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Diabetes and arterial hypertension continue to be the main causes of chronic renal failure in 2010, with a rising prevalence in part due to the worldwide obesity epidemic. Proteinuria is a main feature of chronic renal disease and mediated by defects in the glomerular filtration barrier and is as a good predictor of cardiovascular events. Indeed, chronic renal disease due to glomerulosclerosis is one of the important risk factors for the development of coronary artery disease and stroke. Glomerulosclerosis develops in response to inflammatory activation and increased growth factor production. Preclinical and first preliminary clinical studies provide strong evidence that endogenous endothelin-1 (ET-1), a 21-amino-acid peptide with strong growth-promoting and vasoconstricting properties, plays a central role in the pathogenesis of proteinuria and glomerulosclerosis via activation of its ET(A) subtype receptor involving podocyte injury. These studies have not only shown that endothelin participates in the disease processes of hypertension and glomerulosclerosis but also that features of chronic renal disease such as proteinuria and glomerulosclerosis are reversible processes. Remarkably, the protective effects of endothelin receptors antagonists (ERAs) are present even on top of concomitant treatments with inhibitors of the renin-angiotensin system. This review discusses current evidence for a role of endothelin for proteinuric renal disease and podocyte injury in diabetes and arterial hypertension and reviews the current status of endothelin receptor antagonists as a potential new treatment option in renal medicine.
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PMID:Therapeutic potential of endothelin receptor antagonists for chronic proteinuric renal disease in humans. 2035 30

In patients with chronic renal failure undergoing dialysis the mortality rate from cardiovascular conditions is 10 to 100 fold than in general population. The higher mortality rate is due not only to the influence of traditional risk factors, such as hypertension, diabetes, obesity, dyslipidemia and cigarette smoking, but also to specific factors of uremic patients. Acute complications commonly take place during routine hemodialysis treatments (HD) due to unsteadiness in the cardiovascular system balance. We will review most important cardiovascular complications during HD from hypotension to ventricular hypertrophy, from arrhythmias to sudden death, and finally myocardial ischemia. A large number of structural and functional peripheral vascular and cardiac abnormalities including electrolyte imbalance, hemodynamic instability and neuro-humoral stress exert an overwork on myocardium and lead to occurring of a single cardiovascular complication but are always strictly correlated events.
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PMID:Acute cardiovascular complications of hemodialysis. 2042 75

Liver transplantation has become a lifesaving procedure for patients who have chronic end-stage liver disease and acute liver failure. The satisfactory outcome of liver transplantation has led to insufficient supplies of deceased donor organs, particularly in East Asia. Hence, East Asian surgeons are concentrating on developing and performing living-donor liver transplantation (LDLT). This review article describes an update on the present status of liver transplantation, mainly in adults, and highlights some recent developments on indications for transplantation, patient selection, donor and recipient operation between LDLT and deceased-donor liver transplantation (DDLT), immunosuppression, and long-term management of liver transplant recipients. Currently, the same indication criteria that exist for DDLT are applied to LDLT, with technical refinements for LDLT. In highly experienced centers, LDLT for high-scoring (>30 points) Model of End-Stage Liver Disease (MELD) patients and acute-on-chronic liver-failure patients yields comparably good outcomes to DDLT, because timely liver transplantation with good-quality grafting is possible. With increasing numbers of liver transplantations and long-term survivors, specialized attention should be paid to complications that develop in the long term, such as chronic renal failure, hypertension, diabetes mellitus, dyslipidemia, obesity, bone or neurological complications, and development of de novo tumors, which are highly related to the immunosuppressive treatment.
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PMID:Liver transplantation. 2043 40

Diabetes mellitus (DM) and hypertension (HTN) are common risk factors for heart disease in the population. The goal of this study was to evaluate independent association between type 2 DM and HTN using a very large database. We used ICD-9 codes for type 2 DM (250.00, 250.02) and HTN (401.0, 401.1, 401.9) from the Nationwide Inpatient Sample (NIS) database. We randomly selected the years in the database between 1992 and 2002. We used uni- and multi-variate analysis to evaluate any association between type 2 DM and HTN adjusting for co-morbid conditions. The 1992 database contained a total of 6,195,744 patients. Type 2 DM was associated with 37.5% of patients with HTN vs. 11.4% of the control group (odds ratio (OR): 4.63, Confidence interval (CI) 4.61-4.693, p < 0.001). The 2002 database contained a total of 7,853,982 patients. Type 2 DM was associated with 57.2% of patients with HTN vs. 22.9% of the control group (OR: 4.49, CI 4.47-4.52, p < 0.001). Using multivariate analysis adjusting for age, gender, hyperlipidemia, obesity, smoking, and chronic renal failure, type 2 DM remained independently associated with HTN in both years (for the year 1992: OR: 2.49, CI: 2.47-2.51, p < 0.001 and for the year 2002 OR: 2.19, CI: 2.18-2.20, p < 0.001). The same association was persistently found using samples for each year between 1992 and 2002. The presence of type 2 DM is strongly associated with HTN. This association is independent of co-morbid conditions and was persistent with similar odds ratio over a period of 10 years.
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PMID:Independent association between type 2 diabetes mellitus and hypertension over a period of 10 years in a large inpatient population. 2050 28

