The incessant search for renal biomarkers: is it really justified?
Purpose of review This review summarizes the most recent and relevant findings in the search for novel biomarkers for the most common renal diseases. Recent findings Unprecedented, fast-paced technical advances in biomedical research have offered an opportunity to identify novel and more specific renal biomarkers in several clinical settings. However, despite the huge efforts made, the molecules identified so far have generally failed to provide relevant information beyond what has already been generated by established biomarkers, such as serum creatinine and proteinuria, whereas the complexity and costs of these tech...
Source: Current Opinion in Nephrology and Hypertension - January 28, 2019 Category: Urology & Nephrology Tags: SPECIAL COMMENTARY Source Type: research

Diagnosis of monogenic chronic kidney diseases
Purpose of review The purpose of this review is to emphasize that single gene disorders are an important and sometimes unrecognized cause of progressive chronic kidney disease. We provide an overview of the benefits of making a genetic diagnosis, the currently available genetic testing methods and examples of diseases illustrating the impact of a genetic diagnosis. Recent findings Although there are now a number of monogenic renal diseases, only a few, such as autosomal dominant polycystic kidney disease (ADPKD), are generally diagnosable without genetic testing. Complicating clinical diagnosis is that many diseases t...
Source: Current Opinion in Nephrology and Hypertension - January 28, 2019 Category: Urology & Nephrology Tags: CLINICAL NEPHROLOGY: Edited by David S. Goldfarb Source Type: research

Impact of gender and gender disparities in patients with kidney disease
Purpose of review Despite evidence of gender-specific differences in epidemiology and outcomes in all stages of chronic kidney disease (CKD), most studies ignore the issue of gender. This review addresses this knowledge gap by evaluating data on gender disparity in this population. Recent findings Population-based studies indicate a higher prevalence of CKD in women; however, there are fewer women on renal replacement therapy than men. Men may progress to end-stage kidney disease more rapidly. Gender differences in rates of CKD progression may be influenced by potential antifibrotic and antiapoptotic effects of estrog...
Source: Current Opinion in Nephrology and Hypertension - January 28, 2019 Category: Urology & Nephrology Tags: CLINICAL NEPHROLOGY: Edited by David S. Goldfarb Source Type: research

Renin–angiotensin system inhibition in advanced chronic kidney disease: how low can the kidney function go?
Purpose of review To present the available data on the risks and benefits for ACEi/ARB usage in patients with advanced CKD. Recent findings It has been well established that ACEi/ARB use is beneficial in patients with mild-to-moderate CKD, especially in patients with proteinuria. The majority of available data includes patients with diabetes mellitus. However, data in individuals with advanced CKD are limited. Additionally, data available for this subset of patients is conflicting and the definition of advanced CKD varies across clinical trials. Summary On the basis of our literature review, evidence suggests conti...
Source: Current Opinion in Nephrology and Hypertension - January 28, 2019 Category: Urology & Nephrology Tags: CLINICAL NEPHROLOGY: Edited by David S. Goldfarb Source Type: research

The case for cautious consumption: NSAIDs in chronic kidney disease
Purpose of review Strong epidemiological and pathologic evidence associates NSAIDs with kidney disease, both acute and chronic. Hence, the usage of NSAIDs has decreased in patients with, or at risk for, chronic kidney disease (CKD). Coupled with this has been a rise in use of opioids and other non-NSAID alternatives, which do come with significant, and underrecognized, risk of nonrenal adverse events. We review the literature to understand if this shift is appropriate or deleterious. Recent findings NSAIDs do have a low but tangible risk in causing acute kidney injury, electrolyte imbalances, and increasing blood pres...
Source: Current Opinion in Nephrology and Hypertension - January 28, 2019 Category: Urology & Nephrology Tags: CLINICAL NEPHROLOGY: Edited by David S. Goldfarb Source Type: research

Gadolinium-based contrast agents: why nephrologists need to be concerned
Purpose of review The hegemony of gadolinium-based contrast agent-induced adverse events stretches beyond those who have renal impairment. ‘Nephrogenic’ systemic fibrosis is a misnomer: gadolinium-based contrast agents are the known trigger for the disease; kidney impairment is a risk factor. Impaired (true) glomerular filtration may be one catalyst for gadolinium-based contrast agent-induced adverse events, but it is increasingly evident that the same cluster of symptoms occurs in patients with normal renal function. Recent findings It has been known for nearly 30 years that gadolinium-based contrast agen...
Source: Current Opinion in Nephrology and Hypertension - January 28, 2019 Category: Urology & Nephrology Tags: CLINICAL NEPHROLOGY: Edited by David S. Goldfarb Source Type: research

