JournalTOCs

OA Nephrology
Number of Followers: 2

This is an Open Access Journal

Open Access journal
ISSN (Online) 2053-0293
Published by OA Publishing London

[37 journals]

Atypical haemolytic uraemic syndrome.
- Abstract: Atypical hemolytic uremic syndrome is a result of a spectrum of diseases. Disorders of complement regulation are the most important reasons in the etiology. It is associated with defective regulation of the alternative complement pathway in over 50% of cases. Clinical abnormalities are related with the presence of thrombotic microangiopathy. Patients with atypical hemolytic uremic syndrome have a poor prognosis with a high mortality and morbidity in the acute phase of the disease and progression to end-stage renal disease in 50% of the cases. Various extra renal complications due to systemic thrombotic microangiopathy may occur in HUS, including neurological, pancreatic and cardiac involvement. Eculizumab is a humanized monoclonal anti-C5 antibody. It blocks the alternative complement pathway at the level of proinflammatory C5a and lytic C5b-9 complex generation. Related to increase of experiences, eculizumab therapy may be the first-line treatment. We do not know optimal duration of eculizumab therapy. We do not know also in which patient a severe relapse could be developed. At this moment we can suggest that in both cases eculizumab is life-saving and enhancing the quality of life.
  PubDate: 04/09/2017 10:29:08 pm
Causes of fever in dialysis patients and its treatment.
- Abstract: Introduction: There are various types of fever of unknown origin (FUO) among dialysis patients. Physicians should early determine the causes of fever and start providing patients with appropriate treatment. Discussion: FUO is classified into four types depending on the patients’ background: classical, nosocominal, neutropenic, and human immunodeficiency virus (HIV)-associated FUO. Hemodialysis patients may develop a fever as an allergic reaction to a dialysis circuit. Therefore, various items including dialysis membranes, dialysis circuits, puncture needles, anticoagulants, and endotoxin should be examined. The main pathogenic mechanism underlying the development of FUO in dialysis patients is based on allergic reactions to the materials used in dialysis devices and the contaminants (endotoxins) in the dialysate. When the cause of fever is unclear, diagnosis should be started on the basis of the urgency of treatment and the classification of FUO to provide appropriate treatment. When an allergic reaction to the materials used in dialysis devices is suspected, such materials and the sterilization method should be examined to determine the causes of fever and be replaced with a device made of other materials or another method as necessary. Conclusion: There are various causes of fever in dialysis patients. The identification of the causes of fever and its appropriate treatment based on the severity of the symptoms are essential for dialysis patients with FUO.
  PubDate: 04/09/2017 10:29:08 pm
Recent prophylactic strategies and novel biomarkers for contrast-induced
acute kidney injury.
- Abstract: The article has been forwarded to the production team. The processing may take few weeks. Then the proof will be forwarded to the corresponding author. The final PDF and HTML files will be uploaded when the corrections to the proof are returned by the corresponding author.
  PubDate: 07/27/2014 10:34:15 am
The interaction of fluid status and residual renal function in peritoneal
dialysis patients.
- Abstract: The article has been forwarded to the production team. The processing may take few weeks. Then the proof will be forwarded to the corresponding author. The final PDF and HTML files will be uploaded when the corrections to the proof are returned by the corresponding author.
  PubDate: 07/27/2014 10:34:15 am
The anti-GBM disease: treatments and outcomes.
- Abstract: Anti–glomerular basement membrane (anti-GBM) disease is a rare autoimmune disorder characterized by rapidly progressive glomerulonephritis (RPGN) with diffuse crescentic formation on renal biopsy, and it is a well-characterized cause of glomerulonephritis. Although the effectiveness of treatment using therapeutic plasma exchange combined with immunosuppressive agents to improve renal function has been reported, the prognosis for patients with this disease is poor. To improve the prognosis, it may be necessary to detect this disease in earlier stages and to treat it without delay.
  PubDate: 04/16/2014 12:15:02 pm
Dyslipidemias in chronic kidney disease: Current guidelines and future
perspectives.
