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Sample records for renal disease services

  1. [Hypertension and renal disease

    DEFF Research Database (Denmark)

    Kamper, A.L.; Pedersen, E.B.; Strandgaard, S.

    2009-01-01

    hypertension. Mild degrees of chronic kidney disease (CKD) can be detected in around 10% of the population, and detection is important as CKD is an important risk factor for atherosclerotic cardiovascular disease. Conversely, heart failure may cause an impairment of renal function. In chronic progressive...

  2. Screening and management practices for renal disease in the HIV-positive patient population of an inner metropolitan sexual health service.

    Science.gov (United States)

    Kakar, Sheena; Drak, Douglas; Amin, Tahiya; Cheung, Jason; O'Connor, Catherine C; Gracey, David M

    2017-02-01

    Renal disease is an important and commonly encountered co-morbidity in HIV infection. Despite this, few data are available concerning renal disease in this patient group. A retrospective review was conducted of all HIV-positive patients of an inner metropolitan sexual health service who attended from 1 August 2013 to 31 July 2014 for HIV management. One hundred eighty-eight HIV-positive patients attended the clinic during the study period. The majority were male (96%), Caucasian (70%) and 30-39 years of age (37%). There was a high prevalence of renal risk factors in the population, including potentially nephrotoxic antiretroviral therapy (61%), smoking (38%), hypertension (12%), dyslipidemia (11%) and hepatitis C co-infection (7%). In the previous year, measurements of estimated glomerular filtration rate were performed in all patients, but measurements of lipid profiles, urinary protein and serum phosphate were performed within the last year in only 48%, 33% and 30% of patients, respectively. These are the first comprehensive data regarding renal disease, associated risk factors and screening and management practices in the HIV-positive patient population of a specialized sexual health service in Australia. This patient population demonstrates a particularly high prevalence of risk factors for renal disease. Despite this, screening investigations were not performed as recommended. This represents a potential area to improve patient care.

  3. Hyperparathyroidism of Renal Disease

    Science.gov (United States)

    Yuen, Noah K; Ananthakrishnan, Shubha; Campbell, Michael J

    2016-01-01

    Renal hyperparathyroidism (rHPT) is a common complication of chronic kidney disease characterized by elevated parathyroid hormone levels secondary to derangements in the homeostasis of calcium, phosphate, and vitamin D. Patients with rHPT experience increased rates of cardiovascular problems and bone disease. The Kidney Disease: Improving Global Outcomes guidelines recommend that screening and management of rHPT be initiated for all patients with chronic kidney disease stage 3 (estimated glomerular filtration rate, < 60 mL/min/1.73 m2). Since the 1990s, improving medical management with vitamin D analogs, phosphate binders, and calcimimetic drugs has expanded the treatment options for patients with rHPT, but some patients still require a parathyroidectomy to mitigate the sequelae of this challenging disease. PMID:27479950

  4. 42 CFR 441.40 - End-stage renal disease.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false End-stage renal disease. 441.40 Section 441.40... General Provisions § 441.40 End-stage renal disease. FFP in expenditures for services described in subpart A of part 440 is available for facility treatment of end-stage renal disease only if the...

  5. Renal disease in pregnancy.

    Science.gov (United States)

    Thorsen, Martha S; Poole, Judith H

    2002-03-01

    Anatomic and physiologic adaptations within the renal system during pregnancy are significant. Alterations are seen in renal blood flow and glomerular filtration, resulting in changes in normal renal laboratory values. When these normal renal adaptations are coupled with pregnancy-induced complications or preexisting renal dysfunction, the woman may demonstrate a reduction of renal function leading to an increased risk of perinatal morbidity and mortality. This article will review normal pregnancy adaptations of the renal system and discuss common pregnancy-related renal complications.

  6. Nutrition and renal disease.

    Directory of Open Access Journals (Sweden)

    Iris de Castaño

    2009-11-01

    Full Text Available Kidney plays an important roll in body homeostasis through excretory, metabolic and endocrine functions. Kidneys filter fluids and solutes and reabsorbed water , electrolytes an minerals. Urine volume and solute excretion are adjusted to keep composition of the extracellular space, serum osmolarity and intravascular volume in constant balance. Kidneys also regulate acid base equilibrium, hormone metabolism and excretion and amino acid concentration. Vitamin D hydroxylation takes place in the kidney, this is the active form of this vitamin, which inhibits PTH. In addition they produce erythropoietin which control hemoglobin concentration in erythrocytes. When renal insufficiency develops, and glormerular filtration rate is between 50 to 75% of normal, this functions are decreased .When renal function is less than 10%, this functions ceased. In children small changes in water, solute, acid base, calcium and phosphorus can alter normal growth and development. If kidneys can not maintain internal equilibrium, specific nutrients should be used. Compensation should be done according to age, type or renal disease and level of glomerular filtration rate.

  7. Chronic renal disease in pregnancy.

    Science.gov (United States)

    Ramin, Susan M; Vidaeff, Alex C; Yeomans, Edward R; Gilstrap, Larry C

    2006-12-01

    The purpose of this review was to examine the impact of varying degrees of renal insufficiency on pregnancy outcome in women with chronic renal disease. Our search of the literature did not reveal any randomized clinical trials or meta-analyses. The available information is derived from opinion, reviews, retrospective series, and limited observational series. It appears that chronic renal disease in pregnancy is uncommon, occurring in 0.03-0.12% of all pregnancies from two U.S. population-based and registry studies. Maternal complications associated with chronic renal disease include preeclampsia, worsening renal function, preterm delivery, anemia, chronic hypertension, and cesarean delivery. The live birth rate in women with chronic renal disease ranges between 64% and 98% depending on the severity of renal insufficiency and presence of hypertension. Significant proteinuria may be an indicator of underlying renal insufficiency. Management of pregnant women with underlying renal disease should ideally entail a multidisciplinary approach at a tertiary center and include a maternal-fetal medicine specialist and a nephrologist. Such women should receive counseling regarding the pregnancy outcomes in association with maternal chronic renal disease and the effect of pregnancy on renal function, especially within the ensuing 5 years postpartum. These women will require frequent visits and monitoring of renal function during pregnancy. Women whose renal disease is further complicated by hypertension should be counseled regarding the increased risk of adverse outcome and need for blood pressure control. Some antihypertensives, especially angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers, should be avoided during pregnancy, if possible, because of the potential for both teratogenic (hypocalvaria) and fetal effects (renal failure, oliguria, and demise).

  8. Drug-induced renal disease.

    Science.gov (United States)

    Curtis, J R

    1979-11-01

    The clinical manifestations of drug-induced renal disease may include all the manifestations attributed to natural or spontaneous renal diseases such as acute renal failure, chronic renal failure, acute nephritic syndrome, renal colic, haematuria, selective tubular defects, obstructive nephropathy, etc. It is therefore vital in any patient with renal disease whatever the clinical manifestations might be, to obtain a meticulous drug and toxin inventory. Withdrawal of the offending drug may result in amelioration or cure of the renal disorder although in the case of severe renal failure it may be necessary to utilise haemodialysis or peritoneal dialysis to tide the patient over the period of acute renal failure. Analgesic nephropathy is an important cause of terminal chronic renal failure and it is therefore vital to make the diagnosis as early as possible. The pathogenesis of some drug-induced renal disorders appears to be immunologically mediated. There are many other pathogenetic mechanisms involved in drug-induced renal disorders and some drugs may under appropriate circumstances be responsible for a variety of different nephrotoxic effects. For example, the sulphonamides have been incriminated in examples of crystalluria, acute interstitial nephritis, acute tubular necrosis, generalised hypersensitivity reactions, polyarteritis nodosa and drug-induced lupus erythematosus.

  9. Impact of a renal drug dosing service on dose adjustment in hospitalized patients with chronic kidney disease.

    Science.gov (United States)

    Hassan, Yahaya; Al-Ramahi, Rowa' J; Aziz, Noorizan Abd; Ghazali, Rozina

    2009-10-01

    Appropriate drug selection and dosing for patients with chronic kidney disease (CKD) is important to avoid unwanted drug effects and ensure optimal patient outcomes. To assess the rate of inappropriate dosing in patients with CKD in a nephrology unit and to evaluate the impact on dose adjustment, adverse drug events (ADEs), and drug cost of having a pharmacist accompany a team of physicians on their rounds. This was a comparative study with a preintervention and postintervention design. The preintervention phase served as the control; it was prospective and observational only and was conducted from the beginning of February to the end of May 2007. The second phase (intervention phase) was conducted from the beginning of March to the end of June 2008. Two random samples of 300 patients with an estimated creatinine clearance less than or equal to 50 mL/min were included. During the intervention phase, a clinical pharmacist made rounds with the nephrology unit team and gave dosing adjustment recommendations when needed. A collection of reliable and up-to-date drug information references that are commonly used globally were used during the intervention. In the preintervention group, drug dosage adjustment or avoidance, based on renal function, was necessary in 607 of 2814 (21.6%) prescriptions. Of these, 322 (53.0%) did not comply with guidelines. In the intervention group, adjustment was necessary for 640 of 2981 (21.5%) prescriptions. The pharmacist made 388 recommendations related to dosing adjustment, 212 (54.6%) of which were accepted by physicians. Clinicians' noncompliance with dosing guidelines decreased to 176 (27.5%) (p < 0.001). In the preintervention group, 64 (21.3%) patients had a suspected ADE, with a total of 73 events. In the intervention group, this number was significantly lower with 49 events in 48 (16.0%) patients (p < 0.05). The intervention resulted in drug cost savings of $2250 US. A renal drug dosing service for patients hospitalized with CKD

  10. Renal Disease and Adult Vaccination

    Science.gov (United States)

    ... Resources for Healthcare Professionals Renal Disease and Adult Vaccination Recommend on Facebook Tweet Share Compartir Vaccines are ... have immunity to this disease Learn about adult vaccination and other health conditions Asplenia Diabetes Type 1 ...

  11. Spectrum of pediatric renal diseases in dubai.

    Science.gov (United States)

    Abou-Chaaban, M; Al Murbatty, B; Majid, M A

    1997-01-01

    A total of 712 patients with renal problems, aged 13 years or below (mean age 4.12 years) were seen in the Department of Health and Medical Services Hospitals in Dubai in the period from 1991 to 1996. The male to female ratio was 1:1.1. UAE citizens constituted 32% of the total, with a male to female ratio of 1:1.2. Nephrotic syndrome (26.3%) had the highest prevalence among the renal diseases seen, followed by urinary tract infection (19.1%), glomerulonephritis (GN) (9.7%), congenital renal anomalies (9.7%), and chronic renal failure (CRF) (7%). Congenital renal anomalies were the main cause of CRF in our patients followed by GN. Acute renal failure (ARF) occurred in 1.4% of the patients and was not an alarming problem; it had an uncomplicated course and good prognosis. Continuous ambulatory peritoneal dialysis was the mode of replacement therapy for patients with end-stage renal disease. Eight patients underwent renal transplantation; one cadaver donor, four living non-related donor (abroad) and three living related donor.

  12. Management of renal disease in pregnancy.

    Science.gov (United States)

    Podymow, Tiina; August, Phyllis; Akbari, Ayub

    2010-06-01

    Although renal disease in pregnancy is uncommon, it poses considerable risk to maternal and fetal health. This article discusses renal physiology and assessment of renal function in pregnancy and the effect of pregnancy on renal disease in patients with diabetes, lupus, chronic glomerulonephritis, polycystic kidney disease, and chronic pyelonephritis. Renal diseases occasionally present for the first time in pregnancy, and diagnoses of glomerulonephritis, acute tubular necrosis, hemolytic uremic syndrome, and acute fatty liver of pregnancy are described. Finally, therapy of end-stage renal disease in pregnancy, dialysis, and renal transplantation are reviewed.

  13. Renal calculus disease.

    Science.gov (United States)

    Schulsinger, D A; Sosa, R E

    1998-03-01

    We have seen an explosion in technical innovations for the management of urolithiasis. Today, the endourologist possesses an assortment of minimally invasive tools to treat renal stones. Most patients receive fast, safe and effective treatment in the outpatient setting. Despite the many technical advances, however, anatomical malformations and complex stones still provide significant challenges in diagnosis, access to a targeted stone, fragmentation, and clearance of the resulting fragments. This review examines a variety of urinary stone presentations and treatment strategies for cost-effective management.

  14. End-Stage Renal Disease Prospective Payment System

    Data.gov (United States)

    U.S. Department of Health & Human Services — This final rule implements a case-mix adjusted bundled prospective payment system (PPS) for Medicare outpatient end-stage renal disease (ESRD) dialysis facilities...

  15. End-Stage Renal Disease (ESRD) Quality Initiative

    Data.gov (United States)

    U.S. Department of Health & Human Services — The End Stage Renal Disease (ESRD) Quality Initiative promotes ongoing CMS strategies to improve the quality of care provided to ESRD patients. This initiative...

  16. Acute renal dysfunction in liver diseases

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Renal dysfunction is common in liver diseases, either as part of multiorgan involvement in acute illness or secondary to advanced liver disease. The presence of renal impairment in both groups is a poor prognostic indicator. Renal failure is often multifactorial and can present as pre-renal or intrinsic renal dysfunction. Obstructive or post renal dysfunction only rarely complicates liver disease. Hepatorenal syndrome (MRS) is a unique form of renal failure associated with advanced liver disease or cirrhosis, and is characterized by functional renal impairment without significant changes in renal histology. Irrespective of the type of renal failure, renal hypoperfusion is the central pathogenetic mechanism, due either to reduced perfusion pressure or increased renal vascular resistance. Volume expansion, avoidance of precipitating factors and treatment of underlying liver disease constitute the mainstay of therapy to prevent and reverse renal impairment. Splanchnic vasoconstrictor agents, such as terlipressin, along with volume expansion, and early placement of transjugular intrahepatic portosystemic shunt (TIPS) may be effective in improving renal function in HRS. Continuous renal replacement therapy (CRRT) and molecular absorbent recirculating system (MARS) in selected patients may be life saving while awaiting liver transplantation.

  17. Microvascular Disease After Renal Transplantation

    Directory of Open Access Journals (Sweden)

    Qi Lun Ooi

    2015-11-01

    Full Text Available Background/Aims: Individuals who reach end-stage kidney disease (CKD5 have a high risk of vascular events that persists even after renal transplantation. This study compared the prevalence and severity of microvascular disease in transplant recipients and patients with CKD5. Methods: Individuals with a renal transplant or CKD5 were recruited consecutively from renal clinics, and underwent bilateral retinal photography (Canon CR5-45, Canon. Their retinal images were deidentified and reviewed for hypertensive/microvascular signs by an ophthalmologist and a trained grader (Wong and Mitchell classification, and for vessel caliber at a grading centre using a computer-assisted method and Knudtson's modification of the Parr-Hubbard formula. Results: Ninety-two transplant recipients (median duration 6.4 years, range 0.8 to 28.8 and 70 subjects with CKD5 were studied. Transplant recipients were younger (pConclusions: Hypertensive/microvascular disease occurred just as often and was generally as severe in transplant recipients and subjects with CKD5. Microvascular disease potentially contributes to increased cardiac events post- transplantation.

  18. Lymphangiogenesis in renal diseases

    OpenAIRE

    Yazdani, Saleh

    2015-01-01

    Lymphatic vessels (LVs) are thin walled structures that transport lymph from tissues to lymph nodes. By this function they are complementary to the cardiovascular system in the maintenance of body fluid homeostasis. They play a pivotal role in many (patho)-physiological processes, such as inflammation, immune surveillance and tolerance, fat abortion and metabolism, and general tissue homeostasis, and are involved in disease conditions as diverse as hypertension, atherosclerosis, transplant re...

  19. 42 CFR 415.176 - Renal dialysis services.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Renal dialysis services. 415.176 Section 415.176 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Renal dialysis services. In the case of renal dialysis services, physicians who are not paid under...

  20. Statins and progressive renal disease.

    Science.gov (United States)

    Buemi, Michele; Senatore, Massimino; Corica, Francesco; Aloisi, Carmela; Romeo, Adolfo; Cavallaro, Emanuela; Floccari, Fulvio; Tramontana, Domenico; Frisina, Nicola

    2002-01-01

    Thanks to the administration of hypocholesterolemic drugs, important advances have been made in the treatment of patients with progressive renal disease. In vitro and in vivo findings demonstrate that statins, the inhibitors of HMG-CoA reductase, can provide protection against kidney diseases characterized by inflammation and/or enhanced proliferation of epithelial cells occurring in rapidly progressive glomerulonephritis, or by increased proliferation of mesangial cells occurring in IgA nephropathy. Many of the beneficial effects obtained occur independent of reduced cholesterol levels because statins can directly inhibit the proliferation of different cell types (e.g., mesangial, renal tubular, and vascular smooth muscle cells), and can also modulate the inflammatory response, thus inhibiting macrophage recruitment and activation, as well as fibrosis. The mechanisms underlying the action of statins are not yet well understood, although recent data in the literature indicate that they can directly affect the proliferation/apoptosis balance, the down-regulation of inflammatory chemokines, and the cytogenic messages mediated by the GTPases Ras superfamily. Therefore, as well as reducing serum lipids, statins and other lipid-lowering agents may directly influence intracellular signaling pathways involved in the prenylation of low molecular weight proteins that play a crucial role in cell signal transduction and cell activation. Statins appear to have important potential in the treatment of progressive renal disease, although further studies are required to confirm this in humans.

  1. Diuretic use in renal disease.

    Science.gov (United States)

    Sica, Domenic A

    2011-12-20

    Diuretics are agents commonly used in diseases characterized by excess extracellular fluid, including chronic kidney disease, the nephrotic syndrome, cirrhosis and heart failure. Multiple diuretic classes, including thiazide-type diuretics, loop diuretics and K(+)-sparing diuretics, are used to treat patients with these diseases, either individually or as combination therapies. An understanding of what determines a patient's response to a diuretic is a prerequisite to the correct use of these drugs. The response of patients with these diseases to diuretics, which is related to the dose, is best described by a sigmoid curve whose contour can become distorted by any of the several sodium-retaining states that are directly or indirectly associated with renal disease. Diuretic actions are of considerable importance to patients who have renal disease, as their effective use assists in extracellular fluid volume control, reducing excretion of protein in urine and lessening the risk of developing hyperkalemia. Diuretic-related adverse events that involve the uric acid, Na(+) and K(+) axes are not uncommon; therefore the clinician must be vigilant in looking for biochemical disturbances. As a result of diuretic-related adverse events, clinicians must be resourceful in the dose amount and frequency of dosing.

  2. 75 FR 49215 - Medicare Program; End-Stage Renal Disease Quality Incentive Program

    Science.gov (United States)

    2010-08-12

    ... Renal Disease Quality Incentive Program AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS...) for Medicare outpatient end-stage renal disease (ESRD) dialysis providers and facilities with payment... Erythropoiesis stimulating agent ESRD End stage renal disease FDA Food and Drug Administration Kt/V A measure...

  3. Impact of pregnancy on underlying renal disease.

    Science.gov (United States)

    Baylis, Chris

    2003-01-01

    Normal pregnancy involves marked renal vasodilation and large increases in glomerular filtration rate (GFR). Studies in rats reveal that the gestational renal vasodilation is achieved by parallel reductions in tone in afferent and efferent arterioles so GFR rises without a change in glomerular blood pressure. There is some evidence from animal studies that increased renal generation of nitric oxide (NO) may be involved. Although chronic renal vasodilation has been implicated in causing progression of renal disease in nonpregnant states by glomerular hypertension, there are no long-term deleterious effects of pregnancies on the kidney when maternal renal function is normal because glomerular blood pressure remains normal. When maternal renal function is compromised before conception, there are no long-term adverse effects on renal function in most types of renal disease, providing that the GFR is well maintained before conception. When serum creatinine exceeds approximately 1.4 mg/dL, pregnancy may accelerate the renal disease increases and when serum creatinine >2 mg/dL, the chances are greater than 1 in 3 that pregnancy will hasten the progression of the renal disease. The available animal studies suggest that glomerular hypertension does not occur despite diverse injuries. Thus, the mechanisms of the adverse interaction between pregnancy and underlying renal disease remain unknown.

  4. Prevention Of Chronic Renal Diseases

    Directory of Open Access Journals (Sweden)

    Fejzi Alushi

    2011-10-01

    Full Text Available It is easier to prevent a disease than to cure it. This postulate is a foundation stone of the contemporary medicine, furthermore its mission. The Chronic Kidney Diseases (CKD, amongst them the Chronic Pyelonephrites (CP and the mass kidney reduction  take an important  place in human pathologies in general, and in particular in renal ones. The Chronic Pyelonephrites  are chronic renal pathologies, which on one side are of various causes and on the other side are multi systemic. At the same time they tend, earlier or later, depending on their course, to bring the patient towards the Chronic Kidney Insufficiency  in stage of uremia, consequently in need of substitution therapies e.g. dialysis, peritoneum dialysis or transplant. It is worthy to emphasize that from the prevention and correct cure of CP make profit the patients, the family, the state and in the last analyses  the entire society, because in that way the budget expense destined for the fore going substitution cures, dialysis, peritoneum dialysis or transplant, is considerably  reduced. The same should be mentioned  in relation to the CP and the mass kidney reduction, speaking about our country, which are still at the first place as the very cause of Chronic Kidney  Insufficiencies (CRI, later on advancing toward uremia and terminal uremia along with its grave consequences. In general  the very foundation of the CP is on  the  infections of urinary roads, in particular on the complicated ones, among them it should be mentioned-congenital kidney anomalies, renal calculosis  so much present in our country, and pathologies of segment or vesical-ureteral reflux, and rarely the pathologies of prostate.

  5. Advanced renal disease, end-stage renal disease and renal death among HIV-positive individuals in Europe

    DEFF Research Database (Denmark)

    Ryom, L; Kirk, O; Lundgren, Jens

    2012-01-01

    Many studies have focused on chronic kidney disease in HIV-positive individuals, but few have studied the less frequent events, advanced renal disease (ARD) and end-stage renal disease (ESRD). The aim of this study was to investigate incidence, predictors and outcomes for ARD/ESRD and renal death...

  6. Characteristics and survival of patients with end stage renal disease and spina bifida in the United States renal data system.

    Science.gov (United States)

    Ouyang, Lijing; Bolen, Julie; Valdez, Rodolfo; Joseph, David; Baum, Michelle A; Thibadeau, Judy

    2015-02-01

    We describe the characteristics, treatments and survival of patients with spina bifida in whom end stage renal disease developed from 2004 through 2008 in the United States Renal Data System. We used ICD-9-CM code 741.* to identify individuals with spina bifida using hospital inpatient data from 1977 to 2010, and physician and facility claims from 2004 to 2008. We constructed a 5:1 comparison group of patients with end stage renal disease without spina bifida matched by age at first end stage renal disease service, gender and race/ethnicity. We assessed the risk of mortality and of renal transplantation while on dialysis using multivariate cause specific proportional hazards survival analysis. We also compared survival after the first renal transplant from the first end stage renal disease service to August 2011. We identified 439 patients with end stage renal disease and spina bifida in whom end stage renal disease developed at an average younger age than in patients without spina bifida (41 vs 62 years, p spina bifida those who had spina bifida showed a similar mortality hazard on dialysis and after transplantation. However, patients with end stage renal disease without spina bifida were more likely to undergo renal transplantation than patients with spina bifida (HR 1.51, 95% CI 1.13-2.03). Hospitalizations related to urinary tract infections were positively associated with the risk of death on dialysis in patients with end stage renal disease and spina bifida (HR 1.42, 95% CI 1.33-1.53). Spina bifida was not associated with increased mortality in patients with end stage renal disease on dialysis or after renal transplantation. Proper urological and bladder management is imperative in patients with spina bifida, particularly in adults. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  7. 42 CFR 413.210 - Conditions for payment under the end-stage renal disease (ESRD) prospective payment system.

    Science.gov (United States)

    2010-10-01

    ... REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Payment for End-Stage Renal Disease (ESRD) Services and Organ Procurement Costs § 413.210 Conditions for payment under the end-stage renal disease (ESRD) prospective payment...

  8. Renal injury due to hepatic hydatid disease.

    Science.gov (United States)

    Altay, Mustafa; Unverdi, Selman; Altay, Fatma Aybala; Ceri, Mevlüt; Akay, Hatice; Ozer, Hüseyin; Kiraç, Halil; Denizli, Nazim; Yilmaz, Bilal; Güvence, Necmettin; Duranay, Murat

    2010-08-01

    Many studies on renal hydatid disease have been reported in the literature, and the disease process appears to be well defined. However, renal injury without direct renal invasion remains poorly understood. The present study aims to define the frequency and the property of the renal involvement in hydatid disease. Eighty patients older than 18 years and diagnosed with liver echinococcosis were included in the study. The echinococcosis was diagnosed by the haemagglutination test and abdominal ultrasonography. Twenty-four-hour protein excretion was measured for patients who had elevated serum creatinine levels or whose urinalyses were positive for haematuria or proteinuria. Subsequently, renal biopsy was performed, and the specimens were examined by light microscopy and immunofluorescence staining. Haematuria was detected in 11 patients (13.75%), and proteinuria was detected in nine patients (11.25%). Percutaneous renal biopsy was applied to nine patients who gave signed consents to undergo the test. We detected four immunoglobulin A nephritis (together with tubulointerstitial nephritis in one patient), one membranoproliferative glomerulonephritis, one immunoglobulin M nephritis together with mesangiocapillary glomerulonephritis, one membranous glomerulonephritis, one amyloidosis and one tubulointerstitial nephritis. Renal hydatid cyst was detected only in four patients (5%). Hydatid disease, which affects the kidney, is not rare, and we suggest that urinalysis and, if indicated, renal biopsy should be performed for hepatic hydatid disease diagnosis.

  9. Purinergic Signalling in Inflammatory Renal Disease

    Directory of Open Access Journals (Sweden)

    Nishkantha eArulkumaran

    2013-07-01

    Full Text Available Extracellular purines have a role in renal physiology and adaption to inflammation. However, inflammatory renal disease may be mediated by extracellular purines, resulting in renal injury. The role of purinergic signalling is dependent on the concentrations of extracellular purines. Low basal levels of purines are important in normal homeostasis and growth. Concentrations of extracellular purines are significantly elevated during inflammation and mediate either an adaptive role or propagate local inflammation. Adenosine signalling mediates alterations in regional renal blood flow by regulation of the renal microcirculation, tubulo-glomerular feedback, and tubular transport of sodium and water. Increased extracellular ATP and renal P2 receptor-mediated inflammation are associated with various renal diseases, including hypertension, diabetic nephropathy, and glomerulonephritis. Experimental data suggests P2 receptor deficiency or receptor antagonism is associated with amelioration of antibody-mediated nephritis, suggesting a pathogenic (rather than adaptive role of purinergic signalling. We discuss the role of extracellular nucleotides in adaptation to ischaemic renal injury and in the pathogenesis of inflammatory renal disease.

  10. [Pregnancy in patients with underlying renal disease].

    Science.gov (United States)

    Golshayan, D; Mathieu, C; Burnier, M

    2007-03-07

    Pregnancy has generally been regarded as very high risk in women with chronic renal insufficiency. In this review, we describe the physiologic changes in systemic and renal haemodynamics during pregnancy, as well as the nature and severity of possible maternal and foetal complications in the setting of underlying renal disease. The risks are proportional to the degree of functional renal impairment, the presence or not of proteinuria and/or arterial hypertension at the time of conception, and are related to the type of underlying nephropathy or systemic disease in the mother. Furthermore, if the renal disease has been diagnosed before pregnancy, a better planning of the moment of conception, as well as a tight follow-up, allow for a better maternal and obstetrical outcome.

  11. Renal disease in pregnancy ambulatory issues.

    Science.gov (United States)

    Phelan, Sharon T

    2012-09-01

    Acute and chronic renal disease will complicate prenatal care. Normal physiological changes during pregnancy make the urinary tract system more vulnerable to infectious complications or worsening of preexisting disease. Much of the focus of prenatal care includes screening for these concerns both at the onset of prenatal care and through the pregnancy and postpartum course. With careful and attentive care, the pregnancy outcome for women with significant renal disease has improved and the occurrence of renal injury or obstetric complications due to infectious insults has decreased. This manuscript reviews the current ambulatory prenatal care as it relates to the urinary tract in pregnancy.

  12. Renal stone disease: Pathogenesis, prevention, and treatment

    Energy Technology Data Exchange (ETDEWEB)

    Pak, C.Y.C.

    1987-01-01

    This book contains 10 chapters. Some of the chapter titles are: Radiologic considerations; Physiochemistry of urinary stone formations; Nutritional aspects of stone disease; Prevention of recurrent nephrolithiasis; Struvite stones; and Contemporary approaches to removal of renal and ureteral calculi.

  13. 28 CFR 79.67 - Proof of chronic renal disease.

    Science.gov (United States)

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Proof of chronic renal disease. 79.67... renal disease. (a) In determining whether a claimant developed chronic renal disease following pertinent... claimant. A conclusion that a claimant developed chronic renal disease must be supported by...

  14. Renal disease and hypertension in pregnancy.

    Science.gov (United States)

    Palma-Reis, Ines; Vais, Alina; Nelson-Piercy, Catherine; Banerjee, Anita

    2013-02-01

    Because women are becoming pregnant at a later age, hypertension is more commonly encountered in pregnancy. In addition, with increasing numbers of young women living with renal transplants and kidney disease, it is important for physicians to be aware of the effects of pregnancy on these diseases. A multidisciplinary approach is essential to assess and care for pregnant women with kidney disease. Pre-pregnancy counselling should be offered to all women with chronic kidney disease. A review of medication to avoid teratogenicity and optimise the disease prior to conception is the ideal. Pregnancy may be the first medical review for a young woman, who may present with a previously undiagnosed renal problem.

  15. Drugs in pregnancy. Renal disease.

    Science.gov (United States)

    Marsh, J E; Maclean, D; Pattison, J M

    2001-12-01

    The management of pregnant women with renal impairment presents a major challenge to obstetricians, nephrologists, and ultimately paediatricians. As renal failure progresses there is an increase in both maternal and fetal complications. Often these women have intercurrent medical conditions and, prior to conception, are receiving a broad range of prescribed medications. A successful obstetric outcome relies upon careful pre-pregnancy counselling and planning, obsessive monitoring during pregnancy, and close liaison between different specialist teams. Experience is mounting in the management of pregnant transplant recipients, but the introduction of newer immunosuppressive agents which have great promise in prolonging graft survival present new problems for those recipients of a kidney transplant who are planning to conceive. We review drug prescription for pregnant patients with renal impairment, end-stage renal failure, or a kidney transplant.

  16. Hypertensive pregnancy disorders and future renal disease.

    Science.gov (United States)

    Wagner, Steven; Craici, Iasmina

    2014-10-01

    Hypertensive pregnancy disorders affect approximately 6 to 8 % of otherwise normal pregnancies. A growing body of evidence links these disorders with the future development of hypertension, coronary disease, cerebrovascular disease, and peripheral arterial disease. Larger studies associating hypertensive pregnancy to future development of renal disease have been lacking until recently, with publication of several compelling studies in the last 5 years. In this review, we will focus on the recent evidence associating hypertensive pregnancy disorders with the future development of chronic kidney disease (CKD) and end-stage renal disease (ESRD), as well as the development of microalbuminuria. We will also attempt to answer whether these renal risks are due to direct effects of hypertension during pregnancy, or whether they are due to shared environmental and genetic risk factors.

  17. Lupus nephritis and renal disease in pregnancy.

    Science.gov (United States)

    Germain, S; Nelson-Piercy, C

    2006-01-01

    Management of pregnant women with renal disease involves awareness of, and allowance for, physiological changes including decreased serum creatinine and increased proteinuria. For women with systemic lupus erythematosus (SLE), pregnancy increases likelihood of flare. These can occur at any stage, and are more difficult to diagnose, as symptoms overlap those of normal pregnancy. Renal involvement is no more common in pregnancy. Worsening proteinuria may be lupus flare but differential includes pre-eclampsia. In women with chronic renal disease, pregnancy may accelerate decline in renal function and worsen hypertension and proteinuria, with increased risk of maternal (eg, pre-eclampsia) and fetal (eg, IUGR, IUD) complications, strongly correlating with degree of renal impairment peri-conception. Pregnancy success rate varies from 20% to 95% depending on base-line creatinine. Best outcome is obtained if disease was quiescent for >6 months pre-conception. Women on dialysis or with renal transplants can achieve successful pregnancy but have higher maternal and fetal complication rates. Acute on chronic renal failure can develop secondary to complications such as HELLP and AFLP. Management needs to be by a multidisciplinary team involving physicians and obstetricians, ideally beginning with pre-pregnancy counselling. Treatment of flares includes corticosteroids, hydroxychloroquine, azothioprine, NSAIDs and MME Blood pressure is controlled with methyldopa, nifedipine or hydralazine.

  18. Thrombosis in end-stage renal disease.

    Science.gov (United States)

    Casserly, Liam F; Dember, Laura M

    2003-01-01

    Although renal failure has classically been associated with a bleeding tendency, thrombotic events are common among patients with end-stage renal disease (ESRD). A variety of thrombosis-favoring hematologic alterations have been demonstrated in these patients. In addition, "nontraditional" risk factors for thrombosis, such as hyperhomocysteinemia, endothelial dysfunction, inflammation, and malnutrition, are present in a significant proportion of chronic dialysis patients. Hemodialysis (HD) vascular access thrombosis, ischemic heart disease, and renal allograft thrombosis are well-recognized complications in these patients. Deep venous thrombosis and pulmonary embolism are viewed as rare in chronic dialysis patients, but recent studies suggest that this perception should be reconsidered. Several ESRD treatment factors such as recombinant erythropoietin (EPO) administration, dialyzer bioincompatibility, and calcineurin inhibitor administration may have prothrombotic effects. In this article we review the pathogenesis and clinical manifestations of thrombosis in ESRD and evaluate the evidence that chronic renal failure or its management predisposes to thrombotic events.

  19. The renal arterial resistive index and stage of chronic kidney disease in patients with renal allograft

    DEFF Research Database (Denmark)

    Winther, Stine O; Thiesson, Helle C; Poulsen, Lene N;

    2012-01-01

    The study investigated the optimal threshold value of renal arterial resistive index as assessed by Doppler ultrasonography determining chronic kidney disease stage 4 or higher in patients with renal allograft.......The study investigated the optimal threshold value of renal arterial resistive index as assessed by Doppler ultrasonography determining chronic kidney disease stage 4 or higher in patients with renal allograft....

  20. Pattern of renal diseases in children: A developing country experience

    Directory of Open Access Journals (Sweden)

    Shankar Prasad Yadav

    2016-01-01

    Full Text Available Spectrum of renal disease varies in different ethnic population, geographical location, and by environmental factors. The purpose of this study was to find out the clinical spectrum and occurrence of different pediatric renal diseases at a teaching hospital in the Eastern part of Nepal. All cases of renal diseases from one month to 15 years of age, attending the pediatric renal outpatient department and/or were admitted to the wards during the period of February 2012 to January 2013, were included in the study. Detailed clinical and laboratory evaluations were performed on all patients. Diseases were categorized as per standard definitions and managed with hospital protocols. Renal diseases accounted to be 206 cases (6.9% of total annual pediatric admissions, of which (58% were male and (42% female. Acute glomerulonephritis (AGN was the most common disorder (37.7% followed by nephrotic syndrome (26.1%, urinary tract infection (21.3%, acute kidney injury (AKI (17.9%, obstructive uropathy (1.9%, chronic kidney disease (CKD (1.2%, and others. In AGN group, the most common cause was post-infectious glomerulonephritis (PIGN (32.9% followed by lupus nephritis (4% and Henoch-Schonlein purpura nephritis (0.8%. Urine culture was positive in (9.22% and the most common organism was Escherichia coli (57.9%. The causes of AKI were urosepsis, septicemia, and AGN (18.9% each, followed by dehydration (13.5%. Mortality was found in 5% of cases and the etiologies were AKI in (72.7%, PIGN (18.1%, and CKD (9%. Renal diseases are a significant problem among children and are one of the common causes of hospital admission. These patients need comprehensive services for early identification and management.

  1. Dilemma of Renal Disease in Elderly

    Directory of Open Access Journals (Sweden)

    El Essawy Abdel

    2008-01-01

    Full Text Available The aging process results in profound anatomic and functional changes in a number of human body systems. Changes in kidney function with normal aging are the most dramatic of any human organ or organ system. These include anatomical, physiological, hemodynamic and immunological changes. Increased propensities of systemic diseases and exposure to poly-pharmacy of the aged group have an additive deleterious effect. The aforementioned changes have its implications on clinical presentations, management and prognosis of all renal diseases in elderly. Atypical presentation, more frequent and longer course are the characteristics of acute renal failure in this age group. Also, presentation of glomerular diseases, clinical course, prognosis, decision of performing a renal biopsy and use of immunosuppressive drugs in elderly specially those subgroup above 80 years of age are still a big challenges that needs a consensus and standardization.

  2. Anesthesia for patients with renal/hepatic disease.

    Science.gov (United States)

    Weil, Ann B

    2010-05-01

    General anesthesia may be necessary for patients with significant disease processes such as renal disease or hepatic disease. A basic understanding of the effects of general anesthetics on these organs and the anticipated problems of renal and hepatic impairment on the anesthetic process is necessary to optimize conditions for patients with renal or hepatic disease. Patient preparation, drug selection, and monitoring strategies will be discussed for patients with renal and liver disease.

  3. 28 CFR 79.57 - Proof of chronic renal disease.

    Science.gov (United States)

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Proof of chronic renal disease. 79.57... disease. (a) In determining whether a claimant developed chronic renal disease following pertinent... conclusion that a claimant developed chronic renal disease must be supported by medical documentation. (b)...

  4. Unilateral renal cell carcinoma with coexistent renal disease: a rare cause of end-stage renal disease.

    Science.gov (United States)

    Peces, R; Alvarez-Navascués, R

    2001-02-01

    Renal cell carcinoma (RCC) is a disorder encompassing a wide spectrum of pathological renal lesions. Coexistence of unilateral RCC and associated pathology in the contralateral kidney is an unusual and challenging therapeutic dilemma that can result in renal failure. So far, data on unilateral RCC with chronic renal failure necessitating renal replacement therapy have not been published. The aim of the present study was to evaluate the incidence of end-stage renal disease (ESRD) from unilateral RCC, and to assess the associated pathology and possible pathogenic factors. In 1999, a survey of the 350 patients treated by chronic dialysis in Asturias, Spain, was carried out to identify and collect clinical information on patients with primary unilateral RCC whilst on their renal replacement programme. Seven patients were identified as having ESRD and unilateral RCC, giving an incidence of 2% of patients treated by dialysis. There was a wide spectrum of associated disease and clinical presentation. All patients underwent radical or partial nephrectomy and were free of recurrence 6--64 months after surgery. Six patients were alive and free of malignancy recurrence for 6--30 months after the onset of haemodialysis. ESRD is rare in association with unilateral RCC, but does contribute to significant morbidity. However, the data presented here are encouraging and suggest that cancer-free survival with renal replacement therapy can be achieved in such patients.

  5. 42 CFR 414.320 - Determination of reasonable charges for physician renal transplantation services.

    Science.gov (United States)

    2010-10-01

    ... renal transplantation services. 414.320 Section 414.320 Public Health CENTERS FOR MEDICARE & MEDICAID... Determination of reasonable charges for physician renal transplantation services. (a) Comprehensive payment for... a renal transplantation, including the usual preoperative and postoperative care, and...

  6. Drugs of abuse and renal disease.

    Science.gov (United States)

    Bakir, A A; Dunea, G

    1996-03-01

    The complications of drug abuse encompass a spectrum of glomerular, interstitial, and vascular diseases. They comprise the heroin-associated nephropathy seen in African-American intravenous drug addicts, which, however, has given way in the 1990s to HIV-associated nephropathy. Infections with methicillin-resistant Staphylococcus aureus may cause acute glomerulonephritis by releasing bacterial superantigens. Hepatitis C has supplanted hepatitis B and may give rise to membranoproliferative glomerulonephritis and cryoglobulinemia. Addicts who inject drugs subcutaneously ('skin popping') may develop amyloidosis. Cocaine causes rhabdomyolysis, severe hypertension, occasionally renal failure in the absence of rhabdomyolysis, and may hasten progression to uremia in patients with underlying renal insufficiency. 'Ecstasy', an amphetamine-like recreational drug, has caused acute renal failure, electrolyte disturbances, and malignant hypertension. In Belgium and some other European countries, women taking Chinese herbs in a slimming regimen have developed a severe and irreversible interstitial fibrosis that is assuming epidemic proportions.

  7. Advanced chronic kidney disease, end-stage renal disease and renal death among HIV-positive individuals in Europe

    DEFF Research Database (Denmark)

    Nielsen, Lene Ryom; Kirk, O; Lundgren, J D

    2013-01-01

    Knowledge about advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD) in HIV-positive persons is limited. The aim of this study was to investigate incidence, predictors and outcomes for advanced CKD/ESRD and renal death.......Knowledge about advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD) in HIV-positive persons is limited. The aim of this study was to investigate incidence, predictors and outcomes for advanced CKD/ESRD and renal death....

  8. Fibrogenesis in progressive renal disease

    NARCIS (Netherlands)

    Baelde, H.

    2005-01-01

    Molecular biology offers new opportunities for experimental and clinical medicine. Promising clinical applications for patient care include identification of mRNA expression patterns (gene profiling) in diseased organs in correlation with diagnosis, prognosis, and responsiveness to different treatme

  9. Pregnancy in women with renal disease. Part II: specific underlying renal conditions.

    Science.gov (United States)

    Vidaeff, Alex C; Yeomans, Edward R; Ramin, Susan M

    2008-08-01

    The obstetric outcome in women with kidney disease has improved in recent years due to continuous progress in obstetrics and neonatology, as well as better medical management of hypertension and renal disease. However, every pregnancy in these women remains a high-risk pregnancy. When considering the interaction between renal disease and pregnancy, maternal outcomes are related to the initial level of renal dysfunction more than to the specific underlying disease. With regards to fetal outcomes, though, a distinction may exist between renal dysfunction resulting from primary renal disease and that in which renal involvement is part of a systemic disease. In part II of this review, some specific causes of renal failure affecting pregnancy are considered.

  10. Comparison of the renal disease at the Tibetan plateaus and plain based on renal biopsy data

    Institute of Scientific and Technical Information of China (English)

    周岩

    2014-01-01

    Objective To compare the characteristics of renal disease based on renal biopsy data between the Tibetan plateaus and the plain.Methods 160 chronic kidney diseases patients underwent renal biopsy from the plain and80 cases from Tibet plateau were compared in a parallel controlled manner.The relationship of renal pathology and clinical signs were also compared.Results(1)The male to female ratio was quite different between Tibet

  11. Imaging chronic renal disease and renal transplant in children

    Energy Technology Data Exchange (ETDEWEB)

    Carmichael, Jim; Easty, Marina [Great Ormond Street Hospital, Radiology Department, London (United Kingdom)

    2010-06-15

    At Great Ormond Street Hospital we have the highest number of paediatric renal transplant patients in Europe, taking cases from across the United Kingdom and abroad. Our caseload includes many children with rare complicating medical problems and chronic renal failure related morbidity. This review aims to provide an overview of our experience of imaging children with chronic renal failure and transplants. (orig.)

  12. Quantitative MRI of kidneys in renal disease.

    Science.gov (United States)

    Kline, Timothy L; Edwards, Marie E; Garg, Ishan; Irazabal, Maria V; Korfiatis, Panagiotis; Harris, Peter C; King, Bernard F; Torres, Vicente E; Venkatesh, Sudhakar K; Erickson, Bradley J

    2017-06-28

    To evaluate the reproducibility and utility of quantitative magnetic resonance imaging (MRI) sequences for the assessment of kidneys in young adults with normal renal function (eGFR ranged from 90 to 130 mL/min/1.73 m(2)) and patients with early renal disease (autosomal dominant polycystic kidney disease). This prospective case-control study was performed on ten normal young adults (18-30 years old) and ten age- and sex-matched patients with early renal parenchymal disease (autosomal dominant polycystic kidney disease). All subjects underwent a comprehensive kidney MRI protocol, including qualitative imaging: T1w, T2w, FIESTA, and quantitative imaging: 2D cine phase contrast of the renal arteries, and parenchymal diffusion weighted imaging (DWI), magnetization transfer imaging (MTI), blood oxygen level dependent (BOLD) imaging, and magnetic resonance elastography (MRE). The normal controls were imaged on two separate occasions ≥24 h apart (range 24-210 h) to assess reproducibility of the measurements. Quantitative MR imaging sequences were found to be reproducible. The mean ± SD absolute percent difference between quantitative parameters measured ≥24 h apart were: MTI-derived ratio = 4.5 ± 3.6%, DWI-derived apparent diffusion coefficient (ADC) = 6.5 ± 3.4%, BOLD-derived R2* = 7.4 ± 5.9%, and MRE-derived tissue stiffness = 7.6 ± 3.3%. Compared with controls, the ADPKD patient's non-cystic renal parenchyma (NCRP) had statistically significant differences with regard to quantitative parenchymal measures: lower MTI percent ratios (16.3 ± 4.4 vs. 23.8 ± 1.2, p quantitative measurements was obtained in all cases. Significantly different quantitative MR parenchymal measurement parameters between ADPKD patients and normal controls were obtained by MT, DWI, BOLD, and MRE indicating the potential for detecting and following renal disease at an earlier stage than the conventional qualitative imaging techniques.

  13. Nephrolithiasis-induced end stage renal disease

    Science.gov (United States)

    Ounissi, M; Gargueh, T; Mahfoudhi, M; Boubaker, K; Hedri, H; Goucha, R; Abderrahim, E; Ben Hamida, F; Ben Abdallah, T; El Younsi, F; Ben Maiz, H; Kheder, A

    2010-01-01

    Introduction: Nephrolithiasis still remains a too frequent and underappreciated cause of end stage renal disease (ESRD). Methods and patients: Of the entire cohort of 7128 consecutive patients who started maintenance dialysis in our nephrology department between January 1992 and December 2006, a total of 45 patients (26 women, 19 men) had renal stone disease as the cause of ESRD. The type of nephrolithiasis was determined in 45 cases and etiology in 42. The treatment and evolution of stone disease and patient’s survival were studied. Results: The overall proportion of nephrolithiasis related ESRD was 0.63%. The mean age was 48.4 years. Infection stones (struvite) accounted for 40%, calcium stones, 26.67% (primary hyperparathyroidism:15.56%; familial hypercalciuria: 4.44%, unknown etiology: 6.66%), primary hyperoxaluria type 1, 17.78% and uric acid lithiasis in 15.56% of cases. The mean delay of the evolution of the stone renal disease to chronic renal failure was 85.8 months. The feminine gender, obesity and elevated alkaline phosphatases >128 IU/L were significantly correlated with fast evolution of ESRD. The median evolution to ESRD was 12 months. The normal body mass index (BMI), medical treatment of stone and primary hyperoxaluria type 1 were correlated with fast evolution to ESRD. All patients were treated by hemodialysis during a mean evolution of 60 months. Sixteen patients died. The patient's survival rate at 1, 3 and 5 years was 97.6, 92.8 and 69% respectively. Hypocalcemia, cardiopathy and normal calcium-phosphate product were significantly correlated with lower survival rate. Conclusion: Severe forms of nephrolithiasis remain an underestimated cause of ESRD. These findings highlight the crucial importance of accurate stone analysis and metabolic evaluation to provide early diagnosis and efficient treatment for conditions leading to ESRD. PMID:21694924

  14. Denovo Post Renal Transplantation Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    Halim M

    2008-01-01

    Full Text Available Post-renal transplant de-novo inflammatory bowel disease (IBD may develop despite the presence of mycophenolate mofetil (MMF, a drug used for treatment of IBD, in the immunosuppressive regimen. A 39-year-old man received live unrelated renal transplant, and was started postoperatively on prednisolone, MMF, and tacrolimus, which was changed to sirolimus when he developed diabetes mellitus two months post-transplant. Nine months post-transplant, the patient developed recurrent attacks of bloody diarrhea and ischio-rectal abscesses complicated by anal fistulae not responding to routine surgical treatment. Colonoscopy diagnosed IBD, a Crohn′s disease-like pattern. The patient was treated with steroids and 5-aminosalicylic acid (5-ASA in addition to a two months course of ciprofloxacin and metronidazole. He became asymptomatic and rectal lesions healed within one month of treatment. The patient continued to be asymptomatic, and he maintained normal graft function on the same immunosuppressive treatment in addition to 5-ASA. We conclude that de-novo IBD disease can develop in renal transplant recipients in spite of immunosuppressive therapy including MMF.

  15. Glomerulonephritis and managing the risks of chronic renal disease.

    Science.gov (United States)

    Singh, Gurmeet R

    2009-12-01

    The rising global burden of chronic renal disease, the high cost of providing renal replacement therapies, and renal disease also being a risk factor for cardiovascular disease is increasing focus on renal disease prevention. This article focuses on the aspects of renal disease (specifically poststreptococcal glomerulonephritis [PSGN] and chronic kidney disease [CKD]) in Indigenous populations in Australia, New Zealand, Canada, and the United States that diverge from those typically seen in the general population of those countries. The spectrum of renal and many other diseases seen in Indigenous people in developed countries is similar to that seen in developing countries. Diseases like PSGN that have largely disappeared in developed countries still occur frequently in Indigenous people. CKD during the childhood years is due to congenital anomalies of the kidney and urinary tract in up to 70% of cases and occurs later in polycystic kidney disease and childhood-onset diabetes. Several risk factors for CKD in adulthood are already present in childhood.

  16. Angiogenic Factors and Renal Disease in Pregnancy

    Directory of Open Access Journals (Sweden)

    Julie S. Rhee

    2011-01-01

    Full Text Available Background. Preeclampsia is difficult to diagnose in patients with underlying renal disease and proteinuria. Prior studies show that there is an angiogenic factor imbalance with elevated levels of antiangiogenic proteins soluble fms-like tyrosine kinase 1 (sFlt1 and soluble endoglin (sEng and reduced levels of the proangiogenic protein, placental growth factor (PlGF in women with preeclampsia. These angiogenic biomarkers may be useful in distinguishing preeclampsia from other conditions of pregnancy, which may present with overlapping clinical characteristics. Cases. Case 1: A multiparous woman at 18 weeks gestation with nephrotic syndrome presented with hypertensive emergency and worsening renal insufficiency. She underwent induction of labor for severe preeclampsia. Her sFlt1 and sEng levels were at the 97 percentile while her PlGF level was undetectable (less than the 1st percentile. Case 2: A nulliparous woman with lupus nephritis at 22 weeks gestation presented with fetal demise and heart failure. Three weeks previously, the patient had developed thrombocytopenia and hypertensive urgency. She underwent dilation and evacuation. Her angiogenic profile was consistent with severe preeclampsia. Conclusion. Angiogenic factors may provide evidence to support a diagnosis of preeclampsia in patients with preexisting renal disease and proteinuria, conditions in which the classical definition of hypertension and proteinuria cannot be used.

  17. Angiogenic factors and renal disease in pregnancy.

    Science.gov (United States)

    Rhee, Julie S; Young, Brett C; Rana, Sarosh

    2011-01-01

    Background. Preeclampsia is difficult to diagnose in patients with underlying renal disease and proteinuria. Prior studies show that there is an angiogenic factor imbalance with elevated levels of antiangiogenic proteins soluble fms-like tyrosine kinase 1 (sFlt1) and soluble endoglin (sEng) and reduced levels of the proangiogenic protein, placental growth factor (PlGF) in women with preeclampsia. These angiogenic biomarkers may be useful in distinguishing preeclampsia from other conditions of pregnancy, which may present with overlapping clinical characteristics. Cases. Case 1: A multiparous woman at 18 weeks gestation with nephrotic syndrome presented with hypertensive emergency and worsening renal insufficiency. She underwent induction of labor for severe preeclampsia. Her sFlt1 and sEng levels were at the 97 percentile while her PlGF level was undetectable (less than the 1st percentile). Case 2: A nulliparous woman with lupus nephritis at 22 weeks gestation presented with fetal demise and heart failure. Three weeks previously, the patient had developed thrombocytopenia and hypertensive urgency. She underwent dilation and evacuation. Her angiogenic profile was consistent with severe preeclampsia. Conclusion. Angiogenic factors may provide evidence to support a diagnosis of preeclampsia in patients with preexisting renal disease and proteinuria, conditions in which the classical definition of hypertension and proteinuria cannot be used.

  18. Pregnancy in end stage renal disease.

    Science.gov (United States)

    Hladunewich, Michelle; Hercz, Adam Engel; Keunen, Johannes; Chan, Christopher; Pierratos, Andreas

    2011-01-01

    The ovulatory menstrual cycle is known to be affected on multiple levels in women with advanced renal disease. Menstrual irregularities, sexual dysfunction, and infertility worsen in parallel with the renal disease. Pregnancy in women with ESRD on dialysis is therefore uncommon. Furthermore, when pregnancy does occur, it can prove hazardous to both mother and baby owing to a multitude of potential complications including accelerated hypertension and preeclampsia, poor fetal growth, anemia, and polyhydramnios. Data are emerging, however, to suggest that pregnancy while on intensified renal replacement regimens may result in better pregnancy outcomes, and emerging trends include the decreased rate of therapeutic abortions probably reflecting a change in counseling practices over time. Nevertheless, a pregnant woman on intensive dialysis requires meticulous follow-up by a dedicated team including nephrology, obstetrics, and a full multidisciplinary staff. In this article, we will address fertility issues in young women with ESRD, review pregnancy outcomes in women on both hemodialysis and peritoneal dialysis, and provide suggestions for the management of the pregnant women on intensive hemodialysis.

  19. Pathogenesis of growth failure in renal diseases.

    Science.gov (United States)

    Ahmed, T M; Yi, Z W; Chan, J C

    1994-01-01

    This article reviews our current understanding of the mechanisms of growth failure in chronic renal disease. The neuro-endocrine control of growth hormone secretion and insulin-like growth factor gene expression subject to use of corticosteroids, uremia, and metabolic acidosis are presented. It has been shown in other non-growth hormone deficient conditions such as Turner's syndrome that the use of exogenous growth hormone increases linear growth but also accelerates closure of the growth plate with no significant difference in the final height of such children. An understanding of growth factors is especially important and timely because of the tendency these days to use growth hormone to overcome the growth impairment of children with chronic renal failure.

  20. Potential Use of Autologous Renal Cells from Diseased Kidneys for the Treatment of Renal Failure

    OpenAIRE

    George, Sunil K.; Abolbashari, Mehran; Jackson, John D.; AbouShwareb, Tamer; Atala, Anthony; James J. Yoo

    2016-01-01

    Chronic kidney disease (CKD) occurs when certain conditions cause the kidneys to gradually lose function. For patients with CKD, renal transplantation is the only treatment option that restores kidney function. In this study, we evaluated primary renal cells obtained from diseased kidneys to determine whether their normal phenotypic and functional characteristics are retained, and could be used for cell therapy. Primary renal cells isolated from both normal kidneys (NK) and diseased kidneys (...

  1. Pregnancy in women with renal disease. Yes or no?

    Science.gov (United States)

    Edipidis, K

    2011-01-01

    Women with renal disease who conceive and continue pregnancy, are at significant risk for adverse maternal and fetal outcomes. Although advances in antenatal and neonatal care continue to improve these outcomes, the risks remain proportionate to the degree of underlying renal dysfunction.The aim of this article, is to examine the impact of varying degrees of renal insufficiency on pregnancy outcome, in women with chronic renal disease and to provide if possible, useful conclusions whether and when, a woman with Chronic Kidney Disease (CKD), should decide to get pregnant.This article, reviews briefly the normal physiological changes of renal function during pregnancy, and make an attempt to clarify the nature and severity of the risks, in the settings of chronic renal insufficiency and end stage renal disease, including dialysis patients and transplant recipients.

  2. Nephrolithiasis-induced end stage renal disease

    Directory of Open Access Journals (Sweden)

    M Ounissi

    2010-03-01

    Full Text Available M Ounissi¹, T Gargueh², M Mahfoudhi¹, K Boubaker¹, H Hedri¹, R Goucha¹, E Abderrahim¹, F Ben Hamida¹, T Ben Abdallah¹, F El Younsi¹, H Ben Maiz³, A Kheder¹1Internal Medicine Department, 2Pediatric Department, 3Laboratory of Kidney Diseases, Charles Nicolle Hospital, Tunis, TunisiaIntroduction: Nephrolithiasis still remains a too frequent and underappreciated cause of end stage renal disease (ESRD.Methods and patients: Of the entire cohort of 7128 consecutive patients who started maintenance dialysis in our nephrology department between January 1992 and December 2006, a total of 45 patients (26 women, 19 men had renal stone disease as the cause of ESRD. The type of nephrolithiasis was determined in 45 cases and etiology in 42. The treatment and evolution of stone disease and patient’s survival were studied.Results: The overall proportion of nephrolithiasis related ESRD was 0.63%. The mean age was 48.4 years. Infection stones (struvite accounted for 40%, calcium stones, 26.67% (primary hyperparathyroidism:15.56%; familial hypercalciuria: 4.44%, unknown etiology: 6.66%, primary hyperoxaluria type 1, 17.78% and uric acid lithiasis in 15.56% of cases. The mean delay of the evolution of the stone renal disease to chronic renal failure was 85.8 months. The feminine gender, obesity and elevated alkaline phosphatases >128 IU/L were significantly correlated with fast evolution of ESRD. The median evolution to ESRD was 12 months. The normal body mass index (BMI, medical treatment of stone and primary hyperoxaluria type 1 were correlated with fast evolution to ESRD. All patients were treated by hemodialysis during a mean evolution of 60 months. Sixteen patients died. The patient's survival rate at 1, 3 and 5 years was 97.6, 92.8 and 69% respectively. Hypocalcemia, cardiopathy and normal calcium-phosphate product were significantly correlated with lower survival rate.Conclusion: Severe forms of nephrolithiasis remain an underestimated cause of

  3. Minimal-change renal disease and Graves’ disease: a case report and literature review

    OpenAIRE

    Hasnain, Wirasat; Stillman, Isaac E.; Bayliss, George P.

    2011-01-01

    Objective To describe a possible association between Graves' disease and nephrotic syndrome secondary to minimal change renal disease and to review the literature related to renal diseases in patients with Graves' disease. Methods The clinical, laboratory, and renal biopsy findings in a patient with Graves' disease and minimal change renal disease are discussed. In addition, the pertinent English-language literature published from 1966 to 2009, determined by means of a MEDLINE search, is revi...

  4. Minimal-change renal disease and Graves’ disease: a case report and literature review

    OpenAIRE

    Hasnain, Wirasat; Stillman, Isaac E.; Bayliss, George P.

    2011-01-01

    Objective: To describe a possible association between Graves' disease and nephrotic syndrome secondary to minimal change renal disease and to review the literature related to renal diseases in patients with Graves' disease. Methods: The clinical, laboratory, and renal biopsy findings in a patient with Graves' disease and minimal change renal disease are discussed. In addition, the pertinent English-language literature published from 1966 to 2009, determined by means of a MEDLINE search, is re...

  5. European Veterinary Renal Pathology Service: A Survey Over a 7-Year Period (2008-2015).

    Science.gov (United States)

    Aresu, L; Martini, V; Benali, S L; Brovida, C; Cianciolo, R E; Dalla Riva, R; Trez, D; Van Der Lugt, J J; Van Dongen, A; Zini, E

    2017-09-01

    The European Veterinary Renal Pathology Service (EVRPS) is the first Web-based registry for canine renal biopsy specimens in Europe. The aim was to verify whether differences exist between the clinical and laboratory presentation of dogs with nephropathy according to renal pathological findings, as defined by light and electron microscopy of renal biopsy specimens submitted to EVRPS. Renal biopsy specimens of dogs were collected from the archive of the service (n = 254). Cases were included if both light and electron microscopy were available (n = 162). Renal biopsy specimens were classified based on the morphological diagnoses. Thereafter, they were grouped into 3 disease categories, including immune-complex-mediated glomerulonephritis (ICGN), non-immune-complex-mediated GN (non-ICGN), and renal lesions not otherwise specified (RL-NOS). Differences among morphological diagnoses and among disease categories were investigated for clinical and laboratory variables. Serum albumin concentration was lower in dogs with ICGN than in those with non-ICGN (P = 0.006) or RL-NOS (P = 0.000), and the urine protein-to-creatinine ratio (UPC) was significantly higher in ICGN than in the other 2 disease categories. Regarding morphological diagnoses, albumin was significantly lower in amyloidosis (AMY) and membranous (MGN), membranoproliferative (MPGN) or mixed glomerulonephritis (MixGN) than in minimal change disease, primary (FSGS I) or secondary (FSGS II) focal and segmental glomerulosclerosis and juvenile nephropathies (JN). The UPC was higher in MPGN than in FSGS I and FSGS II. Dogs with ICGN, in particular MPGN, had higher protein loss than those with non-ICGN or RL-NOS, leading to more severe hypoalbuminemia. Clinical and laboratory differentiation among dogs with the different morphological diagnoses and among dogs with different disease categories was difficult due to overlapping results. Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine

  6. Preeclampsia or initial diagnosis of chronic renal disease during pregnancy.

    Science.gov (United States)

    Iavazzo, C; Kalmantis, K; Bozemberg, T; Ntziora, F; Ioakeimidis, A; Paschalinopoulos, D

    2008-01-01

    An unusual case of early nephrotic syndrome without hypertension which slightly resolved after delivery is documented. Renal biopsy was performed postpartum and the diagnosis was focal and segmental glomerulosclerosis with moderate chronic renal changes. It is questioned whether the case was due to preeclampsia or was the initial diagnosis of chronic renal disease which was made during pregnancy. The role of renal biopsy in such cases is briefly discussed (Tab. 2, Ref. 15). Full Text (Free, PDF) www.bmj.sk.

  7. Advanced renal disease, end-stage renal disease and renal death among HIV-positive individuals in Europe

    Directory of Open Access Journals (Sweden)

    Ryom L

    2012-11-01

    Full Text Available Many studies have focused on chronic kidney disease in HIV-positive individuals, but few have studied the less frequent events, advanced renal disease (ARD and end-stage renal disease (ESRD. The aim of this study was to investigate incidence, predictors and outcomes for ARD/ESRD and renal death in EuroSIDA. ARD was defined as confirmed eGFR < 30 ml/min per 1.73 m2 (>3 months apart using Cockcroft-Gault. ESRD was defined as hemo- or peritoneal dialysis>1 month/renal transplant. Renal deaths were defined as renal failure as the underlying cause of death, using CoDe methodology. Patients were followed from baseline (first eGFR after 1/1/2004 until last eGFR, ARD/ESRD/renal death; whichever occurred first. Poisson regression was used to identify predictors. 8817 persons were included, the majority were white (87.3%, males (73.9% infected though homosexual contact (41.5% and with a median age of 42 years (IQR 36–49. 45 persons (0.5% developed the composite endpoint; ARD (24, ESRD (19 and renal death (2 during a median follow up (FU of 4.5 years (IQR 2.7–5.8, incidence rate (IR 1.21/1000 PYFU (95% CI 0.86–1.57. Of 312 persons (3.5% with baseline eGFR<60 ml/min/1.73 m2, 13.3% (7.5–18.9 are estimated to develop ARD/ESRD/renal death within 6 years after baseline compared to 0.86% (0.58–1.1 of all patients, using Kaplan-Meier methods. Predictors in multivariate analysis were older age (IRR 1.29 per 10 years [0.95–1.75] any cardiovascular risk (IRR 2.34 [1.23–4.45], CD4 count (IRR 0.76 per 2-fold higher [0.60–0.97] and eGFR (IRR 0.63 per 5 ml/min/1.73 m2 higher [0.58–0.69]. Ethnicity, gender, nadir CD4, VL, HBV and using potential nephrotoxic antiretrovirals were insignificant in uni- and multivariate analysis. At 1 year after ARD/ESRD, 23.3% (CI 9.8–36.8 were estimated to have died using Kaplan-Meier methods. The 11 deaths were from renal causes (2, non-AIDS-defining malignancies (2, hepatitis-associated liver failure (1, respiratory

  8. Recurrence of light-chain deposition disease after renal transplantation

    DEFF Research Database (Denmark)

    Larsen, Thomas; Hammer, Anne; Jørgensen, Kaj Anker

    2008-01-01

    A 51-year-old male with a history of chronic renal disease received a renal allograft, in which disease recurred. Light-chain deposition disease was confirmed through biopsies of the native kidney and graft, and detection of free kappa light chains in serum. Udgivelsesdato: 2007-Sep-6...

  9. Renal diseases during pregnancy: Critical and current perspectives

    Directory of Open Access Journals (Sweden)

    Sukhminder Jit Singh Bajwa

    2013-01-01

    Full Text Available The advancements in medicine have made early detection and management of medical diseases possible especially during the pregnancy. The physiologic alterations of pregnancy have important implications for renal structure and functions, which may possibly lead to diagnostic dilemmas and wrong interpretation of various investigations carried out during the gestational period. Renal diseases are extremely challenging to treat during pregnancy as various drugs can have adverse effect on the pregnancy outcome. In general, these patients may either progress to normal delivery or may have to undergo surgical delivery under anesthesia. Apart from these anticipated challenges, many other renal problems can develop during the pregnancy in patients with normal renal functions such as urinary tract infections, acute kidney injury or renal trauma. Planning of pregnancy in renal diseases is also associated with increased potential risks especially in patients on dialysis as well as in patients who had undergone renal transplantation.

  10. Chemerin in renal dysfunction and cardiovascular disease.

    Science.gov (United States)

    Bonomini, Mario; Pandolfi, Assunta

    2016-02-01

    The potential involvement of chemerin in cardiovascular and renal dysfunction has recently been acknowledged. There are indeed many links between this protein and inflammation, atherosclerosis, and multiple obesity- and diabetes-related parameters such as body mass index, insulin resistance, and blood levels of insulin, cholesterol, triglycerides, and glucose. In addition, in the last few years, several reports have investigated the circulating chemerin levels and their pathophysiologic significance in chronic kidney disease populations. However, there are still gaps in our understanding of this matter, in particular as to whether elevated chemerin might be the cause behind, or simply mirror, a reduced renal function. The limitations of the present knowledge on chemerin may partly relate to the lack of specific antibodies for assessing the different active isoforms of the protein. Measuring its bioactive serum concentration, and achieving a precise overall pattern of the tissue-specific formation of different isoforms, with the use of suitable technology, will ultimately help define the role of chemerin in disease pathophysiology, or as a diagnostic or therapeutic marker. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Cardiovascular disease in renal transplant recipients.

    Science.gov (United States)

    McQuarrie, Emily P; Fellström, Bengt C; Holdaas, Hallvard; Jardine, Alan G

    2010-05-01

    Renal transplant recipients have a markedly increased risk of premature cardiovascular disease (CVD) compared with the general population, although considerably lower than that of patients receiving maintenance haemodialysis. CVD in transplant recipients is poorly characterised and differs from the nonrenal population, with a much higher proportion of fatal to nonfatal cardiac events. In addition to traditional ischaemic heart disease risk factors such as age, gender, diabetes and smoking, there are additional factors to consider in this population such as the importance of hypertension, left ventricular hypertrophy and uraemic cardiomyopathy. There are factors specific to transplantation such immunosuppressive therapies and graft dysfunction which contribute to this altered risk profile. However, understanding and treatment is limited by the absence of large randomised intervention trials addressing risk factor modification, with the exception of the ALERT study. The approach to managing these patients should begin early and be multifactorial in nature.

  12. Medicare Program; End-Stage Renal Disease Prospective Payment System, Coverage and Payment for Renal Dialysis Services Furnished to Individuals With Acute Kidney Injury, End-Stage Renal Disease Quality Incentive Program, Durable Medical Equipment, Prosthetics, Orthotics and Supplies Competitive Bidding Program Bid Surety Bonds, State Licensure and Appeals Process for Breach of Contract Actions, Durable Medical Equipment, Prosthetics, Orthotics and Supplies Competitive Bidding Program and Fee Schedule Adjustments, Access to Care Issues for Durable Medical Equipment; and the Comprehensive End-Stage Renal Disease Care Model. Final rule.

    Science.gov (United States)

    2016-11-04

    This rule updates and makes revisions to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for calendar year 2017. It also finalizes policies for coverage and payment for renal dialysis services furnished by an ESRD facility to individuals with acute kidney injury. This rule also sets forth requirements for the ESRD Quality Incentive Program, including the inclusion of new quality measures beginning with payment year (PY) 2020 and provides updates to programmatic policies for the PY 2018 and PY 2019 ESRD QIP. This rule also implements statutory requirements for bid surety bonds and state licensure for the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP). This rule also expands suppliers' appeal rights in the event of a breach of contract action taken by CMS, by revising the appeals regulation to extend the appeals process to all types of actions taken by CMS for a supplier's breach of contract, rather than limit an appeal for the termination of a competitive bidding contract. The rule also finalizes changes to the methodologies for adjusting fee schedule amounts for DMEPOS using information from CBPs and for submitting bids and establishing single payment amounts under the CBPs for certain groupings of similar items with different features to address price inversions. Final changes also are made to the method for establishing bid limits for items under the DMEPOS CBPs. In addition, this rule summarizes comments on the impacts of coordinating Medicare and Medicaid Durable Medical Equipment for dually eligible beneficiaries. Finally, this rule also summarizes comments received in response to a request for information related to the Comprehensive ESRD Care Model and future payment models affecting renal care.

  13. Anti-GBM disease and renal vein thrombosis.

    Science.gov (United States)

    Bailey, Phillippa; Sarfraz, Farook; Ravanan, Rommel

    2011-11-15

    A 23-year-old female who presented with advanced renal failure was subsequently diagnosed with renal vein thrombosis and antiglomerular basement membrane (GBM) antibody disease. A previous case of renal vein thrombosis has been reported in association with anti-GBM disease, but to our knowledge, this is the first reported case in which the presentation of anti-GBM disease and renal vein thrombosis was concurrent. Further study is essential to understand if the association of anti-GBM disease and renal vein thrombosis as seen in our case was pure coincidence or is in fact occurs more frequently. It may be that the dual diagnosis is not made as establishing one sufficient diagnosis for renal failure may halt further investigations for additional diagnoses.

