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Okamura T, Tsukamoto K, Arai H, Fujioka Y, Ishigaki Y, Koba S, Ohmura H, Shoji T, Yokote K, Yoshida H, Yoshida M, Deguchi J, Dobashi K, Fujiyoshi A, Hamaguchi H, Hara M, Harada-Shiba M, Hirata T, Iida M, Ikeda Y, Ishibashi S, Kanda H, Kihara S, Kitagawa K, Kodama S, Koseki M, Maezawa Y, Masuda D, Miida T, Miyamoto Y, Nishimura R, Node K, Noguchi M, Ohishi M, Saito I, Sawada S, Sone H, Takemoto M, Wakatsuki A, Yanai H. Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2022. J Atheroscler Thromb 2024; 31:641-853. [PMID: 38123343 DOI: 10.5551/jat.gl2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Affiliation(s)
- Tomonori Okamura
- Preventive Medicine and Public Health, Keio University School of Medicine
| | | | | | - Yoshio Fujioka
- Faculty of Nutrition, Division of Clinical Nutrition, Kobe Gakuin University
| | - Yasushi Ishigaki
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Iwate Medical University
| | - Shinji Koba
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Hirotoshi Ohmura
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Tetsuo Shoji
- Department of Vascular Medicine, Osaka Metropolitan University Graduate school of Medicine
| | - Koutaro Yokote
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine
| | - Hiroshi Yoshida
- Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
| | | | - Juno Deguchi
- Department of Vascular Surgery, Saitama Medical Center, Saitama Medical University
| | - Kazushige Dobashi
- Department of Pediatrics, School of Medicine, University of Yamanashi
| | | | | | - Masumi Hara
- Department of Internal Medicine, Mizonokuchi Hospital, Teikyo University School of Medicine
| | - Mariko Harada-Shiba
- Cardiovascular Center, Osaka Medical and Pharmaceutical University
- Department of Molecular Pathogenesis, National Cerebral and Cardiovascular Center Research Institute
| | - Takumi Hirata
- Institute for Clinical and Translational Science, Nara Medical University
| | - Mami Iida
- Department of Internal Medicine and Cardiology, Gifu Prefectural General Medical Center
| | - Yoshiyuki Ikeda
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Shun Ishibashi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jichi Medical University, School of Medicine
- Current affiliation: Ishibashi Diabetes and Endocrine Clinic
| | - Hideyuki Kanda
- Department of Public Health, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
| | - Shinji Kihara
- Medical Laboratory Science and Technology, Division of Health Sciences, Osaka University graduate School of medicine
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women's Medical University Hospital
| | - Satoru Kodama
- Department of Prevention of Noncommunicable Diseases and Promotion of Health Checkup, Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine
| | - Masahiro Koseki
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Yoshiro Maezawa
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine
| | - Daisaku Masuda
- Department of Cardiology, Center for Innovative Medicine and Therapeutics, Dementia Care Center, Doctor's Support Center, Health Care Center, Rinku General Medical Center
| | - Takashi Miida
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine
| | | | - Rimei Nishimura
- Department of Diabetes, Metabolism and Endocrinology, The Jikei University School of Medicine
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Midori Noguchi
- Division of Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Isao Saito
- Department of Public Health and Epidemiology, Faculty of Medicine, Oita University
| | - Shojiro Sawada
- Division of Metabolism and Diabetes, Faculty of Medicine, Tohoku Medical and Pharmaceutical University
| | - Hirohito Sone
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine
| | - Minoru Takemoto
- Department of Diabetes, Metabolism and Endocrinology, International University of Health and Welfare
| | | | - Hidekatsu Yanai
- Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine Kohnodai Hospital
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Aziz F, Sam R, Lew SQ, Massie L, Misra M, Roumelioti ME, Argyropoulos CP, Ing TS, Tzamaloukas AH. Pseudohyponatremia: Mechanism, Diagnosis, Clinical Associations and Management. J Clin Med 2023; 12:4076. [PMID: 37373769 DOI: 10.3390/jcm12124076] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Pseudohyponatremia remains a problem for clinical laboratories. In this study, we analyzed the mechanisms, diagnosis, clinical consequences, and conditions associated with pseudohyponatremia, and future developments for its elimination. The two methods involved assess the serum sodium concentration ([Na]S) using sodium ion-specific electrodes: (a) a direct ion-specific electrode (ISE), and (b) an indirect ISE. A direct ISE does not require dilution of a sample prior to its measurement, whereas an indirect ISE needs pre-measurement sample dilution. [Na]S measurements using an indirect ISE are influenced by abnormal concentrations of serum proteins or lipids. Pseudohyponatremia occurs when the [Na]S is measured with an indirect ISE and the serum solid content concentrations are elevated, resulting in reciprocal depressions in serum water and [Na]S values. Pseudonormonatremia or pseudohypernatremia are encountered in hypoproteinemic patients who have a decreased plasma solids content. Three mechanisms are responsible for pseudohyponatremia: (a) a reduction in the [Na]S due to lower serum water and sodium concentrations, the electrolyte exclusion effect; (b) an increase in the measured sample's water concentration post-dilution to a greater extent when compared to normal serum, lowering the [Na] in this sample; (c) when serum hyperviscosity reduces serum delivery to the device that apportions serum and diluent. Patients with pseudohyponatremia and a normal [Na]S do not develop water movement across cell membranes and clinical manifestations of hypotonic hyponatremia. Pseudohyponatremia does not require treatment to address the [Na]S, making any inadvertent correction treatment potentially detrimental.
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Affiliation(s)
- Fahad Aziz
- Department of Medicine, Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - Ramin Sam
- Department of Medicine, Zuckerberg San Francisco General Hospital, School of Medicine, University of California in San Francisco, San Francisco, CA 94110, USA
| | - Susie Q Lew
- Department of Medicine, School of Medicine and Health Sciences, George Washington University, Washington, DC 20052, USA
| | - Larry Massie
- Department of Pathology, Raymond G. Murphy Veterans Affairs Medical Center, University of New Mexico School of Medicine, Albuquerque, NM 87108, USA
| | - Madhukar Misra
- Department of Medicine, Division of Nephrology, University of Missouri, Columbia, MO 65211, USA
| | - Maria-Eleni Roumelioti
- Department of Medicine, Division of Nephrology, University of New Mexico School of Medicine, Albuquerque, NM 87106, USA
| | - Christos P Argyropoulos
- Department of Medicine, Division of Nephrology, University of New Mexico School of Medicine, Albuquerque, NM 87106, USA
| | - Todd S Ing
- Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, USA
| | - Antonios H Tzamaloukas
- Research Service, Department of Medicine, Raymond G. Murphy Veterans Affairs Medical Center, University of New Mexico School of Medicine, Albuquerque, NM 87108, USA
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Canney M, Gunning HM, Zheng Y, Rose C, Jauhal A, Hur SA, Sahota A, Reich HN, Barbour SJ. The Risk of Cardiovascular Events in Individuals With Primary Glomerular Diseases. Am J Kidney Dis 2022; 80:740-750. [PMID: 35659570 DOI: 10.1053/j.ajkd.2022.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 04/09/2022] [Indexed: 02/02/2023]
Abstract
RATIONALE & OBJECTIVE Little is known about the risk of cardiovascular disease (CVD) in patients with various primary glomerular diseases. In a population-level cohort of adults with primary glomerular disease, we sought to describe the risk of CVD compared with the general population and the impact of traditional and kidney-related risk factors on CVD risk. STUDY DESIGN Observational cohort study. SETTING & PARTICIPANTS Adults with membranous nephropathy (n = 387), minimal change disease (n = 226), IgA nephropathy (n = 759), and focal segmental glomerulosclerosis (n = 540) from a centralized pathology registry in British Columbia, Canada (2000-2012). EXPOSURE Traditional CVD risk factors (diabetes, age, sex, dyslipidemia, hypertension, smoking, prior CVD) and kidney-related risk factors (type of glomerular disease, estimated glomerular filtration rate [eGFR], proteinuria). OUTCOME A composite CVD outcome of coronary artery, cerebrovascular, and peripheral vascular events, and death due to myocardial infarction or stroke. ANALYTICAL APPROACH Subdistribution hazards models to evaluate the outcome risk with non-CVD death treated as a competing event. Standardized incidence rates (SIR) calculated based on the age- and sex-matched general population. RESULTS During a median 6.8 years of follow-up, 212 patients (11.1%) experienced the CVD outcome (10-year risk, 14.7% [95% CI, 12.8%-16.8%]). The incidence rate was high for the overall cohort (24.7 per 1,000 person-years) and for each disease type (range, 12.2-46.1 per 1,000 person-years), and was higher than that observed in the general population both overall (SIR, 2.46 [95% CI, 2.12-2.82]) and for each disease type (SIR range, 1.38-3.98). Disease type, baseline eGFR, and proteinuria were associated with a higher risk of CVD and, when added to a model with traditional risk factors, led to improvements in model fit (R2 of 14.3% vs 12.7%), risk discrimination (C-statistic of 0.81 vs 0.78; difference, 0.02 [95% CI, 0.01-0.04]), and continuous net reclassification improvement (0.4 [95% CI, 0.2-0.6]). LIMITATIONS Ascertainment of outcomes and comorbidities using administrative data. CONCLUSIONS Patients with primary glomerular disease have a high absolute risk of CVD that is approximately 2.5 times that of the general population. Consideration of eGFR, proteinuria, and type of glomerular disease may improve risk stratification of CVD risk in these individuals. PLAIN-LANGUAGE SUMMARY Patients with chronic kidney disease are known to be at high risk of cardiovascular disease. Cardiovascular risk in patients with primary glomerular diseases is poorly understood because these conditions are rare and require a kidney biopsy for diagnosis. In this study of 1,912 Canadian patients with biopsy-proven IgA nephropathy, minimal change disease, focal segmental glomerulosclerosis, and membranous nephropathy, the rate of cardiovascular events was 2.5 times higher than in the general population and was high for each disease type. Consideration of disease type, kidney function, and proteinuria improved the prediction of cardiovascular events. In summary, our population-level study showed that patients with primary glomerular diseases have a high cardiovascular risk, and that inclusion of kidney-specific risk factors may improve risk stratification.
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Affiliation(s)
- Mark Canney
- Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; BC Renal, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Heather M Gunning
- BC Renal, Provincial Health Services Authority, Vancouver, British Columbia, Canada; Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yuyan Zheng
- BC Renal, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Caren Rose
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; British Columbia Center for Disease Control, Vancouver, British Columbia, Canada
| | - Arenn Jauhal
- Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
| | - Seo Am Hur
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anahat Sahota
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Heather N Reich
- Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
| | - Sean J Barbour
- BC Renal, Provincial Health Services Authority, Vancouver, British Columbia, Canada; Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.
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Abstract
Lipid disorders involving derangements in serum cholesterol, triglycerides, or both are commonly encountered in clinical practice and often have implications for cardiovascular risk and overall health. Recent advances in knowledge, recommendations, and treatment options have necessitated an updated approach to these disorders. Older classification schemes have outlived their usefulness, yielding to an approach based on the primary lipid disturbance identified on a routine lipid panel as a practical starting point. Although monogenic dyslipidemias exist and are important to identify, most individuals with lipid disorders have polygenic predisposition, often in the context of secondary factors such as obesity and type 2 diabetes. With regard to cardiovascular disease, elevated low-density lipoprotein cholesterol is essentially causal, and clinical practice guidelines worldwide have recommended treatment thresholds and targets for this variable. Furthermore, recent studies have established elevated triglycerides as a cardiovascular risk factor, whereas depressed high-density lipoprotein cholesterol now appears less contributory than was previously believed. An updated approach to diagnosis and risk assessment may include measurement of secondary lipid variables such as apolipoprotein B and lipoprotein(a), together with selective use of genetic testing to diagnose rare monogenic dyslipidemias such as familial hypercholesterolemia or familial chylomicronemia syndrome. The ongoing development of new agents-especially antisense RNA and monoclonal antibodies-targeting dyslipidemias will provide additional management options, which in turn motivates discussion on how best to incorporate them into current treatment algorithms.
