Presence Of Kidney Disease Research Articles

FRI0383 Majority of us patients would not meet the proposed acr gout treatment guideline goal of SUA

BackgroundAlthough gout is a relatively common condition, treatment is often not ideal with many patients continuing to experience multiple flares and some developing complications associated with the disease. To improve...

Plasma Kynurenic Acid/Tryptophan Ratio: A Sensitive and Reliable Biomarker for the Assessment of Renal Function

Background: Decreased tryptophan (TRP) and increased kynurenine (KYN) and kynurenic acid (KYNA) in blood have been reported in patients and experimental animals with renal diseases. We investigated if these compounds could be used as new biomarkers for the assessment of renal function. Methods: Eighty hospitalized hypertensive patients (20 with chronic kidney disease (CKD), and other 60 were considered as control) were enrolled for the investigation. Plasma TRP, KYN, and KYNA were determined by high-performance liquid chromatography. Change rate (CR) was employed to evaluate the sensitivity of the parameters of renal function. Results: CR of plasma KYNA/TRP ratio (+103%) was much higher than the CRs of blood urea nitrogen (+44%), serum creatinine (+56%) and estimated glomerular filtration rate (–35%). Plasma KYNA/TRP ratio was in close relationship with blood urea nitrogen (r = 0.622), serum creatinine (r = 0.797), urine micro-albumin/24-h (r = 0.518) and estimated glomerular filtration rate (r = –0.662), respectively, with all p-values <0.001. Conclusions: Plasma KYNA/TRP ratio was sensitive and reliable to indicate renal function and could be used as a new biomarker to assess the risk or presence of kidney disease.

Rastreio de doença coronária no diabético assintomático. Como e em quem?

Screening for coronary artery disease (CAD) in the asymptomatic diabetic patient is controversial with respect to both patient selection and rational choice of screening methods.Epidemiological studies in the real world and improved knowledge on risk markers have changed the criteria that help refine global risk stratification in a patient population that is per se high risk. Over the past years, it is likely that we have been overestimating the risk when using the classical risk factors.This review highlights the role of novel risk markers in the global assessment of diabetic patients, and identifies the best diagnostic approaches to select those patients who might benefit most from revascularization procedures or more aggressive treatment goals, despite the absence of symptoms.Factors such as the presence of kidney disease, cardiovascular autonomic neuropathy or atherosclerotic disease in other arterial territories, may exponentially increase the risk of poor outcomes in diabetic patients.With the aim of rationalizing the use of diagnostic procedures, we propose a sequential approach that combines anatomic and functional data with the coronary calcium score. This approach may serve as a filter to select patients for further assessment with more expensive and less available tests so as to optimize the cost-benefit ratio of screening.

Biophysiologic Outcomes of the Enhancing Adherence in Type 2 Diabetes (ENHANCE) Trial

BackgroundBehavioral research to improve lifestyle in broadly defined populations of patients with type 2 diabetes is limited. ObjectiveWe evaluated a behavioral intervention featuring technology-based self-monitoring on biophysiologic outcomes of glycemic control and markers of cardiovascular risk. DesignIn this single-site, randomized clinical trial, participants were stratified by good and poor glycemic control (glycated hemoglobin <8% or ≥8%) and absence or presence of kidney disease, (estimated glomerular filtration rate ≥60 or <60 mL/min) and randomized within strata. Measurements were obtained at 0, 3, and 6 months. Participants/settingSelf-referred, community-dwelling adults with type 2 diabetes mellitus. InterventionThe intervention group received Social Cognitive Theory-based counseling paired with technology-based self-monitoring, and results were compared with an attention control group. Main outcome measuresGlycated hemoglobin, fasting serum glucose, lipid levels, blood pressure, weight, body mass index, and waist circumference were evaluated. Statistical analyses performedMean differences within and between randomization groups were compared over time. Intervention effects over time were estimated using random intercept models. ResultsTwo hundred ninety-six subjects were randomized, 256 (86.5%) completed 3-month and 246 (83.1%) completed 6-month assessments. Glycated hemoglobin was reduced in the intervention group by 0.5% at 3 months and 0.6% at 6 months (P<0.001 for each), and the control group by 0.3% (P<0.001) at 3 months and 0.2% (P<0.05) at 6 months; but between-group differences were not significant. In those with baseline glycated hemoglobin ≥8% and estimated glomerular filtration rate ≥60 mL/min, glycated hemoglobin was reduced in the intervention group by 1.5% at 3 months and 1.8% at 6 months (P<0.001 for each), and the control group by 0.9% (P<0.001) at 3 months and 0.8% (P<0.05) at 6 months; but between-group differences were not significant. In random intercept models, the estimated reduction in glycated hemoglobin of 0.29% was not significant. ConclusionsTwo behavioral approaches to improving general lifestyle management in individuals with type 2 diabetes mellitus were effective in improving glycemic control, but no significant between-group differences were observed.

