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1.
Curr Opin Nephrol Hypertens ; 32(1): 41-48, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36250456

RESUMO

PURPOSE OF REVIEW: Paediatric kidney disease results in considerable burden on children and their families. Paediatric palliative care is a holistic, family-centred care approach intended to enable flourishing and address the many impediments to life participation which advanced kidney disease can impose. To date, palliative care resources have been underutilized in paediatric nephrology. This review will highlight recent literature targeting the engagement and life participation of children with advanced kidney disease through implementation of novel palliative care approaches and propose directions for future research. RECENT FINDINGS: Children with advanced kidney disease and their families highly value incorporation of their perspectives, particularly on life participation, within care plan development; but what it means to participate in life can be variable, and clinicians need improved tools to ascertain and incorporate these perspectives. Novel palliative care interventions developed for application in comparable disease states offer potential opportunities for paediatric nephrologists to support this goal. SUMMARY: Children with advanced kidney disease and their families will benefit from incorporation of their perspectives and values, facilitated by palliative interventions.


Assuntos
Nefropatias , Nefrologia , Medicina Paliativa , Criança , Humanos , Cuidados Paliativos/métodos , Nefropatias/diagnóstico , Nefropatias/terapia
4.
Medicine (Baltimore) ; 101(39): e30807, 2022 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-36181057

RESUMO

RATIONALE: Hematomas after percutaneous angiography often occur in the thigh, retroperitoneal, intraperitoneal, or abdominal wall. Renal hematoma after percutaneous angiography is very rare. DIAGNOSES: Herein, we present a case of perirenal hematoma and delayed contrast metabolism after cerebral angiograph, which may be caused by improper operation. INTERVENTIONS: Conservative treatments which development by multi-disciplinary collaboration. OUTCOMES: After treatment, the clinical symptoms of the patients gradually disappeared and the imaging results became negative. CONCLUSION: Though the patient missed timely diagnosis and treatment, fortunately no catastrophic events occurred. Meanwhile, the potential causes, diagnosis, and therapeutic management were all discussed.


Assuntos
Hematoma , Nefropatias , Angiografia , Hemorragia Gastrointestinal/complicações , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Hematoma/terapia , Humanos , Nefropatias/diagnóstico por imagem , Nefropatias/etiologia , Nefropatias/terapia , Espaço Retroperitoneal
6.
Dtsch Med Wochenschr ; 147(21): 1398-1406, 2022 10.
Artigo em Alemão | MEDLINE | ID: mdl-36174584

RESUMO

Kidney disease represents an increasing global health problem. Its mitigation requires effective communication between all stakeholders involved in assessment, diagnosis and therapy and individuals affected by kidney disease. However, as of today the nomenclature for kidney function and kidney disease is far from uniform. In 2019, the international non-profit organization Kidney Disease: Improving Global Outcomes (KDIGO) has implemented a consensus process to develop a glossary in English language to standardize the nomenclature for kidney function, kidney structure and kidney disease. Guiding principles for this process were (1) precision, (2) patient-centeredness and (3) consistency with KDIGO guidelines. The current position paper includes a translation of this nomenclature into German that was developed on behalf of the national societies for nephrology in Germany, Austria and Switzerland.


Assuntos
Nefropatias , Nefrologia , Humanos , Nefropatias/terapia , Rim , Alemanha , Prognóstico
8.
G Ital Nefrol ; 39(4)2022 Aug 29.
Artigo em Italiano | MEDLINE | ID: mdl-36073338

RESUMO

This interview describes the numerous and important contributions that Vito Cagli, who was born in Ancona in 1926, has given to the Italian Nephrology and to other fields of Medicine. These contributions, that are very poorly known today, were produced especially in the years in which Cagli worked as deputy director of the Centre for the Investigation and Treatment of Hypertension and Renal Diseases at Policlinico Hospital Umberto I in Rome. This interview also describes the early phase of Italian Nephrology before the introduction in our country of renal biopsy and of hemodialysis.


