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Contributions to Nephrology

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https://www.readbyqxmd.com/read/28535530/mathematical-model-of-potassium-profiling-in-chronic-dialysis
#1
Mauro Ursino, Gabriele Donati
Potassium balance is a difficult task in hemodialysis: low potassium in the dialysate is associated with a high risk of sudden cardiac death, whereas excessive dialysate potassium may provoke insufficient removal and hyperkalemia. A better understanding of the problem can be achieved with the use of mathematical models of solute kinetics. This study is aimed at presenting an improved model of solute kinetics and fluid shifts during hemodialysis. It comprises a 2-compartment (intracellular and extracellular) description of sodium, potassium, and urea, including volume fluid shifts induced by osmotic forces...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/28535529/looking-into-the-graft-without-a-biopsy-biomarkers-of-acute-rejection-in-renal-transplantation
#2
Andrea Angeletti, Paolo Cravedi
Immunosuppression in kidney transplantation is still largely driven by center-specific protocols and adjusted according to the presence of graft dysfunction, drug toxicity or infection. Due to the current inability to titrate immunosuppression to the needs of every single patient, this approach is burdened by an increased risk of under or over-immunosuppression. To extend allograft survival, immunosuppression should be decided based on reliable biomarkers capable of quantifying the alloimmune response and/or noninvasively diagnosing acute rejection...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/28535528/chronic-allograft-injury-an-overview-of-pathogenesis-and-treatment-strategies
#3
Hector M Madariaga, Leonardo V Riella
Chronic allograft injury (CAI) remains one of the biggest challenges in transplantation as it directly affects the long-term allograft survival, an area in which the scientific and transplantation communities have struggled to improve outcomes. Therefore, understanding the mechanisms of CAI is paramount to implement preventive measures and novel therapeutic options. In this review, we will address the latest evidence on CAI, potential etiologies and risk factors including non-adherence, antibody-mediated rejection, recurrence of glomerular disease, BK nephropathy, and calcineurin nephrotoxicity...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/28535527/treatment-of-acute-antibody-mediated-rejection
#4
Giorgia Comai, Matteo Ravaioli, Olga Baraldi, Vania Cuna, Lorenzo Gasperoni, Giovanni Liviano D''Arcangelo, Maria Cappuccilli, Antonio D Pinna, Claudio Ronco, Gaetano La Manna
Acute antibody-mediated rejection (AMR) remains an important challenge in the field of kidney transplantation despite the advances in immunosuppressive strategies, and has been recognized as an important cause of allograft dysfunction and graft loss. The treatments of acute AMR are not standardized and poor evidence is currently available on the effectiveness of therapy regimens with combinations of drugs. Standard treatment for acute AMR is based on 3 cornerstones: removal of donor-specific antibodies (DSAs) from the bloodstream, reduction of DSAs synthesis, and inhibition of the interaction between DSAs and human leukocyte antigen antigens on donor's cells...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/28535526/home-hemodialysis-what-is-old-is-new-again
#5
Peter G Kerr, Juli Jaw
Home hemodialysis (HD) is undergoing a resurgence. A major driver of this is economics, however, providers are also encouraged by a combination of excellent patient outcomes and patient experiences as well as the development of newer technologies that offer ease of use. Home HD offers significant advantages in flexible scheduling and the practical implementation of extended hours dialysis. This paper explores the reasons why home HD is making a comeback and strives to offer approaches to improve the uptake of this dialysis modality...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/28535525/expanded-hemodialysis-a-new-therapy-for-a-new-class-of-membranes
#6
Claudio Ronco, Gaetano La Manna
A wide spectrum of molecules is retained in end-stage kidney disease, normally defined as uremic toxins. These solutes have different molecular weights and radii. Current dialysis membranes and techniques only remove solutes in the range of 50-15,000 Da, with limited or no capability to remove solutes in the middle to high molecular weight range (up to 50,000 Da). Improved removal has been obtained with high cut-off (HCO) membranes, with albumin loss representing a limitation to their practical application...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/28535524/genetics-and-autosomal-dominant-polycystic-kidney-disease-progression
#7
Valentina Corradi, Anna Giuliani, Fiorella Gastaldon, Massimo de Cal, Barbara Mancini, Anna Montaldi, Alberta Alghisi, Irene Capelli, Gaetano La Manna, Claudio Ronco
Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disease, accounting for 10% of European patients on renal replacement therapy. In the previous years, many approaches to slow the progression of ADPKD were studied and many clinical trials published. In addition to having diagnostic role, the description of the genotype is even important to predict the progression of the disease and contributes, combined with several other factors, to a more precise patients classification...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/28535523/mycophenolate-mofetil-a-possible-alternative-treatment-for-iga-nephropathy
