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Exome sequencing as a diagnostic tool in chronic kidney disease: ready for clinical application?
Purpose of review Patients who develop chronic kidney disease at an early age, or from an uncertain cause, may benefit from genomic sequencing approaches to define causative mutations and inform subsequent management. Recent findings Whole-exome sequencing has been used to investigate the molecular genetic variants associated with chronic kidney disease in both specific phenotypes such as steroid-resistant nephrotic syndrome, and in large cohorts of patients not selected for a certain diagnosis. These studies have shown that whole-exome sequencing is able to find a genetic variant in a significant number of patients. ...
Source: Current Opinion in Nephrology and Hypertension - October 5, 2020 Category: Urology & Nephrology Tags: DIAGNOSTICS AND TECHNIQUES: Edited by Maarten W. Taal Source Type: research

Imaging of renal fibrosis
Purpose of review Fibrosis is an important biomarker of chronic kidney injury, and a powerful predictor of renal outcome. Currently, the only method for measuring fibrotic burden is histologic analysis, which requires a kidney biopsy in humans, or kidney removal in animal models. These requirements have not only hindered our ability to manage patients effectively, but have also prevented a full understanding of renal fibrosis pathogenesis, and slowed the translation of new antifibrotic agents. The development of noninvasive fibrosis imaging tools could thus transform both clinical care and renal fibrosis research. Recen...
Source: Current Opinion in Nephrology and Hypertension - October 5, 2020 Category: Urology & Nephrology Tags: DIAGNOSTICS AND TECHNIQUES: Edited by Maarten W. Taal Source Type: research

Cystatin C is ready for clinical use
Purpose of review The goal of this update is to raise awareness of clinical scenarios where cystatin C has clear and immediate benefits as an alternative glomerular filtration rate (GFR) biomarker to supplement creatinine. An additional goal is to focus the estimated GFR (eGFR) controversy onto medication prescribing for agents with narrow therapeutic windows where better GFR estimation will lead to improved medical care. Recent findings Equations that include cystatin C predict GFR more accurately than serum creatinine in children, adults, and older adults with larger effects among persons who are acutely ill. Numero...
Source: Current Opinion in Nephrology and Hypertension - October 5, 2020 Category: Urology & Nephrology Tags: DIAGNOSTICS AND TECHNIQUES: Edited by Maarten W. Taal Source Type: research

GFR slope as a surrogate endpoint for CKD progression in clinical trials
Purpose of review There is a paucity of therapies for chronic kidney disease (CKD), in part because of the slow nature of the disease which poses challenges in selection of endpoints in randomized controlled trials (RCT). There is increasing evidence for the use of glomerular filtration rate (GFR)-based endpoints either as percentage decline using time-to-event analyses, or as difference in slope between treatment arms. We reviewed the rationale for using surrogate endpoints and optimal methods for their evaluation prior to their use and evidence for GFR-based endpoints and particularly GFR slope as validated surrogate e...
Source: Current Opinion in Nephrology and Hypertension - October 5, 2020 Category: Urology & Nephrology Tags: DIAGNOSTICS AND TECHNIQUES: Edited by Maarten W. Taal Source Type: research

Fluid management in chronic kidney disease: what is too much, what is the distribution, and how to manage fluid overload in patients with chronic kidney disease?
Purpose of review Assessment of fluid status to reach normovolemia in patients with chronic kidney disease (CKD) continues to be a tough task. Besides clinical observation, technological methods have been introduced, yet, the best approach is still uncertain. The present review looks at fluid overload in CKD from three perspectives: the critical fluid threshold leading to adverse cardiovascular outcomes, fluid distribution and its clinical correlates, and direct effect of fluid overload on vascular function related to disturbance of the sodium–skin axis and endothelial glycocalyx dysfunction. Recent findings To dete...
Source: Current Opinion in Nephrology and Hypertension - October 5, 2020 Category: Urology & Nephrology Tags: DIAGNOSTICS AND TECHNIQUES: Edited by Maarten W. Taal Source Type: research

Getting the basics right: the monitoring of arteriovenous fistulae, a review of the evidence
Purpose of review Despite being the preferred vascular access for haemodialysis, the arteriovenous fistula (AVF) remains prone to a number of complications, the most common of these being thrombosis secondary to stenosis. This has resulted in the widespread use of monitoring and surveillance programmes. Surveillance uses more resources than monitoring and has not been convincingly shown to improve outcomes. The evidence supporting the use of the various monitoring tools has been relatively neglected and has not been the focus of literature review. This narrative review is the first to appraise the evidence for the use of...
Source: Current Opinion in Nephrology and Hypertension - October 5, 2020 Category: Urology & Nephrology Tags: DIAGNOSTICS AND TECHNIQUES: Edited by Maarten W. Taal Source Type: research

Current and novel imaging techniques to evaluate myocardial dysfunction during hemodialysis
Purpose of review Patients on hemodialysis have significantly higher rates of cardiovascular mortality resulting from a multitude of myocardial dysfunctions. Current imaging modalities allow independent assessment of cardiac morphology, contractile function, coronary arteries and cardiac perfusion. Techniques such as cardiac computed tomography (CT) imaging have been available for some time, but have not yet had widespread adoption because of technical limitations related to cardiac motion, radiation exposure and safety of contrast agents in kidney disease. Recent findings Novel dynamic contrast-enhanced (DCE) CT imag...
Source: Current Opinion in Nephrology and Hypertension - October 5, 2020 Category: Urology & Nephrology Tags: DIAGNOSTICS AND TECHNIQUES: Edited by Maarten W. Taal Source Type: research

Nutritional status assessment: a neglected biomarker in persons with end-stage kidney disease
This article reviews published literature on the associations between malnutrition, mortality, quality of life and hospitalizations in persons on dialysis in order to raise awareness of the importance of preventing and treating it. Recent findings All methods of nutritional assessment namely serum biochemistry, body composition, dietary intake, handgrip strength and nutritional scoring tools are independently associated with increased mortality in dialysis populations. Malnutrition severely affects physical and mental measures of quality of life and increases the number and length of hospitalizations in persons receivin...
Source: Current Opinion in Nephrology and Hypertension - October 5, 2020 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, 2020 Category: Urology & Nephrology Tags: EDITORIAL INTRODUCTIONS Source Type: research

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 exchanger isoform 3 (NHE3...
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