Stages Of Chronic Renal Insufficiency Research Articles

Chronic renal insufficiency can cause early anemia: A cross-sectional study

Background: Chronic renal insufficiency has emerged as a global health issue, causing significant morbidity and mortality. Anybody can develop anemia but it is very common in people with chronic kidney disease (CKD). Renal anemia develops as a result of CKD, and its prevalence rises as the disease progresses. The WHO defines anemia as a hemoglobin level <13 gm/dl for males as well as women in the post-menopausal age group and ˂12 gm/dl for women in the pre-menopausal age group. Aim and Objectives: This study was done to assess whether a correlation exists between the grades of anemia and various stages of chronic renal insufficiency. Materials and Methods: The authors conducted a cross-sectional study involving 145 subjects with diabetes mellitus and CKD. The primary aim was to investigate the various grades of anemia in different stages of CKD patients. We classified the CKD patients into 5 stages based on GFR rates, as defined by guidelines of the national kidney foundation. Results: This study shows that out of 145 subjects having diabetic nephropathy with CKD, 59 subjects had mild anemia, 60 subjects had moderate anemia, and 26 subjects had severe anemia. Data were analyzed using the SPSS 16.0 version. The qualitative results were presented in frequency, percentages, and graphs. Baseline characteristic cases were compared with grades of anemia. For the correlation between two variables, Pearson and Spearman correlation coefficients were applied. The majority of patients with Grade 2 and Grade 3 CKD had mildto-moderate grades of anemia which worsened as the stage of CKD progressed and came out to be highly significant. Conclusion: This study concludes that anemia is a consistent finding in patients of CKD; the severity of anemia progresses as the kidney function is compromised.

Nutritional status of patients according to the stage of chronic renal failure

Introduction. In Burkina Faso, chronic kidney disease (CKD) is a major public health problem due to its increasing prevalence, severity and the high cost of treatment. Aim. The aim of this study was to describe nutritional status of subjects diagnosed with severe and moderate stages of chronic renal insufficiency, followed in nephrology consultation at the Yalgado Ouedraogo University Hospital Center (YO-UHC) of Ouagadougou. Methods. A descriptive cross-sectional study conducted over a period of eight months and included 75 patients in total. The social-demographic parameters were determined on the basis of the patients' declaration and the use of their medical records. Biological parameters were collected from the results of laboratory examinations performed by each patient. The nutritional status of the patients was assessed by the anthropometric method. Finally, all patients were asked about their dietary habits and lifestyle using the 24-hour recall method. Results. Our results revealed a male predominance, out of the total number of patients included. The percentage of men and women was 54.70% and 45.30% respectively with a sex (male/female) ratio of 1.20. The average of Body Mass Index was 24.79 Kg/m2. The percentage of overweight and obesity of women was 64.71% compared to 26.83% for men. The proportion of women with severe chronic kidney disease (58.82%) was twice as high as that of men (29.27%), (P<0.05). The average waist circumference of the subjects aged 30-39 years was significantly lower than that of the subjects aged 60-85 years. So, average hip circumference was 93.77 cm, with a significant difference according to sex (P<0.05). The prevalence of hyperglycaemia and diabetes increased with age. Hyperglycaemia in the 40-49 age group was increased significantly from 16.67% to 26.67% in the 70-85 age group (P<0.05). Diabetes in the 50-59 age group was 10% and doubled in the 70-85 age group (P<0.05). A percentage of 67.99% of the patients had a history of hypertension in either first-degree relatives or collaterals. The highest proportion was found in the hypertensive collaterals (37.33%; P=0.059). This study revealed a low level of physical activity among all patients. Only 38.67% of the patients practiced regular physical activity. There was no significant association between the level of physical activity and the stage of renal failure. Conclusion. Knowledge of nutritional status is a crucial part of better nutritional management of CKD patients. Finally, previous studies on the dietary habits of patients suffering from CKD will allow a better understanding of their nutritional status for a better management according to the stage of progression of the disease.

