Diagnostic assessment of two-dimensional shear wave elastography in relation to dimethyl arginine levels in dogs with chronic kidney disease.

BACKGROUND: In veterinary medicine, previous studies regarding the diagnostic performance of shear wave elastography (SWE) in chronic kidney disease (CKD) are not consistent with each other. Moreover, there has been no study evaluating the relationship between symmetric dimethyl arginine (SDMA) concentration and renal shear wave velocity (SWV) using two-dimensional SWE (2D SWE) in dogs with CKD. OBJECTIVES: This study aimed to evaluate the diagnostic capability of 2D SWE in dogs with CKD and to assess the relationship between renal SWV and SDMA concentration. METHODS: Dogs with healthy kidneys and dogs with CKD underwent 2D SWE and SDMA assay. Renal stiffness was estimated as renal SWV in m/s. RESULTS: SDMA concentration had a weak positive correlation with the left (r = 0.338, p = 0.022) and right renal SWV (r = 0.337, p = 0.044). Renal SWV was not significantly different between healthy kidney and CKD groups in the left (p = 0.085) and right (p = 0.171) kidneys. CONCLUSIONS: 2D SWE may could not distinguish between dogs with healthy kidney and dogs with early stage of CKD, but it would be useful for assessing the serial change of renal function in dogs.

Complications Related to Childhood Idiopathic Nephrotic Syndrome, Its Treatment and the Associated Risks in Patients.

Aim Nephrotic syndrome is the most common childhood glomerular disorder, but data on the associated complications are limited and predisposing risk factors have not been fully defined. The aim of this study was to evaluate disease- and treatment-related acute and chronic complications in patients with childhood idiopathic nephrotic syndrome (INS), and to identify the risk factors involved in the development of complications. Methods This single-center study was performed at the pediatric nephrology department of a tertiary pediatric hospital in Turkey. The study included 411 patients with a diagnosis of childhood INS, 128 of whom had disease-related and treatment-related complications. Patients diagnosed and followed-up between January 2010 and January 2022 were evaluated retrospectively. Results Complications occurred in 31.1% of the 411 patients. Mean age at the time of diagnosis was 7.54 ± 4.37 years, and the male/female ratio was 0.9:1. Among the patients with complications, 96.9% were disease-related, and 50.8% were treatment-related complications. In older age, high proteinuria level, a low estimated glomerular filtration rate (eGFR) level at diagnosis, and female gender were significant risk factors for complication development (P = 0.000, P = 0.006, P = 0.04, and P = 0.07, respectively). Chronic kidney disease (CKD) developed in 7% of patients and 2.9% of patients had end-stage renal disease (ESRD). Additionally, three of 12 patients with progressive ESRD underwent transplantation. Also the incidence of ESRD was significantly higher in the patients with complications than in those without complications (P < 0.05). Conclusion The present findings suggest that careful monitoring of patients with childhood INS at risk for complications and implementation of personalized treatment programs can improve long-term outcomes, especially in patients that progress to ESRD and are followed-up with dialysis or transplantation as targeted therapy.

The Effect of Polyphenols on Kidney Disease: Targeting Mitochondria.

Mitochondrial function, including oxidative phosphorylation (OXPHOS), mitochondrial biogenesis, and mitochondria dynamics, are essential for the maintenance of renal health. Through modulation of mitochondrial function, the kidneys are able to sustain or recover acute kidney injury (AKI), chronic kidney disease (CKD), nephrotoxicity, nephropathy, and ischemia perfusion. Therapeutic improvement in mitochondrial function in the kidneys is related to the regulation of adenosine triphosphate (ATP) production, free radicals scavenging, decline in apoptosis, and inflammation. Dietary antioxidants, notably polyphenols present in fruits, vegetables, and plants, have attracted attention as effective dietary and pharmacological interventions. Considerable evidence shows that polyphenols protect against mitochondrial damage in different experimental models of kidney disease. Mechanistically, polyphenols regulate the mitochondrial redox status, apoptosis, and multiple intercellular signaling pathways. Therefore, this review attempts to focus on the role of polyphenols in the prevention or treatment of kidney disease and explore the molecular mechanisms associated with their pharmacological activity.

Presepsin as a Diagnostic and Prognostic Biomarker in Sepsis.

