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Su J, Chen P, Yang Y, Gao Z, Bi Z, Feng M. Development and validation of a nomogram for predicting the occurrence of renal dysfunction after treatment of immune checkpoint inhibitor: a retrospective case-control study. BMJ Open 2024; 14:e082484. [PMID: 38760047 PMCID: PMC11103235 DOI: 10.1136/bmjopen-2023-082484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/22/2024] [Indexed: 05/19/2024] Open
Abstract
PURPOSE The administration of immune checkpoint inhibitors (ICIs) may lead to renal adverse events, notably including renal dysfunction. To early predict the probability of renal dysfunction after ICIs therapy, a retrospective case-control study was conducted. METHODS Clinical information on ICIs-treated patients was collected. Multivariable logistic regression was applied to identify risk factors for renal dysfunction after ICIs treatment. Moreover, a nomogram model was developed and validated internally. RESULTS A total of 442 patients were included, among which 35 (7.9%) experienced renal dysfunction after ICIs treatment. Lower baseline estimated glomerular filtration rate (eGFR) (OR 0.941; 95% CI 0.917 to 0.966; p<0.001), concurrent exposure of platinum(OR 4.014; 95% CI 1.557 to 10.346; p=0.004), comorbidities of hypertension (OR 3.478; 95% CI 1.600 to 7.562; p=0.002) and infection (OR 5.402; 95% CI 1.544 to 18.904; p=0.008) were found to be independent associated with renal dysfunction after ICIs treatment. To develop a predictive nomogram for the occurrence of renal dysfunction after ICIs treatment, the included cases were divided into training and validation groups in a ratio of 7:3 randomly. The above four independent risk factors were included in the model. The area under the receiver operating characteristic curves of the predictiive model were 0.822 (0.723-0.922) and 0.815 (0.699-0.930) in the training and validation groups, respectively. CONCLUSIONS Lower baseline eGFR, platinum exposure, comorbidities of hypertension and infection were predictors of renal dysfunction in ICIs-treated patients with cancer. A nomogram was developed to predict the probability of renal dysfunction after ICIs treatment, which might be operable and valuable in clinical practice.
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Affiliation(s)
- Jianan Su
- Department of Nephrology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Pengwei Chen
- Department of Nephrology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yaping Yang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Ziqing Gao
- Department of Nephrology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhuofei Bi
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Radiation Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Min Feng
- Department of Nephrology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Fiseha T, Ekong NE, Osborne NJ. Chronic kidney disease of unknown aetiology in Africa: A review of the literature. Nephrology (Carlton) 2024; 29:177-187. [PMID: 38122827 DOI: 10.1111/nep.14264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/25/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
During the last two decades, an epidemic of a severe form of chronic kidney disease (CKD) unrelated to traditional risk factors (diabetes and hypertension) has been recognized in low- to middle-income countries. CKD of unknown aetiology (CKDu) mainly affects young working-age adults, and has become as an important and devastating public health issue. CKDu is a multifactorial disease with associated genetic and environmental risk factors. This review summarizes the current epidemiological evidence on the burden of CKDu and its probable environmental risk factors contributing to CKD in Africa. PubMed/Medline and the African Journals Online databases were searched to identify relevant population-based studies published in the last two decades. In the general population, the burden of CKD attributable to CKDu varied from 19.4% to 79%. Epidemiologic studies have established that environmental factors, including genetics, infectious agents, rural residence, low socioeconomic status, malnutrition, agricultural practise and exposure to agrochemicals, heavy metals, use of traditional herbs, and contaminated water sources or food contribute to the burden of CKD in the region. There is a great need for epidemiological studies exploring the true burden of CKDu and unique geographical distribution, and the role of environmental factors in the development of CKD/CKDu.
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Affiliation(s)
- Temesgen Fiseha
- Department of Clinical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | | | - Nicholas J Osborne
- Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
- European Centre for Environment and Human Health (ECEHH), University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall, UK
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Ren Y, Chen L, Guo R, Ma S, Li S, Zhang Y, Jiang H, Shi H, Zhang P. Altered gut mycobiome in patients with end-stage renal disease and its correlations with serum and fecal metabolomes. J Transl Med 2024; 22:202. [PMID: 38403655 PMCID: PMC10894479 DOI: 10.1186/s12967-024-05004-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/18/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND The relationship between the gut mycobiome and end-stage renal disease (ESRD) remains largely unexplored. METHODS In this study, we compared the gut fungal populations of 223 ESRD patients and 69 healthy controls (HCs) based on shotgun metagenomic sequencing data, and analyzed their associations with host serum and fecal metabolites. RESULTS Our findings revealed that ESRD patients had a higher diversity in the gut mycobiome compared to HCs. Dysbiosis of the gut mycobiome in ESRD patients was characterized by a decrease of Saccharomyces cerevisiae and an increase in various opportunistic pathogens, such as Aspergillus fumigatus, Cladophialophora immunda, Exophiala spinifera, Hortaea werneckii, Trichophyton rubrum, and others. Through multi-omics analysis, we observed a substantial contribution of the gut mycobiome to host serum and fecal metabolomes. The opportunistic pathogens enriched in ESRD patients were frequently and positively correlated with the levels of creatinine, homocysteine, and phenylacetylglycine in the serum. The populations of Saccharomyces, including the HC-enriched Saccharomyces cerevisiae, were frequently and negatively correlated with the levels of various toxic metabolites in the feces. CONCLUSIONS Our results provided a comprehensive understanding of the associations between the gut mycobiome and the development of ESRD, which had important implications for guiding future therapeutic studies in this field.
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Affiliation(s)
- Yi Ren
- Department of Critical Care Nephrology and Blood Purification, the First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China
- Department of Nephrology, People's Hospital of Longhua, Shenzhen, 518109, People's Republic of China
| | - Lei Chen
- Department of Critical Care Nephrology and Blood Purification, the First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Ruochun Guo
- Puensum Genetech Institute, Wuhan, 430076, People's Republic of China
| | - Shiyang Ma
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xiwu Road, Xi'an, 710004, Shaanxi, People's Republic of China
- Shaanxi Key Laboratory of Gastrointestinal Motility Disorders, Xi'an, 710004, Shaanxi, People's Republic of China
- Shaanxi Provincial Clinical Research Center for Gastrointestinal Diseases, Xi'an, 710004, Shaanxi, People's Republic of China
- Digestive Disease Quality Control Center of Shaanxi Province, Xi'an, 710004, People's Republic of China
| | - Shenghui Li
- Puensum Genetech Institute, Wuhan, 430076, People's Republic of China
| | - Yue Zhang
- Puensum Genetech Institute, Wuhan, 430076, People's Republic of China
| | - Hongli Jiang
- Department of Critical Care Nephrology and Blood Purification, the First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China.
| | - Haitao Shi
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xiwu Road, Xi'an, 710004, Shaanxi, People's Republic of China.
- Shaanxi Key Laboratory of Gastrointestinal Motility Disorders, Xi'an, 710004, Shaanxi, People's Republic of China.
- Shaanxi Provincial Clinical Research Center for Gastrointestinal Diseases, Xi'an, 710004, Shaanxi, People's Republic of China.
- Digestive Disease Quality Control Center of Shaanxi Province, Xi'an, 710004, People's Republic of China.
| | - Pan Zhang
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xiwu Road, Xi'an, 710004, Shaanxi, People's Republic of China.
- Shaanxi Key Laboratory of Gastrointestinal Motility Disorders, Xi'an, 710004, Shaanxi, People's Republic of China.
- Shaanxi Provincial Clinical Research Center for Gastrointestinal Diseases, Xi'an, 710004, Shaanxi, People's Republic of China.
- Digestive Disease Quality Control Center of Shaanxi Province, Xi'an, 710004, People's Republic of China.
