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Current Opinion in Nephrology and Hypertension

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https://www.readbyqxmd.com/read/28212179/hard-choices-better-outcomes-a-review-of-shared-decision-making-and-patient-decision-aids-around-dialysis-initiation-and-conservative-kidney-management
#1
Janet L Davis, Sara N Davison
PURPOSE OF REVIEW: Patients reaching end-stage kidney disease face difficult decisions, including choosing among renal replacement therapies (RRTs). With an increasingly elderly and frail population, there is growing interest in conservative kidney management (CKM) as a viable alternative to dialysis. Shared decision-making (SDM) is a patient-centered approach to these decisions, in which choices are viewed within the explicitly discussed values and preferences of the patient. Patient decision aids (PDAs) are tools designed to facilitate these discussions...
February 16, 2017: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/28212178/the-long-journey-through-renal-filtration-new-pieces-in-the-puzzle-of-slit-diaphragm-architecture
#2
Sara Conti, Luca Perico, Florian Grahammer, Tobias B Huber
PURPOSE OF REVIEW: The podocyte slit diaphragm is probably the least understood component of the kidney filtration barrier. In this review, we aim to integrate the most recent findings on the molecular make-up and structural architecture of this specialized cell-cell junction into a current concept of glomerular filtration. RECENT FINDINGS: Analysis of cryopreserved mammalian tissue revealed a bipartite composition of the slit diaphragm. Single NEPH1 molecules span the lower part of the slit close to the glomerular basement membrane whereas NEPHRIN molecules are positioned in the apical part toward Bowman's space...
February 16, 2017: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/28212180/advances-in-the-management-of-hyperkalemia-in-chronic-kidney-disease
#3
Andrea C J Cowan, Elie G Gharib, Matthew A Weir
PURPOSE OF REVIEW: Patients with chronic kidney disease (CKD) have an increased risk of hyperkalemia that increases both short-term and long-term mortality. Historically, managing hyperkalemia has relied upon dietary modifications, augmentation of urinary potassium excretion and enhanced enteral potassium elimination. This review discusses current treatments and their limitations and summarizes the evidence supporting novel agents for potassium lowering in patients with CKD. RECENT FINDINGS: The introduction of two novel ion exchange resins represents the first new pharmacologic therapies for hyperkalemia in the last 50 years...
February 15, 2017: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/28198736/we-can-see-clearly-now-optical-clearing-and-kidney-morphometrics
#4
Victor G Puelles, Marcus J Moeller, John F Bertram
PURPOSE OF REVIEW: For more than a century, kidney microscopic imaging was driven by the need for greater and greater resolution. This was in part provided by the analysis of thinner tissue sections. As a result, most kidney morphometry was performed in 'two' dimensions, largely ignoring the three-dimensionality of kidney tissue and cells. Although stereological techniques address this issue, they have generally been considered laborious and expensive and thereby unattractive for routine use...
February 13, 2017: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/28198735/new-insights-into-crosstalk-in-the-kidney
#5
Kerstin Ebefors, Jenny Nyström
PURPOSE OF REVIEW: The kidney is a highly complex organ and renal function depends on many factors, both extrinsic to the kidney and intrinsic. The kidney responds both to systemic hormonal and neuronal signals and to autocrine and paracrine factors produced within the renal tissue. Recently, there has been an increased emphasis on crosstalk in and between different compartments in the kidney. RECENT FINDINGS: Crosstalk in the kidney between different cellular compartments has added new and important understanding of renal function and the development of kidney disease...
February 13, 2017: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/28198734/new-frontiers-in-intravital-microscopy-of-the-kidney
#6
Andrew M Hall, Claus D Schuh, Dominik Haenni
PURPOSE OF REVIEW: Intravital imaging with multiphoton microscopy enables the detailed study of dynamic cellular processes within functioning organs in living animals, in ways that would not otherwise be possible. It therefore represents a powerful tool in translational kidney research. In this article, we will discuss several new technical developments that have significantly increased the capabilities of kidney imaging. RECENT FINDINGS: Important contemporary advances in biomedical imaging technology include longer wavelength excitation lasers, far-red emitting fluorescent reporters, highly sensitive detectors, fluorescence lifetime measurements, adaptive optics, microendoscopes, high-throughput automated analysis algorithms and tissue clearing techniques...
