Current Issue : July - September Volume : 2016 Issue Number : 3 Articles : 4 Articles
Background: To what extent uric acid (UA) levels and/or metabolic syndrome (Mets) contribute to\nthe onset of chronic kidney disease (CKD) is largely unknown. The present study explores how these\ntwo factors have an association with the new incidence of CKD. Methods: Study design is a cohort\nstudy. A total of 14,485 participants were eligible for the cross-sectional analysis on UA levels and\nthe prevalence of Mets. Among those individuals, 8,223 participants without CKD and 4,839 without\nMets were eligible for the longitudinal analysis of the new incidence of CKD. Parameters monitored\nwere body mass index, systolic and diastolic blood pressure, serum creatinine concentration, estimated\nglolerular filtration rate, lipid profiles, plasma glucose, HbA1c. The primary predictor was the\nlevel of UA and Mets to explain the newly-developed CKD. The observation period was 4 years. Results:\nIn a cross-sectional analysis, higher UA levels were associated with the greater prevalence of\nMets. In addition, UA levels were associated with the numbers of the Mets constituents in both genders.\nIn a longitudinal analysis, higher UA levels were associated with the greater rate of CKD and the\ngreater incidence of Mets. In addition, the incidence of CKD at year 4 was influenced by the presence\nof hyperuricemia, but not by that of the Mets. The odd ratio (OR) to predict the CKD incidence was\n1.42 (95% confidence intervals (CI), 0.52 to 3.78) in the presence of Mets alone, 2.10 (95% CI, 1.36 to\n3.23) in the presence of hyperuricemia alone, and 3.56 (95% CI, 1.55 to 8.21) in the presence of both.\nConclusion: Hyperuricemia has a greater association with the incidence of CKD than Mets does.\nHyperuricemia complicated by Mets is additionally detrimental....
Background: Current first-line anti-proteinuric treatments for nephrotic syndrome (NS) do not produce an effective\nresponse in all patients and are not tolerated by some patients. Additional effective and tolerable treatment\noptions in NS are strongly needed. This retrospective case series is the largest to date to examine Acthar gel\n(adrenocorticotropic hormone, ACTH) in patients with varied-etiology NS.\nMethods: This multicenter retrospective case series included adult patients with NS (N = 44) treated with\nActhar gel at 6 clinical practices. NS etiologies included idiopathic focal segmental glomerulosclerosis (FSGS,\n15), idiopathic membranous nephropathy (iMN, 11), IgA nephropathy (IgAN, 5), diabetic nephropathy (DN, 4),\nsystemic lupus erythematosus class V membranous lupus nephritis (MLN, 2), minimal change disease (MCD, 2),\nmembranoproliferative glomerulonephritis (MPGN, 1), fibrillary glomerulonephritis (FGN, 1), and unbiopsied NS\n(3). Proteinuria response was assessed as percent reduction from baseline and percent of patients meeting\ncomplete remission (final proteinuria <500 mg/d), partial remission (ââ?°Â¥50 % reduction in proteinuria from\nbaseline and final proteinuria 500ââ?¬â??3500 mg/d), clinical response (ââ?°Â¥30 % reduction in proteinuria from baseline\nthat did not meet criteria for complete or partial remission), and no response (failed to meet remission or\nclinical response criteria) following Acthar gel therapy. Safety and tolerability were examined using adverse\nevent (AE) frequency reported by patients or treating nephrologists and frequency of early discontinuation\nof treatment due to AEs.\nResults: 68.2 % (30/44) of patients had received prior NS treatment with immunosuppressive or cytotoxic\ntherapies. Thirty-seven patients completed Acthar gel treatment. Seven patients (15.9 %) had early termination\ndue to AEs, including weight gain (2), hypertension (2), edema (1), fatigue (1), seizures (1) and for reasons not\nstated (2). Proteinuria reduction ââ?°Â¥30 % was shown in 81.1 % (30/37) of patients and 62.2 % (23/37) showed\nââ?°Â¥50 % proteinuria reduction. Proteinuria responses were greatest in MCD (n = 2/2 complete remission), MLN\n(n = 2/2 partial remission), MPGN (n = 1/1 partial remission), FSGS (n = 12/15 [80.0 %] partial remission or\nclinical response), and iMN (n = 8/11 [72.7 %] complete remission, partial remission, or clinical response).\nConclusions: Acthar gel may meet an important treatment need in patients with treatment-resistant NS in\nresponse to first-line therapies, patients unable to tolerate first-line therapies, and in patients with advanced\ndisease....
Background: Hypertension is a public health problem with mostly unknown causes, and where strong hereditary\ngenetic alterations have not been fully elucidated. However, the use of experimental models has provided valuable\ninformation. Recent evidences suggest that alterations in key nephrogenic factors, such as Wilms� tumor 1 transcription\nfactor (WT-1), could contribute to the development of hypertension. The aim of this paper is to evaluate the expression\nof WT-1 and related genes in the nephrogenic process in connection with the development of hypertension as well as\nthe corresponding anatomical and functional correlation.\nMethods: Male spontaneously hypertensive and control rats were evaluated weekly from birth until week 8 of life.\nTheir blood pressure was taken weekly using the tail-cuff blood pressure system. Weekly, 5 rats per group were\nsacrificed with a lethal injection of pentobarbital, and their kidneys were removed, decapsulated and weighed. The\nserum was collected for measuring biochemical parameters. The results were assessed using one-way analysis of\nvariance for comparisons between groups.\nResults: The relationship between renal weight/total body weights was established, without significantly different\nvalues. These data were compared with apoptosis, fibrosis, number and size of the glomeruli. The elevation of systolic\nblood pressure was significant since week 6. Biochemical values differed slightly. Histology showed a slight increase in\ndeposits of collagen fibers since week 4. Additionally, in kidney cortices, the expression of WT-1, heat shock protein 70\n(Hsp70) and vitamin D receptors (VDR) decreased since week 4. Finally, we demonstrated ultrastructural damage to\nmitochondria since week 4.\nConclusions: Our results would suggest an unprecedented link, possibly a regulatory mechanism, between WT-1 on\nnephrogenic alteration processes and their relationship with hypertension. Moreover, and previous to the increase in\nblood pressure, we demonstrated low expressions of WT-1, VDR and Hsp70 in kidneys from neonatal SHRs. If so, this\nmay suggest that deregulation in the expression of WT-1 and its impact on nephrogenesis induction could be crucial\nin understanding the development and maintenance of hypertension....
Balkan endemic nephropathy (BEN) is a disease that affects people that live in the alluvial plains along the tributaries of theDanube\nRiver in the Balkan region. BEN is a chronic tubulointerstitial disease with a slow progression to terminal renal failure and has\nstrong association with upper tract urothelial carcinoma (UTUC). There are several hypotheses about the etiology of BEN, but\nonly the toxic effect of aristolochic acid has been confirmed as a risk factor in the occurrence of the disease. Aberrantly expressed\nmiRNAs have been shown to be associated with many types of cancers. A number of studies have investigated the expression\nof microRNAs in urothelial carcinoma, mainly on urothelial bladder cancer, and only a few have included patients with UTUC.\nHere we present the first study of microRNA profiling in UTUC tissues from patients with BEN (BEN-UTUC) and patients with\nUTUC from nonendemic Balkan regions (non-BEN-UTUC) in comparison to normal kidney tissues. We found 10 miRNAs that\nwere differentially expressed in patients with BEN-UTUC and 15 miRNAs in patients with non-BEN-UTUC. miRNA signature\ndetermined in BEN-UTUC patients differs from the non-BEN-UTUC patients; only miR-205-5p was mutual in both groups....
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