Abstract:
PURPOSE OF REVIEW:In advanced chronic kidney disease (CKD) patients with progressive uremia, dialysis has traditionally been the dominant treatment paradigm. However, there is increasing interest in conservative and preservative management of kidney function as alternative patient-centered treatment approaches in this population. RECENT FINDINGS:The primary objectives of conservative nondialytic management include optimization of quality of life and treating symptoms of end-stage renal disease (ESRD). Dietetic-nutritional therapy can be a cornerstone in the conservative management of CKD by reducing glomerular hyperfiltration, uremic toxin generation, metabolic acidosis, and phosphorus burden. Given the high symptom burden of advanced CKD patients, routine symptom assessment using validated tools should be an integral component of their treatment. As dialysis has variable effects in ameliorating symptoms, palliative care may be needed to manage symptoms such as pain, fatigue/lethargy, anorexia, and anxiety/depression. There are also emerging treatments that utilize intestinal (e.g., diarrhea induction, colonic dialysis, oral sorbents, gut microbiota modulation) and dermatologic pathways (e.g., perspiration reduction) to reduce uremic toxin burden. SUMMARY:As dialysis may not confer better survival nor improved patient-centered outcomes in certain patients, conservative management is a viable treatment option in the advanced CKD population.
journal_name
Curr Opin Nephrol Hypertensjournal_title
Current opinion in nephrology and hypertensionauthors
Zarantonello D,Rhee CM,Kalantar-Zadeh K,Brunori Gdoi
10.1097/MNH.0000000000000670subject
Has Abstractpub_date
2021-01-01 00:00:00pages
97-107issue
1eissn
1062-4821issn
1473-6543journal_volume
30pub_type
杂志文章abstract:PURPOSE OF REVIEW:The discovery of the importance of proteins localized to cilia and basal bodies has provided novel insights into the pathogenesis of various human disorders including cystic kidney disease. The physiological role of cilium-generated signaling in most tissues including the kidney has remained elusive, ...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章
doi:10.1097/01.mnh.0000222690.53970.ca
更新日期:2006-05-01 00:00:00
abstract:PURPOSE OF REVIEW:The purpose of this mini-review is to highlight some unresolved questions and controversies in the evolving story of apolipoprotein L1 (APOL1) nephropathy. RECENT FINDINGS:We highlight studies that introduce complexity in unraveling the mechanisms whereby APOL1 risk variant alleles cause disease. The...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/MNH.0000000000000462
更新日期:2019-01-01 00:00:00
abstract:PURPOSE OF REVIEW:Tubulointerstitial injury is characteristic of aging-associated renal injury and progressive renal disease. Salt-sensitive hypertension is also associated with tubulointerstitial inflammation, especially when accompanied by microvascular disease. Here we summarize recent studies on the pathogenesis an...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/00041552-200305000-00003
更新日期:2003-05-01 00:00:00
abstract:PURPOSE OF REVIEW:Hyperphosphatemia remains an important aspect in the management of end-stage renal disease patients. Consequently, there is a need for new, efficient and well-tolerated phosphate binders. In this review, a new phosphate-binding drug, lanthanum carbonate, with an attractive preclinical efficacy profile...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/01.mnh.0000133973.86816.e9
更新日期:2004-07-01 00:00:00
abstract:PURPOSE OF REVIEW:Aldosterone and the mineralocorticoid receptor contribute to resistant hypertension and cardiovascular mortality, and mineralocorticoid receptor antagonists effectively reduce these complications. Their use is limited in certain populations with a higher risk of hyperkalemia or renal dysfunction. This...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/MNH.0000000000000051
更新日期:2014-09-01 00:00:00
abstract::The mitochondrial enzyme monoamine oxidases A and B are among the major metabolic agents for the degradation of the biogenic amines adrenaline, noradrenaline, dopamine and serotonin. The fact that the kidney contains a large amount of monoamine oxidase suggests that the renal effects of biogenic amines might depend in...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/00041552-199801000-00006
更新日期:1998-01-01 00:00:00
abstract:PURPOSE OF REVIEW:The present review addresses the recent literature demonstrating important differences in the rate of progression of kidney function decline between transplant recipients and patients with native kidney disease. It also highlights the need for prospective studies to determine the importance of nonimmu...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/00041552-200411000-00005
更新日期:2004-11-01 00:00:00
