Pub Date : 2024-06-18DOI: 10.1038/s41581-024-00851-z
Vidya A. Fleetwood, Krista L. Lentine
Kidneys from older donors might improve the quality of life and survival of patients with kidney failure, yet these organs are often underutilized. Re-framing discussions of organ acceptance from older donors and its benefits over dialysis, especially for older patients and those who cannot tolerate prolonged waiting for transplantation, is urgently needed.
{"title":"Unlocking the benefits of transplantation with kidneys from older donors","authors":"Vidya A. Fleetwood, Krista L. Lentine","doi":"10.1038/s41581-024-00851-z","DOIUrl":"10.1038/s41581-024-00851-z","url":null,"abstract":"Kidneys from older donors might improve the quality of life and survival of patients with kidney failure, yet these organs are often underutilized. Re-framing discussions of organ acceptance from older donors and its benefits over dialysis, especially for older patients and those who cannot tolerate prolonged waiting for transplantation, is urgently needed.","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"20 9","pages":"562-563"},"PeriodicalIF":28.6,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141419907","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}
Pub Date : 2024-06-18DOI: 10.1038/s41581-024-00857-7
Katarina Zeder, Edward D. Siew, Gabor Kovacs, Evan L. Brittain, Bradley A. Maron
Pulmonary hypertension (PH) is common in patients with chronic kidney disease (CKD) or kidney failure, with an estimated prevalence of up to 78% in those referred for right-heart catheterization. PH is independently associated with adverse outcomes in CKD, raising the possibility that early detection and appropriate management of PH might improve outcomes in at-risk patients. Among patients with PH, the prevalence of CKD stages 3 and 4 is estimated to be as high as 36%, and CKD is also independently associated with adverse outcomes. However, the complex, heterogenous pathophysiology and clinical profile of CKD–PH requires further characterization. CKD is often associated with elevated left ventricular filling pressure and volume overload, which presumably leads to pulmonary vascular stiffening and post-capillary PH. By contrast, a distinct subgroup of patients at high risk is characterized by elevated pulmonary vascular resistance and right ventricular dysfunction in the absence of pulmonary venous hypertension, which may represent a right-sided cardiorenal syndrome defined in principle by hypervolaemia, salt avidity, low cardiac output and normal left ventricular function. Current understanding of CKD–PH is limited, despite its potentially important ramifications for clinical decision making. In particular, whether PH should be considered when determining the suitability and timing of kidney replacement therapy or kidney transplantation is unclear. More research is urgently needed to address these knowledge gaps and improve the outcomes of patients with or at risk of CKD–PH. In this Review, the authors discuss potential pathophenotypes of coexisting chronic kidney disease and pulmonary hypertension, discuss the principles of clinical management of patients with chronic kidney disease or kidney failure and pulmonary hypertension, and outline key areas for further research.
{"title":"Pulmonary hypertension and chronic kidney disease: prevalence, pathophysiology and outcomes","authors":"Katarina Zeder, Edward D. Siew, Gabor Kovacs, Evan L. Brittain, Bradley A. Maron","doi":"10.1038/s41581-024-00857-7","DOIUrl":"10.1038/s41581-024-00857-7","url":null,"abstract":"Pulmonary hypertension (PH) is common in patients with chronic kidney disease (CKD) or kidney failure, with an estimated prevalence of up to 78% in those referred for right-heart catheterization. PH is independently associated with adverse outcomes in CKD, raising the possibility that early detection and appropriate management of PH might improve outcomes in at-risk patients. Among patients with PH, the prevalence of CKD stages 3 and 4 is estimated to be as high as 36%, and CKD is also independently associated with adverse outcomes. However, the complex, heterogenous pathophysiology and clinical profile of CKD–PH requires further characterization. CKD is often associated with elevated left ventricular filling pressure and volume overload, which presumably leads to pulmonary vascular stiffening and post-capillary PH. By contrast, a distinct subgroup of patients at high risk is characterized by elevated pulmonary vascular resistance and right ventricular dysfunction in the absence of pulmonary venous hypertension, which may represent a right-sided cardiorenal syndrome defined in principle by hypervolaemia, salt avidity, low cardiac output and normal left ventricular function. Current understanding of CKD–PH is limited, despite its potentially important ramifications for clinical decision making. In particular, whether PH should be considered when determining the suitability and timing of kidney replacement therapy or kidney transplantation is unclear. More research is urgently needed to address these knowledge gaps and improve the outcomes of patients with or at risk of CKD–PH. In this Review, the authors discuss potential pathophenotypes of coexisting chronic kidney disease and pulmonary hypertension, discuss the principles of clinical management of patients with chronic kidney disease or kidney failure and pulmonary hypertension, and outline key areas for further research.","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"20 11","pages":"742-754"},"PeriodicalIF":28.6,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141419906","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}
Pub Date : 2024-06-17DOI: 10.1038/s41581-024-00860-y
Yasumichi Arai, Motoko Yanagita
Centenarians — who are a putative model of healthy longevity — often have a low risk of cardiovascular disease, despite an age-associated decline in kidney function. An understanding of the molecular and cellular underpinnings of health kidney ageing in centenarians may provide clues for the prevention or alleviation of the burden of kidney disease in older populations.
