Pub Date : 2015-07-14DOI: 10.33590/emjnephrol/10311578
D. Rebić, Almira Hadžović-Džuvo, A. Valjevac
The endothelial cell layer is responsible for molecular traffic between the blood and surrounding tissue, and endothelial integrity plays a pivotal role in many aspects of vascular function. Cardiovascular disease (CVD) is the main cause of death in patients with chronic kidney disease (CKD) and its incidence and severity increase in direct proportion with kidney function decline. Non-traditional risk factors for CVDs, including endothelial dysfunction (ED), are highly prevalent in this population and play an important role in cardiovascular (CV) events. ED is the first step in the development of atherosclerosis and its severity has prognostic value for CV events. Several risk markers have been associated with ED. Reduced bioavailability of nitric oxide plays a central role, linking kidney disease to ED, atherosclerosis, and CV events. Inflammation, loss of residual renal function, and insulin resistance are closely related to ED in CKD. ED may be followed by structural damage and remodelling that can precipitate both bleeding and thrombotic events. The endothelium plays a main role in vascular tone and metabolic pathways. ED is the first, yet potentially reversible step in the development of atherosclerosis and its severity has prognostic value for CV events. Therefore, evaluation of ED may have major clinical diagnostic and therapeutic implications. In patients with CKD, many risk factors are strongly interrelated and play a major role in the initiation and progression of vascular complications that lead to the high mortality rate due to CVD.
{"title":"Chronic Kidney Disease and Endothelium","authors":"D. Rebić, Almira Hadžović-Džuvo, A. Valjevac","doi":"10.33590/emjnephrol/10311578","DOIUrl":"https://doi.org/10.33590/emjnephrol/10311578","url":null,"abstract":"The endothelial cell layer is responsible for molecular traffic between the blood and surrounding tissue, and endothelial integrity plays a pivotal role in many aspects of vascular function. Cardiovascular disease (CVD) is the main cause of death in patients with chronic kidney disease (CKD) and its incidence and severity increase in direct proportion with kidney function decline. Non-traditional risk factors for CVDs, including endothelial dysfunction (ED), are highly prevalent in this population and play an important role in cardiovascular (CV) events. ED is the first step in the development of atherosclerosis and its severity has prognostic value for CV events. Several risk markers have been associated with ED. Reduced bioavailability of nitric oxide plays a central role, linking kidney disease to ED, atherosclerosis, and CV events. Inflammation, loss of residual renal function, and insulin resistance are closely related to ED in CKD. ED may be followed by structural damage and remodelling that can precipitate both bleeding and thrombotic events. The endothelium plays a main role in vascular tone and metabolic pathways. ED is the first, yet potentially reversible step in the development of atherosclerosis and its severity has prognostic value for CV events. Therefore, evaluation of ED may have major clinical diagnostic and therapeutic implications. In patients with CKD, many risk factors are strongly interrelated and play a major role in the initiation and progression of vascular complications that lead to the high mortality rate due to CVD.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"122 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115780868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-07-14DOI: 10.33590/emjnephrol/10310549
H. Trimarchi
Focal segmental glomerulosclerosis (FSGS) can be classified as primary or secondary. Moreover, many causes of primary FSGS have been identified in recent years. In this regard, genetic circulating permeability factors and the abnormal podocyte expression of co-stimulatory molecules have been reported. However, the classification of this entity remains difficult to understand, mainly due to the fact that it describes a morphologic pattern of scarring. FSGS is a histological pattern shared by almost all the glomerulonephritides that describes a podocyte lesion and not a disease. Therefore, it should be reclassified according to the new pathophysiological findings and the biomarkers encountered in each triggered pathway.