  14. De novo glomerular diseases after renal transplantation.

    Science.gov (United States)

    Ponticelli, Claudio; Moroni, Gabriella; Glassock, Richard J

    2014-08-07

    Glomerular diseases developing in the kidney allograft are more often recurrences of the original disease affecting the native kidneys. However, in an undefined number of cases de novo, glomerular diseases unrelated to the original disease in the native kidneys can develop in the transplanted kidney. The clinical presentation and histologic features of de novo diseases are often similar to those features observed in patients with primary or secondary GN in the native kidneys. However, in transplanted kidneys, the glomerular, vascular, and tubulointerstitial changes are often intertwined with structural abnormalities already present at the time of transplant or caused by antibody- or cell-mediated allograft rejection, immunosuppressive drugs, or superimposed infection (most often of a viral nature). The pathophysiology of de novo glomerular diseases is quite variable. In rare cases of de novo minimal change disease, circulating factors increasing the glomerular permeability likely participate. Maladaptive hemodynamic changes and tissue fibrosis caused by calcineurin inhibitors or other factors may be involved in the pathogenesis of de novo FSGS. The exposure of cryptic podocyte antigens may favor the development of de novo membranous nephropathy. Many cases of de novo membranoproliferative GN are related to hepatitis C virus infection. Patients with Alport syndrome lacking antigenic epitopes in their glomerular basement membrane may develop antibodies against these glomerular basement membrane antigens expressed in the transplanted kidney. Infection may cause acute GN to have a heterogeneous clinical presentation and outcome. De novo pauci-immune GN in renal transplant is rare. Preexisting or acquired intolerance to glucose may, in the long term, cause diabetic nephropathy. The prognosis of de novo diseases depends on the type of GN, the severity of lesions caused by the alloimmune response, or the efficacy of immunosuppressive therapy. In most cases, the management

  15. Novel approaches to assessing renal function in cirrhotic liver disease.

    Science.gov (United States)

    Portal, Andrew J; Austin, Mark; Heneghan, Michael A

    2007-09-01

    Renal dysfunction is common in patients with end-stage liver disease. Etiological factors include conditions as diverse as acute tubular necrosis, immunoglobulin A nephropathy and hepatorenal syndrome. Current standard tests of renal function, such as measurement of serum urea and creatinine levels, are inaccurate as the synthesis of these markers is affected by the native liver pathology. This article reviews novel markers of renal function and their potential use in patients with liver disease.

  16. 78 FR 8535 - Medicare Program: Comprehensive End-Stage Renal Disease Care Model Announcement

    Science.gov (United States)

    2013-02-06

    ... Disease Care Model Announcement AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION... the testing of the Comprehensive End- Stage Renal Disease (ESRD) Care Model, a new initiative from the... (CHIP) beneficiaries. We are interested in identifying models designed to improve care for...

  17. Causes and consequences of increased sympathetic activity in renal disease

    NARCIS (Netherlands)

    Joles, JA; Koomans, HA

    2004-01-01

    Much evidence indicates increased sympathetic nervous activity (SNA) in renal disease. Renal ischemia is probably a primary event leading to increased SNA. Increased SNA often occurs in association with hypertension. However, the deleterious effect of increased SNA on the diseased kidney is not only

  18. Renal histology in polycystic kidney disease with incipient and advanced renal failure.

    Science.gov (United States)

    Zeier, M; Fehrenbach, P; Geberth, S; Möhring, K; Waldherr, R; Ritz, E

    1992-11-01

    Renal specimens were obtained at surgery or postmortem from patients with autosomal dominant polycystic kidney disease (ADPKD). Patients had either serum creatinine (SCr) below 350 mumol/liter (N = 12) or terminal renal failure (N = 50). Specimens were examined by two independent observers using a carefully validated score system. Mean glomerular diameters were similar in ADPKD patients with early renal failure (176 +/- 38 microns) and in victims of traffic accidents (177 +/- 23 microns), while they were significantly greater in diabetics with comparable renal function (205 +/- 16 microns). Glomerular diameters in ADPKD patients with terminal renal failure (191 +/- 45 microns) and with early renal failure were not significantly different. On average, 29% of glomeruli (17 to 62) were globally sclerosed in early renal failure, and 49% (19 to 93) in terminal renal failure. The proportion of glomeruli with segmental sclerosis was less than 4% in both groups. Marked vascular sclerosis, interstitial fibrosis, and tubular atrophy were present in early renal failure, and even more so in terminal renal failure. Interstitial infiltrates were scarce and consisted mainly of CD4 positive lymphocytes and CD68 positive macrophages. Immunestaining with monoclonal renin antibodies showed an increased juxtaglomerular index and expression of renin by arterioles adjacent to cysts, as well as by cyst wall epithelia. The data show more severe vascular and interstitial, but not glomerular, changes in ADPKD with advanced as compared to early renal failure.

  19. Impact of Pregnancy on Underlying Renal Disease

    OpenAIRE

    Baylis, Chris

    2003-01-01

    Normal pregnancy involves marked renal vasodilation and large increases in glomerular filtration rate (GFR). Studies in rats reveal that the gestational renal vasodilation is achieved by parallel reductions in tone in afferent and efferent arterioles so GFR rises without a change in glomerular blood pressure. There is some evidence from animal studies that increased renal generation of nitric oxide (NO) may be involved. Although chronic renal vasodilation has been implicated in causing progre...

  20. Fast renal decline to end-stage renal disease

    DEFF Research Database (Denmark)

    Krolewski, Andrzej S.; Skupien, Jan; Rossing, Peter

    2017-01-01

    A new model of diabetic nephropathy in type 1 diabetes emerged from our studies of Joslin Clinic patients. The dominant feature is progressive renal decline, not albuminuria. This decline is a unidirectional process commencing while patients have normal renal function and, in the majority, progre...... for markers predictive of the rate of renal decline yield findings that may make detection of fast decliners feasible. Identifying such patients will be the foundation for developing effective individualized methods to prevent or delay onset of ESRD in diabetes....... progression as rate of eGFR declines > 5 ml/min/year, a value exceeded by 80% of patients in Joslin's type 1 diabetes ESRD cohort. The extraordinary range of slopes within the rapid progression category prompted us to partition it into “very fast,” “fast” and “moderate” decline. We showed, for the first time......, that very fast and fast decline from normal eGFR to ESRD within 2 to 10 years constitutes 50% of the Joslin cohort. In this review we present data about frequency of fast decliners in both diabetes types, survey some mechanisms underlying fast renal decline, discuss methods of identifying patients at risk...

  1. Growth hormone in chronic renal disease

    Directory of Open Access Journals (Sweden)

    Vishal Gupta

    2012-01-01

    Full Text Available Severe growth retardation (below the third percentile for height is seen in up to one-third children with chronic kidney disease. It is thought to be multifactorial and despite optimal medical therapy most children are unable to reach their normal height. Under-nutrition, anemia, vitamin D deficiency with secondary hyperparathyroidism, metabolic acidosis, hyperphosphatemia, renal osteodystrophy; abnormalities in the growth hormone/insulin like growth factor system and sex steroids, all have been implicated in the pathogenesis of growth failure. Therapy includes optimization of nutritional and metabolic abnormalities. Failure to achieve adequate height despite 3-6 months of optimal medical measures mandates the use of recombinant GH (rGH therapy, which has shown to result in catch-up growth, anywhere from 2 cm to 10 cm with satisfactory liner, somatic and psychological development.

  2. [Childhood genetic renal diseases in southern Israel].

    Science.gov (United States)

    Landau, Daniel; Shalev, Hanna

    2010-03-01

    Genetic kidney diseases (GKDs) are an important and well-known entity in pediatric nephrology. Advances in genetic and molecular approaches in the last 15 years have enabled elucidation of the underlying molecular defects in many of these disorders. Herein, the authors summarize the progress that has been made over this period in disclosing the molecular basis of several novel GKDs which were characterized in this area and include Bartter syndrome type IV, type II Bartter syndrome and transient neonatal hyperkalemia, cystinuria and mental retardation, familial hypomagnesemia with secondary hypocalcemia, infantile nephronophthisis and familial hemolytic uremic syndrome with factor H deficiency. Retrospective analysis of the authors' data reveals that GKDs are over-represented among the pediatric population in southern Israel. GKD are seen 4 times more often than end-stage renal disease (ESRD) and comprise 38% of all cases of ESRD in our area. This high rate of GKD is mainly due to the high frequency of consanguineous marriages that prevails in this area. Understanding of the genetic and molecular background of these diseases is a result of a fruitful collaboration between the pediatric nephrologists and scientists, and has a direct implication on the diagnosis and treatment of the affected families.

  3. [Tumor of upper urinary tract in renal polycystic disease].

    Science.gov (United States)

    Rabii, Redouane; el Mejjad, Amine; Fekak, Hamid; Querfani, Baderdine; Joual, Abdenbi; el Mrini, Mohamed

    2003-09-01

    Upper urinary tract tumours are exceptional in the context of renal polycystic disease. The authors report the case of Mrs B. F., 56 years old, who presented with left loin pain associated with haematuria. Clinical examination was normal and ultrasound examination revealed bilateral renal polycystic disease with a mass in the left renal sinus. CT urography showed a tumour arising from the renal pelvis suggestive of an upper urinary tract tumour. The laboratory assessment revealed normal renal function and normal urine cytology. Treatment consisted of radical nephroureterectomy with resection of a bladder cuff. Histological examination revealed a urothelial tumour of the renal pelvis with negative surgical margins. In the light of this case, the authors discuss the diagnostic difficulties and specificities, the treatment and the outcome of this unusual clinical association.

  4. Clinical evaluation of CT and radionuclide examination in renal diseases

    Energy Technology Data Exchange (ETDEWEB)

    Kutani, W.; Ishida, H.; Shirakawa, S.; Shintaku, T.; Funaki, R. (Osaka Medical Coll., Takatsuki (Japan))

    1980-08-01

    One hundred and twelve cases of renal diseases were studied by computed tomography (CT) using EMI 5005/12. Of them, 60 were examined by both CT and renal scintigraphy, and comparatively evaluated. The CT units were checked before and after the contrast enhancement. Renal scintigrams were obtained by gamma cameras (PHO/GAMMA HP 6406, PHO/GAMMA LFOV) using 99 M Tc-DMSA. CT was especially useful in diagnosing the renal cysts and the hydronephrosis. Cysts in other organs (liver, spleen and pancreas) were simultaneously ascertained in polycystic diseases. CT was not helpful in diagnosing nephritis and diabetic nephropathy. Floating kidney and horse-shoe kidney were difficult to diagnose with CT. The renal scintigram was the reflection of the renal function, and was relatively more useful than CT in diagnosing horse-shoe kidney, floating kidney and nephritis, while it was not useful for non-functioning kidneys.

  5. Peroxisome proliferator-activated receptors and renal diseases.

    Science.gov (United States)

    Wu, Jing; Chen, Lihong; Zhang, Dongjuan; Huo, Ming; Zhang, Xiaoyan; Pu, Dan; Guan, Youfei

    2009-01-01

    Peroxisome proliferator-activated receptors (PPARs) are members of the nuclear hormone receptor superfamily of ligand-dependent transcription factors. Three isoforms of PPAR, i.e., PPAR-a, -d, and -?, have been identified and are differentially expressed in various tissues, including the kidney. The target genes of PPARs are involved in diverse biological processes, including adipogenesis, lipid metabolism, insulin sensitivity, inflammatory response, reproduction, and cell growth and differentiation. PPARs have been reported to protect against renal injury through indirect systemic effects and/or direct renal effects in diabetic nephropathy, glomerulonephritis, renal cell carcinoma, acute renal failure and chronic renal disease. In this review, we summarize the role of the three identified PPAR isoforms, PPARa, -d, and -?, in renal physiology and discuss the renoprotective effects of PPAR ligands in various kidney diseases.

  6. Gentamicin Nephrotoxicity in Subclinical Renal Disease.

    Science.gov (United States)

    Frazier, Donita L.

    The purpose of the present study was to examine the pharmacokinetic disposition of gentamicin and to define the mechanisms which predispose to nephrotoxicity in subclinical renal disease. Subtotally nephrectomized beagle dogs were used as a model for human beings with compromised renal function secondary to a reduced number of functional nephrons. Using ultrastructural morphometry, light microscopy and clinical chemistry data, the model was defined and the nephrotoxic responses of intact dogs administered recommended doses of drug were compared to the response of subtotally nephrectomized dogs administered reduced doses based on each animal's clearance of drug. Lysosomal and mitochondrial morphometric changes suggested mechanisms for increased sensitivity. To determine if increased sensitivity in this model was dependent on altered serum concentrations, variable rate infusions based on individual pharmacokinetic disposition of drug were administered using computer-driven infusion pumps. Identical serum concentration-time profiles were achieved in normal dogs and subtotally nephrectomized dogs, however, toxicity was significantly greater in nephrectomized dogs. The difference in the nephrotoxic response was characterized by administering supratherapeutic doses of drug to dogs. Nephrectomized dogs given a recommended dose of gentamicin became oliguric during the second week of treatment and increasingly uremic after withdrawal of drug. In contrast, intact dogs administered 2 times the recommended dose of gentamicin become only slightly polyuric during week 4 of treatment. The need to individualize dosage regimens based on drug clearance and not serum creatinine nor creatinine clearance alone was substantiated by describing the pharmacokinetic disposition of gentamicin in spontaneously occurring disease states. Four individualized dosage regimens with differing predicted efficacy were then administered to nephrectomized dogs to determine their relative nephrotoxic

  7. Chemokines as Potential Markers in Pediatric Renal Diseases

    Directory of Open Access Journals (Sweden)

    Ana Cristina Simões e Silva

    2014-01-01

    Full Text Available Glomerular diseases and obstructive uropathies are the two most frequent causes of chronic kidney disease (CKD in children. Recently, biomarkers have become a focus of clinical research as potentially useful diagnostic tools in pediatric renal diseases. Among several putative biomarkers, chemokines emerge as promising molecules since they play relevant roles in the pathophysiology of pediatric renal diseases. The evaluation of these inflammatory mediators might help in the management of diverse renal diseases in children and the detection of patients at high risk to develop CKD. The aim of this paper is to revise general aspects of chemokines and the potential link between chemokines and the most common pediatric renal diseases by including experimental and clinical evidence.

  8. [Acute renal failure: a rare presentation of Addison's disease].

    Science.gov (United States)

    Salhi, Houda

    2016-01-01

    Addison's disease is a rare condition. Its onset of symptoms most often is nonspecific contributing to a diagnostic and therapeutic delay. Acute renal failure can be the first manifestation of this disease. We report the case of a patient with Addison's disease who was initially treated for acute renal failure due to multiple myeloma and whose diagnosis was adjusted thereafter. Patient's condition dramatically improved after treatment with intravenous rehydration; injectable hydrocortisone.

  9. Pregnancy in End Stage Renal Disease Patients on Hemodialysis

    Directory of Open Access Journals (Sweden)

    Rohina Swaroop

    2009-07-01

    Full Text Available Pregnancy in patients suffering from chronic renal failure is still rare due to numerous factors that impairfertility. Even if pregnancy does occur pregnancy outcome with a live birth has a low success rate.Moreover there is a significant risk of worsening of renal disease in the mother.The purpose of hemodialysisis not only to maintain life but also to make the quality of life as normal as possible for the patient.Propogation of life is basic to all life forms and the ability to do so can be considered as a success in apatient of chronic renal failure. As patients of End stage renal disease rarely complain about sexual orgynecological problems ,considering them trivial as compared to their more life threatening renal condition,it is the physicians role to be attentive to these aspects of the disease.We hereby report 2 cases ofsuccessful pregnancy managed on hemodialysis by Northwest Louisiana Nephrology

  10. Potential Use of Autologous Renal Cells from Diseased Kidneys for the Treatment of Renal Failure.

    Science.gov (United States)

    George, Sunil K; Abolbashari, Mehran; Jackson, John D; Aboushwareb, Tamer; Atala, Anthony; Yoo, James J

    2016-01-01

    Chronic kidney disease (CKD) occurs when certain conditions cause the kidneys to gradually lose function. For patients with CKD, renal transplantation is the only treatment option that restores kidney function. In this study, we evaluated primary renal cells obtained from diseased kidneys to determine whether their normal phenotypic and functional characteristics are retained, and could be used for cell therapy. Primary renal cells isolated from both normal kidneys (NK) and diseased kidneys (CKD) showed similar phenotypic characteristics and growth kinetics. The expression levels of renal tubular cell markers, Aquaporin-1 and E-Cadherin, and podocyte-specific markers, WT-1 and Nephrin, were similar in both NK and CKD kidney derived cells. Using fluorescence- activated cell sorting (FACS), specific renal cell populations were identified and included proximal tubular cells (83.1% from NK and 80.3% from CKD kidneys); distal tubular cells (11.03% from NK and 10.9% from CKD kidneys); and podocytes (1.91% from NK and 1.78% from CKD kidneys). Ultra-structural analysis using scanning electron microscopy (SEM) revealed microvilli on the apical surface of cultured cells from NK and CKD samples. Moreover, transmission electron microscopy (TEM) analysis showed a similar organization of tight junctions, desmosomes, and other intracellular structures. The Na+ uptake characteristics of NK and CKD derived renal cells were also similar (24.4 mmol/L and 25 mmol/L, respectively) and no significant differences were observed in the protein uptake and transport characteristics of these two cell isolates. These results show that primary renal cells derived from diseased kidneys such as CKD have similar structural and functional characteristics to their counterparts from a normal healthy kidney (NK) when grown in vitro. This study suggests that cells derived from diseased kidney may be used as an autologous cell source for renal cell therapy, particularly in patients with CKD or end

  11. Evaluation of restenosis, renal function and blood pressure after the renal artery stenting in patients with atherosclerosis renovascular disease

    Institute of Scientific and Technical Information of China (English)

    王焱

    2006-01-01

    Objective To evaluate the restenosis, renal function and blood pressure after renal artery stenting in patients with atherosclerosis renovascular disease. Methods Percutaneous renal artery stent (PTRAS) was performed in 135 patients with single or bilateral renal artery stenosis (≥70%). Clinical data of above patients were studied during follow-up period. Results A total of 147

  12. The role of complement in autoimmune renal disease

    NARCIS (Netherlands)

    Seelen, M. A.; Daha, M. R.

    2006-01-01

    The predominance of renal involvement in autoimmune diseases can most likely be assigned to the specialised function of the kidneys filtrating over 120 ml plasma per minute. Complement activation by autoantibodies directed against planted antigens or antigens already present in renal tissue in the s

  13. Pregnancy in women with renal disease. Yes or no?

    OpenAIRE

    Edipidis, K

    2011-01-01

    Women with renal disease who conceive and continue pregnancy, are at significant risk for adverse maternal and fetal outcomes. Although advances in antenatal and neonatal care continue to improve these outcomes, the risks remain proportionate to the degree of underlying renal dysfunction.

  14. Renal denervation in chronic kidney disease

    NARCIS (Netherlands)

    Blankestijn, Peter J.; Joles, Jaap A.

    2012-01-01

    Previous studies have indicated that ablation of renal sympathetic nerves reduces blood pressure in patients with resistant hypertension and preserved renal function. Hering et al. have now investigated the efficacy and safety of this procedure in patients with moderate to severe chronic kidney dise

  15. Hypertension and renal disease : Role of microalbuminuria

    NARCIS (Netherlands)

    Janssen, WMT; deJong, PE; deZeeuw, D

    1996-01-01

    Risks associated with hypertension Hypertension is a risk factor for cardiovascular and possibly renal organ damage. Microalbuminuria is a newly recognized cardiovascular and renal risk factor in diabetic and non-diabetic subjects. The prevalence of microalbuminuria is enhanced in hypertensive subje

  16. Utility of renal biopsy in the clinical management of renal disease.

    Science.gov (United States)

    Dhaun, Neeraj; Bellamy, Christopher O; Cattran, Daniel C; Kluth, David C

    2014-05-01

    Characterizing chronic kidney disease (CKD) at all stages is an essential part of rational management and the renal biopsy plays a key role in defining the processes involved. There remain no global guidelines available to the renal community on indications for this important diagnostic, prognostic, and relatively safe test. Although most nephrologists recognize several clear indications for a renal biopsy, it is still underutilized. It not only helps the clinician to manage the patient with CKD, but it can also help clarify the epidemiology of CKD, and aid research into the pathobiology of disease with the aim of discovering new therapies. It may be useful for instance in elderly patients with CKD, those with diabetes and presumed 'hypertensive nephropathy', and in some patients with advanced CKD as part of the pretransplant work-up. In some populations (for example, immunoglobulin A nephropathy and ANCA vasculitis), renal biopsy allows disease classification that may predict CKD progression and response to therapy. For the individual, interval renal biopsy may be of use in providing ongoing therapeutic and prognostic information. Molecular advances will change the landscape of renal pathology and add a new dimension to the diagnostic precision of kidney biopsy. Organizing the multiplicity of information available in a renal biopsy to maximize benefits to the patient, as well as to the epidemiologist and researcher, is one of the challenges that face the nephrology community.

  17. Late de novo minimal change disease in a renal allograft

    OpenAIRE

    Madhan Krishan; Temple-Camp Cynric

    2009-01-01

    Among the causes of the nephrotic syndrome in renal allografts, minimal change disease is a rarity with only few cases described in the medical literature. Most cases described have occurred early in the post-transplant course. There is no established treatment for the condition but prognosis is favorable. We describe a case of minimal change disease that developed 8 years after a successful transplantation of a renal allograft in a middle-aged woman. The nephrotic syndrome was accompanied by...

  18. Management of patients with hepatitis C infection and renal disease.

    Science.gov (United States)

    Bunchorntavakul, Chalermrat; Maneerattanaporn, Monthira; Chavalitdhamrong, Disaya

    2015-02-27

    Hepatitis C virus (HCV) infection in patients with end-stage renal disease (ESRD) is associated with more rapid liver disease progression and reduced renal graft and patients' survival following kidney transplantation. Evaluations and management of HCV in patients with renal disease are challenging. The pharmacokinetics of interferons (IFN), ribavirin (RBV) and some direct acting antiviral (DAA), such as sofosbuvir, are altered in patients with ESRD. With dose adjustment and careful monitoring, treatment of HCV in patients with ESRD can be associated with sustained virological response (SVR) rates nearly comparable to that of patients with normal renal function. DAA-based regimens, especially the IFN-free and RBV-free regimens, are theoretically preferred for patients with ESRD and KT in order to increase SVR rates and to reduce treatment side effects. However, based on the data for pharmacokinetics, dosing safety and efficacy of DAA for patients with severe renal impairment are lacking. This review will be focused on the evaluations, available pharmacologic data, and management of HCV in patients with severe renal impairment, patients who underwent KT, and those who suffered from HCV-related renal disease, according to the available treatment options, including DAA.

  19. Bilateral impacted femoral neck fracture in a renal disease patient

    Directory of Open Access Journals (Sweden)

    Pramod Devkota

    2013-01-01

    Full Text Available Spontaneous bilateral femoral neck facture in a renal disease patient is not common. We report a case of 47-year-old female patient with chronic renal failure and on regular hemodialysis for the past 5 years who sustained bilateral impacted femoral neck fracture without history of trauma and injury and refused any surgical intervention. The patient was mobilised on wheel chair one year after the fractures. The cause of the fracture and the literature review of the bilateral femoral neck fracture in renal disease are discussed.

  20. Renal histology of mucocutaneous lymph node syndrome (Kawasaki disease).

    Science.gov (United States)

    Salcedo, J R; Greenberg, L; Kapur, S

    1988-01-01

    Renal involvement is well described in patients with mucocutaneous lymph node syndrome (MCLNS), or Kawasaki disease and is manifested by mild azotemia, hematuria, pyuria or cylinduria, and more often, proteinuria. Renal morphology during the acute stages of the illness has never been reported. In this paper we describe the renal histopathologic changes in a child with MCLNS. The glomerular histopathologic findings suggest immune complex damage to the kidney as a possible mechanism of nephrotoxicity in MCLNS. Presence of kidney lesions, which speak in favor of the injurious role of immune complexes in MLCNS may be relevant to the understanding of the pathogenesis of the vascular lesions that are characteristic of this disease.

  1. Transvascular lipoprotein transport in patients with chronic renal disease

    DEFF Research Database (Denmark)

    Jensen, Trine Krogsgaard; Nordestgaard, Børge Grønne; Feldt-Rasmussen, Bo

    2004-01-01

    BACKGROUND: While increased plasma cholesterol is a well-established cardiovascular risk factor in the general population, this is not so among patients with chronic renal disease. We hypothesized that the transvascular lipoprotein transport, in addition to the lipoprotein concentration in plasma......: Transvascular LDL transport may be increased in diabetic patients with chronic renal disease, suggesting that lipoprotein flux into the arterial wall is increased. A similar mechanism does not operate in nondiabetic patients with chronic renal disease.......BACKGROUND: While increased plasma cholesterol is a well-established cardiovascular risk factor in the general population, this is not so among patients with chronic renal disease. We hypothesized that the transvascular lipoprotein transport, in addition to the lipoprotein concentration in plasma......, determines the degree of atherosclerosis among patients with chronic renal disease. METHODS: We used an in vivo method for measurement of transvascular transport of low-density lipoprotein (LDL) in 21 patients with chronic renal disease and in 42 healthy control patients. Autologous 131-iodinated LDL...

  2. Renal dysfunction and coronary disease: a high-risk combination.

    Science.gov (United States)

    Schiele, Francois

    2009-01-01

    Chronic kidney dysfunction is recognized as a risk factor for atherosclerosis and complicates strategies and treatment. Therefore, it is important for cardiologists not only to detect and measure potential kidney dysfunction, but also to know the mechanisms by which the heart and kidney interact, and recognize that in cases of acute coronary syndrome, the presence of renal dysfunction increases the risk of death. The detection and classification of kidney dysfunction into 5 stages is based on the estimated glomerular filtration rate (GFR). The presence of hypertension, endothelial dysfunction, dyslipidemia, inflammation, activation of the renin-angiotensin system and specific calcifications are the main mechanisms by which renal dysfunction can induce or compound cardiovascular disease. The magnitude of renal dysfunction is related to the cardiovascular risk; a linear relation links the extent of GFR decrease and the risk of cardiovascular events. Renal dysfunction and acute coronary syndromes are a dangerous combination: more common comorbidities, more frequent contraindications for effective drugs and higher numbers of drug-related adverse events such as bleeding partially explain the higher mortality in patients with renal dysfunction. In addition, despite higher risk, patients with renal dysfunction often receive fewer guideline-recommended treatments even in the absence of contraindications. Renal dysfunction induces and promotes atherosclerosis by various pathophysiologic pathways and is associated with other cardiovascular risk factors and underuse of appropriate therapy. Therefore, the assessment of renal function is an important step in the risk evaluation of patients with coronary artery disease.

  3. Amygdalin inhibits renal fibrosis in chronic kidney disease.

    Science.gov (United States)

    Guo, Junqi; Wu, Weizheng; Sheng, Mingxiong; Yang, Shunliang; Tan, Jianming

    2013-05-01

    Renal interstitial fibrosis is a common outcome of chronic renal diseases. Amygdalin is one of a number of nitrilosides, the natural cyanide‑containing substances abundant in the seeds of plants of the prunasin family that are used to treat cancer and relieve pain. However, whether amygdalin inhibits the progression of renal fibrosis or not remains unknown. The present study aimed to assess the therapeutic potential of amygdalin by investigating its effect and potential mechanism on the activation of renal interstitial fibroblast cells and renal fibrosis in rat unilateral ureteral obstruction (UUO). Treatment of the cultured renal interstitial fibroblasts with amygdalin inhibited their proliferation and the production of transforming growth factor (TGF)‑β1. In the rat model of obstructive nephropathy, following ureteral obstruction, the administration of amygdalin immediately eliminated the extracellular matrix accumulation and alleviated the renal injury on the 21st day. Collectively, amygdalin attenuated kidney fibroblast (KFB) activation and rat renal interstitial fibrosis. These results indicate that amygdalin is a potent antifibrotic agent that may have therapeutic potential for patients with fibrotic kidney diseases.

  4. Ultrasound-guided percutaneous renal biopsy with an automated biopsy gun in diffuse renal disease

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ji Yang; Moon, Jeoung Mi; Park, Ji Hyun; Kwon, Jae Soo; Song, Ik Hoon; Kim, Sung Rok [Masan Koryo General Hospital, Masan (Korea, Republic of)

    1994-12-15

    We evaluated the effectiveness and clinical usefulness of percutaneous renal biopsy by using automated biopsy gun under the real-time ultrasonographic guidance that was performed in 17 patients with diffuse renal disease. We retrospectively analysed the histopathological diagnosis and the patients' status after percutaneous renal biopsy.Adequate amount of tissue for the histologic diagnosis could be obtained in al patients. Histopathologic diagnosis included the minimal change nephrotic syndrome in 6 patients, the membrano proliferative glomerulonephritis in 4,the membranous glomerulonephritis in 2, the glomerulosclerosis in 2, Ig A nephropathy in 2, and the normal finding in 1. Significant complication occurred in only one patient who developed a transient loss of sensation at and around the biopsy site. In conclusion, automated biopsy gun was a very useful device in performing percutaneous biopsy for diffuse renal disease with a high success rate and a low complication rate

  5. Renal erythropoietin-producing cells in health and disease

    Directory of Open Access Journals (Sweden)

    Tomokazu eSouma

    2015-06-01

    Full Text Available Erythropoietin (Epo is an indispensable erythropoietic hormone primarily produced from renal Epo-producing cells (REPs. Epo production in REPs is tightly regulated in a hypoxia-inducible manner to maintain tissue oxygen homeostasis. Insufficient Epo production by REPs causes renal anemia and anemia associated with chronic disorders. Recent studies have broadened our understanding of REPs from prototypic hypoxia-responsive cells to dynamic fibrogenic cells. In chronic kidney disease, REPs are the major source of scar-forming myofibroblasts and actively produce fibrogenic molecules, including inflammatory cytokines. Notably, myofibroblast-transformed REPs recover their original physiological properties after resolution of the disease insults, suggesting that renal anemia and fibrosis could be reversible to some extent. Therefore, understanding the plasticity of REPs will lead to the development of novel targeted therapeutics for both renal fibrosis and anemia. This review summarizes the regulatory mechanisms how hypoxia-inducible Epo gene expression is attained in health and disease conditions.

  6. Periodontal disease characterization in dogs with normal renal function or chronic renal failure

    OpenAIRE

    Barbudo-Selmi Glenda Ramalho; Carvalho Marileda Bonafim; Selmi André Luis; Martins Silvio Emílio Cuevas

    2004-01-01

    The purpose of this study was to evaluate periodontal disease (PD) in dogs with chronic renal failure (CRF) and to compare it to PD in dogs with normal renal function (NRF). Twelve dogs with CRF and 24 dogs with NRF, all presenting dental pocket formation, were compared. In all dogs, serum creatinine, blood urea nitrogen, urine specific gravity and total red and white blood cells were determined. A complete oral examination was also performed including evaluation of bacterial plaque, gingivit...

  7. BK polyoma virus infection and renal disease in non-renal solid organ transplantation.

    Science.gov (United States)

    Kuppachi, Sarat; Kaur, Deepkamal; Holanda, Danniele G; Thomas, Christie P

    2016-04-01

    BK virus (BKV) is a non-enveloped DNA virus of the polyomaviridae family that causes an interstitial nephritis in immunosuppressed patients. BKV nephropathy is now a leading cause of chronic kidney disease and early allograft failure following kidney transplantation. It is also known to cause renal disease with a progressive decline in kidney function in non-renal solid organ transplant (NRSOT) recipients, although the disease may not be recognized nor its impact appreciated in this patient population. In this report, we review the existing literature to highlight our current understanding of its incidence in NRSOT populations, the approaches to diagnosis and the potential treatment options.

  8. Wnt and planar cell polarity signaling in cystic renal disease.

    Science.gov (United States)

    Goggolidou, Paraskevi

    2014-01-01

    Cystic kidney diseases can cause end stage renal disease, affecting millions of individuals worldwide. They may arise early or later in life, are characterized by a spectrum of symptoms and can be caused by diverse genetic defects. The primary cilium, a microtubule-based organelle that can serve as a signaling antenna, has been demonstrated to have a significant role in ensuring correct kidney development and function. In the kidney, one of the signaling pathways that requires the cilium for normal development is Wnt signaling. In this review, the roles of primary cilia in relation to canonical and non-canonical Wnt/PCP signaling in cystic renal disease are described. The evidence of the associations between cilia, Wnt signaling and cystic renal disease is discussed and the significance of planar cell polarity-related mechanisms in cystic kidney disease is presented. Although defective Wnt signaling is not the only cause of renal disease, research is increasingly highlighting its importance, encouraging the development of Wnt-associated diagnostic and prognostic tools for cystic renal disease.

  9. Multiple facets of HIV-associated renal disease.

    Science.gov (United States)

    da Silva, D R; Gluz, I C; Kurz, J; Thomé, G G; Zancan, R; Bringhenti, R N; Schaefer, P G; Dos Santos, M; Barros, E J G; Veronese, F V

    2016-01-01

    HIV infection has a broad spectrum of renal manifestations. This study examined the clinical and histological manifestations of HIV-associated renal disease, and predictors of renal outcomes. Sixty-one (64% male, mean age 45 years) HIV patients were retrospectively evaluated. Clinical presentation and renal histopathology were assessed, as well as CD4 T-cell count and viral load. The predictive value of histological lesion, baseline CD4 cell count and viral load for end-stage renal disease (ESRD) or death were determined using the Cox regression model. The outcomes of chronic kidney disease (CKD) and ESRD or death were evaluated by baseline CD4 cell count. The percent distribution at initial clinical presentation was non-nephrotic proteinuria (54%), acute kidney injury (28%), nephrotic syndrome (23%), and chronic kidney disease (22%). Focal segmental glomerulosclerosis (28%), mainly the collapsing form (HIVAN), acute interstitial nephritis (AIN) (26%), and immune complex-mediated glomerulonephritis (ICGN) (25%) were the predominant renal histology. Baseline CD4 cell count ≥ 200 cells/mm3 was a protective factor against CKD (hazard ratio=0.997; 95%CI=0.994-0.999; P=0.012). At last follow-up, 64% of patients with baseline CD4 ≥ 200 cells/mm3 had eGFR >60 mL·min-1·(1.73 m2)-1 compared to the other 35% of patients who presented with CD4 HIV-associated renal disease was HIVAN, followed by AIN and ICGN. These findings reinforce the need to biopsy HIV patients with kidney impairment and/or proteinuria. Baseline CD4 cell count ≥ 200 cells/mm3 was associated with better renal function after 2 years of follow-up.

  10. Multiple facets of HIV-associated renal disease

    Directory of Open Access Journals (Sweden)

    D.R. da Silva

    2016-01-01

    Full Text Available HIV infection has a broad spectrum of renal manifestations. This study examined the clinical and histological manifestations of HIV-associated renal disease, and predictors of renal outcomes. Sixty-one (64% male, mean age 45 years HIV patients were retrospectively evaluated. Clinical presentation and renal histopathology were assessed, as well as CD4 T-cell count and viral load. The predictive value of histological lesion, baseline CD4 cell count and viral load for end-stage renal disease (ESRD or death were determined using the Cox regression model. The outcomes of chronic kidney disease (CKD and ESRD or death were evaluated by baseline CD4 cell count. The percent distribution at initial clinical presentation was non-nephrotic proteinuria (54%, acute kidney injury (28%, nephrotic syndrome (23%, and chronic kidney disease (22%. Focal segmental glomerulosclerosis (28%, mainly the collapsing form (HIVAN, acute interstitial nephritis (AIN (26%, and immune complex-mediated glomerulonephritis (ICGN (25% were the predominant renal histology. Baseline CD4 cell count ≥200 cells/mm3 was a protective factor against CKD (hazard ratio=0.997; 95%CI=0.994-0.999; P=0.012. At last follow-up, 64% of patients with baseline CD4 ≥200 cells/mm3 had eGFR >60 mL·min-1·(1.73 m2-1 compared to the other 35% of patients who presented with CD4 <200 cells/mm3 (log rank=9.043, P=0.003. In conclusion, the main histological lesion of HIV-associated renal disease was HIVAN, followed by AIN and ICGN. These findings reinforce the need to biopsy HIV patients with kidney impairment and/or proteinuria. Baseline CD4 cell count ≥200 cells/mm3 was associated with better renal function after 2 years of follow-up.

  11. Multiple facets of HIV-associated renal disease

    Science.gov (United States)

    da Silva, D.R.; Gluz, I.C.; Kurz, J.; Thomé, G.G.; Zancan, R.; Bringhenti, R.N.; Schaefer, P.G.; dos Santos, M.; Barros, E.J.G.; Veronese, F.V.

    2016-01-01

    HIV infection has a broad spectrum of renal manifestations. This study examined the clinical and histological manifestations of HIV-associated renal disease, and predictors of renal outcomes. Sixty-one (64% male, mean age 45 years) HIV patients were retrospectively evaluated. Clinical presentation and renal histopathology were assessed, as well as CD4 T-cell count and viral load. The predictive value of histological lesion, baseline CD4 cell count and viral load for end-stage renal disease (ESRD) or death were determined using the Cox regression model. The outcomes of chronic kidney disease (CKD) and ESRD or death were evaluated by baseline CD4 cell count. The percent distribution at initial clinical presentation was non-nephrotic proteinuria (54%), acute kidney injury (28%), nephrotic syndrome (23%), and chronic kidney disease (22%). Focal segmental glomerulosclerosis (28%), mainly the collapsing form (HIVAN), acute interstitial nephritis (AIN) (26%), and immune complex-mediated glomerulonephritis (ICGN) (25%) were the predominant renal histology. Baseline CD4 cell count ≥200 cells/mm3 was a protective factor against CKD (hazard ratio=0.997; 95%CI=0.994-0.999; P=0.012). At last follow-up, 64% of patients with baseline CD4 ≥200 cells/mm3 had eGFR >60 mL·min-1·(1.73 m2)-1 compared to the other 35% of patients who presented with CD4 <200 cells/mm3 (log rank=9.043, P=0.003). In conclusion, the main histological lesion of HIV-associated renal disease was HIVAN, followed by AIN and ICGN. These findings reinforce the need to biopsy HIV patients with kidney impairment and/or proteinuria. Baseline CD4 cell count ≥200 cells/mm3 was associated with better renal function after 2 years of follow-up. PMID:27007656

  12. Mortality from diabetic renal disease: a hidden epidemic.

    Science.gov (United States)

    Rao, Chalapati; Adair, Timothy; Bain, Chris; Doi, Suhail A R

    2012-04-01

    Population-level mortality indicators can be useful outcome measures of diabetes care. Death registration systems serve as the main source of data for such measures. However, standard mortality indicators based on underlying causes do not adequately reflect the burden from diabetic renal disease. This article presents findings from analysis of multiple causes of death available from death registration data for Australia and USA. Both countries use an automated system that applies prescribed rules to select and code the underlying cause for each registered death. Deaths with diabetes as underlying cause were grouped according to their diabetic complications as defined by the International Classification of Diseases. Age-standardized mortality rates were calculated for the underlying cause rubric 'diabetes with renal complications'. These were contrasted with rates calculated using additional deaths where diabetes was the underlying cause and renal failure was listed as a consequence. These analyses identified that current automated programmes code three-fourths of all diabetes deaths to 'diabetes without complications', despite additional factors being listed. Estimated multiple cause death rates from diabetic renal disease are four to nine times higher than underlying cause rates for 'diabetes with renal complications' in both countries; and show a rising trend in contrast to the latter. These findings indicate that routine underlying cause statistics for USA and Australia grossly under estimate mortality from diabetic renal disease. Clear guidelines on the certification, coding and statistical presentation of diabetes mortality are needed for epidemiology and health policy.

  13. The Role of Matrix Metalloproteinases in Renal Diseases

    Directory of Open Access Journals (Sweden)

    Funda SAĞLAM

    2011-05-01

    Full Text Available Matrix metalloproteinases (MMPs are a family of zinc dependent proteinases and the main promoters of extracellular matrix degradation. Their role in renal diseases is now being understood better. Several progressive renal diseases are characterized with persistent cell proliferation and abnormal production of extracellular matrix by mesengial cells. Understanding mesengial cell proliferation and the factors regulating extracellular matrix metabolism is therefore becoming more important. MMPs have been shown to be produced and excreted from renal glomerular cells and interstitital fibroblast and tubuloepithelial cells have also been shown to excrete MMPs. MMPs function in expansive cell behaviour, embryonic evolution and tissue fibrosis. Production of MMPs are known to increase in inflammation and restructure processes. Data obtained from both experimental and clinical studies has shown the role of MMPs in proliferative glomerulonephritis, hypertensive nephropathy, diabetic nephropathy, HIV nephropathy, toxic nephropathy, obstructive nephropathy, renal cell carcinoma, chronic allograft nephropathy-related fibrosis and in many other renal diseases. In light of these data, therapy options targeting MMPs have become a current issue. Limited data obtained from recent studies are promising about the clinical use of therapies repressing MMPs in future. The roles of MMPs which increase in inflammation and restructure processes in renal diseases and future therapy options are discussed in this review.

  14. Sorbents in acute renal failure and end-stage renal disease: middle molecule and cytokine removal.

    Science.gov (United States)

    Winchester, James F; Silberzweig, Jeffrey; Ronco, Claudio; Kuntsevich, Viktoria; Levine, Daniel; Parker, Tom; Kellum, John A; Salsberg, Jamie A; Quartararo, Peter; Levin, Nathan W

    2004-01-01

    Renal replacement therapy in acute renal failure (ARF) and chronic renal failure (end-stage renal disease; ESRD) has been based on the use of modifications of dialysis (continuous arteriovenous hemofiltration and hemodiafiltration) to remove middle-molecular-weight toxins, consisting of low-molecular-weight proteins and peptides (LMWP) and cytokines involved in inflammation. High-flux dialyzers are not efficient at removing LMWP, and for this reason, sorbents have been studied to augment or replace dialysis. Removal of LMWP such as beta2-microglobulin, leptin, complement factor D, angiogenin and cytokines such as interleukin (IL)-1, IL-6, IL-10, IL-18 and tumor necrosis factor-alpha has been established in animal models of sepsis and in ESRD patients using sorbents. Sorbent devices added to hemodialysis, or the use of such devices alone in inflammatory states, including sepsis, ARF, cardiopulmonary bypass, pre-explantation of donor organs and ESRD, are being studied.

  15. Fetal polycystic renal disease: prenatal sonographic findings with pathologic correlation

    Energy Technology Data Exchange (ETDEWEB)

    Jun, Soon Ae; Park, Yong Hyun; Cha, Sun Hee; Kay, Jung Woong; Cho, Joo Yeon; Cha, Kwang Yul; Cha, Kyung Sub [Cha Women' s Hospital, Seoul (Korea, Republic of); Chi, Je G. [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1990-04-15

    Polycystic renal disease are congenital disorders, most of which are fatal in the postnatal period. A series of ten cases of polycystic renal disease diagnosed prenatally by ultrasonography is presented. Diagnostic criteria of ultrasonography for cystic renal disease are; 1. enlarge kidney (4 cases) 2. echogenic density of kidney (3 cases) 3. 0.4 - 0.9cm sized multiple cysts within the renal cortex (3 cases) 4. decreased amount of amniotic fluid (4 cases) 5. hydronephrosis (4 cases) 6. distended bladder (2 cases) 7. absence of bladder (2 cases) Eight of ten cases were confirmed by autopsy. Seven cases had other associated congenital anomalies, i.e. pulmonary hypoplasia (5), hepatic fibrosis (3), congenital heart disease (3), tracheoesophageal fistula with imperforate anus (1), caudal regression syndrome (1), Meckel-Gruber syndrome (1) and ambiguous genitalia (2). Additional cytogenetic study of the fetus and the careful family history taking followed by prenatal diagnosis of cystic renal disease. Precise prenatal diagnosis may allow patients the option of elective abortion or may prevent unnecessary obstetric intervention.

  16. Developing a provisional and national renal disease registry for Iran

    Directory of Open Access Journals (Sweden)

    Sima Ajami

    2015-01-01

    Full Text Available Background: Disease registry is a database that includes information about people suffering a special kind of disease. The aim of this study was to first identify and compare the National Renal Disease Registry (NRDR characteristics in some countries with Iran; and second, develop a provisional and NRDR for Iran. Materials and Methods: Retrieval of data of the NRDR was performed by scholars responsible in related agencies, including the Ministry of Health and Medical Education, Renal Disease charity, and data registries in the United States, United Kingdom, Malaysia, and Iran. This research was applied, and the study was descriptive-comparative. The study population consisted of the NRDR in selected countries in which data were collected by forms that were designed according to the study objectives. Sources of data were researchers, articles, books, journals, databases, websites, related documents, and people who are active in this regard, and related agencies, including the Ministry of Health and Medical Education, and patient support charity. The researchers collected data for each country based on the study objectives and then put them in comparative tables. Data were analyzed by descriptive, comparative, and theoretical methods. Results: Most of the renal transplant teams report their own results as a single center experiences. America and Britain have a preeminent national registry of renal disease compared to other countries. Conclusion: Given that control, prevention, and treatment of chronic renal diseases incur high expenses and the disease is one of leading mortality factors in Iran and across the world and since national registry system for chronic renal diseases can provide better tools and strategies to manage and evaluate patients′ characteristics as well as risk factors which eventually leads to making better decisions.

  17. Nanomedicines for renal disease: current status and future applications

    DEFF Research Database (Denmark)

    Kamaly, Nazila; He, John C.; Ausiello, Dennis A.;

    2016-01-01

    Treatment and management of kidney disease currently presents an enormous global burden, and the application of nanotechnology principles to renal disease therapy, although still at an early stage, has profound transformative potential. The increasing translation of nanomedicines to the clinic, a...

  18. United States Renal Data System public health surveillance of chronic kidney disease and end-stage renal disease

    OpenAIRE

    Collins, Allan J.; Foley, Robert N.; Gilbertson, David T.; Chen, Shu-Cheng

    2015-01-01

    The United States Renal Data System (USRDS) began in 1989 through US Congressional authorization under National Institutes of Health competitive contracting. Its history includes five contract periods, two of 5 years, two of 7.5 years, and the fifth, awarded in February 2014, of 5 years. Over these 25 years, USRDS reporting transitioned from basic incidence and prevalence of end-stage renal disease (ESRD), modalities, and overall survival, as well as focused special studies on dialysis, in th...

  19. Growth retardation in children with chronic renal disease

    Directory of Open Access Journals (Sweden)

    Peco-Antić Amira

    2014-01-01

    Full Text Available Despite recent advances in the management of children with chronic renal disease (CRD, growth retardation remains its most visible comorbid condition. Growth retardation has adverse impact on morbidity and mortality rates, quality of life and education, and in adult patients on job family life, and independent leaving accomodation. Pathophysiology of impaired growth in CRD is complex and still not fully understood. The following complications are: anorexia, malnutrition, inflammation, decreased residual renal function, dialysis frequency and adequacy, renal anemia, metabolic acidosis, fluid/electrolyte imbalance, renal osteodistrophy, growth hormone (GH and insulin-like growth factor -1 (IGF-1 resistance. Malnutrition is most frequent and most important factor contributing to the degree of growth retardation in infancy. The degree of renal dysfunction is the major determinant of variability in growth from third year of age until puberty onset, while in puberty hypergonadotropic hypogonadism has negative effect. The main factors that influence growth after renal transplantation are the age of the recipient and glucocorticoid drugs dosage with negative effect and allograft function with positive effect. In order to improve growth in children with CRD it is necessary to include: diet with optimal caloric intake, correction of fluid/ electrolyte imbalance, correction of acidosis, renal osteodistrophy and anemia. If growth velocity is insufficient to normalize growth, it is necessary to start recombinant human GH (rhGH therapy at 0.05 mg/kg per day (0.35 mg/kg per week or 28 IU/m2 per week administered by subcutaneous injection.

  20. Renal Primordia Activate Kidney Regenerative Events in a Rat Model of Progressive Renal Disease

    Science.gov (United States)

    Imberti, Barbara; Corna, Daniela; Rizzo, Paola; Xinaris, Christodoulos; Abbate, Mauro; Longaretti, Lorena; Cassis, Paola; Benedetti, Valentina; Benigni, Ariela; Zoja, Carlamaria; Remuzzi, Giuseppe; Morigi, Marina

    2015-01-01

    New intervention tools for severely damaged kidneys are in great demand to provide patients with a valid alternative to whole organ replacement. For repairing or replacing injured tissues, emerging approaches focus on using stem and progenitor cells. Embryonic kidneys represent an interesting option because, when transplanted to sites such as the renal capsule of healthy animals, they originate new renal structures. Here, we studied whether metanephroi possess developmental capacity when transplanted under the kidney capsule of MWF male rats, a model of spontaneous nephropathy. We found that six weeks post-transplantation, renal primordia developed glomeruli and tubuli able to filter blood and to produce urine in cyst-like structures. Newly developed metanephroi were able to initiate a regenerative-like process in host renal tissues adjacent to the graft in MWF male rats as indicated by an increase in cell proliferation and vascular density, accompanied by mRNA and protein upregulation of VEGF, FGF2, HGF, IGF-1 and Pax-2. The expression of SMP30 and NCAM was induced in tubular cells. Oxidative stress and apoptosis markedly decreased. Our study shows that embryonic kidneys generate functional nephrons when transplanted into animals with severe renal disease and at the same time activate events at least partly mimicking those observed in kidney tissues during renal regeneration. PMID:25811887

  1. Value of renal cortical thickness as a predictor of renal function impairment in chronic renal disease patients

    Directory of Open Access Journals (Sweden)

    Samia Rafael Yamashita

    2015-02-01

    Full Text Available Objective: To determine the presence of linear relationship between renal cortical thickness, bipolar length, and parenchymal thickness in chronic kidney disease patients presenting with different estimated glomerular filtration rates (GFRs and to assess the reproducibility of these measurements using ultrasonography. Materials and Methods: Ultrasonography was performed in 54 chronic renal failure patients. The scans were performed by two independent and blinded radiologists. The estimated GFR was calculated using the Cockcroft-Gault equation. Interobserver agreement was calculated and a linear correlation coefficient (r was determined in order to establish the relationship between the different renal measurements and estimated GFR. Results: The correlation between GFR and measurements of renal cortical thickness, bipolar length, and parenchymal thickness was, respectively, moderate (r = 0.478; p < 0.001, poor (r = 0.380; p = 0.004, and poor (r = 0.277; p = 0.116. The interobserver agreement was considered excellent (0.754 for measurements of cortical thickness and bipolar length (0.833, and satisfactory for parenchymal thickness (0.523. Conclusion: The interobserver reproducibility for renal measurements obtained was good. A moderate correlation was observed between estimated GFR and cortical thickness, but bipolar length and parenchymal thickness were poorly correlated.

  2. International Study of Health Care Organization and Financing of renal services in England and Wales.

    Science.gov (United States)

    Nicholson, Tricia; Roderick, Paul

    2007-12-01

    In England and Wales, the quantity and quality of renal services have improved significantly in the last decade. While acceptance rates for renal replacement therapy appear low by international standards, they are now commensurate with many other northern European countries. The major growth in renal services has been in hemodialysis, especially at satellite units. Health care is predominantly publicly funded through a tax-based National Health Service, and such funding has increased in the last 10 years. Improvements in health outcomes in England and Wales are expected to continue due to the recent implementation of standards, initiatives, and monitoring mechanisms for renal transplantation, vascular access, and patient transport.

  3. 42 CFR 414.310 - Determination of reasonable charges for physician services furnished to renal dialysis patients.

    Science.gov (United States)

    2010-10-01

    ... services furnished to renal dialysis patients. 414.310 Section 414.310 Public Health CENTERS FOR MEDICARE... Determination of reasonable charges for physician services furnished to renal dialysis patients. (a) Principle. Physician services furnished to renal dialysis patients are subject to payment if the services are...

  4. Late de novo minimal change disease in a renal allograft

    Directory of Open Access Journals (Sweden)

    Madhan Krishan

    2009-01-01

    Full Text Available Among the causes of the nephrotic syndrome in renal allografts, minimal change disease is a rarity with only few cases described in the medical literature. Most cases described have occurred early in the post-transplant course. There is no established treatment for the condition but prognosis is favorable. We describe a case of minimal change disease that developed 8 years after a successful transplantation of a renal allograft in a middle-aged woman. The nephrotic syndrome was accompanied by deterioration of allograft function. Treatment with mycophenolate mofetil was successful in inducing remission and stabilizing allograft function.

  5. Late de novo minimal change disease in a renal allograft.

    Science.gov (United States)

    Madhan, Krishan K; Temple-Camp, Cynric R E

    2009-03-01

    Among the causes of the nephrotic syndrome in renal allografts, minimal change disease is a rarity with only few cases described in the medical literature. Most cases described have occurred early in the post-transplant course. There is no established treatment for the condition but prognosis is favorable. We describe a case of minimal change disease that developed 8 years after a successful transplantation of a renal allograft in a middle-aged woman. The nephrotic syndrome was accompanied by deterioration of allograft function. Treatment with mycophenolate mofetil was successful in inducing remission and stabilizing allograft function.

  6. Tumour Calcification and Calciphylaxis in End-Stage Renal Disease

    Directory of Open Access Journals (Sweden)

    Jia Di

    2014-01-01

    Full Text Available Although soft tissue and vascular calcifications are common in CKD and progress as an independent risk factor of all-cause mortality, tumour calcification and calciphylaxis are uncommon in patients with end-stage renal disease (ESRD. Here, we discuss a rare case of a patient with tumour calcification complicated with calciphylaxis developed septic shock from infection. Our patient is a 57-year-old man in his late stage of renal disease who presented with a huge mass at the right hip and necrotic cutaneous ulcers on the lower legs followed by local and systemic infection and death due to septic shock.

  7. Renal replacement therapy for rare diseases affecting the kidney

    DEFF Research Database (Denmark)

    Wühl, Elke; van Stralen, Karlijn J; Wanner, Christoph

    2014-01-01

    and separately for children and adults. METHODS: The Orphanet classification of rare disease was searched for rare diseases potentially causing ESRD, and these diagnosis codes were mapped to the corresponding ERA-EDTA primary renal disease codes. Thirty-one diagnoses were defined as rare diseases causing ESRD...... disease affected young patients in up to 46%. On 31 December 2011, 20 595 patients (12.4% of the total RRT population) were on RRT for ESRD caused by a rare disease. The point prevalence was 32.5 per million age-related population in children and 152.0 in adults. Only 5.8% of these patients were younger...

  8. Sirtuins and renal diseases: relationship with aging and diabetic nephropathy.

    Science.gov (United States)

    Kitada, Munehiro; Kume, Shinji; Takeda-Watanabe, Ai; Kanasaki, Keizo; Koya, Daisuke

    2013-02-01

    Sirtuins are members of the Sir2 (silent information regulator 2) family, a group of class III deacetylases. Mammals have seven different sirtuins, SIRT1-SIRT7. Among them, SIRT1, SIRT3 and SIRT6 are induced by calorie restriction conditions and are considered anti-aging molecules. SIRT1 has been the most extensively studied. SIRT1 deacetylates target proteins using the coenzyme NAD+ and is therefore linked to cellular energy metabolism and the redox state through multiple signalling and survival pathways. SIRT1 deficiency under various stress conditions, such as metabolic or oxidative stress or hypoxia, is implicated in the pathophysiologies of age-related diseases including diabetes, cardiovascular diseases, neurodegenerative disorders and renal diseases. In the kidneys, SIRT1 may inhibit renal cell apoptosis, inflammation and fibrosis, and may regulate lipid metabolism, autophagy, blood pressure and sodium balance. Therefore the activation of SIRT1 in the kidney may be a new therapeutic target to increase resistance to many causal factors in the development of renal diseases, including diabetic nephropathy. In addition, SIRT3 and SIRT6 are implicated in age-related disorders or longevity. In the present review, we discuss the protective functions of sirtuins and the association of sirtuins with the pathophysiology of renal diseases, including diabetic nephropathy.

  9. Salt restriction inhibits renal growth and stabilizes injury in rats with established renal disease.

    Science.gov (United States)

    Dworkin, L D; Benstein, J A; Tolbert, E; Feiner, H D

    1996-03-01

    Salt restriction inhibits renal growth and stabilizes injury in rats with established renal disease. Male Munich-Wistar rats that underwent right nephrectomy and segmental infarction of two thirds of the left kidney were fed standard chow for 4 wk and then randomly assigned to ingest standard or low-salt chow for an additional 4 wk. Four wk after ablation, rats had systemic hypertension, proteinuria, and glomerular sclerosis. The prevalence of sclerosis, protein excretion rate, and glomerular volume increased between the fourth and eighth week in rats that were fed standard chow, however, in rats that were fed low-salt chow, the increase in glomerular volume and development of further glomerular sclerosis was prevented whereas the protein excretion rate actually declined. Micropuncture studies performed 8 wk after ablation revealed that the glomerular hydraulic pressure was elevated in remnant kidneys and was not affected by salt restriction. This study demonstrates that dietary salt restriction can prevent further glomerular injury and reduce proteinuria even when instituted in rats with established renal disease. These findings are also consistent with the hypothesis that glomerular hypertrophy promotes injury in this model of hypertension and progressive renal disease.

  10. Preliminary report on digitalization of renal microangiograms used in analysing renal parenchymal diseases.

    Science.gov (United States)

    Takahashi, M; Kaneko, M

    1983-01-01

    Glomerulography is a useful method for the angiographic diagnosis of various renal parenchymal diseases. A new system for digitalization of the glomerulogram has been developed using a high resolution television camera and a CT computer. We describe the fundamental procedures involved in the clinical application of digital glomerulography by applying this method to a renal microangiogram of a cow. This new method aids a clearer understanding of the detailed microvasculatures by providing better magnification and storage and allowing for further processing of the original analogue images. With a computer printout of any part of the glomerulogram also possible, an estimation of the glomerular counts and their distribution can now be given for any unit of cross-sectional area of the renal cortex.

  11. Successful renal transplantation after recovery from acute disseminated encephalomyelitis in a child with end-stage renal disease

    Directory of Open Access Journals (Sweden)

    Bhosale Guruprasad

    2010-01-01

    Full Text Available Acute disseminated encephalomyelitis (ADEM, seen mostly in children, is an acute demyelinating disease, affecting mainly the white matter of brain and spinal cord. We report an unusual case of ADEM in an 11-year old boy with end-stage renal disease, who underwent hemopoietic stem cell transplantation prior to renal transplantation. He needed admission to the intensive care unit and required mechanical ventilation. He responded to intravenous injection of steroids and upon recovery, underwent renal transplantation successfully.

  12. Incidence of renal carcinoma in non-functioning kidney due to renal pelvic stone disease

    Science.gov (United States)

    ZENGIN, KURSAD; TANIK, SERHAT; SENER, NEVZAT CAN; ALBAYRAK, SEBAHATTIN; EKICI, MUSA; BOZKURT, IBRAHIM HALIL; BAKIRTAS, HASAN; GURDAL, MESUT; IMAMOGLU, MUHAMMED ABDURRAHIM

    2015-01-01

    The objective of This study was to report our pathological findings in nephrectomy specimens from patients treated for non-functioning hydronephrotic kidney due to renal pelvic stone disease. A total of 97 patients who underwent nephrectomy for non-functioning hydronephrotic kidneys between January, 2011 and June, 2014 were retrospectively reviewed. A non-functioning kidney was defined as one having paper-thin parenchyma on urinary ultrasound or computed tomography, exhibiting no contrast visualization in the collecting duct system on intravenous urography and having a split renal function of <10% on nuclear renal function studies. Following pathological evaluation, 9 patients were diagnosed with xanthogranulomatous pyelonephritis, 9 with malignant tumors and 79 with chronic pyelonephritis. Of the patients with chronic pyelonephritis, 2 also had renal adenomas. The malignant tumors included 3 transitional cell carcinomas (TCC), 2 squamous cell carcinomas (SCC), 3 renal cell carcinomas (RCC) (1 sarcomatoid, 1 papillary and 1 clear cell RCC), whereas 1 patient had concurrent RCC and TCC. In conclusion, non-functioning kidneys, particularly those with kidney stones, should be managed as possible malignancies, due to the higher incidence of malignant tumors in such patients compared with the normal population. PMID:26171211

  13. Pregnancy in women with renal disease. Part I: general principles.

    Science.gov (United States)

    Vidaeff, Alex C; Yeomans, Edward R; Ramin, Susan M

    2008-08-01

    The purpose of this review is to improve the basis upon which advice on pregnancy is given to women with renal disease and to address issues of obstetric management by drawing upon the accumulated world experience. To ensure the proper rapport between the respect for patient's autonomy and the ethical principle of beneficence, the review attempts to impart up-to-date, evidence-based information on the predictable outcomes and hazards of pregnancy in women with chronic renal disease. The physiology of pregnancy from the perspective of the affected kidney will be discussed as well as the principal predictors of maternal and fetal outcomes and general recommendations of management. The available evidence supports the implication that the degree of renal function impairment is the major determinant for pregnancy outcome. In addition, the presence of hypertension further compounds the risks. On the contrary, the degree of proteinuria does not demonstrate a linear correlation with obstetric outcomes. Management and outcome of pregnancies occurring in women on dialysis and after renal transplant are also discussed. Although the outcome of pregnancies under chronic dialysis has markedly improved in the past decade, the chances of achieving a viable pregnancy are much higher after transplantation. But even in renal transplant recipients, the rate of maternal and fetal complications remains high, in addition to concerns regarding possible adverse effects of immunosuppressive drugs on the developing embryo and fetus.

  14. Renal resistive index and mortality in chronic kidney disease.

    Science.gov (United States)

    Toledo, Clarisse; Thomas, George; Schold, Jesse D; Arrigain, Susana; Gornik, Heather L; Nally, Joseph V; Navaneethan, Sankar D

    2015-08-01

    Renal resistive index (RRI) measured by Doppler ultrasonography is associated with cardiovascular events and mortality in hypertensive, diabetic, and elderly patients. We studied the factors associated with high RRI (≥0.70) and its associations with mortality in chronic kidney disease patients without renal artery stenosis. We included 1962 patients with an estimated glomerular filtration rate of 15 to 59 mL/min per 1.73 m(2) who also had RRI measured (January 1, 2005, to October 2011) from an existing chronic kidney disease registry. Participants with renal artery stenosis (60%-99% or renal artery occlusion) were excluded. Multivariable logistic regression model was used to study factors associated with high RRI (≥0.70), and its association with mortality was studied using Kaplan-Meier plots and Cox proportional hazards model. Hypertension was prevalent in >90% of the patients. In the multivariable logistic regression, older age, female sex, diabetes mellitus, coronary artery disease, peripheral vascular disease, higher systolic blood pressure, and the use of β blockers were associated with higher odds of having RRI≥0.70. During a median follow-up of 2.2 years, 428 patients died. After adjusting for covariates, RRI≥0.70 was associated with increased mortality (adjusted hazard ratio, 1.29; 95% confidence interval, 1.02-1.65; Pchronic kidney disease. Noncardiovascular/non-malignancy-related deaths were higher in those with RRI≥0.70. RRI≥0.70 is associated with higher mortality in hypertensive chronic kidney disease patients without clinically significant renal artery stenosis after accounting for other significant risk factors. Its evaluation may allow early identification of those who are at risk thereby potentially preventing or delaying adverse outcomes.

  15. Vascular function and mild renal impairment in stable coronary artery disease

    NARCIS (Netherlands)

    van der Harst, P; Smilde, TDJ; Buikema, H; Voors, AA; Navis, G; van Veldhuisen, DJ; van Gilst, WH

    2006-01-01

    Objective - In patients with coronary artery disease, the concomitant presence of renal function impairment is associated with decreased survival. We aimed to assess whether in coronary artery diseased patients renal function impairment is associated with systemic vascular function, functional param

  16. Fibroblast growth factor 23 and dietary factors in renal disease

    NARCIS (Netherlands)

    da Cunha Baia, Leandro

    2015-01-01

    Omega-3 poly-unsaturated fatty acids and mineral metabolism: novel therapy for cardiovascular disease in renal patients? Deregulations in mineral metabolism, particularly related to phosphate and its regulating hormone fibroblast growth factor 23 (FGF23), are common in patients with chronic kidney d

  17. Sodium intake, RAAS-blockade and progressive renal disease

    NARCIS (Netherlands)

    de Borst, Martin H; Navis, Gerjan

    2016-01-01

    Pharmacological blockade of the renin-angiotensin-aldosterone system (RAAS) by angiotensin converting enzyme inhibitors or angiotensin receptor blockers is the current standard treatment to prevent progressive renal function loss in patients with chronic kidney disease. Yet in many patients the rena

  18. High prevalence of frailty in end-stage renal disease

    NARCIS (Netherlands)

    Drost, Diederik; Kalf, Annette; Vogtlander, Nils; van Munster, Barbara C.

    2016-01-01

    Purpose Prognosis of the increasing number of elderly patients with end-stage renal disease (ESRD) is poor with high risk of functional decline and mortality. Frailty seems to be a good predictor for those patients that will not benefit from dialysis. Varying prevalences between populations are prob

  19. Senescence rates in patients with end-stage renal disease

    DEFF Research Database (Denmark)

    Koopman, J J E; Rozing, M P; Kramer, Ada;

    2011-01-01

    function of the Gompertz equation as a superior descriptor of senescence rate. Here, we tested both measures of the rate of senescence in a population of patients with end-stage renal disease. It is clinical dogma that patients on dialysis experience accelerated senescence, whereas those with a functional...

  20. Sodium intake, RAAS-blockade and progressive renal disease

    NARCIS (Netherlands)

    de Borst, Martin H; Navis, Gerjan

    2016-01-01

    Pharmacological blockade of the renin-angiotensin-aldosterone system (RAAS) by angiotensin converting enzyme inhibitors or angiotensin receptor blockers is the current standard treatment to prevent progressive renal function loss in patients with chronic kidney disease. Yet in many patients the rena

  1. Sodium intake, RAAS-blockade and progressive renal disease

    NARCIS (Netherlands)

    de Borst, Martin H; Navis, Gerjan

    Pharmacological blockade of the renin-angiotensin-aldosterone system (RAAS) by angiotensin converting enzyme inhibitors or angiotensin receptor blockers is the current standard treatment to prevent progressive renal function loss in patients with chronic kidney disease. Yet in many patients the

  2. Aging-associated renal disease in mice is fructokinase dependent.

    Science.gov (United States)

    Roncal-Jimenez, Carlos A; Ishimoto, Takuji; Lanaspa, Miguel A; Milagres, Tamara; Hernando, Ana Andres; Jensen, Thomas; Miyazaki, Makoto; Doke, Tomohito; Hayasaki, Takahiro; Nakagawa, Takahiko; Marumaya, Shoichi; Long, David A; Garcia, Gabriela E; Kuwabara, Masanari; Sánchez-Lozada, Laura G; Kang, Duk-Hee; Johnson, Richard J

    2016-10-01

    Aging-associated kidney disease is usually considered a degenerative process associated with aging. Recently, it has been shown that animals can produce fructose endogenously, and that this can be a mechanism for causing kidney damage in diabetic nephropathy and in association with recurrent dehydration. We therefore hypothesized that low-level metabolism of endogenous fructose might play a role in aging-associated kidney disease. Wild-type and fructokinase knockout mice were fed a normal diet for 2 yr that had minimal (fructose content. At the end of 2 yr, wild-type mice showed elevations in systolic blood pressure, mild albuminuria, and glomerular changes with mesangial matrix expansion, variable mesangiolysis, and segmental thrombi. The renal injury was amplified by provision of high-salt diet for 3 wk, as noted by the presence of glomerular hypertrophy, mesangial matrix expansion, and alpha smooth muscle actin expression, and with segmental thrombi. Fructokinase knockout mice were protected from renal injury both at baseline and after high salt intake (3 wk) compared with wild-type mice. This was associated with higher levels of active (phosphorylated serine 1177) endothelial nitric oxide synthase in their kidneys. These studies suggest that aging-associated renal disease might be due to activation of specific metabolic pathways that could theoretically be targeted therapeutically, and raise the hypothesis that aging-associated renal injury may represent a disease process as opposed to normal age-related degeneration.

  3. MicroRNA biomarkers in clinical renal disease: from diabetic nephropathy renal transplantation and beyond.

    Science.gov (United States)

    Nassirpour, Rounak; Raj, Dominic; Townsend, Raymond; Argyropoulos, Christos

    2016-12-01

    Chronic Kidney Disease (CKD) is a common health problem affecting 1 in 12 Americans. It is associated with elevated risks of mortality, cardiovascular disease, and high costs for the treatment of renal failure with dialysis or transplantation. Advances in CKD care are impeded by the lack of biomarkers for early diagnosis, assessment of the extent of tissue injury, estimation of disease progression, and evaluation of response to therapy. Such biomarkers should improve the performance of existing measures of renal functional impairment (estimated glomerular filtration rate, eGFR) or kidney damage (proteinuria). MicroRNAs (miRNAs) a class of small, non-coding RNAs that act as post-transcriptional repressors are gaining momentum as biomarkers in a number of disease areas. In this review, we examine the potential utility of miRNAs as promising biomarkers for renal disease. We explore the performance of miRNAs as biomarkers in two clinically important forms of CKD, diabetes and the nephropathy developing in kidney transplant recipients. Finally, we highlight the pitfalls and opportunities of miRNAs and provide a broad perspective for the future clinical development of miRNAs as biomarkers in CKD beyond the current gold standards of eGFR and albuminuria.

