Occurrence Of Kidney Disease Research Articles

Faktor Risiko Penyakit Ginjal Kronik Diabetes (PGK-DM) pada Diabetes Mellitus Tipe-2 (Studi di RSUD DR Soedarso Kota Pontianak Provinsi Kalimantan Barat)

Background: Prevalence of type-2 diabetes mellitus have increased significantly. The increasing number of people with diabetes has a major impact on the development of chronic diabetic kidney disease. The research was aimed to clarify several risk factors of chronic diabetic kidney disease on type-2 diabetes mellitus (CDK-DM).Method: The research was based on case control study design. The number of respondents was 140 respondents consisting 70 cases and 70 controls that met the criteria of inclusion and exclusion. The cases were patients with type-2 chronic diabetic kidney disease stadium 2-5. The controls were patients with type-2 chronic diabetic kidney disease with blood sugar levels ≥ 200 mg/dL. The data were then analyzed using logistic regression.Results: The result shows that risk factors of chronic diabetic kidney disease in type-2 diabetes mellitus are diabetes in family (OR = 6,732; 95% CI = 2,623- 17,276), high blood pressure (OR =6,760; 95% CI = 2,190- 20,867), lack of physical activities (OR = 4,367 95% CI = 1,823-10,462) and lack of family support (OR = 4,203; 95% CI = 1,437-12,295). The probability of chronic diabetic kidney disease occurrence in type-2 diabetes mellitus when four risk factors exist are96,71%.Conclusion: The host factors have important role of chronic diabetic kidney disease in type 2 diabetes mellitus . The factors proven to be risk factors for occurrence of chronic diabetic kidney disease in type 2 diabetes mellitus were diabetic in the family, Hipertension, poor physical exercise and family Support.

Faktor Risiko Penyakit Ginjal Kronik Diabetes (PGK-DM) pada Diabetes Mellitus Tipe-2 (Studi di RSUD DR Soedarso Kota Pontianak Provinsi Kalimantan Barat)

Background: Prevalence of type-2 diabetes mellitus have increased significantly. The increasing number of people with diabetes has a major impact on the development of chronic diabetic kidney disease. The research was aimed to clarify several risk factors of chronic diabetic kidney disease on type-2 diabetes mellitus (CDK-DM).Method: The research was based on case control study design. The number of respondents was 140 respondents consisting 70 cases and 70 controls that met the criteria of inclusion and exclusion. The cases were patients with type-2 chronic diabetic kidney disease stadium 2-5. The controls were patients with type-2 chronic diabetic kidney disease with blood sugar levels ≥ 200 mg / dL. The data were then analyzed using logistic regression.Results: The result shows that risk factors of chronic diabetic kidney disease in type-2 diabetes mellitus are diabetes in family (OR = 6,732; 95% CI = 2,623- 17,276), high blood pressure (OR = 6,760; 95% CI = 2,190- 20,867), lack of physical activities (OR = 4,367 95% CI = 1,823-10,462) and lack of family support (OR = 4,203; 95% CI = 1,437-12,295). The probability of chronic diabetic kidney disease occurrence in type-2 diabetes mellitus when four risk factors exist are 96,71%.Conclusion: The host factors have important role of chronic diabetic kidney disease in type 2 diabetes mellitus . The factors proven to be risk factors for occurrence of chronic diabetic kidney disease in type 2 diabetes mellitus were diabetic in the family, Hipertension, poor physical exercise and family Support.

Faktor Risiko Penyakit Ginjal Kronik Diabetes (PGK-DM) pada Diabetes Mellitus Tipe-2 (Studi di RSUD DR Soedarso Kota Pontianak Provinsi Kalimantan Barat)

