Pub Date : 2011-06-01DOI: 10.1097/01.nep.0000399779.93032.76
M. Hogan
Deceased-donor kidneys from African-Americans with two particular gene variants failed much more quickly than those from African-Americans without the two variants, found a single-center study published in the American Journal of Transplantation (2011;11:1025-1030). These results extend to transplantation the previously reported relationship between the apolipoprotein L1 (APOL1) gene and nondiabetic nephropathy risk in this population. “The APOL1 genetic association with nondiabetic kidney failure in African-Americans is among—if not the—most powerful genetic association in any common disease,” said senior author Barry I. Freedman, MD, Professor and Chief of the Section on Nephrology at Wake Forest School of Medicine, in a phone interview. “It fully explains the excess risk of nondiabetic kidney failure in blacks compared with whites in the United States and accounts for 40 percent or so of all African-Americans on dialysis. That’s very impressive, and there are no other genes in the renal literature of this effect. “If a kidney is donated by an African-American, it does not statistically function for as long as a kidney donated by a white, so one of the questions we had was, could this have anything to do with APOL1?” Finding this relationship between APOL1 risk variants in the donor and graft survival in the recipient could mean big changes for kidney transplantation, but not just yet. “These results have to be For African-American Kidney Donors, Genetic Variants Linked to Graft Survival
发表在《美国移植杂志》(2011;11:1025-1030)上的一项单中心研究发现，患有两种特定基因变异的非裔美国人的死亡肾脏比没有这两种基因变异的非裔美国人的肾脏衰竭得更快。这些结果延伸到移植之前报道的载脂蛋白L1 (APOL1)基因与该人群非糖尿病肾病风险之间的关系。“非裔美国人的APOL1基因与非糖尿病性肾衰竭的关联，如果不是在任何常见疾病中最强大的遗传关联之一，”资深作者、维克森林医学院肾病学教授兼主任Barry I. Freedman医学博士在电话采访中说。这充分解释了美国黑人比白人患非糖尿病性肾衰竭的风险高的原因，在接受透析治疗的所有非洲裔美国人中，黑人占40%左右。这是非常令人印象深刻的，在肾脏文献中没有其他基因有这种效果。“如果一个非裔美国人捐赠的肾脏，从统计上讲，它的功能不如一个白人捐赠的肾脏长，所以我们的问题之一是，这是否与APOL1有关?”发现供体的APOL1风险变异与受体的移植存活之间的关系可能意味着肾移植的重大变化，但目前还不是时候。“对于非裔美国肾脏捐赠者来说，基因变异与移植物存活有关
{"title":"For African-American Kidney Donors, Genetic Variants Linked to Graft Survival","authors":"M. Hogan","doi":"10.1097/01.nep.0000399779.93032.76","DOIUrl":"https://doi.org/10.1097/01.nep.0000399779.93032.76","url":null,"abstract":"Deceased-donor kidneys from African-Americans with two particular gene variants failed much more quickly than those from African-Americans without the two variants, found a single-center study published in the American Journal of Transplantation (2011;11:1025-1030). These results extend to transplantation the previously reported relationship between the apolipoprotein L1 (APOL1) gene and nondiabetic nephropathy risk in this population. “The APOL1 genetic association with nondiabetic kidney failure in African-Americans is among—if not the—most powerful genetic association in any common disease,” said senior author Barry I. Freedman, MD, Professor and Chief of the Section on Nephrology at Wake Forest School of Medicine, in a phone interview. “It fully explains the excess risk of nondiabetic kidney failure in blacks compared with whites in the United States and accounts for 40 percent or so of all African-Americans on dialysis. That’s very impressive, and there are no other genes in the renal literature of this effect. “If a kidney is donated by an African-American, it does not statistically function for as long as a kidney donated by a white, so one of the questions we had was, could this have anything to do with APOL1?” Finding this relationship between APOL1 risk variants in the donor and graft survival in the recipient could mean big changes for kidney transplantation, but not just yet. “These results have to be For African-American Kidney Donors, Genetic Variants Linked to Graft Survival","PeriodicalId":380758,"journal":{"name":"Nephrology Times","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116065019","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}
Pub Date : 2011-06-01DOI: 10.1097/01.NEP.0000399781.70161.DD
T. Bunchman
{"title":"The Long and Short of Posttransplant Care","authors":"T. Bunchman","doi":"10.1097/01.NEP.0000399781.70161.DD","DOIUrl":"https://doi.org/10.1097/01.NEP.0000399781.70161.DD","url":null,"abstract":"","PeriodicalId":380758,"journal":{"name":"Nephrology Times","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121222786","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}
Pub Date : 2011-06-01DOI: 10.1097/01.NEP.0000399784.15904.40
G. Gupta, M. Atta
