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Kain R. [Renal involvement in systemic diseases]. PATHOLOGIE (HEIDELBERG, GERMANY) 2024; 45:261-268. [PMID: 38805092 PMCID: PMC11199298 DOI: 10.1007/s00292-024-01338-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Diseases of the nonneoplastic renal parenchyma occur in the context of a number of disorders that affect the organism systemically and can thus represent a differential diagnosis for autoimmunological kidney diseases. PURPOSE Two common autoimmunologic diseases of the kidney, namely antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and systemic lupus erythematosus (SLE), are presented and put into context of the broader field of renal diseases. Novel diagnostic and therapeutic approaches are discussed. MATERIALS AND METHODS A review of the recent literature and an overview of the disease presentation are provided.
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Affiliation(s)
- Renate Kain
- Klinisches Institut für Pathologie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
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Zhang X, Wang C, Tian Y, Zhang Y, Miao Q, Wu D, Yu C. Low estimated glomerular filtration rate and high body mass index are risk factors for acute kidney injury in systemic lupus erythematosus patients after cardiac surgery. Front Cardiovasc Med 2024; 11:1387612. [PMID: 38911516 PMCID: PMC11190320 DOI: 10.3389/fcvm.2024.1387612] [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: 02/18/2024] [Accepted: 05/27/2024] [Indexed: 06/25/2024] Open
Abstract
Objective The occurrence of acute kidney injury (AKI) is common following cardiac surgery, especially among patients characterized with systemic lupus erythematosus (SLE), but studies on this clinical scenario have been limited by the rarity of SLE. We aimed to explore the risk predictors and outcomes with regards to postoperative AKI among cardiac-surgical patients concomitant with SLE. Methods This was a single-center retrospective study performed in a tertiary hospital. Adult patients diagnosed with SLE who underwent cardiac surgery within the last 22 years were enrolled. Essential variables, including patient-, surgery- and anesthesia-related information, were collected from the medical record system. The definition of AKI was derived from the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Risk predictors suspected to be linked with post-surgical AKI were calculated using the univariable and multivariable analyses. Results Of all 59 SLE patients undergoing cardiac surgery, 57 were ultimately enrolled into the analysis. AKI occurred in 29 patients (50.9%), who had significantly longer extubation time (median difference 1.0 day, P < 0.001), ICU length of stay (median difference 2.0 days, P = 0.001), postoperative length of stay (median difference 5.0 days, P = 0.026), and more postoperative major complications (odds ratio 10.29, P = 0.025) than the others. Preoperative estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2 (odds ratio 5.31, P = 0.021) and body mass index (BMI) ≥ 24 kg/m2 (odds ratio 4.32, P = 0.043) were the only two factors in the multivariable analysis that were significantly correlated with the development of postoperative AKI in patients with SLE after cardiac surgery. Conclusion AKI in SLE patients after cardiac surgery is common and requires scrutiny, especially in overweight patients with moderate to severe preoperative renal dysfunction.
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Affiliation(s)
- Xue Zhang
- Department of Anesthesiology, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Chunrong Wang
- Department of Anesthesiology, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Yajie Tian
- Department of Anesthesiology, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Yuelun Zhang
- Medical Research Center, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Qi Miao
- Department of Cardiac Surgery, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Di Wu
- Department of Rheumatology, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Chunhua Yu
- Department of Anesthesiology, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
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Zhang X, Miao Q, Yu C, Zhang Y, Wu D, Tian Y, Li H, Wang C. Postoperative acute kidney injury after on-pump cardiac surgery in patients with connective tissue disease. Front Cardiovasc Med 2023; 10:1266549. [PMID: 38028488 PMCID: PMC10646509 DOI: 10.3389/fcvm.2023.1266549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Patients with connective tissue disease have a poor prognosis after receiving cardiac surgery. This study described the clinical scenarios and investigated factors correlated with acute kidney injury (AKI) after on-pump cardiac surgery in patients with systemic lupus erythematosus (SLE) or vasculitis. Methods Patients with SLE or vasculitis who underwent on-pump cardiac surgery from March 2002 to March 2022 were enrolled, while patients with preoperative renal dysfunction were excluded. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Uni- and multivariable analyses were performed to identify potential factors associated with postoperative AKI. Results Among 123 patients enrolled, 39 (31.7%) developed AKI within seven days after receiving on-pump cardiac surgery. Four patients died in the hospital, resulting in an overall in-hospital mortality of 3.3%, and all deaths occurred in the AKI group. Patients in the AKI group also had longer ICU stays (median difference 3.0 day, 95% CI: 1.0-4.0, P < 0.001) and extubation time (median difference 1.0 days, 95% CI: 0-2.0, P < 0.001) than those in the non-AKI group. Multivariable logistic regression revealed that BMI over 24 kg/m2 (OR: 3.00, 95% CI: 1.24-7.28) and comorbid SLE (OR: 4.73, 95% CI: 1.73-12.93) were independently correlated with postoperative AKI. Conclusion Factors potentially correlated with AKI following on-pump cardiac surgery in patients with connective tissue disease were explored. Clinicians should pay more attention to preoperative evaluation and intraoperative management in patients with risk factors.
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Affiliation(s)
- Xue Zhang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Qi Miao
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Chunhua Yu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuelun Zhang
- Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Di Wu
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yajie Tian
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hanchen Li
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Chunrong Wang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Hou S, Li X, Meng F, Liu S, Wang Z. A Machine Learning-Based Prediction of Diabetes Insipidus in Patients Undergoing Endoscopic Transsphenoidal Surgery for Pituitary Adenoma. World Neurosurg 2023; 175:e55-e63. [PMID: 36907270 DOI: 10.1016/j.wneu.2023.03.027] [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] [Received: 12/03/2022] [Accepted: 03/06/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND Diabetes insipidus (DI) is a common complication after endoscopic transsphenoidal surgery (TSS) for pituitary adenoma (PA), which affects the quality of life in patients. Therefore, there is a need to develop prediction models of postoperative DI specifically for patients who undergo endoscopic TSS. This study establishes and validates prediction models of DI after endoscopic TSS for patients with PA using machine learning algorithms. METHODS We retrospectively collected information about patients with PA who underwent endoscopic TSS in otorhinolaryngology and neurosurgery departments between January 2018 and December 2020. The patients were randomly split into a training set (70%) and a test set (30%). The 4 machine learning algorithms (logistic regression, random forest, support vector machine, and decision tree) were used to establish the prediction models. Area under the receiver operating characteristic curves were calculated to compare the performance of the models. RESULTS A total of 232 patients were included, and 78 patients (33.6%) developed transient DI after surgery. Data were randomly divided into a training set (n = 162) and a test set (n = 70) for development and validation of the model, respectively. The area under the receiver operating characteristic curve was highest in the random forest model (0.815) and lowest in the logistic regression model (0.601). Invasion of pituitary stalk was the most important feature for model performance, closely followed by macroadenomas, size classification of PA, tumor texture, and Hardy-Wilson suprasellar grade. CONCLUSIONS Machine learning algorithms identify preoperative features of importance and reliably predict DI after endoscopic TSS for patients with PA. Such a prediction model may enable clinicians to develop individualized treatment strategy and follow-up management.
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Affiliation(s)
- Siyuan Hou
- Department of Otolaryngology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaomin Li
- Department of Otolaryngology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Fanyue Meng
- Department of Otolaryngology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shaokun Liu
- Department of Otolaryngology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhenlin Wang
- Department of Otolaryngology, Xuanwu Hospital, Capital Medical University, Beijing, China.
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Makino R, Fujio S, Hanada T, Yonenaga M, Kawade S, Hashiguchi H, Nishio Y, Higa N, Arita K, Yoshimoto K, Hanaya R. Delayed postoperative hyponatremia in patients with acromegaly: incidence and predictive factors. Pituitary 2023; 26:42-50. [PMID: 36323977 DOI: 10.1007/s11102-022-01288-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Delayed postoperative hyponatremia (DPH) is a unique complication of transsphenoidal surgery (TSS) in pituitary tumors. Growth hormone (GH) enhances renal sodium reabsorption; however, the association between postoperative GH reduction and DPH in acromegaly is unclear. This study was performed to clarify the incidence of and the predictive factors for DPH in patients with acromegaly who underwent TSS. METHODS Ninety-four patients with active acromegaly were examined retrospectively. During the postoperative course, patients with serum sodium levels ≤ 134 mEq/L were classified into the DPH group. We compared basic clinical characteristics, tumor characteristics, and preoperative and postoperative examination findings between the DPH and non-DPH groups. RESULTS DPH occurred in 39 patients (41.5%), and the lowest serum sodium levels were generally observed during postoperative days (PODs) 7-9. They needed a 3-day longer hospital stay than those without DPH. The DPH group had lower preoperative body weight and body mass index. In addition, a transient increase in body weight during PODs 5-7 occurred with a transient decrease in urinary volume in the DPH group. Preoperative and postoperative GH and insulin-like growth factor-1 levels did not differ between the two groups. CONCLUSION The findings suggested that lower preoperative weight and a postoperative transient gain in body weight are associated with an increased risk of DPH in acromegaly patients undergoing transsphenoidal surgery.
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Affiliation(s)
- Ryutaro Makino
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
- Pituitary Disorders Center, Kagoshima University Hospital, Kagoshima, Japan
| | - Shingo Fujio
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan.
- Pituitary Disorders Center, Kagoshima University Hospital, Kagoshima, Japan.
| | - Tomoko Hanada
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
- Pituitary Disorders Center, Kagoshima University Hospital, Kagoshima, Japan
| | - Masanori Yonenaga
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Shigeru Kawade
- Pituitary Disorders Center, Kagoshima University Hospital, Kagoshima, Japan
- Department of Diabetes and Endocrine Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Hiroshi Hashiguchi
- Pituitary Disorders Center, Kagoshima University Hospital, Kagoshima, Japan
- Department of Diabetes and Endocrine Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Yoshihiko Nishio
- Department of Diabetes and Endocrine Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Nayuta Higa
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Kazunori Arita
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Koji Yoshimoto
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryosuke Hanaya
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
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Abstract
The prevalence of obesity has increased dramatically during the past decades, which has been a major health problem. Since 1975, the number of people with obesity worldwide has nearly tripled. An increasing number of studies find obesity as a driver of chronic kidney disease (CKD) progression, and the mechanisms are complex and include hemodynamic changes, inflammation, oxidative stress, and activation of the renin-angiotensin-aldosterone system (RAAS). Obesity-related kidney disease is characterized by glomerulomegaly, which is often accompanied by localized and segmental glomerulosclerosis lesions. In these patients, the early symptoms are atypical, with microproteinuria being the main clinical manifestation and nephrotic syndrome being rare. Weight loss and RAAS blockers have a protective effect on obesity-related CKD, but even so, a significant proportion of patients eventually progress to end-stage renal disease despite treatment. Thus, it is critical to comprehend the mechanisms underlying obesity-related CKD to create new tactics for slowing or stopping disease progression. In this review, we summarize current knowledge on the mechanisms of obesity-related kidney disease, its pathological changes, and future perspectives on its treatment.
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Affiliation(s)
- Zongmiao Jiang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Yao Wang
- Department of Orthopedics, The Second Hospital Jilin University, Changchun, China
| | - Xue Zhao
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Haiying Cui
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Mingyue Han
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Xinhua Ren
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Xiaokun Gang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Guixia Wang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
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Luo ZR, Yu LL, Chen LW. Surgical outcomes associated with sleep apnea syndrome in Stanford A aortic dissection patients. BMC Cardiovasc Disord 2022; 22:329. [PMID: 35871643 PMCID: PMC9310499 DOI: 10.1186/s12872-022-02775-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 07/19/2022] [Indexed: 12/02/2022] Open
Abstract
Background Patients suffering from aortic dissection (AD) often experience sleep apnea syndrome (SAS), which aggravates their respiratory function and aortic false lumen expansion. Methods We analyzed the peri-operative data of Stanford A AD patients, with or without SAS, between January 2017 and June 2019. Subjects were separated into SAS positive (SAS+) and SAS negative (SAS−) cohorts, based on the Apnea-Hypopnea Index (AHI) and the Oxygen Desaturation Index (ODI). We next analyzed variables between the SAS+ and SAS− groups. Results 155, out of 198 AAD patients, were enlisted for this study. SAS+ patients exhibited higher rates of pneumonia (p < 0.001), heart failure (HF, p = 0.038), acute kidney injury (AKI, p = 0.001), ventilation time (p = 0.009), and hospitalization duration (p < 0.001). According to subsequent follow-ups, the unstented aorta false lumen dilatation (FLD) rate increased markedly, with increasing degree of SAS (p < 0.001, according to AHI and ODI). The SAS+ patients exhibited worse cumulative survival rate (p = 0.025). The significant risk factors (RF) for poor survival were: severe (p = 0.002) or moderate SAS (p = 0.008), prolonged ventilation time (p = 0.018), AKI (p = 0.015), HF New York Heart Association (NYHA) IV (p = 0.005) or III (p = 0.015), pneumonia (p = 0.005), Marfan syndrome (p = 0.010), systolic blood pressure (BP) upon arrival (p = 0.009), and BMI ≥ 30 (p = 0.004). Conclusions SAS+ Stanford A AD patients primarily exhibited higher rates of complications and low survival rates in the mid-time follow-up. Hence, the RFs associated with poor survival must be monitored carefully in SAS patients. Moreover, the FLD rate is related to the degree of SAS, thus treating SAS may mitigate FLD.
