Pub Date : 2018-07-12DOI: 10.33590/emjnephrol/10314381
Kristine M. Kubisiak, E. Weinhandl
At the 55th European Renal Association–European Dialysis and Transplant Association (ERA–EDTA) Congress in Copenhagen, Denmark, physicians from the USA, UK, and France presented an educational symposium entitled ‘Complex Patients May Be Better Treated with Frequent Hemodialysis: A Review and Comparison of Published Evidence and Recent European Experience’. During this symposium, leading physicians discussed the concepts underlying the prescription of frequent haemodialysis (>3 sessions per week), the role of frequent haemodialysis in managing haemodynamic instability, treating patients who require larger volume clearance due to pregnancy or obesity, and utilising frequent home haemodialysis in the palliative care setting. This report briefly summarises the symposium.
{"title":"Prescribing Frequent Haemodialysis in Complex Patients: Highlights from the 55th ERA–EDTA Congress","authors":"Kristine M. Kubisiak, E. Weinhandl","doi":"10.33590/emjnephrol/10314381","DOIUrl":"https://doi.org/10.33590/emjnephrol/10314381","url":null,"abstract":"At the 55th European Renal Association–European Dialysis and Transplant Association (ERA–EDTA) Congress in Copenhagen, Denmark, physicians from the USA, UK, and France presented an educational symposium entitled ‘Complex Patients May Be Better Treated with Frequent Hemodialysis: A Review and Comparison of Published Evidence and Recent European Experience’. During this symposium, leading physicians discussed the concepts underlying the prescription of frequent haemodialysis (>3 sessions per week), the role of frequent haemodialysis in managing haemodynamic instability, treating patients who require larger volume clearance due to pregnancy or obesity, and utilising frequent home haemodialysis in the palliative care setting. This report briefly summarises the symposium.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116894950","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 : 2018-07-12DOI: 10.33590/emjnephrol/10310223
Christopher Thiam Seong Lim, Fuah Kar Wah
Women who conceive while receiving peritoneal dialysis (PD) are at a high risk of encountering maternal and fetal complications. Although the occurrence of successful pregnancies in women with end-stage renal disease undergoing PD is becoming more common with advancing dialysis technology, women in this population must be monitored by a team of dedicated renal physicians and obstetric teams to ensure the best maternal and fetal outcomes are achieved. Given the haemodynamic advantages of PD over haemodialysis in pregnancy, PD therapy is the favoured renal replacement option in pregnant women with end-stage renal disease. This is particularly true when PD is initiated after conception or if pregnancy occurs within 1 year of starting PD. The management of anaemia, hypertension, dry weight adjustment, and dialysis regimen in a pregnant PD patient will undergo continuous adjustment to maintain haemodynamic and physiologic stability to meet the demands of the pregnancy-associated changes. In this article, the incidence and management of fetal and maternal complications and pregnancy outcomes in women receiving PD are reviewed based on the latest literature available.
{"title":"Pregnancy and Peritoneal Dialysis: An Updated Review","authors":"Christopher Thiam Seong Lim, Fuah Kar Wah","doi":"10.33590/emjnephrol/10310223","DOIUrl":"https://doi.org/10.33590/emjnephrol/10310223","url":null,"abstract":"Women who conceive while receiving peritoneal dialysis (PD) are at a high risk of encountering maternal and fetal complications. Although the occurrence of successful pregnancies in women with end-stage renal disease undergoing PD is becoming more common with advancing dialysis technology, women in this population must be monitored by a team of dedicated renal physicians and obstetric teams to ensure the best maternal and fetal outcomes are achieved. Given the haemodynamic advantages of PD over haemodialysis in pregnancy, PD therapy is the favoured renal replacement option in pregnant women with end-stage renal disease. This is particularly true when PD is initiated after conception or if pregnancy occurs within 1 year of starting PD. The management of anaemia, hypertension, dry weight adjustment, and dialysis regimen in a pregnant PD patient will undergo continuous adjustment to maintain haemodynamic and physiologic stability to meet the demands of the pregnancy-associated changes. In this article, the incidence and management of fetal and maternal complications and pregnancy outcomes in women receiving PD are reviewed based on the latest literature available.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115991758","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 : 2018-07-12DOI: 10.33590/emjnephrol/10312748
Aron Chakera, Kieran T. Mulroney, Hui Juin Shak, Amanda L McGuire, M. Eberl, N. Topley
Peritoneal dialysis (PD) is a cost-effective, home-based treatment option for patients with end-stage renal disease; however, PD is declining in many countries. A major reason for this is peritonitis, which commonly leads to technique failure and has led to negative perceptions of PD by clinicians and patients. To restore confidence in PD, better diagnostics are required to enable appropriate treatment to be started earlier; this needs to be coupled with improved understanding of the biology of peritonitis. Advances in culture-independent microbiological methods, in particular the use of bacterial flow cytometry and immune fingerprinting techniques, can enable organism detection and antimicrobial susceptibility testing to be performed in as little as 3 hours after samples are received. At the same time, improved understanding of peritoneal mesothelial cell responses to infection is providing insights into pathways that may be targeted to dampen deleterious elementsof the host immune response, promote healing, and preserve membrane function.
