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

Erythropoietin mimetic peptides and erythropoietin fusion proteins for treating anemia of chronic kidney disease
Purpose of review First generation erythropoiesis stimulating agents (ESAs) have short duration of action which requires administration once weekly or greater. Second generation ESAs were developed which have longer duration of action and can be administered one to two times monthly. Erythropoietin (EPO) mimetic peptides (EMPs) activate the EPO receptor but have no structural analogy to EPO, offering the potential for lower cost as they are not biologic drugs. The first approved EMP, peginesatide, was withdrawn from the market within a year of its approval because of fatal anaphylactic reactions. In this review, we summa...
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

Will there still be a role for the originator erythropoiesis-simulating agents after the biosimilars and the hypoxia-inducible factor stabilizers approval?
Purpose of review To discuss if there will still be a role for the originator ESAs after the already available biosimilars and the approval of HIF stabilizers in the near future. Recent findings Current treatment with erythropoiesis-simulating agents (ESAs) is effective and generally well tolerated, but requires parenteral injections. It is also surrounded by safety concerns and is still expensive. Functional iron deficiency is the major obstacle for efficient ESA therapy. ESA resistance may develop, calling for high ESA doses, further increasing the side effects associated with ESA use. Biosimilars were introduced fo...
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

Hypoxia-inducible factor stabilizers for treating anemia of chronic kidney disease
Purpose of review Small-molecule inhibitors of prolyl hydroxylase domain enzymes (PHD inhibitors) are novel renal anemia therapies that increase endogenous erythropoietin (EPO) production by stabilizing hypoxia-inducible factor (HIF). This review summarizes recent findings and future perspectives of PHD inhibitors (HIF stabilizers) in chronic kidney disease (CKD)-associated anemia. Recent findings Clinical trials have demonstrated that HIF stabilizers effectively increase hemoglobin levels of both nondialysis and dialysis CKD patients without causing serious adverse effects. HIF stabilizers not only restore EPO produc...
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

Emerging therapeutic options for management of anaemia in with patients with chronic kidney disease
No abstract available (Source: Current Opinion in Nephrology and Hypertension)
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

Editorial introductions
No abstract available (Source: Current Opinion in Nephrology and Hypertension)
Source: Current Opinion in Nephrology and Hypertension - August 2, 2018 Category: Urology & Nephrology Tags: Editorial Introductions Source Type: research

MAGED2: a novel form of antenatal Bartter's syndrome
Purpose of review Antenatal Bartter's syndrome (aBS) is the most severe form of Bartter's syndrome, requiring close follow-up, in particular during the neonatal period, primarily because of prematurity. The recent identification of a novel and very severe form of aBS merits an update on this topic. Recent finding Despite the identification of several genes involved in Bartter's syndrome, about 20% of patients clinically diagnosed with aBS remained without genetic explanation for decades. We recently identified mutations in MAGED2 as a cause of an X-linked form of aBS characterized by a very early onset of severe polyh...
Source: Current Opinion in Nephrology and Hypertension - May 31, 2018 Category: Urology & Nephrology Tags: RENAL PATHOPHYSIOLOGY: Edited by Orson W. Moe and Susan Quaggin Source Type: research

Acute kidney injury to chronic kidney disease transition: insufficient cellular stress response
Purpose of review Recent epidemiological and preclinical mechanistic studies provide strong evidence that acute kidney injury (AKI) and chronic kidney disease (CKD) form an interconnected syndrome. Injured kidneys undergo a coordinated reparative process with an engagement of multiple cell types after injury; however, maladaptation to the injury subjects kidneys to a vicious cycle of fibrogenesis and nephron loss. In this review, we will outline and discuss the pathogenesis of AKI-to-CKD transition with an emphasis on dysregulated ‘cellular stress adaptation’ as a potential therapeutic target. Recent finding...
Source: Current Opinion in Nephrology and Hypertension - May 31, 2018 Category: Urology & Nephrology Tags: RENAL PATHOPHYSIOLOGY: Edited by Orson W. Moe and Susan Quaggin Source Type: research

