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PubMed2005

[Epidemiology and risk factors of chronic renal diseases: a regional level of the problem].

AIM: Assessment of chronic renal disease (CRD) prevalence and morbidity rate and approaches to early CRD in one of the regions of the RF (Tyva Republic). MATERIAL AND METHODS: A population study in the Tyva Republic performed from 01.07.2003 to 30.06.2004 included patients with glomerular filtration rate (GFR) < 30 ml/min, nephrosclerosis signs at autopsy, terminal GFR < 30 ml/min, on replacement renal therapy (RRT). CRD prevalence and morbidity were estimated (stage IV-V). Examination of 374 Tyva citizens was made for estimation of early CRD and risk factors of developing CRD (the sectional study). The participants of the sectional study were examined clinically and biochemically with measurement of albuminuria, calculation of urine albumin/creatinine (ACR) and study of some molecular-genetic characteristics. RESULTS: Prevalence of CRD stage IV-V in Tyva population was 493 cases per million, prevalence of RRT--126 cases per million. Elevated ACR was found in 4.7% of healthy subjects and 15.9% of hypertensive subjects. Initial lowering of GFR occurred in some healthy subjects and in 1 of 12 hypertensive patients. Significant predictors of albuminuria were serum albumin concentration (p < 0.00001), GFR (p < 0.0002), a male sex (p < 0.004), diabetes mellitus (DM) (p = 0.0057) and left ventricular myocardial mass index (p = 0.0253). GFR depended significantly on age (p < 0.000001), male sex (p < 0.000001), uric acid concentration in the serum (p < 0.000001), presence of DM (p = 0.000019), ACR (p = 0.0059), diastolic pressure (p = 0.0347), triglyceridemia (p = 0.0369). Citizens of Tyva had more frequently than citizens of other regions of Russia IlI-genotype of angiotensin 1-converting enzyme (ACE) (p < 0.0001), T-allele of methylentetrahydrofolatereductase (p < 0.0001), E3-allele of gene of apoprotein E (p < 0.0001). Prevalence of aa, ab, bb genotypes of eNO-synthetase was 82.3%, 15% and 2.7% in the group of Tyva examinees vs 62, 31 and 7% in European Russians (p < 0.01). CONCLUSION: Prevalence of both early and advanced stages of CRD among population of Tyva Republic is rather high. CRD morbidity may depend, besides conventional risk factors, some genetic specific features. Screening studies require continuation for early detection of CRD and timely planning of therapeutic and preventive measures.

Female↗

PubMed2005

Management of renal problems in Australian general practice.

The BEACH program, a continuous national study of general practice activity in Australia, gives us an overview of consultations involving the management of renal problems. In this analysis, we have included renal failure, glomerulonephritis/nephrosis (all forms of nephritis and nephrotic syndrome), renal insufficiency, nephropathy (including diabetic and analgesic), and uraemia and nephrosclerosis grouped as 'other'. This synopsis provides a backdrop against which articles in this issue of Australian Family Physician can be further considered.

Adult↗

PubMed2005

Pattern of renal diseases among elderly Egyptians patients with acute or chronic renal diseases in Ain Shams University and Nasser Institute Hospitals, Cairo, Egypt.

This study among elderly renal Egyptian patients (n=220) with only 20 of them were subjected to renal biopsy. Results showed: diabetic nephropathy in 28.2%, hypertensive nephrosclerosis 25.5%, UTI, cystitis and pyelonephritis in 6.8%, renal stones in 5.9%, obstructive uropathy in 7.6%, simple cysts in 4.5%, CRF of unknown origin in 13.1%, and others in 26.4%. DM and HTN were S related to kidney function tests and increase in elderly. Other cardiovascular risk factors and smoking are reported by previous workers to be HS related to renal diseases. Age was significantly related to GFR, BUN and Cr. but sex difference was not significantly related to renal diseases. Multiple myeloma, lupus nephritis, vasculitis and hepatitis B were all recorded in few numbers of elderly Egyptians. HCV was more common and more likely to cause renal diseases. Abdomino-pelvic ultrasound was confirmatory to clinical renal diseases diagnosis. Among patients (n=20) biopsies showed focal necrotizing GN in 20%, membranous nephropathy in 50% and renal amyloidosis in 30%. CTIN was associated in some cases due to NSAID intake. Analgesic nephropathy was a common problem that might lead to ARF in some cases especially in the elderly. Ultrasound results among the biopsy group were confirmatory to clinical diagnosis.

