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Curr Opin Nephrol Hypertens 2019 Apr 9. Epub 2019 Apr 9.

Laboratory of Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Ageing.

Purpose Of Review: To summarize the role of hypoxia signaling in skeletal cells.

Recent Findings: Hypoxia occurs at several stages during bone development. Skeletal cells, like chondrocytes and osteoblasts, respond to this challenge by stabilizing the hypoxia inducible transcription factor HIF, which induces the expression of angiogenic factors and promotes glycolysis. Read More

Curr Opin Nephrol Hypertens 2019 Apr 9. Epub 2019 Apr 9.

Institute for Physiology and Pathophysiology, Johannes Kepler University Linz, Linz, Austria.

Purpose Of Review: Chronic kidney disease (CKD) facilitates a unique environment to strongly accelerate vascular calcification - the pathological deposition of calcium-phosphate in the vasculature. These calcifications are associated with the excessive cardiovascular mortality of CKD patients.

Recent Findings: Vascular calcification is a multifaceted active process, mediated, at least partly, by vascular smooth muscle cells. Read More

Curr Opin Nephrol Hypertens 2019 Apr 9. Epub 2019 Apr 9.

Division of Nephrology, Department of Internal Medicine.

Purpose Of Review: Sodium glucose cotransporter 2 (SGLT2) inhibitors are relatively novel antidiabetic drugs that improve glycemic control and reduce cardiovascular outcomes as well as renal function decline. SGLT2 inhibitors act by inhibiting glucose reabsorption in the proximal tubule of the kidney. Emerging data suggest that these drugs may also influence bone and mineral metabolism. Read More

Curr Opin Nephrol Hypertens 2019 May;28(3):262-266

Department of Medicine/Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, Washington, USA.

Purpose Of Review: Heart failure is highly prevalent in patients with chronic kidney disease (CKD) and a leading cause of morbidity and mortality in this population. Heart failure therapies proven to benefit the general population may have different risk-benefit profiles in patients with concurrent CKD, plausibly because of the unique pathophysiology of heart failure in this population. The present review highlights recent advances in heart failure treatment as they apply to patients with CKD. Read More

Curr Opin Nephrol Hypertens 2019 Mar 28. Epub 2019 Mar 28.

Department of Medicine, Harvard Medical School.

Purpose Of Review: Acute kidney injury (AKI) remains a major unmet medical need and associates with high morbidity, mortality, and healthcare costs. Among survivors, long-term outcomes of AKI can include development of chronic kidney disease (CKD) or progression of preexisting CKD. In this review, we focus on ongoing efforts by the AKI community to understand the human AKI to CKD continuum, with an emphasis on the cellular stress responses that underlie AKI and the maladaptive responses that persist in the acute-to-chronic phase. Read More

Curr Opin Nephrol Hypertens 2019 May;28(3):203-210

Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center.

Purpose Of Review: Preclinical data suggests that transforming growth factor-β (TGF-β) is arguably the most potent profibrotic growth factor in kidney injury. Despite this, recent clinical trials targeting TGF-β have been disappointing. These negative studies suggest that TGF-β signaling in the injured kidney might be more complicated than originally thought. Read More

Curr Opin Nephrol Hypertens 2019 03 14. Epub 2019 Mar 14.

Hypertension Section.

Purpose Of Review: The purpose of this study is to review the current literature related to the role of inorganic phosphate in the pathogenesis of hypertension.

Recent Findings: An increasing number of publications have revealed a detrimental role of inorganic phosphate, which is commonly used as a flavor enhancer or preservative in the processed food, in promoting hypertension in otherwise healthy individuals. Animal experimental data indicate that dietary phosphate excess engages multiple mechanisms that promote hypertension, including overactivation of the sympathetic nervous system, increased vascular stiffness, impaired endothelium-dependent vasodilation, as well as increased renal sodium absorption or renal injury. Read More

Curr Opin Nephrol Hypertens 2019 Mar 6. Epub 2019 Mar 6.