{"title":"Peritonitis in Peritoneal Dialysis Patients: The Case for Rapid Diagnosis, Targeted Treatment, and Monitoring to Improve Outcomes","authors":"Aron Chakera, Kieran T. Mulroney, Hui Juin Shak, Amanda L McGuire, M. Eberl, N. Topley","doi":"10.33590/emjnephrol/10312748","DOIUrl":"https://doi.org/10.33590/emjnephrol/10312748","url":null,"abstract":"Peritoneal dialysis (PD) is a cost-effective, home-based treatment option for patients with end-stage renal disease; however, PD is declining in many countries. A major reason for this is peritonitis, which commonly leads to technique failure and has led to negative perceptions of PD by clinicians and patients. To restore confidence in PD, better diagnostics are required to enable appropriate treatment to be started earlier; this needs to be coupled with improved understanding of the biology of peritonitis. Advances in culture-independent microbiological methods, in particular the use of bacterial flow cytometry and immune fingerprinting techniques, can enable organism detection and antimicrobial susceptibility testing to be performed in as little as 3 hours after samples are received. At the same time, improved understanding of peritoneal mesothelial cell responses to infection is providing insights into pathways that may be targeted to dampen deleterious elementsof the host immune response, promote healing, and preserve membrane function.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"310 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116757530","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 : 2018-07-12DOI: 10.33590/emjnephrol/10310823
M. Salvadori, A. Tsalouchos
Renal involvement with rapidly progressive glomerulonephritis is a common manifestation of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides characterised by end-stage renal disease and high mortality rates in untreated and late referral patients. Long-term renal survival has improved dramatically since the addition of cyclophosphamide and, more recently, rituximab in association with corticosteroids to remission induction therapeutic regimens. However, renal prognosis remains unfavourable for many patients and mortality is still significantly higher than in the general population. In this review, the open challenges to be addressed to optimise remission induction therapy, especially in patients with advanced kidney failure, are analysed. This concerns the first-line therapy (cyclophosphamide or rituximab) based on different parameters (estimated glomerular filtration rate at baseline, new or relapsed disease, ANCA specificity, tissue injury, and safety) and the role of plasma exchange. Furthermore, the paper discusses future perspectives on induction remission therapy by reporting recent advances in new targeted therapies, with particular reference to avacopan, an orally administered selective C5a receptor inhibitor.
