E Ritz

..e. interference with proximal tubular reabsorption of protein) meanwhile has been well documented...

..Therefore, phosphate additives in food are a matter of concern, and their potential impact on health may well have been underappreciated...

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..Great progress has been made in providing algorithms to detect patients at risk and to identify interventions to reduce the risk...

..It broaches the important question of "salt hunger" of the vital role of salt in past times, a costly substance because it was indispensable, and the basis of a tax (the salt tax) which underlay the French Revolution...

..Currently sevelamer and lanthanum carbonate have been introduced and trivalent iron preparations are under development...

..Elucidating and correcting the cardiovascular risk is the most important challenge to clinical nephrology today...

..Alcohol consumption, according to some preliminary information, has a bimodal relationship to cardiovascular risk and progression, with moderate consumption being protective...

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..Clearly, isolated treatment of hypertension is no longer sufficient; risk factors and target organ damage need to be actively searched for and treated if long-term cardiovascular health is to be improved...

..This article summarizes the current hypotheses that link visceral obesity and kidney malfunction and provides information on the epidemiology and renal pathology resulting from visceral obesity...

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..However, it is possible, and indeed likely, that sodium plays an adverse role in the genesis of target organ damage in terminal renal failure...

..The Individualised Risk-profiling In DIabEtes Mellitus (IRIDIEM) study will provide evidence-based guidance in risk factor management, by assessing the efficacy of individualized interventions...

..Several points argue for ancillary treatment with beta-blockers: in CKD often four or more different antihypertensive drugs are required and cardiac indications are frequent...

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..Admittedly, in the absence of definite evidence in dialysis patients, we still conclude that the administration of statins is appropriate in patients with manifest coronary disease...

..In the past salt was essential to preserve food. The past importance of salt as a commodity can well be compared with that of oil today. These and further historical aspects of the role of salt are briefly dealt with in this article...

..Fifth, the pulse pressure profile is altered as a consequence of premature and accelerated aging causing stiffening of the aorta. Knowledge of these pathomechanisms is important for selection of appropriate antihypertensive treatment...

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..In patients with gastrointestinal intolerance to phosphate or with severely symptomatic bone disease, prolonged intravenous administration of Pi is necessary...

..Chronic dialysis treatment creates a particular "microcosmos" in which interpersonal relations and psychological problems carry particular weight...

..This review provides an in-depth discussion of the results of these studies and provides recommendations for patient management...

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..Epidemiologic information suggests that renal and cardiovascular outcome run parallel in this segment of the population...

..The Anemia CORrection in Diabetes (ACORD) Study aimed to investigate the effect of anemia correction on cardiac structure, function, and outcomes in patients with diabetes with anemia and early diabetic nephropathy...

..A major cause is an inappropriate erythropoietin response to anemia, often accompanied by iron deficiency and therapy with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers...

..In addition to blood pressure, proteinuria is a treatment target and should be reduced to below 1 g/24 h...

..This Review outlines the concept of prenatal programming and, in particular, describes its role in kidney disease and hypertension...

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..It is argued that the challenge for the future will be better patient management in earlier phases of diabetic nephropathy to attenuate or prevent progression, as well as cardiovascular complications...

..This form of FSGS represents the tip of an iceberg: a much broader spectrum of renal malfunction is linked to visceral obesity, which is closely connected to, but not completely identical with, the concept of 'metabolic syndrome'...

..The possible role of non muscular heavy chain type II isoform A protein which is associated with non diabetic chronic kidney disease in subjects of African ancestry remains to be determined...

..The effect of salt restriction cannot be reproduced by treatment with diuretics. Inappropriate increase of intrarenal angiotensin II and increased reactive oxygen species are the major culprits responsible for salt-related renal damage...

..In proteinuric diabetic nephropathy, renin-angiotensin system blockade is clearly indicated, but monotherapy is practically always insufficient to achieve target blood pressure values...

..The results of the prospective study of Verburg et al., sequentially measuring the growth of fetuses and the volume of their kidneys in a large population-based sample, identify some determinants of impaired growth of fetal kidneys...

..Classical risk factors cannot fully explain the magnitude of the risk. This article addresses some nontraditional approaches to deal with the excessive cardiovascular risk for patients who are on hemodialysis...

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..Still to be resolved, however, is the optimal dosage; several recent studies indicate that the dosage required for maximal blood pressure reduction is insufficient to provide maximal renoprotection...

..Current salt intake is too high. Current evidence documents that salt is crucial to the genesis of hypertension...

..Apart from blood pressure, proteinuria should be monitored and dosing of ACE inhibitors should be guided, also by reduction of protein excretion...

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..In conclusion, all-trans-RA influences the renal RAS in anti-Thy1.1 nephritis by decreasing ANG II synthesis and receptor expression. The beneficial effect of retinoids may be explained, at least in part, by reduction of RAS activity...

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..001). It is concluded that all-trans-RA limits glomerular proliferation, glomerular lesions, and albuminuria in an established model of renal damage. The findings point to retinoids as potential novel modulators of glomerular injury...

..The results support a role of ET-1 in the genesis of left ventricular capillary/myocyte mismatch in uremia...

..Thus it is very important to lower the nighttime blood pressure and to detect nighttime blood pressure increases using ambulatory blood pressure measurements...

..In kidneys of SNX rats, indirect evidence was found for increased activity of a reduced number of nerve fibers...

..To this end we compared the effects of an ET receptor A blocker (ETA-RB) with that of an ACE-inhibitor (ACE-i) or their combination in rats with Streptozotocin (STZ) diabetes...

..Retinoids may provide a novel therapeutic option for the treatment of glomerulonephritis...