Carbon dioxide (Co2) Angiography in Diabetic Patients with Peripheral Arterial Disease and Chronic Renal Insufficiency as a Standard Procedure

Introduction - The objective of this study is to evaluate the diagnostic and therapeutic carbon dioxide (CO2) angiography in patients with diabetes mellitus, peripheral arterial vascular disease (PAD) and chronic renal insufficiency (CRI) to determine whether to use of carbon dioxide angiography in this type of patients should be a standard. Methods - Lower limb angiographic procedures with CO2 (diagnostic and diagnostic-interventional) were collected from the database of our clinic of 205 consecutive patients between 2012 and 2017 and retrospectively reviewed. Of the 205 patients with PAD undergoing CO2 angiography 196 had a admitting diagnose of CRI≥ stage III(GFR<45, moderate to severe Kidney function loss) and 9 patients had a iodinated contrast medium hypersensitivity Results - Of the 205 patients undergoing CO2 angiography, 122 (60%) had diabetes mellitus. 18% Had PAD Fontaine stage II, 20% stage III and 62% stage IV. Of the patients without known diabetes mellitus at the begin of medical hospitalization, 29 (35%) had a glycated haemoglobin levels above 6.1%. Of the diabetic patients 116 (95%), had CRI≥ stage III (stage III 47%, stage IV 45% and stage V with residual excretion 8%). However of the 116 diabetics with CRI≥ stage III, the CRI was only known at 74%. Of the remainder of the 24% (30 patients) with unknown CRI, 20 had CRI stage III and 10 had stage IV. Lower limb angiographic procedures with CO2 in diabetics, were performed diagnostically at 30% and diagnostically-interventional at 70%. Balloon dilatation was performed in 81% of diagnostic interventional angiographies (30% crural) and in 19% was placed a stent. Postinterventionall, 95% of patients didn’t have any deterioration of the renal parameters. Conclusion - CO2-guided angiographies are technically safe; reduce the need of a iodinated contrast medium(ICM) application, prevent deterioration of renal function in patients with pre-existing renal insufficiency. This study shows diabetic patients with PAD as an increased risk patient for CNI. As shown, 95% of patients with diabetes who also had PAD, had CRI ≥stage.III at the same time. These patients require quickly and low-risk (kidney-safe) lower limb imaging to help preserve the leg. A ICM examination is contraindicated in these patients and CO2 angiography should be used as the standard, so that no comparison group could be produced to compare the results. Despite the CO2 angiography, 30% of the patients were able to undergo a crural balloon dilatation. The study shows the high rate of diabetic patients with PAD with a not necessarily known CRI, in which CO2 angiography should be used as a standard.

Clinical value of contrast-enhanced ultrasonography in evaluating renal cortical perfusion in elderly diabetic patients

Objective To investigate the clinical value of contrast-enhanced ultrasonography(CEUS)in evaluating renal cortical perfusion in elderly diabetic patients. Methods A retrospective cross-sectional study was conducted.A total of 70 diabetic patients with chronic renal insufficiency stage 1 to 5 were enrolled.The glomerular filtration rate(GFR)was estimated according to the creatinine level.Based on GFR, patients were divided into a mild-to-moderate chronic kidney disease(CKD)group(n=42, CKD stage 1 to 3)and a severe CKD group(n=28, CKD stage 4 to 5). All patients underwent CEUS for the assessment of renal perfusion and renal dynamic imaging for the assessment of GFR.QLAB analysis software was used to obtain the time-intensity curve(TIC)and related parameters including area under the curve(AUC), the ascending slope(A), the derived peak intensity(DPI)and the time to peak(TTP). The differences in renal perfusion parameters were compared between the two groups.Pearson correlation test was used to assess the correlation between the quantitative parameters of renal cortical perfusion and GFR. Results There was no significant difference in age, gender, history of hypertension, basal blood glucose level, systolic or diastolic blood pressure between the two groups(all P>0.05). CEUS findings revealed high renal cortical blood perfusion in the mild-to-moderate group.There were significant differences in quantitative perfusion parameters including AUC, DPI, A and TTP between the two groups.Pearson correlation test indicated that TTP and A were significantly correlated with GFR in both groups(r=-0.456 and -0.693, 0.432 and -0.529, all P 0.05). Conclusions Diabetic patients with mild-to-moderate CKD have high renal cortical blood perfusion.CEUS findings can indirectly reflect renal function.The perfusion parameters A and TTP have good correlations with GFR.CEUS can be used as a safe and effective method to evaluate renal function, especially in patients with severe renal insufficiency, but more studies are needed to verify the results. Key words: Ultrasonography, inter ventional; Kidney cortex; Renal circulation