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Liu X, Wang X, Ma H, Zhang W. Mechanisms underlying acupuncture therapy in chronic kidney disease: A narrative overview of preclinical studies and clinical trials. FRONTIERS IN NEPHROLOGY 2022; 2:1006506. [PMID: 37675019 PMCID: PMC10479635 DOI: 10.3389/fneph.2022.1006506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/18/2022] [Indexed: 09/08/2023]
Abstract
Chronic kidney disease (CKD) is associated with high incidence, low awareness, and high disability rates among the population. Moreover, the disease significantly affects the physical and mental health of patients. Approximately 25% of patients with CKD develop end-stage renal disease (ESRD) within 20 years of diagnosis and have to rely on renal replacement therapy, which is associated with high mortality, heavy economic burden, and symptoms including fatigue, pain, insomnia, uremia pruritus, and restless leg syndrome. Currently, the means to delay the progress of CKD are insufficient; therefore, developing strategies for delaying CKD progression has important practical implications. In recent years, more and more people are accepting the traditional Chinese medical technique "acupuncture." Acupuncture has been shown to improve the uncomfortable symptoms of various diseases through stimulation (needling, medicinal moxibustion, infrared radiation, and acupressure) of acupoints. Its application has been known for thousands of years, and its safety and efficacy have been verified. As a convenient and inexpensive complementary therapy for CKD, acupuncture has recently been gaining interest among clinicians and scientists. Nevertheless, although clinical trials and meta-analysis findings have demonstrated the efficacy of acupuncture in reducing albuminuria, improving glomerular filtration rate, relieving symptoms, and improving the quality of life of patients with CKD, the underlying mechanisms involved are still not completely understood. Few studies explored the correlation between acupuncture and renal pathological diagnosis. The aim of this study was to conduct a literature review summarizing the currently known mechanisms by which acupuncture could delay the progress of CKD and improve symptoms in patients with ESRD. This review help provide a theoretical basis for further research regarding the influence of acupuncture on renal pathology in patients with CKD, as well as the differences between specific therapeutic mechanisms of acupuncture in different renal pathological diagnosis. The evidence in this review indicates that acupuncture may produce marked effects on blocking and reversing the critical risk factors of CKD progression (e.g., hyperglycemia, hypertension, hyperlipidemia, obesity, aging, and anemia) to improve the survival of patients with CKD via mechanisms including oxidative stress inhibition, reducing inflammatory effects, improving hemodynamics, maintaining podocyte structure, and increasing energy metabolism.
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Affiliation(s)
- Xinyin Liu
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiaoran Wang
- Department of Nephrology, The First People’s Hospital of Hangzhou Lin’An District, Hangzhou, China
| | - Hongzhen Ma
- Department of Nephrology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Wen Zhang
- Department of Nephrology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
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Antitoxic Effects of Curcumin against Obesity-Induced Multi-Organs' Biochemical and Histopathological Abnormalities in an Animal Model. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:9707278. [PMID: 36248416 PMCID: PMC9560822 DOI: 10.1155/2022/9707278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/17/2022] [Accepted: 09/19/2022] [Indexed: 11/07/2022]
Abstract
Background Obesity is a significant public health problem that is characterized by an increase in oxidative stress and enhanced inflammatory responses associated with immune cell invasion of adipose tissues. This study assessed several biochemical abnormalities, apoptosis, oxidative stress status, and associated histological changes in the liver, duodenum, and heart brought on by high-fat diet-induced obesity in rats. It also assessed the mechanistic benefits of curcumin in reversing these inflammatory, metabolic, and histological impairments. Methods Rats were assigned into three groups each including ten rats: the control group (CD), the high-fat diet group (HFD), and the high-fat diet + curcumin (HFDC) group. Serum glucose, insulin, and triglycerides (TAGs) were observed. In addition, apoptosis (indicated by hepatic DNA fragmentation) and oxidative stress status (indicated by hepatic MPO, GSH, and SOD) were assessed. Histopathological examinations included the GIT (liver and duodenum) and heart in addition to quantitative real-time polymerase chain reaction (qRT-PCR) assays of the adipose tissue genetic expressions for inflammatory signaling pathways (TLR4, IL-6, and TNF-α). Results The overall findings showed that the HFD group exhibited significantly higher levels of glucose, TAGs, and insulin than the control group (P < 0.01). The histological abnormalities of the studied organs in the HFD group were paralleled by these biochemical abnormalities, which were strongly associated with increased apoptosis, increased oxidative stress, and increased expression of the inflammatory signaling markers. There were significant improvements in the HFDC group in terms of biochemical, inflammatory, and histological investigations. Conclusions This study's findings concluded that obesity is significantly associated with biochemical and microscopic alterations in many organs. Curcumin exerted potent antitoxic, antioxidant, tissue-protective, and antiobesity effects. Curcumin is recommended to be added to various dietary regimens to prevent or delay the organs' dysfunction among obese people.
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Luo ZR, Chen XD, Chen LW. Age-dependent differences in the prognostic relevance of body composition-related variables in type A aortic dissection patients. J Cardiothorac Surg 2021; 16:359. [PMID: 34963491 PMCID: PMC8714453 DOI: 10.1186/s13019-021-01742-1] [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: 08/07/2021] [Accepted: 12/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background The current research is allocated to appraise the association between the parameters of body composition and findings in type A aortic dissection (TAAD) cases in diverse age groups. Methods Data from consecutive TAAD patients undergoing implantation of modified triple-branched stent-graft from January 2017 and December 2019 were prospectively collected and analyzed. A regression model of Cox proportional hazard was employed to assess correlations among body composition-related variables (body mass index [BMI], lean body mass [LBM], body surface area [BSA], and LBM index) as well as cumulative mortality. Results Overall, 258 patients (53.9 ± 11.1 years old; 72.9% male) were separated into young (n = 110) and elderly (n = 148) age groups based upon whether they were younger or older than 50 years of age. Of these patients, 247 survivors were included in subsequent analyses over an average 26.8 ± 11.6 month follow-up duration. Multivariate analyses in the elderly group instead of young group indicated that increased BMI (p = 0.042), BMI ≤ 18.5 kg/m2 (p = 0.025), and lower LBM index values (p = 0.019) were significant predictors of increased total all-cause cumulative mortality. BMI was considerably positively correlated with estimated all-cause cumulative mortality in elderly but not young TAAD cases. Conclusion Briefly, these results suggest that BMI and LBM indices are only significant predictors of TAAD patient all-cause mortality in elderly patient cohorts, whereas they do not offer significant prognostic value for younger patients. As such, these age differences must be taken into consideration when conducting stratified risk assessments based upon TAAD patient body composition characteristics. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-021-01742-1.
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Affiliation(s)
- Zeng-Rong Luo
- Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, People's Republic of China
| | - Xiao-Dong Chen
- Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, People's Republic of China
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China. .,Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, People's Republic of China.
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11
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Rodríguez C, Sánchez A, Sáenz-Medina J, Muñoz M, Hernández M, López M, Rivera L, Contreras C, Prieto D. Activation of AMP kinase ameliorates kidney vascular dysfunction, oxidative stress and inflammation in rodent models of obesity. Br J Pharmacol 2021; 178:4085-4103. [PMID: 34192805 DOI: 10.1111/bph.15600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 06/01/2021] [Accepted: 06/08/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND AND PURPOSE Obesity is a risk factor for the development of chronic kidney disease independent of diabetes, hypertension and other co-morbidities. Obesity-associated nephropathy is linked to dysregulation of the cell energy sensor AMP-activated protein kinase (AMPK). We aimed here to assess whether impairment of AMPK activity may cause renal arterial dysfunction in obesity and to evaluate the therapeutic potential of activating renal AMPK. EXPERIMENTAL APPROACH Effects of the AMPK activator A769662 were assessed on intrarenal arteries isolated from ob/ob mice and obese Zucker rats and then mounted in microvascular myographs. Superoxide and hydrogen peroxide production were measured by chemiluminescence and fluorescence, respectively, and protein expression was analysed by western blotting. KEY RESULTS Endothelium-dependent vasodilation and PI3K/Akt/eNOS pathway were impaired in preglomerular arteries from genetically obese rats and mice, along with impaired arterial AMPK activity and blunted relaxations induced by the AMPK activator A769662. Acute ex vivo exposure to A769662 restored endothelial function and enhanced activity of PI3K/Akt/eNOS pathway in obese rats, whereas in vivo treatment with A769662 improved metabolic state and ameliorated endothelial dysfunction, reduced inflammatory markers and vascular oxidative stress in renal arteries and restored redox balance in renal cortex of obese mice. CONCLUSION AND IMPLICATIONS These results demonstrate that AMPK dysregulation underlies obesity-associated kidney vascular dysfunction and activation of AMPK improves metabolic state, protects renal endothelial function and exerts potent vascular antioxidant and anti-inflammatory effects. The beneficial effects of vascular AMPK activation might represent a promising therapeutic approach to the treatment of obesity-related kidney injury.
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Affiliation(s)
- Claudia Rodríguez
- Departamento de Fisiología, Facultad de Farmacia, Universidad Complutense, Madrid, Spain
| | - Ana Sánchez
- Departamento de Fisiología, Facultad de Farmacia, Universidad Complutense, Madrid, Spain
| | - Javier Sáenz-Medina
- Departamento de Urología, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Mercedes Muñoz
- Departamento de Fisiología, Facultad de Farmacia, Universidad Complutense, Madrid, Spain
| | - Medardo Hernández
- Departamento de Fisiología, Facultad de Farmacia, Universidad Complutense, Madrid, Spain
| | - Miguel López
- NeurObesity Group, Department of Physiology, CIMUS, Universidad de Santiago de Compostela-Instituto de Investigación Sanitaria, Santiago de Compostela, Spain
| | - Luis Rivera
- Departamento de Fisiología, Facultad de Farmacia, Universidad Complutense, Madrid, Spain
| | - Cristina Contreras
- Departamento de Fisiología, Facultad de Farmacia, Universidad Complutense, Madrid, Spain
| | - Dolores Prieto
- Departamento de Fisiología, Facultad de Farmacia, Universidad Complutense, Madrid, Spain
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12
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Mei Y, Kuai Y, Hu H, Liu F, Liu B, Sun X, Tan W. Isosteviol Sodium Attenuates High Fat/High Cholesterol-Induced Kidney Dysfunction by Inhibiting Inflammation, Oxidative Stress and Apoptosis. Biol Pharm Bull 2021; 43:1172-1178. [PMID: 32741937 DOI: 10.1248/bpb.b19-01028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The sodium salt of isosteviol (STVNa) is a beyerane diterpene synthesized through acid hydrolysis of stevioside. STVNa improves multiple types of tissue injuries. However, it is not known how isosteviol sodium affects high-fat and high cholesterol diet (HFD)-induced kidney. Therefore, in this study we examined the potential molecular mechanism underlying STVNa mediated protective effect against high fat/high cholesterol-induced kidney dysfunction in HFD-induced kidney injury. Sprague-Dawley (SD) rats were allocated into six groups: the normal group, HFD group and HFD treated with three doses of STVNa, fenofibrate treatment group. The results indicated that HFD induced kidney injury evident by a 60% increase in serum creatinine (CRE) leves. In addition, there was a significant accumulation of triglycerides (approx. 60%), fatty acids (approx. 50%) and total cholesterol (approx. 2.5 fold) in the kidneys. STVNa inhibited HFD-induced kidney injury evident by reducing the increased levels of serum CRE. Specifically, STVNa attenuated HFD-induced kidney injury by inhibiting inflammation, oxidative stress, and apoptosis. These findings indicate that STVNa has a therapeutic potential for HFD-induced kidney dysfunction. The mechanisms of this pharmacological effect are through the inhibition of inflammation, oxidative stress and apoptosis.
