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Current Opinion in Nephrology and Hypertension

Netanya Y Spencer, Robert C Stanton
PURPOSE OF REVIEW: Glucose 6-phosphate dehydrogenase (G6PD) is the rate-limiting enzyme of the pentose phosphate pathway. G6PD is the main source of the essential cellular reductant, NADPH. The purpose of this review is to describe the biochemistry of G6PD and NADPH, cellular factors that regulate G6PD, normal physiologic roles of G6PD, and the pathogenic role altered G6PD/NADPH plays in kidney disease. RECENT FINDINGS: NADPH is required for many essential cellular processes such as the antioxidant system, nitric oxide synthase, cytochrome p450 enzymes, and NADPH oxidase...
October 15, 2016: Current Opinion in Nephrology and Hypertension
Michael G Ziegler, Milos Milic
PURPOSE OF REVIEW: The sympathetic nervous system (SNS) mediates short-term increases in blood pressure. Evidence that psychosocial stress leads to chronic hypertension is mixed. The SNS activation found in obstructive sleep apnea (OSA), caregiving for a severely demented spouse, and obesity more specifically address whether SNS activation might lead to the metabolic syndrome and hypertension. RECENT FINDINGS: Obesity is associated with both increased SNS electrical activity and plasma norepinephrine...
October 15, 2016: Current Opinion in Nephrology and Hypertension
Omar Al Dhaybi, George Bakris
PURPOSE OF REVIEW: Current evidence showcases the pathologic effects of excess aldosterone in promoting glomerular and tubulointerstitial inflammation and fibrosis through various pathways. The place for mineralocorticoid receptor antagonists (MRAs) in chronic kidney disease (CKD) progression is unclear. RECENT FINDINGS: MRAs further reduce albuminuria and blood pressure in CKD patients when used in conjunction with angiotensin-converting enzyme inhibitor or angiotensin receptor blockers...
October 7, 2016: Current Opinion in Nephrology and Hypertension
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November 2016: Current Opinion in Nephrology and Hypertension
Erik Stites, Peter Kennealey, Alexander C Wiseman
PURPOSE OF REVIEW: To review recent pancreas transplantation outcomes and indications and describe studies of the impact of pancreas transplant upon patient survival and secondary complications. RECENT FINDINGS: A number of surgical advances have occurred that have improved the early success rate of transplant, and modern immunosuppressive strategies have improved the rate of longer term allograft survival. Pancreas transplant is associated with a mortality benefit when performed in patients with end-stage renal disease in combination with kidney transplant, but questions regarding the impact upon secondary diabetic complications together with the risk assumed by the surgical procedure and the attendant immunosuppression in the nonuremic patient may have tempered enthusiasm for broader expansion of transplantation...
November 2016: Current Opinion in Nephrology and Hypertension
Richard N Formica
PURPOSE OF REVIEW: Simultaneous liver kidney transplantation (SLK) has taken center stage since the initiation of the new kidney allocation system (KAS). This review places SLK in the context of the changing landscape of organ allocation. RECENT FINDINGS: The introduction of the Mayo End-Stage Liver Disease score into liver allocation policy in 2002 resulted in a significant increase in the number of SLKs performed in the United States. Except for a brief respite in 2009, the rate of SLK has continued to increase with 2015 seeing 626 SLKs...
November 2016: Current Opinion in Nephrology and Hypertension
Lekha Tummalapalli, Girish N Nadkarni, Steven G Coca
PURPOSE OF REVIEW: Current biomarkers for chronic kidney disease (CKD) are limited by lack of sensitivity and inability to prognosticate CKD progression. Significant recent research has better characterized novel biomarker candidates that are associated with CKD progression and cardiovascular mortality in CKD. This review discusses the most significant advances within the past year. RECENT FINDINGS: We discuss biomarkers for outcomes in CKD under two categories: emerging (defined as having been validated in an independent cohort), which include serum cystatin C, serum β-trace protein, β2-microglobulin, soluble urokinase-type plasminogen activator receptor, soluble tumor necrosis factor receptors 1/2, urinary monocyte chemotactic protein-1, neutrophil gelatin-associated lipocalin, kidney injury molecule-1, and fibroblast growth factor-23; and novel (which have shown associations in smaller observational studies but have not been validated yet), which include indoxyl sulfate, p-cresyl sulfate, trimethylamine-N-oxide, IL-18, Klotho, markers of endothelial dysfunction, vimentin, and procollagen type III N-terminal propeptide...
