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Archives Of Kidney Watch Blog From Medicineworld.Org

May 21, 2006, 9:00 AM CT

MRI Alert To Progression Of Polycystic Kidney Disease

MRI Alert To Progression Of Polycystic Kidney Disease
A new method using magnetic resonance imaging (MRI) accurately tracks structural changes that predict functional changes earlier than standard blood and urine tests in people with autosomal dominant polycystic kidney disease (PKD), as per a research studyfunded by the National Institutes of Health (NIH). PKD is a common inherited condition characterized by cysts that grossly distort the kidneys and liver and by hypertension and brain aneurysms (bulges in arteries). Findings are in the May 18 issue of the New England Journal of Medicine.

Scientists found that both small and large cysts and both kidneys grew continuously at steady rates, seemingly tailored to the individual with PKD, regardless of patient age. These structural changes correlate with losses in kidney function, suggesting that MRI can be used to track the major contributor to the progression of PKD, an advance that could speed the discovery of new therapies.

"There is so much variability in the loss of kidney function among PKD patients, even within families with the same altered gene, that it was assumed that cysts and kidneys must grow at variable rates. So it's quite remarkable to find cysts and kidneys in individuals growing at uniform and predictable rates," said Catherine M. Meyers, M.D., a kidney specialist at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). "Our experience is still limited, but this method appears very promising".........

Posted by: Mark      Permalink         Source

April 20, 2006, 9:12 PM CT

Shock Wave Therapy For Kidney Stones May Increase Risk Of Diabetes

Shock Wave Therapy For Kidney Stones May Increase Risk Of Diabetes
Mayo Clinic scientists are sounding an alert about side effects of shock wave lithotripsy: in a research study, they found this common therapy for kidney stones to significantly increase the risk for diabetes and high blood pressure during the later part of life. Risk for diabetes was correlation to the intensity of the therapy and quantity of the shock waves administered; high blood pressure was correlation to therapy of stones in both kidneys.

Shock wave lithotripsy uses shock waves to break up an impassable kidney stone into smaller, sandlike pieces which can be passed spontaneously, commonly within a month. The patient and the lithotriptor that emits the shock waves are placed in a water bath. Water allows easier conduction of the shock waves through the patient's tissue and precise focus on the kidney stone.

"This is a completely new finding," says Amy Krambeck, M.D., Mayo Clinic urology resident and lead study investigator. "This opens the eyes of the world of urology to the fact that high blood pressure and diabetes are potential side effects. We can't say with 100 percent certainty that the shock wave therapy for the kidney stones caused diabetes and hypertension, but the association was very strong. The risk of developing diabetes after shock wave lithotripsy is almost four times the risk of people with kidney stones treated with medicine, and the risk of developing high blood pressure is one and one-half times, which is a significant risk increase."........

Posted by: JoAnn      Permalink         Source

April 20, 2006, 8:39 PM CT

Acidity Increases Risk For Kidney Stones In Diabetics

Acidity Increases Risk For Kidney Stones In Diabetics
People with type 2 diabetes have highly acidic urine, a metabolic feature that explains their greater risk for developing uric-acid kidney stones, scientists at UT Southwestern Medical Center have found.

The study - the first to compare the urinary biochemical characteristics of type 2 diabetics with those of normal volunteers - is available online and would be reported in the recent issue of the Journal of the American Society of Nephrology.

Individuals with type 2 diabetes (non-insulin dependent diabetes mellitus) are at increased risk for developing kidney stones in general, and have a particular risk for uric-acid stones. The mechanisms for this greater risk were previously not entirely understood. This new study demonstrates that the propensity for type 2 diabetics to develop uric-acid stones is elevated because their urine is highly acidic.

"Our next step is to find out what causes type 2 diabetics to have an abnormally acidic urine, and what other urinary factors protect some diabetics who do not form uric-acid stones," said Dr. Mary Ann Cameron, the paper's lead author and a postdoctoral trainee in internal medicine.

Obesity and a diet rich in animal protein are associated with abnormally acidic urine. In earlier studies, UT Southwestern scientists also concluded that uric-acid stones are associated with insulin resistance and type 2 diabetes.........

Posted by: JoAnn      Permalink         Source

April 20, 2006, 9:16 PM CT

Bringing New Life To Kidney Treatment

Bringing New Life To Kidney Treatment
Finding how two proteins conspire to get kidney cells to self-destruct when oxygen supplies are low may one day improve dismal mortality rates for ischemic renal failure, scientists say.