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Affiliation(s)
- Ying Mei
- Institute of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology
| | - Yihe Kuai
- Institute of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology
| | - Hui Hu
- Institute of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology
| | - Fei Liu
- Institute of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology
| | - Bo Liu
- Institute of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology
| | - Xiaoou Sun
- Institute of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology
| | - Wen Tan
- Institute of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology
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13
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Miricescu D, Balan DG, Tulin A, Stiru O, Vacaroiu IA, Mihai DA, Popa CC, Enyedi M, Nedelea AS, Nica AE, Stefani C. Impact of adipose tissue in chronic kidney disease development (Review). Exp Ther Med 2021; 21:539. [PMID: 33815612 PMCID: PMC8014972 DOI: 10.3892/etm.2021.9969] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/14/2021] [Indexed: 12/13/2022] Open
Abstract
Obesity is a worldwide pandemic health issue. Obesity is associated with the pathogenesis of type 2 diabetes, hypertension, dyslipidemia, cardiovascular diseases, cancer, and kidney diseases. This systemic disease can affect the kidneys by two mechanisms: Indirectly through diabetes mellitus (DM) and hypertension and directly through adipokines secreted by adipose tissue. Obesity is a risk factor for chronic kidney disease (CKD), which is associated with an increased risk of morbidity and mortality among the adult population. Increased visceral adipose tissue leads to renal glomerular hyperfiltration and hyperperfusion, which may lead to glomerular hypertrophy, proteinuria, and CKD development. Adipokines are hormones produced by fat tissue. They are involved in energy homeostasis, sugar and fat metabolism, reproduction, immunity, and thermogenesis control. Hormones and cytokines secreted by adipose tissue contribute to the development and progression of CKD. Decreased serum or urinary adiponectin levels are specific in diabetic and non-diabetic CKD patients, while leptin presents increased levels, and both are associated with the development of glomerulopathy. Excessive adipose tissue is associated with inflammation, oxidative stress (OS), insulin resistance and activation of the renin angiotensin-aldosterone system (RAAS). Therefore, adipose tissue dysfunction plays an important role in the development of CKD.
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Affiliation(s)
- Daniela Miricescu
- Department of Biochemistry, Faculty of Dental Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Daniela Gabriela Balan
- Discipline of Physiology, Faculty of Dental Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Adrian Tulin
- Department of Anatomy, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of General Surgery, ‘Prof. Dr. Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania
| | - Ovidiu Stiru
- Department of Cardiovascular Surgery, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Cardiovascular Surgery, ‘Prof. Dr. C.C. Iliescu’ Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
| | - Ileana Adela Vacaroiu
- Department of Nephrology and Dialysis, ‘Sf. Ioan’ Emergency Clinical Hospital, 042122 Bucharest, Romania
- Department of Nephrology, Nutrition and Metabolic Diseases, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Doina Andrada Mihai
- Discipline of Diabetes, Nutrition and Metabolic Diseases, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department II of Diabetes, ‘Prof. N. Paulescu’ National Institute of Diabetes, Nutrition and Metabolic Diseases, 020474 Bucharest, Romania
| | - Cristian Constantin Popa
- Department of Surgery, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Surgery, Bucharest Emergency University Hospital, 050098 Bucharest, Romania
| | - Mihaly Enyedi
- Department of Anatomy, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Radiology, ‘Victor Babes’ Private Medical Clinic, 030303 Bucharest, Romania
| | - Andrei Sorin Nedelea
- Department of Urology, ‘Prof. Dr. Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania
| | - Adriana Elena Nica
- Department of Orthopedics, Anesthesia Intensive Care Unit, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Constantin Stefani
- Department of Family Medicine and Clinical Base, Dr. Carol Davila Central Military Emergency University Hospital, 010825 Bucharest, Romania
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14
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Hall JE, Mouton AJ, da Silva AA, Omoto ACM, Wang Z, Li X, do Carmo JM. Obesity, kidney dysfunction, and inflammation: interactions in hypertension. Cardiovasc Res 2020; 117:1859-1876. [PMID: 33258945 DOI: 10.1093/cvr/cvaa336] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/01/2020] [Accepted: 11/17/2020] [Indexed: 12/20/2022] Open
Abstract
Obesity contributes 65-75% of the risk for human primary (essential) hypertension (HT) which is a major driver of cardiovascular and kidney diseases. Kidney dysfunction, associated with increased renal sodium reabsorption and compensatory glomerular hyperfiltration, plays a key role in initiating obesity-HT and target organ injury. Mediators of kidney dysfunction and increased blood pressure include (i) elevated renal sympathetic nerve activity (RSNA); (ii) increased antinatriuretic hormones such as angiotensin II and aldosterone; (iii) relative deficiency of natriuretic hormones; (iv) renal compression by fat in and around the kidneys; and (v) activation of innate and adaptive immune cells that invade tissues throughout the body, producing inflammatory cytokines/chemokines that contribute to vascular and target organ injury, and exacerbate HT. These neurohormonal, renal, and inflammatory mechanisms of obesity-HT are interdependent. For example, excess adiposity increases the adipocyte-derived cytokine leptin which increases RSNA by stimulating the central nervous system proopiomelanocortin-melanocortin 4 receptor pathway. Excess visceral, perirenal and renal sinus fat compress the kidneys which, along with increased RSNA, contribute to renin-angiotensin-aldosterone system activation, although obesity may also activate mineralocorticoid receptors independent of aldosterone. Prolonged obesity, HT, metabolic abnormalities, and inflammation cause progressive renal injury, making HT more resistant to therapy and often requiring multiple antihypertensive drugs and concurrent treatment of dyslipidaemia, insulin resistance, diabetes, and inflammation. More effective anti-obesity drugs are needed to prevent the cascade of cardiorenal, metabolic, and immune disorders that threaten to overwhelm health care systems as obesity prevalence continues to increase.
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Affiliation(s)
- John E Hall
- Department of Physiology & Biophysics, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 30216-4505, USA.,Mississippi Center for Obesity Research, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 30216-4505, USA.,Mississippi Center for Clinical and Translational Research, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 30216-4505, USA
| | - Alan J Mouton
- Department of Physiology & Biophysics, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 30216-4505, USA.,Mississippi Center for Obesity Research, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 30216-4505, USA
| | - Alexandre A da Silva
- Department of Physiology & Biophysics, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 30216-4505, USA.,Mississippi Center for Obesity Research, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 30216-4505, USA
| | - Ana C M Omoto
- Department of Physiology & Biophysics, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 30216-4505, USA.,Mississippi Center for Obesity Research, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 30216-4505, USA
| | - Zhen Wang
- Department of Physiology & Biophysics, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 30216-4505, USA.,Mississippi Center for Obesity Research, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 30216-4505, USA
| | - Xuan Li
- Department of Physiology & Biophysics, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 30216-4505, USA.,Mississippi Center for Obesity Research, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 30216-4505, USA
| | - Jussara M do Carmo
- Department of Physiology & Biophysics, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 30216-4505, USA.,Mississippi Center for Obesity Research, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 30216-4505, USA
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15
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Voglis S, van Niftrik CHB, Staartjes VE, Brandi G, Tschopp O, Regli L, Serra C. Feasibility of machine learning based predictive modelling of postoperative hyponatremia after pituitary surgery. Pituitary 2020; 23:543-551. [PMID: 32488759 DOI: 10.1007/s11102-020-01056-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE Hyponatremia after pituitary surgery is a frequent finding with potential severe complications and the most common cause for readmission. Several studies have found parameters associated with postoperative hyponatremia, but no reliable specific predictor was described yet. This pilot study evaluates the feasibility of machine learning (ML) algorithms to predict postoperative hyponatremia after resection of pituitary lesions. METHODS Retrospective screening of a prospective registry of patients who underwent transsphenoidal surgery for pituitary lesions. Hyponatremia within 30 days after surgery was the primary outcome. Several pre- and intraoperative clinical, procedural and laboratory features were selected to train different ML algorithms. Trained models were compared using common performance metrics. Final model was internally validated on the testing dataset. RESULTS From 207 patients included in the study, 44 (22%) showed a hyponatremia within 30 days postoperatively. Hyponatremic measurements peaked directly postoperatively (day 0-1) and around day 7. Bootstrapped performance metrics of different trained ML-models showed largest area under the receiver operating characteristic curve (AUROC) for the boosted generalized linear model (67.1%), followed by the Naïve Bayes classifier (64.6%). The discriminative capability of the final model was assessed by predicting on unseen dataset. Large AUROC (84.3%; 67.0-96.4), sensitivity (81.8%) and specificity (77.5%) with an overall accuracy of 78.4% (66.7-88.2) was reached. CONCLUSION Our trained ML-model was able to learn the complex risk factor interactions and showed a high discriminative capability on unseen patient data. In conclusion, ML-methods can predict postoperative hyponatremia and thus potentially reduce morbidity and improve patient safety.
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Affiliation(s)
- Stefanos Voglis
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Frauenklinkstrasse 10, 8091, Zurich, Switzerland.
| | - Christiaan H B van Niftrik
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Frauenklinkstrasse 10, 8091, Zurich, Switzerland
| | - Victor E Staartjes
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Frauenklinkstrasse 10, 8091, Zurich, Switzerland
| | - Giovanna Brandi
- Neurosurgical Intensive Care Unit, Institute for Intensive Care Medicine, University Hospital and University of Zurich, Zurich, Switzerland
| | - Oliver Tschopp
- Department of Endocrinology, Diabetes, and Clinical Nutrition, University Hospital and University of Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Frauenklinkstrasse 10, 8091, Zurich, Switzerland
| | - Carlo Serra
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Frauenklinkstrasse 10, 8091, Zurich, Switzerland
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16
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Williams FB, McBride CA, Badger GJ, Bernstein IM. Measures of adiposity correlate with renal filtration in young nulliparous women: An observational cohort study. Obes Sci Pract 2020; 6:70-75. [PMID: 32128244 PMCID: PMC7042107 DOI: 10.1002/osp4.375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/09/2019] [Accepted: 09/28/2019] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Renal hyperfiltration, which has been documented in severe obesity and obesity-associated hypertension, can occur with hypertensive disorders of pregnancy. Identification of prepregnancy risk factors for unrecognized renal hyperfiltration could inform screening and intervention strategies to protect against pregnancy complications. In young, healthy, nulliparous women, associations between associations between measures of adiposity, insulin resistance, and renal vascular resistance were thus evaluated. METHODS This is a secondary analysis of a prospective observational trial characterizing associations of prepregnancy and late-pregnancy maternal physiology. Seventy-nine nulligravid women aged 18-42 years without major medical conditions were assessed for percent android body fat using dual-energy X-ray absorption. Renal cortical vessel blood flow resistance index (CVRI) was determined using Doppler ultrasonography. Creatinine clearance was calculated from 24-hour urine collection. RESULTS Renal CVRI inversely correlates with body mass index (r = -0.23, p = 0.047), percent android fat (r = -0.30, p = 0.008), and supine pulse (r = -0.44, p < 0.001). Creatinine clearance is positively associated with BMI and HOMA-IR.In regression modeling, supine pulse (r2 = 0.22, p < 0.001) and cardiac index (r2 = 0.05, p = 0.045) predict renal CVRI, whereas HOMA-IR (r2 = 0.11, p = 0.008) and cardiac output (r2 = 0.06, p = 0.039) predict creatinine clearance. Measures of adiposity are not independently predictive of either measure. CONCLUSIONS In healthy young women, measures of adiposity and insulin resistance correlate positively with renal filtration. Preclinical manifestations of renal hyperfiltration may have implications for pregnancy outcomes.
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Affiliation(s)
- Frank B. Williams
- Department of Obstetrics, Gynecology and Reproductive Services, Larner College of MedicineUniversity of VermontBurlingtonVermont
| | - Carole A. McBride
- Department of Obstetrics, Gynecology and Reproductive Services, Larner College of MedicineUniversity of VermontBurlingtonVermont
| | - Gary J. Badger
- Department of Obstetrics, Gynecology and Reproductive Services, Larner College of MedicineUniversity of VermontBurlingtonVermont
| | - Ira M. Bernstein
- Department of Obstetrics, Gynecology and Reproductive Services, Larner College of MedicineUniversity of VermontBurlingtonVermont
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17
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Shi N, Liu K, Fan Y, Yang L, Zhang S, Li X, Wu H, Li M, Mao H, Xu X, Ma SP, Xiao P, Jiang S. The Association Between Obesity and Risk of Acute Kidney Injury After Cardiac Surgery. Front Endocrinol (Lausanne) 2020; 11:534294. [PMID: 33123083 PMCID: PMC7573233 DOI: 10.3389/fendo.2020.534294] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 09/08/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine the relationship between obesity and the risk of AKI after cardiac surgery (CS-AKI) in a cohort study. METHODS A total of 1,601 patients undergoing cardiac surgery were collected and their incidence of CS-AKI was recorded. They were divided into underweight, normal weight, overweight, and obese groups. Logistic regression was used to estimate the association between BMI (body mass index) and CS-AKI risk. Then, a meta-analysis of published cohort studies was conducted to confirm this result using PubMed and Embase databases. RESULTS A significant association was observed in this independent cohort after adjusting age, gender, hypertension and New York Heart Association classification (NYHA) class. Compared with normal BMI group (18.5 ≤ BMI < 24.0), the individuals with aberrant BMI level had an increased AKI risk (OR: 1.68, 95% CI: 1.01-2.78) for BMI < 18.5 group and (OR: 1.43, 95% CI: 0.96-2.15) for BMI ≥ 28.0. Interestingly, the U-shape curve showed the CS-AKI risk reduced with the increasing of BMI when BMI ≤ 24.0. As BMI increases with BMI > 24.0, the risk of developing CS-AKI increased significantly. In the confirmed meta-analysis, compared with normal weight, overweight group with cardiac surgery had higher AKI risk (OR: 1.28, 95% CI: 1.16-1.41, Pheterogeneity = 0.49). The similar association was found in obesity subgroup (OR: 1.79, 95% CI: 1.57-2.03, Pheterogeneity = 0.42). CONCLUSION In conclusion, the results suggested that abnormal BMI was a risk factor for CS-AKI independently.
