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PubMed2003

[Hypertensive nephropathy: pathogenesis, diagnosis and treatment].

Chronic hypertension leads to renal damage known as hypertensive nephropathy or hypertensive nephrosclerosis. Presently, this renal pathology seems to be one of the most frequent causes of end-stage renal disease requiring chronic dialysis. Unfortunately there are many problems with clinical diagnosis of hypertensive nephropathy which cause overestimation of its prevalence. Renal biopsy and morphological examination which is the gold standard of diagnosis is rarely performed in such patients. Histological lesions in hypertensive nephropathy are well recognised: myointimal hyperplasia of arterioles, hyaline arteriosclerosis, wrinkling of basement membrane, collapse of the glomerular tuft, glomerulosclerosis and tubulointerstitial involvement. These changes are believed to result from ischaemia and hyperfiltration. Genetic susceptibility and enhanced apoptosis could be involved in this process as well. One could hope that adequate treatment of hypertension according to international standards would allow to reduce the still increasing number of patients with hypertensive nephropathy. Pathogenesis, epidemiology, and clinical management of hypertensive nephropathy are currently discussed in this brief review.

Arterioles↗

PubMed2003

[Plasmic activity of phospholipid membranes in nephritis].

AIM: To study activity of plasmic phospholipid membranes (PPM) in patients with chronic nephritis (CN) as regards clinical-laboratory and morphological characteristics of the disease. MATERIAL AND METHODS: 10 patients with chronic mesangial glomerulonephritis (CMG) and 4 patients with chronic drug-induced tubulointerstitial nephritis were examined. All the patients had moderate arterial hypertension including 5 patients with CMG combined with nephrotic syndrome. 9 patients had elevated blood creatinine (up to 500 mcmol/l). Measurements were made of routine laboratory indices, blood coagulation and paracoagulation, Willebrand's factor (WF), aggregation time (AT), phospholipid activation of blood coagulation (FABC), morphological indices of activity and sclerosis. RESULTS: In spite of chronic latent intravascular blood coagulation, CN was characterized by apparent lowering of FABC which was more evident in CMG. There was a weak correlation between a FABC fall and the level of proteinuria, lipidemia, AT of platelets, indices of activity. Some parallels exist between creatininemia and activity of PPM. A close reverse relationship was found between FABC and WF, and a direct one between FABC and sclerosis index. CONCLUSION: Subnormal PPM activity in CN correlates with organic microthrombi formation and promotes the discussion of both mechanisms of FABC formation disturbances and possible ways of PPM consumption including enhanced diffusion into the mesangium in progressing nephrosclerosis.

Adult↗

PubMed2003

[The problem of rheumatoid nephropathy].

AIM: To study clinical and morphological variants and frequency of renal involvement in patients with rheumatoid arthritis (RA). MATERIAL AND METHODS: Routine laboratory tests, device (urography, dynamic scintigraphy of the kidneys) and ultrasound investigations, lifetime and postmortem examinations of renal tissue using histological, immunohistochemical and electron-microscopic techniques, biopsy of gingival and rectal mucosa for amyloid detected renal lesions in 268 (46.2%) of RA patients followed up for 25 years meeting the ARA criteria. In 98 (37%) patients renal lesions were verified morphologically. Lifetime renal biopsies were made for 60 of them. RESULTS: The diagnosis of chronic pyelonephritis was made in 117 patients, 42 patients had nephrolithlasis, nephroptosis and papillary necrosis were found in 49 and 3 patients, respectively. Arterial hypertension was present in 96 examinees, nephrotic syndrome was diagnosed in 19 and chronic renal failure--in 67 patients. Drug-related nephropathy occurred in 35 cases, in 26 cases symptoms of pyelonephritis arose prior to RA. Combination of renal diseases was found in 197 patients. Renal pathology was not verified morphologically only in 5 cases. Glomerulonephritis (GN) variants were present in 35 patients: mesangioproliferative (n = 27), membraneous (n = 5), mesangiocapillary (n = 3). 12 of them took Au preparations or D-penicillamin, therefore diagnosis of true rheumatoid GN was feasible only in 23 of them. GN was combined with renal amyloidosis (n = 28), minimal morphological changes (n = 19), interstitial/tubulointerstitial nephritis (n = 4), pyelonephritis (n = 4), arteriolosclerotic nephrosclerosis (n = 3). 41 patients with diagnosed pyelonephritis were found morphologically to have amyloidosis (n = 16), GN (n = 10), minimal morphological changes of renal tissue (n = 6), tubulointerstitial nephritis (n = 3), pyelonephritis, pyelonephritis alone (n = 4). CONCLUSION: The above morphological findings point to high occurrence of renal pathology in RA. In many cases morphological signs are more serious than clinical symptoms. If RA activity is not controlled, nephritis of any type may transform into amyloidosis. When it is impossible to formulate morphological diagnosis in RA patients, it is proposed to use the term "nephropathy". Unrelated to RA nephropathy's diagnosis is valid in cases when renal pathology manifested before RA. Renal diseases arising in the presence of RA may be associated with this disease and should be reflected in its classification.