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Affiliation(s)
- Amanda J Berberich
- Department of Medicine; Schulich School of Medicine and Dentistry, Western University, London, ON, Canada, N6A 5C1.,Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada, N6A 5B7
| | - Robert A Hegele
- Department of Medicine; Schulich School of Medicine and Dentistry, Western University, London, ON, Canada, N6A 5C1.,Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada, N6A 5B7
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Abstract
Nephrotic syndrome (NS) encompasses a variety of disease processes leading to heavy proteinuria and edema. Minimal change disease (MCD) remains the most common primary cause of NS, as well as the most responsive to pharmacologic treatment with often minimal to no chronic kidney disease. Other causes of NS include focal segmental glomerulosclerosis, which follows MCD, and secondary causes, including extrarenal or systemic diseases, infections, and drugs. Although initial diagnosis relies on clinical findings as well as urine and blood chemistries, renal biopsy and genetic testing are important diagnostic tools, especially when considering non-MCD NS. Moreover, biomarkers in urine and serum have become important areas for research in this disease. NS progression and prognosis are variable and depend on etiology, with corticosteroids being the mainstay of treatment. Other alternative therapies found to be successful in inducing and maintaining remission include calcineurin inhibitors and rituximab. Disease course can range from recurrent disease relapse with or without acute kidney injury to end-stage renal disease in some cases. Given the complex pathogenesis of NS, which remains incompletely understood, complications are numerous and diverse and include infections, electrolyte abnormalities, acute kidney injury, and thrombosis. Pediatricians must be aware of the presentation, complications, and overall long-term implications of NS and its treatment.
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Hu H, Xie C, Weng Z, Yu P, Wang Y, Shan L. Dexrazoxane Alleviated Doxorubicin-Induced Nephropathy in Rats. Pharmacology 2022; 107:206-215. [PMID: 35021174 DOI: 10.1159/000521220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/25/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Doxorubicin (DOX), an anthracycline antitumor agent, has been widely used against various solid tumors and hematological malignancies. However, the clinical application of DOX is restricted by its multiple organ toxicity including nephrotoxicity. This study investigated the protective effects and mechanisms of dexrazoxane (DZR) against DOX-induced nephropathy in rats. METHODS Male Sprague Dawley rats received 2.5 mg/kg DOX once a week for 5 consecutive weeks. 24-h urinary protein and renal function injury biomarkers were determined to evaluate the renal function. Histopathological changes and glomerulosclerosis were examined by hematoxylin and eosin and periodic acid-Schiff staining. The change of renal ultrastructure in the DOX-induced rats was observed by the electron microscopy. The renal apoptosis was detected by TUNEL staining and measured the protein expression of Caspase-3, Bcl-2, and Bax. Renal interstitial fibrosis was determined by Masson staining and immunohistochemistry examination. The levels of vimentin, alpha-smooth muscle actin (α-SMA), and transforming growth factor β (TGF-β) in kidney tissue were detected by Western blot. RESULTS DZR pretreatment markedly raised the survival rate and improved the renal dysfunction in DOX-treated rats. DZR ameliorated DOX-induced histopathological lesion of glomerular and tubular and apoptosis. DZR restored the oxidant/antioxidant balance via regulating the levels of MDA, SOD, and TAC. DZR reduced DOX-induced collagen IV deposition and renal interstitial fibrosis and downregulated the fibrosis-related protein expressions of vimentin, α-SMA, and TGF-β1. CONCLUSION Our results suggest DZR exerted its protective effects against DOX-induced nephropathy through inhibition of lipid peroxidation, apoptosis, and fibrosis.
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Affiliation(s)
- Huihui Hu
- Institute of New Drug Research, International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Development of Chinese Ministry of Education, Jinan University College of Pharmacy, Guangzhou, China,
| | - Caipeng Xie
- Institute of New Drug Research, International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Development of Chinese Ministry of Education, Jinan University College of Pharmacy, Guangzhou, China
| | - Zeping Weng
- Department of Pathology, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Pei Yu
- Institute of New Drug Research, International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Development of Chinese Ministry of Education, Jinan University College of Pharmacy, Guangzhou, China
| | - Yuqiang Wang
- Institute of New Drug Research, International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Development of Chinese Ministry of Education, Jinan University College of Pharmacy, Guangzhou, China
| | - Luchen Shan
- Institute of New Drug Research, International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Development of Chinese Ministry of Education, Jinan University College of Pharmacy, Guangzhou, China
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Şimşek ÖÖ, Demircan T, Erfidan G, Emir B, Başaran C, Alparslan C, Arslansoyu Çamlar S, Mutlubaş F, Kasap Demir B, Alaygut D. Epicardial adipose tissue and risk of arrhythmia in nephrotic syndrome. Pediatr Int 2022; 64:e15323. [PMID: 36331224 DOI: 10.1111/ped.15323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 07/07/2022] [Accepted: 08/03/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with nephrotic syndrome (NS) are at a high risk of cardiovascular disease, obesity, and dyslipidemia. The aim of this study was to evaluate the formation of epicardial adipose tissue (EAT) and investigate electrocardiographic (ECG) parameters in patients. METHODS Thirty-two patients aged 0-18 years and 15 control patients were compared. In the patient group, physical examination and laboratory parameters were recorded. Atrial depolarization and ventricular repolarization parameters in ECG were compared between the groups. EAT was evaluated with M-mode measurements on echocardiography. RESULTS There was no difference between the groups in terms of sex, age, body mass index, systolic and diastolic BP. EAT was found to be significantly higher in the patient group. In ECG evaluations it was determined that atrial depolarization and ventricular repolarization parameters increased in the patient group. CONCLUSIONS Cardiovascular morbidity and mortality are high in kidney diseases. Measurement and follow-up of EAT and ECG findings as a noninvasive parameter can provide information in NS.
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Affiliation(s)
- Özgür Özdemir Şimşek
- Department of Pediatric Nephrology, Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Tülay Demircan
- Department of Pediatric Cardiology, Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Gökçen Erfidan
- Department of Pediatric Nephrology, Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Büşra Emir
- Department of Biostatistics, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
| | - Cemaliye Başaran
- Department of Pediatric Nephrology, Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Caner Alparslan
- Department of Pediatric Nephrology, Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Seçil Arslansoyu Çamlar
- Department of Pediatric Nephrology, Izmir Faculty of Medicine, Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Fatma Mutlubaş
- Department of Pediatric Nephrology, Izmir Faculty of Medicine, Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Belde Kasap Demir
- Department of Pediatric Nephrology and Rheumatology, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
| | - Demet Alaygut
- Department of Pediatric Nephrology, Izmir Faculty of Medicine, Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
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Abstract
Membranous nephropathy (MN) is the most common cause of nephrotic syndrome in adult. However, the exact etiology and the best treatment approach are still unclear. It is imperative to understand the nature of and prognosis of MN before initiating treatment which may include disease specific therapy based on a careful risk-stratification approach.
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Affiliation(s)
- Ziad Arabi
- Department of Nephrology, University of Buffalo, NY, USA
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Saadatagah S, Pasha AK, Alhalabi L, Sandhyavenu H, Farwati M, Smith CY, Wood‐Wentz CM, Bailey KR, Kullo IJ. Coronary Heart Disease Risk Associated with Primary Isolated Hypertriglyceridemia; a Population-Based Study. J Am Heart Assoc 2021; 10:e019343. [PMID: 34032140 PMCID: PMC8483538 DOI: 10.1161/jaha.120.019343] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 03/23/2021] [Indexed: 12/18/2022]
Abstract
Background Hypertriglyceridemia is associated with increased risk of coronary heart disease but the association is often attributed to concomitant metabolic abnormalities. We investigated the epidemiology of primary isolated hypertriglyceridemia (PIH) and associated cardiovascular risk in a population-based setting. Methods and Results We identified adults with at least one triglyceride level ≥500 mg/dL between 1998 and 2015 in Olmsted County, Minnesota. We also identified age- and sex-matched controls with triglyceride levels <150 mg/dL. There were 3329 individuals with elevated triglyceride levels; after excluding those with concomitant hypercholesterolemia, a secondary cause of high triglycerides, age <18 years or an incomplete record, 517 patients (49.4±14.0 years, 72.0% men) had PIH (triglyceride 627.6±183.6 mg/dL). The age- and sex-adjusted prevalence of PIH in adults was 0.80% (0.72-0.87); the diagnosis was recorded in 60%, 46% were on a lipid-lowering medication for primary prevention and a triglyceride level <150 mg/dL was achieved in 24.1%. The association of PIH with coronary heart disease was attenuated but remained significant after adjustment for demographic, socioeconomic, and conventional cardiovascular risk factors (hazard ratio [HR], 1.53; 95% CI, 1.06-2.20; P= 0.022). There was no statistically significant association between PIH and cerebrovascular disease (HR, 1.06; 95% CI, 0.65-1.73, P= 0.813), peripheral artery disease (HR, 1.27; 95% CI, 0.43-3.75; P= 0.668), or the composite end point of all 3 (HR, 1.28; 95% CI, 0.92-1.80; P=0.148) in adjusted models. Conclusions PIH was associated with incident coronary heart disease events (although there was attenuation after adjustment for conventional risk factors), supporting a causal role for triglycerides in coronary heart disease. The condition is relatively prevalent but awareness and control are low.
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Affiliation(s)
| | - Ahmed K. Pasha
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
| | - Lubna Alhalabi
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
| | | | - Medhat Farwati
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
| | - Carin Y. Smith
- Division of Clinical Trials and BiostatisticsMayo ClinicRochesterMN
| | | | - Kent R. Bailey
- Division of Clinical Trials and BiostatisticsMayo ClinicRochesterMN
| | - Iftikhar J. Kullo
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
- Gonda Vascular CenterMayo ClinicRochesterMN
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Gaipov A, Nogaibayeva A, Turebekov Z, Zharmukhanbet L, Orazbayev G, Malykh D, Kim N, Abbay A, Tuganbekova S, Aljofan M, Bekishev B. Short-term Effect of LDL-Apheresis on Lipid Profile of Patients with Nephrotic and Non-Nephrotic Hyperlipidemia: A Comparative Study. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2021. [DOI: 10.29333/ejgm/10861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Yanai H, Yoshida H. Secondary dyslipidemia: its treatments and association with atherosclerosis. Glob Health Med 2021; 3:15-23. [PMID: 33688591 PMCID: PMC7936375 DOI: 10.35772/ghm.2020.01078] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/01/2020] [Accepted: 12/07/2020] [Indexed: 04/15/2023]
Abstract
Dyslipidemia is classified into primary and secondary types. Primary dyslipidemia is basically inherited and caused by single or multiple gene mutations that result in either overproduction or defective clearance of triglycerides and cholesterol. Secondary dyslipidemia is caused by unhealthy lifestyle factors and acquired medical conditions, including underlying diseases and applied drugs. Secondary dyslipidemia accounts for approximately 30-40% of all dyslipidemia. Secondary dyslipidemia should be treated by finding and addressing its causative diseases or drugs. For example, treatment of secondary dyslipidemia, such as hyperlipidemia due to hypothyroidism, by using statin without controlling hypothyroidism, may lead to myopathy and serious adverse events such as rhabdomyolysis. Differential diagnosis of secondary dyslipidemia is very important for safe and effective treatment. Here, we describe an overview about diseases and drugs that interfere with lipid metabolism leading to secondary dyslipidemia. Further, we show the association of each secondary dyslipidemia with atherosclerosis and the treatments for such dyslipidemia.