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Affiliation(s)
- Ning Shi
- Clinical Metabolomics Center, China Pharmaceutical University, Nanjing, China
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China
| | - Kang Liu
- Department of Nephrology, Jiangsu Province Hospital, Nanjing, China
| | - Yuanming Fan
- Clinical Metabolomics Center, China Pharmaceutical University, Nanjing, China
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China
| | - Lulu Yang
- Clinical Metabolomics Center, China Pharmaceutical University, Nanjing, China
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China
| | - Song Zhang
- Clinical Metabolomics Center, China Pharmaceutical University, Nanjing, China
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China
| | - Xu Li
- Clinical Metabolomics Center, China Pharmaceutical University, Nanjing, China
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China
| | - Hanzhang Wu
- Department of Nephrology, Jiangsu Province Hospital, Nanjing, China
| | - Meiyuan Li
- Department of Nephrology, Jiangsu Province Hospital, Nanjing, China
| | - Huijuan Mao
- Department of Nephrology, Jiangsu Province Hospital, Nanjing, China
| | - Xueqiang Xu
- Department of Nephrology, Jiangsu Province Hospital, Nanjing, China
| | - Shi-Ping Ma
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China
- *Correspondence: Shujun Jiang, ; Pingxi Xiao, ; Shi-Ping Ma,
| | - Pingxi Xiao
- Department of Cardiology, The Affiliated Sir Run Run Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Shujun Jiang, ; Pingxi Xiao, ; Shi-Ping Ma,
| | - Shujun Jiang
- Clinical Metabolomics Center, China Pharmaceutical University, Nanjing, China
- Department of Infectious Diseases, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China
- *Correspondence: Shujun Jiang, ; Pingxi Xiao, ; Shi-Ping Ma,
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18
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Younus I, Gerges MM, Dobri GA, Ramakrishna R, Schwartz TH. Readmission after endoscopic transsphenoidal pituitary surgery: analysis of 584 consecutive cases. J Neurosurg 2019; 133:1242-1247. [PMID: 31561225 DOI: 10.3171/2019.7.jns191558] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/01/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Hospital readmission is a key component in value-based healthcare models but there are limited data about the 30-day readmission rate after endonasal endoscopic transsphenoidal surgery (EETS) for pituitary adenoma. The objective of this study was to determine the incidence and identify factors associated with 30-day readmission after EETS for pituitary adenoma. METHODS The authors analyzed a prospectively acquired database of patients who underwent EETS for pituitary adenoma from 2005 to 2018 at NewYork-Presbyterian Hospital, Weill Cornell Medicine. Clinical, socioeconomic, and radiographic data were reviewed for cases of unplanned readmission within 30 days of surgery and, as a control group, for all other patients in the series who were not readmitted. Statistical significance was determined with an alpha < 0.05 using Pearson's chi-square and Fisher's exact tests for categorical variables and the independent-samples t-test for continuous variables. RESULTS Of 584 patients undergoing EETS for pituitary adenoma, 27 (4.6%) had unplanned readmission within 30 days. Most readmissions occurred within the first week after surgery, with a mean time to readmission of 6.6 ± 3.9 days. The majority of readmissions (59%) were for hyponatremia. These patients had a mean sodium level of 120.6 ± 4.6 mEq/L at presentation. Other causes of readmission were epistaxis (11%), spinal headache (11%), sellar hematoma (7.4%), CSF leak (3.7%), nonspecific headache (3.7%), and pulmonary embolism (3.7%). The postoperative length of stay was significantly shorter for patients who were readmitted than for the controls (2.7 ± 1.0 days vs 3.9 ± 3.2 days; p < 0.05). Patients readmitted for hyponatremia had an initial length of stay of 2.6 ± 0.9 days, the shortest of any cause for readmission. The mean BMI was significantly lower for readmitted patients than for the controls (26.4 ± 3.9 kg/m2 vs 29.3 ± 6.1 kg/m2; p < 0.05). CONCLUSIONS Readmission after EETS for pituitary adenoma is a relatively rare phenomenon, with delayed hyponatremia being the primary cause. The study results demonstrate that shorter postoperative length of stay and lower BMI were associated with 30-day readmission.
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Affiliation(s)
| | - Mina M Gerges
- Departments of2Neurosurgery
- 6Department of Neurosurgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Georgiana A Dobri
- Departments of2Neurosurgery
- 4Neuroscience, and
- 5Endocrinology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York; and
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19
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Gigante A, Giannakakis K, Di Mario F, Barbano B, Rosato E, Pofi R, Di Paolo M, Rocca AR, Cianci R. BMI, nephroangiosclerosis and glomerulonephritis: Is there any meeting point? Nephrology (Carlton) 2019; 23:991-996. [PMID: 28817218 DOI: 10.1111/nep.13155] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 06/26/2017] [Accepted: 08/11/2017] [Indexed: 11/29/2022]
Abstract
AIM Overweight has been related to renal arteriolosclerosis and is able to modify intrarenal haemodynamics. Increasing evidence suggests an association between weight in excess and primary glomerulonephritis (GN). The aim of this study was to evaluate the relationship between nutritional status and intrarenal arterial stiffness in primary GN associated to arteriolosclerosis. We have considered the glomerular diameter (GD) as morphological parameter in overweight and obese patients. METHODS Clinical, laboratory, anthropometric data and renal Doppler ultrasound were performed immediately before kidney biopsy. RESULTS Primary GN was diagnosed in 92 patients. Mild arteriolosclerosis was found in 19.6% of patients, moderate in the 20.6%, severe in the 10.9% while nephroangiosclerosis was diagnosed in 8.7% of patients. A positive correlation was found between body mass index (BMI) and renal resistive index (RRI) (P < 0.01, r = 0.34). RRI were significantly higher in patients with severe arteriolosclerosis at kidney biopsy (P < 0.05). Furthermore, higher BMI (P < 0.01) was found in patients with renal arteriolosclerosis than patients without renal arteriolosclerosis (26.1 ± 4.4 kg/m2 vs. 24.4 ± 4.5 kg/m2 ). Finally, in overweight and obesity patients we found a positive correlation between maximal GD and BMI (P < 0.01) and maximal GD and RRI (P < 0.01). CONCLUSION In overweight and obese patients affected by primary GN, it might be found not only glomerular but also renal vascular lesions. Finally, we believe that nephroangiosclerosis, in combination with weight in excess, is able to modify intrarenal haemodynamic parameters. Moreover, in response to these changes, the renal tissue morphologically promotes a GD increase regardless of the underlying GN.
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Affiliation(s)
- Antonietta Gigante
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Konstantinos Giannakakis
- Department of Radiology, Oncology, Radiology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Francesca Di Mario
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Biagio Barbano
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Edoardo Rosato
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Riccardo Pofi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Marcello Di Paolo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Anna Rachele Rocca
- Nephrology and Dialysis A Unit, Sapienza University of Rome, Rome, Italy
| | - Rosario Cianci
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
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20
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Lio A, Bovio E, Nicolò F, Saitto G, Scafuri A, Bassano C, Chiariello L, Ruvolo G. Influence of Body Mass Index on Outcomes of Patients Undergoing Surgery for Acute Aortic Dissection: A Propensity-Matched Analysis. Tex Heart Inst J 2019; 46:7-13. [PMID: 30833831 DOI: 10.14503/thij-17-6365] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
To determine whether body mass index ≥30 kg/m2 affects morbidity and mortality rates in patients undergoing surgery for type A acute aortic dissection, we conducted a retrospective study of 201 patients with type A dissection. Patients were divided into 2 groups according to body mass index (BMI): nonobese (BMI, <30 kg/m2; 158 patients) and obese (BMI, ≥30 kg/m2; 43 patients). Propensity score matching was used to reduce selection bias. The overall mortality rate was 19% (38/201 patients). The perioperative mortality rate was higher in the obese group, both in the overall cohort (33% vs 15%; P=0.01) and in the propensity-matched cohort (32% vs 12%; P=0.039). In the propensity-matched cohort, patients with obesity had higher rates of low cardiac output syndrome (26% vs 6%; P=0.045) and pulmonary complications (32% vs 9%; P=0.033) than those without obesity. The overall 5-year survival rates were 52.5% ± 7.8% in the obese group and 70.3% ± 4.4% in the nonobese group (P=0.036). In the propensity-matched cohort, the 5-year survival rates were 54.3% ± 8.9% in the obese group and 81.6% ± 6.8% in the nonobese group (P=0.018). Patients with obesity (BMI, ≥30 kg/m2) who underwent surgery for type A acute aortic dissection had higher operative mortality rates and an increased risk of low cardiac output syndrome, pulmonary complications, and other postoperative morbidities than did patients without obesity. Additional extensive studies are needed to confirm our findings.
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Patel VJ, Joharapurkar AA, Kshirsagar SG, Sutariya BK, Patel MS, Patel HM, Pandey DK, Bahekar RH, Jain MR. Coagonist of glucagon-like peptide-1 and glucagon receptors ameliorates kidney injury in murine models of obesity and diabetes mellitus. World J Diabetes 2018; 9:80-91. [PMID: 29988851 PMCID: PMC6033704 DOI: 10.4239/wjd.v9.i6.80] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 05/10/2018] [Accepted: 05/15/2018] [Indexed: 02/05/2023] Open
Abstract
AIM To investigate the role of glucagon-like peptide-1 (GLP-1)/glucagon receptors coagonist on renal dysfunction associated with diabetes and obesity.
METHODS Chronic high-fat diet fed C57BL/6J mice, streptozotocin-treated high-fat diet fed C57BL/6J mice and diabetic C57BLKS/J db/db mice were used as models of diabetes-induced renal dysfunction. The streptozotocin-treated high-fat diet fed mice and db/db mice were treated with the GLP-1 and glucagon receptors coagonist (Aib2 C24 Chimera2, 150 μg/kg, sc) for twelve weeks, while in chronic high-fat diet fed mice, coagonist (Aib2 C24 Chimera2, 150 μg/kg, sc) treatment was continued for forty weeks. Kidney function, histology, fibrosis, inflammation, and plasma biochemistry were assessed at the end of the treatment.
RESULTS Coagonist treatment decreased body weight, plasma lipids, insulin resistance, creatinine, blood urea nitrogen, urinary albumin excretion rate and renal lipids. In kidney, expression of lipogenic genes (SREBP-1C, FAS, and SCD-1) was decreased, and expression of genes involved in β-oxidation (CPT-1 and PPAR-α) was increased due to coagonist treatment. In plasma, coagonist treatment increased adiponectin and FGF21 and decreased IL-6 and TNF-α. Coagonist treatment reduced expression of inflammatory (TNF-α, MCP-1, and MMP-9) and pro-fibrotic (TGF-β, COL1A1, and α-SMA) genes and also improved histological derangement in renal tissue.
CONCLUSION Coagonist of GLP-1 and glucagon receptors alleviated diabetes and obesity-induced renal dysfunction by reducing glucose intolerance, obesity, and hyperlipidemia.
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Affiliation(s)
- Vishal J Patel
- Department of Pharmacology and Toxicology, Zydus Research Centre, Cadila Healthcare Limited, Ahmedabad 382210, India
| | - Amit A Joharapurkar
- Department of Pharmacology and Toxicology, Zydus Research Centre, Cadila Healthcare Limited, Ahmedabad 382210, India
| | - Samadhan G Kshirsagar
- Department of Pharmacology and Toxicology, Zydus Research Centre, Cadila Healthcare Limited, Ahmedabad 382210, India
| | - Brijesh K Sutariya
- Department of Pharmacology and Toxicology, Zydus Research Centre, Cadila Healthcare Limited, Ahmedabad 382210, India
| | - Maulik S Patel
- Department of Pharmacology and Toxicology, Zydus Research Centre, Cadila Healthcare Limited, Ahmedabad 382210, India
| | - Hiren M Patel
- Department of Pharmacology and Toxicology, Zydus Research Centre, Cadila Healthcare Limited, Ahmedabad 382210, India
| | - Dheerendra K Pandey
- Department of Pharmacology and Toxicology, Zydus Research Centre, Cadila Healthcare Limited, Ahmedabad 382210, India
| | - Rajesh H Bahekar
- Department of Pharmacology and Toxicology, Zydus Research Centre, Cadila Healthcare Limited, Ahmedabad 382210, India
| | - Mukul R Jain
- Department of Pharmacology and Toxicology, Zydus Research Centre, Cadila Healthcare Limited, Ahmedabad 382210, India
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Abstract
Obesity is a complex disease with many causal factors, associated with multiple comorbidities that contribute to significant morbidity and mortality. It is a highly prevalent disease that poses an enormous health and economic burden to society. This article reviews the mechanisms of obesity and its related comorbidities.