Background: Prevalence of type-2 diabetes mellitus have increased significantly. The increasing number of people with diabetes has a major impact on the development of chronic diabetic kidney disease. The research was aimed to clarify several risk factors of chronic diabetic kidney disease on type-2 diabetes mellitus (CDK-DM).Method: The research was based on case control study design. The number of respondents was 140 respondents consisting 70 cases and 70 controls that met the criteria of inclusion and exclusion. The cases were patients with type-2 chronic diabetic kidney disease stadium 2-5. The controls were patients with type-2 chronic diabetic kidney disease with blood sugar levels ≥ 200 mg / dL. The data were then analyzed using logistic regression.Results: The result shows that risk factors of chronic diabetic kidney disease in type-2 diabetes mellitus are diabetes in family (OR = 6,732; 95% CI = 2,623- 17,276), high blood pressure (OR = 6,760; 95% CI = 2,190- 20,867), lack of physical activities (OR = 4,367 95% CI = 1,823-10,462) and lack of family support (OR = 4,203; 95% CI = 1,437-12,295). The probability of chronic diabetic kidney disease occurrence in type-2 diabetes mellitus when four risk factors exist are 96,71%.Conclusion: The host factors have important role of chronic diabetic kidney disease in type 2 diabetes mellitus . The factors proven to be risk factors for occurrence of chronic diabetic kidney disease in type 2 diabetes mellitus were diabetic in the family, Hipertension, poor physical exercise and family Support.

Faktor Risiko Penyakit Ginjal Kronik Diabetes (PGK-DM) pada Diabetes Mellitus Tipe-2 (Studi di RSUD DR Soedarso Kota Pontianak Provinsi Kalimantan Barat)

Background: Prevalence of type-2 diabetes mellitus have increased significantly. The increasing number of people with diabetes has a major impact on the development of chronic diabetic kidney disease. The research was aimed to clarify several risk factors of chronic diabetic kidney disease on type-2 diabetes mellitus (CDK-DM).Method: The research was based on case control study design. The number of respondents was 140 respondents consisting 70 cases and 70 controls that met the criteria of inclusion and exclusion. The cases were patients with type-2 chronic diabetic kidney disease stadium 2-5. The controls were patients with type-2 chronic diabetic kidney disease with blood sugar levels ≥ 200 mg/dL. The data were then analyzed using logistic regression.Results: The result shows that risk factors of chronic diabetic kidney disease in type-2 diabetes mellitus are diabetes in family (OR = 6,732; 95% CI = 2,623- 17,276), high blood pressure (OR =6,760; 95% CI = 2,190- 20,867), lack of physical activities (OR = 4,367 95% CI = 1,823-10,462) and lack of family support (OR = 4,203; 95% CI = 1,437-12,295). The probability of chronic diabetic kidney disease occurrence in type-2 diabetes mellitus when four risk factors exist are96,71%.Conclusion: The host factors have important role of chronic diabetic kidney disease in type 2 diabetes mellitus . The factors proven to be risk factors for occurrence of chronic diabetic kidney disease in type 2 diabetes mellitus were diabetic in the family, Hipertension, poor physical exercise and family Support.

PS-044 - Effect of longitudinal exposure to tacrolimus on chronic kidney disease occurrence at one year post liver transplantation

PS-044 - Effect of longitudinal exposure to tacrolimus on chronic kidney disease occurrence at one year post liver transplantation

Exploring the Utility of Pulse Wave Analysis in Patients with Uncontrolled Brachial Blood Pressures in the Routine Outpatient Setting

Background There is an increasing interest in the relationship between excess weight and the occurrence of kidney disease. Reports from studies examining the significance of body mass index (BMI) as a risk factor for development of CKD have been largely controversial. Such studies are sparse among the indigenous Nigerian population. Objective We examined the relationship between increased weight and renal function among participants during a public medical screening programme. Method This is a cross-sectional study involving 659 participants during a public medical screening programme. The Participants were categorized into two groups; those with eGFR ≥ 60 and <60 mL/min/1.73m 2 . BMI was calculated and classified using the WHO criteria. Correlation was performed with Pearson’s correlation test. Logistic regression was used to examine the association between BMI and CKD after adjusting for potential cofounders. Results The mean age of the participants was 39.11 ± 15.18 years. About one third were overweight while 18.2% had BMI 30.0 kg/m 2 or greater. There was a significant difference in the mean eGFR among person with normal weight compared with obese individuals and a negative association between eGFR and BMI (-.339, p=0.000). Logistic regression showed that higher BMI remained independently associated with CKD (OR 1.218, 95% CI 1.084-1.368 p=0.000) after adjusting for potential confounders. Conclusion These findings showed that excess weight has a significant association with glomerular filtration rate and should be considered an important risk factor for CKD. Keeping a healthy range BMI may contribute to the prevention of chronic kidney disease.