November 2016: Current Opinion in Nephrology and Hypertension
Sindhu Chandran, Sandy Feng
PURPOSE OF REVIEW: The attainment of tolerance remains a highly desirable goal in recipients of kidney transplants. Achievement of this goal would extend graft survival and eradicate toxicities related to long-term immunosuppression. Understanding mechanisms of tolerance and strategies to induce tolerance - their risk/benefit profiles - is essential for future success. RECENT FINDINGS: Mechanistic studies of spontaneously tolerant kidney transplant recipients have uncovered potential roles for B or regulatory T cells, or both, in the maintenance of tolerance...
November 2016: Current Opinion in Nephrology and Hypertension
Thomas A Mavrakanas, David M Charytan
PURPOSE OF REVIEW: This review article focuses on the most significant cardiovascular complications in dialysis patients [sudden cardiac death (SCD), acute coronary syndromes, heart failure, and atrial fibrillation]. RECENT FINDINGS: Current and ongoing research aims to quantify the rate and pattern of significant arrhythmia in dialysis patients and to determine the predominant mechanism of SCD. Preliminary findings from these studies suggest a high rate of atrial fibrillation and that bradycardia and asystole may be more frequent than ventricular arrhythmia as a cause of sudden death...
November 2016: Current Opinion in Nephrology and Hypertension
Huda Mahmoud, Charlotte Buchanan, Susan T Francis, Nicholas M Selby
PURPOSE OF REVIEW: MRI can noninvasively assess the structure and function of the kidney in a single MRI scan session. This review summarizes recent advancements in functional renal MRI techniques, with a particular focus on clinical applications. RECENT FINDINGS: A number of MRI techniques now provide measures of relevance to the pathophysiology of kidney disease. Diffusion-weighted imaging, used in chronic kidney disease and renal transplantation, shows promise as a measure of renal fibrosis...
November 2016: Current Opinion in Nephrology and Hypertension
Cheston B Cunha, Erika M C D'Agata
PURPOSE OF REVIEW: Rates of multidrug-resistant organisms (MDRO), including methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and multidrug-resistant gram-negative bacteria, continue to rise among the population of chronic hemodialysis. Antimicrobial exposure is the main risk factor for MDRO emergence and dissemination. Up to 30% of antimicrobial doses administered in out-patient dialysis units may not be indicated. Antimicrobial stewardship programs (ASP) improve antimicrobial prescribing patterns...
November 2016: Current Opinion in Nephrology and Hypertension
Ambreen Gul, Dana Miskulin, Antonia Harford, Philip Zager
PURPOSE OF REVIEW: This review focuses on recent advances in our understanding of intradialytic hypotension (IDH) and measures that may reduce its frequency. RECENT FINDINGS: The frequency and severity of IDH predict the risk for adverse clinical outcomes. The highest mortality risks associated with IDH were observed when the intradialytic systolic blood pressure (SBP) nadirs were <90 and <100 mmHg and the predialysis SBP were ≤159 mmHg or ≥160 mmHg, respectively...
November 2016: Current Opinion in Nephrology and Hypertension
Thiago J Borges, Naoka Murakami, Leonardo V Riella
PURPOSE OF REVIEW: The present review aims to highlight the major recent advances in transplantation with regards to basic, translational, and clinical research. RECENT FINDINGS: We describe new concepts in understanding allorecognition and allospecificity of T cells, and discuss current challenges in targeting memory T cells, including the limitation of rodent disease models. From a clinical perspective, we highlight the advances in molecular biopsy characterization, which have expanded our knowledge of potential drivers of injury and may provide better parameters for patient risk stratification...
