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Primary Renal Disease (primary + renal_disease)

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Medical Sciences	100%

Selected Abstracts

Home Hemodialysis: Associations with Modality Failure

HEMODIALYSIS INTERNATIONAL, Issue 1 2003
BA Young
Purpose: To determine risk factors for home hemodialysis (HH) failure. Methods: We conducted a prospective study from 12/2000 to 9/2002 using data from the 1709 patients who received renal replacement therapy at the Northwest Kidney Centers (NWKC). Prevalent and incident Home Hemodialysis (HH) patients were included in the analysis. Baseline demographics, date of entry and date of exit from HH were ascertained for all patients. Differences among groups were assessed by independent t-test for continuous variables and by chi-squared test for categorical variables. Risk of HH failure was assessed with logistic regression. Results: Of the 116 patients who initiated training in the NWKC HH program (6.8%), 77.7% remained in the HH program, 10.3% received a transplant and 10.3% returned to in-center dialysis. Compared to patients who received a transplant or returned to in-center dialysis, HH patients were more likely to be older (65 vs. 54 yrs, P < .05) and were on dialysis longer (3.8 ± 4.7 vs. 2.3 ± 3.0 yrs, p < 0.05). Ethnicity, gender, primary renal disease and helper status were similar between groups, and were not associated with increased risk of HH failure. Unadjusted 3-year mortality was 31.7% for HH patients. HH patients who died were more likely to be older (p < 0.05) and to have diabetes (P < 0.01) than those who returned to in-center dialysis or who received a transplant. Conclusions: In HH patients, older age but not ethnicity, gender or helper status was associated with treatment failure. Older age and diabetes remain risk factors for mortality in the HH population. [source]

Interpreting incidence trends for treated end-stage renal disease: Implications for evaluating disease control in Australia

NEPHROLOGY, Issue 4 2004
JOHN H STEWART
SUMMARY: Background: Five sources of change modify trends in incidence of treated end-stage renal disease (ESRD): (i) demography; (ii) disease control, comprising prevention and treatment of progressive kidney disease; (iii) competing risks, which encompass dying from untreated uraemia or non-renal comorbidity; (iv) lead-time bias; and (v) classification bias. Thus, rising crude incidence of treated ESRD may conceal effective disease control when there has been demographic change, lessening competing risks, or the introduction of bias. Methods: Age-specific incidences of treated ESRD in Australia were calculated from Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry data by indigenous/non-indigenous status (all causes) and by primary renal disease (non-indigenous only) for two successive decades, 1982,1991 and 1992,2001. Results: We postulate that less competing risks explained much of the increase in treated ESRD in the elderly and Indigenous Australians. The increase in glomerulonephritic ESRD in non-indigenous Australians could be ascribed mainly to immigration from non-European countries. There was no significant change in incidence of treated ESRD in Indigenous or non-indigenous persons aged less than 25 years, in non-indigenous persons aged 25,64 years for ESRD caused by hereditary polycystic disease or hypertension, or in type 1 diabetics aged over 55 years. End-stage renal disease from analgesic nephropathy had declined. The increase in treated ESRD caused by type 2 diabetic nephropathy appeared to be multifactorial. Lead-time/length bias and less competing risks may have concealed a small favourable trend in other primary renal diseases. Conclusion: Whether recent disease control measures have had an impact on incidence of treated ESRD is not yet certain, but seems more likely than implied by previous reports. [source]

The role of unilateral nephrectomy in the treatment of nephrogenic hypertension in children

BJU INTERNATIONAL, Issue 1 2005
Navroop S. Johal
OBJECTIVES To define the efficacy of unilateral nephrectomy in a large series of patients presenting with renal disease and hypertension, as the latter may be a prominent finding in children with nephrourological disease (renal parenchymal disease, renovascular disease, obstruction, renal dysplasia and cancer). PATIENTS AND METHODS We retrospectively reviewed the hospital and outpatient records of 118 children who presented for evaluation with hypertension, and who had a nephrectomy between 1968 and 2003. Patients included in the study were those who had a unilateral nephrectomy for benign renal hypertension with a normal contralateral kidney; in all, 21 had complete records and follow-up were evaluated. The hypertension was associated with primary renal disease, obstruction and renovascular disease. Blood pressure and medication requirements were compared before and after surgery, the blood pressure values also being compared with published nomograms. RESULTS Patients were diagnosed with hypertension at a median age of 5 years and had a nephrectomy at a median of 11 months after the diagnosis. The median follow-up after surgery was 39 months. Most patients responded well and became normotensive, or there was a reduction in the need for medication. The median time to normalization was 2, 10 and 11 days in patients with primary renal disease, obstruction and renovascular disease, respectively. CONCLUSION Nephrectomy is successful in normalizing blood pressure in children with benign renal hypertension and with a normal contralateral kidney. [source]

Advanced glycation end-products and the kidney

EUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 8 2010
Martin Busch
Eur J Clin Invest 2010; 40 (8): 742,755 Abstract Background, Advanced glycation end-products (AGEs) are increased in situations with hyperglycemia and oxidative stress such as diabetes mellitus. They are products of nonenzymatic glycation and oxidation of proteins and lipids. The kidney plays an important role in clearance and metabolism of AGEs. Methods, Medline© and other relevant databases were searched. In addition, key review articles were scanned for relevant original publication. Finally, original data from our research group were also included. Results, Kidney podocytes and endothelial cells express specific receptors for AGEs. Their activation leads to multiple pathophysiological effects including hypertrophy with cell cycle arrest and apoptosis, altered migration, and generation of proinflammatory cytokines. AGEs have been primarily implicated in the pathophysiology of diabetic nephropathy and diabetic microvascular complications. AGEs are also involved in other primary renal diseases as well as in the development and progression of atherosclerosis. However, serum or plasma concentrations of AGEs do not correlate well with cardiovascular events in patients with chronic kidney disease (CKD). This is likely due to the fact that serum concentrations failed to correlate with AGEs deposited in target tissues. Several inhibitors of the AGE-RAGE axis are currently tested for various indications. Conclusion, AGEs and their receptors are involved in the pathogenesis of vascular and kidney disease. The role of circulating AGEs as biomarkers for cardiovascular risk estimation is questionable. Whether putative inhibitors of AGEs will get the maturity for its therapeutic use in the future remains open. [source]