SEARCH · PubMed Health

Results for “NEPHROSCLEROSIS”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 631 records · Page 35Linked to original sources

PubMed2005

Incidence of Demodex folliculorum in patients with end stage chronic renal failure.

BACKGROUND: Demodex folliculorum (DF), found in the pilosebaceous unit, is the most common ectoparasite in humans. It has been implicated in various clinical lesions such as pustular folliculitis, papulopustular scalp eruption, perioral dermatitis, and skin lesions of immunosuppressed patients on chemotherapy or with acquired immunodeficiency syndrome (AIDS). OBJECTIVE: We aimed to determine DF carriers and location of DF among patients on chronic dialysis because of end stage renal failure (ESRF), to compare them with healthy controls, and to examine the relationship between DF incidence and dialysis method and symptoms. METHODS: Sixty-seven patients on dialysis and 67 healthy controls were taken into the study. The patient groups were classified according to the diseases causing ESRF [diabetes mellitus (DM), polycystic disease (PCD), glomerulonephritis (GN), hypertensive nephrosclerosis (HTNS), others (OT), unknown etiology (UE)], and mode of dialysis. Five standardized skin surface biopsies (SSSB) were taken. The determination of five and more living parasites/cm2 area was diagnosed as infestation. RESULTS: The mean mite count in the ESRF group, 6.12/cm2, was significantly higher than that in controls, 0.31/cm2, (Independent Samples Test, p=0.000). The DF positivity according to primary disease causing ESRF revealed that it was most frequent in DM with 12 patients (44.4%), followed by UE with nine patients (33.4%). CONCLUSIONS: Our findings indicate that the DF number is increased in ESRF patients on dialysis treatment. We recommend that demodicidosis should be included in the differential diagnosis of facial eruptions in patients with ESRF.

Adolescent↗

PubMed2005

Association between attributed cause of end-stage renal disease and risk of death in Brazilian patients receiving renal replacement therapy.

BACKGROUND: Studies conducted in several countries have indicated that the survival of patients undergoing renal replacement therapy (RRT) depends on the attributed cause of end-stage renal disease (ESRD). OBJECTIVES: This study was conducted to evaluate the association between attributed cause of ESRD and mortality risk in RRT patients in Brazil. METHODS: We analyzed 88,881 patients from the Brazilian Ministry of Health Registry who were undergoing RRT between April 1997 and July 2000. Cox proportional hazards models were used to estimate the relative risk (RR) of death in patients with ESRD secondary to diabetes mellitus (DM), polycystic kidney disease (PKD), and primary glomerulopathies (GN) compared with a reference group comprised of patients with ESRD caused by hypertensive nephropathy. Patient's age, gender, and length of time (years) in RRT before inclusion in the registry (vintage) were included in the adjusted Cox model. RESULTS: Compared with the reference group, the mortality risk was 27% lower in patients with PKD (RR=0.73, 95% CI: 0.65-0.83, p<0.0001); 29% lower in patients with GN (RR=0.71, 95% CI: 0.68-0.74, p<0.0001); and 100% greater in DM patients (RR=2.00, 95% CI: 1.92-2.10, p<0.0001). These relative risks remained statistically significant after adjustment for age, gender, and length of time in RRT before inclusion in the registry. CONCLUSIONS: Our data indicate that compared with the patients with hypertensive nephrosclerosis as attributed cause of ESRD, patients undergoing RRT in Brazil with idiopathic glomerulopathy and polycystic kidney disease have a lower risk of mortality, and patients with diabetes mellitus have a greater risk of mortality.

Adult↗

PubMed1976

Cadmium in liver, kidney, and hair of humans, fetal through old age.