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Affiliation(s)
- Jagriti Upadhyay
- Section of Endocrinology, Diabetes and Metabolism, Boston VA Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, USA; Division of Endocrinology, Boston Medical Center, Boston University, 88 East Newton Street, Boston, MA 02118; Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.
| | - Olivia Farr
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Nikolaos Perakakis
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Wael Ghaly
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Christos Mantzoros
- Section of Endocrinology, Diabetes and Metabolism, Boston VA Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, USA; Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
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Abstract
PURPOSE OF REVIEW Several interrelated mechanisms promote the development of hypertension in obesity, often contributing to end organ damage including cardiovascular disease and chronic kidney disease. RECENT FINDINGS The treatment of hypertension in obesity is complicated by a high prevalence of resistant hypertension, as well as unpredictable hemodynamic effects of many medications. Weight loss stabilizes neurohormonal activity and causes clinically significant reductions in blood pressure. While lifestyle interventions can improve blood pressure, they fail to consistently yield sustained weight loss and have not demonstrated long-term benefits. Bariatric surgery provides more permanent weight reduction, corresponding with dramatic declines in blood pressure and attenuation of long-term cardiovascular risk. Hypertension is closely linked to the prevalence, pathophysiology, and morbidity of obesity. There are multiple barriers to managing hypertension in obesity. Surgical weight loss offers the most promise in reducing blood pressure and decreasing end organ damage in this patient population.
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Lee K. Lung function and impaired kidney function in relation to metabolic syndrome. Int Urol Nephrol 2017; 49:1217-1223. [PMID: 28299524 DOI: 10.1007/s11255-017-1567-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 03/08/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE This study aimed to assess the relationships between abnormal lung function and indicators of chronic kidney disease in relation to metabolic syndrome (MetS) by using data from the 2011-2013 Korea National Health and Nutrition Examination Survey. METHODS Using the data of 8551 Korean adults (3798 men, 4753 women, ≥40 years), lung function categories [obstructive lung disease (OLD), restrictive lung disease (RLD), and non-obstructive/non-restrictive lung disease (reference group)] were defined for each gender. Albuminuria and low estimated glomerular filtration rate (eGFR) were defined as urine albumin-to-creatinine ratio ≥30 mg/g and eGFR < 60 mL/min/1.73 m2. Gender-specific logistic regression analysis was performed after adjusting for age, educational level, smoking, alcohol use, physical activity, and medication use for chronic diseases. RESULTS Compared to the reference group, low eGFR was associated with higher odds for RLD in men and RLD or OLD in women when they did not have MetS. In those with MetS, low eGFR was associated with higher odds for OLD in men and RLD or OLD in women. Albuminuria was associated with higher odds for RLD in men who did not have MetS, while it was associated with higher odds for RLD or OLD in men and women who had MetS. CONCLUSIONS Abnormal lung function was associated with increased odds for chronic kidney disease indicators, when combined with MetS in both gender. Even in those without MetS, RLD in men was associated with increased odds for low eGFR or albuminuria, while RLD or OLD in women was associated with increased odds for low eGFR.
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Affiliation(s)
- Kayoung Lee
- Department of Family Medicine, Busan Paik Hospital, Inje University College of Medicine, 633-165 Gaegum-dong, Busan Jin-Gu, Busan, 614-735, Republic of Korea.
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25
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Abstract
The prevalence of obesity-related hypertension is high worldwide and has become a major health issue. The mechanisms by which obesity relates to hypertensive disease are still under intense research scrutiny, and include altered hemodynamics, impaired sodium homeostasis, renal dysfunction, autonomic nervous system imbalance, endocrine alterations, oxidative stress and inflammation, and vascular injury. Most of these contributing factors interact with each other at multiple levels. Thus, as a multifactorial and complex disease, obesity-related hypertension should be recognized as a distinctive form of hypertension, and specific considerations should apply in planning therapeutic approaches to treat obese individuals with high blood pressure.
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Affiliation(s)
- Dinko Susic
- Hypertension Research Laboratory, Ochsner Clinic Foundation, 1514 Jefferson Highway New Orleans, Louisiana 70121, USA
| | - Jasmina Varagic
- Hypertension & Vascular Research, Department of Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157, USA; Department of Physiology and Pharmacology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157, USA.
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26
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Chiang CK, Wang CC, Lu TF, Huang KH, Sheu ML, Liu SH, Hung KY. Involvement of Endoplasmic Reticulum Stress, Autophagy, and Apoptosis in Advanced Glycation End Products-Induced Glomerular Mesangial Cell Injury. Sci Rep 2016; 6:34167. [PMID: 27665710 PMCID: PMC5035926 DOI: 10.1038/srep34167] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 09/08/2016] [Indexed: 12/24/2022] Open
Abstract
Advanced glycation end-products (AGEs)-induced mesangial cell death is one of major causes of glomerulus dysfunction in diabetic nephropathy. Both endoplasmic reticulum (ER) stress and autophagy are adaptive responses in cells under environmental stress and participate in the renal diseases. The role of ER stress and autophagy in AGEs-induced mesangial cell death is still unclear. Here, we investigated the effect and mechanism of AGEs on glomerular mesangial cells. AGEs dose-dependently decreased mesangial cell viability and induced cell apoptosis. AGEs also induced ER stress signals in a time- and dose-dependent manner. Inhibition of ER stress with 4-phenylbutyric acid effectively inhibited the activation of eIF2α and CHOP signals and reversed AGEs-induced cell apoptosis. AGEs also activated LC-3 cleavage, increased Atg5 expression, and decreased p62 expression, which indicated the autophagy induction in mesangial cells. Inhibition of autophagy by Atg5 siRNAs transfection aggravated AGEs-induced mesangial cell apoptosis. Moreover, ER stress inhibition by 4-phenylbutyric acid significantly reversed AGEs-induced autophagy, but autophagy inhibition did not influence the AGEs-induced ER stress-related signals activation. These results suggest that AGEs induce mesangial cell apoptosis via an ER stress-triggered signaling pathway. Atg5-dependent autophagy plays a protective role. These findings may offer a new strategy against AGEs toxicity in the kidney.
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Affiliation(s)
- Chih-Kang Chiang
- Institute of Toxicology, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Integrated Diagnostics &Therapeutics, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Ching-Chia Wang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Tien-Fong Lu
- Institute of Toxicology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kuo-How Huang
- Department of Urology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Meei-Ling Sheu
- Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan
| | - Shing-Hwa Liu
- Institute of Toxicology, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Kuan-Yu Hung
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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27
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Wołyniec Z, Dębska-Ślizień A, Wołyniec W, Rutkowski B. Impact of Obesity on Renal Graft Function—Analysis of Kidney Grafts From the Same Donor. Transplant Proc 2016; 48:1482-8. [DOI: 10.1016/j.transproceed.2015.12.135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/30/2015] [Indexed: 01/10/2023]
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28
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Cohen JB, Stephens-Shields AJ, Denburg MR, Anderson AH, Townsend RR, Reese PP. Obesity, Renin-Angiotensin System Blockade and Risk of Adverse Renal Outcomes: A Population-Based Cohort Study. Am J Nephrol 2016; 43:431-40. [PMID: 27228992 DOI: 10.1159/000446862] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 05/06/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Obesity substantially increases the risk of the development of chronic kidney disease. Adipose tissue expresses all of the components of the renin-angiotensin system (RAS), contributing to the high prevalence of hypertension in obese patients and driving renal hyperfiltration and subsequent glomerular injury. METHODS We performed a retrospective cohort study using a United Kingdom primary care database, evaluating the effect of time-updated exposure to RAS blockade versus all other antihypertensive medications in obese, hypertensive, non-diabetic patients. We used Cox proportional hazards modeling with and without marginal structural modeling to assess the hazards of developing a primary outcome of 50% reduction in estimated glomerular filtration rate (eGFR) (across 2 consecutive values), end stage renal disease or death. RESULTS A total of 219,701 patients met inclusion criteria, with a median 7.2 years of follow-up. Median baseline eGFR was 72.6 ml/min/1.73 m2. Compared to other antihypertensive medications, patients treated with RAS blockade had a modestly elevated hazard of adverse renal outcomes using traditional Cox regression (hazard ratio (HR) 1.04, 95% CI 1.01-1.07) and no significantly increased hazard by marginal structural modeling (HR 1.02, 95% CI 0.97-1.08). Patients treated with RAS blockade had a significantly reduced hazard of incident diabetes, but no significant difference in mortality. CONCLUSION This study, conducted in a large real-world cohort, provides evidence that RAS blockade may not provide benefit with regard to longitudinal renal outcomes in obese, hypertensive patients. Further research is needed to elucidate the hemodynamic and renoprotective role of antihypertensive medications in obese patients.
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Affiliation(s)
- Jordana B Cohen
- Renal, Electrolyte and Hypertension Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pa., USA
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29
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Lee K. Metabolic Syndrome and Decreased Estimated Glomerular Filtration Rate in Relation to Muscle Mass. Metab Syndr Relat Disord 2016; 14:404-409. [PMID: 27077710 DOI: 10.1089/met.2016.0017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the association between decreased estimated glomerular filtration rate (eGFR <60 mL/min/1.73 m2) and metabolic syndrome (MetS) according to muscle mass. METHODS Body composition was measured in 3351 men and 4394 women aged between 19 and 97 years using the 2010-2011 Korea National Health and Nutrition Examination Survey data using dual-energy X-ray absorptiometry and low and high muscle mass. Groups were identified using the mean sex-specific appendicular muscle mass/height2. eGFR was computed using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation; MetS was defined by the Harmonized definition and International Diabetes Federation criteria. RESULTS When stratified by muscle mass and adjusted for covariates, MetS was not associated with decreased eGFR in men with high muscle mass, but was associated in men with low muscle mass (odds ratio 3.19-3.87). MetS was associated with decreased eGFR in women with high (odds ratio 2.41-2.68) and low (odds ratio 2.45-2.55) muscle mass. Men with MetS and low muscle mass, women with MetS and high muscle mass, and women with MetS and low muscle mass had 2.95-3.21, 2.23-2.59, and 2.75-2.76 times higher odds for decreased eGFR, respectively, compared with their MetS-free and high muscle mass counterparts, after adjusting for covariates. The odds ratio was not significant for men with high muscle mass and MetS. CONCLUSIONS MetS was associated with decreased eGFR in women, regardless of muscle mass, and in men with low muscle mass. High muscle mass in men may attenuate the association.
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Affiliation(s)
- Kayoung Lee
- Department of Family Medicine, Busan Paik Hospital, Inje University College of Medicine , Busan, South Korea
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30
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Cardiovascular and renal effects of weight reduction in obesity and the metabolic syndrome. Curr Hypertens Rep 2016; 17:34. [PMID: 25833456 DOI: 10.1007/s11906-015-0544-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Obesity is a critical public health issue worldwide. Patients with obesity have markedly increased morbidity and mortality compared to the general population. The increased health risks of obesity in part are due to its close association with each of the other components of the metabolic syndrome, including hypertension, dyslipidemia, and insulin resistance. Accordingly, obese individuals are at particularly increased risk of cardiovascular disease and chronic kidney disease. Modest weight loss results in improvements in serum cholesterol levels, blood pressure, and glycemic profiles. Lifestyle interventions for weight loss have long been the mainstay of treatment in obesity. However, the existing literature demonstrates limited weight loss sustainability and inconsistent cardiovascular and renal benefits using these modalities. In addition to improvements in intermediate risk factors, surgical interventions provide a more lasting impact on long-term cardiovascular and renal outcomes, though carry higher short-term risks due to perioperative complications.
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31
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Raghu G, Jakhotia S, Yadagiri Reddy P, Anil Kumar P, Bhanuprakash Reddy G. Ellagic acid inhibits non-enzymatic glycation and prevents proteinuria in diabetic rats. Food Funct 2016; 7:1574-83. [DOI: 10.1039/c5fo01372k] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The formation of advanced glycation end products (AGEs) is a characteristic feature of diabetic tissues and accumulation of AGEs been implicated in the pathogenesis of diabetic nephropathy (DN). Ellagic acid prevented the accumulation of AGEs and in turn ameliorated proteinurea in diabetic rats.
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Affiliation(s)
- G. Raghu
- National Institute of Nutrition
- Hyderabad
- India
| | | | | | - P. Anil Kumar
- Department of Biochemistry
- University of Hyderabad
- Hyderabad
- India
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32
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Abstract
The increasing prevalence of obesity in developed nations has far-reaching implications for medical toxicology. The management of obese patients is complicated by comorbid illnesses, changes in cardiovascular and respiratory physiology, alterations in pharmacokinetics, and a lack of studies to identify appropriate dosing for current therapeutics and antidotes. In this review article, we examine obesity-associated physiologic and pharmacokinetic changes that may increase the vulnerability of obese patients to overdose. Further research is needed to characterize the relationship between drug toxicity and obesity.
