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The Role of Caveolae on Albumin Passage through Glomerular Endothelial and Epithelial Cells: The New Etiology of Urinary Albumin Excretion.
Authors: Moriyama T, Karasawa K, Nitta K Abstract BACKGROUND: In the traditional theory of albuminuria, small amounts of albumin pass through the fenestrae in glomerular endothelial cells, then through the slit membrane in the gaps between foot processes of glomerular epithelial cells. In the novel theory, large amounts of albumin pass through glomerular capillaries and are taken up by megalin and cubilin receptors on tubular epithelial cells. These etiologies of urinary albumin excretion are still controversial, and the details of albumin passage through the three layers of glomerular capillaries (glomerular endot...
Source: Contributions to Nephrology - May 9, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Rituximab as a Therapeutic Option for Steroid-Sensitive Minimal Change Nephrotic Syndrome in Adults.
Authors: Iwabuchi Y, Moriyama T, Itabashi M, Takei T, Nitta K Abstract Minimal change nephrotic syndrome (MCNS) usually responds to steroids but frequently relapses, requiring additional treatment with immunosuppressive agents. Rituximab is a chimeric murine/human monoclonal immunoglobulin G1 antibody that targets CD20, a B-cell differentiation marker. B-cell recovery begins at approximately 6 months following the completion of treatment. Rituximab has a beneficial effect, with the sustained remission or reduction of proteinuria in patients with steroid-dependent MCNS. Relapses are thought to be associated with an ...
Source: Contributions to Nephrology - May 9, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Large Renal Corpuscle: Clinical Significance of Evaluation of the Largest Renal Corpuscle in Kidney Biopsy Specimens.
Authors: Kataoka H, Mochizuki T, Nitta K Abstract Renal prognostic factors of chronic kidney disease are important concerns for patients. Kidney biopsy can be used to evaluate not only the activity of the original disease but also various risk factors related to the lifestyle of patients. Considering that lifestyle-related factors, including obesity and metabolic syndrome, are crucial prognostic risk factors of kidney disease progression and all-cause mortality, evaluation of lifestyle-related prognostic factors in kidney biopsy of all kidney diseases is important. Renal corpuscle size (glomerular size) is an easil...
Source: Contributions to Nephrology - May 9, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

New Insights into Cystic Kidney Diseases.
Authors: Mochizuki T, Makabe S, Aoyama Y, Kataoka H, Nitta K Abstract Hereditary cystic kidney diseases are considered as "ciliopathies" caused by abnormalities of the "primary cilia" situated on the tubules. As a result of dysplasia and dysfunction of cilia, formation of cysts occurs at various stages of life. Although occurring at a low incidence, hereditary cystic kidney diseases that develop from the fetal stage to childhood are diverse and are often associated with systemic disorders. The incidence of autosomal dominant polycystic kidney disease, which is the only adult-onset hereditary cys...
Source: Contributions to Nephrology - May 9, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Recent Advances in Treatment Strategies for Lupus Nephritis.
Authors: Karasawa K, Uchida K, Takabe T, Moriyama T, Nitta K Abstract Systemic lupus erythematosus (SLE) is an autoimmune chronic inflammatory disease that affects multiple organs and tissues. Lupus nephritis (LN) is a serious complication of SLE, which occurs at a high rate. Conventional treatment strategies of LN have been widely accepted by two concepts such as induction therapy and maintenance therapy. In LN induction therapy until recently, cyclophosphamide in combination with prednisone (PSL) has been the standard method of treatment for proliferative forms of LN. In the latest review, the combination of myco...
Source: Contributions to Nephrology - May 9, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Association between Increases in Normalized Protein Catabolic Rate and Increases in Creatinine Generation Rate in Dialysis Patients.
