Pub Date : 2021-01-01Epub Date: 2021-07-27DOI: 10.1159/000517670
Maria Luisa Pereira de Melo, Ilana Nogueira Bezerra, Nayara de Souza Gomes Cabral, Rafaelle de Azevedo Santiago, Clarisse Vasconcelos de Azevedo
Chronic kidney disease (CKD) is considered a public health problem and part of the growing burden of noncommunicable diseases. Many studies have searched for ways to reduce the risk of complications and death. One possible approach to modify the course of this disease is the adoption of healthy dietary habits. Previous studies have suggested that healthy dietary patterns, such as the Dietary Approaches to Stop Hypertension (DASH), the Mediterranean diet, the vegetarian diet, and a diet adhering to the Healthy Eating Index, are associated with improved renal health. In this chapter, we reviewed the scientific literature and presented the potential role of dietary patterns in the prevention of CKD, contributing to dietary strategies for promoting kidney health. We found that nutritional planning plays an important role in kidney health maintenance and in the protection of kidneys from further damage. The DASH, Mediterranean, and vegetarian dietary patterns can be viable strategies for CKD prevention. However, individualized nutritional monitoring is necessary for individuals with overt kidney disease. Randomized, controlled, and prospective studies focusing on nutritional interventions applied to renal patients undergoing conservative and dialytic treatment and to the general population are necessary to assess habits that can prevent the occurrence and worsening of kidney disease.
{"title":"Dietary Patterns for Promoting Kidney Health.","authors":"Maria Luisa Pereira de Melo, Ilana Nogueira Bezerra, Nayara de Souza Gomes Cabral, Rafaelle de Azevedo Santiago, Clarisse Vasconcelos de Azevedo","doi":"10.1159/000517670","DOIUrl":"https://doi.org/10.1159/000517670","url":null,"abstract":"<p><p>Chronic kidney disease (CKD) is considered a public health problem and part of the growing burden of noncommunicable diseases. Many studies have searched for ways to reduce the risk of complications and death. One possible approach to modify the course of this disease is the adoption of healthy dietary habits. Previous studies have suggested that healthy dietary patterns, such as the Dietary Approaches to Stop Hypertension (DASH), the Mediterranean diet, the vegetarian diet, and a diet adhering to the Healthy Eating Index, are associated with improved renal health. In this chapter, we reviewed the scientific literature and presented the potential role of dietary patterns in the prevention of CKD, contributing to dietary strategies for promoting kidney health. We found that nutritional planning plays an important role in kidney health maintenance and in the protection of kidneys from further damage. The DASH, Mediterranean, and vegetarian dietary patterns can be viable strategies for CKD prevention. However, individualized nutritional monitoring is necessary for individuals with overt kidney disease. Randomized, controlled, and prospective studies focusing on nutritional interventions applied to renal patients undergoing conservative and dialytic treatment and to the general population are necessary to assess habits that can prevent the occurrence and worsening of kidney disease.</p>","PeriodicalId":10725,"journal":{"name":"Contributions to nephrology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39232447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01Epub Date: 2021-08-03DOI: 10.1159/000517698
Dearbhla M Kelly, Eoin M Kelleher, Manish M Sood
Chronic kidney disease (CKD) is strongly associated with the full spectrum of cerebrovascular disease including ischaemic and haemorrhagic stroke, small vessel disease, and vascular cognitive impairment. Shared conventional vascular risk factors such as age, hypertension, and diabetes mellitus may account for many of these associations, but novel renal-specific risk factors such as uraemia-related coagulopathy or endothelial dysfunction have also been proposed. In this chapter, we will explore the impact of CKD on stroke risk, mechanisms, and outcomes. We will also outline potential challenges and inequities in stroke care delivery and research for these patients along with some strategies to help improve stroke prevention and management for this high-risk group.
