Carmine Zoccali

Renal ischemia by atherosclerotic renal disease (ARD) is one of the main causes of end stage renal disease. This disease, when bilateral and severe, may precipitate flashing pulmonary oedema and therefore, further increase the cardiovascular (CV) burden of patients with advanced atherosclerotic complications. This week we have three nice lectures focusing on NMR as a screening technique to identify patients that may favourably respond to renal revascularization, on the usefulness of ARD screening in patients with coronary heart disease (CHD) and on the high risk associated with reno-vasculopathies. Dr Philip Kalra (Salford, UK) emphasises that dynamic magnetic resonance (MR) imaging can predict which kidneys will improve after revascularization. In presenting these intriguing new findings, he wisely cautions on the risk posed by gadolinium containing contrast. Dr. Johannes Mann (Munich, Germany) is adamant in stating that to date there is still no convincing evidence for recommending screening for renal artery stenosis in all patients with CHD or heart failure. He recommends a conservative approach limiting screening to patients who manifest a decrease in the GFR with inhibition of the renin system, to those with flash pulmonary oedema and to those with drug resistant hypertension. Finally, Dr. David Goldsmith (London, UK)  presents the whole spectrum of cardiovascular disease in patients with renovasculopathies and nicely recapitulates possible treatments in these high risk patients.

This week I propose a new poll related with serum creatinine measurement. This is a major issue for chronic kidney disease (CKD) detection and screening and having a feed-back from the NDTe readership will be very useful for understanding which steps should be undertaken to maximise the yields of a well thought application of this fundamental indicator of renal function in public health terms.

Enjoy your NDTe!

Carmine Zoccali – Editor in Chief NDT-Educational