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Butranova OI, Ushkalova EA, Zyryanov SK, Chenkurov MS, Baybulatova EA. Pharmacokinetics of Antibacterial Agents in the Elderly: The Body of Evidence. Biomedicines 2023; 11:1633. [PMID: 37371728 DOI: 10.3390/biomedicines11061633] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
Infections are important factors contributing to the morbidity and mortality among elderly patients. High rates of consumption of antimicrobial agents by the elderly may result in increased risk of toxic reactions, deteriorating functions of various organs and systems and leading to the prolongation of hospital stay, admission to the intensive care unit, disability, and lethal outcome. Both safety and efficacy of antibiotics are determined by the values of their plasma concentrations, widely affected by physiologic and pathologic age-related changes specific for the elderly population. Drug absorption, distribution, metabolism, and excretion are altered in different extents depending on functional and morphological changes in the cardiovascular system, gastrointestinal tract, liver, and kidneys. Water and fat content, skeletal muscle mass, nutritional status, use of concomitant drugs are other determinants of pharmacokinetics changes observed in the elderly. The choice of a proper dosing regimen is essential to provide effective and safe antibiotic therapy in terms of attainment of certain pharmacodynamic targets. The objective of this review is to perform a structure of evidence on the age-related changes contributing to the alteration of pharmacokinetic parameters in the elderly.
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Affiliation(s)
- Olga I Butranova
- Department of General and Clinical Pharmacology, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN University), 6 Miklukho-Maklaya St., 117198 Moscow, Russia
| | - Elena A Ushkalova
- Department of General and Clinical Pharmacology, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN University), 6 Miklukho-Maklaya St., 117198 Moscow, Russia
| | - Sergey K Zyryanov
- Department of General and Clinical Pharmacology, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN University), 6 Miklukho-Maklaya St., 117198 Moscow, Russia
- State Budgetary Institution of Healthcare of the City of Moscow "City Clinical Hospital No. 24 of the Moscow City Health Department", Pistzovaya Srt. 10, 127015 Moscow, Russia
| | - Mikhail S Chenkurov
- Department of General and Clinical Pharmacology, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN University), 6 Miklukho-Maklaya St., 117198 Moscow, Russia
| | - Elena A Baybulatova
- Department of General and Clinical Pharmacology, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN University), 6 Miklukho-Maklaya St., 117198 Moscow, Russia
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Wang A, Zhang T, Li J, Wang W, Xu C, Duan H, Tian X, Zhang D. Genetic and Environmental Correlation Analysis of Serum Creatinine Levels in Chinese Twins. Twin Res Hum Genet 2023; 26:219-222. [PMID: 37170793 DOI: 10.1017/thg.2023.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Almost all creatinine is excreted by the kidney in individuals. Serum creatinine concentration, a widely used renal function index in clinical practice, can be affected by both genetic and environmental factors, as evidenced by current research exploring the relationship between these factors and kidney function. However, few studies have explored the heritability of serum creatinine in Asian populations. Therefore, we explored the genetic and environmental factors that affect the serum creatinine level in Asian populations. Participants in this study came from the Qingdao Twin Registry in China, and 374 pairs of twins were included, of which 139 pairs were dizygotic twins, whose ages ranged from 40 to 80 years old, and the serum creatinine level ranged from 10 to 126 μmol/L. Structural equation models were constructed using Mx software to calculate heritability, with adjusted covariates being age, sex, and body mass index. The results of heritability analysis showed that ACE was the best fit model. Serum creatinine level is influenced by genetic and environmental factors. The result of heritability was 35.44%, and the influence of shared environmental factors accounted for 52.13%. This study provided the relevant basis for future research on genetic and environmental factors affecting serum creatinine levels in Asian populations.
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Affiliation(s)
- Anni Wang
- Department of Epidemiology and Health Statistics, The School of Public Health of Qingdao University, Qingdao, Shandong Province, China
| | - Tianhao Zhang
- Department of Epidemiology and Health Statistics, The School of Public Health of Qingdao University, Qingdao, Shandong Province, China
| | - Jingxian Li
- Department of Epidemiology and Health Statistics, The School of Public Health of Qingdao University, Qingdao, Shandong Province, China
| | - Weijing Wang
- Department of Epidemiology and Health Statistics, The School of Public Health of Qingdao University, Qingdao, Shandong Province, China
| | - Chunsheng Xu
- Qingdao Municipal Centre for Disease Control and Prevention, Qingdao, Shandong Province, China
| | - Haiping Duan
- Qingdao Municipal Centre for Disease Control and Prevention, Qingdao, Shandong Province, China
| | - Xiaocao Tian
- Qingdao Municipal Centre for Disease Control and Prevention, Qingdao, Shandong Province, China
| | - Dongfeng Zhang
- Department of Epidemiology and Health Statistics, The School of Public Health of Qingdao University, Qingdao, Shandong Province, China
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Telomere Attrition in Chronic Kidney Diseases. Antioxidants (Basel) 2023; 12:antiox12030579. [PMID: 36978826 PMCID: PMC10045531 DOI: 10.3390/antiox12030579] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 03/02/2023] Open
Abstract
Telomeres are dynamic DNA nucleoprotein structures located at the end of chromosomes where they maintain genomic stability. Due to the end replication problem, telomeres shorten with each cell division. Critically short telomeres trigger cellular senescence, which contributes to various degenerative and age-related diseases, including chronic kidney diseases (CKDs). Additionally, other factors such as oxidative stress may also contribute to accelerated telomere shortening. Indeed, telomeres are highly susceptible to oxidative damage due to their high guanine content. Here, we provide a comprehensive review of studies examining telomere length (TL) in CKDs to highlight the association between TL and the development and progression of CKDs in humans. We then focus on studies investigating TL in patients receiving kidney replacement therapy. The mechanisms of the relationship between TL and CKD are not fully understood, but a shorter TL has been associated with decreased kidney function and the progression of nephropathy. Interestingly, telomere lengthening has been observed in some patients in longitudinal studies. Hemodialysis has been shown to accelerate telomere erosion, whereas the uremic milieu is not reversed even in kidney transplantation patients. Overall, this review aims to provide insights into the biological significance of telomere attrition in the pathophysiology of kidney disease, which may contribute to the development of new strategies for the management of patients with CKDs.
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Wang Y, Xiong X, Wang K, Bao Y, Zhang T, Ainiwaer D, Wang G, Li H, Sun Z. Peripheral Klotho protects the kidney and brain by regulating M2a/M2c macrophage polarization in d-gal-treated aged mice. Tissue Cell 2023. [PMID: 36863110 DOI: 10.1016/j.tice.2023.102049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
In elderly individuals, aging can cause changes in the structure and function of one or more organs, increasing their susceptibility to various damage factors, especially the heart, kidney, brain and other important organs. Therefore, the incidence of cardiovascular disease, neurodegenerative diseases and chronic kidney disease in the elderly population is significantly higher than that in the general population. In our previous study, the hearts of aged mice did not express the antiaging protein Klotho (KL), but peripheral elevation of KL may significantly delay cardiac aging. The kidney and brain are the main organs that produce KL, but the effects and mechanism of peripheral KL supplementation on the kidney and hippocampus are still unclear. To study the effect and possible mechanism of KL against kidney and hippocampus aging, 60 male BALB/c mice were randomly divided into the Adult group, the KL group, the D-gal-induced Aged group, and the KL + Aged group. The results showed that KL increased anti-inflammatory M2a/M2c macrophages in the kidney and hippocampus of aging mice, significantly reduced tissue inflammation and oxidative stress, and improved organ function and aging status. More importantly, we demonstrate that despite the impermeable bloodbrain barrier in mice, peripherally administered KL surprisingly enhances M2-type microglia polarization, induces cognitive enhancement and reduces neuroinflammation. Cellular experimental results suggest that KL may play a role in delaying senescence by regulating the TLR4/Myd88/NF-κB signaling pathway to regulate macrophage polarization and reduce aging-related inflammation and oxidative stress.
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Affiliation(s)
- Yiping Wang
- Department of Pathophysiology, College of Basic Medicine, Xinjiang Medical University, Urumqi, Xinjiang 830000, China
| | - Xicheng Xiong
- Department of Pathophysiology, College of Basic Medicine, Xinjiang Medical University, Urumqi, Xinjiang 830000, China
| | - Kun Wang
- Laboratory Animal Centre, Xinjiang Medical University, Urumqi, Xinjiang 830000, China
| | - Yali Bao
- Department of Pathophysiology, College of Basic Medicine, Xinjiang Medical University, Urumqi, Xinjiang 830000, China; Xinjiang Key Laboratory of Molecular Biology for Endemic Diseases, Urumqi 830000, China
| | - Tian Zhang
- Department of Pathophysiology, College of Basic Medicine, Xinjiang Medical University, Urumqi, Xinjiang 830000, China; Xinjiang Key Laboratory of Molecular Biology for Endemic Diseases, Urumqi 830000, China
| | - Dina Ainiwaer
- Department of Pathophysiology, College of Basic Medicine, Xinjiang Medical University, Urumqi, Xinjiang 830000, China; Xinjiang Key Laboratory of Molecular Biology for Endemic Diseases, Urumqi 830000, China
| | - Gang Wang
- Department of Pathophysiology, College of Basic Medicine, Xinjiang Medical University, Urumqi, Xinjiang 830000, China
| | - Huihui Li
- Department of Pathophysiology, College of Basic Medicine, Xinjiang Medical University, Urumqi, Xinjiang 830000, China
| | - Zhan Sun
- Department of Pathophysiology, College of Basic Medicine, Xinjiang Medical University, Urumqi, Xinjiang 830000, China; Xinjiang Key Laboratory of Molecular Biology for Endemic Diseases, Urumqi 830000, China.