Cadmium concentrations were measured in the liver, kidney, and hair of 107 individuals from the Cincinnati area. The tissue samples were obtained from hospital and coroner autopsy cases and represent a cross-section of individuals from fetal to old age. The sections used were standardized and analyzed for cadmium by atomic absorption. Information obtained at the time of autopsy included the cause of death, the conditions of the tissues, the body height and weight, the amount of anthracosis in the lungs, as well as age, sex, and race. The liver concentrations increased steadily until the late decades. The kidney concentrations increased to the fourth decade, peaked, and decreased steadily from the sixth decade thereafter. The leveling effect in the liver may have been due to the increased presence of fatty livers, and the kidney decreases to nephrosclerosis. The kidney and liver were statistically well correlated. Hair, which achieved a surprisingly high Cd concentration in early infancy, tended to decrease throughout the rest of the age span and correlated poorly with the liver and kidney. There seemed to be no relationship between the amount of pulmonary anthracosis and the cadmium found in any of the tissues. The results obtained here for liver and kidney were in line with other reports in the literature; however, the hair results were somewhat different.

Adolescent↗

PubMed2004

Hypotensive and prophylactic effects of angiotensin II subtype 1 receptor antagonist, irbesartan, in stroke-prone spontaneously hypertensive rats.

We determined the acute hypotensive effect of a single administration and the prophylactic effect of chronic treatment with Irbesartan, an angiotensin II receptor antagonist, on the development of end-organ damage in stroke-prone spontaneously hypertensive rats (SHRSP). The acute hypotensive effect was determined by a telemetrical method in SHRSP fed a normal diet. The prophylactic effect was examined by biochemical, histopathological and immunohistochemical methods in SHRSP fed a high-salt and low-protein diet. Irbesartan (3, 10, 30 and 100 mg/kg) reduced blood pressure in a dose-dependent manner without affecting heart rate. Irbesartan (3, 10 and 30 mg/kg) increased the survival rate in SHRSP fed a high-salt and low-protein diet. Furthermore, Irbesartan ameliorated the appearance of stroke symptoms in dose-dependent manner showing association with the prevention of microscopic lesions. Irbesartan ameliorated the increases in urinary protein excretion and N-acetyl-D-glucosamidase activity by preventing nephrosclerosis, as judged by microscopic observations, and ameliorated the increases in the expression of collagen IV and fibronectin in the kidney. These findings demonstrate that Irbesartan is a potent antihypertensive drug offering a protective effect on the development of hypertension-induced end-organ damages in SHRSP. Thus, Irbesartan is useful for the therapy of hypertension with end-organ damage.

Angiotensin II Type 1 Receptor Blockers↗

PubMedDate not supplied

Renal endpoints in hypertension trials.

A growing interest in the investigation of renal function has developed in recent years in big trials. This is justified by the high prevalence of nephrosclerosis as a cause of end-stage renal disease and the capacity of minor alterations of renal function to predict poor outcome for the patients. The finding of a small increase in serum creatinine values, a diminished estimated glomerular filtration rate, microalbuminuria and/or proteinuria, heralds a significant elevation in cardiovascular events and death as well as in total mortality. This paper describes the detection, prevalence and relevance of minor alterations in the stratification of cardiovascular risk in the hypertensive patient.

Antihypertensive Agents↗

PubMed2004

Bilateral purely laparoscopic nephrectomy for renal masses using five ports without repositioning: a case report.

BACKGROUND AND PURPOSE: Bilateral nephrectomy is an infrequently performed procedure. The indications include bilateral masses too large for nephron-sparing surgery, recalcitrant hypertension in dialysis patients, pain, infection, reflux, or large symptomatic polycystic kidneys. Bilateral pretransplant purely laparoscopic nephrectomy for bilateral renal masses has not been reported previously. We present our experience with this procedure using five transabdominal trocars without having to reposition the patient. METHODS: We employed a five-port technique in a middle-aged woman with end-stage renal disease who presented with an infected peritoneal dialysis catheter. On abdominal CT, she had bilateral enhancing renal masses. Six weeks after removal of the catheter, she underwent bilateral transperitoneal laparoscopic nephrectomy. The technique is described, and recommendations are made regarding potential obstacles. RESULTS: The procedure was performed in 185 minutes, and the total hospital time was 41 hours. The estimated blood loss was 50 mL. Final pathology examination revealed a 5.5-cm right renal-cell carcinoma stage T1N0M0 and left hydronephrosis, atrophy, nephrosclerosis, and thick-walled renal cysts without malignancy. On 3-month follow-up she is well, without complaints. CONCLUSION: Bilateral pretransplant purely laparoscopic nephrectomy can be performed without significant repositioning, redraping, and resterilization. In this case, operative time and cosmesis were acceptable, and surgical morbidity was low.

