Current opinion in nephrology and hypertension
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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.
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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. · 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. · 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.