Current opinion in nephrology and hypertension
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Curr. Opin. Nephrol. Hypertens. · May 2013
ReviewEstimating glomerular filtration rate: is it good enough? And is it time to move on?
The aim is to examine a dominant narrative in nephrology over the past decade: that measured glomerular filtration rate (GFR) is the gold standard measure of kidney function; accurate assessment of GFR is critical and paramount; and further efforts to refine GFR estimation should continue. ⋯ Compared with estimated GFR, measured GFR does not consistently predict renal-related outcomes better. Clinical decision-making almost never requires precise and accurate knowledge of a patient's static GFR value. Efforts at perfecting cross-sectional estimates of GFR may have reached a point of diminishing returns.
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Curr. Opin. Nephrol. Hypertens. · May 2013
ReviewDisparities, race/ethnicity and access to pediatric kidney transplantation.
Kidney transplantation remains the optimal treatment for children with end-stage renal disease; yet, in the United States, profound differences in access to transplant persist, with black children experiencing significantly reduced access to transplant compared with white children. The reasons for these disparities remain poorly understood. Several recent studies provide new insights into the interplay of socioeconomic status, racial/ethnic disparities and access to pediatric kidney transplantation. ⋯ Future approaches to overcome disparities in pediatric kidney transplant access must focus on the continuum of the transplant process, including equitable health care access. Public health advocacy efforts to promote national policies that address disparate multilevel socioeconomic factors are essential.
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Curr. Opin. Nephrol. Hypertens. · May 2013
ReviewBidirectional relationships between acute kidney injury and chronic kidney disease.
Chronic kidney disease (CKD) remains one of the most potent predictors of acute kidney injury (AKI); however, recent epidemiologic studies have demonstrated a complex interplay between these two clinical entities. A growing body of evidence supports a bidirectional relationship: AKI leads to CKD, and the presence of CKD increases the risk of AKI. Additionally, several studies suggest that the presence of underlying CKD does modify the relation between AKI and adverse outcomes. In this article, we will review recent studies supporting the hypothesis that AKI leads to CKD and will explore the role of CKD as an effect modifier for AKI. ⋯ Recent findings support a strong association between AKI and CKD. There is uncertainty as to whether this relationship is causal. CKD is an effect modifier in AKI.
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Curr. Opin. Nephrol. Hypertens. · May 2012
ReviewRecent advances in acute kidney injury epidemiology.
Expanding rates of acute kidney injury (AKI) coupled with increasing awareness of its short-term and long-term sequelae have focused efforts to identify patients at risk for this disease and its complications. This review details the recent attempts to identify novel risk factors for AKI, describes further refinements in the diagnostic and prognostic approach using biological markers of injury, and highlights the features of AKI that independently predict poor long-term outcomes. ⋯ Although the pathophysiologic link is unclear, proteinuria is an easily measurable risk factor for AKI worth considering before anticipated procedures or medication exposures carrying nephrologic risk. Investigation extending beyond agreement with serum creatinine is needed to fully understand the diagnostic and prognostic value of AKI biomarkers. Severity and duration are components of AKI that can help risk-stratify survivors in need of monitoring or nephrology referral.
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Curr. Opin. Nephrol. Hypertens. · May 2012
ReviewThe pathogenesis of membranous nephropathy: evolution and revolution.
The morphological features of membranous nephropathy have been recognized for over five decades, but the pathogenetic mechanisms underlying this lesion in humans have only recently been elucidated. This review analyzes the recent developments in understanding the pathogenesis of the primary and secondary forms of membranous nephropathy. ⋯ The identification of target antigens provides new tools for diagnosis, prognosis and monitoring of therapy in human membranous nephropathy.