Adult↗

PubMed2003

[The role of digital subtraction angiography in the diagnosis of renal artery injury].

In 3806 patients with vasorenal hypertension the results of kidney angiographic investigation were analyzed. In order to study the efficacy of application of intravenous digital substructional angiography (DSA), the data, obtained in 1621 patients using this method, were compared with such in general group of patients. Informativeness of DSA had constituted 88.9%. Accompanying chronic disease of intestine, excessive body mass, nephrosclerosis are complicating interpretation of obtained results in 10.1% of observations. Possible conduction of ambulatory investigations, decrease traumaticity, invasiveness, duration of procedure, shortening of financial expense constitute the main advantages of DSA. Application of method is recommended in all patients with vasorenal hypertension in ambulatory environment.

Angiography, Digital Subtraction↗

PubMed1992

[Acute renal insufficiency secondary to the use of angiotensin converting enzyme inhibitors in 2 patients without renal artery stenosis].

Two female patients who developed acute renal failure secondary to the use of angiotensin converting enzyme (ACE) inhibitors for hypertension are presented. None had renal artery stenosis on angiography or duplex doppler ultrasound examination. A 66 year old patient with a single functioning kidney recovered basal renal function; the other patient, aged 77 years, remained with a permanent severe renal damage. Risk factors were advanced age, mild chronic renal failure due to nephrosclerosis and diuretic use. We conclude that acute renal failure related to ACE inhibitors may be severe and can occur even in patients without renal artery stenosis. Diuretics, associated to ACE inhibitors, should be prescribed with caution, specially in older hypertensive patients with pre-existing chronic renal failure. Diabetic patients are at special risk due to the high incidence of small vessel disease in them.

Acute Kidney Injury↗

PubMed1992

Non-oliguric acute renal failure in gout.

Four patients of pure gouty nephropathy are presented. Gout was of over five years duration and asymptomatic nephropathy manifested as non-oliguric acute renal failure. Diseases commonly associated with it like uric acid stones, urinary tract infections, hypertension, diabetes mellitus, hyperlipidemid, obesity and nephrosclerosis were absent. Reduction in serum uric acid level resulted in prompt improvement in renal functions. Early detection and control of hyperuricemia may help in restoration of renal functions.

Acute Kidney Injury↗

PubMed1992

Factors affecting chronic renal failure progression: results from a multicentre trial. The Northern Italian Cooperative Study Group.

In order to evaluate the prognostic factors concerning the rate of progressive deterioration of renal function, we made an inductive analysis of the behaviour of 456 patients in a multicentre, formal prospective trial aimed at clarifying the possible role of protein restriction in retarding the progression of chronic renal insufficiency (CRI). The main clinical and laboratory findings in patients whose plasma creatinine (PCr) levels doubled in comparison with baseline randomization values or who needed dialysis within 24 months after onset of the study were compared with those of the other patients. In addition, independently of the assigned diet, we tested the main variables that might affect CRI progression (sex, systolic and diastolic blood pressure, change in body weight, hematocrit, calcium-phosphate product, proteinuria, protein catabolic rate, total cholesterol and triglycerides). We used multiple regression analyses and also plotted the mean values of these parameters in each patient against an estimate of the deterioration of chronic renal failure based on the difference between the final and the initial reciprocal of the PCr and the creatinine clearance (CCr) levels. A descriptive analysis of the behaviour of PCr in the three CRI groups and in the four underlying diseases groups was made. PCr levels at entry, underlying disease and proteinuria were prognostic factors for CRI progression. The increase in PCr was 0.0102 mg/dl/month in patients with nephrosclerosis, 0.0203 mg/dl/month in interstitial nephropathy, 0.0360 mg/dl/month in glomerulonephritis and 0.0704 mg/dl/month in polycystic kidney disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed2003