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Alterations in Kidney Structures Caused by Age Vary According to Sex and Dehydration Condition. Int J Mol Sci 2022; 23:ijms232415672. [PMID: 36555312 PMCID: PMC9779677 DOI: 10.3390/ijms232415672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/25/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022] Open
Abstract
Aging is a complex biological process, resulting in gradual and progressive decline in structure and function in many organ systems. Our objective is to determine if structural changes produced by aging vary with sex in a stressful situation such as dehydration. The expression of Slc12a3 mRNA in the renal cortex, α-smooth muscle actin (α-SMA), and fibronectin was evaluated in male and female rats, aged 3 and 18 months, submitted and not submitted to water deprivation (WD) for 48 h, respectively. When comparing ages, 18-month-old males showed a lower expression of Slc12a3 mRNA than 3-month-old males, and control and WD 18-month-old male and female rats exhibited a higher expression of α-SMA than the respective 3-month-old rats. Fibronectin was higher in both control and WD 18-month-old males than the respective 3-month-old males. In females, only the control 18-month-old rats showed higher fibronectin than the control 3-month-old rats. When we compared sex, control and WD 3-month-old female rats had a lower expression of Slc12a3 mRNA than the respective males. The WD 18-month-old male rats presented a higher expression of fibronectin and α-SMA than the WD 18-month-old female rats. When we compared hydric conditions, the WD 18-month-old males displayed a lower relative expression of Slc12a3 mRNA and higher α-SMA expression than the control 18-month-old males. Aging, sex, and dehydration lead to alterations in kidney structure.
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Su H, Gao D, Chen Y, Zuo Z. The Relationship Between Klotho and SIRT1 Expression in Renal Aging Related Disease. Int J Gen Med 2022; 15:7885-7893. [PMID: 36304672 PMCID: PMC9595124 DOI: 10.2147/ijgm.s384119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
Background This study focused on renal arteriosclerosis and aimed to explore the relationship between Klotho and SIRT1 by morphological staining, which will help to provide new ideas for the treatment of renal-aging-related diseases and a theoretical basis for the development of new drugs. Methods Kidney tissue samples were collected from patients who underwent nephrectomy. HK-2 cells were cultured. The Hematoxylin-eosin (HE) staining, Periodic Acid-Schiff (PAS) staining, Masson’s Trichrome staining, Immunohistochemistry (IHC) staining, Immunofluorescence (ICC) and bioinformatics means were used for this study. Results HE staining showed that glomerulosclerosis was atrophic and cast was significantly increased luminal narrowing of renal arterioles in aging group. PAS staining showed that the number of podocytes was reduced, the mesangial matrix expansion and the intimal fibrosis of renal arterioles. Masson’s trichrome staining showed that there was massive collagen proliferation in the tubulointerstitial in aging group, as well as intimal thickening and fibrin deposition in the tubular walls of arterioles. IHC staining showed that the expression of Klotho and SIRT1 protein was downregulated in aging group and the trend of the two was positively correlated (P < 0.01). Klotho and SIRT1 co-localized in HK-2 cells and kidney tissue. The GEPIA database analysis showed a significant positive correlation between Klotho and SIRT1 in multiple human tissues and tumors. Conclusion Glomerulosclerosis in aging group is accompanied by low expression of Klotho and SIRT1 in renal tissue, and Klotho is positively correlated with SIRT1. Klotho-SIRT1 pathway may be involved in the occurrence and development of renal-aging-related diseases.
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Affiliation(s)
- Hong Su
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China,The Chongqing Key Laboratory of Translational Medicine in Major Metabolic Diseases, Chongqing, 400016, People’s Republic of China,Department of Pathology, Shenyang KingMed Center for Clinical Laboratory Co., Ltd, Shenyang, 110164, People’s Republic of China
| | - Diansa Gao
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Yanlin Chen
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Zhong Zuo
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China,Correspondence: Zhong Zuo, Email
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Noronha IL, Santa-Catharina GP, Andrade L, Coelho VA, Jacob-Filho W, Elias RM. Glomerular filtration in the aging population. Front Med (Lausanne) 2022; 9:769329. [PMID: 36186775 PMCID: PMC9519889 DOI: 10.3389/fmed.2022.769329] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 08/24/2022] [Indexed: 12/11/2022] Open
Abstract
In the last decades, improvements in the average life expectancy in the world population have been associated with a significant increase in the proportion of elderly people, in parallel with a higher prevalence of non-communicable diseases, such as hypertension and diabetes. As the kidney is a common target organ of a variety of diseases, an adequate evaluation of renal function in the approach of this population is of special relevance. It is also known that the kidneys undergo aging-related changes expressed by a decline in the glomerular filtration rate (GFR), reflecting the loss of kidney function, either by a natural senescence process associated with healthy aging or by the length of exposure to diseases with potential kidney damage. Accurate assessment of renal function in the older population is of particular importance to evaluate the degree of kidney function loss, enabling tailored therapeutic interventions. The present review addresses a relevant topic, which is the effects of aging on renal function. In order to do that, we analyze and discuss age-related structural and functional changes. The text also examines the different options for evaluating GFR, from the use of direct methods to the implementation of several estimating equations. Finally, this manuscript supports clinicians in the interpretation of GFR changes associated with age and the management of the older patients with decreased kidney function.
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Affiliation(s)
- Irene L. Noronha
- Renal Division, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
- Laboratory of Cellular, Genetic and Molecular Nephrology, University of São Paulo Medical School, São Paulo, Brazil
- *Correspondence: Irene L. Noronha
| | | | - Lucia Andrade
- Renal Division, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Venceslau A. Coelho
- Geriatric Division, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Wilson Jacob-Filho
- Geriatric Division, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Rosilene M. Elias
- Renal Division, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
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Hsieh T, Jin J. Loss of Calponin 2 causes age-progressive proteinuria in mice. Physiol Rep 2022; 10:e15370. [PMID: 36117313 PMCID: PMC9483440 DOI: 10.14814/phy2.15370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 06/15/2023] Open
Abstract
Proteinuria is a major manifestation of kidney disease, reflecting injuries of glomerular podocytes. Actin cytoskeleton plays a pivotal role in stabilizing the foot processes of podocytes against the hydrostatic pressure of filtration. Calponin is an actin associated protein that regulates mechanical tension-related cytoskeleton functions and its role in podocytes has not been established. Here we studied the kidney phenotypes of calponin isoform 2 knockout (KO) mice. Urine samples were examined to quantify the ratio of albumin and creatinine. Kidney tissue samples were collected for histology and ultrastructural studies. A mouse podocyte cell line (E11) was used to study the expression and cellular localization of calponin 2. In comparison with wild-type (WT) controls, calponin 2 KO mice showed age-progressive high proteinuria and degeneration of renal glomeruli. High levels of calponin 2 are expressed in E11 podocytes and colocalized with actin stress fibers, tropomyosin and myosin IIA. Electron microscopy showed that aging calponin 2 KO mice had effacement of the podocyte foot processes and increased thickness of the glomerular basement membrane as compared to that of WT control. The findings demonstrate that deletion of calponin 2 aggravates age-progressive degeneration of the glomerular structure and function as filtration barrier. The critical role of calponin 2 in podocytes suggests a molecular target for understanding the pathogenesis of proteinuria and therapeutic development.
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Affiliation(s)
- Tzu‐Bou Hsieh
- Department of Obstetrics & GynecologyWayne State University School of MedicineDetroitMichiganUSA
| | - Jian‐Ping Jin
- Department of Obstetrics & GynecologyWayne State University School of MedicineDetroitMichiganUSA
- Department of PhysiologyWayne State University School of MedicineDetroitMichiganUSA
- Department of Physiology and BiophysicsUniversity of Illinois at Chicago College of MedicineChicagoIllinoisUSA
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The Aging Kidney-As Influenced by Heavy Metal Exposure and Selenium Supplementation. Biomolecules 2021; 11:biom11081078. [PMID: 34439746 PMCID: PMC8391790 DOI: 10.3390/biom11081078] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/12/2021] [Accepted: 07/16/2021] [Indexed: 12/29/2022] Open
Abstract
The aging process in the kidneys has been well studied. It is known that the glomerular filtration rate (GFR) declines with age in subjects older than 50–60 years. However, there is still insufficient knowledge regarding the response of the aged kidney to environmental toxicants such as mercury, cadmium, and lead. Here, we present a review on the functional decline and proposed mechanisms in the aging kidney as influenced by metal pollutants. Due to the prevalence of these toxicants in the environment, human exposure is nearly unavoidable. Further, it is well known that acute and chronic exposures to toxic metals may be detrimental to kidneys of normal adults, thus it may be hypothesized that exposure of individuals with reduced GFR will result in additional reductions in renal function. Individuals with compromised renal function, either from aging or from a combination of aging and disease, may be particularly susceptible to environmental toxicants. The available data appear to show an association between exposure to mercury, cadmium and/or lead and an increase in incidence and severity of renal disease in elderly individuals. Furthermore, some physiological thiols, as well as adequate selenium status, appear to exert a protective action. Further studies providing improved insight into the mechanisms by which nephrotoxic metals are handled by aging kidneys, as well as possibilities of therapeutic protection, are of utmost importance.
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Cohen C. [Molecular mechanisms of renal aging]. Nephrol Ther 2021; 17S:S108-S114. [PMID: 33910690 DOI: 10.1016/j.nephro.2020.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 02/06/2020] [Indexed: 11/28/2022]
Abstract
Chronic kidney disease (CKD) is characterized by the progressive decline of renal function, that occurs once a critical number of nephrons has been lost, regardless the etiology. CKD prevalence is constantly increasing, especially with age. Nevertheless, the molecular mechanisms underlying this progression are not very well known. With an increasing number of patients with CKD, especially elderly patients, it urges to better understand the pathophysiology of this progression to elaborate new therapeutic strategies. Recent works have highlighted the role of some cellular processes, such as senescence, during age-related kidney dysfunction. Senescence corresponds to a cellular state associated with a cell cycle blockade. Although the cell cannot proliferate, she is able to secrete a lot of proteins grouped under the term of senescence associated secretory phenotype (SASP). Identification of molecular mechansims involved in age related kidney dysfunction could help to determine new therapeutic targets.
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Affiliation(s)
- Camille Cohen
- Department of Growth and Signaling, Institut national de la santé et de la recherche médicale U1151, Centre national de la recherche scientifique UMR8253, université Paris Descartes, Institut Necker Enfants-Malades (INEM), 75015 Paris, France; Service de néphrologie-transplantation, hôpital Necker, 149, rue de Sèvres, 75015 Paris, France.
