Entries Tagged as 'Curr Opin Nephrol Hypertens'
Renin inhibition: should it supplant ACE inhibitors and ARBS in high risk patients?
Curr Opin Nephrol Hypertens. 2008 Sep;17(5):484-90
Authors: Gaddam KK, Oparil S
PURPOSE OF REVIEW: The direct renin inhibitor aliskiren has recently been approved for the treatment of hypertension in humans. The potential for these newer agents having an advantage over the existing renin-angiotensin-aldosterone system (RAAS) antagonists in the treatment of hypertension and related target organ damage has drawn the interest of several investigators. In this review, we discuss the potential advantages and disadvantages of this newest antihypertensive class over other available RAAS antagonists. RECENT FINDINGS: The antihypertensive efficacy of aliskiren monotherapy has been compared with that of other RAAS antagonists and combinations of aliskiren with these agents. These studies have shown that aliskiren is equally effective as angiotensin receptor blockers and may be slightly more effective than angiotensin converting enzyme inhibitors in lowering blood pressure. In contrast to the other RAAS antagonists, aliskiren shuts down the entire downstream RAAS cascade. This results in greatly increased plasma renin concentration due to removal of angiotensin II-mediated feedback inhibition of renin release, which has raised concerns about whether direct renin inhibition adds anything to inhibition of downstream components of the RAAS cascade. SUMMARY: The potential advantages and disadvantages of aliskiren therapy versus existing RAAS antagonists in treating hypertension and target organ damage are under investigation.
PMID: 18695389 [PubMed - indexed for MEDLINE]
[Read more →]
Tags: Curr Opin Nephrol Hypertens
Elevations in serum creatinine with RAAS blockade: why isn’t it a sign of kidney injury?
Curr Opin Nephrol Hypertens. 2008 Sep;17(5):443-9
Authors: Ryan MJ, Tuttle KR
PURPOSE OF REVIEW: The aim of this article is to review the pertinent physiology and pathophysiology of the renin-angiotensin-aldosterone system (RAAS), summarize the proven beneficial cardiovascular and renal effects of RAAS blockade, examine clinical situations in which RAAS blockade may induce reductions in glomerular filtration rate, and explore why increases in serum creatinine in the setting of angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) therapy do not necessarily signify the presence of clinically relevant kidney failure. RECENT FINDINGS: RAAS inhibition appears to reduce the likelihood of atrial fibrillation. RAAS inhibition leads to improved insulin sensitivity and glycemic control, but does not appear to prevent diabetes. The beneficial effects of ACEi/ARB therapy extend to those with significant renal disease. Combination ACEi/ARB is safe, and reduces proteinuria more than either agent alone in patients with macroalbuminuric nephropathy. Acute deteriorations in renal function that result from RAAS inhibition are usually reversible. SUMMARY: RAAS blockade exerts potent hemodynamic, antihypertensive, and antiinflammatory effects, and slows progression of kidney disease beyond that due to lowering of blood pressure. The benefit extends to those with advanced disease. In spite of established benefit, ACEi and ARB therapy remains underutilized, in part due to concerns about acute deteriorations in renal function that result from interruption of the RAAS.
PMID: 18695383 [PubMed - indexed for MEDLINE]
[Read more →]
Tags: Curr Opin Nephrol Hypertens
Do thiazides worsen metabolic syndrome and renal disease? The pivotal roles for hyperuricemia and hypokalemia.
Curr Opin Nephrol Hypertens. 2008 Sep;17(5):470-6
Authors: Reungjui S, Pratipanawatr T, Johnson RJ, Nakagawa T
PURPOSE OF REVIEW: The aims of this article are to review the current controversies related to the use of thiazide diuretics as first-line treatment of hypertension and to discuss the causal roles for hyperuricemia and hypokalemia on the adverse consequences of thiazide usage. RECENT FINDINGS: Thiazides significantly reduce morbidity and mortality in hypertensive subjects. There remains, however, debate about thiazide usage as first-line treatment of hypertension. This negative impact of thiazides may be partially attributed to the ability of thiazides to exacerbate features of metabolic syndrome or increase the risk for developing diabetes. Several clinical trials suggest that thiazide-induced hyperuricemia and hypokalemia may account for some of these negative effects. Thiazide treatment is also associated with a decline of renal function in spite of a lowering blood pressure. In this review, we discuss the clinical and experimental evidence supporting a potential role of hyperuricemia and hypokalemia on the development of renal injury and worsening of the metabolic syndrome. SUMMARY: Hyperuricemia and hypokalemia may have pivotal roles in the exacerbation of the metabolic syndrome in response to thiazides. We propose that controlling serum uric acid and serum potassium could improve thiazide efficacy and also reduce its risk for inducing metabolic syndrome or diabetes.
PMID: 18695387 [PubMed - indexed for MEDLINE]
[Read more →]
Tags: Curr Opin Nephrol Hypertens
Assessment of renal function in elderly patients.