[Salt intake and the progression of chronic renal diseases].

To what extent dietary salt intake is involved in the pathogenesis of progressive renal diseases has never been fully understood in humans. To this aim, we investigated the relationship between urinary sodium excretion (under a low salt & low protein diet) and urinary protein excretion/renal function in patients with three major renal diseases: chronic glomerulonephritis(GN), diabetic nephropathy(DN) and nephrosclerosis(NS). The results were as follows; 1) A significant positive correlation was found between urinary sodium excretion (equivalent to the daily salt intake) and daily urinary protein excretion in patients with a GN and DN. However, no relationship was found between the two parameters in patients with NS. 2) Reduction in salt intake led to a significant decrease in daily protein excretion, the effect of which was prominent in patients with GN and DN. 3) A significant positive correlation was found between urinary sodium excretion and estimated protein intake(EPI) in all three groups. 4) There was a significant positive correlation between EPI and urinary protein excretion in DN, but not in GN. 5) Reduction in salt and protein intake(calculated as an EPI) ameliorates the slope of reciprocal creatinine concentration(1/Cr) in patients with GN and DN. These results indicate that slat restriction is strongly associated with the preservation of renal function in patients with GN and DN, suggesting that this dietary strategy can be a useful measure for retarding the progressive nature of these diseases. Of note is that both salt and protein restriction was renoprotective only in patients with DN. Thus, patients with GN and DN must be followed-up on the basis of a salt-restricted diet throughout their clinical course.

Aged↗

PubMed2002

Prevalence of hepatitis B and C viruses in pre-dialysis patients with chronic renal failure.

CRF affects people in their prime of life; they are often the Nation's workforces thereby leading to severe economic and social problems. Many patients with CRF who need dialysis, present for the first time in end stage renal failure. The commonest causes of CRF in Nigeria and other tropical countries have been reported to be hypertensive nephrosclerosis and chronic glomerulonephritis. Various studies in and outside Nigeria have documented an increased seroprevalence of anti-HCV and HBsAg in chronic renal failure patients on maintenance haemodialysis. Any association established between these viruses and CRF would suggest that the prevention and/or treatment of these viruses may likely lead to a reduction in the prevalence of CRF. Thus, forty-five (45) consecutive subjects with CRF and (45) age- and sex-matched control subjects who satisfied the eligibility criteria for the study were enrolled. Marker of HBV (HBsAg) was assayed using HUMAN Enzyme linked Immunosorbent Assay (ELISA) Test. Marker of HCV (anti-HCV) was determined using the HUMAN ELISA Test. The mean age of the subjects was 37 +/- 14 years (range 17 to 62 years) while the mean age of the control subjects was 38 +/- 14 years (range of 18 to 66 years). There were no statistically significant differences in the prevalence of HBsAg and anti-HCV in the CRF patients and controls P=0.74 and P=1.0 respectively. Although, the sample was small anti-HCV seropositive CRF patients were significantly younger than anti-HCV seropositive controls P<0.027. In conclusion, this study has shown that there were no significant differences in the prevalences of HBsAg and anti-HCV in the CRF patients and controls. A larger scale study may be more desirable in defining the role of these viruses in patients with chronic renal failure.

Adolescent↗

PubMed2004

[Work capacity in patients on hemodialysis].