In this study, we investigated an association between changes of normalized protein catabolic rate (nPCR), as a proxy for protein intake and percent creatinine generation rate (%CGR), as a proxy for muscle mass in patients receiving hemodialysis. Multiple linear regression models were employed, and we included several sensitivity analyses. The results showed that increases in nPCR were associated with increases in %CGR. The association was stronger in patients with baseline %CGR levels below 100%. This was the first study to demonstrate that an increase in dietary protein intake might increase the muscle mass, but this stu...
Source: Contributions to Nephrology - May 9, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Renal Anemia and Iron Metabolism.
This study presents information regarding iron metabolism in patients on HD, the factors that influence iron metabolism in such patients, and the problems with existing treatment guidelines in Japan, apart from discussing the optimal iron levels and optimal Hb production indices. PMID: 29734151 [PubMed - in process] (Source: Contributions to Nephrology)
Source: Contributions to Nephrology - May 9, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Cell Sheet Engineering and Kidney Diseases.
Authors: Oka M, Miyabe Y, Sugiura N, Nitta K Abstract Treatment using the cell sheet technology has been applied to various organs, including the cornea, heart, esophagus, periodontium, cartilage, middle ear, and lungs. It has been shown that the therapeutic efficacy of cell sheet transplantation involves 2 aspects, supplementation of cells and provision of cytokines to the affected organ. In addition, cell sheet transplantation also promotes repair of damage through the paracrine effects of cytokines derived from the transplanted cells. It is known that in cases of cell transplantation by injection, the transplant...
Source: Contributions to Nephrology - May 9, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Clinical Impact of Left Ventricular Diastolic Dysfunction in Chronic Kidney Disease.
Authors: Ogawa T, Nitta K Abstract Left ventricular diastolic dysfunction (LVDD) frequently occurs in chronic kidney disease (CKD) and is associated with heart failure and higher mortality. LVDD is observed in patients with early stages of CKD and is associated with cardiovascular events, in patients undergoing incident hemodialysis in the absence of systolic function. The pathogenesis of CKD includes abnormal ventricular filling in diastole and a higher LV filling pressure (LVFP) because of LV hypertrophy (LVH), in addition to myocardial interstitial fibrosis. Therefore, LV dysfunction tends to cause pulmonary con...
Source: Contributions to Nephrology - May 9, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Treatment of Posttransplantation Anemia.
Authors: Unagami K, Okumi M, Tamura T, Ishida H, Tanabe K, Nitta K Abstract Kidney transplantation represents a renal replacement therapy for end-stage renal failure, with outcomes improving from year to year. With the improved survival prognosis, treatment of complications of chronic kidney disease after transplantation is becoming increasingly important. In particular, posttransplantation anemia (PTA) is often protracted, which could be related to a variety of factors, including the renal function status, graft rejection episodes, and infectious causes. PTA occurs in about 30-40% of transplant recipients, and is ...
Source: Contributions to Nephrology - May 9, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Role of Frailty on Outcomes of Dialysis Patients.
Authors: Nitta K, Hanafusa N, Tsuchiya K Abstract Frailty is a clinical state in which there is an increase in the individual's vulnerability to developing increased dependency and/or mortality when exposed to a stressor. Since the mean age of dialysis patients is increasing worldwide, frailty has recently come to be considered one of the risk factors for mortality in the older dialysis population. The prevalence of frailty among dialysis patients has ranged from 3.0- to 10-fold higher than in community-dwelling elderly, depending on the method of assessing frailty and patient characteristics. Since frailty has bee...
Source: Contributions to Nephrology - May 9, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Socioeconomics of Administering Rituximab for Nephrotic Syndrome.
Authors: Takura T, Takei T, Nitta K Abstract Nephrotic syndrome is a type of intractable disease caused by a disorder in the kidneys, which produces swelling. Although some patients show rapid improvement and recover completely with conventional treatment, many others experience frequent recurrence (frequently relapsing nephrotic syndrome) while some remain dependent on the same high dose of steroids they were initially prescribed at the start of treatment (steroid-dependent nephrotic syndrome). In the latter cases, side effects of prolonged steroid use are a major issue. Some reports show that administering rituxi...