  4. Chronic kidney disease in children with unilateral renal tumor.

    Science.gov (United States)

    Cozzi, Denis A; Ceccanti, Silvia; Frediani, Simone; Schiavetti, Amalia; Cozzi, Francesco

    2012-05-01

    In patients who have undergone nephrectomy lower stage chronic kidney disease may develop, which is an independent risk factor for cardiovascular disease and overall mortality. We investigated whether the prevalence of lower stage chronic kidney disease is related to the amount of renal parenchyma excised in children with unilateral renal tumor. A total of 15 patients treated with nephrectomy and 10 treated with nephron sparing surgery were enrolled at a single academic center. The Kidney Disease Outcomes Quality Initiative guidelines were used to classify patients by chronic kidney disease stage based on estimated glomerular filtration rate values. The Modification of Diet in Renal Disease study equation and Schwartz equation were used in patients older and younger than 17 years, respectively. At a mean followup of more than 12 years 8 patients who had undergone nephrectomy and 1 treated with bilateral nephron sparing surgery presented with stage II chronic kidney disease (estimated glomerular filtration rate 60 to 89 ml/min/1.73 m(2)). Sequential measurements from diagnosis to 12 to 17 years postoperatively showed that stage II chronic kidney disease in patients who had undergone nephrectomy manifested as a negligible postoperative increase in mean ± SD estimated glomerular filtration rate (75.7 ± 25.5 vs 79.4 ± 3.9 ml/min/1.73 m(2), p = 0.6). Five of the 8 patients presented with stage II chronic kidney disease even before nephrectomy. The other 7 patients who had undergone nephrectomy and those treated with nephron sparing surgery presented with a significant postoperative increase in mean ± SD estimated glomerular filtration rate (81.1 ± 24 vs 102.3 ± 3 ml/min/1.73 m(2), p = 0.02, and 88.7 ± 2 vs 107.4 ± 14 ml/min/1.73 m(2), p = 0.005, respectively). A subset of children with unilateral renal tumor presents before and/or after nephrectomy, and not after nephron sparing surgery, with stage II chronic kidney disease, probably due to a reduced renal

  5. Mechanisms of renal NaCl retention in proteinuric disease

    DEFF Research Database (Denmark)

    Svenningsen, Per; Friis, Ulla G; Versland, Jostein B

    2013-01-01

    In diseases with proteinuria, for example nephrotic syndrome and pre-eclampsia, there often are suppression of plasma renin-angiotensin-aldosterone system components, expansion of extracellular volume and avid renal sodium retention. Mechanisms of sodium retention in proteinuria are reviewed....... In animal models of nephrotic syndrome, the amiloride-sensitive epithelial sodium channel ENaC is activated while more proximal renal Na(+) transporters are down-regulated. With suppressed plasma aldosterone concentration and little change in ENaC abundance in nephrotic syndrome, the alternative modality...

  6. Nondiabetic renal disease in patients with type 2 diabetes

    Directory of Open Access Journals (Sweden)

    Ikram Mami

    2017-01-01

    Full Text Available Diabetic nephropathy (DN is one of the major complications of type 2 diabetes mellitus (T2DM. The diagnosis of DN is mostly clinical. Kidney biopsy is indicated only if nondiabetic renal disease (NDRD is suspected. This study is aimed to assess the prevalence of NDRD and to determine predictor and prognostic factors of DN, NDRD. It was a retrospective analytic study including T2DM patients in whom renal biopsies were performed at our department from 1988 to 2014. Seventy-five patients were included. Mean age was 52.7 years with sex ratio at 1.56. Renal biopsy findings were isolated NDRD in 33 cases, NDRD superimposed on DN in 24 cases, and isolated DN in 18 cases. Most common NDRD found were focal segmental glomerulosclerosis (21% and membranous nephropathy (19%. Multivariate analysis showed that the absence of ischemic heart disease [odds ratio (OR = 0.178, 95% confidence interval (CI = 0.041–0.762], absence of peripheral vascular disease (OR = 0.173, 95% CI = 0.045–0.669, and presence of hematuria (OR = 7.200, 95%CI = 0.886–58.531 were independent predictors of NDRD. 24 patients reached end-stage renal disease 55% in DN group, 16% in DN associated to NDRD group, and 30% in NDRD group. The prevalence of NDRD found in our study confirmed usefulness of renal biopsy in patients with T2DM, especially in those without degenerative complications, hypertension, and insulin therapy.

  7. Diabetes mellitus and renal involvement in chronic viral liver disease.

    Science.gov (United States)

    Iovanescu, V F; Streba, C T; Ionescu, M; Constantinescu, A F; Vere, C C; Rogoveanu, I; Moța, E

    2015-01-01

    Chronic viral liver disease is often associated with other conditions. Diabetes mellitus (DM) is frequently reported in this context and may play a role in the progression of the liver disease to hepatocellular carcinoma (HCC). Renal disease is also an important extrahepatic manifestation of hepatitis viral infection and its presence is associated with poor prognosis and management issues. Our study had multiple purposes: to determine the frequency of the association between chronic viral liver disease and diabetes mellitus, evaluate the potential of diabetes mellitus as a risk factor for HCC and assess an eventual renal involvement. We included in our study a number of 246 patients with chronic liver disease, from whom 136 were diagnosed with chronic viral hepatitis and 110 with viral liver cirrhosis. These patients were assessed by using a clinical examination and a series of tests, including serum transaminase levels, serum bilirubin, serum albumin, markers of cholestasis, fasting plasma glucose levels, serum creatinine, urea, albuminuria, Addis-Hamburger test, electrophoresis of urinary proteins, abdominal ultrasound and, in some cases, CT examination. We obtained the following results: diabetes mellitus is often associated with chronic liver disease of viral etiology, having been identified in 18.29% of the patients in our study. Age above 60 in patients with chronic hepatitis (p=0.013diabetes mellitus. Renal disease was present in 13.4% of the patients with chronic liver disease and it was especially associated with liver cirrhosis and hepatitis C virus. The most common form of renal injury was glomerulonephritis. Acute kidney injury was diagnosed only in cirrhotic patients as hepatorenal syndrome, occurring in 7.27% of the subjects, while chronic kidney disease was identified only in two cases of chronic viral hepatitis. Four patients in our study were diagnosed with HCC and none of them presented diabetes mellitus. Our study revealed that there is a

  8. Impact of Renal Disease on Patients with Hepatitis C: A Retrospective Analysis of Disease Burden, Clinical Outcomes, and Health Care Utilization and Cost.

    Science.gov (United States)

    Solid, Craig A; Peter, Senaka A; Natwick, Tanya; Guo, Haifeng; Collins, Allan J; Arduino, Jean Marie

    2017-01-01

    Few studies explore the magnitude of the disease burden and health care utilization imposed by renal disease among patients with hepatitis C virus (HCV). We aimed to describe the characteristics, outcomes, and health care utilization and costs of patients with HCV with and without renal impairment. This retrospective analysis used 2 administrative claims databases: the US commercially insured population in Truven Health MarketScan® data (aged 20-64 years), and the US Medicare fee-for-service population in the Medicare 20% sample (aged ≥65 years). Baseline characteristics and comorbid conditions were identified from claims during 2011; patients were followed for up to 1 year (beginning January 1, 2012) to identify health outcomes of interest and health care utilization and costs. In the MarketScan and Medicare databases, 35,965 and 10,608 patients with HCV were identified, 8.5 and 26.5% with evidence of renal disease (chronic kidney disease [CKD] or end-stage renal disease [ESRD]). Most comorbid conditions and unadjusted outcome rates increased across groups from patients with no evidence of renal disease to non-ESRD CKD to ESRD. Health care utilization followed a similar pattern, as did the costs. Our findings suggest that HCV patients with concurrent renal disease have significantly more comorbidity, a higher likelihood of negative health outcomes, and higher health care utilization and costs. © 2017 S. Karger AG, Basel.

  9. FUROSEMIDE TEST: ITS PATTERN IN NOT SEVERE CHRONIC RENAL DISEASE

    Directory of Open Access Journals (Sweden)

    Carlos G. Musso

    2008-01-01

    Full Text Available Furosemide test is a simple and useful test of renal physiology used to evaluate the capability of the collecting tubules to secrete potassium under the effect of serum aldosterone. Its behaviour pattern has already been established in children and young adults but not described in chronic renal disease patients yet, which we explored in this study.Material & Method: Twenty-six young volunteers (between 20 and 40 years old, chronically on a low potassium diet (40 mmol of K day were studied: twenty of them were healthy young ( they were neither suffering form diseases nor on any medication, and the rest were young patients suffering from stage II / III chronic renal disease (damaged kidney with GFR between 83.1 ml-min to 39.2 ml-min secondary to glomerular diseases documented by kidney biopsy. None of the studied chronic renal disease patients were suffering from diabetes mellitus, urinary obstruction, nor treated with dyskalemia generating drugs, such as: diuretics, angiotensin converting enzyme inhibitors, angiotensin receptor antagonists, etc. Before, while the test was being carried out and after 180 minutes of a single dose of intravenous furosemide (1 mg/kg, urine and blood samples were obtained, for creatinine and potassium levels. From these data we calculated fractional excretion (FE of potassium. Statistical analysis was performed applying Student´s t-test.Results: There was no significant difference neither in pre-furosemide (basal and post-furosemide average FE of potassium between the healthy and chronic renal disease (CRD group: 16.4 ± 8.6% (CRD vs 11.5 ± 4.6% (healthy (p = NS ; 40.8 ± 3.2 % (CRD vs 35.4 ± 8.9% (healthy (p = NS respectively. Conversely, there was a significant difference in post-furosemide peak FE of potassium value, which was higher and delayed in the CRD group compared to the healthy one: 49.5 ± 8.2 % at 118 mins (CRD vs 31.6 ± 11% at 30 mins (healthy (p = 0.001.Conclusion: Furosemide test showed a

  10. The glomerulo-tubular junction: a target in renal diseases.

    Science.gov (United States)

    Lindop, G B M; Gibson, I W; Downie, T T; Vass, D; Cohen, E P

    2002-05-01

    Both global and segmental glomerulopathies may damage specific areas of the renal glomerulus. Diseases associated with glomerular hyperperfusion cause lesions at the vascular pole, while diseases associated with proteinuria often damage the tubular pole. Atubular glomeruli are now known to be plentiful in a variety of common renal diseases. These glomeruli are disconnected from their tubule at the tubular pole and therefore cannot participate in the production of urine. It is widely believed that the disconnection is a result of external compression by periglomerular fibrosis. However, the variable anatomy and cell populations within both the glomerulus and the beginning of the proximal tubule at the glomerulo-tubular junction may also have important roles to play in the response to damage at this sensitive site of the nephron.

  11. Lipoprotein X Causes Renal Disease in LCAT Deficiency.

    Science.gov (United States)

    Ossoli, Alice; Neufeld, Edward B; Thacker, Seth G; Vaisman, Boris; Pryor, Milton; Freeman, Lita A; Brantner, Christine A; Baranova, Irina; Francone, Nicolás O; Demosky, Stephen J; Vitali, Cecilia; Locatelli, Monica; Abbate, Mauro; Zoja, Carlamaria; Franceschini, Guido; Calabresi, Laura; Remaley, Alan T

    2016-01-01

    Human familial lecithin:cholesterol acyltransferase (LCAT) deficiency (FLD) is characterized by low HDL, accumulation of an abnormal cholesterol-rich multilamellar particle called lipoprotein-X (LpX) in plasma, and renal disease. The aim of our study was to determine if LpX is nephrotoxic and to gain insight into the pathogenesis of FLD renal disease. We administered a synthetic LpX, nearly identical to endogenous LpX in its physical, chemical and biologic characteristics, to wild-type and Lcat-/- mice. Our in vitro and in vivo studies demonstrated an apoA-I and LCAT-dependent pathway for LpX conversion to HDL-like particles, which likely mediates normal plasma clearance of LpX. Plasma clearance of exogenous LpX was markedly delayed in Lcat-/- mice, which have low HDL, but only minimal amounts of endogenous LpX and do not spontaneously develop renal disease. Chronically administered exogenous LpX deposited in all renal glomerular cellular and matrical compartments of Lcat-/- mice, and induced proteinuria and nephrotoxic gene changes, as well as all of the hallmarks of FLD renal disease as assessed by histological, TEM, and SEM analyses. Extensive in vivo EM studies revealed LpX uptake by macropinocytosis into mouse glomerular endothelial cells, podocytes, and mesangial cells and delivery to lysosomes where it was degraded. Endocytosed LpX appeared to be degraded by both human podocyte and mesangial cell lysosomal PLA2 and induced podocyte secretion of pro-inflammatory IL-6 in vitro and renal Cxl10 expression in Lcat-/- mice. In conclusion, LpX is a nephrotoxic particle that in the absence of Lcat induces all of the histological and functional hallmarks of FLD and hence may serve as a biomarker for monitoring recombinant LCAT therapy. In addition, our studies suggest that LpX-induced loss of endothelial barrier function and release of cytokines by renal glomerular cells likely plays a role in the initiation and progression of FLD nephrosis.

  12. Environmental renal disease: Lead, cadmium and Balkan endemic nephropathy

    Energy Technology Data Exchange (ETDEWEB)

    Wedeen, R.P. (VA Medical Center, East Orange, NJ (United States))

    1991-11-01

    The similarity of lead and cadmium nephropathy to Balkan endemic nephropathy warrants careful reevaluation of the possibility that these nephrotoxic metals contribute to the production of the endemic renal disease. Low-level environmental exposure may result in a relationship between the concentration of the metals in tissue storage sites and biological fluids that differs from that encountered after occupational exposure. Urine and blood concentrations may therefore be inadequate measures of exposure. Lead is accumulated in the skeleton and cadmium in the liver and kidneys with biological half lives approximating a decade. Non-invasive in vivo x-ray fluorescence or neutron activation analysis can therefore be used to measure cumulative tissue stores. Multiple regression analysis of epidemiologic data could reveal the relative contribution of causal factors, including lead and cadmium, and help to distinguish Balkan endemic nephropathy from other renal diseases using rigorous diagnostic criteria. As long as Balkan endemic nephropathy remains a diagnosis of exclusion, the accuracy of the diagnosis of other renal disease determines the reliability of identification of the endemic disease.31 references.

  13. Renal transplant improves pulmonary hypertension in patients with end stage renal disease

    Directory of Open Access Journals (Sweden)

    Bozbas Serife

    2011-06-01

    Full Text Available Abstract Background Pulmonary hypertension (PH is present in a significant proportion of patients with end stage renal disease (ESRD and is of prognostic importance. Data on the effect of renal transplant on PH is very limited. In this study, the aim was to examine the effect of renal transplant on systolic pulmonary artery pressure (SPAP determined by Doppler echocardiography. Methods Analysis was performed on the records of 500 consecutive patients who underwent renal transplant at our center between the years 1999 to 2008. The prevalence of PH in the preoperative assessment period was established. Patients were diagnosed as having PH when measured SPAP values were > 35 mm Hg. Results Pulmonary hypertension was detected in 85 of the 500 (17% patients under pre-transplant evaluation. At post-transplant follow up Doppler echocardiographic examination was performed on 50 of the 85 patients. After exclusion of 8 cases (1 due to massive pulmonary thromboemboli; 7 due to graft failure requiring dialysis therapy analyses were performed on 42 patients who had undergone both pre- and post-transplant echocardiographic examination. Mean SPAP at pre-transplant evaluation was 45.9 ± 8.8 mm Hg and in 6 (14.3% cases SPAP was above 50 mm Hg. Compared to pre-transplant values, a significant decrease was observed in mean SPAP values in an average of 53 months of postoperative follow up (41.8 ± 7.4 mm Hg vs. 45.9 ± 8.8 mm Hg, p Conclusion These findings indicate that patients with ESRD accompanied by PH may benefit from renal transplant. Further research is required for more concrete conclusions to be drawn on this subject.

  14. Vocational Rehabilitation and End Stage Renal Disease. Proceedings of the Workshop (Denver, Colorado, December 11-13, 1979).

    Science.gov (United States)

    George Washington Univ. Medical Center, Washington, DC. Rehabilitation Research and Training Center.

    This document contains 12 papers presented to medical and vocational rehabilitation professionals on the topic of vocational rehabilitation and End Stage Renal Disease (ESRD) at a Denver conference in 1979. The following papers are contained in this report: "Rehabilitation and ESRD: Services with a New Thrust" by Kathleen E. Lloyd;…

  15. Invasive versus non-invasive diagnosis of renal bone disease.

    Science.gov (United States)

    Fournier, A; Oprisiu, R; Said, S; Sechet, A; Ghazali, A; Marié, A; el Esper, I; Brazier, M; Achard, J M; Morinière, P

    1997-07-01

    At present, bone histomorphometry remains the gold standard for the diagnosis of the various types of renal bone disease. In the search for a non-invasive method of diagnosis, biochemical serum markers of bone remodelling, in addition to serum intact parathyroid hormone and aluminium determinations, have been proposed as the most reliable tools and are at present widely used in clinical practice. Their respective diagnostic values, as separate items and in combined analysis, are thoroughly discussed in the present review.

  16. Non-diabetic renal disease in type 2 diabetes mellitus: Study of renal - retinal relationship.

    Science.gov (United States)

    Prakash, J; Gupta, T; Prakash, S; Bhushan, P; Usha; Sivasankar, M; Singh, S P

    2015-01-01

    Diabetic nephropathy (DN) has become the leading cause of end-stage renal disease worldwide. Non-diabetic renal disease (NDRD), is known to occur in diabetic patients. The renal and retinal relationship in type 2 diabetes mellitus (T2DM) with nephropathy is not uniform. This study was carried to study the histological spectrum of nephropathy in type 2 diabetic patients with proteinuria and its relationship with diabetic retinopathy (DR). Total 31 (males - 26; females - 5) proteinuric type 2 diabetic patients were studied. Average age of patients was 50.7 years. Nephrotic syndrome was noted in 21 (67.7%) patients. Overall, isolated DN, NDRD and NDRD superimposed on DN (mixed lesion) were observed in 12 (38.7%), 13 (41.9%) and 6 (19.4%) cases, respectively. DR was absent in 21/31 (67.7%) cases. The spectrum of nephropathy in patients without DR included: DN in 6 (28.57%), NDRD in 12 (57.14%) and mixed lesion in 3 (14.29%). Kidney histology in patients with DR (n-10) revealed DN in 6 (60%), NDRD in 1 (10%) and mixed lesion in 3 (30%) patients. Thus, absence of DR favors NDRD but does not exclude DN because isolated DN was noted in 28.57% cases in absence of DR. Similarly biopsy proven NDRD (pure NDRD; 10% and mixed lesion; 30%) was noted in 40% of cases in presence of DR. In summary, patients with T2DM had higher incidence of NDRD. DR is less frequent (32.3%) in type 2 diabetes and is a poor predictor of type of nephropathy. Hence, renal biopsy is essential for precise diagnosis of nephropathy in patients with T2DM.

  17. Hypertension in children with end-stage renal disease.

    Science.gov (United States)

    Roszkowska-Blaim, Maria; Skrzypczyk, Piotr

    2015-09-01

    This review summarizes current data on the epidemiology, pathophysiology, and treatment of hypertension (HTN) in children with end-stage renal disease (ESRD). Worldwide prevalence of ESRD ranges from 5.0 to 84.4 per million age-related population. HTN is present in 27-79% of children with ESRD, depending on the modality of renal replacement therapy and the exact definition of hypertension. Ambulatory BP monitoring has been recommended for the detection of HTN and evaluation of treatment effectiveness. HTN in dialyzed patients is mostly related to hypervolemia, sodium overload, activation of the renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system, impaired nitric oxide synthesis, reduced vitamin D levels, and effects of microRNA. In children undergoing chronic dialysis therapy, important factors include optimization of renal replacement therapy and preservation of residual renal function, allowing reduction of volume- and sodium-overload, along with appropriate drug treatment, particularly with calcium channel blockers, RAAS inhibitors, and loop diuretics.

  18. Drosophila provides rapid modeling of renal development, function, and disease.

    Science.gov (United States)

    Dow, Julian A T; Romero, Michael F

    2010-12-01

    The evolution of specialized excretory cells is a cornerstone of the metazoan radiation, and the basic tasks performed by Drosophila and human renal systems are similar. The development of the Drosophila renal (Malpighian) tubule is a classic example of branched tubular morphogenesis, allowing study of mesenchymal-to-epithelial transitions, stem cell-mediated regeneration, and the evolution of a glomerular kidney. Tubule function employs conserved transport proteins, such as the Na(+), K(+)-ATPase and V-ATPase, aquaporins, inward rectifier K(+) channels, and organic solute transporters, regulated by cAMP, cGMP, nitric oxide, and calcium. In addition to generation and selective reabsorption of primary urine, the tubule plays roles in metabolism and excretion of xenobiotics, and in innate immunity. The gene expression resource FlyAtlas.org shows that the tubule is an ideal tissue for the modeling of renal diseases, such as nephrolithiasis and Bartter syndrome, or for inborn errors of metabolism. Studies are assisted by uniquely powerful genetic and transgenic resources, the widespread availability of mutant stocks, and low-cost, rapid deployment of new transgenics to allow manipulation of renal function in an organotypic context.

  19. RENAL REPLACEMENT THERAPY FOR END-STAGE RENAL DISEASE PATIENTS IN RUSSIAN FEDERATION, 1998–2011 (Report of the Russian Registry of Renal Replacement Therapy

    Directory of Open Access Journals (Sweden)

    N. A. Tomilina

    2015-01-01

    Full Text Available The report of the Russian Renal Replacement Therapy Registry covers the period from the year 1998 to 2011 and represents data on the national, regional, and individual patient levels. We summarize information about epidemiology of treated end-stage renal disease in Russia, and describe in details incidence and prevalence for all modalities of renal replacement therapy. The article contains broad spectrum of data on quality of treatment indicators, waiting list, pharmacological treatment, mortality, and survival patterns in patients on hemodialysis, peritoneal dialysis and with functioning renal graft. 

  20. The Economic Burden of Chronic Kidney Disease and End-Stage Renal Disease.

    Science.gov (United States)

    Wang, Virginia; Vilme, Helene; Maciejewski, Matthew L; Boulware, L Ebony

    2016-07-01

    The growing prevalence and progression of chronic kidney disease (CKD) raises concerns about our capacity to manage its economic burden to patients, caregivers, and society. The societal direct and indirect costs of CKD and end-stage renal disease are substantial and increase throughout disease progression. There is significant variability in the evidence about direct and indirect costs attributable to CKD and end-stage renal disease, with the most complete evidence concentrated on direct health care costs of patients with advanced to end-stage CKD. There are substantial gaps in evidence that need to be filled to inform clinical practice and policy.

  1. Angiotensin Signaling in Cardio-Renal Disease

    Science.gov (United States)

    Diz, Debra I.; Arnold, Amy C.; Nautiyal, Manisha; Isa, Katsunori; Shaltout, Hossam A.; Tallant, E. Ann

    2011-01-01

    Aging, hypertension and fetal programmed cardiovascular disease are associated with a functional deficiency of angiotensin (Ang)-(1–7) in the brain dorsomedial medulla. The resulting unrestrained activity of Ang II in brainstem regions negatively impacts resting mean arterial pressure, sympathovagal balance and baroreflex sensitivity for control of heart rate. The differential effects of Ang II and Ang-(1–7) may be related to the cellular sources of these peptides as well as different precursor pathways. Long-term alterations of the brain renin-angiotensin system may influence signaling pathways including phosphoinositol-3-kinase and mitogen-activated protein kinase and their downstream mediators, and as a consequence may influence metabolic function. Differential regulation of signaling pathways in aging and hypertension by Ang II versus Ang-(1–7) may contribute to the autonomic dysfunction accompanying these states. PMID:21367658

  2. Clinical outcomes of end stage renal disease and adequacy of adult maintenance hemodialysis patients

    OpenAIRE

    Ismail Mahmud Ali, Amirthalingam R

    2014-01-01

    Background & Aim: End stage renal disease (ESRD) is an irreversible loss of kidney function caused by various risk factors and affected persons of lives mainly depending on the technology of renal replacement therapy (RRT) or renal transplantation (RT) to sustain the life. Aim of this study is to overview the clinical outcomes of ESRD and adequacy of maintenance hemodialysis among the patients. Materials & Methods: Currently, there are sixty two end stage renal disease patient’s clinical data...

  3. Survival Analysis of Patients with End Stage Renal Disease

    Science.gov (United States)

    Urrutia, J. D.; Gayo, W. S.; Bautista, L. A.; Baccay, E. B.

    2015-06-01

    This paper provides a survival analysis of End Stage Renal Disease (ESRD) under Kaplan-Meier Estimates and Weibull Distribution. The data were obtained from the records of V. L. MakabaliMemorial Hospital with respect to time t (patient's age), covariates such as developed secondary disease (Pulmonary Congestion and Cardiovascular Disease), gender, and the event of interest: the death of ESRD patients. Survival and hazard rates were estimated using NCSS for Weibull Distribution and SPSS for Kaplan-Meier Estimates. These lead to the same conclusion that hazard rate increases and survival rate decreases of ESRD patient diagnosed with Pulmonary Congestion, Cardiovascular Disease and both diseases with respect to time. It also shows that female patients have a greater risk of death compared to males. The probability risk was given the equation R = 1 — e-H(t) where e-H(t) is the survival function, H(t) the cumulative hazard function which was created using Cox-Regression.

  4. Arterial spin labelling in imaging of renal diseases and renal allograft pathology; MRT-Perfusionsmessung mit Arterial Spin Labelling. Anwendung fuer die Niere und Transplantatniere

    Energy Technology Data Exchange (ETDEWEB)

    Hueper, Katja; Gutberlet, Marcel [Medizinische Hochschule Hannover (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie; Kuehn, Bernd [Siemens AG/Siemens Healthcare GmbH, Erlangen (Germany)

    2016-06-15

    Arterial Spin Labelling (ASL) is a technique for non-invasive and contrast-free assessment of perfusion with MRI. Renal ASL allows examination of renal pathophysiology, evaluation of the course of renal disease and therapy effects by longitudinal measurements as well as characterization of renal tumors. In this article, techniques of ASL will be explained and challenges of renal ASL will be emphasized. In addition, examples for clinical application of ASL for diagnosis of renal disease and renal allograft pathology will be given.

  5. Renal impairment in different phenotypes of Wilson disease.

    Science.gov (United States)

    Wang, Honghao; Zhou, Zhihua; Hu, Jiyuan; Han, Yongzhu; Wang, Xun; Cheng, Nan; Wu, Yunfan; Yang, Renmin

    2015-11-01

    Wilson's disease (WD) is a rare autosomal recessive genetic disease resulting in the chronic deposition of copper in both liver and brain. This can lead to hepatic, neurologic, and psychiatric manifestations. Renal impairment can occur in any period of WD, but the mechanism is not yet known. In this study, we analyzed the clinical data of 691 newly diagnosed WD patients to investigate the blood urea nitrogen (BUN), creatinine (Cr), and uric acid (UA) levels in different subtypes of WD. This study included 691 newly diagnosed WD patients, 34 asymptomatic cases, and 127 healthy controls. The entire sample was assessed for serum levels of BUN, Cr, and UA. We found that the levels of BUN and Cr in WD patients who had neurological manifestations were higher (p < 0.001). In contrast, those patients presenting with a combined neurological and hepatic condition showed the lowest serum levels of UA (p = 0.026). There are differences in renal impairment between the endo-phenotypes of WD. Renal impairment can reflect differential copper deposition in organs other than the liver.

  6. Periodontal disease characterization in dogs with normal renal function or chronic renal failure

    Directory of Open Access Journals (Sweden)

    Barbudo-Selmi Glenda Ramalho

    2004-01-01

    Full Text Available The purpose of this study was to evaluate periodontal disease (PD in dogs with chronic renal failure (CRF and to compare it to PD in dogs with normal renal function (NRF. Twelve dogs with CRF and 24 dogs with NRF, all presenting dental pocket formation, were compared. In all dogs, serum creatinine, blood urea nitrogen, urine specific gravity and total red and white blood cells were determined. A complete oral examination was also performed including evaluation of bacterial plaque, gingivitis, gingival recession, pocket, calculus, dental mobility, dental loss, and ulcers. These data were used to calculate plaque index (PI, gingival index (GI and periodontal destruction index (PDI. PD was graded as mild, moderate or severe based on the results. Mild, moderate or severe PD was observed in dogs with NRF, whereas dogs with CRF presented either mild or severe PD. Dogs with NRF showed higher involvement of the maxillary teeth, whereas dogs with CRF showed a higher involvement of the mandibular teeth. Plaque index was significantly higher in dogs with NRF. It was concluded that lesion distribution and periodontal disease progression may be altered in dogs with CRF, and gingival inflammatory response differs in dogs with NRF and CRF regarding to the stage of periodontal disease.

  7. Renal Impairment and Cardiovascular Disease in HIV-Positive Individuals

    DEFF Research Database (Denmark)

    Ryom, Lene; Lundgren, Jens D; Ross, Mike

    2016-01-01

    follow-up duration of 8.0 years (interquartile range, 5.4-8.9 years) 1357 of 35 357 individuals developed CVD (incidence rate, 5.2 cases/1000 person-years [95% confidence interval {CI}, 5.0-5.5]). Confirmed baseline eGFR and CVD were closely related with 1.8% of individuals (95% CI, 1.6%-2.0%) with an e...... relation between confirmed impaired eGFR and CVD was observed. This finding highlights the need for renal preventive measures and intensified monitoring for emerging CVD, particularly in older individuals with continuously low eGFRs.......BACKGROUND: While the association between renal impairment and cardiovascular disease (CVD) is well established in the general population, the association remains poorly understood in human immunodeficiency virus (HIV)-positive individuals. METHODS: Individuals with ≥2 estimated glomerular...

  8. Pulmonary cystic disease associated with integumentary and renal manifestations.

    Science.gov (United States)

    Cayetano, Katherine S; Albertson, Timothy E; Chan, Andrew L

    2013-11-01

    A 69-year-old man with multiple skin lesions on his face, neck and upper torso, which first appeared in the 3rd decade of his life, was admitted to our hospital. He had cystic changes in his lungs noted on chest computed tomography (CT) scanning, as well as a left kidney mass. This patient exhibited a rare complex of renal, cutaneous and pulmonary manifestations, eponymously named Birt-Hogg-Dube syndrome, with characteristic skin features (fibrofolliculomas, trichodiscomas and acrochordons). This syndrome is due to an autosomal dominant germ-line mutation of the folliculin (FLCN) gene located at chromosome 17p11.2. Diagnosis and differentiation from other disease complexes including the skin, kidneys and lungs are important in prognostication and management of potentially life-threatening complications such as renal cell carcinoma and pneumothoraces.

  9. Predictors of advanced chronic kidney disease and end-stage renal disease in HIV-positive persons

    DEFF Research Database (Denmark)

    Nielsen, Lene Ryom; Mocroft, Amanda; Kirk, Ole

    2014-01-01

    Whilst several antiretroviral drugs have been associated with moderate chronic kidney disease (CKD), their contribution to advanced CKD and end-stage renal disease (ESRD) remain unknown.......Whilst several antiretroviral drugs have been associated with moderate chronic kidney disease (CKD), their contribution to advanced CKD and end-stage renal disease (ESRD) remain unknown....

  10. Homocysteine as a predictive biomarker in early diagnosis of renal failure susceptibility and prognostic diagnosis for end stages renal disease.

    Science.gov (United States)

    Amin, Hatem K; El-Sayed, Mohamed-I Kotb; Leheta, Ola F

    2016-09-01

    Glomerular filtration rate and/or creatinine are not accurate methods for renal failure prediction. This study tested homocysteine (Hcy) as a predictive and prognostic marker for end stage renal disease (ESRD). In total, 176 subjects were recruited and divided into: healthy normal group (108 subjects); mild-to-moderate impaired renal function group (21 patients); severe impaired renal function group (7 patients); and chronic renal failure group (40 patients) who were on regular hemodialysis. Blood samples were collected, and serum was separated for analysis of total Hcy, creatinine, high sensitive C-reactive protein (CRP), serum albumin, and calcium. Data showed that Hcy level was significantly increased from normal-to-mild impairment then significantly decreases from mild impairment until the patient reaches severe impairment while showing significant elevation in the last stage of chronic renal disease. Creatinine level was increased in all stages of kidney impairment in comparison with control. CRP level was showing significant elevation in the last stage. A significant decrease in both albumin and calcium was occurred in all stages of renal impairment. We conclude Hcy in combination with CRP, creatinine, albumin, and calcium can be used as a prognostic marker for ESRD and an early diagnostic marker for the risk of renal failure.

  11. Family Stress with Chronic Childhood Illness: Cystic Fibrosis, Neuromuscular Disease, and Renal Disease.

    Science.gov (United States)

    Holroyd, Jean; Guthrie, Donald

    1986-01-01

    Parents of children with neuromuscular disease, cystic fibrosis, and renal disease were compared with parents of control subjects matched by age to the clinical cases. The three clinical groups exhibited different patterns of stressful response, consistent with the nature of their illnesses and the requirements for care imposed on the families.…

  12. CUBN as a novel locus for end-stage renal disease: insights from renal transplantation.

    Directory of Open Access Journals (Sweden)

    Anna Reznichenko

    Full Text Available Chronic kidney disease (CKD is a complex disorder. As genome-wide association studies identified cubilin gene CUBN as a locus for albuminuria, and urinary protein loss is a risk factor for progressive CKD, we tested the hypothesis that common genetic variants in CUBN are associated with end-stage renal disease (ESRD and proteinuria. First, a total of 1142 patients with ESRD, admitted for renal transplantation, and 1186 donors were genotyped for SNPs rs7918972 and rs1801239 (case-control study. The rs7918972 minor allele frequency (MAF was higher in ESRD patients comparing to kidney donors, implicating an increased risk for ESRD (OR 1.39, p = 0.0004 in native kidneys. Second, after transplantation recipients were followed for 5.8 [3.8-9.2] years (longitudinal study documenting ESRD in transplanted kidneys--graft failure (GF. During post-transplant follow-up 92 (9.6% cases of death-censored GF occurred. Donor rs7918972 MAF, representing genotype of the transplanted kidney, was 16.3% in GF vs 10.7% in cases with functioning graft. Consistently, a multivariate Cox regression analysis showed that donor rs7918972 is a predictor of GF, although statistical significance was not reached (HR 1.53, p = 0.055. There was no association of recipient rs7918972 with GF. Rs1801239 was not associated with ESRD or GF. In line with an association with the outcome, donor rs7918972 was associated with elevated proteinuria levels cross-sectionally at 1 year after transplantation. Thus, we identified CUBN rs7918972 as a novel risk variant for renal function loss in two independent settings: ESRD in native kidneys and GF in transplanted kidneys.

  13. Renal cell carcinoma co-existent with other renal disease: clinico-pathological features in pre-dialysis patients and those receiving dialysis or renal transplantation.

    Science.gov (United States)

    Peces, Ramón; Martínez-Ara, Jorge; Miguel, José Luis; Arrieta, Javier; Costero, Olga; Górriz, José Luis; Picazo, Mari-Luz; Fresno, Manuel

    2004-11-01

    Patients on chronic dialysis are prone to developing acquired cystic kidney disease (ACKD), which may lead to the development of renal cell carcinoma (RCC). The risk factors for the development of RCC so far have not been determined in pre-dialysis patients with co-existent renal disease. The aim of this study was to evaluate the clinico-pathological features of RCC in pre-dialysis patients with associated renal diseases or in those undergoing chronic dialysis and renal transplantation. We studied 32 kidneys from 31 patients with RCC and associated renal diseases. Of those, 18 kidneys were from 17 patients not on renal replacement therapy (RRT) when diagnosed with RCC; 14 patients received dialysis or dialysis followed by renal transplantation. Several clinico-pathological features were analysed and compared between the two groups. Overall, there was a preponderance of males (75%); nephrosclerosis was the predominant co-existent disease (31%). The median intervals from renal disease to RCC in the dialysis and transplanted groups were significantly longer than in the pre-dialysis group (15.8+/-1.1 vs 2.4+/-0.7 years, P<0.0001). In contrast to pre-dialysis RCC, the dialysis and transplant RCC groups had greater frequency of ACKD (100 vs 28%, P<0.0001), papillary type RCC (43 vs 11%, P<0.05) and multifocal tumours (43 vs 5%, P<0.05). At the end of the study, 71% of dialysis and transplanted patients and 72% of pre-dialysis patients were alive. ACKD develops in dialysis patients, as it does in those with renal disease prior to RRT. The duration of renal disease, rather than the dialysis procedure itself, appears to be the main determinant of ACKD and RCC. The RCC occurring in patients with ACKD and prolonged RRT is more frequently of the papillary type and multifocal than the RCC occurring in patients with no or few acquired cysts and a short history of renal disease. Long-term outcomes did not differ between the two groups.

  14. Renal Alterations in Feline Immunodeficiency Virus (FIV-Infected Cats: A Natural Model of Lentivirus-Induced Renal Disease Changes

    Directory of Open Access Journals (Sweden)

    Mauro Pistello

    2012-08-01

    Full Text Available Human immunodeficiency virus (HIV is associated with several renal syndromes including acute and chronic renal failures, but the underlying pathogenic mechanisms are unclear. HIV and feline immunodeficiency virus (FIV share numerous biological and pathological features, including renal alterations. We investigated and compared the morphological changes of renal tissue of 51 experimentally and 21 naturally infected cats. Compared to the latter, the experimentally infected cats exhibited some mesangial widening and glomerulonephritis, milder proteinuria, and lower tubular and interstitial alterations. The numbers of giant protein tubular casts and tubular microcysts were also lower. In contrast, diffuse interstitial infiltrates and glomerular and interstitial amyloidosis were detected only in naturally infected cats. Similar alterations are found in HIV infected patients, thus supporting the idea of a causative role of FIV infection in renal disease, and underlining the relevance of the FIV and its natural host as an animal model for investigating lentivirus-associated nephropathy.

  15. Renal and extrarenal manifestations of autosomal dominant polycystic kidney disease

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    E.A. Romão

    2006-04-01

    Full Text Available The objective of the present study was to determine the frequency of the most common clinical features in patients with autosomal dominant polycystic kidney disease in a sample of the Brazilian population. The medical records of 92 patients with autosomal dominant polycystic kidney disease attended during the period from 1985 to 2003 were reviewed. The following data were recorded: age at diagnosis, gender, associated clinical manifestations, occurrence of stroke, age at loss of renal function (beginning of dialysis, and presence of a family history. The involvement of abdominal viscera was investigated by ultrasonography. Intracranial alterations were prospectively investigated by magnetic resonance angiography in 42 asymptomatic patients, and complemented with digital subtraction arteriography when indicated. Mean age at diagnosis was 35.1 ± 14.9 years, and mean serum creatinine at referral was 2.4 ± 2.8 mg/dL. The most frequent clinical manifestations during the disease were arterial hypertension (63.3%, lumbar pain (55.4%, an abdominal mass (47.8%, and urinary infection (35.8%. Loss of renal function occurred in 27 patients (mean age: 45.4 ± 9.5 years. The liver was the second organ most frequently affected (39.1%. Stroke occurred in 7.6% of the patients. Asymptomatic intracranial aneurysm was detected in 3 patients and arachnoid cysts in 3 other patients. In conclusion, the most common clinical features were lumbar pain, arterial hypertension, abdominal mass, and urinary infection, and the most serious complications were chronic renal failure and stroke. Both intracranial aneurysms and arachnoid cysts occurred in asymptomatic patients at a frequency of 7.14%.

  16. Life and death in a welfare state: end-stage renal disease in the United Kingdom.

    Science.gov (United States)

    Halper, T

    1985-01-01

    The uniquely parsimonious approach to treatment of end-stage renal disease patients in the U.K. was initially developed under the imprimatur of the nation's medical elite and sanctioned by the central government. Public value for public money and an equitable balance of scarce resources among many social and medical claims still guide the National Health Service. But these clinically dominated allocative decisions are imperfect, often counter-productive, and, ultimately, political. There is a marked dissonance between compassionate and bureaucratic themes.

  17. [The bilateral renal lymphoma: an incurable disease? Case report].

    Science.gov (United States)

    Napoli, Marcello; Montinaro, A M; D'Ambrosio, E; Di Renzo, N; Ambrosino, C; Lefons, M; Pati, C; Sozzo, E

    2014-01-01

    The bilateral primary renal lymphoma (PRL) is a rare disease with a high mortality rate (75% within the first year). We report the case of a fifty-three years old women observed in January 2011 for renal colic. Ultrasonography showed hypoechoic lobular formations in the kidney. Blood tests showed: creatinine 1.8 mg/dl, urea 75 mg/dl , Creatinine Clerance 35 ml/m, hemoglobinemia 11 g/dl, with blood cells 8.500/mcL, Albumin 2.8 g/dl, Beta -2 micro - 27.3/mL. Proteinuria was 0.3 g/24 hours. The CT scan showed kidneys with larger dimensions and multiple hypodense areas infiltrating the renal parenchyma with contrast-enhanced low in which kidneys had lesions similar to "leopard skin". The CT scan showed no enlarged lymph nodes. Renal biopsy showed: renal parenchyma largely occupied by infiltration of lymphoid elements, small and medium-sized, densely packed with compression of the tubular structures . Immunofluorescence for immunoglobulin (Ig) G, IgA, IgM, C3, C4, C1q, fibrinogen, kappa and lambda were negative. The bone marrow biopsy excluded lymphomatous infiltration. The histological diagnosis was "non-Hodgkin's B-cell lymphoma"; the clinical diagnosis was LRBP. The patient was treated by 6 cycles of R-CHOP-21 protocol (rituximab - endoxan, adriblastina , vincristine, prendnisone), the latter of which practiced in August 2011. The pt is currently in follow-up hematology and nephrology . The first TAC control , in October 2011, showed a complete regression of the lesions infiltrating . This finding was confirmed by two other CT scan performed in February and October 2012. The last blood tests of February 2013 showed : creatinine 1.1 mg / dl , Urea 40 mg/dl, proteinuria absent. Currently, the pt is asymptomatic and is being treated by low dose of ACE inhibitor. The bilateral PRL is considered a severe disease with one-year mortality of 75% . The successful outcome of the case described can be attributed to haematological therapy and to the early diagnosis.

  18. Psychiatric disorders in patients with end-stage renal disease.

    Science.gov (United States)

    Martiny, Camila; e Silva, Adriana Cardoso de Oliveira; Neto, José Pedro Simões; Nardi, Antonio Egidio

    2012-09-01

    Psychiatric disorders in patients with end-stage renal disease are associated with poor prognosis and quality of life. The goal of this study is to investigate the association between psychiatric disorders and renal disease in patients undergoing dialysis treatment, compared with other chronic diseases, appreciating the demographic status of these patients. Sixty-nine patients participated in a diagnostic interview and gave socio-demographic data. The population was composed of 55% men aged 19-77 years with an average age of 50 years (95% CI = 47-54 years). The prevalence of psychiatric disorders found in this study (46.6%) was compared with that found in patients with asthma, polycystic ovary syndrome and HIV-positive. Moreover, the prevalence of the four most common psychiatric disorders which were identified among patients on dialysis were also the subject of comparison between them and others. These results demonstrate the relationship between the various psychiatric disorders and are compatible with other research studies.

  19. Edema in renal diseases – current view on pathogenesis

    Directory of Open Access Journals (Sweden)

    Irina Bobkova

    2016-10-01

    Full Text Available Edema is a common complication of numerous renal disease. In the recent past several aspects of the pathophysiology of this condition have been elucidated. We herein present a case of nephrotic syndrome in a 30 year-old men. The discussion revolves around the following key questions on fluid accumulation in renal disease: 1. What is edema? What diseases can cause edema? 2. What are the mechanisms of edema in nephrotic syndrome?   2a. The “underfill” theory   2b. The “overfill” theory   2c. Tubulointerstitial inflammation   2d. Vascular permeability 3. What are the mechanisms of edema in nephritic syndrome? 4. How can the volume status be assessed in patients with nephrotic syndrome? 5. What are therapeutic strategies for edema management? 6. What are the factors affecting response to diuretics? 7. How can we overcome the diuretics resistance?   7a. Effective doses of loop diuretics   7b. Combined diuretic therapy   7c. Intravenous administration of diuretics   7d. Albumin infusions   7e. Alternative methods of edema management 8. Conclusion.

  20. Pregnancy tests with end-stage renal disease.

    Science.gov (United States)

    Fahy, Brenda G; Gouzd, Valerie A; Atallah, Joseph N

    2008-12-01

    Tests to ascertain pregnancy status are often obtained during preoperative evaluation, especially when there is a history of uncertain pregnancy or suggestion of current pregnancy. A serum pregnancy test, a beta-human chorionic gonadotropin (beta-HCG) level, was preoperatively obtained from a woman of childbearing age with end-stage renal disease (ESRD) with an unreliable history of irregular menstruation coupled with unprotected sexual activity. The beta-HCG was elevated in the range indicating pregnancy. Further work-up showed that this hormonal elevation was secondary to ESRD without pregnancy.

  1. Successful aging theory and the patient with chronic renal disease: application in the clinical setting.

    Science.gov (United States)

    Blevins, Candy; Toutman, Meredith Flood

    2011-01-01

    As life expectancies increase, nurses will care for more individuals with chronic conditions, one of which is chronic renal disease. Increasing diversity and complexity of older adult healthcare needs signals a need to reconceptualize perceptions of successful aging. By emphasizing health promotion and adaptation, successful aging is possible for those with chronic renal disease. This article provides an overview of theory-based strategies for fostering successful aging in the patient with chronic renal disease.

  2. Renovascular heart failure: heart failure in patients with atherosclerotic renal artery disease.

    Science.gov (United States)

    Kawarada, Osami; Yasuda, Satoshi; Noguchi, Teruo; Anzai, Toshihisa; Ogawa, Hisao

    2016-07-01

    Atherosclerotic renal artery disease presents with a broad spectrum of clinical features, including heart failure as well as hypertension, and renal failure. Although recent randomized controlled trials failed to demonstrate renal artery stenting can reduce blood pressure or the number of cardiovascular or renal events more so than medical therapy, increasing attention has been paid to flash pulmonary edema and congestive heart failure associated with atherosclerotic renal artery disease. This clinical entity "renovascular heart failure" is diagnosed retrospectively. Given the increasing global burden of heart failure, this review highlights the background and catheter-based therapeutic aspects for renovascular heart failure.

  3. Contextualising renal patient routines: Everyday space-time contexts, health service access, and wellbeing.

    Science.gov (United States)

    McQuoid, Julia; Jowsey, Tanisha; Talaulikar, Girish

    2017-06-01

    Stable routines are key to successful illness self-management for the growing number of people living with chronic illness around the world. Yet, the influence of chronically ill individuals' everyday contexts in supporting routines is poorly understood. This paper takes a space-time geographical approach to explore the everyday space-time contexts and routines of individuals with chronic kidney disease (CKD). We ask: what is the relationship between renal patients' space-time contexts and their ability to establish and maintain stable routines, and, what role does health service access play in this regard? We draw from a qualitative case study of 26 individuals with CKD in Australia. Data comprised self-reported two day participant diaries and semi-structured interviews. Thematic analysis of interview transcripts was guided by an inductive-deductive approach. We examined the embeddedness of routines within the space-time contexts of participants' everyday lives. We found that participants' everyday space-time contexts were highly complex, especially for those receiving dialysis and/or employed, making routines difficult to establish and vulnerable to disruption. Health service access helped shape participants' everyday space-time contexts, meaning that incidences of unpredictability in accessing health services set-off 'ripple effects' within participants' space-time contexts, disrupting routines and making everyday life negotiation more difficult. The ability to absorb ripple effects from unpredictable health services without disrupting routines varied by space-time context. Implications of these findings for the deployment of the concept of routine in health research, the framing of patient success in self-managing illness, and health services design are discussed. In conclusion, efforts to understand and support individuals in establishing and maintaining routines that support health and wellbeing can benefit from approaches that contextualise and de

  4. Bariatric Surgery as a Bridge to Renal Transplantation in Patients with End-Stage Renal Disease.

    Science.gov (United States)

    Al-Bahri, Shadi; Fakhry, Tannous K; Gonzalvo, John Paul; Murr, Michel M

    2017-05-13

    Obesity is a relative contraindication to organ transplantation. Preliminary reports suggest that bariatric surgery may be used as a bridge to transplantation in patients who are not eligible for transplantation because of morbid obesity. The Bariatric Center at Tampa General Hospital, University of South Florida, Tampa, Florida. We reviewed the outcomes of 16 consecutive patients on hemodialysis for end-stage renal disease (ESRD) who underwent bariatric surgery from 1998 to 2016. Demographics, comorbidities, weight loss, as well as transplant status were reported. Data is mean ± SD. Six men and ten women aged 43-66 years (median = 54 years) underwent laparoscopic Roux-en-Y gastric bypass (LRYGB, n = 12), laparoscopic adjustable gastric banding (LAGB, n = 3), or laparoscopic sleeve gastrectomy (LSG, n = 1). Preoperative BMI was 48 ± 8 kg/m(2). Follow-up to date was 1-10 years (median = 2.8 years); postoperative BMI was 31 ± 7 kg/m(2); %EBWL was 62 ± 24. Four patients underwent renal transplantation (25%) between 2.5-5 years after bariatric surgery. Five patients are currently listed for transplantation. Five patients were not listed for transplantation due to persistent comorbidities; two of these patients died as a consequence of their comorbidities (12.5%) more than 1 year after bariatric surgery. Two patients were lost to follow-up (12.5%). Bariatric surgery is effective in patients with ESRD and improves access to renal transplantation. Bariatric surgery offers a safe approach to weight loss and improvement in comorbidities in the majority of patients. Referrals of transplant candidates with obesity for bariatric surgery should be considered early in the course of ESRD.

  5. UAB HRFD Core Center: Core A: The Hepato/Renal Fibrocystic Diseases Translational Resource

    Science.gov (United States)

    2016-08-23

    Hepato/Renal Fibrocystic Disease; Autosomal Recessive Polycystic Kidney Disease; Joubert Syndrome; Bardet Biedl Syndrome; Meckel-Gruber Syndrome; Congenital Hepatic Fibrosis; Caroli Syndrome; Oro-Facial-Digital Syndrome Type I; Nephronophthisis; Glomerulocystic Kidney Disease

  6. Oral Manifestations of Chronic Kidney Disease and Renal Secondary Hyperparathyroidism: A Comparative Review.

    Science.gov (United States)

    Davis, Eric M

    2015-01-01

    Recent epidemiological studies have demonstrated that significant associations exist between oral disease and diseases involving non-oral tissues. Occasionally, the roles may be reversed and the oral cavity can be severely affected by systemic disease originating in another part of the body. Renal secondary hyperparathyroidism is a common endocrinopathy that occurs as a consequence of chronic azotemic kidney disease. Renal osteodystrophy, the most dramatic clinical consequence of renal secondary hyperparathyroidism is uncommon, but can result in demineralization of maxillofacial bones, loosening of teeth, and pathological jaw fractures. The purpose of this report is to update the current understanding of the pathophysiology of this endocrine disease and to compare the oral manifestations of renal secondary hyperparathyroidism in humans and companion animals. A 50-year review of the veterinary literature was undertaken to examine the clinical presentation of renal osteodystrophy in dogs, and to determine what clinical consequences of renal secondary hyperparathyroidism have been reported in domestic cats.

  7. Neocytolysis contributes to the anemia of renal disease

    Science.gov (United States)

    Rice, L.; Alfrey, C. P.; Driscoll, T.; Whitley, C. E.; Hachey, D. L.; Suki, W.

    1999-01-01

    Neocytolysis is a recently described physiological process affecting the selective hemolysis of young red blood cells in circumstances of plethora. Erythropoietin (EPO) depression appears to initiate the process, providing the rationale to investigate its contributions to the anemia of renal disease. When EPO therapy was withheld, four of five stable hemodialysis patients showed chromium 51 (51Cr)-red cell survival patterns indicative of neocytolysis; red cell survival was short in the first 9 days, then normalized. Two of these four patients received oral 13C-glycine and 15N-glycine, and there was a suggestion of pathological isotope enrichment of stool porphyrins when EPO therapy was held, again supporting selective hemolysis of newly released red cells that take up the isotope (one patient had chronic hemolysis indicated by isotope studies of blood and stool). Thus, neocytolysis can contribute to the anemia of renal disease and explain some unresolved issues about such anemia. One implication is the prediction that intravenous bolus EPO therapy is metabolically and economically inefficient compared with lower doses administered more frequently subcutaneously.

  8. In vivo bone aluminum measurements in patients with renal disease

    Energy Technology Data Exchange (ETDEWEB)

    Ellis, K.J.; Kelleher, S.P.

    1986-01-01

    Contamination of the dialysis solution with trace amounts of aluminum and long-term use of aluminum-based phosphate binders have led to increased body burden of aluminum in patients with end-stage renal disease. A significant clinical problem associated with aluminum-overload is the early diagnosis of aluminum-induced dialysis dementia and osteomalacic osteodystrophy. There are few, if any, blood or urine indices that provide an early monitor of this bone disease, especially in the asymptomatic patient. Although a bone biopsy is usually the basis for the final clinical diagnosis, this procedure is not recommended for routine monitoring of patients. The present technique demonstrates the direct in vivo measurement of bone aluminum levels in patients with renal failure. The interference normally present from activation of bone phosphorus is eliminated by using a thermal/epithermal neutron beam. For the clinical management of the patients, the Al/Ca ratio for the hand may be more useful than an absolute measurement of the total body or skeletal aluminum burden. The relationship between the increased serum Al levels following disferrioxamine infusion and the direct in vivo measurement of bone aluminum using the Al/Ca ratio are currently under investigation. The neutron activation procedure presented in this pilot study is a promising new technique with an immediate clinical application. 5 refs., 3 figs., 1 tab.

  9. Biomarkers of Renal Disease and Progression in Patients with Diabetes

    Directory of Open Access Journals (Sweden)

    Radovan Hojs

    2015-05-01

    Full Text Available Diabetes prevalence is increasing worldwide, mainly due to the increase in type 2 diabetes. Diabetic nephropathy occurs in up to 40% of people with type 1 or type 2 diabetes. It is important to identify patients at risk of diabetic nephropathy and those who will progress to end stage renal disease. In clinical practice, most commonly used markers of renal disease and progression are serum creatinine, estimated glomerular filtration rate and proteinuria or albuminuria. Unfortunately, they are all insensitive. This review summarizes the evidence regarding the prognostic value and benefits of targeting some novel risk markers for development of diabetic nephropathy and its progression. It is focused mainly on tubular biomarkers (neutrophil-gelatinase associated lipocalin, kidney injury molecule 1, liver-fatty acid-binding protein, N-acetyl-beta-d-glucosaminidase, markers of inflammation (pro-inflammatory cytokines, tumour necrosis factor-α and tumour necrosis factor-α receptors, adhesion molecules, chemokines and markers of oxidative stress. Despite the promise of some of these new biomarkers, further large, multicenter prospective studies are still needed before they can be used in everyday clinical practice.

  10. Renal arterial resistive index is associated with severe histological changes and poor renal outcome during chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Bigé Naïke

    2012-10-01

    Full Text Available Abstract Background Chronic kidney disease (CKD is a growing public health problem and end stage renal disease (ESRD represents a large human and economic burden. It is important to identify patients at high risk of ESRD. In order to determine whether renal Doppler resistive index (RI may discriminate those patients, we analyzed whether RI was associated with identified prognosis factors of CKD, in particular histological findings, and with renal outcome. Methods RI was measured in the 48 hours before renal biopsy in 58 CKD patients. Clinical and biological data were collected prospectively at inclusion. Arteriosclerosis, interstitial fibrosis and glomerulosclerosis were quantitatively assessed on renal biopsy in a blinded fashion. MDRD eGFR at 18 months was collected for 35 (60% patients. Renal function decline was defined as a decrease in eGFR from baseline of at least 5 mL/min/ 1.73 m2/year or need for chronic renal replacement therapy. Pearson’s correlation, Mann–Whitney and Chi-square tests were used for analysis of quantitative and qualitative variables respectively. Kaplan Meier analysis was realized to determine renal survival according to RI value using the log-rank test. Multiple logistic regression was performed including variables with p Results Most patients had glomerulonephritis (82%. Median age was 46 years [21–87], eGFR 59 mL/min/ 1.73m2 [5–130], percentage of interstitial fibrosis 10% [0–90], glomerulosclerosis 13% [0–96] and RI 0.63 [0.31-1.00]. RI increased with age (r = 0.435, p = 0.0063, pulse pressure (r = 0.303, p = 0.022, renal atrophy (r = −0.275, p = 0.038 and renal dysfunction (r = −0.402, p = 0.0018. Patients with arterial intima/media ratio ≥ 1 (p = 0.032, interstitial fibrosis > 20% (p = 0.014 and renal function decline (p = 0.0023 had higher RI. Patients with baseline RI ≥ 0.65 had a poorer renal outcome than those with baseline RI Conclusions Our results suggest that RI ≥ 0.65 is associated

  11. Expression of Beta-Human Chorionic Gonadotropin Genes in Renal Cell Cancer and Benign Renal Disease Tissues

    Institute of Scientific and Technical Information of China (English)

    姜永光; 曾甫清; 肖传国; 刘俊敏

    2003-01-01

    To study the expression of beta-human chorionic gonadotropin (βhCG) genes in renal cellcarcinomas (RCC) and benign renal disease tissues, nested reverse transcription-polymerase chainreaction (RT-PCR) and restriction endonuclease analysis were employed to detect the expression ofβhCG genes in 44 cases of RCC tissues and 24 cases of benign renal disease tissues. It was foundthat 52% RCC samples revealed positive for βhCG mRNA expression. Positive rate in advancedstage and poorly differentiated RCC was higher, but there was no significant difference. The posi-tive rate of βhCG mRNA expression was 54% in 24 cases of benign renal tissues, including 3 casesout of 6 polycystic kidneys, 7 cases out of 13 renal atrophies, 2 cases out of 2 oncocytomas and 1case out of 2 pyonephrotic kidneys. β7 was most frequently transcribed subtype gene independent onthe histology. These findings suggested βhCG gene transcription is not only involved in RCC but al-so in benign renal diseases.

  12. Renal replacement therapy in Latin American end-stage renal disease.

    Science.gov (United States)

    Rosa-Diez, Guillermo; Gonzalez-Bedat, Maria; Pecoits-Filho, Roberto; Marinovich, Sergio; Fernandez, Sdenka; Lugon, Jocemir; Poblete-Badal, Hugo; Elgueta-Miranda, Susana; Gomez, Rafael; Cerdas-Calderon, Manuel; Almaguer-Lopez, Miguel; Freire, Nelly; Leiva-Merino, Ricardo; Rodriguez, Gaspar; Luna-Guerra, Jorge; Bochicchio, Tomasso; Garcia-Garcia, Guillermo; Cano, Nuria; Iron, Norman; Cuero, Cesar; Cuevas, Dario; Tapia, Carlos; Cangiano, Jose; Rodriguez, Sandra; Gonzalez, Haydee; Duro-Garcia, Valter

    2014-08-01

    The Latin American Dialysis and Renal Transplant Registry (RLADTR) was founded in 1991; it collects data from 20 countries which are members of Sociedad Latinoamericana de Nefrología e Hipertension. This paper presents the results corresponding to the year 2010. This study is an annual survey requesting data on incident and prevalent patients undergoing renal replacement treatment (RRT) in all modalities: hemodialysis (HD), peritoneal dialysis (PD) and living with a functioning graft (LFG), etc. Prevalence and incidence were compared with previous years. The type of renal replacement therapy was analyzed, with special emphasis on PD and transplant (Tx). These variables were correlated with the gross national income (GNI) and the life expectancy at birth. Twenty countries participed in the surveys, covering 99% of the Latin American. The prevalence of end stage renal disease (ESRD) under RRT in Latin America (LA) increased from 119 patients per million population (pmp) in 1991 to 660 pmp in 2010 (HD 413 pmp, PD 135 pmp and LFG 111 pmp). HD proportionally increased more than PD, and Tx HD continues to be the treatment of choice in the region (75%). The kidney Tx rate increased from 3.7 pmp in 1987 to 6.9 pmp in 1991 and to 19.1 in 2010. The total number of Tx's in 2010 was 10 397, with 58% deceased donors. The total RRT prevalence correlated positively with GNI (r(2) 0.86; P global incidence rate correlated significantly only with GNI (r(2) 0.63; P < 0.05). Diabetes remained the leading cause of ESRD. The most frequent causes of death were cardiovascular (45%) and infections (22%). Neoplasms accounted for 10% of the causes of death. The prevalence of RRT continues to increase, particularly in countries with 100% public health or insurance coverage for RRT, where it approaches rates comparable to those displayed by developed countries with a better GNI. The incidence also continues to increase in both countries that have not yet extended its coverage to 100% of the

  13. Renal replacement therapy in Latin American end-stage renal disease

    Science.gov (United States)

    Rosa-Diez, Guillermo; Gonzalez-Bedat, Maria; Pecoits-Filho, Roberto; Marinovich, Sergio; Fernandez, Sdenka; Lugon, Jocemir; Poblete-Badal, Hugo; Elgueta-Miranda, Susana; Gomez, Rafael; Cerdas-Calderon, Manuel; Almaguer-Lopez, Miguel; Freire, Nelly; Leiva-Merino, Ricardo; Rodriguez, Gaspar; Luna-Guerra, Jorge; Bochicchio, Tomasso; Garcia-Garcia, Guillermo; Cano, Nuria; Iron, Norman; Cuero, Cesar; Cuevas, Dario; Tapia, Carlos; Cangiano, Jose; Rodriguez, Sandra; Gonzalez, Haydee; Duro-Garcia, Valter

    2014-01-01

    The Latin American Dialysis and Renal Transplant Registry (RLADTR) was founded in 1991; it collects data from 20 countries which are members of Sociedad Latinoamericana de Nefrología e Hipertension. This paper presents the results corresponding to the year 2010. This study is an annual survey requesting data on incident and prevalent patients undergoing renal replacement treatment (RRT) in all modalities: hemodialysis (HD), peritoneal dialysis (PD) and living with a functioning graft (LFG), etc. Prevalence and incidence were compared with previous years. The type of renal replacement therapy was analyzed, with special emphasis on PD and transplant (Tx). These variables were correlated with the gross national income (GNI) and the life expectancy at birth. Twenty countries participed in the surveys, covering 99% of the Latin American. The prevalence of end stage renal disease (ESRD) under RRT in Latin America (LA) increased from 119 patients per million population (pmp) in 1991 to 660 pmp in 2010 (HD 413 pmp, PD 135 pmp and LFG 111 pmp). HD proportionally increased more than PD, and Tx HD continues to be the treatment of choice in the region (75%). The kidney Tx rate increased from 3.7 pmp in 1987 to 6.9 pmp in 1991 and to 19.1 in 2010. The total number of Tx's in 2010 was 10 397, with 58% deceased donors. The total RRT prevalence correlated positively with GNI (r2 0.86; P < 0.05) and life expectancy at birth (r2 0.58; P < 0.05). The HD prevalence and the kidney Tx rate correlated significantly with the same indexes, whereas the PD rate showed no correlation with these variables. A tendency to rate stabilization/little growth was reported in the most regional countries. As in previous reports, the global incidence rate correlated significantly only with GNI (r2 0.63; P < 0.05). Diabetes remained the leading cause of ESRD. The most frequent causes of death were cardiovascular (45%) and infections (22%). Neoplasms accounted for 10% of the causes of death. The

  14. PROTEINURIA - A RISK FACTOR FOR PREGNANCY-RELATED RENAL-FUNCTION DECLINE IN PRIMARY GLOMERULAR-DISEASE

    NARCIS (Netherlands)

    HEMMELDER, MH; DEZEEUW, D; FIDLER, [No Value; DEJONG, PE

    1995-01-01

    Pregnancy may be followed by a postpartum acceleration of renal function loss in patients with renal disease. We retrospectively analyzed the effects of pregnancy on progressive renal function decline, and the risk factors for an acceleration, in a group of 19 renal disease patients with 30 pregnanc

  15. [Management of patients with end-stage renal disease prior to initiation of renal replacement therapy in 2013 in France].

    Science.gov (United States)

    Tuppin, Philippe; Cuerq, Anne; Torre, Sylvie; Couchoud, Cécile; Fagot-Campagna, Anne

    2017-04-01

    This study evaluated the management of patients with end-stage renal disease prior to initiation of renal replacement therapy. Among the 51 million national health insurance general scheme beneficiaries (77% of the population), persons 18 years and older, starting dialysis or undergoing preemptive renal transplantation in 2013, were included in this study. Data were derived from the French national health insurance system (SNIIRAM). In this population of 6674 patients (median age: 68 years), 88% initiated renal replacement therapy by haemodialysis, 8% by peritoneal dialysis, and 4% by renal transplantation. During the year preceding initiation of dialysis, 76% of patients had been hospitalised with at least one diagnostic code for renal disease in 83% of cases, 16% had not received any reimbursements for serum creatinine assay and 32% had not seen a nephrologist; 87% were taking at least one antihypertensive drug (60% were taking at least a renin-angiotensin system inhibitor) and 30% were taking a combination of 4 or more classes of antihypertensive drugs. For patients initiating haemodialysis in a haemodialysis centre, 39% had undergone a procedure related to arteriovenous fistula and 10% had been admitted to an intensive care unit. This study, based on the available reimbursement data, shows that, despite frequent use of the health care system by this population, there is still room for improvement of screening and management of patients with end-stage renal disease and preparation for renal replacement therapy. Copyright © 2016 Association Société de néphrologie. Published by Elsevier Masson SAS. All rights reserved.

  16. Twenty-eight-year review of childhood renal diseases from renal biopsy data: A single centre in China.

    Science.gov (United States)

    Jiang, Mengjie; Xiao, Zizheng; Rong, Liping; Xu, Yuanyuan; Chen, Lizhi; Mo, Ying; Sun, Liangzhong; Sun, Wei; Jiang, Xiaoyun

    2016-12-01

    The aim of the present study was to investigate the clinicopathologic characteristics of biopsy-proven childhood renal diseases and to compare the trends and changes during two different time intervals between 1984 and 2011 at the First Affiliated Hospital of Sun Yat-sen University in China. We retrospectively analyzed kidney biopsy data from children with renal diseases and compared the data during two time intervals, namely 1984-1997 and 1998-2011. A total of 1313 children were enrolled in the present study. There were 921 children with primary glomerular disease (PGD) and 312 children with secondary glomerular disease (SGD), accounting for 70.1% and 23.8% of participants, respectively. The major clinical manifestation of PGD was nephrotic syndrome (NS), which accounted for 31.2% of cases, while the main aetiology of SGD was lupus nephritis (40.7%). The main biopsy patterns of PGD were IgA nephritis (27.6%), minimal change disease (24.0%), and mesangial proliferative glomerulonephritis (16.9%). PGD was the major class of disease in both time intervals, but the ratio of PGD decreased over time, while the ratio of SGD and other glomerular diseases increased. PGD was also the major class of disease in each age group; however, the incidence of PGD decreased with increasing age. The incidence patterns of paediatric renal diseases changed over the 28-year period of this study. Our results show that different renal diseases characterize different age intervals. Furthermore, there are several associations between clinical presentation and biopsy features in childhood renal disease. © 2015 Asian Pacific Society of Nephrology.

  17. Global differences in dialysis modality mix: the role of patient characteristics, macroeconomics and renal service indicators.

    Science.gov (United States)

    van de Luijtgaarden, Moniek W M; Jager, Kitty J; Stel, Vianda S; Kramer, Anneke; Cusumano, Ana; Elliott, Robert F; Geue, Claudia; MacLeod, Alison M; Stengel, Benedicte; Covic, Adrian; Caskey, Fergus J

    2013-05-01

    An increase in the dialysis programme expenditure is expected in most countries given the continued rise in the number of people with end-stage renal disease (ESRD) globally. Since chronic peritoneal dialysis (PD) therapy is relatively less expensive compared with haemodialysis (HD) and because there is no survival difference between PD and HD, identifying factors associated with PD use is important. Incidence counts for the years 2003-05 were available from 36 countries worldwide. We studied associations of population characteristics, macroeconomic factors and renal service indicators with the percentage of patients on PD at Day 91 after starting dialysis. With linear regression models, we obtained relative risks (RRs) with 95% confidence intervals (CIs). The median percentage of incident patients on PD was 12% (interquartile range: 7-26%). Determinants independently associated with lower percentages of patients on PD were as follows: patients with diabetic kidney disease (per 5% increase) (RR 0.93; 95% CI 0.89-0.97), health expenditure as % gross domestic product (per 1% increase) (RR 0.93; 95% CI 0.87-0.98), private-for-profit share of HD facilities (per 1% increase) (RR 0.996; 95% CI 0.99-1.00; P = 0.04), costs of PD consumables relative to staffing (per 0.1 increase) (RR 0.97; 95% CI 0.95-0.99). The factors associated with a lower percentage of patients on PD include higher diabetes prevalence, higher healthcare expenditures, larger share of private-for-profit centres and higher costs of PD consumables relative to staffing. Whether dialysis modality mix can be influenced by changing healthcare organization and funding requires additional studies.

  18. A CASE OF RENAL DISEASE IN HIV INFECTED PATIENT

    Directory of Open Access Journals (Sweden)

    Ni Made Vina Septiani

    2013-11-01

    Full Text Available Normal 0 false false false EN-US X-NONE X-NONE MicrosoftInternetExplorer4 Kidney diseases in human immunodeficiency virus (HIV infected patients has been been fourth leading cause of death after sepsis, pneumonia, and liver disease. HIV-associated nephropathy (HIVAN is the most common. We report a case, a male patient, 48 years, who experienced shortness of breath, cough and intermittent fever and has been reported as HIV positive, without previous antiretroviral treatment and last CD4+ count is 89 cells/mm3. There are elevated BUN and SC from day to day during treatment and proteinuria +2 as a sign of kidney disease with normal blood pressure and there was no edema. Patients given an antibiotic and ACE inhibitors as antiproteinuria. Patients with suspicion of HIVAN in this case can progress very rapidly and causes progressive decline in renal function. Prognosis of patients with HIVAN if not handled properly will develop end stage renal disease (ESRD in 1-4 months and had a mortality rate 4.7 times higher than HIV patients without renal impairment. /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;}

  19. Obesity end stage renal disease and survival in an elderly cohort with cardiovascular disease

    Science.gov (United States)

    Obesity is highly prevalent in African-Americans and is associated with increased risk of end stage renal disease (ESRD) and death. It is not known if the effect of obesity is similar among Blacks and whites. The aim of this study is to examine racial differences in the association of obesity with E...

  20. Renal relevant radiology: radiologic imaging in autosomal dominant polycystic kidney disease.

    Science.gov (United States)

    Rahbari-Oskoui, Frederic; Mittal, Ankush; Mittal, Pardeep; Chapman, Arlene

    2014-02-01

    Autosomal-dominant polycystic kidney disease is a systemic disorder and the most common hereditary renal disease, which is characterized by cyst growth, progressive renal enlargement, and development of renal failure. The cystic nature of autosomal dominant polycystic kidney disease and its renal and extrarenal complications (kidney stones, cyst hemorrhage, intracerebral aneurysm, liver cysts, cardiac valve abnormalities, etc.) give radiologic imaging studies a central role in the management of these patients. This article reviews the indications, comparative use, and limitation of various imaging modalities (ultrasonography, magnetic resonance imaging, computerized tomography scan, Positron emission tomography scan, and renal scintigraphy) for the diagnosis and management of complications in autosomal dominant polycystic kidney disease. Finally, this work provides evidence for the value of total kidney volume to predict disease progression in autosomal dominant polycystic kidney disease.