- Abstract: Dyslipidemia is a major problem in chronic kidney disease (CKD) and hemodialysis (HD) patients. Although there has been a much progress and reduction in prevalence of dyslipidemia after the report of Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel, ATP III) there were few specific recommendations for the evaluation and treatment of dyslipidemias CKD patients in these reports. Besides, the NCEP guidelines are applicable to patients with Stages 1-4 CKD not specifically concerned with Stage 5 CKD, and kidney transplant recipients. It is also evident that when these guidelines were published, there were no large randomized controlled trials evaluating the effects of lipid lowering therapy in this patient group. Given the fact that patients with CKD should be considered in the highest risk group for cardiovascular disease, it was decided that specific recommendations regarding dyslipidemia should be applied to patients with CKD. Thus from the outset of Kidney Disease Outcomes Quality Initiative (K/DOQI), it was strongly agreed that management of dyslipidemias in patients with kidney disease would be one of the most important issues. However, recent randomized controlled trials showed that dyslipidemia treatment in these patients had showed modes benefit at best with regard to cardiovascular mortality. The specific recommendations about dyslipidemias in CKD patients are reviewed along with the new studies and future perspectives.
  PubDate: 04/16/2014 12:15:02 pm
The current evidence supporting rituximab treatment in primary glomerular
diseases causing nephrotic syndrome: Critical review.
- Abstract: Rituximabis a chimeric monoclonal antibody directed against the CD20 receptor on B cells present along all maturational stages of its cycle but not in plasma cells. The administration of one dose of 375 mg/m2 per week for 4 weeks or the administration of a total dose 2 grams within a 2 weeks interval, causes depletion of circulating B lymphocytes which lasts for 6 to 7 months . Although rituximab was designed for the treatment of relapsing or refractory non-Hodgkin lymphoma B, since its introduction in the therapeutic scene, it was considered an attractive drug for the treatment of various autoimmune diseases mediated by antibodies. Current evidence from observational studies suggests that rituximab can induce remission of nephrotic syndrome in patients suffering from membranous glomerulonephritis, minimal change nephropathy and focal segmental glomerulosclerosis. However, the absence of controlled clinical trials in which rituximab compare against the standard of reference in each case, which should be used to define specific indications. With the level of current evidence, it seems reasonable to consider that rituximab is a therapeutic option for patients who have contraindications, intolerance or lack of response to conventional treatment regimens and for patients who have demonstrated dependence of calcineurin inhibitors and are exposed at the risk of chronic nephrotoxicity.
  PubDate: 04/16/2014 12:15:02 pm
Fibroblast growth factor-23 and adverse clinical outcomes in chronic
kidney disease patients.
- Abstract: Fibroblast growth factor (FGF)-23 is a bone-derived phosphatonin secreted in response to oral phosphorus load. It requires Klotho for specific binding to the FGF receptor (FGFR) in classic target organs such as kidneys and parathyroid glands. Serum FGF-23 levels rise early in chronic kidney disease (CKD), and attenuate hyperphosphatemia in expense of 1,25(OH)2 vitamin D suppression, thus initiating the development of secondary hyperparathyroidism. Increased levels of FGF-23 have also been independently associated with CKD progression, mortality and cardiovascular morbidity but the underlying mechanisms are still under investigation. However, it has been suggested that excessively high FGF-23 levels might exert off-target effects in the cardiovascular system. In agreement with the above, recent studies provided evidence that CKD is a Klotho deficient state, which allows excessively high serum FGF-23 levels to induce left ventricular hypertrophy by Klotho-independent FGFR activation, while simultaneously attenuating its anti-calcifying effects.
  PubDate: 04/16/2014 12:15:02 pm
Hereditary interstitial kidney disease: known genes and opportunities for
diagnosis.
