Hyperlipemia in renal disease

Thesis (M.D.)--Boston Universit

African American End Stage Renal Disease & Medication Adherence: What Are the Effects of Everyday Racism?

End-stage renal disease (ESRD) is the ninth leading cause of death in the US. African Americans are nearly four times more likely to develop ESRD compared to Whites. ESRD requires a complex medication regimen, and poor medication adherence leads to increased hospitalizations, morbidity, and mortality in end-stage renal disease (ESRD) patients. Studies demonstrate that African American ESRD patients have poorer rates of medication adherence when compared to Whites. However, the reasons for this racial inequity are not understood. This is the first study to explore how everyday racism within the healthcare system, contributes to this disparity. A mixed methods study was conducted to investigate the relationship between everyday racism and medication adherence within the African American ESRD community using Critical Race Theory (CRT) as the theoretical foundation. Data were collected from 46 African American ESRD patients in the South. All participants completed a cross-sectional survey comprised of a medication adherence survey and an everyday racism in the healthcare setting survey. Additionally, 27 of the total sample (N=46) participated in in-depth interviews. A statistically significant negative relationship was found between medication adherence and everyday racism in the healthcare setting (r = -.477, p < .01). Interviews revealed that everyday racism perpetuated within the healthcare setting negatively affected participants’ medication adherence. Three themes were identified: 1) Concern that medical providers did not explain or properly manage medication regimen they prescribed 2) Concern that the medications are not safe 3) Information about medication and labs were withheld or not fully explained

Health outcomes of children born to mothers with chronic kidney disease: a pilot study

This study aimed to study the health of children born to mothers with chronic kidney disease. Twenty-four children born to mothers with chronic kidney disease were compared with 39 matched control children born to healthy mothers without kidney disease. The well-being of each child was individually assessed in terms of physical health, neurodevelopment and psychological health. Families participating with renal disease were more likely to be from lower socio-economic backgrounds. Significantly fewer vaginal deliveries were reported for mothers with renal disease and their infants were more likely to experience neonatal morbidity. Study and control children were comparable for growth parameters and neurodevelopment as assessed by the Griffiths scales. There was no evidence of more stress amongst mothers with renal disease or of impaired bonding between mother and child when compared to controls. However, there was evidence of greater externalizing behavioral problems in the group of children born to mothers with renal disease. Engaging families in such studies is challenging. Nonetheless, families who participated appreciated being asked. The children were apparently healthy but there was evidence in this small study of significant antenatal and perinatal morbidity compared to controls. Future larger multi-center studies are required to confirm these early findings

Thrombocytopenia in end-stage renal disease and chronic viral hepatitis B or C

Objectives. We evaluated platelet counts in end-stage renal disease and chronic viral hepatitis. Materials and Methods. We studied 70 patients with end-stage renal disease and chronic viral hepatitis and compared them to a control group of 45 patients without hepatitis. Results. The presence of viral hepatitis was associated with a higher prevalence of thrombocytopenia. Correlations between age, C-reactive protein, liver stiffness measurement, and platelet count were observed. C-reactive protein levels \u3e 10 mg/dl were associated with a lower risk of thrombocytopenia in patients with end-stage renal disease and chronic viral hepatitis, yet age \u3e 60 years, dialysis vintage \u3e 10 years, aspartate and alanine aminotransferase levels \u3e 20 IU/L, albumin levels \u3c 3.5 g/dl, and fibrosis stage ≥ 3 were not related. Conclusions. Chronic viral hepatitis leads to a higher prevalence of thrombocytopenia. Platelet counts in these patients begin to decrease significantly once liver fibrosis reaches stage III

Effects of hemodialysis on circulating adrenomedullin concentrations in patients with end-stage renal disease

To characterize the determinants of circulating levels of adrenomedullin (AM), the plasma levels of this peptide were measured in 58 patients with end-stage renal disease on hemodialysis, Predialysis plasma levels of AM were more than twice as high in patients on hemodialysis as compared to controls. In hemodialysis patients with heart failure (NYHA classes II-IV) or hypertensive HD patients plasma levels of AM were significantly higher than in patients with end-stage renal disease only. Plasma levels of AM were clot altered immediately by hemodialysis but decreased significantly 14-20 h after hemodialysis, AM plasma levels before hemodialysis and 14-20 h after hemodialysis were correlated with the corresponding mean arterial pressure

Murine models of renal disease: Possibilities and problems in studies using mutant mice

The elucidation of the pathogenesis of human renal disease at the molecular level has been facilitated by the growing field of gene targeting and the development of mouse strains with single-gene deletions - the `knock-out' mice. Experimental nephrology, therefore, requires well-characterized and reliable models of human renal disease that can be induced reproducibly in mice. Today surgical procedures for the induction of renal ischemia, chronic renal failure, and ureter obstruction are feasible in mice. Models of mesangioproliferative or crescentic glomerulonephritis, glomerulosclerosis, and tubulointerstitial disease are readily available; however, these depend heavily on the mouse genetic background. Attention to the genetic background and appropriate backcrossing are, therefore, of great importance in the design and interpretation of experimental studies, especially in transgenic mice. Simple murine models displaying the clinical features of other human renal diseases such as IgA nephropathy, membranous glomerulonephritis, and renal vasculitis are still lacking. Mouse strains that spontaneously develop distinct renal pathologies similar to lupus nephritis and focal-segmental glomerulosclerosis can be intercrossed with transgenic mice to study the impact of single-gene deletions on the renal phenotype. The present review provides a survey about currently available spontaneous and inducible murine models of renal disease with special attention to problems and future perspectives for their use in transgenic animals. Copyright (C) 2000 S. Karger AG, Basel