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Affiliation(s)
- Hidekatsu Yanai
- Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine Kohnodai Hospital, Chiba, Japan
- Address correspondence to:Hidekatsu Yanai, Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine Kohnodai Hospital, 1-7-1 Kohnodai, Ichikawa, Chiba 272- 8516, Japan. E-mail:
| | - Hiroshi Yoshida
- Department of Laboratory Medicine, The Jikei University Kashiwa Hospital, Chiba, Japan
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Shahid S, Masood K, Khan AW. Prediction of impacts on liver enzymes from the exposure of low-dose medical radiations through artificial intelligence algorithms. Rev Assoc Med Bras (1992) 2021; 67:248-259. [PMID: 34406249 DOI: 10.1590/1806-9282.67.02.20200653] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/16/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES This study aimed to develop artificial intelligence and machine learning-based models to predict alterations in liver enzymes from the exposure of low annual average effective doses in radiology and nuclear medicine personnel of Institute of Nuclear Medicine and Oncology Hospital. METHODS Ninety workers from the Radiology and Nuclear Medicine departments were included. A high-capacity thermoluminescent was used for annual average effective radiation dose measurements. The liver function tests were conducted for all subjects and controls. Three supervised learning models (multilayer precentron; logistic regression; and random forest) were applied and cross-validated to predict any alteration in liver enzymes. The t-test was applied to see if subjects and controls were significantly different in liver function tests. RESULTS The annual average effective doses were in the range of 0.07-1.15 mSv. Alanine transaminase was 50% high and aspartate transaminase was 20% high in radiation workers. There existed a significant difference (p=0.0008) in Alanine-aminotransferase between radiation-exposed and radiation-unexposed workers. Random forest model achieved 90-96.6% accuracies in Alanine-aminotransferase and Aspartate-aminotransferase predictions. The second best classifier model was the Multilayer perceptron (65.5-80% accuracies). CONCLUSION As there is a need of regular monitoring of hepatic function in radiation-exposed people, our artificial intelligence-based predicting model random forest is proved accurate in prediagnosing alterations in liver enzymes.
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Affiliation(s)
- Saman Shahid
- National University of Computer and Emerging Sciences, Foundation for the Advancement of Science and Technology, Department of Sciences & Humanities - Lahore, Pakistan
| | - Khalid Masood
- Institute of Nuclear Medicine and Oncology Lahore, Department of Medical Physics - Lahore, Pakistan
| | - Abdul Waheed Khan
- Institute of Nuclear Medicine and Oncology Lahore, Department of Medical Physics - Lahore, Pakistan
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Busuioc RM, Covic A, Kanbay M, Banach M, Burlacu A, Mircescu G. Protein convertase subtilisin/kexin type 9 biology in nephrotic syndrome: implications for use as therapy. Nephrol Dial Transplant 2020; 35:1663-1674. [PMID: 31157893 DOI: 10.1093/ndt/gfz108] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 04/19/2019] [Indexed: 01/12/2023] Open
Abstract
Low-density lipoprotein cholesterol (LDL-C) levels almost constantly increased in patients with nephrotic syndrome (NS). Protein convertase subtilisin/kexin type 9 (PCSK9) [accelerates LDL-receptor (LDL-R) degradation] is overexpressed by liver cells in NS. Their levels, correlated inversely to LDL-R expression and directly to LDL-C, seem to play a central role in hypercholesterolaemia in NS. Hypersynthesis resulting from sterol regulatory element-binding protein dysfunction, hyperactivity induced by c-inhibitor of apoptosis protein expressed in response to stimulation by tumour necrosis factor-α produced by damaged podocytes and hypo-clearance are the main possible mechanisms. Increased LDL-C may damage all kidney cell populations (podocytes, mesangial and tubular cells) in a similar manner. Intracellular cholesterol accumulation produces oxidative stress, foam cell formation and apoptosis, all favoured by local inflammation. The cumulative effect of cellular lesions is worsened proteinuria and kidney function loss. Accordingly, NS patients should be considered high risk and treated by lowering LDL-C. However, there is still not enough evidence determining whether lipid-lowering agents are helpful in managing dyslipidaemia in NS. Based on good efficacy and safety proved in the general population, therapeutic modulation of PCSK9 via antibody therapy might be a reasonable solution. This article explores the established and forthcoming evidence implicating PCSK9 in LDL-C dysregulation in NS.
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Affiliation(s)
| | - Adrian Covic
- "Gr. T. Popa," University of Medicine and Pharmacy, Iasi, Romania.,Nephrology Clinic, Dialysis and Renal Transplant Center - 'C.I. Parhon' University Hospital Iasi, Romania
| | | | - Maciej Banach
- Department of Hypertension, WAM University Hospital in Lodz, Medical University of Lodz, Lodz, Poland.,Polish Mother's Memorial Hospital Research Institute, Lodz, Poland.,Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland
| | - Alexandru Burlacu
- "Gr. T. Popa," University of Medicine and Pharmacy, Iasi, Romania.,Head of Department of Interventional Cardiology - Cardiovascular Diseases Institute Iasi, Romania
| | - Gabriel Mircescu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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14
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Hyponatremia in Patients with Hematologic Diseases. J Clin Med 2020; 9:jcm9113721. [PMID: 33228240 PMCID: PMC7699475 DOI: 10.3390/jcm9113721] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/10/2020] [Accepted: 11/17/2020] [Indexed: 12/14/2022] Open
Abstract
Hyponatremia is the most common electrolyte disorder in clinical practice and is associated with increased morbidity and mortality. It is frequently encountered in hematologic patients with either benign or malignant diseases. Several underlying mechanisms, such as hypovolemia, infections, toxins, renal, endocrine, cardiac, and liver disorders, as well as the use of certain drugs appear to be involved in the development or the persistence of hyponatremia. This review describes the pathophysiology of hyponatremia and discusses thoroughly the contributing factors and mechanisms that may be encountered specifically in patients with hematologic disorders. The involvement of the syndrome of inappropriate antidiuretic hormone (SIADH) secretion and renal salt wasting syndrome (RSWS) in the development of hyponatremia in such patients, as well as their differential diagnosis and management, are also presented. Furthermore, the distinction between true hyponatremia and pseudohyponatremia is explained. Finally, a practical algorithm for the evaluation of hyponatremia in hematologic patients, as well as the principles of hyponatremia management, are included in this review.
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Abstract
Podocytopathies are kidney diseases in which direct or indirect podocyte injury drives proteinuria or nephrotic syndrome. In children and young adults, genetic variants in >50 podocyte-expressed genes, syndromal non-podocyte-specific genes and phenocopies with other underlying genetic abnormalities cause podocytopathies associated with steroid-resistant nephrotic syndrome or severe proteinuria. A variety of genetic variants likely contribute to disease development. Among genes with non-Mendelian inheritance, variants in APOL1 have the largest effect size. In addition to genetic variants, environmental triggers such as immune-related, infection-related, toxic and haemodynamic factors and obesity are also important causes of podocyte injury and frequently combine to cause various degrees of proteinuria in children and adults. Typical manifestations on kidney biopsy are minimal change lesions and focal segmental glomerulosclerosis lesions. Standard treatment for primary podocytopathies manifesting with focal segmental glomerulosclerosis lesions includes glucocorticoids and other immunosuppressive drugs; individuals not responding with a resolution of proteinuria have a poor renal prognosis. Renin-angiotensin system antagonists help to control proteinuria and slow the progression of fibrosis. Symptomatic management may include the use of diuretics, statins, infection prophylaxis and anticoagulation. This Primer discusses a shift in paradigm from patient stratification based on kidney biopsy findings towards personalized management based on clinical, morphological and genetic data as well as pathophysiological understanding.
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16
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Jiang XS, Chen XM, Hua W, He JL, Liu T, Li XJ, Wan JM, Gan H, Du XG. PINK1/Parkin mediated mitophagy ameliorates palmitic acid-induced apoptosis through reducing mitochondrial ROS production in podocytes. Biochem Biophys Res Commun 2020; 525:954-961. [PMID: 32173525 DOI: 10.1016/j.bbrc.2020.02.170] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 02/28/2020] [Indexed: 01/02/2023]
Abstract
Diabetic nephropathy (DN), the primary cause of end-stage renal disease (ESRD), is often accompanied by dyslipidemia, which is closely related to the occurrence and development of DN and even the progression to ESRD. Mitophagy, the selective degradation of damaged and dysfunctional mitochondria by autophagy, is a crucial mitochondrial quality control mechanism, and largely regulated by PINK1 (PTEN-induced putative kinase 1)/Parkin signaling pathway. In the present study, we demonstrated that PA induced mitochondrial damage and excessive mitoROS generation in podocytes. We also found PA treatment resulted in the activation of mitophagy by increasing co-localization of GFP-LC3 with mitochondria and enhancing the formation of mitophagosome, stabilization of PINK1 and mitochondrial translocation of Parkin, which indicated that PINK1/Parkin pathway was involved in PA-induced mitophagy in podocytes. Furthermore, inhibition of mitophagy by silencing Parkin dramatically aggravated PA-induced mitochondrial dysfunction, mitoROS production, and further enhanced PA-induced apoptosis of podocytes. Finally, we showed that PINK1/Parkin pathway were up-regulated in kidney of high fat diet (HFD)-induced obese rats. Taken together, our results suggest that PINK1/Parkin mediated mitophagy plays a protective role in PA-induced podocytes apoptosis through reducing mitochondrial ROS production and that enhancing mitophagy provides a potential therapeutic strategy for kidney diseases with hyperlipidemia, such as DN.
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Affiliation(s)
- Xu-Shun Jiang
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Youyi Road 1, Chongqing, 400042, China
| | - Xue-Mei Chen
- Emergency Department, The First Affiliated Hospital of Chongqing Medical University, Youyi Road 1, Chongqing, 400042, China
| | - Wei Hua
- Department of Nephrology, Occupational Disease Prevention and Control Hospital of Chongqing, Chongqing, China
| | - Jun-Ling He
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ting Liu
- Department of Nephrology, Chengdu Fifth People's Hospital, Chengdu, 611130, China
| | - Xun-Jia Li
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Youyi Road 1, Chongqing, 400042, China
| | - Jiang-Min Wan
- Department of Nephrology, Chongqing Qijiang People's Hospital, Tuowai, Chongqing, 401420, China
| | - Hua Gan
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Youyi Road 1, Chongqing, 400042, China
| | - Xiao-Gang Du
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Youyi Road 1, Chongqing, 400042, China; The Chongqing Key Laboratory of Translational Medicine in Major Metabolic Diseases, The First Affiliated Hospital of Chongqing Medical University, Youyi Road 1, Chongqing, 400042, China.