  1. Role of the intrarenal renin-angiotensin system in the progression of renal disease.

    Science.gov (United States)

    Urushihara, Maki; Kagami, Shoji

    2016-07-05

    The intrarenal renin-angiotensin system (RAS) has many well-documented pathophysiologic functions in both blood pressure regulation and renal disease development. Angiotensin II (Ang II) is the major bioactive product of the RAS. It induces inflammation, renal cell growth, mitogenesis, apoptosis, migration, and differentiation. In addition, Ang II regulates the gene expression of bioactive substances and activates multiple intracellular signaling pathways that are involved in renal damage. Activation of the Ang II type 1 (AT1) receptor pathway results in the production of proinflammatory mediators, intracellular formation of reactive oxygen species, cell proliferation, and extracellular matrix synthesis, which in turn facilities renal injury. Involvement of angiotensinogen (AGT) in intrarenal RAS activation and development of renal disease has previously been reported. Moreover, studies have demonstrated that the urinary excretion rates of AGT provide a specific index of the intrarenal RAS status. Enhanced intrarenal AGT levels have been observed in experimental models of renal disease, supporting the concept that AGT plays an important role in the development and progression of renal disease. In this review, we focus on the role of intrarenal RAS activation in the pathophysiology of renal disease. Additionally, we explored the potential of urinary AGT as a novel biomarker of intrarenal RAS status in renal disease.

  2. Peripheral artery disease: a cause of refractory hypertension after renal transplantation.

    Science.gov (United States)

    Dourado, Raquel; Gonçalves, Pedro de Araújo; Almeida, Manuel; Weigert, André; Bruges, Margarida; Gaspar, Augusta; Negrão, Acácio Pita; Machado, Domingos; Clemente, Belarmino; Teles, Rui; Machado, Francisco Pereira; Silva, Aniceto

    2008-03-01

    The authors report the case of a 44-year-old man, with a history of hypertension, smoking, peripheral artery disease and chronic renal failure. After renal transplantation, the patient developed persistent high blood pressure, despite optimal medical therapy. When angiotensin-converting enzyme (ACE) inhibitor therapy was begun, he developed acute anuric renal failure, which was reversed after interruption of the ACE inhibitor. After the initial clinical evaluation, the patient was referred for renal angiography, which revealed critical stenosis of the proximal left common iliac artery, just above the renal graft artery anastomosis. The patient underwent successful angioplasty and stenting of the lesion, with complete normalization of blood pressure.

  3. Mizoribine: A New Approach in the Treatment of Renal Disease

    Directory of Open Access Journals (Sweden)

    Yukihiko Kawasaki

    2009-01-01

    Full Text Available Mizoribine (MZB is an imidazole nucleoside and an immunosuppressive agent. The immunosuppressive effect of MZB has been reported to be due to the inhibition of DNA synthesis in the S phase of the cell cycle. Because of its relative lack of toxicity, during the past decade MZB has been frequently used instead of azathioprine as a component of immunosuppressive drug regimens. MZB is being used to treat renal transplantation patients, IgA nephropathy, lupus erythematosus, and childhood nephrotic syndrome (NS, and some recent studies have assessed the efficacy of oral MZB pulse therapy for severe lupus nephritis, steroid-resistant NS, and frequently relapsing-steroid-dependent NS. This review summarizes the published findings on the efficacy of MZB for renal disease including IgA nephropathy, lupus nephritis, and NS, as well as of oral MZB pulse therapy for severe lupus nephritis and NS, and also the mechanism of the effect of oral MZB pulse therapy on the lymphocyte cell cycle.

  4. Acute kidney injury: Renal disease in the ICU.

    Science.gov (United States)

    Seller-Pérez, G; Más-Font, S; Pérez-Calvo, C; Villa-Díaz, P; Celaya-López, M; Herrera-Gutiérrez, M E

    2016-01-01

    Acute kidney injury (AKI) in the ICU frequently requires costly supportive therapies, has high morbidity, and its long-term prognosis is not as good as it has been presumed so far. Consequently, AKI generates a significant burden for the healthcare system. The problem is that AKI lacks an effective treatment and the best approach relies on early secondary prevention. Therefore, to facilitate early diagnosis, a broader definition of AKI should be established, and a marker with more sensitivity and early-detection capacity than serum creatinine - the most common marker of AKI - should be identified. Fortunately, new classification systems (RIFLE, AKIN or KDIGO) have been developed to solve these problems, and the discovery of new biomarkers for kidney injury will hopefully change the way we approach renal patients. As a first step, the concept of renal failure has changed from being a "static" disease to being a "dynamic process" that requires continuous evaluation of kidney function adapted to the reality of the ICU patient. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  5. Agalsidase benefits renal histology in young patients with Fabry disease.

    Science.gov (United States)

    Tøndel, Camilla; Bostad, Leif; Larsen, Kristin Kampevold; Hirth, Asle; Vikse, Bjørn Egil; Houge, Gunnar; Svarstad, Einar

    2013-01-01

    The effect of early-onset enzyme replacement therapy on renal morphologic features in Fabry disease is largely unknown. Here, we evaluated the effect of 5 years of treatment with agalsidase alfa or agalsidase beta in 12 consecutive patients age 7-33 years (median age, 16.5 years). We performed renal biopsies at baseline and after 5 years of enzyme replacement therapy; 7 patients had additional biopsies after 1 and 3 years. After a median of 65 months, biopsy findings from all patients showed total clearance of glomerular endothelial and mesangial cell inclusions, and findings from 2 patients showed complete clearance of inclusions from epithelial cells of the distal tubule. The 4 patients who received the highest dose of agalsidase exhibited substantial clearance of podocyte inclusions, and the youngest patient had nearly complete clearance of these inclusions. Linear regression analysis showed a highly significant correlation between podocyte globotriaocylceramide clearance and cumulative agalsidase dose (r=0.804; P=0.002). Microalbuminuria normalized in five patients. In summary, long-term enzyme replacement therapy in young patients can result in complete globotriaocylceramide clearance of mesangial and glomerular endothelial cells across all dosage regimens, and clearance of podocyte inclusions is dose-dependent.

  6. Renal replacement therapy for autosomal dominant polycystic kidney disease (ADPKD) in Europe

    DEFF Research Database (Denmark)

    Spithoven, Edwin M; Kramer, Anneke; Meijer, Esther

    2014-01-01

    BACKGROUND: Autosomal dominant polycystic kidney disease (ADPKD) is the fourth most common renal disease requiring renal replacement therapy (RRT). Still, there are few epidemiological data on the prevalence of, and survival on RRT for ADPKD. METHODS: This study used data from the ERA-EDTA Registry...

  7. Angiotensin-converting enzyme gene I/D polymorphism and renal disease

    NARCIS (Netherlands)

    Navis, G; van der Kleij, FGH; de Zeeuw, D; de Jong, PE

    1999-01-01

    In recent years a vast amount of data has been published on the association between the insertion/deletion (VD) polymorphism of the gene coding for angiotensin-converting enzyme and renal disease. It has be come clear that the polymorphism does not affect the prevalence of renal disease. However, da

  8. Care of the Patient with Renal Disease: Peritoneal Dialysis and Transplants, Nursing 321A.

    Science.gov (United States)

    Hulburd, Kimberly

    A description is provided of a course, "Care of the Patient with Renal Disease," offered at the community college level to prepare licensed registered nurses to care for patients with renal disease, including instruction in performing the treatments of peritoneal dialysis and continuous ambulatory peritoneal dialysis (CAPD). The first…

  9. 42 CFR 488.60 - Special procedures for approving end stage renal disease facilities.

    Science.gov (United States)

    2010-10-01

    ... ENFORCEMENT PROCEDURES Special Requirements § 488.60 Special procedures for approving end stage renal disease... 42 Public Health 5 2010-10-01 2010-10-01 false Special procedures for approving end stage renal disease facilities. 488.60 Section 488.60 Public Health CENTERS FOR MEDICARE & MEDICAID...

  10. End-stage renal disease in sub-Saharan and South Africa.

    Science.gov (United States)

    Naicker, Saraladevi

    2003-02-01

    uropathy. The availability of dialysis and transplantation is quite variable in Africa: treatment rates in North Africa are 30 to 186.5 per million population (pmp) in countries with more established programs: Algeria 78.5; Egypt 129.3; Libya 30; Morocco 55.6; Tunisia 186.5 pmp. In South Africa, treatment rates of 99 pmp were reported; Dialysis and transplant programs in the rest of Africa are dependent on the availability of funding and donors. Services are still predominantly urban and therefore generally inaccessible to the poorer, less educated rural patient. There is not enough money for healthcare in the developing world, particularly for expensive and chronic treatment such as RRT. The goal should be to have a circumscribed chronic dialysis program, with as short a time on dialysis as possible, and to increase the availability of transplantation (both living donor and cadaver). Efforts should be made to optimize therapy of renal disease and renal failure globally and particularly in developing countries. Strategies should be developed to screen for and manage conditions such as hypertension and diabetes mellitus at the primary healthcare level in an effort to decrease the incidence of chronic renal failure. Increasingly, health is influenced by social and economic circumstances. Any improvements in health thus demand integrated, comprehensive action against all the determinants of ill health.

  11. The end-stage renal disease industry and exit strategies for nephrologists.

    Science.gov (United States)

    Sullivan, John D

    2006-01-01

    The purpose of this presentation is to identify exit strategies for nephrologists under changing conditions in the dialysis market. The end-stage renal disease service provider market continues to be highly receptive to consolidation. Taking advantage of large economies of scale, large for-profit dialysis chains have surpassed independent operators in both number of clinics and total patients. With relatively low barriers to entry, new smaller clinics continue to open, serving a niche outside the larger chains. Additional competition comes in the form of medium players funded by venture capitalists with the added pressure of rapid growth and financial return. To ensure market power in both dialysis products and managed care negotiation leverage, medium and large service providers will continue to seek out attractive acquisition targets. For nephrologists to capitalize on investment, clinic and business preparation will continue to be the driving force for these divestitures.

  12. Intravenous Renal Cell Transplantation for Polycystic Kidney Disease

    Science.gov (United States)

    2014-06-01

    reports 28.2 (per million population) PKD patients on dialysis in 1985, 62.9 in 2000 and 92.5 in 2011. Although these data may reflect better diagnosis ...improves renal function and structure in other models of renal failure: CKD due to cisplatin-mediated injury (4), diabetic nephropathy (Am J Physiol...cells prevents progression of chronic renal failure in rats with ischemic-diabetic nephropathy . Am J Physiol. Renal. 305:F1804- F1812 6. Mason SB

  13. Lymphocyte subpopulations during cytomegalovirus disease in renal transplant recipients

    Directory of Open Access Journals (Sweden)

    S.M. Castro

    2003-06-01

    Full Text Available We have determined the number of circulating T, B and natural killer cells in renal transplant recipients in order to detect changes during cytomegalovirus (CMV infections. Serial blood samples were taken from 61 patients on standard triple immunosuppression therapy (cyclosporin A, azathioprine and prednisone. Using two-color flow cytometry analysis, the absolute number of CD3+, CD4+, CD8+, CD19+, CD3+HLA-DR+ and CD16+56+ cells was determined. Forty-eight patients (78.7% developed active CMV infection, and all of them subsequently recovered. Twenty of the infected patients (32.8% presented symptoms compatible with CMV disease during the infectious process. The number of lymphocytes and their main subpopulations were normal before the onset of CMV disease. During the disease there was a decrease followed by a significant increase (P<0.005 in the number of CD3+, CD4+, CD8+ and CD3+HLA-DR+ cells. No significant changes were observed in natural killer cells or B lymphocytes during the disease. We conclude, as observed in all viremic patients recovering from infection, that recovery is associated with an increase in the number of T cell subsets. The monitoring of different lymphocyte subsets along with antigenemia can be extremely useful in the detection of patients at high risk of developing CMV symptoms, allowing the early introduction of antiviral therapy or the reduction of immunosuppression therapy.

  14. Renal parenchymal histopathology predicts life-threatening chronic kidney disease as a result of radical nephrectomy.

    Science.gov (United States)

    Sejima, Takehiro; Honda, Masashi; Takenaka, Atsushi

    2015-01-01

    The preoperative prediction of post-radical nephrectomy renal insufficiency plays an important role in the decision-making process regarding renal surgery options. Furthermore, the prediction of both postoperative renal insufficiency and postoperative cardiovascular disease occurrence, which is suggested to be an adverse consequence caused by renal insufficiency, contributes to the preoperative policy decision as well as the precise informed consent for a renal cell carcinoma patient. Preoperative nomograms for the prediction of post-radical nephrectomy renal insufficiency, calculated using patient backgrounds, are advocated. The use of these nomograms together with other types of nomograms predicting oncological outcome is beneficial. Post-radical nephrectomy attending physicians can predict renal insufficiency based on the normal renal parenchymal pathology in addition to preoperative patient characteristics. It is suggested that a high level of global glomerulosclerosis in nephrectomized normal renal parenchyma is closely associated with severe renal insufficiency. Some studies showed that post-radical nephrectomy severe renal insufficiency might have an association with increased mortality as a result of cardiovascular disease. Therefore, such pathophysiology should be recognized as life-threatening, surgically-related chronic kidney disease. On the contrary, the investigation of the prediction of mild post-radical nephrectomy renal insufficiency, which is not related to adverse consequences in the postoperative long-term period, is also promising because the prediction of mild renal insufficiency might be the basis for the substitution of radical nephrectomy for nephron-sparing surgery in technically difficult or compromised cases. The deterioration of quality of life caused by post-radical nephrectomy renal insufficiency should be investigated in conjunction with life-threatening matters.

  15. Renal expression of FGF23 in progressive renal disease of diabetes and the effect of ACE inhibitor.

    Directory of Open Access Journals (Sweden)

    Cristina Zanchi

    Full Text Available Fibroblast growth factor 23 (FGF23 is a phosphaturic hormone mainly produced by bone that acts in the kidney through FGF receptors and Klotho. Here we investigated whether the kidney was an additional source of FGF23 during renal disease using a model of type 2 diabetic nephropathy. Renal expression of FGF23 and Klotho was assessed in Zucker diabetic fatty (ZDF and control lean rats at 2, 4, 6, 8 months of age. To evaluate whether the renoprotective effect of angiotensin converting enzyme (ACE inhibitor in this model was associated with changes in FGF23 and Klotho, ZDF rats received ramipril from 4, when proteinuric, to 8 months of age. FGF23 mRNA was not detectable in the kidney of lean rats, nor of ZDF rats at 2 months of age. FGF23 became measurable in the kidney of diabetic rats at 4 months and significantly increased thereafter. FGF23 protein localized in proximal and distal tubules. Renal Klotho mRNA and protein decreased during time in ZDF rats. As renal disease progressed, serum phosphate levels increased in parallel with decline of fractional phosphorus excretion. Ramipril limited proteinuria and renal injury, attenuated renal FGF23 upregulation and ameliorated Klotho expression. Ramipril normalized serum phosphate levels and tended to increase fractional phosphorus excretion. These data indicate that during progressive renal disease the kidney is a site of FGF23 production which is limited by ACE inhibition. Interfering pharmacologically with the delicate balance of FGF23 and phosphorus in diabetes may have implications in clinics.

  16. Renal disease masquerading as pyrexia of unknown origin

    Directory of Open Access Journals (Sweden)

    D Korivi

    2013-01-01

    Full Text Available Pyrexia of unknown origin is a challenging clinical problem. Infections, malignancies, and connective tissue diseases form the major etiologies for this condition. We report a case of a 57-year-old diabetic male who presented with fever of unknown origin for several months. The course of investigations led to a kidney biopsy which clinched the cause of his fever as well as the underlying diagnosis. The light microscopy findings of expansile storiform fibrosis with a dense inflammatory infiltrate suggested the diagnosis which was confirmed by positive staining of Immunoglobulin G4, the dense lympho-plasmacytic infiltrate and elevated serum IgG4 concentrations. A course of steroids followed by mycophenolate mofetil as maintenance immunosuppression rendered the patient afebrile with improvement of renal function.

  17. CT appearance of acute inflammatory disease of the renal interstitium

    Energy Technology Data Exchange (ETDEWEB)

    Gold, R.P. (New York Medical Coll., Valhalla); McClennan, B.L.; Rottenberg, R.R.

    1983-08-01

    Today, infection remains the most common disease of the urinary tract and constitutes almost 75% of patient problems requiring urologic evaluation. There have been several major factors responsible for our better understanding of the nature and pathophysiology of urinary tract infection. One has been quantitated urine bacteriology and another, the discovery that a significant part of the apparently healthy adult female population has asymptomatic bacteriuria. Abnormal conditions such as neurogenic bladder, bladder malignancy, prolonged catheter drainage and reflux, altered host resistance, diabetes mellitus, and urinary tract obstruction, as well as pregnancy, may either predispose to or be implicated in the pathogenesis of urinary tract infection. There is a wide range of conditions that result in acute renal inflammation and those under discussion affect primarily the interstitium. This term refers to the connective tissue elements separating the tubules in the cortex and medulla. Hence, the interstitial nephritides are to be distinguished from the glomerulonephritides and fall into two general etiologic categories: infectious and noninfectious.

  18. New Options of Apheresis in Renal Diseases: How and When?

    Science.gov (United States)

    Korsak, Jolanta; Wańkowicz, Zofia

    2016-01-01

    The 100-year anniversary of the first experimental apheresis performed by John Abel on uremic dogs in 1914 provides the opportunity for discussion on the current state of classic apheresis as well as technological progress and clinical experiences with its new options presented in the world literature in the last 15 years, such as the following: double filtration, plasma adsorption and immunoadsorption, leuko- and cytapheresis and low-density lipoprotein apheresis. In our review, we highlight the potential limitations for further development of those highly promising techniques, such as the following: the lack of multicenter, controlled clinical studies; insufficient knowledge of the mechanisms of those techniques and last but not least, the restricted access to apheresis, caused both by high expenditure and organizational negligence, even in highly developed countries. Special attention was paid to the most recent recommendations by the American Society of Apheresis in primary and secondary renal diseases, which are the subject of our professional interest.

  19. End-stage renal disease causes an imbalance between endothelial and smooth muscle progenitor cells

    NARCIS (Netherlands)

    Westerweel, Peter E; Hoefer, Imo E; Blankestijn, Peter J; de Bree, Petra; Groeneveld, Dafna; van Oostrom, Olivia; Braam, Branko; Koomans, Hein A; Verhaar, Marianne C

    2007-01-01

    Patients with end-stage renal disease (ESRD) on hemodialysis have an increased risk of cardiovascular disease (CVD). Circulating endothelial progenitor cells (EPC) contribute to vascular regeneration and repair, thereby protecting against CVD. However, circulating smooth muscle progenitor cells (SPC

  20. Clinical Scenarios in Chronic Kidney Disease: Kidneys' Structural Changes in End-Stage Renal Disease.

    Science.gov (United States)

    Meola, Mario; Samoni, Sara; Petrucci, Ilaria

    2016-01-01

    Acquired cystic kidney disease (ACKD) and renal cell carcinoma (RCC) are the most important manifestations of end-stage kidneys' structural changes. ACKD is caused by kidney damage or scarring and it is characterized by the presence of small, multiple cortical and medullary cysts filled with a fluid similar to preurine. ACKD prevalence varies according to predialysis and dialysis age and its pathogenesis is unknown, although it is stated that progressive destruction of renal tissue induces hypertrophy/compensatory hyperplasia of residual nephrons and may trigger the degenerative process. ACKD is almost asymptomatic, but it can lead to several complications (bleeding, rupture, infections, RCC). Ultrasound (US) is the first level imaging technique in ACKD, because of its sensitivity and reliability. The most serious complication of ACKD is RCC, which is stimulated by the same growth factors and proto-oncogenes that lead to the genesis of cysts. Two different histological types of RCC have been identified: (1) RCC associated with ACKD and (2) papillary renal clear cell carcinoma. Tumors in end-stage kidneys are mainly small, multifocal and bilateral, with a papillary structure and a low degree of malignancy. At US, RCC appears as a small inhomogeneous nodule (<3 cm), clearly outlined from the renal profile and hypoechoic if compared with sclerotic parenchyma. In some cases, tumor appears as a homogeneous and hyperechoic multifocal mass. The most specific US sign of a small tumor in end-stage kidney is the important arterial vascularization, in contrast with renal parenchymal vascular sclerosis.

  1. Renal infarct: a rare disease due to a rare etiology

    Science.gov (United States)

    Akshintala, Divya; Bansal, Saurabh K.; Emani, Vamsi Krishna; Yadav, Manajyoti

    2015-01-01

    Renal infarction is caused by profound hypoperfusion secondary to embolic/thrombotic occlusion of the renal artery or vasospasm of the renal artery. We present a case of a 54-year-old patient who presented with nausea, vomiting, and vague abdominal pain. He had frequent episodes of migraine headaches and he treated himself with as needed rizatriptan. CT scan of the abdomen showed renal cortical infarction. After extensive investigations, etiology of his renal infarct was deemed to be due to rizatriptan. PMID:26091657

  2. Renal infarct: a rare disease due to a rare etiology

    Directory of Open Access Journals (Sweden)

    Divya Akshintala

    2015-06-01

    Full Text Available Renal infarction is caused by profound hypoperfusion secondary to embolic/thrombotic occlusion of the renal artery or vasospasm of the renal artery. We present a case of a 54-year-old patient who presented with nausea, vomiting, and vague abdominal pain. He had frequent episodes of migraine headaches and he treated himself with as needed rizatriptan. CT scan of the abdomen showed renal cortical infarction. After extensive investigations, etiology of his renal infarct was deemed to be due to rizatriptan.

  3. Latin American Dialysis and Transplant Registry: Experience and contributions to end-stage renal disease epidemiology.

    Science.gov (United States)

    Cusumano, Ana Maria; Rosa-Diez, Guillermo Javier; Gonzalez-Bedat, Maria Carlota

    2016-09-01

    In 2015, 634387 million people (9% of the world's population) resided in Latin America (LA), with half of those populating Brazil and Mexico. The LA Dialysis and Transplant Registry was initiated in 1991, with the aim of collecting data on renal replacement therapy (RRT) from the 20 LA-affiliated countries. Since then, the Registry has revealed a trend of increasing prevalence and incidence of end-stage kidney disease on RRT, which is ongoing and is correlated with gross national income, life expectancy at birth, and percentage of population that is older than 65 years. In addition, the rate of kidney transplantation has increased yearly, with > 70% being performed from deceased donors. According to the numbers reported for 2013, the rates of prevalence, incidence and transplantation were (in patients per million population) 669, 149 and 19.4, respectively. Hemodialysis was the treatment of choice (90%), and 43% of the patients undergoing this treatment was located in Brazil; in contrast, peritoneal dialysis prevailed in Costa Rica, El Salvador and Guatemala. To date, the Registry remains the only source of RRT data available to healthcare authorities in many LA countries. It not only serves to promote knowledge regarding epidemiology of end-stage renal disease and the related RRT but also for training of nephrologists and renal researchers, to improve understanding and clinical application of dialysis and transplantation services. In LA, accessibility to RRT is still limited and it remains necessary to develop effective programs that will reduce risk factors, promote early diagnosis and treatment of chronic kidney disease, and strengthen transplantation programs.

  4. Leptospirosis Renal Disease: Emerging Culprit of Chronic Kidney Disease Unknown Etiology.

    Science.gov (United States)

    Yang, Chih-Wei

    2017-09-20

    Leptospirosis is the most prevalent zoonosis affecting more than 1 million populations worldwide. Interestingly, leptospirosis endemic regions coincide with chronic kidney disease (CKD) hotspots largely due to flooding and agricultural overlaps. Acute leptospirosis induces multiple organ dysfunction including acute kidney injury and may predispose to CKD and end-stage renal disease, if not treated timely. Asymptomatic infection may carry the bacteria in the kidney and CKD progresses insidiously. Histologic finding of leptospirosis renal disease includes tubulointerstitial nephritis, interstitial fibrosis, and tubular atrophy. Proximal tubule dysfunction and hypokalemia are observed in adult male workers with leptospirosis, a characteristic similarity to CKD unknown etiology (CKDu). CKDu is a form of CKD that is not attributable to traditional risk factors clustering in agricultural communities affecting young male farmers. Kidney pathology shows a chronic tubulointerstitial disease. CKDu is being reported as an endemic nephropathy across the globe. Recent surveys suggest that asymptomatic leptospira renal colonization is an overlooked risk for renal fibrosis and CKDu. Population with anti-leptospira seropositivity is associated with lower estimated glomerular filtration rate in endemic regions and carrier may progress to CKD. Leptospirosis has been considered as a risk factor for CKDu in Sri Lanka and in Mesoamerican area. Sugarcane workers in Nicaragua showed increased anti-leptospira seropositivity and higher urinary biomarkers for kidney injury. Emerging evidence with signs of infection were reported in these endemic population, indicating that leptospira exposure could play a role in CKDu as a cause of primary kidney disease or a susceptible factor when secondary injury such as heat stress or dehydration aggravates kidney disease. Therefore, leptospirosis as an emerging culprit of CKDu deserves further in-depth investigation. © 2017 S. Karger AG, Basel.

  5. The chronic renal disease course: from early symptons to discovery

    Directory of Open Access Journals (Sweden)

    Vera Lucia Fortunato Fortes

    2013-07-01

    Full Text Available An exploratory and descriptive study with a qualitative approach aim at understanding the significance of the discovery of chronic kidney disease and the need for the hemodialysis machine. The research was made with twenty patients from two hemodialysis services of the city of RS. The data collection took place between September and December of 2007, throughout semi-structured interviews. The thematic analysis generated the following categories: history of chronic kidney disease, from the silence of the disease to the classical clinical symptoms; the discovery and its immediate effects; life after the discovery; acceptance of the dependence on a machine. We conclude that there is a need to adapt the daily life of patients with chronic kidney disease, because the hemodialysis causes physical and social changes, requiring support from health-team to manage the disease. The professional should not abdicate knowledge, safety and technical skill, as requirements to care.

  6. [HNF1B-related disease: paradigm of a developmental gene and unexpected recognition of a new renal disease].

    Science.gov (United States)

    Chauveau, Dominique; Faguer, Stanislas; Bandin, Flavio; Guigonis, Vincent; Chassaing, Nicolas; Decramer, Stéphane

    2013-11-01

    HNF1B encodes for a transcription factor involved in the early development of the kidney, pancreas, liver and genital tract. Mutations in HNF1B are dominantly inherited and consist of whole-gene deletion, or small mutation. De novo mutation occurs in half of tested kindreds. HNF1B-related disease combines renal and non-renal manifestations. Renal involvement is heterogeneous and may escape early recognition. During fetal life and childhood, it mostly consists of hyperechogenic kidneys or bilateral renal cystic hypodysplasia. The adult phenotype encompasses tubulointerstitial profile at presentation and slowly progressive renal decline (-2 ml/min/year). Renal involvement includes renal cysts (mostly few cortical cysts), a solitary kidney, pelvi-caliceal abnormalities, hypokalemia and hypomagnesemia related to tubular leak, and more rarely, Fanconi syndrome and chromophobe renal carcinoma. The latter warrants ultrasound screening. Extrarenal phenotype consists of diabetes mellitus (MODY-5), exocrine pancreas failure and pancreas atrophy; fluctuation liver tests abnormalities; diverse genital tract abnormalities in females or infertility in males; and mild mental retardation in rare individuals. Phenotype heterogeneity within families is striking. Individuals progressing to end-stage renal disease are eligible for kidney transplantation (or combined pancreas and kidney transplantation for diabetic individuals). While HNF1B disease was still unknown one decade ago, it has emerged as the second most prevalent dominantly inherited kidney disease. Data available pave the way for early recognition and improved specific management, including genetic counselling.

  7. Contribution of renal innervation to hypertension in rat autosomal dominant polycystic kidney disease.

    Science.gov (United States)

    Gattone, Vincent H; Siqueira, Tibério M; Powell, Charles R; Trambaugh, Chad M; Lingeman, James E; Shalhav, Arieh L

    2008-08-01

    The kidney has both afferent (sensory) and efferent (sympathetic) nerves that can influence renal function. Renal innervation has been shown to play a role in the pathogenesis of many forms of hypertension. Hypertension and flank pain are common clinical manifestations of autosomal dominant (AD) polycystic kidney disease (PKD). We hypothesize that renal innervation contributes to the hypertension and progression of cystic change in rodent PKD. In the present study, the contribution of renal innervation to hypertension and progression of renal histopathology and dysfunction was assessed in male Han:SPRD-Cy/+ rats with ADPKD. At 4 weeks of age, male offspring from crosses of heterozygotes (Cy/+) were randomized into either 1) bilateral surgical renal denervation, 2) surgical sham denervation control, or 3) nonoperated control groups. A midline laparotomy was performed to allow the renal denervation (i.e., physical stripping of the nerves and painting the artery with phenol/alcohol). Blood pressure (tail cuff method), renal function (BUN) and histology were assessed at 8 weeks of age. Bilateral renal denervation reduced the cystic kidney size, cyst volume density, systolic blood pressure, and improved renal function (BUN) as compared with nonoperated controls. Operated control cystic rats had kidney weights, cyst volume densities, systolic blood pressures, and plasma BUN levels that were intermediate between those in the denervated animals and the nonoperated controls. The denervated group had a reduced systolic blood pressure compared with the operated control animals, indicating that the renal innervations was a major contributor to the hypertension in this model of ADPKD. Renal denervation was efficacious in reducing some pathology, including hypertension, renal enlargement, and cystic pathology. However, sham operation also affected the cystic disease but to a lesser extent. We hypothesize that the amelioration of hypertension in Cy/+ rats was due to the effects

  8. Improving the quality of communication and service provision for renal patients of South Asian origin: the contribution of a cultural and health improvement officer.

    Science.gov (United States)

    Akhtar, Tahira; Hipkiss, Vicki; Stoves, John

    2014-09-01

    A large number of patients with advanced chronic kidney disease in Bradford, UK are of South Asian origin. Effective delivery of care for these patients demands a consistently high standard of communication between patients, their families and renal unit staff. Communication may be problematic for a number of reasons, including language barriers and an incomplete appreciation of important cultural or religious beliefs. In 2010, we received charitable funding for an Ethnic Liaison Support Worker, renamed Cultural and Health Improvement Officer (CHIO). The CHIO is able to engage with and support patients, relatives and other members of the multidisciplinary renal team. Core responsibilities include ensuring that patients and their families feel at ease whenever they are in communication with the renal services team in Bradford; contributing to formal discussion and explanation of important clinical issues in the patient's first language (typically Urdu or Punjabi), thereby encouraging patients to feel more involved in decisions about their care; listening to ad hoc patient queries and concerns and addressing these directly or indirectly through timely involvement of other members of the renal team; cultivating a greater awareness of and empathy towards the holistic needs of patients and their families within the renal MDT; and strengthening the links between renal and social care services. The involvement of the CHIO is especially important when discussing sensitive and complex issues such as conservative and end-of-life care with patients and their families, as communication needs to be detailed, precise and unequivocal. This is crucial to providing a bespoke supportive service for our all patients, especially those who have opted for conservative management. The significant contribution of the CHIO to the quality of renal services in Bradford has been recognised and a permanent CHIO post has now been established.

  9. Renal arteriography

    Science.gov (United States)

    ... Read More Acute arterial occlusion - kidney Acute kidney failure Aneurysm Atheroembolic renal disease Blood clots Renal cell carcinoma Renal venogram X-ray Review Date 1/5/2016 Updated by: Jason Levy, ...

  10. Changes in Renal Function and Blood Pressure in Patients with Stone Disease

    Science.gov (United States)

    Worcester, Elaine M.

    2007-04-01

    Stone disease is a rare cause of renal failure, but a history of kidney stones is associated with an increased risk for chronic kidney disease, particularly in overweight patients. Loss of renal function seems especially notable for patients with stones associated with cystinuria, hyperoxaluria, and renal tubular acidosis, in whom the renal pathology shows deposits of mineral obstructing inner medullary collecting ducts, often diffusely. However, even idiopathic calcium oxalate stone formers have a mild but significant decrease in renal function, compared to age, sex and weight-matched normals, and appear to lose renal function with age at a slightly faster rate than non-stone formers. There is also an increased incidence of hypertension among stone formers, although women are more likely to be affected than men.

  11. 76 FR 18930 - Medicare Programs: Changes to the End-Stage Renal Disease Prospective Payment System Transition...

    Science.gov (United States)

    2011-04-06

    ...: Changes to the End-Stage Renal Disease Prospective Payment System Transition Budget-Neutrality Adjustment... period. SUMMARY: This interim final rule with comment will revise the end-stage renal disease (ESRD...-Stage Renal Disease Prospective Payment System'', hereinafter, referred to as the CY 2011 ESRD PPS...

  12. Renal Failure in Sickle Cell Disease: Prevalence, Predictors of Disease, Mortality and Effect on Length of Hospital Stay.

    Science.gov (United States)

    Yeruva, Sri L H; Paul, Yonette; Oneal, Patricia; Nouraie, Mehdi

    2016-09-01

    Renal dysfunction in sickle cell disease is not only a chronic comorbidity but also a mortality risk factor. Though renal dysfunction starts early in life in sickle cell patients, the predictors that can identify sickle cell disease patients at risk of developing renal dysfunction is not known. We used the Truven Health MarketScan(®) Medicaid Databases from 2007 to 2012. Incidence of new acute renal failure (ARF) and chronic kidney disease (CKD) was calculated in this cohort. There were 9481 patients with a diagnosis of sickle cell disease accounting for 64,201 hospital admissions, during the study period. Both ARF and CKD were associated with higher risk of inpatient mortality, longer duration of the hospital stay and expensive hospitalizations. The yearly incidence of new ARF in sickle cell disease patients was 1.4% and annual CKD incidence was 1.3%. The annual rate of new ARF and CKD in the control group was 0.4 and 0.6%, respectively. The most important predictors of new CKD were proteinuria, ARF and hypertension. Chronic kidney disease, hypertension and sickle cell crisis were the most important predictors of new ARF. The annual rate of incidences of ARF and CKD were 2- to 3-fold higher in sickle cell disease compared to the non sickle cell disease group. Besides the common risk factors for renal disease in the general population, it is imperative to monitor the sickle cell disease patients with more severe disease to prevent them from developing renal dysfunction.

  13. Successful pregnancy outcome among women with end-stage renal disease requiring haemodialysis.

    Science.gov (United States)

    Arora, Nalini; Mahajan, Kirti; Jana, Narayan; Maiti, Tapan Kumar; Mandal, Debasmita; Pandey, Rajendra

    2009-04-01

    Pregnancy is rare in women with end-stage renal disease, and perinatal outcome remains suboptimal because of prematurity and foetal growth restriction. Successful obstetrical outcome in two women presented with chronic renal failure requiring serial haemodialysis and multiple blood transfusions during pregnancy is reported. Both women had vaginal delivery of low birth weight neonates--2100 g and 1540 g at 33 and 37 weeks' gestations respectively. With specialised neonatal care, both neonates survived, and the mothers were counselled for renal replacement therapy.

  14. Renal histology before and after effective enzyme replacement therapy in a patient with classical Fabry's disease.

    Science.gov (United States)

    Hirashio, S; Taguchi, T; Naito, T; Maki, K; Ogata, S; Taniyama, K; Taniguchi, Y; Yorioka, N

    2009-05-01

    A 38-year-old man underwent renal biopsy because of proteinuria. It revealed swelling and vacuolation of glomerular epithelial cells, as well as myelin-like structures characteristic of Fabry's disease. Detection of decreased plasma activity of alpha-galactosidase A confirmed the diagnosis. Enzyme replacement therapy was provided with recombinant agalsidase-beta, resulting in improvement of his symptoms. When renal biopsy was repeated, specific staining for globotriaosylceramide showed that renal deposits were decreased by enzyme therapy.

  15. Renal Abnormalities in Patients with Sickle Cell Disease: A Single Center Report from Saudi Arabia

    OpenAIRE

    Aleem Aamer

    2008-01-01

    Patients with sickle cell disease (SCD) are at increased risk of serious morbidity and mortality. Renal abnormalities in SCD are well known but renal involvement in Saudi patients with SCD has not been studied. We sought to identify renal abnormalities in adolescent and adult Saudi patients with SCD. We prospectively studied 73 patients with SCD followed up at King Khalid University Hospital, Riyadh, Saudi Arabia from July 2005 to November 2006,. All patients underwent evaluation of kidney fu...

  16. Ramadan fasting and patients with renal diseases: A mini review of the literature.

    Science.gov (United States)

    Emami-Naini, Afsoon; Roomizadeh, Peyman; Baradaran, Azar; Abedini, Amin; Abtahi, Mohammad

    2013-08-01

    Fasting during the month of Ramadan is one of the five pillars of Islam. During this month, adult Muslims are obligated to refrain from eating and drinking from dawn to dusk. Although based on Islamic principles patients are exempted from fasting, each year, many Muslim patients express their willingness to observe the fast in Ramadan month to respect the cultural customs. There are concerns about the impact of fluid restriction and dehydration during Ramadan fasting for patients with renal diseases. In this study, we reviewed the PubMed, Google Scholar, EBSCO, SCIRUS, Embase, and DOAJ data sources to identify the published studies on the impact of Ramadan fasting on patients with renal diseases. Our review on published reports on renal transplant recipients revealed no injurious effect of Ramadan fasting for the renal graft function. Nearly all studies on this topic suggest that Ramadan fasting is safe when the function of the renal graft is acceptable and stable. Regarding the impact of Ramadan fasting on patients with chronic kidney disease, there is concern about the role of renal hypoperfusion in developing tubular cell injury. Finally, there is controversy between studies about the risk of dehydration in Ramadan in developing renal stones. There are uncertainties about the change in the incidence of renal colic in Ramadan month compared with the other periods of the year. Despite such discrepancies, nearly all studies are in agreement on consuming adequate amounts of water from dusk to dawn to reduce the risk of renal stone formation.

  17. An Ontology- and Constraint-based Approach for Dynamic Personalized Planning in Renal Disease Management

    Directory of Open Access Journals (Sweden)

    Normadiah Mahiddin

    2011-10-01

    Full Text Available Healthcare service providers, including those involved in renal disease management, are concerned about the planning of their patients’ treatments. With efforts to automate the planning process, shortcomings are apparent due to the following reasons: (1 current plan representations or ontologies are too fine grained, and (2 current planning systems are often static. To address these issues, we introduce a planning system called Dynamic Personalized Planner (DP Planner which consists of: (1 a suitably light-weight and generic plan representation, and (2 a constraint-based dynamic planning engine. The plan representation is based on existing plan ontologies, and developed in XML. With the available plans, the planning engine focuses on personalizing pre-existing (or generic plans that can be dynamically changed as the condition of the patient changes over time. To illustrate our dynamic personalized planning approach, we present an example in renal disease management. In a comparative study, we observed that the resulting DP Planner possesses features that rival that of other planning systems, in particular that of Asgaard and O-Plan.

  18. Influenza vaccination in patients with end-stage renal disease.

    Science.gov (United States)

    Principi, Nicola; Esposito, Susanna

    2015-08-01

    Patients with end-stage renal disease (ESRD) are considered at higher risk of influenza-related complications and are listed worldwide among the subjects for whom yearly influenza vaccination is strongly recommended. However, influenza vaccination coverage of patients with ESRD is significantly lower than desired. This paper explores why compliance with official recommendations for influenza vaccination is poor in patients with ESRD and analyzes the true risk of infection as well as the immunogenicity, the effectiveness and the safety of influenza vaccination in these patients. Epidemiological and clinical data support the importance of influenza in conditioning clinical deterioration of patients with ESRD, particularly in relation to their level of immunosuppression. However, the variable levels of immunodeficiency detected in patients with ESRD may reduce the immune response to influenza vaccination, which appears to be lower than that usually found in healthy subjects. However, few studies are available, and they are difficult to compare for several reasons. Additionally, limited data have been collected on influenza vaccine effectiveness, although the available studies support positive results of vaccination on outcomes of severe disease. Despite such limitations, it is important to highlight that all the available studies have confirmed the good safety and tolerability of inactivated influenza vaccines. These findings, together with the risks associated with influenza in these patients, support annual influenza vaccination in patients with ESRD as well as vaccination of their close contacts and should be presented in educational programs organized for nephrologists and patient associations.

  19. Trace elements in sera from patients with renal disease

    Science.gov (United States)

    Miura, Yoshinori; Nakai, Keiko; Sera, Kouichiro; Sato, Michirou

    1999-04-01

    In hemodialysis (HD) patients, an accumulation of trace elements such as aluminum, copper, silicon and vanadium has been reported. Aluminum-caused encephalopathy and aluminum-related bone diseases are important trace element-related complications. Using particle induced X-ray emission (PIXE) we determined concentrations of aluminum, silicon, copper, zinc, selenium and bromine in sera of 29 patients with HD, 14 nondialysis patients with renal disease (RD) and 27 normal controls. The concentration of serum silicon of the patients with HD was 107.4 ± 61.3 μmol/l, which is markedly higher than that of normal controls (48.3 ± 25.8 μmol/l, p < 0.0001). The serum concentrations of zinc and bromine in patients with HD were 11.9 ± 1.7 and 21.3 ± 3.0 μmol/l, respectively. Both were markedly lower than those of normal controls (15.6 ± 2.6, 69.2 ± 8.3 μmol/l, p < 0.0001). The concentrations of aluminium and bromine in the serum of patients with RD were 171.9 ± 64.3 and 81.9 ± 11.6 μmol/l, which were markedly higher than those of normal controls ( p < 0.0001, p < 0.001). No significant differences were observed in the concentration of copper and selenium among three groups.

  20. Chronic Renal Disease and Risk of Cardiovascular Morbidity-Mortality

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    Antonio Santoro

    2014-07-01

    Full Text Available The pathogenesis of cardiovascular disease in CKD differs subtly from that of non-CKD patients. As renal function declines, the role and impact of treating classical risk factors may change and diminish. However, hypertension, hypercholesterolaemia and smoking cessation management should be optimized and may require multiple agents and approaches, particularly as CKD advances. Hypertension treatment would appear to be one management area in which performance is less than ideal. Moreover there are mechanisms and risk factors that are specific to CKD, capable of triggering a vascular pathology and that justify the surplus of CV morbidity in CKD patients and that require we consider CKD as a CV risk factor per se. In the initial stages of CKD it would be advisable to implement all the preventative measures to stem the onset of CV disease, whereas in the more advanced stages a multifactorial approach is likely to be necessary, as we have learned from the STENO-study within the diabetes.

  1. Perioperative outcomes of laparoscopic radical nephrectomy for renal cell carcinoma in patients with dialysis-dependent end-stage renal disease.

    Science.gov (United States)

    Yamashita, Kaori; Ito, Fumio; Nakazawa, Hayakazu

    2012-06-01

    The aims of this study were: (i) to analyze the perioperative outcomes of laparoscopic radical nephrectomy for renal cell carcinoma in patients with dialysis-dependent end-stage renal disease and (ii) to reveal perioperative management problems that are unique to these patients. Between June 2004 and June 2011, laparoscopic radical nephrectomy was performed in 39 patients who had renal cell carcinoma and dialysis-dependent end-stage renal disease. The operative outcomes of these patients were compared with the operative outcomes of 104 non-end-stage renal disease patients with sporadic renal cell carcinoma who underwent laparoscopic radical nephrectomy during the same period. Laparoscopic surgery was completed in thirty-eight end-stage renal disease patients. One patient was converted to open surgery because of an intraoperative injury to the inferior vena cava. This patient was excluded from the analysis. The mean operative time was 240 min; blood loss, 157 mL; and postoperative hospital stay, 9.6 days. Postoperative complications were observed in six patients, as follows: retroperitoneal hematoma and abscess in one patient, thrombosis of the arteriovenous fistula in three patients, pneumonia in one patient, and gastrointestinal bleeding in one patient. Eleven patients required blood transfusions. There was no significant difference between the end-stage renal disease patients and the non-end-stage renal disease patients in the mean operative time or the amount of blood loss. In conclusion, laparoscopic radical nephrectomy is feasible for dialysis-dependent end-stage renal disease patients, as well as for non-end-stage renal disease patients; however, end-stage renal disease patients may have a higher probability of experiencing non-life-threatening complications.

  2. Interdisciplinary counseling service for renal malignancies: a patient-centered approach to raise guideline adherence.

    Science.gov (United States)

    Huber, Johannes; Ihrig, Andreas; Winkler, Eva; Brechtel, Anette; Friederich, Hans-Christoph; Herzog, Wolfgang; Frank, Martin; Grüllich, Carsten; Hallscheidt, Peter; Zeier, Martin; Pahernik, Sascha; Hohenfellner, Markus

    2015-01-01

    Tumor boards have become an integral part of high-quality cancer care, but in general, patients are not directly involved. To overcome this weakness, we established an interdisciplinary counseling service for renal malignancies where 4 specialists talked to the patient at once. We evaluated this approach from the patients' and physicians' perspective. For 3 months, we assessed organizational and clinical data. Within a standardized telephone interview lasting for 14 ± 8 minutes, we explored the patients' view 1 week after counseling. A focus group contributed the physicians' perspective. Costs and revenues were calculated from the hospital's perspective. We included 52 consecutive patients aged 62 ± 10 years. Patients' initiative for a "second opinion" triggered 37% of all appointments. Patients had localized (52%) and systemic (48%) disease presenting with primary diagnosis (48%), relapse (27%), or under continuous therapy (25%). The treatment strategy was changed significantly in 16 of 30 (53%) patients reporting a specific external opinion. The most frequent changes in recommendation were nephron-sparing surgery instead of radical nephrectomy in 8 cases and divergent judgments on restaging causing changes in systemic treatment in 6 cases. We successfully interviewed 43 of 52 patients. Overall, patients rated the consultation as very positive and only 1 patient (2%) was dissatisfied. Patients rated the quality of interpersonal interaction as very positive and said they would recommend the consultation service to others. Disease state was not associated with ratings. Physicians expressed a very positive opinion, highlighting the patients' benefit and very constructive case discussions. Nevertheless, they report remarkable efforts concerning time investment and effective coordination of medical experts. We estimated a deficit of 39 Euro per patient given the German health care system. There might be relevant secondary positive economic effects for the hospital

  3. Chronic kidney disease related to renal tuberculosis: a case report

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    Geraldo Bezerra da Silva Junior

    2016-06-01

    Full Text Available Abstract: Genitourinary tuberculosis (TB is the third most common form of extrapulmonary TB. A 34-year-old man with severe kidney function loss secondary to renal TB initially presented with urinary symptoms, including dysuria and polacyuria. The diagnosis was based on clinical history and laboratory tests; the urinalysis revealed acid-fast bacilli. The patient's condition stabilized after beginning TB-specific treatment, but the right kidney function loss persisted. Renal TB can lead to irreversible loss of renal function. As such, renal function should be considered in all patients from TB-endemic areas who present with urinary symptoms and whose urine cultures are negative for common pathogens.

  4. Minimal change disease with acute renal failure: a case against the nephrosarca hypothesis.

    Science.gov (United States)

    Cameron, Mary Ann; Peri, Usha; Rogers, Thomas E; Moe, Orson W

    2004-10-01

    An unusual but well-documented presentation of minimal change disease is nephrotic proteinuria and acute renal failure. One pathophysiological mechanism proposed to explain this syndrome is nephrosarca, or severe oedema of the kidney. We describe a patient with minimal change disease who presented with heavy proteinuria and acute renal failure but had no evidence of renal interstitial oedema on biopsy. Aggressive fluid removal did not reverse the acute renal failure. Renal function slowly returned concomitant with resolution of the nephrotic syndrome following corticosteroid therapy. The time profile of the clinical events is not compatible with the nephrosarca hypothesis and suggests an alternative pathophysiological model for the diminished glomerular filtration rate seen in some cases of minimal change disease.

  5. [Kidney diseases with chronic renal failure in the Italian renal biopsy registries].

    Science.gov (United States)

    Lupo, A; Bernich, P; Antonucci, F; Dugo, M; Riegler, P; Carraro, M

    2008-01-01

    The prevalence of chronic renal failure (CRF) at the time of kidney biopsy ranges between 5% and 37% in different renal biopsy registries. This wide variability is mainly dependent on the different definitions of CRF. In the period 1998-2006, the Triveneto Renal Biopsy Registry recorded 816 cases with CRF (defined as serum creatinine persistently > or =1.5 mg/dL), accounting for a prevalence of 27%. At the time of biopsy, the average age and glomerular filtration rate were 54 years and 41 mL/min, respectively; 70% of CRF patients are men and the prevalence of CRF increases with age. IgA nephropathy (IgAN) is the main histological form of glomerulonephritis, accounting for 23% of all cases of CRF. However, in subjects older than 65 years, membranous glomerulonephritis (MG) exceeds IgAN, thus becoming the main diagnosis in elderly patients with renal impairment. With a cutoff value for proteinuria of 3 g/day, the main diagnoses in cases with proteinuria below and above the cutoff are IgAN and MG, respectively. IgAN remains the main histological form of nephropathy throughout all levels of renal failure. These data confirm the findings of the Italian Registry of Renal Biopsies, but correspond only in part with data from other registries. The differences can to a certain extent be explained by the different criteria for the definition of renal impairment, patient selection, and differences in diagnosis among registries.

  6. Associations between proteinuria, systemic hypertension and glomerular filtration rate in dogs with renal and non-renal diseases.

    Science.gov (United States)

    Wehner, A; Hartmann, K; Hirschberger, J

    2008-02-02

    Proteinuria and systemic hypertension are well recognised risk factors in chronic renal failure (CRF). They are consequences of renal disease but also lead to a further loss of functional kidney tissue. The objectives of this study were to investigate the associations between proteinuria, systemic hypertension and glomerular filtration rate (GFR) in dogs with naturally occurring renal and non-renal diseases, and to determine whether proteinuria and hypertension were associated with shorter survival times in dogs with CRF. Measurements of exogenous creatinine plasma clearance (ECPC), urine protein:creatinine ratio (UPC), and Doppler sonographic measurements of systolic blood pressure (SBP) were made in 60 dogs with various diseases. There was a weak but significant inverse correlation between UPC and ECPC, a significant inverse correlation between SBP and ECPC and a weak but significant positive correlation between UPC and SBP. Some of the dogs with CRF were proteinuric and almost all were hypertensive. Neoplasia was commonly associated with proteinuria in the dogs with a normal ECPC. CRF was the most common cause leading to hypertension. In the dogs with CRF, hypertension and marked proteinuria were associated with significantly shorter survival times.

  7. Presentation, pathology, and outcome of HIV associated renal disease in a specialist centre for HIV/AIDS

    OpenAIRE

    1998-01-01

    OBJECTIVES: To describe the presentation, pathology, and outcome of biopsy proved renal disease in HIV infected patients at a central London HIV unit from 1992 to 1996. METHODS: Retrospective review of a computerised database and case notes to identify patients with renal disease confirmed by antemortem percutaneous renal biopsy or necropsy. RESULTS: 17 patients were identified, 13 had biopsy and four necropsy confirmed renal disease. Abnormalities included HIV associated nephropathy (H...

  8. Renal Function in Glycogen Storage Disease Type I, Natural Course, and Renopreservative Effects of ACE Inhibition

    NARCIS (Netherlands)

    Martens, Danielle H. J.; Rake, Jan Peter; Navis, Gerjan; Fidler, Vaclav; van Dael, Catharina M. L.; Smit, G. Peter A.

    2009-01-01

    Background and objectives: Renal failure is a major complication in glycogen storage disease type I (GSD I). We studied the natural course of renal function in GSD I patients. We studied differences between patients in optimal and nonoptimal metabolic control and possible renoprotective effects of a

  9. Corynebacterium renale as a cause of reactions to the complement fixation test for Johne's disease

    NARCIS (Netherlands)

    Gilmour, N.J.L.; Goudswaard, J.

    Complement fixation (C.F.) tests and fluorescent antibody (F.A.) tests were carried out on sera from rabbits inoculated with Corynebacterium renale and Mycobacterium johnei, and on sera from cattle with C. renale pyelonephritis and with Johne's disease. Cross-reactions were a feature of the C.F.

  10. Pregnancy in end-stage renal disease patients on hemodialysis: two case reports

    OpenAIRE

    Swaroop, Rohina; Zabaneh, Raja; Parimoo, Nakul

    2009-01-01

    Introduction Pregnancy in patients with end-stage renal disease is rare due to numerous factors that impair fertility. Even if pregnancy does occur pregnancy outcome with a live birth has a low success rate. Case presentation We report two cases of successful pregnancy in patients with end-stage renal disease on hemodialysis. Conclusion The purpose of hemodialysis is not only to maintain life but also to make quality of life as normal as possible for the end-stage renal disease patient. Propa...

  11. Palliative care in advanced kidney disease: a nurse-led joint renal and specialist palliative care clinic.

    Science.gov (United States)

    Harrison, Kerry; Watson, Sarah

    2011-01-01

    The National Service Framework for Renal Services Part 2 identifies quality requirements for end-of-life care for individuals with kidney failure, recognizing the potential to forge closer relationships between renal and specialist palliative care providers. This article describes a pilot project set up by two Clinical Nurse Specialists, one working in hospice specialist palliative care and the other in renal palliative care within an acute trust. The purpose of the pilot was to work in collaboration to run a streamlined nurse-led clinic that would meet the palliative care needs of chronic kidney disease (CKD) Stage 5 patients and their carers. To achieve this the clinic would have to provide optimal symptom management, empower patients to make their own choices, and support them with advance care planning underpinned by the End of Life Care Strategy. The partnership also aimed to promote service improvement and practice development using transference of knowledge, skills, and expertise. Initial informal feedback, including a very small patient survey, suggests that the clinic was well received by patients, carers, and other health professionals. The clinic is ongoing and deserves more formal evaluation to encourage future service development.

  12. Increased risk of emergency hospital admissions for children with renal diseases during heatwaves in Brisbane, Australia

    Institute of Scientific and Technical Information of China (English)

    Xiao-Yu Wang; Adrian Barnett; Yu-Ming Guo; Wei-Wei Yu; Xiao-Ming Shen; Shi-Lu Tong

    2014-01-01

    Background: Heatwaves have a significant impact on population health including both morbidity and mortality. In this study we examined the association between heatwaves and emergency hospital admissions (EHAs) for renal diseases in children (aged 0-14 years) in Brisbane, Australia. Methods: Daily data on EHAs for renal diseases in children and exposure to temperature and air pollution were obtained for Brisbane city from January 1, 1996 to December 31, 2005. A time-stratified case-crossover design was used to compare the risks for renal diseases between heatwave and non-heatwave periods. Results: There were 1565 EHAs for renal diseases in children during the study period. Heatwaves exhibited a signifi cant impact on EHAs for renal diseases in children after adjusting for confounding factors (odds ratio: 3.6; 95% confidence interval: 1.4-9.5). The risk estimates differed with lags and the use of different heatwave defi nitions. Conclusions: There was a significant increase in EHAs for renal diseases in children during heatwaves in Brisbane, a subtropical city where people are well accustomed to warm weather. This finding may have significant implications for pediatric renal care, particularly in subtropical and tropical regions.

  13. Misdiagnosis of Addison's disease in a patient with end-stage renal disease.

    Science.gov (United States)

    Kocyigit, Ismail; Unal, Aydin; Tanriverdi, Fatih; Hayri Sipahioglu, Murat; Tokgoz, Bulent; Oymak, Oktay; Utas, Cengiz

    2011-01-01

    Addison's disease is a rare disorder in patients with end-stage renal disease (ESRD). In patients, the diagnosis of Addison's disease is difficult in clinical practice because most of the clinical findings of this disease are similar to those of the renal failure. We present a 51-year-old male patient, who underwent hemodialysis therapy for 8 years, diagnosed with Addison's disease after having myalgia, skin hyperpigmentation, weight loss, sweating, and nausea for the past few weeks. The physical examination was completely normal except for muscle weakness, hyperpigmentation on labial mucosa and skin in a patient. The laboratory tests revealed anemia and hypoglycemia. Serum cortisol, adrenocorticotropic hormone (ACTH) levels, and ACTH stimulation test results were consistent with Addison's disease. Adrenal computerized tomography revealed bilateral atrophic glands. Additionally, it was found that elevated serum thyroid stimulating hormone levels and antithyroid peroxidase antibody titer were positive. Our purpose is to emphasize that physicians should be alert to the potential for additional different conditions particularly in terms of adrenal failure in patients with ESRD.

  14. Renal sonographic findings of type I glycogen storage disease in infancy and early childhood

    Energy Technology Data Exchange (ETDEWEB)

    Lin, Chun-Chen; Lin, Shuan-Pei [Mackay Memorial Hospital, Department of Pediatrics, Taipei (Taiwan); Tsai, Jeng-Daw; Lee, Hung-Chang [Mackay Memorial Hospital, Department of Pediatrics, Taipei (Taiwan); Taipei Medical University, Department of Pediatrics, Taipei (Taiwan)

    2005-08-01

    Type I glycogen storage disease (GSD-I) is an inherited disorder affecting glycogenolysis and gluconeogenesis. The characteristic manifestations are hepatomegaly, hypoglycemia, hyperlacticacidemia, hyperuricemia, and hyperlipidemia. Renal disease is regarded as a long-term complication and is reported mainly in older patients. We report the renal manifestations and renal ultrasonographic findings of GSD-I in infancy and early childhood in order to assess the role of renal sonography in the diagnosis of GSD-I. We retrospectively reviewed our hospital's database for patients with GSD-I from January 1993 to September 2004. The records of five patients were reviewed for this study. These five patients were diagnosed when they were younger than 3 years old. Data extracted from the charts included the initial extrarenal and renal manifestations, laboratory data, and imaging studies. We analyzed the indications for, and results of, renal sonography. In addition to the clinical presentations and laboratory abnormalities, all five children had nephromegaly and increased echogenicity on ultrasonography on their first visit, although only a minor degree of tubular dysfunction was noted clinically. Three of these five patients had nephrocalcinosis or renal stones or both. Hyperechoic large kidneys, nephrocalcinosis, and renal stones are common in GSD-I. They can be present in early infancy. Abnormalities on renal sonography might suggest GSD-I in a patient with suspected inborn errors of metabolism. (orig.)

  15. Clinical pharmacy activities in chronic kidney disease and end-stage renal disease patients: a systematic literature review

    Directory of Open Access Journals (Sweden)

    Stemer Gunar

    2011-07-01

    Full Text Available Abstract Background Chronic kidney disease (CKD and end-stage renal disease (ESRD represent worldwide health problems with an epidemic extent. Therefore, attention must be given to the optimisation of patient care, as gaps in the care of CKD and ESRD patients are well documented. As part of a multidisciplinary patient care strategy, clinical pharmacy services have led to improvements in patient care. The purpose of this study was to summarise the available evidence regarding the role and impact of clinical pharmacy services for these patient populations. Methods A literature search was conducted using the Medline, Embase and International Pharmaceutical Abstracts databases to identify relevant studies on the impact of clinical pharmacists on CKD and ESRD patients, regarding disease-oriented and patient-oriented outcomes, and clinical pharmacist interventions on drug-related problems. Results Among a total of 21 studies, only four (19% were controlled trials. The majority of studies were descriptive (67% and before-after studies (14%. Interventions comprised general clinical pharmacy services with a focus on detecting, resolving and preventing drug-related problems, clinical pharmacy services with a focus on disease management, or clinical pharmacy services with a focus on patient education in order to increase medication knowledge. Anaemia was the most common comorbidity managed by clinical pharmacists, and their involvement led to significant improvement in investigated disease-oriented outcomes, for example, haemoglobin levels. Only four of the studies (including three controlled trials presented data on patient-oriented outcomes, for example, quality of life and length of hospitalisation. Studies investigating the number and type of clinical pharmacist interventions and physician acceptance rates reported a mean acceptance rate of 79%. The most common reported drug-related problems were incorrect dosing, the need for additional

  16. Cardiovascular disease in patients with end-stage renal disease on hemodialysis in a developing country

    Directory of Open Access Journals (Sweden)

    Leila S. V. Silva

    2012-01-01

    Full Text Available Cardiovascular disease is the main cause of death among patients with end-stage renal disease (ESRD. The present study was undertaken to identify the main cardiovascular diseases and their risk factors in 160 patients with ESRD on hemodialysis (HD in Brazil. Their mean age was 47 ± 39 years. The main risk factors for cardiovascular diseases were arterial hypertension (89.4%, dyslipidemia (78.3%, low high-density lipoprotein levels (84.2% and low physical activity (64.1%. Family history of coronary insufficiency and high low-density lipoprotein levels were significantly associated with coronary artery disease (P = 0.005 and P = 0.029, respectively. Sedentary life style, diabetes mellitus, secondary hyperparathyroidism and hyperglycemia also showed a significant association with the underlying vascular disease (P = 0.017, P = 0.039, P = 0.037 and P = 0.030, respectively. Hypercalcemia, hypertension and black race were factors significantly associated with left ventricular systolic dysfunction (P = 0.01, P = 0.0013 and P = 0.024, respectively. Our study shows that the most prevalent cardiovascular diseases in patients with ESRD were left ventricular hypertrophy, atherosclerotic disease, valvular disease and coronary artery disease. Hypertension and dyslipidemia were the common risk factors associated with cardiovascular diseases. The present study was undertaken to identify the main cardiovascular diseases and their risk factors in 160 patients with ESRD on HD in a single center in Brazil.

  17. Increased renal versican expression is associated with progression of chronic kidney disease.

    Science.gov (United States)

    Rudnicki, Michael; Perco, Paul; Neuwirt, Hannes; Noppert, Susie-Jane; Leierer, Johannes; Sunzenauer, Judith; Eder, Susanne; Zoja, Carlamaria; Eller, Kathrin; Rosenkranz, Alexander R; Müller, Gerhard A; Mayer, Bernd; Mayer, Gert

    2012-01-01

    Novel prognostic markers for progression of kidney disease are needed to distinguish patients who might benefit from a more aggressive nephroprotective therapy. Expression of the proteoglycan versican was evaluated in renal transcriptomics profiles and in an independent set of 74 renal biopsies. Versican levels were correlated to histologic damage scores and to renal outcome, and versican expression and regulation was evaluated in vitro. In transcriptomics profiles of renal tissue versican was positively correlated with (i) histological parameters in kidney biopsies, (ii) progressive decline of renal function in proteinuric kidney diseases, and (iii) impaired renal function and histology scores in diabetic nephropathy. In an independent cohort of 74 biopsies of glomerular diseases renal RNA levels of versican isoforms V0 and V1, but not V2 and V3 correlated significantly with creatinine after a mean follow up time of 53 months. Versican isoforms V0 and V1 together with serum creatinine at time of biopsy and the degree of glomerulosclerosis predicted 20% and 24% of the variability of creatinine at follow up, which was significantly more than serum creatinine and histological parameters alone (16%). However, when patients with acute kidney failure at time of biopsy (n = 5) were excluded, the additive predictive value of versican V1 was only marginally higher (35%) than creatinine and glomerulosclerosis alone (34%). Versican isoforms V0 and V1 were primarily expressed in vitro in proximal tubule cells and in fibroblasts. The results in humans were confirmed in three rodent models of kidney disease, in which renal versican expression was significantly upregulated as compared to corresponding controls. These data show for the first time an association of renal versican isoform V0 and V1 expression with progressive renal disease.

  18. Increased renal versican expression is associated with progression of chronic kidney disease.

    Directory of Open Access Journals (Sweden)

    Michael Rudnicki

    Full Text Available Novel prognostic markers for progression of kidney disease are needed to distinguish patients who might benefit from a more aggressive nephroprotective therapy. Expression of the proteoglycan versican was evaluated in renal transcriptomics profiles and in an independent set of 74 renal biopsies. Versican levels were correlated to histologic damage scores and to renal outcome, and versican expression and regulation was evaluated in vitro. In transcriptomics profiles of renal tissue versican was positively correlated with (i histological parameters in kidney biopsies, (ii progressive decline of renal function in proteinuric kidney diseases, and (iii impaired renal function and histology scores in diabetic nephropathy. In an independent cohort of 74 biopsies of glomerular diseases renal RNA levels of versican isoforms V0 and V1, but not V2 and V3 correlated significantly with creatinine after a mean follow up time of 53 months. Versican isoforms V0 and V1 together with serum creatinine at time of biopsy and the degree of glomerulosclerosis predicted 20% and 24% of the variability of creatinine at follow up, which was significantly more than serum creatinine and histological parameters alone (16%. However, when patients with acute kidney failure at time of biopsy (n = 5 were excluded, the additive predictive value of versican V1 was only marginally higher (35% than creatinine and glomerulosclerosis alone (34%. Versican isoforms V0 and V1 were primarily expressed in vitro in proximal tubule cells and in fibroblasts. The results in humans were confirmed in three rodent models of kidney disease, in which renal versican expression was significantly upregulated as compared to corresponding controls. These data show for the first time an association of renal versican isoform V0 and V1 expression with progressive renal disease.

  19. Successful Renal Transplantation in a Patient with Behcet Disease and Hodgkin Lymphoma in Remission

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    Vural Taner YILMAZ

    2011-05-01

    Full Text Available Behcet's disease (BD is an inflammatory multisystemic disease characterized by perivascular inflammation and generally presents with recurrent oral and genital ulcers and uveitis. It is known that BD may also involve the kidneys. Amyloidosis, glomerulonephritis (crescentic, proliferative, IgA nephropathy, interstitial nephritis are commonly described renal lesions which may lead to end-stage renal disease (ESRD in BD. Immunosuppressive therapies used for the treatment of BD may cause malignant diseases (lymphoma, skin and solid organ malignancies, etc. The risk with azathioprin is especially high after 10 years of treatment. Cyclosporine, another immunosuppressive agent frequently used for treatment of BD, also has tumorigenic potential and is associated with renal toxicity and renal failure. Renal transplantation may be performed in patients with malignancies after a 2-5 year complete remission period, although it may differ according to the type of tumor. We report a case of end-stage renal disease and Hodgkin's lymphoma occurring after treatment with immunosuppressive medicine for BD. The patient was successfully treated with renal transplantation.

  20. Lower Extremity Revascularization in End-Stage Renal Disease.

    Science.gov (United States)

    Jones, Douglas W; Dansey, Kirsten; Hamdan, Allen D

    2016-11-01

    Patients with end-stage renal disease (ESRD) who present with critical limb ischemia (CLI) have become an increasingly common and complex treatment problem for vascular surgeons. Dialysis patients have high short-term mortality rates regardless of whether revascularization is pursued. ESRD patients with CLI can be managed with: local wound care, endovascular or surgical revascularization, or amputation. Some patients may heal small foot wounds with local wound care alone, even if distal perfusion is marginal, as long as any infectious process has been controlled. Surgical revascularization has a mortality rate of 5-10% but has a high chance of limb salvage. However, overall 5-year survival may be as low as 28%. Endovascular therapy also carries a high perioperative mortality risk in this population with similar limb salvage rates. Amputation is indicated in patients with advanced stage CLI, as described by the Society for Vascular Surgery's Wound, Ischemia and foot Infection (WIfI) system. Statistical models predict that endovascular or surgical revascularization strategies are less costly and more functionally beneficial to patients than primary amputation alone. Decisions on how to manage ESRD patients with CLI are complex but revascularization can often result in limb salvage, despite limited overall survival. Dialysis patients with good life expectancy and good quality conduit may benefit most from surgical bypass.

  1. Fertility and contraception in end-stage renal disease.

    Science.gov (United States)

    Schmidt, R J; Holley, J L

    1998-01-01

    The hormonal aberrations that occur with end-stage renal disease (ESRD) are presented in this review in relation to fertility and conception among women on dialysis. The imbalance in gonadotropin production in dialysis-dependent men and women is characterized by elevations in luteinizing hormone (LH). In women dialysis patients, the normal estradiol-stimulated LH surge does not occur, resulting in anovulation. In men dialysis patients spermatogenesis is impaired, and low testosterone levels cause elevated LH. Infertility in those with ESRD is a culmination of many factors, including impotence and loss of libido, anovulation, and an altered hormonal milieu. Despite these inhibitors of conception, women on dialysis can conceive; pregnancy has been reported in 1% to 7% of women on dialysis in survey studies. The influence of dialysis mode (hemodialysis v peritoneal dialysis), recombinant human erythropoietin (EPO), and dialysis adequacy on the likelihood of conception among patients of either sex on dialysis is unknown. Reduced sexual activity and interest has consistently been reported in the ESRD population. The reasons for this are complex and likely involve the effects of comorbid illnesses, overall health status, body image factors, and hormonal alterations. Nephrologists rarely discuss conception and contraception with their women dialysis patients. Greater attention to these issues is needed.

  2. Fertility preservation in patients receiving cyclophosphamide therapy for renal disease.

    Science.gov (United States)

    Gajjar, Radha; Miller, Steven D; Meyers, Kevin E; Ginsberg, Jill P

    2015-07-01

    Cyclophosphamide continues to have an important role in the treatment of renal disease, including nephrotic syndrome and lupus nephritis, despite known complications of gonadotoxicity and potential infertility in both male and female patients. It is important that the physician recommending this therapy mitigates the effect of the drug on fertility by adhering to recommendations on dosing limits and offering fertility-preserving strategies. In addition to well-established methods, such as sperm banking and embryo cryopreservation, advances in reproductive technology have yielded strategies such as oocyte cryopreservation, resulting in more fertility-preserving options for the pediatric patient. Despite these advances, there continues to be a significant barrier to referral and access to sperm banks and fertility specialists. These issues are further complicated by ethical issues associated with the treatment of pediatric patients. In this review we explore the development of recommended dosing limits and include a discussion of the available fertility-preserving methods, strategies for increasing access to fertility specialists, and the ethical considerations facing the pediatric healthcare provider.

  3. LIFE EXPERIENCES OF PATIENTS SUFFERING END STAGE RENAL DISEASE

    Directory of Open Access Journals (Sweden)

    Yulis Setiya Dewi

    2017-04-01

    Full Text Available Introduction: Haemodialysis (HD is one of therapies to sustain life for people with End Stage Renal Disease (ESRD. HD and ESRD are the source of the stressor for the patients. The purpose of this study was to gain insight about the life experiences of patients suffering from ESRD and coping that they used in dealing with stressors. Method: This study employed hermeneutic phenomenological study as methodology. Samples were taken at RSU Dr. Soedono Madiun in December 2010–May 2011 using purposive sampling. Participants in this study amounted to 9 people who all male and had suffered kidney failure and undergoing HD for more than 2 years. Data were processed and analysed through the nine stages data interpretation according collaizi. Result: Client's life experiences with HD and coping strategies they used to cope with critical situations have been identified and grouped into several themes. The first theme was the reaction of participants when receiving the diagnosis should undergo HD including: sad, rejection, fear, shock and feelings of resignation and hope. The second theme was perceived to critical situations by clients include shortness of breath, weakness, body swelling, itching, diarrhea and could not urinate. Last theme was the meaning of life in hemodialysis derived from attitudinal values (the values to be and experiential values (the values of appreciation. Discussion: Ways in which clients address critical situations were quite diverse. Emotional informational, instrumental supports from spouse or significant other were needed by participants to overcome the critical situation. This study suggests that nurse should perform therapeutic communication to HD patients so that patients may cope with the disease more positively.

