Current Issue : April - June Volume : 2014 Issue Number : 2 Articles : 7 Articles
Background: Dendritic cells (DC) are professional antigen-presenting cells in the immune system. They patrol the\r\nblood as circulating dendritic cell precursors (DCP). Decreased blood DCP count has been shown to be related to\r\natherosclerotic plaque burden. Since chronic kidney disease (CKD) is associated with chronic inflammation and\r\nincreased cardiovascular risk, the aim of our study was to investigate a potential effect of CKD on circulating DCP\r\nnumbers especially in patients with a history of cardiovascular disease.\r\nMethods: The number of circulating myeloid (mDCP), plasmacytoid (pDCP), and total DCP (tDCP) was analysed by\r\nflow cytometry in 245 patients with CKD stage 3 (with and without known cardiovascular events) and 85 coronary\r\nhealthy controls. In addition, data were compared with a historical group of 130 patients with known coronary\r\nartery disease (CAD).\r\nResults: Compared to controls, patients with CKD 3 revealed a significant decrease in circulating mDCP (-29%),\r\npDCP (-43%), and tDCP (-38%) (P < 0.001, respectively). Compared with CAD-patients, the decrease in circulating\r\nDCP in CKD was comparable or even more pronounced indicating a potential role for DCP in cardiovascular risk\r\npotentiation due to CKD.\r\nConclusions: Based on previous findings in CAD, the marked decrease of DCP in CKD implicates a potential role for\r\nDCP as a mediator of cardiovascular disease. Whether....
Abstract\r\nBackground: Cardiovascular disease is a major cause of death in patients with stage 4ââ?¬â??5 Chronic Kidney disease\r\n(CKD, eGFR < 30). There are only limited data on the risk factors predicting these complications in CKD patients. Our\r\naim was to determine the role of clinical and echocardiographic parameters in predicting mortality and\r\ncardiovascular complications in CKD patients.\r\nMethods: We conducted a prospective observational cohort study of 153 CKD patients between 2007 and 2009. All\r\npatients underwent echocardiography at baseline and were followed for a mean of 2.6 years using regular clinic\r\nvisits and review of files and hospital presentations to record the incidence of cardiovascular events and death.\r\nResults: Of 153 patients enrolled, 57 (37%) were on dialysis and 45 (78%) of these patients were on haemodialysis. An\r\nenlarged LV was present in 32% of patients and in 22% the LVEF was below 55%. LV mass index was increased in 75%\r\nof patients. Some degree of diastolic dysfunction was present in 85% of patients and 35% had grade 2 or higher\r\ndiastolic dysfunction. During follow up 41 patients (27%) died, 15 (39%) from cardiovascular causes. Mortality was 24.0%\r\nin the non-dialysis patients versus 31.6% in patients on dialysis (p=ns). On multivariate analysis age >75 years, previous\r\nhistory of MI, diastolic dysfunction and detectable serum troponin T were significant independent predictor of mortality\r\n(P < 0.01).\r\nConclusion: Patients with stage 4ââ?¬â??5 CKD had a mortality rate of 27% over a mean follow up of 2.6 years.\r\nAge >75 years, history of MI, diastolic dysfunction and troponin T were independent predictors of mortality....
Background: The Camp COOL programme aims to help young Dutch people with end-stage renal disease (ESRD)\r\ndevelop self-management skills. Fellow patients already treated in adult care (hereafter referred to as ââ?¬Ë?buddiesââ?¬â?¢)\r\norganise the day-to-day program, run the camp, counsel the attendees, and also participate in the activities. The\r\nattendees are young people who still have to transfer to adult care. This study aimed to explore the effects of this\r\nspecific form of peer-to-peer support on the self-management of young people (16ââ?¬â??25 years) with ESRD who\r\nparticipated in Camp COOL (CC) (hereafter referred to as ââ?¬Ë?participantsââ?¬â?¢).\r\nMethods: A mixed methods research design was employed. Semi-structured interviews (n = 19) with initiators/staff,\r\nparticipants, and healthcare professionals were conducted. These were combined with retrospective and pre-post\r\nsurveys among participants (n = 62), and observations during two camp weeks.\r\nResults: Self-reported effects of participants were: increased self-confidence, more disease-related knowledge, feeling\r\ncapable of being more responsible and open towards others, and daring to stand up for yourself. According to\r\nparticipants, being a buddy or having one positively affected them. Self-efficacy of attendees and independence\r\nof buddies increased, while attendeesââ?¬â?¢ sense of social inclusion decreased (measured as domains of health-related\r\nquality of life). The buddy role was a pro-active combination of being supervisor, advisor, and leader.\r\nConclusions: Camp COOL allowed young people to support each other in adjusting to everyday life with ESRD.\r\nParticipating in the camp positively influenced self-management in this group. Peer-to-peer support through buddies\r\nwas much appreciated. Support from young adults was not only beneficial for adolescent attendees, but also for young\r\nadult buddies. Paediatric nephrologists are encouraged to refer patients to CC and to facilitate such initiatives. Together\r\nwith nephrologists in adult care, they could take on a role in selecting buddies....
