scholarly journals Antisense Oligonucleotide: A Potential Therapeutic Intervention for Chronic Kidney Disease

2022 ◽  
Vol 2 (1) ◽  
pp. 16-37
Author(s):  
Yalin Li ◽  
Yuqin Tan ◽  
Rui Zhang ◽  
Tao Wang ◽  
Ning Na ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Antisense Oligonucleotide ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Public Health Issue ◽  
Global Public Health ◽  
Converting Enzyme Inhibitors ◽  
Development Platform

Chronic kidney disease (CKD) is a global public health issue that places an increasing burden on the healthcare systems of both the developed and developing countries. CKD is a progressive and irreversible condition, affecting approximately 10% of the population worldwide. Patients that have progressed to end-stage renal disease (ESRD) require expensive renal replacement therapy, i.e., dialysis or kidney transplantation. Current CKD therapy largely relies on the use of angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs). However, these treatments by no means halt the progression of CKD to ESRD. Therefore, the development of new therapies is urgently needed. Antisense oligonucleotide (ASO) has recently attracted considerable interest as a drug development platform. Thus far, eight ASO-based drugs have been granted approval by the US Food and Drug Administration for the treatment of various diseases. Herein, we review the ASOs developed for the identification of CKD-relevant genes and/or the simultaneous development of the ASOs as potential therapeutics towards treating CKD.

Intraoperative Hyperkalemia

2018 ◽  
pp. 269-274
Author(s):  
M. Angele Theard ◽  
Alexandra Bastien
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Close Monitoring ◽  
Converting Enzyme Inhibitors ◽  
Renin Inhibitors ◽  
Increased Risk ◽  
Receptor Blockers

Patients with hypertension, diabetes, and heart disease are at risk for chronic kidney disease and therefore require close monitoring of potassium (K+) levels in order to avoid some of the more concerning consequences of hyperkalemia. Medical therapy in these patients, which often includes angiotensin converting enzyme inhibitors, angiotensin receptor blockers, renin inhibitors, and mineralocorticoid receptor antagonists, while helpful in managing some of the aforementioned comorbidities and ameliorating chronic kidney disease in these patients, places them at increased risk for unwanted K+ elevations. Symptoms of hyperkalemia maybe nonspecific (fatigue, weakness, and gastrointestinal upset), requiring attention therefore to preoperative laboratory analysis to avert the potentially lethal intraoperative consequences of hyperkalemia like asystole and ventricular fibrillation. Emergency surgery in these patients after trauma complicated by crush injury is particularly challenging requiring that the anesthesiologist be well-versed in recognizing the signs of and managing intraoperative hyperkalemia.

scholarly journals Eat Your Broccoli: Oxidative Stress, NRF2, and Sulforaphane in Chronic Kidney Disease

Nutrients ◽  
2021 ◽  
Vol 13 (1) ◽  
pp. 266
Author(s):  
Scott E. Liebman ◽  
Thu H. Le
Keyword(s):  
Oxidative Stress ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Enzyme Inhibitors ◽  
Therapeutic Potential ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme Inhibitors ◽  
Receptor Blockers ◽  
End Stage

The mainstay of therapy for chronic kidney disease is control of blood pressure and proteinuria through the use of angiotensin-converting enzyme inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs) that were introduced more than 20 years ago. Yet, many chronic kidney disease (CKD) patients still progress to end-stage kidney disease—the ultimate in failed prevention. While increased oxidative stress is a major molecular underpinning of CKD progression, no treatment modality specifically targeting oxidative stress has been established clinically. Here, we review the influence of oxidative stress in CKD, and discuss regarding the role of the Nrf2 pathway in kidney disease from studies using genetic and pharmacologic approaches in animal models and clinical trials. We will then focus on the promising therapeutic potential of sulforaphane, an isothiocyanate derived from cruciferous vegetables that has garnered significant attention over the past decade for its potent Nrf2-activating effect, and implications for precision medicine.

Pregnancy in patients with chronic kidney disease and on dialysis

2018 ◽  
Author(s):  
Kate Bramham ◽  
Catherine Nelson-Piercy
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Childbearing Age ◽  
Converting Enzyme Inhibitors ◽  
Blood Pressure Targets ◽  
Increased Risk

Chronic kidney disease (CKD) affects a small but increasing minority of women becoming pregnant. It is associated with additional risks depending on pre-pregnancy glomerular filtration rate, proteinuria, and hypertension. Some drugs are contraindicated in pregnancy. These are powerful reasons for counselling all women of childbearing age about pregnancy in CKD. With minor CKD the main issue is moderately increased risk of pregnancy-associated hypertension and pre-eclampsia. More advanced CKD is associated with reduced fertility, progressively increased risk of pre-term delivery and a significant chance of permanent loss of maternal renal function. Distinguishing pre-eclampsia from the natural effects of pregnancy on manifestations of CKD can be challenging. Blood pressure targets may be modified during pregnancy and angiotensin converting enzyme inhibitors and angiotensin receptor blockers are contraindicated. Dialysis may be initiated if pregnancy occurs at advanced levels of CKD. Pregnancy may also occur in patients on dialysis, usually in women with some residual native renal function. More intensive dialysis may improve outcomes.

Chronic Kidney Disease and Neurocognition

2019 ◽  
pp. 136-147
Author(s):  
David A. Drew ◽  
Daniel E. Weiner
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Neurocognitive Impairment ◽  
Cognitive Changes ◽  
Converting Enzyme Inhibitors ◽  
Receptor Blockers

Patients with kidney disease are at high risk for developing neurocognitive impairment. Declining kidney function and proteinuria are both strongly associated with a greater prevalence and severity of impairment. Cerebrovascular disease is thought to be the predominant pathophysiologic process underlying the association between kidney disease and neurocognitive impairment, although retention of uremic metabolites may also contribute. Use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers to reduce proteinuria in patients with chronic kidney disease may limit cognitive decline, although whether this is a result of slower kidney function decline is uncertain. Dialysis treatments mitigate cognitive changes specifically related to uremia but do not improve underlying neurocognitive impairment if present. Limited data indicate that kidney transplantation may result in improved cognitive function in many transplant recipients, suggesting a prominent role for a well-functioning kidney in neurocognitive function. Reflecting the underlying pathology, neurocognitive tests that include assessment of executive function are recommended for patients with kidney disease.

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