Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Many renal structural and functional abnormalities have been associated with sickle cell disease. The patients have an impaired urinary concentrating ability but an intact diluting capacity. There are defects in both urinary acidification and potassium excretion, although overt metabolic acidosis and hyperkalemia occur infrequently. Proximal tubular function is supranormal, as manifested by increased reabsorption of phosphate and increased secretion of creatinine. The former results in mild hyperphosphatemia, while the latter causes substantial overestimation of the glomerular filtration rate (GFR) by creatinine clearance. Both GFR and renal plasma flow are increased in young patients with sickle cell disease, but prostaglandin inhibitors decrease the GFR. The GFR progressively decreases with increasing age. Proteinuria, and even nephrotic syndrome, are relatively frequent; the most common renal lesion in children is focal glomerular sclerosis, which may be associated with progressive deterioration in renal function. Glomerular hyperfiltration has been implicated in the pathogenesis of the glomerular lesions, as well as in the development of renal failure. In patients with end-stage renal disease, both hemodialysis and kidney transplantation have been successful. Recurrent hematuria is a relatively common problem in patients with sickle cell disease. The bleeding usually remits spontaneously, but occasionally requires therapy with aminocaproic acid. Papillary necrosis may occur, and is thought to result from medullary ischemia.
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PMID:Renal abnormalities in sickle cell disease. 217 77

Changes in renal function were followed lifelong in male rats with only 1 kidney either intact or damaged by ureteral obstruction or ischemia. After surgery the rats were given a low (12%) or a high (36%) protein diet. After a period with a stable glomerular filtration rate, which was longer on the low protein diet, there was a linear decline in rats with an intact single kidney. The rate of decline was highest on the high protein diet, resulting in a shorter survival time. A decrease in urine osmolality and an increase in protein excretion preceded the decrease in filtration rate, while it was followed by an increase in blood pressure. The glomerular filtration rate of the rats with a single damaged kidney initially recovered to 75 to 80% of that of rats with an intact single kidney on the same diet. There was a linear decrease in the glomerular filtration rate, with the highest rate of decrease on the high protein diet. The mean survival time was less than that of rats with a single intact kidney. Proteinuria preceded the decrease in filtration rate, while hypertension was observed later. We conclude that in rats with a solitary kidney renal failure eventually develops. A low protein diet postpones and attenuates this development but it does not prevent it.
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PMID:The effect of protein intake on the lifelong changes in renal function of rats with a solitary kidney damaged at young age. 237 42

For the calculation of the donor influence on the results of renal grafting, all non-renal causes of transplant failure must be excluded. The following criteria for the selection of a suitable kidney donor were found: the urine production of the donor in the last hour before nephrectomy should amount to at least 200 ml and the age difference between donor and recipient should be not more than 20 years. Proteinuria, a high serum creatinine level, vascular anomalies and a long operation time for vascular anastomosis were unfavourable. The preservation time, the warm ischemia time and the sex of the donor have little effect. If no rejection crises occurred within the first 3 weeks after transplantation, the transplant survival rate increased from 45% to 71%.
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PMID:[Choice of donor and the results of renal grafting (author's transl)]. 679 34

Long-term prognosis in kidney transplant recipients depends on multiple factors. To investigate whether mild proteinuria within the first 6 months following transplantation is a determinant of the long-term function and survival of kidney transplants, 357 patients transplanted between 1980 and 1990 were retrospectively examined over a period of 5 years. 25.5% of the patients developed an early proteinuria between 0.25 and 1.0 g/day over 6 or more months. This group was well matched concerning gender, age of recipient, underlying disease, time on hemodialysis, donor age, cold ischemia time and HLA mismatches with the group without proteinuria (n = 266). Five-year transplant survival in the group with proteinuria was 58.9% in contrast to 85.6% in recipients without proteinuria. Intermittent proteinuria did not worsen long-term prognosis. Proteinuria of 12 months or longer further reduced 5-year transplant survival to 42.6%. Over the whole observation period, serum creatinine in recipients with proteinuria was about 0.5 mg/dl higher as compared with patients without proteinuria. No correlation between proteinuria and gender, age of recipient, duration of hemodialysis, age of donor, cold ischemia time and mismatches could be detected. In conclusion, early proteinuria apparently is not due to established donor or recipient factors. However, there is a strong correlation of proteinuria with worse transplant function and survival.
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PMID:Influence of proteinuria on long-term transplant survival in kidney transplant recipients. 904 35