Anatomopathologic Study of Kidneys parasitized by Dioctophyme renale in Dogs

Background: Dioctophymiasis is a disease caused by the nematode Dioctophyme renale and is a relatively common condition in dogs. The parasite affects the kidney, especially the right, enters the kidney capsule and causes destruction and atrophy of the parenchyma. The lesion severity depends on the amount of parasites affecting the kidney, the duration of the infection, number of kidneys involved and concurrent occurrence of kidney disease. The disease’s clinical presentation may be asymptomatic or with nonspecific clinical signs. The diagnosis is based on ultrasound examination and the detection of eggs in urine, however, diagnosis is often reached only through necropsy or histopathology. This study aimed to analyze the dog kidney anatomical and pathological changes when parasitized by Dioctophyme renale.Materials, Methods & Results: The kidneys of 21 dogs diagnosed with dioctophymiasis were nephrectomized, analyzed by ultrasound and forwarded to macro and microscopic analysis. Macroscopically, the kidney size was measured as well as its renal capsule thicknes. The presences of dilatation of the renal pelvis and ureter, as well as changes of the capsule, were also observed. These fragments were collected and submitted for routine analysis and stained with hematoxylin and eosin. Histopathological examination was performed blindly by three evaluators. The intensity of fibrosis was evaluated by the presence or absence of infiltration, the absence or presence of parasite eggs and when present whether there was inflammatory tissue response, among other changes. All received organs were right kidneys and showed clear atrophy or absence of the parenchyma. The kidney size ranged from 3,8x2,5x1,3 cm to 8,4x8,2x4,0 cm and the capsule thickness between 0.1 and 3.6cm. In renal capsule were observed whitish, irregular and firm plates (10 out of 21 cases) and papilliform projections (4 out of 21). In two specimens were identified cases of hydroureter and hydronephrosis. Microscopically, all specimens had some degree of fibrosis which replaced the renal parenchyma, six classified as mild, ten were moderate and five intense. In 13 cases there was intense deposition of parasite eggs and 18 cases showed inflammatory infiltrate of which one was pyogranulomatous and one granulomatous. Papilliform projections were observed in six out of 21 cases (composed of connective tissue proliferation and neovascularization), there was also hyperplasia of the pelvis transition epithelial (6 out of 21) and osseous metaplasia of the renal capsule (4 out of 21). The vessels walls were hypertrophic in nine out of 21 cases.Discussion: The diagnosis of dioctophymiasis was performed by ultrasonography. All 21 kidneys analyzed were rights; this is related to the parasite penetration in the duodenal wall, which tends to migrate by anatomic proximity to the right kidneys. Dioctophyme renale feeds through digestion and ingestion of the renal parenchyma by the action of parasite’s oesophageal enzymes causing progressive destruction of the cortical and medullar layers and consequently the proliferation of fibrous tissue. In this study, different intensities of fibrosis were observed. Bone metaplasia characterizes the chronicity of the process and the connective tissue’s attempt to adapt. Animals affected by dioctophymiasis often develop chronic renal failure. Chronic renal failure is characterized by continuous and irreversible morphologic changes in the renal parenchyma with loss of nephron components and the formation of a vicious cycle of replacement by fibrous connective tissue. The hypertrophy of vascular epithelium observed in six cases of this study may be associated with fibrous connective tissue proliferation stimulus. The injuries described here may be related to the parasitosis late diagnosis.