The systems biology of uric acid transporters: the role of remote sensing and signaling
Purpose of review Uric acid homeostasis in the body is mediated by a number of SLC and ABC transporters in the kidney and intestine, including several multispecific ‘drug’ transporters (e.g., OAT1, OAT3, and ABCG2). Optimization of uric acid levels can be viewed as a ‘systems biology’ problem. Here, we consider uric acid transporters from a systems physiology perspective using the framework of the ‘Remote Sensing and Signaling Hypothesis.’ This hypothesis explains how SLC and ABC ‘drug’ and other transporters mediate interorgan and interorganismal communication (e.g., gut m...
Source: Current Opinion in Nephrology and Hypertension - May 31, 2018 Category: Urology & Nephrology Tags: RENAL PATHOPHYSIOLOGY: Edited by Orson W. Moe and Susan Quaggin Source Type: research

Role of Klotho in bone and implication for CKD
Purpose of review Klotho is a transmembrane protein that acts as a co-receptor for fibroblast growth factor 23 (FGF23). Recent investigations have discovered the presence of Klotho in bone-forming osteoblasts and osteocytes. This review summarizes emerging literature on the roles of bone Klotho in mineral and bone metabolism and discusses their possible involvement in renal osteodystrophy. Recent findings Mouse genetic studies have demonstrated that loss of Klotho in osteocytes leads to increased bone formation and bone volume. The identification of Klotho expression in bone cells pointed to the possibility that the b...
Source: Current Opinion in Nephrology and Hypertension - May 31, 2018 Category: Urology & Nephrology Tags: RENAL PATHOPHYSIOLOGY: Edited by Orson W. Moe and Susan Quaggin Source Type: research

Pathogenesis of cerebral edema in patients with acute renal and liver failure and the role of the nephrologist in the management
Purpose of review Acute liver failure (ALF) is a severe and complex illness and one of the most daunting conditions managed in the ICU. Because the renal care is intertwined with multiple disciplines, the aim of this review is to examine the multifactorial pathogenesis of cerebral edema in ALF, covering basic established facts as well as recent advances in our understanding of this condition. Recent findings Acetaminophen remains the most common cause of ALF in the United States and many European countries. The incidence of cerebral edema continues to decline owing to earlier detection and improved management. The pat...
Source: Current Opinion in Nephrology and Hypertension - May 31, 2018 Category: Urology & Nephrology Tags: RENAL PATHOPHYSIOLOGY: Edited by Orson W. Moe and Susan Quaggin Source Type: research

Application of echocardiographic data in patients with chronic kidney disease
Purpose of review Patients with chronic kidney disease (CKD) are at a high risk for cardiovascular events and mortality, particularly heart failure. Echocardiography is the most commonly used diagnostic imaging modality for heart failure. The purpose of this review is to summarize recent literature that demonstrates how echocardiography may be used to define cardiac structure and function in the CKD population and to identify echocardiographic abnormalities that have utility in predicting clinical outcomes in this population. Recent findings Recent studies have highlighted the high prevalence of echocardiographic abno...
Source: Current Opinion in Nephrology and Hypertension - May 31, 2018 Category: Urology & Nephrology Tags: RENAL PATHOPHYSIOLOGY: Edited by Orson W. Moe and Susan Quaggin Source Type: research

Source and microenvironmental regulation of erythropoietin in the kidney
Purpose of review Historically, the identity of O2-sensing renal erythropoietin (Epo)-producing (REP) cells was a matter of debate. This review summarizes how recent breakthroughs in transgenic mouse and in-situ hybridization techniques have facilitated sensitive and specific detection of REP cells and accelerated advancements in the understanding of the regulation of renal Epo production in health and disease. Recent findings REP cells are a dynamically regulated unique subpopulation of tubulointerstitial cells with features of fibroblasts, pericytes and neurons. Under normal conditions, REP cells are located in the ...
Source: Current Opinion in Nephrology and Hypertension - May 31, 2018 Category: Urology & Nephrology Tags: RENAL PATHOPHYSIOLOGY: Edited by Orson W. Moe and Susan Quaggin Source Type: research