The quality indicators program in the community has existed in Clalit Health Services for over a decade. As a part of this program, approximately 70 evidence-based quality indicators have been defined, in 11 different domains. The indicators relate to preventive medicine (immunizations, early detection of diseases, e.g. colorectal cancer, breast cancer, hypertension, chronic renal failure), chronic disease management (diabetes, hyperlipidemia, ischemic heart disease, asthma, congestive heart failure), care of the elderly (prevention of repeated hospitalizations) and child care (obesity detection, anemia detection and treatment). The indicators program is founded on one of the worldwide leading information systems, based on a common data warehouse with data regarding sociodemographic factors, purchase of medications, health services utilization, laboratory and imaging data, as well as a unique, validated registry of chronic diseases. The program has led to progress in several domains, including control of diabetes and hyperlipidemia, pneumococcal vaccination and early detection of colorectal cancer. The program narrowed the gaps and reduced inequalities between the Arab and Jewish populations, and between socioeconomic levels. The improvement in quality indicators is based on teamwork of physicians, nurses, other health professionals and administrative staff. The day-to-day work and the major effort invested in Clalit's enrollees are reflected in the continuing improvement in clinical quality.
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PMID:[The quality indigators program in Clalit Health Services: the first decade]. 2081 90

Bariatric surgery is now recognized as a sure and effective way for weight reduction in morbid obesity. However some procedures induce intestinal malabsorption leading to enteric hyperoxaluria. So bariatric surgery could place these patients not only at risk for nephrolithiasis but also for oxalate induced nephropathy and chronic renal failure. Because of the growing incidence of obesity worldwide, physicians and patients should be aware of such potential complications. There is no mean to discuss this treatment because of its spectacular efficiency on obesity and its comorbidities. But it is necessary to choose the surgical technique according to the risk factors of the patients. Following surgery, preventive treatment strategies are indicated, such as modified dietary lifestyle and specific drugs as we suggested to limit or even avoid these complications. However observance could fail in the long term. In case of oxalate nephropathy, surgery may be proposed to restore the intestinal tract but with the risk of overweight relapse. To illustrate this matter, we report here significant observations of three patients, which, having successfully benefited from the same bariatric surgery, have presented lithiasic complications for two of them and oxalate nephropathy leading to chronic renal failure and hemodialysis for the third.
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PMID:[Bariatric surgery, calcium oxalate urinary stones and oxalate nephropathy]. 2113 57

Live-donor kidney transplants are being done since more than fifty years ago. In recent years, a marked increase in live donations is observed, as a result of the limited availability of organs from deceased donors. Also, the use of laparoscopic nephrectomy has contributed to increase live donations. A systematic review of the literature shows that short and long-term risks of morbidity and mortality of the donor are reasonably low. Even so, an increased incidence of high blood pressure and mild proteinuria has been reported. On the contrary, no detrimental effect on renal failure is observed and the incidence of long-term chronic renal failure is lower in the donor population when compared with the incidence observed in the general population. In any case, a regular follow-up of the donors is advisable in order to prevent or early detect those medical conditions that would represent a health risk, in particular those conditions that possibly will affect renal function: hypertension, diabetes, proteinuria and obesity. It would be also necessary to establish a nation-wide scientific registry, with prospective regular data collection, that will make possible a more accurate assessment of the long-term risk of uninephrectomy and early detection of new medical information that would contribute to redefine the risk of kidney donation or to establish new requisites in the donor evaluation protocols.
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PMID:[Short, medium and long-term follow-up of living donors]. 2118 69