The quality of life is considerably impaired in patients on regular hemodialysis has been changed. It is difficult to determine it because there are no general definitions or measuring instruments. There are objective and subjective components of the quality of life, one among them being occupational ability. During the progression of chronic renal disease (CRD) to terminal renal failure (TRF) physical activity of the patients becomes poorer. In this stage, their physical activity is by 40-60% below the value expected for the same healthy age cohort. The intention of this analysis was to determine occupational ability in patients on regular hemodialysis. The analysis included 161 patients on hemodialysis, 78 (48.5%) female and 83 (51.5%) male, mean age 61.2 +/- 13.1 years, and mean time on hemodialysis was 54 +/- 71.9 months. All patients filled-out a self-administered questionnaire on schooling and occupational ability. The cause of TRF was glomerulonephritis in 45 (26.8%), diabetes mellitus in 42 (26.3%), nephrosclerosis in 26 (16.1%), and pyelonephritis in 12 (7.4%) patients. Age distribution was as follows: 0-19 years 1 patient, 20-44 years 14 (8.7%); 45-64 years 64 (39.8%) and 65 years 82 (50.9%) patients. Educational structure: elementary school 65 (40.4%), secondary school 79 (49.1%), college 10 (6.2%), and university 6 (3.7%) patients. Occupational structure: retired 123 (76.4%), housekeeper 20 (12.4%), never employed 4 (2.5%), employed 10 (6.2%), unemployed 2 (1.2%), 1 child and 1 student. Among employed patients there were 7 men and 3 women. Their educational level was as follow: elementary school 1 patient, secondary school 8 patients, college 1 patient. At the beginning of hemodialysis their occupational status was: full-time employment 30 (18.6%) patients, part-time employment 1 patient, longer time on sick-leave payment (3.1%), retired 95 (59%), pupils and students 3, unemployed 2, and 1 child did not attended school. Time interval between the beginning of hemodialysis and retirement was: less than 1 year work 13 (36.1%) patients, 1-2 year work 6 (16.7%), three year work 2 patients, more than 8 year work 2 patients, and 10 year work only 3 patients, for 14, 18 and 26 years each. Two patients lost their job for employer bankruptcy. The judgment of patients regarding their occupational ability was as follows: out of 161 patients, 23 (14.3%) felt fit for work, 12 on full-time and 11 on part-time basis. Occupationally incapable were 46.6% of patients, and 63 felt unable to take care of another person. Some kind of additional activity, like working in garden or taking care of children was reported by 26 patients. The aforementioned results showed that 22.4% of the patients were occupationally active at the time of starting hemodialysis. Many patients were retired after hemodialysis had started. Only 6.2% of hemodialysis patients were occupationally active although 14.3% felt occupationally capable. The main reasons for such a low level of employment were advanced age, diminished physical activity due to the disease, and difficulties associated with the socioeconomic situation in the country.

Activities of Daily Living↗

PubMed2004

Simultaneous transjugular renal biopsy and hemodialysis catheter placement in patients with ARF.

BACKGROUND: Previous studies have evaluated transjugular renal biopsy in patients with contraindications to percutaneous renal biopsy or those undergoing simultaneous renal and hepatic biopsies. We sought to evaluate transjugular renal biopsy in patients with acute renal failure (ARF) or ARF in the presence of chronic renal insufficiency (CRI) who required venous catheter placement for hemodialysis (HD). METHODS: Ten consecutive patients (6 patients, ARF; 4 patients, ARF on CRI) at a single tertiary-care medical center, while undergoing placement of HD access through the internal jugular route, also underwent transjugular renal biopsy using the Quick-Core (Cook, Bloomington, IN) system to delineate the cause of ARF. Transjugular renal biopsy was performed because it was the opinion of the attending nephrologist that a histological diagnosis might alter management. RESULTS: Renal biopsy findings were diabetic nephropathy (3 patients), acute tubular necrosis (ATN; 2 patients), nephrosclerosis (2 patients), immunoglobulin A nephropathy (1 patient), lupus nephritis with focal crescents and ATN (1 patient), and pauci-immune necrotizing glomerulonephritis (1 patient). There were no major complications from the procedures. Among the 6 patients with ARF, management was directly affected in 3 patients (either initiation of appropriate immunosuppressive therapy or withholding of such therapy). In the remaining 3 patients with ARF and in patients with ARF on CRI, performing transjugular renal biopsy at the time of HD access placement obviated additional testing and/or unnecessary therapy. Four patients recovered renal function and HD therapy was discontinued, 2 patients died, and 1 patient was lost to follow-up. CONCLUSION: Simultaneous transjugular renal biopsy/HD catheter placement should be considered in patients with ARF requiring HD therapy for whom knowledge of the renal histological diagnosis may alter patient management.

