1
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Asowata EO, Romoli S, Sargeant R, Tan JY, Hoffmann S, Huang MM, Mahbubani KT, Krause FN, Jachimowicz D, Agren R, Koulman A, Jenkins B, Musial B, Griffin JL, Soderberg M, Ling S, Hansen PBL, Saeb-Parsy K, Woollard KJ. Multi-omics and imaging mass cytometry characterization of human kidneys to identify pathways and phenotypes associated with impaired kidney function. Kidney Int 2024; 106:85-97. [PMID: 38431215 DOI: 10.1016/j.kint.2024.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/16/2024] [Accepted: 01/24/2024] [Indexed: 03/05/2024]
Abstract
Despite the recent advances in our understanding of the role of lipids, metabolites, and related enzymes in mediating kidney injury, there is limited integrated multi-omics data identifying potential metabolic pathways driving impaired kidney function. The limited availability of kidney biopsies from living donors with acute kidney injury has remained a major constraint. Here, we validated the use of deceased transplant donor kidneys as a good model to study acute kidney injury in humans and characterized these kidneys using imaging and multi-omics approaches. We noted consistent changes in kidney injury and inflammatory markers in donors with reduced kidney function. Neighborhood and correlation analyses of imaging mass cytometry data showed that subsets of kidney cells (proximal tubular cells and fibroblasts) are associated with the expression profile of kidney immune cells, potentially linking these cells to kidney inflammation. Integrated transcriptomic and metabolomic analysis of human kidneys showed that kidney arachidonic acid metabolism and seven other metabolic pathways were upregulated following diminished kidney function. To validate the arachidonic acid pathway in impaired kidney function we demonstrated increased levels of cytosolic phospholipase A2 protein and related lipid mediators (prostaglandin E2) in the injured kidneys. Further, inhibition of cytosolic phospholipase A2 reduced injury and inflammation in human kidney proximal tubular epithelial cells in vitro. Thus, our study identified cell types and metabolic pathways that may be critical for controlling inflammation associated with impaired kidney function in humans.
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Affiliation(s)
- Evans O Asowata
- Bioscience Renal, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom; Department of Surgery, University of Cambridge and NIHR Biomedical Research Centre, Cambridge, United Kingdom
| | - Simone Romoli
- Bioscience Renal, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom
| | - Rebecca Sargeant
- Imaging and Data Analytics, Clinical Pharmacology & Safety Sciences, R&D, AstraZeneca, Cambridge, United Kingdom
| | - Jennifer Y Tan
- Imaging and Data Analytics, Clinical Pharmacology & Safety Sciences, R&D, AstraZeneca, Cambridge, United Kingdom
| | - Scott Hoffmann
- Imaging and Data Analytics, Clinical Pharmacology & Safety Sciences, R&D, AstraZeneca, Cambridge, United Kingdom
| | - Margaret M Huang
- Department of Surgery, University of Cambridge and NIHR Biomedical Research Centre, Cambridge, United Kingdom
| | - Krishnaa T Mahbubani
- Department of Surgery, University of Cambridge and NIHR Biomedical Research Centre, Cambridge, United Kingdom
| | - Fynn N Krause
- Bioscience Renal, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom; Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom
| | - Daniel Jachimowicz
- Discovery Biology, Discovery Sciences, R&D, AstraZeneca, Gothenburg, Sweden
| | - Rasmus Agren
- Translational Science and Experimental Medicine, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Albert Koulman
- NIHR BRC Core Metabolomics and Lipidomics Laboratory, University of Cambridge, Cambridge, United Kingdom
| | - Benjamin Jenkins
- NIHR BRC Core Metabolomics and Lipidomics Laboratory, University of Cambridge, Cambridge, United Kingdom
| | - Barbara Musial
- Bioscience Renal, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom
| | - Julian L Griffin
- Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom
| | - Magnus Soderberg
- Department of Pathology, Clinical Pharmacology & Safety Sciences, R&D, AstraZeneca, Gothenburg, Sweden
| | - Stephanie Ling
- Imaging and Data Analytics, Clinical Pharmacology & Safety Sciences, R&D, AstraZeneca, Cambridge, United Kingdom
| | - Pernille B L Hansen
- Bioscience Renal, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Kourosh Saeb-Parsy
- Department of Surgery, University of Cambridge and NIHR Biomedical Research Centre, Cambridge, United Kingdom.
| | - Kevin J Woollard
- Bioscience Renal, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom.
