Incidence Of Chronic Renal Disease Research Articles

MANAGING A PATIENT WITH RENAL OSTEODYSTROPHY AND MULTIPLE FRACTURES: A MULTIDISCIPLINARY APPROACH

Renal Osteodystrophy is a type of metabolic bone disease characterized by bone mineralization deficiency due to electrolyte and endocrine abnormalities. Patients with chronic kidney disease (CKD) are more likely to experience falls and fractures due to renal osteodystrophy and the high prevalence of risk factors for falls. Treatment involves medical management to resolve the etiology of the underlying renal condition, as well as management (and prevention) of pathological fractures.A 66-year-old female patient, with severe osteoporosis and chronic kidney disease undergoing haemodialysis, has presented with multiple fractures along the years. She was submitted to bilateral proximal femoral nailing as fracture treatment on the left and prophylactically due to pathological bone injury on the right, followed by revision of the left nail with a longer one after varus angulation and fracture distal to the nail extremity. Meanwhile, the patient suffered a pathological fracture of the radial and cubital diaphysis and was submitted to conservative treatment with cast, with consolidation of the fracture. Posteriorly, she re-fractured these bones after a fall and repeated the conservative treatment.Clinical management: There is a multidisciplinary approach to manage the chronic illness of the patient, including medical management to resolve the etiology and consequences of her chronic kidney disease, pain control, conservative or surgical fracture management and prevention of falls.The incidence of chronic renal disease is increasing and the patients with this condition live longer than previously and are more physically active. Thus, patients may experience trauma as a direct result of increased physical activity in a setting of weakened pathologic bone. Their quality of life is primarily limited by musculoskeletal problems, such as bone pain, muscle weakness, growth retardation, and skeletal deformity. A multidisciplinary approach is required to treat these patients, controlling their chronic diseases, managing fractures and preventing falls.

Effects of resistance training on kidney morphology of aged ovariectomized rats

With the advancing age, there is an increase of the incidence of chronic renal diseases. However, it is suggested that exercise, as resistance training, is a key factor in positively modulate the kidney structure and function. Thus, this study aimed to analyze the effects of estrogen deprivation and a moderate resistance protocol on the right kidney structure of rats. A total of 32 animals were randomly divided in four groups (n = 8/per group): control group (CG); resistance trained animals (RT); control ovariectomized animals (OvxC); and trained ovariectomized animals (OvxT). Sections of the right kidney were stained with hematoxylin and eosin for morphometry and blood was collected for biochemical analysis. Our results showed that the group submitted to both ovariectomy and resistance training had significant impact on renal corpuscle components (Bowman’s space, renal corpuscle area, and visceral layer), and proximal and distal tubules. Additionally, resistance training, with or without estrogen deprivation, increases creatine phosphokinase and decreases ultrasensitive C-reactive protein. In summary, we suggested that moderate resistance training may be a key factor to maintain the kidney structure and function across age. However, future studies are need to corroborate with our findings.

Urinary excretion of electrolytes and their correlation with clinical parameters in chronic kidney disease

Introduction: With the increasing incidence of chronic renal disease on a global scale, it is important to document the chemical abnormalities that not only indicate deteriorating renal function, but also aggravate the clinical picture by causing sustained electrolyte imbalance, ultimately contributing to End Stage Renal Disease (ESRD).
 Objective: To investigate 24-hr urinary electrolytes excretion of non-dialysis patients presenting with history of chronic kidney disease (CKD) and correlate the biochemical abnormalities with clinical parameters.
 Materials & Methods: A total of 100 patients with CKD were included in a private clinic setup from February 2017 to December 2019 to retrospectively analyze the relationship of 24-hr urinary electrolytes with clinical indicators in these subjects. Besides demographic data, biochemical indices of concern were obtained through standard laboratory techniques. The patients were then divided on the basis of results into four quartile groups. Descriptive data analysis was done through SPSS 22.0.
 Results: Nephropathic patients had low eGFR, albumin, hemoglobin, blood calcium as well as 24-hr urine calcium and had high body mass index (BMI), systolic blood pressure, diastolic blood pressure, blood creatinine, blood sodium and 24-hr urine sodium. According to quartiles of 24-hr urinary sodium; in the Q4 group, 24-hr urine protein, 24-hr urine potassium and 24-hr urine calcium were the highest while according to quartile of 24-hr urinary potassium; the Q3 group had the highest 24-hr urine protein. According to quartile of urinary calcium, Q4 group blood calcium, 24-hr urine sodium and 24-hr urine potassium was high. The results revealed a positive correlation of 24-hr urinary sodium and potassium with 24-hr urine protein and a negative correlation of 24⁃hr urinary calcium with 24-hr urine protein.
 Conclusion: The levels of urinary electrolytes in patients with CKD are associated with urinary protein. It is, therefore, recommended that the above-mentioned disease be treated in these patients for their proper management.
 Keywords: Urine Chemistry; Proteinuria; Renal Insufficiency, Chronic.