The Associations between Metabolic Syndrom Components and Chronic Renal Disease at Gatot Subroto Hospital, Jakarta

Background: The incidence of chronic renal disease in Indonesia is increasing. Metabolic syndrome is one of the risk factors of chronic renal disease. Insulin resistance (type 2 diabetes mellitus, high fasting-blood glucose, glucose intolerance), hypertension, hypertriglyceridemia, low serum HDL level, obesity, and micro albuminuria are components of metabolic syndrome according to WHO criteria. Metabolic syndrome causes chronic inflammation and eventually damages renal cells. This study aimed to examine the associations between metabolic syndrom components and chronic renal disease. Subjects and Method: This was a cross sectional study carried out at Gatot Subroto Hospital, Jakarta. A sample of 113 patients with chronic renal disease was selected for this study. The dependent variable was patient of chronic renal disease. The independent variable was metabolic syndrome components based on WHO criteria. The data of chronic renal disease were obtained from the medical record. The data were described in percent and analyzed by a multiple logistic regression. Results: Of all 113 patients with chronic renal disease sample in this study, 66 (58.4%) had metabolic syndrome. Chronic renal disease was associated with type 2 diabetes mellitus (OR= 8.29; 95% CI= 0.77 to 52.50; p= 0.049) and high fasting-blood glucose level (OR= 6.34; 95% CI= 1.01 to 68.08; p= 0.087). Conclusion: Type 2 diabetes mellitus and high fasting-blood glucose level are associated with an increased risk of chronic renal disease. Keywords: chronic renal disease, metabolic syndrome, risk facto

Renal AA-amyloidosis in intravenous drug users - a role for HIV-infection?

Background: Chronic renal disease is a serious complication of long-term intravenous drug use (IVDU). Recent reports have postulated a changing pattern of underlying nephropathy over the last decades. Methods: Retrospective investigation including all patients with prior or present IVDU that underwent renal biopsy because of chronic kidney disease between 01.04.2002 and 31.03.2012 in the city of Frankfurt/Main, Germany. Results: Twenty four patients with IVDU underwent renal biopsy because of progressive chronic kidney disease or proteinuria. Renal AA-amyloidosis was the predominant cause of renal failure in 50% of patients. Membranoproliferative glomerulonephritis (GN) was the second most common cause found in 21%. Patients with AA-amyloidosis were more likely to be HIV infected (67 vs.17%; p=0.036) and tended to have a higher rate of repeated systemic infections (92 vs. 50%; p=0.069). Patients with AA-amyloidosis presented with progressive renal disease and nephrotic-range proteinuria but most patients had no peripheral edema or systemic hypertension. Development of proteinuria preceded the decline of GFR for approximately 1--2 years. Conclusions: AA-amyloidosis was the predominant cause of progressive renal disease in the last 10 years in patients with IVDU. The highest rate of AA-amyloidosis observed was seen in HIV infected patients with IVDU. We speculate that chronic HIV-infection as well as the associated immunosuppression might promote development of AA-amyloidosis by increasing frequency and duration of infections acquired by IVDU

Identifying chemokines as therapeutic targets in renal disease: Lessons from antagonist studies and knockout mice

Chemokines, in concert with cytokines and adhesion molecules, play multiple roles in local and systemic immune responses. In the kidney, the temporal and spatial expression of chemokines correlates with local renal damage and accumulation of chemokine receptor-bearing leukocytes. Chemokines play important roles in leukocyte trafficking and blocking chemokines can effectively reduce renal leukocyte recruitment and subsequent renal damage. However, recent data indicate that blocking chemokine or chemokine receptor activity in renal disease may also exacerbate renal inflammation under certain conditions. An increasing amount of data indicates additional roles of chemokines in the regulation of innate and adaptive immune responses, which may adversively affect the outcome of interventional studies. This review summarizes available in vivo studies on the blockade of chemokines and chemokine receptors in kidney diseases, with a special focus on the therapeutic potential of anti-chemokine strategies, including potential side effects, in renal disease. Copyright (C) 2004 S. Karger AG, Basel

Perceptions of Renal Disease Risk Among African Americans: A Review of the Literature

African Americans are disproportionately at risk for renal disease, especially those with type 2 diabetes (McDonough et al., 2011). Despite this disease disparity, the literature lacks research on renal disease awareness and risk perceptions among African Americans with type 2 diabetes. Therefore, a literature review guided by the Common Sense Model was conducted to review and synthesize the literature on African Americans’ awareness of renal disease and existing risk perceptions, capturing sociocultural factors in the African American community that could influence the development of those risk perceptions. The literature identified an overall lack of knowledge about renal disease risk factors, inaccurate risk perceptions, and a low concern for renal disease among African Americans. Numerous sociocultural factors were identified that could be influential to African Americans’ renal disease awareness and risk perceptions, and these can be used to guide future care and policy