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Revista Da Associacao Medica Brasileira... Jan 2020Chronic kidney disease is highly prevalent (10-13% of the population), irreversible, progressive, and associated with higher cardiovascular risk. Patients with this... (Review)
Review
Chronic kidney disease is highly prevalent (10-13% of the population), irreversible, progressive, and associated with higher cardiovascular risk. Patients with this pathology remain asymptomatic most of the time, presenting the complications typical of renal dysfunction only in more advanced stages. Its treatment can be conservative (patients without indication for dialysis, usually those with glomerular filtration rate above 15 ml/minute) or replacement therapy (hemodialysis, peritoneal dialysis, and kidney transplantation). The objectives of the conservative treatment for chronic kidney disease are to slow down the progression of kidney dysfunction, treat complications (anemia, bone diseases, cardiovascular diseases), vaccination for hepatitis B, and preparation for kidney replacement therapy.
Topics: Humans; Kidney Failure, Chronic; Prevalence; Renal Dialysis; Renal Insufficiency; Renal Insufficiency, Chronic; Risk Factors
PubMed: 31939529
DOI: 10.1590/1806-9282.66.S1.3 -
The Lancet. Oncology Nov 2014This International Myeloma Working Group consensus updates the disease definition of multiple myeloma to include validated biomarkers in addition to existing... (Review)
Review
This International Myeloma Working Group consensus updates the disease definition of multiple myeloma to include validated biomarkers in addition to existing requirements of attributable CRAB features (hypercalcaemia, renal failure, anaemia, and bone lesions). These changes are based on the identification of biomarkers associated with near inevitable development of CRAB features in patients who would otherwise be regarded as having smouldering multiple myeloma. A delay in application of the label of multiple myeloma and postponement of therapy could be detrimental to these patients. In addition to this change, we clarify and update the underlying laboratory and radiographic variables that fulfil the criteria for the presence of myeloma-defining CRAB features, and the histological and monoclonal protein requirements for the disease diagnosis. Finally, we provide specific metrics that new biomarkers should meet for inclusion in the disease definition. The International Myeloma Working Group recommends the implementation of these criteria in routine practice and in future clinical trials, and recommends that future studies analyse any differences in outcome that might occur as a result of the new disease definition.
Topics: Biomarkers, Tumor; Bone Marrow Cells; Humans; Multiple Myeloma; Prognosis; Renal Insufficiency
PubMed: 25439696
DOI: 10.1016/S1470-2045(14)70442-5 -
Nephron 2022Kidney Disease Improving Global Outcomes (KDIGO) guidelines address the definition, classification, and management of acute kidney injury (AKI) and chronic kidney... (Review)
Review
Kidney Disease Improving Global Outcomes (KDIGO) guidelines address the definition, classification, and management of acute kidney injury (AKI) and chronic kidney disease (CKD). In practice, some clinical presentations of acute kidney diseases and disorders (AKD) do not meet the criteria for AKI or CKD. In principle, these presentations may be caused by the same diseases that cause AKI or CKD, which could be detected, evaluated, and treated before they evolve to AKI or CKD. In 2020, KDIGO convened a consensus conference to review recent evidence on the epidemiology of AKD and harmonize the definition and classification of AKD to be consistent with KDIGO definitions and classifications of AKI and CKD.
Topics: Acute Disease; Acute Kidney Injury; Consensus; Female; Humans; Kidney; Male; Renal Insufficiency, Chronic
PubMed: 34167119
DOI: 10.1159/000516647 -
Nephrology, Dialysis, Transplantation :... Dec 2019There have been significant recent advances in our understanding of the mechanisms that maintain potassium homoeostasis and the clinical consequences of hyperkalemia. In... (Review)
Review
There have been significant recent advances in our understanding of the mechanisms that maintain potassium homoeostasis and the clinical consequences of hyperkalemia. In this article we discuss these advances within a concise review of the pathophysiology, risk factors and consequences of hyperkalemia. We highlight aspects that are of particular relevance for clinical practice. Hyperkalemia occurs when renal potassium excretion is limited by reductions in glomerular filtration rate, tubular flow, distal sodium delivery or the expression of aldosterone-sensitive ion transporters in the distal nephron. Accordingly, the major risk factors for hyperkalemia are renal failure, diabetes mellitus, adrenal disease and the use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers or potassium-sparing diuretics. Hyperkalemia is associated with an increased risk of death, and this is only in part explicable by hyperkalemia-induced cardiac arrhythmia. In addition to its well-established effects on cardiac excitability, hyperkalemia could also contribute to peripheral neuropathy and cause renal tubular acidosis. Hyperkalemia-or the fear of hyperkalemia-contributes to the underprescription of potentially beneficial medications, particularly in heart failure. The newer potassium binders could play a role in attempts to minimize reduced prescribing of renin-angiotensin inhibitors and mineraolocorticoid antagonists in this context.
