Current Issue : January - March Volume : 2018 Issue Number : 1 Articles : 5 Articles
Background: Secondary hyperparathyroidism (SHPT) is a severe complication for dialysis patients. Vitamin D\nreceptor activators (VDRAs) are used to treat SHPT, but the comparative efficacy and safety between paricalcitol and\nother vitamin D receptor activators for management of SHPT in dialysis patients has been unproven.\nMethods: We searched PubMed, Embase, and the Cochrane Library for the time period through June 2017 to\nidentify randomized controlled trials that evaluated paricalcitol compared with other VDRAs for treatment of SHPT.\nThe primary outcome was the percentage of patients with target reduction of intact parathyroid hormone (iPTH)\nfrom baseline. Secondary outcomes included incidences of hypercalcemia and hyperphosphatemia. The randomeffects\nmodel was used to estimate relative risks (RRs) with 95% confidence intervals (CIs).\nResults: Eight studies (N = 759) were eligible for final inclusion. Compared with other VDRAs, no significant differences\nwere found in the percentage of patients with target reduction of intact parathyroid hormone (iPTH) from baseline for\nparicalcitol treatment of SHPT in dialysis patients (RR, 1.01; 95% CI, 0. 87ââ?¬â??1.18; p = 0.85). There were no differences in\nthe incidence of hypercalcemia (RR, 0.95; 95% CI, 0.74ââ?¬â??1.21; p = 0. 65) and hyperphosphatemia (RR, 0.94; 95% CI,\n0.77ââ?¬â??1.16; p = 0.58).\nConclusions: The presently available evidence is insufficient to draw a conclusion regarding whether paricalcitol\ntherapy has a comparative efficacy and safety over other VDRAs for treating dialysis patients with SHPT. Largesample,\nwell-conducted, high-quality RCTs with patient-level outcomes (i.e., mortality) are urgently needed....
Study Objective. To study the effectiveness of complex monitoring of the kidney function, based on biochemical and radionuclide\nmethods in patients with metastatic renal cell carcinoma (mRCC). Materials and Methods. 41 mRCC patients after nephrectomy\nreceived nivolumab (n=23) and interferon-...
End-stage renal disease (ESRD) is managed by either lifesaving hemodialysis (HD) and peritoneal dialysis (PD) or a kidney\ntransplant. In Malaysia, the prevalence of dialysis-treated ESRD patients has shown an exponential growth from 504 per million\npopulation (pmp) in 2005 to 1155 pmp in 2014. There were 1046 pmp patients on HD and 109 pmp patients on PD in 2014. Kidney\ntransplants are limited due to lack of donors. Malaysia adopts public-private financing model for dialysis. Majority of HD patients\nwere treated in the private sector but almost all PD patients were treated in government facilities. Inequality in access to dialysis is\nvisible within geographical regions wheremajority ofHD centres are scattered around developed areas.Theexpenditure on dialysis\nhas been escalating in recent years but economic evaluations of dialysis modalities are scarce. Evidence shows that health policies\nand reimbursement strategies influence dialysis provision. Increased uptake of PD can produce significant economic benefits and\nimprove patients� access to dialysis. As a result, some countries implemented a PD-First or Favored Policy to expand PD use.Thus,\na current comparative costs analysis of dialysis is strongly recommended to assist decision-makers to establish a more equitable\nand economically sustainable dialysis provision in the future....