Carcinoma, Renal Cell↗

PubMed1994

Chronic haemodialysis for very old patients.

There is in the Western World a progressive ageing of the population, and consequently haemodialysis patients are also getting older. Some ethical questions have been raised as a consequence of the economic issues related to the scarcity of available resources. In this paper we review our experience in the treatment of very old chronic haemodialysis patients. Fifty patients (7.2% of our haemodialysis patients) aged over 80 years at the beginning of dialysis were included (f = 25, m = 26, age = 82.6 +/- 0.3 years). In 42% of the patients the aetiology of renal disease was unknown. In the remainder, the aetiology was: interstitial nephritis 26%, hypertensive nephrosclerosis 14%, chronic glomerulonephritis 8%, diabetes 8% and polycystic disease 2%. There was a great comorbidity: intradialytic hypotension 82%, cardiac disease 74%, gastrointestinal disease 32%, cerebrovascular disease 26%. Vascular access related problems were the main reason for hospitalization. The major cause of death was vascular (cardiac and cerebral disease). Actuarial survival was 89%, 78%, 56% and 48% at 6, 12, 24 and 36 months, respectively. We think that haemodialysis is the best available choice for treating very old chronic renal failure patients. However further studies are needed to improve the quality of life of these patients.

Aged↗

PubMed2000

The controversy over homocysteine and cardiovascular risk.

Elevated plasma total homocysteine (tHcy) is a risk factor for occlusive cardiovascular disease (CVD). This concept is based on the observations of premature vascular disease in patients with homocystinuria, the relation between tHcy and both clinical CVD as well as preclinical atherosclerotic disease, the relation between tHcy in children and CVD in their parents or relatives, and reduction in CVD or surrogate endpoints after tHcy-lowering intervention with B vitamins. Plausible mechanisms include the in vivo interference with nitric oxide-dependent reactive vasodilatation. Some observations have raised questions about tHcy as a risk factor. 1) Some prospective studies showed a weak relation or no relation between tHcy and CVD. 2) Several traditional risk factors are associated with tHcy and may confound the relation between tHcy and CVD. 3) tHcy is related to renal function, and hyperhomocysteinemia may reflect early nephrosclerosis. 4) The C677T transition of the methylenetetrahydrofolate reductase gene causes a moderate increase in tHcy but no or only minor increased CVD risk. However, the strength of some of these arguments can be questioned because there is increasing evidence that tHcy is a proximate risk factor provoking the acute event, it strongly interacts with traditional risk factors, and it may predict CVD or death in patients with chronic renal failure. Furthermore, the studies of the C677T polymorphism lack statistical power, and the TT genotype may even modulate CVD risk independently of homocysteine. Thus, only placebo-controlled intervention studies with tHcy-lowering B vitamins and clinical endpoints can provide additional valid arguments for the debate over whether tHcy is a causal CVD risk factor.

Cardiovascular Diseases↗

PubMed1989

Angiotensin-converting enzyme inhibitors in the treatment of mild to moderate essential hypertension.

The rationale for the use of new drugs in the treatment of mild to moderate hypertension is based on the knowledge that these drugs can both achieve the same goals as old drugs and offer additional advantages. Available data indicate that angiotensin-converting enzyme inhibitors (ACEIs) are as effective in reducing blood pressure as thiazide diuretics and beta-blockers, and that they maintain their effect without the development of tolerance. Therefore they may be expected to achieve at least the same prevention of target organ damage (heart failure, cerebral strokes, and arterial nephrosclerosis) as achieved by previous drugs and also to be effective when target organs have already been damaged. Moreover ACEIs seem to offer two possible advantages: cardioprotection and a favorable influence on the quality of life. Many experimental but indeed few clinical data suggest that these drugs can exert primary cardioprotection and that they might exert a beneficial therapeutic effect in hypertensives with coronary heart disease. Owing to the quality of their hypotensive effect, to the lack of detrimental effects on physical, psychical, and sexual activity, and to the positive influence on the sense of well-being, ACEIs seem to be better tolerated than previous drugs. However, although available data suggest that ACEIs can be considered a further advance in the treatment of hypertension, more extensive information is needed to confirm these promising results.