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Fiseha T, Ahmed E, Chalie S, Gebreweld A. Prevalence and associated factors of impaired renal function and albuminuria among adult patients admitted to a hospital in Northeast Ethiopia. PLoS One 2021; 16:e0246509. [PMID: 33539455 PMCID: PMC7861367 DOI: 10.1371/journal.pone.0246509] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 01/20/2021] [Indexed: 11/22/2022] Open
Abstract
Background Chronic kidney disease (CKD) is increasingly common in hospitalized patients and is associated with increased risk for in-hospital morbidity and mortality. However, data regarding the prevalence of CKD in the African hospitalized patient population are limited. We therefore examined the prevalence and associated factors of impaired renal function and albuminuria among adult patients admitted to the internal medicine wards of a hospital in Northeast Ethiopia. Methods A cross-sectional study was conducted from January 1 to April 30, 2020 at the inpatient settings of Dessie referral hospital. Data on demographics and medical history were obtained, and serum creatinine and albuminuria were analyzed. Estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) equation. CKD was defined as impaired eGFR (<60 ml/min/1.73m2) and/or albuminuria. Univariate and multivariable analysis were conducted to determine factors associated with impaired eGFR and albuminuria. Results A total of 369 patients were included in this study. The prevalence of impaired eGFR was 19.0% (95%CI: 15.2%–23.2%) and albuminuria was 30.9% (95%CI: 26.3%–35.7%). Overall, 33.9% (95%CI: 29.2%–38.9%) of the patients had some degree of CKD, but only 21.6% (95%CI: 15.1%–29.4%) were aware of their renal disease. In multivariable analysis, older age, a family history of kidney disease, diabetes, hypertension and HIV were independently associated with both impaired eGFR and albuminuria while male gender was independently associated with only albuminuria. Conclusions CKD is common in adult patients admitted to the internal medicine wards, but only few patients are aware of their condition. These findings highlight the need for feasible approaches to timely identify kidney disease and raise awareness on the importance of detection and early intervention in the inpatient settings.
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Affiliation(s)
- Temesgen Fiseha
- Department of Clinical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
- * E-mail:
| | - Ermiyas Ahmed
- Department of Clinical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Semagn Chalie
- Department of Clinical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Angesom Gebreweld
- Department of Medical Laboratory Science, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Tsujita M, Goto N, Futamura K, Okada M, Hiramitsu T, Narumi S, Uchida K, Morozumi K, Watarai Y. The importance of kidney volume as a marker in the assessment of living-donor kidney transplantation in Japan. Clin Exp Nephrol 2021; 25:537-544. [PMID: 33411116 DOI: 10.1007/s10157-020-02014-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 12/24/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND In living kidney transplantation, predicting the risk of end-stage kidney disease in the organ donors though crucial remains to be resolved. Thus, any useful biomarker to predict kidney outcome would be highly desirable to safeguard donors. METHODS This retrospective study was conducted at Nagoya Daini Red Cross Hospital to confirm whether an increase in preserved kidney volume (PKV) was a predict marker of proteinuria. A change of PKV before and 1 year after kidney donation was measured, and its association with proteinuria 3 years after the donation was analyzed. RESULTS A total of 119 kidney donors who met the Japanese donor guideline were enrolled. The mean age was 57.4 years, 46.2% were male. The mean values of the variables before kidney donation (baseline) were: BMI levels: 23.4 kg/m2, BSA-adjusted PKV: 132.9 cm3/1.73 m2, and estimated glomerular filtration rate (eGFRave): 82.9 mL/min/1.73 m2. A positive correlation was noted between BSA-adjusted PKV and eGFRave (r = 0.61, p < 0.001). BSA-adjusted PKV increased by 19.5% 1 year after donation, and the median urine protein was 0.04 g/gCre. Linear regression analyses showed that change of PKV and BSA-adjusted PKV before the donation were significantly associated with proteinuria 3 years after donation. CONCLUSION Change of PKV and BSA-adjusted PKV before donation is important factors for proteinuria after donation under the Japanese donor guidelines. Further studies are needed to confirm whether these factors are associated with renal survival after donation.
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Affiliation(s)
- Makoto Tsujita
- Department of Kidney Transplantation, Masuko Memorial Hospital, 35-28 Takebashi-cho, Nakamura-ku, Nagoya, 453-8566, Japan. .,Department of Kidney Disease Center, Transplant Nephrology and Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
| | - Norihiko Goto
- Department of Kidney Disease Center, Transplant Nephrology and Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Kenta Futamura
- Department of Kidney Disease Center, Transplant Nephrology and Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Manabu Okada
- Department of Kidney Disease Center, Transplant Nephrology and Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Takahisa Hiramitsu
- Department of Kidney Disease Center, Transplant Nephrology and Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Shunji Narumi
- Department of Kidney Disease Center, Transplant Nephrology and Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Kazuharu Uchida
- Department of Kidney Transplantation, Masuko Memorial Hospital, 35-28 Takebashi-cho, Nakamura-ku, Nagoya, 453-8566, Japan
| | - Kunio Morozumi
- Department of Kidney Transplantation, Masuko Memorial Hospital, 35-28 Takebashi-cho, Nakamura-ku, Nagoya, 453-8566, Japan
| | - Yoshihiko Watarai
- Department of Kidney Disease Center, Transplant Nephrology and Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
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Santin Y, Lluel P, Rischmann P, Gamé X, Mialet-Perez J, Parini A. Cellular Senescence in Renal and Urinary Tract Disorders. Cells 2020; 9:cells9112420. [PMID: 33167349 PMCID: PMC7694377 DOI: 10.3390/cells9112420] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/02/2020] [Accepted: 11/04/2020] [Indexed: 02/06/2023] Open
Abstract
Cellular senescence is a state of cell cycle arrest induced by repetitive cell mitoses or different stresses, which is implicated in various physiological or pathological processes. The beneficial or adverse effects of senescent cells depend on their transitory or persistent state. Transient senescence has major beneficial roles promoting successful post-injury repair and inhibiting malignant transformation. On the other hand, persistent accumulation of senescent cells has been associated with chronic diseases and age-related illnesses like renal/urinary tract disorders. The deleterious effects of persistent senescent cells have been related, in part, to their senescence-associated secretory phenotype (SASP) characterized by the release of a variety of factors responsible for chronic inflammation, extracellular matrix adverse remodeling, and fibrosis. Recently, an increase in senescent cell burden has been reported in renal, prostate, and bladder disorders. In this review, we will summarize the molecular mechanisms of senescence and their implication in renal and urinary tract diseases. We will also discuss the differential impacts of transient versus persistent status of cellular senescence, as well as the therapeutic potential of senescent cell targeting in these diseases.
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Affiliation(s)
- Yohan Santin
- Institut des Maladies Métaboliques et Cardiovasculaires, Inserm, Université Paul Sabatier, UMR 1048—I2MC, 31432 Toulouse, France; (Y.S.); (J.M.-P.)
| | - Philippe Lluel
- Urosphere SAS, Rue des Satellites, 31400 Toulouse, France;
| | - Pascal Rischmann
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, 31432 Toulouse, France; (P.R.); (X.G.)
| | - Xavier Gamé
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, 31432 Toulouse, France; (P.R.); (X.G.)
| | - Jeanne Mialet-Perez
- Institut des Maladies Métaboliques et Cardiovasculaires, Inserm, Université Paul Sabatier, UMR 1048—I2MC, 31432 Toulouse, France; (Y.S.); (J.M.-P.)
| | - Angelo Parini
- Institut des Maladies Métaboliques et Cardiovasculaires, Inserm, Université Paul Sabatier, UMR 1048—I2MC, 31432 Toulouse, France; (Y.S.); (J.M.-P.)
- Correspondence: ; Tel.: +33-561325601
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Gao Y, Yuan D, Gai L, Wu X, Shi Y, He Y, Liu C, Zhang C, Zhou G, Yuan C. Saponins from Panax japonicus ameliorate age-related renal fibrosis by inhibition of inflammation mediated by NF-κB and TGF-β1/Smad signaling and suppression of oxidative stress via activation of Nrf2-ARE signaling. J Ginseng Res 2020; 45:408-419. [PMID: 34025134 PMCID: PMC8134850 DOI: 10.1016/j.jgr.2020.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/22/2020] [Accepted: 08/26/2020] [Indexed: 12/23/2022] Open
Abstract
Background The decreased renal function is known to be associated with biological aging, of which the main pathological features are chronic inflammation and renal interstitial fibrosis. In previous studies, we reported that total saponins from Panax japonicus (SPJs) can availably protect acute myocardial ischemia. We proposed that SPJs might have similar protective effects for aging-associated renal interstitial fibrosis. Thus, in the present study, we evaluated the overall effect of SPJs on renal fibrosis. Methods Sprague-Dawley (SD) aging rats were given SPJs by gavage beginning from 18 months old, at 10 mg/kg/d and 60 mg/kg/d, up to 24 months old. After the experiment, changes in morphology, function and fibrosis of their kidneys were detected. The levels of serum uric acid (UA), β2-microglobulin (β2-MG) and cystatin C (Cys C) were assayed with ELISA kits. The levels of extracellular matrix (ECM), matrix metalloproteinases (MMPs), tissue inhibitors of metalloproteinases (TIMPs), inflammatory factors and changes of oxidative stress parameters were examined. Results After SPJs treatment, SD rats showed significantly histopathological changes in kidneys accompanied by decreased renal fibrosis and increased renal function; As compared with those in 3-month group, the levels of serum UA, Cys C and β2-MG in 24-month group were significantly increased (p < 0.05). Compared with those in the 24-month group, the levels of serum UA, Cys C and β2-MG in the SPJ-H group were significantly decreased. While ECM was reduced and the levels of MMP-2 and MMP-9 were increased, the levels of TIMP-1, TIMP-2 and transforming growth factor-β1 (TGF-β1)/Smad signaling were decreased; the expression level of phosphorylated nuclear factor kappa-B (NF-κB) was down-regulated with reduced inflammatory factors; meanwhile, the expression of nuclear factor erythroid 2-related factor 2-antioxidant response element (Nrf2-ARE) signaling was aggrandized. Conclusion These results suggest that SPJs treatment can improve age-associated renal fibrosis by inhibiting TGF-β1/Smad, NFκB signaling pathways and activating Nrf2-ARE signaling pathways and that SPJs can be a potentially valuable anti-renal fibrosis drug.
