101
|
Schiavi SC, Moysés RMA. Turning over renal osteodystrophy dogma: direct actions of FGF23 on osteoblast β-catenin pathway. Kidney Int 2017; 90:17-20. [PMID: 27312441 DOI: 10.1016/j.kint.2016.03.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 03/01/2016] [Accepted: 03/09/2016] [Indexed: 01/08/2023]
Abstract
Although recognized as a major complication of chronic kidney disease (CKD), the pathophysiology of the CKD-related mineral and bone disorder (CKD-MBD) is not completely understood. Recently, the inhibition of Wnt/β-catenin pathway in osteocytes by sclerostin has been shown to play a role in CKD-MBD. The study by Carrilo-Lopez et al. confirms this inhibition in an experimental model of CKD. Moreover, they describe direct actions of FGF23-Klotho on osteoblasts, increasing the expression of DKK1, another Wnt/β-catenin pathway inhibitor.
Collapse
Affiliation(s)
| | - Rosa M A Moysés
- Medicine Master Degree Program, Universidade Nove de Julho, Universidade Nove de Julho, São Paulo, Brazil; Nephrology Division, Universidade de São Paulo, São Paulo, Brazil.
| |
Collapse
|
102
|
Need for better PTH assays for clinical research and patient treatment. ACTA ACUST UNITED AC 2017; 56:183-185. [DOI: 10.1515/cclm-2017-0617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
103
|
Facial swelling in a child on chronic hemodialysis: Answers. Pediatr Nephrol 2017; 32:1351-1353. [PMID: 27858195 DOI: 10.1007/s00467-016-3525-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/08/2016] [Accepted: 09/13/2016] [Indexed: 10/20/2022]
|
104
|
Hocher B, Pasch A. Hope for CKD-MBD Patients: New Diagnostic Approaches for Better Treatment of CKD-MBD. KIDNEY DISEASES 2017; 3:8-14. [PMID: 28785559 DOI: 10.1159/000477244] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 04/19/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Chronic kidney disease-mineral and bone disorder (CKD-MBD) patients have a huge morbidity and mortality. Only relatively minor progress in therapeutic strategies has been made in the past decades. This is at least partially due to a lack of predictive diagnostic tools allowing personalized treatment of CKD-MBD patients. SUMMARY In this review we describe recent progress in the diagnosis of disturbances of calcium and phosphate metabolism in patients with CKD-MBD, measuring biological active nonoxidized parathyroid hormone as well as the overall likelihood of a patient to get calcified. KEY MESSAGE There is hope. The new tools have the potential of allowing personalized therapy for the treatment of CKD-MBD and hence improving outcome.
Collapse
Affiliation(s)
- Berthold Hocher
- Institute of Nutritional Science, University of Potsdam, Potsdam-Rehbrücke, Germany.,IFLb, Institut für Labormedizin Berlin, Berlin, Germany.,Department of Embryology, Medical School of Jinan University, Guangzhou, China.,Department of Nephrology, Guangzhou Overseas Chinese Hospital, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Andreas Pasch
- Department of Clinical Research, University Hospital Bern, University of Bern, Bern, Switzerland
| |
Collapse
|
105
|
Yamamoto S, Fukagawa M. Uremic Toxicity and Bone in CKD. J Nephrol 2017; 30:623-627. [PMID: 28573386 DOI: 10.1007/s40620-017-0406-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 04/18/2017] [Indexed: 01/16/2023]
Abstract
Patients with chronic kidney disease (CKD), especially those on dialysis treatment, are at high risk of bone fracture. In CKD-mineral and bone disorder (CKD-MBD), secondary hyperparathyroidism in patients with advanced CKD induces bone abnormalities, and skeletal resistance to parathyroid hormone (PTH) starts in the early stages of kidney disease. Uremic toxins such as indoxyl sulfate and p-cresyl sulfate reduce the expression of PTH receptor as well as PTH-induced cyclic adenosine 3',5' monophosphate production in osteoblasts. CKD also impairs bone strength, especially quality. In a rat model, kidney damage reduces the bone-storage modulus and changes the cortical bone chemical composition with or without hyperparathyroidism. The oral charcoal adsorbent AST-120 improves CKD-induced bone abnormalities as blood levels of indoxyl sulfate decrease. Uremic osteoporosis, a new concept of CKD-related bone fragility, is a main cause of CKD-induced bone abnormalities, particularly impaired bone quality. There is limited information about the effect and safety of anti-osteoporotic drugs for patients with CKD, especially those on dialysis, but the use of AST-120 and renin-angiotensin system inhibitors may modulate bone quality and decrease the incidence of fracture. Thus, the management of CKD-MBD plus use of other therapeutic interventions for uremic osteoporosis is necessary to prevent bone fragility in patients with CKD.