Leave no stone unturned: defining recurrence in kidney stone formers
Purpose of review Established guidelines provide recommendations on the management of kidney stones to prevent recurrence. However, clear and clinically useful terminology for recurrence of kidney stones is needed. This review describes the various manifestations of kidney stone recurrence and the reported rates of kidney stone recurrence in various clinical settings. Recent findings Kidney stone recurrence has a wide range of symptomatic and radiographic presentations. Symptomatic recurrence may include characteristic symptoms of stone passage via the ureter (renal colic and gross hematuria). This may be self-managed...
Source: Current Opinion in Nephrology and Hypertension - January 28, 2019 Category: Urology & Nephrology Tags: CLINICAL NEPHROLOGY: Edited by David S. Goldfarb Source Type: research

Differences in national and international guidelines regarding use of kidney stone formers as living kidney donors
Purpose of review Traditionally, nephrolithiasis was considered a relative contraindication to kidney donation because of a risk of recurrent stones in donors and adverse stone-related outcomes in recipients. However, the scarcity of organs has driven the transplant community to re-examine and broaden selection criteria for living donors with stones. In this review, we summarize and contrast the guidelines published by various prominent national and international societies on this topic. Recent findings Although recent iterations of living donor guidelines are less stringent with respect to nephrolithiasis than those ...
Source: Current Opinion in Nephrology and Hypertension - January 28, 2019 Category: Urology & Nephrology Tags: CLINICAL NEPHROLOGY: Edited by David S. Goldfarb Source Type: research

Citrate therapy for calcium phosphate stones
Purpose of review Calcium phosphate (CaP) stones represent an increasingly encountered form of recurrent nephrolithiasis, but current prophylactic medical regimens are suboptimal. Although hypocitraturia is a well-described risk factor for CaP stones, strategies that enhance citrate excretion have not consistently been effective at reducing CaP saturation and stone recurrence. This review summarizes the role of citrate therapy in CaP nephrolithiasis. Recent findings Citrate in urine inhibits CaP stone formation through multiple mechanisms, including the formation of soluble citrate–calcium complexes, and inhibit...
Source: Current Opinion in Nephrology and Hypertension - January 28, 2019 Category: Urology & Nephrology Tags: CLINICAL NEPHROLOGY: Edited by David S. Goldfarb Source Type: research

Editorial: Controversies in kidney stones and other chronic kidney disease topics
No abstract available (Source: Current Opinion in Nephrology and Hypertension)
Source: Current Opinion in Nephrology and Hypertension - January 28, 2019 Category: Urology & Nephrology Tags: CLINICAL NEPHROLOGY: Edited by David S. Goldfarb Source Type: research

The renin–angiotensin system in the arcuate nucleus controls resting metabolic rate
Purpose of review Obesity represents the primary challenge to improving cardiovascular health, and suppression of resting metabolic rate (RMR) is implicated in the maintenance of obesity. Increasing evidence supports a major role for the renin–angiotensin system (RAS) within the brain in the control of RMR. Recent findings The angiotensin II (ANG) Agtr1a receptor colocalizes with the leptin receptor (Lepr) primarily within cells of the arcuate nucleus (ARC) of the hypothalamus that also express Agouti-related peptide (Agrp). This sub-population of Agtr1a receptors is required for stimulation of thermogenic sympa...
Source: Current Opinion in Nephrology and Hypertension - January 28, 2019 Category: Urology & Nephrology Tags: PATHOPHYSIOLOGY OF HYPERTENSION: Edited by Nancy J. Brown Source Type: research

New insights regarding epithelial Na+ channel regulation and its role in the kidney, immune system and vasculature
Purpose of review This review describes recent findings regarding the epithelial Na+ channel (ENaC) and its roles in physiologic and pathophysiologic states. We discuss new insights regarding ENaC's structure, its regulation by various factors, its potential role in hypertension and nephrotic syndrome, and its roles in the immune system and vasculature. Recent findings A recently resolved structure of ENaC provides clues regarding mechanisms of ENaC activation by proteases. The use of amiloride in nephrotic syndrome, and associated complications are discussed. ENaC is expressed in dendritic cells and contributes to im...
Source: Current Opinion in Nephrology and Hypertension - January 28, 2019 Category: Urology & Nephrology Tags: PATHOPHYSIOLOGY OF HYPERTENSION: Edited by Nancy J. Brown Source Type: research