Chronic Kidney Disease and Lipid Disorders.

Introduction:Chronic kidney disease (CKD) represents a serious public health problem due to the increase in incidence and prevalence of this disease worldwide. Given the significant morbidity and mortality from cardiovascular disease (CVD) in the population of patients with CKD, and the fact that dyslipidemia itself is a risk factor for CVD, increases the importance of lipid metabolism study in patients with CKD. Goal: Evaluate the lipid status of patients with chronic kidney disease.Material and methods:A one-year prospective study included 150 adult patients who were in various stages of chronic renal failure (stage I to IV). Estimate of creatinine clearance was performed using Cockroft-Goult formula. The classification of patients according to stages of chronic renal insufficiency was performed in accordance with the criteria of Kidney Disease Outcomes Quality Initiative (K/DOQI).Results:Of the total number of patients (N=150) there was 71 males and 79 females. The mean age of patients was 55.43 years. Average values of serum cholesterol were highest in patients with stage II renal disease and the lowest in patients classified as stage IV (5.76±1.60 mmol/L vs. 5.07±1.88 mmol/L). Analysis of the average value of triglycerides in blood show a slight increase through the stages of CKD in a manner that patients classified into stage I have low serum triglyceride levels (1.73±1.17 mmol/L (range 0.61 to 5.5 mmol/L), and patients classified in stage III the highest value 2.13±1.11 mmol/L (range 0.62 to 4.66 mmol/L).Conclusion:Average cholesterol levels does not statistically significantly change with progression of chronic renal disease. There is an almost linear increase in average triglyceride levels in chronic renal disease. Triglyceride levels in serum begins to increase in the early stage of chronic renal disease and reach the peak in stage IV.

THE OPTIMIZATION OF DIALYSIS PROGRAM FOR UREMIC POLYNEUROPATHY TREATMENT

The impact of changes dialysis program on ENMG rates in patients with a terminal stage of chronic renal insufficiency receiving regular dialysis treatment was studied. The study made it possible to determine that the strengthening of the dialysis program with the increase in KT/V to 1.4 promotes regression of neurological manifestations of uremic polyneuropathy and improvement of neurophysiological indicses of functioning of the peripheral nerves in patients with a terminal stage of chronic renal insufficiency. Significantly improved indicators of functional activity as axial cylinders of the peripheral nerves and the myelin sheath. Optimisation of dialysis program allows to improve the functional activity of peripheral nerves already by the end of the first month, the maximum therapeutic effect at 6month treatment and to obtain the steadfast compensation sensory and motor deficit of uremic polyneuropathy. Thus, for the correction of uremic polyneuropathy it is expedient to strengthen the dialysis program with the increase in KT/V to 1.4.

The role of 99mTc-MIBI SPECT/low dose CT with 3D subtraction in patients with secondary hyperparathyroidism due to chronic kidney disease.

