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Consanguineous marriages are common in many countries of the Middle East including Lebanon. Their impact on the repartition of kidney diseases and on the risk for familial nephritis is not known. We surveyed all of the dialysis centers in Lebanon. Nine hundred and twenty-five (925) patients and their private physicians were asked to answer a questionnaire. More than half of the hemodialysis (HD) patients had an unknown etiology of their kidney disease. Diabetes, polycystic kidney disease (PKD), chronic pyelonephritis and nephrosclerosis (NS) were the most commonly documented diagnoses. Consanguinity was present in 26% of the total HD population. More consanguineous patients with unknown renal etiology were diagnosed with their kidney diseases and initiated on dialysis before the age of 30 when compared with their non-consanguineous counter-parts (45% versus 33%, P<0.02 and 42% versus 27%, P<0.01), respectively. Similarly, consanguineous polycystic patients were diagnosed and started earlier on dialysis when compared with the non-consanguineous population (34% versus 12%, P<0.05 and 28% versus 8%, P<0.05), respectively suggesting a different disease pattern. Furthermore, the risk for family history of kidney disease was noticeable in the non-consanguineous population and significantly higher among the consanguineous patients (12% versus 18%, P<0.04). Consanguinity-associated kidney diseases affected all religious communities, in particular the Muslim and the Druze (36 and 39%), respectively versus 17% of the Christian community. Certain geographical areas were more involved than others such as the North, South and the Bekaa with the highest percentage (40%) in the latter. Socio-economical level was not a contributing factor. We conclude that the documentation of the underlying etiology in end-stage renal diseases (ESRD) seems to be deficient. Furthermore, consanguinity is prevalent in the Lebanese dialysis patients population, in particular the Muslim and the Druze communities. Consanguinity-associated kidney diseases pattern seems to differ from that of the general HD population by disease diagnosis and initiation at a younger age and a significantly higher risk for familial renal disease. It is a cultural phenomenon prevalent predominantly in the rural areas. We recommend a multi-approach including educational, informative and probably legislative strategy in order to limit and hopefully discourage consanguineous marriages.
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PMID:Consanguinity-associated kidney diseases in Lebanon: an epidemiological study. 1283 87

This study examines the association between education and mortality from specific causes of death based on mortality records for 1996 and 1997, and 1996 population census data from the Region of Madrid (Spain). Poisson regression models were used to estimate the percentage increase in mortality associated with 1 year less education. The percentage increases in mortality from stomach cancer, lung, bladder and liver cancers, for aids, chronic obstructive pulmonary disease, pneumonia and influenza, and chronic liver disease and cirrhosis were higher in men than in women, whereas the percentage increases in mortality from colon cancer, diabetes mellitus, ischemic heart disease and nephritis, nephrosis and nephrotic syndrome were higher in women. The results found for some causes of death--lung cancer, ischemic heart disease, diabetes mellitus and chronic obstructive pulmonary disease--reflect the variations by educational level in the prevalence of lifestyle-related risk factors in men and women. Various hypotheses have been suggested for other causes of death, but it is not known why the magnitude of the association between education and mortality from some causes of death differs between men and women. Future studies of this subject may provide some clues as to the underlying mechanisms of this association.
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PMID:The size of educational differences in mortality from specific causes of death in men and women. 1288 84

This paper attempts to illustrate historically how important developments in the comparatively new field of physical chemistry during the second half of the 19th century made possible the understanding of ions and acid-base phenomena in clinical and laboratory medicine. Primarily based upon the revolutionary concept of ionization by Svante Arrhenius, it was the studies of two Americans, Lawrence Joseph Henderson and Donald Dexter van Slyke, during the first two decades of the 20th century that resulted in the elucidation and clinical laboratory evaluation of two major diseases, diabetes and nephritis, and the resulting recognition of the phenomena of acidosis and alkalosis.
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PMID:Historical review: concept of acid-base balance in medicine. 1295 53

Efficacy of treatment of 208 diabetic patients with acute pyelonephritis was analyzed. Surgical treatment was performed in 58 patients (43 with insulin-non-depended and 15 with insulin-depended types). All the patients were divided into 4 groups depending on forms of pyelonephritis: non-destructive (116 patients), purulent-destructive (58), calcllious (34), purulent-calculous (10). Algorithm of differential diagnosis between non-destructive and purulent-destructive forms of acute pyelonephritis in diabetic patients are presented. It is demonstrated that surgical treatment is the main method in complex therapy of purulent-destructive forms. Rational surgical policy is substantiated. In patient with diabetes and purulent pyelonephritis nephrectomy is more expediently. Nephrostomy may be used only in light forms of diabetes with local destructive forms ofapostematosic nephritis. Radical surgical policy permitted to achieve positive result of treatment in majority of patients. Lethal outcomes were seen in two-sided lesion of kidneys with apostems, and carbuncles.
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PMID:[Surgical policy in acute purulent pyelonephritis in patients with diabetes]. 1498 64

