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Current Opinion in Nephrology and Hypertension

Bethany Roehm, Daniel E Weiner
PURPOSE OF REVIEW: Hypertension is highly prevalent in the United States and a major risk factor for the development of cardiovascular disease. Hypertension is common in chronic kidney disease (CKD), and likely contributes to the association between CKD and cardiovascular disease. The ideal systolic BP to reduce cardiovascular disease risk in individuals with CKD is controversial. RECENT FINDINGS: Several societies have released guidelines on the treatment of hypertension in the past year, each differing in important aspects, including BP targets...
February 12, 2019: Current Opinion in Nephrology and Hypertension
Nimrit Goraya, Donald E Wesson
PURPOSE OF REVIEW: We review the growing clinical evidence that metabolic acidosis mediates chronic kidney disease (CKD) progression and that treatment to increase the associated low serum bicarbonate (HCO3) in CKD is disease-modifying. RECENT FINDINGS: Seven prospective studies of patients with wide ranges of estimated glomerular filtration rates (eGFRs) and serum HCO3 examined the effect on CKD of increasing serum HCO3 using dietary acid reduction with either oral alkali (sodium bicarbonate or sodium citrate), a vegetarian diet very low in acid-producing protein (0...
January 23, 2019: Current Opinion in Nephrology and Hypertension
Carmine Zoccali, Francesca Mallamaci
PURPOSE OF REVIEW: We will summarize recent epidemiological observations on the risk for overt diabetic kidney disease (DKD) in nonproteinuric patients, will focus on novel studies based on a proteomic biomarker of DKD and will discuss the possibility of preventing the progression of DKD in nonproteinuric patients by sodium glucose transporter 2 (SGLT2) inhibitors. RECENT FINDINGS: Although less frequently than in type 2 diabetes, DKD may develop also in nonproteinuric type 1 diabetes...
January 21, 2019: Current Opinion in Nephrology and Hypertension
Amarpali Brar, Mariana Markell
PURPOSE OF REVIEW: Despite evidence of gender-specific differences in epidemiology and outcomes in all stages of chronic kidney disease (CKD), most studies ignore the issue of gender. This review addresses this knowledge gap by evaluating data on gender disparity in this population. RECENT FINDINGS: Population-based studies indicate a higher prevalence of CKD in women; however, there are fewer women on renal replacement therapy than men. Men may progress to end-stage kidney disease more rapidly...
January 15, 2019: Current Opinion in Nephrology and Hypertension
Zhen Zhang, Yuki Sugiura, Tomoatsu Mune, Mitsuru Nishiyama, Yoshio Terada, Kuniaki Mukai, Koshiro Nishimoto
PURPOSE OF REVIEW: Immunohistochemistry for aldosterone synthase (CYP11B2) has markedly provided a comprehensive picture of the adrenocortical diseases, particularly primary aldosteronism. The findings from CYP11B2 immunohistochemistry are consistent with the clinical courses of most patients with primary aldosteronism. We herein review the updated pathophysiology and usefulness of the method for understanding individual patients with different subtypes of primary aldosteronism. RECENT FINDINGS: After our discovery of aldosterone-producing cell clusters (APCCs) using the immunohistochemistry for CYP11B2, we found possible APCC-to-APA transitional lesions (pAATLs) in a few cases that had been hitherto classified as unilateral hyperplasia or multiple nodules...
January 2, 2019: Current Opinion in Nephrology and Hypertension
Roopa Shah, Matthew A Sparks
PURPOSE OF REVIEW: To present the available data on the risks and benefits for ACEi/ARB usage in patients with advanced CKD. RECENT FINDINGS: It has been well established that ACEi/ARB use is beneficial in patients with mild-to-moderate CKD, especially in patients with proteinuria. The majority of available data includes patients with diabetes mellitus. However, data in individuals with advanced CKD are limited. Additionally, data available for this subset of patients is conflicting and the definition of advanced CKD varies across clinical trials...
December 24, 2018: Current Opinion in Nephrology and Hypertension
Stephanie M Mutchler, Thomas R Kleyman
PURPOSE OF REVIEW: This review describes recent findings regarding the epithelial Na channel (ENaC) and its roles in physiologic and pathophysiologic states. We discuss new insights regarding ENaC's structure, its regulation by various factors, its potential role in hypertension and nephrotic syndrome, and its roles in the immune system and vasculature. RECENT FINDINGS: A recently resolved structure of ENaC provides clues regarding mechanisms of ENaC activation by proteases...
December 24, 2018: Current Opinion in Nephrology and Hypertension
(no author information available yet)
No abstract text is available yet for this article.
December 13, 2018: Current Opinion in Nephrology and Hypertension
Guorui Deng, Justin L Grobe
PURPOSE OF REVIEW: Obesity represents the primary challenge to improving cardiovascular health, and suppression of resting metabolic rate (RMR) is implicated in the maintenance of obesity. Increasing evidence supports a major role for the renin-angiotensin system (RAS) within the brain in the control of RMR. RECENT FINDINGS: The angiotensin II (ANG) Agtr1a receptor colocalizes with the leptin receptor (Lepr) primarily within cells of the arcuate nucleus (ARC) of the hypothalamus that also express Agouti-related peptide (Agrp)...
December 10, 2018: Current Opinion in Nephrology and Hypertension
Matthew R D'Costa, Vernon M Pais, Andrew D Rule
PURPOSE OF REVIEW: Established guidelines provide recommendations on the management of kidney stones to prevent recurrence. However, clear and clinically useful terminology for recurrence of kidney stones is needed. This review describes the various manifestations of kidney stone recurrence and the reported rates of kidney stone recurrence in various clinical settings. RECENT FINDINGS: Kidney stone recurrence has a wide range of symptomatic and radiographic presentations...