Adrenergic beta-Antagonists↗

PubMed1990

Microalbuminuria in essential hypertension.

Clinically apparent proteinuria in essential hypertension is associated with increased cardiovascular and total mortality and is an independent risk factor for cardiovascular and cerebrovascular disease. Subclinical elevation of urinary albumin excretion is seen more frequently than clinical proteinuria in essential hypertension and the levels of microalbuminuria (excretions of 30 to 300 mg/24 h) correlate with blood pressure. The increased urinary albumin excretion in hypertension may be explained by several factors such as renal hemodynamic changes, permselectivity changes of the glomerular filter, and structural arteriolar and glomerular changes due to nephrosclerosis. It has been clearly demonstrated that microalbuminuria is a risk factor for the development of clinical proteinuria, renal failure and increased cardiovascular mortality in insulin-dependent diabetes mellitus. It is still not known whether microalbuminuria also predicts development of proteinuria and decline in renal function in hypertension but there is some evidence indicating that microalbuminuria may be a marker of increased cardiovascular risk in hypertensives.

Albuminuria↗

PubMed1997

Leukocyte infiltration and ICAM-1 expression in two-kidney one-clip hypertension.

How an increase in blood pressure, in and of itself, induces hypertensive nephrosclerosis is unclear. In an earlier study we found that leukocyte infiltration, proximal tubular cell proliferation, matrix deposition and interstitial fibrosis occur in the unclipped kidney of 2 K 1 C Goldblatt hypertensive rats. In this study we tested the hypothesis that the cell surface adhesion molecule ICAM-1 is expressed on the vascular endothelium and tubular epithelium of unclipped kidneys at 4 weeks. As a positive control, we examined the clipped kidney as well. We found that systolic blood pressure was significantly elevated in renovascular hypertensive rats compared to sham-operated controls after 4 weeks (198 +/- 5 mmHg vs 121 +/- 2 mmHg, P < 0.001). Furthermore, quantitative (densitometry) measurements showed that ICAM-1 expression on vascular endothelium and on tubular cells was significantly increased in unclipped kidneys compared to controls (P < 0.05). The same was true for monocyte and granulocyte infiltration (P < 0.05). These same variables were even more prominent in the clipped kidneys, compared to unclipped and control kidneys (P < 0.05). Our data show that ICAM-1 is expressed in unclipped kidneys exposed to hypertension as well as in clipped kidneys exposed to ischemia. We suggest that mechanical injury induced by increased blood pressure is responsible for an inflammatory adhesion molecule-mediated response and concomitant renal injury.

Animals↗

PubMed1999

Dyslipidaemia and the progression of renal disease in chronic renal failure patients.

BACKGROUND: Dyslipidaemia is common in patients with chronic renal failure (CRF), and there is increasing evidence to support the role of dyslipidaemia as a contributing factor in the progression of chronic renal disease. However, few prospective studies have been carried out which address the possible relationship between dyslipidaemia and the rate of progression of renal disease in patients with renal failure. METHODS: Between January 1985 and December 1997, we prospectively assessed the risk of CRF progression to dialysis in a cohort of 138 patients. Forty CRF patients reached end-stage renal disease (ESRD) and had to start supportive therapy during the follow-up period [group ESRD(+)]. The remaining 98 CRF patients served as controls [group ESRD(-)]. Potential clinical and laboratory risk factors for more rapid CRF decline to dialysis, including lipid abnormalities and baseline creatinine clearance were determined at the start of the follow-up period. RESULTS: Several significant differences were found in univariate analysis between the two groups of CRF, ESRD(+) and ESRD(-), namely a shorter follow-up period, a lower level of baseline creatinine clearance, a faster rate of creatinine clearance decline, a higher level of serum triglycerides, fibrinogen, total homocyst(e)ine and proteinuria, and a lower level of serum high-density lipoprotein in the ESRD(+) group than in the ESRD(-) group. However, by multivariate Cox analysis proteinuria [relative risk (95% confidence interval) 1.32 (1.16-1.50) for each g/day P = 0.001], baseline creatinine clearance [0.53 (0.40-0.70) for each 10 ml/min, P = 0.001] and chronic interstitial nephritis and hypertensive nephrosclerosis [0.38 (0.17-0.84) for presence, P = 0.005] were the only significant risk factors for CRF progression to dialysis. Hypertriglyceridaemia and male gender were selected in the final model, but were of borderline significance. CONCLUSIONS: These results suggest a limited role for dyslipidaemia in the progression of chronic renal disease to dialysis in CRF patients, in contrast with the powerful influence of proteinuria, baseline creatinine clearance and nephropathy type in predicting this progression.