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Sivanandam LK, Jhoond MK, Sujanyal SA, Sridhar S, Nasser N, Sanker V, Gupta U. A rare extrapulmonary manifestation of tuberculosis in a chronic kidney disease patient. Clin Case Rep 2023; 11:e7807. [PMID: 37649900 PMCID: PMC10462775 DOI: 10.1002/ccr3.7807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 07/12/2023] [Accepted: 08/04/2023] [Indexed: 09/01/2023] Open
Abstract
Key Clinical Message Chronic kidney disease (CKD) and tuberculoma are two distinct medical conditions. Nonetheless, they can be related in very rare cases. The purpose of this case report is to consider screening tests such as IGRA (interferon gamma release assay) and TST (tuberculin skin test), for tuberculosis in CKD patients with a risk of infection, thereby increasing the awareness of tuberculoma in CKD and ensuring early treatment which would eventually decrease the morbidity and mortality rates in such patients. Abstract Chronic kidney disease (CKD) associated with tuberculoma represents one of the rarest conditions occurring worldwide. Among tuberculous patients, only 1% show central nervous system involvement. We present a case of a 45-year-old male with CKD who presented with a seizure and was diagnosed to have tuberculoma.
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Affiliation(s)
| | - Manpreet Kaur Jhoond
- Team ErevnitesTrivandrumIndia
- General MedicineSri Lakshmi Narayana Institute of Medical SciencesPuducherryIndia
| | | | - Shreya Sridhar
- Team ErevnitesTrivandrumIndia
- Sapthagiri Institute of Medical Sciences and Research CentreBangaloreKarnatakaIndia
| | - Nathalie Nasser
- Team ErevnitesTrivandrumIndia
- Faculty of Medical SciencesLebanese UniversityBeirutLebanon
| | - Vivek Sanker
- Team ErevnitesTrivandrumIndia
- Noorul Islam Institute of Medical SciencesTrivandrumKeralaIndia
| | - Umang Gupta
- Team ErevnitesTrivandrumIndia
- Nepalgunj Medical CollegeNepalgunjNepal
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Cervantes CE, Atta MG. Updates on HIV and Kidney Disease. Curr HIV/AIDS Rep 2023; 20:100-110. [PMID: 36695948 DOI: 10.1007/s11904-023-00645-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2022] [Indexed: 01/26/2023]
Abstract
PURPOSE OF REVIEW With the advent of antiretroviral therapy, HIV infection has become a chronic disease in developed countries. RECENT FINDINGS Non-HIV-driven risk factors for kidney disease, such as APOL1 risk variants and other genetic and environmental factors, have been discovered and are better described. Consequently, the field of HIV-associated kidney disease has evolved with greater attention given to traditional risk factors of CKD and antiretroviral treatment's nephrotoxicity. In this review, we explore risk factors of HIV-associated kidney disease, diagnostic tools, kidney pathology in HIV-positive individuals, and antiretroviral therapy-associated nephrotoxicity.
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Affiliation(s)
- C Elena Cervantes
- Department of Medicine, Division of Nephrology, Johns Hopkins University, 1830 E. Monument Street, Suite 416, Baltimore, MD, 21218, USA
| | - Mohamed G Atta
- Department of Medicine, Division of Nephrology, Johns Hopkins University, 1830 E. Monument Street, Suite 416, Baltimore, MD, 21218, USA.
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Babu G, Nobel FA. Identification of differentially expressed genes and their major pathways among the patient with COVID-19, cystic fibrosis, and chronic kidney disease. INFORMATICS IN MEDICINE UNLOCKED 2022; 32:101038. [PMID: 35966126 PMCID: PMC9357445 DOI: 10.1016/j.imu.2022.101038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/31/2022] [Accepted: 08/01/2022] [Indexed: 11/19/2022] Open
Abstract
The SARS-CoV-2 virus causes Coronavirus disease, an infectious disease. The majority of people who are infected with this virus will have mild to moderate respiratory symptoms. Multiple studies have proved that there is a substantial pathophysiological link between COVID-19 disease and patients having comorbidities such as cystic fibrosis and chronic kidney disease. In this study, we attempted to identify differentially expressed genes as well as genes that intersected among them in order to comprehend their compatibility. Gene expression profiling indicated that 849 genes were mutually exclusive and functional analysis was done within the context of gene ontology and key pathways involvement. Three genes (PRPF31, FOXN2, and RIOK3) were commonly upregulated in the analysed datasets of three disease categories. These genes could be potential biomarkers for patients with COVID-19 and cystic fibrosis, and COVID-19 and chronic kidney disease. Further extensive analyses have been performed to describe how these genes are regulated by various transcription factors and microRNAs. Then, our analyses revealed six hub genes (PRPF31, FOXN2, RIOK3, UBC, HNF4A, and ELAVL). As they were involved in the interaction between COVID-19 and the patient with CF and CKD, they could help researchers identify potential therapeutic molecules. Some drugs have been predicted based on the upregulated genes, which may have a significant impact on reducing the burden of these diseases in the future.
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Affiliation(s)
- Golap Babu
- Department of Biochemistry and Molecular Biology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Fahim Alam Nobel
- Department of Biochemistry and Molecular Biology, Mawlana Bhashani Science and Technology University, Santosh, Tangail, 1902, Bangladesh
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Jolly AM, Thomas J. Chronic kidney disease of unknown etiology in India: a comparative study with Mesoamerican and Sri Lankan nephropathy. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:15303-15317. [PMID: 34984612 DOI: 10.1007/s11356-021-16548-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/11/2021] [Indexed: 06/14/2023]
Abstract
Chronic kidney disease of unknown etiology [CKDu] is a condition characterized by decline in kidney function and is not associated with diabetic nephropathy or hypertensive nephropathy. In this review, we have done a detailed literature analysis on CKDu in India, and then had a comparison with that of Mesoamerica and Sri Lanka. In India, CKDu became the second most common type of CKD after diabetic nephropathy. Silica was seen in the groundwater of both India and Sri Lanka, whereas in Mesoamerica silica exposure through particulate matter was seen among CKDu communities. DDE is a common agrochemical seen in both India and Sri Lanka. The risk factors vary from region to region and it is important to categorize CKDu population based on the risk factors to avoid misinterpretation of the condition as non-CKDu category and to evade further complications. More studies have to be conducted to reveal the detailed pathophysiological mechanisms and its relation with irrational exploitation of environmental resources.
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Affiliation(s)
- Aleeta Maria Jolly
- Department of Pharmacology, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, Ponekkara, Kerala, India
| | - Jaya Thomas
- Department of Pharmacology, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, Ponekkara, Kerala, India.
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8
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Koehler FC, Di Cristanziano V, Späth MR, Hoyer-Allo KJR, Wanken M, Müller RU, Burst V. OUP accepted manuscript. Clin Kidney J 2022; 15:1231-1252. [PMID: 35756741 PMCID: PMC9217627 DOI: 10.1093/ckj/sfac008] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Indexed: 01/18/2023] Open
Abstract
Hantavirus-induced diseases are emerging zoonoses with endemic appearances and frequent outbreaks in different parts of the world. In humans, hantaviral pathology is characterized by the disruption of the endothelial cell barrier followed by increased capillary permeability, thrombocytopenia due to platelet activation/depletion and an overactive immune response. Genetic vulnerability due to certain human leukocyte antigen haplotypes is associated with disease severity. Typically, two different hantavirus-caused clinical syndromes have been reported: hemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome (HCPS). The primarily affected vascular beds differ in these two entities: renal medullary capillaries in HFRS caused by Old World hantaviruses and pulmonary capillaries in HCPS caused by New World hantaviruses. Disease severity in HFRS ranges from mild, e.g. Puumala virus-associated nephropathia epidemica, to moderate, e.g. Hantaan or Dobrava virus infections. HCPS leads to a severe acute respiratory distress syndrome with high mortality rates. Due to novel insights into organ tropism, hantavirus-associated pathophysiology and overlapping clinical features, HFRS and HCPS are believed to be interconnected syndromes frequently involving the kidneys. As there are no specific antiviral treatments or vaccines approved in Europe or the USA, only preventive measures and public awareness may minimize the risk of hantavirus infection. Treatment remains primarily supportive and, depending on disease severity, more invasive measures (e.g., renal replacement therapy, mechanical ventilation and extracorporeal membrane oxygenation) are needed.
