EMJ Nephrology最新文献

{"title":"Hypertension in Patients Receiving Dialysis: A Review of the Current Clinical Approach","authors":"Colm Rowan, Stephen Mahony, L. Redahan","doi":"10.33590/emjnephrol/10105805","DOIUrl":"https://doi.org/10.33590/emjnephrol/10105805","url":null,"abstract":"Cardiovascular disease is a leading cause of morbidity and mortality in end-stage renal disease (ESRD). Hypertension plays a major contributory role, resulting in progressive left ventricular hypertrophy, and increasing the risk of sudden cardiac death. The prevalence and pathophysiological mechanisms differ fundamentally from the non-dialysis-dependent population.\u0000\u0000Sodium restriction can be as effective as antihypertensive medication in mitigating the haemodynamic effects resulting from impaired sodium handling. Tailoring dialysate sodium may enhance diffusion and facilitate greater sodium elimination where dietary measures alone prove ineffective.\u0000\u0000Unlike hypertension in the wider population, volume overload plays a major pathophysiological role in ESRD. Probing dry weight in patients on dialysis who are seemingly euvolaemic enables clinically significant blood pressure (BP) reduction, and translates to improvements in markers of future cardiovascular morbidity and mortality.\u0000\u0000Pharmacotherapy remains an important aspect in controlling hypertension in dialysis. Although no large-scale studies have identified the optimal medical therapy, numerous meta-analyses and randomised control trials (RCT) have demonstrated the efficacy of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARB), calcium channel blockers, β-blockers, and hydralazine/isosorbide dinitrate in the treatment of hypertension in ESRD. Whether the beneficial haemodynamic properties of mineralocorticoid receptor antagonists outweigh the risk of hyperkalaemia is the subject of ongoing RCTs. Numerous meta-analyses have demonstrated that adequate pharmacological control of BP translates to improved cardiovascular morbidity and mortality.\u0000\u0000The fluctuation of volume status in the inter/intra-dialytic period complicates the diagnosis of hypertension in ESRD. As with patients not receiving dialysis, 24-hour blood pressure monitoring appears to have the greatest sensitivity in diagnosing hypertension and predicting outcomes from hypertension. Where resources are limited, home BP monitoring appears to have the greatest value.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"11 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132737659","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}

{"title":"Prevalence of SARS-CoV-2 Cellular and Humoral Immunity Amongst Patients on Dialysis After the First Vaccination Campaign","authors":"R. Duarte, Rosa Soares, I-Tse Lu, F. Ferrer, Paula Gama, H. Gonçalves, K. Lopes, F. Sofia, Carlos Cortes, Ana Vila Lobos","doi":"10.33590/emjnephrol/10023287","DOIUrl":"https://doi.org/10.33590/emjnephrol/10023287","url":null,"abstract":"Background: Immunisation remains critical in prevention of serious COVID-19 infection. This study aimed to characterise the prevalence of humoral and cellular immunity in patients on maintenance dialysis in a nephrology centre 8 months after vaccination onset.\u0000\u0000Methods: Real-world single-centre prevalence cross-sectional study enrolling patients on peritoneal and haemodialysis. Humoral response was measured as specific IgG (anti-spike protein receptor-binding domain IgG) and cellular response as T cell reactivity through interferon γ quantification as response to antigen.\u0000\u0000Results: Of the 86 patients enrolled, 79.4% and 84.1% showed humoral and cellular immunity, respectively. Anti-spike protein receptor-binding domain IgG correlated with specific T cell reactivity (ρ=0.58; p<0.001). Vaccinated patients with associated high comorbidity burden and low serum albumin were at risk of absent immunity (p<0.05).\u0000\u0000Conclusion: The prevalence of humoral and cellular immunity against severe acute respiratory syndrome coronavirus 2 in vaccinated Portuguese patients on maintenance dialysis is high. High comorbidity burden and low serum albumin are risk factors for absent immune response.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130561008","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}

{"title":"The Ground Is Full of Pitfalls: Association of Chronic Kidney Disease, Conflict Zones, and the Quality of Healthcare in Africa","authors":"M. Asserraji, Mohammed Bahi","doi":"10.33590/emjnephrol/22-00048","DOIUrl":"https://doi.org/10.33590/emjnephrol/22-00048","url":null,"abstract":"Public health in sub-Saharan African countries is experiencing a double burden of diseases. First, for decades, these countries have been struggling against infectious diseases. Second, the demographic transition in the area is leading to a rising prevalence of non-communicable diseases (NCDs). Unfortunately, the health systems in sub-Saharan Africa are vulnerable, under-resourced, and unable to address these public health issues. Furthermore, protracted political instability and the consequent conflict zones are worsening the situation. In this short essay, the authors report their real-world experience of providing kidney care for patients with NCDs and chronic kidney disease (CKD) in Bunia, the capital city of the Ituri, a north-eastern district of the Democratic Republic of the Congo (DRC) that has been conflict-ridden for years. In conclusion, there is a lack of evidence and research regarding the heavy burden of NCDs and the appropriate healthcare policy in humanitarian settings such as conflict zones. A co-ordinated, standardised, and evidence-based approach is strongly recommended to reach affected populations in these areas.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"132 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132414378","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}