Preliminary investigation of flooding problems and the occurrence of kidney disease around Hadejia-Nguru wetlands, Nigeria and the need for an ecohydrology solution

Increasing incidences of flooding and kidney disease in the communities surrounding the Hadejia-Nguru wetlands present a cause for concern. This paper presents the outcome of preliminary investigations carried out in the affected communities of Jigawa and Yobe States. The results show that 85% of the profiled communities mostly located within the floodplain area experience both human and financial losses due to these problems. The flooding is believed to occur as a result of changes in rainfall patterns and the flow regime of the riverine systems, reduction of river channel capacity, low lying topography and bioinvasion by Typha grass. The prevalence of kidney disease has been traced to possible contamination of water sources due to the large-scale use of agrochemicals to improve agricultural production and pollutants from other sources upstream and within the wetlands area. Water quality analysis conducted on water samples from the Hadejia and Yobe rivers revealed high concentrations of lead (Pb) and cadmium (Cd) ranging from 13 to over 150 times above acceptable limits. Records from health centers near the communities show that 40% of patients admitted suffered from Chronic Kidney Disease (CKD), 70% of whom were from Gashua, Nguru and Jakusko in Yobe and some communities in Jigawa State. Despite these findings, establishing cause-and-effect relationships requires an in-depth investigation of hydrological, environmental, ecological and socio-economic changes occurring in the wetlands area. Although our findings reveal some promising possibilities for establishing targets and intervention program, ecohydrological systemic approaches are recommended to identify cause-and-effect links and provide sustainable solutions.

Spatial distribution of renal disease in the contaminated site of Taranto (Italy)

Introduction: Environmental exposure to heavy metals, in particular to cadmium, arsenic and lead, has been associated with kidney disease. The aim of the present study is to investigate the occurrence of kidney disease in the Italian contaminated site (CS) of Taranto, characterized by an industrial area with the presence of various plants including a major steel mill. Methods: This is an exploratory ecological study. The cases were all subjects residing in the CS with a first hospital discharge diagnosis (primary or secondary) of kidney diseases (ICD-9-CM codes 580-586) in the years 2006-2010. Kidney disease cases associated with other disorders were excluded. Hospital discharge rates for kidney disease were compared to those of the regional population using the Standardized Hospitalization Ratio (SHR). All the subjects’ residences at the time of diagnosis were then geocoded, and SHRs were computed separately for areas at high and low exposure as per available environmental monitoring data. Moreover, the study took into account historical exposure levels and modelling for current levels of fine particulate matter (PM2.5) and cadmium. Results: SHRs for kidney disease of the CS, when compared to the regional population, showed a significant excess of 17% in males and of 8% in females. The excess was mainly explained by males (age group 60+). When focusing on the microgeographic study within the CS, the SHRs showed a significant excess of 28% in males (age group 20-59) and a non-significant excess of 25% in females (age group 20-59) residing at diagnosis in the areas at higher exposure. No correlation was found between residence and current spatial distribution of PM2.5 and cadmium. Conclusion: The excess of hospitalization for renal disease observed in the CS of Taranto does not affect children and adolescents, but rather mainly concerns adult males. This possibly suggest an occupational component, and correlates with historical patterns of atmospheric pollution.

First report of Polycystic kidney disease occurrence in Persian cats in Serbia.

Polycystic kidney disease (PKD) is an inherited autosomal disorder in cats, mostly diagnosed in Persian cats. Renal cysts can be diagnosed by ultrasound, but cats must be at least 16 weeks old. The goals of this study were to assess the occurrence of PKD in Serbia using a randomly selected group of Persian cats, to compare the diagnostic efficacy of ultrasound and genetic tests, and to measure haematological and selected biochemical parameters. We examined 70 cats of Persian breed, between 4 months and 8 years of age. Complete blood count and selected biochemical parameters were measured, renal ultrasound was performed. Swabs of the oral cavity were obtained for genetic testing. Percentage of PKD positive cats identified by genetic testing was 48.6%, whilst only 18.6% were detected through ultrasound. Animals that were polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) positive and ultrasound negative ranged from 4 months to 3.5 years. All haematological and biochemical parameters were within the the normal range values in all examined cats. Genetic methods proved to be the most effective for reliable and early diagnosis of PKD in Persian cats. DNA analysis can be used right after birth, and excludes the need for other diagnostic procedures, such as ultrasound.

Beneficial Effects of Caloric Restriction on Chronic Kidney Disease in Rodent Models: A Meta-Analysis and Systematic Review.

