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The staging of chronic kidney disease requires measurement of glomerular filtration rate (GFR). As direct GFR measurement is impractical, estimates are used. The MDRD equation was 'Hobson's choice' and although known to be unreliable at higher levels of kidney function it is still in widespread use. The CKD-EPI equation is a new alternative. Is it better?
The optimal blood-pressure goals to prevent progression of chronic kidney disease (CKD) remain controversial. The results of the AASK cohort study provide additional support for more aggressive blood-pressure control (<130/90 mmHg) in proteinuric but not nonproteinuric patients with hypertensive CKD.
March 10, 2011 will mark the 6th World Kidney Day, an annual event jointly sponsored by the International Society of Nephrology and the International Federation of Kidney Foundations. World Kidney Day aims to raise awareness among both the general public and government health officials about the dangers of kidney disease, especially chronic kidney disease.
Two new vasopressin antagonists, conivaptan and tolvaptan have recently been licensed for the treatment of hyponatremia in the USA. Their safety and clinical effectiveness seems promising, but high costs and the lack of data regarding their use in symptomatic patients call for further studies to clarify their future clinical role.
Patients with end-stage renal disease have a heightened risk of cardiovascular morbidity and mortality. Cardiac arrest causes around one-quarter of deaths in this population, and a recent study has investigated whether echocardiographic parameters and serum biomarkers can be used to predict the risk of sudden cardiac death in patients on peritoneal dialysis.
Prediction of renal allograft outcomes has been elusive despite the number of risk factors that correlate with graft failure. Using a large French transplant database and novel statistical methods, Foucher et al. have produced a predictive scoring system for graft failure worthy of study in other populations.
Disturbed intrauterine organogenesis has long-term consequences on organ function in adulthood, so-called prenatal programming. In this Review, Ritz and colleagues outline the concept of prenatal programming and, in particular, describe its role in kidney disease and hypertension. Intrauterine growth restriction (IUGR) as a predictor of renal and cardiovascular disease in adulthood, and the potential of low birthweight as a (clinical) surrogate marker of IUGR, are also discussed.
Annual cardiovascular mortality rates are much higher in patients with chronic kidney disease (CKD) than in the general population. Sudden cardiac death rate increases with CKD stage and could be responsible for 60% of cardiac deaths in patients undergoing dialysis. In this Review, the authors describe the epidemiology and risk factors for sudden cardiac death in patients with CKD and discuss potential therapeutic approaches.
Infection with hepatitis B virus (HBV) or hepatitis C virus (HCV) in kidney transplant candidates was once considered a contraindication to transplantation, but advances in antiviral therapy have now enabled successful transplantation in these patients. In this Review, Huskey and Wiseman discuss the management of chronic HBV and HCV infection in both kidney donors and recipients, including post-transplantation outcomes and recommendations for treatment and organ allocation in these individuals.
Levels of serum inflammatory biomarkers—such as C-reactive protein—fluctuate substantially over time in patients undergoing dialysis. Monitoring these changes could provide us with useful information concerning the underlying processes that cause inflammation. In this Review, Meuwese and colleagues examine the implications and causes of inflammatory marker variability in patients on dialysis, and discuss the advantages of repeated measurements of inflammation over single measurements in clinical practice.
Proteinuria is a prognostic indicator of renal function loss, and understanding the mechanisms underlying proteinuric nephropathy is a topic of intense interest. In this Perspectives article, Richard Baines and Nigel Brunskill consider the importance of megalin, cubilin, and other receptors in the handling of filtered proteins by PTECs and describe how these factors could contribute to the development of proteinuric nephropathy.