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17
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Johansson AC, Samuelsson O, Attman PO, Haraldsson B, Moberly J, Knight–Gibson C, Alaupovic P. Dyslipidemia in Peritoneal Dialysis — Relation to Dialytic Variables. Perit Dial Int 2020. [DOI: 10.1177/089686080002000307] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo investigate whether the specific lipoprotein (LP) abnormalities of peritoneal dialysis (PD) are associated with functional variables of this mode of dialysis.DesignA survey of the LP profile in relation to peritoneal dialysis capacity (PDC) variables. The LP profile was compared to that of a group of age- and sex-matched controls.SettingThe Peritoneal Dialysis Unit at Sahlgrenska University Hospital in Gothenburg, Sweden.PatientsTwenty-two nondiabetic PD patients (5 women, 17 men) who had been on PD for at least 6 months.Main Outcome MeasuresThe LP profile included plasma lipids, apolipoproteins (Apo), and individual ApoA- and ApoB-containing LP. The PDC measurement determined peritoneal glucose uptake, protein losses, effective peritoneal surface area, and total weekly creatinine clearance.ResultsThe patients had been on PD for 6 to 48 months (mean 15.3 months) and had a total weekly creatinine clearance of 69.7 ± 13.3 L/1.73m2body surface area, an average peritoneal glucose uptake corresponding to 446 ± 162 kcal/24 hour, and a protein loss of 8.1 ± 2.5 g/24 hr. The patients had significantly higher total cholesterol (7.1 mmol/L), VLDL-cholesterol (1.0 mmol/L), LDL-cholesterol (4.7 mmol/L), and triglyceride levels (2.5 mmol/L); whereas the HDL-cholesterol level (1.2 mmol/L) was significantly lower than in controls. The PD patients had increased levels of ApoB-containing LPs, both of the cholesterol-rich LP-B and of the triglyceride-rich LP-B complex, reflected in higher plasma concentrations of ApoB, ApoC-III, and ApoE. Furthermore, they had significantly lower levels of LP-A-I:A-II, as well as of ApoA-I and ApoA-II. The LP-A-I:A-II and ApoA-II levels correlated inversely with the duration of PD treatment ( r = 0.54, p < 0.01 and r = 0.52, p < 0.05, respectively). The ApoA-II level was inversely correlated with the peritoneal surface area ( r = 0.53, p < 0.05). There were no other correlations between LP variables and PDC variables, nor did any of the LP variables correlate with peritoneal glucose uptake or protein losses.ConclusionThe proatherogenic lipoprotein profile of patients on PD is characterized by increased concentrations of cholesterol-rich and triglyceride-rich ApoB-containing LPs. While the duration of treatment appears to have some influence on the development of this type of dyslipidemia, the pathophysiological links to the dialysis mode must be further explored.
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Affiliation(s)
| | | | | | | | - James Moberly
- Renal Division, Baxter Healthcare Corporation, McGaw Park, Illinois
| | - Carolyn Knight–Gibson
- Lipid and Lipoprotein Laboratory, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, U.S.A
| | - Petar Alaupovic
- Lipid and Lipoprotein Laboratory, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, U.S.A
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18
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Shaikh A, Ibrahim M, Khan M. Effect of Ficus glomerata leaf extract in streptozotocin-induced early diabetic complications and its characterization by LC-MS. EXCLI JOURNAL 2020; 19:33-47. [PMID: 32038115 PMCID: PMC7003634 DOI: 10.17179/excli2019-1441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 12/19/2019] [Indexed: 11/18/2022]
Abstract
Diabetes mellitus is a complex metabolic disorder that leads to various micro-vascular complications. The present study elucidated the effect of chloroform extract of leaves of Ficus glomerata (CHFG) in streptozotocin-induced early diabetic renal and neural complications. Wistar rats were injected with STZ (55 mg/kg, i.p.) to produce experimental diabetes. Two weeks after the stabilization of diabetes, CHFG extract at the dose of 200 and 400 mg/kg (CHFG 200 and CHFG 400) and metformin at the dose of 250 mg/kg (Met 250) was administered to the diabetic rats for further two weeks. Diabetic rats showed an increase in blood glucose, plasma urea, uric acid, creatinine, triglyceride, and total cholesterol level. The change in behavioral parameters such as thermal hyperalgesia and cold allodynia with compromised sciatic nerve and kidney antioxidant status were seen in diabetic rats. Diabetic rats treated with CHFG 200, CHFG 400, and Met 250 showed a decrease in blood glucose, plasma urea, uric acid, creatinine, triglyceride, and total cholesterol level. Also, it improved altered behavioral parameters such as thermal hyperalgesia and cold allodynia. It also restored the sciatic nerve and kidney antioxidant status. The results of kidney and sciatic nerves histopathological study were in line with the results of biochemical parameters that confirmed the favorable role of CHFG. Characterization of CHFG by LC-MS revealed the presence of diverse phytoconstituents, which might be responsible for its protective effect.
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Affiliation(s)
- Abusufyan Shaikh
- School of Pharmacy, Anjuman-I-Islam's Kalsekar Technical Campus, New Panvel, Maharashtra, affiliated to Mumbai University, Mumbai, India.,Research Scholar, JNTUH, Kukatpally, Telangana, India
| | | | - Mohib Khan
- Oriental College of Pharmacy, Navi Mumbai, India
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19
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Gooding JR, Agrawal S, McRitchie S, Acuff Z, Merchant ML, Klein JB, Smoyer WE, Sumner SJ. Predicting and Defining Steroid Resistance in Pediatric Nephrotic Syndrome Using Plasma Metabolomics. Kidney Int Rep 2020; 5:81-93. [PMID: 31922063 PMCID: PMC6943762 DOI: 10.1016/j.ekir.2019.09.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 09/09/2019] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Nephrotic syndrome (NS) is a kidney disease that affects both children and adults. Glucocorticoids have been the primary therapy for >60 years but are ineffective in approximately 20% of children and approximately 50% of adult patients. Unfortunately, patients with steroid-resistant NS (SRNS; vs. steroid-sensitive NS [SSNS]) are at high risk for both glucocorticoid-induced side effects and disease progression. METHODS We performed proton nuclear magnetic resonance (1H NMR) metabolomic analyses on plasma samples (n = 86) from 45 patients with NS (30 SSNS and 15 SRNS) obtained at initial disease presentation before glucocorticoid initiation and after approximately 7 weeks of glucocorticoid therapy to identify candidate biomarkers able to either predict SRNS before treatment or define critical molecular pathways/targets regulating steroid resistance. RESULTS Stepwise logistic regression models identified creatinine concentration and glutamine concentration (odds ratio [OR]: 1.01; 95% confidence interval [CI]: 0.99-1.02) as 2 candidate biomarkers predictive of SRNS, and malonate concentration (OR: 0.94; 95% CI: 0.89-1.00) as a third candidate predictive biomarker using a similar model (only in children >3 years). In addition, paired-sample analyses identified several candidate biomarkers with the potential to identify mechanistic molecular pathways/targets that regulate clinical steroid resistance, including lipoproteins, adipate, pyruvate, creatine, glucose, tyrosine, valine, glutamine, and sn-glycero-3-phosphcholine. CONCLUSION Metabolomic analyses of serial plasma samples from children with SSNS and SRNS identified elevated creatinine and glutamine concentrations, and reduced malonate concentrations, as auspicious candidate biomarkers to predict SRNS at disease onset in pediatric NS, as well as additional candidate biomarkers with the potential to identify mechanistic molecular pathways that may regulate clinical steroid resistance.
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Affiliation(s)
- Jessica R. Gooding
- National Institutes of Health Eastern Regional Comprehensive Metabolomics Resource Core (ERCMRC) at University of North Carolina, Chapel Hill, North Carolina, USA
- Discovery, Science and Technology, RTI International, Research Triangle Park, North Carolina, USA
| | - Shipra Agrawal
- Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
- Center for Clinical and Translational Research, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Susan McRitchie
- National Institutes of Health Eastern Regional Comprehensive Metabolomics Resource Core (ERCMRC) at University of North Carolina, Chapel Hill, North Carolina, USA
- Nutrition Research Institute, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Zach Acuff
- National Institutes of Health Eastern Regional Comprehensive Metabolomics Resource Core (ERCMRC) at University of North Carolina, Chapel Hill, North Carolina, USA
- Discovery, Science and Technology, RTI International, Research Triangle Park, North Carolina, USA
| | | | - Jon B. Klein
- Kidney Disease Program, University of Louisville, Louisville, Kentucky, USA
- Robley Rex VA Medical Center, Louisville, Kentucky, USA
| | - William E. Smoyer
- Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
- Center for Clinical and Translational Research, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Susan J. Sumner
- National Institutes of Health Eastern Regional Comprehensive Metabolomics Resource Core (ERCMRC) at University of North Carolina, Chapel Hill, North Carolina, USA
- Nutrition Research Institute, University of North Carolina, Chapel Hill, North Carolina, USA
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20
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Hamieda SF, Hassan AI, Abdou MI, Khalil WA, Abd-el Nour KN. Biophysical Studies of Some Bee Products as Radioprotectors.. [DOI: 10.1101/472233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
AbstractThe study had been planned to evaluate some antioxidant ingredients in honey and propolis. Also, a study on ionizing gamma irradiated rats was done to assess these antioxidants as radioprotectors. Bioactive ingredients, such as phenols, flavonoids and trace elements, were explored using FTIR, UV-Vis and AAS spectroscopic techniques. Animals were exposed to fractionated gamma radiation doses. Honey, propolis and their combination were administrated before and during the irradiation period. Serum levels of total protein, albumin and uric acid were estimated. Also, the osmotic fragility of Red Blood Corpuscles (RBCs) membranes and a microscopic examination of blood films were investigated. The analysis demonstrated that the level of phenolic, flavonoid and trace elements are higher in propolis than honey. The levels of total protein and albumin decreased post irradiation while the level of uric acid increased. Likewise, osmotic fragility of RBCs membranes was increased with a sticking forming RBCs aggregation. It had been found that administration of the natural antioxidants induced amelioration in most of the studied parameters. It can be concluded that natural antioxidants produced a modulation against oxidative stress induced by ionizing radiation.Summary StatementAssessment of some antioxidant ingredients in honey and propolis. Also, a study on ionizing gamma irradiated rats was done to assess these antioxidants as radioprotectors.
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21
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Silva AIR, Tavares J, Vaz AS, Brito N, Vasconcelos M, Sevivas T, Moura L, Cordinhã C. Cerebral Venous Sinus Thrombosis in a Child with Idiopathic Nephrotic Syndrome: a case report. ACTA ACUST UNITED AC 2018; 40:418-422. [PMID: 30080915 PMCID: PMC6534000 DOI: 10.1590/2175-8239-jbn-2018-0009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 03/02/2018] [Indexed: 12/15/2022]
Abstract
Complications are rare in pediatric cases of idiopathic nephrotic syndrome (NS). Thromboembolism ranks among the most uncommon and difficult complications to diagnose, particularly in the first episode of NS, since clinical signs might be unspecific. This report describes the case of a 5-year-old girl with NS for the first time presenting with severe hypoalbuminemia (< 2g/dL). The patient responded poorly to therapy with corticosteroids. On day 8 of hospitalization she started having headaches and vomiting; she did not present hemodynamic alterations, fever or exanthems, and her neurological parameters were normal. The patient was suspected for intracranial hypertension, and computed tomography scans revealed she had cerebral venous sinus thrombosis (CVST). She was started on anticoagulants and showed clinical signs of improvement. The patient had no evident prothrombotic risk factors. She had three other episodes since she was diagnosed, one in which her plasma antithrombin level was low. Although antithrombin levels were normal in her first episode, she was tested after the resolution of proteinuria. The low levels of antithrombin seen in the first recurrence might have mirrored the initial drop in plasma antithrombin levels, an idea supported by the severe hypoalbuminemia she had when diagnosed. This severe manifestation of acquired thrombophilia might be in the origin of CVST. This report presents a rare case of thromboembolic complication in a pediatric patient with NS. The patient progressed well since she was started on anticoagulants. Although she did not present any evident risk factors at first, the development of her case indicated that severe acquired thrombophilia might have worked as the pathophysiological mechanism leading to CVST.