abstract:PURPOSE OF REVIEW:Peroxisome proliferator-activated receptor gamma (PPARγ) is a ligand-activated nuclear transcription factor that regulates many important physiological processes including glucose and lipid metabolism, energy homeostasis, cell proliferation, inflammation, immunity and reproduction. The current review ...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/MNH.0b013e32834de526
更新日期:2012-01-01 00:00:00
abstract::The parathyroid hormone (PTH)/parathyroid hormone-related peptide (PTHrP) receptor belongs to a newly discovered family of G protein-coupled receptors. Members of this family, which have been isolated from mammals, include the receptors for PTH/PTHrP, calcitonin, secretin, growth hormone-releasing hormone, vasoactive ...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:
更新日期:1994-07-01 00:00:00
abstract:PURPOSE OF REVIEW:Strong epidemiological and pathologic evidence associates NSAIDs with kidney disease, both acute and chronic. Hence, the usage of NSAIDs has decreased in patients with, or at risk for, chronic kidney disease (CKD). Coupled with this has been a rise in use of opioids and other non-NSAID alternatives, w...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/MNH.0000000000000473
更新日期:2019-03-01 00:00:00
abstract::The immunosuppressants cyclosporine and FK506 (tacrolimus) are extremely potent inhibitors of T-lymphocyte activation. Recent studies have shown that these agents are actually prodrugs that become active only when bound to specific members of the cyclophilin or FK506 binding protein receptor gene families. The cyclosp...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/00041552-199212000-00008
更新日期:1992-12-01 00:00:00
abstract::Overexpression of the cytokine transforming growth factor-beta has been identified as the key mediator of chronic progressive kidney fibrosis in experimental and human kidney diseases. The renoprotective effects of angiotensin II blockade and low-protein diets have recently been linked to downregulation of transformin...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/00041552-199707000-00014
更新日期:1997-07-01 00:00:00
abstract:PURPOSE OF REVIEW:Sirtuins are a family of nicotinamide adenine dinucleotide+-dependent enzymes catalyzing target protein deacetylation to modulate cellular metabolism, response to oxidative stress and inflammation, senescence, autophagy and apoptosis. In this review, we provide an overview of recent studies regarding ...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章
doi:10.1097/MNH.0000000000000660
更新日期:2021-01-01 00:00:00
abstract:PURPOSE OF REVIEW:This review surveys the literature on the search for the genetic basis of hypertension during the 10 months since November 2003. The goals set forth by this search are defined and the highlights of the work accomplished are provided. RECENT FINDINGS:The search for the genetic basis of hypertension is...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/00041552-200503000-00009
更新日期:2005-03-01 00:00:00
abstract:PURPOSE OF REVIEW:The imbalances in the activities of various components of the neurohormonal system that maintain renal homeostasis may have important implications in pathophysiology. This review aims to examine the evidence for disparities between angiotensin II and nitric oxide in acute and chronic kidney diseases. ...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/MNH.0b013e3282f29a8b
更新日期:2008-01-01 00:00:00
abstract::The L-arginine: nitric oxide pathway is widely recognized as an important regulator of cell function and communication in a variety of physiological and pathophysiological situations. Recent advances in the biochemistry and molecular biology of nitric oxide synthases have contributed significantly to our understanding...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/00041552-199301000-00018
更新日期:1993-01-01 00:00:00
abstract:PURPOSE OF REVIEW:Nitric oxide is a potent, endogenous vasodilator that regulates systemic blood pressure and renal function, among other functions. The bioactivity of nitric oxide is reduced by superoxide, a major reactive oxygen species. Overproduction of superoxide and other related reactive oxygen species resulting...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/01.mnh.0000191912.65281.e9
更新日期:2006-01-01 00:00:00
abstract:PURPOSE OF REVIEW:The renin-angiotensin system, traditionally viewed as a circulatory system, has significantly expanded in the last two decades to include independently regulated local systems in several tissues, newly identified active products of angiotensin II, and new receptors and functions of renin-angiotensin s...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/MNH.0b013e3282f521a8
更新日期:2008-03-01 00:00:00
abstract:PURPOSE OF REVIEW:Epithelial sodium channels mediate Na+ transport across high resistance, Na+-transporting epithelia. This review describes recent findings that indicate that epithelial sodium channels are activated by the proteolytic release of inhibitory peptides from the alpha and gamma subunits. RECENT FINDINGS:N...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/MNH.0b013e32821f6072