Source: Contributions to Nephrology - May 9, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Use of Beta-Blockers on Maintenance Dialysis Patients and Ischemic Cerebral and Cardiovascular Deaths: An Examination Using Propensity Score.
Authors: Omae K, Ogawa T, Yoshikawa M, Sakura H, Nitta K Abstract Beta-blockers are frequently used in dialysis patients because of their cardioprotective properties. However, the effect of beta-blockers on reducing dialysis mortality has not been sufficiently examined to date. Thus, we sought to examine the effects on cardiovascular prognosis of beta-blockers using our outpatient dialysis database. From 389 dialysis patients registered in our database, subjects taking beta-blockers were extracted and matched with patients not taking beta-blockers using propensity scores based on 39 variables. Cardiovascular mortal...
Source: Contributions to Nephrology - May 9, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Direct Effects of Immunomodulatory Agents on Podocytes in Immune-Mediated Glomerular Diseases.
Authors: Manabe S, Nitta K, Nagata M Abstract Amelioration of podocyte injury, which can lead to podocyte detachment, is the target of therapeutic intervention in glomerular diseases. Since podocytes are terminally differentiated cells with little or no proliferative ability, their loss results in permanent glomerular dysfunction. In immune-mediated glomerular diseases, a variety of immunomodulatory agents are used to maintain podocytes by systemic immunosuppression, which indirectly ameliorates podocyte injury by interrupting the input of immunological stress. However, in contrast to the indirect therapeutic strat...
Source: Contributions to Nephrology - May 9, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Preliminaries.
Authors: PMID: 29734159 [PubMed - in process] (Source: Contributions to Nephrology)
Source: Contributions to Nephrology - May 9, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Author Index.
Authors: PMID: 29734160 [PubMed - in process] (Source: Contributions to Nephrology)
Source: Contributions to Nephrology - May 9, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Subject Index.
Authors: PMID: 29734161 [PubMed - in process] (Source: Contributions to Nephrology)
Source: Contributions to Nephrology - May 9, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Evolution of Technology for Continuous Renal Replacement Therapy: Forty Years of Improvement.
Authors: Ronco C Abstract Continuous arteriovenous hemofiltration (CAVH) was proposed in 1977 as an alternative treatment for acute renal failure in patients in whom peritoneal dialysis or hemodialysis was clinically or technically precluded. In the mid-1980s, this technique was extended to infants and children. CAVH presented important advantages in the areas of hemodynamic stability, control of circulating volume, and nutritional support. However, there were serious shortcomings such as the need for arterial cannulation and limited solute clearance. These problems were solved by the introduction of continuous art...
Source: Contributions to Nephrology - March 31, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Evolution of Vascular Access and Anticoagulation.
Authors: Honore PM, Spapen HD Abstract Continuous renal replacement therapy (CRRT) is an important and widely used adjuvant treatment in critically ill patients. However, any CRRT protocol can be adhered to only when the technique is correctly installed and functioning properly. Within this context, an appropriate vascular access and a safe and effective circuit anticoagulation method are key requisites. The right internal jugular (RIJ) vein is the preferred route for insertion with the tip of the catheter placed in the right atrium. Both femoral veins offer a valuable alternative access, but catheters must be long...
Source: Contributions to Nephrology - March 31, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Indications and Timing of Continuous Renal Replacement Therapy Application.
Authors: Bagshaw SM, Wald R Abstract Renal replacement therapy (RRT) is increasingly utilized to support critically ill patients with severe acute kidney injury (AKI). The clinical dilemma of when to ideally start RRT in these patients has been a longstanding issue that is in need of higher quality evidence to guide clinical practice. When clinicians are confronted with patients with life-threatening complications of AKI, the decision to start RRT is straightforward. However, in the absence of clear indications, the ideal circumstances and timing that balance the perceived benefits and risks of early versus delayed...
