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Current Opinion in Nephrology and Hypertension

William Beaubien-Souligny, Josée Bouchard, André Denault
PURPOSE OF REVIEW: Following the miniaturization of ultrasound devices, point-of-care ultrasound (POCUS) has been proposed as a tool to enhance the value of physical examination in various clinical settings. The objective of this review is to describe the potential applications of POCUS in end-stage renal disease patients (ESRD). RECENT FINDINGS: With basic training, the clinician can perform pulmonary, vascular, cardiac, and abdominal POCUS at the bedside of ESRD patients...
September 3, 2018: Current Opinion in Nephrology and Hypertension
Jessica M Ruck, Dorry L Segev
PURPOSE OF REVIEW: Due to the organ shortage, which prevents over 90 000 individuals in the United States from receiving life-saving transplants, the transplant community has begun to critically reevaluate whether organ sources that were previously considered too risky provide a survival benefit to waitlist candidates. RECENT FINDINGS: Organs that many providers were previously unwilling to use for transplantation, including kidneys with a high Kidney Donor Profile Index or from increased risk donors who have risk factors for window period hepatitis C virus (HCV) and HIV infection, have been shown to provide a survival benefit to transplant waitlist candidates compared with remaining on dialysis...
August 29, 2018: Current Opinion in Nephrology and Hypertension
Paloma L Martin-Moreno, Carlos Panizo
PURPOSE OF REVIEW: Posttransplant lymphoproliferative disorder (PTLD), frequently associated with Epstein-Barr virus (EBV), is one of the most serious complications leading to worse patient and graft outcomes. Hence, we summarize in this review relevant studies published about PTLD in the last 18 months. RECENT FINDINGS: Recent studies have improved the knowledge about epidemiology, prophylaxis, diagnosis and PTLD treatment. Special interest has developed in improving the last PTLD classification of the World Health Organization, increasing the accuracy of diagnostic tests for EBV viral load quantification and discriminating the genetic differences between PTLD types...
August 27, 2018: Current Opinion in Nephrology and Hypertension
Sahir Kalim
PURPOSE OF REVIEW: Protein carbamylation is a posttranslational protein modification caused, in part, by exposure to urea's dissociation product cyanate. Additional modulators of protein carbamylation include circulating free amino acid levels, inflammation, diet, smoking, and environmental pollution exposures. Carbamylation reactions can modify protein charge, structure, and function, leading to adverse molecular and cellular responses. These changes have been linked to several pathologic biochemical pathways relevant to patients with end stage renal disease (ESRD) such as accelerated atherosclerosis and dysfunctional erythropoiesis, among others...
August 24, 2018: Current Opinion in Nephrology and Hypertension
Abdou Niang, Arpana Iyengar, Valerie A Luyckx
PURPOSE OF REVIEW: To assess the use, access to and outcomes of hemodialysis and peritoneal dialysis in low-resource settings. RECENT FINDINGS: Hemodialysis tends to predominate because of costs and logistics, however services tend to be located in larger cities, often paid for out of pocket. Outcomes of dialysis-requiring acute kidney injury and end-stage kidney disease may be similar with hemodialysis and peritoneal dialysis, and therefore choice of therapy is dominated by availability, accessibility and patient or physician choice...
August 24, 2018: Current Opinion in Nephrology and Hypertension
Daniela Ponce, Alexandre Minetto Brabo, André Luís Balbi
PURPOSE OF REVIEW: Although historically peritoneal dialysis was widely used in nephrology, it has been underutilized in recent years. In this review, we present several key opportunities and strategies for revitalization of urgent start peritoneal dialysis use, and discuss the recent literature on clinical experience with peritoneal dialysis use in the acute and unplanned setting. RECENT FINDINGS: Interest in using urgent start peritoneal dialysis to manage acute kidney injury (AKI) and unplanned chronic kidney disease (CKD) stage 5 patients has been increasing...