  4. End-stage renal disease in Nigeria: An overview of the epidemiology and the pathogenetic mechanisms

    Directory of Open Access Journals (Sweden)

    M O Odubanjo

    2011-01-01

    Full Text Available There is paucity of information on the magnitude of the burden of renal disease in our environment. Obtaining accurate data is hampered by the poor socioeconomic status of most patients with lack of access to specialized care in tertiary institutions, where most of the data is generated. The incidence of chronic renal failure (CRF and end-stage renal disease (ESRD in any specified area is known to be influenced by the prevalence of specific disease entities resulting in CRF. Hypertension, glomerulonephritis (GN, sickle cell disease, quartan malaria nephropathy, urinary tract schistosomiasis and other parasite-related forms of chronic GN are known to contribute significantly to the incidence of CRF in Nigeria. As is the situation in other parts of the world, diabetic nephropathy appears to be of increasing importance in the causation of ESRD in Nigeria. Even though the underlying cause of renal disease can often not be treated, extensive studies in experimental animals and preliminary studies in humans suggest that progression in chronic renal disease may largely be due to secondary factors, attention to which may be important in the prevention and/or control of renal disease.

  5. In vivo vascular wall shear rate and circumferential strain of renal disease patients.

    Science.gov (United States)

    Park, Dae Woo; Kruger, Grant H; Rubin, Jonathan M; Hamilton, James; Gottschalk, Paul; Dodde, Robert E; Shih, Albert J; Weitzel, William F

    2013-02-01

    This study measures the vascular wall shear rate at the vessel edge using decorrelation based ultrasound speckle tracking. Results for nine healthy and eight renal disease subjects are presented. Additionally, the vascular wall shear rate and circumferential strain during physiologic pressure, pressure equalization and hyperemia are compared for five healthy and three renal disease subjects. The mean and maximum wall shear rates were measured during the cardiac cycle at the top and bottom wall edges. The healthy subjects had significantly higher mean and maximum vascular wall shear rate than the renal disease subjects. The key findings of this research were that the mean vascular wall shear rates and circumferential strain changes between physiologic pressure and hyperemia that was significantly different between healthy and renal disease subjects.

  6. Hypokalemic Rhabdomyolysis Induced Acute Renal Failure As a Presentation of Coeliac Disease

    Directory of Open Access Journals (Sweden)

    Funda Sarı

    2012-03-01

    Full Text Available Adult coeliac disease commonly presents without classical symptoms as chronic diarrhea and weight loss. We describe the case of a 31-year-old woman with persistent life-threatening hypokalemia, acute renal failure, and acute quadriplegia due to diarrhea that had continued for one month. Although there are cases of coeliac disease diagnosed with hypokalemic rhabdomyolysis in the literature, none of the cases developed acute renal failure. This is the first case in the literature diagnosed with acute renal failure due to hypokalemic rhabdomyolysis as a presentation of coeliac disease. In acute renal failure cases that present with hypokalemic rhabdomyolysis due to severe diarrhea, coeliac disease should be considered as a differential diagnosis despite the negative antigliadin IgA antibody.

  7. Improving Outcomes in Patients with Lupus and End Stage Renal Disease

    OpenAIRE

    Inda-Filho, Antonio; Neugarten, Joel; Putterman, Chaim; Broder, Anna

    2013-01-01

    The development of lupus-related end stage renal disease (ESRD) confers the highest mortality rates among individuals with lupus. Lupus-related ESRD is also associated with higher morbidity and mortality rates compared with non-lupus ESRD.

  8. The rate of progression of renal disease may not be slower in women compared with men

    DEFF Research Database (Denmark)

    Jafar, Tazeen H; Schmid, Christopher H; Stark, Paul C

    2003-01-01

    of renal disease progression with gender. METHODS: We analysed a pooled database of patients with non-diabetic renal disease enrolled in 11 randomized controlled trials evaluating the efficacy of angiotensin-converting enzyme inhibitors (ACEIs) for slowing renal disease progression. The primary end point...... patient characteristics, and changes from baseline to follow-up systolic blood pressure (SBP) and urine protein (UP) excretion. RESULTS: The total number of patients was 1860: 645 (35%) females and 1215 (65%) males. Mean duration of follow-up was 2.2 years. The proportions randomized to ACEI (51%), mean...... ACEIs and baseline UP, and 1.36 (1.06-1.75) after adjusting for baseline variables and changes in SBP and UP during follow-up. Similar results were found for the outcome of ESRD. CONCLUSIONS: Our findings suggest that the rate of renal disease progression may not be slower, and may even be faster...

  9. Progression to calcific mitral stenosis in end-stage renal disease.

    Science.gov (United States)

    D'Cruz, I A; Madu, E C

    1995-12-01

    A 59-year-old man with end-stage renal disease and on hemodialysis had neither mitral stenosis nor mitral calcification on echo-Doppler examination in 1989, but had extensive mitral calcification and definite mitral stenosis on conventional and transesophageal echocardiography in 1994. The left ventricle had marked concentric hypertrophy. To our knowledge this is the first documentation of the development of calcific mitral stenosis in end-stage renal disease revealed by serial echo-Doppler studies.

  10. Developmental Abnormalities, Blood Pressure Variability and Renal Disease In Riley Day Syndrome

    OpenAIRE

    Norcliffe-Kaufmann, Lucy; Axelrod, Felicia B.; Kaufmann, Horacio

    2011-01-01

    Riley Day syndrome, commonly referred to as familial dysautonomia (FD), is a genetic disease with extremely labile blood pressure due to baroreflex deafferenation. Chronic renal disease is very frequent in these patients and was attributed to recurrent arterial hypotension and renal hypoperfusion. Aggressive treatment of hypotension, however, has not reduced its prevalence. We evaluated the frequency of kidney malformations as well as the impact of hypertension, hypotension and blood pressure...

  11. The Association Between Insulin Resistance And Advanced Renal Disease In Type 1 Diabetes

    Directory of Open Access Journals (Sweden)

    Duţă Irina

    2015-06-01

    Full Text Available Background and Aims. Insulin resistance is documented in type 1 diabetes and it has been associated with chronic complications. Diabetic nephropathy is a major cause of morbidity and mortality. The purpose of this article is to quantify insulin resistance in type 1 diabetes subjects according to the presence or absence of advanced renal disease. A secondary objective was to study the possible association between insulin resistance and advanced renal disease.

  12. Macroscopic Hydatiduria: An Uncommon Pathognomonic Pres-enta¬tion of Renal Hydatid Disease

    Directory of Open Access Journals (Sweden)

    Ali HAMIDI MADANI

    2015-10-01

    Full Text Available Isolated renal hydatid disease is a rare endemic infestation caused by larval form of Echinococcus granulosus. Hydatiduria is an uncommon presentation of renal hydatid disease. In 2012 a 34-year-old female referred to Razi Hospital, Rasht, Iran with complaints of right flank pain and grape-like material in urine. Diagnosis was made by ultrasonography and CT scan. The patient was treated surgically with nephrectomy in combination with perioperative chemotherapy with albendazol.  

  13. Successful pregnancy in an end-stage renal disease patient on peritoneal dialysis.

    Science.gov (United States)

    Inal, Salih; Reis, Kadriye Altok; Armağan, Berkan; Oneç, Küşrad; Biri, Aydan

    2012-01-01

    Among women with chronic kidney disease, successful pregnancy with a surviving infant is rather rare. Although these pregnancies carry higher risk, with the possibility of adverse maternal and fetal outcomes, they can be managed with close monitoring and intense renal replacement therapy. Given the hemodynamic advantages of peritoneal dialysis over hemodialysis in pregnancy, peritoneal dialysis therapy is thought to be a favorable renal replacement option in pregnant patients with chronic kidney disease.

  14. Octreotide reduces hepatic, renal and breast cystic volume in autosomal-dominant polycystic kidney disease.

    Science.gov (United States)

    Peces, Ramón; Cuesta-López, Emilio; Peces, Carlos; Pérez-Dueñas, Virginia; Vega-Cabrera, Cristina; Selgas, Rafael

    2011-06-01

    A 43-year-old woman with autosomal-dominant polycystic kidney disease (ADPKD) received octreotide for 12 months, and this was associated with a 6.3% reduction in liver volume, an 8% reduction in total kidney volume and stabilization of renal function. There was also a reduction of cyst size in fibrocystic disease of breast. These data suggest that the cyst fluid accumulation in different organs from patients with ADPKD is a dynamic process which can be reversed by octreotide. This is the first report of a case of simultaneous reduction in hepatic, renal and breast cystic volume with preservation of renal function in a patient with ADPKD receiving octreotide.

  15. Pregnancy in end-stage renal disease patients on dialysis: how to achieve a successful delivery.

    Science.gov (United States)

    Manisco, Gianfranco; Potì', Marcello; Maggiulli, Giuseppe; Di Tullio, Massimo; Losappio, Vincenzo; Vernaglione, Luigi

    2015-06-01

    Pregnancy in women with chronic kidney disease has always been considered as a challenging event both for the mother and the fetus. Over the years, several improvements have been achieved in the outcome of pregnant chronic renal patients with increasing rates of successful deliveries. To date, evidence suggests that the stage of renal failure is the main predictive factor of worsening residual kidney function and complications in pregnant women. Moreover, the possibility of success of the pregnancy depends on adequate depurative and pharmacological strategies in patients with end-stage renal disease. In this paper, we propose a review of the current literature about this topic presenting our experience as well.

  16. Incidence and Predictors of End-Stage Renal Disease in Outpatients With Systolic Heart Failure

    DEFF Research Database (Denmark)

    Bosselmann, Helle Skovmand; Gislason, Gunnar; Gustafsson, Finn

    2013-01-01

    Background- Renal dysfunction is an important prognostic factor in heart failure (HF), but whether this dysfunction progresses to end-stage renal disease (ESRD) is unknown. Therefore, we examined incidence and predictors of ESRD in outpatients with HF. Methods and Results- Patients with systolic HF...... were identified in The Danish Heart Failure database and new-onset ESRD from the Danish Registry on Dialysis. Renal function was estimated by The Chronic Kidney Disease Epidemiology Collaboration equation and patients grouped by estimated glomerular filtration rate (eGFR)-group I: ≥60 mL/min per 1.73 m...

  17. Effect of inhibition of converting enzyme on renal hemodynamics and sodium management in polycystic kidney disease.

    Science.gov (United States)

    Torres, V E; Wilson, D M; Burnett, J C; Johnson, C M; Offord, K P

    1991-10-01

    We compared the tubular transport of sodium and the erythrocyte sodium-lithium countertransport activity in hypertensive patients with autosomal dominant polycystic kidney disease (ADPKD) and in normotensive control subjects. In addition, we assessed the effects of inhibition of converting enzyme on renal hemodynamics and sodium excretion in hypertensive patients with ADPKD to provide information on mechanisms responsible for the increased renal vascular resistance and filtration fraction and the adjustment of the pressure-natriuresis relationship during saline expansion, observed in patients with ADPKD, hypertension, and preserved renal function. In comparison with normotensive control subjects, the hypertensive patients with ADPKD had lower renal plasma flows, higher renal vascular resistances and filtration fractions, and similar proximal and distal fractional reabsorptions of sodium. The administration of enalapril resulted in significant increases in the renal plasma flow and significant reductions in mean arterial pressure, renal vascular resistance, and filtration fraction, but the glomerular filtration rate remained unchanged. Despite the significant reduction in mean arterial pressure during inhibition of converting enzyme, the distal fractional reabsorption of sodium decreased while the total fractional excretion of sodium remained unchanged or increased slightly. No significant differences were detected between the normotensive control subjects and the hypertensive patients with ADPKD in erythrocyte sodium-lithium countertransport activity, plasma renin activity, plasma aldosterone concentration, or atrial natriuretic factor. These results suggest that the renal renin-angiotensin system plays a central role in the alterations in renal hemodynamics and sodium management associated with the development of hypertension in ADPKD.

  18. Atherosclerotic ischemic renal disease. Diagnosis and prevalence in an hypertensive and/or uremic elderly population

    Directory of Open Access Journals (Sweden)

    Rossi Michele

    2003-02-01

    Full Text Available Abstract Background Atherosclerotic ischemic renal disease is a frequent cause of end-stage renal failure leading to dialysis among the elderly; Its prevalence is inferred from autopsy or retrospective arteriographic studies. This study has been conducted on 269 subjects over 50 with hypertension and/or CRF, unrelated to other known causes of renal disease. Methods All 269 patients were studied either by color-flow duplex sonography (n = 238 or by renal scintigraphy (n = 224, and 199 of the 269 patients were evaluated using both of these techniques. 40 patients, found to have renal artery stenosis (RAS, were subjected to 3D-contrast enhancement Magnetic Resonance Angiography (MRA and/or Selective Angiography (SA. An additional 23 cases, negative both to scintigraphy and to ultrasound study, underwent renal angiography (MRA and/or SA. Results Color-duplex sonography, carried out in 238 patients, revealed 49 cases of RAS. MR or SA was carried out in 35 of these 49 patients, and confirmed the diagnosis in 33. Color-duplex sonography showed a PPV value of 94.3% and NPV of 87.0% while renal scintigraphy, carried out in 224 patients, had a PPV of 72.2% and a NPV of 29.4%. Patients with RAS showed a higher degree of renal insufficiency compared to non stenotic patients while there were no differences in proteinuria. RAS, based on color-duplex sonography studies, was present in 11% of patients in the age group 50–59, 18% in the 60–69 and 23% at age 70 and above. Conclusions A relatively large percentage of the elderly population with renal insufficiency and/or hypertension is affected by RAS and is at risk of developing end-stage renal failure. Color-duplex ultrasonography is a valid routine method of investigation of population at risk for renal artery stenosis.

  19. Mesenchymal stem cells derived from adipose tissue are not affected by renal disease.

    Science.gov (United States)

    Roemeling-van Rhijn, Marieke; Reinders, Marlies E J; de Klein, Annelies; Douben, Hannie; Korevaar, Sander S; Mensah, Fane K F; Dor, Frank J M F; IJzermans, Jan N M; Betjes, Michiel G H; Baan, Carla C; Weimar, Willem; Hoogduijn, Martin J

    2012-10-01

    Mesenchymal stem cells are a potential therapeutic agent in renal disease and kidney transplantation. Autologous cell use in kidney transplantation is preferred to avoid anti-HLA reactivity; however, the influence of renal disease on mesenchymal stem cells is unknown. To investigate the feasibility of autologous cell therapy in patients with renal disease, we isolated these cells from subcutaneous adipose tissue of healthy controls and patients with renal disease and compared them phenotypically and functionally. The mesenchymal stem cells from both groups showed similar morphology and differentiation capacity, and were both over 90% positive for CD73, CD105, and CD166, and negative for CD31 and CD45. They demonstrated comparable population doubling times, rates of apoptosis, and were both capable of inhibiting allo-antigen- and anti-CD3/CD28-activated peripheral blood mononuclear cell proliferation. In response to immune activation they both increased the expression of pro-inflammatory and anti-inflammatory factors. These mesenchymal stem cells were genetically stable after extensive expansion and, importantly, were not affected by uremic serum. Thus, mesenchymal stem cells of patients with renal disease have similar characteristics and functionality as those from healthy controls. Hence, our results indicate the feasibility of their use in autologous cell therapy in patients with renal disease.

  20. Endothelin-A receptor blockade slows the progression of renal injury in experimental renovascular disease.

    Science.gov (United States)

    Kelsen, Silvia; Hall, John E; Chade, Alejandro R

    2011-07-01

    Endothelin (ET)-1, a potent renal vasoconstrictor with mitogenic properties, is upregulated by ischemia and has been shown to induce renal injury via the ET-A receptor. The potential role of ET-A blockade in chronic renovascular disease (RVD) has not, to our knowledge, been previously reported. We hypothesized that chronic ET-A receptor blockade would preserve renal hemodynamics and slow the progression of injury of the stenotic kidney in experimental RVD. Renal artery stenosis, a major cause of chronic RVD, was induced in 14 pigs and observed for 6 wk. In half of the pigs, chronic ET-A blockade was initiated (RVD+ET-A, 0.75 mg·kg(-1)·day(-1)) at the onset of RVD. Single-kidney renal blood flow, glomerular filtration rate, and perfusion were quantified in vivo after 6 wk using multidetector computer tomography. Renal microvascular density was quantified ex vivo using three-dimensional microcomputer tomography, and growth factors, inflammation, apoptosis, and fibrosis were determined in renal tissue. The degree of stenosis and increase in blood pressure were similar in RVD and RVD+ET-A pigs. Renal hemodynamics, function, and microvascular density were decreased in the stenotic kidney but preserved by ET-A blockade, accompanied by increased renal expression of vascular endothelial growth factor, hepatocyte growth factor, and downstream mediators such as phosphorilated-Akt, angiopoietins, and endothelial nitric oxide synthase. ET-A blockade also reduced renal apoptosis, inflammation, and glomerulosclerosis. This study shows that ET-A blockade slows the progression of renal injury in experimental RVD and preserves renal hemodynamics, function, and microvascular density in the stenotic kidney. These results support a role for ET-1/ET-A as a potential therapeutic target in chronic RVD.

  1. Cellular and functional aspects of the renal kallikrein system in health and disease.

    Science.gov (United States)

    Vio, C P; Olavarría, V; González, C; Nazal, L; Córdova, M; Balestrini, C

    1998-01-01

    The kallikrein kinin system is a tissue-derived system with potent renal and cardiovascular effects. Within the kidney, the components of the kallikrein kinin system (kallikrein, kininogen, kinins, kininases, kinin receptors and mediators/modulators) originate from or are located in discrete segments of the nephron in highly specialized cells which determine its physiological effects. The kallikrein system acts on the kidney in a paracrine fashion in two anatomical microenvironments where the system regulates glomerular function, renal hemodynamics, and salt and water excretion. Impairment of the renal kallikrein system contributes to the development of hypertension, in particular to the salt-sensitive hypertension, and other pathologies like diabetes. There are several links between the vasodepressor kallikrein system and the vasopressor renin system which are relevant to normal renal function and to the pathophysiology of hypertension and renal diseases. Local induction of kininase II or angiotensin converting enzyme in the kidney could be a novel mechanism contributing to the renal damage in hypertension and other renal diseases. This review evaluates cellular and functional aspects of the renal kallikrein system with emphasis placed on the cellular localization of its components along the nephron, the links to other vasoactive systems, and the contribution of the system to the pathogenesis of hypertension.

  2. Acceptance and effects of a therapeutic renal food in pet cats with chronic kidney disease.

    Science.gov (United States)

    Fritsch, Dale A; Jewell, Dennis E; Leventhal, P S; Brejda, J; Ahle, N W; Schiefelbein, H M; Forrester, S D

    2015-01-01

    Renal foods are used to manage chronic kidney disease (CKD) in dogs and cats, but their effectiveness may be limited by the ability to transition animals to them. In a prospective study, pet cats with previously undiagnosed kidney disease (20 International Renal Interest Society (IRIS) 1, 61 IRIS 2, 14 IRIS 3/4, 33 at risk for CKD) were transitioned to a renal food. Markers of renal function were measured and owners answered questionnaires about their pet over one year. All but eight cats (120/128; 94 per cent) successfully transitioned to the renal food. Most of the time, cats moderately or extremely liked the food (89 per cent), ate at least half (73 per cent) and were moderately or extremely enthusiastic while eating (68 per cent). Cats rarely disliked the food (2 per cent) or refused to eat it (1 per cent). Markers of renal function were unchanged in IRIS 1 and 2 cats and changed little in IRIS 3/4 cats. In all groups, owner-assessed quality of life improved initially and then remained stable. Mean bodyweight did not change in cats with CKD. Most cats with CKD successfully transitioned to the renal food. The results also support previous studies that the renal food can help stabilise cats with CKD.

  3. Applications of urinary proteomics in renal disease research using animal models.

    Science.gov (United States)

    Lv, Yang; Cai, Guangyan; Chen, Xiangmei

    2015-01-01

    Animal models of renal disease are essential tools in research on kidney disease and have provided valuable insights into pathogenesis. Use of animal models minimises inter-individual differences, allows specific pathological changes to be examined, and facilitates collection of tissue samples. Thus, mechanistic research and identification of biomarkers are possible. Various animal models manifesting specific pathological lesions can be used to investigate acute or chronic kidney disease (CKD). Urine, a terminal metabolic product, is produced via glomerular filtration, reabsorption, and excretion in the tubular and collecting ducts, reflecting the functions of glomeruli or tubular tissue stimulated in various ways or subject to disease. Almost 70 % of urinary proteins originate from the kidney (the other 30 % come from plasma), and urinary sampling is important to noninvasively detect renal disease. Proteomics is powerful when used to screen urine components. Increasingly, urine proteomics is used to explore the pathogenesis of kidney disease in animals and to identify novel biomarkers of renal disease. In this section, we will introduce the field of urinary proteomics as applied in different models of animal renal disease and the valuable role played by proteomics in noninvasive diagnosis and rational treatment of human renal disease.

  4. Acute renal failure in patients with chronic kidney disease

    African Journals Online (AJOL)

    2007-08-16

    Aug 16, 2007 ... chronic may also complicate treatment with amphotericin B, which ... renal manifestations of systemic lupus erythematosus. • Useful investigations include ... History and physical examination will often give clues to the likely ...

  5. HIV testing in patients with end stage renal disease.

    OpenAIRE

    1990-01-01

    One hundred and twenty eight British and Irish nephrologists were questioned about their policy for HIV testing of patients with end stage renal failure being considered for renal replacement therapy. A total of 101 (79%) replied. In the case of candidates for dialysis roughly one third of respondents tested only people they considered at risk of infection with HIV and nearly one fifth considered testing unnecessary. In the case of candidates for transplantation routine HIV testing was carrie...

  6. Extra-renal manifestations of autosomal dominant polycystic kidney disease (ADPKD): considerations for routine screening and management.

    Science.gov (United States)

    Luciano, Randy L; Dahl, Neera K

    2014-02-01

    Autosomal-dominant polycystic kidney disease (ADPKD) is a systemic disease, marked by progressive increase of bilateral renal cysts, resulting in chronic kidney disease (CKD) and often leading to end-stage renal disease (ESRD). Apart from renal cysts, patients often have extra-renal disease, involving the liver, heart and vasculature. Other less common but equally important extra-renal manifestations of ADPKD include diverticular disease, hernias, male infertility and pain. Extra-renal disease burden is often asymptomatic, but may result in increased morbidity and mortality. If the disease burden is significant, screening may prove beneficial. We review the rationale for current screening recommendations and propose some guidelines for screening and management of ADPKD patients.

  7. Upper Gastrointestinal Disorders in Children with End -Stage Renal Disease

    Directory of Open Access Journals (Sweden)

    Esfahani S.T

    2009-04-01

    Full Text Available This study was undertaken to define the prevalence of the upper Gastrointestinal (GI lesions, dyspeptic symptoms, H.pylori infection, and the impact of duration of dialysis on upper GI symptoms and lesions of children with End-stage renal disease. We studied 69 children with ESRD who were under regular hemodialysis therapy in our department. The age of the patients were between 4-18 years (mean: 11.3. 57(82.6% of 69 patients had GI symptoms and 12(17.4% were symptom free, the prevalence of each symptom in 57 symptomatic children was as follows: anorexia 48(84.2%, nausea/vomiting 39 (68.4%, belching/heartburn 20(35%, abdominal distention 15(26.3%, and epigastric pain 8(14%. 65(92.4% of 69 patients with ESRD had pathologic lesions and the most common lesion was gastritis .There was no case of gastric angiodysplasia in our patients. 15(21.7% of 69 patients had H. pylori infection. The prevalence of H.pylori infection in non-uremic children with upper GI symptoms is about 27% in our pediatric gastroenterology department, so there was no significant difference in prevalence of H.pylori infection between uremic and non-uremic children in our study (p value = 0.4735. There was no significant relationship between duration of dialysis and dyspeptic symptoms or upper GI lesions (p values were 0.8775 and 0.7435, respectively. Conclusions: Upper GI disorders are very common in children with ESRD, even when they have no upper GI symptoms, the most common lesion is gastritis. The prevalence of H.pylori infection is not different between children with ESRD and non-uremic children with upper GI symptoms, and duration of hemodialysis therapy has no significant effect on prevalence of GI symptoms and lesions.

  8. Sono-Guided Percutaneous Automated Gun Biopsy in Pediatric Renal Disease

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jong Chul [Chungnam National University College of Medicine, Daejeon (Korea, Republic of)

    1996-12-15

    To evaluate whether sono-guided percutaneous automated gun biopsy is also useful in pediatricpatients with renal diseases. In the prone position of twenty pediatric patients with renal parenchymal diseases, percutaneous biopsy was done through lateral aspect of the lower pole of left kidney with automated biopsy gun under the guidance of ultrasonography. The biopsy needle was either of 18 or 20 gauge. The obtained core of renal tissue was examined with light, immunofluorescent or electron microscope by the renal pathologist. In 18 among 20 patients, adequate renal tissue core sufficient to be pathologically diagnosed was obtained. The histologic findings were as follows : IG A nephropathy (n = 2), lupus nephritis (n =2), minimal change glomerulonephritis (n = 5), membranoproliferative glomerulonephritis (n = 3), mesangialproliferative glomeru-lonephritis (n = 1), diffuse proliferative glomerulonephritis (n = 3), focalglomerulo-sclerosis (n = 1), membranous glomerulopathy (n = 1). No significant complications occurred during or after the biopsy. Sono-guided percutaneous renal biopsy using automated biopsy gun is also useful todiagnose renal parenchymal diseases without significant complications in pediatric patients

  9. Renal amyloidosis in a patient with X-linked agammaglobulinemia (Bruton's disease) and bronchiectasis.

    Science.gov (United States)

    Gonzalo-Garijo, M A; Sánchez-Vega, S; Pérez-Calderón, R; Pérez-Rangel, I; Corrales-Vargas, S; Fernández de Mera, J J; Robles, R

    2014-01-01

    We present a patient with Bruton's disease and bronchiectasis who developed renal AA amyloidosis. A 38 year-old man was diagnosed with X-linked agammaglobulinemia (Bruton's disease) when he was 3 years old, and he has been treated with parenteral immunoglobulin since then. Eighteen years later, he was diagnosed with central pulmonary bronchiectasis by computerized tomography (CT). In 2008, he gradually developed anemia, edema of lower limbs, and loss of weight. Laboratory studies revealed deterioration of renal function, normocytic normochromic anemia and nephrotic range proteinuria. Hepatitis B and C and HIV serology were negative. Ultrasound and CT of abdomen were normal. A renal biopsy revealed deposits with positive PAS and Congo red staining in glomeruli, interstitium, and vessel's walls. Immunohistochemistry showed positive staining of the A amyloid. Direct immunofluorescence was positive with thioflavin and showed focal and glomerular mesangial IgG deposits, suggesting renal AA amyloidosis. For 2 years the patient conducted pharmacological treatment and follow-up for the Nephrology department with poor prognosis and progression of renal function impairment. In January 2011 he began dialysis treatment with improvement, and he is currently on the waiting list for renal transplantation. We present a patient with Bruton's disease and bronchiectasis who developed renal AA amyloidosis a finding rarely reported.

  10. Castleman Disease in the Kidney and Retroperitoneum Mimicking Renal Cell Carcinoma with Retroperitoneal Lymphadenopathy: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Ko, Hee Sun; Woo, Ji Young; Hong, Hye Suk; Jung, Ah Young; Yang, Ik; Lee, Yul [Dept. of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul (Korea, Republic of)

    2012-09-15

    Castleman disease, or angiofollicular lymph node hyperplasia, is a fairly rare benign tumor of lymphoid origin with unknown etiology. Castleman disease arises mostly in the mediastinum, and some cases of renal and retroperitoneal involvement have been reported. However, Castleman disease that simultaneously involves the kidney and regional lymph nodes has not been reported in radiologic literature. We report a case of renal and pararenal Castleman disease, mimicking renal cell carcinoma with retroperitoneal lymphadenopathy.

  11. The effect of bariatric surgery on renal function and disease: a focus on outcomes and inflammation.

    Science.gov (United States)

    Neff, Karl J; Frankel, Andrew H; Tam, Frederick W K; Sadlier, Denise M; Godson, Catherine; le Roux, Carel W

    2013-11-01

    Renal dysfunction and disease, including hyperfiltration, proteinuria and hypofiltration, are commonly associated with obesity. Diabetic kidney disease is also common in obese cohorts. Weight loss interventions, including bariatric surgery, can effectively reduce weight and improve renal outcomes. Some of this effect may be due to the remission of Type 2 diabetes and hypertension. However, other mechanisms, including the resolution of inflammatory processes, may also contribute. The effect of bariatric surgery on renal function has only recently become a focus of particular investigation. In this study, we will review the effects of bariatric surgery on obesity-associated kidney disease. We will discuss the pitfalls in assessing renal function in obese cohorts and will examine the effect of bariatric surgery on renal function and urinary protein excretion using different mechanisms. We will give particular attention to the evidence for bariatric surgery in cohorts with established renal disease and suggest future directions. In particular, we will outline the evidence for inflammation as an important therapeutic target, and the emerging medical therapies being considered to exploit this target in obesity- and diabetes-related kidney disease.

  12. How to differentiate renal senescence from chronic kidney disease in clinical practice.

    Science.gov (United States)

    Musso, Carlos G; Jauregui, Jose R

    2016-09-01

    Renal aging is frequently confused with chronic nephropathy in clinical practice, since there are some similarities between them, particularly regarding reduced glomerular filtration rate (GFR). However, there are many differences between these two entities which can help any practitioner to distinguish between them, such as: GFR deterioration rate, hematocrit, renal handling of urea, creatinine and some electrolytes, tubular acidification, urinalysis, and renal imaging. Differentiation between renal aging and chronic renal disease is crucial in order to avoid unnecessary medicalization of what is a physiological change associated with the healthy aging process, and the potential harmful consequences of such overdiagnosis. A recently described equation (HUGE), as well as an adequate nephrological evaluation and follow up can help physicians to distinguish both entities.

  13. Acute renal graft-versus-host disease in a murine model of allogeneic bone marrow transplantation.

    Science.gov (United States)

    Schmid, Peter M; Bouazzaoui, Abdellatif; Schmid, Karin; Birner, Christoph; Schach, Christian; Maier, Lars S; Holler, Ernst; Endemann, Dierk H

    2017-03-23

    Acute kidney injury (AKI) is a very common complication after allogeneic bone marrow transplantation (BMT) and associated with poor prognosis. Generally kidneys are assumed to be no direct target of Graft-versus-Host Disease (GvHD), and renal impairment is often attributed to several other factors occurring in the early phase after BMT. Our study aimed to prove the existence of renal GvHD in a fully MHC-mismatched model of BALB/c mice conditioned and transplanted according to two different intensity protocols. Syngeneically transplanted and untreated animals served as controls. 4 weeks after transplantation, allogeneic animals developed acute GvHD that was more pronounced in the high-intensity protocol (HIP) group than in the low-intensity protocol (LIP) group. Urea and creatinine as classic serum markers of renal function could not verify renal impairment 4 weeks after BMT. Creatinine levels were even reduced as a result of catabolic metabolism and loss of muscle mass due to acute GvHD. Proteinuria, albuminuria, and urinary N-acetyl-beta-Dglucosaminidase (NAG) levels were measured as additional renal markers before and after transplantation. Albuminuria and NAG were only significantly increased after allogeneic transplantation, correlating with disease severity between HIP and LIP animals. Histological investigations of the kidneys showed renal infiltration of T-cells and macrophages with endarteriitis, interstitial nephritis, tubulitis, and glomerulitis. T-cells consisted of CD4+, CD8+, and FoxP3+ cells. Renal expression analysis of allogeneic animals showed increases in indoleamine-2,3 dioxygenase (IDO), different cytokines (TNFα, IFN-γ, IL-1α, IL2, IL-6, and IL-10), and adhesion molecules (ICAM-1 and VCAM-1), resembling findings from other tissues in acute GvHD. In summary, our study supports the entity of renal GvHD with histological features suggestive of cell-mediated renal injury. Albuminuria and urinary NAG levels may serve as early markers of renal

  14. [Assessment of renal function in elderly after eighty years: Cockroft and Gault or Modification of diet in renal disease equation?].

    Science.gov (United States)

    Andro, M; Estivin, S; Comps, E; Gentric, A

    2011-11-01

    Assessment of renal function is essential in the management of hospitalised patients, particularly in geriatric practice. Impairment of renal function is common in the elderly, aged of 80 years and over, and should be taken into account before prescribing drugs eliminated through the kidneys or performing investigations requiring iodine injection. Renal failure is also a predictor of mortality. In clinical practice, creatinine-based equations are recommended to assess kidney function. The most widely used equations are the Cockroft and Gault (CG) and the simplified Modification of diet in renal disease (MDRD) formulas. The former estimates the clearance of creatinine in millilitres per minute, the latter estimates the glomerular filtration rate in millilitres per minute per 1.73 m(2). In 2002, the French high authority for health recommended the use of the CG formula, but no recommendation was given for the elderly. In the literature, no study has compared CG and MDRD formulas with a reference method in this very old population. In the octogenarians, two studies have compared these formulas with the creatinine clearance calculated on the basis of a 24-hour urine collection and four studies have compared the formulas head to head. All these studies showed that the results obtained with the MDRD formula are higher from 10 to 30 mL/min/1.73 m(2) than the results obtained with the CG formula. Studies simulating drug prescription showed that the use of the MDRD formula would lead to a risk of drug over dosage in 20 to 36% of the elderly. Also, two studies have suggested that only creatinine clearance measured by the CG formula is a predictor of mortality in the very old population. In conclusion, in the octogenarian, none of these two formulas is ideal. However, based on the results of studies targeted to this elderly population, the best solution seems to be the use of the CG formula expecting new methods of evaluation of renal function.

  15. Protective effects of genetic inhibition of Discoidin Domain Receptor 1 in experimental renal disease.

    Science.gov (United States)

    Kerroch, Monique; Alfieri, Carlo; Dorison, Aude; Boffa, Jean-Jacques; Chatziantoniou, Christos; Dussaule, Jean-Claude

    2016-02-16

    Chronic kidney disease is a progressive incurable pathology affecting millions of people. Intensive investigations aim to identify targets for therapy. We have previously demonstrated that abnormal expression of the Discoidin Domain Receptor 1 (DDR1) is a key factor of renal disease by promoting inflammation and fibrosis. The present study investigates whether blocking the expression of DDR1 after the initiation of renal disease can delay or arrest the progression of this pathology. Severe renal disease was induced by either injecting nephrotoxic serum (NTS) or performing unilateral ureteral obstruction in mice, and the expression of DDR1 was inhibited by administering antisense oligodeoxynucleotides either at 4 or 8 days after NTS (corresponding to early or more established phases of disease, respectively), or at day 2 after ligation. DDR1 antisense administration at day 4 stopped the increase of proteinuria and protected animals against the progression of glomeruloneprhitis, as evidenced by functional, structural and cellular indexes. Antisense administration at day 8 delayed progression -but to a smaller degree- of renal disease. Similar beneficial effects on renal structure and inflammation were observed with the antisense administration of DDR1 after ureteral ligation. Thus, targeting DDR1 can be a promising strategy in the treatment of chronic kidney disease.

  16. Derangements in phosphate metabolism in chronic kidney diseases/endstage renal disease: therapeutic considerations.

    Science.gov (United States)

    Molony, Donald A; Stephens, Brett W

    2011-03-01

    The changes in phosphate (PO(4)) metabolism across the spectrum of chronic kidney disease (CKD) and specific strategies to address these abnormalities by reducing PO(4) loads are discussed in this review. This review also addresses briefly the evidence for specific PO(4) serum targets in CKD and endstage renal disease (ESRD) and the potential for other biomarkers such as fibroblast growth factor-23 (FGF-23) to define disease and monitor the effectiveness of therapy. As renal function declines, single nephron excretion of PO(4) must increase to maintain PO(4) balance. Abnormalities in PO(4) metabolism occur early in CKD. Compensatory changes in renal PO(4) handling are sufficient to maintain a normal serum PO(4) level in early stages of CKD, but in more advanced CKD, these processes no longer suffice and overt hyperphosphatemia develops. The resulting increased PO(4) burden contributes directly to development of secondary hyperparathyroidism. The FGF-23 increases early in CKD, likely in response to abnormal PO(4) metabolism, and mediates processes that help restore serum PO(4) levels to normal in CKD stage 3 and in early stage 4. The increased PO(4) burden and subsequent overt hyperphosphatemia are associated with increased mortality and morbidity. Dietary PO(4) restriction, modification of dialysis prescriptions, and administration of oral PO(4) binders can restore PO(4) balance. As CKD progresses, population-based studies demonstrate that diet alone is typically not able to prevent or treat hyperphosphatemia. Dialysis modalities that are currently used often fail to remove sufficient PO(4) to prevent hyperphosphatemia in patients with an inadequately controlled dietary PO(4) load. This is particularly likely among patients without significant residual renal function. Thus, in the majority of ESRD patients, PO(4) binders remain the mainstay of therapy for hyperphosphatemia. All currently available PO(4) binders can restore serum PO(4) to the required level when

  17. Factors determining renal impairment in unilateral ureteral colic secondary to calcular disease: a prospective study.

    Science.gov (United States)

    Al-Ani, Ammar; Al-Jalham, Khaled; Ibrahim, Tarek; Majzoub, Ahmad; Al-Rayashi, Maged; Hayati, Ahmed; Mubarak, Walid; Al-Rayahi, Jehan; Khairy, Ahmed T

    2015-07-01

    To evaluate all possible risk factors that can cause impairment of overall renal function in patients with unilateral ureteral calculus and a normal contralateral kidney. This is a prospective study of 90 patients who presented to our institute complaining of renal colic secondary to unilateral ureteral calculus. All patients were evaluated with a thorough history, physical examination, and laboratory and radiological investigations including renal function testing, urine analysis, non-contrast computed topography, and radionucleotide scan. Patients were divided into two groups according to their calculated creatinine clearance using the Modification of Diet in Renal Disease (MDRD) formula. Group I (favorable group) had a creatinine clearance >60 ml/min, while group II (unfavorable group) had a creatinine clearance II included 36 patients (40 %). On univariate analysis, factors that were associated with overall renal function impairment were patients' age, urea-to-creatinine ratio (UCR), use of nonsteroidal anti-inflammatory drugs, stone location, and presence of obstruction. However, using binary logistic regression analysis, only patients' age, UCR, and presence of obstruction sustained statistical significance in association with renal function impairment. The study of factors that help explain the presence of renal impairment in patients with unilateral ureteral calculus is important in the clinical setting. Patients' age, urea-to-creatinine ratio, and degree of obstruction seem to be significantly associated with overall renal function impairment.

  18. Renal Impairment with Sublethal Tubular Cell Injury in a Chronic Liver Disease Mouse Model.

    Science.gov (United States)

    Ishida, Tokiko; Kotani, Hirokazu; Miyao, Masashi; Kawai, Chihiro; Jemail, Leila; Abiru, Hitoshi; Tamaki, Keiji

    2016-01-01

    The pathogenesis of renal impairment in chronic liver diseases (CLDs) has been primarily studied in the advanced stages of hepatic injury. Meanwhile, the pathology of renal impairment in the early phase of CLDs is poorly understood, and animal models to elucidate its mechanisms are needed. Thus, we investigated whether an existing mouse model of CLD induced by 3,5-diethoxycarbonyl-1,4-dihydrocollidine (DDC) shows renal impairment in the early phase. Renal injury markers, renal histology (including immunohistochemistry for tubular injury markers and transmission electron microscopy), autophagy, and oxidative stress were studied longitudinally in DDC- and standard diet-fed BALB/c mice. Slight but significant renal dysfunction was evident in DDC-fed mice from the early phase. Meanwhile, histological examinations of the kidneys with routine light microscopy did not show definitive morphological findings, and electron microscopic analyses were required to detect limited injuries such as loss of brush border microvilli and mitochondrial deformities. Limited injuries have been recently designated as sublethal tubular cell injury. As humans with renal impairment, either with or without CLD, often show almost normal tubules, sublethal injury has been of particular interest. In this study, the injuries were associated with mitochondrial aberrations and oxidative stress, a possible mechanism for sublethal injury. Intriguingly, two defense mechanisms were associated with this injury that prevent it from progressing to apparent cell death: autophagy and single-cell extrusion with regeneration. Furthermore, the renal impairment of this model progressed to chronic kidney disease with interstitial fibrosis after long-term DDC feeding. These findings indicated that DDC induces renal impairment with sublethal tubular cell injury from the early phase, leading to chronic kidney disease. Importantly, this CLD mouse model could be useful for studying the pathophysiological mechanisms of

  19. Renal Impairment with Sublethal Tubular Cell Injury in a Chronic Liver Disease Mouse Model.

    Directory of Open Access Journals (Sweden)

    Tokiko Ishida

    Full Text Available The pathogenesis of renal impairment in chronic liver diseases (CLDs has been primarily studied in the advanced stages of hepatic injury. Meanwhile, the pathology of renal impairment in the early phase of CLDs is poorly understood, and animal models to elucidate its mechanisms are needed. Thus, we investigated whether an existing mouse model of CLD induced by 3,5-diethoxycarbonyl-1,4-dihydrocollidine (DDC shows renal impairment in the early phase. Renal injury markers, renal histology (including immunohistochemistry for tubular injury markers and transmission electron microscopy, autophagy, and oxidative stress were studied longitudinally in DDC- and standard diet-fed BALB/c mice. Slight but significant renal dysfunction was evident in DDC-fed mice from the early phase. Meanwhile, histological examinations of the kidneys with routine light microscopy did not show definitive morphological findings, and electron microscopic analyses were required to detect limited injuries such as loss of brush border microvilli and mitochondrial deformities. Limited injuries have been recently designated as sublethal tubular cell injury. As humans with renal impairment, either with or without CLD, often show almost normal tubules, sublethal injury has been of particular interest. In this study, the injuries were associated with mitochondrial aberrations and oxidative stress, a possible mechanism for sublethal injury. Intriguingly, two defense mechanisms were associated with this injury that prevent it from progressing to apparent cell death: autophagy and single-cell extrusion with regeneration. Furthermore, the renal impairment of this model progressed to chronic kidney disease with interstitial fibrosis after long-term DDC feeding. These findings indicated that DDC induces renal impairment with sublethal tubular cell injury from the early phase, leading to chronic kidney disease. Importantly, this CLD mouse model could be useful for studying the

  20. Long-Term Health and Work Outcomes of Renal Transplantation and Patterns of Work Status During the End-Stage Renal Disease Trajectory

    NARCIS (Netherlands)

    van der Mei, Sijrike F.; Kuiper, Daphne; Groothoff, Johan W.; van den Heuvel, Wim J. A.; van Son, Willem J.; Brouwer, Sandra

    2011-01-01

    Introduction The aim of this study was to examine the health-and work outcomes of renal transplant recipients long-term after transplantation as well as the pattern of work status, work ability and disability benefits during the end-stage renal disease (ESRD) trajectory that precedes transplantation

  1. A Comparative Study of Sonographic Grading of Renal Parenchymal Changes and Estimated Glomerular Filtration Rate (eGFR) using Modified Diet in Renal Disease Formula

    Science.gov (United States)

    Shivalli, Siddharudha; Pai, B.H. Santhosh; Acharya, Koteshwara Devadasa; Gopalakrishnan, Ravichandra; Srikanth, Vivek; Reddy, Vishwanath; Haris, Arafat

    2016-01-01

    Introduction The sonographic findings are of help in evaluating the nephrological diseases. Glomerular filtration rate is another parameter for assessing the reserved renal function and an indicator of prognosis. In clinical practice GFR estimation (eGFR) is done by using a mathematical formula. In our study, we compared the sonographic grading of renal parenchymal changes with eGFR calculated using Modified Diet in Renal Diseases formula based on serum creatinine, age, gender and ethnicity. Aim To evaluate the relevance of sonographic grading of renal parenchymal changes in assessing the severity of the renal disease and comparing it to the eGFR calculated using MDRD formula based on the age, gender and serum creatinine value of the patient. Materials and Methods The adult patients with suspected kidney disease referred for sonography of abdomen were our study participants. As per our study design following strict inclusion and exclusion criteria, patients were selected as study participants and for each of the patient’s renal parenchymal status, serum creatinine, age, gender and ethnicity were documented. Results A total of 70 patients were our study participants, out of which 67.1% were males and 32.9% were females. Our study showed a linear correlation between sonographic grading of renal parenchymal changes with eGFR. Conclusion We conclude that by evaluating the kidneys with sonography and calculating eGFR using MDRD formula the renal status will be more accurately interpreted. PMID:27042555

  2. Dupplex doppler sonography in patients with medical renal diseases: correlation with clinical and histopathologic findings

    Energy Technology Data Exchange (ETDEWEB)

    Song, Soon Young; Koh, Byung Hee; Lee, Seung Chul; Bae, Jae Ik; Kim, Yong Soo; Rhim, Hyun Chul; Cho, On Koo; Park, Chan Hyun; Park, Moon Hyang [Hanyang Univ. College of Medicine, Seoul (Korea, Republic of)

    1997-11-01

    To compare the RI (resistive index) of renal artery with serum creatinine level and histological change in 50 patients with renal parenchymal disease. To measure RI in each patient, Doppler studies were performed three times in each kidney at the level of the interlobar arteries, and the average value of RI was taken. The study was performed 1 -3 days after renal biopsy and the time interval between blood sampling for serum creatinine and duplex study was also 1 - 3 days. The RI of patients with renal disease was also correlated with patient's age, sex and serum creatinine level, and RI was also correlated with the degree of severity of glomerular, interstitial, and vascular change in the kidneys. Statistical analysis was performed using Student's t test and Pearson's correlation method. The RI of the normal control and renal disease group was 0.566{+-}0.037 and 0.584{+-}0.038, respectively with no statistical significance(p=0.444). In the group with renal disease, there was no significant correlation between RI and a patient's age, sex, and serum creatinine level(p>0.05). RI was not significantly different between predominantly glomerular disease (n=45) and nonglomerular or mixed disease(n=5)(p=0.558), and did not correlate with the severity of glomerular sclerosis, interstitial fibrosis, or atherosclerosis(p>0.05). The authors conclude that RI is not helpful for the diagnosis and differential diagnosis of renal parenchymal diseases and does not correlate with serum creatinine levels. In order to define the role of the RI, further clinical experience with more cases is required.

  3. A Case of Pulmonary-Renal Syndrome Leading to the Diagnosis of Legionnaires' Disease.

    Science.gov (United States)

    Sabani, Erasmia; Sarafidis, Pantelis A; Lazaridis, Antonios; Kouloukourgiotou, Theodora; Stylianou, Konstantinos; Pantzaki, Afroditi; Papagianni, Aikaterini; Efstratiadis, Georgios

    2016-01-01

    We report a case of a 51-year-old Caucasian man referred at our department due to acute renal failure (ARF) complicating respiratory failure during hospitalization in a regional hospital. The patient was previously started on steroids due to the suspicion of rapidly progressive glomerulonephritis (RPGN) in the context of Goodpasture syndrome. However, clinical and laboratory findings did not support this diagnosis; instead a careful evaluation limited differential diagnosis of the renal insult to acute tubular necrosis or acute interstitial nephritis (AIN) following respiratory infection. With lung function fully improved but renal function not recovering, a renal biopsy revealed AIN, a finding leading to further diagnostic testing and finally to the diagnosis of Legionnaires' disease as a cause of this patient's pulmonary-renal syndrome. The management consisted of progressive tapering of oral steroids associated with full recovery of the patient's renal function. This is a rare case of Legionnaires' disease causing immune-mediated AIN and highlights the possibility of Legionella infection as a cause of pulmonary-renal syndrome.

  4. A Case of Pulmonary-Renal Syndrome Leading to the Diagnosis of Legionnaires’ Disease

    Directory of Open Access Journals (Sweden)

    Erasmia Sabani

    2016-01-01

    Full Text Available We report a case of a 51-year-old Caucasian man referred at our department due to acute renal failure (ARF complicating respiratory failure during hospitalization in a regional hospital. The patient was previously started on steroids due to the suspicion of rapidly progressive glomerulonephritis (RPGN in the context of Goodpasture syndrome. However, clinical and laboratory findings did not support this diagnosis; instead a careful evaluation limited differential diagnosis of the renal insult to acute tubular necrosis or acute interstitial nephritis (AIN following respiratory infection. With lung function fully improved but renal function not recovering, a renal biopsy revealed AIN, a finding leading to further diagnostic testing and finally to the diagnosis of Legionnaires’ disease as a cause of this patient’s pulmonary-renal syndrome. The management consisted of progressive tapering of oral steroids associated with full recovery of the patient’s renal function. This is a rare case of Legionnaires’ disease causing immune-mediated AIN and highlights the possibility of Legionella infection as a cause of pulmonary-renal syndrome.

  5. Usefulness of resistive index on spectral Doppler ultrasonography in the detection of renal cell carcinoma in patients with end-stage renal disease

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sang Youn; Woo, Sung Min; Cho, Jeong Yeon; Kim, Seung Hyup [Dept. of Radiology, Seoul National University Hospital, Seoul (Korea, Republic of); Hwang, Sung Il; Lee, Hak Jong [Dept. of Radiology, Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Moon, Min Hoan; Sung, Chang Kyu [Dept. of adiology, Seoul National University Boramae Hospital, Seoul (Korea, Republic of)

    2014-04-15

    The aim of this study was to explore the usefulness of the resistive index (RI) on spectral Doppler ultrasonography (US) in the detection of renal cell carcinoma (RCC) in patients with end-stage renal disease (ESRD). Seventeen ESRD patients with kidneys in which renal masses were suspected in routine US were subjected. They underwent computed tomography scans and additional Doppler US for the characterization of the detected lesions. All underwent radical nephrectomy with the suspicion of RCC. Fourteen patients finally were included. RI measurements were conducted in the region of the suspected renal mass and the background renal parenchyma. The intra class correlation coefficient was used to assess the reproducibility of the RI measurement. A paired t-test was used to compare the RI values between the renal mass and the background renal parenchyma (P<0.05). The RI values measured at the RCCs were significantly lower than those measured at the background renal parenchyma (0.41-0.65 vs. 0.75-0.89; P<0.001). The intrareader reproducibility proved to be excellent and good for the renal masses and the parenchyma, respectively (P<0.001). RI on spectral Doppler US is useful in detecting RCC in patients with ESRD. The RI values measured at the RCCs were significantly lower than those measured at the background renal parenchyma.

  6. Malignant pleural mesothelioma with associated minimal change disease and acute renal failure.

    Science.gov (United States)

    Li, Jordan Y Z; Yong, Tuck Y; Kuss, Bryone J; Klebe, Sonja; Kotasek, Dusan; Barbara, Jeffrey A J

    2010-01-01

    Paraneoplastic manifestations in malignant pleural mesothelioma are rare. We report a case of malignant pleural mesothelioma associated with minimal change disease (MCD). A 58-year-old man with occupational exposure to asbestos presented with severe peripheral edema, heavy proteinuria, and acute renal failure shortly after the diagnosis of mesothelioma had been confirmed. The renal biopsy demonstrated MCD. The underlying pathogenesis of this association remains unknown.

  7. Renal Cell Protection of Erythropoietin beyond Correcting The Anemia in Chronic Kidney Disease Patients

    OpenAIRE

    Hamid Nasri

    2013-01-01

    Currently many patients with chronic renal failure have profited from the use of erythropoietin to correct anemia (1,2). In chronic kidney disease, anemia is believed to be a surrogate index for tissue hypoxia that continues preexisting renal tissue injury (1-3). Erythropoietin is an essential glycoprotein that accelerates red blood cell maturation from erythroid progenitors and facilitates erythropoiesis. It is a 30.4 kD glycoprotein and class I cytokine containing 165 amino acids (3,4). App...

  8. Dialysis Free Protocol for Some End Stage Renal Disease Patients (Khosroshahi Protocol)

    OpenAIRE

    Hamid Tayebi Khosroshahi; Kamyar Kalantar-zadeh

    2012-01-01

    Background: The number of patients with End Stage Renal Disease (ESRD) is growing annually around the world. Provision of renal replacement therapy in the form of dialysis and transplant is relatively expensive. Recent studies have shown no survival benefit of early initiation of dialysis. Given recent outcome data of the timing of dialysis treatment and the expenses and logistics of hemodialysis procedure have stimulated research on alternative strategies. The aim of this study is to int...

  9. [Autosomal-recessive renal cystic disease and congenital hepatic fibrosis: clinico-anatomic case].

    Science.gov (United States)

    Rostol'tsev, K V; Burenkov, R A; Kuz'micheva, I A

    2012-01-01

    Clinico-anatomic observation of autosomal-recessive renal cystic disease and congenital hepatic fibrosis at two fetuses from the same family was done. Mutation of His3124Tyr in 58 exon of PKHD1 gene in heterozygous state was found out. The same pathomorphological changes in the epithelium of cystic renal tubules and bile ducts of the liver were noted. We suggest that the autopsy research of fetuses with congenital abnormalities, detected after prenatal ultrasonic screening, has high diagnostic importance.

  10. Health beliefs and quality of life in end - stage renal disease

    OpenAIRE

    2011-01-01

    Background: Patients’ beliefs regarding their health are important to understand responses to chronicdisease.Objective: The present study aimed (i) to determine whether beliefs about health differ betweendifferent renal replacement therapies in End-Stage Renal Disease (ESRD) patients and (ii) to examinewhether these beliefs are associated with health related quality of life (HQoL) as well as mental health.Methodology: A sample of 89 ESRD patients, 41 in haemodialysis (HD) treatment and 48 inp...

  11. End-stage renal disease in Tabuk Area, Saudi Arabia: An epidemiological study

    OpenAIRE

    Osama El Minshawy; Tawfik Ghabrah; Eman El Bassuoni

    2014-01-01

    The purpose of this study was to determine the prevalence, etiology and risk fac-tors of treated end-stage renal disease (ESRD) in the region of Tabuk, Saudi Arabia. We studied 460 renal replacement therapy patients through a review of medical records and patient interviews and obtained patient demographics, family history, risk factors for ESRD, environmental exposure to toxins, work conditions, social history and causes of death. The estimated prevalence of treated ESRD was 460 per million ...

  12. Integrin β4 in EMT: an implication of renal diseases.

    Science.gov (United States)

    Wang, Qi; Wang, Yan; Huang, Xiaoyan; Liang, Wei; Xiong, Zibo; Xiong, Zuying

    2015-01-01

    Renal fibrosis is a main cause of chronic renal failure. Epithelial-to-mesenchymal transition (EMT) markers play a role in renal fibrosis. Transforming growth factor-β1 (TGF-β1) has been shown to initiate and complete the whole EMT process. It is now well accepted that loss of E-cadherin, EMT marker α-SMA, and connective tissue growth factor (CTGF) expression are key events in the EMT process. We found that by stimulating human renal proximal tubular epithelial (HK-2) cells with TGF-β1, the expression of E-cadherin was down regulated and the expression of α-SMA and CTGF were up regulated in a dose dependent manner. In our present study we also found that integrin β4 and peroxisome proliferators-activated receptor-γ (PPAR-γ) play roles in EMT process, with TGF-β1 stimulation increasing integrin β4 expression in HK2 cells. Integrin β4 and PPARγ were detected in tubulointerstitial tissues, immunohistochemistry analysis showed enhanced expression of integrin β4 in early stage, with over-expression at later stage. In contrast, the expression of PPARγ showed little increased in early stage, but was dramatically decreased at later stage. This is consistent with TGF-β1 inducing EMT. Our immune-precipitation studies show that integrin β4 disassociation with PPARγ is present in E-cadherin signaling. It suggests that PPARγ has a role in EMT inhibition.

  13. Determinants and prevalence of depression in patients with chronic renal disease, and their caregivers

    Directory of Open Access Journals (Sweden)

    Hawamdeh S

    2017-07-01

    Full Text Available Sana Hawamdeh, Aljawharah Mohammed Almari, Asrar Salem Almutairi, Wireen Leila T Dator College of Nursing, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia Introduction: This study explored the prevalence of depression among the patients with chronic kidney disease and their caregivers and its association to their demographic profile.Methods: A descriptive, correlational, cross-sectional study that used the Hamilton rating scale tool to assess the prevalence of depression among 226 patients undergoing hemodialysis and 105 of their caregivers in a hospital in Saudi Arabia.Results: Patients with chronic renal disease and their caregivers experience depression at varying levels. Depression was positively associated with the socioeconomic and marital status of the patients. Socioeconomic status of the caregivers was seen to be associated with their depression.Conclusion: Depression is highly prevalent among patients with chronic renal disease and their caregivers. Keywords: caregivers, chronic renal disease, depression

  14. 77. Ultrasonography assessment of congenital renal anomalies in children with congenital heart diseases

    Directory of Open Access Journals (Sweden)

    M.H. Hamadah

    2016-07-01

    Full Text Available Ultrasound (US assessment of renal anomalies in children requiring pediatric cardiac surgery is not a standard practice. This study aimed to study the role of bedside US performed by intensivists to detect occult renal anomalies associated with congenital heart disease (CHD. Prospective descriptive study for 100 consecutive children with CHD admitted to Pediatric Cardiac Intensive Care Unit (PCICU from Januarry 1st, 2015 through June, July 2015. Ultrasound of kidneys was performed initially by trained pediatric cardiac intensivists to ascertain the presence of both kidneys in renal fossae and to check for gross kidney anomalies. After screening of 100 consecutive children with CHD with renal US, we identified in 94 cases (94% normal right and left kidney in the standard sonographer shape in the renal fossae. In 6 cases further investigation revealed ectopic kidney in 3 patients (50%, solitary functional kidney in 2 patients (33.4% and bilateral grade IV hydronephrosis in one patient (16.6%. Urinary tract infection developed peri-operatively in 66% of the cases with kidney anomalies. No significant renal impairment was noted in these patients post-surgery. We observed no specific association between the type of renal anomaly and specific CHD. Renal US in children with CHD demonstrated prevalence of associated congenital renal anomalies in 6% of children undergoing cardiac surgery. The presence of occult kidney anomalies did not impact the kidney function or the short term outcome after cardiac repair except for an increased risk of urosepsis. Performing renal US should be a standard practice in all children with CHD.

  15. Pregnancy in End Stage Renal Disease Patients, Treatment with Hemodialysis: A Case Report

    Directory of Open Access Journals (Sweden)

    Savaş SİPAHİ

    2012-01-01

    Full Text Available Occasionally, pregnancy can occur in patients receiving hemodialysis due to chronic kidney disease. Despite successful pregnancies reported in the literature, high complication rates and progression of renal disease can be observed. Major risk factors are maternal age, type of renal disease, dialysis prior to pregnancy, age at the time of dialysis, dialysis modality, hemoglobin, blood urea nitrogen, creatinine levels during pregnancy and dialysis dose. Improvements in dialysis technology and patient follow-up and multidisciplinary approach in the last years have lead to higher rates of fertilisation and succesful pregnancies with live births.

  16. The Putative Role of the Antiageing Protein Klotho in Cardiovascular and Renal Disease

    Directory of Open Access Journals (Sweden)

    Giuseppe Maltese

    2012-01-01

    Full Text Available Ageing is a multifactorial process often characterized by a progressive decline in physiological function(s. Ageing can and is often associated with an increased incidence of cardiovascular and renal disease. Klotho is a novel antiageing gene that encodes a protein with multiple pleiotropic functions including an emerging role in cardiorenal disease. Mice deficient for this gene display a phenotype of premature human ageing characterized by diffuse vascular calcification, altered calcium/phosphate metabolism, and shortened lifespan. Klotho is mainly expressed in the renal tubules but it also exists as circulating soluble form detectable in the blood, with systemic effects. Reduction in soluble Klotho has been associated with renal disease, hyperphosphataemia, increased oxidative stress, endothelial dysfunction, and diffuse vascular calcification. Conversely, overexpression of Klotho promotes cardiovascular-renal protection. The majority of the research on Klotho has been conducted in vitro and in animal studies but there is emerging data from human studies which suggest that Klotho may be a modifiable factor involved in the pathogenesis of cardiovascular and renal disease in at-risk populations. Further data is required to confirm if this novel protein can emerge as therapeutic tool that may be used to prevent or slow progression of cardiorenal disease.

  17. Disease progression in pre-dialysis patients : renal function, symptoms, and health-related quality of life

    NARCIS (Netherlands)

    Goeij, Moniek Cornelia Maria de

    2013-01-01

    This thesis investigated the effect of several risk factors on objectively assessed disease progression (renal function decline and time until the start of renal replacement therapy) and subjectively assessed disease progression (disease-related symptoms and health-related quality of life) in patien

  18. Costos de intervenciones para pacientes con insuficiencia renal crónica Costs of intervention for patients with chronic renal disease

    Directory of Open Access Journals (Sweden)

    Armando Arredondo

    1998-06-01

    ças resultam significativas para o desenho e avaliação de padrões de designação de recursos.INTRODUCTION: The results of a study which identified the cost of health interventions in the management of patients with chronic renal disease are presented. MATERIAL AND METHOD: The costing method was based on a consensus technique and the instrumentation of case management through the identification of the materials used and functions of production for the demand of each service solicited. The interventions included: peritoneal dialysis, hemodialysis, and renal transplant. RESULTS: The cost per event in U.S. dollars was $3.71, $57.95, and $8,778.32, respectively. The annual cost of case management was: Peritoneal Dialysis $5,643.07, Hemodialysis $9,631.60 and renal transplant $3,021.67. CONCLUSIONS: The information generated from the costs of the events differed considerably from the information that was generated by the annual cost of case management. These differences are significant for the design and evaluation of patterns for allocating resources.

  19. Prognostic Indicators of Renal Disease Progression in Adults with Fabry Disease: Natural History Data from the Fabry Registry

    NARCIS (Netherlands)

    C. Wanner; J.P. Oliveira; A. Ortiz; M. Mauer; D.P. Germain; G.E. Linthorst; A.L. Serra; L. Marodi; R. Mignani; B. Cianciaruso; B. Vujkovac; R. Lemay; D. Beitner-Johnson; S. Waldek; D.G. Warnock

    2010-01-01

    Background and objectives: These analyses were designed to characterize renal disease progression in untreated adults with Fabry disease. Design, setting, participants, & measurements: Data from the Fabry Registry for 462 untreated adults (121 men and 341 women) who had at least two estimated GFR (e

  20. Doença renal ateroembólica: uma causa de insuficiência renal aguda pouco explorada Atheroembolic renal disease: a cause of acute renal failure not much explored

    Directory of Open Access Journals (Sweden)

    Claus Dieter Dummer

    2010-01-01

    Full Text Available O ateroembolismo é uma doença multisistêmica que afeta vários órgãos, entre os quais o rim, através da liberação de êmbolos de colesterol de uma placa aterosclerótica erosada, ocasionando obstrução vascular em diversos tecidos. A doença renal ateroembólica (DRAE, histologicamente representada por cristais de colesterol nas arteríolas do rim acompanhados de um infiltrado inflamatório perivascular, é causa de insuficiência renal aguda muitas vezes grave e prolongada, que ocorre semanas ou mesmo meses após o episódio embólico. A DRAE apresesenta prognóstico ruim com elevada mortalidade. Apresentamos neste relato o caso de um paciente com DRAE que se manifestou clinicamente dois meses após a realização de um cateterismo cardíaco seguido de uma angioplastia coronária. A prevalência, manifestações clínicas, histologia renal, tratamento e o prognóstico da DRAE são discutidos.Atheroembolism is a multisytemic disease which affects many organs, including the kidneys, by the release of cholesterol emboli to tissues from an erosed atherosclerotic plaque, causing vascular obstruction in many tissues. The atheroembolic renal disease (AERD is histologically represented by cholesterol crystals in renal arterioles with an inflammatory infiltrate around the vessels, and causes acute renal failure that may be severe and prolonged, weeks or even months after the embolic episode. The AERD carries a bad prognosis, with a high mortality. We herein report a case of a patient presenting AERD which was manifested two months after he was submitted to a cardiac catheterism and coronary angioplasty. The prevalence, clinical findings, renal histology, treatment and prognosis of AERD are discussed.

  1. Circadian sleep-wake rhythm disturbances in end-stage renal disease

    NARCIS (Netherlands)

    Koch, B.C.P.; Nagtegaal, J.E.; Kerkhof, G.A.; ter Wee, P.M.

    2009-01-01

    End-stage renal disease (ESRD) is an increasing health problem worldwide. Given the increasing prevalence of this disease, the high cost of hemodialysis treatment and the burden of hemodialysis on a patient's life, more research on improving the clinical outcomes and the quality of life of hemodialy

  2. Marriage and End-Stage Renal Disease: Implications for African Americans

    Science.gov (United States)

    Shortridge, Emily F.; James, Cara V.

    2010-01-01

    African Americans are disproportionately represented among patients with end-stage renal disease (ESRD). ESRD is managed with a strict routine that might include regular dialysis as well as dietary, fluid intake, and other lifestyle changes. In a disease such as this, with such disruptive treatment modalities, marriage, specifically, and its ties…

  3. End-stage renal disease due to delayed diagnosis of renal tuberculosis: a fatal case report

    Directory of Open Access Journals (Sweden)

    Elizabeth De Francesco Daher

    Full Text Available Renal TB is difficult to diagnose, because many patients present themselves with lower urinary symptoms which are typical of bacterial cystitis. We report a case of a young woman with renal TB and ESRD. She was admitted with complaints of adynamia, anorexia, fever, weight loss, dysuria and generalized edema for 10 months. At physical examination she was febrile (39ºC, and her abdomen had increased volume and was painful at palpation. Laboratorial tests showed serum urea=220mg/dL, creatinine=6.6mg/dL, hemoglobin=7.9g/dL, hematocrit=24.3%, leukocytes=33,600/mm³ and platelets=664,000/mm³. Urinalysis showed an acid urine (pH=5.0, leukocyturia (2+/4+ and mild proteinuria (1+/4+. She was also oliguric (urinary volume <400mL/day. Abdominal echography showed thick and contracted bladder walls and heterogeneous liquid collection in the left pelvic region. Two laparotomies were performed, in which abscess in pelvic region was found. Anti-peritoneal tuberculosis treatment with rifampin, isoniazid and pyrazinamide was started. During the follow-up, the urine culture was found to be positive for M. tuberculosis. Six months later the patient had complaints of abdominal pain and dysuria. New laboratorial tests showed serum urea=187mg/dL, creatinine=8.0mg/dL, potassium=6.5mEq/L. Hemodialysis was then started. The CT scan showed signs of chronic nephropathy, dilated calyces and thinning of renal cortex in both kidneys and severe dilation of ureter. The patient developed neurologic symptoms, suggesting tuberculous meningoencephalitis, and died despite of support measures adopted. The patient had ESRD due to secondary uropathy to prolonged tuberculosis of urinary tract that was caused by delayed clinical and laboratorial diagnosis, and probably also due to inadequate antituberculous drugs administration.

  4. TREATMENT OF RENAL STONES WITH PERCUTANEOUS NEPHROLITHOTOMY IMPROVES RENAL FUNCTIONS IN CHRONIC KIDNEY DISEASE PATIENTS

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    Ekrem Akdeniz

    2016-01-01

    Full Text Available Objective:In this study, we aimed to investigate the impact of percutaneous nephrolitotomy on kidney functions in stage III or higher chronic renal failure patients using glomerular filtration rate and serum creatinine level. Material and Method:Between 2010 and 2014, percutaneous nephrolithotomy was applied to patients who had glomerular filtration rate below 60 mL/min/1.73m2. Pre-operative demographic features, stone burden and localization, urine analysis and microbial test, serum creatinine level, direct urinary system graphy, and spiral non-enhanced computerized tomography were obtained. Intraoperative renal unit counts, anesthesia and surgery time, and X-ray exposure time were calculated. Early and late post-operative complications, hospitalization time, stone-free rate, and glomerular function rate were evaluated, retrospectively. Findings:Pre-operatively, mean creatinine value was 2,42±0.76 mg/dL, mean glomerular filtration rate was 45.3±13mL/min/1.73m2, mean stone burden was 393±40 mm², mean intervention time was 79±34 min and 12 patients were stone free (70.5%. Decrease of hemoglobin 1,6 g/dL and transfusion was done only two patients (11.8% due to excessive bleeding. In early and long term follow-up, mean creatinine values and glomerular filtration rate were 1.98±0.72mg/dL, 2.16±0.78mL/dL and 54.1±14 mL/min/1.73m2and 51.8±15 mL/min/1.73m2, respectively. Comparison of pre-operative and post-operative creatinine and glomerular filtration rates revealed significant decrease in creatinine level and increase in glomerular filtration rate. Results:Percutaneous nephrolithotomy which eliminates urinary obstruction is safely used in the treatment of kidney stones with minimal damage on kidney functions. Stage III or higher renal failure patients who have obstructive kidney stones or recurrent urinary tract infections can effectively be treated and this may help patients to prevent progression to end-stage renal failure.

  5. Cell therapy in renal and cardiovascular disease Terapia celular en enfermedades renales y cardiovasculares

    Directory of Open Access Journals (Sweden)

    Juan Manuel Senior Sánchez

    2006-01-01

    Full Text Available Although there have been important advances in the field of molecular biology, the mechanisms responsible for nephrogenesis and the factors that modulate the process of development, proliferation, growth, and maturation during fetal and adult life have not been thoroughly explained. Animals, including mammals, share the intrinsic ability to regenerate tissues and organs as an important biological defense mechanism. In the case of the kidney, after tissue damage secondary to injury, anatomical and functional recovery of integrity is achieved, accompanied by the activation of a complex, poorly understood process, leading to the replacement of damaged tubular cells by functional ones that reorganize tubular architecture. This regeneration and repair process is produced by somatic, exogenous, adult stem cells, and probably by intrinsic renal stem cells, that are responsible for maintaining renal homeostasis Aunque se han logrado grandes avances en el campo de la biología molecular, todavía no se han esclarecido completamente los mecanismos responsables de la organogénesis y los factores que modulan el proceso de desarrollo, proliferación, crecimiento y maduración celulares durante la vida fetal y adulta. Los animales comparten la capacidad de regenerar tejidos y órganos, como un mecanismo biológico importante de defensa. En el caso del riñón, luego del daño tisular secundario a una noxa, se produce recuperación anatómica y funcional de la integridad, acompañada por la activación de un proceso sofisticado, mal comprendido, que lleva al reemplazo de las células tubulares dañadas por otras funcionalmente normales que reorganizan la arquitectura tubular. Este fenómeno de recambio se produce gracias a la presencia de células madre adultas somáticas exógenas, responsables del proceso de mantenimiento de la homeostasis renal, y posiblemente por células renales intrínsecas.

