Transplantation in the Age of Precision Medicine: The Emerging Field of Treg Therapy
Solid organ transplantation has experienced incredible success over the past half century in rescuing patients with end-stage organ failure and bestowing them with a high quality of life. This success in large part is the result of advances in immunosuppression, however, these regimens come with significant costs including opportunistic infections, and in some cases, direct toxicity to the newly transplanted organs. Further advances are needed. Immunosuppression and tolerance based on regulatory T cells provide an attractive alternative because of their ability to target these immunomodulatory functions specifically to the...
Source: Seminars in Nephrology - January 1, 2022 Category: Urology & Nephrology Authors: Charles G. Rickert, James F. Markmann Source Type: research
Emerging Concepts in Managing Malignancy in Kidney Transplant Patients
Cancer remains a significant cause of morbidity and mortality in kidney transplant recipients, due to long-term immunosuppression. Salient issues to consider in decreasing the burden of malignancy among kidney transplant recipients include pretransplant recipient evaluation, post-transplant screening and monitoring, and optimal treatment strategies for the kidney transplant recipients with cancer. In this review, we address cancer incidence and outcomes, approaches to cancer screening and monitoring pretransplant and post-transplant, as well as treatment strategies, immunosuppressive management, and multidisciplinary appro...
Source: Seminars in Nephrology - January 1, 2022 Category: Urology & Nephrology Authors: Brittany Schreiber, Maen Abdelrahim, Ala Abudayyeh, Naoka Murakami Source Type: research
Histocompatibility Assessment in Precision Medicine for Transplantation: Towards a Better Match
Human Leukocyte Antigen (HLA) diversity is the key driver of alloimmune responses. Ideally, patients would receive an allograft that is fully matched at the allelic level. However, the extensive polymorphism in the HLA loci renders this impractical. Thus, there is growing interest in determining whether HLA mismatches at the eplet/epitope level better reflects the true disparity between a donor-recipient pair, with the goal of predicting permissible mismatches versus those that should be avoided because they will elicit a strong alloimmune response. (Source: Seminars in Nephrology)
Source: Seminars in Nephrology - January 1, 2022 Category: Urology & Nephrology Authors: Melissa Y. Yeung Source Type: research
Glomerular Diseases of the Kidney Allograft: Toward a Precision Medicine Approach
The continual development of potent immunosuppressive regimens has led to a decreased incidence of acute rejection and improvement of short-term kidney allograft survival. In contrast to acute rejection, glomerular diseases of the kidney allograft are being encountered more frequently and are emerging as leading causes of late kidney allograft failure. Although data on the pathogeneses of glomerular diseases in the kidney allograft are sparse, cumulative evidence suggests that post-transplant glomerular diseases may be the result of inherited predispositions and immunologic triggers. (Source: Seminars in Nephrology)
Source: Seminars in Nephrology - January 1, 2022 Category: Urology & Nephrology Authors: Francesca Zanoni, Pascale Khairallah, Krzysztof Kiryluk, Ibrahim Batal Source Type: research
The Complement System in the Modern Era of Kidney Transplantation: Mechanisms of Injury and Targeted Therapies
Kidney transplantation remains the treatment of choice for patients with end-stage kidney disease. Significant progress has been made over the course of many years to improve both patient and graft outcomes after transplant. Modern immunosuppressive therapy has reduced the rate of acute rejection and resulted in excellent short- and long-term graft survival. Over the past decade or so, we have become more cognizant of the role of the complement in many events related to the transplant process. A myriad of events that include the cause of death in deceased donors, organ procurement and preservation events, cold ischemia tim...