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Affiliation(s)
- Felix C Koehler
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- CECAD, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Veronica Di Cristanziano
- Institute of Virology, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Martin R Späth
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- CECAD, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - K Johanna R Hoyer-Allo
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- CECAD, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Manuel Wanken
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Roman-Ulrich Müller
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- CECAD, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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Hockham C, Bao L, Tiku A, Badve SV, Bello AK, Jardine MJ, Jha V, Toyama T, Woodward M, Jun M. OUP accepted manuscript. Clin Kidney J 2022; 15:1144-1151. [PMID: 35664281 PMCID: PMC9155252 DOI: 10.1093/ckj/sfac030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Indexed: 11/20/2022] Open
Abstract
Background Previous reports on the prevalence of chronic kidney disease (CKD) in Asia have suggested important sex disparities but have been inconsistent in nature. We sought to synthesize available sex-disaggregated CKD prevalence data in Asia to quantify sex disparities in the region. Methods We systematically searched MEDLINE and Embase for observational studies involving ≥500 adults who reported sex-disaggregated CKD prevalence data in any of the 26 countries in East, Southeast and South Asia. For each study we calculated the female:male prevalence ratio (PR), with a ratio >1 indicating a higher female prevalence. For each country, log-transformed PRs were pooled using random effects meta-analysis. These were then combined using a fixed effects model, weighting by population size, to estimate a pooled PR for each of East, Southeast and South Asia and Asia overall. Results Sex-disaggregated data were available from 171 cohorts, spanning 15 countries and comprising 2 550 169 females and 2 595 299 males. Most studies (75.4%) came from East Asia (China, Taiwan, Japan and South Korea). Across Asia, CKD prevalence was higher in females {pooled prevalence 13.0% [95% confidence interval (CI) 11.3–14.9]} compared with males [pooled prevalence 12.1% (95% CI 10.3–14.1)], with a pooled PR of 1.07 (95% CI 0.99–1.17). Substantial heterogeneity was observed between countries. The pooled PRs for East, Southeast and South Asia were 1.11 (95% CI 1.02–1.21), 1.09 (0.88–1.36) and 1.03 (0.87–1.22), respectively. Conclusions Current evidence suggests considerable between-country and -region heterogeneity in the female:male PR of CKD. However, there remains a large part of the region where data on sex-specific CKD prevalence are absent or limited. Country-level assessment of the differential burden of CKD in females and males is needed to define locally relevant policies that address the needs of both sexes.
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Affiliation(s)
| | - Lexia Bao
- George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- University of British Columbia, Vancouver, BC, Canada
| | - Anushree Tiku
- George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Sunil V Badve
- George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Department of Renal Medicine, St George Hospital, Sydney, NSW, Australia
| | - Aminu K Bello
- Division of Nephrology, University of Alberta, Edmonton, AB, Canada
| | - Meg J Jardine
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
- Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Vivekanand Jha
- George Institute for Global Health, School of Public Health, Imperial College London, London, UK
- George Institute for Global Health, University of New South Wales International, New Delhi, India
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Tadashi Toyama
- Department of Nephrology, Kanazawa University, Kanazawa, Japan
| | - Mark Woodward
- George Institute for Global Health, School of Public Health, Imperial College London, London, UK
- George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Min Jun
- George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
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Tran Ngoc C, Barango P, Harrison R, Jones A, Shongwe SV, Tuyishime A, Uwinkindi F, Xu H, Shoop-Worrall S. Risk factors associated with albuminuria in Rwanda: results from a STEPS survey. BMC Nephrol 2021; 22:361. [PMID: 34724916 PMCID: PMC8561895 DOI: 10.1186/s12882-021-02574-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/25/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) are a growing burden which affects every part of the world, including developing countries. Chronic kidney disease (CKD) has varied etiology which can result from or complicate other NCDs such as diabetes and cardiovascular diseases. The growing prevalence of NCDs coupled with the increasing age in most developing countries, has seen a marked increase of CKD in these settings. CKD has been described as "the most neglected NCD" and greatly affects the quality of life of patients. It also places a huge economic burden on societies. However, few epidemiological data exist, particularly in sub-Saharan Africa. Assessment of the prevalence of albuminuria as a marker of kidney damage and CKD progression and its main risk factors was thus needed in Rwanda. METHODS This study analyzed data collected during the first STEPwise approach to NCD risk factor Surveillance (STEPS) survey in Rwanda, conducted from 2012 to 2013, to assess the prevalence of albuminuria. A multistage cluster sampling allowed to select a representative sample of the general population. Furthermore, descriptive, as well as univariable analyses and multiple logistic regression were performed to respond to the research question. RESULTS This survey brought a representative sample of 6,998 participants, among which 4,384 (62.65%) were female. Median age was 33 years (interquartile range, IQR 26-44), and over three quarters (78.45%) lived in rural areas. The albuminuria prevalence was 105.9 per 1,000 population. Overall, semi-urban and urban residency were associated with lower odds of CKD (odds ratio, OR 0.36, CI 0.23-0.56, p<0.001 and OR 0.34, CI 0.23-0.50, p<0.001, respectively) than rural status. Being married or living with a partner had higher odds (OR 1.44 (CI 1.03-2.02, p=0.031) and OR 1.62 (CI 1.06-2.48, p=0.026), respectively) of CKD than being single. Odds of positive albuminuria were also greater among participants living with human immunodeficiency virus (HIV) (OR 1.64, CI 1.09- 2.47, p=0.018). Gender, age group, smoking status and vegetable consumption, body mass index (BMI) and hypertension were not associated with albuminuria. CONCLUSION The albuminuria prevalence was estimated at 105.9 per 1,000 in Rwanda. Rural residence, partnered status and HIV positivity were identified as main risk factors for albuminuria. Increased early screening of albuminuria to prevent CKD among high-risk groups, especially HIV patients, is therefore recommended.
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Affiliation(s)
- Candide Tran Ngoc
- World Health Organization, Country Office for Rwanda, Kigali, Rwanda.
| | - Prebo Barango
- World Health Organization, Inter Country Support Team, Eastern and Southern Africa, Harare, Zimbabwe
| | - Roger Harrison
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Andrew Jones
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Steven Velabo Shongwe
- World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | | | | | - Hongyi Xu
- World Health Organization, Headquarters, Geneva, Switzerland
| | - Stephanie Shoop-Worrall
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, UK
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11
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[Antimalaria therapy of chronic renal failure]. Nephrol Ther 2021; 17:520-525. [PMID: 34412998 DOI: 10.1016/j.nephro.2021.05.007] [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: 05/22/2020] [Revised: 05/10/2021] [Accepted: 05/27/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The treatment of uncoded malaria (malaria) remains very delicate in chronic renal failure which is associated with immunity abnormalities which weaken the uremic subject and create a vicious morbid circle. OBJECTIVE Describe the malaria treatment profile of the chronic renal failure patient with malaria. METHODOLOGY This was a retrospective study of patients with chronic renal failure presenting with diagnosed simple malaria admitted to the nephrology departments of the university hospital centers of Treichville and Yopougon from October 1, 2018 to February 28, 2019 and having given their informed consent verbal. RESULTS We identified 278 chronic renal failure patients, 40 (14.4%) of whom had malaria. The mean age was 42±13 years with a male predominance (sex-ratio: 1.1). The clinical signs were hyperthermia (70%), diffuse pain (67.5%) and headache (37.5%). Chronic renal failure was discovered at stage 5 in 87.5% of cases and 85% started chronic dialysis using a dialysis using a hemodialysis catheter (94%). Malaria was confirmed by a thick drop (66%) and a Quantitative Buffy Coast Malaria Test (44%). There was severe anemia with an average hemoglobin level of 7.1±1.9g/dL and thrombocytopenia (38.4%). Malaria was first treated with artemether (67%) or artesunate (25%) intramuscularly (67.5%) or intravenously (25%). The average duration of treatment with artemether was 3 days and artesunate 4.5 days±1.1. Seventy-eight percent of the patients had an injectable antimalarial without oral relay. The clinical course was favorable in 77%. Diabetes was a factor influencing patient evolution. CONCLUSION This study reveals a misuse of antimalarials because the national recommendations for the treatment of malaria were not respected. The presence of anemia would make the parenteral routes preferable.