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Key Words
- ARE, antioxidant response element
- Aging
- COX2, cyclooxygenase-2
- Cys C, cystatin C
- ECM, extracellular matrix
- HO-1, human heme oxygenase 1
- IL-6, interleukin-6
- IκB, inhibitor of NF-κB
- LPO, lipid peroxides
- MCP-1, monocyte chemoattractant protein-1
- MMPs, matrix metalloproteinases
- NF-κB, nuclear factor kappa-B
- NQO1, recombinant NADH dehydrogenase quinone 1
- Nrf2, nuclear factor erythroid 2-related factor 2
- Nrf2-ARE signaling pathways
- PJ, Panax japonicas
- Renal fibrosis
- SD, Sprague-Dawley
- SPJ-H, high-dose of SPJ
- SPJ-L, low-dose of SPJ
- SPJs, saponins from panax japonicus
- TGF-β1, tumor growth factor-β1
- TGF-β1/Smad
- TIMPs, tissue inhibitors of metalloproteinases
- TNF-α, tumor necrosis factor-α
- Total saponins of panax japonicus
- UA, uric acid
- α-SMA, α-smooth muscle aorta
- β2-MG, β2-microglobulin
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Affiliation(s)
- Yan Gao
- College of Medical Science, China Three Gorges University, Yichang, China
| | - Ding Yuan
- College of Medical Science, China Three Gorges University, Yichang, China
| | - Liyue Gai
- College of Medical Science, China Three Gorges University, Yichang, China
| | - Xuelian Wu
- College of Medical Science, China Three Gorges University, Yichang, China
| | - Yue Shi
- College of Medical Science, China Three Gorges University, Yichang, China
| | - Yumin He
- College of Medical Science, China Three Gorges University, Yichang, China
| | - Chaoqi Liu
- College of Medical Science, China Three Gorges University, Yichang, China
| | - Changcheng Zhang
- College of Medical Science, China Three Gorges University, Yichang, China
| | - Gang Zhou
- College of Traditional Chinese Medicine, China Three Gorges University, Yichang, China
| | - Chengfu Yuan
- College of Medical Science, China Three Gorges University, Yichang, China.,Third-Grade Pharmacological Laboratory on Chinese Medicine Approved by State Administration of Traditional Chinese Medicine, China Three Gorges University, Yichang, China
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15
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Aguiar LKD, Prado RR, Gazzinelli A, Malta DC. Factors associated with chronic kidney disease: epidemiological survey of the National Health Survey. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2020; 23:e200044. [PMID: 32520099 DOI: 10.1590/1980-549720200044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 03/07/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To identify the prevalence of chronic kidney disease (CKD) self-reported in Brazil and characterize the factors associated with it. METHODS This study was a cross-sectional health survey with a household-based, the National Health Survey, performed in 2013. The outcome in the present study was the prevalence of CKD. The groups of explanatory variables were socio-demographic characteristics, lifestyles, chronic self-reported diseases, anthropometry, and health evaluation. The prevalence of CKD, e their 95% respective confidence interval were estimated, univariate analysis and the multiple logistic regression model were calculated, and remained the variables statistically significant (p < 0.05). RESULTS It noticed that 1.42% (95%CI 1.33 - 1.52) of the 60,202 interviewees self-reported CKD. The OR increased progressively with age, being 2.68 among the elderly with 65 years or more (95%CI 1.75 - 4.09). Having health plans with OR = 1.51 (95%CI 1.28 - 1.78), as well as smoking, hypertension and high cholesterol and poor self-reported health with OR = 1.75 (95%CI 1.45 - 2.12), OR = 1.20 (95%CI 1.02 - 1.42), OR = 1.83 (95%CI 1.56 - 2.15), OR = 4.70 (95%CI 3.75 - 5.88), respectively, showed a higher chance of CKD. CONCLUSIONS The associated variables were increasing age, health plan coverage, smoking, hypertension, hypercholesterolemia, and regular or poor health status. The knowledge of CKD prevalence in Brazil and risk and protection factors are essential for disease prevention and the establishment of supporting public health policies.
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Affiliation(s)
- Lilian Kelen de Aguiar
- Escola de Enfermagem, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil.,Escola Superior de Saúde, Universidade do Estado do Amazonas - Boca do Acre (AM), Brasil
| | | | - Andrea Gazzinelli
- Escola de Enfermagem, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil
| | - Deborah Carvalho Malta
- Escola de Enfermagem, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil
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Shen X, Dong X, Han Y, Li Y, Ding S, Zhang H, Sun Z, Yin Y, Li W, Li W. Ginsenoside Rg1 ameliorates glomerular fibrosis during kidney aging by inhibiting NOX4 and NLRP3 inflammasome activation in SAMP8 mice. Int Immunopharmacol 2020; 82:106339. [PMID: 32114413 DOI: 10.1016/j.intimp.2020.106339] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 02/19/2020] [Accepted: 02/21/2020] [Indexed: 01/08/2023]
Abstract
Aging is closely related to the progress of renal fibrosis, which eventually results in renal dysfunction. Ginsenoside Rg1 (Rg1) has been reported to have an extensive anti-aging effect. However, the role and mechanism of Rg1 in aging-related renal fibrosis remain unclear. The present study aimed to evaluate the protective effect and mechanism of Rg1 in renal fibrosis during kidney aging in a model of SAMP8 mice. Taking SAMR1 mice as the control group, SAMP8 mice were administered Apocynin (50 mg/kg), Tempol (50 mg/kg), or Rg1 (5, 10 mg/kg) intragastrically for 9 weeks as treatment groups. The results showed that the elevated levels of blood urea nitrogen, serum creatinine and senescence-associated β-galactosidase (β-Gal) were markedly decreased, the glomerular mesangial proliferation was significantly alleviated and the increased levels of collagen IV and TGF-β1 were significantly downregulated by Rg1 in SAMP8 mice. In addition, the generation of ROS and the expression of NADHP oxidase 4 (NOX4) in the renal cortex were significantly reduced by Rg1 treatment. The expression levels of NLRP3 inflammasome-related proteins and the inflammation-related cytokine IL-1β were also inhibited by Rg1 treatment in the SAMP8 mice. These results suggested that Rg1 could delay kidney aging and inhibit aging-related glomerular fibrosis by reducing NOX4-derived ROS generation and downregulating NLRP3 inflammasome expression.
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Affiliation(s)
- Xiaoyan Shen
- Key Laboratory of Anti-inflammatory and Immunopharmacology, Ministry of Education, Department of Pharmacology, Basic Medicine College, Anhui Medical University, Hefei 230032, Anhui, China
| | - Xianan Dong
- Key Laboratory of Anti-inflammatory and Immunopharmacology, Ministry of Education, Department of Pharmacology, Basic Medicine College, Anhui Medical University, Hefei 230032, Anhui, China
| | - Yuli Han
- Key Laboratory of Anti-inflammatory and Immunopharmacology, Ministry of Education, Department of Pharmacology, Basic Medicine College, Anhui Medical University, Hefei 230032, Anhui, China
| | - Yan Li
- Key Laboratory of Anti-inflammatory and Immunopharmacology, Ministry of Education, Department of Pharmacology, Basic Medicine College, Anhui Medical University, Hefei 230032, Anhui, China
| | - Shixin Ding
- Key Laboratory of Anti-inflammatory and Immunopharmacology, Ministry of Education, Department of Pharmacology, Basic Medicine College, Anhui Medical University, Hefei 230032, Anhui, China
| | - Han Zhang
- Key Laboratory of Anti-inflammatory and Immunopharmacology, Ministry of Education, Department of Pharmacology, Basic Medicine College, Anhui Medical University, Hefei 230032, Anhui, China
| | - Zhenghao Sun
- Key Laboratory of Anti-inflammatory and Immunopharmacology, Ministry of Education, Department of Pharmacology, Basic Medicine College, Anhui Medical University, Hefei 230032, Anhui, China
| | - Yanyan Yin
- Key Laboratory of Anti-inflammatory and Immunopharmacology, Ministry of Education, Department of Pharmacology, Basic Medicine College, Anhui Medical University, Hefei 230032, Anhui, China
| | - Weiping Li
- Key Laboratory of Anti-inflammatory and Immunopharmacology, Ministry of Education, Department of Pharmacology, Basic Medicine College, Anhui Medical University, Hefei 230032, Anhui, China; Anqing Medical and Pharmaceutical College, Anqing 246052, Anhui, China.
| | - Weizu Li
- Key Laboratory of Anti-inflammatory and Immunopharmacology, Ministry of Education, Department of Pharmacology, Basic Medicine College, Anhui Medical University, Hefei 230032, Anhui, China.
