title: Clinical value of natriuretic peptides in chronic kidney disease.
abstract: According to several lines of evidence, natriuretic peptides (NP) are the main components of a cardiac-renal axis that operate in clinical conditions of decreased cardiac hemodynamic tolerance to regulate sodium homeostasis, blood pressure and vascular function. Even though it is reasonable to assume that NP may exert a relevant role in the adaptive response to renal mass ablation, evidence gathered so far suggest that this contribution is probably complex and dependent on the type and degree of the functional mass loss. In the last years NP have been increasingly used to diagnose, monitor treatment and define the prognosis of several cardiovascular (CV) diseases. However, in many clinical settings, like chronic kidney disease (CKD), the predictive value of these biomarkers has been questioned. In fact, it is now well established that renal function significantly affects the plasmatic levels of NP and that renal failure is the clinical condition associated with the highest plasmatic levels of these peptides. The complexity of the relation between NP plasmatic levels and CV and renal functions has obvious consequences, as it may limit the predictive value of NP in CV assessment of CKD patients and be a demanding exercise for clinicians involved in the daily management of these patients. This review describes the role of NP in the regulatory response to renal function loss and addresses the main factors involved in the clinical valorization of the peptides in the context of significant renal failure.
authors: Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Center and Nephrology and Infectious Diseases Research and Development Group, INEB (I3S) Faculty of Medicine, University of Porto, Porto, Portugal. Electronic address: csaraujo@med.up.pt.
authors: Carla
authors: C
authors: Santos-Araújo
authors: Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Center, Faculty of Medicine, University of Porto, Porto, Portugal.
authors: Adelino
authors: A
authors: Leite-Moreira
authors: Nephrology and Infectious Diseases Research and Development Group, INEB (I3S) and Department of Renal, Urologic and Infectious Diseases, Faculty of Medicine, University of Porto, Porto, Portugal.
authors: Manuel
authors: M
authors: Pestana
mesh_terms: D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000150:complications / Q000503:physiopathology; D006801:Humans; D007668:Kidney / Q000473:pathology / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy; D016030:Kidney Transplantation; D045265:Natriuretic Peptides / Q000097:blood* / Q000502:physiology; D009392:Nephrectomy; D009929:Organ Size; D011237:Predictive Value of Tests; D011379:Prognosis; D006435:Renal Dialysis / Q000379:methods; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000503:physiopathology
chemical_list: D015415:Biomarkers; D045265:Natriuretic Peptides
keywords: B-type natriuretic peptide; Chronic kidney disease (CKD); Dialysis; Diálisis; Enfermedad renal crónica (ERC); Heart failure; Insuficiencia cardiaca; N-terminal-pro-BNP; Pro-BNP aminoterminal; Péptido natriurético tipo B