August 22, 2018: Current Opinion in Nephrology and Hypertension
V R Latha Gullapudi, Isma Kazmi, Nicholas M Selby
PURPOSE OF REVIEW: Intra-dialytic hypotension (IDH) remains a significant problem for patients undergoing chronic haemodialysis. IDH causes symptoms that degrade patients' experience, compromises dialysis delivery and is strongly associated with adverse patient outcomes. Greater understanding of the link between IDH and dialysis-induced ischaemia in heart and brain has characterized mechanistic pathways, with repeated episodes of ischaemia resulting in organ dysfunction. This review provides updates from published evidence over the last 2 years across the range of potential interventions for IDH...
August 16, 2018: Current Opinion in Nephrology and Hypertension
James O Burton, Matthew P M Graham-Brown
PURPOSE OF REVIEW: There is increasing evidence that extended-hours regimens are associated with improved outcomes for patients on maintenance haemodialysis programmes. Home haemodialysis programmes are a well established way for patients to benefit from extended-hours dialysis overnight; however, there are significant barriers to home haemodialysis, which means that for many this is not an option. In centre, nocturnal haemodialysis is an increasingly recognized way of offering extended-hours treatment to patients unable to undertake home-based programmes and is an underutilized modality for such patients to gain from the physiological benefits of extended-hours dialysis regimens...
August 16, 2018: Current Opinion in Nephrology and Hypertension
Maarten W Taal
No abstract text is available yet for this article.
August 7, 2018: Current Opinion in Nephrology and Hypertension
Nienke M A Idzerda, Michelle J Pena, Hiddo J L Heerspink
PURPOSE OF REVIEW: In the last decade many attempts have been made to reduce the high residual risk of end-stage kidney disease and cardiovascular disease in patients with diabetic kidney disease by targeting a variety of risk markers. Subsequent analyses revealed that the variation in individual drug response to the tested interventions partly explains why these trials did not result in additional kidney or cardiovascular protection. This review summarizes recent insights regarding individual variation in drug response...
August 7, 2018: Current Opinion in Nephrology and Hypertension
Habib Hamidi, Matthias Kretzler
PURPOSE OF REVIEW: Current clinical pathological classifications of glomerular diseases are inadequate at predicting patient disease progression or response to therapy. With the advent of precision medicine and its successes in oncology, it is important to understand if similar approaches in glomerular diseases can improve patient management. The purpose of this review is to summarize approaches to obtain comprehensive molecular profiles from human biopsies and utilize them to define the pathophysiology of glomerular failure...
August 1, 2018: Current Opinion in Nephrology and Hypertension
Matthew Tabinor, Simon J Davies
PURPOSE OF REVIEW: To summarize the findings of recent trials and meta-analyses designed to determine whether bioimpedance spectroscopy adds value to the clinical assessment of fluid status in dialysis patients so as to achieve a normally hydrated weight and put these in a contemporary context. RECENT FINDINGS: Eight trials (published 2010-2018) and two meta-analyses (2017) are reviewed. Both haemodialysis and peritoneal dialysis modalities are represented. Despite considerable heterogeneity in intervention, all are open-label randomized comparisons of a bioimpedance intervention with normal clinical practice in which clinicians were blinded to bioimpedance data...
July 30, 2018: Current Opinion in Nephrology and Hypertension
Dominik Steubl, Lesley A Inker
PURPOSE OF REVIEW: Chronic kidney disease is an increasing health burden. Estimating equations using serum concentrations of creatinine and cystatin C facilitate the assessment of kidney function as reflected in estimated glomerular filtration rate (eGFR). Reduced eGFR is associated with increased risk for numerous adverse outcomes and is an important aspect in many clinical situations. However, current equations are suboptimal in some clinical settings. The review focuses on approaches to improve the estimation of GFR and aims to familiarize the reader with the underlying methodological hypotheses how new markers could contribute to improve the overall performance of estimating equations...