The aim of the present work was to assess the incidence of parathyroid glands hyperplasia or adenoma in patients with various stages of chronic renal insufficiency using 99mTc-methoxyisobutylisonitrile (MIBI) SPECT and 3D subtraction technique with 99mTc-pertechnetate (Tc). Sixty one patients underwent hybrid SPECT with low-dose CT of the parathyroid glands and thyroid SPECT scintigraphy. Thirty six patients were with chronic kidney disease (CKD) without renal failure (RF) and 25 patients underwent peritoneal dialysis or hemodialysis. In each patient, two SPECT studies were performed - an early and a late one with low dose of CT with MIBI injection. Additional SPECT was performed on another day with Tc. SPECT studies were evaluated visually using volume rendering method and semi-quantitatively by 3D subtraction of Tc SPECT from early MIBI SPECT. From all 61 patients, 40/61 (66%) findings were positive, 7/61 (12%) inconclusive, and 14/61 (23%) negative. Solitary lesions were detected in 22 patients. More than one lesion was found in 18 patients. The incidence of secondary hyperparathyroidism was detected in 40/61 patients (66%) with chronic kidney disease using scintigraphy and 16 patients (40%) from them underwent surgery. MIBI SPECT/low dose CT with 3D dual - tracer subtraction (MIBI-Tc) method is an effective tool for preoperative detection of the parathyroid glands hyperplasia or adenoma.

Advanced Oxidation Protein Products and Advanced Glycation End Products in Children and Adolescents With Chronic Renal Insufficiency

Advanced oxidation protein products (AOPPs) represent dityrosine-containing cross-linked protein modifications formed mainly via myeloperoxidase reaction, supposed to accelerate the uremia-associated atherogenesis and renal fibrosis. DESIGN, SUBJECTS, AND MAIN OUTCOME MEASURES: In a cross-sectional study, we investigated the accumulation of AOPPs and advanced glycation end product (AGE)-specific fluorescence corrected for albumin in children and adolescents with chronic renal failure (CRF, n = 42), end-stage renal disease (ESRD, n = 12), kidney transplanted patients (Tx, n = 16), and age-matched healthy controls (n = 38). AOPP levels were 2.4-fold higher in the CRF and ESRD patients, and 1.6-fold higher in the transplanted subjects when compared with the controls (P < .001). In comparison with healthy controls, AGE levels rose 2-fold in the CRF, 7-fold in the ESRD, and 5-fold in the kidney transplanted children and adolescents, (P < .001). Patients with cardiovascular affliction presented with higher AGE levels than those without diagnosed cardiovascular disease (P < .02). In patients with stabilized renal function, AOPP and AGE levels did not change significantly during 12months. Pattern of accumulation of AOPP and AGE in children and adolescents with chronic renal disease differs. Accelerated rise in AOPP levels in some children and adolescents in predialysis stage of chronic renal insufficiency, inadequate to deterioration of renal function, might require further attention.

Single dose pharmacokinetics of the transdermal rotigotine patch in patients with impaired renal function

To evaluate the influence of different stages of chronic renal insufficiency on the pharmacokinetics and safety/tolerability of the transdermally applied dopamine agonist rotigotine in an open label group comparison including 32 subjects (healthy, mild, moderate or severe impairment of renal function and patients with end-stage renal insufficiency requiring haemodialysis). METHODS All subjects received a single transdermal 10 cm² patch (24 h patch-on period) containing 4.5 mg rotigotine (nominal drug release 2 mg 24 h⁻¹). Main evaluations included relative bioavailability and renal elimination of rotigotine and its metabolites. Point estimates for the ratios between the groups with moderate to severe renal impairment and healthy subjects for the pharmacokinetic parameters AUC(0,t(last) ) and C(max) for the active substance unconjugated rotigotine were near 1:0.88 for AUC and 0.93 for C(max) for moderate renal impairment, 1.14 and 1.18 for severe renal impairment and 1.05 and 1.25 for end-stage renal insufficiency requiring haemodialysis. There was no correlation of these parameters with creatinine clearance. The amount of unconjugated rotigotine excreted into urine and renal clearance decreased with increasing severity of renal insufficiency but had no observable effect on total clearance as the amounts excreted were below 1% of the administered dose. Occurrence of adverse events did not increase with the degree of renal insufficiency. The pharmacokinetic profiles of unconjugated rotigotine were similar in healthy subjects and subjects with impaired renal function indicating that no dose adjustments are required for transdermal rotigotine in patients with different stages of chronic renal insufficiency including patients on haemodialysis.