Sickle cell anemia and the related hemoglobinopathies are associated with a large spectrum of renal abnormalities. The patients have impaired urinary concentrating ability, defects in urinary acidification and potassium excretion, and supranormal proximal tubular function. The latter is manifest by increased secretion of creatinine and by reabsorption of phosphorus and beta(2)-microglobulin. Young patients with sickle cell disease (SCD) have supranormal renal hemodynamics with elevations in both effective renal plasma flow (ERPF) and glomerular filtration rate (GFR). These parameters decrease with age as well as following the administration of prostaglandin inhibitors. Proteinuria, a common finding in adults with sickle cell disease, may progress to the nephrotic syndrome. Proteinuria, hypertension, and increasing anemia predict end-stage renal disease (ESRD). While ESRD can be managed by dialysis and/or renal transplantation, there may be an increased rate of complications in renal transplant recipients with SCD. Hematuria is seen in individuals with all of the SCDs as well as with sickle cell trait. In most cases the etiology of the hematuria turns out to be benign. However, there does appear to be an increased association between SCD and renal medullary carcinoma. Therefore, those SCD patients who present with hematuria should initially undergo a thorough evaluation in order to exclude this aggressive neoplasm. Papillary necrosis may occur due to medullary ischemia and infarction. Erythropoietin levels are usually lower than expected for their degree of anemia and decrease further as renal function deteriorates. An abnormal balance of renal prostaglandins may be responsible for some of the changes in sickle cell nephropathy. Acute renal failure is a component of the acute multiorgan failure syndrome (MOFS). Finally, progression of sickle cell nephropathy to ESRD may be slowed by adequate control of hypertension and proteinuria. However, the prevention of the renal complications of SCD will require a cure for this genetic disorder.
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PMID:Renal abnormalities in sickle cell disease. 1142 1

As a consequence of an advancing discrepancy between supply of suitable grafts and demand from potential recipients, less than optimal organs are increasingly being used. Although clinical studies demonstrate the involvement of various risk factors, including donor age and duration of ischemia on long-term graft outcome, their individual contribution and correlation has not been followed experimentally. After cold ischemic times of 5, 60, and 120 min, kidney allografts of 3-, 12-, and 18-mo-old Fischer 344 donors were transplanted into 3-mo-old Lewis rats. Age-related changes were examined in matched native uninephrectomized controls. Proteinuria and creatinine clearance were determined, and histologic and immunohistologic studies were assessed and quantified at the end of the observation period (20 wk). All grafts functioned satisfactorily with the exception of one graft each from 12- and 18-mo-old donors with prolonged ischemia (120 min). Functional deterioration and structural changes progressed in parallel to increasing donor age and prolonged ischemia. The impact of expanded ischemia was particularly detrimental in grafts from older donor animals. Donor age and duration of ischemia act in a synergistic manner in our model. Brief ischemic times seem of particular relevance when grafts from older donors are being used.
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PMID:Contribution of prolonged ischemia and donor age to chronic renal allograft dysfunction. 1086 89

Proteinuria is a risks factor that accelerates the progression of renal insufficiency by several mechanisms. In the renal transplant proteinuria is a predictor of progressive renal insufficiency and it is associated with poor patient and graft survival. We have performed a longitudinal observational case-control study to defect and quantify proteinuria in a group of 100 cadaveric renal transplant recipients and to evaluate the influence of several factors on its appearance. We have considered the variables age and sex of the donor and recipient, number of HLA-DR, A and B mismatches, cold ischemia time, basal renal disease, initial immunosuppression, immediate versus delayed graft function and acute rejection. Three patients who did with a functioning graft were excluded from the analysis of the data. All variables were analysed in a regression model of multivariate analysis. Proteinuria in the moths 1, 3, 6, 9 and 12 was: 0.38 +/- 0.27 g/day, 0.38 +/- 0.32 g/day, 0.44 +/- 0.99 g/day, 0.42 +/- 0.58 g/day and 0.37 +/- 0.54 g/day, respectively. We analysed the profile of the proteinuria in each patient individually. Fifty three patients (54.6%) did not develop proteinuria, 12 patients (12.4%) had transient initial proteinuria, 23 patients (23.7%) had persistent proteinuria and 9 patients (9.3%) had progressive proteinuria. The renal function differed between groups. Higher creatinine levels were found in the patients with persistent proteinuria and those with progressive proteinuria. We analysed the patients according to several variables. The age of the donor was higher in the group of patients with persistent proteinuria and the incidence of acute rejection was higher in the group of patients who developed progressive proteinuria, with differences statistically significant. There was no difference in the univariate analysis in the other variables considered. The multivariate analysis confirms that the age of the donor and the basal glomerular disease predict persistent proteinuria and acute rejection predicts progressive proteinuria. According to our study, proteinuria is frequent in the renal transplant recipient with different evolutionary profiles. Two types are associated with bad renal function and have different predictive factors. We encourage the use of drugs which reduce proteinuria.
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PMID:[Changing profiles of proteinuria in renal transplantation. Predictive factors for its appearance]. 1236 27