Department of Internal Medicine, Division of Nephrology and Hypertension and Molecular Medicine Program, University of Utah and Medical Service, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah, USA.

Purpose Of Review: This review focuses on the role of intracellular chloride in regulating transepithelial ion transport in the distal convoluted tubule (DCT) in response to perturbations in plasma potassium homeostasis.

Recent Findings: Low dietary potassium increases the phosphorylation and activity of the sodium chloride cotransporter (NCC) in the DCT, and vice versa, affecting sodium-dependent potassium secretion in the downstream aldosterone-sensitive distal nephron. In cells, NCC phosphorylation is increased by lowering of intracellular chloride, via activation of the chloride-sensitive with no lysine (WNK)-SPAK/OSR1 (Ste20-related proline/alanine-rich kinase/oxidative stress response) kinase cascade. Read More

Curr Opin Nephrol Hypertens 2019 May;28(3):238-244

Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba.

Purpose Of Review: Although renin-angiotensin aldosterone system (RAAS) inhibitors have become the mainstay treatment for patients with chronic diseases, hyperkalemia is a major contributory deterrent to their use in patients with chronic kidney disease (CKD) and heart failure. For the first time in 50 years, two new therapies (patiromer and ZS-9) have recently emerged for the concomitant treatment of hyperkalemia in these patients. The objective of this review is to discuss the efficacy and safety of these new agents. Read More

Curr Opin Nephrol Hypertens 2019 May;28(3):278-287

Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA.

Purpose Of Review: Atypical hemolytic uremic syndrome (aHUS) is a diagnosis that has captured the interest of specialists across multiple fields. The hallmark features of aHUS are microangiopathic hemolysis and thrombocytopenia, which creates a diagnostic dilemma because of the occurrence of these findings in a wide variety of clinical disorders.

Recent Findings: In most of the instances, aHUS is a diagnosis of exclusion after ruling out causes such as Shigella toxin, acquired or genetic a disintegrin and metalloproteinase thrombospondin motif 13 deficiency (thrombotic thrombocytopenic purpura), and vitamin B12 deficiency. Read More

Curr Opin Nephrol Hypertens 2019 May;28(3):211-218

Wellcome Centre for Cell-Matrix Research, Faculty of Biology, Medicine and Health, University of Manchester.

Purpose Of Review: Human kidney development and the mechanisms of many kidney diseases are incompletely understood partly due to the lack of appropriate models. Kidney organoids derived from human pluripotent stem cells (hPSCs) are a new and rapidly developing in-vitro system covering the window of early nephrogenesis and having the capacity for disease modelling. The application of global analytic tools such as RNA sequencing and proteomics is providing new and unexpected insights into kidney organoids with relevance for development and disease. Read More

Curr Opin Nephrol Hypertens 2019 May;28(3):219-226

Purpose Of Review: Transcriptome analysis of human kidney samples provides an integrated output of genetic, physiological, or environmental inputs. This review summarizes recent findings including gene expression and genetic variation integration, bulk and single cell gene expression analysis, and describes how such studies have improved our understanding of kidney disease development.

Recent Findings: Bulk or whole tissue analysis of patient kidney samples identified a large number of genes, whose levels correlate with kidney function and/or structural damage. Read More

Curr Opin Nephrol Hypertens 2019 May;28(3):233-237

Department of Pediatrics and Child Health, Max Rady College of Medicine, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada.

Purpose Of Review: Lifetime risk of outcomes is emerging as a highly relevant health indicator, even in the context of low absolute risk of disease progression in short time frames. Evidence to support this concept for kidney failure is increasing, with growing emphasis on the long-term impact of risk factors occurring early in life.

Recent Findings: Proteinuria and stage of chronic kidney disease (CKD) are now established predictors of CKD progression in children, and youth with type 2 diabetes are emerging as a group at significant risk. Read More

Curr Opin Nephrol Hypertens 2019 May;28(3):251-261

The George Institute for Global Health, UNSW Sydney.