Evolution of light chain deposition disease over 8 years

A 44-year-old female was diagnosed with proteinuria due to nodular glomerulosclerosis secondary to light chain deposition disease (LCDD). After 6 years, deterioration of kidney function occurred and autologous stem cell transplantation was considered, but the patient refused specific therapies. The disease progressed slowly, over a period of 8 years reaching now chronic renal insufficiency stage 4 with a creatinine clearance of 20 ml/min, in spite of no specific therapy. This case, documented by repeated biopsies, demonstrates the very slow loss of kidney function, suggesting the possibility of conservative treatment strategies without taking the risks of chemotherapy or autologous stem cell transplantation, since no long term follow up data of these therapies are available for LCDD.

Predicting renal functional outcomes after surgery for renal cortical tumors: A multifactorial retrospective analysis

e16005 Background: Nephrectomy (Nx) is the standard of care for localized renal tumors. The risk of developing chronic renal insufficiency (CRI) increases after renal surgery. This study examines the functional outcomes for radical and partial Nx stratified by pre- and perioperative variables using estimated GFR. Methods: Using the Columbia Urologic Oncology Database, a retrospective analysis of patients treated with partial or radical Nx for renal cancer from 1988 to 2008 was conducted. Postoperative chronic renal function was measured using GFR as estimated by the MDRD study equation. Three primary outcomes were measured: 1) presence of new onset postoperative CRI (defined as GFR lower than 60 mL/min per 1.73 m2), 2) percent change in postoperative GFR from preoperative value, and 3) change in CRI stage postoperatively. Regression models were used to determine the effect of surgical procedure (radical vs partial Nx), approach, and multiple preoperative characteristics on functional outcomes. Results: 174 patients met the criteria for analysis after radical Nx and 102 after partial Nx for a total of 276 patients. 209 patients had preoperative GFR &gt; 60, 67 had preoperative GFR &lt; 60, and 6 had preoperative GFR &lt; 30. After a minimum of 3 months postoperatively, 108/209 (52%) and 2/209 (1%) patients developed new-onset GFR &lt;60 and &lt;30, respectively. On multivariate analysis controlling for age, sex, race, diabetes and hypertension, preoperative CKD stage (p&lt;0.001) and procedure (p&lt;0.001) were both independent predictors of GFR progression to &lt;60; similarly, preoperative CKD stage (p&lt;0.001) and procedure (p&lt;0.01) were independent predictors of percent change in postoperative GFR. Patient with worsened preoperative CRI stage were less likely to have further progression of CRI postoperatively (p&lt;0.001) independent of the surgical procedure. Surgical approach was not an independent predictor of any renal functional outcomes measured. Conclusions: Patients undergoing renal surgery have a high rate of new-onset postoperative renal failure. After controlling for preoperative risk factors, patients undergoing radical Nx are at higher risk for decline in renal function. Surgical approach, however, was not a significant predictor for the development of CRI. No significant financial relationships to disclose.