Acute Disease↗

PubMed2005

Study of efficacy and safety of losartan (losar) in Asian Indian hypertensives.

Although there has been widespread dissemination of knowledge about hypertension, it remains poorly treated in most populations. Systemic hypertension is associated with increased risk for coronary artery disease, stroke, nephrosclerosis, peripheral vascular disease, etc. The treatment of hypertension includes non-pharmacological measures and the specific drug therapy. Losartan potassium is an orally active, non-peptide angiotensin II receptor antagonist. It is the first of this new class of drugs introduced for clinical use in hypertension. Data was obtained of 347 patients from 140 general physicians. The study revealed that losartan potassium is used in the treatment of mild to moderate hypertension with excellent to good response in 98.8% of the cases. Mild adverse reactions were reported in 5.8% of the cases. None of the adverse reactions were severe enough which required discontinuation of therapy or needed hospitalisation. Thus, the present postmarketing surveillance study confirms the safety and efficacy of losartan potassium in Indian population.

Antihypertensive Agents↗

PubMed2005

Reduplicated basal lamina of the peritubular capillaries in renal biopsy specimens.

Reduplicated basal lamina of the peritubular capillaries (PTC) is usually found in kidney allografts in association with chronic transplant nephropathy and sometimes in native renal biopsies. In order to assess the incidence of this phenomenon in native renal biopsy specimens, we have carried out a retrospective review of the diagnostic ultrastructural pathology records of 80 consecutive renal biopsies excluding renal allografts and children with clinical signs of heavy proteinuria. Reduplicated basal lamina of the PTC was found in 19 out of the 80 cases (23.8%) with renal diseases. It was frequently seen in lupus nephritis, IgA nephropathy, and membranoproliferative glomerulonephropathy, being the subtypes of mesangial proliferative lesions. In a few cases it was also found in anti-neutrophil cytoplasmic autoantibody (ANCA) associated glomerulonephritis and benign nephrosclerosis renal biopsies. Reduplicated basal lamina of the PTC was strongly associated with glomerular and peritubular inflammation, and tubular necrosis. Peritubular interstitial edema, slight to moderately increased collagen fibrils, many spiraled collagen fibrils (indicative of degeneration), and collagen fibrils drawing from basal lamina were found around the reduplicated basal lamina of the PTC but not in normal basal lamina. These results indicate that in native renal biopsy specimens, reduplication of the basal lamina of the PTC is associated with endothelial cell injury and capillary permeability abnormality.

Adult↗

PubMed2005

Successful use of icodextrin in elderly patients on continuous ambulatory peritoneal dialysis.

In peritoneal dialysis (PD), a 7.5% polyglucose-containing dialysis solution (icodextrin) provides prolonged ultrafiltration as compared with glucose-based dialysis solutions. In the present study, we attempted to clarify the safety and effectiveness of icodextrin in elderly patients on continuous ambulatory peritoneal dialysis (CAPD). Clinical data and outcomes of 16 patients aged 65 or older were monitored for 12 weeks before and during icodextrin treatment. The group included 13 men and 3 women with a mean age of 69 +/- 5 years (range: 66-78 years). The underlying kidney disease was chronic nephritis in 7 patients, diabetes mellitus in 8 patients, and nephrosclerosis in I patient. From the beginning of peritoneal dialysis, 1 patients had been treated with icodextrin; the other 10 were changed to icodextrin from glucose dialysis solution. At the end of study, body weight had increased to 63.8 +/- 9.3 kg from 61.6 +/- 9.3 kg, accompanied by an increase in ultrafiltration to 480 +/- 207 mL daily from 369 +/- 436 mL daily. No significant change in urine volume occurred. Despite the increase in body weight, cardiothoracic rate decreased to 51.1% +/- 3.4% from 52.3% +/- 4.9%. All patients reported an improvement of edema and appetite. Edema scores were significantly decreased to 0.85 +/- 0.90 from 1.63 +/- 0.96 (p < 0.03). No adverse side effects were associated with the use of icodextrin. From the foregoing data, we concluded that, as compared with conventional glucose solution, icodextrin has beneficial effects on ultrafiltration volume and clinical symptoms in elderly patients on CAPD.