Purpose Of Review: The direct oral anticoagulants (DOACs) have emerged as an effective and safe alternative to vitamin K antagonists (VKAs) for stroke and venous thromboembolism (VTE) prevention. However, patients with chronic kidney disease (CKD) experience an increase in the risk of both thromboembolism and bleeding, and the risk-benefit profile of DOACs, particularly in advanced CKD remains a source of ongoing debate. This review summarizes the recent evidence on the effects of DOACs in CKD across a range of clinical indications including newly emerging indications. Read More

Curr Opin Nephrol Hypertens 2019 May;28(3):245-250

William B. Schwartz Division of Nephrology, Tufts Medical Center, Boston, Massachusetts, USA.

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. Read More

Curr Opin Nephrol Hypertens 2019 May;28(3):267-277

Department of Internal Medicine, Texas A&M Health Sciences Center College of Medicine.

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 (0.3 g/kg/day) supplemented with ketoanalogues or added base-producing fruits and vegetables. Read More

Curr Opin Nephrol Hypertens 2019 May;28(3):227-232

CNR National Research Council Clinical Epidemiology and Pathophysiology of Renal Disease and Hypertension Unit.

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. However, the progression rate to kidney failure in nonproteinuric diabetic people is much lower than in proteinuric ones. Read More

Curr Opin Nephrol Hypertens 2019 Mar;28(2):178-182

Department of Medicine, Division of Nephrology, SUNY Downstate Medical Center, Brooklyn, New York, USA.

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. Read More

Curr Opin Nephrol Hypertens 2019 Mar;28(2):105-112

Department of Uro-Oncology, Saitama Medical University International Medical Center, Saitama, Japan.

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. Read More

Curr Opin Nephrol Hypertens 2019 Mar;28(2):183-194

Division of Nephrology, Department of Internal Medicine.

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. Read More

Curr Opin Nephrol Hypertens 2019 Mar;28(2):128-129

Nephrology Division, New York University Langone Health, NY Harbor VA Medical Center, NYU School of Medicine, New York, New York, USA.

Curr Opin Nephrol Hypertens 2019 Mar;28(2):171-177

Division of Nephrology, Department of Medicine, Duke University School of Medicine.

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. Read More

Curr Opin Nephrol Hypertens 2019 Mar;28(2):113-119

Department of Medicine.

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. Read More

Curr Opin Nephrol Hypertens 2019 Mar;28(2):130-139

Department of Internal Medicine, and Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, USA.

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. Read More

Curr Opin Nephrol Hypertens 2019 Mar;28(2):154-162

Kidney Institute of New Mexico.

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. Read More

Curr Opin Nephrol Hypertens 2019 Mar;28(2):97-104

Heart Failure Research Group, Baker Heart and Diabetes Institute.

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. Experimental hypertension is consistently accompanied by changes in the composition of the gut microbiota. Read More

Curr Opin Nephrol Hypertens 2019 Mar;28(2):195-202

Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy.

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. Read More

Curr Opin Nephrol Hypertens 2019 Mar;28(2):163-170

Department of Medicine & Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.

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. Read More

Curr Opin Nephrol Hypertens 2019 Mar;28(2):148-153

Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota.

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. Read More

Curr Opin Nephrol Hypertens 2019 Mar;28(2):140-147

Nephrology Section, New York Harbor VA Medical Center and NYU School of Medicine, New York, New York, USA.

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. Read More

Curr Opin Nephrol Hypertens 2019 Mar;28(2):120-127

Department of Pharmacology, Center for Hypertension Research, Obesity Research & Education Initiative, Iowa Neuroscience Institute, Abboud Cardiovascular Research Center, and Fraternal Order of Eagles' Diabetes Research Center, Carver College of Medicine, University of Iowa, Iowa City, USA.