Immunohistochemistry for aldosterone synthase CYP11B2 and matrix-assisted laser desorption ionization imaging mass spectrometry for in-situ aldosterone detection
Purpose of review Immunohistochemistry for aldosterone synthase (CYP11B2) has markedly provided a comprehensive picture of the adrenocortical diseases, particularly primary aldosteronism. The findings from CYP11B2-immunohistochemistry are consistent with the clinical courses of most patients with primary aldosteronism. We herein review the updated pathophysiology and usefulness of the method for understanding individual patients with different subtypes of primary aldosteronism. Recent findings After our discovery of aldosterone-producing cell clusters (APCCs) using the immunohistochemistry for CYP11B2, we found possib...
Source: Current Opinion in Nephrology and Hypertension - January 28, 2019 Category: Urology & Nephrology Tags: PATHOPHYSIOLOGY OF HYPERTENSION: Edited by Nancy J. Brown Source Type: research

The gut microbiota and blood pressure in experimental models
Purpose of review To summarize evidence supporting that microorganisms colonizing our gastrointestinal tract, collectively known as the gut microbiota, are implicated in the development and maintenance of hypertension in experimental models. Recent findings The use of gnotobiotic (germ-free) mice has been essential for advancement in this area: they develop higher blood pressure (BP) if they receive faecal transplants from hypertensive patients compared to normotensive donors, and germ-free mice have a blunted response to angiotensin II. Experimental hypertension is consistently accompanied by changes in the compositi...
Source: Current Opinion in Nephrology and Hypertension - January 28, 2019 Category: Urology & Nephrology Tags: PATHOPHYSIOLOGY OF HYPERTENSION: Edited by Nancy J. Brown Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Nephrology and Hypertension)
Source: Current Opinion in Nephrology and Hypertension - January 28, 2019 Category: Urology & Nephrology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Genes and environment in chronic kidney disease hotspots
We report on evidence supporting both genes and environment in these CKD hotspots. Differing genetic susceptibility between populations and within populations may explain why causal environmental risk factors have been so hard to identify conclusively. Similarly, one cannot explain why these epidemics of kidney disease are happening now without invoking environmental changes. Summary Approaches to these CKD hotspots are of necessity becoming more holistic. Genetic studies may help us identify the environmental triggers by teaching us about disease biology and may empower environmental risk factor studies by allowing for...
Source: Current Opinion in Nephrology and Hypertension - November 28, 2018 Category: Urology & Nephrology Tags: SPECIAL COMMENTARIES Source Type: research

Dilemmas and challenges in apolipoprotein L1 nephropathy research
Purpose of review The purpose of this mini-review is to highlight some unresolved questions and controversies in the evolving story of apolipoprotein L1 (APOL1) nephropathy. Recent findings We highlight studies that introduce complexity in unraveling the mechanisms whereby APOL1 risk variant alleles cause disease. These include studies which support a possible protective role for the APOL1 GO nonrisk ancestral allele, and studies which explore the initiating events that may trigger other downstream pathways mediating APOL1 cellular injury. We also review studies that reconcile the perplexing findings regarding APOL1 a...
Source: Current Opinion in Nephrology and Hypertension - November 28, 2018 Category: Urology & Nephrology Tags: SPECIAL COMMENTARIES Source Type: research

Unmet challenges in membranous nephropathy
Purpose of review Despite major advances in since the discovery of the phospholipase A2 receptor (PLA2R) as the major autoantigen on podocytes in primary membranous nephropathy, there are still several unanswered questions as highlighted here. Recent findings A substantial body of literature, included in more than 680 articles since 2009, has documented genetic susceptibility to primary membranous nephropathy involving PLA2R1 and class II MHC alleles, the clinical value of anti-PLA2R assays, the significance of epitope spreading of the anti-PLA2R response, discovery of thrombospondin type I domain-containing 7A (THSD7...
Source: Current Opinion in Nephrology and Hypertension - November 28, 2018 Category: Urology & Nephrology Tags: SPECIAL COMMENTARIES Source Type: research

Protective association between JC polyoma viruria and kidney disease
Purpose of review The presence of viruses in urine (urine virome) typically reflects infection in the kidneys and urinary tract. The urinary virome is associated with HIV-associated nephropathy and chronic glomerulosclerosis. There are many associations of this microbiome with human diseases that remain to be described. This manuscript reviews emerging data on relationships between kidney disease and urinary tract infection/colonization with JC polyomavirus (JCPyV). Recent findings Approximately 30% of the adult population sheds JCPyV in the urine. Further, urinary tract infection with one polyomavirus strain appears ...
Source: Current Opinion in Nephrology and Hypertension - November 28, 2018 Category: Urology & Nephrology Tags: SPECIAL COMMENTARIES Source Type: research