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Abstract
Acute kidney injury (AKI) is a common and critical clinical disorder with non-negligible morbidity and mortality and remains a large public health problem. Asia, as the world's largest and most populous continent, is crucial in eliminating unsatisfactory outcomes of AKI. The diversities in climate, customs, and economic status lead to various clinical features of AKI across Asia. In this review, we focus on the epidemiologic data and clinical features of AKI in different Asian countries and clinical settings, and we show the huge medical and economic burden of AKI in Asian countries. Drugs and sepsis are the most common etiologies for AKI, however, an adequate surveillance system has not been well established. There is significant undertreatment of AKI in many regions, and medical resources for renal replacement therapy are not universally available. Although substantial improvement has been achieved, health care for AKI still needs improvement, especially in developing regions.
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Affiliation(s)
- Junwen Huang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China; Peking University Institute of Nephrology, Beijing, China; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
| | - Damin Xu
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China; Peking University Institute of Nephrology, Beijing, China; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
| | - Li Yang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China; Peking University Institute of Nephrology, Beijing, China; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.
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13
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Spectrum and Clinical Characteristics of Renal Diseases in Ghanaian Adults: A 13-Year Retrospective Study. Int J Nephrol 2020; 2020:8967258. [PMID: 32328308 PMCID: PMC7174960 DOI: 10.1155/2020/8967258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/27/2020] [Accepted: 03/16/2020] [Indexed: 11/18/2022] Open
Abstract
Background Renal diseases over the years have become one of the leading causes of morbidity and mortality worldwide. In this study, we assessed the spectrum and clinical characteristics of Ghanaians with renal diseases at the nephrology unit of Komfo Anokye Teaching Hospital (KATH), Kumasi. Methods This was a retrospective hospital-based study conducted at Komfo Anokye Teaching Hospital (KATH) from the years 2005 to 2017. A non-randomized sampling approach was used to include 1426 participants who were diagnosed with AKI, CKD, ESRD, and nephrotic syndrome at the nephrology unit of KATH during the years under review. All the 1426 patients were eligible for the study. Demographic characteristics as well as clinical data such as the kind of renal disease presentation, causes of the renal disease, and the treatment options were also obtained from their records. Results Overall, 1009 of the total participants had CKD (70.76%), 295 participants had ESRD (20.69%), 72 participants had AKI (5.05%), and 50 participants had nephrotic syndrome (3.51%). Furthermore, 69 (23.4%) participants with ESRD were on dialysis whiles 6 (8.3) and 17 (1.7) participants with only AKI and CKD superimposed AKI, respectively, were on dialysis. 226 (76.6%) participants with ESRD were on conservative therapy. Hypertension emerged as the major cause of renal disease presentation (53.93%) with bilateral leg edema (13.46%) being the major complaint. There was a significant association between CKD and age (p ≤ 0.001). Nephrotic syndrome also showed a significant association with age (p ≤ 0.001). Conclusion This study revealed that patients at the nephrology unit of KATH, Ghana, are mainly adults between ages 46–55. The clinical pattern of renal diseases is dominated by CKD and ESRD. We conclude that hypertension, chronic glomerulonephritis, diabetic nephropathy, and sepsis are the most common causes of renal diseases. The commonest clinical presentations are bilateral leg edema, palpitations, headache, breathlessness, dizziness, and vomiting. Early diagnosis and management of these conditions may prevent or delay the progress to end-stage renal disease.
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15
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Burdmann EA. Flaviviruses and Kidney Diseases. Adv Chronic Kidney Dis 2019; 26:198-206. [PMID: 31202392 DOI: 10.1053/j.ackd.2019.01.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/08/2019] [Accepted: 01/09/2019] [Indexed: 12/17/2022]
Abstract
The genus Flavivirus comprises approximately 73 viruses, which share several common aspects, such as dimension, structure, nucleic acid properties, and shape in electronic microscopy. Global incidence of flavivirus infection increased dramatically over the last decades, causing large outbreaks in several areas of the world. These viruses are expanding from endemic tropical and subtropical areas to previously nonendemic areas, affecting and causing diseases in millions of individuals worldwide and posing a formidable challenge to public health in several countries. The majority of clinically significant flavivirus-associated infections are mosquito borne (arboviruses-acronym for ARthropod-BOrne VIRUSES), such as dengue, yellow fever, Japanese encephalitis, Zika, and West Nile fever. Most diseases caused by flaviviruses are asymptomatic or manifest as self-limited, mild, undifferentiated febrile diseases. In a limited number of cases, these diseases may evolve to severe inflammatory, multisystem diseases, causing high morbidity and mortality. Some flaviviruses have been consistently identified in kidney tissue and urine and have been clinically associated with kidney diseases. In this review, we will provide an overview of the epidemiology, risk factors, kidney pathology, etiopathogenesis, and outcomes of acute and chronic kidney syndromes associated with dengue, yellow fever, Zika, and West Nile virus disease.
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16
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Stel VS, Awadhpersad R, Pippias M, Ferrer-Alamar M, Finne P, Fraser SD, Heaf JG, Hemmelder MH, Martínez-Castelao A, de Meester J, Palsson R, Prischl FC, Segelmark M, Traynor JP, Santamaria R, Reisaeter AV, Massy ZA, Jager KJ. International comparison of trends in patients commencing renal replacement therapy by primary renal disease. Nephrology (Carlton) 2019; 24:1064-1076. [PMID: 30456883 DOI: 10.1111/nep.13531] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2018] [Indexed: 01/05/2023]
Abstract
AIM To examine international time trends in the incidence of renal replacement therapy (RRT) for end-stage renal disease (ESRD) by primary renal disease (PRD). METHODS Renal registries reporting on patients starting RRT per million population for ESRD by PRD from 2005 to 2014, were identified by internet search and literature review. The average annual percentage change (AAPC) with a 95% confidence interval (CI) of the time trends was computed using Joinpoint regression. RESULTS There was a significant decrease in the incidence of RRT for ESRD due to diabetes mellitus (DM) in Europe (AAPC = -0.9; 95%CI -1.3; -0.5) and to hypertension/renal vascular disease (HT/RVD) in Australia (AAPC = -1.8; 95%CI -3.3; -0.3), Canada (AAPC = -2.9; 95%CI -4.4; -1.5) and Europe (AAPC = -1.1; 95%CI -2.1; -0.0). A decrease or stabilization was observed for glomerulonephritis in all regions and for autosomal dominant polycystic kidney disease (ADPKD) in all regions except for Malaysia and the Republic of Korea. An increase of 5.2-16.3% was observed for DM, HT/RVD and ADPKD in Malaysia and the Republic of Korea. CONCLUSION Large international differences exist in the trends in incidence of RRT by primary renal disease. Mapping of these international trends is the first step in defining the causes and successful preventative measures of CKD.
