Editorial: Nomenclature for kidney function and disease: executive summary and glossary from a Kidney Disease: Improving Global Outcomes consensus conference
No abstract available (Source: Current Opinion in Nephrology and Hypertension)
Source: Current Opinion in Nephrology and Hypertension - August 1, 2020 Category: Urology & Nephrology Tags: SPECIAL COMMENTARIES Source Type: research

Burosumab in X-linked hypophosphatemia and perspective for chronic kidney disease
Purpose of review Perturbations in phosphate and vitamin D homeostasis impacts skeletal health in children and adults. Study of inherited and acquired hypophosphatemic syndromes led to the discovery of fibroblast growth factor 23 (FGF23) as a potent regulator of phosphate and vitamin D metabolism, and advanced our understanding of the pathophysiology of mineral and bone disorder in chronic kidney disease (CKD-MBD). Here, we review a recently approved therapy for patients with X-linked hypophosphatemia (XLH) using a novel anti-FGF23 antibody, burosumab, and discuss the implications of such targeted therapy in CKD. Recent...
Source: Current Opinion in Nephrology and Hypertension - August 1, 2020 Category: Urology & Nephrology Tags: SPECIAL COMMENTARIES Source Type: research

Tubular effects of sodium–glucose cotransporter 2 inhibitors: intended and unintended consequences
Purpose of review Sodium–glucose cotransporter 2 (SGLT2) inhibitors are antihyperglycemic drugs that act by inhibiting renal sodium–glucose cotransport. Here we present new insights into ‘off target’, or indirect, effects of SGLT2 inhibitors. Recent findings SGLT2 inhibition causes an acute increase in urinary glucose excretion. In addition to lowering blood glucose, there are several other effects that contribute to the overall beneficial renal and cardiovascular effects. Reabsorption of about 66% of sodium is accomplished in the proximal tubule and dependent on the sodium–hydrogen excha...
Source: Current Opinion in Nephrology and Hypertension - August 1, 2020 Category: Urology & Nephrology Tags: SPECIAL COMMENTARIES Source Type: research

Actions of immune cells in the hypertensive kidney
Purpose of review Inflammatory processes play a critical role in the pathogenesis of hypertension. Innate and adaptive immune responses participate in blood pressure (BP) elevation and end-organ damage. In this review, we discuss recent studies illustrating mechanisms through which immune cells and cytokines regulate BP via their actions in the kidney. Recent findings Cells of the innate immune system, including monocytes, neutrophils, and dendritic cells, can all promote BP elevation via effects on kidney function. These innate immune cells can directly impact oxidative stress and cytokine generation in the kidney an...
Source: Current Opinion in Nephrology and Hypertension - August 1, 2020 Category: Urology & Nephrology Tags: SPECIAL COMMENTARIES Source Type: research

Iron deficiency and iron therapy in heart failure and chronic kidney disease
Purpose of review Iron deficiency is common and associated with adverse outcomes in heart failure, regardless of anemia. Iron deficiency, absolute and functional, with and without anemia, is associated with adverse outcomes in chronic kidney disease (CKD). Heart failure and CKD frequently occur together. Intravenous iron therapy has been shown to reduce heart failure symptoms and improve physical function in heart failure with reduced ejection fraction with iron deficiency. In CKD, intravenous or oral iron therapy are often used for management of anemia, along with erythropoiesis stimulating agents, yet the risks and ben...
Source: Current Opinion in Nephrology and Hypertension - August 1, 2020 Category: Urology & Nephrology Tags: PHARMACOLOGY AND THERAPEUTICS: Edited by Sankar D. Navaneethan Source Type: research

Therapeutic options for chronic kidney disease-associated pulmonary hypertension
Purpose of review Pulmonary hypertension is a common and devastating complication of chronic kidney disease (CKD). Traditionally considered a consequence of volume overload, recent findings now expand this paradigm. These novel mechanisms herald new treatment options. This review summarizes the current evidence to provide a theoretical model of the contributing factors for CKD-associated pulmonary hypertension. Along this framework, we highlight current and emerging therapeutic strategies for each putative factor. Recent findings A series of retrospective studies of right heart catheterization data provide insights in...
Source: Current Opinion in Nephrology and Hypertension - August 1, 2020 Category: Urology & Nephrology Tags: PHARMACOLOGY AND THERAPEUTICS: Edited by Sankar D. Navaneethan Source Type: research

