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Advances in Chronic Kidney Disease

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https://www.readbyqxmd.com/read/30309463/working-toward-an-improved-understanding-of-chronic-cardiorenal-syndrome-type-4
#1
REVIEW
Daniel Edmonston, Jessica D Morris, John P Middleton
Chronic diseases of the heart and of the kidneys commonly coexist in individuals. Certainly combined and persistent heart and kidney failure can arise from a common pathologic insult, for example, as a consequence of poorly controlled hypertension or of severe diffuse arterial disease. However, strong evidence is emerging to suggest that cross talk exists between the heart and the kidney. Independent processes are set in motion when kidney function is chronically diminished, and these processes can have distinct adverse effects on the heart...
September 2018: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/30309462/advanced-heart-failure-therapies-and-cardiorenal-syndrome
#2
REVIEW
Jennifer A Cowger, Ryhm Radjef
Heart failure (HF) is extremely prevalent and for those with end-stage (stage D) disease, 1-year survival is only 25-50%. Several studies have captured the mortality impact of kidney disease on patients with HF, and measures of kidney function are a component of many HF risk stratification scores. The management of advanced HF complicated by cardiorenal syndrome (CRS) is challenging, and irreversible kidney failure often limits patient candidacy for advanced HF therapies, such as transplant or left ventricular assist device therapy...
September 2018: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/30309461/extracorporeal-isolated-ultrafiltration-for-management-of-congestion-in-heart-failure-and-cardiorenal-syndrome
#3
REVIEW
Amir Kazory, Maria Rosa Costanzo
Acute decompensated heart failure has the highest rate of hospital readmission among all medical conditions and portends a significant financial burden on health care system. Congestion, the hallmark of acute decompensated heart failure, represents the primary reason for hospitalization and the driver of adverse outcomes in these patients. Although diuretic-based medical regimens remain the mainstay of management of acute decompensated heart failure, they often show suboptimal efficacy and safety profiles in this setting...
September 2018: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/30309460/diuretics-in-the-management-of-cardiorenal-syndrome
#4
REVIEW
Chandrika Chitturi, James E Novak
The leading cause of death worldwide is cardiovascular disease. The heart and the kidneys are functionally interdependent, such that dysfunction in one organ may cause dysfunction in the other. By one estimate, more than 60% of patients with congestive heart failure develop chronic kidney disease. Volume overload and congestion are hallmarks of heart failure, and these findings are associated with severe symptoms and poor outcomes. Given the importance of congestion, diuretics remain a cornerstone of heart failure management...
September 2018: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/30309459/toward-precision-medicine-in-the-cardiorenal-syndrome
#5
REVIEW
Nicholas Wettersten, Alan S Maisel, Dinna N Cruz
Although the field of oncology has made significant steps toward individualized precision medicine, cardiology and nephrology still often use a "one size fits all" approach. This applies to the intersection of the heart-kidney interaction and the cardiorenal syndrome as well. Recent studies have shown that the prognostic implications of worsening renal function (WRF) in acute heart failure are variable; thus, there is a need to differentiate the implications of WRF to better guide precise care. This may best be performed with biomarkers that can give the clinician a real-time evaluation of the physiologic state at the time of developing WRF...
September 2018: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/30309458/heart-kidney-interactions-in-cardiorenal-syndrome-type-1
#6
REVIEW
Alberto Palazzuoli, Gaetano Ruocco
The exact significance of kidney function deterioration during acute decompensated heart failure (ADHF) episodes is still under debate. Several studies reported a wide percentage of worsening renal function (WRF) in ADHF patients ranging from 20% to 40%. This is probably because of different populations enrolled with different baseline kidney and cardiac function, varying definition of acute kidney injury (AKI), etiology of kidney dysfunction (KD), and occurrence of transient or permanent KD over the observational period...