Aged↗

PubMed1991

Plasma levels of growth hormone correlate with the severity of pathologic changes in the renal structure of aging rats.

It is well known that pharmacologic administration of growth hormone (GH), prolactin (Prl) or adrenal steroids can induce nephrosclerotic lesions in rodents. In this study we correlated circulating levels of endogenous GH, Prl, and corticosterone with the degree of structural nephropathy in rats of different ages. Female young (3 to 4 months), old (25 months), and senescent (33 to 35 months) and male young (3 to 4 months) and old (24 to 26 months) Sprague-Dawley rats were used. Sequential blood samples were removed through intraatrial cannulas while the animals remained conscious and undisturbed. Plasma Prl showed a 3-fold increase in old compared with young males, while old and senescent females displayed a 13- and 64-fold increase, respectively, for Prl. Plasma GH decreased significantly in old compared with young males, while senescent females had elevated GH levels compared with their young and old counterparts. Plasma corticosterone showed an age-related decline in females but not in males. The kidneys from old males showed a marked degree of glomerular sclerosis and obliteration. The presence of tubular metaplasia of Bowman's capsule as well as deposits of iron in the tubular epithelium was common in old males but rare in old and senescent females. There was a strong correlation of plasma GH, but not Prl, with the severity of renal histopathology. Plasma corticosterone showed an inverse correlation with the severity of renal histopathology in old males and senescent females. These results are consistent with the hypothesis that GH contributes to nephrosclerosis of aging rats, whereas the role of corticosterone and Prl in the pathogenesis of these lesions remains unclear.

Aging↗

PubMedDate not supplied

Characterization of kidney lesions in Indian adults: towards a renal biopsy registry.

BACKGROUND: In the absence of a renal biopsy registry, there is a paucity of data on the renal disease pattern seen in India. This study reviews the changing pattern of renal disease seen at a single center over the last 30 yrs. METHODS: Histopathological data of 5415 adequate native kidney biopsies performed on consecutive adult Indian patients presenting to our hospital from 1986-2002 were analyzed. This pathological demography classified according to the modified World Health Organization (WHO) classification was compared to the earlier published cohort collected from 1971-1985 (n=2827) to ascertain the changing trends. RESULTS: The indications for renal biopsy were comparable between the cohorts and included nephrotic syndrome (65%), nephritic syndrome (13%) and chronic renal failure (10.2%). Primary glomerular disease accounted for 71% of all biopsies. Non-immunoglobulin A (IgA) mesangio proliferative glomerulonephritis as a group was the predominant pathology (20.2%), followed by idiopathic focal segmental glomerulosclerosis (FSGS) (17%), minimal change disease (MCD) (11.6%), membranous glomerulopathy (MN) (9.8%), IgA nephropathy (8.6%) and membranoproliferative glomerulonephritis (MPGN) (3.7%). Of the patients with secondary kidney diseases, lupus nephritis (6.5%), diabetic nephropathy (2.5%), interstitial nephropathy (2.5%) and benign nephrosclerosis (2.2%) were notable. During the 31 yrs of the study period, there was a steady increase in FSGS prevalence (p<0.001), MN (p<0.0001), and post infectious glomerulonephritis (PIGN) (p<0.001). A reduction in the frequency of MPGN (p<0.001) and MCD (p<0.001) was observed. CONCLUSIONS: This is the largest series of renal biopsy data from India; and therefore, could reflect the demographic picture of renal diseases in this country. It discusses evolving patterns over 30 yrs and highlights differences with the developed world. This report represents the basis for the future of a renal biopsy registry in India.

Adolescent↗

PubMedDate not supplied

IgA nephropathy associated with psoriasis vulgaris: a contribution to the entity of 'psoriatic nephropathy'.