Assuntos
Hipertensão , Nefropatias , Nefrologia , Humanos , Itália , Nefropatias/terapia , Nefrologistas
9.
Toxins (Basel) ; 14(9)2022 09 06.
Artigo em Inglês | MEDLINE | ID: mdl-36136562

RESUMO

Chronic kidney disease (CKD) is projected to become the fifth global cause of death by 2040 as a result of key shortcomings in the current methods available to diagnose and treat kidney diseases. In this regard, the novel holobiont concept, used to describe an individual host and its microbial community, may pave the way towards a better understanding of kidney disease pathogenesis and progression. Microbiota-modulating or -derived interventions include probiotics, prebiotics, synbiotics and postbiotics. As of 2019, the concept of postbiotics was updated by the International Scientific Association of Probiotics and Prebiotics (ISAPP) to refer to preparations of inanimate microorganisms and/or their components that confer a health benefit to the host. By explicitly excluding purified metabolites without a cellular biomass, any literature making use of such term is potentially rendered obsolete. We now review the revised concept of postbiotics concerning their potential clinical applications and research in kidney disease, by discussing in detail several formulations that are undergoing preclinical development such as GABA-salt for diet-induced hypertension and kidney injury, sonicated Lactobacillus paracasei in high fat diet-induced kidney injury, GABA-salt, lacto-GABA-salt and postbiotic-GABA-salt in acute kidney injury, and O. formigenes lysates for hyperoxaluria. Furthermore, we provide a roadmap for postbiotics research in kidney disease to expedite clinical translation.


Assuntos
Nefropatias , Probióticos , Simbióticos , Humanos , Nefropatias/etiologia , Nefropatias/terapia , Prebióticos , Probióticos/uso terapêutico , Ácido gama-Aminobutírico
10.
BMJ Open ; 12(8): e062392, 2022 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-35940837

RESUMO

OBJECTIVE: To determine intervention effects and synthesise qualitative research that explored women with or at high risk of kidney disease experiences of shared decision-making in relation to their reproductive health, family planning options and pregnancy. DESIGN: A systematic review of interventions and a qualitative evidence synthesis. DATA SOURCES: We searched Cochrane, CINAHL, MEDLINE, Scopus, ProQuest, Elsevier, PubMed, ScienceDirect and Web of Science. ELIGIBILITY CRITERIA: Shared decision-making interventions and qualitative studies related to reproductive health involving women with or at high risk of kidney disease published from 1980 until January 2021 in English (clinical settings, global perspective). DATA EXTRACTION AND SYNTHESIS: Titles were screened against the inclusion criteria and full-text articles were reviewed by the whole team. Framework synthesis was undertaken. RESULTS: We screened 1898 studies. No evidence-based interventions were identified. 18 qualitative studies were included, 11 kidney disease-specific studies and 7 where kidney disease was a common comorbidity. Women frequently felt unprepared and uninformed about their reproductive options. Conversations with healthcare professionals were commonly described as frustrating and unhelpful, often due to a perceived loss of autonomy and a mismatch in preferences and life goals. Examples of shared decision-making were rare. Kidney disease exacerbated societal expectations of traditional gender roles (eg, wife, mother, carer) including capability to have children and associated factors, for example, parenting, (sexual) relationships, body image and independent living (including financial barriers to starting a family). Local interventions were limited to types of counselling. A new health system model was developed to support new interventions. CONCLUSION: There is a clear need to establish new interventions, test those already in development and develop new clinical guidance for the management of women with or at high risk of kidney disease in relation to their reproductive health, including options to preserve fertility earlier. Other health conditions with established personalised reproductive care packages, for example, cancer, could be used to benchmark kidney practice alongside the new model developed here.


Assuntos
Serviços de Planejamento Familiar , Nefropatias , Criança , Feminino , Pessoal de Saúde , Humanos , Nefropatias/terapia , Gravidez , Pesquisa Qualitativa , Saúde Reprodutiva
11.
Int J Nanomedicine ; 17: 3603-3618, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35990308

RESUMO

Globally, kidney disease has become a serious health challenge, with approximately 10% of adults suffering with the disease, and increasing incidence and mortality rates every year. Small extracellular vesicles (sEVs) are 30 nm-100 nm sized nanovesicles released by cells into the extracellular matrix (ECM), which serve as mediators of intercellular communication. Depending on the cell origin, sEVs have different roles which depend on internal cargoes including, nucleic acids, proteins, and lipids. Mesenchymal stem cell (MSCs) exert anti-inflammatory, anti-aging, and wound healing functions mainly via sEVs in a stable and safe manner. MSC-derived sEVs (MSC-sEVs) exert roles in several kidney diseases by transporting renoprotective cargoes to reduce oxidative stress, inhibit renal cell apoptosis, suppress inflammation, and mediate anti-fibrosis mechanisms. Additionally, because MSC-sEVs efficiently target damaged kidneys, they have the potential to become the next generation cell-free therapies for kidney disease. Herein, we review recent research data on how MSC-sEVs could be used to treat kidney disease.