Direct oral anticoagulants in chronic kidney disease: an update
Purpose of review Direct oral anticoagulants (DOACs) are variably eliminated by the kidneys rendering their use potentially problematic in patients with chronic kidney disease (CKD) or necessitating appropriate dose adjustment. Recent findings Both observational and limited randomized trial data for DOACs compared with no treatment or with warfarin for patients with atrial fibrillation on maintenance dialysis were recently published. In a randomized trial in patients on hemodialysis, there was no significant difference in vascular calcification between patients who received rivaroxaban with or without vitamin K2 or vi...
Source: Current Opinion in Nephrology and Hypertension - August 1, 2020 Category: Urology & Nephrology Tags: PHARMACOLOGY AND THERAPEUTICS: Edited by Sankar D. Navaneethan Source Type: research

LDL-cholesterol reduction in chronic kidney disease: options beyond statins
Purpose of review Individuals with chronic kidney disease (CKD) are at increased risk of atherosclerotic cardiovascular disease (ASCVD) events. LDL cholesterol (LDL-C) is a key modifiable cause of ASCVD and lowering LDL-C with statins reduces the risk of ASCVD events in a wide range of populations, including those with CKD. This review considers the utility of recently developed nonstatin LDL-C-lowering therapies in CKD. Recent findings The cholesterol absorption inhibitor, ezetimibe, reduces LDL-C by 15–20% and is well tolerated in CKD. Monoclonal antibodies (mAbs) targeting proprotein convertase subtilisin kex...
Source: Current Opinion in Nephrology and Hypertension - August 1, 2020 Category: Urology & Nephrology Tags: PHARMACOLOGY AND THERAPEUTICS: Edited by Sankar D. Navaneethan Source Type: research

Advances in exercise therapy in predialysis chronic kidney disease, hemodialysis, peritoneal dialysis, and kidney transplantation
Purpose of review Chronic kidney disease (CKD) is characterized by poor levels of physical activity which contribute to increased morbidity across the disease trajectory. The short nature, small samples, and poor methodology across most studies have failed to translate the role of exercise in CKD into its adoption as a frontline adjunct therapeutic option. This review focuses on recent advances surrounding the benefits of exercise interventions across the CKD spectrum. Recent findings Key recent advances in exercise studies have focused on the efficacy of novel intervention strategies across the CKD spectrum. These in...
Source: Current Opinion in Nephrology and Hypertension - August 1, 2020 Category: Urology & Nephrology Tags: PHARMACOLOGY AND THERAPEUTICS: Edited by Sankar D. Navaneethan Source Type: research

Recent advances in the treatment of uremic pruritus
This article provides a focused update on uremic pruritus, highlighting the latest evidence concerning the epidemiology, pathophysiology, and treatment options for this common and bothersome condition. Recent findings Half of dialysis patients and a quarter of those with nondialysis chronic kidney disease experience bothersome itch that reduces quality of life and is increasingly recognized to be associated with poor outcomes including mortality. The KALM-1 trial, which reported effective symptomatic relief with difelikefalin, has bolstered support for the role of an imbalance of μ and κ-opioid receptor activit...
Source: Current Opinion in Nephrology and Hypertension - August 1, 2020 Category: Urology & Nephrology Tags: PHARMACOLOGY AND THERAPEUTICS: Edited by Sankar D. Navaneethan Source Type: research

Pharmacologic and psychological interventions for depression treatment in patients with kidney disease
Purpose of review It remains controversial whether existing therapies, including pharmacologic and psychological interventions, are effective for treatment of depression in patients with chronic kidney disease (CKD) and end-stage kidney disease. Recent findings Most studies of depression treatment were underpowered or uncontrolled. The CKD Antidepressant Sertraline Trial showed no benefit of a serotonin-selective reuptake inhibitor (SSRI), sertraline, over double-blind matched placebo for the treatment of depressive symptoms in patients with nondialysis CKD. A Trial of Sertraline vs. Cognitive Behavioral Therapy (CBT)...
Source: Current Opinion in Nephrology and Hypertension - August 1, 2020 Category: Urology & Nephrology Tags: PHARMACOLOGY AND THERAPEUTICS: Edited by Sankar D. Navaneethan Source Type: research

Editorial: Management of cardiovascular risk factors and other comorbidities in chronic kidney disease
No abstract available (Source: Current Opinion in Nephrology and Hypertension)
Source: Current Opinion in Nephrology and Hypertension - August 1, 2020 Category: Urology & Nephrology Tags: PHARMACOLOGY AND THERAPEUTICS: Edited by Sankar D. Navaneethan Source Type: research

Editorial introduction
No abstract available (Source: Current Opinion in Nephrology and Hypertension)
Source: Current Opinion in Nephrology and Hypertension - August 1, 2020 Category: Urology & Nephrology Tags: EDITORIAL INTRODUCTION Source Type: research