{"title":"Primary Focal Segmental Glomerulosclerosis: Why Are Pieces of This Puzzle Still Missing?","authors":"H. Trimarchi","doi":"10.33590/emjnephrol/10310549","DOIUrl":"https://doi.org/10.33590/emjnephrol/10310549","url":null,"abstract":"Focal segmental glomerulosclerosis (FSGS) can be classified as primary or secondary. Moreover, many causes of primary FSGS have been identified in recent years. In this regard, genetic circulating permeability factors and the abnormal podocyte expression of co-stimulatory molecules have been reported. However, the classification of this entity remains difficult to understand, mainly due to the fact that it describes a morphologic pattern of scarring. FSGS is a histological pattern shared by almost all the glomerulonephritides that describes a podocyte lesion and not a disease. Therefore, it should be reclassified according to the new pathophysiological findings and the biomarkers encountered in each triggered pathway.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127814095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-07-14DOI: 10.33590/emjnephrol/10314123
F. Berthoux, H. Mohey, N. Maillard, C. Mariat
Knowledge of the pathophysiology of immunoglobulin A nephropathy (IgAN) has progressed significantly, with this disease being clearly identified as an autoimmune disease with a peculiar autoantigen (galactosedeficient IgA1 [Gd-IgA1]), specific autoantibodies (IgG and IgA1 anti-glycans), and formation followed by mesangial deposition of circulating immune complexes with the involvement of other players, such as mesangial transferrin receptor (TfR), monocyte Fcα receptor (CD89), and glomerular transglutaminase 2 (TG2). The pathogenesis still requires additional clarifications in order to explain the initiation of the disease and to establish the respective role of genetics, environment, and hazard concordance in the cascade of events/steps. The clinical application of this new knowledge is spreading slowly and includes possible measurement of serum Gd-IgA1, IgG anti-Gd-IgA1, IgA anti-Gd-IgA1, soluble CD89, and soluble TfR in the urine of patients with IgAN.
{"title":"IgA Nephropathy: New Aspects in Pathophysiology and Pathogenesis","authors":"F. Berthoux, H. Mohey, N. Maillard, C. Mariat","doi":"10.33590/emjnephrol/10314123","DOIUrl":"https://doi.org/10.33590/emjnephrol/10314123","url":null,"abstract":"Knowledge of the pathophysiology of immunoglobulin A nephropathy (IgAN) has progressed significantly, with this disease being clearly identified as an autoimmune disease with a peculiar autoantigen (galactosedeficient IgA1 [Gd-IgA1]), specific autoantibodies (IgG and IgA1 anti-glycans), and formation followed by mesangial deposition of circulating immune complexes with the involvement of other players, such as mesangial transferrin receptor (TfR), monocyte Fcα receptor (CD89), and glomerular transglutaminase 2 (TG2). The pathogenesis still requires additional clarifications in order to explain the initiation of the disease and to establish the respective role of genetics, environment, and hazard concordance in the cascade of events/steps. The clinical application of this new knowledge is spreading slowly and includes possible measurement of serum Gd-IgA1, IgG anti-Gd-IgA1, IgA anti-Gd-IgA1, soluble CD89, and soluble TfR in the urine of patients with IgAN.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"8 1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132893100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-07-05DOI: 10.33590/emjnephrol/10311591
L. Di Lullo, V. Barbera, A. Bellasi, M. Cozzolino, A. De Pascalis, D. Russo, L. Russo, F. Santoboni, A. Santoboni, C. Ronco
In chronic kidney disease (CKD) and end-stage renal disease patients cardiovascular disease is the main cause of morbidity and mortality, with incidence of cardiac related mortality increasing as renal function declines. Even after controlling for traditional cardiovascular risk factors such as smoking, age, gender, dyslipidaemia, and arterial hypertension, patients with CKD have a higher incidence of major cardiovascular events. CKD is characterised by the presence of many other non-traditional cardiovascular risk factors, such as chronic inflammation and accelerated atherosclerosis, oxidative stress, and especially, secondary hyperparathyroidism. This review will summarise the current evidence on vascular calcifications and valvular heart disease in CKD patients, from pathophysiology to therapeutic strategies.