{"title":"Stroke and Chronic Kidney Disease.","authors":"Dearbhla M Kelly, Eoin M Kelleher, Manish M Sood","doi":"10.1159/000517698","DOIUrl":"https://doi.org/10.1159/000517698","url":null,"abstract":"<p><p>Chronic kidney disease (CKD) is strongly associated with the full spectrum of cerebrovascular disease including ischaemic and haemorrhagic stroke, small vessel disease, and vascular cognitive impairment. Shared conventional vascular risk factors such as age, hypertension, and diabetes mellitus may account for many of these associations, but novel renal-specific risk factors such as uraemia-related coagulopathy or endothelial dysfunction have also been proposed. In this chapter, we will explore the impact of CKD on stroke risk, mechanisms, and outcomes. We will also outline potential challenges and inequities in stroke care delivery and research for these patients along with some strategies to help improve stroke prevention and management for this high-risk group.</p>","PeriodicalId":10725,"journal":{"name":"Contributions to nephrology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39271473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01Epub Date: 2021-08-03DOI: 10.1159/000517700
Ramon Róseo Paula Pessoa Bezerra de Menezes, Tiago Lima Sampaio, Alice Maria Costa Martins, Renata de Sousa Alves, Emanuel Paula Magalhães
Clinical Background: Mental disorders, especially depression, are associated with several comorbidities in the kidneys. Depression is the psychiatric disorder that mostly affects individuals with chronic kidney disease (CKD) and end-stage kidney disease. Epidemiology: The mainly prescribed drugs involved in overdose cases are opioids, benzodiazepines, and antidepressants. Antidepressants are the main psychiatric drugs that lead to kidney injury, mainly the second-generation ones. However, the prevalence of depression in dialysis patients varies from 22.8 to 39.3%. Therefore, psychiatric patients have 1.5-3 times more hospitalization compared to patients having only CKD. Challenges: Randomized clinical studies should be encouraged. Studies have shown an association between depression and progression of kidney disease. The mechanisms are not completely clear, but changes on neurotransmitter release and endocrine functions appear to be related to it. Additionally, the use of antidepressant and other psychoactive drugs can induce kidney injury. Hyponatremia induced by second-generation antidepressant drugs is an important feature and can be a risk factor for elderly or patients with comorbidities such as cerebral edema, brain damage or coma. Besides this class, drugs used for anxiety and bipolar disorders or sympathomimetic drugs of abuse can trigger acute kidney injury, possibly due to endothelial dysfunction and thromboembolic and ischemic events. Prevention and Treatment: The early detection of renal impairment and the prescription of nephroprotective strategies has been a clinical challenge. Some studies aim to describe the biochemical mechanisms involved and develop clinical management strategies for these patients. This chapter brings attention to this topic, discussing the major mechanisms and clinical features of kidney injury associated with mental illness, and the most relevant clinical strategies.