Long-term renal outcome in infants with congenital lower urinary tract obstruction

Congenital Lower Urinary Tract Obstructions (LUTO) is a heterogeneous group of diseases in which urine elimination is obstructed at the level of bladder neck or urethra. The aim of the study is to evaluate the long-term renal outcome of patients suffering of congenital LUTO. We retrospectively reviewed patients with congenital LUTO. All patients had at least 1 year follow-up. Data on surgery, renal imaging and Schwartz estimate creatinine clearance were collected. Incidence of Chronic Renal Disease (CRD) is presented with Kaplan-Meier method. 40 patients were included, 23 patients with Posterior Urethral Valve (PUVs) and 17 patients with other aetiologies: anterior urethral valve (2), urethral atresia (2), urethral stenosis (2), cloacal malformations (2), obstructive ureterocele (1), bladder trigone malformation (1) and neonatal bladder-sphincter dysfunction without neurological abnormalities (7). Incidence of CRD at age 10 years was 37% in congenital LUTO, 42% in PUVs and 30% in other aetiologies, and was significantly higher in PUVs (P=0.032). Renal prognosis was significantly worsened by discover of retentional bladder wall changes in initial cystoscopy, and by loss of parenchymal differentiation or cortical microcysts in first ultrasonography. The use of urinary diversion was significantly higher in LUTO of other aetiologies. A high incidence of CRD is observed in patients with congenital LUTO, significantly higher in patients with PUV. LUTO of other aetiologies require step by step surgical management and higher use of urinary diversion. Precise initial evaluation in cystoscopy and ultrasonography is required and participate to evaluate future renal outcome. 4.

Manipulating dietary fibre: Gum Arabic making friends of the colon and the kidney

Abstract There is an appreciation that the incidence of chronic renal disease is increasing worldwide. This is a health issue, which carries significant morbidity and mortality for patients. Furthermore treatment of patients with renal failure is expensive and therefore represents a significant financial burden to health economies. This review provides an overview of the in vitro, in vivo and clinical evidence supporting the potential therapeutic benefit of manipulating dietary fibre intake and specifically supplementation of the diet with Gum Arabic in patients with progressive renal disease.

Rosuvastatin beneficially alters the glomerular structure of kidneys from spontaneously hypertensive rats (SHRs)

The incidence of chronic renal diseases is increasing worldwide, and there is a great need to identify therapies capable of arresting or reducing disease progression. The current treatment of chronic nephropathies is limited to angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, but increasing clinical and experimental evidence suggests that statins could play a therapeutic role. Ultrastructural studies have shown the presence of gap junctions within all the cells of the glomerulus and podocytes have been found to contain primarily connexin-43. The present study aims to observe the beneficial effects of rosuvastatin on structural and ultrastructural renal morphology and on glomerular connexin-43 expression in normotensive rats and spontaneously hypertensive rats (SHR). Rats were randomly allocated into four groups: WKY-C: normotensive animals no receiving rosuvastatin; WKY-ROS: normotensive animals receiving rosuvastatin; SHR-C: hypertensive animals no receiving rosuvastatin; SHR-ROS: hypertensive animals receiving rosuvastatin. Our results show no differences in blood urea, creatinine, uric acid and creatine phosphokinase levels between the groups, however, there was an decreasing of 24-h protein excretion in SHR-ROS. Capsular area in SHR-ROS was decreased, however, there was no alteration in urinary space. By transmission electron microscopy the slit diaphragm and podocyte foot processes were more preserved in SHR-ROS. By scanning electron microscopy the podocyte foot processes were more preserved in SHR-ROS. Increased connexin-43 immunofluorescence was observed in glomeruli of WKY-ROS and SHR-ROS. In conclusion, we hypothesize that renal pleiotropic effect of rosuvastatin can be a therapeutic tool for improving kidney ultrastructure and, consequently, renal function in hypertensive individuals.