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Affiliation(s)
- Matthew Zuckerman
- University of Colorado, Anschutz Medical Campus, 12401 East 17th Avenue, Rm 759, Aurora, CO, 80045, USA,
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33
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Abstract
Kidney disease is common in patients with type 1 and type 2 diabetes mellitus and is associated with adverse health outcomes, including progression to end-stage renal disease. In the general population, adherence to a healthy lifestyle is known to reduce the risk of cardiovascular events and death. Among individuals with diabetic kidney disease, modifications in lifestyle factors, including diet, physical activity, smoking habits, and body mass index, represent a promising cost-effective therapeutic adjunct to pharmacologic treatment of kidney disease incidence and progression.
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Affiliation(s)
- Chijoke Onyenwenyi
- Department of Medicine, Division of Nephrology, The University of Illinois at Chicago, 820 South Wood Street, 418W CSN, MC 793, Chicago, IL 60612, Phone (312) 996-6736, Fax (312) 996-7378,
| | - Ana C. Ricardo
- Department of Medicine, Division of Nephrology, The University of Illinois at Chicago, 820 South Wood Street, 418W CSN, MC 793, Chicago, IL 60612, Phone (312) 996-8392, Fax (312) 996-7378,
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34
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Piccoli GB, Grassi G, Cabiddu G, Nazha M, Roggero S, Capizzi I, De Pascale A, Priola AM, Di Vico C, Maxia S, Loi V, Asunis AM, Pani A, Veltri A. Diabetic Kidney Disease: A Syndrome Rather Than a Single Disease. Rev Diabet Stud 2015; 12:87-109. [PMID: 26676663 PMCID: PMC5397985 DOI: 10.1900/rds.2015.12.87] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 04/15/2015] [Accepted: 04/22/2015] [Indexed: 12/13/2022] Open
Abstract
The term "diabetic kidney" has recently been proposed to encompass the various lesions, involving all kidney structures that characterize protean kidney damage in patients with diabetes. While glomerular diseases may follow the stepwise progression that was described several decades ago, the tenet that proteinuria identifies diabetic nephropathy is disputed today and should be limited to glomerular lesions. Improvements in glycemic control may have contributed to a decrease in the prevalence of glomerular lesions, initially described as hallmarks of diabetic nephropathy, and revealed other types of renal damage, mainly related to vasculature and interstitium, and these types usually present with little or no proteinuria. Whilst glomerular damage is the hallmark of microvascular lesions, ischemic nephropathies, renal infarction, and cholesterol emboli syndrome are the result of macrovascular involvement, and the presence of underlying renal damage sets the stage for acute infections and drug-induced kidney injuries. Impairment of the phagocytic response can cause severe and unusual forms of acute and chronic pyelonephritis. It is thus concluded that screening for albuminuria, which is useful for detecting "glomerular diabetic nephropathy", does not identify all potential nephropathies in diabetes patients. As diabetes is a risk factor for all forms of kidney disease, diagnosis in diabetic patients should include the same combination of biochemical, clinical, and imaging tests as employed in non-diabetic subjects, but with the specific consideration that chronic kidney disease (CKD) may develop more rapidly and severely in diabetic patients.
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Affiliation(s)
- Giorgina B. Piccoli
- SS Nefrologia, SCDU Urologia, San Luigi Gonzaga Hospital, Department of Clinical and Biological Sciences, University of Torino, Italy
| | - Giorgio Grassi
- SCDU Endocrinologia, Diabetologia e Metabolismo, Citta della Salute e della Scienza Torino, Italy
| | | | - Marta Nazha
- SS Nefrologia, SCDU Urologia, San Luigi Gonzaga Hospital, Department of Clinical and Biological Sciences, University of Torino, Italy
| | - Simona Roggero
- SS Nefrologia, SCDU Urologia, San Luigi Gonzaga Hospital, Department of Clinical and Biological Sciences, University of Torino, Italy
| | - Irene Capizzi
- SS Nefrologia, SCDU Urologia, San Luigi Gonzaga Hospital, Department of Clinical and Biological Sciences, University of Torino, Italy
| | - Agostino De Pascale
- SCDU Radiologia, san Luigi Gonzaga Hospital, Department of Oncology, University of Torino, Italy
| | - Adriano M. Priola
- SCDU Radiologia, san Luigi Gonzaga Hospital, Department of Oncology, University of Torino, Italy
| | - Cristina Di Vico
- SS Nefrologia, SCDU Urologia, San Luigi Gonzaga Hospital, Department of Clinical and Biological Sciences, University of Torino, Italy
| | | | | | - Anna M. Asunis
- SCD Anatomia Patologica, Brotzu Hospital, Cagliari, Italy
| | | | - Andrea Veltri
- SCDU Radiologia, san Luigi Gonzaga Hospital, Department of Oncology, University of Torino, Italy
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35
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Obesity and kidney disease: differential effects of obesity on adipose tissue and kidney inflammation and fibrosis. Curr Opin Nephrol Hypertens 2015; 24:28-36. [PMID: 25470014 DOI: 10.1097/mnh.0000000000000087] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW To provide a perspective by investigating the potential cross-talk between the adipose tissue and the kidney during obesity. RECENT FINDINGS It is well established that excessive caloric intake contributes to organ injury. The associated increased adiposity initiates a cascade of cellular events that leads to progressive obesity-associated diseases such as kidney disease. Recent evidence has indicated that adipose tissue produces bioactive substances that contribute to obesity-related kidney disease, altering the renal function and structure. In parallel, proinflammatory processes within the adipose tissue can also lead to pathophysiological changes in the kidney during the obese state. SUMMARY Despite considerable efforts to better characterize the pathophysiology of obesity-related metabolic disease, there are still a lack of efficient therapeutic strategies. New strategies focused on regulating adipose function with respect to AMP-activated protein kinase activation, NADPH oxidase function, and TGF-β may contribute to reducing adipose inflammation that may also provide renoprotection.
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36
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Cui W, Maimaitiyiming H, Zhou Q, Norman H, Zhou C, Wang S. Interaction of thrombospondin1 and CD36 contributes to obesity-associated podocytopathy. BIOCHIMICA ET BIOPHYSICA ACTA 2015; 1852:1323-33. [PMID: 25835637 PMCID: PMC4433874 DOI: 10.1016/j.bbadis.2015.03.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 03/19/2015] [Accepted: 03/23/2015] [Indexed: 01/16/2023]
Abstract
Obesity is associated with podocyte injury and the development of proteinuria. Elevated plasma free fatty acid is one of the characteristics of obesity and has been linked to podocyte dysfunction. However, the mechanisms remain unclear. In the current study, we examined the effect of saturated free fatty acid (FFA) on human podocyte apoptosis and function in vitro. The mechanism and its in vivo relevance were also determined. We found that FFA treatment induced human podocyte apoptosis and dysfunction, which was associated with increased expression of a matricellular protein-thrombospondin1 (TSP1). FFA stimulated TSP1 expression in podocytes at the transcriptional levels through activation of MAPK pathway. Addition of purified TSP1 to cell culture media induced podocyte apoptosis and dysfunction. Tis effect is though a TGF-β independent mechanism. Moreover, peptide treatment to block TSP1 binding to its receptor-CD36 attenuated FFA induced podocyte apoptosis, suggesting that TSP1/CD36 interaction mediates FFA-induced podocyte apoptosis. Importantly, using a diet-induced obese mouse model, in vivo data demonstrated that obesity-associated podocyte apoptosis and dysfunction were attenuated in TSP1 deficient mice as well as in CD36 deficient mice. Taken together, these studies provide novel evidence that the interaction of TSP1 with its receptor CD36 contributes to obesity--associated podocytopathy.
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Affiliation(s)
- Wenpeng Cui
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY 40536, USA; Department of Nephrology, Second Hospital of Jilin University, Changchun 130041, China
| | - Hasiyeti Maimaitiyiming
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY 40536, USA; Lexington Veterans Affairs Medical Center, Lexington, KY, USA
| | - Qi Zhou
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY 40536, USA; Lexington Veterans Affairs Medical Center, Lexington, KY, USA
| | - Heather Norman
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY 40536, USA; Lexington Veterans Affairs Medical Center, Lexington, KY, USA
| | - Changcheng Zhou
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY 40536, USA
| | - Shuxia Wang
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY 40536, USA; Lexington Veterans Affairs Medical Center, Lexington, KY, USA.
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Zheng LY, Umans JG, Yeh F, Francesconi KA, Goessler W, Silbergeld EK, Bandeen-Roche K, Guallar E, Howard BV, Weaver VM, Navas-Acien A. The association of urine arsenic with prevalent and incident chronic kidney disease: evidence from the Strong Heart Study. Epidemiology 2015; 26:601-12. [PMID: 25929811 PMCID: PMC4844343 DOI: 10.1097/ede.0000000000000313] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Few studies have evaluated associations between low to moderate arsenic levels and chronic kidney disease (CKD). The objective was to evaluate the associations of inorganic arsenic exposure with prevalent and incident CKD in American Indian adults. METHODS We evaluated the associations of inorganic arsenic exposure with CKD in American Indians who participated in the Strong Heart Study in 3,851 adults ages 45-74 years in a cross-sectional analysis, and 3,119 adults with follow-up data in a prospective analysis. Inorganic arsenic, monomethylarsonate, and dimethylarsinate were measured in urine at baseline. CKD was defined as estimated glomerular filtration rate ≤ 60 ml/min/1.73 m, kidney transplant or dialysis. RESULTS CKD prevalence was 10.3%. The median (IQR) concentration of inorganic plus methylated arsenic species (total arsenic) in urine was 9.7 (5.8, 15.7) μg/L. The adjusted odds ratio (OR; 95% confidence interval) of prevalent CKD for an interquartile range in total arsenic was 0.7 (0.6, 0.8), mostly due to an inverse association with inorganic arsenic (OR: 0.4 [0.3, 0.4]). Monomethylarsonate and dimethylarsinate were positively associated with prevalent CKD after adjustment for inorganic arsenic (OR: 3.8 and 1.8). The adjusted hazard ratio of incident CKD for an IQR in sum of inorganic and methylated arsenic was 1.2 (1.03, 1.41). The corresponding HRs for inorganic arsenic, monomethylarsonate, and dimethylarsinate were 1.0 (0.9, 1.2), 1.2 (1.00, 1.3), and 1.2 (1.0, 1.4). CONCLUSIONS The inverse association of urine inorganic arsenic with prevalent CKD suggests that kidney disease affects excretion of inorganic arsenic. Arsenic species were positively associated with incident CKD. Studies with repeated measures are needed to further characterize the relation between arsenic and kidney disease development.
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Affiliation(s)
- Laura Y. Zheng
- Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jason G. Umans
- MedStar Health Research Institute and Georgetown University, Washington DC, USA
- Georgetown-Howard Universities Center for Clinical and Translational Science, Washington DC, USA
| | - Fawn Yeh
- College of Public Health, University of Oklahoma, Oklahoma City, OK, USA
| | - Kevin A. Francesconi
- Institute of Chemistry – Analytical Chemistry, Karl-Franzens University, Graz, Austria
| | - Walter Goessler
- Institute of Chemistry – Analytical Chemistry, Karl-Franzens University, Graz, Austria
| | - Ellen K Silbergeld
- Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eliseo Guallar
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Area of Epidemiology and Population Genetics, National Center for Cardiovascular Research (CNIC), Madrid, Spain
- Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Barbara V. Howard
- MedStar Health Research Institute and Georgetown University, Washington DC, USA
- Georgetown-Howard Universities Center for Clinical and Translational Science, Washington DC, USA
| | - Virginia M. Weaver
- Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Area of Epidemiology and Population Genetics, National Center for Cardiovascular Research (CNIC), Madrid, Spain
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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Hall JE, do Carmo JM, da Silva AA, Wang Z, Hall ME. Obesity-induced hypertension: interaction of neurohumoral and renal mechanisms. Circ Res 2015; 116:991-1006. [PMID: 25767285 DOI: 10.1161/circresaha.116.305697] [Citation(s) in RCA: 680] [Impact Index Per Article: 75.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Excess weight gain, especially when associated with increased visceral adiposity, is a major cause of hypertension, accounting for 65% to 75% of the risk for human primary (essential) hypertension. Increased renal tubular sodium reabsorption impairs pressure natriuresis and plays an important role in initiating obesity hypertension. The mediators of abnormal kidney function and increased blood pressure during development of obesity hypertension include (1) physical compression of the kidneys by fat in and around the kidneys, (2) activation of the renin-angiotensin-aldosterone system, and (3) increased sympathetic nervous system activity. Activation of the renin-angiotensin-aldosterone system is likely due, in part, to renal compression, as well as sympathetic nervous system activation. However, obesity also causes mineralocorticoid receptor activation independent of aldosterone or angiotensin II. The mechanisms for sympathetic nervous system activation in obesity have not been fully elucidated but may require leptin and activation of the brain melanocortin system. With prolonged obesity and development of target organ injury, especially renal injury, obesity-associated hypertension becomes more difficult to control, often requiring multiple antihypertensive drugs and treatment of other risk factors, including dyslipidemia, insulin resistance and diabetes mellitus, and inflammation. Unless effective antiobesity drugs are developed, the effect of obesity on hypertension and related cardiovascular, renal and metabolic disorders is likely to become even more important in the future as the prevalence of obesity continues to increase.
