Treatment for Kidney Diseases

• "Clinical Trials."\n\nIn 2011 "BMJ" asked clinicians about the usefulness of clinical trials and the extent to which they felt there were issues and recommendations relating to clinical trial reporting. The responses are also reported in the tables here:\n\nThese tables are based on clinical trials reported to The Centers for Medicare and Medicaid Services (CMS) between January 1, 2000 and December 31, 2009. (See ) For the sake of simplicity, information for clinical trials published before 2000 and after 2009 was not examined.

The causes of kidney disease are multifactorial in origin, but the majority of kidney diseases are due to a combination of environmental factors and genetic predisposition.

In a recent survey, the prevalence of kidney diseases in the USA is estimated at about 13% for the 15-65 year age group, with a higher prevalence in men than women (36% vs 11%). Kidney diseases cause major functional and physical limitation in the elderly, costing billions of dollars in medical expenses nationwide. Furthermore, kidney disease related mortality in the US population is 5 times higher than in China despite having roughly one half the population.

The treatments of kidney diseases are highly varying, partly due to differences in pathophysiology, severity of disease, and severity of comorbid conditions. Thus treatment in order to be effective would need to be tailored to the symptoms and underlying pathophysiology of each specific patient. However, some treatments are common for certain indications, such as in chronic kidney disease, and some treatments for specific indications exist, such as blood pressure medication for hypertension.

Although the severity of the disease depends on the type of kidney diseases, when renal dysfunction is in progress, it is often reflected peripherally by signs and symptoms such as fatigue and lethargy, weight gain, anemia, anorexia, malaise, and oliguria. Other signs that indicate severe kidney disease are low urine output (oliguria), decreased urine concentration (>100 mOsm/kg), edema, swelling (e.g., ascites, pleural effusion), abnormal visual field, and thrombocytopenia. Although nonspecific signs can be an indication of severe kidney disease, no single symptom can accurately predict the progress of a patient with renal disease.

Chronic kidney disease is often reversible once treatment is initiated. The rate of remission/cure increases as the underlying disease or disorder is eliminated. The long-term kidney survival is the same as it would be for healthy individuals of the same age.

Recent findings of this study showed that people with chronic kidney diseases' life quality improved after treatment due to improvements in their body image and self-esteem.

Results from a recent clinical trial contribute to a broad literature on the treatment of renal disease, and to clarify some important aspects of treatment for renal diseases. Our analyses provide information on the factors influencing the choice of treatment in the kidney care environment. In particular, our findings contribute to the evidence base for the use of a number of medications used in patients with kidney problems, and demonstrate that treatments for renal disease vary widely from one clinical practice setting to another.

The most recent research shows only marginal evidence regarding some kidney diseases (cancer, acute kidney injury and chronic kidney disease) on which we do not need to draw more conclusions because at this time there is no evidence of a benefit to patients. New data may provide additional indications for initiation of treatment, but more research is still lacking. This information will be helpful in the decision making of clinicians and patients.

The current paradigm is that most patients with glomerulonephritis will have a good outcome with current treatments and will eventually not require renal replacement therapy. A newer framework is that the majority of patients with glomerulonephritis will have a poor outcome and that renal replacement therapy will be required in the majority of cases. Clinicians should be aware of this paradigm shift and the changes that are going to play critical roles in the practice of nephrology in the future.

Most common side effects of rituximab included flu-like illness, fatigue, anemia, and an increased risk of serious infection. Treatment-related side effects were more severe in patients with higher B-cell counts. The incidence of side effects in children was similar to that in adults.