BackgroundNumerous studies have demonstrated the life-extending effect of caloric restriction. It is generally accepted that caloric restriction has health benefits, such as prolonging lifespan and delaying the onset and progression of CKD in various species, especially in rodent models. Although many studies have tested the efficacy of caloric restriction, no complete quantitative analysis of the potential beneficial effects of reducing caloric intake on the development and progression of CKD has been published.MethodsAll studies regarding the relationship between caloric restriction and chronic kidney diseases were searched in electronic databases, including PubMed/MEDLINE, EMBASE, Science Citation Index (SCI), OVID evidence-based medicine, Chinese Bio-medical Literature and Chinese science and technology periodicals (CNKI, VIP, and Wan Fang). The pooled odds ratios (OR) and 95% confidence intervals (95% CI) were calculated by using fixed- or random-effects models.ResultsThe data from 27 of all the studies mentioned above was used in the Meta analysis. Through the meta-analysis, we found that the parameter of blood urea nitrogen, serum creatinine and urinary protein levels of the AL group was significant higher than that of the CR group, which are 4.11 mg/dl, 0.08mg/dl and 33.20mg/kg/24h, respectively. The incidence of the nephropathy in the caloric restriction (CR) group was significantly lower than that in the ad libitum—fed (AL) group. We further introduced the subgroup analysis and found that the effect of caloric restriction on the occurrence of kidney disease was only significant with prolonged intervention; the beneficial effects of CR on the 60%-caloric-restriction group were greater than on the less-than-60%-caloric-restriction group, and caloric restriction did not show obvious protective effects in genetically modified strains. Moreover, survival rate of the caloric restriction group is much higher than that of the ad libitum—fed (AL) group.ConclusionsOur findings demonstrate for the first time that compared with the AL group, the caloric restriction indeed decreased urea nitrogen, creatinine, urine protein, incidence of kidney diseases and increased the survival rate on 700~800 days.

English

INTRODUCTION: Horse Shoe Kidney was first recognized during an autopsy by De Carpi in 1521. This anomaly consists of two distinct renal masses lying vertically on either side of the midline and connected at their respective lower poles by a parenchymatous or fibrous isthmus that crosses the mid plane of the body. This isthmus lies at the level of 4th lumbar vertebra just beneath the origin of inferior mesenteric artery in about 40% of cases. Fusion of upper poles instead of the lower poles results in an inverted horse Shoe Kidney which constitute 5-10% of ail Horse-Shoe kidneys, (i.e. in 95% of HSK, fusion is at lower poles). HSK is found more commonly in males by a 2:1 margin. AIM OF STUDY: An attempt has been made to know the various anomalies. The study has been taken up with the fond hope of helping the clinician, sonologist, and surgeons during their routine work. To apply this knowledge to the incoming post graduates in their research works. EMBRIOLOGICAL BASIS & KDNEY: The abnormality originates between 4th and 6th weeks of gestation, after the ureteral bud has entered the renal blastema. Boyden (1931) postulated that at the 14mm stage (4.5 weeks) the developing metanephric masses lie close to one another, any disturbance in their relationship may result in joining at their inferior poles. A slight alteration in the position of the umbilical or common iliac artery could change the orientation of migrating kidneys thus leading to contact and fusion. In 1941 Dees (Nation 1945, Bell 1946, Gleen 1959, Campbell 1970) described horse-shoe kidney disease occurrence in 0.25% of the population or about 1 in 400. OBSERVATION: In the present study 176 specimens of kidneys were studied out of which 40 were fetal specimens and the rest were adult specimens consisting of both cadaveric and sonograms. The adult specimens from cadavers were 76 and 60 from sonograms. MATERIAL & METHODS: Abdomen is opened; superficial viscera and coils of intestine removed to get a clear view of posterior abdominal organs and anomalies are noted. SUMMARY & CONCLUSION: The abnormality originates between 4th and 6th weeks of gestation, after the ureteral bud has entered the renal blastema. Boyden (1931) postulated that at the 14mm stage (4.5weeks) the developing metanephric masses lie close to one another, any disturbance in their relationship may result in joining at their inferior poles. Usually the fusion of the both kidneys occurs before they have rotated on their long axis, thus pelvis and ureters of HSK are being usually placed anteriorly. Rarely, fusion occurs after some rotation had already taken place in which case the pelves are anterimedialy placed.