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Aguiar LKD, Ladeira RM, Machado ÍE, Bernal RTI, Moura LD, Malta DC. Fatores associados à doença renal crônica segundo critérios laboratoriais da Pesquisa Nacional de Saúde. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2020; 23:e200101. [DOI: 10.1590/1980-549720200101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/07/2020] [Indexed: 11/21/2022] Open
Abstract
RESUMO: Objetivo: Identificar a prevalência da taxa de filtração glomerular estimada pelo clearance da creatinina endógena (estimativa da taxa de filtração glomerular - eTFG) menor que 60 mL/min/1,73 m2 no Brasil e os fatores associados. Métodos: Trata-se de um inquérito epidemiológico transversal de base domiciliar. Os dados foram obtidos em subamostra de participantes da Pesquisa Nacional de Saúde (PNS), realizada em 2013, na qual foi feita coleta de sangue para medida de creatinina plasmática e calculado a eTFG (n = 7.457). Os grupos de variáveis explicativas foram: características sociodemográficas, estilos de vida, doenças crônicas, antropometria e avaliação de saúde. Foram estimadas as prevalências de eTFG < 60 mL/min/1,73 m2 e os respectivos intervalos de confiança de 95% (IC95%) utilizando a regressão de Poisson para calcular a razão de prevalência bruta (RPb) e ajustada (RPaj) por idade, sexo, escolaridade e região. Resultados: A prevalência de eTFG < 60 mL/min/1,73 m2 foi de 6,48% (IC95% 5,88 - 7,09). Após ajuste, mantiveram-se associados: sexo feminino (RP = 1,40; IC95% 1,16 - 1,68), idade 45-59 anos (RPaj = 7,27; IC95% 3,8 - 14,1), 60 anos ou mais (RPaj = 33,55; IC95% 17,8 - 63,4), obesidade (RP = 1,32; IC95% 1,1 - 1,7), diabetes (RP = 1,44; IC95% 1,2 - 1,8), autoavaliação de saúde ruim/muito ruim (RP = 1,50; IC95% 1,2 - 1,9); menor RPaj foi encontrado nas regiões Nordeste e Sudeste, entre fumantes e com consumo elevado de sal. Conclusão: eTFG < 60 mL/min/1,73 m2 foi mais elevada no sexo feminino, aumentou com a idade, foi associada com obesidade, diabetes e pior avaliação de saúde. O conhecimento da prevalência da doença renal crônica, por meio de exames bioquímicos e dos fatores de risco e proteção, é essencial para subsidiar políticas públicas de saúde.
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Affiliation(s)
- Lilian Kelen de Aguiar
- Universidade Federal de Minas Gerais, Brazil; Universidade do Estado do Amazonas, Brazil
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18
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Tumaini B, Munseri P, Pallangyo K. Disease spectrum and outcomes among elderly patients in two tertiary hospitals in Dar es Salaam, Tanzania. PLoS One 2019; 14:e0213131. [PMID: 31600198 PMCID: PMC6786655 DOI: 10.1371/journal.pone.0213131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 09/27/2019] [Indexed: 11/18/2022] Open
Abstract
Background There has been an increase in the number of individuals aged ≥60 years in Tanzania and in sub Saharan Africa in general due to improved survival. However, data is scarce on the disease burden and outcomes following admission in this population. We herein describe the pattern of diagnoses, outcomes and factors associated with the outcomes among elderly patients admitted at Muhimbili National Hospital (MNH) and Jakaya Kikwete Cardiac Institute (JKCI) medical wards. Methodology From October to December 2017, we consecutively enrolled patients aged ≥60 years (elderly) admitted to the MNH and JKCI medical wards. The ICD 10 was used to code for disease diagnosis at discharge or death. The Modified Barthel index was used to assess for functional activity on admission and at discharge. Results We enrolled 336 (30.1%) elderly participants out of 1301 medical admissions. The mean age ± SD was 70.6 ± 8.9 years; 169 (50%) were female and the average number of diagnoses was 2 per participant. The most common diagnoses were: hypertension 151 (44.9%), stroke 106 (31.5%), heart failure 62 (18.5%), pneumonia 60 (17.9%), diabetes mellitus 58 (17.3%) and chronic kidney disease 55 (16.4%). The median duration of hospital stay was 5 (IQR 3–10) days and in-hospital mortality was 86 (25.6%), 56 (65%) deaths were due to non-communicable diseases and 48 (55.8%) deaths occurred within 72 hours of hospitalization. A modified Barthel score ≤20 on admission was associated with an OR 15.43 (95% CI: 7.5–31.7, p<0.001) for death. Conclusion Elderly patients constituted a significant proportion of medical admissions at MNH and JKCI with high in-hospital mortality. A modified Barthel index score ≤20 during admission is associated with mortality and can be used to identify patients requiring special attention.
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Affiliation(s)
- Basil Tumaini
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- * E-mail:
| | - Patricia Munseri
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Kisali Pallangyo
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Malta DC, Machado ÍE, Pereira CA, Figueiredo AW, Aguiar LKD, Almeida WDSD, Souza MDFMD, Rosenfeld LG, Szwarcwald CL. Evaluation of renal function in the Brazilian adult population, according to laboratory criteria from the National Health Survey. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2019; 22Suppl 02:E190010.SUPL.2. [PMID: 31596381 DOI: 10.1590/1980-549720190010.supl.2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 02/12/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the renal function of the Brazilian adult population, according to laboratory criteria of the National Health Survey (Pesquisa Nacional de Saúde - PNS). METHODOLOGY A descriptive study was carried out with laboratory data from the PNS, which was collected between the years 2014 and 2015. Population prevalence of the serum creatinine (CR) and estimated glomerular filtration rate (GFR) according to sociodemographic variables, were analyzed from the PNS laboratory data. RESULTS The sample consisted of 8,535 individuals aged 18 years old or older for the study of CR and 7,457 for the study of GFR. The GFR prevalence < 60 mL/min/1.73 m2 was 6.7% (95%CI 6.0 - 7.4), higher in women (8.2% 95%CI 7.2 - 9.2) than in men (5.0% 95%CI 4.2 - 6.0) p < 0.001, and in elderly > 60 years old it was 21.4%. For the values of CR ≥ 1.3 mg/dL in men were 5.5% (95%CI 4.6 - 6.5), and in women values of CR ≥ 1.1 mg/dL were 4.6% (95%CI 4.0 - 5.4), with no diference between the genders, p = 0.140. CONCLUSION Results from the PNS laboratory identified a higher prevalence of chronic kidney disease in the Brazilian population than that estimated in self-reported studies, with higher GFR < 60 mL/min/1.73 m2 in women, and reaching one fifth of the elderly. These tests may be useful for the purpose of identifying the disease early on and thus preventing the progression of renal damage and reduce the risk of cardiovascular events and mortality.
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Affiliation(s)
- Deborah Carvalho Malta
- Departamento de Enfermagem Materno Infantil e Saúde Pública, Escola de Enfermagem, Universidade Federal de Minas Gerais-Belo Horizonte (MG), Brasil.,Programa de Pós-graduação em Enfermagem, Escola de Enfermagem Universidade Federal de Minas Gerais - Belo Horizonte(MG), Brasil
| | - Ísis Eloah Machado
- Programa de Pós-graduação em Enfermagem, Escola de Enfermagem Universidade Federal de Minas Gerais - Belo Horizonte(MG), Brasil
| | - Cimar Azeredo Pereira
- Diretoria de Pesquisas, Instituto Brasileiro de Geografia e Estatística - Rio de Janeiro (RJ), Brasil
| | - André Willian Figueiredo
- Diretoria de Pesquisas, Instituto Brasileiro de Geografia e Estatística - Rio de Janeiro (RJ), Brasil
| | - Lilian Kelen de Aguiar
- Programa de Pós-graduação em Enfermagem, Escola de Enfermagem Universidade Federal de Minas Gerais - Belo Horizonte(MG), Brasil.,Universidade do Estado do Amazonas - Manaus (AM), Brasil
| | - Wanessa da Silva de Almeida
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brasil
| | | | | | - Célia Landman Szwarcwald
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brasil
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Bao C, Yang Z, Cai Q, Li Q, Li H, Shu B. Incremental load training improves renal fibrosis by regulating the TGF‑β1/TAK1/MKK3/p38MAPK signaling pathway and inducing the activation of autophagy in aged mice. Int J Mol Med 2019; 44:1677-1686. [PMID: 31545406 PMCID: PMC6777683 DOI: 10.3892/ijmm.2019.4344] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 07/26/2019] [Indexed: 02/07/2023] Open
Abstract
Recent studies have confirmed that kidney tissue fibrosis is closely linked to the natural aging of organs. One of its major characteristics is the reduction of autophagic activity. However, to date, few studies have assessed whether incremental load training is able to improve the occurrence of renal fibrosis caused by natural aging and the underlying mechanisms. In the present study involving male C57/BL mice, an elderly exercise group (OY group) was subjected to progressive load‑increasing rotary‑bar training (5 days/week, lasting for 6 weeks), with an elderly control group (OC group) and a young control group (YC group) used as controls. Renal fibrosis and autophagy‑associated indicators were assessed by Masson's staining, reverse transcription‑quantitative PCR analysis, western blotting, immunofluorescence and transmission electron microscopy. The results suggested that collagen deposition in the basal part of the renal tubular epithelium and glomeruli in the OY group was significantly lower than that in the OC group. In the OC group, the protein expression levels of E‑cadherin, Beclin 1 and light chain 3 were significantly decreased, and increases in α‑smooth muscle actin‑positive signals were observed in the glomerular matrix and renal capsule wall. Furthermore, the expression of transforming growth factor (TGF)‑β1 and its downstream signaling molecules TGF‑β‑activated kinase 1 (TAK1), mitogen‑activated protein kinase (MAPK) kinase (MKK3) and p38MAPK were downregulated following training. The present study confirmed that incremental load training may improve renal fibrosis in aged mice by regulating the TGF‑β1/TAK1/MMK3/p38MAPK signaling pathway and inducing the activation of autophagy to reduce the synthesis of extracellular matrix and delay the epithelial‑mesenchymal transition. The present study provides a novel experimental basis for the intervention of incremental load training to prevent senile renal fibrosis.