Acute Kidney Injury↗

PubMedDate not supplied

[Cerebrovascular disease: its relationship with cardiovascular and renal pathology in 134 clinical autopsies].

OBJECTIVE: To establish the relationship between cardiopathy and chronic nephropathy, and cerebral vascular pathology in clinical necropsies performed in adult patients. MATERIAL AND METHODS: The protocols of 861 clinical autopsies done during the lapse 1990-2000 were reviewed, of these, 134 cases with diagnosis of cerebrovascular disease (CVD) were selected. Analyzed features included: neuropathological study of CVD, renal and cardiovascular pathology, and cause of death. RESULTS: CVD represented 15.5% of all autopsies done during the study period. Ischemic CVD constituted 56.7% of the cases, whereas cases of hemorrhagic CVD accounted for 43.3% of the total. Causes included arterial hypertension (33%), atherosclerosis (19%), emboli and vascular malformations (13% each, respectively), coagulopathies (8%), angeiitis (4%), tumors (1%), and unknown origin (11%). Ischemic CVD was caused by atherosclerosis in 34.2% of the cases, lacunar infarcts in 32.8%, of embolic cause in 14.4% of the cases, angeiitis in 1.3%, and of unknown origin in 17.1% of the cases. Hemorrhagic CVD presented as intraparenchymal hematoma in 50% of the cases, as sub-arachnoid hemorrhage in 28%, as disseminated petechial hemorrhages in 19%, and intraventricular in 3% of the cases. Ischemic CVD was associated with hypertensive cardiopathy in 86.5% of the cases, and with nephrosclerosis in 51.3%, whereas hemorrhagic CVD was seen associated with the same pathological entities in 86.2% and 29.3% of the cases, respectively. Cerebral herniation was the cause of death in 2.6% of the patients with ischemic CVD, and in 74.1% of the patients with hemorrhagic CVD. CONCLUSIONS: CVD was associated with a high frequency of intercurrent pathological processes, namely hypertensive cardiopathy, atherosclerosis, nephroscleroisis, and other chronic nephropathies, that eventually interact, and constitute well known predisposing and/or concomitant factors to the cerebrovascular event

Adult↗

PubMed2004

[Epidemiology of chronic renal disease in the North-West of Russia: setting-up the register].

AIM: To study epoidemiology of chronic renal disease (CRD) in the North-West region of the Russian Federation. MATERIAL AND METHODS: A population retrospective trial was performed from 01.07.98 to 30.06.99 in the Vologda region, towns Veliky Novgorod and Syktyvkar (total population 1840000). 490 cases of chronic renal failure (CRF) with creatinin levels > 300 mcmol/l corresponding to CRD stage IV and V by glomerular filtration rate were detected. CRD stage IV-V prevalence, morbidity including sex- and age-specific parameters, cumulative survival in different etiology of CRD regarding replacement therapy (RT) and nephrologist supervision were estimated. RESULTS: Mean prevalence and morbidity were 266 and 108 cases per million. Number of affected males and females was the same. CRD was provoked by chronic glomerulonephritis (CGN)--41%, chronic interstitional nephritis--16%, diabetes mellitus--14%, renal polycystic disease--8%, amyloidosis--6%, hypertension nephrosclerosis--2%, other causes--3%, cases of unclear etiology--10%. Among patients with primary renal pathology on RT, number of CGN patients was higher--61% while diabetic and amyloidosis shares were much lower 1.6 and 0.8%. 31.1% patients given no RT had Cr > 500 mcmol/l and glomerular filtration rate < 10 ml/min. Incidence of CRD stage IV-V in RT patients was 80 per million, 8 patients per million for 1 year started RT for the first time. CRF mortality was 85 patients per million a year. 88.4% of deaths in patients given no RT was due to uremia. Cumulative survival for RT patients and RT untreated was 90 and 50% a year, respectively. Survival of the RT untreated observed by the nephrologist was significantly higher (p = 0.003). CONCLUSION: New cases of CRD stage IV-V were comparable in number to European incidence rate while prevalence was much less because of lower number of old patients and RT treated. The problem of CRD treatment is urgent for RF and requires updating nephrological service and development of RT programs.