Claudins and nephrolithiasis
Purpose of review The greatest risk factor for kidney stone formation is increased urinary calcium excretion. Most filtered calcium is reabsorbed from the proximal tubule and the thick ascending limb (TAL) of Henle's loop via a paracellular pathway. Claudins are tight junction proteins that confer the permeability properties of an epithelium. We review the contribution of renal claudins to nephron calcium permeability and how perturbations in these pathways cause alterations in tubular calcium transport, hypercalciuria, nephrocalcinosis, or nephrolithiasis. Recent findings Claudin-16 and Claudin-19 form a complex with...
Source: Current Opinion in Nephrology and Hypertension - May 31, 2018 Category: Urology & Nephrology Tags: RENAL PATHOPHYSIOLOGY: Edited by Orson W. Moe and Susan Quaggin Source Type: research

Evidence basis for integrated management of mineral metabolism in patients with end-stage renal disease
Purpose of review Treatment of mineral metabolism is a mainstay of dialysis care including some of its most widely used and costly pharmaceuticals. Although many mineral metabolites are associated with increased risk of mortality, cardiovascular disease, and other morbidities, few clinical trials are available to guide therapy and most focus on single drug approaches. In practice, providers manage many aspects of mineral metabolism simultaneously in integrated treatment approaches that incorporate multiple agents and changes in the dialysis prescription. The present review discusses the rationale and existing evidence fo...
Source: Current Opinion in Nephrology and Hypertension - May 31, 2018 Category: Urology & Nephrology Tags: MINERAL METABOLISM: Edited by Tamara Isakova and David A. Bushinsky Source Type: research

Rationale to reduce calcium intake in adult patients with chronic kidney disease
Purpose of review Calcium is an essential ion for the maintenance of normal bone health and physiologic functions. The extracellular and intracellular levels of calcium are maintained through hormonal regulation called homeostasis. Balance, the net intake minus excretion of calcium, is maintained by hormonal regulation of intestinal absorption and fecal/urinary excretion. Homeostasis and balance are disconnected in patients with chronic kidney disease (CKD). The purpose of this review is to understand how calcium homeostasis and balance are impaired in CKD. Recent findings Two formal calcium balance studies have found...
Source: Current Opinion in Nephrology and Hypertension - May 31, 2018 Category: Urology & Nephrology Tags: MINERAL METABOLISM: Edited by Tamara Isakova and David A. Bushinsky Source Type: research

Time to rethink the use of bone biopsy to prevent fractures in patients with chronic kidney disease
Purpose of review The purpose of this review is to provide evidence to justify the use of bone biopsy data to guide decisions regarding fracture prevention in patients with chronic kidney disease (CKD). To date, no data can support the use of bone biopsy for this purpose. However, we believe that bone turnover, mineralization and volume (TMV) data might help decide, which therapy to use. Recent findings Previous bone biopsy-based prospective and intervention studies have used bone turnover as an outcome measure. Recent data have shown that bone volume (trabecular and cortical) and mineralization should also be evaluat...
Source: Current Opinion in Nephrology and Hypertension - May 31, 2018 Category: Urology & Nephrology Tags: MINERAL METABOLISM: Edited by Tamara Isakova and David A. Bushinsky Source Type: research

Beginnings of nephrolithiasis: insights into the past, present and future of Randall's plaque formation research
Purpose of review Kidney stones form as a result of heterogeneous nucleation on a calcium phosphate lesion in the renal papilla known as Randall's plaque. Stone disease has plagued humans for millennia with relatively little progress made in the realm of prevention. An understanding of the historical aspects of research into Randall's plaque is necessary to interpret novel correlative imaging discoveries. Focus for the past several decades has been on the distal papillary tip, and the overlooked Anderson–Carr–Randall progression is revitalized with novel supporting evidence. Recent findings Novel correlati...
Source: Current Opinion in Nephrology and Hypertension - May 31, 2018 Category: Urology & Nephrology Tags: MINERAL METABOLISM: Edited by Tamara Isakova and David A. Bushinsky Source Type: research