September 2018: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/30309457/pathophysiological-mechanisms-in-cardiorenal-syndrome
#7
REVIEW
Janani Rangaswami, Roy O Mathew
Cardiorenal syndrome represents the confluence of intricate hemodynamic, neurohormonal, and inflammatory pathways that initiate and propagate the maladaptive cross talk between the heart and kidneys. Several of these pathophysiological principles were described in older historical experiments. The last decade has witnessed major efforts in streamlining its definition, clinical phenotypes, and classification to improve diagnostic accuracy and deliver optimal goal-directed medical therapies. The ability to characterize the various facets of cardiorenal syndrome based on its pathophysiology is poised in an exciting vantage point, in the backdrop of several advanced diagnostic strategies, notably cardiorenal biomarkers that may help with accurate delineation of clinical phenotype, prognosis, and delivery of optimal medical therapies in future studies...
September 2018: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/30309456/epidemiology-of-cardiorenal-syndrome
#8
REVIEW
Junior Uduman
Cardiorenal syndrome is a spectrum of disorders that emphasizes the bidirectional nature of cardiac and kidney injury. Observational and retrospective studies have helped us to understand the prevalence and burden of each of the 5 types of cardiorenal syndromes. Cardiorenal syndrome type 1 is the most common. The nature of epidemiologic data limits clear delineation between cardiorenal syndrome types 2 and 4. Overall, the presence of cardiac or renal dysfunction strongly predicts a poor outcome of the contrary organ...
September 2018: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/30309455/cardiorenal-syndrome-an-overview
#9
REVIEW
Claudio Ronco, Antonio Bellasi, Luca Di Lullo
It is well established that a large number of patients with acute decompensated heart failure present with various degrees of heart and kidney dysfunction usually primary disease of heart or kidney often involve dysfunction or injury to the other. The term cardiorenal syndrome increasingly had been used without a consistent or well-accepted definition. To include the vast array of interrelated derangements and to stress the bidirectional nature of heart-kidney interactions, a new classification of the cardiorenal syndrome with 5 subtypes that reflect the pathophysiology, the time frame, and the nature of concomitant cardiac and renal dysfunction was proposed...
September 2018: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/30309454/cardiorenal-syndrome-a-call-to-action-for-a-pressing-medical-issue
#10
EDITORIAL
Peter A McCullough, Sandeep Soman
No abstract text is available yet for this article.
September 2018: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/30309453/a-tale-of-two-failures-a-guide-to-shared-decision-making-for-heart-and-renal-failure
#11
EDITORIAL
Hesham Shaban, Jerry Yee
No abstract text is available yet for this article.
September 2018: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/30139463/incomplete-distal-renal-tubular-acidosis-and-kidney-stones
#12
REVIEW
Daniel G Fuster, Orson W Moe
Renal tubular acidosis (RTA) is comprised of a diverse group of congenital or acquired diseases with the common denominator of defective renal acid excretion with protean manifestation, but in adults, recurrent kidney stones and nephrocalcinosis are mainly found in presentation. Calcium phosphate (CaP) stones and nephrocalcinosis are frequently encountered in distal hypokalemic RTA type I. Alkaline urinary pH, hypocitraturia, and, less frequently, hypercalciuria are the tripartite lithogenic factors in distal RTA (dRTA) predisposing to CaP stone formation; the latter 2 are also commonly encountered in other causes of urolithiasis...
July 2018: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/30139462/pseudo-renal-tubular-acidosis-conditions-mimicking-renal-tubular-acidosis
#13
REVIEW
Junior Uduman, Jerry Yee
Hyperchloremic metabolic acidosis, particularly renal tubular acidosis, can pose diagnostic challenges. The laboratory phenotype of a low total carbon dioxide content, normal anion gap, and hyperchloremia may be misconstrued as hypobicarbonatemia from renal tubular acidosis. Several disorders can mimic renal tubular acidosis, and these must be appropriately diagnosed to prevent inadvertent and inappropriate application of alkali therapy. Key physiologic principles and limitations in the assessment of renal acid handling that can pose diagnostic challenges are enumerated...