{"title":"Vascular and Valvular Calcifications in Chronic Kidney Disease: An Update","authors":"L. Di Lullo, V. Barbera, A. Bellasi, M. Cozzolino, A. De Pascalis, D. Russo, L. Russo, F. Santoboni, A. Santoboni, C. Ronco","doi":"10.33590/emjnephrol/10311591","DOIUrl":"https://doi.org/10.33590/emjnephrol/10311591","url":null,"abstract":"In chronic kidney disease (CKD) and end-stage renal disease patients cardiovascular disease is the main cause of morbidity and mortality, with incidence of cardiac related mortality increasing as renal function declines. Even after controlling for traditional cardiovascular risk factors such as smoking, age, gender, dyslipidaemia, and arterial hypertension, patients with CKD have a higher incidence of major cardiovascular events. CKD is characterised by the presence of many other non-traditional cardiovascular risk factors, such as chronic inflammation and accelerated atherosclerosis, oxidative stress, and especially, secondary hyperparathyroidism. This review will summarise the current evidence on vascular calcifications and valvular heart disease in CKD patients, from pathophysiology to therapeutic strategies.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125347526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-07-05DOI: 10.33590/emjnephrol/10312231
A. Lunn
Creatinine, although widely used as a biomarker to measure renal function, has long been known as an insensitive marker of renal impairment. Patients with reduced renal function can have a creatinine level within the normal range, with a rapid rise when renal function is significantly reduced. As of 1976, the correlation between height, the reciprocal of creatinine, and measured glomerular filtration rate (GFR) in children has been described. It has been used to derive a simple formula for estimated glomerular filtration rate (eGFR) that could be used at the bedside as a more sensitive method of identifying children with renal impairment. Formulae based on this association, with modifications over time as creatinine assay methods have changed, are still widely used clinically at the bedside and in research studies to assess the degree of renal impairment in children. Adult practice has moved in many countries to computer-generated results that report eGFR alongside creatinine results using more complex, but potentially more accurate estimates of GFR, which are independent of height. This permits early identification of patients with chronic kidney disease. This review assesses the feasibility of automated reporting of eGFR and the advantages and disadvantages of this in children.
{"title":"Automatic Reporting of Creatinine-Based Estimated Glomerular Filtration Rate in Children: Is this Feasible?","authors":"A. Lunn","doi":"10.33590/emjnephrol/10312231","DOIUrl":"https://doi.org/10.33590/emjnephrol/10312231","url":null,"abstract":"Creatinine, although widely used as a biomarker to measure renal function, has long been known as an insensitive marker of renal impairment. Patients with reduced renal function can have a creatinine level within the normal range, with a rapid rise when renal function is significantly reduced. As of 1976, the correlation between height, the reciprocal of creatinine, and measured glomerular filtration rate (GFR) in children has been described. It has been used to derive a simple formula for estimated glomerular filtration rate (eGFR) that could be used at the bedside as a more sensitive method of identifying children with renal impairment. Formulae based on this association, with modifications over time as creatinine assay methods have changed, are still widely used clinically at the bedside and in research studies to assess the degree of renal impairment in children.\u0000\u0000Adult practice has moved in many countries to computer-generated results that report eGFR alongside creatinine results using more complex, but potentially more accurate estimates of GFR, which are independent of height. This permits early identification of patients with chronic kidney disease. This review assesses the feasibility of automated reporting of eGFR and the advantages and disadvantages of this in children.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"205 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123416537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-07-01DOI: 10.33590/emjnephrol/10314170
M. Kiremit, S. Guven, R. Horuz, B. Erkurt, S. Albayrak
We report herein the management of a challenging case due to anatomic and stone-related complications in a 37-month-old Caucasian toddler with megacalycosis and complex stone in the left kidney and duplicated ureter on the right side.