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2
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NAD + Metabolism and Interventions in Premature Renal Aging and Chronic Kidney Disease. Cells 2022; 12:cells12010021. [PMID: 36611814 PMCID: PMC9818486 DOI: 10.3390/cells12010021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/17/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Premature aging causes morphological and functional changes in the kidney, leading to chronic kidney disease (CKD). CKD is a global public health issue with far-reaching consequences, including cardio-vascular complications, increased frailty, shortened lifespan and a heightened risk of kidney failure. Dialysis or transplantation are lifesaving therapies, but they can also be debilitating. Currently, no cure is available for CKD, despite ongoing efforts to identify clinical biomarkers of premature renal aging and molecular pathways of disease progression. Kidney proximal tubular epithelial cells (PTECs) have high energy demand, and disruption of their energy homeostasis has been linked to the progression of kidney disease. Consequently, metabolic reprogramming of PTECs is gaining interest as a therapeutic tool. Preclinical and clinical evidence is emerging that NAD+ homeostasis, crucial for PTECs' oxidative metabolism, is impaired in CKD, and administration of dietary NAD+ precursors could have a prophylactic role against age-related kidney disease. This review describes the biology of NAD+ in the kidney, including its precursors and cellular roles, and discusses the importance of NAD+ homeostasis for renal health. Furthermore, we provide a comprehensive summary of preclinical and clinical studies aimed at increasing NAD+ levels in premature renal aging and CKD.
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3
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de Boer IH, Alpers CE, Azeloglu EU, Balis UGJ, Barasch JM, Barisoni L, Blank KN, Bomback AS, Brown K, Dagher PC, Dighe AL, Eadon MT, El-Achkar TM, Gaut JP, Hacohen N, He Y, Hodgin JB, Jain S, Kellum JA, Kiryluk K, Knight R, Laszik ZG, Lienczewski C, Mariani LH, McClelland RL, Menez S, Moledina DG, Mooney SD, O'Toole JF, Palevsky PM, Parikh CR, Poggio ED, Rosas SE, Rosengart MR, Sarwal MM, Schaub JA, Sedor JR, Sharma K, Steck B, Toto RD, Troyanskaya OG, Tuttle KR, Vazquez MA, Waikar SS, Williams K, Wilson FP, Zhang K, Iyengar R, Kretzler M, Himmelfarb J. Rationale and design of the Kidney Precision Medicine Project. Kidney Int 2021; 99:498-510. [PMID: 33637194 PMCID: PMC8330551 DOI: 10.1016/j.kint.2020.08.039] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/08/2020] [Accepted: 08/14/2020] [Indexed: 02/07/2023]
Abstract
Chronic kidney disease (CKD) and acute kidney injury (AKI) are common, heterogeneous, and morbid diseases. Mechanistic characterization of CKD and AKI in patients may facilitate a precision-medicine approach to prevention, diagnosis, and treatment. The Kidney Precision Medicine Project aims to ethically and safely obtain kidney biopsies from participants with CKD or AKI, create a reference kidney atlas, and characterize disease subgroups to stratify patients based on molecular features of disease, clinical characteristics, and associated outcomes. An additional aim is to identify critical cells, pathways, and targets for novel therapies and preventive strategies. This project is a multicenter prospective cohort study of adults with CKD or AKI who undergo a protocol kidney biopsy for research purposes. This investigation focuses on kidney diseases that are most prevalent and therefore substantially burden the public health, including CKD attributed to diabetes or hypertension and AKI attributed to ischemic and toxic injuries. Reference kidney tissues (for example, living-donor kidney biopsies) will also be evaluated. Traditional and digital pathology will be combined with transcriptomic, proteomic, and metabolomic analysis of the kidney tissue as well as deep clinical phenotyping for supervised and unsupervised subgroup analysis and systems biology analysis. Participants will be followed prospectively for 10 years to ascertain clinical outcomes. Cell types, locations, and functions will be characterized in health and disease in an open, searchable, online kidney tissue atlas. All data from the Kidney Precision Medicine Project will be made readily available for broad use by scientists, clinicians, and patients.