BK virus has emerged as an important cause of graft loss in kidney transplant recipients. While surveillance strategies have increased early detection and, consequently, reduced graft loss, achieving a delicate balance in the use of potent immunosuppression remains key to preventing acute rejection and BK virus reactivation. In the kidney transplant population, BK virus, a polyomavirus, fi rst emerged as a clinical concern only in the mid1990s, after the introduction of more potent immunosuppressive medications. A signifi cant correlation was observed between the emergence of the infection and of the immunosuppressive regimen containing lymphocytedepleting agents for induction therapy followed by maintenance with calcineurin inhibitors (CNIs) and antiproliferative agents (mycophenolate mofetil, or MMF). At the current time, though, it seems more likely that the risk of BK virus reactivation relates to the total burden of immunosuppression, not to any one drug. Although the majority of reactivation occurs in the fi rst year posttransplant, BK virus nephropathy is a well-known cause of late allograft dysfunction. Risk factors for the condition include male gender, history of acute rejection, prolonged cold ischemia time, and degree of HLA mismatch. A robust association has been demonstrated between BK virus nephropathy and recipient seronegativity at the time of transplantation, similar to the epidemiology of other opportunistic viruses— e.g., herpes viruses, Epstein-Barr virus, and cytomegalovirus. Despite this known risk, testing for BK virus serostatus is not routinely performed, probably because seropositive renal transplant recipients can also develop BK virus nephropathy. Thus, although the precise etiopathogenesis remains unclear, BK virus nephropathy likely arises from complementary determinants in the host, the allograft, and the virus, in the setting of immunosuppression. When BK virus nephropathy does occur, reported rates of graft loss have ranged from 10% to 80%.
{"title":"BK Virus Allograft Nephropathy: Unresolved Issues Complicate Diagnosis and Management","authors":"G. Gupta, M. Atta","doi":"10.1097/01.NEP.0000399784.15904.40","DOIUrl":"https://doi.org/10.1097/01.NEP.0000399784.15904.40","url":null,"abstract":"BK virus has emerged as an important cause of graft loss in kidney transplant recipients. While surveillance strategies have increased early detection and, consequently, reduced graft loss, achieving a delicate balance in the use of potent immunosuppression remains key to preventing acute rejection and BK virus reactivation. In the kidney transplant population, BK virus, a polyomavirus, fi rst emerged as a clinical concern only in the mid1990s, after the introduction of more potent immunosuppressive medications. A signifi cant correlation was observed between the emergence of the infection and of the immunosuppressive regimen containing lymphocytedepleting agents for induction therapy followed by maintenance with calcineurin inhibitors (CNIs) and antiproliferative agents (mycophenolate mofetil, or MMF). At the current time, though, it seems more likely that the risk of BK virus reactivation relates to the total burden of immunosuppression, not to any one drug. Although the majority of reactivation occurs in the fi rst year posttransplant, BK virus nephropathy is a well-known cause of late allograft dysfunction. Risk factors for the condition include male gender, history of acute rejection, prolonged cold ischemia time, and degree of HLA mismatch. A robust association has been demonstrated between BK virus nephropathy and recipient seronegativity at the time of transplantation, similar to the epidemiology of other opportunistic viruses— e.g., herpes viruses, Epstein-Barr virus, and cytomegalovirus. Despite this known risk, testing for BK virus serostatus is not routinely performed, probably because seropositive renal transplant recipients can also develop BK virus nephropathy. Thus, although the precise etiopathogenesis remains unclear, BK virus nephropathy likely arises from complementary determinants in the host, the allograft, and the virus, in the setting of immunosuppression. When BK virus nephropathy does occur, reported rates of graft loss have ranged from 10% to 80%.","PeriodicalId":380758,"journal":{"name":"Nephrology Times","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116008133","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}
Pub Date : 2011-05-01DOI: 10.1097/01.NEP.0000398887.83065.5B
F. Fervenza
Membranous nephropathy is a common immune-mediated glomerular disease and remains the leading cause of nephrotic syndrome in Caucasian adults.1 Although the disease progresses relatively slowly in most patients, approximately 40% eventually develop end-stage renal disease (ESRD).2 Despite this risk, there has been little progress in the treatment of this condition over the last 30 years. While available immunosuppressive therapies, including corticosteroids, alkylating agents, and calcineurin inhibitors, are at least partially successful in reducing proteinuria in membranous nephropathy, their use is controversial, and they all are associated with signifi cant adverse effects and a high relapse rate.3 This set of circumstances holds particularly true in the case of cyclophosphamide, where side effects include risk of infertility and the long-term increased chance of malignancy. Since membranous nephropathy is a disease with remissions and relapses, repeated use of cyclophosphamide results in a progressive increase in long-term risks. There is a need to evaluate new treatments for patients with membranous nephropathy that result in a higher response rate, lower relapse rate, and fewer adverse effects.