Assuntos
Vesículas Extracelulares , Nefropatias , Células-Tronco Mesenquimais , Terapia Baseada em Transplante de Células e Tecidos , Vesículas Extracelulares/metabolismo , Humanos , Nefropatias/terapia , Células-Tronco Mesenquimais/metabolismo , Cicatrização
12.
Arch. esp. urol. (Ed. impr.) ; 75(6): 524-531, Aug. 28, 2022. tab, graf, ilus
Artigo em Espanhol | IBECS | ID: ibc-209632

RESUMO

Minimally invasive techniques for the treatment and diagnosis of kidney disease seek to preserve the greatest amount of parenchyma. Bleeding after these practices is rare, but must be treated quickly given its severity. Iatrogenic renal vascular injuries (IRVI) resulting from these procedures include active bleeding, arterial pseudoaneurysms, and arteriovenous fistulas. Renal artery embolization (RAE) is the main pillar in the treatment of this type of complications. Objective: To assess the results of RAE for the treatment of IRVI and its impact on the renal function of patients. Method: Retrospective analysis of all patients who presented vascular complications after renal procedures and who were referred for management by RAE, between August 2012 and December 2020. Results: 18 patients were included. 4 patients presented with pseudoaneurysm, 10 patients with active bleeding, and 1 patient with arteriovenous fistula; 2 patients had a combination of different IRVI; 1 patient did not present any findings at the time of renal angiography in dissonance with her computed tomography angiography. Technical and clinical success was achieved in all patients. One renal artery dissection was the only complication. No differences were found in serum creatinine (p = 0.51), urea (p = 0.37), hemoglobin (p = 0.26) and hematocrit (p = 0.24) after embolization. Conclusion: EAR is a safe and effective method for the treatment of IRVI, achieving a very high technical and clinical success rate with a low incidence of complications and without significant repercussions on the renal function of patients (AU)


Las técnicas miniinvasivas para tratamiento y diagnóstico de la patología renal, buscan preservar la mayorcantidad de parénquima. Los sangrados posteriores a estasprácticas son de rara presentación, pero deben ser tratadosrápidamente dada su gravedad. Las lesiones iatrogénicasvasculares (LIV) renales derivadas de estos procedimientos incluyen sangrados activos, pseudoaneurismas arteriales y fistulas arteriovenosas. La embolización arterial renal (EAR) es el principal pilar en el tratamiento de este tipode complicaciones.Objetivo: Evaluar los resultados de la EAR para eltratamiento de LIV y su impacto en la función renal de lospacientes.Método: Análisis retrospectivo de todos los pacientesque presentaron complicaciones vasculares posteriores aprocedimientos renales y que fueron derivados para manejomediante EAR, entre agosto de 2012 y diciembre de 2020.Resultados: Se incluyeron 18 pacientes. 4 pacientesdebutaron con pseudoaneurisma, 10 pacientes con sangradoactivo y 1 paciente con fístula arteriovenosa; 2 pacientestenían combinación de diferentes LIV; 1 paciente no presento ningún hallazgo al momento de la angiografía renalen disonancia con su angio-TC. El éxito técnico y clínicose logró en todos los pacientes. Una disección de arteriarenal fue la única complicación. No se encontraron diferencias en la creatinina sérica (p = 0,51), urea (p = 0,37),hemoglobina (p = 0,26) y hematocrito (p = 0,24) despuésde la embolización.Conclusión: La EAR es un método segúro y eficazpara el tratamiento de LIV, alcanzando una tasa de éxitotécnico y clínico muy alta con una baja incidencia de complicaciones y sin repercusiones significativas sobre la función renal de los pacientes. (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Embolização Terapêutica , Procedimentos Endovasculares , Nefropatias/terapia , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/terapia , Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Fístula Arteriovenosa/etiologia , Fístula Arteriovenosa/terapia , Resultado do Tratamento , Doença Iatrogênica
13.
Int J Biochem Cell Biol ; 149: 106262, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35787447