Sepsis is a condition characterized by high morbidity and mortality which is commonly encountered in an emergency and critical care setting. Despite a substantial body of research, the ideal biomarker for the diagnosis and prognostic stratification of septic patients remains unknown. This review aimed to summarize the publications referring to the validity of the biomarker presepsin when used for the detection, monitoring and prognosis in patients suffering with sepsis. This work is a narrative review based on a PubMed/Medline search conducted in order to identify all relevant publications referring to the use of presepsin in sepsis. Search was not limited by year of publication so all articles archived in the database would be retrieved. No article from before 2010 was identified. A total of 57 publications of the last decade were included, all of which support the use of presepsin as a biomarker for the assessment of septic patients. It has been used alone or in combination with commonly used biomarkers in the evaluation of patients with sepsis in settings such as the emergency department and the intensive care unit. It is useful in the initial workup of patients with suspected sepsis in the emergency setting and may be a predictive factor of mortality and the most severe complication of sepsis. Presepsin seems to be a valuable tool for the laboratory workup of sepsis, especially when used in conjunction with other biomarkers and clinical rating scores with an established role in this population. Further research is needed to evaluate the clinical implications of utilizing presepsin measurements in the workup of sepsis.

Analysis of structural components of decellularized scaffolds in renal fibrosis.

Chronic kidney disease has been recognized as a major public health problem worldwide and renal fibrosis is a common pathological process occurring in chronic renal failure. It is very promising to find the strategies to slow or even prevent the progression of fibrosis. This study focused on whether renal fibrosis decellularized scaffolds has the potential to be a model of cellular mechanisms of tissue fibrosis or donors for tissue engineering. In order to evaluate the feasibility of decellularized scaffolds derived from pathological kidneys, histology, proteomics and ELISA will be used to analysis the changes in the structure and main components of fibrotic tissue. The fibrosis model in this paper was induced by adenine-fed and the results showed that the structure of fibrotic scaffold was changed and some protein were up-regulated or down-regulated, but the cytokines associated with renal regeneration after injury were remained. In cell experiments, endothelial progenitor cells proliferated well, which proved that the fibrotic scaffolds have non-cytotoxic. All these conclusions indicate that the renal fibrosis decellularized scaffolds model has the ability to study fibrosis mechanism and the potential to be engineering donors as well as normal scaffolds.

Autosomal Dominant Polycystic Kidney Disease and Pericardial Effusion.

The autosomal dominant polycystic kidney disease (ADPKD) accounts for one out of 400-1000 live births, being a hereditary disorder with cystic and noncystic manifestations as well as extrarenal involvement. The pericardial effusion (PE) in the context of a patient with ADPKD is complex, and it is not entirely defined. Several theories have been proposed. The most accepted, so far, is linked to mutations in the PKD1 gene which can entail an abnormal production of matrix components, matrix-degrading enzymes, and inhibitors of metalloproteinases, and defects in connective tissue which would lead to an abnormal distensibility of the connective tissue. We report the case of a 35-year-old female Moroccan patient with the diagnosis of ADPKD associated with arterial hypertension who came into the Emergency Department with lower abdominal pain lasting for five days being diagnosed as salpingitis. Abdominal computed tomography scan with contrast showed both kidneys with several cystic images with a thin wall. A transthoracic echocardiogram revealed the presence of moderate PE more in the anterior aspect. A greater set of standard tests to rule out collagen vascular disease, rheumatoid diseases, autoimmune disorders, and malignancies was ordered. These tests yielded no abnormality. The association of ADPKD with PE is rare. The awareness of this connection by the emergency physicians is key to prevent misplaced concern.

Endothelial dysfunction in individuals born after fetal growth restriction: cardiovascular and renal consequences and preventive approaches.

Individuals born after intrauterine growth restriction (IUGR) have an increased risk of perinatal morbidity/mortality, and those who survive face long-term consequences such as cardiovascular-related diseases, including systemic hypertension, atherosclerosis, coronary heart disease and chronic kidney disease. In addition to the demonstrated long-term effects of decreased nephron endowment and hyperactivity of the hypothalamic-pituitary-adrenal axis, individuals born after IUGR also exhibit early alterations in vascular structure and function, which have been identified as key factors of the development of cardiovascular-related diseases. The endothelium plays a major role in maintaining vascular function and homeostasis. Therefore, it is not surprising that impaired endothelial function can lead to the long-term development of vascular-related diseases. Endothelial dysfunction, particularly impaired endothelium-dependent vasodilation and vascular remodeling, involves decreased nitric oxide (NO) bioavailability, impaired endothelial NO synthase functionality, increased oxidative stress, endothelial progenitor cells dysfunction and accelerated vascular senescence. Preventive approaches such as breastfeeding, supplementation with folate, vitamins, antioxidants, L-citrulline, L-arginine and treatment with NO modulators represent promising strategies for improving endothelial function, mitigating long-term outcomes and possibly preventing IUGR of vascular origin. Moreover, the identification of early biomarkers of endothelial dysfunction, especially epigenetic biomarkers, could allow early screening and follow-up of individuals at risk of developing cardiovascular and renal diseases, thus contributing to the development of preventive and therapeutic strategies to avert the long-term effects of endothelial dysfunction in infants born after IUGR.