Serum Cystatin C in Estimating Glomerular Filtration Rate

Serum Cystatin C in Estimating Glomerular Filtration RateUsing serum cystatin C in estimating glomerular filtration rate (GFR) has in recent times been recommended. A number of simple formulas for calculating GFR have been derived specifically from serum cystatin C concentrations. The purpose of this study was to assess the significance of cystatin C and of the two most frequently applied of these formulas in estimating glomerular filtration rate compared to serum creatinine and its derived formulas for estimating glomerular filtration rate from creatinine concentrations. The study included 74 patients: 59 were in various stages of chronic renal insufficiency (divided into two subgroups: I with GFR ≥ 60 mL/min/1.73m2and II with GFR&lt;60 mL/min/1.73m2) and 15 on hemodialysis. A control group of 30 healthy participants was also included in the study. Serum values of cystatin C ranged from: 0.86 ± 0.16 mg/L in subgroup I, and 1.77 ± 0.79 mg/L in subgroup II, to 6.9 ± 1.83 mg/L in patients on hemodialysis. The correlation between the two formulas derived from cystatin C and the clearance of creatinine, as well as the Cockcroft and Gault's formula, was significant, while one of the formulas derived from cystatin C did not show a significant correlation with MDRD. It was concluded that serum cystatin C is a significant marker in estimating glomerular filtration rate, especially in the advanced stages of chronic renal insufficiency.

Experimental intravenous cell therapy of acute and chronic renal failure

The therapeutic effect of intravenous injection of human fetal bone marrow mesenchymal stem cells or summary culture of kidney cells were studied on models of chronic or acute renal failure in outbred albino rats. Both cell types promoted improvement and normalization of the renal function in rats with stable chronic renal insufficiency (2 weeks after kidney cell injection, 1 month after bone marrow mesenchymal stem cell injection). Renal function remained normal or subnormal during the delayed period (3-3.5 months after injection). In rats with latent stage of chronic renal insufficiency, exacerbation was induced by additional 40-min ischemia. All rats receiving intravenous injection of saline died. Improvement of the functional parameters started 2 weeks after injection of kidney cells or bone marrow mesenchymal stem cells, and normalization was observed after 1.1-5 months. During the delayed period (after 3-4 months), functional parameters retained at normal or subnormal levels. In experimental series III, all rats with acute renal failure intravenously injected with saline (control) died from uremia on days 2-4. After injection of kidney cells 50% rats survived and renal function in these animals returned to normal after 2 weeks. After injection of bone marrow mesenchymal stem cells 83% rats survived, functional parameters returned to normal after 3 weeks.

Evaluation of the Clinical Efficacy of Benazepril in the Treatment of Chronic Renal Insufficiency in Cats

Background: Chronic renal insufficiency (CRI) is a common disease in cats. Angiotensin‐converting enzyme inhibitors (ACEI) have beneficial effects in humans with CRI by reducing the loss of protein in the urine and increasing life expectancy.Hypothesis: The ACEI benazepril has beneficial effects on survival, clinical variables, or both as compared with placebo in cats with CRI.Animals: 61 cats with naturally occurring CRI.Methods: The cats were enrolled into a prospective, randomized, double‐blind, placebo‐controlled clinical trial. Cats received placebo or 0.5–1 mg/kg benazepril once daily for up to 6 months.Results: Urine protein/urine creatinine ratios were significantly (P &lt; .05) lower with benazepril as compared with placebo at days 120 and 180. Three cats with placebo and 1 cat with benazepril were removed prematurely from the study because of deterioration of CRI or death. Cats were classified into 4 stages of CRI according to the International Renal Interest Society (IRIS) classification scheme. Incidence rates of cats with IRIS classification stage 2 or stage 3 that remained in stage 2 or 3 without progressing to stage 4 were higher with benazepril (93 ± 5%) as compared with placebo (73 ± 13%).Clinical Importance: These results suggest a potential for benazepril to delay the progression of disease, extend survival time, or both in cats with CRI.

