Current opinion in nephrology and hypertension
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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
ReviewBidirectional relationships between acute kidney injury and chronic kidney disease.
Chronic kidney disease (CKD) remains one of the most potent predictors of acute kidney injury (AKI); however, recent epidemiologic studies have demonstrated a complex interplay between these two clinical entities. A growing body of evidence supports a bidirectional relationship: AKI leads to CKD, and the presence of CKD increases the risk of AKI. Additionally, several studies suggest that the presence of underlying CKD does modify the relation between AKI and adverse outcomes. In this article, we will review recent studies supporting the hypothesis that AKI leads to CKD and will explore the role of CKD as an effect modifier for AKI. ⋯ Recent findings support a strong association between AKI and CKD. There is uncertainty as to whether this relationship is causal. CKD is an effect modifier in AKI.
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Curr. Opin. Nephrol. Hypertens. · May 2012
ReviewRecent advances in acute kidney injury epidemiology.
Expanding rates of acute kidney injury (AKI) coupled with increasing awareness of its short-term and long-term sequelae have focused efforts to identify patients at risk for this disease and its complications. This review details the recent attempts to identify novel risk factors for AKI, describes further refinements in the diagnostic and prognostic approach using biological markers of injury, and highlights the features of AKI that independently predict poor long-term outcomes. ⋯ Although the pathophysiologic link is unclear, proteinuria is an easily measurable risk factor for AKI worth considering before anticipated procedures or medication exposures carrying nephrologic risk. Investigation extending beyond agreement with serum creatinine is needed to fully understand the diagnostic and prognostic value of AKI biomarkers. Severity and duration are components of AKI that can help risk-stratify survivors in need of monitoring or nephrology referral.
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Curr. Opin. Nephrol. Hypertens. · May 2012
ReviewThe pathogenesis of membranous nephropathy: evolution and revolution.
The morphological features of membranous nephropathy have been recognized for over five decades, but the pathogenetic mechanisms underlying this lesion in humans have only recently been elucidated. This review analyzes the recent developments in understanding the pathogenesis of the primary and secondary forms of membranous nephropathy. ⋯ The identification of target antigens provides new tools for diagnosis, prognosis and monitoring of therapy in human membranous nephropathy.
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Curr. Opin. Nephrol. Hypertens. · Jan 2012
ReviewAdenosine and protection from acute kidney injury.
Acute kidney injury (AKI) is a major clinical problem without effective therapy. Development of AKI among hospitalized patients drastically increases mortality and morbidity. With increases in complex surgical procedures together with a growing elderly population, the incidence of AKI is rising. Renal adenosine receptor manipulation may have great therapeutic potential in mitigating AKI. In this review, we discuss renal adenosine receptor biology and potential clinical therapies for AKI. ⋯ Despite the current lack of therapies for the treatment and prevention of AKI, recent research suggests that modulation of renal adenosine receptors holds promise in treating AKI and extrarenal injury.