1. The role of vascular lesions in diabetes across a spectrum of clinical kidney diseaseRosa Rodriguez-Rodriguez, Radovan Hojs, Francesco Trevisani, Enrique Morales, Gema Fernández, Sebastjan Bevc, Clara Maria Cases Corona, Josep Maria Cruzado, María Quaro, Maruja Navarro Díaz, Mads Hornum, Beatriz Fernandez-Fernandez, Arianna Bettiga, Federico Di Marco, Marina López Martínez, Francisco J. Moreso, Clara García Garro, Khaled Khazim, Fedaa Ghanem, Manuel Praga, Meritxell Ibernón, Ivo Laranjinha, Luís Mendonça, Miguel Bigotte Vieira, Bo Feldt-Rasmussen, Patricia Fox Concepción, Natalia Negrín Mena, Alberto Ortiz, Esteban L. Porrini, 2021, izvirni znanstveni članek Opis: Introduction: The clinical-histologic correlation in diabetic nephropathy is not completely known.
Methods: We analyzed nephrectomy specimens from 90 patients with diabetes and diverse degrees of proteinuria and glomerular filtration rate (GFR).
Results: Thirty-six (40%) subjects had normoalbuminuria, 33 (37%) microalbuminuria, and 21 (23%) non-nephrotic proteinuria. Mean estimated GFR (eGFR) was 65±23 (40% <60 ml/min per 1.73 m2). About 170 glomeruli per patient were analyzed, and all samples included vascular tissue. Six subjects (7%) were classified in diabetic nephropathy class I, 61 (68%) in class II-a, 13 (14%) in class II-b, 9 (10%) class III, and 1 (1%) in class IV. Eighty percent to 90% of those with normoalbuminuria or microalbuminuria were classified in class II-a or II-b and <10% in class III; 52% of those with proteinuria were in class II-a, 15% in class II-b, and 19% in class III. Nodular sclerosis (57%) and mesangial expansion (15%) were more frequent in cases with proteinuria than in normoalbuminuria (28% and 8%; P = 0.028 and 0.017). About 20% to 30% of all cases, regardless the level of albuminuria or proteinuria or the histologic class had tubular atrophy, interstitial fibrosis, or inflammation in >10% to 20% of the sample. Moderate hyalinosis and arteriolar sclerosis were observed in 80% to 100% of cases with normoalbuminuria, microalbuminuria, proteinuria, as well as in class I, II, or III.
Conclusions: Weak correspondence between analytical parameters and kidney histology was found. Thus, disease may progress undetected from the early clinical stages of the disease. Finally, vascular damage was a very common finding, which highlights the role of ischemic intrarenal disease in diabetes.
Ključne besede: albuminuria, chronic kidney disease, diabetes, diabetic nephropathy, histology, normoalbuminuria
Objavljeno v DKUM: 06.12.2024; Ogledov: 0; Prenosov: 3
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2. Assessment of kidney function : clinical indications for measured GFRNatalie Ebert, Sebastjan Bevc, Arend Bökenkamp, Francois Gaillard, Mads Hornum, Kitty Jager, Christophe Mariat, Bjørn Odvar Eriksen, Runolfur Palsson, Andrew D. Rule, 2021, pregledni znanstveni članek Opis: In the vast majority of cases, glomerular filtration rate (GFR) is estimated using serum creatinine, which is highly influenced by age, sex, muscle mass, body composition, severe chronic illness and many other factors. This often leads to misclassification of patients or potentially puts patients at risk for inappropriate clinical decisions. Possible solutions are the use of cystatin C as an alternative endogenous marker or performing direct measurement of GFR using an exogenous marker such as iohexol. The purpose of this review is to highlight clinical scenarios and conditions such as extreme body composition, Black race, disagreement between creatinine- and cystatin C–based estimated GFR (eGFR), drug dosing, liver cirrhosis, advanced chronic kidney disease and the transition to kidney replacement therapy, non-kidney solid organ transplant recipients and living kidney donors where creatinine-based GFR estimation may be invalid. In contrast to the majority of literature on measured GFR (mGFR), this review does not include aspects of mGFR for research or public health settings but aims to reach practicing clinicians and raise their understanding of the substantial limitations of creatinine. While including cystatin C as a renal biomarker in GFR estimating equations has been shown to increase the accuracy of the GFR estimate, there are also limitations to eGFR based on cystatin C alone or the combination of creatinine and cystatin C in the clinical scenarios described above that can be overcome by measuring GFR with an exogenous marker. We acknowledge that mGFR is not readily available in many centres but hope that this review will highlight and promote the expansion of kidney function diagnostics using standardized mGFR procedures as an important milestone towards more accurate and personalized medicine.
