Gene/Protein Disease Symptom Drug Enzyme Compound
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Necrotizing fasciitis (NF) is an infection localized at the fascial structures (both the superficial and deep ones) layering the muscles though never affecting them. NF death rate is very high (20-40%). NF can be a post-surgery, traumatic or infective complication and its prognosis quoad vitam is fatal without a timely and correct therapy. A 57-year-old woman was got into observation due to her temperature, left thigh pain, erythema and tumefaction in the left groin-crural seat. She suffered from obesity, insulin-dependent mellitus diabetes and modest but chronic renal failure and ischaemic cardiopathy from previous Acute Myocardial Infarctions. It was then started a wide-spectrum antibiotics therapy. But after just six hours there took place a rapid development of the clinical picture with the appearance of haemorrhagic-content blisters and areas of cutaneous necrosis. The patient therefore underwent-under general anaestesia-multiple incisions in the groin-crural seat and on the ipsilateral thigh. The multiple biopsies carried out during the operation too underwent cultural and histomorphopathological analysis. The anatomic pathological study highlighted the presence of necrosis of the fascia, vascular thrombosis and myonecrosis. The cultural analysis of the tissue biopsies showed a polymicrobial infection. Both the pharmacological therapy and the surgical cleaning were carried out daily but without any improvement of the clinical picture. On the eighth day a worsening of the patient's general conditions took place, with a multiple organ failure determining the patient's exitus.
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PMID:Necrotizing fasciitis. Case report. 1909 34

Successful kidney transplantation leads to restoration of renal function. Some metabolic disorders from chronic renal failure may persist and new metabolic abnormalities can develop (obesity, diabetes, hypertension, bone disease, and anemia). Additionally, influence of immunosuppressive drugs (corticosteroids, cyclosporine A, tacrolimus, and rapamycin) may aggravate the course of diabetes, hypertension, and dyslipidemia. Nutritional management of renal transplantation is divided into the pretransplant period, transplant surgery, and early and late posttransplant period. Patients in the pretransplant period in dialysis treatment may develop protein-energy malnutrition and negative nitrogen balance, with loss of lean body mass and fat deposits. Nutritional management in the early posttransplant period with a functioning kidney graft necessitates fluid and electrolyte balance control with protein intake of 1,2/kg BW/day and 30-35 kcal/kg BW/day. In a nonfunctioning kidney graft, dialysis treatment continues and the therapeutic dose of immunosuppressive drugs must be reduced. The principal objective in the late posttransplant period is the maintenance of optimal nutritional status. Nutrition is important in managing obesity, insulin resistance, diabetes, hyperlipidemia, and hypertension. Other posttransplant conditions for which diet and/or nutritional supplements may be beneficial include hypomagnesemia, hypophosphatemia, hyperuricemia, hyperkalemia, hyperhomocysteinemia, chronic renal allograft failure, renal anemia, and renal bone disease.
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PMID:Nutritional consequences of renal transplantation. 1912 81

When possible, living donor transplantation represents the best therapeutic strategy for patients suffering from chronic renal failure. Studying the donor allows a complete and thorough clinical, laboratory and instrumental assessment that guarantees good organ function whilst protecting the health of the donor. The main parameters considered within this framework are age, renal function, nephrological complications, comorbidities (diabetes, hypertension, obesity, etc.), malignancies, and infection. Moreover, particular attention is paid to the sociopsychological aspects of the donation, particularly related to the donor, the recipient, and the entire family situation.
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PMID:[Clinical evaluation of living donor]. 1964 34