RESUMO

Exosomes are the self-packed nanoscale vesicles (nanovesicles) derived from late endosomes and released from the cells to the extracellular milieu. Exosomal biogenesis is based on endosomal pathway to form the nanovesicles surrounded by membrane originated from plasma membranes of the parental cells. During biogenesis, exosomes selectively encapsulate an array of biomolecules (proteins, nucleic acids, lipids, metabolites, etc.), thereby conveying diverse messages for cell-cell communications. Once released, these exosomal contents trigger signaling and trafficking that play roles in cell growth, development, immune responses, homeostasis, remodeling, etc. Recent advances in exosomal research have provided a wealth of useful information that enhances our knowledge on the roles for exosomes in pathogenic mechanisms of human diseases involving a wide variety of organ systems. In the kidney, exosomes play divergent roles, ranging from pathogenesis to therapeutics, based on their original sources and type of interventions. Herein, we summarize and update the current knowledge on the divergent roles of exosomes involving the pathogenesis, diagnostics, prognostics, and therapeutics in various groups of kidney diseases, including acute kidney injury, immune-mediated kidney diseases (e.g., IgA nephropathy, lupus nephritis, membranous nephropathy, focal segmental glomerulosclerosis), chronic kidney disease (caused by diabetic nephropathy and others), renal cell carcinoma, nephrolithiasis, kidney transplantation and related complications, and polycystic kidney disease. Finally, the future perspectives on research in this area are discussed.


Assuntos
Injúria Renal Aguda , Exossomos , Nefropatias , Insuficiência Renal Crônica , Injúria Renal Aguda/metabolismo , Exossomos/metabolismo , Humanos , Rim/patologia , Nefropatias/diagnóstico , Nefropatias/etiologia , Nefropatias/terapia , Prognóstico , Insuficiência Renal Crônica/metabolismo
15.
Adv Chronic Kidney Dis ; 29(2): 141-148.e1, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35817521

RESUMO

Sickle cell disease causes several kidney manifestations. They include defects in urine concentration, impaired handling of potassium and hydrogen ion, albuminuria, acute kidney injury, and chronic kidney disease to name a few. Glomerular hyperfiltration, tubular hyperfunctioning, endothelial damage from repeated sickling and vaso-occlusive episodes, and iron-induced proinflammatory changes in the glomerular mesangium and tubulointerstitium are some of the mechanisms of kidney damage. Albuminuria is one of the most and common clinical features of kidney disease and progresses with age. Kidney disease in patients with sickle cell is associated with increased mortality. Annual screening for proteinuria starting at age 10 years and limiting the use of nonsteroidal anti-inflammatory agents and the use of angiotensin-converting enzyme inhibitors may help in early detection and delaying the progression of kidney disease. Adequate hydration, angiotensin-converting enzyme inhibitors, and adequate control of sickle cell are the main stay of treatment for albuminuria. The hemoglobin goal for patients with sickle cell nephropathy is lesser (10 g/dL) than that for patients with chronic kidney disease due to other causes given that a higher hemoglobin level increases viscosity and the risk of precipitating vaso-occlusive episodes. A multidisciplinary approach is recommended for managing patients with sickle cell and kidney diseases.


Assuntos
Anemia Falciforme , Nefropatias , Insuficiência Renal Crônica , Albuminúria/complicações , Albuminúria/tratamento farmacológico , Anemia Falciforme/tratamento farmacológico , Anemia Falciforme/terapia , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Criança , Taxa de Filtração Glomerular , Hemoglobinas , Humanos , Rim , Nefropatias/complicações , Nefropatias/terapia , Insuficiência Renal Crônica/complicações
16.
Adv Chronic Kidney Dis ; 29(2): 86-102.e1, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35817530

RESUMO

Monoclonal gammopathies occur secondary to a broad range of clonal B lymphocyte or plasma cell disorders, producing either whole or truncated monoclonal immunoglobulins. The kidneys are often affected by these monoclonal proteins, and, although not mutually exclusive, can involve the glomeruli, tubules, interstitium, and vasculature. The nephrotoxic potential of these monoclonal proteins is dependent on a variety of physicochemical characteristics that are responsible for the diverse clinicopathologic manifestations, including glomerular diseases with organized deposits, glomerular diseases with granular deposits, and other lesions, such as C3 glomerulopathy and thrombotic microangiopathy with unique pathophysiologic features. The diseases that involve primarily the tubulointerstitial and vascular compartments are light chain cast nephropathy, light chain proximal tubulopathy, crystal-storing histiocytosis, and crystalglobulin-induced nephropathy with distinct acute and chronic clinicopathologic features. The diagnosis of a monoclonal gammopathy-related kidney disease is established by identification of an underlying active or more commonly, low-grade hematologic malignancy, serologic evidence of a monoclonal gammopathy when detectable, and most importantly, monoclonal protein-induced pathologic lesions seen in a kidney biopsy, confirming the association with the monoclonal protein. Establishing a diagnosis may be challenging at times, particularly in the absence of an overt hematologic malignancy, with or without monoclonal gammopathy, such as proliferative glomerulonephritis with monoclonal immunoglobulin deposits. Overall, the treatment is directed against the underlying hematologic disorder and the potential source of the monoclonal protein.