Source: Seminars in Nephrology - January 1, 2022 Category: Urology & Nephrology Authors: Mohamed Hassan Kamel, Aala Jaberi, Craig E. Gordon, Laurence H. Beck, Jean Francis Source Type: research
Novel Biomarkers in Kidney Transplantation
Rejection remains a major cause of renal allograft failure. Current diagnostic studies, interrogating the blood or urine, lack the sensitivity and specificity for early detection of rejection. Transplant kidney biopsy remains the gold standard, but is associated with morbidity. Advances in understanding the immunobiology of rejection have led to multiple, novel diagnostic tests facilitating non-invasive, earlier detection of renal allograft rejection. (Source: Seminars in Nephrology)
Source: Seminars in Nephrology - January 1, 2022 Category: Urology & Nephrology Authors: Karim M. Yatim, Jamil R. Azzi Source Type: research
Introduction: Moving Toward a More Personalized Approach to Kidney Transplantation
In 2011, the term precision medicine was coined by the committee charged with “Developing a New Taxonomy of Disease” initiated by the National Research Council of the National Academies. Although the specific task of the Committee was to form a framework to shift the taxonomy in medical practice from a disease-based system to a molecular biology–based system, the broade r intent was to utilize this taxonomy to drive more accurate diagnosis and thus more targeted treatment to improve overall health outcomes. (Source: Seminars in Nephrology)
Source: Seminars in Nephrology - January 1, 2022 Category: Urology & Nephrology Authors: Anil Chandraker Source Type: research
Masthead
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Source: Seminars in Nephrology - January 1, 2022 Category: Urology & Nephrology Source Type: research
Editorial Board
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Source: Seminars in Nephrology - January 1, 2022 Category: Urology & Nephrology Source Type: research
Table of Contents
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Source: Seminars in Nephrology - January 1, 2022 Category: Urology & Nephrology Source Type: research
Erratum
Parsons JA, Taylor DM, Caskey FJ, Ives J: Ethical Duties of Nephrologists: When Patients are Nonadherent to Treatment. Semin. Nephrol 41:262, 2021 (Source: Seminars in Nephrology)
Source: Seminars in Nephrology - November 1, 2021 Category: Urology & Nephrology Source Type: research
Introduction: Psychosocial Issues in Kidney Disease
There is a form of Cartesian duality that pervades much of Western medicine in deciphering whether a particular presentation is biomedical or psychiatric in nature. This determination then dictates the patent's diagnosis, treatment, and even care team members. Despite early calls from champions of patient-centered nephrology care,1 the modern practice of nephrology still lags behind other medical subspecialties (eg, oncology, cardiology) in the systematic application of a broad biopsychosocial approach. (Source: Seminars in Nephrology)
Source: Seminars in Nephrology - November 1, 2021 Category: Urology & Nephrology Authors: Daniel Cukor Source Type: research
Applying A Biopsychosocial Framework to Achieve Durable Behavior Change in Kidney Disease
Chronic disease self-management is the establishment and maintenance of behaviors needed to be an active participant in one's health care and experience the best health outcomes. Kidney disease self-management behaviors to slow disease progression include engaging in exercise or physical activity; adhering to a diet low in sodium, potassium, and phosphorus; monitoring laboratory parameters; managing complex medication regimens; coping with disease-related emotional distress; and communicating effectively with providers. (Source: Seminars in Nephrology)
Source: Seminars in Nephrology - November 1, 2021 Category: Urology & Nephrology Authors: Devika Nair, Daniel Cukor, Warren D. Taylor, Kerri L. Cavanaugh Source Type: research
Diagnosis and Management of Depression in Patients With Kidney Disease
Depression disproportionately affects patients with kidney disease, including those with nondialysis chronic kidney disease, end-stage kidney disease requiring dialysis, and kidney transplant recipients. Patients across the spectrum of kidney disease should be screened for depression every 6 to 12 months using self-report questionnaires, followed by an interview with a clinician to confirm the presence of sadness or anhedonia when depressive symptoms are identified. Pharmacologic treatment with selective serotonin reuptake inhibitors has not consistently shown benefit compared with placebo and may be associated with seriou...
Source: Seminars in Nephrology - November 1, 2021 Category: Urology & Nephrology Authors: L. Parker Gregg, Joseph M. Trombello, Meredith McAdams, S. Susan Hedayati Source Type: research
Anxiety Presentations and Treatments in Populations With Kidney Disease
Anxiety is common in patients with chronic kidney disease, but in its extreme expressions, anxiety can also be a complicating comorbid psychiatric illness. There is only a small literature base on anxiety disorders in patients with renal disease, and many of the studies are not sufficiently specific about which anxiety disorders are being studied. Larger epidemiological studies are required to delineate the incidence, prevalence, and outcomes associated with the varied anxiety disorders. In addition, the impact of the co-occurrence of anxiety with other chronic psychiatric or medical problems, needs further study. (Source:...
Source: Seminars in Nephrology - November 1, 2021 Category: Urology & Nephrology Authors: Stephanie Donahue, Davin K. Quinn, Daniel Cukor, Paul L. Kimmel Source Type: research