{"title":"The Renal Effects of SGLT2 Inhibitors","authors":"Hanny Sawaf, Moarij Qaz, Jeeda Ismail, Ali Mehdi","doi":"10.33590/emjnephrol/22-00080","DOIUrl":"https://doi.org/10.33590/emjnephrol/22-00080","url":null,"abstract":"Sodium–glucose co-transporter inhibitors (SGLT2i) have recently gained a lot of emphasis in their role in preventing progression of chronic kidney disease and helping with cardiac mortality. Various studies have proven the benefit of these medications in the management of patients with kidney and heart disease. SGLT2i exert their effect in the proximal convoluted tubule with various downstream effects noted in the kidney also. With spreading use of these medications, it is imperative to understand the effects they have on various electrolytes and the pathways involved in bringing about these changes in the kidney. Here, the authors review the current knowledge of SGLT2i with their effects on the kidney, electrolytes, and water balance.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133969866","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}

{"title":"Pathophysiology of Diabetic Kidney Disease","authors":"Moarij Qaz, Hanny Sawaf, Jeeda Ismail, Humaira Qazi, T. Vachharajani","doi":"10.33590/emjnephrol/22-00060","DOIUrl":"https://doi.org/10.33590/emjnephrol/22-00060","url":null,"abstract":"Diabetic kidney disease (DKD) has been an immense burden on the healthcare system, and is the leading cause of end stage kidney disease worldwide. DKD involves various intersecting pathways that lead to progressive kidney damage. Due to its versatile pathogenesis, DKD has been a formidable adversary. For many decades, there has not been much development in the arsenal in the fight against DKD, but recently, multiple new prospects have emerged due to the breakthrough in understanding of DKD pathology.\u0000\u0000Tireless research of the changes occurring in the kidney as a result of diabetes, and the factors driving these changes, has led to the invention of medications that hopefully will be highly impactful in preventing end stage kidney disease in patients with diabetes. In this review, the authors summarise the timeline of the pathological changes that occur in DKD, the mechanism driving these pathological changes, and the recent discoveries in the pathways leading to DKD. These span over changes in metabolic pathways, inflammatory cascades, epigenetic alterations, and the description of their effects at cellular to structural levels in the kidney as a byproduct of uncontrolled hyperglycaemia. The authors also correlate these mechanisms with a few of the medications that are being utilised to slow down DKD, and some in the pipeline, with some references to the trials that support their use.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"8 9-10","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114048404","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}

{"title":"Low-Dose Dopamine in the Management of Intradialysis Hypotension: A Retrospective Cohort Study in Nigeria","authors":"P. Uduagbamen, M. Ogunmola, Igwebuike Nwogbe, T. Falana","doi":"10.33590/emjnephrol/22-00073","DOIUrl":"https://doi.org/10.33590/emjnephrol/22-00073","url":null,"abstract":"Introduction: Intradialytic hypotension (IDH) still remains a common finding in maintenance haemodialysis despite improvements in dialysis delivery. Measures are needed to minimise some aftermath of IDH like dialysis termination, which can impact poorly on dialysis outcome.\u0000\u0000Methods: This retrospective study assessed IDH in a low-income setting, and compared two cohorts of IDH with and without dopamine treatment.\u0000\u0000Results: Of the 416 participants, 92 (22.1%) had at least an episode of symptomatic IDH. Of these, 20 (21.7%) were treated with dopamine. Of the 2,205 sessions, 468 (21.2%) had symptomatic IDH, of which 63 (13.4%) with severe IDH were treated with dopamine. The mean age of all participants and dopamine treatment participants were 50.8 ± 9.3 years and 64.6 ± 9.5 years, respectively (P=0.001). Blood pressure (BP) reductions following dialysis were more with females (P=0.04). Dialysis dose was adequate in 7.9% and 4.2% of sessions with and without dopamine (P<0.001). Improvements in glomerular filtration rate were greater in dopamine-treated sessions (P=0.03 and P=0.04, respectively). Fewer anti-hypertensives (aOR: 14.64; 95% confidence interval [CI]: 7.88–20.41), low predialysis systolic (aOR:5.59; 95% CI: 3.88–9.41), and diastolic blood pressure (aOR: 5.78; 95% CI: 4.06-9.81) were independently associated with dopamine-treated sessions.\u0000\u0000Conclusion: IDH was found in 21.2% of dialysis sessions. 13.4% with severe IDH had dopamine treatment. Participants with dopamine-treated sessions had fewer dialysis terminations and hospitalisations, and dopamine treatment improved the prescribed dialysis and gave higher dialysis doses. Considering the economic effects of dialysis termination in low-income nations, intradialytic dopamine could be very beneficial.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129937509","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}