BACKGROUND: It is generally accepted that there is no higher prevalence of renal disease in psoriatic patients, except in the case of secondary renal amyloidosis in psoriatic arthropathy. Contrary to this, however, some authors suggest that kidney diseases in psoriasis vulgaris may be more common and they presume the existence of 'psoriatic nephropathy'. METHOD: We report a case of IgA nephropathy in a patient with psoriasis vulgaris as a contribution to the ongoing discussion concerning this entity of 'psoriatic nephropathy'. RESULT: A 62-year-old man with a history of psoriasis vulgaris, without evidence of psoriatic arthropathy, was admitted to hospital for nephrotic proteinuria 6.74 g/day and a moderate decrease of glomerular filtration rate with a serum creatinine level of 213 micromol/L and creatinine clearance of 0.95 ml/s. Kidney biopsy revealed IgA nephropathy with vascular nephrosclerosis and tubulointerstitial nephritis. After 1 month of treatment with prednisone 1 mg/kg/day, proteinuria decreased to 2.45 g/day, and skin lesions almost completely resolved. CONCLUSION: About 10 cases of IgA nephropathy associated with psoriasis are referred to in the literature. We report an-other interesting case of IgA nephropathy in a psoriatic patient, as a contribution to the discussion regarding the hypothetical conception of 'psoriatic nephropathy'. We recommend routine urinalysis, careful examination of kidney function and a wider application of renal biopsy in psoriatic patients.

Glomerulonephritis, IGA↗

PubMedDate not supplied

[Is hypertension related to the number of nephrons?].

The kidney has a key role in blood pressure control, and an abnormal regulation of sodium balance is involved in essential hypertension. It has been suggested that a reduced nephron number at birth could be one possible mechanism. Indeed various strains of hypertensive animals exhibit a reduced nephron number. In human beings, two autopsy studies have clearly shown a lower (about 50%) nephron number in hypertensive subjects. The glomeruli are also enlarged, indicating hyperfiltration. This could be the cause of both high blood pressure and later nephrosclerosis. A low number of nephrons is part of the perinatal programming which occurs together with fetal growth retardation, and this has been reproduced experimentally. There is a negative correlation between birth weight and glomerular number. Such a situation is associated with a largely increased risk of cardiovascular complications in adulthood.

Animals↗

PubMed1991

Hereditary porphyria manifesting itself during renal failure in a 49-year-old woman.

Clinical findings in a female patient aged 49 years suggested Conn's syndrome (hypokalemia, alkalosis, hypertension) developing in the course of renal failure. During treatment biochemically confirmed porphyria manifested itself, and the patient died several days later. On autopsy and in histological examinations malignant nephrosclerosis of vascular origin, nodular hyperplasia of the adrenal cortex and lesions of other organs were found. The largest content of porphyrins was shown in the adrenals, and then in the liver, pituitary gland, thyroid and pancreas. A study of other family members confirmed the genetic background of porphyria. Probably, this hereditary latent hepatic porphyria manifested itself after a breakdown of the feedback mechanisms between the kidneys and the endocrine glands, the adrenals in particular.

Family↗

PubMed1990

Treatment of cryptococcal meningitis with five anti-fungal drugs: the role of amphotericin B.

Experiments are described of the treatment of two patients with cryptococcal meningitis using antifungal drugs and amphotericin B. The first patient was a 56-year-old man with a slight azotaemia caused by hypertensive nephrosclerosis. Lumbar puncture revealed a positive India ink stain and a positive culture for Cryptococcus neoformans; serum titre for cryptococcal antigen was elevated. Amphotericin B was not administered because of the patient's slight azotaemia. After admission, the patient received oral and intravenous fluconazole (400 mg per day), for a total dose of 40 g of fluconazole over 103 days from October 1 while simultaneously receiving treatment with oral itraconazole (200 mg per day) from October 1 to December 5. In addition, he was given intravenous miconazole (600-1000 mg per day, total 74.4 g) and intrathecal miconazole (5-20 mg per day, total 375 mg) from December 1 to March 4 1990. Concomitantly, oral flucytosine (6 g per day) was given from December 5 to March 1 1990. Lumbar puncture performed at the completion of these treatments indicated the India ink stain still was positive and the serum titre for cryptococcal antigen high. Finally, amphotericin B alone was administered to the patient intravenously and intrathecally from March 4 to May 1, with an initial dose of 5 mg i.v. gradually increasing by 5 mg increments up to 50 mg per day. The patient's clinical symptoms immediately improved; the India ink stain became negative for the first time after admission and the serum titre for cryptococcal antigen also gradually decreased. On May 1, the patient was completely cured of cryptococcal meningitis.(ABSTRACT TRUNCATED AT 250 WORDS)