{"title":"Home Nephrology Retrograde Intrarenal Surgery for Complex Stones in a Toddler with…\u0000Retrograde Intrarenal Surgery for Complex Stones in a Toddler with Congenital Renal Anomalies: Technical Details","authors":"M. Kiremit, S. Guven, R. Horuz, B. Erkurt, S. Albayrak","doi":"10.33590/emjnephrol/10314170","DOIUrl":"https://doi.org/10.33590/emjnephrol/10314170","url":null,"abstract":"We report herein the management of a challenging case due to anatomic and stone-related complications in a 37-month-old Caucasian toddler with megacalycosis and complex stone in the left kidney and duplicated ureter on the right side.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125424465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-07-18DOI: 10.33590/emjnephrol/10312716
D. Rebić, S. Rašić
Left ventricular (LV) structure and function abnormalities are frequent in patients with chronic uraemia; these disorders increase the risk of cardiovascular (CV) and overall morbidity and mortality in the predialysed population, during dialysis treatment, and in renal transplant recipients. Since the first description of the association between chronic kidney disease (CKD) and heart disease, many epidemiological studies have confirmed and extended this finding. The risk of cardiovascular disease (CVD) is notably increased in patients with CKD. When adjusted for traditional CV risk factors, impaired kidney function increases the risk of CVD 2 to 4-fold. CVD is frequently underdiagnosed and undertreated in patients with CKD. This review will attempt to summarise current knowledge of the prevalence and pathophysiological mechanisms of LV disease in chronic uraemia, and to discuss useful medical strategies in this population.
{"title":"Cardiovascular Remodelling In Chronic Kidney Disease","authors":"D. Rebić, S. Rašić","doi":"10.33590/emjnephrol/10312716","DOIUrl":"https://doi.org/10.33590/emjnephrol/10312716","url":null,"abstract":"Left ventricular (LV) structure and function abnormalities are frequent in patients with chronic uraemia; these disorders increase the risk of cardiovascular (CV) and overall morbidity and mortality in the predialysed population, during dialysis treatment, and in renal transplant recipients. Since the first description of the association between chronic kidney disease (CKD) and heart disease, many epidemiological studies have confirmed and extended this finding. The risk of cardiovascular disease (CVD) is notably increased in patients with CKD. When adjusted for traditional CV risk factors, impaired kidney function increases the risk of CVD 2 to 4-fold. CVD is frequently underdiagnosed and undertreated in patients with CKD. This review will attempt to summarise current knowledge of the prevalence and pathophysiological mechanisms of LV disease in chronic uraemia, and to discuss useful medical strategies in this population.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"97 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127219332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-07-18DOI: 10.33590/emjnephrol/10313014
C. Giuliani, A. Peri
Hyponatraemia is the most common electrolyte disorder in clinical practice. It is associated with increased morbidity, mortality, and length of hospital stay, and therefore represents a clinical, economic, and social burden for healthcare costs and caregivers. Acute and severe hyponatraemia is associated with severe neurological alterations that may lead to cerebral oedema and death. Even mild chronic hyponatraemia has been associated with neurological and extraneurological disorders, such as gait disturbances, attention deficit, increased risk of bone loss, falls, and fractures. These aspects appear relevant particularly in the elderly. Furthermore, an overly rapid correction of hyponatraemia may cause osmotic demyelination, thus making it necessary to define safe treatment strategies. In the last few years, the availability of new drugs, i.e. the vasopressin receptor antagonists or vaptans, has improved the therapeutic choices for the treatment of hyponatraemia. This review summarises the main aspects regarding the use of these drugs, in particular tolvaptan and conivaptan, which are the only vaptans currently available in clinical practice.