{"title":"SGLT2 Inhibitors for Nephrologists","authors":"Mufti Baleegh-ur-Raheem Mahmood, Sidra Farishta","doi":"10.33590/emjnephrol/22-00083","DOIUrl":"https://doi.org/10.33590/emjnephrol/22-00083","url":null,"abstract":"Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers are the mainstay of therapy for the prevention of progressive renal damage in diabetic and non-diabetic kidney diseases, especially glomerulonephritides. Sodium-glucose co-transporter-2 inhibitors are a relatively new class of oral antidiabetic drugs. Early evidence suggests that there are renal and cardiovascular benefits of this class of drugs that extend beyond glycaemic control for patients both with and without diabetes. With each and every trial, the limit for the glomerular filtration rate has been set lower, making the drugs more suitable from the perspective of nephrologists. This drug class has the potential to become the mainstay of reno-protective strategies used by nephrologists, in addition to angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers. This article reviews the evidence and reports that are already published regarding the use of sodium-glucose co-transporter-2 inhibitors to treat non-diabetic glomerular disease.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"118 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128146026","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}

{"title":"The Dual Role of Endothelin-1 and Angiotensin II in Disease Progression of Focal Segmental Glomerulosclerosis and IgA Nephropathy","authors":"E. Roberts","doi":"10.33590/emjnephrol/22c0912","DOIUrl":"https://doi.org/10.33590/emjnephrol/22c0912","url":null,"abstract":"IgA nephropathy (IgAN) and focal segmental glomerulosclerosis (FSGS) are rare primary glomerulopathies, though the incidence of IgAN is greater. Endothelin 1 (ET-1) and angiotensin II (Ang II) are implicated in the development and progression of IgAN and FSGS. Both conditions impact health-related quality of life (HRQoL) and may lead to kidney failure. IgAN and FSGS are both evidenced clinically by proteinuria, with a greater degree of such associated with more progressive disease and shorter times to kidney failure. Accordingly, the reduction of proteinuria in patients with these conditions is a key target. Currently, IgAN and FSGS treatments are unsuccessful or only partially successful in a number of patients. Immunosuppressant therapy is first-line for primary FSGS and utilised for patients with IgAN who remain at high risk of progression despite maximal supportive care; however, while effective, there is a significant risk of toxicity and relapse is frequent. A number of clinical trials are ongoing to investigate the use of non-immunosuppressive agents in the management of these conditions. The dual endothelin Type A receptor/Ang II subtype 1 receptor (ETAR/AT1R) antagonist (DEARA) sparsentan is currently being assessed as a means to control kidney disease progression. Interim study results show that sparsentan can lead to greater reductions in proteinuria than AT1R antagonism alone in IgAN and more patients reaching partial remission (PR) in FSGS. Herein, a symposium by leading experts at the European Renal Association (ERA) 59th Congress in Paris, 19th−22nd May 2022, is presented. It highlights IgAN and FSGS and the role of proteinuria in these conditions, and how targeting ET-1 and Ang II can lead to a reduction in proteinuria in IgAN and potential FSGS PR.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134161861","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}

{"title":"COVID-19-Associated Nephropathy: An Emerging Clinical Entity","authors":"Nejc Piko, R. Ekart, R. Hojs, S. Bevc","doi":"10.33590/emjnephrol/22-0005","DOIUrl":"https://doi.org/10.33590/emjnephrol/22-0005","url":null,"abstract":"Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new pathogen that was responsible for the global pandemic that started in Wuhan, China in 2019. It causes COVID-19, manifesting as viral pneumonia with concomitant acute respiratory failure and, in certain cases, multiorgan failure and death.\u0000\u0000Kidney involvement is common and can be aetiologically heterogeneous. Acute kidney injury is mostly caused indirectly, especially in the context of systemic inflammation, hypoxaemia, hypotension, shock, and increased oxidative stress. Complement activation, tubulointerstitial damage, and endothelial dysfunction with resultant thromboses are also important factors in kidney injury. Histologically, SARS-CoV-2 was found to induce predominant tubulointerstitial changes and in some cases, glomerular changes. In a certain subgroup of patients with the APOL1 high-risk allele variant, a collapsing glomerulopathy, similar to HIV-associated nephropathy, was found. This entity was later named COVID-19-associated nephropathy. In this article, the authors present the pathophysiology behind SARS-CoV-2-related kidney involvement and the development of COVID-19-associated nephropathy.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115508674","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}

{"title":"Ageing in Chronic Kidney Disease","authors":"Robin Stannard","doi":"10.33590/emjnephrol/22f0630","DOIUrl":"https://doi.org/10.33590/emjnephrol/22f0630","url":null,"abstract":"DAY 4 of the 59th ERA Congress 2022 included an expert session on cellular ageing. In a symposium session featuring specialist insight from researchers in the field, discussions focused on the cellular processes that contribute to aging, environmental influences that correlate with ageing phenotype, and chronic kidney disease (CKD) as a model for dysregulated ageing. Exploring treatments and lifestyle changes that slow ageing and increase health span, experts also shared research underlining the importance of the microbiome and the role dysbiosis plays in triggering age-related pathways.","PeriodicalId":348431,"journal":{"name":"EMJ Nephrology","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133058056","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}