Amphotericin B↗

PubMed1991

Frozen-section analysis of allograft renal biopsy specimens. Reliable histopathologic data for rapid decision making.

Rapid tissue diagnosis during acute events associated with renal transplantation is often necessary to permit immediate decisions regarding initiation or modification of therapy. To achieve this, we performed frozen section analyses with cryoprotected alcoholic Bouin's-fixed tissue, which permits evaluation within 2.5 hours. During a 30-month period, 200 allograft biopsies were performed; 68 frozen sections were obtained when deemed necessary by the clinical team. We compared frozen-section diagnoses with those following regular evaluation of the biopsy specimen. Agreement in diagnoses occurred in 61 (88.4%) of 69 specimens. Acute rejection was the dominant diagnosis (n = 39); others were acute tubular necrosis, cyclosporine toxicity, chronic rejection, and infection. Major misdiagnoses included acute vascular processes (three capillary and/or venous thromboses and one vascular inflammation); acute cellular rejection was missed in two cases, reflecting a sampling error. Secondary diagnoses not of immediate therapeutic importance were detected in seven frozen sections and missed in nine. These included chronic glomerulopathies, nephrosclerosis, and mild chronic rejection. Although acute vascular phenomena may be difficult to recognize in frozen sections, we conclude that allograft biopsy frozen-section analysis is a valuable part of the care of transplant recipients.

Biopsy↗

PubMed1991

Hypertensive renal damage.

The primary focus of both nonpharmacologic and pharmacologic therapy should be to control systemic blood pressure in a simple, affordable, and nontoxic fashion that provides an adequate quality of life. Although newer agents provide hope for greater capability of preventing renal dysfunction, their cost may prevent their broad availability in the black hypertensive population (see Chapter 5). Judicious use of traditional therapies, combined with newer approaches when possible, may offer prescribing physicians the best opportunity to control blood pressure in ways to avoid renal dysfunction. The lessons of the past 20 years have taught us that lowering blood pressure by any means helps in reducing target organ damage. More recent observations in hypertensive blacks illustrate the need for improved therapies to prevent renal dysfunction. A more physiologic approach to blood pressure control in the black patient that conserves perfusion to the kidney may delay the development of nephrosclerosis. Increased awareness, educational support, and encouragement will be necessary to insure compliance with therapy for a disease that is largely asymptomatic.

Aging↗

PubMed1991

The pathogenesis of hypertension: black-white differences.

In summary, for reasons that are not clear, some persons seem to be extremely good at retaining sodium on a high-sodium diet or poor at excreting sodium on a high-sodium intake. This is more frequent in Western hemisphere blacks than in whites in the West or in blacks in Africa. These geographic/ethnic differences in sodium handling ability may be related to environmental factors or, more likely, to inherited differences in the ability to conserve sodium based on the evolutionary principle of survival fo the fittest for the ability to conserve sodium. The frequency of this salt-conserving (thrifty) genotype in Western hemisphere blacks may have been further increased as a consequence of severe selection pressures for survival based on the ability to conserve sodium during the slavery period of history in the West. One characteristic of the blood pressure control systems of Western hemisphere blacks is suppression of plasma renin activity without suppression of aldosterone production. In addition there is greater nephrosclerosis in blacks than whites and a more rapid decline in creatinine clearance with age. When more sodium is ingested than the kidneys are able to handle (excrete), there is a (transient) slight positive sodium balance; as a result sodium, chloride, and water are retained, resulting in an expansion of plasma volume (Fig. 7-3). The initial physiologic responses include (increased) secretion of atrial natriuretic peptides and the digitalis-like substance (natriuretic hormone), and inhibition of vasopressin and aldosterone secretion. The net effect is directly enhanced natriuresis and diuresis, and a reduction in plasma volume, with no significant effect on blood pressure. However, if there is a continuing tendency to sodium retention and volume expansion, the capacity of the aforementioned mechanisms to control plasma volume will be exceeded; then, the chronically elevated level of the digitalis-like substance will inhibit the sodium pumps in the arterial and venous smooth muscle cells and in the sympathetic neurons. The increased venous tone will help to reduce plasma volume directly by reducing central venous volume. Arterial tone will be increased by direct action of the digitalis-like substance on the arterial smooth muscle and, indirectly, via the hormone's action on the sympathetic neurons. Initially, of course, blood pressure will be maintained in the normal range (but will be labile) because of the compensating cardiovascular reflexes. Once the capacity of these reflexes to control blood pressure is exceeded, however, the blood pressure will begin to rise; this will induce a pressure natriuresis to help restore plasma volume to normal.(ABSTRACT TRUNCATED AT 400 WORDS)