Evaluation of The Clinical Efficacy of Benazepril in The Treatment of Chronic Renal Insufficiency in Cats

Chronic renal insufficiency (CRI) is a common disease in cats. Angiotensin-converting enzyme inhibitors (ACEI) have beneficial effects in humans with CRI by reducing the loss of protein in the urine and increasing life expectancy. The ACEI benazepril has beneficial effects on survival, clinical variables, or both as compared with placebo in cats with CRI. 61 cats with naturally occurring CRI. The cats were enrolled into a prospective, randomized, double-blind, placebo-controlled clinical trial. Cats received placebo or 0.5-1 mg/kg benazepril once daily for up to 6 months. Urine protein/urine creatinine ratios were significantly (P < .05) lower with benazepril as compared with placebo at days 120 and 180. Three cats with placebo and 1 cat with benazepril were removed prematurely from the study because of deterioration of CRI or death. Cats were classified into 4 stages of CRI according to the International Renal Interest Society (IRIS) classification scheme. Incidence rates of cats with IRIS classification stage 2 or stage 3 that remained in stage 2 or 3 without progressing to stage 4 were higher with benazepril (93 +/- 5%) as compared with placebo (73 +/- 13%). These results suggest a potential for benazepril to delay the progression of disease, extend survival time, or both in cats with CRI.

Left Ventricular Geometry in Children with Mild to Moderate Chronic Renal Insufficiency

Left ventricular hypertrophy (LVH) is the most important independent marker of cardiovascular risk in adults with chronic kidney disease. Cardiovascular morbidity seems increased even in children with chronic renal insufficiency (CRI), but the age and stage of CRI when cardiac alterations become manifest are unknown. For assessing the prevalence and factors associated with abnormal LV geometry in children with CRI, echocardiograms, ambulatory BP monitoring, and biochemical profiles were obtained in 156 children aged 3 to 18 yr with stages 2 through 4 chronic kidney disease (GFR 49 +/- 19 ml/min per 1.73 m2) and compared with echocardiograms obtained in 133 healthy children of comparable age and gender. LV mass was indexed to height2.7. Concentric LV remodeling was observed in 10.2%, concentric LVH in 12.1%, and eccentric LVH in 21% of patients. LVH was more common in boys (43.3 versus 19.4%; P < 0.005). Probability of LVH independently increased with male gender (odds ratio [OR] 2.62; P < 0.05) and standardized body mass index (OR 1.56; P = 0.01). Low hemoglobin, low GFR, young age, and high body mass index were independent correlates of LV mass index (0.005 < P < 0.05). LV concentricity (relative wall thickness) was positively associated with serum albumin (P < 0.05). Probability of abnormal LV geometry increased with C-reactive protein >10 mg/dl (OR 26; P < 0.001). In conclusion, substantial cardiac remodeling of both concentric and eccentric type is present at young age and early stages of CRI in children. Prevalence of LVH is related to male gender, anemia, and ponderosity but not to BP. Additional effects of volume status and inflammation on cardiac geometry are also evident.

Changing trends in the referral patterns of pediatric nephrology patients

This study investigates the changing referral patterns of young patients to a tertiary pediatric nephrology center with a well-defined catchment area over two consecutive 8.5-year periods. We paid special attention to the known increase of obesity and diabetes mellitus in childhood. Demographic data (site of residence, height, weight, gender and renal diagnosis) were collected on 6,154 children aged 0-19 years, referred as in- and outpatients to the Children's Hospital of Eastern Ontario for nephrological work-up. Body mass index (BMI) Z-scores were calculated on the basis of data from the National (USA) Center for Health Statistics (2000). In 6,124 (99.5%) patients a final renal diagnosis could be made, allowing calculation of the incidence of a variety of renal diseases in pediatric patients, data that are not readily available. BMI increased significantly over the years, with a Z-score that rose from a median of +0.20 to +0.32 in the two 8.5-year study periods (p<0.0001). The increase in obesity coincided with a significant increase in the incidence of chronic renal insufficiency (CRI). The combined incidence of CRI and end stage renal disease rose from 0.994 to 2.334 per 100,000 children per year (p=0.0014). This study provides new information on the (changing) pattern of pediatric renal disease over almost two decades. Pediatric renal patients became progressively overweight and showed an increase in the incidence of CRI. This is the first time that this phenomenon, well known in adults, has been observed in the pediatric age group.