July 30, 2018: Current Opinion in Nephrology and Hypertension
Philip A Kalra, Alexandru Burlacu, Charles J Ferro, Adrian Covic
PURPOSE OF REVIEW: Non-valvular atrial fibrillation is common in patients with severe chronic kidney disease (CKD) and historically patients have been treated with vitamin K antagonists (VKA). However, these agents have questionable efficacy and are associated with increased bleeding risk. Non-vitamin K oral anticoagulants (NOAC) have advantages over VKA in early stage CKD. In this review, we sought to establish evidence for best practice in patients with severe CKD (creatinine clearance <30 ml/min including dialysis patients) and nonvalvular atrial fibrillation...
July 16, 2018: Current Opinion in Nephrology and Hypertension
Michael B Butterworth
PURPOSE OF REVIEW: The review describes studies investigating the role of microRNAs in the signaling pathway of the mineralocorticoid hormone, aldosterone. RECENT FINDINGS: Emerging evidence indicates that aldosterone alters the expression of microRNAs in target tissues thereby modulating the expression of key regulatory proteins. SUMMARY: The mineralocorticoid hormone aldosterone is released by the adrenal glands in a homeostatic mechanism to regulate blood volume...
September 2018: Current Opinion in Nephrology and Hypertension
Sho Hasegawa, Tetsuhiro Tanaka, Masaomi Nangaku
PURPOSE OF REVIEW: Small-molecule inhibitors of prolyl hydroxylase domain enzymes (PHD inhibitors) are novel renal anemia therapies that increase endogenous erythropoietin (EPO) production by stabilizing hypoxia-inducible factor (HIF). This review summarizes recent findings and future perspectives of PHD inhibitors (HIF stabilizers) in chronic kidney disease (CKD)-associated anemia. RECENT FINDINGS: Clinical trials have demonstrated that HIF stabilizers effectively increase hemoglobin levels of both nondialysis and dialysis CKD patients without causing serious adverse effects...
September 2018: Current Opinion in Nephrology and Hypertension
Anita T Layton, Volker Vallon
PURPOSE OF REVIEW: To maintain electrolyte homeostasis, the kidneys reabsorb more than 99% of the filtered Na under physiological conditions, resulting in less than 1% of the filtered Na excreted in urine. In contrast, due to distal tubular secretion, urinary K output may exceed filtered load. This review focuses on a relatively new methodology for investigating renal epithelial transport, computational modelling and highlights recent insights regarding renal Na and K transport and O2 consumption under pathophysiological conditions, with a focus on nephrectomy...
September 2018: Current Opinion in Nephrology and Hypertension
Aline M A de Souza, Crystal A West
PURPOSE OF REVIEW: Renal ion transport undergoes dramatic changes during the course of gestation. These adaptations are necessary to meet the dynamic requirements of pregnancy and support fetal development. Pregnancy is characterized by a high demand for both sodium and potassium. Recently there has been work in the field profiling the modifications of the renal tubules in pregnancy to meet these demands. The purpose of this review is to summarize these findings. RECENT FINDINGS: The work to date suggests an important role for the distal nephron in both the renal sodium and potassium reabsorption during pregnancy...
September 2018: Current Opinion in Nephrology and Hypertension
Sehrish Ali, Natasha Dave, Sankar D Navaneethan
No abstract text is available yet for this article.
September 2018: Current Opinion in Nephrology and Hypertension
Teresa M Buck, Jeffrey L Brodsky
PURPOSE OF REVIEW: The epithelial sodium channel, ENaC, is responsible for Na reabsorption in several epithelia and is composed of homologous α, β, and γ subunits. Here, we will explore the differential regulation of ENaC subunits during biogenesis in the early secretory pathway. RECENT FINDINGS: ENaC subunits are subject to numerous posttranslational modifications, including glycosylation, protease activation, disulfide bond formation, palmitoylation, and glycosylation, each of which modulate channel function...
September 2018: Current Opinion in Nephrology and Hypertension
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