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Affiliation(s)
- Ian H de Boer
- Department of Medicine, University of Washington, Seattle, Washington, USA.
| | - Charles E Alpers
- Department of Pathology, University of Washington, Seattle, Washington, USA
| | - Evren U Azeloglu
- Department of Medicine, Icahn School of Medicine at Mt. Sinai, New York, New York, USA
| | - Ulysses G J Balis
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Laura Barisoni
- Department of Pathology, Duke University, Durham, North Carolina, USA
| | - Kristina N Blank
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Andrew S Bomback
- Department of Medicine, Columbia University, New York, New York, USA
| | - Keith Brown
- Patient Representative, Kidney Precision Medicine Project Steering Committee Member
| | - Pierre C Dagher
- Department of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Ashveena L Dighe
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Michael T Eadon
- Department of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Tarek M El-Achkar
- Department of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Joseph P Gaut
- Department of Pathology, Washington University School of Medicine, St. Louis, St. Louis, Missouri, USA
| | - Nir Hacohen
- Broad Institute, Cambridge, Massachusetts, USA
| | - Yongqun He
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jeffrey B Hodgin
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Sanjay Jain
- Department of Medicine, Washington University School of Medicine, St. Louis, St. Louis, Missouri, USA
| | - John A Kellum
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Krzysztof Kiryluk
- Department of Medicine, Columbia University, New York, New York, USA
| | - Richard Knight
- American Association of Kidney Patients, Kidney Precision Medicine Project Patient Partner
| | - Zoltan G Laszik
- Department of Pathology, University of California, San Francisco, San Francisco, California, USA
| | - Chrysta Lienczewski
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Laura H Mariani
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Robyn L McClelland
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Steven Menez
- Department of Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Dennis G Moledina
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sean D Mooney
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - John F O'Toole
- Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, Ohio, USA
| | - Paul M Palevsky
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Renal Section, Veterans Administration Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Chirag R Parikh
- Department of Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Emilio D Poggio
- Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Matthew R Rosengart
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Minnie M Sarwal
- Department of Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Jennifer A Schaub
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - John R Sedor
- Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kumar Sharma
- Department of Medicine, UT Health San Antonio, San Antonio, Texas, USA
| | - Becky Steck
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Robert D Toto
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Olga G Troyanskaya
- Department of Computer Science, Princeton University, Princeton, New Jersey, USA
| | - Katherine R Tuttle
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Miguel A Vazquez
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Sushrut S Waikar
- Department of Medicine, Boston University Medical Center, Boston, Massachusetts, USA
| | - Kayleen Williams
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Francis Perry Wilson
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kun Zhang
- Institute for Genomic Sciences, University of California, San Diego, California, USA
| | - Ravi Iyengar
- Mount Sinai Institute for Systems Biomedicine, Mount Sinai, New York, New York, USA
| | - Matthias Kretzler
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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4
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Fowler KJ. Advancing American Kidney Health (AAKH): Catalyst for Investment in Kidney Diseases Clinical Trials and Precision Medicine: An Opportunity to Advance Upstream Interventions and the Importance of Nephrology. Clin J Am Soc Nephrol 2020; 15:1689-1691. [PMID: 32759179 PMCID: PMC7769015 DOI: 10.2215/cjn.03660320] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Kevin John Fowler
- Principal, The Voice of the Patient/Board of Directors, Kidney Health Initiative, Elmhurst, Illinois
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5
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Rangarajan S, Agarwal A. Current State and Future of Research in Nephrology. Adv Chronic Kidney Dis 2020; 27:305-311.e1. [PMID: 33131643 DOI: 10.1053/j.ackd.2020.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 01/17/2023]
Abstract
The focus of this article is to review the available funding opportunities for the nephrology workforce at all career levels and review the current challenges involved in the career of a physician-scientist. While the scarcity of nephrology fellows for training programs is a continuing challenge, increased funding for the National Institutes of Health is encouraging particularly for early career investigators. In addition to National Institutes of Health funding, other funding sources are also discussed as they provide much needed bridge funding during key transition periods for young careers. Recent initiatives such as the Advancing American Kidney Health, KidneyX, and National Institute of Diabetes and Digestive and Kidney Diseases' Kidney Precision Medicine Project offer new research opportunities for bringing much needed innovation to improve lives of people with kidney diseases. The time is now for us to seize the opportunity and ensure that a strong workforce will be able to take advantage of these potential game changers for nephrology.
