Nephroprotective Action of Renin-Angiotensin-Aldosterone System Blockade in Chronic Kidney Disease Patients: The Landscape After ALTITUDE and VA NEPHRON-D Trails
The intervention in the renin-angiotensin-aldosterone system (RAAS) is currently the most effective strategy that combines blood pressure lowering and renoprotection. Several large, randomized, controlled trials evidenced the renoprotective potential of the angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) in nephropathies of almost any etiology. Mineralocorticoid receptor antagonists and direct renin inhibitor, aliskiren, as add-on treatments to standard therapy including the optimal dose of ACEIs or ARBs reduce albuminuria or proteinuria and slow development of renal dysfunction more than placebo.
Chronic kidney disease (CKD) is prevalent worldwide and is associated with significant co-morbidities including cardiovascular disease (CVD). Traditionally, the subtotal nephrectomy (remnant kidney) experimental model has been performed in rats to model progressive renal disease. The model experimentally mimics CKD by reducing nephron number, resulting in renal insufficiency. Presently, there is a lack of translation of pre-clinical findings into successful clinical results. The pre-clinical nephrology field would benefit from reproducible progressive renal disease models in mice in order to avail of more widely available ...
Publication date: September 2019Source: Advances in Chronic Kidney Disease, Volume 26, Issue 5Author(s): Latisha Heinlen, Eliza F. ChakravartyLupus nephritis is the most common organ-threatening manifestation of systemic lupus erythematosus, affecting more than one-third of patients. Induction of remission and maintenance of relapse-free disease have been and continue to be a critical focus of investigation. Because the need for renal replacement therapy in those with an insufficient response to therapy is associated with significantly increased morbidity and mortality, providers and patients are willing to accept moderate...
Publication date: September 2019Source: Advances in Chronic Kidney Disease, Volume 26, Issue 5Author(s): Nestor Oliva-Damaso, Juan Payan, Elena Oliva-Damaso, Teresa Pereda, Andrew S. BombackIn systemic lupus erythematosus, nephrotic-range proteinuria typically signals the presence of a proliferative lupus nephritis (class III/IV) and/or membranous lupus nephritis (class V, with or without concomitant class III or IV lesions). However, in rare instances, systemic lupus erythematosus patients with nephrotic syndrome have kidney biopsy findings of normal glomeruli or focal segmental glomerulosclerosis lesions, with or without...
Conclusions: There was no statistical significant association between any of the studied heavy metals and CKD, although there was a significant burden of heavy metals in the studied subjects.
Obesity is an independent risk factor for renal functional decline in people with chronic kidney disease and is highly prevalent amongst people with the leading cause of chronic kidney disease, diabetic kidney disease . Intentional weight loss strategies hold promise as a means of arresting progressive renal functional decline in diabetic kidney disease . Optimisation of renal outcomes after metabolic surgery centres on blood pressure and glycaemic control as well as addressing proteinuria.
We examined the relationship between baseline MetS and renal dysfunction after a 3-year evaluation based on estimated glomerul ar filtration rate (eGFRCKDEPI) using the CKD-EPI equations modified by the Japan coefficient. CKD was defined as dipstick-positive proteinuria (> or = 1 +) or a low eGFRCKDEPI (
ConclusionsFebuxostat presents a superior effect in delaying renal impairment progression compared with allopurinol in CKD patients complicated with HUA.
Vitamin D has been demonstrated to lessen proteinuria severity in chronic kidney disease (CKD). Compared with healthy populations, patients with CKD may have lower serum levels of 1,25-dihydroxy vitamin D (1,25-(OH)2 D) and 25-hydroxy vitamin D (25-(OH) D). We investigated the effect of oral low-dose active vitamin D (calcitriol at 0.25 μg, 3 times weekly) on urinary protein excretion.
ConclusionsSleep debt was associated with the prevalence of proteinuria in a dose-dependent manner.
Conclusion: Use of MRAs alone or on top of RAS blockade confers important antiproteinuric effects in patients with CKD, with a slight increase in mean potassium levels.