Ključne besede: biomarker, chronic kidney disease, clinical indications, creatinine, cystatin C, kidney function, measured glomerular filtration rate
Objavljeno v DKUM: 12.08.2024; Ogledov: 52; Prenosov: 9
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3. The role of oxidative stress in kidney injuryNejc Piko, Sebastjan Bevc, Radovan Hojs, Robert Ekart, 2023, pregledni znanstveni članek Opis: Acute kidney injury and chronic kidney disease are among the most common non-communicable diseases in the developed world, with increasing prevalence. Patients with acute kidney injury are at an increased risk of developing chronic kidney disease. One of kidney injury’s most common clinical sequelae is increased cardiovascular morbidity and mortality. In recent years, new insights into the pathophysiology of renal damage have been made. Oxidative stress is the imbalance favoring the increased generation of ROS and/or reduced body’s innate antioxidant defense mechanisms and is of pivotal importance, not only in the development and progression of kidney disease but also in understanding the enhanced cardiovascular risk in these patients. This article summarizes and emphasizes the role of oxidative stress in acute kidney injury, various forms of chronic kidney disease, and also in patients on renal replacement therapy (hemodialysis, peritoneal dialysis, and after kidney transplant). Additionally, the role of oxidative stress in the development of drug-related nephrotoxicity and also in the development after exposure to various environmental and occupational pollutants is presented.
Ključne besede: acute kidney injury, acute tubular necrosis, chronic kidney disease, oxidative stress, reactive oxygen species
Objavljeno v DKUM: 19.03.2024; Ogledov: 210; Prenosov: 32
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4. SGLT2i for evidence based cardiorenal protection in diabetic and non-diabetic chronic kidney disease : a comprehensive review by EURECA-m and ERBP working groups of ERAPatrick B. Mark, Pantelis Sarafidis, Robert Ekart, Charles J. Ferro, Olga Balafa, Beatriz Fernandez-Fernandez, William G. Herrington, Patrick Rossignol, Lucia Del Vecchio, Jose M. Valdivielso, 2023, pregledni znanstveni članek Opis: Chronic kidney disease (CKD) is a major public health issue affecting an estimated 850 million people globally. The leading causes of CKD is diabetes and hypertension, which together account for >50% of patients with end-stage kidney disease. Progressive CKD leads to the requirement for kidney replacement therapy with transplantation or dialysis. In addition, CKD, is a risk factor for premature cardiovascular disease, particularly from structural heart disease and heart failure (HF). Until 2015, the mainstay of treatment to slow progression of both diabetic and many non-diabetic kidney diseases was blood pressure control and renin-angiotensin system inhibition; however, neither angiotensin-converting enzyme inhibitors (ACEIs) nor angiotensin receptor blockers (ARBs) reduced cardiovascular events and mortality in major trials in CKD. The emergence of cardiovascular and renal benefits observed with sodium-glucose cotransporter-2 inhibitors (SGLT2i) from clinical trials of their use as anti-hyperglycaemic agents has led to a revolution in cardiorenal protection for patients with diabetes. Subsequent clinical trials, notably DAPA-HF, EMPEROR, CREDENCE, DAPA-CKD and EMPA-KIDNEY have demonstrated their benefits in reducing risk of HF and progression to kidney failure in patients with HF and/or CKD. The cardiorenal benefits—on a relative scale—appear similar in patients with or without diabetes. Specialty societies’ guidelines are continually adapting as trial data emerges to support increasingly wide use of SGLT2i. This consensus paper from EURECA-m and ERBP highlights the latest evidence and summarizes the guidelines for use of SGLT2i for cardiorenal protection focusing on benefits observed relevant to people with CKD.
Ključne besede: cardiorenal syndrome, cardiovascular, chronic renal failure, diabetic kidney disease, heart failure
Objavljeno v DKUM: 21.02.2024; Ogledov: 241; Prenosov: 14
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5. Analiza pulznega vala pri hemodializnih bolnikihJan Gumilar, 2018, končno poročilo o rezultatih raziskav Ključne besede: aplanacijska tonometrija, arterijska togost, pulzni tlak, končna ledvična odpoved, hemodializa, preživetje, applanation tonometry, pulse pressure, arterial stiffness, chronic kidney disease, haemodialysis, survival
Objavljeno v DKUM: 25.03.2019; Ogledov: 1665; Prenosov: 110
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