{"title":"B Cell-Targeted Therapy in Membranous Nephropathy: Time for a Randomized Trial","authors":"F. Fervenza","doi":"10.1097/01.NEP.0000398887.83065.5B","DOIUrl":"https://doi.org/10.1097/01.NEP.0000398887.83065.5B","url":null,"abstract":"Membranous nephropathy is a common immune-mediated glomerular disease and remains the leading cause of nephrotic syndrome in Caucasian adults.1 Although the disease progresses relatively slowly in most patients, approximately 40% eventually develop end-stage renal disease (ESRD).2 Despite this risk, there has been little progress in the treatment of this condition over the last 30 years. While available immunosuppressive therapies, including corticosteroids, alkylating agents, and calcineurin inhibitors, are at least partially successful in reducing proteinuria in membranous nephropathy, their use is controversial, and they all are associated with signifi cant adverse effects and a high relapse rate.3 This set of circumstances holds particularly true in the case of cyclophosphamide, where side effects include risk of infertility and the long-term increased chance of malignancy. Since membranous nephropathy is a disease with remissions and relapses, repeated use of cyclophosphamide results in a progressive increase in long-term risks. There is a need to evaluate new treatments for patients with membranous nephropathy that result in a higher response rate, lower relapse rate, and fewer adverse effects.","PeriodicalId":380758,"journal":{"name":"Nephrology Times","volume":"51 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"113959954","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}
Pub Date : 2011-05-01DOI: 10.1097/01.NEP.0000398885.75442.23
L. Butcher
The concepts of “accountable care”—by which health care providers are fi nancially rewarded if they improve patient care while lowering costs—offer great potential for nephrology. “The basic principles of accountable care are very attractive to me as a nephrologist and as somebody who recognizes that the renal industry is a collaboration of many different players and parts,” said Franklin W. Maddux, MD, Senior Vice President and Chief Medical Information Offi cer of Fresenius Medical Care. “When you look at the fundamental value proposition of accountable care, it fi ts renal disease quite well.” While Robert Provenzano, MD, Vice President of Medical Affairs for DaVita, shares Dr. Maddux’s enthusiasm for the concept, he considers the regulations proposed by the Centers for Medicare & Medicaid Services (CMS) to be “almost heartbreaking” because they put too much risk and expense on physicians. “They could have made this easier,” he said. He and others interviewed for this article are optimistic that, while CMS may have paid little attention to nephrology in the proposed rule for accountable care organizations (ACOs) issued March 31, the agency will eventually fi nd a way to apply accountable care concepts to kidney care. After a comment period that ends June 6, CMS will consider feedback and issue its fi nal rule in time for ACOs to begin contracting with the Medicare program as of Jan. 1, 2012. “I’ve never seen a rule from CMS with so many requests for the community to make open comments about particular areas of it,” Dr. Maddux said. “Everything from who can be an ACO to how patients are attributed to an ACO to how the payment and risk work is open for substantial comment.”