Black People↗

PubMedDate not supplied

The pattern of proteinuria in congestive cardiac failure due to common heart diseases.

The association between proteinuria and congestive cardiac failure was investigated in patients with hypertensive heart disease, cardiomyopathy, rheumatic heart disease and cor pulmonale. In 33 such patients, proteinuria occurred before and after successful treatment of the cardiac failure. Overall there was a wide variation in the degree of proteinuria amongst the various groups and statistical analysis showed that the distribution of levels of proteinuria and the mean levels of proteinuria were statistically different between any two groups of patients, P = 0.05. Biopsy proven hypertensive nephrosclerosis was found to be a cause of heavy proteinuria which was in the nephrotic range in two such patients. Congestive cardiac failure due to hypertensive heart disease should be included in the differential diagnosis of massive proteinuria even in the absence of renal insufficiency.

Adult↗

PubMedDate not supplied

[Use of synthetic resin cases for the scanning electron microscopic study of the kidney tubule system].

Aim of our present work was to investigate a new method to study the three-dimensional arrangement, the length and the diameter of the different parts of the renal tubules. The ureter was cannulated after blocking the urinary flow with a binding of the ureter itself at its intermediate third, and injected in it against flow a synthetic resin (Mercox) normally used for vascular corrosion casts. It was demonstrated that the binding maintained only for 24 hours is adequate for morphological studies of the urinary tracts from papillar ducts until the Henle's loop. On the contrary the binding maintained for 7 days induced marked changes in the tubular architecture similar to the first anatomo-pathological changes of the nephrosclerosis following a chronic obstructive nephropathy.

Animals↗

PubMed1990

[Kidney involvement in patients with rheumatoid arthritis].

Renal pathology was revealed in 284 out of 498 patients with rheumatoid arthritis (RA) subjected to the 15 years' prospective controlled follow-up and given individualized pharmacotherapy. Biopsy specimens of the kidney were examined in 90 cases. Of these, in 14 patients, they were examined repeatedly. On morphology the following alterations were detected in renal tissue: minimum morphological alterations (18 cases), glomerulonephritis (32 cases), amyloidosis (53 cases), interstitial nephritis (4 cases), and arteriosclerotic nephrosclerosis (1 case). In patients with nephropathy, no pathology nas revealed on morphology (5 cases). Chronic pyelonephritis was diagnosed in 137, nephroptosis in 47, nephrolithiasis in 17, papillary necrosis in 3, and drug nephropathy in 33 patients. Many patients had concomitant renal pathology. Repeated morphological examinations of renal tissue point to dynamic morphological alterations occurring during treatment and disease. Chlorbutin was found to exert a beneficial effect not only on the manifestations of arthritis but also on renal tissue. It could be seen in patients with a primary morphological diagnosis of mesangioproliferative nephritis and minimum morphological alterations in renal tissue. In some cases the clinical and morphological data did not agree, which provides evidence in favour of making renal biopsy in RA patients with a purpose of early diagnosis and specification of renal pathology, choice of the treatment policy.

Arthritis, Rheumatoid↗