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Affiliation(s)
- John E Hall
- From the Departments of Physiology and Biophysics (J.E.H., J.M.d.C., A.A.d.S., Z.W., M.E.H.), Medicine (M.E.H.), Mississippi Center for Obesity Research (J.E.H., J.M.d.C., A.A.d.S., Z.W., M.E.H.), and Cardiovascular-Renal Research Center (J.E.H., J.M.d.C., A.A.d.S., Z.W., M.E.H.), University of Mississippi Medical Center, Jackson.
| | - Jussara M do Carmo
- From the Departments of Physiology and Biophysics (J.E.H., J.M.d.C., A.A.d.S., Z.W., M.E.H.), Medicine (M.E.H.), Mississippi Center for Obesity Research (J.E.H., J.M.d.C., A.A.d.S., Z.W., M.E.H.), and Cardiovascular-Renal Research Center (J.E.H., J.M.d.C., A.A.d.S., Z.W., M.E.H.), University of Mississippi Medical Center, Jackson
| | - Alexandre A da Silva
- From the Departments of Physiology and Biophysics (J.E.H., J.M.d.C., A.A.d.S., Z.W., M.E.H.), Medicine (M.E.H.), Mississippi Center for Obesity Research (J.E.H., J.M.d.C., A.A.d.S., Z.W., M.E.H.), and Cardiovascular-Renal Research Center (J.E.H., J.M.d.C., A.A.d.S., Z.W., M.E.H.), University of Mississippi Medical Center, Jackson
| | - Zhen Wang
- From the Departments of Physiology and Biophysics (J.E.H., J.M.d.C., A.A.d.S., Z.W., M.E.H.), Medicine (M.E.H.), Mississippi Center for Obesity Research (J.E.H., J.M.d.C., A.A.d.S., Z.W., M.E.H.), and Cardiovascular-Renal Research Center (J.E.H., J.M.d.C., A.A.d.S., Z.W., M.E.H.), University of Mississippi Medical Center, Jackson
| | - Michael E Hall
- From the Departments of Physiology and Biophysics (J.E.H., J.M.d.C., A.A.d.S., Z.W., M.E.H.), Medicine (M.E.H.), Mississippi Center for Obesity Research (J.E.H., J.M.d.C., A.A.d.S., Z.W., M.E.H.), and Cardiovascular-Renal Research Center (J.E.H., J.M.d.C., A.A.d.S., Z.W., M.E.H.), University of Mississippi Medical Center, Jackson
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Yoon SJ, Kim DH, Nam GE, Yoon YJ, Han KD, Jung DW, Park SW, Kim YE, Lee SH, Lee SS, Kim YH. Prevalence and control of hypertension and albuminuria in South Korea: focus on obesity and abdominal obesity in the Korean National Health and Nutrition Examination Survey, 2011-2012. PLoS One 2014; 9:e111179. [PMID: 25360593 PMCID: PMC4215993 DOI: 10.1371/journal.pone.0111179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 09/24/2014] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Albuminuria is associated with cardiovascular disease, and the relationship between albuminuria and hypertension is well established in many studies. So the control of hypertension is critical for decreasing cardiovascular events and albuminuria. Obesity and abdominal obesity are also associated with hypertension and albuminuria. Therefore, we analyzed the relationship between albuminuria and the prevalence and control of hypertension in the general Korean population according to obesity status. METHODS We analyzed data from the 2011-2012 Korea National Health and Nutrition Examination Survey, and 9,519 subjects were included. Subjects were divided into four groups: non-obese/normal waist circumference, non-obese/high waist circumference, obese/normal waist circumference, and obese/high waist circumference. RESULTS Systolic blood pressure and diastolic blood pressure were positively associated with albumin-creatinine ratio in all groups (all p values <0.005). Non-obese/normal waist circumference group were more likely to have hypertension (odds ratios [95% confidential intervals (CIs)] were 3.20 [2.21-4.63] in microalbuminuria level and 3.09 [1.05-9.14] in macroalbuminuria level), and less likely to have controlled hypertension (odds ratios <1 for both albuminuria levels) after adjusting for all covariates. Obese/normal waist circumference group were also more likely to have hypertension (odds ratio [95% CI] were 3.10 [1.56-6.15] in microalbuminuria level and 21.75 [3.66-129.04] in macroalbuminuria level), and less likely to have controlled hypertension in macroalbuminuria level (odds ratio [95% CI], 0.04 [0.01-0.15]). CONCLUSIONS Non-obese and normal waist circumference subjects have an increased prevalence and decreased control of hypertension in microalbuminuria and macroalbuminuria levels. Screening for albuminuria may provide helpful information about hypertension and blood pressure control, particularly in the non-obese and normal waist circumference subjects.
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Affiliation(s)
- Su-Jung Yoon
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Do-Hoon Kim
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Ga-Eun Nam
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Yeo-Joon Yoon
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Kyung-Do Han
- Department of Medical Statistics, Catholic University College of Medicine, Seoul, South Korea
| | - Dong-Wook Jung
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Sang-Woon Park
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Young-Eun Kim
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Sung-Ho Lee
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Sang-Su Lee
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Yang-Hyun Kim
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
- * E-mail:
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Felizardo RJF, Silva MBD, Aguiar CF, Câmara NOS. Obesity in kidney disease: A heavyweight opponent. World J Nephrol 2014; 3:50-63. [PMID: 25332896 PMCID: PMC4202492 DOI: 10.5527/wjn.v3.i3.50] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 04/18/2014] [Accepted: 06/11/2014] [Indexed: 02/05/2023] Open
Abstract
Obesity is an important worldwide challenge that must be faced in most developed and developing countries because of unhealthy nutritional habits. The consequences of obesity and being overweight are observed in different organs, but the kidney is one of the most affected. Excess adipose tissue causes hemodynamic alterations in the kidney that can result in renal disease. However, obesity is also commonly associated with other comorbidities such as chronic inflammation, hypertension and diabetes. This association of several aggravating factors is still a matter of concern in clinical and basic research because the pathophysiologic mechanisms surrounding chronic kidney disease development in obese patients remain unclear. This review will discuss the consequences of obesity in the context of renal injury.
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Kumar AB, Bridget Zimmerman M, Suneja M. Obesity and Post-Cardiopulmonary Bypass-Associated Acute Kidney Injury: A Single-Center Retrospective Analysis. J Cardiothorac Vasc Anesth 2014; 28:551-6. [DOI: 10.1053/j.jvca.2013.05.037] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Indexed: 11/11/2022]
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Abstract
STUDY DESIGN Retrospective analysis. OBJECTIVE A national population-based database was analyzed to characterize the risks of postoperative complications and mortality associated with the patient's body mass index (BMI) after lumbar spinal surgery. SUMMARY OF BACKGROUND DATA Obesity has been associated with greater perioperative complications and worsened surgical outcomes after lumbar spinal surgery. However, the stratified BMI risks of postoperative complications relative to normal weight patients have not been well characterized. METHODS The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify patients who underwent lumbar spinal surgery between 2006 and 2011. Patients were stratified into BMI cohorts: normal (18.5-24.99 kg/m), overweight (25.00-29.99 kg/m), class 1 (30.00-34.99 kg/m), class 2 (35.00-39.99 kg/m), and class 3 (≥40 kg/m) obesity. Preoperative patient characteristics and perioperative outcomes were assessed. The relative risks of 30-day postoperative complications and mortality for each BMI cohort were calculated in reference to the normal weight cohort using a 95% confidence interval. RESULTS A total of 24,196 patients underwent lumbar spine surgery between 2006 and 2011 of which 19,195 (79.3%) were overweight or obese. The risk for deep vein thrombosis increased beginning with overweight patients and compounded for the subsequent obesity classes. The risk for superficial wound infection and pulmonary embolism increased beginning with the class 1 obesity cohort. Furthermore, the relative risk increase for urinary tract infection, acute renal failure, and sepsis was significantly increased only among class 3 obesity patients. Lastly, there was no relative risk increase in 30-day mortality in any cohort after lumbar spine surgery. CONCLUSION Overweight and obese patients demonstrated an increased risk of postoperative complications relative to normal weight patients. Despite these findings, a BMI 25 kg/m or more was not associated with a greater risk of mortality. Further studies are warranted to characterize the impact of postoperative complications associated with overweight and obese patients on hospital resource utilization and costs after lumbar spine surgery.
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Stanton RC. Clinical challenges in diagnosis and management of diabetic kidney disease. Am J Kidney Dis 2014; 63:S3-21. [PMID: 24461728 DOI: 10.1053/j.ajkd.2013.10.050] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 10/08/2013] [Indexed: 12/11/2022]
Abstract
Diabetic kidney disease (DKD) is a major and increasing worldwide public health issue. There is a great need for implementing treatments that either prevent or significantly slow the progression of DKD. Although there have been significant improvements in management, the increasing numbers of patients with DKD illustrate that current management is not wholly adequate. The reasons for suboptimal management include the lack of early diagnosis, lack of aggressive interventions, and lack of understanding about which interventions are most successful. There are a number of challenges and controversies regarding the current management of patients with DKD. Understanding of these issues is needed in order to provide the best care to patients with DKD. This article describes some of the clinically important challenges associated with DKD: the current epidemiology and cost burden and the role of biopsy in the diagnosis of DKD. Treatment controversies regarding current pharmacologic and nonpharmacologic approaches are reviewed and recommendations based on the published literature are made.
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Affiliation(s)
- Robert C Stanton
- Kidney and Hypertension Division, Joslin Diabetes Center, Boston, MA.
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45
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Park MJ, Kim DI, Lim SK, Choi JH, Han HJ, Yoon KC, Park SH. High glucose-induced O-GlcNAcylated carbohydrate response element-binding protein (ChREBP) mediates mesangial cell lipogenesis and fibrosis: the possible role in the development of diabetic nephropathy. J Biol Chem 2014; 289:13519-30. [PMID: 24616092 DOI: 10.1074/jbc.m113.530139] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Carbohydrate response element-binding protein (ChREBP) is a transcription factor responsible for carbohydrate metabolism in the liver. However, the role of ChREBP in diabetic nephropathy has not been elucidated. Thus, we investigated the role of ChREBP in mesangial cells in diabetic nephropathy. Treatment with 25 mM glucose (high glucose; HG) increased cellular O-GlcNAc and O-GlcNAcylated ChREBP in mesangial cells compared with normal 5.5 mM glucose. O-(2-acetamido-2-deoxy-D-glucopyranosylidene) amino N-phenylcarbamate (PUGNAc), a drug that increases O-GlcNAc, augmented the expression of ChREBP targets, whereas DON, a drug that decreases O-GlcNAc and O-GlcNAcase overexpression, mitigated the increase with HG. O-GlcNAc augmented the protein stability, transcriptional activity, and nuclear translocation of ChREBP. HG treatment also stimulated lipid accumulation and the contents of triglyceride and cholesterol in mesangial cells. In addition, HG triggered expression of hypoxia-inducible factor 1-α, vascular endothelial growth factor, and extracellular matrix components related to nephrosclerosis. The ChREBP mutant, W130A, did not exhibit HG-induced lipid accumulation and fibrotic proteins, suggesting that the Trp-130 residue in the MCR3 domain is important in the development of glomerulosclerosis. O-GlcNAcylated ChREBP was elevated in mesangium cells of streptozotocin-induced diabetic rats. In conclusion, HG increased the O-GlcNAcylated ChREBP level, which resulted in lipid accumulation and up-regulation of fibrotic proteins in mesangial cells. These effects may lead mesangial cells to an ultimately pathological state.