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). Read More

Curr Opin Nephrol Hypertens 2019 Jan;28(1):34-39

Division of Nephrology, St. Joseph's Healthcare Hamilton, McMaster University.

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. Read More

Curr Opin Nephrol Hypertens 2019 Jan;28(1):87-96

Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.

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. Read More

Curr Opin Nephrol Hypertens 2019 Jan;28(1):16-25

Division of Nephrology, Department of Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.

Purpose Of Review: The current review examines what is known about the FGF-23/α-Klotho co-dependent and independent pathophysiological effects, and whether FGF-23 and/or α-Klotho are potential therapeutic targets.

Recent Findings: FGF-23 is a hormone derived mainly from bone, and α-Klotho is a transmembrane protein. Together they form a trimeric signaling complex with FGFRs in target tissues to mediate the physiological functions of FGF-23. Read More

Curr Opin Nephrol Hypertens 2019 Jan;28(1):70-76

Department of Medicine, Boston University School of Medicine and Section of Nephrology, Boston Medical Center, Boston, Massachusetts, USA.

Purpose Of Review: Despite major advances in since the discovery of the phospholipase A2 receptor (PLA2R) as the major autoantigen on podocytes in primary membranous nephropathy, there are still several unanswered questions as highlighted here.

Recent Findings: A substantial body of literature, included in more than 680 articles since 2009, has documented genetic susceptibility to primary membranous nephropathy involving PLA2R1 and class II MHC alleles, the clinical value of anti-PLA2R assays, the significance of epitope spreading of the anti-PLA2R response, discovery of thrombospondin type I domain-containing 7A (THSD7A) as a minor antigen in primary membranous nephropathy, and the ability to transfer disease into mice by infusion of anti-THSD7A sera. However, the normal physiology and pathophysiology of PLA2R and THSD7A in podocytes is still unknown and the genetic influence on disease susceptibility is unexplained. Read More

Curr Opin Nephrol Hypertens 2019 Jan;28(1):58-64

Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.

Purpose Of Review: Maintaining euvolaemia is an essential yet challenging objective in management of patients on peritoneal dialysis. Optimal method to assess volume status remains to be determined. In this review, we will discuss the risk factors and clinical outcomes of fluid overload in PD patients, and examine the role of bioimpedance study in fluid management. Read More

Curr Opin Nephrol Hypertens 2019 Jan;28(1):77-86

Department of Nephrology, Rambam Healthcare Campus.

Purpose Of Review: The purpose of this mini-review is to highlight some unresolved questions and controversies in the evolving story of apolipoprotein L1 (APOL1) nephropathy.

Recent Findings: We highlight studies that introduce complexity in unraveling the mechanisms whereby APOL1 risk variant alleles cause disease. These include studies which support a possible protective role for the APOL1 GO nonrisk ancestral allele, and studies which explore the initiating events that may trigger other downstream pathways mediating APOL1 cellular injury. Read More

Curr Opin Nephrol Hypertens 2019 Jan;28(1):47-57

Department of Diabetes, Endocrinology and Metabolism, City of Hope National Medical Center, Duarte, California, USA.

Purpose Of Review: The leading cause of death in both chronic kidney disease (CKD) and renal transplant patients is cardiovascular events. Post-transplant diabetes mellitus (PTx-DM), which is a major cardiovascular risk factor, is a metabolic disorder that affects 5.5-60. Read More

Curr Opin Nephrol Hypertens 2019 Jan;28(1):10-15

Departments of Pediatrics and Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan, USA.

Purpose Of Review: Elevated circulating levels of growth hormone (GH) and/or increased expression of the GH receptor in the kidney are associated with the development of nephropathy in type1 diabetes and acromegaly. Conditions of GH excess are characterized by hyperfiltration, glomerular hypertrophy, glomerulosclerosis and albuminuria, whereas states of decreased GH secretion or action are protected against glomerulopathy. The direct role of GH's action on glomerular cells, particularly podocytes, has been the focus of recent studies. Read More

Curr Opin Nephrol Hypertens 2019 Jan;28(1):1-9

Nephrology Research Group, Vall d'Hebron Research Institute (VHIR).

