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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Human immunodeficiency virus-associated nephropathy (HIVAN) develops more often in HIV-infected blacks than whites. Blacks also show marked familial clustering of other causes of end-stage renal disease (ESRD), particularly diabetes mellitus-, hypertension-, and systemic lupus erythematosus-associated ESRD. We compared the family history of ESRD in 201 blacks with ESRD caused by HIVAN (cases) to that of 50 HIV-infected blacks without renal disease (controls) to determine whether HIV-associated ESRD shows familial aggregation. Cases were identified using the Southeastern Kidney Council/ESRD Network 6 Family History of ESRD database. Cases initiated dialysis between September 1993 and October 1998. Controls were consecutively identified, HIV-infected blacks with serum creatinine concentrations of 1.3 mg/dL or less and no proteinuria, treated in an infectious disease clinic during September 1998. Cases and controls had similar mean ages and family sizes. First- or second-degree relatives with ESRD were reported by 24.4% of the cases compared with 6% of the controls (P = 0.004). Logistic regression analysis, controlling for sex, family size, and age, showed cases were 5.4 times more likely than controls to have close relatives with ESRD (P = 0.007). The 49 HIVAN cases who reported a positive family history had a mean of 1.2 additional relatives with ESRD per case (60 total relatives with ESRD). HIVAN was not listed as the cause of ESRD in any of the 27 relatives who underwent dialysis in Network 6 facilities. We conclude that ESRD clusters in the families of nearly 25% of blacks initiating renal replacement therapy for HIVAN. This familial aggregation of ESRD appears to be independent of HIV infection. Although environmental factors cannot be excluded, it is possible an inherited susceptibility to renal failure is present in many blacks with HIV infection who subsequently develop nephropathy.
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PMID:Familial clustering of end-stage renal disease in blacks with HIV-associated nephropathy. 1043 Sep 71

Probiotics are specific products of microorganisms, and by being biologically active positively act on stabilizing the bacteriological flora of the gastrointestinal tract. They are live or lyophilized bacterial cultures, especially those derived from lactic fermentation (Lactobacillacea and Streptococcacea). The first to use the term probiotics were Lilly and Stillwell in 1965 when referring to substances produced by protozoa, which in turn stimulated the growth of other organisms. Probiotics are devoid of side affects and do not cause accumulation of toxic substances in the body. They are administered for therapeutic, prophylactic and nutritional purposes both in humans and in animals. Interest into probiotics has been spurred on by the growing abundance of civilization disorders such as neoplasms, atherosclerosis, heart disease, hypertension and HIV infection. Probiotics are potentially capable of annihilating these disorders. Starter cultures are pure mixed bacterial, fungal or mold cultures which by transformation of their metabolism faciliate favourable changes in apperance, aroma, consistency, and durability of foodstuffs. Contemporary knowledge concerning probiotics and their action is derived from many years of tradition in consumption of fermented milk products and the documentation of much research into strains of lactic bacteria, their harmless action on health and overall beneficial effect.
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PMID:[Probiotics and their therapeutic properties]. 1044 11

Anatomo-pathological correlation in a case of systemic talc granulomatosis affecting lungs, pleura, liver, spleen and mesenteric lymph nodes resulting in pulmonary arterial hypertension and cor pulmonale is described. The patient, a 26-year-old male HIV-negative intravenous drug addict had no lymphopenia or any histopathologic findings at necroscopy compatible with AIDS, despite of a chronic high-risk behavior favoring this illness.
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PMID:[Systemic talc granulomatosis in a HIV-negative intravenous drug addict]. 1051 62

Focal and segmental glomerulosclerosis (FSGS) is a common, non-specific renal lesion. Although it is often secondary to other disorders, including HIV infection, obesity, hypertension and diabetes, FSGS also appears as an isolated, idiopathic condition. FSGS is characterized by increased urinary protein excretion and decreasing kidney function. Often, renal insufficiency in affected patients progresses to end-stage renal failure, a highly morbid state requiring either dialysis therapy or kidney transplantation. Here we present evidence implicating mutations in the gene encoding alpha-actinin-4 (ACTN4; ref. 2), an actin-filament crosslinking protein, as the cause of disease in three families with an autosomal dominant form of FSGS. In vitro, mutant alpha-actinin-4 binds filamentous actin (F-actin) more strongly than does wild-type alpha-actinin-4. Regulation of the actin cytoskeleton of glomerular podocytes may be altered in this group of patients. Our results have implications for understanding the role of the cytoskeleton in the pathophysiology of kidney disease and may lead to a better understanding of the genetic basis of susceptibility to kidney damage.
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PMID:Mutations in ACTN4, encoding alpha-actinin-4, cause familial focal segmental glomerulosclerosis. 1070 Jan 77