Assuntos
Glomerulonefrite , Neoplasias Hematológicas , Nefropatias , Paraproteinemias , Glomerulonefrite/diagnóstico , Glomerulonefrite/etiologia , Glomerulonefrite/terapia , Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/patologia , Humanos , Rim/metabolismo , Nefropatias/diagnóstico , Nefropatias/etiologia , Nefropatias/terapia , Glomérulos Renais/patologia , Paraproteinemias/complicações , Paraproteinemias/diagnóstico , Paraproteinemias/terapia
17.
Semin Nephrol ; 42(2): 185-196, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35718365

RESUMO

There is increasing understanding that a multifaceted interplay of sex-dependent genetic and immune dysregulation underpins the development of glomerular disorders. Regional and ethnic variations in glomerular disease incidence make delineating the effects of sex and gender on disease pathophysiology more complex, but there is a marked paucity of research in this area. This review article presents a summary of the current understanding of sex and gender in glomerular disease, highlighting the broader effects of sex and gender on autoimmunity, clinical presentations, and pathophysiology of individual glomerular diseases, as well as exploring sex, gender, and glomerular disease within a wider socioenvironmental context. It is important to specifically consider the effects of sex and gender when presenting and analyzing clinical and scientific studies on glomerular disease. Failure to do so risks promoting disparities within health care provision, neglecting opportunities to identify sex-specific biomarkers, and potentially hindering the development of sex-specific therapies.


Assuntos
Glomerulonefrite , Nefropatias , Autoimunidade , Feminino , Glomerulonefrite/epidemiologia , Glomerulonefrite/terapia , Humanos , Incidência , Nefropatias/epidemiologia , Nefropatias/terapia , Glomérulos Renais , Masculino
19.
Adv Chronic Kidney Dis ; 29(1): 76-82, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-35690408

RESUMO

The Executive Order on Advancing American Kidney Health aimed to slow the progression of kidney disease, increase access to kidney transplantation, and expand home dialysis. In order to support the kidney health strategy laid out by the Advancing American Kidney Health, the National Institutes of Health, the National Institute of Diabetes, and Digestive, and Kidney Diseases, as well as other funding agencies must dedicate robust research funding to kidney disease. Currently, federal research investment for kidney health is less than 1% of Medicare fee-for-service expenditures for Americans with kidney disease. To address disparities in federal research funding, nephrology organizations are working together to advocate for increased federal commitment to kidney disease research. Underfunding of kidney disease research impedes scientific opportunities and innovation and prevents the collaboration of young investigators with research faculty that can accelerate the exodus of talent within the nephrology research workforce. This review provides an overview of the current state of federal research funding for kidney disease within the United States. In addition, we discuss ongoing advocacy efforts and programs that aim to increase federal funding for kidney-related research and accelerate the development of new and better therapies.


Assuntos
Objetivos , Nefropatias , Idoso , Humanos , Rim , Nefropatias/terapia , Medicare , National Institutes of Health (U.S.) , Estados Unidos
20.
Can J Urol ; 29(3): 11190-11193, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35691043

RESUMO

Subcapsular renal hematoma (SRH) is an infrequent complication of urologic interventions but can lead to serious consequences in patients with a solitary kidney. We present our experience with conservative management of a patient with a solitary kidney and multiple medical comorbidities who developed a SRH and subsequent renal failure after nephroureteral catheter placement. Literature on the management of this unique clinical scenario is limited. Herein, we share our experience with supportive care and temporary dialysis in a medically complex patient whose outcome is complete renal recovery.


Assuntos
Injúria Renal Aguda , Nefropatias , Rim Único , Injúria Renal Aguda/etiologia , Tratamento Conservador , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Hematoma/terapia , Humanos , Rim , Nefropatias/complicações , Nefropatias/terapia , Rim Único/complicações
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