A guideline for the inpatient care of children with pyelonephritis

BACKGROUND AND OBJECTIVES:Febrile urinary tract infections and pyelonephritis are common in children and frequently lead to hospitalization for management, especially in the child who appears toxic. The American Academy of Pediatrics (AAP) practice parameter on the diagnosis, treatment and evaluation of the initial urinary tract infection in febrile infants and young children provides experience and evidence-based guidelines for the practitioner caring for children between the ages of 2 months to 2 years. No established guideline exists for older children and the AAP guideline does not specifically focus on inpatient care.METHODS:We conducted a comprehensive review of recently published literature and practice guidelines to develop a consensus on the inpatient diagnosis and management of children with pyelonephritis.RESULTS:Eight recommendations are proposed for the diagnosis and management, including revised guidelines for the imaging studies postpyelonephritis on the basis of current best evidence.CONCLUSION:Proper diagnosis of pyelonephritis, timely initiation of appropriate therapy and identification of children at risk for renal injury will help to reduce immediate as well as long-term complications due to chronic kidney disease.

Stimulation of Sigma-1 receptor by dehydroepiandrosterone ameliorates hypertension-induced kidney hypertrophy in ovariectomized rats

The incidence of chronic renal disease in women increases with aging, especially after menopause, suggesting that loss of sex hormones contributes to the development and progression of renal diseases. Recent studies revealed that decreased dehydroepiandrosterone (DHEA) levels are associated with endothelial dysfunction, renal injury and increased cardiovascular mortality in postmenopausal women. We here investigate the role of DHEA, also known as Sigma-1 receptor (Sigma-1R) agonist, on kidney injury induced by pressure overload (PO) after ovariectomy (OVX) and defined mechanisms underlying its protective action. Wistar rats subjected to bilateral OVX were further treated with abdominal aortic stenosis between the right and left renal arteries. DHEA (15 and 30 mg/kg) was administered orally once a day for 14 days starting from two weeks after aortic banding. Time course study indicated that the right kidney (RK) weight-to-body weight (BW) ratio increases time-dependently from one to four weeks along with increased mean arterial blood pressure (MABP) after banding in the abdominal aorta with no change in the left kidney (LK) weight-to-BW ratio. Similarly, we found significant time-dependent decrease in Sigma-1R expression in the RK with no changes in the LK. Administration of the Sigma-1R agonist, DHEA, significantly inhibited hypertension-induced increases in the RKW-to-BW ratio and increased expression of Sigma-1R in the RK. DHEA also attenuated PO-induced disturbance of heart rate and MABP. DHEA administration significantly restored PO-induced impaired endothelial nitric oxide synthase (eNOS) activity with concomitant increased phosphorylation of eNOS (Ser1179) and Akt activity with increased phosphorylation at Ser 473 and at Thr 308 in the RK. We here documented, for the first time, the potential role of Sigma-1R to protect the kidney from PO-induced injury in ovariectomized rats. DHEA administration protects hypertension-induced kidney injury via upregulation of Sigma-1R and stimulation of Akt-eNOS signaling in ovariectomized rats.