Chronic Disease↗

PubMed2004

Metanephric adenoma: case report and review of the literature.

Metanephric adenomas are benign tumors frequently found post-mortem (from 7% to 22% of autopsies) which originate from distal tubules; they are generally small in dimensions (smaller than 1 cm) and located in the renal cortex. Etiology is unknown, even though they could be associated with smoke, tubular nephrosclerosis, dialysis. An endocrinal relationship was proposed, because of its more frequent incidence in female (2:1). Metanephric adenoma is an uncommon kind of renal adenoma with no malignant potentiality: from the clinical and diagnostic viewpoint its own greater importance depends on the probability of diagnostic misunderstanding with Wilms' tumor; furthermore its echographic, tomographic and arteriographic characteristics are often similar to small renal adenocarcinoma ones (100). Polycytemia is frequently associated to metanephric adenoma as paraneoplastic syndrome and, more rarely, abdominal mass, abdominal pain, hematuria and hypertension (140). The most important study on metanephric adenoma is the one realized by E.K. Mostofi, including 50 cases from the Department of Genitourinary Pathology, Armed Forces Institute of Pathology, Washington, D.C., published in 1995; in this study half of findings was incidental; mean dimension of tumor about 5,5 cm and in 50% it could be seen a distinct capsule sourrounding the tumor (in the remaining cases the capsule was discontinuos or absent) (210). An important radiological characteristic is that metanephric adenomas are more frequent calcificated than other histotypes and, from the pathological viewpoint, the most important differential element seems to be the smaller dimensions of its cells with hyperchromatic nuclei in the absence or lack in mitotic activity and in the absence of chromosome aberrations. In the case of difficult histological diagnosis, cytogenetic and immunohistochemical analysis can be useful. In conclusion, because it is impossible to distinguish in the preoperatory between the metaneprhic adenomas and the other tumoral types on the bases of the symptoms, dimensions or radiographic appearance, it is mandatory to treat it as malignant eteroformations in a therapeutical strategy, when it is possible.

Adenoma↗

PubMed2005

Progression of renal failure -- the role of hypertension.

High blood pressure plays a key role in the progression of renal failure. Hypertension is a common presentation of kidney disease and an almost invariable accompaniment of renal failure. Hypertension is also a major contributor to cardiovascular disease, the major cause of morbidity and mortality in renal failure. Hypertension is both cause and consequence of renal failure, but the precise nature and prevalence of hypertensive nephrosclerosis as a cause of renal failure remains controversial. There is strong evidence that hypertension accelerates the progression of experimental renal disease and that control of blood pressure is effective in preventing this progression. Hypertension, both accelerated and "benign" (a misnomer), has long been recognised as a poor prognostic feature in human renal disease and more recently in renal allograft survival. Blood pressure control is very effective in retarding renal disease progression. There are compelling indications for angiotensin-converting enzyme inhibitors in both non-diabetic and type 1 diabetic nephropathies, and for angiotensin receptor blockers in type 2 diabetic nephropathy. Most patients will require combination drug therapy to control blood pressure and reduce both progression of renal failure and the associated cardiovascular morbidity and mortality.

Angiotensin II Type 1 Receptor Blockers↗

PubMed1992

Continuous stretch-relaxation in culture alters rat mesangial cell morphology, growth characteristics, and metabolic activity.