Diabetes is a major epidemic, and diabetic nephropathy is the most common cause of end-stage renal disease. Two critical components of diabetic nephropathy are persistent inflammation and chronic renal ischemia from widespread vasculopathy. Moreover, acute ischemic renal injury is common in diabetes, potentially causing chronic kidney disease or end-stage renal disease. Accordingly, we tested the hypothesis that acute renal ischemia accelerates nephropathy in diabetes by activating proinflammatory pathways. Lean and obese-diabetic ZS rats (F(1) hybrids of spontaneously hypertensive heart failure and Zucker fatty diabetic rats) were subjected to bilateral renal ischemia or sham surgery before the onset of proteinuria. The postischemic state in rats with obesity-diabetes was characterized by progressive chronic renal failure, increased proteinuria, and renal expression of proinflammatory mediators. Leukocyte number in obese-diabetic rat kidney was markedly increased for months after ischemia. Intrarenal blood flow velocity was decreased after ischemia in lean control and obese-diabetic rats, although it recovered in lean rats. At 2 mo after ischemia, blood flow velocity decreased further in sham-surgery and postischemia obese-diabetic rats, so that RBC flow velocity was only 39% of control in the obese-diabetic rats after ischemia. In addition, microvascular density remained depressed at 2 mo in kidneys of obese-diabetic rats after ischemia. Abnormal microvascular permeability and increases in interstitial fibrosis and apoptotic renal cell death were also more pronounced after ischemia in obese-diabetic rats. These data support the hypothesis that acute renal ischemia in obesity-diabetes severely aggravates chronic inflammation and vasculopathy, creating a self-perpetuating postischemia inflammatory syndrome, which accelerates renal failure.
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PMID:Postischemic inflammatory syndrome: a critical mechanism of progression in diabetic nephropathy. 1965 16

GLUT9 is a novel, facilitative glucose transporter isoform that exists as two alternative splice variants encoding two proteins that differ in their NH(2)-terminal sequence (GLUT9a and GLUT9b). Both forms of GLUT9 protein and mRNA are expressed in the epithelia of various tissues; however, the two splice variants are expressed differentially within polarized cells, with GLUT9a localized predominantly on the basolateral surfaces and GLUT9b expressed on apical surfaces. Protein expression of GLUT9 drops under conditions of starvation but increases with addition of glucose and under hyperglycemic conditions. The substrate specificity of GLUT9 is unique since, in addition to transporting hexose sugars, it also is a high-capacity uric acid transporter. Several recent large-scale human genetic studies show a correlation between SNPs mapped to GLUT9 and the serum uric acid levels in several different cohorts. The relationship between GLUT9 and uric acid is highly clinically significant. Elevated uric acid levels have been associated with metabolic syndrome, obesity, diabetes, hypertension, and chronic renal failure. Although some believe uric acid is elevated as a result of these diseases, there is now evidence that uric acid may play a role in the pathogenesis of these diseases. It is also known that GLUT9 is expressed in articular cartilage and is a uric acid transporter, and thus it is possible that GLUT9 plays a role in gout, a disease of uric acid deposition in the joints. In addition, some studies have suggested that intake of fructose plays an important role in causing elevated serum uric acid levels, especially in diabetes and obesity. It is possible that GLUT9, which seems to be both a fructose and a uric acid transporter, plays an important role in these conditions associated with hyperuricemia.
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PMID:Facilitative glucose transporter 9, a unique hexose and urate transporter. 1979 40

Restrictive diets have long been an essential part of standard nutritional therapy for a wide range of diseases like obesity, diabetes, hyperlipidaemia, arterial hypertension and chronic renal failure. Although a relevant number of studies have been published in this field, most of these have concentrated on adults below age 65. Data on the effects of restrictive diets in older persons are still scarce. With increasing age, restrictive diets seem to be less effective with regard to relevant study endpoints like morbidity, quality of life and mortality. This applies in particular to chronic indications which are in most cases associated with additional co-morbidities. Here the focus shifts towards providing adequate nutritional intake rich in macro- and especially micronutrients and a diet that is also highly palatable as older individuals are at increased risk of becoming malnourished and sarcopenic. In this context, nutritional prevention and therapy are of utmost importance for maintaining quality of life. This review summarizes the present evidence for the application of restrictive diets in older persons and balances it against potential risks.
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PMID:Restrictive diets in the elderly: never say never again? 1993 33