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6
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Misra PS, Silva E Silva V, Collister D. Roadblocks and Opportunities to the Implementation of Novel Therapies for Acute Kidney Injury: A Narrative Review. Can J Kidney Health Dis 2019; 6:2054358119880519. [PMID: 31636913 PMCID: PMC6787878 DOI: 10.1177/2054358119880519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 08/12/2019] [Indexed: 11/29/2022] Open
Abstract
Background: Acute kidney injury (AKI) is a complex and heterogeneous clinical syndrome
with limited effective treatment options. Therefore, a coherent research
structure considering AKI pathophysiology, treatment, translation, and
implementation is critical to advancing patient care in this area. Purpose of review: In this narrative review, we discuss novel therapies for AKI from their
journey from bench to bedside to population and focus on roadblocks and
opportunities to their successful implementation. Sources of information: Peer-reviewed articles, opinion pieces from research leaders and research
funding agencies, and clinical and research expertise. Methods: This narrative review details the challenges of translation of preclinical
studies in AKI and highlights trending research areas and innovative designs
in the field. Key developments in preclinical research, clinical trials, and
knowledge translation are discussed. Furthermore, this article discusses the
current need to involve patients in clinical research and the barriers and
opportunities for effective knowledge translation. Key findings: Preclinical studies have largely been unsuccessful in generating novel
therapies for AKI, due both to the complexity and heterogeneity of the
disease, as well as the limitations of commonly available preclinical models
of AKI. The emergence of kidney organoid technology may be an opportunity to
reverse this trend. However, the roadblocks encountered at the bench have
not precluded researchers from running well-designed and impactful clinical
trials, and the field of renal replacement therapy in AKI is highlighted as
an area that has been particularly active. Meanwhile, knowledge translation
initiatives are bolstered by the presence of large administrative databases
to permit ongoing monitoring of clinical practices and outcomes, with
research output from such evaluations having the potential to directly
impact patient care and inform the generation of meaningful clinical
practice guidelines. Limitations: There are limited objective data examining the process of knowledge creation
and translation in AKI, and as such the opinions and research areas of the
authors are significantly drawn upon in the discussion. Implications: The use of an organized knowledge-to-action framework involving multiple
stakeholders, especially patient partners, is critical to translating basic
research findings to improvements in patient care in AKI, an area where
effective treatment options are lacking.