Relationship between disease stage and renal function in bisphosphonate-related osteonecrosis of the jaw.

OBJECTIVES: Bisphosphonate is the primary cause of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Bisphosphonates are eliminated from the human body by the kidneys. It is anticipated that bisphosphonate levels in the body will increase if the kidney is in a weak state or if there is systemic disease that affects kidney function. The aim of this study was to analyze the relevance of renal function in the severity of BRONJ. MATERIALS AND METHODS: Ninety-three patients diagnosed with BRONJ in Pusan National University Dental Hospital from January 2012 to December 2014 were included in this study. All patients underwent a clinical exam, radiographs, and serologic lab test, including urine analysis. The patient's medical history was also taken, including the type of bisphosphonate drug, the duration of administration and drug holiday, route of administration, and other systemic diseases. In accordance with the guidelines of the 2009 position paper of American Association of Oral and Maxillofacial Surgeons, the BRONJ stage was divided into 4 groups, from stage 0 to 3, according to the severity of disease. IBM SPSS Statistics version 21.0 (IBM Co., USA) was used to perform regression analysis with a 0.05% significance level. RESULTS: BRONJ stage and renal factor (estimated glomerular filtration rate) showed a moderate statistically significant correlation. In the group with higher BRONJ stage, the creatinine level was higher, but the increase was not statistically significant. Other factors showed no significant correlation with BRONJ stage. There was a high statistically significant correlation between BRONJ stage and 'responder group' and 'non-responder group,' but there was no significant difference with the 'worsened group.' In addition, the age of the patients was a relative factor with BRONJ stage. CONCLUSION: With older age and lower renal function, BRONJ is more severe, and there may be a decrease in patient response to treatment.

NLRP3 inflammasome: A therapeutic option for kidney disease? / El inflamasoma NLRP3: ¿Es realmente una opción terapéutica para la enfermedad renal?

ABSTRACT Objective To determine if considering inflammasome NLRP3 as a treatment option for kidney disease is possible. Methods Literature review related to NLRP3 inflammasome structure, biological function and relationship with renal disease and others (hypertension, diabetes, gout, atherosclerosis, amyloidosis, Alzheimer's disease); the systematic review was made searching in the databases PubMed and SciELO for the following terms: "The NLRP3 inflammasome therapeutic for kidney disease", "NLRP3 nflammasome in kidney disease" in PubMed, and "Inflammasome" for Scielo. Results 146 documents were found, althoughonly 34 matched the working hypothesis concerning the NLRP3 inflammasome as a central component of various diseases in humans, with potential therapeutic use. The NLRP3 inflammasome is responsible for the maturation of inflammatory pro-interleukin IL-1 β and IL-18, which can be triggered by aggregated or crystalline materials (particles), and by various microorganisms and toxins derived from these; however, the way how activation mechanisms work is not completely clear. Conclusions Research on new therapies that focus on removing or inhibiting inflammasome components, both individually and together, is proposed.(AU)

RESUMEN Objetivo Determinar si el inflamasoma NLRP3 puede considerarse como opción de tratamiento para la enfermedad renal. Métodos Con el fin de encontrar bibliografía relacionada con la estructura del inflamasoma NLRP3, su función biológica y su relación con la enfermedad renal y otras (hipertensión, diabetes, gota, aterosclerosis, amiloidosis, enfermedad de Alzheimer), se realizó una revisión sistemática en dos bases de datos (PubMed y SciELO) con los términos: "NLRP3 inflammasome therapeutic for kidney disease" y "NLRP3 inflammasome in kidney disease" en PubMed, e "Iinflammasome" en SciELO. Resultados Se encontró un total de 146 documentos, de los cuales solo 34 concuerdan con la hipótesis de trabajo desarrollada con relación al inflamasoma NLRP3 como componente central de diversas enfermedades en seres humanos y con potencial uso terapéutico. El inflamasoma NLRP3 es responsable de la maduración de la interleucina inflamatoria pro-IL-1 β y IL-18, l cual puede darse por causa de materiales agregados o cristalinos (partículas), y por diversos microorganismos y toxinas derivadas de los mismos; sin embargo, los mecanismos de activación de este proceso siguen sin ser claros en la actualidad. Conclusiones Se propone estudiar nuevas terapias que se centren en la eliminación o inhibición de los componentes inflamasoma, de manera individual y conjunta.(AU)