Mesangial cells serve many functions in the glomerulus, including regulation of glomerular ultrafiltration coefficient, matrix production, and eicosanoid generation. The glomerulus is a vascular bed, and the mesangial cell is continually exposed to rhythmic alterations in intraglomerular pressure. Since increased intraglomerular pressure has been implicated as a potential causative agent in the ultimate development of nephrosclerosis, we sought to determine the effect of continuous stretch-relaxation upon parameters of mesangial cell growth and function. Early passage (2-4) cultured rat mesangial cells were plated onto either rigid-bottom or flexible-bottom culture plates coated with type I collagen. After cell attachment, the cells on flexible supports were exposed to continuous stretch-relaxation for 72 to 96 hours at a rate of 100 cycles/minutes at an applied pressure of 7 to 8 KPa (53 to 61 mm Hg). Cellular morphology was altered by continuous stretch-relaxation, with the majority of mesangial cells presenting stellate or straplike morphology. Fluorescein isothiocyanate-labeled phalloidin staining indicated an increase in density of actin filaments running the long axis of the cell. Stretch-relaxation resulted in an approximately 50% increase in cell number. Prostaglandin production, assessed as irPGE2 production, was increased by stretching in mesangial cells from 28 +/- 1 to 49 +/- 4 pg/10(6) cells (N = 12; p less than 0.005). Mechanical stretch/relaxation increased the percentage of protein representing collagenous proteins from 47 +/- 6% to 70 +/- 4%, as assessed by collagenase susceptibility (p less than 0.025). Analysis of pepsin-resistant proteins synthesized indicated that stretch/relaxation resulted in increases in the relative amounts of types I and III collagens produced/cell. Additionally, stretch/relaxation selectively increased the relative amount of type I-homotrimers produced. Thus, when mesangial cells are exposed to cyclic stretch/relaxation, they exhibit significant alterations in morphology, growth, prostaglandin and collagen production.

Animals↗

PubMed1992

Clinical relevance of albuminuria in hypertensive patients.

Albuminuria (including the form not detectable by conventional tests, i.e., microalbuminuria) as well as renal dysfunction have recently been recognized as important complications in the patient with essential hypertension. The presence of albuminuria predicts cardiovascular events. Albuminuria is associated with more severe hypertension, with evidence of more advanced target organ damage (e.g., left ventricular hypertrophy), and is more prevalent in high-risk groups (e.g., the elderly). On the other hand, albuminuria may also be associated with generalized endothelial barrier dysfunction and thus predispose to accelerated atherogenesis. Ischemic nephropathy from nonmalignant nephrosclerosis has emerged as an important cause of terminal renal failure in the elderly patient with essential hypertension.

Albuminuria↗

PubMed2005

Laparoscopic renal cryotherapy: biology, techniques and outcomes.

AIM: The development of minimally invasive approaches to renal cell carcinoma (RCC) over the last 10 years has given rise to newer therapies such as renal cryotherapy. Patients with significant comorbidities who are not suitable for open surgery may be candidates for this procedure. Herein, we review the biology, techniques and outcomes of laparoscopic renal cryotherapy as performed at our institution. METHODS: We present our initial experience with laparoscopic cryotherapy for the treatment of small, peripheral renal lesions and provide a review of the literature. A retrospective review was performed on our first 25 patients treated with transperitoneal laparoscopic cryotherapy for small peripheral renal lesions by a single surgeon between 2002 and 2003. RESULTS: We treated 25 patients, average age of 65 years (range 32-83) with transperitoneal laparoscopic renal cryotherapy for small, enhancing, peripheral lesions suspicious for RCC. Mean pretreatment creatinine of 1.06 was unchanged after treatment. Mean tumor size was 2.4 cm (range 1.5-3.6 cm), with a mean EBL of 80 mL. Pathology revealed 72% RCC, 2 oncocytomas, one each arterio-nephrosclerosis, inflammatory tissue, focal-segmental glomerulosclerosis, angiomyolipoma and one normal tissue specimen. Average tumor grade was 2.3 (range 2-4). Mean hospital stay was 2.3 days (range 1-5). Three cases were converted to open. Two complications included transfusion and hydronephrosis, both managed conservatively. Mean follow-up is 16.2 months (range 6-36 months). There have been no recurrences to date despite a rigorous surveillance protocol. CONCLUSIONS: Renal cryotherapy is a viable option for nephron sparing surgery in small, peripheral, renal lesions. The procedure is well tolerated, may be considered in patients who are not good candidates for open surgical approaches, results in minimal morbidity, and has very encouraging treatment results. Close surveillance post-treatment is essential. Longer follow-up data will be necessary to establish the durability of laparoscopic renal cryotherapy.

Adult↗