2025-10-24 カリフォルニア大学サンディエゴ校(UCSD)
With chronic kidney disease and acute kidney injury on the rise in the U.S., research into these life-threatening but understudied conditions is more vital than ever. Photo Credit: Susanne Clara Bard/Adobe Firefly/Descript/UC San Diego Health Sciences
<関連情報>
- https://today.ucsd.edu/story/healing-without-harm-collaboration-is-key-in-clinical-pharmacists-quest-to-safeguard-kidney-health
- https://journals.lww.com/jasn/fulltext/2025/05000/asn_kidney_health_guidance_on_the_outpatient.19.aspx
- https://www.mdpi.com/1422-0067/22/6/2784
透析を必要とする急性腎不全患者の外来管理に関するASN腎臓保健ガイダンス ASN Kidney Health Guidance on the Outpatient Management of Patients with Dialysis-Requiring Acute Kidney Injury
Vijayan, Anitha; Heung, Michael; Awdishu, Linda; Babroudi, Seda; Green, Gopa B. Koester, Lisa; McCoy, Ian E.; Menon, Shina; Palevsky, Paul M.; Proctor, Lorri A.; Selewski, David T.; Struthers, Sarah A.; for the ASN Kidney Health Guidance Workgroup on Outpatient Dialysis for AKI
Journal of the American Society of Nephrology Published:May 2025
DOI: 10.1681/ASN.0000000646
Abstract
Podcast
This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/JASN/2025_03_11_KTS_March2025.mp
Introduction
AKI is a common and serious complication among hospitalized adult and pediatric patients,1 with severe cases requiring KRT. Although recent studies have shown improving hospital mortality rates for patients with dialysis-requiring AKI (AKI-D),2 up to 30% of AKI-D survivors will require dialysis beyond discharge.3 Data from the United States Renal Data System (USRDS) demonstrate a marked increase in patients with AKI receiving outpatient hemodialysis in ESRD facilities, from 6400 individuals in 2017 to a peak of 11,964 in 2020.4 After hospitalization, patients with AKI-D who are dialysis dependent at discharge remain at significantly higher risk of adverse outcomes, including CKD, permanent dialysis dependence, cardiovascular disease, rehospitalization, and death.5
In the United States, despite numerous regulatory and policy initiatives aimed at facilitating outpatient care of patients with AKI-D, there remain significant gaps in care.6 A paucity of high-level evidence to guide management has resulted in wide variability in clinical practices. AKI survivors report inconsistent care in outpatient dialysis facilities and, despite significant pathophysiological differences, their care often mirrors that of the patient with ESRD.7,8 Recognizing the significant vulnerability of this population, the American Society of Nephrology (ASN) Kidney Health Guidance (KHG) oversight committee convened a multidisciplinary expert workgroup to address the need for clinical guidance in the care of patients with AKI-D who continue to require dialysis after hospital discharge. This guidance does not address the management of patients with AKI-D who achieve dialysis independence before discharge from the hospital. In addition, while the clinical guidance in this document may be applicable globally, some of the regulatory challenges and suggestions are primarily meant for patients dialyzing in outpatient facilities in the United States.
尿中エクソソームはバンコマイシン関連急性腎障害における炎症経路を特定する Urinary Exosomes Identify Inflammatory Pathways in Vancomycin Associated Acute Kidney Injury
Linda Awdishu,Amy Le,Jordan Amato,Vidhyut Jani,Soma Bal,Robert H. Mills,Marvic Carrillo-Terrazas,David J. Gonzalez,Ashita Tolwani,Anjali Acharya,Jorge Cerda,Melanie S. Joy,,Paola Nicoletti,Etienne Macedo,Sucheta Vaingankar,Ravindra Mehta,Satish P. RamachandraRao andon behalf of the Direct Investigators
International Journal of Molecular Sciences Published: 10 March 2021
DOI:https://doi.org/10.3390/ijms22062784
Abstract
Background: Vancomycin is commonly used as a first line therapy for gram positive organisms such as methicillin resistant Staphylococcus aureus. Vancomycin-induced acute kidney injury (V-AKI) has been reported in up to 43% of patients, especially in those with higher targeted trough concentrations. The precise mechanism of injury in humans remains elusive, with recent evidence directed towards proximal tubule cell apoptosis. In this study, we investigated the protein contents of urinary exosomes in patients with V-AKI to further elucidate biomarkers of mechanisms of injury and potential responses. Methods: Urine samples from patients with V-AKI who were enrolled in the DIRECT study and matched healthy controls from the UAB-UCSD O’Brien Center Biorepository were included in the analysis. Exosomes were extracted using solvent exclusion principle and polyethylene glycol induced precipitation. Protein identity and quantification was determined by label-free liquid chromatography mass spectrometry (LC/MS). The mean peak serum creatinine was 3.7 ± 1.4 mg/dL and time to kidney injury was 4.0 ± 3.0 days. At discharge, 90% of patients demonstrated partial recovery; 33% experienced full recovery by day 28. Proteomic analyses on five V-AKI and 7 control samples revealed 2009 proteins in all samples and 251 proteins significantly associated with V-AKI (Pi-score > 1). The top discriminatory proteins were complement C3, complement C4, galectin-3-binding protein, fibrinogen, alpha-2 macroglobulin, immunoglobulin heavy constant mu and serotransferrin. Conclusion: Urinary exosomes reveal up-regulation of inflammatory proteins after nephrotoxic injury in V-AKI. Further studies are necessary in a large patient sample to confirm these findings for elucidation of pathophysiologic mechanisms and validation of potential injury biomarkers.