Age-related renal disease in female Dahl salt-sensitive rats is attenuated with 17²-estradiol supplementation by modulating nitric oxide synthase expression

The incidence of chronic renal disease in women increases with aging, especially after menopause, suggesting that loss of sex hormones may contribute to the development and progression of renal disease. However, the mechanisms by which sex hormones, particularly estrogens, contribute to the disease process are unclear. The present study examined the effects of ovariectomy (OVX) with or without 17 beta-estradiol (E2) supplementation (OVX+E2) on the expression of inducible (iNOS) and endothelial (eNOS) nitric oxide synthase in the kidney. The study was performed in young (4 months [4M]) and aged (12 months [12M]) female Dahl salt-sensitive rats fed a low-sodium (0.1% NaCl) diet. At 3 months of age, the animals were either subjected to sham surgery, OVX, or OVX with implantation of an E2 silastic pellet. The treatments were administered for either 1 or 9 months, rendering the animals 4 months of age or 12 months of age at the time of sacrifice, respectively. Renal expression of NOS isoforms was measured by Western blotting and immunohistochemistry. OVX in the aged rats was associated with 35% and 25% decreases in medullary iNOS (mean [SEM] relative optical density [ROD]: 4M OVX, 1.81 [0.14] vs 12M OVX, 1.17 [0.16]; P < 0.05) and eNOS (mean ROD: 4M OVX, 1.91 [0.09] vs 12M OVX, 1.43 [0.15]; P < 0.05) protein expression, respectively, and a 25-fold increase in the abundance of CD68-positive cells, indicating macrophage infiltration (mean cells/mm2: 4M OVX, 1.18 [0.09] vs 12M OVX, 30.0 [0.74]; P < 0.001). E2 supplementation either partially or completely attenuated these changes in iNOS (mean ROD: 4M OVX+E2, 2.26 [0.08] vs 12M OVX+E2, 1.70 [0.09]; P < 0.05), eNOS (mean ROD: 4M OVX+E2, 2.03 [0.07] vs 12M OVX+E2, 1.77 [0.11]; P = NS) and CD68 (mean cells/mm2: 4M OVX+E2, 1.46 [0.07] vs 12M OVX+E2, 6.87 [1.6]; P < 0.01) associated with OVX in the aging kidney. These data suggest that ovarian E2 loss with aging may contribute to the development of age-related renal disease through downregulation of iNOS and eNOS protein abundance and increased renal inflammation in this animal model. Furthermore, E2 supplementation may be protective in the aging kidney by attenuating these changes.

Contemporary Concepts in Prevention and Treatment of Cardiac Allograft Vasculopathy

Cardiac allograft vasculopathy (CAV), is characterized by heterogeneous proliferative thickening of the vascular intima of the cardiac allograft vasculature. Since its presentation is commonly clinically silent, early diagnosis and preventative therapy are critical. Preventative therapy including optimization of immunosuppressive therapy and treatment of comorbidities associated with CAV progression must be initiated early since most of the intimal thickening occurs during the first year posttransplant. Long-term use of calcineurin inhibitors is associated with a high incidence of chronic renal disease and also contributes to hyperlipidemia and hypertension, all of which may exacerbate CAV. In addition, statins, antihypertensive agents and anti-CMV agents all have demonstrated benefits in reducing CAV. Once established, the limited treatment options include nonpharmacologic interventions such as retransplantation, percutaneous coronary interventions, coronary artery bypass grafting, transmyocardial laser revascularization and heparin-induced/mediated extracorporeal LDL plasmapheresis (HELP). As the use of new assessment tools increases our understanding of this disease, better preventative and treatment strategies are evolving.

Renal Osteodystrophy

The incidence of chronic renal disease is increasing, and the pattern of renal osteodystrophy seems to be shifting from the classic hyperparathyroid presentation to one of low bone turnover. Patients with persistent disease also live longer than previously and are more physically active. Thus, patients may experience trauma as a direct result of increased physical activity in a setting of weakened pathologic bone. Patient quality of life is primarily limited by musculoskeletal problems, such as bone pain, muscle weakness, growth retardation, and skeletal deformity. Chronic renal disease also increases the risk of comorbidity, such as infection, bleeding, and anesthesia-related problems. Current treatment strategies include dietary changes, plate-and-screw fixation, and open reduction and internal fixation.