Since 1995, the Medical Evidence Report for end-stage renal disease (Form 2728) has been used nationally to collect information on comorbid conditions. To date, these data have not been validated. A national cross-sectional study of 1005 incident dialysis patients (734 hemodialysis and 271 peritoneal dialysis) enrolled between October 1995 and June 1998 was conducted using clinical data to validate 17 comorbid conditions on Form 2728. Sensitivity and specificity were calculated for each condition. The relationship between patient characteristics and sensitivity was assessed in multivariate analysis. Sensitivity was fairly high (0.67 to 0.83) for HIV disease, diabetes, and hypertension; intermediate (0.40 to 0.52) for peripheral vascular disease, neoplasm, myocardial infarction, cerebrovascular disease, coronary artery disease, cardiac arrest, and congestive heart failure; and poor (<0.36) for dysrhythmia, ambulation status, pericarditis, chronic obstructive pulmonary disease, and smoking. Sensitivity did not change significantly over calendar time. The sensitivity of Form 2728 averaged across all 17 conditions was 0.59 (95% confidence interval, 0.43 to 0.75). The average sensitivity was 0.10 greater in peritoneal dialysis than hemodialysis patients. 0.11 greater in diabetic patients than nondiabetic patients, and 0.04 less with each added comorbid condition. The specificity was very good for hypertension (0.91) and excellent (>0.95) for the other 16 conditions. Comorbid conditions are significantly underreported on Form 2728, but diagnoses are not falsely attributed to patients. Scientific research, quality of care comparisons, and payment policies that use Form 2728 data should take into account these limitations. Considerable effort should be expended to improve Form 2728 coding if it is to provide accurate estimates of total disease burden in end-stage renal disease patients.
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PMID:Validation of comorbid conditions on the end-stage renal disease medical evidence report: the CHOICE study. Choices for Healthy Outcomes in Caring for ESRD. 1070 76

A study was conducted in the Internal Medicine unit of Bobo-Dioulasso Hospital. Of the 1828 HIV positive patients admitted in medical wards, 268 presented neurological symptoms. 25.4% had positive Toxoplasma gondii serology. Encephalitis was associated with 12.5% of this latter group and intracranial hypertension with focal neurological defects affected a further 47.5% of them. Presumptive treatment of toxoplasmosis led to significant clinical improvement in 60% of cases. Toxoplasma gondii serology should be part of the standard check-up for every HIV-infected patient, and toxoplasmosis chemoprophylaxis should be given to those with positive toxoplasma serology. Presumptive therapy of toxoplasmosis should be started for all HIV positive patients with focal neurological manifestations in the absence of a cerebral scanner.
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PMID:[Toxoplasma serology in HIV infected patients and suspected cerebral toxoplasmosis at the Central Hospital of Bobo-Dioulasso (Burkina Faso)]. 1077 87

There is a growing disparity between the demand for and the supply of kidneys for transplantation. The demographics of the donor pool are also changing. The average potential cadaveric organ donor is now more likely to be older, at greater risk for co-morbid conditions such as hypertension or viral infections, and more likely to die from cerebrovascular disease. These factors have led to an expansion of the criteria that defines the suitable organ donor. Expanded criteria donors are defined as the following: (1) at the upper and lower extremes in age; (2) having a history of hypertension or diabetes; (3) hemodynamically unstable; (4) non-heartbeating (cardiopulmonary death rather than brain death); (5) seropositive for hepatitis B or C; (6) having systemic infections; (7) having displayed high-risk social behavior for HIV infection; (8) having a history of malignancy; (9) having abnormal organ function; or (10) with renal anatomic anomalies or injuries. Use of kidneys from these "expanded criteria donors" is a two-edged sword. While they provide more organs for transplantation, the risk of suboptimal recipient outcome is increased. A rational approach to the use of each of these types of kidneys and proper selection of recipients is essential to obtain acceptable results. The article reviews the factors that have contributed to the successful transplantation of kidneys procured from expanded criteria organ donors and how these organs can be allocated most efficaciously to the appropriate recipients.
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PMID:Expanded criteria donors: attempts to increase the renal transplant donor pool. 1078 30

