Hypertension Institute

Progressive loss of kidney function in chronic kidney disease and end-stage kidney disease leads to distinct pathological changes in mineral and bone metabolism. Historically, the management of these patients focused on lowering their serum phosphate, parathyroid hormone, and normalizing serum calcium. However, persistently high morbidity and mortality of these patients from cardiovascular diseases and after bone fractures call for more specific therapies. Here, we summarize established and emerging therapies for managing the three main domains of mineral bone disorder in patients with advanced chronic kidney disease and end-stage kidney disease: Control of mineral imbalance, management of vascular disease or other soft tissue calcifications, and management of bone disorders.

Diabetes is a widespread disease affecting millions of people, making it one of the leading causes of death in the world. It is a leading cause of cardiovascular disease and end-stage renal disease. Despite advancements in treatment, including insulin therapy and glucose monitoring devices, diabetes continues to significantly impact quality of life and current modalities do not reverse the end-organ damage associated with its progression. While traditionally indicated for type 1 diabetes, recent clinical practice refinements have made pancreas transplants available to select type 2 diabetics meeting specific criteria. These transplants are usually a part of a simultaneous kidney-pancreas transplant. However, although less frequently performed, transplants of pancreas alone or pancreas after kidney transplant are still available. For selected diabetic patients, pancreas transplants offer significant survival benefits and the improvement of cardiovascular and metabolic complications; however, they are not without risks. Complications such as bleeding, vascular thrombosis, infection, organ leak, and rejection are possible. Another challenge to pancreas transplantation is the decreasing number of procedures being performed due to decline in the volume of available high-quality allografts and resource constraints of transplant centers. Advancements in monitoring and treatment of diabetes are contributing to the decline in pancreas transplants nowadays.

Given Croatia's high and rising prevalence of arterial hypertension, we aimed to investigate the population-level determinants of hypertension. Out of 2049 individuals recruited in the EHUH 2 study (random sample), in this analysis, we included 864 individuals (men 34.5%) who provided valid 24-h urine samples. Data on demographics, lifestyle, clinical and laboratory parameters were collected. Hypertension was defined as blood pressure at least 140/90 mm Hg or antihypertensive use. Key determinants of hypertension included male sex [odds ratio (OR) 2.27], salt intake more than 5 g/day (OR 2.46), presence of diabetes (OR 1.95), residence in rural areas (OR 1.63) and a high sodium-to-potassium ratio (OR 1.24). Current smokers had fewer odds than nonsmokers (OR 0.55). When estimated pulse wave velocity (ePWV) was added, model 2 became stronger ( R2 = 0.455), and each increase of 1 m/s of ePWV increased odd for hypertension by 3.73. The higher prevalence of hypertension observed in rural areas was linked to low socioeconomic status, obesity and high sodium/potassium ratio. Ex-smokers had a higher risk obviously because they replaced one poor habit with another one. Based on our results, we can recommend in low-medium-income countries like Croatia tailor screening programs for hypertension not only for individuals with chronic kidney disease, diabetes, or obesity but also for those with low socioeconomic status and rural residents. We can suggest that two low-cost methods, sodium-to-potassium ratio and ePWV, become a regular routine part of these screening programs. In smoking cessation programs, smokers should be educated how to quit smoking, but also how to live healthier.

Kidney intratubular casts are frequently observed in the distal nephron segments of the kidney and have long been regarded as a sign of kidney disease. However, the composition and pathological significance of intratubular casts have remained understudied. We leveraged Hematoxylin and Eosin (H&E) staining to identify intratubular casts along with concurrent Co-detection by indexing (CODEX) multiplexed spatial protein imaging on human kidney biopsy sections from the Kidney Precision Medicine Project (KPMP). We also conducted immunoblotting of Prominin-1 (PROM1/CD133) in urine and assessed its levels from publicly available urinary proteomics datasets of the KPMP consortium. We analyzed 493 intratubular casts across 42 individuals with kidney disease or healthy controls. We identified PROM1 and insulin-like growth factor binding protein 7 (IGFBP7) as major constituents of casts (positive staining in 89.0% and 39.1%, respectively). Staining for uromodulin (UMOD), an established cast component, was present in 86.6%. These components showed variable patterns across disease states. Intratubular casts were predominantly detected in the distal nephron segments, and their presence was associated with a marked loss of sodium-chloride cotransporter (NCC) and aquaporin-2 (AQP2) expression in the cast-containing tubular epithelium, suggesting underlying injury. The loss of these transporters correlated with protein components within casts, and the presence of intra-cast PROM1 showed the strongest association, with an odds ratio of 26.7 (95% confidence interval: 13.1-54.7). Urinary PROM1 secretion was confirmed by immunoblotting and was greater in patients with acute kidney injury (AKI) compared to healthy controls (P = 0.01). We identified PROM1, a dedifferentiation and injury marker expressed in epithelial cells, as a novel major constituent of intratubular casts. Our studies suggest that protein composition signature within casts varies with disease state and is associated with tubular injury in distal nephron segments. Our study also suggests that urinary PROM1 may have potential as a biomarker for AKI.