Purpose Of Review: The majority of end-stage renal disease including dialysis and kidney transplant patients are men. In contrast, the incidence of chronic kidney disease (CKD) is higher in women compared with men. In this review, we dissect the sex hormone levels and its effects on experimental models and patients with CKD. Read More

Curr Opin Nephrol Hypertens 2019 Jan;28(1):26-33

Department of Internal Medicine, CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, the Netherlands.

Purpose Of Review: Chronic kidney disease (CKD) remains a serious diabetic complication despite the use of widely employed interventions such as angiotensin-converting enzyme inhibitors and glucose-lowering treatments. Accumulation of methylglyoxal, a highly reactive glucose metabolite and a major precursor in the formation of advanced glycation end products, may link the hemodynamic, inflammatory, metabolic, and structural changes that drive diabetic CKD. Therefore, methylglyoxal may serve as a potential therapeutic target to prevent diabetic CKD. Read More

Curr Opin Nephrol Hypertens 2019 Jan;28(1):65-69

Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.

Purpose Of Review: The presence of viruses in urine (urine virome) typically reflects infection in the kidneys and urinary tract. The urinary virome is associated with HIV-associated nephropathy and chronic glomerulosclerosis. There are many associations of this microbiome with human diseases that remain to be described. Read More

Curr Opin Nephrol Hypertens 2019 Jan;28(1):40-46

Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy.

Purpose Of Review: Mesenchymal stromal cells (MSC) have emerged as one of the most promising candidates for immunomodulatory cell therapy in kidney transplantation. Here we describe novel insights into the MSC mechanism of action and provide an overview of initial safety and feasibility studies with MSC in kidney transplantation.

Recent Findings: Clinical studies of MSC-based cell therapy in kidney transplant recipients demonstrated the safety and feasibility of cell therapy and provide the first encouraging evidence of the efficacy of MSC in enabling the minimization of immunosuppressive drugs. Read More

Curr Opin Nephrol Hypertens 2018 11;27(6):472-477

Department of Infection Immunity and Inflammation, University of Leicester.

Purpose Of Review: There is increasing evidence that extended-hours regimens are associated with improved outcomes for patients on maintenance hemodialysis programs. Home hemodialysis programs are a well established way for patients to benefit from extended-hours dialysis overnight; however, there are significant barriers to home hemodialysis, which means that for many this is not an option. In center, nocturnal hemodialysis is an increasingly recognized way of offering extended-hours treatment to patients unable to undertake home-based programs and is an underutilized modality for such patients to gain from the physiological benefits of extended-hours dialysis regimens. Read More

Curr Opin Nephrol Hypertens 2018 11;27(6):487-496

Department of Anesthesiology and Intensive Care, Montreal Heart Institute.

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. Read More

Curr Opin Nephrol Hypertens 2018 11;27(6):445-453

Department of Surgery, Johns Hopkins University School of Medicine.

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. The development of direct-acting antivirals to cure HCV infection has enabled prospective trials on the transplantation of organs from HCV-infected donors into HCV-negative recipients, with promising preliminary results. Read More

Curr Opin Nephrol Hypertens 2018 11;27(6):440-444

Hematology Department, Clinica Universidad de Navarra and Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.

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. Read More

Curr Opin Nephrol Hypertens 2018 11;27(6):454-462

Nephrology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.

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. Read More

Curr Opin Nephrol Hypertens 2018 11;27(6):463-471

Institute of Biomedical Ethics and the History of Medicine, University of Zurich, Winterthurerestrasse, Zurich, Switzerland.

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. Read More

Curr Opin Nephrol Hypertens 2018 11;27(6):478-486

UNESP - Botucatu School of Medicine, University Sao Paulo State.

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. Read More