Predictors of Diabetic Retinopathy in a Community Health Center Population

Abstract Objective. To determine the predictors of diabetic retinopathy (DR) in a Federally Qualified Health Center population of patients. Research design and methods. We retrospectively evaluated 526 patients who were screened for DR in the first year of a newly implemented telemedicine program (July 2009 to June 2010). Through this program, a total of 139 patients were diagnosed with DR, whereas 387 patients were not and then served as the comparator group. Multivariate logistic regression was used to determine the predictors of DR in this cohort of patients. Results. After multivariate analysis, four positive predictors of DR were found: insulin use (adjusted odds ratio [AOR] 1.94 [1.17–3.22]), years with diabetes (AOR 1.22 [1.16–1.28]), A1C (AOR 1.15 [1.02–1.29]), and kidney disease (AOR 5.11 [2.33–11.20]). No variables were found to decrease the odds of DR. Conclusion. Among patients with diabetes, use of insulin therapy, longer duration of diabetes, presence of kidney disease, and higher A1C values increase the odds of DR. These preliminary data may suggest patients who are at higher risk of DR to further prioritize screening for DR with a newly implemented telemedicine program.

New roles for renin and prorenin in heart failure and cardiorenal crosstalk

The renin-angiotensin-aldosterone-system (RAAS) plays a central role in the pathophysiology of heart failure and cardiorenal interaction. Drugs interfering in the RAAS form the pillars in treatment of heart failure and cardiorenal syndrome. Although RAAS inhibitors improve prognosis, heart failure–associated morbidity and mortality remain high, especially in the presence of kidney disease. The effect of RAAS blockade may be limited due to the loss of an inhibitory feedback of angiotensin II on renin production. The subsequent increase in prorenin and renin may activate several alternative pathways. These include the recently discovered (pro-) renin receptor, angiotensin II escape via chymase and cathepsin, and the formation of various angiotensin subforms upstream from the blockade, including angiotensin 1–7, angiotensin III, and angiotensin IV. Recently, the direct renin inhibitor aliskiren has been proven effective in reducing plasma renin activity (PRA) and appears to provide additional (tissue) RAAS blockade on top of angiotensin-converting enzyme and angiotensin receptor blockers, underscoring the important role of renin, even (or more so) under adequate RAAS blockade. Reducing PRA however occurs at the expense of an increase plasma renin concentration (PRC). PRC may exert direct effects independent of PRA through the recently discovered (pro-) renin receptor. Additional novel possibilities to interfere in the RAAS, for instance using vitamin D receptor activation, as well as the increased knowledge on alternative pathways, have revived the question on how ideal RAAS-guided therapy should be implemented. Renin and prorenin are pivotal since these are at the base of all of these pathways.

The kidney function trends in human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) patients at the Nylon DistrictHospital, Douala, Cameroon