#8
Olga Baraldi, Giorgia Comai, Vania Cuna, Maria Cappuccilli, Carla Serra, Claudio Ronco, Gaetano La Manna
IgA nephropathy (IgAN) is the most common primary glomerulonephritis in developed countries and a leading cause of chronic kidney disease. IgAN is a mesangial proliferative glomerulonephritis characterized by diffuse mesangial deposition of IgA, often accompanied by the deposition of IgG and the C3 component of complement in a similar distribution. This condition is in most cases oligosymptomatic, often discovered coincidentally. Currently, there is no specific treatment available for IgAN and the use of immunosuppression therapy is debated...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/28535522/restenosis-in-hemodialytic-fistulas-and-chronic-kidney-disease-associated-vascular-disease-two-pathologies-driven-by-metakaryotic-stem-cells
#9
Gianandrea Pasquinelli, William G Thilly, Elena V Gostjeva, Paola Todeschini, Giuseppe Cianciolo, Claudio Ronco, Gaetano La Manna
Chronic kidney disease (CKD) exacerbating vascular disease poses a major challenge to nephrology. Surgically placed vascular fistulas, as an aid to hemodialysis prior to kidney transplant, have extended many lives, while post-surgical restenosis closure of the fistula by smooth muscle cells affects many lives. When post-surgical restenosis is developed, palliative measures are almost always surgical: there are no effective drug treatments. In this study, we offer a testable hypothesis that effects of CKD on widely distributed vascular diseases and the phenomenon of fistula restenosis are both driven by the pathologic creation of non-dividing smooth muscle cells via asymmetric division of exponentially increasing metakaryotic stem cells...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/28535521/fibroblast-growth-factor-23-mineral-metabolism-and-beyond
#10
Alexander Grabner, Sandro Mazzaferro, Giuseppe Cianciolo, Stefanie Krick, Irene Capelli, Silverio Rotondi, Claudio Ronco, Gaetano La Manna, Christian Faul
Patients affected by chronic kidney disease (CKD) exhibit a high risk of cardiovascular mortality that is poorly explained by traditional risk factors. There is a growing awareness about the role of derangement of mineral metabolism that is currently accepted as a trigger and sustainer of cardiovascular disease (CVD) in CKD patients. The synthetic definition of CKD mineral and bone disorder (CKD-MBD) split the concept that the indexes of mineral metabolism extend their effects beyond the bone until the vascular wall and metabolic milieu of CKD patients through complex pathways...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/28535520/phosphate-in-chronic-kidney-disease-progression
#11
Mario Cozzolino, Denis Foque, Paola Ciceri, Andrea Galassi
A direct and independent association between serum phosphate (P) levels and mortality has been reported. High circulating P concentrations, still within the normal range, was associated with unfavourable outcomes in normal subjects as well as in chronic kidney disease (CKD) patients. Experimental data support the notion that P overload may hamper survival expectancy, directly inducing vascular, skeletal, and renal ageing. The balance of P results from dietary intake, intestinal absorption, glomerular filtration, tubular resorption, and hormonal asset...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/28535519/development-of-the-new-kibou%C3%A2-equipment-for-continuous-renal-replacement-therapy-from-scratch-to-the-final-configuration
#12
Mauro Neri, Anna Lorenzin, Alessandra Brendolan, Francesco Garzotto, Fiorenza Ferrari, Silvia De Rosa, Raffaele Bonato, Gianluca Villa, Simona Bazzano, Fiorella D''Ippoliti, Zaccaria Ricci, Gaetano La Manna, Claudio Ronco
A new technology has recently appeared in the area of extracorporeal therapies for critically ill patients with acute kidney injury. The International Renal Research Institute of Vicenza was involved from the beginning in the development of a new continuous renal replacement therapy (CRRT) equipment with peculiar characteristics. We report the overall experience from design of the new machine to its in vitro and in vivo testing. Kibou® (Asahi Kasei Kuraray Medical Co., Ltd., Tokyo, Japan) is a new multifunctional machine designed for delivering RRT...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/28535518/extracorporeal-sorbent-technologies-basic-concepts-and-clinical-application
#13
William R Clark, Fiorenza Ferrari, Gaetano La Manna, Claudio Ronco
Limitations imposed by the characteristics of some solutes and the structure of dialysis membranes have spurred new interest in the use of mechanisms beyond diffusion and convection for extracorporeal solute removal. Sorbents have been utilized for more than 50 years in extracorporeal blood treatments for specific purposes, and better understanding of their basic aspects may further expand the potential for their clinical application. In this chapter, the basic principles applying to sorbents are discussed, including composition and structure, along with the fundamental mechanisms of solute removal...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/28535517/coupled-plasma-filtration-adsorption-application-for-liver-and-thyroid-toxins