{"title":"Induction Therapy in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis with Renal Involvement: The Nephrologist’s Point of View","authors":"M. Salvadori, A. Tsalouchos","doi":"10.33590/emjnephrol/10310823","DOIUrl":"https://doi.org/10.33590/emjnephrol/10310823","url":null,"abstract":"Renal involvement with rapidly progressive glomerulonephritis is a common manifestation of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides characterised by end-stage renal disease and high mortality rates in untreated and late referral patients. Long-term renal survival has improved dramatically since the addition of cyclophosphamide and, more recently, rituximab in association with corticosteroids to remission induction therapeutic regimens. However, renal prognosis remains unfavourable for many patients and mortality is still significantly higher than in the general population. In this review, the open challenges to be addressed to optimise remission induction therapy, especially in patients with advanced kidney failure, are analysed. This concerns the first-line therapy (cyclophosphamide or rituximab) based on different parameters (estimated glomerular filtration rate at baseline, new or relapsed disease, ANCA specificity, tissue injury, and safety) and the role of plasma exchange. Furthermore, the paper discusses future perspectives on induction remission therapy by reporting recent advances in new targeted therapies, with particular reference to avacopan, an orally administered selective C5a receptor inhibitor.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127035248","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 : 2018-07-01DOI: 10.33590/emjnephrol/10313848
I. Okpechi, O. Ameh
Glomerular diseases are a common cause of chronic kidney disease in several low-to-middle-income countries (LMIC). Additionally, they represent up to 52% of patients with end-stage renal disease (ESRD) in Africa. Current guideline recommendations for the treatment of glomerular diseases may not always be applicable in LMIC due to various challenges related to disease diagnosis and the availability of medicines. A treatment approach that starts with disease diagnosis and proper use of adjuvant therapies mainly targeted at blood pressure and proteinuria reduction is an effective therapeutic option and is recommended for patients in LMIC with glomerular pathologies. The use of immunosuppressive therapies in adults with glomerular diseases should, as far as is possible, be guided by the histological diagnosis obtained through renal biopsy. Prednisone and cyclophosphamide still form the bulk of treatment for glomerular diseases in most countries. Due to the adverse effects associated with immunosuppression, prednisone and cyclophosphamide use must be carefully weighed against the risk of potential side effects, and there is a need for frequent monitoring to assess treatment efficacy, patient response, and adverse effects. It is not advisable to use immunosuppressive drugs (e.g., cyclosporine) that require monitoring of plasma levels in centres where such facilities are not available, given the possible associated nephrotoxicity. The purpose of this narrative review is to provide an update on the treatment of common glomerular diseases and to highlight simple approaches to treatment in LMIC. Knowledge of guideline recommendations on the treatment of various glomerular diseases will provide important understanding on useful therapeutic approaches.
{"title":"Update on the Treatment of Glomerulonephritis in Adults in Low-to-Middle-Income Countries","authors":"I. Okpechi, O. Ameh","doi":"10.33590/emjnephrol/10313848","DOIUrl":"https://doi.org/10.33590/emjnephrol/10313848","url":null,"abstract":"Glomerular diseases are a common cause of chronic kidney disease in several low-to-middle-income countries (LMIC). Additionally, they represent up to 52% of patients with end-stage renal disease (ESRD) in Africa. Current guideline recommendations for the treatment of glomerular diseases may not always be applicable in LMIC due to various challenges related to disease diagnosis and the availability of medicines. A treatment approach that starts with disease diagnosis and proper use of adjuvant therapies mainly targeted at blood pressure and proteinuria reduction is an effective therapeutic option and is recommended for patients in LMIC with glomerular pathologies. The use of immunosuppressive therapies in adults with glomerular diseases should, as far as is possible, be guided by the histological diagnosis obtained through renal biopsy. Prednisone and cyclophosphamide still form the bulk of treatment for glomerular diseases in most countries. Due to the adverse effects associated with immunosuppression, prednisone and cyclophosphamide use must be carefully weighed against the risk of potential side effects, and there is a need for frequent monitoring to assess treatment efficacy, patient response, and adverse effects. It is not advisable to use immunosuppressive drugs (e.g., cyclosporine) that require monitoring of plasma levels in centres where such facilities are not available, given the possible associated nephrotoxicity. The purpose of this narrative review is to provide an update on the treatment of common glomerular diseases and to highlight simple approaches to treatment in LMIC. Knowledge of guideline recommendations on the treatment of various glomerular diseases will provide important understanding on useful therapeutic approaches.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127100718","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}
O. Maoujoud, Y. Cherrah, M. Arrayhani, N. Zemraoui, H. Dkhissi, D. el kabbaj, Oualim Zouhair, K. Filali, S. Ahid
Background: There is a significant emerging burden of chronic kidney disease (CKD) and end-stage renal disease (ESRD) in low and middle-income countries. Nonetheless, despite these trends, knowledge of CKD epidemiology and management remains incomplete. This review presents a critical analysis and comparison of the current data related to CKD epidemiology in Morocco and an overview of the health economic context of the management of ESRD. Main text: In Morocco, the demographic transition occurring as a result of urbanisation, population ageing, and the global epidemic of diabetes exposes a growing number of people with CKD who are consuming a significant proportion of healthcare budgets. While the real prevalence of ESRD may be underestimated due to limited access to medical coverage for a fraction of the population, the growing costs in the face of limited resources may shortly compromise the healthcare system. Conclusion: Based on the available data, the prevalence of CKD may grow during the coming decades, according to the increasing prevalence of its major risk factors (diabetes, hypertension, and older age). Thus, early diagnosis, treatment of the underlying cause, and implementation of preventive measures are fundamental for CKD patients.
