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Advances in the Diagnosis and Management of Renal Diseases

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Guest Editor
Department of Nephrology and Transplantation Medicine - University Clinical Hospital Jan Mikulicz Radecki, Borowska 213, 50-556, Wrocław, Poland
Interests: kidney stones; arterial hypertension; renal hypertension; urination disorders; cysts nephropathy; glomerulonephritis; proteinuria, hematuria; diabetic kidney disease; polycystic kidney disease; urinary tract infections; cystitis; pyelonephritis; chronic kidney disease; transplant kidney; renal failure; edema; acidosis; metabolic disorders; hyperparathyroidism; nephrocalcinosis; abnormal GFR
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Guest Editor
Department of Pediatric Nephrology, Wroclaw Medical University, Wybrzeże L. Pasteura 1, 50-367 Wrocław, Poland
Interests: acute kidney injury; biomarkers in nephrology; CAKUT; obstructive uropathy; vesico-ureteral reflux; hemolytic uremic syndrome; idiopathic/congenital/infantile nephrotic syndrome; primary glomerulopathies; chronic kidney disease; hemodialysis; peritoneal dialysis; transition medicine; hypertension
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The last decade has seen a number of advances in the diagnostics and management of glomerulopathies, interstitial and hypertensive nephropathy, kidney stone disease, vasculitis, and diabetic kidney disease.

Since the progressive loss of functioning renal tissue may result from a number of different disturbances (congenital hypoplasia or obstructive uropathy with or without associated infections, other anomalies, polycystic kidneys, chronic pyelonephritis, glomerulonephritis, etc.), an exact diagnosis is essential for the establishment of appropriate therapy.

With a few exceptions, invasive diagnostics—namely, a kidney biopsy—are currently required for the precise diagnosis of many chronic kidney diseases. In order to effectively develop personalized medicine for renal diseases, we urgently need to develop highly accurate biomarkers for use in the clinic, since the current biomarkers of kidney damage (creatinine and/or urine albumin excretion) apply to later stages of the disease. A promising non-invasive approach is urinary proteome analysis, which has the potential to identify various types of renal disease. Renal failure, a consequence of renal disease progression, is among the most deadly and economically costly diseases faced by patients and modern society. Despite this, there are relatively few new therapies in development for the treatment of renal disease. Multiple factors have contributed to the diminishing interest in pharmaceutical investment for the field of renal disease: many costly phase 3 trials have failed to provide improved renal outcomes, and the awareness of renal diseases remains poor among patients, physicians, and payers. Nevertheless, several therapeutics remain in development for the treatment of CKD, including mineralocorticoid-receptor antagonists, sodium/glucose cotransporter 2 inhibitors, anti-inflammatory drugs, and drugs that mitigate oxidative injury.

The success of the future management of renal disease will depend not only on an improved understanding of disease pathogenesis but also on increasing the awareness of this disease among the public and the greater medical community, as well as quick diagnostics and appropriate treatment.

Prof. Dr. Mariusz A. Kusztal
Prof. Dr. Kinga Musiał
Guest Editors

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Keywords

  • chronic kidney disease
  • glomerulonephritis
  • biomarkers
  • kidney biopsy
  • treatment

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Published Papers (4 papers)