- Abstract: Inherited forms of tubulointerstitial kidney disease with an autosomal dominant pattern cause a slowly progressive renal failure often leading to end stage renal disease. The diagnosis may be missed as there are limited renal and extra-renal phenotypes. Typically the urine is inactive, with normal or small kidneys on renal ultrasound and sometimes small cortical or corticomedullary cyst formation. Extra-renal phenotypes may include childhood anaemia and gout, out of keeping with the degree of renal failure. In order to make a diagnosis, a detailed family history and a high index of suspicion is essential. Genetic screening for mutations in MUC1, UMOD and REN will allow a precise diagnosis to be made, allow screening of at risk cases and aid transplantation decisions. Here we discuss the phenotypes common to all forms of autosomal dominant hereditary interstitial kidney disease and the features that may help to refine a precise diagnosis.
  PubDate: 04/16/2014 12:15:02 pm
Searching for CYP24A1 mutations in cohorts of patients with calcium
nephrolithiasis.
- Abstract: The genetics underlying idiopathic hypercalciuria leading to calcium containing renal stones remains elusive. The discovery of rare monogenic tubulopathies, often leading to hypercalciuria, has increased our understanding of tubular physiology and pathophysiology. However, insights into idiopathic calcium stone formation have not been gained from these disorders. Genes involved in vitamin D-mediated calcium regulation are candidate genes for calcium nephrolithiasis. Bi-allelic mutations in CYP24A1 mutations have recently been associated with hypercalciuria, nephrocalcinosis and renal stones. We examined 2 cohorts of stone forming patients for mutations in CYP24A1, which encodes the vitamin D 24-hydroxylase enzyme. The first cohort had a biochemical phenotype of suppressed PTH and high normal serum calcium, whilst the second cohort had a hypercalciuria phenotype. We did not identify bi-allelic sequence variants in CYP24A1 in our cohorts. We conclude that CYP24A1 mutations remain a rare cause of calcium nephrolithiasis and hypercalciuria.
  PubDate: 04/16/2014 12:15:02 pm
The Apelin-APJ system: its role in renal physiology and potential
therapeutic applications for renal disease.
- Abstract: Apelin is a vasoactive peptide isolated as a selective endogenous ligand of orphan receptor, APJ, which was genetically identified to have closest identity to the angiotensin II type 1 receptor (AT-1). Subsequent studies elucidated the roles of the apelin-APJ system in human physiology, including the regulation of cardiovascular function and fluid homeostasis. In spite of the high homology between APJ receptor and AT-1 receptor, the apelin-APJ system has been found to exert opposing actions to angiotensin II (Ang II)-AT-1. Recent reports also showed the roles of apelin-APJ in renal physiology, including the maintenance of water balance in the kidney. In addition, the renoprotective effect of the apelin-APJ system in renal diseases has been reported in the context of renal fibrosis, renal ischemia/reperfusion injury, and diabetic nephropathy, suggesting that the apelin-APJ system may become a new therapeutic target for renal diseases.
  PubDate: 04/16/2014 12:15:02 pm
The percutaneous native kidney biopsy: a nephrologist’s perspective.
- Abstract: Kidney biopsy is one of the most important diagnostic tools in a nephrologist’s armamentarium. It has been shown that performance of a kidney biopsy in the appropriate clinical setting has the potential to alter the clinical diagnosis as well change the therapy in many cases. Current biopsy practice is very safe with minimal complications and ability to obtain adequate tissue for histological diagnosis in more than 95% of cases. It is important for nephrologists to know about the various indications, contraindications, and modifications in the procedure as well as the complications. Learning the proper technique of kidney biopsy is to be learned by all the trainees not only due to the importance of the procedure but also due to the fact that kidney biopsy is one of the triggers enabling the development of nephrology as a separate subspecialty. In this article we critically review various aspects of a kidney biopsy that is important for practicing nephrologists.
  PubDate: 04/16/2014 12:15:02 pm
Peri-operative renal protective strategies in cardiac surgery.