Fibroblast growth factor receptor as a potential candidate for phosphate sensing
Purpose of review Phosphate plays essential roles in many biological processes. Serum phosphate level needs to be regulated because hypophosphatemia and hyperphosphatemia cause rickets/osteomalacia and ectopic calcification, respectively. Fibroblast growth factor (FGF) 23 is the principal hormone to regulate serum phosphate level. FGF23 is produced by the bone and works to reduce serum phosphate level by binding to FGF receptor (FGFR) 1c and α-Klotho complex in the kidney. It has been unclear how the bone senses the changes of serum phosphate level and how the bone regulates the production of FGF23. Recent finding...
Source: Current Opinion in Nephrology and Hypertension - May 29, 2020 Category: Urology & Nephrology Tags: RENAL PATHOPHYSIOLOGY: Edited by Orson W. Moe and Susan E. Quaggin Source Type: research

Molecular regulation and function of FoxO3 in chronic kidney disease
Purpose of review FOXOs are transcription factors that regulate downstream target genes to counteract to cell stress. Here we review the function and regulation of FOXO transcription factors, the mechanism of FOXO3 activation in the kidney, and the role of FOXO3 in delaying the development of chronic kidney disease (CKD). Recent findings Progressive renal hypoxia from vascular dropout and metabolic perturbation is a pathogenic factor for the initiation and development of CKD. Hypoxia and low levels of α-ketoglutarate generated from the TCA cycle inhibit prolyl hydroxylase domain (PHD)-mediated prolyl hydroxylati...
Source: Current Opinion in Nephrology and Hypertension - May 29, 2020 Category: Urology & Nephrology Tags: RENAL PATHOPHYSIOLOGY: Edited by Orson W. Moe and Susan E. Quaggin Source Type: research

The role of PPARα in autosomal dominant polycystic kidney disease
Purpose of review Metabolic reprogramming is a prominent feature of cyst epithelial cells in autosomal dominant polycystic kidney disease (ADPKD). Peroxisome proliferator activated receptor alpha (PPARα) is a transcription factor that regulates many aspects of cellular metabolism. The purpose of this review is to understand the role of PPARα in ADPKD. Recent findings PPARα expression is reduced in ADPKD kidneys of mice and humans. This downregulation is in part secondary to microRNA mediated translational repression and leads to impairment of fatty acid metabolism. Genetic studies demonstrate that de...
Source: Current Opinion in Nephrology and Hypertension - May 29, 2020 Category: Urology & Nephrology Tags: RENAL PATHOPHYSIOLOGY: Edited by Orson W. Moe and Susan E. Quaggin Source Type: research

The role of uric acid in inflammasome-mediated kidney injury
Purpose of review Uric acid is produced after purine nucleotide degradation, upon xanthine oxidase catalytic action. In the evolutionary process, humans lost uricase, an enzyme that converts uric acid into allantoin, resulting in increased serum uric acid levels that may vary according to dietary ingestion, pathological conditions, and other factors. Despite the controversy over the inflammatory role of uric acid in its soluble form, crystals of uric acid are able to activate the NLRP3 inflammasome in different tissues. Uric acid, therefore, triggers hyperuricemic-related disease such as gout, metabolic syndrome, and kid...
Source: Current Opinion in Nephrology and Hypertension - May 29, 2020 Category: Urology & Nephrology Tags: RENAL PATHOPHYSIOLOGY: Edited by Orson W. Moe and Susan E. Quaggin Source Type: research

Hypoxia-inducible factor prolyl hydroxylase inhibitor in the treatment of anemia in chronic kidney disease
Purpose of review Hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) are orally active small molecules and are launched as novel therapeutic agents for anemia in chronic kidney disease (CKD). In contrast to conventional exogenous erythropoietin (EPO) administration, HIF-PHIs stimulate endogenous EPO production and improve iron metabolism via stabilization of hypoxia-inducible factor (HIF). This review summarizes the mechanism of action, the results of clinical trials, and future perspectives of HIF-PHIs. Recent findings Six HIF-PHIs are currently under phase III studies, some of which have been already ...
Source: Current Opinion in Nephrology and Hypertension - May 29, 2020 Category: Urology & Nephrology Tags: RENAL PATHOPHYSIOLOGY: Edited by Orson W. Moe and Susan E. Quaggin Source Type: research