Fluid management and bioimpedance study in peritoneal dialysis
Purpose of review Maintaining euvolaemia is an essential yet challenging objective in management of patients on peritoneal dialysis. Optimal method to assess volume status remains to be determined. In this review, we will discuss the risk factors and clinical outcomes of fluid overload in PD patients, and examine the role of bioimpedance study in fluid management. Recent findings Applying bioimpedance study to measure body composition has attracted increasing attention because it is noninvasive and provides point-of-care assessment of fluid status. Observational studies suggested that presence of residual renal functi...
Source: Current Opinion in Nephrology and Hypertension - November 28, 2018 Category: Urology & Nephrology Tags: SPECIAL COMMENTARIES Source Type: research

Pre, peri and posttransplant diabetes mellitus
Purpose of review The leading cause of death in both chronic kidney disease (CKD) and renal transplant patients is cardiovascular events. Post-transplant diabetes mellitus (PTx-DM), which is a major cardiovascular risk factor, is a metabolic disorder that affects 5.5–60.2% of renal allograft recipients by 1-year posttransplant (PTx). PTx-DM has been associated with a negative impact on patient and graft outcomes and survival. Recent findings Individuals who develop PTx-DM are usually prone to this condition prior to and/or after developing CKD. Genetic factors, obesity, inflammation, medications and CKD all are ...
Source: Current Opinion in Nephrology and Hypertension - November 28, 2018 Category: Urology & Nephrology Tags: SPECIAL COMMENTARIES Source Type: research

Mesenchymal stromal cells in kidney transplantation
Purpose of review Mesenchymal stromal cells (MSC) have emerged as one of the most promising candidates for immunomodulatory cell therapy in kidney transplantation. Here we describe novel insights into the MSC mechanism of action and provide an overview of initial safety and feasibility studies with MSC in kidney transplantation. Recent findings Clinical studies of MSC-based cell therapy in kidney transplant recipients demonstrated the safety and feasibility of cell therapy and provide the first encouraging evidence of the efficacy of MSC in enabling the minimization of immunosuppressive drugs. In our initial experienc...
Source: Current Opinion in Nephrology and Hypertension - November 28, 2018 Category: Urology & Nephrology Tags: SPECIAL COMMENTARIES Source Type: research

Leveraging pragmatic clinical trial design to advance phosphate management in end-stage renal disease
Purpose of review Phosphate lowering toward the normal range is advocated and widely practiced in patients with end-stage renal disease receiving dialysis. This approach is guided by basic science data and large observational studies that have demonstrated a consistent association between hyperphosphatemia and adverse events, including cardiovascular morbidity and all-cause mortality. There has never been a clinical trial to assess the efficacy of phosphate lowering in maintenance dialysis recipients. Recent findings Despite several trials comparing the effect of different phosphate-binding agents on biochemical targe...
Source: Current Opinion in Nephrology and Hypertension - November 28, 2018 Category: Urology & Nephrology Tags: SPECIAL COMMENTARIES Source Type: research

Methylglyoxal stress, the glyoxalase system, and diabetic chronic kidney disease
Purpose of review Chronic kidney disease (CKD) remains a serious diabetic complication despite the use of widely employed interventions such as angiotensin-converting enzyme inhibitors and glucose-lowering treatments. Accumulation of methylglyoxal, a highly reactive glucose metabolite and a major precursor in the formation of advanced glycation end products, may link the hemodynamic, inflammatory, metabolic, and structural changes that drive diabetic CKD. Therefore, methylglyoxal may serve as a potential therapeutic target to prevent diabetic CKD. Recent findings Higher plasma methylglyoxal levels were shown to be ass...
Source: Current Opinion in Nephrology and Hypertension - November 28, 2018 Category: Urology & Nephrology Tags: HORMONES, AUTACOIDS, NEUROTRANSMITTERS AND GROWTH FACTORS: Edited by Mark Cooper and Merlin Thomas Source Type: research

Fibroblast growth factor 23 and α-Klotho co-dependent and independent functions
Purpose of review The current review examines what is known about the FGF-23/α-Klotho co-dependent and independent pathophysiological effects, and whether FGF-23 and/or α-Klotho are potential therapeutic targets. Recent findings FGF-23 is a hormone derived mainly from bone, and α-Klotho is a transmembrane protein. Together they form a trimeric signaling complex with FGFRs in target tissues to mediate the physiological functions of FGF-23. Local and systemic factors control FGF-23 release from osteoblast/osteocytes in bone, and circulating FGF-23 activates FGFR/α-Klotho complexes in kidney proxi...
Source: Current Opinion in Nephrology and Hypertension - November 28, 2018 Category: Urology & Nephrology Tags: HORMONES, AUTACOIDS, NEUROTRANSMITTERS AND GROWTH FACTORS: Edited by Mark Cooper and Merlin Thomas Source Type: research