- Abstract: Acute Kidney Injury develops in up to 30% of patients who undergo cardiac surgery, with up to 3% of patients requiring dialysis. The requirement for dialysis after cardiac surgery is associated with an increased risks of infection, prolonged stay in critical care units, and long-term need for dialysis. The development of Acute Kidney Injury is independently associated with substantial short and long-term morbidity and mortality. Its pathogenesis involves multiple pathways. Hemodynamic, inflammatory, metabolic and nephrotoxic factors are involved and overlap each other leading to kidney injury. High-risk patients can be targeted for renal protective strategies. Nonetheless, there is little compelling evidence from randomized trials supporting specific interventions to protect or prevent Acute Kidney Injury in cardiac surgery patients. Several strategies have shown some promise, including less invasive procedures in those at greatest risk, natriuretic peptide, fenoldopam, preoperative hydration, preoperative optimization of anemia and postoperative early use of renal replacement therapy. Larger-scale trials remain needed to confirm their efficacy.
  PubDate: 04/16/2014 12:15:02 pm
Dyslipidaemia in patients with chronic kidney disease and treatment.
- Abstract: Introduction Treatment of dyslipidemia complicated by chronic kidney disease (CKD) is important for preventing the development of cardiovascular disease (CVD). The pathogenesis of dyslipidemia associated with CKD varies depending on urinary protein level and the stage of CKD. Hypocholesterolemia is associated with malnutrition and inflammation and also leads to the poor prognosis of dialysis patients. Statins are expected to prevent the development of CVD in nondialysis CKD patients; however, there is no evidence of the efficacy of statins in preventing the development of CVD in dialysis patients. Treatment strategies for dyslipidemia in CKD patients mainly include lifestyle changes, dietary therapies, and medications such as statins; care should be taken with regard to the side effects of medicines. Conclusion Patients who showed abnormal findings in the lipid test should be treated by considering not only their test results but also their general condition including nutritional condition, medical history, and complications. Personalized treatment of each patient, rather than across-the-board treatment, is necessary.
  PubDate: 04/16/2014 12:15:02 pm
Epidemiology of new-onset diabetes mellitus after dialysis.
- Abstract: Introduction Diabetic nephropathy is the leading cause of end-stage renal disease patients undergoing dialysis. Most studies evaluate the association between pre-existing diabetes mellitus, but very few focus on new-onset diabetes mellitus after dialysis. Chronic dialysis patients are often older and have multiple comorbidities, including cardiovascular diseases and pancreatic disorder. In addition, these patients have been found to be in a state of chronic inflammation. These characteristics have been associated with the development of insulin resistance and diabetes. Herein, we critically review the epidemiology, risk factors and mortality of new-onset diabetes mellitusafter dialysis. Conclusion The dialysis population has a higher incidence of new-onset diabetes mellitus and a greater risk of mortality than the general population. In addition, the post-transplant incidence of diabetes mellitus, which always occurs the first year after transplant, is much higher than the pre-transplant incidence. However, dialysis modality does not appear to be associated with new-onset diabetes mellitus after dialysis and post-transplant. The independent predictors of new-onset diabetes mellitus are old age, cardiovascular comorbidity and dyslipidemia. Other possible contributing factors are inflammation and use of some commonly prescribed drugs for cardiovascular disease, such as statin. Physicians may want to pay more attention the possibility of new-onset diabetes mellituswhen treating high-risk patients undergoing dialysis.
  PubDate: 04/16/2014 12:15:02 pm
The comorbidity scoring systems for predicting survival in elderly
dialysis patients and additional management strategies.
- Abstract: Introduction The worldwide elderly (≥ 65 years old) dialysis population has grown significantly and is expected to have more comorbid conditions and shorter life expectancies than the general elderly population. Predicting outcomes for this population is important for decision-making. There are some studies about comorbidity scoring systems for predicting survival in dialysis patients. To establish a simple and practicable scoring system for predicting survival in the elderly population is increasingly important for physicians worldwide. Conclusion: Of the current comorbidity scoring systems for predicting survival in dialysis patients, the Charlson comorbidity index (CCI) is considered the most predictive than other commonly used comorbidity scoring systems. Recently, a new comorbidity index (nCI)with good predictive value for patient outcomes was developed and validated in chronic dialysis patients. The nCI, even without the age component, is a strong predictor of mortality in elderly dialysis patients.Using one or both of these scoring systems, a physician may be able to provide some helpful objective opinions and suggestions to elderly patients who must choose between initiating and not initiating dialysis.