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Affiliation(s)
- Paraish S Misra
- Kidney Research Scientist Core Education and National Training Program, Canada.,McEwen Stem Cell Institute, Department of Medicine, University of Toronto, ON, Canada
| | - Vanessa Silva E Silva
- Kidney Research Scientist Core Education and National Training Program, Canada.,The Canadian Donation and Transplantation Research Program, Canada.,School of Nursing, Queen's University, Kingston, ON, Canada.,School of Nursing, Federal University of Sao Paulo, Brazil
| | - David Collister
- Kidney Research Scientist Core Education and National Training Program, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
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Singh N, Avigan ZM, Kliegel JA, Shuch BM, Montgomery RR, Moeckel GW, Cantley LG. Development of a 2-dimensional atlas of the human kidney with imaging mass cytometry. JCI Insight 2019; 4:129477. [PMID: 31217358 DOI: 10.1172/jci.insight.129477] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 05/10/2019] [Indexed: 12/19/2022] Open
Abstract
An incomplete understanding of the biology of the human kidney, including the relative abundances of and interactions between intrinsic and immune cells, has long constrained the development of therapies for kidney disease. The small amount of tissue obtained by renal biopsy has previously limited the ability to use patient samples for discovery purposes. Imaging mass cytometry (IMC) is an ideal technology for quantitative interrogation of scarce samples, permitting concurrent analysis of more than 40 markers on a single tissue section. Using a validated panel of metal-conjugated antibodies designed to confer unique signatures on the structural and infiltrating cells comprising the human kidney, we performed simultaneous multiplexed imaging with IMC in 23 channels on 16 histopathologically normal human samples. We devised a machine-learning pipeline (Kidney-MAPPS) to perform single-cell segmentation, phenotyping, and quantification, thus creating a spatially preserved quantitative atlas of the normal human kidney. These data define selected baseline renal cell types, respective numbers, organization, and variability. We demonstrate the utility of IMC coupled to Kidney-MAPPS to qualitatively and quantitatively distinguish individual cell types and reveal expected as well as potentially novel abnormalities in diseased versus normal tissue. Our studies define a critical baseline data set for future quantitative analysis of human kidney disease.
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Affiliation(s)
- Nikhil Singh
- Section of Nephrology, Department of Internal Medicine
| | | | | | | | | | - Gilbert W Moeckel
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
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8
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Korbet SM, Gashti CN, Evans JK, Whittier WL. Risk of percutaneous renal biopsy of native kidneys in the evaluation of acute kidney injury. Clin Kidney J 2018; 11:610-615. [PMID: 30289129 PMCID: PMC6165762 DOI: 10.1093/ckj/sfy048] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 05/14/2018] [Indexed: 02/06/2023] Open
Abstract
Background Percutaneous renal biopsy (PRB) of native kidneys (NKs) to better understand and treat acute kidney injury (AKI) is being advocated, but little is known about the risk of complications. Methods We performed a retrospective study of PRB of NKs in 955 adults from 1991 to 2015 at an academic medical center with real-time ultrasound and automated biopsy needles. Patients undergoing PRB for evaluation of AKI (n = 160) were compared with 795 patients biopsied for other reasons (not-AKI) for postbiopsy complications [need for transfusion of packed red blood cells (PRBCs), an interventional radiologic or surgical procedure, readmission or death]. Results Patients biopsied for AKI were older (58 ± 16 versus 44 ± 16 years; P < 0.0001), with a higher serum creatinine (SCr) (4.5 ± 2.7 versus 1.8 ± 1.6 mg/dL; P < 0.0001) and lower hemoglobin (Hgb) (10.4 ± 1.7 versus 12.1 ± 2.1; P < 0.0001) and a greater proportion had an abnormal bleeding time (12.5% versus 7.4%, P 0.04), partial thromboplastin time (15.2% versus 5.3%, P < 0.0001) and/or prothrombin time (27.0% versus 12.8%; P < 0.0001) compared with not-AKI patients. Complications post-PRB were significantly greater in patients biopsied for AKI {11.3% versus 6.7%; P=0.04; odds ratio [OR] 1.78 [95% confidence interval (CI) 1.01–3.12]} with patients biopsied for AKI requiring more blood transfusions (10.0% versus 5.3%; P 0.02; OR 2.04 (95% CI 1.12–3.74)]. By multivariate analysis, baseline features predictive of a complication were increased SCr and decreased Hgb level, as well as female gender and increased systolic blood pressure. Conclusion Patients biopsied for evaluation of AKI are at greater risk of complications due to increased risk factors.
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Affiliation(s)
- Stephen M Korbet
- Section of Nephrology, Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Casey N Gashti
- Section of Nephrology, Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Joni K Evans
- Section of Nephrology, Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - William L Whittier
- Section of Nephrology, Department of Medicine, Rush University Medical Center, Chicago, IL, USA
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9
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Abstract
Acute kidney injury (AKI) is a common complication in hospitalized patients and is associated with adverse short- and long-term outcomes. AKI is diagnosed by serum creatinine (SCr)-based consensus definitions that capture an abrupt decrease in glomerular filtration rate associated with AKI. However, SCr-based AKI definitions lack sensitivity and specificity for diagnosing structural kidney injury. Moreover, AKI is a heterogeneous condition consisting of distinct phenotypes based on its etiology, prognosis, and molecular pathways, and that may potentially require different therapies. SCr-based AKI definitions provide no information on these AKI phenotypes. This review highlights traditional and novel tools that overcome the limitations of SCr-based AKI definitions to improve AKI phenotyping.