Dehydration, low blood pressure, septic shock, trauma or removing a kidney for transplantation can temporarily halt or reduce blood and oxygen supplies, says Dr. Zheng Dong, cell biologist at the Medical College of Georgia.

Ischemia leads to cell suicide or apoptosis, especially in the energy-consuming tubular cells of the kidneys, he says. Fifty percent mortality rates from resulting ischemic renal failure haven't changed in nearly as a number of years, Dr. Dong says.

Tubular cells - which have the daunting daily task of reabsorbing nearly 50 gallons of usuable fluid volume, including salt and glucose the kidneys filter from the blood every 24 hours - are especially vulnerable to apoptosis and injury, Dr. Dong says.

"They are highly energy-dependent," he says. "That is why when you shut off the blood supply, these cells are quickly, irreversibly damaged and they die." Tubular cell injury and death is why kidneys are so vulnerable, for example in critically ill patients.

It's in this oxygen-deprived environment that two proteins, Bid and Bax - each a known killer in its own right - are activated and may partner to induce cell death. The killing proteins are pervasive, especially in the kidneys, says Dr. Dong, who recently received a $1 million grant from the National Institute of Diabetes & Digestive & Kidney Diseases, to better understand their role in cell death during ischemic renal failure.........

Posted by: Mark      Permalink         Source

January 24, 2006, 9:42 PM CT

Obesity Is A Risk Factor For Kidney Failure

Obesity Is A Risk Factor For Kidney Failure
Scientists at the University of California, San Francisco have determined that there is a strong relationship between being obese and developing end-stage renal disease, or kidney failure.

The long-range study found that the obese have up to a seven times greater risk of kidney failure than normal weight people, suggesting that obesity should be considered a risk factor for the condition, and that kidney failure is yet another consequence of obesity.

"There are more and more people with kidney failure, but it hasn't been appreciated much that kidney failure can be a consequence of obesity," said Chi-yuan Hsu, MD, UCSF assistant professor of medicine and lead author of the study. "We think this study is important because it demonstrates quite convincingly that people who are obese or overweight are at much higher risk of kidney failure."

The study, reported in the January 3 issue of the Annals of Internal Medicine, was conducted jointly with Kaiser Permanente of Northern California Division of Research.

Research findings showed that being even moderately overweight nearly doubles the risk of developing the condition, which is a complete failure of the kidneys to process waste so that dialysis or transplantation become necessary.

"If you are mildly overweight, not even frankly obese, you are roughly 90 percent more likely to develop end-stage renal failure," Hsu said, with the risk reaching over 700 percent greater for the morbidly obese.........

Posted by: JoAnn      Permalink

December 25, 2005, 10:32 AM CT

Merry Christmas To All Our Readers

Merry Christmas To All Our Readers
Medicineworld wishes all our readers merry Christmas.

Oh, jingle bells, jingle bells

Jingle all the way

Oh, what fun it is to ride

In a one horse open sleigh

Jingle bells, jingle bells

Jingle all the way

Oh, what fun it is to ride

In a one horse open sleigh........

Daniel      Permalink

December 21, 2005

Links Between Kidney Function And Bone

Links Between Kidney Function And Bone Keith A. Hruska, MD
Multitasking might seem like a modern invention, but in biology it's been an established technique for millennia.

The organs of the human body, for example, all have their well-known primary specialties, but a number of of them also play secondary roles in support of each other.

One such moonlighter is the human kidney, which purifies waste from the blood, but also has a more recently identified role as a contributor to the structural integrity of the human skeleton.

Keith A. Hruska, MD, professor of pediatrics, medicine and of cell biology and physiology at the School of Medicine and head of pediatric nephrology at St. Louis Children's Hospital, has developed several new insights into the connections between the kidney and the skeleton and hopes to put them to use soon in new therapys for kidney patients that will ease the harmful effects their condition inflicts on both the skeleton and the heart.

To recognize the connections between the kidney and the skeleton, doctors first had to understand that the skeleton isn't the dry and unchanging place it .

was once thought to be.

"In the past, the skeleton has been viewed as mostly a dead structure, but that's not the case at all," Hruska explains. "The adult skeleton is very active tissue that is continually remodeling, dismantling damaged bone and replacing it with new bone".

Cells inside the bone marrow accomplish this task, regularly destroying and rebuilding bone structure to adjust for wear, injury and changes in the mechanical loads and pressures placed on the bones.

Kidney disease's direct connection to bone health was initially masked by a complication of chronic kidney disease (CKD) known as secondary hyperparathyroidism. This complication, which afflicts about 100,000 new patients with kidney disease each year, raises bloodstream levels of the parathyroid hormone.........