Source: Contributions to Nephrology - March 31, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Prescription and Delivery of the Right Continuous Renal Replacement Therapies Dose.
Authors: Villa G, Neri M, Ronco C, Cerdá J Abstract This chapter focuses on the definitions and impact of prescription and delivery of the right dose of treatment in patients on continuous renal replacement therapy (CRRT). We define "dose" and the concepts of efficiency, intensity, and efficacy; differentiate their multiple components; and describe the practical application of those concepts to direct patient care. In the article, we emphasize the effects of delivered dose variation on solute control, and list the main factors affecting CRRT dose delivery. Finally, we summarize the main indicators ...
Source: Contributions to Nephrology - March 31, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Membranes and Sorbents.
Authors: Clark WR, Gao D, Lorenzin A, Ronco C Abstract For continuous renal replacement therapy (CRRT), the extracorporeal filter provides solute depuration, fluid removal, and control of electrolyte and acid-base balance in critically ill patients with acute kidney injury (AKI). The membranes comprising CRRT filters are almost exclusively based on hollow fiber designs and, while adapted from the chronic hemodialysis field, have features that are specific to the requirements of CRRT nevertheless. In addition, these devices have evolved through the 40 years of CRRT in response to changes in clinical practice and the...
Source: Contributions to Nephrology - March 31, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Advances in Machine Technology.
Authors: Clark WR, Villa G, Neri M, Ronco C Abstract Continuous renal replacement therapy (CRRT) machines have evolved into devices specifically designed for critically ill over the past 40 years. In this chapter, a brief history of this evolution is first provided, with emphasis on the manner in which changes have been made to address the specific needs of the critically ill patient with acute kidney injury. Subsequently, specific examples of technology developments for CRRT machines are discussed, including the user interface, pumps, pressure monitoring, safety features, and anticoagulation capabilities. PMID...
Source: Contributions to Nephrology - March 31, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Extra-Renal Indications for Continuous Renal Replacement Therapy.
Authors: Vaara ST, Bellomo R Abstract Continuous renal replacement therapy (CRRT) has many potential indications that extend beyond the traditional removal of uremic waste products. Many of these stem from the capacity of CRRT to remove middle-sized molecules and its suitability for haemodynamically unstable patients. Using CRRT for immunomodulation to remove circulating plasma cytokines has created great enthusiasm and, in the past, immunomodulation was a frequently reported indication for commencing CRRT. Unfortunately, recent evidence from randomized controlled trials has been discouraging, and CRRT cannot be re...
Source: Contributions to Nephrology - March 31, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Technical Complications of Continuous Renal Replacement Therapy.
Authors: Ricci Z, Romagnoli S Abstract Continuous renal replacement therapy (CRRT) is commonly applied in critically ill patients affected by severe acute kidney injury for solute and volume control and to optimize acid-base and electrolytes balance. Although CRRT represents a life-saving procedure for these patients, it is a representation of a non-physiologic artificial kidney and the potential benefits of the treatment could be hampered by clinical and technical side effects. Different parts of the CRRT system can be a source of technical complications. Vascular access dysfunction, activation of the coagulation ...
Source: Contributions to Nephrology - March 31, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Clinical Complications of Continuous Renal Replacement Therapy.
Authors: Sigwalt F, Bouteleux A, Dambricourt F, Asselborn T, Moriceau F, Rimmelé T Abstract The various complications of continuous renal replacement therapy (CRRT) are mostly preventable. Hemodynamic disturbances are dominated by hypotension due to the modification of volume status, myocardial dysfunction, cardiac arrhythmia, or modification of systemic vascular resistances, which are correlated with body temperature changes. Metabolic complications remain at the forefront and have profoundly changed with the use of regional citrate anticoagulation (RCA). RCA may lead to two distinct situations: citrate ove...
Source: Contributions to Nephrology - March 31, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Discontinuation of Continuous Renal Replacement Therapy and Dialysis Dependence.