Growth hormone and chronic kidney disease
Purpose of review Elevated circulating levels of growth hormone (GH) and/or increased expression of the GH receptor in the kidney are associated with the development of nephropathy in type1 diabetes and acromegaly. Conditions of GH excess are characterized by hyperfiltration, glomerular hypertrophy, glomerulosclerosis and albuminuria, whereas states of decreased GH secretion or action are protected against glomerulopathy. The direct role of GH's action on glomerular cells, particularly podocytes, has been the focus of recent studies. In this review, the emerging role of GH on the biological function of podocytes and its ...
Source: Current Opinion in Nephrology and Hypertension - November 28, 2018 Category: Urology & Nephrology Tags: HORMONES, AUTACOIDS, NEUROTRANSMITTERS AND GROWTH FACTORS: Edited by Mark Cooper and Merlin Thomas Source Type: research

Sex hormones and their influence on chronic kidney disease
Purpose of review The majority of end-stage renal disease including dialysis and kidney transplant patients are men. In contrast, the incidence of chronic kidney disease (CKD) is higher in women compared with men. In this review, we dissect the sex hormone levels and its effects on experimental models and patients with CKD. Recent findings Sex hormones are clearly involved in CKD progression to end-stage renal disease (ESRD). A significant reduction in lipid peroxidation as a mechanism of renoprotection has been observed in kidneys of streptozotocin (STZ)-diabetic ovariectomized rats after estradiol administration. Fu...
Source: Current Opinion in Nephrology and Hypertension - November 28, 2018 Category: Urology & Nephrology Tags: HORMONES, AUTACOIDS, NEUROTRANSMITTERS AND GROWTH FACTORS: Edited by Mark Cooper and Merlin Thomas Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Nephrology and Hypertension)
Source: Current Opinion in Nephrology and Hypertension - November 28, 2018 Category: Urology & Nephrology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Point-of-care ultrasound in end-stage kidney disease: beyond lung ultrasound
The objective of this review is to describe the potential applications of POCUS in end-stage renal disease patients (ESRD). Recent findings With basic training, the clinician can perform pulmonary, vascular, cardiac, and abdominal POCUS at the bedside of ESRD patients. Pulmonary ultrasound can be used to quantify pulmonary congestion and for the differential diagnosis of dyspnea. Ultrasound of the inferior vena cava combined with simple cardiac ultrasound can be used to promptly investigate the mechanism of hemodynamic instability. Vascular ultrasound can be used for troubleshooting of arteriovenous fistula problems and...
Source: Current Opinion in Nephrology and Hypertension - October 5, 2018 Category: Urology & Nephrology Tags: DIALYSIS AND TRANSPLANTATION: Edited by J. Kevin Tucker and Anil Chandraker Source Type: research

Urgent start peritoneal dialysis
Purpose of review Although historically peritoneal dialysis was widely used in nephrology, it has been underutilized in recent years. In this review, we present several key opportunities and strategies for revitalization of urgent start peritoneal dialysis use, and discuss the recent literature on clinical experience with peritoneal dialysis use in the acute and unplanned setting. Recent findings Interest in using urgent start peritoneal dialysis to manage acute kidney injury (AKI) and unplanned chronic kidney disease (CKD) stage 5 patients has been increasing. To overcome some of the classic limitations of peritoneal...
Source: Current Opinion in Nephrology and Hypertension - October 5, 2018 Category: Urology & Nephrology Tags: DIALYSIS AND TRANSPLANTATION: Edited by J. Kevin Tucker and Anil Chandraker Source Type: research

Nocturnal hemodialysis: an underutilized modality?
Purpose of review There is increasing evidence that extended-hours regimens are associated with improved outcomes for patients on maintenance hemodialysis programs. Home hemodialysis programs are a well established way for patients to benefit from extended-hours dialysis overnight; however, there are significant barriers to home hemodialysis, which means that for many this is not an option. In center, nocturnal hemodialysis is an increasingly recognized way of offering extended-hours treatment to patients unable to undertake home-based programs and is an underutilized modality for such patients to gain from the physiolog...
Source: Current Opinion in Nephrology and Hypertension - October 5, 2018 Category: Urology & Nephrology Tags: DIALYSIS AND TRANSPLANTATION: Edited by J. Kevin Tucker and Anil Chandraker Source Type: research

Hemodialysis versus peritoneal dialysis in resource-limited settings
Purpose of review To assess the use, access to and outcomes of hemodialysis and peritoneal dialysis in low-resource settings. Recent findings Hemodialysis tends to predominate because of costs and logistics, however services tend to be located in larger cities, often paid for out of pocket. Outcomes of dialysis-requiring acute kidney injury and end-stage kidney disease may be similar with hemodialysis and peritoneal dialysis, and therefore choice of therapy is dominated by availability, accessibility and patient or physician choice. Some countries have implemented peritoneal dialysis-first policies to reduce costs and...
Source: Current Opinion in Nephrology and Hypertension - October 5, 2018 Category: Urology & Nephrology Tags: DIALYSIS AND TRANSPLANTATION: Edited by J. Kevin Tucker and Anil Chandraker Source Type: research