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Affiliation(s)
| | - João Tavares
- Centro Hospitalar e Universitário de Coimbra, Hospital Pediátrico, Coimbra, Portugal
| | - Ana Sofia Vaz
- Centro Hospitalar e Universitário de Coimbra, Hospital Pediátrico, Coimbra, Portugal
| | - Nádia Brito
- Hospital Distrital da Figueira da Foz, Serviço de Pediatria, Coimbra, Portugal
| | - Mónica Vasconcelos
- Centro Hospitalar e Universitário de Coimbra, Centro de Desenvolvimento da Criança, Hospital Pediátrico, Neuropediatria, Coimbra, Portugal
| | - Teresa Sevivas
- Centro Hospitalar e Universitário de Coimbra, Serviço de Sangue e Medicina Transfusional, Coimbra, Portugal
| | - Lurdes Moura
- Centro Hospitalar e Universitário de Coimbra, Hospital Pediátrico, Coimbra, Portugal
| | - Carolina Cordinhã
- Centro Hospitalar e Universitário de Coimbra, Hospital Pediátrico, Unidade de Nefrologia Pediátrica, Coimbra, Portugal
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22
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Kumar D, Behal S, Bhattacharyya R, Banerjee D. Pseudoesterase activity of albumin: A probable determinant of cholesterol biosynthesis. Med Hypotheses 2018; 115:42-45. [PMID: 29685194 DOI: 10.1016/j.mehy.2018.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 03/27/2018] [Accepted: 03/29/2018] [Indexed: 11/28/2022]
Abstract
The association between hypoalbuminemia and coronary artery disease is known from some time. However, the reason as to how such phenomenon is correlated remains unknown. We have observed from published scientific literature that HSA has the potential to control cholesterol biosynthesis due to its pseudoesterase activity. In-silico observations have supported our view since acetyl coA, the precursor molecule of cholesterol biosynthesis is shown to bind with Tyr 411 of HSA. Incidentally, Tyr411 is a critical moiety for pseudoesterase activity of albumin. With this frame of reference in mind we hypothesize that pseudoesterase activity of HSA is an important determinant of lipid metabolism including cholesterol biosynthesis. Therefore, albumin has the potential to influence the atherosclerotic state important for pathogenesis of coronary artery diseases.
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Affiliation(s)
- Deepak Kumar
- Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Sakshi Behal
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Rajasri Bhattacharyya
- Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Dibyajyoti Banerjee
- Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
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23
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Liu T, Chen XM, Sun JY, Jiang XS, Wu Y, Yang S, Huang HZ, Ruan XZ, Du XG. Palmitic Acid-Induced Podocyte Apoptosis via the Reactive Oxygen Species-Dependent Mitochondrial Pathway. Kidney Blood Press Res 2018; 43:206-219. [PMID: 29490300 DOI: 10.1159/000487673] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 02/15/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Chronic kidney disease (CKD) is often accompanied by hyperlipidemia, which accelerates progression of the disease. Podocyte injury can lead to dysfunction of the glomerular filtration barrier, which is associated with proteinuria, a risk marker for the progression of CKD. Our previous studies demonstrated that palmitic acid (PA) can induce podocyte apoptosis; however, the underlying mechanisms are unclear. In the present study, we investigated the specific molecular mechanisms of PA-induced apoptosis in cultured podocytes. METHODS We cultured mouse podocytes and treated them with PA. Then, cell viability was measured using the Cell Counting Kit-8 colorimetric assay, lipid uptake was assessed by Oil Red O staining and boron-dipyrromethene staining, apoptosis was measured by flow cytometry, mitochondrial injury was assessed by JC-1 staining and transmission electron microscopy, and mitochondrial production of reactive oxygen species (ROS) was evaluated by fluorescence microscopy using the MitoSOX Red reagent. The effects of PA on the mitochondria-mediated caspase activation pathway were investigated by examining the expression of caspase-8, cleaved caspase-9, cleaved caspase-3, cleaved poly (ADP-ribose) polymerase (PARP), B-cell lymphoma 2 (Bcl-2), Bax, Bid, cytochrome c, and Fas-associated protein with death domain (FADD) using western blotting. The translocation of Bax and cytochrome c were detected by immunofluorescence. RESULTS PA treatment significantly increased lipid accumulation and induced podocyte apoptosis. We investigated whether the two primary apoptosis signaling pathways (death receptor-mediated pathway and mitochondria-mediated pathway) were involved in the execution of PA-induced podocyte apoptosis, and found that the levels of FADD, caspase-8, and Bid did not significantly change during this process. Meanwhile, PA treatment induced an increase in Bax protein expression and a decrease in Bcl-2 protein expression, with Bax translocation to the mitochondria. Furthermore, PA treatment induced mitochondrial impairment, and triggered the release of cytochrome c from the mitochondria to cytosol, with a concomitant dose-dependent increase in the levels of cleaved caspase-9, cleaved caspase-3, and PARP. Meanwhile, PA treatment increased mitochondrial production of ROS, and the mitochondria-targeted antioxidant mitoTEMPO significantly ameliorated PA-induced podocyte apoptosis. CONCLUSION Our findings indicated that PA induced caspase-dependent podocyte apoptosis through the mitochondrial pathway, and mitochondrial ROS production participated in this process, thus potentially contributing to podocyte injury.
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Affiliation(s)
- Ting Liu
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xue-Mei Chen
- Emergency Department, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ji-Ye Sun
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xu-Shun Jiang
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yue Wu
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shan Yang
- Emergency Department, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hui-Zhe Huang
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiong-Zhong Ruan
- Centre for Nephrology, Royal Free and University College Medical School, University College London, Royal Free Campus, London, United Kingdom.,Centre for Lipid Research, Key Laboratory of Molecular Biology on Infectious Diseases, Ministry of Education, Chongqing Medical University, Chongqing, China
| | - Xiao-Gang Du
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,The Chongqing Key Laboratory of Translational Medicine in Major Metabolic Disease, Chongqing, China
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Abstract
Xanthelasmas are localized accumulation of lipid deposits on the eyelids. Lesions are typically asymptomatic and treatment is often sought for cosmetic purposes. Unfortunately, there is paucity of strong evidence in the literature for the effective treatment of normolipidemic xanthelasmas. A literature search using the term “xanthelasma” was carried out in PubMed and Medline databases. Only articles related to treatment were considered and analyzed for their data. Commonly cited treatments include topical trichloroacetic acid, liquid nitrogen cryotherapy, and various lasers including carbon dioxide, Er:YAG, Q-switched Nd:YAG, and pulse dye laser. However, traditional surgical excision has also been used. This article reviews these currently accepted modalities of treatment.
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Affiliation(s)
- Zainab Laftah
- King's College Hospital, Dermatology department, Denmark Hill, London SE5 9RS, UK
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Autophagy Protects against Palmitic Acid-Induced Apoptosis in Podocytes in vitro. Sci Rep 2017; 7:42764. [PMID: 28225005 PMCID: PMC5320537 DOI: 10.1038/srep42764] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 01/13/2017] [Indexed: 01/01/2023] Open
Abstract
Autophagy is a highly conserved degradation process that is involved in the clearance of proteins and damaged organelles to maintain intracellular homeostasis and cell integrity. Type 2 diabetes is often accompanied by dyslipidemia with elevated levels of free fatty acids (FFAs). Podocytes, as an important component of the filtration barrier, are susceptible to lipid disorders. The loss of podocytes causes proteinuria, which is involved in the pathogenesis of diabetic nephropathy. In the present study, we demonstrated that palmitic acid (PA) promoted autophagy in podocytes. We further found that PA increased the production of reactive oxygen species (ROS) in podocytes and that NAC (N-acetyl-cysteine), a potent antioxidant, significantly eliminated the excessive ROS and suppressed autophagy, indicating that the increased generation of ROS was associated with the palmitic acid-induced autophagy in podocytes. Moreover, we also found that PA stimulation decreased the mitochondrial membrane potential in podocytes and induced podocyte apoptosis, while the inhibition of autophagy by chloroquine (CQ) enhanced palmitic acid-induced apoptosis accompanied by increased ROS generation, and the stimulation of autophagy by rapamycin (Rap) remarkably suppressed palmitic acid-induced ROS generation and apoptosis. Taken together, these in vitro findings suggest that PA-induced autophagy in podocytes is mediated by ROS production and that autophagy plays a protective role against PA-induced podocyte apoptosis.
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Alnaeb ME, Youssef F, Mikhailidis DP, Hamilton G. Short-term Lipid-Lowering Treatment with Atorvastatin Improves Renal Function But Not Renal Blood Flow Indices in Patients with Peripheral Arterial Disease. Angiology 2016; 57:65-71. [PMID: 16444458 DOI: 10.1177/000331970605700109] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Some studies have suggested that lipid lowering with statins exerts favorable effects on the progression of chronic kidney disease. Therefore, the authors assessed the effects of short-term atorvastatin treatment on biochemical markers of renal function and evaluated duplex indices of renal blood flow (RBF) in patients with peripheral arterial disease. Hyperlipidemic claudicants (n=18), aged 44-85 years, were treated for 8 weeks with 20 mg/day atorvastatin. Blood tests at baseline and after 8 weeks included serum fasting lipids, creatinine, urate, and cystatin C (a sensitive indicator of renal function) levels. RBF was also assessed (n=9) by measuring pulsatile and resistance duplex indices. As expected, there was a significant improvement in total cholesterol, low-density lipoprotein cholesterol, and triglycerides. There was also a significant (p<0.0001) fall in serum creatinine from 89 (58-125) to 79 µmol/L (54-119) and an increase in calculated creatinine clearance (CrCl) from 72 (40-129) to 80 mL/minute (47-138; p<0.0001). Serum cystatin C values decreased significantly (p=0.0002) from 1.04 (0.57-1.56) to 0.90 mg/L (0.47-1.47). There were no detectable changes in the RBF duplex indices. Treatment of stable claudicants with atorvastatin for 8 weeks was associated with improved renal function (as assessed by serum creatinine, cystatin C, and calculated CrCl) without changes in RBF. Further studies are required to identify the mechanisms involved in this phenomenon.
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Affiliation(s)
- M E Alnaeb
- University Department of Surgery, Royal Free Hospital NHS Trust and Royal Free and University College Medical School, University College London, London, UK
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Patil VP, Patil AB, Patil VS, Ingleshwar DG. Paraoxonase Activity and Lipid Profile in Paediatric Nephrotic Syndrome: A Cross-sectional Study. J Clin Diagn Res 2016; 10:BC17-20. [PMID: 27134858 DOI: 10.7860/jcdr/2016/18524.7440] [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: 12/24/2015] [Accepted: 01/28/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Dyslipidaemia of Nephrotic Syndrome (NS) is known to be linked to oxidative reactions and atherosclerosis. Paraoxonase (PON1) has been implicated in the prevention of Low Density Lipoprotein (LDL) lipid peroxidation and also degrades biologically active oxidised lipids in lipoprotein. AIM The present study was taken up to assess PON1 levels in paediatric nephrotic syndrome and also to see if any correlation exists between lipid parameters and PON1. MATERIALS AND METHODS This study consists of Group 1 with 40 cases of NS in the age group of 2-14 years and Group 2 with 40 age and sex matched healthy controls. Lipid profile and paraoxonase activity was measured in serum samples of both the groups. RESULTS Statistical analysis by student's t-test showed that the mean levels of Total Cholesterol, Trigylycerides, LDL, and VLDL were significantly increased in Group 1 when compared to Group 2 (p <0.001). The mean levels of HDL were similar in both groups. The levels of PON1 were significantly lowered in Group 1 when compared to Group 2. Correlation studies showed no significant correlation between lipid profile and PON1. CONCLUSION Cases have atherosclerotic dyslipidaemia and significantly decreased PON1 activity. Decreased PON1 may lead to increased oxidation of LDL accelerating the process of atherosclerosis.
