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Biomedical subjects

Steven Fishbane

Publications and source records attributed to Steven Fishbane.

27 records · Page 2Linked to original sources
PubMed2002

Contribution of prostaglandin D2 synthase to progression of renal failure and dialysis dementia.

This article reviews the possible role of prostaglandin D(2) synthase (PGD(2)S) in the progression of chronic renal failure and dialysis dementia. Such a proposal is based on our observation that PGD(2)S significantly increases the rate of apoptosis in cultured pig kidney proximal tubule LLC-PK1 and rat neuronal PC12 cells. Apoptosis was caspase mediated and inhibitable by PGE(1), PGE(2), PGF(2alpha), platelet-derived growth factor (PDGF), and by PGD(2)S inhibitors, selenium and anti-PGD(2)S antibody. Apoptosis was restored by the addition of downstream metabolic products, PGD(2) and 15 deoxy PG triangle up (12,14)J(2). The proposal that PGD(2)S contributes to progression of renal failure and dialysis dementia is based on: (1) the progressive creatinine-like increase in PGD(2)S levels in blood as renal function decreases, increased renal cyclooxygenase (COX) 2 in chronic renal failure, and reported increase in apoptosis noted in the remnant kidney model, and (2) a 35- to 150-fold increase in blood levels of PGD(2)S in dialysis patients. Both conditions appear to favor shifting the PG metabolic pathway to downstream apoptotic metabolites, PGD(2) and 15 deoxy PG triangle up (12,14)J(2). The diverse role that PGs, growth factors, and COX play in progression of chronic renal failure, their interactions with PGD(2)S, and the status of COX inhibitors in retarding the progression of renal failure are reviewed. In addition, the need for a more systematic longitudinal assessment of dementia in dialysis patients by standardized neuropsychologic testing, testing blood levels and glycosylated isoforms of PGD(2)S, and the effect of COX inhibition and erythropoietin administration on dialysis dementia are discussed.

Animals↗
PubMed2002

Anemia treatment in chronic renal insufficiency.

Anemia is a common complication of chronic renal insufficiency, one that leads to a reduced quality of life and an increased burden on the heart. In recent years, it has been shown that anemia is underrecognized and undertreated in these patients. The benefits of recombinant human erythropoietin treatment in this patient population have been well shown. The major side effect, hypertension, is particularly important in chronic renal insufficiency, requiring careful monitoring. In this review, the benefits of anemia therapy are weighed against the risks and costs. On balance, it is concluded that anemia treatment meets a basic and important health need in these patients.

Anemia↗
PubMedDate not supplied

Quality outcomes and obstacles to their achievement in end-stage renal disease.

Much effort has gone into improving the quality of care in end-stage renal disease (ESRD) in recent years. In particular, the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) serves as a positive example. However, there are certain barriers to quality of care that may hinder such efforts. In this article we discuss obstacles to quality of care in ESRD and present potential solutions.

Humans↗
PubMedDate not supplied

Serum ferritin in chronic kidney disease: reconsidering the upper limit for iron treatment.

Intravenous iron treatment in hemodialysis patients improves the response to recombinant human erythropoietin (rHuEPO) and facilitates achievement of targets for hemoglobin and hematocrit. Excessive treatment, however, could expose patients to risks related to iron overload and oxidative stress. Therefore international treatment guidelines generally recommend that intravenous iron be discontinued when serum ferritin is greater than 500-1000 ng/ml. In this article we explore the relevant issues that inform the decisions as to what levels of serum ferritin are used as the upper limit for treatment. We conclude that the current published literature is inadequate for developing evidence-based guidelines. Clinical judgment is critical to properly weigh the risks and benefits of intravenous iron treatment in the context of the individual patient.

Anemia, Iron-Deficiency↗
PubMedDate not supplied

Recombinant human erythropoietin: has treatment reached its full potential?

For more than 15 years recombinant human erythropoietin (r-HuEPO) has been used for the treatment of renal anemia benefiting patients with improved quality of life and reduced need for blood transfusions. It is still early in the history of r-HuEPO treatment; therapy has changed little and there have been few investigations into whether current treatment strategies are optimal. Of note, current therapy makes little attempt to mimic normal erythropoietin biology. Large doses of drug are administered episodically resulting in great fluxes in serum erythropoietin levels. It is unlikely that this approach is very efficient from the erythropoietic standpoint. Furthermore the effects of these nonbiologic kinetics on extraerythroid organs that express erythropoietin receptors are unknown. In this review the current state of r-HuEPO treatment is compared to the normal biology of erythropoietin and potential pitfalls caused by divergences are explored.

Anemia↗