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Affiliation(s)
- Vianda S Stel
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Ryan Awadhpersad
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Maria Pippias
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | | | - Patrik Finne
- Department of Nephrology, Helsinki University Hospital, Helsinki, Finland.,Finnish Registry for Kidney Diseases, Helsinki, Finland
| | - Simon D Fraser
- Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - James G Heaf
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Marc H Hemmelder
- Dutch Renal Registry Renine, Nefrovisie Foundation, Utrecht, the Netherlands
| | | | - Johan de Meester
- Department of Nephrology & Dialysis & Hypertension, Dutch-speaking Belgian Renal Registry (NBVN), Sint-Niklaas, Belgium
| | - Runolfur Palsson
- Division of Nephrology, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Friedrich C Prischl
- Department of Nephrology, Fourth Department of Internal Medicine, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Mårten Segelmark
- Department of Clinical Sciences Lund, Nephrology, Lund University, Skane University Hospital, Lund, Sweden
| | | | - Rafael Santamaria
- Nephrology Service, Reina Sofia University Hospital/Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Cordoba, Spain
| | - Anna Varberg Reisaeter
- Norwegian Renal Registry, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Ziad A Massy
- Division of Nephrology, Ambroise Pare University Hospital, APHP, University of Paris Ouest-Versailles-St-Quentin-en-Yvelines (UVSQ), Paris, France.,Institut National de la Sante et de la Recherche Medicale (INSERM) U1018, Team 5, CESP UVSQ, University Paris Saclay, Villejuif, France
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Chen YY, Fang WH, Wang CC, Kao TW, Chang YW, Yang HF, Wu CJ, Sun YS, Chen WL. Crosssectional Assessment of Bone Mass Density in Adults with Hepatitis B Virus and Hepatitis C Virus Infection. Sci Rep 2019; 9:5069. [PMID: 30911051 PMCID: PMC6433944 DOI: 10.1038/s41598-019-41674-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 03/13/2019] [Indexed: 12/13/2022] Open
Abstract
Osteoporosis is one of the major complications in chronic hepatitis B virus (HBV) and hepatitis C (HCV) infection. However, few studies had examined the relationship between hepatic viral infection with bone loss. Our aim was to investigate the association between hepatic viral infection with bone mineral density (BMD) in a cross-sectional study. Participants who attended the health examinations at the Tri-Service General Hospital (TSGH), Taiwan, were enrolled in the study. Diagnosis of viral hepatitis was confirmed by the serum viral markers of hepatitis B surface antigen (HBsAg) and anti-HCV, and BMD measurement was performed by the bone densitometry. Subjects were divided into four groups by the presence of viral markers. The association between hepatic viral infection and BMD was examined by a multivariate linear regression model. HBV infection was inversely associated with BMD after full adjusting with β values of -0.17 (95% CI: -0.29, -0.05) (p < 0.05). The relationship remained significant in males (β = -0.16, 95% CI = -0.31, -0.01) (p < 0.05). In subjects with body mass index less than 30 HBV infection was associated with reduced BMD (β = -0.16, 95% CI = -0.29, -0.02) (p < 0.05). However, HCV infection was only associated with an increase in BMD in patients with BMI less than 30 (β = 0.17, 95% CI = 0.21, 0.32) (p < 0.05). Chronic HBV infection was significantly associated with reduced BMD in males. The impact of viral hepatitis on bone health deserves further investigation for the potential pathophysiological mechanisms.
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Affiliation(s)
- Yuan-Yuei Chen
- Department of Internal Medicine, Tri-Service General Hospital Songshan Branch; and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital; and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Wen-Hui Fang
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital; and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chung-Ching Wang
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital; and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Tung-Wei Kao
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital; and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital; and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Graduate Institute of Clinical Medical, College of Medicine, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Yaw-Wen Chang
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital; and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital; and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Hui-Fang Yang
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital; and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital; and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chen-Jung Wu
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital; and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital; and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Division of Family Medicine, Department of Community Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan, Republic of China
| | - Yu-Shan Sun
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital; and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital; and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Wei-Liang Chen
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital; and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China. .,Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital; and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.
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18
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Prasad N, Patel MR. Infection-Induced Kidney Diseases. Front Med (Lausanne) 2018; 5:327. [PMID: 30555828 PMCID: PMC6282040 DOI: 10.3389/fmed.2018.00327] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 11/07/2018] [Indexed: 12/13/2022] Open
Abstract
Infection induced kidney diseases are of concern for clinicians because timely detection and treatment of infections may cure or limit the extent of injury inflicted by microorganisms causing the infections. Infections can cause kidney injury by either direct invasion, or indirectly by immune mediated mechanisms, which manifest as post-infectious glomerulonephritis, or infection-related glomerulonephritis. Clinical manifestations may be acute or chronic depending on the microorganisms, endemic/epidemic nature and source of infection. All microbials virus, bacteria, mycobacteria, fungus, and protozoa have been implicated in kidney diseases either causing direct kidney injuries or immune-mediated injuries. Infection control practices in large parts of world is limited by poverty, social behavior, high population density, deforestation, inadequate access to safe drinking water, and poor health care facilities. Although, antimicrobials and vaccinations have successfully eradicated and cured many infectious diseases; however injudicious antimicrobial use and emergence of resistant organisms complicated the disease severity like secondary renal amyloidosis with chronic persistent infection. Re-emergence of various infections has been a recent pattern in developed world leading to uncertain diagnostic challenges, and association with kidney diseases.
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Affiliation(s)
- Narayan Prasad
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Manas Ranjan Patel
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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19
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Sundin PO, Udumyan R, Fall K, Montgomery S. Hospital admission with pneumonia and subsequent persistent risk of chronic kidney disease: national cohort study. Clin Epidemiol 2018; 10:971-979. [PMID: 30147376 PMCID: PMC6101736 DOI: 10.2147/clep.s169039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Although acute onset kidney complications associated with severe infections including pneumonia are well characterized, little is known about possible subsequent delayed risk of chronic kidney disease (CKD). Patients and methods Associations between hospital admission with pneumonia in adulthood and raised risks of subsequent CKD were evaluated in a cohort of all male residents in Sweden born from 1952 to 1956 (n=284,198) who attended mandatory military conscription examinations in late adolescence (n=264,951) and were followed up through 2009. CKD and pneumonia were identified using Swedish national registers, and their associations were evaluated using Cox regression. Excluding the first year, the subsequent period was divided into ≤5, >5–≤15, and >15 years after hospital admission with pneumonia. Follow-up ended on the date of first incident diagnosis of kidney disease, death, emigration, or December 31,2009, whichever occurred first. Results During a median follow-up of 36.7 (interquartile range 35.3–37.9) years from late adolescence, 5,822 men had an inpatient pneumonia diagnosis without contemporaneous kidney disease. Among exposed men, 136 (2.3%) were later diagnosed with CKD compared with 2,749 (1.2%) of the unexposed. The adjusted hazard ratio for CKD in the first year after the first episode of pneumonia was 14.55 (95% confidence interval, 10.41–20.32), identifying early onset kidney complications and possibly pre-existing undiagnosed CKD. Starting follow-up 1 year after pneumonia to reduce the potential influence of surveillance bias and the risk of reverse causation, the adjusted hazard ratio for CKD in the first 5 years of follow-up was 5.20 (95% confidence interval, 3.91–6.93) and then attenuated with increasing time. Conclusion Pneumonia among inpatients is associated with a persistently increased risk for subsequent CKD, with the highest risk during the years immediately after pneumonia. Health care professionals should be aware of this period of heightened risk to facilitate early diagnosis and secondary preventive interventions.
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Affiliation(s)
- Per-Ola Sundin
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden,
| | - Ruzan Udumyan
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden,
| | - Katja Fall
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden, .,Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden, .,Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology and Public Health, University College, London, UK
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20
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Infections and the kidney: a tale from the tropics. Pediatr Nephrol 2018; 33:1317-1326. [PMID: 28879600 DOI: 10.1007/s00467-017-3785-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 08/01/2017] [Accepted: 08/10/2017] [Indexed: 01/30/2023]
Abstract
Tropical infections are caused by a variety of bacteria, viruses and parasitic organisms across varying geographical regions and are more often reported in adults than in children. Most of the infections are acute, presenting as a febrile illness with involvement of multiple organ systems, including the kidney. The gamut of renal manifestations extends from asymptomatic urinary abnormalities to acute kidney injury and-albeit rarely-chronic kidney disease. Tropical infections can involve the glomerular, tubulointerstitial and vascular compartments of the kidney. Leptospirosis, malaria, dengue, rickettsial fever and schistosomiasis are the most prevalent tropical infections which affect the kidneys of children living in the tropics. In this review we discuss renal involvement in these most prevalent tropical infections.
