The systemic nature of CKD - PubMed (original) (raw)

Review

. 2017 Jun;13(6):344-358.

doi: 10.1038/nrneph.2017.52. Epub 2017 Apr 24.

Raymond Vanholder 2, Ziad A Massy 3 4 5 6 7, Alberto Ortiz 8, Pantelis Sarafidis 9, Friedo W Dekker 10, Danilo Fliser 11, Denis Fouque 12, Gunnar H Heine 11, Kitty J Jager 13, Mehmet Kanbay 14, Francesca Mallamaci 1 15, Gianfranco Parati 16, Patrick Rossignol 7 17 18 19 20, Andrzej Wiecek 21, Gerard London 22; European Renal and Cardiovascular Medicine (EURECA-m) Working Group of the European Renal Association – European Dialysis Transplantation Association (ERA-EDTA)

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Review

The systemic nature of CKD

Carmine Zoccali et al. Nat Rev Nephrol. 2017 Jun.

Abstract

The accurate definition and staging of chronic kidney disease (CKD) is one of the major achievements of modern nephrology. Intensive research is now being undertaken to unravel the risk factors and pathophysiologic underpinnings of this disease. In particular, the relationships between the kidney and other organs have been comprehensively investigated in experimental and clinical studies in the last two decades. Owing to technological and analytical limitations, these links have been studied with a reductionist approach focusing on two organs at a time, such as the heart and the kidney or the bone and the kidney. Here, we discuss studies that highlight the complex and systemic nature of CKD. Energy balance, innate immunity and neuroendocrine signalling are highly integrated biological phenomena. The diseased kidney disrupts such integration and generates a high-risk phenotype with a clinical profile encompassing inflammation, protein-energy wasting, altered function of the autonomic and central nervous systems and cardiopulmonary, vascular and bone diseases. A systems biology approach to CKD using omics techniques will hopefully enable in-depth study of the pathophysiology of this systemic disease, and has the potential to unravel critical pathways that can be targeted for CKD prevention and therapy.

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