Aged↗

PubMed1999

Urine IgG2/IgG4-ratio indicates the significance of the charge selective properties of the glomerular capillary wall for the macromolecular transport in glomerular diseases.

BACKGROUND: Alterations of the charge-selective properties of the glomerular capillary wall are important constituents of the pathogenesis of many glomerular diseases. Thus, differences in the degree of such changes could be of help in understanding the mechanisms governing the transport of macromolecules across the glomerular capillary wall. METHODS: The ratio between urine concentrations of neutral IgG2 and negatively charged IgG4 (IgG2/IgG4-ratio) was measured in 150 proteinuric patients and 21 healthy controls. The patients were subdivided into seven biopsy verified diagnostic groups. RESULTS: The study revealed decreased IgG2/ IgG4-ratio in membranous glomerulonephritis (0.57) compared to healthy controls (2.09) and to all other diagnosis groups; crescentic necrotizing glomerulonephritis (1.28), diffuse proliferative glomerulonephritis (1.10), IgA nephropathy (1.11), mesangial proliferative glomerulonephritis (1.55), minimal change nephropathy (1.00), and nephrosclerosis secondary to hypertension (1.06). Although not statistically significant, there was a tendency towards lower IgG2/IgG4-ratio values in all the studied glomerular diseases compared to healthy controls. CONCLUSIONS: Since IgG is transported entirely through the large pores of the glomerular basement membrane decreased IgG2/IgG4-ratio implies that this pathway is strongly influenced by the charge-selective properties of the glomerular capillary wall. The conclusion that could be drawn from that is that the large pore radius must be discrete, in the order of 80-90 A, and thus not non-discriminatory to macromolecules as previously thought.

Adolescent↗

PubMed1999

The epidemiology and prognosis of glomerulonephritis in Denmark 1985-1997.

BACKGROUND: The existence of a national renal biopsy register and a national terminal uraemia status register in Denmark provides an opportunity to study the prognosis of glomerulonephritis (GN), and factors influencing prognosis. METHODS: Multivariate analysis of 2380 renal biopsies with GN performed between 1985 and 1997 was done to determine the influence of clinical and histological factors on prognosis. RESULTS: The incidence of GN (39/mo/year) and individual diagnoses did not change during the period. After 10 years, 32%, were dead, 13% terminally uraemic, 5%, uraemic and 50% well. Older age increased mortality, but not the incidence of renal failure after the first year. Male sex increased both mortality and incidence of renal failure (34 vs 24% at 10 years, P < 0.001). The diagnoses could be divided into three prognostic groups compared with the general population: a good prognostic group (minimal change GN and membranous GN ), with a relative mortality of three and a combined renal and patient mortality of four; a poor prognostic group [crescentic GN, HUS/TTP, chronic GN] with relative mortalities of 8-19 and 13-33, respectively; and the remainder with mortalities of 4-7 and 6-12. The presence of multiple glomerular pathology, chronic GN, nephrosclerosis and chronic interstitial nephropathy worsened the prognosis, while the presence of immune deposits only worsened the prognosis of focal segmental glomerulopathy. Mortality was related to uraemia and co-morbidity at biopsy, and to the incidence of renal failure. Renal failure was correlated to uraemia and hypertension at biopsy but not to nephrotic syndrome or atherosclerosis. All vascular complications were increased and were positively related to hypertension and negatively correlated to the incidence of uraemia. Crescentric glomerulonephritis combined with anti-GBM disease had a worse prognosis than Wegener's granulomatosis, with microscopic polyangiitis and pauci-immune disease occupying an intermediate position. The prognosis of mesangioproliferative GN was unaffected by the presence of IgA nephropathy and systemic lupus erythematosus.