Collapse
Affiliation(s)
- Suguru Yamamoto
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.,Division of Blood Purification Therapy, Niigata University Medical and Dental Hospital, Niigata, 951-8520, Japan
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology and Metabolism, Department of Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
| |
Collapse
|
106
|
Abstract
PURPOSE OF REVIEW The term renal osteodystrophy has been used to describe a wide variety of bone problems facing patients with chronic kidney disease (CKD). Here, we review the history of the use of this term. RECENT FINDINGS Bone disease resulting from CKD was first noticed in 1890. The term "renal osteodystrophy" was used to define the bone disease in 1942. Since then, important discoveries have increased our knowledge of the complexities of bone physiology in these patients. At the same time, secular changes in the disease have occurred. The terms used to describe the bone histological findings have changed as well, reflecting new understanding of the physiological processes. However, since different investigators used the terms in different ways, the need to standardize the nomenclature has become increasingly important. Ongoing international collaboration about nosography will allow more optimal communication among scientists and clinicians as we continue to make new discoveries.
Collapse
Affiliation(s)
- Susan M Ott
- University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
| |
Collapse
|
107
|
Demian MN, Lam NN, Mac-Way F, Sapir-Pichhadze R, Fernandez N. Opportunities for Engaging Patients in Kidney Research. Can J Kidney Health Dis 2017; 4:2054358117703070. [PMID: 28491336 PMCID: PMC5406191 DOI: 10.1177/2054358117703070] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 01/26/2017] [Indexed: 01/03/2023] Open
Abstract
Purpose: The purpose of this review is to provide a summary of the rationale for engaging patients in research as well as to review the established and envisioned advantages and strategies for patient-researcher partnerships. The authors of this article, which include a patient and 4 researchers in kidney disease, discuss the expected benefits and opportunities for patient engagement in their respective research programs. The 4 research programs span the spectrum of kidney disease and focus on enhancing bone health, increasing living donor kidney transplants, improving medication adherence, and preventing kidney transplant rejection. Sources of Information: The sources of information for this review include published studies on the topics of patient engagement and the 4 research programs of the new investigators. Key Findings: (1) Patient, health care provider, and researcher partnerships can contribute useful insights capable of enhancing research in kidney disease. (2) Regardless of the research program, there are various strategies and opportunities for engagement of patients with lived experience across the various stages of research in kidney disease. (3) Envisioned advantages of patient-researcher partnerships include: targeting patient-identified research priorities, integrating patients’ experiential knowledge, improving study design and feasibility through patient-researcher input, facilitating dissemination of research findings to other patients, effectively responding to patient concerns about studies, and inspiring researchers to conduct their research. Limitations: The limitations of the current review include the relative scarcity of literature on patient engagement within the field of kidney disease. Implications: The findings of the current review suggest that it will be important for future studies to identify optimal strategies for patient engagement in setting research priorities, study design, participant recruitment, execution of research projects, and knowledge dissemination and translation.
Collapse
Affiliation(s)
- Maryam N Demian
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Ngan N Lam
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Fabrice Mac-Way
- Division of Nephrology, Department of Medicine, Laval University, Quebec City, Québec, Canada
| | - Ruth Sapir-Pichhadze
- Division of Nephrology, Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Nicolas Fernandez
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Québec, Canada
| |
Collapse
|
108
|
Barreto FC, Barreto DV, Stinghen AEM, Massy ZA. Comment on Indoxyl Sulfate-Review of Toxicity and Therapeutic Strategies. Toxins 2016, 8, 358. Toxins (Basel) 2017; 9:toxins9040142. [PMID: 28420181 PMCID: PMC5408216 DOI: 10.3390/toxins9040142] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 03/19/2017] [Accepted: 04/11/2017] [Indexed: 01/30/2023] Open
Abstract
Recently, the clinical and experimental evidences that support the toxic effects of indoxyl sulfate, a protein-bound uremic toxin in chronic kidney disease (CKD) patients, has been discussed. In this panorama, the authors described several in vitro and in vivo studies, suggesting that indoxyl sulfate may play a part in the pathogenesis of low turnover bone disease. However, the discussion claims the need for relevant clinical studies in CKD patients whose bone turnover biomarkers and bone histomorphometry were assessed in order to demonstrate the association between serum levels of indoxyl sulfate and bone turnover. We would like to underline the availability of this clinical data to support the concept that indoxyl sulfate may play a part in the pathogenesis of low turnover bone disease in CKD patients.