{"title":"Prescription Drug Overdose, Depression, and Other Mental Disorders in the Context of Kidney Disease.","authors":"Ramon Róseo Paula Pessoa Bezerra de Menezes, Tiago Lima Sampaio, Alice Maria Costa Martins, Renata de Sousa Alves, Emanuel Paula Magalhães","doi":"10.1159/000517700","DOIUrl":"https://doi.org/10.1159/000517700","url":null,"abstract":"<p><p>Clinical Background: Mental disorders, especially depression, are associated with several comorbidities in the kidneys. Depression is the psychiatric disorder that mostly affects individuals with chronic kidney disease (CKD) and end-stage kidney disease. Epidemiology: The mainly prescribed drugs involved in overdose cases are opioids, benzodiazepines, and antidepressants. Antidepressants are the main psychiatric drugs that lead to kidney injury, mainly the second-generation ones. However, the prevalence of depression in dialysis patients varies from 22.8 to 39.3%. Therefore, psychiatric patients have 1.5-3 times more hospitalization compared to patients having only CKD. Challenges: Randomized clinical studies should be encouraged. Studies have shown an association between depression and progression of kidney disease. The mechanisms are not completely clear, but changes on neurotransmitter release and endocrine functions appear to be related to it. Additionally, the use of antidepressant and other psychoactive drugs can induce kidney injury. Hyponatremia induced by second-generation antidepressant drugs is an important feature and can be a risk factor for elderly or patients with comorbidities such as cerebral edema, brain damage or coma. Besides this class, drugs used for anxiety and bipolar disorders or sympathomimetic drugs of abuse can trigger acute kidney injury, possibly due to endothelial dysfunction and thromboembolic and ischemic events. Prevention and Treatment: The early detection of renal impairment and the prescription of nephroprotective strategies has been a clinical challenge. Some studies aim to describe the biochemical mechanisms involved and develop clinical management strategies for these patients. This chapter brings attention to this topic, discussing the major mechanisms and clinical features of kidney injury associated with mental illness, and the most relevant clinical strategies.</p>","PeriodicalId":10725,"journal":{"name":"Contributions to nephrology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39271479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01Epub Date: 2021-08-03DOI: 10.1159/000517710
Yu An, Zhi-Hong Liu
Clinical Background: As a result of modern industrialization, air pollution has become a potential contributor to global burden of noncommunicable diseases, such as cardiovascular disease, respiratory disease, and kidney disease. Epidemiology: Emerging epidemiological evidence has demonstrated that exposure to ambient air pollution is associated with an increased risk for the development and progression of chronic kidney disease (CKD) and CKD-related mortality. Exposure to PM2.5, even at relatively low concentrations, is a risk factor for a lower estimated glomerular filtration rate and a faster decline in glomerular filtration rate. It has been estimated that the global burden of CKD attributable to PM2.5 is 6.95 million incident cases of CKD per year. Low- and middle-income countries in the Eastern Mediterranean and South-East Asia regions experienced the highest urban air pollution levels, thus facing a heavier burden of related disease. Challenges: Despite a growing awareness of kidney damage related to air pollution, large gaps still exist between the exact toxicological effect of particles on the kidney and the increasing prevalence of air pollution-related kidney diseases. Considering the geographic variation of air pollution, more longitudinal studies in different parts of the world are urgently needed, especially in those most affected countries. Prevention and Treatment: Air pollution control should be regarded as a high priority in urban plan and policy making. Actions are required to narrow gaps in knowledge and clean air, thus preventing air pollution-related kidney disease.
{"title":"Air Pollution and Kidney Diseases: PM2.5 as an Emerging Culprit.","authors":"Yu An, Zhi-Hong Liu","doi":"10.1159/000517710","DOIUrl":"https://doi.org/10.1159/000517710","url":null,"abstract":"<p><p>Clinical Background: As a result of modern industrialization, air pollution has become a potential contributor to global burden of noncommunicable diseases, such as cardiovascular disease, respiratory disease, and kidney disease. Epidemiology: Emerging epidemiological evidence has demonstrated that exposure to ambient air pollution is associated with an increased risk for the development and progression of chronic kidney disease (CKD) and CKD-related mortality. Exposure to PM2.5, even at relatively low concentrations, is a risk factor for a lower estimated glomerular filtration rate and a faster decline in glomerular filtration rate. It has been estimated that the global burden of CKD attributable to PM2.5 is 6.95 million incident cases of CKD per year. Low- and middle-income countries in the Eastern Mediterranean and South-East Asia regions experienced the highest urban air pollution levels, thus facing a heavier burden of related disease. Challenges: Despite a growing awareness of kidney damage related to air pollution, large gaps still exist between the exact toxicological effect of particles on the kidney and the increasing prevalence of air pollution-related kidney diseases. Considering the geographic variation of air pollution, more longitudinal studies in different parts of the world are urgently needed, especially in those most affected countries. Prevention and Treatment: Air pollution control should be regarded as a high priority in urban plan and policy making. Actions are required to narrow gaps in knowledge and clean air, thus preventing air pollution-related kidney disease.</p>","PeriodicalId":10725,"journal":{"name":"Contributions to nephrology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39273608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01Epub Date: 2021-08-03DOI: 10.1159/000517702