Daniel      Permalink

December 20, 2005

Blood test can accurately diagnose heart failure

Blood test can accurately diagnose heart failure
A large-scale analysis has shown that a blood test previously found useful in diagnosing or ruling out heart failure in emergency room patients remains effective in patients with chronic kidney disease. The study also demonstrates that the test for a marker called NT-proBNP can identify patients at a higher risk for death, independent of kidney dysfunction. The report from researchers at the Massachusetts General Hospital (MGH) will appear in the January 3, 2006 Journal of the American College of Cardiology and is receiving early online release.

"It is well understood that kidney disease reduces the usefulness of testing for both NT-proBNP and a related biomarker called BNP, and the conventional understanding was that NT-proBNP was the more affected of the two," says James Januzzi Jr., MD, of the MGH Cardiology Division, the paper's senior author. "However, while kidney disease did lead to higher values of NT-proBNP in our study, what really matters is clinical performance; and at optimal cut-points, no matter how hard we looked, we found the relationship between chronic kidney disease and the diagnostic accuracy of NT-proBNP was no different than that of BNP. Our findings thus directly contradict observations based on smaller, less characterized patient populations".

Congestive heart failure, which occurs when an impaired heart muscle cannot pump blood efficiently, is a growing health problem and major cause of cardiac death. The diagnosis of heart failure may be challenging because its symptoms can overlap those of other conditions. Missing a heart failure diagnosis can put patients at high risk of serious problems, including death, but overdiagnosis may lead patients to receive unnecessary therapy.

Published earlier this year, the PRIDE study showed NT-proBNP to be highly sensitive and specific for the diagnosis of acute heart failure in patients with shortness of breath and to strongly predict patient deaths. A major concern about the widespread use of the marker had been prior assertions that kidney disease - very common in patients with heart failure - might confound the results of NT-proBNP testing, since levels of the marker were higher among those with reduced renal function.........

Daniel      Permalink

December 17, 2005

Gene Mutation In Bardet-Beidl syndrome (BBS)

Gene Mutation In Bardet-Beidl syndrome (BBS)
Johns Hopkins researchers studying a rare inherited syndrome marked by eye and kidney problems, learning disabilities and obesity have discovered a genetic mutation that makes the syndrome more severe but that alone doesn't cause it. Their report appears in the advance online edition of Nature (Dec. 4).

The new discovery about Bardet-Beidl syndrome (BBS) came from a panoply of studies -- starting with comparative genomics and experiments with yeast, and moving to experiments with zebrafish and genetic analysis of families with the syndrome -- and mirrors what experts expect for the genetically complex common diseases that kill most Americans, like diabetes, heart disease and cancer.

"Researchers are going to have to think very hard before they discount genetic variation that appears not to directly cause a disease," says the study's leader, Nicholas Katsanis, Ph.D., associate professor in the McKusick-Nathans Institute of Genetic Medicine at Johns Hopkins. "The onus is on us to figure out how to dissect the effects of what appear to be silent genetic variants. I have a greatly renewed respect for the complexity of the genome, for the subtle ways that genes and gene products interact with each other".

Conventional wisdom says that a collection of subtle genetic variations contribute to a person's risk of common diseases, but hunting for such subtle effects is daunting. As a result, most gene hunts have targeted relatively rare diseases that appear from their pattern in families to be fairly simple genetically.

Katsanis and colleagues have recognized for years that BBS, eventhough rare, is more similar to the genetic complexity of common diseases, in part because patients with this condition have extremely variable severity, even within families. The newly identified mutation, in a gene called MGC1203, is the first to affect only the severity of the syndrome. Mutations in eight other genes, all dubbed BBS genes, are known to cause the disease, often in combination with each other.........

Sue      Permalink

No Kidney Benefit for ACE-Inhibitors (December 11, 2005)
The best way to protect kidneys of diabetic patients is to lower blood pressure. Period. So says Juan P. Casas M.D. and his colleagues of the British Heart Foundation Laboratory at University College London, who reported that a meta-analysis of 127 randomized trials did not confirm a renoprotective effect for either ACE-inhibitors or angiotensin receptor blockers.

Did you know?
The National Institute of Dental and Craniofacial Research (NIDCR), part of the National Institutes of Health, announced today the launch of a seven-year clinical study that could accelerate research on better pain-controlling therapys for a jaw condition called temporomandibular joint and muscle disorders (TMJDs). Archives of kidney watch blog

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