We can state that unhealthy diets are among the top 10 causes of mortality in Western countries. The Mediterranean diet is gaining popularity because it encourages weight loss, improving the quality of life by offering a variety of healthy and palatable foods. Moreover, it ensures adequate intake of fruits, vegetables, nuts, fish, fibers, legumes, cereals and olive oil, which have been associated with a longer lifespan of people thanks to their anti-inflammatory and antioxidant properties. Thus the Mediterranean diet could act as therapy in inflammatory diseases including cardiovascular disease, obesity, type 2 diabetes, metabolic syndrome and chronic renal failure.
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PMID:The Mediterranean diet: a matter of history, tradition, culture and health. 2001 49

The aim of this study was to evaluate the epidemiological data and the main comorbidities of patients with erysipelas admitted to a tertiary hospital. All patients admitted due to erysipelas during the period from 1999 to 2008 were included in a prospective and cross-sectional study. The Fisher exact test and logistic regression were used for statistical analysis. A total of 428 individuals were hospitalized with 41 rehospitalizations; 51.17% of the patients were women, the mean age was 58.6 years. The main comorbidities were hypertension (51.6%), diabetes mellitus (41.6%), chronic venous insufficiency (36.2%), other cardiovascular diseases (33.2%) including angina, peripheral arterial insufficiency, acute myocardial infarction, and strokes, obesity (12.1%), chronic renal failure (6.8%), neoplasms (4.9%), cirrhosis (4.9%), chronic lymphedema (4.2%), and leg ulcers (2.6%). Erysipelas is a seasonal disease that affects adults and the elderly people, has a repetitive nature, and is associated with comorbidities.
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PMID:Epidemiological data and comorbidities of 428 patients hospitalized with erysipelas. 2014 45

Because of the increasing incidence of cardiac failure and chronic renal failure due to the progressive aging of the population, the extensive application of cardiac interventional techniques, the rising rates of obesity and diabetes mellitus, coexistence of heart failure and renal failure in the same patient are frequent. More than half of subjects with heart failure had renal impairment, and mortality worsened incrementally across the range of renal dysfunctions. In patients with heart failure, renal dysfunction can result from intrinsic renal disease, hemodynamic abnormalities, or their combination. Severe pump failure leads to low cardiac output and hypotension, and neurohormonal activation produces both fluid retention and vasoconstriction. However, the cardiorenal connection is more elaborate than the hemodynamic model alone; effects of the renin-angiotensin system, the balance between nitric oxide and reactive oxygen species, inflammation, anemia and the sympathetic nervous system should be taken into account. The management of cardiorenal patients requires a tailored therapy that prioritizes the preservation of the equilibrium of each individual patient. Intravascular volume, blood pressure, renal hemodynamic, anemia and intrinsic renal disease management are crucial for improving patients' survival. Complications should be foreseen and prevented, looking carefully at basic physical examination, weight and blood pressure monitoring, and blood, urine urea and electrolytes measurement.
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PMID:Cardiorenal syndrome: still not a defined entity. 2017 50

Quadriceps tendon rupture is an uncommon injury; the incidence of simultaneous bilateral quadriceps tendon rupture is extremely rare. Two distinct categories-individuals older than 50 years and between 27 and 54 years-have been described. Bilateral quadriceps tendon rupture is more common in patients older than 50 years and is thought to be the result of tendon weakening due to obesity and arteriosclerosis-induced fibrotic changes, or previous injury.In younger individuals, bilateral simultaneous quadriceps rupture is less frequent and has been associated with anabolic steroid use, but more frequently with underlying comorbid medical conditions such as chronic renal failure, hyperparathyroidism, endocrine disorder, gout, diabetes and obesity, which predispose the patients to tendon rupture. Our case report is unique because we report the simultaneous bilateral quadriceps tendon rupture following minor trauma in an otherwise healthy 43-year-old man with no predisposing comorbidity.
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PMID:Bilateral quadriceps tendon rupture: a rare finding in a healthy man after minimal trauma. 2034 79


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