#14
Gabriele Donati, Irene Capelli, Anna Laura Croci Chiocchini, Nicolò Natali, Anna Scrivo, Gaetano La Manna
Coupled plasma filtration and adsorption (CPFA) is a detoxification system that combines a plasma adsorption circuit and a continuous renal replacement therapy circuit. Its main application is for sepsis and septic shock with or without acute renal failure. Several recent studies have suggested that CPFA can reduce the mortality when the volume of plasma absorbed on the styrenic resin is at least >0.18 L/kg/day. At present, new applications for CPFA are under investigation, also in patients without significant kidney failure...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/28535516/citrate-anticoagulation-during-continuous-renal-replacement-therapy
#15
Davide Ricci, Laura Panicali, Maria Grazia Facchini, Elena Mancini
During extracorporeal dialysis, some anticoagulation strategy is necessary to prevent the coagulation of blood. Heparin has historically been used as an anticoagulant because of its efficacy combined with low cost. However, a variable incidence of hemorrhagic complications (5-30%) has been documented in patients undergoing continuous renal replacement therapy (CRRT) with heparin as an anticoagulant. Citrate has anticoagulation properties secondary to its ability to chelate calcium, which is necessary for the coagulation cascade...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/28535515/extracorporeal-treatments-in-patients-with-acute-kidney-injury-and-sepsis
#16
Marita Marengo, Sergio Dellepiane, Vincenzo Cantaluppi
Acute kidney injury (AKI) is one of the most common sepsis complications, and AKI development increases the risk of sepsis episodes by affecting host immune competence. The concomitance of these 2 clinical syndromes is associated with an extremely poor prognosis with mortality rates ranging from 50 to 70%. These unacceptable outcomes reflect the poor knowledge of the underlying pathogenic mechanisms and the lack of appropriate diagnostic and therapeutic methodologies as well as of appropriate experimental models...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/27951581/micrornas-are-associated-with-uremic-toxicity-cardiovascular-calcification-and-disease
#17
Ziad A Massy, Valérie Metzinger-Le Meuth, Laurent Metzinger
BACKGROUND: Vascular calcification has been recognized to be a major risk factor in chronic kidney disease (CKD) and downstream cardiovascular complications. Micro-RNAs (miRNAs) are small noncoding RNAs comprising 20-25 nucleotides that regulate gene expression by inhibiting or degrading the target mRNA, and constitute potential new biomarkers and future therapeutic strategies. SUMMARY: We tested the relevance of several cardiovascular-specific miRNAs as new biomarkers for CKD, cardiovascular disease, and cardiovascular complications...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/27951580/the-evolution-of-home-hd-meeting-modern-patient-needs
#18
Mark Roger Marshall, Christopher T Chan
Patients with end-stage renal disease undergoing conventional renal replacement therapy face high morbidities and inappropriately high mortality rates globally. Intensive home hemodialysis has emerged as an alternate form of renal replacement therapy with superior clinical outcomes. In order to describe the international trends in conducting home hemodialysis, we performed a cross-sectional survey of 25 centers reporting the global trends and practices of intensive home hemodialysis. While the practice of home hemodialysis has continued to evolve, similar logistical barriers exist around the world...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/27951579/evidence-for-the-clinical-advantages-of-predilution-on-line-hemodiafiltration
#19
Ikuto Masakane, Kan Kikuchi, Hideki Kawanishi
BACKGROUND: On-line hemodiafiltration (OL-HDF) is a rapidly developing dialysis modality that is expected to ameliorate the quality of life and survival rate of chronic dialysis patients. There are generally 2 types of dilution methods in OL-HDF: postdilution and predilution. SUMMARY: Postdilution OL-HDF is widely performed worldwide, whereas predilution OL-HDF accounts for >90% of all OL-HDF sessions performed in Japan. The reasons for the preference for predilution are to increase the substitution volume at a lower blood flow rate and to remove larger low-molecular-weight proteins (LMWPs)...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/27951578/carbohydrate-counting-a-simple-method-of-dietary-management-for-glycemic-control-in-japanese-diabetic-hemodialysis-patients
#20
Yukie Kitajima, Noriko Mikami, Toru Hyodo, Miho Hida, Junko Kawakami
BACKGROUND: Carbohydrate counting used in dietary therapy for diabetes is based on the concept that the postprandial rise in blood glucose levels is primarily affected by ingested carbohydrates. This method has been widely accepted and used since 1993, when its usefulness was demonstrated in the United States, largely due to the ease with which patients can understand the method. However, in Japan, there is a common misunderstanding that energy intake determines postprandial blood glucose levels...
2017: Contributions to Nephrology
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