Chromatin dynamics in kidney development and function.

Epigenetic mechanisms are fundamental key features of developing cells connecting developmental regulatory factors to chromatin modification. Changes in the environment during renal development can have long-lasting effects on the permanent tissue structure and the level of expression of important functional genes. These changes are believed to contribute to kidney disease occurrence and progression. Although the mechanisms of early patterning and cell fate have been well described for renal development, little is known about associated epigenetic modifications and their impact on how genes interact to specify the renal epithelial cells of nephrons and how this specification is relevant to maintaining normal renal function. A better understanding of the renal cell-specific epigenetic modifications and the interaction of different cell types to form this highly complex organ will not only help to better understand developmental defects and early loss of kidney function in children, but also help to understand and improve chronic disease progression, cell regeneration and renal aging.

Activity and stability of uricase from Lactobacillus plantarum immobilizated on natural zeolite for uric acid biosensor.

Determination of uric acid concentration in human urine and blood is needed to diagnose several diseases, especially the occurrence of kidney disease in gout patients. Therefore, it is needed to develop a simple and inexpensive method for uric acid detection. The purpose of the research was to observe the use of Indonesian microbe that was immobilized on natural zeolite as a source of uricase for uric acid biosensor. Selection of mediators and determination of optimum condition measurement, the stability and kinetic properties of L. plantarum uricase were performed using carbon paste electrode. Cyclic voltammetry was employed to investigate the catalytic behavior of the biosensor. The result indicated that the best mediator for measurement of L. plantarum uricase activity was Qo (2,3-dimethoxy-5-methyl-1,4 benzoquinone). Optimum conditions for immobilization of L. plantarum uricase on zeolite were obtained at pH 7.6, with temperature of 28 degrees C, using uric acid concentration of 0.015 mM and zeolite mass at 135 mg K(M) and V(Max) of L. plantarum uricase obtained from Lineweaver-burk equation for the immobilization uricase on zeolite were 8.6728 x 10(-4) mM and 6.3052 mM, respectively. K(M) value of L. plantarum uricase directly immobilized onto the electrode surface was smaller than K(M) value of L. plantarum uricase immobilized on zeolite. The smaller K(M) value shows the higher affinity toward the substrate. The Electrode when kept at 10 degrees C was stable until 6 days, however the immobilized electrode on zeolite was stable until 18 days. Therefore, Indonesian L. plantarum could be used as a uric acid biosensor.

Association of rs1800471 polymorphism of TGFB1 gene with chronic kidney disease occurrence and progression and hypertension appearance

IntroductionTransforming growth factor β1 (TGF-β1) is a cytokine involved in the process of pathological tissue sclerosis, which is part of the pathophysiological mechanism of end stage renal disease development. The aim of the study was to evaluate the association of the single nucleotide polymorphism rs1800471 of the TGFB1 gene with chronic kidney disease (CKD) occurrence and progression as well as hypertension appearance.Material and methodsIt was a case-control study where 109 patients with CKD and 111 very old people were enrolled. The association of the studied polymorphism with mentioned diseases was assessed in the whole study group as well as in the subgroups stratified according to the underlying etiology of CKD: nephropathy in type 1 diabetes (n = 13), chronic glomerulonephritis (n = 50) and chronic interstitial nephritis (n = 46).ResultsNo association of CKD progression with rs1800471 polymorphism was observed. The C allele was identified as the one associated with higher risk of the disease occurrence in the dominant model of inheritance (p = 0.035). The C allele in women, opposite to male gender, was associated with higher risk of CKD development (p = 0.038). GG genotype was associated with elevated risk of hypertension appearance (p = 0,0021).ConclusionsDue to the lack of accordance with previously performed studies it is still impossible to state an unequivocal conclusion regarding the association between rs1800471 polymorphism of the TGFB1 gene and risk of CKD occurrence and progression as well as hypertension appearance. That is why it is necessary to perform further studies in this field.