Background: Chronic musculoskeletal (MS) pain is common in patients with chronic kidney disease (CKD)\r\nundergoing haemodialysis. However, epidemiological data for chronic MS pain and factors associated with chronic\r\nMS pain in patients with early- or late-stage CKD who are not undergoing dialysis are limited.\r\nMethod: A cross-sectional study to evaluate the prevalence of chronic MS pain and factors associated with chronic\r\nMS pain in patients with early- and late-stage CKD who were not undergoing dialysis, was conducted. In addition,\r\nthe distribution of pain severity among patients with different stages of CKD was evaluated.\r\nResults: Of the 456 CKD patients studied, 53.3% (n = 243/456) had chronic MS pain. Chronic MS pain was\r\nindependently and significantly associated with hyperuricemia as co-morbidity, as well as with the calcium Ã?â??\r\nphosphate product levels. In CKD patients with hyperuricemia, chronic MS pain showed a negative, independent\r\nsignificant association with diabetes mellitus as a co-morbidity (odds ratio: 0.413, p = 0.020). However, in the CKD\r\npatients without hyperuricemia as a co-morbidity, chronic MS pain showed an independent significant association\r\nwith the calcium Ã?â?? phosphate product levels (odds ratio: 1.093, p = 0.027). Furthermore, stage-5 CKD patients\r\nseemed to experience more severe chronic MS pain than patients with other stages of CKD.\r\nConclusion: Chronic MS pain is common in CKD patients. Chronic MS pain was independently and significantly\r\nassociated with hyperuricemia as co-morbidity, and with the calcium Ã?â?? phosphate product levels in early- and\r\nlate-stage CKD patients who were not on dialysis....
Several reports show that patients with chronic disease who are empowered with information technology (IT) tools\r\nfor monitoring, training and self-management have improved outcomes, however there are few such applications\r\nemployed in kidney disease. This review explores the current and potential uses of health IT platforms to advance\r\nkidney disease care by offering innovative solutions to inform, engage and communicate with individuals with CKD....
Background: Nephrotic syndrome (NS) is pathological condition characterized by heavy proteinuria. Our study\r\ninvestigates hypothesis that change in cell proliferation of proximal tubules influences primary cilia structure and\r\nfunction and promotes cystogenesis in congenital nephrotic syndrome of the Finnish type (CNF) and focal\r\nsegmental glomerulosclerosis (FSGS).\r\nMethods: CNF kidneys were analyzed genetically. Proliferation (Ki-67), apoptosis (caspase-3), and primary cilia\r\n(a-tubulin) length and structure were analyzed immunohistochemically and ultrastructurally in healthy, CNF and\r\nFSGS kidneys. Cyst diameters were measured and correlated with proliferation index.\r\nResults: Proximal tubules cells of healthy kidneys did not proliferate. In nephrotic kidneys, tubules with apparently\r\nnormal diameter covered by cuboidal/columnar epithelium (PTNC) contained 81.54% of proliferating cells in CNF\r\nand 36.18% in FSGS, while cysts covered with columnar epithelium (CC) contained 37.52% of proliferating cells in\r\nCNF and 45.23% in FSGS. The largest cysts, covered with squamous epithelium (CS) had 11.54% of proliferating cells\r\nin CNF and 13.76% in FSGS. Increase in cysts diameter correlated with changes in proliferation index, tubular cells\r\nshape, primary cilia formation and appearance of apoptotic cells.\r\nConclusions: We present a novel histopathological data on the structure and possible changes in function of\r\ntubular cell in NS kidneys during cystogenesis. We suggest existence of common principles of cystogenesis in CNF\r\nand FSGS kidneys, including serious disturbances of tubular cells proliferation and apoptosis, and faulty primary cilia\r\nsignaling leading to deterioration of proteinuria in NS kidneys....
Background: Contrast-induced acute kidney injury (CI-AKI) particularly in high risk patients with chronic kidney\r\ndisease (CKD), increases morbidity and mortality. Neutrophil gelatinase-associated lipocalin (NGAL) is a protein\r\nexcreted by the kidney during AKI. There are no urine (u) NGAL data as an early CI-AKI marker in CKD patients\r\nundergoing coronary procedures.\r\nMethods: This prospective study enrolled 130 patients with estimated glomerular filtration rate (eGFR) < 60 ml/min/\r\n1.73 m2 undergoing elective coronary procedures. Serial urine samples, obtained at baseline and 3, 6, 12, 18, and 24 h\r\npost contrast administration were analyzed by NGAL ELISA kit. AKI was defined as an increase in serum creatinine (SCr)\r\nof = 0.3 mg/dl or = 1.5 times baseline SCr within 48 h per 2012 KDIGO guidelines. Receiver operator characteristic curve\r\nanalyses identified optimal uNGAL and delta of uNGAL values for diagnosing CI-AKI.\r\nResults: The uNGAL was significantly and inverse correlated with eGFR (R =0.25, P < 0.005). CI-AKI developed in 16/130\r\n(12.31%) patients: 13 and 3 in CI-AKI stages I and II, respectively. uNGAL and delta of uNGAL were significantly higher\r\nin the CI-AKI group when compared with the No CI-AKI group (P < 0.05). The best uNGAL cut-off for optimal\r\nsensitivity 94%, specificity 78%, and area under the curve 0.84 for predicting CI-AKI was 117 ng/mL at 6 h, respectively.\r\nCorresponding values for predicting CI-AKI stage II were 100%, 87% and 0.9 when using an uNGAL of 264 ng/mL\r\nat 6 h.\r\nConclusions: Monitoring of uNGAL levels not only provide the early detecting CI-AKI but also predict the severity of\r\nCI-AKI in CKD patients undergoing elective coronary procedures...
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