  6. Vitamin-K-Dependent Protection of the Renal Microvasculature: Histopathological Studies in Normal and Diseased Kidneys

    Science.gov (United States)

    Wei, Fang-Fei; Drummen, Nadja E.A.; Thijs, Lutgarde; Jacobs, Lotte; Herfs, Marjolein; van't Hoofd, Cynthia; Vermeer, Cees; Staessen, Jan A.

    2016-01-01

    Vitamin-K-dependent carboxylation of matrix Gla protein (MGP) protects the macrocirculation against calcification. We recently reported in a multiethnic population study that the estimated glomerular filtration rate, a microvascular trait, decreased and the risk of chronic kidney disease increased with higher circulating levels of inactive dephospho-uncarboxylated MGP, a marker of vitamin K deficiency. These findings highlighted the possibility that vitamin K might have a beneficial effect on the renal microcirculation. To substantiate these epidemiological findings, we undertook a pilot study, in which we stained renal tissue samples obtained by biopsy from 2 healthy kidney donors and 4 patients with nephropathy for carboxylated and uncarboxylated MGP and calcium deposits. Three patients had renal calcifications, which were consistently associated with carboxylated and uncarboxylated MGP. Normal renal tissue was devoid of microcalcifications and staining for carboxylated and uncarboxylated MGP. Pending confirmation in a larger study covering a wider range of renal pathologies, these histopathological findings suggest that MGP might inhibit calcification not only in large arteries, as was known before, but in renal tissue as well, thereby highlighting potentially new avenues for promoting renal health, for instance by vitamin K supplementation.

  7. Renal disease in human immunodeficiency virus - Not just HIV-associated nephropathy.

    Science.gov (United States)

    Vali, P S; Ismal, K; Gowrishankar, S; Sahay, M

    2012-03-01

    The aim of the study was to determine the various histopathological lesions in human immunodeficiency virus (HIV) patients with renal dysfunction and to establish clinicopathological correlation. Over a period of two years from January 2008 to March 2010, 27 HIV positive patients with renal dysfunction were subjected to renal biopsy. Of the 27 patients, 23 were males and four were females (85.2% males, 14.8% females). Mean age was 38.2 ± 10.36 (range 20 - 60) years. The probable mode of acquisition of HIV infection was sexual in 22 patients (81.5%). Thirteen patients (48%) had nephrotic proteinuria. The CD4 count ranged from 77 to 633/microliter. The kidneys were of normal size in 19 (70.4%) and bulky in eight (29.6%) patients. Thirteen patients required renal replacement therapy. Eleven patients had acute tubule-interstitial lesions (40.7%) while 15 (55.5%) had glomerular lesions. The various glomerular lesions were, focal segmental glomerulosclerosis in five, amyloidosis in three, diffuse proliferative GN in two, and membranoproliferative glomerulonephritis (GN), membranous GN, minimal change disease, diabetic nephropathy, crescentic GN, and thrombotic microangiopathy were seen in one each. None of the clinical or laboratory variables, except hypertension, was found to predict glomerular versus non-glomerular lesions on biopsy. In conclusion we show that a variety of glomerular and tubulointerstitial lesions can be seen on renal histology. Hence, renal biopsy is indicated in renal dysfunction associated with HIV for making proper diagnosis and therapy.

  8. Renal transplantation in systemic lupus erythematosus: Comparison of graft survival with other causes of end-stage renal disease.

    Science.gov (United States)

    Horta-Baas, Gabriel; Camargo-Coronel, Adolfo; Miranda-Hernández, Dafhne Guadalupe; Gónzalez-Parra, Leslie Gabriela; Romero-Figueroa, María Del Socorro; Pérez-Cristóbal, Mario

    2017-08-14

    End-stage renal disease (ESRD) due to lupus nephritis (LN) occurs in 10%-30% of patients. Initially systemic lupus erythematosus (SLE) was a contraindication for kidney transplantation (KT). Today, long-term graft survival remains controversial. Our objective was to compare the survival after KT in patients with SLE or other causes of ESRD. All SLE patients who had undergone KT in a retrospective cohort were included. Renal graft survival was compared with that of 50 controls, matched for age, sex, and year of transplantation. Survival was evaluated by the Kaplan-Meier test and the Cox proportional hazards model. Twenty-five subjects with SLE were included. The estimated 1-year, 2- and 5-year survival rates for patients with SLE were 92%, 66% and 66%. Renal graft survival did not differ between patients with SLE and other causes of ESRD (P=.39). The multivariate analysis showed no significant difference in graft survival between the two groups (hazard ratio, HR=1.95, 95% confidence interval [CI] 0.57-6.61, P=.28). The recurrence rate of LN was 8% and was not associated with graft loss. Acute rejection was the only variable associated with graft loss in patients with SLE (HR=16.5, 95% CI 1.94-140.1, P=.01). Renal graft survival in SLE patients did not differ from that reported for other causes of ESRD. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  9. Oxidative Balance Score and the Risk of End-Stage Renal Disease and Cardiovascular Disease.

    Science.gov (United States)

    Ilori, Titilayo O; Wang, Xiao; Huang, Morong; Gutierrez, Orlando M; Narayan, K M Venkat; Goodman, Michael; McClellan, William; Plantinga, Laura; Ojo, Akinlolu O

    2017-01-01

    Oxidative balance score (OBS) is a composite measure of oxidative stress-related exposures. The aim of this study was to investigate the association between OBS, end-stage renal disease (ESRD), and cardiovascular disease (CVD). Using data from the Chronic Renal Insufficiency Cohort, we calculated the main exposure OBS by summing up 12 apriori-defined pro- and antioxidant factors obtained from the diet history questionnaire and lifestyle assessment. We divided OBS into quartiles (Q1-Q4), with Q1 (predominance of pro-oxidants) as the reference. We analyzed OBS quartiles as an ordinal variable. Crude and adjusted hazards ratios (HRs) and 95% CIs were estimated using Cox proportional hazards models for time to ESRD and CVD. Compared to Q1, Q4 (high antioxidant) was associated with ESRD in the crude model (HR 1.35, 95% CI 1.08-1.69) and adjusting for age, sex, and race (HR 1.36, 95% CI 1.09-1.71) but not in the fully adjusted model (HR 1.12, 95% CI 0.84-1.51). HR of ESRD increased as the OBS quartiles increased in the crude model (ptrend < 0.05) but not in the fully adjusted model (ptrend = 0.30). Compared to Q1, Q4 was associated with CVD in the crude (HR 1.33, 95% CI 1.06-1.68) but not adjusted models. The HR of CVD increased with an increase in OBS quartiles in the crude model (ptrend < 0.05). The reverse association between OBS and progression to ESRD suggests that perhaps the effect of oxidative balance-related exposure is different in the setting of established chronic kidney disease. © 2017 S. Karger AG, Basel.

  10. Risk Factors for Severe Renal Disease in Bardet-Biedl Syndrome.

    Science.gov (United States)

    Forsythe, Elizabeth; Sparks, Kathryn; Best, Sunayna; Borrows, Sarah; Hoskins, Bethan; Sabir, Ataf; Barrett, Timothy; Williams, Denise; Mohammed, Shehla; Goldsmith, David; Milford, David V; Bockenhauer, Detlef; Foggensteiner, Lukas; Beales, Philip L

    2017-03-01

    Bardet-Biedl syndrome is a rare autosomal recessive, multisystem disease characterized by retinal dystrophy, renal malformation, obesity, intellectual disability, polydactyly, and hypogonadism. Nineteen disease-causing genes (BBS1-19) have been identified, of which mutations in BBS1 are most common in North America and Europe. A hallmark of the disease, renal malformation is heterogeneous and is a cause of morbidity and mortality through the development of CKD. We studied the prevalence and severity of CKD in 350 patients with Bardet-Biedl syndrome-related renal disease attending the United Kingdom national Bardet-Biedl syndrome clinics to further elucidate the phenotype and identify risk indicators of CKD. Overall, 31% of children and 42% of adults had CKD; 6% of children and 8% of adults had stage 4-5 CKD. In children, renal disease was often detected within the first year of life. Analysis of the most commonly mutated disease-associated genes revealed that, compared with two truncating mutations, two missense mutations associated with less severe CKD in adults. Moreover, compared with mutations in BBS10, mutations in BBS1 associated with less severe CKD or lack of CKD in adults. Finally, 51% of patients with available ultrasounds had structural renal abnormalities, and 35% of adults were hypertensive. The presence of structural abnormalities or antihypertensive medication also correlated statistically with stage 3b-5 CKD. This study describes the largest reported cohort of patients with renal disease in Bardet-Biedl syndrome and identifies risk factors to be considered in genetic counseling.

  11. Etiology of End-Stage Renal Disease and Arterial Stiffness among Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Balsam El Ghoul

    2017-01-01

    Full Text Available Background. Prior studies have demonstrated that conventional and emerging CV risk factors are associated with worsening arterial stiffness among end-stage renal disease (ESRD patients on hemodialysis. The present cross-sectional study evaluates the association between the etiology of ESRD and arterial stiffness among a cohort of hemodialysis patients. Methods. Etiology of ESRD was identified from patients’ medical records and classified as either vascular renal disease, diabetic nephropathy, nondiabetic glomerulopathy, tubular interstitial nephropathy, hereditary nephropathy, or ESRD of unconfirmed etiology. Results. A total of 82 subjects were enrolled. cfPWV was independently associated with the composite of either diabetic nephropathy or vascular renal disease (p=0.022, pulse pressure (p=0.001, and a history of CV events (p=0.025, but not history of hypertension or diabetes mellitus alone. The median cfPWVs in diabetic nephropathy and vascular renal disease were comparable and significantly higher than median cfPWVs in other etiologies of ESRD. Conclusion. The study suggests that the etiology of ESRD is independently associated with arterial stiffness among hemodialysis patients. Furthermore, arterial stiffness was higher among patients who developed renal sequelae of either diabetes mellitus or hypertension as compared with those who have a history of either diabetes mellitus or hypertension alone.

  12. Why and how to measure renal function in patients with liver disease.

    Science.gov (United States)

    Piano, Salvatore; Romano, Antonietta; Di Pascoli, Marco; Angeli, Paolo

    2017-01-01

    Patients with advanced liver disease frequently have impaired renal function. Both acute kidney injury (AKI) and chronic kidney disease (CKD) are quite common in patients with cirrhosis and both are associated with a worse prognosis in these patients. A careful assessment of renal function is highly important in these patients to help physicians determine their diagnosis, prognosis and therapeutic management and to define transplantation strategies (liver transplantation alone vs simultaneous liver and kidney transplantation). Although they are still widely used in clinical practice, conventional biomarkers of renal function such as serum creatinine have several limitations in these patients. Recent progress has been made in the evaluation of renal function and new diagnostic criteria for AKI have been proposed. However, certain issues such as the noninvasive assessment of the glomerular filtration rate and/or improvement in the differential diagnosis between hepatorenal syndrome and acute tubular necrosis must still be addressed. The purposes of this paper are: (i) to highlight the importance of the evaluation of renal function in patients with cirrhosis; (ii) to review the state of the art in the assessment of renal function in these patients as well as advances that we expect will be made to improve the accuracy of available tools. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  13. Disease activity in systemic lupus erythematosus patients with end-stage renal disease: systematic review of the literature.

    Science.gov (United States)

    Mattos, Patrícia; Santiago, Mittermayer B

    2012-06-01

    It is not unusual that patients with systemic lupus erythematosus (SLE) progress to terminal renal failure and subsequently require renal replacement therapy. Previous studies have shown that clinical and/or serological remission in patients with SLE is common in those who develop end-stage renal disease (ESRD). On the other hand, the persistence of lupus activity among patients undergoing long-term dialysis is not rare, either. The aim of this study is to define, by means of a systematic review, the course of SLE activity in patients who developed ESRD. Data were obtained through searches for articles in the MEDLINE (1966 to 2011), SCielo, and LILACS databases, using the following keywords: "chronic renal failure", "systemic lupus erythematosus", "end-stage renal disease", "lupus activity", "disease activity", "lupus flare", "hemodialysis", and "renal replacement therapy" and their corresponding translations in Portuguese. Twenty-four articles were found which evaluated the degree of lupus activity in patients with ESRD. Fifteen of these studies spoke of a substantial reduction of clinical and/or serological activity after the development of ESRD, while nine articles found that the amount of clinical and/or serological activity was similar to that of the phase prior to terminal renal failure, or it occurred in at least 50% of the patients studied. Although the majority of studies showed that lupus flares tend to decrease in frequency in patients who develop ESRD, in this scenario, one should be prepared to correctly diagnose a recurrence of the disease, as well as to perform appropriate therapy.

  14. Intensified Multifactorial Intervention in Type 2 Diabetes and Microalbuminuria Reduces End Stage Renal Disease and Mortality

    DEFF Research Database (Denmark)

    Oellgaard, Jens; Gæde, Peter; Rossing, Peter

    2016-01-01

    Center for Basic Metabolic research. Background: Despite declining rates of late diabetic complications in other organ systems, renal complication rates do not decline to the same extent according to epidemiological studies. The objective was to describe renal outcomes over 21.2 years in patients...... with type 2 diabetes and microalbuminuria and the influence of an intensified, multifactorial treatment regimen. Methods: 160 patients with type 2 diabetes and microalbuminuria assigned to conventional or intensified multifactorial intervention targeting multiple risk factors in a prospective, open...... treatment for 8 years in type 2 diabetes patients with microalbuminuria slows long-term progression in nephropathy and loss of renal function and reduces the risk of end stage renal disease and the mortality rate....

  15. Determinants of renal tissue hypoxia in a rat model of polycystic kidney disease.

    Science.gov (United States)

    Ow, Connie P C; Abdelkader, Amany; Hilliard, Lucinda M; Phillips, Jacqueline K; Evans, Roger G

    2014-11-15

    Renal tissue oxygen tension (PO2) and its determinants have not been quantified in polycystic kidney disease (PKD). Therefore, we measured kidney tissue PO2 in the Lewis rat model of PKD (LPK) and in Lewis control rats. We also determined the relative contributions of altered renal oxygen delivery and consumption to renal tissue hypoxia in LPK rats. PO2 of the superficial cortex of 11- to 13-wk-old LPK rats, measured by Clark electrode with the rat under anesthesia, was higher within the cysts (32.8 ± 4.0 mmHg) than the superficial cortical parenchyma (18.3 ± 3.5 mmHg). PO2 in the superficial cortical parenchyma of Lewis rats was 2.5-fold greater (46.0 ± 3.1 mmHg) than in LPK rats. At each depth below the cortical surface, tissue PO2 in LPK rats was approximately half that in Lewis rats. Renal blood flow was 60% less in LPK than in Lewis rats, and arterial hemoglobin concentration was 57% less, so renal oxygen delivery was 78% less. Renal venous PO2 was 38% less in LPK than Lewis rats. Sodium reabsorption was 98% less in LPK than Lewis rats, but renal oxygen consumption did not significantly differ between the two groups. Thus, in this model of PKD, kidney tissue is severely hypoxic, at least partly because of deficient renal oxygen delivery. Nevertheless, the observation of similar renal oxygen consumption, despite markedly less sodium reabsorption, in the kidneys of LPK compared with Lewis rats, indicates the presence of inappropriately high oxygen consumption in the polycystic kidney.

  16. The effect of outpatient dialysis global budget cap on healthcare utilization by end-stage renal disease patients.

    Science.gov (United States)

    Chang, Ray-E; Hsieh, Chi-Jeng; Myrtle, Robert C

    2011-07-01

    Controlling the cost of chronic diseases remains one of the vexing problems of developed and developing nations alike. Taiwan, faced with rapidly escalating healthcare costs associated with End Stage Renal Disease (ESRD) services utilization, imposed an outpatient dialysis global budget (ODBG) on outpatient dialysis care. This study, using a before and after study design with a comparison group, assessed the impact of this policy innovation on outpatient, inpatient and emergency room utilization. Using a difference in difference (DID) strategy and the generalized estimating equation (GEE) approach, this study found providers responded to these changes through cost reduction and revenue enhancement strategies. This study extends our understanding of provider responses to changes in reimbursement policies that target one segment of the continuum of care required by chronic disease patients.

  17. Sensorineural Hearing Affection In Sickle Cell Disease Patients With Chronic Renal Failure Under Dialysis

    Directory of Open Access Journals (Sweden)

    Saeed Abdelwhab Saeed MD*, Magdy M El Sharkawy

    2002-09-01

    Full Text Available Objective: to study the problem of hearing loss in patients of chronic renal failure on regular haemodialysis and The factors which affect it. And to study the effect of sickle cell disease on hearing loss. we studied hearing loss in dialysis patients, sickle cell disease patients and patients of sickle cell disease with chronic renal failure under dialysis compared to normal control subjects. Design: !"",include sickle cell disease patients with chronic renal fa"# $%& ' ", i ,nclude ( # #"# $%&'", , ,( #&'", i 9nclude the normal *+&*+' All groups are subjected to full history, thorough clinical examination including neurological and ENT examination, investigations includes Hb, s. creatinine, s.albumen, s.calcium and calculation of kt/v for dialysis patients. Full audiological assessment, using #,-GSI audiometer was done for all groups with special concentration at frequency of - .Results: hearing loss was found in patients with chronic renal failure more than normal control. Patient with sickle cell disease have hearing disorders significantly higher than $/%- .% 0( # #cell disease have significantly. Marked degree of SNHL than those with SCD only. Hearing loss in patients with 12( # * 3 &4 !4! '#"#"patients with chronic renal failure with or without SCD correlate with duration of dialysis , presence of peripheral neuropathy, s. calcium level, efficiency of dialysis marked by kt/v. Conclusion and recommendation: hearing disorder is common in patients with chronic renal failure under regular haemodialysis and it increase with duration of dialysis it should be suspected if there is Peripheral neuropathy. It can be reduced with efficient dialysis, correction of anemia, adjustment of calcium level. Patients with SCD suffer also some degree of hearing loss especially at higher frequency and this degree of hearing loss

  18. Increased Blood Pressure Variability Prior to Chronic Kidney Disease Exacerbates Renal Dysfunction in Rats

    Directory of Open Access Journals (Sweden)

    Frederico Felipe Costa Tebas Freitas

    2016-09-01

    Full Text Available Increased blood pressure variability (BPV, which can be experimentally induced by sinoaortic denervation (SAD, has emerged as a new marker of the prognosis of cardiovascular and renal outcomes. Considering that increased BPV can lead to organ-damage, the goal of the present study was to evaluate the effects of SAD on renal function in an experimental model of chronic kidney disease (CKD. SAD was performed in male Wistar rats 2 weeks before 5/6 nephrectomy and the animals were evaluated 4 weeks after the induction of CKD. Our data demonstrated that BPV was increased in SAD and CKD animals and that the combination of both conditions (SAD+CKD exacerbated BPV. The baroreflex sensitivity index was diminished in the SAD and CKD groups; this reduction was more pronounced when SAD and CKD were performed together. 5/6 nephrectomy led to hypertension, which was higher in SAD+CKD animals. Regarding renal function, the combination of SAD and CKD resulted in reduced renal plasma and blood flow, increased renal vascular resistance and augmented uraemia when compared to CKD animals. Glomerular filtration rate and BPV were negatively correlated in SAD, CKD and SAD+CKD animals. Moreover, SAD+CKD animals presented a higher level of glomerulosclerosis when compared to all other groups. Cardiac and renal hypertrophy, as well as oxidative stress, was also further increased when SAD and CKD were combined. These results show that SAD prior to 5/6 nephrectomy exacerbates renal dysfunction, suggesting that previous augmented BPV should be considered as an important factor to the progression of renal diseases.

  19. Increased Blood Pressure Variability Prior to Chronic Kidney Disease Exacerbates Renal Dysfunction in Rats

    Science.gov (United States)

    Freitas, Frederico F. C. T.; Araujo, Gilberto; Porto, Marcella L.; Freitas, Flavia P. S.; Graceli, Jones B.; Balarini, Camille M.; Vasquez, Elisardo C.; Meyrelles, Silvana S.; Gava, Agata L.

    2016-01-01

    Increased blood pressure variability (BPV), which can be experimentally induced by sinoaortic denervation (SAD), has emerged as a new marker of the prognosis of cardiovascular and renal outcomes. Considering that increased BPV can lead to organ-damage, the goal of the present study was to evaluate the effects of SAD on renal function in an experimental model of chronic kidney disease (CKD). SAD was performed in male Wistar rats 2 weeks before 5/6 nephrectomy and the animals were evaluated 4 weeks after the induction of CKD. Our data demonstrated that BPV was increased in SAD and CKD animals and that the combination of both conditions (SAD+CKD) exacerbated BPV. The baroreflex sensitivity index was diminished in the SAD and CKD groups; this reduction was more pronounced when SAD and CKD were performed together. 5/6 nephrectomy led to hypertension, which was higher in SAD+CKD animals. Regarding renal function, the combination of SAD and CKD resulted in reduced renal plasma and blood flow, increased renal vascular resistance and augmented uraemia when compared to CKD animals. Glomerular filtration rate and BPV were negatively correlated in SAD, CKD, and SAD+CKD animals. Moreover, SAD+CKD animals presented a higher level of glomerulosclerosis when compared to all other groups. Cardiac and renal hypertrophy, as well as oxidative stress, was also further increased when SAD and CKD were combined. These results show that SAD prior to 5/6 nephrectomy exacerbates renal dysfunction, suggesting that previous augmented BPV should be considered as an important factor to the progression of renal diseases. PMID:27721797

  20. The Gomez' equations and renal hemodynamic function in kidney disease research.

    Science.gov (United States)

    Bjornstad, Petter; Škrtić, Marko; Lytvyn, Yuliya; Maahs, David M; Johnson, Richard J; Cherney, David Z I

    2016-09-07

    Diabetic kidney disease (DKD) remains the leading cause of end-stage renal disease. A major challenge in preventing DKD is the difficulty in identifying high-risk patients at an early, pre-clinical stage. Albuminuria and eGFR as measures of renal function in DKD research and clinical practice are limited by regression of one-third of patients with microalbuminuria to normoalbuminuria and eGFR is biased and imprecise in the normal-elevated range. Moreover, existing methods that are used to assess renal function do not give detailed insight into the location of the renal hemodynamic effects of pharmacological agents at the segmental level. To gain additional information about the intrarenal circulation in-vivo in humans, mathematical equations were developed by Gomez et al in the 1950s. These equations used measurements of GFR, renal blood flow (RBF), effective renal plasma flow (ERPF), renal vascular resistance (RVR), hematocrit and serum protein to calculate afferent and efferent arteriolar resistances, glomerular hydrostatic pressure and filtration pressure. Although indirect and based on physiological assumptions, these techniques have the potential to improve researchers' ability to identify early pre-clinical changes in renal hemodynamic function in patients with a variety of conditions including DKD, thereby offering tremendous potential in mechanistic human research studies. In this review, we focus on the application of Gomez' equations and summarize the potential and limitations of this technique in DKD research. We also summarize illustrative data derived from Gomez' equations in patients with type 1 (T1D) and type 2 diabetes (T2D) and hypertension.

  1. Renal Osteodystrophy

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    Aynur Metin Terzibaşoğlu

    2004-12-01

    Full Text Available Chronic renal insufficiency is a functional definition which is characterized by irreversible and progressive decreasing in renal functions. This impairment is in collaboration with glomeruler filtration rate and serum creatinine levels. Besides this, different grades of bone metabolism disorders develop in chronic renal insufficiency. Pathologic changes in bone tissue due to loss of renal paranchyme is interrelated with calcium, phosphorus vitamine-D and parathyroid hormone. Clinically we can see high turnover bone disease, low turnover bone disease, osteomalacia, osteosclerosis and osteoporosis in renal osteodystropy. In this article we aimed to review pathology of bone metabolism disorders due to chronic renal insufficiency, clinic aspects and treatment approaches briefly.

  2. The Healthy Start Renal Clinic: Benefits of Tracking and Early Intervention in Pre-End Stage Renal Disease Patients

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    Self, Ida; Lindberg, Jill; Filangeri, Judith; Anderson, Shannon; Szerlip, Marjorie; Best, Julie; Sadler, Rebecca; Savoie, Judy; Jackson, Dina; James, Carla; Husserl, Fred; Copely, J. Brian

    1999-01-01

    Several studies have demonstrated a strong association between the benefits of pre-end stage renal disease (ESRD) education and decreased length of hospital stay (LOS) and hospital charges, delay of renal replacement therapy (RRT), and a smooth transition to RRT. The Ochsner Healthy Start Renal Clinic (HSRC) is a multidisciplinary early education and tracking program for pre-ESRD patients and their families. We identified and educated pre-ESRD patients about kidney disease, allowing them to discuss and make informed decisions about their treatment and be better prepared to cope with the transition to RRT and the changes in their lives resulting from kidney failure. HSRC patients demonstrated a significant decrease in length of hospital stay (p = 0.05), a trend towards decreased hospital episodes and charges, decreased use of temporary venous access, and a smooth transition to RRT. The control group was made up of patients who had either refused the structured education or had been referred to HSRC late and received only conventional instruction by a social worker at the point where dialysis was imminent. We compared the number of episodes of hospitalization, LOS, and overall hospital charges for the period immediately surrounding initiation of chronic dialysis (2 months before and 1 month following onset) of all 36 patients who began chronic hemodialysis in our facility between November 1997 and November 1998. HSRC patients had LOS half as long (p=0.05), fewer hospital episodes, and hospital charges of $5,000 less per patient than the non-HSRC group. Initial data strongly suggest that early education and intervention through the coordination of a multidisciplinary team maximize the continuity of patient care. PMID:21845139

  3. Renal function assessment in atrial fibrillation: Usefulness of chronic kidney disease epidemiology collaboration vs reexpressed 4 variable modification of diet in renal disease

    Institute of Scientific and Technical Information of China (English)

    Rami; Riziq-Yousef; Abumuaileq; Emad; Abu-Assi; Andrea; López-López; Sergio; Raposeiras-Roubin; Moisés; RodríguezMa?ero; Luis; Martínez-Sande; Francisco; Javier; García-Seara; Xesus; Alberte; Fernandez-López; Jose; Ramón; GonzálezJuanatey

    2015-01-01

    AIM: To compare the performance of the re-expressed Modification of Diet in Renal Disease equation vs the new Chronic Kidney Disease Epidemiology Collaboration equation in patients with non-valvular atrial fibrillation.METHODS: We studied 911 consecutive patients with non-valvular atrial fibrillation on vitamin-K antagonist. The performance of the re-expressed Modification of Diet in Renal Disease equation vs the new Chronic Kidney Disease Epidemiology Collaboration equation in patients with non-valvular atrial fibrillation with respect to either a composite endpoint of major bleeding, thromboembolic events and all-cause mortality or each individual component of the composite endpoint was assessed using continuous and categorical ≥ 60, 59-30, and < 30 m L/min per 1.73 m2 estimated glomerular filtration rate.RESULTS: During 10 ± 3 mo, the composite endpoint occurred in 98(10.8%) patients: 30 patients developed major bleeding, 18 had thromboembolic events, and 60 died. The new equation provided lower prevalence of renal dysfunction < 60 m L/min per 1.73 m2(32.9%),compared with the re-expressed equation(34.1%). Estimated glomerular filtration rate from both equations was independent predictor of composite endpoint(HR = 0.98 and 0.97 for the re-expressed and the new equation, respectively; P < 0.0001) and all-cause mortality(HR = 0.98 for both equations, P < 0.01). Strong association with thromboembolic events was observed only when estimated glomerular filtration rate was < 30 m L/min per 1.73 m2: HR is 5.1 for the re-expressed equation, and HR = 5.0 for the new equation. No significant association with major bleeding was observed for both equations.CONCLUSION: The new equation reduced the prevalence of renal dysfunction. Both equations performed similarly in predicting major adverse outcomes.

  4. Chronic renal disease in a captive two-toed sloth (Choloepus didactylus) with concurrent hepatocellular carcinoma.

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    Salas, Elisa; Wolf, Tiffany; Harris, Seth

    2014-06-01

    A 13-yr-old female two-toed sloth (Choloepus didactylus) with a prolonged history of worsening azotemia was necropsied shortly after euthanasia. On necropsy, the sloth had poor body condition, bilaterally shrunken kidneys, and a large neoplastic mass replacing the right liver lobe. Histologic examination demonstrated chronic renal disease with metastatic mineralization as the cause of morbidity. The liver mass was not associated with any known clinical signs and was diagnosed as a solitary and well-differentiated hepatocellular carcinoma. To the authors' knowledge, this is the first report of hepatocellular carcinoma diagnosed in a sloth and the first detailed description of chronic renal disease in this species.

  5. Cardiovascular disease in patients with renal disease: the role of statins.

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    Fellström, Bengt; Holdaas, Hallvard; Jardine, Alan G; Svensson, Maria K; Gottlow, Mattis; Schmieder, Roland E; Zannad, Faiez

    2009-01-01

    Atherosclerosis is common in patients with chronic kidney disease (CKD), and cardiovascular disease (CVD) represents a major cause of death. The National Kidney Foundation guidelines favour the use of statin therapy for treatment of dyslipidaemia in patients with CKD. Much evidence supports statin therapy for reducing CVD and improving outcomes in the general population, but there is less evidence in patients with CKD. Consequently, prevention of CVD in CKD is based primarily on extrapolation from non-CKD trials. Significantly, in trials specifically designed to investigate patients with CKD, evidence is emerging for improved cardiovascular outcomes with statin therapy. This review describes available data relating to cardiovascular outcomes and the role of statins in patients with CKD, including pre-dialysis, dialysis, and renal transplant patients. The PubMed database was searched (1998-present) to ensure comprehensive identification of publications (including randomised clinical trials) relevant to CKD patients, patterns of cardiovascular outcome in such patients and their relationship to lipid profile, and the role of statins for the prevention and treatment of cardiovascular complications. There are conflicting data on the relationship between dyslipidaemia and cardiovascular outcomes, with one major study of statin therapy (4D--Deutsche Diabetes Dialyse Studie) providing equivocal results. Further studies, including AURORA (A study to evaluate the Use of Rosuvastatin in subjects On Regular haemodialysis: an Assessment of survival and cardiovascular events; NCT00240331) in patients receiving haemodialysis, and SHARP (Study of Heart And Renal Protection; NCT00125593) in patients with CKD including those on dialysis, should help to clarify the role of statin therapy in these populations. More studies are needed to elucidate the role of statins in improving cardiovascular outcomes for CKD patients. It is anticipated that ongoing clinical trials geared towards the

  6. Retrospective review of bone mineral metabolism management in end-stage renal disease patients wait-listed for renal transplant

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    Chavlovski A

    2012-09-01

    Full Text Available Anna Chavlovski,1 Greg A Knoll,1–3 Timothy Ramsay,4 Swapnil Hiremath,1–3 Deborah L Zimmerman1–31University of Ottawa, 2Ottawa Hospital, 3Kidney Research Centre, Ottawa Hospital Research Institute, 4Ottawa Methods Centre, Ottawa, ON, CanadaBackground: In patients with end-stage renal disease, use of vitamin D and calcium-based phosphate binders have been associated with progression of vascular calcification that might have an impact on renal transplant candidacy. Our objective was to examine management of mineral metabolism in patients wait-listed for renal transplant and to determine the impact on cardiac perfusion imaging.Methods: Data was collected retrospectively on patients wait-listed for a renal transplant (n = 105, being either active (n = 73 and on hold (n = 32. Demographic data, medications, serum concentrations of calcium, phosphate, parathyroid hormone, and cardiac perfusion imaging studies were collected from the electronic health record. Chi-square and Student’s t-tests were used to compare active and on-hold patients as appropriate. Logistic regression was used to examine variables associated with worsening cardiac imaging studies.Results: The wait-listed patients were of mean age 56 ± 14 years and had been on dialysis for 1329 ± 867 days. On-hold patients had received a significantly greater total dose of calcium (2.35 ± .94 kg versus 1.49 ± 1.52 kg; P = 0.02 and were more likely to have developed worsening cardiovascular imaging studies (P = 0.03. Total doses of calcium and calcitriol were associated with worsening cardiovascular imaging studies (P = 0.05.Conclusion: Patients on hold on the renal transplant waiting list received higher total doses of calcium. A higher total dose of calcium and calcitriol was also associated with worsening cardiovascular imaging. Time on dialysis before transplant has been associated with worse post-transplant outcomes, and it is possible that the total calcium and calcitriol dose

  7. Efficacy and complications of ultrasound-guided percutaneous renal biopsy using 18 G automatic biopsy gun in diffuse renal disease: Analysis of 203 cases

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    Gwon, Dong Il; Lee, Kang Hoon; Song, Kyung Sup; An, Suk Joo; Son, Sang Bum; Kim, Hyeon Suk [The Catholic University of Korea, St. Paul' s Hospital, Seoul (Korea, Republic of); Kim, Jee Young; Kim, Won Young; Park, Young Ha [The Catholic University of Korea, St. Vincent' s Hospital, Suwon (Korea, Republic of)

    2000-12-15

    To evaluate the efficacy and complications of ultrasound-guided percutaneous renal biopsy using 18G automatic biopsy gun in patients with diffuse renal disease. 203 ultrasound-guided renal biopsies using 18G automatic biopsy gun were performed in 197 patients for the diagnosis of diffuse renal disease. The success and complication rates were retrospectively evaluated by analysis of pathologic and clinical records and post-procedure ultrasonograms of the patients. Out of 203 renal biopsies, adequate tissues for pathologic diagnosis were obtained in 184 (90.6%) biopsies. The mean number of needle passes was 2.08, and the mean number of retrieved glomeruli was 7.71 {+-} 4.23. Minor complications occurred in seven biopsies (3.45%) including asymptomatic macroscopic hematuria in five (2.45%) and small subcapsular hematomas in two (1%). No patients required transfusion or surgery because of biopsy-related complication. Ultrasound-guided percutaneous renal biopsy using 18G automatic biopsy gun was an effective method for the pathologic diagnosis of diffuse renal disease and safe with low complication rate related to the procedure.

  8. A Case of Immunotactoid Glomerulopathy with Rapid Progression to End-Stage Renal Disease

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    Shikha Jain

    2009-01-01

    Full Text Available Immunotactoid glomerulopathy (IGN is a rare immunoglobulin deposition disease. It is often mistaken for cryoglobulinemia or amyloidosis due to the similarities on biopsy findings. The disease progresses to end-stage renal disease (ESRD within 7 months to 10 years. This is the first case reported of a patient with a diagnosis of IGN who developed acute kidney injury (AKI and ESRD within 1 week of initial presentation.

  9. Dietary Energy Density, Renal Function, and Progression of Chronic Kidney Disease

    OpenAIRE

    2016-01-01

    Background. There is evidence of the association between dietary energy density and chronic diseases. However, no report exists regarding the relation between DED and chronic kidney disease (CKD). Objective. To examine the association between dietary energy density (DED), renal function, and progression of chronic kidney disease (CKD). Design. Cross-sectional. Setting. Three nephrology clinics. Subjects. Two hundred twenty-one subjects with diagnosed CKD. Main Outcome Measure. Dietary intake ...

  10. Personalized Medicine: New Perspectives for the Diagnosis and the Treatment of Renal Diseases

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    Anna Gluba-Brzózka

    2017-06-01

    Full Text Available The prevalence of renal diseases is rising and reaching 5–15% of the adult population. Renal damage is associated with disturbances of body homeostasis and the loss of equilibrium between exogenous and endogenous elements including drugs and metabolites. Studies indicate that renal diseases are influenced not only by environmental but also by genetic factors. In some cases the disease is caused by mutation in a single gene and at that time severity depends on the presence of one or two mutated alleles. In other cases, renal disease is associated with the presence of alteration within a gene or genes, but environmental factors are also necessary for the development of disease. Therefore, it seems that the analysis of genetic aspects should be a natural component of clinical and experimental studies. The goal of personalized medicine is to determine the right drug, for the right patient, at the right time. Whole-genome examinations may help to change the approach to the disease and the patient resulting in the creation of “personalized medicine” with new diagnostic and treatment strategies designed on the basis of genetic background of each individual. The identification of high-risk patients in pharmacogenomics analyses will help to avoid many unwarranted side effects while optimizing treatment efficacy for individual patients. Personalized therapies for kidney diseases are still at the preliminary stage mainly due to high costs of such analyses and the complex nature of human genome. This review will focus on several areas of interest: renal disease pathogenesis, diagnosis, treatment, rate of progression and the prediction of prognosis.

  11. (131)I treatment in Differentiated Thyroid Cancer and End-Stage Renal Disease.

    Science.gov (United States)

    Ortega, A J M; Vázquez, R G; Cuenca, J I C; Brocca, M A M; Castilla, J; Martínez, J M M; González, E N

    2016-01-01

    Radioiodine (RAI) is a cornerstone in the treatment of Differentiated Thyroid Cancer (DTC). In patients on haemodialysis due to End-Stage Renal Disease (ESRD), it must be used cautiously, considering the renal clearance of this radionuclide. Also, the safety of the procedure and subsequent long-term outcome is still not well defined. In 2001, we described a dosimetric method and short-term results in three patients, with a good safety profile. We hypothesize that our method is safe in a long-term scenario without compromising the prognosis of both renal and thyroid disease. Descriptive-retrospective study. A systematic search was carried out using our clinical database from 2000 to 2014. DTC and radioiodine treatment while on haemodialysis. peritoneal dialysis. Final sample n=9 patients (n=5 males), age 48 years (median age 51 years males, 67 years female group); n=8 papillary thyroid cancer, n=1 follicular thyroid cancer; n=5 lymph node invasion; n=1 metastatic disease. Median RAI dose administered on haemodialysis 100mCi. 7.5 years after radioiodine treatment on haemodialysis, n=7 deemed free of thyroid disease, n=1 persistent non-localised disease. No complications related to the procedure or other target organs were registered. After 3.25 years, n=4 patients underwent successful renal transplantation; n=4 patients did not meet transplantation criteria due to other conditions unrelated to the thyroid disease or its treatment. One patient died due to ischemic cardiomyopathy (free of thyroid disease). Radioiodine treatment during haemodialysis is a long-term, safe procedure without worsening prognosis of either renal or thyroid disease. Copyright © 2015 Elsevier España, S.L.U. and SEMNIM. All rights reserved.

  12. Can we routinely measure patient involvement in treatment decision-making in chronic kidney care? A service evaluation in 27 renal units in the UK.

    Science.gov (United States)

    Durand, Marie-Anne; Bekker, Hilary L; Casula, Anna; Elias, Robert; Ferraro, Alastair; Lloyd, Amy; van der Veer, Sabine N; Metcalfe, Wendy; Mooney, Andrew; Thomson, Richard G; Tomson, Charles R V

    2016-04-01

    Shared decision making is considered an important aspect of chronic disease management. We explored the feasibility of routinely measuring kidney patients' involvement in making decisions about renal replacement therapy (RRT) in National Health Service settings. We disseminated a 17-item paper questionnaire on involvement in decision-making among adult patients with established kidney failure who made a decision about RRT in the previous 90 days (Phase 1) and patients who had been receiving RRT for 90-180 days (Phase 2). Recruitment rates were calculated as the ratio between the number of included and expected eligible patients (I : E ratio). We assessed our sample's representativeness by comparing demographics between participants and incident patients in the UK Renal Registry. Three hundred and five (Phase 1) and 187 (Phase 2) patients were included. For Phase 1, the I : E ratio was 0.44 (range, 0.08-2.80) compared with 0.27 (range, 0.04-1.05) in Phase 2. Study participants were more likely to be white compared with incident RRT patients (88 versus 77%; P measurement of patient involvement in established kidney disease treatment decisions is feasible, but there are challenges in selecting the measure needed to capture experience of involvement, reducing variation in response rate by service and identifying when to capture experience in a service managing people's chronic disease over time.

  13. Relationship between Renal Artery Stenosis and Severity of Coronary Artery Disease in Patients with Coronary Atherosclerotic Disease

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    Amirfarhang Zandparsa

    2012-09-01

    Full Text Available Objective: The aim of the present investigation was to explore probable association of renal artery stenosis (RAS with coronary artery disease (CAD and the prevalence of renal artery stenosis (RAS in patients with CAD. Patients and methods: This study comprised 165 consecutive patients with CAD, including 52.7% males and 47.2% females with respective mean ages of 60.3 ±8.9 and 59.5±10.1. The patients underwent simultaneous coronary and renal angiographies, and the lumen reduction of 50% or more was considered as significant stenosis. Indeed, stenosis of more than 70% of the arterial lumen was regarded as severe. Results: According to our findings, the prevalence of renal artery stenosis in our hypertensive and normotensive patients were 46.2% and 19.5% respectively (p=0.002. Renal artery angiography revealed that 64 (38.8% of the patients had simultaneous renal artery stenosis. RAS is more common in females than males (p=0.031. Multivariate analysis revealed that among all examined factors, hypertension and serum creatinine were associated with RAS. There was no correlations found between gensini score and RAS (p=0.63. Conclusion: We found a relatively high prevalence of RAS including 46.2% in hypertensive and 19.5% in normotensive patients in our patients with CAD.

  14. Early Stage of Chronic Kidney Disease with Renal Injury Caused by Hypertension in a Dog

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    Akira Yabuki

    2011-01-01

    Full Text Available A 10-year-old spayed female Papillon weighing 4.0 kg presented with a history of persistent hematuria and pollakiuria. Concurrent bladder calculi, a mammary gland tumor, and nonazotemic early stage of chronic kidney disease with contracted kidneys were noted in this dog. The dog underwent cystectomy, unilateral mastectomy, and intraoperative renal biopsy. On the basis of histopathological analysis of renal biopsy results, it was suspected that renal injury of the dog was caused by persistent hypertension, and a follow-up examination revealed severe hypertension. The dog was treated with a combination of an angiotensin-converting enzyme inhibitor and calcium channel blocker. The treatment produced a good outcome in the dog, and there has been no progression of the chronic kidney disease for over 2 years.

  15. Renal histology in two adult patients with type I glycogen storage disease.

    Science.gov (United States)

    Obara, K; Saito, T; Sato, H; Ogawa, M; Igarashi, Y; Yoshinaga, K

    1993-02-01

    Two adult patients with type I glycogen storage disease (I-GSD) had chronic renal disease with heavy proteinuria. Renal biopsies showed focal glomerular sclerosis, interstitial fibrosis, tubular atrophy or vacuolation, and prominent arteriosclerosis. Marked glomerular hypertrophy was demonstrated histometrically. Oil red O staining in one patient revealed numerous lipid deposits in the glomerular mesangium, tubular epithelial cells and interstitium. Electron microscopy in the other patient revealed diffuse thickening of the glomerular basement membrane (GBM) and lipid droplets within the mesangium. The glomerular hypertrophy, thickening of the GBM, and subsequent sclerosis were similar to those in insulin-dependent diabetes mellitus. These findings may explain the similarities between the natural histories of renal involvement in the two disorders. Particularly, glomerular hypertrophy may be a key step leading to glomerular sclerosis, which is the predominant finding I-GSD. Hyperlipidemia, which is commonly seen in I-GSD, may also accelerate the glomerular sclerosing process.

  16. Scleroderma renal crisis in a case of mixed connective tissue disease

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    Mukul Vij

    2014-01-01

    Full Text Available Mixed connective tissue disease (MCTD is an overlap syndrome first defined in 1972 by Sharp et al. In this original study, the portrait emerged of a connective tissue disorder sharing features of systemic lupus erythematosus, systemic sclerosis (scleroderma and polymyositis. Scleroderma renal crisis (SRC is an extremely infrequent but serious complication that can occur in MCTD. The histologic picture of SRC is that of a thrombotic micro-angiopathic process. Renal biopsy plays an important role in confirming the clinical diagnosis, excluding overlapping/superimposed diseases that might lead to acute renal failure in MCTD patients, helping to predict the clinical outcome and optimizing patient management. We herewith report a rare case of SRC in a patient with MCTD and review the relevant literature.

  17. l-Carnitine improves cognitive and renal functions in a rat model of chronic kidney disease.

    Science.gov (United States)

    Abu Ahmad, Nur; Armaly, Zaher; Berman, Sylvia; Jabour, Adel; Aga-Mizrachi, Shlomit; Mosenego-Ornan, Efrat; Avital, Avi

    2016-10-01

    Over the past decade, the prevalence of chronic kidney disease (CKD) has reached epidemic proportions. The search for novel pharmacological treatment for CKD has become an area of intensive clinical research. l-Carnitine, considered as the "gatekeeper" responsible for admitting long chain fatty acids into cell mitochondria. l-Carnitine synthesis and turnover are regulated mainly by the kidney and its levels inversely correlate with serum creatinine of normal subjects and CKD patients. Previous studies showed that l-carnitine administration to elderly people is improving and preserving cognitive function. As yet, there are no clinical intervention studies that investigated the effect of l-carnitine administration on cognitive impairment evidenced in CKD patients. Thus, we aimed to investigate the effects of l-carnitine treatment on renal function and on the cognitive performance in a rat model of progressive CKD. To assess the role of l-carnitine on CKD condition, we estimated the renal function and cognitive abilities in a CKD rat model. We found that all CKD animals exhibited renal function deterioration, as indicated by elevated serum creatinine, BUN, and ample histopathological abnormalities. l-Carnitine treatment of CKD rats significantly reduced serum creatinine and BUN, attenuated renal hypertrophy and decreased renal tissue damage. In addition, in the two way shuttle avoidance learning, CKD animals showed cognitive impairment which recovered by the administration of l-carnitine. We conclude that in a rat model of CKD, l-carnitine administration significantly improved cognitive and renal functions.

  18. Diagnosis and surgical treatment of renal hydatid disease: a retrospective analysis of 30 cases.

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    Mulati Rexiati

    Full Text Available Echinococcosis (CE is an infection which is caused by the larval stage of a tapeworm and is endemic in stockbreeding regions of developing countries. The kidney is the most commonly affected organ in the urinary tract. However, reports on renal hydatid disease are limited in the literature, and usually there are no specific clinical characteristics and promising operative methods. The purpose of this study is to assess the most appropriate surgical technique for the patient with urinary tract CE. We retrospectively analyzed thirty patients with renal hydatid cysts who received different surgical treatments in the urology department of the First Affiliated Hospital of Xinjiang Medical University from February 1985 to April 2010. Twenty patients were males and ten were females. The diagnostic accuracy was 74%, 87.5%, and 66.6% respectively by using of ultrasound, CT, and laboratory tests. Thirty patients were followed up for 1-15 years after surgery. One patient experienced a recurrence of renal CE. The ultrasound, CT, and immunological tests are an important means of diagnosis. The surgical treatment principle of renal hydatid should be based on residual renal function, hydatid cyst size, number, location, and surgical techniques to determine the surgical plan to retain the renal function.

  19. Effect of chronic antioxidant therapy with superoxide dismutase-mimetic drug, tempol, on progression of renal disease in rats with renal mass reduction.

    Science.gov (United States)

    Quiroz, Yasmir; Ferrebuz, Atilio; Vaziri, Nosratola D; Rodriguez-Iturbe, Bernardo

    2009-01-01

    Oxidative stress and inflammation play a major role in the progression of renal damage and antioxidants are potentially useful therapeutic options in chronic renal disease. We investigated if treatment with tempol, a superoxide dismutase mimetic that has beneficial effects in several experimental models of hypertension and acute kidney injury, ameliorates the chronic renal damage resulting in renal mass reduction. Rats with surgical 5/6 nephrectomy were randomly assigned to receive no treatment (CRF group, n = 10) or tempol, 1 mmol/l in the drinking water (CRF-tempol group, n = 10). Sham-operated rats (n = 10) served as controls. All rats were followed for 12 weeks post-nephrectomy. Tempol treatment reduced plasma malondialdehyde (MDA) levels and halved the number of superoxide-positive cells in the remnant kidney; however, the number of hydrogen peroxide-positive cells increased and the overall renal oxidative stress (MDA and nitrotyrosine abundance) and inflammation (interstitial p65 NF-kappaB, macrophage and lymphocyte infiltration) were unchanged. Proteinuria, renal function and glomerular and tubulointerstitial damage in the remnant kidney were similar in the CRF and CRF-tempol groups. In conclusion, tempol administration, at the dose used in these studies, decreased plasma MDA and heightened superoxide dismutation in the kidney, but was incapable of reducing renal oxidative stress or improving renal function or structure in the remnant kidney model.

  20. The efficacy of hemodialysis in interventional therapy in coronary artery disease patients with chronic renal insufficiency.

    Science.gov (United States)

    Zhai, Hongxia; Li, Liang; Yin, Yaxin; Zhang, Jinjin; Chen, Haiwei; Liu, Runmei; Xia, Yun-feng

    2016-01-01

    The aim of this study was to explore the efficacy and safety of hemodialysis in interventional therapy for patients with coronary artery disease combined with chronic renal insufficiency. With the aging and social development, the number of coronary artery disease patients with chronic renal insufficiency gradually increased. Total 58 coronary heart disease patients with chronic renal dysfunction were selected. These patients were characterized with typical angina symptoms and typical electrocardiogram (ECG) changes of onset angina. Continuous oral administration of sodium bicarbonate tablets 1 g 3/day × 3 days and slow intravenous input sodium chloride 1000 ∼1500 mL 3-12 h before operation were given. By this way, all patients were treated by hydration and alkalization. After percutaneous coronary intervention (PCI) treatment, patients were immediately transferred to undergo 4 h of dialysis treatment without removing indwelling of femoral artery puncture sheath tube to protect renal function. Changes in renal function including serum creatinine, glomerular filtration rate, and urine were observed and recorded. All patients were successfully underwent PCI treatment. Within one month after PCI, there were no obvious complication and no stent thrombosis occurred. Among of 58 patients, 56 cases showed no significant increase in serum creatinine levels compared with those before operation. However, serum creatinine level of one patient increased to 251 umol/L and one patient still required permanent dialysis. Using hemodialysis in interventional therapy in coronary artery disease patients with chronic renal insufficiency could significantly improve the prognosis of the patients.

  1. Analysis of the New Zealand Black contribution to lupus-like renal disease

    Energy Technology Data Exchange (ETDEWEB)

    Drake, C.G.; Rozzo, S.J.; Hirschfeld, H.F.; Smarnworawong, N.P. [National Center for Immunology and Respiratory Medicine, Denver, CO (United States); Palmer, E. [Basel Institute of Immunology, Basel (Switzerland); Kotzin, B.L. [National Jewish Center for Immunology and Respiratory Medicine, Denver, CO (United States)]|[Univ. of Colorado Health Sciences Center, Denver, CO (United States)

    1995-03-01

    F{sub 1} progeny of New Zealand Black (NZB) and New Zealand White (NZW) mice spontaneously develop an autoimmune process remarkably similar to human systemic lupus erythematosus. Previous studies have implicated major genetic contributions from the NZW MHC and from a dominant NZB gene on chromosome 4. To identify additional NZB contributions to lupus-like disease, (NZB x SM/J)F{sub 1} x NZW backcross mice were followed for the development of severe renal disease and were comprehensively genotyped. Despite a 50% incidence of disease significant associations between the presence of the NZB genotype and disease were noted on chromosomes 1, 4, 7, 10, 13, and 19. The data indicated that multiple NZB genes, in different combinations, contribute to severe renal disease, and that no single gene is required. To further investigate this NZB contribution, NZB x SM/J (NXSM) recombinant inbred (RI) strains were crossed with NZW mice, and F{sub 1} progeny were analyzed for the presence of lupus-like renal disease. Interestingly, nearly all of the (RI x NZW)F{sub 1} cohorts studies expressed some level of disease. Five RI strains generated a high incidence of disease, similar to (NZB x NZW)F{sub 1} mice, and nearly one-half of the cohorts developed disease at intermediate levels. Only two cohorts demonstrated very little disease, supporting the conclusion that multiple genes are capable of disease induction. Experiments correlating the genotypes of these RI strains with their ability to generate disease revealed that none of the disease-associated loci defined by the backcross analysis were present in all five RI strains that generated disease at high levels. Overall, both the backcross data and RI analysis provide additional support for the genetic complexity of lupus nephritis and uphold the conclusion that heterogeneous combinations of contributing NZB genes seem to operate in a threshold manner to generate the disease phenotype. 31 refs., 3 figs., 2 tabs.

  2. Effects of fasting during Ramadan on renal function of patients with chronic kidney disease.

    Science.gov (United States)

    Mbarki, Houda; Tazi, Nada; Najdi, Adil; Tachfouti, Nabil; Arrayhani, Mohamed; Sqalli, Tarik

    2015-03-01

    Fasting during Ramadan is prohibited when an individual's health is endangered. Little work has been published in this direction in patients with chronic kidney disease (CKD). We aimed to evaluate the impact of fasting during Ramadan on the renal function of patients with CKD, adjusting for the initial degree of renal impairment. We prospectively studied 60 patients with CKD (35 females; mean age 45.6 ± 15.8 years). All study patients were older than 15 years, being followed-up at the nephrology clinic for more than six months, having a stable CKD during the preceding six months and who had fasted during Ramadan the previous year. Patients who had a medical contra-indication for fasting were excluded from the study [severe or resistant arterial hypertension, insulin-requiring diabetes, acute renal failure (ARF), active renal disease, repetitive urolithiasis or terminal chronic renal failure]. Statistical analysis was performed in collaboration with the epidemiology lab at the Fez Medical School using the SPSS software version 17. Three of the study patients developed ARF in the first week and four of them at the end of the month of the study period. The risk of developing ARF was significantly higher for patients with baseline creatinine clearance of <60 mL/min/1.73 m 2 . However, the small sample size does not allow us to draw any firm conclusions on fasting during Ramadan in stable CKD patients. Studies on larger numbers of patients are recommended.

  3. Extracorporeal membrane oxygenation in the neonate with congenital renal disease and pulmonary hypoplasia.

    Science.gov (United States)

    Caesar, R E; Packer, M G; Kaplan, G W; Dudell, G G; Guerrant, A L; Griswold, W R; Lemire, J M; Mendoza, S A; Reznik, V M

    1995-11-01

    Extracorporeal membrane oxygenation (ECMO) is an effective treatment modality for the newborn with refractory hypoxemia. Oligohydramnios can be associated with congenital renal disease (CRD) and can result in respiratory insufficiency from pulmonary hypoplasia, delayed lung maturation, and persistent pulmonary hypertension of the newborn. In this retrospective study, the authors reviewed the outcome of four children with CRD who required ECMO in the neonatal period. Between October 1987 and December 1995, ECMO was used in four newborns with CRD and pulmonary hypoplasia unresponsive to maximal medical management. The causes of CRD were urinary obstruction (2), renal dysplasia (1), and vesicoureteral reflux (1). Neonatal survivors of ECMO with CRD had regular follow-up with a nephrologist, urologist, and pediatrician. Developmental history, assessment of renal function, and a nutritional evaluation were recorded on each visit. The follow-up period ranged from 6 months to 5 years. All patients with CRD were successfully weaned from ECMO. One child died, at 1 month of age, because of renal failure. The estimated glomerular filtration rates in the three survivors were 20, 24, and 60 mL/min/1.73 m2. Growth and development have been delayed in two patients. Based on the author's experience, ECMO may improve the survival of neonates with pulmonary hypoplasia and CRD. Factors associated with successful long-term outcome include (1) renal disease amenable to surgical correction, (2) aggressive nutritional support, and (3) a reliable social support system.

  4. Non-diabetic renal disease (NDRD) in patients with type 2 diabetes mellitus (type 2 DM).

    Science.gov (United States)

    Prakash, Jai

    2013-03-01

    In contrast to Type 1 diabetes mellitus (DM), the incidence of non-diabetic renal disease (NDRD) is very high in Type 2 diabetic patients. A wide spectrum of non-diabetic nephropathy (NDN) including both glomerular and tubulointerstitial lesions are reported in patients with Type 2 DM and their precise diagnosis requires histological examination of kidney tissue. Renal biopsy studies suggest that 25-50% of patients with Type 2 diabetes had glomerular lesions unrelated to or in addition to diabetic nephropathy. Histological studies confirm that NDRD can occur in isolated form without diabetic nephropathy or superimposed on diabetic nephropathy. Diabetic nephropathy can occur in absence of retinopathy and chance of getting diabetic and non-diabetic renal lesions are nearly equal in Type 2 diabetic patient in absence of diabetic retinopathy (RP). The presence of RP suggests the concurrence of DN, but does not exclude non-diabetic nephropathy. Clearly, renal biopsy is indicated in proteinuric Type 2 diabetic patients for precise diagnosis of diabetic vs non-diabetic renal disease. Appropriate treatment of NDRD is associated with good clinical outcome. Thus, it is gratifying to treat NDRD in selected patients. Besides, 40 to 60% of ESRD in Type 2 diabetic patients is not caused by diabetic nephropathy.

  5. [Early identification of impaired renal function in obese children with non-alcoholic fatty liver disease].

    Science.gov (United States)

    Lin, Hu; Fu, Junfen; Chen, Xuefeng; Huang, Ke; Wu, Wei; Liang, Li

    2013-07-01

    To early assess the impaired renal function in the obese children with non-alcoholic fatty liver disease (NAFLD) and to identify the relationship between NAFLD and impairment of renal function. Three hundred and eighty-six obese children were enrolled and divided into NAFLD group and simple obesity group (control) according to the diagnostic criteria. Clinical biochemical parameters and early impaired renal functions were evaluated and compared. Among all patients 234 obese children aged over 10 y were subdivided into 3 groups: NAFLD combined with metabolic syndrome (NAFLD+MS) group, NAFLD group and simple obesity group (control), and the above indexes were compared among 3 groups. The urinary microalbumin levels in NAFLD, NAFLD+MS (>10y) and NAFLD groups (>10y) were significantly higher than those in controls. Additionally, the positive correlations of urinary microalbumin with systolic pressure, triglyceride and 2h-postprandial blood glucose were found. There is early renal dysfunction in children with NAFLD and those accompanied with MS, which may be associated with hypertension and glucose-lipid metabolic disorder. The results indicate that NAFLD is not only an early sign of early impaired renal function but also an early stage of chronic kidney disease (CKD) in obese children.

  6. Herlyn-Werner-Wunderlich Syndrome with Unilateral Hemivaginal Obstruction, Ipsilateral Renal Agenesis, and Contralateral Renal Thin GBM Disease: A Case Report with Radiological Follow Up

    Energy Technology Data Exchange (ETDEWEB)

    Park, Noh Hyuck; Park, Hee Jin; Park, Chan Sup [Myongji Hospital, Kwandong University, Koyang (Korea, Republic of); Park, Sung Il [Bucheon Hospital, Soonchunhyang University, Bucheon (Korea, Republic of)

    2010-08-15

    Herlyn-Werner-Wunderlich syndrome is a rare Mullerian ductal anomaly that is characterized by the presence of a hemivaginal septum, a didelphic uterus and ipsilateral renal agenesis. It is generally difficult to diagnose the uterine malformation before menarche owing to its small size. Therefore, a follow-up study is very important for confirming the uterine malformation in girls with renal agenesis. We report a patient with renal agenesis and microscopic hematuria, who showed symptoms before menarche. A follow-up study eventually revealed uterine didelphys with a hemivaginal obstruction. A biopsy proved that the microscopic hematuria was caused by thin glomerular basement membrane disease of the contralateral kidney

  7. The Potential Role of Catheter-Based Renal Sympathetic Denervation in Chronic and End-Stage Kidney Disease.

    Science.gov (United States)

    Sata, Yusuke; Schlaich, Markus P

    2016-07-01

    Sympathetic activation is a hallmark of chronic and end-stage renal disease and adversely affects cardiovascular prognosis. Hypertension is present in the vast majority of these patients and plays a key role in the progressive deterioration of renal function and the high rate of cardiovascular events in this patient cohort. Augmentation of renin release, tubular sodium reabsorption, and renal vascular resistance are direct consequences of efferent renal sympathetic nerve stimulation and the major components of neural regulation of renal function. Renal afferent nerve activity directly influences sympathetic outflow to the kidneys and other highly innervated organs involved in blood pressure control via hypothalamic integration. Renal denervation of the kidney has been shown to reduce blood pressure in many experimental models of hypertension. Targeting the renal nerves directly may therefore be specifically useful in patients with chronic and end-stage renal disease. In this review, we will discuss the potential role of catheter-based renal denervation in patients with impaired kidney function and also reflect on the potential impact on other cardiovascular conditions commonly associated with chronic kidney disease such as heart failure and arrhythmias.

  8. Akt1-mediated fast/glycolytic skeletal muscle growth attenuates renal damage in experimental kidney disease.

    Science.gov (United States)

    Hanatani, Shinsuke; Izumiya, Yasuhiro; Araki, Satoshi; Rokutanda, Taku; Kimura, Yuichi; Walsh, Kenneth; Ogawa, Hisao

    2014-12-01

    Muscle wasting is frequently observed in patients with kidney disease, and low muscle strength is associated with poor outcomes in these patients. However, little is known about the effects of skeletal muscle growth per se on kidney diseases. In this study, we utilized a skeletal muscle-specific, inducible Akt1 transgenic (Akt1 TG) mouse model that promotes the growth of functional skeletal muscle independent of exercise to investigate the effects of muscle growth on kidney diseases. Seven days after Akt1 activation in skeletal muscle, renal injury was induced by unilateral ureteral obstruction (UUO) in Akt1 TG and wild-type (WT) control mice. The expression of atrogin-1, an atrophy-inducing gene in skeletal muscle, was upregulated 7 days after UUO in WT mice but not in Akt1 TG mice. UUO-induced renal interstitial fibrosis, tubular injury, apoptosis, and increased expression of inflammatory, fibrosis-related, and adhesion molecule genes were significantly diminished in Akt1 TG mice compared with WT mice. An increase in the activating phosphorylation of eNOS in the kidney accompanied the attenuation of renal damage by myogenic Akt1 activation. Treatment with the NOS inhibitor L-NAME abolished the protective effect of skeletal muscle Akt activation on obstructive kidney disease. In conclusion, Akt1-mediated muscle growth reduces renal damage in a model of obstructive kidney disease. This improvement appears to be mediated by an increase in eNOS signaling in the kidney. Our data support the concept that loss of muscle mass during kidney disease can contribute to renal failure, and maintaining muscle mass may improve clinical outcome.

  9. Prevalence and patterns of renal involvement in imaging of malignant lymphoproliferative diseases

    Energy Technology Data Exchange (ETDEWEB)

    Bach, Andreas Gunter; Behrmann, Curd; Spielmann, Rolf Peter; Surov, Alexey (Dept. of Radiology, Martin-Luther-Univ. Halle-Wittenberg, Halle (Germany)), Email: andreas.bach@medizin.uni-halle.de; Holzhausen, Hans Jurgen (Dept. of Pathology, Martin-Luther-Univ. Halle-Wittenberg, Halle (Germany)); Katzer, Michaela (Dept. of Urology, Martin-Luther-Univ. Halle-Wittenberg, Halle (Germany)); Arnold, Dirk (Univ. Cancer Center Hamburg, Hamburg (Germany))

    2012-04-15

    Background: Renal involvement in patients with lymphoproliferative disease is an uncommon radiological finding. Purpose: To determine its prevalence and radiological appearances in a patient population. Material and Methods: All forms of lymphoproliferative disease (ICD: C81-C96) were considered. From January 2005 to January 2010, 668 consecutive patients with lymphoproliferative disease were identified with the help of the radiological database and patient records. Inclusion criteria were complete staging including appropriate CT scan and/or MRI. All stored images (initial staging and follow-up examinations) were reviewed. Results: Review of all stored images revealed renal infiltration in patients with non-Hodgkin lymphoma (11 of 364 = 3.0%; median age = 65 years, m:f = 6:5) but also multiple myeloma (2 of 162 = 1.2%; median age = 72 years; m:f = 1:1) and leukemia (5 of 101 4.9%; median age = 12 years; m:f = 2:3). There were no cases of renal infiltration in 41 patients with Hodgkin's disease. In total there were six patients with solitary lesions, five patients with diffuse renal enlargement, four patients with perirenal lesions, and two patients with direct invasion of the kidney. Conclusion: In leukemia the most common imaging pattern is diffuse enlargement. In the other subtypes of lymphoproliferative disease no specific correlation between typical CT patterns and subtype of lymphoproliferative disease can be found. The prevalence of renal involvement is in line with earlier studies. Contrary to earlier reports, multiple lesions were not found to be a common pattern

  10. Lactate dehydrogenase as a biomarker for early renal damage in patients with sickle cell disease

    Directory of Open Access Journals (Sweden)

    Mohammad S Alzahri

    2015-01-01

    Full Text Available Among many complications of sickle cell disease, renal failure is the main contributor to early mortality. It is present in up to 21% of patients with sickle cell disease. Although screening for microalbuminuria and proteinuria is the current acceptable practice to detect and follow renal damage in patients with sickle cell disease, there is a crucial need for other, more sensitive biomarkers. This becomes especially true knowing that those biomarkers start to appear only after more than 60% of the kidney function is lost. The primary purpose of this study is to determine whether lactate dehydrogenase (LDH correlates with other, direct and indirect bio-markers of renal insufficiency in patients with sickle cell disease and, therefore, could be used as a biomarker for early renal damage in patients with sickle cell disease. Fifty-five patients with an established diagnosis of sickle cell disease were recruited to in the study. Blood samples were taken and 24-h urine collection samples were collected. Using Statcrunch, a data analysis tool available on the web, we studied the correlation between LDH and other biomarkers of kidney function as well as the distribution and relationship between the variables. Regression analysis showed a significant negative correlation between serum LDH and creatinine clearance, R (correlation coefficient = -0.44, P = 0.0008. This correlation was more significant at younger age. This study shows that in sickle cell patients LDH correlates with creatinine clearance and, therefore, LDH could serve as a biomarker to predict renal insufficiency in those patients.

  11. The complexity of the cardio-renal link : taxonomy, syndromes, and diseases

    NARCIS (Netherlands)

    Zoccali, Carmine; Goldsmith, David; Agarwal, Rajiv; Blankestijn, Peter J.; Fliser, Danilo; Wiecek, Andrzej; Suleymanlar, Gultekin; Ortiz, Alberto; Massy, Ziad; Covic, Adrian; Martinez-Castelao, Alberto; Jager, Kitty J.; Dekker, Friedo W.; Lindholm, Bengt; London, Gerard

    2011-01-01

    Bidirectional mechanisms exist that link diseases affecting the heart and kidney. This link is complex and remains poorly understood; therefore, charting the shared territory of cardiovascular (CV) and renal medicine poses major problems. Until now, no convincing rationale for delineating new syndro

  12. Hepatocyte Nuclear Factor 1beta-Associated Kidney Disease: More than Renal Cysts and Diabetes

    NARCIS (Netherlands)

    Verhave, J.C.; Bech, A.P.; Wetzels, J.F.; Nijenhuis, T.

    2016-01-01

    Hepatocyte nuclear factor 1beta (HNF1beta)-associated disease is a recently recognized clinical entity with a variable multisystem phenotype. Early reports described an association between HNF1B mutations and maturity-onset diabetes of the young. These patients often presented with renal cysts and

  13. Exercise training in pediatric patients with end-stage renal disease

    NARCIS (Netherlands)

    M. van Bergen (Monique); T. Takken (Tim); R.H.H. Engelbert (Raoul); J. Groothoff (Jaap); J. Nauta (Jeroen); J. van Hoeck (Koen); P. Helders (Paul); M. Lilien (Marc)

    2009-01-01

    textabstractThe objective of this study was to determine the feasibility and efficacy of an exercise training program to improve exercise capacity and fatigue level in pediatric patients with end-stage renal disease (ESRD). Twenty children on dialysis intended to perform a 12-week graded

  14. Exercise training in pediatric patients with end-stage renal disease

    NARCIS (Netherlands)

    van Bergen, M.; Takken, T.; Engelbert, R.; Groothoff, J.; Nauta, J.; van Hoeck, K.; Helders, P.; Lilien, M.

    2009-01-01

    The objective of this study was to determine the feasibility and efficacy of an exercise training program to improve exercise capacity and fatigue level in pediatric patients with end-stage renal disease (ESRD). Twenty children on dialysis intended to perform a 12-week graded community-based

  15. Smoking and hyperparathyroidism in patients with end-stage renal disease (ESRD)

    NARCIS (Netherlands)

    G.L. Tripepi (Giovanni); F.U.S. Mattace Raso (Francesco); P. Pizzini (Patrizia); S. Cutrupi (Sebastiano); J.C.M. Witteman (Jacqueline); C. Zoccali (Carmine); F. Mallamaci (Francesca)

    2012-01-01

    textabstractBackground and methods: Smoking is associated with hyperparathyroidism in the elderly general population and nicotine, the main component of tobacco smoke, stimulates PTH release in experimental models. Although smoking is a persisting problem in patients with endstage renal disease (ESR

  16. Assessment of Respiratory Complications Associated with End Stage Renal Disease in Northern Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Alosayfir Mohammed Abdulrahman S.

    2016-12-01

    Full Text Available Background. The prevalence of End Stage Renal Disease (ESRD is increasing in different parts of the Kingdom of Saudi Arabia (KSA, particularly Hail Region. Therefore, the aim of this study was to assess the respiratory complications that associated with ESRD.