{"title":"Epidemiology, Health Economic Context, and Management of Chronic Kidney Diseases in Low and Middle-Income Countries: The Case of Morocco","authors":"O. Maoujoud, Y. Cherrah, M. Arrayhani, N. Zemraoui, H. Dkhissi, D. el kabbaj, Oualim Zouhair, K. Filali, S. Ahid","doi":"10.33590/emj/10313025","DOIUrl":"https://doi.org/10.33590/emj/10313025","url":null,"abstract":"Background: There is a significant emerging burden of chronic kidney disease (CKD) and end-stage renal disease (ESRD) in low and middle-income countries. Nonetheless, despite these trends, knowledge of CKD epidemiology and management remains incomplete. This review presents a critical analysis and comparison of the current data related to CKD epidemiology in Morocco and an overview of the health economic context of the management of ESRD.\u0000\u0000Main text: In Morocco, the demographic transition occurring as a result of urbanisation, population ageing, and the global epidemic of diabetes exposes a growing number of people with CKD who are consuming a significant proportion of healthcare budgets. While the real prevalence of ESRD may be underestimated due to limited access to medical coverage for a fraction of the population, the growing costs in the face of limited resources may shortly compromise the healthcare system.\u0000\u0000Conclusion: Based on the available data, the prevalence of CKD may grow during the coming decades, according to the increasing prevalence of its major risk factors (diabetes, hypertension, and older age). Thus, early diagnosis, treatment of the underlying cause, and implementation of preventive measures are fundamental for CKD patients.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128913470","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 : 2017-07-18DOI: 10.33590/emjnephrol/10313761
Jane Tricker
In many European countries, high-volume online haemodiafiltration (OL-HDF) is becoming the method of choice for treating patients with chronic kidney disease. The high convective (Qs >20 L/session) and diffusive properties of this treatment have been shown to be beneficial for patient survival. For optimum outcomes, the dialyser membrane must be able to cope with high transmembrane pressures. For this reason, the most widely-used membranes for this technique are synthetic and asymmetric in structure, making it easier for the membrane to divert the pressure away from its surface. However, patients allergic or sensitive to synthetic molecules, cannot access these high convective volumes (CV) reached in high-volume HDF, because alternative semi-natural membranes for allergic patients, such as cellulose acetate-based membranes, do not have adequate pressure-handling properties for high-volume HDF. At this symposium, a new type of cellulose triacetate (CTA)-based membrane that is biocompatible, able to perform high-volume OL-HDF, and suitable for sensitive patients was introduced.
{"title":"New Biocompatible Haemodiafiltration Membrane to Enable Maximum Substitution for Sensitive Patients","authors":"Jane Tricker","doi":"10.33590/emjnephrol/10313761","DOIUrl":"https://doi.org/10.33590/emjnephrol/10313761","url":null,"abstract":"In many European countries, high-volume online haemodiafiltration (OL-HDF) is becoming the method of choice for treating patients with chronic kidney disease. The high convective (Qs >20 L/session) and diffusive properties of this treatment have been shown to be beneficial for patient survival. For optimum outcomes, the dialyser membrane must be able to cope with high transmembrane pressures. For this reason, the most widely-used membranes for this technique are synthetic and asymmetric in structure, making it easier for the membrane to divert the pressure away from its surface. However, patients allergic or sensitive to synthetic molecules, cannot access these high convective volumes (CV) reached in high-volume HDF, because alternative semi-natural membranes for allergic patients, such as cellulose acetate-based membranes, do not have adequate pressure-handling properties for high-volume HDF.\u0000\u0000At this symposium, a new type of cellulose triacetate (CTA)-based membrane that is biocompatible, able to perform high-volume OL-HDF, and suitable for sensitive patients was introduced.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125309388","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 : 2017-07-18DOI: 10.33590/emjnephrol/10314971
J. Dhanapriya, T. Dineshkumar, R. Sakthirajan, N. Gopalakrishnan
Acute kidney injury (AKI) in tropical countries is strikingly different from that in countries with a temperate climate. Tropical regions are characterised by year-round high temperatures and the absence of frost, which supports the propagation of infections that can potentially cause AKI. The aetiology and presentation of AKI reflects the ethnicity, socioeconomic factors, and ecological conditions in tropical countries. Apart from infections, other causes of AKI include exposure to animal toxins, ingestion of plant toxins or chemicals, poisoning, and obstetric complications. The low income status, poor access to treatment, and sociocultural practices (use of indigenous medicines) contribute to poor outcomes of patients with AKI. The exact aetiologic diagnosis often cannot be made due to lack of appropriate laboratory services. The epidemiology of AKI in tropical regions is changing over time. Renal replacement therapy is inaccessible to the majority and late presentation with delayed treatment add to the risk for future development of chronic kidney disease. AKI is often the primary cause of chronic kidney disease in the developing world, which increases demand for renal replacement therapy and transplantation. Most causes of AKI in developing countries are preventable and strategies to improve the public health and increased access to effective medical care are the need of the hour. This review offers comprehensive ideas about epidemiology, aetio-pathogenesis, clinical presentation, diagnosis, treatment, and prevention of community-acquired AKI in the tropics, with special reference to the Indian subcontinent. AKI is an under-recognised cause of morbidity and mortality in developing countries and even small, simple interventions could have an impact on its outcome.