Protein carbamylation in end stage renal disease: is there a mortality effect?
Purpose of review Protein carbamylation is a posttranslational protein modification caused, in part, by exposure to urea's dissociation product cyanate. Additional modulators of protein carbamylation include circulating free amino acid levels, inflammation, diet, smoking, and environmental pollution exposures. Carbamylation reactions can modify protein charge, structure, and function, leading to adverse molecular and cellular responses. These changes have been linked to several pathologic biochemical pathways relevant to patients with end stage renal disease (ESRD) such as accelerated atherosclerosis and dysfunctional er...
Source: Current Opinion in Nephrology and Hypertension - October 5, 2018 Category: Urology & Nephrology Tags: DIALYSIS AND TRANSPLANTATION: Edited by J. Kevin Tucker and Anil Chandraker Source Type: research

Expanding deceased donor kidney transplantation: medical risk, infectious risk, hepatitis C virus, and HIV
Purpose of review Due to the organ shortage, which prevents over 90 000 individuals in the United States from receiving life-saving transplants, the transplant community has begun to critically reevaluate whether organ sources that were previously considered too risky provide a survival benefit to waitlist candidates. Recent findings Organs that many providers were previously unwilling to use for transplantation, including kidneys with a high Kidney Donor Profile Index or from increased risk donors who have risk factors for window period hepatitis C virus (HCV) and HIV infection, have been shown to provide a surviva...
Source: Current Opinion in Nephrology and Hypertension - October 5, 2018 Category: Urology & Nephrology Tags: DIALYSIS AND TRANSPLANTATION: Edited by J. Kevin Tucker and Anil Chandraker Source Type: research

Update on posttransplant lymphoproliferative disease
Purpose of review Posttransplant lymphoproliferative disorder (PTLD), frequently associated with Epstein–Barr virus (EBV), is one of the most serious complications leading to worse patient and graft outcomes. Hence, we summarize in this review relevant studies published about PTLD in the last 18 months. Recent findings Recent studies have improved the knowledge about epidemiology, prophylaxis, diagnosis and PTLD treatment. Special interest has developed in improving the last PTLD classification of the World Health Organization, increasing the accuracy of diagnostic tests for EBV viral load quantification and dis...
Source: Current Opinion in Nephrology and Hypertension - October 5, 2018 Category: Urology & Nephrology Tags: DIALYSIS AND TRANSPLANTATION: Edited by J. Kevin Tucker and Anil Chandraker Source Type: research

Systems biology approaches to identify disease mechanisms and facilitate targeted therapy in the management of glomerular disease
Purpose of review Current clinical pathological classifications of glomerular diseases are inadequate at predicting patient disease progression or response to therapy. With the advent of precision medicine and its successes in oncology, it is important to understand if similar approaches in glomerular diseases can improve patient management. The purpose of this review is to summarize approaches to obtain comprehensive molecular profiles from human biopsies and utilize them to define the pathophysiology of glomerular failure. Recent findings Multicenter research networks have provided the framework to capture both pros...
Source: Current Opinion in Nephrology and Hypertension - October 5, 2018 Category: Urology & Nephrology Tags: DIAGNOSTICS AND TECHNIQUES: Edited by Maarten W. Taal Source Type: research

Personalized medicine in diabetic kidney disease: a novel approach to improve trial design and patient outcomes
Purpose of review In the last decade many attempts have been made to reduce the high residual risk of end-stage kidney disease and cardiovascular disease in patients with diabetic kidney disease by targeting a variety of risk markers. Subsequent analyses revealed that the variation in individual drug response to the tested interventions partly explains why these trials did not result in additional kidney or cardiovascular protection. This review summarizes recent insights regarding individual variation in drug response. Additionally, we explore novel approaches to incorporate this drug response variability in the design ...
Source: Current Opinion in Nephrology and Hypertension - October 5, 2018 Category: Urology & Nephrology Tags: DIAGNOSTICS AND TECHNIQUES: Edited by Maarten W. Taal Source Type: research