Human immunodeficiency virus (HIV) related kidney disease is one of the leading causes of death and affects predominantly people of black descent. Data is unavailable on the presence of kidney disease amongst HIV positive patients in Cameroon and a high prevalence of the disease depicts a high incidence of HIV associated nephropathy. A cohort study was carried out from May to August 2010 at the Nylon District Hospital Douala to investigate the Kidney function trends amongst seropositive individuals. Kidney function tests like serum urea, serum creatinine, creatinine clearance, proteinuria and urine chemistry was measured amongst 329 participants amongst whom 100 (30.4%) were HIV negative and 229 (69.6%) were HIV positive. The age range of the study population was 18 to 60 years, with mean age of 35.122 ± 0.543. There were 94(28.6%) males and 235 (71.5%) females. The percentage of HIV seropositivity was higher in females than in males (74.3% vs. 25.7% p < 0.05).Although, Serum creatinine, creatinine clearance and proteinuria were significantly higher in the control group than in the HIV infected subjects (p < 0.0001, p = 0.046 and p = 0.001, respectively), these values were not indicative of renal pathology. Considering only HIV positive individuals the mean serum creatinine was significantly higher in the Antiretoviral treatment (ART) naive group when compared to those who were already on ART. These findings indicate that renal function is not affected by the seropositivity status of individuals. Key words: Kidney function, human immunodeficiency virus/acquired immune deficiency syndrome(HIV/AIDS) seropositivity, Cameroon.

Reviewing the benefits of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in diabetic nephropathy – are they drug specific or class specific?

Hypertension is prevalent in patients with type 2 diabetes mellitus and contributes to substantial morbidity and mortality. Preventing microalbuminuria (MAU) is important in these patients because MAU is associated with an increased risk of end-stage renal disease and cardiovascular events. Current hypertension treatment recommendations are based on drug 'class' effects. For the treatment of hypertension in patients with diabetes, important agent-specific effects should be brought into consideration in the choice of drug. For these patients, and especially in the presence of kidney disease, the choice of agent must effectively target not only blood pressure reduction, but also prevention and treatment of MAU for optimal organ outcomes. A review of the current evidence suggests a diversity of MAU-associated risk reduction according to agent within the angiotensin receptor blocker and angiotensin-converting enzyme inhibitor classes, ranging from nonefficacy to significant efficacy. Recommendations should clearly state absolute risk reduction according to agent, based on the best available evidence.

Serum Creatinine vs. Albuminuria as Biomarkers for the Estimation of Cardiovascular Risk

Cardiovascular (CV) disease is the leading cause of morbidity and mortality among people with chronic kidney disease (CKD). CKD has increased over the past decade to become a worldwide public health problem. The definition of a biomarker is a characteristic objectively measured and evaluated as an indicator of normal biologic processes, pathogenic processes, or pharmacologic response to a therapeutic intervention. Thus, biomarkers of kidney function would include serum creatinine and more recently estimated glomerular filtration rate (eGFR). These biomarkers and microalbuminuria, potential biomarker, predict CV events and mortality. Recent analyses of cross-sectional data indicate that eGFR is a much stronger predictor of CV events than is microalbuminuria. While microalbuminuria indicates endothelial dysfunction and is associated with increased risk for CV events, its level is related more to the level of blood pressure and glycemic control than directly to the pathophysiology of atherosclerosis. Hence, microalbuminuria could be viewed as a biomarker but not a risk factor for CV risk since, risk factors must be an integral part of the disease pathophysiology. Conversely, while microalbuminuria is not of prognostic value to predict CKD outcomes, increases over time into the albuminuria range, >200 mg/day, clearly indicate presence of kidney disease and are associated with a more rapid decline in kidney function. Thus, concomitant evaluation of both biomarkers eGFR and albuminuria is recommended to assess kidney function and CV risk thoroughly.

Relation Between Renal Function and Outcomes in Patients With Non–ST-Segment Elevation Acute Coronary Syndrome