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Affiliation(s)
- Dennis G Moledina
- Program of Applied Translational Research, Section of Nephrology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
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10
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Levey AS, Levin A. A Rebuttal to "The CKD Classification System in the Precision Medicine Era". Clin J Am Soc Nephrol 2017; 12:1711-1713. [PMID: 28784654 PMCID: PMC5628716 DOI: 10.2215/cjn.03970417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/14/2023]
Affiliation(s)
- Andrew S. Levey
- Division of Nephrology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts; and
| | - Adeera Levin
- Head University of British Columbia Division of Nephrology, Executive Director Provincial Renal Agency, University of British Columbia, Vancouver, British Columbia, Canada
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11
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Norton JM, Ketchum CJ, Narva AS, Star RA, Rodgers GP. Complementary Initiatives from the NIDDK to Advance Kidney Health. Clin J Am Soc Nephrol 2017; 12:1544-1547. [PMID: 28716859 PMCID: PMC5586571 DOI: 10.2215/cjn.02120217] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Jenna M. Norton
- Division of Kidney and Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases and
| | - Christian J. Ketchum
- Division of Kidney and Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases and
| | - Andrew S. Narva
- Division of Kidney and Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases and
| | - Robert A. Star
- Division of Kidney and Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases and
| | - Griffin P. Rodgers
- Office of the Director, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
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12
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Abstract
AKI is an increasingly common disorder that is strongly linked to short- and long-term morbidity and mortality. Despite a growing heterogeneity in its causes, providing a timely and certain diagnosis of AKI remains challenging. In this review, we summarize the evolution of AKI biomarker studies over the past few years, focusing on two major areas of investigation: the early detection and prognosis of AKI. We highlight some of the lessons learned in conducting AKI biomarker studies, including ongoing attempts to address the limitations of creatinine as a reference standard and the recent shift toward evaluating the prognostic potential of these markers. Lastly, we suggest current gaps in knowledge and barriers that may be hindering their incorporation into care and a full ascertainment of their value.
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Affiliation(s)
- Rakesh Malhotra
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California
| | - Edward D. Siew
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical center, Nashville, Tennessee
- Tennessee Valley Healthcare System, Veteran's Administration Medical Center, Veterans Health Administration, Nashville, Tennessee; and
- Vanderbilt Center for Kidney Disease and Integrated Program for Acute Kidney Injury Research, Nashville, Tennessee
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13
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Chevalier RL. The proximal tubule is the primary target of injury and progression of kidney disease: role of the glomerulotubular junction. Am J Physiol Renal Physiol 2016; 311:F145-61. [PMID: 27194714 PMCID: PMC4967168 DOI: 10.1152/ajprenal.00164.2016] [Citation(s) in RCA: 266] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 05/03/2016] [Indexed: 12/16/2022] Open
Abstract
There is an alarming global increase in the incidence of end-stage kidney disease, for which early biomarkers and effective treatment options are lacking. Largely based on the histology of the end-stage kidney and on the model of unilateral ureteral obstruction, current investigation is focused on the pathogenesis of renal interstitial fibrosis as a central mechanism in the progression of chronic kidney disease (CKD). It is now recognized that cumulative episodes of acute kidney injury (AKI) can lead to CKD, and, conversely, CKD is a risk factor for AKI. Based on recent and historic studies, this review shifts attention from the glomerulus and interstitium to the proximal tubule as the primary sensor and effector in the progression of CKD as well as AKI. Packed with mitochondria and dependent on oxidative phosphorylation, the proximal tubule is particularly vulnerable to injury (obstructive, ischemic, hypoxic, oxidative, metabolic), resulting in cell death and ultimately in the formation of atubular glomeruli. Animal models of human glomerular and tubular disorders have provided evidence for a broad repertoire of morphological and functional responses of the proximal tubule, revealing processes of degeneration and repair that may lead to new therapeutic strategies. Most promising are studies that encompass the entire life cycle from fetus to senescence, recognizing epigenetic factors. The application of techniques in molecular characterization of tubule segments and the development of human kidney organoids may provide new insights into the mammalian kidney subjected to stress or injury, leading to biomarkers of early CKD and new therapies.