In a cross-sectional, non-randomized, prospective study in an outpatient clinic a possible relationship between the cerebrospinal fluid (CSF) concentrations of the potent vasoconstrictor peptide endothelin-1 (ET-1) and prevalence and degree of HIV-encephalopathy was studied. Forty-eight CSF samples from HIV-infected patients undergoing lumbar punction for diagnostic reasons were investigated for ET-1 concentrations. In 37 patients ET-1 was also measured in plasma. Patients were investigated clinically and staged with respect to HIV encephalopathy. Patients with arterial hypertension, diabetes or acute opportunistic infections were excluded from the study. In the remaining, 18 of the CSF samples were from patients with normal neurological findings (grade 0-0.5), whereas 30 were from patients with HIV encephalopathy (grade 1-3). The mean CSF ET-1 concentration was significantly elevated (P = 0.001) in patients with HIV encephalopathy (1.97 +/- 2.33 pmol/l) as compared to those patients without encephalopathy (0.57 +/- 0.67 pmol/l). Moreover, there was a significant correlation between ET-1 CSF concentrations and the degree of HIV encephalopathy (r = 0.49, P < 0.001). In addition, there was a significant correlation between ET-1 levels in the CSF and the IgG serum to CSF ratio. However, we found no correlation between HIV encephalopathy and neither CSF total protein, IgG, albumin or the serum to CSF ratio of IgG or albumin. In conclusion, we could demonstrate a close relationship between CSF ET-1 concentrations and the degree of HIV encephalopathy. Thus, by virtue of its long-lasting and potent vasoconstrictor activity ET-1 might contribute to the pathogenesis of HIV encephalopathy.
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PMID:Endothelin-1 is elevated in the cerebrospinal fluid of HIV-infected patients with encephalopathy. 1088 34

HIV infection has reached endemic proportions in many African countries. In addition, HIV infection is a significant cause of renal dysfunction in the United States. HIV patients are at higher risk of developing hypertension at a younger age than the general population. Predisposing factors for developing hypertension include vasculitis in small, medium, and large vessels in the form of leukocytoclastic vasculitis, and aneurysms of the large vessels such as the carotid, femoral, and abdominal aorta with impairment of flow to the renal arteries. A syndrome of acquired glucocorticoid resistance has been described in patients with HIV with hypercortisolism and a lower affinity of the glucocorticoid receptors. The syndrome is characterized clinically by weakness, hypertension or hypotension, and skin pigmentation changes. Acute and chronic renal failure is often associated with HIV infection. The associated dysfunction in water and salt handling often induces hypertension. Finally, atherosclerosis has been described in young adults with HIV infection secondary to receiving highly active antiretroviral therapy.
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PMID:Hypertension in the HIV-infected patient. 1099 24

Cocaine abuse and HIV disease each have potentially adverse effects upon the heart and cardiovascular system which may be exacerbated when these risk factors are combined. The development of a safe and effective agent to treat both cocaine addiction and its cardiovascular sequelae, that is well-tolerated by HIV patients, would thus be of considerable clinical utility. In this article we discuss the rationale for the investigation of angiotensin converting enzyme (ACE) inhibitors, commonly used to treat hypertension, for treatment in cocaine-abusing populations, based on their potential to reduce cocaine use by modulating levels of dopamine and corticotropin releasing factor in the brain, and on their ability to reverse cardiovascular and platelet abnormalities. We present preliminary findings from echocardiographic and platelet activation studies in 16 HIV-positive, cocaine abusing patients, as well as tolerability and efficacy studies of the ACE-inhibitor, fosinopril, for the treatment of cocaine abuse in both HIV-positive (n=6) and HIV-negative (n=5) methadone-maintained cocaine abusers. Findings suggest that HIV-positive cocaine-abusing patients possess abnormalities of diastolic heart function and platelet activation that are potentially reversible with ACE-inhibitor therapy. Findings also suggest that fosinopril is well-tolerated regardless of HIV serostatus, does not appear to cause hypotension, and may possess effectiveness for reducing cocaine use. We conclude that ACE-inhibitor therapy may offer a new pharmacologic approach to the treatment of cocaine abuse and its complications, and that controlled research of this class of agents may be promising.
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PMID:Cocaine, HIV, and their cardiovascular effects: is there a role for ACE-inhibitor therapy? 1106 82


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