Collapse
Affiliation(s)
- Fellype C Barreto
- Division of Nephrology, Department of Internal Medicine, Federal University of Paraná, 80060-900 Curitiba, Brazil.
| | - Daniela V Barreto
- Division of Nephrology, Department of Internal Medicine, Federal University of Paraná, 80060-900 Curitiba, Brazil.
| | - Andrea E M Stinghen
- Experimental Nephrology Laboratory, Basic Pathology Department, Federal University of Paraná, 81531-980 Curitiba, Brazil.
| | - Ziad A Massy
- Division of Nephrology, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt, Paris 92104, France.
- INSERM Unit 1018, CESP, University of Versailles-Saint-Quentin-en-Yvelines, University Paris-Saclay, 54500 Villejuif, France.
| |
Collapse
|
109
|
Adynamic bone disease is a predominant bone pattern in early stages of chronic kidney disease. J Nephrol 2017; 30:629-634. [DOI: 10.1007/s40620-017-0397-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 03/29/2017] [Indexed: 10/24/2022]
|
110
|
Martinaityte I, Jorde R, Emaus N, Eggen AE, Joakimsen RM, Kamycheva E. Bone mineral density is associated with vitamin D related rs6013897 and estrogen receptor polymorphism rs4870044: The Tromsø study. PLoS One 2017; 12:e0173045. [PMID: 28253304 PMCID: PMC5333870 DOI: 10.1371/journal.pone.0173045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 02/14/2017] [Indexed: 12/19/2022] Open
Abstract
Background Bone mineral density (BMD) is determined by bone remodeling processes regulated by endocrine, autocrine and genetic mechanisms. Thus, some studies have reported that BMD is associated with single nucleotide polymorphisms (SNPs) associated with vitamin D receptor (VDR), serum 25(OH)D levels and estrogen receptor 1 (ESR1), but without consensus. Therefore, we aimed to map and compare the risk genotypes for forearm and total hip low BMD. Methods and findings Data were derived from a population-based study in northern Norway; the Tromsø Study. Distal forearm BMD was measured with a single x-ray absorptiometric device, while total hip BMD was measured with a dual-energy x-ray absorptiometric device. There were 7,317 and 4,082 successful analyses of distal forearm and total hip BMD, respectively, and at least one SNP of interest. We evaluated plausible BMD modulating factors and associations of BMD and SNPs related to vitamin D metabolism (FokI, Cdx2, BsmI, rs2298850, rs10741657, rs3794060, rs6013897), ApaI-BsmI-TaqI haplotypes and ESR1 SNP rs4870044. Results Age, BMI, physical activity and smoking were significantly associated with BMD. In a linear regression model with adjustment for age and gender and with the major homozygote as reference, rs6013897 had a standardized beta coefficient (β) of –0.031 (P = 0.024) for total hip BMD. β for ESR1 SNP rs4870044 was –0.016 (P = 0.036) for forearm BMD and –0.034 (P = 0.015) for total hip BMD. The other SNPs nor serum 25(OH)D were significantly associated with BMD. Conclusions Both forearm and total hip BMD were associated with ESR1 SNP rs4870044. Of the vitamin D–related genes, only CYP24A1 gene rs6013897 was associated with total hip BMD, but the association was weak and needs confirmation in other studies. Serum 25(OH)D was not associated with BMD in our population, probably due to the generally sufficient vitamin D levels in the population.
