Current opinion in nephrology and hypertension
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Curr. Opin. Nephrol. Hypertens. · Nov 2014
End-stage renal disease risk in live kidney donors: what have we learned from two recent studies?
Living kidney donation improves the lives of those with kidney failure, but there are potential risks to the donor. We review two recent publications that describe the long-term risk of end-stage renal disease (ESRD) in living kidney donors. ⋯ The results of these studies should be discussed with potential living kidney donors with an emphasis on the low 15-year incidence of ESRD following donation. The lifetime incidence of ESRD for donors of different age, race, and other characteristics requires further study.
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Curr. Opin. Nephrol. Hypertens. · May 2014
ReviewEarly-invasive strategies for the management of coronary heart disease in chronic kidney disease: is acute kidney injury a consideration?
People with chronic kidney disease (CKD) are less likely to receive early-invasive management of acute coronary syndrome (ACS). The purpose of this article is to review the risks and outcomes of early-invasive versus conservative strategies, and to consider how contrast-induced acute kidney injury (CI-AKI) should factor in treatment decisions for people with CKD. ⋯ These findings illustrate that the additional short-term risk of AKI associated with invasive management should be considered alongside long-term treatment effects on other clinical outcomes and should not act as a deterrent to their use. Strategies to increase the uptake of an invasive management approach, accompanied by the use of CI-AKI prevention strategies, could benefit high-risk individuals with CKD.
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Curr. Opin. Nephrol. Hypertens. · May 2014
ReviewEstimating and measuring glomerular filtration rate: methods of measurement and markers for estimation.
Glomerular filtration rate (GFR) is the best overall measure of kidney function. Reference GFR measurements (e.g. inulin clearance) are laborious. Estimation of GFR using equations based on endogenous filtration markers is simpler, cheaper and easy to apply in practice but suffers from limited accuracy and reproducibility. This review summarizes the recent studies comparing measured and estimated GFR in various populations and disease settings. We consider the utility of newer estimating equations based on standardized methodology, including those incorporating cystatin C. ⋯ The ideal biomarker and equation to estimate GFR would provide reproducible and accurate results across the entire range of GFRs, populations and diseases. Newer GFR markers and equations are required to fulfil this holy grail of research.
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Curr. Opin. Nephrol. Hypertens. · Mar 2014
ReviewAre diuretics harmful in the management of acute kidney injury?
To assess the role of diuretics in acute kidney injury (AKI) and their effectiveness in preventing AKI, achieving fluid balance, and decreasing progression to chronic kidney disease (CKD). ⋯ Diuretics are ineffective and even detrimental in the prevention and treatment of AKI, and neither shorten the duration of AKI, nor reduce the need for renal replacement therapy. Diuretics have an important role in volume management in AKI, but they are not recommended for the prevention of AKI. There is increased emphasis on the prevention of progression of AKI to CKD.
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Curr. Opin. Nephrol. Hypertens. · Mar 2014
Role of hypoxia in progressive chronic kidney disease and implications for therapy.
Chronic hypoxia in the tubulointerstitium has been recognized as a final common pathway that leads to the development of end-stage renal disease. Hypoxia-inducible factor (HIF), a master regulator of the adaptive response against hypoxia, is involved in the pathogenesis of chronic kidney disease (CKD). This review focuses on HIF and novel therapeutic strategies targeting HIF. ⋯ HIF plays a crucial role in the pathophysiology of CKD. The underlying molecular mechanisms, including epigenetics, have been thoroughly investigated. On the basis of the experimental data available to date, the pharmacological activation of HIF is likely a novel promising therapy for CKD.