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Affiliation(s)
- Vijayetha P Patil
- Assistant Professor, Department of Biochemistry, SDM College of Medical Sciences and Hospital , Dharwad, Karnataka, India
| | - Anuradha B Patil
- Professor and Head, Department of Biochemistry, J.N. Medical College , Belgaum, Karnataka, India
| | - Vidya S Patil
- Professor and Head, Department of Biochemistry, SDM College of Medical Sciences and Hospital , Dharwad, Karnataka, India
| | - Deepti G Ingleshwar
- Assistant Professor, Department of Biochemistry, SDM College of Medical Sciences and Hospital , Dharwad, Karnataka, India
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van der Heijden RA, Bijzet J, Meijers WC, Yakala GK, Kleemann R, Nguyen TQ, de Boer RA, Schalkwijk CG, Hazenberg BPC, Tietge UJF, Heeringa P. Obesity-induced chronic inflammation in high fat diet challenged C57BL/6J mice is associated with acceleration of age-dependent renal amyloidosis. Sci Rep 2015; 5:16474. [PMID: 26563579 PMCID: PMC4643235 DOI: 10.1038/srep16474] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 10/13/2015] [Indexed: 01/13/2023] Open
Abstract
Obesity-induced inflammation presumably accelerates the development of chronic kidney diseases. However, little is known about the sequence of these inflammatory events and their contribution to renal pathology. We investigated the effects of obesity on the evolution of age-dependent renal complications in mice in conjunction with the development of renal and systemic low-grade inflammation (LGI). C57BL/6J mice susceptible to develop age-dependent sclerotic pathologies with amyloid features in the kidney, were fed low (10% lard) or high-fat diets (45% lard) for 24, 40 and 52 weeks. HFD-feeding induced overt adiposity, altered lipid and insulin homeostasis, increased systemic LGI and adipokine release. HFD-feeding also caused renal upregulation of pro-inflammatory genes, infiltrating macrophages, collagen I protein, increased urinary albumin and NGAL levels. HFD-feeding severely aggravated age-dependent structural changes in the kidney. Remarkably, enhanced amyloid deposition rather than sclerosis was observed. The degree of amyloidosis correlated significantly with body weight. Amyloid deposits stained positive for serum amyloid A (SAA) whose plasma levels were chronically elevated in HFD mice. Our data indicate obesity-induced chronic inflammation as a risk factor for the acceleration of age-dependent renal amyloidosis and functional impairment in mice, and suggest that obesity-enhanced chronic secretion of SAA may be the driving factor behind this process.
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Affiliation(s)
- Roel A van der Heijden
- Department of Pathology &Medical Biology, Medical Biology Section, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Top Institute Food and Nutrition, Wageningen, The Netherlands
| | - Johan Bijzet
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wouter C Meijers
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gopala K Yakala
- Translational Laboratory in Genetic Medicine (TLGM), Agency for Science, Technology and Research (A*STAR) and Department of Medicine, National University of Singapore, Singapore
| | - Robert Kleemann
- Department of Metabolic Health Research, The Netherlands Organization for Applied Scientific Research (TNO), Leiden, The Netherlands.,Top Institute Food and Nutrition, Wageningen, The Netherlands
| | - Tri Q Nguyen
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rudolf A de Boer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Casper G Schalkwijk
- Experimental Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.,Top Institute Food and Nutrition, Wageningen, The Netherlands
| | - Bouke P C Hazenberg
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Uwe J F Tietge
- Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Peter Heeringa
- Department of Pathology &Medical Biology, Medical Biology Section, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Top Institute Food and Nutrition, Wageningen, The Netherlands
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Fervenza FC, Canetta PA, Barbour SJ, Lafayette RA, Rovin BH, Aslam N, Hladunewich MA, Irazabal MV, Sethi S, Gipson DS, Reich HN, Brenchley P, Kretzler M, Radhakrishnan J, Hebert LA, Gipson PE, Thomas LF, McCarthy ET, Appel GB, Jefferson JA, Eirin A, Lieske JC, Hogan MC, Greene EL, Dillon JJ, Leung N, Sedor JR, Rizk DV, Blumenthal SS, Lasic LB, Juncos LA, Green DF, Simon J, Sussman AN, Philibert D, Cattran DC. A Multicenter Randomized Controlled Trial of Rituximab versus Cyclosporine in the Treatment of Idiopathic Membranous Nephropathy (MENTOR). Nephron Clin Pract 2015; 130:159-68. [PMID: 26087670 DOI: 10.1159/000430849] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 04/17/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Idiopathic membranous nephropathy remains the leading cause of nephrotic syndrome in Caucasian adults. Immunosuppressive therapy with cyclosporine (CSA) is often successful in reducing proteinuria, but its use is associated with a high relapse rate. Rituximab, a monoclonal antibody that specifically targets CD20 on the surface of B-cells, is effective in achieving a complete remission of proteinuria in patients with idiopathic membranous nephropathy. However, whether rituximab is as effective as CSA in inducing and maintaining complete or partial remission of proteinuria in these patients is unknown. The membranous nephropathy trial of rituximab (MENTOR) hypothesizes that B-cell targeting with rituximab is non-inferior to CSA in inducing long-term remission of proteinuria. METHODS AND DESIGN Patients with idiopathic membranous nephropathy, proteinuria ≥5 g/24 h, and a minimum of 3 months of Angiotensin-II blockade will be randomized into a 12-month treatment period with i.v. rituximab, 1,000 mg (2 infusions, 14 days apart; repeated at 6 months if a substantial reduction in proteinuria (equal to or >25%) is seen at 6 months) or oral CSA 3.5-5 mg/kg/day for 6 months (continued for another 6 months if a substantial reduction in proteinuria (equal to or >25%) is seen at 6 months). The efficacy of treatment will be assessed by the remission status (based on changes in proteinuria) at 24 months from randomization. Patient safety will be assessed via collection of adverse event data and evaluation of pre- and posttreatment laboratory data. At the 6-month post-randomization visit, patients who have been randomized to either CSA or rituximab but who do not have a reduction in proteinuria ≥25% (confirmed on repeat measurements within 2 weeks) will be considered treatment failures and exit the study. DISCUSSION This study will test for the first time whether treatment with rituximab is non-inferior to CSA in inducing long-term remission (complete or partial) of proteinuria in patients with idiopathic membranous nephropathy.
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Hua W, Huang HZ, Tan LT, Wan JM, Gui HB, Zhao L, Ruan XZ, Chen XM, Du XG. CD36 Mediated Fatty Acid-Induced Podocyte Apoptosis via Oxidative Stress. PLoS One 2015; 10:e0127507. [PMID: 26000608 PMCID: PMC4441449 DOI: 10.1371/journal.pone.0127507] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 04/13/2015] [Indexed: 12/14/2022] Open
Abstract
Background Hyperlipidemia-induced apoptosis mediated by fatty acid translocase CD36 is associated with increased uptake of ox-LDL or fatty acid in macrophages, hepatocytes and proximal tubular epithelial cells, leading to atherosclerosis, liver damage and fibrosis in obese patients, and diabetic nephropathy (DN), respectively. However, the specific role of CD36 in podocyte apoptosis in DN with hyperlipidemia remains poorly investigated. Methods The expression of CD36 was measured in paraffin-embedded kidney tissue samples (Ctr = 18, DN = 20) by immunohistochemistry and immunofluorescence staining. We cultured conditionally immortalized mouse podocytes (MPC5) and treated cells with palmitic acid, and measured CD36 expression by real-time PCR, Western blot analysis and immunofluorescence; lipid uptake by Oil red O staining and BODIPY staining; apoptosis by flow cytometry assay, TUNEL assay and Western blot analysis; and ROS production by DCFH-DA fluorescence staining. All statistical analyses were performed using SPSS 21.0 statistical software. Results CD36 expression was increased in kidney tissue from DN patients with hyperlipidemia. Palmitic acid upregulated CD36 expression and promoted its translocation from cytoplasm to plasma membrane in podocytes. Furthermore, palmitic acid increased lipid uptake, ROS production and apoptosis in podocytes, Sulfo-N-succinimidyloleate (SSO), the specific inhibitor of the fatty acid binding site on CD36, decreased palmitic acid-induced fatty acid accumulation, ROS production, and apoptosis in podocytes. Antioxidant 4-hydroxy-2,2,6,6- tetramethylpiperidine -1-oxyl (tempol) inhibited the overproduction of ROS and apoptosis in podocytes induced by palmitic acid. Conclusions CD36 mediated fatty acid-induced podocyte apoptosis via oxidative stress might participate in the process of DN.
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Affiliation(s)
- Wei Hua
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Youyi Road 1, Chongqing, 400042, China
| | - Hui-zhe Huang
- Faculty of Basic Medical Sciences, Chongqing Medical University, Medical College Road 1, Chongqing, 400016, China
| | - Lan-ting Tan
- Emergency Department, The First Affiliated Hospital of Chongqing Medical University, Youyi Road 1, Chongqing, 400042, China
| | - Jiang-min Wan
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Youyi Road 1, Chongqing, 400042, China
| | - Hai-bo Gui
- Emergency Department, The First Affiliated Hospital of Chongqing Medical University, Youyi Road 1, Chongqing, 400042, China
| | - Liang Zhao
- Faculty of Basic Medical Sciences, Chongqing Medical University, Medical College Road 1, Chongqing, 400016, China
| | - Xiong-zhong Ruan
- Centre for Nephrology, Royal Free and University College Medical School, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, United Kingdom
- Centre for Lipid Research, Key Laboratory of Molecular Biology on Infectious Diseases, Ministry of Education, Chongqing Medical University, Youyi Road 1, Chongqing, 400042, China
| | - Xue-mei Chen
- Emergency Department, The First Affiliated Hospital of Chongqing Medical University, Youyi Road 1, Chongqing, 400042, China
- * E-mail: (XMC); (XGD)
| | - Xiao-gang Du
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Youyi Road 1, Chongqing, 400042, China
- Laboratory of Lipid & Glucose Metabolism, The First Affiliated Hospital of Chongqing Medical University, Youyi Road 1, Chongqing, 400042, China
- * E-mail: (XMC); (XGD)
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Rysz J, Gluba-Brzózka A, Banach M, Więcek A. Should we use statins in all patients with chronic kidney disease without dialysis therapy? The current state of knowledge. Int Urol Nephrol 2015; 47:805-13. [PMID: 25758011 DOI: 10.1007/s11255-015-0937-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 02/19/2015] [Indexed: 01/19/2023]
Abstract
PURPOSE The aim of this article was to present the most important matters associated with dyslipidemia treatment in CKD patients. Moreover, the most important recommendations of the current (2013) KDIGO clinical practice guideline for lipid management in chronic kidney disease are presented. METHODS Authors looked through the most recent large clinical trials and meta-analyses and presented their results. We searched using the electronic databases [MEDLINE, EMBASE, Scopus, DARE]. Additionally, abstracts from national and international cardiovascular meetings were studied. RESULTS Analysis results suggest that statins exert beneficial effects on kidney since they considerably reduce 24 h urinary protein excretion and are associated with a rise in GFR. Beneficial effects of statins may be influenced by kidney disease stage, doses of medicine and treatment duration. Data suggest that statins are effective and safe for secondary prevention of CV events in individuals with mild CKD. Patients treated with statins had decreased frequency of major atherosclerotic events compared with placebo, reduced risk of CV mortality and deaths from all causes. CONCLUSIONS Meta-analyses results suggest that statins are associated with lipid lowering, cardiovascular and anti-proteinuric benefits in CKD patients. However, their effects on overall and cardiovascular mortality are much less obvious. Bearing in mind the advantageous effects and low risk of adverse effects, it seems that mild renal impairment should not exclude these patients from receiving a statin. However, because CKD patients in stages III-V are underrepresented in clinical trials, administration of statins to these patients who have not yet had a vascular event remains controversial.