{"title":"Healthy ageing and the kidney — lessons from centenarians","authors":"Yasumichi Arai, Motoko Yanagita","doi":"10.1038/s41581-024-00860-y","DOIUrl":"10.1038/s41581-024-00860-y","url":null,"abstract":"Centenarians — who are a putative model of healthy longevity — often have a low risk of cardiovascular disease, despite an age-associated decline in kidney function. An understanding of the molecular and cellular underpinnings of health kidney ageing in centenarians may provide clues for the prevention or alleviation of the burden of kidney disease in older populations.","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"20 9","pages":"558-559"},"PeriodicalIF":28.6,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141333552","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}
Pub Date : 2024-06-12DOI: 10.1038/s41581-024-00849-7
Paula Unger Avila, Tsimafei Padvitski, Ana Carolina Leote, He Chen, Julio Saez-Rodriguez, Martin Kann, Andreas Beyer
The precise control of gene expression is required for the maintenance of cellular homeostasis and proper cellular function, and the declining control of gene expression with age is considered a major contributor to age-associated changes in cellular physiology and disease. The coordination of gene expression can be represented through models of the molecular interactions that govern gene expression levels, so-called gene regulatory networks. Gene regulatory networks can represent interactions that occur through signal transduction, those that involve regulatory transcription factors, or statistical models of gene–gene relationships based on the premise that certain sets of genes tend to be coexpressed across a range of conditions and cell types. Advances in experimental and computational technologies have enabled the inference of these networks on an unprecedented scale and at unprecedented precision. Here, we delineate different types of gene regulatory networks and their cell-biological interpretation. We describe methods for inferring such networks from large-scale, multi-omics datasets and present applications that have aided our understanding of cellular ageing and disease mechanisms. Perturbations in the regulation of gene expression can contribute to disease- and ageing-associated changes in cell physiology. This review describes how the coordination of gene expression within and between cells can be represented through models of the molecular interactions that govern gene expression levels, and how such models can be used to understand age-associated changes in cell physiology.
{"title":"Gene regulatory networks in disease and ageing","authors":"Paula Unger Avila, Tsimafei Padvitski, Ana Carolina Leote, He Chen, Julio Saez-Rodriguez, Martin Kann, Andreas Beyer","doi":"10.1038/s41581-024-00849-7","DOIUrl":"10.1038/s41581-024-00849-7","url":null,"abstract":"The precise control of gene expression is required for the maintenance of cellular homeostasis and proper cellular function, and the declining control of gene expression with age is considered a major contributor to age-associated changes in cellular physiology and disease. The coordination of gene expression can be represented through models of the molecular interactions that govern gene expression levels, so-called gene regulatory networks. Gene regulatory networks can represent interactions that occur through signal transduction, those that involve regulatory transcription factors, or statistical models of gene–gene relationships based on the premise that certain sets of genes tend to be coexpressed across a range of conditions and cell types. Advances in experimental and computational technologies have enabled the inference of these networks on an unprecedented scale and at unprecedented precision. Here, we delineate different types of gene regulatory networks and their cell-biological interpretation. We describe methods for inferring such networks from large-scale, multi-omics datasets and present applications that have aided our understanding of cellular ageing and disease mechanisms. Perturbations in the regulation of gene expression can contribute to disease- and ageing-associated changes in cell physiology. This review describes how the coordination of gene expression within and between cells can be represented through models of the molecular interactions that govern gene expression levels, and how such models can be used to understand age-associated changes in cell physiology.","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"20 9","pages":"616-633"},"PeriodicalIF":28.6,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141308941","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}
Pub Date : 2024-06-07DOI: 10.1038/s41581-024-00859-5
Vallabh O. Shah, Tassy Parker, Giselle Rodriguez de Sosa, Mark L. Unruh
American Indian and Alaska Native peoples have low life expectancy and a disproportionate disease burden (including of chronic kidney disease), owing to inadequate education, poverty, discrimination and underfunding in the delivery of health services, and healthcare institutions’ lack of appreciation for cultural differences. These broad quality-of-life issues are rooted in economic adversity and poor social conditions.