Elevated plasma VEGF concentrations in preeclampsia are associated with local placental ischemia and endothelial dysfunction. We investigated the urinary VEGF excretion in women with severe preeclampsia (n=37) and its relation with proteinuria compared to that in healthy pregnant (n=32) and non-pregnant women (n=30). In women with severe preeclampsia VEGF levels were 54.0 (19.9-192.4) ng/mmol creatinine, significantly (p<0.0001) higher than levels in pregnant controls (28.2 (6.7-63.0) ng/mmol creatinine) and non-pregnant controls (29.5 (10.1-59.1) ng/mmol creatinine). Proteinuria was not significantly correlated with urinary VEGF levels. In conclusion, high urinary VEGF concentrations in severe preeclampsia might reflect increased renal production of VEGF rather than elevated VEGF levels in the systemic circulation.
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PMID:High levels of urinary vascular endothelial growth factor in women with severe preeclampsia. 1507 30

Proteinuria 1 year after transplantation is associated with poor renal outcome. It is unclear whether low-grade (<1 g/24 h) proteinuria earlier after transplantation and its short-term change affect long-term graft survival. The effects of proteinuria and its change on long-term graft survival were retrospectively assessed in 484 renal transplant recipients. One- and 3-month proteinuria correlated with donor age, donor cardiovascular death, prolonged cold and warm ischemia times and acute rejection. One- and 3-month proteinuria (per 0.1 g/24 h, hazard ratio (HR): 1.07 and 1.15, p<0.0001)-especially low-grade proteinuria (HR: 1.20 and 1.26, p<0.0001)-were powerful, independent predictors of graft loss. Its short-term reduction correlated with arterial pressure (AP) (the lower the 3-month diastolic and 12-month systolic AP, the lower the risk of increasing proteinuria during 1-3 months and 3-12 months periods, respectively: Odds ratio (OR) per 10 MmHg: 0.78, p=0.01 and 0.85, respectively, p=0.02), and was associated with decreased long-term graft loss (per 0.1 g/24 h: HR: 0.88 and 0.98, respectively, p<0.0001), independently of initial proteinuria. Early low-grade proteinuria due to pre-transplant renal lesions, ischemia-reperfusion and immunologic injuries is a potent predictor of graft loss. Short-term reduction in proteinuria is associated with improved long-term graft survival.
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PMID:Early low-grade proteinuria: causes, short-term evolution and long-term consequences in renal transplantation. 1668 77

The ischemia/reperfusion (I/R) model in rats allows pharmacological investigation of protective renal effects of certain agents to thereby diminish the incidence of delayed graft function (DGF). The aim of this study was to determine the effects of preconditioning with triiodothyronine (T(3)) on renal function and oxidative status in renal I/R injury. Forty male Wistar rats were preconditioned with T(3) (100 microg/kg) or control (normal saline) at 24 hours prior to 45 minutes of renal ischemia, followed by a 4-hour (groups C-4h and T(3)-4h) or 24-hour (groups C-24h and T(3)-24h) reperfusion period. We determined renal function parameters (urea, creatinine, and proteinuria), oxidative stress biomarkers in plasma (malondialdehyde [MDA], glutathione [GSH], and superoxide dismutase [SOD]), urine (hydrogen peroxide [H(2)O(2)]), and renal tissue (GSH and MDA), and poly(ADP-ribose) polymerase (PARP-1) expression. Proteinuria was significantly lower in the T(3)-treated group (4.63 +/- 1.9 vs 9.27 +/- 0.72 mg/mL/100 g body weight). Pretreated rats showed lower levels of plasma and tissue MDA and urine H(2)O(2) (50.57 +/- 1.17 vs 71.16 +/- 1.14 micromol/100 g body weight). The T(3) treatment was associated with lower postischemia GSH concentrations (3.82 +/- 1.16 vs 4.89 +/- 0.68 nmol/mg protein) and higher SOD levels at 24 hours (11.27 +/- 0.86 vs 9.92 +/- 1.77 nmol/mg protein). Preconditioning with the hormone also reduced PARP-1 tissue expression by 18% (P <or= .05). These findings suggested that preconditioning with T(3) reduced proteinuria, improved lipid peroxidation biomarkers, and increased antioxidant enzyme levels in renal I/R injury.
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PMID:Effect of preconditioning with triiodothyronine on renal ischemia/reperfusion injury and poly(ADP-ribose) polymerase expression in rats. 1971 35


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