Current opinion in nephrology and hypertension
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Curr. Opin. Nephrol. Hypertens. · Nov 2008
ReviewPredicting and preventing acute kidney injury after cardiac surgery.
Acute kidney injury (AKI) after cardiac surgery is associated with significant morbidity and mortality. Despite the proliferation of predictive clinical scoring models of renal risk after cardiac surgery, limitations in preventing AKI through the use of pharmacological agents remain. Here we review the evolution of predictive models of renal risk after cardiac surgery, and highlight the important gains made in preventing its occurrence. ⋯ Clinical scoring systems predicting AKI risk after cardiac surgery are available and should be employed in the preoperative assessment. Elucidation of beneficial preventive strategies of AKI after cardiac surgery requires ongoing research.
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Curr. Opin. Nephrol. Hypertens. · May 2008
ReviewSalt intake, blood pressure and clinical outcomes.
Salt intake has long been known to influence blood pressure among hypertensive patients, but its effect among those without overt hypertension, as well as its effects on cardiovascular disease itself, have been disputed. This report reviews the evidence for an effect on both blood pressure and cardiovascular disease, particularly among normotensive participants, including recent data from randomized trials. ⋯ Average sodium consumption in the US population is excessively high, and well above recommended limits. Because most sodium derives from processed and restaurant foods, a reduction of sodium in these sources, as recently called for by the American Medical Association, is necessary to reduce exposure.
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The paucity of early, predictive, noninvasive biomarkers has impaired our ability to institute potentially effective therapies for acute kidney injury and chronic kidney disease in a timely manner. ⋯ The tools of functional genomics and proteomics have provided us with promising novel biomarkers for acute kidney injury and chronic kidney disease. It will be important in future studies to validate the sensitivity and specificity of these biomarker panels in clinical samples from large cohorts and in multiple clinical situations. Such studies will be facilitated by the availability of commercial tools for reproducible measurement of these panels.
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Curr. Opin. Nephrol. Hypertens. · May 2007
ReviewUnderstanding estimated glomerular filtration rate: implications for identifying chronic kidney disease.
Glomerular filtration rate (GFR) can be estimated using serum markers such as serum creatinine (SCr) or cystatin C. This review presents new insights into estimated GFR based on theory, validation studies, SCr assay standardization, cystatin C, and longitudinal comparison with measured GFR. ⋯ As a screening test, SCr should be interpreted as a marker of CKD probability in the context of the patient's clinical presentation. Measured GFR or creatinine clearance may be helpful in high-risk patients with normal SCr levels. GFR estimating equations should be reserved for patients with identified CKD. Standardized SCr and cystatin C assays are needed.