Occurrence of kidney diseases and patterns of glomerular disease based on a 10-year kidney biopsy material: A retrospective single-centre analysis in Estonia

Kidney biopsy is an important diagnostic tool in assessing glomerular damage. This study aimed to determine the occurrence of glomerular disease during the past decade at a single centre, to assess potential changes in the structure of primary glomerulopathies over time, and to define gender- and age-related differences. A total of 578 consecutive native kidney biopsies during the period 2000-2010 was retrospectively reviewed at Tartu University Hospital, Estonia. Biopsies were evaluated according to clinical data with standard histological methods. The patients' mean age was 39.9 ± 17.9 (range 4-87) years. Less than half of informative kidney biopsies (n = 547) comprised primary glomerulopathies (45.4%), the patients' mean age was 38.7 ± 17.7 (4-79) years and the predominant group comprised male patients. Secondary glomerulopathies made up 22.3%, tubulointerstitial diseases 8.2% and other conditions 24.1%. Among primary glomerulopathies, inflammatory damage to glomeruli dominated (63.4%), whereas immunoglobulin A (IgA) nephropathy was the most common disease (35.5%). Non-inflammatory diseases of glomeruli made up 34.6%, among which the most common was focal and segmental glomerulosclerosis (16.1%), followed by minimal change disease (14.1%). Membranoproliferative glomerulonephritis was a rare form of glomerular damage among primary glomerulopathies (7.7%). Comparison between male and female cases in the primary glomerulopathies group revealed a statistically significant difference in their frequency (p = 0.01). Inflammatory glomerulopathies mostly prevailed in the spectrum of primary glomerulopathies. IgA nephropathy was the most common glomerulopathy. Comparing the data with those from a 15-year earlier period at the same centre, a change towards non-inflammatory glomerulopathies was noticed.

Nephroangiosclerosis in Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy: Is NOTCH3 Mutation the Common Culprit?

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a systemic arterial disease characterized by impairment of vascular smooth muscle cell structure and function related to NOTCH3 mutations. Pathological findings include pathognomonic granular osmiophilic material (GOM) deposition with nonspecific hyalinization within the artery wall in a variety of tissues. The main clinical presentation is iterative strokes in young adults despite the lack of cardiovascular risk factors, leading to early dementia. Although arteriosclerosis and GOM have been found in kidneys from patients with CADASIL, kidney disease has been described only once up to now, in association with immunoglobulin A nephropathy. We report the case of a 61-year-old patient with a medical history of CADASIL and recent mild hypertension. His mother also showed neuropsychiatric symptoms and end-stage renal disease of unknown cause. The patient had a chronic kidney disease defined by means of estimated glomerular filtration rate using the 4-variable Modification of Diet in Renal Disease Study equation of 58 mL/min/1.73 m(2) associated with mild proteinuria and intermittent microscopic hematuria. Renal histological analysis showed severe arteriosclerosis and mild interstitial fibrosis. Glomeruli did not show mesangial immunoglobulin A deposition or focal segmental proliferation. Electron microscopic analysis showed typical GOM deposition in the vicinity of altered vascular smooth muscle cells in interlobular and juxtaglomerular arteries. The nephroangiosclerosis-like lesions were unusually severe in contrast to the recent mild hypertension. The presence of GOM strongly suggests that renal lesions were related to the NOTCH3 mutation. Here, we describe the first case of familial occurrence of kidney disease with decreased kidney function in the absence of coexisting nephropathy in patients with CADASIL. We discuss the role of NOTCH3 mutation in the pathogenesis of nephroangiosclerosis through functional impairment of renal microcirculation or primary Notch3-related vascular disease.

Lack of Food Supply and Health Provision and Kidney Diseases among the Soldiers of the Royal Hungarian Army in 1942-43

Explorers and members of the armed forces frequently have to make expeditions in to unknown and hostile country, where the opportunities for obtaining food are either limited or altogether absent. In such circumstances the expedition has to take with it sufficient food for its members. The planning and provision of the rations may make all the differences between the success or failure of the expedition or militar y operation. In 1920-1942 the food supply and health provision was acceptable among the soldiers of th e Royal Hungarian Army and no signs of kidney diseases and nephrotic syndrome could be seen. In August 1942 in Russia the temperature was plus 41°C and in 1943 January it was and 41°C. May be that this indetermination in the temperature and starvation and undernutrition, accompanied with lack of fluid s resulted in the greater frequency of the occurrence of kidney diseases and not punctually registered nephrotic syndrome among the soldiers of the Royal Hungarian Army. In almost a year of the eastern front the 2nd Army lost 125,000 men and dead, wounded or captured, only 70,000 returned.

