PubMed · 387969
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W M Cobb. 1979. The challenges ahead.. https://pubmed.ncbi.nlm.nih.gov/387969/
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BACKGROUND: Glomerular filtration rate (GFR) is a heritable trait, and hyperfiltration (GFR increment in remnant nephrons) may accelerate renal functional decline in chronic kidney disease (CKD). Mesangial and vascular smooth myocytes control GFR by contraction, dependent on voltage-gated Ca(2+) influx, which is controlled by the regulatory β₁-subunit (KCNMB1) of large-conductance heteromeric K+ ('BK') channels. KCNMB1 gain-of-function variant Glu65Lys results in generalized vasorelaxation and thus protection against systemic hypertension. Here we asked whether the Glu65Lys variant influences GFR, in the basal state or during progressive renal decline. METHODS: We explored Glu65Lys effects on GFR in three populations spanning two ethnicities and two diseases (hypertension and nephrosclerosis). GFR was either estimated (eGFR from serum creatinine) or directly measured (iothalamate clearance). RESULTS: The 65Lys variant was relatively common, occurring on ∼5-10% of chromosomes in different biogeographic ancestry groups, and 65Lys carriers exhibited higher eGFR in two primary care populations: extreme BP values in Kaiser clinics (p = 0.029, accounting for ∼0.2% of trait variance), or treated hypertensives in VA clinics (p = 0.017, accounting for ∼0.9% of trait variance). In blacks with progressive renal disease (NIDDK AASK), 65Lys carriers displayed a steeper slope in GFR chronic decline (p = 0.030, accounting for ∼0.4% of trait variance), and Glu65Lys genotype also predicted time of onset of renal failure (log rank p = 0.019). CONCLUSIONS: Common KCNMB1 gain-of-function variant Glu65Lys influences GFR, and 65Lys carriers exhibit not only elevated baseline GFR, but also more rapid GFR decline (and consequent development of renal failure) in CKD. The results suggest that profiling patients at Glu65Lys can assist in gauging renal prognosis as well as selection of rational therapy in hypertension with progressive renal disease.
Whether South Africa can grow enough food over the next 20 years to meet the needs of a population estimated to be increasing by up to 1 million a year depends primarily on the extent, nature and condition of its natural resources and secondly on how they will be conserved and used. These, together with other relevant matters, are the subjects considered for both White and Black areas, especially as they affect the production of our basic foodstuff--maize. The maize production potential of the homelands is considerable, but at present they are largely dependent on imports obtained from White farms. Possible reasons for this unhealthy state of affairs are discussed. What can be done to enable the homelands to make their contribution to the food supplies of the country?
Perinatal deaths and perinatal mortality rates in Cape Town for the period 1967--1977 have been analysed, and large differences were found between the various ethnic groups. In non-Whites stillbirths accounted for more than two-thirds of perinatal deaths in 1977, and in at least 75% of these fetal death preceded labour. Perinatal mortality rates must be considered together with the number of perinatal deaths if the true magnitude of the problem with regard to the various obstetric complications and procedures is to be appreciated. The main perinatal problems as they affect the infant were (i) during pregnancy--antepartum haemorrhage (especially abruptio placentae), intra-uterine growth retardaton, multiple pregnancy, proteinuric hypertension and unbooked status; (ii) during labour and delivery--preterm labour, stillbirths (especially before labour) and vaginal breech delivery; (iii) in the early neonatnal period--immaturity and respiratory distress and neonatal infection.