Uric acid stone disease: lessons from recent human physiologic studies
Purpose of review An overly acidic urine resulting in supersaturation of urine with respect to uric acid is the major mechanism responsible for uric acid nephrolithiasis. The present review summarizes findings from recent human physiologic studies examining the pathophysiology and reversibility of low urine pH in uric acid stone formers. Recent findings Epidemiologic and metabolic studies have confirmed an increase in the prevalence of uric acid nephrolithiasis and reported its association with several features of the metabolic syndrome including dyslipidemia, hyperglycemia, hepatic steatosis, and greater visceral adi...
Source: Current Opinion in Nephrology and Hypertension - May 29, 2020 Category: Urology & Nephrology Tags: MINERAL METABOLISM: Edited by Aline Martin and Tamara Isakova Source Type: research

Lessons from rodent gastric bypass model of enteric hyperoxaluria
Purpose of review The aim of the article is to review studies on bone health and oxalate metabolism/therapeutics in the obese rodent model of Roux-en-Y gastric bypass (RYGB) and examine pathways to decrease procedural morbidity. Recent findings Compared with controls, RYGB rodents have up to 40-fold more fat in their stool (steatorrhea) which positively correlates to increased urinary oxalate. These unabsorbed intestinal fatty acids bind calcium and prevent gut calcium oxalate formation, increasing soluble luminal oxalate availability and absorption (enteric hyperoxaluria). When intraluminal fecal fat exceeded about 1...
Source: Current Opinion in Nephrology and Hypertension - May 29, 2020 Category: Urology & Nephrology Tags: MINERAL METABOLISM: Edited by Aline Martin and Tamara Isakova Source Type: research

Stiripentol identifies a therapeutic target to reduce oxaluria
Purpose of review Oxalate is a metabolic end-product promoting the formation of calcium oxalate crystals in urine. Massive urine oxalate excretion occurs in genetic diseases, mainly primary hyperoxaluria type I and II, threatening renal function. Ethylene glycol poisoning may induce the precipitation of calcium oxalate crystals in renal tubules, leading to acute renal failure. In both cases, oxalate results from glyoxylate transformation to oxalate in the liver, by lactate dehydrogenase (LDH) enzymes, especially the LDH-5 isoenzyme. The purpose of the review is to highlight LDH as a potential therapeutic target according...
Source: Current Opinion in Nephrology and Hypertension - May 29, 2020 Category: Urology & Nephrology Tags: MINERAL METABOLISM: Edited by Aline Martin and Tamara Isakova Source Type: research

Genetic variants of mineral metabolism in health and disease
Purpose of review Disturbances in mineral metabolism are common among individuals with chronic kidney disease and have consistently been associated with cardiovascular and bone disease. The current review aims to describe the current knowledge of the genetic aspects of mineral metabolism disturbances and to suggest directions for future studies to uncover the cause and pathogenesis of chronic kidney disease – mineral bone disorder. Recent findings The most severe disorders of mineral metabolism are caused by highly penetrant, rare, single-gene disruptive mutations. More recently, genome-wide association studies ...
Source: Current Opinion in Nephrology and Hypertension - May 29, 2020 Category: Urology & Nephrology Tags: MINERAL METABOLISM: Edited by Aline Martin and Tamara Isakova Source Type: research

Calciprotein particles: mineral behaving badly?
Purpose of review Calciprotein particles (CPP) are formed in supersaturated solutions of calcium, phosphate and the mineral-binding protein fetuin-A. CPP have garnered considerable interest as potential mediators of mineral stress, but little consideration has been given to their origin, clearance and role in metabolism. Recent findings CPP are made whilst buffering the mineral absorbed from the intestine after a meal or during remodelling of bone matrix. The postprandial rise in circulating CPP rise may be sensed by osteoblasts/osteocytes in bone, stimulating the secretion of the master phosphatonin fibroblast growth...
Source: Current Opinion in Nephrology and Hypertension - May 29, 2020 Category: Urology & Nephrology Tags: MINERAL METABOLISM: Edited by Aline Martin and Tamara Isakova Source Type: research

Circadian rhythms of mineral metabolism in chronic kidney disease–mineral bone disorder
Purpose of review The circadian rhythms have a systemic impact on all aspects of physiology. Kidney diseases are associated with extremely high-cardiovascular mortality, related to chronic kidney disease–mineral bone disorder (CKD–MBD), involving bone, parathyroids and vascular calcification. Disruption of circadian rhythms may cause serious health problems, contributing to development of cardiovascular diseases, metabolic syndrome, cancer, organ fibrosis, osteopenia and aging. Evidence of disturbed circadian rhythms in CKD–MBD parameters and organs involved is emerging and will be discussed in this rev...
Source: Current Opinion in Nephrology and Hypertension - May 29, 2020 Category: Urology & Nephrology Tags: MINERAL METABOLISM: Edited by Aline Martin and Tamara Isakova Source Type: research