Collapse
Affiliation(s)
- Ieva Martinaityte
- Tromsø Endocrine Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
- * E-mail:
| | - Rolf Jorde
- Tromsø Endocrine Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Nina Emaus
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Anne Elise Eggen
- Epidemiology of chronic diseases research group, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ragnar Martin Joakimsen
- Tromsø Endocrine Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Elena Kamycheva
- Tromsø Endocrine Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| |
Collapse
|
111
|
Abstract
Preexisting diabetes increases risk of fractures after kidney transplantation (KT). However, little is known about mechanisms and prevention of increased fragility in these patients. Pathophysiology of osteoporosis after KT is complex and characterized by high prevalence of adynamic bone disease. Despite high prevalence of preexisting diabetes in KT recipients, diabetes patients were underrepresented in the studies that explored mechanisms and treatments of osteoporosis after KT. Therefore, caution should be exercised before considering conventional fracture prevention strategies in this unique group of patients. Many traditional osteoporosis medications reduce bone turnover and, hence, can be ineffective or even harmful in diabetic patients after KT. Contrary to predictions, evidence from the studies conducted in mostly non-diabetic subjects demonstrated that bisphosphonates failed to reduce fracture rates after KT. Therefore, bisphosphonates use should be limited in diabetic patients until more evidence supporting their post-transplant efficacy is available. We recommend the following strategies that may help reduce fracture risk in diabetes subjects after KT such as adequate management of calcium, parathyroid hormone, and vitamin D levels, optimization of glycemic control, use of steroid-sparing immunosuppressive regimens, and fall prevention.
Collapse
Affiliation(s)
- Elvira O Gosmanova
- Nephrology Section, Stratton VA Medical Center, 113 Holland Avenue, Room A738, Albany, New York, NY, 12208, USA
| | - Aidar R Gosmanov
- Endocrinology Section, Stratton VA Medical Center, 113 Holland Avenue, Room A738, Albany, New York, NY, 12208, USA.
| |
Collapse
|
112
|
Evenepoel P, Bover J, Ureña Torres P. Parathyroid hormone metabolism and signaling in health and chronic kidney disease. Kidney Int 2016; 90:1184-1190. [PMID: 27653840 DOI: 10.1016/j.kint.2016.06.041] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 06/24/2016] [Accepted: 06/27/2016] [Indexed: 11/25/2022]
Abstract
Circulating parathyroid hormone (PTH) shows a complex relationship with hard outcomes in subjects with chronic kidney disease (CKD). Moreover, intervention studies directly targeting PTH failed to yield unequivocal results. Disturbed PTH metabolism, posttranslational modifications of PTH, and end-organ hyporesponsiveness to PTH may explain the poor performance of PTH as an outcome biomarker and precise target of therapy in the setting of CKD, at least in the gray middle target zone. PTH fragments accumulate in CKD patients and may exert effects that are distinct from, if not opposite to biointact (1-84)PTH. Posttranslational modification of PTH and especially oxidation may alter the interaction of PTH with its receptor. Its clinical relevance, however, remains a matter of ongoing debate. Less controversial is the issue of end-organ hyporesponsiveness to PTH. This phenomenon, formally referred to as PTH resistance, has long been recognized in CKD, but factors and mechanisms contributing to it remain poorly defined. Subsequent evidence identified downregulation of the PTH receptor and competing downstream signals as underlying pathophysiologic mechanisms. End-organ hyporesponsiveness to PTH in CKD, along with important analytical and biological variability, renders defining the PTH target range in CKD challenging. Although this may still be accomplished at the population level, it may prove to be very difficult at the individual level. This is a disillusioning thought in an era of personalized medicine. Parallel to the search of a functional and readily available assay quantifying PTH signaling tone or sensitivity, additional biomarkers (or a panel of biomarkers) should be formally evaluated.
Collapse
Affiliation(s)
- Pieter Evenepoel
- KU Leuven, Department of Immunology and Microbiology, Laboratory of Nephrology and University Hospitals Leuven, Department of Nephrology and Renal Transplantation, B-3000 Leuven, Belgium; Board member of the ERA-EDTA CKD-MBD Working Group.
| | - Jordi Bover
- Fundació Puigvert, Department of Nephrology, IIB Sant Pau, RedinREn, Barcelona, Catalonia, Spain; Board member of the ERA-EDTA CKD-MBD Working Group
| | - Pablo Ureña Torres
- Ramsay-Générale de Santé, Clinique du Landy, Service de Néphrologie-Dialyse, Saint Ouen, France, INSERM U1151-CNRS UMR8253 Université Paris Descartes, and Service des Explorations Fonctionnelles, Hôpital Necker-Enfants Malades, Paris, France; Board member of the ERA-EDTA CKD-MBD Working Group
| |
Collapse
|
113
|
Liu J, Zhang L, Zhou Y, Zhu D, Wang Q, Hao L. Aberrant activation of Wnt pathways in arteries associates with vascular calcification in chronic kidney disease. Int Urol Nephrol 2016; 48:1313-1319. [DOI: 10.1007/s11255-016-1291-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 04/11/2016] [Indexed: 12/12/2022]
|