Clinical trials provide limited information about the outcome of patients with acute coronary syndromes (ACSs) and kidney disease (KD) owing to underrepresentation of this population in most studies. To evaluate the outcome of patients with non-ST-segment elevation ACS (NSTE-ACS) and KD in a real-world setting, we compared the risk of in-hospital and 30-day mortality by the presence of KD (defined as an estimated glomerular filtration rate <60 mL/min/1.73 m(2)) in 13 141 patients with NSTE-ACS enrolled in 3 multinational ACS registries between 2000 and 2006 as part of the European Public Health Outcome Research and Indicators Collection Project. Patients with KD (n = 4181) composed 31.8% of the study population and had significantly higher rates of in-hospital (5.4%) and 30-day (7.2%) case fatality compared with patients without KD (1.1% and 1.7%, respectively; P < .001 for both). In multivariate analysis, the presence of KD was independently associated with a significantly higher mortality risk (in-hospital: odds ratio [OR], 2.11; 95% confidence interval [CI], 1.48-3.00; 30-day: OR, 1.95; 95% CI, 1.46-2.61). Patients with KD who underwent coronary angiography experienced a 36% (P = .05) and 40% (P < .001) lower risk of in-hospital and 30-day mortality, respectively, but this high-risk population still exhibited significantly higher case-fatality rates during hospitalization (3.3%) and at 30 days (4.6%) compared with patients without KD who underwent coronary angiography (0.7% and 1.3%, respectively; P < .001 for all). In a real-world setting, KD was present in approximately one-third of patients with NSTE-ACS and is a powerful independent predictor of subsequent mortality. Patients with NSTE-ACS and KD referred for coronary angiography have a significantly lower risk of death, but this high-risk population continues to exhibit increased mortality rates despite intervention procedures.

Should proteinuria reduction be the criterion for antihypertensive drug selection for patients with kidney disease?

Proteinuria, that is, more than 200 mg/day of urinary albumin, is associated with the presence of kidney disease. Its increase over time is strongly correlated with progression of nephropathy. Retrospective analyses of nephropathy outcome trials show that proteinuria reduction of 30% or more after initiation of blood pressure (BP)-lowering therapy is associated with slower nephropathy progression than lowering BP without its reduction. Retrospective analyses of five large nephropathy outcome trials demonstrate that nephropathy progression slowed by an additional 28-39% over the control or placebo group when proteinuria was reduced in concert with BP. Two separate trials demonstrate that nephropathy progression was slowed to a lesser degree when BP was reduced to a similar degree, but proteinuria reduced less than 30%. These associations do not hold for those with microalbuminuria, in which BP reduction is the key element to slowing nephropathy progression. Recent cardiovascular outcome trials fail to show a relationship between reductions in proteinuria and nephropathy outcomes. This large cardiovascular endpoint trial, however, was not only powered for nephropathy outcomes but also failed to show a benefit between proteinuria reduction and cardiovascular events, a previously established observation. All patients with a history of hypertension and either kidney disease or diabetes should have an annual check for albuminuria. If albumin is present in amounts of more than 200 mg/day, strategies for BP-lowering therapy should also focus on a reduction of more than 30% of urinary protein.

The message for World Kidney Day 2009: hypertension and kidney disease: a marriage that should be prevented

The prevalence of chronic kidney disease (CKD) continues to increase worldwide as does end stage renal disease. The most common, but not only, causes of CKD are hypertension and diabetes. CKD is associated with a significant increase in cardiovascular (CV) risk as most patients with CKD die of a CV cause. Moreover, CV risk increases proportionally as estimated glomerular filtration rate falls below 60 mL/min. CV causes of death in CKD are more prevalent than those from cancer; as a result, the identification and reduction of CKD is a public health priority. High blood pressure is a key pathogenic factor that contributes to the deterioration of kidney function. The presence of kidney disease is a common and underappreciated preexisting medical cause of resistant hypertension. Therefore, treatment of hypertension has become the most important intervention in the management of all forms of CKD. For this reason, World Kidney Day on March 12, 2009 will emphasize the role of hypertension.

The message for World Kidney Day 2009: hypertension and kidney disease—a marriage that should be prevented

The kidney is both a cause and victim of hypertension. High BP is a key pathogenetic factor that contributes to deterioration of kidney function. Presence of kidney disease is a common and underappreciated pre-existing medical cause of resistant hypertension (1). Therefore, treatment of hypertension has become the most important intervention in the management of all forms of chronic kidney disease (CKD). For this reason, the forthcoming World Kidney Day (WKD) on March 12th 2009 will emphasize the role of hypertension for renal disease. In contrast to a decade ago, today most laboratories around the world report estimated GFR (eGFR) instead of, or in addition to, serum creatinine. This now provides the physician with information about kidney function that is, in general, more informative. As a result, a greater percentage of patients with diabetes or hypertension and their physicians have a better knowledge of their kidney function. Assessment of eGFR as an index of kidney function should be complemented by assessing urine for protein or albumin (preferred). In spite of these laboratory updates, recent data demonstrate that a given patient's knowledge that he or she has CKD is very low. In a recent analysis of almost half a million people in Taiwan who took part in a standard medical screening program, 12% had CKD (2). It was noteworthy that less than 4% of those with CKD were aware of their condition. People with CKD are several times more likely to die from cardiovascular (CV) causes than those without CKD; thus, hypertension is a major risk factor in this context (3). The combination of CKD and hypertension, therefore, is a major public health issue; because of the costly treatments necessary for end-stage renal disease (ESRD), end-stage CKD has also become a substantial burden to health budgets. The frequency of CKD continues to …

