Low serum magnesium as a risk factor for peripheral artery disease in chronic kidney disease:an open verdict

Contains fulltext : 229888.pdf (Publisher’s version ) (Open Access

Protein kinase signaling:Intracellular messengers as potential targets for intervention in renal disease

Het aantal patiënten met nierfalen is in de afgelopen decennia gestegen. Om nieuwe therapieën mogelijk te maken is het nodig om schadelijke mechanismen in de nier te ontdekken. Promovendus Martin de Borst onderzocht welke rol proteïne kinases spelen, de boodschappermoleculen binnen in cellen. Hij gebruikte een nieuwe technologie. Deze maakt het mogelijk de activiteit van duizenden proteïne kinases tegelijkertijd te bestuderen. Eerder werd de technologie alleen toegepast in gekweekte cellen en bloedcellen. De Borst toont aan dat deze nieuwe techniek ook bruikbaar is om beschadigde weefsels, in dit geval nierweef­sel, te onderzoeken

Dietary potassium and the kidney:lifesaving physiology

Potassium often has a negative connotation in Nephrology as patients with chronic kidney disease (CKD) are prone to develop hyperkalaemia. Approaches to the management of chronic hyperkalaemia include a low potassium diet or potassium binders. Yet, emerging data indicate that dietary potassium may be beneficial for patients with CKD. Epidemiological studies have shown that a higher urinary potassium excretion (as proxy for higher dietary potassium intake) is associated with lower blood pressure (BP) and lower cardiovascular risk, as well as better kidney outcomes. Considering that the composition of our current diet is characterized by a high sodium and low potassium content, increasing dietary potassium may be equally important as reducing sodium. Recent studies have revealed that dietary potassium modulates the activity of the thiazide-sensitive sodium-chloride cotransporter in the distal convoluted tubule (DCT). The DCT acts as a potassium sensor to control the delivery of sodium to the collecting duct, the potassium-secreting portion of the kidney. Physiologically, this allows immediate kaliuresis after a potassium load, and conservation of potassium during potassium deficiency. Clinically, it provides a novel explanation for the inverse relationship between dietary potassium and BP. Moreover, increasing dietary potassium intake can exert BP-independent effects on the kidney by relieving the deleterious effects of a low potassium diet (inflammation, oxidative stress and fibrosis). The aim of this comprehensive review is to link physiology with clinical medicine by proposing that the same mechanisms that allow us to excrete an acute potassium load also protect us from hypertension, cardiovascular disease and CKD