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Sayanthooran S, Gunerathne L, Abeysekera TDJ, Magana-Arachchi DN. Transcriptome analysis supports viral infection and fluoride toxicity as contributors to chronic kidney disease of unknown etiology (CKDu) in Sri Lanka. Int Urol Nephrol 2018; 50:1667-1677. [PMID: 29808448 DOI: 10.1007/s11255-018-1892-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 05/10/2018] [Indexed: 01/22/2023]
Abstract
PURPOSE Chronic kidney disease of unknown etiology (CKDu), having epidemic characteristics, is being diagnosed increasingly in certain tropical regions of the world, mainly Latin America and Sri Lanka. They have been observed primarily in farming communities and current hypotheses point toward many environmental and occupational triggers. CKDu does not have common etiologies of chronic kidney disease (CKD) such as hypertension, diabetes, or autoimmune disease. We aimed to understand the molecular processes underlying CKDu in Sri Lanka using transcriptome analysis. METHODS RNA extracted from whole blood was reverse transcribed and used for microarray analysis using the Human HT-12 v.4 array (Illumina). Pathway analysis was carried out using ingenuity pathway analysis (IPA-Qiagen). Microarray results were validated using real-time PCR of five selected genes. RESULTS Pathways related to innate immune response, including interferon signaling, inflammasome signaling and TREM1 signaling had the most significant positive activation z scores, where as EIF2 signaling and mTOR signaling had the most significant negative activation z scores. Pathways previously linked to fluoride toxicity; G-protein activation, Cdc42 signaling, Rac signaling and RhoA signaling were activated in CKDu patients. The most significantly activated biological functions were cell death, cell movement and antimicrobial response. Significant toxicological functions were mitochondrial dysfunction, oxidative stress and apoptosis. CONCLUSIONS Based on the molecular pathway analysis in CKDu patients and review of literature, viral infections and fluoride toxicity appear to be contributing to the molecular mechanisms underlying CKDu.
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Affiliation(s)
- Saravanabavan Sayanthooran
- Molecular Microbiology and Human Diseases, National Institute of Fundamental Studies, Kandy, 20000, Sri Lanka
| | | | - Tilak D J Abeysekera
- Centre for Education, Research and Training on Kidney Diseases (CERTKID), Faculty of Medicine, University of Peradeniya, Peradeniya, 20400, Sri Lanka
| | - Dhammika N Magana-Arachchi
- Molecular Microbiology and Human Diseases, National Institute of Fundamental Studies, Kandy, 20000, Sri Lanka.
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Kidney disease in the setting of HIV infection: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int 2018; 93:545-559. [PMID: 29398134 DOI: 10.1016/j.kint.2017.11.007] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 10/23/2017] [Accepted: 11/08/2017] [Indexed: 12/12/2022]
Abstract
HIV-positive individuals are at increased risk for kidney disease, including HIV-associated nephropathy, noncollapsing focal segmental glomerulosclerosis, immune-complex kidney disease, and comorbid kidney disease, as well as kidney injury resulting from prolonged exposure to antiretroviral therapy or from opportunistic infections. Clinical guidelines for kidney disease prevention and treatment in HIV-positive individuals are largely extrapolated from studies in the general population, and do not fully incorporate existing knowledge of the unique HIV-related pathways and genetic factors that contribute to the risk of kidney disease in this population. We convened an international panel of experts in nephrology, renal pathology, and infectious diseases to define the pathology of kidney disease in the setting of HIV infection; describe the role of genetics in the natural history, diagnosis, and treatment of kidney disease in HIV-positive individuals; characterize the renal risk-benefit of antiretroviral therapy for HIV treatment and prevention; and define best practices for the prevention and management of kidney disease in HIV-positive individuals.
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Levin A, Tonelli M, Bonventre J, Coresh J, Donner JA, Fogo AB, Fox CS, Gansevoort RT, Heerspink HJL, Jardine M, Kasiske B, Köttgen A, Kretzler M, Levey AS, Luyckx VA, Mehta R, Moe O, Obrador G, Pannu N, Parikh CR, Perkovic V, Pollock C, Stenvinkel P, Tuttle KR, Wheeler DC, Eckardt KU. Global kidney health 2017 and beyond: a roadmap for closing gaps in care, research, and policy. Lancet 2017; 390:1888-1917. [PMID: 28434650 DOI: 10.1016/s0140-6736(17)30788-2] [Citation(s) in RCA: 584] [Impact Index Per Article: 83.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/09/2017] [Accepted: 02/15/2017] [Indexed: 12/18/2022]
Abstract
The global nephrology community recognises the need for a cohesive plan to address the problem of chronic kidney disease (CKD). In July, 2016, the International Society of Nephrology hosted a CKD summit of more than 85 people with diverse expertise and professional backgrounds from around the globe. The purpose was to identify and prioritise key activities for the next 5-10 years in the domains of clinical care, research, and advocacy and to create an action plan and performance framework based on ten themes: strengthen CKD surveillance; tackle major risk factors for CKD; reduce acute kidney injury-a special risk factor for CKD; enhance understanding of the genetic causes of CKD; establish better diagnostic methods in CKD; improve understanding of the natural course of CKD; assess and implement established treatment options in patients with CKD; improve management of symptoms and complications of CKD; develop novel therapeutic interventions to slow CKD progression and reduce CKD complications; and increase the quantity and quality of clinical trials in CKD. Each group produced a prioritised list of goals, activities, and a set of key deliverable objectives for each of the themes. The intended users of this action plan are clinicians, patients, scientists, industry partners, governments, and advocacy organisations. Implementation of this integrated comprehensive plan will benefit people who are at risk for or affected by CKD worldwide.
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Affiliation(s)
- Adeera Levin
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Joseph Bonventre
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Josef Coresh
- Johns Hopkins University Bloomberg School of Public Health, George W Comstock Center for Public Health Research and Prevention, Baltimore, MD, USA; Johns Hopkins University School of Medicine, Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD, USA
| | - Jo-Ann Donner
- International Society of Nephrology, Brussels, Belgium
| | - Agnes B Fogo
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Ron T Gansevoort
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Hiddo J L Heerspink
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Meg Jardine
- The George Institute for Global Health, Sydney, NSW, Australia; Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Bertram Kasiske
- Hennepin County Medical Center, Minneapolis, MN, USA; University of Minnesota, Minneapolis, MN, USA
| | - Anna Köttgen
- Division of Genetic Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Matthias Kretzler
- Department of Internal Medicine and Department of ComputationalMedicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Andrew S Levey
- Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Valerie A Luyckx
- Institute of Biomedical Ethics and Klinik für Nephrologie University Hospital, University of Zurich, Zurich, Switzerland
| | - Ravindra Mehta
- Department of Medicine, University of California, San Diego, CA, USA
| | - Orson Moe
- Department of Internal Medicine and Charles and Jane Pak Center of Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Gregorio Obrador
- Faculty of Health Sciences, Universidad Panamericana, Mexico City, Mexico
| | - Neesh Pannu
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Chirag R Parikh
- Program of Applied Translational Research, Department of Medicine, Yale University, New Haven, CT, USA; Veterans Affairs Medical Center, West Haven, CT, USA
| | - Vlado Perkovic
- The George Institute for Global Health, Sydney, NSW, Australia; University of Sydney, Sydney, NSW, Australia
| | - Carol Pollock
- Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Peter Stenvinkel
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Health Care Kidney Research Institute, Nephrology Division and Institute for Translational Health Sciences, University of Washington, Spokane, WA, USA
| | - David C Wheeler
- Centre for Nephrology, Royal Free Hospital, University College London, London, UK
| | - Kai-Uwe Eckardt
- Department of Nephrology and Hypertension, University of Erlangen-Nürnberg, Erlangen, Germany
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24
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Obrador GT, Schultheiss UT, Kretzler M, Langham RG, Nangaku M, Pecoits-Filho R, Pollock C, Rossert J, Correa-Rotter R, Stenvinkel P, Walker R, Yang CW, Fox CS, Köttgen A. Genetic and environmental risk factors for chronic kidney disease. Kidney Int Suppl (2011) 2017; 7:88-106. [PMID: 30675423 DOI: 10.1016/j.kisu.2017.07.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
In order to change the current state of chronic kidney disease knowledge and therapeutics, a fundamental improvement in the understanding of genetic and environmental causes of chronic kidney disease is essential. This article first provides an overview of the existing knowledge gaps in our understanding of the genetic and environmental causes of chronic kidney disease, as well as their interactions. The second part of the article formulates goals that should be achieved in order to close these gaps, along with suggested timelines and stakeholders that are to be involved. A better understanding of genetic and environmental factors and their interactions that influence kidney function in healthy and diseased conditions can provide novel insights into renal physiology and pathophysiology and result in the identification of novel therapeutic or preventive targets to tackle the global public health care problem of chronic kidney disease.