February 13, 2017: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/28198733/clinical-relevance-of-sarcopenia-in-chronic-kidney-disease
#7
Ranjani N Moorthi, Keith G Avin
PURPOSE OF REVIEW: In this article, we review sarcopenia in chronic kidney disease (CKD). We aim to present how definitions of sarcopenia from the general population may pertain to those with CKD, its assessment by clinicians and emerging therapies for sarcopenia in CKD. For this review, we limit our description and recommendations to patients with CKD who are not on dialysis. RECENT FINDINGS: Poorer parameters of lean mass, strength and physical function are associated with worsening patient-centered outcomes such as limiting mobility, falls and mortality in CKD; however, the magnitude of these associations are different in those with and without CKD...
February 13, 2017: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/28198732/intensive-blood-pressure-lowering-in-chronic-kidney-disease-the-time-has-come
#8
Marcel Ruzicka, Swapnil Hiremath
PURPOSE OF REVIEW: Release of the findings from the Systolic Blood Pressure Intervention Trial has resulted in a renewed examination of intensive blood pressure (BP) lowering. Only a few national hypertension guidelines (Canada and Australia) have changed recommendations, but considerable heterogeneity still exists with respect to the patient population to whom intensive BP lowering may apply. RECENT FINDINGS: There is fairly robust evidence that lower BP targets in nondiabetic chronic kidney disease (CKD) results in a decrease in heart failure and mortality...
February 13, 2017: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/27977428/breaking-down-the-complement-system-a-review-and-update-on-novel-therapies
#9
Yuvaram N V Reddy, Andrew M Siedlecki, Jean M Francis
PURPOSE OF REVIEW: The complement system represents one of the more primitive forms of innate immunity. It has increasingly been found to contribute to pathologies in the native and transplanted kidney. We provide a concise review of the physiology of the complement cascade, and discuss current and upcoming complement-based therapies. RECENT FINDINGS: Current agents in clinical use either bind to complement components directly or prevent complement from binding to antibodies affixed to the endothelial surface...
March 2017: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/27930384/the-endothelial-mineralocorticoid-receptor-mediator-of-the-switch-from-vascular-health-to-disease
#10
Ana P Davel, Imran J Anwar, Iris Z Jaffe
PURPOSE OF REVIEW: Endothelial dysfunction is an early feature of vascular disease induced by cardiovascular risk factors (CRFs). In growing populations with obesity, diabetes, hypertension, and heart failure, mineralocorticoid receptor antagonism improves endothelial function. This review summarizes recent advances in our understanding of the specific role of endothelial cell mineralocorticoid receptor in vascular function in health and disease. RECENT FINDINGS: Using transgenic mice with mineralocorticoid receptor expression specifically modulated in endothelial cells, recent studies support the emerging concept that while endothelial cell mineralocorticoid receptor may be protective in health, in the presence of CRFs, endothelial cell mineralocorticoid receptor activity contributes to endothelial dysfunction and progression of vascular disease...
March 2017: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/27922850/clinical-nephrology
#11
Bertrand L Jaber
No abstract text is available yet for this article.
March 2017: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/27922849/renal-denervation-for-uncontrolled-hypertension-critical-review-of-the-evidence
#12
Chongjia Chen, Ashish Upadhyay
PURPOSE OF REVIEW: Hypertension (HTN) is a major global public health problem. Endovascular catheter-based radiofrequency ablation of renal sympathetic nerve endings (renal denervation) is a novel treatment option for uncontrolled HTN. RECENT FINDINGS: Early clinical studies primarily in Australia and Europe established renal denervation as a well tolerated and feasible procedure that resulted in a sustained reduction in blood pressure among individuals with severe resistant HTN...
March 2017: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/27906749/sodium-and-potassium-in-the-pathogenesis-of-hypertension-focus-on-the-brain
#13
Horacio J Adrogué, Nicolaos E Madias
PURPOSE OF REVIEW: Primary hypertension is characterized by Na excess and K deficit in the body, which together are key to its pathogenesis. These derangements work jointly in the brain and the peripheral vascular wall to establish hypertension. In this review, we highlight recent evidence describing the central mechanisms through which Na surfeit and K deficit enhance sympathetic nerve activity, thereby raising peripheral vascular resistance and generating hypertension. RECENT FINDINGS: Animal studies point to a small increase in plasma and cerebrospinal fluid (CSF) [Na], a small decrease in CSF [K], and increased levels of circulating angiotensin II, aldosterone, and endogenous ouabain as the central signals evoking hypertension...