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Affiliation(s)
- Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, WAM University Hospital of Lodz, Zeromskiego 113, 90-549, Lodz, Poland,
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Keys HM. A 4-Year-Old Boy With Mild Generalized Edema. J Nurse Pract 2015. [DOI: 10.1016/j.nurpra.2014.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
On the basis of observational studies, the most common cause of nephrotic syndrome in school-aged children is minimal change disease. On the basis of research evidence and consensus, corticosteroids are considered first-line therapy for treatment of nephrotic syndrome. On the basis of consensus, prednisone therapy should be initiated at doses of 60 mg/m2 per day (2 mg/kg per day) administered for 4 to 6 weeks, followed by 40 mg/m2 per dose (1.5 mg/kg) every other day for at least 6 to 8 weeks. On the basis of consensus and expert opinion, it is important to recognize and manage the complications that can arise in patients with nephrotic syndrome, such as dyslipidemia, infection, and thrombosis. On the basis of research evidence, consensus, and expert opinion, several alternative therapies have been observed to have variable efficacy in children with both corticosteroid-dependent and corticosteroid-resistant nephrotic syndrome, although caution must be exercised in the administration of these corticosteroid-sparing medications secondary to toxic adverse effects. On the basis of observational studies, the course of nephrotic syndrome in most patients is that of relapse and remission.
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Affiliation(s)
- Tecile Prince Andolino
- St. Luke's University Health Network, Bethlehem, PA. Icahn School of Medicine at Mount Sinai, New York, NY. When this review was submitted, Dr. Andolino was in her third and final year of a pediatric nephrology fellowship at Sinai
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Halcox J, Misra A. Type 2 diabetes mellitus, metabolic syndrome, and mixed dyslipidemia: how similar, how different, and how to treat? Metab Syndr Relat Disord 2014; 13:1-21. [PMID: 25402738 DOI: 10.1089/met.2014.0049] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Individuals with mixed atherogenic dyslipidemia, type 2 diabetes mellitus (T2DM), and metabolic syndrome are at high risk of developing cardiovascular disease (CVD) and can often benefit greatly from preventive lifestyle and medical interventions. These conditions typically co-exist in an individual, and the lipid profiles associated with them have several features in common. The worldwide prevalence of T2DM, atherogenic dyslipidemia, and metabolic syndrome is increasing, particularly in southern Asia and the Middle East. Statins can lower low-density lipoprotein-cholesterol and reduce the risk of CVD in these high-risk individuals, but there is a residual risk of CVD associated with additional lipid abnormalities, such as high levels of triglycerides and low levels of high-density lipoprotein cholesterol. These abnormalities are commonly found in patients with T2DM and metabolic syndrome. Additional lipid-modifying therapies that target these abnormalities, such as fibrates and omega-3 polyunsaturated fatty acids, may be able to improve lipid profiles and further reduce the risk of CVD in these patients.
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Affiliation(s)
- Julian Halcox
- 1 University of Swansea , Singleton Park, Swansea, United Kingdom
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Yeoh ECK, Claude JR, Rajasoorya C. Paradox of rising thyroid stimulating hormone despite increasing thyroxine dose in hypothyroidism and the association with nephrotic syndrome. Nephrology (Carlton) 2014; 18:647-8. [PMID: 23980816 DOI: 10.1111/nep.12102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2013] [Indexed: 11/28/2022]
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Abstract
Nephrotic syndrome refers to excessive proteinuria, with associated hypoalbuminemia, edema, and hyperlipidemia. A diverse spectrum of disorders has been associated with nephrotic syndrome and related neurologic complications, although the relative infrequency of these cases limits conclusive associations. Neurologic manifestations of nephrotic syndrome may result from hypoproteinemia, hypercoagulability, hyperlipidemia, hypertension, amyloid deposition, hormonal changes, or electrolyte disorders. Neurologic diagnosis hinges on prompt recognition of this syndrome and rational therapeutic strategies are aimed at the underlying systemic disorder.
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Abstract
BACKGROUND Nephrotic syndrome is the collective name given to a group of symptoms that include proteinuria, lipiduria, hypoalbuminaemia, oedema, hypercholesterolaemia, elevated triglycerides, and hyperlipidaemia. Hyperlipidaemia is thought to aggravate glomerulosclerosis (hardening of blood vessels in the kidneys) and enhance progression of glomerular disease. Studies have established that reduction in total cholesterol and low density lipoprotein (LDL) cholesterol is associated with reduction in risk of cardiovascular diseases. In 2011, the European Society of Cardiology and European Atherosclerosis Society guidelines for the management of dyslipidaemia recommended use of statins as first-line agents in the management of nephrotic dyslipidaemia. However, the effectiveness and safety of statins for people with nephrotic syndrome remains uncertain. Furthermore, the efficacy of second-line lipid-lowering drugs, such as ezetimibe and nicotinic acid, has not been proven in patients with nephrotic syndrome who are unable to tolerate statin therapy. OBJECTIVES This review aimed to evaluate the benefits and harms of lipid-lowering agents in adults and children with nephrotic syndrome. SEARCH METHODS We searched the Cochrane Renal Group's Specialised Register (to 18 March 2013) through contact with the Trials Search Co-ordinator using search terms relevant to this review. SELECTION CRITERIA All randomised controlled trials (RCTs) and quasi-RCTs (RCTs in which allocation to treatment was obtained by alternation, use of alternate medical records, date of birth or other predictable methods) looking at participants with nephrotic syndrome that compared any lipid-lowering agent to placebo, no treatment or other lipid-lowering agents, given for not less than four weeks, were included. DATA COLLECTION AND ANALYSIS Two authors independently assessed study eligibility and risk of bias, and extracted data. Statistical analyses were performed using a random effects model. Dichotomous results were expressed as risk ratios (RR) with 95% confidence intervals (CI). For continuous measures mean difference (MD) was used, or the standardised mean difference (SMD) where different scales had been used. MAIN RESULTS We included five RCTs enrolling a total of 203 participants. Of these, four studies compared statins with no treatment or placebo, and one compared fibrates with placebo. We found no published studies comparing second-line agents such as ezetimibe, bile acid sequestrants, and nicotinic acid with placebo or no treatment. Our assessment of the risk of bias found that one study was judged overall to be at low risk of bias and the remaining four were judged to be at high risk of bias.Most outcomes were supported by single study data. One study reported significantly increased high density lipoprotein (HDL) cholesterol among participants in the statin arm compared with the no treatment group (MD 5.40 mg/dL, 95% CI 2.31 to 8.49). Another study reported higher serum albumin in the statin group compared to those who received no treatment (MD 0.60 g/dL, 95% CI 0.14 to 1.06). No serious adverse events, such as rhabdomyolysis, were reported, however some minor events occurred. One study reported no significant difference in the number of participants with elevated liver enzymes (RR 3.00, 95% CI 0.13 to 69.52); three studies reported liver enzymes remained within the normal range (no data provided). Four studies reported creatinine phosphokinase (CPK). One study indicated that CPK values fluctuated in both the simvastatin and placebo groups (no data provided); the remaining three studies reported CPK either stayed within the normal range (one study) or there was no significant difference between the lipid lowering agents and placebo. AUTHORS' CONCLUSIONS None of the included studies reported patient-centred outcomes including all-cause mortality, cardiovascular mortality, or non-fatal myocardial infarction; only single studies reported cholesterol (HDL, LDL and total cholesterol), triglycerides, serum creatinine, blood urea nitrogen, liver enzymes, and protein (serum, urine). High quality RCTs need to be conducted to assess the safety and efficacy of lipid-lowering drugs for people with nephrotic syndrome.
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Affiliation(s)
- Xiangyu Kong
- Department of Epidemiology and Biostatistics, School of Public Health, Chengdu Medical College, Chengdu, China
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Kaysi S, Hadj Abdelkader M, Aniort J, Garrouste C, Philipponnet C, Deteix P, Heng AE. Chronic renal failure complications and management in kidney transplanted and nontransplanted patients. Transplant Proc 2013. [PMID: 23195013 DOI: 10.1016/j.transproceed.2012.05.084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Our purpose was to compare the management of chronic kidney disease (CKD) according to Kidney Disease Quality Initiative (K/DOQI) recommendations in kidney transplanted patients (T) and nontransplanted ones (NT). METHODS Data concerning CKD complications were collected retrospectively. Patients seen in consultations in our department from May 2009 to June 2010 were selected if they had at least 6 months of follow-up, CKD stage 4 or 5, and no exclusion criteria namely hospitalization, active cancer, or infection in the 3 months before data collection. RESULTS Fifty-eight T were compared with 85 NT matched by CKD stage (4-5). Anemia within K/DOQI target was better controlled among NT (51.2% versus 41.3%); however, ferritin levels within K/DOQI target were higher (80% T versus 51.7% NT). Average arterial blood pressure was similar in both groups but 51.7% of T were in K/DOQI target versus 41% of NT. Dyslipidemia within cholesterol K/DOQI target was better controlled in 60% (NT) versus 35% NT with 63.5% versus 38% NT within low-density lipoprotein K/DOQI targets. Phosphorus level was better controlled among T; parathyroid was better controlled in among 65% NT versus 50% T within the target level. CONCLUSION Most complications of CKD were better managed among NT.
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Affiliation(s)
- S Kaysi
- Department of Nephrology, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
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Fervenza FC, Glassock RJ, Bleyer AJ. American Society of Nephrology Quiz and Questionnaire 2012: glomerulonephritis. Clin J Am Soc Nephrol 2013; 8:1460-5. [PMID: 23539226 DOI: 10.2215/cjn.00440113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Presentation of the Nephrology Quiz and Questionnaire (NQQ) has become an annual tradition at the meetings of the American Society of Nephrology. It is a very popular session, judged by consistently large attendance. Members of the audience test their knowledge and judgment on a series of case-oriented questions prepared and discussed by experts. They can also compare their answers in real time, using audience response devices, to those of program directors of nephrology training programs in the United States, acquired through an Internet-based questionnaire. The topic presented here is GN. Cases representing this category, along with single best answer questions, were prepared by a panel of experts (Drs. Fervenza, Glassock, and Bleyer). The correct and incorrect answers were then briefly discussed after the audience responses and the results of the questionnaire were displayed. This article recapitulates the session and reproduces its educational value for a larger audience--that of the readers of the Clinical Journal of the American Society of Nephrology. Have fun.
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Affiliation(s)
- Fernando C Fervenza
- Division of Nephrology and Hypertension, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
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Irazabal MV, Eirin A, Lieske J, Beck LH, Sethi S, Borland TM, Dillon JJ, Nachman PH, Nasr SH, Cornell LD, Leung N, Cattran DC, Fervenza FC. Low- and high-molecular-weight urinary proteins as predictors of response to rituximab in patients with membranous nephropathy: a prospective study. Nephrol Dial Transplant 2012; 28:137-46. [PMID: 22987142 DOI: 10.1093/ndt/gfs379] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Selective urinary biomarkers have been considered superior to total proteinuria in predicting response to treatment and outcome in patients with membranous nephropathy (MN). METHODS We prospectively tested whether urinary (U) excretion of retinol-binding protein (RBP), α1-microglobulin (α1M), albumin, immunoglobulin IgG and IgM and/or anti-phospholipase 2 receptor (PLA(2)R) levels could predict response to rituximab (RTX) therapy better than standard measures in MN. We also correlated changes in antibodies to PLA(2)R with these urinary biomarkers. RESULTS Twenty patients with MN and proteinuria (P) >5 g/24 h received RTX (375 mg/m(2) × 4) and at 12 months, 1 patient was in complete remission (CR), 9 were in partial remission (PR), 5 had a limited response (LR) and 4 were non-responders (NR). At 24 months, CR occurred in 4, PR in 12, LR in 1, NR in 2 and 1 patient relapsed. By simple linear regression analysis, UIgG at baseline (mg/24 h) was a significant predictor of change in proteinuria at 12 months (Δ urinary protein) (P = 0.04). In addition, fractional excretion (FE) of IgG, urinary alpha 1 microglobulin (Uα1M) (mg/24 h) and URBP (μg/24 h) were also predictors of response (P = 0.05, 0.04, and 0.03, respectively). On the other hand, UIgM, FEIgM, albumin and FE albumin did not predict response (P = 0.10, 0.27, 0.22 and 0.20, respectively). However, when results were analyzed in relation to proteinuria at 24 months, none of the U markers that predicted response at 12 m could predict response at 24 m (P = 0.55, 0.42, 0.29 and 0.20). Decline in anti-PLA(2)R levels was associated with and often preceded urinary biomarker response but positivity at baseline was not a predictor of proteinuria response. CONCLUSIONS The results suggest that in patients with MN, quantification of low-, medium- and high-molecular-weight urinary proteins may be associated with rate of response to RTX, but do not correlate with longer term outcomes.