  17. The complexity of the cardio-renal link : taxonomy, syndromes, and diseases

    NARCIS (Netherlands)

    Zoccali, Carmine; Goldsmith, David; Agarwal, Rajiv; Blankestijn, Peter J.; Fliser, Danilo; Wiecek, Andrzej; Suleymanlar, Gultekin; Ortiz, Alberto; Massy, Ziad; Covic, Adrian; Martinez-Castelao, Alberto; Jager, Kitty J.; Dekker, Friedo W.; Lindholm, Bengt; London, Gerard

    2011-01-01

    Bidirectional mechanisms exist that link diseases affecting the heart and kidney. This link is complex and remains poorly understood; therefore, charting the shared territory of cardiovascular (CV) and renal medicine poses major problems. Until now, no convincing rationale for delineating new syndro

  18. Hyaluronan Biology and Regulation in Renal Tubular Epithelial Cells and its Role in Kidney Stone Disease

    NARCIS (Netherlands)

    M. Asselman (Marino)

    2008-01-01

    textabstractRenal stone disease is a widespread problem afflicting more and more people throughout the world. Epidemiological studies show an increase in incidence and prevalence rates. In North America and Europe the yearly incidence is estimated to be about 0.5% 1, 2. The prevalence of kidney ston

  19. Hypertension, Chronic Kidney Disease, and Renal Pathology in a Child with Hermansky-Pudlak Syndrome

    Directory of Open Access Journals (Sweden)

    Roberto Gordillo

    2011-01-01

    Full Text Available We report a child with Hermansky-Pudlak Syndrome (HPS and chronic kidney disease (stage II with histological diagnosis of focal segmental glomerulosclerosis (FSGS. A 15-year-old male of Puerto Rico ancestry with history of HPS, hypertension (HTN, asthma, obesity, and chronic kidney disease (CKD stage II presented with new-onset proteinuria without edema. His blood pressure had been controlled, serum creatinine had been 0.9–1.4 mg/dL, and first morning urine protein/creatinine ratio (UPC ranged from 0.2 to 0.38. Due to persistent nonorthostatic proteinuria with CKD, renal biopsy was performed and FSGS (not otherwise specified with chronic diffuse tubulopathy (tubular cytoplasmic droplets and acute tubular injury was reported. Ceroid-like material is known to infiltrate tissues (i.e., lungs, colon, and kidney in HPS, but the reason for the renal insufficiency is unknown. Nonspecific kidney disease and in one adult case IgA nephropathy with ANCA-positive glomerulonephritis have previously been reported in patients with Hermansky-Pudlak syndrome. To our knowledge, we report the first pediatric renal pathology case of HPS associated with CKD. This paper discusses presentation and management of renal disease in HPS.

  20. Management of renal cyst infection in patients with autosomal dominant polycystic kidney disease : a systematic review

    NARCIS (Netherlands)

    Lantinga, Marten A; Casteleijn, Niek F; Geudens, Alix; de Sévaux, Ruud G L; van Assen, Sander; Leliveld, Anna; Gansevoort, Ron T; Drenth, Joost P H

    2017-01-01

    BACKGROUND: Renal cyst infection is one of the complications faced by patients with autosomal dominant polycystic kidney disease (ADPKD). Cyst infection is often difficult to treat and potentially leads to sepsis and death. No evidence-based treatment strategy exists. We therefore performed a system

  1. Exercise training in pediatric patients with end-stage renal disease

    NARCIS (Netherlands)

    M. van Bergen (Monique); T. Takken (Tim); R.H.H. Engelbert (Raoul); J. Groothoff (Jaap); J. Nauta (Jeroen); J. van Hoeck (Koen); P. Helders (Paul); M. Lilien (Marc)

    2009-01-01

    textabstractThe objective of this study was to determine the feasibility and efficacy of an exercise training program to improve exercise capacity and fatigue level in pediatric patients with end-stage renal disease (ESRD). Twenty children on dialysis intended to perform a 12-week graded community-b

  2. End-stage renal disease among Roma and non-Roma : Roma are at risk

    NARCIS (Netherlands)

    Kolvek, Gabriel; Rosicova, Katarina; Rosenberger, Jaroslav; Podracka, Ludmila; Stewart, Roy E.; Nagyova, Iveta; Reijneveld, Sijmen A.; van Dijk, Jitse P.

    Ethnic differences in the occurrence of end-stage renal disease (ESRD) are reported on various populations across the world, but evidence on Roma is lacking. The aim of this study was to explore the relative risk (RR) of ESRD for Roma who constitute a major minority in Slovakia. Patients treated by

  3. Improved survival rate in patients with diabetes and end-stage renal disease in Denmark

    DEFF Research Database (Denmark)

    Sørensen, V R; Mathiesen, E R; Heaf, J;

    2007-01-01

    AIMS/HYPOTHESIS: We investigated the survival rate of Danish diabetic patients with end-stage renal disease (ESRD) between 1990 and 2005 and evaluated possible predictors of survival rate. MATERIALS AND METHODS: Data were obtained from the Danish National Register on Dialysis and Transplantation...

  4. Gastrointestinal factors contribute to glucometabolic disturbances in nondiabetic patients with end-stage renal disease

    DEFF Research Database (Denmark)

    Idorn, Thomas; Knop, Filip K; Jørgensen, Morten;

    2013-01-01

    Nondiabetic patients with end-stage renal disease (ESRD) have disturbed glucose metabolism, the underlying pathophysiology of which is unclear. To help elucidate this, we studied patients with ESRD and either normal or impaired glucose tolerance (10 each NGT or IGT, respectively) and 11 controls...

  5. How End-Stage Renal Disease Patients Manage the Medicare Part D Coverage Gap

    Science.gov (United States)

    Kovacs, Pamela J.; Perkins, Nathan; Nuschke, Elizabeth; Carroll, Norman

    2012-01-01

    Medicare Part D was enacted to help elderly and disabled individuals pay for prescription drugs, but it was structured with a gap providing no coverage in 2010 between $2,830 and $6,440. Patients with end-stage renal disease (ESRD) are especially likely to be affected due to high costs of dialysis-related drugs and the importance of adherence for…

  6. Some plants described by Pliny for the treatment of renal diseases.

    Science.gov (United States)

    De Matteis Tortora, M

    1994-01-01

    Pliny the Elder described medicinal plants in books XX-XXVII of Naturalis Historia, reporting the therapeutic properties and preparations of the plants for use in different parts of the body. An exhibition of 20 plants chosen from those indicated for renal diseases is described.

  7. Hyaluronan Biology and Regulation in Renal Tubular Epithelial Cells and its Role in Kidney Stone Disease

    NARCIS (Netherlands)

    M. Asselman (Marino)

    2008-01-01

    textabstractRenal stone disease is a widespread problem afflicting more and more people throughout the world. Epidemiological studies show an increase in incidence and prevalence rates. In North America and Europe the yearly incidence is estimated to be about 0.5% 1, 2. The prevalence of kidney ston

  8. Hypertension, chronic kidney disease, and renal pathology in a child with hermansky-pudlak syndrome.

    Science.gov (United States)

    Gordillo, Roberto; Del Rio, Marcela; Thomas, David B; Flynn, Joseph T; Woroniecki, Robert P

    2011-01-01

    We report a child with Hermansky-Pudlak Syndrome (HPS) and chronic kidney disease (stage II) with histological diagnosis of focal segmental glomerulosclerosis (FSGS). A 15-year-old male of Puerto Rico ancestry with history of HPS, hypertension (HTN), asthma, obesity, and chronic kidney disease (CKD) stage II presented with new-onset proteinuria without edema. His blood pressure had been controlled, serum creatinine had been 0.9-1.4 mg/dL, and first morning urine protein/creatinine ratio (UPC) ranged from 0.2 to 0.38. Due to persistent nonorthostatic proteinuria with CKD, renal biopsy was performed and FSGS (not otherwise specified) with chronic diffuse tubulopathy (tubular cytoplasmic droplets) and acute tubular injury was reported. Ceroid-like material is known to infiltrate tissues (i.e., lungs, colon, and kidney) in HPS, but the reason for the renal insufficiency is unknown. Nonspecific kidney disease and in one adult case IgA nephropathy with ANCA-positive glomerulonephritis have previously been reported in patients with Hermansky-Pudlak syndrome. To our knowledge, we report the first pediatric renal pathology case of HPS associated with CKD. This paper discusses presentation and management of renal disease in HPS.

  9. Mild systemic thermal therapy ameliorates renal dysfunction in a rodent model of chronic kidney disease.

    Science.gov (United States)

    Iwashita, Yoshihiro; Kuwabara, Takashige; Hayata, Manabu; Kakizoe, Yutaka; Izumi, Yuichiro; Iiyama, Junichi; Kitamura, Kenichiro; Mukoyama, Masashi

    2016-06-01

    Thermal therapy has become a nonpharmacological therapy in clinical settings, especially for cardiovascular diseases. However, the practical role of thermal therapy on chronic kidney disease remains elusive. We performed the present study to investigate whether a modified thermal protocol, repeated mild thermal stimulation (MTS), could affect renal damages in chronic kidney disease using a mouse renal ablation model. Mice were subjected to MTS or room temperature (RT) treatment once daily for 4 wk after subtotal nephrectomy (Nx) or sham operation (Sh). We revealed that MTS alleviated renal impairment as indicated by serum creatinine and albuminuria in Nx groups. In addition, the Nx + MTS group showed attenuated tubular histological changes and reduced urinary neutrophil gelatinase-associated lipocalin excretion approximately by half compared with the Nx + RT group. Increased apoptotic signaling, such as TUNEL-positive cell count and cleavage of caspase 3, as well as enhanced oxidative stress were significantly reduced in the Nx + MTS group compared with the Nx + RT group. These changes were accompanied with the restoration of kidney Mn-SOD levels by MTS. Heat shock protein 27, a key molecular chaperone, was phosphorylated by MTS only in Nx kidneys rather than in Sh kidneys. MTS also tended to increase the phosphorylation of p38 MAPK and Akt in Nx kidneys, possibly associated with the activation of heat shock protein 27. Taken together, these results suggest that modified MTS can protect against renal injury in a rodent model of chronic kidney disease.

  10. Incidental renal artery stenosis is an independent predictor of mortality in patients with peripheral vascular disease

    NARCIS (Netherlands)

    Mui, KW; Sleeswijk, M; van den Hout, H; van Baal, J; Navis, G; Woittiez, AJ

    In patients with peripheral vascular disease (PVD), mortality is high and renal artery stenosis (RAS) is a frequent incidental finding. RAS carries a high risk for mortality, but whether incidentally discovered RAS is a risk factor for mortality is unknown. The prognostic impact of incidental RAS

  11. Cystic renal dysplasia as a leading sign of inherited metabolic disease.

    NARCIS (Netherlands)

    Distelmaier, F.; Vogel, M.; Spiekerkotter, U.; Gempel, K.; Klee, D.; Braunstein, S.; Groneck, H.P.; Mayatepek, E.; Wendel, U.A.H.; Schwahn, B.

    2007-01-01

    Glutaric acidemia type II and carnitine palmitoyltransferase type II deficiency are rare, but potentially treatable, inherited metabolic diseases. Hallmarks of the early onset form of both conditions are renal abnormalities and neonatal metabolic crisis. In this article, we report on two newborns

  12. Better survival of renal cell carcinoma in patients with inflammatory bowel disease

    NARCIS (Netherlands)

    Derikx, L.A.A.P.; Nissen, L.H.C.; Drenth, J.P.H.; Herpen, C.M.L. van; Kievit, W.; Verhoeven, R.H.; Mulders, P.F.A.; Kaa, C.A. van de; Boers-Sonderen, M.J.; Heuvel, T.R. van den; Pierik, M.; Nagtegaal, I.D.; Hoentjen, F.

    2015-01-01

    BACKGROUND: Immunosuppressive therapy may impact cancer risk in inflammatory bowel disease (IBD). Cancer specific data regarding risk and outcome are scarce and data for renal cell carcinoma (RCC) are lacking. We aimed(1) to identify risk factors for RCC development in IBD patients (2) to compare RC

  13. End-stage renal disease among Roma and non-Roma : Roma are at risk

    NARCIS (Netherlands)

    Kolvek, Gabriel; Rosicova, Katarina; Rosenberger, Jaroslav; Podracka, Ludmila; Stewart, Roy E.; Nagyova, Iveta; Reijneveld, Sijmen A.; van Dijk, Jitse P.

    2012-01-01

    Ethnic differences in the occurrence of end-stage renal disease (ESRD) are reported on various populations across the world, but evidence on Roma is lacking. The aim of this study was to explore the relative risk (RR) of ESRD for Roma who constitute a major minority in Slovakia. Patients treated by

  14. Con: Nutritional vitamin D replacement in chronic kidney disease and end-stage renal disease.

    Science.gov (United States)

    Agarwal, Rajiv; Georgianos, Panagiotis I

    2016-05-01

    Insufficiency of 25-hydroxyvitamin D [25(OH)D] is highly prevalent among patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD) and is a critical component in the pathogenesis of secondary hyperparathyroidism. Accordingly, current National Kidney Foundation-Kidney Disease Outcomes Quality Initiative and Kidney Disease: Improving Global Outcomes guidelines recommend the correction of hypovitaminosis D through nutritional vitamin D replacement as a first-step therapeutic approach targeting secondary hyperparathyroidism. In this Polar Views debate, we summarize the existing evidence, aiming to defend the position that nutritional vitamin D replacement is not evidence-based and should not be applied to patients with CKD. This position is supported by the following: (i) our meta-analysis of randomized controlled trials shows that whereas nutritional vitamin D significantly increases serum 25(OH)D levels relative to placebo, there is no evidence either in predialysis CKD or in ESRD that parathyroid hormone (PTH) is lowered; (ii) on the other hand, in randomized head-to-head comparisons, nutritional vitamin D is shown to be inferior to activated vitamin D analogs in reducing PTH levels; (iii) nutritional vitamin D is reported to exert minimal to no beneficial actions in a series of surrogate risk factors, including aortic stiffness, left ventricular mass index (LVMI), epoetin utilization and immune function among others; and (iv) there is no evidence to support a benefit of nutritional vitamin D on survival and other 'hard' clinical outcomes. Whereas nutritional vitamin D replacement may restore 25(OH)D concentration to near normal, the real target of treating vitamin D insufficiency is to treat secondary hyperparathyroidism, which is untouched by nutritional vitamin D. Furthermore, the pleotropic benefits of nutritional vitamin D remain to be proven. Thus, there is little, if any, benefit of nutritional vitamin D replacement in CKD.

  15. Plasma S100A12 Levels and Peripheral Arterial Disease in End-Stage Renal Disease

    Directory of Open Access Journals (Sweden)

    Yayoi Shiotsu

    2011-12-01

    Full Text Available Background: S100A12 is an endogenous ligand of the receptor for advanced glycation end products (RAGE. Plasma S100A12 levels are high in end-stage renal disease (ESRD patients undergoing maintenance hemodialysis (HD. Peripheral arterial disease (PAD is common in HD patients and is associated with increased cardiovascular morbidity and mortality rates in this population. To date, however, no study has specifically assessed the relationship between plasma S100A12 and PAD in HD patients. Methods: We conducted a cross-sectional study of 152 HD patients in our affiliated hospital. We investigated PAD history and patient characteristics and quantified plasma S100A12 levels in all participants. Results: HD patients with PAD (n = 26; 21.9 [13.6–33.4] ng/ml showed significantly higher plasma S100A12 levels than HD patients without PAD (n = 126; 11.8 [7.5–17.6]ng/ml; p Conclusion: These results suggest that plasma S100A12 levels are strongly associated with PAD prevalence in ESRD patients undergoing HD.

  16. Spectrum of Clinical Presentations in Human Immunodeficiency Virus (HIV) Infected Patients with Renal Disease.

    Science.gov (United States)

    Okafor, U H; Unuigbe, E I; Wokoma, F S

    2011-01-01

    HIV infection is a multiorgan disease with the kidney not spared. A variety of renal syndromes with varying clinical presentations has been reported amongst HIV infected patients. This study aims to highlight the spectrum of clinical presentations in HIV infected patients with renal disease. HIV infected patients presenting at University of Benin Teaching Hospital (UBTH) Benin City were the study population. A total of 383 patients were studied. Their biodata, clinical presentations and laboratory investigations including serum urea, creatinine and albumin, urine protein and creatinine were assessed. Their glomerular filtration rate (GFR) and protein urine excretion were calculated using six equations of modification of diet in renal disease (MDRD) and protein: creatinine ratio respectively. Patients were stratified according to their renal functions into normal, mild, moderate and severe renal function impairment. The data was analysed using statistical software program SPSS Vs 15.0. 53.3% of 383 patients screened had renal function impairment, 40.2% mild, 37.7% moderate and 22.2% severe impairment. Mean age was 35.6±8.3, 36.0±9.9 and 36.3±8.3 years for mild, moderate and severe renal function impairment (RFI) respectively. Easy fatigability was the commonest symptoms occurring in 47.5%, 30.0%, 37.5% and 22.5% of control, mild RFI, moderate RFI and severe RFI subjects respectively (p = 0.568). Oliguria, facial and body swelling occurred more in patients with RFI especially in patients with severe renal impairment. The difference is statistically significant (p = 0.046, 0.041, and 0.033 respectively). Pallor was the commonest clinical sign occurring in 32.5%, 50.0%, 35.0% and 62.5% of control and patients with mild, moderate, and severe RFI respectively; the difference was not statistically significant (p = 0.459). Ascites, facial puffiness and pedal oedema were commoner in patients with RFI especially those with severe RFI. The differences were statistically

  17. Epidemiology of end-stage renal disease and current status of hemodialysis in Yugoslavia.

    Science.gov (United States)

    Djukanović, L; Radović, M; Baković, J; Budosan, I; Bukvić, D; Cveticanin, A; Davinić, S; Dragoljić, B; Djordjević, V; Djurić, S; Haviza-Lilić, B; Ilić, M; Janos, B; Jelacić, R; Jelić, S; Kostić, N; Mandić, M; Ostrić, V; Pljesa, S; Radisić, M; Radojević, M; Rakić, N; Rangelov, V; Ratković, M; Stojanović, M; Stojanović, R; Tintor, D; Vasić, V

    2002-09-01

    Maintenance hemodialysis (HD) in Yugoslavia started in the sixties and followed the dialysis trends in the Western Europe. However, in the last decade the development of renal replacement therapy (RRT) slowed down. In this report the epidemiology of ESRD from 1997-1999 and the survey of the status of HD treatment in Yugoslavia in 1999 are presented. Epidemiological data are obtained by the annual center questionnaires (response rate: 92.6 -94.2%). The survey of HD status is based on a specific questionnaire and covered 2108 patients (65%). At the end of 1999 there were 56 RRT centers in Yugoslavia treating 3939 patients: 3232 (82%) patients by HD, 248 (6.3%) by peritoneal dialysis, and 459 (11.7%) living with transplanted kidney. In a three year period, incidence of ESRD ranged from 108-128 pmp, point prevalence from 435-463 pmp and mortality rate from 20.7-17.9. Numerous refugee patients were treated over the last 10 years. Main causes of ESRD were glomerulonephritis (30%); Balkan nephropathy represented 11% and diabetic nephropathy 7% of all primary renal diseases. Cardiovascular and cerebrovascular diseases were the most common causes of death of RRT patients. Most centers are overcrowded and HD machines are worn out. Mean Kt/V was 1.19+/-0.08, mean URR% 58.8+/-7.4. The shortage of drugs prevented adequate management: 83% of HD patients had hemoglobin level less than 100 g/L but only 10.3 -17.8% were treated with rHuEpo; 64.5% of patients had phosphate levels higher than 1.7 mmol/L but only 33.5% used phosphate binders; 47% of patients had hypertension despite the antihypertensive therapy. The prevalence of hepatitis B remained unchanged (about 14%) in HD population during the last three years, but the prevalence of anti-HCV positive patients decreased (31-23%). In conclusion, there is a well developed dialysis service in Yugoslavia but insufficient conditions for adequate treatment.

  18. Long term end-stage renal disease and death following acute renal replacement therapy in the ICU

    DEFF Research Database (Denmark)

    Lohse, R.; Damholt, M. B.; Wiis, J.

    2016-01-01

    INTRODUCTION: In ICU the need for acute renal replacement therapy (RRT) associates with high mortality and risk of end-stage renal disease (ESRD), but there are limited long-term data. We investigated these outcomes and their risk factors. METHODS: Retrospective analysis of all adult patients...... admitted to a general, university hospital ICU 2005-2012, excluding chronic dialysis patients. ESRD was defined as need of RRT > 90 days or kidney transplant. RESULTS: Of 5766 patients included, 1004 (16%) received acute RRT; their 30-day mortality was 42% vs. 16% for those not requiring acute RRT...... (adjusted hazard ratio (HR) 1.13 (0.96-1.32)). The 90-day mortality was 55% for patients receiving acute RRT vs. 22% for those who did not (adjusted HR 1.32 (1.15-1.51)) and 1-year mortality was 63% vs. 30%, respectively, (adjusted HR 1.31 (1.16-1.48)). The 7-year risk of ESRD for ICU patients surviving 90...

  19. beta. /sub 2/-microglobulin radioimmunoassay in children with renal diseases

    Energy Technology Data Exchange (ETDEWEB)

    Ametov, A.S.; Gavryushova, L.P.; Tvorogova, T.M.; Petrova, T.V.; Larina, I.M.; Dunaeva, I.P. (Nauchno-Issledovatel' skij Inst. Rentgenologii i Radiologii, Moscow (USSR))

    1982-01-01

    A study of the level of the low-molecular protein ..beta../sub 2/- microglobulin in the blood and urine of 97 children with glomerulo- and pyelonephritis has shown its great fluctuations in the urine depending on the activity of a pyelonephritic process. A correlation has been found between its content in the urine and tubular functions. Dependence of the protein concentration in the blood and urine on the rate of glomerular filtration has been noted. Its level and some fractions of the complement show good correlation that can be indicative of the participation of this protein in the fixation of the afore-mentioned fractions in the formation of immune complexes which determine the severity of a pathological renal process.

  20. HIV and HCV Medications in End-Stage Renal Disease.

    Science.gov (United States)

    Greenberg, Keiko I; Perazella, Mark A; Atta, Mohamed G

    2015-01-01

    Human immunodeficiency virus (HIV) infection and hepatitis C virus (HCV) infection affect populations worldwide. With the availability of over 35 Food and Drug Administration approved medications for treatment of HIV, the morbidity and mortality associated with HIV has greatly improved. On the other hand, treatment options for HCV have been limited until very recently. While the use of protease inhibitors (such as boceprevir and telaprevir) has become standard of care for treatment of hepatitis C in the general population, data for individuals with impaired kidney function, particularly those on dialysis, are extremely limited. Use of medications in dialysis patients can be challenging given the dose adjustments that must be made for renally cleared molecules, and potentially increased impact of adverse effects such as anemia. Recommendations for dosing of marketed therapies for HIV and HCV are reviewed.

  1. [End stage renal disease lymphopenia; characterization and clinical correlation].

    Science.gov (United States)

    Lepe-Zúñiga, José Luis; Morales-Molina, Pedro; García-Nandayapa, Gabriela Alejandra

    2016-01-01

    Introducción: los pacientes con insuficiencia renal crónica en etapa terminal (ERET), presentan alteraciones inmunológicas diversas que los hacen más susceptibles a infecciones. Entre las alteraciones reportadas se encuentra la linfopenia. Se han realizado pocos estudios en nuestro medio que muestren la frecuencia y características de esta alteración así como su trascendencia clínica, relacionada con las infecciones que afectan a estos pacientes. Métodos: se analizó una serie de variables, incluyendo los valores de linfocitos y la presencia de infecciones, en un grupo de 190 pacientes con ERET de febrero 2008 a noviembre 2012. Se correlacionan y comparan los valores obtenidos entre ellos en dos momentos de su evolución: antes y durante su tratamiento dialítico. Resultados: en los pacientes con ERET, se obtuvo un perfil hematológico característico, caracterizado por anemia crónica severa, leucocitos totales normales o por arriba de lo normal y linfocitos normales o por debajo de lo normal (linfopenia). El grado de alteración hematológica correlacionó con el grado de afección renal y se corrigió en la medida que se corrigieron las alteraciones bioquímicas relacionadas con la ERET mediante diálisis peritoneal. Conclusiones: la linfopenia se encontró en cerca de la mitad de los pacientes con ERET y se asoció con el incremento de infecciones; el tipo de infecciones fue similar a lo observado en pacientes sin linfopenia y diferente al observado en pacientes con inmunodeficiencias primarias o adquiridas que afectan a los linfocitos.

  2. Biopsy-proven renal disease in Ile-Ife, Nigeria: A histopathologic review.

    Science.gov (United States)

    Onwubuya, I M; Adelusola, K A; Sabageh, D; Ezike, K N; Olaofe, O O

    2016-01-01

    Although various patterns of renal diseases have been reported from different renal biopsy registries worldwide, data from Nigeria remain scanty. A 10-year retrospective review of renal biopsies was conducted in our tertiary health care facility. All cases were reclassified based on their light microscopic features after the application of standard histochemical stains. A total of 165 cases were reviewed with a male:female ratio of 1.8:1 and a mean age of 15.4 ± 12.0 years. About 69.7% of the cases were below the age of 16 years, while only 2.4% were older than 50 years. The most common indications for biopsy were nephrotic syndrome (72.1%) and acute renal failure of unknown etiology (11.5%). Overall, glomerulonephritis (80%) was the most common histologic category and occurred only in individuals younger than 50 years old. Minimal change disease (22.9%) and membranoproliferative glomerulonephritis (21.9%) were the most common varieties in children, while membranous glomerulonephritis (30.6%) and focal segmental glomerulosclerosis (27.8%) were the commonest among the adult population. The initial histologic diagnosis was revised in 18 cases while a diagnosis was arrived at in seven cases initially adjudged as inadequate for assessment. This study showed that renal biopsy was predominantly performed in children and adolescents. Although glomerulonephritis was the predominant disease, the predominant histologic patterns varied with the patient age. Despite the scarcity of advanced diagnostic tools in resource-poor environments, routine use of histochemical stains is helpful in the evaluation of renal biopsies.

  3. Copious Podocyturia without Proteinuria and with Normal Renal Function in a Young Adult with Fabry Disease

    Science.gov (United States)

    Trimarchi, H.; Canzonieri, R.; Muryan, A.; Schiel, A.; Forrester, M.; Karl, A.; Lombi, F.; Andrews, J.; Pomeranz, V.; Rengel, T.; Zotta, E.

    2015-01-01

    The time for starting a patient with Fabry disease on enzyme replacement therapy is still a matter of debate, particularly when no overt classical clinical signs or symptoms are present. With respect to Fabry nephropathy, a dual problem coexists: the reluctance of many nephrologists to start enzyme replacement infusion until signs of renal disease appear as the appearance of proteinuria or an elevation in serum creatinine and the lack of validated biomarkers of early renal damage. In this regard, proteinuria is nowadays considered as an early and appropriate marker of kidney disease and of cardiovascular morbidity and mortality. However, in this report we demonstrate that podocyturia antedates the classical appearance of proteinuria and could be considered as an even earlier biomarker of kidney damage. Podocyturia may be a novel indication for the initiation of therapy in Fabry disease. PMID:26064721

  4. Copious Podocyturia without Proteinuria and with Normal Renal Function in a Young Adult with Fabry Disease

    Directory of Open Access Journals (Sweden)

    H. Trimarchi

    2015-01-01

    Full Text Available The time for starting a patient with Fabry disease on enzyme replacement therapy is still a matter of debate, particularly when no overt classical clinical signs or symptoms are present. With respect to Fabry nephropathy, a dual problem coexists: the reluctance of many nephrologists to start enzyme replacement infusion until signs of renal disease appear as the appearance of proteinuria or an elevation in serum creatinine and the lack of validated biomarkers of early renal damage. In this regard, proteinuria is nowadays considered as an early and appropriate marker of kidney disease and of cardiovascular morbidity and mortality. However, in this report we demonstrate that podocyturia antedates the classical appearance of proteinuria and could be considered as an even earlier biomarker of kidney damage. Podocyturia may be a novel indication for the initiation of therapy in Fabry disease.

  5. Renal papillary necrosis in patients with sickle cell disease: How to recognize this 'forgotten' diagnosis.

    Science.gov (United States)

    Henderickx, Michaël M E L; Brits, Tim; De Baets, Karen; Seghers, Mattias; Maes, Philip; Trouet, Dominique; De Wachter, Stefan; De Win, Gunter

    2017-06-01

    Renal papillary necrosis is not commonly seen in daily practice, but can have severe consequences when it is not diagnosed in time. It is known to be associated with sickle cell hemoglobinopathies; however a wide range of etiologies are possible, and it is therefore not the first diagnosis clinicians consider in patients with sickle cell disease who present with hematuria. A literature search was performed to summarize the current knowledge about renal papillary necrosis associated with sickle cell disease. These findings are illustrated with a case of a 9-year old girl with sickle cell disease who was referred with painless gross hematuria. Typical radiologic signs for renal papillary necrosis are necrotic cavities that fill with contrast, small collections of contrast peripheral to the calyces in the papillary region (ball-on-tee sign), calcification of the papillary defect, filling defects, hydronephrosis, blunted papillary tip, clefts in the renal medulla filled with contrast, hyperattenuated medullary calcifications, non-enhanced lesions surrounded by rings of excreted contrast, and clubbed calyces. This study focuses on the pathophysiology of renal papillary necrosis associated with sickle cell disease, the possible symptoms, as well as the diagnostic steps, with a special interest in particular presentation on old (retrograde pyelography) and new (computed tomography) gold standard in radiologic imaging, and the management for this pathology. This study aims to remind clinicians of this "forgotten" diagnosis and what signs to look for in pediatric patients with sickle cell disease who present with hematuria. In pediatric cases radiation protection is important, therefore knowing what radiologic signs can be found on retrograde pyelography can lead to early identification of this pathology without having to proceed to computed tomography. Copyright © 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  6. Diagnosis and Treatment of Low Testosterone among patients with End-Stage Renal Disease

    OpenAIRE

    Bao, Yeran; Johansen, Kirsten L.

    2014-01-01

    The prevalence of low testosterone level is particularly high among patients with end-stage renal disease (ESRD) and has been associated with mortality. In populations without ESRD, low testosterone level has also been associated with a number of morbidities including cardiovascular disease, diabetes mellitus, low muscle mass, low bone mass, low physical performance, and frailty. However, there is controversy regarding what constitutes low testosterone level in the aging population and at wha...

  7. Hemorrhagic Fever with Renal Syndrome: Diagnostic Problems with a Known Disease

    OpenAIRE

    Wichmann, Dominic; Slenczka, Werner; Alter, Peter; Boehm, Stephan; Feldmann, Heinz

    2001-01-01

    Hemorrhagic fever with renal syndrome (HFRS), caused by different hantaviruses, is a distinct clinical syndrome endemic in several parts of Asia and Europe. However, the clinical picture can sometimes be indistinguishable from that of other infectious or noninfectious diseases. In this report we describe a clinical case, which is a rare occurrence but is a prime example of the difficulties in the diagnosis of HFRS in areas with a low prevalence of the disease.

  8. Monolobar Caroli’s disease with renal cysts: Case report

    Directory of Open Access Journals (Sweden)

    Shruti Thakur

    2014-03-01

    Full Text Available Caroli’s disease is autosomal recessive, non-obstructive dilatation of intrahepatic biliary ducts. The exact etiology is unclear. Two variants of Caroli’s disease are well known-simple; in which bile ducts are dilated without hepatic fibrosis and the second type which is associated with congenital hepatic fibrosis along with its sequelae, also known as Caroli’s syndrome. Simple Caroli’s disease without hepatic fibrosis is quite rare. The importance of recognizing this disease as a cause of biliary stasis is its frequent association with lithiasis, recurrent cholangitis, liver abscesses, cirrhosis and cholangiocarcinoma.

  9. Measurement of renal function in patients with chronic kidney disease.

    Science.gov (United States)

    Sandilands, Euan A; Dhaun, Neeraj; Dear, James W; Webb, David J

    2013-10-01

    Chronic kidney disease affects millions of people worldwide and is associated with an increased morbidity and mortality as a result of kidney failure and cardiovascular disease. Accurate assessment of kidney function is important in the clinical setting as a screening tool and for monitoring disease progression and guiding prognosis. In clinical research, the development of new methods to measure kidney function accurately is important in the search for new therapeutic targets and the discovery of novel biomarkers to aid early identification of kidney injury. This review considers different methods for measuring kidney function and their contribution to the improvement of detection, monitoring and treatment of chronic kidney disease.

  10. Hydrogen sulfide in renal physiology, disease and transplantation - The smell of renal protection

    NARCIS (Netherlands)

    Koning, Anne M.; Frenay, Anne-Roos S.; Leuvenink, Henri G. D.; van Goor, Harry

    2015-01-01

    Hydrogen sulfide (H2S), the third gasotransmitter, next to nitric oxide and carbon monoxide, is a key mediator in physiology and disease. It is involved in homeostatic functions, such as blood pressure control, electrolyte balance and apoptosis, and regulates pathological mechanisms, including

  11. CUBN as a novel locus for end-stage renal disease : insights from renal transplantation

    NARCIS (Netherlands)

    Reznichenko, Anna; Snieder, Harold; van den Born, Jacob; de Borst, Martin H; Damman, Jeffrey; van Dijk, Marcory C R F; van Goor, Harry; Hepkema, Bouke G; Hillebrands, Jan-Luuk; Leuvenink, Henri G D; Niesing, Jan; Bakker, Stephan J L; Seelen, Marcus; Navis, Gerjan

    2012-01-01

    Chronic kidney disease (CKD) is a complex disorder. As genome-wide association studies identified cubilin gene CUBN as a locus for albuminuria, and urinary protein loss is a risk factor for progressive CKD, we tested the hypothesis that common genetic variants in CUBN are associated with end-stage r

  12. CUBN as a novel locus for end-stage renal disease: insights from renal transplantation.

    NARCIS (Netherlands)

    Reznichenko, A.; Snieder, H.; Born, J. van den; Borst, M.H. de; Damman, J.; Dijk, M.C.R.F. van; Goor, H. van; Hepkema, B.G.; Hillebrands, J.L.; Leuvenink, H.G.; Niesing, J.; Bakker, S.J.; Seelen, M.; Navis, G.

    2012-01-01

    Chronic kidney disease (CKD) is a complex disorder. As genome-wide association studies identified cubilin gene CUBN as a locus for albuminuria, and urinary protein loss is a risk factor for progressive CKD, we tested the hypothesis that common genetic variants in CUBN are associated with end-stage r

  13. Hydrogen sulfide in renal physiology, disease and transplantation - The smell of renal protection

    NARCIS (Netherlands)

    Koning, Anne M.; Frenay, Anne-Roos S.; Leuvenink, Henri G. D.; van Goor, Harry

    2015-01-01

    Hydrogen sulfide (H2S), the third gasotransmitter, next to nitric oxide and carbon monoxide, is a key mediator in physiology and disease. It is involved in homeostatic functions, such as blood pressure control, electrolyte balance and apoptosis, and regulates pathological mechanisms, including oxida

  14. Urinary fibrinogen and renal tubulointerstitial fibrinogen deposition: Discriminating between primary FSGS and minimal change disease.

    Science.gov (United States)

    Wang, Yu; Zheng, Chunxia; Xu, Feng; Liu, Zhihong

    2016-09-23

    Primary focal segmental glomerulosclerosis (FSGS) and minimal change disease (MCD) are common types of primary glomerular disease; they share numerous clinical and pathological similarities but have different treatment regimens and prognoses. It is therefore necessary to distinguish between them and to explore the mechanism underlying their differences. Fibrinogen is reportedly involved in podocyte damage and in renal fibrosis in vitro and in animal models of kidney disease. We thus tested urinary fibrinogen, serum fibrinogen, and renal fibrinogen deposition levels in a cohort comprising 50 patients with FSGS and 40 patients with MCD. Our results suggested that urinary fibrinogen and renal interstitial fibrinogen deposition levels were significantly higher in the FSGS patients than in the MCD patients, while serum fibrinogen levels did not differ between the groups. Receiver operating characteristic (ROC) curve analysis showed an excellent diagnostic ability for urinary fibrinogen and a fair diagnostic ability for tubulointerstitial fibrinogen deposition in differentiating FSGS from MCD. Additionally, we found that urinary fibrinogen levels were positively correlated with the 24-h urine protein levels in patients with FSGS but not in patients with MCD. In conclusion, urinary fibrinogen and renal interstitial fibrinogen deposition is elevated in primary FSGS compared to MCD, which may be relevant to both diagnosis and pathogenesis.

  15. Renal function markers and thyroid hormone status in undialyzed chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Balaji Rajagopalan

    2013-01-01

    Full Text Available Objective: The study was undertaken to quantify thyroid hormones in undialyzed chronic kidney disease patients’ verses controls and to study the correlation between renal function markers and thyroid hormones. Background: Chronic kidney disease (CKD is associated with a higher prevalence of primary hypothyroidism (HT, but at the same studies on thyroid hormone status in uremic patients has reported conflicting results. Methods: Thyroid hormones and renal function parameters like serum urea, creatinine, creatinine clearance, total protein and albumin were estimated and correlations between thyroid hormones and renal function parameters were studied in 60 undialyzed chronic kidney disease patients’ verses 100 healthy controls. Results: We found both T3 and T4 were significantly reduced (p<0.0001 for T3 and 0.007 for T4 whereas TSH remains to be unchanged in patient group compared to controls. We also observed that urea and creatinine were negatively correlated whereas creatinine clearance was positively correlated with both T3 and T4 that has high statistical (two-tailed significance at 0.01 level. But urea alone is negatively correlated with TSH that has statistical (two-tailed significance at 0.05 level. Conclusion: From our data, we speculate that renal insufficiency may lead to thyroid hormone disturbances.

  16. Factor analysis of dynamic structures (FADS) in the diagnosis of the renal disease

    Energy Technology Data Exchange (ETDEWEB)

    Macleod, M.A.; Houston, A.S.

    1989-09-01

    Factor analysis of dynamic structures (FADS) has been used in the interpretation of dynamic scintigraphic studies since the technique was described by Bazin et al. (1980). This study was designed to analyse to what extent, if any, does physiological factor analysis of dynamic renal data really help the clinician and by how much the method improves the diagnostic accuracy when compared to deconvolution analysis and parenchymal transit time (PTT) measurements. One hundred and fifty patients who were clinically, biochemically and radiologically investigated for renal disease were included in the study. Fifty of these were found to have no clinical evidence of renal disease, 50 were diagnosed as having non obstructive kidney disease and 50 had evidence of renal obstruction. Data obtained from /sup 99m/Tc-DTPA renography were processed using deconvolution (with PTTs) and physiological factor analysis and the results compared by ROC analysis. Clinically the information gained from factor analysis was superior to that obtained from deconvolution with PTT measurements in that a more accurate differentiation between an obstructive nephropathy and an obstructive uropathy was obtained. It is considered that physiological factor analysis enhances the clinical information obtained from renography, increases diagnostic accuracy and obviates the need for diuresis renography. (orig.).

  17. Tempol, a Superoxide Dismutase-Mimetic Drug, Ameliorates Progression of Renal Disease in CKD Mice

    Directory of Open Access Journals (Sweden)

    Wei Ding

    2015-07-01

    Full Text Available Background: Oxidative stress has been implicated in the pathogenesis of chronic kidney disease (CKD and antioxidants may ameliorate disease progression. We investigate the beneficial effect of Tempol, a superoxide dismutase-mimetic drug, on progression of disease in a mouse model of CKD. Methods: CKD was surgically induced in c57BL/6 mice by 5/6 nephrectomy. Mice were randomly divided into 3 groups: sham group, 5/6 nephrectomized group (Nx and Nx+Tempol (2 mmol/l in drinking water. Mice were sacrificed at the end of 12 weeks. Renal function, structure as well as expression of key molecules involved in the pathogenesis of inflammation, fibrosis and progression in mice were measured. Results: Reduced body weight and impaired renal function (elevation on serum creatinine, blood urea nitrogen, urine albumin, segmental sclerosis and tubulointerstitial damage was demonstrated in Nx mice but was significantly improved by Tempol administration. Nx animals exhibited significantly elevated proinflammatory and profibrotic factors, activation of NF-κB, increased expression of NADPH oxidase related subunits (p47phox, p67phox, gp91phox, and elevated activation of TGF-ß/Smad3, EGFR, MAPK signaling pathway. Tempol inhibited NF-κB mediated inflammation, TGF-ß/Smad3-induced renal fibrosis as well as EGFR and MAPK signaling pathway activation. Conclusions: Tempol administration attenuated renal injury in CKD mice through NF-κB, TGF-ß/Smad3, redox-senstive EGFR activation and c-Raf/MEK/ERK pathways.

  18. The Spectrum of Glomerular Diseases on Renal Biopsy: Data From A Single Tertiary Center In Oman

    Directory of Open Access Journals (Sweden)

    Dawood Al Riyami

    2013-05-01

    Full Text Available Objective: To study the pattern of glomerular disease (GD from the result of renal biopsies at our center.Methods: We conducted a retrospective review of 190 adult native renal biopsy reports from the pathology registry of renal biopsy performed at our hospital between 1992 and 2010.Results: Lupus nephritis was the most common pathology 48/133 (36.1% with a female preponderance. The most common primary glomerular disease was focal segmental glomerulosclerosis (FSGS 26/133(19.5%, followed by membranous glemerulopathy (MGN 13/133 (9.8%, and mesangial proliferative glomerulonephritis 6/133 (4.5%. IgA nephropathy and acute proliferative glomerulonephritis each accounted for 4/133 (3.0%. Membranoproliferative glomerulonephritis accounted for 3/133 (2.3%. Focal proliferative and cresentic glomerulonephritis each accounted for 2/133 (1.5%. Vasculitis was not common and there was no report of anti-GBM disease.Conclusion: Among the secondary glomerular diseases, lupus nephritis was the commonest condition with a female preponderance. Among the primary glomerular diseases, FSGS was the commonest. These results are consistent with global trend. IgA nephropathy is not common as the case in the Caucasian population. Vasculitis was not common and there was no report of anti-GBM disease.

  19. Diffusion-weighted imaging in assessing renal pathology of chronic kidney disease: A preliminary clinical study

    Energy Technology Data Exchange (ETDEWEB)

    Li, Qinghai; Li, Jinning; Zhang, Lan; Chen, Ying; Zhang, Minming [Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009 (China); Yan, Fuhua, E-mail: zemylife@163.com [Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025 (China)

    2014-05-15

    Objective: To investigate the clinical potential of diffusion-weighted imaging (DWI) in assessing renal pathology of chronic kidney disease (CKD). Methods: Seventy-one CKD patients and twelve healthy volunteers were examined using DWI with prospective acquisition correction. Renal biopsy specimens from the CKD patients were scored based on the severity of renal pathology and to confirm pathology type. CKD patients were divided into three groups according to pathology scores: mild, moderate, or severe. The association between renal apparent diffusion coefficient (ADC) values and pathology scores was investigated using Pearson's correlation and single factor analysis of variance. Multiple linear regression analysis was performed to explore associations between renal ADC values and pathology score, glomerular filtration rate, serum creatinine, and age. The Kruskal–Wallis H test was conducted to compare ADC values and pathology type. Results: Renal ADC values correlated negatively with pathology scores (r = −0.633, P < 0.001). The ADC values among the four groups (mild, moderate, severe impairment, and controls) were significantly different (F = 19.512, P < 0.001). However, when patients were stratified by pathology type, no significant differences were found in ADC values among these groups (χ{sup 2} = 9.929, P = 0.270). Further multiple linear regression analysis showed that only the pathology score and ADC values were related (t = −4.586, P = 0.000). Conclusions: DWI has clinical potential in assessing the severity of renal pathology in CKD and shows promise as a non-invasive and effective technique to guide therapy and follow-up.

  20. Renal Abnormalities in Patients with Sickle Cell Disease: A Single Center Report from Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Aleem Aamer

    2008-01-01

    Full Text Available Patients with sickle cell disease (SCD are at increased risk of serious morbidity and mortality. Renal abnormalities in SCD are well known but renal involvement in Saudi patients with SCD has not been studied. We sought to identify renal abnormalities in adolescent and adult Saudi patients with SCD. We prospectively studied 73 patients with SCD followed up at King Khalid University Hospital, Riyadh, Saudi Arabia from July 2005 to November 2006,. All patients underwent evaluation of kidney function and urine examination to detect proteinuria and other urinary abnormalities. In addition, 53 patients from the cohort had 24-hour urine collection to measure creatinine clearance and to quantitate proteinuria. The patient population consisted of 34 males (46.5% and 39 females (53.5% with a median age of 23 years (range 14-40. Proteinuria was present in 30 patients (41%. Creatinine clearance was low in 12 patients (22.5% and seven of these patients had low or low-normal serum creatinine despite reduced creatinine clearance. Low serum creatinine was common and present in 28 patients (38%. Two patients had chronic renal failure and one of them is on regular dialysis. Other abnormalities detected include hematuria in seven patients (8.5% and hemoglobinuria in 12 patients (14.5%. In conclusion, renal abnormalities are present in a significant number of Saudi patients with SCD and proteinuria is the most common abnormality. Serum creatinine may remain low or within low-normal range in SCD patients despite reduced creatinine clearance. As proteinuria is a risk factor for developing renal failure in future, routine screening of SCD patients is recommended for timely intervention in order to prevent or delay renal damage.

  1. [Molecular biology of renal cancer: bases for genetic directed therapy in advanced disease].

    Science.gov (United States)

    Maroto Rey, José Pablo; Cillán Narvaez, Elena

    2013-06-01

    There has been expansion of therapeutic options in the management of metastatic renal cell carcinoma due to a better knowledge of the molecular biology of kidney cancers. There are different tumors grouped under the term renal cell carcinoma, being clear cell cancer the most frequent and accounting for 80% of kidney tumors. Mutations in the Von Hippel-Lindau gene can be identified in up to 80% of sporadic clear cell cancer, linking a genetically inheritable disease where vascular tumors are frequent, with renal cell cancer. Other histologic types present specific alterations in molecular pathways, like c-MET in papillary type I tumors, and Fumarase Hydratase in papillary type II tumors. Identification of the molecular alteration for a specific tumor may offer an opportunity for treatment selection based on biomarkers, and, in the future, for developing an engineering designed genetic treatment.

  2. Captopril-induced sialadenitis in a patient with end-stage renal disease

    Science.gov (United States)

    Mahdiabadi, Fatemeh Musavi; Nikvarz, Naemeh

    2016-01-01

    Sialadenitis is a rare adverse effect of captopril. We report a case of captopril-induced sialadenitis in a patient with end-stage renal disease (ESRD). A 20-year-old man with ESRD encountered parotid and submandibular swelling after receiving two doses of captopril, administered sublingually. Despite of prescribing dexamethasone, resuming hemodialysis, and discontinuing other drugs that also can cause parotitis, he improved later than what was reported in patients with normal renal function. In conclusion recovery from captopril-induced sialadenitis in patients with ESRD may be more prolonged than that of patients with normal renal function; moreover, early hemodialysis which helps in drug removal may be the most effective treatment. PMID:27162811

  3. Treatment for end-stage renal disease: an organogenesis/tissue engineering odyssey.

    Science.gov (United States)

    Hammerman, Marc R

    2004-04-01

    The means by which kidney function can be replaced in humans with end-stage renal disease (ESRD) include dialytic therapies and renal allotransplantation. Dialysis, is lifesaving, but often poorly tolerated. Transplantation of human kidneys is limited by the availability of donor organs. During the past decades, several different approaches have been applied towards new means to replace renal function through organogenesis and tissue engineering. These include: (1) incorporation of new nephrons into the kidney; (2) growing new kidneys in situ; (3) use of stem cells; (4) generation of histocompatible tissues using nuclear transplantation; and (5) bioengineering of an artificial kidney. The development of these approaches has depended upon understanding and integrating discoveries made in a diversity of scientific disciplines. The means by which such integration has driven advances in the treatment of ESRD provides a generic roadmap for the successful application of organogenesis and tissue engineering to organ replacement therapy.

  4. Effect of bicarbonate supplementation on renal function and nutritional indices in predialysis advanced chronic kidney disease.

    Science.gov (United States)

    Jeong, Jiwon; Kwon, Soon Kil; Kim, Hye-Young

    2014-12-01

    Current practice guidelines recommend alkali therapy in patients with chronic kidney disease (CKD) and metabolic acidosis to prevent complications. This study aims to investigate the effect of oral sodium bicarbonate supplementation on the progression of renal function and nutritional indices in patients with predialysis advanced CKD. Forty patients with predialysis stage 5 CKD(estimated glomerular filtration rate, eGFR total lymphocyte count (TLC), and Ondodera's prognostic nutritional index (OPNI) during the study between the two groups. In stage 5 CKD, there were significant differences in the changes of TLC and OPNI between the two groups. In conclusion, our results demonstrate that bicarbonate supplementation slows the rate of decline of renal function in stage 4 CKD and improves nutritional indices in stage 5 CKD. Alkali therapy in advanced CKD may have beneficial effect on renal function and malnutrition.

  5. Renal cystic disease proteins play critical roles in the organization of the olfactory epithelium.

    Directory of Open Access Journals (Sweden)

    Jennifer L Pluznick

    Full Text Available It was reported that some proteins known to cause renal cystic disease (NPHP6; BBS1, and BBS4 also localize to the olfactory epithelium (OE, and that mutations in these proteins can cause anosmia in addition to renal cystic disease. We demonstrate here that a number of other proteins associated with renal cystic diseases - polycystin 1 and 2 (PC1, PC2, and Meckel-Gruber syndrome 1 and 3 (MKS1, MKS3 - localize to the murine OE. PC1, PC2, MKS1 and MKS3 are all detected in the OE by RT-PCR. We find that MKS3 localizes specifically to dendritic knobs of olfactory sensory neurons (OSNs, while PC1 localizes to both dendritic knobs and cilia of mature OSNs. In mice carrying mutations in MKS1, the expression of the olfactory adenylate cyclase (AC3 is substantially reduced. Moreover, in rats with renal cystic disease caused by a mutation in MKS3, the laminar organization of the OE is perturbed and there is a reduced expression of components of the odor transduction cascade (G(olf, AC3 and α-acetylated tubulin. Furthermore, we show with electron microscopy that cilia in MKS3 mutant animals do not manifest the proper microtubule architecture. Both MKS1 and MKS3 mutant animals show no obvious alterations in odor receptor expression. These data show that multiple renal cystic proteins localize to the OE, where we speculate that they work together to regulate aspects of the development, maintenance or physiological activities of cilia.

  6. New treatment for old disease: management of resistant hypertension by percutaneous renal sympathetic denervation.

    Science.gov (United States)

    Kanai, Takashi; Krum, Henry

    2013-09-01

    Hypertension is a major contributor to cardiovascular events, such as stroke and myocardial infarction, with accelerated sympathetic nerve activity implicated in its pathogenesis. However, hypertension in many patients is not adequately controlled, despite the availability of numerous medication classes. Novel procedure-as well as device-based strategies, such as percutaneous renal sympathetic nerve denervation therapy-have been developed to improve blood pressure in these refractory patients. Renal sympathetic denervation delivers not only a decrease in blood pressure levels but also renal as well as systemic sympathetic nerve activity. The reduction in blood pressure appears to be sustained over 3 years after the procedure, which implies no counterregulatory mechanism or re-innervation of afferent renal sympathetic nerve so far. Renal sympathetic denervation is expected to be a promising treatment for patients with hypertension, congestive heart failure, chronic kidney disease, and metabolic syndrome implicated in the pathogenesis of potentiated sympathetic nerve activity. This review will focus on the current devices and procedures, their outcomes and prospects in the treatment of hypertension.

  7. Bilateral multiple cystic kidney disease and renal cortical abscess in a Boerboel

    Directory of Open Access Journals (Sweden)

    A. M. Kitshoffa

    2011-04-01

    Full Text Available Cystic renal disease is rare in dogs and although infected renal cysts have been reported in humans, no report could be found in dogs. A 58 kg, 5-year-old, castrated, male Boerboel presented with weight loss, pyrexia, lethargy and vomiting, 20 months after an incident of haematuria was reported. The initial ultrasonographic diagnosis was bilateral multiple renal cysts of unknown aetiology. The cysts had significantly increased in size over the 20-month period and some contained echogenic specks which could be related to infection, normal cellular debris or haemorrhage. In both kidneys the renal contours were distorted (the left more than the right. The abnormal shape of the left kidney was largely due to multiple cysts and a large crescent-shaped septate mass on the cranial pole of the kidney. Aspirates of the septate mass were performed (left kidney and the cytology and culture were indicative of an abscess. It is suggested that the previous incident of haematuria provided a portal of entry for bacteria into the cysts resulting in renal cortical abscess formation.

  8. Angiotensin-converting enzyme inhibitors in the therapy of renal diseases.

    Science.gov (United States)

    Lefebvre, H P; Toutain, P L

    2004-10-01

    Renal diseases, especially chronic renal failure (CRF), are common in canine and feline medicine. The renin-angiotensin-aldosterone system (RAAS) plays a pivotal role in these conditions in the development of renal lesions and the progression of kidney dysfunction. Angiotensin-converting enzyme inhibitors (ACEI) are currently considered as the most efficient agents in therapeutic strategies. The benefit of an ACEI treatment can be explained by at least three mechanisms: ACEI limit systemic and glomerular capillary hypertension, have an antiproteinuric effect, and retard the development of glomerulosclerosis and tubulointerstitial lesions. These effects have been studied in dogs and cats, and there is now some evidence to support the recommendation of ACEI therapy in dogs and cats with CRF. Nevertheless the prescription of ACEI in such patients should take into account the potential influence of renal impairment on ACEI disposition, and adverse effects on the renal function itself (especially hypotension and acute reductions in glomerular filtration rate). The risk of drug interaction with diuretics, nonsteroidal anti-inflammatory drugs and anesthetics, should not be overestimated. Furthermore, hypotension may occur in patients on a low sodium diet.

  9. Renal distribution of Vasohibin-1 in patients with chronic kidney disease.

    Science.gov (United States)

    Hinamoto, Norikazu; Maeshima, Yohei; Saito, Daisuke; Yamasaki, Hiroko; Tanabe, Katsuyuki; Nasu, Tatsuyo; Watatani, Hiroyuki; Ujike, Haruyo; Kinomura, Masaru; Sugiyama, Hitoshi; Sonoda, Hikaru; Kanomata, Naoki; Sato, Yasufumi; Makino, Hirofumi

    2014-01-01

    Experimental studies have demonstrated the involvement of angiogenesis-related factors in the progression of chronic kidney disease (CKD). There have so far been no reports investigating the distribution and clinical roles of Vasohibin-1 (VASH-1), a negative feedback regulator of angiogenesis, in CKD. We recruited 54 Japanese CKD patients and 6 patients who had normal renal tissues excised due to localized renal cell carcinoma. We evaluated the correlations between the renal expression level of VASH-1 and the clinical/histological parameters. VASH-1 was observed in renal endothelial/mesangial cells, crescentic lesions and interstitial inflammatory cells. Significant positive correlations were observed between 1) crescent formation and the number of VASH-1+ cells in the glomerulus (r=0.48, p=0.001) or cortex (r=0.64, p<0.0001), 2) interstitial cell infiltration and the number of VASH-1+ cells in the cortex (r=0.34, p=0.02), 3) the glomerular VEGFR-2+ area and the number of VASH-1+ cells in the glomerulus (r=0.44, p=0.01) or medulla (r=0.63, p=0.01). These results suggest that the renal levels of VASH-1 may be affected by local inflammation, crescentic lesions and VEGFR-2.

  10. Endogenous ouabain in renal Na(+) handling and related diseases.

    Science.gov (United States)

    Manunta, Paolo; Messaggio, Elisabetta; Casamassima, Nunzia; Gatti, Guido; Carpini, Simona Delli; Zagato, Laura; Hamlyn, John M

    2010-12-01

    The Na(+) pump and its Endogenous modulator Ouabain (EO) can be considered as an ancestral enzymatic system, conserved among species ranging from Drosophila to humans, related to Na handling. In this review, we examine how EO is linked with vascular function in hypertension and if it impacts the pathogenesis of heart and renal failure. Moreover, the molecular mechanism of endogenous ouabain-linked hypertension involves the sodium pump/sodium-calcium exchanger duet. Biosynthesis of EO occurs in adrenal glands and is under the control of angiotensin II, ACTH and epinephrine. Elevated concentrations of EO and in the sub-nanomolar concentration range were found to stimulate proliferation and differentiation of cardiac and smooth muscle cells. They may have a primary role in the development of cardiac dysfunction and failure. Experimental data suggest that the Na/K-ATPase α(2)-catalytic subunit causes EO-induced vasoconstriction. Finally, maneuvers that promote Na depletion, as diuretic therapy or reduced Na intake, raise the EO levels. Taken together, these findings suggest a key role for EO in body Na homeostasis.

  11. Introduction of Renal Key Performance Indicators Associated with Increased Uptake of Peritoneal Dialysis in a Publicly Funded Health Service.

    Science.gov (United States)

    Toussaint, Nigel D; McMahon, Lawrence P; Dowling, Gregory; Holt, Stephen G; Smith, Gillian; Safe, Maria; Knight, Richard; Fair, Kathleen; Linehan, Leanne; Walker, Rowan G; Power, David A

    2017-01-01

    ♦ BACKGROUND: Increased demand for treatment of end-stage kidney disease has largely been accommodated by a costly increase in satellite hemodialysis (SHD) in most jurisdictions. In the Australian State of Victoria, a marked regional variation in the uptake of home-based dialysis suggests that use of home therapies could be increased as an alternative to SHD. An earlier strategy based solely on increased remuneration had failed to increase uptake of home therapies. Therefore, the public dialysis funder adopted the incidence and prevalence of home-based dialysis therapies as a key performance indicator (KPI) for its health services to encourage greater uptake of home therapies. ♦ METHODS: A KPI data collection and bench-marking program was established in 2012 by the Victorian Department of Health and Human Services, with data provided monthly by all renal units in Victoria using a purpose-designed website portal. A KPI Working Group was responsible for analyzing data each quarter and ensuring indicators remained accurate and relevant and each KPI had clear definitions and targets. We present a prospective, observational study of all dialysis patients in Victoria over a 4-year period following the introduction of the renal KPI program, with descriptive analyses to evaluate the proportion of patients using home therapies as well as home dialysis modality survival. ♦ RESULTS: Following the introduction of the KPI program, the net growth of dialysis patient numbers in Victoria remained stable over 4 years, at 75 - 80 per year (approximately 4%). However, unlike the previous decade, about 40% of this growth was through an increase in home dialysis, which was almost exclusively peritoneal dialysis (PD). The increase was identified particularly in the young (20 - 49) and the elderly (> 80). Disappointingly, however, 67% of these incident patients ceased PD within 2 years of commencement, 46% of whom transferred to SHD. ♦ CONCLUSIONS: Introduction of a KPI program

  12. Cardiovascular disease and renal insufficiency:special considerations with cardiac surgery

    Institute of Scientific and Technical Information of China (English)

    Colin Lenihan; Donal Reddan

    2005-01-01

    Cardiovascular disease is an important cause of mortality in the chronic kidney disease (CKD) population. This review discusses cardiac surgery in the CKD population and considers ostoperative acute renal failure (ARF). CKD patients have worse outcomes following coronary artery bypass grafting (CABG) and cardiac valvular surgery than the general population. However,surgical revascularization is an effective treatment for coronary artery disease (CAD) in this population and may be associated with improved survival over percutaneous intervention (PCI) in advanced CKD. Cardiac surgery in the CKD population requires careful perioperative planning and management. Acute renal failure (ARF) is a serious complication following cardiac surgery, occurring in 1 to 8% of cases. Management of postoperative ARF is largely supportive and emphasis is placed on preoperative risk stratification and prevention.

  13. End-stage renal disease in Tunisian infants: Etiology and outcome.

    Science.gov (United States)

    Jellouli, M; Boussetta, A; Abidi, K; Hammi, Y; Zarrouk, C; Gargah, T

    2016-01-01

    End stage renal disease (ESRD) in infants has particular features in terms of etiologies and therapeutic modalities. The aim of our study is to describe the etiologies and the ESRD outcomes among Tunisian infants. This retrospective study was conducted over 15 years (from January 1998 to December 31, 2013) in the Pediatric Department at Charles Nicolle Hospital. In total, 157 pediatric patients had ESRD. The mean incidence was 4.25 million children. The study involved 24 infants; the sex ratio was equal to 2. The mean age at diagnosis of ESRD was 8 months (range, 1-21 months). Growth retardation was noticed in 14 patients. The main causes were Congenital Anomalies of the Kidneys and Urinary Tract (9 infants) and hereditary renal disease (9 infants). All patients were treated with peritoneal dialysis; 16 infants presented peritonitis. Mortality rate was about 28%. The leading causes of death were cardiovascular diseases and infections.

  14. Developmental Origins of Chronic Renal Disease: An Integrative Hypothesis

    Directory of Open Access Journals (Sweden)

    F. Boubred

    2013-01-01

    Full Text Available Cardiovascular diseases are one of the leading causes of mortality. Hypertension (HT is one of the principal risk factors associated with death. Chronic kidney disease (CKD, which is probably underestimated, increases the risk and the severity of adverse cardiovascular events. It is now recognized that low birth weight is a risk factor for these diseases, and this relationship is amplified by a rapid catch-up growth or overfeeding during infancy or childhood. The pathophysiological and molecular mechanisms involved in the “early programming” of CKD are multiple and partially understood. It has been proposed that the developmental programming of arterial hypertension and chronic kidney disease is related to a reduced nephron endowment. However, this mechanism is still discussed. This review discusses the complex relationship between birth weight and nephron endowment and how early growth and nutrition influence long term HT and CKD. We hypothesize that fetal environment reduces moderately the nephron number which appears insufficient by itself to induce long term diseases. Reduced nephron number constitutes a “factor of vulnerability” when additional factors, in particular a rapid postnatal growth or overfeeding, promote the early onset of diseases through a complex combination of various pathophysiological pathways.

  15. Serum aldosterone and death, end-stage renal disease, and cardiovascular events in blacks and whites: findings from the Chronic Renal Insufficiency Cohort (CRIC) Study.

    Science.gov (United States)

    Deo, Rajat; Yang, Wei; Khan, Abigail M; Bansal, Nisha; Zhang, Xiaoming; Leonard, Mary B; Keane, Martin G; Soliman, Elsayed Z; Steigerwalt, Susan; Townsend, Raymond R; Shlipak, Michael G; Feldman, Harold I

    2014-07-01

    Prior studies have demonstrated that elevated aldosterone concentrations are an independent risk factor for death in patients with cardiovascular disease. Limited studies, however, have evaluated systematically the association between serum aldosterone and adverse events in the setting of chronic kidney disease. We investigated the association between serum aldosterone and death and end-stage renal disease in 3866 participants from the Chronic Renal Insufficiency Cohort. We also evaluated the association between aldosterone and incident congestive heart failure and atherosclerotic events in participants without baseline cardiovascular disease. Cox proportional hazards models were used to evaluate independent associations between elevated aldosterone concentrations and each outcome. Interactions were hypothesized and explored between aldosterone and sex, race, and the use of loop diuretics and renin-angiotensin-aldosterone system inhibitors. During a median follow-up period of 5.4 years, 587 participants died, 743 developed end-stage renal disease, 187 developed congestive heart failure, and 177 experienced an atherosclerotic event. Aldosterone concentrations (per SD of the log-transformed aldosterone) were not an independent risk factor for death (adjusted hazard ratio, 1.00; 95% confidence interval, 0.93-1.12), end-stage renal disease (adjusted hazard ratio, 1.07; 95% confidence interval, 0.99-1.17), or atherosclerotic events (adjusted hazard ratio, 1.04; 95% confidence interval, 0.85-1.18). Aldosterone was associated with congestive heart failure (adjusted hazard ratio, 1.21; 95% confidence interval, 1.02-1.35). Among participants with chronic kidney disease, higher aldosterone concentrations were independently associated with the development of congestive heart failure but not for death, end-stage renal disease, or atherosclerotic events. Further studies should evaluate whether mineralocorticoid receptor antagonists may reduce adverse events in individuals with

  16. Review of eprodisate for the treatment of renal disease in AA amyloidosis

    Directory of Open Access Journals (Sweden)

    Javaid MM

    2012-02-01

    Full Text Available Adam Rumjon1, Thomas Coats1, Muhammad M Javaid21Department of Nephrology, King's College Hospital NHS Foundation Trust, London, 2Department of Nephrology, Dartford and Gravesham NHS Trust, Darent Valley Hospital, Dartford, UKAbstract: Secondary (AA amyloidosis is a multisystem disorder complicating chronic infections or inflammatory diseases. It is characterized by extracellular deposit of fibrils composed of fragments of serum amyloid A (SAA, an acute phase reactant protein. The kidney is the most frequent organ involved, manifesting as progressive proteinuria and renal impairment. Attenuation of the level of circulating SAA protein by treating the underlying inflammatory condition remains the primary strategy in treating AA amyloidosis. However, at times, achieving adequate control of protein production can prove difficult. In addition, relapse of renal function often occurs rapidly following any subsequent inflammatory stimulus in patients with existing amyloidosis. Recently there has been an interest in finding other potential strategies targeting amyloid deposits themselves. Eprodisate is a sulfonated molecule with a structure similar to heparan sulfate. It competitively binds to the glycosaminoglycan-binding sites on SAA and inhibits fibril polymerization and amyloid deposition. Recent randomized clinical trial showed that it may slow down progressive renal failure in patients with AA amyloidosis. However confirmatory studies are needed and results of a second Phase III study are eagerly awaited to clarify whether or not eprodisate has a place in treating renal amyloid disease.Keywords: AA amyloidosis, eprodisate, pathogenesis

  17. Role of Epigenetic Histone Modifications in Diabetic Kidney Disease Involving Renal Fibrosis

    Directory of Open Access Journals (Sweden)

    Jing Sun

    2017-01-01

    Full Text Available One of the commonest causes of end-stage renal disease is diabetic kidney disease (DKD. Renal fibrosis, characterized by the accumulation of extracellular matrix (ECM proteins in glomerular basement membranes and the tubulointerstitium, is the final manifestation of DKD. The TGF-β pathway triggers epithelial-to-mesenchymal transition (EMT, which plays a key role in the accumulation of ECM proteins in DKD. DCCT/EDIC studies have shown that DKD often persists and progresses despite glycemic control in diabetes once DKD sets in due to prior exposure to hyperglycemia called “metabolic memory.” These imply that epigenetic factors modulate kidney gene expression. There is evidence to suggest that in diabetes and hyperglycemia, epigenetic histone modifications have a significant effect in modulating renal fibrotic and ECM gene expression induced by TGF-β1, as well as its downstream profibrotic genes. Histone modifications are also implicated in renal fibrosis through its ability to regulate the EMT process triggered by TGF-β signaling. In view of this, efforts are being made to develop HAT, HDAC, and HMT inhibitors to delay, stop, or even reverse DKD. In this review, we outline the latest advances that are being made to regulate histone modifications involved in DKD.

  18. Hypertensive Retinopathy as the First Manifestation of Advanced Renal Disease in a Young Patient: Report of a Case

    Science.gov (United States)

    Arriozola-Rodríguez, Karen Janeth; Serna-Ojeda, Juan Carlos; Martínez-Hernández, Virginia Alejandra; Rodríguez-Loaiza, José Luis

    2015-01-01

    The purpose of this paper was to report the case of a 23-year-old patient suffering from bilateral acute visual loss who received the diagnosis of hypertensive retinopathy. After systemic evaluation, he was diagnosed with bilateral renal disease and chronic renal failure, requiring a kidney transplantation to manage the systemic illness, followed by gradual improvement of his visual acuity. PMID:26955342

  19. The risk of developing end-stage renal disease in patients with type 2 diabetes and nephropathy : The RENAAL Study

    NARCIS (Netherlands)

    Keane, WF; Brenner, BM; de Zeeuw, D; Grunfeld, JP; McGill, J; Mitch, WE; Ribeiro, AB; Shahinfar, S; Simpson, RL; Snapinn, SM; Toto, R

    Background. Diabetic nephropathy has become the single most important cause of end-stage renal disease (ESRD) worldwide. Strategies to slow the rate of loss of renal function in these patients have been developed. We examined the risk factors that predict loss of kidney function (doubling of serum

  20. Safety and efficacy of liraglutide in patients with type 2 diabetes and end-stage renal disease

    DEFF Research Database (Denmark)

    Idorn, Thomas; Knop, Filip K; Jørgensen, Morten;

    2013-01-01

    Diabetes is the leading cause of end-stage renal disease (ESRD). Owing to renal clearance, several antidiabetic agents cannot be used in patients with ESRD. The present protocol describes an investigator-initiated trial aiming to test safety and efficacy of treatment with the glucagon-like peptide...

  1. Nontraditional cardiovascular risk factors in end-stage renal disease : studies on inflammatory markers and thyroid hormones

    NARCIS (Netherlands)

    Meuwese, Christiaan Lucas

    2014-01-01

    Patients with end-stage renal disease have an approximate eight fold increased mortality rate due to cardiovascular causes as compared with individuals of equal age and sex without renal dysfunction. Whereas traditional cardiovascular risk factors (such as smoking, hypertension and obesity) fail to

  2. Accepting or declining dialysis : considerations taken into account by elderly patients with end-stage renal disease

    NARCIS (Netherlands)

    Visser, Annemieke; Dijkstra, G.J.; Kuiper, D.; de Jong, P.E.; Franssen, C.F.; Gansevoort, R.T.; Izaks, G.J.; Jager, K.J.; Reijneveld, S.A.