Adolescent↗

PubMed2000

Predictors of hospitalization and death among pre-dialysis patients: a retrospective cohort study.

BACKGROUND: Although there is abundant research describing predictors of patient morbidity and mortality among dialysis patients, predictors of adverse clinical outcomes among pre-dialysis patients are less well defined. The purpose of this study was to identify baseline predictors of first non-elective hospitalization among a retrospective cohort of 362 pre-dialysis patients. METHODS: Univariate and multivariate Cox proportional hazard models were used to identify predictors of hospitalization prior to dialysis initiation, adjusted for baseline creatinine level. Dialysis initiation, loss to follow-up, and study conclusion were censored events. Secondary outcomes included cause-specific hospitalization and death. RESULTS: Univariate analysis indicated that advanced age (RR 1.026, CI 1.016-1.037), number of prescribed anti-hypertensive medications (RR 1.149, CI 1.019-1.296), history of myocardial infarction (RR 1.979, CI 1.339-2.926), congestive heart failure (RR 2.299, CI 1.616-3.270), angina (RR 2.289, CI 1.695-3.091), peripheral vascular disease (RR 1.841, CI 1.282-2.644), renal failure secondary to nephrosclerosis (RR 1.413, CI 1.033-1.933) or renal artery stenosis (RR 1.587, CI 1.036-2.430), lower baseline haemoglobin level (RR 0.986, CI 0.979-0.992), and baseline creatinine greater than 300 micromol/l (RR 1.636, CI 1.233-2.171) were predictors of hospitalization. Gender, diabetes, diastolic blood pressure, mean arterial pressure, history of stroke, and hypoalbuminaemia did not predict outcome. Multivariate analysis, adjusted for baseline creatinine level, selected advanced age (RR 1. 017, CI 1.006-1.027), angina (RR 1.893, CI 1.371-2.613), peripheral vascular disease (RR 1.545, CI 1.054-2.266), and haemoglobin level (RR 0.987, CI 0.944-0.979) as independent predictors of hospitalization. CONCLUSION: Advanced age, co-morbid cardiovascular illness and anaemia are independent predictors of non-elective hospitalization prior to dialysis initiation. Further study is needed to determine the extent to which aggressive pre-dialysis management of anaemia and cardiovascular disease can improve patient outcomes.

Aged↗

PubMed2002

Significance of high C-reactive protein levels in pre-dialysis patients.

BACKGROUND: An elevated serum C-reactive protein (CRP) has been shown to be strongly predictive of morbidity and mortality in dialysis patients. However, the significance of high CRP levels in the pre-dialysis period has not been studied extensively. The aim of our study was to analyse the evolution of our pre-dialysis population according to their basal levels of CRP. METHODS: A cohort of 66 pre-dialysis patients was followed for 1 year, after initial determination of serum CRP. The evolution of blood pressure (BP) control, CRP levels, nutritional data (body mass index, serum albumin, prealbumin, transferrin, cholesterol), proteinuria, calcium-phosphorus product, bicarbonate, haemoglobin (Hb), the weekly dose of erythropoietin (Epo)/kg body weight, and the Hb/Epo dose ratio were measured and compared between patients with high (>6 mg/l) or low (<6 mg/l) CRP levels at baseline. The decline in renal function, hospitalization, and death also were measured and compared between the two groups. RESULTS: At baseline, 23 patients (35%) showed high (>6 mg/l) CRP levels. CRP was higher in patients with a previous history of cardiovascular disease (P<0.01), as well as in patients in whom ischaemic nephropathy or nephrosclerosis was the cause of end-stage renal disease (P<0.01). There were no differences between diabetic and non-diabetic patients. During the study period, patients with higher CRP levels at baseline maintained higher levels (P<0.001). During this period, these patients showed lower (P<0.05) albumin concentration, higher bicarbonate levels, lower Hb concentration, and lower Hb/Epo ratio and needed higher Epo doses. There were no differences in systolic BP, the degree of proteinuria, and the decline in renal function between groups; diastolic BP was lower in patients with high CRP levels. Hospitalization was higher (P<0.005) in this group. Only one patient died. CONCLUSIONS: The prevalence of inflammation is high in pre-dialysis patients. High serum CRP levels predict a constant inflammatory state on follow-up. As occurs in dialysis patients, pre-dialysis inflammation predicts lower serum albumin concentration, poorer response to Epo, and a higher hospitalization rate. The decline in renal function does not seem to be related to the inflammatory state. Mortality was not affected on short-term follow-up.