Impact of implementation of the MELD scoring system on the prevalence and incidence of chronic renal disease following liver transplantation

Impact of implementation of the MELD scoring system on the prevalence and incidence of chronic renal disease following liver transplantation

Impact of implementation of the MELD scoring system on the prevalence and incidence of chronic renal disease following liver transplantation

The implementation of the model for end-stage liver disease (MELD) score decreased mortality of those awaiting liver transplantation (LT); however, the impact of the MELD allocation system on the risk of chronic renal disease after LT remains unknown. We conducted a non-concurrent single-center cohort study of 174 patients undergoing LT at our center. We compared patients who underwent LT one year prior to MELD implementation (pre-MELD cohort) to those patients who underwent LT 1 year following MELD implementation (MELD cohort). All patients were followed for at least 2 years after LT. Stage 3 chronic renal disease (CRD-3) was defined by an estimated creatinine clearance (CL(Cr)) below 60 ml/min/1.73 m2, and stage 4 chronic renal disease (CRD-4) was defined by an estimated CL(Cr) below 30 mL/min/1.73 m2 according to the validated Modification of Diet and Renal Disease (MDRD) formula. Requirement of kidney transplantation and need for hemodialysis were also evaluated following LT. The pre-MELD cohort (n=97) and the MELD cohort (n=77) were comparable in baseline characteristics, prevalence of diabetes and hypertension, and immunosuppression. Mean calculated MELD score in the pre-MELD cohort was significantly lower than in the MELD cohort (16 vs. 19, P < 0.05). The estimated CL(Cr) at time of LT was lower in the MELD cohort compared with the pre-MELD cohort (75 vs. 95, P < 0.01). However, the incidence and prevalence of CRD-3 and CRD-4 at 6, 12, and 24 months after LT were comparable between the two cohorts. Need for kidney transplantation or hemodialysis after LT was comparable between the groups. In multivariate analysis, serum creatinine at LT was the only variable associated with the development of CRD-3 in the first 2 years after LT. In conclusion, the implementation of the MELD allocation system is not associated with increased mortality or occurrence of CRD-3 or CRD-4 in the first 2 years after LT.

Individualized Risk Management in Diabetics: How to Implement Best Practice Guidelines – Design and Concept of the IRIDIEM Studies

The prevalence of type 2 diabetes mellitus is rising rapidly in all developed countries, particularly in the growing population of persons >50 years of age. As a dangerous consequence, this is accompanied by a proportionate increase in the incidence of chronic renal disease. Evidence-based medicine has shown that tight blood glucose control can delay the onset and retard the progression of diabetic complications, and while it is a challenge to closely manage the complexity of diabetes, it is more difficult to effectively treat the multiple associated comorbidities that develop. Best practice guidelines support early intervention and aggressive treatment of hypertension, hyperglycaemia, proteinuria, hypercholesterolemia, and anaemia. To date, guideline-based management has been proven to be difficult. This article describes the concept of the IRIDIEM studies. The objective of these studies is to endorse and facilitate the use of current best practice guidelines for the management of frequent comorbid diseases and established risk factors in the treatment of type 2 diabetes associated with chronic kidney disease. Additionally, IRIDIEM will assess the impact of this improved disease management model on the progression of chronic kidney disease that can result from electronically prompting clinicians with evidence-based treatment advice.

Report on a workshop to develop management recommendations for the prevention of progression in chronic renal disease.

EVERAL large clinical trials on the management/prevention of progressive renal disease have been published within the last year.‘” Three of these trials relate to diabetic nephropathy in insulin-dependent diabetes mellitus (IDDM), and a fourth relates to renal disease of diverse etiologies (excluding IDDM). These studies show that the incidence of chronic renal disease can be decreased by approximately 50%, that the rate of progression of proteinuria can be decreased by a similar percentage, and that these favorable results also apply to patients with advanced nephropathy. Thus, for the first time, it has been conclusively shown that chronic progressive renal disease is amenable to both prevention and treatment. There had not been a consensus as to the implications of these studies for general patient care. For this reason, a conference was held on April 4 and 5, 1994, for the purpose of developing practical management recommendations. The conference was composed of several panels of nephrology experts drawn from around the world. The panels reviewed the existent literature, listened to presentations on the published studies, and reviewed manuscripts in press from secondary analyses of the Modification of Diet in Renal Disease (MDRD) study data. The panels developed initial recommendations and presented them to an audience of more than 150 physicians who provided a critique of the recommendations. A draft of the recommendation report was then read to the audience participants for final comments. The final recommendations were agreed upon and are the subject of this report.