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Affiliation(s)
- Robert L Chevalier
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia
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14
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Cavanaugh KL. Patient Experience Assessment is a Requisite for Quality Evaluation: A Discussion of the In-Center Hemodialysis Consumer Assessment of Health Care Providers and Systems (ICH CAHPS) Survey. Semin Dial 2016; 29:135-43. [PMID: 26858008 DOI: 10.1111/sdi.12469] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Patient experience surveys provide a critical and unique perspective on the quality of patient-centered healthcare delivery. These surveys provide a mechanism to systematically express patients' voice on topics valued by patients to make decisions about choices in care. They also provide an assessment to healthcare organizations about their service that cannot be obtained from any other source. Regulatory agencies have mandated the assessment of patients' experience as part of healthcare value based purchasing programs and weighted the results to account for up to 30% of the total scoring. This is a testimony to the accepted importance of this metric as a fundamental assessment of quality. After more than a decade of rigorous research, there is a significant body of growing evidence supporting specifically the validity and use of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys, including a version specific to in-center hemodialysis (ICH CAHPS). This review will focus on the ICH CAHPS survey including a review of its development, content, administration, and also a discussion of common criticisms. Although it is suggested that the survey assesses activities and experiences that are not modifiable by the healthcare organization (or the dialysis facility in our case) emerging evidence suggests otherwise. Dialysis providers have an exclusive opportunity to lead the advancement of understanding the implications and serviceability of the evaluation of the patient experience in health care.
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Affiliation(s)
- Kerri L Cavanaugh
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt Center for Kidney Disease, Nashville, Tennessee
- Vanderbilt Center for Effective Health Communication, Nashville, Tennessee
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15
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Sands JM. Understanding renal physiology leads to therapeutic advances in renal disease. Physiology (Bethesda) 2015; 30:171-2. [PMID: 25933816 PMCID: PMC4422976 DOI: 10.1152/physiol.00005.2015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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16
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Navaneethan SD, Boulware LE, Sedor JR. Patients as stakeholders in setting kidney disease research priorities. Am J Kidney Dis 2015; 65:641-3. [PMID: 25919496 DOI: 10.1053/j.ajkd.2015.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 01/15/2015] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - John R Sedor
- Case Western Reserve University, Cleveland, Ohio
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17
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Cavanaugh KL. Prioritizing patient-centered care implementation and research for patients with kidney disease. Semin Dial 2014; 28:131-40. [PMID: 25470535 DOI: 10.1111/sdi.12326] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Patient-centered care is upheld as one of the fundamental components of high quality health care. Although a deceptively easy concept, patient-centered care is an elusive goal in clinical practice. A core objective for patient-centered care is a collaboration between health care providers and patients that aligns therapy with patients' values and preferences through shared decision making. Advances in communication training that are tailored to the specific requirements of nephrology care are promising methods for enhancing the skill-set of our providers. However, patient-centered care extends beyond shared decision-making and also involves attention to patients' physical and emotional symptoms, care coordination, and the inclusion of family members. Research about patient-centered care processes, interventions and outcomes among patients with kidney disease is sparse. Recent discussions among nephrology experts name patient-centered care as a priority for research and quality improvement in care. Given recent advances in methods for quantifying patient-centered care as well as patient reported outcomes, now is the time to prioritize our resources to evolve our health system and meet the needs of all patients with kidney disease.
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Affiliation(s)
- Kerri L Cavanaugh
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt Center for Kidney Disease, Nashville, Tennessee
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