Pub Date : 2016-07-01DOI: 10.33590/emjnephrol/10310617
A. Galassi, M. E. Giovenzana, F. Prolo, A. Bellasi, M. Cozzolino
A consistent body of evidence supports an independent association between uric acid (UA) level and the risk of chronic kidney disease (CKD) in humans. It has been observed in experimental data that UA is capable of inducing renal damage through several pathways, including activation of the renin-angiotensin-aldosterone system (RAAS), oxidative stress, and inflammation. Treatment with urate lowering agents and RAAS inhibitors prevented renal insult mediated by UA in animal models. Both of the xanthine oxidase inhibitors available in clinical practice, allopurinol and febuxostat, were efficient in controlling gout flares. However, data from randomised controlled trials are still inconsistent in relation to their benefit for slowing CKD progression. This review discusses the metabolism of urates in humans as well as the experimental and clinical evidence linking UA to CKD. Current evidence about the effect of allopurinol and febuxostat on CKD progression is also considered.
{"title":"Uric Acid in Chronic Kidney Disease: A Clinical Appraisal","authors":"A. Galassi, M. E. Giovenzana, F. Prolo, A. Bellasi, M. Cozzolino","doi":"10.33590/emjnephrol/10310617","DOIUrl":"https://doi.org/10.33590/emjnephrol/10310617","url":null,"abstract":"A consistent body of evidence supports an independent association between uric acid (UA) level and the risk of chronic kidney disease (CKD) in humans. It has been observed in experimental data that UA is capable of inducing renal damage through several pathways, including activation of the renin-angiotensin-aldosterone system (RAAS), oxidative stress, and inflammation. Treatment with urate lowering agents and RAAS inhibitors prevented renal insult mediated by UA in animal models. Both of the xanthine oxidase inhibitors available in clinical practice, allopurinol and febuxostat, were efficient in controlling gout flares. However, data from randomised controlled trials are still inconsistent in relation to their benefit for slowing CKD progression. This review discusses the metabolism of urates in humans as well as the experimental and clinical evidence linking UA to CKD. Current evidence about the effect of allopurinol and febuxostat on CKD progression is also considered.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125520087","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 : 2016-07-01DOI: 10.33590/emjnephrol/10311174
Gabriele Pricoco, D. Cantone, E. Marino, F. Bruno
In this review, the authors briefly examine the most recent evidence concerning the role of several proteins involved in tubular urate transport. They also analyse the influence of extracellular volume, electrolyte disorders, acid-base imbalance, and insulin-resistance on renal clearance of uric acid.
{"title":"Tubular Handling of Uric Acid and Factors Influencing Its Renal Excretion: A Short Review","authors":"Gabriele Pricoco, D. Cantone, E. Marino, F. Bruno","doi":"10.33590/emjnephrol/10311174","DOIUrl":"https://doi.org/10.33590/emjnephrol/10311174","url":null,"abstract":"In this review, the authors briefly examine the most recent evidence concerning the role of several proteins involved in tubular urate transport. They also analyse the influence of extracellular volume, electrolyte disorders, acid-base imbalance, and insulin-resistance on renal clearance of uric acid.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126716122","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}
Peritoneal dialysis (PD) may be a feasible, safe, and complementary alternative to haemodialysis, not only in the chronic setting, but also in the acute. Recently, interest in using PD to manage acute kidney injury (AKI) patients has been increasing. Some Brazilian studies have shown that, with careful thought and planning, critically ill patients can be successfully treated with PD. To overcome some of the classic limitations of PD use in AKI, such as a high chance of infectious and mechanical complications, and no control of urea, potassium, and bicarbonate levels, the use of cycles, flexible catheters, and a high volume of dialysis fluid has been proposed. This knowledge can be used in the case of an unplanned start on chronic PD and may be a tool to increase the PD penetration rate among incident patients starting chronic dialysis therapy. PD should be offered in an unbiased way to all patients starting unplanned dialysis, and without contraindications to PD. In the following manuscript, advances in technical aspects and the advantages and limitations of PD will be discussed, and recent literature on clinical experience with PD use in the acute and unplanned setting will be reviewed.