Relationship between disease stage and renal function in bisphosphonate-related osteonecrosis of the jaw

OBJECTIVES: Bisphosphonate is the primary cause of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Bisphosphonates are eliminated from the human body by the kidneys. It is anticipated that bisphosphonate levels in the body will increase if the kidney is in a weak state or if there is systemic disease that affects kidney function. The aim of this study was to analyze the relevance of renal function in the severity of BRONJ. MATERIALS AND METHODS: Ninety-three patients diagnosed with BRONJ in Pusan National University Dental Hospital from January 2012 to December 2014 were included in this study. All patients underwent a clinical exam, radiographs, and serologic lab test, including urine analysis. The patient's medical history was also taken, including the type of bisphosphonate drug, the duration of administration and drug holiday, route of administration, and other systemic diseases. In accordance with the guidelines of the 2009 position paper of American Association of Oral and Maxillofacial Surgeons, the BRONJ stage was divided into 4 groups, from stage 0 to 3, according to the severity of disease. IBM SPSS Statistics version 21.0 (IBM Co., USA) was used to perform regression analysis with a 0.05% significance level. RESULTS: BRONJ stage and renal factor (estimated glomerular filtration rate) showed a moderate statistically significant correlation. In the group with higher BRONJ stage, the creatinine level was higher, but the increase was not statistically significant. Other factors showed no significant correlation with BRONJ stage. There was a high statistically significant correlation between BRONJ stage and ‘responder group’ and ‘non-responder group,’ but there was no significant difference with the ‘worsened group.’ In addition, the age of the patients was a relative factor with BRONJ stage. CONCLUSION: With older age and lower renal function, BRONJ is more severe, and there may be a decrease in patient response to treatment.

Factores de progresión de disfunción renal en diabéticos ingresados en Medicina Interna / Renal disease´s progression factors in diabetic people admitted in Internal Medicine

Introducción: la nefropatía diabética es un factor de riesgo para desarrollar eventos cardiovasculares. Debido a que si su presencia se establece se reduce el filtrado glomerular y se acelera la aterosclerosis. Existen muchos factores de progresión que comprometen aun más sus aspectos fisiopatológicos y el pronóstico. Objetivo: caracterizar factores de progresión de disfunción renal en diabéticos ingresados en el Servicio de Medicina Interna, período 2012 a 2013. Materiales y Métodos: se realizó un estudio descriptivo, transversal y observacional en diabéticos ingresados en Servicio de Medicina Interna, Hospital Militar de Matanzas, con menos de diez años de evolución, en el período de 2012 a 2013; con consentimiento informado de pacientes y Jefe del Servicio. Se caracterizó la función renal para detectar precozmente factores de progresión de nefropatía diabética, en cada uno, en cuanto a filtrado glomerular y microalbuminuria. Para ello se revisaron historias clínicas. Las variables de afectación renal con factores de riesgo de progresión, tanto clínicos como paraclínicos fueron: edad, microalbuminuria, alteraciones del filtrado glomerular, hiperuricemia, dislipidemia, hiperglucemia, nivel de tensión arterial, sedentarismo, dieta y hábitos tóxicos. Usando la planilla de recolección de datos y la representación mediante tablas, números y por ciento. Resultados: la hipertrigliceridemia, hiperuricemia e hiperglucemia constituyeron los más asociados a descenso del filtrado glomerular y microalbuminuria positiva con 94,44 %, 80,33 % y 48,24 % respectivamente; en tan solo diez años de evolución de la diabetes. Conclusiones: evidente presencia de factores de progresión de enfermedad renal crónica en pacientes diabéticos.