Simultaneous management of disordered phosphate and iron homeostasis to correct fibroblast growth factor 23 and associated outcomes in chronic kidney disease
Purpose of review Hyperphosphatemia, iron deficiency, and anemia are powerful stimuli of fibroblast growth factor 23 (FGF23) production and are highly prevalent complications of chronic kidney disease (CKD). In this manuscript, we put in perspective the newest insights on FGF23 regulation by iron and phosphate and their effects on CKD progression and associated outcomes. We especially focus on new studies aiming to reduce FGF23 levels, and we present new data that suggest major benefits of combined corrections of iron, phosphate, and FGF23 in CKD. Recent findings New studies show that simultaneously correcting iron de...
Source: Current Opinion in Nephrology and Hypertension - May 29, 2020 Category: Urology & Nephrology Tags: MINERAL METABOLISM: Edited by Aline Martin and Tamara Isakova Source Type: research

Editorial: New and repurposed therapeutics for mineral, stone and vascular disorders
No abstract available (Source: Current Opinion in Nephrology and Hypertension)
Source: Current Opinion in Nephrology and Hypertension - May 29, 2020 Category: Urology & Nephrology Tags: MINERAL METABOLISM: Edited by Aline Martin and Tamara Isakova Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Nephrology and Hypertension)
Source: Current Opinion in Nephrology and Hypertension - May 29, 2020 Category: Urology & Nephrology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Anemia management in dialysis patients: a PIVOT and a new path?
Purpose of review We will examine the current and future options in management of anemia in dialysis patients focusing on recent trials in iron supplementation and alternatives to erythropoietin-stimulating agents (ESAs). Recent findings We review the literature on Erythropoietin (EPO)-stimulating agents, focusing on the risk benefits of various options available. We review the recent practice changing trial in iron supplementation in dialysis patients with chronic kidney disease and movements in the research on alternatives to EPO-stimulating agents primarily hypoxia-inducible factor prolyl hydroxylase inhibitors (HI...
Source: Current Opinion in Nephrology and Hypertension - April 1, 2020 Category: Urology & Nephrology Tags: EPIDEMIOLOGY AND PREVENTION: Edited by Navdeep Tangri Source Type: research

Assessing physical function in chronic kidney disease
Purpose of review People with chronic kidney disease have a high prevalence of poor physical function, which in turn is associated with poor health-related quality of life, and an increased risk of adverse events, including hospitalizations and all-cause mortality. Implementing early interventions may prove to be effective for preventing decline in physical function; however, it is imperative that clinicians screen patients to identify those at the highest risk of decline. In this review, we present subjective and objective screening tools that can easily and cost-effectively be implemented into routine nephrology practi...
Source: Current Opinion in Nephrology and Hypertension - April 1, 2020 Category: Urology & Nephrology Tags: EPIDEMIOLOGY AND PREVENTION: Edited by Navdeep Tangri Source Type: research

Integrating risk prediction models into chronic kidney disease care
Purpose of review Although the concept of risk prediction in chronic kidney disease (CKD) is not new, how to integrate risk prediction models into CKD care remains largely unknown, particularly in the prevention and early management of CKD. The present review presents a timely overview of recent CKD risk prediction models and conceptualizes how these may be integrated into the care of patients with CKD. Recent findings In recent literature, prediction of time-to-ESKD has been thoroughly validated in multiple international cohorts, new models focused on CKD incidence, morbidity, and mortality have been developed, and o...
Source: Current Opinion in Nephrology and Hypertension - April 1, 2020 Category: Urology & Nephrology Tags: EPIDEMIOLOGY AND PREVENTION: Edited by Navdeep Tangri Source Type: research

Screening for chronic kidney disease: moving toward more sustainable health care
Purpose of review Chronic kidney disease (CKD) is a pervasive and growing health concern that has a significant impact on mortality and morbidity, putting stress on global healthcare systems. CKD affects ∼14% of general populations and ∼36% of high-risk populations and is projected to rise in the coming decade due to increasing rates of diabetes and hypertension. Recent findings Screen, triage, and treat programs aim to detect early stage disease with the intention of promoting medical and lifestyle interventions in line with a patient's level of risk that may slow disease progression and reduce morbidity and ...
Source: Current Opinion in Nephrology and Hypertension - April 1, 2020 Category: Urology & Nephrology Tags: EPIDEMIOLOGY AND PREVENTION: Edited by Navdeep Tangri Source Type: research

