Seminars in nephrology最新文献

Acute kidney injury (AKI) and chronic kidney disease (CKD) are increasingly recognized as interconnected syndromes with overlapping pathophysiological mechanisms. A growing body of evidence suggests that macrophages are central regulators of the AKI-to-CKD transition, influencing both injury and repair through dynamic, microenvironment-dependent phenotypic shifts. M1-like macrophages dominate early injury responses in AKI, while M2-like macrophages can adopt a pro-fibrotic phenotype potentially contributing to the progression of CKD. Beyond this classical dichotomy, single-cell and spatial transcriptomic studies reveal a complex spectrum of macrophage states shaped by origin, tissue niche, temporal dynamics, and intercellular signaling. This review summarizes the current understanding of macrophage ontogeny, heterogeneity, and functional specialization in AKI and progression to CKD. We highlight how macrophages respond to local cues, engage in crosstalk with other cell types, and mediate phase-specific effects on inflammation and tissue remodeling. We also evaluate the consequences of macrophage depletion in AKI and the progression of AKI to CKD, highlighting divergent outcomes. Advancing our understanding of macrophage complexity is essential for developing precise immunomodulatory strategies for treating AKI and preventing CKD progression. By disentangling the context-specific roles of macrophages, future therapies can be tailored to attenuate pathogenic responses without compromising essential reparative functions, ultimately improving long-term renal outcomes. Semin Nephrol 36:x-xx © 20XX Elsevier Inc. All rights reserved.

Maintaining kidney health throughout the human lifespan remains a significant global challenge. Worldwide, an estimated 850 million people have some level of kidney disease, with many unaware because of asymptomatic progression. Whether initiated by acute or chronic insults, renal injury and disease can have life-threatening consequences requiring interventions spanning the gamut of supportive care to kidney replacement therapies. Design of precision therapeutics is likely to benefit from understanding the heterogenous cell types and states that arise in the context of kidney injury and disease. Here we review an array of cellular states that have been detected following acute ischemic kidney injury, hypothesized to promote transition to chronic kidney disease. We focused on studies describing the cellular states of the proximal tubule (PT), a segment of the nephron most vulnerable to ischemic injury. PT cells have been shown in preclinical animal studies to have a heterogeneous response to ischemic injury, including repaired and failed-repair cellular states, inter alia. We end by discussing targeting these cellular states and/or pathological processes. Semin Nephrol 36:x-xx © 20XX Elsevier Inc. All rights reserved.

Over the past 25 years, neuroimmune regulation has emerged as a compelling approach to the prevention and treatment of acute kidney injury. Vagus nerve stimulation through the cholinergic anti-inflammatory pathway can suppress inflammatory responses and demonstrate therapeutic potential in both animal disease models and a variety of human inflammatory conditions. The mechanisms underlying this neuroimmune-regulated protection are complex, but research undertaken since 2000 has significantly advanced our understanding of the key elements involved. This research has also yielded intriguing results and unexpected observations. In this review, we highlight current insights into vagus nerve-mediated neuroimmune regulation, areas of ongoing uncertainty, and promising directions for therapeutic modulation in AKI. Semin Nephrol 36:x-xx © 20XX Elsevier Inc. All rights reserved.

Acute kidney injury (AKI), a drop in kidney function with multiple etiologies, is a common complication in hospitalized patients and is associated with poorer patient outcomes. With the advent of electronic health records, machine learning algorithms have been developed that can predict the incidence and severity of AKI, AKI persistence, as well as patient outcomes like mortality and the need for kidney replacement therapies. Furthermore, it can risk-stratify patients based on early presentations to aid with clinical management. Newer technologies like natural language processing and generative artificial intelligence (AI) (e.g., ChatGPT) also show promise in the realm of AKI prediction and management. This review provides an overview of the role of AI in adults with AKI, as well as explores some limitations and ethical considerations that need to be addressed as we move forward. Semin Nephrol 36:x-xx © 20XX Elsevier Inc. All rights reserved.

Acute kidney injury (AKI) is a relatively common complication of trauma and is associated with significant morbidity and mortality in clinical studies. Given logistical and cost constraints, the majority of animal research on trauma-induced AKI is done in small animal models. However, large animal models have significant advantages from a scientific standpoint compared to small animal models because their size and anatomy are more analogous to humans. This review discusses a variety of trauma models in dogs, sheep, pigs, and nonhuman primates and the impact on AKI in several settings: hemorrhagic shock, ischemia-reperfusion injury, rhabdomyolysis, extracorporeal therapies, burns, and polytrauma.

Image analysis has played a critical role in our understanding of kidney morphology, function, and disease. This analysis has been historically limited to visualizing defined regions within the kidney in two dimensions. However, in recent years, significant advancements in microscopy have facilitated three-dimensional imaging and analysis of large tissue specimens and, in some cases, whole organs or organism. The use of these microscopy techniques combined with tissue-clearing strategies has resulted in detailed, multidimensional views of complex structures and processes within the kidney. This review discusses advanced light microscopy applications and optical clearing protocols that have been successfully modified for use in the kidney. Furthermore, this review will highlight how quantification of three-dimensional images has been applied in the kidney and thus contributed to novel spatiotemporal insights. Semin Nephrol 36:x-xx © 20XX Elsevier Inc. All rights reserved.

Acute kidney injury (AKI) continues to pose a significant clinical burden, characterized by high morbidity and mortality rates. Emerging evidence has established mitochondrial dysfunction as a central driver in the pathogenesis of AKI, encompassing deficits in bioenergetics, excessive production of reactive oxygen species, and disruption of mitochondrial dynamics. Therapeutic interventions targeting mitochondrial pathways-most notably peptide-based agents such as SS-31-have demonstrated promising results in preclinical models. Recent discoveries have identified phospholipid scramblase 3 (PLSCR3) as an essential mediator of SS-31's mitochondrial protective effects, positioning it as a novel therapeutic target. This review synthesizes current mitochondrial-directed approaches for AKI, with a particular emphasis on the mechanistic role of PLSCR3 in maintaining mitochondrial homeostasis and injury responses. Despite encouraging data, mitochondrial therapies face several translational hurdles, including limited bioavailability, challenges in establishing effective dosing regimens, incomplete mechanistic understanding, and variability in efficacy across different experimental models. Moreover, concerns regarding cost, accessibility, and long-term safety remain unresolved, contributing to inconsistent outcomes in clinical trials. Herein we evaluate the emerging role of PLSCR3 as a potentially druggable mitochondrial target, supported by recent genetic, biochemical, and in vivo evidence, and discuss translational strategies that may bridge the gap between experimental promise and clinical application. Semin Nephrol 36:x-xx © 20XX Elsevier Inc. All rights reserved.