Pathophysiological Mechanisms in Cardiorenal Syndrome

Publication date: September 2018Source: Advances in Chronic Kidney Disease, Volume 25, Issue 5Author(s): Janani Rangaswami, Roy O. MathewCardiorenal syndrome represents the confluence of intricate hemodynamic, neurohormonal, and inflammatory pathways that initiate and propagate the maladaptive cross talk between the heart and kidneys. Several of these pathophysiological principles were described in older historical experiments. The last decade has witnessed major efforts in streamlining its definition, clinical phenotypes, and classification to improve diagnostic accuracy and deliver optimal goal-directed medical therapies. The ability to characterize the various facets of cardiorenal syndrome based on its pathophysiology is poised in an exciting vantage point, in the backdrop of several advanced diagnostic strategies, notably cardiorenal biomarkers that may help with accurate delineation of clinical phenotype, prognosis, and delivery of optimal medical therapies in future studies. This promises to help integrate precision medicine into the clinical diagnosis and treatment strategies for cardiorenal syndrome and, through a heightened understanding of its pathophysiology, to deliver appropriate therapies that will reduce its associated morbidity and mortality.
Source: Advances in Chronic Kidney Disease - Category: Urology & Nephrology Source Type: research

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Publication date: Available online 19 October 2018Source: Pharmacology &TherapeuticsAuthor(s): Chengyuan Tang, Zhengwei Ma, Jiefu Zhu, Zhiwen Liu, Yuxue Liu, Yu Liu, Juan Cai, Zheng DongAbstractAcute kidney injury (AKI) is a major kidney disease with poor clinical outcome. Besides its acute consequence of high mortality, AKI may also contribute significantly to the occurrence and progression of chronic kidney diseases (CKD). Accumulating evidence has demonstrated that maladaptive and incomplete kidney repair after AKI leads to the development of renal fibrosis and, ultimately, CKD. p53, a well-known tumor suppressor, p...
Source: Pharmacology and Therapeutics - Category: Drugs & Pharmacology Source Type: research
CONCLUSIONS: The uraemia produced by an adenine rich diet or high doses of uraemic toxins induced the abnormal deposit of ECM proteins in the vascular wall or its production by HASMCs. The understanding of the mechanisms that underlie this pathophysiological process may be useful in the prevention of cardiovascular damage associated with the progress of chronic kidney disease, a disease, at the moment that is irreversible and occasional silent until its diagnosis in advanced stages. PMID: 30337107 [PubMed - as supplied by publisher]
Source: Nefrologia : publicacion oficial de la Sociedad Espanola Nefrologia - Category: Urology & Nephrology Tags: Nefrologia Source Type: research
Authors: Moreno JA, Gomez-Guerrero C, Mas S, Sanz AB, Lorenzo O, Ruiz-Ortega M, Opazo L, Mezzano S, Egido J Abstract INTRODUCTION: Diabetic nephropathy (DN) is the leading cause of chronic kidney disease (CKD) and end stage renal disease (ESRD). Beyond the new anti-diabetic drugs that possess markedly cardiovascular and renal protective effects, no novel direct therapies for DN have become available on the market in the last twenty years. Recently well-designed clinical trials for the treatment of DN, with attractive pathogenetic rationale, e.g. bardoxolone and atrasentan, were cancelled or stopped because of safet...
Source: Expert Opinion on Investigational Drugs - Category: Drugs & Pharmacology Tags: Expert Opin Investig Drugs Source Type: research
Conclusion The intrarenal RAS is activated in kidney transplant donors immediately after kidney donation, independent of the systemic BP and filtration of increased plasma AGT, due to augmented inflammation. PMID: 30333423 [PubMed - as supplied by publisher]
Source: Internal Medicine - Category: Internal Medicine Tags: Intern Med Source Type: research
This study aimed to assess the potential relationship between the serum creatinine level and the onset of impaired fasting glucose (IFG). Methods In this large, community-based, retrospective longitudinal cohort study, we examined the records of 7,905 Japanese participants (3,863 men, 4,042 women) of 18-80 years of age who underwent annual health checkups at a single center between April 2003 and August 2013. After applying the exclusion criteria, 6,490 participants were reviewed to identify those with the onset of IFG, defined as a fasting plasma glucose ≥6.11 mM. Among the participants, 278 met the criterion for the o...
Source: Internal Medicine - Category: Internal Medicine Tags: Intern Med Source Type: research
This study aims to elucidate 1-year clinical outcomes using this technique for patients with stage 4 or 5 advanced chronic kidney disease (CKD). Research has proven that imaging-guided percutaneous coronary intervention (PCI) reduces contrast volume significantly; however, only short-term clinical benefits have been reported. Minimum-contrast (MINICON) studies are based on the registry design pattern to enroll PCI results in patients with advanced CKD stage 4 or 5 comorbid with coronary artery disease. We excluded cases of emergency PCI or maintenance dialysis from this study. In this study, we compared the intravascular u...
Source: Cardiovascular Intervention and Therapeutics - Category: Cardiology Source Type: research
Conclusion: Lowering D-Ca level below 3.0 mEq/L seems not to have a meaningful effect on patient outcomes.Nephron
Source: Nephron - Category: Urology & Nephrology Source Type: research
Publication date: November 2018Source: American Journal of Kidney Diseases, Volume 72, Issue 5Author(s): L. Parker Gregg, S. Susan HedayatiPatients with non–dialysis-dependent chronic kidney disease (NDD-CKD) are 10 times more likely to die of cardiovascular (CV) diseases than the general population, and dialysis-dependent patients are at even higher risk. Although traditional CV risk factors are highly prevalent in individuals with CKD, these patients were often excluded from studies targeting modification of these risks. Although treatment of hypertension is beneficial in CKD, the best target blood pressure has not...
Source: American Journal of Kidney Diseases - Category: Urology & Nephrology Source Type: research
Publication date: November 2018Source: American Journal of Kidney Diseases, Volume 72, Issue 5, Supplement 1Author(s): Marva Moxey-MimsPediatric-onset chronic kidney disease (CKD) is as relevant to adults as it is to children. Congenital anomalies of the kidney and urinary tract may have a significant impact on health from birth or during childhood or may not manifest until adulthood. Many acquired kidney diseases start to appear in late childhood and adolescence. The propensity for more rapid progression of CKD to end-stage kidney disease in adults of African ancestry, as well as disparities in access to kidney transplant...
Source: American Journal of Kidney Diseases - Category: Urology & Nephrology Source Type: research
This article describes CKD-related disparities linked to a variety of clinical, socioeconomic, and cultural factors, as well as to select social determinants of health that are defined by social positioning and often by race within the United States. Our advancing understanding of these issues has led to improvements in patient outcomes and is narrowing the gap in disparities across most aspects of CKD and CKD risk factors. There are also extensive data indicating similar improvements in quality measures for patients on dialysis therapy. This article also reviews the state of CKD in African Americans from a population pers...
Source: American Journal of Kidney Diseases - Category: Urology & Nephrology Source Type: research
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