Curr Opin Nephrol Hypertens. 2008 Nov;17(6):604-8
Authors: Fliser D
PURPOSE OF REVIEW: The proportion of elderly individuals is growing rapidly in all societies and the incidence of chronic kidney disease among elderly people increases constantly. Accurate monitoring of kidney function, that is, glomerular filtration rate, in elderly people is therefore of considerable clinical interest in order to detect individuals who are at risk for developing chronic kidney disease. This paper reviews the currently used methods for assessment of glomerular filtration rate and their utility in elderly people. RECENT FINDINGS: Serum creatinine is an unreliable indicator of glomerular filtration rate in elderly people, particularly in those who are sick or malnourished or both. Thus, more reliable glomerular filtration rate estimates should be employed whenever indicated, for example, timed creatinine clearance, serum creatinine-based equations such as the Modification of Diet in Renal Disease formula, or serum cystatin C. However, no single method may be satisfactory. SUMMARY: Accurate assessment of renal function is a prerequisite for the correct management of elderly people at risk of developing chronic kidney disease; for example, those with diabetes, hypertension, and other clinical conditions that may considerably accelerate an age-related decrease in glomerular filtration rate. The Modification of Diet in Renal Disease formula should be used in most cases, but serum cystatin C or even an isotope clearance method may be helpful if there is concern about the reliability of the Modification of Diet in Renal Disease equation in an elderly individual in whom precise assessment of kidney function is mandatory.
PMID: 18941354 [PubMed - indexed for MEDLINE]
[Read more →]
Tags: Curr Opin Nephrol Hypertens
Clinical significance and preventive strategies for contrast-induced nephropathy.
Curr Opin Nephrol Hypertens. 2008 Nov;17(6):616-23
Authors: Sterling KA, Tehrani T, Rudnick MR
PURPOSE OF REVIEW: Contrast-induced nephropathy continues to be a common cause of in-hospital acute kidney injury. Published studies on pathogenesis, clinical significance, diagnosis, and preventive measures have dramatically increased significantly in the past several years. This review will focus on new developments in contrast-induced nephropathy. RECENT FINDINGS: Studies on the clinical significance of contrast-induced nephropathy are reviewed along with initial reports of biomarkers in diagnosing this complication of iodinated contrast administration. Emerging literature on the relative nephrotoxicity of iso-osmolar versus low-osmolar contrast media and the value of bicarbonate hydration are discussed. More recent preventive measures using prostacyclin, ‘statins’, and erythropoietin are also reviewed. SUMMARY: Contrast-induced nephropathy is an increasing cause of acute kidney injury and is associated with significant mortality and morbidity. Future developments in this field will focus on refining the clinical significance of this complication, earlier diagnosis with biomarkers, clarifying the role for bicarbonate and iso-osmolar contrast agents as preventive strategies, and the introduction of new prophylactic techniques on the basis of an improved understanding of pathogenesis at the cellular level.
PMID: 18941356 [PubMed - indexed for MEDLINE]
[Read more →]
Tags: Curr Opin Nephrol Hypertens
Triumph and tragedy: anemia management in chronic kidney disease.
Curr Opin Nephrol Hypertens. 2008 Nov;17(6):580-8
Authors: Novak JE, Szczech LA
PURPOSE OF REVIEW: Recent trial data have resulted in a reevaluation of the management of anemia in chronic kidney disease, including the use of erythropoiesis-stimulating agents, intravenous iron, and novel pharmaceuticals. In this review, we evaluate the latest research on anemia management in chronic kidney disease. RECENT FINDINGS: Clinical trials of erythropoiesis-stimulating agents indicate that targeting the complete correction of anemia in patients with chronic kidney disease results in a greater risk of morbidity and mortality despite improved hemoglobin and quality of life. Conversely, intravenous iron has been found effective and relatively well tolerated in treating anemia in chronic kidney disease, even in patients with elevated ferritin. New agents to manage anemia, including long-acting erythropoietin derivatives, are also in active development. SUMMARY: Erythropoiesis-stimulating agents should be used to target hemoglobin 11-12 g/dl in patients with chronic kidney disease. Intravenous iron may be beneficial for patients with hemoglobin less than 11 g/dl and transferrin saturation less than 25% despite elevated ferritin (500-1200 ng/ml). An upcoming placebo-controlled trial of darbepoetin should help to define the role of erythropoiesis-stimulating agents in chronic kidney disease.
PMID: 18941350 [PubMed - indexed for MEDLINE]
[Read more →]
Tags: Curr Opin Nephrol Hypertens
Nephrogenic systemic fibrosis: epidemiology update.
Curr Opin Nephrol Hypertens. 2008 May;17(3):315-9
Authors: Marckmann P
PURPOSE OF REVIEW: The aim of this article is to outline the history of nephrogenic systemic fibrosis, a new and serious disease of patients with renal failure, and to give an update on its aetiology and prevalence. RECENT FINDINGS: Epidemiological and histochemical studies demonstrated that gadolinium-containing contrast agents used for magnetic resonance imaging have an essential causative role in most, if not all, cases of nephrogenic systemic fibrosis. One particular agent, gadodiamide, caused the majority of cases, but gadopentetate dimeglumine has also been implicated in several cases. Increasingly poor renal function, aberrations in calcium-phosphate metabolism and erythropoietin treatment seem to increase the risk of the disease and its severity. Up to 25-30% of patients with renal failure exposed to gadolinium-based contrast agents may develop nephrogenic systemic disease. The figure varies with type of gadolinium-based contrast agent and patient characteristics. There is no established curative treatment of the disease, but rapid recovery of renal function or hastened kidney transplantation may be beneficial. SUMMARY: It is mandatory to avoid exposing patients with renal failure to gadodiamide and gadopentetate dimeglumine. Other linear gadolinium-based contrast agents should be used with great caution. It is premature to conclude whether cyclic gadolinium-based contrast agents are totally safe in renal failure.
PMID: 18408485 [PubMed - indexed for MEDLINE]
[Read more →]
Tags: Curr Opin Nephrol Hypertens