{"title":"The Use of Vaptans in Hyponatraemia","authors":"C. Giuliani, A. Peri","doi":"10.33590/emjnephrol/10313014","DOIUrl":"https://doi.org/10.33590/emjnephrol/10313014","url":null,"abstract":"Hyponatraemia is the most common electrolyte disorder in clinical practice. It is associated with increased morbidity, mortality, and length of hospital stay, and therefore represents a clinical, economic, and social burden for healthcare costs and caregivers. Acute and severe hyponatraemia is associated with severe neurological alterations that may lead to cerebral oedema and death. Even mild chronic hyponatraemia has been associated with neurological and extraneurological disorders, such as gait disturbances, attention deficit, increased risk of bone loss, falls, and fractures. These aspects appear relevant particularly in the elderly. Furthermore, an overly rapid correction of hyponatraemia may cause osmotic demyelination, thus making it necessary to define safe treatment strategies. In the last few years, the availability of new drugs, i.e. the vasopressin receptor antagonists or vaptans, has improved the therapeutic choices for the treatment of hyponatraemia. This review summarises the main aspects regarding the use of these drugs, in particular tolvaptan and conivaptan, which are the only vaptans currently available in clinical practice.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"187 ","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"113990929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-07-18DOI: 10.33590/emjnephrol/10313322
J. Bell
The Alexion Satellite Symposium provided an introduction to thrombotic microangiopathies (TMA) by Prof Dirk Kuypers, who described atypical haemolytic uraemic syndrome (aHUS) as a rare but severe disease that causes TMA and can result in organ failure. Prof Josep Campistol presented two patient cases to illustrate the need to make a differential diagnosis between aHUS, thrombotic thrombocytopaenic purpura (TTP), and Shiga toxin-related-HUS (STEC-HUS). Prof Christophe Legendre then described aHUS clinical management, introduced eculizumab as the only approved treatment for aHUS, and provided an overview of the efficacy and safety data from recent clinical trials.
{"title":"Diagnostic Challenges in Thrombotic Microangiopathies","authors":"J. Bell","doi":"10.33590/emjnephrol/10313322","DOIUrl":"https://doi.org/10.33590/emjnephrol/10313322","url":null,"abstract":"The Alexion Satellite Symposium provided an introduction to thrombotic microangiopathies (TMA) by Prof Dirk Kuypers, who described atypical haemolytic uraemic syndrome (aHUS) as a rare but severe disease that causes TMA and can result in organ failure. Prof Josep Campistol presented two patient cases to illustrate the need to make a differential diagnosis between aHUS, thrombotic thrombocytopaenic purpura (TTP), and Shiga toxin-related-HUS (STEC-HUS). Prof Christophe Legendre then described aHUS clinical management, introduced eculizumab as the only approved treatment for aHUS, and provided an overview of the efficacy and safety data from recent clinical trials.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114362316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-07-18DOI: 10.33590/emjnephrol/10310115
A. Marks, N. Fluck, C. Black
With the introduction of the National Kidney Foundation Kidney Disease Outcomes Quality Initiative chronic kidney disease (CKD) guidelines, CKD has been identified as common, particularly in the elderly. The outcomes for those with CKD can be poor: mortality, initiation of renal replacement therapy, and progressive deterioration in kidney function, with its associated complications. In young people with CKD, the risk of poor outcome is high and the social cost substantial, but the actual number of patients affected is relatively small. In the elderly, the risk of poor outcome is substantially lower, but due to the high prevalence of CKD the actual number of poor outcomes attributable to CKD is higher. Predicting which patients are at greatest risk, and being able to tailor care appropriately, has significant potential benefits. Risk prediction models in CKD are being developed and show promise but thus far have limitations. In this review we describe the pathway for developing and evaluating risk prediction tools, and consider what models we have for CKD prediction and where next.
{"title":"Chronic Kidney Disease – Where Next? Predicting Outcomes and Planning Care Pathways","authors":"A. Marks, N. Fluck, C. Black","doi":"10.33590/emjnephrol/10310115","DOIUrl":"https://doi.org/10.33590/emjnephrol/10310115","url":null,"abstract":"With the introduction of the National Kidney Foundation Kidney Disease Outcomes Quality Initiative chronic kidney disease (CKD) guidelines, CKD has been identified as common, particularly in the elderly. The outcomes for those with CKD can be poor: mortality, initiation of renal replacement therapy, and progressive deterioration in kidney function, with its associated complications. In young people with CKD, the risk of poor outcome is high and the social cost substantial, but the actual number of patients affected is relatively small. In the elderly, the risk of poor outcome is substantially lower, but due to the high prevalence of CKD the actual number of poor outcomes attributable to CKD is higher. Predicting which patients are at greatest risk, and being able to tailor care appropriately, has significant potential benefits. Risk prediction models in CKD are being developed and show promise but thus far have limitations. In this review we describe the pathway for developing and evaluating risk prediction tools, and consider what models we have for CKD prediction and where next.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"66 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127142439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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