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Affiliation(s)
- Chuncha Bao
- Department of Rehabilitation Medicine, University Town Hospital, Chongqing Medical University, Chongqing 401331, P.R. China
| | - Zhong Yang
- Department of Clinical Blood Teaching and Research, Army Medical University, Chongqing 400038, P.R. China
| | - Qiyan Cai
- Department of Histology and Embryology, Army Medical University, Chongqing 400038, P.R. China
| | - Qian Li
- Department of Rehabilitation Medicine, University Town Hospital, Chongqing Medical University, Chongqing 401331, P.R. China
| | - Hongli Li
- Department of Histology and Embryology, Army Medical University, Chongqing 400038, P.R. China
| | - Bin Shu
- Department of Rehabilitation Medicine, University Town Hospital, Chongqing Medical University, Chongqing 401331, P.R. China
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21
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Mukamal KJ, Siscovick DS, de Boer IH, Ix JH, Kizer JR, Djoussé L, Fitzpatrick AL, Tracy RP, Boyko EJ, Kahn SE, Arnold AM. Metabolic Clusters and Outcomes in Older Adults: The Cardiovascular Health Study. J Am Geriatr Soc 2019; 66:289-296. [PMID: 29431855 DOI: 10.1111/jgs.15205] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND/OBJECTIVES Few studies have the requisite phenotypic information to define metabolic patterns that may inform our understanding of the pathophysiology and consequences of diabetes in older adults. We sought to characterize clusters of older adults on the basis of shared metabolic features. DESIGN Population-based prospective cohort study. SETTING Four U.S. Cardiovascular Health Study field centers. PARTICIPANTS Individuals aged 65 and older taking no glucose-lowering agents (N = 2,231). MEASUREMENTS K-means cluster analysis of 11 metabolic parameters (fasting and postload serum glucose and plasma insulin, fasting C-peptide, body mass index, C-reactive protein (CRP), estimated glomerular filtration rate (eGFR), albuminuria, carboxymethyl lysine (an advanced glycation end-product), procollagen III N-terminal propeptide (a fibrotic marker)) and their associations with incident cardiovascular disease, diabetes, disability, and mortality over 8 to 14.5 years of follow-up and with measures of subclinical cardiovascular disease. RESULTS A 6-cluster solution provided robust differentiation into distinct, identifiable clusters. Cluster A (n = 739) had the lowest glucose and insulin and highest eGFR and the lowest rates of all outcomes. Cluster B (n = 419) had high glucose and insulin and intermediate rates of most outcomes. Cluster C (n = 118) had the highest insulin. Cluster D (n = 129) had the highest glucose with much lower insulin. Cluster E (n = 314) had the lowest eGFR and highest albuminuria. Cluster F (n = 512) had the highest CRP. Rates of CVD, mortality, and subclinical atherosclerosis were highest in clusters C, D, and E and were similar to rates in participants with treated diabetes. Incidence of disability was highest in Cluster C. CONCLUSION Clustering according to metabolic parameters identifies distinct phenotypes that are strongly associated with clinical and functional outcomes, even at advanced age.
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Affiliation(s)
- Kenneth J Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - David S Siscovick
- Department of Medicine, University of Washington, Seattle, Washington.,New York Academy of Medicine, New York, New York
| | - Ian H de Boer
- Department of Medicine, University of Washington, Seattle, Washington.,Department of Epidemiology, University of Washington, Seattle, Washington
| | - Joachim H Ix
- Veterans Affairs San Diego Healthcare System, San Diego, California.,School of Medicine, University of California, San Diego, California
| | - Jorge R Kizer
- Department of Medicine, Albert Einstein College of Medicine, New York, New York.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, New York
| | - Luc Djoussé
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Boston Veterans Affairs Healthcare System, Boston, Massachusetts
| | - Annette L Fitzpatrick
- Department of Epidemiology, University of Washington, Seattle, Washington.,Department of Global Health, University of Washington, Seattle, Washington
| | - Russell P Tracy
- Department of Pathology, College of Medicine, University of Vermont, Burlington, Vermont.,Department of Biochemistry, College of Medicine, University of Vermont, Burlington, Vermont
| | - Edward J Boyko
- Department of Medicine, University of Washington, Seattle, Washington.,Department of Epidemiology, University of Washington, Seattle, Washington.,Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Steven E Kahn
- Department of Medicine, University of Washington, Seattle, Washington.,Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Alice M Arnold
- Department of Biostatistics, University of Washington, Seattle, Washington
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22
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Wei SY, Pan SY, Li B, Chen YM, Lin SL. Rejuvenation: Turning back the clock of aging kidney. J Formos Med Assoc 2019; 119:898-906. [PMID: 31202499 DOI: 10.1016/j.jfma.2019.05.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/14/2019] [Accepted: 05/24/2019] [Indexed: 12/11/2022] Open
Abstract
Aging is inevitable in life. It is defined as impaired adaptive capacity to environmental or internal stresses with growing rates of disease and death. Aging is also an important risk factor for various kidney diseases such as acute kidney injury and chronic kidney disease. Patients older than 65 years have nearly 28% risk of failing recovery of kidney function when suffering from acute kidney injury. It is reported that more than a third of population aged 65 years and older have chronic kidney disease in Taiwan, and the occurrence of multiple age-related disorders is predicted to increase in parallel. Renal aging is a complex, multifactorial process characterized by many anatomical and functional changes. Several factors are involved in renal aging, such as loss of telomeres, cell cycle arrest, chronic inflammation, activation of renin-angiotensin system, decreased klotho expression, and development of tertiary lymphoid tissues. These changes can also be observed in many other different types of renal injury. Recent studies suggested that young blood may rejuvenate aged organs, including the kidneys. In order to develop new therapeutic strategies for renal aging, the mechanisms underlying renal aging and by which young blood can halt or reverse aging process warrants further study.
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Affiliation(s)
- Shi-Yao Wei
- Graduate Institute of Physiology, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Nephrology, Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Szu-Yu Pan
- Graduate Institute of Physiology, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Bing Li
- Department of Nephrology, Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Yung-Ming Chen
- Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shuei-Liong Lin
- Graduate Institute of Physiology, College of Medicine, National Taiwan University, Taipei, Taiwan; Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan; Research Center for Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei, Taiwan.
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23
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Decision-Making in Geriatric Patients with End-Stage Renal Disease: Thinking Beyond Nephrology. J Clin Med 2018; 8:jcm8010005. [PMID: 30577486 PMCID: PMC6352025 DOI: 10.3390/jcm8010005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/08/2018] [Accepted: 12/15/2018] [Indexed: 12/12/2022] Open
Abstract
Compared to younger individuals, the prevalence of end-stage renal disease (ESRD) in elders is notably higher. While renal replacement therapy, usually with hemodialysis, is accepted therapy in younger patients with ESRD, decisions regarding the treatment of advanced kidney disease in the elderly population are more complex, secondary to the physiologic changes of aging, concurrent geriatric syndromes, and varying goals of care. Evaluation for possible initiation of dialysis in geriatric patients should be multidisciplinary in nature and patient-focused, including a consideration of physical, cognitive, and social function. If renal replacement therapy is not pursued, optimization of medical management or symptom management needs to be the goal of care.
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24
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Hypertension exaggerates renovascular resistance via miR-122-associated stress response in aging. J Hypertens 2018; 36:2226-2236. [DOI: 10.1097/hjh.0000000000001770] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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25
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Amelioratory Effects of Testosterone Propionate on Age-related Renal Fibrosis via Suppression of TGF-β1/Smad Signaling and Activation of Nrf2-ARE Signaling. Sci Rep 2018; 8:10726. [PMID: 30013094 PMCID: PMC6048025 DOI: 10.1038/s41598-018-29023-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 07/04/2018] [Indexed: 12/18/2022] Open
Abstract
Androgen plays a pivotal role in the progression of renal fibrosis. However, whether exogenous androgen treatment to aged male rats can improve the age-related renal fibrosis was not explored. In our study, the changes of morphological structure, renal fibrosis, ultrastructure and renal function, the expressions of extracellular matrix (ECM), matrix metalloproteinases (MMPs) and its tissue inhibitors of metalloproteinases (TIMPs), the expressions of tumor growth factor β1 (TGF-β1)/Smad signaling and oxidative stress parameters as well as nuclear factor erythroid 2-related factor 2-antioxidant response element (Nrf2-ARE) signaling were tested in kidney of aged male Wistar rats after subcutaneous testosterone propionate (TP, 2 mg/kg/d, 84-day) injection. Aged rats showed significantly renal histopathological changes, increased renal fibrosis, increased thickening of the glomerular basement membrane and the Bowman’s capsule basement membrane, declined renal functional, increased ECM, lower expressions of MMP-2 and MMP-9 and higher expressions of TIMP-1 and TIMP-2 in renal tissues and higher expressions of TGF-β1/Smad signaling, as well as lower expressions of Nrf2-ARE signaling compared to young rats. TP treatment significantly improved age-related above indexes. These results suggested that TP supplement may alleviate age-related renal fibrosis via suppression of TGF-β1/Smad signaling and activation of Nrf2-ARE signaling in aged rats.
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26
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Novel treatment strategies for chronic kidney disease: insights from the animal kingdom. Nat Rev Nephrol 2018; 14:265-284. [PMID: 29332935 DOI: 10.1038/nrneph.2017.169] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Many of the >2 million animal species that inhabit Earth have developed survival mechanisms that aid in the prevention of obesity, kidney disease, starvation, dehydration and vascular ageing; however, some animals remain susceptible to these complications. Domestic and captive wild felids, for example, show susceptibility to chronic kidney disease (CKD), potentially linked to the high protein intake of these animals. By contrast, naked mole rats are a model of longevity and are protected from extreme environmental conditions through mechanisms that provide resistance to oxidative stress. Biomimetic studies suggest that the transcription factor nuclear factor erythroid 2-related factor 2 (NRF2) offers protection in extreme environmental conditions and promotes longevity in the animal kingdom. Similarly, during months of fasting, immobilization and anuria, hibernating bears are protected from muscle wasting, azotaemia, thrombotic complications, organ damage and osteoporosis - features that are often associated with CKD. Improved understanding of the susceptibility and protective mechanisms of these animals and others could provide insights into novel strategies to prevent and treat several human diseases, such as CKD and ageing-associated complications. An integrated collaboration between nephrologists and experts from other fields, such as veterinarians, zoologists, biologists, anthropologists and ecologists, could introduce a novel approach for improving human health and help nephrologists to find novel treatment strategies for CKD.
