or nephrocalcinosis. Adult and pediatric nephrologists and urologists should have a basic understanding of monogenic rare kidney stone diseases and their associated diagnoses, treatments, and complications. In many disorders, early detection allows for the initiation of tailored therapies that may alter the natural history of the disease, preserve kidney function, and modify extra renal manifestations.","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"8 1","pages":""},"PeriodicalIF":13.2,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144087542","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}