Blood pressure targets in chronic kidney disease: an update on the evidence
Purpose of review Hypertension is the leading modifiable cause of cardiovascular events and of mortality and is generally considered as a direct cause of chronic kidney disease. Defining optimal blood pressure targets in patients with chronic kidney disease is therefore of critical importance. Recent findings Over the recent years, results and post-hoc analyses of several important trials comparing blood pressure targets which included patients with chronic kidney disease have been published. Although these results provide important means to understand the consequences of high blood pressure and to improve the managem...
Source: Current Opinion in Nephrology and Hypertension - April 1, 2020 Category: Urology & Nephrology Tags: EPIDEMIOLOGY AND PREVENTION: Edited by Navdeep Tangri Source Type: research

Applications of machine learning methods in kidney disease: hope or hype?
Purpose of review The universal adoption of electronic health records, improvement in technology, and the availability of continuous monitoring has generated large quantities of healthcare data. Machine learning is increasingly adopted by nephrology researchers to analyze this data in order to improve the care of their patients. Recent findings In this review, we provide a broad overview of the different types of machine learning algorithms currently available and how researchers have applied these methods in nephrology research. Current applications have included prediction of acute kidney injury and chronic kidney d...
Source: Current Opinion in Nephrology and Hypertension - April 1, 2020 Category: Urology & Nephrology Tags: EPIDEMIOLOGY AND PREVENTION: Edited by Navdeep Tangri Source Type: research

Acute kidney injury and maladaptive tubular repair leading to renal fibrosis
Purpose of review Despite improvements in acute kidney injury (AKI) detection, therapeutic options to halt the progression of AKI to chronic kidney disease (CKD) remain limited. In this review, we focus on recent discoveries related to the pathophysiology of the AKI to CKD continuum, particularly involving the renal tubular epithelial cells, and also discuss related ongoing clinical trials. While our focus is on injured renal tubular epithelial cells as initiators of the cascade of events resulting in paracrine effects on other cells of the kidney, the summation of maladaptive responses from various kidney cell types ult...
Source: Current Opinion in Nephrology and Hypertension - April 1, 2020 Category: Urology & Nephrology Tags: RENAL IMMUNOLOGY AND PATHOLOGY: Edited by Agnes B. Fogo Source Type: research

The glomerular crescent: triggers, evolution, resolution, and implications for therapy
Purpose of review Crescents are classical histopathological lesions found in severe forms of rapidly progressive glomerulonephritis, also referred to as crescentic glomerulonephritis (CGN). Crescent formation is a consequence of diverse upstream pathomechanisms and unraveling these mechanisms is of great interest for improving the management of patients affected by CGN. Thus, in this review, we provide an update on the latest insight into the understanding on how crescents develop and how they resolve. Recent findings Cellular crescents develop from activated parietal epithelial cells (PECs) residing along Bowman's ca...
Source: Current Opinion in Nephrology and Hypertension - April 1, 2020 Category: Urology & Nephrology Tags: RENAL IMMUNOLOGY AND PATHOLOGY: Edited by Agnes B. Fogo Source Type: research

Parietal epithelial cells role in repair versus scarring after glomerular injury
Purpose of review The recent years have been marked by the publication of several articles highlighting the pathophysiological role of glomerular parietal epithelial cells (PEC) and refining their phenotypic heterogeneity. Recent findings The present review synthetizes recent findings on (i) the potential regenerative role of PEC in glomerular diseases, and (ii) the mechanisms and signaling of leading to PEC pathogenic involvement in crescentic glomerulonephritis (CGN) and focal segmental glomerulosclerosis (FSGS). Summary The debate is still open regarding the podocyte regenerative properties of PEC in glomerular ...
Source: Current Opinion in Nephrology and Hypertension - April 1, 2020 Category: Urology & Nephrology Tags: RENAL IMMUNOLOGY AND PATHOLOGY: Edited by Agnes B. Fogo Source Type: research

The varying roles of macrophages in kidney injury and repair
Purpose of review Macrophages play an important role in regulating homeostasis, kidney injury, repair, and tissue fibrogenesis. The present review will discuss recent advances that explore the novel subsets and functions of macrophage in the pathogenesis of kidney damage and hypertension. Recent findings Macrophages differentiate into a variety of subsets in microenvironment-dependent manner. Although the M1/M2 nomenclature is still applied in considering the pro-inflammatory versus anti-inflammatory effects of macrophages in kidney injury, novel, and accurate macrophage phenotypes are defined by flow cytometric marke...
Source: Current Opinion in Nephrology and Hypertension - April 1, 2020 Category: Urology & Nephrology Tags: RENAL IMMUNOLOGY AND PATHOLOGY: Edited by Agnes B. Fogo Source Type: research