The Message for World Kidney Day 2009: Hypertension and Kidney Disease: A Marriage That Should Be Prevented

The prevalence of chronic kidney disease (CKD) continues to increase worldwide as does end stage renal disease. The most common, but not only, causes of CKD are hypertension and diabetes. CKD is associated with a significant increase in cardiovascular (CV) risk as most patients with CKD die of a CV cause. Moreover, CV risk increases proportionally as estimated glomerular filtration rate falls below 60 mL/min. CV causes of death in CKD are more prevalent than those from cancer; as a result, the identification and reduction of CKD is a public health priority. High blood pressure is a key pathogenic factor that contributes to the deterioration of kidney function. The presence of kidney disease is a common and underappreciated preexisting medical cause of resistant hypertension. Therefore, treatment of hypertension has become the most important intervention in the management of all forms of CKD. For this reason, World Kidney Day on March 12, 2009 will emphasize the role of hypertension.

The message for World Kidney Day 2009: hypertension and kidney disease – a marriage that should be prevented

The prevalence of chronic kidney disease (CKD) continues to increase worldwide as does end-stage renal disease. The most common, but not the only, causes of CKD are hypertension and diabetes. CKD is associated with a significant increase in cardiovascular risk as most patients with CKD die of a cardiovascular cause. Moreover, cardiovascular risk increases proportionally as estimated glomerular filtration rate falls below 60 ml/min. Cardiovascular causes of death in CKD are more prevalent than those from cancer; as a result, the identification and reduction of CKD is a public health priority. High blood pressure is a key pathogenic factor that contributes to the deterioration of kidney function. The presence of kidney disease is a common and underappreciated preexisting medical cause of resistant hypertension. Therefore, treatment of hypertension has become the most important intervention in the management of all forms of CKD. For this reason, the forthcoming World Kidney Day on 12 March 2009 will emphasize the role of hypertension.

The Message for World Kidney Day 2009

The kidney is both a cause and victim of hypertension. High BP is a key pathogenetic factor that contributes to deterioration of kidney function. Presence of kidney disease is a common and underappreciated pre-existing medical cause of resistant hypertension (1). Therefore, treatment of hypertension has become the most important intervention in the management of all forms of chronic kidney disease (CKD). For this reason, the forthcoming World Kidney Day (WKD) on March 12th 2009 will emphasize the role of hypertension for renal disease. In contrast to a decade ago, today most laboratories around the world report estimated GFR (eGFR) instead of, or in addition to, serum creatinine. This now provides the physician with information about kidney function that is, in general, more informative. As a result, a greater percentage of patients with diabetes or hypertension and their physicians have a better knowledge of their kidney function. Assessment of eGFR as an index of kidney function should be complemented by assessing urine for protein or albumin (preferred). In spite of these laboratory updates, recent data demonstrate that a given patient's knowledge that he or she has CKD is very low. In a recent analysis of almost half a million people in Taiwan who took part in a standard medical screening program, 12% had CKD (2). It was noteworthy that less than 4% of those with CKD were aware of their condition. People with CKD are several times more likely to die from cardiovascular (CV) causes than those without CKD; thus, hypertension is a major risk factor in this context (3). The combination of CKD and hypertension, therefore, is a major public health issue; because of the costly treatments necessary for end-stage renal disease (ESRD), end-stage CKD has also become a substantial burden to health budgets. The frequency of CKD continues to …

The message for World Kidney Day 2009: Hypertension and kidney disease: A marriage that should be prevented