Matthew Sinclair, Christina M Wyatt
Clinical Background and Epidemiology: Worldwide, an estimated 38 million people are living with HIV infection. The classic kidney disease of HIV infection, commonly known as HIV-associated nephropathy, is a collapsing form of focal segmental glomerulosclerosis that almost exclusively affects individuals of African descent with advanced HIV disease. People living with HIV are also at risk for immune-complex kidney diseases, antiretroviral nephrotoxicity, and kidney disease due to co-infections and comorbidities. Challenges: The burden of HIV-related kidney disease is greatest in traditionally disadvantaged populations in resource-limited settings in sub-Saharan Africa and the Caribbean and among minority populations in the United States and Europe. Factors contributing to these disparities include a higher prevalence of HIV infection, limited access to optimal antiretroviral therapy, and genetic susceptibility to kidney disease. Treatment and Prevention: Current treatment guidelines recommend the initiation of life-long antiretroviral therapy in all people living with HIV to prevent AIDS and non-AIDS complications, including kidney disease. People living with HIV who progress to end-stage kidney disease despite treatment are candidates for dialysis and kidney transplant, including the possibility of accepting organs from HIV-positive donors in some settings. Although HIV prevention is currently the only definitive solution, expanding access to antiretroviral therapy, dialysis, and kidney transplantation in people living with HIV are important intermediate steps to address the global burden of HIV-related kidney disease.
{"title":"Regional and Racial Disparities in HIV-Related Kidney Disease.","authors":"Matthew Sinclair, Christina M Wyatt","doi":"10.1159/000517702","DOIUrl":"https://doi.org/10.1159/000517702","url":null,"abstract":"<p><p>Clinical Background and Epidemiology: Worldwide, an estimated 38 million people are living with HIV infection. The classic kidney disease of HIV infection, commonly known as HIV-associated nephropathy, is a collapsing form of focal segmental glomerulosclerosis that almost exclusively affects individuals of African descent with advanced HIV disease. People living with HIV are also at risk for immune-complex kidney diseases, antiretroviral nephrotoxicity, and kidney disease due to co-infections and comorbidities. Challenges: The burden of HIV-related kidney disease is greatest in traditionally disadvantaged populations in resource-limited settings in sub-Saharan Africa and the Caribbean and among minority populations in the United States and Europe. Factors contributing to these disparities include a higher prevalence of HIV infection, limited access to optimal antiretroviral therapy, and genetic susceptibility to kidney disease. Treatment and Prevention: Current treatment guidelines recommend the initiation of life-long antiretroviral therapy in all people living with HIV to prevent AIDS and non-AIDS complications, including kidney disease. People living with HIV who progress to end-stage kidney disease despite treatment are candidates for dialysis and kidney transplant, including the possibility of accepting organs from HIV-positive donors in some settings. Although HIV prevention is currently the only definitive solution, expanding access to antiretroviral therapy, dialysis, and kidney transplantation in people living with HIV are important intermediate steps to address the global burden of HIV-related kidney disease.</p>","PeriodicalId":10725,"journal":{"name":"Contributions to nephrology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39271477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01Epub Date: 2021-08-03DOI: 10.1159/000517701
Jay L Koyner
Clinical Background: Clinical infections and its most severe forms sepsis and septic shock are commonly associated with changes in kidney function. This acute kidney injury (AKI) is associated with increased risk of morbidity and mortality in hospitalized patients. Epidemiology: Recent standardized, separate consensus definitions of sepsis and AKI have informed the epidemiology of these 2 distinct processes. While there is no consensus definition specific to sepsis-associated AKI, several studies have utilized the combined definitions of these two syndromes to identify those patients at the highest risk for adverse outcomes. Challenges: Prevention of sepsis-associated AKI is difficult in part because patients will often present for medical care with the sepsis-associated AKI already clinically apparent. Additionally, for those that do not have AKI on presentation the ability to detect injury early is limited by the imperfect current gold standard biomarkers serum creatinine and urine output. Prevention and Treatment: Despite these challenges, there has been increased investigation of novel biomarkers of AKI. Additionally, there has been intense investigation into the ideal care of patients with sepsis, AKI as well as sepsis-associated AKI. While there are limited specific therapeutic options outside of antibiotics for infections, several studies have investigated the use of care bundles to treat these syndromes. While there is continued investigation into novel therapeutics and the use of dialysis and extracorporeal modalities, these trials have failed to revolutionize clinical care. This review summarizes the current state of sepsis-associated AKI care and discusses strategies to improve care.