{"title":"Urgent Start Peritoneal Dialysis: A Viable Option for Acute and Chronic Kidney Failure","authors":"D. Ponce, Dayana Bittencourt Dias, A. Balbi","doi":"10.33590/emj/10310890","DOIUrl":"https://doi.org/10.33590/emj/10310890","url":null,"abstract":"Peritoneal dialysis (PD) may be a feasible, safe, and complementary alternative to haemodialysis, not only in the chronic setting, but also in the acute. Recently, interest in using PD to manage acute kidney injury (AKI) patients has been increasing. Some Brazilian studies have shown that, with careful thought and planning, critically ill patients can be successfully treated with PD. To overcome some of the classic limitations of PD use in AKI, such as a high chance of infectious and mechanical complications, and no control of urea, potassium, and bicarbonate levels, the use of cycles, flexible catheters, and a high volume of dialysis fluid has been proposed. This knowledge can be used in the case of an unplanned start on chronic PD and may be a tool to increase the PD penetration rate among incident patients starting chronic dialysis therapy. PD should be offered in an unbiased way to all patients starting unplanned dialysis, and without contraindications to PD. In the following manuscript, advances in technical aspects and the advantages and limitations of PD will be discussed, and recent literature on clinical experience with PD use in the acute and unplanned setting will be reviewed.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"194 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121615938","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/10310510
Juliette B. Bell
Dr Heaf opened the symposium by welcoming the attendees and introducing the speakers. Prof Cowie explained the concept of remote monitoring and outlined some of the tools available in cardiology, which include telephone monitoring, standalone equipment, and implanted devices. The challenges and usage of remote monitoring throughout 15 years of use in cardiology were explained, and emphasis was placed on the ability of remote monitoring devices to enable shared decision-making between the patient and healthcare professionals (HCPs) and their ability to align management strategies with patient needs. Prof Pestana then described the advantages and limitations of home-based peritoneal dialysis (PD). PD is an existing therapy that may benefit from additional patient and clinical support through telemonitoring and remote monitoring devices. Studies that assessed telemonitoring as a support for home-based PD versus centre-based haemodialysis were evaluated and the importance of shared decision-making was emphasised. The requirement for personalised decision-making tools in order to enhance medical supervision and provide more data for clinical decisions was discussed.
{"title":"Supporting CKD Patients at Home","authors":"Juliette B. Bell","doi":"10.33590/emjnephrol/10310510","DOIUrl":"https://doi.org/10.33590/emjnephrol/10310510","url":null,"abstract":"Dr Heaf opened the symposium by welcoming the attendees and introducing the speakers. Prof Cowie explained the concept of remote monitoring and outlined some of the tools available in cardiology, which include telephone monitoring, standalone equipment, and implanted devices. The challenges and usage of remote monitoring throughout 15 years of use in cardiology were explained, and emphasis was placed on the ability of remote monitoring devices to enable shared decision-making between the patient and healthcare professionals (HCPs) and their ability to align management strategies with patient needs. Prof Pestana then described the advantages and limitations of home-based peritoneal dialysis (PD). PD is an existing therapy that may benefit from additional patient and clinical support through telemonitoring and remote monitoring devices. Studies that assessed telemonitoring as a support for home-based PD versus centre-based haemodialysis were evaluated and the importance of shared decision-making was emphasised. The requirement for personalised decision-making tools in order to enhance medical supervision and provide more data for clinical decisions was discussed.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"2 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":"129752080","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/10311490
Andrzej Kulesza, L. Niemczyk, M. Niemczyk
Autosomal dominant polycystic kidney disease (ADPKD) affects approximately 1 in 1,000 people in the general population. The natural history of ADPKD includes the progression of chronic kidney disease to end-stage renal disease (ESRD) in a large proportion of patients. Renal transplantation is the treatment modality of choice in these patients. However, there are some specific issues that should be addressed in ADPKD, and the aim of the current review is to describe the issues that need to be considered in the pre and post-transplant management of ADPKD patients, excluding routine procedures.