Introduction: Diabetic Nephropathy is a very important risk factor for the development of cardiovascular disorders. It´s related with glomerular filtrate reduction and atherosclerosis. Then also many renal disease´s progression factors affect their physiophatological aspects and the prognosis. Objective: To caracterize renal disease´s progression factors in diabetic people admitted in Internal Medicine period of 2012 to2013. Materials and Methods: A retrospective descriptive longitudinal study was carried out. The sample was formed by 496 patients entered in the Internal Medicine Service, Military Hospital of Matanzas, and they haved less than ten years of evolution of their illness, in the understood period of 2012 at 2013. The used variables of chronic renal disease´s progression factors were: age, microalbuminuria, glomerular filtrate, toxic habits, diet, sedentarism, blood pressure level, serum uric acid and lipid levels. For organizing the obtained indicators authors applied the descriptive statistic method, analyzing the information through distribution tables. The results were represented in numbers and percent. Results: The most associated renal disease´s progression factors were hypertrygliceridemia, hyperuricemia and hyperglucemia. They respectively showed about 94,44 %, 80,33 % and 48,24 %. They were also associated with the worst affectation on glomerular filtrate and microalbuminuria in less than ten years old of diabetes evolution. Conclusions: there is a high presence of chronic renal disease´s progression factors in diabetic people.

Chronic renal disease is not chronic kidney disease: implications for use of the QRISK and Joint British Societies risk scores.

BACKGROUND: Chronic kidney disease (CKD) is a major risk factor for cardiovascular disease (CVD) and European guidelines advocate assessment of CVD risk. QRISK and JBS3 risk calculators do not use the consensus definition of CKD stages 3-5 but instead use a definition referring to renal pathologies and CKD stages 4 and 5. Consequently, there is potential for doctors to misclassify their patients when using these risk calculators. OBJECTIVES: To quantify the number of people who may be affected by such misclassifications. METHODS: Database analysis using the Clinical Practice Research Datalink (CPRD).We identified 2512053 adults aged 25-84 without prior history of CVD on 1st January 2014. We identified those with 'chronic renal disease' and/or CKD by searching medical event history data. RESULTS: The study population was 48.7% male with mean age of 50.2 years. A total of 80718 had diagnostic READ codes for CKD stages 3, 4 or 5. Of these, 6585 individuals (8.2%) were classified as having 'chronic renal disease' according to the updated QRISK 2014, up from 3365 according to QRISK 2013. Whilst the updated QRISK definition of 'chronic renal disease' in total identified 62% more people than previously and had improved sensitivity for CKD stages 3 to 5, sensitivity remained poor (8.16%; 95% CI: 7.97-8.35%). CONCLUSION: Misuse of risk scores by general practitioners could result in clinically important differences in risk estimates. Users of risk scores should recognize the potential for error and developers should aim to label risk factors more clearly.

Factores de progresión de disfunción renal en diabéticos ingresados en Medicina Interna / Renal disease´s progression factors in diabetic people admitted in Internal Medicine

Introducción: la nefropatía diabética es un factor de riesgo para desarrollar eventos cardiovasculares. Debido a que si su presencia se establece se reduce el filtrado glomerular y se acelera la aterosclerosis. Existen muchos factores de progresión que comprometen aun más sus aspectos fisiopatológicos y el pronóstico.Objetivo: caracterizar factores de progresión de disfunción renal en diabéticos ingresados en el Servicio de Medicina Interna, período 2012 a 2013.Materiales y Métodos: se realizó un estudio descriptivo, transversal y observacional en diabéticos ingresados en Servicio de Medicina Interna, Hospital Militar de Matanzas, con menos de diez años de evolución, en el período de 2012 a 2013; con consentimiento informado de pacientes y Jefe del Servicio. Se caracterizó la función renal para detectar precozmente factores de progresión de nefropatía diabética, en cada uno, en cuanto a filtrado glomerular y microalbuminuria. Para ello se revisaron historias clínicas. Las variables de afectación renal con factores de riesgo de progresión, tanto clínicos como paraclínicos fueron: edad, microalbuminuria, alteraciones del filtrado glomerular, hiperuricemia, dislipidemia, hiperglucemia, nivel de tensión arterial, sedentarismo, dieta y hábitos tóxicos. Usando la planilla de recolección de datos y la representación mediante tablas, números y por ciento.Resultados: la hipertrigliceridemia, hiperuricemia e hiperglucemia constituyeron los más asociados a descenso del filtrado glomerular y microalbuminuria positiva con 94,44 %, 80,33 % y 48,24 % respectivamente; en tan solo diez años de evolución de la diabetes.Conclusiones: evidente presencia de factores de progresión de enfermedad renal crónica en pacientes diabéticos. (AU)