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Affiliation(s)
- Maria V Irazabal
- Division of Nephrology and Hypertension, Mayo Clinic College of Medicine, Rochester, MN, USA
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Omokehinde T, El Esnawi M, Jagboto S, Arogundade R. Hemoptysis in TB Endemic Area. Think Again! Qatar Med J 2011. [DOI: 10.5339/qmj.2011.2.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
This case report illustrates an acute presentation of hemoptysis in a 21-year-old man from a TB endemic region. Further clinical evaluation resulted in extensive hypercoagulability complications of nephritic syndrome due to idiopathic membranous glomerulonephritis (MGN.) This emphasizes that proteinuria seen at a subnephrotic level, or on urine dipstick in a setting where glomerular disease might not be initially apparent, may warrant a keener look.
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Affiliation(s)
- T.R. Omokehinde
- Nephrology Section, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - M.A. El Esnawi
- Nephrology Section, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - S. Jagboto
- Nephrology Section, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - R. Arogundade
- Nephrology Section, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
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Vaziri ND, Gollapudi P, Han S, Farahmand G, Yuan J, Rahimi A, Moradi H. Nephrotic syndrome causes upregulation of HDL endocytic receptor and PDZK-1-dependent downregulation of HDL docking receptor. Nephrol Dial Transplant 2011; 26:3118-23. [PMID: 21459782 DOI: 10.1093/ndt/gfr136] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Nephrotic syndrome (NS) is associated with dysregulation of lipid/lipoprotein metabolism and impaired high-density lipoprotein (HDL)-mediated reverse cholesterol transport and atherosclerosis. HDL serves as vehicle for transport of surplus lipids from the peripheral tissues for disposal in the liver via two receptors: (i) scavenger receptor class B type I (SR-BI) which serves as a docking receptor, enabling HDL to unload its lipid cargo and return to circulation to repeat the cycle, and (ii) beta chain ATP synthase which serves as the endocytic receptor mediating removal and catabolism of lipid-poor HDL. SR-BI abundance is regulated by PDZ-containing kidney protein 1 (PDZK1), a multifunctional protein, which prevents SRB-1 degradation at the post-translational level. This study explored the effect of NS on hepatic expression of these important molecules. METHODS Gene expression, protein abundance and immunohistological appearance of the above proteins were measured in the liver of rats with puromycin-induced NS and control rats. RESULTS The nephrotic animals exhibited severe proteinuria, hypoalbuminemia, hypercholesterolemia, hypertriglyceridemia, reduced HDL/total cholesterol ratio, normal glomerular filtration rate, significant upregulation of the endocytic HDL receptor messenger RNA (mRNA) and protein (P < 0.005) and significant reduction of SR-BI protein (P < 0.002) despite its normal mRNA abundance. The reduction in SR-BI protein abundance in NS animals was accompanied by parallel reductions in PDZK1 mRNA (P = 0.02) and protein abundance (P = 0.012). CONCLUSIONS NS results in elevation of hepatic HDL endocytic receptor and deficiency of HDL docking receptor. The latter is associated with and, in part, mediated by downregulation of PDZK1. Together, these abnormalities can increase catabolism and diminish recycling of HDL and contribute to the defective reverse cholesterol/lipid transport in NS.
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Affiliation(s)
- Nosratola D Vaziri
- Division of Nephrology and Hypertension, University of California, Irvine, Orange, CA 92868, USA.
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Hereditary fibrinogen A α-chain amyloidosis: phenotypic characterization of a systemic disease and the role of liver transplantation. Blood 2010; 115:2998-3007. [DOI: 10.1182/blood-2009-06-223792] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Variants of fibrinogen A α-chain (AFib) cause the most common type of hereditary renal amyloidosis in Europe and, possibly, the United States as well. Variant fibrinogen is produced in the liver, and solitary renal allografts fail within 1 to 7 years with recurrent amyloidosis. We assessed 22 AFib patients for combined liver and kidney transplantation (LKT) and report the clinical features and outcome. Twenty-one had E526V and 1, the R554L variant. Coronary atherosclerosis was identified in 68% and systemic atheromatosis in 55%. Vascular atheroma excised at endarterectomy and endomyocardial biopsies contained purely variant fibrinogen amyloid. Half had autonomic neuropathy. Six of 9 patients who underwent LKT are alive (67%), with good allograft function and no amyloidosis at median 67 months (range, 33-155 months) of follow-up. Serial technetium-99m–labeled dimercaptosuccinic acid (99mTc-DMSA) renal scintigraphy in 2 cases of preemptive LKT demonstrated preserved native kidney residual function at 5 years. Four explanted livers were used successfully for domino transplantation. Fibrinogen amyloidosis is a systemic amyloid disease with visceral, vascular, cardiac, and neurologic involvement. LKT is curative; however, cardiovascular amyloidosis may preclude this option. Our data encourage evaluation of preemptive solitary liver transplantation early in the course of amyloid nephropathy to prevent hemodialysis and kidney transplantation.
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Abstract
The nephrotic syndrome is defined by a urinary protein excretion exceeding 3g per day, associated with hypoalbuminaemia (< 30 g/L) and hypoprotidaemia (< 60 g/L). The clinical consequences of the nephrotic syndrome are multiple, essentially dominated by sodium retention and oedema formation. The oedema physiopathology is related to both increased capillary permeability and primary activation of the Na/K pump in the collect duct. Other complications of the nephrotic syndrome include thromboembolic complications, dyslipidaemia, and infections. The treatment of these complications represents an important part of the general management of the nephritic syndrome.
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Baker JE, Fish BL, Su J, Haworth ST, Strande JL, Komorowski RA, Migrino RQ, Doppalapudi A, Harmann L, Allen Li X, Hopewell JW, Moulder JE. 10 Gy total body irradiation increases risk of coronary sclerosis, degeneration of heart structure and function in a rat model. Int J Radiat Biol 2010; 85:1089-100. [PMID: 19995235 DOI: 10.3109/09553000903264473] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To determine the impact of 10 Gy total body irradiation (TBI) or local thorax irradiation, a dose relevant to a radiological terrorist threat, on lipid and liver profile, coronary microvasculature and ventricular function. MATERIALS AND METHODS WAG/RijCmcr rats received 10 Gy TBI followed by bone marrow transplantation, or 10 Gy local thorax irradiation. Age-matched, non-irradiated rats served as controls. The lipid profile and liver enzymes, coronary vessel morphology, nitric oxide synthase (NOS) isoforms, protease activated receptor (PAR)-1 expression and fibrinogen levels were compared. Two-dimensional strain echocardiography assessed global radial and circumferential strain on the heart. RESULTS TBI resulted in a sustained increase in total and low density lipoprotein (LDL) cholesterol (190 +/- 8 vs. 58 +/- 6; 82 +/- 8 vs. 13 +/- 3 mg/dl, respectively). The density of small coronary arterioles was decreased by 32%. Histology revealed complete blockage of some vessels while cardiomyocytes remained normal. TBI resulted in cellular peri-arterial fibrosis whereas control hearts had symmetrical penetrating vessels with less collagen and fibroblasts. TBI resulted in a 32 +/- 4% and 28 +/- 3% decrease in endothelial NOS and inducible NOS protein, respectively, and a 21 +/- 4% and 35 +/- 5% increase in fibrinogen and PAR-1 protein respectively, after 120 days. TBI reduced radial strain (19 +/- 8 vs. 46 +/- 7%) and circumferential strain (-8 +/- 3 vs. -15 +/- 3%) compared to controls. Thorax-only irradiation produced no changes over the same time frame. CONCLUSIONS TBI with 10 Gy, a dose relevant to radiological terrorist threats, worsened lipid profile, injured coronary microvasculature, altered endothelial physiology and myocardial mechanics. These changes were not manifest with local thorax irradiation. Non-thoracic circulating factors may be promoting radiation-induced injury to the heart.
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Affiliation(s)
- John E Baker
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
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Kanbay M, Delibasi T, Kaya A, Aydogan T, Koca C, Akcay A, Duranay M, Yigitoglu R. Effect of Dialysis Type on Serum Lipids, Apolipoproteins, and Lipoproteins. Ren Fail 2009; 28:567-71. [PMID: 17050239 DOI: 10.1080/08860220600839761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
AIM Dyslipidemia is common among patients with end-stage renal disease, whether treated by hemodialysis (HD) or peritoneal dialysis (PD). However, there are not enough data about the effect of dialysis type on serum lipoprotein (a) [Lp(a)], apolipoprotein (a) [Apo(a)], apolipoprotein (b) [Apo(b)], and lipid levels. The aim of this study was to determine the effect of dialysis type on serum lipid levels. MATERIALS AND METHODS This study enrolled 40 HD patients (20 men and 20 women, aged 48.1 +/- 17.6 years) and 69 PD patients (35 men and 34 women, aged 45.2 +/- 16.3 years). Serum lipid profile including total cholesterol (TC), low-density lipoprotein (LDL-C), high-density lipoprotein (HDL-C), triglyceride (TG), Apo(a), Apo(b), and Lp(a) were determined in HD and PD patients. Patients who have used statins within the last six months were not included in the study. RESULTS No significant differences in TC, LDL-C, HDL-C, TG, Apo(a), Apo(b), or Lp(a) serum levels were found between HD and PD patients. Serum TC, LDL-C, HDL-C, TG, Apo(a), Apo(b), and Lp(a) in HD and PD patients were 172.2 +/- 42.7 (mg/dL) vs. 181.0 +/- 53.0 (mg/dL), 97.2 +/- 36.2 (mg/dL) vs. 101.4 +/- 33.6 (mg/dL), 45.3 +/- 11.9 (mg/dL) vs. 41.4 +/- 11.1 (mg/dL), 144.7 +/- 71.8 (mg/dL) vs. 173.0 +/- 76.8 (mg/dL), 1.2 +/- 0.5 (g/L) vs. 1.0 +/- 0.2 (g/L), 0.9 +/- 0.3 (g/L) vs. 1.2 +/- 0.3 (g/L), and 43.1 +/- 40.6 (mg/dL) vs. 46.0 +/- 42.7 (mg/dL), respectively. CONCLUSION The results of this study show that the maintenance CAPD treatment is associated with more pronounced alterations of the lipoproteins and lipid metabolism than those observed during HD treatment.
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Affiliation(s)
- Mehmet Kanbay
- Department of Nephrology, Fatih University, Faculty of Medicine, Turkey.
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Bell S, Cooney J, Packard CJ, Caslake M, Deighan CJ. Omega-3 fatty acids improve postprandial lipaemia in patients with nephrotic range proteinuria. Atherosclerosis 2009; 205:296-301. [DOI: 10.1016/j.atherosclerosis.2008.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Revised: 11/24/2008] [Accepted: 12/01/2008] [Indexed: 10/21/2022]
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Goldsmith D. Tratamiento de la dislipemia y la diabetes mellitus en pacientes con enfermedad renal crónica. Evidencias e implicaciones. Med Clin (Barc) 2009; 132 Suppl 1:27-32. [DOI: 10.1016/s0025-7753(09)70959-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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