{"title":"Renal Transplantation in Autosomal Dominant Polycystic Kidney Disease","authors":"Andrzej Kulesza, L. Niemczyk, M. Niemczyk","doi":"10.33590/emjnephrol/10311490","DOIUrl":"https://doi.org/10.33590/emjnephrol/10311490","url":null,"abstract":"Autosomal dominant polycystic kidney disease (ADPKD) affects approximately 1 in 1,000 people in the general population. The natural history of ADPKD includes the progression of chronic kidney disease to end-stage renal disease (ESRD) in a large proportion of patients. Renal transplantation is the treatment modality of choice in these patients. However, there are some specific issues that should be addressed in ADPKD, and the aim of the current review is to describe the issues that need to be considered in the pre and post-transplant management of ADPKD patients, excluding routine procedures.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"217 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":"114415327","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/10313813
M. Varrier, R. Fisher, M. Ostermann
The syndrome of acute kidney injury (AKI) occurs frequently in hospitalised patients, leading to increased morbidity, mortality, and healthcare expenditure. In the context of a precipitating insult, disturbances in both global and microcirculatory renal blood flow, tubular cell damage, and activation of pro- inflammatory pathways lead to impairment of numerous elements of renal function. Classification systems, including the recent ‘Kidney Disease: Improving Global Outcomes’ (KDIGO) classification, typically define and stage AKI in terms of the magnitude of rise in serum creatinine (SCr) and the presence of oliguria. At present there is no cure for AKI and the key principles of its management include early recognition, haemodynamic optimisation, correction of hypovolaemia, ceasing and avoidance of nephrotoxic medications, and treatment of the underlying cause. Recent data show that the type and volume of fluid therapy can affect renal function and that further guidance is required. In the future it is hoped that novel technologies, including biomarkers and real-time measurement of glomerular filtration rate will allow the earlier identification of patients with AKI, whilst a greater understanding of the pathogenesis of AKI will lead to the identification of new therapeutic targets. Despite SCr usually recovering after an episode of AKI, there is growing recognition that survivors of AKI are at an increased risk of subsequent chronic kidney disease, including end-stage renal failure and premature death.
{"title":"Acute Kidney Injury – An Update","authors":"M. Varrier, R. Fisher, M. Ostermann","doi":"10.33590/emjnephrol/10313813","DOIUrl":"https://doi.org/10.33590/emjnephrol/10313813","url":null,"abstract":"The syndrome of acute kidney injury (AKI) occurs frequently in hospitalised patients, leading to increased morbidity, mortality, and healthcare expenditure. In the context of a precipitating insult, disturbances in both global and microcirculatory renal blood flow, tubular cell damage, and activation of pro- inflammatory pathways lead to impairment of numerous elements of renal function. Classification systems, including the recent ‘Kidney Disease: Improving Global Outcomes’ (KDIGO) classification, typically define and stage AKI in terms of the magnitude of rise in serum creatinine (SCr) and the presence of oliguria. At present there is no cure for AKI and the key principles of its management include early recognition, haemodynamic optimisation, correction of hypovolaemia, ceasing and avoidance of nephrotoxic medications, and treatment of the underlying cause. Recent data show that the type and volume of fluid therapy can affect renal function and that further guidance is required. In the future it is hoped that novel technologies, including biomarkers and real-time measurement of glomerular filtration rate will allow the earlier identification of patients with AKI, whilst a greater understanding of the pathogenesis of AKI will lead to the identification of new therapeutic targets. Despite SCr usually recovering after an episode of AKI, there is growing recognition that survivors of AKI are at an increased risk of subsequent chronic kidney disease, including end-stage renal failure and premature death.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"45 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":"132441531","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/10310806
A. Fanouriakis, G. Bertsias
Despite the significant advances in the field, up to one-third of lupus nephritis (LN) patients still do not respond adequately to initial immunosuppressive treatment. This group of patients is heterogeneous in terms of clinical presentation (deterioration of glomerular filtration rate, variable degrees of persistent proteinuria, active urine sediment) and the potential for reversion (ongoing kidney inflammation versus irreversible damage due to scarring and fibrosis). A repeat kidney biopsy can be highly informative in this regard and should be strongly considered. High-quality evidence regarding the treatment of refractory LN is lacking, and management is largely based on observational studies and expert opinion. Options include switching between mycophenolate mofetil (MMF) and cyclophosphamide (CYC), using rituximab as monotherapy or add-on therapy, or combining MMF with a calcineurin inhibitor in cases of persistent proteinuria. Renal response can be maintained with MMF or prolonged pulses of intravenous CYC administered bimonthly or quarterly. The efficacy of novel biological agents and those under development in refractory forms of LN remains to be determined. Tight control of cardiovascular risk factors, use of hydroxychloroquine, immunisations, and osteoporosis prophylaxis are important adjunctive measures. For the future, we anticipate that research efforts for the identification of accurate biomarkers together with accumulating data from observational and controlled studies will assist therapeutic decisions and improve outcomes in patients with refractory LN.
