Assessment of Renal Function by the Stable Oxygen and Hydrogen Isotopes in Human Blood Plasma

Water (H2O) is the most abundant and important molecule of life. Natural water contains small amount of heavy isotopes. Previously, few animal model studies have shown that the isotopic composition of body water could play important roles in physiology and pathophysiology. Here we study the stable isotopic ratios of hydrogen (δ2H) and oxygen (δ18O) in human blood plasma. The stable isotopic ratio is defined and determined by δsample = [(Rsample/RSTD)−1] * 1000, where R is the molar ratio of rare to abundant, for example, 18O/16O. We observe that the δ2H and the δ18O in human blood plasma are associated with the human renal functions. The water isotope ratios of the δ2H and δ18O in human blood plasma of the control subjects are comparable to those of the diabetes subjects (with healthy kidney), but are statistically higher than those of the end stage renal disease subjects (p<0.001 for both ANOVA and Student's t-test). In addition, our data indicate the existence of the biological homeostasis of water isotopes in all subjects, except the end stage renal disease subjects under the haemodialysis treatment. Furthermore, the unexpected water contents (δ2H and δ18O) in blood plasma of body water may shed light on a novel assessment of renal functions

Clinical trials treating focal segmental glomerulosclerosis should measure patient quality of life

Optimal therapy of patients with steroid-resistant primary focal segmental glomerulosclerosis (FSGS) remains controversial. This report describes the initial study design, baseline characteristics, and quality of life of patients enrolled in the FSGS Clinical Trial, a large multicenter randomized study of this glomerulopathy comparing a 12-month regimen of cyclosporine to the combination of mycophenolate mofetil and oral dexamethasone. Patients with age ranging 2–40 years, with an estimated glomerular filtration rate >40 ml/min per 1.73 m2, a first morning urine protein-to-creatinine ratio over one, and resistant to corticosteroids were eligible. The primary outcome was complete or partial remission of proteinuria over 52 weeks after randomization. In all, 192 patients were screened, of whom 138 were randomized for treatment. Ethnic distributions were 53 black, 78 white, and 7 other. By self- or parent-proxy reporting, 26 of the 138 patients were identified as Hispanic. The baseline glomerular filtration rate was 112.4 (76.5, 180.0) ml/min per 1.73 m2, and urine protein was 4.0 (2.1, 5.3) g/g. Overall, the quality of life of the patients with FSGS was lower than healthy controls and similar to that of patients with end-stage renal disease. Thus, the impact of FSGS on quality of life is significant and this measurement should be included in all trials

Proteineria and Progression in Glomerular Diseases.

Contains fulltext : 27029.pdf (publisher's version ) (Open Access)Proteinuria is a strong predictor of progressive renal insufficiency. The precise mechanisms to explain this relationship are still unknown, although many experimental studies have shown that proteinuria may induce tubulo-interstitial injury. Many investigators have observed that tubulo-interstitial injury better reflects renal insufficiency than glomerular injury. Indeed, in pilot-studies we demonstrated that the urinary excretion of the low molecular weight protein 2-microglobulin, a marker of tubulo-interstitial injury, predicted the development of chronic renal insufficiency in patients with idiopathic membranous nephropathy. It remains unknown which components in proteinuric urine are responsible for the induction of tubulo-interstitial injury. Identification of these components should enable to develop more specific therapeutic interventions and to identify patients at risk for chronic renal insufficiency with higher specificity and at an earlier stage. Therefore, we have initiated studies in patients with proteinuria to evaluate tubulo-toxic injury and possible mediators. We specifically have focussed on patients with membranous nephropathy, the most common cause of the nephrotic syndrome in adults. In these patients we also have evaluated the efficacy of immunosuppressive therapy. Our studies demonstrated that urinary albumin per se is not the cause of renal damage. Other components must be more important. In patients with proteinuria serum creatinine proved not a good marker of glomerular filtration rate. We have validated the accuracy of urinary 2-microglobulin excretion in predicting outcome in patients with idiopathic membranous nephropathy. Sensitivity and specificity were 88% and 91% respectively. Use of this urinary marker allows tailor-made treatment in individual patients. In patients with iMN cyclophosphamide is more effective and less toxic than chlorambucil.RU Radboud Universiteit Nijmegen, 29 november 2005Promotor : Wetzels, J.F.M.156 p

Effect of atrial natriuretic factor on skin microcirculation versus skeletal muscle blood flow

Contains fulltext : 23769___.PDF (publisher's version ) (Open Access

The Sulphur Directive and Stakeholders of Estonia’s Maritime Sector

The paper examines Estonia’s maritime sector from the point of view of its stakeholders and their strategic choices regarding several critical issues. Business activities of maritime sector are dependent on public services and regulations on safety, security related services and regulations, environmental conditions related issues, and the sulphur emission regulation which will be introduced from 2015, as the most recent example. One impact of this dependence is that a big number of different stakeholders are involved and would like to see their values and preferences are brought into governance process. The paper provides a structured overview of these stakeholders and their position in governance issues

Immunosuppressieve behandeling van patienten met een nefrotisch syndroom op basis van 'minimal change' nefropathie.

Item does not contain fulltex

Immunosuppressieve therapie van idiopathische membraneuze glomerulopathie.

Item does not contain fulltex