“负责任医疗”的概念——如果医疗服务提供者在降低成本的同时改善了病人的护理，他们就会得到经济上的奖励——为肾脏病学提供了巨大的潜力。Fresenius Medical care的高级副总裁兼首席医疗信息官Franklin W. Maddux医学博士说:“作为一名肾病专家和认识到肾脏行业是许多不同参与者和部分的合作的人，负责任医疗的基本原则对我非常有吸引力。”“当你看到负责任医疗的基本价值主张时，它非常适合肾脏疾病。”虽然DaVita医疗事务副总裁Robert Provenzano医学博士和Maddux博士一样对这一概念充满热情，但他认为医疗保险和医疗补助服务中心(CMS)提出的规定“几乎令人心碎”，因为它们给医生带来了太多的风险和费用。“他们本可以让事情变得更简单，”他说。他和其他接受本文采访的人乐观地认为，虽然CMS可能在3月31日发布的负责任医疗组织(ACOs)的建议规则中很少关注肾脏病学，但该机构最终将找到一种将负责任医疗概念应用于肾脏护理的方法。在6月6日结束的评论期之后，CMS将考虑反馈意见，并及时发布最终规则，以便ACOs从2012年1月1日开始与医疗保险计划签订合同。Maddux博士说:“我从来没有见过CMS的规定有这么多要求社区对特定领域发表公开评论的要求。”“从谁可以成为助理医生，到如何将患者归为助理医生，再到如何支付和风险工作，一切都可以公开发表大量评论。”
{"title":"Accountable Care Model: Fit for Nephrology, but Room for Improvement in CMS Proposal","authors":"L. Butcher","doi":"10.1097/01.NEP.0000398885.75442.23","DOIUrl":"https://doi.org/10.1097/01.NEP.0000398885.75442.23","url":null,"abstract":"The concepts of “accountable care”—by which health care providers are fi nancially rewarded if they improve patient care while lowering costs—offer great potential for nephrology. “The basic principles of accountable care are very attractive to me as a nephrologist and as somebody who recognizes that the renal industry is a collaboration of many different players and parts,” said Franklin W. Maddux, MD, Senior Vice President and Chief Medical Information Offi cer of Fresenius Medical Care. “When you look at the fundamental value proposition of accountable care, it fi ts renal disease quite well.” While Robert Provenzano, MD, Vice President of Medical Affairs for DaVita, shares Dr. Maddux’s enthusiasm for the concept, he considers the regulations proposed by the Centers for Medicare & Medicaid Services (CMS) to be “almost heartbreaking” because they put too much risk and expense on physicians. “They could have made this easier,” he said. He and others interviewed for this article are optimistic that, while CMS may have paid little attention to nephrology in the proposed rule for accountable care organizations (ACOs) issued March 31, the agency will eventually fi nd a way to apply accountable care concepts to kidney care. After a comment period that ends June 6, CMS will consider feedback and issue its fi nal rule in time for ACOs to begin contracting with the Medicare program as of Jan. 1, 2012. “I’ve never seen a rule from CMS with so many requests for the community to make open comments about particular areas of it,” Dr. Maddux said. “Everything from who can be an ACO to how patients are attributed to an ACO to how the payment and risk work is open for substantial comment.”","PeriodicalId":380758,"journal":{"name":"Nephrology Times","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125875752","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}
Pub Date : 2011-05-01DOI: 10.1097/01.NEP.0000398884.81279.E2
D. Segev
{"title":"Transplantation of HIV-Infected Organs: The Time Has Come","authors":"D. Segev","doi":"10.1097/01.NEP.0000398884.81279.E2","DOIUrl":"https://doi.org/10.1097/01.NEP.0000398884.81279.E2","url":null,"abstract":"","PeriodicalId":380758,"journal":{"name":"Nephrology Times","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124469762","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}
Pub Date : 2011-05-01DOI: 10.1097/01.NEP.0000398882.73656.A7
M. Hogan
{"title":"Belatacept: Positive Outcomes Persist Over Time, and Safety Profile Improves","authors":"M. Hogan","doi":"10.1097/01.NEP.0000398882.73656.A7","DOIUrl":"https://doi.org/10.1097/01.NEP.0000398882.73656.A7","url":null,"abstract":"","PeriodicalId":380758,"journal":{"name":"Nephrology Times","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133240045","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}
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