Advances in kidney disease and health最新文献

Pregnancy-related acute kidney injury (PrAKI) is a serious complication causing substantial maternal and fetal morbidity and mortality with long-term sequelae including chronic kidney disease (CKD) and cardiovascular disease. PrAKI affects individuals across high- and low-resource settings, though epidemiology, etiologies, and outcomes differ substantially by context. In low-resource settings, PrAKI remains a leading cause of maternal mortality, precipitated by septic abortion, hemorrhage, and hypertensive disorders compounded by limited access to renal replacement therapy. In high-income countries, PrAKI incidence of is rising due to increasing maternal age, cardiometabolic comorbidities, and hypertensive disorders of pregnancy. PrAKI ranges from transient, reversible dysfunction to severe injury necessitating dialysis, with adverse at each stage. Diagnosis is uniquely challenging because physiological adaptations of pregnancy lower serum creatinine, rendering conventional thresholds less reliable. Current AKI definitions and kidney function estimating equations remain unvalidated in pregnant populations and pre-existing CKD may mask superimposed injury when baseline creatinine values are unknown. Management requires a multidisciplinary approach tailored to gestational age and underlying etiology. In this review, we focus on diagnostic strategies for PrAKI-including gestational age-adjusted creatinine trajectories, proteinuria assessment, and emerging kidney and placental biomarkers-alongside clinical management principles, and current gaps in knowledge.

The heart and kidneys are connected in both health and disease. Coordinated dysfunction of these organ systems is a result of complex interactions related to vascular and biochemical maladaptations. The historical perspective that kidney dysfunction in heart failure is overwhelmingly a product of reduced cardiac forward flow and arterial underfilling has been challenged by mounting evidence. Efforts in 2004 to introduce the term cardiorenal syndrome were based on observations that increased circulatory volume, specifically venous congestion, play a key role in kidney dysfunction. Contemporary studies done after 2004, as well as revisiting historical renal physiology experiments in a new light, have illuminated some of the pathophysiology of how venous congestion in decompensated heart failure causes the "congested kidney." Cardiorenal syndrome, specifically type 1 occurring in the setting of acute heart failure, in part is defined by the fact that renal venous hypertension drives kidney dysfunction. To illuminate this point further, we compare and contrast the importance of arterial underfilling in cardiogenic shock vs cardiorenal syndrome.

Artificial intelligence (AI) and large language models are increasingly reshaping nephrology education. This review advances a hierarchical framework for understanding AI in nephrology education. At the primary level, AI may represent a scalable educational infrastructure that helps address the mismatch between educational demand and delivery capacity. At the secondary level, 3 mechanisms enable this infrastructure: workflow integration, continuous adaptation, and scalability. At the tertiary level, downstream outcomes include enhanced clinical reasoning, curriculum acceleration, burden reduction, improved patient education, and equitable access. However, safe and effective implementation requires addressing limitations related to accuracy, hallucinations, bias, transparency, privacy, and alignment with evolving clinical guidelines. Emerging innovations, including adaptive tutors, digital twins, and AI-orchestrated curricula, highlight a rapidly evolving educational ecosystem. Overall, AI and large language models hold substantial promise to modernize nephrology education and patient engagement, provided they are integrated with rigorous governance, continuous expert oversight, and ethical safeguards.

Hyperammonemia is a rare but life-threatening disorder that arises from hepatic and diverse nonhepatic etiologies and demands prompt physiologic evaluation and intervention to prevent neurologic injury. This review highlights the physiological roles of the intestine, liver, skeletal muscle, brain, and kidneys in ammonia homeostasis, with emphasis on acid-base and potassium regulation. We summarize major causes of hyperammonemia, diagnostic strategies, and nondialytic therapies, review principles guiding kidney replacement therapy selection and dosing, and identify key uncertainties that warrant future study in adult populations.

Despite the current therapeutic options including lifestyle modifications and pharmacotherapy, blood pressure remains inadequately controlled in the majority of hypertensive individuals. Several new medications have been recently Food and Drug Administration approved or are in phase 1 or 2 clinical trials for hypertension. This includes the nonselective endothelin receptor antagonist aprocitentan, which was Food and Drug Administration approved in 2024 for uncontrolled hypertension. Aldosterone synthase inhibitors including baxdrostat, lorundrostat, and vicadrostat are in phase 1 or 2 trials for hypertension or chronic kidney disease with evidence of significant blood pressure lowering. Finally, the novel small-interfering RNA-based zilebesiran targeting angiotensinogen represents a new class of antihypertensive medications with durable blood pressure-lowering dosing only every 3 or 6 months. Each of these medications has unique properties that can potentially contribute to improvement in blood pressure control for individual patients and at the population level. Development of these novel antihypertensives promises a welcome set of new options for the treatment of hypertension.