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Affiliation(s)
- Gregorio T Obrador
- Department of Epidemiology, Biostatistics and Public Health, Universidad Panamericana School of Medicine, Mexico City, Mexico
| | - Ulla T Schultheiss
- Institute of Genetic Epidemiology, Medical Center and Faculty of Medicine-University of Freiburg, Freiburg, Germany.,Renal Division, Department of Medicine IV, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Matthias Kretzler
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA
| | - Robyn G Langham
- Monash Rural Health, Monash University, Clayton VIC, Australia
| | - Masaomi Nangaku
- Department of Hemodialysis and Apheresis, Division of Nephrology and Endocrinology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Roberto Pecoits-Filho
- Department of Internal Medicine, School of Medicine, Pontificia Universidade Catolica do Paraná, Curitiba, Brazil
| | - Carol Pollock
- Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | | | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zuibrán, Mexico City, Mexico
| | - Peter Stenvinkel
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Robert Walker
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Chih-Wei Yang
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Caroline S Fox
- Genetics and Pharmacogenomics, Merck Research Laboratories, Boston, Massachusetts, USA
| | - Anna Köttgen
- Institute of Genetic Epidemiology, Medical Center and Faculty of Medicine-University of Freiburg, Freiburg, Germany
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25
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Luyckx VA, Tuttle KR, Garcia-Garcia G, Gharbi MB, Heerspink HJL, Johnson DW, Liu ZH, Massy ZA, Moe O, Nelson RG, Sola L, Wheeler DC, White SL. Reducing major risk factors for chronic kidney disease. Kidney Int Suppl (2011) 2017; 7:71-87. [PMID: 30675422 DOI: 10.1016/j.kisu.2017.07.003] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Chronic kidney disease (CKD) is a global public health concern and a key determinant of poor health outcomes. While the burden of CKD is reasonably well defined in developed countries, increasing evidence indicates that the CKD burden may be even greater in developing countries. Diabetes, hypertension, and obesity are major contributors to the global burden of the disease and are important traditional CKD risk factors; however, nontraditional CKD risk factors such as nephrotoxin exposure, kidney stones, fetal and maternal factors, infections, environmental factors, and acute kidney injury are also increasingly being recognized as major threats to global kidney health. A broad approach to CKD prevention begins with the identification of CKD risk factors in the population, followed by the development of appropriate mitigation strategies. Effective prevention policies rely on an accurate understanding of the incidence and prevalence of CKD in a given setting, as well as the distribution and burden of risk factors. Populations or individuals at CKD risk must be screened and treated early to prevent the onset of and delay the progression of the kidney disease. Systematically collected data should be analyzed at country, province, and district levels to identify regional disparities and CKD hotspots and develop targeted prevention strategies. Race-ethnicity, genetics, sex, socioeconomic status, and geography are likely modifiers of CKD risk. A comprehensive, informed approach to prevention that takes into account all of these factors is therefore required to successfully tackle the global CKD epidemic.
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Affiliation(s)
- Valerie A Luyckx
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland.,Klinik für Nephrologie, Universitätsspital, Zurich, Switzerland
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Health Care Kidney Research Institute, Nephrology Division and Institute for Translational Health Sciences, University of Washington, Spokane, Washington, USA
| | - Guillermo Garcia-Garcia
- Servicio de Nefrologia, Hospital Civil de Guadalajara Fray Antonio Alcalde, University of Guadalajara Health Sciences Center, Hospital 278, Guadalajara, Jalisco, Mexico
| | - Mohammed Benghanem Gharbi
- Urinary Tract Diseases Department, Faculty of Medicine and Pharmacy of Casablanca, University Hassan II of Casablanca, Casablanca, Morocco
| | - Hiddo J L Heerspink
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - David W Johnson
- Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia.,Metro South and Ipswich Nephrology and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Ziad A Massy
- Division of Nephrology, Ambroise Paré Hospital, APHP, Boulogne Billancourt/Paris, France.,French National Institute of Health and Medical Research (INSERM) U1018, Team5, Centre for Research in Epidemiology and Population Health (CESP), Paris-Ile-de-France-West, Versailles-Saint-Quentin-en-Yvelines University, Villejuif, France
| | - Orson Moe
- Department of Internal Medicine and Charles and Jane Pak Center of Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Robert G Nelson
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona, USA
| | - Laura Sola
- Division Epidemiologia, Direccion General de Salud (DIGESA)-Ministerio Salud Publica, Montevideo, Uruguay
| | - David C Wheeler
- Centre for Nephrology, Royal Free Hospital, University College London, London, UK
| | - Sarah L White
- Charles Perkins Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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26
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Jagannathan R, Patzer RE. Urbanization and kidney function decline in low and middle income countries. BMC Nephrol 2017; 18:276. [PMID: 28851306 PMCID: PMC5576323 DOI: 10.1186/s12882-017-0685-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 08/05/2017] [Indexed: 01/08/2023] Open
Abstract
Urbanization is expected to increase in low and middle-income countries (LMICs), and might contribute to the increased disease burden. The association between urbanization and CKD is incompletely understood among LMICs. Recently, Inoue et al., explored the association of urbanization on renal function from the China Health and Nutrition Survey. The study found that individuals living in an urban environment had a higher odds of reduced renal function independent of behavioral and cardiometabolic measures, and this effect increased in a dose dependent manner. In this commentary, we discuss the results of these findings and explain the need for more surveillance studies among LMICs.
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Affiliation(s)
- Ram Jagannathan
- Global Diabetes Research Center, School of Public Health, Rollins School of Public Health, Atlanta, GA, USA
| | - Rachel E Patzer
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, 101 Woodruff Circle, 5101 Woodruff Memorial Research Building, Atlanta, GA, USA.
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27
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Saranburut K, Vathesatogkit P, Thongmung N, Chittamma A, Vanavanan S, Tangstheanphan T, Sritara P, Kitiyakara C. Risk scores to predict decreased glomerular filtration rate at 10 years in an Asian general population. BMC Nephrol 2017; 18:240. [PMID: 28716010 PMCID: PMC5512831 DOI: 10.1186/s12882-017-0653-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 07/03/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Asians have among the highest prevalence of chronic kidney disease (CKD) or end-stage renal disease in the world. A risk score capable of identifying high risk individuals at the primary care level could allow targeted therapy to prevent future development of CKD. Risk scores for new CKD have been developed in US general populations, but the impact of various risks factors for development of CKD may differ in Asian subjects. In this study, we aimed to develop risk models and simplified risk scores to predict the development of decreased glomerular filtration rate (GFR) at 10 years in an Asian general population using readily obtainable clinical and laboratory parameters. METHODS Employees of EGAT (The Electric Generating Authority of Thailand) were studied prospectively. Multivariable logistic regression models were used to assess risk factors and used to derive risk models and risk scores for developing decreased GFR at 10 years: Model 1 (Clinical only), Model 2 (Clinical + Limited laboratory tests), and Model 3 (Clinical + Full laboratory tests). The performance of the risk models or risk scores to predict incident cases with decreased GFR were evaluated by tests of calibration and discrimination. RESULTS Of 3186 subjects with preserved GFR (eGFR ≥60) at baseline, 271 (8.5%) developed decreased GFR (eGFR < 60) at 10 years. Model 1 (Age, sex, systolic blood pressure, history of diabetes, and waist circumference) had good performance (χ2 = 9.02; AUC = 0.72). Model 2 (Age, Sex, systolic blood pressure, diabetes, glomerular filtration rate) had better discrimination (χ2 = 10.87, AUC = 0.79) than Model 1. Model 3 (Model 2+ Uric acid, Hemoglobin) did not provide significant improvement over Model 2. Based on these findings, simplified categorical risk scores were developed for Models 1 and 2. CONCLUSIONS Clinical or combined clinical and laboratory risk models or risk scores using tests readily available in a resource-limited setting had good accuracy and discrimination power to estimate the 10-year probability of developing decreased GFR in a Thai general population. The benefits of the risk scores in identifying high risk individuals in the Thai or other Asian communities for special intervention requires further studies.