March 2017: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/27906748/evolving-therapies-for-hepatitis-c-virus-in-chronic-kidney-disease-the-beginning-of-a-new-era
#14
Craig E Gordon, Claudia Nader
PURPOSE OF REVIEW: The current review highlights recent advances in treatment of chronic hepatitis C virus infection using new classes of agents, direct-acting antivirals (DAAs), with a focus on the evidence for their use in the setting of chronic kidney disease (CKD) stages 4-5, hemodialysis, and kidney transplantation. RECENT FINDINGS: DAA agents target-specific proteins involved in the hepatitis C virus life cycle and interrupt viral replication. Sustained virologic response, a marker of viral eradication, occurs in more than 90% of patients treated with DAA agents in the general population...
March 2017: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/27906747/update-on-angiotensin-at2-receptors
#15
Robert M Carey
PURPOSE OF REVIEW: This review updates major new findings and concepts introduced during the past year on the role of angiotensin II (Ang II) subtype 2 receptors (AT2Rs) in the control of blood pressure and renal function. RECENT FINDINGS: AT2R activation prevents sodium (Na) retention and lowers blood pressure in the Ang II infusion model of experimental hypertension and prevents salt-sensitive hypertension in the obese Zucker rat model of obesity and the metabolic syndrome...
March 2017: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/27906746/recent-developments-on-the-vascular-effects-of-20-hydroxyeicosatetraenoic-acid
#16
Victor Garcia, Michal L Schwartzman
PURPOSE OF REVIEW: 20-Hydroxyeicosatetraenoic acid (20-HETE) is a potent vasoactive eicosanoid and a key constituent of the microcirculation. Its effects on vascular function are multifaceted and include stimulation of smooth muscle, contractility, migration, and proliferation, as well as endothelial cell dysfunction and inflammation. Such effects have significant implications with regard to the control of vascular homeostasis and pathophysiology. The clinical relevance of 20-HETE is highlighted by recent studies linking 20-HETE and its biosynthetic enzymes to the development of hypertension, stroke, and myocardial infarction...
March 2017: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/27898524/uromodulin-in-kidney-health-and-disease
#17
Pranav S Garimella, Mark J Sarnak
PURPOSE OF REVIEW: Although uromodulin or Tamm-Horsfall protein was discovered over 60 years ago, its functional role in humans remains unclear. This review highlights new studies elucidating the clinical correlates of uromodulin, its association with kidney function decline, nephrolithiasis and urinary host defense. RECENT FINDINGS: Uromodulin is evolutionarily conserved and has multiple functional roles. In large population studies, higher levels of uromodulin are associated with higher estimated glomerular filtration rate (eGFR) and kidney size, possibly indicating greater kidney functional reserve...
March 2017: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/27898523/role-of-corin-in-the-regulation-of-blood-pressure
#18
Hui Li, Yue Zhang, Qingyu Wu
PURPOSE OF REVIEW: Corin is a transmembrane protease that activates atrial natriuretic peptide (ANP), an important hormone in regulating salt-water balance and blood pressure. This review focuses on the regulation of corin function and potential roles of corin defects in hypertensive, heart, and renal diseases. RECENT FINDINGS: Proprotein convertase subtilisin/kexin-6 has been identified as a primary enzyme that converts zymogen corin to an active protease. Genetic variants that impair corin intracellular trafficking, cell surface expression, and zymogen activation have been found in patients with hypertension, cardiac hypertrophy, and pre-eclampsia...
March 2017: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/27898522/context-dependent-effects-of-dipeptidyl-peptidase-4-inhibitors
#19
Edwin K Jackson
PURPOSE OF REVIEW: The antidiabetic mechanism of dipeptidyl peptidase 4 (DPP4) inhibitors is attributed to attenuation of incretin metabolism. Because DPP4 has at least 45 substrates, context-dependent off-target effects of DPP4 inhibitors are likely. Here, we consider the clinical ramifications of the context-dependent effects of DPP4 inhibitors. RECENT FINDINGS: Although incretins protect organs from diabetic injury, nonincretin DPP4 substrates also accumulate when DPP4 is inhibited...
March 2017: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/27820706/dipeptidyl-peptidase-4-inhibition-and-renoprotection-the-role-of-antifibrotic-effects
#20
Yuta Takagaki, Daisuke Koya, Keizo Kanasaki
PURPOSE OF REVIEW: This article analyzes the potential beneficial effects of dipeptidyl peptidase (DPP)-4 inhibitors on renal diseases. RECENT FINDINGS: The pathological significance of DPP-4, either dependent or independent on catalytic activities, on renal diseases has been reported in preclinical studies. With regard to this, we have shown that damaged endothelial cells are converted to a mesenchymal cell phenotype, which is associated with the induction of DPP-4 in endothelial cells...
January 2017: Current Opinion in Nephrology and Hypertension
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