Impact of Renal Disease on Natriuretic Peptide Testing for Diagnosing Decompensated Heart Failure and Predicting Mortality

Concomitant occurrence of kidney disease (KD) and heart failure (HF) is common and associated with poor outcomes. Natriuretic peptide studies have typically excluded many individuals with KD. We compared the accuracy of B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) for diagnosing decompensated HF and predicting mortality across the spectrum of renal function. BNP and NT-proBNP were prospectively measured in a cohort of 831 dyspnea patients. KD was defined as an estimated glomerular filtration rate <60 mL . min(-1) . (1.73 m(2))(-1). The accuracy and predictive value of each test for diagnosing decompensated HF and predicting all-cause 1-year mortality were assessed by ROC area under the curve (AUC) and multivariate regression analysis. Among the 831 dyspnea patients, 393 (47%) had KD. The diagnostic accuracies of BNP and NT-proBNP in detecting decompensated HF were similar to each other in patients without KD (AUC 0.75 vs 0.74, respectively; P = 0.60) and in patients with KD (AUC 0.68 vs 0.66; P = 0.10). One-year mortality rates were 36.3% and 19.0% in those with and without KD, respectively (P <0.001). Progressively higher BNP and NT-proBNP concentrations remained predictive of increased mortality in KD patients. Compared with the lowest quartile, quartile 4 of BNP had an adjusted hazards ratio (HR) of 2.6 (95% CI 1.4-4.8; P = 0.004 for trend) and NT-proBNP quartile 4 had an HR of 4.5 (95% CI 2.0-10.2; P <0.001 for trend). Only NT-proBNP remained a predictor of death after adjustment for clinical confounders and the other natriuretic peptide marker. NT-proBNP and BNP are equivalent predictors of decompensated HF across a spectrum of renal function, but NT-proBNP is a superior predictor of mortality.

Epidemiologic and clinical factors associated with Chronic Kidney Disease among Asian Americans and Native Hawaiians

Objective. To examine the association between key susceptibility factors and measures of chronic kidney disease in Asian American and Native Hawaiian participants enrolled in the Hawai‘i site of the national Kidney Early Evaluation Program (KEEP-2) study community screening program. Design. In 2001–2003, 793 participants from five ethnic groups (Japanese, Native Hawaii an, Chinese, Filipino and Caucasian) were enrolled in the Hawai‘i KEEP-2 program. Odds ratios were used as the measure of association and were computed using unconditional logistic regression. Renal susceptibility factors for chronic kidney disease were included in a multivariable model if found to be statistically significant in univariate analysis. The proportion of Hawai‘i KEEP-2 study participants manifesting various clinical characteristics were compared by ethnicity with Japanese as the referent group. Results. Significant ethnic differences in the occurrence of chronic kidney disease were found, with Japanese having the lowest occurrence of chronic kidney disease (18%) and Native Hawaiians the highest (40%). Within each ethnic group, the occurrence of chronic kidney disease was associated with a different ethnic-specific clustering of susceptibility factors. Hypertension was associated with chronic kidney disease among four of the five ethnic groups: Japanese, Caucasian, Native Hawaiian and Filipino. Overweight was associated with a decreased occurrence of chronic kidney disease among Caucasians, while diabetes and lower educational attainment were associated with increased occurrence of chronic kidney disease among Native Hawaiians. For Filipinos, diabetes and age 65 years and older were both associated with an increased occurrence for chronic kidney disease while lower educational attainment was associated with a reduced occurrence of chronic kidney disease. Among Chinese, no factors were significantly associated with chronic kidney disease, although trends for all factors paralleled those of the overall study group. Conclusions. The occurrence of chronic kidney disease in the Hawai‘i KEEP-2 study was nearly fourfold greater compared with the general US population. The clustering of susceptibility factors for chronic kidney disease occurrence was found to differ for all five ethnic groups.