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Manohar Bairy, Faith H W See, Ru Sin Lim
BACKGROUND: Estimating the glomerular filtration rate (eGFR) when the creatinine (Cr) is rapidly changing, as in acute kidney injury (AKI), has been a challenge. The Kinetic Estimated Glomerular Filtration Rate (KeGFR) formula by S. Chen estimates the GFR in the acute state by factoring the time interval between rising Cr values and the volume of distribution (VD). It provides the clinician with an eGFR value for each non-steady state Cr value. We applied the KeGFR formula to detect AKI in an adult non-ICU inpatient setting...
September 19, 2018: Nephron
Camiel L M de Roij van Zuijdewijn, Dinky E de Haseth, Bastiaan van Dam, Willem A Bax, Muriel P C Grooteman, Michiel L Bots, Peter J Blankestijn, Menso J Nubé, Marinus A van den Dorpel, Pieter M Ter Wee, Erik L Penne
BACKGROUND/AIMS: In hemodialysis (HD) patients, the bromcresol green (BCG) assay overestimates, whereas the bromcresol purple (BCP) assay underestimates albumin concentration. Since corrected calcium concentrations depend on albumin, the albumin assay may have implications for the management of bone mineral disorders. METHODS: A subset of patients from CONTRAST, a cohort of prevalent HD patients, was analyzed. Bone mineral parameters and prescription of medication were compared between patients in whom albumin was assessed by BCP versus BCG...
September 13, 2018: Nephron
Paul Vos, Robert Zietse, Michel van Geel, Alice S Brooks, Karlien Cransberg
BACKGROUND: Alport syndrome is a rare inheritable kidney disease frequently leading to end-stage kidney disease in young adults. Patients could benefit from early recognition of the disease. In several children with Alport syndrome, a parent was noticed to have renal symptoms attributed to another renal disease. AIM: To review the renal history of the closest family members of a cohort of pediatric patients with genetically proven Alport syndrome. METHODS: The medical records of all children with genetically proven Alport syndrome identified at our pediatric nephrology department in the last 20 years were reviewed, with focus on the medical history of affected parents...
September 13, 2018: Nephron
Mostafa Abdelsalam, Sherouk Salah Eldin Elnagar, Ashraf H Mohamed, Mona Tawfik, Nagy Sayed Ahmed
AIM: Acute kidney injury (AKI) is a major health problem with poor patient prognosis. We evaluated the clinical characteristics, risk factors, associated comorbidities, and outcomes of AKI patients. METHODOLOGY: A single-center prospective observational study. The patients were admitted in Mansoura Nephrology and Dialysis Unit over a period of 1 year from January to December, 2016. Patients were diagnosed as AKI or AKI in addition to chronic kidney disease according to the creatinine criteria of KDIGO 2013...
September 11, 2018: Nephron
Paul M Palevsky
BACKGROUND: The selection of appropriate endpoints is critical to the success of any clinical trial. Endpoints need to be precisely defined and need to provide an appropriate balance between sensitivity for detection of the effects of the intervention of interest and specificity for the outcome of interest. SUMMARY: In acute kidney injury (AKI), the 2 most common endpoints utilized either rely on small, short-term changes in serum creatinine or are a composite of longer term major adverse kidney events, including death, need for dialysis, and a persistent decline in kidney function...
September 11, 2018: Nephron
Maria E Ougaard, Frederikke E Sembach, Peter H Kvist, Morten Tonnesen, Klaus S Frederiksen, Martin Egfjord, Henrik E Jensen, Elisabeth D Galsgaard
BACKGROUND/AIMS: Murine nephrotoxic nephritis (NTN) is a well-established model resembling chronic kidney disease. Investigating gene expression patterns separately in the glomerular and cortical tubulointerstitial structure could provide new knowledge about structure-specific changes in expression of genes in the NTN model. METHODS: Glomerular, cortical tubulointerstitial and whole kidney tissues from mice subjected to nephrotoxic serum (NTS) or phosphate buffered saline (PBS) were collected on day 7, 21 and 42 using laser microdissection (LMD)...
September 11, 2018: Nephron
Kelly K Andringa, Ravindra L Mehta, Paul W Sanders, Anupam Agarwal
No abstract text is available yet for this article.