Chronic volume overload is the major cause of hypertension and other cardiovascular morbidity in dialysis patients. One of the most important goals of physicians who take care of patients with chronic renal failure is to obtain near euvolemia or "dry body weight" in order to maintain or normalize blood pressure and prevent further cardiovascular events. In clinical practice, exact estimation of dry weight in hemodialysis patients remains a major challenge. Alterations in body composition, particularly malnutrition, are common in patients receiving long-term hemodialysis and contribute to a high mortality rate. In contrast, obesity - a known risk factor for cardiovascular morbidity and mortality - is prevalent amongst kidney allograft recipients in - long term after renal transplantation. Several technological tools and biochemical markers for estimation of plasma volume and body composition are available for clinical use. Our aim was to highlight the importance of control of body fluid volume and body composition in patients with chronic kidney disease and to describe the different methods available for such measurements.
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PMID:The importance of body composition and dry weight assessments in patients with chronic kidney disease. 2161 69

High-dietary fat intake is a major risk factor for development of metabolic and cardiovascular-renal dysfunction including obesity, coronary artery disease, hypertension, and chronic renal failure. We examined the effect of a high-fat diet on renal function and morphology in spontaneously hypertensive rats (SHR), a phenotype designed to mimic metabolic syndrome. High-fat diet induced increase (P < 0.05) in blood pressure, body weight, and renal lipid deposition in these rats. This increase in body weight was accompanied by elevations (P < 0.05) of blood glucose and low-density lipoprotein (LDL) levels, a decrease (P < 0.05) in adiponectin and increases (P < 0.05) in plasma monocyte chemotactic protein-1 (MCP-1) along with renal macrophage infiltration. These pathophysiological perturbations were attenuated (P < 0.05) by heme oxygenase-1 (HO-1) induction by treatment with cobalt protoporphyrin (CoPP). Further effects of CoPP included increased (P < 0.05) renal expression of adiponectin along with enhancement (P < 0.05) of pAKT, pAMPK, and p-eNOS in SHRs fed a high-fat diet. Prevention of such beneficial effects of CoPP by the concurrent administration of the heme-HO inhibitor stannous mesoporphyrin (SnMP) corroborates the role of HO system in mediating such effects. Taken together, our results demonstrate that high-fat diet induces a metabolic syndrome-like phenotype in hypertensive rats, which is amenable to rescue by increases in HO-1- and adiponectin-dependent pathways.
Obesity (Silver Spring) 2012 May
PMID:High-fat diet exacerbates renal dysfunction in SHR: reversal by induction of HO-1-adiponectin axis. 2219 21

Adiponectin is a novel collagen-like protein synthesized by white adipose tissue. Its levels are decreased in obesity, type-2 diabetes and insulin-resistant states, and are increased in chronic renal failure. It has anti-inflammatory and anti-atherogenic properties. This study was planned to evaluate the levels of adiponectin in uremic patients with and without diabetes and to find any relationship between adiponectin levels and some cardiovascular risk factors, and to determine the possible predictive value of adiponectin for cardiovascular complications (CVC). The study included 100 subjects, 20 of them were healthy subjects and served as the control group (group I), 40 were uremic non-diabetic patients (group II) (half of them were without CVC, group IIA, and the other half were patients with CVC, group IIB) and, lastly, 40 uremic diabetic patients (group III) (half of them were without CVC, group IIIA, and the other half were patients with CVC, group IIIB). All subjects were subjected to complete clinical examination, including determination of mean arterial blood pressure (MABP), body mass index (BMI), waist to hip ratio, routine laboratory investigations, fasting plasma glucose, fasting plasma insulin, lipid profile (cholesterol, TG, LDL, HDL), determination of insulin resistance by homeostasis model assessment index (HOMA-IR) and estimation of serum levels of adiponectin. There was a significant increase in serum adiponectin levels in all the uremic patients (group II and group III) when compared with the control (group I) group, P <0.01; also, serum adiponectin levels were significantly decreased in uremic diabetic patients (group III) when compared with uremic non-diabetic patients (group II), P <0.01; but this was still higher than in the controls. The patients with CVC, whether uremic non-diabetic (group IIB) or uremic diabetic (group IIIB), had a significant decrease in serum adiponectin levels when compared with patients without CVC (group IIA and group IIIA), P <0.01. Serum adiponectin has a significant positive correlation with HDL and a significant negative correlation with MABP, BMI, plasma insulin, HOMA-IR, LDL, TG and cholesterol in all the patients. Therefore, it can be concluded that adiponectin levels in uremic patients, whether diabetic or non-diabetic, may be a good indicator of cardiovascular disease risk.
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PMID:Association of adiponectin with cardiovascular events in diabetic and non-diabetic hemodialysis patients. 2280 86


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