Authors: Romero-González G, Lorenzin A, Neri M, Ferrari F, Molano-Triviño A, Brendolan A, Ronco C Abstract Renal replacement therapy (RRT) is a form of extracorporeal support for critical patients, especially for those with acute kidney injury. This therapy enables to gain adequate control over the great metabolic and fluids demand when kidneys are not able to do so; this condition is habitually present in patients who are admitted to intensive care units. However, it is also clear that these patients present a higher mortality rate and, in some cases, complications associated with the therapy. Theref...
Source: Contributions to Nephrology - March 31, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Ensuring Quality of Care through Monitoring of Continuous Renal Replacement Therapies.
Authors: Rosner MH Abstract The continuous renal replacement therapy (CRRT) has offered life-saving treatment for kidney failure. Technological advances coupled with findings from clinical trials have allowed for refinements both in the therapy and in the way it is applied to patients. However, outcomes for patients requiring CRRT remain suboptimal. The use of information technology coupled with structured quality improvement programs offers a methodology for studying the delivery of CRRT with an eye toward improving outcomes. Furthermore, integration of information from the CRRT treatment can be combined with real...
Source: Contributions to Nephrology - March 31, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Continuous Renal Replacement Therapy Quality Control and Performance Measures.
Authors: Shen B, Xu J, Wang Y, Jiang W, Teng J, Ding X Abstract Continuous renal replacement therapy (CRRT) is one of the most predominant forms of renal replacement therapy (RRT) currently in use now, this therapy being the initial RRT modality in most critically ill patients. However, in general, the quality of CRRT is still suboptimal. The quality of CRRT is affected by many factors, including the optimal prescription and precision delivery, the CRRT providers' professional level, and the CRRT device used. Establishment of a comprehensive quality control system covering all the aspects and procedures of CRRT is ...
Source: Contributions to Nephrology - March 31, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Pediatric Continuous Renal Replacement Therapy for "40 Years of Continuous Renal Replacement Therapy".
Pediatric Continuous Renal Replacement Therapy for "40 Years of Continuous Renal Replacement Therapy". Contrib Nephrol. 2018;194:146-154 Authors: Goldstein SL Abstract The provision of continuous renal replacement therapy (CRRT) to pediatric patients presents numerous clinical and technical challenges that have been addressed over the past 40 years. Children provide an informative population for acute kidney injury and CRRT study, as pediatric subspecialists practice with a preventive perspective and children often do not have the multiple severe chronic comorbidities that confound adult stud...
Source: Contributions to Nephrology - March 31, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

From Continuous Renal Replacement Therapies to Multiple Organ Support Therapy.
Authors: Ricci Z, Romagnoli S, Ronco C, La Manna G Abstract The incidence of the multiple organ dysfunction syndrome (MODS) is rapidly increasing in intensive care units (ICU). It usually combines with sepsis and is the most frequent cause of death in the ICU patients. The nature of the ICU patients has changed in the last years. It includes a variety of patients with severe cases due to major surgical interventions, trauma, hemodynamic instability, sepsis, and so on but also older people than previous times. All these situations can easily lead to MODS. In the prior years, the only available and efficient therapy ...
Source: Contributions to Nephrology - March 31, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

The Association between Serum Uric Acid and Renal Damage: The Takahata Study - New Insights.
Authors: Konta T, Kamei K, Ichikawa K, Kayama T, Kubota I Abstract BACKGROUND: Hyperuricemia is a risk factor for causing end-stage kidney disease and cardiovascular disease in the general population; however, several aspects, such as the site of kidney damaged by hyperuricemia and the threshold levels of serum uric acid for the development of renal damage, have not been fully clarified. SUMMARY: To examine these aspects, we analyzed data from the Takahata study, a community-based cohort study involving participants of an annual health check-up, and used urinary albumin creatinine ratio (UACR) and urinary &beta...