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27
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Bridges CC, Zalups RK. The aging kidney and the nephrotoxic effects of mercury. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2017; 20:55-80. [PMID: 28339347 PMCID: PMC6088787 DOI: 10.1080/10937404.2016.1243501] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Owing to advances in modern medicine, life expectancies are lengthening and leading to an increase in the population of older individuals. The aging process leads to significant alterations in many organ systems, with the kidney being particularly susceptible to age-related changes. Within the kidney, aging leads to ultrastructural changes such as glomerular and tubular hypertrophy, glomerulosclerosis, and tubulointerstitial fibrosis, which may compromise renal plasma flow (RPF) and glomerular filtration rate (GFR). These alterations may reduce the functional reserve of the kidneys, making them more susceptible to pathological events when challenged or stressed, such as following exposure to nephrotoxicants. An important and prevalent environmental toxicant that induces nephrotoxic effects is mercury (Hg). Since exposure of normal kidneys to mercuric ions might induce glomerular and tubular injury, aged kidneys, which may not be functioning at full capacity, may be more sensitive to the effects of Hg than normal kidneys. Age-related renal changes and the effects of Hg in the kidney have been characterized separately. However, little is known regarding the influence of nephrotoxicants, such as Hg, on aged kidneys. The purpose of this review was to summarize known findings related to exposure of aged and diseased kidneys to the environmentally relevant nephrotoxicant Hg.
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Affiliation(s)
- Christy C Bridges
- a Mercer University School of Medicine , Division of Basic Medical Sciences , Macon , Georgia , USA
| | - Rudolfs K Zalups
- a Mercer University School of Medicine , Division of Basic Medical Sciences , Macon , Georgia , USA
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28
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Bigler M, Koutsantonis D, Odriozola A, Halm S, Tschanz SA, Zakrzewicz A, Weichert A, Baum O. Morphometry of skeletal muscle capillaries: the relationship between capillary ultrastructure and ageing in humans. Acta Physiol (Oxf) 2016; 218:98-111. [PMID: 27174490 DOI: 10.1111/apha.12709] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 04/25/2016] [Accepted: 05/11/2016] [Indexed: 12/31/2022]
Abstract
AIM To determine whether the ultrastructure of the capillary system in human skeletal muscle changes during advancing senescence, we evaluated the compartmental and subcompartmental organization of capillaries from vastus lateralis muscle (VL) biopsies of 41 non-diseased persons aged 23-75 years. METHODS From each VL biopsy, 38-40 randomly selected capillaries were assessed by transmission electron microscopy and subsequent morphometry with a newly established tablet-based image analysis technique. RESULTS Quantification of the compartmental organization revealed most indicators of the capillary ultrastructure to be only non-significantly altered (P > 0.05) over age. However, the peri-capillary basement membrane (BM) was thicker in the older participants than in the younger ones (P ≤ 0.05). Regression analysis revealed a bipartite relationship between the two parameters: a homogenous slight increase in BM thickness up to the age of approximately 50 years was followed by a second phase with more scattered BM thickness values. In 44.5% of the capillary profiles, projections/filopodia of the pericytes (PCs) traversed the BM and invaded endothelial cells (ECs) visible as PC pegs in pale cytoplasm holes (EC sockets). Strikingly, PC pegs were often in proximity to the EC nucleus. In PC profiles, sockets were likewise detected in 14.2% of the capillaries. Within these PC sockets, cellular profiles were frequently seen, which could be assigned to EC filopodia, internal PC curling or PC-PC interactions. Quantification of the occurrence of peg-socket junctions revealed the proportions of empty EC sockets and empty PC sockets to increase (P ≤ 0.05) during ageing. CONCLUSION Our investigation demonstrates advancing senescence to be associated with increase in BM thickness and loss of EC and PC filopodia length in skeletal muscle capillaries.
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Affiliation(s)
- M. Bigler
- Institute of Anatomy; University of Bern; Bern Switzerland
| | | | - A. Odriozola
- Institute of Anatomy; University of Bern; Bern Switzerland
| | - S. Halm
- Institute of Anatomy; University of Bern; Bern Switzerland
| | - S. A. Tschanz
- Institute of Anatomy; University of Bern; Bern Switzerland
| | - A. Zakrzewicz
- Institute of Physiology; CharitéCrossOver (CCO); Charité - Universitätsmedizin Berlin; Berlin Germany
| | - A. Weichert
- Institute of Physiology; CharitéCrossOver (CCO); Charité - Universitätsmedizin Berlin; Berlin Germany
- Department of Obstetrics; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - O. Baum
- Institute of Physiology; CharitéCrossOver (CCO); Charité - Universitätsmedizin Berlin; Berlin Germany
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29
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Roncal-Jimenez CA, Ishimoto T, Lanaspa MA, Milagres T, Hernando AA, Jensen T, Miyazaki M, Doke T, Hayasaki T, Nakagawa T, Marumaya S, Long DA, Garcia GE, Kuwabara M, Sánchez-Lozada LG, Kang DH, Johnson RJ. Aging-associated renal disease in mice is fructokinase dependent. Am J Physiol Renal Physiol 2016; 311:F722-F730. [PMID: 27465991 DOI: 10.1152/ajprenal.00306.2016] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 07/26/2016] [Indexed: 01/31/2023] Open
Abstract
Aging-associated kidney disease is usually considered a degenerative process associated with aging. Recently, it has been shown that animals can produce fructose endogenously, and that this can be a mechanism for causing kidney damage in diabetic nephropathy and in association with recurrent dehydration. We therefore hypothesized that low-level metabolism of endogenous fructose might play a role in aging-associated kidney disease. Wild-type and fructokinase knockout mice were fed a normal diet for 2 yr that had minimal (<5%) fructose content. At the end of 2 yr, wild-type mice showed elevations in systolic blood pressure, mild albuminuria, and glomerular changes with mesangial matrix expansion, variable mesangiolysis, and segmental thrombi. The renal injury was amplified by provision of high-salt diet for 3 wk, as noted by the presence of glomerular hypertrophy, mesangial matrix expansion, and alpha smooth muscle actin expression, and with segmental thrombi. Fructokinase knockout mice were protected from renal injury both at baseline and after high salt intake (3 wk) compared with wild-type mice. This was associated with higher levels of active (phosphorylated serine 1177) endothelial nitric oxide synthase in their kidneys. These studies suggest that aging-associated renal disease might be due to activation of specific metabolic pathways that could theoretically be targeted therapeutically, and raise the hypothesis that aging-associated renal injury may represent a disease process as opposed to normal age-related degeneration.
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Affiliation(s)
| | - Takuji Ishimoto
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora, Colorado; Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Miguel A Lanaspa
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora, Colorado
| | - Tamara Milagres
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora, Colorado
| | - Ana Andres Hernando
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora, Colorado
| | - Thomas Jensen
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora, Colorado
| | - Makoto Miyazaki
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora, Colorado
| | - Tomohito Doke
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takahiro Hayasaki
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takahiko Nakagawa
- TMK Project, Medical Innovation Center, Kyoto University, Kyoto, Japan
| | - Shoichi Marumaya
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - David A Long
- Developmental Biology and Cancer Programme, UCL Institute of Child Health, London, United Kingdom
| | - Gabriela E Garcia
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora, Colorado
| | - Masanari Kuwabara
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora, Colorado
| | - Laura G Sánchez-Lozada
- Laboratory of Renal Physiopathology and Department of Nephrology, Instituto Nacional de Cardiologia I.Ch., Mexico City, Mexico
| | - Duk-Hee Kang
- Department of Internal Medicine, Ewha Womans University School of Medicine, Ewha Medical Research Center, Seoul, Republic of Korea; and
| | - Richard J Johnson
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora, Colorado; Division of Nephrology, Eastern Colorado Health Care System, Department of Veteran Affairs, Denver, Colorado
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30
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Svensson K, Schnyder S, Cardel B, Handschin C. Loss of Renal Tubular PGC-1α Exacerbates Diet-Induced Renal Steatosis and Age-Related Urinary Sodium Excretion in Mice. PLoS One 2016; 11:e0158716. [PMID: 27463191 PMCID: PMC4963111 DOI: 10.1371/journal.pone.0158716] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 06/21/2016] [Indexed: 12/22/2022] Open
Abstract
The kidney has a high energy demand and is dependent on oxidative metabolism for ATP production. Accordingly, the kidney is rich in mitochondria, and mitochondrial dysfunction is a common denominator for several renal diseases. While the mitochondrial master regulator peroxisome proliferator-activated receptor γ coactivator 1α (PGC-1α) is highly expressed in kidney, its role in renal physiology is so far unclear. Here we show that PGC-1α is a transcriptional regulator of mitochondrial metabolic pathways in the kidney. Moreover, we demonstrate that mice with an inducible nephron-specific inactivation of PGC-1α in the kidney display elevated urinary sodium excretion, exacerbated renal steatosis during metabolic stress but normal blood pressure regulation. Overall, PGC-1α seems largely dispensable for basal renal physiology. However, the role of PGC-1α in renal mitochondrial biogenesis indicates that activation of PGC-1α in the context of renal disorders could be a valid therapeutic strategy to ameliorate renal mitochondrial dysfunction.
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Affiliation(s)
- Kristoffer Svensson
- Biozentrum, University of Basel, Klingelbergstrasse 50/70, CH-4056, Basel, Switzerland
| | - Svenia Schnyder
- Biozentrum, University of Basel, Klingelbergstrasse 50/70, CH-4056, Basel, Switzerland
| | - Bettina Cardel
- Biozentrum, University of Basel, Klingelbergstrasse 50/70, CH-4056, Basel, Switzerland
| | - Christoph Handschin
- Biozentrum, University of Basel, Klingelbergstrasse 50/70, CH-4056, Basel, Switzerland
- * E-mail:
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31
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Parrish AR. The cytoskeleton as a novel target for treatment of renal fibrosis. Pharmacol Ther 2016; 166:1-8. [PMID: 27343756 DOI: 10.1016/j.pharmthera.2016.06.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 06/07/2016] [Indexed: 12/23/2022]
Abstract
The incidence of chronic kidney disease (CKD) is increasing, with an estimated prevalence of 12% in the United States (Synder et al., 2009). While CKD may progress to end-stage renal disease (ESRD), which necessitates renal replacement therapy, i.e. dialysis or transplantation, most CKD patients never reach ESRD due to the increased risk of death from cardiovascular disease. It is well-established that regardless of the initiating insult - most often diabetes or hypertension - fibrosis is the common pathogenic pathway that leads to progressive injury and organ dysfunction (Eddy, 2014; Duffield, 2014). As such, there has been extensive research into the molecular and cellular mechanisms of renal fibrosis; however, translation to effective therapeutic strategies has been limited. While a role for the disruption of the cytoskeleton, most notably the actin network, has been established in acute kidney injury over the past two decades, a role in regulating renal fibrosis and CKD is only recently emerging. This review will focus on the role of the cytoskeleton in regulating pro-fibrotic pathways in the kidney, as well as data suggesting that these pathways represent novel therapeutic targets to manage fibrosis and ultimately CKD.