{"title":"Chronic kidney disease in American Indians and Alaska Natives","authors":"Vallabh O. Shah, Tassy Parker, Giselle Rodriguez de Sosa, Mark L. Unruh","doi":"10.1038/s41581-024-00859-5","DOIUrl":"10.1038/s41581-024-00859-5","url":null,"abstract":"American Indian and Alaska Native peoples have low life expectancy and a disproportionate disease burden (including of chronic kidney disease), owing to inadequate education, poverty, discrimination and underfunding in the delivery of health services, and healthcare institutions’ lack of appreciation for cultural differences. These broad quality-of-life issues are rooted in economic adversity and poor social conditions.","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"20 8","pages":"487-488"},"PeriodicalIF":28.6,"publicationDate":"2024-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141287140","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}
Pub Date : 2024-06-04DOI: 10.1038/s41581-024-00858-6
Sabine H. Josemans, Lucas Lindeboom, Karin G. F. Gerritsen, Fokko P. Wieringa, Jeroen P. Kooman, Joris I. Rotmans
The increasing prevalence of chronic kidney disease (CKD) is placing a growing burden on healthcare systems, which results in considerable economic and environmental challenges. Sustainable CKD care and optimization of patient outcomes requires a new approach to the organization of healthcare systems, in which home monitoring will have a pivotal role.
{"title":"Home monitoring of patients with chronic kidney disease","authors":"Sabine H. Josemans, Lucas Lindeboom, Karin G. F. Gerritsen, Fokko P. Wieringa, Jeroen P. Kooman, Joris I. Rotmans","doi":"10.1038/s41581-024-00858-6","DOIUrl":"10.1038/s41581-024-00858-6","url":null,"abstract":"The increasing prevalence of chronic kidney disease (CKD) is placing a growing burden on healthcare systems, which results in considerable economic and environmental challenges. Sustainable CKD care and optimization of patient outcomes requires a new approach to the organization of healthcare systems, in which home monitoring will have a pivotal role.","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"20 8","pages":"491-492"},"PeriodicalIF":28.6,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141248206","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}
Pub Date : 2024-06-03DOI: 10.1038/s41581-024-00852-y
Andrew D. Rule, Richard J. Glassock
The use of cystatin C-inclusive equations will continue to propagate the unnecessary overdiagnosis of chronic kidney disease (CKD) in older people. Cystatin C is less biologically specific for CKD than is serum creatinine, inflates the risks of adverse outcomes compared to measured glomerular filtration rate, and does not establish chronicity at a single time point.
使用包含胱抑素 C 的方程将继续助长对老年人慢性肾病（CKD）不必要的过度诊断。与血清肌酐相比，胱抑素 C 对慢性肾脏病的生物特异性较差，与测量的肾小球滤过率相比，胱抑素 C 会增加不良后果的风险，而且不能在单一时间点确定慢性肾脏病。
{"title":"Cystatin C and the misdiagnosis of CKD in older adults","authors":"Andrew D. Rule, Richard J. Glassock","doi":"10.1038/s41581-024-00852-y","DOIUrl":"10.1038/s41581-024-00852-y","url":null,"abstract":"The use of cystatin C-inclusive equations will continue to propagate the unnecessary overdiagnosis of chronic kidney disease (CKD) in older people. Cystatin C is less biologically specific for CKD than is serum creatinine, inflates the risks of adverse outcomes compared to measured glomerular filtration rate, and does not establish chronicity at a single time point.","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"20 9","pages":"560-561"},"PeriodicalIF":28.6,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141235950","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}
Pub Date : 2024-05-31DOI: 10.1038/s41581-024-00855-9
Ellen F. Carney
{"title":"Mutational signatures of ccRCC vary between geographical regions","authors":"Ellen F. Carney","doi":"10.1038/s41581-024-00855-9","DOIUrl":"10.1038/s41581-024-00855-9","url":null,"abstract":"","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"20 7","pages":"429-429"},"PeriodicalIF":28.6,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141182433","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：