September 10, 2018: Nephron
Sayaka Shimizu, Shingo Fukuma, Tatsuyoshi Ikenoue, Tadao Akizawa, Shunichi Fukuhara
BACKGROUND/AIMS: Hemodialysis patients are at high risk of hospitalization and their condition may worsen with repeated hospitalization. The aim of this study was to evaluate the impact of the cumulative number of hospitalizations on post-discharge mortality. METHODS: This study was a prospective cohort study. We examined 3,359 adult patients on hemodialysis for at least 90 days who participated in the Japanese Dialysis Outcomes and Practice Patterns Study phases 3 and 4 (2005-2012)...
August 28, 2018: Nephron
Zoltán H Endre
While there are no clear definitions of recovery, it is clear that the goals of recovery depend on the severity of acute kidney injury and the clinical context. The degree of renal recovery affects both renal and clinical prognosis. There are presently few guidelines on recovery targets, which range in extent from dialysis independence via normalization of serum creatinine to recovery of renal functional reserve. However, while there are no validated biomarkers for predicting recovery, evidence suggests that both functional and damage biomarkers can aid the assessment of recovery...
August 28, 2018: Nephron
Ming-Hsien Tsai, Chen-Yang Hsu, Ming-Yen Lin, Ming-Fang Yen, Hsiu-Hsi Chen, Yueh-Hsia Chiu, Shang-Jyh Hwang
BACKGROUND/AIMS: Taiwan has the highest incidence of end-stage renal disease, which requires renal replacement therapy. Chronic kidney disease (CKD) contributes to this burden. However, the current data on the epidemiologic features of CKD in Taiwan are incomplete. Therefore, we aimed to investigate the prevalence and incidence of CKD in a population-based study and then estimate the average dwelling time (ADT) in the main clinical burden of CKD (stages 3-5). METHODS: A prospective cohort study was designed with an integrated community-based multiple screening program of 106,094 individuals aged ≥20 years in Keelung, Taiwan, in 1999-2009...
August 23, 2018: Nephron
F Perry Wilson, Jason H Greenberg
Broad adoption of electronic health record (EHR) systems has facilitated acute kidney injury (AKI) research in 2 ways. First, the detection of AKI based on changes in serum creatinine has largely replaced the sensitive but nonspecific administrative coding of AKI that predominated in earlier studies. Second, the ability to implement real-time AKI interventions such as alerts and best-practice advisories has emerged as a promising tool to fight against the harmful sequela of AKI, which include short-term adverse outcomes as well as progression to chronic kidney disease, dialysis, and death...
August 2, 2018: Nephron
Roslyn B Mannon
With the growing wait list of individuals waiting for kidney transplantation, there has been renewed interest in the quality and function of donor organs. In particular, concern about the development of delayed allograft function (DGF) after transplantation continues to lead to the avoidance of donor organs offered to a transplant center. DGF is associated with worse short-and long-term outcomes and associated with higher rejection rates. There are no FDA-approved therapies to mitigate the ischemic injury that occurs...
July 13, 2018: Nephron
Mark L Hepokoski, Atul Malhotra, Prabhleen Singh, Laura E Crotty Alexander
Mechanical ventilation is associated with significant increases in the risk of acute kidney injury (AKI). The rate of AKI due to mechanical ventilation and the associated mortality remain unacceptably high. Preventative and therapeutic strategies are clearly lacking. Ventilator-induced kidney injury is believed to occur due to changes in hemodynamics that impair renal perfusion, neurohumoral-mediated alterations in intra-renal blood flow, and systemic inflammatory mediators generated by ventilator-induced lung injury...
July 11, 2018: Nephron
Tomoyasu Otsuki, Kei Utsunomiya, Masari Moriuchi, Shu Horikoshi, Masahiro Okamura, Hiroko Suzuki, Makiyo Okamura, Noriaki Maruyama, Nami Shibahara, Masanori Abe
OBJECTIVE: This study investigated the effects of sucroferric oxyhydroxide on fibroblast growth factor (FGF)-23 and dose reduction of erythropoiesis-stimulating agents (ESA) and intravenous saccharated ferric oxide in hemodialysis patients. METHODS: In this prospective, open-label, parallel-group, multicenter trial involving patients receiving lanthanum carbonate hydrate, eligible patients were randomized to a sucroferric oxyhydroxide group or a control group. Hemoglobin, serum phosphate, FGF-23, iron, and ferritin levels, as well as transferrin saturation, doses of intravenous saccharated ferric oxide and ESA administered, and the erythropoietin responsiveness index (ERI) were monitored for 24 weeks...