..Our findings demonstrate that retinoids are potent inhibitors of the actions of Ang II on VSMCs. The findings support the notion that retinoids may interfere with proliferative vascular disease...

..In contrast, the diabetic SHR/N-cp exhibits marked structural lesions, particularly podocyte damage and mesangial expansion that promise to make it a more suitable model for investigation of diabetic glomerulosclerosis...

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..e. capillary/myocyte mismatch in experimental renal failure...

..This may be important because even within the normoalbuminuric range, higher rates of albuminuria are known to be associated with higher renal and cardiovascular risk...

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..Ongoing studies try to define the relative merits of high dose monotherapy (ACE inhibitors or angiotensin receptor blockers) versus a combination therapy of the two...

..It is concluded that the increased ET-R(B) and ET-1 mRNA and protein expression observed in animal models of renal disease is also demonstrable among patients with renal disease and high-grade proteinuria...

..The endogenous NO synthase inhibitor ADMA is significantly associated with progression of nondiabetic kidney diseases. Lowering plasma ADMA concentrations may be a novel therapeutic target to prevent progressive renal impairment...

..In conclusion, FGF23 is a novel independent predictor of progression of renal disease in patients with nondiabetic CKD. Its pathophysiological significance remains to be elucidated...

..In our opinion patients with proteinuria >1 g/day despite optimal blood pressure control under RAS-blocking monotherapy are a high-risk group which will presumably benefit from combination therapy...

..Further studies are required to determine whether reversal of anaemia has beneficial effects on microvascular and macrovascular diabetic complications, particularly cardiac disease, retinopathy and peripheral arterial disease...

..We conclude that lowering parathyroid hormone with a calcimimetic significantly improves cardiac histology and function but not the left ventricular mass in SNX...

..The current study on the apolipoprotein E -/- mouse was designed to investigate whether nephron reduction by uninephrectomy causes cardiac remodeling and whether this is prevented by antioxidative treatment...

..This finding is consistent with the notion that ET(A)-receptor mediated events play a partly BP-independent role in the genesis of CTN. Combination therapy exerts no additive nephroprotection...

..Recent evidence points to adverse effects of aldosterone on podocytes, mediated by reactive oxygen species and resulting from hypothetical stimulants of aldosterone synthesis by visceral adipocytes...

..The available experimental and clinical evidence to suggest such a pathophysiological role of sympathetic overactivity is summarized in this current review...

..Combining the AT1 blocker with mineralocorticoid receptor blockade failed to further increase the regression of glomerulosclerosis...

..These data suggest that in a model of type II diabetes, the dopamine D3-RA had a beneficial effect on renal morphology and albuminuria, which was comparable in magnitude to that of ACE-i treatment...

..Receptor-specific retinoids may provide a novel therapeutic approach for the treatment of chronic glomerulonephritis...

..This is particularly the case for podocyte changes pointing to angiotensin II-dependent pathomechanisms...

..Furthermore, it interferes with the development of cardiovascular risk factors and cardiac remodeling...

..CONCLUSIONS: These results are compatible with the notion that accumulation of the endogenous NO synthase inhibitor ADMA in senescent individuals is involved in the decrease of renal perfusion and increase of blood pressure...

..In this article, the consequences of hyperphosphatemia are reviewed, and recent developments in the treatment of the condition are discussed...

..These observations document that experimental renovascular hypertension induces a rapidly developing LVH characterized by marked cardiac remodeling and substantial loss of cadiomyocytes...

..Furthermore, intrauterine programming during organogenesis, e.g., by hyperglycemia, seems to be important: In animal experiments, offspring of either hyperglycemic or diabetic mothers have fewer nephrons...

..The results of the study will provide important information on the efficacy and safety of atorvastatin to support its use in patients with an impaired renal function who are at a high risk of vascular morbidity and mortality...

..We conclude that LD isotretinoin attenuates progressive renal damage, whereas HD isotretinoin cumulates and aggravates renal damage independent of blood pressure reduction...

..Several studies have provided encouraging evidence that antihypertensive therapy, particularly with angiotensin-converting enzyme inhibitors or calcium antagonists, can slow the progression of renal damage...

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..The sequelae of sympathetic overactivity extend beyond their effects on blood pressure and include accelerated progression of renal failure and presumably increased cardiac arrhythmia...

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..1+/-4 versus 32.5+/-1.4 mmol/kg; P=0.01). The calcimimetic R-568 causes an initial BP increase in sham-operated and uremic rats, which in uremic rats is followed by a marked and sustained antihypertensive effect...

..Renal injury induced by cigarette smoke condensate in this model is reversed by renal denervation. We conclude that cigarette smoke-induced renal damage is due, at least in part, to activation of the sympathetic nerve system...

..Further studies are indicated to define the potential use of retinoid agonists in inflammatory renal disease...

..Calcitriol and R-568 were similarly effective in ameliorating kidney damage...

..There is little documentation whether late referral is more frequent in the very elderly (> or =75 years) as compared with non-elderly patients and whether it contributes, at least in part, to their particularly poor outcome...

..The aim of the present study was to characterize aortic calcification in renal compared with non-renal patients...

..A more marked inflammatory response in renal patients is suggested by more frequent presence and greater intensity of markers of inflammation...

..Moreover, hypoadiponectinemia is a novel putative CV risk factor in patients with mild and moderate renal failure...

..However, the benefit of statins in such patients receiving hemodialysis, who are at high risk for cardiovascular disease and death, has not been examined...

..The latter observation has led to an "old for old" program in Europe...

..Numerous factors may trigger intra-uterine restriction of fetal growth, such as uterine underperfusion, maternal malnutrition, hyperglycaemia and hyperinsulinaemia of the mother, smoking or medications...

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