Aging trends in the U.S. have resulted in the over 65 years age group with End Stage Renal Disease (ESRD) becoming the fastest growing segment of the population presenting for dialysis. Their profile differs from younger adults in that they present with significant comorbidity and vascular access problems, and require earlier preparation for dialysis. ESRD in the geriatric population most commonly results from diabetes, hypertension, glomerular and tubulointerstitial nephritis. Described are experiences with initiating a centenarian nursing home resident with uremia on hemodialysis; resulting in improved quality of life and illustrating that age alone should never be a barrier to receiving dialysis. Renal replacement therapy can enhance quality of life and function even in the old. A review of select literature pertinent to ESRD in the geriatric population follows.
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PMID:Dialysis in the old: a centenarian nursing home resident with end-stage renal disease. 1511 80

A 37-year-old black woman with nephritis secondary to systemic lupus erythematosus, steroid-induced diabetes mellitus, and hypertension presented with fever, nausea, vomiting, and right upper quadrant abdominal pain with distension. Abdominal computed tomography (CT) scan revealed a colonic mass, and CT- guided fine-needle aspiration demonstrated birefringent crystalline material. After several weeks of antibiotic therapy, the patient underwent laparoscopic examination followed by extended right hemicolectomy for a large mass in the subserosa of the transverse colon. Pathological examination of this mass revealed it to be a gouty tophus. To our knowledge, no case of tophaceous gout presenting as an intestinal mass has previously been reported.
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PMID:Intestinal pseudotumorous gouty nodulosis: a colonic tophus without manifestation of gouty arthritis. 1525 57

We report the 1-year results with a triple immunosuppressive regimen in pediatric recipients of a first kidney transplant, in order to evaluate its safety and efficacy in the prevention of acute rejection and in the reduction of steroid side effects. The immunosuppression is as follows: (i) basiliximab (20 mg if body weight >30 kg; 10 mg if < 30 kg) is given pretransplant and at day 4; (ii) tacrolimus (Tac) is administered in order to obtain blood trough levels of 10-20 and 5-10 ng/ml during and after the first 2 months post-transplant, respectively; (iii) steroids are tapered during the first 6 months and then replaced by mycophenolate mofetil (depending on previous rejection episodes, infection status and the result of a routine biopsy) at a dosage of 4-600 mg/m(2) body surface area. Fifty-three children (median age 13 years, range 2-20) have entered this protocol. One-year patient and kidney survival are 100% and 94% respectively. During the first year a total of nine rejections in seven patients (13% of the cohort study) occurred, all but one responsive to steroids. Renal function was satisfactory throughout the first year (mean CrCl was 63.8 +/- 18 and 60.9 +/- 15.5 ml/min/1.73 m(2) at 6 and 12 months respectively). Subclinical signs of rejection were absent in more than 80% of biopsies (grade I Banff) at 6 months (n = 47); at the 12th month biopsy (n = 42) score I was stable in 20 patients (16 after stopping steroids) and had worsened in eight biopsies (six after stopping steroids). Major complications were insulin-dependent diabetes in three (5.6%) children with the need of insulin for a mean of 3 months; transient hyperglycemia (11 patients), treated with a dietary regimen, symptomatic viral infections (in 11 patients: two parvovirus B19, three cytomegalovirus and two Epstein-Barr virus systemic infections, three interstitial pneumonia, two BK nephritis). Tac doses more than 0.3-0.4 mg/kg/day are at significantly higher risk of viral infection. In conclusion, this immunosuppressive regimen is associated with a low percentage of clinical (13%) and subclinical rejections, but with a relatively high number of infections, prevented by a reduction in Tac doses (<0.3 mg/kg/day) during the first 2 months after transplantation. The assessment of steroid withdrawal needs a longer follow-up.
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PMID:One-year results of basiliximab induction and tacrolimus associated with sequential steroid and MMF treatment in pediatric kidney transplant recipient. 1561 81