{"title":"Acute Kidney Injury in Tropical Countries","authors":"J. Dhanapriya, T. Dineshkumar, R. Sakthirajan, N. Gopalakrishnan","doi":"10.33590/emjnephrol/10314971","DOIUrl":"https://doi.org/10.33590/emjnephrol/10314971","url":null,"abstract":"Acute kidney injury (AKI) in tropical countries is strikingly different from that in countries with a temperate climate. Tropical regions are characterised by year-round high temperatures and the absence of frost, which supports the propagation of infections that can potentially cause AKI. The aetiology and presentation of AKI reflects the ethnicity, socioeconomic factors, and ecological conditions in tropical countries. Apart from infections, other causes of AKI include exposure to animal toxins, ingestion of plant toxins or chemicals, poisoning, and obstetric complications. The low income status, poor access to treatment, and sociocultural practices (use of indigenous medicines) contribute to poor outcomes of patients with AKI. The exact aetiologic diagnosis often cannot be made due to lack of appropriate laboratory services. The epidemiology of AKI in tropical regions is changing over time. Renal replacement therapy is inaccessible to the majority and late presentation with delayed treatment add to the risk for future development of chronic kidney disease. AKI is often the primary cause of chronic kidney disease in the developing world, which increases demand for renal replacement therapy and transplantation. Most causes of AKI in developing countries are preventable and strategies to improve the public health and increased access to effective medical care are the need of the hour. This review offers comprehensive ideas about epidemiology, aetio-pathogenesis, clinical presentation, diagnosis, treatment, and prevention of community-acquired AKI in the tropics, with special reference to the Indian subcontinent. AKI is an under-recognised cause of morbidity and mortality in developing countries and even small, simple interventions could have an impact on its outcome.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122562990","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 : 2017-07-18DOI: 10.33590/emjnephrol/10310690
M. Salvadori, A. Tsalouchos
Autosomal dominant polycystic kidney disease is the most common inherited kidney disease and results from mutations in the polycystin 1 gene (PKD1) or the polycystin 2 gene (PKD2). The disease is characterised by the progressive development of fluid-filled cysts derived from renal tubular epithelial cells that destroy the architecture of the renal parenchyma and lead to kidney failure. Until recently, the causes and the molecular pathways that lead to cystogenesis remained obscure. In the last decade, enormous progress has been made in understanding the pathogenesis of autosomal dominant polycystic kidney disease and developing new therapies. The purpose of this review is to provide an update on the promising therapies that are being developed and tested, based on knowledge of recent advances in molecular and cellular targets involved in cystogenesis.