Background: The Australian Institute of Health and Welfareââ?¬â?¢s first report into acute kidney injury demonstrated a\nsignificant increase in the incidence of acute-tubulo interstitial nephritis, the ICD-10 code representing both acute\ninterstitial nephritis and pyelonephritis, in women aged less than 55 years. In contrast, recent case series have reported\nrising rates of drug induced acute interstitial nephritis predominantly among elderly patients. Due to several limitations\nwith the Australian Institute of Health and Welfare report, this new trend requires further investigation to determine if\nrates of acute interstitial nephritis are truly increasing among younger Australian women.\nMethods: Patients who underwent a renal biopsy at a single center from 2000 to 2015 were reviewed and those with\nbiopsy confirmed acute interstitial nephritis were selected. Cause of acute interstitial nephritis, patient demographics,\nco-morbidities and renal indices for these patients when available were recorded and compared.\nResults: Eight hundred ninety-eight patients who underwent renal biopsy from 2000 to 2015 were reviewed and 40\npatients were identified with biopsy confirmed acute interstitial nephritis. The rate of acute interstitial nephritis\nincreased significantly over the study period (4 patients/2.2% of biopsies performed in 2000ââ?¬â??03 vs. 19 patients/6.7% of\nall biopsies performed in 2012ââ?¬â??15; p = 0.002). There was a marked increase in the number of women with AIN in the\nlast four years of the study (2 patients and 2.1% of biopsies performed in women in 2000ââ?¬â??2003 compared with 13\npatients and 9.0% of biopsies performed in women in 2012ââ?¬â??2015). Immune mediated causes of acute interstitial\nnephritis and NSAID associated AIN were more common in women (9 females vs. 3 males), occurred more frequently\nin the last eight years of the study and predominantly in patients under 55 years of age.\nConclusions: Our study demonstrates a significant increase in the number of patients with biopsy confirmed AIN. Also,\nwe provide preliminary evidence in support of an increase in rates of younger women with immune mediated acute\ninterstitial nephritis. These results support the findings of the Australian Institute of Health and Welfare and suggest\nthat younger women may be at higher risk of immune mediated and NSAID associated acute interstitial nephritis....
Background: Uric acid (UA) plays important roles in inducing renal inflammation, intra-renal vasoconstriction and renal\ndamage. Endothelin-1 (ET-1) is a well-known profibrotic factor in the kidney and is associated with fibroblast expansion.\nWe examined the role of hyperuricemia conditions in causing elevation of ET-1 expression and kidney injury.\nMethods: Hyperuricemia was induced in mice using daily intraperitoneal injection of uric acid 125 mg/Kg body\nweight. An NaCl injection was used in control mice. Mice were euthanized on days-7 (UA7) and 14 (UA14). We also\nadded allopurinol groups (UAL7 and UAL14) with supplementation of allopurinol 50 mg/Kg body weight orally. Uric\nacid and creatinine serum were measured from blood serum. Periodic Acid Schiff (PAS) and Sirius Red staining were\ndone for glomerulosclerosis, tubular injury and fibrosis quantification. mRNA expression examination was performed for\nnephrin, podocin, preproEndothelin-1 (ppET-1), MCP-1 and ICAM-1. PDGFR�² immunostaining was done for\nquantification of fibroblast, while �±-SMA immunostaining was done for localizing myofibroblast. Western blot analysis\nwas conducted to quantify TGF-�²1, �±-SMA and Endothelin A Receptor (ETAR) protein expression.\nResults: Uric acid and creatinine levels were elevated after 7 and 14 days and followed by significant increase of\nglomerulosclerosis and tubular injury score in the uric acid group (p < 0.05 vs. control). Both UA7 and UA14 groups had\nhigher fibrosis, tubular injury and glomerulosclerosis with significant increase of fibroblast cell number compared with\ncontrol. RT-PCR revealed down-regulation of nephrin and podocin [removed]p < 0.05 vs. control), and up-regulation of\nMCP-1, ET-1 and ICAM-1 [removed]p < 0.05 vs. control). Western blot revealed higher expression of TGF-�²1 and �±-SMA\nprotein expression. Determination of allopurinol attenuated kidney injury was based on reduction of fibroblast cell\nnumber, inflammation mediators and ppET-1 expression with reduction of TGF-�²1 and �±-SMA protein expression.\nConclusions: UA induced glomerulosclerosis, tubular injury and renal fibrosis with reduction of podocyte function and\ninflammatory mediator elevation. ET-1 and fibroblast expansion might modulate hyperuricemia induced renal fibrosis....
Loading....