α-Klotho's effects on mineral homeostasis are fibroblast growth factor-23 dependent
Purpose of review α-Klotho (Klotho) occurs in three isoforms, a membrane-bound form acting as a coreceptor for fibroblast growth factor-23 (FGF23) signalling, a shed soluble form consisting of Klotho's large ectodomain thought to act as an enzyme or a hormone, and a secreted truncated form generated by alternative splicing of the Klotho mRNA with unknown function. The purpose of this review is to highlight the recent advances in our understanding of Klotho's function in mineral homeostasis. Recent findings A number of seminal discoveries have recently been made in this area, shifting existing paradigms. The crys...
Source: Current Opinion in Nephrology and Hypertension - May 31, 2018 Category: Urology & Nephrology Tags: MINERAL METABOLISM: Edited by Tamara Isakova and David A. Bushinsky Source Type: research

Management of stones and bones: reduction of uncertainty through research
No abstract available (Source: Current Opinion in Nephrology and Hypertension)
Source: Current Opinion in Nephrology and Hypertension - May 31, 2018 Category: Urology & Nephrology Tags: MINERAL METABOLISM: Edited by Tamara Isakova and David A. Bushinsky Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Nephrology and Hypertension)
Source: Current Opinion in Nephrology and Hypertension - May 31, 2018 Category: Urology & Nephrology Tags: Editorial Introductions Source Type: research

Fracture risk and treatment in chronic kidney disease
Purpose of review Chronic kidney disease (CKD) is associated with the development of mineral bone disorder (MBD), osteoporosis, and fragility fractures. The purpose of this review is to provide an update on recent findings in the diagnosis and treatment of osteoporosis in patients with CKD. Recent findings Multiple observational studies have shown that bone mineral density measurement using DEXA is equally predictive in CKD stages 1–3, as in the general population. Post hoc analyses from randomized trials of bisphosphonates, SERM, RANKL inhibitors and PTH agonists all suggest equal efficacy in mild–moderat...
Source: Current Opinion in Nephrology and Hypertension - April 5, 2018 Category: Urology & Nephrology Tags: EPIDEMIOLOGY AND PREVENTION: Edited by Navdeep Tangri Source Type: research

An update on predicting renal progression in IgA nephropathy
Purpose of review Immunoglobulin A (IgA) nephropathy (IgAN) is a heterogeneous disease, and predicting individual patient risk of renal progression is challenging. Recent studies provide new evidence regarding the use of clinical, histologic, and biomarker predictors of renal outcome in IgAN. Recent findings A meta-analysis of clinical trials demonstrated that early change in proteinuria is a valid surrogate outcome measure for longer term decline in renal function, which supports the use of proteinuria to dynamically re-evaluate patient prognosis over time. The MEST histologic classification has been further validate...
Source: Current Opinion in Nephrology and Hypertension - April 5, 2018 Category: Urology & Nephrology Tags: EPIDEMIOLOGY AND PREVENTION: Edited by Navdeep Tangri Source Type: research

Controversies in vascular access
Purpose of review There is renewed interest in vascular access research, fueled by new perspectives and a critical re-examination of traditional thinking. This review summarizes important developments in vascular access from the past year, highlight areas of controversy, and makes recommendations for future research. Recent findings Recent studies provide an innovative and critical look at the assumptions underlying the promotion of fistulas as the preferred form of vascular access and highlight the need for a randomized comparison of different forms of access. Promising work that will help determine predictors of fis...
Source: Current Opinion in Nephrology and Hypertension - April 5, 2018 Category: Urology & Nephrology Tags: EPIDEMIOLOGY AND PREVENTION: Edited by Navdeep Tangri Source Type: research