Topics: Global Health; Glomerular Filtration Rate; Heart Failure; Homeostasis; Humans; Hyperkalemia; Incidence; Potassium; Renal Insufficiency; Risk Factors
PubMed: 31800080
DOI: 10.1093/ndt/gfz206 -
Nature Reviews. Nephrology Apr 2017Consensus definitions have been reached for both acute kidney injury (AKI) and chronic kidney disease (CKD) and these definitions are now routinely used in research and...
Consensus definitions have been reached for both acute kidney injury (AKI) and chronic kidney disease (CKD) and these definitions are now routinely used in research and clinical practice. The KDIGO guideline defines AKI as an abrupt decrease in kidney function occurring over 7 days or less, whereas CKD is defined by the persistence of kidney disease for a period of >90 days. AKI and CKD are increasingly recognized as related entities and in some instances probably represent a continuum of the disease process. For patients in whom pathophysiologic processes are ongoing, the term acute kidney disease (AKD) has been proposed to define the course of disease after AKI; however, definitions of AKD and strategies for the management of patients with AKD are not currently available. In this consensus statement, the Acute Disease Quality Initiative (ADQI) proposes definitions, staging criteria for AKD, and strategies for the management of affected patients. We also make recommendations for areas of future research, which aim to improve understanding of the underlying processes and improve outcomes for patients with AKD.
Topics: Acute Kidney Injury; Humans; Remission Induction; Renal Insufficiency, Chronic
PubMed: 28239173
DOI: 10.1038/nrneph.2017.2 -
Kidney International Apr 2024
Topics: Humans; Renal Insufficiency, Chronic
PubMed: 38490803
DOI: 10.1016/j.kint.2023.10.018 -
Pediatric Clinics of North America Feb 2019Chronic kidney disease is an ongoing deterioration of renal function that often progresses to end-stage renal disease. Management goals in children include slowing... (Review)
Review
Chronic kidney disease is an ongoing deterioration of renal function that often progresses to end-stage renal disease. Management goals in children include slowing disease progression, prevention and treatment of complications, and optimizing growth, development, and quality of life. Nutritional management is critically important to achieve these goals. Control of blood pressure, proteinuria, and metabolic acidosis with dietary and pharmacologic measures may slow progression of chronic kidney disease. Although significant progress in management has been made, further research is required to resolve many outstanding controversies. We review recent developments in pediatric chronic kidney disease, focusing on dietary measures to improve outcomes.
Topics: Child; Diagnosis, Differential; Disease Progression; Humans; Kidney Function Tests; Quality of Life; Renal Insufficiency, Chronic
PubMed: 30454747
DOI: 10.1016/j.pcl.2018.09.007 -
American Journal of Physiology. Renal... Dec 2020Acute kidney injury (AKI) has been widely recognized as an important risk factor for the occurrence and development of chronic kidney disease (CKD). Even milder AKI has... (Review)
Review
Acute kidney injury (AKI) has been widely recognized as an important risk factor for the occurrence and development of chronic kidney disease (CKD). Even milder AKI has adverse consequences and could progress to renal fibrosis, which is the ultimate common pathway for various terminal kidney diseases. Thus, it is urgent to develop a strategy to hinder the transition from AKI to CKD. Some mechanisms of the AKI-to-CKD transition have been revealed, such as nephron loss, cell cycle arrest, persistent inflammation, endothelial injury with vascular rarefaction, and epigenetic changes. Previous studies have elucidated the pivotal role of mitochondria in acute injuries and demonstrated that the fitness of this organelle is a major determinant in both the pathogenesis and recovery of organ function. Recent research has suggested that damage to mitochondrial function in early AKI is a crucial factor leading to tubular injury and persistent renal insufficiency. Dysregulation of mitochondrial homeostasis, alterations in bioenergetics, and organelle stress cross talk contribute to the AKI-to-CKD transition. In this review, we focus on the pathophysiology of mitochondria in renal recovery after AKI and progression to CKD, confirming that targeting mitochondria represents a potentially effective therapeutic strategy for the progression of AKI to CKD.