The kidney is both a cause and victim of hypertension. High BP is a key pathogenetic factor that contributes to deterioration of kidney function. Presence of kidney disease is a common and underappreciated pre-existing medical cause of resistant hypertension (1). Therefore, treatment of hypertension has become the most important intervention in the management of all forms of chronic kidney disease (CKD). For this reason, the forthcoming World Kidney Day (WKD) on March 12th 2009 will emphasize the role of hypertension for renal disease. In contrast to a decade ago, today most laboratories around the world report estimated GFR (eGFR) instead of, or in addition to, serum creatinine. This now provides the physician with information about kidney function that is, in general, more informative. As a result, a greater percentage of patients with diabetes or hypertension and their physicians have a better knowledge of their kidney function. Assessment of eGFR as an index of kidney function should be complemented by assessing urine for protein or albumin (preferred). In spite of these laboratory updates, recent data demonstrate that a given patient's knowledge that he or she has CKD is very low. In a recent analysis of almost half a million people in Taiwan who took part in a standard medical screening program, 12% had CKD (2). It was noteworthy that less than 4% of those with CKD were aware of their condition. People with CKD are several times more likely to die from cardiovascular (CV) causes than those without CKD; thus, hypertension is a major risk factor in this context (3). The combination of CKD and hypertension, therefore, is a major public health issue; because of the costly treatments necessary for end-stage renal disease (ESRD), end-stage CKD has also become a substantial burden to health budgets. The frequency of CKD continues to …

The message for World Kidney Day 2009: hypertension and kidney disease—a marriage that should be prevented

The prevalence of chronic kidney disease (CKD) continues to increase worldwide as does end stage renal disease. The most common, but not only, causes of CKD are hypertension and diabetes. CKD is associated with a significant increase in cardiovascular (CV) risk as most patients with CKD die of a CV cause. Moreover, CV risk increases proportionally as estimated glomerular filtration rate falls below 60 mL/min. CV causes of death in CKD are more prevalent than those from cancer; as a result, the identification and reduction of CKD is a public health priority. High blood pressure is a key pathogenic factor that contributes to the deterioration of kidney function. The presence of kidney disease is a common and underappreciated preexisting medical cause of resistant hypertension. Therefore, treatment of hypertension has become the most important intervention in the management of all forms of CKD. For this reason, World Kidney Day on March 12, 2009 will emphasize the role of hypertension.

The message for World Kidney Day 2009: hypertension and kidney disease— a marriage that should be prevented

The prevalence of chronic kidney disease (CKD) continues to increase worldwide as does end stage renal disease. The most common, but not the only, causes of CKD are hypertension and diabetes. CKD is associated with a significant increase in cardiovascular (CV) risk as most patients with CKD die of a CV cause. Moreover, CV risk increases proportionally as eGFR falls below 60 ml min(-1). CV causes of death in CKD are more prevalent than those from cancer are; as a result, the identification and reduction of CKD is a public health priority. High blood pressure is a key pathogenic factor that contributes to the deterioration of kidney function. The presence of kidney disease is a common and underappreciated pre-existing medical cause of resistant hypertension. Therefore, treatment of hypertension has become the most important intervention in the management of all forms of CKD. For this reason, the forthcoming World Kidney Day on 12 March 2009 will emphasize the role of hypertension.

Neurology of endemic skeletal fluorosis

Endemic skeletal fluorosis is widely prevalent in India and is a major public health problem. The first ever report of endemic skeletal fluorosis and neurological manifestation was from Prakasam district in Andhra Pradesh in the year 1937. Epidemiological and experimental studies in the endemic areas suggest the role of temperate climate, hard physical labor, nutritional status, presence of abnormal concentrations of trace elements like strontium, uranium, silica in water supplies, high fluoride levels in foods and presence of kidney disease in the development of skeletal fluorosis. Neurological complications of endemic skeletal fluorosis, namely radiculopathy, myelopathy or both are mechanical in nature and till date the evidence for direct neurotoxicity of fluoride is lacking. Prevention of the disease should be the aim, knowing the pathogenesis of fluorosis. Surgery has a limited role in alleviating the neurological disability and should be tailored to the individual based on the imaging findings.