Novel oral anticoagulants in chronic kidney disease: ready for prime time?
Purpose of review Patients with chronic kidney disease (CKD) are at increased risk of atrial fibrillation, stroke, and bleeding posing unique clinical challenges. Novel oral anticoagulants (NOACs) including dabigatran, rivaroxaban, and apixaban have become recognized as alternative therapy to Vitamin K Antagonists (VKA) regarding the prevention of venous thromboembolism (VTE) and reduce the risk of stroke in atrial fibrillation. However, the understanding of NOACs in CKD is still underdeveloped. This review summarizes recent literature on the efficacy and safety of NOACs in patients with CKD. Recent findings Studies f...
Source: Current Opinion in Nephrology and Hypertension - April 5, 2018 Category: Urology & Nephrology Tags: EPIDEMIOLOGY AND PREVENTION: Edited by Navdeep Tangri Source Type: research

Advances in molecular diagnosis and therapeutics in nephrotic syndrome and focal and segmental glomerulosclerosis
Purpose of review The widespread adoption of next-generation sequencing by research and clinical laboratories has begun to uncover the previously unknown genetic basis of many diseases. In nephrology, one of the best examples of this is seen in focal and segmental glomerulosclerosis (FSGS) and nephrotic syndrome. We review advances made in 2017 as a result of human and molecular genetic studies as it relates to FSGS and nephrotic syndrome. Recent findings There are more than 50 monogenic genes described in steroid-resistant nephrotic syndrome and FSGS, with seven reported in 2017. In individuals presenting with FSGS o...
Source: Current Opinion in Nephrology and Hypertension - April 5, 2018 Category: Urology & Nephrology Tags: EPIDEMIOLOGY AND PREVENTION: Edited by Navdeep Tangri Source Type: research

Fluid status assessment in hemodialysis patients and the association with outcome: review of recent literature
Purpose of review In this review, we will discuss the most recent literature regarding fluids status assessment in hemodialysis patients, and the associations with outcome. Recent findings Research toward technique-assisted assessment of fluid status in hemodialysis patients has been going on for many years. However, there is no absolute agreement between techniques, such as bioimpedance, lung ultrasound, biochemical markers or vena caval diameter, likely because they reflect different fluid compartments with potentially altered distribution in hemodialysis patients. Recent studies, mostly based on bioimpedance, have ...
Source: Current Opinion in Nephrology and Hypertension - April 5, 2018 Category: Urology & Nephrology Tags: EPIDEMIOLOGY AND PREVENTION: Edited by Navdeep Tangri Source Type: research

The association of proton pump inhibitors and chronic kidney disease: cause or confounding?
Purpose of review To discuss whether the recently described relationship between proton pump inhibitor (PPI) use and the risk of adverse kidney outcomes represents a causal relationship or is merely the result of confounding. Recent findings A wave of observational studies has described an association between PPI use and the risk of development of chronic kidney disease and its progression to end-stage renal disease. The results are generally robust and remarkably consistent across different studies. The application of modern pharmacoepidemiologic methods to estimate the effect of a putative unmeasured or unknown conf...
Source: Current Opinion in Nephrology and Hypertension - April 5, 2018 Category: Urology & Nephrology Tags: EPIDEMIOLOGY AND PREVENTION: Edited by Navdeep Tangri Source Type: research

Gender differences in hypertension
Purpose of review The review is a short discussion of sex/gender differences in blood pressure control with a focus on gender differences in hypertension awareness, prevalence, and treatment, the new American College of Cardiology/American Heart Association Guidelines, and recent discoveries in animal models and humans on mechanisms responsible for sex/gender differences in hypertension. Recent findings Hypertension awareness is greater in women than men, the prevalence of hypertension is higher in men than women until after menopause, and although the American College of Cardiology/American Heart Association Guidelin...
Source: Current Opinion in Nephrology and Hypertension - April 5, 2018 Category: Urology & Nephrology Tags: Special Commentary Source Type: research