  PubDate: 04/16/2014 12:15:02 pm
Indoxyl sulphate and p-cresyl sulphate: therapeutically modifiable
nephrovascular toxins.
- Abstract: Introduction Over the past decade, indoxyl sulphate (IS) and p-cresyl sulphate (PCS) have emerged as potentially important, therapeutically modifiable, toxins in patients with chronic kidney disease (CKD). Both are protein-bound uremic retention solutes that are generated from colonic bacterial fermentation of dietary protein and have been associated with cardiovascular disease, kidney disease progression and overall mortality in the CKD population. This review provides an overview of the toxicokinetics and nephrovascular toxicity of IS and PCS, and then focuses specifically on the strengths and weakness of proposed therapeutic opportunities for targeting these molecules, including inhibition of colonic bacterial biosynthesis (protein restriction and pre- and probiotic therapy), suppression of absorption (oral adsorbents), augmentation of clearance (enhanced dialysis) and modulation of cellular pathways (organic anion transporters and antioxidants). Conclusion The uremic retention solutes, IS and PCS, have been identified as potentially important nephrovascular toxins that are highly amenable to therapeutic manipulation. In particular, targeting biosynthesis through pre- and probiotic therapy holds great potential as a tolerable, targeted and cost efficient therapy for reducing serum concentrations of IS and PCS in the clinical setting. Well-designed clinical trials in the CKD population are warranted to investigate whether reductions in IS and PCS translate into improved cardiovascular outcomes.
  PubDate: 04/16/2014 12:15:02 pm
The crucial role of tubulotoxic chemicals in renal failure.
- Abstract: Glomerulonephritis (GN) is seen as a serious immunologic disease of the glomeruli. However, permanent renal damage has never been produced experimentally by immunization without the concomitant use of Freund´s adjuvant (FA) or other tubulotoxic chemicals. Also contradictory is that renal failure is strongly associated with the degree of tubulointerstitial damage, both in experimental and human GN, whereas a weak or no association at all has been found with the degree of glomerular damage. There is solid clinical and experimental evidence that exposure to tubulotoxic chemicals alone is able to produce GN and renal failure, and there is increasing evidence that such exposure is a major cause of renal failure in other kidney diseases. As several studies have observed improvement of renal function after cessation of hydrocarbon exposure, it is reasonable to expect that avoiding other types of toxic exposure may be beneficial as well. It should therefore be mandatory to ask all patients with renal failure about possible exposure to tubulotoxic chemicals, preferably by experienced occupational hygienists, and to support attempts to avoid such exposure.
  PubDate: 04/16/2014 12:15:02 pm
Nephropathies in HIV-infected patients: an overview.
- Abstract: BACKGROUND: The incidence and spectrum of kidney disease in Human Immunodeficiency Virus (HIV)-infected patients have been altered by the diffused use of highly active antiretroviral therapy (HAART); indeed, acute and chronic kidney disease (CKD) has emerged as a significant cause of morbidity and mortality among HIV-infected population. Risk factors associated with kidney disease in such HIV-infected population include aging, hypertension, diabetes mellitus, co-infection with hepatitis C virus (HCV), low CD4 cell count, and high HIV viral load. MATERIALS AND METHODS: We conduct a reviewon the actual knowledge about acute and chronic HIV-associated renal disease, metabolic alterations and related nephropathies, and the side effects of HAART.CONCLUSION: Early identification and treatment of kidney disease is imperative for preventing further renal damage in HIV-infected populations and for instituting appropriate management efficiently. The Infectious Diseases Society of America (IDSA) guidelines recommend urinalysis and estimation of kidney function for all HIV-infected persons at the time of HIV diagnosis. Periodic monitoring of albuminuria, tubular parameters such as low-molecular-weight proteinuria, and the estimated glomerular filtration rate (eGFR) may be useful for early diagnosis of patients at risk for acute or chronic renal disease.