BackgroundThis study aimed to assess the knowledge, attitudes, and practices (KAP) related to hypertensive nephropathy among patients diagnosed with hypertension in the Xinjiang of China.MethodsA cross-sectional survey was conducted between April 1 and April 30, 2024, in Xinjiang, China. Data were collected using a structured questionnaire designed to capture demographic characteristics and evaluate patients' KAP toward hypertensive nephropathy. Participants were individuals with a confirmed diagnosis of hypertension.ResultsA total of 687 hypertensive patients were included in the final analysis, yielding a response rate of 98%. Among them, 58% were male. The majority of respondents (43%) had been diagnosed with hypertension for three years or less. Their median [q25, q75] knowledge, attitude, and practice scores were 6 (2,10) (possible range: 0–32), 24 (23,26) (possible range: 6–30), and 25 (18,31) (possible range: 9–45), respectively. The structural equation modeling (SEM) showed that knowledge had direct effects on attitude (β = 0.42, P < 0.001) and practice (β = 2.87, P < 0.001). Meanwhile, attitude had a direct effect on practice (β = -0.31, P < 0.001). Furthermore, knowledge indirectly affected practice through attitude (β = -0.13, P = 0.005).ConclusionPatients diagnosed with hypertension in Xinjiang exhibited limited knowledge, generally positive attitudes, but suboptimal health practices regarding hypertensive nephropathy. To improve clinical outcomes, educational interventions targeting hypertension-related renal complications should be prioritized, with a focus on enhancing patient knowledge as a means to foster more effective self-care behaviors.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-025-10079-7.

Diabetic kidney disease (DKD) is the leading cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD) worldwide, disproportionately affecting underserved and safety-net populations. Los Angeles County Department of Health Services (LAC-DHS) Kidney Health Workgroup has developed pragmatic population health frameworks and Expected Practices for DKD co-management with primary-care providers: pragmatic definitions of low kidney function (LKF, <50% of normal) and very low kidney function (VLKF, <25%), and proteinuria severity classification as early (>150 mg/g), heavy (>1 g/g), and massive (>7 g/g) to guide referral urgency; biopsy-agnostic diagnosis of DKD when four out of five criteria are met, including diabetes history or A1c more than 6%, LKF, proteinuria, diabetic microangiopathy, and larger kidney length (>12 cm) or faster CKD progression (>25 ml/min/year); Kidney Disease Integrated Therapy (KDIT) combining four medication categories (RAAS blockade, SGLT2 inhibitors, GLP-1 agonists, nonsteroidal mineralocorticoid antagonist) and renal nutrition and lifestyle medicine (PLADO/PLAFOND diets), adequate hydration, and exercise; and eConsults to support timely detection, dialysis vascular access placement, shared decision-making, and ESRD care coordination. The DKD management model demonstrates that resource-limited systems can deliver innovative, high-quality kidney care and provide a scalable framework for equity-focused and pragmatic kidney care in municipal health systems.

Intro: Peripheral venous stenting is an important treatment for iliocaval venous obstruction, but stent migration is a rare, serious complication with an incidence of 0.9–4.3% and mortality rates up to 60%. Migration to the heart or lungs can cause life-threatening events. Presentations are often vague—dyspnea, dizziness, chest discomfort—leading to delays in care. No standard surveillance guidelines exist. Early recognition is crucial to reducing morbidity and mortality. Aim: To emphasize early detection of venous stent migration through clinical vigilance and prompt imaging, and to highlight the importance of continued monitoring for thromboembolic complications post-retrieval. Description: A 52-year-old woman with hypertension, diabetes, hypothyroidism, and prior left iliac vein stenting for chronic venous insufficiency presented to primary care with postural dizziness, exertional dyspnea, and mild headache. Physical exam and vital signs were unremarkable. Given her history, a transthoracic echocardiogram was obtained, revealing a dislodged stent extending from the right atrium into the right ventricle. She was referred urgently to the hospital, where intravenous heparin was initiated. Percutaneous retrieval via transfemoral access was unsuccessful due to stent entrapment in cardiac structures. Open-heart surgical retrieval was performed following confirmation of normal coronary anatomy. Initial recovery was uneventful; however, several weeks later, she developed a segmental pulmonary embolism, treated successfully with apixaban. She returned to baseline without further complications. Early detection enabled timely intervention and likely prevented fatal outcomes. Discussion: Venous stent migration can cause embolism, valvular damage, arrhythmias, and tamponade. Diagnosis is challenging due to vague symptoms and lack of surveillance protocols. This case highlights the role of outpatient providers in early detection and referral. Multidisciplinary coordination among primary care, cardiology, vascular surgery, and radiology is essential. Vigilance must continue post-retrieval, as the patient’s pulmonary embolism illustrates the ongoing thromboembolic risk. Continued monitoring, anticoagulation, and follow-up imaging are critical to mitigating late complications. Conclusion: Venous stent migration, though rare, can have severe consequences. Early outpatient recognition, prompt imaging, and long-term surveillance are essential to improve patient outcomes.