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Research

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13 pages, 1506 KiB  
Article
Evaluation of Active Renin Concentration in A Cohort of Adolescents with Primary Hypertension
by Anna Deja, Piotr Skrzypczyk, Magdalena Nowak, Małgorzata Wrońska, Michał Szyszka, Anna Ofiara, Justyna Lesiak-Kosmatka, Anna Stelmaszczyk-Emmel and Małgorzata Pańczyk-Tomaszewska
Int. J. Environ. Res. Public Health 2022, 19(10), 5960; https://doi.org/10.3390/ijerph19105960 - 13 May 2022
Cited by 1 | Viewed by 1830
Abstract
Our study aimed to assess active renin concentration in children with primary hypertension. Thus, we evaluated active renin concentration, clinical parameters, office and ambulatory blood pressure, and biochemical parameters in 51 untreated adolescents with primary hypertension (median: 14.4 [interquartile range—IQR: 13.8–16.8] years) and [...] Read more.
Our study aimed to assess active renin concentration in children with primary hypertension. Thus, we evaluated active renin concentration, clinical parameters, office and ambulatory blood pressure, and biochemical parameters in 51 untreated adolescents with primary hypertension (median: 14.4 [interquartile range—IQR: 13.8–16.8] years) and 45 healthy adolescents. Active renin concentration did not differ between patients with hypertension and healthy children (median: 28.5 [IQR: 21.9–45.2] vs. 24.9 [IQR: 16.8–34.3] [pg/mL], p = 0.055). In the whole group of 96 children, active renin concentration correlated positively with serum potassium and office and ambulatory systolic and diastolic blood pressures. Among children with hypertension, patients with isolated systolic hypertension had lower renin concentration than patients with systolic-diastolic hypertension (26.2 [IQR: 18.6–34.2] vs. 37.8 [IQR: 27.0–49.6] [pg/mL], p = 0.014). The active renin concentration did not differ between patients with isolated systolic hypertension and healthy children. In multivariate analysis, diastolic blood pressure Z-score (beta = 0.238, 95 confidence interval [0.018–0.458], p = 0.035) was the only predictor of active renin concentration in the studied children. We concluded that active renin concentration is positively associated with blood pressure and potassium in children, and diastolic blood pressure was the strongest predictor of renin level. Patients with isolated systolic hypertension may differ from patients with systolic-diastolic hypertension in less severe activation of the renin-angiotensin-aldosterone system. Full article
(This article belongs to the Special Issue Advances in the Diagnosis and Management of Renal Diseases)
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12 pages, 532 KiB  
Article
Investigation of the Relationship between Lean Muscle Mass and Erythropoietin Resistance in Maintenance Haemodialysis Patients: A Cross-Sectional Study
by Wen-Fang Chiang, Po-Jen Hsiao, Kun-Lin Wu, Hung-Ming Chen, Chi-Ming Chu and Jenq-Shyong Chan
Int. J. Environ. Res. Public Health 2022, 19(9), 5704; https://doi.org/10.3390/ijerph19095704 - 7 May 2022
Cited by 3 | Viewed by 1988
Abstract
Each patient undergoing maintenance haemodialysis (MHD) has a different response to erythropoiesis-stimulating agents (ESAs). Haemodilution due to fluid overload has been shown to contribute to anaemia. Body mass index (BMI) has been shown to influence ESA response in dialysis patients; however, BMI calculation [...] Read more.
Each patient undergoing maintenance haemodialysis (MHD) has a different response to erythropoiesis-stimulating agents (ESAs). Haemodilution due to fluid overload has been shown to contribute to anaemia. Body mass index (BMI) has been shown to influence ESA response in dialysis patients; however, BMI calculation does not distinguish between fat and lean tissue. The association between lean muscle mass and erythropoietin hyporesponsiveness is still not well-known among MHD patients. We designed a cross-sectional study and used bioimpedance spectroscopy (BIS) to analyse the relationship between body composition, haemoglobin level, and erythropoietin resistance index (ERI) in MHD patients. Seventy-seven patients were enrolled in the study group. Compared with patients with haemoglobin ≥ 10 g/dL, those with haemoglobin < 10 g/dL had higher serum ferritin levels, malnutrition–inflammation scores (MIS), relative overhydration, ESA doses, and ERIs. In multivariate logistic regression, higher ferritin levels and MIS were the only predictors of lower haemoglobin levels. The ERI was significantly positively correlated with age, Kt/V, ferritin levels, and MIS and negatively correlated with albumin levels, BMI, and lean tissue index (LTI). Multivariate linear regression analysis revealed that ferritin levels, BMI, and LTI were the most important predictors of ERI. In MHD patients, using BIS to measure body composition can facilitate the development of early interventions that aim to prevent sarcopenia, support ESA responsiveness, and, consequently, improve anaemia management. Full article
(This article belongs to the Special Issue Advances in the Diagnosis and Management of Renal Diseases)
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11 pages, 1016 KiB  
Article
Renal Function in Patients with Cystic Fibrosis: A Single-Center Study
by Marta Rachel, Sabina Galiniak, Marek Biesiadecki and Agnieszka Gala-Błądzińska
Int. J. Environ. Res. Public Health 2022, 19(9), 5454; https://doi.org/10.3390/ijerph19095454 - 29 Apr 2022
Cited by 3 | Viewed by 2406
Abstract
Cystic fibrosis (CF) is the most common incurable autosomal recessive disease affecting the Caucasian population. As the prognosis for life extension of CF patients improves, co-morbidities, including kidney disease, become more common. Identifying those at the highest risk of kidney injury is therefore [...] Read more.
Cystic fibrosis (CF) is the most common incurable autosomal recessive disease affecting the Caucasian population. As the prognosis for life extension of CF patients improves, co-morbidities, including kidney disease, become more common. Identifying those at the highest risk of kidney injury is therefore extremely important. The aim of this study was to evaluate the biomarkers of renal function in 50 CF patients using the estimated glomerular filtration rate (eGFR) based on creatinine and cystatin C equation as well as serum creatinine (sCr), serum cystatin C (CysC), serum urea and urinary neutrophil gelatinase-associated lipocalin (uNGAL) concentrations. sCr, CysC, urea and uNGAL were estimated. eGFR was calculated according to the CKD-EPI formula. CysC was significantly increased, while eGFR was significantly lower in the CF group than in the controls (p < 0.001 and p < 0.01, respectively). There was no significant difference in the sCr, urea and uNGAL concentrations between patients with CF and healthy subjects. For the purpose of our analysis, in order to assess renal function in patients with CF in clinical practice, the concentration of serum CysC and eGFRCKD-EPI should be determined. Patients with CF presented with renal function impairment pictured by increased serum CysC and decreased eGFR values compared to controls. Unchanged uNGAL concentrations suggested preserved tubular function despite aminoglycoside treatment. Further prospective studies are needed to clarify whether kidney impairment observed in the course of CF progresses. Full article
(This article belongs to the Special Issue Advances in the Diagnosis and Management of Renal Diseases)
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Review