{"title":"Management of Refractory Lupus Nephritis","authors":"A. Fanouriakis, G. Bertsias","doi":"10.33590/emjnephrol/10310806","DOIUrl":"https://doi.org/10.33590/emjnephrol/10310806","url":null,"abstract":"Despite the significant advances in the field, up to one-third of lupus nephritis (LN) patients still do not respond adequately to initial immunosuppressive treatment. This group of patients is heterogeneous in terms of clinical presentation (deterioration of glomerular filtration rate, variable degrees of persistent proteinuria, active urine sediment) and the potential for reversion (ongoing kidney inflammation versus irreversible damage due to scarring and fibrosis). A repeat kidney biopsy can be highly informative in this regard and should be strongly considered. High-quality evidence regarding the treatment of refractory LN is lacking, and management is largely based on observational studies and expert opinion. Options include switching between mycophenolate mofetil (MMF) and cyclophosphamide (CYC), using rituximab as monotherapy or add-on therapy, or combining MMF with a calcineurin inhibitor in cases of persistent proteinuria. Renal response can be maintained with MMF or prolonged pulses of intravenous CYC administered bimonthly or quarterly. The efficacy of novel biological agents and those under development in refractory forms of LN remains to be determined. Tight control of cardiovascular risk factors, use of hydroxychloroquine, immunisations, and osteoporosis prophylaxis are important adjunctive measures. For the future, we anticipate that research efforts for the identification of accurate biomarkers together with accumulating data from observational and controlled studies will assist therapeutic decisions and improve outcomes in patients with refractory LN.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"96 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":"115662545","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/10314961
A. Rodríguez de Ledesma
This educational symposium provided an insight into the most current clinical evidence of the efficacy and safety of renin—angiotensin—aldosterone system inhibitors (RAASis) for patients with chronic kidney disease (CKD). The programme provided an opportunity to discuss ways to optimise and maintain RAASis in this population by introducing CKD patient cases and the dilemmas of their clinical presentation, and novel treatment options, including benefits, harms, and potential consequences. Prof David C. Wheeler introduced the debate about the use of RAASis and the associated risk of hyperkalaemia in CKD patients. Prof Francesco Locatelli discussed the management of blood pressure (BP) in CKD and reviewed the most current guidelines for the prevention of hyperkalaemia in this population. Prof Adrian Covic presented the controversies around the use of RAASis in specific group populations. Survival, cardiovascular events (CVEs), and progression of CKD were the main points of his presentation. Finally, Prof David C. Wheeler discussed the latest research on novel therapies for the management of hyperkalaemia.
本次教育研讨会提供了关于肾素-血管紧张素-醛固酮系统抑制剂(RAASis)治疗慢性肾脏疾病(CKD)患者的有效性和安全性的最新临床证据。该计划提供了一个机会，通过介绍CKD患者病例及其临床表现的困境，以及新的治疗方案，包括益处，危害和潜在后果，讨论如何优化和维持该人群的RAASis。David C. Wheeler教授介绍了关于慢性肾病患者使用RAASis和相关高钾血症风险的争论。Francesco Locatelli教授讨论了CKD患者血压(BP)的管理，并回顾了该人群中预防高钾血症的最新指南。阿德里安·科维奇教授介绍了在特定人群中使用RAASis的争议。生存率、心血管事件(CVEs)和CKD的进展是他演讲的重点。最后，David C. Wheeler教授讨论了高钾血症治疗新疗法的最新研究进展。
{"title":"The Ongoing Management of Hyperkalaemia in Chronic Kidney Disease Patients: Cases for Clinical Decisions","authors":"A. Rodríguez de Ledesma","doi":"10.33590/emjnephrol/10314961","DOIUrl":"https://doi.org/10.33590/emjnephrol/10314961","url":null,"abstract":"This educational symposium provided an insight into the most current clinical evidence of the efficacy and safety of renin—angiotensin—aldosterone system inhibitors (RAASis) for patients with chronic kidney disease (CKD). The programme provided an opportunity to discuss ways to optimise and maintain RAASis in this population by introducing CKD patient cases and the dilemmas of their clinical presentation, and novel treatment options, including benefits, harms, and potential consequences.\u0000\u0000Prof David C. Wheeler introduced the debate about the use of RAASis and the associated risk of hyperkalaemia in CKD patients. Prof Francesco Locatelli discussed the management of blood pressure (BP) in CKD and reviewed the most current guidelines for the prevention of hyperkalaemia in this population. Prof Adrian Covic presented the controversies around the use of RAASis in specific group populations. Survival, cardiovascular events (CVEs), and progression of CKD were the main points of his presentation. Finally, Prof David C. Wheeler discussed the latest research on novel therapies for the management of hyperkalaemia.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"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":"128887852","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/10313449
M. Salvadori, G. Rosso, E. Bertoni
The complement system is involved in several renal diseases and in renal transplantation (RTx). The authors review the complement cascade and its involvement in innate and adaptive immunity in the field of RTx. The complement cascade is involved in several steps of RTx: ischaemia—reperfusion injury (IRI), T cell-mediated acute rejection (TMR), antibody-mediated rejection (ABMR), and progressive kidney injury and fibrosis. The high frequency of complement involvement in RTx is the subject of several studies because complement could be a relevant target in treating the aforementioned conditions. There is an increasing number of ongoing clinical trials aimed at verifying the efficacy and safety of many drug candidates. The anti-C5 monoclonal antibody is already approved to prevent and treat ABMR and is the subject of trials investigating the treatment of other conditions such as IRI, TMR, and progressive fibrosis. Other molecular targets, such as C1, C3, C5a, and C5a receptor, are the subject of international trials and could prove to be effective in the near future.
