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

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

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

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

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

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

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

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

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

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

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

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

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

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

Nephrolithiasis in women: how different from men?
Purpose of review Men have more kidney stones compared with women; however, the difference is progressively decreasing. The reasons for higher prevalence of stones in men, as well as increasing prevalence in women, is a subject of ongoing speculation. In this review, we summarize the evidence of differences between men and women and expand on the speculative causes. Recent findings Stone incidence is rising in women and adolescent girls. Stone disease is more heritable among men than women, and women demonstrate greater influence of the unique environment. Women under the age of 50 years who have been pregnant, have m...
Source: Current Opinion in Nephrology and Hypertension - January 30, 2020 Category: Urology & Nephrology Tags: CLINICAL NEPHROLOGY: Edited by David S. Goldfarb Source Type: research