Retrospective Study of Renal Failure in Dogs and Cats Admitted to University of Veterinary and Pharmaceutical Sciences, Brno During 1999-2001

Retrospective Study of Renal Failure in Dogs and Cats Admitted to University of Veterinary and Pharmaceutical Sciences, Brno During 1999-2001

The severity of secondary hyperparathyroidism in chronic renal insufficiency is GFR-dependent, race-dependent, and associated with cardiovascular disease.

Secondary hyperparathyroidism (SHPT) is an important complication of end-stage renal disease. However, SHPT begins during earlier stages of chronic renal insufficiency (CRI), and little is known about risk factors for SHPT in this population. This study evaluated 218 patients in an ethnically diverse ambulatory nephrology practice at the University of California San Francisco during calendar years 1999 and 2000. Demographic data, comorbid diseases, medications, and laboratory parameters were collected, and independent correlates of intact parathyroid hormone (PTH) were identified by using multiple linear regression. The mean estimated GFR was 34 ml/min per 1.73 m(2) (10%-90% range, 13 to 61 ml/min per 1.73 m(2)); PTH was inversely related to GFR (P < 0.0001). The adjusted mean PTH was higher among African Americans and lower among Asian/Pacific Islanders compared with white patients (233 versus 95 versus 139 pg/ml; P < 0.0001). Moreover, among the 196 patients with GFR <60 ml/min per 1.73 m(2), the slope of GFR versus PTH was significantly steeper among African Americans than among white patients (10.6 versus 3.9 pg/ml per ml per min per 1.73 m(2); P = 0.01). After adjusting for age and diabetes, PTH was associated with a history of myocardial infarction (OR, 1.6; 95% CI, 1.1 to 2.3 per unit natural log PTH) and congestive heart failure (OR, 2.0; 95% CI, 1.3 to 2.9 per unit natural log PTH) and not associated with other co-morbid conditions. These factors should be considered when screening and managing SHPT in CRI.

Sevelamer hydrochloride (Renagel), a non-calcaemic phosphate binder, arrests parathyroid gland hyperplasia in rats with progressive chronic renal insufficiency.

It has been demonstrated that dietary phosphate restriction suppresses parathyroid hormone (PTH) secretion and parathyroid cell proliferation in experimental animals with chronic renal insufficiency (CRI) independently of serum calcium and 1,25(OH)(2)D3 levels. This study was conducted to examine whether sevelamer hydrochloride (Renagel); hereafter referred to as sevelamer), a non-calcaemic phosphate binder could inhibit the parathyroid gland (PTG) hyperplasia in rats with progressive CRI. Male Sprague-Dawley rats were injected twice with low doses of adriamycin (ADR). Two weeks after the last injection of ADR, rats were fed a diet containing 1 or 3% sevelamer for 84 days. Time course changes of serum levels of calcium, phosphorus, and PTH were measured. At the end of study, serum 1,25(OH)(2)D3 levels were measured and the maximal two-dimension area of the PTG in paraffin section was calculated using an imaging analyser. Dietary sevelamer treatment inhibited the elevations of serum phosphorus, calciumxphosphorus product, and PTH levels that occurred as the study progressed. Sevelamer also suppressed maximal PTG area and there existed positive strong correlation between maximal PTG area and serum PTH levels at the end of the study. Serum phosphorus levels positively correlated well with serum PTH levels and maximal PTG area. In contrast, serum calcium or 1,25(OH)(2)D3 levels did not show any correlation with serum PTH levels and maximal PTG area. Sevelamer treatment arrested hyperphosphataemia and PTG hyperplasia accompanied by the elevation of serum PTH levels. The correlation analysis suggests that reduced serum phosphorus levels contributed to the suppression of PTG hyperplasia and resulted in the reduction of PTH levels in this animal model after the sevelamer treatment. The management of phosphorus control started from early stage of CRI could prevent PTG hyperplasia and facilitate later management of secondary hyperparathyroidism.