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Affiliation(s)
- Alan R Parrish
- Department of Medical Pharmacology and Physiology, School of Medicine, University of Missouri, Columbia, MO 65212, USA.
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32
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Denic A, Alexander MP, Kaushik V, Lerman LO, Lieske JC, Stegall MD, Larson JJ, Kremers WK, Vrtiska TJ, Chakkera HA, Poggio ED, Rule AD. Detection and Clinical Patterns of Nephron Hypertrophy and Nephrosclerosis Among Apparently Healthy Adults. Am J Kidney Dis 2016; 68:58-67. [PMID: 26857648 DOI: 10.1053/j.ajkd.2015.12.029] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 12/28/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Even among ostensibly healthy adults, there is often mild pathology in the kidney. The detection of kidney microstructural variation and pathology by imaging and the clinical pattern associated with these structural findings is unclear. STUDY DESIGN Cross-sectional (clinical-pathologic correlation). SETTING & PARTICIPANTS Living kidney donors at Mayo Clinic (Minnesota and Arizona sites) and Cleveland Clinic 2000 to 2011. PREDICTORS Predonation kidney function, risk factors, and contrast computed tomographic scan of the kidneys. These scans were segmented for cortical volume and medullary volume, reviewed for parenchymal cysts, and scored for kidney surface roughness. OUTCOMES Nephrosclerosis (glomerulosclerosis, interstitial fibrosis/tubular atrophy, and arteriosclerosis) and nephron size (glomerular volume, mean profile tubular area, and cortical volume per glomerulus) determined from an implantation biopsy of the kidney cortex at donation. RESULTS Among 1,520 living kidney donors, nephrosclerosis associated with increased kidney surface roughness, cysts, and smaller cortical to medullary volume ratio. Larger nephron size (nephron hypertrophy) associated with larger cortical volume. Nephron hypertrophy and larger cortical volume associated with higher systolic blood pressure, glomerular filtration rate, and urine albumin excretion; larger body mass index; higher serum uric acid level; and family history of end-stage renal disease. Both nephron hypertrophy and nephrosclerosis associated with older age and mild hypertension. The net effect of both nephron hypertrophy and nephrosclerosis associating with cortical volume was that nephron hypertrophy diminished volume loss with age-related nephrosclerosis and fully negated volume loss with mild hypertension-related nephrosclerosis. LIMITATIONS Kidney donors are selected on health, restricting the spectrum of pathologic findings. Kidney biopsies in living donors are a small tissue sample leading to imprecise estimates of structural findings. CONCLUSIONS Among apparently healthy adults, the microstructural findings of nephron hypertrophy and nephrosclerosis differ in their associations with kidney function, macrostructure, and risk factors.
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Affiliation(s)
- Aleksandar Denic
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Mariam P Alexander
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Vidhu Kaushik
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Lilach O Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - John C Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Mark D Stegall
- Division of Transplant Surgery, Mayo Clinic, Rochester, Minnesota
| | - Joseph J Larson
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Walter K Kremers
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
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33
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Humphreys BD, Cantaluppi V, Portilla D, Singbartl K, Yang L, Rosner MH, Kellum JA, Ronco C. Targeting Endogenous Repair Pathways after AKI. J Am Soc Nephrol 2015; 27:990-8. [PMID: 26582401 DOI: 10.1681/asn.2015030286] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
AKI remains a highly prevalent disease associated with poor short- and long-term outcomes and high costs. Although significant advances in our understanding of repair after AKI have been made over the last 5 years, this knowledge has not yet been translated into new AKI therapies. A consensus conference held by the Acute Dialysis Quality Initiative was convened in April of 2014 and reviewed new evidence on successful kidney repair to identify the most promising pathways that could be translated into new treatments. In this paper, we provide a summary of current knowledge regarding successful kidney repair and offer a framework for conceptualizing the therapeutic targeting that may facilitate this process. We outline gaps in knowledge and suggest a research agenda to more efficiently bring new discoveries regarding repair after AKI to the clinic.
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Affiliation(s)
- Benjamin D Humphreys
- Renal Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri;
| | - Vincenzo Cantaluppi
- Nephrology, Dialysis and Kidney Transplantation Unit, Department of Medical Sciences, University of Torino, Azienda Ospedaliera Città della Salute e della Scienza 'Molinette,' Turin, Italy
| | - Didier Portilla
- Division of Nephrology, Center for Immunity, Inflammation and Regenerative Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Kai Singbartl
- Center for Critical Care Nephrology and Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Li Yang
- Renal Division, Peking University First Hospital, Beijing, China; and
| | - Mitchell H Rosner
- Division of Nephrology, Center for Immunity, Inflammation and Regenerative Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - John A Kellum
- Center for Critical Care Nephrology and Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Claudio Ronco
- Department of Nephrology Dialysis and Transplantation, San Bortolo Hospital and the International Renal Research Institute, Vicenza, Italy
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34
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Mechanisms of maladaptive repair after AKI leading to accelerated kidney ageing and CKD. Nat Rev Nephrol 2015; 11:264-76. [PMID: 25643664 DOI: 10.1038/nrneph.2015.3] [Citation(s) in RCA: 528] [Impact Index Per Article: 58.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Acute kidney injury is an increasingly common complication of hospital admission and is associated with high levels of morbidity and mortality. A hypotensive, septic, or toxic insult can initiate a cascade of events, resulting in impaired microcirculation, activation of inflammatory pathways and tubular cell injury or death. These processes ultimately result in acutely impaired kidney function and initiation of a repair response. This Review explores the various mechanisms responsible for the initiation and propagation of acute kidney injury, the prototypic mechanisms by which a substantially damaged kidney can regenerate its normal architecture, and how the adaptive processes of repair can become maladaptive. These mechanisms, which include G2/M cell-cycle arrest, cell senescence, profibrogenic cytokine production, and activation of pericytes and interstitial myofibroblasts, contribute to the development of progressive fibrotic kidney disease. The end result is a state that mimics accelerated kidney ageing. These mechanisms present important opportunities for the design of targeted therapeutic strategies to promote adaptive renal recovery and minimize progressive fibrosis and chronic kidney disease after acute insults.
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35
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The aging kidney: increased susceptibility to nephrotoxicity. Int J Mol Sci 2014; 15:15358-76. [PMID: 25257519 PMCID: PMC4200815 DOI: 10.3390/ijms150915358] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 08/12/2014] [Accepted: 08/18/2014] [Indexed: 12/13/2022] Open
Abstract
Three decades have passed since a series of studies indicated that the aging kidney was characterized by increased susceptibility to nephrotoxic injury. Data from these experimental models is strengthened by clinical data demonstrating that the aging population has an increased incidence and severity of acute kidney injury (AKI). Since then a number of studies have focused on age-dependent alterations in pathways that predispose the kidney to acute insult. This review will focus on the mechanisms that are altered by aging in the kidney that may increase susceptibility to injury, including hemodynamics, oxidative stress, apoptosis, autophagy, inflammation and decreased repair.
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Atkinson TJ, Fudin J, Pandula A, Mirza M. Medication pain management in the elderly: unique and underutilized analgesic treatment options. Clin Ther 2013; 35:1669-89. [PMID: 24161287 DOI: 10.1016/j.clinthera.2013.09.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 09/10/2013] [Accepted: 09/11/2013] [Indexed: 01/21/2023]
Abstract
BACKGROUND By 2030, the US population of adults aged ≥65 years will increase by >80%, and these adults will account for nearly 20% of the US population. In this population, the decline of multiple physiologic processes and diseases collectively influence treatment options. Physiologic changes, drug-drug interactions resulting from polypharmacy, and drug-disease interactions combine to make elderly patients more sensitive to the adverse events (AEs) associated with medications, all of which must be considered in drug selection. OBJECTIVE This article focuses on select underutilized medication options for analgesia that may provide significant advantages in the elderly population above and beyond commonly prescribed conventional choices. METHODS We performed a complete review of the literature using the search terms pain management, elderly, opioids, NSAIDs, topical NSAIDs, levorphanol, buprenorphine transdermal, and tapentadol. Databases searched included PubMed, Google Scholar, Ovid, and Athens. Package inserts were utilized for approval dates, indications, and formulations available. We looked at reviews of agents to identify important studies for consideration that searches may have missed. Pharmacology and pharmacokinetic data were taken from randomized trials focusing in this area. Pivotal Phase III trials were utilized for discussion of clinical trial experience and to summarize efficacy and AEs. For purposes of validity, only peer-reviewed literature was included. RESULTS There were limited data that specifically outlined analgesic drug selection and highlighted safer alternatives for the elderly patient based on polypharmacy risks, end-organ deterioration, and/or drug choices that presented less risk. We focused on unique opioid alternatives: levorphanol, which offers several therapeutic advantages similar to methadone but without the pharmacokinetic and drug-interaction pitfalls associated with methadone; tapentadol, associated with significantly less gastrointestinal distress and constipation; and transdermal buprenorphine, an agonist/antagonist with less risk for the toxicities associated with conventional opioids and with compliance benefits. Topical NSAIDs are discussed as a viable therapeutic option. Specific attention to a more desirable tolerability profile, including avoidance of drug interactions, end-organ dysfunction, and gastrointestinal bleed with topical NSAID agents versus their oral counterparts is discussed, including the ability to achieve superior tissue levels for appropriately selected inflammatory conditions. CONCLUSION It is incumbent that providers consider these options as part of an analgesic armamentarium in an effort to maximize therapeutic benefit and minimize risks in the increasing elderly patient population.
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