July 2018: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/30139461/clinical-approach-to-proximal-renal-tubular-acidosis-in-children
#14
REVIEW
Gal Finer, Daniel Landau
Proximal renal tubular acidosis (pRTA) is an inherited or acquired clinical syndrome in which there is a decreased bicarbonate reclamation in the proximal tubule resulting in normal anion gap hyperchloremic metabolic acidosis. In children, pRTA may be isolated but is often associated with a general proximal tubular dysfunction known as Fanconi syndrome which frequently heralds an underlying systemic disorder from which it arises. When accompanied by Fanconi syndrome, pRTA is characterized by additional renal wasting of phosphate, glucose, uric acid, and amino acids...
July 2018: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/30139460/renal-tubular-acidosis-h-base-and-ammonia-transport-abnormalities-and-clinical-syndromes
#15
REVIEW
Ira Kurtz
Renal tubular acidosis (RTA) represents a group of diseases characterized by (1) a normal anion gap metabolic acidosis; (2) abnormalities in renal HCO3 - absorption or new renal HCO3 - generation; (3) changes in renal NH4 + , Ca2+ , K+ , and H2 O homeostasis; and (4) extrarenal manifestations that provide etiologic diagnostic clues. The focus of this review is to give a general overview of the pathogenesis of the various clinical syndromes causing RTA with a particular emphasis on type I (hypokalemic distal RTA) and type II (proximal) RTA while reviewing their pathogenesis from a physiological "bottom-up" approach...
July 2018: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/30139459/hyperkalemic-forms-of-renal-tubular-acidosis-clinical-and-pathophysiological-aspects
#16
REVIEW
Daniel Batlle, Jose Arruda
In contrast to distal type I or classic renal tubular acidosis (RTA) that is associated with hypokalemia, hyperkalemic forms of RTA also occur usually in the setting of mild-to-moderate CKD. Two pathogenic types of hyperkalemic metabolic acidosis are frequently encountered in adults with underlying CKD. One type, which corresponds to some extent to the animal model of selective aldosterone deficiency (SAD) created experimentally by adrenalectomy and glucocorticoid replacement, is manifested in humans by low plasma and urinary aldosterone levels, reduced ammonium excretion, and preserved ability to lower urine pH below 5...
July 2018: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/30139458/hypokalemic-distal-renal-tubular-acidosis
#17
REVIEW
Patricia G Vall├ęs, Daniel Batlle
Distal renal tubular acidosis (DRTA) is defined as hyperchloremic, non-anion gap metabolic acidosis with impaired urinary acid excretion in the presence of a normal or moderately reduced glomerular filtration rate. Failure in urinary acid excretion results from reduced H+ secretion by intercalated cells in the distal nephron. This results in decreased excretion of NH4 + and other acids collectively referred as titratable acids while urine pH is typically above 5.5 in the face of systemic acidosis. The clinical phenotype in patients with DRTA is characterized by stunted growth with bone abnormalities in children as well as nephrocalcinosis and nephrolithiasis that develop as the consequence of hypercalciuria, hypocitraturia, and relatively alkaline urine...
July 2018: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/30139457/renal-tubular-acidosis-and-the-nephrology-teaching-paradigm
#18
EDITORIAL
Daniel Batlle, Jose Arruda
No abstract text is available yet for this article.
July 2018: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/30139456/it-is-really-time-for-ammonium-measurement
#19
EDITORIAL
Kalani L Raphael, Jerry Yee
No abstract text is available yet for this article.
July 2018: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/29793670/renal-functional-reserve-revisited
#20
REVIEW
Ragnar Palsson, Sushrut S Waikar
Kidney function, like the function of other organs, is dynamic and continuously adjusts to changes in the internal environment to maintain homeostasis. The glomerular filtration rate, which serves as the primary index of kidney function in clinical practice, increases in response to various physiological and pathological stressors including oral protein intake. The difference between the glomerular filtration rate in the resting state and at maximum capacity has been termed renal functional reserve (RFR). RFR could provide additional information on kidney health and renal function prognosis...
May 2018: Advances in Chronic Kidney Disease
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