{"title":"New Therapies Targeting Cystogenesis in Autosomal Polycystic Kidney Disease","authors":"M. Salvadori, A. Tsalouchos","doi":"10.33590/emjnephrol/10310690","DOIUrl":"https://doi.org/10.33590/emjnephrol/10310690","url":null,"abstract":"Autosomal dominant polycystic kidney disease is the most common inherited kidney disease and results from mutations in the polycystin 1 gene (PKD1) or the polycystin 2 gene (PKD2). The disease is characterised by the progressive development of fluid-filled cysts derived from renal tubular epithelial cells that destroy the architecture of the renal parenchyma and lead to kidney failure. Until recently, the causes and the molecular pathways that lead to cystogenesis remained obscure. In the last decade, enormous progress has been made in understanding the pathogenesis of autosomal dominant polycystic kidney disease and developing new therapies. The purpose of this review is to provide an update on the promising therapies that are being developed and tested, based on knowledge of recent advances in molecular and cellular targets involved in cystogenesis.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120950375","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 : 2017-07-18DOI: 10.33590/emjnephrol/10310735
A. Azim, Armin Ahmed, A. Baronia, R. Marak, N. Muzzafar
Intra-abdominal candidiasis (IAC) is the second most common form of invasive candidiasis after candidaemia. IAC is a broad term and can be classified on the basis of anatomical site (Candida peritonitis, pancreatic candidiasis, biliary tract candidiasis, gastrointestinal candidiasis, and hepatosplenic candidiasis) as well as clinical setting (community acquired versus nosocomial). The risk factors linked with IAC are candida colonisation, anastomotic leak, multiple instrumentation, long-term broad spectrum antibiotic use, total parenteral nutrition, and immunocompromised state. Clinically, IAC is not different from intraabdominal bacterial infection. Patients generally present with signs and symptoms of intra-abdominal sepsis after not responding to antibiotic therapy and with a background history of multiple surgical interventions or history of delayed source control. Radiological investigations, like ultrasonography and computed tomography scan, not only aid in diagnosis but also assist in differentiating medical from surgical cases. Microbiological diagnosis requires isolation of candida from an intra-abdominal specimen. Differentiation between colonisation and infection is difficult. Generally, progressive and persistent colonisation is associated with high risk of infection. Blood cultures have poor sensitivity for IAC. Non-culture based techniques used for diagnosis are mannan/anti-mannan assay, beta-D glucan assay, and validated polymerase chain reaction. Four types of antifungal strategies described in the literature are prophylaxis (risk factor driven), pre-emptive (colonisation or biomarker driven), empirical (fever driven), and targeted therapy (microbiology driven). Over recent years, global epidemiology has shown a shift from Candida albicans to non-albicans. Local epidemiology plays an important role in selection of the appropriate empirical therapy. The purpose of this review is to discuss different types of IAC based on their classification, risk factors, and management.
{"title":"Intra-Abdominal Candidiasis","authors":"A. Azim, Armin Ahmed, A. Baronia, R. Marak, N. Muzzafar","doi":"10.33590/emjnephrol/10310735","DOIUrl":"https://doi.org/10.33590/emjnephrol/10310735","url":null,"abstract":"Intra-abdominal candidiasis (IAC) is the second most common form of invasive candidiasis after candidaemia. IAC is a broad term and can be classified on the basis of anatomical site (Candida peritonitis, pancreatic candidiasis, biliary tract candidiasis, gastrointestinal candidiasis, and hepatosplenic candidiasis) as well as clinical setting (community acquired versus nosocomial). The risk factors linked with IAC are candida colonisation, anastomotic leak, multiple instrumentation, long-term broad spectrum antibiotic use, total parenteral nutrition, and immunocompromised state. Clinically, IAC is not different from intraabdominal bacterial infection. Patients generally present with signs and symptoms of intra-abdominal sepsis after not responding to antibiotic therapy and with a background history of multiple surgical interventions or history of delayed source control. Radiological investigations, like ultrasonography and computed tomography scan, not only aid in diagnosis but also assist in differentiating medical from surgical cases. Microbiological diagnosis requires isolation of candida from an intra-abdominal specimen. Differentiation between colonisation and infection is difficult. Generally, progressive and persistent colonisation is associated with high risk of infection. Blood cultures have poor sensitivity for IAC. Non-culture based techniques used for diagnosis are mannan/anti-mannan assay, beta-D glucan assay, and validated polymerase chain reaction. Four types of antifungal strategies described in the literature are prophylaxis (risk factor driven), pre-emptive (colonisation or biomarker driven), empirical (fever driven), and targeted therapy (microbiology driven). Over recent years, global epidemiology has shown a shift from Candida albicans to non-albicans. Local epidemiology plays an important role in selection of the appropriate empirical therapy. The purpose of this review is to discuss different types of IAC based on their classification, risk factors, and management.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115671927","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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