Bicarbonates↗

PubMed2002

Prognostic factors in mesangioproliferative glomerulonephritis.

BACKGROUND: The aim of our study was to examine patients with mesangioproliferative glomerulonephritis (MPGN), with or without glomerular IgA deposits, and to analyse the effect of different clinical and histopathological variables at the time of biopsy on progression to end-stage renal failure (ESRF) and death. METHODS: We retrospectively examined 273 patients who got this diagnosis in Norway from April 1988 to December 1990 after a renal biopsy. All patients were followed for a median duration of 34.8 months (0.8-68 months). RESULTS: The mean age at the time of biopsy was 40+/-17 years (range 1.1-79 years). Glomerular IgA deposits were present in 45% of the patients; IgA deposits did not affect prognosis. Three years after the time of biopsy, 7% had developed ESRF (chronic dialysis treatment or kidney transplantation) and 8% had died. By Kaplan-Meier analyses, the following clinical variables indicated progression to ESRF: increased serum creatinine, proteinuria > or =1 g/24 h, systolic blood pressure (BP) > or =160 mmHg, diastolic BP > or =90 mmHg, serum albumin <35 g/l, presence of urinary granular casts and age > or =60 years. Morphological variables indicating progression to ESRF were presence of focal mesangial sclerosis, focal glomerular crescents or necroses, benign nephrosclerosis and increased interstitial score. In the multivariable analysis, the following variables indicated progression to ESRF: increased serum creatinine (P<0.001), decreased serum albumin (P<0.05), increased diastolic BP (P<0.05), low age (P<0.05) and increased interstitial score (P<0.001). CONCLUSIONS: It is possible from clinical and histopathological variables to identify low-risk and high-risk patients at the time of biopsy. There is, however, considerable convergence. A major new observation is the finding of young age, decreased serum albumin and the presence of urinary granular casts as important clinical risk factors. Interstitial damage was the most important histopathological predictor of ESRF.

Adolescent↗

PubMed2003

Strain differences in the development of hypertension and glomerular lesions induced by deoxycorticosterone acetate salt in mice.

BACKGROUND: The genetic background may exert important modifying effects on the course and severity of experimental kidney diseases in mice. We investigated its influence on the development of hypertension and renal injury following treatment with deoxycorticosterone acetate (DOCA) salt in several mouse strains. METHODS: Four mouse strains were used for comparison: 129/Sv, C57BL/6 and F1 and F2 intercrosses of 129/Sv x C57BL/6. Male mice were uninephrectomized and DOCA hypertension was induced for 6 weeks. DOCA animals and controls received 1% NaCl for drinking. Renal damage was evaluated following measurements of blood pressure, urine albumin and renal matrix expansion. RESULTS: DOCA-induced blood pressure increase, glomerulosclerosis, interstitial fibrosis and albuminuria were markedly higher in 129/Sv than in C57BL/6 mice. F1 and F2 intercrosses displayed intermediate blood pressure, glomerular and interstitial fibrosis comparable to C57BL/6 but albuminuria as high as 129/Sv mice. CONCLUSIONS: 129/Sv mice are more susceptible to the development of DOCA-induced high blood pressure and renal damage than C57BL/6 mice. Intercrosses of both strains show a complex and non-uniform segregation of the susceptibility to DOCA-salt hypertension and nephrosclerosis.

Analysis of Variance↗