July 10, 2018: Nephron
Jin Ju Song, Kyu-Beck Lee, Young Youl Hyun, Hyang Kim
BACKGROUND/AIMS: Albuminuria is a risk factor for coronary artery calcification (CAC) and cardiovascular disease (CVD). Although the urine dipstick test is widely used to screen albuminuria, little is known about the association between low-grade urine dipstick albumin and CAC. The aim of this study is to investigate the relationship between the trace of urine dipstick albumin and CAC in Korean adults. METHODS: This cross-sectional study analyzed 45,006 participants without previous CVD, who underwent coronary computed tomography and urine dipstick test from 2012 to 2014 as part of a health examination program in Korea...
July 10, 2018: Nephron
Shinji Tanaka, Mark D Okusa
BACKGROUND: No approved pharmacological agents are available for the treatment and prevention of acute kidney injury (AKI). The nervous system has been reported to play an important role, directly or indirectly via the immune system, in the pathophysiology of AKI. Neuromodulation, such as vagus nerve stimulation and pulsed ultrasound, is emerging as an innovative therapeutic treatment for various diseases including AKI. However, lack of effective methods to selectively stimulate or inhibit neurons has hampered the complete understanding of the roles of the nervous system in AKI because electrical stimulation is nonspecific for cell types...
July 10, 2018: Nephron
John M Arthur, Nithin Karakala, Ricky D Edmondson
The search for acute kidney injury (AKI) biomarkers has identified a number of urine proteins that can be used to predict the presence of AKI but has struggled to identify proteins that are prognostic for severe AKI. In this review, we discuss 2 currently available biomarkers and the designs of the studies in which they were identified and relate this to the AKI characteristics they predict clinically. We discuss recent advances in mass spectrometry and sample preparation, which have improved the ability to identify low abundance proteins as well as the ability to characterize more of the protein by mass spectrometry...
July 10, 2018: Nephron
Sundararaman Swaminathan
BACKGROUND: Iron is critical for fundamental biologic functions such as cell division and mitochondrial electron transport. However, by the virtue of its ability to donate electrons, iron is probably the most effective oxidant in biologic systems. SUMMARY: To avoid damage from iron-mediated oxidative injury or ferroptosis, multiple defense mechanisms exist including iron binding proteins and robust glutathione-dependent intracellular pathways. Hepcidin, through its ability to sequester iron within macrophages and induce H-ferritin, serves as an endogenous protective molecule against ferroptosis...
July 6, 2018: Nephron
Roger van Groenendael, Matthijs Kox, Lucas T van Eijk, Peter Pickkers
The systemic inflammatory response following infectious or non-infectious insults is related to morbidity (including acute kidney injury) and mortality. Pregnancy is associated with immunotolerance and an increased glomerular filtration rate. EA-230, a linear tetrapeptide (Alanine-Glutamine-Glycine-Valine), derived from the β-chain of the human chorionic gonadotropin hormone, has shown immunomodulatory and renoprotective properties in several pre-clinical animal models of systemic inflammation. Furthermore, an excellent safety profile of EA-230 was observed in phase 1 studies in humans, and the immunomodulatory effects of EA-230 were recently demonstrated in a phase IIa study during human experimental endotoxemia...
July 6, 2018: Nephron
Anne von Mässenhausen, Wulf Tonnus, Andreas Linkermann
Renal tubules represent an intercellular unit and function as a syncytium. When acute tubular necrosis was first visualized to occur through a process of synchronized regulated necrosis (SRN) in handpicked primary renal tubules, it became obvious that SRN actually promotes nephron loss. This realization adds to our current understanding of acute kidney injury (AKI)-chronic kidney disease (CKD) transition and argues for the prevention of AKI episodes to prevent CKD progression. Because SRN is triggered by necroptosis and executed by ferroptosis, 2 recently identified signaling pathways of regulated necrosis, a combination therapy employing necrostatins and ferrostatins may be beneficial for protection against nephron loss...
June 29, 2018: Nephron
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