Most of the present knowledge on pathomechanism of renal fibrosis is based on experimental studies with laboratory animals. Today, a variety of genetic and inducible animal models that mimic primary causes of human disease such as diabetes mellitus, glomerulonephritis, or lupus erythematodes are available. However, only few of these models progress consistently to interstitial fibrosis in the kidney involving interestitial fibrosis, tubular atrophy, and glomerulosclerosis, which are common features of renal fibrogenesis. In this chapter, the mouse models of nephrotoxic serum nephritis, COL4A3-deficiency, and unilateral urethral obstruction, which all result reliably into renal fibrosis, are described.
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PMID:Animal models of renal fibrosis. 1611 58

In peritoneal dialysis (PD), a 7.5% polyglucose-containing dialysis solution (icodextrin) provides prolonged ultrafiltration as compared with glucose-based dialysis solutions. In the present study, we attempted to clarify the safety and effectiveness of icodextrin in elderly patients on continuous ambulatory peritoneal dialysis (CAPD). Clinical data and outcomes of 16 patients aged 65 or older were monitored for 12 weeks before and during icodextrin treatment. The group included 13 men and 3 women with a mean age of 69 +/- 5 years (range: 66-78 years). The underlying kidney disease was chronic nephritis in 7 patients, diabetes mellitus in 8 patients, and nephrosclerosis in I patient. From the beginning of peritoneal dialysis, 1 patients had been treated with icodextrin; the other 10 were changed to icodextrin from glucose dialysis solution. At the end of study, body weight had increased to 63.8 +/- 9.3 kg from 61.6 +/- 9.3 kg, accompanied by an increase in ultrafiltration to 480 +/- 207 mL daily from 369 +/- 436 mL daily. No significant change in urine volume occurred. Despite the increase in body weight, cardiothoracic rate decreased to 51.1% +/- 3.4% from 52.3% +/- 4.9%. All patients reported an improvement of edema and appetite. Edema scores were significantly decreased to 0.85 +/- 0.90 from 1.63 +/- 0.96 (p < 0.03). No adverse side effects were associated with the use of icodextrin. From the foregoing data, we concluded that, as compared with conventional glucose solution, icodextrin has beneficial effects on ultrafiltration volume and clinical symptoms in elderly patients on CAPD.
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PMID:Successful use of icodextrin in elderly patients on continuous ambulatory peritoneal dialysis. 1668 12

Excess body weight may be associated with various functional/structural lesions of the kidney. The spectrum ranges from glomerulomegaly with or without focal or segmental glomerulosclerosis, to diabetic nephropathy, to carcinoma of the kidney and nephrolithiasis. The first sign of renal injury is microalbuminuria or frank proteinuria, in particular in the presence of hypertension. The occurrence of microalbuminuria and/or chronic kidney insufficiency (glomerular filtration rate < 60 mL/min/1.73 m2) is related to the increasing number of components of the metabolic syndrome, ie, central obesity, elevated fasting blood glucose level, hypertriglycerides, low high-density lipoprotein cholesterol, and hypertension. In the long run, end-stage renal failure may develop. An increased body mass index is particularly harmful in patients with reduced renal functional mass (unilateral renal agenesis or nephrectomy) and other renal diseases (immunoglobulin A nephritis and chronic graft dysfunction after kidney transplantation). In the pathogenesis of obesity-associated glomerulopathy, hyperfiltration is of fundamental importance. The factors involved are energy intake (high protein and salt), hyperinsulinemia, and enhanced tubuloglomerular feedback because of increased sodium reabsorption. The adrenergic and renin-angiotensin-aldosterone systems as well as glucocorticoids are stimulated. In addition, several active proteins generated in the central adipose tissue, such as leptin, proinflammatory cytokines, plasminogen activator inhibitor-1, angiotensinogen, and growth factors (transforming growth factor-beta1), as well as low levels of the protective adiponectin, may contribute to renal injury. Of greatest importance is the development of hypertension and of diabetes, which are directly related to the severity of central obesity. Obesity-associated renal disease should be prevented or retarded by weight reduction following lifestyle modification (salt restriction, hypocaloric diet, aerobic exercise), or eventually by antiobesity medication or bariatric surgery. In the presence of glomerulopathy and/or hypertension, angiotensin converting enzyme inhibitors or angiotensin II type I receptor blockers are the drugs of choice to improve glomerular hyperfiltration.
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PMID:Renal disease in obesity: the need for greater attention. 1682 23


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