Carcinomas, sarcomas and other lesions in Osborne-Mendel rats ingesting endrin.

Osborne-Mendel male and female rats ingesting 0.1, 1.0, 5, 10, or 25 ppm endrin in the diet developed high incidences of maligant tumors in a variety of organs, as well as neoplastic lesions of the liver. The incidence of carcinomas and sarcomas was highest in male rats ingesting 0.1 ppm and in female rats ingesting 0.1 or 1.0 ppm endrin. The tumors were highly malignant and there were some extremely rare or unusual tumors such as Kupffer cell sarcomas of the liver and leiomyosarcomas of the mammary gland and stomach. Carcinomas or sarcomas were also present in the adrenal cortex, mammary gland, thyroid, uterus, lymph nodes, as well as other organs. Male rats also developed an increased incidence of chronic renal disease. It is concluded that endrin is a carcinogen when given to Osborne-Mendel male and female rats in the diet.

Arteriovenous fistula from drug abuse. Implications for hemodialysis

MAJOR surgical complications of intravascular drug abuse, including phlebitis, false aneurysm, and arterial thrombosis, have been reported from this¹and other institutions.^2,3Among the major medical problems is an increased incidence of chronic renal disease.^4,5The unfortunate combination of renal failure and peripheral vascular damage is particularly detrimental to vascular access for longterm hemodialysis. We have seen yet another vascular complication, an arteriovenous fistula of the antecubital fossa that prompted the immediate failure of a Scribner hemodialysis shunt placed in the ipsilateral wrist. <h3>Report of a Case</h3> A 24-year-old man was hospitalized in January 1974, for shortness of breath, fatigue, epistaxis, and syncopal attacks. An episode of hematuria had occurred at the age of 9 years when he was told he had Bright disease. At the age of 17 years, he was rejected for military duty because of proteinuria. He admitted to repeated intravenous use of amphetamines,

Arteriovenous Fistula From Drug Abuse

MAJOR surgical complications of intravascular drug abuse, including phlebitis, false aneurysm, and arterial thrombosis, have been reported from this¹and other institutions.^2,3Among the major medical problems is an increased incidence of chronic renal disease.^4,5The unfortunate combination of renal failure and peripheral vascular damage is particularly detrimental to vascular access for longterm hemodialysis. We have seen yet another vascular complication, an arteriovenous fistula of the antecubital fossa that prompted the immediate failure of a Scribner hemodialysis shunt placed in the ipsilateral wrist. <h3>Report of a Case</h3> A 24-year-old man was hospitalized in January 1974, for shortness of breath, fatigue, epistaxis, and syncopal attacks. An episode of hematuria had occurred at the age of 9 years when he was told he had Bright disease. At the age of 17 years, he was rejected for military duty because of proteinuria. He admitted to repeated intravenous use of amphetamines,

The aetiology of chronic nephritis in Queensland.

Four published articles are submitted as a thesis for the degree of Doctor of Medicine in the University of theme of the thesis, that childhood plumbism was responsible for the high incidence of chronic renal disease in Queensland, is developed in the first article, The Aetiology of Chronic Nephritis in Queensland. other articles present in detail with relevant historical information, and discuss critically, the three main lines of evidence used in the argument. In addition to establishing the theme for the first time the thesis has a wider significance. It reopens the question of the relation between lead and renal disease. In the early part of the present century, plumbism was widely held to be a cause of chronic kidney disease. In recent years, for a number of reasons discussed in the thesis, many authorities have refused to accept this relation. thesis shows lead to be a causal agent, and provides a firm basis for the use of the lead content of bone in investigating the aetiology of chronic renal disease.