更新日期:2007-09-01 00:00:00
abstract::The ability to record sympathetic nerve activity in conscious human subjects using intraneural microelectrodes (microneurography) has proven to be a powerful clinical research tool, which has shed new light on the pathophysiology of important blood pressure problems as exemplified in studies of patients with chronic r...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/00041552-199411000-00014
更新日期:1994-11-01 00:00:00
abstract::Several recently completed or ongoing large-scale clinical trials, including the Modification of Diet in Renal Disease Study, the Diabetes Control and Complications Trial, and the African-American Study of Kidney Disease and Hypertension, have all chosen the renal clearance of sodium 125I-iothalmate to monitor renal d...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/00041552-199511000-00010
更新日期:1995-11-01 00:00:00
abstract:PURPOSE OF REVIEW:Obesity is becoming recognized as one of the most important risk factors for the development of hypertension. The purpose of the review is to examine the latest evidence linking hypertension to obesity, summarize the benefits of weight reduction and present results of recent clinical trials evaluating...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/01.mnh.0000242173.14082.dc
更新日期:2006-09-01 00:00:00
abstract:PURPOSE OF REVIEW:The renin-angiotensin-aldosterone system is an important modulator of renal salt excretion and arterial pressure. An important body of evidence now supports that angiotensin II (AngII) modulates the function of the renal sodium-chloride cotransporter (NCC), independently of aldosterone. Here we summar...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/MNH.0b013e32835571a4
更新日期:2012-09-01 00:00:00
abstract:PURPOSE OF REVIEW:Development of the mammalian kidney is a complex process involving numerous signals and signaling pathways. Other complex tissues have benefited enormously from studies in lower, simpler organisms. The present review provides an update on what we have learned from the fruitfly Drosophila melanogaster,...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/00041552-200301000-00003
更新日期:2003-01-01 00:00:00
abstract:PURPOSE OF REVIEW:African-Americans are more likely than Caucasians to develop hypertension-related end-stage renal disease. Elevations in blood pressure levels clearly potentiate pre-existing renal disease and also contribute to kidney injury independently of other primary renal diseases in this cohort. Until recently...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/00041552-200301000-00013
更新日期:2003-01-01 00:00:00
abstract:PURPOSE OF REVIEW:Fibrosis is an important biomarker of chronic kidney injury, and a powerful predictor of renal outcome. Currently, the only method for measuring fibrotic burden is histologic analysis, which requires a kidney biopsy in humans, or kidney removal in animal models. These requirements have not only hinder...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章
doi:10.1097/MNH.0000000000000650
更新日期:2020-11-01 00:00:00
abstract:PURPOSE OF REVIEW:The review will examine clinically relevant advances in the area of polycystic kidney disease (PKD), mainly focusing on autosomal dominant polycystic kidney disease (ADPKD). Discussion will focus on predicting the course of ADPKD, clinical trials and new research endeavors. RECENT FINDINGS:During the...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/MNH.0b013e32835011a7
更新日期:2012-03-01 00:00:00
abstract:PURPOSE OF REVIEW:In this review, we discuss how the genetic hypercalciuric stone-forming (GHS) rats, which closely model idiopathic hypercalciuria and stone formation in humans, provide insights into the pathophysiology and consequences of clinical hypercalciuria. RECENT FINDINGS:Hypercalciuria in the GHS rats is due...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/MNH.0000000000000130
更新日期:2015-07-01 00:00:00
abstract::Acute hypertension provokes a rapid decrease in proximal tubule salt and water reabsorption that increases the levels of sodium chloride at the macula densa, the error signal to increase arteriolar resistance to autoregulate renal blood flow and glomerular filtration rate, and contributes to pressure natriuresis. The ...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/00041552-200003000-00009
更新日期:2000-03-01 00:00:00
abstract::Recent investigations cast some doubts on the status of insulin resistance as a trigger in hyperinsulinemia-associated hypertension or obesity-related hypertension, or both. Major epidemiological studies have shown that central adiposity is a powerful risk factor for stroke or coronary artery disease when accompanied ...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/00041552-199501000-00010
更新日期:1995-01-01 00:00:00