Source: Contributions to Nephrology - February 3, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Uric Acid: The Unknown Uremic Toxin.
Authors: Treviño-Becerra A Abstract This review brings together concepts of uric acid metabolism affecting renal parenchyma and its function and the current therapies to reduce hyperuricemia (HyU) and avoid renal disease progression. High uric acid plays an important role in several chronic diseases including kidney diseases such as lithiasis, gout nephropathy, and preeclampsia. In the last 30 years, it has been shown that reducing HyU with low protein and low purine diets in addition to allopurinol creates physiopathological conditions that produce a slight increase in the glomerular filtration rate (GFR). ...
Source: Contributions to Nephrology - February 3, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

The Pathophysiology of Uric Acid on Renal Diseases.
Authors: Sánchez-Lozada LG Abstract BACKGROUND: Asymptomatic hyperuricemia was regarded as a marker and considered secondary to some pathological conditions such as hypertension. During the last 16 years, a vast amount of experimental work has shown that uric acid can cause intracellular alterations that lead to cardiovascular, renal, and metabolic disease. Epidemiological and clinical studies support this notion in specific populations. However, the clinical studies done so far are of such a small number that it is difficult to reach a consensus in regard to the benefit of treating asymptomatic hyperuricemi...
Source: Contributions to Nephrology - February 3, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Renal Effects of Hyperuricemia.
Authors: Méndez Landa CE Abstract BACKGROUND: From a clinical point of view, uric acid has been dismissed as a cause of injury and renal progression, and the mechanisms by which uric acid directly causes renal injury have not been fully understood. Hyperuricemia is associated with metabolic syndrome, diabetes, hypertension, and kidney and cardiovascular diseases. Although it remains controversial whether hyperuricemia is a causal factor for kidney disease, kidneys play a major role in the regulation of serum uric acid levels. SUMMARY: Similar to the management of other substances, renal uric acid managem...
Source: Contributions to Nephrology - February 3, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Uric Acid: The Lower the Better?
Authors: Bellomo G, Selvi A Abstract BACKGROUND: Uric acid (UA) is still considered a risk factor, or even a causative agent, for chronic kidney disease (CKD); however, a few, important, clinical questions remain unanswered; in particular: when and whether urate-lowering therapy should be commenced in subjects with asymptomatic hyperuricemia and/or monosodium urate crystals deposition? What is the most appropriate UA target to be achieved and how long does it need to be maintained? How does treatment need be adjusted in patients with chronic kidney disease? SUMMARY: The observational and intervention studies av...
Source: Contributions to Nephrology - February 3, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Renal Handling of Uric Acid.
Authors: Andrade Sierra J, Flores Fonseca MM Abstract Hyperuricemia occurs in 21.4% of the adult population and is associated with several conditions that increase oxidative stress and contributes to the pathogenesis of inflammatory mechanisms for the development and progression of diseases. Serum blood or urine samples of uric acid levels were used to mainly identify clinical problems, depending on the uric acid pathway alterations, which include synthesis, reabsorption or its excretion. Several proteins that act particularly as transporters (URAT1, GLUT9, 1-NPT1, 1-NPT4, OAT4, 9-MCT9, hUAT1, etc.) have been ident...
Source: Contributions to Nephrology - February 3, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Gout: A Disease of Kings.
Authors: Tang SCW Abstract As a disease of kings, and the king of diseases, gout is one of the oldest joint diseases known to humans. First described as far back as 2640 B.C., gout is still the most common form of inflammatory arthritis haunting humans in the 21st century. The disease is caused by the chronic elevation of serum uric acid levels above the saturation point for monosodium urate crystal formation. Its incidence is progressively rising even today, but there are also regional and ethnic variations. Finally, the role of genetics is only beginning to be unraveled. PMID: 29393108 [PubMed - in process] (...
Source: Contributions to Nephrology - February 3, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Hyperuricemia and Progression of Chronic Kidney Disease: Role of Phenotype Transition of Renal Tubular and Endothelial Cells.