    2009-01-01

    Background: Elderly patients with end-stage renal disease have to make a difficult decision whether or not to start dialysis. This study explores the considerations taken into account by these patients in decision-making regarding renal replacement therapy. Method: In-depth interviews were conducted

  3. Franz Volhard and Theodor Fahr: achievements and controversies in their research in renal disease and hypertension.

    Science.gov (United States)

    Heidland, A; Gerabek, W; Sebekova, K

    2001-01-01

    The clinician, Franz Volhard, and the pathologist, Theodor Fahr, worked closely together in Mannheim from 1909 until 1915 and introduced a novel classification of renal diseases. In the monograph entitled 'Die Bright'sche Nierenkrankheit, Klinik, Pathologie und Atlas' (1914) they differentiated between degenerative (nephroses), inflammatory (nephritides) and arteriosclerotic (scleroses) diseases. Nephrosclerosis was divided into the benign and malignant form, of which the latter stood the test of time as a new disease entity. Fahr further divided benign nephrosclerosis into the compensated and decompensated form--depending on the presence or absence of glomerular injury. In the pathogenesis of malignant nephrosclerosis, Volhard stressed the decisive role of severe blood pressure elevation, while Fahr postulated an inflammatory mechanism, a concept later confirmed by Adalbert Bohle for at least a minority of patients. A very far reaching concept of Franz Volhard was his idea that pale (renal) hypertension results from a pressor substance released from ischaemic kidney(s) contributing--via a vicious circle--to a further rise in blood pressure with subsequent renovascular injury and aggravation of hypertension. This hypothesis was supported in 1930 by initial experiments of his collaborator, Hartwich (demonstrating in dogs a mild rise in blood pressure after ligation of branches of the renal artery) and definitively proven by Goldblatt (1934) in dogs by induction of severe and persistent hypertension after clamping of both renal arteries. The consequent detection of the renin angiotensin system was the final confirmation of Volhard's postulated renal pressor substance. In the pathogenesis of red (essential) hypertension, Volhard stressed the role of hereditary factors, age, obesity and potentially of severe alcoholism. He emphasised a premature reduction of vascular distensibility (due to elastosis of the prearterioles), a high cardiac output as well as a dampening of

  4. End-stage renal disease after treatment with {sup 90}Y-DOTATOC

    Energy Technology Data Exchange (ETDEWEB)

    Cybulla, M.; Weiner, S.M.; Otte, A. [Dept. of Internal Medicine, University Hospital Freiburg (Germany)

    2001-10-01

    DOTA-D-Phe{sup 1}-Tyr{sup 3}-octreotide (DOTATOC), a newly developed somatostatin analogue which can be stably labelled with the {beta}-emitter yttrium-90, can be used for receptor-mediated internal radiotherapy. A 78-year-old woman suffering from a carcinoid of the small intestine with multiple metastases in the liver as well as mesenteric and supraclavicular lymph node metastases was treated with this therapy after the disease had progressed under other chemotherapy options employed years previously. The patient received four single doses of {sup 90}Y-DOTATOC at 6-week intervals, yielding a cumulative dose of 9,620 MBq (5,659 MBq/m{sup 2}). Restaging revealed stable metastatic disease. Serum creatinine and urea nitrogen levels were within the normal range prior to starting and during DOTATOC therapy. However, 15 months after cessation of DOTATOC therapy, a progressive deterioration of renal function occurred, leading to end-stage renal disease. Urinalysis revealed a slight proteinuria of 700 mg/day without haematuria, leucocyturia or casts. There was no obvious risk factor for chronic renal insufficiency except DOTATOC therapy. However, it was not feasible to use kidney biopsy to prove the presence of radiation-induced nephritis. Intermittent haemodialysis was started as the creatinine clearance declined to below 10 ml/min. Diuresis was not affected. The presented case shows delayed renal insufficiency after a relatively low cumulative dose of {sup 90}Y-DOTATOC (5,659 MBq/m{sup 2}). This serious adverse event indicates that further studies are needed to evaluate which dose of {sup 90}Y-DOTATOC, under which renal protection regimen, will provide optimal management, balancing risks and benefits. (orig.)

  5. A survey of hospital outpatient services for chronic diseases in ...

    African Journals Online (AJOL)

    A survey of hospital outpatient services for chronic diseases in Gauteng. ... in particular aspects of the organisation of services, and indirect indicators of patient care. Design ... Management guidelines were used for all conditions in 5 hospitals.

  6. US Forest Service Forest Health Protection Insect and Disease Survey

    Data.gov (United States)

    US Forest Service, Department of Agriculture — This data is a compilation of forest insect, disease and abiotic damage mapped by aerial detection surveys on forested areas in the United States. US Forest Service,...

  7. Ageing Renal Patients: We Need More Collaboration between Geriatric Services and Nephrology Departments

    Directory of Open Access Journals (Sweden)

    Helen Alston

    2015-10-01

    Full Text Available There has been a significant increase in the number of frail older patients diagnosed with advanced chronic kidney disease (CKD over the past thirty years. These elderly patients have high levels of comorbidity, and as a consequence the face of renal medicine is changing—There is an increasing need to focus on traditionally geriatric areas of expertise such as falls prevention and rehabilitation, and to shift our emphasis onto improving patient well-being rather than longevity. Over the past decade, many nephrologists have found that they are already acting as de facto “amateur geriatricians”. This denies patients both the benefits of specialist geriatric assessment, and equally importantly denies them access to the wider geriatric multidisciplinary team. This article describes the prevalence and underlying causes of the so-called “Geriatric Giants” in patients with advanced CKD, and discusses possible improvements in care that closer working with geriatricians could bring.

  8. Efficacy and Complications of Ultrasound-Guided Percutaneous Renal Biopsy Using Automatic Biopsy Gun in Pediatric Diffuse Renal Disease: Analysis of 97 Cases

    Energy Technology Data Exchange (ETDEWEB)

    Han, Seung Min; Chung, Tae Woong; Yoon, Woong [Chonnam National University Hospital, Gwangju (Korea, Republic of)

    2007-09-15

    To evaluate the diagnostic efficacy and complications of ultrasound-guided percutaneous renal biopsy using automatic biopsy gun in patients with pediatric diffuse renal disease. Using an 18G automatic biopsy gun, biopsies were performed on 97 pediatric patients with clinically suspicious diffuse renal disease. The acquired tissue specimens were analyzed by photomicroscopy, immunofluorescence, and electron microscopy to support the diagnosis. In the 97 biopsies, the success of the histologic diagnosis, number of glomeruli, and complication rates were retrospectively evaluated by analyzing the variable exams and clinical records. Adequate tissue for histologic diagnosis was obtained in 91 of 97 biopsies (94%) and the mean number of glomeruli was 9.6. Complications such as minute pain, gross hematuria, and small perirenal hematoma presented in 22 of the 97 biopsies (23%), all of which either improved within 5-72 hours or did not need specific treatment. Ultrasound-guided percutaneous renal biopsy using 18G automatic biopsy gun is an effective and safe method for the histologic diagnosis of pediatric diffuse renal disease without any major complication

  9. Renal Cell Protection of Erythropoietin beyond Correcting The Anemia in Chronic Kidney Disease Patients.

    Science.gov (United States)

    Nasri, Hamid

    2014-01-01

    Currently many patients with chronic renal failure have profited from the use of erythropoietin to correct anemia (1,2). In chronic kidney disease, anemia is believed to be a surrogate index for tissue hypoxia that continues preexisting renal tissue injury (1-3). Erythropoietin is an essential glycoprotein that accelerates red blood cell maturation from erythroid progenitors and facilitates erythropoiesis. It is a 30.4 kD glycoprotein and class I cytokine containing 165 amino acids (3,4). Approximately 90% of systemic erythropoietin in adults is produced by peritubular interstitial fibroblasts in the renal cortex and outer medulla of the kidney (3-5). A feedback mechanism involving oxygen delivery to the tissues seems to regulate erythropoietin production. Hypoxia-inducible factor regulates transcription of the erythropoietin gene in the kidney, which determines erythropoietin synthesis (3-5). Erythropoietin is an essential glycoprotein that accelerates red blood cell maturation from erythroid progenitors and mediates erythropoiesis in the bone marrow (4-6). Kidney fibrosis is the last common pathway in chronic renal failure irrespective of the initial etiology (5,6). Constant inflammatory cell infiltration and pericyte-myofibroblast transition lead to renal fibrosis and insufficiency which result in decreased production of erythropoietin (4-7). Thus far, therapeutic efforts to treat patients with chronic renal failure by administering erythropoietin have been made only to correct anemia and putative hypoxic tissue damage. The introduction of recombinant human erythropoietin has marked a significant advance in the management of anemia associated with chronic renal failure (6-9). With an increasing number of patients with chronic renal failure receiving erythropoietin treatment, emerging evidence suggests that erythropoietin not only has an erythropoietic function, but also has renoprotective potential. In fact, in recent years, the additional non

  10. Enhanced propagation of adult human renal epithelial progenitor cells to improve cell sourcing for tissue-engineered therapeutic devices for renal diseases.

    Science.gov (United States)

    Westover, Angela J; Buffington, Deborah A; Humes, H D

    2012-08-01

    Renal cell therapy employing cells derived from adult renal epithelial cell (REC) progenitors promises to reduce the morbidity of patients with renal insufficiency due to acute renal failure and end stage renal disease. To this end, tissue engineered devices addressing the neglected biologic component of renal replacement therapy are being developed. Because human donor tissue is limited, novel enhanced progenitor cell propagation (EP) techniques have been developed and applied to adult human kidney transplant discards from six donors. Changes include more efficient digestion and the amplification of progenitors prior to terminal epithelial differentiation promoted by contact inhibition and the addition of retinoic acid. Differentiated morphology in EP populations was demonstrated by the ability to form polarized epithelium with tight junctions, apical central cilia and expression of brush border membrane enzymes. Evaluation of lipopolysaccharide stimulated interleukin-8 secretion and γ-glutamyl transpeptisade activity in EP derived cells was used to confirm therapeutic equivalence to REC obtained using published techniques, which have previously shown efficacy in large animal models and clinical trials. Yield exceeded 10(16) cells/gram cortex from the only kidney obtained due to an anatomical defect, while the average yield from diseased kidneys ranged from 1.1 × 10(9) to 8.8 × 10(11) cells/gram cortex, representing an increase of more than 10 doublings over standard methods. Application of the EP protocol to REC expansion has solved the problem of cell sourcing as the limiting factor to the manufacture of cell based therapies targeting renal diseases and may provide a method for autologous device fabrication from core kidney biopsies. Copyright © 2012 John Wiley & Sons, Ltd.

  11. Temporal profile of the renal transcriptome of HIV-1 transgenic mice during disease progression.

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    Ying Fan

    Full Text Available Profiling of temporal changes of gene expression in the same kidney over the course of renal disease progression is challenging because repeat renal biopsies are rarely indicated in clinical practice. Here, we profiled the temporal change in renal transcriptome of HIV-1 transgenic mice (Tg26, an animal model for human HIV-associated nephropathy (HIVAN, and their littermates at three different time points (4, 8, and 12 weeks of age representing early, middle, and late stages of renal disease by serial kidney biopsy. We analyzed both static levels of gene expression at three stages of disease and dynamic changes in gene expression between different stages. Analysis of static and dynamic changes in gene expression revealed that up-regulated genes at the early and middle stages are mostly involved in immune response and inflammation, whereas down-regulated genes mostly related to fatty acid and retinoid metabolisms. We validated the expression of a selected panel of genes that are up-regulated at the early stage (CCL2, CCL5, CXCL11, Ubd, Anxa1, and Spon1 by real-time PCR. Among these up-regulated genes, Spon1, which is a previously identified candidate gene for hypertension, was found to be up-regulated in kidney of human with diabetic nephropathy. Immunostaining of human biopsy samples demonstrated that protein expression of Spon1 was also markedly increased in kidneys of patients with both early and late HIVAN and diabetic nephropathy. Our studies suggest that analysis of both static and dynamic changes of gene expression profiles in disease progression avails another layer of information that could be utilized to gain a more comprehensive understanding of disease progression and identify potential biomarkers and drug targets.

  12. Anorexia in end-stage renal disease: pathophysiology and treatment.

    Science.gov (United States)

    Aguilera, A; Selgas, R; Diéz, J J; Bajo, M A; Codoceo, R; Alvarez, V

    2001-11-01

    Anorexia is a frequent complication of uraemic syndrome, which contributes to malnutrition in dialysis patients. Uraemic anorexia has been associated with many factors. This paper reviews the current knowledge about mechanisms responsible for uraemic anorexia, the treatments and new drugs used to control the loss of appetite. Traditionally, anorexia in dialysis patients has been considered as a sign of uraemic toxicity, therefore, two hypotheses have been proposed, the 'middle molecule' and 'peak-concentration' hypotheses, both of which are still unproved. Recently, our group proposed the tryptophan-serotonin hypothesis, which is based on a disorder in the amino acid profile acquired in the uraemic status. This is characterised by low concentrations of large neutral and branched chain amino acids (LNAA/BCAA) in the cerebrospinal fluid. This situation permits a high level of tryptophan transport across the blood-brain barrier, causing an increase in the synthesis of serotonin (responsible for appetite inhibition). There are two main treatment targets for anorexia in dialysis patients. The first is to decrease the free plasma tryptophan concentration and transport across the blood brain barrier to the cerebrospinal fluid, thus decreasing the intracerebral serotonin levels. Nutritional formulae enriched with LNAA and BCAA have this effect. Secondly, plasma levels of cytokines with cachectin effect (TNF-alpha), should be decreased. This also induces a decrease in LNAA and BCAA levels. In this group are megestrol acetate, anti-TNF-alpha antibodies, thalidomide, pentoxifyilline, n-3 fatty acids and possibly nandrolone decanoate. Additionally, other targets should be explored including antagonists of cholecystokinin (a potent anorexigen retained by renal failure), analogues of neuropeptide Y (the most potent orexigen), cannabinoids, cyproheptadine, hydrazine sulfate. In conclusion, uraemic anorexia is a complex complication associated with malnutrition, high morbidity and

  13. Acute renal failure unmasking Lesch-Nyhan disease in a patient with tuberous sclerosis complex.

    Science.gov (United States)

    Thumfart, Julia; Weschke, Bernhard; Ringe, Hannelore; Weinhold, Natalie; Müller, Dominik

    2016-07-01

    We report on a male patient with Tuberous Sclerosis Complex (TSC), which was prenatally diagnosed. At the age of 3 months the patient developed acute renal failure with excessive hyperuricemia. Kidney function improved after rehydration and application of rasburicase, however without full recovery. Due to the inappropriate high levels of uric acid compared to kidney function, screening of hypoxanthine-guanine phosphoribosyltransferase (HPRT) related diseases was initiated. Mutation analysis revealed a deletion of exon 2 and 3 of the HPRT gene confirming the diagnosis of Lesch-Nyhan Disease (LND). After initiation of allopurinol therapy renal function further improved. In the following months the patient developed clinically a typical neurological phenotype of LND and TSC with seizures, severe dystonia and developmental delay. Acute renal failure is a rare complication of HPRT related diseases. Combination of two inherited diseases may lead to a delayed diagnosis due to a mixed and maybe misleading phenotype. Copyright © 2016 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

  14. Thrombotic Microangiopathy in Inverted Formin 2-Mediated Renal Disease

    DEFF Research Database (Denmark)

    Challis, Rachel C; Ring, Troels; Xu, Yaobo

    2017-01-01

    and her mother also had Charcot-Marie-Tooth disease. Using whole-exome sequencing, we identified a mutation in the inverted formin 2 gene (INF2) in the mutational hotspot for FSGS. Subsequent analysis of the Newcastle aHUS cohort identified another family with a functionally-significant mutation in INF2...

  15. RENAL COMPLICATIONS IN GLYCOGEN-STORAGE-DISEASE TYPE-I

    NARCIS (Netherlands)

    REITSMABIERENS, WCC

    1993-01-01

    Deficiency of the enzyme glucose-6-phosphatase is the biochemical defect in glycogen storage disease type I (GSD I). Normally this enzyme is present in the liver, intestine and kidneys. The lack of the enzyme in the kidney makes it obvious that glycogen storage will not be restricted to the liver bu

  16. Relative risk of renal disease among people living with HIV: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Islam Fakhrul M

    2012-03-01

    Full Text Available Abstract Background Antiretroviral therapy (ART has substantially decreased mortality and HIV-related morbidity. However, other morbidities appear to be more common among PLHIV than in the general population. This study aimed to estimate the relative risk of renal disease among people living with HIV (PLHIV compared to the HIV-uninfected population. Methods We conducted a systematic review and meta-analysis of relative risks of renal disease among populations of PLHIV reported in studies from the peer-reviewed literature. We searched Medline for relevant journal articles published before September 2010, yielding papers published during or after 2002. We also searched conference proceedings of the International AIDS Society (IAS and Conference on Retroviruses and Opportunistic Infections (CROI prior to and including 2010. Eligible studies were observational studies reporting renal disease defined as acute or chronic reduced renal function with glomerular filtration rate less than or equal to 60 ml/min/1.73 m2 among HIV-positive adults. Pooled relative risks were calculated for various groupings, including class of ART drugs administered. Results The overall relative risk of renal disease was 3.87 (95% CI: 2.85-6.85 among HIV-infected people compared to HIV-uninfected people. The relative risk of renal disease among people with late-stage HIV infection (AIDS was 3.32 (1.86-5.93 compared to other PLHIV. The relative risk of renal disease among PLHIV who were receiving antiretroviral therapy (ART was 0.54 (0.29-0.99 compared to treatment-naïve PLHIV; the relative risk of renal disease among PLHIV who were treated with tenofovir was 1.56 (0.83-2.93 compared to PLHIV who were treated with non-tenofovir therapy. The risk of renal disease was also found to significantly increase with age. Conclusion PLHIV are at increased risk of renal disease, with greater risk at later stages of infection and at older ages. ART prolongs survival and decreases the

  17. Changes in renal function after discontinuation of vitamin D analogues in advanced chronic kidney disease.

    Science.gov (United States)

    Caravaca, Francisco; Caravaca-Fontán, Fernando; Azevedo, Lilia; Luna, Enrique

    2017-07-01

    In routine clinical practice, the prescription of vitamin D analogues (VDA) in patients with chronic kidney disease (CKD) is often associated with a decline of the estimated renal function. The reason for this is not fully understood. To analyse the effects of VDA discontinuation in advanced CKD and to determine the factors associated with changes in renal function. Retrospective cohort study of adult patients with advanced CKD. The case subgroup was treated with VDA and this medication was discontinued at baseline (the first visit). The control subgroup was not treated with VDA and they were selected according to comparability principles for CKD progression by propensity score matching. The primary outcome measure was a change to both the estimated glomerular filtration rate (MDRD-GFR) and the measured glomerular filtration rate (mGFR by combined creatinine and urea clearances). Baseline parameters related to mineral metabolism and creatinine generation were analysed as potential determinants of renal function changes. The study sample consisted of 67 cases and 67 controls. Renal function improved in 67% of cases and worsened in 72% of controls (prenal function recovery (Odds ratio=3.49; p=0.001), and of the extent of renal function recovery (beta=0.276; p=0.001). Discontinuation of VDA treatment in CKD patients is associated with significant recovery of estimated renal function. The extent of these changes is mainly associated with baseline total serum calcium. Copyright © 2017 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  18. Simultaneous management of renal carcinoma with caval vein thrombosis and double coronary artery disease

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    Marco Grasso

    2013-12-01

    Full Text Available Introduction: Recent advances in surgical and anesthesiology techniques allow simultaneous thoracic and abdominal operations to be performed for severe heart disease and benignant or malignant abdominal diseases. Case report: The simultaneous surgical management in a 75-year-old patient suffering from severe double coronary artery disease and a renal cell carcinoma with extended intravascular growth into the inferior vena cava is reported. Conclusion: The postoperative course was uneventful. Simultaneous surgery proved to be beneficial and safe, showing optimal results in our patient.

  19. Independent Role of Underlying Kidney Disease on Renal Prognosis of Patients with Chronic Kidney Disease under Nephrology Care.

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    Luca De Nicola

    Full Text Available Primary kidney disease is suggested to affect renal prognosis of CKD patients; however, whether nephrology care modifies this association is unknown. We studied patients with CKD stage I-IV treated in a renal clinic and with established diagnosis of CKD cause to evaluate whether the risk of renal event (composite of end-stage renal disease and eGFR decline ≥ 40% linked to the specific diagnosis is modified by the achievement or maintenance in the first year of nephrology care of therapeutic goals for hypertension (BP ≤ 130/80 mmHg in patients with proteinuria ≥ 1 50 mg/24h and/or diabetes and ≤ 140/90 in those with proteinuria <150 mg/24h and without diabetes anemia (hemoglobin, Hb ≥ 11 g/dL, and proteinuria (≤ 0.5 g/24h. Survival analysis started after first year of nephrology care. We studied 729 patients (age 64 ± 15 y; males 59.1%; diabetes 34.7%; cardiovascular disease (CVD 44.9%; hypertensive nephropathy, HTN 53.8%; glomerulonephritis, GN 17.3%; diabetic nephropathy, DN 15.9%; tubule-interstitial nephropathy, TIN 9.5%; polycystic kidney disease, PKD 3.6%. During first year of Nephrology care, therapy was overall intensified in most patients and prevalence of main therapeutic goals generally improved. During subsequent follow up (median 3.3 years, IQR 1.9-5.1, 163 renal events occurred. Cox analysis disclosed a higher risk for PKD (Hazard Ratio 5.46, 95% Confidence Intervals 2.28-10.6 and DN (1.28,2.99-3.05, versus HTN (reference, independently of age, gender, CVD, BMI, eGFR or CKD stage, use of RAS inhibitors and achievement or maintenance in the first year of nephrology care of each of the three main therapeutic goals. No interaction was found on the risk of CKD progression between diagnostic categories and month-12 eGFR (P=0.737, as with control of BP (P=0.374, Hb (P=0.248 or proteinuria (P=0.590. Therefore, in CKD patients under nephrology care, diagnosis of kidney disease should be considered in conjunction with the main

  20. Independent Role of Underlying Kidney Disease on Renal Prognosis of Patients with Chronic Kidney Disease under Nephrology Care.

    Science.gov (United States)

    De Nicola, Luca; Provenzano, Michele; Chiodini, Paolo; Borrelli, Silvio; Garofalo, Carlo; Pacilio, Mario; Liberti, Maria Elena; Sagliocca, Adelia; Conte, Giuseppe; Minutolo, Roberto

    2015-01-01

    Primary kidney disease is suggested to affect renal prognosis of CKD patients; however, whether nephrology care modifies this association is unknown. We studied patients with CKD stage I-IV treated in a renal clinic and with established diagnosis of CKD cause to evaluate whether the risk of renal event (composite of end-stage renal disease and eGFR decline ≥ 40%) linked to the specific diagnosis is modified by the achievement or maintenance in the first year of nephrology care of therapeutic goals for hypertension (BP ≤ 130/80 mmHg in patients with proteinuria ≥ 1 50 mg/24h and/or diabetes and ≤ 140/90 in those with proteinuria nephrology care. We studied 729 patients (age 64 ± 15 y; males 59.1%; diabetes 34.7%; cardiovascular disease (CVD) 44.9%; hypertensive nephropathy, HTN 53.8%; glomerulonephritis, GN 17.3%; diabetic nephropathy, DN 15.9%; tubule-interstitial nephropathy, TIN 9.5%; polycystic kidney disease, PKD 3.6%). During first year of Nephrology care, therapy was overall intensified in most patients and prevalence of main therapeutic goals generally improved. During subsequent follow up (median 3.3 years, IQR 1.9-5.1), 163 renal events occurred. Cox analysis disclosed a higher risk for PKD (Hazard Ratio 5.46, 95% Confidence Intervals 2.28-10.6) and DN (1.28,2.99-3.05), versus HTN (reference), independently of age, gender, CVD, BMI, eGFR or CKD stage, use of RAS inhibitors and achievement or maintenance in the first year of nephrology care of each of the three main therapeutic goals. No interaction was found on the risk of CKD progression between diagnostic categories and month-12 eGFR (P=0.737), as with control of BP (P=0.374), Hb (P=0.248) or proteinuria (P=0.590). Therefore, in CKD patients under nephrology care, diagnosis of kidney disease should be considered in conjunction with the main risk factors to refine renal risk stratification.

  1. Renal Failure: A Modern Semiology for an Old Disease.

    Science.gov (United States)

    Nasuto, Michelangelo; Pansini, Vittorio; Cortet, Bernard; Guglielmi, Giuseppe; Cotten, Anne

    2016-09-01

    Chronic kidney disease (CKD) is a complex systemic disease that induces mineral metabolic dysfunction leading to bone fragility and tissue calcifications. Bone abnormalities in CKD can include increased bone turnover and resorption due to secondary hyperparathyroidism, decreased bone turnover and bone formation, defective bone mineralization, or a mixed pattern of these abnormalities. Other features of musculoskeletal involvement include synovial, tendon, and ligament thickening due to β2-microglobulin amyloidosis, soft tissue masses, or axial and peripheral arthropathies. The accurate assessment of bone involvement in early-stage CKD is crucial for the success of therapeutic interventions. We summarize the key semiologic features of bone abnormalities in CKD and review musculoskeletal complications as depicted by conventional radiography, computed tomography, magnetic resonance, and ultrasound imaging. We also discuss different experimental diagnostic approaches developed for the purpose of identifying changes in bone quality and structure in early-stage CKD. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  2. [Itai-itai disease: cadmium-induced renal tubular osteomalacia].

    Science.gov (United States)

    Aoshima, Keiko

    2012-01-01

    Cadmium (Cd) is one of the most toxic elements to which humans could be exposed at work or in the environment. The outbreak of itai-itai disease, which is the most severe stage of chronic Cd poisoning, occurred in the Cd-polluted Jinzu River basin in Toyama. In this area, the river was contaminated by slag from a mine upstream; as a consequence, the soil in rice paddies was polluted with heavy metals including Cd through irrigation water from around 1910 to the 1960s. The government of Toyama prefecture carried out an extensive survey on Cd concentration in rice and soil of the paddy fields and declared that the upper layer of a total of 1500 ha of paddy fields should be replaced by nonpolluted soil. Then, an intervention program of soil replacement in the polluted paddy fields was continually carried out from 1980 to 2011. As a result, Cd concentration in rice markedly decreased. The kidney is the organ critically affected after long-term exposure to Cd. Proximal tubular dysfunction (RTD) has been found among the inhabitants of the Jinzu River basin. The very recent report by the Environmental Agency in Japan in 2009 has disclosed that b2-microglobulinuria with RTD is still found at a high prevalence among the inhabitants of the Jinzu River basin of both sexes. Twenty patients with itai-itai disease (1 male and 19 females), who attended our hospital and received medical examination during 2000 to 2008, had applied for recognition as itai-itai disease patients to the government of Toyama prefecture. In this paper, the recent epidemiological and clinical features of itai-itai disease are discussed on the basis of a review of the cases of these 19 female patients.

  3. Clinical Overview of Hepatitis C Patients with Terminal Renal Disease

    OpenAIRE

    Naylê Maria Oliveira da Silva; Ricardo do Carmo Zanella

    2015-01-01

    Hepatitis C is a serious public health issue, and it is estimated that 3% of the world’s population is infected. Patients in hemodialysis units have an increased risk for contracting HCV, and high prevalence rates have been found in hemodialysis units around the world. HCV induces chronic liver disease, which is characterized by a persistent hepatic parenchyma inflammatory process that may progress to cirrhosis and hepatocarcinoma. Viral clearance occurs in a minority of patients with viral h...

  4. Renal manifestations of human brucellosis: First report of minimal change disease

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    Nikolaos Sabanis

    2016-01-01

    Full Text Available Human brucellosis is considered a great example of the complexity of clinical manifestations possibly affecting multiple organs or systems. Renal manifestations of human brucellosis have been documented in few case reports and one case series. Herein, we present a case of Nephrotic syndrome (NS due to minimal change disease in the course of acute brucellosis. A 53-year-old male farmer was admitted to our department with acute brucellosis and NS. Renal biopsy revealed minimal change disease. Combined treatment with prednisone (1 mg/kg, rifampicin (600 mg/day, and doxycycline (200 mg/day was initiated. Complete remission of NS was achieved at the end of the fourth week. One year later, the patient remained in complete remission of NS without any sign of relapse of brucellosis.

  5. Renal manifestations of human brucellosis: First report of minimal change disease.

    Science.gov (United States)

    Sabanis, Nikolaos; Gavriilaki, Eleni; Paschou, Eleni; Tsotsiou, Eleni; Kalaitzoglou, Asterios; Kavlakoudis, Christos; Vasileiou, Sotirios

    2016-05-01

    Human brucellosis is considered a great example of the complexity of clinical manifestations possibly affecting multiple organs or systems. Renal manifestations of human brucellosis have been documented in few case reports and one case series. Herein, we present a case of Nephrotic syndrome (NS) due to minimal change disease in the course of acute brucellosis. A 53-year-old male farmer was admitted to our department with acute brucellosis and NS. Renal biopsy revealed minimal change disease. Combined treatment with prednisone (1 mg/kg), rifampicin (600 mg/day), and doxycycline (200 mg/day) was initiated. Complete remission of NS was achieved at the end of the fourth week. One year later, the patient remained in complete remission of NS without any sign of relapse of brucellosis.

  6. [Two cases of bilateral renal cell carcinoma in patients with Von Hipple-Lindau disease].

    Science.gov (United States)

    Matsukawa, Yoshihisa; Hattori, Ryohei; Komatsu, Tomonori; Yoshino, Yasushi; Ono, Yoshinari; Gotoh, Momokazu

    2007-01-01

    Von Hipple-Lindau (VHL) disease is a rare familial cancer syndrome that is dominantly inherited and pre-disposes affected individuals to developing various tumors, including hemangioblastoma of the retina and central nervous system, and multicentric renal cell carcinoma. We report two cases of VHL disease with bilateral renal cell carcinoma. Case 1: A 53-year-old woman was referred to our hospital because of bilateral kidney tumor incidentally found. We performed left laparoscopic radical nephrectomy and laparoscopic nephrectomy, ex vivo excision and reconstruction, and autotransplantation for the right kidney. Case 2: A 43-year-old woman was referred to our hospital because of left kidney tumor incidentally found. Because the suspectious lesion in the right kidney was very small, we decided to follow it up with no treatment. We performed laparoscopic nephrectomy, ex vivo excision and reconstruction, and autotransplantation for left kidney.

  7. Impact of Iodinated Contrast on Renal Function and Hemodynamics in Rats with Chronic Hyperglycemia and Chronic Kidney Disease.

    Science.gov (United States)

    Fernandes, Sheila Marques; Martins, Daniel Malisani; da Fonseca, Cassiane Dezoti; Watanabe, Mirian; Vattimo, Maria de Fátima Fernandes

    2016-01-01

    Iodinated contrast (IC) is clinically used in diagnostic and interventional procedures, but its use can result in contrast-induced acute kidney injury (CI-AKI). Chronic kidney disease (CKD) and chronic hyperglycemia (CH) are important predisposing factors to CI-AKI. The aim of this study was to investigate the impact of iodinated contrast on the renal function and hemodynamics in rats with chronic hyperglycemia and chronic kidney disease. A total of 30 rats were divided into six groups; Sham: control of chronic renal disease; Citrate: control of chronic hyperglycemia (CH); Nx5/6: rats with 5/6 nephrectomy; Chronic Hyperglycemia: rats receiving Streptozotocin 65 mg/kg; Nx5/6 + IC: rats Nx5/6 received 6 mL/kg of IC; CH + IC: Chronic hyperglycemia rats receiving 6 mL/kg of IC. Renal function (inulin clearance; urinary neutrophil gelatinase-associated lipocalin, NGAL) and hemodynamics (arterial blood pressure; renal blood flow; renal vascular resistance) were evaluated. Iodinated contrast significantly increased urinary NGAL and reduced inulin clearance, while the hemodynamics parameters showed changes in arterial blood pressure, renal blood flow, and renal vascular resistance in both CKD and CH groups. The results suggest that the iodinated contrast in risk factors models has important impact on renal function and hemodynamics. NGAL was confirmed to play a role of highlight in diagnosis of CI-AKI.

  8. Low birth weight is associated with earlier onset of end-stage renal disease in Danish patients with autosomal dominant polycystic kidney disease

    DEFF Research Database (Denmark)

    Orskov, Bjarne; Christensen, Karl Bang; Feldt-Rasmussen, Bo

    2012-01-01

    Low-birth-weight individuals have a higher risk of hypertension and end-stage renal disease (ESRD). Here we investigated whether low birth weight was associated with earlier onset of ESRD in patients with autosomal dominant polycystic kidney disease (ADPKD). In collaboration with all Danish depar...... birth weight may contribute to considerable phenotypic variability in the progression of renal disease between individuals with ADPKD....

  9. Current knowledge on helicobacter pylori infection in end stage renal disease patients

    Directory of Open Access Journals (Sweden)

    Khedmat Hossein

    2009-01-01

    Full Text Available Gastric infection with Helicobacter Pylori in end-stage renal disease patients is of rele-vance because of its potential impact on the quality of life as well as morbidity and mortality of patients. Existed data on the issue are controversial, and we attempt in this article to evaluate the available data to approach extended perception of the current knowledge on the epidemiology, relevance, and optimum therapeutic strategies.

  10. Coping with chronic illness: A study with end-stage renal disease patients

    OpenAIRE

    Cassaretto, Mónica; Paredes, Rosario

    2012-01-01

    This study identifies coping styles and strategies used by 40 end-stage renal disease patients over 20 years old who receive treatment in a general hospital in Peru. The instruments applied were a personal sociodemographic questionnaire and the Coping Inventory (Carver, Scheier & Weintraub, 1989). Results showed that emotion focused coping were most frequently used followed by problem focused coping. Planning, acceptance and positive reinterpretation-growth coping strategies were more frequen...

  11. Nucleic acids within urinary exosomes/microvesicles are potential biomarkers for renal disease

    OpenAIRE

    Miranda, Kevin C; Daniel T Bond; Mckee, Mary; Skog, Johan; Păunescu, Teodor G.; Da Silva, Nicolas; Brown, Dennis; Russo, Leileata M.

    2010-01-01

    Urinary exosomes or microvesicles are being studied intensively to identify potential new biomarkers for renal disease. We sought to identify whether these microvesicles contain nucleic acids. We isolated microvesicles from human urine in the same density range as that previously described for urinary exosomes and found them to have an RNA integrity profile similar to that of kidney tissue, including 18S and 28S rRNA. This profile was better preserved in urinary microvesicles compared with wh...

  12. A Meta-analysis of angitensin-converting enzyme inhibitors on normotensive early diabetic renal diseases

    Institute of Scientific and Technical Information of China (English)

    GENG Li; GU Ming-jun; LIU Zhi-min; FAN Cheng-hui

    2001-01-01

    To make a systematic assessment on whether the progression of early diabetic renal disease with normotension may be slowed down by angiotensin-converting enzyme (ACE) inhibitors. Methods: Randomized clinical experiments published on MEDLINE from January 1990 to April 1999 and on China Biological Medicine were reviewed for studying the effects of ACE-inhibitors on normotensive patients with early diabetic renal diseases. Based on the inclusion criteria, 10 studies were selected. Their results were combined and analyzed with RevMan3.1 software.Results: The pooled effect of urinary microalbumin excretion rate, systolic blood pressure, diastolic blood pressure and mean arterial blood pressure were -77.502 mg/24 h [-100.748 to-54.256], -5.002 mmHg [-9.630 to 0.685], -2.949mmHg [-4.005 to 1.892], -4.284 mmHg [-5.444 to 3.123] respectively. Using clinical albuminuria as the end-point. The pooled odd ratio was 0.27 [95% CI 0.18 0.40]. The sub-group analysis showed that those results had no difference between type 1 and type 2 diabetes. There was no significant correlation between the pooled effects of urinary micro-albuminuria excretion rate and systolic blood pressure, diastolic blood pressure or mean arterial blood pressure. Conclusion:ACE inhibitors can decline urinary micro-albuminuria excretion rate in normotensive patients with early diabetic renal disease and delay the progression of early diabetic renal disease to clinical albuminuria. These effects may not be dependent on its blood pressure-reduction effect.

  13. More on Renal Salt Wasting Without Cerebral Disease: Response to Saline Infusion

    OpenAIRE

    Bitew, Solomon; Imbriano, Louis; Miyawaki, Nobuyuki; Fishbane, Steven; Maesaka, John K.

    2009-01-01

    Background and objectives: The existence and prevalence of cerebral salt wasting (CSW) or the preferred term, renal salt wasting (RSW), and its differentiation from syndrome of inappropriate antidiuretic hormone (SIADH) have been controversial. This controversy stems from overlapping clinical and laboratory findings and an inability to assess the volume status of these patients. The authors report another case of RSW without clinical cerebral disease and contrast it to SIADH.

  14. Coping with chronic illness: A study with end-stage renal disease patients

    OpenAIRE

    Cassaretto, Mónica; Paredes, Rosario

    2012-01-01

    This study identifies coping styles and strategies used by 40 end-stage renal disease patients over 20 years old who receive treatment in a general hospital in Peru. The instruments applied were a personal sociodemographic questionnaire and the Coping Inventory (Carver, Scheier & Weintraub, 1989). Results showed that emotion focused coping were most frequently used followed by problem focused coping. Planning, acceptance and positive reinterpretation-growth coping strategies were more frequen...

  15. Direct conscious telemetry recordings demonstrate increased renal sympathetic nerve activity in rats with chronic kidney disease

    OpenAIRE

    Ibrahim M. Salman; Divya Sarma Kandukuri; Joanne Lesley Harrison; Cara Margaret Hildreth; Jacqueline Kathleen Phillips

    2015-01-01

    Chronic kidney disease (CKD) is associated with sympathetic hyperactivity and impaired blood pressure control reflex responses, yet direct evidence demonstrating these features of autonomic dysfunction in conscious animals is still lacking. Here we measured renal sympathetic nerve activity (RSNA) and mean arterial pressure (MAP) using telemetry-based recordings in a rat model of CKD, the Lewis Polycystic Kidney (LPK) rat, and assessed responses to chemoreflex activation and acute stress. Male...

  16. [Takayasu arteritis associated with heart valve diseases (pulmonary and aortic) and arteritis (coronary and renal)].

    Science.gov (United States)

    Rangel-Abundis, A; Fraga, A; Badui, E; Guijosa, N; Navarro, J

    1992-01-01

    The most severe arteritis due to Takayasu's disease are those related to renal and coronary arteries. The first one because it produces severe arterial hypertension and the second one because it puts the patient in high risk of suffering either myocardial ischemia or infarction. These situations worsen when this entity is associated to valvular heart lesions. The authors present the clinical cases of two female patients with Takayasu's disease. One of them in acute phase of the illness, where coronary arteritis, mild coarctation of the aorta, right pulmonary artery stenosis, and pulmonary valve stenosis were present. The second patient was seen during the remission phase of the disease with obstruction of the left subclavicular artery, renal arteritis, severe arterial hypertension and aortic valve insufficiency. The authors discuss the prognosis of patients with Takayasu's disease associated to valvular heart disease and its role in the etiology of pulmonary valvular stenosis. Finally, the authors point out the importance of recognizing the active and non active phases of the Takayasu's disease in relation of the adequate stage for surgical treatment of the lesions caused by this disease.

  17. Bidirectional relationship between renal function and periodontal disease in older Japanese women.

    Science.gov (United States)

    Yoshihara, Akihiro; Iwasaki, Masanori; Miyazaki, Hideo; Nakamura, Kazutoshi

    2016-09-01

    The purpose of this study was to evaluate the reciprocal effects of chronic kidney disease (CKD) and periodontal disease. A total of 332 postmenopausal never smoking women were enrolled, and their serum high-sensitivity C-reactive protein, serum osteocalcin and serum cystatin C levels were measured. Poor renal function was defined as serum cystatin C > 0.91 mg/l. Periodontal disease markers, including clinical attachment level and the periodontal inflamed surface area (PISA), were also evaluated. Logistic regression analysis was conducted to evaluate the relationships between renal function and periodontal disease markers, serum osteocalcin level and hsCRP level. The prevalence-rate ratios (PRRs) on multiple Poisson regression analyses were determined to evaluate the relationships between periodontal disease markers and serum osteocalcin, serum cystatin C and serum hsCRP levels. On logistic regression analysis, PISA was significantly associated with serum cystatin C level. The odds ratio for serum cystatin C level was 2.44 (p = 0.011). The PRR between serum cystatin C level and periodontal disease markers such as number of sites with clinical attachment level ≥6 mm was significantly positive (3.12, p periodontal disease can have reciprocal effects. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. Podocyturia: A Clue for the Rational Use of Amiloride in Alport Renal Disease

    Directory of Open Access Journals (Sweden)

    H. Trimarchi

    2016-01-01

    Full Text Available No specific or efficient treatment exists for Alport syndrome, an X-linked hereditary disease caused by mutations in collagen type IV, a crucial component of the glomerular basement membrane. Kidney failure is usually a major complication of the disease, and patients require renal replacement therapy early in life. Microhematuria and subsequently proteinuria are hallmarks of kidney involvement, which are due to primary basement membrane alterations that mainly cause endothelial thrombosis and podocyte contraction and ulterior irreversible detachment. Commonly drug-based approaches include angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, which are employed to reduce proteinuria and thus retard kidney disease progression and cardiovascular morbidity and mortality. However, as any hereditary disease, it is expressed as early as in the intrauterine life, and usually an index case is helpful to detect family-related cases. As no specific treatment exists, pathophysiologically based approaches are useful. The present case illustrates the reduction rate of urinary podocyte loss and proteinuria after amiloride administration and suggests the molecular pathways involved in Alport renal disease. Finally, podocyturia rather than proteinuria should be considered as an earlier biomarker of kidney involvement and disease progression in Alport disease.

  19. Podocyturia: A Clue for the Rational Use of Amiloride in Alport Renal Disease

    Science.gov (United States)

    Trimarchi, H.; Canzonieri, R.; Muryan, A.; Schiel, A.; Araoz, A.; Paulero, M.; Andrews, J.; Rengel, T.; Forrester, M.; Lombi, F.; Pomeranz, V.; Iriarte, R.; Zotta, E.

    2016-01-01

    No specific or efficient treatment exists for Alport syndrome, an X-linked hereditary disease caused by mutations in collagen type IV, a crucial component of the glomerular basement membrane. Kidney failure is usually a major complication of the disease, and patients require renal replacement therapy early in life. Microhematuria and subsequently proteinuria are hallmarks of kidney involvement, which are due to primary basement membrane alterations that mainly cause endothelial thrombosis and podocyte contraction and ulterior irreversible detachment. Commonly drug-based approaches include angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, which are employed to reduce proteinuria and thus retard kidney disease progression and cardiovascular morbidity and mortality. However, as any hereditary disease, it is expressed as early as in the intrauterine life, and usually an index case is helpful to detect family-related cases. As no specific treatment exists, pathophysiologically based approaches are useful. The present case illustrates the reduction rate of urinary podocyte loss and proteinuria after amiloride administration and suggests the molecular pathways involved in Alport renal disease. Finally, podocyturia rather than proteinuria should be considered as an earlier biomarker of kidney involvement and disease progression in Alport disease. PMID:26942026

  20. Manifestações cutâneas na doença renal terminal Cutaneous manifestations in end-stage renal disease

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    Omar Lupi

    2011-04-01

    Full Text Available A prevalência da doença renal crônica aumentou nos últimos anos. Os efeitos dessa doença são complexos e podem levar à disfunção de múltiplos órgãos, entre eles, a pele. A maioria dos pacientes apresenta pelo menos uma alteração dermatológica. Algumas vezes, esses sintomas podem ser o primeiro sinal evidente de doença renal. Este artigo aborda as manifestações cutâneas relacionadas a disfunção renal grave ou doença renal terminal, divididas em não específicas e específicas, revisando quadro clínico, etiopatogenia e opções terapêuticas dessas dermatoses. Seu reconhecimento e trata mento precoces diminuem a morbidade, melhorando a qualidade de vida desses doentes.The prevalence of chronic kidney disease has increased over the last years. The effects of this disease are complex and may lead to dysfunction of multiple organs, including the skin, with most patients presenting with at least one dermatologic alteration. Sometimes these symptoms can be the first clear sign of kidney disease. This article discusses the skin manifestations related to severe renal impairment or end-stage renal disease (ESRD, which are divided into nonspecific and specific, and reviews the clinical features, etiopathogenesis and therapeutic options for these dermatoses. Early recognition and treatment reduce morbidity and improve these patients' quality of life.

  1. Renal infarction resulting from traumatic renal artery dissection.

    Science.gov (United States)

    Kang, Kyung Pyo; Lee, Sik; Kim, Won; Jin, Gong Yong; Na, Ki Ryang; Yun, Il Yong; Park, Sung Kwang

    2008-06-01

    Renal artery dissection may be caused by iatrogenic injury, trauma, underlying arterial diseases such as fibromuscular disease, atherosclerotic disease, or connective tissue disease. Radiological imaging may be helpful in detecting renal artery pathology, such as renal artery dissection. For patients with acute, isolated renal artery dissection, surgical treatment, endovascular management, or medical treatment have been considered effective measures to preserve renal function. We report a case of renal infarction that came about as a consequence of renal artery dissection.

  2. Evaluation of circulating levels and renal clearance of natural amino acids in patients with Cushing's disease.

    Science.gov (United States)

    Faggiano, A; Pivonello, R; Melis, D; Alfieri, R; Filippella, M; Spagnuolo, G; Salvatore, F; Lombardi, G; Colao, A

    2002-02-01

    Although the hypercortisolism-induced impairment of protein homeostasis is object of several studies, a detailed evaluation of the complete amino acid profile of patients with Cushing's syndrome (CS) has never been performed. The aim of the current open transversal controlled study was to evaluate serum and urinary concentrations as well as renal clearance of the complete series of natural amino acids and their relationship with glucose tolerance in patients with Cushing's disease (CD). Twenty patients with CD (10 active and 10 cured) and 20 sex- and age-matched healthy controls entered the study. Measurement of serum and urinary levels of the complete series of natural amino acids was performed in all patients analyzed by cationic exchange high performance liquid cromatography (HPLC) after 2 weeks of a standardized protein intake regimen. The renal clearance (renal excretion rate) of each amino acid was calculated on the basis of the serum and urinary concentrations of creatinine and the specific amino acid. Fasting glucose and insulin levels, glucose and insulin response to standard glucose load, insulinogenic and homeostasis model insulin resistance (Homa-R) indexes were also evaluated and correlated to the circulating levels and renal clearances of each amino acid. Significantly higher serum (p<0.01) and urinary (p<0.05) levels of alanine and cystine, lower serum and higher urinary levels of leucine, isoleucine and valine (p<0.05) and higher renal excretion rates of leucine, isoleucine and valine (p<0.01) were found in patients with active CD than in patients cured from the disease and in controls. No difference was found between cured patients and controls. Creatinine clearance was similar in active and cured patients and in controls. In patients with active CD, urinary cortisol levels were significantly correlated to urinary cystine levels (r=0.85; p<0.01) and renal excretion rate of leucine (r=-0.76; p<0.05), isoleucine (r=-0.76; p<0.05) and valine (r=-0

  3. Large kidneys predict poor renal outcome in subjects with diabetes and chronic kidney disease

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    Vendrely Benoit

    2010-03-01

    Full Text Available Abstract Background Renal hypertrophy occurs early in diabetic nephropathy, its later value is unknown. Do large kidneys still predict poor outcome in patients with diabetes and Chronic Kidney Disease (CKD? Methods Seventy-five patients with diabetes and CKD according to a Glomerular Filtration Rate (GFR, by 51Cr-EDTA clearance below 60 mL/min/1.73 m2 or an Albumin Excretion Rate above 30 mg/24 H, had an ultrasound imaging of the kidneys and were cooperatively followed during five years by the Diabetology and Nephrology departments of the Centre Hospitalier Universitaire de Bordeaux. Results The patients were mainly men (44/75, aged 62 ± 13 yrs, with long-standing diabetes (duration:17 ± 9 yrs, 55/75 type 2, and CKD: initial GFR: 56.5 (8.5-209 mL/min/1.73 m2, AER: 196 (20-2358 mg/24 H. Their mean kidney lenght (108 ± 13 mm, 67-147 was correlated to the GFR (r = 0.23, p Conclusions Large kidneys still predict progression in advanced CKD complicating diabetes. In these patients, ultrasound imaging not only excludes obstructive renal disease, but also provides information on the progression of the renal disease.

  4. Differential expression of laminin isoforms in diabetic nephropathy and other renal diseases.

    Science.gov (United States)

    Setty, Suman; Michael, Alfred A; Fish, Alfred J; Michael Mauer, S; Butkowski, Ralph J; Virtanen, Ismo; Kim, Youngki

    2012-06-01

    Laminin a non-collagenous glycoprotein is a major component of the renal glomerular basement membrane and mesangium. Thus far eleven distinct chains have been described, permutations of which make up 15 laminin isoforms. Laminin molecules interact with cells and other matrix molecules during organ development and differentiation. We studied the distribution of laminin isoforms in patients with type 1 diabetic nephropathy, membranous nephropathy, membranoproliferative glomerulonephritis and IgA nephropathy/ Henoch-Schönlein purpura. Immunofluorescence microscopic studies with laminin-chain-specific antibodies to the α1, α2, α5, β1, β2 and γ1 chains detected α2, β1 and γ1 chain expression in the normal mesangium and α5, β2 and γ1 in normal glomerular basement membrane. Significantly, constituents of the glomerular basement membrane, α5, β2 and γ1 chains were overexpressed in kidneys with diabetic nephropathy. Initially the constituents of the mesangium increased commensurate with the degree of mesangial expansion and degree of diabetic nephropathy. Reduction in α2 chain intensity was observed with severe mesangial expansion and in the areas of nodular glomerulosclerosis. In addition, with late disease aberrant expression of α2 and β2 chains was observed in the mesangium. Glomerular basement membrane in renal disease overexpressed molecules normally present in that location. In summary, the alterations in basement membrane composition in various renal diseases seem to not only reflect the balance between synthesis and degradation of normal basement membrane constituents, but also their aberrant expression.

  5. Ex vivo exposure of bone marrow from chronic kidney disease donor rats to pravastatin limits renal damage in recipient rats with chronic kidney disease

    NARCIS (Netherlands)

    Koppen, A. van; Papazova, D.A.; Oosterhuis, N.R.; Gremmels, H.; Giles, R.H.; Fledderus, J.O.; Joles, J.A.; Verhaar, M.C.

    2015-01-01

    Introduction: Healthy bone marrow cell (BMC) infusion improves renal function and limits renal injury in a model of chronic kidney disease (CKD) in rats. However, BMCs derived from rats with CKD fail to retain beneficial effects, demonstrating limited therapeutic efficacy. Statins have been reported

  6. Ex vivo exposure of bone marrow from chronic kidney disease donor rats to pravastatin limits renal damage in recipient rats with chronic kidney disease

    NARCIS (Netherlands)

    van Koppen, Arianne; Papazova, Diana A.; Oosterhuis, Nynke R.; Gremmels, Hendrik; Giles, Rachel H.; Fledderus, Joost O.; Joles, Jaap A.; Verhaar, Marianne C.

    2015-01-01

    INTRODUCTION: Healthy bone marrow cell (BMC) infusion improves renal function and limits renal injury in a model of chronic kidney disease (CKD) in rats. However, BMCs derived from rats with CKD fail to retain beneficial effects, demonstrating limited therapeutic efficacy. Statins have been reported

  7. Inhibition of G0/G1 Switch 2 Ameliorates Renal Inflammation in Chronic Kidney Disease

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    Naoya Matsunaga

    2016-11-01

    Full Text Available Chronic kidney disease (CKD is a global health problem, and novel therapies to treat CKD are urgently needed. Here, we show that inhibition of G0/G1 switch 2 (G0s2 ameliorates renal inflammation in a mouse model of CKD. Renal expression of chemokine (C-C motif ligand 2 (Ccl2 was increased in response to p65 activation in the kidneys of wild-type 5/6 nephrectomy (5/6Nx mice. Moreover, 5/6Nx Clk/Clk mice, which carry homozygous mutations in the gene encoding circadian locomotor output cycles kaput (CLOCK, did not exhibit aggravation of apoptosis or induction of F4/80-positive cells. The renal expression of G0s2 in wild-type 5/6Nx mice was important for the transactivation of Ccl2 by p65. These pathologies were ameliorated by G0s2 knockdown. Furthermore, a novel small-molecule inhibitor of G0s2 expression was identified by high-throughput chemical screening, and the inhibitor suppressed renal inflammation in 5/6Nx mice. These findings indicated that G0s2 inhibitors may have applications in the treatment of CKD.

  8. A Spanish version for the new ERA-EDTA coding system for primary renal disease.

    Science.gov (United States)

    Zurriaga, Óscar; López-Briones, Carmen; Martín Escobar, Eduardo; Saracho-Rotaeche, Ramón; Moina Eguren, Íñigo; Pallardó Mateu, Luis; Abad Díez, José María; Sánchez Miret, José Ignacio

    2015-01-01

    The European Renal Association and the European Dialysis and Transplant Association (ERA-EDTA) have issued an English-language new coding system for primary kidney disease (PKD) aimed at solving the problems that were identified in the list of "Primary renal diagnoses" that has been in use for over 40 years. In the context of Registro Español de Enfermos Renales (Spanish Registry of Renal Patients, [REER]), the need for a translation and adaptation of terms, definitions and notes for the new ERA-EDTA codes was perceived in order to help those who have Spanish as their working language when using such codes. Bilingual nephrologists contributed a professional translation and were involved in a terminological adaptation process, which included a number of phases to contrast translation outputs. Codes, paragraphs, definitions and diagnostic criteria were reviewed and agreements and disagreements aroused for each term were labelled. Finally, the version that was accepted by a majority of reviewers was agreed. A wide agreement was reached in the first review phase, with only 5 points of discrepancy remaining, which were agreed on in the final phase. Translation and adaptation into Spanish represent an improvement that will help to introduce and use the new coding system for PKD, as it can help reducing the time devoted to coding and also the period of adaptation of health workers to the new codes. Copyright © 2015 The Authors. Published by Elsevier España, S.L.U. All rights reserved.

  9. Renal failure (chronic)

    OpenAIRE

    Clase, Catherine

    2011-01-01

    Chronic renal failure is characterised by a gradual and sustained decline in renal clearance or glomerular filtration rate (GFR). Continued progression of renal failure will lead to renal function too low to sustain healthy life. In developed countries, such people will be offered renal replacement therapy in the form of dialysis or renal transplantation. Requirement for dialysis or transplantation is termed end-stage renal disease (ESRD).Diabetes, glomerulonephritis, hypertension, pyelone...

  10. FTY720 prevents progression of renal fibrosis by inhibiting renal microvasculature endothelial dysfunction in a rat model of chronic kidney disease.

    Science.gov (United States)

    Ni, Haifeng; Chen, Junfeng; Pan, Mingming; Zhang, Minghui; Zhang, Jiandong; Chen, Pingsheng; Liu, Bicheng

    2013-12-01

    Recent studies have shown that chronic endothelial dysfunction can impair multiple aspects of renal physiology and, in turn, contribute to renal fibrosis. Sphingosine 1-phosphate (S1P) has been highlighted as an endothelial barrier-stabilizing mediator. The aim of our study was to investigate the effect of FTY720, an S1P analog, on the progression of renal fibrosis by inhibiting renal microvasculature endothelial dysfunction in a rat model of chronic kidney disease. Thirty male Sprague-Dawley rats were used in this study. Seven days after surgery, we placed the animals into three groups: sham surgery; 5/6 nephrectomized (Nx) rats; and 5/6Nx + FTY720 (1 mg/kg/day). All of the animals were sacrificed 12 weeks after surgery. We obtained and analyzed blood and kidney tissue samples from all of the groups. Glomerular capillary density and peritubular capillary (PTC) density were determined by CD31 immunostaining. The expression of transforming growth factor beta 1 (TGF-β1), collagen IV, fibronectin, endothelial nitric oxide synthase (eNOS) and vascular endothelial growth factor (VEGF) were analyzed by immunohistochemistry, reverse transcription-polymerase chain reaction and western blotting. The 5/6Nx group exhibited increased blood urea nitrogen and serum creatinine, visible renal histological changes, pro-fibrotic molecule (TGF-β1) and production of extracellular matrix proteins such as collagen IV and fibronectin and decreased glomerular and PTC density, compared to the sham controls (P kidney disease.

  11. [Renal abnormalities in ankylosing spondylitis].

    Science.gov (United States)

    Samia, Barbouch; Hazgui, Faiçal; Abdelghani, Khaoula Ben; Hamida, Fethi Ben; Goucha, Rym; Hedri, Hafedh; Taarit, Chokri Ben; Maiz, Hedi Ben; Kheder, Adel

    2012-07-01

    We will study the epidemiologic, clinical, biological, therapeutic, prognostic characteristics and predictive factors of development of nephropathy in ankylosing spondylitis patients. We retrospectively reviewed the medical record of 32 cases with renal involvement among 212 cases of ankylosing spondylitis followed in our service during the period spread out between 1978 and 2006. The renal involvement occurred in all patients a mean of 12 years after the clinical onset of the rheumatic disease. Thirty-two patients presented one or more signs of renal involvement: microscopic hematuria in 22 patients, proteinuria in 23 patients, nephrotic syndrome in 11 patients and decreased renal function in 24 patients (75%). Secondary renal amyloidosis (13 patients), which corresponds to a prevalence of 6,1% and tubulointerstitial nephropathy (7 patients) were the most common cause of renal involvement in ankylosing spondylitis followed by IgA nephropathy (4 patients). Seventeen patients evolved to the end stage renal disease after an average time of 29.8 ± 46 months. The average follow-up of the patients was 4,4 years. By comparing the 32 patients presenting a SPA and renal disease to 88 with SPA and without nephropathy, we detected the predictive factors of occurred of nephropathy: tobacco, intense inflammatory syndrome, sacroileite stage 3 or 4 and presence of column bamboo. The finding of 75% of the patients presented a renal failure at the time of the diagnosis of renal involvement suggests that evidence of renal abnormality involvement should be actively sought in this disease. Copyright © 2011 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.

  12. Impact of HLA on the underlying primary diseases in Turkish patients with end-stage renal disease.

    Science.gov (United States)

    Karahan, Gonca Emel; Seyhun, Yalcin; Oguz, Fatma Savran; Kekik, Cigdem; Onal, Ayse Emel; Yazici, Halil; Turkmen, Aydin; Aydin, Ali Emin; Sever, Mehmet Sukru; Eldegez, Ulug; Carin, Mahmut Nezih

    2009-01-01

    The number of patients with end stage renal disease (ESRD) is increasing faster than the number of renal transplantations performed per year worldwide. Of the primary diseases leading to ESRD, diabetic nephropathy is the leading cause. The purpose of the present study is to investigate the association of HLA with the primary diseases leading to ESRD in Turkish patients. A total of 3230 individuals comprising 587 ESRD patients and 2643 healthy controls were enrolled into the study. Class I HLA-A, -B typing was performed by CDC method, while class II HLA-DRB1 typing was performed by low resolution PCR-SSP. We found a significant negative association between almost all A locus antigens and primary disease groups classified as chronic glomerulonephritis and hypertensive nephrosclerosis (p HLA-B58 and HLA-DRB1*03 significantly correlated with amyloidosis and diabetic nephropathy, respectively. Determination of HLAs as risk factors for primary diseases leading to ESRD might be beneficial in preventing progression to ESRD and recurrence of the primary disease post-transplantation.

  13. Hypertension and renal disease%高血压和肾病

    Institute of Scientific and Technical Information of China (English)

    Huang Chunfa; 郑苏梨

    2011-01-01

    The relationship between chronic kidney disease (CKD) and hypertension remains enigmatic and a matter of considerable clinical and academic interest with evidence indicating that hypertension is both a cause and a consequence of kidney disease[1-2].Hypertension is present in more than 80% of patients with CKD and contributes to progression of renal disease toward end stage (ESRD) as well as to cardiovascular events such as heart attack and stroke[3-5].Proteinuria is an important co-morbidity in hypertensives with CKD and increase the risk of disease progression and cardiovascular events.慢性肾脏病(chronic kidney disease,CKD)和高血压之间的关系仍迷雾重重.许多临床研究和学术研究的证据表明:高血压和肾脏病互为因果.80%以上的CKD患者出现高血压;高血压不仅引发心脏病发作、脑卒中等心血管事件,而且还会导致肾病恶化进展至终末期肾病(end stage renal disease,ESRD).蛋白尿是高血压合并CKD重要的并发症,可促进疾病进展,增加心血管事件的风险.

  14. Mutation databases for inherited renal disease: are they complete, accurate, clinically relevant, and freely available?

    Science.gov (United States)

    Savige, Judy; Dagher, Hayat; Povey, Sue

    2014-07-01

    This study examined whether gene-specific DNA variant databases for inherited diseases of the kidney fulfilled the Human Variome Project recommendations of being complete, accurate, clinically relevant and freely available. A recent review identified 60 inherited renal diseases caused by mutations in 132 genes. The disease name, MIM number, gene name, together with "mutation" or "database," were used to identify web-based databases. Fifty-nine diseases (98%) due to mutations in 128 genes had a variant database. Altogether there were 349 databases (a median of 3 per gene, range 0-6), but no gene had two databases with the same number of variants, and 165 (50%) databases included fewer than 10 variants. About half the databases (180, 54%) had been updated in the previous year. Few (77, 23%) were curated by "experts" but these included nine of the 11 with the most variants. Even fewer databases (41, 12%) included clinical features apart from the name of the associated disease. Most (223, 67%) could be accessed without charge, including those for 50 genes (40%) with the maximum number of variants. Future efforts should focus on encouraging experts to collaborate on a single database for each gene affected in inherited renal disease, including both unpublished variants, and clinical phenotypes. © 2014 WILEY PERIODICALS, INC.

  15. Effects of renal artery stenting on renal function and blood pressure in patients with atherosclerotic renovascular disease

    Institute of Scientific and Technical Information of China (English)

    张奇; 沈卫峰; 张瑞岩; 张建盛; 胡健; 张宪

    2003-01-01

    Objective To study the effects of percutaneous renal artery intervention on renal function and blood pressure in patients with renal artery stenosis. Methods Eighty-seven patients with severe uni- or bi-lateral renal artery stenosis (luminal diameter narrowing ≥70%) and clinical hypertension received renal artery stenting between January 2002 and December 2002. The changes in blood pressure and serum creatinine level and creatinine clearance (CCr) 48 hours after intervention and during 6 months of follow-up were assessed.Results Renal stenting was performed in 98 stenotic arteries of 87 patients, and the procedural success rate was 100%. Serum creatinine level was slightly elevated from (176±21) μmol/L to (179±11) μmol/L (P=0.15) 48 hours after the procedure, but significantly decreased to (149±15) μmol/L at 6 months (P<0.001). CCr was also greatly improved [(37±11) ml/min before versus (51±8) ml/min at 6 months, P<0.001]. During follow-up, 61% of the patients experienced a normal renal function. Despite conventional medical treatment, systolic and diastolic blood pressures were also significantly decreased after stenting [(163±23)/(96±13) mm Hg before versus (148±12)/(79±15) mm Hg at 6 months, all P<0.001], and hypertension was well controlled in 67% of the patients at 6 months ' follow-up.Conclusion Renal artery stenting has a high success rate and is effective in improving renal function and blood pressure for patients with severe renal artery stenosis.

  16. THE PRACTICAL USE OF CYSTATIN C MEASUREMENT IN PATIENTS WITH VARIOUS RENAL DISEASES

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    Objective:To investigate the clinical usefulness in terms of estimation for glomerular fil tration rate(GFR), we determined the serum cystatin C levels in 72 healthy adult s , 63 children, and 109 patients with various renal diseases, and compared the s erum cystatin C concentrations with serum creatinine levels. In addition, the re nal function was evaluated in 5 adults receiving renal transplantations using cy statin C.Methods:Serum cystatin C levels were measured by a par ticle-enhanced nephelometric immunoassay on Dade Behring nephelometer system. Se rum and urine creatinine concentrations were determined by use of Jaff's kinetic assay.Results: The cystatin C concentration at birth was typica lly double that found in adults, then fell to a constant level after 1 year, a v a lue that was maintained to about 60 years. The studies of cystatin C in the elde rly showed that the circulation cystatin C levels rose gradually above 60 years. There was a significant positive correlation between serum cystatin C and creat inine level (r=0.921,P<0.01) in the patients with various renal diseases. S erum cystatin C was inversely and logarithmically correlated with creatinine cle arance as shown in the equation lg cystatin C =-0.6061gCCr+1.209(r=-0.887,P <0.01). Serum cystatin C levels rose prior to creatinine concentrations and sta rted to increase over normal range when creatinine clearance remained within no rmal range. After renal transplantation,cystatin C concentration significantly d e creased during the first week(-43% vs -21% for creatinine) in patients without d elayed graft function. In some cases of acute renal impairment, the increase in serum cystatin C values was more prominent than that of creatinine.Conclusion:Serum cystatin C is probably more attractive for esti mation of renal function than serum creatinine and creatinine clearance especial ly for detection of the mild reduction of glomerular filtrate rate in patients w ith various kidney diseases

  17. Association between Low Serum Bicarbonate Concentrations and Cardiovascular Disease in Patients in the End-Stage of Renal Disease

    Directory of Open Access Journals (Sweden)

    Vaia D. Raikou

    2016-11-01

    Full Text Available Background: Metabolic acidosis, a common condition particularly in the end-stage of renal disease patients, results in malnutrition, inflammation and oxidative stress. In this study, we focused on the association between low serum bicarbonate and cardiovascular disease in patients on intermittent dialysis. Methods: We studied 52 on-line-pre-dilution hemodiafiltration (on-l HDF patients, 32 males and 20 females, with a mean age of 58.01 ± 15.4 years old. Metabolic acidosis was determined by serum bicarbonate concentrations less than 22 mmol/L. Residual renal function (RRF was defined by interdialytic urine volume. Kaplan–Meier curves and Cox regression models were performed to predict coronary artery disease (CAD, defined by ejection fraction <50%, or diastolic dysfunction congestive heart failure (CHF and peripheral vascular disease (PVD. Results: Kaplan–Meier analyses showed that a lower or higher than 22 mmol/L serum bicarbonate metabolic acidosis status was significantly associated with both PVD and diastolic dysfunction (log-rank = 5.07, p = 0.02 and log-rank = 5.84, p = 0.01, respectively. A similar prevalence of serum bicarbonate on CAD or CHF by low ejection fraction was not shown. The RRF was associated with PVD event and serum bicarbonate less than 22 mmol/L (log-rank = 5.49, p = 0.01 and log-rank = 3.9, p = 0.04, respectively. Cox regression analysis revealed that serum bicarbonate and RRF were significant risk factors for PVD after adjustment for confounders. Furthermore, RRF adjusted for covariates was shown to be a significant risk factor for diastolic dysfunction. Conclusion: Low serum bicarbonate was associated with peripheral vascular disease and diastolic dysfunction in intermittent dialysis. The residual renal function may impact patients’ outcomes through its relationship with metabolic acidosis status, particularly for peripheral vascular disease manifestation.

  18. Persistent proteinuria as an indicator of renal disease in HIV-infected children

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    Yuni Hisbiiyah

    2017-01-01

    Full Text Available Background Persistent proteinuria (microalbuminuria has been reported to be a precursor of HIV-related renal disease. Screening allows for early management in order to prevent the progression of renal disease and decrease morbidity and mortality associated with chronic kidney disease in HIV. Several studies have been done on renal manifestation in HIV-infected children from American and African regions, but similar studies from Asia are lacking. Objective To determine the prevalence of persistent proteinuria in HIV-positive children on antiretroviral therapy (ARV in Dr. Soetomo Hospital, Surabaya. Methods A cross-sectional study on children with HIV and treated with  highly active antiretroviral therapy (HARRT was done from August 2014 to February 2015. Microalbuminuria was measured by the ratio of urine albumin to creatinine (ACR, while proteinuria was measured by dipstick. Measurements were performed 3 times in 4-8 weeks. All subjects underwent complete evaluation of blood tests, serum creatinine, blood urea nitrogen (BUN, CD4 counts, and urinalysis. Data were analyzed using Chi-square and logistic regression tests. Results Of 38 children on HARRT enrolled in this study, 2 subjects developed acute kidney injury (AKI, 4 subjects were suspected to have urinary tract infection (UTI, and 1 subject was suspected to have urinary tract stones. The prevalence of persistent microalbuminuria was 2.6%. There was no correlation between immunological status, WHO clinical stage, or duration of ARV and the incidence of persistent proteinuria (P>0.05. Conclusion The prevalence of persistent proteinuria is  lower in younger HIV-infected children at a non-advanced stage and HIV-infected children with normal immunological status who are on HAART. We provide baseline data on the renal conditions of HIV-infected children in the era of HAART, before tenovofir is  increasingly used as an antiretroviral therapy regimen in Indonesia.

  19. Discovering hidden relationships between renal diseases and regulated genes through 3D network visualizations

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    Bhavnani Suresh K

    2010-11-01

    Full Text Available Abstract Background In a recent study, two-dimensional (2D network layouts were used to visualize and quantitatively analyze the relationship between chronic renal diseases and regulated genes. The results revealed complex relationships between disease type, gene specificity, and gene regulation type, which led to important insights about the underlying biological pathways. Here we describe an attempt to extend our understanding of these complex relationships by reanalyzing the data using three-dimensional (3D network layouts, displayed through 2D and 3D viewing methods. Findings The 3D network layout (displayed through the 3D viewing method revealed that genes implicated in many diseases (non-specific genes tended to be predominantly down-regulated, whereas genes regulated in a few diseases (disease-specific genes tended to be up-regulated. This new global relationship was quantitatively validated through comparison to 1000 random permutations of networks of the same size and distribution. Our new finding appeared to be the result of using specific features of the 3D viewing method to analyze the 3D renal network. Conclusions The global relationship between gene regulation and gene specificity is the first clue from human studies that there exist common mechanisms across several renal diseases, which suggest hypotheses for the underlying mechanisms. Furthermore, the study suggests hypotheses for why the 3D visualization helped to make salient a new regularity that was difficult to detect in 2D. Future research that tests these hypotheses should enable a more systematic understanding of when and how to use 3D network visualizations to reveal complex regularities in biological networks.

  20. Comparative effectiveness studies to improve clinical outcomes in end stage renal disease: the DEcIDE patient outcomes in end stage renal disease study

    Directory of Open Access Journals (Sweden)

    Boulware Ebony L

    2012-12-01

    Full Text Available Abstract Background Evidence is lacking to inform providers’ and patients’ decisions about many common treatment strategies for patients with end stage renal disease (ESRD. Methods/design The DEcIDE Patient Outcomes in ESRD Study is funded by the United States (US Agency for Health Care Research and Quality to study the comparative effectiveness of: 1 antihypertensive therapies, 2 early versus later initiation of dialysis, and 3 intravenous iron therapies on clinical outcomes in patients with ESRD. Ongoing studies utilize four existing, nationally representative cohorts of patients with ESRD, including (1 the Choices for Healthy Outcomes in Caring for ESRD study (1041 incident dialysis patients recruited from October 1995 to June 1999 with complete outcome ascertainment through 2009, (2 the Dialysis Clinic Inc (45,124 incident dialysis patients initiating and receiving their care from 2003–2010 with complete outcome ascertainment through 2010, (3 the United States Renal Data System (333,308 incident dialysis patients from 2006–2009 with complete outcome ascertainment through 2010, and (4 the Cleveland Clinic Foundation Chronic Kidney Disease Registry (53,399 patients with chronic kidney disease with outcome ascertainment from 2005 through 2009. We ascertain patient reported outcomes (i.e., health-related quality of life, morbidity, and mortality using clinical and administrative data, and data obtained from national death indices. We use advanced statistical methods (e.g., propensity scoring and marginal structural modeling to account for potential biases of our study designs. All data are de-identified for analyses. The conduct of studies and dissemination of findings are guided by input from Stakeholders in the ESRD community. Discussion The DEcIDE Patient Outcomes in ESRD Study will provide needed evidence regarding the effectiveness of common treatments employed for dialysis patients. Carefully planned dissemination strategies to the