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Affiliation(s)
- Min-Jung Park
- From the Department of Veterinary Physiology, College of Veterinary Medicine, Chonnam National University, Gwangju 500-757, Korea
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Min HS, Kim JE, Lee MH, Song HK, Lee MJ, Lee JE, Kim HW, Cha JJ, Hyun YY, Han JY, Cha DR, Kang YS. Effects of Toll-like receptor antagonist 4,5-dihydro-3-phenyl-5-isoxasole acetic acid on the progression of kidney disease in mice on a high-fat diet. Kidney Res Clin Pract 2014; 33:33-44. [PMID: 26877948 PMCID: PMC4714156 DOI: 10.1016/j.krcp.2013.11.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Revised: 09/23/2013] [Accepted: 10/17/2013] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Obesity-related metabolic disorders are closely associated with inflammation induced by innate immunity. Toll-like receptors (TLRs) play a pivotal role in the innate immune system by activating proinflammatory signaling pathways. GIT27 (4,5-dihydro-3-phenyl-5-isoxasole acetic acid) is an active immunomodulatory agent that primarily targets macrophages and inhibits secretion of tumor necrosis factor α [as well as interleukin (IL)-1β, IL-10, and interferon γ]. However, the effect of TLR antagonist on kidney diseases has rarely been reported. We investigated whether the TLR antagonist GIT27 has beneficial effects on the progression of kidney disease in obese mice on a high-fat diet (HFD). METHODS Six-week-old male C57BL/6 mice were divided into three groups: mice fed with normal chow diet (N=4); mice fed with a HFD (60% of total calories from fat, 5.5% from soybean oil, and 54.5% from lard, N=4); and GIT27-treated mice fed with a HFD (N=7). RESULTS Glucose intolerance, oxidative stress, and lipid abnormalities in HFD mice were improved by GIT27 treatment. In addition, GIT27 treatment decreased the urinary excretion of albumin and protein in obesity-related kidney disease, urinary oxidative stress markers, and inflammatory cytokine levels. This treatment inhibited the expression of proinflammatory cytokines in the kidneys and adipose tissue, and improved extracellular matrix expansion and tubulointerstitial fibrosis in obesity-related kidney disease. CONCLUSION TLR inhibition by administering GIT27 improved metabolic parameters. GIT27 ameliorates abnormalities of lipid metabolism and may have renoprotective effects on obesity-related kidney disease through its anti-inflammatory properties.
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Affiliation(s)
- Hye Sook Min
- Department of Internal Medicine, Korea University College of Medicine, Ansan, Korea
| | - Jung Eun Kim
- Department of Internal Medicine, Korea University College of Medicine, Ansan, Korea
| | - Mi Hwa Lee
- Department of Internal Medicine, Korea University College of Medicine, Ansan, Korea
| | - Hye Kyoung Song
- Department of Internal Medicine, Korea University College of Medicine, Ansan, Korea
| | - Mi Jin Lee
- Department of Internal Medicine, Korea University College of Medicine, Ansan, Korea
| | - Ji Eun Lee
- Department of Internal Medicine, Wonkwang University College of Medicine, Sanbon, Korea
| | - Hyun Wook Kim
- Department of Internal Medicine, Wonkwang University College of Medicine, Sanbon, Korea
| | - Jin Joo Cha
- Department of Internal Medicine, Korea University College of Medicine, Ansan, Korea
| | - Young Youl Hyun
- Department of Internal Medicine, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Jee Young Han
- Department of Pathology, Inha University College of Medicine, Incheon, Korea
| | - Dae Ryong Cha
- Department of Internal Medicine, Korea University College of Medicine, Ansan, Korea
| | - Young Sun Kang
- Department of Internal Medicine, Korea University College of Medicine, Ansan, Korea
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Hussain NS, Piper M, Ludlam WG, Ludlam WH, Fuller CJ, Mayberg MR. Delayed postoperative hyponatremia after transsphenoidal surgery: prevalence and associated factors. J Neurosurg 2013; 119:1453-60. [DOI: 10.3171/2013.8.jns13411] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Transient delayed postoperative hyponatremia (DPH) after transsphenoidal surgery (TSS) is common and can have potentially devastating consequences. However, the true prevalence of transient symptomatic and asymptomatic DPH has not been studied in a large patient cohort with close and accurate follow-up.
Methods
A retrospective analysis of a single-institution prospective database was conducted; all patients undergoing TSS for lesions involving the pituitary gland were followed up in a multidisciplinary neuroendocrine clinic, and demographic, imaging, and clinical data were prospectively collected. Patients were examined preoperatively and followed up postoperatively in a standardized fashion, and their postoperative sodium levels were measured at Weeks 1 and 2 postoperatively. Levels of hyponatremia were rated as mild (serum sodium concentration 130–134 mEq/L), moderate (125–129 mEq/L), or severe (< 125 mEq/L). Routine clinical questionnaires were administered at all postoperative office visits. Postoperative hyponatremia was analyzed for correlations with demographic and clinical features and with immediate postoperative physiological characteristics.
Results
Over a 4-year interval, 373 procedures were performed in 339 patients who underwent TSS for sellar and parasellar lesions involving the pituitary gland. The mean (± SD) age of patients was 48 ± 18 years; 61.3% of the patients were female and 46.1% were obese (defined as a body mass index [BMI] ≥ 30). The overall prevalence of DPH within the first 30 days postoperatively was 15.0%; 7.2% of the patients had mild, 3.8% moderate, and 3.8% severe hyponatremia. The incidence of symptomatic hyponatremia requiring hospitalization was 6.4%. The Fisher exact test detected a statistically significant association of DPH with female sex (p = 0.027) and a low BMI (p = 0.001). Spearman rank correlation detected a statistically significant association between BMI and nadir serum sodium concentration (r = 0.158, p = 0.002) and an inverse association for age (r = −0.113, p = 0.031). Multivariate analyses revealed a positive correlation between postoperative hyponatremia and a low BMI and a trend toward association with age; there were no associations between other preoperative demographic or perioperative risk factors, including immediate postoperative alterations in serum sodium concentration. Patients were treated with standardized protocols for hyponatremia, and DPH was not associated with permanent morbidity or mortality.
Conclusions
Delayed postoperative hyponatremia was a common result of TSS; a low BMI was the only clear predictor of which patients will develop DPH. Alterations in immediate postoperative sodium levels did not predict DPH. Therefore, an appropriate index of suspicion and close postoperative monitoring of serum sodium concentration should be maintained for these patients, and an appropriate treatment should be undertaken when hyponatremia is identified.
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Affiliation(s)
- Namath S. Hussain
- 1Seattle Pituitary Center, Swedish Neuroscience Institute, Seattle, Washington; and
| | - Mackenzie Piper
- 1Seattle Pituitary Center, Swedish Neuroscience Institute, Seattle, Washington; and
| | - W. Grant Ludlam
- 1Seattle Pituitary Center, Swedish Neuroscience Institute, Seattle, Washington; and
| | | | - Cindy J. Fuller
- 1Seattle Pituitary Center, Swedish Neuroscience Institute, Seattle, Washington; and
| | - Marc R. Mayberg
- 1Seattle Pituitary Center, Swedish Neuroscience Institute, Seattle, Washington; and
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Nam GE, Han K, Park YG, Kim YH, Lee KS, Cho KH, Choi YS, Kim SM, Kim DH. Abdominal obesity is associated with albuminuria in women: the 2011 Korea National Health and Nutrition Examination Survey. J Womens Health (Larchmt) 2013; 23:267-74. [PMID: 24286240 DOI: 10.1089/jwh.2013.4497] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The effects of obesity on the kidney, apart from diabetes or hypertension, have not drawn much attention. Moreover, only a few studies have reported the relationship between obesity status and albuminuria in Asian countries, including South Korea. Therefore, this study aimed to investigate the association between obesity status and albuminuria in Korean adults. METHODS We analyzed data from the 2011 Korea National Health and Nutrition Examination Survey. Of the 4,979 subjects included in the general-population group, 3,274 were sorted into a nondiabetic and nonhypertensive population group. Obesity status was measured by body mass index and waist circumference. Albuminuria was defined as a urine albumin-to-creatinine ratio ≥30 mg/g. RESULTS Abdominally obese women were at higher risk for albuminuria than were women without abdominal obesity both in the general population (odds ratio [OR], 95% confidence interval [CI]: 2.08 [1.04-4.16]) and in the nondiabetic and nonhypertensive population (OR [95% CI]: 6.96 [2.34-20.64]) after further adjustment for confounders. Among generally nonobese women, abdominally obese women were at higher risk for albuminuria than were women without abdominal obesity both in the general population (OR [95% CI]: 2.82 [1.51-5.29]) and in the nondiabetic and nonhypertensive population (OR [95% CI]: 5.32 [1.47-19.22]). CONCLUSION Abdominal obesity is associated with an increased risk for albuminuria in Korean women, independently of diabetes or hypertension. Screening for abdominal obesity, especially in women, may therefore provide earlier identification of individuals at risk for developing renal disease and cardiovascular disease, even those who are nondiabetic and nonhypertensive.
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Affiliation(s)
- Ga Eun Nam
- 1 Department of Family Medicine, Korea University College of Medicine , Seoul, South Korea
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Meyvis K, Verrijken A, Wouters K, Van Gaal L. Plasma adiponectin level is inversely correlated with albuminuria in overweight and obese nondiabetic individuals. Metabolism 2013; 62:1570-6. [PMID: 23911242 DOI: 10.1016/j.metabol.2013.05.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 05/16/2013] [Accepted: 05/17/2013] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To explore the relationship between adiponectin and albuminuria in a large group of overweight and obese nondiabetic individuals after controlling for potential confounders. MATERIAL AND METHODS Detailed anthropometry, computed tomography-measured visceral abdominal adipose tissue, 24-h albuminuria, adiponectin and a series of biochemical parameters were assessed. Four hundred forty patients, predominantly of Caucasian origin, were included (80.2% female). A multiple linear regression model was developed, with albuminuria as the dependent variable and potential predictors as independent variables. RESULTS The mean age was 40±13 years, the mean body mass index was 35.7±6.6 kg/m2, and the median visceral abdominal adipose tissue was 142.4 (92.3-194.0) cm2. 10.9% of subjects exhibited microalbuminuria. The median adiponectin level was 9.08 (6.23-12.94) μg/ml, and the median fasting serum glucose level was 83 (77-89) mg/dl. The strongest significant univariate correlations with albuminuria were visceral abdominal adipose tissue (r=0.258, p<0.001), adiponectin (r=-0.265, p<0.001), waist circumference (r=0.250, p<0.001), waist-to-hip ratio (r=0.236, p<0.001) and high-density lipoprotein cholesterol (r=-0.211, p<0.001). The multiple linear regression model revealed a significant positive independent correlation between visceral abdominal adipose tissue and albuminuria (r=0.134, p=0.033), between fasting glucose levels and albuminuria (r=0.390, p=0.029) and between gender and albuminuria (r=0.107, p=0.038). A significant independent negative correlation was identified between adiponectin and albuminuria (r=-0.255, p=0.022). CONCLUSIONS We observed an independent inverse relationship between adiponectin and albuminuria in overweight and obese nondiabetic individuals. Further investigations are needed to confirm this finding and to clarify whether adiponectin is a risk marker or plays a causative role in developing obesity-induced nephropathy.
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Affiliation(s)
- Karen Meyvis
- Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, University of Antwerp, Belgium
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Kalashikam RR, Battula KK, Kirlampalli V, Friedman JM, Nappanveettil G. Obese locus in WNIN/obese rat maps on chromosome 5 upstream of leptin receptor. PLoS One 2013; 8:e77679. [PMID: 24204914 PMCID: PMC3804619 DOI: 10.1371/journal.pone.0077679] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 09/04/2013] [Indexed: 11/18/2022] Open
Abstract
WNIN/Obese (WNIN/Ob) rat a new mutant model of metabolic syndrome was identified in 1996 from an inbred Wistar rat strain, WNIN. So far several papers are published on this model highlighting its physical, biochemical and metabolic traits. WNIN/Ob is leptin resistant with unaltered leptin or its receptor coding sequences - the two well-known candidate genes for obesity. Genotyping analysis of F2 progeny (raised from WNIN/Ob × Fisher - 344) in the present study localized the mutation to a recombinant region of 14.15cM on chromosome 5. This was further corroborated by QTL analysis for body weight, which narrowed this region to 4.43 cM with flanking markers D5Rat256 & D5Wox37. Interval mapping of body weight QTL shows that the LOD score peak maps upstream of leptin receptor and shows an additive effect suggesting this as a novel mutation and signifying the model as a valuable resource for studies on obesity and metabolic syndrome.
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Affiliation(s)
- Rajender Rao Kalashikam
- Molecular Genetics, National Centre for Laboratory Animal Science (NCLAS), National Institute of Nutrition (NIN), Hyderabad, India
| | - Kiran Kumar Battula
- Molecular Genetics, National Centre for Laboratory Animal Science (NCLAS), National Institute of Nutrition (NIN), Hyderabad, India
| | - Veerababu Kirlampalli
- Molecular Genetics, National Centre for Laboratory Animal Science (NCLAS), National Institute of Nutrition (NIN), Hyderabad, India
| | - Jeffrey M. Friedman
- Molecular Genetics Laboratory, Howard Hughes Medical Institute, Rockefeller University, New York, New York, United States of America
- * E-mail: (JMF); (GN)
| | - Giridharan Nappanveettil
- Molecular Genetics, National Centre for Laboratory Animal Science (NCLAS), National Institute of Nutrition (NIN), Hyderabad, India
- * E-mail: (JMF); (GN)
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