Topics: Acute Kidney Injury; Animals; Disease Progression; Energy Metabolism; Humans; Kidney; Mitochondria; Mitochondrial Dynamics; Mitophagy; Renal Insufficiency, Chronic; Risk Factors
PubMed: 33073587
DOI: 10.1152/ajprenal.00285.2020 -
Nature Reviews. Nephrology May 2021Mitochondria are essential for the activity, function and viability of eukaryotic cells and mitochondrial dysfunction is involved in the pathogenesis of acute kidney... (Review)
Review
Mitochondria are essential for the activity, function and viability of eukaryotic cells and mitochondrial dysfunction is involved in the pathogenesis of acute kidney injury (AKI) and chronic kidney disease, as well as in abnormal kidney repair after AKI. Multiple quality control mechanisms, including antioxidant defence, protein quality control, mitochondrial DNA repair, mitochondrial dynamics, mitophagy and mitochondrial biogenesis, have evolved to preserve mitochondrial homeostasis under physiological and pathological conditions. Loss of these mechanisms may induce mitochondrial damage and dysfunction, leading to cell death, tissue injury and, potentially, organ failure. Accumulating evidence suggests a role of disturbances in mitochondrial quality control in the pathogenesis of AKI, incomplete or maladaptive kidney repair and chronic kidney disease. Moreover, specific interventions that target mitochondrial quality control mechanisms to preserve and restore mitochondrial function have emerged as promising therapeutic strategies to prevent and treat kidney injury and accelerate kidney repair. However, clinical translation of these findings is challenging owing to potential adverse effects, unclear mechanisms of action and a lack of knowledge of the specific roles and regulation of mitochondrial quality control mechanisms in kidney resident and circulating cell types during injury and repair of the kidney.
Topics: Acute Kidney Injury; Animals; Humans; Mitochondria; Renal Insufficiency, Chronic
PubMed: 33235391
DOI: 10.1038/s41581-020-00369-0 -
Nephron 2023There is a pandemic of obesity worldwide and in Europe up to 30% of the adult population is already obese. Obesity is strongly related to the risk of CKD, progression of... (Review)
Review
There is a pandemic of obesity worldwide and in Europe up to 30% of the adult population is already obese. Obesity is strongly related to the risk of CKD, progression of CKD, and end-stage renal disease (ESRD), also after adjustment for age, sex, race, smoking status, comorbidities, and laboratory tests. In the general population, obesity increases the risk of death. In nondialysis-dependent CKD patients, the association between body mass index and weight with mortality is controversial. In ESRD patients, obesity is paradoxically associated with better survival. There are only a few studies investigating changes in weight in these patients and in most weight loss was associated with higher mortality. However, it is not clear if weight change was intentional or unintentional and this is an important limitation of these studies. Management of obesity includes life-style interventions, bariatric surgery, and pharmacotherapy. In the last 2 years, a long-acting glucagon-like peptide-1 (GLP-1) receptor agonist and GLP-1 and glucose-dependent insulinotropic polypeptide receptor agonist were shown to be effective in managing weight loss in non-CKD patients, but we are awaiting results of more definitive studies in CKD patients.
Topics: Adult; Humans; Renal Insufficiency, Chronic; Obesity; Kidney Failure, Chronic; Weight Loss; Glucagon-Like Peptide 1
PubMed: 37271131
DOI: 10.1159/000531379