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
Illness trajectories and their relevance to the care of adults with kidney disease.
Existing practice guidelines for chronic kidney disease advocate a stage-based approach to management, in which treatment recommendations are based largely on the severity of kidney disease, and future risk for adverse health outcomes. However, the course of kidney disease can vary widely among patients with similar levels of kidney function, and each patient will experience their illness in unique ways. ⋯ We here explain how an understanding of illness trajectories may be useful in predicting and guiding care and decision-making in patients with kidney disease. We highlight the importance of competing disease trajectories, the heterogeneity in renal function trajectories among patients with kidney disease, and the variability in these trajectories over time in individual patients. We discuss how individual disease trajectories can shape each patient's experience of illness. Finally, we explain how an understanding of an individual patient's illness trajectory and experience of illness may be useful in guiding discussions about prognosis and treatment decisions and in supporting a patient-centered approach to care.
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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.