Epigenomics and the kidney
Purpose of review Epigenetic modifications are reversible changes to a cell's DNA or histones that alter gene expression but not DNA sequence. The present review will explore epigenomic profiling and bioinformatics techniques for the study of kidney development and disease. Recent findings Reversible DNA and histone modifications influence chromatin accessibility and can be measured by a variety of recent techniques including DNase-seq, ATAC-seq, and single cell ATAC-seq. These approaches have been used to demonstrate that DNA methylation is critical for nephron progenitor maturation, for example. New bioinformatics t...
Source: Current Opinion in Nephrology and Hypertension - April 1, 2020 Category: Urology & Nephrology Tags: RENAL IMMUNOLOGY AND PATHOLOGY: Edited by Agnes B. Fogo Source Type: research

Reconsidering Garth Robinson: fluid flow and the glomerular filtration barrier
Purpose of review The goal of this review is to present recent models of the filtration barrier that may suggest mechanism-based treatments for proteinuric renal disease. The vast majority of renal failure occurs in diseases of glomerular proteinuria. The physiology of the filtration barrier remains incompletely understood, preventing invention of mechanism-based therapies. Research is currently dominated by molecular biology approaches to the kidney instead of engineering-based filtration and transport models. Recent findings Reexamination of two older paradigms (basement membrane and slit diaphragm) and critical ana...
Source: Current Opinion in Nephrology and Hypertension - April 1, 2020 Category: Urology & Nephrology Tags: RENAL IMMUNOLOGY AND PATHOLOGY: Edited by Agnes B. Fogo Source Type: research

Artificial intelligence driven next-generation renal histomorphometry
This article discusses how image analysis and machine learning have enabled comprehensive characterization of kidney morphology for development of automated diagnostic and prognostic renal pathology applications. Recent findings The primordial digital pathology informatics work employed classical image analysis and machine learning to prognosticate renal disease. Although this classical approach demonstrated tremendous potential, subsequent advancements in hardware technology rendered artificial neural networks ‘(ANNs) the method of choice for machine vision in computational pathology’. Offering rapid and re...
Source: Current Opinion in Nephrology and Hypertension - April 1, 2020 Category: Urology & Nephrology Tags: RENAL IMMUNOLOGY AND PATHOLOGY: Edited by Agnes B. Fogo Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Nephrology and Hypertension)
Source: Current Opinion in Nephrology and Hypertension - April 1, 2020 Category: Urology & Nephrology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Mineralocorticoid receptor antagonists in heart failure patients with chronic kidney disease: why, when, and how?
Purpose of review Congestive heart failure (CHF) and chronic kidney disease (CKD) often coexist. However, and despite their established benefits, the use of mineralcorticoid receptor antagonists (MRAs) in patients with both comorbidities is inconsistent. This review will focus on the role of aldosterone in CHF, as well as timing, selection, and management of MRAs in CHF patients with CKD. Recent findings Aldosterone in CHF patients contributes to worsening sodium retention, hypokalemia, metabolic alkalosis, cardiac fibrosis, and CKD progression. MRAs are beneficial in CHF patients with CKD despite the adverse events o...
Source: Current Opinion in Nephrology and Hypertension - January 30, 2020 Category: Urology & Nephrology Tags: CLINICAL NEPHROLOGY: Edited by David S. Goldfarb Source Type: research

The nephrologist's guide to cannabis and cannabinoids
Purpose of review Cannabis (marijuana, weed, pot, ganja, Mary Jane) is the most commonly used federally illicit drug in the United States. The present review provides an overview of cannabis and cannabinoids with relevance to the practice of nephrology so that clinicians can best take care of patients. Recent findings Cannabis may have medicinal benefits for treating symptoms of advanced chronic kidney disease (CKD) and end-stage renal disease including as a pain adjuvant potentially reducing the need for opioids. Cannabis does not seem to affect kidney function in healthy individuals. However, renal function should b...
Source: Current Opinion in Nephrology and Hypertension - January 30, 2020 Category: Urology & Nephrology Tags: CLINICAL NEPHROLOGY: Edited by David S. Goldfarb Source Type: research

Vitamin D in chronic kidney disease: is there a role outside of PTH control?
Purpose of review Vitamin D deficiency is common in patients with kidney disease and many patients receive vitamin D supplementation. Several large, well-designed clinical trials have been published in the last few years evaluating the effects of vitamin D supplementation on important outcomes for patients with kidney disease including effects on cardiovascular disease, secondary hyperparathyroidism, and kidney disease progression. Recent findings Several negative trials have been published showing no effect of cholecalciferol supplementation on cardiovascular events, kidney disease progression, and albuminuria. Long-...
Source: Current Opinion in Nephrology and Hypertension - January 30, 2020 Category: Urology & Nephrology Tags: CLINICAL NEPHROLOGY: Edited by David S. Goldfarb Source Type: research