{"title":"Sepsis and Kidney Injury.","authors":"Jay L Koyner","doi":"10.1159/000517701","DOIUrl":"https://doi.org/10.1159/000517701","url":null,"abstract":"<p><p>Clinical Background: Clinical infections and its most severe forms sepsis and septic shock are commonly associated with changes in kidney function. This acute kidney injury (AKI) is associated with increased risk of morbidity and mortality in hospitalized patients. Epidemiology: Recent standardized, separate consensus definitions of sepsis and AKI have informed the epidemiology of these 2 distinct processes. While there is no consensus definition specific to sepsis-associated AKI, several studies have utilized the combined definitions of these two syndromes to identify those patients at the highest risk for adverse outcomes. Challenges: Prevention of sepsis-associated AKI is difficult in part because patients will often present for medical care with the sepsis-associated AKI already clinically apparent. Additionally, for those that do not have AKI on presentation the ability to detect injury early is limited by the imperfect current gold standard biomarkers serum creatinine and urine output. Prevention and Treatment: Despite these challenges, there has been increased investigation of novel biomarkers of AKI. Additionally, there has been intense investigation into the ideal care of patients with sepsis, AKI as well as sepsis-associated AKI. While there are limited specific therapeutic options outside of antibiotics for infections, several studies have investigated the use of care bundles to treat these syndromes. While there is continued investigation into novel therapeutics and the use of dialysis and extracorporeal modalities, these trials have failed to revolutionize clinical care. This review summarizes the current state of sepsis-associated AKI care and discusses strategies to improve care.</p>","PeriodicalId":10725,"journal":{"name":"Contributions to nephrology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39273614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Clinical Background: Renal involvement in sickle cell disease (SCD), called sickle cell nephropathy (SCN), includes several renal manifestations, such as renal acidification defect, distal nephron dysfunction, renal papillary necrosis, and proteinuria related to glomerular injury, leading to end-stage renal disease. Epidemiology: Many patients with SCD have a defect in urinary concentration, a problem caused by the destruction of the renal medulla that initiates in childhood. The presence of proteinuria in SCD is age-related and starts as microalbuminuria in adolescence and progresses to macroalbuminuria. Proteinuria is responsible for the progression to chronic kidney disease in some patients with SCD with glomerular filtration rate (GFR) decreased due to interactions between various processes involving the vascular, glomerular, tubular, and interstitial compartments of the kidney. Challenges: Renal complications are hardly identifiable in the early stages, as serum creatinine increases only in the final stages of SCN. Subnormal GFR and elevated serum creatinine levels develop only when there is significant proteinuria. Prevention and Treatment: The identification of biomarkers of early, non-invasive kidney injury, and their inclusion in clinical practice will contribute to the identification of the mechanisms involved in the development of renal syndromes, facilitating the development of more effective strategies in the prevention and treatment of SCD.