  PubDate: 04/16/2014 12:15:02 pm
Focal segmental glomerulosclerosis variants in children with nephrotic
syndrome.
- Abstract: AimsTodetermine pathological variants of childhood focal segmental glomerulosclerosis (FSGS) and assess efficacy of prednisolone (Pred) + methylprednisolone (MP) + cyclosporin A (CsA) treatment. Subjects and MethodsThis retrospective cohort study included 134 native Kazakh children (3 months–17 years) with nephrotic syndrome (NS) hospitalized in the Nephrology Department of the Republic Children’s Clinical Hospital from 2004 to 2011. Kidney biopsy and pathological investigations were performed in 38 NS patients with proven steroid resistance. ResultsFSGS was confirmed in 38 (28.4%) patients (treatment group). The main FSGS variants were glomerular tip lesions (GTLs) and not otherwise specified (NOS) types. Historical (no Bx) controls were treated with CsA or alkylating agents. Pred + MP + CsA immunosuppressive therapy was highly effective, allowing complete remission in 88.9% patients with minimum side effects. Patients with the NOS variant (NPHS2 and WT1 mutations) did not achieve remission. Combination CsA treatment was significantly more effective than alkylating agent treatment in steroid-resistant nephrotic syndrome (SRNS) patients without genetic mutations. ConclusionsTip lesions are predominant in childhood SRNS. Pred + MP + CsA therapy is safe and effective for childhood FSGS. Establishing a podocyte mutation profile is important to predict treatment outcome.
  PubDate: 04/16/2014 12:15:02 pm
The role of platelets in the prognosis of renal disease.
- Abstract: Platelets were first discovered in 1842, identified as ‘little globules’ or ‘granular masses’. Since then our understanding of these small non-nucleated cells has massively increased, and over the years the humble platelet has been found to be a critical player in many physiological processes. Here we explore the role of platelets in patients with renal diseases and examine their significance in outcomes.
  PubDate: 04/16/2014 12:15:02 pm
Racial and socioeconomic disparities in end stage renal disease in the
United States.
- Abstract: African Americans are disproportionately burdened by advanced chronic kidney disease and end stage renal disease (ESRD). Low socioeconomic status (SES) has been shown to be associated with an increased risk of ESRD and mortality. Low SES may affect ESRD risk and outcomes through social and psychosocial factors, which in turn manifest as unhealthy choices and encumbrance to access health care or health information. Individuals of low SES may also have negative health consequences from factors related to the physical environment such as over-exposure to toxins or pollutants. Race and SES are highly correlated in the United States (U.S.) and certain ethnic minority groups, namely African Americans, Hispanics and Native Americans, are more likely to experience poverty and may do so for their entire lifespan. Thus leading many to surmise that SES related factors might explain the disparities in ESRD incidence and outcomes observed in African Americans. However, low SESappears to have a stronger association with ESRD risk among African Americans than among whites intimating that socioeconomic influences may be different and/or cumulative among African Americans. This review discusses the role of SES in explaining racial disparities in ESRD incidence and outcomes and illuminates gaps in our current knowledge and potential areas of future research.
  PubDate: 04/16/2014 12:15:02 pm
Extra-immunological role of complement activation in diabetic nephropathy.
