Current opinion in nephrology and hypertension
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Curr. Opin. Nephrol. Hypertens. · Nov 2013
ReviewAngiogenic factors in preeclampsia: potential for diagnosis and treatment.
The review summarizes new observations of key roles for circulating angiogenic factors in diagnosing, managing, and treating preeclampsia. ⋯ Circulating angiogenic biomarkers help in diagnostic and prognostic profiling of preeclampsia and may facilitate better management of these patients.
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Acute kidney injury (AKI) is extremely common in hospitalized patients and its presence infers a poorer chance of survival, longer hospital stays and an increased risk of subsequent chronic kidney disease. Recent reports have suggested that standards of care for patients with AKI are often suboptimal and that this contributes to poor outcomes. In an attempt to address delays in diagnosing AKI, there has been increasing interest in e-alert systems for AKI. This review aims to discuss recent developments in e-alert methodologies, as well as examining the evidence to support their effectiveness. ⋯ The current ad-hoc development of e-alert systems needs to be addressed by arriving at consensus around the way in which these systems should apply diagnostic criteria, particularly with respect to selection of baseline creatinine value. Enhancements in IT provision may provide the only durable solution to this, while at the same time facilitating wider uptake. Wider use will allow for further study of the value of e-alerts, including their use in other settings such as primary care.
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Curr. Opin. Nephrol. Hypertens. · Jul 2013
ReviewOsmoregulation, vasopressin, and cAMP signaling in autosomal dominant polycystic kidney disease.
Autosomal dominant polycystic kidney disease (ADPKD) is the most frequent inherited nephropathy. This review will focus on the vasopressin and 3'-5'-cyclic adenosine monophosphate (cAMP) signaling pathways in ADPKD and will discuss how these insights offer new possibilities for the follow-up and treatment of the disease. ⋯ These advances open perspectives for the understanding of cystogenesis in ADPKD, the mechanisms of osmoregulation, the role of polycystins in the brain, and the pleiotropic action of vasopressin.
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Curr. Opin. Nephrol. Hypertens. · May 2013
ReviewEstimating glomerular filtration rate: is it good enough? And is it time to move on?
The aim is to examine a dominant narrative in nephrology over the past decade: that measured glomerular filtration rate (GFR) is the gold standard measure of kidney function; accurate assessment of GFR is critical and paramount; and further efforts to refine GFR estimation should continue. ⋯ Compared with estimated GFR, measured GFR does not consistently predict renal-related outcomes better. Clinical decision-making almost never requires precise and accurate knowledge of a patient's static GFR value. Efforts at perfecting cross-sectional estimates of GFR may have reached a point of diminishing returns.
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Curr. Opin. Nephrol. Hypertens. · May 2013
ReviewDisparities, race/ethnicity and access to pediatric kidney transplantation.
Kidney transplantation remains the optimal treatment for children with end-stage renal disease; yet, in the United States, profound differences in access to transplant persist, with black children experiencing significantly reduced access to transplant compared with white children. The reasons for these disparities remain poorly understood. Several recent studies provide new insights into the interplay of socioeconomic status, racial/ethnic disparities and access to pediatric kidney transplantation. ⋯ Future approaches to overcome disparities in pediatric kidney transplant access must focus on the continuum of the transplant process, including equitable health care access. Public health advocacy efforts to promote national policies that address disparate multilevel socioeconomic factors are essential.