November 2016: Current Opinion in Nephrology and Hypertension
Martin B Lee, Joanne M Bargman
PURPOSE OF REVIEW: To clarify misconceptions about the feasibility and risks of peritoneal dialysis that unnecessarily limit peritoneal dialysis uptake or continuation in patients for whom peritoneal dialysis is the preferred dialysis modality. The inappropriate choice of haemodialysis as a result of these misconceptions contributes to low peritoneal dialysis penetrance, increases transfer from peritoneal dialysis to haemodialysis, increases expenditure on haemodialysis and compromises quality of life for these patients...
November 2016: Current Opinion in Nephrology and Hypertension
Laurence Lepage, Katherine Desforges, Jean-Philippe Lafrance
PURPOSE OF REVIEW: Hyperkalemia is frequent, but occurs mostly in patients with chronic kidney disease and is often the cause of discontinuation or omission of renin-angiotensin-aldosterone system inhibitors in patients with diabetes, chronic kidney disease and heart failure. RECENT FINDINGS: Without much evidence in the literature on its efficacy, sodium polystyrene sulfonate is being used frequently in the clinical setting to treat hyperkalemia. In the last few years, two new promising agents have been developed to treat hyperkalemia - patiromer and sodium zirconium cyclosilicate 9 (ZS-9)...
November 2016: Current Opinion in Nephrology and Hypertension
Pedro Magalhães, Harald Mischak, Petra Zürbig
PURPOSE OF REVIEW: Urine is the most useful of body fluids for biomarker research. Therefore, we have focused on urinary proteomics, using capillary electrophoresis coupled to mass spectrometry, to investigate kidney diseases in recent years. RECENT FINDINGS: Several urinary proteomics studies for the detection of various kidney diseases have indicated the potential of this approach aimed at diagnostic and prognostic assessment. Urinary protein biomarkers such as collagen fragments, serum albumin, α-1-antitrypsin, and uromodulin can help to explain the processes involved during disease progression...
November 2016: Current Opinion in Nephrology and Hypertension
Fansan Zhu, Laura Rosales, Peter Kotanko
PURPOSE OF REVIEW: The aim of this article is to present current information on techniques for fluid status assessment in patients with kidney disease. The methods can be broadly categorized into biomarkers, ultrasound, blood volume monitoring, and bioimpedance. RECENT FINDINGS: Biomarkers including atrial natriuretic peptide and B-type natriuretic peptide have been shown to provide information about relative changes in fluid status. Ultrasound is applied to measure inferior vena cava indices, pulmonary indicators, and vascular indicators of fluid overload...
November 2016: Current Opinion in Nephrology and Hypertension
David E McCartney, Richard J McManus
PURPOSE OF REVIEW: This article reviews recent developments in self-monitoring and self-management of hypertension aimed at the improvement of blood pressure (BP) control. RECENT FINDINGS: There is an increasing body of evidence examining the effects of self-monitoring on BP control. Several landmark studies in recent years have demonstrated clinically relevant benefit from self-monitoring based interventions. Self-management of BP with self-titration has shown particular promise, as has self-monitoring combined with intensive health-care led support...
November 2016: Current Opinion in Nephrology and Hypertension
Philip A Kalra, Sunil Bhandari
PURPOSE OF REVIEW: Iron deficiency anaemia (IDA) is common and associated with fatigue, reduced quality of life and poorer clinical outcomes. Treatment with oral iron is often inadequate and international guidelines recommend intravenous (i.v.) iron as the preferred option for the treatment of IDA in certain clinical situations. In this review, we assess the safety of using i.v. iron with a particular focus on patients with chronic kidney disease. RECENT FINDINGS: Recent publications have raised safety concerns regarding the incidence of serious reactions accompanying i...
November 2016: Current Opinion in Nephrology and Hypertension
David Wojciechowski, Flavio Vincenti
PURPOSE OF REVIEW: The review will focus on the impact and current status of costimulatory blockade in renal transplantation. RECENT FINDINGS: The mainstay of immunosuppression in kidney transplantation is calcineurin inhibitors (CNIs) which have reduced acute rejection rates but failed to improve long-term allograft survival. Their cardiometabolic side-effects and nephrotoxicity have shifted the focus of investigation to CNI-free regimens. Costimulation blockade with belatacept, a second generation, higher avidity variant of cytotoxic T-lymphocyte associated protein 4 has emerged as part of a CNI-free regimen...
November 2016: Current Opinion in Nephrology and Hypertension
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