Authors: Kang DH Abstract BACKGROUND: Although the clinical implication of hyperuricemia in chronic kidney disease has been an issue of active debate, recent data suggested a causative role of uric acid (UA) in the development of renal disease. Afferent arteriopathy, an induction of oxidative stress and an activation of local inflammation, have been regarded as the mechanisms of UA-induced renal disease, which contribute to glomerular hypertrophy and interstitial fibrosis via endothelial dysfunction. However, there have been rare studies on the direct effect of UA on phenotype transition of renal cells such as epit...
Source: Contributions to Nephrology - February 3, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Time to Target Uric Acid to Retard Chronic Kidney Disease Progression.
Authors: Uchida S, Kumagai T, Chang WX, Tamura Y, Shibata S Abstract Uric acid (UA) remains a risk factor for the progression of chronic kidney disease (CKD). Most observational studies showed a slight elevation in the serum UA level and this independently predicts the incidence and development of CKD. The recent meta-analysis, however, did not reach the conclusion that urate-lowering therapy with allopurinol retards the progression of CKD. The target level of serum UA if treated is another issue of debate. Our recent analysis by propensity score analysis has shown that the serum UA should be targeted below 6.0 mg/...
Source: Contributions to Nephrology - February 3, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Treatment of Hyperuricemia in Chronic Kidney Disease.
Authors: Ramirez-Sandoval JC, Madero M Abstract Hyperuricemia may be a major contributor to the development or progression of chronic kidney disease (CKD). Although there is no clear cutoff uric acid (UA) value associated to the risk for kidney damage, it appears to be an increased risk as UA rises. Lifestyle interventions such as exercise, weight reduction, low consumption of purine-rich meat, or avoiding high fructose intake are recommended for all hyperuricemic patients. Lowering urate drugs such as allopurinol or febuxostat may be an option as a renoprotective agent; yet, randomized clinical trials evaluating t...
Source: Contributions to Nephrology - February 3, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Significance of Hyperuricemia among Community-Based Screening Participants.
Authors: Iseki K Abstract BACKGROUND: Chronic kidney disease (CKD) is a risk factor of cardiovascular disease (CVD) and end-stage renal disease (ESRD). Early detection and management of risk factors of incidence and progression of CKD are necessary. We have been studying these risk factors among community-based screening participants in Okinawa, Japan. Okinawa was one of the longevity areas in the world; however, the incidence and prevalence of ESRD increased. In Japan, the incidence of ESRD is 2 times higher in men compared to that in women. Such gender difference in ESRD incidence may be explained by the differen...
Source: Contributions to Nephrology - February 3, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Uric Acid Renal Lithiasis: New Concepts.
Authors: Pazos Pérez F Abstract BACKGROUND: Uric acid (UA) stones are responsible for 5-10% of the formation of all kidney stones. Recently, an association between UA stones and insulin resistance, diabetes mellitus, and obesity has been demonstrated and so the incidence has increased. The development of UA stones is dependent on several risk factors, including genetic predisposition, geographical location, dietary indiscretion, and various metabolic characteristics. SUMMARY: UA nephrolithiasis can arise from diverse etiologies, all with distinct underlying defects converging to one or more of 3 defects ...
Source: Contributions to Nephrology - February 3, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Pediatric Acute Kidney Injury.
Authors: Fragasso T, Ricci Z, Goldstein SL Abstract BACKGROUND: Acute kidney injury (AKI) in children is a serious condition with an important impact on morbidity and mortality. Onset can be insidious and it is frequently unrecognized in the early phase when the therapeutic opportunities are theoretically more effective. SUMMARY: The present review focuses on the most recent epidemiology studies and the progress in pediatric AKI (pAKI) research. Standardization of definition (presented in the Kidney Disease: Improving Global Outcomes) and novel biomarkers have been developed to help clinicians recognize kidney ...