{"title":"Complement Involvement in Renal Transplantation","authors":"M. Salvadori, G. Rosso, E. Bertoni","doi":"10.33590/emjnephrol/10313449","DOIUrl":"https://doi.org/10.33590/emjnephrol/10313449","url":null,"abstract":"The complement system is involved in several renal diseases and in renal transplantation (RTx). The authors review the complement cascade and its involvement in innate and adaptive immunity in the field of RTx. The complement cascade is involved in several steps of RTx: ischaemia—reperfusion injury (IRI), T cell-mediated acute rejection (TMR), antibody-mediated rejection (ABMR), and progressive kidney injury and fibrosis. The high frequency of complement involvement in RTx is the subject of several studies because complement could be a relevant target in treating the aforementioned conditions. There is an increasing number of ongoing clinical trials aimed at verifying the efficacy and safety of many drug candidates. The anti-C5 monoclonal antibody is already approved to prevent and treat ABMR and is the subject of trials investigating the treatment of other conditions such as IRI, TMR, and progressive fibrosis. Other molecular targets, such as C1, C3, C5a, and C5a receptor, are the subject of international trials and could prove to be effective in the near future.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"32 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":"134357407","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/10311843
J. Neves, S. Jorge, J. Lopes
Acute kidney injury (AKI) is a common problem highly associated with hospitalisation. AKI is the cause of harmful short-term consequences: longer hospital stays, greater disability after discharge, and greater risk of in-hospital mortality, as well as adverse long-term outcomes, such as progression to chronic kidney disease, development of cardiovascular disease, and increased risk of long-term mortality. The concept of AKI has changed since the introduction of the ‘Risk, Injury, Failure, Loss of kidney function, End-stage kidney disease’ (RIFLE) classification. More recently, the ‘Kidney Disease Improving Global Outcomes’ (KDIGO) classification appears to have provided increased diagnostic sensitivity and outcome-prediction capability. Novel biomarkers and further research on the role of the immune system in AKI may help improve the diagnosis, severity, outcome evaluation, and treatment of the condition. In this review we describe the epidemiology, diagnosis, and prognosis of AKI, as well as possible future directions for its clinical management.
{"title":"Acute Kidney Injury: Epidemiology, Diagnosis, Prognosis, and Future Directions","authors":"J. Neves, S. Jorge, J. Lopes","doi":"10.33590/emjnephrol/10311843","DOIUrl":"https://doi.org/10.33590/emjnephrol/10311843","url":null,"abstract":"Acute kidney injury (AKI) is a common problem highly associated with hospitalisation. AKI is the cause of harmful short-term consequences: longer hospital stays, greater disability after discharge, and greater risk of in-hospital mortality, as well as adverse long-term outcomes, such as progression to chronic kidney disease, development of cardiovascular disease, and increased risk of long-term mortality. The concept of AKI has changed since the introduction of the ‘Risk, Injury, Failure, Loss of kidney function, End-stage kidney disease’ (RIFLE) classification. More recently, the ‘Kidney Disease Improving Global Outcomes’ (KDIGO) classification appears to have provided increased diagnostic sensitivity and outcome-prediction capability. Novel biomarkers and further research on the role of the immune system in AKI may help improve the diagnosis, severity, outcome evaluation, and treatment of the condition. In this review we describe the epidemiology, diagnosis, and prognosis of AKI, as well as possible future directions for its clinical management.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"23 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":"127968081","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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