{"title":"Sickle Cell Disease and the Kidney: Pathophysiology and Novel Biomarkers.","authors":"Romélia Pinheiro Gonçalves Lemes, Marilia Rocha Laurentino, Luan Rebouças Castelo, Geraldo Silva Junior","doi":"10.1159/000517703","DOIUrl":"https://doi.org/10.1159/000517703","url":null,"abstract":"<p><p>Clinical Background: Renal involvement in sickle cell disease (SCD), called sickle cell nephropathy (SCN), includes several renal manifestations, such as renal acidification defect, distal nephron dysfunction, renal papillary necrosis, and proteinuria related to glomerular injury, leading to end-stage renal disease. Epidemiology: Many patients with SCD have a defect in urinary concentration, a problem caused by the destruction of the renal medulla that initiates in childhood. The presence of proteinuria in SCD is age-related and starts as microalbuminuria in adolescence and progresses to macroalbuminuria. Proteinuria is responsible for the progression to chronic kidney disease in some patients with SCD with glomerular filtration rate (GFR) decreased due to interactions between various processes involving the vascular, glomerular, tubular, and interstitial compartments of the kidney. Challenges: Renal complications are hardly identifiable in the early stages, as serum creatinine increases only in the final stages of SCN. Subnormal GFR and elevated serum creatinine levels develop only when there is significant proteinuria. Prevention and Treatment: The identification of biomarkers of early, non-invasive kidney injury, and their inclusion in clinical practice will contribute to the identification of the mechanisms involved in the development of renal syndromes, facilitating the development of more effective strategies in the prevention and treatment of SCD.</p>","PeriodicalId":10725,"journal":{"name":"Contributions to nephrology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39273615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01Epub Date: 2021-08-24DOI: 10.1159/000517704
Ricardo Pereira Silva, Camilo Diógenes
Clinical Background: The heart can cause kidney disease, and the kidney can cause heart disease. As an example of the first situation, we can mention dilated cardiomyopathies, which can lead to renal failure of the pre-renal type due to the state of renal hypoflow. As an example of the second situation, we can remember that renal failure is a risk factor for cardiovascular diseases, such as coronary heart disease, due to the acceleration in the process of atherosclerosis that it promotes. Epidemiology: In this chapter, we will address what we consider to be the two main aspects of the interrelationships between heart and kidney disease that are "cardiorenal syndrome (CRS)" and "chronic kidney disease (CKD) and coronary heart disease (CHD)." Challenges: For CRS, we discuss its epidemiology, types, pathophysiological mechanisms common to CRS types 1, 2, 3 and 4 and pathogenesis of CSR type 5. Treatment: For "CKD and CHD" we discuss the association of CKD and CHD in community-based populations, traditional risk factor in CKD, non-traditional risk factor in CKD, reduced risk of CHD in patients with CKD, statin treatment, hypertension treatment, anti-platelet aggregation therapy, treatment of CHD in patients with CKD and prognosis of CHDF in CKD patients.