December 5, 2018: Current Opinion in Nephrology and Hypertension
Vasishta S Tatapudi, David S Goldfarb
PURPOSE OF REVIEW: Traditionally, nephrolithiasis was considered a relative contraindication to kidney donation because of a risk of recurrent stones in donors and adverse stone-related outcomes in recipients. However, the scarcity of organs has driven the transplant community to re-examine and broaden selection criteria for living donors with stones. In this review, we summarize and contrast the guidelines published by various prominent national and international societies on this topic...
December 5, 2018: Current Opinion in Nephrology and Hypertension
Margaret E Armstrong, Christie P Thomas
PURPOSE OF REVIEW: The purpose of this review is to emphasize that single gene disorders are an important and sometimes unrecognized cause of progressive chronic kidney disease. We provide an overview of the benefits of making a genetic diagnosis, the currently available genetic testing methods and examples of diseases illustrating the impact of a genetic diagnosis. RECENT FINDINGS: Although there are now a number of monogenic renal diseases, only a few, such as autosomal dominant polycystic kidney disease (ADPKD), are generally diagnosable without genetic testing...
March 2019: Current Opinion in Nephrology and Hypertension
David S Goldfarb
No abstract text is available yet for this article.
March 2019: Current Opinion in Nephrology and Hypertension
Jeffrey D Rimer, Khashayar Sakhaee, Naim M Maalouf
PURPOSE OF REVIEW: Calcium phosphate (CaP) stones represent an increasingly encountered form of recurrent nephrolithiasis, but current prophylactic medical regimens are suboptimal. Although hypocitraturia is a well-described risk factor for CaP stones, strategies that enhance citrate excretion have not consistently been effective at reducing CaP saturation and stone recurrence. This review summarizes the role of citrate therapy in CaP nephrolithiasis. RECENT FINDINGS: Citrate in urine inhibits CaP stone formation through multiple mechanisms, including the formation of soluble citrate-calcium complexes, and inhibition of CaP nucleation, crystal growth and crystal aggregation...
March 2019: Current Opinion in Nephrology and Hypertension
Katarina Leyba, Brent Wagner
PURPOSE OF REVIEW: The hegemony of gadolinium-based contrast agent-induced adverse events stretches beyond those who have renal impairment. 'Nephrogenic' systemic fibrosis is a misnomer: gadolinium-based contrast agents are the known trigger for the disease; kidney impairment is a risk factor. Impaired (true) glomerular filtration may be one catalyst for gadolinium-based contrast agent-induced adverse events, but it is increasingly evident that the same cluster of symptoms occurs in patients with normal renal function...
March 2019: Current Opinion in Nephrology and Hypertension
Hamdi A Jama, David M Kaye, Francine Z Marques
PURPOSE OF REVIEW: To summarize evidence supporting that microorganisms colonizing our gastrointestinal tract, collectively known as the gut microbiota, are implicated in the development and maintenance of hypertension in experimental models. RECENT FINDINGS: The use of gnotobiotic (germ-free) mice has been essential for advancement in this area: they develop higher blood pressure (BP) if they receive faecal transplants from hypertensive patients compared to normotensive donors, and germ-free mice have a blunted response to angiotensin II...
March 2019: Current Opinion in Nephrology and Hypertension
Luca Perico, Norberto Perico, Ariela Benigni
PURPOSE OF REVIEW: This review summarizes the most recent and relevant findings in the search for novel biomarkers for the most common renal diseases. RECENT FINDINGS: Unprecedented, fast-paced technical advances in biomedical research have offered an opportunity to identify novel and more specific renal biomarkers in several clinical settings. However, despite the huge efforts made, the molecules identified so far have generally failed to provide relevant information beyond what has already been generated by established biomarkers, such as serum creatinine and proteinuria, whereas the complexity and costs of these technology platforms hamper their widespread implementation...
March 2019: Current Opinion in Nephrology and Hypertension
Sriram Sriperumbuduri, Swapnil Hiremath
PURPOSE OF REVIEW: Strong epidemiological and pathologic evidence associates NSAIDs with kidney disease, both acute and chronic. Hence, the usage of NSAIDs has decreased in patients with, or at risk for, chronic kidney disease (CKD). Coupled with this has been a rise in use of opioids and other non-NSAID alternatives, which do come with significant, and underrecognized, risk of nonrenal adverse events. We review the literature to understand if this shift is appropriate or deleterious...
March 2019: Current Opinion in Nephrology and Hypertension
Ron Wald, Kevin E Thorpe, Michael W Walsh
PURPOSE OF REVIEW: Phosphate lowering toward the normal range is advocated and widely practiced in patients with end-stage renal disease receiving dialysis. This approach is guided by basic science data and large observational studies that have demonstrated a consistent association between hyperphosphatemia and adverse events, including cardiovascular morbidity and all-cause mortality. There has never been a clinical trial to assess the efficacy of phosphate lowering in maintenance dialysis recipients...
January 2019: Current Opinion in Nephrology and Hypertension
David J Friedman
PURPOSE OF REVIEW: Chronic kidney disease (CKD) can cluster in geographic locations or in people of particular genetic ancestries. We explore APOL1 nephropathy and Balkan nephropathy as examples of CKD clustering that illustrate genetics and environment conspiring to cause high rates of kidney disease. Unexplained hotspots of kidney disease in Asia and Central America are then considered from the perspective of potential gene × environment interactions. RECENT FINDINGS: We report on evidence supporting both genes and environment in these CKD hotspots...
January 2019: Current Opinion in Nephrology and Hypertension
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