- Abstract: Introduction Activation of complement cascades has been implicated in the crosstalk between the immune system and metabolism. Membrane attack complex (MAC), which is formed by activation of the complement system, plays a role in the formation of atherosclerotic plaque. Acylation stimulating protein (ASP), a C3 breakdown product (C3a desArg), is associated with insulin resistance and is implicated in tissue inflammation. Obesity and dyslipidemia-induced ASP-C5L2 (C5a receptor-like 2) axis stimulation induce diabetic microvascular endothelial dysfunction. Moreover, intracellular reactive oxygen species in the microvascular endothelium and the coagulation system also induce complement activation, resulting in acceleration of atherosclerosis and tissue injury in the kidney. A substantial amount of evidence has elucidated the association between complement activation and the progression of kidney injury. These insights into the pathological mechanisms associated with several complement pathways will aid in the development of novel therapeutic approaches. Conclusion The complement system is a versatile player not only in host defense but also in complex metabolic and regenerative functions. Further studies are warranted to identify in more detail components of the complement system as possible targets for prevention of diabetic nephropathy.
  PubDate: 04/16/2014 12:15:02 pm
High efficiency post-dilution online haemodiafiltration improves all-cause
mortality: Standard care for ESRD patients'
- Abstract: Renewed interest in convective renal replacement therapy is fuelled by the desire to reduce the high mortality of current maintenance dialysis patients. Despite encouraging data from retrospective analyses or prospective cohort studies, widespread implementation of on-line haemodiafiltration (OL-HDF) has been hampered by the lack of conclusive evidence of improved survival compared to haemodialysis. Recently, three large randomized trials have been published comparing OL-HDF to high - or low - flux haemodialysis. The primary analysis of the ESHOL trial and the secondary analyses of the CONTRAST study and the Turkish OL-HDF study found that high convective volumes confer a survival benefit to HDF patients. However, the evidence from these 3 studies is not unanimous and the trials have each been criticized for selection bias or violation of the study protocol. Moreover, it is not clear why some patients who were randomized to high volume OL-HDF are able to achieve high convection volumes and others were not. Whether or not factors such as quality of vascular access or cardiac function may somehow select patients who are not able to achieve high convection volumes cannot be excluded. Thus, it is plausible that better survival rates in those with better vascular access simply reflect "healthier" patients. A consistent theme that emerges from all three trials is that actual replacement volume seems to matter. Higher volumes were associated with better survival. The mechanisms underlying reduction of all cause mortality remain obscure but may involve better removal of uremic toxins, less systemic inflammation and a lower number of intradialytic hypotensive episodes. There is no doubt, that OL-HDF will be used more frequently. However, there is an urgent need to define the required minimum /optimal convection volumes (expressed as liters per body weight or per surface) in ESRD patients suited for OL-HDF by well designed trials.
  PubDate: 04/16/2014 12:15:02 pm
The importance urine albumin-creatinine ratio in the diagnosis and
prognosis of chronic kidney disease.
- Abstract: The new Kidney Disease Improving Global Outcomes guidelines represent a significant change from the National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (KDIGO), in that the urinary albumin/creatinine ratio (UACR) is now integral to the classification of Chronic Kidney Disease (CKD). The UACR has been found to be fundamentally important for both the diagnosis and the prognosis of CKD. It is now recommended that all patients with diabetes or hypertension be screened annually with this test. The presence of albuminuria changes selection of medications for the treatment of hypertension. More research is needed to determine definitively whether or not treatment of albuminuria delays progression of CKD and reduces mortality.
  PubDate: 04/16/2014 12:15:02 pm
Uric acid in chronic kidney disease.
- Abstract: Uric acid is the end product of purine metabolism in humans, and hyperuricemia was historically thought to cause only gout and urolithiasis. A number of more recent studies have suggested that uric acid may also play a role in hypertension, cardiovascular disease, metabolic syndrome and renal disease. Animal studies demonstrate that elevated uric acid level causes hypertension and endothelial dysfunction, arteriolopathy and chronic kidney disease. Observational studies in human subjects suggest an association of hyperuricemia with incident kidney disease; however, studies investigating the role of uric acid in chronic kidney disease progression have provided varied results. Small randomized-controlled trials investigating the use of uric-acid lowering drugs have provided promising results but larger interventional clinical trials are needed to establish the role of uric acid in these diseases. This review discusses the current understanding of uric acid in the various comorbidities and diseases managed by nephrologists.
  PubDate: 04/16/2014 12:15:02 pm