Source: Contributions to Nephrology - February 3, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

The Burden of Acute Kidney Injury and Related Financial Issues.
Authors: Ostermann M, Cerdá J Abstract BACKGROUND: Acute kidney injury (AKI) is one of the most common complications in acutely ill patients. The epidemiology, clinical presentation, and outcome vary between patients and countries. SUMMARY: Patients with AKI often exhibit multiple organ dysfunction that is caused, in part, by marked cross-talk between the kidney and other organs and tissues. These deleterious interactions arise, at least in part, from systemic inflammatory changes, an increased cytokine load, increases in leukocyte trafficking and activation of neurohormonal processes. Typical short-term...
Source: Contributions to Nephrology - February 3, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Uric Acid in Pregnancy: New Concepts.
Authors: Moreno Santillan AA, Briones Garduño JC, Diaz de Leon Ponce MA Abstract The relationship between hyperuricemia and hypertensive disorders is well established; however, until today, the role of uric acid in the clinical course of severe preeclampsia has not been elucidated. Some recent studies suggest that at the time of presentation, subjects with severe preeclampsia frequently have significantly elevated serum uric acid levels, and that the degree of elevation correlates with the severity of the maternal syndrome and fetal morbimortality. In this chapter, we present our workgroup experience. In 201...
Source: Contributions to Nephrology - February 3, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Systemic Implications of Hyperuricemia.
Authors: Tamayo Y Orozco JA Abstract Systemic implications of hyperuricemia need to be reconsidered in the context of the energy and protein wasting being an early indicator of organ deterioration in patients affected by the cardiometabolic syndrome and other frequent pathology states like pre-eclampsia, hyperparathyroidism, and chronic renal failure. This chapter points out physiological alterations that are to be made related to hyperuricemia, new diagnostic strategies, and early therapeutic interventions in the context of the old enemy: asymptomatic hyperuricemia. This chapter also concludes with a proposal to u...
Source: Contributions to Nephrology - February 3, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Uric Acid as a Cause of the Metabolic Syndrome.
Authors: King C, Lanaspa MA, Jensen T, Tolan DR, Sánchez-Lozada LG, Johnson RJ Abstract Hyperuricemia is common in subjects with obesity, metabolic syndrome, and type 2 diabetes. For many years, hyperuricemia was attributed to the effects of insulin resistance to reduce urinary excretion of uric acid, and it was believed that uric acid may not have any causal role in the metabolic syndrome. However, in recent years, hyperuricemia has been found to independently predict the development of diabetes. Experimental studies have also shown that hyperuricemia may mediate insulin resistance, fatty liver, and dyslipi...
Source: Contributions to Nephrology - February 3, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Acute Kidney Injury in the Geriatric Population.
Authors: Rosner MH, La Manna G, Ronco C Abstract The aging kidney is more susceptible to injury. Thus, it is not surprising that acute kidney injury (AKI) is a disorder with a relative high incidence in the elderly population, especially those with critical illness. Given the comorbid conditions common in the geriatric population as well as the increase in exposure to various nephrotoxic insults, it is likely that the incidence of AKI will grow in the coming decades. Thus, it is critical to gain an understanding of the cellular and molecular pathways operative in increasing the susceptibility to AKI with an aim to ...
Source: Contributions to Nephrology - February 3, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Acute Kidney Injury and Information Technology.
Authors: Küllmar M, Zarbock A Abstract Acute kidney injury (AKI) is a common complication that occurs in critically ill patients and it is associated with a worse outcome. Since therapy options are limited, prevention and early detection are the essential cornerstones to improve patient outcomes. Therefore, using health information technology (HIT) to detect AKI early might be useful for clinicians. Patient data can be extracted real-time from electronic health records. Programmed electronic alert systems (e-alerts) can increase clinicians' awareness for AKI. Integrated into clinical decision support systems, ...
Source: Contributions to Nephrology - February 3, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research