Introduction: Diabetic Nephropathy is a very important risk factor for the development of cardiovascular disorders. It´s related with glomerular filtrate reduction and atherosclerosis. Then also many renal disease´s progression factors affect their physiophatological aspects and the prognosis.Objective: To caracterize renal disease´s progression factors in diabetic people admitted in Internal Medicine period of 2012 to2013.Materials and Methods: A retrospective descriptive longitudinal study was carried out. The sample was formed by 496 patients entered in the Internal Medicine Service, Military Hospital of Matanzas, and they haved less than ten years of evolution of their illness, in the understood period of 2012 at 2013. The used variables of chronic renal disease´s progression factors were: age, microalbuminuria, glomerular filtrate, toxic habits, diet, sedentarism, blood pressure level, serum uric acid and lipid levels. For organizing the obtained indicators authors applied the descriptive statistic method, analyzing the information through distribution tables. The results were represented in numbers and percent. Results: The most associated renal disease´s progression factors were hypertrygliceridemia, hyperuricemia and hyperglucemia. They respectively showed about 94,44 %, 80,33 % and 48,24 %. They were also associated with the worst affectation on glomerular filtrate and microalbuminuria in less than ten years old of diabetes evolution.Conclusions: there is a high presence of chronic renal disease´s progression factors in diabetic people. (AU)

Chronic Kidney Disease Guideline Implementation in Primary Care: A Qualitative Report from the TRANSLATE CKD Study.

BACKGROUND: Primary care physicians (PCPs) are optimally situated to identify and manage early stage chronic kidney disease (CKD). Nonetheless, studies have documented suboptimal PCP understanding, awareness, and management of early CKD. The TRANSLATE CKD study is an ongoing national, mixed-methods, cluster randomized control trial that examines the implementation of evidence-based guidelines for CKD into primary care practice. METHODS: As part of the mixed-methods process evaluation, semistructured interviews were conducted by phone with 27 providers participating in the study. Interviews were audio-taped and transcribed. Thematic content analysis was used to identify themes. Themes were categorized according to the 4 domains of Normalization Process Theory (NPT). RESULTS: Identified themes illuminated the complex work undertaken to manage CKD in primary care practices. Barriers to guideline implementation were identified in each of the 4 NPT domains, including (1) lack of knowledge and understanding around CKD (coherence), (2) difficulties engaging providers and patients in CKD management (cognitive participation), (3) limited time and competing demands (collective action), and (4) challenges obtaining and using data to monitor progress (reflexive monitoring). CONCLUSIONS: Addressing the barriers to implementation with concrete interventions at the levels at which they occur, informed by NPT, will ultimately improve the quality of CKD patient care.

BMP-7 Signaling and its Critical Roles in Kidney Development, the Responses to Renal Injury, and Chronic Kidney Disease.

Chronic kidney disease (CKD) is a significant health problem that most commonly results from congenital abnormalities in children and chronic renal injury in adults. The therapeutic potential of BMP-7 was first recognized nearly two decades ago with studies demonstrating its requirement for kidney development and ability to inhibit the pathogenesis of renal injury in models of CKD. Since this time, our understanding of CKD has advanced considerably and treatment strategies have evolved with the identification of many additional signaling pathways, cell types, and pathologic processes that contribute to disease progression. The purpose of this review is to revisit the seminal studies that initially established the importance of BMP-7, highlight recent advances in BMP-7 research, and then integrate this knowledge with current research paradigms. We will provide an overview of the evolutionarily conserved roles of BMP proteins and the features that allow BMP signaling pathways to function as critical signaling nodes for controlling biological processes, including those related to CKD. We will discuss the multifaceted functions of BMP-7 during kidney development and the potential for alterations in BMP-7 signaling to result in congenital abnormalities and pediatric kidney disease. We will summarize the renal protective effects of recombinant BMP-7 in experimental models of CKD and then propose a model to describe the potential physiological role of endogenous BMP-7 in the innate repair mechanisms of the kidneys that respond to renal injury. Finally, we will highlight emerging clinical approaches for applying our knowledge of BMP-7 toward improving the treatment of patients with CKD.

Hepatitis C infection and chronic renal diseases.

Hepatitis C virus (HCV) infection and chronic renal diseases can be linked in two different ways. Some forms of renal disease are precipitated by HCV infection, while patients with end-stage renal disease are at increased risk for acquiring HCV infection. Patients with chronic HCV infection and renal disease have a poor prognosis. Most studies on treatment of HCV and renal diseases have been uncontrolled trials with small number of subjects. So, there is a lack of evidence-based recommendations and guidelines on the management of this condition. In this review, we will attempt to provide the most recent insights on HCV infection both as a extrahepatic manifestations and as a complication of end-stage renal patients.