Chronic kidney disease and kidney stones
Purpose of review Both chronic kidney disease (CKD) and kidney stones are major public health problems, which are closely interrelated. Recurrent kidney stones predispose to CKD although CKD seems to decrease risk of further kidney stone formation. Herein, we review new information of this interrelationship. Recent findings Several epidemiological studies in the past have shown an association between history of kidney stones and risk for CKD and CKD progression. Recent literature supports this concept and it is reviewed in this article. The issue of whether CKD protects against new kidney stone formation remains unset...
Source: Current Opinion in Nephrology and Hypertension - January 30, 2020 Category: Urology & Nephrology Tags: CLINICAL NEPHROLOGY: Edited by David S. Goldfarb Source Type: research

Occupational kidney stones
Purpose of review Kidney stones are a common and preventable disorder. Certain occupations may increase risk for stone disease which will be discussed in this review. Few observational studies have examined this association. Recent findings Some occupations prevent individuals from drinking enough fluids to maintain a dilute urine or to void when they need to. People may have poor access to fluids or to bathroom facilities. These issues pose a risk for stone disease and are exacerbated by those who work in warmer climates. Individuals who do more activity while working, especially outdoors, perspire more, leading to m...
Source: Current Opinion in Nephrology and Hypertension - January 30, 2020 Category: Urology & Nephrology Tags: CLINICAL NEPHROLOGY: Edited by David S. Goldfarb Source Type: research

Using race in the estimation of glomerular filtration rates: time for a reversal?
Purpose of review Bedside estimates of renal function are essential for clinical practice in the modern era and have largely relied on serum creatinine concentrations despite the known drawbacks associated with this choice of biomarker, including the fact that creatinine clearance overestimates the glomerular filtration rate. Recent findings Initial estimates relied primarily on equations that incorporated factors known to influence creatinine concentrations such as age, sex and anthropometric measures. More recent estimates of glomerular filtration rate have replaced the anthropometric measures with the social constr...
Source: Current Opinion in Nephrology and Hypertension - January 30, 2020 Category: Urology & Nephrology Tags: CLINICAL NEPHROLOGY: Edited by David S. Goldfarb Source Type: research

Bisphosphonate therapy in CKD: the current state of affairs
Purpose of review Chronic kidney disease (CKD) is associated with the development of mineral and bone disorders (MBD), including renal osteodystrophy (ROD). ROD is a global disorder of bone strength that is associated with an increased fracture risk. The use of bisphosphonates for fracture risk reduction in CKD remains controversial. This review provides a synopsis of the state-of-the literature regarding the safety and potential antifracture benefits of bisphosphonates in CKD patients. Recent findings In preclinical studies of animals with CKD 3–4 and evidence of CKD-MBD, bisphosphonates resulted in changes in ...
Source: Current Opinion in Nephrology and Hypertension - January 30, 2020 Category: Urology & Nephrology Tags: CLINICAL NEPHROLOGY: Edited by David S. Goldfarb Source Type: research

Evolution and evolving resolution of controversy over existence and prevalence of cerebral/renal salt wasting
Purpose of review The topic of hyponatremia is in a state of flux. We review a new approach to diagnosis that is superior to previous methods. It simplifies identifying the causes of hyponatremia, the most important issue being the differentiation of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) from cerebral/renal salt wasting (RSW). We also report on the high prevalence of RSW without cerebral disease in the general wards of the hospital. Recent findings We applied our new approach to hyponatremia by utilizing sound pathophysiologic criteria in 62 hyponatremic patients. Seventeen (27%) had ...
Source: Current Opinion in Nephrology and Hypertension - January 30, 2020 Category: Urology & Nephrology Tags: CLINICAL NEPHROLOGY: Edited by David S. Goldfarb Source Type: research

Mechanisms of sodium retention in nephrotic syndrome
Purpose of review Proteinuria in nephrotic syndrome is associated with sodium retention and edema. Recent studies from mice, rats and humans have shown that the sodium retention depends on urinary serine proteases and that it can be mitigated by blockers (amiloride, triamterene) of the epithelial sodium channel ENaC. The present review outlines the mechanisms of protease-stimulated sodium retention during proteinuric diseases. Recent findings Inhibition of protease activity in nephrotic mice using aprotinin alleviates sodium retention. From both human and mice studies, an increased proteolytic cleavage of the γE...
Source: Current Opinion in Nephrology and Hypertension - January 30, 2020 Category: Urology & Nephrology Tags: CLINICAL NEPHROLOGY: Edited by David S. Goldfarb Source Type: research