Which anticoagulants should be used for stroke prevention in non-valvular atrial fibrillation and severe chronic kidney disease?
Purpose of review Non-valvular atrial fibrillation is common in patients with severe chronic kidney disease (CKD) and historically patients have been treated with vitamin K antagonists (VKA). However, these agents have questionable efficacy and are associated with increased bleeding risk. Non-vitamin K oral anticoagulants (NOAC) have advantages over VKA in early stage CKD. In this review, we sought to establish evidence for best practice in patients with severe CKD (creatinine clearance (Source: Current Opinion in Nephrology and Hypertension)
Source: Current Opinion in Nephrology and Hypertension - October 5, 2018 Category: Urology & Nephrology Tags: DIAGNOSTICS AND TECHNIQUES: Edited by Maarten W. Taal Source Type: research

Techniques to improve intradialytic haemodynamic stability
Purpose of review Intra-dialytic hypotension (IDH) remains a significant problem for patients undergoing chronic haemodialysis. IDH causes symptoms that degrade patients’ experience, compromises dialysis delivery and is strongly associated with adverse patient outcomes. Greater understanding of the link between IDH and dialysis-induced ischaemia in heart and brain has characterized mechanistic pathways, with repeated episodes of ischaemia resulting in organ dysfunction. This review provides updates from published evidence over the last 2 years across the range of potential interventions for IDH. Recent findings ...
Source: Current Opinion in Nephrology and Hypertension - October 5, 2018 Category: Urology & Nephrology Tags: DIAGNOSTICS AND TECHNIQUES: Edited by Maarten W. Taal Source Type: research

The use of bioimpedance spectroscopy to guide fluid management in patients receiving dialysis
Purpose of review To summarize the findings of recent trials and meta-analyses designed to determine whether bioimpedance spectroscopy adds value to the clinical assessment of fluid status in dialysis patients so as to achieve a normally hydrated weight and put these in a contemporary context. Recent findings Eight trials (published 2010–2018) and two meta-analyses (2017) are reviewed. Both haemodialysis and peritoneal dialysis modalities are represented. Despite considerable heterogeneity in intervention, all are open-label randomized comparisons of a bioimpedance intervention with normal clinical practice in w...
Source: Current Opinion in Nephrology and Hypertension - October 5, 2018 Category: Urology & Nephrology Tags: DIAGNOSTICS AND TECHNIQUES: Edited by Maarten W. Taal Source Type: research

How best to estimate glomerular filtration rate? Novel filtration markers and their application
Purpose of review Chronic kidney disease is an increasing health burden. Estimating equations using serum concentrations of creatinine and cystatin C facilitate the assessment of kidney function as reflected in estimated glomerular filtration rate (eGFR). Reduced eGFR is associated with increased risk for numerous adverse outcomes and is an important aspect in many clinical situations. However, current equations are suboptimal in some clinical settings. The review focuses on approaches to improve the estimation of GFR and aims to familiarize the reader with the underlying methodological hypotheses how new markers could c...
Source: Current Opinion in Nephrology and Hypertension - October 5, 2018 Category: Urology & Nephrology Tags: DIAGNOSTICS AND TECHNIQUES: Edited by Maarten W. Taal Source Type: research

Personalized medicine in nephrology: a novel approach or just good medicine?
No abstract available (Source: Current Opinion in Nephrology and Hypertension)
Source: Current Opinion in Nephrology and Hypertension - October 5, 2018 Category: Urology & Nephrology Tags: DIAGNOSTICS AND TECHNIQUES: Edited by Maarten W. Taal Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Nephrology and Hypertension)
Source: Current Opinion in Nephrology and Hypertension - October 5, 2018 Category: Urology & Nephrology Tags: Editorial Introductions Source Type: research

Role of microRNAs in aldosterone signaling
Purpose of review The review describes studies investigating the role of microRNAs in the signaling pathway of the mineralocorticoid hormone, aldosterone. Recent findings Emerging evidence indicates that aldosterone alters the expression of microRNAs in target tissues thereby modulating the expression of key regulatory proteins. Summary The mineralocorticoid hormone aldosterone is released by the adrenal glands in a homeostatic mechanism to regulate blood volume. The long-term renal action of aldosterone is to increase the retrieval of sodium from filtered plasma to restore blood pressure. Emerging evidence indicat...
Source: Current Opinion in Nephrology and Hypertension - August 2, 2018 Category: Urology & Nephrology Tags: MOLECULAR CELL BIOLOGY AND PHYSIOLOGY OF SOLUTE TRANSPORT: Edited by Arohan R. Subramanya Source Type: research