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Affiliation(s)
- Krittika Saranburut
- Cardiovascular and Metabolic Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400 Thailand
| | - Prin Vathesatogkit
- Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama 6 Rd, Bangkok, 10400 Thailand
| | - Nisakron Thongmung
- Research Center, Biochemistry and Chemical Analysis Unit, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400 Thailand
| | - Anchalee Chittamma
- Division of Clinical Chemistry, Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400 Thailand
| | - Somlak Vanavanan
- Division of Clinical Chemistry, Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400 Thailand
| | - Tuangrat Tangstheanphan
- Medical and Health Office, Electricity Generating Authority of Thailand, Bangkruay, Nonthaburi, 11130 Thailand
| | - Piyamitr Sritara
- Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama 6 Rd, Bangkok, 10400 Thailand
| | - Chagriya Kitiyakara
- Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama 6 Rd, Bangkok, 10400 Thailand
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28
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Huang Z, Wei H, Cheng C, Yang S, Wang J, Liu X. Low bone mineral density in chronic hepatitis B virus infection: A case-control study. Pak J Med Sci 2017; 33:457-461. [PMID: 28523056 PMCID: PMC5432723 DOI: 10.12669/pjms.332.12099] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Objective: Osteoporosis is the well-known major complication in chronic hepatitis B virus (HBV) infection. Fewer reports are available of the relationship between bone loss and chronic HBV infection. We investigated the bone mineral density (BMD) and prevalence of osteoporosis in chronic HBV patients in comparison with healthy subjects. Methods: We assessed 148 chronic HBV patients and 148 age- and gender-matched healthy controls by dual energy X-ray absorptiometry (DEXA) for determination of BMD. T-score was used to define bone status according to the World Health Organization’s classification. Results: The BMD values were significantly lower in HBV patients in all scan of specific regions compared with the controls (P < 0.05). The prevalence of osteoporosis in either of lumbar spine (LS), total hip (TH) or the femoral neck (FN) was significantly higher in the HBV patients group compared with the healthy controls. The rate of osteopenia and osteoporosis for HBV patients aged 45–54 years was significantly higher than that of the healthy controls. Conclusions: Chronic HBV infection was associated with low BMD and increased the risk of developing subsequent osteoporosis.
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Affiliation(s)
- Zengfa Huang
- Zengfa Huang, Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hui Wei
- Hui Wei, Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cheng Cheng
- Cheng Cheng, Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuhua Yang
- Shuhua Yang, Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Wang
- Jing Wang, Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xianzhe Liu
- Xianzhe Liu, Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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29
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Evaluation of the Framingham Heart Study risk factors and risk score for incident chronic kidney disease at 10 years in a Thai general population. Int Urol Nephrol 2017; 49:851-857. [DOI: 10.1007/s11255-017-1530-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 01/25/2017] [Indexed: 01/08/2023]
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30
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Chronic Kidney Disease Induced Intestinal Mucosal Barrier Damage Associated with Intestinal Oxidative Stress Injury. Gastroenterol Res Pract 2016; 2016:6720575. [PMID: 27493661 PMCID: PMC4963601 DOI: 10.1155/2016/6720575] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 06/14/2016] [Indexed: 12/11/2022] Open
Abstract
Background. To investigate whether intestinal mucosal barrier was damaged or not in chronic kidney disease progression and the status of oxidative stress. Methods. Rats were randomized into two groups: a control group and a uremia group. The uremia rat model was induced by 5/6 kidney resection. In postoperative weeks (POW) 4, 6, 8, and 10, eight rats were randomly selected from each group to prepare samples for assessing systemic inflammation, intestinal mucosal barrier changes, and the status of intestinal oxidative stress. Results. The uremia group presented an increase trend over time in the serum tumor necrosis factor-alpha, interleukin-6 (IL-6) and IL-10, serum D-lactate and diamine oxidase, and intestinal permeability, and these biomarkers were significantly higher than those in control group in POW 8 and/or 10. Chiu's scores in uremia group were also increased over time, especially in POW 8 and 10. Furthermore, the intestinal malondialdehyde, superoxide dismutase, and glutathione peroxidase levels were significantly higher in uremia group when compared with those in control group in POW 8 and/or 10. Conclusions. The advanced chronic kidney disease could induce intestinal mucosal barrier damage and further lead to systemic inflammation. The underlying mechanism may be associated with the intestinal oxidative stress injury.
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31
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Matsui M, Roche L, Geroult S, Soupé-Gilbert ME, Monchy D, Huerre M, Goarant C. Cytokine and Chemokine Expression in Kidneys during Chronic Leptospirosis in Reservoir and Susceptible Animal Models. PLoS One 2016; 11:e0156084. [PMID: 27219334 PMCID: PMC4878748 DOI: 10.1371/journal.pone.0156084] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 05/09/2016] [Indexed: 01/24/2023] Open
Abstract
Leptospirosis is caused by pathogenic spirochetes of the genus Leptospira. Humans can be infected after exposure to contaminated urine of reservoir animals, usually rodents, regarded as typical asymptomatic carriers of leptospires. In contrast, accidental hosts may present an acute form of leptospirosis with a range of clinical symptoms including the development of Acute Kidney Injury (AKI). Chronic Kidney Disease (CKD) is considered as a possible AKI-residual sequela but little is known about the renal pathophysiology consequent to leptospirosis infection. Herein, we studied the renal morphological alterations in relation with the regulation of inflammatory cytokines and chemokines, comparing two experimental models of chronic leptospirosis, the golden Syrian hamster that survived the infection, becoming carrier of virulent leptospires, and the OF1 mouse, a usual reservoir of the bacteria. Animals were monitored until 28 days after injection with a virulent L. borgpetersenii serogroup Ballum to assess chronic infection. Hamsters developed morphological alterations in the kidneys with tubulointerstitial nephritis and fibrosis. Grading of lesions revealed higher scores in hamsters compared to the slight alterations observed in the mouse kidneys, irrespective of the bacterial load. Interestingly, pro-fibrotic TGF-β was downregulated in mouse kidneys. Moreover, cytokines IL-1β and IL-10, and chemokines MIP-1α/CCL3 and IP-10/CXCL-10 were significantly upregulated in hamster kidneys compared to mice. These results suggest a possible maintenance of inflammatory processes in the hamster kidneys with the infiltration of inflammatory cells in response to bacterial carriage, resulting in alterations of renal tissues. In contrast, lower expression levels in mouse kidneys indicated a better regulation of the inflammatory response and possible resolution processes likely related to resistance mechanisms.
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Affiliation(s)
- Mariko Matsui
- Institut Pasteur International Network, Institut Pasteur de Nouvelle-Calédonie, Leptospirosis Research and Expertise Unit, Noumea, New Caledonia
| | - Louise Roche
- Institut Pasteur International Network, Institut Pasteur de Nouvelle-Calédonie, Leptospirosis Research and Expertise Unit, Noumea, New Caledonia
| | - Sophie Geroult
- Institut Pasteur International Network, Institut Pasteur de Nouvelle-Calédonie, Leptospirosis Research and Expertise Unit, Noumea, New Caledonia
| | - Marie-Estelle Soupé-Gilbert
- Institut Pasteur International Network, Institut Pasteur de Nouvelle-Calédonie, Leptospirosis Research and Expertise Unit, Noumea, New Caledonia
| | - Didier Monchy
- Anatomic Pathology Laboratory, Gaston-Bourret Territorial Hospital Center, Noumea, New Caledonia
| | - Michel Huerre
- Unité de Recherche et Expertise en Histotechnologie et Pathologie, Institut Pasteur, Paris, France.,Departement de Pathologie, Institut Curie, Paris, France
| | - Cyrille Goarant
- Institut Pasteur International Network, Institut Pasteur de Nouvelle-Calédonie, Leptospirosis Research and Expertise Unit, Noumea, New Caledonia
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