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12 pages, 7048 KiB  
Review
Cognitive Impairment in End Stage Renal Disease Patients Undergoing Hemodialysis: Markers and Risk Factors
by Piotr Olczyk, Mariusz Kusztal, Tomasz Gołębiowski, Krzysztof Letachowicz and Magdalena Krajewska
Int. J. Environ. Res. Public Health 2022, 19(4), 2389; https://doi.org/10.3390/ijerph19042389 - 18 Feb 2022
Cited by 21 | Viewed by 3599
Abstract
(1) Background: Cognitive impairment (CI) is common in chronic kidney disease (CKD) and patients treated with hemodialysis. (2) Methods: The systematic review was prepared following the PRISMA statement (2013). The biomedical electronic databases MEDLINE and SCOPUS were searched. (3) Results: out of 1093 [...] Read more.
(1) Background: Cognitive impairment (CI) is common in chronic kidney disease (CKD) and patients treated with hemodialysis. (2) Methods: The systematic review was prepared following the PRISMA statement (2013). The biomedical electronic databases MEDLINE and SCOPUS were searched. (3) Results: out of 1093 studies, only 30, which met problem and population criteria, were included in this review. The risk factors for CI can be divided into three groups: traditional risk factors (present in the general population), factors related to dialysis sessions, and nontraditional risk factors occurring more frequently in the HD group. (4) Conclusions: the methods of counteracting CI effective in the general population should also be effective in HD patients. However, there is a need to develop unique anti-CI approaches targeting specific HD risk factors, i.e., modified hemodialysis parameters stabilizing cerebral saturation and blood flow. Full article
(This article belongs to the Special Issue Advances in the Diagnosis and Management of Renal Diseases)
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