Renal tubular solute transport and oxygen consumption: insights from computational models
Purpose of review To maintain electrolyte homeostasis, the kidneys reabsorb more than 99% of the filtered Na+ under physiological conditions, resulting in less than 1% of the filtered Na+ excreted in urine. In contrast, due to distal tubular secretion, urinary K+ output may exceed filtered load. This review focuses on a relatively new methodology for investigating renal epithelial transport, computational modelling and highlights recent insights regarding renal Na+ and K+ transport and O2 consumption under pathophysiological conditions, with a focus on nephrectomy. Recent findings Recent modelling studies investigated...
Source: Current Opinion in Nephrology and Hypertension - August 2, 2018 Category: Urology & Nephrology Tags: MOLECULAR CELL BIOLOGY AND PHYSIOLOGY OF SOLUTE TRANSPORT: Edited by Arohan R. Subramanya Source Type: research

Adaptive remodeling of renal Na+ and K+ transport during pregnancy
Purpose of review Renal ion transport undergoes dramatic changes during the course of gestation. These adaptations are necessary to meet the dynamic requirements of pregnancy and support fetal development. Pregnancy is characterized by a high demand for both sodium and potassium. Recently there has been work in the field profiling the modifications of the renal tubules in pregnancy to meet these demands. The purpose of this review is to summarize these findings. Recent findings The work to date suggests an important role for the distal nephron in both the renal sodium and potassium reabsorption during pregnancy. There...
Source: Current Opinion in Nephrology and Hypertension - August 2, 2018 Category: Urology & Nephrology Tags: MOLECULAR CELL BIOLOGY AND PHYSIOLOGY OF SOLUTE TRANSPORT: Edited by Arohan R. Subramanya Source Type: research

Distal tubule basolateral potassium channels: cellular and molecular mechanisms of regulation
Purpose of review Multiple clinical and translational evidence support benefits of high potassium diet; however, there many uncertainties underlying the molecular and cellular mechanisms determining effects of dietary potassium. Kir4.1 and Kir5.1 proteins form a functional heteromer (Kir4.1/Kir5.1), which is the primary inwardly rectifying potassium channel on the basolateral membrane of both distal convoluted tubule (DCT) and the collecting duct principal cells. The purpose of this mini-review is to summarize latest advances in our understanding of the evolution, physiological relevance and mechanisms controlling these ...
Source: Current Opinion in Nephrology and Hypertension - August 2, 2018 Category: Urology & Nephrology Tags: MOLECULAR CELL BIOLOGY AND PHYSIOLOGY OF SOLUTE TRANSPORT: Edited by Arohan R. Subramanya Source Type: research

Epithelial sodium channel biogenesis and quality control in the early secretory pathway
Purpose of review The epithelial sodium channel, ENaC, is responsible for Na+ reabsorption in several epithelia and is composed of homologous α, β, and γ subunits. Here, we will explore the differential regulation of ENaC subunits during biogenesis in the early secretory pathway. Recent findings ENaC subunits are subject to numerous posttranslational modifications, including glycosylation, protease activation, disulfide bond formation, palmitoylation, and glycosylation, each of which modulate channel function. For example, glycan addition is regulated by sodium and affects protease activation at the c...
Source: Current Opinion in Nephrology and Hypertension - August 2, 2018 Category: Urology & Nephrology Tags: MOLECULAR CELL BIOLOGY AND PHYSIOLOGY OF SOLUTE TRANSPORT: Edited by Arohan R. Subramanya Source Type: research

Iron therapy for managing anaemia in chronic kidney disease
Purpose of review Iron deficiency is a major contributory cause to the development of anaemia in chronic kidney disease (CKD), and thus, iron replacement therapy plays a critical role in the management of this condition. The two main routes for administering iron are oral and intravenous, and there have been a number of new publications relevant to both routes of administration. Recent findings Recent developments on the topic of iron management in CKD include the introduction of new oral iron preparations, as well as two recent meta-analyses on iron therapy in CKD (one on oral versus intravenous iron, and one on high...
Source: Current Opinion in Nephrology and Hypertension - August 2, 2018 Category: Urology & Nephrology Tags: PHARMACOLOGY AND THERAPEUTICS: Edited by Sankar D. Navaneethan Source Type: research

Activin receptor ligand traps in chronic kidney disease
Purpose of review Sotatercept and luspatercept are recombinant soluble activin type-II receptor-IgG-Fc fusion proteins that are tested in clinical trials for the treatment of various types of anemias, including renal anemia. The mechanism of the action of the novel drugs is incompletely understood, but it seems to be based on the inactivation of soluble proteins of the transforming growth factor-ß (TGFß) family. This review considers pros and cons of the clinical use of the drugs in reference to the current therapy with recombinant erythropoiesis-stimulating agents (ESAs). Recent findings One or more activ...
Source: Current Opinion in Nephrology and Hypertension - August 2, 2018 Category: Urology & Nephrology Tags: PHARMACOLOGY AND THERAPEUTICS: Edited by Sankar D. Navaneethan Source Type: research