{"title":"Heart Disease and the Kidneys.","authors":"Ricardo Pereira Silva, Camilo Diógenes","doi":"10.1159/000517704","DOIUrl":"https://doi.org/10.1159/000517704","url":null,"abstract":"Clinical Background: The heart can cause kidney disease, and the kidney can cause heart disease. As an example of the first situation, we can mention dilated cardiomyopathies, which can lead to renal failure of the pre-renal type due to the state of renal hypoflow. As an example of the second situation, we can remember that renal failure is a risk factor for cardiovascular diseases, such as coronary heart disease, due to the acceleration in the process of atherosclerosis that it promotes. Epidemiology: In this chapter, we will address what we consider to be the two main aspects of the interrelationships between heart and kidney disease that are \"cardiorenal syndrome (CRS)\" and \"chronic kidney disease (CKD) and coronary heart disease (CHD).\" Challenges: For CRS, we discuss its epidemiology, types, pathophysiological mechanisms common to CRS types 1, 2, 3 and 4 and pathogenesis of CSR type 5. Treatment: For \"CKD and CHD\" we discuss the association of CKD and CHD in community-based populations, traditional risk factor in CKD, non-traditional risk factor in CKD, reduced risk of CHD in patients with CKD, statin treatment, hypertension treatment, anti-platelet aggregation therapy, treatment of CHD in patients with CKD and prognosis of CHDF in CKD patients.","PeriodicalId":10725,"journal":{"name":"Contributions to nephrology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39340484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The study of kidney diseases has been described since the Hippocratic era, but nephrology as a medical specialty dates from the mid-20th century. Despite all interesting aspects of nephrology, there is a lack of interest by young physicians for the specialty worldwide. Great discoveries have been made throughout the years, leading to great achievements in diagnosis, classification, and treatment of kidney diseases. There is a current interest in the search for novel biomarkers for early detection of kidney dysfunction, and, in the future, there will be novel diagnostic tests for kidney diseases. There have been significant improvements in dialysis and transplant techniques, and novel modalities are being studied, including new renal replacement therapy modalities, such as the wearable artificial kidney. Another trend in the contemporary world, and one that should increase in the future, is the increasing patient connectivity, using novel technologies that will allow access to healthcare and improve outcomes.
{"title":"The Future of Nephrology and Public Health.","authors":"Geraldo Silva Junior, Giovani Gadonski, Alejandro Ferreiro Fuentes, Masaomi Nangaku, Giuseppe Remuzzi, Claudio Ronco","doi":"10.1159/000517714","DOIUrl":"https://doi.org/10.1159/000517714","url":null,"abstract":"<p><p>The study of kidney diseases has been described since the Hippocratic era, but nephrology as a medical specialty dates from the mid-20th century. Despite all interesting aspects of nephrology, there is a lack of interest by young physicians for the specialty worldwide. Great discoveries have been made throughout the years, leading to great achievements in diagnosis, classification, and treatment of kidney diseases. There is a current interest in the search for novel biomarkers for early detection of kidney dysfunction, and, in the future, there will be novel diagnostic tests for kidney diseases. There have been significant improvements in dialysis and transplant techniques, and novel modalities are being studied, including new renal replacement therapy modalities, such as the wearable artificial kidney. Another trend in the contemporary world, and one that should increase in the future, is the increasing patient connectivity, using novel technologies that will allow access to healthcare and improve outcomes.</p>","PeriodicalId":10725,"journal":{"name":"Contributions to nephrology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39271932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01Epub Date: 2021-08-04DOI: 10.1159/000517725
Polianna Albuquerque, Sandra Mara Mota
Snakebite-related acute kidney injury (AKI) is mainly caused by bites from the Viperidae family which are common snakes worldwide. It is a frequent and potentially fatal clinical complication. Coagulation abnormalities are usually present and are most likely to contribute to AKI development. A better comprehension of AKI pathogenesis following the toxicsyndrome may improve patient management by primary healthcare providers, allowing earlier diagnosis and treatment. This chapter highlights the main studies about snakevenom-related AKI, the most common snakes around the world, and the respective mechanisms of AKI.
{"title":"Snakebite-Associated Kidney Injury.","authors":"Polianna Albuquerque, Sandra Mara Mota","doi":"10.1159/000517725","DOIUrl":"https://doi.org/10.1159/000517725","url":null,"abstract":"<p><p>Snakebite-related acute kidney injury (AKI) is mainly caused by bites from the Viperidae family which are common snakes worldwide. It is a frequent and potentially fatal clinical complication. Coagulation abnormalities are usually present and are most likely to contribute to AKI development. A better comprehension of AKI pathogenesis following the toxicsyndrome may improve patient management by primary healthcare providers, allowing earlier diagnosis and treatment. This chapter highlights the main studies about snakevenom-related AKI, the most common snakes around the world, and the respective mechanisms of AKI.</p>","PeriodicalId":10725,"journal":{"name":"Contributions to nephrology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39275593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}